Section[ 3 - ED Payment Data
Title[ 3 - Contents
3.01 Insurance Coverage or Other Expected Source of Payment — 61
3.02 Insurance Company — 62
3.03 Insurance Company Address — 63
3.04 Insurance Plan Type — 65
3.05 Insurance Policy ID — 66
3.06 ED Payment Authorization Requirement — 67
3.07 Status of ED Payment Authorization Attempt — 68
3.08 Date/Time of ED Payment Authorization Attempt — 70
3.09 ED Payment Authorization Decision — 71
3.10 Date/Time of ED Payment Authorization Decision — 73
3.11 Entity Contacted to Authorize ED Payment — 74
3.12 ED Payment Authorization Code — 75
3.13 Person Contacted to Authorize ED Payment — 76
3.14 Telephone Number of Entity or Person Contacted to Authorize ED Payment — 77
3.15 Total ED Facility Charges — 78
3.16 Total ED Professional Fees — 79
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