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Get Highmark CS 105943 2014-2024

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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