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    Anirudh
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    The document contains a list of patient names and dates of service. The comments section shows that for various claims, the user checked the claim status on the Medicare (Novitas) website and found that the claims had been paid, with amounts paid to the provider and patient responsibility amounts. The checks were issued on 06/01/2021 in a bulk payment of $38,199.94.

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    The document contains a list of patient names and dates of service. The comments section shows that for various claims, the user checked the claim status on the Medicare (Novitas) website and found that the claims had been paid, with amounts paid to the provider and patient responsibility amounts. The checks were issued on 06/01/2021 in a bulk payment of $38,199.94.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    18 views9 pages

    Client Name Insurance Name Voucher

    Uploaded by

    Anirudh
    The document contains a list of patient names and dates of service. The comments section shows that for various claims, the user checked the claim status on the Medicare (Novitas) website and found that the claims had been paid, with amounts paid to the provider and patient responsibility amounts. The checks were issued on 06/01/2021 in a bulk payment of $38,199.94.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    Client name Insurance name voucher

    RELIAS EMERGENCY MEDICINE SPECIALISTS OF TUPELO, LLC NOVITAS SOLUTIONS 5046590

    RELIAS EMERGENCY MEDICINE SPECIALISTS OF TUPELO, LLC NOVITAS SOLUTIONS 5079130

    RELIAS EMERGENCY MEDICINE SPECIALISTS OF TUPELO, LLC NOVITAS SOLUTIONS 5070610

    RELIAS EMERGENCY MEDICINE SPECIALISTS OF TUPELO, LLC NOVITAS SOLUTIONS 5073830

    RELIAS EMERGENCY MEDICINE SPECIALISTS OF TUPELO, LLC NOVITAS SOLUTIONS 5073840

    RELIAS EMERGENCY MEDICINE SPECIALISTS OF TUPELO, LLC NOVITAS SOLUTIONS 5078440

    RELIAS EMERGENCY MEDICINE SPECIALISTS OF TUPELO, LLC NOVITAS SOLUTIONS 5078450

    RELIAS EMERGENCY MEDICINE SPECIALISTS OF TUPELO, LLC NOVITAS SOLUTIONS 5071800

    RELIAS EMERGENCY MEDICINE SPECIALISTS OF TUPELO, LLC NOVITAS SOLUTIONS 5071810

    RELIAS EMERGENCY MEDICINE SPECIALISTS OF TUPELO, LLC NOVITAS SOLUTIONS 5077950

    RELIAS EMERGENCY MEDICINE SPECIALISTS OF TUPELO, LLC NOVITAS SOLUTIONS 5049780


    RELIAS EMERGENCY MEDICINE SPECIALISTS OF TUPELO, LLC NOVITAS SOLUTIONS 5074110

    RELIAS EMERGENCY MEDICINE SPECIALISTS OF TUPELO, LLC NOVITAS SOLUTIONS 5075410

    RELIAS EMERGENCY MEDICINE SPECIALISTS OF TUPELO, LLC NOVITAS SOLUTIONS 5078520

    RELIAS EMERGENCY MEDICINE SPECIALISTS OF TUPELO, LLC NOVITAS SOLUTIONS 5069580

    RELIAS EMERGENCY MEDICINE SPECIALISTS OF TUPELO, LLC NOVITAS SOLUTIONS 5073490

    RELIAS EMERGENCY MEDICINE SPECIALISTS OF TUPELO, LLC NOVITAS SOLUTIONS 5076220

    RELIAS EMERGENCY MEDICINE SPECIALISTS OF TUPELO, LLC NOVITAS SOLUTIONS 5076230

    RELIAS EMERGENCY MEDICINE SPECIALISTS OF TUPELO, LLC NOVITAS SOLUTIONS 5072230

    RELIAS EMERGENCY MEDICINE SPECIALISTS OF TUPELO, LLC NOVITAS SOLUTIONS 5080610

    RELIAS EMERGENCY MEDICINE SPECIALISTS OF TUPELO, LLC NOVITAS SOLUTIONS 5080620

    RELIAS EMERGENCY MEDICINE SPECIALISTS OF TUPELO, LLC NOVITAS SOLUTIONS 5076560

    RELIAS EMERGENCY MEDICINE SPECIALISTS OF TUPELO, LLC NOVITAS SOLUTIONS 5074560


    RELIAS EMERGENCY MEDICINE SPECIALISTS OF TUPELO, LLC NOVITAS SOLUTIONS 5074570

    RELIAS EMERGENCY MEDICINE SPECIALISTS OF TUPELO, LLC NOVITAS SOLUTIONS 5072720


    patient name dos

    DONALD P ROTEN 4/12/2021

    HAROLD B ROWAN 5/12/2021

    IRENE RUFF 5/10/2021

    IRENE RUFF 5/11/2021

    IRENE RUFF 5/11/2021

    CHARLES L RUSSELL 5/13/2021

    CHARLES L RUSSELL 5/13/2021

    HAYWOOD RUTHERFORD 5/7/2021

    HAYWOOD RUTHERFORD 5/7/2021

    SHIRLEY A SANDERS 5/13/2021

    JAMES SANSING 4/30/2021


    KIMBERLY SARTAIN 5/6/2021

    FRANCES D SHEFFIELD 5/12/2021

    LINDA SHIRLEY 5/13/2021

    KRISTIE L SIMMONS 5/10/2021

    MICHAEL SKINNER 5/5/2021

    DONALD L SLOAN 5/13/2021

    DONALD L SLOAN 5/13/2021

    MARY M SMITH 5/12/2021

    MARY SPIVEY 5/13/2021

    MARY SPIVEY 5/13/2021

    MARCELLA D STELL 5/3/2021

    FRED R STEVENS 5/11/2021


    FRED R STEVENS 5/11/2021

    STEPHEN E STONE 5/11/2021


    comments Allocated to
    06/02/2021 AS WRKG UNPD AR RPT: CHKD IN TC NO RECENT EOB RECVD,
    CHKD CLAIM STATUS IN MEDICARE (NOVITAS) WEB FOUND CLAIM
    ANIRUDH
    PAID $98.90 WITH PT RESP $24.72 UNDER CHECK# 887712113 ISSUED ON
    06/01/2021 BULK AMT $38,199.94, CLAIM# 0221138302930.

    06/02/2021 AS WRKG UNPD AR RPT: CHKD IN TC NO RECENT EOB RECVD,


    CHKD CLAIM STATUS IN MEDICARE (NOVITAS) WEB FOUND CLAIM
    ANIRUDH
    PAID $171.68 WITH NO PT RESP UNDER CHECK# 887712113 ISSUED ON
    06/01/2021 BULK AMT $38,199.94, CLAIM# 0221138302230.

    06/02/2021 AS WRKG UNPD AR RPT: CHKD IN TC NO RECENT EOB RECVD,


    CHKD CLAIM STATUS IN MEDICARE (NOVITAS) WEB FOUND CLAIM
    ANIRUDH
    PAID $178.02 WITH PT RESP $1.59 UNDER CHECK# 887712113 ISSUED ON
    06/01/2021 BULK AMT $38,199.94, CLAIM# 0221138303020.

    06/02/2021 AS WRKG UNPD AR RPT: CHKD IN TC NO RECENT EOB RECVD,


    CHKD CLAIM STATUS IN MEDICARE (NOVITAS) WEB FOUND CLAIM
    ANIRUDH
    PAID $6.34 WITH PT RESP $1.59 UNDER CHECK# 887712113 ISSUED ON
    06/01/2021 BULK AMT $38,199.94, CLAIM# 0221138303030.

    06/02/2021 AS WRKG UNPD AR RPT: CHKD IN TC NO RECENT EOB RECVD,


    CHKD CLAIM STATUS IN MEDICARE (NOVITAS) WEB FOUND CLAIM
    ANIRUDH
    PAID $171.68 WITH NO PT RESP UNDER CHECK# 887712113 ISSUED ON
    06/01/2021 BULK AMT $38,199.94, CLAIM# 0221138303460.

    06/02/2021 AS WRKG UNPD AR RPT: CHKD IN TC NO RECENT EOB RECVD,


    CHKD CLAIM STATUS IN MEDICARE (NOVITAS) WEB FOUND CLAIM
    ANIRUDH
    PAID $6.34 WITH PT RESP $1.59 UNDER CHECK# 887712113 ISSUED ON
    06/01/2021 BULK AMT $38,199.94, CLAIM# 0221138300390.

    06/02/2021 AS WRKG UNPD AR RPT: CHKD IN TC NO RECENT EOB RECVD,


    CHKD CLAIM STATUS IN MEDICARE (NOVITAS) WEB FOUND CLAIM
    ANIRUDH
    PAID $171.68 WITH NO PT RESP UNDER CHECK# 887712113 ISSUED ON
    06/01/2021 BULK AMT $38,199.94, CLAIM# 0221138303180.

    06/02/2021 AS WRKG UNPD AR RPT: CHKD IN TC NO RECENT EOB RECVD,


    CHKD CLAIM STATUS IN MEDICARE (NOVITAS) WEB FOUND CLAIM
    ANIRUDH
    PAID $171.68 WITH NO PT RESP UNDER CHECK# 887712113 ISSUED ON
    06/01/2021 BULK AMT $38,199.94, CLAIM# 0221138303600.

    06/02/2021 AS WRKG UNPD AR RPT: CHKD IN TC NO RECENT EOB RECVD,


    CHKD CLAIM STATUS IN MEDICARE (NOVITAS) WEB FOUND CLAIM
    ANIRUDH
    PAID $5.31 WITH PT RESP $1.33 UNDER CHECK# 887712113 ISSUED ON
    06/01/2021 BULK AMT $38,199.94, CLAIM# 0221138303500.

    06/02/2021 AS WRKG UNPD AR RPT: CHKD IN TC NO RECENT EOB RECVD,


    CHKD CLAIM STATUS IN MEDICARE (NOVITAS) WEB FOUND CLAIM
    ANIRUDH
    PAID $32.77 WITH PT RESP $8.19 UNDER CHECK# 887712113 ISSUED ON
    06/01/2021 BULK AMT $38,199.94, CLAIM# 0221138301010.

    06/02/2021 AS WRKG UNPD AR RPT: CHKD IN TC NO RECENT EOB RECVD,


    CHKD CLAIM STATUS IN MEDICARE (NOVITAS) WEB FOUND CLAIM
    ANIRUDH
    PAID $143.68 WITH PT RESP $35.93 UNDER CHECK# 887712113 ISSUED ON
    06/01/2021 BULK AMT $38,199.94, CLAIM# 0221138301640.
    06/02/2021 AS WRKG UNPD AR RPT: CHKD IN TC NO RECENT EOB RECVD,
    CHKD CLAIM STATUS IN MEDICARE (NOVITAS) WEB FOUND CLAIM
    ANIRUDH
    PAID $117.79 WITH NO PT RESP UNDER CHECK# 887712113 ISSUED ON
    06/01/2021 BULK AMT $38,199.94, CLAIM# 0221138303350.

    06/02/2021 AS WRKG UNPD AR RPT: CHKD IN TC NO RECENT EOB RECVD,


    CHKD CLAIM STATUS IN MEDICARE (NOVITAS) WEB FOUND CLAIM ANIRUDH
    PAID $177.22 WITH PT RESP $44.32 UNDER CHECK# 887712113 ISSUED ON
    06/01/2021 BULK AMT $38,199.94, CLAIM# 0221138302300.

    06/02/2021 AS WRKG UNPD AR RPT: CHKD IN TC NO RECENT EOB RECVD,


    CHKD CLAIM STATUS IN MEDICARE (NOVITAS) WEB FOUND CLAIM
    ANIRUDH
    PAID $178.02 WITH PT RESP $1.59 UNDER CHECK# 887712113 ISSUED ON
    06/01/2021 BULK AMT $38,199.94, CLAIM# 0221138302350.

    06/02/2021 AS WRKG UNPD AR RPT: CHKD IN TC NO RECENT EOB RECVD,


    CHKD CLAIM STATUS IN MEDICARE (NOVITAS) WEB FOUND CLAIM
    ANIRUDH
    PAID $117.79 WITH NO PT RESP UNDER CHECK# 887712113 ISSUED ON
    06/01/2021 BULK AMT $38,199.94, CLAIM# 0221138303520.

    06/02/2021 AS WRKG UNPD AR RPT: CHKD IN TC NO RECENT EOB RECVD,


    CHKD CLAIM STATUS IN MEDICARE (NOVITAS) WEB FOUND CLAIM
    ANIRUDH
    PAID $171.68 WITH NO PT RESP UNDER CHECK# 887712113 ISSUED ON
    06/01/2021 BULK AMT $38,199.94, CLAIM# 0221138303660.

    06/02/2021 AS WRKG UNPD AR RPT: CHKD IN TC NO RECENT EOB RECVD,


    CHKD CLAIM STATUS IN MEDICARE (NOVITAS) WEB FOUND CLAIM
    ANIRUDH
    PAID $6.34 WITH PT RESP $1.59 UNDER CHECK# 887712113 ISSUED ON
    06/01/2021 BULK AMT $38,199.94, CLAIM# 0221138300620.

    06/02/2021 AS WRKG UNPD AR RPT: CHKD IN TC NO RECENT EOB RECVD,


    CHKD CLAIM STATUS IN MEDICARE (NOVITAS) WEB FOUND CLAIM
    ANIRUDH
    PAID $171.68 WITH NO PT RESP UNDER CHECK# 887712113 ISSUED ON
    06/01/2021 BULK AMT $38,199.94, CLAIM# 0221138300650.

    06/02/2021 AS WRKG UNPD AR RPT: CHKD IN TC NO RECENT EOB RECVD,


    CHKD CLAIM STATUS IN MEDICARE (NOVITAS) WEB FOUND CLAIM
    ANIRUDH
    PAID $178.02 WITH PT RESP $1.59 UNDER CHECK# 887712113 ISSUED ON
    06/01/2021 BULK AMT $38,199.94, CLAIM# 0221138299610.

    06/02/2021 AS WRKG UNPD AR RPT: CHKD IN TC NO RECENT EOB RECVD,


    CHKD CLAIM STATUS IN MEDICARE (NOVITAS) WEB FOUND CLAIM
    ANIRUDH
    PAID $342.38 WITH PT RESP $85.59 UNDER CHECK# 887712113 ISSUED ON
    06/01/2021 BULK AMT $38,199.94, CLAIM# 0221138302420.

    06/02/2021 AS WRKG UNPD AR RPT: CHKD IN TC NO RECENT EOB RECVD,


    CHKD CLAIM STATUS IN MEDICARE (NOVITAS) WEB FOUND CLAIM
    ANIRUDH
    PAID $127.26 WITH PT RESP $2.37 UNDER CHECK# 887712113 ISSUED ON
    06/01/2021 BULK AMT $38,199.94, CLAIM# 0221138303380.

    06/02/2021 AS WRKG UNPD AR RPT: CHKD IN TC NO RECENT EOB RECVD,


    CHKD CLAIM STATUS IN MEDICARE (NOVITAS) WEB FOUND CLAIM
    ANIRUDH
    PAID $178.02 WITH PT RESP $1.59 UNDER CHECK# 887712113 ISSUED ON
    06/01/2021 BULK AMT $38,199.94, CLAIM# 0221138301550.

    06/02/2021 AS WRKG UNPD AR RPT: CHKD IN TC NO RECENT EOB RECVD,


    CHKD CLAIM STATUS IN MEDICARE (NOVITAS) WEB FOUND CLAIM
    ANIRUDH
    PAID $6.34 WITH PT RESP $1.59 UNDER CHECK# 887712113 ISSUED ON
    06/01/2021 BULK AMT $38,199.94, CLAIM# 0221138302810.
    06/02/2021 AS WRKG UNPD AR RPT: CHKD IN TC NO RECENT EOB RECVD,
    CHKD CLAIM STATUS IN MEDICARE (NOVITAS) WEB FOUND CLAIM
    ANIRUDH
    PAID $171.68 WITH NO PT RESP UNDER CHECK# 887712113 ISSUED ON
    06/01/2021 BULK AMT $38,199.94, CLAIM# 0221138303610.

    06/02/2021 AS WRKG UNPD AR RPT: CHKD IN TC NO RECENT EOB RECVD,


    CHKD CLAIM STATUS IN MEDICARE (NOVITAS) WEB FOUND CLAIM ANIRUDH
    PAID $75.61 WITH PT RESP $18.91 UNDER CHECK# 887712113 ISSUED ON
    06/01/2021 BULK AMT $38,199.94, CLAIM# 0221138302580.

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