{"aaData": [["INELIGIBLE HOSP.", "
I
\n", "
YES
\n", "
PRIOR TO 8/1/19
\n", "
8/1/19 AND AFTER
\n", "", "", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
15,40,45,55,60,65,70,85
\n", "
251
\n", "
1213
\n", "", "
PATIENT
\n", "
20
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["TORT FEASOR", "
TF
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
0
\n", "
1228
\n", "", "
THIRD PARTY
\n", "
22
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["MILITARY", "
M
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
NON-ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
0
\n", "
1211
\n", "", "
VENDOR
\n", "
17
\n", "
FEDERAL
\n", "
NO
\n"], ["FEDERAL AGENCIES-REFUND", "
F2
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
NON-ACCRUED
\n", "
REFUND
\n", "", "
0
\n", "
1218
\n", "", "
VENDOR
\n", "
15
\n", "
FEDERAL
\n", "
NO
\n"], ["FEDERAL AGENCIES-REIMB.", "
F1
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
NON-ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
0
\n", "
1211
\n", "", "
THIRD PARTY
\n", "
16
\n", "
FEDERAL
\n", "
NO
\n"], ["EX-EMPLOYEE", "
E
\n", "
NO
\n", "
YES
\n", "
NO
\n", "", "", "
1
\n", "
0
\n", "
YES
\n", "
YES
\n", "
NON-ACCRUED
\n", "", "", "
0
\n", "
1228
\n", "", "
OTHER-PERSON
\n", "
13
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["CURRENT EMP.", "
CE
\n", "
NO
\n", "
YES
\n", "
NO
\n", "", "", "
1
\n", "
0
\n", "
YES
\n", "
YES
\n", "
NON-ACCRUED
\n", "", "", "
0
\n", "
1228
\n", "", "
OTHER-PERSON
\n", "
14
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["VENDOR", "
V
\n", "
NO
\n", "
YES
\n", "
NO
\n", "", "", "
1
\n", "
0
\n", "
YES
\n", "
YES
\n", "
NON-ACCRUED
\n", "", "", "
0
\n", "
1228
\n", "", "
VENDOR
\n", "
11
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["C (MEANS TEST)", "
C
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
INPATIENT
\n", "", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
30,40,55,80,85,50,60,65,70
\n", "
240
\n", "
1221
\n", "", "
MEANS TEST PATIENT
\n", "
24
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["SHARING AGREEMENTS", "
SA
\n", "
NO
\n", "
YES
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
NON-ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
0
\n", "
1228
\n", "", "
INSTITUTION
\n", "
18
\n", "", "
NO
\n"], ["EMERGENCY/HUMANITARIAN", "
H
\n", "
YES
\n", "
PRIOR TO 8/1/19
\n", "
8/1/19 AND AFTER
\n", "", "", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
20,40,55,85
\n", "
252
\n", "
1213
\n", "", "
PATIENT
\n", "
25
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["INTERAGENCY", "
IA
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
NON-ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
0
\n", "
1228
\n", "", "
INSTITUTION
\n", "
19
\n", "
FEDERAL
\n", "
NO
\n"], ["MEDICARE", "
MC
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
0
\n", "
1228
\n", "", "
INSTITUTION
\n", "
28
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["RX CO-PAYMENT/SC VET", "
PS
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
RX
\n", "
RX DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
25,40,55,80,85,50,60,65,70
\n", "
298
\n", "
1212
\n", "
File: 420.3, IEN: 193
\n", "
PATIENT
\n", "
29
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["RX CO-PAYMENT/NSC VET", "
PN
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
RX
\n", "
RX DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
25,40,55,80,85,50,60,65,70
\n", "
294
\n", "
1212
\n", "
File: 420.3, IEN: 193
\n", "
PATIENT
\n", "
30
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["NURSING HOME CARE PER DIEM", "
NP
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
INPATIENT
\n", "
INPT LTC DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
296
\n", "
1221
\n", "", "
PATIENT
\n", "
31
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["HOSPITAL CARE PER DIEM", "
HP
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
INPATIENT
\n", "
INPATIENT DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
295
\n", "
1221
\n", "", "
PATIENT
\n", "
32
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["PREPAYMENT", "
PP
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
ACCRUED
\n", "", "", "
0
\n", "
1212
\n", "
File: 420.3, IEN: 193
\n", "
PATIENT
\n", "
33
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["CHAMPVA SUBSISTENCE", "
CS
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
1
\n", "
YES
\n", "
NO
\n", "
NON-ACCRUED
\n", "
REIMBURSEMENT
\n", "
5,40,55,85
\n", "
0
\n", "
1221
\n", "
File: 420.3, IEN: 130
\n", "
PATIENT
\n", "
34
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["CHAMPVA THIRD PARTY", "
CT
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
NON-ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
0
\n", "
1221
\n", "
File: 420.3, IEN: 130
\n", "
THIRD PARTY
\n", "
35
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["CHAMPVA", "
CV
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
NON-ACCRUED
\n", "", "", "
0
\n", "
1221
\n", "", "
THIRD PARTY
\n", "
36
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["NURSING HOME CARE(NSC)", "
NC
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
LTC
\n", "
INPT LTC DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
243
\n", "
1221
\n", "", "
PATIENT
\n", "
3
\n", "", "
YES
\n"], ["TRICARE", "
T1
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
NON-ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
0
\n", "
1311
\n", "", "
THIRD PARTY
\n", "
37
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["TRICARE PATIENT", "
T2
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "", "", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
NON-ACCRUED
\n", "
REIMBURSEMENT
\n", "
10,40,55,85
\n", "
0
\n", "
1311
\n", "", "
PATIENT
\n", "
38
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["TRICARE THIRD PARTY", "
T3
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
NON-ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
0
\n", "
1311
\n", "", "
THIRD PARTY
\n", "
39
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["ADULT DAY HEALTH CARE", "
AD
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
LTC
\n", "
OPT LTC DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
30,40,55,80,85,50,60,65,70
\n", "
0
\n", "
1319
\n", "", "
PATIENT
\n", "
40
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["DOMICILIARY", "
DO
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "", "", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
30,40,55,80,85,50,60,65,70
\n", "
0
\n", "
1319
\n", "", "
PATIENT
\n", "
41
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["RESPITE CARE-INSTITUTIONAL", "
RC
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
LTC
\n", "
INPT LTC DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
30,40,55,80,85,50,60,65,70
\n", "
0
\n", "
1319
\n", "", "
PATIENT
\n", "
42
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["RESPITE CARE-NON-INSTITUTIONAL", "
RN
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
LTC
\n", "
OPT LTC DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
30,40,55,80,85,50,60,65,70
\n", "
0
\n", "
1319
\n", "", "
PATIENT
\n", "
43
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["GERIATRIC EVAL-INSTITUTIONAL", "
GE
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
LTC
\n", "
INPT LTC DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
30,40,55,80,85,50,60,65,70
\n", "
0
\n", "
1319
\n", "", "
PATIENT
\n", "
44
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["GERIATRIC EVAL-NON-INSTITUTION", "
GN
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
LTC
\n", "
OPT LTC DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
30,40,55,80,85,50,60,65,70
\n", "
0
\n", "
1319
\n", "", "
PATIENT
\n", "
45
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["NURSING HOME CARE-LTC", "
NL
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
LTC
\n", "
INPT LTC DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
30,40,55,80,85,50,60,65,70
\n", "
0
\n", "
1319
\n", "", "
PATIENT
\n", "
46
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["OUTPATIENT CARE(NSC)", "
OC
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
OUTPATIENT
\n", "
OUTPATIENT DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
244
\n", "
1221
\n", "", "
PATIENT
\n", "
2
\n", "", "
YES
\n"], ["NURSING HOME PROCEEDS", "
NH
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
NON-ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
0
\n", "
1228
\n", "", "
OTHER-PERSON
\n", "
5
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["PARKING FEES", "
PF
\n", "
NO
\n", "
YES
\n", "
NO
\n", "", "", "
1
\n", "
0
\n", "
YES
\n", "
YES
\n", "
NON-ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
0
\n", "
1228
\n", "", "
OTHER-PERSON
\n", "
6
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["CWT PROCEEDS", "
CW
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
NON-ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
0
\n", "
1228
\n", "", "
OTHER-PERSON
\n", "
7
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["COMP & PEN PROCEEDS", "
CM
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
NON-ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
0
\n", "
1228
\n", "", "
OTHER-PERSON
\n", "
8
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["ENHANCED USE LEASE PROCEEDS", "
EP
\n", "
NO
\n", "
YES
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
YES
\n", "
YES
\n", "
NON-ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
0
\n", "
1228
\n", "", "
OTHER-PERSON
\n", "
10
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["FEE REIMB INS", "
FR
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
249
\n", "
1212
\n", "", "
THIRD PARTY
\n", "
47
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["EMERGENCY/HUMANITARIAN REIMB.", "
HR
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
252
\n", "
1213
\n", "", "
THIRD PARTY
\n", "
48
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["INELIGIBLE HOSP. REIMB.", "
IR
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
NON-ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
251
\n", "
1213
\n", "", "
THIRD PARTY
\n", "
49
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["CHOICE THIRD PARTY", "
C1
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
249
\n", "
1212
\n", "", "
THIRD PARTY
\n", "
50
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["CC THIRD PARTY", "
C2
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
249
\n", "
1212
\n", "", "
THIRD PARTY
\n", "
51
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["HOSPITAL CARE (NSC)", "
HC
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
INPATIENT
\n", "
INPATIENT DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
245
\n", "
1221
\n", "
File: 420.3, IEN: 183
\n", "
PATIENT
\n", "
1
\n", "", "
YES
\n"], ["CCN THIRD PARTY", "
C3
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
249
\n", "
1212
\n", "", "
THIRD PARTY
\n", "
52
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["CC MTF THIRD PARTY", "
C4
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
249
\n", "
1212
\n", "", "
THIRD PARTY
\n", "
53
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["CHOICE NO-FAULT AUTO", "
C5
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
247
\n", "
1212
\n", "", "
THIRD PARTY
\n", "
54
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["CHOICE TORT FEASOR", "
C6
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
0
\n", "
1228
\n", "", "
THIRD PARTY
\n", "
55
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["CCN WORKERS' COMP", "
CD
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
246
\n", "
1212
\n", "", "
THIRD PARTY
\n", "
56
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["CCN NO-FAULT AUTO", "
CB
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
247
\n", "
1212
\n", "", "
THIRD PARTY
\n", "
57
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["CCN TORT FEASOR", "
CC
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
0
\n", "
1228
\n", "", "
THIRD PARTY
\n", "
58
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["CC WORKERS' COMP", "
CA
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
246
\n", "
1212
\n", "", "
THIRD PARTY
\n", "
59
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["CC NO-FAULT AUTO", "
C8
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
247
\n", "
1212
\n", "", "
THIRD PARTY
\n", "
60
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["CC TORT FEASOR", "
C9
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
0
\n", "
1228
\n", "", "
THIRD PARTY
\n", "
61
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["WORKMAN'S COMP.", "
WC
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
EITHER
\n", "
REIMBURSEMENT
\n", "", "
246
\n", "
1212
\n", "", "
THIRD PARTY
\n", "
23
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["CHOICE WORKERS' COMP", "
C7
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
246
\n", "
1212
\n", "", "
THIRD PARTY
\n", "
62
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["CHOICE INPT", "
CF
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
INPATIENT
\n", "
INPATIENT DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
30,40,55,80,85,50,60,65,70
\n", "
240
\n", "
1221
\n", "", "
PATIENT
\n", "
63
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["CHOICE RX CO-PAYMENT", "
CG
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
CC RX
\n", "
COMM CARE RX DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
25,40,55,80,85,50,60,65,70
\n", "
294
\n", "
1212
\n", "", "
PATIENT
\n", "
64
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["CC INPT", "
CJ
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
INPATIENT
\n", "
INPATIENT DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
30,40,55,80,85,50,60,65,70
\n", "
240
\n", "
1221
\n", "", "
PATIENT
\n", "
65
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["CC RX CO-PAYMENT", "
CK
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
CC RX
\n", "
COMM CARE RX DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
25,40,55,80,85,50,60,65,70
\n", "
294
\n", "
1212
\n", "", "
PATIENT
\n", "
66
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["CCN INPT", "
CO
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
INPATIENT
\n", "
INPATIENT DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
30,40,55,80,85,50,60,65,70
\n", "
240
\n", "
1221
\n", "", "
PATIENT
\n", "
67
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["CCN RX CO-PAYMENT", "
CQ
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
CC RX
\n", "
COMM CARE RX DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
25,40,55,80,85,50,60,65,70
\n", "
294
\n", "
1212
\n", "", "
PATIENT
\n", "
68
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["CC MTF INPT", "
CX
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
INPATIENT
\n", "
INPATIENT DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
30,40,55,80,85,50,60,65,70
\n", "
240
\n", "
1221
\n", "", "
PATIENT
\n", "
69
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["CC MTF RX CO-PAYMENT", "
CY
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
CC RX
\n", "
COMM CARE RX DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
25,40,55,80,85,50,60,65,70
\n", "
294
\n", "
1212
\n", "", "
PATIENT
\n", "
70
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["CC NURSING HOME CARE - LTC", "
CL
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
LTC
\n", "
CC LTC DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
30,40,55,80,85,50,60,65,70
\n", "
0
\n", "
1319
\n", "", "
PATIENT
\n", "
71
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["NO-FAULT AUTO ACC.", "
NA
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
247
\n", "
1212
\n", "", "
THIRD PARTY
\n", "
26
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["CC RESPITE CARE", "
CN
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
LTC
\n", "
CC LTC DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
30,40,55,80,85,50,60,65,70
\n", "
0
\n", "
1319
\n", "", "
PATIENT
\n", "
72
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["CCN NURSING HOME CARE - LTC", "
CR
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
LTC
\n", "
CC LTC DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
30,40,55,80,85,50,60,65,70
\n", "
0
\n", "
1319
\n", "", "
PATIENT
\n", "
73
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["CCN RESPITE CARE", "
CU
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
LTC
\n", "
CC LTC DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
30,40,55,80,85,50,60,65,70
\n", "
0
\n", "
1319
\n", "", "
PATIENT
\n", "
74
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["CHOICE NURSING HOME CARE - LTC", "
CH
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
LTC
\n", "
CC LTC DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
30,40,55,80,85,50,60,65,70
\n", "
0
\n", "
1319
\n", "", "
PATIENT
\n", "
75
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["CHOICE RESPITE CARE", "
CI
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
LTC
\n", "
CC LTC DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
30,40,55,80,85,50,60,65,70
\n", "
0
\n", "
1319
\n", "", "
PATIENT
\n", "
76
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["TRICARE DES", "
T4
\n", "
NO
\n", "
NO
\n", "
NO
\n", "
OUTPATIENT
\n", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
NON-ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
0
\n", "
1311
\n", "", "
THIRD PARTY
\n", "
77
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["TRICARE SCI", "
T5
\n", "
NO
\n", "
NO
\n", "
NO
\n", "
OUTPATIENT
\n", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
NON-ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
0
\n", "
1311
\n", "", "
THIRD PARTY
\n", "
78
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["TRICARE TBI", "
T6
\n", "
NO
\n", "
NO
\n", "
NO
\n", "
OUTPATIENT
\n", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
NON-ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
0
\n", "
1311
\n", "", "
THIRD PARTY
\n", "
79
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["TRICARE BLIND REHABILITATION", "
T7
\n", "
NO
\n", "
NO
\n", "
NO
\n", "
OUTPATIENT
\n", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
NON-ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
0
\n", "
1311
\n", "", "
THIRD PARTY
\n", "
80
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["TRICARE DENTAL", "
T8
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
NON-ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
0
\n", "
1311
\n", "", "
THIRD PARTY
\n", "
81
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["CRIME OF PER.VIO.", "
CP
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
248
\n", "
1212
\n", "
File: 420.3, IEN: 193
\n", "
THIRD PARTY
\n", "
27
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["TRICARE PHARMACY", "
T9
\n", "
NO
\n", "
NO
\n", "
NO
\n", "
CC RX
\n", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
NON-ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
0
\n", "
1311
\n", "", "
THIRD PARTY
\n", "
82
\n", "
NON-FEDERAL
\n", "
NO
\n"], ["CHOICE OPT", "
CZ
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
OUTPATIENT
\n", "
OUTPATIENT DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
30,40,55,80,85,50,60,65,70
\n", "
240
\n", "
1221
\n", "", "
PATIENT
\n", "
83
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["CC OPT", "
D1
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
OUTPATIENT
\n", "
OUTPATIENT DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
30,40,55,80,85,50,60,65,70
\n", "
240
\n", "
1221
\n", "", "
PATIENT
\n", "
84
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["CCN OPT", "
D2
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
OUTPATIENT
\n", "
OUTPATIENT DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
30,40,55,80,85,50,60,65,70
\n", "
240
\n", "
1221
\n", "", "
PATIENT
\n", "
85
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["CC MTF OPT", "
D3
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
OUTPATIENT
\n", "
OUTPATIENT DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
30,40,55,80,85,50,60,65,70
\n", "
240
\n", "
1221
\n", "", "
PATIENT
\n", "
86
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["CC URGENT CARE", "
U1
\n", "
YES
\n", "
PRIOR TO 8/1/15
\n", "
8/1/15 AND AFTER
\n", "
OUTPATIENT
\n", "
OUTPATIENT DISPLAY
\n", "
1
\n", "
1
\n", "
YES
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "
30,40,55,80,85,50,60,65,70
\n", "
240
\n", "
1221
\n", "", "
PATIENT
\n", "
87
\n", "
NON-FEDERAL
\n", "
YES
\n"], ["REIMBURS.HEALTH INS.", "
RI
\n", "
NO
\n", "
NO
\n", "
NO
\n", "", "", "
0
\n", "
0
\n", "
NO
\n", "
NO
\n", "
ACCRUED
\n", "
REIMBURSEMENT
\n", "", "
249
\n", "
1212
\n", "", "
THIRD PARTY
\n", "
21
\n", "
NON-FEDERAL
\n", "
NO
\n"]]}