Tyler Martinez
1.1 KiB
1.1 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 | Roberts, Alice | 02/05/2026 | CO Medicaid | Yes | Q944140 | 01/01/2026 | 12/31/2026 | 3125 | R69 | PCS T1019 | T1019 | U1 | DD Waiver | 1 | $333.62 | INV-2026-02-05-Q944140 | Yes |
| 3 | Smith, Bob | 06/25/2026 | CO Medicaid | Yes | R649327 | 01/01/2026 | 12/31/2026 | 4521 | R69 | S5150 | S5150 | U8 | DD Waiver | 1 | $235.55 | INV-2026-06-25-R649327 | Yes |
| 4 | Davis, Carol | 02/25/2026 | CO Medicaid | Yes | Y188426 | 01/01/2026 | 12/31/2026 | 2890 | R69 | PCS T1019 | T1019 | KX:SC:U2 | DD Waiver | 1 | $222.72 | INV-2026-02-25-Y188426 | Yes |
| 5 | Lee, David | 06/04/2026 | CO Medicaid | Yes | R649327 | 01/01/2026 | 12/31/2026 | 4521 | R69 | S5150 | S5150 | U8 | DD Waiver | 1 | $214.22 | INV-2026-06-04-R649327 | Yes |
| 6 | Garcia, Eve | 06/22/2026 | CO Medicaid | Yes | R649327 | 01/01/2026 | 12/31/2026 | 4521 | R69 | S5150 | S5150 | U8 | DD Waiver | 1 | $213.25 | INV-2026-06-22-R649327 | Yes |