Name	Value
CODE	N1
STATUS EFFECTIVE DATE	2003-06-01 00:00:00 STATUS: ACTIVE FEE USE: APPLICABLE
DESCRIPTION EFFECTIVE DATE	DESCRIPTION: You may appeal this decision in writing within the required time limits following receipt of this notice by following the instructions included in your contract or plan benefit documents. DESCRIPTION: Alert: You may appeal this decision in writing within the required time limits following receipt of this notice by following the instructions included in your contract or plan benefit documents.

Name

Value

CODE

STATUS EFFECTIVE DATE

2003-06-01 00:00:00

STATUS: ACTIVE

FEE USE: APPLICABLE

DESCRIPTION EFFECTIVE DATE

DESCRIPTION:

You may appeal this decision in writing within the required time 
limits following receipt of this notice by following the instructions 
included in your contract or plan benefit documents.

DESCRIPTION:

Alert: You may appeal this decision in writing within the required time limits following receipt of this notice by following the instructions included in your contract or plan benefit documents.

N1 (29) REMITTANCE REMARK (161.93)