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  • ClaimsInquiry191141301

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    Isam Saleh
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    This claims inquiry report from the Bioinformatics Center(DNA) summarizes lab tests performed on patient Ahmad from November 28th, 2022. It includes a complete blood count, C-reactive protein assay, rheumatoid factor assay, and antistreptolysin O screen. The total claimed amount for the 4 tests is 13.60 JD with 0 JD due from the patient as their insurance with Jordan Petroleum Refinery Co fully covered the costs.

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    1669924239608_ClaimsInquiry191141301

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    This claims inquiry report from the Bioinformatics Center(DNA) summarizes lab tests performed on patient Ahmad from November 28th, 2022. It includes a complete blood count, C-reactive protein assay, rheumatoid factor assay, and antistreptolysin O screen. The total claimed amount for the 4 tests is 13.60 JD with 0 JD due from the patient as their insurance with Jordan Petroleum Refinery Co fully covered the costs.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    1 views2 pages

    ClaimsInquiry191141301

    Uploaded by

    Isam Saleh
    This claims inquiry report from the Bioinformatics Center(DNA) summarizes lab tests performed on patient Ahmad from November 28th, 2022. It includes a complete blood count, C-reactive protein assay, rheumatoid factor assay, and antistreptolysin O screen. The total claimed amount for the 4 tests is 13.60 JD with 0 JD due from the patient as their insurance with Jordan Petroleum Refinery Co fully covered the costs.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    Claims Inquiry Report

    HCP Name: 19114 - Bioinformatics Center(DNA)


    Subscriber ID: 9001616803
    Date From: 01/12/2022

    Date To: 01/12/2022

    Insured Company: ALL


    Insurer Company: ALL

    Patient Name Item Description Qty Visit Date Process Date Claimed Due
    Insured Company: Jordan Petroleum Refinery Co - Zarqa
    ‫ احمد‬. ANTISTREPTOLYSIN O, SCREEN , ASOT 1 28/11/2022 3.20 0.00

    ‫ احمد‬. COMPLETE BLOOD COUNT (CBC) 1 28/11/2022 4.00 0.00


    ‫ احمد‬. C-REACTIVE PROTEIN , CRP 1 28/11/2022 3.20 0.00

    ‫ احمد‬. ASSAY OF RHEUMATOID FACTOR, RF 1 28/11/2022 3.20 0.00


    Subtotal: 13.60 0.00

    Total: 13.60 0.00


    Debit Processing Result Message

    0.00

    0.00
    0.00

    0.00
    0.00

    0.00

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