Managed care plan as his only insurance coverage

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Mr. Spencer sees Dr. Hansfield on 08/03/YY for an office visit. Mr. Spencer has a managed care plan as his only insurance coverage. On 09/30/YY Mr. Spencer receives a document in the mail from his insurance payer. This document has CPT and ICD-10-CM codes listed on it along with payment information. What is this document?

Reference no: EM133983793

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