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Ball, Lucille - 2/5/1968 MRN 1234-5678

General
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Insurance may not be accepted
Required
Payer Schedules (Cases)
Default Schedule
  1. Empire Blue Cross Blue Shield of New York
  2. Medicare
  3. Medicaid
Workmans Comp Note Required
  1. Empire Blue Cross Blue Shield of New York
  2. Medicare
Mental Health
Applies to all psych visits
  1. Medicaid
Authorizations
Occupational Therapy Approved
Empire Blue Cross Blue Shield of New York
Effective: 7/2/2021 - 12/28/2021
Auth #: 08Q5T504R
Visits: 3/13 Remaining
Description: OT Auth Ahava
Payer Schedule: Workmans Comp
Physical Therapy Depleted
Empire Blue Cross Blue Shield of New York
Effective: 5/4/2021 - 12/21/2021
Auth #: 17V5T338P
Visits: 0/10 Remaining
Description: PT Auth Ahava
Payer Schedule: Default Schedule
Provider: Dr. Victor Frankenstein
Billable ICDs: M62.1 M25.512
Billable CPTs: 97110
Calendar — Zev Carrey - 1/10/22