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Broker
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Claims
| Claim Number | Date of Service | Status | Total Charge | Allowed Charge | Member Responsibility | Five Point Responsibility |
|---|---|---|---|---|---|---|
| 222-027-R-000168-005 | 1/17/2024 | In Process | $1,344.00 | $0.0 | $1,344.00 | $0.0 |
| 222-027-R-000168-010 | 1/17/2024 | Paid | $1,344.00 | $0.0 | $1,344.00 | $0.0 |
| 222-027-R-000168-025 | 1/17/2024 | Denied | $1,344.00 | $0.0 | $1,344.00 | $0.0 |
| 222-027-R-000168-040 | 1/17/2024 | Paid | $1,344.00 | $0.0 | $1,344.00 | $0.0 |
Claim Details
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Notes
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