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Authorization Results Learn more about Authorizations

Transaction ID: Customer ID:

Certification Number

123456789

Status

Modified

Patient Name

Diagnosis Version

ICD-9

Patient Date of Birth

03/03/2010

Request Type

Inpatient Authorization

Patient Gender

Male

Payer

Aetna

Certification Information

Certification Number

123456789

Status

Modified

Message

Provider Information

Requesting Provider

Referred-To-Provider

Riviera, Nick

Service Information

Service Type/Quantity

3 Days

Admission Type

Elective

Place of Service

Inpatient Hospital

Type of Service

Cardiac

Service/Admission Data

12/24/2012

Additional Services Information

Procedure Code

49000

Status

No action required

Date of Service

12/24/2012 - 12/24/2012

Payer Contact Information

Contact Name

Aetna

Phone Number

(800) 955-5682