Primary Payer ID:
{{ primaryOhiInfo?.claimOhiHeaderBean?.ohiPayerID }} {{ primaryOhiInfo?.claimOhiHeaderBean?.ohiPayerID }}
Payment Seq. Indicator: P
Filing Indicator: {{ primaryOhiInfo?.claimOhiHeaderBean?.filingIndicator }} {{ primaryOhiInfo?.claimOhiHeaderBean?.filingIndicator }}
Claim Adjustment Date: {{ primaryOhiInfo?.claimOhiHeaderBean?.claimAdjustmentDate }} {{ primaryOhiInfo?.claimOhiHeaderBean?.claimAdjustmentDate }}
Other Payer Name:
{{ primaryOhiInfo?.claimOhiHeaderBean?.otherPayerName }} {{ primaryOhiInfo?.claimOhiHeaderBean?.otherPayerName }}
OHI Group Name: {{ primaryOhiInfo?.claimOhiHeaderBean?.ohiGroupName }} {{ primaryOhiInfo?.claimOhiHeaderBean?.ohiGroupName }}
Insurance Type: {{ primaryOhiInfo?.claimOhiHeaderBean?.insuranceType }} {{ primaryOhiInfo?.claimOhiHeaderBean?.insuranceType }}
{{row[column['property']]}} {{row[column['property']]}} {{ row?.adjustmentCode }} {{ row?.descriptionLong }} {{row[column['property']]}} {{ row?.adjustmentCode }} {{ row?.descriptionLong }}
Medicare Inpatient Adjudication
Covered Days: {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.coveredDays }} {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.coveredDays }}
Lifetime Reserve Days: {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.lifetimeReserveDays }} {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.lifetimeReserveDays }}
Lifetime Psych. Days: {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.lifetimePsychiatricDays }} {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.lifetimePsychiatricDays }}
Claim DRG Amount: {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.claimDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareInPatientAdjudicationBean?.claimDrugAmount }} {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.claimDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareInPatientAdjudicationBean?.claimDrugAmount }}
Claim Disproportionate Share: {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.claimDisproportionateShare }} {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.claimDisproportionateShare }}
MSP Pass-Thru Amt: {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.mspPassThruAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareInPatientAdjudicationBean?.mspPassThruAmount }} {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.mspPassThruAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareInPatientAdjudicationBean?.mspPassThruAmount }}
Claim PPS Capital Amt: {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.claimPpsCapitalAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareInPatientAdjudicationBean?.claimPpsCapitalAmount }} {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.claimPpsCapitalAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareInPatientAdjudicationBean?.claimPpsCapitalAmount }}
PPS Claim Capital FSP DRG: {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalFspDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalFspDrugAmount }} {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalFspDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalFspDrugAmount }}
PPS Claim Capital HSP DRG: {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalHspDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalHspDrugAmount }} {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalHspDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalHspDrugAmount }}
PPS Claim Capital DSH DRG: {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalDshDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalDshDrugAmount }} {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalDshDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalDshDrugAmount }}
PPS Oper. Fed. Spec. DRG Amt: {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsOperatingFederalSpecDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsOperatingFederalSpecDrugAmount }} {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsOperatingFederalSpecDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsOperatingFederalSpecDrugAmount }}
Old Capital Amount: {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.oldCapitalAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareInPatientAdjudicationBean?.oldCapitalAmount }} {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.oldCapitalAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareInPatientAdjudicationBean?.oldCapitalAmount }}
PPS Capital IME Amount: {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalImeAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalImeAmount }} {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalImeAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalImeAmount }}
PPS Oper. Hosp. Spec. DRG Amt: {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsOperHospitalSpecicalDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsOperHospitalSpecicalDrugAmount }} {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsOperHospitalSpecicalDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsOperHospitalSpecicalDrugAmount }}
PPS Capital Outlier Amount: {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalOutlierAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalOutlierAmount }} {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalOutlierAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalOutlierAmount }}
Claim Indirect Teaching Amt: {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.claimIndirectTeachingAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareInPatientAdjudicationBean?.claimIndirectTeachingAmount }} {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.claimIndirectTeachingAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareInPatientAdjudicationBean?.claimIndirectTeachingAmount }}
Non-Payable Prof. Component: {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.nonPayableProfessionalComponent }} {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.nonPayableProfessionalComponent }}
PPS Capital Exception Amt: {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalExceptionAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalExceptionAmount }} {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalExceptionAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalExceptionAmount }}
Cost Report Day Count: {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.costReportDayCount }} {{ primaryOhiInfo?.medicareInPatientAdjudicationBean?.costReportDayCount }}
Remit. Remark Code:
{{ r?.code }} {{ r?.code }}
{{ r?.remarkLong }} {{ r?.code }} : {{ r?.remarkLong }}
Medicare Outpatient Adjudication
Reimbursement Rate: {{ primaryOhiInfo?.medicareOutPatientAdjudicationBean?.reimbursementRate }} {{ primaryOhiInfo?.medicareOutPatientAdjudicationBean?.reimbursementRate }}
Claim HCPCS Pay Amt: {{ primaryOhiInfo?.medicareOutPatientAdjudicationBean?.claimHcpcsPayableAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareOutPatientAdjudicationBean?.claimHcpcsPayableAmount }} {{ primaryOhiInfo?.medicareOutPatientAdjudicationBean?.claimHcpcsPayableAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareOutPatientAdjudicationBean?.claimHcpcsPayableAmount }}
ESRD Paid Amount: {{ primaryOhiInfo?.medicareOutPatientAdjudicationBean?.esrdPaidAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareOutPatientAdjudicationBean?.esrdPaidAmount }} {{ primaryOhiInfo?.medicareOutPatientAdjudicationBean?.esrdPaidAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareOutPatientAdjudicationBean?.esrdPaidAmount }}
Non-Payable Prof: {{ primaryOhiInfo?.medicareOutPatientAdjudicationBean?.nonPayableProfessionalComponentAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareOutPatientAdjudicationBean?.nonPayableProfessionalComponentAmount }} {{ primaryOhiInfo?.medicareOutPatientAdjudicationBean?.nonPayableProfessionalComponentAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ primaryOhiInfo?.medicareOutPatientAdjudicationBean?.nonPayableProfessionalComponentAmount }}
Remit. Remark Code:
{{ r?.code }} {{ r?.code }}
{{ r?.remarkLong }} {{ r?.code }} : {{ r?.remarkLong }}
Secondary Payer ID:
{{ secondaryOhiInfo?.claimOhiHeaderBean?.ohiPayerID }} {{ secondaryOhiInfo?.claimOhiHeaderBean?.ohiPayerID }}
Payment Seq. Indicator: S
Filing Indicator: {{ secondaryOhiInfo?.claimOhiHeaderBean?.filingIndicator }} {{ secondaryOhiInfo?.claimOhiHeaderBean?.filingIndicator }}
Claim Adjustment Date: {{ secondaryOhiInfo?.claimOhiHeaderBean?.claimAdjustmentDate }} {{ secondaryOhiInfo?.claimOhiHeaderBean?.claimAdjustmentDate }}
Other Payer Name:
{{ secondaryOhiInfo?.claimOhiHeaderBean?.otherPayerName }} {{ secondaryOhiInfo?.claimOhiHeaderBean?.otherPayerName }}
OHI Group Name: {{ secondaryOhiInfo?.claimOhiHeaderBean?.ohiGroupName }} {{ secondaryOhiInfo?.claimOhiHeaderBean?.ohiGroupName }}
Insurance Type: {{ secondaryOhiInfo?.claimOhiHeaderBean?.insuranceType }} {{ secondaryOhiInfo?.claimOhiHeaderBean?.insuranceType }}
{{row[column['property']]}} {{row[column['property']]}} {{ row?.adjustmentCode }} {{ row?.descriptionLong }} {{row[column['property']]}} {{ row?.adjustmentCode }} {{ row?.descriptionLong }}
Medicare Inpatient Adjudication
Covered Days: {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.coveredDays }} {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.coveredDays }}
Lifetime Reserve Days: {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.lifetimeReserveDays }} {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.lifetimeReserveDays }}
Lifetime Psych. Days: {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.lifetimePsychiatricDays }} {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.lifetimePsychiatricDays }}
Claim DRG Amount: {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.claimDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.claimDrugAmount }} {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.claimDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.claimDrugAmount }}
Claim Disproportionate Share: {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.claimDisproportionateShare }} {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.claimDisproportionateShare }}
MSP Pass-Thru Amt: {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.mspPassThruAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.mspPassThruAmount }} {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.mspPassThruAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.mspPassThruAmount }}
Claim PPS Capital Amt: {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.claimPpsCapitalAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.claimPpsCapitalAmount }} {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.claimPpsCapitalAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.claimPpsCapitalAmount }}
PPS Claim Capital FSP DRG: {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalFspDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalFspDrugAmount }} {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalFspDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalFspDrugAmount }}
PPS Claim Capital HSP DRG: {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalHspDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalHspDrugAmount }} {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalHspDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalHspDrugAmount }}
PPS Claim Capital DSH DRG: {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalDshDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalDshDrugAmount }} {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalDshDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalDshDrugAmount }}
PPS Oper. Fed. Spec. DRG Amt: {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsOperatingFederalSpecDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsOperatingFederalSpecDrugAmount }} {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsOperatingFederalSpecDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsOperatingFederalSpecDrugAmount }}
Old Capital Amount: {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.oldCapitalAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.oldCapitalAmount }} {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.oldCapitalAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.oldCapitalAmount }}
PPS Capital IME Amount: {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalImeAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalImeAmount }} {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalImeAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalImeAmount }}
PPS Oper. Hosp. Spec. DRG Amt: {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsOperHospitalSpecicalDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsOperHospitalSpecicalDrugAmount }} {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsOperHospitalSpecicalDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsOperHospitalSpecicalDrugAmount }}
PPS Capital Outlier Amount: {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalOutlierAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalOutlierAmount }} {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalOutlierAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalOutlierAmount }}
Claim Indirect Teaching Amt: {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.claimIndirectTeachingAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.claimIndirectTeachingAmount }} {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.claimIndirectTeachingAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.claimIndirectTeachingAmount }}
Non-Payable Prof. Component: {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.nonPayableProfessionalComponent }} {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.nonPayableProfessionalComponent }}
PPS Capital Exception Amt: {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalExceptionAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalExceptionAmount }} {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalExceptionAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalExceptionAmount }}
Cost Report Day Count: {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.costReportDayCount }} {{ secondaryOhiInfo?.medicareInPatientAdjudicationBean?.costReportDayCount }}
Remit. Remark Code:
{{ r?.code }} {{ r?.code }}
{{ r?.remarkLong }} {{ r.code }} : {{ r.remarkLong }}
Medicare Outpatient Adjudication
Reimbursement Rate: {{ secondaryOhiInfo?.medicareOutPatientAdjudicationBean?.reimbursementRate }} {{ secondaryOhiInfo?.medicareOutPatientAdjudicationBean?.reimbursementRate }}
Claim HCPCS Pay Amt: {{ secondaryOhiInfo?.medicareOutPatientAdjudicationBean?.claimHcpcsPayableAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareOutPatientAdjudicationBean?.claimHcpcsPayableAmount }} {{ secondaryOhiInfo?.medicareOutPatientAdjudicationBean?.claimHcpcsPayableAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareOutPatientAdjudicationBean?.claimHcpcsPayableAmount }}
ESRD Paid Amount: {{ secondaryOhiInfo?.medicareOutPatientAdjudicationBean?.esrdPaidAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareOutPatientAdjudicationBean?.esrdPaidAmount }} {{ secondaryOhiInfo?.medicareOutPatientAdjudicationBean?.esrdPaidAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareOutPatientAdjudicationBean?.esrdPaidAmount }}
Non-Payable Prof: {{ secondaryOhiInfo?.medicareOutPatientAdjudicationBean?.nonPayableProfessionalComponentAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareOutPatientAdjudicationBean?.nonPayableProfessionalComponentAmount }} {{ secondaryOhiInfo?.medicareOutPatientAdjudicationBean?.nonPayableProfessionalComponentAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ secondaryOhiInfo?.medicareOutPatientAdjudicationBean?.nonPayableProfessionalComponentAmount }}
Remit. Remark Code:
{{ r?.code }} {{ r?.code }}
{{ r?.remarkLong }} {{ r?.code }} : {{ r?.remarkLong }}
Tertiary Payer ID:
{{ tertiaryOhiInfo?.medicareOutPatientAdjudicationBean?.ohiPayerID }} {{ tertiaryOhiInfo?.medicareOutPatientAdjudicationBean?.ohiPayerID }}
Payment Seq. Indicator: T
Filing Indicator: {{ tertiaryOhiInfo?.claimOhiHeaderBean?.filingIndicator }} {{ tertiaryOhiInfo?.claimOhiHeaderBean?.filingIndicator }}
Claim Adjustment Date: {{ tertiaryOhiInfo?.claimOhiHeaderBean?.claimAdjustmentDate }} {{ tertiaryOhiInfo?.claimOhiHeaderBean?.claimAdjustmentDate }}
Other Payer Name:
{{ tertiaryOhiInfo?.claimOhiHeaderBean?.otherPayerName }} {{ tertiaryOhiInfo?.claimOhiHeaderBean?.otherPayerName }}
OHI Group Name: {{ tertiaryOhiInfo?.claimOhiHeaderBean?.ohiGroupName }} {{ tertiaryOhiInfo?.claimOhiHeaderBean?.ohiGroupName }}
Insurance Type: {{ tertiaryOhiInfo?.claimOhiHeaderBean?.insuranceType }} {{ tertiaryOhiInfo?.claimOhiHeaderBean?.insuranceType }}
{{row[column['property']]}} {{row[column['property']]}} {{ row?.adjustmentCode }} {{ row?.descriptionLong }} {{row[column['property']]}} {{ row?.adjustmentCode }} {{ row?.descriptionLong }}
Medicare Inpatient Adjudication
Covered Days: {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.coveredDays }} {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.coveredDays }}
Lifetime Reserve Days: {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.lifetimeReserveDays }} {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.lifetimeReserveDays }}
Lifetime Psych. Days: {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.lifetimePsychiatricDays }} {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.lifetimePsychiatricDays }}
Claim DRG Amount: {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.claimDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.claimDrugAmount }} {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.claimDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.claimDrugAmount }}
Claim Disproportionate Share: {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.claimDisproportionateShare }} {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.claimDisproportionateShare }}
MSP Pass-Thru Amt: {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.mspPassThruAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.mspPassThruAmount }} {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.mspPassThruAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.mspPassThruAmount }}
Claim PPS Capital Amt: {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.claimPpsCapitalAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.claimPpsCapitalAmount }} {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.claimPpsCapitalAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.claimPpsCapitalAmount }}
PPS Claim Capital FSP DRG: {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalFspDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalFspDrugAmount }} {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalFspDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalFspDrugAmount }}
PPS Claim Capital HSP DRG: {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalHspDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalHspDrugAmount }} {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalHspDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalHspDrugAmount }}
PPS Claim Capital DSH DRG: {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalDshDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalDshDrugAmount }} {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalDshDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalDshDrugAmount }}
PPS Oper. Fed. Spec. DRG Amt: {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsOperatingFederalSpecDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsOperatingFederalSpecDrugAmount }} {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsOperatingFederalSpecDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsOperatingFederalSpecDrugAmount }}
Old Capital Amount: {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.oldCapitalAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.oldCapitalAmount }} {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.oldCapitalAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.oldCapitalAmount }}
PPS Capital IME Amount: {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalImeAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalImeAmount }} {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalImeAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalImeAmount }}
PPS Oper. Hosp. Spec. DRG Amt: {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsOperHospitalSpecicalDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsOperHospitalSpecicalDrugAmount }} {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsOperHospitalSpecicalDrugAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsOperHospitalSpecicalDrugAmount }}
PPS Capital Outlier Amount: {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalOutlierAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalOutlierAmount }} {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalOutlierAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalOutlierAmount }}
Claim Indirect Teaching Amt: {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.claimIndirectTeachingAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.claimIndirectTeachingAmount }} {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.claimIndirectTeachingAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.claimIndirectTeachingAmount }}
Non-Payable Prof. Component: {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.nonPayableProfessionalComponent }} {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.nonPayableProfessionalComponent }}
PPS Capital Exception Amt: {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalExceptionAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalExceptionAmount }} {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalExceptionAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.ppsCapitalExceptionAmount }}
Cost Report Day Count: {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.costReportDayCount }} {{ tertiaryOhiInfo?.medicareInPatientAdjudicationBean?.costReportDayCount }}
Remit. Remark Code:
{{ r?.code }} {{ r?.code }}
{{ r.remarkLong }} {{ r?.code }} : {{ r?.remarkLong }}
Medicare Outpatient Adjudication
Reimbursement Rate: {{ tertiaryOhiInfo?.medicareOutPatientAdjudicationBean?.reimbursementRate }} {{ tertiaryOhiInfo?.medicareOutPatientAdjudicationBean?.reimbursementRate }}
Claim HCPCS Pay Amt: {{ tertiaryOhiInfo?.medicareOutPatientAdjudicationBean?.claimHcpcsPayableAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareOutPatientAdjudicationBean?.claimHcpcsPayableAmount }} {{ tertiaryOhiInfo?.medicareOutPatientAdjudicationBean?.claimHcpcsPayableAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareOutPatientAdjudicationBean?.claimHcpcsPayableAmount }}
ESRD Paid Amount: {{ tertiaryOhiInfo?.medicareOutPatientAdjudicationBean?.esrdPaidAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareOutPatientAdjudicationBean?.esrdPaidAmount }} {{ tertiaryOhiInfo?.medicareOutPatientAdjudicationBean?.esrdPaidAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareOutPatientAdjudicationBean?.esrdPaidAmount }}
Non-Payable Prof: {{ tertiaryOhiInfo?.medicareOutPatientAdjudicationBean?.nonPayableProfessionalComponentAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareOutPatientAdjudicationBean?.nonPayableProfessionalComponentAmount }} {{ tertiaryOhiInfo?.medicareOutPatientAdjudicationBean?.nonPayableProfessionalComponentAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+ tertiaryOhiInfo?.medicareOutPatientAdjudicationBean?.nonPayableProfessionalComponentAmount }}
Remit. Remark Code:
{{ r?.code }} {{ r?.code }}
{{ r?.remarkLong }} {{ r?.code }} : {{ r?.remarkLong }}