Renee Horton

 
 CORVEL 
 Certification Recommendation 
 CLAIM #: 
 PZC03624364 
 INSURED: 
 Super Store Industries 
 DOI: 
 18/04/2020 
 CARRIER/TPA: 
 Crum & Forster / 
 CLAIMANT: Edward Foster 
 ADJUSTER: 
 Leticia Bailon 
 CORVEL #: 113638363-UMO-2 
 Determination Date: 
 02/11/2015
 RFA Received Date: 
 07/30/2018 
 Provider: 
 Jenny Wong, DO 
 Pre-cert #: 
 113638363-UMO-2 
 Network: 
 per adjuster 
 CorVel Corporation has been asked to review the below noted treatment request for medical necessity and 
 appropriateness.
 CorVel Corporation hours of operation are from 8:30 a.m. to 5:30 p.m. PST, Monday through Friday. 
 ORNGER_CERT 
 :12-EMBID-4253654: 
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