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

UNTDHLTH/UNTDHLTH -1 ALLOW -1
WALMART ALLOWANCE 0 0
HEALTH PARTNERS ALLOW -3 -3
MVP OF NY ALLOW -6 -6
UMR ALLOWANCE -1 -1
ULTRABENEFITS ALLOW -36 -36
STOP SHOP HEALTH ALLOWANC 0 0
MEDICAL MUTUAL ALLOWANCE 0 0
PSYCH MHN/PHS ALLOW 0 0
PSYCH VALUE BEHAV 0ALLOW
0
DIVERSIFIED ADMIN ALLOW 0 0
DIVERSIFIED GRP BRKG 0 ALLW 0
GUARDIAN LIFE ALLOW0 0
HEALTHNET (PHS) ALLOW 0 0
HEALTHNET/HEALTHNET 0 ALLOW0
KANAWHA HLTHCR SOLUT 0 ALLW0
MAILHANDLERS BENEFIT -6 ALLW -6
H/L COMM TIMELY FILING -3 -3
H/L COMM REG. ERROR 0 0
H/L COMMERCIAL OTHER 0 0
H/L COMMERCIAL NON 0 CRED 0
H/L COMM CLINICAL 0ERROR
0
H/L COMM NO AUTH -1ON FILE -1
H/L COMMERCIAL MED 1 NECESS 1
H/L COMMERCIAL DAYS -2 DENY -2
H/L COMM AUTH/SVC 0 MISMTCH0
H/L COMM NON COVERED -1 SVC -1
H/L COMM ADMINISTRATION 0 0
H/L COMM PATIENT/MEMBER 0 0
H/L COMM PRO FEE CRDTL 0 0
H/L COM PRO FEE OTHER 0 0
H/L COM PRO FEE MED -2 NEC -2
H/L COM PRO FEE TIMELY -8 FL -8
H/L COM PRO FEE NO 0AUTH
0
SAGA ALLOWANCE 0 0
PSY ADVANCE BEHAV 0ALLOW
0
H/L BC PRO FEE MED 0NEC
0
H/L SAGA TIMLEY FILING 0 0
H/L SAGA REG ERROR0 0
H/L SAGA OTHER 0 0
H/L SAGA NON CREDENTIAL 0 0
H/L SAGA CLINICAL ERROR 0 0
H/L SAGA NO AUTH ON 0 FILE 0
H/L SAGA MEDICAL NEC 0 0
H/L SAGA DAYS DENIED 0 0
H/L SAGA AUTH/SVC 0MISMATC
0
H/L SAGA NON COVERED 0 SVC 0