chrg# cdsc cdept csrv cupr crev# 3095 med/surg, semi ... - CT.gov

SUPP BLUE CROSS -237 ALLOW -237
SUPP TRICARE ALLOW0 0
SUPP COMM ALLOW-3 -3
RAC MEDICARE RECY 0ALLOW
0
FIRST COAST MCR-B -396 ALLOW -396
H/L MDCRE TIMELY FILING -5 -5
H/L MDCRE REG ERROR 0 0
H/L MEDICARE OTHER0 0
H/L MEDICARE NON CREDENTI 0 0
H/L MDCR CLINICAL -1 ERROR -1
H/L MDCRE NO AUTH 0ON FILE 0
H/L MEDICARE MEDICAL -130 NEC-130
H/L MDCRE DAYS DENIED 0 0
H/L MDCRE AUTH/SVC 0 MISMTC 0
H/L MDCRE NON COVERED -208 SVC -208
H/L MDCRE ADMINISTRATION 0 0
H/L MDCRE PATIENT/MEMBER 0 0
H/L MEDICARE RAC MED -1 NEC -1
H/L MCR RAC DRG CHANGE 0 0
H/L MCR 1 DAY PRE PAY 0 DNL 0
H/L MCR 1 DAY POST 0PAY DL 0
H/L MCR PRO FEE MED -2 NEC -2
H/L MCR PRO FEE TIMELY -1 FL -1
H/L MCR PRO FEE NO 0AUTH
0
H/L MCR PRO FEE CREDENTL -15 -15
MEDICAID ALLOWANCE -441 -441
PSYCH BEHAVORAL HLTH 0 ALLW 0
STATE AGENCIES ALLOW -3 -3
LMHA ALLOW 0 0
HEALTHNET MCD MCO 0 ALLOW 0
BLUE CARE FAMILY ALLOW 0 0
COMM HLTH NETWK 0MCD ALLOW0
PREF ONE/FST CHC ALLOW 0 0
AETNA BETTER HLTH 0ALLOW
0
AMERICHOICE UNHLTHC 0 ALLOW0
OUT OF STATE MEDICAID -9 ALL -9
RI MEDICAID ALLOWANCE -4 -4
COVENTRY HEALTH ALLOWANCE
-5 -5
MASS MEDICAID ALLOW -17 -17
NEW YORK MEDICAID -1ALLOW
-1
FIRST HEALTH ALLOWANCE 0 0
CHARTER OAK CHN ALLOW 0 0
CH OAK AMERICHOICE 0 ALLOW 0
CH OAK AETNA B/HLTH 0 ALLOW 0
MEDIBLUE ALLOWANCE -20 -20
TCORS AUTO ALLOWANCE 0 0
SAFETY NET FOUND ALLOW 0 0