FB UNAUTHORIZED EDIT (1057) INPUT TEMPLATE (.402)

Name	Value
NAME	FB UNAUTHORIZED EDIT
DESCRIPTION	If dispositioned claim has been reopened, this template is used to keep the authorization information in synch with the unauthorized claim
DATE CREATED	2001-07-19 15:10:00
FILE	FEE BASIS PATIENT
DATE LAST USED	2001-07-19 00:00:00