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Medical Fee Dispute Resolution Findings and Decision
General InformationRequestor Name
Peak Integrated
HealthcareRespondent Name
Old Republic Insurance Co. FDR Tracking Number
M423210601Carriers Austin
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Who needs this date of service?
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What is this date of service?
This date of service refers to the specific date on which a service was provided.
Who is required to file this date of service?
The healthcare provider or organization that provided the service is required to file this date of service.
How to fill out this date of service?
The date of service can be filled out on the required forms provided by the healthcare institution or organization.
What is the purpose of this date of service?
The purpose of the date of service is to accurately record when a service was provided for billing and record-keeping purposes.
What information must be reported on this date of service?
The information that must be reported on this date of service includes the name of the patient, the type of service provided, the provider's information, and the date and time of the service.
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