Claims Review

Last Date of Treatment
Included DOS Range05-08-202502-24-2026
Last Data Load05-19-2026
Not Reviewed:
DOS:
Search:
Total Records: 22
Begin DOS
End DOS
Claim Num
Provider
T
ICD 1
ICD 2
ICD 3
ICD 4
ICD 5
INC
EXC
REV
Billed Amt.
Paid Amt.
Load Date
Linked
Rec Amt
Notes
LOB
+05-08-2505-08-2525136326644TONIOLO,JAMES,MDY$1,255.00$372.8406-04-25N$0.00NCommercial Self-Insured
+05-08-2505-08-2525136326403ANDREWS,STEVEN,MDY$815.00$455.9906-04-25N$0.00NCommercial Self-Insured
+05-08-2505-08-2525137263353TONIOLO,JAMES,MDY$1,340.00$398.6406-04-25N$0.00NCommercial Self-Insured
+05-08-2505-08-2525134434850AURORA MED CENTER MT PLEASY$13,278.97$1,800.0006-04-25N$0.00NCommercial Self-Insured
+05-14-2505-14-2525142331712PRYOMSKI,NICHOLAS,MDY$540.00$283.9606-12-25N$0.00NCommercial Self-Insured
+05-28-2505-28-2525160118031AURORA MEDICAL CENTER KENOY$530.00$232.0006-24-25N$0.00NCommercial Self-Insured
+06-02-2506-16-2525191180007AURORA MEDICAL CENTER KENOY$1,945.00$928.0007-22-25N$0.00NCommercial Self-Insured
+07-29-2507-29-2525223190520NEIMON,ROBERT,MDY$930.00$272.6009-04-25N$0.00NCommercial Self-Insured
+07-29-2507-29-2525217371288AURORA MED CENTER MT PLEASY$4,220.00$273.0008-29-25N$0.00NCommercial Self-Insured
+09-03-2509-03-2525258440773SIMON,ANDREW,MDY$120.00$34.8310-11-25N$0.00NCommercial Self-Insured
+09-03-2509-03-2525257474568JACOBSEN,WALTER,PDOY$795.00$427.2010-11-25N$0.00NCommercial Self-Insured
+09-17-2509-17-2525261887234CHEN,MARGARET,MDY$680.00$312.5010-28-25N$0.00YCommercial Self-Insured
+10-02-2510-02-2525278334901MIDWEST SPINE & ORTHOY$2,150.00$876.4011-05-25N$0.00NWorkers Compensation
+10-15-2510-22-2525289441027REGIONAL REHAB CENTERY$3,880.00$1,440.0011-14-25Y$0.00YCommercial Self-Insured
+11-04-2511-04-2525301228874PATEL,SUNITA,DOY$440.00$198.7512-01-25N$0.00NMedicare Advantage
+11-18-2511-18-2525317884456LAKEFRONT CHIROPRACTICY$325.00$142.0012-10-25N$0.00NCommercial Self-Insured
+12-01-2512-01-2525333120098NORTHSHORE PAIN MGMTY$750.00$0.0012-22-25N$0.00YCommercial Self-Insured
+12-09-2512-09-2525341776622GARCIA,ELENA,PTY$275.00$156.2001-08-26N$0.00NCommercial Self-Insured
+01-06-2601-06-2626014882301BRENNAN,TIMOTHY,MDY$5,640.00$2,108.0001-28-26Y$0.00YWorkers Compensation
+01-20-2601-20-2626020441189ADVANCED ORTHOPEDICS LLCY$1,890.00$744.3002-10-26N$0.00NCommercial Self-Insured
+02-03-2602-03-2626034115877TONIOLO,JAMES,MDY$980.00$341.6002-20-26N$0.00NCommercial Self-Insured
+02-17-2602-24-2626048229934AURORA MEDICAL CENTER KENOY$7,320.00$2,640.0003-12-26Y$0.00YCommercial Self-Insured
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