Using the Blue Cross/Blue Shield EOB is the services for Nancy Drew paid correctly? O 1) Yes the payment looks correct O2), No the calculation for total paid to provider for 11200 is incorrect 3) No the calculation for total paid to provider for 84443 is incorrect O 4) No the calculation for total paid to provider for 99213 is incorrect Submit

Using the Blue Cross/Blue Shield EOB is the services for Nancy Drew paid correctly? 1) Yes the payment looks correct 2). No the calculation for total paid to provider for 11200 is incorrect 3) No the calculation for total paid to provider for 84443 is incorrect 4) No the calculation for total paid to provider for 99213 is incorrect Provider: Healthcare Clinic NPI: 524875211 REASON CODES (RC): PR1 - Not a covered benefit, patient responsibility PR2 - Physician contractual discount per insurance contract PR3 - Service not paid separately PR4 - Deductible for year has been met, amount duc by patient is 20% coinsurance PR5 - PPO plan, patient responsible for co-pay PR6 - 80/20 plan with deductible AMBA Al Rights Reserved