2.0 KiB
2.0 KiB
| 1 | Client | Visit Date | Payer | Authorized | Member ID | Auth Start Date | Auth End Date | Authorization # | ICD-10 | Service | Procedure Code | Modifiers | Client Classes | Billable Hours | Billable Amount | Invoice # | Claimed |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2 | Wilson, Michelle | 01/01/2026 | CO Medicaid | Yes | R649327 | 01/01/2026 | 12/31/2026 | 3 | R69 | Homemaker S5150 | S5150 | U8 | DD Waiver | 1 | $212.77 | INV-2026-01-01-R649327 | Yes |
| 3 | Roberts, Alice | 02/05/2026 | CO Medicaid | Yes | Q944140 | 01/01/2026 | 12/31/2026 | 3125 | R69 | PCS T1019 | T1019 | U1 | DD Waiver | 1 | $112.29 | INV-2026-02-05-Q944140 | Yes |
| 4 | Wilson, Michelle | 02/12/2026 | CO Medicaid | Yes | R649327 | 01/01/2026 | 12/31/2026 | 3 | R69 | Homemaker S5150 | S5150 | U8 | DD Waiver | 1 | $213.25 | INV-2026-02-12-R649327 | Yes |
| 5 | Stoumbaugh, Kiera | 02/25/2026 | CO Medicaid | Yes | Y188426 | 01/01/2026 | 12/31/2026 | 2 | R69 | PCS T1019 | T1019 | KX:SC:U2 | DD Waiver | 1 | $222.72 | INV-2026-02-25-Y188426 | Yes |
| 6 | Wilson, Michelle | 06/04/2026 | CO Medicaid | Yes | R649327 | 01/01/2026 | 12/31/2026 | 3 | R69 | Homemaker S5150 | S5150 | U8 | DD Waiver | 1 | $214.22 | INV-2026-06-04-R649327 | Yes |
| 7 | Wilson, Michelle | 06/11/2026 | CO Medicaid | Yes | R649327 | 01/01/2026 | 12/31/2026 | 3 | R69 | Homemaker S5150 | S5150 | U8 | DD Waiver | 1 | $213.25 | INV-2026-06-11-R649327 | Yes |
| 8 | Wilson, Michelle | 06/22/2026 | CO Medicaid | Yes | R649327 | 01/01/2026 | 12/31/2026 | 3 | R69 | Homemaker S5150 | S5150 | U8 | DD Waiver | 1 | $213.25 | INV-2026-06-22-R649327 | Yes |
| 9 | Wilson, Michelle | 06/25/2026 | CO Medicaid | Yes | R649327 | 01/01/2026 | 12/31/2026 | 3 | R69 | Homemaker S5150 | S5150 | U8 | DD Waiver | 1 | $235.55 | INV-2026-06-25-R649327 | Yes |
| 10 | Wilson, Michelle | 02/02/2026 | CO Medicaid | Yes | R649327 | 01/01/2026 | 12/31/2026 | 3 | R69 | Homemaker S5150 | S5150 | U8 | DD Waiver | 1 | $212.28 | INV-2026-02-02-R649327 | Yes |
| 11 | Wilson, Michelle | 02/05/2026 | CO Medicaid | Yes | R649327 | 01/01/2026 | 12/31/2026 | 3 | R69 | Homemaker S5150 | S5150 | U8 | DD Waiver | 1 | $212.28 | INV-2026-02-05-R649327 | Yes |