Primary Secondary Tertiary Fourth Fifth Sixth Seventh Eighth Ninth Tenth Eleventh OHI Payer ID: {{obj.ohiPayerId}}
OHI Payer Name:	{{obj.payerName}}	Other Subscriber Info:	{{obj.otherSubInfo}}
Payment Seq. Indicator:	{{obj.paymentSeqInd}}	ID Code:	{{obj.idCode}}
OHI Group Name:	{{obj.groupName}}	Secondary ID:	{{obj.secondaryId}}
Filing Indicator:	{{obj.filingIndicator}}	Remittance Date:	{{obj.remittDate}}
Insurance Type:	{{obj.insuranceType}}	Payer Prior Authorization #:	{{obj.payerPriorAuthNum}}
Claim Adj. Date:	{{obj.claimAdjDate}}	Payer Prior Reference #:	{{obj.payerPriorRefNum}}
RARC Codes:	{{obj.rarcCodes.join(", ")}}

Adjustment Code
{{adjC}}