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Claim CLM-40021

RejectedCO-16
Client
Aaliyah Adams
Program
Housing
Payer
Medicaid — DC
Service Date Range
Feb 2, 2025 – Feb 6, 2025
Total Units
7
Billed
$166
Paid
—
Created
Feb 9, 2025
Submitted
Feb 10, 2025
Note IDClientService DateCodeUnitsAmountStaffApproval Date
CN-20250Aaliyah AdamsFeb 2, 2025H00433$66Dana ReyesFeb 2, 2025
CN-20268Aaliyah AdamsFeb 6, 2025T10174$100Dana ReyesFeb 6, 2025
Totals7$166