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| # | Location | File | Last Modified |
|---|---|---|---|
| 1 | CPEE_v1_Build_7.zip\CPEE_v1_Build_7\Build 7 - Sprint 15\CPE001-112 - PL Zip in the PPS payment methodology for ASC Hospital Based Facility | Unit Test CPE001-112 - 2.docx | Tue Apr 24 15:18:40 2018 UTC |
| 2 | CPEE_v1_Build_7.zip\CPEE_v1_Build_7\Build 7 - Sprint 15\CPE001-112 - PL Zip in the PPS payment methodology for ASC Hospital Based Facility | Unit Test CPE001-112 - 2.docx | Tue Apr 24 17:55:54 2018 UTC |
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| 1 | DUZ: 83038 8 Health A dministrat ion Center Page: 1 | |
| 2 | Date: MAR 23, 2018 Post-Pro cessing Cl aim Report | |
| 3 | Time: 918 | |
| 4 | ||
| 5 | PDI: 201807591 000060- BATCH: Cl aim #: RLT 8250 | |
| 6 | EIN: 010211534 - -A1 S tatus: Pay ment Req. | |
| 7 | Program: CHAMPVA | |
| 8 | Vendor: MERCY HOS P Type: Out patient | |
| 9 | Pay Prov?: Yes Ser/Admis Date: MAR 1,2018 | |
| 10 | Sponsor: LEBLANC,R ICHARD P Comp. Date: | |
| 11 | Bene: LEBLANC,C ATHERINE J POS: AMB ULATORY SU R | |
| 12 | Bene Sex: F Bene DOB: 09/11/57 P L ZIP: 441 26 | |
| 13 | ||
| 14 | Press <RET URN> to co ntinue, <^ > to exit. | |
| 15 | ||
| 16 | DX's/Px's/ NDC's P/L Unt/Qty Total Chg TotalAA Mcai d O HI #1 PD OHI #1 P R Deduc t Pa yments AI Reas | |
| 17 | AlwUnt Chg/Unt AA/Unt A ddl OHI OHI PR B al Cst S hare | |
| 18 | ---------- --------- ------- ---------- - ------- ---- ---- ------- - ---------- -------- --- ----- ------ -- --------- -- ---- | |
| 19 | H26.9 1 AC | |
| 20 | ||
| 21 | H52.209 1 AC | |
| 22 | ||
| 23 | 66172-RT 1 12,000.0 0 83 4.00 2,000.00 10,000 .00 0.00 834.00 AC | |
| 24 | 1 12,000.0 0 83 4.00 0.00 | |
| 25 | ||
| 26 | X3000 1 400.0 0 40 0.00 100.00 300 .00 0.00 300.00 AC | |
| 27 | 1 400.0 0 40 0.00 0.00 | |
| 28 | ||
| 29 | X3000 1 350.0 0 35 0.00 100.00 250 .00 0.00 250.00 AC | |
| 30 | 1 350.0 0 35 0.00 0.00 | |
| 31 | ||
| 32 | X3000 1 300.0 0 30 0.00 100.00 200 .00 0.00 200.00 AC | |
| 33 | 1 300.0 0 30 0.00 0.00 | |
| 34 | ||
| 35 | J2250 1 50.0 0 5 0.00 10.00 40 .00 0.00 40.00 AC | |
| 36 | 1 50.0 0 5 0.00 0.00 | |
| 37 | ||
| 38 | J2405 1 40.0 0 4 0.00 10.00 30 .00 0.00 30.00 AC | |
| 39 | 1 40.0 0 4 0.00 0.00 | |
| 40 | ||
| 41 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ----- | |
| 42 | Totals: 13,140.0 0 1,97 4.00 2,320.00 10,820 .00 0.00 1,654.00 | |
| 43 | 0.00 | |
| 44 | ||
| 45 | Press <RET URN> to Co ntinue, <^ > to exit. | |
| 46 | ||
| 47 | Tot al Charges Billed: 13,14 0.00 CITI Maximum Re imbursemen t Rate: N/ A | |
| 48 | Calculated Allowable Amount: 1,97 4.00 MEDICAID Amount: N/ A | |
| 49 | A mount Appl ied to Ded uctible: 0.00 Am ount Paid by TPL: N/ A | |
| 50 | Cos t Share Cr edited to Cat Cap: 0.00 Amoun t Reversed from Dedu ctible: N/ A | |
| 51 | Amount Paid by O ther Insur ance(s): 2,32 0.00 Am ount Rever sed from C at Cap: N/ A | |
| 52 | Pa tient Resp onsibility Amount: 10,82 0.00 Amount Red uced from Previous P ayment: N/ A | |
| 53 | Amount Pa id by Bene ficiary to Vendor: 0.00 L ast PDI Pa yment Diff erence: 0.0 0 | |
| 54 | Total Amount to be PAID o n claim: 1,65 4.00 Total Paym ent for Cu rrent PDI# 201807591 000060: +1,654.0 0 | |
| 55 | Amou nt PAID to Vendor: 1,65 4.00 | |
| 56 | Amount PA ID to Bene ficiary: 0.00 | |
| 57 | ||
| 58 | Press <RET URN> to Co ntinue, <^ > to exit. | |
| 59 | ||
| 60 | ||
| 61 | CHAM PVA Benefi ciary Dedu ctible 201 8: 0.00 | |
| 62 | CHAMPVA F amily Dedu ctible 201 8: 0.00 | |
| 63 | CHAMP VA Family Catastroph ic Cap 201 8: 0.00 | |
| 64 | ||
| 65 | Press <RET URN> to Co ntinue, <^ > to exit. | |
| 66 | ||
| 67 | ||
| 68 | ||
| 69 | Actions fo r Claim: | |
| 70 | ||
| 71 | 1) SNA CAPPS (Pen ding Batch Process) 2) Clai mCheck (Co mplete) | |
| 72 | ||
| 73 | ||
| 74 | Claim Reas ons: 319 - CFR 17.272(B)( 3) REQUIRE S PROVIDER TO ACCEPT CHAMPVA A LLOWABLE A S FULL PAY MENT. | |
| 75 | 322 - COST SHARE FOR CLAIM MAY NOT ALWAY S BE PATIE NT LIABILI TY; OHI / CAT CAP MA Y IMPACT. | |
| 76 | 356 - REMI NDER - MAI L CLAIMS T O: CHAMPVA , PO Box 4 69064, DEN VER, CO 80 246-9064 | |
| 77 | 371 - WHEN RESUBMITT ING CLAIMS YOU MUST ATTACH THE CHAMPVA E OB FOR PRO PER PROCES SING. | |
| 78 | ||
| 79 | Select OPT ION NAME: AMB SUR G MENU AMB Surg Menu | |
| 80 | ||
| 81 | <DEV> A PG ASC Pa yment Grou p | |
| 82 | <DEV> A PR ASC Pa yment Rate s | |
| 83 | <DEV> A ZC AMB ZI P Codes | |
| 84 | ||
| 85 | You have P ENDING ALE RTS | |
| 86 | Enter "VA to jump t o VIEW ALE RTS option | |
| 87 | ||
| 88 | Select AMB Surg Menu <TEST ACC OUNT> Opti on: APG A SC Payment Group | |
| 89 | ||
| 90 | Select CHA MPVA ASC P AYMENT GRO UPS CPT-4 CODE: 6617 2 | |
| 91 | ||
| 92 | DEVICE: SSH VIRTUA L TERMINAL Right Margin: 80 // | |
| 93 | CHAMPVA AS C PAYMENT GROUPS Lis t MAR 23, 2018@07:1 7 PAGE 1 | |
| 94 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
| 95 | ||
| 96 | CPT-4 CODE : 66172 | |
| 97 | BEGIN EFFE CTIVE DATE : NOV 01, 1994 PAYMENT GR OUP: 6 | |
| 98 | DUZ: THO MPSON,DORT HEA P DATE CHANG ED: NOV 16 , 2017 | |
| 99 | ||
| 100 | Select CHA MPVA ASC P AYMENT GRO UPS CPT-4 CODE: | |
| 101 | ||
| 102 | <DEV> A PG ASC Pa yment Grou p | |
| 103 | <DEV> A PR ASC Pa yment Rate s | |
| 104 | <DEV> A ZC AMB ZI P Codes | |
| 105 | ||
| 106 | You have P ENDING ALE RTS | |
| 107 | Enter "VA to jump t o VIEW ALE RTS option | |
| 108 | ||
| 109 | Select AMB Surg Menu <TEST ACC OUNT> Opti on: AZC A MB ZIP Cod es | |
| 110 | ||
| 111 | Select CHA MPVA AMB Z IP CODES: 44126 | |
| 112 | ||
| 113 | DEVICE: SSH VIRTUA L TERMINAL Right Margin: 80 // | |
| 114 | CHAMPVA AM B ZIP CODE S List MAR 23, 2018@07:1 7 PAGE 1 | |
| 115 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
| 116 | ||
| 117 | ZIP CODE: 44126 STATE POST AL ABBREV: OH | |
| 118 | DATE: NOV 01, 1994 MSA CODE: 1680 | |
| 119 | ||
| 120 | Select CHA MPVA AMB Z IP CODES: | |
| 121 | ||
| 122 | <DEV> A PG ASC Pa yment Grou p | |
| 123 | <DEV> A PR ASC Pa yment Rate s | |
| 124 | <DEV> A ZC AMB ZI P Codes | |
| 125 | ||
| 126 | You have P ENDING ALE RTS | |
| 127 | Enter "VA to jump t o VIEW ALE RTS option | |
| 128 | ||
| 129 | Select AMB Surg Menu <TEST ACC OUNT> Opti on: APR A SC Payment Rates | |
| 130 | ||
| 131 | Select CHA MPVA ASC P AYMENT RAT ES MSA COD E: 1680 | |
| 132 | ||
| 133 | DEVICE: ;; 999 SSH V IRTUAL TER MINAL R ight Margi n: 80// | |
| 134 | CHAMPVA AS C PAYMENT RATES List MAR 23, 2018@07:1 8 PAGE 1 | |
| 135 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
| 136 | ||
| 137 | MSA CODE: 1680 | |
| 138 | BEGIN EFFE CTIVE DATE : NOV 01, 1994 | |
| 139 | DOLLAR RAT E FOR GROU P: 0274 | |
| 140 | DOLLAR RAT E FOR GROU P: 0311 | |
| 141 | DOLLAR RAT E FOR GROU P: 0423 | |
| 142 | DOLLAR RAT E FOR GROU P: 0526 | |
| 143 | DOLLAR RAT E FOR GROU P: 0652 | |
| 144 | DOLLAR RAT E FOR GROU P: 0745 | |
| 145 | DOLLAR RAT E FOR GROU P: 0850 | |
| 146 | DOLLAR RAT E FOR GROU P: 0954 | |
| 147 | DOLLAR RAT E FOR GROU P: 1239 | |
| 148 | DOLLAR RAT E FOR GROU P: 1413 | |
| 149 | BEGIN EFFE CTIVE DATE : NOV 01, 1995 | |
| 150 | DOLLAR RAT E FOR GROU P: 0283 | |
| 151 | DOLLAR RAT E FOR GROU P: 0321 | |
| 152 | DOLLAR RAT E FOR GROU P: 0437 | |
| 153 | DOLLAR RAT E FOR GROU P: 0543 | |
| 154 | DOLLAR RAT E FOR GROU P: 0673 | |
| 155 | DOLLAR RAT E FOR GROU P: 0770 | |
| 156 | DOLLAR RAT E FOR GROU P: 0877 | |
| 157 | DOLLAR RAT E FOR GROU P: 0985 | |
| 158 | DOLLAR RAT E FOR GROU P: 1280 | |
| 159 | DOLLAR RAT E FOR GROU P: 1460 | |
| 160 | BEGIN EFFE CTIVE DATE : NOV 01, 1996 | |
| 161 | DOLLAR RAT E FOR GROU P: 0291 | |
| 162 | DOLLAR RAT E FOR GROU P: 0331 | |
| 163 | DOLLAR RAT E FOR GROU P: 0449 | |
| 164 | DOLLAR RAT E FOR GROU P: 0558 | |
| 165 | DOLLAR RAT E FOR GROU P: 0692 | |
| 166 | DOLLAR RAT E FOR GROU P: 0791 | |
| 167 | DOLLAR RAT E FOR GROU P: 0901 | |
| 168 | DOLLAR RAT E FOR GROU P: 1013 | |
| 169 | DOLLAR RAT E FOR GROU P: 1315 | |
| 170 | DOLLAR RAT E FOR GROU P: 1500 | |
| 171 | BEGIN EFFE CTIVE DATE : NOV 01, 1997 | |
| 172 | DOLLAR RAT E FOR GROU P: 0292 | |
| 173 | DOLLAR RAT E FOR GROU P: 0332 | |
| 174 | DOLLAR RAT E FOR GROU P: 0451 | |
| 175 | DOLLAR RAT E FOR GROU P: 0559 | |
| 176 | DOLLAR RAT E FOR GROU P: 0694 | |
| 177 | DOLLAR RAT E FOR GROU P: 0794 | |
| 178 | DOLLAR RAT E FOR GROU P: 0904 | |
| 179 | DOLLAR RAT E FOR GROU P: 1016 | |
| 180 | DOLLAR RAT E FOR GROU P: 1319 | |
| 181 | DOLLAR RAT E FOR GROU P: 1505 | |
| 182 | BEGIN EFFE CTIVE DATE : NOV 01, 1998 | |
| 183 | DOLLAR RAT E FOR GROU P: 0293 | |
| 184 | DOLLAR RAT E FOR GROU P: 0333 | |
| 185 | DOLLAR RAT E FOR GROU P: 0453 | |
| 186 | DOLLAR RAT E FOR GROU P: 0561 | |
| 187 | DOLLAR RAT E FOR GROU P: 0697 | |
| 188 | DOLLAR RAT E FOR GROU P: 0796 | |
| 189 | DOLLAR RAT E FOR GROU P: 0907 | |
| 190 | DOLLAR RAT E FOR GROU P: 1020 | |
| 191 | DOLLAR RAT E FOR GROU P: 1324 | |
| 192 | DOLLAR RAT E FOR GROU P: 1510 | |
| 193 | DOLLAR RAT E FOR GROU P: 2335 | |
| 194 | BEGIN EFFE CTIVE DATE : NOV 01, 1999 | |
| 195 | DOLLAR RAT E FOR GROU P: 0293 | |
| 196 | DOLLAR RAT E FOR GROU P: 0333 | |
| 197 | DOLLAR RAT E FOR GROU P: 0453 | |
| 198 | DOLLAR RAT E FOR GROU P: 0562 | |
| 199 | DOLLAR RAT E FOR GROU P: 0697 | |
| 200 | DOLLAR RAT E FOR GROU P: 0796 | |
| 201 | DOLLAR RAT E FOR GROU P: 0907 | |
| 202 | DOLLAR RAT E FOR GROU P: 1020 | |
| 203 | DOLLAR RAT E FOR GROU P: 1325 | |
| 204 | DOLLAR RAT E FOR GROU P: 1511 | |
| 205 | DOLLAR RAT E FOR GROU P: 2335 | |
| 206 | BEGIN EFFE CTIVE DATE : NOV 01, 2000 | |
| 207 | DOLLAR RAT E FOR GROU P: 0295 | |
| 208 | DOLLAR RAT E FOR GROU P: 0335 | |
| 209 | DOLLAR RAT E FOR GROU P: 0457 | |
| 210 | DOLLAR RAT E FOR GROU P: 0566 | |
| 211 | DOLLAR RAT E FOR GROU P: 0702 | |
| 212 | DOLLAR RAT E FOR GROU P: 0802 | |
| 213 | DOLLAR RAT E FOR GROU P: 0913 | |
| 214 | DOLLAR RAT E FOR GROU P: 1026 | |
| 215 | DOLLAR RAT E FOR GROU P: 1333 | |
| 216 | DOLLAR RAT E FOR GROU P: 1520 | |
| 217 | DOLLAR RAT E FOR GROU P: 2567 | |
| 218 | BEGIN EFFE CTIVE DATE : NOV 01, 2001 | |
| 219 | DOLLAR RAT E FOR GROU P: 0296 | |
| 220 | DOLLAR RAT E FOR GROU P: 0337 | |
| 221 | DOLLAR RAT E FOR GROU P: 0458 | |
| 222 | DOLLAR RAT E FOR GROU P: 0568 | |
| 223 | DOLLAR RAT E FOR GROU P: 0705 | |
| 224 | DOLLAR RAT E FOR GROU P: 0805 | |
| 225 | DOLLAR RAT E FOR GROU P: 0917 | |
| 226 | DOLLAR RAT E FOR GROU P: 1030 | |
| 227 | DOLLAR RAT E FOR GROU P: 1338 | |
| 228 | DOLLAR RAT E FOR GROU P: 1527 | |
| 229 | DOLLAR RAT E FOR GROU P: 2677 | |
| 230 | BEGIN EFFE CTIVE DATE : NOV 01, 2002 | |
| 231 | DOLLAR RAT E FOR GROU P: 0307 | |
| 232 | DOLLAR RAT E FOR GROU P: 0349 | |
| 233 | DOLLAR RAT E FOR GROU P: 0476 | |
| 234 | DOLLAR RAT E FOR GROU P: 0589 | |
| 235 | DOLLAR RAT E FOR GROU P: 0732 | |
| 236 | DOLLAR RAT E FOR GROU P: 0835 | |
| 237 | DOLLAR RAT E FOR GROU P: 0951 | |
| 238 | DOLLAR RAT E FOR GROU P: 1070 | |
| 239 | DOLLAR RAT E FOR GROU P: 1389 | |
| 240 | DOLLAR RAT E FOR GROU P: 1585 | |
| 241 | DOLLAR RAT E FOR GROU P: 2618 | |
| 242 | BEGIN EFFE CTIVE DATE : NOV 01, 2003 | |
| 243 | DOLLAR RAT E FOR GROU P: 0197 | |
| 244 | DOLLAR RAT E FOR GROU P: 0344 | |
| 245 | DOLLAR RAT E FOR GROU P: 0472 | |
| 246 | DOLLAR RAT E FOR GROU P: 0520 | |
| 247 | DOLLAR RAT E FOR GROU P: 0649 | |
| 248 | DOLLAR RAT E FOR GROU P: 0776 | |
| 249 | DOLLAR RAT E FOR GROU P: 0858 | |
| 250 | DOLLAR RAT E FOR GROU P: 0977 | |
| 251 | DOLLAR RAT E FOR GROU P: 1161 | |
| 252 | DOLLAR RAT E FOR GROU P: 1473 | |
| 253 | DOLLAR RAT E FOR GROU P: 2889 | |
| 254 | BEGIN EFFE CTIVE DATE : APR 01, 2004 | |
| 255 | DOLLAR RAT E FOR GROU P: 0193 | |
| 256 | DOLLAR RAT E FOR GROU P: 0337 | |
| 257 | DOLLAR RAT E FOR GROU P: 0463 | |
| 258 | DOLLAR RAT E FOR GROU P: 0510 | |
| 259 | DOLLAR RAT E FOR GROU P: 0636 | |
| 260 | DOLLAR RAT E FOR GROU P: 0761 | |
| 261 | DOLLAR RAT E FOR GROU P: 0841 | |
| 262 | DOLLAR RAT E FOR GROU P: 0958 | |
| 263 | DOLLAR RAT E FOR GROU P: 1138 | |
| 264 | DOLLAR RAT E FOR GROU P: 1444 | |
| 265 | DOLLAR RAT E FOR GROU P: 2889 | |
| 266 | BEGIN EFFE CTIVE DATE : NOV 01, 2005 | |
| 267 | DOLLAR RAT E FOR GROU P: 0193 | |
| 268 | DOLLAR RAT E FOR GROU P: 0337 | |
| 269 | DOLLAR RAT E FOR GROU P: 0463 | |
| 270 | DOLLAR RAT E FOR GROU P: 0510 | |
| 271 | DOLLAR RAT E FOR GROU P: 0636 | |
| 272 | DOLLAR RAT E FOR GROU P: 0761 | |
| 273 | DOLLAR RAT E FOR GROU P: 0841 | |
| 274 | DOLLAR RAT E FOR GROU P: 0958 | |
| 275 | DOLLAR RAT E FOR GROU P: 1138 | |
| 276 | DOLLAR RAT E FOR GROU P: 1444 | |
| 277 | DOLLAR RAT E FOR GROU P: 3151 | |
| 278 | BEGIN EFFE CTIVE DATE : NOV 01, 2006 | |
| 279 | DOLLAR RAT E FOR GROU P: 0193 | |
| 280 | DOLLAR RAT E FOR GROU P: 0337 | |
| 281 | DOLLAR RAT E FOR GROU P: 0463 | |
| 282 | DOLLAR RAT E FOR GROU P: 0510 | |
| 283 | DOLLAR RAT E FOR GROU P: 0636 | |
| 284 | DOLLAR RAT E FOR GROU P: 0761 | |
| 285 | DOLLAR RAT E FOR GROU P: 0841 | |
| 286 | DOLLAR RAT E FOR GROU P: 0958 | |
| 287 | DOLLAR RAT E FOR GROU P: 1138 | |
| 288 | DOLLAR RAT E FOR GROU P: 1444 | |
| 289 | DOLLAR RAT E FOR GROU P: 3214 | |
| 290 | BEGIN EFFE CTIVE DATE : NOV 01, 2007 | |
| 291 | DOLLAR RAT E FOR GROU P: 0193 | |
| 292 | DOLLAR RAT E FOR GROU P: 0337 | |
| 293 | DOLLAR RAT E FOR GROU P: 0463 | |
| 294 | DOLLAR RAT E FOR GROU P: 0510 | |
| 295 | DOLLAR RAT E FOR GROU P: 0636 | |
| 296 | DOLLAR RAT E FOR GROU P: 0761 | |
| 297 | DOLLAR RAT E FOR GROU P: 0841 | |
| 298 | DOLLAR RAT E FOR GROU P: 0958 | |
| 299 | DOLLAR RAT E FOR GROU P: 1138 | |
| 300 | DOLLAR RAT E FOR GROU P: 1444 | |
| 301 | DOLLAR RAT E FOR GROU P: 3270 | |
| 302 | BEGIN EFFE CTIVE DATE : NOV 01, 2008 | |
| 303 | DOLLAR RAT E FOR GROU P: 0193 | |
| 304 | DOLLAR RAT E FOR GROU P: 0337 | |
| 305 | DOLLAR RAT E FOR GROU P: 0463 | |
| 306 | DOLLAR RAT E FOR GROU P: 0510 | |
| 307 | DOLLAR RAT E FOR GROU P: 0636 | |
| 308 | DOLLAR RAT E FOR GROU P: 0761 | |
| 309 | DOLLAR RAT E FOR GROU P: 0841 | |
| 310 | DOLLAR RAT E FOR GROU P: 0958 | |
| 311 | DOLLAR RAT E FOR GROU P: 1138 | |
| 312 | DOLLAR RAT E FOR GROU P: 1444 | |
| 313 | DOLLAR RAT E FOR GROU P: 5747 | |
| 314 | BEGIN EFFE CTIVE DATE : NOV 01, 2009 | |
| 315 | DOLLAR RAT E FOR GROU P: 0194 | |
| 316 | DOLLAR RAT E FOR GROU P: 0339 | |
| 317 | DOLLAR RAT E FOR GROU P: 0466 | |
| 318 | DOLLAR RAT E FOR GROU P: 0513 | |
| 319 | DOLLAR RAT E FOR GROU P: 0640 | |
| 320 | DOLLAR RAT E FOR GROU P: 0766 | |
| 321 | DOLLAR RAT E FOR GROU P: 0846 | |
| 322 | DOLLAR RAT E FOR GROU P: 0964 | |
| 323 | DOLLAR RAT E FOR GROU P: 1145 | |
| 324 | DOLLAR RAT E FOR GROU P: 1453 | |
| 325 | DOLLAR RAT E FOR GROU P: 5921 | |
| 326 | BEGIN EFFE CTIVE DATE : NOV 01, 2010 TERMINATIO N DATE: OC T 31, 2011 | |
| 327 | DUZ: ZZR OBERTSON,A LFONSO D LAST DATE CHANGED: S EP 27, 201 1 | |
| 328 | DOLLAR RAT E FOR GROU P: 0194 | |
| 329 | DOLLAR RAT E FOR GROU P: 0339 | |
| 330 | DOLLAR RAT E FOR GROU P: 0466 | |
| 331 | DOLLAR RAT E FOR GROU P: 0513 | |
| 332 | DOLLAR RAT E FOR GROU P: 0640 | |
| 333 | DOLLAR RAT E FOR GROU P: 0766 | |
| 334 | DOLLAR RAT E FOR GROU P: 0846 | |
| 335 | DOLLAR RAT E FOR GROU P: 0964 | |
| 336 | DOLLAR RAT E FOR GROU P: 1145 | |
| 337 | DOLLAR RAT E FOR GROU P: 1453 | |
| 338 | DOLLAR RAT E FOR GROU P: 5921 | |
| 339 | BEGIN EFFE CTIVE DATE : NOV 01, 2011 TERMINATIO N DATE: OC T 31, 2012 | |
| 340 | DUZ: THO MPSON,DORT HEA P LAST DATE CHANGED: O CT 26, 201 1 | |
| 341 | DOLLAR RAT E FOR GROU P: 0196 | |
| 342 | DOLLAR RAT E FOR GROU P: 0342 | |
| 343 | DOLLAR RAT E FOR GROU P: 0470 | |
| 344 | DOLLAR RAT E FOR GROU P: 0518 | |
| 345 | DOLLAR RAT E FOR GROU P: 0646 | |
| 346 | DOLLAR RAT E FOR GROU P: 0773 | |
| 347 | DOLLAR RAT E FOR GROU P: 0854 | |
| 348 | DOLLAR RAT E FOR GROU P: 0973 | |
| 349 | DOLLAR RAT E FOR GROU P: 1155 | |
| 350 | DOLLAR RAT E FOR GROU P: 1466 | |
| 351 | DOLLAR RAT E FOR GROU P: 6579 | |
| 352 | BEGIN EFFE CTIVE DATE : NOV 01, 2012 TERMINATIO N DATE: OC T 31, 2013 | |
| 353 | DUZ: WON G,DUANE R LAST DATE CHANGED: O CT 19, 201 2 | |
| 354 | DOLLAR RAT E FOR GROU P: 0199 | |
| 355 | DOLLAR RAT E FOR GROU P: 0347 | |
| 356 | DOLLAR RAT E FOR GROU P: 0476 | |
| 357 | DOLLAR RAT E FOR GROU P: 0525 | |
| 358 | DOLLAR RAT E FOR GROU P: 0654 | |
| 359 | DOLLAR RAT E FOR GROU P: 0783 | |
| 360 | DOLLAR RAT E FOR GROU P: 0865 | |
| 361 | DOLLAR RAT E FOR GROU P: 0986 | |
| 362 | DOLLAR RAT E FOR GROU P: 1170 | |
| 363 | DOLLAR RAT E FOR GROU P: 1486 | |
| 364 | DOLLAR RAT E FOR GROU P: 5788 | |
| 365 | BEGIN EFFE CTIVE DATE : NOV 01, 2013 TERMINATIO N DATE: OC T 31, 2014 | |
| 366 | DUZ: THO MPSON,DORT HEA P LAST DATE CHANGED: D EC 24, 201 3 | |
| 367 | DOLLAR RAT E FOR GROU P: 00201 | |
| 368 | DOLLAR RAT E FOR GROU P: 00350 | |
| 369 | DOLLAR RAT E FOR GROU P: 00480 | |
| 370 | DOLLAR RAT E FOR GROU P: 00530 | |
| 371 | DOLLAR RAT E FOR GROU P: 00660 | |
| 372 | DOLLAR RAT E FOR GROU P: 00790 | |
| 373 | DOLLAR RAT E FOR GROU P: 00873 | |
| 374 | DOLLAR RAT E FOR GROU P: 00995 | |
| 375 | DOLLAR RAT E FOR GROU P: 01180 | |
| 376 | DOLLAR RAT E FOR GROU P: 01500 | |
| 377 | DOLLAR RAT E FOR GROU P: 07216 | |
| 378 | BEGIN EFFE CTIVE DATE : NOV 01, 2014 TERMINATIO N DATE: OC T 31, 2015 | |
| 379 | DUZ: THO MPSON,DORT HEA P LAST DATE CHANGED: O CT 27, 201 4 | |
| 380 | DOLLAR RAT E FOR GROU P: 00203 | |
| 381 | DOLLAR RAT E FOR GROU P: 00354 | |
| 382 | DOLLAR RAT E FOR GROU P: 00486 | |
| 383 | DOLLAR RAT E FOR GROU P: 00536 | |
| 384 | DOLLAR RAT E FOR GROU P: 00668 | |
| 385 | DOLLAR RAT E FOR GROU P: 00800 | |
| 386 | DOLLAR RAT E FOR GROU P: 00884 | |
| 387 | DOLLAR RAT E FOR GROU P: 01006 | |
| 388 | DOLLAR RAT E FOR GROU P: 01194 | |
| 389 | DOLLAR RAT E FOR GROU P: 01518 | |
| 390 | DOLLAR RAT E FOR GROU P: 06607 | |
| 391 | BEGIN EFFE CTIVE DATE : NOV 01, 2015 TERMINATIO N DATE: OC T 31, 2016 | |
| 392 | DUZ: THO MPSON,DORT HEA P LAST DATE CHANGED: O CT 27, 201 5 | |
| 393 | DOLLAR RAT E FOR GROU P: 00205 | |
| 394 | DOLLAR RAT E FOR GROU P: 00358 | |
| 395 | DOLLAR RAT E FOR GROU P: 00492 | |
| 396 | DOLLAR RAT E FOR GROU P: 00543 | |
| 397 | DOLLAR RAT E FOR GROU P: 00676 | |
| 398 | DOLLAR RAT E FOR GROU P: 00810 | |
| 399 | DOLLAR RAT E FOR GROU P: 00895 | |
| 400 | DOLLAR RAT E FOR GROU P: 01018 | |
| 401 | DOLLAR RAT E FOR GROU P: 01208 | |
| 402 | DOLLAR RAT E FOR GROU P: 01535 | |
| 403 | DOLLAR RAT E FOR GROU P: 07405 | |
| 404 | BEGIN EFFE CTIVE DATE : NOV 01, 2016 TERMINATIO N DATE: OC T 31, 2017 | |
| 405 | DUZ: THO MPSON,DORT HEA P LAST DATE CHANGED: O CT 31, 201 6 | |
| 406 | DOLLAR RAT E FOR GROU P: 00207 | |
| 407 | DOLLAR RAT E FOR GROU P: 00362 | |
| 408 | DOLLAR RAT E FOR GROU P: 00498 | |
| 409 | DOLLAR RAT E FOR GROU P: 00549 | |
| 410 | DOLLAR RAT E FOR GROU P: 00684 | |
| 411 | DOLLAR RAT E FOR GROU P: 00819 | |
| 412 | DOLLAR RAT E FOR GROU P: 00905 | |
| 413 | DOLLAR RAT E FOR GROU P: 01030 | |
| 414 | DOLLAR RAT E FOR GROU P: 01222 | |
| 415 | DOLLAR RAT E FOR GROU P: 01552 | |
| 416 | DOLLAR RAT E FOR GROU P: 09889 | |
| 417 | BEGIN EFFE CTIVE DATE : NOV 01, 2017 TERMINATIO N DATE: OC T 31, 2018 | |
| 418 | DUZ: THO MPSON,DORT HEA P LAST DATE CHANGED: O CT 23, 201 7 | |
| 419 | DOLLAR RAT E FOR GROU P: 000211 | |
| 420 | DOLLAR RAT E FOR GROU P: 000369 | |
| 421 | DOLLAR RAT E FOR GROU P: 000508 | |
| 422 | DOLLAR RAT E FOR GROU P: 000561 | |
| 423 | DOLLAR RAT E FOR GROU P: 000697 | |
| 424 | DOLLAR RAT E FOR GROU P: 000834 | |
| 425 | DOLLAR RAT E FOR GROU P: 000923 | |
| 426 | DOLLAR RAT E FOR GROU P: 001050 | |
| 427 | DOLLAR RAT E FOR GROU P: 001246 | |
| 428 | DOLLAR RAT E FOR GROU P: 001584 | |
| 429 | DOLLAR RAT E FOR GROU P: 007118 | |
| 430 | DOLLAR RAT E FOR GROU P: 000621 | |
| 431 | DOLLAR RAT E FOR GROU P: 001055 | |
| 432 | DOLLAR RAT E FOR GROU P: 001369 | |
| 433 | DOLLAR RAT E FOR GROU P: 001737 | |
| 434 | DOLLAR RAT E FOR GROU P: 001759 | |
| 435 | DOLLAR RAT E FOR GROU P: 001768 | |
| 436 | DOLLAR RAT E FOR GROU P: 001824 | |
| 437 | DOLLAR RAT E FOR GROU P: 002112 | |
| 438 | DOLLAR RAT E FOR GROU P: 002085 | |
| 439 | DOLLAR RAT E FOR GROU P: 002711 | |
| 440 | DOLLAR RAT E FOR GROU P: 003329 | |
| 441 | DOLLAR RAT E FOR GROU P: 005055 | |
| 442 | DOLLAR RAT E FOR GROU P: 000484 | |
| 443 | DOLLAR RAT E FOR GROU P: 000704 | |
| 444 | DOLLAR RAT E FOR GROU P: 001180 | |
| 445 | DOLLAR RAT E FOR GROU P: 001295 | |
| 446 | DOLLAR RAT E FOR GROU P: 000989 | |
| 447 | DOLLAR RAT E FOR GROU P: 001336 | |
| 448 | DOLLAR RAT E FOR GROU P: 001612 | |
| 449 | DOLLAR RAT E FOR GROU P: 002064 | |
| 450 | DOLLAR RAT E FOR GROU P: 001708 | |
| 451 | DOLLAR RAT E FOR GROU P: 002711 | |
| 452 | DOLLAR RAT E FOR GROU P: 002567 | |
| 453 | DOLLAR RAT E FOR GROU P: 001929 | |
| 454 | DOLLAR RAT E FOR GROU P: 002007 | |
| 455 | DOLLAR RAT E FOR GROU P: 002173 | |
| 456 | DOLLAR RAT E FOR GROU P: 003070 | |
| 457 | DOLLAR RAT E FOR GROU P: 003128 | |
| 458 | DOLLAR RAT E FOR GROU P: 003308 | |
| 459 | DOLLAR RAT E FOR GROU P: 004063 | |
| 460 | ||
| 461 | ||
| 462 | Select CHA MPVA ASC P AYMENT RAT ES MSA COD E: | |
| 463 | ||
| 464 | Select AMB Surg Menu <TEST ACC OUNT> Opti on: AZC A MB ZIP Cod es | |
| 465 | ||
| 466 | Select CHA MPVA AMB Z IP CODES: 45271 | |
| 467 | ||
| 468 | DEVICE: SSH VIRTUA L TERMINAL Right Margin: 80 // | |
| 469 | CHAMPVA AM B ZIP CODE S List MAR 23, 2018@07:4 3 PAGE 1 | |
| 470 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
| 471 | ||
| 472 | ZIP CODE: 45271 STATE POST AL ABBREV: OH | |
| 473 | DATE: NOV 01, 1994 MSA CODE: 1640 | |
| 474 | ||
| 475 | Select CHA MPVA AMB Z IP CODES: | |
| 476 | ||
| 477 | <DEV> A PG ASC Pa yment Grou p | |
| 478 | <DEV> A PR ASC Pa yment Rate s | |
| 479 | <DEV> A ZC AMB ZI P Codes | |
| 480 | ||
| 481 | You have P ENDING ALE RTS | |
| 482 | Enter "VA to jump t o VIEW ALE RTS option | |
| 483 | ||
| 484 | Select AMB Surg Menu <TEST ACC OUNT> Opti on: APR A SC Payment Rates | |
| 485 | ||
| 486 | Select CHA MPVA ASC P AYMENT RAT ES MSA COD E: 1640 | |
| 487 | ||
| 488 | DEVICE: ;; 999 SSH V IRTUAL TER MINAL R ight Margi n: 80// | |
| 489 | CHAMPVA AS C PAYMENT RATES List MAR 23, 2018@07:4 3 PAGE 1 | |
| 490 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
| 491 | ||
| 492 | MSA CODE: 1640 | |
| 493 | BEGIN EFFE CTIVE DATE : NOV 01, 1994 | |
| 494 | DOLLAR RAT E FOR GROU P: 0272 | |
| 495 | DOLLAR RAT E FOR GROU P: 0308 | |
| 496 | DOLLAR RAT E FOR GROU P: 0419 | |
| 497 | DOLLAR RAT E FOR GROU P: 0521 | |
| 498 | DOLLAR RAT E FOR GROU P: 0646 | |
| 499 | DOLLAR RAT E FOR GROU P: 0738 | |
| 500 | DOLLAR RAT E FOR GROU P: 0842 | |
| 501 | DOLLAR RAT E FOR GROU P: 0945 | |
| 502 | DOLLAR RAT E FOR GROU P: 1228 | |
| 503 | DOLLAR RAT E FOR GROU P: 1400 | |
| 504 | BEGIN EFFE CTIVE DATE : NOV 01, 1995 | |
| 505 | DOLLAR RAT E FOR GROU P: 0279 | |
| 506 | DOLLAR RAT E FOR GROU P: 0317 | |
| 507 | DOLLAR RAT E FOR GROU P: 0431 | |
| 508 | DOLLAR RAT E FOR GROU P: 0535 | |
| 509 | DOLLAR RAT E FOR GROU P: 0663 | |
| 510 | DOLLAR RAT E FOR GROU P: 0758 | |
| 511 | DOLLAR RAT E FOR GROU P: 0864 | |
| 512 | DOLLAR RAT E FOR GROU P: 0971 | |
| 513 | DOLLAR RAT E FOR GROU P: 1261 | |
| 514 | DOLLAR RAT E FOR GROU P: 1439 | |
| 515 | BEGIN EFFE CTIVE DATE : NOV 01, 1996 | |
| 516 | DOLLAR RAT E FOR GROU P: 0288 | |
| 517 | DOLLAR RAT E FOR GROU P: 0327 | |
| 518 | DOLLAR RAT E FOR GROU P: 0444 | |
| 519 | DOLLAR RAT E FOR GROU P: 0552 | |
| 520 | DOLLAR RAT E FOR GROU P: 0685 | |
| 521 | DOLLAR RAT E FOR GROU P: 0782 | |
| 522 | DOLLAR RAT E FOR GROU P: 0892 | |
| 523 | DOLLAR RAT E FOR GROU P: 1002 | |
| 524 | DOLLAR RAT E FOR GROU P: 1300 | |
| 525 | DOLLAR RAT E FOR GROU P: 1484 | |
| 526 | BEGIN EFFE CTIVE DATE : NOV 01, 1997 | |
| 527 | DOLLAR RAT E FOR GROU P: 0289 | |
| 528 | DOLLAR RAT E FOR GROU P: 0328 | |
| 529 | DOLLAR RAT E FOR GROU P: 0447 | |
| 530 | DOLLAR RAT E FOR GROU P: 0554 | |
| 531 | DOLLAR RAT E FOR GROU P: 0687 | |
| 532 | DOLLAR RAT E FOR GROU P: 0786 | |
| 533 | DOLLAR RAT E FOR GROU P: 0895 | |
| 534 | DOLLAR RAT E FOR GROU P: 1006 | |
| 535 | DOLLAR RAT E FOR GROU P: 1306 | |
| 536 | DOLLAR RAT E FOR GROU P: 1490 | |
| 537 | BEGIN EFFE CTIVE DATE : NOV 01, 1998 | |
| 538 | DOLLAR RAT E FOR GROU P: 0290 | |
| 539 | DOLLAR RAT E FOR GROU P: 0330 | |
| 540 | DOLLAR RAT E FOR GROU P: 0448 | |
| 541 | DOLLAR RAT E FOR GROU P: 0556 | |
| 542 | DOLLAR RAT E FOR GROU P: 0690 | |
| 543 | DOLLAR RAT E FOR GROU P: 0788 | |
| 544 | DOLLAR RAT E FOR GROU P: 0898 | |
| 545 | DOLLAR RAT E FOR GROU P: 1009 | |
| 546 | DOLLAR RAT E FOR GROU P: 1310 | |
| 547 | DOLLAR RAT E FOR GROU P: 1495 | |
| 548 | DOLLAR RAT E FOR GROU P: 2292 | |
| 549 | BEGIN EFFE CTIVE DATE : NOV 01, 1999 | |
| 550 | DOLLAR RAT E FOR GROU P: 0290 | |
| 551 | DOLLAR RAT E FOR GROU P: 0330 | |
| 552 | DOLLAR RAT E FOR GROU P: 0449 | |
| 553 | DOLLAR RAT E FOR GROU P: 0557 | |
| 554 | DOLLAR RAT E FOR GROU P: 0691 | |
| 555 | DOLLAR RAT E FOR GROU P: 0789 | |
| 556 | DOLLAR RAT E FOR GROU P: 0899 | |
| 557 | DOLLAR RAT E FOR GROU P: 1011 | |
| 558 | DOLLAR RAT E FOR GROU P: 1313 | |
| 559 | DOLLAR RAT E FOR GROU P: 1497 | |
| 560 | DOLLAR RAT E FOR GROU P: 2292 | |
| 561 | BEGIN EFFE CTIVE DATE : NOV 01, 2000 | |
| 562 | DOLLAR RAT E FOR GROU P: 0293 | |
| 563 | DOLLAR RAT E FOR GROU P: 0333 | |
| 564 | DOLLAR RAT E FOR GROU P: 0454 | |
| 565 | DOLLAR RAT E FOR GROU P: 0562 | |
| 566 | DOLLAR RAT E FOR GROU P: 0698 | |
| 567 | DOLLAR RAT E FOR GROU P: 0797 | |
| 568 | DOLLAR RAT E FOR GROU P: 0907 | |
| 569 | DOLLAR RAT E FOR GROU P: 1020 | |
| 570 | DOLLAR RAT E FOR GROU P: 1325 | |
| 571 | DOLLAR RAT E FOR GROU P: 1511 | |
| 572 | DOLLAR RAT E FOR GROU P: 2534 | |
| 573 | BEGIN EFFE CTIVE DATE : NOV 01, 2001 | |
| 574 | DOLLAR RAT E FOR GROU P: 0297 | |
| 575 | DOLLAR RAT E FOR GROU P: 0337 | |
| 576 | DOLLAR RAT E FOR GROU P: 0459 | |
| 577 | DOLLAR RAT E FOR GROU P: 0568 | |
| 578 | DOLLAR RAT E FOR GROU P: 0705 | |
| 579 | DOLLAR RAT E FOR GROU P: 0805 | |
| 580 | DOLLAR RAT E FOR GROU P: 0917 | |
| 581 | DOLLAR RAT E FOR GROU P: 1031 | |
| 582 | DOLLAR RAT E FOR GROU P: 1339 | |
| 583 | DOLLAR RAT E FOR GROU P: 1528 | |
| 584 | DOLLAR RAT E FOR GROU P: 2681 | |
| 585 | BEGIN EFFE CTIVE DATE : NOV 01, 2002 | |
| 586 | DOLLAR RAT E FOR GROU P: 0304 | |
| 587 | DOLLAR RAT E FOR GROU P: 0346 | |
| 588 | DOLLAR RAT E FOR GROU P: 0471 | |
| 589 | DOLLAR RAT E FOR GROU P: 0583 | |
| 590 | DOLLAR RAT E FOR GROU P: 0724 | |
| 591 | DOLLAR RAT E FOR GROU P: 0827 | |
| 592 | DOLLAR RAT E FOR GROU P: 0942 | |
| 593 | DOLLAR RAT E FOR GROU P: 1059 | |
| 594 | DOLLAR RAT E FOR GROU P: 1375 | |
| 595 | DOLLAR RAT E FOR GROU P: 1569 | |
| 596 | DOLLAR RAT E FOR GROU P: 2565 | |
| 597 | BEGIN EFFE CTIVE DATE : NOV 01, 2003 | |
| 598 | DOLLAR RAT E FOR GROU P: 0195 | |
| 599 | DOLLAR RAT E FOR GROU P: 0341 | |
| 600 | DOLLAR RAT E FOR GROU P: 0467 | |
| 601 | DOLLAR RAT E FOR GROU P: 0515 | |
| 602 | DOLLAR RAT E FOR GROU P: 0643 | |
| 603 | DOLLAR RAT E FOR GROU P: 0769 | |
| 604 | DOLLAR RAT E FOR GROU P: 0850 | |
| 605 | DOLLAR RAT E FOR GROU P: 0968 | |
| 606 | DOLLAR RAT E FOR GROU P: 1150 | |
| 607 | DOLLAR RAT E FOR GROU P: 1460 | |
| 608 | DOLLAR RAT E FOR GROU P: 2835 | |
| 609 | BEGIN EFFE CTIVE DATE : APR 01, 2004 | |
| 610 | DOLLAR RAT E FOR GROU P: 0191 | |
| 611 | DOLLAR RAT E FOR GROU P: 0334 | |
| 612 | DOLLAR RAT E FOR GROU P: 0459 | |
| 613 | DOLLAR RAT E FOR GROU P: 0506 | |
| 614 | DOLLAR RAT E FOR GROU P: 0630 | |
| 615 | DOLLAR RAT E FOR GROU P: 0754 | |
| 616 | DOLLAR RAT E FOR GROU P: 0834 | |
| 617 | DOLLAR RAT E FOR GROU P: 0949 | |
| 618 | DOLLAR RAT E FOR GROU P: 1128 | |
| 619 | DOLLAR RAT E FOR GROU P: 1431 | |
| 620 | DOLLAR RAT E FOR GROU P: 2835 | |
| 621 | BEGIN EFFE CTIVE DATE : NOV 01, 2005 | |
| 622 | DOLLAR RAT E FOR GROU P: 0191 | |
| 623 | DOLLAR RAT E FOR GROU P: 0334 | |
| 624 | DOLLAR RAT E FOR GROU P: 0459 | |
| 625 | DOLLAR RAT E FOR GROU P: 0506 | |
| 626 | DOLLAR RAT E FOR GROU P: 0630 | |
| 627 | DOLLAR RAT E FOR GROU P: 0754 | |
| 628 | DOLLAR RAT E FOR GROU P: 0834 | |
| 629 | DOLLAR RAT E FOR GROU P: 0949 | |
| 630 | DOLLAR RAT E FOR GROU P: 1128 | |
| 631 | DOLLAR RAT E FOR GROU P: 1431 | |
| 632 | DOLLAR RAT E FOR GROU P: 3093 | |
| 633 | BEGIN EFFE CTIVE DATE : NOV 01, 2006 | |
| 634 | DOLLAR RAT E FOR GROU P: 0191 | |
| 635 | DOLLAR RAT E FOR GROU P: 0334 | |
| 636 | DOLLAR RAT E FOR GROU P: 0459 | |
| 637 | DOLLAR RAT E FOR GROU P: 0506 | |
| 638 | DOLLAR RAT E FOR GROU P: 0630 | |
| 639 | DOLLAR RAT E FOR GROU P: 0754 | |
| 640 | DOLLAR RAT E FOR GROU P: 0834 | |
| 641 | DOLLAR RAT E FOR GROU P: 0949 | |
| 642 | DOLLAR RAT E FOR GROU P: 1128 | |
| 643 | DOLLAR RAT E FOR GROU P: 1431 | |
| 644 | DOLLAR RAT E FOR GROU P: 3154 | |
| 645 | BEGIN EFFE CTIVE DATE : NOV 01, 2007 | |
| 646 | DOLLAR RAT E FOR GROU P: 0191 | |
| 647 | DOLLAR RAT E FOR GROU P: 0334 | |
| 648 | DOLLAR RAT E FOR GROU P: 0459 | |
| 649 | DOLLAR RAT E FOR GROU P: 0506 | |
| 650 | DOLLAR RAT E FOR GROU P: 0630 | |
| 651 | DOLLAR RAT E FOR GROU P: 0754 | |
| 652 | DOLLAR RAT E FOR GROU P: 0834 | |
| 653 | DOLLAR RAT E FOR GROU P: 0949 | |
| 654 | DOLLAR RAT E FOR GROU P: 1128 | |
| 655 | DOLLAR RAT E FOR GROU P: 1431 | |
| 656 | DOLLAR RAT E FOR GROU P: 3210 | |
| 657 | BEGIN EFFE CTIVE DATE : NOV 01, 2008 | |
| 658 | DOLLAR RAT E FOR GROU P: 0191 | |
| 659 | DOLLAR RAT E FOR GROU P: 0334 | |
| 660 | DOLLAR RAT E FOR GROU P: 0459 | |
| 661 | DOLLAR RAT E FOR GROU P: 0506 | |
| 662 | DOLLAR RAT E FOR GROU P: 0630 | |
| 663 | DOLLAR RAT E FOR GROU P: 0754 | |
| 664 | DOLLAR RAT E FOR GROU P: 0834 | |
| 665 | DOLLAR RAT E FOR GROU P: 0949 | |
| 666 | DOLLAR RAT E FOR GROU P: 1128 | |
| 667 | DOLLAR RAT E FOR GROU P: 1431 | |
| 668 | DOLLAR RAT E FOR GROU P: 5641 | |
| 669 | BEGIN EFFE CTIVE DATE : NOV 01, 2009 | |
| 670 | DOLLAR RAT E FOR GROU P: 0192 | |
| 671 | DOLLAR RAT E FOR GROU P: 0336 | |
| 672 | DOLLAR RAT E FOR GROU P: 0461 | |
| 673 | DOLLAR RAT E FOR GROU P: 0509 | |
| 674 | DOLLAR RAT E FOR GROU P: 0634 | |
| 675 | DOLLAR RAT E FOR GROU P: 0759 | |
| 676 | DOLLAR RAT E FOR GROU P: 0839 | |
| 677 | DOLLAR RAT E FOR GROU P: 0955 | |
| 678 | DOLLAR RAT E FOR GROU P: 1135 | |
| 679 | DOLLAR RAT E FOR GROU P: 1440 | |
| 680 | DOLLAR RAT E FOR GROU P: 5813 | |
| 681 | BEGIN EFFE CTIVE DATE : NOV 01, 2010 TERMINATIO N DATE: OC T 31, 2011 | |
| 682 | DUZ: ZZR OBERTSON,A LFONSO D LAST DATE CHANGED: S EP 27, 201 1 | |
| 683 | DOLLAR RAT E FOR GROU P: 0192 | |
| 684 | DOLLAR RAT E FOR GROU P: 0336 | |
| 685 | DOLLAR RAT E FOR GROU P: 0461 | |
| 686 | DOLLAR RAT E FOR GROU P: 0509 | |
| 687 | DOLLAR RAT E FOR GROU P: 0634 | |
| 688 | DOLLAR RAT E FOR GROU P: 0759 | |
| 689 | DOLLAR RAT E FOR GROU P: 0839 | |
| 690 | DOLLAR RAT E FOR GROU P: 0955 | |
| 691 | DOLLAR RAT E FOR GROU P: 1135 | |
| 692 | DOLLAR RAT E FOR GROU P: 1440 | |
| 693 | DOLLAR RAT E FOR GROU P: 5813 | |
| 694 | BEGIN EFFE CTIVE DATE : NOV 01, 2011 TERMINATIO N DATE: OC T 31, 2012 | |
| 695 | DUZ: THO MPSON,DORT HEA P LAST DATE CHANGED: O CT 26, 201 1 | |
| 696 | DOLLAR RAT E FOR GROU P: 0194 | |
| 697 | DOLLAR RAT E FOR GROU P: 0339 | |
| 698 | DOLLAR RAT E FOR GROU P: 0465 | |
| 699 | DOLLAR RAT E FOR GROU P: 0513 | |
| 700 | DOLLAR RAT E FOR GROU P: 0640 | |
| 701 | DOLLAR RAT E FOR GROU P: 0766 | |
| 702 | DOLLAR RAT E FOR GROU P: 0847 | |
| 703 | DOLLAR RAT E FOR GROU P: 0964 | |
| 704 | DOLLAR RAT E FOR GROU P: 1144 | |
| 705 | DOLLAR RAT E FOR GROU P: 1453 | |
| 706 | DOLLAR RAT E FOR GROU P: 6459 | |
| 707 | BEGIN EFFE CTIVE DATE : NOV 01, 2012 TERMINATIO N DATE: OC T 31, 2013 | |
| 708 | DUZ: WON G,DUANE R LAST DATE CHANGED: O CT 19, 201 2 | |
| 709 | DOLLAR RAT E FOR GROU P: 0197 | |
| 710 | DOLLAR RAT E FOR GROU P: 0344 | |
| 711 | DOLLAR RAT E FOR GROU P: 0471 | |
| 712 | DOLLAR RAT E FOR GROU P: 0520 | |
| 713 | DOLLAR RAT E FOR GROU P: 0649 | |
| 714 | DOLLAR RAT E FOR GROU P: 0776 | |
| 715 | DOLLAR RAT E FOR GROU P: 0857 | |
| 716 | DOLLAR RAT E FOR GROU P: 0977 | |
| 717 | DOLLAR RAT E FOR GROU P: 1159 | |
| 718 | DOLLAR RAT E FOR GROU P: 1473 | |
| 719 | DOLLAR RAT E FOR GROU P: 5683 | |
| 720 | BEGIN EFFE CTIVE DATE : NOV 01, 2013 TERMINATIO N DATE: OC T 31, 2014 | |
| 721 | DUZ: THO MPSON,DORT HEA P LAST DATE CHANGED: D EC 24, 201 3 | |
| 722 | DOLLAR RAT E FOR GROU P: 00199 | |
| 723 | DOLLAR RAT E FOR GROU P: 00347 | |
| 724 | DOLLAR RAT E FOR GROU P: 00476 | |
| 725 | DOLLAR RAT E FOR GROU P: 00525 | |
| 726 | DOLLAR RAT E FOR GROU P: 00654 | |
| 727 | DOLLAR RAT E FOR GROU P: 00783 | |
| 728 | DOLLAR RAT E FOR GROU P: 00865 | |
| 729 | DOLLAR RAT E FOR GROU P: 00986 | |
| 730 | DOLLAR RAT E FOR GROU P: 01170 | |
| 731 | DOLLAR RAT E FOR GROU P: 01486 | |
| 732 | DOLLAR RAT E FOR GROU P: 07083 | |
| 733 | BEGIN EFFE CTIVE DATE : NOV 01, 2014 TERMINATIO N DATE: OC T 31, 2015 | |
| 734 | DUZ: THO MPSON,DORT HEA P LAST DATE CHANGED: O CT 27, 201 4 | |
| 735 | DOLLAR RAT E FOR GROU P: 00201 | |
| 736 | DOLLAR RAT E FOR GROU P: 00351 | |
| 737 | DOLLAR RAT E FOR GROU P: 00482 | |
| 738 | DOLLAR RAT E FOR GROU P: 00531 | |
| 739 | DOLLAR RAT E FOR GROU P: 00662 | |
| 740 | DOLLAR RAT E FOR GROU P: 00793 | |
| 741 | DOLLAR RAT E FOR GROU P: 00876 | |
| 742 | DOLLAR RAT E FOR GROU P: 00997 | |
| 743 | DOLLAR RAT E FOR GROU P: 01184 | |
| 744 | DOLLAR RAT E FOR GROU P: 01504 | |
| 745 | DOLLAR RAT E FOR GROU P: 06486 | |
| 746 | BEGIN EFFE CTIVE DATE : NOV 01, 2015 TERMINATIO N DATE: OC T 31, 2016 | |
| 747 | DUZ: THO MPSON,DORT HEA P LAST DATE CHANGED: O CT 27, 201 5 | |
| 748 | DOLLAR RAT E FOR GROU P: 00203 | |
| 749 | DOLLAR RAT E FOR GROU P: 00355 | |
| 750 | DOLLAR RAT E FOR GROU P: 00488 | |
| 751 | DOLLAR RAT E FOR GROU P: 00538 | |
| 752 | DOLLAR RAT E FOR GROU P: 00670 | |
| 753 | DOLLAR RAT E FOR GROU P: 00802 | |
| 754 | DOLLAR RAT E FOR GROU P: 00887 | |
| 755 | DOLLAR RAT E FOR GROU P: 01009 | |
| 756 | DOLLAR RAT E FOR GROU P: 01197 | |
| 757 | DOLLAR RAT E FOR GROU P: 01522 | |
| 758 | DOLLAR RAT E FOR GROU P: 07269 | |
| 759 | BEGIN EFFE CTIVE DATE : NOV 01, 2016 TERMINATIO N DATE: OC T 31, 2017 | |
| 760 | DUZ: THO MPSON,DORT HEA P LAST DATE CHANGED: O CT 31, 201 6 | |
| 761 | DOLLAR RAT E FOR GROU P: 00205 | |
| 762 | DOLLAR RAT E FOR GROU P: 00359 | |
| 763 | DOLLAR RAT E FOR GROU P: 00494 | |
| 764 | DOLLAR RAT E FOR GROU P: 00544 | |
| 765 | DOLLAR RAT E FOR GROU P: 00678 | |
| 766 | DOLLAR RAT E FOR GROU P: 00811 | |
| 767 | DOLLAR RAT E FOR GROU P: 00896 | |
| 768 | DOLLAR RAT E FOR GROU P: 01021 | |
| 769 | DOLLAR RAT E FOR GROU P: 01211 | |
| 770 | DOLLAR RAT E FOR GROU P: 01538 | |
| 771 | DOLLAR RAT E FOR GROU P: 09708 | |
| 772 | BEGIN EFFE CTIVE DATE : NOV 01, 2017 TERMINATIO N DATE: OC T 31, 2018 | |
| 773 | DUZ: THO MPSON,DORT HEA P LAST DATE CHANGED: O CT 23, 201 7 | |
| 774 | DOLLAR RAT E FOR GROU P: 000209 | |
| 775 | DOLLAR RAT E FOR GROU P: 000365 | |
| 776 | DOLLAR RAT E FOR GROU P: 000504 | |
| 777 | DOLLAR RAT E FOR GROU P: 000556 | |
| 778 | DOLLAR RAT E FOR GROU P: 000691 | |
| 779 | DOLLAR RAT E FOR GROU P: 000827 | |
| 780 | DOLLAR RAT E FOR GROU P: 000915 | |
| 781 | DOLLAR RAT E FOR GROU P: 001041 | |
| 782 | DOLLAR RAT E FOR GROU P: 001235 | |
| 783 | DOLLAR RAT E FOR GROU P: 001570 | |
| 784 | DOLLAR RAT E FOR GROU P: 006987 | |
| 785 | DOLLAR RAT E FOR GROU P: 000615 | |
| 786 | DOLLAR RAT E FOR GROU P: 001045 | |
| 787 | DOLLAR RAT E FOR GROU P: 001357 | |
| 788 | DOLLAR RAT E FOR GROU P: 001721 | |
| 789 | DOLLAR RAT E FOR GROU P: 001743 | |
| 790 | DOLLAR RAT E FOR GROU P: 001752 | |
| 791 | DOLLAR RAT E FOR GROU P: 001808 | |
| 792 | DOLLAR RAT E FOR GROU P: 002093 | |
| 793 | DOLLAR RAT E FOR GROU P: 002066 | |
| 794 | DOLLAR RAT E FOR GROU P: 002687 | |
| 795 | DOLLAR RAT E FOR GROU P: 003299 | |
| 796 | DOLLAR RAT E FOR GROU P: 005010 | |
| 797 | DOLLAR RAT E FOR GROU P: 000480 | |
| 798 | DOLLAR RAT E FOR GROU P: 000698 | |
| 799 | DOLLAR RAT E FOR GROU P: 001170 | |
| 800 | DOLLAR RAT E FOR GROU P: 001284 | |
| 801 | DOLLAR RAT E FOR GROU P: 000980 | |
| 802 | DOLLAR RAT E FOR GROU P: 001324 | |
| 803 | DOLLAR RAT E FOR GROU P: 001597 | |
| 804 | DOLLAR RAT E FOR GROU P: 002046 | |
| 805 | DOLLAR RAT E FOR GROU P: 001693 | |
| 806 | DOLLAR RAT E FOR GROU P: 002687 | |
| 807 | DOLLAR RAT E FOR GROU P: 002544 | |
| 808 | DOLLAR RAT E FOR GROU P: 001912 | |
| 809 | DOLLAR RAT E FOR GROU P: 001989 | |
| 810 | DOLLAR RAT E FOR GROU P: 002154 | |
| 811 | DOLLAR RAT E FOR GROU P: 003042 | |
| 812 | DOLLAR RAT E FOR GROU P: 003100 | |
| 813 | DOLLAR RAT E FOR GROU P: 003278 | |
| 814 | DOLLAR RAT E FOR GROU P: 004027 | |
| 815 | ||
| 816 | ||
| 817 | Select CHA MPVA ASC P AYMENT RAT ES MSA COD E: |
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