Health & Welfare Claim Inquiry for

Claim Number: You must Login First
Date Received Date Paid
00/00/0000 00/00/0000

Claim Type:
Status:

Diagnosis: PAYMENT DIAGNOSIS (DGN) CODES

Procedure:

Adj: $ .00 COB: $ .00 Total: $ .00

$Disallow$ $DisReason$

Provider:

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