Claim total
$127.17
base $127.17 · payer covered $92.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Overdose1149222004
- Start
- 2019-11-25
- Stop
- 2019-11-25
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Sau Wiegand
- Care site
- care site MVNA
- Payer
- payer Dual Eligible
Record id
0400ef40-232f-be7a-55c3-d7787bcd10e7