Debra Griggs

Billing Manager

Hackensack Family Medical Center

$417$ Main Street, Suite $6$D

Hackensack, NJ $07601$

Re: Melanie A Scott, Account # $31275$

Dear Ms$.$ Griggs:

We received a claim for the above$-$named patient; date of service

January $2,2016.$ The claim listed the patient as an established patient

in your practice; however, we reviewed her file and have found no

previous claims on file. We also noted that the ICD code

$(2)$ is

not consistent with the

$(3)$ used. There is no

${?}^{(4)}$ to support this claim. You will need to review your

records and submit a corrected claim within $10$ business days or we

will consider this claim closed.

Sincerely,

Beth Vanderlynn

Account Management