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

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

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

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TR PAUL ALLOWANCE0 0<br />

UNICARE/CIGNA ALLOWANCE -16 -16<br />

UTICA NATIONAL ALLOWANCE 0 0<br />

WAUSAU INSURANCE 0ALLOW<br />

0<br />

ADMINISTRATIVE ALLOWANCE -6 -6<br />

MEDICAID HUSKY -2069 A ALLOW -2069<br />

MEDICAID HUSKY B -55 ALLOW -55<br />

CHARTER OAK HUSKY -63ALLOW<br />

-63<br />

BC OF MA ALLOWANCE -208 -208<br />

TRICARE SECONDARY 0ALLOW<br />

0<br />

BC OF RI ALLOWANCE -69 -69<br />

OUT OF STATE BC -360 ALLOWANCE -360<br />

MEDICAID FAM PLAN 0ALLOW<br />

0<br />

PSY BEAC HLTH MCR 0ALLOW<br />

0<br />

MAIN SENSE ALLOWANCE 0 0<br />

CHESTERFIELD ALLOWANCE -6 -6<br />

EE BENE CONCEPTS ALLOW -2 -2<br />

UNITED HEALTH OF NE -1 ALLOW -1<br />

NEIGHBOR HEALTH RI 0ALLOW<br />

0<br />

BMC ALLOWANCE -2 -2<br />

FALLON MASSHEALTH -1 ALLOW -1<br />

NEIGH MASSHEALTH -1ALLOW<br />

-1<br />

NETWORK HEALTH MASS 0 ALLOW0<br />

AFTRA ALLOWANCE 0 0<br />

CHARITY ALLOWANCE -77 -77<br />

H/L MED DENY 30 DAY 0 REAMT 0<br />

ESCHEAT SOC UNCLAIMED 2 2<br />

SMALL BALANCE W/O -368 -368<br />

NAT'L HEALTHQUEST -1ALLOW<br />

-1<br />

POSPROMPT PAY -297 DISCOUNT -297<br />

HEALTH PLANS INC ALLOW 0 0<br />

MID WEST LIFE ALLOW -4 -4<br />

PART B REBILL ALLOWANCE 7 7<br />

LONDON HEALTH ADMIN 0 ALLOW0<br />

SEVEN CORNERS PAYMENT 0 0<br />

IMG ALLOWANCE 0 0<br />

STATEMENT PROMPT -1660PAY DISC -1660<br />

ALLOW PRO FEE COMMERCIAL -9 -9<br />

CHARITY MED B/D DED 0 W/O 0<br />

CHARITY MED B/D COINS -6 W/O -6<br />

CHARITY MED B/D NONCOV -1 WO-1<br />

STATE MED B/D DEDU<strong>CT</strong> -4 W/O -4<br />

STATE MED B/D COINS -313 W/O -313<br />

STATE MED B/D NON 0COV W/O 0<br />

ZZ HYDE BEHVR HLTH 0ALLOW<br />

0<br />

PRIMARILY CARE ALLOWANCE 0 0<br />

BENEMAX ALLOWANCE 0 0

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