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

H/L SAGA B/D I/P ALLOW 0 0
SNF B/D O/P ALLOW 0 0
BCCG B/D ALLOWANCE -1 -1
ADMINISTRATIVE BD 0OP ALLW 0
ADMINISTRATIVE BD 0IP ALLW 0
CHARITY B/D O/P ALLOW -1 -1
CHARITY B/D I/P ALLOW 0 0
ESCHEAT SOC B/D UNCLAIMED 0 0
RETURN CHECK B/D FEE 0 ADJ 0
ZZ HYDE BEHVR B/D ALLOW 0 0
SMALL BAL B/D O/P W/O 0 0
SMALL BAL B/D I/P W/O 0 0
CHARITY B/D MDCRE-DED 0 W/O 0
CHARITY B/D MED-COINS 0 W/O 0
CHARITY B/D MDCR-N/C -1 W/O -1
STATE B/D MDCR-DED 0 W/O 0
STATE B/D MDCR-COINS 0 W/O 0
STATE B/D MDCR-N/C 0 W/O 0
ESCHEAT SOC B/D SM 0CR BAL 0
SELF PAY B/D PAYMENT -116 -116
CAREPAYMENT B/D PAYMENT 6 6
CAREPYMT ADD ON BD 0 PYMT 0
MED BUR ECONOMICS -6 PMT -6
CENTURY FIN SERV PMT 0 0
MARCAM ASSOCIATES -102 PMT -102
MBSC PAYMENT -12 -12
TCORS B/D PAYMENT-4 -4
MERCHANTS ASSOC -62 OF FL PMT-62
MEDICARE B/D PAYMENT 2 2
SUPP STATE B/D PAYMENT 0 0
SUPP BLUE CROSS B/D 0 PMT 0
SUPP TRICARE B/D PAYMENT 1 1
SUPP COMMRCL B/D 0PYMT
0
RAC MEDICARE B/D PAYMENT 0 0
MEDICAID B/D PAYMENT -2 -2
MEDICAID MGD CARE 0B/D PMT 0
B/D PART B REBILL PAYMENT 0 0
MIC MEDICAID B/D PAYMENT 0 0
BLUE CROSS B/D PAYMENT 1 1
COMMERCIAL B/D PAYMENT 7 7
SAGA B/D PAYMENT 0 0
SNF B/D PAYMENT 0 0
BCCG B/D PAYMENT-2 -2
PERSONAL B/D PYRL -6 DED PMT -6
ZZ HYDE BEHVR B/D PYMT 0 0
DUE TO MEDICARE 0 0
BAD DEBT PASS THRU 0PMTS
0