Assigned
Justin Rosser
and 2 more
-
Concept Code
Claim #1
-
Сoncept test design
Claim #2
Assigned
Terry Passaquindici Arcand
-
Сoncept test design
Claim #3
Assigned
Terry Passaquindici Arcand
-
Concept Code
Claim #1
Assigned
Justin Rosser
and 2 more
-
Concept Code
Claim #1
Assigned
Justin Rosser
and 2 more
-
Concept Code
Claim #1
Assigned
Justin Rosser
and 2 more
| ClaimID | LineNumber | FormType | PatientID | ProviderID | LineStatus | ICDTypeCode | AdmittingDiagnosisCode | DiagnosisCode1 | DiagnosisCode2 | DiagnosisCode3 | DiagnosisCode4 | DiagnosisCode5 | ProcedureCode | ProcedureModifier1 | ProcedureModifier2 | ProcedureModifier3 | ProcedureModifier4 | Units | PlaceOfService | StartDate | EndDate | ReceivedDate | ProcessedDate | PaidDate | AdmissionDate | DischargeDate | Age | ProviderDay | BilledAmount | AllowedAmount | TotalPaid | COBAmount | DeductibleAmount | LineOfBusiness | GroupName | DRG | DischargeStatus | BillType | Division | AdjudicationType | AdjustedLine | Label | LoadDate | TaxonomyCode |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
hide notesAdd notes to this claim
| ClaimID | LineNumber | FormType | PatientID | ProviderID | LineStatus | ICDTypeCode | AdmittingDiagnosisCode | DiagnosisCode1 | DiagnosisCode2 | DiagnosisCode3 | DiagnosisCode4 | DiagnosisCode5 | ProcedureCode | ProcedureModifier1 | ProcedureModifier2 | ProcedureModifier3 | ProcedureModifier4 | Units | PlaceOfService | StartDate | EndDate | ReceivedDate | ProcessedDate | PaidDate | AdmissionDate | DischargeDate | Age | ProviderDay | BilledAmount | AllowedAmount | TotalPaid | COBAmount | DeductibleAmount | LineOfBusiness | GroupName | DRG | DischargeStatus | BillType | Division | AdjudicationType | AdjustedLine | Label | LoadDate | TaxonomyCode |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
Add notes to this claim
| ClaimID | LineNumber | FormType | PatientID | ProviderID | LineStatus | ICDTypeCode | AdmittingDiagnosisCode | DiagnosisCode1 | DiagnosisCode2 | DiagnosisCode3 | DiagnosisCode4 | DiagnosisCode5 | ProcedureCode | ProcedureModifier1 | ProcedureModifier2 | ProcedureModifier3 | ProcedureModifier4 | Units | PlaceOfService | StartDate | EndDate | ReceivedDate | ProcessedDate | PaidDate | AdmissionDate | DischargeDate | Age | ProviderDay | BilledAmount | AllowedAmount | TotalPaid | COBAmount | DeductibleAmount | LineOfBusiness | GroupName | DRG | DischargeStatus | BillType | Division | AdjudicationType | AdjustedLine | Label | LoadDate | TaxonomyCode |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
Add notes to this claim
| ClaimID | LineNumber | FormType | PatientID | ProviderID | LineStatus | ICDTypeCode | AdmittingDiagnosisCode | DiagnosisCode1 | DiagnosisCode2 | DiagnosisCode3 | DiagnosisCode4 | DiagnosisCode5 | ProcedureCode | ProcedureModifier1 | ProcedureModifier2 | ProcedureModifier3 | ProcedureModifier4 | Units | PlaceOfService | StartDate | EndDate | ReceivedDate | ProcessedDate | PaidDate | AdmissionDate | DischargeDate | Age | ProviderDay | BilledAmount | AllowedAmount | TotalPaid | COBAmount | DeductibleAmount | LineOfBusiness | GroupName | DRG | DischargeStatus | BillType | Division | AdjudicationType | AdjustedLine | Label | LoadDate | TaxonomyCode |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
Add notes to this claim
| ClaimID | LineNumber | FormType | PatientID | ProviderID | LineStatus | ICDTypeCode | AdmittingDiagnosisCode | DiagnosisCode1 | DiagnosisCode2 | DiagnosisCode3 | DiagnosisCode4 | DiagnosisCode5 | ProcedureCode | ProcedureModifier1 | ProcedureModifier2 | ProcedureModifier3 | ProcedureModifier4 | Units | PlaceOfService | StartDate | EndDate | ReceivedDate | ProcessedDate | PaidDate | AdmissionDate | DischargeDate | Age | ProviderDay | BilledAmount | AllowedAmount | TotalPaid | COBAmount | DeductibleAmount | LineOfBusiness | GroupName | DRG | DischargeStatus | BillType | Division | AdjudicationType | AdjustedLine | Label | LoadDate | TaxonomyCode |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
Add notes to this claim
| ClaimID | LineNumber | FormType | PatientID | ProviderID | LineStatus | ICDTypeCode | AdmittingDiagnosisCode | DiagnosisCode1 | DiagnosisCode2 | DiagnosisCode3 | DiagnosisCode4 | DiagnosisCode5 | ProcedureCode | ProcedureModifier1 | ProcedureModifier2 | ProcedureModifier3 | ProcedureModifier4 | Units | PlaceOfService | StartDate | EndDate | ReceivedDate | ProcessedDate | PaidDate | AdmissionDate | DischargeDate | Age | ProviderDay | BilledAmount | AllowedAmount | TotalPaid | COBAmount | DeductibleAmount | LineOfBusiness | GroupName | DRG | DischargeStatus | BillType | Division | AdjudicationType | AdjustedLine | Label | LoadDate | TaxonomyCode |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 100008993 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 57 | 59 | 60 | null | null | 2 | 69 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101087006 | 5 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 41 | 43 | 44 | null | null | 4 | 81 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 1 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0364T | HN | null | null | null | 1 | 12 | 83 | 0 | 40 | 42 | 43 | null | null | 3 | 83 | 25 | 25 | 25 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |
| 101207480 | 4 | Professional | 100041862 | 100037544 | Final-Paid | 10 | null | F84.0 | null | null | null | null | 0365T | HN | null | null | null | 7 | 12 | 83 | 0 | 39 | 41 | 42 | null | null | 4 | 83 | 175 | 175 | 175 | 0 | 0 | COMMERCIAL | Demo | null | null | null | null | Yes | No | PAID | POC | 101YM0800X |