BCBSHMO_FaxCoverSheet

3755 admiral drive suite 106 high point, nc 27265 p 336 887 9460 f 336 887 5710 hightpoint\@hstriad com send to bcbs hmo from yolanda keel attention medical determination dept date 5/1/17 ref office location 3755 admiral drive, suite 106 fax # 336 794 1556 phone # 336 887 9460 urgent reply asap please comment x 4 please review for your information total pages, including cover 2 comments dr clifton mays, dc 	 npi 1326035627 tax id 455374100 patient benny clark hedrick dob 02 11 1947 id# ypwj1247965101 procedures 97110, 97032, 97012, 97140, 97035 dx code(s) effective dates 3/3/2017 12/31/2017