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  • Highmark Cs 105943 2014

Get Highmark Cs 105943 2014-2025

Im has been processed. You should review it to make sure you received the services that are being billed. Explanation of Benefits THIS IS NOT A BILL 1 Contract Holder Name: SAMUEL SAMPLE 2 Member ID: 012345678910 EXPLANATION AT A GLANCE 5 Date of Service: 01/28/14 6 We Sent Payment To: PATHOLOGY PRACTICE A Network Provider Group Name: ABC CORP. Group ID: 123456 789 3 Claim Activity For: SAMUEL SAMPLE 4 Claim Number: 12345678910 7 Claim Payment Amount: $ 90.00 Provider May Bill.

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Explanation of Remark Codes: 03 – Deductible amount. 04 – Co-insurance amount. 05 – Non-covered service.

Explanation of Remark Codes J4047 - This is the difference between the provider's charge and our allowance. Since the provider is in-network, you are not responsible for this amount.

You may receive an EOB from your health plan after your visit with the provider. It will show you the total charges for your visit and how much you and your health plan owe. An EOB is NOT A BILL. You can also use it to track how you and your family use your coverage.

An Explanation of Benefits (EOB) code corresponds to a printed message about the status or action taken on a claim. Providers will find a list of all EOB codes used with the corresponding description on the last page of the Remittance Advice.

Your Explanation of Benefits (EOB) helps you understand your out-of-pocket costs for covered services. This includes how much your provider charged for the services, how much your health care plan paid, and what amount you owe.

The explanation of benefits lists the cost of your care, and how much your health insurance company will pay. “Provider Charges” is the amount your provider bills for your visit. “Allowed Charges” is the amount your provider will be paid. ... “Paid by Insurer” is the amount your health plan will pay to your provider.

X5018 - The allowance for this service has been applied to the dollar deductible amount required under the patient's coverage.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232