| Name | Value |
|---|---|
| CATEGORY | REIMBURS.HEALTH INS. |
| ABBREVIATION | RI |
| REFER TO DMC? | NO |
| REFER TO TOP? | NO |
| REFER TO CS? | NO |
| ELIG FOR RPP | 0 |
| PRINT SPECIAL NOTICE? | 0 |
| CHARGE ADMINISTRATIVE? | NO |
| CHARGE PENALTY? | NO |
| ACCRUED? | ACCRUED |
| REFUND/REIMBURSEMENT | REIMBURSEMENT |
| SEGMENT | 249 |
| GL # | 1212 |
| TYPE | THIRD PARTY |
| CATEGORY NUMBER | 21 |
| RECEIVABLE CODE | NON-FEDERAL |
| CHARGE INTEREST? | NO |