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

SUB PT/OT GOAL STATUS 0 0
SUB PT/OT GOAL STATUS 0 0
SUB PT/OT D/C STATUS 0 0
SUB PT/OT D/C STATUS 0 0
SUB PT/OT D/C STATUS 0 0
SUB PT/OT D/C STATUS 0 0
SUB PT/OT D/C STATUS 0 0
SUB PT/OT D/C STATUS 0 0
DKH AIM PMT 0 0
GUEST TRAY 20 20
GUEST MEAL SPECIAL0 0
SELF PAY DISCOUNT -392 -392
STATE MLIA ALLOWANCE -827 -827
CARE PAYMENT ALLOWANCE 0 0
RETURNED CK FEE ALLOW 2 2
ESCH SOC SM CR BAL1 1
COMB ACCT BAL ALLOW -18 -18
ONE CALL MEDICAL ALLOW -5 -5
MBSC ALLOWANCE 0 0
NIPPON LIFE ALLOWANCE 0 0
CAREPYMT ADD ON AR 0 ALLOW 0
REFUND 0 0
VOIDED REFUND 0 0
MEDICARE ALLOW-5284 -5284
MCR IP PART B ONLY 0ALLOW
0
PSY UNTD BEHAVE -37 MED ALLOW-37
TRAILBLAZER ALLOW0 0
PSYCH MHN MED AV 0ALLOW
0
MEDICARE APPEALS -1 ALLOW -1
MEDICARE MAN CARE -4 ALLOW -4
FALLON SENIOR PLAN -4ALLOW
-4
BLUE CHIP ALLOW -7 -7
TUFTS MCR PREFERRED 0 ALLOW 0
HLTHNT SMARTCHOICE 0 ALLOW 0
AMER PROG T/OPTION 0 ALLOW 0
EVERCARE MEDICARE -3ALLOW
-3
CONNECTICARE MCR -516ALLOW-516
HEALTHNET PEARL MCR 0 ALLOW 0
AETNA MEDICARE ADV -29 ALLOW-29
MEDICARE SECONDARY -48 ALLOW-48
CIGNA MEDICARE ADV -1 ALLOW -1
AARP MED COMPLETE -829 ALLOW-829
H/L MCR PRO FEE OTHER 0 0
WORKERS COMP OF RI 0 ALLOW 0
SUPP STATE ALLOW-220 -220
H/L MCR ABN N/S MCAID -82 SUP -82
H/L MCR ABN SIGNED -6MCAID
-6