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  • Outpatient Claims Details: Notes

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    Mohamed Ramadan
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    This document summarizes an outpatient claim with the following key details: - Claim ID: 720214 - Beneficiary name: Hamza Omar Mohammad Mahmoud Al Daqee - Several lab tests were performed including alkaline phosphatase, CBC, calcium, and phosphorus. Vitamin D testing was rejected due to lack of insurance coverage. - The claim status is unspecified lab completed on September 1, 2018.

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    24952-720214

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    This document summarizes an outpatient claim with the following key details: - Claim ID: 720214 - Beneficiary name: Hamza Omar Mohammad Mahmoud Al Daqee - Several lab tests were performed including alkaline phosphatase, CBC, calcium, and phosphorus. Vitamin D testing was rejected due to lack of insurance coverage. - The claim status is unspecified lab completed on September 1, 2018.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    9 views1 page

    Outpatient Claims Details: Notes

    Uploaded by

    Mohamed Ramadan
    This document summarizes an outpatient claim with the following key details: - Claim ID: 720214 - Beneficiary name: Hamza Omar Mohammad Mahmoud Al Daqee - Several lab tests were performed including alkaline phosphatase, CBC, calcium, and phosphorus. Vitamin D testing was rejected due to lack of insurance coverage. - The claim status is unspecified lab completed on September 1, 2018.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    Outpatient Claims Details

    Outpatient Claim ID : 720214 Beneficiary ID : 343944

    Client Name : Ministry of Communications and Information Technology :‫ﺍﺳﻢ ﺍﻟﻌﻤﻴﻞ‬


    Beneficiary Name: ‫ﺣﻤﺰﺓ ﻋﻤﺮﻭ ﻣﺤﻤﺪ ﻣﺤﻤﻮﺩ ﺍﻟﺪﻗﻰ‬ ‫ﺣﻤﺰﺓ ﻋﻤﺮﻭ ﻣﺤﻤﺪ ﻣﺤﻤﻮﺩ ﺍﻟﺪﻗﻰ‬ : ‫ﺍﺳﻢ ﺍﻟﻤﺆﻣﻦ‬
    Card Number : 24952 : ‫ﺭﻗﻢ ﺍﻟﻜﺎﺭﺕ‬
    Employee code : MCIT-002495-C1 : ‫ﺭﻗﻢ ﺍﻟﻤﻮﻇﻒ‬
    Service Name : Lab-Srv : ‫ﻧﻮﻉ ﺍﻟﺨﺪﻣﺔ‬
    E55. : ‫ﻛﻮﺩ‬
    ICD Code :
    Provider Branch : : ‫ﺍﻟﻔﺮﻉ‬
    Notes : : ‫ﻣﻼﺣﻈﺎﺕ‬

    Medical Diagnoses Medical Proc. / Drug Dose Qty Approval Status Notes
    ‫ﺍﻟﺘﺸﺨﻴﺺ ﺍﻟﻄﺒﻰ‬ ‫ ﺍﻟﻌﻼﺝ‬/ ‫ﺍﻻﺟﺮﺍﺀ ﺍﻟﻄﺒﻰ‬ ‫ﺍﻟﺠﺮﻋﻪ‬ ‫ﺍﻟﻜﻤﻴﺔ‬ ‫ﺣﺎﻟﺔ ﺍﻟﻤﻮﺍﻓﻘﺔ‬ ‫ﻣﻼﺣﻈﺎﺕ‬
    Alkaline Phosphatas 1 Approved
    CBC 1 Approved
    Calcium Ionized 1 Approved
    Phosphorus 1 Approved
    vit D 25 Hydroxy Cholecalciferol 1 Rejected ‫ﺍﻟﺘﺤﻠﻴﻞ ﻏﻴﺮ ﻣﻐﻄﻰ ﺗﺄﻣﻨﻴﺎ‬

    Unspecified Lab
    0%
    09/01/2018
    720214
    Mohamed Abdelazim
    7

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