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Below is a line from a remittance advice. Please answer the two questions below based on the following information: POSProcBilledAllowedDEDUCTCOINS PROV PD 1199203169.00169.0069.0020.0080.00 What amount

Below is a line from a remittance advice. Please answer the two questions below based on the following information:

POSProcBilledAllowedDEDUCTCOINS PROV PD

1199203169.00169.0069.0020.0080.00

What amount can be billed to the patient? ______________

What amount is paid by the insurance company? _______________

What is the name of the HIPAA electronic claim form for physicians? ______________

What is the name of the HIPAA electronic RA?

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