doczyai-pipelines/streamlit/contract_fields.csv

1	Interrogation Question?	Field Name	SF_DB_COL_NAME	DATA_TYPE	PRIORITY	Group #	Related Generic Data Pipeline Field Name?	Source of Data	Theme	Required Field?	Use of Field Beyond Contract Config?
2	What is the title of the contract?	Contract Title	CONTRACT_TITLE	VARCHAR	C	GEN	No	Title	Contract	Always Required
3	What is the title of the contract? (Page #)		CONTRACT_TITLE_PG	VARCHAR
4	What type of contract or agreement is the document?	Contract Type	CONTRACT_HEADER	VARCHAR	A	PHY	No	Title or Preamble	Contract	Always Required	UNIQUE KEY
5	What type of contract or agreement is the document? (Page #)		CONTRACT_HEADER_PG	VARCHAR		FAC
6	If the contract is numbered, which number is it (e.g., if contract is titled Amendment #1, then enter "1")?	Number or Letter Used to Name Amendment, Addendum, Rider, Exhibit, Attachment, Schedule	CONTRACT_NUM		A	ANC	No	Title or Preamble	Contract	Required Only If Agreement NOT the Base Contract	GREEN LIGHT - IF SEQUENCE OF AMENDMENTS OR ADDENDUMS IS MISSING A NUMBER OR LETTER THEN STOP, DO NOT REVIEW CONTRACT CONFIGURATION UNTIL ALL AMENDMENTS AND ADDENDUMS ARE RECEIVED UNIQUE KEY
7	If the contract is numbered, which number is it (e.g., if contract is titled Amendment #1, then enter "1")? (Page #)		CONTRACT_NUM_PG
8	If this agreement is not the base contract, then what is the title of the associated base contract?	Associated Base Contract Title	CONTRACT_BASE_TITLE		C		No	Preamble	Contract	Required Only If Agreement Is NOT the Base Contract
9	If this agreement is not the base contract, then what is the title of the associated base contract? (Page#)		CONTRACT_BASE_TITLE_PG
10	If this agreement is not the base contract, then what is the effective date of the associated base contract?	Associated Base Contract Effective Date	CONTRACT_BASE_EFFECTIVE_DT		C		No	Preamble	Contract	Required Only If Agreement Is NOT the Base Contract
11	If this agreement is not the base contract, then what is the effective date of the associated base contract? (Page#)		CONTRACT_BASE_EFFECTIVE_DT_PG
12	Is the contract the final version of the contract as evidenced by whether all signature lines in the signatory section of the agreement are signed?	Contract Signatory Complete (Y/N)?	CONTRACT_SIGNATORY_IND		A		No	Signature Page	Contract	Always Required	GREEN LIGHT - IF NOT ALL SIGNATURES ARE COMPLETE THEN STOP, DO NOT REVIEW CONTRACT CONFIGURATION UNTIL FINAL VERSION OF CONTRACT IS RECEIVED UNIQUE KEY
13	Is the contract the final version of the contract as evidenced by whether all signature lines in the signatory section of the agreement are signed? (Page#)		CONTRACT_SIGNATORY_IND_PG
14	What is the name of the payer that is a party to the contract as stated in the Preamble?	Payer Name per Preamble	PAYER_NAME		A		Yes	Preamble	Payer	Always Required	GREEN LIGHT - IF PAYER NAME DOES NOT EQUAL "CLIENT NAME" THEN STOP, DO NOT REVIEW CONTRACT CONFIGURATION; UNIQUE KEY
15	What is the name of the payer that is a party to the contract as stated in the Preamble? (Page#)		PAYER_NAME_PG
16	What is the name of the Group provider that is a party to the contract as stated in the Preamble?	Group Provider Name per Preamble	PROV_GROUP_NAME		A		Yes	Preamble	Provider	Always Required	UNIQUE KEY
17	What is the name of the Group provider that is a party to the contract as stated in the Preamble? (Page#)		PROV_GROUP_NAME_PG
18	What is the Group provider's taxpayer identification number stated in the Preamble?	Group Provider Taxpayer Identification Number per Preamble	PROV_GROUP_TIN		A		Yes	Preamble	Provider	Required Only If Available	UNIQUE KEY
19	What is the Group provider's taxpayer identification number stated in the Preamble? (Page#)		PROV_GROUP_TIN_PG
20	What is the name of the Group provider that is a party to the contract as stated in the Signatory Section?	Group Provider Name per Signatory	PROV_GROUP_NAME_SIGNATORY		A		Yes	Signature Page	Provider	Always Required	UNIQUE KEY PDM
21	What is the name of the Group provider that is a party to the contract as stated in the Signatory Section? (Page#)		PROV_GROUP_NAME_SIGNATORY_PG
22	What is the group provider's taxpayer identification number stated in the Signatory Section?	Group Provider Taxpayer Identification Number per Signatory	PROV_GROUP_TIN_SIGNATORY		A		Yes	Signature Page	Provider	Always Required	UNIQUE KEY PDM
23	What is the group provider's taxpayer identification number stated in the Signatory Section? (Page#)		PROV_GROUP_TIN_SIGNATORY_PG
24	What is the group provider's national provider identifier number?	Group Provider National Provider Identifier	PROV_GROUP_NPI		A		Yes	Signature Page, Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	UNIQUE KEY PDM
25	What is the group provider's national provider identifier number? (Page#)		PROV_GROUP_NPI_PG
26	What is the contact information of the Group provider named in this contract?	Group Provider Address Line 1	PROV_GROUP_ADDRESS_LINE1		D		Yes	Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	LOCAL COVERAGE DETERMINATION (LCD) PAYMENT ACCURACY PDM
27		Group Provider Address Line 2	PROV_GROUP_ADDRESS_LINE2		D		Yes	Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	LOCAL COVERAGE DETERMINATION (LCD) PAYMENT ACCURACY PDM
28		Group Provider City	PROV_GROUP_CITY		D		Yes	Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	LOCAL COVERAGE DETERMINATION (LCD) PAYMENT ACCURACY PDM
29		Group Provider State	PROV_GROUP_STATE_CD		D		Yes	Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	LOCAL COVERAGE DETERMINATION (LCD) PAYMENT ACCURACY PDM UNIQUE KEY
30		Group Provider ZIP	PROV_GROUP_POSTAL_CD		D		Yes	Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	LOCAL COVERAGE DETERMINATION (LCD) PAYMENT ACCURACY PDM
31		Group Provider Phone Number	PROV_GROUP_PHONE_NUM		D		Yes	Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	PDM
32		Group Provider Fax Number	PROV_GROUP_FAX_NUM		D		Yes	Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	PDM
33	What is the contact information of the Group provider named in this contract? (Page#)		PROV_GROUP_PG
34	What are the group providers identification numbers other than TIN and NPI?	Group Provider CAQH Number	PROV_GROUP_CAQH_NUM		D		Yes	Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	PDM
35		Group Provider Medicaid Number	PROV_GROUP_MEDICAID_NUM		D		Yes	Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	PDM
36		Group Provider Medicare Number	PROV_GROUP_MEDICARE_NUM		D		Yes	Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	PDM
37		Group Provider Marketplace Number	PROV_GROUP_MARKETPLACE_NUM		D		Yes	Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	PDM
38		Other Group Provider Identifiers	PROV_GROUP_OTHER_NUM		D		No	Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	PDM
39	What are the group providers identification numbers other than TIN and NPI? (Page#)		PROV_GROUP_NUM_PG
40	What are the names of other providers associated with this agreement? (Note that amendments are needed to capture TINs added through acquisition/merger)	Associated Provider Full Names (Doing Business As…, Also Known As…, DBA, AKA)	PROV_DOING_BUSINESS_AS		A		Yes	Preamble, contract signatory section, and/or Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	UNIQUE KEY PDM
41		Individual Provider First Name	PROV_FIRST_NAME_OTHER		A		Yes	Preamble, contract signatory section, and/or Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	UNIQUE KEY PDM
42		Individual Provider Middle Initial	PROV_MIDDLE_NAME_OTHER		A		Yes	Preamble, contract signatory section, and/or Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	UNIQUE KEY PDM
43		Individual Provider Last Name	PROV_LAST_NAME_OTHER		A		Yes	Preamble, contract signatory section, and/or Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	UNIQUE KEY PDM
44	What are the names of other providers associated with this agreement? (Note that amendments are needed to capture TINs added through acquisition/merger) (Page#)		PROV_OTHER_PG
45	What are the provider taxpayer identification numbers for each of the other providers associated with this agreement?	Associated Provider Taxpayer Identification Numbers	PROV_TIN_OTHER		A		No (but please use GDP TIN format throughout)	Preamble, contract signatory section, and/or Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	UNIQUE KEY PDM
46	What are the provider taxpayer identification numbers for each of the other providers associated with this agreement? (Page#)		PROV_TIN_OTHER_PG
47	What are the provider national provider identifier numbers for each of the other providers associated with this agreement?	Associated Provider National Provider Identifiers	PROV_NPI_OTHER		A		No (but please use GDP NPI format throughout)	Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	UNIQUE KEY PDM
48	What are the provider national provider identifier numbers for each of the other providers associated with this agreement? (Page#)		PROV_NPI_OTHER_PG
49	What is the contact information for each of the other providers associated with this agreement?	Individual Provider Address Line 1	PROV_OTHER_ADDRESS_LINE1		D		Yes	Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	LOCAL COVERAGE DETERMINATION (LCD) PAYMENT ACCURACY PDM
50		Individual Provider Address Line 2	PROV_OTHER_ADDRESS_LINE2		D		Yes	Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	LOCAL COVERAGE DETERMINATION (LCD) PAYMENT ACCURACY PDM
51		Individual Provider City	PROV_OTHER_CITY		D		Yes	Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	LOCAL COVERAGE DETERMINATION (LCD) PAYMENT ACCURACY PDM
52		Individual Provider State	PROV_OTHER_STATE_CD		D		Yes	Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	LOCAL COVERAGE DETERMINATION (LCD) PAYMENT ACCURACY PDM
53		Individual Provider ZIP	PROV_OTHER_POSTAL_CD		D		Yes	Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	LOCAL COVERAGE DETERMINATION (LCD) PAYMENT ACCURACY PDM
54		Individual Provider Phone Number	PROV_OTHER_PHONE_NUM		D		Yes	Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	PDM
55		Individual Provider Fax Number	PROV_OTHER_FAX_NUM		D		Yes	Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	PDM
56	What is the contact information for each of the other providers associated with this agreement? (Page#)		PROV_OTHER_PG
57	What are the individual providers identification numbers other than TIN and NPI?	Individual Provider CAQH Number	PROV_OTHER_CAQH_NUM		D		Yes	Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	PDM
58		Individual Provider Medicaid Number	PROV_OTHER_MEDICAID_NUM		D		Yes	Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	PDM
59		Individual Provider Medicare Number	PROV_OTHER_MEDICARE_NUM		D		Yes	Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	PDM
60		Individual Provider Marketplace Number	PROV_OTHER_MARKETPLACE_NUM		D		Yes	Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	PDM
61		Other Individual Provider Identifiers	PROV_OTHER_NUM		D		No	Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	PDM
62	What are the individual providers identification numbers other than TIN and NPI? (Page#)		PROV_OTHER_NUM_PG
63	What is individual provider specialty per contract?	Individual Provider Specialty per Contract	PROV_SPECIALTY		B		Yes	Exhibit, Attachment, or Schedule to contract	Provider	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS PDM PRICING
64	What is individual provider specialty per contract? (Page#)		PROV_SPECIALTY_PG
65	What is individual provider specialty as mapped by AArete?	Individual Provider Specialty as Mapped	AAR_PROV_SPECIALTY_AARETE_MAPPED		B		Yes	AArete Derived	Provider	Always Required	PAYMENT ACCURACY INTELLIGENT EDITS PDM PRICING
66	What is individual provider specialty as mapped by AArete? (Page#)
67	What is the contract effective date as stated in Preamble of the agreement?	Contract Effective Date per Preamble	CONTRACT_EFFECTIVE_DT		A		No (but please use GDP date format throughout)	Preamble	Key Dates	Always Required	PAYMENT ACCURACY UNIQUE KEY
68	What is the contract effective date as stated in Preamble of the agreement? (Page#)		CONTRACT_EFFECTIVE_DT_PG
69	What is the contract effective date as stated in the signatory section of the agreement?	Contract Effective Date per Signatory	CONTRACT_EFFECTIVE_DT_SIGNATORY		A		No (but please use GDP date format throughout)	Signature Page	Key Dates	Always Required	PAYMENT ACCURACY UNIQUE KEY
70	What is the contract effective date as stated in the signatory section of the agreement? (Page#)		CONTRACT_EFFECTIVE_DT_SIGNATORY_PG
71	Are the contract effective dates in the Preamble and the final signatory section consistent?	Contract Effective Date Consistency (Y/N)?	AAR_IS_EFFECTIVE_DT_CONSISTENT_IND				No	AArete Derived (Does Column D = Column E)?	Key Dates	Always Required	PAYMENT ACCURACY
72	Are the contract effective dates in the Preamble and the final signatory section consistent? (Page#)		R100
73	What is the contract termination date?	Contract Termination Date	CONTRACT_TERMINATION_DT		A		No (but please use GDP date format throughout)	Term & Termination Section of Contract	Key Dates	Always Required	PAYMENT ACCURACY UNIQUE KEY
74	What is the contract termination date? (Page#)		CONTRACT_TERMINATION_DT_PG
75	Does the contract automatically renew (Yes/No)?	Contract Auto Renewal (Y/N)?	CONTRACT_AUTO_RENEWAL_IND		A		No	Term & Termination Section of Contract	Key Dates	Required Only If Available	PAYMENT ACCURACY UNIQUE KEY
76	Does the contract automatically renew (Yes/No)? (Page#)		CONTRACT_AUTO_RENEWAL_IND_PG
77	If contract automatically renews, then what is the length of the renewal term?	Contract Auto Renewal Terms?	CONTRACT_AUTO_RENEWAL_TERM		A		No	Term & Termination Section of Contract	Key Dates	Required Only If Available	PAYMENT ACCURACY UNIQUE KEY
78	If contract automatically renews, then what is the length of the renewal term? (Page#)		CONTRACT_AUTO_RENEWAL_TERM_PG
79	If contract automatically renews, then then what is the adjusted contract termination date?	Contract Adjusted Termination Date Resulting from Auto Renewal	AA_CONTRACT_ADJUSTED_TERMINATION_DT_FROM_AUTO_RENEWAL				No	AArete Derived from Contract Termination Date As Adjusted for Renewals	Key Dates	Always Required	GREEN LIGHT - IF DATE IS LESS THAN TODAY'S DATE THEN STOP, DO NOT REVIEW CONTRACT CONFIGURATION UNLESS THERE IS AN EFFECTIVE AMENDMENT
80	If contract automatically renews, then then what is the adjusted contract termination date? (Page#)		R101
81	What is timeline for payer to give notice of policy changes to provider per base agreement? (INSERT NUMBER)	Timeline Payer Policy Change Notice	R102		E		No	Base Agreement	Key Dates	Required Only If Available	PAYMENT ACCURACY COST AVOIDANCE
82	What is timeline for payer to give notice of policy changes to provider per base agreement? (INSERT UNIT OF MEASURE)		R103		E
83	Concat - What is timeline for payer to give notice of policy changes to provider per base agreement? (INSERT NUMBER)		PAYER_POLICY_CHANGE_NOTICE_TIMELINE
84	What is timeline for payer to give notice of policy changes to provider per base agreement? (INSERT TRIGGER "FROM" or "BEFORE")		PAYER_POLICY_CHANGE_NOTICE_INFO		E
85	What is timeline for payer to give notice of policy changes to provider per base agreement? (Page#)		PAYER_POLICY_CHANGE_NOTICE_INFO_PG		E
86	What is timeline for provider timely filing of claims submitted to the payer per base agreement (INSERT NUMEBER)?	Timeline Provider Claim Timely Filing	R104		E		No	Base Agreement	Key Dates	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
87	What is timeline for provider timely filing of claims submitted to the payer per base agreement (INSERT UNIT OF MEASURE)?		R105		E
88	Concat - What is timeline for provider timely filing of claims submitted to the payer per base agreement (INSERT NUMEBER)?		PROV_CLAIM_TIMELY_FILING_TIMELINE
89	What is timeline for provider timely filing of claims submitted to the payer per base agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_CLAIM_TIMELY_FILING_INFO		E
90	What is timeline for provider timely filing of claims submitted to the payer per base agreement (Page#)?		PROV_CLAIM_TIMELY_FILING_PG		E
91	What is timeline for provider to file a corrected claim with the payer per the base agreement (INSERT NUMBER)?	Timeline Provider Corrected Claim Filing	R106		E		No	Base Agreement	Key Dates	Required Only If Available	PAYMENT ACCURACY
92	What is timeline for provider to file a corrected claim with the payer per the base agreement (INSERT UNIT OF MEASURE)?		R107		E
93	Concat - What is timeline for provider to file a corrected claim with the payer per the base agreement (INSERT NUMBER)?		PROV_CORRECTED_CLAIM_FILING_TIMELINE
94	What is timeline for provider to file a corrected claim with the payer per the base agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_CORRECTED_CLAIM_FILING_INFO		E
95	What is timeline for provider to file a corrected claim with the payer per the base agreement (Page#)?		PROV_CORRECTED_CLAIM_FILING_PG		E
96	What is timeline for payer to prompt pay paper claims to the provider per base agreement (INSERT NUMBER)?	Timeline Payer Prompt Payment Paper	R108		E		No	Base Agreement	Key Dates	Required Only If Available	PREPAY
97	What is timeline for payer to prompt pay paper claims to the provider per base agreement (INSERT UNIT OF MEASURE)?		R109		E
98	Concat - What is timeline for payer to prompt pay paper claims to the provider per base agreement (INSERT NUMBER)?		PAYER_PROMPT_PAY_PAPER_CLAIM_TIMELINE
99	What is timeline for payer to prompt pay paper claims to the provider per base agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PAYER_PROMPT_PAY_PAPER_CLAIM_INFO		E
100	What is timeline for payer to prompt pay paper claims to the provider per base agreement (Page#)?		PAYER_PROMPT_PAY_PAPER_CLAIM_PG		E
101	What is timeline for payer to prompt pay electronic claims to the provider per base agreement (INSERT NUMBER)?	Timeline Payer Prompt Payment Electronic	R110		E		No	Base Agreement	Key Dates	Required Only If Available	PREPAY
102	What is timeline for payer to prompt pay electronic claims to the provider per base agreement (INSERT UNIT OF MEASURE)?		R111		E
103	Concat - What is timeline for payer to prompt pay electronic claims to the provider per base agreement (INSERT NUMBER)?		PAYER_PROMPT_PAY_ELECTRONIC_CLAIM_TIMELINE
104	What is timeline for payer to prompt pay electronic claims to the provider per base agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PAYER_PROMPT_PAY_ELECTRONIC_CLAIM_INFO		E
105	What is timeline for payer to prompt pay electronic claims to the provider per base agreement (Page#)?		PAYER_PROMPT_PAY_ELECTRONIC_CLAIM_PG		E
106	What is timeline for payer to audit claims per base agreement (INSERT NUMBER)?	Timeline Payer Claim Audit	R112		E		No	Base Agreement	Key Dates	Required Only If Available	PAYMENT ACCURACY
107	What is timeline for payer to audit claims per base agreement (INSERT UNIT OF MEASURE)?		R113		E
108	Concat - What is timeline for payer to audit claims per base agreement (INSERT NUMBER)?		PAYER_AUDIT_CLAIM_TIMELINE
109	What is timeline for payer to audit claims per base agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PAYER_AUDIT_CLAIM_INFO		E
110	What is timeline for payer to audit claims per base agreement (Page#)?		PAYER_AUDIT_CLAIM_PG		E
111	What is timeline for provider to submit a payment appeal to the payer per base agreement (INSERT NUMBER)?	Timeline Provider Payment Appeal	R114		E		No	Base Agreement	Key Dates	Required Only If Available	APPEALS INVOICING
112	What is timeline for provider to submit a payment appeal to the payer per base agreement (INSERT UNIT OF MEASURE)?		R115		E
113	Concat - What is timeline for provider to submit a payment appeal to the payer per base agreement (INSERT NUMBER)?		PROV_SUBMIT_PAYMENT_APPEAL_TIMELINE
114	What is timeline for provider to submit a payment appeal to the payer per base agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_SUBMIT_PAYMENT_APPEAL_INFO		E
115	What is timeline for provider to submit a payment appeal to the payer per base agreement (Page#)?		PROV_SUBMIT_PAYMENT_APPEAL_PG		E
116	What is timeline for provider to submit a payment dispute to the payer per base agreement (INSERT NUMBER)?	Timeline Provider Payment Dispute	R116		E		No	Base Agreement	Key Dates	Required Only If Available	APPEALS INVOICING
117	What is timeline for provider to submit a payment dispute to the payer per base agreement (INSERT UNIT OF MEASURE)?		R117		E
118	Concat - What is timeline for provider to submit a payment dispute to the payer per base agreement (INSERT NUMBER)?		PROV_SUBMIT_PAYMENT_DISPUTE_TIMELINE
119	What is timeline for provider to submit a payment dispute to the payer per base agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_SUBMIT_PAYMENT_DISPUTE_INFO		E
120	What is timeline for provider to submit a payment dispute to the payer per base agreement (Page#)?		PROV_SUBMIT_PAYMENT_DISPUTE_PG		E
121	What is timeline for provider to submit a payment reconsideration request to the payer per base agreement (INSERT NUMBER)?	Timeline Provider Payment Reconsideration	R118		E		No	Base Agreement	Key Dates	Required Only If Available	APPEALS INVOICING
122	What is timeline for provider to submit a payment reconsideration request to the payer per base agreement (INSERT UNIT OF MEASURE)?		R119		E
123	Concat - What is timeline for provider to submit a payment reconsideration request to the payer per base agreement (INSERT NUMBER)?		PROV_SUBMIT_PAYMENT_RECONSIDERATION_TIMELINE
124	What is timeline for provider to submit a payment reconsideration request to the payer per base agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_SUBMIT_PAYMENT_RECONSIDERATION_INFO		E
125	What is timeline for provider to submit a payment reconsideration request to the payer per base agreement (Page#)?		PROV_SUBMIT_PAYMENT_RECONSIDERATION_PG		E
126	What is timeline for payer to identify overpayments in paid claims per base agreement (INSERT NUMBER)?	Timeline Payer Overpayment Identification	R120		E		No	Base Agreement	Key Dates	Required Only If Available	PAYMENT ACCURACY
127	What is timeline for payer to identify overpayments in paid claims per base agreement (INSERT UNIT OF MEASURE)?		R121		E
128	Concat - What is timeline for payer to identify overpayments in paid claims per base agreement (INSERT NUMBER)?		PAYER_IDENTIFY_OVERPAYMENT_TIMELINE
129	What is timeline for payer to identify overpayments in paid claims per base agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PAYER_IDENTIFY_OVERPAYMENT_INFO		E
130	What is timeline for payer to identify overpayments in paid claims per base agreement (Page#)?		PAYER_IDENTIFY_OVERPAYMENT_PG		E
131	What is timeline for provider to submit an overpayment appeal to the payer per base agreement (INSERT NUMBER)?	Timeline Provider Overpayment Appeal	R122		E		No	Base Agreement	Key Dates	Required Only If Available	APPEALS INVOICING
132	What is timeline for provider to submit an overpayment appeal to the payer per base agreement (INSERT UNIT OF MEASURE)?		R123		E
133	Concat - What is timeline for provider to submit an overpayment appeal to the payer per base agreement (INSERT NUMBER)?		PROV_SUBMIT_OVERPAYMENT_APPEAL_TIMELINE
134	What is timeline for provider to submit an overpayment appeal to the payer per base agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_SUBMIT_OVERPAYMENT_APPEAL_INFO		E
135	What is timeline for provider to submit an overpayment appeal to the payer per base agreement (Page#)?		PROV_SUBMIT_OVERPAYMENT_APPEAL_PG		E
136					E
137	What is timeline for payer to give notice of policy changes to provider per Medicare agreement (INSERT NUMBER)?	Timeline Medicare Payer Policy Change Notice	R124		E		No	Medicare Agreement	Key Dates	Required Only If Available	PAYMENT ACCURACY COST AVOIDANCE
138	What is timeline for payer to give notice of policy changes to provider per Medicare agreement (INSERT UNIT OF MEASURE)?		R125		E
139	Concat - What is timeline for payer to give notice of policy changes to provider per Medicare agreement (INSERT NUMBER)?		PAYER_NOTICE_POLICY_CHANGE_MEDICARE_TIMELINE
140	What is timeline for payer to give notice of policy changes to provider per Medicare agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PAYER_NOTICE_POLICY_CHANGE_MEDICARE_INFO		E
141	What is timeline for payer to give notice of policy changes to provider per Medicare agreement (Page#)?		PAYER_NOTICE_POLICY_CHANGE_MEDICARE_PG		E
142	What is timeline for provider timely filing of claims submitted to the payer per Medicare agreement (INSERT NUMBER)?	Timeline Medicare Provider Claim Timely Filing	126		E		No	Medicare Agreement	Key Dates	Required Only If Available	PAYMENT ACCURACY
143	What is timeline for provider timely filing of claims submitted to the payer per Medicare agreement (INSERT UNIT OF MEASURE)?		R127		E
144	Concat - What is timeline for provider timely filing of claims submitted to the payer per Medicare agreement (INSERT NUMBER)?		PROV_CLAIM_TIMELY_FILING_MEDICARE_TIMELINE
145	What is timeline for provider timely filing of claims submitted to the payer per Medicare agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_CLAIM_TIMELY_FILING_MEDICARE_INFO		E
146	What is timeline for provider timely filing of claims submitted to the payer per Medicare agreement (Page#)?		PROV_CLAIM_TIMELY_FILING_MEDICARE_PG		E
147	What is timeline for provider to file a corrected claim with the payer per the Medicare agreement (INSERT NUMBER)?	Timeline Medicare Provider Corrected Claim Filing	R128		E		No	Medicare Agreement	Key Dates	Required Only If Available	PAYMENT ACCURACY
148	What is timeline for provider to file a corrected claim with the payer per the Medicare agreement (INSERT UNIT OF MEASURE)?		R129		E
149	Concat - What is timeline for provider to file a corrected claim with the payer per the Medicare agreement (INSERT NUMBER)?		PROV_CORRECTED_CLAIM_FILING_MEDICARE_TIMELINE
150	What is timeline for provider to file a corrected claim with the payer per the Medicare agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_CORRECTED_CLAIM_FILING_MEDICARE_INFO		E
151	What is timeline for provider to file a corrected claim with the payer per the Medicare agreement (Page#)?		PROV_CORRECTED_CLAIM_FILING_MEDICARE_PG		E
152	What is timeline for payer to prompt pay paper claims to the provider per Medicare agreement (INSERT NUMBER)?	Timeline Medicare Payer Prompt Payment Paper	R130		E		No	Medicare Agreement	Key Dates	Required Only If Available	PREPAY
153	What is timeline for payer to prompt pay paper claims to the provider per Medicare agreement (INSERT UNIT OF MEASURE)?		R131		E
154	Concat - What is timeline for payer to prompt pay paper claims to the provider per Medicare agreement (INSERT NUMBER)?		PROV_PROMPT_PAY_PAPER_CLAIM_MEDICARE_TIMELINE
155	What is timeline for payer to prompt pay paper claims to the provider per Medicare agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_PROMPT_PAY_PAPER_CLAIM_MEDICARE_INFO		E
156	What is timeline for payer to prompt pay paper claims to the provider per Medicare agreement (Page#?		PROV_PROMPT_PAY_PAPER_CLAIM_MEDICARE_PG		E
157	What is timeline for payer to prompt pay electronic claims to the provider per Medicare agreement (INSERT NUMBER)?	Timeline Medicare Payer Prompt Payment Electronic	R132		E		No	Medicare Agreement	Key Dates	Required Only If Available	PREPAY
158	What is timeline for payer to prompt pay electronic claims to the provider per Medicare agreement (INSERT UNIT OF MEASURE)?		R133		E
159	Concat - What is timeline for payer to prompt pay electronic claims to the provider per Medicare agreement (INSERT NUMBER)?		PROV_PROMPT_PAY_ELECTRONIC_CLAIM_MEDICARE_TIMELINE
160	What is timeline for payer to prompt pay electronic claims to the provider per Medicare agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_PROMPT_PAY_ELECTRONIC_CLAIM_MEDICARE_INFO		E
161	What is timeline for payer to prompt pay electronic claims to the provider per Medicare agreement (Page#)?		PROV_PROMPT_PAY_ELECTRONIC_CLAIM_MEDICARE_PG		E
162	What is timeline for payer to audit claims per Medicare agreement (INSERT NUMBER)?	Timeline Medicare Payer Claim Audit	R134		E		No	Medicare Agreement	Key Dates	Required Only If Available	PAYMENT ACCURACY
163	What is timeline for payer to audit claims per Medicare agreement (INSERT UNIT OF MEASURE)?		R135		E
164	Concat - What is timeline for payer to audit claims per Medicare agreement (INSERT NUMBER)?		PAYER_CLAIM_AUDIT_MEDICARE_TIMELINE
165	What is timeline for payer to audit claims per Medicare agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PAYER_CLAIM_AUDIT_MEDICARE_INFO		E
166	What is timeline for payer to audit claims per Medicare agreement? (Page#)		PAYER_CLAIM_AUDIT_MEDICARE_PG		E
167	What is timeline for provider to submit a payment appeal to the payer per Medicare agreement (INSERT NUMBER)?	Timeline Medicare Provider Payment Appeal	R136		E		No	Medicare Agreement	Key Dates	Required Only If Available	APPEALS INVOICING
168	What is timeline for provider to submit a payment appeal to the payer per Medicare agreement (INSERT UNIT OF MEASURE)?		R137		E
169	Concat - What is timeline for provider to submit a payment appeal to the payer per Medicare agreement (INSERT NUMBER)?		PROV_SUBMIT_PAYMENT_APPEAL_MEDICARE_TIMELINE
170	What is timeline for provider to submit a payment appeal to the payer per Medicare agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_SUBMIT_PAYMENT_APPEAL_MEDICARE_INFO		E
171	What is timeline for provider to submit a payment appeal to the payer per Medicare agreement (INSERT NUMBER)? (Page#)		PROV_SUBMIT_PAYMENT_APPEAL_MEDICARE_PG		E
172	What is timeline for provider to submit a payment dispute to the payer per Medicare agreement (INSERT NUMBER) ?	Timeline Medicare Provider Payment Dispute	R138		E		No	Medicare Agreement	Key Dates	Required Only If Available	APPEALS INVOICING
173	What is timeline for provider to submit a payment dispute to the payer per Medicare agreement (INSERT UNIT OF MEASURE) ?		R139		E
174	Concat - What is timeline for provider to submit a payment dispute to the payer per Medicare agreement (INSERT NUMBER) ?		PROV_SUBMIT_PAYMENT_DISPUTE_MEDICARE_TIMELINE
175	What is timeline for provider to submit a payment dispute to the payer per Medicare agreement (INSERT TRIGGER "FROM" OR "BEFORE") ?		PROV_SUBMIT_PAYMENT_DISPUTE_MEDICARE_INFO		E
176	What is timeline for provider to submit a payment dispute to the payer per Medicare agreement ? (Page#)		PROV_SUBMIT_PAYMENT_DISPUTE_MEDICARE_P		E
177	What is timeline for provider to submit a payment reconsideration request to the payer per Medicare agreement (INSERT NUMBER)?	Timeline Medicare Provider Payment Reconsideration	R140		E		No	Medicare Agreement	Key Dates	Required Only If Available	APPEALS INVOICING
178	What is timeline for provider to submit a payment reconsideration request to the payer per Medicare agreement (INSERT UNIT OF MEASURE)?		R141		E
179	Concat - What is timeline for provider to submit a payment reconsideration request to the payer per Medicare agreement (INSERT NUMBER)?		PROV_SUBMIT_PAYMENT_RECONSIDERATION_MEDICARE_TIMELINE
180	What is timeline for provider to submit a payment reconsideration request to the payer per Medicare agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_SUBMIT_PAYMENT_RECONSIDERATION_MEDICARE_INFO		E
181	What is timeline for provider to submit a payment reconsideration request to the payer per Medicare agreement? (Page#)		PROV_SUBMIT_PAYMENT_RECONSIDERATION_MEDICARE_PG		E
182	What is timeline for payer to identify overpayments in paid claims per Medicare agreement (INSERT NUMBER)?	Timeline Medicare Payer Overpayment Identification	R142		E		No	Medicare Agreement	Key Dates	Required Only If Available	PAYMENT ACCURACY
183	What is timeline for payer to identify overpayments in paid claims per Medicare agreement (INSERT UNIT OF MEASURE)?		R143		E
184	Concat - What is timeline for payer to identify overpayments in paid claims per Medicare agreement (INSERT NUMBER)?		PROV_OVERPAYMENT_IDENTIFICATION_MEDICARE_TIMELINE
185	What is timeline for payer to identify overpayments in paid claims per Medicare agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_OVERPAYMENT_IDENTIFICATION_MEDICARE_INFO		E
186	What is timeline for payer to identify overpayments in paid claims per Medicare agreement? (Page#)		PROV_OVERPAYMENT_IDENTIFICATION_MEDICARE_PG		E
187	What is timeline for provider to submit an overpayment appeal to the payer per Medicare agreement (INSERT NUMBER)?	Timeline Medicare Provider Overpayment Appeal	R144		E		No	Medicare Agreement	Key Dates	Required Only If Available	APPEALS INVOICING
188	What is timeline for provider to submit an overpayment appeal to the payer per Medicare agreement (INSERT UNIT OF MEASURE)?		R145		E
189	Concat - What is timeline for provider to submit an overpayment appeal to the payer per Medicare agreement (INSERT NUMBER)?		PROV_OVERPAYMENT_APPEAL_MEDICARE_TIMELINE
190	What is timeline for provider to submit an overpayment appeal to the payer per Medicare agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_OVERPAYMENT_APPEAL_MEDICARE_INFO		E
191	What is timeline for provider to submit an overpayment appeal to the payer per Medicare agreement? (Page#)		PROV_OVERPAYMENT_APPEAL_MEDICARE_PG		E
192	Does Medicare agreement allow offshore (Yes/No)?	Medicare Offshore (Y/N)?	MEDICARE_ALLOW_OFSHORE		E		No	Medicare Agreement		Required Only If Available
193	Does Medicare agreement allow offshore (Yes/No)? (Page#)		MEDICARE_ALLOW_OFFSHORE_PG		E
194					E
195	What is timeline for payer to give notice of policy changes to provider per Medicaid agreement (INSERT NUMBER)?	Timeline Medicaid Payer Policy Change Notice	R146		E		No	Medicaid Agreement	Key Dates	Required Only If Available	PAYMENT ACCURACY COST AVOIDANCE
196	What is timeline for payer to give notice of policy changes to provider per Medicaid agreement (INSERT UNIT OF MEASURE)?		R147		E
197	Concat - What is timeline for payer to give notice of policy changes to provider per Medicaid agreement (INSERT NUMBER)?		PAYER_NOTICE_POLICY_CHANGE_MEDICAID_TIMELINE
198	What is timeline for payer to give notice of policy changes to provider per Medicaid agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PAYER_NOTICE_POLICY_CHANGE_MEDICAID_INFO		E
199	What is timeline for payer to give notice of policy changes to provider per Medicaid agreement? (Page#)		PAYER_NOTICE_POLICY_CHANGE_MEDICAID_PG		E
200	What is timeline for provider timely filing of claims submitted to the payer per Medicaid agreement (INSERT NUMBER)?	Timeline Medicaid Provider Claim Timely Filing	R148		E		No	Medicaid Agreement	Key Dates	Required Only If Available	PAYMENT ACCURACY
201	What is timeline for provider timely filing of claims submitted to the payer per Medicaid agreement (INSERT UNIT OF MEASURE)?		R149		E
202	Concat - What is timeline for provider timely filing of claims submitted to the payer per Medicaid agreement (INSERT NUMBER)?		PROV_CLAIM_TIMELY_FILING_MEDICAID_TIMELINE
203	What is timeline for provider timely filing of claims submitted to the payer per Medicaid agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_CLAIM_TIMELY_FILING_MEDICAID_INFO		E
204	What is timeline for provider timely filing of claims submitted to the payer per Medicaid agreement? (Page#)		PROV_CLAIM_TIMELY_FILING_MEDICAID_PG		E
205	What is timeline for provider to file a corrected claim with the payer per the Medicaid agreement (INSERT NUMBER)?	Timeline Medicaid Provider Corrected Claim Filing	R150		E		No	Medicaid Agreement	Key Dates	Required Only If Available	PAYMENT ACCURACY
206	What is timeline for provider to file a corrected claim with the payer per the Medicaid agreement (INSERT UNIT OF MEASURE)?		R151		E
207	Concat - What is timeline for provider to file a corrected claim with the payer per the Medicaid agreement (INSERT NUMBER)?		PROV_CORRECTED_CLAIM_FILING_MEDICAID_TIMELINE
208	What is timeline for provider to file a corrected claim with the payer per the Medicaid agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_CORRECTED_CLAIM_FILING_MEDICAID_INFO		E
209	What is timeline for provider to file a corrected claim with the payer per the Medicaid agreement? (Page#)		PROV_CORRECTED_CLAIM_FILING_MEDICAID_PG		E
210	What is timeline for payer to prompt pay paper claims to the provider per Medicaid agreement (INSERT NUMBER)?	Timeline Medicaid Payer Prompt Payment Paper	R152		E		No	Medicaid Agreement	Key Dates	Required Only If Available	PREPAY
211	What is timeline for payer to prompt pay paper claims to the provider per Medicaid agreement (INSERT UNIT OF MEASURE)?		R153		E
212	Concat - What is timeline for payer to prompt pay paper claims to the provider per Medicaid agreement (INSERT NUMBER)?		PROV_PROMPT_PAY_PAPER_CLAIM_MEDICAID_TIMELINE
213	What is timeline for payer to prompt pay paper claims to the provider per Medicaid agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_PROMPT_PAY_PAPER_CLAIM_MEDICAID_INFO		E
214	What is timeline for payer to prompt pay paper claims to the provider per Medicaid agreement? (Page#)		PROV_PROMPT_PAY_PAPER_CLAIM_MEDICAID_PG		E
215	What is timeline for payer to prompt pay electronic claims to the provider per Medicaid agreement (INSERT NUMBER)?	Timeline Medicaid Payer Prompt Payment Electronic	R154		E		No	Medicaid Agreement	Key Dates	Required Only If Available	PREPAY
216	What is timeline for payer to prompt pay electronic claims to the provider per Medicaid agreement (INSERT UNIT OF MEASURE)?		R155		E
217	Concat - What is timeline for payer to prompt pay electronic claims to the provider per Medicaid agreement (INSERT NUMBER)?		PROV_PROMPT_PAY_ELECTRONIC_CLAIM_MEDICAID_TIMELINE
218	What is timeline for payer to prompt pay electronic claims to the provider per Medicaid agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_PROMPT_PAY_ELECTRONIC_CLAIM_MEDICAID_INFO		E
219	What is timeline for payer to prompt pay electronic claims to the provider per Medicaid agreement? (Page#)		PROV_PROMPT_PAY_ELECTRONIC_CLAIM_MEDICAID_PG		E
220	What is timeline for payer to audit claims per Medicaid agreement (INSERT NUMBER)?	Timeline Medicaid Payer Claim Audit	R156		E		No	Medicaid Agreement	Key Dates	Required Only If Available	PAYMENT ACCURACY
221	What is timeline for payer to audit claims per Medicaid agreement (INSERT UNIT OF MEASURE)?		R157		E
222	Concat - What is timeline for payer to audit claims per Medicaid agreement (INSERT NUMBER)?		PROV_CLAIM_AUDIT_MEDICAID_TIMELINE
223	What is timeline for payer to audit claims per Medicaid agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_CLAIM_AUDIT_MEDICAID_INFO		E
224	What is timeline for payer to audit claims per Medicaid agreement? (Page#)		PROV_CLAIM_AUDIT_MEDICAID_PG		E
225	What is timeline for provider to submit a payment appeal to the payer per Medicaid agreement (INSERT NUMBER)?	Timeline Medicaid Provider Payment Appeal	R158		E		No	Medicaid Agreement	Key Dates	Required Only If Available	APPEALS INVOICING
226	What is timeline for provider to submit a payment appeal to the payer per Medicaid agreement (INSERT UNIT OF MEASURE)?		R159		E
227	Concat - What is timeline for provider to submit a payment appeal to the payer per Medicaid agreement (INSERT NUMBER)?		PROV_PAYMENT_APPEAL_MEDICAID_TIMELINE
228	What is timeline for provider to submit a payment appeal to the payer per Medicaid agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_PAYMENT_APPEAL_MEDICAID_INFO		E
229	What is timeline for provider to submit a payment appeal to the payer per Medicaid agreement? (Page#)		PROV_PAYMENT_APPEAL_MEDICAID_PG		E
230	What is timeline for provider to submit a payment dispute to the payer per Medicaid agreement (INSERT NUMBER)?	Timeline Medicaid Provider Payment Dispute	R160		E		No	Medicaid Agreement	Key Dates	Required Only If Available	APPEALS INVOICING
231	What is timeline for provider to submit a payment dispute to the payer per Medicaid agreement (INSERT UNIT OF MEASURE)?		R161		E
232	Concat - What is timeline for provider to submit a payment dispute to the payer per Medicaid agreement (INSERT NUMBER)?		PROV_SUBMIT_PAYMENT_DISPUTE_MEDICAID_TIMELINE
233	What is timeline for provider to submit a payment dispute to the payer per Medicaid agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_SUBMIT_PAYMENT_DISPUTE_MEDICAID_INFO		E
234	What is timeline for provider to submit a payment dispute to the payer per Medicaid agreement ? (Page#)		PROV_SUBMIT_PAYMENT_DISPUTE_MEDICAID_PG		E
235	What is timeline for provider to submit a payment reconsideration request to the payer per Medicaid agreement (INSERT NUMBER)?	Timeline Medicaid Provider Payment Reconsideration	R162		E		No	Medicaid Agreement	Key Dates	Required Only If Available	APPEALS INVOICING
236	What is timeline for provider to submit a payment reconsideration request to the payer per Medicaid agreement (INSERT UNIT OF MEASURE)?		R163		E
237	Concat - What is timeline for provider to submit a payment reconsideration request to the payer per Medicaid agreement (INSERT NUMBER)?		PROV_PAYMENT_RECONSIDERATION_MEDICAID_TIMELINE
238	What is timeline for provider to submit a payment reconsideration request to the payer per Medicaid agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_PAYMENT_RECONSIDERATION_MEDICAID_INFO		E
239	What is timeline for provider to submit a payment reconsideration request to the payer per Medicaid agreement? (Page#)		PROV_PAYMENT_RECONSIDERATION_MEDICAID_PG		E
240	What is timeline for payer to identify overpayments in paid claims per Medicaid agreement (INSERT NUMBER)?	Timeline Medicaid Payer Overpayment Identification	R164		E		No	Medicaid Agreement	Key Dates	Required Only If Available	PAYMENT ACCURACY
241	What is timeline for payer to identify overpayments in paid claims per Medicaid agreement (INSERT UNIT OF MEASURE)?		R165		E
242	Concat - What is timeline for payer to identify overpayments in paid claims per Medicaid agreement (INSERT NUMBER)?		PROV_IDENTIFY_OVERPAYMENTS_MEDICAID_TIMELINE
243	What is timeline for payer to identify overpayments in paid claims per Medicaid agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_IDENTIFY_OVERPAYMENTS_MEDICAID_INFO		E
244	What is timeline for payer to identify overpayments in paid claims per Medicaid agreement? (Page#)		PROV_IDENTIFY_OVERPAYMENTS_MEDICAID_PG		E
245	What is timeline for provider to submit an overpayment appeal to the payer per Medicaid agreement (INSERT NUMBER)?	Timeline Medicaid Provider Overpayment Appeal	R166		E		No	Medicaid Agreement	Key Dates	Required Only If Available	APPEALS INVOICING
246	What is timeline for provider to submit an overpayment appeal to the payer per Medicaid agreement (INSERT UNIT OF MEASURE)?		R167		E
247	Concat - What is timeline for provider to submit an overpayment appeal to the payer per Medicaid agreement (INSERT NUMBER)?		PROV_OVERPAYMENT_APPEAL_MEDICAID_TIMELINE
248	What is timeline for provider to submit an overpayment appeal to the payer per Medicaid agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_OVERPAYMENT_APPEAL_MEDICAID_INFO		E
249	What is timeline for provider to submit an overpayment appeal to the payer per Medicaid agreement? (Page#)		PROV_OVERPAYMENT_APPEAL_MEDICAID_PG		E
250	Does Medicaid agreement allow offshore (Yes/No)?	Medicaid Offshore (Y/N)?	MEDICAID_ALLOW_OFFSHORE		E		No	Medicaid Agreement		Required Only If Available
251	Does Medicaid agreement allow offshore (Yes/No)? (Page#)		MEDICAID_ALLOW_OFFSHORE_PG		E
252					E
253	What is timeline for payer to give notice of policy changes to provider per State Marketplace agreement (INSERT NUMBER)?	Timeline State Marketplace Payer Policy Change Notice	R168		E		No	State Marketplace Agreement	Key Dates	Required Only If Available	PAYMENT ACCURACY COST AVOIDANCE
254	What is timeline for payer to give notice of policy changes to provider per State Marketplace agreement (INSERT UNIT OF MEASURE)?		R169		E
255	Concat - What is timeline for payer to give notice of policy changes to provider per State Marketplace agreement (INSERT NUMBER)?		PAYER_NOTICE_POLICY_CHANGE_MARKETPLACE_TIMELINE
256	What is timeline for payer to give notice of policy changes to provider per State Marketplace agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PAYER_NOTICE_POLICY_CHANGE_MARKETPLACE_INFO		E
257	What is timeline for payer to give notice of policy changes to provider per State Marketplace agreement? (Page#)		PAYER_NOTICE_POLICY_CHANGE_MARKETPLACE_PG		E
258	What is timeline for provider timely filing of claims submitted to the payer per State Marketplace agreement (INSERT NUMBER)?	Timeline State Marketplace Provider Claim Timely Filing	R170		E		No	State Marketplace Agreement	Key Dates	Required Only If Available	PAYMENT ACCURACY
259	What is timeline for provider timely filing of claims submitted to the payer per State Marketplace agreement (INSERT UNIT OF MEASURE)?		R171		E
260	Concat - What is timeline for provider timely filing of claims submitted to the payer per State Marketplace agreement (INSERT NUMBER)?		PROV_CLAIM_TIMELY_FILING_MARKETPLACE_TIMELINE
261	What is timeline for provider timely filing of claims submitted to the payer per State Marketplace agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_CLAIM_TIMELY_FILING_MARKETPLACE_INFO		E
262	What is timeline for provider timely filing of claims submitted to the payer per State Marketplace agreement? (Page#)		PROV_CLAIM_TIMELY_FILING_MARKETPLACE_PG		E
263	What is timeline for provider to file a corrected claim with the payer per the State Marketplace agreement (INSERT NUMBER)?	Timeline State Marketplace Provider Corrected Claim Filing	R172		E		No	State Marketplace Agreement	Key Dates	Required Only If Available	PAYMENT ACCURACY
264	What is timeline for provider to file a corrected claim with the payer per the State Marketplace agreement (INSERT UNIT OF MEASURE)?		R173		E
265	Concat - What is timeline for provider to file a corrected claim with the payer per the State Marketplace agreement (INSERT NUMBER)?		PROV_CORRECTED_CLAIM_FILING_MARKETPLACE_TIMELINE
266	What is timeline for provider to file a corrected claim with the payer per the State Marketplace agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_CORRECTED_CLAIM_FILING_MARKETPLACE_INFO		E
267	What is timeline for provider to file a corrected claim with the payer per the State Marketplace agreement? (Page#)		PROV_CORRECTED_CLAIM_FILING_MARKETPLACE_PG		E
268	What is timeline for payer to prompt pay paper claims to the provider per State Marketplace agreement (INSERT NUMBER) ?	Timeline State Marketplace Payer Prompt Payment Paper	R174		E		No	State Marketplace Agreement	Key Dates	Required Only If Available	PREPAY
269	What is timeline for payer to prompt pay paper claims to the provider per State Marketplace agreement (INSERT UNIT OF MEASURE) ?		R175		E
270	Concat - What is timeline for payer to prompt pay paper claims to the provider per State Marketplace agreement (INSERT NUMBER) ?		PROV_PROMPT_PAY_PAPER_CLAIM_MARKETPLACE_TIMELINE
271	What is timeline for payer to prompt pay paper claims to the provider per State Marketplace agreement (INSERT TRIGGER "FROM" OR "BEFORE") ?		PROV_PROMPT_PAY_PAPER_CLAIM_MARKETPLACE_INFO		E
272	What is timeline for payer to prompt pay paper claims to the provider per State Marketplace agreement? (Page#)		PROV_PROMPT_PAY_PAPER_CLAIM_MARKETPLACE_PG		E
273	What is timeline for payer to prompt pay electronic claims to the provider per State Marketplace agreement (INSERT NUMBER) ?	Timeline State Marketplace Payer Prompt Payment Electronic	R176		E		No	State Marketplace Agreement	Key Dates	Required Only If Available	PREPAY
274	What is timeline for payer to prompt pay electronic claims to the provider per State Marketplace agreement (INSERT UNIT OF MEASURE) ?		R177		E
275	Concat - What is timeline for payer to prompt pay electronic claims to the provider per State Marketplace agreement (INSERT NUMBER) ?		PROV_PROMPT_PAY_ELECTRONIC_CLAIM_MARKETPLACE_TIMELINE
276	What is timeline for payer to prompt pay electronic claims to the provider per State Marketplace agreement (INSERT TRIGGER "FROM" OR "BEFORE") ?		PROV_PROMPT_PAY_ELECTRONIC_CLAIM_MARKETPLACE_INFO		E
277	What is timeline for payer to prompt pay electronic claims to the provider per State Marketplace agreement? (Page#)		PROV_PROMPT_PAY_ELECTRONIC_CLAIM_MARKETPLACE_PG		E
278	What is timeline for payer to audit claims per State Marketplace agreement (INSERT NUMBER)?	Timeline State Marketplace Payer Claim Audit	R178		E		No	State Marketplace Agreement	Key Dates	Required Only If Available	PAYMENT ACCURACY
279	What is timeline for payer to audit claims per State Marketplace agreement (INSERT UNIT OF MEASURE)?		R179		E
280	Concat - What is timeline for payer to audit claims per State Marketplace agreement (INSERT NUMBER)?		PROV_CLAIM_AUDIT_MARKETPLACE_TIMELINE
281	What is timeline for payer to audit claims per State Marketplace agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_CLAIM_AUDIT_MARKETPLACE_INFO		E
282	What is timeline for payer to audit claims per State Marketplace agreement? (Page#)		PROV_CLAIM_AUDIT_MARKETPLACE_PG		E
283	What is timeline for provider to submit a payment appeal to the payer per State Marketplace agreement (INSERT NUMBER)?	Timeline State Marketplace Provider Payment Appeal	R180		E		No	State Marketplace Agreement	Key Dates	Required Only If Available	APPEALS INVOICING
284	What is timeline for provider to submit a payment appeal to the payer per State Marketplace agreement (INSERT UNIT OF MEASURE)?		R181		E
285	Concat - What is timeline for provider to submit a payment appeal to the payer per State Marketplace agreement (INSERT NUMBER)?		PROV_PAYMENT_APPEAL_MARKETPLACE_TIMELINE
286	What is timeline for provider to submit a payment appeal to the payer per State Marketplace agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_PAYMENT_APPEAL_MARKETPLACE_INFO		E
287	What is timeline for provider to submit a payment appeal to the payer per State Marketplace agreement? (Page#)		PROV_PAYMENT_APPEAL_MARKETPLACE_PG		E
288	What is timeline for provider to submit a payment dispute to the payer per State Marketplace agreement (INSERT NUMBER) ?	Timeline State Marketplace Provider Payment Dispute	R182		E		No	State Marketplace Agreement	Key Dates	Required Only If Available	APPEALS INVOICING
289	What is timeline for provider to submit a payment dispute to the payer per State Marketplace agreement (INSERT UNIT OF MEASURE) ?		R183		E
290	Concat - What is timeline for provider to submit a payment dispute to the payer per State Marketplace agreement (INSERT NUMBER) ?		PROV_PAYMENT_DISPUTE_MARKETPLACE_TIMELINE
291	What is timeline for provider to submit a payment dispute to the payer per State Marketplace agreement (INSERT TRIGGER "FROM" OR "BEFORE") ?		PROV_PAYMENT_DISPUTE_MARKETPLACE_INFO		E
292	What is timeline for provider to submit a payment dispute to the payer per State Marketplace agreement ? (Page#)		PROV_PAYMENT_DISPUTE_MARKETPLACE_PG		E
293	What is timeline for provider to submit a payment reconsideration request to the payer per State Marketplace agreement (INSERT NUMBER)?	Timeline State Marketplace Provider Payment Reconsideration	R184		E		No	State Marketplace Agreement	Key Dates	Required Only If Available	APPEALS INVOICING
294	What is timeline for provider to submit a payment reconsideration request to the payer per State Marketplace agreement (INSERT UNIT OF MEASURE)?		R185		E
295	Concat - What is timeline for provider to submit a payment reconsideration request to the payer per State Marketplace agreement (INSERT NUMBER)?		PROV_PAYMENT_RECONSIDERATION_MARKETPLACE_TIMELINE
296	What is timeline for provider to submit a payment reconsideration request to the payer per State Marketplace agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_PAYMENT_RECONSIDERATION_MARKETPLACE_INFO		E
297	What is timeline for provider to submit a payment reconsideration request to the payer per State Marketplace agreement? (Page#)		PROV_PAYMENT_RECONSIDERATION_MARKETPLACE_PG		E
298	What is timeline for payer to identify overpayments in paid claims per State Marketplace agreement (INSERT NUMBER)?	Timeline State Marketplace Payer Overpayment Identification	R186		E		No	State Marketplace Agreement	Key Dates	Required Only If Available	PAYMENT ACCURACY
299	What is timeline for payer to identify overpayments in paid claims per State Marketplace agreement (INSERT UNIT OF MEASURE)?		R187		E
300	Concat - What is timeline for payer to identify overpayments in paid claims per State Marketplace agreement (INSERT NUMBER)?		PROV_IDENTIFY_OVERPAYMENT_MARKETPLACE_TIMELINE
301	What is timeline for payer to identify overpayments in paid claims per State Marketplace agreement (INSERT TRIGGER "FROM" OR "BEFORE")?		PROV_IDENTIFY_OVERPAYMENT_MARKETPLACE_INFO		E
302	What is timeline for payer to identify overpayments in paid claims per State Marketplace agreement? (Page#)		PROV_IDENTIFY_OVERPAYMENT_MARKETPLACE_PG		E
303	What is timeline for provider to submit an overpayment appeal to the payer per State Marketplace agreement (INSERT NUMBER)?	Timeline State Marketplace Provider Overpayment Appeal	R188		E		No	State Marketplace Agreement	Key Dates	Required Only If Available	APPEALS INVOICING
304	What is timeline for provider to submit an overpayment appeal to the payer per State Marketplace agreement (INSERT UNIT OF MEASURE )?		R189		E
305	Concat - What is timeline for provider to submit an overpayment appeal to the payer per State Marketplace agreement (INSERT NUMBER)?		PROV_OVERPAYMENT_APPEAL_MARKETPLACE_TIMELINE
306	What is timeline for provider to submit an overpayment appeal to the payer per State Marketplace agreement (INSERT TRIGGER "FROM" OR "BEFORE" )?		PROV_OVERPAYMENT_APPEAL_MARKETPLACE_INFO		E
307	What is timeline for provider to submit an overpayment appeal to the payer per State Marketplace agreement? (Page#)		PROV_OVERPAYMENT_APPEAL_MARKETPLACE_PG		E
308	Does State Marketplace agreement allow offshore (Yes/No)?	State Marketplace Offshore (Y/N)?	MARKETPLACE_ALLOW_OFFSHORE				No	State Marketplace Agreement		Required Only If Available
309	Does State Marketplace agreement allow offshore (Yes/No)? (Page#)		MARKETPLACE_ALLOW_OFSHORE_PG
310
311	What is start date of line of business specific compensation exhibit?	Effective Date of Pricing Terms	LOB_PRICING_TERMS_EFFECTIVE_DT		A		No (but please use GDP date format throughout)	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	LOB/Provider Type Specific	Always Required	PAYMENT ACCURACY UNIQUE KEY
312	What is start date of line of business specific compensation exhibit? (Page#)		LOB_PRICING_TERMS_EFFECTIVE_DT_PG
313	What is termination date of line of business specific compensation exhibit?	Termination Date of Pricing Terms	LOB_PRICING_TERMS_TERMINATION_DT		A		No (but please use GDP date format throughout)	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	LOB/Provider Type Specific	Always Required	GREEN LIGHT - IF DATE IS LESS THAN TODAY'S DATE THEN STOP, DO NOT REVIEW CONTRACT CONFIGURATION UNLESS THERE IS AN EFFECTIVE AMENDMENT UNIQUE KEY
314	What is termination date of line of business specific compensation exhibit? (Page#)		LOB_PRICING_TERMS_TERMINATION_DT_PG
315	Is the contract related to a Professional, Institutional or Ancillary provider?	Type of Contract	CONTRACT_TYPE		A		Yes	AArete Derived from Title or Preamble	LOB/Provider Type Specific	Always Required	UNIQUE KEY
316	Is the contract related to a Professional, Institutional or Ancillary provider? (Page#)		CONTRACT_TYPE_PG
317	If the contract is based on line of business, then create one row for each line of business	Line of Business	CONTRACT_LOB		A		Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	LOB/Provider Type Specific	Always Required	UNIQUE KEY
318	If the contract is based on line of business, then create one row for each line of business (Page#)		CONTRACT_LOB_PG
319	If the contract is based on network type, then create one row within each impacted line of business for each specifically listed network	Network	CONTRACT_NETWORK		A		Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	LOB/Provider Type Specific	Required Only If Available	UNIQUE KEY
320	If the contract is based on network type, then create one row within each impacted line of business for each specifically listed network (Page#)		CONTRACT_NETWORK_PG
321	If the contract if for Marketplace line of business, then create one row within the Marketplace line of business for each specifically listed metal level	Plan - Metal Level	CONTRACT_MARKETPLACE_METAL_LEVEL		A		Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	LOB/Provider Type Specific	Required Only If Available	UNIQUE KEY
322	If the contract if for Marketplace line of business, then create one row within the Marketplace line of business for each specifically listed metal level (Page#)		CONTRACT_MARKETPLACE_METAL_LEVEL_PG
323	If the contract is based on service areas, then create one row within each impacted line of business for each specifically listed area, county, ZIP, etc.	Plan- Service Area	CONTRACT_SERVICE_AREA		A		Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	LOB/Provider Type Specific	Required Only If Available	UNIQUE KEY
324	If the contract is based on service areas, then create one row within each impacted line of business for each specifically listed area, county, ZIP, etc. (Page#)		CONTRACT_SERVICE_AREA_PG
325	If the contract is for Medicare or Medicaid line of business, then create one row within each impacted Medicare/Medicaid line of business for each specifically listed program	Program	MEDICARE_MEDICAID_LOB		A		Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	LOB/Provider Type Specific	Required Only If Available	UNIQUE KEY
326	If the contract is for Medicare or Medicaid line of business, then create one row within each impacted Medicare/Medicaid line of business for each specifically listed program (Page#)		MEDICARE_MEDICAID_LOB_PG
327	If the contract is based on type of provider, then create one row within each impacted line of business for each specifically listed provider type of place of service	Type of Provider	PROV_TYPE		A		Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	LOB/Provider Type Specific	Always Required	UNIQUE KEY
328	If the contract is based on type of provider, then create one row within each impacted line of business for each specifically listed provider type of place of service (Page#)		PROV_TYPE_PG
329	If the contract is limited to certain Professional specialties, then create one row within each line of business for each specifically listed specialty	Provider Specialty	PROV_SPECIALTYTY		A		Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	LOB/Provider Type Specific	Required Only If Available	UNIQUE KEY
330	If the contract is limited to certain Professional specialties, then create one row within each line of business for each specifically listed specialty (Page#)		PROV_SPECIALTYTY_PG
331	Is the provider contracted to participate in the line of business, network, plan, program for the given provider type?	Participation Status	PROV_PARTICIPATION_STATUS		A		Yes	Derived From Combination of LOB, Network, Metal Level, Service Area, Program and/or Type of Provider Fields	LOB/Provider Type Specific	Always Required	UNIQUE KEY
332	Is the provider contracted to participate in the line of business, network, plan, program for the given provider type? (Page#)		PROV_PARTICIPATION_STATUS_PG
333
334	If contract automatically renews, then does the contract include annual rate escalators for year-over-year rate increases (Yes/No)?	Rate Escalators (Y/N)?	RATE_ESCALATOR_IND				No	From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Discounts, Premiums, Sequestration, Penalties, Interest	Required Only If Available	PAYMENT ACCURACY NETWORK PRICING
335	If contract automatically renews, then does the contract include annual rate escalators for year-over-year rate increases (Yes/No)? (Page#)		RATE_ESCALATOR_IND_PG
336	If contract includes annual rate escalators, on what are they based?	Rate Escalator Basis	RATE_ESCALATOR_BASIS				No	From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Discounts, Premiums, Sequestration, Penalties, Interest	Required Only If Available	PAYMENT ACCURACY NETWORK PRICING
337	If contract includes annual rate escalators, on what are they based? (Page#)		RATE_ESCALATOR_BASIS_PG
338	If contract includes annual rate escalators based on % rate increase, then what is the yearly percentage increase?	Rate Escalator %	RATE_ESCALATOR_YEARLY_PERCENT_INCREASE				No	From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Discounts, Premiums, Sequestration, Penalties, Interest	Required Only If Available	PAYMENT ACCURACY NETWORK
339	If contract includes annual rate escalators based on % rate increase, then what is the yearly percentage increase? (Page#)		RATE_ESCALATOR_YEARLY_PERCENT_INCREASE_PG
340	Does contract include terms for discounts applied to total claim (Yes/No)?	Claim Discount (Y/N)	CLAIM_DISCOUNT_IND				No	From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Discounts, Premiums, Sequestration, Penalties, Interest	Required Only If Available	PAYMENT ACCURACY NETWORK
341	Does contract include terms for discounts applied to total claim (Yes/No)? (Page#)		CLAIM_DISCOUNT_IND_PG
342	What is claim discount rate?	Claim Discount Rate	CLM_DISC_RATE				No	From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Discounts, Premiums, Sequestration, Penalties, Interest	Required Only If Available	PAYMENT ACCURACY NETWORK
343	What is claim discount rate? (Page#)		CLAIM_DISCOUNT_RATE_PG
344	What is claim discount start date?	Claim Discount Start Date	CLAIM_DISCOUNT_START_DT				No	From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Discounts, Premiums, Sequestration, Penalties, Interest	Required Only If Available	PAYMENT ACCURACY NETWORK
345	What is claim discount start date? (Page#)		CLAIM_DISCOUNT_START_DT_PG
346	What is claim discount termination date?	Claim Discount Termination Date	CLAIM_DISCOUNT_TERMINATION_DT				No	From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Discounts, Premiums, Sequestration, Penalties, Interest	Required Only If Available	PAYMENT ACCURACY NETWORK
347	What is claim discount termination date? (Page#)		CLAIM_DISCOUNT_TERMINATION_DT_PG
348	Does contract include terms for premiums applied to total claim (Yes/No)?	Claim Premium (Y/N)	CLAIM_PREMIUM_IND				No	From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Discounts, Premiums, Sequestration, Penalties, Interest	Required Only If Available	PAYMENT ACCURACY NETWORK
349	Does contract include terms for premiums applied to total claim (Yes/No)? (Page#)		CLAIM_PREMIUM_IND_PG
350	What is claim premium rate?	Claim Premium Rate	CLAIM_PREMIUM_RATE				No	From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Discounts, Premiums, Sequestration, Penalties, Interest	Required Only If Available	PAYMENT ACCURACY NETWORK
351	What is claim premium rate? (Page#)		CLAIM_PREMIUM_RATE_PG
352	What is claim premium start date?	Claim Premium Start Date	CLAIM_PREMIUM_START_DT				No	From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Discounts, Premiums, Sequestration, Penalties, Interest	Required Only If Available	PAYMENT ACCURACY NETWORK
353	What is claim premium start date? (Page#)		CLAIM_PREMIUM_START_DT_PG
354	What is claim premium termination date?	Claim Premium Termination Date	CLAIM_PREMIUM_TERMINATION_DT				No	From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Discounts, Premiums, Sequestration, Penalties, Interest	Required Only If Available	PAYMENT ACCURACY NETWORK
355	What is claim premium termination date? (Page#)		CLAIM_PREMIUM_TERMINATION_DT_PG
356	Does contract include terms for sequestration amounts applied to total claim (Yes/No)?	Claim Sequestration (Y/N)	CLAIM_SEQUESTRATION_IND				No	From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Discounts, Premiums, Sequestration, Penalties, Interest	Required Only If Available	PAYMENT ACCURACY NETWORK
357	Does contract include terms for sequestration amounts applied to total claim (Yes/No)? (Page#)		CLAIM_SEQUESTRATION_IND_PG
358	What is claim sequestration rate?	Claim Sequestration Rate	CLAIM_SEQUESTRATION_RATE				No	From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Discounts, Premiums, Sequestration, Penalties, Interest	Required Only If Available	PAYMENT ACCURACY NETWORK
359	What is claim sequestration rate? (Page#)		CLAIM_SEQUESTRATION_RATE_PG
360	What is claim sequestration start date?	Claim Sequestration Start Date	CLAIM_SEQUESTRATION_START_DT				No	From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Discounts, Premiums, Sequestration, Penalties, Interest	Required Only If Available	PAYMENT ACCURACY NETWORK
361	What is claim sequestration start date? (Page#)		CLAIM_SEQUESTRATION_START_DT_PG
362	What is claim sequestration termination date?	Claim Sequestration Termination Date	CLAIM_SEQUESTRATION_TERMINATION_DT				No	From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Discounts, Premiums, Sequestration, Penalties, Interest	Required Only If Available	PAYMENT ACCURACY NETWORK
363	What is claim sequestration termination date? (Page#)		CLAIM_SEQUESTRATION_TERMINATION_DT_PG
364	Does the contract include terms for penalties and interest (Yes/No)?	Penalties & Interest (Y/N)?	PENALTIES_INTEREST_IND				No	From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Discounts, Premiums, Sequestration, Penalties, Interest	Required Only If Available	PAYMENT ACCURACY NETWORK
365	Does the contract include terms for penalties and interest (Yes/No)? (Page#)		PENALTIES_INTEREST_IND_PG
366	What triggers computation of penalties and interest?	Penalties & Interest Trigger	PENALTIES_INTEREST_TRIGGER				No	From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Discounts, Premiums, Sequestration, Penalties, Interest	Required Only If Available	PAYMENT ACCURACY NETWORK
367	What triggers computation of penalties and interest? (Page#)		PENALTIES_INTEREST_TRIGGER_PG
368	What is rate charged for penalties and interest?	Penalties & Interest Rate	PENALTIES_INTEREST_RATE				No	From Base Contract or from LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Discounts, Premiums, Sequestration, Penalties, Interest	Required Only If Available	PAYMENT ACCURACY NETWORK
369	What is rate charged for penalties and interest? (Page#)		PENALTIES_INTEREST_RATE_PG
370	What is contract's Chargemaster protection language?		CONTRACT_CHARGEMASTER_PROTECTION_LANGUAGE
371	What is contract's Chargemaster protection language? (Page#)		CONTRACT_CHARGEMASTER_PROTECTION_LANGUAGE_PG
372
373	Does the Reimbursement methodology include lesser of language (Yes/No)?	Lesser Of Language (Y/N)?	LESSER_OF_LANGUAGE_IND				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Always Required	PAYMENT ACCURACY NETWORK
374	Does the Reimbursement methodology include lesser of language (Yes/No)? (Page#)		LESSER_OF_LANGUAGE_IND_PG
375	Does the Reimbursement methodology include greater of language (Yes/No)?	Greater Of Language (Y/N)?	GREATER_OF_LANGUAGE				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Always Required	PAYMENT ACCURACY NETWORK
376	Does the Reimbursement methodology include greater of language (Yes/No)? (Page#)		GREATER_OF_LANGUAGE_PG
377	What is the primary Reimbursement methodology?	Reimbursement Methodology - Primary	PRIMARY_REIMBURSEMENT_METHODOLOGY				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Always Required	PAYMENT ACCURACY NETWORK
378	What is the primary Reimbursement methodology? (Page#)		PRIMARY_REIMBURSEMENT_METHODOLOGY_PG
379	If the Primary Reimbursement methodology is based on Procedure Codes, then list the applicable codes or code ranges	Applicable Procedure Codes - Primary	PRIMARY_REIMBURSEMENT_PROC_CODES				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
380	If the Primary Reimbursement methodology is based on Procedure Codes, then list the applicable codes or code ranges (Page#)		PRIMARY_REIMBURSEMENT_PROC_CODES_PG
381	If the Primary Reimbursement methodology is based on Revenue Codes, then list the applicable codes or code ranges	Applicable Revenue Codes - Primary	PRIMARY_REIMBURSEMENT_REVENUE_CODES				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
382	If the Primary Reimbursement methodology is based on Revenue Codes, then list the applicable codes or code ranges (Page#)		PRIMARY_REIMBURSEMENT_REVENUE_CODES_PG
383	If the Primary Reimbursement methodology is based on Revenue/ Procedure code combinations, then list the applicable code combinations	Applicable Revenue /Procedure Code Combinations - Primary	PRIMARY_REIMBURSEMENT_PROC_REVENUE_CODE_COMBO				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
384	If the Primary Reimbursement methodology is based on Revenue/ Procedure code combinations, then list the applicable code combinations (Page#)		PRIMARY_REIMBURSEMENT_PROC_REVENUE_CODE_COMBO_PG
385	If the Primary Reimbursement methodology is based on Diagnosis Codes, then list the applicable codes or code ranges	Applicable Diagnosis Codes - Primary	PRIMARY_REIMBURSEMENT_DIAG_CODES				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
386	If the Primary Reimbursement methodology is based on Diagnosis Codes, then list the applicable codes or code ranges (Page#)		PRIMARY_REIMBURSEMENT_DIAG_CODES_PG
387	If the Primary Reimbursement methodology is based on Grouper Codes, then list the applicable codes or code ranges	Applicable Grouper Codes - Primary	PRIMARY_REIMBURSEMENT_GROUPER_CODES				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
388	If the Primary Reimbursement methodology is based on Grouper Codes, then list the applicable codes or code ranges (Page#)		PRIMARY_REIMBURSEMENT_GROUPER_CODES_PG
389	If the Primary Reimbursement methodology is based on Place of Service Codes, then list the applicable codes or code ranges	Applicable Place of Service Codes - Primary	PRIMARY_REIMBURSEMENT_PLACEOFSERVICE_CODES				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
390	If the Primary Reimbursement methodology is based on Place of Service Codes, then list the applicable codes or code ranges (Page#)		PRIMARY_REIMBURSEMENT_PLACEOFSERVICE_CODES_PG
391	If the Primary Reimbursement methodology is based on Admit Type codes, then list the applicable codes or code ranges	Applicable Admit Type Codes - Primary	PRIMARY_REIMBURSEMENT_ADMITTYPE_CODES				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
392	If the Primary Reimbursement methodology is based on Admit Type codes, then list the applicable codes or code ranges (Page#)		PRIMARY_REIMBURSEMENT_ADMITTYPE_CODES_PG
393	If the Primary Reimbursement methodology is based on Status Indicator codes, then list the applicable codes or code ranges	Applicable Status Indicator Codes - Primary	PRIMARY_REIMBURSEMENT_STATUS_INDICATOR_CODES				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
394	If the Primary Reimbursement methodology is based on Status Indicator codes, then list the applicable codes or code ranges (Page#)		PRIMARY_REIMBURSEMENT_STATUS_INDICATOR_CODES_PG
395	If the primary reimbursement methodology is based on a Fee Schedule, what is the name of the fee schedule on which it is based?	Fee Schedule - Primary	PRIMARY_REIMBURSEMENT_FEE_SCHEDULE				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
396	If the primary reimbursement methodology is based on a Fee Schedule, what is the name of the fee schedule on which it is based? (Page#)		PRIMARY_REIMBURSEMENT_FEE_SCHEDULE_PG
397	If the primary reimbursement methodology is based on a Fee Schedule, on which fee schedule VERSION is it based?	Fee Schedule Version - Primary	PRIMARY_REIMBURSEMENT_FEE_SCHEDULE_VERSION				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
398	If the primary reimbursement methodology is based on a Fee Schedule, on which fee schedule VERSION is it based? (Page#)		PRIMARY_REIMBURSEMENT_FEE_SCHEDULE_VERSION_PG
399	If the primary reimbursement methodology is based on Billed Charges, Fee Schedule, Cost Plus, AWP, or other percentage rate, what is the reimbursed percentage?	Reimbursement % Rate - Primary	PRIMARY_REIMBURSEMENT_RATE				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
400	If the primary reimbursement methodology is based on Billed Charges, Fee Schedule, Cost Plus, AWP, or other percentage rate, what is the reimbursed percentage? (Page#)		PRIMARY_REIMBURSEMENT_RATE_PG
401	If the primary reimbursement methodology is based on a fee for service, flat rate, all-inclusive rate, episode of care rate, case rate, per diem rate, or other dollar rate, what is the reimbursed dollar amount?	Reimbursement $ Rate - Primary	PRIMARY_REIMBURSEMENT_FLAT_FEE				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
402	If the primary reimbursement methodology is based on a fee for service, flat rate, all-inclusive rate, episode of care rate, case rate, per diem rate, or other dollar rate, what is the reimbursed dollar amount? (Page#)		PRIMARY_REIMBURSEMENT_FLAT_FEE_PG
403	If the Primary reimbursement is based on codes listed on the CMS fee schedule, what is the comparable Medicare fee schedule rate?	Medicare $ Rate - Primary	PRIMARY_REIMBURSEMENT_CMS_MEDICARE_RATE				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
404	If the Primary reimbursement is based on codes listed on the CMS fee schedule, what is the comparable Medicare fee schedule rate? (Page#)		PRIMARY_REIMBURSEMENT_CMS_MEDICARE_RATE_PG
405	If the Primary reimbursement is based on codes listed on the State Medicaid fee schedule, what is the comparable Medicaid fee schedule rate?	Medicaid $ Rate - Primary	PRIMARY_REIMBURSEMENT_MEDICAID_RATE				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
406	If the Primary reimbursement is based on codes listed on the State Medicaid fee schedule, what is the comparable Medicaid fee schedule rate? (Page#)		PRIMARY_REIMBURSEMENT_MEDICAID_RATE_PG
407	If the primary reimbursement methodology is based on a grouper rate, what is the applicable grouper methodology?	Reimbursement Grouper - Primary	PRIMARY_REIMBURSEMENT_GROUPER				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
408	If the primary reimbursement methodology is based on a grouper rate, what is the applicable grouper methodology? (Page#)		PRIMARY_REIMBURSEMENT_GROUPER_PG
409	Deprecated - See columns PD, PE, PF Are there any carve outs or exceptions to the primary reimbursement methodology?	Reimbursement Exceptions - Primary	PRIMARY_REIMBURSEMENT_EXCEPTION_IND				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
410	Deprecated - See columns PD, PE, PF Are there any carve outs or exceptions to the primary reimbursement methodology? (Page#)		PRIMARY_REIMBURSEMENT_EXCEPTION_IND_PG
411	Are there any carve outs?		PRIMARY_REIMBURSEMENT_CARVEOUT_IND
412	If there are any exceptions to Primary Reimbursement Methodology, describe exceptions?		PRIMARY_REIMBURSEMENT_DESCRIBE_EXCEPTION
413	If there are any exceptions to Primary Reimbursement Methodology, describe exceptions? ( Page #)		PRIMARY_REIMBURSEMENT_DESCRIBE_EXCEPTION_PG
414
415	If the contract includes lesser of or greater of language, what is the secondary Reimbursement methodology?	Reimbursement Methodology -Secondary	SECONDARY_REIMBURSEMENT_METHODOLOGY				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
416	If the contract includes lesser of or greater of language, what is the secondary Reimbursement methodology? (Page#)		SECONDARY_REIMBURSEMENT_METHODOLOGY_PG
417	If the Secondary Reimbursement methodology is based on Procedure Codes, then list the applicable codes or code ranges	Applicable Procedure Codes - Secondary	SECONDARY_REIMBURSEMENT_PROC_CODES				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
418	If the Secondary Reimbursement methodology is based on Procedure Codes, then list the applicable codes or code ranges (Page#)		SECONDARY_REIMBURSEMENT_PROC_CODES_PG
419	If the Secondary Reimbursement methodology is based on Revenue Codes, then list the applicable codes or code ranges	Applicable Revenue Codes - Secondary	SECONDARY_REIMBURSEMENT_REVENUE_CODES				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
420	If the Secondary Reimbursement methodology is based on Revenue Codes, then list the applicable codes or code ranges (Page#)		SECONDARY_REIMBURSEMENT_REVENUE_CODES_PG
421	If the Secondary Reimbursement methodology is based on Revenue/ Procedure code combinations, then list the applicable code combinations	Applicable Revenue /Procedure Code Combinations - Secondary	SECONDARY_REIMBURSEMENT_PROC_REVENUE_CODE_COMBO				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
422	If the Secondary Reimbursement methodology is based on Revenue/ Procedure code combinations, then list the applicable code combinations (Page#)		SECONDARY_REIMBURSEMENT_PROC_REVENUE_CODE_COMBO_PG
423	If the Secondary Reimbursement methodology is based on Diagnosis Codes, then list the applicable codes or code ranges	Applicable Diagnosis Codes - Secondary	SECONDARY_REIMBURSEMENT_DIAG_CODES				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
424	If the Secondary Reimbursement methodology is based on Diagnosis Codes, then list the applicable codes or code ranges (Page#)		SECONDARY_REIMBURSEMENT_DIAG_CODES_PG
425	If the Secondary Reimbursement methodology is based on Grouper Codes, then list the applicable codes or code ranges	Applicable Grouper Codes - Secondary	SECONDARY_REIMBURSEMENT_GROUPER_CODES				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
426	If the Secondary Reimbursement methodology is based on Grouper Codes, then list the applicable codes or code ranges (Page#)		SECONDARY_REIMBURSEMENT_GROUPER_CODES_PG
427	If the Secondary Reimbursement methodology is based on Place of Service Codes, then list the applicable codes or code ranges	Applicable Place of Service Codes - Secondary	SECONDARY_REIMBURSEMENT_PLACEOFSERVICE_CODES				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
428	If the Secondary Reimbursement methodology is based on Place of Service Codes, then list the applicable codes or code ranges (Page#)		SECONDARY_REIMBURSEMENT_PLACEOFSERVICE_CODES_PG
429	If the Secondary Reimbursement methodology is based on Admit Type codes, then list the applicable codes or code ranges	Applicable Admit Type Codes - Secondary	SECONDARY_REIMBURSEMENT_ADMITTYPE_CODES				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
430	If the Secondary Reimbursement methodology is based on Admit Type codes, then list the applicable codes or code ranges (Page#)		SECONDARY_REIMBURSEMENT_ADMITTYPE_CODES_PG
431	If the Secondary Reimbursement methodology is based on Status Indicator codes, then list the applicable codes or code ranges	Applicable Status Indicator Codes - Secondary	SECONDARY_REIMBURSEMENT_STATUS_INDICATOR_CODES				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
432	If the Secondary Reimbursement methodology is based on Status Indicator codes, then list the applicable codes or code ranges (Page#)		SECONDARY_REIMBURSEMENT_STATUS_INDICATOR_CODES_PG
433	If the secondary reimbursement methodology is based on a Fee Schedule, what is the name of the fee schedule on which it is based?	Fee Schedule - Secondary	SECONDARY_REIMBURSEMENT_FEE_SCHEDULE				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
434	If the secondary reimbursement methodology is based on a Fee Schedule, what is the name of the fee schedule on which it is based? (Page#)		SECONDARY_REIMBURSEMENT_FEE_SCHEDULE_PG
435	If the secondary reimbursement methodology is based on a Fee Schedule, on which fee schedule VERSION is it based?	Fee Schedule Version - Secondary	SECONDARY_REIMBURSEMENT_FEE_SCHEDULE_VERSION				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
436	If the secondary reimbursement methodology is based on a Fee Schedule, on which fee schedule VERSION is it based? (Page#)		SECONDARY_REIMBURSEMENT_FEE_SCHEDULE_VERSION_PG
437	If the Secondary reimbursement methodology is based on Billed Charges, Fee Schedule, Cost Plus, AWP, or other percentage rate, what is the reimbursed percentage?	Reimbursement % Rate - Secondary	SECONDARY_REIMBURSEMENT_RATE				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
438	If the Secondary reimbursement methodology is based on Billed Charges, Fee Schedule, Cost Plus, AWP, or other percentage rate, what is the reimbursed percentage? (Page#)		SECONDARY_REIMBURSEMENT_RATE_PG
439	If the Secondary reimbursement methodology is based on a fee for service, flat rate, all-inclusive rate, episode of care rate, case rate, per diem rate, or other dollar rate, what is the reimbursed dollar amount?	Reimbursement $ Rate - Secondary	SECONDARY_REIMBURSEMENT_FLAT_FEE				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
440	If the Secondary reimbursement methodology is based on a fee for service, flat rate, all-inclusive rate, episode of care rate, case rate, per diem rate, or other dollar rate, what is the reimbursed dollar amount? (Page#)		SECONDARY_REIMBURSEMENT_FLAT_FEE_PG
441	If the Secondary reimbursement is based on codes listed on the CMS fee schedule, what is the comparable Medicare fee schedule rate?	Medicare $ Rate - Secondary	SECONDARY_REIMBURSEMENT_CMS_MEDICARE_RATE				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
442	If the Secondary reimbursement is based on codes listed on the CMS fee schedule, what is the comparable Medicare fee schedule rate? (Page#)		SECONDARY_REIMBURSEMENT_CMS_MEDICARE_RATE_PG
443	If the Secondary reimbursement is based on codes listed on the State Medicaid fee schedule, what is the comparable Medicaid fee schedule rate?	Medicaid $ Rate - Secondary	SECONDARY_REIMBURSEMENT_MEDICAID_RATE				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
444	If the Secondary reimbursement is based on codes listed on the State Medicaid fee schedule, what is the comparable Medicaid fee schedule rate? (Page#)		SECONDARY_REIMBURSEMENT_MEDICAID_RATE_PG
445	If the Secondary reimbursement methodology is based on a grouper rate, what is the applicable grouper methodology?	Reimbursement Grouper - Secondary	SECONDARY_REIMBURSEMENT_GROUPER				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
446	If the Secondary reimbursement methodology is based on a grouper rate, what is the applicable grouper methodology? (Page#)		SECONDARY_REIMBURSEMENT_GROUPER_PG
447	Are there any exceptions to the Secondary reimbursement methodology?	Reimbursement Exceptions - Secondary	SECONDARY_REIMBURSEMENT_EXCEPTION_IND				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
448	Are there any exceptions to the Secondary reimbursement methodology? (Page#)		SECONDARY_REIMBURSEMENT_EXCEPTION_IND_PG
449
450	If the contract includes lesser of or greater of language, what is the tertiary Reimbursement methodology (if any)?	Reimbursement Methodology - Tertiary	TERTIARY_REIMBURSEMENT_METHODOLOGY				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
451	If the contract includes lesser of or greater of language, what is the tertiary Reimbursement methodology (if any)? (Page#)		TERTIARY_REIMBURSEMENT_METHODOLOGY_PG
452	If the Tertiary Reimbursement methodology is based on Procedure Codes, then list the applicable codes or code ranges	Applicable Procedure Codes - Tertiary	TERTIARY_REIMBURSEMENT_PROC_CODES				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
453	If the Tertiary Reimbursement methodology is based on Procedure Codes, then list the applicable codes or code ranges (Page#)		TERTIARY_REIMBURSEMENT_PROC_CODES_PG
454	If the Tertiary Reimbursement methodology is based on Revenue Codes, then list the applicable codes or code ranges	Applicable Revenue Codes - Tertiary	TERTIARY_REIMBURSEMENT_REVENUE_CODES				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
455	If the Tertiary Reimbursement methodology is based on Revenue Codes, then list the applicable codes or code ranges (Page#)		TERTIARY_REIMBURSEMENT_REVENUE_CODES_PG
456	If the Tertiary Reimbursement methodology is based on Revenue/ Procedure code combinations, then list the applicable code combinations	Applicable Revenue /Procedure Code Combinations - Tertiary	TERTIARY_REIMBURSEMENT_PROC_REVENUE_CODE_COMBO				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
457	If the Tertiary Reimbursement methodology is based on Revenue/ Procedure code combinations, then list the applicable code combinations (Page#)		TERTIARY_REIMBURSEMENT_PROC_REVENUE_CODE_COMBO_PG
458	If the Tertiary Reimbursement methodology is based on Diagnosis Codes, then list the applicable codes or code ranges	Applicable Diagnosis Codes - Tertiary	TERTIARY_REIMBURSEMENT_DIAG_CODES				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
459	If the Tertiary Reimbursement methodology is based on Diagnosis Codes, then list the applicable codes or code ranges (Page#)		TERTIARY_REIMBURSEMENT_DIAG_CODES_PG
460	If the Tertiary Reimbursement methodology is based on Grouper Codes, then list the applicable codes or code ranges	Applicable Grouper Codes - Tertiary	TERTIARY_REIMBURSEMENT_GROUPER_CODES				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
461	If the Tertiary Reimbursement methodology is based on Grouper Codes, then list the applicable codes or code ranges (Page#)		TERTIARY_REIMBURSEMENT_GROUPER_CODES_PG
462	If the Tertiary Reimbursement methodology is based on Place of Service Codes, then list the applicable codes or code ranges	Applicable Place of Service Codes - Tertiary	TERTIARY_REIMBURSEMENT_PLACEOFSERVICE_CODES				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
463	If the Tertiary Reimbursement methodology is based on Place of Service Codes, then list the applicable codes or code ranges (Page#)		TERTIARY_REIMBURSEMENT_PLACEOFSERVICE_CODES_PG
464	If the Tertiary Reimbursement methodology is based on Admit Type codes, then list the applicable codes or code ranges	Applicable Admit Type Codes - Tertiary	TERTIARY_REIMBURSEMENT_ADMITTYPE_CODES				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
465	If the Tertiary Reimbursement methodology is based on Admit Type codes, then list the applicable codes or code ranges (Page#)		TERTIARY_REIMBURSEMENT_ADMITTYPE_CODES_PG
466	If the Tertiary Reimbursement methodology is based on Status Indicator codes, then list the applicable codes or code ranges	Applicable Status Indicator Codes - Tertiary	TERTIARY_REIMBURSEMENT_STATUS_INDICATOR_CODES				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
467	If the Tertiary Reimbursement methodology is based on Status Indicator codes, then list the applicable codes or code ranges (Page#)		TERTIARY_REIMBURSEMENT_STATUS_INDICATOR_CODES_PG
468	If the tertiary reimbursement methodology is based on a Fee Schedule, what is the name of the fee schedule on which it is based?	Fee Schedule - Tertiary	TERTIARY_REIMBURSEMENT_FEE_SCHEDULE				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
469	If the tertiary reimbursement methodology is based on a Fee Schedule, what is the name of the fee schedule on which it is based? (Page#)		TERTIARY_REIMBURSEMENT_FEE_SCHEDULE_PG
470	If the tertiary reimbursement methodology is based on a Fee Schedule, on which fee schedule VERSION is it based?	Fee Schedule Version - Tertiary	TERTIARY_REIMBURSEMENT_FEE_SCHEDULE_VERSION				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
471	If the tertiary reimbursement methodology is based on a Fee Schedule, on which fee schedule VERSION is it based? (Page#)		TERTIARY_REIMBURSEMENT_FEE_SCHEDULE_VERSION_PG
472	If the Tertiary reimbursement methodology is based on Billed Charges, Fee Schedule, Cost Plus, AWP, or other percentage rate, what is the reimbursed percentage?	Reimbursement % Rate - Tertiary	TERTIARY_REIMBURSEMENT_RATE				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
473	If the Tertiary reimbursement methodology is based on Billed Charges, Fee Schedule, Cost Plus, AWP, or other percentage rate, what is the reimbursed percentage? (Page#)		TERTIARY_REIMBURSEMENT_RATE_PG
474	If the Tertiary reimbursement methodology is based on a fee for service, flat rate, all-inclusive rate, episode of care rate, case rate, per diem rate, or other dollar rate, what is the reimbursed dollar amount?	Reimbursement $ Rate - Tertiary	TERTIARY_REIMBURSEMENT_FLAT_FEE				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
475	If the Tertiary reimbursement methodology is based on a fee for service, flat rate, all-inclusive rate, episode of care rate, case rate, per diem rate, or other dollar rate, what is the reimbursed dollar amount? (Page#)		TERTIARY_REIMBURSEMENT_FLAT_FEE_PG
476	If the Tertiary reimbursement is based on codes listed on the CMS fee schedule, what is the comparable Medicare fee schedule rate?	Medicare $ Rate - Tertiary	TERTIARY_REIMBURSEMENT_CMS_MEDICARE_RATE				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
477	If the Tertiary reimbursement is based on codes listed on the CMS fee schedule, what is the comparable Medicare fee schedule rate? (Page#)		TERTIARY_REIMBURSEMENT_CMS_MEDICARE_RATE_PG
478	If the Tertiary reimbursement is based on codes listed on the State Medicaid fee schedule, what is the comparable Medicaid fee schedule rate?	Medicaid $ Rate - Tertiary	TERTIARY_REIMBURSEMENT_MEDICAID_RATE				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
479	If the Tertiary reimbursement is based on codes listed on the State Medicaid fee schedule, what is the comparable Medicaid fee schedule rate? (Page#)		TERTIARY_REIMBURSEMENT_MEDICAID_RATE_PG
480	If the Tertiary reimbursement methodology is based on a grouper rate, what is the applicable grouper methodology?	Reimbursement Grouper - Tertiary	TERTIARY_REIMBURSEMENT_GROUPER				Yes	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
481	If the Tertiary reimbursement methodology is based on a grouper rate, what is the applicable grouper methodology? (Page#)		TERTIARY_REIMBURSEMENT_GROUPER_PG
482	Are there any exceptions to the Tertiary reimbursement methodology?	Reimbursement Exceptions - Tertiary	TERTIARY_REIMBURSEMENT_EXCEPTION_IND				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Reimbursement Methodology	Required Only If Available	PAYMENT ACCURACY NETWORK
483	Are there any exceptions to the Tertiary reimbursement methodology? (Page#)		TERTIARY_REIMBURSEMENT_EXCEPTION_IND_PG
484
485	Does the contract include a carve out for timeline for payer to implement changes in regulations per LOB Specific agreement?	Timeline State Marketplace Payer Policy Change Notice	CARVEOUT_IND_IMPLEMENT_POLICY_CHANGE				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Key Dates	Required Only If Available	PAYMENT ACCURACY COST AVOIDANCE
486	Does the contract include a carve out for timeline for payer to implement changes in regulations per LOB Specific agreement? (Page#)		CARVEOUT_IND_IMPLEMENT_POLICY_CHANGE_PG
487	Does the contract include a carve out for Emergency Department (Yes/No)?	Emergency Carve Out (Y/N)?	EMERGENCY_DEPARTMENT_CAREVEOUT_IND		F		No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
488	Does the contract include a carve out for Emergency Department (Yes/No)? (Page#)		EMERGENCY_DEPARTMENT_CAREVEOUT_IND_PG
489	If the contract includes a carve out for Emergency Department, list the applicable codes or code ranges	Emergency Codes or Code Range	EMERGENCY_DEPARTMENT_CAREVOUT_CODES		F		No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
490	If the contract includes a carve out for Emergency Department, list the type of applicable codes or code ranges	Types of Codes ( Ex. Revenue Codes, CPT, HCPCS, DRG etc)	EMERGENCY_DEPARTMENT_CARVEOUT_REIMBURSEMENT_METHODOLOGY
491	If the contract includes a carve out for Emergency Department, describe how these codes are reimbursed	Emergency Reimbursement Methodology	EMERGENCY_DEPARTMENT_CARVEOUT_SCHEDULE_NAME		G		No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
492	If the contract includes a carve out for Emergency Department, describe schedule name		EMERGENCY_DEPARTMENT_CAREVEOUT_SCHEDULE_VERSION		G
493	If the contract includes a carve out for Emergency Department, describe reference year or version		EMERGENCY_DEPARTMENT_CARVEOUT_DESCRIBE		G
494	If the contract includes a carve out for Emergency Department, describe reimbursement rate		OBSERVATION_CAREVEOUT_IND		G
495	If the contract includes a carve out for Emergency Department, what is the amount not to exceed?		OBSERVATION_CAREVEOUT_IND_PG
496	If the contract includes a carve out for Emergency Department, describe exclusions/exceptions		OBSERVATION_CAREVOUT_CODES
497	Does the contract include a carve out for Observation Codes(Yes/No)?		OBSERVATION_CARVEOUT_REIMBURSEMENT_METHODOLOGY		F
498	Does the contract include a carve out for Observation Codes(Yes/No)? (Page#)		OBSERVATION_CARVEOUT_SCHEDULE_NAME
499	If the contract includes a carve out for Observation, list the applicable codes or code ranges	Observation Codes or Code Range	OBSERVATION_CAREVEOUT_SCHEDULE_VERSION		F		No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
500	If the contract includes a carve out for Observation, list the type of applicable codes or code ranges	Types of Codes ( Ex. Revenue Codes, CPT, HCPCS, DRG etc)	OBSERVATION_CARVEOUT_DESCRIBE
501	If the contract includes a carve out for Observation, describe how these codes are reimbursed	Observation Reimbursement Methodology	AMBULATORY_SURGERY_CAREVEOUT_IND		G		No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
502	If the contract includes a carve out for Observation, describe schedule name		AMBULATORY_SURGERY_CAREVEOUT_IND_PG		G
503	If the contract includes a carve out for Observation, describe schedule reference year or version		AMBULATORY_SURGERY_CAREVOUT_CODES		G
504	If the contract includes a carve out for Observation, describe reimbursement rate		AMBULATORY_SURGERY_CARVEOUT_REIMBURSEMENT_METHODOLOGY		G
505	If the contract includes a carve out for Observation, describe exclusion/exceptions		AMBULATORY_SURGERY_CARVEOUT_SCHEDULE_NAME
506	Does the contract include a carve out for Ambulatory Surgery (Yes/No)?	Ambulatory Surgery Carve Out (Y/N)?	AMBULATORY_SURGERY_CAREVEOUT_SCHEDULE_VERSION				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
507	Does the contract include a carve out for Ambulatory Surgery (Yes/No)? (Page#)		AMBULATORY_SURGERY_CARVEOUT_DESCRIBE
508	If the contract includes a carve out for Ambulatory Surgery, list the applicable codes or code ranges	Ambulatory Surgery Codes or Code Range	INTENSIVE_CARE_CAREVEOUT_IND				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
509	If the contract includes a carve out for Ambulatory Surgery, list the type of applicable codes or code ranges		INTENSIVE_CARE_CAREVEOUT_IND_PG
510	If the contract includes a carve out for Ambulatory Surgery, describe how these codes are reimbursed	Ambulatory Surgery Reimbursement Methodology	INTENSIVE_CARE_CAREVOUT_CODES				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
511	If the contract includes a carve out for Ambulatory Surgery, describe schedule name		INTENSIVE_CARE_CARVEOUT_REIMBURSEMENT_METHODOLOGY
512	If the contract includes a carve out for Ambulatory Surgery, describe schedule reference year or version		INTENSIVE_CARE_CARVEOUT_SCHEDULE_NAME
513	If the contract includes a carve out for Ambulatory Surgery, describe reimbursement rate		INTENSIVE_CARE_CAREVEOUT_SCHEDULE_VERSION
514	If the contract includes a carve out for Ambulatory Surgery, describe exclusion/exceptions		INTENSIVE_CARE_CARVEOUT_DESCRIBE
515	Does the contract include a carve out for Intensive Care Unit (Yes/No)?	Intensive Care Carve Out (Y/N)?	TRAUMA_CAREVEOUT_IND				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
516	Does the contract include a carve out for Intensive Care Unit (Yes/No)? (Page#)		TRAUMA_CAREVEOUT_IND_PG
517	If the contract includes a carve out for Intensive Care Unit, list the applicable codes or code ranges	Intensive Care Codes or Code Range	TRAUMA_CAREVOUT_CODES				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
518	If the contract includes a carve out for Intensive Care Unit, list the type of applicable codes or code ranges		TRAUMA_CARVEOUT_REIMBURSEMENT_METHODOLOGY
519	If the contract includes a carve out for Intensive Care Unit, describe how these codes are reimbursed	Intensive Care Reimbursement Methodology	TRAUMA_CARVEOUT_SCHEDULE_NAME				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
520	If the contract includes a carve out for Intensive Care Unit, describe schedule name		TRAUMA_CAREVEOUT_SCHEDULE_VERSION
521	If the contract includes a carve out for Intensive Care Unit, describe schedule reference year or version		TRAUMA_CARVEOUT_DESCRIBE
522	If the contract includes a carve out for Intensive Care Unit, describe reimbursement rate		CANCER_CAREVEOUT_IND
523	If the contract includes a carve out for Intensive Care Unit, describe exclusions/exceptions		CANCER_CAREVEOUT_IND_PG
524	Does the contract include a carve out for Trauma (Yes/No)?	Trauma Carve Out (Y/N)?	CANCER_CAREVOUT_CODES				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
525	Does the contract include a carve out for Trauma (Yes/No)? (Page#)		CANCER_CARVEOUT_REIMBURSEMENT_METHODOLOGY
526	If the contract includes a carve out for Trauma, list the applicable codes or code ranges	Trauma Codes or Code Range	CANCER_CARVEOUT_SCHEDULE_NAME				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
527	If the contract includes a carve out for Trauma, list the type of applicable codes or code ranges		CANCER_CAREVEOUT_SCHEDULE_VERSION
528	If the contract includes a carve out for Trauma, describe how these codes are reimbursed	Trauma Reimbursement Methodology	CANCER_CARVEOUT_DESCRIBE				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
529	If the contract includes a carve out for Trauma, describe schedule name		HIV_CAREVEOUT_IND
530	If the contract includes a carve out for Trauma, describe schedule reference year or version		HIV_CAREVEOUT_IND_PG
531	If the contract includes a carve out for Trauma, describe reimbursement rate		HIV_CAREVOUT_CODES
532	If the contract includes a carve out for Trauma, describe exclusions/exceptions		HIV_CARVEOUT_REIMBURSEMENT_METHODOLOGY
533	Does the contract include a carve out for Cancer (Yes/No)?	Cancer Carve Out (Y/N)?	HIV_CARVEOUT_SCHEDULE_NAME				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
534	Does the contract include a carve out for Cancer (Yes/No)? (Page#)		HIV_CAREVEOUT_SCHEDULE_VERSION
535	If the contract includes a carve out for Cancer, list the applicable codes or code ranges	Cancer Codes or Code Range	HIV_CARVEOUT_DESCRIBE				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
536	If the contract includes a carve out for Cancer, list the type of applicable codes or code ranges		JOINT_REPLACE_CAREVEOUT_IND
537	If the contract includes a carve out for Cancer, describe how these codes are reimbursed	Cancer Reimbursement Methodology	JOINT_REPLACE_CAREVEOUT_IND_PG				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
538	If the contract includes a carve out for Cancer, describe schedule name		JOINT_REPLACE_CAREVOUT_CODES
539	If the contract includes a carve out for Cancer, describe schedule reference year or version		JOINT_REPLACE_CARVEOUT_REIMBURSEMENT_METHODOLOGY
540	If the contract includes a carve out for Cancer, describe reimbursement rate		JOINT_REPLACE_CARVEOUT_SCHEDULE_NAME
541	If the contract includes a carve out for Cancer, describe exclusions/exceptions		JOINT_REPLACE_CAREVEOUT_SCHEDULE_VERSION
542	Does the contract include a carve out for HIV (Yes/No)?	HIV Carve Out (Y/N)?	JOINT_REPLACE_CARVEOUT_DESCRIBE				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
543	Does the contract include a carve out for HIV (Yes/No)? (Page#)		TRANSPLANT_CAREVEOUT_IND
544	If the contract includes a carve out for HIV, list the applicable codes or code ranges	HIV Codes or Code Range	TRANSPLANT_CAREVEOUT_IND_PG				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
545	If the contract includes a carve out for HIV, list the type of applicable codes or code ranges		TRANSPLANT_CAREVOUT_CODES
546	If the contract includes a carve out for HIV, describe how these codes are reimbursed	HIV Reimbursement Methodology	TRANSPLANT_CARVEOUT_REIMBURSEMENT_METHODOLOGY				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
547	If the contract includes a carve out for HIV, describe schedule name		TRANSPLANT_CARVEOUT_SCHEDULE_NAME
548	If the contract includes a carve out for HIV, describe schedule reference year or version		TRANSPLANT_CAREVEOUT_SCHEDULE_VERSION
549	If the contract includes a carve out for HIV, describe reimbursement rate		TRANSPLANT_CARVEOUT_DESCRIBE
550	If the contract includes a carve out for HIV, describe exclusions/exceptions		OBGYN_CAREVEOUT_IND
551	Does the contract include a carve out for Major Joint Replacement (Yes/No)?	Joint Replacement Carve Out (Y/N)?	OBGYN_CAREVEOUT_IND_PG				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
552	Does the contract include a carve out for Major Joint Replacement (Yes/No)? (Page#)		OBGYN_CAREVOUT_CODES
553	If the contract includes a carve out for Major Joint Replacement, list the applicable codes or code ranges	Joint Replacement Codes or Code Range	OBGYN_CARVEOUT_REIMBURSEMENT_METHODOLOGY				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
554	If the contract includes a carve out for Major Joint Replacement, list the type of applicable codes or code ranges		OBGYN_CARVEOUT_SCHEDULE_NAME
555	If the contract includes a carve out for Major Joint Replacement, describe how these codes are reimbursed	Joint Replacement Reimbursement Methodology	OBGYN_CAREVEOUT_SCHEDULE_VERSION				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
556	If the contract includes a carve out for Major Joint Replacement, describe schedule name		OBGYN_CARVEOUT_DESCRIBE
557	If the contract includes a carve out for Major Joint Replacement, describe schedule reference year or version		OBGYN_CARVEOUT_LESSER_OF_BILLED_IND
558	If the contract includes a carve out for Major Joint Replacement, describe reimbursement rate		OBGYN_BILLED_CHARGE_REIMBURSEMENT_RATE
559	If the contract includes a carve out for Major Joint Replacement, describe exclusions/exceptions		OBGYN_CARVEOUT_DESCRIBE_EXCEPTIONS
560	Does the contract include a carve out for Transplant (Yes/No)?	Transplant Carve Out (Y/N)?	NEONATAL_CAREVEOUT_IND				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
561	Does the contract include a carve out for Transplant (Yes/No)? (Page#)		NEONATAL_CAREVEOUT_IND_PG
562	If the contract includes a carve out for Transplant, list the applicable codes or code ranges	Transplant Codes or Code Range	NEONATAL_CAREVOUT_CODES				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
563	If the contract includes a carve out for Transplant, list the type of applicable codes or code ranges		NEONATAL_CARVEOUT_REIMBURSEMENT_METHODOLOGY
564	If the contract includes a carve out for Transplant, describe how these codes are reimbursed	Transplant Reimbursement Methodology	NEONATAL_CARVEOUT_SCHEDULE_NAME				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
565	If the contract includes a carve out for Transplant, describe schedule name		NEONATAL_CAREVEOUT_SCHEDULE_VERSION
566	If the contract includes a carve out for Transplant, describe schedule reference year or version		NEONATAL_CARVEOUT_DESCRIBE
567	If the contract includes a carve out for Transplant, describe reimbursement rate		BEH_HEALTH_SUB_ABUSE_CAREVEOUT_IND
568	If the contract includes a carve out for Transplant, describe exclusions/exceptions		BEH_HEALTH_SUB_ABUSE_CAREVEOUT_IND_PG
569	Does the contract include a carve out for OB/GYN Services (Yes/No)?	OB/GYN Carve Out (Y/N)?	BEH_HEALTH_SUB_ABUSE_CAREVOUT_CODES				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
570	Does the contract include a carve out for OB/GYN Services (Yes/No)? (Page#)		BEH_HEALTH_SUB_ABUSE_CARVEOUT_REIMBURSEMENT_METHODOLOGY
571	If the contract includes a carve out for OB/GYN Services, list the applicable codes or code ranges	OB/GYN Codes or Code Range	BEH_HEALTH_SUB_ABUSE_CARVEOUT_SCHEDULE_NAME				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
572	If the contract includes a carve out for OB/GYN Services, list the type of applicable codes or code ranges		BEH_HEALTH_SUB_ABUSE_CAREVEOUT_SCHEDULE_VERSION
573	If the contract includes a carve out for OB/GYN Services, describe how these codes are reimbursed	OB/GYN Reimbursement Methodology	BEH_HEALTH_SUB_ABUSE_CARVEOUT_DESCRIBE				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
574	If the contract includes a carve out for OB/GYN Services, describe schedule name		OPHTHAMOLOGY_CAREVEOUT_IND
575	If the contract includes a carve out for OB/GYN Services, describe schedule reference year or version		OPHTHAMOLOGY_CAREVEOUT_IND_PG
576	If the contract includes a carve out for OB/GYN Services, describe reimbursement rate		OPHTHAMOLOGY_CAREVOUT_CODES
577	If the contract includes a carve out for OB/GYN Services, is there a lesser of billed charges clause? (Yes/No)		OPHTHAMOLOGY_CARVEOUT_REIMBURSEMENT_METHODOLOGY
578	If the contract includes a carve out for OB/GYN Services, describe billed charges reimbursement rate		OPHTHAMOLOGY_CARVEOUT_SCHEDULE_NAME
579	If the contract includes a carve out for OB/GYN, describe exclusions/exceptions		OPHTHAMOLOGY_CAREVEOUT_SCHEDULE_VERSION
580	Does the contract include a carve out for Neonatal Services (Yes/No)?	Neonatal Carve Out (Y/N)?	OPHTHAMOLOGY_CARVEOUT_DESCRIBE				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
581	Does the contract include a carve out for Neonatal Services (Yes/No)? (Page#)		NEVER_EVENT_CAREVEOUT_IND
582	If the contract includes a carve out for Neonatal Services, list the applicable codes or code ranges	Neonatal Codes or Code Range	NEVER_EVENT_CAREVEOUT_IND_PG				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
583	If the contract includes a carve out for Neonatal Services, list the type of applicable codes or code ranges		NEVER_EVENT_CAREVOUT_CODES
584	If the contract includes a carve out for Neonatal Services, describe how these codes are reimbursed	Neonatal Reimbursement Methodology	NEVER_EVENT_CARVEOUT_REIMBURSEMENT_METHODOLOGY				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
585	If the contract includes a carve out for Neonatal Services, describe schedule name		NEVER_EVENT_CARVEOUT_SCHEDULE_NAME
586	If the contract includes a carve out for Neonatal Services, describe schedule reference year or version		NEVER_EVENT_CAREVEOUT_SCHEDULE_VERSION
587	If the contract includes a carve out for Neonatal Services, describe reimbursement rate		NEVER_EVENT_CARVEOUT_DESCRIBE
588	If the contract includes a carve out for Neonatal Services, describe exceptions/exclusions		NOT_MED_NECESSARY_CAREVEOUT_IND
589	Does the contract include a carve out for Behavioral Health & Substance Abuse Services (Yes/No)?	Behavioral Health & Substance Abuse Carve Out (Y/N)?	NOT_MED_NECESSARY_CAREVEOUT_IND_PG				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
590	Does the contract include a carve out for Behavioral Health & Substance Abuse Services (Yes/No)? (Page#)		NOT_MED_NECESSARY_CAREVOUT_CODES
591	If the contract includes a carve out for Behavioral Health & Substance Abuse Services, list the applicable codes or code ranges	Behavioral Health & Substance Abuse Codes or Code Range	NOT_MED_NECESSARY_CARVEOUT_REIMBURSEMENT_METHODOLOGY				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
592	If the contract includes a carve out for Behavioral Health & Substance Abuse Services, list the type of applicable codes or code ranges		NOT_MED_NECESSARY_CARVEOUT_SCHEDULE_NAME
593	If the contract includes a carve out for Behavioral Health & Substance Abuse Services, describe how these codes are reimbursed	Behavioral Health & Substance Abuse Reimbursement Methodology	NOT_MED_NECESSARY_CAREVEOUT_SCHEDULE_VERSION				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
594	If the contract includes a carve out for Behavioral Health & Substance Abuse Services, describe schedule name		NOT_MED_NECESSARY_CARVEOUT_DESCRIBE
595	If the contract includes a carve out for Behavioral Health & Substance Abuse Services, describe schedule reference year or version		EXPERIMENTAL_PROCEDURES_CAREVEOUT_IND
596	If the contract includes a carve out for Behavioral Health & Substance Abuse Services, describe reimbursement rate		EXPERIMENTAL_PROCEDURES_CAREVEOUT_IND_PG
597	If the contract includes a carve out for Behavioral Health & Substance Abuse Services, describe exceptions/exclusions		EXPERIMENTAL_PROCEDURES_CAREVOUT_CODES
598	Does the contract include a carve out for Ophthalmology & Vision Services (Yes/No)?	Ophthalmology & Vision Services Carve Out (Y/N)?	EXPERIMENTAL_PROCEDURES_CARVEOUT_REIMBURSEMENT_METHODOLOGY				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
599	Does the contract include a carve out for Ophthalmology & Vision Services (Yes/No)? (Page#)		EXPERIMENTAL_PROCEDURES_CARVEOUT_SCHEDULE_NAME
600	If the contract includes a carve out for Ophthalmology & Vision Services, list the applicable codes or code ranges	Ophthalmology & Vision Services Codes or Code Range	EXPERIMENTAL_PROCEDURES_CAREVEOUT_SCHEDULE_VERSION				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
601	If the contract includes a carve out for Ophthalmology & Vision Services, list the type of applicable codes or code ranges		EXPERIMENTAL_PROCEDURES_CARVEOUT_DESCRIBE
602	If the contract includes a carve out for Ophthalmology & Vision Services, describe how these codes are reimbursed	Ophthalmology & Vision Services Reimbursement Methodology	INVESTIGATIONAL_PROCEDURES_CAREVEOUT_IND				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
603	If the contract includes a carve out for Ophthalmology & Vision Services, describe schedule name		INVESTIGATIONAL_PROCEDURES_CAREVEOUT_IND_PG
604	If the contract includes a carve out for Ophthalmology & Vision Services, describe schedule reference year or version		INVESTIGATIONAL_PROCEDURES_CAREVOUT_CODES
605	If the contract includes a carve out for Ophthalmology & Vision Services, describe reimbursement rate		INVESTIGATIONAL_PROCEDURES_CARVEOUT_REIMBURSEMENT_METHODOLOGY
606	If the contract includes a carve out for Ophthalmology & Vision Services, describe exceptions/exclusions		INVESTIGATIONAL_PROCEDURES_CARVEOUT_SCHEDULE_NAME
607	Does the contract include a carve out for never events (Yes/No)?	Never Event Carve Out (Y/N)?	INVESTIGATIONAL_PROCEDURES_CAREVEOUT_SCHEDULE_VERSION				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
608	Does the contract include a carve out for never events (Yes/No)? (Page#)		INVESTIGATIONAL_PROCEDURES_CARVEOUT_DESCRIBE
609	If the contract includes a carve out for never events, list the applicable codes or code ranges	Never Event Codes or Code Range	UNLISTED_CAREVEOUT_IND				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
610	If the contract includes a carve out for never events, list the type of applicable codes or code ranges		UNLISTED_CAREVEOUT_IND_PG
611	If the contract includes a carve out for never events, describe how these codes are reimbursed	Never Event Reimbursement Methodology	UNLISTED_CAREVOUT_CODES				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
612	If the contract includes a carve out for never events, describe schedule name		UNLISTED_CARVEOUT_REIMBURSEMENT_METHODOLOGY
613	If the contract includes a carve out for never events, describe schedule reference year or version		UNLISTED_CARVEOUT_SCHEDULE_NAME
614	If the contract includes a carve out for never events, describe reimbursement rate		UNLISTED_CAREVEOUT_SCHEDULE_VERSION
615	If the contract includes a carve out for never events, describe exceptions/exclusions		UNLISTED_CARVEOUT_DESCRIBE
616	Does the contract include a carve out for procedures that are not medically necessary (Yes/No)?	Not Medically Necessary Procedures Carve Out (Y/N)?	UNLISTED_CARVEOUT_DESCRIBE_EXCEPTIONS				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
617	Does the contract include a carve out for procedures that are not medically necessary (Yes/No)? (Page#)		INVALID_CODES_CAREVEOUT_IND
618	If the contract includes a carve out for procedures that are not medically necessary, list the applicable codes or code ranges	Not Medically Necessary Codes or Code Range	INVALID_CODES_CAREVEOUT_IND_PG				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
619	If the contract includes a carve out for procedures that are not medically necessary, list the type of applicable codes or code ranges		INVALID_CODES_CAREVOUT_CODES
620	If the contract includes a carve out for procedures that are not medically necessary, describe how these codes are reimbursed	Not Medically Necessary Reimbursement Methodology	INVALID_CODES_CARVEOUT_REIMBURSEMENT_METHODOLOGY				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
621	If the contract includes a carve out for procedures that are not medically necessary, describe schedule name		INVALID_CODES_CARVEOUT_SCHEDULE_NAME
622	If the contract includes a carve out for procedures that are not medically necessary, describe schedule reference year or version		INVALID_CODES_CAREVEOUT_SCHEDULE_VERSION
623	If the contract includes a carve out for procedures that are not medically necessary, describe reimbursement rate		INVALID_CODES_CARVEOUT_DESCRIBE
624	If the contract includes a carve out for procedures that are not medically necessary, describe exceptions/exclusions		DME_CAREVEOUT_IND
625	Does the contract include a carve out for experimental procedures (Yes/No)?	Experimental Procedures Carve Out (Y/N)?	DME_CAREVEOUT_IND_PG				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
626	Does the contract include a carve out for experimental procedures (Yes/No)? (Page#)		DME_CAREVOUT_CODES
627	If the contract includes a carve out for experimental procedures, list the applicable codes or code ranges	Experimental Codes or Code Range	DME_CARVEOUT_REIMBURSEMENT_METHODOLOGY				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
628	If the contract includes a carve out for experimental procedures, list the type of applicable codes or code ranges		DME_CARVEOUT_SCHEDULE_NAME
629	If the contract includes a carve out for experimental procedures, describe how these codes are reimbursed	Experimental Reimbursement Methodology	DME_CAREVEOUT_SCHEDULE_VERSION				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
630	If the contract includes a carve out for experimental procedures, describe schedule name		DME_CARVEOUT_DESCRIBE
631	If the contract includes a carve out for experimental procedures, describe schedule reference year or version		DME_CARVEOUT_DESCRIBE_EXCEPTIONS
632	If the contract includes a carve out for experimental procedures, describe reimbursement rate		PROSTHETICS_CAREVEOUT_IND
633	If the contract includes a carve out for experimental procedures, describe exceptions/exclusions		PROSTHETICS_CAREVEOUT_IND_PG
634	Does the contract include a carve out for investigational procedures (Yes/No)?	Investigational Procedures Carve Out (Y/N)?	PROSTHETICS_CAREVOUT_CODES				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
635	Does the contract include a carve out for investigational procedures (Yes/No)? (Page#)		PROSTHETICS_CARVEOUT_REIMBURSEMENT_METHODOLOGY
636	If the contract includes a carve out for investigational procedures, list the applicable codes or code ranges	Investigational Codes or Code Range	PROSTHETICS_CARVEOUT_SCHEDULE_NAME				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
637	If the contract includes a carve out for investigational procedures, list the type of applicable codes or code ranges		PROSTHETICS_CAREVEOUT_SCHEDULE_VERSION
638	If the contract includes a carve out for investigational procedures, describe how these codes are reimbursed	Investigational Reimbursement Methodology	PROSTHETICS_CARVEOUT_DESCRIBE				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
639	If the contract includes a carve out for investigational procedures, describe schedule name		IMPLANTS_CAREVEOUT_IND
640	If the contract includes a carve out for investigational procedures, describe schedule reference year or version		IMPLANTS_CAREVEOUT_IND_PG
641	If the contract includes a carve out for investigational procedures, describe reimbursement rate		IMPLANTS_CAREVOUT_CODES
642	If the contract includes a carve out for investigational procedures, describe exceptions/exclusions		IMPLANTS_CARVEOUT_REIMBURSEMENT_METHODOLOGY
643	Does the contract include a carve out for Unlisted codes (Yes/No)?	Unlisted Codes Carve Out (Y/N)?	IMPLANTS_CARVEOUT_SCHEDULE_NAME				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
644	Does the contract include a carve out for Unlisted codes (Yes/No)? (Page#)		IMPLANTS_CAREVEOUT_SCHEDULE_VERSION
645	If the contract includes a carve out for Unlisted codes, list the applicable codes or code ranges	Unlisted Codes or Code Range	IMPLANTS_CARVEOUT_DESCRIBE				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
646	If the contract includes a carve out for Unlist the type of applicable codes or code ranges		IMPLANTS_CARVEOUT_DESCRIBE_EXCEPTIONS
647	If the contract includes a carve out for Unlisted codes, describe how these codes are reimbursed	Unlisted Code Reimbursement Methodology	HEARING_AID_SVCS_CAREVEOUT_IND				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
648	If the contract includes a carve out for Unlisted codes, describe schedule name		HEARING_AID_SVCS_CAREVEOUT_IND_PG
649	If the contract includes a carve out for Unlisted codes, describe schedule reference year or version		HEARING_AID_SVCS_CAREVOUT_CODES
650	If the contract includes a carve out for Unlisted codes, describe reimbursement rate		HEARING_AID_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGY
651	If the contract includes a carve out for Unlisted Codes, describe exceptions/exclusions		HEARING_AID_SVCS_CARVEOUT_SCHEDULE_NAME
652	Does the contract include a carve out for invalid codes (Yes/No)?	Invalid Codes Carve Out (Y/N)?	HEARING_AID_SVCS_CAREVEOUT_SCHEDULE_VERSION				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
653	Does the contract include a carve out for invalid codes (Yes/No)? (Page#)		HEARING_AID_SVCS_CARVEOUT_DESCRIBE
654	If the contract includes a carve out for invalid codes, list the applicable codes or code ranges	Invalid Codes or Code Range	ANESTHESIA_CAREVEOUT_IND				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
655	If the contract includes a carve out for invalid codes, list the type of applicable codes or code ranges		ANESTHESIA_CAREVEOUT_IND_PG
656	If the contract includes a carve out for invalid codes, describe how these codes are reimbursed	Invalid Code Reimbursement Methodology	ANESTHESIA_CAREVOUT_CODES				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
657	If the contract includes a carve out for invalid codes, describe schedule name		ANESTHESIA_CARVEOUT_REIMBURSEMENT_METHODOLOGY
658	If the contract includes a carve out for invalid codes, describe schedule reference year or version		ANESTHESIA_CARVEOUT_SCHEDULE_NAME
659	If the contract includes a carve out for invalid codes, describe reimbursement rate		ANESTHESIA_CAREVEOUT_SCHEDULE_VERSION
660	If the contract includes a carve out for invalid codes, describe exceptions/exclusions		ANESTHESIA_CARVEOUT_DESCRIBE
661	Does the contract include a carve out for Durable Medical Equipment (Yes/No)?	Durable Medical Equipment Carve Out (Y/N)?	ANESTHESIA_CARVEOUT_LESSER_OF_BILLED_IND				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
662	Does the contract include a carve out for Durable Medical Equipment (Yes/No)? (Page#)		ANESTHESIA_BILLED_CHARGE_REIMBURSEMENT_RATE
663	If the contract includes a carve out for Durable Medical Equipment, list the applicable codes or code ranges	Durable Medical Equipment Codes or Code Range	ADMINISTERED_DRUGS_CAREVEOUT_IND				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
664	If the contract includes a carve out for Durable Medical Equipment, list the type of applicable codes or code ranges		ADMINISTERED_DRUGS_CAREVEOUT_IND_PG
665	If the contract includes a carve out for Durable Medical Equipment, describe how these codes are reimbursed	Durable Medical Equipment Reimbursement Methodology	ADMINISTERED_DRUGS_CAREVOUT_CODES				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
666	If the contract includes a carve out for Durable Medical Equipment, describe schedule name		ADMINISTERED_DRUGS_CARVEOUT_REIMBURSEMENT_METHODOLOGY
667	If the contract includes a carve out for Durable Medical Equipment, describe schedule reference year or version		ADMINISTERED_DRUGS_CARVEOUT_SCHEDULE_NAME
668	If the contract includes a carve out for Durable Medical Equipment, describe reimbursement rate		ADMINISTERED_DRUGS_CAREVEOUT_SCHEDULE_VERSION
669	If the contract includes a carve out for Durable Medical Equipment, describe exceptions/exclusions		ADMINISTERED_DRUGS_CARVEOUT_DESCRIBE
670	Does the contract include a carve out for prosthetics (Yes/No)?	Prosthetics Carve Out (Y/N)?	ADMINISTERED_DRUGS_CARVEOUT_DESCRIBE_EXCEPTIONS				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
671	Does the contract include a carve out for prosthetics (Yes/No)? (Page#)		ADMINISTERED_DRUGS_CARVEOUT_LESSER_OF_BILLED_IND
672	If the contract includes a carve out for prosthetics, list the applicable codes or code ranges	Prosthetics Codes or Code Range	ADMINISTERED_DRUGS_BILLED_CHARGE_REIMBURSEMENT_RATE				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
673	If the contract includes a carve out for prosthetics, list the type of applicable codes or code ranges		GLOBAL_SVCS_CAREVEOUT_IND
674	If the contract includes a carve out for prosthetics, describe how these codes are reimbursed	Prosthetics Reimbursement Methodology	GLOBAL_SVCS_CAREVEOUT_IND_PG				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
675	If the contract includes a carve out for prosthetics, describe schedule name		GLOBAL_SVCS_CAREVOUT_CODES
676	If the contract includes a carve out for prosthetics, describe schedule reference year or version		GLOBAL_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGY
677	If the contract includes a carve out for prosthetics, describe reimbursement rate		GLOBAL_SVCS_CARVEOUT_SCHEDULE_NAME
678	If the contract includes a carve out for prosthetics, what is reimbursement if threshold is reached (% of billed charges)?		GLOBAL_SVCS_CAREVEOUT_SCHEDULE_VERSION
679	If the contract includes a carve out for prosthetics, describe exceptions/exclusions		GLOBAL_SVCS_CARVEOUT_DESCRIBE
680	Does the contract include a carve out for implants (Yes/No)?	Implants Carve Out (Y/N)?	BUNDLED_UNBUNDLED_CAREVEOUT_IND				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
681	Does the contract include a carve out for implants (Yes/No)? (Page#)		BUNDLED_UNBUNDLED_CAREVEOUT_IND_PG
682	If the contract includes a carve out for implants, list the applicable codes or code ranges	Implants Codes or Code Range	BUNDLED_UNBUNDLED_CAREVOUT_CODES				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
683	If the contract includes a carve out for implants, list the type of applicable codes or code ranges		BUNDLED_UNBUNDLED_CARVEOUT_REIMBURSEMENT_METHODOLOGY
684	If the contract includes a carve out for implants, describe how these codes are reimbursed	Implants Reimbursement Methodology	BUNDLED_UNBUNDLED_CARVEOUT_SCHEDULE_NAME				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
685	If the contract includes a carve out for implants, describe schedule name		BUNDLED_UNBUNDLED_CAREVEOUT_SCHEDULE_VERSION
686	If the contract includes a carve out for implants, describe schedule reference year or version		BUNDLED_UNBUNDLED_CARVEOUT_DESCRIBE
687	If the contract includes a carve out for implants, describe reimbursement rate		MULTIPLE_PROCEDURE_REDUCTIONS_CAREVEOUT_IND
688	If the contract includes a carve out for prosthetics, what is reimbursement if threshold is reached (% of billed charges)?		MULTIPLE_PROCEDURE_REDUCTIONS_CAREVEOUT_IND_PG
689	If the contract includes a carve out for implants, describe exceptions/exclusions		MULTIPLE_PROCEDURE_REDUCTIONS_CAREVOUT_CODES
690	Does the contract include a carve out for Hearing Aids & Hearing Services (Yes/No)?	Hearing Aids & Hearing Services Carve Out (Y/N)?	MULTIPLE_PROCEDURE_REDUCTIONS_CARVEOUT_REIMBURSEMENT_METHODOLOGY				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
691	Does the contract include a carve out for Hearing Aids & Hearing Services (Yes/No)? (Page#)		MULTIPLE_PROCEDURE_REDUCTIONS_CARVEOUT_SCHEDULE_NAME
692	If the contract includes a carve out for Hearing Aids & Hearing Services, list the applicable codes or code ranges	Hearing Aids & Hearing Services Codes or Code Range	MULTIPLE_PROCEDURE_REDUCTIONS_CAREVEOUT_SCHEDULE_VERSION				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
693	If the contract includes a carve out for Hearing Aids & Hearing Services, list the type of applicable codes or code ranges		MULTIPLE_PROCEDURE_REDUCTIONS_CARVEOUT_DESCRIBE
694	If the contract includes a carve out for Hearing Aids & Hearing Services, describe how these codes are reimbursed	Hearing Aids & Hearing Services Reimbursement Methodology	SECOND_SURGERIES_CAREVEOUT_IND				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
695	If the contract includes a carve out for Hearing Aids & Hearing Services, describe schedule name		SECOND_SURGERIES_CAREVEOUT_IND_PG
696	If the contract includes a carve out for Hearing Aids & Hearing Services, describe schedule reference year or version		SECOND_SURGERIES_CAREVOUT_CODES
697	If the contract includes a carve out for Hearing Aids & Hearing Services, describe reimbursement rate		SECOND_SURGERIES_CARVEOUT_REIMBURSEMENT_METHODOLOGY
698	If the contract includes a carve out for Hearing Aids & Hearing Services, describe exceptions/exclusions		SECOND_SURGERIES_CARVEOUT_SCHEDULE_NAME
699	Does the contract include a carve out for anesthesia (Yes/No)?	Anesthesia Carve Out (Y/N)?	SECOND_SURGERIES_CAREVEOUT_SCHEDULE_VERSION				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
700	Does the contract include a carve out for anesthesia (Yes/No)? (Page#)		SECOND_SURGERIES_CARVEOUT_DESCRIBE
701	If the contract includes a carve out for anesthesia, list the applicable codes or code ranges	Anesthesia Codes or Code Range	SUBSEQUENT_SURGERIES_CAREVEOUT_IND				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
702	If the contract includes a carve out for anesthesia, list the type of applicable codes or code ranges		SUBSEQUENT_SURGERIES_CAREVEOUT_IND_PG
703	If the contract includes a carve out for anesthesia, describe how these codes are reimbursed	Anesthesia Reimbursement Methodology	SUBSEQUENT_SURGERIES_CAREVOUT_CODES				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
704	If the contract includes a carve out for anesthesia, describe schedule name		SUBSEQUENT_SURGERIES_CARVEOUT_REIMBURSEMENT_METHODOLOGY
705	If the contract includes a carve out for anesthesia, describe schedule reference year or version		SUBSEQUENT_SURGERIES_CARVEOUT_SCHEDULE_NAME
706	If the contract includes a carve out for anesthesia, describe reimbursement rate		SUBSEQUENT_SURGERIES_CAREVEOUT_SCHEDULE_VERSION
707	If the contract includes a carve out for anesthesia, is there a lesser of billed charges clause? (Yes/No)		SUBSEQUENT_SURGERIES_CARVEOUT_DESCRIBE
708	If the contract includes a carve out for anesthesia, describe billed charges reimbursement rate		MID_LEVEL_PROFESSIONAL_CAREVEOUT_IND
709	If the contract includes a carve out for anesthesia, describe exceptions/exclusions		MID_LEVEL_PROFESSIONAL_CAREVEOUT_IND_PG
710	Does the contract include a carve out for medical pharmacy and/or physician administered drugs (Yes/No)?	Medical Pharmacy Carve Out (Y/N)?	MID_LEVEL_PROFESSIONAL_CAREVOUT_CODES				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
711	Does the contract include a carve out for medical pharmacy and/or physician administered drugs (Yes/No)? (Page#)		MID_LEVEL_PROFESSIONAL_CARVEOUT_REIMBURSEMENT_METHODOLOGY
712	If the contract includes a carve out for medical pharmacy and/or physician administered drugs, list the applicable codes or code ranges	Medical Pharmacy Codes or Code Range	MID_LEVEL_PROFESSIONAL_CARVEOUT_SCHEDULE_NAME				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
713	If the contract includes a carve out for medical pharmacy and/or physician administered drugs, list the type of applicable codes or code ranges		MID_LEVEL_PROFESSIONAL_CAREVEOUT_SCHEDULE_VERSION
714	If the contract includes a carve out for medical pharmacy and/or physician administered drugs, describe how these codes are reimbursed	Medical Reimbursement Methodology	MID_LEVEL_PROFESSIONAL_CARVEOUT_DESCRIBE				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
715	If the contract includes a carve out for medical pharmacy and/or physician administered drugs, describe schedule name		TECHNICAL_COMPONENT_CAREVEOUT_IND
716	If the contract includes a carve out for medical pharmacy and/or physician administered drugs, describe schedule reference year or version		TECHNICAL_COMPONENT_CAREVEOUT_IND_PG
717	If the contract includes a carve out for medical pharmacy and/or physician administered drugs, describe reimbursement rate		TECHNICAL_COMPONENT_CAREVOUT_CODES
718	If the contract includes a carve out for medical pharmacy and/or physician administered drugs, describe exceptions/exclusions		TECHNICAL_COMPONENT_CARVEOUT_REIMBURSEMENT_METHODOLOGY
719	If the contract includes a carve out for medical pharmacy and/or physician administered drugs, is there a lesser of billed charges clause? (Yes/No)		TECHNICAL_COMPONENT_CARVEOUT_SCHEDULE_NAME
720	If the contract includes a carve out for medical pharmacy and/or physician administered drugs, describe billed charges reimbursement rate		TECHNICAL_COMPONENT_CAREVEOUT_SCHEDULE_VERSION
721	If the contract includes a carve out for medical pharmacy and/or physician administered drugs, what is reimbursement if threshold is reached (% of billed charges)?		TECHNICAL_COMPONENT_CARVEOUT_DESCRIBE
722	Does the contract include a carve out for global services (Yes/No)?	Global Services Carve Out (Y/N)?	PROFESSIONAL_COMPONENT_CAREVEOUT_IND				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
723	Does the contract include a carve out for global services (Yes/No)? (Page#)		PROFESSIONAL_COMPONENT_CAREVEOUT_IND_PG
724	If the contract includes a carve out for global services, list the applicable codes or code ranges	Global Services Codes or Code Range	PROFESSIONAL_COMPONENT_CAREVOUT_CODES				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
725	If the contract includes a carve out for global services, list the type of applicable codes or code ranges		PROFESSIONAL_COMPONENT_CARVEOUT_REIMBURSEMENT_METHODOLOGY
726	If the contract includes a carve out for global services, describe how these codes are reimbursed	Global Services Reimbursement Methodology	PROFESSIONAL_COMPONENT_CARVEOUT_SCHEDULE_NAME				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
727	If the contract includes a carve out for global services, describe schedule name		PROFESSIONAL_COMPONENT_CAREVEOUT_SCHEDULE_VERSION
728	If the contract includes a carve out for global services, describe schedule reference year or version		PROFESSIONAL_COMPONENT_CARVEOUT_DESCRIBE
729	If the contract includes a carve out for global services, describe reimbursement rate		LAB_PATHOLOGY_CAREVEOUT_IND
730	If the contract includes a carve out for global services, describe exceptions/exclusions		LAB_PATHOLOGY_CAREVEOUT_IND_PG
731	Does the contract include a carve out for bundled or unbundled codes (e.g., bundling, unbundling) (Yes/No)?	Bundled Services Carve Out (Y/N)?	LAB_PATHOLOGY_CAREVOUT_CODES				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
732	Does the contract include a carve out for bundled or unbundled codes (e.g., bundling, unbundling) (Yes/No)? (Page#)		LAB_PATHOLOGY_CARVEOUT_REIMBURSEMENT_METHODOLOGY
733	If the contract includes a carve out for bundling or unbundling, list the applicable codes or code ranges	Bundled Services Codes or Code Range	LAB_PATHOLOGY_CARVEOUT_SCHEDULE_NAME				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
734	If the contract includes a carve out for bundling or unbundling, list the type of applicable codes or code ranges		LAB_PATHOLOGY_CAREVEOUT_SCHEDULE_VERSION
735	If the contract includes a carve out for bundling or unbundling, describe how these codes are reimbursed	Bundled Services Reimbursement Methodology	LAB_PATHOLOGY_CARVEOUT_DESCRIBE				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
736	If the contract includes a carve out for bundling or unbundling, describe schedule name		LAB_PATHOLOGY_CARVEOUT_LESSER_OF_BILLED_IND
737	If the contract includes a carve out for bundling or unbundling, describe schedule reference year or version		LAB_PATHOLOGY_BILLED_CHARGE_REIMBURSEMENT_RATE
738	If the contract includes a carve out for bundling or unbundling, describe reimbursement rate		LAB_PATHOLOGY_CARVEOUT_DESCRIBE_EXCEPTIONS
739	If the contract includes a carve out for bundling or unbundling, describe exceptions/exclusions		RADIOLOGY_IMAGING_CAREVEOUT_IND
740	Does the contract include a carve out for Multiple Procedure Reductions (i.e., discounted procedures) (Yes/No)?	Reductions Carve Out (Y/N)?	RADIOLOGY_IMAGING_CAREVEOUT_IND_PG				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
741	Does the contract include a carve out for Multiple Procedure Reductions (i.e., discounted procedures) (Yes/No)? (Page#)		RADIOLOGY_IMAGING_CAREVOUT_CODES
742	If the contract includes a carve out for Multiple Procedure Reductions, which types of reductions apply?	Reduced Services Codes or Code Range	RADIOLOGY_IMAGING_CARVEOUT_REIMBURSEMENT_METHODOLOGY				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
743	If the contract address Multiple Procedure Reductions, for each type of reduction, what reimbursement methodology applies?	Reduced Services Reimbursement Methodology	RADIOLOGY_IMAGING_CARVEOUT_SCHEDULE_NAME				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
744	If the contract includes a carve out for Multiple Procedure Reductions, describe schedule name		RADIOLOGY_IMAGING_CAREVEOUT_SCHEDULE_VERSION
745	If the contract address Multiple Procedure Reductions, describe schedule reference year or version		RADIOLOGY_IMAGING_CARVEOUT_DESCRIBE
746	If the contract includes a carve out for Multiple Procedure Reductions, describe reimbursement rate		RADIOLOGY_IMAGING_CARVEOUT_DESCRIBE_EXCEPTIONS
747	If the contract includes a carve out for Multiple Procedure Reductions, describe exceptions/exclusions		DIAGNOSTIC_SVCS_CAREVEOUT_IND
748	Does the contract include a carve out for second surgeries and/or procedures (Yes/No)?	Second Surgery/Procedure Carve Out (Y/N)?	DIAGNOSTIC_SVCS_CAREVEOUT_IND_PG				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
749	Does the contract include a carve out for second surgeries and/or procedures (Yes/No)? (Page#)		DIAGNOSTIC_SVCS_CAREVOUT_CODES
750	If the contract includes a carve out for second surgeries and/or procedures, list the applicable codes or code ranges	Second Surgery/Procedure Codes or Code Range	DIAGNOSTIC_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGY				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
751	If the contract includes a carve out for second surgeries and/or procedures, list the type of applicable codes or code ranges		DIAGNOSTIC_SVCS_CARVEOUT_SCHEDULE_NAME
752	If the contract includes a carve out for second surgeries and/or procedures, describe how these codes are reimbursed	Second Surgery/Procedure Reimbursement Methodology	DIAGNOSTIC_SVCS_CAREVEOUT_SCHEDULE_VERSION				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
753	If the contract includes a carve out for second surgeries and/or procedures, describe schedule name		DIAGNOSTIC_SVCS_CARVEOUT_DESCRIBE
754	If the contract includes a carve out for second surgeries and/or procedures, describe schedule reference year or version		PREADMISSION_PROC_CAREVEOUT_IND
755	If the contract includes a carve out for second surgeries and/or procedures, describe reimbursement rate		PREADMISSION_PROC_CAREVEOUT_IND_PG
756	If the contract includes a carve out for second surgeries and/or procedures, describe exceptions/exclusions		PREADMISSION_PROC_CAREVOUT_CODES
757	Does the contract include a carve out for subsequent surgeries and/or procedures (Yes/No)?	Subsequent Surgery/Procedure Carve Out (Y/N)?	PREADMISSION_PROC_CARVEOUT_REIMBURSEMENT_METHODOLOGY				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
758	Does the contract include a carve out for subsequent surgeries and/or procedures (Yes/No)? (Page#)		PREADMISSION_PROC_CAREVEOUT_WINDOW
759	If the contract includes a carve out for subsequent surgeries and/or procedures, list the applicable codes or code ranges	Subsequent Surgery/Procedure Codes or Code Range	PREADMISSION_PROC_CARVEOUT_SCHEDULE_NAME				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
760	If the contract includes a carve out for subsequent surgeries and/or procedures, list the type of applicable codes or code ranges		PREADMISSION_PROC_CAREVEOUT_SCHEDULE_VERSION
761	If the contract includes a carve out for subsequent surgeries and/or procedures, describe how these codes are reimbursed	Subsequent Surgery/Procedure Reimbursement Methodology	PREADMISSION_PROC_CARVEOUT_DESCRIBE				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
762	If the contract includes a carve out for subsequent surgeries and/or procedures, describe schedule name		POSTDISCHARGE_PROC_CAREVEOUT_IND
763	If the contract includes a carve out for subsequent surgeries and/or procedures, describe schedule reference year or version		POSTDISCHARGE_PROC_CAREVEOUT_IND_PG
764	If the contract includes a carve out for subsequent surgeries and/or procedures, describe reimbursement rate		POSTDISCHARGE_PROC_CAREVOUT_CODES
765	If the contract includes a carve out for subsequent surgeries and/or procedures, describe exceptions/exclusions		POSTDISCHARGE_PROC_CARVEOUT_REIMBURSEMENT_METHODOLOGY
766	Does the contract include a carve out for Mid-Level Professionals (Yes/No)?	Mid-Level Carve Out (Y/N)?	POSTDISCHARGE_PROC_CARVEOUT_WINDOW				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
767	Does the contract include a carve out for Mid-Level Professionals (Yes/No)? (Page#)		POSTDISCHARGE_PROC_CARVEOUT_SCHEDULE_NAME
768	If the contract includes a carve out for Mid-Level Professionals, list the applicable codes or code ranges	Mid-Level Codes or Code Range	POSTDISCHARGE_PROC_CAREVEOUT_SCHEDULE_VERSION				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
769	If the contract includes a carve out for Mid-Level Professionals, list the type of applicable codes or code ranges		POSTDISCHARGE_PROC_CARVEOUT_DESCRIBE
770	If the contract includes a carve out for Mid-Level Professionals, list the type of applicable codes or code ranges	Mid-Level Reimbursement Methodology	READMISSIONS_CAREVEOUT_IND				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
771	If the contract includes a carve out for Mid-Level Professionals, describe schedule name		READMISSIONS_CAREVEOUT_IND_PG
772	If the contract includes a carve out for Mid-Level Professionals, describe schedule reference year or version		READMISSIONS_CAREVOUT_CODES
773	If the contract includes a carve out for Mid-Level Professionals, describe reimbursement rate		READMISSIONS_CARVEOUT_REIMBURSEMENT_METHODOLOGY
774	If the contract includes a carve out for Mid-Level Professionals, describe exceptions/exclusions		READMISSIONS_CAREVEOUT_WINDOW
775	Does the contract include a carve out for Technical Component (Yes/No)?	Technical Component Carve Out (Y/N)?	READMISSIONS_CARVEOUT_SCHEDULE_NAME				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
776	Does the contract include a carve out for Technical Component (Yes/No)? (Page#)		READMISSIONS_CAREVEOUT_SCHEDULE_VERSION
777	If the contract includes a carve out for Technical Component, list the applicable codes or code ranges	Technical Component Codes or Code Range	READMISSIONS_CARVEOUT_DESCRIBE				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
778	If the contract includes a carve out for Technical Component, list the type of applicable codes or code ranges		STATUS_INDICATORS_CAREVEOUT_IND
779	If the contract includes a carve out for Technical Component, describe how these codes are reimbursed	Technical Component Reimbursement Methodology	STATUS_INDICATORS_CAREVEOUT_IND_PG				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
780	If the contract includes a carve out for Technical Component, describe schedule name		STATUS_INDICATORS_CAREVOUT_CODES
781	If the contract includes a carve out for Technical Component, describe schedule reference year or version		STATUS_INDICATORS_CARVEOUT_REIMBURSEMENT_METHODOLOGY
782	If the contract includes a carve out for Technical Component, describe reimbursement rate		STATUS_INDICATORS_CARVEOUT_SCHEDULE_NAME
783	If the contract includes a carve out for Technical Component, describe any exclusions/exceptions		STATUS_INDICATORS_CAREVEOUT_SCHEDULE_VERSION
784	Does the contract include a carve out for Professional Component (Yes/No)?	Professional Component Carve Out (Y/N)?	STATUS_INDICATORS_CARVEOUT_DESCRIBE				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
785	Does the contract include a carve out for Professional Component (Yes/No)? (Page#)		OUTLIER_PROVISIONS_CAREVEOUT_IND
786	If the contract includes a carve out for Professional Component, list the applicable codes or code ranges	Professional Component Codes or Code Range	OUTLIER_PROVISIONS_CAREVEOUT_IND_PG				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
787	If the contract includes a carve out for Professional Component, list the type of applicable codes or code ranges		OUTLIER_PROVISIONS_CAREVOUT_CODES
788	If the contract includes a carve out for Professional Component, describe how these codes are reimbursed	Professional Component Reimbursement Methodology	OUTLIER_PROVISIONS_CARVEOUT_REIMBURSEMENT_METHODOLOGY				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
789	If the contract includes a carve out for Professional Component, describe schedule name		OUTLIER_PROVISIONS_CARVEOUT_SCHEDULE_NAME
790	If the contract includes a carve out for Professional Component, describe schedule reference year or version		OUTLIER_PROVISIONS_CAREVEOUT_SCHEDULE_VERSION
791	If the contract includes a carve out for Professional Component, describe reimbursement rate		OUTLIER_PROVISIONS_CARVEOUT_DESCRIBE
792	If the contract includes a carve out for Professional Component, describe any exclusions/exceptions		OUTLIER_PROVISIONS_CARVEOUT_DESCRIBE_EXCEPTIONS
793	Does the contract include a carve out for Laboratory / Pathology (Yes/No)?	Laboratory / Pathology Carve Out (Y/N)?					No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
794	Does the contract include a carve out for Laboratory / Pathology (Yes/No)? (Page#)
795	If the contract includes a carve out for Laboratory / Pathology , list the applicable codes or code ranges	Laboratory / Pathology Codes or Code Range	STOP_LOSS_CAREVEOUT_IND				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
796	If the contract includes a carve out for Laboratory / Pathology , list the type of applicable codes or code ranges		STOP_LOSS_CAREVEOUT_IND_PG
797	If the contract includes a carve out for Laboratory / Pathology , describe how these codes are reimbursed	Laboratory / Pathology Reimbursement Methodology	STOP_LOSS_CAREVOUT_THRESHOLD				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
798	If the contract includes a carve out for Laboratory / Pathology , describe schedule name		STOP_LOSS_CARVEOUT_PERCENT_ALLOWED
799	If the contract includes a carve out for Laboratory / Pathology , describe schedule reference year or version		STOP_LOSS_CARVEOUT_EMS_TRAUMA_CODES
800	If the contract includes a carve out for Laboratory / Pathology , describe reimbursement rate		STOP_LOSS_CARVEOUT_EMS_TRAUMA_RATES
801	If the contract includes a carve out for Laboratory / Pathology , is there a lesser of billed charges clause? (Yes/No)
802	If the contract includes a carve out for Laboratory / Pathology , describe billed charges reimbursement rate
803	If the contract includes a carve out for Laboratory / Pathology , describe exception/exclusions		VACCINE_CHILDREN_CAREVEOUT_IND
804	Does the contract include a carve out for Radiology/Imaging Services (Yes/No)?	Radiology/Imaging Carve Out (Y/N)?	VACCINE_CHILDREN_CAREVEOUT_IND_PG				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
805	Does the contract include a carve out for Radiology/Imaging Services (Yes/No)? (Page#)		VACCINE_CHILDREN_CAREVOUT_CODES
806	If the contract includes a carve out for Radiology/Imaging Services, list the applicable codes or code ranges	Radiology/Imaging Codes or Code Range	VACCINE_CHILDREN_CARVEOUT_REIMBURSEMENT_METHODOLOGY				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
807	If the contract includes a carve out for Radiology/Imaging Services, list the type of applicable codes or code ranges		VACCINE_CHILDREN_CARVEOUT_SCHEDULE_NAME
808	If the contract includes a carve out for Radiology/Imaging Services, describe how these codes are reimbursed	Radiology/Imaging Reimbursement Methodology	VACCINE_CHILDREN_CAREVEOUT_SCHEDULE_VERSION				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
809	If the contract includes a carve out for Radiology/Imaging Services, describe schedule name		VACCINE_CHILDREN_CARVEOUT_DESCRIBE
810	If the contract includes a carve out for Radiology/Imaging Services, describe schedule reference year or version		SURGICAL_ASSIST_CAREVEOUT_IND
811	If the contract includes a carve out for Radiology/Imaging Services, describe reimbursement rate		SURGICAL_ASSIST_CAREVEOUT_IND_PG
812	If the contract includes a carve out for Radiology / Imaging , describe exceptions/exclusions		SURGICAL_ASSIST_CAREVOUT_CODES
813	Does the contract include a carve out for diagnostic services (Yes/No)?	Diagnostic Services Carve Out (Y/N)?	SURGICAL_ASSIST_CARVEOUT_REIMBURSEMENT_METHODOLOGY				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
814	Does the contract include a carve out for diagnostic services (Yes/No)? (Page#)		SURGICAL_ASSIST_CARVEOUT_SCHEDULE_NAME
815	If the contract includes a carve out for diagnostic services, list the applicable codes or code ranges	Diagnostic Services Codes or Code Range	SURGICAL_ASSIST_CAREVEOUT_SCHEDULE_VERSION				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
816	If the contract includes a carve out for diagnostic services, list the type of applicable codes or code ranges		SURGICAL_ASSIST_CARVEOUT_DESCRIBE
817	If the contract includes a carve out for diagnostic services, describe how these codes are reimbursed	Diagnostic Services Reimbursement Methodology					No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
818	If the contract includes a carve out for diagnostic services, describe schedule name
819	If the contract includes a carve out for diagnostic services, describe schedule reference year or version		PHY_CLINICAL_PSYCHOLOGIST_CAREVEOUT_IND
820	If the contract includes a carve out for diagnostic services, describe reimbursement rate		PHY_CLINICAL_PSYCHOLOGIST_CAREVEOUT_IND_PG
821	If the contract includes a carve out for diagnostic services, describe exceptions/exclusions		PHY_CLINICAL_PSYCHOLOGIST_CAREVOUT_CODES
822	Does the contract include a carve out for pre-admission procedures (Yes/No)?	Pre-Admission Procedures Carve Out (Y/N)?	PHY_CLINICAL_PSYCHOLOGIST_CARVEOUT_REIMBURSEMENT_METHODOLOGY				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
823	Does the contract include a carve out for pre-admission procedures (Yes/No)? (Page#)		PHY_CLINICAL_PSYCHOLOGIST_CARVEOUT_SCHEDULE_NAME
824	If the contract includes a carve out for pre-admission procedures, list the applicable codes or code ranges	Pre-Admission Services Codes or Code Range	PHY_CLINICAL_PSYCHOLOGIST_CAREVEOUT_SCHEDULE_VERSION				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
825	If the contract includes a carve out for pre-admission procedures, list the type of applicable codes or code ranges		PHY_CLINICAL_PSYCHOLOGIST_CARVEOUT_DESCRIBE
826	If the contract includes a carve out for pre-admission procedures, describe how these codes are reimbursed	Pre-Admission Services Reimbursement Methodology	AUDIO_CHIRO_DIETICIAN_CAREVEOUT_IND				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
827	If the contract includes a carve out for pre-admissions procedures, how long is the pre-admission window?	Pre-Admission Window	AUDIO_CHIRO_DIETICIAN_CAREVEOUT_IND_PG				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
828	If the contract includes a carve out for pre-admission procedures, describe schedule name		AUDIO_CHIRO_DIETICIAN_CAREVOUT_CODES
829	If the contract includes a carve out for pre-admissions procedures, describe schedule reference year or version		AUDIO_CHIRO_DIETICIAN_CARVEOUT_REIMBURSEMENT_METHODOLOGY
830	If the contract includes a carve out for pre-admission procedures, describe reimbursement rate		AUDIO_CHIRO_DIETICIAN_CARVEOUT_SCHEDULE_NAME
831	If the contract includes a carve out for pre-admission procedures, describe exceptions/exclusions		AUDIO_CHIRO_DIETICIAN_CAREVEOUT_SCHEDULE_VERSION
832	Does the contract include a carve out for post-discharge procedures (Yes/No)?	Post-Discharge Procedures Carve Out (Y/N)?	AUDIO_CHIRO_DIETICIAN_CARVEOUT_DESCRIBE				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
833	Does the contract include a carve out for post-discharge procedures (Yes/No)? (Page#)		CERT_BH_ANALYST_CAREVEOUT_IND
834	If the contract includes a carve out for post-discharge procedures, list the applicable codes or code ranges	Post-Discharge Services Codes or Code Range	CERT_BH_ANALYST_CAREVEOUT_IND_PG				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
835	If the contract includes a carve out for post-discharge procedures, list the type of applicable codes or code ranges		CERT_BH_ANALYST_CAREVOUT_CODES
836	If the contract includes a carve out for post-discharge procedures, describe how these codes are reimbursed	Post-Discharge Services Reimbursement Methodology	CERT_BH_ANALYST_CARVEOUT_REIMBURSEMENT_METHODOLOGY				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
837	If the contract includes a carve out for post-discharge procedures, how long is the post-discharge window?	Post-Discharge Window	CERT_BH_ANALYST_CARVEOUT_SCHEDULE_NAME				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
838	If the contract includes a carve out for post-discharge procedures, describe schedule name		CERT_BH_ANALYST_CAREVEOUT_SCHEDULE_VERSION
839	If the contract includes a carve out for post-discharge procedures, describe schedule reference year or version		CERT_BH_ANALYST_CARVEOUT_DESCRIBE
840	If the contract includes a carve out for post-discharge procedures, describe reimbursement rate		INDEPENDENT_LICENSURES_CAREVEOUT_IND
841	If the contract includes a carve out for post-discharge procedures, describe exceptions/exclusions		INDEPENDENT_LICENSURES_CAREVEOUT_IND_PG
842	Does the contract include a carve out for readmissions (Yes/No)?	Readmissions Carve Out (Y/N)?	INDEPENDENT_LICENSURES_CAREVOUT_CODES				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
843	Does the contract include a carve out for readmissions (Yes/No)? (Page#)		INDEPENDENT_LICENSURES_CARVEOUT_REIMBURSEMENT_METHODOLOGY
844	If the contract includes a carve out for readmissions, list the applicable codes or code ranges	Readmissions Codes or Code Range	INDEPENDENT_LICENSURES_CARVEOUT_SCHEDULE_NAME				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
845	If the contract includes a carve out for readmissions, list the type of applicable codes or code ranges		INDEPENDENT_LICENSURES_CAREVEOUT_SCHEDULE_VERSION
846	If the contract includes a carve out for readmissions, describe how these codes are reimbursed	Readmissions Reimbursement Methodology	INDEPENDENT_LICENSURES_CARVEOUT_DESCRIBE				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
847	If the contract includes a carve out for readmissions, how long is the readmission window?	Readmissions Window	BH_OP_CLINICS_CAREVEOUT_IND				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
848	If the contract includes a carve out for readmissions, describe schedule name		BH_OP_CLINICS_CAREVEOUT_IND_PG
849	If the contract includes a carve out for readmissions, describe schedule reference year or version		BH_OP_CLINICS_CAREVOUT_CODES
850	If the contract includes a carve out for readmissions, describe reimbursement rate		BH_OP_CLINICS_CARVEOUT_REIMBURSEMENT_METHODOLOGY
851	If the contract includes a carve out for readmissions, describe exceptions/exclusions		BH_OP_CLINICS_CARVEOUT_SCHEDULE_NAME
852	Does the contract include a carve out for certain Status Indicators (Yes/No)?	Status Indicator Carve Out (Y/N)?	BH_OP_CLINICS_CAREVEOUT_SCHEDULE_VERSION				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
853	Does the contract include a carve out for certain Status Indicators (Yes/No)? (Page#)		BH_OP_CLINICS_CARVEOUT_DESCRIBE
854	If the contract includes a carve out for certain Status Indicators, list the applicable codes or code ranges	Status Indicator Codes or Code Range	POS_THERAPISTS_CAREVEOUT_IND				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
855	If the contract includes a carve out for certain Status Indicators, list the type of applicable codes or code ranges		POS_THERAPISTS_CAREVEOUT_IND_PG
856	If the contract includes a carve out for certain Status Indicators, describe how these codes are reimbursed	Status Indicator Reimbursement Methodology	POS_THERAPISTS_CAREVOUT_CODES				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
857	If the contract includes a carve out for certain Status Indicators, describe schedule name		POS_THERAPISTS_CARVEOUT_REIMBURSEMENT_METHODOLOGY
858	If the contract includes a carve out for certain Status Indicators, describe schedule reference year or version		POS_THERAPISTS_CARVEOUT_SCHEDULE_NAME
859	If the contract includes a carve out for certain Status Indicators, describe reimbursement rate		POS_THERAPISTS_CAREVEOUT_SCHEDULE_VERSION
860	If the contract includes a carve out for certain Status Indicators, describe exceptions/exclusions		POS_THERAPISTS_CARVEOUT_DESCRIBE
861	Does the contract include a carve out for outlier provisions (Yes/No)?	Outlier Provisions (Y/N)?	TRANSPORTATION_SVCS_CAREVEOUT_IND				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY NETWORK
862	Does the contract include a carve out for outlier provisions (Yes/No)? (Page#)		TRANSPORTATION_SVCS_CAREVEOUT_IND_PG
863	If the contract includes a carve out for outlier provisions, what is the outlier threshold?	Outlier Threshold	TRANSPORTATION_SVCS_CAREVOUT_CODES				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY NETWORK
864	If the contract includes a carve out for outlier provisions, what is the reimbursement method?	Outlier Allowed Amount	TRANSPORTATION_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGY				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY NETWORK
865	If the contract includes a carve out for outlier provisions, describe schedule name		TRANSPORTATION_SVCS_CARVEOUT_SCHEDULE_NAME
866	If the contract includes a carve out for outlier provisions, describe schedule reference year or version		TRANSPORTATION_SVCS_CAREVEOUT_SCHEDULE_VERSION
867	If the contract includes a carve out for outlier provisions, describe reimbursement rate		TRANSPORTATION_SVCS_CARVEOUT_DESCRIBE
868	If contract includes a carve out for outlier provisions, describe exceptions/exclusions		PCP_MEDICAL_CAREVEOUT_IND
869	If contract includes a carve out for outlier provisions, for any exclusions/exceptions, list applicable codes that will be excluded from the outlier payment		PCP_MEDICAL_CAREVEOUT_IND_PG				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY NETWORK
870	If contract includes a carve out for outlier provisions, describe any maximum daily rates for total payments		PCP_MEDICAL_CAREVOUT_CODES
871	Does the contact include a carve out for stop loss (Yes/No)?	Stop Loss (Y/N)?	PCP_MEDICAL_CARVEOUT_REIMBURSEMENT_METHODOLOGY				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY NETWORK
872	Does the contact include a carve out for stop loss (Yes/No)? (Page#)		PCP_MEDICAL_CARVEOUT_SCHEDULE_NAME
873	If the contract includes a carve out for stop loss, what is the stop loss threshold?	Stop Loss Threshold	PCP_MEDICAL_CAREVEOUT_SCHEDULE_VERSION				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY NETWORK
874	If the contract includes a carve out for stop loss, what is the percent allowed above the stop loss threshold?	Stop Loss Allowed Amount	PCP_MEDICAL_CARVEOUT_DESCRIBE				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY NETWORK
875	If the contract includes a carve out for stop loss, what are the EMS Trauma codes?		PCP_BH_CAREVEOUT_IND
876	If the contract includes a carve out for stop list the EMS type of applicable codes or code ranges		PCP_BH_CAREVEOUT_IND_PG
877	If the contract includes a carve out for stop loss, what are the EMS Trauma rates?		PCP_BH_CAREVOUT_CODES
878	Does the contact include a carve out for NICU stop loss (Yes/No)?		PCP_BH_CARVEOUT_REIMBURSEMENT_METHODOLOGY
879	Does the contact include a carve out for Catastrophic stop loss (Yes/No)?		PCP_BH_CARVEOUT_SCHEDULE_NAME
880	What is the threshold for Catastrophic Stoploss Threshold		PCP_BH_CAREVEOUT_SCHEDULE_VERSION
881	What is the threshold for Catastrophic Stoploss % of Billed charges		PCP_BH_CARVEOUT_DESCRIBE
882	If the contract includes a carve out for stop loss, describe any exclusions/exceptions		BH_MID_LEVEL_PRACTIONER_CAREVEOUT_IND				No	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY NETWORK
883	If the contract includes a carve out for stop loss, describe any exclusions/exceptions (Page#)		BH_MID_LEVEL_PRACTIONER_CAREVOUT_CODES
884	Does the contract include a carveout for Vaccine for Children (Yes/No)?	Client-Specific Carve Out #1 (Y/N)	BH_MID_LEVEL_PRACTIONER_CARVEOUT_REIMBURSEMENT_METHODOLOGY				TBD	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
885	Does the contract include a carveout for Vaccine for Children (Yes/No)? (Page#)		BH_MID_LEVEL_PRACTIONER_CARVEOUT_SCHEDULE_NAME
886	If the contract includes Vaccine for Children carve outs, list the applicable codes or code ranges	Client-Specific Carve Out #1 Codes or Code Range	BH_MID_LEVEL_PRACTIONER_CAREVEOUT_SCHEDULE_VERSION				TBD	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
887	If the contract includes Vaccine for Children carve outs, list the type of applicable codes or code ranges		BH_MID_LEVEL_PRACTIONER_CARVEOUT_DESCRIBE
888	If the contract includes Vaccine for Children client-specific carve outs, describe how these codes are reimbursed	Client-Specific Carve Out #1 Reimbursement Methodology	BH_MID_LEVEL_PRACTIONER_CARVEOUT_DESCRIBE				TBD	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
889	If the contract includes Vaccine for Children carve outs, describe schedule name
890	If the contract includes Vaccine for Children client-specific carve outs, describe schedule reference year or version
891	If the contract includes Vaccine for Children carve outs, describe reimbursement rate
892	If the contract includes Vaccine for Children client-specific carve outs, describe any exclusions/exceptions
893	Does the contract include Surgical Assist/Assistant carve outs (Yes/No)?	Client-Specific Carve Out #2 (Y/N)					TBD	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
894	Does the contract include Surgical Assist/Assistant carve outs (Yes/No)? (Page#)
895	If the contract includes Surgical Assist/Assistant carve outs, list the applicable codes or code ranges	Client-Specific Carve Out #2 Codes or Code Range	BCBA_BH_CAREVEOUT_IND				TBD	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
896	If the contract includes Surgical Assist/Assistant carve outs, list the type of applicable codes or code ranges		BCBA_BH_CAREVEOUT_IND_PG
897	If the contract includes Surgical Assist/Assistant carve outs, describe how these codes are reimbursed		BCBA_BH_CAREVOUT_CODES
898	If the contract includes Surgical Assist/Assistant carve outs, describe schedule name		BCBA_BH_CARVEOUT_REIMBURSEMENT_METHODOLOGY
899	If the contract includes Surgical Assist/Assistant carve outs, describe schedule reference year or version		BCBA_BH_CARVEOUT_SCHEDULE_NAME
900	If the contract includes Surgical Assist/Assistant carve outs, describe reimbursement rate		BCBA_BH_CAREVEOUT_SCHEDULE_VERSION
901	If the contract includes Surgical Assist/Assistant carve outs, describe any exclusions/exceptions		BCBA_BH_CARVEOUT_DESCRIBE
902	If the contract includes other client-specific carve outs, describe how these codes are reimbursed	Client-Specific Carve Out #2 Reimbursement Methodology	INDEPENDENT_LICENSURES_BH_CAREVEOUT_IND				TBD	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
903	If the contract includes other client-specific carve outs, describe how these codes are reimbursed (Page#)		INDEPENDENT_LICENSURES_BH_CAREVEOUT_IND_PG
904	Does the contract include Physicians/Clinical Psychologists (MD, DO, PhD, DPN) carve outs (Yes/No)?	Client-Specific Carve Out #3 (Y/N)	INDEPENDENT_LICENSURES_BH_CAREVOUT_CODES				TBD	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
905	Does the contract include Physicians/Clinical Psychologists (MD, DO, PhD, DPN) carve outs (Yes/No)? (Page#)		INDEPENDENT_LICENSURES_BH_CARVEOUT_REIMBURSEMENT_METHODOLOGY
906	If the contract includes physicians/Clinical Psychologists (MD, DO, PhD, DPN) carve outs, list the applicable codes or code ranges	Client-Specific Carve Out #3 Codes or Code Range	INDEPENDENT_LICENSURES_BH_CARVEOUT_SCHEDULE_NAME				TBD	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
907	If the contract includes physicians/Clinical Psychologists (MD, DO, PhD, DPN) carve outs, list the type of applicable codes or code ranges		INDEPENDENT_LICENSURES_BH_CAREVEOUT_SCHEDULE_VERSION
908	If the contract includes physicians/Clinical Psychologists (MD, DO, PhD, DPN) carve outs, describe how these codes are reimbursed	Client-Specific Carve Out #3 Reimbursement Methodology	INDEPENDENT_LICENSURES_BH_CARVEOUT_DESCRIBE				TBD	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
909	If the contract includes physicians/Clinical Psychologists (MD, DO, PhD, DPN) carve outs, describe schedule name
910	If the contract includes physicians/Clinical Psychologists (MD, DO, PhD, DPN) carve outs, describe schedule reference year or version
911	If the contract includes physicians/Clinical Psychologists (MD, DO, PhD, DPN) carve outs, describe reimbursement rate
912	If the contract includes physicians/Clinical Psychologists (MD, DO, PhD, DPN) carve outs, describe any exclusions/exceptions
913	Does the contract include Audiologists, Chiropractors, Registered Dieticians (AUDs, DCs, RDs)carve outs (Yes/No)?	Client-Specific Carve Out #4-25 (Y/N)					TBD	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
914	Does the contract include Audiologists, Chiropractors, Registered Dieticians (AUDs, DCs, RDs)carve outs (Yes/No)? (Page#)
915	If the contract includes Audiologists, Chiropractors, Registered Dieticians (AUDs, DCs, RDs) carve outs, list the applicable codes or code ranges	Client-Specific Carve Out #4-25 Codes or Code Range					TBD	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
916	If the contract includes Audiologists, Chiropractors, Registered Dieticians (AUDs, DCs, RDs) carve outs, list the type of applicable codes or code ranges
917	If the contract includes audiologists, Chiropractors, Registered Dieticians (AUDs, DCs, RDs), describe how these codes are reimbursed	Client-Specific Carve Out #4-25 Reimbursement Methodology					TBD	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
918	If the contract includes audiologists, Chiropractors, Registered Dieticians (AUDs, DCs, RDs), describe schedule name
919	If the contract includes audiologists, Chiropractors, Registered Dieticians (AUDs, DCs, RDs), describe schedule reference year or version
920	If the contract includes audiologists, Chiropractors, Registered Dieticians (AUDs, DCs, RDs), describe reimbursement rate
921	If the contract includes Audiologists, Chiropractors, Registered Dieticians (AUDs, DCs, RDs) carve outs, describe any exclusions/exceptions
922	Does the contract include Board Certified Behavioral Analyst (BCBA) carve outs (Yes/No)?	Client-Specific Carve Out #4-25 (Y/N)					TBD	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
923	Does the contract include Board Certified Behavioral Analyst (BCBA) carve outs (Yes/No)? (Page#)		DENTIST_CAREVEOUT_IND
924	If the contract includes Board Certified Behavioral Analyst (BCBA) carve outs, list the applicable codes or code ranges	Client-Specific Carve Out #4-25 Codes or Code Range	DENTIST_CAREVEOUT_IND_PG				TBD	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
925	If the contract includes Board Certified Behavioral Analyst (BCBA) carve outs, list the type of applicable codes or code ranges		DENTIST_CAREVOUT_CODES
926	If the contract includes Board Certified Behavioral Analyst (BCBA) carve outs, describe how these codes are reimbursed	Client-Specific Carve Out #4-25 Reimbursement Methodology	DENTIST_CARVEOUT_REIMBURSEMENT_METHODOLOGY				TBD	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
927	If the contract includes Board Certified Behavioral Analyst (BCBA) carve outs, describe schedule name		DENTIST_CARVEOUT_SCHEDULE_NAME
928	If the contract includes Board Certified Behavioral Analyst (BCBA) carve outs, describe schedule reference year or version		DENTIST_CAREVEOUT_SCHEDULE_VERSION
929	If the contract includes Board Certified Behavioral Analyst (BCBA) carve outs, describe reimbursement rate		DENTIST_CARVEOUT_DESCRIBE
930	If the contract includes Board Certified Behavioral Analyst (BCBA) carve outs, describe any exclusions/exceptions		SUPPLIES_DEVICES_CAREVEOUT_IND
931	Does the contract include Independent Licensures (LPC, LMFT, LISAC, LCSW) carve outs (Yes/No)?	Client-Specific Carve Out #4-25 (Y/N)	SUPPLIES_DEVICES_CAREVEOUT_IND_PG				TBD	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
932	Does the contract include Independent Licensures (LPC, LMFT, LISAC, LCSW) carve outs (Yes/No)? (Page#)		SUPPLIES_DEVICES_CAREVOUT_CODES
933	If the contract includes Independent Licensures (LPC, LMFT, LISAC, LCSW) carve outs, list the applicable codes or code ranges	Client-Specific Carve Out #4-25 Codes or Code Range	SUPPLIES_DEVICES_CARVEOUT_REIMBURSEMENT_METHODOLOGY				TBD	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
934	If the contract includes Independent Licensures (LPC, LMFT, LISAC, LCSW) carve outs, list the type of applicable codes or code ranges		SUPPLIES_DEVICES_CARVEOUT_SCHEDULE_NAME
935	If the contract includes Independent Licensures (LPC, LMFT, LISAC, LCSW) carve outs, describe how these codes are reimbursed	Client-Specific Carve Out #4-25 Reimbursement Methodology	SUPPLIES_DEVICES_CAREVEOUT_SCHEDULE_VERSION				TBD	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
936	If the contract includes Independent Licensures (LPC, LMFT, LISAC, LCSW) carve outs, describe schedule name		SUPPLIES_DEVICES_CARVEOUT_DESCRIBE
937	If the contract includes Independent Licensures (LPC, LMFT, LISAC, LCSW) carve outs, describe schedule reference year or version		SUPPLIES_DEVICES_CARVEOUT_LESSER_OF_BILLED_IND
938	If the contract includes Independent Licensures (LPC, LMFT, LISAC, LCSW) carve outs, describe reimbursement rate		SUPPLIES_DEVICES_BILLED_CHARGE_REIMBURSEMENT_RATE
939	If the contract includes Independent Licensures (LPC, LMFT, LISAC, LCSW) carve outs, describe any exclusions/exceptions		IMMUNIZATION_CAREVEOUT_IND
940	Does the contract include Behavioral Health Outpatient Clinics/Integrated Clinics carve outs (Yes/No)?	Client-Specific Carve Out #4-25 (Y/N)	IMMUNIZATION_CAREVEOUT_IND_PG				TBD	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
941	Does the contract include Behavioral Health Outpatient Clinics/Integrated Clinics carve outs (Yes/No)? (Page#)		IMMUNIZATION_CAREVOUT_CODES
942	If the contract includes Behavioral Health Outpatient Clinics/Integrated Clinics carve outs, list the applicable codes or code ranges	Client-Specific Carve Out #4-25 Codes or Code Range	IMMUNIZATION_CARVEOUT_REIMBURSEMENT_METHODOLOGY				TBD	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
943	If the contract includes Behavioral Health Outpatient Clinics/Integrated Clinics carve outs, list the type of applicable codes or code ranges		IMMUNIZATION_CARVEOUT_SCHEDULE_NAME
944	If the contract includes Behavioral Health Outpatient Clinics/Integrated Clinics carve outs, describe how these codes are reimbursed	Client-Specific Carve Out #4-25 Reimbursement Methodology	IMMUNIZATION_CAREVEOUT_SCHEDULE_VERSION				TBD	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
945	If the contract includes Behavioral Health Outpatient Clinics/Integrated Clinics carve outs, describe schedule name		IMMUNIZATION_CARVEOUT_DESCRIBE
946	If the contract includes Behavioral Health Outpatient Clinics/Integrated Clinics carve outs, describe schedule reference year or version		IMMUNIZATION_CARVEOUT_LESSER_OF_BILLED_IND
947	If the contract includes Behavioral Health Outpatient Clinics/Integrated Clinics carve outs, describe reimbursement rate		IMMUNIZATION_BILLED_CHARGE_REIMBURSEMENT_RATE
948	If the contract includes Behavioral Health Outpatient Clinics/Integrated Clinics carve outs, describe any exclusions/exceptions		IMMUNIZATION_CARVEOUT_DESCRIBE_EXCEPTIONS
949	Does the contract include Physical, Occupational, Speech Therapists (PTs/OTs/STs) carve outs (Yes/No)?	Client-Specific Carve Out #4-25 (Y/N)	OB_EPIDURAL_CAREVEOUT_IND				TBD	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
950	Does the contract include Physical, Occupational, Speech Therapists (PTs/OTs/STs) carve outs (Yes/No)? (Page#)		OB_EPIDURAL_CAREVOUT_CODES
951	If the contract includes Physical, Occupational, Speech Therapists (PTs/OTs/STs) carve outs, list the applicable codes or code ranges	Client-Specific Carve Out #4-25 Codes or Code Range	OB_EPIDURAL_CARVEOUT_REIMBURSEMENT_METHODOLOGY				TBD	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
952	If the contract includes Physical, Occupational, Speech Therapists (PTs/OTs/STs) carve outs, list the type of applicable codes or code ranges		OB_EPIDURAL_CARVEOUT_SCHEDULE_NAME
953	If the contract includes Physical, Occupational, Speech Therapists (PTs/OTs/STs) carve outs, describe how these codes are reimbursed	Client-Specific Carve Out #4-25 Reimbursement Methodology	OB_EPIDURAL_CAREVEOUT_SCHEDULE_VERSION				TBD	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
954	If the contract includes Physical, Occupational, Speech Therapists (PTs/OTs/STs) carve outs, describe schedule name		OB_EPIDURAL_CARVEOUT_DESCRIBE
955	If the contract includes Physical, Occupational, Speech Therapists (PTs/OTs/STs) carve outs, describe schedule reference year or version		PEDIATRIC_SUBSPECIALTY_CAREVEOUT_IND
956	If the contract includes Physical, Occupational, Speech Therapists (PTs/OTs/STs) carve outs, describe reimbursement rate		PEDIATRIC_SUBSPECIALTY_CAREVEOUT_IND_PG
957	If the contract includes Physical, Occupational, Speech Therapists (PTs/OTs/STs) carve outs, describe any exclusions/exceptions		PEDIATRIC_SUBSPECIALTY_CAREVOUT_CODES
958	Does the contract include Transportation Services carve outs (Yes/No)?	Client-Specific Carve Out #4-25 (Y/N)	PEDIATRIC_SUBSPECIALTY_CARVEOUT_REIMBURSEMENT_METHODOLOGY				TBD	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
959	Does the contract include Transportation Services carve outs (Yes/No)? (Page#)		PEDIATRIC_SUBSPECIALTY_CARVEOUT_SCHEDULE_NAME
960	If the contract includes Transportation Services carve outs, list the applicable codes or code ranges	Client-Specific Carve Out #4-25 Codes or Code Range	PEDIATRIC_SUBSPECIALTY_CAREVEOUT_SCHEDULE_VERSION				TBD	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
961	If the contract includes Transportation Services carve outs, list the type of applicable codes or code ranges		PEDIATRIC_SUBSPECIALTY_CARVEOUT_DESCRIBE
962	If the contract includes Transportation Services carve outs, describe how these codes are reimbursed	Client-Specific Carve Out #4-25 Reimbursement Methodology	NEUROSURGEY_SUBSPECIALTY_CAREVEOUT_IND				TBD	From LOB Specific Exhibit, Attachment, Schedule or Amendment, Addendum, Rider	Carve Outs	Required Only If Available	PAYMENT ACCURACY INTELLIGENT EDITS
963	If the contract includes Transportation Services carve outs, describe schedule name		NEUROSURGEY_SUBSPECIALTY_CAREVEOUT_IND_PG
964	If the contract includes Transportation Services carve outs, describe schedule reference year or version		NEUROSURGEY_SUBSPECIALTY_CAREVOUT_CODES
965	If the contract includes Transportation Services carve outs, describe reimbursement rate		NEUROSURGEY_SUBSPECIALTY_CARVEOUT_REIMBURSEMENT_METHODOLOGY
966	If the contract includes Transportation Services carve outs, describe any exclusions/exceptions		NEUROSURGEY_SUBSPECIALTY_CARVEOUT_SCHEDULE_NAME
967	Does the contract include PCP - Medical carve outs (Yes/No)?		NEUROSURGEY_SUBSPECIALTY_CAREVEOUT_SCHEDULE_VERSION
968	Does the contract include PCP - Medical carve outs (Yes/No)? (Page#)		NEUROSURGEY_SUBSPECIALTY_CARVEOUT_DESCRIBE
969	If the contract includes PCP - Medical carve outs, list the applicable codes or code ranges		ORTHOPEDIC_SURGERY_CAREVEOUT_IND
970	If the contract includes PCP - Medical carve outs, list the type of applicable codes or code ranges		ORTHOPEDIC_SURGERY_CAREVEOUT_IND_PG
971	If the contract includes PCP - Medical carve outs, describe how these codes are reimbursed		ORTHOPEDIC_SURGERY_CAREVOUT_CODES
972	If the contract includes PCP - Medical carve outs, describe schedule name		ORTHOPEDIC_SURGERY_CARVEOUT_REIMBURSEMENT_METHODOLOGY
973	If the contract includes PCP - Medical carve outs, describe schedule reference year or version		ORTHOPEDIC_SURGERY_CARVEOUT_SCHEDULE_NAME
974	If the contract includes PCP - Medical carve outs, describe reimbursement rate		ORTHOPEDIC_SURGERY_CAREVEOUT_SCHEDULE_VERSION
975	If the contract includes PCP - Medical carve outs, describe any exclusions/exceptions		ORTHOPEDIC_SURGERY_CARVEOUT_DESCRIBE
976	Does the contract include PCP - BH carve outs (Yes/No)?		ALL_OTHER_SPECIALTY_CAREVEOUT_IND
977	Does the contract include PCP - BH carve outs (Yes/No)? (Page#)		ALL_OTHER_SPECIALTY_CAREVEOUT_IND_PG
978	If the contract includes PCP - BH carve outs, list the applicable codes or code ranges		ALL_OTHER_SPECIALTY_CAREVOUT_CODES
979	If the contract includes PCP - BH carve outs, list the type of applicable codes or code ranges		ALL_OTHER_SPECIALTY_CARVEOUT_REIMBURSEMENT_METHODOLOGY
980	If the contract includes PCP - BH carve outs, describe how these codes are reimbursed		ALL_OTHER_SPECIALTY_CARVEOUT_SCHEDULE_NAME
981	If the contract includes PCP - BH carve outs, describe schedule name		ALL_OTHER_SPECIALTY_CAREVEOUT_SCHEDULE_VERSION
982	If the contract includes PCP - BH carve outs, describe schedule reference year or version		ALL_OTHER_SPECIALTY_CARVEOUT_DESCRIBE
983	If the contract includes PCP - BH carve outs, describe reimbursement rate		PEDIATRIC_PCP_CAREVEOUT_IND
984	If the contract includes PCP - BH carve outs, describe any exclusions/exceptions		PEDIATRIC_PCP_CAREVEOUT_IND_PG
985	Does the contract include BH Physicians/Clinicals Psychologists ( MDs, Dos, PHDs)/Mid-level Practitioners (ex. NPs,Pas etc) carve outs (Yes/No)?		PEDIATRIC_PCP_CAREVOUT_CODES
986	Does the contract include BH Physicians/Clinicals Psychologists ( MDs, Dos, PHDs)/Mid-level Practitioners (ex. NPs,Pas etc) carve outs (Yes/No)? (Page#)		PEDIATRIC_PCP_CARVEOUT_REIMBURSEMENT_METHODOLOGY
987	If the contract includes BH Physicians/Clinicals Psychologists ( MDs, Dos, PHDs)/Mid-level Practitioners (ex. NPs,Pas etc) carve outs, list the applicable codes or code ranges		PEDIATRIC_PCP_CARVEOUT_SCHEDULE_NAME
988	If the contract includes BH Physicians/Clinicals Psychologists ( MDs, Dos, PHDs)/Mid-level Practitioners (ex. NPs,Pas etc) carve outs, list the type of applicable codes or code ranges		PEDIATRIC_PCP_CAREVEOUT_SCHEDULE_VERSION
989	If the contract includes BH Physicians/Clinicals Psychologists ( MDs, Dos, PHDs)/Mid-level Practitioners (ex. NPs,Pas etc) carve outs, describe how these codes are reimbursed		PEDIATRIC_PCP_CARVEOUT_DESCRIBE
990	If the contract includes BH Physicians/Clinicals Psychologists ( MDs, Dos, PHDs)/Mid-level Practitioners (ex. NPs,Pas etc) carve outs, describe schedule name		ANESTHESIOLOGY_RN_SVCS_CAREVEOUT_IND
991	If the contract includes BH Physicians/Clinicals Psychologists ( MDs, Dos, PHDs)/Mid-level Practitioners (ex. NPs,Pas etc) carve outs, describe schedule reference year or version		ANESTHESIOLOGY_RN_SVCS_CAREVEOUT_IND_PG
992	If the contract includes BH Physicians/Clinicals Psychologists ( MDs, Dos, PHDs)/Mid-level Practitioners (ex. NPs,Pas etc) carve outs, describe reimbursement rate		ANESTHESIOLOGY_RN_SVCS_CAREVOUT_CODES
993	If the contract includes BH Physicians/Clinicals Psychologists ( MDs, Dos, PHDs)/Mid-level Practitioners (ex. NPs,Pas etc) carve outs, describe any exclusions/exceptions		ANESTHESIOLOGY_RN_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGY
994	Does the contract include Mid-Level - BH carve outs (Yes/No)?		ANESTHESIOLOGY_RN_SVCS_CARVEOUT_SCHEDULE_NAME
995	Does the contract include Mid-Level - BH carve outs (Yes/No)? (Page#)		ANESTHESIOLOGY_RN_SVCS_CAREVEOUT_SCHEDULE_VERSION
996	If the contract includes Mid-Level - BH carve outs, list the applicable codes or code ranges		ANESTHESIOLOGY_RN_SVCS_CARVEOUT_DESCRIBE
997	If the contract includes Mid-Level - BH carve outs, list the type of applicable codes or code ranges		EPSDT_CAREVEOUT_IND
998	If the contract includes Mid-Level - BH carve outs, describe how these codes are reimbursed		EPSDT_CAREVEOUT_IND_PG
999	If the contract includes Mid-Level - BH carve outs, describe schedule name		EPSDT_CAREVOUT_CODES
1000	If the contract includes Mid-Level - BH carve outs, describe schedule reference year or version		EPSDT_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1001	If the contract includes Mid-Level - BH carve outs, describe reimbursement rate		EPSDT_CARVEOUT_SCHEDULE_NAME
1002	If the contract includes Mid-Level - BH carve outs, describe any exclusion/exceptions		EPSDT_CAREVEOUT_SCHEDULE_VERSION
1003	Does the contract include BCBA - BH carve outs (Yes/No)?		EPSDT_CARVEOUT_DESCRIBE
1004	Does the contract include BCBA - BH carve outs (Yes/No)? (Page#)		ANCILLARY_CAREVEOUT_IND
1005	If the contract includes BCBA - BH carve outs, list the applicable codes or code ranges		ANCILLARY_CAREVEOUT_IND_PG
1006	If the contract includes BCBA - BH carve outs, list the type of applicable codes or code ranges		ANCILLARY_CAREVOUT_CODES
1007	If the contract includes BCBA - BH carve outs, describe how these codes are reimbursed		ANCILLARY_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1008	If the contract includes BCBA - BH carve outs, describe schedule name		ANCILLARY_CARVEOUT_SCHEDULE_NAME
1009	If the contract includes BCBA - BH carve outs, describe schedule reference year or version		ANCILLARY_CAREVEOUT_SCHEDULE_VERSION
1010	If the contract includes BCBA - BH carve outs, describe reimbursement rate		ANCILLARY_CARVEOUT_DESCRIBE
1011	If the contract includes BCBA - BH carve outs, describe any exclusion/exceptions		PHYASSISTANT_RNPRACTITIONER_CAREVEOUT_IND
1012	Does the contract include Independent Licensures - BH carve outs (Yes/No)?		PHYASSISTANT_RNPRACTITIONER_CAREVEOUT_IND_PG
1013	Does the contract include Independent Licensures - BH carve outs (Yes/No)? (Page#)		PHYASSISTANT_RNPRACTITIONER_CAREVOUT_CODES
1014	If the contract includes Independent Licensures - BH carve outs, list the applicable codes or code ranges		PHYASSISTANT_RNPRACTITIONER_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1015	If the contract includes Independent Licensures - BH carve outs, list the type of applicable codes or code ranges		PHYASSISTANT_RNPRACTITIONER_CARVEOUT_SCHEDULE_NAME
1016	If the contract includes Independent Licensures - BH carve outs, describe how these codes are reimbursed		PHYASSISTANT_RNPRACTITIONER_CAREVEOUT_SCHEDULE_VERSION
1017	If the contract includes Independent Licensures - BH carve outs, describe schedule name		PHYASSISTANT_RNPRACTITIONER_CARVEOUT_DESCRIBE
1018	If the contract includes Independent Licensures - BH carve outs, describe schedule reference year or version		ONCOLOGY_SVCS_CAREVEOUT_IND
1019	If the contract includes Independent Licensures - BH carve outs, describe reimbursement rate		ONCOLOGY_SVCS_CAREVEOUT_IND_PG
1020	If the contract includes Independent Licensures - BH carve outs, describe any exclusions/exceptions		ONCOLOGY_SVCS_CAREVOUT_CODES
1021	Does the contract include Behavioral health Outpatient Clinics/Integrated Clinics - BH carve outs (Yes/No)?		ONCOLOGY_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1022	Does the contract include Behavioral health Outpatient Clinics/Integrated Clinics - BH carve outs (Yes/No)? (Page#)		ONCOLOGY_SVCS_CARVEOUT_SCHEDULE_NAME
1023	If the contract includes Behavioral health Outpatient Clinics/Integrated Clinics - BH carve outs, list the applicable codes or code ranges		ONCOLOGY_SVCS_CAREVEOUT_SCHEDULE_VERSION
1024	If the contract includes Behavioral health Outpatient Clinics/Integrated Clinics - BH carve outs, list the type of applicable codes or code ranges		ONCOLOGY_SVCS_CARVEOUT_DESCRIBE
1025	If the contract includes Behavioral health Outpatient Clinics/Integrated Clinics - BH carve outs, describe how these codes are reimbursed		REHABILITATION_SVCS_CAREVEOUT_IND
1026	If the contract includes Behavioral health Outpatient Clinics/Integrated Clinics - BH carve outs, describe schedule name		REHABILITATION_SVCS_CAREVEOUT_IND_PG
1027	If the contract includes Behavioral health Outpatient Clinics/Integrated Clinics - BH carve outs, describe schedule reference year or version		REHABILITATION_SVCS_CAREVOUT_CODES
1028	If the contract includes Behavioral health Outpatient Clinics/Integrated Clinics - BH carve outs, describe reimbursement rate		REHABILITATION_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1029	If the contract includes Behavioral health Outpatient Clinics/Integrated Clinics - BH carve outs, describe exclusions/exceptions		REHABILITATION_SVCS_CARVEOUT_SCHEDULE_NAME
1030	Does the contract include Physicians/Clinical Psychologists - BH carve outs (Yes/No)?		REHABILITATION_SVCS_CAREVEOUT_SCHEDULE_VERSION
1031	Does the contract include Physicians/Clinical Psychologists - BH carve outs (Yes/No)? (Page#)		REHABILITATION_SVCS_CARVEOUT_DESCRIBE
1032	If the contract includes Physicians/Clinical Psychologists - BH carve outs, list the applicable codes or code ranges		SURGERY_CAREVEOUT_IND
1033	If the contract includes Physicians/Clinical Psychologists - BH carve outs, list the type of applicable codes or code ranges		SURGERY_CAREVEOUT_IND_PG
1034	If the contract includes Physicians/Clinical Psychologists - BH carve outs, describe how these codes are reimbursed		SURGERY_CAREVOUT_CODES
1035	If the contract includes Physicians/Clinical Psychologists - BH carve outs, describe schedule name		SURGERY_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1036	If the contract includes Physicians/Clinical Psychologists - BH carve outs, describe schedule reference year or version		SURGERY_CARVEOUT_SCHEDULE_NAME
1037	If the contract includes Physicians/Clinical Psychologists - BH carve outs, describe reimbursement rate		SURGERY_CAREVEOUT_SCHEDULE_VERSION
1038	If the contract includes Physicians/Clinical Psychologists - BH carve outs, describe exclusions/exceptions		SURGERY_CARVEOUT_DESCRIBE
1039	Does the contract include Dentist carve outs (Yes/No)?		LITHOTRIPSY_CAREVEOUT_IND
1040	Does the contract include Dentist carve outs (Yes/No)? (Page#)		LITHOTRIPSY_CAREVEOUT_IND_PG
1041	If the contract includes Dentist carve outs, list the applicable codes or code ranges		LITHOTRIPSY_CAREVOUT_CODES
1042	If the contract includes Dentist carve outs, list the type of applicable codes or code ranges		LITHOTRIPSY_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1043	If the contract includes Dentist carve outs, describe how these codes are reimbursed		LITHOTRIPSY_CARVEOUT_SCHEDULE_NAME
1044	If the contract includes Dentist carve outs, describe schedule name		LITHOTRIPSY_CAREVEOUT_SCHEDULE_VERSION
1045	If the contract includes Dentist carve outs, describe schedule reference year or version		LITHOTRIPSY_CARVEOUT_DESCRIBE
1046	If the contract includes Dentist carve outs, describe reimbursement rate		CARDIAC_SVCS_CAREVEOUT_IND
1047	If the contract includes Dentist carve outs, describe exclusions/exceptions		CARDIAC_SVCS_CAREVEOUT_IND_PG
1048	Does the contract include Supplies and Devices carve outs (Yes/No)?		CARDIAC_SVCS_CAREVOUT_CODES
1049	Does the contract include Supplies and Devices carve outs (Yes/No)? (Page#)		CARDIAC_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1050	If the contract includes Supplies and Devices carve outs, list the applicable codes or code ranges		CARDIAC_SVCS_CARVEOUT_SCHEDULE_NAME
1051	If the contract includes Supplies and Devices carve outs, list the type of applicable codes or code ranges		CARDIAC_SVCS_CAREVEOUT_SCHEDULE_VERSION
1052	If the contract includes Supplies and Devices carve outs, describe how these codes are reimbursed		CARDIAC_SVCS_CARVEOUT_DESCRIBE
1053	If the contract includes Supplies and Devices carve outs, describe schedule name		SPECIAL_CARE_UNIT_SVCS_CAREVEOUT_IND
1054	If the contract includes Supplies and Devices carve outs, describe schedule reference year or version		SPECIAL_CARE_UNIT_SVCS_CAREVEOUT_IND_PG
1055	If the contract includes Supplies and Devices carve outs, describe reimbursement rate		SPECIAL_CARE_UNIT_SVCS_CAREVOUT_CODES
1056	If the contract includes Supplies and Devices carve outs, is there a lesser of billed charges clause? (Yes/No)		SPECIAL_CARE_UNIT_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1057	If the contract includes Supplies and Devices carve outs, describe billed charges reimbursement rate		SPECIAL_CARE_UNIT_SVCS_CARVEOUT_SCHEDULE_NAME
1058	If the contract includes Supplies and Devices carve outs, describe exclusions/exceptions		SPECIAL_CARE_UNIT_SVCS_CAREVEOUT_SCHEDULE_VERSION
1059	Does the contract include Immunizations carve outs (Yes/No)?		SPECIAL_CARE_UNIT_SVCS_CARVEOUT_DESCRIBE
1060	Does the contract include Immunizations carve outs (Yes/No)? (Page#)		SKILLED_RN_SVCS_CAREVEOUT_IND
1061	If the contract includes Immunizations carve outs, list the applicable codes or code ranges		SKILLED_RN_SVCS_CAREVEOUT_IND_PG
1062	If the contract includes Immunizations carve outs, list the type of applicable codes or code ranges		SKILLED_RN_SVCS_CAREVOUT_CODES
1063	If the contract includes Immunizations carve outs, describe how these codes are reimbursed		SKILLED_RN_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1064	If the contract includes Immunizations carve outs, describe schedule name		SKILLED_RN_SVCS_CARVEOUT_SCHEDULE_NAME
1065	If the contract includes Immunizations carve outs, describe schedule reference year or version		SKILLED_RN_SVCS_CAREVEOUT_SCHEDULE_VERSION
1066	If the contract includes Immunizations carve outs, describe reimbursement rate		SKILLED_RN_SVCS_CARVEOUT_DESCRIBE
1067	If the contract includes Immunizations carve outs, is there a lesser of billed charges clause? (Yes/No)		INFUSION_SVCS_CAREVEOUT_IND
1068	If the contract includes Immunizations carve outs, describe billed charges reimbursement rate		INFUSION_SVCS_CAREVEOUT_IND_PG
1069	If the contract includes a carve out for immunizations, describe exceptions		INFUSION_SVCS_CAREVOUT_CODES
1070	Does the contract include OB Epidural carve outs (Yes/No)?		INFUSION_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1071	If the contract includes OB Epidural carve outs, list the applicable codes or code ranges		INFUSION_SVCS_CARVEOUT_SCHEDULE_NAME
1072	If the contract includes OB Epidural carve outs, list the type of applicable codes or code ranges		INFUSION_SVCS_CAREVEOUT_SCHEDULE_VERSION
1073	If the contract includes OB Epidural carve outs, describe how these codes are reimbursed		INFUSION_SVCS_CARVEOUT_DESCRIBE
1074	If the contract includes OB Epidural carve outs, describe schedule name		OBESITY_SVCS_CAREVEOUT_IND
1075	If the contract includes OB Epidural carve outs, describe schedule reference year or version		OBESITY_SVCS_CAREVEOUT_IND_PG
1076	If the contract includes OB Epidural carve outs, describe reimbursement rate		OBESITY_SVCS_CAREVOUT_CODES
1077	If the contract includes OB Epidural carve outs, describe exclusions/exceptions		OBESITY_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1078	Does the contract include Pediatric Subspecialties carve outs (Yes/No)?		OBESITY_SVCS_CARVEOUT_SCHEDULE_NAME
1079	Does the contract include Pediatric Subspecialties carve outs (Yes/No)? (Page#)		OBESITY_SVCS_CAREVEOUT_SCHEDULE_VERSION
1080	If the contract includes Pediatric Subspecialties carve outs, list the applicable codes or code ranges		OBESITY_SVCS_CARVEOUT_DESCRIBE
1081	If the contract includes Pediatric Subspecialties carve outs, list the type of applicable codes or code ranges		SPECIALTY_CARE_PHYSICIAN_CAREVEOUT_IND
1082	If the contract includes Pediatric Subspecialties carve outs, describe how these codes are reimbursed		SPECIALTY_CARE_PHYSICIAN_CAREVEOUT_IND_PG
1083	If the contract includes Pediatric Subspecialties carve outs, describe schedule name		SPECIALTY_CARE_PHYSICIAN_CAREVOUT_CODES
1084	If the contract includes Pediatric Subspecialties carve outs, describe schedule reference year or version		SPECIALTY_CARE_PHYSICIAN_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1085	If the contract includes Pediatric Subspecialties carve outs, describe reimbursement rate		SPECIALTY_CARE_PHYSICIAN_CARVEOUT_SCHEDULE_NAME
1086	If the contract includes Pediatric Subspecialties carve outs, describe exclusions/exceptions		SPECIALTY_CARE_PHYSICIAN_CAREVEOUT_SCHEDULE_VERSION
1087	Does the contract include Neurosurgery Subspecialties carve outs (Yes/No)?		SPECIALTY_CARE_PHYSICIAN_CARVEOUT_DESCRIBE
1088	Does the contract include Neurosurgery Subspecialties carve outs (Yes/No)? (Page#)		DRUGS_ORGANS_IMPLANTS_IP_CAREVEOUT_IND
1089	If the contract includes Neurosurgery Subspecialties carve outs, list the applicable codes or code ranges		DRUGS_ORGANS_IMPLANTS_IP_CAREVEOUT_IND_PG
1090	If the contract includes Neurosurgery Subspecialties carve outs, list the type of applicable codes or code ranges		DRUGS_ORGANS_IMPLANTS_IP_CAREVOUT_CODES
1091	If the contract includes Neurosurgery Subspecialties carve outs, describe how these codes are reimbursed		DRUGS_ORGANS_IMPLANTS_IP_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1092	If the contract includes Neurosurgery Subspecialties carve outs, describe schedule name		DRUGS_ORGANS_IMPLANTS_IP_CARVEOUT_SCHEDULE_NAME
1093	If the contract includes Neurosurgery Subspecialties carve outs, describe schedule reference year or version		DRUGS_ORGANS_IMPLANTS_IP_CAREVEOUT_SCHEDULE_VERSION
1094	If the contract includes Neurosurgery Subspecialties carve outs, describe reimbursement rate		DRUGS_ORGANS_IMPLANTS_IP_CARVEOUT_DESCRIBE
1095	If the contract includes Neurosurgery Subspecialties carve outs, describe exclusions/exceptions		DRUGS_ORGANS_IMPLANTS_OP_CAREVEOUT_IND
1096	Does the contract include Orthopedic Surgery subspecialties carve outs (Yes/No)?		DRUGS_ORGANS_IMPLANTS_OP_CAREVEOUT_IND_PG
1097	Does the contract include Orthopedic Surgery subspecialties carve outs (Yes/No)? (Page#)		DRUGS_ORGANS_IMPLANTS_OP_CAREVOUT_CODES
1098	If the contract includes Orthopedic Surgery subspecialties carve outs, list the applicable codes or code ranges		DRUGS_ORGANS_IMPLANTS_OP_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1099	If the contract includes Orthopedic Surgery subspecialties carve outs, list the type of applicable codes or code ranges		DRUGS_ORGANS_IMPLANTS_OP_CARVEOUT_SCHEDULE_NAME
1100	If the contract includes Orthopedic Surgery subspecialties carve outs, describe how these codes are reimbursed		DRUGS_ORGANS_IMPLANTS_OP_CAREVEOUT_SCHEDULE_VERSION
1101	If the contract includes Orthopedic Surgery subspecialties carve outs, describe schedule name		DRUGS_ORGANS_IMPLANTS_OP_CARVEOUT_DESCRIBE
1102	If the contract includes Orthopedic Surgery subspecialties carve outs, describe schedule reference year or version		BLOOD_PRODUCTS_CAREVEOUT_IND
1103	If the contract includes Orthopedic Surgery subspecialties carve outs, describe reimbursement rate		BLOOD_PRODUCTS_CAREVEOUT_IND_PG
1104	If the contract includes Orthopedic Surgery subspecialties carve outs, describe exclusions/exceptions		BLOOD_PRODUCTS_CAREVOUT_CODES
1105	Does the contract include All Other Specialists carve outs (Yes/No)?		BLOOD_PRODUCTS_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1106	Does the contract include All Other Specialists carve outs (Yes/No)? (Page#)		BLOOD_PRODUCTS_CARVEOUT_SCHEDULE_NAME
1107	If the contract includes All Other Specialists carve outs, list the applicable codes or code ranges		BLOOD_PRODUCTS_CAREVEOUT_SCHEDULE_VERSION
1108	If the contract includes All Other Specialist the type of applicable codes or code ranges		BLOOD_PRODUCTS_CARVEOUT_DESCRIBE
1109	If the contract includes All Other Specialists carve outs, describe how these codes are reimbursed		HIGH_COST_DRUGS_CAREVEOUT_IND
1110	If the contract includes All Other Specialists carve outs, describe schedule name		HIGH_COST_DRUGS_CAREVEOUT_IND_PG
1111	If the contract includes All Other Specialists carve outs, describe schedule reference year or version		HIGH_COST_DRUGS_CAREVOUT_CODES
1112	If the contract includes All Other Specialists carve outs, describe reimbursement rate		HIGH_COST_DRUGS_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1113	If the contract includes All Other Specialists carve outs, describe exclusions/exceptions		HIGH_COST_DRUGS_CARVEOUT_SCHEDULE_NAME
1114	Does the contract include Pediatric Primary Care Physicians carve outs (Yes/No)?		HIGH_COST_DRUGS_CAREVEOUT_SCHEDULE_VERSION
1115	Does the contract include Pediatric Primary Care Physicians carve outs (Yes/No)? (Page#)		HIGH_COST_DRUGS_CARVEOUT_DESCRIBE
1116	If the contract includes Pediatric Primary Care Physicians carve outs, list the applicable codes or code ranges		PHYSICAL_REHABILITATION_CAREVEOUT_IND
1117	If the contract includes Pediatric Primary Care Physicians carve outs, list the type of applicable codes or code ranges		PHYSICAL_REHABILITATION_CAREVEOUT_IND_PG
1118	If the contract includes Pediatric Primary Care Physicians carve outs, describe how these codes are reimbursed		PHYSICAL_REHABILITATION_CAREVOUT_CODES
1119	If the contract includes Pediatric Primary Care Physicians carve outs, describe schedule name		PHYSICAL_REHABILITATION_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1120	If the contract includes Pediatric Primary Care Physicians carve outs, describe schedule reference year or version		PHYSICAL_REHABILITATION_CARVEOUT_SCHEDULE_NAME
1121	If the contract includes Pediatric Primary Care Physicians carve outs, describe reimbursement rate		PHYSICAL_REHABILITATION_CAREVEOUT_SCHEDULE_VERSION
1122	If the contract includes Pediatric Primary Care Physicians carve outs, describe exclusions/exceptions		PHYSICAL_REHABILITATION_CARVEOUT_DESCRIBE
1123	Does the contract include Medical/Surgical Services by Anesthesiology or Certified Registered Nurse carve outs (Yes/No)?		SLEEP_STUDIES_CAREVEOUT_IND
1124	Does the contract include Medical/Surgical Services by Anesthesiology or Certified Registered Nurse carve outs (Yes/No)? (Page#)		SLEEP_STUDIES_CAREVEOUT_IND_PG
1125	If the contract includes Medical/Surgical Services by Anesthesiology or Certified Registered Nurse carve outs, list the applicable codes or code ranges		SLEEP_STUDIES_CAREVOUT_CODES
1126	If the contract includes Medical/Surgical Services by Anesthesiology or Certified Registered Nurse carve outs, list the type of applicable codes or code ranges		SLEEP_STUDIES_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1127	If the contract includes Medical/Surgical Services by Anesthesiology or Certified Registered Nurse carve outs, describe how these codes are reimbursed		SLEEP_STUDIES_CARVEOUT_SCHEDULE_NAME
1128	If the contract includes Medical/Surgical Services by Anesthesiology or Certified Registered Nurse carve outs, describe schedule name		SLEEP_STUDIES_CAREVEOUT_SCHEDULE_VERSION
1129	If the contract includes Medical/Surgical Services by Anesthesiology or Certified Registered Nurse carve outs, describe schedule reference year or version		SLEEP_STUDIES_CARVEOUT_DESCRIBE
1130	If the contract includes Medical/Surgical Services by Anesthesiology or Certified Registered Nurse carve outs, describe reimbursement rate		LAP_BAND_SVCS_CAREVEOUT_IND
1131	If the contract includes Medical/Surgical Services by Anesthesiology or Certified Registered Nurse carve outs, describe exclusions/exceptions		LAP_BAND_SVCS_CAREVEOUT_IND_PG
1132	Does the contract include EPSDT carve outs (Yes/No)?		LAP_BAND_SVCS_CAREVOUT_CODES
1133	Does the contract include EPSDT carve outs (Yes/No)? (Page#)		LAP_BAND_SVCS_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1134	If the contract includes EPSDT carve outs, list the applicable codes or code ranges		LAP_BAND_SVCS_CARVEOUT_SCHEDULE_NAME
1135	If the contract includes EPSDT carve outs, list the type of applicable codes or code ranges		LAP_BAND_SVCS_CAREVEOUT_SCHEDULE_VERSION
1136	If the contract includes EPSDT carve outs, describe how these codes are reimbursed		LAP_BAND_SVCS_CARVEOUT_DESCRIBE
1137	If the contract includes EPSDT carve outs, describe schedule name		NEWBORN_NICU_CAREVEOUT_IND
1138	If the contract includes EPSDT carve outs, describe schedule reference year or version		NEWBORN_NICU_CAREVEOUT_IND_PG
1139	If the contract includes EPSDT carve outs, describe reimbursement rate		NEWBORN_NICU_CAREVOUT_CODES
1140	If the contract includes EPSDT carve outs, describe exclusions/exceptions		NEWBORN_NICU_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1141	Does the contract include Ancillary carveout to professional contract (Yes/No)?		NEWBORN_NICU_CARVEOUT_SCHEDULE_NAME
1142	Does the contract include Ancillary carveout to professional contract (Yes/No)? (Page#)		NEWBORN_NICU_CAREVEOUT_SCHEDULE_VERSION
1143	If the contract includes Ancillary carveout to professional contract, list the applicable codes or code ranges		NEWBORN_NICU_CARVEOUT_DESCRIBE
1144	If the contract includes Ancillary carveout to professional contract, list the type of applicable codes or code ranges		EMCO_CAREVEOUT_IND
1145	If the contract includes Ancillary carveout to professional contract, describe how these codes are reimbursed		EMCO_CAREVEOUT_IND_PG
1146	If the contract includes Ancillary carveout to professional contract, describe schedule name		EMCO_CAREVOUT_CODES
1147	If the contract includes Ancillary carveout to professional contract, describe schedule reference year or version		EMCO_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1148	If the contract includes Ancillary carveout to professional contract, describe reimbursement rate		EMCO_CARVEOUT_SCHEDULE_NAME
1149	If the contract includes Ancillary carveout to professional contract, describe exclusions/exceptions		EMCO_CAREVEOUT_SCHEDULE_VERSION
1150	Does the contract include Physician Assistant and Nurse Practitioner carve outs (Yes/No)?		EMCO_CARVEOUT_DESCRIBE
1151	Does the contract include Physician Assistant and Nurse Practitioner carve outs (Yes/No)? (Page#)		BURNS_CAREVEOUT_IND
1152	If the contract includes Physician Assistant and Nurse Practitioner carve outs, list the applicable codes or code ranges		BURNS_CAREVEOUT_IND_PG
1153	If the contract includes Physician Assistant and Nurse Practitioner carve outs, list the type of applicable codes or code ranges		BURNS_CAREVOUT_CODES
1154	If the contract includes Physician Assistant and Nurse Practitioner carve outs, describe how these codes are reimbursed		BURNS_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1155	If the contract includes Physician Assistant and Nurse Practitioner carve outs, describe schedule name		BURNS_CARVEOUT_SCHEDULE_NAME
1156	If the contract includes Physician Assistant and Nurse Practitioner carve outs, describe schedule reference year or version		BURNS_CAREVEOUT_SCHEDULE_VERSION
1157	If the contract includes Physician Assistant and Nurse Practitioner carve outs, describe reimbursement rate		BURNS_CARVEOUT_DESCRIBE
1158	If the contract includes Physician Assistant and Nurse Practitioner carve outs, describe exclusions/exceptions		KYPHOPLASTY_CAREVEOUT_IND
1159	Does the contract include a carve out for Oncology Services (Yes/No)?		KYPHOPLASTY_CAREVEOUT_IND_PG
1160	Does the contract include a carve out for Oncology Services (Yes/No)? (Page#)		KYPHOPLASTY_CAREVOUT_CODES
1161	If the contract includes a carve out for Oncology Services, list the applicable codes or code ranges		KYPHOPLASTY_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1162	If the contract includes a carve out for Oncology Services, list the type of applicable codes or code ranges		KYPHOPLASTY_CARVEOUT_SCHEDULE_NAME
1163	If the contract includes a carve out for Oncology Services, describe how these codes are reimbursed		KYPHOPLASTY_CAREVEOUT_SCHEDULE_VERSION
1164	If the contract includes a carve out for Oncology Services, describe schedule name		KYPHOPLASTY_CARVEOUT_DESCRIBE
1165	If the contract includes a carve out for Oncology Services, describe reference year or version		CRYOSURGICAL_ABLATION_PROSTATE_CAREVEOUT_IND
1166	If the contract includes a carve out for Oncology Services, describe reimbursement rate		CRYOSURGICAL_ABLATION_PROSTATE_CAREVEOUT_IND_PG
1167	If the contract includes a carve out for Oncology Services, describe exclusions/exceptions		CRYOSURGICAL_ABLATION_PROSTATE_CAREVOUT_CODES
1168	Does the contract include a carve out for Rehabilitation Services (Yes/No)?		CRYOSURGICAL_ABLATION_PROSTATE_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1169	Does the contract include a carve out for Rehabilitation Services (Yes/No)? (Page#)		CRYOSURGICAL_ABLATION_PROSTATE_CARVEOUT_SCHEDULE_NAME
1170	If the contract includes a carve out for Rehabilitation Services , list the applicable codes or code ranges		CRYOSURGICAL_ABLATION_PROSTATE_CAREVEOUT_SCHEDULE_VERSION
1171	If the contract includes a carve out for Rehabilitation Services , list the type of applicable codes or code ranges		CRYOSURGICAL_ABLATION_PROSTATE_CARVEOUT_DESCRIBE
1172	If the contract includes a carve out for Rehabilitation Services, describe how these codes are reimbursed		TUMT_CAREVEOUT_IND
1173	If the contract includes a carve out for Rehabilitation Services , describe schedule name		TUMT_CAREVEOUT_IND_PG
1174	If the contract includes a carve out for Rehabilitation Services, describe reference year or version		TUMT_CAREVOUT_CODES
1175	If the contract includes a carve out for Rehabilitation Services, describe reimbursement rate		TUMT_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1176	If the contract includes a carve out for Rehabilitation Services, describe exceptions/exclusions		TUMT_CARVEOUT_SCHEDULE_NAME
1177	Does the contract include a carve out for Surgery (Yes/No)?		TUMT_CAREVEOUT_SCHEDULE_VERSION
1178	Does the contract include a carve out for Surgery (Yes/No)? (Page#)		TUMT_CARVEOUT_DESCRIBE
1179	If the contract includes a carve out for Surgery Services , list the applicable codes or code ranges		TUNA_CAREVEOUT_IND
1180	If the contract includes a carve out for Surgery Services , list the type of applicable codes or code ranges		TUNA_CAREVEOUT_IND_PG
1181	If the contract includes a carve out for Surgery Services, describe how these codes are reimbursed		TUNA_CAREVOUT_CODES
1182	If the contract includes a carve out for Surgery Services , describe schedule name		TUNA_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1183	If the contract includes a carve out for Surgery Services, describe reference year or version		TUNA_CARVEOUT_SCHEDULE_NAME
1184	If the contract includes a carve out for Outpatient Surgery Services, describe reimbursement rate		TUNA_CAREVEOUT_SCHEDULE_VERSION
1185	If the contract includes a carve out for Outpatient Surgery Services, describe amount not to exceed		TUNA_CARVEOUT_DESCRIBE
1186	If the contract includes a carve out for Surgery Services , describe exceptions/exclusions		HYPERBARIC_TREATMENT_CAREVEOUT_IND
1187	Does the contract include a carve out for Lithotripsy Services (Yes/No)?		HYPERBARIC_TREATMENT_CAREVEOUT_IND_PG
1188	Does the contract include a carve out for Lithotripsy Services (Yes/No)? (Page#)		HYPERBARIC_TREATMENT_CAREVOUT_CODES
1189	If the contract includes a carve out for Lithotripsy Services , list the applicable codes or code ranges		HYPERBARIC_TREATMENT_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1190	If the contract includes a carve out for Lithotripsy Services , list the type of applicable codes or code ranges		HYPERBARIC_TREATMENT_CARVEOUT_SCHEDULE_NAME
1191	If the contract includes a carve out for Lithotripsy Services, describe how these codes are reimbursed		HYPERBARIC_TREATMENT_CAREVEOUT_SCHEDULE_VERSION
1192	If the contract includes a carve out for Lithotripsy Services , describe schedule name		HYPERBARIC_TREATMENT_CARVEOUT_DESCRIBE
1193	If the contract includes a carve out for Lithotripsy Services, describe reference year or version		CLINIC_VISITS_CAREVEOUT_IND
1194	If the contract includes a carve out for Lithotripsy Services, describe reimbursement rate		CLINIC_VISITS_CAREVEOUT_IND_PG
1195	If the contract includes a carve out for Lithotripsy Services, describe exceptions/exclusions		CLINIC_VISITS_CAREVOUT_CODES
1196	Does the contract include a carve out for Cardiac Services (Yes/No)?		CLINIC_VISITS_CARVEOUT_REIMBURSEMENT_METHODOLOGY
1197	Does the contract include a carve out for Cardiac Services (Yes/No)? (Page#)		CLINIC_VISITS_CARVEOUT_SCHEDULE_NAME
1198	If the contract includes a carve out for Cardiac Services , list the applicable codes or code ranges		CLINIC_VISITS_CAREVEOUT_SCHEDULE_VERSION
1199	If the contract includes a carve out for Cardiac Services , list the type of applicable codes or code ranges		CLINIC_VISITS_CARVEOUT_DESCRIBE
1200	If the contract includes a carve out for Cardiac Services, describe how these codes are reimbursed
1201	If the contract includes a carve out for Cardiac Services , describe schedule name
1202	If the contract includes a carve out for Cardiac Services, describe reference year or version
1203	If the contract includes a carve out for Cardiac Services, describe reimbursement rate
1204	If the contract includes a carve out for Cardiac Services ,describe exceptions/exclusions
1205	Does the contract include a carve out for Special Care Unit Services (Yes/No)?
1206	Does the contract include a carve out for Special Care Unit Services (Yes/No)? (Page#)
1207	If the contract includes a carve out for Special Care Unit Services , list the applicable codes or code ranges
1208	If the contract includes a carve out for Special Care Unit Services , list the type of applicable codes or code ranges
1209	If the contract includes a carve out for Cardiac Services, describe how these codes are reimbursed
1210	If the contract includes a carve out for Special Care Unit Services , describe schedule name
1211	If the contract includes a carve out for Cardiac Services, describe reference year or version
1212	If the contract includes a carve out for Special Unit Services, describe reimbursement rate
1213	If the contract includes a carve out for Cardiac Services, describe exceptions/exclusions
1214	Does the contract include a carve out for Skilled Nursing Services (Yes/No)?
1215	Does the contract include a carve out for Skilled Nursing Services (Yes/No)? (Page#)
1216	If the contract includes a carve out for Skilled Nursing Services , list the applicable codes or code ranges
1217	If the contract includes a carve out for Skilled Nursing Services , list the type of applicable codes or code ranges
1218	If the contract includes a carve out for Skilled Nursing Service, describe how these codes are reimbursed
1219	If the contract includes a carve out for Skilled Nursing Services , describe schedule name
1220	If the contract includes a carve out for Skilled Nursing Services, describe reference year or version
1221	If the contract includes a carve out for Skilled Nursing Services, describe reimbursement rate
1222	If the contract includes a carve out for Skilled Nursing Services, describe exceptions/exclusions
1223	Does the contract include a carve out for Infusion Services (Yes/No)?
1224	Does the contract include a carve out for Infusion Services (Yes/No)? (Page#)
1225	If the contract includes a carve out for Infusion Services , list the applicable codes or code ranges
1226	If the contract includes a carve out for Infusion Services , list the type of applicable codes or code ranges
1227	If the contract includes a carve out for Infusion Services, describe how these codes are reimbursed
1228	If the contract includes a carve out for Infusion Services , describe schedule name
1229	If the contract includes a carve out for Infusion Services, describe reference year or version
1230	If the contract includes a carve out for Infusion Services, describe reimbursement rate
1231	If the contract includes a carve out for Infusion Services, describe exceptions/exclusions
1232	Does the contract include a carve out for Obesity Services (Yes/No)?
1233	Does the contract include a carve out for Obesity Services (Yes/No)? (Page#)
1234	If the contract includes a carve out for Obesity Services , list the applicable codes or code ranges
1235	If the contract includes a carve out for Obesity Services , list the type of applicable codes or code ranges
1236	If the contract includes a carve out for Infusion Services, describe how these codes are reimbursed
1237	If the contract includes a carve out for Obesity Services , describe schedule name
1238	If the contract includes a carve out for Obesity Services, describe reference year or version
1239	If the contract includes a carve out for Infusion Services, describe reimbursement rate
1240	If the contract includes a carve out for Obesity Services , describe exceptions/exclusions
1241	Does the contract include a carve out for Specialty Care Physician Services (Yes/No)?
1242	Does the contract include a carve out for Specialty Care Physician Services (Yes/No)? (Page#)
1243	If the contract includes a carve out for Specialty Care Physician Services , list the applicable codes or code ranges
1244	If the contract includes a carve out for Specialty Care Physician Services , list the type of applicable codes or code ranges
1245	If the contract includes a carve out for Infusion Specialty Care Physician Services , describe how these codes are reimbursed
1246	If the contract includes a carve out for Specialty Care Physician Services , describe schedule name
1247	If the contract includes a carve out for Specialty Care Physician Services, describe reference year or version
1248	If the contract includes a carve out for Specialty Care Physician Services, describe reimbursement rate
1249	If the contract includes a carve out for Specialty Care Physician Services , describe exceptions/exclusions
1250	Does the contract include a carve out for High Cost Drugs, Organ Acquisition, Implants Inpatient (Yes/No)?
1251	Does the contract include a carve out for High Cost Drugs, Organ Acquisition, Implants Inpatient (Yes/No)? (Page#)
1252	If the contract includes a carve out for High Cost Drugs, Organ Acquisition, Implants Inpatient , list the applicable codes or code ranges
1253	If the contract includes a carve out for High Cost Drugs, Organ Acquisition, Implants Inpatient , list the type of applicable codes or code ranges
1254	If the contract includes a carve out for High Cost Drugs, Organ Acquisition, Implants Inpatient , describe how these codes are reimbursed
1255	If the contract includes a carve out for High Cost Drugs, Organ Acquisition, Implants Inpatient , describe schedule name
1256	If the contract includes a carve out for High Cost Drugs, Organ Acquisition, Implants Inpatient, describe reference year or version
1257	If the contract includes a carve out for High Cost Drugs, Organ Acquisition, Implants Inpatient, describe reimbursement rate
1258	If the contract includes a carve out for High Cost Drugs, Organ Acquisition, Implants Inpatient , describe exclusions/exceptions
1259	Does the contract include a carve out for High Cost Drugs, Implants Outpatient (Yes/No)?
1260	Does the contract include a carve out for High Cost Drugs, Implants Outpatient (Yes/No)? (Page#)
1261	If the contract includes a carve out for High Cost Drugs, Implants Outpatient , list the applicable codes or code ranges
1262	If the contract includes a carve out for High Cost Drugs, Implants Outpatient , list the type of applicable codes or code ranges
1263	If the contract includes a carve out for High Cost Drugs, Implants Outpatient , describe how these codes are reimbursed
1264	If the contract includes a carve out for High Cost Drugs, Implants Outpatient , describe schedule name
1265	If the contract includes a carve out for High Cost Drugs, Implants Outpatient , describe reference year or version
1266	If the contract includes a carve out for High Cost Drugs, Implants Outpatient , describe reimbursement rate
1267	If the contract includes a carve out for High Cost Drugs, Implants Outpatient , describe exclusions/exceptions
1268	Does the contract include a carve out for Blood Products - Outpatient/Inpatient (Yes/No)?
1269	Does the contract include a carve out for Blood Products - Outpatient/Inpatient (Yes/No)? (Page#)
1270	If the contract includes a carve out for Blood Products - Outpatient/Inpatient , list the applicable codes or code ranges
1271	If the contract includes a carve out for Blood Products - Outpatient/Inpatient , list the type of applicable codes or code ranges
1272	If the contract includes a carve out for Blood Products - Outpatient/Inpatient , describe how these codes are reimbursed
1273	If the contract includes a carve out for Blood Products - Outpatient/Inpatient , describe schedule name
1274	If the contract includes a carve out for Blood Products - Outpatient/Inpatient , describe reference year or version
1275	If the contract includes a carve out for Blood Products - Outpatient/Inpatient , describe reimbursement rate
1276	If the contract includes a carve out for Blood Products - Outpatient/Inpatient , describe exclusions/exceptions
1277	Does the contract include a carve out for High Cost Drugs (Yes/No)?
1278	Does the contract include a carve out for High Cost Drugs (Yes/No)? (Page#)
1279	If the contract includes a carve out for High Cost Drugs, list the applicable codes or code ranges
1280	If the contract includes a carve out for High Cost Drugs, list the type of applicable codes or code ranges
1281	If the contract includes a carve out for High Cost Drugs, describe how these codes are reimbursed
1282	If the contract includes a carve out for High Cost Drugs, describe schedule name
1283	If the contract includes a carve out for High Cost Drugs, describe reference year or version
1284	If the contract includes a carve out for High Cost Drugs, describe reimbursement rate
1285	If the contract includes a carve out for High Cost Drugs, describe exclusions/exceptions
1286	Does the contract include a carve out for Physical Rehabilitation (Yes/No)?
1287	Does the contract include a carve out for Physical Rehabilitation (Yes/No)? (Page#)
1288	If the contract includes a carve out for Inpatient Physical Rehabilitation , list the applicable codes or code ranges
1289	If the contract includes a carve out for Inpatient Physical Rehabilitation , list the type of applicable codes or code ranges
1290	If the contract includes a carve out for Inpatient Physical Rehabilitation , describe how these codes are reimbursed
1291	If the contract includes a carve out for Inpatient Physical Rehabilitation , describe schedule name
1292	If the contract includes a carve out for Inpatient Physical Rehabilitation , describe reference year or version
1293	If the contract includes a carve out for Inpatient Physical Rehabilitation , describe reimbursement rate
1294	If the contract includes a carve out for Inpatient Physical Rehabilitation , describe exclusions/exceptions
1295	Does the contract include a carve out for Sleep Studies (Yes/No)?
1296	Does the contract include a carve out for Sleep Studies (Yes/No)? (Page#)
1297	If the contract includes a carve out for Sleep Studies, list the applicable codes or code ranges
1298	If the contract includes a carve out for Sleep Studies, list the type of applicable codes or code ranges
1299	If the contract includes a carve out for Sleep Studies, describe how these codes are reimbursed
1300	If the contract includes a carve out for Sleep Studies, describe schedule name
1301	If the contract includes a carve out for Sleep Studies, describe reference year or version
1302	If the contract includes a carve out for Sleep Studies, describe reimbursement rate
1303	If the contract includes a carve out for Sleep Studies, describe exclusions/exceptions
1304	Does the contract include a carve out for Lap Band Services (Yes/No)?
1305	Does the contract include a carve out for Lap Band Services (Yes/No)? (Page#)
1306	If the contract includes a carve out for Lap Band Services , list the applicable codes or code ranges
1307	If the contract includes a carve out for Lap Band Services , list the type of applicable codes or code ranges
1308	If the contract includes a carve out for Lap Band Services , describe how these codes are reimbursed
1309	If the contract includes a carve out for Lap Band Services , describe schedule name
1310	If the contract includes a carve out for Lap Band Services, describe reference year or version
1311	If the contract includes a carve out for Lap Band Services , describe reimbursement rate
1312	If the contract includes a carve out for Lap Band Services , describe exclusions/exceptions
1313	Does the contract include a carve out for Newborn/NICU (Yes/No)?
1314	Does the contract include a carve out for Newborn/NICU (Yes/No)? (Page#)
1315	If the contract includes a carve out for Newborn/NICU, list the applicable codes or code ranges
1316	If the contract includes a carve out for Newborn/NICU, list the type of applicable codes or code ranges
1317	If the contract includes a carve out for Newborn/NICU, describe how these codes are reimbursed
1318	If the contract includes a carve out for Newborn/NICU, describe schedule name
1319	If the contract includes a carve out for Newborn/NICU, describe reference year or version
1320	If the contract includes a carve out for Newborn/NICU, describe reimbursement rate
1321	If the contract includes a carve out for Newborn/NICU, describe exclusions/exceptions
1322	Does the contract include a carve out for Extracorporeal Membrane Oxygenation (ECMO) (Yes/No)?
1323	Does the contract include a carve out for Extracorporeal Membrane Oxygenation (ECMO) (Yes/No)? (Page#)
1324	If the contract includes a carve out for Extracorporeal Membrane Oxygenation (ECMO), list the applicable codes or code ranges
1325	If the contract includes a carve out for Extracorporeal Membrane Oxygenation (ECMO), list the type of applicable codes or code ranges
1326	If the contract includes a carve out for Extracorporeal Membrane Oxygenation (ECMO), describe how these codes are reimbursed
1327	If the contract includes a carve out for Extracorporeal Membrane Oxygenation (ECMO), describe schedule name
1328	If the contract includes a carve out for Extracorporeal Membrane Oxygenation (ECMO), describe reference year or version
1329	If the contract includes a carve out for Extracorporeal Membrane Oxygenation (ECMO), describe reimbursement rate
1330	If the contract includes a carve out for Extracorporeal Membrane Oxygenation (ECMO), describe exclusions/exceptions
1331	Does the contract include a carve out for Burns (Yes/No)?
1332	Does the contract include a carve out for Burns (Yes/No)? (Page#)
1333	If the contract includes a carve out for Burns, list the applicable codes or code ranges
1334	If the contract includes a carve out for Burns, list the type of applicable codes or code ranges
1335	If the contract includes a carve out for Burns, describe how these codes are reimbursed
1336	If the contract includes a carve out for Burns, describe schedule name
1337	If the contract includes a carve out for Burns, describe reference year or version
1338	If the contract includes a carve out for Burns, describe reimbursement rate
1339	If the contract includes a carve out for Burns, describe exclusions/exceptions
1340	Does the contract include a carve out for Kyphoplasty (Yes/No)?
1341	Does the contract include a carve out for Kyphoplasty (Yes/No)? (Page#)
1342	If the contract includes a carve out for Kyphoplasty, list the applicable codes or code ranges
1343	If the contract includes a carve out for Kyphoplasty, list the type of applicable codes or code ranges
1344	If the contract includes a carve out for Kyphoplasty, describe how these codes are reimbursed
1345	If the contract includes a carve out for Kyphoplasty, describe schedule name
1346	If the contract includes a carve out for Kyphoplasty, describe reference year or version
1347	If the contract includes a carve out for Kyphoplasty, describe reimbursement rate
1348	If the contract includes a carve out for Kyphoplasty, describe exclusions/exceptions
1349	Does the contract include a carve out for Cryosurgical Ablation of the Prostate (Yes/No)?
1350	Does the contract include a carve out for Cryosurgical Ablation of the Prostate (Yes/No)? (Page#)
1351	If the contract includes a carve out for Cryosurgical Ablation of the Prostate, list the applicable codes or code ranges
1352	If the contract includes a carve out for Cryosurgical Ablation of the Prostate, list the type of applicable codes or code ranges
1353	If the contract includes a carve out for Cryosurgical Ablation of the Prostate, describe how these codes are reimbursed
1354	If the contract includes a carve out for Cryosurgical Ablation of the Prostate, describe schedule name
1355	If the contract includes a carve out for Cryosurgical Ablation of the Prostate, describe reference year or version
1356	If the contract includes a carve out for Cryosurgical Ablation of the Prostate, describe reimbursement rate
1357	If the contract includes a carve out for Cryosurgical Ablation of the Prostate, describe exclusions/exceptions
1358	Does the contract include a carve out for Transurethral Thermal Ablation (TUMT) (Yes/No)?
1359	Does the contract include a carve out for Transurethral Thermal Ablation (TUMT) (Yes/No)? (Page#)
1360	If the contract includes a carve out for Transurethral Thermal Ablation (TUMT), list the applicable codes or code ranges
1361	If the contract includes a carve out for Transurethral Thermal Ablation (TUMT), list the type of applicable codes or code ranges
1362	If the contract includes a carve out for Transurethral Thermal Ablation (TUMT), describe how these codes are reimbursed
1363	If the contract includes a carve out for Transurethral Thermal Ablation (TUMT), describe schedule name
1364	If the contract includes a carve out for Transurethral Thermal Ablation (TUMT), describe reference year or version
1365	If the contract includes a carve out for Transurethral Thermal Ablation (TUMT), describe reimbursement rate
1366	If the contract includes a carve out for Transurethral Thermal Ablation (TUMT), describe exclusions/exceptions
1367	Does the contract include a carve out for Transurethral Needle Ablation (TUNA) (Yes/No)?
1368	Does the contract include a carve out for Transurethral Needle Ablation (TUNA) (Yes/No)? (Page#)
1369	If the contract includes a carve out for Transurethral Needle Ablation (TUNA), list the applicable codes or code ranges
1370	If the contract includes a carve out for Transurethral Needle Ablation (TUNA), list the type of applicable codes or code ranges
1371	If the contract includes a carve out for Transurethral Needle Ablation (TUNA), describe how these codes are reimbursed
1372	If the contract includes a carve out for Transurethral Needle Ablation (TUNA), describe schedule name
1373	If the contract includes a carve out for Transurethral Needle Ablation (TUNA), describe reference year or version
1374	If the contract includes a carve out for Transurethral Needle Ablation (TUNA), describe reimbursement rate
1375	If the contract includes a carve out for Transurethral Needle Ablation (TUNA), describe exclusions/exceptions
1376	Does the contract include a carve out for Hyperbaric Treatment (Yes/No)?
1377	Does the contract include a carve out for Hyperbaric Treatment (Yes/No)? (Page#)
1378	If the contract includes a carve out for Hyperbaric Treatment, list the applicable codes or code ranges
1379	If the contract includes a carve out for Hyperbaric Treatment, list the type of applicable codes or code ranges
1380	If the contract includes a carve out for Hyperbaric Treatment, describe how these codes are reimbursed
1381	If the contract includes a carve out for Hyperbaric Treatment, describe schedule name
1382	If the contract includes a carve out for Hyperbaric Treatment, describe reference year or version
1383	If the contract includes a carve out for Hyperbaric Treatment, describe reimbursement rate
1384	If the contract includes a carve out for Hyperbaric Treatment, describe exclusions/exceptions
1385	Does the contract include a carve out for Clinic Visits (Yes/No)?
1386	Does the contract include a carve out for Clinic Visits (Yes/No)? (Page#)
1387	If the contract includes a carve out for Clinic Visits, list the applicable codes or code ranges
1388	If the contract includes a carve out for Clinic Visits, list the type of applicable codes or code ranges
1389	If the contract includes a carve out for Clinic Visits, describe how these codes are reimbursed
1390	If the contract includes a carve out for Clinic Visits, describe schedule name
1391	If the contract includes a carve out for Clinic Visits, describe reference year or version
1392	If the contract includes a carve out for Clinic Visits, describe reimbursement rate
1393	If the contract includes a carve out for Clinic Visits ,describe exclusions/exceptions
1394	Does the contract include a carve out for Boarder Baby (Yes/No)?
1395	Does the contract include a carve out for Boarder Baby (Yes/No)? (Page#)
1396	If the contract includes a carve out for Boarder Baby, list the applicable codes or code ranges
1397	If the contract includes a carve out for Boarder Baby, list the type of applicable codes or code ranges
1398	If the contract includes a carve out for Boarder Baby, describe how these codes are reimbursed
1399	If the contract includes a carve out for Boarder Baby, describe schedule name
1400	If the contract includes a carve out for Boarder Baby, describe reference year or version
1401	If the contract includes a carve out for Boarder Baby, describe reimbursement rate
1402	If the contract includes a carve out for Boarder Baby ,describe exclusions/exceptions
1403	Does the contract include a carve out for PICU (Yes/No)?
1404	Does the contract include a carve out for PICU (Yes/No)? (Page#)
1405	If the contract includes a carve out for PICU, list the applicable codes or code ranges
1406	If the contract includes a carve out for PICU, list the type of applicable codes or code ranges
1407	If the contract includes a carve out for PICU, describe how these codes are reimbursed
1408	If the contract includes a carve out for PICU, describe schedule name
1409	If the contract includes a carve out for PICU, describe reference year or version
1410	If the contract includes a carve out for PICU, describe reimbursement rate
1411	If the contract includes a carve out for PICU ,describe exclusions/exceptions
1412	Does the contract include a carve out for Psychiatric Services (Yes/No)?
1413	Does the contract include a carve out for Psychiatric Services (Yes/No)? (Page#)
1414	If the contract includes a carve out for Psychiatric Services, list the applicable codes or code ranges
1415	If the contract includes a carve out for Psychiatric Services, list the type of applicable codes or code ranges
1416	If the contract includes a carve out for Psychiatric Services, describe how these codes are reimbursed
1417	If the contract includes a carve out for Psychiatric Services, describe schedule name
1418	If the contract includes a carve out for Psychiatric Services, describe reference year or version
1419	If the contract includes a carve out for Psychiatric Services, describe reimbursement rate
1420	If the contract includes a carve out for Psychiatric Services, describe exclusions/exceptions
1421	Does the contract include a carve out for Sub-Acute Facility Care (Yes/No)?
1422	Does the contract include a carve out for Sub-Acute Facility Care (Yes/No)? (Page#)
1423	If the contract includes a carve out for Sub-Acute Facility Care, list the applicable codes or code ranges
1424	If the contract includes a carve out for Sub-Acute Facility Care, list the type of applicable codes or code ranges
1425	If the contract includes a carve out for Sub-Acute Facility Care, describe how these codes are reimbursed
1426	If the contract includes a carve out for Sub-Acute Facility Care, describe schedule name
1427	If the contract includes a carve out for Sub-Acute Facility Care, describe reference year or version
1428	If the contract includes a carve out for Sub-Acute Facility Care, describe reimbursement rate
1429	If the contract includes a carve out for Sub-Acute Facility Care, describe exclusions/exceptions
1430	Does the contract include a carve out for Ungrouped Inpatient Services (Yes/No)?
1431	Does the contract include a carve out for Ungrouped Inpatient Services (Yes/No)? (Page#)
1432	If the contract includes a carve out for Ungrouped Inpatient Services, list the applicable codes or code ranges
1433	If the contract includes a carve out for Ungrouped Inpatient Services, list the type of applicable codes or code ranges
1434	If the contract includes a carve out for Ungrouped Inpatient Services, describe how these codes are reimbursed
1435	If the contract includes a carve out for Ungrouped Inpatient Services, describe schedule name
1436	If the contract includes a carve out for Ungrouped Inpatient Services, describe reference year or version
1437	If the contract includes a carve out for Ungrouped Inpatient Services, describe reimbursement rate
1438	If the contract includes a carve out for Ungrouped Inpatient Services, describe exclusions/exceptions
1439	Does the contract include a carve out for Surgical Day Limit (Yes/No)?
1440	Does the contract include a carve out for Surgical Day Limit (Yes/No)? (Page#)
1441	If the contract includes a carve out for Surgical Day Limit, list the applicable codes or code ranges
1442	If the contract includes a carve out for Surgical Day Limit, list the type of applicable codes or code ranges
1443	If the contract includes a carve out for Surgical Day Limit, describe how these codes are reimbursed
1444	If the contract includes a carve out for Surgical Day Limit, describe schedule name
1445	If the contract includes a carve out for Surgical Day Limit, describe reference year or version
1446	If the contract includes a carve out for Surgical Day Limit, describe reimbursement rate
1447	If the contract includes a carve out for Surgical Day Limit, describe exclusions/exceptions
1448	Does the contract include a carve out for Surgical Add PD (Yes/No)?
1449	Does the contract include a carve out for Surgical Add PD (Yes/No)? (Page#)
1450	If the contract includes a carve out for Surgical Add PD, list the applicable codes or code ranges
1451	If the contract includes a carve out for Surgical Add PD, list the type of applicable codes or code ranges
1452	If the contract includes a carve out for Surgical Add PD, describe how these codes are reimbursed
1453	If the contract includes a carve out for Surgical Add PD, describe schedule name
1454	If the contract includes a carve out for Surgical Add PD, describe reference year or version
1455	If the contract includes a carve out for Surgical Add PD, describe reimbursement rate
1456	If the contract includes a carve out for Surgical Add PD, describe exclusions/exceptions
1457	Does the contract include a carve out for All Other Acute Svcs Rate (Yes/No)?
1458	Does the contract include a carve out for All Other Acute Svcs Rate (Yes/No)? (Page#)
1459	If the contract includes a carve out for All Other Acute Svcs Rate, list the applicable codes or code ranges
1460	If the contract includes a carve out for All Other Acute Svcs Rate, list the type of applicable codes or code ranges
1461	If the contract includes a carve out for All Other Acute Svcs Rate, describe how these codes are reimbursed
1462	If the contract includes a carve out for All Other Acute Svcs Rate, describe schedule name
1463	If the contract includes a carve out for All Other Acute Svcs Rate, describe reference year or version
1464	If the contract includes a carve out for All Other Acute Svcs Rate, describe reimbursement rate
1465	If the contract includes a carve out for All Other Acute Svcs Rate, describe exclusions/exceptions
1466	Does the contract include a carve out for Acute Day Limit (Yes/No)?
1467	Does the contract include a carve out for Acute Day Limit (Yes/No)? (Page#)
1468	If the contract includes a carve out for Acute Day Limit, list the applicable codes or code ranges
1469	If the contract includes a carve out for Acute Day Limit, list the type of applicable codes or code ranges
1470	If the contract includes a carve out for Acute Day Limit, describe how these codes are reimbursed
1471	If the contract includes a carve out for Acute Day Limit, describe schedule name
1472	If the contract includes a carve out for Acute Day Limit, describe reference year or version
1473	If the contract includes a carve out for Acute Day Limit, describe reimbursement rate
1474	If the contract includes a carve out for Acute Day Limit, describe exclusions/exceptions
1475	Does the contract include a carve out for Acute Add PD (Yes/No)?
1476	Does the contract include a carve out for Acute Add PD (Yes/No)? (Page#)
1477	If the contract includes a carve out for Acute Add PD, list the applicable codes or code ranges
1478	If the contract includes a carve out for Acute Add PD, list the type of applicable codes or code ranges
1479	If the contract includes a carve out for Acute Add PD, describe how these codes are reimbursed
1480	If the contract includes a carve out for Acute Add PD, describe schedule name
1481	If the contract includes a carve out for Acute Add PD, describe reference year or version
1482	If the contract includes a carve out for Acute Add PD, describe reimbursement rate
1483	If the contract includes a carve out for Acute Add PD, describe exclusions/exceptions
1484	Does the contract include a carve out for Neuro (Yes/No)?
1485	Does the contract include a carve out for Neuro (Yes/No)? (Page#)
1486	If the contract includes a carve out for Neuro, list the applicable codes or code ranges
1487	If the contract includes a carve out for Neuro, list the type of applicable codes or code ranges
1488	If the contract includes a carve out for Neuro, describe how these codes are reimbursed
1489	If the contract includes a carve out for Neuro, describe schedule name
1490	If the contract includes a carve out for Neuro, describe reference year or version
1491	If the contract includes a carve out for Neuro, describe reimbursement rate
1492	If the contract includes a carve out for Neuro, describe exclusions/exceptions
1493	Does the contract include a carve out for Neuro Day Limit (Yes/No)?
1494	Does the contract include a carve out for Neuro Day Limit (Yes/No)? (Page#)
1495	If the contract includes a carve out for Neuro Day Limit , list the applicable codes or code ranges
1496	If the contract includes a carve out for Neuro Day Limit , list the type of applicable codes or code ranges
1497	If the contract includes a carve out for Neuro Day Limit , describe how these codes are reimbursed
1498	If the contract includes a carve out for Neuro Day Limit , describe schedule name
1499	If the contract includes a carve out for Neuro Day Limit , describe reference year or version
1500	If the contract includes a carve out for Neuro Day Limit , describe reimbursement rate
1501	If the contract includes a carve out for Neuro Day Limit , describe exclusions/exceptions
1502	Does the contract include a carve out for Neuro PD (Yes/No)?
1503	Does the contract include a carve out for Neuro PD (Yes/No)? (Page#)
1504	If the contract includes a carve out for Neuro PD, list the applicable codes or code ranges
1505	If the contract includes a carve out for Neuro PD, list the type of applicable codes or code ranges
1506	If the contract includes a carve out for Neuro PD, describe how these codes are reimbursed
1507	If the contract includes a carve out for Neuro PD, describe schedule name
1508	If the contract includes a carve out for Neuro PD, describe reference year or version
1509	If the contract includes a carve out for Neuro PD, describe reimbursement rate
1510	If the contract includes a carve out for Neuro PD, describe exclusions/exceptions
1511	Does the contract include a carve out for AICD/Pacemaker (Yes/No)?
1512	Does the contract include a carve out for AICD/Pacemaker (Yes/No)? (Page#)
1513	If the contract includes a carve out for AICD/Pacemaker, list the applicable codes or code ranges
1514	If the contract includes a carve out for AICD/Pacemaker, list the type of applicable codes or code ranges
1515	If the contract includes a carve out for AICD/Pacemaker, describe how these codes are reimbursed
1516	If the contract includes a carve out for AICD/Pacemaker, describe schedule name
1517	If the contract includes a carve out for AICD/Pacemaker, describe reference year or version
1518	If the contract includes a carve out for AICD/Pacemaker, describe reimbursement rate
1519	If the contract includes a carve out for AICD/Pacemaker, describe exclusions/exceptions
1520	Does the contract include a carve out for Angioplasty (Yes/No)?
1521	Does the contract include a carve out for Angioplasty (Yes/No)? (Page#)
1522	If the contract includes a carve out for Angioplasty, list the applicable codes or code ranges
1523	If the contract includes a carve out for Angioplasty, list the type of applicable codes or code ranges
1524	If the contract includes a carve out for Angioplasty, describe how these codes are reimbursed
1525	If the contract includes a carve out for Angioplasty, describe schedule name
1526	If the contract includes a carve out for Angioplasty, describe reference year or version
1527	If the contract includes a carve out for Angioplasty, describe reimbursement rate
1528	If the contract includes a carve out for Angioplasty, describe exclusions/exceptions
1529	Does the contract include a carve out for Cardiac Caths (Yes/No)?	Y
1530	Does the contract include a carve out for Cardiac Caths (Yes/No)? (Page#)
1531	If the contract includes a carve out for Cardiac Caths, list the applicable codes or code ranges
1532	If the contract includes a carve out for Cardiac Caths, list the type of applicable codes or code ranges
1533	If the contract includes a carve out for Cardiac Caths, describe how these codes are reimbursed
1534	If the contract includes a carve out for Cardiac Caths, describe schedule name
1535	If the contract includes a carve out for Cardiac Caths, describe reference year or version
1536	If the contract includes a carve out for Cardiac Caths, describe reimbursement rate
1537	If the contract includes a carve out for Cardiac Caths, describe exclusions/exceptions
1538	Does the contract include a carve out for CV Surgery (Yes/No)?
1539	Does the contract include a carve out for CV Surgery (Yes/No)? (Page#)
1540	If the contract includes a carve out for CV Surgery, list the applicable codes or code ranges
1541	If the contract includes a carve out for CV Surgery, list the type of applicable codes or code ranges
1542	If the contract includes a carve out for CV Surgery, describe how these codes are reimbursed
1543	If the contract includes a carve out for CV Surgery, describe schedule name
1544	If the contract includes a carve out for CV Surgery, describe reference year or version
1545	If the contract includes a carve out for CV Surgery, describe reimbursement rate
1546	If the contract includes a carve out for CV Surgery, describe exclusions/exceptions
1547	Does the contract include a carve out for Card Day Limit (Yes/No)?
1548	Does the contract include a carve out for Card Day Limit (Yes/No)? (Page#)
1549	If the contract includes a carve out for Card Day Limit, list the applicable codes or code ranges
1550	If the contract includes a carve out for Card Day Limit, list the type of applicable codes or code ranges
1551	If the contract includes a carve out for Card Day Limit, describe how these codes are reimbursed
1552	If the contract includes a carve out for Card Day Limit, describe schedule name
1553	If the contract includes a carve out for Card Day Limit, describe reference year or version
1554	If the contract includes a carve out for Card Day Limit, describe reimbursement rate
1555	If the contract includes a carve out for Card Day Limit, describe exclusions/exceptions
1556	Does the contract include a carve out for Card PD (Yes/No)?
1557	Does the contract include a carve out for Card PD (Yes/No)? (Page#)
1558	If the contract includes a carve out for Card PD, list the applicable codes or code ranges
1559	If the contract includes a carve out for Card PD, list the type of applicable codes or code ranges
1560	If the contract includes a carve out for Card PD, describe how these codes are reimbursed
1561	If the contract includes a carve out for Card PD, describe schedule name
1562	If the contract includes a carve out for Card PD, describe reference year or version
1563	If the contract includes a carve out for Card PD, describe reimbursement rate
1564	If the contract includes a carve out for Card PD, describe exclusions/exceptions
1565	Does the contract include a carve out for C-Section (Yes/No)?
1566	Does the contract include a carve out for C-Section (Yes/No)? (Page#)
1567	If the contract includes a carve out for C-Section, list the applicable codes or code ranges
1568	If the contract includes a carve out for C-Section, list the type of applicable codes or code ranges
1569	If the contract includes a carve out for C-Section, describe how these codes are reimbursed
1570	If the contract includes a carve out for C-Section, describe schedule name
1571	If the contract includes a carve out for C-Section, describe reference year or version
1572	If the contract includes a carve out for C-Section, describe reimbursement rate
1573	If the contract includes a carve out for C-Section, describe exclusions/exceptions
1574	Does the contract include a carve out for C-Section Day Limit (Yes/No)?
1575	Does the contract include a carve out for C-Section Day Limit (Yes/No)? (Page#)
1576	If the contract includes a carve out for C-Section Day Limit, list the applicable codes or code ranges
1577	If the contract includes a carve out for C-Section Day Limit, list the type of applicable codes or code ranges
1578	If the contract includes a carve out for C-Section Day Limit, describe how these codes are reimbursed
1579	If the contract includes a carve out for C-Section Day Limit, describe schedule name
1580	If the contract includes a carve out for C-Section Day Limit, describe reference year or version
1581	If the contract includes a carve out for C-Section Day Limit, describe reimbursement rate
1582	If the contract includes a carve out for C-Section Day Limit, describe exclusions/exceptions
1583	Does the contract include a carve out for C-Section PD (Yes/No)?
1584	Does the contract include a carve out for C-Section PD (Yes/No)? (Page#)
1585	If the contract includes a carve out for C-Section PD, list the applicable codes or code ranges
1586	If the contract includes a carve out for C-Section PD, list the type of applicable codes or code ranges
1587	If the contract includes a carve out for C-Section PD, describe how these codes are reimbursed
1588	If the contract includes a carve out for C-Section PD, describe schedule name
1589	If the contract includes a carve out for C-Section PD, describe reference year or version
1590	If the contract includes a carve out for C-Section PD, describe reimbursement rate
1591	If the contract includes a carve out for C-Section PD, describe exclusions/exceptions
1592	Does the contract include a carve out for OB Day Limit (Yes/No)?
1593	Does the contract include a carve out for OB Day Limit (Yes/No)? (Page#)
1594	If the contract includes a carve out for OB Day Limit, list the applicable codes or code ranges
1595	If the contract includes a carve out for OB Day Limit, list the type of applicable codes or code ranges
1596	If the contract includes a carve out for OB Day Limit, describe how these codes are reimbursed
1597	If the contract includes a carve out for OB Day Limit, describe schedule name
1598	If the contract includes a carve out for OB Day Limit, describe reference year or version
1599	If the contract includes a carve out for OB Day Limit, describe reimbursement rate
1600	If the contract includes a carve out for OB Day Limit, describe exclusions/exceptions
1601	Does the contract include a carve out for OB PD (Yes/No)?
1602	Does the contract include a carve out for OB PD (Yes/No)? (Page#)
1603	If the contract includes a carve out for OB PD, list the applicable codes or code ranges
1604	If the contract includes a carve out for OB PD, list the type of applicable codes or code ranges
1605	If the contract includes a carve out for OB PD, describe how these codes are reimbursed
1606	If the contract includes a carve out for OB PD, describe schedule name
1607	If the contract includes a carve out for OB PD, describe reference year or version
1608	If the contract includes a carve out for OB PD, describe reimbursement rate
1609	If the contract includes a carve out for OB PD, describe exclusions/exceptions
1610	Does the contract include a carve out for Gamma Knife Outpatient (Yes/No)?
1611	Does the contract include a carve out for Gamma Knife Outpatient (Yes/No)? (Page#)
1612	If the contract includes a carve out for Gamma Knife Outpatient, list the applicable codes or code ranges
1613	If the contract includes a carve out for Gamma Knife Outpatient, list the type of applicable codes or code ranges
1614	If the contract includes a carve out for Gamma Knife Outpatient, describe how these codes are reimbursed
1615	If the contract includes a carve out for Gamma Knife Outpatient, describe schedule name
1616	If the contract includes a carve out for Gamma Knife Outpatient, describe reference year or version
1617	If the contract includes a carve out for Gamma Knife Outpatient, describe reimbursement rate
1618	If the contract includes a carve out for Gamma Knife Outpatient, describe exclusions/exceptions
1619	Does the contract include a carve out for DaVinci (Yes/No)?
1620	Does the contract include a carve out for DaVinci (Yes/No)? (Page#)
1621	If the contract includes a carve out for DaVinci, list the applicable codes or code ranges
1622	If the contract includes a carve out for DaVinci, list the type of applicable codes or code ranges
1623	If the contract includes a carve out for DaVinci, describe how these codes are reimbursed
1624	If the contract includes a carve out for DaVinci, describe schedule name
1625	If the contract includes a carve out for DaVinci, describe reference year or version
1626	If the contract includes a carve out for DaVinci, describe reimbursement rate
1627	If the contract includes a carve out for DaVinci, describe exclusions/exceptions
1628	Does the contract include a carve out for OP EP with Ablation, OP EP (Yes/No)?
1629	Does the contract include a carve out for OP EP with Ablation, OP EP (Yes/No)? (Page#)
1630	If the contract includes a carve out for OP EP with Ablation, OP EP, list the applicable codes or code ranges
1631	If the contract includes a carve out for OP EP with Ablation, OP EP, list the type of applicable codes or code ranges
1632	If the contract includes a carve out for OP EP with Ablation, OP EP, describe how these codes are reimbursed
1633	If the contract includes a carve out for OP EP with Ablation, OP EP, describe schedule name
1634	If the contract includes a carve out for OP EP with Ablation, OP EP, describe reference year or version
1635	If the contract includes a carve out for OP EP with Ablation, OP EP, describe reimbursement rate
1636	If the contract includes a carve out for OP EP with Ablation, OP EP, describe exclusions/exceptions
1637	Does the contract include a carve out for Non-Physician Health Professionals (Yes/No)?
1638	Does the contract include a carve out for Non-Physician Health Professionals (Yes/No)? (Page#)
1639	If the contract includes a carve out for Non-Physician Health Professionals, list the applicable codes or code ranges
1640	If the contract includes a carve out for Non-Physician Health Professionals, list the type of applicable codes or code ranges
1641	If the contract includes a carve out for Non-Physician Health Professionals, describe how these codes are reimbursed
1642	If the contract includes a carve out for Non-Physician Health Professionals, describe schedule name
1643	If the contract includes a carve out for Non-Physician Health Professionals, describe reference year or version
1644	If the contract includes a carve out for Non-Physician Health Professionals, describe reimbursement rate
1645	If the contract includes a carve out for Non-Physician Health Professionals, describe any exclusions/exceptions
1646	Does the contract include a carve out for Mental Health Services (Yes/No)?
1647	Does the contract include a carve out for Mental Health Services (Yes/No)? (Page#)
1648	If the contract includes a carve out for Mental Health Services, list the applicable codes or code ranges
1649	If the contract includes a carve out for Mental Health Services, list the type of applicable codes or code ranges
1650	If the contract includes a carve out for Mental Health Services, describe how these codes are reimbursed
1651	If the contract includes a carve out for Mental Health Services, describe schedule name
1652	If the contract includes a carve out for Mental Health Services, describe reference year or version
1653	If the contract includes a carve out for Mental Health Services, describe reimbursement rate
1654	If the contract includes a carve out for Mental Health Services, describe any exclusions/exceptions
1655	Does the contract include a carve out for MRI (Yes/No)?
1656	Does the contract include a carve out for MRI (Yes/No)? (Page#)
1657	If the contract includes a carve out for MRI, list the applicable codes or code ranges
1658	If the contract includes a carve out for MRI, list the type of applicable codes or code ranges
1659	If the contract includes a carve out for MRI, describe how these codes are reimbursed
1660	If the contract includes a carve out for MRI, describe schedule name
1661	If the contract includes a carve out for MRI, describe reference year or version
1662	If the contract includes a carve out for MRI, describe reimbursement rate
1663	If the contract includes a carve out for MRI, describe any exclusions/exceptions
1664	Does the contract include a carve out for CT Scans (Yes/No)?
1665	Does the contract include a carve out for CT Scans (Yes/No)? (Page#)
1666	If the contract includes a carve out for CT Scans, list the applicable codes or code ranges
1667	If the contract includes a carve out for CT Scans, list the type of applicable codes or code ranges
1668	If the contract includes a carve out for CT Scans, describe how these codes are reimbursed
1669	If the contract includes a carve out for CT Scans, describe schedule name
1670	If the contract includes a carve out for CT Scans, describe reference year or version
1671	If the contract includes a carve out for CT Scans, describe reimbursement rate
1672	If the contract includes a carve out for CT Scans, describe any exclusions/exceptions
1673	Does the contract include a carve out for Home Infusion Therapy Drugs (Yes/No)?
1674	Does the contract include a carve out for Home Infusion Therapy Drugs (Yes/No)? (Page#)
1675	If the contract includes a carve out for Home Infusion Therapy Drugs, list the applicable codes or code ranges
1676	If the contract includes a carve out for Home Infusion Therapy Drugs, list the type of applicable codes or code ranges
1677	If the contract includes a carve out for Home Infusion Therapy Drugs, describe how these codes are reimbursed
1678	If the contract includes a carve out for Home Infusion Therapy Drugs, describe schedule name
1679	If the contract includes a carve out for Home Infusion Therapy Drugs, describe reference year or version
1680	If the contract includes a carve out for Home Infusion Therapy Drugs, describe reimbursement rate
1681	If the contract includes a carve out for Home Infusion Therapy Drugs, describe any exclusions/exceptions
1682	Is there an exhibit, attachment or schedule that defines terms for Value Based Contracting (or Value Based Care)? (Yes/No)
1683	Is there an exhibit, attachment or schedule that defines terms for Value Based Contracting (or Value Based Care)? (Yes/No) (Page#)
1684	Does the contract include a carve out for Radiation Therapy (Yes/No)?
1685	Does the contract include a carve out for Radiation Therapy (Yes/No)? (Page#)
1686	If the contract includes a carve out for Radiation Therapy, list the applicable codes or code ranges
1687	If the contract includes a carve out for Radiation Therapy, list the type of applicable codes or code ranges
1688	If the contract includes a carve out for Radiation Therapy, describe how these codes are reimbursed
1689	If the contract includes a carve out for Radiation Therapy, describe schedule name
1690	If the contract includes a carve out for Radiation Therapy, describe reference year or version
1691	If the contract includes a carve out for Radiation Therapy, describe reimbursement rate
1692	If the contract includes a carve out for Radiation Therapy, describe any exclusions/exceptions