Specimen Patient Name Account Name Pilot Rep Invalid Note
1002099 Example Patient HQ Example Account A Example Rep M INVALID POLICY ID
1002290 Example Patient ZQ Example Account A Example Rep M MISSING INSURANCE ADDRESS
1002353 Example Patient VD Example Account A Example Rep M INVALID MEMBER ID
1002486 Example Patient OX Example Account A Example Rep M INVALID MEMBER ID
1002538 Example Patient RJ Example Account A Example Rep M MISSING INSURANCE NAME
U08500239 Example Patient YN Example Account AA Example Rep P ANOTHER PAYOR PRESENT
U08500415 Example Patient AHU Example Account AA Example Rep P ANOTHER PAYOR PRESENT
U08500480 Example Patient FD Example Account AA Example Rep P ANOTHER PAYOR PRESENT
U095000389 Example Patient ME Example Account AA Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000390 Example Patient PI Example Account AA Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000783 Example Patient AAT Example Account AA Example Rep P BILL TO LOCAL PLAN
U095000784 Example Patient SO Example Account AA Example Rep P BILL TO LOCAL PLAN
U10500310 Example Patient FT Example Account AA Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500311 Example Patient SP Example Account AA Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500312 Example Patient ADJ Example Account AA Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500775 Example Patient TH Example Account AA Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10501145 Example Patient QD Example Account AA Example Rep P ICD9 WITH ICD10 SERVICE DATE
U08500055 Example Patient JK Example Account AB Example Rep P MISSING INSURANCE NAME/INFO,MISSING DX CODES,INVALID POLICY ID
U08500101 Example Patient M Example Account AB Example Rep P MEMBER NOT FOUND
U08500142 Example Patient RS Example Account AB Example Rep P MEMBER NOT FOUND
U08500144 Example Patient NF Example Account AB Example Rep P ANOTHER PAYOR PRESENT
U08500208 Example Patient KL Example Account AB Example Rep P ANOTHER PAYOR PRESENT
U08500225 Example Patient WO Example Account AB Example Rep P ANOTHER PAYOR PRESENT
U08500256 Example Patient KF Example Account AB Example Rep P ANOTHER PAYOR PRESENT
U08500258 Example Patient AII Example Account AB Example Rep P BILL TO LOCAL PLAN
U08500259 Example Patient RE Example Account AB Example Rep P INVALID MEMBER ID
U08500304 Example Patient AAG Example Account AB Example Rep P COVERAGE TERMINATED
U08500332 Example Patient XS Example Account AB Example Rep P INVALID MEMBER ID
U08500334 Example Patient TB Example Account AB Example Rep P INVALID MEMBER ID
U08500335 Example Patient VR Example Account AB Example Rep P ANOTHER PAYOR PRESENT
U08500336 Example Patient VK Example Account AB Example Rep P COVERAGE TERMINATED
U08500340 Example Patient P Example Account AB Example Rep P INVALID MEMBER ID
U08500411 Example Patient AEE Example Account AB Example Rep P ANOTHER PAYOR PRESENT
U08500458 Example Patient JL Example Account AB Example Rep P ANOTHER PAYOR PRESENT
U08500461 Example Patient BD Example Account AB Example Rep P ANOTHER PAYOR PRESENT
U08500465 Example Patient NF Example Account AB Example Rep P ANOTHER PAYOR PRESENT
U08500467 Example Patient QW Example Account AB Example Rep P ANOTHER PAYOR PRESENT
U08500470 Example Patient XA Example Account AB Example Rep P MEMBER ID INVALID
U08500471 Example Patient OQ Example Account AB Example Rep P MEMBER NOT FOUND
U08500566 Example Patient FL Example Account AB Example Rep P ANOTHER PAYER PRESENT,ANOTHER PAYOR PRESENT
U08500568 Example Patient OL Example Account AB Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U08500605 Example Patient AIF Example Account AB Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U08500608 Example Patient NV Example Account AB Example Rep P ANOTHER PAYER PRESENT,ANOTHER PAYOR PRESENT
U08500609 Example Patient ABZ Example Account AB Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U08500610 Example Patient GY Example Account AB Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U08500612 Example Patient WS Example Account AB Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U08500613 Example Patient WM Example Account AB Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U08500676 Example Patient QO Example Account AB Example Rep P MEMBER NOT FOUND
U08500677 Example Patient JY Example Account AB Example Rep P MEMBER NOT FOUND
U08500680 Example Patient LG Example Account AB Example Rep P NOT ELIGIBLE ON DATE OF SERVICE
U08500683 Example Patient YT Example Account AB Example Rep P MEMBER NOT FOUND
U08500684 Example Patient QY Example Account AB Example Rep P MEMBER NOT FOUND
U08500685 Example Patient ABN Example Account AB Example Rep P MEMBER NOT FOUND
U08500728 Example Patient JV Example Account AB Example Rep P MEMBER NOT FOUND
U095000078 Example Patient PQ Example Account AB Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U12501196 Example Patient OC Example Account AB Example Rep P INVALID MEMBER ID
U02600678 Example Patient AAD Example Account AC Example Rep Q ANOTHER PAYOR PRESENT
U02600679 Example Patient ACG Example Account AC Example Rep Q INVALID INFO
U02600681 Example Patient AGE Example Account AC Example Rep Q INVALID INFO
U02600992 Example Patient ZI Example Account AC Example Rep Q ANOTHER PAYOR PRESENT
U01600020 Example Patient TN Example Account AD Example Rep Q INVALID DIAGNOSIS CODE
U01600148 Example Patient DY Example Account AD Example Rep Q INVALID DIAGNOSIS CODE
U01600592 Example Patient AI Example Account AD Example Rep Q INVALID DIAGNOSIS CODE
U12500136 Example Patient VH Example Account AD Example Rep Q MISSING DIAGNOSIS CODES
U12500533 Example Patient TD Example Account AD Example Rep Q INVALID DIAGNOSIS CODE
U12500534 Example Patient PS Example Account AD Example Rep Q NOT ELIGIBLE ON DATE OF SERVICE
U12500708 Example Patient YY Example Account AD Example Rep Q ICD9 WITH ICD10 SERVICE DATE
U02600215 Example Patient IH Example Account AE Example Rep C INVALID INFO
U02600607 Example Patient ABR Example Account AE Example Rep C INVALID INFO
U02600609 Example Patient EW Example Account AE Example Rep C INVALID INFO
U02600610 Example Patient XX Example Account AE Example Rep C INVALID INFO
U08500421 Example Patient UO Example Account AF Example Rep N MEMBER ID INVALID
U08500425 Example Patient XF Example Account AF Example Rep N MEMBER NOT FOUND
U08500427 Example Patient AFI Example Account AF Example Rep N MEMBER NOT FOUND
U08500428 Example Patient MD Example Account AF Example Rep N MEMBER NOT FOUND
U08500532 Example Patient AGA Example Account AF Example Rep N MEMBER NOT FOUND
U08500533 Example Patient AHT Example Account AF Example Rep N ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U08500534 Example Patient SF Example Account AF Example Rep N MEMBER NOT FOUND
U08500535 Example Patient QN Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U08500541 Example Patient QA Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U08500542 Example Patient EK Example Account AF Example Rep N MEMBER NOT FOUND
U08500696 Example Patient JT Example Account AF Example Rep N MEMBER NOT FOUND
U08500698 Example Patient LZ Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U08500700 Example Patient OA Example Account AF Example Rep N MEMBER NOT FOUND
U08500745 Example Patient HV Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U08500751 Example Patient FB Example Account AF Example Rep N MEMBER NOT FOUND
U08500756 Example Patient XP Example Account AF Example Rep N COVERAGE TERMINATED
U08500764 Example Patient BB Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U095000030 Example Patient TM Example Account AF Example Rep N MEMBER NOT FOUND
U095000033 Example Patient EG Example Account AF Example Rep N MEMBER NOT FOUND
U095000039 Example Patient QJ Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U095000181 Example Patient OK Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U095000182 Example Patient HD Example Account AF Example Rep N COVERAGE TERMINATED
U095000188 Example Patient ZM Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U095000189 Example Patient A Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U095000190 Example Patient TG Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U095000197 Example Patient JP Example Account AF Example Rep N NOT ELIGIBLE ON DATE OF SERVICE
U095000200 Example Patient ZA Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U095000201 Example Patient DP Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U095000205 Example Patient ADT Example Account AF Example Rep N MEMBER NOT FOUND
U095000312 Example Patient AGD Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U095000320 Example Patient WZ Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U095000321 Example Patient ADY Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U095000322 Example Patient HS Example Account AF Example Rep N ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000324 Example Patient S Example Account AF Example Rep N MEMBER NOT FOUND
U095000325 Example Patient AK Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U095000326 Example Patient SY Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U095000327 Example Patient AAW Example Account AF Example Rep N MEMBER NOT FOUND
U095000328 Example Patient GL Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U095000329 Example Patient GA Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U095000330 Example Patient CC Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U095000333 Example Patient AJD Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U095000391 Example Patient ACR Example Account AF Example Rep N NOT ELIGIBLE ON DATE OF SERVICE
U095000392 Example Patient FQ Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U095000399 Example Patient GF Example Account AF Example Rep N MEMBER NOT FOUND
U095000401 Example Patient AT Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U095000402 Example Patient AFN Example Account AF Example Rep N MEMBER NOT FOUND
U095000535 Example Patient PM Example Account AF Example Rep N MEMBER NOT FOUND
U095000537 Example Patient EL Example Account AF Example Rep N MEMBER NOT FOUND
U095000542 Example Patient AFH Example Account AF Example Rep N ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000545 Example Patient XI Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U095000547 Example Patient AGA Example Account AF Example Rep N MEMBER NOT FOUND
U095000549 Example Patient QV Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U095000552 Example Patient YG Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U095000556 Example Patient IK Example Account AF Example Rep N ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000557 Example Patient GU Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U095000559 Example Patient ID Example Account AF Example Rep N MEMBER NOT FOUND
U095000560 Example Patient RI Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U095000561 Example Patient ZP Example Account AF Example Rep N COVERAGE TERMINATED
U095000562 Example Patient EX Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U095000563 Example Patient AES Example Account AF Example Rep N ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000597 Example Patient XP Example Account AF Example Rep N COVERAGE TERMINATED
U095000637 Example Patient UC Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U095000641 Example Patient AR Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U095000798 Example Patient JT Example Account AF Example Rep N BILL TO LOCAL PLAN
U095000801 Example Patient TM Example Account AF Example Rep N MEMBER NOT FOUND
U095000804 Example Patient AHT Example Account AF Example Rep N BILL TO LOCAL PLAN
U095000806 Example Patient ABB Example Account AF Example Rep N COVERAGE TERMINATED
U095000807 Example Patient AHS Example Account AF Example Rep N MEMBER NOT FOUND
U095000808 Example Patient FB Example Account AF Example Rep N MEMBER NOT FOUND
U095000809 Example Patient GZ Example Account AF Example Rep N MEMBER NOT FOUND
U10500191 Example Patient AGU Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U10500192 Example Patient FE Example Account AF Example Rep N MEMBER NOT FOUND
U10500193 Example Patient JZ Example Account AF Example Rep N COVERAGE TERMINATED
U10500196 Example Patient QJ Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U10500198 Example Patient XE Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U10500201 Example Patient AIP Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U10500202 Example Patient DF Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U10500203 Example Patient OK Example Account AF Example Rep N ICD9 WITH ICD10 SERVICE DATE
U10500206 Example Patient ACH Example Account AF Example Rep N ICD9 WITH ICD10 SERVICE DATE
U10500209 Example Patient DP Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U10500216 Example Patient XN Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U10500217 Example Patient AAI Example Account AF Example Rep N ICD9 WITH ICD10 SERVICE DATE
U10500218 Example Patient RT Example Account AF Example Rep N ICD9 WITH ICD10 SERVICE DATE
U10500219 Example Patient EH Example Account AF Example Rep N ICD9 WITH ICD10 SERVICE DATE
U10500220 Example Patient ACJ Example Account AF Example Rep N ICD9 WITH ICD10 SERVICE DATE
U10500221 Example Patient AHR Example Account AF Example Rep N ICD9 WITH ICD10 SERVICE DATE
U10500222 Example Patient AAH Example Account AF Example Rep N ICD9 WITH ICD10 SERVICE DATE
U10500223 Example Patient GI Example Account AF Example Rep N ICD9 WITH ICD10 SERVICE DATE
U10500225 Example Patient CR Example Account AF Example Rep N ICD9 WITH ICD10 SERVICE DATE
U10500226 Example Patient UT Example Account AF Example Rep N ICD9 WITH ICD10 SERVICE DATE
U10500228 Example Patient AJE Example Account AF Example Rep N ANOTHER PAYOR PRESENT
U10500488 Example Patient QV Example Account AF Example Rep N COVERAGE TERMINATED
U10500493 Example Patient AAW Example Account AF Example Rep N MEMBER NOT FOUND
U10500495 Example Patient RV Example Account AF Example Rep N MEMBER NOT FOUND
U10500635 Example Patient YG Example Account AF Example Rep N COVERAGE TERMINATED
U10500768 Example Patient AGA Example Account AF Example Rep N MEMBER NOT FOUND
U10500773 Example Patient XU Example Account AF Example Rep N BILL LOCAL PLAN
U11500687 Example Patient DB Example Account AF Example Rep N COVERAGE TERMINATED
U11500695 Example Patient AGA Example Account AF Example Rep N MEMBER NOT FOUND
U11500833 Example Patient ACR Example Account AF Example Rep N COVERAGE TERMINATED
1002691 Example Patient BY Example Account AG Example Rep D INVALID POLICY ID
1002694 Example Patient GK Example Account AG Example Rep D INVALID POLICY ID
1002696 Example Patient VF Example Account AG Example Rep D INVALID POLICY ID
1002698 Example Patient NI Example Account AG Example Rep D INVALID POLICY ID
1002700 Example Patient JN Example Account AG Example Rep D INVALID POLICY ID
1002701 Example Patient KK Example Account AG Example Rep D INVALID MEMBER ID
1002707 Example Patient IB Example Account AG Example Rep D INVALID POLICY ID
1002710 Example Patient JF Example Account AG Example Rep D INVALID POLICY ID
1002648 Example Patient VE Example Account AH Example Rep D INVALID POLICY ID
1002651 Example Patient VG Example Account AH Example Rep D MISSING INSURANCE NAME
1002660 Example Patient EA Example Account AH Example Rep D INVALID POLICY ID
1002664 Example Patient LW Example Account AH Example Rep D MISSING INSURANCE NAME
U02600067 Example Patient J Example Account AI Example Rep K MISSING DATE OF INJURY
U02600369 Example Patient ACT Example Account AI Example Rep K MISSING DATE OF INJURY,INVALID DIAGNOSIS CODE
U11500660 Example Patient ZF Example Account AI Example Rep K MISSING INSURANCE NAME
U11500661 Example Patient ACU Example Account AI Example Rep K MISSING INSURANCE NAME
U11500702 Example Patient LX Example Account AI Example Rep K MISSING INSURANCE NAME
U11500799 Example Patient SJ Example Account AI Example Rep K MISSING INSURANCE NAME
U11500801 Example Patient KP Example Account AI Example Rep K MISSING INSURANCE NAME
U11500803 Example Patient ADW Example Account AI Example Rep K INVALID POLICY ID
U11500804 Example Patient AGB Example Account AI Example Rep K MISSING INSURANCE NAME
U11500805 Example Patient MS Example Account AI Example Rep K MISSING INSURANCE NAME
U11500807 Example Patient ZD Example Account AI Example Rep K MISSING INSURANCE NAME
U11500808 Example Patient UV Example Account AI Example Rep K MISSING INSURANCE NAME
U11500809 Example Patient AHW Example Account AI Example Rep K MISSING DX CODES,INVALID POLICY ID
U11500811 Example Patient ES Example Account AI Example Rep K MISSING INSURANCE NAME
U11500812 Example Patient ADD Example Account AI Example Rep K MISSING INSURANCE NAME
U11500813 Example Patient AIY Example Account AI Example Rep K MISSING INSURANCE NAME
U11500816 Example Patient UU Example Account AI Example Rep K MISSING INSURANCE NAME
U11500818 Example Patient SV Example Account AI Example Rep K MISSING DX CODES
U11501048 Example Patient IN Example Account AI Example Rep K MISSING INSURANCE NAME
U11501051 Example Patient KB Example Account AI Example Rep K MISSING INSURANCE NAME
U11501053 Example Patient US Example Account AI Example Rep K MISSING INSURANCE NAME
U11501055 Example Patient MG Example Account AI Example Rep K MISSING INSURANCE NAME
U11501059 Example Patient TI Example Account AI Example Rep K MISSING INSURANCE NAME
U11501060 Example Patient AGY Example Account AI Example Rep K MISSING INSURANCE NAME
U11501062 Example Patient AEM Example Account AI Example Rep K MISSING INSURANCE NAME
U11501064 Example Patient AER Example Account AI Example Rep K MISSING INSURANCE NAME
U11501066 Example Patient TL Example Account AI Example Rep K MISSING INSURANCE NAME
U11501067 Example Patient YC Example Account AI Example Rep K MISSING INSURANCE NAME
U11501068 Example Patient PE Example Account AI Example Rep K MISSING INSURANCE NAME
U11501069 Example Patient Y Example Account AI Example Rep K MISSING INSURANCE NAME
U12500279 Example Patient ACV Example Account AI Example Rep K WORK RELATED INJURY BILL WC CARRIE
U12500284 Example Patient PY Example Account AI Example Rep K MISSING DATE OF INJURY
U12500979 Example Patient AJI Example Account AI Example Rep K INVALID POLICY ID
U12500981 Example Patient AIQ Example Account AI Example Rep K MISSING DATE OF INJURY,MISSING INSURANCE NAME
U12501228 Example Patient D Example Account AI Example Rep K MISSING DATE OF INJURY
S02600032 Example Patient BW Example Account AJ Example Rep H INVALID DIAGNOSIS CODE,MISSING DIAGNOSIS CODES
U02600352 Example Patient DV Example Account AK Example Rep P INVALID MEMBER ID
U02600361 Example Patient RB Example Account AK Example Rep P MEMBER NOT FOUND
U08500192 Example Patient DV Example Account AK Example Rep P INVALID MEMBER ID
U08500194 Example Patient LN Example Account AK Example Rep P INVALID INFO BILLING PROVIDER ADDR
U08500720 Example Patient ACF Example Account AK Example Rep P MEMBER NOT FOUND
U08500721 Example Patient XH Example Account AK Example Rep P MEMBER NOT FOUND
U095000086 Example Patient PU Example Account AK Example Rep P MEMBER NOT FOUND
U095000088 Example Patient BP Example Account AK Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000223 Example Patient YJ Example Account AK Example Rep P ANOTHER PAYOR PRESENT
U095000365 Example Patient ZO Example Account AK Example Rep P ANOTHER PAYOR PRESENT
U095000381 Example Patient AAE Example Account AK Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U10500153 Example Patient YW Example Account AK Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500154 Example Patient AS Example Account AK Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500299 Example Patient LD Example Account AK Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500418 Example Patient JX Example Account AK Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500419 Example Patient YJ Example Account AK Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500420 Example Patient YZ Example Account AK Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500421 Example Patient XL Example Account AK Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500777 Example Patient ZG Example Account AK Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500779 Example Patient ADH Example Account AK Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10501139 Example Patient LN Example Account AK Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10501140 Example Patient ZE Example Account AK Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10501141 Example Patient UM Example Account AK Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10501142 Example Patient YW Example Account AK Example Rep P ICD9 WITH ICD10 SERVICE DATE
S02600039 Example Patient KY Example Account AL Example Rep P MISSING DIAGNOSIS CODES,INVALID DIAGNOSIS CODE
S12500090 Example Patient AJF Example Account AL Example Rep P INVALID DIAGNOSIS CODE
1002405 Example Patient AAM Example Account AM Example Rep D INVALID MEMBER ID
1002407 Example Patient U Example Account AM Example Rep D INVALID MEMBER ID
1002412 Example Patient YR Example Account AM Example Rep D INVALID DIAGNOSIS CODE
1002342 Example Patient AGP Example Account AN Example Rep D MEMBER NOT FOUND
1002430 Example Patient TA Example Account AN Example Rep D MEMBER NOT FOUND
1002378 Example Patient PA Example Account AO Example Rep D INVALID MEMBER ID
1002388 Example Patient ABP Example Account AO Example Rep D INVALID DATE OF SERVICE
1002492 Example Patient AIL Example Account AO Example Rep D MISSING INSURANCE NAME
1002496 Example Patient UK Example Account AO Example Rep D MISSING INSURANCE NAME
1002196 Example Patient WP Example Account AP Example Rep D MEMBER NOT FOUND
1002467 Example Patient WA Example Account AP Example Rep D MISSING INSURANCE NAME
1002513 Example Patient ABL Example Account AP Example Rep D INVALID MEMBER ID
1002531 Example Patient XC Example Account AP Example Rep D NOT ELIGIBLE ON DATE OF SERVICE
1002588 Example Patient AD Example Account AP Example Rep D MISSING MEMBER ID,INVALID POLICY ID
U12500709 Example Patient LL Example Account AQ Example Rep L PECOS ENROLLMENT REQUIRED
U12500912 Example Patient KZ Example Account AQ Example Rep L INVALID DIAGNOSIS CODE
U08500521 Example Patient IA Example Account AR Example Rep L ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT,MEMBER ID INVALID
U08500691 Example Patient AFD Example Account AR Example Rep L MEMBER NOT FOUND
U095000218 Example Patient AFR Example Account AR Example Rep L ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000220 Example Patient AX Example Account AR Example Rep L ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000424 Example Patient JQ Example Account AR Example Rep L ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000565 Example Patient ACY Example Account AR Example Rep L INVALID MEMBER ID
U10500268 Example Patient AFQ Example Account AR Example Rep L ICD9 WITH ICD10 SERVICE DATE
U10500269 Example Patient QQ Example Account AR Example Rep L MISSING INSURANCE NAME,INVALID POLICY ID
U10500676 Example Patient LE Example Account AR Example Rep L CLAIM SUBMISSION ERROR
U11501042 Example Patient AHD Example Account AR Example Rep L NOT ELIGIBLE ON DATE OF SERVICE
U02600040 Example Patient HF Example Account AS Example Rep P MEMBER NOT FOUND
U02600174 Example Patient ABQ Example Account AS Example Rep P NOT ELIGIBLE ON DATE OF SERVICE
U02600521 Example Patient DK Example Account AS Example Rep P COVERAGE TERMINATED
U08500128 Example Patient ADV Example Account AS Example Rep P INVALID INFO BILLING PROVIDER ADDR
U08500129 Example Patient FC Example Account AS Example Rep P COVERAGE TERMINATED
U08500131 Example Patient AFV Example Account AS Example Rep P ANOTHER PAYOR PRESENT
U08500139 Example Patient AFV Example Account AS Example Rep P ANOTHER PAYOR PRESENT
U08500327 Example Patient JH Example Account AS Example Rep P ANOTHER PAYOR PRESENT
U08500656 Example Patient FG Example Account AS Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000053 Example Patient ADG Example Account AS Example Rep P ANOTHER PAYOR PRESENT
U095000163 Example Patient WJ Example Account AS Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000167 Example Patient ABJ Example Account AS Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000168 Example Patient NT Example Account AS Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000169 Example Patient AFV Example Account AS Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000170 Example Patient Z Example Account AS Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000336 Example Patient BU Example Account AS Example Rep P ANOTHER PAYOR PRESENT
U095000338 Example Patient QP Example Account AS Example Rep P ANOTHER PAYOR PRESENT
U095000343 Example Patient FC Example Account AS Example Rep P COVERAGE TERMINATED
U095000463 Example Patient JH Example Account AS Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000483 Example Patient AFV Example Account AS Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U10500183 Example Patient AHL Example Account AS Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500184 Example Patient SI Example Account AS Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500185 Example Patient AHQ Example Account AS Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500465 Example Patient KO Example Account AS Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500821 Example Patient IW Example Account AS Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500822 Example Patient DJ Example Account AS Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500823 Example Patient GC Example Account AS Example Rep P ICD9 WITH ICD10 SERVICE DATE
U01600134 Example Patient UJ Example Account AT Example Rep F MISSING INSURANCE NAME
U02600395 Example Patient KW Example Account AT Example Rep F INVALID MEMBER ID
U02600744 Example Patient AGI Example Account AT Example Rep F INVALID MEMBER ID
U02600746 Example Patient JR Example Account AT Example Rep F INVALID DIAGNOSIS CODE
U02600748 Example Patient XV Example Account AT Example Rep F INVALID MEMBER ID
U02600977 Example Patient EF Example Account AT Example Rep F MISSING INSURANCE NAME
U095000415 Example Patient FX Example Account AT Example Rep F MEMBER NOT FOUND
U095000417 Example Patient MC Example Account AT Example Rep F MISSING INSURANCE NAME/INFO
U10500558 Example Patient AHF Example Account AT Example Rep F MEMBER NOT FOUND
U11500328 Example Patient AGX Example Account AT Example Rep F MISSING DATE OF INJURY
U12500357 Example Patient QM Example Account AT Example Rep F MISSING DATE OF INJURY
U12500792 Example Patient IL Example Account AT Example Rep F ANOTHER PAYOR PRESENT
U12501266 Example Patient PH Example Account AT Example Rep F INVALID MEMBER ID
U12501339 Example Patient BG Example Account AT Example Rep F MISSING MEMBER ID
U01600070 Example Patient GD Example Account AU Example Rep F ADDITL INFO REQUIRED BY PT/REF
U01600277 Example Patient AAX Example Account AU Example Rep F MISSING INSURANCE NAME,INVALID POLICY ID
U02600022 Example Patient MY Example Account AU Example Rep F MISSING DATE OF INJURY
U02600340 Example Patient EZ Example Account AU Example Rep F MISSING INSURANCE NAME
U02600922 Example Patient ADR Example Account AU Example Rep F MISSING DATE OF INJURY
U095000664 Example Patient RM Example Account AU Example Rep F INVALID MEMBER ID
U095000665 Example Patient IV Example Account AU Example Rep F MEMBER NOT FOUND
U10500783 Example Patient OD Example Account AU Example Rep F MISSING DATE OF BIRTH
U10500917 Example Patient AJK Example Account AU Example Rep F MISSING DX CODES
U11500960 Example Patient WK Example Account AU Example Rep F MEMBER NOT FOUND
U11500964 Example Patient MR Example Account AU Example Rep F MEMBER NOT FOUND
U08500255 Example Patient VZ Example Account AV Example Rep A MISSING INSURANCE NAME/INFO,INVALID POLICY ID
1001595 Example Patient PO Example Account AW Example Rep D MISSING MEMBER ID
1001609 Example Patient AGC Example Account AW Example Rep D INVALID MEMBER ID
1002200 Example Patient RO Example Account AX Example Rep D MISSING INSURANCE NAME
1002224 Example Patient AFL Example Account AX Example Rep D INVALID POLICY ID
1002229 Example Patient AEU Example Account AX Example Rep D INVALID POLICY ID
1002279 Example Patient GS Example Account AX Example Rep D MISSING INSURANCE NAME
1002282 Example Patient VB Example Account AX Example Rep D INVALID POLICY ID
1002296 Example Patient CD Example Account AX Example Rep D MISSING INS INFO
1002300 Example Patient VA Example Account AX Example Rep D INVALID POLICY ID
1002301 Example Patient WU Example Account AX Example Rep D MISSING INS INFO
1002306 Example Patient CZ Example Account AX Example Rep D INVALID POLICY ID
1002346 Example Patient NS Example Account AX Example Rep D MISSING INSURANCE NAME
1002347 Example Patient MI Example Account AX Example Rep D MISSING INSURANCE NAME
1002444 Example Patient KG Example Account AX Example Rep D MISSING INSURANCE NAME
1002445 SANDRA O’QUINN Example Account AX Example Rep D MISSING INSURANCE NAME
1002446 Example Patient KD Example Account AX Example Rep D MISSING INSURANCE NAME
1002449 Example Patient GN Example Account AX Example Rep D MISSING INSURANCE NAME
1002466 Example Patient AGL Example Account AX Example Rep D MISSING INSURANCE NAME
1002470 Example Patient AIZ Example Account AX Example Rep D MISSING INSURANCE NAME
1002471 Example Patient RN Example Account AX Example Rep D MISSING INSURANCE NAME
1002501 Example Patient PF Example Account AX Example Rep D MISSING INSURANCE NAME
1002514 Example Patient MW Example Account AX Example Rep D MISSING INSURANCE NAME
1002521 Example Patient E Example Account AX Example Rep D MISSING INSURANCE NAME
1002526 Example Patient KN Example Account AX Example Rep D MISSING INSURANCE NAME
1002576 Example Patient WQ Example Account AX Example Rep D MISSING INSURANCE NAME
1002577 Example Patient PG Example Account AX Example Rep D MISSING INSURANCE NAME
1002614 Example Patient V Example Account AX Example Rep D MISSING INSURANCE NAME
1002712 Example Patient FY Example Account AX Example Rep D MISSING INSURANCE NAME
1002731 Example Patient AJA Example Account AX Example Rep D MISSING INSURANCE NAME
1002737 Example Patient CP Example Account AX Example Rep D MISSING INSURANCE NAME
1002741 Example Patient FW Example Account AX Example Rep D MISSING INSURANCE NAME
1001298 Example Patient UY Example Account AY Example Rep D NOT ELIGIBLE ON DATE OF SERVICE
1001306 Example Patient AEY Example Account AY Example Rep D MISSING INSURANCE NAME
1001315 Example Patient CU Example Account AY Example Rep D MISSING INSURANCE NAME
1001357 Example Patient ABK Example Account AY Example Rep D MEMBER NOT FOUND
1001365 Example Patient BJ Example Account AY Example Rep D INVALID DIAGNOSIS CODE
1001375 Example Patient ABY Example Account AY Example Rep D ANOTHER PAYOR PRESENT
1001390 Example Patient RW Example Account AY Example Rep D MISSING INSURANCE NAME
1001397 Example Patient NJ Example Account AY Example Rep D INVALID MEMBER ID
1001401 Example Patient RA Example Account AY Example Rep D INVALID DIAGNOSIS CODE
1001474 Example Patient UL Example Account AY Example Rep D MISSING INSURANCE NAME
1001492 Example Patient AC Example Account AY Example Rep D COVERAGE TERMINATED
1001531 Example Patient HW Example Account AY Example Rep D MISSING INSURANCE NAME
1001550 Example Patient AHA Example Account AY Example Rep D MISSING INSURANCE NAME
1001553 Example Patient AW Example Account AY Example Rep D INVALID POLICY ID
1001554 Example Patient RQ Example Account AY Example Rep D INVALID POLICY ID
1001555 Example Patient I Example Account AY Example Rep D INVALID POLICY ID
1001628 Example Patient TV Example Account AY Example Rep D NOT ELIGIBLE ON DATE OF SERVICE
1001645 Example Patient VC Example Account AY Example Rep D MISSING INSURANCE NAME
1001649 Example Patient ADS Example Account AY Example Rep D MISSING INSURANCE NAME
1001665 Example Patient AEK Example Account AY Example Rep D INVALID MEMBER ID
1001727 Example Patient TP Example Account AY Example Rep D MISSING INSURANCE NAME
1001804 Example Patient FP Example Account AY Example Rep D MISSING INSURANCE NAME
1001966 Example Patient SE Example Account AY Example Rep D MISSING INSURANCE NAME
1002006 Example Patient WE Example Account AY Example Rep D INVALID MEMBER ID
1002007 Example Patient AEH Example Account AY Example Rep D INVALID POLICY ID
U07500082 Example Patient MH Example Account AZ Example Rep P MISSING DX CODES
U08500483 Example Patient AEC Example Account AZ Example Rep P MEMBER NOT FOUND
U08500484 Example Patient IG Example Account AZ Example Rep P ANOTHER PAYOR PRESENT
U08500649 Example Patient HJ Example Account AZ Example Rep P ANOTHER PAYOR PRESENT
U095000106 Example Patient HB Example Account AZ Example Rep P ANOTHER PAYOR PRESENT
U10500450 Example Patient ACQ Example Account AZ Example Rep P ICD9 WITH ICD10 SERVICE DATE
U11500130 Example Patient TK Example Account AZ Example Rep P ICD9 WITH ICD10 SERVICE DATE
U11500219 Example Patient AEZ Example Account AZ Example Rep P ICD9 WITH ICD10 SERVICE DATE
U11500220 Example Patient QR Example Account AZ Example Rep P ICD9 WITH ICD10 SERVICE DATE
U12500701 Example Patient AFC Example Account AZ Example Rep P MISSING DX CODES
U12500702 Example Patient MT Example Account AZ Example Rep P INVALID DIAGNOSIS CODE
U01600615 Example Patient N Example Account B Example Rep P NOT ELIGIBLE ON DATE OF SERVICE
U08500174 Example Patient SN Example Account B Example Rep P ANOTHER PAYOR PRESENT
U08500175 Example Patient WI Example Account B Example Rep P INVALID MEMBER ID
U08500179 Example Patient II Example Account B Example Rep P MISSING INSURANCE NAME/INFO,INVALID POLICY ID
U08500180 Example Patient AHP Example Account B Example Rep P MISSING INSURANCE NAME/INFO,INVALID POLICY ID
U08500181 Example Patient SZ Example Account B Example Rep P MISSING INSURANCE NAME/INFO,INVALID POLICY ID
U08500182 Example Patient LM Example Account B Example Rep P MISSING INSURANCE NAME/INFO,INVALID POLICY ID
U08500183 Example Patient YQ Example Account B Example Rep P MISSING INSURANCE NAME/INFO,INVALID POLICY ID
U08500184 Example Patient DG Example Account B Example Rep P MISSING INSURANCE NAME/INFO,INVALID POLICY ID
U08500203 Example Patient AJ Example Account B Example Rep P MEMBER NOT FOUND
U08500204 Example Patient AFE Example Account B Example Rep P MISSING DX CODES
U08500237 Example Patient UA Example Account B Example Rep P NOT ELIGIBLE ON DATE OF SERVICE
U08500492 Example Patient NB Example Account B Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U08500497 Example Patient JS Example Account B Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U08500599 Example Patient KI Example Account B Example Rep P ANOTHER PAYER PRESENT,ANOTHER PAYOR PRESENT
U08500600 Example Patient HN Example Account B Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U08500601 Example Patient ZU Example Account B Example Rep P MEMBER NOT FOUND
U095000013 Example Patient O Example Account B Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000015 Example Patient VW Example Account B Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000017 Example Patient NA Example Account B Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000354 Example Patient LJ Example Account B Example Rep P MEMBER NOT FOUND
U095000356 Example Patient ZV Example Account B Example Rep P ANOTHER PAYOR PRESENT
U095000383 Example Patient DI Example Account B Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000384 Example Patient NQ Example Account B Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000386 Example Patient AHB Example Account B Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000679 Example Patient HE Example Account B Example Rep P BILL TO LOCAL PLAN
U095000680 Example Patient AAB Example Account B Example Rep P COVERAGE TERMINATED
U095000686 Example Patient NU Example Account B Example Rep P BILL TO LOCAL PLAN
U10500148 Example Patient IJ Example Account B Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500150 Example Patient YF Example Account B Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500797 Example Patient DC Example Account B Example Rep P ANOTHER PAYOR PRESENT
U10501143 Example Patient AEN Example Account B Example Rep P ICD9 WITH ICD10 SERVICE DATE
U11500119 Example Patient AGQ Example Account B Example Rep P MEMBER NOT FOUND
U12500600 Example Patient TU Example Account B Example Rep P PECOS ENROLLMENT REQUIRED
U08500585 Example Patient IX Example Account BA Example Rep R ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U08500587 Example Patient JE Example Account BA Example Rep R ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U08500588 Example Patient SM Example Account BA Example Rep R ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U08500589 Example Patient DX Example Account BA Example Rep R ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U08500590 Example Patient AG Example Account BA Example Rep R ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U08500591 Example Patient LK Example Account BA Example Rep R ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U08500594 Example Patient UG Example Account BA Example Rep R ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U08500595 Example Patient OY Example Account BA Example Rep R ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U08500660 Example Patient BT Example Account BA Example Rep R ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U08500661 Example Patient LT Example Account BA Example Rep R ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U08500663 Example Patient BR Example Account BA Example Rep R ANOTHER PAYER PRESENT,ANOTHER PAYOR PRESENT
U01600165 Example Patient KQ Example Account BB Example Rep C INVALID INFO
U01600270 Example Patient EM Example Account BB Example Rep C INVALID INFO
U01600273 Example Patient WW Example Account BB Example Rep C INVALID INFO
U01600436 Example Patient AHV Example Account BB Example Rep C INVALID INFO
U01600931 Example Patient UW Example Account BB Example Rep C COVERAGE TERMINATED
U01600940 Example Patient ACE Example Account BB Example Rep C MEMBER NOT FOUND
U01601169 Example Patient QF Example Account BB Example Rep C INVALID INFO
U02600166 Example Patient WW Example Account BB Example Rep C INVALID INFO
U02600302 Example Patient KQ Example Account BB Example Rep C INVALID INFO
U02600307 Example Patient ZH Example Account BB Example Rep C INVALID INFO
U02600309 Example Patient AJG Example Account BB Example Rep C MISSING INSURANCE NAME
U02600486 Example Patient EM Example Account BB Example Rep C INVALID INFO
U02600568 Example Patient AHV Example Account BB Example Rep C INVALID INFO
U02600569 Example Patient CN Example Account BB Example Rep C INVALID INFO
U02600732 Example Patient AGF Example Account BB Example Rep C ANOTHER PAYOR PRESENT
U02601042 Example Patient UW Example Account BB Example Rep C COVERAGE TERMINATED
U07500022 Example Patient AHN Example Account BB Example Rep C MISSING DX CODES
U07500073 Example Patient AFS Example Account BB Example Rep C MISSING INSURANCE NAME/INFO
U085000033 Example Patient AB Example Account BB Example Rep C MEMBER NOT FOUND
U08500196 Example Patient AGK Example Account BB Example Rep C MISSING DX CODES
U08500733 Example Patient VL Example Account BB Example Rep C INVALID MEMBER ID
U095000081 Example Patient AB Example Account BB Example Rep C MEMBER NOT FOUND
U10500304 Example Patient YI Example Account BB Example Rep C ICD9 WITH ICD10 SERVICE DATE
U10500387 Example Patient PW Example Account BB Example Rep C ICD9 WITH ICD10 SERVICE DATE
U10500396 Example Patient BI Example Account BB Example Rep C MISSING DX CODES
U10500681 Example Patient B Example Account BB Example Rep C ICD9 WITH ICD10 SERVICE DATE
U10500684 Example Patient SL Example Account BB Example Rep C ANOTHER PAYOR PRESENT
U11500319 Example Patient GB Example Account BB Example Rep C NOT ELIGIBLE ON DATE OF SERVICE
U11500638 Example Patient FK Example Account BB Example Rep C MEMBER NOT FOUND
U11501074 Example Patient QF Example Account BB Example Rep C ADDITL INFO REQUIRED BY PT REF
U11501078 Example Patient UF Example Account BB Example Rep C MEMBER NOT FOUND
U12500203 Example Patient FR Example Account BB Example Rep C COVERAGE TERMINATED
U02600727 Example Patient OR Example Account BC Example Rep C INVALID INFO
U02600901 Example Patient OH Example Account BC Example Rep C INVALID INFO
U11500104 Example Patient TW Example Account BD Example Rep C INVALID DIAGNOSIS CODE
U12500449 Example Patient RL Example Account BD Example Rep C PECOS ENROLLMENT REQUIRED
U02600025 Example Patient PT Example Account BE Example Rep P MEMBER NOT FOUND
U08500155 Example Patient ACP Example Account BE Example Rep P INVALID MEMBER ID
U08500251 Example Patient ADM Example Account BE Example Rep P MISSING INSURANCE NAME/INFO,INVALID POLICY ID
U08500487 Example Patient ABX Example Account BE Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U08500669 Example Patient VJ Example Account BE Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000056 Example Patient EO Example Account BE Example Rep P ANOTHER PAYOR PRESENT
U095000058 Example Patient BE Example Account BE Example Rep P MEMBER NOT FOUND
U095000105 Example Patient AFO Example Account BE Example Rep P ANOTHER PAYOR PRESENT
U095000308 Example Patient WN Example Account BE Example Rep P COVERAGE TERMINATED
U095000315 Example Patient AEV Example Account BE Example Rep P ANOTHER PAYER PRESENT,ANOTHER PAYOR PRESENT
U095000317 Example Patient CF Example Account BE Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000318 Example Patient AFB Example Account BE Example Rep P INVALID MEMBER ID
U095000431 Example Patient AU Example Account BE Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000723 Example Patient AIT Example Account BE Example Rep P BILL TO LOCAL PLAN
U095000731 Example Patient VJ Example Account BE Example Rep P BILL TO LOCAL PLAN
U10500442 Example Patient AAF Example Account BE Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500443 Example Patient PZ Example Account BE Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500445 Example Patient CF Example Account BE Example Rep P MEMBER NOT FOUND
U10500790 Example Patient ADL Example Account BE Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10501153 Example Patient JG Example Account BE Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10501155 Example Patient EB Example Account BE Example Rep P ICD9 WITH ICD10 SERVICE DATE
U11500970 Example Patient WR Example Account BE Example Rep P INVALID MEMBER ID
U12500264 Example Patient QE Example Account BE Example Rep P ANOTHER PAYOR PRESENT
U12500266 Example Patient WN Example Account BE Example Rep P COVERAGE TERMINATED
U12500620 Example Patient AIG Example Account BE Example Rep P BEHAVORIAL HEALTH – CANNOT BILL
1000201 Example Patient OU Example Account BF Example Rep D MISSING INSURANCE NAME/INFO,INVALID POLICY ID
1000251 Example Patient DZ Example Account BF Example Rep D MISSING INSURANCE NAME/INFO,INVALID POLICY ID
1000731 Example Patient AIS Example Account BF Example Rep D NOT ELIGIBLE ON DATE OF SERVICE
1000745 Example Patient LS Example Account BF Example Rep D MISSING INSURANCE NAME/INFO,INVALID POLICY ID
1000763 Example Patient AGR Example Account BF Example Rep D NOT ELIGIBLE ON DATE OF SERVICE
1000770 Example Patient YX Example Account BF Example Rep D MISSING INSURANCE NAME/INFO
1000827 Example Patient IF Example Account BF Example Rep D MISSING INSURANCE NAME/INFO
1000844 Example Patient IZ Example Account BF Example Rep D MISSING INSURANCE NAME/INFO
1000854 Example Patient ADE Example Account BF Example Rep D MEMBER NOT FOUND
1000869 Example Patient AGZ Example Account BF Example Rep D COVERAGE TERMINATED
1000873 Example Patient CS Example Account BF Example Rep D MISSING INSURANCE NAME/INFO
1000884 Example Patient FF Example Account BF Example Rep D MEMBER NOT FOUND
1000890 Example Patient QS Example Account BF Example Rep D INVALID DIAGNOSIS CODE,DIAGNOSIS CODE INVALID
1000895 Example Patient ABO Example Account BF Example Rep D MEMBER NOT FOUND
1000898 Example Patient SA Example Account BF Example Rep D MEMBER NOT FOUND
1001008 Example Patient BZ Example Account BF Example Rep D MISSING INSURANCE NAME/INFO
1001015 Example Patient ZN Example Account BF Example Rep D MEMBER NOT FOUND
1001027 Example Patient VV Example Account BF Example Rep D MEMBER NOT FOUND
1001043 Example Patient AHK Example Account BF Example Rep D NOT ELIGIBLE ON DATE OF SERVICE
1001082 Example Patient NE Example Account BF Example Rep D MEMBER NOT FOUND
1001248 Example Patient AJB Example Account BF Example Rep D ANOTHER PAYOR PRESENT
1001249 Example Patient MQ Example Account BF Example Rep D MEMBER NOT FOUND
1001320 Example Patient DH Example Account BF Example Rep D NOT ELIGIBLE ON DATE OF SERVICE
1001324 Example Patient ADB Example Account BF Example Rep D MISSING INSURANCE NAME
1001525 Example Patient CB Example Account BF Example Rep D INVALID MEMBER ID
1001558 Example Patient LI Example Account BF Example Rep D INVALID POLICY ID
1001559 Example Patient TZ Example Account BF Example Rep D MISSING MEMBER ID
1001612 Example Patient QU Example Account BF Example Rep D MEMBER NOT FOUND
1002242 Example Patient JD Example Account BF Example Rep D INVALID POLICY ID
1002304 Example Patient RL Example Account BF Example Rep D NOT ELIGIBLE ON DATE OF SERVICE
U08500515 Example Patient LY Example Account BG Example Rep P MEMBER NOT FOUND
U08500602 Example Patient VQ Example Account BG Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U08500603 Example Patient AET Example Account BG Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U08500714 Example Patient SC Example Account BG Example Rep P ANOTHER PAYOR PRESENT
U095000350 Example Patient SC Example Account BG Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U10500155 Example Patient ZJ Example Account BG Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500156 Example Patient CK Example Account BG Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500434 Example Patient YV Example Account BG Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500437 Example Patient EV Example Account BG Example Rep P INVALID MEMBER ID
U10500727 Example Patient JO Example Account BG Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500728 Example Patient KS Example Account BG Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500729 Example Patient VU Example Account BG Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500730 Example Patient KT Example Account BG Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500731 Example Patient UX Example Account BG Example Rep P BILL LOCAL PLAN
U01600620 Example Patient NX Example Account BH Example Rep P INVALID DIAGNOSIS CODE
U07500108 Example Patient YL Example Account BH Example Rep P MEMBER NOT FOUND
U08500123 Example Patient RG Example Account BH Example Rep P MEMBER NOT FOUND
U08500125 Example Patient BL Example Account BH Example Rep P MEMBER ID INVALID
U08500737 Example Patient CW Example Account BH Example Rep P MEMBER NOT FOUND
U08500739 Example Patient CE Example Account BH Example Rep P MISSING DX CODES
U095000481 Example Patient AHH Example Account BH Example Rep P COVERAGE TERMINATED
U095000658 Example Patient RC Example Account BH Example Rep P BILL TO LOCAL PLAN
U095000659 Example Patient GX Example Account BH Example Rep P MISSING INSURANCE NAME/INFO
U10501158 Example Patient HU Example Account BH Example Rep P MISSING DX CODES
U10501159 Example Patient GQ Example Account BH Example Rep P MISSING DATE OF INJURY
U11500610 Example Patient EE Example Account BH Example Rep P COVERAGE TERMINATED
U12500294 Example Patient KX Example Account BH Example Rep P INVALID DIAGNOSIS CODE
1001817 Example Patient AGG Example Account BI Example Rep D MISSING INSURANCE NAME
1001838 Example Patient SD Example Account BI Example Rep D MISSING INSURANCE NAME
1001840 Example Patient EQ Example Account BI Example Rep D MISSING INSURANCE NAME,INVALID DIAGNOSIS CODE
1001841 Example Patient AIN Example Account BI Example Rep D MISSING INSURANCE NAME
1001842 Example Patient BN Example Account BI Example Rep D MISSING INSURANCE NAME
1001870 Example Patient AAU Example Account BI Example Rep D MISSING INSURANCE NAME
1001871 Example Patient MJ Example Account BI Example Rep D MISSING INSURANCE NAME
S02600036 Example Patient AFW Example Account BJ Example Rep O MISSING DIAGNOSIS CODES,INVALID DIAGNOSIS CODE
F01600015 Example Patient MP Example Account BK Example Rep K INVALID POLICY ID
F01600017 Example Patient QH Example Account BK Example Rep K MEMBER NOT FOUND
F01600023 Example Patient LR Example Account BK Example Rep K INVALID MEMBER ID
F06500013 Example Patient UE Example Account BK Example Rep K MISSING INS INFO
F06500045 Example Patient UH Example Account BK Example Rep K MISSING INSURANCE NAME
F06500046 Example Patient MP Example Account BK Example Rep K MISSING INSURANCE NAME
F06500055 Example Patient QZ Example Account BK Example Rep K INVALID INFO
F06500061 Example Patient AIA Example Account BK Example Rep K INVALID INFO
U01600045 Example Patient QX Example Account BK Example Rep K INVALID INFO
U01600090 Example Patient NC Example Account BK Example Rep K INVALID INFO
U01600093 Example Patient HH Example Account BK Example Rep K INVALID INFO
U01600098 Example Patient TR Example Account BK Example Rep K INVALID INFO
U01600100 Example Patient ADQ Example Account BK Example Rep K INVALID INFO
U01600113 Example Patient AE Example Account BK Example Rep K INVALID INFO
U01600115 Example Patient GM Example Account BK Example Rep K INVALID INFO
U01600124 Example Patient HM Example Account BK Example Rep K MISSING INSURANCE NAME
U01600177 Example Patient WF Example Account BK Example Rep K INVALID INFO
U01600181 Example Patient AAJ Example Account BK Example Rep K INVALID INFO
U01600189 Example Patient LA Example Account BK Example Rep K INVALID INFO
U01600194 Example Patient AEL Example Account BK Example Rep K INVALID INFO
U01600196 Example Patient NZ Example Account BK Example Rep K INVALID INFO
U01600203 Example Patient RR Example Account BK Example Rep K INVALID INFO
U01600205 Example Patient AIA Example Account BK Example Rep K INVALID INFO
U01600213 Example Patient ER Example Account BK Example Rep K INVALID INFO
U01600223 Example Patient DS Example Account BK Example Rep K INVALID INFO
U01600231 Example Patient TS Example Account BK Example Rep K INVALID INFO
U01600321 Example Patient AAZ Example Account BK Example Rep K INVALID INFO
U01600323 Example Patient ZW Example Account BK Example Rep K INVALID INFO
U01600326 Example Patient JM Example Account BK Example Rep K INVALID INFO
U01600327 Example Patient AAO Example Account BK Example Rep K INVALID INFO
U01600329 Example Patient TY Example Account BK Example Rep K INVALID INFO
U01600335 Example Patient SX Example Account BK Example Rep K INVALID INFO
U01600347 Example Patient AGJ Example Account BK Example Rep K INVALID INFO
U01600361 Example Patient MX Example Account BK Example Rep K INVALID INFO
U01600365 Example Patient LF Example Account BK Example Rep K INVALID INFO
U01600382 Example Patient AHZ Example Account BK Example Rep K ANOTHER PAYOR PRESENT
U01600386 Example Patient AEW Example Account BK Example Rep K INVALID INFO
U01600390 Example Patient AAN Example Account BK Example Rep K INVALID INFO
U01600396 Example Patient AEI Example Account BK Example Rep K INVALID INFO
U01600397 Example Patient YA Example Account BK Example Rep K INVALID INFO
U01600400 Example Patient AEF Example Account BK Example Rep K INVALID INFO
U01600403 Example Patient AHC Example Account BK Example Rep K MISSING INSURANCE NAME,INVALID POLICY ID
U01600407 Example Patient ABA Example Account BK Example Rep K INVALID INFO
U01600461 Example Patient HL Example Account BK Example Rep K INVALID INFO
U01600463 Example Patient TF Example Account BK Example Rep K INVALID INFO
U01600563 Example Patient MN Example Account BK Example Rep K INVALID INFO
U01600686 Example Patient AFG Example Account BK Example Rep K MEMBER NOT FOUND
U01600689 Example Patient HI Example Account BK Example Rep K INVALID INFO
U01600702 Example Patient HR Example Account BK Example Rep K INVALID INFO
U01600739 Example Patient WH Example Account BK Example Rep K INVALID INFO
U01600784 Example Patient MV Example Account BK Example Rep K INVALID INFO
U01600797 Example Patient AM Example Account BK Example Rep K INVALID INFO
U01600809 Example Patient QI Example Account BK Example Rep K COVERAGE TERMINATED
U01600856 Example Patient L Example Account BK Example Rep K INVALID INFO
U01600977 Example Patient IU Example Account BK Example Rep K INVALID INFO
U01600982 Example Patient KM Example Account BK Example Rep K MISSING INSURANCE NAME
U01600985 Example Patient JC Example Account BK Example Rep K MISSING INSURANCE NAME
U01600994 Example Patient SU Example Account BK Example Rep K INVALID INFO
U01601021 Example Patient XB Example Account BK Example Rep K INVALID INFO
U01601022 Example Patient NY Example Account BK Example Rep K INVALID INFO
U01601033 Example Patient HP Example Account BK Example Rep K ANOTHER PAYOR PRESENT
U01601129 Example Patient QB Example Account BK Example Rep K INVALID INFO
U01601136 Example Patient AAP Example Account BK Example Rep K INVALID INFO
U01601144 Example Patient AIE Example Account BK Example Rep K ANOTHER PAYOR PRESENT
U01601149 Example Patient OB Example Account BK Example Rep K INVALID INFO
U01601150 Example Patient ACW Example Account BK Example Rep K INVALID INFO
U01601161 Example Patient AFP Example Account BK Example Rep K MISSING DATE OF INJURY
U02600073 Example Patient AIO Example Account BK Example Rep K INVALID INFO
U02600118 Example Patient ADF Example Account BK Example Rep K ANOTHER PAYOR PRESENT
U02600127 Example Patient JW Example Account BK Example Rep K INVALID INFO
U02600138 Example Patient IE Example Account BK Example Rep K INVALID INFO
U02600141 Example Patient FU Example Account BK Example Rep K INVALID INFO
U02600147 Example Patient ED Example Account BK Example Rep K INVALID INFO
U02600182 Example Patient VN Example Account BK Example Rep K INVALID INFO
U02600189 Example Patient AFT Example Account BK Example Rep K INVALID INFO
U02600213 Example Patient AIU Example Account BK Example Rep K INVALID INFO
U02600256 Example Patient TS Example Account BK Example Rep K INVALID INFO
U02600261 Example Patient ADQ Example Account BK Example Rep K INVALID INFO
U02600268 Example Patient IR Example Account BK Example Rep K INVALID INFO
U02600270 Example Patient AEX Example Account BK Example Rep K INVALID INFO
U02600284 Example Patient AAR Example Account BK Example Rep K INVALID INFO
U02600289 Example Patient AHO Example Account BK Example Rep K INVALID INFO
U02600291 Example Patient SG Example Account BK Example Rep K INVALID INFO
U02600328 Example Patient AAJ Example Account BK Example Rep K INVALID INFO
U02600412 Example Patient MM Example Account BK Example Rep K INVALID INFO
U02600413 Example Patient JM Example Account BK Example Rep K INVALID INFO
U02600420 Example Patient DS Example Account BK Example Rep K INVALID INFO
U02600421 Example Patient AAO Example Account BK Example Rep K INVALID INFO
U02600422 Example Patient RR Example Account BK Example Rep K INVALID INFO
U02600425 Example Patient WG Example Account BK Example Rep K INVALID INFO
U02600436 Example Patient MX Example Account BK Example Rep K INVALID INFO
U02600438 Example Patient AIR Example Account BK Example Rep K INVALID INFO
U02600446 Example Patient AEW Example Account BK Example Rep K INVALID INFO
U02600450 Example Patient NW Example Account BK Example Rep K INVALID INFO
U02600464 Example Patient ADO Example Account BK Example Rep K INVALID INFO
U02600494 Example Patient MN Example Account BK Example Rep K INVALID INFO
U02600496 Example Patient TY Example Account BK Example Rep K INVALID INFO
U02600507 Example Patient AIV Example Account BK Example Rep K INVALID INFO
U02600542 Example Patient ER Example Account BK Example Rep K INVALID INFO
U02600558 Example Patient ZW Example Account BK Example Rep K INVALID INFO
U02600561 Example Patient AEF Example Account BK Example Rep K INVALID INFO
U02600655 Example Patient ZY Example Account BK Example Rep K ANOTHER PAYOR PRESENT
U02600670 Example Patient TF Example Account BK Example Rep K INVALID INFO
U02600671 Example Patient BH Example Account BK Example Rep K INVALID INFO
U02600673 Example Patient LF Example Account BK Example Rep K INVALID INFO
U02600697 Example Patient HX Example Account BK Example Rep K INVALID INFO
U02600712 Example Patient JB Example Account BK Example Rep K INVALID INFO
U02600716 Example Patient AH Example Account BK Example Rep K INVALID INFO
U02600719 Example Patient AO Example Account BK Example Rep K INVALID INFO
U02600764 Example Patient NH Example Account BK Example Rep K INVALID INFO
U02600765 Example Patient GM Example Account BK Example Rep K INVALID INFO
U02600775 Example Patient H Example Account BK Example Rep K INVALID INFO
U02600780 Example Patient MV Example Account BK Example Rep K INVALID INFO
U02600781 Example Patient CO Example Account BK Example Rep K INVALID INFO
U02600826 Example Patient RZ Example Account BK Example Rep K INVALID INFO
U02600828 Example Patient XW Example Account BK Example Rep K INVALID INFO
U02600844 Example Patient TO Example Account BK Example Rep K INVALID INFO
U02600845 Example Patient OT Example Account BK Example Rep K INVALID INFO
U02600846 Example Patient RD Example Account BK Example Rep K INVALID INFO
U02600850 Example Patient AEJ Example Account BK Example Rep K INVALID INFO
U02600858 Example Patient HA Example Account BK Example Rep K COVERAGE TERMINATED
U02600861 Example Patient KU Example Account BK Example Rep K INVALID INFO
U02600983 Example Patient TE Example Account BK Example Rep K MISSING INSURANCE NAME,INVALID INSURANCE NAME
U02601140 Example Patient AIE Example Account BK Example Rep K ANOTHER PAYOR PRESENT
U095000756 Example Patient ABI Example Account BK Example Rep K INVALID DX CODE
U095000758 Example Patient FI Example Account BK Example Rep K MISSING INSURANCE NAME/INFO
U095000763 Example Patient AFU Example Account BK Example Rep K MISSING INSURANCE NAME/INFO
U095000768 Example Patient AAZ Example Account BK Example Rep K MISSING INSURANCE NAME/INFO
U10500002 Example Patient IY Example Account BK Example Rep K MISSING INS INFO
U10500006 Example Patient VX Example Account BK Example Rep K ICD10 WITH ICD9 SERVICE DATE
U10500013 Example Patient AGN Example Account BK Example Rep K MISSING INS INFO
U10500020 Example Patient AIW Example Account BK Example Rep K NOT ELIGIBLE ON DATE OF SERVICE
U10500032 Example Patient AN Example Account BK Example Rep K MISSING INS INFO
U10500040 Example Patient SW Example Account BK Example Rep K MISSING INS INFO
U10500051 Example Patient ON Example Account BK Example Rep K MISSING INS INFO
U10500052 Example Patient VN Example Account BK Example Rep K MISSING INS INFO
U10500057 Example Patient GE Example Account BK Example Rep K MISSING INS INFO
U10500058 Example Patient VS Example Account BK Example Rep K MISSING INSURANCE ADDRESS
U10500113 Example Patient AAK Example Account BK Example Rep K MISSING INSURANCE ADDRESS
U10500234 Example Patient ACI Example Account BK Example Rep K MISSING INS INFO
U10500247 Example Patient TS Example Account BK Example Rep K INVALID INFO
U10500260 Example Patient MX Example Account BK Example Rep K MISSING INS INFO
U10500296 Example Patient LV Example Account BK Example Rep K MEMBER NOT FOUND
U10500339 Example Patient NC Example Account BK Example Rep K MISSING INS INFO
U10500342 Example Patient ABU Example Account BK Example Rep K MISSING INS INFO
U10500350 Example Patient XY Example Account BK Example Rep K MISSING INS INFO
U10500368 Example Patient MU Example Account BK Example Rep K MISSING INS INFO
U10500376 Example Patient AAJ Example Account BK Example Rep K MISSING INS INFO
U10500403 Example Patient HA Example Account BK Example Rep K MISSING INS INFO
U10500511 Example Patient SG Example Account BK Example Rep K INVALID INFO
U10500639 Example Patient JJ Example Account BK Example Rep K MISSING INSURANCE ADDRESS
U10500712 Example Patient LF Example Account BK Example Rep K NOT ELIGIBLE ON DATE OF SERVICE
U10500868 Example Patient AEJ Example Account BK Example Rep K INVALID MEMBER ID
U10501076 Example Patient RD Example Account BK Example Rep K INVALID INFO
U10501081 Example Patient ADC Example Account BK Example Rep K ADDITL INFO REQUIRED BY PT REF
U10501086 Example Patient NY Example Account BK Example Rep K INVALID INFO
U10501100 Example Patient ABF Example Account BK Example Rep K NOT ELIGIBLE ON DATE OF SERVICE
U10501128 Example Patient CT Example Account BK Example Rep K NOT ELIGIBLE ON DATE OF SERVICE
U11500160 Example Patient GV Example Account BK Example Rep K MISSING INSURANCE NAME
U11500180 Example Patient AIH Example Account BK Example Rep K ADDITL INFO REQUIRED BY PT REF
U11500231 Example Patient ABA Example Account BK Example Rep K MISSING INSURANCE NAME
U11500237 Example Patient NL Example Account BK Example Rep K MISSING INSURANCE NAME
U11500262 Example Patient AE Example Account BK Example Rep K MISSING INSURANCE NAME
U11500267 Example Patient OO Example Account BK Example Rep K MEMBER NOT FOUND
U11500273 Example Patient EN Example Account BK Example Rep K COVERAGE TERMINATED
U11500467 Example Patient YD Example Account BK Example Rep K MISSING INSURANCE NAME
U11500538 Example Patient PJ Example Account BK Example Rep K NOT ELIGIBLE ON DATE OF SERVICE
U11500948 Example Patient AAY Example Account BK Example Rep K MISSING INSURANCE NAME
U11501109 Example Patient AN Example Account BK Example Rep K COVERAGE TERMINATED
U12500005 Example Patient VN Example Account BK Example Rep K MISSING INSURANCE NAME
U12500018 Example Patient HT Example Account BK Example Rep K COVERAGE TERMINATED
U12500033 Example Patient AED Example Account BK Example Rep K MISSING DX CODES
U12500037 Example Patient VT Example Account BK Example Rep K MISSING INSURANCE NAME
U12500186 Example Patient AIE Example Account BK Example Rep K ANOTHER PAYOR PRESENT
U12500725 Example Patient MX Example Account BK Example Rep K INVALID INFO
U12500833 Example Patient ZY Example Account BK Example Rep K ANOTHER PAYOR PRESENT
U12500900 Example Patient ACM Example Account BK Example Rep K COVERAGE TERMINATED
U12501295 Example Patient OF Example Account BK Example Rep K MISSING INSURANCE NAME
U12501307 Example Patient AN Example Account BK Example Rep K COVERAGE TERMINATED
U12501361 Example Patient AIX Example Account BK Example Rep K COVERAGE TERMINATED
S02600023 Example Patient PL Example Account BL Example Rep C MEMBER NOT FOUND
S02600049 Example Patient AGS Example Account BL Example Rep C MISSING DIAGNOSIS CODES,INVALID DIAGNOSIS CODE
1001167 Example Patient HO Example Account BM Example Rep D ADDITL INFO REQUIRED BY PT REF
U02600480 Example Patient AAV Example Account BN Example Rep K INVALID INFO
U02600481 Example Patient ADC Example Account BN Example Rep K INVALID INFO
U11500019 Example Patient BQ Example Account BN Example Rep K INVALID DIAGNOSIS CODE,ICD9 WITH ICD10 SERVICE DATE
U10500357 Example Patient AAC Example Account BO Example Rep K ICD9 WITH ICD10 SERVICE DATE
U10500855 Example Patient JA Example Account BO Example Rep K ICD9 WITH ICD10 SERVICE DATE
U11500722 Example Patient F Example Account BO Example Rep K MISSING DX CODES
F01600007 Example Patient OS Example Account C Example Rep P INVALID POLICY ID
U01600016 Example Patient XT Example Account C Example Rep P INVALID DIAGNOSIS CODE
U02600374 Example Patient IO Example Account C Example Rep P MEMBER NOT FOUND
U02600376 Example Patient OP Example Account C Example Rep P MEMBER NOT FOUND
U08500112 Example Patient KA Example Account C Example Rep P NOT ELIGIBLE ON DATE OF SERVICE
U08500546 Example Patient OI Example Account C Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000046 Example Patient AHM Example Account C Example Rep P ANOTHER PAYOR PRESENT
U095000047 Example Patient AGV Example Account C Example Rep P ANOTHER PAYOR PRESENT
U095000069 Example Patient VY Example Account C Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000070 Example Patient FH Example Account C Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000176 Example Patient UQ Example Account C Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000179 Example Patient IP Example Account C Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000488 Example Patient AID Example Account C Example Rep P ANOTHER PAYOR PRESENT
U10500074 Example Patient HC Example Account C Example Rep P INVALID MEMBER ID
U10500075 Example Patient MK Example Account C Example Rep P MEMBER NOT FOUND
U10500164 Example Patient GR Example Account C Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500165 Example Patient KA Example Account C Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500815 Example Patient TX Example Account C Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500816 Example Patient GO Example Account C Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500817 Example Patient OM Example Account C Example Rep P ICD9 WITH ICD10 SERVICE DATE
U11500109 Example Patient NL Example Account C Example Rep P ICD9 WITH ICD10 SERVICE DATE
U11500111 Example Patient AHG Example Account C Example Rep P ICD9 WITH ICD10 SERVICE DATE
U11500113 Example Patient KA Example Account C Example Rep P ICD9 WITH ICD10 SERVICE DATE
U11500114 Example Patient HC Example Account C Example Rep P ICD9 WITH ICD10 SERVICE DATE
U11500115 Example Patient AHI Example Account C Example Rep P ICD9 WITH ICD10 SERVICE DATE
U11500116 Example Patient ADX Example Account C Example Rep P ICD9 WITH ICD10 SERVICE DATE
U11500117 Example Patient FM Example Account C Example Rep P ICD9 WITH ICD10 SERVICE DATE
U11500409 Example Patient MF Example Account C Example Rep P INVALID DIAGNOSIS CODE
U11500411 Example Patient RK Example Account C Example Rep P INVALID DIAGNOSIS CODE
U11500414 Example Patient PV Example Account C Example Rep P MISSING DIAGNOSIS CODES
U11500417 Example Patient IM Example Account C Example Rep P MISSING DIAGNOSIS CODES
U11500715 Example Patient RF Example Account C Example Rep P INVALID DIAGNOSIS CODE
U11500717 Example Patient QC Example Account C Example Rep P INVALID DIAGNOSIS CODE
U12500074 Example Patient JI Example Account C Example Rep P MISSING DIAGNOSIS CODES
U12500285 Example Patient DO Example Account C Example Rep P INVALID DIAGNOSIS CODE
U12500286 Example Patient DA Example Account C Example Rep P INVALID DIAGNOSIS CODE
U12500287 Example Patient AHG Example Account C Example Rep P INVALID DIAGNOSIS CODE
U12500289 Example Patient WX Example Account C Example Rep P INVALID DIAGNOSIS CODE
U12500316 Example Patient OG Example Account C Example Rep P INVALID DIAGNOSIS CODE
U12500646 Example Patient AGT Example Account C Example Rep P MISSING INSURANCE NAME,INVALID DIAGNOSIS CODE
U12500953 Example Patient EC Example Account C Example Rep P INVALID DIAGNOSIS CODE
S07500018 Example Patient TT Example Account D Example Rep L COVERAGE TERMINATED
U095000282 Example Patient YE Example Account E Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000581 Example Patient AHJ Example Account E Example Rep P MISSING INS INFO
U095000584 Example Patient CM Example Account E Example Rep P MEMBER NOT FOUND
1000002 Example Patient TQ Example Account F Example Rep D INVALID POLICY ID
1000003 Example Patient EI Example Account F Example Rep D NOT ELIGIBLE ON DATE OF SERVICE
1000011 Example Patient YK Example Account F Example Rep D INVALID POLICY ID
1000029 Example Patient AGW Example Account F Example Rep D INVALID MEMBER ID
1000039 Example Patient UI Example Account F Example Rep D ANOTHER PAYOR PRESENT
1000043 Example Patient AEB Example Account F Example Rep D ANOTHER PAYOR PRESENT
1000044 Example Patient FS Example Account F Example Rep D MISSING INSURANCE NAME/INFO,INVALID POLICY ID
1000045 Example Patient CY Example Account F Example Rep D MEMBER NOT FOUND
1000049 Example Patient ADI Example Account F Example Rep D MEMBER NOT FOUND
1000052 Example Patient DQ Example Account F Example Rep D MEMBER ID INVALID
1000053 Example Patient HG Example Account F Example Rep D MEMBER NOT FOUND
1000067 Example Patient DL Example Account F Example Rep D NOT ELIGIBLE ON DATE OF SERVICE
1000073 Example Patient YH Example Account F Example Rep D MEMBER ID INVALID
1000084 Example Patient XM Example Account F Example Rep D ANOTHER PAYOR PRESENT
1000096 Example Patient ZC Example Account F Example Rep D MEMBER ID INVALID
1000101 Example Patient XG Example Account F Example Rep D MEMBER ID INVALID
1000102 Example Patient AJN Example Account F Example Rep D MEMBER ID INVALID
1000107 Example Patient AHX Example Account F Example Rep D MEMBER NOT FOUND
1000122 Example Patient ZZ Example Account F Example Rep D MISSING INSURANCE NAME/INFO,INVALID POLICY ID
1000129 Example Patient UR Example Account F Example Rep D MISSING INSURANCE NAME/INFO,INVALID POLICY ID
1000132 Example Patient AEQ Example Account F Example Rep D MEMBER NOT FOUND
1000133 Example Patient AJL Example Account F Example Rep D MISSING INSURANCE NAME/INFO,INVALID POLICY ID
1000146 Example Patient GG Example Account F Example Rep D MISSING INSURANCE NAME/INFO,INVALID POLICY ID
1000157 Example Patient LC Example Account F Example Rep D MISSING INSURANCE NAME/INFO,INVALID POLICY ID
1000158 Example Patient SK Example Account F Example Rep D MISSING INSURANCE NAME/INFO,INVALID POLICY ID
1000164 Example Patient DE Example Account F Example Rep D MISSING INSURANCE NAME/INFO,INVALID POLICY ID
1000165 Example Patient HY Example Account F Example Rep D ANOTHER PAYOR PRESENT
1000173 Example Patient OJ Example Account F Example Rep D MISSING INSURANCE NAME/INFO,INVALID POLICY ID
1000174 Example Patient EI Example Account F Example Rep D INVALID POLICY ID
1000177 Example Patient ADK Example Account F Example Rep D MEMBER NOT FOUND
1000184 Example Patient WB Example Account F Example Rep D MISSING INSURANCE NAME
1000213 Example Patient K Example Account F Example Rep D COVERAGE TERMINATED
1000214 Example Patient YK Example Account F Example Rep D MEMBER NOT FOUND
1000218 Example Patient SH Example Account F Example Rep D INVALID POLICY ID,MISSING INSURANCE NAME/INFO
1000237 Example Patient AEP Example Account F Example Rep D MISSING INSURANCE NAME/INFO,INVALID POLICY ID
1000740 Example Patient WT Example Account F Example Rep D MISSING INSURANCE NAME/INFO,INVALID POLICY ID
1000742 Example Patient DD Example Account F Example Rep D MISSING INSURANCE NAME/INFO,INVALID POLICY ID
1000761 Example Patient XQ Example Account F Example Rep D MISSING INSURANCE NAME/INFO
1000859 Example Patient RP Example Account F Example Rep D MISSING INSURANCE NAME/INFO
1000863 Example Patient QG Example Account F Example Rep D MISSING INSURANCE NAME/INFO
1000864 Example Patient MB Example Account F Example Rep D MISSING INSURANCE NAME/INFO
1000925 Example Patient KJ Example Account F Example Rep D NOT ELIGIBLE ON DATE OF SERVICE
1000945 Example Patient AIC Example Account F Example Rep D MEMBER NOT FOUND
1000960 Example Patient ADP Example Account F Example Rep D MISSING INSURANCE NAME/INFO
1000962 Example Patient KH Example Account F Example Rep D MEMBER NOT FOUND
1000963 Example Patient GH Example Account F Example Rep D INVALID MEMBER ID
1000966 Example Patient ABT Example Account F Example Rep D MEMBER NOT FOUND
1000995 Example Patient AFA Example Account F Example Rep D MEMBER NOT FOUND
1000998 Example Patient ADN Example Account F Example Rep D NOT ELIGIBLE ON DATE OF SERVICE
1001012 Example Patient Q Example Account F Example Rep D MEMBER NOT FOUND
1001058 Example Patient Q Example Account F Example Rep D MEMBER NOT FOUND
1001081 Example Patient EU Example Account F Example Rep D MISSING INS INFO
1001094 Example Patient VI Example Account F Example Rep D MISSING INS INFO
1001097 Example Patient DL Example Account F Example Rep D MISSING INSURANCE NAME
1001107 Example Patient AA Example Account F Example Rep D INVALID MEMBER ID
1001176 Example Patient KE Example Account F Example Rep D MISSING INSURANCE ADDRESS
1001201 Example Patient CJ Example Account F Example Rep D NOT ELIGIBLE ON DATE OF SERVICE
1001215 Example Patient Q Example Account F Example Rep D MEMBER NOT FOUND
1001225 Example Patient XM Example Account F Example Rep D ANOTHER PAYOR PRESENT
1001338 Example Patient Q Example Account F Example Rep D MEMBER NOT FOUND
1001340 Example Patient ABG Example Account F Example Rep D MISSING INSURANCE NAME
1001372 Example Patient QG Example Account F Example Rep D MEMBER NOT FOUND
1001420 Example Patient GW Example Account F Example Rep D INVALID MEMBER ID
1001432 Example Patient JU Example Account F Example Rep D COVERAGE TERMINATED
1001433 Example Patient KH Example Account F Example Rep D MEMBER NOT FOUND
1001456 Example Patient IT Example Account F Example Rep D MISSING INSURANCE NAME
1001461 Example Patient YP Example Account F Example Rep D COVERAGE TERMINATED
1001462 Example Patient ACA Example Account F Example Rep D MISSING INSURANCE NAME
1001484 Example Patient CG Example Account F Example Rep D INVALID MEMBER ID
1001504 Example Patient ZL Example Account F Example Rep D COVERAGE TERMINATED
1001538 Example Patient QK Example Account F Example Rep D INVALID POLICY ID
1001543 Example Patient DT Example Account F Example Rep D INVALID POLICY ID
1001544 Example Patient AIB Example Account F Example Rep D INVALID POLICY ID
1001546 Example Patient ABG Example Account F Example Rep D MISSING INSURANCE NAME
1001576 Example Patient PP Example Account F Example Rep D MISSING INSURANCE NAME
1001624 Example Patient X Example Account F Example Rep D MISSING INSURANCE NAME
1001631 Example Patient NM Example Account F Example Rep D MISSING INSURANCE NAME
1001634 Example Patient KR Example Account F Example Rep D MISSING MEMBER ID
1001639 Example Patient PN Example Account F Example Rep D MISSING MEMBER ID
1001732 Example Patient ACB Example Account F Example Rep D NOT ELIGIBLE ON DATE OF SERVICE
1001737 Example Patient PR Example Account F Example Rep D NOT ELIGIBLE ON DATE OF SERVICE
1001740 Example Patient AIC Example Account F Example Rep D MEMBER NOT FOUND
1001762 Example Patient Q Example Account F Example Rep D NOT ELIGIBLE ON DATE OF SERVICE
1001782 Example Patient MZ Example Account F Example Rep D INVALID MEMBER ID
1001797 Example Patient YO Example Account F Example Rep D MISSING INSURANCE NAME
1001815 Example Patient ABG Example Account F Example Rep D MISSING INSURANCE NAME
1001860 Example Patient BF Example Account F Example Rep D MISSING INSURANCE NAME
1001864 Example Patient ZK Example Account F Example Rep D INVALID MEMBER ID
1001865 Example Patient XR Example Account F Example Rep D INVALID DIAGNOSIS CODE
1001866 Example Patient NN Example Account F Example Rep D INVALID MEMBER ID
1001911 Example Patient AEO Example Account F Example Rep D MISSING INSURANCE NAME
1001918 Example Patient AFM Example Account F Example Rep D MISSING INSURANCE NAME
1001933 Example Patient PC Example Account F Example Rep D MISSING INSURANCE NAME
1001951 Example Patient RY Example Account F Example Rep D COVERAGE TERMINATED
1002012 Example Patient JU Example Account F Example Rep D COVERAGE TERMINATED
1002026 Example Patient FN Example Account F Example Rep D INVALID MEMBER ID
1002035 Example Patient AAS Example Account F Example Rep D NOT ELIGIBLE ON DATE OF SERVICE
1002057 Example Patient CV Example Account F Example Rep D MISSING INSURANCE NAME,INVALID POLICY ID
1002061 Example Patient DN Example Account F Example Rep D INVALID MEMBER ID
1002063 Example Patient AAL Example Account F Example Rep D INVALID MEMBER ID
1002091 Example Patient ADZ Example Account F Example Rep D COVERAGE TERMINATED
1002101 Example Patient LO Example Account F Example Rep D INVALID POLICY ID
1002121 Example Patient CI Example Account F Example Rep D INVALID DIAGNOSIS CODE
1002128 Example Patient WL Example Account F Example Rep D INVALID DIAGNOSIS CODE
1002168 Example Patient BV Example Account F Example Rep D INVALID POLICY ID
1002186 Example Patient PB Example Account F Example Rep D INVALID POLICY ID
1002190 Example Patient RY Example Account F Example Rep D COVERAGE TERMINATED
1002260 Example Patient AJC Example Account F Example Rep D INVALID POLICY ID
1002338 Example Patient ABD Example Account F Example Rep D MISSING INS INFO
1002360 Example Patient EJ Example Account F Example Rep D INVALID MEMBER ID
1002375 Example Patient PR Example Account F Example Rep D INVALID MEMBER ID
1002390 Example Patient AQ Example Account F Example Rep D INVALID MEMBER ID
1002406 Example Patient EP Example Account F Example Rep D NOT ELIGIBLE ON DATE OF SERVICE
1002425 Example Patient UP Example Account F Example Rep D INVALID MEMBER ID
1002432 Example Patient ABT Example Account F Example Rep D INVALID MEMBER ID
1002528 Example Patient AEA Example Account F Example Rep D INVALID MEMBER ID
1002547 Example Patient G Example Account F Example Rep D MISSING INSURANCE NAME
1002548 Example Patient TC Example Account F Example Rep D NOT ELIGIBLE ON DATE OF SERVICE
1002585 Example Patient RY Example Account F Example Rep D COVERAGE TERMINATED
1002599 Example Patient PR Example Account F Example Rep D INVALID MEMBER ID
U01600785 Example Patient ACK Example Account F Example Rep D MISSING DATE OF INJURY
U12501274 Example Patient FO Example Account G Example Rep K INVALID DIAGNOSIS CODE
S01600009 Example Patient CL Example Account H Example Rep N NOT ELIGIBLE ON DATE OF SERVICE
U085000014 Example Patient AJM Example Account I Example Rep P ANOTHER PAYOR PRESENT
U085000016 Example Patient AFZ Example Account I Example Rep P MEMBER NOT FOUND
U08500578 Example Patient NP Example Account I Example Rep P MISSING INSURANCE NAME/INFO
S12500021 Example Patient MO Example Account J Example Rep I MEMBER NOT FOUND
S11500067 Example Patient PK Example Account K Example Rep P ANOTHER PAYOR PRESENT
S11500094 Example Patient W Example Account K Example Rep P MEMBER NOT FOUND
S11500115 Example Patient ABV Example Account K Example Rep P MEMBER NOT FOUND
S11500116 Example Patient AAQ Example Account K Example Rep P ICD9 WITH ICD10 SERVICE DATE
S11500126 Example Patient UN Example Account K Example Rep P ICD9 WITH ICD10 SERVICE DATE
S11500132 Example Patient XJ Example Account K Example Rep P INVALID DX CODE
U07500058 Example Patient AJJ Example Account K Example Rep P MEMBER ID INVALID
U08500163 Example Patient GP Example Account K Example Rep P MEMBER NOT FOUND
U08500355 Example Patient R Example Account K Example Rep P ANOTHER PAYOR PRESENT
U08500366 Example Patient IS Example Account K Example Rep P MEMBER NOT FOUND
U08500445 Example Patient KC Example Account K Example Rep P ANOTHER PAYOR PRESENT
U08500446 Example Patient ABE Example Account K Example Rep P ANOTHER PAYOR PRESENT
U08500448 Example Patient AJH Example Account K Example Rep P ANOTHER PAYOR PRESENT
U08500452 Example Patient AGH Example Account K Example Rep P COVERAGE TERMINATED
U08500456 Example Patient SR Example Account K Example Rep P ANOTHER PAYOR PRESENT
U08500624 Example Patient BX Example Account K Example Rep P MEMBER NOT FOUND
U08500625 Example Patient ABS Example Account K Example Rep P ANOTHER PAYOR PRESENT
U08500630 Example Patient ET Example Account K Example Rep P MEMBER NOT FOUND
U08500632 Example Patient UD Example Account K Example Rep P ANOTHER PAYOR PRESENT
U08500702 Example Patient AAA Example Account K Example Rep P MEMBER NOT FOUND
U08500704 Example Patient NK Example Account K Example Rep P MEMBER NOT FOUND
U08500708 Example Patient ML Example Account K Example Rep P INVALID MEMBER ID
U08500712 Example Patient MA Example Account K Example Rep P MEMBER NOT FOUND
U08500769 Example Patient ABV Example Account K Example Rep P MEMBER NOT FOUND
U08500772 Example Patient ABW Example Account K Example Rep P MEMBER NOT FOUND
U095000112 Example Patient XD Example Account K Example Rep P ANOTHER PAYOR PRESENT
U095000114 Example Patient SB Example Account K Example Rep P MEMBER NOT FOUND
U095000116 Example Patient RH Example Account K Example Rep P MEMBER NOT FOUND
U095000123 Example Patient AIM Example Account K Example Rep P MEMBER NOT FOUND
U095000125 Example Patient YB Example Account K Example Rep P MEMBER NOT FOUND
U095000154 Example Patient WC Example Account K Example Rep P MEMBER NOT FOUND
U095000157 Example Patient ACL Example Account K Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000271 Example Patient HZ Example Account K Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000440 Example Patient VO Example Account K Example Rep P BILL LOCAL PLAN
U095000441 Example Patient ABH Example Account K Example Rep P ANOTHER PAYOR PRESENT
U095000524 Example Patient ADU Example Account K Example Rep P BILL LOCAL PLAN
U095000532 Example Patient AFX Example Account K Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000604 Example Patient LU Example Account K Example Rep P BILL TO LOCAL PLAN
U095000605 Example Patient OZ Example Account K Example Rep P BILL TO LOCAL PLAN
U095000703 Example Patient ZX Example Account K Example Rep P INVALID MEMBER ID
U10500076 Example Patient BS Example Account K Example Rep P BILL TO LOCAL PLAN
U10500157 Example Patient AGO Example Account K Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500158 Example Patient PX Example Account K Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500160 Example Patient ACC Example Account K Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500801 Example Patient AFK Example Account K Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10501147 Example Patient SS Example Account K Example Rep P ICD9 WITH ICD10 SERVICE DATE
U11500105 Example Patient PX Example Account K Example Rep P ICD9 WITH ICD10 SERVICE DATE
U11500106 Example Patient LP Example Account K Example Rep P ICD9 WITH ICD10 SERVICE DATE
U11500108 Example Patient FZ Example Account K Example Rep P ICD9 WITH ICD10 SERVICE DATE
U12500937 Example Patient YU Example Account K Example Rep P NOT ELIGIBLE ON DATE OF SERVICE
U01600494 Example Patient HK Example Account L Example Rep B INVALID DIAGNOSIS CODE
U02600809 Example Patient VP Example Account L Example Rep B INVALID DIAGNOSIS CODE
U12500917 Example Patient LQ Example Account L Example Rep B INVALID MEMBER ID
U01600019 Example Patient CA Example Account M Example Rep H PECOS ENROLLMENT REQUIRED
U08500687 Example Patient IC Example Account M Example Rep H ANOTHER PAYOR PRESENT
U095000093 Example Patient ACN Example Account M Example Rep H MEMBER NOT FOUND
U095000098 Example Patient BC Example Account M Example Rep H ANOTHER PAYOR PRESENT
U095000208 Example Patient ZS Example Account M Example Rep H ANOTHER PAYOR PRESENT
U095000264 Example Patient ND Example Account M Example Rep H PECOS ENROLLMENT REQUIRED
U095000445 Example Patient CH Example Account M Example Rep H ANOTHER PAYER PRESENT,ANOTHER PAYOR PRESENT
U095000446 Example Patient ACX Example Account M Example Rep H ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000607 Example Patient CX Example Account M Example Rep H MISSING REF PHYSICIAN INFO
U095000608 Example Patient FA Example Account M Example Rep H MISSING REF PHYSICIAN INFO
U095000609 Example Patient ACO Example Account M Example Rep H MISSING REF PHYSICIAN INFO
U095000671 Example Patient BA Example Account M Example Rep H ICD10 WITH ICD9 SERVICE DATE
U10500432 Example Patient DM Example Account M Example Rep H ICD9 WITH ICD10 SERVICE DATE
U10500433 Example Patient C Example Account M Example Rep H ICD9 WITH ICD10 SERVICE DATE
U11500222 Example Patient GT Example Account M Example Rep H MISSING REF PHYSICIAN INFO,ICD9 WITH ICD10 SERVICE DATE
U11500223 Example Patient AIJ Example Account M Example Rep H PECOS ENROLLMENT REQUIRED,ICD9 WITH ICD10 SERVICE DATE
U12500063 Example Patient ADA Example Account M Example Rep H INVALID MEMBER ID
U12500291 Example Patient ZB Example Account M Example Rep H PECOS ENROLLMENT REQUIRED
U02600051 Example Patient KV Example Account N Example Rep H INVALID DIAGNOSIS CODE
1002519 Example Patient VM Example Account O Example Rep D INVALID DIAGNOSIS CODE
1002622 Example Patient RU Example Account O Example Rep D MISSING INSURANCE NAME
U02600871 Example Patient XZ Example Account P Example Rep C INVALID INFO
U02601001 Example Patient AP Example Account P Example Rep C ANOTHER PAYOR PRESENT
U02601232 Example Patient AFJ Example Account P Example Rep C ANOTHER PAYOR PRESENT
U095000504 Example Patient AY Example Account Q Example Rep J MISSING DX CODES
F01600012 Example Patient NG Example Account R Example Rep B INVALID POLICY ID
U01600597 Example Patient AZ Example Account R Example Rep B INVALID INFO
U01600722 Example Patient BM Example Account R Example Rep B INVALID INFO
1002087 Example Patient WV Example Account S Example Rep D INVALID POLICY ID
1002315 Example Patient LH Example Account S Example Rep D COVERAGE TERMINATED
1002316 Example Patient OE Example Account S Example Rep D INVALID POLICY ID
1002457 Example Patient BK Example Account S Example Rep D MISSING INSURANCE NAME
U01600251 Example Patient XO Example Account T Example Rep K ANOTHER PAYOR PRESENT
U01600252 Example Patient T Example Account T Example Rep K MISSING INSURANCE NAME
U01600315 Example Patient WY Example Account T Example Rep K INVALID INFO
U01600581 Example Patient QL Example Account T Example Rep K INVALID POLICY ID
U085000021 Example Patient WD Example Account U Example Rep G MEMBER NOT FOUND
U08500200 Example Patient WD Example Account U Example Rep G MEMBER NOT FOUND
U07500126 Example Patient CQ Example Account V Example Rep G BILL LOCAL PLAN
S02600001 Example Patient BO Example Account W Example Rep R INVALID DIAGNOSIS CODE
S11500002 Example Patient ABC Example Account W Example Rep R MEMBER NOT FOUND
S11500006 Example Patient RX Example Account W Example Rep R INVALID DIAGNOSIS CODE
S11500025 Example Patient OW Example Account W Example Rep R ANOTHER PAYOR PRESENT
S11500111 Example Patient ABM Example Account W Example Rep R ANOTHER PAYOR PRESENT
U02600904 Example Patient NO Example Account X Example Rep P INVALID MEMBER ID
U07500029 Example Patient PD Example Account X Example Rep P MEMBER ID INVALID
U08500503 Example Patient AL Example Account X Example Rep P ANOTHER PAYER PRESENT,ANOTHER PAYOR PRESENT
U08500507 Example Patient EY Example Account X Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U08500510 Example Patient YS Example Account X Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U08500511 Example Patient SQ Example Account X Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000008 Example Patient UB Example Account X Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000012 Example Patient YM Example Account X Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000145 Example Patient NR Example Account X Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000146 Example Patient AFF Example Account X Example Rep P ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000147 Example Patient TJ Example Account X Example Rep P ANOTHER PAYER PRESENT,ANOTHER PAYOR PRESENT
U095000506 Example Patient UZ Example Account X Example Rep P NOT ELIGIBLE ON DATE OF SERVICE
U095000693 Example Patient AEG Example Account X Example Rep P BILL TO LOCAL PLAN
U095000694 Example Patient DR Example Account X Example Rep P BILL TO LOCAL PLAN
U10500318 Example Patient GJ Example Account X Example Rep P MEMBER NOT FOUND
U10500547 Example Patient AV Example Account X Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500550 Example Patient DU Example Account X Example Rep P ICD9 WITH ICD10 SERVICE DATE
U10500556 Example Patient FJ Example Account X Example Rep P MEMBER NOT FOUND
U10501010 Example Patient XK Example Account X Example Rep P ANOTHER PAYOR PRESENT
U11501033 Example Patient AF Example Account X Example Rep P MISSING INSURANCE NAME
U12500368 Example Patient LB Example Account X Example Rep P INVALID MEMBER ID
U095000252 Example Patient AJO Example Account Y Example Rep R ANOTHER PAYOR PRESENT
U095000405 Example Patient ZT Example Account Y Example Rep R ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000410 Example Patient QT Example Account Y Example Rep R ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000448 Example Patient ZR Example Account Y Example Rep R ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000449 Example Patient ACD Example Account Y Example Rep R ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000502 Example Patient DW Example Account Y Example Rep R ANOTHER PAYOR PRESENT,ANOTHER PAYER PRESENT
U095000740 Example Patient OV Example Account Y Example Rep R BILL TO LOCAL PLAN
U095000741 Example Patient IQ Example Account Y Example Rep R BILL TO LOCAL PLAN
U095000788 Example Patient AIK Example Account Y Example Rep R BILL TO LOCAL PLAN
U10500271 Example Patient ACS Example Account Y Example Rep R ICD9 WITH ICD10 SERVICE DATE
U10500452 Example Patient AHE Example Account Y Example Rep R ICD9 WITH ICD10 SERVICE DATE
U10500453 Example Patient ST Example Account Y Example Rep R ICD9 WITH ICD10 SERVICE DATE
U10500454 Example Patient AGM Example Account Y Example Rep R ICD9 WITH ICD10 SERVICE DATE
U10500851 Example Patient AHY Example Account Y Example Rep R ICD9 WITH ICD10 SERVICE DATE
U11500653 Example Patient AFY Example Account Y Example Rep R COVERAGE TERMINATED
U11500842 Example Patient FV Example Account Z Example Rep E MISSING INSURANCE NAME