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markr85/Example Claims Data

Created September 14, 2019 00:15
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Data-ex1
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Example Claims Data
CLAIM,123456789,19600101,,KING,NY,,,,M,JOHN DOE,14605,18,123456789,MB,ACTIVE,20180101,,GR001,GR_NAME,PLNA_NAME,
00304,BTQ000001,MRN001,BTQ00000120180301,,,20180301,20180301,20180501,20180401,20180301,,,9,3,34,,1,ACTIVE,INSTITUTIONAL,01,,,,1740554229,PARTIAL,
00304,1740554229,,1043693955,,,,,,,,,,,135,100,15,85,0,85,35,0,0,15,0,0
DIAG,Z7189,,,ABK
LINE,1,20180301,,,,0500,1,,,,,,,,G9001,,,HC,,,,,,35,0,15,0,100,85,0,0,0,135,100,0,15,85
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