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Your Inquiry Details
Date Received: 01-19-2010 From: CUSTOMER SERVICE
Inquiry #: 01192010-7034559-010000 Subject: RETURNED AUTHORIZATION REQUEST
Member Name: SUSAN ASLAN Member #: 987654321
Inquiry Message:

CUSTOMER SERVICE - 01192010 - 11:09:22 ET-------------------------
Member Name: SUSAN ASLAN
Member #: 987654321
Provider ID: 123456
Inquiry ID #: 01192010-7034559-010000
Auth #: 01-010710-1-2
Responding Voided Authorization #: 01-010710-1-2
Would you like to submit a new Request for Service?      Request Submitted/Saved on  01/19/2010

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