Patient record
| Payer | Plan | Member ID | Group ID | Relationship | Primary |
|---|---|---|---|---|---|
| PRIVATE | PR | Secondary |
PSB F6 E1 · Manual exception
Routine B1 processing uses active coverage already on file and does not call E1. Use this manual check only when eligibility is uncertain. Results are coverage proposals; applying coverage remains a separate user decision.
| Result | Mode | Actor | Response | Recorded |
|---|---|---|---|---|
| No E1 eligibility evidence recorded. | ||||
| Medication | Sig | Qty / days supply | Refills remaining | Last fill | Next due | Status |
|---|---|---|---|---|---|---|
| YELLOW CANDY 0 00010101010 · Rx 27999 |
— | 14 / 14 days | 0 of 0 | 2016-08-22 | 2016-09-05 | Completed |
| RED CANDY 24328340928 · Rx 26780 |
— | 112 / 28 days | 99 of 99 | 2015-05-29 | 2015-06-26 | Overdue |
| ORANGE CANDY 45678912301 · Rx 26779 |
— | 28 / 28 days | 99 of 99 | 2015-05-29 | 2015-06-26 | Overdue |
| GREEN CANDY 00100011101 · Rx 26778 |
— | 84 / 28 days | 99 of 99 | 2015-05-29 | 2015-06-26 | Overdue |
| RED CANDY 24328340928 · Rx 26464 |
XFer To BRAD WOLZAK @ GENOA REDISCOVER[(816) 347-0075] On 03-18-2015 | 28 / 28 days | 11 of 11 | 2015-01-23 | 2015-02-20 | Overdue |
| ORANGE CANDY 45678912301 · Rx 26463 |
XFer To BRAD WOLZAK @ GENOA REDISCOVER[(816) 347-0075] On 03-18-2015 | 28 / 28 days | 11 of 11 | 2015-01-23 | 2015-02-20 | Overdue |
| YELLOW CANDY 24392034092 · Rx 26462 |
XFer To BRAD WOLZAK @ GENOA REDISCOVER[(816) 347-0075] On 03-18-2015 | 28 / 28 days | 11 of 11 | 2015-01-23 | 2015-02-20 | Overdue |
| GREEN CANDY 00100011101 · Rx 26461 |
XFer To BRAD WOLZAK @ GENOA REDISCOVER[(816) 347-0075] On 03-18-2015 | 28 / 28 days | 11 of 11 | 2015-01-23 | 2015-02-20 | Overdue |
| PURPLE CANDY 00000012255 · Rx 26465 |
XFer To BRAD WOLZAK @ GENOA REDISCOVER[(816) 347-0075] On 03-18-2015 | 28 / 14 days | 11 of 11 | 2015-01-23 | 2015-02-06 | Overdue |