Name	Value
CODE	MA01
STATUS EFFECTIVE DATE	2003-06-01 00:00:00 STATUS: ACTIVE FEE USE: NOT APPLICABLE
DESCRIPTION EFFECTIVE DATE	DESCRIPTION: Alert: If you do not agree with what we approved for these services, you may appeal our decision. To make sure that we are fair to you, we require another individual that did not process your initial claim to conduct the appeal. However, in order to be eligible for an appeal, you must write to us within 120 days of the date you received this notice, unless you have a good reason for being late.

Name

Value

CODE

MA01

STATUS EFFECTIVE DATE

2003-06-01 00:00:00

STATUS: ACTIVE

FEE USE: NOT APPLICABLE

DESCRIPTION EFFECTIVE DATE

DESCRIPTION:

Alert: If you do not agree with what we approved for these services, you 
may appeal our decision. To make sure that we are fair to you, we require 
another individual that did not process your initial claim to conduct the 
appeal. However, in order to be eligible for an appeal, you must write to 
us within 120 days of the date you received this notice, unless you have 
a good reason for being late.

MA01 (171) REMITTANCE REMARK (161.93)