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The following is an example of an 'Error Report'  (*Feel free to PRINT this report)

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ERROR REPORT FOR : SMITH, STEVEN, M.D. 07-14-94 11:42 am

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Formatting errors are immediately reported back to you.

There is never a charge for rejected claims.

The following claims were not processed. Please make the indicated changes and resubmit.


>>> NO CHARGE HAS BEEN MADE TO YOUR ACCOUNT FOR THESE CLAIMS <<<


Patient		Company				Id Number	Amount
BROWN, CONNIE	BLUE SHIELD OF CALIFORNIA	XEA598800023	38.00

CodeFrom	To		Diag	Pos	Tos	Amount
07-08-94	07-08-94	1 	11 	1 	38.00

TYPE OF ERROR : NO PROCEDURE CODE SPECIFIED


Patient		Company				Id Number	Amount
TAYLOR,STEVEN	BLUE SHIELD OF CALIFORNIA	XEA598800023	38.00
Code	From		To		Diag	Pos	Tos	Amount

J7140 07-10-94 07-10-94 1 11 1 38.00

TYPE OF ERROR : MISSING PATIENT DATE OF BIRTH