iMovePortal

Claims -

Patient Type

DOS From:

DOS To:

Patient: (last name, first)

Payer

Paid?

Status

Tags

FUD From:

FUD To:

		Claim ID	Payer	Total Charge	Ins. Paid	Ins. Adj.	Patient Paid	Patient Adj.	Balance	Status	DOS	First	Last

DOS	Code	Due	Paid	Patient Resp.
CLARK KENT	2022-5-1	12345789	97112
CLARK KENT	2022-5-1	12345789	97112
	Balance:	$100.00
	Subtotal:	$46.00
	Patient Responsibility:	$54.00

DOS	Code	Due	Paid	Patient Resp.
CLARK KENT	2022-5-1	12345789	97112
CLARK KENT	2022-5-1	12345789	97112
	Balance:	$100.00
	Subtotal:	$46.00
	Patient Responsibility:	$54.00

Patient	DOS	Claim #	Code	Adjustment	New Value
CLARK KENT	2022-5-1	12345789	97112
CLARK KENT	2022-5-1	12345789	97112
	Balance:	$100.00
	Subtotal:	$46.00
	Patient Responsibility:	$54.00

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