Institutional Claim

Question or Hint Answer or Word

What claim form did the provider utilize to submit this? UB-04 (wrong answers: CMS-1500, Medical Claim Form, What the office uses)
Why was the member at Park Nicollet Methodist Hospital? Maternity Delivery Care
Use SmartData. What is the address of the facility visited? 6500 Excelsior Blvd St Louis Park, MN 55426
Use help.yourbind.com. What is the copay for Delivery at Park Nicollet Methodist Hospital? $500 (wrong answers: $1,500, $1,000, $100)
How much did the facility bill? How much did we pay the provider? $8,972.85 - facility. $5,397.00 - insurance paid
Look at the notes on this claim. When was this adjusted and why? Adjusted on 12/4, because it was processed with $1,500 copay instead of $500 smart copay
What network priced this claim? United Healthcare