Patient Name
Doe, Jane
Gender
Female
DOB
06/01/1990
Address
1505 Brookeville Way, Falls Church, VA 22043
Prior Auth Details
Provider Info
Provider name
Robert Franklin
Provider NPI
0123456789
Practice address
123 Main Street
Practice phone
833-294-6502
Practice fax
623-540-5597
tax id
32-5649812
Coverage type
In-Network
Site of service
Physician_office
Primary Insurance Info
Verified Insurance name
Aetna
policy effective date
01/01/2015
Employer Name
Apple, Inc.
provided insurance name
Aetna
policy end date
12/31/2025
funding type
Fully-funded
Member ID
W987654321
Payor phone
800-539-5837
benefits verified
careviso
Group ID
4569812
Plan name
Aetna Choice PPO II
Date Verified
04/01/2025
Active Coverage
Yes
plan type
PPO
Other Information
Date of Service
03/01/2026
Order id
a23594867902
ICD Codes
M17.0
Collection Date
03/02/2026
Linked Cases
24rv63o8drt is related to 24dn35j9amj
Attachments
No attachments
Case Comments
Collapse
PA is on file. Case is approved for codes J12345. Auth#123456789, Eff dates 03/01/2026 to 06/01/2026. Code: J12345.
Case History
Date/Time
Jane Doe (jack@example.com)
Created case 24dn35j9amj via portal
Date/Time
Jane Doe
Added Verified Test
Demo Product
Date/Time
Jane Doe
Added procedure codes
J1234, 67028
Date/Time
Jane Doe
Added ICD Codes
M17.0
Date/Time
Jane Doe
Changed status
open
closed