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John Doe
Excellent Insurance
Basic Details
Payer Type:
Home Care Provider
Payer Name:
John
Social Security Number:
(120) 888-0173
Billing ID:
ID-001
EDI Processor:
MD Online
Claim Form Type:
Claim 1500
Plan Type:
Medicated
Address Details
Address:
47 W 13th St, New York, NY 10011, USA
City:
New York
State:
New York
Zipcode:
NY 10011
Contract Details
Contact Email:
john@gmail.com
Contract File:
file.pdf
Contract Start Date:
20/10/2024
Contract End Date:
20/11/2024
Care Type Details
Care Type:
OT - Scheduled Visit
Rate:
$ 20
Per:
Unit
Units:
15 min
Billing Code:
2313
