Telemedicine Billing Example
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Date of VisitPatient NamePatient DOBProvider NamePayerMember IDModifier CodeDescription
Payment Amount
Payment Status
Deposit Date
Deposit Amount
CC FeesCC NumberPayment Type
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2018-04-17 19:00:00 UTC
Christopher Long5/6/87
Michael Barnes, MD
BCBS of TexasZGP98976590GT Modifier65Processed
2018-04-19 08:00:00 UTC
62.822.187359Co-Pay
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2018-04-18 07:30:00 UTC
Kimberly Shankle6/13/89
Michael Barnes, MD
AetnaW145852425Processed
2018-04-20 08:00:00 UTC
24.160.842690Co-Pay
4
2018-04-20 14:30:00 UTC
Edith Campos5/30/76
Michael Barnes, MD
175Not Collected169.835.188934Self Pay
5
2018-04-20 14:30:00 UTC
John Garcia09/29/1990
Michael Barnes, MD
United Healthcare
98457867GT Modifier 25Processed
2018-04-21 08:00:00 UTC
24.160.848989Co-Pay
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