Name	Value
CODE	N12
STATUS EFFECTIVE DATE	2003-06-01 00:00:00 STATUS: ACTIVE FEE USE: NOT APPLICABLE
DESCRIPTION EFFECTIVE DATE	DESCRIPTION: Policy provides coverage supplemental to Medicare. As the member does not appear to be enrolled in the applicable part of Medicare, the member is responsible for payment of the portion of the charge that would have been covered by Medicare.

Name

Value

CODE

N12

STATUS EFFECTIVE DATE

2003-06-01 00:00:00

STATUS: ACTIVE

FEE USE: NOT APPLICABLE

DESCRIPTION EFFECTIVE DATE

DESCRIPTION:

Policy provides coverage supplemental to Medicare. As the member does not appear to be enrolled in the applicable part of Medicare, the member is responsible for payment of the portion of the charge that would have been covered by Medicare.

N12 (316) REMITTANCE REMARK (161.93)