| CODE |
160 |
| STATUS EFFECTIVE DATE |
-
- 2003-06-30 00:00:00
- STATUS: ACTIVE
- FEE USE: NOT APPLICABLE
-
- 2003-09-30 00:00:00
- STATUS: ACTIVE
- FEE USE: APPLICABLE
|
| DESCRIPTION EFFECTIVE DATE |
-
- DESCRIPTION:
Injury/illness was the result of an activity that is a benefit exclusion.
-
- DESCRIPTION:
Injury/illness was the result of an activity that is a benefit exclusion.
|
| SUSPENSION DESCRIPTION |
Injury/illness was the result of an activity that is a benefit exclusion.
|
| REMITTANCE REMARK |
|
| CORE SCENARIO |
Billed Service Not Covered |
| ADJUSTMENT GROUP |
|
