claimnum | patnum | dateservice | datesent | claimstatus | trial_datereceived_6 | plannum | provtreat | claimfee | inspayest | inspayamt | dedapplied | preauthstring | isprosthesis | priordate | reasonunderpaid | claimnote | trial_claimtype_18 | provbill | referringprov | trial_refnumstring_21 | placeservice | accidentrelated | trial_accidentdate_24 | accidentst | employrelated | isortho | orthoremainm | orthodate | patrelat | plannum2 | patrelat2 | trial_writeoff_33 | radiographs | trial_clinicnum_35 | claimform | trial_attachedimages_37 | trial_attachedmodels_38 | trial_attachedflags_39 | attachmentid | canadianmaterialsforwarded | trial_canadianreferralprovidernum_42 | canadianreferralreason | trial_canadianisinitiallower_44 | canadiandateinitiallower | canadianmandprosthmaterial | trial_canadianisinitialupper_47 | trial_canadiandateinitialupper_48 | canadianmaxprosthmaterial | trial_inssubnum_50 | inssubnum2 | canadatransrefnum | trial_canadaesttreatstartdate_53 | canadainitialpayment | trial_canadapaymentmode_55 | canadatreatduration | canadanumanticipatedpayments | canadaanticipatedpayamount | priorauthorizationnumber | specialprogramcode | uniformbilltype | medtype | admissiontypecode | admissionsourcecode | patientstatuscode | trial_customtracking_66 | dateresent | correctiontype | trial_claimidentifier_69 | origrefnum | provorderoverride | orthototalm | shareofcost | trial_secusernumentry_74 | trial_secdateentry_75 | secdatetedit | trial_orderingreferralnum_77 | datesentorig | trial_dateillnessinjurypreg_79 | dateillnessinjurypregqualifier | trial_dateother_81 | dateotherqualifier | isoutsidelab | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 15 | 2023-06-12T00:00:00.000Z | 2023-07-13T00:00:00.000Z | S | 0001-01-01T00:00:00.000Z | 14 | 1 | 140 | 126 | 0 | 0 | N | 0001-01-01T00:00:00.000Z | P | 1 | 0 | 0 | 0001-01-01T00:00:00.000Z | 2 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | * TR | 0 | 0001-01-01T00:00:00.000Z | 0 | 0001-01-01T00:00:00.000Z | 0 | 6 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 15/1 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 2023-07-13T11:48:28.000Z | 0 | 2023-07-13T00:00:00.000Z | 0001-01-01T00:00:00.000Z | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | |||||||||||||||||||
| 2 | 16 | 2023-06-12T00:00:00.000Z | 2023-07-13T00:00:00.000Z | S | 0001-01-01T00:00:00.000Z | 15 | 1 | 180 | 166 | 0 | 0 | * | 0001-01-01T00:00:00.000Z | P | 1 | 0 | 0 | 0001-01-01T00:00:00.000Z | 2 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | * TR | 0 | 0001-01-01T00:00:00.000Z | 0 | 0001-01-01T00:00:00.000Z | 0 | 7 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 16/2 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 2023-07-13T11:48:28.000Z | 0 | 2023-07-13T00:00:00.000Z | 0001-01-01T00:00:00.000Z | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | |||||||||||||||||||
| 3 | 17 | 2023-06-12T00:00:00.000Z | 2023-07-13T00:00:00.000Z | S | 0001-01-01T00:00:00.000Z | 15 | 1 | 68 | 68 | 0 | 0 | N | 0001-01-01T00:00:00.000Z | * | 1 | 0 | 0 | 0001-01-01T00:00:00.000Z | 2 | 0 | 0 | 0001-01-01T00:00:00.000Z | 2 | 14 | 2 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0001-01-01T00:00:00.000Z | 0 | 7 | 6 | 0001-01-01T00:00:00.000Z | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 17/3 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 2023-07-13T11:48:28.000Z | 0 | 2023-07-13T00:00:00.000Z | 0001-01-01T00:00:00.000Z | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | ||||||||||||||||||||
| 4 | 17 | 2023-06-12T00:00:00.000Z | 0001-01-01T00:00:00.000Z | H | 0001-01-01T00:00:00.000Z | 14 | 1 | 68 | 0 | 0 | 0 | * | 0001-01-01T00:00:00.000Z | S | 1 | 0 | 0 | 0001-01-01T00:00:00.000Z | 2 | 0 | 0 | 0001-01-01T00:00:00.000Z | 2 | 15 | 2 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0001-01-01T00:00:00.000Z | 0 | 6 | 7 | 0001-01-01T00:00:00.000Z | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 17/4 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 2023-07-13T11:48:28.000Z | 0 | 0001-01-01T00:00:00.000Z | 0001-01-01T00:00:00.000Z | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | ||||||||||||||||||||
| 7 | 11 | 2023-06-12T00:00:00.000Z | 2023-07-13T00:00:00.000Z | S | 0001-01-01T00:00:00.000Z | 12 | 1 | 230 | 140 | 0 | 75 | N | 0001-01-01T00:00:00.000Z | * | 1 | 0 | 0 | 0001-01-01T00:00:00.000Z | 2 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0001-01-01T00:00:00.000Z | 0 | 4 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 11/7 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 2023-07-13T11:48:28.000Z | 0 | 2023-07-13T00:00:00.000Z | 0001-01-01T00:00:00.000Z | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | ||||||||||||||||||||
| 8 | 12 | 2023-06-12T00:00:00.000Z | 2023-07-13T00:00:00.000Z | * | 0001-01-01T00:00:00.000Z | 12 | 1 | 140 | 125 | 0 | 0 | N | 0001-01-01T00:00:00.000Z | P | 1 | 0 | 0 | 0001-01-01T00:00:00.000Z | 2 | 0 | 0 | 0001-01-01T00:00:00.000Z | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0001-01-01T00:00:00.000Z | 0 | 4 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 12/8 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 2023-07-13T11:48:28.000Z | 0 | 2023-07-13T00:00:00.000Z | 0001-01-01T00:00:00.000Z | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | ||||||||||||||||||||
| 9 | 13 | 2023-06-12T00:00:00.000Z | 2023-07-13T00:00:00.000Z | S | 0001-01-01T00:00:00.000Z | 13 | 1 | 140 | 35 | 0 | 50 | * | 0001-01-01T00:00:00.000Z | P | 1 | 0 | 0 | 0001-01-01T00:00:00.000Z | 2 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | 0 | 30 | 0 | 0 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0001-01-01T00:00:00.000Z | 0 | 5 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | * TR | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 2023-07-13T11:48:28.000Z | 0 | 2023-07-13T00:00:00.000Z | 0001-01-01T00:00:00.000Z | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | ||||||||||||||||||||
| 10 | 9 | 2023-06-12T00:00:00.000Z | 2023-07-13T00:00:00.000Z | R | 2023-07-13T00:00:00.000Z | 9 | 3 | 300 | 150 | 150 | 0 | N | 0001-01-01T00:00:00.000Z | P | 1 | 0 | 0 | 0001-01-01T00:00:00.000Z | 2 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0001-01-01T00:00:00.000Z | 0 | 2 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 9/10 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 2023-07-13T11:48:28.000Z | 0 | 2023-07-13T00:00:00.000Z | 0001-01-01T00:00:00.000Z | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | ||||||||||||||||||||
| 11 | 9 | 2023-06-14T00:00:00.000Z | 2023-07-13T00:00:00.000Z | S | 0001-01-01T00:00:00.000Z | 9 | 3 | 450 | 225 | 0 | 0 | * | 0001-01-01T00:00:00.000Z | P | 1 | 0 | 0 | 0001-01-01T00:00:00.000Z | 2 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | * TR | 0 | 0001-01-01T00:00:00.000Z | 0 | 0001-01-01T00:00:00.000Z | 0 | 2 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 9/11 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 2023-07-13T11:48:28.000Z | 0 | 2023-07-13T00:00:00.000Z | 0001-01-01T00:00:00.000Z | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | |||||||||||||||||||
| 12 | 10 | 2023-06-12T00:00:00.000Z | 2023-07-13T00:00:00.000Z | * | 0001-01-01T00:00:00.000Z | 10 | 1 | 150 | 120 | 0 | 0 | * | 0001-01-01T00:00:00.000Z | * | 1 | 0 | 0 | 0001-01-01T00:00:00.000Z | 2 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0001-01-01T00:00:00.000Z | 0 | 3 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 10/12 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 2023-07-13T11:48:28.000Z | 0 | 2023-07-13T00:00:00.000Z | 0001-01-01T00:00:00.000Z | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | ||||||||||||||||||||
| 15 | 8 | 2023-07-14T00:00:00.000Z | 2023-07-13T00:00:00.000Z | * | 0001-01-01T00:00:00.000Z | 6 | 1 | 150 | 62 | 0 | 50 | N | 0001-01-01T00:00:00.000Z | P | 1 | 0 | 0 | 0001-01-01T00:00:00.000Z | 2 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | 0 | 10 | 0 | 0 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0001-01-01T00:00:00.000Z | 0 | 1 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | * TR | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 2023-07-13T11:48:28.000Z | 0 | 2023-07-13T00:00:00.000Z | 0001-01-01T00:00:00.000Z | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | ||||||||||||||||||||
| 14 | 9 | 2023-04-06T00:00:00.000Z | 2023-04-06T00:00:00.000Z | * | 2023-07-13T00:00:00.000Z | 9 | 3 | 80 | 80 | 80 | 0 | N | 0001-01-01T00:00:00.000Z | * | 1 | 0 | 0 | 0001-01-01T00:00:00.000Z | 2 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0001-01-01T00:00:00.000Z | 0 | 2 | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 0 | 9/14 | 0 | 0 | 0 | 0 | 0001-01-01T00:00:00.000Z | 2023-07-13T11:48:28.000Z | 0 | 2023-04-06T00:00:00.000Z | 0001-01-01T00:00:00.000Z | 0 | 0001-01-01T00:00:00.000Z | 0 | 0 |