Claims & Registry

Current Attribution Assignment

Physician Name
Physician Specialty
Clinic Affiliation
Assignment Method
Last Verification

Dr. Jeff Anscomb
Internal Mediciane
Chicago Internal Medicine Associates
(Payer, Data Model, Patient, Client System)
01/01/2015

Updated Attribution Information

Physician Name
Physician Specialty
Clinic Affiliation
Assignment Method
Last Verification

Dr. Diana Baren
Internal Mediciane
South Breeze Internal Medicine
Patient Provided
08/31/2015

Review Outcome

Invalid Attribution Update

Confirmed Attribution Update

Disposition

Routing

Notes

Current Demographics

Patient Name
Patient Address
Patient Address 2
City
State, Zip Code
Email
Primary Contact
Primary Contact Type
Source

David Eustis
101 Apple Street
Apartment 23092
Chicago
IL, 60603
deustis@aol.com
(111) 111-1111
Mobile
Patient

Updated Demographics

Patient Name
Patient Address
Patient Address 2
City
State, Zip Code
Email
Primary Contact
Primary Contact Type
Source

David Eustis
101 Apple Street
Apartment 2392
Chicago
IL, 60603
deustis@aol.com
(121) 111-1111
Mobile
Patient

Review Outcome

Updated Demographics

Revised Demographics Invalid

Routing

Notes

Coverage on File

Payer Type
Payer Plan
COB Order
Subscriber ID
Group Number
Status
Verification Source
Last Verification

Government
Medicare Part B
1
121345678
12345
Inactive
Payer Transaction
07/01/2015

Coverage Found

Payer Type
Payer Plan
COB Order
Subscriber ID
Group Number
Status
Verification Source
Last Verification

Commercial
Medicare Plus Blue
2
121345678
12345
Active
Payer Transaction
08/01/2015

Review Outcome

Updated Coverage

Added Coverage

Found Coverage Inactive

Routing

Notes

There are no claims to reconcile.

There are no registries to reconcile.

Action	whiteNumberBox	Note	Activity	Call User
No answer, left message with person	09/27/2015 - 9:02 AM	Grace was not home. A message was left with her husband.	Patient Engagement	Susan Peterson
Left Voicemail	09/29/2015 - 11:05 AM	No answer. Left message.	Patient Engagement	Jared Allen
Guarantor Requests Call Back	09/30/2015 - 3:02 PM	Spoke with Grace, however something came up and the call needed to be disconnected	Patient Engagement	Susan Peterson