| Name | Value |
|---|---|
| CODE | B13 |
| STATUS EFFECTIVE DATE |
|
| DESCRIPTION EFFECTIVE DATE |
|
| ASSOCIATED SUSPEND CODE | File: 161.27, IEN: 5 |
| SUSPENSION DESCRIPTION | Previously paid. Payment for this claim/service may have been provided in a previous payment. |
| REMITTANCE REMARK |
|
| CORE SCENARIO | Billed Service Not Covered |
| ADJUSTMENT GROUP |
|