| Name | Value |
|---|---|
| CATEGORY | INELIGIBLE HOSP. |
| ABBREVIATION | I |
| REFER TO DMC? | NO |
| REFER TO TOP? | YES |
| REFER TO CS? | NO |
| ELIG FOR RPP | 1 |
| PRINT SPECIAL NOTICE? | 1 |
| CHARGE ADMINISTRATIVE? | YES |
| CHARGE PENALTY? | NO |
| ACCRUED? | ACCRUED |
| REFUND/REIMBURSEMENT | REIMBURSEMENT |
| PARAGRAPH CODES | 15,40,45,55,60,65,70,85 |
| SEGMENT | 251 |
| GL # | 1213 |
| TYPE | PATIENT |
| CATEGORY NUMBER | 20 |
| RECEIVABLE CODE | NON-FEDERAL |
| CHARGE INTEREST? | YES |