| A | B |
|---|
| 0A | PAID AT CONTRACTED RATE - DO NOT BILL MEMBER |
| 0B | MEMBER INELIGIBLE |
| 0C | COORDINATION OF BENEFITS HAS BEEN APPLIED |
| 07 | REFUND RECEIVED |
| 1H | REPRICED FOR INTERPRETER SERVICE |
| 1I | CHARGES INCLUDED IN PER DIEM RATE FOR THIS CONFINEMENT |
| 2A | CLAIM HAS BEEN VOIDED |
| 0V | CHECK HAS BEEN VOIDED |
| 2C | CLAIM LINE HAS BEEN VOIDED |
| 08 | INTERCOMPANY REFUND ADJUSTMENT - FINANCE |
| 2E | THIS CLAIM HAS BEEN ADJUSTED |
| 1K | SERVICE IS ENCOUNTERED - NO PAYMENT ISSUED |
| 69 | DEFAULT PRICE CATEGORY |
