claim_id,member_id,claim_type,service_date_from,service_date_to,adjudication_date,plan_id,rendering_npi,billing_npi,provider_specialty,network_status,primary_icd10_cm,dx2,dx3,dx4,dx5,drg_code,drg_type,mdc_code,length_of_stay,poa_flag,cpt_code,cpt_category,modifier1,modifier2,revenue_code,place_of_service,pos_description,service_units,billed_amount,allowed_amount,paid_amount,member_deductible,member_copay,member_coinsurance,member_oop,cob_amount,claim_status,denial_code_carc,denial_reason_desc,auth_required_flag,auth_number,er_flag,preventive_flag,elective_flag,high_cost_flag,readmission_flag_30d,fraud_label,fraud_pattern_type,hedis_bcs,hedis_col,hedis_cdc_a1c,hedis_awv,hedis_depression
CLM0000000001,MBR00000001,Institutional-OP,2021-07-12,2021-07-12,2021-07-27,PLN6351,1337791138,1337791138,Internal Medicine,Out-of-Network,Z00.01,E11.9,,,,,,,0,,71046,Radiology,,,0636,22,Outpatient Hospital,3,283.44,177.05,103.8,0.0,50.0,23.25,73.25,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000002,MBR00000001,Professional,2023-06-05,2023-06-05,2023-06-15,PLN8283,1213165847,1213165847,Critical Access Hospital,In-Network,E11.9,F41.9,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,3,402.14,276.09,241.09,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000003,MBR00000001,Professional,2021-12-14,2021-12-14,2022-01-27,PLN5156,1114982472,1114982472,Orthopedic Surgery,In-Network,Z23,N18.3,,,,,,,0,,23472,Surgery,,,,11,Office,3,5212.44,3844.64,3421.38,423.26,0.0,0.0,423.26,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000004,MBR00000001,Professional,2021-03-27,2021-03-27,2021-04-04,PLN7100,1991459367,1991459367,Neurology,Out-of-Network,R51,E78.5,,,,,,,0,,99204,E&M,,,,11,Office,2,315.09,132.77,53.49,78.58,0.0,0.7,79.28,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000000005,MBR00000001,Professional,2022-10-07,2022-10-07,2022-10-28,PLN2851,1213165847,1213165847,Critical Access Hospital,In-Network,Z23,E11.9,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,3,62.33,32.52,0.0,32.52,75.0,0.0,107.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000006,MBR00000001,Institutional-IP,2022-12-21,2022-12-22,2023-01-14,PLN2798,1780163051,1780163051,SNF,In-Network,I25.10,Z00.01,,,,682,MS-DRG,14,1,Y,97110,Medicine,,,0200,21,Inpatient Hospital,2,103.29,49.62,0.0,49.62,50.0,0.0,99.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000007,MBR00000001,Professional,2023-12-31,2023-12-31,2024-01-12,PLN8698,1364429278,1364429278,OB/GYN,In-Network,J06.9,M81.0,,,,,,,0,,81001,Pathology/Lab,,,,81,Independent Laboratory,2,43.9,22.92,0.0,22.92,0.0,0.0,22.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000008,MBR00000001,Professional,2022-06-17,2022-06-17,2022-07-18,PLN8618,1757138478,1757138478,Pediatrics,In-Network,I50.9,E11.9,,,,,,,0,,99213,E&M,,,,23,Emergency Room,1,202.61,168.38,0.0,139.56,75.0,0.0,214.56,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000009,MBR00000001,Professional,2023-05-26,2023-05-26,2023-07-05,PLN7196,1997536841,1997536841,Family Medicine,Out-of-Network,Z23,F41.9,,,,,,,0,,99283,E&M,,,,11,Office,3,580.66,305.29,305.29,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000010,MBR00000001,Professional,2022-08-09,2022-08-09,2022-09-10,PLN4090,1410468316,1410468316,SNF,In-Network,E78.5,M54.5,,,,,,,0,,90837,Medicine,,,,11,Office,1,471.67,256.87,206.87,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000011,MBR00000001,Institutional-IP,2023-10-09,2023-10-10,2023-10-17,PLN9413,1500949740,1500949740,Pediatrics,In-Network,Z12.31,J45.20,,,,690,MS-DRG,1,1,Y,72148,Radiology,,,0730,21,Inpatient Hospital,2,2144.21,1649.42,1169.4,344.63,0.0,135.39,480.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000012,MBR00000001,Professional,2022-06-18,2022-06-18,2022-07-04,PLN4399,1745114564,1745114564,Endocrinology,In-Network,R51,E11.65,,,,,,,0,,99204,E&M,,,,11,Office,3,319.2,186.82,38.51,98.31,50.0,0.0,148.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000013,MBR00000001,Professional,2023-01-10,2023-01-10,2023-02-11,PLN2854,1390307371,1390307371,DME Supplier,In-Network,R05,K21.0,,,,,,,0,,78452,Radiology,,,,50,Federally Qualified Health Center,2,5398.29,2895.43,2409.92,0.0,0.0,485.51,485.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000014,MBR00000001,Professional,2023-11-21,2023-11-21,2023-11-29,PLN9333,1660288235,1660288235,ASC,In-Network,M81.0,I10,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,1,89.14,34.5,34.5,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000000015,MBR00000001,Institutional-IP,2023-08-19,2023-08-23,2023-09-12,PLN5092,1716521444,1716521444,Oncology,In-Network,I63.9,I10,,,,292,MS-DRG,14,4,Y,93000,Radiology,,,0120,21,Inpatient Hospital,3,137.19,95.17,70.01,0.0,25.0,0.16,25.16,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000016,MBR00000001,Professional,2022-03-16,2022-03-16,2022-04-27,PLN4693,1700633438,1700633438,DME Supplier,In-Network,I25.10,R10.9,,,,,,,0,,33533,Surgery,,,,49,Independent Clinic,2,19485.54,13213.17,12777.1,0.0,15.0,421.07,436.07,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000000017,MBR00000001,Institutional-OP,2022-07-10,2022-07-10,2022-08-22,PLN7130,1108115157,1108115157,General Acute Care Hospital,In-Network,Z12.31,E78.5,,,,,,,0,,71046,Radiology,,,0730,22,Outpatient Hospital,1,147.12,116.63,0.0,116.63,0.0,0.0,116.63,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000018,MBR00000001,Professional,2022-10-12,2022-10-12,2022-11-23,PLN1638,1213165847,1213165847,Critical Access Hospital,In-Network,Z12.31,Z00.00,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,2,289.9,176.94,0.0,176.94,0.0,0.0,176.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000019,MBR00000001,Institutional-OP,2021-05-16,2021-05-16,2021-06-15,PLN8643,1135158374,1135158374,Pulmonology,In-Network,Z79.4,F32.9,,,,,,,0,,90837,Medicine,,,0510,22,Outpatient Hospital,2,306.5,114.65,97.17,1.26,0.0,16.22,17.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000020,MBR00000001,Professional,2021-09-13,2021-09-13,2021-10-22,PLN7992,1514306773,1514306773,Endocrinology,In-Network,F32.9,N18.3,,,,,,,0,,87491,Pathology/Lab,,,,49,Independent Clinic,2,176.12,133.77,128.3,0.0,0.0,5.47,5.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000021,MBR00000001,Institutional-OP,2023-02-16,2023-02-16,2023-03-20,PLN1575,1124394415,1124394415,Pediatrics,In-Network,Z23,Z23,,,,,,,0,,97110,Medicine,,,0301,22,Outpatient Hospital,1,251.84,87.74,0.0,87.74,0.0,0.0,87.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000022,MBR00000001,Professional,2021-03-20,2021-03-20,2021-04-28,PLN6909,1450553056,1450553056,Clinical Laboratory,In-Network,Z00.00,E78.5,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,3,437.4,207.15,187.14,0.0,0.0,20.01,20.01,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000023,MBR00000001,Professional,2022-10-21,2022-10-21,2022-11-13,PLN6058,1644128543,1644128543,Gastroenterology,In-Network,E11.40,Z23,,,,,,,0,,99221,E&M,,,,11,Office,2,412.23,258.6,0.0,258.6,0.0,0.0,258.6,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000024,MBR00000001,Institutional-OP,2022-06-15,2022-06-15,2022-07-22,PLN1398,1935547131,1935547131,Pulmonology,In-Network,Z12.31,E78.5,,,,,,,0,,72148,Radiology,,,0510,22,Outpatient Hospital,3,1625.38,953.11,938.11,0.0,15.0,0.0,15.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000025,MBR00000001,Institutional-OP,2022-06-16,2022-06-16,2022-07-10,PLN9805,1135158374,1135158374,Pulmonology,In-Network,M54.5,E11.40,,,,,,,0,,66984,Surgery,,,0301,22,Outpatient Hospital,3,2158.47,1459.13,1318.95,0.0,0.0,140.18,140.18,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000026,MBR00000001,Institutional-OP,2023-07-16,2023-07-16,2023-08-20,PLN3392,1124394415,1124394415,Pediatrics,In-Network,M17.11,E78.5,,,,,,,0,,99232,E&M,,,0270,22,Outpatient Hospital,2,237.79,147.06,103.59,0.0,25.0,18.47,43.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000027,MBR00000001,Professional,2021-10-29,2021-10-29,2021-11-14,PLN1307,1856686341,1856686341,Geriatrics,In-Network,N18.3,F10.20,,,,,,,0,,85610,Pathology/Lab,,,,22,Outpatient Hospital,2,32.51,19.93,17.73,0.0,0.0,2.2,2.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000028,MBR00000001,Professional,2023-05-16,2023-05-16,2023-05-28,PLN3291,1717546253,1717546253,Family Medicine,In-Network,I10,I10,,,,,,,0,,99232,E&M,,,,49,Independent Clinic,3,173.68,107.54,107.54,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000029,MBR00000001,Professional,2023-05-09,2023-05-09,2023-06-04,PLN5559,1438368327,1438368327,Home Health,In-Network,N18.3,Z79.4,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,3,367.23,176.28,126.28,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000030,MBR00000001,Institutional-IP,2023-12-23,2023-12-30,2024-01-18,PLN7007,1520687146,1520687146,ASC,In-Network,J06.9,F32.9,,,,683,MS-DRG,8,7,Y,86900,Pathology/Lab,,,0270,21,Inpatient Hospital,1,60.1,48.13,13.13,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000000031,MBR00000001,Professional,2023-06-18,2023-06-18,2023-07-03,PLN2069,1245650222,1245650222,Gastroenterology,In-Network,I10,M54.5,,,,,,,0,,99203,E&M,,,,31,Skilled Nursing Facility,3,174.32,80.8,64.68,0.0,0.0,16.12,16.12,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000032,MBR00000001,Professional,2022-07-10,2022-07-10,2022-07-22,PLN1183,1372918899,1372918899,Family Medicine,In-Network,N18.3,J20.9,,,,,,,0,,90837,Medicine,,,,22,Outpatient Hospital,1,206.02,113.42,0.0,113.42,25.0,0.0,138.42,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000000033,MBR00000001,Professional,2022-02-03,2022-02-03,2022-02-12,PLN4466,1372918899,1372918899,Family Medicine,In-Network,R05,J06.9,,,,,,,0,,72148,Radiology,,,,21,Inpatient Hospital,3,1561.44,1247.29,1217.19,0.0,0.0,30.1,30.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000034,MBR00000001,Institutional-OP,2023-05-06,2023-05-06,2023-06-08,PLN6023,1974006077,1974006077,Orthopedic Surgery,In-Network,N40.0,F10.20,,,,,,,0,,78452,Radiology,,,0360,22,Outpatient Hospital,2,6391.78,2261.19,2261.19,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000035,MBR00000001,Professional,2023-10-13,2023-10-13,2023-11-07,PLN9763,1395983630,1395983630,Nephrology,In-Network,I10,Z79.4,,,,,,,0,,99284,E&M,,,,11,Office,1,750.65,438.51,438.51,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000036,MBR00000001,Professional,2021-11-04,2021-11-04,2021-11-29,PLN6130,1795618275,1795618275,Pulmonology,In-Network,I10,E11.9,,,,,,,0,,27447,Surgery,,,,20,Urgent Care,2,6233.93,2582.45,2582.45,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000037,MBR00000002,Professional,2022-02-09,2022-02-09,2022-03-22,PLN3893,1812060197,1812060197,Oncology,Out-of-Network,F41.9,E78.5,,,,,,,0,,G0439,Medicine,,,,11,Office,1,644.39,465.91,465.91,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000000038,MBR00000002,Professional,2022-06-29,2022-06-29,2022-07-28,PLN3422,1865904917,1865904917,Outpatient Clinic,In-Network,Z00.00,I10,,,,,,,0,,85025,Pathology/Lab,,,,22,Outpatient Hospital,3,53.79,28.98,0.0,28.98,0.0,0.0,28.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000039,MBR00000002,Professional,2021-04-28,2021-04-28,2021-05-22,PLN7395,1946680931,1946680931,Critical Access Hospital,Out-of-Network,Z00.00,Z00.00,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,2,239.37,191.99,191.99,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000040,MBR00000002,Institutional-OP,2021-12-11,2021-12-11,2021-12-22,PLN2371,1520687146,1520687146,ASC,In-Network,E11.9,Z23,,,,,,,0,,99233,E&M,,,0900,22,Outpatient Hospital,1,242.79,123.0,0.0,123.0,15.0,0.0,138.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000041,MBR00000002,Professional,2021-07-02,2021-07-02,2021-08-05,PLN2012,1283743001,1283743001,Family Medicine,In-Network,I10,J20.9,,,,,,,0,,99213,E&M,,,,21,Inpatient Hospital,3,226.71,184.8,0.0,184.8,25.0,0.0,209.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000042,MBR00000002,Professional,2023-04-26,2023-04-26,2023-05-04,PLN4273,1540044947,1540044947,Pulmonology,Out-of-Network,N39.0,N40.0,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,3,139.18,74.1,24.1,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000043,MBR00000002,Professional,2022-06-26,2022-06-26,2022-07-10,PLN1542,1244186984,1244186984,Family Medicine,Out-of-Network,Z00.00,Z00.01,,,,,,,0,,45380,Surgery,,,,31,Skilled Nursing Facility,3,2562.27,2175.69,2175.69,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000000044,MBR00000002,Professional,2022-10-24,2022-10-24,2022-11-30,PLN5055,1366426662,1366426662,Urology,In-Network,E11.9,E78.5,,,,,,,0,,43239,Surgery,,,,11,Office,3,1099.8,492.51,365.96,0.0,50.0,76.55,126.55,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000045,MBR00000002,Institutional-IP,2021-03-29,2021-04-02,2021-04-17,PLN2373,1500037969,1500037969,Pulmonology,In-Network,Z12.31,Z00.00,,,,682,MS-DRG,20,4,Y,G0439,Medicine,,,0200,21,Inpatient Hospital,3,393.64,228.9,11.47,190.09,25.0,2.34,217.43,0.0,Paid,,,0,,0,1,0,0,1,0,None,0,0,0,1,0
CLM0000000046,MBR00000002,Professional,2022-09-20,2022-09-20,2022-10-20,PLN5623,1236418230,1236418230,DME Supplier,In-Network,N39.0,K21.0,,,,,,,0,,23472,Surgery,,,,49,Independent Clinic,3,6664.65,4161.77,4043.88,42.89,75.0,0.0,117.89,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000047,MBR00000002,Institutional-IP,2023-02-26,2023-03-02,2023-03-21,PLN8796,1361302520,1361302520,Critical Access Hospital,In-Network,J06.9,E11.9,,,,292,MS-DRG,22,4,Y,58661,Surgery,,,0370,21,Inpatient Hospital,3,2794.64,2046.68,2046.68,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000048,MBR00000002,Professional,2023-01-25,2023-01-25,2023-02-10,PLN9557,1355166277,1355166277,Endocrinology,In-Network,Z12.31,J20.9,,,,,,,0,,99232,E&M,,,,49,Independent Clinic,1,220.99,78.48,66.26,0.0,0.0,12.22,12.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000049,MBR00000002,Professional,2023-05-21,2023-05-21,2023-06-21,PLN1997,1696843572,1696843572,Critical Access Hospital,Out-of-Network,J06.9,E78.5,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,2,113.46,78.45,61.32,0.0,15.0,2.13,17.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000050,MBR00000002,Professional,2021-05-05,2021-05-05,2021-06-07,PLN2857,1847081578,1847081578,Urology,Out-of-Network,Z00.00,Z23,,,,,,,0,,33533,Surgery,,,,11,Office,1,18623.95,9388.75,8200.32,255.23,50.0,883.2,1188.43,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000000051,MBR00000002,Professional,2022-08-25,2022-08-25,2022-09-07,PLN2862,1609526529,1609526529,Psychiatry,In-Network,E66.9,Z23,,,,,,,0,,97530,Medicine,,,,11,Office,2,110.86,56.77,21.77,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000000052,MBR00000002,Professional,2022-06-13,2022-06-13,2022-07-07,PLN2673,1224179551,1224179551,Physical Therapy,In-Network,M54.5,J06.9,,,,,,,0,,99203,E&M,,,,20,Urgent Care,3,364.92,135.72,100.72,0.0,35.0,0.0,35.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000053,MBR00000002,Professional,2023-09-06,2023-09-06,2023-10-17,PLN9571,1186826716,1186826716,Physical Therapy,In-Network,K21.0,I10,,,,,,,0,,99284,E&M,,,,12,Home,2,872.23,352.68,0.0,306.77,50.0,0.0,356.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000054,MBR00000002,Institutional-OP,2023-01-27,2023-01-27,2023-02-24,PLN8293,1865904917,1865904917,Outpatient Clinic,In-Network,Z87.891,Z87.891,,,,,,,0,,99222,E&M,,,0370,22,Outpatient Hospital,1,582.66,377.2,338.11,0.0,0.0,39.09,39.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000055,MBR00000002,Professional,2023-11-11,2023-11-11,2023-12-17,PLN5214,1757138478,1757138478,Pediatrics,In-Network,J20.9,M54.5,,,,,,,0,,70450,Radiology,,,,22,Outpatient Hospital,1,1225.38,389.28,389.28,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000056,MBR00000002,Professional,2021-01-28,2021-01-28,2021-03-08,PLN2464,1778483301,1778483301,Home Health,In-Network,I25.10,E11.65,,,,,,,0,,23472,Surgery,,,,11,Office,1,6607.28,2001.36,2001.36,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000057,MBR00000002,Professional,2022-05-06,2022-05-06,2022-05-16,PLN2402,1571574052,1571574052,Critical Access Hospital,In-Network,E78.5,I25.10,,,,,,,0,,99284,E&M,,,,11,Office,3,767.84,615.82,0.0,0.0,15.0,51.42,66.42,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000058,MBR00000002,Professional,2023-02-10,2023-02-10,2023-02-26,PLN6671,1915531927,1915531927,Critical Access Hospital,In-Network,E78.5,E11.9,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,3,1453.54,436.57,0.0,103.29,25.0,13.82,142.11,0.0,Denied,PR-1,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000059,MBR00000002,Professional,2021-04-08,2021-04-08,2021-05-21,PLN9477,1337791138,1337791138,Internal Medicine,Out-of-Network,Z23,J06.9,,,,,,,0,,43239,Surgery,,,,11,Office,3,1301.46,487.67,0.0,487.67,0.0,0.0,487.67,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000060,MBR00000002,Institutional-IP,2022-12-15,2022-12-20,2023-01-19,PLN3344,1790497490,1790497490,OB/GYN,In-Network,Z12.31,R51,,,,195,MS-DRG,8,5,Y,45378,Surgery,,,0450,21,Inpatient Hospital,1,2542.46,1459.99,1188.37,221.62,50.0,0.0,271.62,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000061,MBR00000002,Institutional-IP,2021-09-11,2021-09-12,2021-09-20,PLN3287,1124394415,1124394415,Pediatrics,In-Network,J06.9,E78.5,,,,194,MS-DRG,11,1,Y,23472,Surgery,,,0200,21,Inpatient Hospital,1,4864.64,2048.82,0.0,255.82,0.0,0.0,255.82,0.0,Denied,CO-29,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000062,MBR00000002,Institutional-IP,2021-03-23,2021-03-29,2021-05-06,PLN3931,1968299309,1968299309,Internal Medicine,In-Network,F41.9,I10,,,,195,MS-DRG,23,6,Y,66984,Surgery,,,0370,21,Inpatient Hospital,2,1591.64,831.92,806.92,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000063,MBR00000002,Professional,2022-12-22,2022-12-22,2022-12-31,PLN3133,1696843572,1696843572,Critical Access Hospital,Out-of-Network,I10,K21.0,,,,,,,0,,85025,Pathology/Lab,,,,23,Emergency Room,2,41.95,27.18,0.0,27.18,25.0,0.0,52.18,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000064,MBR00000003,Professional,2022-04-12,2022-04-12,2022-04-22,PLN6323,1390307371,1390307371,DME Supplier,In-Network,R05,J06.9,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,2,4358.36,1964.91,1493.87,396.04,75.0,0.0,471.04,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000065,MBR00000003,Institutional-OP,2022-03-21,2022-03-21,2022-04-12,PLN2222,1817234602,1817234602,Clinical Laboratory,In-Network,Z00.00,F41.9,,,,,,,0,,84443,Pathology/Lab,,,0120,22,Outpatient Hospital,2,111.95,40.34,0.0,40.34,0.0,0.0,40.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000066,MBR00000003,Professional,2021-12-23,2021-12-23,2022-01-07,PLN1131,1395983630,1395983630,Nephrology,In-Network,E11.9,E11.9,,,,,,,0,,71046,Radiology,,,,11,Office,3,142.73,55.82,0.0,55.82,0.0,0.0,55.82,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000067,MBR00000003,Institutional-IP,2023-01-21,2023-01-23,2023-03-03,PLN8816,1571574052,1571574052,Critical Access Hospital,In-Network,M17.11,Z00.00,,,,682,MS-DRG,24,2,Y,99232,E&M,,,0900,21,Inpatient Hospital,3,256.51,93.73,93.73,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000000068,MBR00000003,Institutional-IP,2022-11-09,2022-11-11,2022-12-03,PLN6574,1790497490,1790497490,OB/GYN,In-Network,E66.9,I25.10,,,,690,MS-DRG,7,2,Y,G0444,Medicine,,,0301,21,Inpatient Hospital,2,50.97,29.53,3.96,0.0,25.0,0.57,25.57,0.0,Paid,,,0,,0,1,0,0,1,0,None,0,0,0,0,1
CLM0000000069,MBR00000003,Professional,2023-01-01,2023-01-01,2023-01-16,PLN7147,1395983630,1395983630,Nephrology,In-Network,F41.9,E78.5,,,,,,,0,,99232,E&M,,,,21,Inpatient Hospital,2,378.98,134.53,134.53,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000070,MBR00000003,Professional,2023-05-13,2023-05-13,2023-06-09,PLN8651,1390307371,1390307371,DME Supplier,In-Network,I25.10,E78.5,,,,,,,0,,97110,Medicine,,,,11,Office,1,224.39,115.68,0.0,115.68,0.0,0.0,115.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000071,MBR00000003,Institutional-IP,2022-10-25,2022-10-29,2022-11-03,PLN9510,1994661817,1994661817,SNF,Out-of-Network,E11.9,R51,,,,292,MS-DRG,21,4,Y,G0444,Medicine,,,0636,21,Inpatient Hospital,2,65.04,25.13,0.0,25.13,25.0,0.0,50.13,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000000072,MBR00000003,Professional,2021-03-23,2021-03-23,2021-04-10,PLN6027,1235381502,1235381502,Cardiology,In-Network,Z00.01,E11.9,,,,,,,0,,99222,E&M,,,,23,Emergency Room,2,535.95,453.04,453.04,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000073,MBR00000003,Professional,2021-06-22,2021-06-22,2021-07-06,PLN9508,1891849440,1891849440,Oncology,In-Network,K21.0,I25.10,,,,,,,0,,99203,E&M,,,,11,Office,3,379.33,291.61,276.61,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000074,MBR00000003,Professional,2023-12-22,2023-12-22,2024-01-26,PLN8382,1590915516,1590915516,Physical Therapy,Out-of-Network,I10,E66.9,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,1,342.3,251.46,0.0,251.46,0.0,0.0,251.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000075,MBR00000003,Professional,2021-11-10,2021-11-10,2021-11-26,PLN4004,1790497490,1790497490,OB/GYN,In-Network,I50.9,E78.5,,,,,,,0,,74177,Radiology,,,,11,Office,3,2281.13,1582.19,1532.19,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000076,MBR00000003,Institutional-IP,2022-04-14,2022-04-19,2022-05-06,PLN7330,1422747896,1422747896,Urology,In-Network,I10,N40.0,,,,196,MS-DRG,20,5,Y,33533,Surgery,,,0360,21,Inpatient Hospital,2,17127.89,14043.76,13539.1,454.66,50.0,0.0,504.66,0.0,Adjusted,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000000077,MBR00000003,Professional,2022-02-18,2022-02-18,2022-03-29,PLN2104,1840431511,1840431511,Geriatrics,Out-of-Network,E78.5,J20.9,,,,,,,0,,97530,Medicine,,,,11,Office,2,235.69,103.13,53.13,0.0,50.0,0.0,50.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000078,MBR00000003,Institutional-OP,2023-12-21,2023-12-21,2024-01-04,PLN3126,1817234602,1817234602,Clinical Laboratory,In-Network,F41.9,J06.9,,,,,,,0,,97530,Medicine,,,0730,22,Outpatient Hospital,3,230.95,186.09,186.09,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000079,MBR00000003,Institutional-OP,2023-06-22,2023-06-22,2023-07-23,PLN3250,1806688928,1806688928,Geriatrics,In-Network,E11.65,R05,,,,,,,0,,33533,Surgery,,,0740,22,Outpatient Hospital,1,11890.51,6569.8,5110.54,367.32,15.0,1076.94,1459.26,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000000080,MBR00000003,Institutional-OP,2022-06-14,2022-06-14,2022-06-26,PLN6175,1727809972,1727809972,Home Health,In-Network,J45.20,M54.5,,,,,,,0,,99233,E&M,,,0320,22,Outpatient Hospital,2,451.07,164.23,139.23,0.0,25.0,0.0,25.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000081,MBR00000003,Professional,2023-01-18,2023-01-18,2023-01-27,PLN1745,1540044947,1540044947,Pulmonology,Out-of-Network,M54.5,E78.5,,,,,,,0,,G0444,Medicine,,,,50,Federally Qualified Health Center,1,48.42,29.59,0.0,29.59,0.0,0.0,29.59,0.0,Adjusted,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000000082,MBR00000003,Professional,2022-08-27,2022-08-27,2022-09-18,PLN8553,1518055405,1518055405,Urology,In-Network,M17.11,K21.0,,,,,,,0,,27447,Surgery,,,,81,Independent Laboratory,1,5518.9,3969.68,3467.31,477.37,25.0,0.0,502.37,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000083,MBR00000003,Institutional-OP,2022-12-08,2022-12-08,2023-01-13,PLN6951,1990090423,1990090423,Orthopedic Surgery,In-Network,M17.11,I25.10,,,,,,,0,,43239,Surgery,,,0120,22,Outpatient Hospital,3,1080.19,760.86,760.86,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000084,MBR00000003,Institutional-IP,2023-11-11,2023-11-16,2023-12-24,PLN1306,1545347862,1545347862,SNF,In-Network,I10,F32.9,,,,682,MS-DRG,22,5,Y,93000,Radiology,,,0320,21,Inpatient Hospital,2,110.93,58.55,58.55,0.0,0.0,0.0,0.0,0.0,Adjusted,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000085,MBR00000003,Professional,2023-01-06,2023-01-06,2023-02-06,PLN6107,1242201429,1242201429,General Acute Care Hospital,In-Network,K21.0,G43.909,,,,,,,0,,85025,Pathology/Lab,,,,22,Outpatient Hospital,2,86.37,46.96,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000086,MBR00000003,Institutional-OP,2021-05-04,2021-05-04,2021-06-09,PLN6001,1800011727,1800011727,Clinical Laboratory,Out-of-Network,E87.6,G43.909,,,,,,,0,,33533,Surgery,,,0761,22,Outpatient Hospital,1,15018.39,10043.27,9839.44,188.83,15.0,0.0,203.83,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000000087,MBR00000003,Institutional-IP,2022-07-06,2022-07-11,2022-07-15,PLN8923,1561134315,1561134315,DME Supplier,In-Network,J20.9,N39.0,,,,292,MS-DRG,18,5,Y,99214,E&M,,,0370,21,Inpatient Hospital,1,350.75,174.36,145.77,0.0,25.0,3.59,28.59,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000088,MBR00000003,Institutional-OP,2023-06-17,2023-06-17,2023-07-19,PLN9212,1355166277,1355166277,Endocrinology,In-Network,F41.9,F32.9,,,,,,,0,,78452,Radiology,,,0120,22,Outpatient Hospital,1,2613.47,1963.67,1948.67,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000089,MBR00000003,Institutional-OP,2021-02-13,2021-02-13,2021-03-25,PLN9969,1631954542,1631954542,Oncology,In-Network,K21.0,I10,,,,,,,0,,45380,Surgery,,,0510,22,Outpatient Hospital,1,1227.92,642.88,519.9,0.0,0.0,122.98,122.98,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000000090,MBR00000003,Institutional-OP,2022-01-26,2022-01-26,2022-02-27,PLN5571,1575695214,1575695214,SNF,In-Network,F10.20,Z87.891,,,,,,,0,,27447,Surgery,,,0450,22,Outpatient Hospital,2,5925.53,2462.09,2127.79,0.0,75.0,259.3,334.3,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000091,MBR00000003,Professional,2021-08-09,2021-08-09,2021-09-11,PLN9322,1139906830,1139906830,Endocrinology,Out-of-Network,E11.9,J45.20,,,,,,,0,,99233,E&M,,,,11,Office,1,217.57,74.57,74.57,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000092,MBR00000003,Professional,2023-03-01,2023-03-01,2023-04-05,PLN3472,1609526529,1609526529,Psychiatry,In-Network,I10,Z23,,,,,,,0,,99204,E&M,,,,11,Office,2,301.43,117.04,116.52,0.0,0.0,0.52,0.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000093,MBR00000003,Institutional-IP,2021-06-03,2021-06-08,2021-07-06,PLN7305,1910255109,1910255109,DME Supplier,In-Network,K21.0,E11.9,,,,682,MS-DRG,18,5,Y,99283,E&M,,,0730,21,Inpatient Hospital,2,579.39,354.5,306.07,0.0,25.0,23.43,48.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000094,MBR00000003,Institutional-IP,2022-11-15,2022-11-18,2022-12-06,PLN9921,1800011727,1800011727,Clinical Laboratory,Out-of-Network,Z00.00,R10.9,,,,683,MS-DRG,12,3,Y,71046,Radiology,,,0360,21,Inpatient Hospital,1,238.9,88.19,0.0,88.19,75.0,0.0,163.19,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000000095,MBR00000003,Institutional-IP,2021-03-12,2021-03-18,2021-04-01,PLN1850,1910255109,1910255109,DME Supplier,In-Network,E66.9,E78.5,,,,872,MS-DRG,15,6,Y,78452,Radiology,,,0320,21,Inpatient Hospital,2,3813.49,1956.44,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-18,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000096,MBR00000003,Professional,2023-10-09,2023-10-09,2023-10-26,PLN1948,1840431511,1840431511,Geriatrics,Out-of-Network,Z23,G43.909,,,,,,,0,,99203,E&M,,,,21,Inpatient Hospital,2,202.14,110.5,0.0,110.5,0.0,0.0,110.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000097,MBR00000003,Institutional-IP,2021-12-16,2021-12-24,2022-01-05,PLN7559,1239316214,1239316214,Internal Medicine,In-Network,I10,F41.9,,,,683,MS-DRG,14,8,Y,58661,Surgery,,,0360,21,Inpatient Hospital,3,2537.43,928.29,903.29,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000098,MBR00000003,Professional,2022-03-23,2022-03-23,2022-04-05,PLN5843,1530904931,1530904931,Internal Medicine,In-Network,C50.912,J20.9,,,,,,,0,,78452,Radiology,,,,11,Office,2,4074.96,2342.09,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000099,MBR00000003,Institutional-OP,2023-05-13,2023-05-13,2023-05-25,PLN3631,1847081578,1847081578,Urology,Out-of-Network,E11.9,J06.9,,,,,,,0,,27130,Surgery,,,0120,22,Outpatient Hospital,3,4048.45,2880.77,2796.8,0.0,0.0,83.97,83.97,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000100,MBR00000003,Institutional-OP,2022-02-20,2022-02-20,2022-04-05,PLN6880,1910255109,1910255109,DME Supplier,In-Network,E78.5,C50.912,,,,,,,0,,74177,Radiology,,,0730,22,Outpatient Hospital,1,1861.21,1266.34,1266.34,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000101,MBR00000003,Professional,2021-05-07,2021-05-07,2021-05-18,PLN9258,1817234602,1817234602,Clinical Laboratory,In-Network,E78.5,F32.9,,,,,,,0,,90460,Medicine,,,,22,Outpatient Hospital,3,46.45,16.9,0.0,16.9,35.0,0.0,51.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000102,MBR00000003,Institutional-IP,2023-09-18,2023-09-21,2023-10-17,PLN8037,1337791138,1337791138,Internal Medicine,Out-of-Network,E66.9,F41.9,,,,194,MS-DRG,10,3,Y,47562,Surgery,,,0900,21,Inpatient Hospital,3,5695.91,2945.73,0.0,0.0,0.0,190.46,190.46,0.0,Denied,CO-11,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000103,MBR00000003,Institutional-IP,2021-05-03,2021-05-22,2021-05-24,PLN6393,1575695214,1575695214,SNF,In-Network,E11.9,J20.9,,,,196,MS-DRG,13,19,Y,80053,Pathology/Lab,,,0301,21,Inpatient Hospital,1,140.6,58.61,0.0,34.19,75.0,0.0,109.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000104,MBR00000003,Professional,2022-06-29,2022-06-29,2022-07-28,PLN7519,1964402759,1964402759,Outpatient Clinic,In-Network,J44.1,R10.9,,,,,,,0,,99221,E&M,,,,11,Office,3,313.98,98.32,98.32,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000105,MBR00000003,Professional,2021-05-17,2021-05-17,2021-06-22,PLN3143,1696843572,1696843572,Critical Access Hospital,Out-of-Network,J45.20,E66.9,,,,,,,0,,70553,Radiology,,,,11,Office,1,1710.37,1221.3,1127.72,68.58,25.0,0.0,93.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000106,MBR00000003,Institutional-OP,2023-02-04,2023-02-04,2023-03-17,PLN7049,1531398223,1531398223,OB/GYN,In-Network,I25.10,Z12.31,,,,,,,0,,G0468,Medicine,,,0730,22,Outpatient Hospital,2,545.16,411.58,361.58,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000107,MBR00000003,Institutional-OP,2021-10-23,2021-10-23,2021-11-14,PLN3727,1856686341,1856686341,Geriatrics,In-Network,I10,J06.9,,,,,,,0,,90837,Medicine,,,0120,22,Outpatient Hospital,1,303.44,136.13,9.75,101.38,25.0,0.0,126.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000108,MBR00000003,Professional,2023-10-18,2023-10-18,2023-11-10,PLN7206,1132188260,1132188260,Family Medicine,In-Network,Z23,I10,,,,,,,0,,47562,Surgery,,,,11,Office,1,3179.27,1379.14,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-18,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000109,MBR00000003,Institutional-OP,2021-08-10,2021-08-10,2021-09-07,PLN2916,1717912431,1717912431,Oncology,In-Network,N39.0,R07.9,,,,,,,0,,85025,Pathology/Lab,,,0740,22,Outpatient Hospital,3,66.18,31.16,8.11,23.05,0.0,0.0,23.05,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000110,MBR00000003,Institutional-OP,2023-01-04,2023-01-04,2023-02-12,PLN8288,1717546253,1717546253,Family Medicine,In-Network,J06.9,E11.9,,,,,,,0,,45380,Surgery,,,0270,22,Outpatient Hospital,2,3111.45,2064.18,0.0,0.0,0.0,240.75,240.75,0.0,Denied,CO-15,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000000111,MBR00000003,Institutional-OP,2021-01-16,2021-01-16,2021-02-05,PLN5242,1757138478,1757138478,Pediatrics,In-Network,F32.9,C50.912,,,,,,,0,,77067,Radiology,,,0730,22,Outpatient Hospital,1,473.54,393.49,393.49,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000000112,MBR00000003,Institutional-OP,2021-05-04,2021-05-04,2021-05-20,PLN7034,1948810580,1948810580,DME Supplier,In-Network,N39.0,N18.3,,,,,,,0,,47562,Surgery,,,0200,22,Outpatient Hospital,3,2753.83,1748.88,1713.88,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000113,MBR00000003,Professional,2021-10-30,2021-10-30,2021-11-26,PLN9252,1168881145,1168881145,Orthopedic Surgery,In-Network,I50.9,C50.912,,,,,,,0,,70450,Radiology,,,,11,Office,2,757.42,641.67,566.67,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000114,MBR00000004,Institutional-OP,2023-08-26,2023-08-26,2023-10-01,PLN6592,1964402759,1964402759,Outpatient Clinic,In-Network,N18.3,M17.11,,,,,,,0,,99233,E&M,,,0200,22,Outpatient Hospital,3,320.12,163.3,163.3,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000115,MBR00000004,Institutional-OP,2023-12-27,2023-12-27,2024-02-01,PLN6645,1395983630,1395983630,Nephrology,In-Network,G43.909,Z23,,,,,,,0,,85025,Pathology/Lab,,,0510,22,Outpatient Hospital,2,70.36,24.59,0.0,24.59,0.0,0.0,24.59,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000116,MBR00000004,Institutional-IP,2022-11-03,2022-11-05,2022-12-10,PLN5519,1530904931,1530904931,Internal Medicine,In-Network,E11.9,F32.9,,,,683,MS-DRG,15,2,Y,43239,Surgery,,,0370,21,Inpatient Hospital,1,975.05,622.03,607.03,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000117,MBR00000004,Professional,2022-01-04,2022-01-04,2022-02-11,PLN8448,1891849440,1891849440,Oncology,In-Network,E78.5,I10,,,,,,,0,,99214,E&M,,,,11,Office,1,396.13,186.31,186.31,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000000118,MBR00000004,Professional,2021-12-08,2021-12-08,2022-01-11,PLN7995,1991459367,1991459367,Neurology,Out-of-Network,E66.9,E11.9,,,,,,,0,,33533,Surgery,,,,21,Inpatient Hospital,1,28569.4,20568.73,20533.73,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000000119,MBR00000004,Professional,2021-08-20,2021-08-20,2021-08-27,PLN2505,1717912431,1717912431,Oncology,In-Network,N40.0,I10,,,,,,,0,,99222,E&M,,,,11,Office,1,661.48,315.34,233.94,81.4,0.0,0.0,81.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000120,MBR00000004,Institutional-OP,2022-01-08,2022-01-08,2022-01-26,PLN4465,1148984206,1148984206,Psychiatry,In-Network,I10,I63.9,,,,,,,0,,99214,E&M,,,0740,22,Outpatient Hospital,1,332.78,190.24,11.93,178.15,0.0,0.16,178.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000121,MBR00000004,Professional,2022-06-27,2022-06-27,2022-08-01,PLN9112,1994661817,1994661817,SNF,Out-of-Network,Z12.31,Z23,,,,,,,0,,23472,Surgery,,,,11,Office,2,3144.95,1671.17,1646.17,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000122,MBR00000004,Institutional-OP,2023-01-21,2023-01-21,2023-02-25,PLN4648,1624202402,1624202402,Orthopedic Surgery,In-Network,K21.0,I10,,,,,,,0,,47562,Surgery,,,0301,22,Outpatient Hospital,2,5922.22,4211.88,3377.88,442.94,0.0,391.06,834.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000123,MBR00000004,Institutional-OP,2021-09-09,2021-09-09,2021-10-15,PLN2644,1198133277,1198133277,SNF,In-Network,E78.5,E11.9,,,,,,,0,,G0439,Medicine,,,0740,22,Outpatient Hospital,1,592.12,464.87,0.0,464.87,25.0,0.0,489.87,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000000124,MBR00000004,Professional,2021-02-09,2021-02-09,2021-02-22,PLN7855,1757138478,1757138478,Pediatrics,In-Network,E78.5,E11.9,,,,,,,0,,27447,Surgery,,,,21,Inpatient Hospital,3,3352.94,1307.96,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000125,MBR00000004,Professional,2022-09-05,2022-09-05,2022-09-26,PLN6155,1817234602,1817234602,Clinical Laboratory,In-Network,Z00.00,I10,,,,,,,0,,80061,Pathology/Lab,,,,12,Home,1,97.01,82.18,0.0,82.18,15.0,0.0,97.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000126,MBR00000004,Institutional-OP,2021-09-23,2021-09-23,2021-10-31,PLN2872,1434029575,1434029575,Endocrinology,In-Network,M54.5,G43.909,,,,,,,0,,72148,Radiology,,,0270,22,Outpatient Hospital,3,1623.24,1065.9,995.84,0.0,0.0,70.06,70.06,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000127,MBR00000004,Professional,2022-03-15,2022-03-15,2022-03-25,PLN3676,1198133277,1198133277,SNF,In-Network,I10,K21.0,,,,,,,0,,45380,Surgery,,,,23,Emergency Room,3,2473.12,1812.5,1409.98,352.52,50.0,0.0,402.52,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,1,0,0,0
CLM0000000128,MBR00000004,Institutional-OP,2023-02-19,2023-02-19,2023-03-29,PLN2871,1109850785,1109850785,ASC,Out-of-Network,Z00.00,I25.10,,,,,,,0,,99203,E&M,,,0320,22,Outpatient Hospital,1,339.15,129.42,120.98,0.0,0.0,8.44,8.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000129,MBR00000004,Institutional-OP,2023-09-10,2023-09-10,2023-10-03,PLN8997,1997536841,1997536841,Family Medicine,Out-of-Network,E78.5,F03.90,,,,,,,0,,97110,Medicine,,,0510,22,Outpatient Hospital,1,168.53,77.74,0.0,77.74,0.0,0.0,77.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000130,MBR00000004,Professional,2022-08-09,2022-08-09,2022-09-17,PLN3292,1569105090,1569105090,Geriatrics,In-Network,E66.9,Z00.00,,,,,,,0,,72148,Radiology,,,,11,Office,1,1059.9,897.03,803.75,0.0,0.0,93.28,93.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000131,MBR00000004,Institutional-IP,2023-10-14,2023-10-20,2023-10-31,PLN5889,1915531927,1915531927,Critical Access Hospital,In-Network,K57.30,N18.3,,,,683,MS-DRG,11,6,Y,99204,E&M,,,0301,21,Inpatient Hospital,3,359.77,192.94,177.94,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000132,MBR00000004,Institutional-OP,2021-10-22,2021-10-22,2021-11-03,PLN3727,1713934949,1713934949,Neurology,In-Network,E11.9,I25.10,,,,,,,0,,99222,E&M,,,0900,22,Outpatient Hospital,2,323.45,120.63,120.63,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000133,MBR00000004,Institutional-OP,2023-02-20,2023-02-20,2023-03-17,PLN2402,1847081578,1847081578,Urology,Out-of-Network,Z23,E11.65,,,,,,,0,,87491,Pathology/Lab,,,0360,22,Outpatient Hospital,2,162.29,75.53,0.0,75.53,15.0,0.0,90.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000134,MBR00000004,Institutional-IP,2023-12-09,2023-12-13,2024-01-14,PLN2118,1193493783,1193493783,Critical Access Hospital,Out-of-Network,Z12.31,J06.9,,,,195,MS-DRG,12,4,N,84443,Pathology/Lab,,,0200,21,Inpatient Hospital,1,179.9,148.11,0.0,148.11,0.0,0.0,148.11,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000135,MBR00000004,Institutional-OP,2021-08-25,2021-08-25,2021-09-26,PLN7163,1585582070,1585582070,Outpatient Clinic,In-Network,R05,E78.5,,,,,,,0,,80061,Pathology/Lab,,,0301,22,Outpatient Hospital,2,48.51,19.36,0.0,19.36,25.0,0.0,44.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000136,MBR00000004,Professional,2023-03-20,2023-03-20,2023-05-03,PLN8672,1395983630,1395983630,Nephrology,In-Network,Z12.31,J06.9,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,1,265.13,171.87,171.87,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000137,MBR00000004,Professional,2022-06-03,2022-06-03,2022-06-14,PLN4343,1528335731,1528335731,Critical Access Hospital,In-Network,R10.9,M54.5,,,,,,,0,,99213,E&M,,,,81,Independent Laboratory,1,222.92,145.75,110.75,0.0,35.0,0.0,35.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000138,MBR00000004,Institutional-IP,2023-08-23,2023-08-31,2023-09-03,PLN7633,1660288235,1660288235,ASC,In-Network,J44.1,J44.1,,,,196,MS-DRG,7,8,N,47562,Surgery,,,0120,21,Inpatient Hospital,1,4374.6,2259.27,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-15,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000139,MBR00000004,Institutional-OP,2021-12-01,2021-12-01,2021-12-26,PLN3135,1569105090,1569105090,Geriatrics,In-Network,Z79.4,E11.9,,,,,,,0,,27447,Surgery,,,0740,22,Outpatient Hospital,3,3026.89,1931.9,1931.9,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000140,MBR00000004,Institutional-OP,2023-11-18,2023-11-18,2023-12-30,PLN7040,1313212303,1313212303,Family Medicine,In-Network,E11.9,F03.90,,,,,,,0,,33533,Surgery,,,0320,22,Outpatient Hospital,2,25299.61,14625.41,13479.33,200.19,0.0,945.89,1146.08,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000000141,MBR00000004,Professional,2023-05-25,2023-05-25,2023-06-05,PLN3954,1236418230,1236418230,DME Supplier,In-Network,N18.3,J45.20,,,,,,,0,,70450,Radiology,,,,22,Outpatient Hospital,1,974.94,810.31,795.31,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000142,MBR00000004,Professional,2023-02-12,2023-02-12,2023-02-21,PLN6353,1520687146,1520687146,ASC,In-Network,I10,E78.5,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,1,55.6,40.05,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000000143,MBR00000004,Institutional-IP,2021-02-01,2021-02-02,2021-02-23,PLN4960,1268679390,1268679390,Critical Access Hospital,In-Network,K21.0,N20.0,,,,871,MS-DRG,14,1,Y,70553,Radiology,,,0730,21,Inpatient Hospital,3,4278.95,3271.77,3221.77,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000144,MBR00000005,Institutional-OP,2021-04-01,2021-04-01,2021-04-14,PLN1386,1114982472,1114982472,Orthopedic Surgery,In-Network,I25.10,F41.9,,,,,,,0,,99214,E&M,,,0510,22,Outpatient Hospital,3,410.78,138.51,0.0,138.51,0.0,0.0,138.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000145,MBR00000005,Institutional-OP,2022-12-27,2022-12-27,2023-01-10,PLN6657,1910255109,1910255109,DME Supplier,In-Network,E66.9,Z00.00,,,,,,,0,,99221,E&M,,,0740,22,Outpatient Hospital,1,325.42,171.47,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000146,MBR00000005,Professional,2022-06-09,2022-06-09,2022-07-13,PLN1724,1727809972,1727809972,Home Health,In-Network,K21.0,R05,,,,,,,0,,47562,Surgery,,,,20,Urgent Care,2,3257.53,1948.39,1283.41,450.8,75.0,139.18,664.98,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000147,MBR00000005,Institutional-OP,2021-12-20,2021-12-20,2022-01-31,PLN8289,1809014947,1809014947,Urology,In-Network,I11.9,J06.9,,,,,,,0,,99233,E&M,,,0301,22,Outpatient Hospital,2,557.1,313.05,254.63,0.0,0.0,58.42,58.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000148,MBR00000005,Institutional-IP,2023-07-11,2023-07-13,2023-07-19,PLN1596,1125190055,1125190055,Nephrology,In-Network,F41.9,Z12.31,,,,871,MS-DRG,14,2,Y,45380,Surgery,,,0730,21,Inpatient Hospital,1,1640.51,874.18,849.18,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000000149,MBR00000005,Institutional-OP,2022-06-11,2022-06-11,2022-07-22,PLN3092,1847081578,1847081578,Urology,Out-of-Network,N39.0,I10,,,,,,,0,,99283,E&M,,,0270,22,Outpatient Hospital,2,427.6,351.19,276.19,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000150,MBR00000005,Institutional-OP,2022-05-18,2022-05-18,2022-06-08,PLN5843,1606140917,1606140917,ASC,In-Network,Z12.31,E11.65,,,,,,,0,,58661,Surgery,,,0730,22,Outpatient Hospital,3,4579.43,3094.33,3094.33,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000151,MBR00000005,Professional,2021-12-20,2021-12-20,2022-01-06,PLN1387,1198133277,1198133277,SNF,In-Network,I10,E11.9,,,,,,,0,,99213,E&M,,,,21,Inpatient Hospital,2,279.94,201.3,0.0,201.3,15.0,0.0,216.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000152,MBR00000005,Institutional-OP,2023-12-11,2023-12-11,2024-01-19,PLN9712,1809014947,1809014947,Urology,In-Network,I10,I50.9,,,,,,,0,,23472,Surgery,,,0900,22,Outpatient Hospital,1,5070.55,3032.55,3032.55,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000153,MBR00000005,Professional,2022-02-04,2022-02-04,2022-02-14,PLN2201,1571574052,1571574052,Critical Access Hospital,In-Network,I10,E66.9,,,,,,,0,,99284,E&M,,,,20,Urgent Care,3,593.98,378.01,93.83,282.45,0.0,1.73,284.18,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000154,MBR00000005,Institutional-OP,2021-10-12,2021-10-12,2021-11-01,PLN5323,1295371663,1295371663,Critical Access Hospital,In-Network,I10,R05,,,,,,,0,,74177,Radiology,,,0740,22,Outpatient Hospital,3,1533.57,1223.86,1223.86,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000155,MBR00000005,Professional,2023-01-09,2023-01-09,2023-02-11,PLN1746,1622771872,1622771872,Pediatrics,In-Network,E11.9,R05,,,,,,,0,,70450,Radiology,,,,23,Emergency Room,3,1572.09,1211.14,1211.14,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000156,MBR00000005,Institutional-OP,2021-02-07,2021-02-07,2021-02-27,PLN9021,1606140917,1606140917,ASC,In-Network,Z23,I10,,,,,,,0,,33533,Surgery,,,0270,22,Outpatient Hospital,2,28705.98,11231.19,11231.19,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000000157,MBR00000005,Professional,2022-10-15,2022-10-15,2022-11-16,PLN7487,1205377316,1205377316,Orthopedic Surgery,In-Network,G43.909,J20.9,,,,,,,0,,97530,Medicine,,,,31,Skilled Nursing Facility,3,286.5,187.17,137.17,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000158,MBR00000006,Professional,2022-09-11,2022-09-11,2022-10-12,PLN8400,1795618275,1795618275,Pulmonology,In-Network,F41.9,N17.9,,,,,,,0,,23472,Surgery,,,,50,Federally Qualified Health Center,1,4922.09,3332.3,2675.07,0.0,0.0,657.23,657.23,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000159,MBR00000006,Institutional-OP,2021-09-25,2021-09-25,2021-10-30,PLN7764,1372918899,1372918899,Family Medicine,In-Network,R51,E11.9,,,,,,,0,,99221,E&M,,,0270,22,Outpatient Hospital,3,444.33,141.68,0.0,141.68,0.0,0.0,141.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000160,MBR00000006,Professional,2023-04-23,2023-04-23,2023-05-17,PLN5997,1645194539,1645194539,SNF,In-Network,J06.9,J45.20,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,3,43.07,27.23,27.23,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,1,0,0
CLM0000000161,MBR00000006,Professional,2021-02-17,2021-02-17,2021-03-18,PLN5711,1213165847,1213165847,Critical Access Hospital,In-Network,Z12.31,I50.9,,,,,,,0,,47562,Surgery,,,,49,Independent Clinic,2,3672.02,2771.92,2462.38,226.38,50.0,33.16,309.54,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000162,MBR00000006,Institutional-OP,2023-12-11,2023-12-11,2024-01-21,PLN2210,1109850785,1109850785,ASC,Out-of-Network,E66.9,R10.9,,,,,,,0,,66984,Surgery,,,0636,22,Outpatient Hospital,1,3176.06,1372.41,1310.62,0.0,0.0,61.79,61.79,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000163,MBR00000006,Professional,2023-07-27,2023-07-27,2023-08-05,PLN3954,1660288235,1660288235,ASC,In-Network,E66.9,Z23,,,,,,,0,,27130,Surgery,,,,11,Office,2,7151.55,3326.74,3311.74,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000164,MBR00000006,Institutional-IP,2021-07-12,2021-07-19,2021-08-14,PLN2082,1974006077,1974006077,Orthopedic Surgery,In-Network,M54.5,E11.9,,,,291,MS-DRG,14,7,Y,99204,E&M,,,0200,21,Inpatient Hospital,3,582.31,451.1,42.71,383.39,25.0,0.0,408.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000165,MBR00000006,Institutional-OP,2022-06-24,2022-06-24,2022-07-25,PLN8684,1569105090,1569105090,Geriatrics,In-Network,Z12.31,Z00.01,,,,,,,0,,97530,Medicine,,,0200,22,Outpatient Hospital,1,213.48,137.22,87.22,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000166,MBR00000006,Professional,2021-08-04,2021-08-04,2021-08-21,PLN2823,1968299309,1968299309,Internal Medicine,In-Network,E87.6,Z23,,,,,,,0,,80053,Pathology/Lab,,,,31,Skilled Nursing Facility,2,152.46,126.59,126.59,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000167,MBR00000006,Professional,2022-11-09,2022-11-09,2022-11-26,PLN2383,1366576336,1366576336,Geriatrics,In-Network,R10.9,R05,,,,,,,0,,97530,Medicine,,,,12,Home,3,233.19,187.85,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000168,MBR00000006,Institutional-IP,2022-01-21,2022-01-27,2022-02-26,PLN2671,1590915516,1590915516,Physical Therapy,Out-of-Network,J45.20,I10,,,,195,MS-DRG,20,6,Y,23472,Surgery,,,0730,21,Inpatient Hospital,1,6378.45,2028.07,1671.3,356.77,0.0,0.0,356.77,0.0,Pended,,,0,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000000169,MBR00000006,Institutional-OP,2022-06-19,2022-06-19,2022-07-06,PLN3936,1132188260,1132188260,Family Medicine,In-Network,M54.5,J06.9,,,,,,,0,,43239,Surgery,,,0636,22,Outpatient Hospital,3,1601.87,725.61,725.61,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000170,MBR00000006,Professional,2023-11-14,2023-11-14,2023-12-15,PLN6382,1531398223,1531398223,OB/GYN,In-Network,I10,J44.1,,,,,,,0,,99233,E&M,,,,11,Office,2,308.5,124.59,89.59,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000171,MBR00000006,Professional,2022-11-09,2022-11-09,2022-12-22,PLN9264,1767011137,1767011137,DME Supplier,In-Network,M54.5,R07.9,,,,,,,0,,70450,Radiology,,,,11,Office,3,841.85,345.6,320.6,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000172,MBR00000006,Professional,2023-08-08,2023-08-08,2023-09-12,PLN2093,1991459367,1991459367,Neurology,Out-of-Network,I25.10,F41.9,,,,,,,0,,99214,E&M,,,,23,Emergency Room,1,362.47,253.56,70.11,171.8,0.0,11.65,183.45,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000173,MBR00000006,Professional,2022-11-18,2022-11-18,2022-11-28,PLN1296,1575695214,1575695214,SNF,In-Network,Z00.00,I25.10,,,,,,,0,,27447,Surgery,,,,49,Independent Clinic,2,5743.48,3703.09,3262.3,425.79,15.0,0.0,440.79,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000174,MBR00000006,Professional,2022-06-04,2022-06-04,2022-06-12,PLN5110,1991459367,1991459367,Neurology,Out-of-Network,Z23,J06.9,,,,,,,0,,99221,E&M,,,,65,End-Stage Renal Disease,3,339.94,225.94,146.45,0.0,75.0,4.49,79.49,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000175,MBR00000006,Institutional-OP,2021-01-17,2021-01-17,2021-02-15,PLN6188,1702692193,1702692193,Physical Therapy,In-Network,R10.9,I10,,,,,,,0,,90460,Medicine,,,0120,22,Outpatient Hospital,2,55.65,41.47,0.0,41.47,0.0,0.0,41.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000176,MBR00000006,Professional,2021-04-08,2021-04-08,2021-04-28,PLN3304,1242201429,1242201429,General Acute Care Hospital,In-Network,Z00.00,I50.9,,,,,,,0,,82043,Pathology/Lab,,,,31,Skilled Nursing Facility,2,48.09,17.9,0.0,17.9,0.0,0.0,17.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000177,MBR00000006,Professional,2022-08-07,2022-08-07,2022-09-05,PLN3759,1366286000,1366286000,SNF,In-Network,I10,I50.9,,,,,,,0,,81001,Pathology/Lab,,,,22,Outpatient Hospital,2,37.03,18.11,0.0,18.11,0.0,0.0,18.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000178,MBR00000006,Institutional-OP,2022-07-06,2022-07-06,2022-07-17,PLN2650,1284035364,1284035364,Pediatrics,In-Network,I25.10,F03.90,,,,,,,0,,81001,Pathology/Lab,,,0301,22,Outpatient Hospital,3,59.99,29.94,29.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000179,MBR00000006,Professional,2022-07-04,2022-07-04,2022-07-28,PLN8528,1872272835,1872272835,Internal Medicine,In-Network,Z12.11,I10,,,,,,,0,,81001,Pathology/Lab,,,,12,Home,1,24.46,8.96,0.0,8.96,50.0,0.0,58.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000180,MBR00000006,Institutional-OP,2023-07-15,2023-07-15,2023-07-24,PLN5642,1624202402,1624202402,Orthopedic Surgery,In-Network,R10.9,Z12.31,,,,,,,0,,99233,E&M,,,0360,22,Outpatient Hospital,3,414.28,314.6,96.32,209.97,0.0,8.31,218.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000181,MBR00000006,Institutional-OP,2021-04-15,2021-04-15,2021-04-22,PLN8899,1224179551,1224179551,Physical Therapy,In-Network,E11.9,J44.1,,,,,,,0,,33533,Surgery,,,0730,22,Outpatient Hospital,1,13013.33,9915.89,9392.08,0.0,25.0,498.81,523.81,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000000182,MBR00000006,Professional,2022-12-23,2022-12-23,2023-01-01,PLN3877,1284035364,1284035364,Pediatrics,In-Network,N18.3,F41.9,,,,,,,0,,23472,Surgery,,,,11,Office,3,5558.52,4068.67,4043.67,0.0,25.0,0.0,25.0,0.0,Pended,,,1,,0,0,1,0,0,1,Duplicate,0,0,0,0,0
CLM0000000183,MBR00000006,Professional,2023-03-28,2023-03-28,2023-05-05,PLN3652,1795618275,1795618275,Pulmonology,In-Network,Z12.11,J44.1,,,,,,,0,,99283,E&M,,,,12,Home,1,372.21,140.14,0.0,140.14,0.0,0.0,140.14,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000184,MBR00000006,Professional,2022-12-09,2022-12-09,2023-01-17,PLN6586,1193493783,1193493783,Critical Access Hospital,Out-of-Network,J44.1,E11.9,,,,,,,0,,93306,Radiology,,,,12,Home,3,1353.91,637.44,637.44,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000185,MBR00000006,Professional,2021-09-16,2021-09-16,2021-10-10,PLN3525,1125190055,1125190055,Nephrology,In-Network,E11.9,E66.9,,,,,,,0,,99232,E&M,,,,49,Independent Clinic,3,153.51,65.34,65.34,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000186,MBR00000006,Professional,2022-03-21,2022-03-21,2022-04-05,PLN5835,1845057593,1845057593,Orthopedic Surgery,In-Network,G43.909,E78.5,,,,,,,0,,72148,Radiology,,,,11,Office,3,2576.27,2049.09,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000187,MBR00000006,Professional,2021-03-01,2021-03-01,2021-03-17,PLN1686,1410468316,1410468316,SNF,In-Network,F32.9,M17.11,,,,,,,0,,81001,Pathology/Lab,,,,49,Independent Clinic,3,23.38,13.82,0.0,13.82,75.0,0.0,88.82,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000188,MBR00000006,Professional,2021-07-13,2021-07-13,2021-07-22,PLN4718,1366286000,1366286000,SNF,In-Network,F41.9,I10,,,,,,,0,,99283,E&M,,,,11,Office,3,636.45,251.47,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000189,MBR00000006,Institutional-OP,2023-05-30,2023-05-30,2023-06-06,PLN8516,1389336600,1389336600,Critical Access Hospital,In-Network,F41.9,Z00.00,,,,,,,0,,99221,E&M,,,0320,22,Outpatient Hospital,3,252.63,103.39,69.7,18.01,0.0,15.68,33.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000190,MBR00000006,Professional,2022-11-08,2022-11-08,2022-12-03,PLN8194,1645194539,1645194539,SNF,In-Network,I10,J06.9,,,,,,,0,,90837,Medicine,,,,20,Urgent Care,2,517.9,231.52,201.83,0.0,0.0,29.69,29.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000191,MBR00000006,Professional,2023-08-06,2023-08-06,2023-09-12,PLN9247,1700633438,1700633438,DME Supplier,In-Network,Z79.4,E78.5,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,3,74.51,51.36,0.0,51.36,0.0,0.0,51.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000000192,MBR00000006,Professional,2023-01-28,2023-01-28,2023-03-12,PLN3050,1997536841,1997536841,Family Medicine,Out-of-Network,J06.9,E78.5,,,,,,,0,,82043,Pathology/Lab,,,,22,Outpatient Hospital,2,66.55,39.43,0.0,39.43,0.0,0.0,39.43,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000000193,MBR00000006,Professional,2021-09-21,2021-09-21,2021-10-25,PLN6691,1514306773,1514306773,Endocrinology,In-Network,I10,E11.9,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,3,424.41,315.27,0.0,315.27,75.0,0.0,390.27,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000000194,MBR00000006,Institutional-OP,2023-06-10,2023-06-10,2023-07-20,PLN5042,1689639685,1689639685,SNF,In-Network,E78.5,F41.9,,,,,,,0,,70553,Radiology,,,0370,22,Outpatient Hospital,3,2249.75,1403.18,1125.83,164.52,0.0,112.83,277.35,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000195,MBR00000006,Institutional-OP,2023-01-23,2023-01-23,2023-03-04,PLN3722,1247341320,1247341320,Urology,Out-of-Network,K21.0,F32.9,,,,,,,0,,99233,E&M,,,0370,22,Outpatient Hospital,2,431.2,241.22,0.0,241.22,35.0,0.0,276.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000196,MBR00000006,Professional,2021-07-29,2021-07-29,2021-09-01,PLN5346,1575695214,1575695214,SNF,In-Network,N39.0,Z23,,,,,,,0,,43239,Surgery,,,,20,Urgent Care,2,2194.01,1350.49,1275.49,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000197,MBR00000006,Institutional-IP,2021-01-06,2021-01-08,2021-02-18,PLN4073,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,E66.9,J06.9,,,,603,MS-DRG,7,2,Y,99213,E&M,,,0761,21,Inpatient Hospital,1,311.68,236.25,0.0,175.92,75.0,0.0,250.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000198,MBR00000006,Professional,2023-04-17,2023-04-17,2023-05-05,PLN1879,1295371663,1295371663,Critical Access Hospital,In-Network,E66.9,J20.9,,,,,,,0,,27447,Surgery,,,,23,Emergency Room,1,5320.85,3667.21,3642.21,0.0,25.0,0.0,25.0,0.0,Adjusted,,,1,,1,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000000199,MBR00000006,Institutional-OP,2023-03-01,2023-03-01,2023-03-30,PLN2072,1500949740,1500949740,Pediatrics,In-Network,N18.3,Z00.00,,,,,,,0,,93225,Medicine,,,0320,22,Outpatient Hospital,1,869.79,496.06,417.8,0.0,75.0,3.26,78.26,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000200,MBR00000006,Professional,2021-04-09,2021-04-09,2021-05-07,PLN4334,1193493783,1193493783,Critical Access Hospital,Out-of-Network,N39.0,Z00.00,,,,,,,0,,74177,Radiology,,,,22,Outpatient Hospital,3,2865.87,2099.49,2099.49,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000201,MBR00000006,Institutional-OP,2022-05-24,2022-05-24,2022-06-19,PLN3766,1219817751,1219817751,OB/GYN,In-Network,J20.9,E78.5,,,,,,,0,,99214,E&M,,,0510,22,Outpatient Hospital,3,397.88,147.16,0.0,147.16,0.0,0.0,147.16,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000202,MBR00000006,Professional,2023-09-28,2023-09-28,2023-11-07,PLN1295,1752470395,1752470395,Home Health,In-Network,M54.5,Z12.31,,,,,,,0,,81001,Pathology/Lab,,,,31,Skilled Nursing Facility,1,37.43,11.26,11.26,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000203,MBR00000006,Professional,2023-05-18,2023-05-18,2023-06-28,PLN1770,1691062876,1691062876,SNF,In-Network,F41.9,J18.9,,,,,,,0,,43239,Surgery,,,,11,Office,3,1270.01,836.22,794.21,42.01,0.0,0.0,42.01,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000204,MBR00000006,Professional,2023-06-14,2023-06-14,2023-07-03,PLN2406,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,N39.0,I25.10,,,,,,,0,,99213,E&M,,,,11,Office,2,223.56,179.25,0.0,179.25,50.0,0.0,229.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000205,MBR00000006,Professional,2022-03-07,2022-03-07,2022-03-22,PLN4139,1865904917,1865904917,Outpatient Clinic,In-Network,M81.0,Z00.00,,,,,,,0,,99213,E&M,,,,11,Office,2,318.69,135.27,135.27,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000206,MBR00000006,Institutional-IP,2021-05-13,2021-05-19,2021-06-17,PLN9399,1974006077,1974006077,Orthopedic Surgery,In-Network,J18.9,J06.9,,,,690,MS-DRG,1,6,Y,33533,Surgery,,,0900,21,Inpatient Hospital,1,10509.04,4578.12,4503.12,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000000207,MBR00000006,Institutional-IP,2022-01-20,2022-01-24,2022-02-01,PLN1041,1366576336,1366576336,Geriatrics,In-Network,I10,Z12.31,,,,603,MS-DRG,14,4,Y,99214,E&M,,,0270,21,Inpatient Hospital,3,448.59,354.57,207.66,96.91,50.0,0.0,146.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000208,MBR00000007,Professional,2023-01-23,2023-01-23,2023-03-07,PLN2253,1528335731,1528335731,Critical Access Hospital,In-Network,E11.40,R05,,,,,,,0,,93225,Medicine,,,,23,Emergency Room,2,950.49,604.45,449.95,25.5,75.0,54.0,154.5,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000209,MBR00000007,Institutional-OP,2023-07-10,2023-07-10,2023-07-25,PLN1393,1609138981,1609138981,Critical Access Hospital,In-Network,Z12.11,Z23,,,,,,,0,,86900,Pathology/Lab,,,0320,22,Outpatient Hospital,1,26.69,18.61,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000210,MBR00000007,Professional,2022-12-07,2022-12-07,2023-01-17,PLN6699,1168246159,1168246159,Internal Medicine,In-Network,Z23,M54.5,,,,,,,0,,G0444,Medicine,,,,11,Office,3,37.86,21.49,0.0,21.49,35.0,0.0,56.49,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000000211,MBR00000007,Institutional-OP,2021-02-12,2021-02-12,2021-03-07,PLN7257,1518055405,1518055405,Urology,In-Network,J45.20,Z79.4,,,,,,,0,,99284,E&M,,,0450,22,Outpatient Hospital,2,691.74,571.14,518.62,0.0,15.0,37.52,52.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000212,MBR00000007,Professional,2022-10-09,2022-10-09,2022-11-03,PLN1404,1749327647,1749327647,Geriatrics,In-Network,F32.9,E11.9,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,2,183.02,117.3,0.0,117.3,0.0,0.0,117.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000213,MBR00000007,Professional,2021-07-24,2021-07-24,2021-08-25,PLN5713,1845057593,1845057593,Orthopedic Surgery,In-Network,E11.9,E11.9,,,,,,,0,,74177,Radiology,,,,11,Office,2,2365.13,803.36,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000214,MBR00000007,Professional,2022-10-30,2022-10-30,2022-11-06,PLN4331,1148984206,1148984206,Psychiatry,In-Network,E11.65,F10.20,,,,,,,0,,74177,Radiology,,,,22,Outpatient Hospital,2,1663.85,559.07,544.07,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000215,MBR00000007,Institutional-IP,2022-03-28,2022-03-29,2022-04-12,PLN9371,1475984649,1475984649,SNF,In-Network,Z00.00,N39.0,,,,194,MS-DRG,1,1,Y,85610,Pathology/Lab,,,0636,21,Inpatient Hospital,1,41.29,26.68,26.68,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000216,MBR00000007,Institutional-OP,2022-08-07,2022-08-07,2022-08-16,PLN3547,1366286000,1366286000,SNF,In-Network,G43.909,E11.9,,,,,,,0,,93306,Radiology,,,0900,22,Outpatient Hospital,1,1700.57,851.23,851.23,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000217,MBR00000007,Institutional-IP,2022-10-15,2022-10-19,2022-10-31,PLN8403,1139906830,1139906830,Endocrinology,Out-of-Network,E66.9,I10,,,,641,MS-DRG,6,4,N,99232,E&M,,,0320,21,Inpatient Hospital,2,358.45,141.92,0.0,141.92,0.0,0.0,141.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000218,MBR00000007,Professional,2022-11-30,2022-11-30,2023-01-07,PLN6828,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,J06.9,Z79.4,,,,,,,0,,93306,Radiology,,,,11,Office,2,3191.65,1526.85,973.3,478.55,75.0,0.0,553.55,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000219,MBR00000007,Professional,2021-01-06,2021-01-06,2021-02-13,PLN4530,1389336600,1389336600,Critical Access Hospital,In-Network,J06.9,E11.9,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,3,31.07,25.87,22.26,0.0,0.0,3.61,3.61,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000220,MBR00000007,Institutional-OP,2023-11-24,2023-11-24,2023-12-23,PLN3852,1550154147,1550154147,Outpatient Clinic,In-Network,E11.9,F41.9,,,,,,,0,,83036,Pathology/Lab,,,0740,22,Outpatient Hospital,3,52.32,23.43,0.0,0.0,25.0,0.0,25.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000000221,MBR00000007,Institutional-OP,2022-09-22,2022-09-22,2022-10-12,PLN7058,1687650653,1687650653,Internal Medicine,In-Network,E78.5,I10,,,,,,,0,,80053,Pathology/Lab,,,0320,22,Outpatient Hospital,1,129.37,97.4,36.03,61.37,0.0,0.0,61.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000222,MBR00000007,Professional,2022-07-10,2022-07-10,2022-08-19,PLN8659,1644128543,1644128543,Gastroenterology,In-Network,J20.9,M54.5,,,,,,,0,,58661,Surgery,,,,12,Home,2,4629.42,2257.27,1777.86,414.67,15.0,49.74,479.41,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000223,MBR00000007,Institutional-OP,2022-02-19,2022-02-19,2022-02-27,PLN4641,1219817751,1219817751,OB/GYN,In-Network,C50.912,Z12.31,,,,,,,0,,99284,E&M,,,0510,22,Outpatient Hospital,3,882.72,317.62,282.62,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000224,MBR00000007,Institutional-IP,2021-04-25,2021-05-02,2021-05-12,PLN9388,1284035364,1284035364,Pediatrics,In-Network,N17.9,Z00.00,,,,871,MS-DRG,17,7,N,93225,Medicine,,,0761,21,Inpatient Hospital,2,915.89,408.57,0.0,408.57,15.0,0.0,423.57,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000225,MBR00000007,Professional,2022-11-21,2022-11-21,2022-12-22,PLN3353,1242201429,1242201429,General Acute Care Hospital,In-Network,N39.0,J20.9,,,,,,,0,,87491,Pathology/Lab,,,,49,Independent Clinic,3,158.29,70.26,47.72,0.0,15.0,7.54,22.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000226,MBR00000007,Institutional-IP,2022-02-02,2022-02-06,2022-03-05,PLN6650,1227362142,1227362142,DME Supplier,In-Network,F41.9,J20.9,,,,292,MS-DRG,18,4,Y,23472,Surgery,,,0270,21,Inpatient Hospital,1,2711.0,2210.59,2210.59,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000227,MBR00000007,Professional,2023-09-21,2023-09-21,2023-11-01,PLN7864,1295371663,1295371663,Critical Access Hospital,In-Network,M54.5,I10,,,,,,,0,,99233,E&M,,,,12,Home,2,200.7,75.42,75.42,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000228,MBR00000007,Professional,2022-12-22,2022-12-22,2023-01-10,PLN9430,1564502315,1564502315,ASC,In-Network,I25.10,I10,,,,,,,0,,99232,E&M,,,,11,Office,3,139.22,63.15,63.15,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000229,MBR00000007,Institutional-OP,2022-04-28,2022-04-28,2022-06-07,PLN9195,1856686341,1856686341,Geriatrics,In-Network,I10,I48.91,,,,,,,0,,99213,E&M,,,0370,22,Outpatient Hospital,2,224.94,132.32,92.74,0.0,35.0,4.58,39.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000230,MBR00000007,Institutional-OP,2021-02-04,2021-02-04,2021-02-23,PLN8274,1990090423,1990090423,Orthopedic Surgery,In-Network,F41.9,E78.5,,,,,,,0,,99214,E&M,,,0301,22,Outpatient Hospital,1,252.13,103.89,0.0,103.89,25.0,0.0,128.89,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000231,MBR00000007,Professional,2022-08-31,2022-08-31,2022-10-01,PLN5831,1935547131,1935547131,Pulmonology,In-Network,F32.9,N18.3,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,3,75.85,39.05,37.53,0.0,0.0,1.52,1.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000232,MBR00000007,Professional,2023-07-15,2023-07-15,2023-08-20,PLN3951,1450094833,1450094833,Outpatient Clinic,In-Network,J44.1,Z23,,,,,,,0,,47562,Surgery,,,,11,Office,2,5096.21,1958.77,1958.77,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000233,MBR00000007,Professional,2022-05-22,2022-05-22,2022-06-16,PLN9555,1463205530,1463205530,Nephrology,In-Network,Z12.31,I25.10,,,,,,,0,,99214,E&M,,,,12,Home,3,417.75,260.96,0.0,227.87,75.0,0.0,302.87,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000234,MBR00000007,Professional,2022-12-14,2022-12-14,2023-01-20,PLN2077,1800011727,1800011727,Clinical Laboratory,Out-of-Network,E78.5,E78.5,,,,,,,0,,58661,Surgery,,,,23,Emergency Room,1,4588.3,2218.05,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-4,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000235,MBR00000007,Institutional-IP,2021-05-10,2021-05-15,2021-06-17,PLN6194,1609526529,1609526529,Psychiatry,In-Network,C50.912,Z23,,,,683,MS-DRG,7,5,Y,99221,E&M,,,0360,21,Inpatient Hospital,2,268.61,165.93,165.93,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000000236,MBR00000007,Professional,2022-03-22,2022-03-22,2022-04-08,PLN5768,1337791138,1337791138,Internal Medicine,Out-of-Network,Z79.4,N39.0,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,3,3080.77,1202.17,1187.17,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000237,MBR00000007,Professional,2023-05-19,2023-05-19,2023-06-11,PLN7719,1609138981,1609138981,Critical Access Hospital,In-Network,N39.0,Z12.31,,,,,,,0,,66984,Surgery,,,,11,Office,3,1321.68,997.47,668.93,303.54,25.0,0.0,328.54,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000238,MBR00000007,Institutional-OP,2022-04-09,2022-04-09,2022-05-08,PLN2875,1845900543,1845900543,ASC,In-Network,I63.9,I10,,,,,,,0,,G0468,Medicine,,,0450,22,Outpatient Hospital,2,657.6,413.17,186.23,176.94,50.0,0.0,226.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000239,MBR00000007,Professional,2023-08-28,2023-08-28,2023-10-10,PLN2532,1716521444,1716521444,Oncology,In-Network,N40.0,E78.5,,,,,,,0,,99232,E&M,,,,49,Independent Clinic,2,145.96,52.54,52.54,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000240,MBR00000008,Professional,2022-03-25,2022-03-25,2022-04-10,PLN7052,1660288235,1660288235,ASC,In-Network,M81.0,Z23,,,,,,,0,,90686,Medicine,,,,11,Office,1,105.17,57.69,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-15,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000000241,MBR00000008,Institutional-OP,2023-06-08,2023-06-08,2023-07-17,PLN6028,1540044947,1540044947,Pulmonology,Out-of-Network,Z79.4,F10.20,,,,,,,0,,66984,Surgery,,,0510,22,Outpatient Hospital,3,2526.53,2060.78,2060.78,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000242,MBR00000008,Professional,2022-12-06,2022-12-06,2023-01-04,PLN6366,1935547131,1935547131,Pulmonology,In-Network,E11.65,I10,,,,,,,0,,93225,Medicine,,,,23,Emergency Room,3,668.47,345.33,306.23,0.0,0.0,39.1,39.1,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000243,MBR00000008,Professional,2023-11-04,2023-11-04,2023-12-05,PLN3741,1148984206,1148984206,Psychiatry,In-Network,Z51.11,I10,,,,,,,0,,76700,Radiology,,,,12,Home,2,1441.6,1079.06,691.6,303.97,25.0,58.49,387.46,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000244,MBR00000008,Professional,2022-08-07,2022-08-07,2022-09-01,PLN1053,1817234602,1817234602,Clinical Laboratory,In-Network,Z12.31,Z12.31,,,,,,,0,,90460,Medicine,,,,11,Office,1,31.41,14.84,0.0,14.84,0.0,0.0,14.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000245,MBR00000008,Professional,2022-05-28,2022-05-28,2022-06-08,PLN7517,1518055405,1518055405,Urology,In-Network,F32.9,E66.9,,,,,,,0,,G0439,Medicine,,,,23,Emergency Room,3,482.22,175.46,0.0,175.46,0.0,0.0,175.46,0.0,Paid,,,0,,1,1,0,0,0,0,None,0,0,0,1,0
CLM0000000246,MBR00000008,Institutional-OP,2022-01-23,2022-01-23,2022-02-03,PLN1952,1622771872,1622771872,Pediatrics,In-Network,E66.9,G20,,,,,,,0,,27130,Surgery,,,0120,22,Outpatient Hospital,1,3391.24,2583.41,2583.41,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000247,MBR00000008,Institutional-IP,2022-12-16,2022-12-23,2023-01-01,PLN1554,1935547131,1935547131,Pulmonology,In-Network,I10,R05,,,,871,MS-DRG,1,7,Y,33533,Surgery,,,0761,21,Inpatient Hospital,2,12392.94,3960.63,3935.63,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000000248,MBR00000008,Professional,2023-12-10,2023-12-10,2023-12-17,PLN2333,1622771872,1622771872,Pediatrics,In-Network,I10,K57.30,,,,,,,0,,99221,E&M,,,,31,Skilled Nursing Facility,3,341.1,278.52,253.52,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000249,MBR00000008,Professional,2021-07-04,2021-07-04,2021-07-20,PLN9946,1799205295,1799205295,General Acute Care Hospital,In-Network,E78.5,I63.9,,,,,,,0,,66984,Surgery,,,,11,Office,1,2295.12,1817.52,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-4,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000250,MBR00000008,Professional,2023-10-23,2023-10-23,2023-12-01,PLN5214,1997536841,1997536841,Family Medicine,Out-of-Network,J20.9,I11.9,,,,,,,0,,58661,Surgery,,,,11,Office,2,1869.29,1389.23,1389.23,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000251,MBR00000008,Institutional-OP,2023-12-06,2023-12-06,2024-01-15,PLN7180,1266606767,1266606767,ASC,In-Network,E11.65,E78.5,,,,,,,0,,45380,Surgery,,,0320,22,Outpatient Hospital,3,2274.96,852.92,817.92,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000000252,MBR00000008,Institutional-OP,2023-04-23,2023-04-23,2023-05-29,PLN5418,1268679390,1268679390,Critical Access Hospital,In-Network,J20.9,K21.0,,,,,,,0,,99232,E&M,,,0730,22,Outpatient Hospital,1,395.69,295.76,0.0,295.76,15.0,0.0,310.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000253,MBR00000008,Institutional-IP,2022-09-28,2022-09-30,2022-11-02,PLN7719,1103747954,1103747954,Urology,In-Network,E11.9,Z00.00,,,,641,MS-DRG,11,2,Y,99233,E&M,,,0761,21,Inpatient Hospital,1,202.14,163.19,116.91,0.0,35.0,11.28,46.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000254,MBR00000008,Professional,2023-08-03,2023-08-03,2023-08-29,PLN4583,1486164553,1486164553,DME Supplier,In-Network,K92.1,F03.90,,,,,,,0,,81001,Pathology/Lab,,,,50,Federally Qualified Health Center,3,33.99,11.18,0.0,11.18,75.0,0.0,86.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000255,MBR00000008,Institutional-OP,2021-10-14,2021-10-14,2021-10-31,PLN1254,1139906830,1139906830,Endocrinology,Out-of-Network,E11.9,I10,,,,,,,0,,84443,Pathology/Lab,,,0301,22,Outpatient Hospital,2,144.48,112.06,112.06,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000256,MBR00000008,Institutional-OP,2022-11-26,2022-11-26,2023-01-01,PLN6791,1334916761,1334916761,ASC,In-Network,Z51.11,M17.11,,,,,,,0,,90686,Medicine,,,0761,22,Outpatient Hospital,2,130.48,102.46,85.24,0.0,0.0,17.22,17.22,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000000257,MBR00000008,Professional,2023-06-01,2023-06-01,2023-07-10,PLN9569,1563980627,1563980627,Critical Access Hospital,In-Network,F32.9,J06.9,,,,,,,0,,99203,E&M,,,,20,Urgent Care,2,287.11,101.21,0.0,101.21,35.0,0.0,136.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000258,MBR00000008,Professional,2023-06-01,2023-06-01,2023-07-10,PLN8366,1103747954,1103747954,Urology,In-Network,Z00.00,I25.10,,,,,,,0,,93225,Medicine,,,,23,Emergency Room,1,580.27,371.47,272.38,99.09,0.0,0.0,99.09,0.0,Pended,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000259,MBR00000008,Professional,2022-10-05,2022-10-05,2022-11-11,PLN8614,1550154147,1550154147,Outpatient Clinic,In-Network,F41.9,Z79.4,,,,,,,0,,99213,E&M,,,,12,Home,2,148.16,111.01,61.01,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000260,MBR00000008,Institutional-IP,2022-02-27,2022-03-08,2022-03-15,PLN6268,1817234602,1817234602,Clinical Laboratory,In-Network,K21.0,F32.9,,,,470,MS-DRG,4,9,U,99283,E&M,,,0740,21,Inpatient Hospital,1,291.18,89.52,0.0,89.52,0.0,0.0,89.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000261,MBR00000008,Professional,2023-11-06,2023-11-06,2023-11-21,PLN1809,1242201429,1242201429,General Acute Care Hospital,In-Network,E87.6,Z00.01,,,,,,,0,,99232,E&M,,,,49,Independent Clinic,3,388.29,181.59,0.0,181.59,0.0,0.0,181.59,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000262,MBR00000008,Professional,2023-01-08,2023-01-08,2023-01-15,PLN7392,1696843572,1696843572,Critical Access Hospital,Out-of-Network,I25.10,Z23,,,,,,,0,,99284,E&M,,,,11,Office,1,321.7,271.12,0.0,271.12,0.0,0.0,271.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000263,MBR00000008,Institutional-IP,2023-04-24,2023-04-26,2023-05-15,PLN5028,1168881145,1168881145,Orthopedic Surgery,In-Network,J45.20,J20.9,,,,603,MS-DRG,15,2,Y,99203,E&M,,,0360,21,Inpatient Hospital,3,313.01,131.24,0.0,131.24,0.0,0.0,131.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000264,MBR00000008,Institutional-IP,2022-11-14,2022-11-20,2022-11-22,PLN1817,1247341320,1247341320,Urology,Out-of-Network,M54.5,Z51.11,,,,690,MS-DRG,2,6,Y,90686,Medicine,,,0301,21,Inpatient Hospital,3,105.4,41.09,41.09,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000000265,MBR00000008,Professional,2023-08-19,2023-08-19,2023-09-03,PLN3353,1752470395,1752470395,Home Health,In-Network,E11.9,N39.0,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,1,65.23,54.92,54.92,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000266,MBR00000008,Professional,2022-06-08,2022-06-08,2022-07-16,PLN8223,1946680931,1946680931,Critical Access Hospital,Out-of-Network,E78.5,N39.0,,,,,,,0,,33533,Surgery,,,,11,Office,1,12762.12,5538.62,5538.62,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000000267,MBR00000008,Professional,2022-08-22,2022-08-22,2022-09-05,PLN8294,1974006077,1974006077,Orthopedic Surgery,In-Network,K21.0,M54.5,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,1,1960.25,1299.63,1274.63,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000268,MBR00000008,Professional,2023-05-31,2023-05-31,2023-06-29,PLN7701,1463205530,1463205530,Nephrology,In-Network,Z12.31,I48.91,,,,,,,0,,70450,Radiology,,,,11,Office,1,1357.48,981.36,981.36,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000269,MBR00000008,Institutional-OP,2022-07-21,2022-07-21,2022-08-01,PLN3582,1767011137,1767011137,DME Supplier,In-Network,Z12.31,J06.9,,,,,,,0,,45380,Surgery,,,0360,22,Outpatient Hospital,2,2769.18,841.1,0.0,110.12,0.0,0.0,110.12,0.0,Denied,CO-11,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000000270,MBR00000008,Institutional-IP,2021-09-26,2021-09-30,2021-10-07,PLN2868,1108115157,1108115157,General Acute Care Hospital,In-Network,J44.1,E11.9,,,,196,MS-DRG,16,4,Y,90460,Medicine,,,0270,21,Inpatient Hospital,1,76.95,45.64,45.64,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000271,MBR00000008,Institutional-OP,2023-04-10,2023-04-10,2023-05-04,PLN9811,1749494482,1749494482,Pediatrics,In-Network,M54.5,I10,,,,,,,0,,99203,E&M,,,0120,22,Outpatient Hospital,2,317.42,105.1,105.1,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000272,MBR00000008,Institutional-OP,2022-02-16,2022-02-16,2022-03-30,PLN9439,1847081578,1847081578,Urology,Out-of-Network,I48.91,E78.5,,,,,,,0,,99204,E&M,,,0450,22,Outpatient Hospital,1,455.53,359.92,359.92,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000273,MBR00000008,Institutional-OP,2021-04-25,2021-04-25,2021-05-12,PLN5537,1500949740,1500949740,Pediatrics,In-Network,E11.9,Z23,,,,,,,0,,99221,E&M,,,0900,22,Outpatient Hospital,3,211.45,86.42,86.42,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000274,MBR00000008,Professional,2022-02-13,2022-02-13,2022-02-20,PLN8896,1767011137,1767011137,DME Supplier,In-Network,E78.5,N20.0,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,2,64.13,47.73,0.0,47.73,0.0,0.0,47.73,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000275,MBR00000009,Professional,2021-03-01,2021-03-01,2021-03-27,PLN2068,1486164553,1486164553,DME Supplier,In-Network,F32.9,N18.3,,,,,,,0,,74177,Radiology,,,,22,Outpatient Hospital,1,2409.4,738.81,588.21,0.0,25.0,125.6,150.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000276,MBR00000009,Institutional-OP,2023-08-20,2023-08-20,2023-09-03,PLN9350,1609526529,1609526529,Psychiatry,In-Network,R10.9,J45.20,,,,,,,0,,80061,Pathology/Lab,,,0301,22,Outpatient Hospital,1,129.04,66.37,16.37,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000277,MBR00000009,Institutional-IP,2023-12-14,2023-12-16,2024-01-22,PLN2748,1198133277,1198133277,SNF,In-Network,Z00.00,G43.909,,,,291,MS-DRG,19,2,Y,45378,Surgery,,,0740,21,Inpatient Hospital,2,1254.89,983.25,702.39,255.86,25.0,0.0,280.86,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000278,MBR00000009,Institutional-OP,2021-10-19,2021-10-19,2021-11-18,PLN3558,1198133277,1198133277,SNF,In-Network,E11.9,K92.1,,,,,,,0,,58661,Surgery,,,0636,22,Outpatient Hospital,3,1854.28,1510.47,1228.34,0.0,75.0,207.13,282.13,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000279,MBR00000009,Institutional-IP,2023-10-01,2023-10-05,2023-10-30,PLN6394,1997536841,1997536841,Family Medicine,Out-of-Network,Z12.31,I10,,,,682,MS-DRG,4,4,Y,99214,E&M,,,0120,21,Inpatient Hospital,2,400.4,305.6,0.0,305.6,0.0,0.0,305.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000280,MBR00000009,Professional,2023-02-19,2023-02-19,2023-03-16,PLN9962,1946680931,1946680931,Critical Access Hospital,Out-of-Network,J45.20,G43.909,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,1,28.06,22.17,0.0,22.17,35.0,0.0,57.17,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000281,MBR00000010,Professional,2023-11-13,2023-11-13,2023-12-27,PLN2707,1564502315,1564502315,ASC,In-Network,I10,I10,,,,,,,0,,58661,Surgery,,,,21,Inpatient Hospital,2,3787.94,1904.92,1726.36,0.0,25.0,153.56,178.56,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000282,MBR00000010,Professional,2021-06-28,2021-06-28,2021-07-11,PLN5400,1135158374,1135158374,Pulmonology,In-Network,E66.9,I10,,,,,,,0,,99214,E&M,,,,11,Office,2,237.44,163.59,0.0,163.59,0.0,0.0,163.59,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000283,MBR00000010,Institutional-IP,2021-03-10,2021-03-18,2021-03-19,PLN6162,1273488618,1273488618,General Acute Care Hospital,In-Network,F32.9,Z12.31,,,,470,MS-DRG,6,8,Y,99214,E&M,,,0370,21,Inpatient Hospital,1,456.59,201.29,0.0,201.29,50.0,0.0,251.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000284,MBR00000010,Institutional-OP,2023-10-05,2023-10-05,2023-10-29,PLN7459,1717912431,1717912431,Oncology,In-Network,I48.91,J44.1,,,,,,,0,,99214,E&M,,,0900,22,Outpatient Hospital,1,416.84,332.13,307.13,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000285,MBR00000010,Institutional-OP,2021-10-22,2021-10-22,2021-11-08,PLN7370,1624802371,1624802371,ASC,Out-of-Network,Z23,K21.0,,,,,,,0,,93306,Radiology,,,0761,22,Outpatient Hospital,2,2436.49,804.21,789.21,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000286,MBR00000010,Professional,2022-10-15,2022-10-15,2022-11-22,PLN5750,1235381502,1235381502,Cardiology,In-Network,F41.9,Z23,,,,,,,0,,45380,Surgery,,,,11,Office,1,1291.49,841.83,694.9,0.0,15.0,131.93,146.93,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000000287,MBR00000010,Professional,2023-09-15,2023-09-15,2023-10-19,PLN7437,1530904931,1530904931,Internal Medicine,In-Network,E11.40,Z96.641,,,,,,,0,,27130,Surgery,,,,11,Office,3,5375.92,2599.11,2599.11,0.0,0.0,0.0,0.0,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000288,MBR00000010,Professional,2022-01-11,2022-01-11,2022-02-03,PLN6186,1186826716,1186826716,Physical Therapy,In-Network,Z12.31,R51,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,2,220.5,107.44,72.44,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000289,MBR00000010,Professional,2021-04-08,2021-04-08,2021-05-06,PLN7130,1118885473,1118885473,ASC,In-Network,N18.3,F10.20,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,1,187.41,129.08,79.08,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000290,MBR00000010,Institutional-OP,2023-05-17,2023-05-17,2023-06-17,PLN5610,1205377316,1205377316,Orthopedic Surgery,In-Network,Z12.11,J44.1,,,,,,,0,,99222,E&M,,,0360,22,Outpatient Hospital,1,531.85,211.42,171.27,0.0,0.0,40.15,40.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000291,MBR00000010,Institutional-OP,2022-05-10,2022-05-10,2022-05-29,PLN4063,1125190055,1125190055,Nephrology,In-Network,I10,I25.10,,,,,,,0,,47562,Surgery,,,0360,22,Outpatient Hospital,1,2940.19,1500.15,1465.15,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000292,MBR00000010,Professional,2021-01-25,2021-01-25,2021-02-19,PLN7067,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,E66.9,M54.5,,,,,,,0,,76700,Radiology,,,,11,Office,2,585.0,192.26,0.0,192.26,35.0,0.0,227.26,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000293,MBR00000010,Institutional-OP,2022-01-09,2022-01-09,2022-01-19,PLN2977,1994661817,1994661817,SNF,Out-of-Network,Z23,E78.5,,,,,,,0,,99214,E&M,,,0761,22,Outpatient Hospital,2,301.15,251.39,37.13,189.26,25.0,0.0,214.26,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000294,MBR00000010,Professional,2022-08-04,2022-08-04,2022-08-22,PLN3666,1186826716,1186826716,Physical Therapy,In-Network,E11.9,I10,,,,,,,0,,99213,E&M,,,,49,Independent Clinic,1,329.16,207.04,0.0,200.84,15.0,0.0,215.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000295,MBR00000010,Institutional-OP,2023-08-22,2023-08-22,2023-09-22,PLN1141,1563980627,1563980627,Critical Access Hospital,In-Network,I10,Z00.01,,,,,,,0,,99232,E&M,,,0636,22,Outpatient Hospital,3,336.4,128.6,0.0,86.54,75.0,0.0,161.54,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000296,MBR00000010,Institutional-IP,2021-09-05,2021-09-06,2021-10-01,PLN3800,1125190055,1125190055,Nephrology,In-Network,I50.9,I25.10,,,,871,MS-DRG,3,1,Y,27130,Surgery,,,0270,21,Inpatient Hospital,1,4973.78,4015.21,3689.97,311.09,0.0,14.15,325.24,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000297,MBR00000010,Professional,2022-07-22,2022-07-22,2022-08-16,PLN1764,1590915516,1590915516,Physical Therapy,Out-of-Network,Z00.00,M54.5,,,,,,,0,,33533,Surgery,,,,31,Skilled Nursing Facility,3,13520.71,7180.5,6529.38,0.0,0.0,651.12,651.12,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000000298,MBR00000010,Institutional-OP,2021-07-18,2021-07-18,2021-08-08,PLN9689,1569105090,1569105090,Geriatrics,In-Network,E78.5,E11.9,,,,,,,0,,27130,Surgery,,,0370,22,Outpatient Hospital,3,3677.92,2619.85,2594.85,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000299,MBR00000010,Professional,2021-11-14,2021-11-14,2021-12-26,PLN1322,1511044648,1511044648,Endocrinology,In-Network,G43.909,E78.5,,,,,,,0,,58661,Surgery,,,,11,Office,3,4279.07,1829.27,1658.32,95.95,75.0,0.0,170.95,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000300,MBR00000011,Institutional-IP,2021-10-16,2021-10-17,2021-10-31,PLN3720,1242201429,1242201429,General Acute Care Hospital,In-Network,I10,I10,,,,682,MS-DRG,4,1,Y,70450,Radiology,,,0320,21,Inpatient Hospital,2,696.92,456.42,126.45,279.97,50.0,0.0,329.97,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000301,MBR00000011,Professional,2022-07-29,2022-07-29,2022-08-14,PLN1892,1609526529,1609526529,Psychiatry,In-Network,E11.9,M81.0,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,2,2223.24,1814.36,1814.36,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000000302,MBR00000011,Professional,2022-12-28,2022-12-28,2023-01-26,PLN7080,1247341320,1247341320,Urology,Out-of-Network,I10,E11.65,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,3,443.33,188.67,109.06,0.0,75.0,4.61,79.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000303,MBR00000011,Institutional-IP,2021-05-04,2021-05-09,2021-06-13,PLN4612,1622771872,1622771872,Pediatrics,In-Network,Z00.00,J18.9,,,,872,MS-DRG,18,5,Y,86900,Pathology/Lab,,,0120,21,Inpatient Hospital,3,40.35,12.62,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000304,MBR00000011,Professional,2021-03-25,2021-03-25,2021-04-21,PLN6538,1994661817,1994661817,SNF,Out-of-Network,E78.5,M17.11,,,,,,,0,,90837,Medicine,,,,20,Urgent Care,3,501.84,360.5,285.5,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000305,MBR00000011,Professional,2023-03-12,2023-03-12,2023-03-22,PLN7421,1366286000,1366286000,SNF,In-Network,F32.9,K57.30,,,,,,,0,,76700,Radiology,,,,11,Office,1,1215.81,754.72,754.72,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000000306,MBR00000011,Institutional-OP,2021-11-18,2021-11-18,2021-11-27,PLN7065,1660288235,1660288235,ASC,In-Network,B97.89,I10,,,,,,,0,,99203,E&M,,,0510,22,Outpatient Hospital,3,323.38,216.83,0.0,216.83,0.0,0.0,216.83,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000307,MBR00000011,Professional,2022-11-09,2022-11-09,2022-11-21,PLN3168,1745114564,1745114564,Endocrinology,In-Network,E11.65,F32.9,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,2,60.59,35.58,0.0,0.0,75.0,0.0,75.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000308,MBR00000011,Institutional-IP,2021-03-26,2021-03-27,2021-04-10,PLN5741,1313212303,1313212303,Family Medicine,In-Network,I11.9,N18.3,,,,872,MS-DRG,18,1,Y,58661,Surgery,,,0200,21,Inpatient Hospital,3,2234.68,1286.68,999.57,21.25,35.0,230.86,287.11,0.0,Paid,,,1,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000000309,MBR00000011,Institutional-IP,2022-10-20,2022-10-21,2022-12-03,PLN7701,1242201429,1242201429,General Acute Care Hospital,In-Network,N40.0,E11.40,,,,683,MS-DRG,9,1,Y,72148,Radiology,,,0740,21,Inpatient Hospital,3,1483.23,1084.74,1084.74,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000310,MBR00000011,Professional,2023-09-23,2023-09-23,2023-10-30,PLN7113,1644128543,1644128543,Gastroenterology,In-Network,E11.40,M54.5,,,,,,,0,,77067,Radiology,,,,23,Emergency Room,3,390.45,209.58,174.58,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,1,1,0,0,0,0,None,1,0,0,0,0
CLM0000000311,MBR00000011,Institutional-OP,2022-04-25,2022-04-25,2022-05-15,PLN2007,1514306773,1514306773,Endocrinology,In-Network,E11.9,Z23,,,,,,,0,,47562,Surgery,,,0360,22,Outpatient Hospital,1,5443.21,3262.97,2751.3,436.67,75.0,0.0,511.67,0.0,Paid,,,1,,0,0,1,0,0,1,Unbundling,0,0,0,0,0
CLM0000000312,MBR00000011,Professional,2022-09-25,2022-09-25,2022-10-21,PLN6747,1845900543,1845900543,ASC,In-Network,I10,Z12.31,,,,,,,0,,58661,Surgery,,,,11,Office,1,3578.63,1716.36,1701.36,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000313,MBR00000011,Professional,2021-11-19,2021-11-19,2021-12-25,PLN3004,1242201429,1242201429,General Acute Care Hospital,In-Network,M54.5,I11.9,,,,,,,0,,99233,E&M,,,,11,Office,2,423.88,302.35,0.0,0.0,25.0,43.8,68.8,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000314,MBR00000011,Professional,2021-11-10,2021-11-10,2021-12-01,PLN3660,1125190055,1125190055,Nephrology,In-Network,F41.9,E11.9,,,,,,,0,,45378,Surgery,,,,21,Inpatient Hospital,3,1460.47,880.15,858.86,0.0,0.0,21.29,21.29,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000315,MBR00000011,Institutional-IP,2021-03-13,2021-03-20,2021-03-24,PLN5041,1691062876,1691062876,SNF,In-Network,E66.9,I10,,,,291,MS-DRG,17,7,Y,99203,E&M,,,0370,21,Inpatient Hospital,3,202.16,146.28,121.21,0.0,0.0,25.07,25.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000316,MBR00000011,Professional,2022-06-09,2022-06-09,2022-07-20,PLN3304,1994661817,1994661817,SNF,Out-of-Network,N39.0,Z96.641,,,,,,,0,,70450,Radiology,,,,11,Office,2,1538.63,508.89,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-97,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000317,MBR00000011,Professional,2023-11-04,2023-11-04,2023-12-16,PLN9417,1631954542,1631954542,Oncology,In-Network,Z00.01,R10.9,,,,,,,0,,99213,E&M,,,,22,Outpatient Hospital,3,164.95,76.55,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000000318,MBR00000012,Professional,2021-05-08,2021-05-08,2021-06-13,PLN1300,1749327647,1749327647,Geriatrics,In-Network,Z23,N39.0,,,,,,,0,,84443,Pathology/Lab,,,,22,Outpatient Hospital,1,75.59,54.66,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000319,MBR00000012,Institutional-IP,2022-04-02,2022-04-13,2022-04-18,PLN2690,1717912431,1717912431,Oncology,In-Network,J20.9,E11.9,,,,194,MS-DRG,21,11,Y,80061,Pathology/Lab,,,0301,21,Inpatient Hospital,1,87.29,37.16,2.08,0.0,35.0,0.08,35.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000320,MBR00000012,Professional,2023-07-06,2023-07-06,2023-07-25,PLN6377,1453936007,1453936007,ASC,In-Network,K21.0,F41.9,,,,,,,0,,72148,Radiology,,,,23,Emergency Room,1,2429.61,963.36,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-29,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000321,MBR00000012,Professional,2022-06-28,2022-06-28,2022-08-11,PLN4641,1687650653,1687650653,Internal Medicine,In-Network,I10,I10,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,1,47.1,37.95,30.62,0.0,0.0,7.33,7.33,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000322,MBR00000012,Professional,2023-04-13,2023-04-13,2023-04-21,PLN9309,1745114564,1745114564,Endocrinology,In-Network,Z79.4,I10,,,,,,,0,,23472,Surgery,,,,21,Inpatient Hospital,2,3951.36,2756.98,2386.87,0.0,0.0,370.11,370.11,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000323,MBR00000012,Professional,2022-02-16,2022-02-16,2022-03-02,PLN6070,1622771872,1622771872,Pediatrics,In-Network,J44.1,F41.9,,,,,,,0,,33533,Surgery,,,,11,Office,2,23256.69,12897.77,12764.38,133.39,0.0,0.0,133.39,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000000324,MBR00000012,Institutional-IP,2022-10-22,2022-10-24,2022-12-01,PLN3961,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,I10,E66.9,,,,871,MS-DRG,6,2,Y,23472,Surgery,,,0200,21,Inpatient Hospital,2,4708.04,3003.76,2928.76,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000325,MBR00000012,Professional,2023-12-18,2023-12-18,2024-01-31,PLN2399,1219817751,1219817751,OB/GYN,In-Network,E78.5,I10,,,,,,,0,,71046,Radiology,,,,11,Office,2,114.58,88.56,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000326,MBR00000012,Professional,2022-10-17,2022-10-17,2022-10-26,PLN8648,1422747896,1422747896,Urology,In-Network,J44.1,K21.0,,,,,,,0,,47562,Surgery,,,,20,Urgent Care,2,5357.99,2412.71,2102.69,310.02,0.0,0.0,310.02,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000327,MBR00000012,Professional,2023-05-22,2023-05-22,2023-06-28,PLN1908,1148984206,1148984206,Psychiatry,In-Network,I50.9,J06.9,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,2,192.37,79.86,46.09,33.77,0.0,0.0,33.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000328,MBR00000012,Institutional-IP,2023-01-30,2023-02-01,2023-03-10,PLN1425,1295371663,1295371663,Critical Access Hospital,In-Network,E78.5,Z12.31,,,,603,MS-DRG,19,2,Y,27130,Surgery,,,0450,21,Inpatient Hospital,2,3840.35,2386.61,1953.64,397.97,35.0,0.0,432.97,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000329,MBR00000012,Institutional-IP,2021-04-15,2021-04-22,2021-05-16,PLN4572,1812060197,1812060197,Oncology,Out-of-Network,E11.65,E11.9,,,,641,MS-DRG,3,7,U,99283,E&M,,,0200,21,Inpatient Hospital,1,433.17,188.93,0.0,188.93,0.0,0.0,188.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000330,MBR00000012,Professional,2021-06-25,2021-06-25,2021-07-14,PLN6284,1689639685,1689639685,SNF,In-Network,E11.9,Z12.31,,,,,,,0,,43239,Surgery,,,,11,Office,2,2141.87,959.41,825.96,133.45,0.0,0.0,133.45,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000331,MBR00000012,Institutional-IP,2022-10-28,2022-10-30,2022-11-24,PLN5035,1139906830,1139906830,Endocrinology,Out-of-Network,Z23,I10,,,,291,MS-DRG,8,2,Y,99221,E&M,,,0320,21,Inpatient Hospital,1,285.75,223.34,21.28,202.06,0.0,0.0,202.06,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000000332,MBR00000012,Institutional-IP,2022-01-17,2022-01-18,2022-02-27,PLN3111,1125190055,1125190055,Nephrology,In-Network,Z00.00,Z23,,,,683,MS-DRG,22,1,Y,47562,Surgery,,,0740,21,Inpatient Hospital,1,2586.19,900.34,900.34,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000333,MBR00000012,Professional,2022-06-15,2022-06-15,2022-06-28,PLN5487,1717546253,1717546253,Family Medicine,In-Network,F41.9,I10,,,,,,,0,,27447,Surgery,,,,12,Home,1,3989.94,2352.86,2032.0,231.01,0.0,89.85,320.86,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000334,MBR00000012,Professional,2022-06-14,2022-06-14,2022-06-24,PLN8106,1109850785,1109850785,ASC,Out-of-Network,I10,E78.5,,,,,,,0,,33533,Surgery,,,,20,Urgent Care,2,17357.93,8793.77,8523.14,0.0,0.0,270.63,270.63,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000000335,MBR00000012,Professional,2023-05-19,2023-05-19,2023-06-18,PLN2426,1219817751,1219817751,OB/GYN,In-Network,I25.10,Z00.00,,,,,,,0,,66984,Surgery,,,,11,Office,1,1541.42,981.85,956.85,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000336,MBR00000012,Institutional-OP,2023-12-21,2023-12-21,2024-01-30,PLN3430,1514306773,1514306773,Endocrinology,In-Network,Z12.11,Z00.00,,,,,,,0,,80061,Pathology/Lab,,,0120,22,Outpatient Hospital,1,59.02,23.05,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000337,MBR00000012,Professional,2023-12-29,2023-12-29,2024-01-17,PLN1942,1809014947,1809014947,Urology,In-Network,J45.20,C50.912,,,,,,,0,,90460,Medicine,,,,11,Office,1,56.74,35.27,0.0,35.27,75.0,0.0,110.27,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000338,MBR00000012,Professional,2021-03-29,2021-03-29,2021-04-08,PLN4836,1561134315,1561134315,DME Supplier,In-Network,M54.5,I48.91,,,,,,,0,,99204,E&M,,,,21,Inpatient Hospital,2,587.53,414.95,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000339,MBR00000012,Professional,2023-03-27,2023-03-27,2023-05-03,PLN7688,1865904917,1865904917,Outpatient Clinic,In-Network,I50.9,M54.5,,,,,,,0,,99406,Medicine,,,,65,End-Stage Renal Disease,2,97.04,50.31,50.31,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000340,MBR00000012,Professional,2023-03-06,2023-03-06,2023-03-29,PLN4493,1355166277,1355166277,Endocrinology,In-Network,Z12.11,E11.40,,,,,,,0,,27447,Surgery,,,,11,Office,2,5599.74,2369.59,2344.59,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000341,MBR00000012,Institutional-OP,2023-08-06,2023-08-06,2023-09-18,PLN6790,1585582070,1585582070,Outpatient Clinic,In-Network,F32.9,E11.9,,,,,,,0,,99284,E&M,,,0270,22,Outpatient Hospital,2,466.68,298.38,273.93,0.0,0.0,24.45,24.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000342,MBR00000012,Professional,2022-04-13,2022-04-13,2022-05-09,PLN3420,1518055405,1518055405,Urology,In-Network,J06.9,J18.9,,,,,,,0,,78452,Radiology,,,,23,Emergency Room,2,5337.59,4406.74,4265.59,116.15,25.0,0.0,141.15,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000343,MBR00000012,Professional,2022-07-05,2022-07-05,2022-08-16,PLN5295,1224179551,1224179551,Physical Therapy,In-Network,I10,E78.5,,,,,,,0,,27447,Surgery,,,,11,Office,3,2753.13,2339.37,0.0,287.07,0.0,0.0,287.07,0.0,Denied,CO-27,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000344,MBR00000012,Institutional-IP,2022-05-10,2022-05-11,2022-06-15,PLN6754,1235381502,1235381502,Cardiology,In-Network,I10,J06.9,,,,690,MS-DRG,4,1,Y,45378,Surgery,,,0320,21,Inpatient Hospital,2,1644.6,603.4,0.0,429.67,75.0,0.0,504.67,0.0,Denied,CO-11,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000345,MBR00000012,Institutional-OP,2022-02-14,2022-02-14,2022-03-29,PLN8301,1946680931,1946680931,Critical Access Hospital,Out-of-Network,S72.001A,Z23,,,,,,,0,,78452,Radiology,,,0120,22,Outpatient Hospital,1,6068.57,1867.43,1512.51,329.92,25.0,0.0,354.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000346,MBR00000012,Institutional-OP,2021-09-28,2021-09-28,2021-11-10,PLN6208,1284035364,1284035364,Pediatrics,In-Network,E11.9,E11.9,,,,,,,0,,77067,Radiology,,,0301,22,Outpatient Hospital,3,424.8,264.12,236.9,0.0,0.0,27.22,27.22,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000000347,MBR00000012,Institutional-IP,2022-12-06,2022-12-09,2022-12-23,PLN6711,1809014947,1809014947,Urology,In-Network,E11.9,K21.0,,,,683,MS-DRG,7,3,Y,23472,Surgery,,,0370,21,Inpatient Hospital,1,6982.86,3231.22,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000348,MBR00000012,Professional,2021-01-19,2021-01-19,2021-02-16,PLN1908,1124394415,1124394415,Pediatrics,In-Network,J18.9,Z00.00,,,,,,,0,,99221,E&M,,,,20,Urgent Care,3,375.89,275.3,275.3,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000349,MBR00000012,Professional,2023-04-01,2023-04-01,2023-04-10,PLN3633,1486164553,1486164553,DME Supplier,In-Network,E66.9,R05,,,,,,,0,,87491,Pathology/Lab,,,,22,Outpatient Hospital,3,204.89,157.14,82.14,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000350,MBR00000012,Institutional-OP,2023-07-11,2023-07-11,2023-07-25,PLN2880,1860435061,1860435061,DME Supplier,In-Network,E11.9,E11.9,,,,,,,0,,74177,Radiology,,,0450,22,Outpatient Hospital,2,2653.22,1294.42,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000351,MBR00000012,Institutional-IP,2021-09-07,2021-09-16,2021-09-27,PLN7181,1500037969,1500037969,Pulmonology,In-Network,G43.909,F41.9,,,,470,MS-DRG,5,9,Y,70450,Radiology,,,0740,21,Inpatient Hospital,2,951.44,791.51,442.78,326.79,0.0,21.94,348.73,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000000352,MBR00000012,Professional,2021-08-22,2021-08-22,2021-09-22,PLN9620,1624202402,1624202402,Orthopedic Surgery,In-Network,E78.5,M54.5,,,,,,,0,,G0444,Medicine,,,,22,Outpatient Hospital,1,101.14,47.93,12.93,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000000353,MBR00000012,Professional,2022-07-06,2022-07-06,2022-07-22,PLN1369,1899127912,1899127912,Neurology,In-Network,Z23,B97.89,,,,,,,0,,G0468,Medicine,,,,11,Office,1,451.99,170.28,135.28,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000354,MBR00000012,Institutional-IP,2023-07-16,2023-07-30,2023-08-17,PLN1056,1103747954,1103747954,Urology,In-Network,F32.9,I10,,,,872,MS-DRG,4,14,Y,99203,E&M,,,0320,21,Inpatient Hospital,1,243.86,121.69,121.69,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000355,MBR00000012,Professional,2021-05-05,2021-05-05,2021-06-03,PLN4781,1114982472,1114982472,Orthopedic Surgery,In-Network,I48.91,M54.5,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,2,417.17,306.45,284.07,0.0,0.0,22.38,22.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000356,MBR00000012,Institutional-OP,2022-04-18,2022-04-18,2022-05-15,PLN7051,1717546253,1717546253,Family Medicine,In-Network,Z12.31,K21.0,,,,,,,0,,82043,Pathology/Lab,,,0370,22,Outpatient Hospital,1,69.84,55.86,55.86,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000357,MBR00000012,Institutional-IP,2021-08-25,2021-08-28,2021-09-22,PLN9487,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,Z12.31,Z23,,,,682,MS-DRG,14,3,Y,99203,E&M,,,0200,21,Inpatient Hospital,2,327.48,242.76,0.0,0.0,0.0,2.31,2.31,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000358,MBR00000012,Professional,2023-07-22,2023-07-22,2023-08-07,PLN2120,1193493783,1193493783,Critical Access Hospital,Out-of-Network,R07.9,N39.0,,,,,,,0,,99284,E&M,,,,50,Federally Qualified Health Center,1,557.02,436.64,421.64,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000359,MBR00000012,Institutional-OP,2023-08-24,2023-08-24,2023-09-22,PLN9915,1433937353,1433937353,Nephrology,In-Network,Z12.11,Z00.00,,,,,,,0,,43239,Surgery,,,0740,22,Outpatient Hospital,1,2112.05,1016.63,1016.63,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000360,MBR00000012,Institutional-OP,2021-04-03,2021-04-03,2021-05-17,PLN5036,1334916761,1334916761,ASC,In-Network,N39.0,R05,,,,,,,0,,80053,Pathology/Lab,,,0900,22,Outpatient Hospital,2,135.21,104.42,104.42,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000361,MBR00000012,Professional,2021-06-08,2021-06-08,2021-07-01,PLN6006,1840431511,1840431511,Geriatrics,Out-of-Network,I10,E66.9,,,,,,,0,,45378,Surgery,,,,81,Independent Laboratory,2,1655.63,1255.65,1255.65,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000362,MBR00000012,Professional,2021-06-22,2021-06-22,2021-07-01,PLN4435,1609526529,1609526529,Psychiatry,In-Network,Z12.31,I10,,,,,,,0,,99214,E&M,,,,11,Office,2,281.55,193.13,0.0,193.13,25.0,0.0,218.13,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000363,MBR00000012,Institutional-OP,2023-06-08,2023-06-08,2023-07-09,PLN4612,1964402759,1964402759,Outpatient Clinic,In-Network,I10,E11.65,,,,,,,0,,99221,E&M,,,0761,22,Outpatient Hospital,2,310.07,245.39,139.99,0.0,75.0,30.4,105.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000364,MBR00000012,Professional,2023-09-14,2023-09-14,2023-10-05,PLN2840,1242201429,1242201429,General Acute Care Hospital,In-Network,Z23,Z12.31,,,,,,,0,,71046,Radiology,,,,11,Office,2,306.76,146.44,105.46,15.98,25.0,0.0,40.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000365,MBR00000012,Institutional-OP,2022-02-12,2022-02-12,2022-03-02,PLN1013,1475984649,1475984649,SNF,In-Network,M17.11,R51,,,,,,,0,,45380,Surgery,,,0740,22,Outpatient Hospital,1,2764.0,1505.84,1505.84,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000000366,MBR00000012,Professional,2021-06-22,2021-06-22,2021-07-06,PLN1680,1438368327,1438368327,Home Health,In-Network,I10,I10,,,,,,,0,,76700,Radiology,,,,11,Office,1,545.52,236.96,0.0,236.96,25.0,0.0,261.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000367,MBR00000012,Institutional-OP,2022-12-28,2022-12-28,2023-01-04,PLN8687,1713934949,1713934949,Neurology,In-Network,I10,J06.9,,,,,,,0,,80061,Pathology/Lab,,,0360,22,Outpatient Hospital,1,105.52,64.06,0.0,64.06,75.0,0.0,139.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000368,MBR00000013,Institutional-IP,2023-09-03,2023-09-08,2023-10-08,PLN9169,1168881145,1168881145,Orthopedic Surgery,In-Network,Z87.891,Z51.11,,,,195,MS-DRG,15,5,Y,99284,E&M,,,0450,21,Inpatient Hospital,2,620.68,204.83,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000369,MBR00000013,Professional,2023-09-24,2023-09-24,2023-10-09,PLN6246,1124394415,1124394415,Pediatrics,In-Network,E11.9,E11.9,,,,,,,0,,43239,Surgery,,,,11,Office,2,993.28,313.58,238.58,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000370,MBR00000013,Institutional-OP,2022-05-03,2022-05-03,2022-05-28,PLN7749,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,E11.9,R51,,,,,,,0,,58661,Surgery,,,0730,22,Outpatient Hospital,1,1710.04,593.64,593.64,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000371,MBR00000013,Professional,2023-05-06,2023-05-06,2023-06-12,PLN6706,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,I25.10,K21.0,,,,,,,0,,70553,Radiology,,,,11,Office,2,2934.49,1252.3,1060.58,156.72,35.0,0.0,191.72,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000372,MBR00000013,Professional,2023-11-13,2023-11-13,2023-12-03,PLN9343,1991459367,1991459367,Neurology,Out-of-Network,Z12.31,F41.9,,,,,,,0,,47562,Surgery,,,,11,Office,1,3310.75,1289.23,1138.0,136.23,15.0,0.0,151.23,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000373,MBR00000013,Professional,2023-06-24,2023-06-24,2023-08-06,PLN2897,1244186984,1244186984,Family Medicine,Out-of-Network,J44.1,I10,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,2,1149.81,890.16,426.66,426.33,15.0,22.17,463.5,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000374,MBR00000013,Professional,2022-06-04,2022-06-04,2022-07-15,PLN1026,1575695214,1575695214,SNF,In-Network,Z00.00,K21.0,,,,,,,0,,99221,E&M,,,,11,Office,2,341.06,267.92,252.25,0.0,15.0,0.67,15.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000375,MBR00000013,Professional,2021-10-13,2021-10-13,2021-11-08,PLN4553,1239316214,1239316214,Internal Medicine,In-Network,E11.9,I25.10,,,,,,,0,,99283,E&M,,,,11,Office,2,434.6,264.39,62.39,202.0,0.0,0.0,202.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000376,MBR00000013,Professional,2022-02-12,2022-02-12,2022-03-14,PLN3337,1395983630,1395983630,Nephrology,In-Network,E78.5,E78.5,,,,,,,0,,97110,Medicine,,,,11,Office,1,143.07,68.11,57.23,0.0,0.0,10.88,10.88,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000377,MBR00000013,Professional,2022-02-01,2022-02-01,2022-02-26,PLN5925,1806688928,1806688928,Geriatrics,In-Network,J44.1,E78.5,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,3,27738.91,12248.89,11770.13,478.76,0.0,0.0,478.76,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000000378,MBR00000013,Professional,2023-12-18,2023-12-18,2024-01-02,PLN1581,1108115157,1108115157,General Acute Care Hospital,In-Network,E11.9,I25.10,,,,,,,0,,23472,Surgery,,,,11,Office,1,5183.53,2871.5,2142.08,453.35,75.0,201.07,729.42,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000379,MBR00000013,Professional,2023-03-14,2023-03-14,2023-03-30,PLN8290,1528335731,1528335731,Critical Access Hospital,In-Network,E87.6,E78.5,,,,,,,0,,23472,Surgery,,,,49,Independent Clinic,1,3184.64,2573.25,2431.52,0.0,75.0,66.73,141.73,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000380,MBR00000013,Institutional-OP,2023-07-30,2023-07-30,2023-08-18,PLN2081,1585582070,1585582070,Outpatient Clinic,In-Network,R07.9,M17.11,,,,,,,0,,G0439,Medicine,,,0636,22,Outpatient Hospital,3,305.03,201.94,195.76,0.0,0.0,6.18,6.18,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000000381,MBR00000013,Professional,2023-05-02,2023-05-02,2023-06-11,PLN6626,1124394415,1124394415,Pediatrics,In-Network,F41.9,E78.5,,,,,,,0,,66984,Surgery,,,,11,Office,1,3603.97,2851.94,2801.94,0.0,50.0,0.0,50.0,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000382,MBR00000013,Institutional-OP,2022-06-06,2022-06-06,2022-07-17,PLN7278,1422747896,1422747896,Urology,In-Network,E11.9,E11.40,,,,,,,0,,99232,E&M,,,0120,22,Outpatient Hospital,1,264.04,171.61,121.61,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000383,MBR00000013,Professional,2023-05-16,2023-05-16,2023-06-16,PLN8725,1556140803,1556140803,Cardiology,In-Network,I10,N39.0,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,2,493.48,208.71,1.81,206.9,0.0,0.0,206.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000384,MBR00000013,Professional,2022-12-02,2022-12-02,2022-12-17,PLN1193,1891849440,1891849440,Oncology,In-Network,R10.9,I10,,,,,,,0,,85025,Pathology/Lab,,,,23,Emergency Room,1,97.83,39.86,39.86,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000385,MBR00000013,Professional,2023-03-22,2023-03-22,2023-04-27,PLN8199,1433937353,1433937353,Nephrology,In-Network,I10,I11.9,,,,,,,0,,99406,Medicine,,,,21,Inpatient Hospital,3,58.73,39.43,0.0,39.43,75.0,0.0,114.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000386,MBR00000013,Professional,2021-11-26,2021-11-26,2021-12-29,PLN5868,1609138981,1609138981,Critical Access Hospital,In-Network,Z23,N20.0,,,,,,,0,,90686,Medicine,,,,22,Outpatient Hospital,1,53.3,32.54,0.0,32.54,35.0,0.0,67.54,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000000387,MBR00000013,Professional,2021-09-11,2021-09-11,2021-10-19,PLN5659,1997536841,1997536841,Family Medicine,Out-of-Network,J06.9,J45.20,,,,,,,0,,99203,E&M,,,,11,Office,3,295.7,144.24,97.28,0.0,35.0,11.96,46.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000388,MBR00000013,Institutional-OP,2021-07-17,2021-07-17,2021-08-13,PLN9220,1193493783,1193493783,Critical Access Hospital,Out-of-Network,E11.9,Z23,,,,,,,0,,77067,Radiology,,,0761,22,Outpatient Hospital,1,313.45,140.52,65.52,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000000389,MBR00000013,Professional,2021-11-13,2021-11-13,2021-12-25,PLN7238,1266606767,1266606767,ASC,In-Network,Z00.00,J06.9,,,,,,,0,,45380,Surgery,,,,11,Office,2,1871.98,1479.35,0.0,134.52,0.0,168.26,302.78,0.0,Denied,CO-27,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000000390,MBR00000013,Professional,2023-12-08,2023-12-08,2024-01-13,PLN5441,1556140803,1556140803,Cardiology,In-Network,E11.9,Z00.00,,,,,,,0,,47562,Surgery,,,,50,Federally Qualified Health Center,2,3130.53,1980.57,1980.57,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000391,MBR00000013,Institutional-OP,2023-10-29,2023-10-29,2023-11-07,PLN5335,1817234602,1817234602,Clinical Laboratory,In-Network,J18.9,K57.30,,,,,,,0,,85025,Pathology/Lab,,,0120,22,Outpatient Hospital,3,89.34,74.96,0.0,74.96,35.0,0.0,109.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000392,MBR00000013,Professional,2021-06-10,2021-06-10,2021-07-06,PLN7525,1799205295,1799205295,General Acute Care Hospital,In-Network,E11.9,Z87.891,,,,,,,0,,G0444,Medicine,,,,22,Outpatient Hospital,3,41.61,23.94,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000000393,MBR00000013,Institutional-OP,2022-08-30,2022-08-30,2022-09-27,PLN6457,1242201429,1242201429,General Acute Care Hospital,In-Network,C50.912,Z23,,,,,,,0,,99213,E&M,,,0120,22,Outpatient Hospital,1,305.21,179.83,144.83,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000394,MBR00000013,Institutional-IP,2023-10-27,2023-10-29,2023-11-15,PLN4779,1687650653,1687650653,Internal Medicine,In-Network,E78.5,I10,,,,196,MS-DRG,16,2,Y,99233,E&M,,,0200,21,Inpatient Hospital,2,358.71,238.55,56.62,173.13,0.0,8.8,181.93,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000395,MBR00000013,Professional,2023-04-07,2023-04-07,2023-05-06,PLN2152,1433937353,1433937353,Nephrology,In-Network,Z12.31,K57.30,,,,,,,0,,99233,E&M,,,,11,Office,1,377.06,269.68,219.13,0.0,0.0,50.55,50.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000396,MBR00000013,Professional,2022-11-02,2022-11-02,2022-12-08,PLN8980,1514306773,1514306773,Endocrinology,In-Network,E66.9,J06.9,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,3,35.12,28.78,0.0,28.78,0.0,0.0,28.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000397,MBR00000013,Professional,2022-10-19,2022-10-19,2022-11-20,PLN7435,1268679390,1268679390,Critical Access Hospital,In-Network,J44.1,J20.9,,,,,,,0,,G0439,Medicine,,,,23,Emergency Room,1,528.08,160.57,0.0,142.46,25.0,0.0,167.46,0.0,Paid,,,0,,1,1,0,0,0,0,None,0,0,0,1,0
CLM0000000398,MBR00000013,Institutional-IP,2021-12-24,2022-01-03,2022-02-02,PLN7427,1800011727,1800011727,Clinical Laboratory,Out-of-Network,N18.3,I10,,,,603,MS-DRG,10,10,Y,72148,Radiology,,,0301,21,Inpatient Hospital,1,2394.31,991.65,966.65,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000399,MBR00000013,Institutional-OP,2023-10-10,2023-10-10,2023-10-21,PLN9618,1946680931,1946680931,Critical Access Hospital,Out-of-Network,I10,I10,,,,,,,0,,99283,E&M,,,0120,22,Outpatient Hospital,3,503.43,256.17,0.0,256.17,0.0,0.0,256.17,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000400,MBR00000013,Professional,2021-04-01,2021-04-01,2021-04-15,PLN6426,1795618275,1795618275,Pulmonology,In-Network,N18.3,M54.5,,,,,,,0,,93306,Radiology,,,,22,Outpatient Hospital,3,1522.47,963.18,963.18,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000401,MBR00000013,Institutional-OP,2023-08-10,2023-08-10,2023-09-22,PLN1413,1268679390,1268679390,Critical Access Hospital,In-Network,M81.0,E11.9,,,,,,,0,,43239,Surgery,,,0761,22,Outpatient Hospital,1,1436.22,443.62,277.65,115.97,50.0,0.0,165.97,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000402,MBR00000014,Professional,2023-08-12,2023-08-12,2023-08-23,PLN1762,1366286000,1366286000,SNF,In-Network,J45.20,E11.9,,,,,,,0,,87491,Pathology/Lab,,,,22,Outpatient Hospital,1,232.44,180.33,12.49,152.84,15.0,0.0,167.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000403,MBR00000014,Professional,2021-10-14,2021-10-14,2021-11-10,PLN9256,1563980627,1563980627,Critical Access Hospital,In-Network,M17.11,E78.5,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,2,26.65,17.83,16.38,0.0,0.0,1.45,1.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000404,MBR00000014,Professional,2022-07-15,2022-07-15,2022-07-26,PLN3358,1433937353,1433937353,Nephrology,In-Network,E78.5,E11.9,,,,,,,0,,99214,E&M,,,,20,Urgent Care,1,397.42,262.49,0.0,262.49,50.0,0.0,312.49,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000405,MBR00000014,Institutional-OP,2023-08-27,2023-08-27,2023-09-15,PLN6014,1245650222,1245650222,Gastroenterology,In-Network,E66.9,B97.89,,,,,,,0,,23472,Surgery,,,0730,22,Outpatient Hospital,3,6441.87,4587.37,4217.81,369.56,0.0,0.0,369.56,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000406,MBR00000014,Professional,2022-06-04,2022-06-04,2022-06-19,PLN2731,1450094833,1450094833,Outpatient Clinic,In-Network,Z00.00,I25.10,,,,,,,0,,99203,E&M,,,,21,Inpatient Hospital,3,385.76,188.48,153.1,0.0,0.0,35.38,35.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000407,MBR00000014,Institutional-OP,2021-11-25,2021-11-25,2021-12-10,PLN4990,1948810580,1948810580,DME Supplier,In-Network,E78.5,Z00.00,,,,,,,0,,47562,Surgery,,,0761,22,Outpatient Hospital,1,4770.35,3317.65,2453.2,431.23,0.0,433.22,864.45,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000408,MBR00000014,Professional,2021-03-18,2021-03-18,2021-03-25,PLN9892,1860435061,1860435061,DME Supplier,In-Network,I50.9,E11.9,,,,,,,0,,99213,E&M,,,,12,Home,3,184.42,79.91,0.0,79.91,25.0,0.0,104.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000409,MBR00000014,Institutional-OP,2022-04-28,2022-04-28,2022-05-24,PLN3965,1575695214,1575695214,SNF,In-Network,M54.5,E78.5,,,,,,,0,,70450,Radiology,,,0636,22,Outpatient Hospital,2,702.49,301.07,301.07,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000410,MBR00000014,Institutional-OP,2021-11-01,2021-11-01,2021-12-14,PLN2837,1372918899,1372918899,Family Medicine,In-Network,Z12.31,E78.5,,,,,,,0,,27447,Surgery,,,0360,22,Outpatient Hospital,3,5719.86,4431.04,4381.04,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000411,MBR00000014,Institutional-IP,2023-07-22,2023-07-27,2023-08-09,PLN7498,1124394415,1124394415,Pediatrics,In-Network,I10,G43.909,,,,470,MS-DRG,13,5,Y,71046,Radiology,,,0370,21,Inpatient Hospital,1,233.29,95.63,0.0,95.63,0.0,0.0,95.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000412,MBR00000014,Institutional-IP,2023-08-02,2023-08-03,2023-09-10,PLN4830,1486164553,1486164553,DME Supplier,In-Network,I10,I48.91,,,,291,MS-DRG,22,1,Y,86900,Pathology/Lab,,,0636,21,Inpatient Hospital,2,34.43,26.43,21.5,0.0,0.0,4.93,4.93,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000000413,MBR00000014,Professional,2021-12-21,2021-12-21,2021-12-30,PLN3738,1840431511,1840431511,Geriatrics,Out-of-Network,E66.9,J20.9,,,,,,,0,,23472,Surgery,,,,23,Emergency Room,3,6944.37,3957.66,3957.66,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000414,MBR00000014,Institutional-OP,2021-08-19,2021-08-19,2021-09-18,PLN6841,1295371663,1295371663,Critical Access Hospital,In-Network,E11.65,J06.9,,,,,,,0,,85025,Pathology/Lab,,,0200,22,Outpatient Hospital,2,79.04,27.01,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000415,MBR00000014,Institutional-IP,2021-11-15,2021-11-29,2021-12-25,PLN3521,1817234602,1817234602,Clinical Laboratory,In-Network,C50.912,I10,,,,196,MS-DRG,23,14,Y,97530,Medicine,,,0740,21,Inpatient Hospital,2,126.44,48.13,48.13,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000416,MBR00000014,Professional,2022-03-17,2022-03-17,2022-04-26,PLN5206,1372918899,1372918899,Family Medicine,In-Network,R05,Z00.00,,,,,,,0,,99232,E&M,,,,11,Office,3,309.18,143.27,136.42,6.85,0.0,0.0,6.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000417,MBR00000014,Institutional-OP,2023-01-03,2023-01-03,2023-01-27,PLN8354,1540044947,1540044947,Pulmonology,Out-of-Network,Z23,Z12.31,,,,,,,0,,99204,E&M,,,0636,22,Outpatient Hospital,1,532.07,344.35,25.96,283.39,35.0,0.0,318.39,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000418,MBR00000014,Institutional-IP,2021-06-16,2021-06-18,2021-07-19,PLN6337,1575695214,1575695214,SNF,In-Network,J18.9,E78.5,,,,683,MS-DRG,7,2,Y,99213,E&M,,,0301,21,Inpatient Hospital,1,169.67,100.49,75.49,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000419,MBR00000014,Institutional-IP,2023-12-31,2024-01-01,2024-01-20,PLN4433,1713934949,1713934949,Neurology,In-Network,M54.5,Z00.00,,,,470,MS-DRG,3,1,Y,81001,Pathology/Lab,,,0636,21,Inpatient Hospital,2,30.65,25.9,0.0,25.9,75.0,0.0,100.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000420,MBR00000014,Institutional-IP,2023-02-06,2023-02-10,2023-02-25,PLN3424,1687650653,1687650653,Internal Medicine,In-Network,Z79.4,J06.9,,,,470,MS-DRG,13,4,Y,76700,Radiology,,,0900,21,Inpatient Hospital,2,1421.05,1199.27,845.86,353.41,0.0,0.0,353.41,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000000421,MBR00000014,Professional,2021-05-24,2021-05-24,2021-06-12,PLN6863,1609138981,1609138981,Critical Access Hospital,In-Network,G43.909,Z00.00,,,,,,,0,,93306,Radiology,,,,11,Office,3,2696.8,1259.76,1091.92,92.84,75.0,0.0,167.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000422,MBR00000014,Professional,2021-12-11,2021-12-11,2022-01-11,PLN5219,1609138981,1609138981,Critical Access Hospital,In-Network,N20.0,G20,,,,,,,0,,70450,Radiology,,,,23,Emergency Room,1,1684.64,857.37,782.37,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000423,MBR00000014,Professional,2023-02-07,2023-02-07,2023-03-05,PLN4393,1125190055,1125190055,Nephrology,In-Network,N40.0,E11.9,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,2,1520.26,469.24,444.24,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000424,MBR00000014,Institutional-OP,2022-07-06,2022-07-06,2022-08-05,PLN6011,1946680931,1946680931,Critical Access Hospital,Out-of-Network,Z00.00,K21.0,,,,,,,0,,99221,E&M,,,0370,22,Outpatient Hospital,3,430.93,258.41,258.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000425,MBR00000014,Institutional-IP,2022-08-01,2022-08-07,2022-08-29,PLN3540,1691062876,1691062876,SNF,In-Network,G43.909,K57.30,,,,195,MS-DRG,19,6,Y,99203,E&M,,,0636,21,Inpatient Hospital,3,294.38,112.89,0.0,112.89,0.0,0.0,112.89,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000426,MBR00000014,Institutional-OP,2021-02-15,2021-02-15,2021-03-19,PLN5350,1148984206,1148984206,Psychiatry,In-Network,Z12.31,K57.30,,,,,,,0,,G0439,Medicine,,,0320,22,Outpatient Hospital,3,459.62,239.44,239.44,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,1,Duplicate,0,0,0,1,0
CLM0000000427,MBR00000014,Professional,2022-03-26,2022-03-26,2022-04-24,PLN3285,1284035364,1284035364,Pediatrics,In-Network,N39.0,E66.9,,,,,,,0,,99222,E&M,,,,11,Office,3,342.42,156.67,0.0,156.67,35.0,0.0,191.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000428,MBR00000014,Institutional-OP,2022-11-04,2022-11-04,2022-11-24,PLN2524,1809014947,1809014947,Urology,In-Network,I10,J44.1,,,,,,,0,,43239,Surgery,,,0761,22,Outpatient Hospital,2,816.9,514.2,377.56,136.64,0.0,0.0,136.64,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000429,MBR00000014,Professional,2023-04-02,2023-04-02,2023-05-15,PLN7353,1980712759,1980712759,Outpatient Clinic,Out-of-Network,F41.9,E11.9,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,2,43.41,18.78,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000430,MBR00000014,Professional,2022-05-05,2022-05-05,2022-06-12,PLN6966,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,Z79.4,E78.5,,,,,,,0,,85610,Pathology/Lab,,,,12,Home,1,76.0,41.04,41.04,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000431,MBR00000014,Institutional-OP,2022-08-31,2022-08-31,2022-09-22,PLN5325,1717912431,1717912431,Oncology,In-Network,Z23,E78.5,,,,,,,0,,43239,Surgery,,,0450,22,Outpatient Hospital,1,1366.54,774.6,724.6,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000432,MBR00000014,Institutional-IP,2021-09-01,2021-09-11,2021-09-13,PLN1627,1148984206,1148984206,Psychiatry,In-Network,I10,I25.10,,,,682,MS-DRG,4,10,Y,27130,Surgery,,,0360,21,Inpatient Hospital,2,7057.04,3902.47,3902.47,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000433,MBR00000014,Institutional-OP,2023-05-24,2023-05-24,2023-06-04,PLN9020,1687650653,1687650653,Internal Medicine,In-Network,Z23,M54.5,,,,,,,0,,90686,Medicine,,,0270,22,Outpatient Hospital,1,56.8,31.19,31.19,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000000434,MBR00000014,Institutional-IP,2023-02-04,2023-02-07,2023-03-08,PLN3156,1366576336,1366576336,Geriatrics,In-Network,I10,Z12.31,,,,194,MS-DRG,21,3,Y,27130,Surgery,,,0360,21,Inpatient Hospital,3,3606.23,1783.52,1783.52,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000000435,MBR00000015,Professional,2023-03-26,2023-03-26,2023-05-02,PLN8918,1910255109,1910255109,DME Supplier,In-Network,I10,Z00.00,,,,,,,0,,97110,Medicine,,,,23,Emergency Room,2,157.46,75.8,0.0,75.8,0.0,0.0,75.8,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000436,MBR00000015,Professional,2023-01-02,2023-01-02,2023-01-28,PLN7294,1997536841,1997536841,Family Medicine,Out-of-Network,G43.909,E78.5,,,,,,,0,,99406,Medicine,,,,22,Outpatient Hospital,2,61.53,28.72,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000437,MBR00000015,Institutional-OP,2023-12-15,2023-12-15,2024-01-01,PLN2517,1486164553,1486164553,DME Supplier,In-Network,Z87.891,I63.9,,,,,,,0,,99221,E&M,,,0120,22,Outpatient Hospital,3,322.29,203.32,126.9,0.0,75.0,1.42,76.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000438,MBR00000015,Professional,2023-08-22,2023-08-22,2023-09-14,PLN4203,1980712759,1980712759,Outpatient Clinic,Out-of-Network,N39.0,Z87.891,,,,,,,0,,71046,Radiology,,,,23,Emergency Room,1,297.16,162.76,0.0,0.0,0.0,0.0,0.0,0.0,Denied,PR-1,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000439,MBR00000015,Institutional-OP,2023-06-07,2023-06-07,2023-07-20,PLN8822,1856686341,1856686341,Geriatrics,In-Network,E11.9,Z23,,,,,,,0,,97530,Medicine,,,0636,22,Outpatient Hospital,1,226.2,138.6,119.44,0.0,0.0,19.16,19.16,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000440,MBR00000015,Professional,2022-01-03,2022-01-03,2022-02-03,PLN6299,1795618275,1795618275,Pulmonology,In-Network,N39.0,R10.9,,,,,,,0,,45378,Surgery,,,,21,Inpatient Hospital,1,1115.51,842.24,842.24,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000441,MBR00000015,Professional,2021-03-15,2021-03-15,2021-04-24,PLN1026,1609526529,1609526529,Psychiatry,In-Network,B97.89,K21.0,,,,,,,0,,58661,Surgery,,,,49,Independent Clinic,2,1792.03,891.19,891.19,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000442,MBR00000015,Institutional-OP,2021-01-01,2021-01-01,2021-01-19,PLN3311,1213165847,1213165847,Critical Access Hospital,In-Network,M54.5,E66.9,,,,,,,0,,33533,Surgery,,,0360,22,Outpatient Hospital,2,23775.99,7933.86,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-18,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000000443,MBR00000015,Institutional-OP,2023-05-04,2023-05-04,2023-05-14,PLN8920,1994661817,1994661817,SNF,Out-of-Network,E78.5,E66.9,,,,,,,0,,81001,Pathology/Lab,,,0270,22,Outpatient Hospital,1,51.22,35.97,35.97,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000444,MBR00000015,Professional,2023-09-12,2023-09-12,2023-09-19,PLN5540,1575695214,1575695214,SNF,In-Network,F41.9,N18.3,,,,,,,0,,71046,Radiology,,,,22,Outpatient Hospital,2,115.07,57.11,0.0,57.11,0.0,0.0,57.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000445,MBR00000015,Professional,2022-12-13,2022-12-13,2023-01-11,PLN6506,1752470395,1752470395,Home Health,In-Network,I10,R10.9,,,,,,,0,,33533,Surgery,,,,20,Urgent Care,3,11895.71,6332.8,6066.16,266.64,0.0,0.0,266.64,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000000446,MBR00000015,Professional,2023-03-01,2023-03-01,2023-03-17,PLN1249,1366576336,1366576336,Geriatrics,In-Network,E11.9,E78.5,,,,,,,0,,93306,Radiology,,,,11,Office,3,3069.0,994.95,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000447,MBR00000015,Professional,2021-04-09,2021-04-09,2021-05-08,PLN1693,1727809972,1727809972,Home Health,In-Network,G43.909,Z79.4,,,,,,,0,,70450,Radiology,,,,23,Emergency Room,3,1328.17,424.01,192.53,231.48,0.0,0.0,231.48,0.0,Paid,,,0,,1,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000000448,MBR00000015,Institutional-OP,2022-09-12,2022-09-12,2022-10-02,PLN3654,1109850785,1109850785,ASC,Out-of-Network,I10,E11.9,,,,,,,0,,99203,E&M,,,0360,22,Outpatient Hospital,1,260.78,109.09,109.09,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000449,MBR00000015,Professional,2022-10-26,2022-10-26,2022-11-16,PLN5264,1227362142,1227362142,DME Supplier,In-Network,N18.3,R10.9,,,,,,,0,,99214,E&M,,,,81,Independent Laboratory,2,190.4,90.95,90.95,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000450,MBR00000015,Professional,2021-06-21,2021-06-21,2021-07-17,PLN7477,1845057593,1845057593,Orthopedic Surgery,In-Network,M54.5,I50.9,,,,,,,0,,99232,E&M,,,,11,Office,1,212.28,146.59,146.59,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000451,MBR00000015,Institutional-OP,2023-04-03,2023-04-03,2023-05-03,PLN8427,1624802371,1624802371,ASC,Out-of-Network,Z23,E11.9,,,,,,,0,,45380,Surgery,,,0636,22,Outpatient Hospital,1,2541.14,887.06,872.06,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000000452,MBR00000015,Institutional-OP,2022-01-03,2022-01-03,2022-02-05,PLN8455,1502838586,1502838586,ASC,In-Network,N39.0,I25.10,,,,,,,0,,93000,Radiology,,,0270,22,Outpatient Hospital,2,138.12,69.71,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000453,MBR00000015,Professional,2021-08-04,2021-08-04,2021-08-19,PLN4666,1266606767,1266606767,ASC,In-Network,E11.9,Z00.00,,,,,,,0,,90686,Medicine,,,,20,Urgent Care,2,102.87,65.4,0.0,65.4,0.0,0.0,65.4,0.0,Paid,,,0,,0,1,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000000454,MBR00000015,Institutional-OP,2023-02-02,2023-02-02,2023-02-27,PLN9504,1891849440,1891849440,Oncology,In-Network,Z23,N39.0,,,,,,,0,,80061,Pathology/Lab,,,0730,22,Outpatient Hospital,3,115.14,88.45,78.05,0.0,0.0,10.4,10.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000455,MBR00000015,Professional,2022-04-22,2022-04-22,2022-05-07,PLN4567,1856686341,1856686341,Geriatrics,In-Network,F32.9,N40.0,,,,,,,0,,23472,Surgery,,,,23,Emergency Room,2,6330.82,3139.67,0.0,4.55,25.0,0.0,29.55,0.0,Denied,CO-11,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000456,MBR00000015,Professional,2022-08-10,2022-08-10,2022-09-15,PLN1032,1390307371,1390307371,DME Supplier,In-Network,K21.0,M54.5,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,2,1947.59,817.97,753.74,0.0,0.0,64.23,64.23,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000457,MBR00000015,Institutional-OP,2022-08-18,2022-08-18,2022-09-21,PLN4020,1622771872,1622771872,Pediatrics,In-Network,E66.9,I50.9,,,,,,,0,,45378,Surgery,,,0200,22,Outpatient Hospital,3,2493.23,2116.53,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-18,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000458,MBR00000016,Professional,2022-11-13,2022-11-13,2022-11-29,PLN1522,1132188260,1132188260,Family Medicine,In-Network,E66.9,I50.9,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,1,478.14,337.87,37.44,300.43,0.0,0.0,300.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000459,MBR00000016,Institutional-OP,2022-03-29,2022-03-29,2022-04-27,PLN2399,1132188260,1132188260,Family Medicine,In-Network,F32.9,R10.9,,,,,,,0,,99222,E&M,,,0320,22,Outpatient Hospital,3,284.36,141.88,0.0,141.88,25.0,0.0,166.88,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000460,MBR00000016,Institutional-IP,2023-06-12,2023-06-17,2023-06-26,PLN1925,1500949740,1500949740,Pediatrics,In-Network,Z12.31,Z12.11,,,,872,MS-DRG,12,5,Y,86900,Pathology/Lab,,,0730,21,Inpatient Hospital,3,42.78,25.82,0.0,25.82,0.0,0.0,25.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000461,MBR00000016,Institutional-OP,2023-08-18,2023-08-18,2023-09-07,PLN5902,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,I10,E11.9,,,,,,,0,,99203,E&M,,,0301,22,Outpatient Hospital,1,250.05,187.35,187.35,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000462,MBR00000016,Professional,2022-06-14,2022-06-14,2022-07-07,PLN8271,1563980627,1563980627,Critical Access Hospital,In-Network,Z00.00,J06.9,,,,,,,0,,99284,E&M,,,,11,Office,3,808.91,392.69,392.69,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000463,MBR00000016,Professional,2021-07-04,2021-07-04,2021-07-24,PLN6668,1168246159,1168246159,Internal Medicine,In-Network,I10,E11.9,,,,,,,0,,99214,E&M,,,,23,Emergency Room,2,450.68,203.39,153.39,0.0,50.0,0.0,50.0,0.0,Pended,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000464,MBR00000016,Institutional-OP,2021-11-02,2021-11-02,2021-12-11,PLN7270,1224179551,1224179551,Physical Therapy,In-Network,Z00.00,M54.5,,,,,,,0,,23472,Surgery,,,0761,22,Outpatient Hospital,1,3729.71,1166.75,1166.75,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000465,MBR00000016,Institutional-OP,2023-04-25,2023-04-25,2023-06-02,PLN7302,1845057593,1845057593,Orthopedic Surgery,In-Network,Z87.891,Z00.00,,,,,,,0,,99284,E&M,,,0301,22,Outpatient Hospital,2,758.94,345.31,320.31,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000466,MBR00000016,Institutional-OP,2021-10-09,2021-10-09,2021-11-14,PLN4874,1205377316,1205377316,Orthopedic Surgery,In-Network,N39.0,F41.9,,,,,,,0,,23472,Surgery,,,0900,22,Outpatient Hospital,1,5366.12,4116.18,3770.53,345.65,0.0,0.0,345.65,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000467,MBR00000016,Professional,2023-05-03,2023-05-03,2023-06-15,PLN2719,1124394415,1124394415,Pediatrics,In-Network,Z00.00,N17.9,,,,,,,0,,81001,Pathology/Lab,,,,22,Outpatient Hospital,3,58.95,46.77,26.56,0.0,15.0,5.21,20.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000468,MBR00000016,Institutional-IP,2022-12-27,2023-01-06,2023-01-28,PLN3299,1997536841,1997536841,Family Medicine,Out-of-Network,N18.3,E11.65,,,,683,MS-DRG,22,10,Y,66984,Surgery,,,0636,21,Inpatient Hospital,2,1440.73,667.5,534.79,0.0,0.0,132.71,132.71,0.0,Paid,,,0,,0,0,1,0,0,1,Phantom,0,0,0,0,0
CLM0000000469,MBR00000016,Professional,2022-05-06,2022-05-06,2022-06-02,PLN5615,1896447406,1896447406,Nephrology,Out-of-Network,E66.9,J20.9,,,,,,,0,,71046,Radiology,,,,23,Emergency Room,3,268.85,225.06,145.65,79.41,0.0,0.0,79.41,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000470,MBR00000016,Professional,2021-05-19,2021-05-19,2021-06-09,PLN1439,1109850785,1109850785,ASC,Out-of-Network,Z00.00,E11.9,,,,,,,0,,99406,Medicine,,,,23,Emergency Room,3,102.85,87.08,0.0,87.08,0.0,0.0,87.08,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000471,MBR00000016,Professional,2022-08-14,2022-08-14,2022-09-17,PLN7808,1845057593,1845057593,Orthopedic Surgery,In-Network,I10,E11.9,,,,,,,0,,80053,Pathology/Lab,,,,31,Skilled Nursing Facility,1,113.65,53.54,0.0,53.54,75.0,0.0,128.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000472,MBR00000016,Institutional-OP,2023-01-29,2023-01-29,2023-02-11,PLN2306,1372918899,1372918899,Family Medicine,In-Network,F41.9,Z12.31,,,,,,,0,,76700,Radiology,,,0900,22,Outpatient Hospital,3,799.97,250.15,240.91,0.0,0.0,9.24,9.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000473,MBR00000016,Professional,2021-06-18,2021-06-18,2021-07-15,PLN2117,1542828721,1542828721,Orthopedic Surgery,In-Network,Z00.00,Z12.31,,,,,,,0,,97110,Medicine,,,,22,Outpatient Hospital,3,231.15,162.68,162.68,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000000474,MBR00000016,Professional,2023-06-23,2023-06-23,2023-07-30,PLN6635,1355166277,1355166277,Endocrinology,In-Network,Z00.00,C50.912,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,3,169.2,57.33,57.33,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000475,MBR00000017,Institutional-OP,2021-08-02,2021-08-02,2021-08-30,PLN6960,1891849440,1891849440,Oncology,In-Network,I25.10,R10.9,,,,,,,0,,G0468,Medicine,,,0450,22,Outpatient Hospital,2,531.71,174.42,0.0,174.42,35.0,0.0,209.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000476,MBR00000017,Institutional-OP,2022-03-28,2022-03-28,2022-04-13,PLN8609,1236418230,1236418230,DME Supplier,In-Network,J20.9,K92.1,,,,,,,0,,99204,E&M,,,0900,22,Outpatient Hospital,1,356.45,230.99,0.0,230.99,0.0,0.0,230.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000477,MBR00000017,Professional,2022-08-06,2022-08-06,2022-08-13,PLN7194,1645194539,1645194539,SNF,In-Network,F10.20,R10.9,,,,,,,0,,99233,E&M,,,,21,Inpatient Hospital,3,241.54,191.12,141.12,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000478,MBR00000017,Institutional-OP,2023-03-21,2023-03-21,2023-04-08,PLN7038,1366426662,1366426662,Urology,In-Network,Z12.31,Z12.31,,,,,,,0,,47562,Surgery,,,0301,22,Outpatient Hospital,1,6260.08,2028.77,1642.06,386.71,0.0,0.0,386.71,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000479,MBR00000017,Institutional-OP,2021-09-04,2021-09-04,2021-09-26,PLN2191,1334916761,1334916761,ASC,In-Network,Z96.641,J06.9,,,,,,,0,,G0439,Medicine,,,0740,22,Outpatient Hospital,2,424.64,296.19,296.19,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000000480,MBR00000017,Professional,2022-01-03,2022-01-03,2022-02-13,PLN8348,1422747896,1422747896,Urology,In-Network,Z00.00,E11.9,,,,,,,0,,45380,Surgery,,,,31,Skilled Nursing Facility,2,2868.57,2037.39,2037.39,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000000481,MBR00000017,Institutional-OP,2023-06-03,2023-06-03,2023-06-19,PLN4822,1486164553,1486164553,DME Supplier,In-Network,Z23,Z12.31,,,,,,,0,,99232,E&M,,,0730,22,Outpatient Hospital,3,206.25,87.89,0.0,87.89,0.0,0.0,87.89,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000482,MBR00000017,Institutional-OP,2021-12-27,2021-12-27,2022-01-20,PLN8958,1556140803,1556140803,Cardiology,In-Network,Z00.00,E11.9,,,,,,,0,,99213,E&M,,,0510,22,Outpatient Hospital,3,182.39,72.87,37.87,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000483,MBR00000017,Institutional-OP,2022-11-06,2022-11-06,2022-11-26,PLN6904,1186826716,1186826716,Physical Therapy,In-Network,E11.9,J44.1,,,,,,,0,,45378,Surgery,,,0320,22,Outpatient Hospital,2,2599.29,2179.57,2164.57,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000484,MBR00000017,Professional,2022-03-12,2022-03-12,2022-04-10,PLN7676,1450553056,1450553056,Clinical Laboratory,In-Network,E66.9,F41.9,,,,,,,0,,90837,Medicine,,,,21,Inpatient Hospital,3,370.72,149.18,74.18,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000485,MBR00000017,Institutional-IP,2021-03-03,2021-03-07,2021-04-05,PLN3825,1749327647,1749327647,Geriatrics,In-Network,I10,R05,,,,291,MS-DRG,17,4,Y,93000,Radiology,,,0120,21,Inpatient Hospital,1,113.55,53.38,28.38,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000486,MBR00000017,Institutional-OP,2022-07-18,2022-07-18,2022-08-05,PLN4756,1609526529,1609526529,Psychiatry,In-Network,E11.9,I10,,,,,,,0,,58661,Surgery,,,0120,22,Outpatient Hospital,1,4095.5,1741.71,1202.07,489.64,50.0,0.0,539.64,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000487,MBR00000017,Institutional-IP,2022-01-27,2022-01-30,2022-02-03,PLN5711,1366286000,1366286000,SNF,In-Network,N18.3,M17.11,,,,194,MS-DRG,4,3,Y,99284,E&M,,,0450,21,Inpatient Hospital,1,352.62,160.14,124.28,0.0,25.0,10.86,35.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000488,MBR00000017,Professional,2021-10-18,2021-10-18,2021-11-17,PLN5298,1687650653,1687650653,Internal Medicine,In-Network,Z00.00,I25.10,,,,,,,0,,G0444,Medicine,,,,50,Federally Qualified Health Center,1,89.03,49.97,0.0,49.97,0.0,0.0,49.97,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000000489,MBR00000017,Professional,2023-07-29,2023-07-29,2023-08-24,PLN8909,1268679390,1268679390,Critical Access Hospital,In-Network,I25.10,I50.9,,,,,,,0,,99232,E&M,,,,11,Office,3,177.92,81.27,0.0,81.27,0.0,0.0,81.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000490,MBR00000017,Institutional-OP,2023-04-28,2023-04-28,2023-05-05,PLN3822,1135158374,1135158374,Pulmonology,In-Network,K57.30,F41.9,,,,,,,0,,99233,E&M,,,0636,22,Outpatient Hospital,2,205.44,86.11,11.11,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000491,MBR00000017,Professional,2021-10-31,2021-10-31,2021-11-14,PLN8920,1395983630,1395983630,Nephrology,In-Network,Z12.31,Z00.00,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,3,644.9,504.0,308.03,195.97,0.0,0.0,195.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000492,MBR00000017,Institutional-OP,2022-07-28,2022-07-28,2022-09-07,PLN1232,1872613201,1872613201,Internal Medicine,In-Network,Z00.00,M54.5,,,,,,,0,,47562,Surgery,,,0730,22,Outpatient Hospital,3,3160.75,1637.42,1335.39,0.0,15.0,287.03,302.03,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000493,MBR00000017,Professional,2023-02-28,2023-02-28,2023-03-27,PLN1398,1563980627,1563980627,Critical Access Hospital,In-Network,E78.5,E11.9,,,,,,,0,,99406,Medicine,,,,50,Federally Qualified Health Center,1,97.99,51.29,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000494,MBR00000017,Institutional-OP,2021-02-28,2021-02-28,2021-03-15,PLN6564,1980712759,1980712759,Outpatient Clinic,Out-of-Network,K92.1,Z23,,,,,,,0,,84443,Pathology/Lab,,,0360,22,Outpatient Hospital,1,122.62,58.11,0.0,58.11,25.0,0.0,83.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000495,MBR00000017,Professional,2021-04-13,2021-04-13,2021-04-22,PLN3871,1563980627,1563980627,Critical Access Hospital,In-Network,R10.9,E11.9,,,,,,,0,,27447,Surgery,,,,21,Inpatient Hospital,1,2840.34,893.73,751.82,0.0,0.0,141.91,141.91,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000496,MBR00000017,Institutional-OP,2022-08-15,2022-08-15,2022-09-13,PLN6071,1809014947,1809014947,Urology,In-Network,M81.0,J44.1,,,,,,,0,,93000,Radiology,,,0761,22,Outpatient Hospital,1,131.93,69.43,0.0,69.43,0.0,0.0,69.43,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000497,MBR00000017,Institutional-OP,2023-10-16,2023-10-16,2023-11-17,PLN2876,1800011727,1800011727,Clinical Laboratory,Out-of-Network,K21.0,R51,,,,,,,0,,82043,Pathology/Lab,,,0360,22,Outpatient Hospital,1,36.21,22.86,0.0,22.86,75.0,0.0,97.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000498,MBR00000017,Professional,2023-10-13,2023-10-13,2023-11-21,PLN8538,1186826716,1186826716,Physical Therapy,In-Network,E78.5,I10,,,,,,,0,,99213,E&M,,,,11,Office,2,130.43,51.34,16.34,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000499,MBR00000017,Professional,2022-05-08,2022-05-08,2022-06-21,PLN4806,1366426662,1366426662,Urology,In-Network,Z79.4,M54.5,,,,,,,0,,66984,Surgery,,,,23,Emergency Room,2,1999.66,1686.73,0.0,228.91,0.0,0.0,228.91,0.0,Denied,CO-50,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000500,MBR00000017,Institutional-OP,2023-02-10,2023-02-10,2023-02-24,PLN5199,1809014947,1809014947,Urology,In-Network,N40.0,Z23,,,,,,,0,,99232,E&M,,,0320,22,Outpatient Hospital,2,266.13,223.56,127.39,0.0,75.0,21.17,96.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000501,MBR00000017,Institutional-OP,2022-06-23,2022-06-23,2022-07-06,PLN6908,1295371663,1295371663,Critical Access Hospital,In-Network,I10,I10,,,,,,,0,,87491,Pathology/Lab,,,0740,22,Outpatient Hospital,2,204.8,148.53,148.53,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000502,MBR00000017,Institutional-IP,2023-09-18,2023-09-23,2023-10-15,PLN9252,1528335731,1528335731,Critical Access Hospital,In-Network,Z87.891,E78.5,,,,683,MS-DRG,14,5,Y,97110,Medicine,,,0450,21,Inpatient Hospital,3,168.57,108.8,73.8,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000503,MBR00000017,Professional,2022-09-16,2022-09-16,2022-10-20,PLN8781,1997536841,1997536841,Family Medicine,Out-of-Network,Z79.4,M81.0,,,,,,,0,,97530,Medicine,,,,49,Independent Clinic,3,168.7,66.59,0.0,66.59,0.0,0.0,66.59,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000504,MBR00000017,Institutional-OP,2023-09-03,2023-09-03,2023-10-08,PLN9244,1891849440,1891849440,Oncology,In-Network,R05,Z23,,,,,,,0,,71046,Radiology,,,0120,22,Outpatient Hospital,1,210.99,124.76,0.0,124.76,0.0,0.0,124.76,0.0,Denied,CO-4,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000505,MBR00000017,Institutional-OP,2022-02-02,2022-02-02,2022-02-13,PLN9570,1500949740,1500949740,Pediatrics,In-Network,I50.9,E11.9,,,,,,,0,,27130,Surgery,,,0761,22,Outpatient Hospital,2,4679.99,2659.25,2659.25,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000506,MBR00000018,Professional,2023-10-17,2023-10-17,2023-11-30,PLN7097,1749327647,1749327647,Geriatrics,In-Network,I50.9,R51,,,,,,,0,,27447,Surgery,,,,31,Skilled Nursing Facility,1,5585.47,2287.92,2287.92,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000507,MBR00000018,Professional,2023-03-06,2023-03-06,2023-04-01,PLN3118,1624802371,1624802371,ASC,Out-of-Network,R05,K21.0,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,1,129.63,93.52,0.0,93.52,25.0,0.0,118.52,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000508,MBR00000018,Professional,2023-04-21,2023-04-21,2023-05-23,PLN5321,1749494482,1749494482,Pediatrics,In-Network,I10,Z23,,,,,,,0,,70553,Radiology,,,,11,Office,3,1897.49,803.35,0.0,0.0,25.0,0.0,25.0,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000509,MBR00000018,Institutional-OP,2021-01-16,2021-01-16,2021-02-13,PLN7142,1364429278,1364429278,OB/GYN,In-Network,N39.0,Z00.00,,,,,,,0,,86900,Pathology/Lab,,,0900,22,Outpatient Hospital,2,43.04,15.52,0.0,15.52,50.0,0.0,65.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000510,MBR00000018,Institutional-OP,2023-06-02,2023-06-02,2023-06-18,PLN9107,1980712759,1980712759,Outpatient Clinic,Out-of-Network,K57.30,J45.20,,,,,,,0,,99222,E&M,,,0270,22,Outpatient Hospital,3,484.06,383.68,383.68,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000511,MBR00000018,Professional,2021-06-27,2021-06-27,2021-07-09,PLN4436,1366576336,1366576336,Geriatrics,In-Network,J44.1,I11.9,,,,,,,0,,58661,Surgery,,,,20,Urgent Care,1,2629.38,2033.44,2033.44,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000512,MBR00000019,Professional,2023-10-23,2023-10-23,2023-11-28,PLN4761,1806688928,1806688928,Geriatrics,In-Network,R10.9,K21.0,,,,,,,0,,82043,Pathology/Lab,,,,31,Skilled Nursing Facility,2,37.25,25.13,25.13,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000513,MBR00000019,Professional,2021-07-26,2021-07-26,2021-08-15,PLN5399,1644128543,1644128543,Gastroenterology,In-Network,Z00.00,I10,,,,,,,0,,45380,Surgery,,,,23,Emergency Room,2,2828.23,1072.9,851.25,0.0,50.0,171.65,221.65,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,1,0,0,0
CLM0000000514,MBR00000019,Professional,2023-06-24,2023-06-24,2023-08-05,PLN8677,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,E11.9,E11.65,,,,,,,0,,58661,Surgery,,,,49,Independent Clinic,2,2355.59,744.13,669.15,59.98,15.0,0.0,74.98,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000515,MBR00000019,Institutional-OP,2022-11-27,2022-11-27,2022-12-19,PLN6896,1691062876,1691062876,SNF,In-Network,E11.9,E78.5,,,,,,,0,,27447,Surgery,,,0370,22,Outpatient Hospital,2,4841.89,1820.73,1404.54,249.18,35.0,132.01,416.19,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000516,MBR00000019,Institutional-OP,2022-03-06,2022-03-06,2022-04-09,PLN5195,1624202402,1624202402,Orthopedic Surgery,In-Network,Z12.31,Z00.00,,,,,,,0,,99222,E&M,,,0200,22,Outpatient Hospital,3,536.53,362.59,291.81,0.0,0.0,70.78,70.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000517,MBR00000019,Professional,2023-09-03,2023-09-03,2023-09-12,PLN7458,1696843572,1696843572,Critical Access Hospital,Out-of-Network,N18.3,I10,,,,,,,0,,93225,Medicine,,,,22,Outpatient Hospital,1,724.03,265.48,265.48,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000518,MBR00000019,Professional,2022-03-02,2022-03-02,2022-03-13,PLN6331,1433937353,1433937353,Nephrology,In-Network,E78.5,Z00.00,,,,,,,0,,77067,Radiology,,,,50,Federally Qualified Health Center,1,529.84,295.63,0.0,295.63,15.0,0.0,310.63,0.0,Pended,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000000519,MBR00000019,Professional,2021-03-11,2021-03-11,2021-04-20,PLN5795,1295371663,1295371663,Critical Access Hospital,In-Network,E11.9,I10,,,,,,,0,,G0439,Medicine,,,,11,Office,1,572.07,261.24,255.52,5.72,0.0,0.0,5.72,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000000520,MBR00000019,Institutional-OP,2021-03-24,2021-03-24,2021-04-11,PLN6192,1227362142,1227362142,DME Supplier,In-Network,E11.65,N39.0,,,,,,,0,,99232,E&M,,,0900,22,Outpatient Hospital,2,253.36,83.98,0.0,83.98,0.0,0.0,83.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000521,MBR00000019,Professional,2023-07-23,2023-07-23,2023-08-03,PLN6618,1812060197,1812060197,Oncology,Out-of-Network,M17.11,I50.9,,,,,,,0,,99221,E&M,,,,23,Emergency Room,2,182.49,128.39,43.18,9.96,75.0,0.25,85.21,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000522,MBR00000019,Professional,2022-02-26,2022-02-26,2022-04-08,PLN1751,1295371663,1295371663,Critical Access Hospital,In-Network,Z00.00,E11.40,,,,,,,0,,23472,Surgery,,,,11,Office,3,2680.47,2153.52,1938.17,0.0,0.0,215.35,215.35,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000523,MBR00000019,Institutional-OP,2023-06-17,2023-06-17,2023-07-23,PLN4375,1778483301,1778483301,Home Health,In-Network,E78.5,E11.40,,,,,,,0,,99222,E&M,,,0370,22,Outpatient Hospital,2,630.49,313.2,0.0,244.38,15.0,0.0,259.38,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000524,MBR00000019,Institutional-IP,2021-01-22,2021-01-24,2021-01-29,PLN4224,1845900543,1845900543,ASC,In-Network,E11.65,E66.9,,,,470,MS-DRG,17,2,Y,78452,Radiology,,,0761,21,Inpatient Hospital,1,6514.3,4276.87,4260.27,16.6,0.0,0.0,16.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000525,MBR00000019,Institutional-OP,2021-03-25,2021-03-25,2021-04-15,PLN2267,1778483301,1778483301,Home Health,In-Network,Z12.31,Z00.00,,,,,,,0,,47562,Surgery,,,0900,22,Outpatient Hospital,3,6129.29,2045.35,1970.35,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000526,MBR00000019,Professional,2023-12-18,2023-12-18,2024-01-19,PLN4363,1520687146,1520687146,ASC,In-Network,Z79.4,E78.5,,,,,,,0,,99203,E&M,,,,21,Inpatient Hospital,3,205.36,81.01,0.0,81.01,0.0,0.0,81.01,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000527,MBR00000019,Professional,2021-06-06,2021-06-06,2021-06-22,PLN7710,1891849440,1891849440,Oncology,In-Network,N18.3,Z00.00,,,,,,,0,,27447,Surgery,,,,12,Home,1,3264.35,1010.53,780.22,195.31,35.0,0.0,230.31,0.0,Paid,,,1,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000000528,MBR00000019,Institutional-OP,2023-01-23,2023-01-23,2023-02-26,PLN8975,1268679390,1268679390,Critical Access Hospital,In-Network,E11.65,J44.1,,,,,,,0,,93225,Medicine,,,0301,22,Outpatient Hospital,1,730.93,575.4,0.0,0.0,35.0,6.99,41.99,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000529,MBR00000019,Institutional-OP,2022-01-19,2022-01-19,2022-02-05,PLN5449,1463205530,1463205530,Nephrology,In-Network,E11.9,I10,,,,,,,0,,93000,Radiology,,,0270,22,Outpatient Hospital,3,179.41,63.39,63.39,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000530,MBR00000019,Institutional-OP,2022-07-02,2022-07-02,2022-07-12,PLN7052,1644128543,1644128543,Gastroenterology,In-Network,J18.9,K21.0,,,,,,,0,,76700,Radiology,,,0120,22,Outpatient Hospital,1,1364.55,937.69,937.69,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000000531,MBR00000019,Institutional-IP,2021-05-06,2021-05-13,2021-05-25,PLN6815,1687650653,1687650653,Internal Medicine,In-Network,I10,E11.9,,,,195,MS-DRG,3,7,Y,87491,Pathology/Lab,,,0120,21,Inpatient Hospital,3,146.05,49.98,0.0,49.98,0.0,0.0,49.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000532,MBR00000019,Professional,2021-10-20,2021-10-20,2021-11-12,PLN7507,1514306773,1514306773,Endocrinology,In-Network,G20,K21.0,,,,,,,0,,87491,Pathology/Lab,,,,65,End-Stage Renal Disease,1,239.49,175.75,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000533,MBR00000019,Institutional-IP,2023-04-11,2023-04-14,2023-05-05,PLN6507,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,E11.9,I50.9,,,,194,MS-DRG,9,3,Y,93306,Radiology,,,0320,21,Inpatient Hospital,3,1987.11,1679.38,1679.38,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000534,MBR00000019,Professional,2022-08-10,2022-08-10,2022-08-27,PLN1625,1691062876,1691062876,SNF,In-Network,E11.9,Z23,,,,,,,0,,27447,Surgery,,,,11,Office,3,2905.11,2005.53,1535.17,381.13,15.0,74.23,470.36,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000535,MBR00000019,Professional,2022-07-06,2022-07-06,2022-08-19,PLN3427,1245650222,1245650222,Gastroenterology,In-Network,M17.11,J45.20,,,,,,,0,,99284,E&M,,,,81,Independent Laboratory,3,411.81,147.01,0.0,147.01,25.0,0.0,172.01,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000536,MBR00000019,Professional,2023-11-01,2023-11-01,2023-11-09,PLN9998,1872272835,1872272835,Internal Medicine,In-Network,J06.9,E11.9,,,,,,,0,,86900,Pathology/Lab,,,,49,Independent Clinic,3,45.75,25.06,0.0,25.06,15.0,0.0,40.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000537,MBR00000019,Professional,2022-03-26,2022-03-26,2022-04-02,PLN5427,1205377316,1205377316,Orthopedic Surgery,In-Network,Z23,Z12.31,,,,,,,0,,99222,E&M,,,,49,Independent Clinic,1,260.66,127.42,42.2,82.86,0.0,2.36,85.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000538,MBR00000019,Professional,2023-05-31,2023-05-31,2023-06-07,PLN6421,1606140917,1606140917,ASC,In-Network,Z12.31,I25.10,,,,,,,0,,99204,E&M,,,,11,Office,3,423.36,243.76,243.76,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000539,MBR00000019,Professional,2023-03-05,2023-03-05,2023-03-29,PLN4809,1767011137,1767011137,DME Supplier,In-Network,E66.9,E78.5,,,,,,,0,,93225,Medicine,,,,49,Independent Clinic,1,355.7,120.65,0.0,120.65,25.0,0.0,145.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000540,MBR00000019,Professional,2022-05-20,2022-05-20,2022-06-25,PLN4132,1624202402,1624202402,Orthopedic Surgery,In-Network,E78.5,E66.9,,,,,,,0,,72148,Radiology,,,,11,Office,1,1464.65,1179.55,998.01,146.54,35.0,0.0,181.54,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000000541,MBR00000019,Institutional-OP,2021-11-17,2021-11-17,2021-12-10,PLN4453,1364429278,1364429278,OB/GYN,In-Network,M54.5,F32.9,,,,,,,0,,78452,Radiology,,,0301,22,Outpatient Hospital,3,6801.29,2947.41,2797.44,0.94,0.0,149.03,149.97,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000542,MBR00000019,Institutional-OP,2022-01-23,2022-01-23,2022-02-17,PLN4588,1964402759,1964402759,Outpatient Clinic,In-Network,E11.9,E11.9,,,,,,,0,,76700,Radiology,,,0900,22,Outpatient Hospital,3,1378.12,945.41,920.41,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000543,MBR00000019,Professional,2023-08-13,2023-08-13,2023-09-14,PLN4611,1716521444,1716521444,Oncology,In-Network,J20.9,F32.9,,,,,,,0,,45380,Surgery,,,,21,Inpatient Hospital,2,2479.71,1393.68,1365.38,0.0,0.0,28.3,28.3,0.0,Paid,,,1,,0,0,1,0,0,1,Phantom,0,1,0,0,0
CLM0000000544,MBR00000019,Professional,2021-12-01,2021-12-01,2021-12-26,PLN6500,1585582070,1585582070,Outpatient Clinic,In-Network,J20.9,F03.90,,,,,,,0,,97110,Medicine,,,,11,Office,2,120.59,93.62,16.84,0.0,75.0,1.78,76.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000545,MBR00000019,Institutional-OP,2022-12-18,2022-12-18,2022-12-25,PLN7978,1531398223,1531398223,OB/GYN,In-Network,Z00.00,E11.9,,,,,,,0,,33533,Surgery,,,0360,22,Outpatient Hospital,3,27989.32,19454.91,19215.94,238.97,0.0,0.0,238.97,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000000546,MBR00000019,Professional,2021-05-17,2021-05-17,2021-06-04,PLN1534,1450553056,1450553056,Clinical Laboratory,In-Network,Z12.31,I10,,,,,,,0,,27130,Surgery,,,,11,Office,3,3783.8,3199.91,3124.91,0.0,75.0,0.0,75.0,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000547,MBR00000019,Institutional-OP,2022-01-15,2022-01-15,2022-01-30,PLN7292,1590915516,1590915516,Physical Therapy,Out-of-Network,N18.3,I63.9,,,,,,,0,,27130,Surgery,,,0730,22,Outpatient Hospital,3,2897.61,2218.38,2143.38,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000548,MBR00000020,Professional,2023-10-21,2023-10-21,2023-11-20,PLN3536,1550154147,1550154147,Outpatient Clinic,In-Network,Z23,G20,,,,,,,0,,97530,Medicine,,,,11,Office,2,180.17,80.5,55.5,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000549,MBR00000020,Institutional-IP,2022-08-15,2022-08-16,2022-09-22,PLN2763,1845900543,1845900543,ASC,In-Network,E11.40,S72.001A,,,,683,MS-DRG,19,1,Y,27447,Surgery,,,0301,21,Inpatient Hospital,1,2828.92,854.48,829.48,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000550,MBR00000020,Professional,2023-06-20,2023-06-20,2023-07-10,PLN9367,1390307371,1390307371,DME Supplier,In-Network,E11.9,Z23,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,1,381.15,206.48,0.0,35.24,0.0,21.57,56.81,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000551,MBR00000020,Institutional-OP,2021-10-12,2021-10-12,2021-11-08,PLN2509,1334916761,1334916761,ASC,In-Network,I10,M81.0,,,,,,,0,,G0468,Medicine,,,0730,22,Outpatient Hospital,2,418.74,202.58,0.0,202.58,25.0,0.0,227.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000552,MBR00000020,Professional,2023-04-14,2023-04-14,2023-05-18,PLN3805,1915531927,1915531927,Critical Access Hospital,In-Network,Z00.00,E11.9,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,2,5406.28,1817.39,1703.36,0.0,0.0,114.03,114.03,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000553,MBR00000020,Professional,2023-12-15,2023-12-15,2023-12-31,PLN1241,1717546253,1717546253,Family Medicine,In-Network,G43.909,N18.3,,,,,,,0,,72148,Radiology,,,,21,Inpatient Hospital,1,2907.77,1860.48,1568.48,0.0,0.0,292.0,292.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000554,MBR00000020,Professional,2023-10-11,2023-10-11,2023-11-22,PLN1901,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,Z23,I10,,,,,,,0,,99232,E&M,,,,81,Independent Laboratory,3,254.95,215.31,215.31,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000555,MBR00000020,Professional,2022-04-22,2022-04-22,2022-05-12,PLN4236,1550154147,1550154147,Outpatient Clinic,In-Network,Z23,E78.5,,,,,,,0,,99232,E&M,,,,20,Urgent Care,2,221.02,110.49,0.0,110.49,0.0,0.0,110.49,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000556,MBR00000020,Institutional-OP,2023-01-17,2023-01-17,2023-02-10,PLN1725,1502838586,1502838586,ASC,In-Network,I10,R05,,,,,,,0,,99232,E&M,,,0450,22,Outpatient Hospital,3,294.97,113.45,113.45,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000557,MBR00000020,Professional,2023-09-09,2023-09-09,2023-09-25,PLN7767,1502838586,1502838586,ASC,In-Network,Z00.00,Z00.00,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,1,430.03,241.93,241.93,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000558,MBR00000020,Professional,2023-06-10,2023-06-10,2023-06-29,PLN5780,1915531927,1915531927,Critical Access Hospital,In-Network,E11.9,I10,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,2,187.37,119.32,102.93,0.0,0.0,16.39,16.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000559,MBR00000020,Institutional-IP,2023-12-07,2023-12-12,2024-01-13,PLN6921,1717546253,1717546253,Family Medicine,In-Network,M54.5,J44.1,,,,682,MS-DRG,8,5,Y,93225,Medicine,,,0200,21,Inpatient Hospital,2,409.75,334.96,334.96,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000560,MBR00000020,Professional,2021-02-04,2021-02-04,2021-02-22,PLN7992,1817234602,1817234602,Clinical Laboratory,In-Network,K21.0,Z79.4,,,,,,,0,,99204,E&M,,,,49,Independent Clinic,2,211.3,74.29,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000561,MBR00000020,Institutional-OP,2022-08-10,2022-08-10,2022-08-26,PLN5095,1266606767,1266606767,ASC,In-Network,Z12.31,E78.5,,,,,,,0,,78452,Radiology,,,0450,22,Outpatient Hospital,2,6698.08,2305.46,2305.46,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000562,MBR00000020,Institutional-OP,2023-05-17,2023-05-17,2023-06-28,PLN7595,1103747954,1103747954,Urology,In-Network,M54.5,C50.912,,,,,,,0,,G0444,Medicine,,,0450,22,Outpatient Hospital,2,49.27,36.97,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,0,0,0,1,Identity_Theft,0,0,0,0,1
CLM0000000563,MBR00000020,Professional,2023-03-11,2023-03-11,2023-03-28,PLN4535,1974006077,1974006077,Orthopedic Surgery,In-Network,J45.20,I11.9,,,,,,,0,,45378,Surgery,,,,11,Office,3,967.84,752.04,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000564,MBR00000020,Institutional-IP,2021-06-18,2021-06-29,2021-07-05,PLN7782,1689639685,1689639685,SNF,In-Network,M17.11,G43.909,,,,195,MS-DRG,12,11,Y,93225,Medicine,,,0761,21,Inpatient Hospital,1,719.02,477.55,388.1,0.0,0.0,89.45,89.45,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000565,MBR00000020,Institutional-IP,2022-09-19,2022-09-24,2022-10-08,PLN5581,1609138981,1609138981,Critical Access Hospital,In-Network,J45.20,E78.5,,,,682,MS-DRG,18,5,Y,58661,Surgery,,,0510,21,Inpatient Hospital,1,2175.69,1619.95,1370.05,249.9,0.0,0.0,249.9,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000566,MBR00000020,Professional,2021-07-01,2021-07-01,2021-07-13,PLN4876,1946680931,1946680931,Critical Access Hospital,Out-of-Network,Z12.31,J44.1,,,,,,,0,,47562,Surgery,,,,23,Emergency Room,2,6468.95,2049.12,2042.28,6.84,0.0,0.0,6.84,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000567,MBR00000020,Institutional-IP,2021-04-11,2021-04-13,2021-05-10,PLN1269,1518055405,1518055405,Urology,In-Network,E78.5,Z23,,,,292,MS-DRG,1,2,Y,83036,Pathology/Lab,,,0301,21,Inpatient Hospital,1,97.24,78.46,23.21,0.0,50.0,5.25,55.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000000568,MBR00000020,Professional,2021-05-03,2021-05-03,2021-05-12,PLN1590,1845057593,1845057593,Orthopedic Surgery,In-Network,E11.9,Z12.31,,,,,,,0,,99233,E&M,,,,23,Emergency Room,2,576.24,382.37,279.58,102.79,0.0,0.0,102.79,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000569,MBR00000020,Professional,2023-11-09,2023-11-09,2023-12-10,PLN2279,1366286000,1366286000,SNF,In-Network,R10.9,I10,,,,,,,0,,27130,Surgery,,,,21,Inpatient Hospital,3,6466.61,5206.33,0.0,34.93,0.0,0.0,34.93,0.0,Denied,CO-50,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000570,MBR00000020,Institutional-IP,2021-10-25,2021-10-27,2021-11-11,PLN5031,1125190055,1125190055,Nephrology,In-Network,R05,E78.5,,,,690,MS-DRG,13,2,Y,99232,E&M,,,0900,21,Inpatient Hospital,1,222.33,124.86,98.77,0.0,15.0,11.09,26.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000571,MBR00000020,Institutional-IP,2022-05-16,2022-05-22,2022-05-26,PLN1637,1500949740,1500949740,Pediatrics,In-Network,J20.9,Z23,,,,682,MS-DRG,14,6,Y,45378,Surgery,,,0320,21,Inpatient Hospital,3,2084.14,1580.5,0.0,93.8,15.0,207.12,315.92,0.0,Denied,CO-15,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000572,MBR00000020,Institutional-OP,2021-10-08,2021-10-08,2021-11-14,PLN1384,1295371663,1295371663,Critical Access Hospital,In-Network,Z23,Z00.00,,,,,,,0,,27447,Surgery,,,0636,22,Outpatient Hospital,3,3933.71,3146.14,3146.14,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000573,MBR00000020,Professional,2023-09-06,2023-09-06,2023-10-18,PLN1931,1139906830,1139906830,Endocrinology,Out-of-Network,N39.0,M54.5,,,,,,,0,,93306,Radiology,,,,22,Outpatient Hospital,3,1656.9,629.67,195.63,410.19,0.0,23.85,434.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000574,MBR00000020,Institutional-OP,2023-09-01,2023-09-01,2023-09-21,PLN1674,1865904917,1865904917,Outpatient Clinic,In-Network,I63.9,S72.001A,,,,,,,0,,99283,E&M,,,0320,22,Outpatient Hospital,2,453.79,136.78,86.78,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000575,MBR00000020,Professional,2022-12-19,2022-12-19,2023-01-17,PLN2282,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,J20.9,Z12.31,,,,,,,0,,80061,Pathology/Lab,,,,22,Outpatient Hospital,1,127.33,61.99,0.0,46.41,75.0,0.0,121.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000576,MBR00000020,Institutional-IP,2023-06-27,2023-07-04,2023-07-15,PLN7817,1817234602,1817234602,Clinical Laboratory,In-Network,C50.912,R05,,,,195,MS-DRG,10,7,Y,G0468,Medicine,,,0200,21,Inpatient Hospital,2,262.32,118.13,11.79,56.34,50.0,0.0,106.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000577,MBR00000020,Professional,2021-04-26,2021-04-26,2021-05-21,PLN2680,1139906830,1139906830,Endocrinology,Out-of-Network,G43.909,I10,,,,,,,0,,93225,Medicine,,,,21,Inpatient Hospital,1,946.85,299.95,299.95,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000578,MBR00000020,Professional,2023-12-31,2023-12-31,2024-02-02,PLN7384,1545347862,1545347862,SNF,In-Network,Z12.31,E78.5,,,,,,,0,,71046,Radiology,,,,81,Independent Laboratory,1,169.45,141.22,0.0,141.22,75.0,0.0,216.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000579,MBR00000020,Professional,2022-04-02,2022-04-02,2022-05-05,PLN4283,1622771872,1622771872,Pediatrics,In-Network,N40.0,K57.30,,,,,,,0,,76700,Radiology,,,,23,Emergency Room,2,586.22,408.34,400.65,0.0,0.0,7.69,7.69,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000580,MBR00000020,Professional,2022-03-15,2022-03-15,2022-04-25,PLN3194,1575695214,1575695214,SNF,In-Network,E11.9,Z12.31,,,,,,,0,,G0444,Medicine,,,,11,Office,2,104.6,42.16,17.16,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000000581,MBR00000021,Professional,2021-08-03,2021-08-03,2021-09-02,PLN8385,1219817751,1219817751,OB/GYN,In-Network,I63.9,I25.10,,,,,,,0,,99221,E&M,,,,23,Emergency Room,1,188.62,158.35,158.35,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000582,MBR00000021,Professional,2023-08-19,2023-08-19,2023-09-18,PLN6606,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,Z23,N40.0,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,2,75.41,31.7,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000583,MBR00000021,Professional,2021-07-05,2021-07-05,2021-08-16,PLN6705,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,J20.9,J20.9,,,,,,,0,,72148,Radiology,,,,21,Inpatient Hospital,1,2196.68,1656.02,1134.88,456.29,35.0,29.85,521.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000584,MBR00000021,Professional,2023-07-29,2023-07-29,2023-09-03,PLN9587,1422747896,1422747896,Urology,In-Network,Z23,Z00.00,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,1,110.84,51.37,45.55,0.0,0.0,5.82,5.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000000585,MBR00000021,Professional,2023-02-23,2023-02-23,2023-03-21,PLN1026,1219817751,1219817751,OB/GYN,In-Network,Z00.00,N39.0,,,,,,,0,,99221,E&M,,,,50,Federally Qualified Health Center,1,345.61,189.79,0.0,189.79,35.0,0.0,224.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000586,MBR00000021,Institutional-IP,2023-04-26,2023-04-30,2023-05-04,PLN9455,1528335731,1528335731,Critical Access Hospital,In-Network,I48.91,I10,,,,641,MS-DRG,19,4,U,99213,E&M,,,0761,21,Inpatient Hospital,2,121.46,64.86,29.86,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000587,MBR00000021,Institutional-OP,2021-02-02,2021-02-02,2021-02-25,PLN4791,1631954542,1631954542,Oncology,In-Network,Z87.891,E78.5,,,,,,,0,,97110,Medicine,,,0761,22,Outpatient Hospital,3,250.52,139.0,64.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000588,MBR00000021,Institutional-OP,2023-03-20,2023-03-20,2023-04-28,PLN7584,1334916761,1334916761,ASC,In-Network,R51,E11.9,,,,,,,0,,99203,E&M,,,0636,22,Outpatient Hospital,1,332.09,197.24,147.24,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000589,MBR00000021,Institutional-OP,2023-11-24,2023-11-24,2023-12-30,PLN5183,1219817751,1219817751,OB/GYN,In-Network,J20.9,N40.0,,,,,,,0,,97530,Medicine,,,0900,22,Outpatient Hospital,1,143.48,45.07,45.07,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000590,MBR00000021,Institutional-OP,2022-03-08,2022-03-08,2022-04-11,PLN6439,1500037969,1500037969,Pulmonology,In-Network,I10,F10.20,,,,,,,0,,87491,Pathology/Lab,,,0740,22,Outpatient Hospital,2,105.39,87.18,0.0,87.18,15.0,0.0,102.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000591,MBR00000021,Professional,2022-05-08,2022-05-08,2022-06-20,PLN7145,1991459367,1991459367,Neurology,Out-of-Network,I10,E11.9,,,,,,,0,,99283,E&M,,,,21,Inpatient Hospital,3,384.03,233.68,169.68,64.0,0.0,0.0,64.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000592,MBR00000021,Professional,2021-05-03,2021-05-03,2021-06-04,PLN4105,1520687146,1520687146,ASC,In-Network,M54.5,J44.1,,,,,,,0,,74177,Radiology,,,,23,Emergency Room,2,1029.5,585.19,0.0,0.0,15.0,4.52,19.52,0.0,Denied,CO-15,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000593,MBR00000021,Professional,2022-06-21,2022-06-21,2022-07-30,PLN4482,1968299309,1968299309,Internal Medicine,In-Network,J06.9,F10.20,,,,,,,0,,90686,Medicine,,,,12,Home,3,50.66,20.81,0.0,20.81,50.0,0.0,70.81,0.0,Paid,,,0,,0,1,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000000594,MBR00000021,Professional,2023-01-08,2023-01-08,2023-02-05,PLN4659,1795618275,1795618275,Pulmonology,In-Network,E78.5,E78.5,,,,,,,0,,99204,E&M,,,,11,Office,3,529.85,238.52,218.44,0.0,0.0,20.08,20.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000595,MBR00000021,Institutional-OP,2021-11-24,2021-11-24,2021-12-16,PLN6656,1946680931,1946680931,Critical Access Hospital,Out-of-Network,E11.9,R07.9,,,,,,,0,,93306,Radiology,,,0740,22,Outpatient Hospital,3,2926.19,2430.3,2355.3,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000596,MBR00000021,Institutional-OP,2023-03-23,2023-03-23,2023-05-06,PLN5316,1550154147,1550154147,Outpatient Clinic,In-Network,N20.0,E11.9,,,,,,,0,,90686,Medicine,,,0450,22,Outpatient Hospital,3,95.36,32.24,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000000597,MBR00000021,Institutional-IP,2021-04-04,2021-04-08,2021-05-08,PLN1578,1453283987,1453283987,Critical Access Hospital,In-Network,Z12.31,I10,,,,683,MS-DRG,4,4,Y,99283,E&M,,,0360,21,Inpatient Hospital,2,414.51,300.71,250.47,0.24,50.0,0.0,50.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000598,MBR00000021,Institutional-OP,2023-01-09,2023-01-09,2023-01-21,PLN9384,1727809972,1727809972,Home Health,In-Network,I50.9,I10,,,,,,,0,,G0439,Medicine,,,0270,22,Outpatient Hospital,3,381.13,319.0,304.0,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000000599,MBR00000021,Institutional-OP,2022-10-07,2022-10-07,2022-11-04,PLN9386,1545347862,1545347862,SNF,In-Network,J20.9,R07.9,,,,,,,0,,99214,E&M,,,0730,22,Outpatient Hospital,1,208.04,128.37,46.73,0.0,75.0,6.64,81.64,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000600,MBR00000021,Professional,2021-09-09,2021-09-09,2021-10-02,PLN5975,1366576336,1366576336,Geriatrics,In-Network,J20.9,N18.3,,,,,,,0,,83036,Pathology/Lab,,,,21,Inpatient Hospital,1,93.89,60.09,35.09,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000000601,MBR00000021,Professional,2022-01-13,2022-01-13,2022-02-17,PLN2601,1410468316,1410468316,SNF,In-Network,N18.3,I10,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,2,265.12,160.95,160.95,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000602,MBR00000021,Institutional-OP,2021-09-20,2021-09-20,2021-10-18,PLN5074,1124394415,1124394415,Pediatrics,In-Network,R05,M54.5,,,,,,,0,,23472,Surgery,,,0740,22,Outpatient Hospital,1,4117.77,2266.6,2191.6,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000603,MBR00000021,Institutional-IP,2022-11-15,2022-11-26,2022-11-26,PLN7599,1556140803,1556140803,Cardiology,In-Network,M17.11,Z23,,,,470,MS-DRG,19,11,Y,99213,E&M,,,0320,21,Inpatient Hospital,3,131.33,67.84,67.84,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000604,MBR00000021,Professional,2022-11-29,2022-11-29,2022-12-21,PLN8748,1334916761,1334916761,ASC,In-Network,E11.9,E87.6,,,,,,,0,,93225,Medicine,,,,11,Office,3,697.64,340.18,265.18,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000605,MBR00000021,Professional,2022-09-01,2022-09-01,2022-09-14,PLN8960,1845057593,1845057593,Orthopedic Surgery,In-Network,E11.9,J06.9,,,,,,,0,,82043,Pathology/Lab,,,,22,Outpatient Hospital,1,75.99,23.06,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000606,MBR00000021,Institutional-OP,2021-08-01,2021-08-01,2021-08-25,PLN4292,1564502315,1564502315,ASC,In-Network,E66.9,Z12.31,,,,,,,0,,90837,Medicine,,,0270,22,Outpatient Hospital,3,497.44,180.1,13.91,166.19,0.0,0.0,166.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000607,MBR00000021,Institutional-OP,2021-08-26,2021-08-26,2021-09-15,PLN1637,1780163051,1780163051,SNF,In-Network,F41.9,Z00.00,,,,,,,0,,97110,Medicine,,,0270,22,Outpatient Hospital,3,138.87,101.7,0.0,101.7,15.0,0.0,116.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000608,MBR00000021,Professional,2023-06-07,2023-06-07,2023-07-15,PLN7395,1624802371,1624802371,ASC,Out-of-Network,Z87.891,J20.9,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,1,86.17,63.03,38.03,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000609,MBR00000021,Institutional-OP,2022-05-21,2022-05-21,2022-06-01,PLN1145,1355166277,1355166277,Endocrinology,In-Network,M54.5,I10,,,,,,,0,,99214,E&M,,,0730,22,Outpatient Hospital,1,308.08,129.39,10.36,84.03,35.0,0.0,119.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000610,MBR00000021,Professional,2022-04-22,2022-04-22,2022-06-04,PLN9292,1817234602,1817234602,Clinical Laboratory,In-Network,I50.9,J45.20,,,,,,,0,,G0444,Medicine,,,,22,Outpatient Hospital,3,61.35,40.97,0.0,40.97,0.0,0.0,40.97,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000000611,MBR00000021,Institutional-OP,2021-12-04,2021-12-04,2021-12-15,PLN8820,1434029575,1434029575,Endocrinology,In-Network,E78.5,R05,,,,,,,0,,45378,Surgery,,,0370,22,Outpatient Hospital,1,1323.63,981.48,931.75,49.73,0.0,0.0,49.73,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000612,MBR00000021,Institutional-IP,2023-10-16,2023-10-19,2023-11-14,PLN9692,1780163051,1780163051,SNF,In-Network,F41.9,F32.9,,,,195,MS-DRG,8,3,Y,97110,Medicine,,,0370,21,Inpatient Hospital,3,247.37,114.38,0.0,114.38,0.0,0.0,114.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000613,MBR00000021,Institutional-OP,2021-09-20,2021-09-20,2021-09-28,PLN9338,1856686341,1856686341,Geriatrics,In-Network,R51,G43.909,,,,,,,0,,86900,Pathology/Lab,,,0360,22,Outpatient Hospital,2,37.2,28.54,0.0,0.0,35.0,0.0,35.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000614,MBR00000021,Institutional-OP,2023-04-22,2023-04-22,2023-05-09,PLN2428,1696843572,1696843572,Critical Access Hospital,Out-of-Network,F32.9,E11.9,,,,,,,0,,71046,Radiology,,,0370,22,Outpatient Hospital,2,285.27,117.41,0.0,117.41,50.0,0.0,167.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000615,MBR00000021,Institutional-OP,2023-04-23,2023-04-23,2023-05-27,PLN9821,1872613201,1872613201,Internal Medicine,In-Network,E11.9,Z00.00,,,,,,,0,,77067,Radiology,,,0360,22,Outpatient Hospital,1,342.91,199.8,185.87,0.0,0.0,13.93,13.93,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000000616,MBR00000021,Professional,2021-09-24,2021-09-24,2021-10-23,PLN7058,1622771872,1622771872,Pediatrics,In-Network,N39.0,Z00.00,,,,,,,0,,99213,E&M,,,,23,Emergency Room,1,309.98,124.0,124.0,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000617,MBR00000022,Institutional-OP,2021-01-14,2021-01-14,2021-02-18,PLN5602,1545347862,1545347862,SNF,In-Network,Z00.00,J20.9,,,,,,,0,,76700,Radiology,,,0120,22,Outpatient Hospital,3,1235.88,423.5,388.5,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000618,MBR00000022,Professional,2021-10-01,2021-10-01,2021-11-11,PLN8848,1540044947,1540044947,Pulmonology,Out-of-Network,Z23,I10,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,2,372.48,115.85,4.63,111.22,0.0,0.0,111.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000619,MBR00000022,Professional,2021-10-22,2021-10-22,2021-11-16,PLN9563,1767011137,1767011137,DME Supplier,In-Network,N18.3,Z87.891,,,,,,,0,,90460,Medicine,,,,49,Independent Clinic,3,63.02,27.2,0.0,27.2,15.0,0.0,42.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000620,MBR00000022,Institutional-IP,2023-03-27,2023-04-02,2023-04-13,PLN9608,1691062876,1691062876,SNF,In-Network,Z12.31,Z87.891,,,,194,MS-DRG,19,6,N,99221,E&M,,,0120,21,Inpatient Hospital,1,329.57,189.13,0.0,189.13,0.0,0.0,189.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000621,MBR00000022,Professional,2022-08-05,2022-08-05,2022-08-19,PLN4071,1366576336,1366576336,Geriatrics,In-Network,E78.5,Z12.11,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,1,94.97,69.45,69.45,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000622,MBR00000022,Professional,2022-04-17,2022-04-17,2022-05-14,PLN4747,1366576336,1366576336,Geriatrics,In-Network,I25.10,I48.91,,,,,,,0,,80053,Pathology/Lab,,,,23,Emergency Room,2,90.55,33.97,8.91,0.0,25.0,0.06,25.06,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000623,MBR00000022,Professional,2022-06-06,2022-06-06,2022-06-24,PLN3526,1556140803,1556140803,Cardiology,In-Network,E11.9,J20.9,,,,,,,0,,72148,Radiology,,,,21,Inpatient Hospital,2,2132.02,1509.75,1509.75,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000624,MBR00000022,Professional,2023-11-10,2023-11-10,2023-12-16,PLN5394,1364429278,1364429278,OB/GYN,In-Network,E11.9,J06.9,,,,,,,0,,78452,Radiology,,,,11,Office,1,4948.13,1789.98,1789.98,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000625,MBR00000022,Professional,2023-10-27,2023-10-27,2023-11-06,PLN2307,1108115157,1108115157,General Acute Care Hospital,In-Network,K21.0,Z12.11,,,,,,,0,,58661,Surgery,,,,23,Emergency Room,3,2392.94,1120.99,986.6,134.39,0.0,0.0,134.39,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000626,MBR00000022,Institutional-OP,2021-01-29,2021-01-29,2021-03-02,PLN9331,1168246159,1168246159,Internal Medicine,In-Network,I11.9,I10,,,,,,,0,,84443,Pathology/Lab,,,0740,22,Outpatient Hospital,2,164.19,102.03,0.0,102.03,0.0,0.0,102.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000627,MBR00000022,Professional,2023-07-13,2023-07-13,2023-07-25,PLN1539,1590915516,1590915516,Physical Therapy,Out-of-Network,Z23,E11.9,,,,,,,0,,45380,Surgery,,,,11,Office,1,2995.97,1446.79,1426.59,0.0,0.0,20.2,20.2,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000000628,MBR00000022,Institutional-IP,2022-01-31,2022-02-04,2022-03-12,PLN9556,1948810580,1948810580,DME Supplier,In-Network,E11.9,J44.1,,,,291,MS-DRG,6,4,Y,86900,Pathology/Lab,,,0270,21,Inpatient Hospital,1,49.6,24.63,22.33,0.0,0.0,2.3,2.3,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000629,MBR00000022,Professional,2023-04-04,2023-04-04,2023-04-15,PLN8356,1790497490,1790497490,OB/GYN,In-Network,E11.40,N20.0,,,,,,,0,,99284,E&M,,,,49,Independent Clinic,3,687.63,560.05,227.95,332.1,0.0,0.0,332.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000630,MBR00000022,Professional,2023-12-15,2023-12-15,2024-01-09,PLN8900,1622771872,1622771872,Pediatrics,In-Network,E66.9,Z12.31,,,,,,,0,,83036,Pathology/Lab,,,,22,Outpatient Hospital,3,99.97,53.97,28.97,0.0,25.0,0.0,25.0,0.0,Pended,,,0,,0,0,0,0,0,1,Unbundling,0,0,1,0,0
CLM0000000631,MBR00000022,Professional,2022-07-17,2022-07-17,2022-08-04,PLN2417,1511044648,1511044648,Endocrinology,In-Network,R10.9,N20.0,,,,,,,0,,84443,Pathology/Lab,,,,22,Outpatient Hospital,2,89.0,52.01,0.0,52.01,25.0,0.0,77.01,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000632,MBR00000022,Professional,2022-11-15,2022-11-15,2022-12-03,PLN6104,1622771872,1622771872,Pediatrics,In-Network,Z00.00,M54.5,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,2,32.99,22.97,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000000633,MBR00000022,Institutional-OP,2022-04-15,2022-04-15,2022-05-12,PLN2733,1847081578,1847081578,Urology,Out-of-Network,R10.9,J44.1,,,,,,,0,,43239,Surgery,,,0200,22,Outpatient Hospital,1,810.19,357.74,299.1,0.0,50.0,8.64,58.64,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000634,MBR00000022,Institutional-OP,2021-03-23,2021-03-23,2021-04-03,PLN8778,1227362142,1227362142,DME Supplier,In-Network,E66.9,M17.11,,,,,,,0,,84443,Pathology/Lab,,,0370,22,Outpatient Hospital,1,69.46,58.95,43.95,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000000635,MBR00000023,Professional,2021-02-10,2021-02-10,2021-03-24,PLN3065,1556140803,1556140803,Cardiology,In-Network,Z23,J20.9,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,3,1382.26,442.45,129.43,278.02,35.0,0.0,313.02,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000636,MBR00000023,Professional,2022-01-30,2022-01-30,2022-03-08,PLN3796,1812060197,1812060197,Oncology,Out-of-Network,J44.1,R07.9,,,,,,,0,,99213,E&M,,,,11,Office,3,141.64,43.4,37.97,0.0,0.0,5.43,5.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000637,MBR00000023,Institutional-IP,2023-06-19,2023-06-24,2023-07-21,PLN8468,1817234602,1817234602,Clinical Laboratory,In-Network,I10,J06.9,,,,690,MS-DRG,6,5,N,23472,Surgery,,,0740,21,Inpatient Hospital,2,4603.95,1989.71,1776.53,0.0,0.0,213.18,213.18,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000638,MBR00000023,Professional,2022-01-09,2022-01-09,2022-01-22,PLN2380,1809014947,1809014947,Urology,In-Network,E78.5,I50.9,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,2,16005.8,11321.48,11321.48,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000000639,MBR00000023,Professional,2022-04-17,2022-04-17,2022-05-15,PLN8998,1450553056,1450553056,Clinical Laboratory,In-Network,I25.10,N39.0,,,,,,,0,,99214,E&M,,,,11,Office,2,425.45,285.58,285.58,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000640,MBR00000023,Professional,2022-08-05,2022-08-05,2022-08-26,PLN7550,1716521444,1716521444,Oncology,In-Network,I10,C50.912,,,,,,,0,,99221,E&M,,,,31,Skilled Nursing Facility,3,452.22,184.8,0.0,153.96,35.0,0.0,188.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000641,MBR00000023,Institutional-IP,2021-12-18,2021-12-22,2021-12-31,PLN4803,1103747954,1103747954,Urology,In-Network,I11.9,F03.90,,,,683,MS-DRG,11,4,Y,93306,Radiology,,,0200,21,Inpatient Hospital,2,1712.43,981.17,979.7,1.47,0.0,0.0,1.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000642,MBR00000023,Professional,2022-06-21,2022-06-21,2022-07-29,PLN2679,1213165847,1213165847,Critical Access Hospital,In-Network,R51,M54.5,,,,,,,0,,83036,Pathology/Lab,,,,22,Outpatient Hospital,1,56.85,27.03,0.0,27.03,15.0,0.0,42.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000000643,MBR00000023,Institutional-OP,2022-10-27,2022-10-27,2022-11-12,PLN7017,1575695214,1575695214,SNF,In-Network,F03.90,Z00.00,,,,,,,0,,58661,Surgery,,,0636,22,Outpatient Hospital,1,2473.24,1270.8,1195.39,0.0,50.0,25.41,75.41,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000644,MBR00000023,Professional,2023-07-22,2023-07-22,2023-08-31,PLN5889,1556140803,1556140803,Cardiology,In-Network,I10,Z79.4,,,,,,,0,,G0468,Medicine,,,,11,Office,1,294.93,175.98,140.98,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000645,MBR00000023,Professional,2023-04-06,2023-04-06,2023-05-01,PLN1464,1624802371,1624802371,ASC,Out-of-Network,K21.0,I10,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,2,449.14,295.85,0.0,295.85,75.0,0.0,370.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000646,MBR00000023,Institutional-OP,2023-06-15,2023-06-15,2023-07-06,PLN7625,1606140917,1606140917,ASC,In-Network,K57.30,Z23,,,,,,,0,,93000,Radiology,,,0360,22,Outpatient Hospital,3,172.51,88.67,0.0,38.6,0.0,0.0,38.6,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000647,MBR00000023,Professional,2022-07-27,2022-07-27,2022-08-12,PLN6331,1767011137,1767011137,DME Supplier,In-Network,I10,J20.9,,,,,,,0,,84443,Pathology/Lab,,,,23,Emergency Room,1,100.52,74.18,0.0,74.18,0.0,0.0,74.18,0.0,Denied,CO-97,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000648,MBR00000023,Professional,2023-02-05,2023-02-05,2023-03-14,PLN3405,1799205295,1799205295,General Acute Care Hospital,In-Network,K21.0,I10,,,,,,,0,,85025,Pathology/Lab,,,,23,Emergency Room,2,82.47,27.88,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000649,MBR00000023,Professional,2021-06-13,2021-06-13,2021-07-02,PLN1783,1530904931,1530904931,Internal Medicine,In-Network,E11.9,Z51.11,,,,,,,0,,45378,Surgery,,,,11,Office,1,2484.43,1724.73,1649.73,0.0,75.0,0.0,75.0,0.0,Pended,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000650,MBR00000023,Institutional-OP,2021-06-11,2021-06-11,2021-06-19,PLN4354,1939033455,1939033455,Pulmonology,In-Network,G43.909,Z23,,,,,,,0,,99406,Medicine,,,0270,22,Outpatient Hospital,1,37.19,23.07,7.2,0.0,15.0,0.87,15.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000651,MBR00000023,Institutional-IP,2023-10-07,2023-10-18,2023-10-27,PLN9248,1438368327,1438368327,Home Health,In-Network,K21.0,J06.9,,,,196,MS-DRG,4,11,Y,81001,Pathology/Lab,,,0450,21,Inpatient Hospital,3,45.82,31.51,0.0,31.51,35.0,0.0,66.51,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000000652,MBR00000023,Professional,2022-10-24,2022-10-24,2022-11-27,PLN2502,1514306773,1514306773,Endocrinology,In-Network,I63.9,E11.65,,,,,,,0,,99221,E&M,,,,11,Office,1,237.32,185.51,185.51,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000653,MBR00000023,Professional,2021-05-04,2021-05-04,2021-05-18,PLN6477,1168246159,1168246159,Internal Medicine,In-Network,F41.9,I10,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,1,46.83,30.79,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000654,MBR00000023,Professional,2022-03-23,2022-03-23,2022-04-12,PLN4731,1434029575,1434029575,Endocrinology,In-Network,N40.0,K21.0,,,,,,,0,,27130,Surgery,,,,49,Independent Clinic,1,2727.02,1270.23,1270.23,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000655,MBR00000023,Professional,2023-11-28,2023-11-28,2023-12-22,PLN2667,1550154147,1550154147,Outpatient Clinic,In-Network,I10,Z00.00,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,1,324.73,143.21,126.93,0.0,0.0,16.28,16.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000656,MBR00000023,Professional,2021-01-24,2021-01-24,2021-02-12,PLN6844,1514306773,1514306773,Endocrinology,In-Network,K21.0,G43.909,,,,,,,0,,43239,Surgery,,,,49,Independent Clinic,2,906.45,433.65,433.65,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000657,MBR00000023,Professional,2022-04-30,2022-04-30,2022-05-26,PLN3063,1168246159,1168246159,Internal Medicine,In-Network,E87.6,M54.5,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,3,5659.26,2073.67,1596.02,315.32,35.0,127.33,477.65,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000658,MBR00000023,Professional,2023-07-06,2023-07-06,2023-07-13,PLN8470,1990090423,1990090423,Orthopedic Surgery,In-Network,E11.65,C50.912,,,,,,,0,,99222,E&M,,,,65,End-Stage Renal Disease,3,389.69,296.46,296.46,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000659,MBR00000023,Institutional-OP,2023-11-03,2023-11-03,2023-12-11,PLN9712,1239316214,1239316214,Internal Medicine,In-Network,E87.6,Z00.00,,,,,,,0,,99283,E&M,,,0370,22,Outpatient Hospital,1,588.2,225.53,0.0,225.53,35.0,0.0,260.53,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000660,MBR00000023,Institutional-IP,2022-02-08,2022-02-09,2022-03-14,PLN1815,1939033455,1939033455,Pulmonology,In-Network,J44.1,R05,,,,195,MS-DRG,1,1,Y,93000,Radiology,,,0740,21,Inpatient Hospital,3,96.29,36.09,36.09,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000661,MBR00000023,Institutional-IP,2023-09-29,2023-10-02,2023-10-23,PLN6369,1372918899,1372918899,Family Medicine,In-Network,N39.0,J06.9,,,,871,MS-DRG,18,3,Y,33533,Surgery,,,0510,21,Inpatient Hospital,3,15075.55,5419.51,5344.51,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,1,0,1,Unbundling,0,0,0,0,0
CLM0000000662,MBR00000023,Institutional-IP,2023-02-24,2023-02-26,2023-04-02,PLN2498,1242201429,1242201429,General Acute Care Hospital,In-Network,R07.9,M54.5,,,,194,MS-DRG,17,2,Y,72148,Radiology,,,0450,21,Inpatient Hospital,1,1313.21,722.14,722.14,0.0,0.0,0.0,0.0,0.0,Pended,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000663,MBR00000023,Professional,2022-03-21,2022-03-21,2022-04-27,PLN4842,1563980627,1563980627,Critical Access Hospital,In-Network,J06.9,I10,,,,,,,0,,93306,Radiology,,,,22,Outpatient Hospital,2,3082.64,2465.04,2041.76,0.0,25.0,398.28,423.28,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000664,MBR00000023,Institutional-IP,2023-05-04,2023-05-11,2023-06-13,PLN2915,1283743001,1283743001,Family Medicine,In-Network,J18.9,I10,,,,291,MS-DRG,9,7,Y,90837,Medicine,,,0360,21,Inpatient Hospital,3,441.57,148.73,124.47,0.0,0.0,24.26,24.26,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000665,MBR00000023,Professional,2023-05-27,2023-05-27,2023-06-27,PLN9197,1622771872,1622771872,Pediatrics,In-Network,G43.909,Z00.00,,,,,,,0,,58661,Surgery,,,,11,Office,1,1835.11,1553.2,1553.2,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000666,MBR00000023,Institutional-OP,2021-10-29,2021-10-29,2021-11-10,PLN5121,1545347862,1545347862,SNF,In-Network,E66.9,I10,,,,,,,0,,70450,Radiology,,,0510,22,Outpatient Hospital,3,1556.96,1222.29,933.19,0.0,75.0,214.1,289.1,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000667,MBR00000023,Professional,2021-04-09,2021-04-09,2021-04-17,PLN6590,1520687146,1520687146,ASC,In-Network,F32.9,N39.0,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,3,54.39,31.19,30.81,0.0,0.0,0.38,0.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000668,MBR00000023,Institutional-IP,2023-05-06,2023-05-11,2023-05-16,PLN4373,1366286000,1366286000,SNF,In-Network,F41.9,E11.65,,,,291,MS-DRG,20,5,Y,70553,Radiology,,,0450,21,Inpatient Hospital,2,1871.66,1274.48,1274.48,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000000669,MBR00000023,Institutional-OP,2021-04-01,2021-04-01,2021-05-07,PLN4063,1273488618,1273488618,General Acute Care Hospital,In-Network,Z00.00,Z12.31,,,,,,,0,,27447,Surgery,,,0730,22,Outpatient Hospital,1,2629.3,976.69,467.16,458.93,50.0,0.6,509.53,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000670,MBR00000023,Professional,2023-05-03,2023-05-03,2023-05-13,PLN6515,1268679390,1268679390,Critical Access Hospital,In-Network,R10.9,I10,,,,,,,0,,85025,Pathology/Lab,,,,20,Urgent Care,1,76.71,53.36,53.36,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000671,MBR00000023,Professional,2022-01-25,2022-01-25,2022-02-20,PLN1430,1575695214,1575695214,SNF,In-Network,M54.5,Z12.31,,,,,,,0,,93306,Radiology,,,,22,Outpatient Hospital,3,1586.48,1210.61,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000672,MBR00000023,Institutional-OP,2023-02-09,2023-02-09,2023-03-22,PLN9733,1915531927,1915531927,Critical Access Hospital,In-Network,N39.0,F41.9,,,,,,,0,,93306,Radiology,,,0370,22,Outpatient Hospital,1,1190.81,370.78,0.0,370.78,0.0,0.0,370.78,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000673,MBR00000023,Professional,2022-10-30,2022-10-30,2022-11-13,PLN2462,1727809972,1727809972,Home Health,In-Network,E11.9,E11.9,,,,,,,0,,99203,E&M,,,,23,Emergency Room,1,327.97,215.41,0.0,215.41,0.0,0.0,215.41,0.0,Paid,,,0,,1,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000000674,MBR00000023,Professional,2021-02-12,2021-02-12,2021-02-22,PLN6274,1899127912,1899127912,Neurology,In-Network,N18.3,I10,,,,,,,0,,81001,Pathology/Lab,,,,23,Emergency Room,2,50.65,17.8,0.0,17.8,35.0,0.0,52.8,0.0,Denied,CO-11,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000675,MBR00000023,Professional,2021-01-11,2021-01-11,2021-02-10,PLN9648,1545347862,1545347862,SNF,In-Network,J06.9,E78.5,,,,,,,0,,76700,Radiology,,,,11,Office,1,584.68,214.87,0.0,214.87,35.0,0.0,249.87,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000676,MBR00000023,Professional,2022-11-21,2022-11-21,2023-01-02,PLN1127,1749494482,1749494482,Pediatrics,In-Network,I25.10,I25.10,,,,,,,0,,85610,Pathology/Lab,,,,21,Inpatient Hospital,2,34.87,14.12,0.0,14.12,75.0,0.0,89.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000677,MBR00000023,Professional,2022-07-19,2022-07-19,2022-08-18,PLN4657,1790497490,1790497490,OB/GYN,In-Network,I50.9,I10,,,,,,,0,,99233,E&M,,,,11,Office,3,272.34,101.62,41.91,0.0,50.0,9.71,59.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000678,MBR00000023,Institutional-OP,2021-02-17,2021-02-17,2021-03-09,PLN9109,1790497490,1790497490,OB/GYN,In-Network,N18.3,I48.91,,,,,,,0,,45378,Surgery,,,0120,22,Outpatient Hospital,2,2061.45,1545.23,1545.23,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000679,MBR00000023,Institutional-OP,2023-12-05,2023-12-05,2024-01-13,PLN8477,1114982472,1114982472,Orthopedic Surgery,In-Network,Z00.00,I25.10,,,,,,,0,,86900,Pathology/Lab,,,0370,22,Outpatient Hospital,2,33.7,10.56,0.0,10.56,50.0,0.0,60.56,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000680,MBR00000023,Professional,2021-09-19,2021-09-19,2021-10-01,PLN3518,1948810580,1948810580,DME Supplier,In-Network,F10.20,N40.0,,,,,,,0,,G0468,Medicine,,,,22,Outpatient Hospital,1,401.61,130.4,88.94,0.0,35.0,6.46,41.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000681,MBR00000023,Institutional-OP,2023-07-29,2023-07-29,2023-08-26,PLN5195,1713934949,1713934949,Neurology,In-Network,J20.9,J06.9,,,,,,,0,,G0439,Medicine,,,0730,22,Outpatient Hospital,2,423.35,296.4,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000000682,MBR00000023,Institutional-OP,2021-05-08,2021-05-08,2021-05-19,PLN6858,1872613201,1872613201,Internal Medicine,In-Network,E11.9,M54.5,,,,,,,0,,76700,Radiology,,,0510,22,Outpatient Hospital,2,778.23,318.23,0.0,0.0,0.0,19.21,19.21,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000683,MBR00000023,Professional,2021-09-12,2021-09-12,2021-10-18,PLN8123,1450553056,1450553056,Clinical Laboratory,In-Network,J06.9,E11.40,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,1,199.75,162.98,112.98,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000684,MBR00000023,Institutional-IP,2022-08-03,2022-08-04,2022-08-24,PLN9723,1631954542,1631954542,Oncology,In-Network,F10.20,N18.3,,,,690,MS-DRG,11,1,Y,27447,Surgery,,,0320,21,Inpatient Hospital,1,2303.52,1107.65,973.72,58.93,75.0,0.0,133.93,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000685,MBR00000024,Professional,2022-08-02,2022-08-02,2022-08-18,PLN1705,1980712759,1980712759,Outpatient Clinic,Out-of-Network,R10.9,I10,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,2,436.15,346.46,346.46,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000686,MBR00000024,Professional,2022-10-24,2022-10-24,2022-11-30,PLN7782,1337791138,1337791138,Internal Medicine,Out-of-Network,E66.9,Z87.891,,,,,,,0,,43239,Surgery,,,,49,Independent Clinic,2,1000.92,514.81,464.81,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000687,MBR00000024,Institutional-OP,2021-07-07,2021-07-07,2021-07-27,PLN3676,1168881145,1168881145,Orthopedic Surgery,In-Network,N17.9,J18.9,,,,,,,0,,G0444,Medicine,,,0370,22,Outpatient Hospital,2,37.89,12.02,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,0,0,0,1,Phantom,0,0,0,0,1
CLM0000000688,MBR00000024,Institutional-OP,2021-10-17,2021-10-17,2021-11-08,PLN3751,1531398223,1531398223,OB/GYN,In-Network,F41.9,Z12.11,,,,,,,0,,66984,Surgery,,,0320,22,Outpatient Hospital,1,2109.65,1778.31,1778.31,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000689,MBR00000024,Institutional-OP,2021-10-16,2021-10-16,2021-11-07,PLN9203,1438368327,1438368327,Home Health,In-Network,E78.5,N39.0,,,,,,,0,,45378,Surgery,,,0740,22,Outpatient Hospital,2,2349.61,1897.31,1522.72,0.0,0.0,374.59,374.59,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000690,MBR00000024,Professional,2022-04-28,2022-04-28,2022-05-10,PLN6482,1994661817,1994661817,SNF,Out-of-Network,E66.9,I25.10,,,,,,,0,,97530,Medicine,,,,11,Office,1,153.34,77.48,2.48,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000691,MBR00000024,Professional,2023-10-08,2023-10-08,2023-11-07,PLN2846,1438368327,1438368327,Home Health,In-Network,M54.5,Z23,,,,,,,0,,99284,E&M,,,,11,Office,2,430.57,171.29,136.29,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000692,MBR00000024,Professional,2022-05-22,2022-05-22,2022-07-04,PLN7753,1433937353,1433937353,Nephrology,In-Network,Z87.891,J20.9,,,,,,,0,,99222,E&M,,,,11,Office,2,459.99,275.97,275.97,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000693,MBR00000024,Professional,2023-12-29,2023-12-29,2024-02-01,PLN6329,1645194539,1645194539,SNF,In-Network,N18.3,Z00.00,,,,,,,0,,70553,Radiology,,,,11,Office,2,3386.05,2510.44,2192.02,318.42,0.0,0.0,318.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000694,MBR00000024,Professional,2021-10-03,2021-10-03,2021-10-28,PLN5291,1728018911,1728018911,Nephrology,In-Network,I10,E66.9,,,,,,,0,,47562,Surgery,,,,21,Inpatient Hospital,2,4867.46,2388.16,2313.16,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000695,MBR00000024,Professional,2021-09-23,2021-09-23,2021-10-29,PLN6809,1631954542,1631954542,Oncology,In-Network,Z23,G43.909,,,,,,,0,,76700,Radiology,,,,11,Office,2,1106.78,633.13,608.13,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000696,MBR00000024,Institutional-IP,2021-04-21,2021-04-24,2021-05-31,PLN4719,1422747896,1422747896,Urology,In-Network,E11.9,M17.11,,,,195,MS-DRG,15,3,U,27447,Surgery,,,0900,21,Inpatient Hospital,3,4556.29,2272.76,1929.74,0.0,50.0,293.02,343.02,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000697,MBR00000024,Professional,2021-08-21,2021-08-21,2021-10-01,PLN1660,1433937353,1433937353,Nephrology,In-Network,I10,M17.11,,,,,,,0,,45378,Surgery,,,,11,Office,2,1155.89,644.2,583.18,0.0,0.0,61.02,61.02,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000698,MBR00000024,Professional,2021-12-08,2021-12-08,2021-12-22,PLN6296,1486164553,1486164553,DME Supplier,In-Network,E78.5,E11.9,,,,,,,0,,G0468,Medicine,,,,20,Urgent Care,3,509.78,395.23,395.23,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000699,MBR00000024,Professional,2022-02-25,2022-02-25,2022-03-11,PLN8695,1236418230,1236418230,DME Supplier,In-Network,E11.9,Z00.00,,,,,,,0,,45378,Surgery,,,,23,Emergency Room,1,1268.34,415.94,0.0,415.94,0.0,0.0,415.94,0.0,Paid,,,0,,1,1,0,0,0,0,None,0,1,0,0,0
CLM0000000700,MBR00000024,Institutional-OP,2023-02-21,2023-02-21,2023-03-15,PLN1429,1575695214,1575695214,SNF,In-Network,Z12.31,N39.0,,,,,,,0,,72148,Radiology,,,0200,22,Outpatient Hospital,1,1994.07,632.66,447.57,110.09,75.0,0.0,185.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000701,MBR00000024,Professional,2022-05-04,2022-05-04,2022-05-21,PLN6832,1337791138,1337791138,Internal Medicine,Out-of-Network,E11.9,N39.0,,,,,,,0,,90837,Medicine,,,,12,Home,1,225.11,150.91,132.26,0.0,0.0,18.65,18.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000702,MBR00000024,Professional,2023-01-22,2023-01-22,2023-01-29,PLN4606,1606140917,1606140917,ASC,In-Network,N18.3,S72.001A,,,,,,,0,,45378,Surgery,,,,23,Emergency Room,2,1880.86,1292.93,1169.93,73.0,50.0,0.0,123.0,0.0,Paid,,,0,,1,1,0,0,0,0,None,0,1,0,0,0
CLM0000000703,MBR00000024,Professional,2021-04-08,2021-04-08,2021-05-02,PLN4440,1561134315,1561134315,DME Supplier,In-Network,F10.20,M17.11,,,,,,,0,,99213,E&M,,,,11,Office,2,284.44,134.74,122.77,0.0,0.0,11.97,11.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000704,MBR00000024,Professional,2023-11-03,2023-11-03,2023-12-01,PLN6627,1550154147,1550154147,Outpatient Clinic,In-Network,F41.9,J06.9,,,,,,,0,,82043,Pathology/Lab,,,,20,Urgent Care,3,72.02,42.04,7.04,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000705,MBR00000024,Professional,2021-06-11,2021-06-11,2021-07-12,PLN5334,1609526529,1609526529,Psychiatry,In-Network,N18.3,F32.9,,,,,,,0,,93000,Radiology,,,,21,Inpatient Hospital,3,174.97,84.23,17.23,67.0,0.0,0.0,67.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000706,MBR00000024,Institutional-OP,2021-02-06,2021-02-06,2021-03-03,PLN5316,1355166277,1355166277,Endocrinology,In-Network,K21.0,N39.0,,,,,,,0,,47562,Surgery,,,0510,22,Outpatient Hospital,3,3064.33,979.91,0.0,0.0,75.0,33.37,108.37,0.0,Denied,CO-27,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000707,MBR00000024,Professional,2022-04-11,2022-04-11,2022-04-29,PLN8734,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,K21.0,G43.909,,,,,,,0,,83036,Pathology/Lab,,,,20,Urgent Care,1,78.28,63.4,63.4,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000000708,MBR00000024,Professional,2022-12-15,2022-12-15,2023-01-15,PLN9024,1767011137,1767011137,DME Supplier,In-Network,N20.0,N40.0,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,3,46.14,19.57,0.0,19.57,0.0,0.0,19.57,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000709,MBR00000024,Professional,2021-09-15,2021-09-15,2021-09-28,PLN4573,1700633438,1700633438,DME Supplier,In-Network,N18.3,N18.3,,,,,,,0,,99203,E&M,,,,11,Office,2,238.23,151.67,0.0,151.67,75.0,0.0,226.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000710,MBR00000024,Professional,2021-06-28,2021-06-28,2021-08-02,PLN9324,1118885473,1118885473,ASC,In-Network,N39.0,Z51.11,,,,,,,0,,99283,E&M,,,,49,Independent Clinic,3,449.5,185.59,151.5,0.0,0.0,34.09,34.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000711,MBR00000024,Institutional-OP,2023-07-15,2023-07-15,2023-08-06,PLN8402,1502838586,1502838586,ASC,In-Network,F03.90,J06.9,,,,,,,0,,77067,Radiology,,,0730,22,Outpatient Hospital,3,722.52,227.08,207.7,0.0,0.0,19.38,19.38,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000000712,MBR00000024,Institutional-IP,2023-06-22,2023-07-02,2023-06-29,PLN7563,1860435061,1860435061,DME Supplier,In-Network,N18.3,E66.9,,,,871,MS-DRG,2,10,Y,45378,Surgery,,,0370,21,Inpatient Hospital,2,1376.52,1056.12,806.85,0.0,50.0,199.27,249.27,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000713,MBR00000024,Professional,2023-04-03,2023-04-03,2023-04-12,PLN5859,1865904917,1865904917,Outpatient Clinic,In-Network,E78.5,Z00.00,,,,,,,0,,99284,E&M,,,,50,Federally Qualified Health Center,2,566.28,248.11,243.4,4.71,0.0,0.0,4.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000714,MBR00000024,Institutional-IP,2021-08-30,2021-09-06,2021-09-29,PLN3138,1749327647,1749327647,Geriatrics,In-Network,J18.9,E66.9,,,,470,MS-DRG,11,7,Y,99221,E&M,,,0370,21,Inpatient Hospital,2,414.96,331.65,331.65,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000715,MBR00000024,Professional,2022-08-11,2022-08-11,2022-09-07,PLN5445,1872613201,1872613201,Internal Medicine,In-Network,E11.9,Z23,,,,,,,0,,99222,E&M,,,,20,Urgent Care,1,514.83,247.34,150.37,81.97,15.0,0.0,96.97,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000000716,MBR00000024,Professional,2023-01-26,2023-01-26,2023-02-18,PLN1025,1689639685,1689639685,SNF,In-Network,M17.11,G43.909,,,,,,,0,,99204,E&M,,,,11,Office,3,424.2,137.51,0.0,137.51,75.0,0.0,212.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000717,MBR00000024,Professional,2022-04-19,2022-04-19,2022-05-01,PLN5597,1872613201,1872613201,Internal Medicine,In-Network,C50.912,Z87.891,,,,,,,0,,93306,Radiology,,,,49,Independent Clinic,3,2225.68,1750.47,0.0,0.0,15.0,4.13,19.13,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000718,MBR00000024,Institutional-OP,2021-07-15,2021-07-15,2021-08-14,PLN6523,1997536841,1997536841,Family Medicine,Out-of-Network,J44.1,M54.5,,,,,,,0,,93225,Medicine,,,0200,22,Outpatient Hospital,2,677.79,395.4,266.41,97.78,25.0,6.21,128.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000719,MBR00000024,Institutional-OP,2023-06-29,2023-06-29,2023-07-15,PLN4236,1486164553,1486164553,DME Supplier,In-Network,I10,E11.9,,,,,,,0,,84443,Pathology/Lab,,,0730,22,Outpatient Hospital,2,98.42,64.45,29.45,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000720,MBR00000024,Professional,2023-10-25,2023-10-25,2023-12-03,PLN1648,1372918899,1372918899,Family Medicine,In-Network,F32.9,N40.0,,,,,,,0,,27447,Surgery,,,,11,Office,1,2427.64,1805.03,1523.79,0.0,0.0,281.24,281.24,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000721,MBR00000024,Institutional-OP,2021-07-01,2021-07-01,2021-07-13,PLN2332,1872272835,1872272835,Internal Medicine,In-Network,F10.20,Z23,,,,,,,0,,71046,Radiology,,,0270,22,Outpatient Hospital,2,240.56,136.76,61.76,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000722,MBR00000024,Professional,2023-02-09,2023-02-09,2023-03-25,PLN6647,1689639685,1689639685,SNF,In-Network,E78.5,J06.9,,,,,,,0,,70450,Radiology,,,,11,Office,3,1669.11,749.0,685.83,63.17,0.0,0.0,63.17,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000723,MBR00000024,Professional,2023-08-30,2023-08-30,2023-10-01,PLN7864,1948810580,1948810580,DME Supplier,In-Network,R51,K21.0,,,,,,,0,,99284,E&M,,,,20,Urgent Care,2,925.87,697.24,697.24,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000724,MBR00000024,Professional,2022-08-16,2022-08-16,2022-09-09,PLN6070,1502838586,1502838586,ASC,In-Network,Z00.00,G43.909,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,3,1490.43,933.17,933.17,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000725,MBR00000024,Professional,2021-02-23,2021-02-23,2021-03-04,PLN4904,1948810580,1948810580,DME Supplier,In-Network,K21.0,Z00.00,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,3,3166.56,2154.42,2079.42,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000726,MBR00000024,Professional,2023-01-27,2023-01-27,2023-02-11,PLN8964,1856686341,1856686341,Geriatrics,In-Network,E11.9,F32.9,,,,,,,0,,99283,E&M,,,,11,Office,3,521.85,235.83,210.83,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000727,MBR00000024,Institutional-OP,2023-10-09,2023-10-09,2023-11-04,PLN6605,1752470395,1752470395,Home Health,In-Network,K21.0,E66.9,,,,,,,0,,99406,Medicine,,,0301,22,Outpatient Hospital,1,74.4,58.05,58.05,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000728,MBR00000024,Professional,2021-10-14,2021-10-14,2021-11-08,PLN6673,1563980627,1563980627,Critical Access Hospital,In-Network,Z00.01,E78.5,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,1,608.14,348.84,313.84,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000000729,MBR00000024,Professional,2021-06-01,2021-06-01,2021-06-28,PLN6004,1283743001,1283743001,Family Medicine,In-Network,J20.9,J06.9,,,,,,,0,,93000,Radiology,,,,49,Independent Clinic,3,111.53,75.32,75.32,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000730,MBR00000024,Professional,2021-10-04,2021-10-04,2021-10-16,PLN8341,1645194539,1645194539,SNF,In-Network,E78.5,N18.3,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,3,5555.58,3302.12,3302.12,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000731,MBR00000025,Professional,2023-06-09,2023-06-09,2023-07-20,PLN4406,1390307371,1390307371,DME Supplier,In-Network,Z51.11,I10,,,,,,,0,,58661,Surgery,,,,11,Office,1,4603.49,1558.81,1483.81,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000732,MBR00000025,Professional,2022-09-03,2022-09-03,2022-10-17,PLN6646,1713934949,1713934949,Neurology,In-Network,F41.9,R51,,,,,,,0,,85025,Pathology/Lab,,,,21,Inpatient Hospital,3,76.56,41.74,0.0,41.74,75.0,0.0,116.74,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000733,MBR00000025,Professional,2021-01-20,2021-01-20,2021-01-30,PLN4772,1114982472,1114982472,Orthopedic Surgery,In-Network,J20.9,E11.9,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,3,64.96,47.62,12.62,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000734,MBR00000025,Professional,2022-10-06,2022-10-06,2022-11-10,PLN7213,1511044648,1511044648,Endocrinology,In-Network,Z23,G43.909,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,1,566.55,442.74,442.74,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000735,MBR00000025,Professional,2023-06-12,2023-06-12,2023-07-08,PLN8849,1752470395,1752470395,Home Health,In-Network,N39.0,M17.11,,,,,,,0,,45378,Surgery,,,,21,Inpatient Hospital,2,1152.57,918.44,893.44,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000736,MBR00000025,Professional,2021-07-22,2021-07-22,2021-08-12,PLN9648,1696843572,1696843572,Critical Access Hospital,Out-of-Network,Z87.891,Z87.891,,,,,,,0,,78452,Radiology,,,,11,Office,1,3032.51,1514.39,1150.37,283.99,25.0,55.03,364.02,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000737,MBR00000025,Institutional-IP,2022-10-02,2022-10-06,2022-11-12,PLN8725,1361302520,1361302520,Critical Access Hospital,In-Network,F32.9,E66.9,,,,291,MS-DRG,15,4,Y,99214,E&M,,,0740,21,Inpatient Hospital,2,267.45,114.18,114.18,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000738,MBR00000025,Institutional-OP,2021-09-08,2021-09-08,2021-10-10,PLN1996,1500949740,1500949740,Pediatrics,In-Network,E11.9,F32.9,,,,,,,0,,87491,Pathology/Lab,,,0301,22,Outpatient Hospital,3,174.71,62.26,53.3,0.0,0.0,8.96,8.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000739,MBR00000025,Professional,2021-01-21,2021-01-21,2021-02-26,PLN5125,1450094833,1450094833,Outpatient Clinic,In-Network,Z00.00,R05,,,,,,,0,,71046,Radiology,,,,22,Outpatient Hospital,2,264.06,222.02,0.0,26.18,0.0,0.0,26.18,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000740,MBR00000025,Institutional-OP,2022-03-15,2022-03-15,2022-03-22,PLN4159,1389336600,1389336600,Critical Access Hospital,In-Network,E11.9,N18.3,,,,,,,0,,77067,Radiology,,,0510,22,Outpatient Hospital,3,753.57,488.0,378.12,0.0,50.0,59.88,109.88,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000000741,MBR00000025,Institutional-IP,2023-04-28,2023-04-30,2023-05-09,PLN2816,1542828721,1542828721,Orthopedic Surgery,In-Network,K92.1,Z12.11,,,,683,MS-DRG,17,2,Y,99222,E&M,,,0370,21,Inpatient Hospital,2,508.34,282.28,0.0,0.0,0.0,45.3,45.3,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000742,MBR00000025,Institutional-IP,2023-01-03,2023-01-05,2023-01-23,PLN1575,1745114564,1745114564,Endocrinology,In-Network,Z12.11,Z12.31,,,,196,MS-DRG,12,2,Y,66984,Surgery,,,0636,21,Inpatient Hospital,3,3069.77,2130.18,1668.14,224.59,0.0,237.45,462.04,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000743,MBR00000025,Institutional-IP,2021-04-22,2021-04-26,2021-05-27,PLN7992,1242201429,1242201429,General Acute Care Hospital,In-Network,J20.9,E66.9,,,,291,MS-DRG,15,4,Y,70450,Radiology,,,0270,21,Inpatient Hospital,1,1818.27,716.18,641.18,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000744,MBR00000025,Professional,2021-07-23,2021-07-23,2021-09-02,PLN2777,1334916761,1334916761,ASC,In-Network,E66.9,J44.1,,,,,,,0,,47562,Surgery,,,,11,Office,3,2398.94,1509.46,1173.5,104.11,25.0,206.85,335.96,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000745,MBR00000025,Institutional-OP,2022-08-15,2022-08-15,2022-09-11,PLN2083,1845057593,1845057593,Orthopedic Surgery,In-Network,Z00.00,K57.30,,,,,,,0,,77067,Radiology,,,0301,22,Outpatient Hospital,3,795.14,530.67,138.68,341.99,50.0,0.0,391.99,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000000746,MBR00000025,Professional,2021-12-18,2021-12-18,2022-01-04,PLN2126,1139906830,1139906830,Endocrinology,Out-of-Network,S72.001A,J06.9,,,,,,,0,,99284,E&M,,,,12,Home,1,656.91,280.06,230.06,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000747,MBR00000025,Professional,2021-12-30,2021-12-30,2022-01-30,PLN3781,1118885473,1118885473,ASC,In-Network,Z23,K21.0,,,,,,,0,,43239,Surgery,,,,11,Office,2,1362.98,670.4,595.4,0.0,75.0,0.0,75.0,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000748,MBR00000025,Institutional-IP,2022-04-23,2022-04-25,2022-05-31,PLN2717,1631954542,1631954542,Oncology,In-Network,I10,F32.9,,,,291,MS-DRG,8,2,Y,99203,E&M,,,0450,21,Inpatient Hospital,3,183.26,56.41,0.0,0.0,0.0,0.28,0.28,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000749,MBR00000025,Institutional-OP,2023-04-12,2023-04-12,2023-05-14,PLN2365,1531398223,1531398223,OB/GYN,In-Network,Z23,N40.0,,,,,,,0,,43239,Surgery,,,0320,22,Outpatient Hospital,2,2261.6,1767.95,1767.95,0.0,0.0,0.0,0.0,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000750,MBR00000025,Professional,2022-09-23,2022-09-23,2022-10-22,PLN9438,1355166277,1355166277,Endocrinology,In-Network,F32.9,K21.0,,,,,,,0,,97530,Medicine,,,,31,Skilled Nursing Facility,2,234.33,119.23,69.23,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000751,MBR00000025,Institutional-OP,2023-07-24,2023-07-24,2023-08-08,PLN8445,1767011137,1767011137,DME Supplier,In-Network,I25.10,K57.30,,,,,,,0,,27447,Surgery,,,0200,22,Outpatient Hospital,1,4731.76,2374.3,1983.19,0.0,15.0,376.11,391.11,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000752,MBR00000025,Institutional-IP,2021-04-22,2021-04-24,2021-06-01,PLN2123,1556140803,1556140803,Cardiology,In-Network,Z00.00,E78.5,,,,690,MS-DRG,8,2,Y,90837,Medicine,,,0360,21,Inpatient Hospital,3,233.32,119.52,0.0,119.52,15.0,0.0,134.52,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000000753,MBR00000025,Institutional-IP,2022-05-24,2022-06-05,2022-07-05,PLN2249,1355166277,1355166277,Endocrinology,In-Network,J06.9,I25.10,,,,690,MS-DRG,5,12,Y,86900,Pathology/Lab,,,0200,21,Inpatient Hospital,3,55.63,47.27,22.27,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000754,MBR00000025,Institutional-OP,2022-08-26,2022-08-26,2022-09-02,PLN5001,1236418230,1236418230,DME Supplier,In-Network,Z87.891,K92.1,,,,,,,0,,G0468,Medicine,,,0360,22,Outpatient Hospital,1,500.1,295.28,260.28,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000755,MBR00000025,Institutional-OP,2023-04-10,2023-04-10,2023-04-30,PLN3101,1124394415,1124394415,Pediatrics,In-Network,J18.9,J20.9,,,,,,,0,,G0439,Medicine,,,0370,22,Outpatient Hospital,3,270.21,159.1,0.0,159.1,0.0,0.0,159.1,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000000756,MBR00000025,Professional,2022-07-19,2022-07-19,2022-08-10,PLN2508,1500949740,1500949740,Pediatrics,In-Network,E11.9,E78.5,,,,,,,0,,90460,Medicine,,,,12,Home,3,29.89,17.44,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000757,MBR00000025,Institutional-OP,2023-10-01,2023-10-01,2023-10-27,PLN6174,1968299309,1968299309,Internal Medicine,In-Network,E11.9,F41.9,,,,,,,0,,58661,Surgery,,,0900,22,Outpatient Hospital,1,4842.47,1785.9,1358.92,426.98,0.0,0.0,426.98,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000758,MBR00000025,Professional,2023-07-07,2023-07-07,2023-07-22,PLN7025,1389336600,1389336600,Critical Access Hospital,In-Network,M17.11,I48.91,,,,,,,0,,85610,Pathology/Lab,,,,65,End-Stage Renal Disease,2,27.11,15.82,0.0,15.82,25.0,0.0,40.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000759,MBR00000025,Institutional-OP,2023-01-25,2023-01-25,2023-03-09,PLN9791,1812060197,1812060197,Oncology,Out-of-Network,N18.3,R10.9,,,,,,,0,,27130,Surgery,,,0270,22,Outpatient Hospital,2,6723.64,2668.51,0.0,0.0,0.0,0.0,0.0,0.0,Denied,PR-1,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000760,MBR00000025,Institutional-OP,2022-03-12,2022-03-12,2022-04-07,PLN7410,1410468316,1410468316,SNF,In-Network,F32.9,E11.9,,,,,,,0,,83036,Pathology/Lab,,,0510,22,Outpatient Hospital,1,52.11,29.97,14.97,0.0,15.0,0.0,15.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000000761,MBR00000025,Institutional-IP,2021-12-19,2021-12-31,2021-12-28,PLN2732,1622771872,1622771872,Pediatrics,In-Network,N39.0,E11.9,,,,292,MS-DRG,7,12,Y,23472,Surgery,,,0510,21,Inpatient Hospital,2,6148.7,4064.09,3439.83,198.59,0.0,425.67,624.26,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000762,MBR00000025,Professional,2022-08-08,2022-08-08,2022-09-05,PLN2752,1910255109,1910255109,DME Supplier,In-Network,F32.9,I10,,,,,,,0,,99283,E&M,,,,49,Independent Clinic,3,313.79,215.57,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000763,MBR00000025,Professional,2022-05-23,2022-05-23,2022-06-24,PLN1722,1366286000,1366286000,SNF,In-Network,E78.5,I10,,,,,,,0,,90460,Medicine,,,,11,Office,1,53.59,24.02,1.82,22.19,0.0,0.01,22.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000764,MBR00000025,Professional,2021-02-02,2021-02-02,2021-02-21,PLN5758,1168246159,1168246159,Internal Medicine,In-Network,Z79.4,Z12.31,,,,,,,0,,78452,Radiology,,,,23,Emergency Room,1,2671.5,859.7,486.98,372.72,0.0,0.0,372.72,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000765,MBR00000025,Professional,2021-09-09,2021-09-09,2021-09-24,PLN8486,1752470395,1752470395,Home Health,In-Network,K57.30,M81.0,,,,,,,0,,93000,Radiology,,,,11,Office,3,172.83,94.11,19.11,0.0,75.0,0.0,75.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000766,MBR00000025,Institutional-IP,2023-07-04,2023-07-06,2023-08-16,PLN3277,1645194539,1645194539,SNF,In-Network,J44.1,J06.9,,,,871,MS-DRG,14,2,N,G0444,Medicine,,,0370,21,Inpatient Hospital,2,53.63,19.87,4.68,0.0,15.0,0.19,15.19,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000000767,MBR00000025,Institutional-OP,2022-05-17,2022-05-17,2022-06-26,PLN9875,1366576336,1366576336,Geriatrics,In-Network,E11.9,E78.5,,,,,,,0,,99406,Medicine,,,0270,22,Outpatient Hospital,3,89.78,35.05,0.0,35.05,15.0,0.0,50.05,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000768,MBR00000025,Institutional-IP,2023-11-06,2023-11-08,2023-11-18,PLN7967,1644128543,1644128543,Gastroenterology,In-Network,I11.9,F03.90,,,,470,MS-DRG,21,2,W,87491,Pathology/Lab,,,0510,21,Inpatient Hospital,1,240.98,197.34,0.0,197.34,35.0,0.0,232.34,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000000769,MBR00000025,Professional,2021-09-27,2021-09-27,2021-10-18,PLN2615,1717912431,1717912431,Oncology,In-Network,Z12.31,R07.9,,,,,,,0,,72148,Radiology,,,,11,Office,2,1943.61,1357.69,1357.69,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000000770,MBR00000025,Institutional-OP,2023-11-26,2023-11-26,2023-12-05,PLN5810,1103747954,1103747954,Urology,In-Network,Z00.01,N39.0,,,,,,,0,,99233,E&M,,,0900,22,Outpatient Hospital,3,563.12,186.1,0.0,186.1,0.0,0.0,186.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000771,MBR00000025,Institutional-OP,2023-06-03,2023-06-03,2023-06-16,PLN7241,1235381502,1235381502,Cardiology,In-Network,J20.9,Z12.31,,,,,,,0,,83036,Pathology/Lab,,,0120,22,Outpatient Hospital,3,93.89,46.96,0.0,46.96,0.0,0.0,46.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000000772,MBR00000025,Institutional-IP,2022-01-28,2022-02-01,2022-02-20,PLN9897,1609138981,1609138981,Critical Access Hospital,In-Network,Z87.891,E78.5,,,,690,MS-DRG,18,4,Y,43239,Surgery,,,0740,21,Inpatient Hospital,2,1080.09,360.87,285.87,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000773,MBR00000025,Professional,2022-10-30,2022-10-30,2022-12-11,PLN6532,1125190055,1125190055,Nephrology,In-Network,E78.5,R07.9,,,,,,,0,,27447,Surgery,,,,31,Skilled Nursing Facility,3,3965.19,2792.75,2280.68,477.07,35.0,0.0,512.07,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000774,MBR00000025,Institutional-IP,2023-12-19,2023-12-23,2024-01-04,PLN3406,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,J06.9,R05,,,,871,MS-DRG,22,4,Y,76700,Radiology,,,0510,21,Inpatient Hospital,1,782.51,627.94,552.94,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000775,MBR00000025,Professional,2022-11-25,2022-11-25,2022-12-15,PLN2818,1518055405,1518055405,Urology,In-Network,E11.9,J06.9,,,,,,,0,,85610,Pathology/Lab,,,,20,Urgent Care,1,63.83,53.53,0.0,53.53,15.0,0.0,68.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000776,MBR00000025,Professional,2023-10-18,2023-10-18,2023-11-12,PLN2260,1660288235,1660288235,ASC,In-Network,I10,I11.9,,,,,,,0,,99284,E&M,,,,12,Home,1,815.38,309.68,51.68,254.27,0.0,3.73,258.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000777,MBR00000025,Institutional-IP,2021-05-01,2021-05-02,2021-05-14,PLN2206,1518055405,1518055405,Urology,In-Network,Z23,J06.9,,,,194,MS-DRG,16,1,Y,66984,Surgery,,,0636,21,Inpatient Hospital,3,1530.53,1073.12,778.8,143.18,75.0,76.14,294.32,0.0,Paid,,,1,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000000778,MBR00000025,Institutional-IP,2021-06-29,2021-07-08,2021-07-28,PLN2007,1500037969,1500037969,Pulmonology,In-Network,E11.9,E66.9,,,,683,MS-DRG,13,9,Y,99204,E&M,,,0320,21,Inpatient Hospital,1,286.4,101.13,101.13,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000779,MBR00000025,Professional,2021-01-02,2021-01-02,2021-02-01,PLN6098,1752470395,1752470395,Home Health,In-Network,N39.0,R10.9,,,,,,,0,,82043,Pathology/Lab,,,,21,Inpatient Hospital,1,28.46,22.7,0.0,22.7,50.0,0.0,72.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000780,MBR00000025,Institutional-OP,2021-12-23,2021-12-23,2022-01-06,PLN6850,1528335731,1528335731,Critical Access Hospital,In-Network,Z51.11,I10,,,,,,,0,,27447,Surgery,,,0120,22,Outpatient Hospital,2,5034.64,1860.05,1506.07,0.0,15.0,338.98,353.98,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000781,MBR00000026,Institutional-OP,2023-05-15,2023-05-15,2023-05-24,PLN7599,1717546253,1717546253,Family Medicine,In-Network,Z12.31,Z23,,,,,,,0,,93306,Radiology,,,0320,22,Outpatient Hospital,1,2523.08,776.52,236.27,465.25,75.0,0.0,540.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000782,MBR00000026,Institutional-IP,2023-11-22,2023-11-27,2023-12-12,PLN2648,1749494482,1749494482,Pediatrics,In-Network,J18.9,J20.9,,,,683,MS-DRG,22,5,N,45378,Surgery,,,0320,21,Inpatient Hospital,3,1305.0,531.87,0.0,432.35,0.0,11.59,443.94,0.0,Denied,CO-18,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000783,MBR00000026,Professional,2022-08-17,2022-08-17,2022-09-24,PLN1724,1366286000,1366286000,SNF,In-Network,E11.9,M54.5,,,,,,,0,,84443,Pathology/Lab,,,,65,End-Stage Renal Disease,1,139.01,51.79,46.01,0.0,0.0,5.78,5.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000784,MBR00000026,Professional,2022-04-08,2022-04-08,2022-04-15,PLN3382,1118885473,1118885473,ASC,In-Network,J44.1,E11.40,,,,,,,0,,77067,Radiology,,,,11,Office,2,551.48,205.55,180.55,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000000785,MBR00000026,Institutional-IP,2023-10-18,2023-10-20,2023-11-19,PLN3290,1103747954,1103747954,Urology,In-Network,J44.1,E78.5,,,,196,MS-DRG,24,2,Y,99406,Medicine,,,0450,21,Inpatient Hospital,1,84.09,60.49,0.0,60.49,0.0,0.0,60.49,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000786,MBR00000026,Institutional-OP,2022-10-07,2022-10-07,2022-11-15,PLN3361,1433937353,1433937353,Nephrology,In-Network,I50.9,E66.9,,,,,,,0,,72148,Radiology,,,0730,22,Outpatient Hospital,1,2618.22,1715.75,1450.41,265.34,0.0,0.0,265.34,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000787,MBR00000026,Professional,2022-08-12,2022-08-12,2022-09-24,PLN4755,1433937353,1433937353,Nephrology,In-Network,Z00.00,I10,,,,,,,0,,58661,Surgery,,,,21,Inpatient Hospital,2,2268.82,713.35,678.35,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000788,MBR00000026,Professional,2021-04-03,2021-04-03,2021-05-02,PLN6079,1245650222,1245650222,Gastroenterology,In-Network,Z00.00,E11.40,,,,,,,0,,99283,E&M,,,,20,Urgent Care,1,499.13,256.44,0.0,0.0,0.0,0.71,0.71,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000789,MBR00000026,Professional,2021-08-24,2021-08-24,2021-09-06,PLN8547,1860435061,1860435061,DME Supplier,In-Network,I10,I50.9,,,,,,,0,,45378,Surgery,,,,21,Inpatient Hospital,1,1925.59,1101.93,0.0,147.1,25.0,0.0,172.1,0.0,Denied,CO-18,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000790,MBR00000026,Professional,2023-02-04,2023-02-04,2023-02-25,PLN1131,1745114564,1745114564,Endocrinology,In-Network,E11.40,Z00.00,,,,,,,0,,45380,Surgery,,,,23,Emergency Room,1,1888.59,980.4,974.35,0.0,0.0,6.05,6.05,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,1,0,0,0
CLM0000000791,MBR00000026,Institutional-IP,2023-02-04,2023-02-16,2023-02-13,PLN3804,1463205530,1463205530,Nephrology,In-Network,J06.9,I10,,,,195,MS-DRG,23,12,N,74177,Radiology,,,0370,21,Inpatient Hospital,1,1661.59,648.43,633.43,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000792,MBR00000027,Professional,2022-06-28,2022-06-28,2022-07-26,PLN4755,1213165847,1213165847,Critical Access Hospital,In-Network,J44.1,Z12.31,,,,,,,0,,58661,Surgery,,,,49,Independent Clinic,3,4795.36,3432.36,3432.36,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000793,MBR00000027,Professional,2023-02-07,2023-02-07,2023-02-20,PLN1709,1531398223,1531398223,OB/GYN,In-Network,Z23,I25.10,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,1,11157.55,5659.5,5584.5,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000000794,MBR00000027,Professional,2023-01-27,2023-01-27,2023-02-21,PLN1750,1767011137,1767011137,DME Supplier,In-Network,F41.9,E66.9,,,,,,,0,,90686,Medicine,,,,49,Independent Clinic,3,114.34,37.38,32.81,0.0,0.0,4.57,4.57,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000000795,MBR00000027,Institutional-OP,2021-03-13,2021-03-13,2021-04-09,PLN5576,1235381502,1235381502,Cardiology,In-Network,E78.5,Z79.4,,,,,,,0,,43239,Surgery,,,0761,22,Outpatient Hospital,3,2080.83,1657.98,1562.77,0.0,0.0,95.21,95.21,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000796,MBR00000027,Professional,2023-07-04,2023-07-04,2023-07-24,PLN1096,1847081578,1847081578,Urology,Out-of-Network,I10,J20.9,,,,,,,0,,93225,Medicine,,,,22,Outpatient Hospital,2,944.55,513.41,498.41,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000797,MBR00000027,Professional,2023-01-30,2023-01-30,2023-02-25,PLN1749,1372918899,1372918899,Family Medicine,In-Network,J06.9,N18.3,,,,,,,0,,82043,Pathology/Lab,,,,22,Outpatient Hospital,3,62.48,32.15,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000798,MBR00000027,Institutional-IP,2021-08-29,2021-08-30,2021-09-21,PLN8984,1550154147,1550154147,Outpatient Clinic,In-Network,I10,B97.89,,,,690,MS-DRG,7,1,Y,45378,Surgery,,,0740,21,Inpatient Hospital,3,1592.51,1021.12,0.0,105.09,75.0,10.22,190.31,0.0,Denied,CO-29,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000799,MBR00000027,Institutional-OP,2021-08-21,2021-08-21,2021-09-05,PLN7051,1606140917,1606140917,ASC,In-Network,Z23,E78.5,,,,,,,0,,45378,Surgery,,,0270,22,Outpatient Hospital,1,994.71,429.27,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-29,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000800,MBR00000027,Professional,2023-11-16,2023-11-16,2023-12-15,PLN9198,1606140917,1606140917,ASC,In-Network,E78.5,J18.9,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,2,141.27,75.9,25.9,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000801,MBR00000027,Professional,2021-10-06,2021-10-06,2021-11-02,PLN7570,1865904917,1865904917,Outpatient Clinic,In-Network,Z79.4,Z12.31,,,,,,,0,,27447,Surgery,,,,31,Skilled Nursing Facility,2,5334.23,3144.8,0.0,215.0,50.0,0.0,265.0,0.0,Denied,CO-15,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000802,MBR00000027,Institutional-IP,2021-02-05,2021-02-08,2021-02-20,PLN1702,1856686341,1856686341,Geriatrics,In-Network,I10,Z12.31,,,,641,MS-DRG,16,3,Y,99221,E&M,,,0370,21,Inpatient Hospital,1,249.07,120.4,0.0,120.4,0.0,0.0,120.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000803,MBR00000027,Professional,2021-02-04,2021-02-04,2021-03-03,PLN2157,1284035364,1284035364,Pediatrics,In-Network,I10,I10,,,,,,,0,,66984,Surgery,,,,11,Office,3,2358.91,1697.09,1331.18,365.91,0.0,0.0,365.91,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000804,MBR00000027,Institutional-OP,2021-09-07,2021-09-07,2021-10-13,PLN8293,1700633438,1700633438,DME Supplier,In-Network,E11.9,Z12.11,,,,,,,0,,45380,Surgery,,,0740,22,Outpatient Hospital,1,1395.33,452.28,162.16,255.12,35.0,0.0,290.12,0.0,Paid,,,0,,0,0,1,0,0,1,Unbundling,0,1,0,0,0
CLM0000000805,MBR00000027,Institutional-OP,2022-11-18,2022-11-18,2022-12-09,PLN9358,1564502315,1564502315,ASC,In-Network,Z79.4,N40.0,,,,,,,0,,45378,Surgery,,,0301,22,Outpatient Hospital,2,1210.8,667.46,632.24,0.0,0.0,35.22,35.22,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000806,MBR00000027,Professional,2022-05-15,2022-05-15,2022-05-27,PLN5992,1108115157,1108115157,General Acute Care Hospital,In-Network,E11.9,R07.9,,,,,,,0,,99232,E&M,,,,23,Emergency Room,3,343.63,170.0,128.13,0.0,35.0,6.87,41.87,0.0,Adjusted,,,0,,1,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000000807,MBR00000027,Institutional-OP,2023-03-13,2023-03-13,2023-04-20,PLN6527,1518055405,1518055405,Urology,In-Network,E66.9,J06.9,,,,,,,0,,27130,Surgery,,,0320,22,Outpatient Hospital,3,3745.43,3181.13,2565.75,350.53,0.0,264.85,615.38,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000808,MBR00000027,Institutional-IP,2021-09-12,2021-09-22,2021-10-02,PLN7914,1486164553,1486164553,DME Supplier,In-Network,J06.9,I10,,,,196,MS-DRG,4,10,Y,97530,Medicine,,,0320,21,Inpatient Hospital,2,236.35,180.19,0.0,180.19,25.0,0.0,205.19,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000000809,MBR00000027,Professional,2021-09-10,2021-09-10,2021-09-24,PLN5652,1389336600,1389336600,Critical Access Hospital,In-Network,Z23,Z12.31,,,,,,,0,,93225,Medicine,,,,81,Independent Laboratory,1,563.16,434.31,359.31,0.0,75.0,0.0,75.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000810,MBR00000027,Professional,2022-03-19,2022-03-19,2022-04-28,PLN5827,1700633438,1700633438,DME Supplier,In-Network,M54.5,E78.5,,,,,,,0,,85610,Pathology/Lab,,,,22,Outpatient Hospital,3,50.91,26.72,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000811,MBR00000027,Institutional-IP,2023-05-18,2023-05-22,2023-06-24,PLN2288,1910255109,1910255109,DME Supplier,In-Network,E78.5,I11.9,,,,195,MS-DRG,4,4,Y,45380,Surgery,,,0200,21,Inpatient Hospital,2,2294.39,880.08,880.08,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000000812,MBR00000027,Institutional-OP,2022-07-05,2022-07-05,2022-08-15,PLN5599,1749327647,1749327647,Geriatrics,In-Network,E78.5,Z00.00,,,,,,,0,,99222,E&M,,,0370,22,Outpatient Hospital,1,571.63,433.8,433.8,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000813,MBR00000027,Professional,2023-04-15,2023-04-15,2023-04-23,PLN3652,1450094833,1450094833,Outpatient Clinic,In-Network,M54.5,R51,,,,,,,0,,G0444,Medicine,,,,11,Office,1,57.4,35.85,0.0,35.85,35.0,0.0,70.85,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000000814,MBR00000027,Professional,2021-04-13,2021-04-13,2021-04-25,PLN1170,1991459367,1991459367,Neurology,Out-of-Network,J45.20,Z23,,,,,,,0,,G0468,Medicine,,,,81,Independent Laboratory,1,336.04,204.07,189.07,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000815,MBR00000027,Institutional-OP,2022-03-25,2022-03-25,2022-04-12,PLN8632,1790497490,1790497490,OB/GYN,In-Network,G43.909,Z12.31,,,,,,,0,,99232,E&M,,,0120,22,Outpatient Hospital,2,243.22,203.92,167.51,0.0,0.0,36.41,36.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000816,MBR00000027,Professional,2022-04-24,2022-04-24,2022-06-06,PLN3423,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,N17.9,I10,,,,,,,0,,45378,Surgery,,,,11,Office,1,2186.79,932.66,0.0,277.39,0.0,0.0,277.39,0.0,Denied,PR-1,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000817,MBR00000027,Professional,2021-03-16,2021-03-16,2021-04-19,PLN6033,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,K57.30,Z12.31,,,,,,,0,,72148,Radiology,,,,22,Outpatient Hospital,3,1318.26,967.65,798.31,0.0,0.0,169.34,169.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000818,MBR00000027,Professional,2021-12-11,2021-12-11,2022-01-09,PLN9322,1856686341,1856686341,Geriatrics,In-Network,E78.5,M17.11,,,,,,,0,,71046,Radiology,,,,11,Office,1,122.43,37.28,0.0,37.28,15.0,0.0,52.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000819,MBR00000027,Institutional-IP,2021-11-03,2021-11-04,2021-12-05,PLN7802,1334916761,1334916761,ASC,In-Network,I48.91,Z00.01,,,,871,MS-DRG,11,1,Y,93306,Radiology,,,0360,21,Inpatient Hospital,1,1563.05,526.72,462.65,0.0,0.0,64.07,64.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000820,MBR00000027,Institutional-OP,2022-05-14,2022-05-14,2022-06-09,PLN4227,1624802371,1624802371,ASC,Out-of-Network,F41.9,N20.0,,,,,,,0,,90460,Medicine,,,0740,22,Outpatient Hospital,3,76.44,60.67,55.37,0.0,0.0,5.3,5.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000821,MBR00000027,Professional,2021-07-01,2021-07-01,2021-08-11,PLN2851,1186826716,1186826716,Physical Therapy,In-Network,I25.10,Z12.31,,,,,,,0,,99221,E&M,,,,20,Urgent Care,3,233.53,139.31,139.31,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000822,MBR00000028,Professional,2021-10-23,2021-10-23,2021-10-30,PLN2142,1453936007,1453936007,ASC,In-Network,I50.9,N39.0,,,,,,,0,,90686,Medicine,,,,11,Office,1,120.38,68.21,38.89,29.32,0.0,0.0,29.32,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000000823,MBR00000028,Institutional-IP,2023-11-16,2023-11-20,2023-12-28,PLN2057,1109850785,1109850785,ASC,Out-of-Network,I25.10,E78.5,,,,292,MS-DRG,21,4,Y,99232,E&M,,,0740,21,Inpatient Hospital,2,401.8,273.97,251.97,0.0,0.0,22.0,22.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000824,MBR00000028,Institutional-IP,2021-06-06,2021-06-10,2021-07-14,PLN3901,1502838586,1502838586,ASC,In-Network,F32.9,Z23,,,,683,MS-DRG,12,4,Y,93306,Radiology,,,0270,21,Inpatient Hospital,1,2064.53,1748.61,1462.02,83.48,15.0,188.11,286.59,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000825,MBR00000028,Professional,2023-06-15,2023-06-15,2023-07-06,PLN8953,1935547131,1935547131,Pulmonology,In-Network,Z00.00,N39.0,,,,,,,0,,93000,Radiology,,,,20,Urgent Care,2,104.01,62.36,37.36,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000826,MBR00000029,Professional,2022-08-18,2022-08-18,2022-09-25,PLN9081,1644128543,1644128543,Gastroenterology,In-Network,I11.9,E11.9,,,,,,,0,,72148,Radiology,,,,20,Urgent Care,3,2074.95,922.51,922.51,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000827,MBR00000029,Institutional-IP,2021-03-27,2021-04-04,2021-04-29,PLN7157,1219817751,1219817751,OB/GYN,In-Network,Z00.00,E11.9,,,,683,MS-DRG,18,8,Y,27130,Surgery,,,0510,21,Inpatient Hospital,3,6903.22,3867.4,3867.4,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000828,MBR00000029,Professional,2022-03-15,2022-03-15,2022-04-18,PLN2035,1114982472,1114982472,Orthopedic Surgery,In-Network,I10,Z00.01,,,,,,,0,,99283,E&M,,,,21,Inpatient Hospital,3,340.99,133.68,0.0,133.68,0.0,0.0,133.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000829,MBR00000029,Professional,2022-07-17,2022-07-17,2022-07-29,PLN9802,1395983630,1395983630,Nephrology,In-Network,Z00.00,J18.9,,,,,,,0,,81001,Pathology/Lab,,,,21,Inpatient Hospital,1,52.56,25.9,25.9,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000830,MBR00000029,Institutional-OP,2021-10-31,2021-10-31,2021-12-03,PLN9339,1778483301,1778483301,Home Health,In-Network,J44.1,C50.912,,,,,,,0,,99233,E&M,,,0320,22,Outpatient Hospital,3,348.39,159.53,0.0,159.53,25.0,0.0,184.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000831,MBR00000029,Institutional-OP,2021-10-20,2021-10-20,2021-12-03,PLN7175,1872272835,1872272835,Internal Medicine,In-Network,Z23,F32.9,,,,,,,0,,99214,E&M,,,0740,22,Outpatient Hospital,3,283.62,181.25,181.25,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000832,MBR00000029,Professional,2023-02-19,2023-02-19,2023-04-02,PLN2907,1545347862,1545347862,SNF,In-Network,K57.30,E78.5,,,,,,,0,,99221,E&M,,,,11,Office,1,198.67,126.41,126.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000833,MBR00000029,Institutional-OP,2021-02-05,2021-02-05,2021-02-25,PLN5921,1624802371,1624802371,ASC,Out-of-Network,I25.10,M54.5,,,,,,,0,,27130,Surgery,,,0270,22,Outpatient Hospital,2,5226.73,3823.27,3823.27,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000834,MBR00000029,Institutional-IP,2023-10-14,2023-10-18,2023-10-31,PLN6216,1752470395,1752470395,Home Health,In-Network,I48.91,I10,,,,470,MS-DRG,19,4,Y,76700,Radiology,,,0730,21,Inpatient Hospital,3,566.21,386.21,0.0,0.0,0.0,36.15,36.15,0.0,Denied,CO-97,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000835,MBR00000029,Institutional-OP,2021-12-19,2021-12-19,2021-12-28,PLN1440,1502838586,1502838586,ASC,In-Network,I10,I11.9,,,,,,,0,,23472,Surgery,,,0301,22,Outpatient Hospital,1,5935.58,4595.92,4520.92,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000836,MBR00000029,Institutional-OP,2022-02-22,2022-02-22,2022-03-01,PLN6671,1915531927,1915531927,Critical Access Hospital,In-Network,E78.5,M17.11,,,,,,,0,,99233,E&M,,,0900,22,Outpatient Hospital,2,533.64,167.0,0.0,167.0,0.0,0.0,167.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000837,MBR00000029,Institutional-IP,2021-05-20,2021-05-24,2021-07-03,PLN8719,1366286000,1366286000,SNF,In-Network,J44.1,F32.9,,,,195,MS-DRG,20,4,Y,83036,Pathology/Lab,,,0510,21,Inpatient Hospital,2,64.97,35.7,35.7,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,1,0,0
CLM0000000838,MBR00000029,Professional,2023-08-23,2023-08-23,2023-10-03,PLN7225,1273488618,1273488618,General Acute Care Hospital,In-Network,I10,J44.1,,,,,,,0,,99221,E&M,,,,81,Independent Laboratory,2,294.42,104.04,104.04,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000839,MBR00000029,Professional,2021-09-01,2021-09-01,2021-10-07,PLN7362,1689639685,1689639685,SNF,In-Network,M54.5,J45.20,,,,,,,0,,90837,Medicine,,,,11,Office,3,320.07,129.73,129.73,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000840,MBR00000029,Professional,2023-05-31,2023-05-31,2023-06-11,PLN8941,1727809972,1727809972,Home Health,In-Network,N40.0,E11.9,,,,,,,0,,66984,Surgery,,,,21,Inpatient Hospital,1,3016.06,1921.98,1720.57,0.0,35.0,166.41,201.41,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000841,MBR00000029,Professional,2021-12-24,2021-12-24,2022-01-29,PLN1779,1366426662,1366426662,Urology,In-Network,M17.11,E87.6,,,,,,,0,,71046,Radiology,,,,11,Office,3,292.88,222.48,207.49,0.0,0.0,14.99,14.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000842,MBR00000029,Institutional-IP,2021-02-04,2021-02-15,2021-02-18,PLN5253,1224179551,1224179551,Physical Therapy,In-Network,R05,Z12.31,,,,690,MS-DRG,17,11,Y,76700,Radiology,,,0301,21,Inpatient Hospital,3,858.65,399.59,0.0,296.14,75.0,0.0,371.14,0.0,Denied,CO-119,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000843,MBR00000030,Professional,2022-03-24,2022-03-24,2022-04-01,PLN8125,1235381502,1235381502,Cardiology,In-Network,J20.9,Z00.00,,,,,,,0,,47562,Surgery,,,,31,Skilled Nursing Facility,2,5265.11,1684.04,1624.29,9.75,50.0,0.0,59.75,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000844,MBR00000030,Institutional-OP,2022-07-27,2022-07-27,2022-09-06,PLN7743,1542828721,1542828721,Orthopedic Surgery,In-Network,E11.9,R07.9,,,,,,,0,,86900,Pathology/Lab,,,0301,22,Outpatient Hospital,2,24.25,11.11,0.0,11.11,50.0,0.0,61.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000845,MBR00000030,Institutional-OP,2022-05-28,2022-05-28,2022-07-06,PLN4225,1556140803,1556140803,Cardiology,In-Network,E87.6,Z12.31,,,,,,,0,,85025,Pathology/Lab,,,0301,22,Outpatient Hospital,1,70.95,29.13,0.0,29.13,75.0,0.0,104.13,0.0,Denied,CO-15,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000000846,MBR00000030,Professional,2023-12-17,2023-12-17,2024-01-03,PLN5116,1239316214,1239316214,Internal Medicine,In-Network,Z12.11,G43.909,,,,,,,0,,71046,Radiology,,,,22,Outpatient Hospital,2,222.52,121.89,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000847,MBR00000030,Institutional-IP,2022-07-24,2022-07-28,2022-08-14,PLN2286,1186826716,1186826716,Physical Therapy,In-Network,F41.9,F41.9,,,,641,MS-DRG,14,4,U,99233,E&M,,,0900,21,Inpatient Hospital,1,214.7,67.8,17.8,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000000848,MBR00000030,Institutional-OP,2023-05-04,2023-05-04,2023-06-06,PLN7052,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,Z12.31,E78.5,,,,,,,0,,93000,Radiology,,,0730,22,Outpatient Hospital,2,175.05,72.69,0.0,72.69,0.0,0.0,72.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000849,MBR00000030,Institutional-IP,2022-02-10,2022-02-13,2022-03-22,PLN1313,1186826716,1186826716,Physical Therapy,In-Network,E11.9,N20.0,,,,196,MS-DRG,22,3,Y,80061,Pathology/Lab,,,0761,21,Inpatient Hospital,3,83.72,41.54,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000850,MBR00000030,Institutional-OP,2021-06-08,2021-06-08,2021-07-16,PLN6923,1550154147,1550154147,Outpatient Clinic,In-Network,N40.0,J06.9,,,,,,,0,,87491,Pathology/Lab,,,0301,22,Outpatient Hospital,2,231.5,155.53,0.0,113.67,50.0,0.0,163.67,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000851,MBR00000030,Professional,2022-06-30,2022-06-30,2022-08-08,PLN6642,1268679390,1268679390,Critical Access Hospital,In-Network,Z00.00,Z12.31,,,,,,,0,,43239,Surgery,,,,11,Office,3,1429.74,473.38,423.38,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000852,MBR00000030,Professional,2022-09-06,2022-09-06,2022-10-17,PLN3636,1696843572,1696843572,Critical Access Hospital,Out-of-Network,Z23,E11.9,,,,,,,0,,27447,Surgery,,,,49,Independent Clinic,2,3508.46,1194.79,1119.79,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000853,MBR00000030,Professional,2022-04-03,2022-04-03,2022-05-10,PLN1666,1727809972,1727809972,Home Health,In-Network,M54.5,Z12.11,,,,,,,0,,33533,Surgery,,,,49,Independent Clinic,3,19186.53,6560.88,6545.88,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000000854,MBR00000030,Professional,2023-04-20,2023-04-20,2023-05-17,PLN8907,1239316214,1239316214,Internal Medicine,In-Network,Z79.4,R10.9,,,,,,,0,,27447,Surgery,,,,12,Home,2,3476.44,1598.16,1436.15,112.01,50.0,0.0,162.01,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000855,MBR00000030,Professional,2023-11-23,2023-11-23,2024-01-01,PLN9125,1660288235,1660288235,ASC,In-Network,E78.5,Z23,,,,,,,0,,71046,Radiology,,,,49,Independent Clinic,2,146.19,45.2,45.2,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000856,MBR00000030,Institutional-OP,2021-03-30,2021-03-30,2021-04-26,PLN7261,1644128543,1644128543,Gastroenterology,In-Network,F32.9,N39.0,,,,,,,0,,80053,Pathology/Lab,,,0370,22,Outpatient Hospital,2,111.84,95.02,0.0,95.02,75.0,0.0,170.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000857,MBR00000030,Institutional-IP,2021-03-16,2021-03-18,2021-04-22,PLN3922,1717912431,1717912431,Oncology,In-Network,M17.11,I25.10,,,,195,MS-DRG,24,2,Y,74177,Radiology,,,0370,21,Inpatient Hospital,2,1072.98,499.72,474.72,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000000858,MBR00000030,Professional,2021-10-27,2021-10-27,2021-12-06,PLN2252,1550154147,1550154147,Outpatient Clinic,In-Network,Z79.4,E11.40,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,1,46.92,21.68,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000859,MBR00000030,Professional,2022-10-04,2022-10-04,2022-11-04,PLN6368,1571574052,1571574052,Critical Access Hospital,In-Network,J06.9,N18.3,,,,,,,0,,23472,Surgery,,,,81,Independent Laboratory,2,5090.64,3096.31,3029.67,16.64,50.0,0.0,66.64,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000860,MBR00000030,Professional,2021-02-16,2021-02-16,2021-03-09,PLN6203,1702692193,1702692193,Physical Therapy,In-Network,I10,K92.1,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,1,5261.17,3011.88,2547.1,464.78,0.0,0.0,464.78,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000861,MBR00000030,Professional,2021-08-01,2021-08-01,2021-08-16,PLN4666,1749327647,1749327647,Geriatrics,In-Network,I10,I10,,,,,,,0,,99406,Medicine,,,,23,Emergency Room,2,97.42,67.32,67.32,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000862,MBR00000030,Professional,2022-03-24,2022-03-24,2022-04-05,PLN4906,1974006077,1974006077,Orthopedic Surgery,In-Network,I10,F41.9,,,,,,,0,,23472,Surgery,,,,11,Office,3,4032.29,2218.19,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-29,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000863,MBR00000030,Professional,2022-02-16,2022-02-16,2022-03-30,PLN1180,1438368327,1438368327,Home Health,In-Network,I10,C50.912,,,,,,,0,,99222,E&M,,,,11,Office,2,466.09,174.47,174.47,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000864,MBR00000030,Institutional-OP,2023-07-16,2023-07-16,2023-08-02,PLN9666,1502838586,1502838586,ASC,In-Network,E78.5,Z00.00,,,,,,,0,,33533,Surgery,,,0450,22,Outpatient Hospital,3,28187.5,16951.08,16951.08,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000000865,MBR00000030,Institutional-OP,2022-08-22,2022-08-22,2022-09-13,PLN6173,1645194539,1645194539,SNF,In-Network,I10,E78.5,,,,,,,0,,99222,E&M,,,0636,22,Outpatient Hospital,1,268.26,213.34,213.34,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000866,MBR00000030,Professional,2023-08-14,2023-08-14,2023-09-22,PLN2201,1463205530,1463205530,Nephrology,In-Network,I48.91,B97.89,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,3,366.85,110.92,110.92,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000867,MBR00000030,Institutional-OP,2023-04-12,2023-04-12,2023-05-19,PLN1389,1847081578,1847081578,Urology,Out-of-Network,Z00.00,I48.91,,,,,,,0,,71046,Radiology,,,0450,22,Outpatient Hospital,2,152.05,51.64,51.64,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000868,MBR00000030,Institutional-OP,2022-03-30,2022-03-30,2022-05-10,PLN6841,1968299309,1968299309,Internal Medicine,In-Network,Z00.01,I10,,,,,,,0,,99232,E&M,,,0200,22,Outpatient Hospital,1,303.28,251.76,201.76,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000869,MBR00000030,Professional,2023-12-07,2023-12-07,2023-12-16,PLN1739,1266606767,1266606767,ASC,In-Network,Z00.00,F41.9,,,,,,,0,,47562,Surgery,,,,11,Office,2,6586.67,4424.45,0.0,0.0,75.0,549.93,624.93,0.0,Denied,CO-11,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000870,MBR00000030,Professional,2023-07-13,2023-07-13,2023-08-16,PLN8340,1475984649,1475984649,SNF,In-Network,J06.9,F41.9,,,,,,,0,,76700,Radiology,,,,20,Urgent Care,1,1135.99,758.57,457.41,266.16,35.0,0.0,301.16,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000871,MBR00000030,Professional,2022-06-25,2022-06-25,2022-07-19,PLN1618,1139906830,1139906830,Endocrinology,Out-of-Network,N40.0,I10,,,,,,,0,,99203,E&M,,,,11,Office,3,372.03,113.14,113.14,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000872,MBR00000030,Professional,2023-07-21,2023-07-21,2023-08-05,PLN1908,1395983630,1395983630,Nephrology,In-Network,I63.9,Z23,,,,,,,0,,93225,Medicine,,,,50,Federally Qualified Health Center,2,801.97,390.01,390.01,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000000873,MBR00000030,Professional,2021-10-09,2021-10-09,2021-11-10,PLN8151,1219817751,1219817751,OB/GYN,In-Network,Z12.31,I10,,,,,,,0,,74177,Radiology,,,,11,Office,3,2168.28,1302.07,856.68,445.39,0.0,0.0,445.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000874,MBR00000030,Institutional-IP,2021-08-16,2021-08-19,2021-08-27,PLN1745,1696843572,1696843572,Critical Access Hospital,Out-of-Network,M81.0,N20.0,,,,292,MS-DRG,7,3,Y,77067,Radiology,,,0370,21,Inpatient Hospital,3,492.39,194.22,115.97,78.25,0.0,0.0,78.25,0.0,Paid,,,0,,0,1,0,0,0,1,Upcoding,1,0,0,0,0
CLM0000000875,MBR00000030,Professional,2023-05-17,2023-05-17,2023-06-30,PLN8622,1556140803,1556140803,Cardiology,In-Network,N40.0,F32.9,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,2,2534.71,906.05,906.05,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000000876,MBR00000030,Professional,2023-05-15,2023-05-15,2023-06-27,PLN6026,1453936007,1453936007,ASC,In-Network,F41.9,I10,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,2,54.81,38.42,38.42,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000877,MBR00000030,Professional,2021-08-31,2021-08-31,2021-10-05,PLN9236,1475984649,1475984649,SNF,In-Network,J44.1,F41.9,,,,,,,0,,93306,Radiology,,,,11,Office,1,1194.39,478.34,478.34,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000878,MBR00000030,Professional,2023-04-06,2023-04-06,2023-05-07,PLN3928,1716521444,1716521444,Oncology,In-Network,M54.5,Z12.31,,,,,,,0,,81001,Pathology/Lab,,,,31,Skilled Nursing Facility,1,49.81,39.32,0.0,39.32,0.0,0.0,39.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000879,MBR00000030,Professional,2022-07-11,2022-07-11,2022-07-31,PLN7208,1872272835,1872272835,Internal Medicine,In-Network,Z23,E66.9,,,,,,,0,,99203,E&M,,,,23,Emergency Room,3,378.15,220.07,220.07,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000880,MBR00000030,Professional,2022-09-04,2022-09-04,2022-09-28,PLN1904,1994661817,1994661817,SNF,Out-of-Network,Z00.00,J44.1,,,,,,,0,,45378,Surgery,,,,11,Office,2,2127.69,773.93,448.63,325.3,0.0,0.0,325.3,0.0,Adjusted,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000881,MBR00000030,Professional,2023-07-17,2023-07-17,2023-07-26,PLN4197,1268679390,1268679390,Critical Access Hospital,In-Network,Z00.00,F32.9,,,,,,,0,,27447,Surgery,,,,11,Office,2,3086.2,1880.75,1843.69,2.06,35.0,0.0,37.06,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000882,MBR00000030,Professional,2021-06-25,2021-06-25,2021-07-11,PLN8452,1717546253,1717546253,Family Medicine,In-Network,N39.0,I50.9,,,,,,,0,,33533,Surgery,,,,49,Independent Clinic,3,26612.97,13324.06,10867.27,10.98,75.0,2370.81,2456.79,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000000883,MBR00000030,Institutional-OP,2022-03-19,2022-03-19,2022-04-28,PLN2892,1795618275,1795618275,Pulmonology,In-Network,Z00.00,Z23,,,,,,,0,,99204,E&M,,,0740,22,Outpatient Hospital,2,409.6,308.84,283.84,0.0,25.0,0.0,25.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000884,MBR00000030,Professional,2021-11-14,2021-11-14,2021-11-23,PLN2415,1235381502,1235381502,Cardiology,In-Network,I10,E78.5,,,,,,,0,,99203,E&M,,,,23,Emergency Room,1,182.51,141.87,136.02,0.0,0.0,5.85,5.85,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000885,MBR00000030,Institutional-IP,2022-09-02,2022-09-07,2022-09-12,PLN9082,1372918899,1372918899,Family Medicine,In-Network,Z12.31,Z12.31,,,,872,MS-DRG,21,5,Y,66984,Surgery,,,0301,21,Inpatient Hospital,3,2765.51,1089.11,997.54,41.57,50.0,0.0,91.57,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000886,MBR00000030,Institutional-OP,2021-06-22,2021-06-22,2021-08-05,PLN6898,1364429278,1364429278,OB/GYN,In-Network,J44.1,E11.9,,,,,,,0,,33533,Surgery,,,0900,22,Outpatient Hospital,2,12561.21,6371.93,6371.93,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000000887,MBR00000030,Professional,2021-05-11,2021-05-11,2021-06-06,PLN5739,1236418230,1236418230,DME Supplier,In-Network,K21.0,Z00.00,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,2,78.29,28.48,0.0,28.48,35.0,0.0,63.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000888,MBR00000030,Professional,2023-02-02,2023-02-02,2023-02-22,PLN8527,1799205295,1799205295,General Acute Care Hospital,In-Network,N40.0,I10,,,,,,,0,,70553,Radiology,,,,11,Office,2,3902.75,2340.86,1976.35,0.0,0.0,364.51,364.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000889,MBR00000030,Institutional-IP,2021-03-03,2021-03-05,2021-04-06,PLN6519,1990090423,1990090423,Orthopedic Surgery,In-Network,I11.9,K21.0,,,,194,MS-DRG,9,2,U,58661,Surgery,,,0370,21,Inpatient Hospital,3,4787.65,3407.78,2990.92,341.86,75.0,0.0,416.86,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000890,MBR00000031,Professional,2022-04-02,2022-04-02,2022-04-23,PLN9884,1994661817,1994661817,SNF,Out-of-Network,E11.40,E11.9,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,2,36.13,29.63,0.0,29.63,50.0,0.0,79.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000891,MBR00000031,Institutional-OP,2023-12-16,2023-12-16,2024-01-21,PLN7781,1540044947,1540044947,Pulmonology,Out-of-Network,E11.9,Z00.00,,,,,,,0,,99222,E&M,,,0510,22,Outpatient Hospital,3,313.46,240.25,140.64,0.0,75.0,24.61,99.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000892,MBR00000031,Institutional-OP,2023-12-30,2023-12-30,2024-02-04,PLN6465,1845900543,1845900543,ASC,In-Network,J06.9,I10,,,,,,,0,,99204,E&M,,,0200,22,Outpatient Hospital,3,263.05,137.06,0.0,137.06,35.0,0.0,172.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000893,MBR00000031,Professional,2021-07-15,2021-07-15,2021-08-10,PLN6280,1186826716,1186826716,Physical Therapy,In-Network,J20.9,Z23,,,,,,,0,,66984,Surgery,,,,11,Office,1,2624.84,1876.28,1841.75,0.0,0.0,34.53,34.53,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000894,MBR00000031,Professional,2023-10-13,2023-10-13,2023-11-23,PLN9488,1168246159,1168246159,Internal Medicine,In-Network,Z00.00,I10,,,,,,,0,,99284,E&M,,,,23,Emergency Room,1,325.11,244.7,0.0,157.89,35.0,0.88,193.77,0.0,Denied,CO-15,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000895,MBR00000031,Institutional-OP,2022-01-03,2022-01-03,2022-01-31,PLN5624,1727809972,1727809972,Home Health,In-Network,I10,E11.9,,,,,,,0,,90837,Medicine,,,0900,22,Outpatient Hospital,2,429.79,264.81,264.81,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000896,MBR00000031,Institutional-IP,2021-08-06,2021-08-08,2021-09-09,PLN7600,1563980627,1563980627,Critical Access Hospital,In-Network,S72.001A,I11.9,,,,196,MS-DRG,1,2,Y,45378,Surgery,,,0740,21,Inpatient Hospital,1,1936.9,1057.74,939.63,43.11,75.0,0.0,118.11,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000897,MBR00000031,Professional,2022-07-07,2022-07-07,2022-08-14,PLN1788,1622771872,1622771872,Pediatrics,In-Network,E78.5,Z00.00,,,,,,,0,,58661,Surgery,,,,11,Office,2,3899.9,2624.38,2624.38,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000000898,MBR00000031,Institutional-OP,2022-06-19,2022-06-19,2022-06-27,PLN8164,1946680931,1946680931,Critical Access Hospital,Out-of-Network,F41.9,J20.9,,,,,,,0,,85610,Pathology/Lab,,,0370,22,Outpatient Hospital,3,44.55,17.89,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000899,MBR00000031,Professional,2022-02-15,2022-02-15,2022-03-05,PLN7233,1148984206,1148984206,Psychiatry,In-Network,I50.9,I48.91,,,,,,,0,,33533,Surgery,,,,50,Federally Qualified Health Center,3,12273.76,5683.48,5569.07,114.41,0.0,0.0,114.41,0.0,Pended,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000000900,MBR00000031,Institutional-OP,2022-04-13,2022-04-13,2022-05-11,PLN1925,1563980627,1563980627,Critical Access Hospital,In-Network,F10.20,E11.40,,,,,,,0,,G0444,Medicine,,,0510,22,Outpatient Hospital,2,102.63,32.63,0.0,32.63,35.0,0.0,67.63,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000000901,MBR00000031,Institutional-OP,2021-04-17,2021-04-17,2021-05-16,PLN3510,1575695214,1575695214,SNF,In-Network,F03.90,J06.9,,,,,,,0,,71046,Radiology,,,0761,22,Outpatient Hospital,2,296.28,246.36,0.0,0.0,25.0,25.75,50.75,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000902,MBR00000031,Professional,2021-10-16,2021-10-16,2021-11-22,PLN6290,1840431511,1840431511,Geriatrics,Out-of-Network,Z96.641,Z23,,,,,,,0,,G0439,Medicine,,,,22,Outpatient Hospital,3,453.14,221.13,0.0,221.13,15.0,0.0,236.13,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000000903,MBR00000031,Professional,2021-08-04,2021-08-04,2021-08-11,PLN8300,1434029575,1434029575,Endocrinology,In-Network,Z23,E78.5,,,,,,,0,,87491,Pathology/Lab,,,,50,Federally Qualified Health Center,1,121.55,54.08,0.0,54.08,35.0,0.0,89.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000904,MBR00000031,Professional,2023-10-18,2023-10-18,2023-11-24,PLN1414,1337791138,1337791138,Internal Medicine,Out-of-Network,K21.0,J44.1,,,,,,,0,,85025,Pathology/Lab,,,,31,Skilled Nursing Facility,2,95.57,68.98,0.0,68.98,25.0,0.0,93.98,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000000905,MBR00000031,Institutional-OP,2022-06-25,2022-06-25,2022-07-22,PLN7447,1235381502,1235381502,Cardiology,In-Network,I10,E78.5,,,,,,,0,,66984,Surgery,,,0301,22,Outpatient Hospital,3,2020.58,620.47,553.6,0.0,0.0,66.87,66.87,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000906,MBR00000031,Professional,2022-08-22,2022-08-22,2022-09-27,PLN8445,1899127912,1899127912,Neurology,In-Network,I11.9,J06.9,,,,,,,0,,99232,E&M,,,,65,End-Stage Renal Disease,1,372.78,142.16,142.16,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000907,MBR00000031,Professional,2022-04-26,2022-04-26,2022-05-10,PLN8850,1227362142,1227362142,DME Supplier,In-Network,E11.9,R07.9,,,,,,,0,,47562,Surgery,,,,49,Independent Clinic,3,3232.99,1168.18,856.48,236.7,75.0,0.0,311.7,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000908,MBR00000031,Institutional-IP,2023-08-27,2023-09-05,2023-09-04,PLN6269,1148984206,1148984206,Psychiatry,In-Network,M54.5,E78.5,,,,470,MS-DRG,9,9,Y,27447,Surgery,,,0360,21,Inpatient Hospital,2,3347.54,2167.18,2014.68,0.0,0.0,152.5,152.5,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000909,MBR00000031,Professional,2023-05-25,2023-05-25,2023-06-06,PLN7235,1727809972,1727809972,Home Health,In-Network,R10.9,I10,,,,,,,0,,99283,E&M,,,,21,Inpatient Hospital,3,364.82,217.44,0.0,217.44,35.0,0.0,252.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000910,MBR00000031,Professional,2023-01-26,2023-01-26,2023-03-03,PLN6422,1132188260,1132188260,Family Medicine,In-Network,J44.1,J45.20,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,1,278.36,234.51,53.93,105.58,75.0,0.0,180.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000911,MBR00000031,Institutional-OP,2021-12-08,2021-12-08,2022-01-01,PLN9848,1389336600,1389336600,Critical Access Hospital,In-Network,Z23,J20.9,,,,,,,0,,27447,Surgery,,,0450,22,Outpatient Hospital,2,5912.07,1952.38,1877.38,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000912,MBR00000031,Professional,2021-12-04,2021-12-04,2022-01-16,PLN2678,1915531927,1915531927,Critical Access Hospital,In-Network,Z12.31,S72.001A,,,,,,,0,,23472,Surgery,,,,11,Office,2,7367.93,5876.16,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-27,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000913,MBR00000031,Institutional-IP,2023-10-27,2023-11-07,2023-11-22,PLN2686,1935547131,1935547131,Pulmonology,In-Network,F41.9,J06.9,,,,291,MS-DRG,21,11,Y,77067,Radiology,,,0740,21,Inpatient Hospital,2,344.44,169.25,0.0,169.25,0.0,0.0,169.25,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000000914,MBR00000031,Professional,2023-10-16,2023-10-16,2023-10-30,PLN5608,1964402759,1964402759,Outpatient Clinic,In-Network,I25.10,E11.9,,,,,,,0,,99284,E&M,,,,11,Office,2,830.35,449.67,24.4,390.27,35.0,0.0,425.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000915,MBR00000031,Professional,2021-11-06,2021-11-06,2021-11-17,PLN4114,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,K21.0,I10,,,,,,,0,,99232,E&M,,,,11,Office,3,241.83,113.63,88.63,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000916,MBR00000031,Professional,2022-01-04,2022-01-04,2022-01-18,PLN2680,1997536841,1997536841,Family Medicine,Out-of-Network,I10,N40.0,,,,,,,0,,45378,Surgery,,,,49,Independent Clinic,1,1937.79,1515.73,1191.96,205.94,0.0,117.83,323.77,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000000917,MBR00000031,Professional,2021-12-29,2021-12-29,2022-02-07,PLN2037,1168246159,1168246159,Internal Medicine,In-Network,Z87.891,I11.9,,,,,,,0,,99213,E&M,,,,11,Office,2,148.3,91.47,91.47,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000918,MBR00000031,Institutional-OP,2023-05-09,2023-05-09,2023-05-23,PLN5449,1806688928,1806688928,Geriatrics,In-Network,M54.5,R10.9,,,,,,,0,,70553,Radiology,,,0320,22,Outpatient Hospital,2,1981.58,823.25,520.15,165.44,15.0,122.66,303.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000919,MBR00000031,Professional,2023-11-06,2023-11-06,2023-12-05,PLN3416,1997536841,1997536841,Family Medicine,Out-of-Network,B97.89,Z87.891,,,,,,,0,,47562,Surgery,,,,49,Independent Clinic,2,4347.1,1693.19,1322.03,189.95,25.0,156.21,371.16,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000920,MBR00000031,Professional,2023-08-30,2023-08-30,2023-09-27,PLN6587,1749494482,1749494482,Pediatrics,In-Network,K21.0,E11.65,,,,,,,0,,72148,Radiology,,,,12,Home,1,2379.91,1845.89,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000921,MBR00000031,Institutional-OP,2023-07-10,2023-07-10,2023-08-03,PLN1900,1624202402,1624202402,Orthopedic Surgery,In-Network,R07.9,E11.9,,,,,,,0,,66984,Surgery,,,0270,22,Outpatient Hospital,2,3472.25,2301.97,2301.97,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000922,MBR00000031,Professional,2022-01-17,2022-01-17,2022-02-10,PLN9034,1198133277,1198133277,SNF,In-Network,Z00.00,M54.5,,,,,,,0,,72148,Radiology,,,,11,Office,2,2948.38,1675.97,1600.97,0.0,75.0,0.0,75.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000923,MBR00000031,Institutional-OP,2021-12-14,2021-12-14,2022-01-18,PLN1991,1991459367,1991459367,Neurology,Out-of-Network,R05,Z12.31,,,,,,,0,,99203,E&M,,,0200,22,Outpatient Hospital,1,356.65,216.46,181.46,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000924,MBR00000031,Professional,2023-09-01,2023-09-01,2023-09-12,PLN5981,1542828721,1542828721,Orthopedic Surgery,In-Network,E87.6,J20.9,,,,,,,0,,78452,Radiology,,,,11,Office,1,6486.82,5012.89,5012.89,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000925,MBR00000031,Professional,2022-03-09,2022-03-09,2022-03-24,PLN7444,1511044648,1511044648,Endocrinology,In-Network,F32.9,Z12.11,,,,,,,0,,99214,E&M,,,,11,Office,2,199.92,88.65,0.0,88.65,0.0,0.0,88.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000926,MBR00000031,Professional,2021-08-24,2021-08-24,2021-09-22,PLN6069,1702692193,1702692193,Physical Therapy,In-Network,I11.9,K21.0,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,3,82.78,38.51,0.0,38.51,0.0,0.0,38.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000927,MBR00000031,Professional,2023-07-12,2023-07-12,2023-08-16,PLN1341,1915531927,1915531927,Critical Access Hospital,In-Network,J18.9,E78.5,,,,,,,0,,90460,Medicine,,,,22,Outpatient Hospital,1,62.31,27.86,27.86,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000928,MBR00000031,Institutional-OP,2022-06-10,2022-06-10,2022-06-20,PLN4925,1856686341,1856686341,Geriatrics,In-Network,J45.20,Z23,,,,,,,0,,23472,Surgery,,,0450,22,Outpatient Hospital,3,5284.19,2857.43,2381.96,0.0,50.0,425.47,475.47,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000929,MBR00000032,Institutional-OP,2021-04-05,2021-04-05,2021-05-17,PLN3600,1968299309,1968299309,Internal Medicine,In-Network,N40.0,F41.9,,,,,,,0,,99214,E&M,,,0900,22,Outpatient Hospital,3,231.31,192.15,0.0,192.15,75.0,0.0,267.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000930,MBR00000032,Institutional-IP,2023-09-09,2023-09-22,2023-10-22,PLN4576,1366576336,1366576336,Geriatrics,In-Network,R07.9,J06.9,,,,291,MS-DRG,23,13,Y,58661,Surgery,,,0370,21,Inpatient Hospital,2,2339.86,1983.89,1816.99,116.9,50.0,0.0,166.9,0.0,Paid,,,0,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000000931,MBR00000032,Professional,2021-11-19,2021-11-19,2021-12-10,PLN5190,1139906830,1139906830,Endocrinology,Out-of-Network,I10,R51,,,,,,,0,,99283,E&M,,,,50,Federally Qualified Health Center,1,453.51,266.3,244.0,0.0,0.0,22.3,22.3,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000932,MBR00000032,Professional,2021-12-05,2021-12-05,2021-12-19,PLN7214,1948810580,1948810580,DME Supplier,In-Network,I10,Z87.891,,,,,,,0,,99222,E&M,,,,11,Office,2,609.13,460.44,362.12,0.0,25.0,73.32,98.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000933,MBR00000032,Professional,2022-08-06,2022-08-06,2022-08-23,PLN1041,1561134315,1561134315,DME Supplier,In-Network,F32.9,E11.9,,,,,,,0,,78452,Radiology,,,,49,Independent Clinic,1,3862.24,2249.07,0.0,0.0,25.0,289.98,314.98,0.0,Denied,CO-50,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000934,MBR00000032,Professional,2021-10-23,2021-10-23,2021-11-03,PLN1922,1624202402,1624202402,Orthopedic Surgery,In-Network,I50.9,E78.5,,,,,,,0,,74177,Radiology,,,,22,Outpatient Hospital,1,1500.75,547.68,418.96,128.72,0.0,0.0,128.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000935,MBR00000032,Professional,2023-06-27,2023-06-27,2023-08-08,PLN2373,1518055405,1518055405,Urology,In-Network,E11.9,Z00.00,,,,,,,0,,93306,Radiology,,,,22,Outpatient Hospital,1,3213.07,1198.05,1072.75,125.3,0.0,0.0,125.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000936,MBR00000032,Professional,2023-01-28,2023-01-28,2023-02-18,PLN4074,1845057593,1845057593,Orthopedic Surgery,In-Network,E78.5,Z00.00,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,2,312.23,165.19,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000937,MBR00000032,Professional,2022-09-11,2022-09-11,2022-10-13,PLN3679,1550154147,1550154147,Outpatient Clinic,In-Network,I10,E78.5,,,,,,,0,,99214,E&M,,,,31,Skilled Nursing Facility,2,189.62,97.54,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000938,MBR00000032,Institutional-OP,2021-08-08,2021-08-08,2021-08-17,PLN9241,1687650653,1687650653,Internal Medicine,In-Network,R51,E78.5,,,,,,,0,,58661,Surgery,,,0900,22,Outpatient Hospital,2,2980.9,1037.88,924.05,0.0,0.0,113.83,113.83,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000939,MBR00000032,Professional,2022-06-21,2022-06-21,2022-07-14,PLN6501,1239316214,1239316214,Internal Medicine,In-Network,J18.9,Z00.00,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,1,3983.81,1711.72,1661.72,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000940,MBR00000032,Professional,2021-10-26,2021-10-26,2021-11-29,PLN5257,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,Z00.00,M54.5,,,,,,,0,,99283,E&M,,,,11,Office,2,644.13,371.22,319.25,0.0,15.0,36.97,51.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000941,MBR00000032,Professional,2023-11-20,2023-11-20,2023-12-07,PLN2321,1103747954,1103747954,Urology,In-Network,Z00.00,E11.9,,,,,,,0,,G0444,Medicine,,,,11,Office,1,60.7,27.38,27.38,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000000942,MBR00000032,Institutional-IP,2023-05-18,2023-06-02,2023-06-17,PLN6341,1433937353,1433937353,Nephrology,In-Network,J45.20,Z23,,,,872,MS-DRG,3,15,Y,99203,E&M,,,0900,21,Inpatient Hospital,1,141.44,46.91,0.0,46.91,50.0,0.0,96.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000943,MBR00000032,Institutional-IP,2021-05-08,2021-05-18,2021-05-25,PLN8299,1569105090,1569105090,Geriatrics,In-Network,M54.5,J06.9,,,,470,MS-DRG,4,10,Y,58661,Surgery,,,0730,21,Inpatient Hospital,3,2878.31,1336.27,849.01,487.26,0.0,0.0,487.26,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000944,MBR00000032,Professional,2022-08-02,2022-08-02,2022-08-13,PLN2979,1410468316,1410468316,SNF,In-Network,I25.10,I25.10,,,,,,,0,,97110,Medicine,,,,31,Skilled Nursing Facility,1,210.16,68.63,66.79,0.0,0.0,1.84,1.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000945,MBR00000032,Institutional-OP,2023-05-05,2023-05-05,2023-06-12,PLN4872,1590915516,1590915516,Physical Therapy,Out-of-Network,B97.89,E11.65,,,,,,,0,,G0444,Medicine,,,0360,22,Outpatient Hospital,3,51.63,29.88,0.0,29.88,25.0,0.0,54.88,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000000946,MBR00000032,Institutional-IP,2022-07-28,2022-08-02,2022-08-23,PLN4463,1193493783,1193493783,Critical Access Hospital,Out-of-Network,Z00.01,M54.5,,,,690,MS-DRG,22,5,Y,23472,Surgery,,,0730,21,Inpatient Hospital,2,5827.77,3809.26,3784.26,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000947,MBR00000032,Professional,2021-05-20,2021-05-20,2021-06-10,PLN4900,1148984206,1148984206,Psychiatry,In-Network,Z12.31,E11.40,,,,,,,0,,72148,Radiology,,,,65,End-Stage Renal Disease,1,1380.88,489.18,489.18,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000948,MBR00000032,Professional,2021-06-03,2021-06-03,2021-06-17,PLN2833,1475984649,1475984649,SNF,In-Network,J44.1,I25.10,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,2,96.12,67.11,14.59,27.52,25.0,0.0,52.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000949,MBR00000032,Institutional-OP,2023-03-14,2023-03-14,2023-03-23,PLN6690,1624802371,1624802371,ASC,Out-of-Network,J45.20,G43.909,,,,,,,0,,99233,E&M,,,0900,22,Outpatient Hospital,2,257.29,191.05,191.05,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000950,MBR00000032,Professional,2022-07-28,2022-07-28,2022-08-23,PLN9755,1139906830,1139906830,Endocrinology,Out-of-Network,I10,E78.5,,,,,,,0,,70450,Radiology,,,,11,Office,1,1493.15,675.07,675.07,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000951,MBR00000032,Professional,2022-08-18,2022-08-18,2022-09-07,PLN5576,1186826716,1186826716,Physical Therapy,In-Network,K21.0,R10.9,,,,,,,0,,99406,Medicine,,,,11,Office,2,87.72,42.09,6.45,0.0,35.0,0.64,35.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000952,MBR00000032,Professional,2021-10-23,2021-10-23,2021-11-23,PLN2561,1528335731,1528335731,Critical Access Hospital,In-Network,I48.91,N39.0,,,,,,,0,,G0444,Medicine,,,,65,End-Stage Renal Disease,1,73.9,60.01,60.01,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000000953,MBR00000032,Professional,2021-10-17,2021-10-17,2021-10-28,PLN3162,1108115157,1108115157,General Acute Care Hospital,In-Network,Z12.31,J18.9,,,,,,,0,,90460,Medicine,,,,20,Urgent Care,3,39.78,30.29,30.29,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000954,MBR00000032,Institutional-OP,2022-03-22,2022-03-22,2022-04-15,PLN4219,1590915516,1590915516,Physical Therapy,Out-of-Network,M54.5,F32.9,,,,,,,0,,74177,Radiology,,,0510,22,Outpatient Hospital,2,1755.48,1120.38,1006.24,44.8,0.0,69.34,114.14,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000955,MBR00000032,Institutional-OP,2022-08-18,2022-08-18,2022-09-25,PLN5211,1780163051,1780163051,SNF,In-Network,E11.9,F03.90,,,,,,,0,,93306,Radiology,,,0740,22,Outpatient Hospital,2,2782.44,1061.34,930.29,0.0,75.0,56.05,131.05,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000000956,MBR00000032,Institutional-OP,2022-05-29,2022-05-29,2022-06-24,PLN1622,1728018911,1728018911,Nephrology,In-Network,Z12.31,C50.912,,,,,,,0,,99203,E&M,,,0120,22,Outpatient Hospital,3,243.49,122.02,97.02,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000957,MBR00000032,Institutional-IP,2023-08-21,2023-08-23,2023-09-14,PLN5369,1334916761,1334916761,ASC,In-Network,Z12.31,E66.9,,,,871,MS-DRG,4,2,N,81001,Pathology/Lab,,,0740,21,Inpatient Hospital,1,38.72,12.76,0.0,12.76,25.0,0.0,37.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000958,MBR00000032,Institutional-IP,2021-07-26,2021-07-27,2021-08-18,PLN9463,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,J06.9,Z12.31,,,,194,MS-DRG,8,1,Y,82043,Pathology/Lab,,,0636,21,Inpatient Hospital,3,53.31,27.26,27.15,0.0,0.0,0.11,0.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000959,MBR00000032,Professional,2022-06-02,2022-06-02,2022-06-22,PLN1206,1390307371,1390307371,DME Supplier,In-Network,J20.9,J20.9,,,,,,,0,,27447,Surgery,,,,11,Office,3,4783.05,1565.72,1257.8,232.92,75.0,0.0,307.92,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000960,MBR00000032,Institutional-OP,2021-09-15,2021-09-15,2021-10-08,PLN4411,1624202402,1624202402,Orthopedic Surgery,In-Network,Z00.01,F32.9,,,,,,,0,,G0468,Medicine,,,0200,22,Outpatient Hospital,1,659.5,504.01,504.01,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000961,MBR00000032,Professional,2021-01-08,2021-01-08,2021-01-31,PLN3420,1609526529,1609526529,Psychiatry,In-Network,R10.9,M54.5,,,,,,,0,,99221,E&M,,,,11,Office,2,425.1,230.55,0.0,230.55,0.0,0.0,230.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000962,MBR00000032,Professional,2022-03-31,2022-03-31,2022-05-13,PLN6712,1575695214,1575695214,SNF,In-Network,I63.9,Z23,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,2,35.39,26.04,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000963,MBR00000032,Institutional-OP,2021-03-03,2021-03-03,2021-03-24,PLN8386,1622771872,1622771872,Pediatrics,In-Network,I48.91,E66.9,,,,,,,0,,70553,Radiology,,,0320,22,Outpatient Hospital,1,4069.22,1578.28,0.0,92.69,0.0,259.79,352.48,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000964,MBR00000032,Institutional-OP,2022-02-12,2022-02-12,2022-02-27,PLN3838,1745114564,1745114564,Endocrinology,In-Network,Z00.00,Z23,,,,,,,0,,99213,E&M,,,0120,22,Outpatient Hospital,3,261.24,148.25,136.15,0.0,0.0,12.1,12.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000965,MBR00000032,Professional,2022-11-24,2022-11-24,2022-12-22,PLN4000,1716521444,1716521444,Oncology,In-Network,E78.5,J20.9,,,,,,,0,,43239,Surgery,,,,11,Office,3,2193.12,1407.1,1144.78,0.0,0.0,262.32,262.32,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000966,MBR00000032,Professional,2022-02-16,2022-02-16,2022-02-23,PLN9805,1247341320,1247341320,Urology,Out-of-Network,I48.91,F32.9,,,,,,,0,,77067,Radiology,,,,11,Office,2,505.93,390.51,390.51,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000000967,MBR00000032,Professional,2023-01-13,2023-01-13,2023-01-24,PLN2731,1631954542,1631954542,Oncology,In-Network,I11.9,F32.9,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,3,72.67,25.39,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000968,MBR00000032,Institutional-IP,2021-11-19,2021-11-23,2021-12-07,PLN5215,1622771872,1622771872,Pediatrics,In-Network,F41.9,R10.9,,,,470,MS-DRG,16,4,Y,27130,Surgery,,,0360,21,Inpatient Hospital,3,3056.71,1245.13,1196.62,0.0,0.0,48.51,48.51,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000969,MBR00000032,Professional,2022-03-16,2022-03-16,2022-04-05,PLN9159,1244186984,1244186984,Family Medicine,Out-of-Network,G43.909,K57.30,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,2,360.88,239.17,189.17,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000970,MBR00000032,Professional,2023-08-17,2023-08-17,2023-09-26,PLN3158,1700633438,1700633438,DME Supplier,In-Network,J45.20,I25.10,,,,,,,0,,99283,E&M,,,,11,Office,3,401.84,240.84,240.84,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000971,MBR00000032,Professional,2021-09-23,2021-09-23,2021-10-04,PLN2709,1780163051,1780163051,SNF,In-Network,N18.3,E11.9,,,,,,,0,,90837,Medicine,,,,31,Skilled Nursing Facility,2,200.48,136.41,136.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000972,MBR00000032,Institutional-OP,2022-07-03,2022-07-03,2022-07-27,PLN2473,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,I48.91,I10,,,,,,,0,,58661,Surgery,,,0761,22,Outpatient Hospital,1,2884.19,1354.04,827.26,300.38,50.0,176.4,526.78,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000973,MBR00000032,Institutional-OP,2023-02-23,2023-02-23,2023-03-05,PLN3961,1994661817,1994661817,SNF,Out-of-Network,I11.9,I10,,,,,,,0,,43239,Surgery,,,0636,22,Outpatient Hospital,2,1238.27,777.84,777.84,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000974,MBR00000033,Institutional-OP,2022-02-01,2022-02-01,2022-03-17,PLN6275,1542828721,1542828721,Orthopedic Surgery,In-Network,Z87.891,F41.9,,,,,,,0,,99213,E&M,,,0761,22,Outpatient Hospital,2,297.87,104.04,45.63,0.0,50.0,8.41,58.41,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000975,MBR00000033,Institutional-OP,2021-11-30,2021-11-30,2021-12-28,PLN2208,1531398223,1531398223,OB/GYN,In-Network,I10,I10,,,,,,,0,,27130,Surgery,,,0200,22,Outpatient Hospital,3,5130.11,2614.61,2614.61,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000976,MBR00000033,Professional,2023-02-04,2023-02-04,2023-02-24,PLN3892,1717546253,1717546253,Family Medicine,In-Network,E11.40,E78.5,,,,,,,0,,G0439,Medicine,,,,11,Office,2,250.72,162.92,138.23,0.0,0.0,24.69,24.69,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000000977,MBR00000033,Professional,2021-03-23,2021-03-23,2021-04-03,PLN4268,1948810580,1948810580,DME Supplier,In-Network,M81.0,J06.9,,,,,,,0,,45380,Surgery,,,,20,Urgent Care,3,1950.9,714.5,536.8,177.7,0.0,0.0,177.7,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000000978,MBR00000033,Professional,2021-10-18,2021-10-18,2021-11-18,PLN9029,1139906830,1139906830,Endocrinology,Out-of-Network,E11.9,Z00.00,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,3,82.9,40.44,40.44,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000979,MBR00000033,Professional,2022-03-25,2022-03-25,2022-04-01,PLN9826,1247341320,1247341320,Urology,Out-of-Network,N20.0,Z79.4,,,,,,,0,,G0444,Medicine,,,,11,Office,1,49.66,15.62,13.23,0.0,0.0,2.39,2.39,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000000980,MBR00000033,Institutional-IP,2021-08-27,2021-09-03,2021-10-10,PLN2374,1247341320,1247341320,Urology,Out-of-Network,Z12.31,Z00.01,,,,195,MS-DRG,7,7,Y,97530,Medicine,,,0740,21,Inpatient Hospital,3,205.07,122.0,25.5,96.5,0.0,0.0,96.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000981,MBR00000033,Professional,2022-08-14,2022-08-14,2022-09-17,PLN1145,1366576336,1366576336,Geriatrics,In-Network,R10.9,E78.5,,,,,,,0,,90460,Medicine,,,,22,Outpatient Hospital,1,42.65,30.56,0.0,30.56,0.0,0.0,30.56,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000982,MBR00000033,Institutional-OP,2022-11-10,2022-11-10,2022-12-23,PLN7042,1571574052,1571574052,Critical Access Hospital,In-Network,E66.9,Z23,,,,,,,0,,93225,Medicine,,,0730,22,Outpatient Hospital,2,652.76,379.71,259.2,95.51,25.0,0.0,120.51,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000983,MBR00000033,Professional,2023-11-24,2023-11-24,2024-01-03,PLN9010,1948810580,1948810580,DME Supplier,In-Network,Z23,Z00.00,,,,,,,0,,70450,Radiology,,,,23,Emergency Room,3,1165.77,745.65,745.65,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000984,MBR00000033,Professional,2022-10-21,2022-10-21,2022-11-24,PLN8263,1366426662,1366426662,Urology,In-Network,G20,Z00.00,,,,,,,0,,G0439,Medicine,,,,11,Office,3,331.1,175.2,118.38,0.0,50.0,6.82,56.82,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000000985,MBR00000033,Institutional-OP,2022-10-11,2022-10-11,2022-11-08,PLN8372,1125190055,1125190055,Nephrology,In-Network,Z12.31,J44.1,,,,,,,0,,85025,Pathology/Lab,,,0120,22,Outpatient Hospital,2,45.8,18.77,0.0,18.77,15.0,0.0,33.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000986,MBR00000033,Institutional-IP,2023-03-06,2023-03-08,2023-03-14,PLN1188,1434029575,1434029575,Endocrinology,In-Network,Z00.01,N39.0,,,,292,MS-DRG,16,2,U,93225,Medicine,,,0900,21,Inpatient Hospital,3,753.18,546.63,546.63,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000987,MBR00000033,Professional,2021-08-17,2021-08-17,2021-09-08,PLN6614,1845057593,1845057593,Orthopedic Surgery,In-Network,N18.3,Z79.4,,,,,,,0,,90460,Medicine,,,,11,Office,1,58.54,29.16,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000988,MBR00000033,Institutional-IP,2022-05-31,2022-06-01,2022-06-18,PLN2396,1806688928,1806688928,Geriatrics,In-Network,F32.9,N39.0,,,,682,MS-DRG,14,1,Y,27130,Surgery,,,0900,21,Inpatient Hospital,1,3599.54,1619.89,1365.58,254.31,0.0,0.0,254.31,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000989,MBR00000033,Institutional-IP,2023-07-01,2023-07-05,2023-07-12,PLN5547,1205377316,1205377316,Orthopedic Surgery,In-Network,J45.20,I10,,,,196,MS-DRG,2,4,Y,99213,E&M,,,0120,21,Inpatient Hospital,1,139.01,78.72,28.72,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000990,MBR00000033,Professional,2021-07-12,2021-07-12,2021-07-22,PLN3569,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,Z00.00,G20,,,,,,,0,,90460,Medicine,,,,11,Office,1,65.38,34.46,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000991,MBR00000033,Professional,2021-11-16,2021-11-16,2021-11-24,PLN3714,1295371663,1295371663,Critical Access Hospital,In-Network,F32.9,K57.30,,,,,,,0,,58661,Surgery,,,,21,Inpatient Hospital,3,4187.5,1621.49,0.0,107.38,0.0,0.0,107.38,0.0,Denied,CO-4,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000992,MBR00000033,Institutional-OP,2021-08-29,2021-08-29,2021-09-05,PLN4441,1168246159,1168246159,Internal Medicine,In-Network,I50.9,I48.91,,,,,,,0,,97110,Medicine,,,0370,22,Outpatient Hospital,1,207.89,132.63,57.63,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000993,MBR00000033,Professional,2023-11-17,2023-11-17,2023-12-29,PLN6022,1438368327,1438368327,Home Health,In-Network,I10,Z00.01,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,1,2176.32,997.51,982.51,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000000994,MBR00000033,Professional,2022-01-23,2022-01-23,2022-02-10,PLN6779,1114982472,1114982472,Orthopedic Surgery,In-Network,Z00.00,I63.9,,,,,,,0,,93000,Radiology,,,,23,Emergency Room,3,83.65,28.06,0.0,28.06,50.0,0.0,78.06,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000000995,MBR00000033,Professional,2021-12-23,2021-12-23,2022-01-12,PLN4675,1590915516,1590915516,Physical Therapy,Out-of-Network,N18.3,F41.9,,,,,,,0,,99406,Medicine,,,,31,Skilled Nursing Facility,2,94.36,79.51,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000996,MBR00000033,Professional,2023-06-12,2023-06-12,2023-07-02,PLN5118,1531398223,1531398223,OB/GYN,In-Network,J06.9,E66.9,,,,,,,0,,99233,E&M,,,,11,Office,1,337.4,266.33,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000997,MBR00000034,Institutional-OP,2023-09-23,2023-09-23,2023-10-23,PLN3951,1395983630,1395983630,Nephrology,In-Network,F41.9,I50.9,,,,,,,0,,43239,Surgery,,,0761,22,Outpatient Hospital,2,1120.08,885.71,835.71,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000000998,MBR00000034,Professional,2021-01-06,2021-01-06,2021-01-28,PLN1111,1624202402,1624202402,Orthopedic Surgery,In-Network,N18.3,F41.9,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,2,196.43,105.2,30.2,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000000999,MBR00000034,Institutional-OP,2023-08-21,2023-08-21,2023-09-27,PLN8866,1910255109,1910255109,DME Supplier,In-Network,M54.5,E78.5,,,,,,,0,,33533,Surgery,,,0761,22,Outpatient Hospital,1,13017.5,7426.41,6735.7,0.0,0.0,690.71,690.71,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000001000,MBR00000034,Institutional-OP,2023-02-14,2023-02-14,2023-03-13,PLN4381,1865904917,1865904917,Outpatient Clinic,In-Network,E11.9,G43.909,,,,,,,0,,72148,Radiology,,,0200,22,Outpatient Hospital,2,1536.55,701.99,701.99,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001001,MBR00000034,Professional,2023-08-05,2023-08-05,2023-09-12,PLN5278,1334916761,1334916761,ASC,In-Network,E11.9,Z12.31,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,1,4702.97,3308.14,3040.96,111.45,25.0,0.0,136.45,130.73,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001002,MBR00000034,Institutional-OP,2021-04-05,2021-04-05,2021-05-04,PLN9209,1198133277,1198133277,SNF,In-Network,I10,M17.11,,,,,,,0,,58661,Surgery,,,0730,22,Outpatient Hospital,2,2400.03,1101.78,1101.78,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001003,MBR00000034,Institutional-OP,2021-02-13,2021-02-13,2021-03-20,PLN8555,1434029575,1434029575,Endocrinology,In-Network,Z87.891,E78.5,,,,,,,0,,47562,Surgery,,,0636,22,Outpatient Hospital,1,3403.57,1700.22,1625.22,0.0,75.0,0.0,75.0,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001004,MBR00000034,Institutional-OP,2022-01-03,2022-01-03,2022-01-30,PLN2783,1806688928,1806688928,Geriatrics,In-Network,I10,M54.5,,,,,,,0,,90686,Medicine,,,0740,22,Outpatient Hospital,2,98.19,75.61,0.0,75.61,0.0,0.0,75.61,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000001005,MBR00000034,Institutional-IP,2023-07-20,2023-07-23,2023-08-06,PLN4634,1453936007,1453936007,ASC,In-Network,I11.9,F41.9,,,,195,MS-DRG,1,3,Y,85610,Pathology/Lab,,,0370,21,Inpatient Hospital,1,62.45,23.41,0.0,23.41,50.0,0.0,73.41,1.43,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001006,MBR00000034,Professional,2022-06-30,2022-06-30,2022-07-30,PLN8125,1235381502,1235381502,Cardiology,In-Network,Z00.00,R10.9,,,,,,,0,,99406,Medicine,,,,22,Outpatient Hospital,3,68.46,24.12,0.0,24.12,15.0,0.0,39.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001007,MBR00000034,Professional,2023-03-01,2023-03-01,2023-03-13,PLN9399,1644128543,1644128543,Gastroenterology,In-Network,Z23,E11.40,,,,,,,0,,90460,Medicine,,,,11,Office,1,76.57,39.09,39.09,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001008,MBR00000034,Professional,2021-09-26,2021-09-26,2021-10-03,PLN5705,1273488618,1273488618,General Acute Care Hospital,In-Network,M81.0,I11.9,,,,,,,0,,99203,E&M,,,,50,Federally Qualified Health Center,1,161.59,95.95,71.02,0.0,0.0,7.16,7.16,17.77,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001009,MBR00000034,Institutional-IP,2022-01-02,2022-01-09,2022-01-16,PLN4374,1817234602,1817234602,Clinical Laboratory,In-Network,Z12.31,K21.0,,,,195,MS-DRG,5,7,Y,93225,Medicine,,,0360,21,Inpatient Hospital,3,677.39,381.11,335.96,0.0,0.0,45.15,45.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001010,MBR00000035,Professional,2023-08-20,2023-08-20,2023-09-06,PLN4665,1910255109,1910255109,DME Supplier,In-Network,I25.10,F10.20,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,2,361.42,159.05,123.22,0.0,35.0,0.83,35.83,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001011,MBR00000035,Institutional-IP,2022-06-21,2022-06-26,2022-07-04,PLN2209,1865904917,1865904917,Outpatient Clinic,In-Network,Z23,I10,,,,196,MS-DRG,12,5,Y,97530,Medicine,,,0360,21,Inpatient Hospital,2,148.31,59.94,59.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001012,MBR00000035,Institutional-OP,2023-05-04,2023-05-04,2023-06-06,PLN1017,1235381502,1235381502,Cardiology,In-Network,Z12.11,N39.0,,,,,,,0,,47562,Surgery,,,0120,22,Outpatient Hospital,2,2385.82,1197.72,1064.75,0.0,0.0,132.97,132.97,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001013,MBR00000035,Professional,2022-12-02,2022-12-02,2023-01-03,PLN8632,1660288235,1660288235,ASC,In-Network,E11.9,Z23,,,,,,,0,,58661,Surgery,,,,11,Office,1,1733.41,639.17,614.17,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001014,MBR00000035,Institutional-OP,2021-07-12,2021-07-12,2021-08-21,PLN1626,1556140803,1556140803,Cardiology,In-Network,Z12.31,I10,,,,,,,0,,71046,Radiology,,,0450,22,Outpatient Hospital,1,267.23,159.37,137.92,0.0,0.0,21.45,21.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001015,MBR00000035,Professional,2023-10-31,2023-10-31,2023-12-05,PLN5160,1284035364,1284035364,Pediatrics,In-Network,N18.3,Z87.891,,,,,,,0,,99406,Medicine,,,,21,Inpatient Hospital,3,77.02,54.39,54.39,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001016,MBR00000035,Professional,2023-11-03,2023-11-03,2023-11-21,PLN5838,1453283987,1453283987,Critical Access Hospital,In-Network,M54.5,Z00.00,,,,,,,0,,90837,Medicine,,,,21,Inpatient Hospital,1,395.54,131.82,131.82,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001017,MBR00000035,Institutional-OP,2023-05-05,2023-05-05,2023-05-25,PLN5888,1109850785,1109850785,ASC,Out-of-Network,R05,F03.90,,,,,,,0,,99214,E&M,,,0360,22,Outpatient Hospital,2,242.52,185.16,105.68,29.48,50.0,0.0,79.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001018,MBR00000035,Professional,2022-05-30,2022-05-30,2022-06-23,PLN1441,1224179551,1224179551,Physical Therapy,In-Network,R07.9,J45.20,,,,,,,0,,80061,Pathology/Lab,,,,21,Inpatient Hospital,2,97.57,43.56,0.0,43.56,0.0,0.0,43.56,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000001019,MBR00000035,Professional,2022-04-15,2022-04-15,2022-05-26,PLN5026,1561134315,1561134315,DME Supplier,In-Network,Z79.4,J06.9,,,,,,,0,,99214,E&M,,,,11,Office,3,264.01,192.1,173.77,0.0,0.0,18.33,18.33,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001020,MBR00000035,Institutional-OP,2021-11-23,2021-11-23,2021-12-10,PLN3169,1514306773,1514306773,Endocrinology,In-Network,I10,I10,,,,,,,0,,99283,E&M,,,0740,22,Outpatient Hospital,3,621.08,245.45,220.45,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001021,MBR00000035,Institutional-OP,2022-12-08,2022-12-08,2023-01-05,PLN2295,1563980627,1563980627,Critical Access Hospital,In-Network,K21.0,Z79.4,,,,,,,0,,99221,E&M,,,0450,22,Outpatient Hospital,2,164.51,54.99,0.0,54.99,0.0,0.0,54.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001022,MBR00000035,Institutional-OP,2021-12-06,2021-12-06,2022-01-06,PLN4824,1571574052,1571574052,Critical Access Hospital,In-Network,Z12.31,M81.0,,,,,,,0,,82043,Pathology/Lab,,,0360,22,Outpatient Hospital,1,75.52,32.31,0.0,32.31,0.0,0.0,32.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001023,MBR00000035,Professional,2021-07-23,2021-07-23,2021-08-10,PLN5916,1550154147,1550154147,Outpatient Clinic,In-Network,Z00.00,I48.91,,,,,,,0,,99283,E&M,,,,23,Emergency Room,2,638.91,496.92,496.92,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001024,MBR00000035,Professional,2021-03-08,2021-03-08,2021-04-16,PLN2481,1939033455,1939033455,Pulmonology,In-Network,I10,Z87.891,,,,,,,0,,83036,Pathology/Lab,,,,22,Outpatient Hospital,3,119.7,71.03,71.03,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000001025,MBR00000035,Professional,2022-04-10,2022-04-10,2022-05-04,PLN5327,1563980627,1563980627,Critical Access Hospital,In-Network,F41.9,Z79.4,,,,,,,0,,97110,Medicine,,,,21,Inpatient Hospital,3,269.98,200.89,0.0,200.89,0.0,0.0,200.89,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001026,MBR00000035,Professional,2023-06-12,2023-06-12,2023-07-10,PLN3891,1939033455,1939033455,Pulmonology,In-Network,E78.5,G20,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,2,104.99,64.22,0.0,64.22,15.0,0.0,79.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001027,MBR00000036,Institutional-OP,2023-05-17,2023-05-17,2023-06-17,PLN2288,1812060197,1812060197,Oncology,Out-of-Network,I48.91,Z00.00,,,,,,,0,,99284,E&M,,,0450,22,Outpatient Hospital,1,858.58,700.78,548.8,0.0,75.0,76.98,151.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001028,MBR00000036,Professional,2023-07-20,2023-07-20,2023-07-29,PLN1233,1550154147,1550154147,Outpatient Clinic,In-Network,F32.9,J45.20,,,,,,,0,,G0468,Medicine,,,,11,Office,1,380.51,166.95,166.95,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001029,MBR00000036,Institutional-OP,2022-10-27,2022-10-27,2022-12-02,PLN8941,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,E11.9,C50.912,,,,,,,0,,84443,Pathology/Lab,,,0360,22,Outpatient Hospital,1,103.31,34.99,31.19,0.0,0.0,3.8,3.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001030,MBR00000036,Professional,2023-08-09,2023-08-09,2023-08-25,PLN7842,1135158374,1135158374,Pulmonology,In-Network,I10,N39.0,,,,,,,0,,74177,Radiology,,,,11,Office,1,2859.14,1341.61,1178.9,162.71,0.0,0.0,162.71,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001031,MBR00000036,Professional,2023-05-08,2023-05-08,2023-05-25,PLN4683,1186826716,1186826716,Physical Therapy,In-Network,J20.9,E78.5,,,,,,,0,,93225,Medicine,,,,22,Outpatient Hospital,3,498.2,271.28,271.28,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001032,MBR00000036,Professional,2023-06-03,2023-06-03,2023-06-12,PLN3987,1845900543,1845900543,ASC,In-Network,M17.11,N20.0,,,,,,,0,,99233,E&M,,,,11,Office,2,314.18,151.61,121.33,0.0,0.0,30.28,30.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001033,MBR00000036,Professional,2022-07-13,2022-07-13,2022-07-20,PLN8387,1103747954,1103747954,Urology,In-Network,E11.9,Z12.31,,,,,,,0,,99213,E&M,,,,11,Office,3,282.49,170.09,155.09,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001034,MBR00000036,Professional,2021-04-04,2021-04-04,2021-04-17,PLN7841,1366286000,1366286000,SNF,In-Network,J44.1,C50.912,,,,,,,0,,99222,E&M,,,,21,Inpatient Hospital,3,577.29,352.67,150.75,201.92,0.0,0.0,201.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001035,MBR00000036,Institutional-OP,2022-02-21,2022-02-21,2022-03-16,PLN6606,1500949740,1500949740,Pediatrics,In-Network,G20,I10,,,,,,,0,,99283,E&M,,,0320,22,Outpatient Hospital,3,368.57,175.17,0.0,175.17,0.0,0.0,175.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001036,MBR00000036,Institutional-IP,2023-07-17,2023-07-22,2023-08-08,PLN4759,1569105090,1569105090,Geriatrics,In-Network,E11.9,J20.9,,,,470,MS-DRG,15,5,Y,99283,E&M,,,0360,21,Inpatient Hospital,1,571.7,457.71,370.04,0.0,15.0,72.67,87.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001037,MBR00000036,Institutional-IP,2023-03-25,2023-04-04,2023-04-30,PLN7171,1244186984,1244186984,Family Medicine,Out-of-Network,E66.9,F41.9,,,,603,MS-DRG,20,10,Y,71046,Radiology,,,0370,21,Inpatient Hospital,3,232.84,117.55,33.79,33.76,50.0,0.0,83.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001038,MBR00000036,Professional,2021-01-14,2021-01-14,2021-02-18,PLN7306,1531398223,1531398223,OB/GYN,In-Network,Z00.01,I10,,,,,,,0,,99222,E&M,,,,12,Home,3,509.83,297.99,267.73,0.0,0.0,30.26,30.26,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001039,MBR00000037,Institutional-OP,2021-04-13,2021-04-13,2021-05-25,PLN6223,1790497490,1790497490,OB/GYN,In-Network,R10.9,I10,,,,,,,0,,77067,Radiology,,,0450,22,Outpatient Hospital,1,804.45,467.18,467.18,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000001040,MBR00000037,Institutional-IP,2022-12-23,2022-12-25,2023-01-17,PLN4157,1313212303,1313212303,Family Medicine,In-Network,I10,M54.5,,,,690,MS-DRG,21,2,Y,99204,E&M,,,0636,21,Inpatient Hospital,1,369.37,288.45,263.45,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001041,MBR00000037,Professional,2023-12-08,2023-12-08,2023-12-29,PLN6459,1847081578,1847081578,Urology,Out-of-Network,Z00.00,J06.9,,,,,,,0,,47562,Surgery,,,,11,Office,2,2870.83,2005.77,1507.54,498.23,0.0,0.0,498.23,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001042,MBR00000037,Institutional-IP,2023-03-12,2023-03-13,2023-04-08,PLN7098,1935547131,1935547131,Pulmonology,In-Network,E11.65,E11.9,,,,194,MS-DRG,4,1,N,23472,Surgery,,,0320,21,Inpatient Hospital,3,7005.48,3137.29,2745.53,391.76,0.0,0.0,391.76,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001043,MBR00000037,Institutional-OP,2023-11-05,2023-11-05,2023-11-25,PLN6533,1518055405,1518055405,Urology,In-Network,M54.5,F41.9,,,,,,,0,,99213,E&M,,,0360,22,Outpatient Hospital,3,239.29,163.2,163.2,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001044,MBR00000037,Institutional-OP,2021-03-14,2021-03-14,2021-04-20,PLN7080,1809014947,1809014947,Urology,In-Network,I10,I25.10,,,,,,,0,,G0444,Medicine,,,0360,22,Outpatient Hospital,3,101.07,41.61,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-4,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000001045,MBR00000037,Institutional-OP,2023-08-23,2023-08-23,2023-10-04,PLN7010,1624202402,1624202402,Orthopedic Surgery,In-Network,E78.5,Z87.891,,,,,,,0,,99233,E&M,,,0450,22,Outpatient Hospital,2,426.72,359.09,359.09,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001046,MBR00000037,Professional,2021-05-21,2021-05-21,2021-06-09,PLN6036,1511044648,1511044648,Endocrinology,In-Network,N39.0,J06.9,,,,,,,0,,99222,E&M,,,,11,Office,3,271.44,199.18,0.0,199.18,15.0,0.0,214.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001047,MBR00000037,Professional,2023-08-27,2023-08-27,2023-10-01,PLN1880,1372918899,1372918899,Family Medicine,In-Network,I10,K21.0,,,,,,,0,,43239,Surgery,,,,11,Office,3,1245.18,434.52,297.39,0.0,75.0,62.13,137.13,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001048,MBR00000037,Professional,2023-12-03,2023-12-03,2023-12-31,PLN1529,1980712759,1980712759,Outpatient Clinic,Out-of-Network,Z00.00,N18.3,,,,,,,0,,84443,Pathology/Lab,,,,12,Home,1,156.46,120.36,0.0,120.36,0.0,0.0,120.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001049,MBR00000037,Professional,2022-07-14,2022-07-14,2022-08-13,PLN7856,1213165847,1213165847,Critical Access Hospital,In-Network,I48.91,Z87.891,,,,,,,0,,33533,Surgery,,,,11,Office,3,15877.61,9811.5,9394.95,416.55,0.0,0.0,416.55,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000001050,MBR00000037,Professional,2022-08-07,2022-08-07,2022-09-13,PLN1328,1645194539,1645194539,SNF,In-Network,E78.5,Z00.01,,,,,,,0,,58661,Surgery,,,,12,Home,3,4359.8,1777.89,1702.89,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001051,MBR00000038,Professional,2022-06-30,2022-06-30,2022-07-30,PLN7203,1840431511,1840431511,Geriatrics,Out-of-Network,E11.9,R05,,,,,,,0,,27130,Surgery,,,,21,Inpatient Hospital,2,6955.41,2308.4,1874.35,434.05,0.0,0.0,434.05,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001052,MBR00000038,Institutional-IP,2022-08-29,2022-09-05,2022-09-18,PLN6888,1728018911,1728018911,Nephrology,In-Network,Z00.01,E66.9,,,,194,MS-DRG,16,7,Y,90460,Medicine,,,0900,21,Inpatient Hospital,1,48.73,24.61,0.0,24.61,0.0,0.0,24.61,0.0,Adjusted,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000001053,MBR00000038,Professional,2023-06-17,2023-06-17,2023-07-08,PLN9420,1124394415,1124394415,Pediatrics,In-Network,N40.0,Z87.891,,,,,,,0,,45380,Surgery,,,,20,Urgent Care,2,2744.06,1717.72,1717.72,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000001054,MBR00000038,Institutional-IP,2021-11-05,2021-11-09,2021-11-22,PLN5070,1132188260,1132188260,Family Medicine,In-Network,E78.5,Z23,,,,603,MS-DRG,11,4,Y,99213,E&M,,,0740,21,Inpatient Hospital,2,166.85,131.66,131.66,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001055,MBR00000038,Institutional-OP,2021-11-07,2021-11-07,2021-12-11,PLN3372,1556140803,1556140803,Cardiology,In-Network,E11.9,I10,,,,,,,0,,99222,E&M,,,0360,22,Outpatient Hospital,2,411.65,340.5,340.5,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001056,MBR00000038,Professional,2023-11-27,2023-11-27,2024-01-03,PLN9674,1313212303,1313212303,Family Medicine,In-Network,I50.9,G43.909,,,,,,,0,,80053,Pathology/Lab,,,,50,Federally Qualified Health Center,2,132.54,64.11,55.77,0.0,0.0,8.34,8.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001057,MBR00000038,Professional,2023-07-20,2023-07-20,2023-08-28,PLN5014,1475984649,1475984649,SNF,In-Network,E11.65,I25.10,,,,,,,0,,99203,E&M,,,,11,Office,1,185.4,60.66,52.82,0.0,0.0,7.84,7.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001058,MBR00000038,Institutional-IP,2022-08-15,2022-08-18,2022-09-25,PLN8881,1585582070,1585582070,Outpatient Clinic,In-Network,N17.9,J20.9,,,,291,MS-DRG,18,3,Y,45380,Surgery,,,0200,21,Inpatient Hospital,2,1755.32,1439.14,1367.39,71.75,0.0,0.0,71.75,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000001059,MBR00000038,Professional,2021-08-08,2021-08-08,2021-08-28,PLN5901,1948810580,1948810580,DME Supplier,In-Network,Z00.00,Z87.891,,,,,,,0,,74177,Radiology,,,,22,Outpatient Hospital,1,1579.11,1073.63,775.38,298.25,0.0,0.0,298.25,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001060,MBR00000038,Professional,2023-11-13,2023-11-13,2023-11-27,PLN2153,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,J44.1,J44.1,,,,,,,0,,99214,E&M,,,,49,Independent Clinic,3,458.5,215.68,179.83,0.0,25.0,10.85,35.85,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000001061,MBR00000038,Institutional-OP,2023-08-21,2023-08-21,2023-09-15,PLN2708,1518055405,1518055405,Urology,In-Network,Z23,E11.9,,,,,,,0,,99233,E&M,,,0370,22,Outpatient Hospital,3,385.83,309.15,0.0,309.15,0.0,0.0,309.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001062,MBR00000038,Professional,2021-12-26,2021-12-26,2022-01-18,PLN9147,1845057593,1845057593,Orthopedic Surgery,In-Network,I11.9,R07.9,,,,,,,0,,90837,Medicine,,,,23,Emergency Room,2,289.55,234.14,202.73,0.0,15.0,16.41,31.41,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001063,MBR00000038,Institutional-IP,2022-08-16,2022-08-21,2022-09-29,PLN9170,1847081578,1847081578,Urology,Out-of-Network,Z00.00,E87.6,,,,690,MS-DRG,5,5,Y,85025,Pathology/Lab,,,0120,21,Inpatient Hospital,2,53.89,27.7,27.7,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000001064,MBR00000038,Institutional-OP,2022-04-05,2022-04-05,2022-04-25,PLN2784,1148984206,1148984206,Psychiatry,In-Network,F41.9,I10,,,,,,,0,,90686,Medicine,,,0761,22,Outpatient Hospital,2,86.95,26.68,0.0,26.68,35.0,0.0,61.68,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000001065,MBR00000038,Professional,2023-07-13,2023-07-13,2023-08-09,PLN6173,1334916761,1334916761,ASC,In-Network,Z87.891,I25.10,,,,,,,0,,70553,Radiology,,,,11,Office,3,2500.21,982.6,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-11,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001066,MBR00000038,Institutional-IP,2023-01-23,2023-01-30,2023-02-17,PLN3529,1571574052,1571574052,Critical Access Hospital,In-Network,J18.9,R05,,,,196,MS-DRG,6,7,Y,99284,E&M,,,0360,21,Inpatient Hospital,2,501.53,401.22,66.75,334.47,0.0,0.0,334.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001067,MBR00000038,Professional,2022-06-24,2022-06-24,2022-07-12,PLN8988,1749327647,1749327647,Geriatrics,In-Network,J44.1,K21.0,,,,,,,0,,45378,Surgery,,,,11,Office,1,1636.43,515.51,169.99,330.52,15.0,0.0,345.52,0.0,Adjusted,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000001068,MBR00000038,Professional,2023-11-26,2023-11-26,2023-12-08,PLN1264,1899127912,1899127912,Neurology,In-Network,F41.9,F32.9,,,,,,,0,,80053,Pathology/Lab,,,,31,Skilled Nursing Facility,1,125.3,95.89,95.89,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001069,MBR00000038,Professional,2022-10-29,2022-10-29,2022-11-22,PLN4204,1809014947,1809014947,Urology,In-Network,R05,R07.9,,,,,,,0,,70553,Radiology,,,,12,Home,3,2367.39,1112.31,1087.31,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001070,MBR00000038,Institutional-IP,2022-06-15,2022-06-17,2022-07-12,PLN8229,1840431511,1840431511,Geriatrics,Out-of-Network,J20.9,I48.91,,,,872,MS-DRG,5,2,Y,33533,Surgery,,,0900,21,Inpatient Hospital,2,21549.37,8714.89,8521.16,158.73,35.0,0.0,193.73,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000001071,MBR00000038,Institutional-IP,2023-10-12,2023-10-17,2023-11-09,PLN1024,1118885473,1118885473,ASC,In-Network,F32.9,K21.0,,,,292,MS-DRG,1,5,Y,70450,Radiology,,,0636,21,Inpatient Hospital,1,1513.48,1213.33,973.68,239.65,0.0,0.0,239.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001072,MBR00000038,Institutional-OP,2022-05-08,2022-05-08,2022-06-20,PLN9081,1193493783,1193493783,Critical Access Hospital,Out-of-Network,Z51.11,E78.5,,,,,,,0,,99204,E&M,,,0730,22,Outpatient Hospital,3,281.08,193.86,0.0,193.86,0.0,0.0,193.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001073,MBR00000038,Institutional-IP,2022-04-03,2022-04-05,2022-04-20,PLN8606,1817234602,1817234602,Clinical Laboratory,In-Network,E78.5,I48.91,,,,682,MS-DRG,16,2,Y,58661,Surgery,,,0370,21,Inpatient Hospital,2,3966.07,1277.9,1242.9,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001074,MBR00000038,Professional,2022-03-02,2022-03-02,2022-03-27,PLN6354,1148984206,1148984206,Psychiatry,In-Network,N18.3,I63.9,,,,,,,0,,23472,Surgery,,,,21,Inpatient Hospital,2,5812.96,4430.33,4212.63,0.0,25.0,192.7,217.7,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001075,MBR00000038,Institutional-OP,2021-08-30,2021-08-30,2021-09-26,PLN2521,1752470395,1752470395,Home Health,In-Network,J06.9,I10,,,,,,,0,,81001,Pathology/Lab,,,0740,22,Outpatient Hospital,3,34.45,26.85,0.0,26.85,0.0,0.0,26.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001076,MBR00000038,Professional,2021-11-02,2021-11-02,2021-11-27,PLN6144,1896447406,1896447406,Nephrology,Out-of-Network,E11.9,G43.909,,,,,,,0,,45380,Surgery,,,,11,Office,2,2281.21,773.41,773.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000001077,MBR00000039,Institutional-OP,2021-04-10,2021-04-10,2021-05-18,PLN3218,1433937353,1433937353,Nephrology,In-Network,F41.9,G43.909,,,,,,,0,,27447,Surgery,,,0740,22,Outpatient Hospital,1,6286.61,2835.16,0.0,208.61,15.0,0.0,223.61,0.0,Denied,CO-27,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001078,MBR00000039,Professional,2023-03-09,2023-03-09,2023-03-28,PLN2647,1946680931,1946680931,Critical Access Hospital,Out-of-Network,J06.9,I10,,,,,,,0,,G0444,Medicine,,,,11,Office,3,71.49,60.5,40.3,0.0,15.0,5.2,20.2,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000001079,MBR00000039,Institutional-OP,2022-10-09,2022-10-09,2022-11-04,PLN8117,1974006077,1974006077,Orthopedic Surgery,In-Network,Z00.00,K92.1,,,,,,,0,,99233,E&M,,,0730,22,Outpatient Hospital,2,511.85,287.51,237.51,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001080,MBR00000039,Institutional-OP,2023-10-19,2023-10-19,2023-11-10,PLN8219,1728018911,1728018911,Nephrology,In-Network,F41.9,F03.90,,,,,,,0,,80053,Pathology/Lab,,,0360,22,Outpatient Hospital,3,126.33,55.07,16.46,0.0,35.0,3.61,38.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001081,MBR00000039,Professional,2022-11-01,2022-11-01,2022-12-13,PLN1933,1622771872,1622771872,Pediatrics,In-Network,K21.0,I10,,,,,,,0,,99214,E&M,,,,11,Office,2,400.6,136.34,0.0,136.34,0.0,0.0,136.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001082,MBR00000039,Professional,2021-03-30,2021-03-30,2021-04-16,PLN7267,1716521444,1716521444,Oncology,In-Network,Z00.00,I50.9,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,1,3087.45,950.48,950.48,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001083,MBR00000039,Professional,2022-11-11,2022-11-11,2022-11-29,PLN6826,1606140917,1606140917,ASC,In-Network,J20.9,E11.9,,,,,,,0,,99233,E&M,,,,11,Office,3,541.5,245.25,245.25,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001084,MBR00000039,Professional,2021-07-11,2021-07-11,2021-08-21,PLN2832,1860435061,1860435061,DME Supplier,In-Network,Z23,E11.9,,,,,,,0,,45378,Surgery,,,,65,End-Stage Renal Disease,1,1189.31,735.9,472.46,263.44,0.0,0.0,263.44,0.0,Adjusted,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000001085,MBR00000039,Professional,2021-02-10,2021-02-10,2021-03-15,PLN3778,1899127912,1899127912,Neurology,In-Network,Z00.00,I10,,,,,,,0,,45378,Surgery,,,,11,Office,2,1438.7,860.15,730.91,0.0,75.0,54.24,129.24,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000001086,MBR00000039,Institutional-IP,2022-12-27,2023-01-03,2023-01-06,PLN4001,1364429278,1364429278,OB/GYN,In-Network,Z12.31,G43.909,,,,872,MS-DRG,21,7,Y,58661,Surgery,,,0120,21,Inpatient Hospital,2,3877.09,1710.01,1383.06,0.0,0.0,326.95,326.95,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001087,MBR00000039,Professional,2021-01-31,2021-01-31,2021-02-17,PLN7569,1946680931,1946680931,Critical Access Hospital,Out-of-Network,E11.65,R05,,,,,,,0,,99213,E&M,,,,23,Emergency Room,2,187.03,64.14,0.0,64.14,25.0,0.0,89.14,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001088,MBR00000039,Professional,2022-03-24,2022-03-24,2022-04-29,PLN6364,1717546253,1717546253,Family Medicine,In-Network,N39.0,J20.9,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,1,592.72,246.38,138.64,102.63,0.0,5.11,107.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001089,MBR00000039,Institutional-OP,2023-09-08,2023-09-08,2023-10-04,PLN3842,1389336600,1389336600,Critical Access Hospital,In-Network,Z00.01,E11.9,,,,,,,0,,99283,E&M,,,0270,22,Outpatient Hospital,1,387.58,237.16,212.16,0.0,25.0,0.0,25.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001090,MBR00000039,Institutional-IP,2021-10-08,2021-10-14,2021-10-21,PLN2500,1502838586,1502838586,ASC,In-Network,M17.11,I10,,,,690,MS-DRG,10,6,Y,45378,Surgery,,,0740,21,Inpatient Hospital,3,2458.06,763.94,334.85,372.08,15.0,42.01,429.09,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000001091,MBR00000039,Professional,2023-02-01,2023-02-01,2023-02-19,PLN1887,1198133277,1198133277,SNF,In-Network,Z12.11,I10,,,,,,,0,,58661,Surgery,,,,31,Skilled Nursing Facility,1,2711.44,1018.42,769.98,0.0,75.0,173.44,248.44,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001092,MBR00000039,Institutional-OP,2022-02-17,2022-02-17,2022-03-19,PLN6402,1571574052,1571574052,Critical Access Hospital,In-Network,Z23,E11.9,,,,,,,0,,99204,E&M,,,0900,22,Outpatient Hospital,3,272.65,197.7,159.25,0.0,0.0,38.45,38.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001093,MBR00000039,Institutional-OP,2021-05-05,2021-05-05,2021-05-31,PLN8313,1780163051,1780163051,SNF,In-Network,I25.10,N39.0,,,,,,,0,,77067,Radiology,,,0320,22,Outpatient Hospital,3,378.51,118.68,98.65,20.03,0.0,0.0,20.03,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000001094,MBR00000039,Institutional-OP,2021-08-04,2021-08-04,2021-09-02,PLN7503,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,J20.9,J45.20,,,,,,,0,,27447,Surgery,,,0730,22,Outpatient Hospital,2,2495.1,1512.25,1311.41,0.0,0.0,200.84,200.84,0.0,Paid,,,1,,0,0,1,0,0,1,Phantom,0,0,0,0,0
CLM0000001095,MBR00000039,Professional,2021-03-23,2021-03-23,2021-04-05,PLN4312,1752470395,1752470395,Home Health,In-Network,F32.9,R10.9,,,,,,,0,,99222,E&M,,,,11,Office,2,626.85,474.22,20.88,438.34,15.0,0.0,453.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001096,MBR00000039,Professional,2021-06-15,2021-06-15,2021-06-28,PLN3134,1540044947,1540044947,Pulmonology,Out-of-Network,Z96.641,Z12.31,,,,,,,0,,99233,E&M,,,,11,Office,2,479.62,311.67,261.67,0.0,50.0,0.0,50.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001097,MBR00000039,Professional,2021-06-27,2021-06-27,2021-07-31,PLN2219,1717546253,1717546253,Family Medicine,In-Network,N39.0,E11.9,,,,,,,0,,99222,E&M,,,,11,Office,3,493.23,335.79,270.16,65.63,0.0,0.0,65.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001098,MBR00000039,Institutional-OP,2023-08-26,2023-08-26,2023-09-25,PLN9180,1609526529,1609526529,Psychiatry,In-Network,E11.9,M17.11,,,,,,,0,,99203,E&M,,,0320,22,Outpatient Hospital,2,342.44,127.6,112.6,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000001099,MBR00000039,Institutional-OP,2023-06-03,2023-06-03,2023-07-15,PLN2307,1245650222,1245650222,Gastroenterology,In-Network,Z87.891,G43.909,,,,,,,0,,99221,E&M,,,0301,22,Outpatient Hospital,3,332.16,108.76,93.76,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001100,MBR00000039,Institutional-OP,2022-01-22,2022-01-22,2022-02-26,PLN4822,1168881145,1168881145,Orthopedic Surgery,In-Network,E11.9,E11.9,,,,,,,0,,99284,E&M,,,0200,22,Outpatient Hospital,2,857.35,515.78,515.78,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001101,MBR00000040,Professional,2023-03-03,2023-03-03,2023-03-27,PLN4329,1364429278,1364429278,OB/GYN,In-Network,Z12.31,Z00.01,,,,,,,0,,66984,Surgery,,,,11,Office,3,1886.3,1388.03,1363.03,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001102,MBR00000040,Professional,2021-08-12,2021-08-12,2021-09-12,PLN5300,1434029575,1434029575,Endocrinology,In-Network,I25.10,I25.10,,,,,,,0,,33533,Surgery,,,,11,Office,2,22612.94,16542.16,15059.57,0.0,0.0,1482.59,1482.59,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000001103,MBR00000040,Institutional-OP,2022-12-01,2022-12-01,2022-12-28,PLN7724,1991459367,1991459367,Neurology,Out-of-Network,I10,N39.0,,,,,,,0,,23472,Surgery,,,0900,22,Outpatient Hospital,2,6767.87,2262.19,2178.72,83.47,0.0,0.0,83.47,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001104,MBR00000040,Professional,2021-08-10,2021-08-10,2021-09-04,PLN4618,1556140803,1556140803,Cardiology,In-Network,Z87.891,E66.9,,,,,,,0,,90686,Medicine,,,,50,Federally Qualified Health Center,2,55.07,16.82,0.0,16.82,35.0,0.0,51.82,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000001105,MBR00000040,Professional,2022-12-03,2022-12-03,2022-12-22,PLN5534,1433937353,1433937353,Nephrology,In-Network,E78.5,M54.5,,,,,,,0,,97530,Medicine,,,,21,Inpatient Hospital,2,139.39,50.28,0.28,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001106,MBR00000040,Institutional-IP,2022-01-27,2022-01-29,2022-02-08,PLN2040,1422747896,1422747896,Urology,In-Network,F03.90,Z87.891,,,,683,MS-DRG,20,2,N,99214,E&M,,,0740,21,Inpatient Hospital,3,412.04,345.23,345.23,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001107,MBR00000040,Institutional-OP,2023-07-30,2023-07-30,2023-08-16,PLN9965,1564502315,1564502315,ASC,In-Network,E78.5,R07.9,,,,,,,0,,G0439,Medicine,,,0200,22,Outpatient Hospital,2,234.27,91.05,91.05,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000001108,MBR00000040,Professional,2023-07-04,2023-07-04,2023-08-09,PLN7195,1717912431,1717912431,Oncology,In-Network,M54.5,Z00.01,,,,,,,0,,93306,Radiology,,,,49,Independent Clinic,3,2916.08,1007.93,1007.93,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001109,MBR00000040,Institutional-OP,2022-01-01,2022-01-01,2022-02-07,PLN3914,1364429278,1364429278,OB/GYN,In-Network,E78.5,Z00.00,,,,,,,0,,81001,Pathology/Lab,,,0900,22,Outpatient Hospital,3,45.65,27.07,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001110,MBR00000040,Professional,2021-02-15,2021-02-15,2021-03-03,PLN7711,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,Z87.891,Z12.31,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,2,56.04,46.05,0.0,46.05,50.0,0.0,96.05,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001111,MBR00000040,Professional,2021-12-19,2021-12-19,2022-01-04,PLN1327,1450553056,1450553056,Clinical Laboratory,In-Network,I10,Z87.891,,,,,,,0,,47562,Surgery,,,,11,Office,1,4739.74,2296.69,2296.69,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001112,MBR00000040,Professional,2021-11-05,2021-11-05,2021-11-25,PLN1547,1780163051,1780163051,SNF,In-Network,J06.9,Z00.00,,,,,,,0,,33533,Surgery,,,,11,Office,3,25399.97,12302.33,11377.71,0.0,0.0,924.62,924.62,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000001113,MBR00000040,Professional,2022-04-11,2022-04-11,2022-04-25,PLN9587,1235381502,1235381502,Cardiology,In-Network,E11.9,K21.0,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,1,97.85,80.3,0.0,60.9,0.0,0.0,60.9,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000001114,MBR00000040,Professional,2022-09-21,2022-09-21,2022-10-16,PLN8467,1422747896,1422747896,Urology,In-Network,M54.5,E66.9,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,1,131.82,88.34,38.34,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001115,MBR00000040,Professional,2023-12-20,2023-12-20,2024-01-19,PLN8708,1450094833,1450094833,Outpatient Clinic,In-Network,R07.9,Z12.31,,,,,,,0,,45380,Surgery,,,,23,Emergency Room,3,2663.86,883.06,883.06,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,1,0,0,0
CLM0000001116,MBR00000040,Professional,2021-03-10,2021-03-10,2021-04-14,PLN7497,1847081578,1847081578,Urology,Out-of-Network,J44.1,Z00.00,,,,,,,0,,99233,E&M,,,,11,Office,3,461.3,276.9,0.0,276.9,25.0,0.0,301.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001117,MBR00000040,Professional,2022-08-31,2022-08-31,2022-09-18,PLN2514,1964402759,1964402759,Outpatient Clinic,In-Network,F32.9,F32.9,,,,,,,0,,93306,Radiology,,,,11,Office,3,2997.78,1071.85,885.63,186.22,0.0,0.0,186.22,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001118,MBR00000040,Professional,2021-07-07,2021-07-07,2021-07-19,PLN4483,1997536841,1997536841,Family Medicine,Out-of-Network,I10,N20.0,,,,,,,0,,87491,Pathology/Lab,,,,23,Emergency Room,3,234.59,176.75,0.0,0.0,75.0,0.0,75.0,0.0,Denied,PR-1,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001119,MBR00000040,Institutional-OP,2022-08-22,2022-08-22,2022-08-30,PLN6224,1948810580,1948810580,DME Supplier,In-Network,J20.9,N39.0,,,,,,,0,,85610,Pathology/Lab,,,0740,22,Outpatient Hospital,2,43.1,29.22,0.0,29.22,0.0,0.0,29.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001120,MBR00000040,Professional,2022-11-29,2022-11-29,2022-12-31,PLN4580,1865904917,1865904917,Outpatient Clinic,In-Network,M81.0,I11.9,,,,,,,0,,66984,Surgery,,,,11,Office,3,2610.7,1557.6,1263.45,0.0,0.0,294.15,294.15,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001121,MBR00000040,Professional,2023-06-06,2023-06-06,2023-07-02,PLN3267,1564502315,1564502315,ASC,In-Network,M54.5,G43.909,,,,,,,0,,99222,E&M,,,,31,Skilled Nursing Facility,3,557.46,417.71,187.87,177.25,15.0,37.59,229.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001122,MBR00000040,Professional,2022-09-06,2022-09-06,2022-10-14,PLN1304,1812060197,1812060197,Oncology,Out-of-Network,R05,Z23,,,,,,,0,,27130,Surgery,,,,11,Office,3,4264.47,1764.48,1764.48,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001123,MBR00000040,Professional,2021-07-14,2021-07-14,2021-07-31,PLN1667,1389336600,1389336600,Critical Access Hospital,In-Network,J06.9,E11.9,,,,,,,0,,99222,E&M,,,,11,Office,1,657.47,412.15,276.08,86.07,50.0,0.0,136.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001124,MBR00000040,Institutional-IP,2023-09-28,2023-10-04,2023-10-13,PLN3397,1366286000,1366286000,SNF,In-Network,I10,N18.3,,,,641,MS-DRG,16,6,Y,23472,Surgery,,,0900,21,Inpatient Hospital,2,5723.21,2534.45,2534.45,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001125,MBR00000040,Institutional-OP,2022-03-20,2022-03-20,2022-04-14,PLN4054,1845057593,1845057593,Orthopedic Surgery,In-Network,E66.9,J06.9,,,,,,,0,,74177,Radiology,,,0120,22,Outpatient Hospital,2,2633.27,1033.14,1033.14,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001126,MBR00000040,Professional,2022-06-10,2022-06-10,2022-06-22,PLN3150,1422747896,1422747896,Urology,In-Network,J20.9,E11.9,,,,,,,0,,45378,Surgery,,,,11,Office,2,2014.05,673.53,566.51,92.02,15.0,0.0,107.02,0.0,Adjusted,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000001127,MBR00000040,Professional,2022-12-04,2022-12-04,2022-12-30,PLN2801,1433937353,1433937353,Nephrology,In-Network,F32.9,M54.5,,,,,,,0,,80053,Pathology/Lab,,,,23,Emergency Room,2,60.25,50.86,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001128,MBR00000040,Professional,2021-10-18,2021-10-18,2021-11-24,PLN3387,1717546253,1717546253,Family Medicine,In-Network,R51,N39.0,,,,,,,0,,27130,Surgery,,,,49,Independent Clinic,1,6172.58,2252.18,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-119,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001129,MBR00000040,Professional,2023-12-18,2023-12-18,2024-01-25,PLN4981,1915531927,1915531927,Critical Access Hospital,In-Network,E66.9,R51,,,,,,,0,,99233,E&M,,,,11,Office,1,287.83,209.19,0.0,0.0,15.0,24.37,39.37,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001130,MBR00000041,Institutional-OP,2021-02-18,2021-02-18,2021-03-05,PLN9107,1168246159,1168246159,Internal Medicine,In-Network,J45.20,Z00.01,,,,,,,0,,27130,Surgery,,,0730,22,Outpatient Hospital,2,6291.14,4288.41,3576.09,422.67,0.0,289.65,712.32,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001131,MBR00000041,Institutional-IP,2021-06-19,2021-06-20,2021-07-29,PLN1295,1749494482,1749494482,Pediatrics,In-Network,G43.909,I50.9,,,,292,MS-DRG,4,1,Y,33533,Surgery,,,0200,21,Inpatient Hospital,1,15008.63,10393.61,8015.88,449.26,75.0,1853.47,2377.73,0.0,Paid,,,0,,0,0,1,1,0,1,Upcoding,0,0,0,0,0
CLM0000001132,MBR00000041,Institutional-OP,2023-12-21,2023-12-21,2024-01-13,PLN3377,1974006077,1974006077,Orthopedic Surgery,In-Network,I25.10,E11.9,,,,,,,0,,23472,Surgery,,,0730,22,Outpatient Hospital,3,3216.59,1675.0,1604.72,0.0,50.0,20.28,70.28,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001133,MBR00000041,Institutional-OP,2022-05-10,2022-05-10,2022-06-12,PLN5808,1531398223,1531398223,OB/GYN,In-Network,N39.0,F41.9,,,,,,,0,,99233,E&M,,,0730,22,Outpatient Hospital,2,463.41,244.64,0.0,244.64,0.0,0.0,244.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001134,MBR00000041,Institutional-IP,2023-09-06,2023-09-09,2023-10-10,PLN6685,1313212303,1313212303,Family Medicine,In-Network,J06.9,Z12.31,,,,683,MS-DRG,18,3,Y,99213,E&M,,,0510,21,Inpatient Hospital,2,202.3,100.73,21.6,0.0,75.0,4.13,79.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001135,MBR00000041,Professional,2023-09-19,2023-09-19,2023-09-29,PLN3105,1795618275,1795618275,Pulmonology,In-Network,I10,J20.9,,,,,,,0,,82043,Pathology/Lab,,,,22,Outpatient Hospital,3,27.28,9.58,9.58,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000001136,MBR00000041,Institutional-OP,2023-12-21,2023-12-21,2024-01-29,PLN9976,1609526529,1609526529,Psychiatry,In-Network,E66.9,J44.1,,,,,,,0,,81001,Pathology/Lab,,,0270,22,Outpatient Hospital,1,59.15,18.87,0.0,18.87,0.0,0.0,18.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001137,MBR00000041,Institutional-OP,2023-03-06,2023-03-06,2023-04-03,PLN9635,1205377316,1205377316,Orthopedic Surgery,In-Network,Z00.00,E78.5,,,,,,,0,,45380,Surgery,,,0120,22,Outpatient Hospital,1,2210.09,1172.03,1172.03,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000001138,MBR00000041,Professional,2023-01-19,2023-01-19,2023-02-18,PLN9833,1545347862,1545347862,SNF,In-Network,K57.30,E11.9,,,,,,,0,,99233,E&M,,,,11,Office,3,424.12,240.06,0.0,240.06,0.0,0.0,240.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001139,MBR00000041,Institutional-IP,2022-11-04,2022-11-08,2022-12-06,PLN1019,1366286000,1366286000,SNF,In-Network,E11.9,N20.0,,,,291,MS-DRG,5,4,Y,71046,Radiology,,,0450,21,Inpatient Hospital,2,196.83,74.54,24.54,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000001140,MBR00000041,Professional,2023-01-19,2023-01-19,2023-02-20,PLN6298,1273488618,1273488618,General Acute Care Hospital,In-Network,E11.9,Z00.00,,,,,,,0,,93306,Radiology,,,,11,Office,1,1922.01,1147.97,901.44,146.97,75.0,24.56,246.53,0.0,Adjusted,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001141,MBR00000041,Professional,2021-10-09,2021-10-09,2021-10-22,PLN6207,1564502315,1564502315,ASC,In-Network,Z00.00,I50.9,,,,,,,0,,93306,Radiology,,,,22,Outpatient Hospital,3,1474.2,545.94,88.29,429.17,25.0,3.48,457.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001142,MBR00000041,Institutional-IP,2023-06-12,2023-06-15,2023-07-25,PLN9974,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,M54.5,G43.909,,,,470,MS-DRG,7,3,N,85610,Pathology/Lab,,,0636,21,Inpatient Hospital,1,30.64,14.44,0.0,14.44,35.0,0.0,49.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001143,MBR00000041,Professional,2021-07-24,2021-07-24,2021-08-22,PLN4661,1168246159,1168246159,Internal Medicine,In-Network,Z12.31,J20.9,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,3,5021.34,2232.38,2142.81,0.0,35.0,54.57,89.57,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001144,MBR00000041,Professional,2022-06-10,2022-06-10,2022-06-25,PLN5393,1700633438,1700633438,DME Supplier,In-Network,I10,I10,,,,,,,0,,93000,Radiology,,,,11,Office,1,149.61,89.95,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001145,MBR00000041,Professional,2022-02-14,2022-02-14,2022-03-01,PLN3909,1545347862,1545347862,SNF,In-Network,G43.909,S72.001A,,,,,,,0,,58661,Surgery,,,,11,Office,2,3504.62,2415.07,2042.63,188.43,0.0,184.01,372.44,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001146,MBR00000041,Institutional-IP,2023-04-14,2023-04-28,2023-04-29,PLN5293,1193493783,1193493783,Critical Access Hospital,Out-of-Network,E78.5,N18.3,,,,195,MS-DRG,8,14,U,43239,Surgery,,,0730,21,Inpatient Hospital,1,2250.67,981.93,981.93,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001147,MBR00000041,Institutional-OP,2021-10-07,2021-10-07,2021-10-29,PLN8921,1749327647,1749327647,Geriatrics,In-Network,Z00.00,M17.11,,,,,,,0,,99213,E&M,,,0360,22,Outpatient Hospital,3,272.79,108.22,85.52,0.0,15.0,7.7,22.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001148,MBR00000041,Institutional-IP,2021-08-15,2021-08-19,2021-09-03,PLN6941,1219817751,1219817751,OB/GYN,In-Network,Z23,Z87.891,,,,683,MS-DRG,5,4,Y,99203,E&M,,,0900,21,Inpatient Hospital,3,365.37,113.39,26.09,52.3,35.0,0.0,87.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001149,MBR00000041,Institutional-OP,2023-06-05,2023-06-05,2023-06-15,PLN9903,1390307371,1390307371,DME Supplier,In-Network,Z00.00,I10,,,,,,,0,,27130,Surgery,,,0301,22,Outpatient Hospital,3,2652.99,1047.24,1006.67,0.0,25.0,15.57,40.57,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001150,MBR00000041,Professional,2022-06-18,2022-06-18,2022-07-17,PLN7883,1132188260,1132188260,Family Medicine,In-Network,R07.9,F41.9,,,,,,,0,,99203,E&M,,,,11,Office,1,155.71,115.2,0.0,115.2,75.0,0.0,190.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001151,MBR00000041,Institutional-IP,2023-03-01,2023-03-03,2023-03-25,PLN5480,1118885473,1118885473,ASC,In-Network,G20,Z79.4,,,,872,MS-DRG,21,2,Y,97110,Medicine,,,0450,21,Inpatient Hospital,3,124.8,96.03,0.0,96.03,0.0,0.0,96.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001152,MBR00000041,Professional,2023-08-21,2023-08-21,2023-09-02,PLN4322,1168246159,1168246159,Internal Medicine,In-Network,J06.9,E78.5,,,,,,,0,,47562,Surgery,,,,11,Office,3,5144.15,3937.19,3779.3,157.89,0.0,0.0,157.89,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001153,MBR00000041,Professional,2023-07-04,2023-07-04,2023-08-10,PLN4727,1219817751,1219817751,OB/GYN,In-Network,E11.9,I50.9,,,,,,,0,,99233,E&M,,,,50,Federally Qualified Health Center,3,543.84,317.52,242.52,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001154,MBR00000041,Institutional-IP,2022-03-14,2022-03-27,2022-04-02,PLN4262,1727809972,1727809972,Home Health,In-Network,I10,M54.5,,,,641,MS-DRG,16,13,N,90837,Medicine,,,0370,21,Inpatient Hospital,3,249.73,161.86,146.86,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001155,MBR00000042,Professional,2021-07-07,2021-07-07,2021-08-05,PLN8314,1410468316,1410468316,SNF,In-Network,Z87.891,M81.0,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,3,143.95,73.41,73.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001156,MBR00000042,Institutional-OP,2023-11-18,2023-11-18,2023-11-30,PLN9978,1872272835,1872272835,Internal Medicine,In-Network,I10,K92.1,,,,,,,0,,99222,E&M,,,0360,22,Outpatient Hospital,2,320.69,219.82,173.45,0.0,25.0,21.37,46.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001157,MBR00000042,Professional,2021-12-06,2021-12-06,2021-12-20,PLN1809,1713934949,1713934949,Neurology,In-Network,M17.11,E66.9,,,,,,,0,,93306,Radiology,,,,11,Office,1,2618.43,2198.1,2013.99,159.11,25.0,0.0,184.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001158,MBR00000042,Institutional-IP,2023-04-23,2023-05-01,2023-05-27,PLN1035,1364429278,1364429278,OB/GYN,In-Network,E11.9,K21.0,,,,682,MS-DRG,15,8,N,83036,Pathology/Lab,,,0360,21,Inpatient Hospital,2,46.19,21.44,0.0,21.44,0.0,0.0,21.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000001159,MBR00000042,Professional,2023-04-22,2023-04-22,2023-05-22,PLN3558,1800011727,1800011727,Clinical Laboratory,Out-of-Network,I50.9,F32.9,,,,,,,0,,66984,Surgery,,,,11,Office,2,2053.1,768.87,655.39,0.0,0.0,113.48,113.48,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001160,MBR00000042,Institutional-OP,2022-04-30,2022-04-30,2022-05-08,PLN1997,1845900543,1845900543,ASC,In-Network,M54.5,Z51.11,,,,,,,0,,71046,Radiology,,,0370,22,Outpatient Hospital,1,226.8,135.12,100.12,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001161,MBR00000042,Institutional-IP,2021-06-29,2021-07-03,2021-07-27,PLN7074,1186826716,1186826716,Physical Therapy,In-Network,I10,M54.5,,,,641,MS-DRG,8,4,Y,82043,Pathology/Lab,,,0200,21,Inpatient Hospital,3,55.8,21.47,0.0,21.47,75.0,0.0,96.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001162,MBR00000042,Professional,2022-06-01,2022-06-01,2022-06-20,PLN7901,1434029575,1434029575,Endocrinology,In-Network,Z23,Z12.11,,,,,,,0,,23472,Surgery,,,,81,Independent Laboratory,3,4276.71,3576.0,0.0,20.42,0.0,0.0,20.42,0.0,Denied,CO-15,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001163,MBR00000042,Institutional-OP,2021-06-09,2021-06-09,2021-07-13,PLN6698,1644128543,1644128543,Gastroenterology,In-Network,G43.909,E66.9,,,,,,,0,,45380,Surgery,,,0320,22,Outpatient Hospital,1,1993.8,1423.35,1196.25,212.1,15.0,0.0,227.1,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000001164,MBR00000042,Institutional-IP,2022-01-21,2022-01-22,2022-03-01,PLN4369,1438368327,1438368327,Home Health,In-Network,M17.11,E11.9,,,,196,MS-DRG,5,1,W,81001,Pathology/Lab,,,0200,21,Inpatient Hospital,1,25.13,14.61,0.0,14.61,0.0,0.0,14.61,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001165,MBR00000042,Professional,2022-02-24,2022-02-24,2022-03-25,PLN7597,1395983630,1395983630,Nephrology,In-Network,I25.10,M54.5,,,,,,,0,,G0444,Medicine,,,,11,Office,1,62.68,42.19,0.0,42.19,25.0,0.0,67.19,0.0,Denied,CO-11,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000001166,MBR00000042,Institutional-IP,2022-07-22,2022-07-25,2022-08-07,PLN9107,1749494482,1749494482,Pediatrics,In-Network,J06.9,Z96.641,,,,690,MS-DRG,9,3,Y,G0439,Medicine,,,0270,21,Inpatient Hospital,2,376.32,182.14,20.69,136.45,25.0,0.0,161.45,0.0,Paid,,,0,,0,1,0,0,1,0,None,0,0,0,1,0
CLM0000001167,MBR00000042,Professional,2021-07-24,2021-07-24,2021-08-30,PLN6151,1716521444,1716521444,Oncology,In-Network,J44.1,E11.9,,,,,,,0,,77067,Radiology,,,,22,Outpatient Hospital,2,318.36,221.02,221.02,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000001168,MBR00000042,Institutional-OP,2023-07-16,2023-07-16,2023-08-01,PLN2617,1727809972,1727809972,Home Health,In-Network,Z00.00,Z12.31,,,,,,,0,,23472,Surgery,,,0360,22,Outpatient Hospital,1,5407.98,2636.06,2302.99,333.07,0.0,0.0,333.07,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001169,MBR00000042,Professional,2021-03-28,2021-03-28,2021-04-25,PLN2641,1564502315,1564502315,ASC,In-Network,N18.3,Z12.31,,,,,,,0,,70450,Radiology,,,,12,Home,2,1776.94,1322.55,1159.07,0.0,15.0,148.48,163.48,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001170,MBR00000042,Institutional-OP,2023-12-16,2023-12-16,2024-01-03,PLN9794,1991459367,1991459367,Neurology,Out-of-Network,I48.91,F03.90,,,,,,,0,,99204,E&M,,,0320,22,Outpatient Hospital,1,413.28,143.76,143.76,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001171,MBR00000042,Professional,2021-12-09,2021-12-09,2022-01-13,PLN1179,1337791138,1337791138,Internal Medicine,Out-of-Network,I10,M54.5,,,,,,,0,,G0468,Medicine,,,,22,Outpatient Hospital,1,280.31,179.33,46.81,57.52,75.0,0.0,132.52,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000001172,MBR00000042,Institutional-OP,2022-06-21,2022-06-21,2022-07-22,PLN2198,1453936007,1453936007,ASC,In-Network,E66.9,E11.9,,,,,,,0,,99221,E&M,,,0120,22,Outpatient Hospital,1,176.65,110.59,105.18,0.0,0.0,5.41,5.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001173,MBR00000042,Institutional-OP,2023-08-17,2023-08-17,2023-09-30,PLN2944,1334916761,1334916761,ASC,In-Network,R05,E11.9,,,,,,,0,,99232,E&M,,,0761,22,Outpatient Hospital,1,343.97,110.19,0.0,110.19,0.0,0.0,110.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001174,MBR00000042,Institutional-OP,2022-12-18,2022-12-18,2023-01-15,PLN7605,1103747954,1103747954,Urology,In-Network,Z12.11,I25.10,,,,,,,0,,99233,E&M,,,0510,22,Outpatient Hospital,3,432.61,190.53,0.0,190.53,0.0,0.0,190.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001175,MBR00000042,Institutional-OP,2021-03-03,2021-03-03,2021-03-22,PLN3289,1295371663,1295371663,Critical Access Hospital,In-Network,Z00.00,E78.5,,,,,,,0,,83036,Pathology/Lab,,,0510,22,Outpatient Hospital,1,92.84,54.89,39.89,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000001176,MBR00000042,Institutional-OP,2022-10-24,2022-10-24,2022-12-05,PLN5604,1486164553,1486164553,DME Supplier,In-Network,Z96.641,I10,,,,,,,0,,99214,E&M,,,0360,22,Outpatient Hospital,2,421.61,161.23,0.0,161.23,0.0,0.0,161.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001177,MBR00000042,Professional,2022-09-12,2022-09-12,2022-10-12,PLN3039,1148984206,1148984206,Psychiatry,In-Network,Z12.31,F41.9,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,2,1152.23,546.89,506.08,0.0,0.0,40.81,40.81,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000001178,MBR00000042,Professional,2023-10-19,2023-10-19,2023-11-14,PLN3739,1991459367,1991459367,Neurology,Out-of-Network,M54.5,K21.0,,,,,,,0,,99284,E&M,,,,12,Home,3,922.27,427.18,19.79,407.39,0.0,0.0,407.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001179,MBR00000042,Institutional-IP,2022-09-09,2022-09-14,2022-10-19,PLN1085,1752470395,1752470395,Home Health,In-Network,N39.0,M54.5,,,,291,MS-DRG,6,5,Y,93225,Medicine,,,0900,21,Inpatient Hospital,1,756.93,274.92,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001180,MBR00000042,Institutional-IP,2023-12-23,2023-12-26,2024-01-09,PLN2318,1622771872,1622771872,Pediatrics,In-Network,E11.9,N18.3,,,,603,MS-DRG,11,3,Y,G0439,Medicine,,,0510,21,Inpatient Hospital,1,639.43,300.03,242.32,0.0,25.0,32.71,57.71,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000001181,MBR00000042,Professional,2022-08-05,2022-08-05,2022-09-05,PLN2073,1809014947,1809014947,Urology,In-Network,J06.9,Z87.891,,,,,,,0,,45380,Surgery,,,,11,Office,3,2232.63,894.9,844.9,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000001182,MBR00000042,Institutional-IP,2021-07-30,2021-08-03,2021-08-16,PLN1871,1500037969,1500037969,Pulmonology,In-Network,R05,K21.0,,,,470,MS-DRG,2,4,Y,85610,Pathology/Lab,,,0510,21,Inpatient Hospital,1,68.1,50.52,50.52,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001183,MBR00000042,Professional,2022-07-08,2022-07-08,2022-08-04,PLN4388,1749327647,1749327647,Geriatrics,In-Network,I10,I10,,,,,,,0,,99204,E&M,,,,11,Office,3,418.02,197.56,172.56,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001184,MBR00000042,Institutional-IP,2023-10-02,2023-10-04,2023-11-06,PLN3391,1609138981,1609138981,Critical Access Hospital,In-Network,N39.0,E78.5,,,,194,MS-DRG,13,2,Y,93306,Radiology,,,0301,21,Inpatient Hospital,1,1661.34,1289.62,1274.62,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001185,MBR00000042,Professional,2021-01-19,2021-01-19,2021-01-30,PLN9746,1645194539,1645194539,SNF,In-Network,E66.9,R05,,,,,,,0,,99232,E&M,,,,50,Federally Qualified Health Center,2,379.22,260.02,0.0,260.02,0.0,0.0,260.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001186,MBR00000042,Institutional-OP,2022-03-13,2022-03-13,2022-04-19,PLN7583,1717546253,1717546253,Family Medicine,In-Network,E11.9,I10,,,,,,,0,,93225,Medicine,,,0320,22,Outpatient Hospital,2,660.53,555.84,505.84,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001187,MBR00000042,Professional,2021-02-21,2021-02-21,2021-03-30,PLN7245,1891849440,1891849440,Oncology,In-Network,R10.9,I63.9,,,,,,,0,,58661,Surgery,,,,12,Home,3,2676.63,2175.36,0.0,217.38,0.0,0.0,217.38,0.0,Denied,CO-15,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001188,MBR00000042,Professional,2023-07-11,2023-07-11,2023-07-29,PLN8150,1872613201,1872613201,Internal Medicine,In-Network,E11.40,E78.5,,,,,,,0,,84443,Pathology/Lab,,,,22,Outpatient Hospital,1,166.21,122.42,47.42,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001189,MBR00000042,Institutional-IP,2022-07-14,2022-07-23,2022-07-24,PLN2384,1125190055,1125190055,Nephrology,In-Network,E11.9,N18.3,,,,291,MS-DRG,11,9,Y,76700,Radiology,,,0740,21,Inpatient Hospital,3,927.79,664.73,664.73,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001190,MBR00000042,Professional,2023-02-24,2023-02-24,2023-04-04,PLN3078,1964402759,1964402759,Outpatient Clinic,In-Network,F41.9,Z23,,,,,,,0,,86900,Pathology/Lab,,,,22,Outpatient Hospital,2,34.58,22.78,0.0,22.78,0.0,0.0,22.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001191,MBR00000042,Professional,2023-11-27,2023-11-27,2023-12-04,PLN5817,1410468316,1410468316,SNF,In-Network,Z00.00,E11.65,,,,,,,0,,23472,Surgery,,,,23,Emergency Room,2,6526.23,2393.41,2116.65,237.12,25.0,14.64,276.76,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001192,MBR00000042,Institutional-IP,2023-07-01,2023-07-06,2023-07-12,PLN1053,1812060197,1812060197,Oncology,Out-of-Network,Z12.11,I10,,,,682,MS-DRG,1,5,Y,74177,Radiology,,,0120,21,Inpatient Hospital,2,1664.43,1387.49,1203.67,0.0,0.0,183.82,183.82,0.0,Pended,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001193,MBR00000042,Institutional-OP,2022-03-23,2022-03-23,2022-04-06,PLN2420,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,I10,C50.912,,,,,,,0,,70553,Radiology,,,0200,22,Outpatient Hospital,1,2751.19,1028.57,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001194,MBR00000043,Institutional-OP,2023-10-21,2023-10-21,2023-11-09,PLN8338,1422747896,1422747896,Urology,In-Network,E78.5,I10,,,,,,,0,,99233,E&M,,,0636,22,Outpatient Hospital,3,527.58,352.92,352.92,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001195,MBR00000043,Professional,2022-06-02,2022-06-02,2022-06-14,PLN6359,1687650653,1687650653,Internal Medicine,In-Network,M17.11,I10,,,,,,,0,,99232,E&M,,,,11,Office,1,333.75,126.39,0.0,126.39,50.0,0.0,176.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001196,MBR00000043,Professional,2023-12-08,2023-12-08,2024-01-09,PLN5343,1283743001,1283743001,Family Medicine,In-Network,K21.0,Z00.00,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,1,30.83,11.3,0.0,11.3,50.0,0.0,61.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001197,MBR00000043,Institutional-IP,2023-12-12,2023-12-13,2023-12-31,PLN3838,1700633438,1700633438,DME Supplier,In-Network,K21.0,G20,,,,291,MS-DRG,4,1,N,99232,E&M,,,0301,21,Inpatient Hospital,2,163.15,111.56,111.56,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001198,MBR00000043,Institutional-IP,2021-08-31,2021-09-10,2021-09-19,PLN2665,1284035364,1284035364,Pediatrics,In-Network,Z00.00,E66.9,,,,470,MS-DRG,14,10,Y,76700,Radiology,,,0900,21,Inpatient Hospital,2,918.39,535.67,460.67,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001199,MBR00000043,Institutional-OP,2023-05-04,2023-05-04,2023-05-29,PLN4744,1389336600,1389336600,Critical Access Hospital,In-Network,I50.9,M54.5,,,,,,,0,,99406,Medicine,,,0320,22,Outpatient Hospital,1,70.09,46.83,44.63,0.0,0.0,2.2,2.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001200,MBR00000043,Professional,2023-02-04,2023-02-04,2023-03-06,PLN2169,1395983630,1395983630,Nephrology,In-Network,J18.9,Z00.00,,,,,,,0,,99232,E&M,,,,11,Office,1,195.6,145.82,0.0,145.82,0.0,0.0,145.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001201,MBR00000043,Professional,2023-04-24,2023-04-24,2023-05-30,PLN3636,1997536841,1997536841,Family Medicine,Out-of-Network,N39.0,R10.9,,,,,,,0,,99406,Medicine,,,,81,Independent Laboratory,3,104.83,36.51,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001202,MBR00000043,Institutional-OP,2021-07-03,2021-07-03,2021-07-15,PLN1057,1283743001,1283743001,Family Medicine,In-Network,I50.9,I10,,,,,,,0,,45378,Surgery,,,0120,22,Outpatient Hospital,3,1394.27,1076.71,915.01,161.7,0.0,0.0,161.7,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000001203,MBR00000043,Professional,2022-07-07,2022-07-07,2022-07-19,PLN9161,1845057593,1845057593,Orthopedic Surgery,In-Network,Z00.00,I10,,,,,,,0,,74177,Radiology,,,,11,Office,3,1258.6,432.96,417.96,0.0,15.0,0.0,15.0,0.0,Adjusted,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001204,MBR00000043,Institutional-OP,2021-06-15,2021-06-15,2021-07-01,PLN5654,1997536841,1997536841,Family Medicine,Out-of-Network,I10,E11.9,,,,,,,0,,99283,E&M,,,0270,22,Outpatient Hospital,3,271.83,216.16,103.15,113.01,0.0,0.0,113.01,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001205,MBR00000043,Professional,2023-09-11,2023-09-11,2023-09-30,PLN4859,1606140917,1606140917,ASC,In-Network,Z12.31,E11.9,,,,,,,0,,G0439,Medicine,,,,20,Urgent Care,1,270.78,179.47,0.0,179.47,0.0,0.0,179.47,0.0,Adjusted,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000001206,MBR00000043,Institutional-OP,2023-08-15,2023-08-15,2023-09-04,PLN5000,1213165847,1213165847,Critical Access Hospital,In-Network,Z23,R10.9,,,,,,,0,,81001,Pathology/Lab,,,0761,22,Outpatient Hospital,2,34.5,19.54,19.54,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001207,MBR00000043,Professional,2022-09-29,2022-09-29,2022-10-28,PLN5746,1624202402,1624202402,Orthopedic Surgery,In-Network,E11.9,J44.1,,,,,,,0,,83036,Pathology/Lab,,,,31,Skilled Nursing Facility,1,55.54,30.81,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000001208,MBR00000043,Institutional-OP,2021-05-23,2021-05-23,2021-06-18,PLN8139,1295371663,1295371663,Critical Access Hospital,In-Network,I10,J06.9,,,,,,,0,,G0439,Medicine,,,0636,22,Outpatient Hospital,3,503.51,156.73,81.73,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000001209,MBR00000043,Institutional-OP,2022-12-21,2022-12-21,2022-12-29,PLN6383,1366286000,1366286000,SNF,In-Network,E78.5,C50.912,,,,,,,0,,99204,E&M,,,0270,22,Outpatient Hospital,2,456.54,232.65,0.0,0.0,75.0,18.94,93.94,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001210,MBR00000043,Professional,2022-04-27,2022-04-27,2022-05-27,PLN6958,1556140803,1556140803,Cardiology,In-Network,N18.3,I48.91,,,,,,,0,,99232,E&M,,,,11,Office,3,167.13,60.35,30.27,0.0,25.0,5.08,30.08,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000001211,MBR00000043,Institutional-OP,2023-05-13,2023-05-13,2023-05-29,PLN6139,1571574052,1571574052,Critical Access Hospital,In-Network,N39.0,E11.9,,,,,,,0,,99203,E&M,,,0370,22,Outpatient Hospital,1,357.15,229.47,154.47,0.0,75.0,0.0,75.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001212,MBR00000043,Professional,2021-04-19,2021-04-19,2021-05-17,PLN9965,1118885473,1118885473,ASC,In-Network,E66.9,I10,,,,,,,0,,97110,Medicine,,,,49,Independent Clinic,1,250.46,172.83,38.92,133.91,0.0,0.0,133.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001213,MBR00000043,Professional,2022-03-22,2022-03-22,2022-04-03,PLN1191,1114982472,1114982472,Orthopedic Surgery,In-Network,M54.5,I10,,,,,,,0,,97110,Medicine,,,,11,Office,1,181.55,149.02,0.0,149.02,25.0,0.0,174.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001214,MBR00000043,Institutional-IP,2022-01-31,2022-02-01,2022-02-22,PLN1841,1644128543,1644128543,Gastroenterology,In-Network,E78.5,J06.9,,,,683,MS-DRG,20,1,N,43239,Surgery,,,0730,21,Inpatient Hospital,2,1310.46,944.16,724.31,0.0,75.0,144.85,219.85,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001215,MBR00000043,Institutional-IP,2023-11-10,2023-11-14,2023-12-19,PLN3395,1135158374,1135158374,Pulmonology,In-Network,Z00.00,Z00.00,,,,291,MS-DRG,7,4,Y,74177,Radiology,,,0730,21,Inpatient Hospital,2,1346.6,1122.94,638.66,434.28,50.0,0.0,484.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001216,MBR00000043,Professional,2021-11-23,2021-11-23,2021-12-07,PLN5092,1528335731,1528335731,Critical Access Hospital,In-Network,N40.0,E78.5,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,1,48.82,20.76,5.76,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001217,MBR00000043,Professional,2023-12-18,2023-12-18,2024-01-21,PLN9375,1778483301,1778483301,Home Health,In-Network,I25.10,E11.9,,,,,,,0,,66984,Surgery,,,,20,Urgent Care,1,2370.36,1609.28,1400.88,0.0,0.0,208.4,208.4,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001218,MBR00000043,Professional,2023-10-07,2023-10-07,2023-11-06,PLN9470,1205377316,1205377316,Orthopedic Surgery,In-Network,I10,C50.912,,,,,,,0,,99221,E&M,,,,20,Urgent Care,1,275.63,121.73,0.0,121.73,0.0,0.0,121.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001219,MBR00000043,Professional,2022-10-05,2022-10-05,2022-11-11,PLN8893,1273488618,1273488618,General Acute Care Hospital,In-Network,I10,J06.9,,,,,,,0,,G0439,Medicine,,,,31,Skilled Nursing Facility,1,287.1,112.69,112.69,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000001220,MBR00000043,Professional,2021-07-11,2021-07-11,2021-08-24,PLN6913,1389336600,1389336600,Critical Access Hospital,In-Network,I10,K21.0,,,,,,,0,,99213,E&M,,,,20,Urgent Care,2,140.65,81.57,0.0,81.57,75.0,0.0,156.57,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001221,MBR00000043,Professional,2021-09-01,2021-09-01,2021-09-23,PLN5202,1168246159,1168246159,Internal Medicine,In-Network,E78.5,M17.11,,,,,,,0,,27130,Surgery,,,,11,Office,3,6618.22,3827.04,3677.4,0.0,15.0,134.64,149.64,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001222,MBR00000043,Institutional-OP,2021-01-19,2021-01-19,2021-03-04,PLN4043,1453283987,1453283987,Critical Access Hospital,In-Network,Z00.00,Z79.4,,,,,,,0,,76700,Radiology,,,0761,22,Outpatient Hospital,3,648.35,529.86,432.61,62.25,35.0,0.0,97.25,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001223,MBR00000043,Professional,2023-04-29,2023-04-29,2023-05-16,PLN3790,1528335731,1528335731,Critical Access Hospital,In-Network,I48.91,F41.9,,,,,,,0,,66984,Surgery,,,,65,End-Stage Renal Disease,2,3344.62,2142.35,2117.35,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001224,MBR00000043,Institutional-OP,2023-03-06,2023-03-06,2023-03-14,PLN1471,1891849440,1891849440,Oncology,In-Network,Z23,E78.5,,,,,,,0,,45380,Surgery,,,0510,22,Outpatient Hospital,1,2368.47,1226.81,1226.81,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000001225,MBR00000043,Professional,2021-12-19,2021-12-19,2022-01-25,PLN3441,1569105090,1569105090,Geriatrics,In-Network,R07.9,E11.9,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,2,49.6,32.32,0.0,32.32,50.0,0.0,82.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001226,MBR00000043,Professional,2023-03-12,2023-03-12,2023-03-26,PLN3978,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,E11.9,Z00.00,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,1,45.49,16.07,0.0,16.07,0.0,0.0,16.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001227,MBR00000043,Professional,2022-09-24,2022-09-24,2022-10-21,PLN5756,1948810580,1948810580,DME Supplier,In-Network,M54.5,I10,,,,,,,0,,87491,Pathology/Lab,,,,23,Emergency Room,1,115.5,92.53,0.0,0.0,50.0,8.15,58.15,0.0,Denied,CO-11,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001228,MBR00000043,Professional,2023-06-14,2023-06-14,2023-07-22,PLN1379,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,R51,E11.9,,,,,,,0,,99233,E&M,,,,11,Office,1,360.95,167.17,117.17,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001229,MBR00000044,Institutional-IP,2021-04-05,2021-04-07,2021-05-07,PLN1284,1845057593,1845057593,Orthopedic Surgery,In-Network,I10,K21.0,,,,195,MS-DRG,2,2,Y,99204,E&M,,,0360,21,Inpatient Hospital,3,445.13,185.2,150.2,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000001230,MBR00000044,Professional,2021-08-06,2021-08-06,2021-09-11,PLN6809,1727809972,1727809972,Home Health,In-Network,K92.1,Z79.4,,,,,,,0,,99232,E&M,,,,11,Office,2,269.48,147.88,147.88,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001231,MBR00000044,Professional,2023-06-04,2023-06-04,2023-07-17,PLN5127,1702692193,1702692193,Physical Therapy,In-Network,I10,E78.5,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,1,5823.31,3466.7,3416.7,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001232,MBR00000044,Professional,2022-02-09,2022-02-09,2022-03-15,PLN9136,1939033455,1939033455,Pulmonology,In-Network,F32.9,E66.9,,,,,,,0,,99214,E&M,,,,11,Office,3,199.08,130.59,115.59,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001233,MBR00000044,Institutional-OP,2023-11-17,2023-11-17,2023-12-06,PLN9399,1691062876,1691062876,SNF,In-Network,I63.9,M54.5,,,,,,,0,,90460,Medicine,,,0370,22,Outpatient Hospital,2,63.3,42.78,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001234,MBR00000044,Professional,2023-08-23,2023-08-23,2023-09-01,PLN3345,1109850785,1109850785,ASC,Out-of-Network,I10,K21.0,,,,,,,0,,80053,Pathology/Lab,,,,50,Federally Qualified Health Center,3,109.43,52.89,52.89,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001235,MBR00000044,Professional,2021-04-14,2021-04-14,2021-04-25,PLN7565,1809014947,1809014947,Urology,In-Network,Z00.00,J20.9,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,3,232.02,150.15,12.99,136.97,0.0,0.19,137.16,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001236,MBR00000044,Professional,2022-03-18,2022-03-18,2022-03-28,PLN5490,1702692193,1702692193,Physical Therapy,In-Network,E11.9,I10,,,,,,,0,,99232,E&M,,,,50,Federally Qualified Health Center,1,185.07,78.96,0.0,0.0,35.0,1.41,36.41,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001237,MBR00000044,Institutional-IP,2023-03-13,2023-03-14,2023-04-16,PLN8179,1453283987,1453283987,Critical Access Hospital,In-Network,E11.9,F41.9,,,,291,MS-DRG,14,1,Y,70450,Radiology,,,0120,21,Inpatient Hospital,1,1401.83,1013.2,1013.2,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001238,MBR00000044,Institutional-OP,2021-05-30,2021-05-30,2021-06-24,PLN1390,1453283987,1453283987,Critical Access Hospital,In-Network,E78.5,I11.9,,,,,,,0,,90837,Medicine,,,0320,22,Outpatient Hospital,2,360.49,205.34,205.34,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001239,MBR00000044,Professional,2023-08-01,2023-08-01,2023-08-27,PLN1763,1767011137,1767011137,DME Supplier,In-Network,J18.9,I10,,,,,,,0,,58661,Surgery,,,,49,Independent Clinic,2,4813.1,1911.1,1876.1,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001240,MBR00000044,Professional,2021-04-18,2021-04-18,2021-05-29,PLN9081,1717546253,1717546253,Family Medicine,In-Network,Z00.00,E78.5,,,,,,,0,,27130,Surgery,,,,11,Office,3,5505.25,2305.91,2290.91,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001241,MBR00000044,Professional,2021-04-30,2021-04-30,2021-06-13,PLN5568,1514306773,1514306773,Endocrinology,In-Network,J20.9,J06.9,,,,,,,0,,99214,E&M,,,,11,Office,2,325.12,250.76,0.0,89.5,25.0,0.0,114.5,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001242,MBR00000044,Institutional-OP,2022-08-19,2022-08-19,2022-09-17,PLN9034,1660288235,1660288235,ASC,In-Network,E11.65,J18.9,,,,,,,0,,G0444,Medicine,,,0450,22,Outpatient Hospital,3,49.66,41.49,0.0,41.49,0.0,0.0,41.49,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000001243,MBR00000044,Professional,2021-09-28,2021-09-28,2021-10-23,PLN4478,1284035364,1284035364,Pediatrics,In-Network,F10.20,Z00.00,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,1,28.16,21.64,0.0,21.64,15.0,0.0,36.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001244,MBR00000045,Institutional-OP,2022-12-01,2022-12-01,2023-01-10,PLN2801,1334916761,1334916761,ASC,In-Network,I11.9,E78.5,,,,,,,0,,90837,Medicine,,,0730,22,Outpatient Hospital,3,340.02,211.46,0.0,211.46,0.0,0.0,211.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001245,MBR00000045,Institutional-OP,2022-03-06,2022-03-06,2022-03-25,PLN1181,1691062876,1691062876,SNF,In-Network,E66.9,E11.9,,,,,,,0,,99283,E&M,,,0200,22,Outpatient Hospital,1,519.85,162.62,112.62,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001246,MBR00000045,Professional,2021-10-24,2021-10-24,2021-12-05,PLN4247,1500949740,1500949740,Pediatrics,In-Network,Z12.31,Z23,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,2,32.51,10.45,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001247,MBR00000045,Institutional-OP,2023-07-06,2023-07-06,2023-07-19,PLN2727,1273488618,1273488618,General Acute Care Hospital,In-Network,I10,E78.5,,,,,,,0,,99233,E&M,,,0740,22,Outpatient Hospital,2,537.84,308.44,258.44,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001248,MBR00000045,Institutional-IP,2021-06-24,2021-07-02,2021-07-07,PLN3307,1364429278,1364429278,OB/GYN,In-Network,E11.65,Z23,,,,682,MS-DRG,7,8,Y,99283,E&M,,,0510,21,Inpatient Hospital,3,584.09,332.12,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001249,MBR00000045,Professional,2022-06-25,2022-06-25,2022-07-28,PLN5136,1727809972,1727809972,Home Health,In-Network,E11.9,J20.9,,,,,,,0,,G0444,Medicine,,,,23,Emergency Room,1,36.97,29.64,25.62,0.0,0.0,4.02,4.02,0.0,Paid,,,0,,1,1,0,0,0,0,None,0,0,0,0,1
CLM0000001250,MBR00000045,Professional,2021-07-04,2021-07-04,2021-07-24,PLN1971,1266606767,1266606767,ASC,In-Network,E11.9,Z23,,,,,,,0,,99203,E&M,,,,11,Office,2,346.28,166.15,166.15,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001251,MBR00000045,Professional,2021-05-30,2021-05-30,2021-06-12,PLN5587,1845900543,1845900543,ASC,In-Network,K92.1,R07.9,,,,,,,0,,78452,Radiology,,,,49,Independent Clinic,2,7019.41,3434.97,3391.2,0.0,0.0,43.77,43.77,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001252,MBR00000045,Professional,2021-08-13,2021-08-13,2021-09-02,PLN2859,1247341320,1247341320,Urology,Out-of-Network,F41.9,E78.5,,,,,,,0,,45380,Surgery,,,,11,Office,2,2330.75,1196.09,1038.15,0.0,50.0,107.94,157.94,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000001253,MBR00000045,Institutional-OP,2021-10-08,2021-10-08,2021-10-24,PLN8565,1193493783,1193493783,Critical Access Hospital,Out-of-Network,M54.5,I10,,,,,,,0,,G0444,Medicine,,,0360,22,Outpatient Hospital,3,83.01,49.38,34.38,0.0,15.0,0.0,15.0,0.0,Pended,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000001254,MBR00000045,Institutional-IP,2022-03-28,2022-03-29,2022-04-11,PLN6810,1361302520,1361302520,Critical Access Hospital,In-Network,F41.9,Z23,,,,871,MS-DRG,17,1,Y,58661,Surgery,,,0200,21,Inpatient Hospital,3,2269.81,1241.33,1012.13,154.2,75.0,0.0,229.2,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001255,MBR00000045,Institutional-OP,2022-05-27,2022-05-27,2022-06-19,PLN3613,1997536841,1997536841,Family Medicine,Out-of-Network,E11.9,M81.0,,,,,,,0,,70553,Radiology,,,0320,22,Outpatient Hospital,3,3262.99,2411.25,2240.61,0.0,35.0,135.64,170.64,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001256,MBR00000045,Professional,2021-06-01,2021-06-01,2021-06-22,PLN6389,1644128543,1644128543,Gastroenterology,In-Network,Z12.31,I10,,,,,,,0,,81001,Pathology/Lab,,,,22,Outpatient Hospital,2,40.1,20.77,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001257,MBR00000045,Professional,2021-02-12,2021-02-12,2021-03-13,PLN6175,1569105090,1569105090,Geriatrics,In-Network,E11.40,M54.5,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,1,1696.37,1395.13,1370.13,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000001258,MBR00000045,Professional,2021-04-14,2021-04-14,2021-04-30,PLN6781,1910255109,1910255109,DME Supplier,In-Network,Z23,B97.89,,,,,,,0,,90460,Medicine,,,,11,Office,3,50.86,22.39,0.0,22.39,0.0,0.0,22.39,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001259,MBR00000045,Institutional-OP,2022-11-22,2022-11-22,2023-01-01,PLN1763,1561134315,1561134315,DME Supplier,In-Network,F32.9,Z00.00,,,,,,,0,,99204,E&M,,,0301,22,Outpatient Hospital,3,212.42,125.95,125.95,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001260,MBR00000045,Professional,2023-12-03,2023-12-03,2023-12-17,PLN7655,1114982472,1114982472,Orthopedic Surgery,In-Network,Z12.31,I11.9,,,,,,,0,,99214,E&M,,,,50,Federally Qualified Health Center,3,237.09,127.26,77.26,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001261,MBR00000045,Professional,2021-01-28,2021-01-28,2021-03-13,PLN5415,1337791138,1337791138,Internal Medicine,Out-of-Network,I10,J06.9,,,,,,,0,,70553,Radiology,,,,11,Office,1,2675.61,1009.34,901.0,0.0,0.0,108.34,108.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001262,MBR00000045,Institutional-IP,2021-02-08,2021-02-14,2021-03-19,PLN1143,1716521444,1716521444,Oncology,In-Network,Z12.31,E11.9,,,,871,MS-DRG,5,6,Y,33533,Surgery,,,0740,21,Inpatient Hospital,2,13793.19,11575.76,9383.01,0.0,0.0,2192.75,2192.75,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000001263,MBR00000045,Institutional-OP,2023-05-06,2023-05-06,2023-05-19,PLN2070,1518055405,1518055405,Urology,In-Network,Z00.00,E66.9,,,,,,,0,,43239,Surgery,,,0360,22,Outpatient Hospital,3,1011.27,696.97,588.46,108.51,0.0,0.0,108.51,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001264,MBR00000045,Professional,2023-03-05,2023-03-05,2023-03-18,PLN1987,1313212303,1313212303,Family Medicine,In-Network,K21.0,F41.9,,,,,,,0,,85025,Pathology/Lab,,,,65,End-Stage Renal Disease,2,68.66,38.02,0.0,38.02,0.0,0.0,38.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001265,MBR00000045,Institutional-IP,2023-03-15,2023-03-19,2023-04-15,PLN7250,1968299309,1968299309,Internal Medicine,In-Network,Z00.00,I10,,,,872,MS-DRG,14,4,Y,80061,Pathology/Lab,,,0510,21,Inpatient Hospital,1,128.42,50.3,50.3,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001266,MBR00000045,Professional,2021-07-09,2021-07-09,2021-07-23,PLN7762,1728018911,1728018911,Nephrology,In-Network,E78.5,K21.0,,,,,,,0,,90686,Medicine,,,,11,Office,1,102.33,80.02,43.9,0.0,35.0,1.12,36.12,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000001267,MBR00000045,Institutional-OP,2023-08-06,2023-08-06,2023-09-01,PLN4037,1244186984,1244186984,Family Medicine,Out-of-Network,K21.0,I48.91,,,,,,,0,,99232,E&M,,,0450,22,Outpatient Hospital,2,335.67,167.07,0.0,167.07,0.0,0.0,167.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001268,MBR00000045,Institutional-OP,2022-11-14,2022-11-14,2022-12-21,PLN7072,1372918899,1372918899,Family Medicine,In-Network,M54.5,E78.5,,,,,,,0,,85610,Pathology/Lab,,,0761,22,Outpatient Hospital,2,43.88,20.7,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001269,MBR00000045,Institutional-OP,2021-06-22,2021-06-22,2021-07-29,PLN1694,1997536841,1997536841,Family Medicine,Out-of-Network,I10,Z87.891,,,,,,,0,,74177,Radiology,,,0301,22,Outpatient Hospital,1,2827.47,874.05,637.68,236.37,0.0,0.0,236.37,0.0,Paid,,,1,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000001270,MBR00000045,Professional,2021-05-07,2021-05-07,2021-06-10,PLN8088,1806688928,1806688928,Geriatrics,In-Network,E11.9,I10,,,,,,,0,,97110,Medicine,,,,49,Independent Clinic,2,171.43,135.54,135.54,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001271,MBR00000045,Institutional-IP,2022-10-22,2022-10-29,2022-11-03,PLN2480,1564502315,1564502315,ASC,In-Network,I10,Z00.00,,,,682,MS-DRG,16,7,Y,93306,Radiology,,,0320,21,Inpatient Hospital,2,3194.79,1749.92,1638.7,0.0,0.0,111.22,111.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001272,MBR00000045,Professional,2023-05-04,2023-05-04,2023-06-09,PLN3883,1545347862,1545347862,SNF,In-Network,Z23,E11.9,,,,,,,0,,97110,Medicine,,,,20,Urgent Care,1,271.41,181.12,181.12,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001273,MBR00000045,Professional,2023-05-06,2023-05-06,2023-06-12,PLN1328,1550154147,1550154147,Outpatient Clinic,In-Network,J06.9,E11.40,,,,,,,0,,81001,Pathology/Lab,,,,20,Urgent Care,2,56.34,29.17,0.0,29.17,0.0,0.0,29.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001274,MBR00000045,Institutional-OP,2022-10-06,2022-10-06,2022-11-04,PLN6276,1609526529,1609526529,Psychiatry,In-Network,M54.5,I10,,,,,,,0,,G0439,Medicine,,,0510,22,Outpatient Hospital,1,629.24,526.85,252.73,229.36,15.0,29.76,274.12,0.0,Pended,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000001275,MBR00000045,Professional,2022-07-19,2022-07-19,2022-08-28,PLN5096,1872272835,1872272835,Internal Medicine,In-Network,E11.9,R07.9,,,,,,,0,,74177,Radiology,,,,23,Emergency Room,1,2624.46,1045.75,830.6,0.0,25.0,190.15,215.15,0.0,Adjusted,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001276,MBR00000046,Institutional-IP,2023-02-01,2023-02-04,2023-03-15,PLN3159,1990090423,1990090423,Orthopedic Surgery,In-Network,E11.9,Z23,,,,871,MS-DRG,2,3,Y,27447,Surgery,,,0761,21,Inpatient Hospital,1,6014.2,4679.02,0.0,0.0,35.0,890.06,925.06,0.0,Denied,CO-50,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001277,MBR00000046,Professional,2021-05-24,2021-05-24,2021-06-06,PLN1811,1500037969,1500037969,Pulmonology,In-Network,J44.1,F41.9,,,,,,,0,,43239,Surgery,,,,12,Home,3,1519.0,978.61,797.22,106.39,75.0,0.0,181.39,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001278,MBR00000046,Professional,2022-02-04,2022-02-04,2022-03-15,PLN5582,1186826716,1186826716,Physical Therapy,In-Network,Z00.00,Z87.891,,,,,,,0,,45380,Surgery,,,,11,Office,2,1540.71,1151.0,1151.0,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000001279,MBR00000046,Professional,2021-04-19,2021-04-19,2021-05-22,PLN8204,1135158374,1135158374,Pulmonology,In-Network,E78.5,I10,,,,,,,0,,77067,Radiology,,,,49,Independent Clinic,2,678.82,367.58,0.0,367.58,0.0,0.0,367.58,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000001280,MBR00000046,Professional,2023-07-08,2023-07-08,2023-08-17,PLN3355,1997536841,1997536841,Family Medicine,Out-of-Network,R51,E11.9,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,2,1466.69,548.15,533.15,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001281,MBR00000046,Institutional-IP,2022-10-26,2022-11-05,2022-11-17,PLN8037,1245650222,1245650222,Gastroenterology,In-Network,N40.0,E11.9,,,,291,MS-DRG,2,10,Y,99233,E&M,,,0120,21,Inpatient Hospital,3,230.6,135.07,135.07,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001282,MBR00000046,Institutional-OP,2023-05-02,2023-05-02,2023-05-15,PLN3564,1475984649,1475984649,SNF,In-Network,J06.9,F41.9,,,,,,,0,,99213,E&M,,,0900,22,Outpatient Hospital,1,305.03,217.33,163.23,37.26,0.0,16.84,54.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001283,MBR00000046,Institutional-OP,2022-06-29,2022-06-29,2022-07-31,PLN4627,1198133277,1198133277,SNF,In-Network,N39.0,J06.9,,,,,,,0,,81001,Pathology/Lab,,,0120,22,Outpatient Hospital,2,21.6,11.44,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001284,MBR00000046,Institutional-OP,2023-10-16,2023-10-16,2023-11-29,PLN1916,1224179551,1224179551,Physical Therapy,In-Network,E11.40,Z12.31,,,,,,,0,,G0444,Medicine,,,0900,22,Outpatient Hospital,3,57.6,42.84,42.84,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000001285,MBR00000046,Professional,2023-10-15,2023-10-15,2023-10-25,PLN7041,1475984649,1475984649,SNF,In-Network,E11.65,E11.9,,,,,,,0,,99213,E&M,,,,21,Inpatient Hospital,1,120.45,92.76,0.0,92.76,25.0,0.0,117.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001286,MBR00000046,Institutional-OP,2022-11-06,2022-11-06,2022-11-18,PLN2851,1366286000,1366286000,SNF,In-Network,I25.10,E66.9,,,,,,,0,,27447,Surgery,,,0636,22,Outpatient Hospital,3,3740.35,2791.03,2342.31,448.72,0.0,0.0,448.72,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001287,MBR00000046,Professional,2023-07-03,2023-07-03,2023-08-09,PLN3245,1410468316,1410468316,SNF,In-Network,J20.9,F32.9,,,,,,,0,,45380,Surgery,,,,31,Skilled Nursing Facility,3,1275.85,698.09,0.0,0.0,0.0,27.59,27.59,0.0,Denied,CO-4,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000001288,MBR00000046,Professional,2022-12-24,2022-12-24,2023-01-05,PLN6276,1114982472,1114982472,Orthopedic Surgery,In-Network,K57.30,B97.89,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,2,151.75,76.64,26.64,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001289,MBR00000046,Professional,2023-03-04,2023-03-04,2023-03-14,PLN1480,1227362142,1227362142,DME Supplier,In-Network,I10,Z23,,,,,,,0,,76700,Radiology,,,,50,Federally Qualified Health Center,3,1168.25,656.65,511.35,110.3,35.0,0.0,145.3,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001290,MBR00000046,Professional,2021-09-28,2021-09-28,2021-10-12,PLN8488,1389336600,1389336600,Critical Access Hospital,In-Network,J20.9,E11.9,,,,,,,0,,90460,Medicine,,,,49,Independent Clinic,3,27.54,13.55,0.0,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001291,MBR00000046,Institutional-OP,2023-12-12,2023-12-12,2023-12-30,PLN1708,1939033455,1939033455,Pulmonology,In-Network,J06.9,E78.5,,,,,,,0,,78452,Radiology,,,0636,22,Outpatient Hospital,1,3275.26,1346.85,1321.85,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001292,MBR00000046,Professional,2021-07-21,2021-07-21,2021-09-03,PLN7921,1337791138,1337791138,Internal Medicine,Out-of-Network,F41.9,Z12.31,,,,,,,0,,43239,Surgery,,,,20,Urgent Care,1,990.81,470.69,8.06,462.63,0.0,0.0,462.63,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001293,MBR00000046,Professional,2023-01-31,2023-01-31,2023-03-06,PLN5919,1622771872,1622771872,Pediatrics,In-Network,Z00.00,Z23,,,,,,,0,,97110,Medicine,,,,21,Inpatient Hospital,3,256.63,146.45,131.45,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001294,MBR00000046,Professional,2022-10-27,2022-10-27,2022-12-09,PLN6773,1799205295,1799205295,General Acute Care Hospital,In-Network,Z79.4,M54.5,,,,,,,0,,99213,E&M,,,,20,Urgent Care,3,243.63,152.17,19.59,57.28,75.0,0.3,132.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001295,MBR00000046,Professional,2021-04-12,2021-04-12,2021-04-22,PLN8784,1239316214,1239316214,Internal Medicine,In-Network,I10,N18.3,,,,,,,0,,99233,E&M,,,,21,Inpatient Hospital,1,385.21,324.07,6.4,267.56,50.0,0.11,317.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001296,MBR00000046,Institutional-OP,2023-04-29,2023-04-29,2023-05-09,PLN2485,1239316214,1239316214,Internal Medicine,In-Network,J20.9,I10,,,,,,,0,,99233,E&M,,,0740,22,Outpatient Hospital,3,536.22,361.96,144.09,217.87,0.0,0.0,217.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001297,MBR00000046,Professional,2021-03-26,2021-03-26,2021-05-01,PLN6105,1799205295,1799205295,General Acute Care Hospital,In-Network,R51,K57.30,,,,,,,0,,66984,Surgery,,,,11,Office,3,1886.6,942.71,405.21,486.22,0.0,51.28,537.5,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001298,MBR00000046,Professional,2022-07-12,2022-07-12,2022-08-25,PLN8626,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,E11.9,I63.9,,,,,,,0,,27130,Surgery,,,,11,Office,1,3885.22,1469.59,1312.56,0.0,35.0,122.03,157.03,0.0,Paid,,,0,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000001299,MBR00000046,Institutional-OP,2023-06-13,2023-06-13,2023-06-29,PLN4171,1390307371,1390307371,DME Supplier,In-Network,J06.9,N39.0,,,,,,,0,,99204,E&M,,,0740,22,Outpatient Hospital,3,515.27,396.8,74.3,322.5,0.0,0.0,322.5,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001300,MBR00000046,Institutional-OP,2021-05-18,2021-05-18,2021-06-20,PLN7608,1109850785,1109850785,ASC,Out-of-Network,E78.5,E78.5,,,,,,,0,,90837,Medicine,,,0301,22,Outpatient Hospital,3,193.97,92.59,62.14,0.0,15.0,15.45,30.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001301,MBR00000046,Professional,2022-01-30,2022-01-30,2022-02-13,PLN7647,1450094833,1450094833,Outpatient Clinic,In-Network,N39.0,G43.909,,,,,,,0,,90460,Medicine,,,,81,Independent Laboratory,2,61.76,50.53,0.0,50.53,0.0,0.0,50.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001302,MBR00000046,Professional,2022-07-11,2022-07-11,2022-08-19,PLN5595,1366426662,1366426662,Urology,In-Network,E11.9,E11.9,,,,,,,0,,90837,Medicine,,,,11,Office,3,368.03,149.65,124.65,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001303,MBR00000046,Institutional-OP,2023-10-10,2023-10-10,2023-10-30,PLN2311,1245650222,1245650222,Gastroenterology,In-Network,I50.9,J20.9,,,,,,,0,,93000,Radiology,,,0320,22,Outpatient Hospital,2,124.9,73.61,38.61,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001304,MBR00000046,Professional,2022-02-23,2022-02-23,2022-03-19,PLN6211,1997536841,1997536841,Family Medicine,Out-of-Network,J44.1,Z23,,,,,,,0,,83036,Pathology/Lab,,,,49,Independent Clinic,1,45.22,31.15,0.0,31.15,75.0,0.0,106.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000001305,MBR00000046,Professional,2021-05-10,2021-05-10,2021-06-22,PLN7457,1520687146,1520687146,ASC,In-Network,Z12.31,R51,,,,,,,0,,99213,E&M,,,,65,End-Stage Renal Disease,1,151.78,60.4,10.4,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001306,MBR00000046,Professional,2021-05-24,2021-05-24,2021-06-25,PLN6948,1475984649,1475984649,SNF,In-Network,F32.9,F41.9,,,,,,,0,,33533,Surgery,,,,12,Home,2,16830.07,6172.28,5601.18,0.0,0.0,571.1,571.1,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000001307,MBR00000046,Professional,2021-08-06,2021-08-06,2021-09-19,PLN4173,1193493783,1193493783,Critical Access Hospital,Out-of-Network,M54.5,F32.9,,,,,,,0,,77067,Radiology,,,,81,Independent Laboratory,3,667.44,319.14,269.14,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000001308,MBR00000046,Institutional-OP,2023-08-07,2023-08-07,2023-09-12,PLN2708,1809014947,1809014947,Urology,In-Network,J06.9,C50.912,,,,,,,0,,G0468,Medicine,,,0120,22,Outpatient Hospital,1,360.86,303.2,6.85,296.35,0.0,0.0,296.35,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001309,MBR00000046,Institutional-OP,2023-04-27,2023-04-27,2023-05-21,PLN4421,1645194539,1645194539,SNF,In-Network,E11.40,Z79.4,,,,,,,0,,99203,E&M,,,0270,22,Outpatient Hospital,1,402.43,213.08,0.0,98.17,35.0,0.0,133.17,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001310,MBR00000046,Professional,2022-04-03,2022-04-03,2022-04-21,PLN4299,1500037969,1500037969,Pulmonology,In-Network,E78.5,E11.9,,,,,,,0,,66984,Surgery,,,,11,Office,1,3505.59,1692.64,0.0,232.77,0.0,0.0,232.77,0.0,Denied,CO-4,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001311,MBR00000046,Institutional-IP,2023-07-17,2023-07-22,2023-07-24,PLN5699,1450094833,1450094833,Outpatient Clinic,In-Network,Z00.00,N18.3,,,,683,MS-DRG,7,5,Y,45380,Surgery,,,0761,21,Inpatient Hospital,1,2641.07,1328.54,1032.72,128.42,35.0,132.4,295.82,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000001312,MBR00000046,Institutional-OP,2023-10-03,2023-10-03,2023-10-22,PLN4808,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,J06.9,F03.90,,,,,,,0,,99214,E&M,,,0740,22,Outpatient Hospital,2,376.55,319.17,284.17,0.0,35.0,0.0,35.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001313,MBR00000047,Institutional-IP,2023-08-08,2023-08-09,2023-08-25,PLN5970,1745114564,1745114564,Endocrinology,In-Network,I25.10,E78.5,,,,872,MS-DRG,4,1,Y,99406,Medicine,,,0450,21,Inpatient Hospital,2,88.98,31.15,0.0,31.15,75.0,0.0,106.15,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001314,MBR00000047,Institutional-IP,2021-01-05,2021-01-09,2021-01-27,PLN8847,1702692193,1702692193,Physical Therapy,In-Network,N39.0,I10,,,,195,MS-DRG,22,4,N,90460,Medicine,,,0120,21,Inpatient Hospital,3,62.85,19.43,19.43,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001315,MBR00000047,Institutional-OP,2021-04-19,2021-04-19,2021-04-27,PLN7860,1139906830,1139906830,Endocrinology,Out-of-Network,Z12.31,F03.90,,,,,,,0,,99213,E&M,,,0370,22,Outpatient Hospital,1,217.54,131.05,121.28,0.0,0.0,9.77,9.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001316,MBR00000047,Professional,2023-03-06,2023-03-06,2023-03-25,PLN9062,1856686341,1856686341,Geriatrics,In-Network,I10,Z96.641,,,,,,,0,,99203,E&M,,,,20,Urgent Care,2,165.62,112.43,112.43,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001317,MBR00000047,Professional,2022-02-23,2022-02-23,2022-04-05,PLN8580,1845057593,1845057593,Orthopedic Surgery,In-Network,C50.912,I10,,,,,,,0,,93000,Radiology,,,,11,Office,3,87.93,31.97,0.0,31.97,75.0,0.0,106.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001318,MBR00000047,Institutional-OP,2021-06-23,2021-06-23,2021-07-17,PLN2851,1780163051,1780163051,SNF,In-Network,Z00.00,E11.9,,,,,,,0,,99203,E&M,,,0510,22,Outpatient Hospital,1,363.81,128.89,0.0,128.89,75.0,0.0,203.89,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001319,MBR00000047,Institutional-OP,2022-12-09,2022-12-09,2023-01-20,PLN1158,1186826716,1186826716,Physical Therapy,In-Network,E11.9,E11.9,,,,,,,0,,93306,Radiology,,,0301,22,Outpatient Hospital,3,3133.56,1985.94,1985.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001320,MBR00000047,Professional,2022-01-25,2022-01-25,2022-02-05,PLN5134,1564502315,1564502315,ASC,In-Network,E11.40,E66.9,,,,,,,0,,80061,Pathology/Lab,,,,81,Independent Laboratory,2,84.52,66.18,16.18,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001321,MBR00000047,Professional,2023-10-04,2023-10-04,2023-11-06,PLN9483,1717546253,1717546253,Family Medicine,In-Network,K21.0,Z00.01,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,1,2985.44,1435.49,1435.49,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001322,MBR00000047,Institutional-IP,2022-09-24,2022-09-27,2022-11-01,PLN3846,1964402759,1964402759,Outpatient Clinic,In-Network,E11.9,M54.5,,,,603,MS-DRG,21,3,Y,90686,Medicine,,,0730,21,Inpatient Hospital,1,125.15,66.31,9.74,54.34,0.0,2.23,56.57,0.0,Paid,,,0,,0,1,0,0,1,0,None,0,0,0,0,0
CLM0000001323,MBR00000047,Professional,2021-09-19,2021-09-19,2021-10-19,PLN8595,1244186984,1244186984,Family Medicine,Out-of-Network,I10,R10.9,,,,,,,0,,99214,E&M,,,,20,Urgent Care,3,344.51,116.86,0.0,116.86,15.0,0.0,131.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001324,MBR00000047,Institutional-OP,2023-10-21,2023-10-21,2023-10-29,PLN9050,1609526529,1609526529,Psychiatry,In-Network,E78.5,Z00.00,,,,,,,0,,99222,E&M,,,0510,22,Outpatient Hospital,1,265.35,207.05,0.0,39.95,15.0,17.44,72.39,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001325,MBR00000047,Institutional-OP,2022-10-20,2022-10-20,2022-11-25,PLN3961,1334916761,1334916761,ASC,In-Network,K21.0,M54.5,,,,,,,0,,87491,Pathology/Lab,,,0730,22,Outpatient Hospital,3,95.97,34.37,34.37,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001326,MBR00000047,Professional,2021-11-21,2021-11-21,2021-12-18,PLN3990,1520687146,1520687146,ASC,In-Network,I10,I10,,,,,,,0,,58661,Surgery,,,,11,Office,2,2352.8,1174.4,1099.4,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001327,MBR00000047,Institutional-IP,2021-06-07,2021-06-11,2021-06-23,PLN7020,1453283987,1453283987,Critical Access Hospital,In-Network,J18.9,N20.0,,,,291,MS-DRG,15,4,Y,72148,Radiology,,,0636,21,Inpatient Hospital,1,1557.37,611.93,257.37,354.56,0.0,0.0,354.56,0.0,Paid,,,1,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000001328,MBR00000047,Institutional-IP,2022-08-31,2022-09-06,2022-09-28,PLN7006,1727809972,1727809972,Home Health,In-Network,Z00.00,I10,,,,292,MS-DRG,8,6,Y,66984,Surgery,,,0450,21,Inpatient Hospital,1,1698.69,860.26,860.26,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001329,MBR00000047,Professional,2023-03-30,2023-03-30,2023-05-10,PLN3614,1991459367,1991459367,Neurology,Out-of-Network,I10,R10.9,,,,,,,0,,G0439,Medicine,,,,23,Emergency Room,1,412.31,335.37,310.37,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,1,1,0,0,0,0,None,0,0,0,1,0
CLM0000001330,MBR00000047,Professional,2023-07-05,2023-07-05,2023-07-13,PLN6357,1239316214,1239316214,Internal Medicine,In-Network,I25.10,I48.91,,,,,,,0,,45378,Surgery,,,,12,Home,1,1894.98,1273.32,1227.34,0.0,0.0,45.98,45.98,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000001331,MBR00000047,Professional,2021-05-20,2021-05-20,2021-06-10,PLN7138,1728018911,1728018911,Nephrology,In-Network,Z87.891,K57.30,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,1,414.6,180.09,0.0,180.09,0.0,0.0,180.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001332,MBR00000047,Institutional-OP,2022-04-19,2022-04-19,2022-04-27,PLN5774,1622771872,1622771872,Pediatrics,In-Network,M17.11,F32.9,,,,,,,0,,77067,Radiology,,,0636,22,Outpatient Hospital,1,680.41,543.96,541.62,0.0,0.0,2.34,2.34,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000001333,MBR00000047,Institutional-OP,2023-12-31,2023-12-31,2024-02-06,PLN7621,1224179551,1224179551,Physical Therapy,In-Network,E11.9,F32.9,,,,,,,0,,27447,Surgery,,,0450,22,Outpatient Hospital,3,5422.69,3317.12,3262.99,0.0,35.0,19.13,54.13,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001334,MBR00000047,Professional,2022-12-25,2022-12-25,2023-02-06,PLN1898,1114982472,1114982472,Orthopedic Surgery,In-Network,M54.5,I10,,,,,,,0,,70450,Radiology,,,,22,Outpatient Hospital,3,1787.11,1104.66,1029.66,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000001335,MBR00000047,Institutional-OP,2021-04-12,2021-04-12,2021-05-21,PLN2307,1840431511,1840431511,Geriatrics,Out-of-Network,Z00.00,I10,,,,,,,0,,99232,E&M,,,0730,22,Outpatient Hospital,3,345.66,171.31,156.31,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001336,MBR00000047,Institutional-IP,2023-10-02,2023-10-05,2023-11-13,PLN3595,1139906830,1139906830,Endocrinology,Out-of-Network,Z00.00,K21.0,,,,195,MS-DRG,6,3,Y,80061,Pathology/Lab,,,0320,21,Inpatient Hospital,1,108.18,44.23,44.23,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001337,MBR00000047,Professional,2023-01-21,2023-01-21,2023-03-04,PLN1129,1193493783,1193493783,Critical Access Hospital,Out-of-Network,E78.5,Z23,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,3,167.08,123.91,123.91,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001338,MBR00000047,Professional,2022-05-19,2022-05-19,2022-06-09,PLN9425,1974006077,1974006077,Orthopedic Surgery,In-Network,N39.0,F41.9,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,2,373.69,294.32,0.0,294.32,0.0,0.0,294.32,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001339,MBR00000047,Institutional-OP,2023-05-01,2023-05-01,2023-05-19,PLN6563,1606140917,1606140917,ASC,In-Network,E66.9,I10,,,,,,,0,,99232,E&M,,,0450,22,Outpatient Hospital,2,319.54,130.61,80.61,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001340,MBR00000047,Professional,2022-12-12,2022-12-12,2022-12-25,PLN2306,1939033455,1939033455,Pulmonology,In-Network,Z12.11,I25.10,,,,,,,0,,76700,Radiology,,,,11,Office,2,905.39,289.74,268.48,0.0,0.0,21.26,21.26,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001341,MBR00000047,Institutional-IP,2021-10-10,2021-10-11,2021-11-05,PLN1419,1994661817,1994661817,SNF,Out-of-Network,I25.10,Z12.31,,,,292,MS-DRG,7,1,Y,85610,Pathology/Lab,,,0370,21,Inpatient Hospital,1,75.74,45.65,20.65,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000001342,MBR00000047,Institutional-IP,2023-05-23,2023-05-28,2023-07-03,PLN5684,1564502315,1564502315,ASC,In-Network,E66.9,I10,,,,196,MS-DRG,8,5,Y,58661,Surgery,,,0510,21,Inpatient Hospital,1,2456.88,1999.77,1539.65,435.12,25.0,0.0,460.12,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001343,MBR00000047,Institutional-IP,2021-10-07,2021-10-08,2021-10-22,PLN4172,1865904917,1865904917,Outpatient Clinic,In-Network,I10,I10,,,,196,MS-DRG,8,1,Y,99283,E&M,,,0301,21,Inpatient Hospital,3,565.05,273.71,0.0,186.57,0.0,0.0,186.57,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001344,MBR00000048,Professional,2021-09-08,2021-09-08,2021-10-06,PLN8298,1968299309,1968299309,Internal Medicine,In-Network,E66.9,I10,,,,,,,0,,99222,E&M,,,,12,Home,2,502.41,323.73,0.0,171.36,35.0,0.0,206.36,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001345,MBR00000048,Professional,2022-10-15,2022-10-15,2022-11-14,PLN9147,1980712759,1980712759,Outpatient Clinic,Out-of-Network,E11.9,J44.1,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,3,359.29,137.19,0.0,137.19,0.0,0.0,137.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001346,MBR00000048,Institutional-OP,2021-01-21,2021-01-21,2021-02-22,PLN7957,1624202402,1624202402,Orthopedic Surgery,In-Network,E78.5,Z00.00,,,,,,,0,,58661,Surgery,,,0370,22,Outpatient Hospital,2,4591.04,3408.97,3408.97,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001347,MBR00000048,Professional,2022-11-22,2022-11-22,2022-12-02,PLN5862,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,Z00.00,M17.11,,,,,,,0,,23472,Surgery,,,,11,Office,3,4066.82,2505.87,2096.39,394.48,15.0,0.0,409.48,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001348,MBR00000048,Professional,2022-08-26,2022-08-26,2022-09-25,PLN9154,1702692193,1702692193,Physical Therapy,In-Network,F41.9,M17.11,,,,,,,0,,85610,Pathology/Lab,,,,21,Inpatient Hospital,2,32.46,19.82,0.0,19.82,0.0,0.0,19.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001349,MBR00000048,Professional,2023-02-28,2023-02-28,2023-04-03,PLN7487,1239316214,1239316214,Internal Medicine,In-Network,K21.0,E11.9,,,,,,,0,,G0444,Medicine,,,,49,Independent Clinic,3,100.05,56.85,41.85,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000001350,MBR00000048,Institutional-OP,2021-06-24,2021-06-24,2021-07-05,PLN8541,1974006077,1974006077,Orthopedic Surgery,In-Network,E11.9,F41.9,,,,,,,0,,83036,Pathology/Lab,,,0510,22,Outpatient Hospital,3,72.01,48.96,0.0,26.21,75.0,0.0,101.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000001351,MBR00000048,Professional,2022-09-28,2022-09-28,2022-11-09,PLN7024,1727809972,1727809972,Home Health,In-Network,F10.20,I10,,,,,,,0,,47562,Surgery,,,,21,Inpatient Hospital,3,3366.63,1492.1,1409.07,0.0,25.0,58.03,83.03,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001352,MBR00000048,Institutional-OP,2022-04-29,2022-04-29,2022-06-01,PLN9773,1366576336,1366576336,Geriatrics,In-Network,R51,Z23,,,,,,,0,,99203,E&M,,,0320,22,Outpatient Hospital,3,210.73,164.33,164.33,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001353,MBR00000048,Professional,2021-07-11,2021-07-11,2021-07-31,PLN8790,1800011727,1800011727,Clinical Laboratory,Out-of-Network,J20.9,I48.91,,,,,,,0,,G0468,Medicine,,,,22,Outpatient Hospital,3,325.18,217.24,217.24,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001354,MBR00000048,Institutional-IP,2022-05-10,2022-05-17,2022-05-19,PLN3599,1511044648,1511044648,Endocrinology,In-Network,E11.9,F32.9,,,,682,MS-DRG,13,7,Y,74177,Radiology,,,0900,21,Inpatient Hospital,3,2422.4,1441.28,1175.36,190.92,75.0,0.0,265.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001355,MBR00000048,Institutional-OP,2023-10-09,2023-10-09,2023-11-08,PLN3792,1168881145,1168881145,Orthopedic Surgery,In-Network,Z87.891,Z12.11,,,,,,,0,,33533,Surgery,,,0510,22,Outpatient Hospital,2,15632.62,12930.79,12930.79,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000001356,MBR00000048,Professional,2023-06-22,2023-06-22,2023-07-23,PLN3601,1575695214,1575695214,SNF,In-Network,Z23,R10.9,,,,,,,0,,97110,Medicine,,,,22,Outpatient Hospital,3,104.59,66.21,0.0,0.0,0.0,6.42,6.42,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001357,MBR00000048,Institutional-IP,2021-07-02,2021-07-06,2021-07-30,PLN3092,1622771872,1622771872,Pediatrics,In-Network,I10,E11.9,,,,195,MS-DRG,17,4,Y,99283,E&M,,,0200,21,Inpatient Hospital,2,646.3,527.98,527.98,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001358,MBR00000049,Institutional-IP,2023-07-17,2023-07-21,2023-08-08,PLN9843,1817234602,1817234602,Clinical Laboratory,In-Network,Z23,E66.9,,,,641,MS-DRG,15,4,Y,47562,Surgery,,,0120,21,Inpatient Hospital,2,5366.31,2116.73,2081.73,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001359,MBR00000049,Institutional-OP,2022-09-11,2022-09-11,2022-09-19,PLN4602,1872272835,1872272835,Internal Medicine,In-Network,E78.5,J06.9,,,,,,,0,,58661,Surgery,,,0740,22,Outpatient Hospital,3,1792.36,668.08,302.2,315.88,50.0,0.0,365.88,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001360,MBR00000049,Professional,2021-02-21,2021-02-21,2021-03-21,PLN5548,1609526529,1609526529,Psychiatry,In-Network,E11.9,M54.5,,,,,,,0,,99204,E&M,,,,65,End-Stage Renal Disease,1,581.74,233.61,0.0,0.0,0.0,19.12,19.12,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001361,MBR00000049,Institutional-IP,2023-10-05,2023-10-11,2023-11-13,PLN9661,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,J06.9,I25.10,,,,682,MS-DRG,22,6,Y,99214,E&M,,,0120,21,Inpatient Hospital,1,440.01,334.97,334.97,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001362,MBR00000049,Professional,2022-07-30,2022-07-30,2022-08-09,PLN8653,1606140917,1606140917,ASC,In-Network,M54.5,F32.9,,,,,,,0,,99233,E&M,,,,49,Independent Clinic,1,418.29,264.42,264.42,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001363,MBR00000049,Professional,2023-09-27,2023-09-27,2023-11-01,PLN3058,1696843572,1696843572,Critical Access Hospital,Out-of-Network,N40.0,R10.9,,,,,,,0,,93000,Radiology,,,,31,Skilled Nursing Facility,3,133.04,112.66,56.57,0.0,50.0,6.09,56.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001364,MBR00000049,Professional,2021-04-18,2021-04-18,2021-05-26,PLN3709,1545347862,1545347862,SNF,In-Network,Z51.11,R05,,,,,,,0,,97110,Medicine,,,,23,Emergency Room,1,185.21,72.63,66.54,0.0,0.0,6.09,6.09,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001365,MBR00000049,Professional,2021-07-03,2021-07-03,2021-07-29,PLN3771,1687650653,1687650653,Internal Medicine,In-Network,E66.9,E78.5,,,,,,,0,,90686,Medicine,,,,20,Urgent Care,1,113.1,68.92,0.0,0.0,0.0,13.57,13.57,0.0,Denied,CO-15,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000001366,MBR00000049,Professional,2023-09-15,2023-09-15,2023-10-29,PLN5621,1500037969,1500037969,Pulmonology,In-Network,I10,E66.9,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,2,2467.79,901.83,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-27,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001367,MBR00000049,Institutional-OP,2021-09-19,2021-09-19,2021-10-15,PLN5092,1571574052,1571574052,Critical Access Hospital,In-Network,F10.20,R07.9,,,,,,,0,,80053,Pathology/Lab,,,0301,22,Outpatient Hospital,3,149.43,116.72,7.25,93.16,15.0,1.31,109.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001368,MBR00000049,Institutional-IP,2022-08-25,2022-08-27,2022-09-26,PLN9502,1109850785,1109850785,ASC,Out-of-Network,J44.1,E11.65,,,,872,MS-DRG,5,2,Y,99221,E&M,,,0636,21,Inpatient Hospital,3,160.65,122.99,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001369,MBR00000049,Professional,2022-10-22,2022-10-22,2022-11-05,PLN6441,1235381502,1235381502,Cardiology,In-Network,E11.9,G43.909,,,,,,,0,,70553,Radiology,,,,23,Emergency Room,2,1782.07,1312.99,1065.29,0.0,0.0,247.7,247.7,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001370,MBR00000049,Professional,2023-11-05,2023-11-05,2023-11-27,PLN4579,1550154147,1550154147,Outpatient Clinic,In-Network,M54.5,J20.9,,,,,,,0,,47562,Surgery,,,,11,Office,1,5993.51,2578.26,2125.72,452.54,0.0,0.0,452.54,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001371,MBR00000049,Institutional-IP,2022-01-05,2022-01-08,2022-02-11,PLN3510,1687650653,1687650653,Internal Medicine,In-Network,J06.9,G43.909,,,,470,MS-DRG,8,3,U,77067,Radiology,,,0636,21,Inpatient Hospital,1,687.79,375.32,304.76,70.56,0.0,0.0,70.56,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000001372,MBR00000049,Professional,2023-04-06,2023-04-06,2023-05-17,PLN6675,1502838586,1502838586,ASC,In-Network,E78.5,I10,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,1,418.58,324.53,324.53,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001373,MBR00000049,Institutional-OP,2023-03-12,2023-03-12,2023-04-18,PLN8557,1366286000,1366286000,SNF,In-Network,E66.9,E11.9,,,,,,,0,,82043,Pathology/Lab,,,0740,22,Outpatient Hospital,3,37.7,24.48,0.0,24.48,0.0,0.0,24.48,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001374,MBR00000049,Professional,2023-02-07,2023-02-07,2023-02-14,PLN4779,1590915516,1590915516,Physical Therapy,Out-of-Network,E78.5,M54.5,,,,,,,0,,77067,Radiology,,,,22,Outpatient Hospital,2,615.15,216.12,0.0,216.12,0.0,0.0,216.12,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000001375,MBR00000049,Institutional-OP,2022-07-27,2022-07-27,2022-08-21,PLN3386,1284035364,1284035364,Pediatrics,In-Network,Z00.00,B97.89,,,,,,,0,,43239,Surgery,,,0360,22,Outpatient Hospital,3,1821.0,1354.73,1136.81,0.0,25.0,192.92,217.92,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001376,MBR00000049,Professional,2021-03-19,2021-03-19,2021-04-27,PLN9907,1845900543,1845900543,ASC,In-Network,I50.9,Z23,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,1,209.77,107.0,107.0,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001377,MBR00000049,Institutional-IP,2021-10-19,2021-10-27,2021-11-28,PLN6705,1366286000,1366286000,SNF,In-Network,Z79.4,I10,,,,682,MS-DRG,20,8,Y,33533,Surgery,,,0320,21,Inpatient Hospital,3,26485.75,9547.68,9497.68,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000001378,MBR00000049,Professional,2022-09-07,2022-09-07,2022-10-04,PLN4185,1606140917,1606140917,ASC,In-Network,J20.9,F41.9,,,,,,,0,,99222,E&M,,,,12,Home,1,260.08,142.42,142.42,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001379,MBR00000049,Professional,2022-03-27,2022-03-27,2022-04-03,PLN8387,1313212303,1313212303,Family Medicine,In-Network,F41.9,J06.9,,,,,,,0,,43239,Surgery,,,,11,Office,3,1999.62,660.58,194.87,459.77,0.0,5.94,465.71,0.0,Paid,,,1,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000001380,MBR00000049,Institutional-OP,2021-07-22,2021-07-22,2021-08-28,PLN1287,1571574052,1571574052,Critical Access Hospital,In-Network,I48.91,N20.0,,,,,,,0,,99221,E&M,,,0370,22,Outpatient Hospital,1,346.67,117.52,102.52,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001381,MBR00000049,Institutional-OP,2023-01-27,2023-01-27,2023-03-04,PLN8292,1891849440,1891849440,Oncology,In-Network,Z00.00,M54.5,,,,,,,0,,82043,Pathology/Lab,,,0510,22,Outpatient Hospital,3,38.07,19.53,19.53,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001382,MBR00000049,Professional,2022-05-21,2022-05-21,2022-06-07,PLN7681,1103747954,1103747954,Urology,In-Network,I25.10,J20.9,,,,,,,0,,99284,E&M,,,,50,Federally Qualified Health Center,1,548.56,411.97,246.93,165.04,0.0,0.0,165.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001383,MBR00000049,Professional,2023-05-10,2023-05-10,2023-05-24,PLN4475,1518055405,1518055405,Urology,In-Network,Z00.01,Z12.11,,,,,,,0,,99232,E&M,,,,21,Inpatient Hospital,2,297.81,100.05,65.05,0.0,35.0,0.0,35.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001384,MBR00000049,Institutional-OP,2022-08-24,2022-08-24,2022-09-19,PLN9028,1865904917,1865904917,Outpatient Clinic,In-Network,Z79.4,K57.30,,,,,,,0,,83036,Pathology/Lab,,,0360,22,Outpatient Hospital,2,62.3,33.18,33.01,0.0,0.0,0.17,0.17,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000001385,MBR00000049,Professional,2022-02-09,2022-02-09,2022-03-14,PLN5008,1968299309,1968299309,Internal Medicine,In-Network,Z23,R05,,,,,,,0,,78452,Radiology,,,,20,Urgent Care,1,4126.01,2540.21,2049.5,490.71,0.0,0.0,490.71,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001386,MBR00000049,Institutional-OP,2021-04-30,2021-04-30,2021-05-12,PLN8128,1542828721,1542828721,Orthopedic Surgery,In-Network,R07.9,Z79.4,,,,,,,0,,93000,Radiology,,,0360,22,Outpatient Hospital,2,161.31,126.2,0.0,0.0,0.0,22.29,22.29,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001387,MBR00000049,Professional,2021-04-25,2021-04-25,2021-05-27,PLN9267,1132188260,1132188260,Family Medicine,In-Network,E11.9,M54.5,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,1,250.32,154.8,119.8,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000001388,MBR00000049,Professional,2022-07-10,2022-07-10,2022-08-11,PLN1061,1994661817,1994661817,SNF,Out-of-Network,N39.0,I48.91,,,,,,,0,,93000,Radiology,,,,31,Skilled Nursing Facility,3,152.71,90.07,75.07,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001389,MBR00000049,Professional,2022-01-22,2022-01-22,2022-02-11,PLN4132,1148984206,1148984206,Psychiatry,In-Network,J44.1,I25.10,,,,,,,0,,74177,Radiology,,,,11,Office,1,1645.46,902.48,814.21,0.0,0.0,88.27,88.27,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001390,MBR00000049,Professional,2023-02-26,2023-02-26,2023-04-04,PLN2106,1518055405,1518055405,Urology,In-Network,Z00.00,M54.5,,,,,,,0,,45380,Surgery,,,,12,Home,2,1581.59,949.81,750.81,0.0,25.0,174.0,199.0,0.0,Paid,,,1,,0,0,1,0,0,1,Unbundling,0,1,0,0,0
CLM0000001391,MBR00000050,Professional,2022-11-22,2022-11-22,2022-12-02,PLN3359,1590915516,1590915516,Physical Therapy,Out-of-Network,I10,N39.0,,,,,,,0,,97530,Medicine,,,,11,Office,1,168.99,105.2,105.2,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001392,MBR00000050,Professional,2021-11-08,2021-11-08,2021-11-28,PLN9878,1631954542,1631954542,Oncology,In-Network,N39.0,F03.90,,,,,,,0,,99284,E&M,,,,21,Inpatient Hospital,2,863.2,718.33,643.33,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001393,MBR00000050,Institutional-OP,2023-04-13,2023-04-13,2023-05-25,PLN4917,1872272835,1872272835,Internal Medicine,In-Network,I10,Z12.31,,,,,,,0,,93306,Radiology,,,0301,22,Outpatient Hospital,3,3021.89,1686.1,1665.68,20.42,0.0,0.0,20.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001394,MBR00000050,Professional,2022-09-12,2022-09-12,2022-09-26,PLN4636,1964402759,1964402759,Outpatient Clinic,In-Network,E78.5,R05,,,,,,,0,,99221,E&M,,,,31,Skilled Nursing Facility,1,307.22,121.31,0.0,121.31,0.0,0.0,121.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001395,MBR00000050,Institutional-IP,2023-08-22,2023-08-25,2023-10-02,PLN6922,1948810580,1948810580,DME Supplier,In-Network,Z87.891,Z87.891,,,,291,MS-DRG,9,3,Y,27130,Surgery,,,0270,21,Inpatient Hospital,2,3624.97,1908.59,1883.59,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,1,0,0,1,Phantom,0,0,0,0,0
CLM0000001396,MBR00000050,Professional,2023-11-10,2023-11-10,2023-12-21,PLN1582,1540044947,1540044947,Pulmonology,Out-of-Network,J44.1,J06.9,,,,,,,0,,99204,E&M,,,,21,Inpatient Hospital,1,551.04,362.19,0.0,360.14,75.0,0.0,435.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001397,MBR00000050,Institutional-IP,2023-11-20,2023-11-22,2023-12-19,PLN8303,1273488618,1273488618,General Acute Care Hospital,In-Network,I63.9,E78.5,,,,872,MS-DRG,22,2,Y,76700,Radiology,,,0636,21,Inpatient Hospital,2,737.56,343.07,318.07,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001398,MBR00000050,Professional,2021-05-19,2021-05-19,2021-06-02,PLN6406,1366576336,1366576336,Geriatrics,In-Network,R51,E78.5,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,3,104.23,76.27,0.0,76.27,15.0,0.0,91.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001399,MBR00000050,Institutional-IP,2022-08-03,2022-08-12,2022-08-21,PLN2843,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,R51,E78.5,,,,872,MS-DRG,21,9,Y,G0468,Medicine,,,0200,21,Inpatient Hospital,1,498.09,394.06,224.8,65.76,50.0,53.5,169.26,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001400,MBR00000050,Institutional-OP,2021-02-01,2021-02-01,2021-02-20,PLN4646,1896447406,1896447406,Nephrology,Out-of-Network,M54.5,Z00.00,,,,,,,0,,99284,E&M,,,0636,22,Outpatient Hospital,2,688.23,433.59,324.41,0.0,75.0,34.18,109.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001401,MBR00000050,Institutional-OP,2023-08-22,2023-08-22,2023-09-20,PLN9801,1453283987,1453283987,Critical Access Hospital,In-Network,I10,I10,,,,,,,0,,93000,Radiology,,,0320,22,Outpatient Hospital,1,147.18,120.22,0.0,120.22,25.0,0.0,145.22,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001402,MBR00000050,Institutional-OP,2023-02-09,2023-02-09,2023-02-26,PLN6593,1809014947,1809014947,Urology,In-Network,K21.0,E78.5,,,,,,,0,,66984,Surgery,,,0370,22,Outpatient Hospital,1,2915.22,1043.59,1018.59,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001403,MBR00000051,Professional,2021-10-14,2021-10-14,2021-11-14,PLN7482,1915531927,1915531927,Critical Access Hospital,In-Network,R07.9,Z12.31,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,1,24937.2,12746.19,12746.19,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000001404,MBR00000051,Professional,2022-10-27,2022-10-27,2022-11-12,PLN1910,1438368327,1438368327,Home Health,In-Network,C50.912,I10,,,,,,,0,,99283,E&M,,,,11,Office,2,351.82,122.39,97.39,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001405,MBR00000051,Professional,2022-09-05,2022-09-05,2022-10-09,PLN3401,1645194539,1645194539,SNF,In-Network,G43.909,R51,,,,,,,0,,86900,Pathology/Lab,,,,22,Outpatient Hospital,3,56.3,35.03,0.03,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000001406,MBR00000051,Institutional-OP,2022-08-18,2022-08-18,2022-09-03,PLN4866,1948810580,1948810580,DME Supplier,In-Network,M81.0,J20.9,,,,,,,0,,74177,Radiology,,,0510,22,Outpatient Hospital,1,2118.71,1472.94,1157.63,315.31,0.0,0.0,315.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001407,MBR00000051,Professional,2022-08-14,2022-08-14,2022-08-21,PLN7025,1910255109,1910255109,DME Supplier,In-Network,E78.5,R05,,,,,,,0,,90686,Medicine,,,,11,Office,1,145.1,54.64,54.64,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000001408,MBR00000051,Institutional-OP,2023-12-14,2023-12-14,2024-01-24,PLN8365,1716521444,1716521444,Oncology,In-Network,F32.9,K21.0,,,,,,,0,,74177,Radiology,,,0301,22,Outpatient Hospital,2,2032.2,652.18,602.18,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001409,MBR00000051,Institutional-OP,2023-04-22,2023-04-22,2023-05-30,PLN4227,1139906830,1139906830,Endocrinology,Out-of-Network,E11.9,J06.9,,,,,,,0,,93000,Radiology,,,0301,22,Outpatient Hospital,1,168.95,140.44,125.44,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001410,MBR00000051,Professional,2022-03-17,2022-03-17,2022-04-14,PLN6504,1168246159,1168246159,Internal Medicine,In-Network,M17.11,F10.20,,,,,,,0,,27447,Surgery,,,,65,End-Stage Renal Disease,1,2580.56,1988.28,1988.28,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001411,MBR00000051,Professional,2023-04-27,2023-04-27,2023-05-04,PLN1655,1118885473,1118885473,ASC,In-Network,J06.9,J20.9,,,,,,,0,,99213,E&M,,,,11,Office,1,122.63,49.57,0.0,0.0,75.0,0.0,75.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001412,MBR00000051,Professional,2021-06-04,2021-06-04,2021-06-30,PLN3448,1283743001,1283743001,Family Medicine,In-Network,E11.9,N39.0,,,,,,,0,,99406,Medicine,,,,31,Skilled Nursing Facility,3,49.15,26.04,0.0,26.04,0.0,0.0,26.04,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000001413,MBR00000051,Professional,2021-11-09,2021-11-09,2021-12-08,PLN9198,1767011137,1767011137,DME Supplier,In-Network,E11.9,Z12.31,,,,,,,0,,70553,Radiology,,,,50,Federally Qualified Health Center,3,2382.67,789.06,659.65,129.41,0.0,0.0,129.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001414,MBR00000051,Professional,2021-05-09,2021-05-09,2021-05-24,PLN6637,1795618275,1795618275,Pulmonology,In-Network,F32.9,E11.9,,,,,,,0,,45378,Surgery,,,,11,Office,3,2364.32,1106.73,691.1,365.63,50.0,0.0,415.63,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000001415,MBR00000051,Professional,2023-08-29,2023-08-29,2023-09-20,PLN3524,1645194539,1645194539,SNF,In-Network,N39.0,Z00.00,,,,,,,0,,90686,Medicine,,,,11,Office,3,75.85,31.83,0.0,31.83,0.0,0.0,31.83,0.0,Pended,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000001416,MBR00000051,Institutional-OP,2021-01-27,2021-01-27,2021-02-04,PLN2154,1556140803,1556140803,Cardiology,In-Network,E66.9,Z12.31,,,,,,,0,,99203,E&M,,,0510,22,Outpatient Hospital,2,172.05,94.54,58.96,0.0,35.0,0.58,35.58,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000001417,MBR00000051,Institutional-IP,2023-09-04,2023-09-10,2023-09-30,PLN7177,1103747954,1103747954,Urology,In-Network,R07.9,K57.30,,,,872,MS-DRG,13,6,Y,85610,Pathology/Lab,,,0320,21,Inpatient Hospital,1,31.01,11.9,0.0,11.9,75.0,0.0,86.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001418,MBR00000051,Professional,2023-07-01,2023-07-01,2023-07-18,PLN5610,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,Z23,Z79.4,,,,,,,0,,99233,E&M,,,,11,Office,3,238.57,201.79,25.99,170.35,0.0,5.45,175.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001419,MBR00000051,Professional,2023-11-05,2023-11-05,2023-12-06,PLN6989,1139906830,1139906830,Endocrinology,Out-of-Network,J06.9,E11.9,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,3,4887.52,1765.17,1715.17,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001420,MBR00000051,Institutional-OP,2023-04-19,2023-04-19,2023-05-30,PLN3769,1691062876,1691062876,SNF,In-Network,Z23,E11.9,,,,,,,0,,45380,Surgery,,,0360,22,Outpatient Hospital,1,1828.03,1279.03,1279.03,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000001421,MBR00000051,Professional,2022-05-17,2022-05-17,2022-06-16,PLN9922,1168246159,1168246159,Internal Medicine,In-Network,Z23,F41.9,,,,,,,0,,85610,Pathology/Lab,,,,21,Inpatient Hospital,1,35.93,16.89,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001422,MBR00000051,Institutional-OP,2023-06-08,2023-06-08,2023-07-03,PLN1912,1438368327,1438368327,Home Health,In-Network,E11.65,J06.9,,,,,,,0,,43239,Surgery,,,0120,22,Outpatient Hospital,3,832.53,656.07,296.51,309.56,50.0,0.0,359.56,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001423,MBR00000051,Professional,2023-12-18,2023-12-18,2024-01-12,PLN3086,1790497490,1790497490,OB/GYN,In-Network,J44.1,J20.9,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,3,4727.87,1560.94,1035.47,405.72,0.0,119.75,525.47,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001424,MBR00000052,Institutional-OP,2023-09-05,2023-09-05,2023-09-27,PLN1354,1518055405,1518055405,Urology,In-Network,Z12.31,E11.9,,,,,,,0,,99213,E&M,,,0900,22,Outpatient Hospital,2,144.66,108.82,58.82,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001425,MBR00000052,Institutional-OP,2023-05-10,2023-05-10,2023-05-20,PLN4654,1109850785,1109850785,ASC,Out-of-Network,J20.9,E78.5,,,,,,,0,,80061,Pathology/Lab,,,0730,22,Outpatient Hospital,1,92.95,40.52,0.0,40.52,0.0,0.0,40.52,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001426,MBR00000052,Institutional-OP,2023-04-20,2023-04-20,2023-05-28,PLN2889,1268679390,1268679390,Critical Access Hospital,In-Network,K92.1,R07.9,,,,,,,0,,99203,E&M,,,0510,22,Outpatient Hospital,2,279.31,216.81,0.0,216.81,15.0,0.0,231.81,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001427,MBR00000052,Institutional-OP,2022-12-17,2022-12-17,2023-01-05,PLN8154,1556140803,1556140803,Cardiology,In-Network,Z12.31,E78.5,,,,,,,0,,23472,Surgery,,,0301,22,Outpatient Hospital,3,4708.16,2800.9,2487.48,313.42,0.0,0.0,313.42,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001428,MBR00000052,Institutional-IP,2023-09-04,2023-09-09,2023-09-27,PLN7481,1585582070,1585582070,Outpatient Clinic,In-Network,R05,I63.9,,,,291,MS-DRG,6,5,Y,33533,Surgery,,,0270,21,Inpatient Hospital,1,22388.64,7474.1,7474.1,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000001429,MBR00000053,Professional,2022-04-19,2022-04-19,2022-05-07,PLN7922,1366576336,1366576336,Geriatrics,In-Network,E11.9,N39.0,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,1,3585.38,1338.73,1207.29,0.0,0.0,131.44,131.44,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001430,MBR00000053,Institutional-OP,2022-07-03,2022-07-03,2022-08-05,PLN5386,1453936007,1453936007,ASC,In-Network,J06.9,E78.5,,,,,,,0,,76700,Radiology,,,0450,22,Outpatient Hospital,1,622.44,437.89,437.89,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001431,MBR00000053,Institutional-IP,2023-07-12,2023-07-16,2023-07-20,PLN9038,1542828721,1542828721,Orthopedic Surgery,In-Network,E78.5,F32.9,,,,690,MS-DRG,11,4,Y,90460,Medicine,,,0740,21,Inpatient Hospital,2,41.57,23.87,23.87,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001432,MBR00000053,Professional,2021-10-15,2021-10-15,2021-10-23,PLN6289,1227362142,1227362142,DME Supplier,In-Network,I10,J18.9,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,3,655.41,515.95,442.52,0.0,15.0,58.43,73.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001433,MBR00000053,Institutional-IP,2023-04-17,2023-05-01,2023-05-01,PLN8194,1266606767,1266606767,ASC,In-Network,Z12.31,J45.20,,,,683,MS-DRG,2,14,Y,84443,Pathology/Lab,,,0450,21,Inpatient Hospital,1,144.44,76.0,0.88,0.0,75.0,0.12,75.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001434,MBR00000053,Professional,2021-05-01,2021-05-01,2021-05-24,PLN1383,1717912431,1717912431,Oncology,In-Network,E11.9,Z00.00,,,,,,,0,,99232,E&M,,,,12,Home,2,220.84,181.42,0.0,181.42,0.0,0.0,181.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001435,MBR00000053,Professional,2022-10-04,2022-10-04,2022-11-03,PLN3577,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,Z00.00,F32.9,,,,,,,0,,99222,E&M,,,,21,Inpatient Hospital,2,297.17,132.58,0.0,86.46,50.0,0.0,136.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001436,MBR00000053,Professional,2021-02-08,2021-02-08,2021-02-21,PLN2428,1372918899,1372918899,Family Medicine,In-Network,J20.9,M17.11,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,3,308.76,146.88,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001437,MBR00000053,Professional,2023-12-28,2023-12-28,2024-01-12,PLN7397,1728018911,1728018911,Nephrology,In-Network,I10,E78.5,,,,,,,0,,99406,Medicine,,,,11,Office,3,61.01,35.33,35.33,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001438,MBR00000053,Professional,2023-07-11,2023-07-11,2023-08-08,PLN4383,1948810580,1948810580,DME Supplier,In-Network,Z12.31,J20.9,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,2,61.29,26.36,26.36,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000001439,MBR00000053,Institutional-OP,2021-10-01,2021-10-01,2021-11-07,PLN9066,1752470395,1752470395,Home Health,In-Network,J20.9,Z00.00,,,,,,,0,,45380,Surgery,,,0360,22,Outpatient Hospital,3,1967.5,936.78,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-4,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000001440,MBR00000053,Professional,2021-06-14,2021-06-14,2021-07-10,PLN2233,1812060197,1812060197,Oncology,Out-of-Network,I25.10,Z23,,,,,,,0,,72148,Radiology,,,,11,Office,3,1550.31,710.43,675.43,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001441,MBR00000053,Institutional-OP,2022-12-04,2022-12-04,2022-12-21,PLN1405,1463205530,1463205530,Nephrology,In-Network,K21.0,M54.5,,,,,,,0,,99214,E&M,,,0450,22,Outpatient Hospital,1,257.63,214.6,0.0,214.6,75.0,0.0,289.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001442,MBR00000053,Institutional-OP,2023-09-15,2023-09-15,2023-10-19,PLN6964,1213165847,1213165847,Critical Access Hospital,In-Network,F32.9,E78.5,,,,,,,0,,80053,Pathology/Lab,,,0301,22,Outpatient Hospital,2,81.09,58.26,47.61,10.65,0.0,0.0,10.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001443,MBR00000053,Professional,2021-12-18,2021-12-18,2021-12-26,PLN6420,1609138981,1609138981,Critical Access Hospital,In-Network,N17.9,M17.11,,,,,,,0,,G0444,Medicine,,,,22,Outpatient Hospital,2,79.24,28.63,0.0,28.63,0.0,0.0,28.63,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000001444,MBR00000053,Institutional-IP,2023-11-19,2023-11-20,2023-12-17,PLN1541,1644128543,1644128543,Gastroenterology,In-Network,I10,R05,,,,470,MS-DRG,24,1,N,90460,Medicine,,,0200,21,Inpatient Hospital,3,68.99,25.36,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000001445,MBR00000053,Professional,2022-05-17,2022-05-17,2022-06-01,PLN3333,1475984649,1475984649,SNF,In-Network,Z79.4,Z12.31,,,,,,,0,,93306,Radiology,,,,11,Office,2,2368.22,1761.45,1718.51,7.94,35.0,0.0,42.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001446,MBR00000053,Institutional-OP,2022-04-29,2022-04-29,2022-05-12,PLN9676,1313212303,1313212303,Family Medicine,In-Network,E78.5,E78.5,,,,,,,0,,23472,Surgery,,,0900,22,Outpatient Hospital,1,6896.82,4194.08,3795.24,0.0,0.0,398.84,398.84,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001447,MBR00000053,Professional,2022-01-07,2022-01-07,2022-02-15,PLN1248,1696843572,1696843572,Critical Access Hospital,Out-of-Network,R05,E78.5,,,,,,,0,,23472,Surgery,,,,65,End-Stage Renal Disease,3,5928.23,2445.93,1988.98,456.95,0.0,0.0,456.95,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001448,MBR00000053,Professional,2021-10-24,2021-10-24,2021-11-29,PLN9051,1514306773,1514306773,Endocrinology,In-Network,E11.9,Z12.11,,,,,,,0,,99284,E&M,,,,21,Inpatient Hospital,2,674.22,373.7,298.7,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001449,MBR00000053,Professional,2022-01-02,2022-01-02,2022-01-11,PLN5569,1125190055,1125190055,Nephrology,In-Network,B97.89,Z87.891,,,,,,,0,,99203,E&M,,,,20,Urgent Care,3,392.61,325.61,0.0,0.0,0.0,63.73,63.73,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001450,MBR00000053,Institutional-IP,2021-07-09,2021-07-22,2021-07-25,PLN2729,1124394415,1124394415,Pediatrics,In-Network,F03.90,Z00.01,,,,470,MS-DRG,21,13,W,99204,E&M,,,0200,21,Inpatient Hospital,1,509.06,361.9,91.88,227.53,35.0,7.49,270.02,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000001451,MBR00000053,Professional,2022-02-17,2022-02-17,2022-03-23,PLN3534,1118885473,1118885473,ASC,In-Network,I10,F32.9,,,,,,,0,,72148,Radiology,,,,22,Outpatient Hospital,3,1389.98,911.98,499.64,372.86,0.0,39.48,412.34,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001452,MBR00000053,Professional,2021-11-14,2021-11-14,2021-12-26,PLN2960,1700633438,1700633438,DME Supplier,In-Network,E78.5,J44.1,,,,,,,0,,99283,E&M,,,,23,Emergency Room,2,473.47,340.26,340.26,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001453,MBR00000053,Institutional-OP,2021-03-04,2021-03-04,2021-04-15,PLN1403,1790497490,1790497490,OB/GYN,In-Network,E11.9,Z51.11,,,,,,,0,,87491,Pathology/Lab,,,0120,22,Outpatient Hospital,2,110.81,91.05,91.05,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001454,MBR00000053,Professional,2022-02-02,2022-02-02,2022-03-16,PLN1685,1422747896,1422747896,Urology,In-Network,I10,Z00.00,,,,,,,0,,86900,Pathology/Lab,,,,23,Emergency Room,3,21.7,13.57,13.57,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001455,MBR00000053,Institutional-IP,2021-02-13,2021-02-19,2021-03-21,PLN4537,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,M54.5,R51,,,,196,MS-DRG,4,6,Y,33533,Surgery,,,0900,21,Inpatient Hospital,1,18447.93,12950.25,12162.78,0.0,0.0,787.47,787.47,0.0,Paid,,,0,,0,0,1,1,1,0,None,0,0,0,0,0
CLM0000001456,MBR00000053,Institutional-IP,2021-07-18,2021-07-19,2021-08-23,PLN9515,1606140917,1606140917,ASC,In-Network,N39.0,F41.9,,,,194,MS-DRG,17,1,Y,G0444,Medicine,,,0636,21,Inpatient Hospital,1,54.46,30.63,0.0,30.63,50.0,0.0,80.63,0.0,Paid,,,0,,0,1,0,0,1,0,None,0,0,0,0,1
CLM0000001457,MBR00000053,Professional,2023-03-05,2023-03-05,2023-03-27,PLN5620,1528335731,1528335731,Critical Access Hospital,In-Network,E78.5,Z12.11,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,3,126.21,92.66,0.0,92.66,50.0,0.0,142.66,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001458,MBR00000053,Professional,2021-01-28,2021-01-28,2021-02-21,PLN5264,1644128543,1644128543,Gastroenterology,In-Network,J06.9,Z00.00,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,3,549.68,362.52,292.17,0.0,35.0,35.35,70.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001459,MBR00000053,Professional,2021-12-07,2021-12-07,2022-01-04,PLN5609,1856686341,1856686341,Geriatrics,In-Network,J06.9,Z12.31,,,,,,,0,,83036,Pathology/Lab,,,,81,Independent Laboratory,1,95.12,51.65,1.65,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000001460,MBR00000053,Institutional-OP,2023-01-20,2023-01-20,2023-03-02,PLN8151,1273488618,1273488618,General Acute Care Hospital,In-Network,I10,Z12.31,,,,,,,0,,80061,Pathology/Lab,,,0200,22,Outpatient Hospital,2,48.14,39.61,0.0,19.51,75.0,0.0,94.51,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001461,MBR00000053,Institutional-IP,2021-01-24,2021-01-26,2021-02-22,PLN5980,1186826716,1186826716,Physical Therapy,In-Network,E11.9,Z12.31,,,,872,MS-DRG,10,2,Y,47562,Surgery,,,0270,21,Inpatient Hospital,1,2752.42,1284.73,904.2,380.53,0.0,0.0,380.53,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001462,MBR00000053,Professional,2023-03-19,2023-03-19,2023-04-05,PLN9630,1168246159,1168246159,Internal Medicine,In-Network,N39.0,I10,,,,,,,0,,45378,Surgery,,,,31,Skilled Nursing Facility,1,1342.94,1083.57,948.29,100.28,35.0,0.0,135.28,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000001463,MBR00000053,Institutional-OP,2021-03-31,2021-03-31,2021-05-13,PLN5432,1687650653,1687650653,Internal Medicine,In-Network,I10,J06.9,,,,,,,0,,99232,E&M,,,0730,22,Outpatient Hospital,3,309.71,126.92,67.12,0.0,50.0,9.8,59.8,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001464,MBR00000053,Professional,2021-03-02,2021-03-02,2021-04-04,PLN1703,1247341320,1247341320,Urology,Out-of-Network,E66.9,I10,,,,,,,0,,99232,E&M,,,,65,End-Stage Renal Disease,2,282.29,209.89,156.38,53.51,0.0,0.0,53.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001465,MBR00000053,Professional,2021-08-03,2021-08-03,2021-08-31,PLN6636,1780163051,1780163051,SNF,In-Network,I50.9,I10,,,,,,,0,,90460,Medicine,,,,11,Office,2,30.69,18.26,17.39,0.0,0.0,0.87,0.87,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001466,MBR00000053,Professional,2023-08-01,2023-08-01,2023-08-25,PLN1825,1556140803,1556140803,Cardiology,In-Network,N20.0,E78.5,,,,,,,0,,G0444,Medicine,,,,81,Independent Laboratory,3,85.89,53.17,3.17,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000001467,MBR00000053,Institutional-OP,2021-02-22,2021-02-22,2021-03-05,PLN7811,1109850785,1109850785,ASC,Out-of-Network,Z23,J44.1,,,,,,,0,,70450,Radiology,,,0900,22,Outpatient Hospital,2,676.87,292.81,267.81,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001468,MBR00000053,Professional,2021-04-19,2021-04-19,2021-04-29,PLN4366,1757138478,1757138478,Pediatrics,In-Network,I10,Z00.00,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,2,471.09,261.76,243.59,0.0,0.0,18.17,18.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001469,MBR00000053,Institutional-IP,2023-11-03,2023-11-05,2023-12-09,PLN2740,1624802371,1624802371,ASC,Out-of-Network,Z12.31,J20.9,,,,194,MS-DRG,8,2,Y,99222,E&M,,,0510,21,Inpatient Hospital,2,641.22,349.05,0.0,349.05,0.0,0.0,349.05,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001470,MBR00000053,Professional,2022-10-31,2022-10-31,2022-11-24,PLN2735,1631954542,1631954542,Oncology,In-Network,J06.9,I25.10,,,,,,,0,,76700,Radiology,,,,11,Office,1,865.79,661.69,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001471,MBR00000053,Institutional-OP,2022-09-15,2022-09-15,2022-10-07,PLN5665,1389336600,1389336600,Critical Access Hospital,In-Network,R51,J06.9,,,,,,,0,,99214,E&M,,,0360,22,Outpatient Hospital,3,419.13,293.91,0.0,293.91,0.0,0.0,293.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001472,MBR00000054,Institutional-OP,2021-02-14,2021-02-14,2021-02-23,PLN4352,1990090423,1990090423,Orthopedic Surgery,In-Network,I25.10,I10,,,,,,,0,,70553,Radiology,,,0740,22,Outpatient Hospital,3,4672.2,2748.39,2326.54,346.85,75.0,0.0,421.85,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001473,MBR00000054,Professional,2022-03-08,2022-03-08,2022-03-19,PLN5557,1946680931,1946680931,Critical Access Hospital,Out-of-Network,Z12.11,J44.1,,,,,,,0,,99232,E&M,,,,31,Skilled Nursing Facility,1,164.17,124.91,61.71,0.0,50.0,13.2,63.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001474,MBR00000054,Professional,2022-09-24,2022-09-24,2022-11-07,PLN5299,1622771872,1622771872,Pediatrics,In-Network,R07.9,I48.91,,,,,,,0,,G0444,Medicine,,,,50,Federally Qualified Health Center,1,42.4,29.29,29.29,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000001475,MBR00000054,Institutional-IP,2022-08-07,2022-08-20,2022-08-21,PLN7378,1450094833,1450094833,Outpatient Clinic,In-Network,M54.5,Z23,,,,603,MS-DRG,18,13,Y,99214,E&M,,,0320,21,Inpatient Hospital,1,317.24,266.37,147.73,93.64,25.0,0.0,118.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001476,MBR00000054,Professional,2022-07-25,2022-07-25,2022-08-17,PLN1416,1631954542,1631954542,Oncology,In-Network,E78.5,F32.9,,,,,,,0,,47562,Surgery,,,,20,Urgent Care,2,6520.96,2713.8,2634.01,79.79,0.0,0.0,79.79,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001477,MBR00000054,Professional,2021-05-04,2021-05-04,2021-05-31,PLN1194,1935547131,1935547131,Pulmonology,In-Network,Z23,Z12.31,,,,,,,0,,99233,E&M,,,,20,Urgent Care,3,449.29,223.05,0.0,223.05,0.0,0.0,223.05,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001478,MBR00000054,Institutional-IP,2023-12-19,2023-12-21,2024-01-10,PLN9399,1872272835,1872272835,Internal Medicine,In-Network,J18.9,I48.91,,,,683,MS-DRG,18,2,Y,66984,Surgery,,,0730,21,Inpatient Hospital,2,1801.36,1158.26,1158.26,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001479,MBR00000054,Professional,2023-02-08,2023-02-08,2023-03-19,PLN5519,1219817751,1219817751,OB/GYN,In-Network,J20.9,K21.0,,,,,,,0,,27130,Surgery,,,,11,Office,1,4064.37,3248.73,3248.73,0.0,0.0,0.0,0.0,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001480,MBR00000054,Institutional-OP,2021-09-22,2021-09-22,2021-11-03,PLN1357,1118885473,1118885473,ASC,In-Network,Z12.31,E78.5,,,,,,,0,,78452,Radiology,,,0450,22,Outpatient Hospital,3,2734.34,1871.5,1796.5,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001481,MBR00000054,Professional,2023-11-28,2023-11-28,2024-01-11,PLN9922,1475984649,1475984649,SNF,In-Network,R07.9,N18.3,,,,,,,0,,97530,Medicine,,,,23,Emergency Room,2,146.81,89.87,0.0,89.87,75.0,0.0,164.87,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001482,MBR00000054,Professional,2021-11-27,2021-11-27,2021-12-13,PLN5925,1609526529,1609526529,Psychiatry,In-Network,Z79.4,Z00.01,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,2,54.05,24.89,24.89,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001483,MBR00000054,Institutional-IP,2021-05-24,2021-06-01,2021-06-18,PLN8027,1453936007,1453936007,ASC,In-Network,R10.9,J20.9,,,,871,MS-DRG,11,8,N,84443,Pathology/Lab,,,0320,21,Inpatient Hospital,2,180.28,123.81,0.0,123.81,0.0,0.0,123.81,0.0,Pended,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000001484,MBR00000054,Institutional-OP,2023-09-05,2023-09-05,2023-10-18,PLN1290,1899127912,1899127912,Neurology,In-Network,E11.9,E78.5,,,,,,,0,,G0444,Medicine,,,0636,22,Outpatient Hospital,2,99.66,67.28,67.28,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000001485,MBR00000054,Professional,2021-06-17,2021-06-17,2021-07-25,PLN4200,1528335731,1528335731,Critical Access Hospital,In-Network,N40.0,E78.5,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,3,350.93,270.58,191.83,0.0,50.0,28.75,78.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001486,MBR00000054,Professional,2021-03-08,2021-03-08,2021-03-28,PLN5661,1840431511,1840431511,Geriatrics,Out-of-Network,J44.1,I10,,,,,,,0,,81001,Pathology/Lab,,,,50,Federally Qualified Health Center,1,59.99,32.66,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001487,MBR00000054,Professional,2022-11-20,2022-11-20,2022-12-11,PLN6914,1486164553,1486164553,DME Supplier,In-Network,I10,R05,,,,,,,0,,99232,E&M,,,,11,Office,3,193.42,70.94,55.94,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001488,MBR00000054,Professional,2021-10-17,2021-10-17,2021-11-18,PLN7394,1266606767,1266606767,ASC,In-Network,E11.9,N39.0,,,,,,,0,,72148,Radiology,,,,11,Office,3,1456.19,543.95,268.45,263.44,0.0,12.06,275.5,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001489,MBR00000054,Institutional-OP,2021-06-16,2021-06-16,2021-07-25,PLN3995,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,I10,M54.5,,,,,,,0,,80061,Pathology/Lab,,,0301,22,Outpatient Hospital,1,56.85,42.31,42.31,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001490,MBR00000054,Professional,2021-04-23,2021-04-23,2021-06-01,PLN6359,1139906830,1139906830,Endocrinology,Out-of-Network,I10,R10.9,,,,,,,0,,78452,Radiology,,,,23,Emergency Room,1,5948.92,2148.89,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001491,MBR00000054,Institutional-IP,2021-05-19,2021-05-20,2021-06-03,PLN5250,1809014947,1809014947,Urology,In-Network,K21.0,N39.0,,,,682,MS-DRG,18,1,Y,99204,E&M,,,0761,21,Inpatient Hospital,1,303.21,184.16,0.0,184.16,0.0,0.0,184.16,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001492,MBR00000054,Professional,2023-11-19,2023-11-19,2023-12-29,PLN3601,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,F03.90,I10,,,,,,,0,,99204,E&M,,,,21,Inpatient Hospital,3,389.81,209.3,0.0,209.3,0.0,0.0,209.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001493,MBR00000054,Professional,2023-01-05,2023-01-05,2023-01-21,PLN1498,1124394415,1124394415,Pediatrics,In-Network,N20.0,G43.909,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,1,175.13,82.12,0.0,82.12,0.0,0.0,82.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001494,MBR00000054,Institutional-OP,2023-07-12,2023-07-12,2023-08-06,PLN8326,1713934949,1713934949,Neurology,In-Network,E11.9,I11.9,,,,,,,0,,90686,Medicine,,,0270,22,Outpatient Hospital,3,62.26,46.85,46.85,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000001495,MBR00000054,Institutional-IP,2022-11-09,2022-11-21,2022-12-02,PLN3570,1856686341,1856686341,Geriatrics,In-Network,M17.11,E66.9,,,,194,MS-DRG,10,12,Y,82043,Pathology/Lab,,,0200,21,Inpatient Hospital,3,35.82,12.62,12.62,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001496,MBR00000054,Professional,2022-08-18,2022-08-18,2022-09-20,PLN3415,1247341320,1247341320,Urology,Out-of-Network,Z12.31,M54.5,,,,,,,0,,99222,E&M,,,,11,Office,1,297.36,182.4,0.0,182.4,0.0,0.0,182.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001497,MBR00000054,Professional,2021-08-27,2021-08-27,2021-10-04,PLN9795,1778483301,1778483301,Home Health,In-Network,E11.9,F10.20,,,,,,,0,,99284,E&M,,,,11,Office,1,454.91,230.14,221.08,0.0,0.0,9.06,9.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001498,MBR00000054,Professional,2023-11-26,2023-11-26,2024-01-01,PLN8897,1239316214,1239316214,Internal Medicine,In-Network,K92.1,F41.9,,,,,,,0,,99214,E&M,,,,11,Office,1,268.99,93.27,0.0,93.27,0.0,0.0,93.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001499,MBR00000054,Professional,2023-06-21,2023-06-21,2023-07-24,PLN1568,1235381502,1235381502,Cardiology,In-Network,R10.9,E78.5,,,,,,,0,,23472,Surgery,,,,11,Office,1,5210.46,3738.22,3738.22,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001500,MBR00000054,Institutional-OP,2022-08-02,2022-08-02,2022-09-04,PLN7233,1366576336,1366576336,Geriatrics,In-Network,I11.9,J20.9,,,,,,,0,,47562,Surgery,,,0370,22,Outpatient Hospital,1,3226.82,1661.62,0.0,0.0,0.0,303.24,303.24,0.0,Denied,CO-18,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001501,MBR00000054,Professional,2021-04-26,2021-04-26,2021-05-15,PLN7626,1845057593,1845057593,Orthopedic Surgery,In-Network,F41.9,Z12.31,,,,,,,0,,99204,E&M,,,,49,Independent Clinic,1,460.9,206.25,0.0,206.25,0.0,0.0,206.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001502,MBR00000054,Professional,2023-04-13,2023-04-13,2023-05-10,PLN8698,1872613201,1872613201,Internal Medicine,In-Network,I50.9,E11.9,,,,,,,0,,70450,Radiology,,,,49,Independent Clinic,2,934.34,677.02,602.02,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001503,MBR00000054,Professional,2021-12-31,2021-12-31,2022-01-16,PLN3539,1389336600,1389336600,Critical Access Hospital,In-Network,M54.5,J20.9,,,,,,,0,,99213,E&M,,,,11,Office,1,157.79,61.94,0.0,61.94,0.0,0.0,61.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001504,MBR00000054,Institutional-OP,2021-08-18,2021-08-18,2021-09-29,PLN4345,1795618275,1795618275,Pulmonology,In-Network,G43.909,I10,,,,,,,0,,99284,E&M,,,0450,22,Outpatient Hospital,1,862.08,702.61,365.63,261.98,75.0,0.0,336.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001505,MBR00000054,Professional,2023-03-21,2023-03-21,2023-03-31,PLN4556,1366286000,1366286000,SNF,In-Network,I10,E78.5,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,2,3139.74,1361.37,1025.06,269.87,0.0,66.44,336.31,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001506,MBR00000054,Institutional-IP,2023-07-06,2023-07-09,2023-08-16,PLN1426,1520687146,1520687146,ASC,In-Network,I10,E66.9,,,,603,MS-DRG,24,3,Y,82043,Pathology/Lab,,,0900,21,Inpatient Hospital,3,41.76,23.35,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001507,MBR00000054,Professional,2022-11-04,2022-11-04,2022-11-25,PLN3858,1186826716,1186826716,Physical Therapy,In-Network,E11.40,K57.30,,,,,,,0,,99232,E&M,,,,20,Urgent Care,3,264.24,124.11,96.62,0.0,15.0,12.49,27.49,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001508,MBR00000054,Professional,2021-03-22,2021-03-22,2021-04-02,PLN2955,1840431511,1840431511,Geriatrics,Out-of-Network,Z23,I10,,,,,,,0,,71046,Radiology,,,,11,Office,2,309.99,199.51,0.0,49.66,15.0,0.0,64.66,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001509,MBR00000054,Professional,2022-10-20,2022-10-20,2022-11-03,PLN6700,1434029575,1434029575,Endocrinology,In-Network,Z96.641,B97.89,,,,,,,0,,99222,E&M,,,,23,Emergency Room,1,591.48,473.74,473.74,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001510,MBR00000054,Institutional-OP,2023-10-04,2023-10-04,2023-11-14,PLN2394,1790497490,1790497490,OB/GYN,In-Network,Z00.00,F41.9,,,,,,,0,,99204,E&M,,,0730,22,Outpatient Hospital,2,292.81,136.12,127.76,0.0,0.0,8.36,8.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001511,MBR00000054,Professional,2023-01-22,2023-01-22,2023-02-22,PLN6006,1434029575,1434029575,Endocrinology,In-Network,E66.9,I10,,,,,,,0,,87491,Pathology/Lab,,,,20,Urgent Care,1,91.79,40.73,40.73,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001512,MBR00000054,Institutional-OP,2021-10-18,2021-10-18,2021-12-01,PLN2150,1696843572,1696843572,Critical Access Hospital,Out-of-Network,R10.9,J18.9,,,,,,,0,,99232,E&M,,,0200,22,Outpatient Hospital,2,239.93,144.13,0.0,144.13,0.0,0.0,144.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001513,MBR00000054,Professional,2022-12-09,2022-12-09,2023-01-15,PLN4143,1795618275,1795618275,Pulmonology,In-Network,Z00.00,Z12.31,,,,,,,0,,76700,Radiology,,,,22,Outpatient Hospital,2,867.04,369.12,323.33,0.0,0.0,45.79,45.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001514,MBR00000054,Institutional-OP,2021-09-30,2021-09-30,2021-10-07,PLN7764,1609526529,1609526529,Psychiatry,In-Network,M54.5,I50.9,,,,,,,0,,99284,E&M,,,0200,22,Outpatient Hospital,3,444.37,139.51,139.51,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001515,MBR00000054,Professional,2023-08-16,2023-08-16,2023-09-25,PLN6673,1108115157,1108115157,General Acute Care Hospital,In-Network,F10.20,G43.909,,,,,,,0,,33533,Surgery,,,,11,Office,3,21078.5,15462.75,15462.75,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000001516,MBR00000055,Professional,2023-07-16,2023-07-16,2023-08-21,PLN2560,1847081578,1847081578,Urology,Out-of-Network,Z00.00,J44.1,,,,,,,0,,99213,E&M,,,,11,Office,3,314.15,221.54,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001517,MBR00000055,Institutional-OP,2022-09-15,2022-09-15,2022-10-27,PLN3111,1148984206,1148984206,Psychiatry,In-Network,Z23,E66.9,,,,,,,0,,99213,E&M,,,0301,22,Outpatient Hospital,1,125.01,87.68,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001518,MBR00000055,Professional,2021-05-29,2021-05-29,2021-07-06,PLN3938,1716521444,1716521444,Oncology,In-Network,E11.9,E66.9,,,,,,,0,,27130,Surgery,,,,11,Office,3,6197.56,4038.42,3913.27,0.0,50.0,75.15,125.15,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001519,MBR00000055,Professional,2022-03-16,2022-03-16,2022-04-12,PLN6724,1974006077,1974006077,Orthopedic Surgery,In-Network,I10,E78.5,,,,,,,0,,G0444,Medicine,,,,11,Office,3,44.56,35.1,35.1,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,1,Upcoding,0,0,0,0,1
CLM0000001520,MBR00000055,Institutional-OP,2021-05-13,2021-05-13,2021-06-08,PLN5562,1716521444,1716521444,Oncology,In-Network,Z12.31,F32.9,,,,,,,0,,99283,E&M,,,0200,22,Outpatient Hospital,2,582.93,361.93,287.25,0.0,25.0,49.68,74.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001521,MBR00000055,Institutional-IP,2023-04-19,2023-04-27,2023-05-27,PLN8419,1213165847,1213165847,Critical Access Hospital,In-Network,E11.9,E78.5,,,,196,MS-DRG,11,8,Y,72148,Radiology,,,0370,21,Inpatient Hospital,1,2511.3,1596.48,1060.75,460.73,75.0,0.0,535.73,0.0,Pended,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000001522,MBR00000055,Institutional-OP,2023-01-16,2023-01-16,2023-01-23,PLN4933,1453936007,1453936007,ASC,In-Network,E11.9,N18.3,,,,,,,0,,23472,Surgery,,,0301,22,Outpatient Hospital,3,5708.16,4229.98,3624.45,0.0,0.0,605.53,605.53,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001523,MBR00000055,Professional,2021-10-11,2021-10-11,2021-11-02,PLN3318,1132188260,1132188260,Family Medicine,In-Network,I11.9,F32.9,,,,,,,0,,70450,Radiology,,,,22,Outpatient Hospital,1,1662.36,1289.16,1176.79,71.23,0.0,41.14,112.37,0.0,Paid,,,1,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000001524,MBR00000055,Institutional-IP,2023-07-27,2023-07-29,2023-08-09,PLN4456,1716521444,1716521444,Oncology,In-Network,Z00.00,Z23,,,,690,MS-DRG,8,2,Y,90460,Medicine,,,0510,21,Inpatient Hospital,3,62.49,47.54,47.54,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001525,MBR00000055,Institutional-IP,2023-04-12,2023-04-20,2023-04-26,PLN9713,1767011137,1767011137,DME Supplier,In-Network,I10,E78.5,,,,641,MS-DRG,20,8,N,23472,Surgery,,,0360,21,Inpatient Hospital,2,7181.14,4820.83,4291.99,478.84,50.0,0.0,528.84,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001526,MBR00000055,Institutional-IP,2023-10-23,2023-10-27,2023-11-03,PLN5614,1757138478,1757138478,Pediatrics,In-Network,F10.20,J20.9,,,,871,MS-DRG,24,4,Y,99406,Medicine,,,0740,21,Inpatient Hospital,1,77.02,28.63,3.63,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001527,MBR00000055,Institutional-IP,2021-11-03,2021-11-12,2021-11-27,PLN4964,1896447406,1896447406,Nephrology,Out-of-Network,C50.912,M81.0,,,,194,MS-DRG,12,9,Y,93225,Medicine,,,0370,21,Inpatient Hospital,2,466.0,244.42,201.03,0.0,15.0,28.39,43.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001528,MBR00000055,Institutional-OP,2021-07-11,2021-07-11,2021-08-18,PLN4331,1224179551,1224179551,Physical Therapy,In-Network,F41.9,I10,,,,,,,0,,90686,Medicine,,,0450,22,Outpatient Hospital,1,97.29,53.28,0.0,53.28,15.0,0.0,68.28,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000001529,MBR00000055,Institutional-OP,2022-06-11,2022-06-11,2022-06-19,PLN5785,1780163051,1780163051,SNF,In-Network,M54.5,J20.9,,,,,,,0,,99221,E&M,,,0730,22,Outpatient Hospital,1,233.04,153.9,83.46,63.39,0.0,7.05,70.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001530,MBR00000055,Professional,2021-10-18,2021-10-18,2021-11-27,PLN3687,1486164553,1486164553,DME Supplier,In-Network,J06.9,R10.9,,,,,,,0,,82043,Pathology/Lab,,,,49,Independent Clinic,2,73.27,50.54,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001531,MBR00000055,Professional,2023-03-21,2023-03-21,2023-04-29,PLN7681,1266606767,1266606767,ASC,In-Network,I11.9,E78.5,,,,,,,0,,58661,Surgery,,,,21,Inpatient Hospital,1,2668.85,1629.73,1552.37,77.36,0.0,0.0,77.36,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001532,MBR00000055,Professional,2022-04-11,2022-04-11,2022-05-01,PLN2478,1453283987,1453283987,Critical Access Hospital,In-Network,F03.90,Z12.31,,,,,,,0,,99283,E&M,,,,11,Office,3,473.7,159.81,159.81,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001533,MBR00000055,Professional,2022-11-19,2022-11-19,2022-12-06,PLN6448,1486164553,1486164553,DME Supplier,In-Network,E11.9,K92.1,,,,,,,0,,27130,Surgery,,,,81,Independent Laboratory,3,4516.79,1725.65,1725.65,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001534,MBR00000055,Institutional-IP,2021-07-08,2021-07-09,2021-08-17,PLN3285,1795618275,1795618275,Pulmonology,In-Network,F41.9,E11.9,,,,682,MS-DRG,11,1,Y,66984,Surgery,,,0120,21,Inpatient Hospital,3,1474.97,479.7,464.7,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001535,MBR00000055,Professional,2021-04-04,2021-04-04,2021-04-16,PLN3879,1313212303,1313212303,Family Medicine,In-Network,J18.9,G43.909,,,,,,,0,,70450,Radiology,,,,49,Independent Clinic,1,889.27,713.16,712.06,0.0,0.0,1.1,1.1,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001536,MBR00000055,Professional,2023-10-24,2023-10-24,2023-11-16,PLN1117,1939033455,1939033455,Pulmonology,In-Network,E66.9,F41.9,,,,,,,0,,23472,Surgery,,,,21,Inpatient Hospital,3,3447.01,1273.88,1238.88,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001537,MBR00000055,Institutional-OP,2022-05-04,2022-05-04,2022-05-29,PLN1347,1540044947,1540044947,Pulmonology,Out-of-Network,I10,R10.9,,,,,,,0,,99283,E&M,,,0510,22,Outpatient Hospital,3,396.55,210.9,0.0,210.9,50.0,0.0,260.9,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001538,MBR00000055,Institutional-OP,2021-06-02,2021-06-02,2021-06-12,PLN1525,1896447406,1896447406,Nephrology,Out-of-Network,Z00.01,I48.91,,,,,,,0,,99221,E&M,,,0200,22,Outpatient Hospital,2,297.71,110.34,0.0,110.34,15.0,0.0,125.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001539,MBR00000055,Professional,2023-06-08,2023-06-08,2023-07-22,PLN9943,1689639685,1689639685,SNF,In-Network,E66.9,M81.0,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,3,40.12,21.34,5.39,0.0,15.0,0.95,15.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001540,MBR00000055,Professional,2021-05-26,2021-05-26,2021-06-19,PLN7871,1856686341,1856686341,Geriatrics,In-Network,F32.9,I25.10,,,,,,,0,,G0444,Medicine,,,,12,Home,2,97.34,30.37,30.37,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000001541,MBR00000055,Professional,2023-12-28,2023-12-28,2024-01-21,PLN6885,1609526529,1609526529,Psychiatry,In-Network,F32.9,I10,,,,,,,0,,99204,E&M,,,,11,Office,1,237.82,142.17,0.0,142.17,75.0,0.0,217.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001542,MBR00000055,Professional,2022-02-27,2022-02-27,2022-04-10,PLN3463,1366576336,1366576336,Geriatrics,In-Network,F32.9,I10,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,3,372.84,239.06,239.06,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001543,MBR00000055,Professional,2022-05-27,2022-05-27,2022-06-04,PLN4881,1118885473,1118885473,ASC,In-Network,E66.9,Z00.00,,,,,,,0,,99221,E&M,,,,11,Office,3,173.51,122.5,47.5,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001544,MBR00000055,Professional,2021-10-11,2021-10-11,2021-11-21,PLN5852,1520687146,1520687146,ASC,In-Network,N39.0,J44.1,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,1,5241.82,1586.08,1571.08,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001545,MBR00000055,Institutional-OP,2021-04-05,2021-04-05,2021-04-24,PLN9155,1334916761,1334916761,ASC,In-Network,E66.9,G43.909,,,,,,,0,,99213,E&M,,,0761,22,Outpatient Hospital,1,190.85,155.97,0.0,155.97,0.0,0.0,155.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001546,MBR00000055,Professional,2022-03-24,2022-03-24,2022-05-05,PLN7353,1453283987,1453283987,Critical Access Hospital,In-Network,F03.90,E11.9,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,1,69.16,33.11,0.0,33.11,0.0,0.0,33.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001547,MBR00000055,Professional,2022-02-05,2022-02-05,2022-03-06,PLN8940,1531398223,1531398223,OB/GYN,In-Network,Z87.891,Z51.11,,,,,,,0,,80061,Pathology/Lab,,,,22,Outpatient Hospital,1,110.18,33.61,33.61,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001548,MBR00000055,Institutional-IP,2022-05-06,2022-05-07,2022-06-03,PLN1791,1939033455,1939033455,Pulmonology,In-Network,Z00.00,J06.9,,,,683,MS-DRG,3,1,Y,33533,Surgery,,,0370,21,Inpatient Hospital,2,17169.97,11554.97,11554.97,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,1,Upcoding,0,0,0,0,0
CLM0000001549,MBR00000055,Professional,2022-06-21,2022-06-21,2022-07-13,PLN4331,1453283987,1453283987,Critical Access Hospital,In-Network,E78.5,E11.9,,,,,,,0,,45378,Surgery,,,,50,Federally Qualified Health Center,2,2542.34,1891.74,1891.74,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000001550,MBR00000055,Professional,2022-11-22,2022-11-22,2022-11-30,PLN6952,1847081578,1847081578,Urology,Out-of-Network,E11.9,J18.9,,,,,,,0,,33533,Surgery,,,,11,Office,2,21499.97,11929.19,11903.82,25.37,0.0,0.0,25.37,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000001551,MBR00000055,Professional,2021-03-22,2021-03-22,2021-03-29,PLN2586,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,Z00.00,J44.1,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,1,380.55,280.92,230.92,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001552,MBR00000055,Professional,2022-02-02,2022-02-02,2022-03-08,PLN1614,1896447406,1896447406,Nephrology,Out-of-Network,K21.0,E11.9,,,,,,,0,,70553,Radiology,,,,11,Office,1,2829.83,889.33,874.33,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001553,MBR00000055,Professional,2023-08-05,2023-08-05,2023-09-06,PLN4550,1389336600,1389336600,Critical Access Hospital,In-Network,F32.9,E66.9,,,,,,,0,,71046,Radiology,,,,22,Outpatient Hospital,1,265.37,107.8,107.8,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001554,MBR00000055,Professional,2023-11-09,2023-11-09,2023-12-23,PLN9981,1795618275,1795618275,Pulmonology,In-Network,Z12.31,I10,,,,,,,0,,99221,E&M,,,,11,Office,1,288.92,159.6,84.6,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001555,MBR00000055,Professional,2022-08-13,2022-08-13,2022-09-06,PLN5198,1994661817,1994661817,SNF,Out-of-Network,N18.3,I10,,,,,,,0,,47562,Surgery,,,,11,Office,1,5112.06,2830.11,2396.79,433.32,0.0,0.0,433.32,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001556,MBR00000055,Institutional-OP,2022-02-05,2022-02-05,2022-02-18,PLN4871,1372918899,1372918899,Family Medicine,In-Network,I10,C50.912,,,,,,,0,,43239,Surgery,,,0370,22,Outpatient Hospital,2,1179.14,802.56,802.56,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001557,MBR00000055,Institutional-OP,2022-04-01,2022-04-01,2022-04-29,PLN7273,1224179551,1224179551,Physical Therapy,In-Network,R10.9,N39.0,,,,,,,0,,99406,Medicine,,,0301,22,Outpatient Hospital,1,50.8,28.25,3.25,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001558,MBR00000055,Professional,2023-05-07,2023-05-07,2023-05-28,PLN8978,1767011137,1767011137,DME Supplier,In-Network,G43.909,E78.5,,,,,,,0,,99203,E&M,,,,11,Office,2,296.19,247.99,212.99,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001559,MBR00000055,Institutional-OP,2022-03-11,2022-03-11,2022-04-20,PLN1987,1915531927,1915531927,Critical Access Hospital,In-Network,Z00.00,I10,,,,,,,0,,99232,E&M,,,0360,22,Outpatient Hospital,3,223.73,108.73,0.0,108.73,25.0,0.0,133.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001560,MBR00000055,Professional,2023-11-01,2023-11-01,2023-12-02,PLN5680,1219817751,1219817751,OB/GYN,In-Network,I63.9,Z12.31,,,,,,,0,,99222,E&M,,,,65,End-Stage Renal Disease,2,596.54,196.49,190.39,0.0,0.0,6.1,6.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001561,MBR00000055,Professional,2021-01-31,2021-01-31,2021-02-25,PLN9321,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,Z12.31,E78.5,,,,,,,0,,99213,E&M,,,,22,Outpatient Hospital,1,300.97,218.23,0.0,218.23,0.0,0.0,218.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001562,MBR00000055,Professional,2022-10-26,2022-10-26,2022-11-29,PLN4790,1891849440,1891849440,Oncology,In-Network,Z00.00,E11.40,,,,,,,0,,72148,Radiology,,,,11,Office,1,1667.22,968.01,943.01,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001563,MBR00000055,Professional,2022-07-23,2022-07-23,2022-08-14,PLN4975,1856686341,1856686341,Geriatrics,In-Network,M54.5,N18.3,,,,,,,0,,99284,E&M,,,,11,Office,3,369.29,183.25,168.25,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001564,MBR00000055,Professional,2022-05-10,2022-05-10,2022-05-28,PLN8476,1556140803,1556140803,Cardiology,In-Network,I10,Z23,,,,,,,0,,99232,E&M,,,,11,Office,2,239.15,170.14,0.0,170.14,0.0,0.0,170.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001565,MBR00000056,Institutional-OP,2022-06-05,2022-06-05,2022-06-17,PLN6797,1990090423,1990090423,Orthopedic Surgery,In-Network,E66.9,J45.20,,,,,,,0,,97530,Medicine,,,0900,22,Outpatient Hospital,3,138.79,44.48,27.11,0.0,15.0,2.37,17.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001566,MBR00000056,Professional,2021-06-23,2021-06-23,2021-07-31,PLN9660,1390307371,1390307371,DME Supplier,In-Network,B97.89,J45.20,,,,,,,0,,99204,E&M,,,,49,Independent Clinic,3,561.29,415.89,415.89,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001567,MBR00000056,Professional,2022-01-14,2022-01-14,2022-02-26,PLN6181,1561134315,1561134315,DME Supplier,In-Network,I48.91,J06.9,,,,,,,0,,23472,Surgery,,,,11,Office,3,6495.01,2239.17,2239.17,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001568,MBR00000056,Professional,2022-01-22,2022-01-22,2022-02-05,PLN8131,1213165847,1213165847,Critical Access Hospital,In-Network,M54.5,E11.9,,,,,,,0,,33533,Surgery,,,,21,Inpatient Hospital,1,14734.87,6526.38,6451.38,0.0,75.0,0.0,75.0,0.0,Pended,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000001569,MBR00000056,Institutional-OP,2022-12-23,2022-12-23,2023-01-29,PLN1179,1213165847,1213165847,Critical Access Hospital,In-Network,Z23,I10,,,,,,,0,,83036,Pathology/Lab,,,0510,22,Outpatient Hospital,3,87.3,52.51,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000001570,MBR00000056,Professional,2022-10-18,2022-10-18,2022-11-19,PLN9436,1660288235,1660288235,ASC,In-Network,J06.9,I25.10,,,,,,,0,,G0468,Medicine,,,,23,Emergency Room,1,408.25,137.49,137.49,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001571,MBR00000056,Institutional-OP,2022-03-27,2022-03-27,2022-04-09,PLN3488,1268679390,1268679390,Critical Access Hospital,In-Network,Z12.31,Z23,,,,,,,0,,80053,Pathology/Lab,,,0761,22,Outpatient Hospital,1,139.34,84.17,8.26,75.91,0.0,0.0,75.91,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001572,MBR00000056,Professional,2022-07-21,2022-07-21,2022-08-04,PLN5943,1749494482,1749494482,Pediatrics,In-Network,R05,I48.91,,,,,,,0,,45378,Surgery,,,,23,Emergency Room,1,2615.45,875.31,752.16,123.15,0.0,0.0,123.15,0.0,Paid,,,0,,1,1,0,0,0,0,None,0,1,0,0,0
CLM0000001573,MBR00000056,Institutional-OP,2022-09-19,2022-09-19,2022-10-02,PLN7288,1361302520,1361302520,Critical Access Hospital,In-Network,E11.9,J06.9,,,,,,,0,,27447,Surgery,,,0510,22,Outpatient Hospital,1,4803.51,1679.36,1084.6,483.34,0.0,111.42,594.76,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001574,MBR00000056,Professional,2021-02-21,2021-02-21,2021-03-16,PLN3532,1135158374,1135158374,Pulmonology,In-Network,E11.9,N18.3,,,,,,,0,,27130,Surgery,,,,11,Office,1,3366.59,1036.78,1021.78,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001575,MBR00000056,Professional,2023-08-28,2023-08-28,2023-09-14,PLN1261,1520687146,1520687146,ASC,In-Network,Z87.891,E11.9,,,,,,,0,,90837,Medicine,,,,20,Urgent Care,1,240.73,99.67,90.62,0.0,0.0,9.05,9.05,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001576,MBR00000056,Professional,2023-09-05,2023-09-05,2023-10-16,PLN1355,1410468316,1410468316,SNF,In-Network,N18.3,F41.9,,,,,,,0,,97530,Medicine,,,,49,Independent Clinic,3,224.89,152.28,102.28,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001577,MBR00000056,Professional,2022-02-03,2022-02-03,2022-03-06,PLN6393,1780163051,1780163051,SNF,In-Network,Z12.11,K21.0,,,,,,,0,,87491,Pathology/Lab,,,,22,Outpatient Hospital,1,205.32,80.49,55.49,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001578,MBR00000056,Professional,2023-04-14,2023-04-14,2023-05-13,PLN3436,1847081578,1847081578,Urology,Out-of-Network,E11.40,N20.0,,,,,,,0,,G0439,Medicine,,,,11,Office,3,628.25,215.94,0.0,215.94,0.0,0.0,215.94,0.0,Adjusted,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000001579,MBR00000056,Professional,2022-03-12,2022-03-12,2022-04-24,PLN4747,1571574052,1571574052,Critical Access Hospital,In-Network,E78.5,Z23,,,,,,,0,,72148,Radiology,,,,11,Office,1,1600.89,1345.94,1275.68,0.0,0.0,70.26,70.26,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001580,MBR00000056,Institutional-IP,2021-03-16,2021-03-25,2021-04-15,PLN4724,1563980627,1563980627,Critical Access Hospital,In-Network,R51,N40.0,,,,291,MS-DRG,3,9,Y,71046,Radiology,,,0320,21,Inpatient Hospital,1,164.63,136.78,116.15,0.0,0.0,20.63,20.63,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001581,MBR00000056,Institutional-IP,2023-08-07,2023-08-10,2023-09-16,PLN6510,1114982472,1114982472,Orthopedic Surgery,In-Network,Z00.01,N18.3,,,,194,MS-DRG,24,3,Y,87491,Pathology/Lab,,,0510,21,Inpatient Hospital,3,199.84,85.95,85.95,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001582,MBR00000056,Professional,2021-10-21,2021-10-21,2021-11-10,PLN3093,1645194539,1645194539,SNF,In-Network,Z51.11,N40.0,,,,,,,0,,58661,Surgery,,,,11,Office,1,3626.82,1309.77,0.0,0.0,0.0,40.23,40.23,0.0,Denied,CO-97,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001583,MBR00000056,Institutional-IP,2022-01-28,2022-02-06,2022-02-12,PLN2109,1337791138,1337791138,Internal Medicine,Out-of-Network,R10.9,N18.3,,,,683,MS-DRG,1,9,N,70553,Radiology,,,0761,21,Inpatient Hospital,2,3354.62,2562.5,2359.04,0.0,0.0,203.46,203.46,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001584,MBR00000056,Institutional-OP,2022-09-23,2022-09-23,2022-10-14,PLN6557,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,I25.10,I10,,,,,,,0,,45378,Surgery,,,0120,22,Outpatient Hospital,1,2114.12,1369.53,1217.51,152.02,0.0,0.0,152.02,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000001585,MBR00000056,Institutional-OP,2022-04-27,2022-04-27,2022-05-11,PLN7215,1355166277,1355166277,Endocrinology,In-Network,I10,E11.9,,,,,,,0,,90460,Medicine,,,0270,22,Outpatient Hospital,1,53.76,16.72,16.72,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001586,MBR00000056,Professional,2021-10-19,2021-10-19,2021-10-27,PLN3776,1148984206,1148984206,Psychiatry,In-Network,G20,Z87.891,,,,,,,0,,27130,Surgery,,,,20,Urgent Care,2,2690.78,1954.01,1539.53,389.48,25.0,0.0,414.48,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001587,MBR00000056,Professional,2023-05-27,2023-05-27,2023-06-15,PLN5533,1239316214,1239316214,Internal Medicine,In-Network,Z23,J18.9,,,,,,,0,,70450,Radiology,,,,22,Outpatient Hospital,2,953.91,703.72,703.72,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001588,MBR00000056,Institutional-OP,2022-01-25,2022-01-25,2022-03-01,PLN5906,1716521444,1716521444,Oncology,In-Network,R51,J44.1,,,,,,,0,,99203,E&M,,,0360,22,Outpatient Hospital,1,372.85,112.54,0.0,112.54,0.0,0.0,112.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001589,MBR00000056,Institutional-OP,2022-10-11,2022-10-11,2022-10-21,PLN3503,1910255109,1910255109,DME Supplier,In-Network,F32.9,I10,,,,,,,0,,70450,Radiology,,,0360,22,Outpatient Hospital,2,1437.24,706.11,644.45,0.0,15.0,46.66,61.66,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001590,MBR00000056,Institutional-OP,2022-12-30,2022-12-30,2023-01-07,PLN5404,1795618275,1795618275,Pulmonology,In-Network,F41.9,I10,,,,,,,0,,80061,Pathology/Lab,,,0370,22,Outpatient Hospital,3,107.26,53.68,38.68,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001591,MBR00000056,Institutional-IP,2023-10-20,2023-10-26,2023-11-25,PLN1244,1118885473,1118885473,ASC,In-Network,E66.9,I50.9,,,,196,MS-DRG,8,6,Y,87491,Pathology/Lab,,,0510,21,Inpatient Hospital,1,174.77,59.59,59.59,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001592,MBR00000056,Institutional-IP,2022-06-09,2022-06-10,2022-07-14,PLN5850,1390307371,1390307371,DME Supplier,In-Network,M54.5,J44.1,,,,195,MS-DRG,24,1,Y,G0468,Medicine,,,0301,21,Inpatient Hospital,1,472.67,269.5,269.5,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001593,MBR00000056,Institutional-OP,2022-05-31,2022-05-31,2022-07-01,PLN1418,1622771872,1622771872,Pediatrics,In-Network,I10,J20.9,,,,,,,0,,58661,Surgery,,,0740,22,Outpatient Hospital,1,4277.54,1637.3,1637.3,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001594,MBR00000056,Professional,2023-09-27,2023-09-27,2023-11-02,PLN7657,1422747896,1422747896,Urology,In-Network,I48.91,Z00.00,,,,,,,0,,93000,Radiology,,,,12,Home,2,184.06,56.69,0.0,56.69,0.0,0.0,56.69,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001595,MBR00000056,Professional,2022-06-09,2022-06-09,2022-06-20,PLN7502,1283743001,1283743001,Family Medicine,In-Network,Z23,N18.3,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,1,2124.56,676.33,0.0,0.0,15.0,30.88,45.88,0.0,Denied,CO-15,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001596,MBR00000056,Institutional-OP,2021-11-23,2021-11-23,2021-12-18,PLN5083,1242201429,1242201429,General Acute Care Hospital,In-Network,K92.1,I48.91,,,,,,,0,,G0468,Medicine,,,0120,22,Outpatient Hospital,2,324.18,212.98,212.98,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001597,MBR00000056,Institutional-OP,2021-02-17,2021-02-17,2021-02-28,PLN6402,1727809972,1727809972,Home Health,In-Network,R07.9,F41.9,,,,,,,0,,71046,Radiology,,,0761,22,Outpatient Hospital,1,124.65,94.06,0.0,94.06,50.0,0.0,144.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001598,MBR00000056,Professional,2021-12-22,2021-12-22,2022-01-14,PLN1509,1361302520,1361302520,Critical Access Hospital,In-Network,M54.5,Z00.00,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,2,225.2,82.93,0.0,82.93,0.0,0.0,82.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001599,MBR00000057,Professional,2021-08-05,2021-08-05,2021-08-20,PLN1015,1205377316,1205377316,Orthopedic Surgery,In-Network,M17.11,Z23,,,,,,,0,,G0444,Medicine,,,,49,Independent Clinic,3,92.25,36.61,36.61,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000001600,MBR00000057,Institutional-OP,2021-11-30,2021-11-30,2022-01-10,PLN6205,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,Z00.00,I10,,,,,,,0,,70450,Radiology,,,0761,22,Outpatient Hospital,3,1292.15,789.78,704.35,0.0,25.0,60.43,85.43,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001601,MBR00000057,Professional,2022-08-15,2022-08-15,2022-08-22,PLN3863,1433937353,1433937353,Nephrology,In-Network,Z79.4,N18.3,,,,,,,0,,78452,Radiology,,,,22,Outpatient Hospital,2,4564.2,2330.65,1879.44,436.21,15.0,0.0,451.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001602,MBR00000057,Institutional-IP,2022-07-29,2022-08-02,2022-09-06,PLN3660,1910255109,1910255109,DME Supplier,In-Network,E78.5,I10,,,,196,MS-DRG,1,4,Y,99204,E&M,,,0740,21,Inpatient Hospital,2,398.96,195.94,195.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001603,MBR00000057,Professional,2021-07-24,2021-07-24,2021-08-01,PLN1803,1337791138,1337791138,Internal Medicine,Out-of-Network,E11.9,Z00.00,,,,,,,0,,99284,E&M,,,,23,Emergency Room,2,850.88,468.6,73.83,379.77,15.0,0.0,394.77,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001604,MBR00000057,Professional,2022-05-24,2022-05-24,2022-07-03,PLN5516,1696843572,1696843572,Critical Access Hospital,Out-of-Network,I63.9,E66.9,,,,,,,0,,70553,Radiology,,,,11,Office,1,4155.28,2458.0,2433.0,0.0,25.0,0.0,25.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001605,MBR00000057,Institutional-OP,2022-05-12,2022-05-12,2022-06-08,PLN5520,1108115157,1108115157,General Acute Care Hospital,In-Network,E78.5,R51,,,,,,,0,,99284,E&M,,,0510,22,Outpatient Hospital,3,787.4,582.14,582.14,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001606,MBR00000057,Institutional-OP,2021-02-16,2021-02-16,2021-03-20,PLN5878,1453283987,1453283987,Critical Access Hospital,In-Network,E66.9,E66.9,,,,,,,0,,93000,Radiology,,,0270,22,Outpatient Hospital,3,90.87,67.4,0.0,67.4,0.0,0.0,67.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001607,MBR00000057,Professional,2021-11-07,2021-11-07,2021-12-18,PLN8380,1511044648,1511044648,Endocrinology,In-Network,E78.5,I25.10,,,,,,,0,,77067,Radiology,,,,11,Office,3,685.52,441.87,277.67,110.17,0.0,54.03,164.2,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000001608,MBR00000057,Professional,2023-03-03,2023-03-03,2023-04-05,PLN3889,1891849440,1891849440,Oncology,In-Network,Z00.01,J06.9,,,,,,,0,,27447,Surgery,,,,11,Office,1,3489.32,1373.98,1061.4,48.27,35.0,229.31,312.58,0.0,Paid,,,0,,0,0,1,0,0,1,Duplicate,0,0,0,0,0
CLM0000001609,MBR00000057,Professional,2021-01-23,2021-01-23,2021-02-14,PLN3268,1644128543,1644128543,Gastroenterology,In-Network,M17.11,Z12.31,,,,,,,0,,45378,Surgery,,,,11,Office,1,1711.31,664.85,552.28,0.0,25.0,87.57,112.57,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000001610,MBR00000057,Professional,2021-11-26,2021-11-26,2021-12-19,PLN5934,1390307371,1390307371,DME Supplier,In-Network,K21.0,M54.5,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,1,33.68,21.18,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001611,MBR00000057,Institutional-OP,2022-06-05,2022-06-05,2022-06-26,PLN1366,1390307371,1390307371,DME Supplier,In-Network,I10,I10,,,,,,,0,,76700,Radiology,,,0900,22,Outpatient Hospital,1,976.22,581.63,550.32,0.0,0.0,31.31,31.31,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001612,MBR00000057,Professional,2021-07-02,2021-07-02,2021-07-30,PLN4228,1103747954,1103747954,Urology,In-Network,J18.9,F10.20,,,,,,,0,,23472,Surgery,,,,31,Skilled Nursing Facility,1,7394.37,3300.41,0.0,342.77,25.0,170.73,538.5,0.0,Denied,PR-1,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001613,MBR00000057,Institutional-OP,2022-12-09,2022-12-09,2022-12-20,PLN9887,1749494482,1749494482,Pediatrics,In-Network,F32.9,E66.9,,,,,,,0,,27130,Surgery,,,0200,22,Outpatient Hospital,1,5759.67,3750.89,3531.26,219.63,0.0,0.0,219.63,0.0,Paid,,,0,,0,0,1,0,0,1,Unbundling,0,0,0,0,0
CLM0000001614,MBR00000057,Institutional-OP,2023-02-23,2023-02-23,2023-03-22,PLN3190,1717912431,1717912431,Oncology,In-Network,E11.65,F41.9,,,,,,,0,,58661,Surgery,,,0450,22,Outpatient Hospital,3,1774.58,997.8,997.8,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001615,MBR00000057,Professional,2022-01-06,2022-01-06,2022-01-23,PLN1295,1609526529,1609526529,Psychiatry,In-Network,F03.90,Z23,,,,,,,0,,99213,E&M,,,,22,Outpatient Hospital,3,299.36,142.2,117.2,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001616,MBR00000057,Professional,2021-09-10,2021-09-10,2021-10-12,PLN4164,1968299309,1968299309,Internal Medicine,In-Network,Z87.891,G43.909,,,,,,,0,,45378,Surgery,,,,81,Independent Laboratory,3,2045.66,1447.97,1397.97,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000001617,MBR00000057,Institutional-OP,2023-05-01,2023-05-01,2023-05-20,PLN8213,1531398223,1531398223,OB/GYN,In-Network,F32.9,J44.1,,,,,,,0,,99214,E&M,,,0370,22,Outpatient Hospital,1,295.67,199.54,0.0,199.54,0.0,0.0,199.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001618,MBR00000057,Professional,2021-08-24,2021-08-24,2021-10-02,PLN2227,1236418230,1236418230,DME Supplier,In-Network,S72.001A,I25.10,,,,,,,0,,99214,E&M,,,,50,Federally Qualified Health Center,1,297.49,177.56,177.56,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001619,MBR00000057,Institutional-OP,2021-06-09,2021-06-09,2021-07-16,PLN5103,1624802371,1624802371,ASC,Out-of-Network,I50.9,R51,,,,,,,0,,47562,Surgery,,,0370,22,Outpatient Hospital,2,5631.05,4634.82,3456.88,366.85,35.0,776.09,1177.94,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001620,MBR00000058,Professional,2021-02-06,2021-02-06,2021-02-15,PLN6445,1990090423,1990090423,Orthopedic Surgery,In-Network,C50.912,Z23,,,,,,,0,,97110,Medicine,,,,22,Outpatient Hospital,2,154.11,102.01,77.01,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001621,MBR00000058,Professional,2021-04-10,2021-04-10,2021-05-21,PLN5774,1778483301,1778483301,Home Health,In-Network,R07.9,J06.9,,,,,,,0,,78452,Radiology,,,,11,Office,1,4409.34,3694.59,3540.08,119.51,35.0,0.0,154.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001622,MBR00000058,Professional,2023-08-13,2023-08-13,2023-08-22,PLN1248,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,I10,Z00.00,,,,,,,0,,47562,Surgery,,,,49,Independent Clinic,1,5689.28,3336.74,2746.49,0.0,15.0,575.25,590.25,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001623,MBR00000058,Professional,2023-10-21,2023-10-21,2023-10-30,PLN5432,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,F32.9,E11.9,,,,,,,0,,99222,E&M,,,,31,Skilled Nursing Facility,3,613.42,368.37,293.37,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001624,MBR00000058,Institutional-IP,2022-08-21,2022-08-25,2022-09-15,PLN9662,1366286000,1366286000,SNF,In-Network,I10,F41.9,,,,292,MS-DRG,20,4,Y,27130,Surgery,,,0270,21,Inpatient Hospital,1,6584.54,3328.48,3328.48,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001625,MBR00000058,Institutional-IP,2023-10-07,2023-10-12,2023-11-02,PLN8619,1974006077,1974006077,Orthopedic Surgery,In-Network,J18.9,E66.9,,,,683,MS-DRG,16,5,U,99204,E&M,,,0320,21,Inpatient Hospital,1,435.72,145.2,145.2,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001626,MBR00000058,Professional,2023-02-14,2023-02-14,2023-03-02,PLN2880,1245650222,1245650222,Gastroenterology,In-Network,E78.5,I10,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,1,284.03,236.19,236.19,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001627,MBR00000058,Professional,2022-03-22,2022-03-22,2022-04-29,PLN2840,1550154147,1550154147,Outpatient Clinic,In-Network,E11.65,F32.9,,,,,,,0,,47562,Surgery,,,,11,Office,2,5390.38,3329.22,2903.51,425.71,0.0,0.0,425.71,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001628,MBR00000058,Professional,2023-02-21,2023-02-21,2023-03-25,PLN7274,1561134315,1561134315,DME Supplier,In-Network,I10,Z23,,,,,,,0,,90837,Medicine,,,,81,Independent Laboratory,2,465.66,221.49,221.49,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001629,MBR00000058,Institutional-OP,2022-04-05,2022-04-05,2022-05-19,PLN1203,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,N18.3,Z79.4,,,,,,,0,,33533,Surgery,,,0900,22,Outpatient Hospital,1,15561.58,5253.97,5228.97,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000001630,MBR00000058,Institutional-OP,2023-11-20,2023-11-20,2023-12-02,PLN8868,1990090423,1990090423,Orthopedic Surgery,In-Network,I10,J44.1,,,,,,,0,,99233,E&M,,,0450,22,Outpatient Hospital,2,223.08,84.07,0.0,84.07,75.0,0.0,159.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001631,MBR00000058,Institutional-IP,2023-07-21,2023-07-29,2023-08-23,PLN9231,1395983630,1395983630,Nephrology,In-Network,J06.9,Z12.31,,,,683,MS-DRG,24,8,Y,97110,Medicine,,,0270,21,Inpatient Hospital,3,291.72,243.35,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001632,MBR00000058,Institutional-OP,2023-07-15,2023-07-15,2023-08-01,PLN4537,1268679390,1268679390,Critical Access Hospital,In-Network,N39.0,I10,,,,,,,0,,70450,Radiology,,,0900,22,Outpatient Hospital,2,1498.85,755.4,510.01,164.08,75.0,6.31,245.39,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001633,MBR00000058,Professional,2022-08-04,2022-08-04,2022-09-17,PLN4536,1118885473,1118885473,ASC,In-Network,G43.909,C50.912,,,,,,,0,,71046,Radiology,,,,31,Skilled Nursing Facility,3,302.77,228.07,66.56,150.37,0.0,11.14,161.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001634,MBR00000058,Professional,2022-07-22,2022-07-22,2022-08-08,PLN5929,1390307371,1390307371,DME Supplier,In-Network,F32.9,M17.11,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,1,348.26,144.73,94.73,0.0,50.0,0.0,50.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001635,MBR00000058,Professional,2021-05-09,2021-05-09,2021-05-23,PLN7209,1284035364,1284035364,Pediatrics,In-Network,I50.9,I10,,,,,,,0,,45378,Surgery,,,,11,Office,3,1522.39,534.2,498.0,0.0,25.0,11.2,36.2,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000001636,MBR00000058,Institutional-OP,2022-12-16,2022-12-16,2023-01-11,PLN6882,1239316214,1239316214,Internal Medicine,In-Network,I10,Z23,,,,,,,0,,99284,E&M,,,0320,22,Outpatient Hospital,3,612.59,461.51,313.78,0.0,75.0,72.73,147.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001637,MBR00000058,Professional,2021-05-06,2021-05-06,2021-06-19,PLN3055,1624202402,1624202402,Orthopedic Surgery,In-Network,K21.0,E11.9,,,,,,,0,,99284,E&M,,,,11,Office,1,746.05,504.23,9.92,494.29,0.0,0.02,494.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001638,MBR00000058,Institutional-OP,2022-08-15,2022-08-15,2022-08-26,PLN2542,1899127912,1899127912,Neurology,In-Network,M54.5,F41.9,,,,,,,0,,71046,Radiology,,,0510,22,Outpatient Hospital,2,249.73,203.63,0.0,203.63,35.0,0.0,238.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001639,MBR00000058,Professional,2021-05-24,2021-05-24,2021-06-03,PLN9655,1575695214,1575695214,SNF,In-Network,I10,Z00.00,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,3,44.01,32.27,16.07,0.0,15.0,1.2,16.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000001640,MBR00000058,Professional,2022-06-06,2022-06-06,2022-06-24,PLN5031,1148984206,1148984206,Psychiatry,In-Network,S72.001A,N39.0,,,,,,,0,,G0444,Medicine,,,,21,Inpatient Hospital,1,81.35,47.65,0.0,47.65,0.0,0.0,47.65,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000001641,MBR00000058,Professional,2023-05-05,2023-05-05,2023-06-17,PLN7328,1749494482,1749494482,Pediatrics,In-Network,I11.9,I10,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,1,3938.58,2628.71,2578.71,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001642,MBR00000058,Institutional-IP,2021-12-04,2021-12-05,2021-12-17,PLN2989,1395983630,1395983630,Nephrology,In-Network,E11.9,I50.9,,,,641,MS-DRG,20,1,Y,99283,E&M,,,0450,21,Inpatient Hospital,1,563.04,423.27,398.27,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000001643,MBR00000058,Professional,2022-10-22,2022-10-22,2022-11-11,PLN6720,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,I10,N39.0,,,,,,,0,,97110,Medicine,,,,11,Office,1,266.64,220.76,0.0,220.76,35.0,0.0,255.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001644,MBR00000058,Institutional-OP,2021-10-12,2021-10-12,2021-11-07,PLN6111,1645194539,1645194539,SNF,In-Network,C50.912,Z79.4,,,,,,,0,,23472,Surgery,,,0900,22,Outpatient Hospital,2,6033.81,2970.11,2752.48,0.0,35.0,182.63,217.63,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001645,MBR00000058,Institutional-IP,2021-11-25,2021-11-30,2021-12-20,PLN4226,1313212303,1313212303,Family Medicine,In-Network,N20.0,J44.1,,,,683,MS-DRG,11,5,N,33533,Surgery,,,0450,21,Inpatient Hospital,2,17980.02,13582.58,13190.79,391.79,0.0,0.0,391.79,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000001646,MBR00000059,Professional,2021-07-20,2021-07-20,2021-08-13,PLN5675,1284035364,1284035364,Pediatrics,In-Network,E78.5,R05,,,,,,,0,,99233,E&M,,,,11,Office,1,493.3,227.11,101.02,126.09,0.0,0.0,126.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001647,MBR00000059,Institutional-OP,2021-06-27,2021-06-27,2021-07-26,PLN2218,1790497490,1790497490,OB/GYN,In-Network,Z79.4,Z00.01,,,,,,,0,,99203,E&M,,,0370,22,Outpatient Hospital,2,388.4,241.37,0.0,241.37,0.0,0.0,241.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001648,MBR00000059,Professional,2022-02-12,2022-02-12,2022-02-26,PLN1837,1518055405,1518055405,Urology,In-Network,I10,N18.3,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,2,315.66,202.4,192.06,0.0,0.0,10.34,10.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001649,MBR00000059,Institutional-OP,2021-05-16,2021-05-16,2021-06-10,PLN1701,1518055405,1518055405,Urology,In-Network,E11.9,J44.1,,,,,,,0,,99284,E&M,,,0730,22,Outpatient Hospital,3,819.28,246.72,0.0,224.51,25.0,0.0,249.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001650,MBR00000059,Professional,2023-09-04,2023-09-04,2023-09-27,PLN1828,1475984649,1475984649,SNF,In-Network,I10,J06.9,,,,,,,0,,85610,Pathology/Lab,,,,21,Inpatient Hospital,2,28.57,18.94,17.15,0.0,0.0,1.79,1.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001651,MBR00000059,Institutional-IP,2023-03-23,2023-03-26,2023-04-01,PLN4397,1563980627,1563980627,Critical Access Hospital,In-Network,K21.0,R10.9,,,,871,MS-DRG,21,3,Y,78452,Radiology,,,0510,21,Inpatient Hospital,2,3691.91,2128.38,2093.38,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000001652,MBR00000059,Professional,2021-08-31,2021-08-31,2021-10-14,PLN4473,1631954542,1631954542,Oncology,In-Network,I25.10,E66.9,,,,,,,0,,99203,E&M,,,,81,Independent Laboratory,1,374.9,186.13,127.51,0.0,35.0,23.62,58.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001653,MBR00000060,Professional,2023-08-29,2023-08-29,2023-09-21,PLN4525,1108115157,1108115157,General Acute Care Hospital,In-Network,K21.0,E11.9,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,3,228.48,159.04,159.04,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001654,MBR00000060,Institutional-IP,2022-02-05,2022-02-12,2022-03-20,PLN6066,1118885473,1118885473,ASC,In-Network,I10,E11.9,,,,194,MS-DRG,21,7,Y,45378,Surgery,,,0900,21,Inpatient Hospital,3,1068.39,713.44,678.44,0.0,35.0,0.0,35.0,0.0,Adjusted,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000001655,MBR00000060,Professional,2022-08-05,2022-08-05,2022-08-17,PLN4274,1856686341,1856686341,Geriatrics,In-Network,Z12.31,J18.9,,,,,,,0,,77067,Radiology,,,,11,Office,1,429.35,280.25,280.25,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000001656,MBR00000060,Institutional-IP,2023-02-05,2023-02-12,2023-02-18,PLN1686,1168246159,1168246159,Internal Medicine,In-Network,N39.0,J06.9,,,,292,MS-DRG,16,7,Y,74177,Radiology,,,0761,21,Inpatient Hospital,3,2021.91,1092.84,1092.84,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001657,MBR00000060,Professional,2023-04-27,2023-04-27,2023-06-03,PLN8889,1198133277,1198133277,SNF,In-Network,N39.0,E66.9,,,,,,,0,,43239,Surgery,,,,81,Independent Laboratory,3,1613.3,631.8,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-18,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001658,MBR00000060,Professional,2021-01-09,2021-01-09,2021-02-15,PLN2012,1845057593,1845057593,Orthopedic Surgery,In-Network,E78.5,R07.9,,,,,,,0,,77067,Radiology,,,,81,Independent Laboratory,1,562.17,384.09,294.05,55.04,35.0,0.0,90.04,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000001659,MBR00000060,Professional,2021-11-07,2021-11-07,2021-11-14,PLN8409,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,M17.11,I10,,,,,,,0,,93000,Radiology,,,,81,Independent Laboratory,2,185.37,153.72,128.72,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001660,MBR00000061,Institutional-OP,2022-01-04,2022-01-04,2022-01-22,PLN2510,1395983630,1395983630,Nephrology,In-Network,E78.5,F32.9,,,,,,,0,,99221,E&M,,,0740,22,Outpatient Hospital,1,176.96,128.46,0.0,128.46,0.0,0.0,128.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001661,MBR00000061,Professional,2022-10-04,2022-10-04,2022-11-09,PLN5558,1364429278,1364429278,OB/GYN,In-Network,Z51.11,K57.30,,,,,,,0,,99406,Medicine,,,,22,Outpatient Hospital,1,99.19,45.27,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001662,MBR00000061,Professional,2023-08-14,2023-08-14,2023-09-22,PLN5308,1366426662,1366426662,Urology,In-Network,I48.91,N39.0,,,,,,,0,,93225,Medicine,,,,22,Outpatient Hospital,2,356.94,181.11,0.0,181.11,0.0,0.0,181.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001663,MBR00000061,Professional,2022-04-25,2022-04-25,2022-05-17,PLN7253,1840431511,1840431511,Geriatrics,Out-of-Network,J06.9,I10,,,,,,,0,,45378,Surgery,,,,11,Office,3,1003.16,596.88,263.69,253.28,50.0,29.91,333.19,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000001664,MBR00000061,Professional,2022-05-23,2022-05-23,2022-06-08,PLN7586,1563980627,1563980627,Critical Access Hospital,In-Network,K57.30,Z79.4,,,,,,,0,,78452,Radiology,,,,12,Home,2,2923.5,2351.79,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001665,MBR00000061,Institutional-IP,2021-04-07,2021-04-08,2021-05-04,PLN7357,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,F41.9,E11.9,,,,603,MS-DRG,15,1,Y,33533,Surgery,,,0900,21,Inpatient Hospital,2,26196.36,20102.31,20087.31,0.0,15.0,0.0,15.0,0.0,Adjusted,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000001666,MBR00000061,Institutional-OP,2022-07-31,2022-07-31,2022-09-05,PLN4421,1236418230,1236418230,DME Supplier,In-Network,F41.9,F32.9,,,,,,,0,,80053,Pathology/Lab,,,0510,22,Outpatient Hospital,3,110.04,48.38,13.38,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001667,MBR00000061,Institutional-IP,2022-06-18,2022-06-20,2022-07-24,PLN1788,1245650222,1245650222,Gastroenterology,In-Network,E11.65,I11.9,,,,291,MS-DRG,16,2,W,99221,E&M,,,0510,21,Inpatient Hospital,1,323.83,147.05,108.42,0.0,35.0,3.63,38.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001668,MBR00000061,Professional,2022-11-29,2022-11-29,2023-01-01,PLN1834,1108115157,1108115157,General Acute Care Hospital,In-Network,Z00.01,K57.30,,,,,,,0,,99203,E&M,,,,11,Office,2,264.38,204.2,129.2,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001669,MBR00000061,Professional,2023-07-17,2023-07-17,2023-08-22,PLN3703,1994661817,1994661817,SNF,Out-of-Network,Z00.00,N18.3,,,,,,,0,,80053,Pathology/Lab,,,,12,Home,2,109.08,74.49,0.0,74.49,0.0,0.0,74.49,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001670,MBR00000061,Institutional-IP,2022-09-14,2022-09-18,2022-10-19,PLN5128,1569105090,1569105090,Geriatrics,In-Network,I10,I10,,,,872,MS-DRG,21,4,Y,99213,E&M,,,0360,21,Inpatient Hospital,3,136.07,101.17,101.17,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001671,MBR00000061,Institutional-OP,2021-02-26,2021-02-26,2021-03-24,PLN5405,1511044648,1511044648,Endocrinology,In-Network,F10.20,M54.5,,,,,,,0,,97110,Medicine,,,0636,22,Outpatient Hospital,3,276.04,90.57,0.0,90.57,0.0,0.0,90.57,0.0,Denied,CO-15,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000001672,MBR00000061,Professional,2023-06-14,2023-06-14,2023-06-22,PLN8914,1631954542,1631954542,Oncology,In-Network,E78.5,E11.9,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,3,88.79,60.01,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000001673,MBR00000061,Institutional-OP,2022-06-07,2022-06-07,2022-07-18,PLN1081,1700633438,1700633438,DME Supplier,In-Network,Z51.11,M17.11,,,,,,,0,,82043,Pathology/Lab,,,0730,22,Outpatient Hospital,3,48.0,37.97,37.97,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001674,MBR00000061,Professional,2022-06-17,2022-06-17,2022-07-31,PLN4012,1135158374,1135158374,Pulmonology,In-Network,J06.9,N40.0,,,,,,,0,,99283,E&M,,,,23,Emergency Room,2,426.35,255.32,0.0,255.32,15.0,0.0,270.32,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001675,MBR00000061,Professional,2023-08-15,2023-08-15,2023-09-28,PLN1768,1518055405,1518055405,Urology,In-Network,I11.9,J44.1,,,,,,,0,,99222,E&M,,,,23,Emergency Room,2,656.76,470.49,399.94,70.55,0.0,0.0,70.55,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001676,MBR00000061,Professional,2022-10-08,2022-10-08,2022-10-31,PLN2157,1224179551,1224179551,Physical Therapy,In-Network,E11.9,N18.3,,,,,,,0,,85025,Pathology/Lab,,,,50,Federally Qualified Health Center,2,79.22,28.63,0.0,28.63,15.0,0.0,43.63,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001677,MBR00000061,Professional,2023-05-16,2023-05-16,2023-06-12,PLN5413,1767011137,1767011137,DME Supplier,In-Network,B97.89,Z23,,,,,,,0,,23472,Surgery,,,,23,Emergency Room,3,6410.28,4811.91,4811.91,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001678,MBR00000061,Professional,2023-08-22,2023-08-22,2023-09-04,PLN4119,1571574052,1571574052,Critical Access Hospital,In-Network,Z79.4,E78.5,,,,,,,0,,80061,Pathology/Lab,,,,22,Outpatient Hospital,1,121.85,40.1,0.0,0.0,50.0,0.0,50.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001679,MBR00000061,Professional,2022-06-25,2022-06-25,2022-07-25,PLN6074,1799205295,1799205295,General Acute Care Hospital,In-Network,I11.9,E11.40,,,,,,,0,,74177,Radiology,,,,23,Emergency Room,3,2749.73,1612.86,1465.13,47.1,0.0,100.63,147.73,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001680,MBR00000061,Professional,2023-12-12,2023-12-12,2023-12-25,PLN4399,1569105090,1569105090,Geriatrics,In-Network,I10,R05,,,,,,,0,,G0439,Medicine,,,,22,Outpatient Hospital,2,296.25,121.37,0.0,121.37,0.0,0.0,121.37,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000001681,MBR00000061,Professional,2021-07-07,2021-07-07,2021-07-28,PLN3831,1124394415,1124394415,Pediatrics,In-Network,J06.9,Z87.891,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,3,91.66,77.85,0.0,77.85,0.0,0.0,77.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001682,MBR00000061,Professional,2023-08-13,2023-08-13,2023-08-27,PLN5427,1939033455,1939033455,Pulmonology,In-Network,I10,F03.90,,,,,,,0,,78452,Radiology,,,,11,Office,3,6833.76,4427.24,4352.24,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001683,MBR00000061,Professional,2023-07-19,2023-07-19,2023-08-13,PLN7573,1812060197,1812060197,Oncology,Out-of-Network,E66.9,Z87.891,,,,,,,0,,77067,Radiology,,,,23,Emergency Room,3,807.21,684.71,0.0,117.7,0.0,0.0,117.7,0.0,Denied,PR-1,,1,,1,1,0,0,0,0,None,1,0,0,0,0
CLM0000001684,MBR00000061,Institutional-OP,2021-04-20,2021-04-20,2021-05-24,PLN3892,1540044947,1540044947,Pulmonology,Out-of-Network,E11.9,J44.1,,,,,,,0,,85025,Pathology/Lab,,,0270,22,Outpatient Hospital,3,70.93,50.54,0.0,50.54,0.0,0.0,50.54,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001685,MBR00000061,Institutional-IP,2021-06-17,2021-06-21,2021-07-16,PLN5936,1717912431,1717912431,Oncology,In-Network,F32.9,N40.0,,,,641,MS-DRG,21,4,N,45378,Surgery,,,0740,21,Inpatient Hospital,1,1128.84,640.77,535.86,0.0,75.0,29.91,104.91,0.0,Adjusted,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000001686,MBR00000061,Professional,2021-02-10,2021-02-10,2021-03-24,PLN6408,1518055405,1518055405,Urology,In-Network,I10,E11.9,,,,,,,0,,66984,Surgery,,,,21,Inpatient Hospital,1,2888.56,2313.02,2163.48,0.0,0.0,149.54,149.54,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001687,MBR00000061,Professional,2021-10-31,2021-10-31,2021-12-07,PLN9420,1236418230,1236418230,DME Supplier,In-Network,Z87.891,Z12.11,,,,,,,0,,90837,Medicine,,,,22,Outpatient Hospital,1,438.68,194.48,156.66,37.82,0.0,0.0,37.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001688,MBR00000061,Professional,2023-12-22,2023-12-22,2024-01-03,PLN5813,1691062876,1691062876,SNF,In-Network,J18.9,E78.5,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,1,23.55,19.7,0.0,0.0,35.0,0.0,35.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001689,MBR00000061,Professional,2021-05-17,2021-05-17,2021-06-05,PLN6860,1422747896,1422747896,Urology,In-Network,I10,Z00.00,,,,,,,0,,90837,Medicine,,,,21,Inpatient Hospital,1,468.18,178.99,178.99,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001690,MBR00000061,Professional,2021-02-06,2021-02-06,2021-02-20,PLN9439,1422747896,1422747896,Urology,In-Network,M17.11,I10,,,,,,,0,,71046,Radiology,,,,11,Office,2,275.17,159.74,113.92,0.0,25.0,20.82,45.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001691,MBR00000061,Professional,2022-05-18,2022-05-18,2022-06-08,PLN3664,1139906830,1139906830,Endocrinology,Out-of-Network,I10,K21.0,,,,,,,0,,45380,Surgery,,,,31,Skilled Nursing Facility,1,1352.42,1055.43,980.43,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,1,Upcoding,0,1,0,0,0
CLM0000001692,MBR00000061,Professional,2022-01-23,2022-01-23,2022-02-23,PLN5742,1728018911,1728018911,Nephrology,In-Network,Z00.01,K21.0,,,,,,,0,,G0444,Medicine,,,,11,Office,2,57.67,36.91,1.79,0.0,35.0,0.12,35.12,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000001693,MBR00000061,Institutional-IP,2022-11-20,2022-11-27,2022-11-28,PLN8730,1840431511,1840431511,Geriatrics,Out-of-Network,E87.6,N39.0,,,,683,MS-DRG,11,7,N,99204,E&M,,,0270,21,Inpatient Hospital,2,467.38,348.24,333.24,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001694,MBR00000061,Professional,2022-10-27,2022-10-27,2022-12-04,PLN1132,1728018911,1728018911,Nephrology,In-Network,E11.9,F32.9,,,,,,,0,,33533,Surgery,,,,49,Independent Clinic,1,10299.58,6420.12,6041.03,379.09,0.0,0.0,379.09,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000001695,MBR00000062,Professional,2023-06-25,2023-06-25,2023-07-03,PLN4625,1689639685,1689639685,SNF,In-Network,J06.9,J44.1,,,,,,,0,,99214,E&M,,,,23,Emergency Room,2,372.63,211.16,0.0,187.29,75.0,0.0,262.29,0.0,Denied,CO-18,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001696,MBR00000062,Professional,2022-03-31,2022-03-31,2022-05-05,PLN5372,1433937353,1433937353,Nephrology,In-Network,I25.10,E11.65,,,,,,,0,,85025,Pathology/Lab,,,,12,Home,1,63.99,47.37,0.0,47.37,50.0,0.0,97.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001697,MBR00000062,Institutional-OP,2022-05-21,2022-05-21,2022-06-04,PLN5778,1135158374,1135158374,Pulmonology,In-Network,F10.20,E11.9,,,,,,,0,,72148,Radiology,,,0450,22,Outpatient Hospital,1,2421.4,1222.1,1045.5,0.0,0.0,176.6,176.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001698,MBR00000062,Institutional-IP,2021-01-25,2021-02-06,2021-02-15,PLN3771,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,B97.89,E11.9,,,,690,MS-DRG,4,12,N,72148,Radiology,,,0370,21,Inpatient Hospital,2,2836.79,1937.03,1922.03,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001699,MBR00000062,Institutional-IP,2023-11-29,2023-12-04,2024-01-10,PLN3779,1564502315,1564502315,ASC,In-Network,E78.5,Z00.00,,,,682,MS-DRG,5,5,Y,86900,Pathology/Lab,,,0730,21,Inpatient Hospital,2,61.18,20.32,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001700,MBR00000062,Institutional-OP,2021-08-22,2021-08-22,2021-09-22,PLN8425,1514306773,1514306773,Endocrinology,In-Network,F41.9,N18.3,,,,,,,0,,82043,Pathology/Lab,,,0450,22,Outpatient Hospital,1,58.13,26.32,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001701,MBR00000062,Professional,2022-10-15,2022-10-15,2022-11-26,PLN8649,1687650653,1687650653,Internal Medicine,In-Network,I10,M54.5,,,,,,,0,,99222,E&M,,,,11,Office,1,658.34,540.03,540.03,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000001702,MBR00000062,Professional,2023-08-23,2023-08-23,2023-10-06,PLN1848,1239316214,1239316214,Internal Medicine,In-Network,J06.9,R10.9,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,3,35.19,19.05,0.0,19.05,50.0,0.0,69.05,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001703,MBR00000062,Institutional-OP,2022-10-24,2022-10-24,2022-11-21,PLN2545,1227362142,1227362142,DME Supplier,In-Network,J45.20,J06.9,,,,,,,0,,33533,Surgery,,,0370,22,Outpatient Hospital,3,28533.02,18665.8,0.0,0.0,75.0,1385.55,1460.55,0.0,Denied,CO-97,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000001704,MBR00000062,Professional,2022-11-16,2022-11-16,2022-12-07,PLN4422,1372918899,1372918899,Family Medicine,In-Network,R10.9,J20.9,,,,,,,0,,G0468,Medicine,,,,20,Urgent Care,3,482.59,180.53,105.53,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001705,MBR00000062,Institutional-IP,2021-07-11,2021-07-23,2021-08-11,PLN7691,1545347862,1545347862,SNF,In-Network,E78.5,J06.9,,,,683,MS-DRG,6,12,Y,99214,E&M,,,0450,21,Inpatient Hospital,2,435.56,137.37,134.6,0.0,0.0,2.77,2.77,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000001706,MBR00000062,Professional,2023-02-16,2023-02-16,2023-03-01,PLN3835,1514306773,1514306773,Endocrinology,In-Network,E11.9,J06.9,,,,,,,0,,99204,E&M,,,,11,Office,3,455.37,235.66,235.66,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001707,MBR00000062,Professional,2021-07-28,2021-07-28,2021-08-21,PLN9440,1438368327,1438368327,Home Health,In-Network,J20.9,M54.5,,,,,,,0,,99204,E&M,,,,49,Independent Clinic,1,505.92,203.37,102.92,0.0,75.0,25.45,100.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001708,MBR00000062,Professional,2023-01-28,2023-01-28,2023-03-10,PLN9875,1219817751,1219817751,OB/GYN,In-Network,E78.5,N18.3,,,,,,,0,,99233,E&M,,,,21,Inpatient Hospital,1,441.85,234.8,184.8,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001709,MBR00000062,Professional,2022-09-24,2022-09-24,2022-11-03,PLN3904,1891849440,1891849440,Oncology,In-Network,N40.0,M54.5,,,,,,,0,,72148,Radiology,,,,11,Office,2,2767.78,1409.25,1366.39,27.86,15.0,0.0,42.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001710,MBR00000062,Institutional-IP,2022-06-21,2022-06-26,2022-08-03,PLN1235,1366576336,1366576336,Geriatrics,In-Network,J44.1,I10,,,,195,MS-DRG,18,5,Y,83036,Pathology/Lab,,,0301,21,Inpatient Hospital,1,112.67,70.47,0.0,70.47,15.0,0.0,85.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000001711,MBR00000062,Professional,2023-03-01,2023-03-01,2023-03-14,PLN8739,1334916761,1334916761,ASC,In-Network,K21.0,I10,,,,,,,0,,66984,Surgery,,,,49,Independent Clinic,2,1667.7,1182.66,1150.94,0.0,25.0,6.72,31.72,0.0,Paid,,,0,,0,0,1,0,0,1,Duplicate,0,0,0,0,0
CLM0000001712,MBR00000062,Professional,2023-02-28,2023-02-28,2023-03-10,PLN6316,1713934949,1713934949,Neurology,In-Network,M54.5,N39.0,,,,,,,0,,85025,Pathology/Lab,,,,22,Outpatient Hospital,2,67.61,34.55,34.55,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001713,MBR00000062,Professional,2021-08-13,2021-08-13,2021-08-25,PLN5872,1132188260,1132188260,Family Medicine,In-Network,N18.3,E78.5,,,,,,,0,,72148,Radiology,,,,22,Outpatient Hospital,2,1946.38,1241.38,1130.43,0.0,50.0,60.95,110.95,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001714,MBR00000062,Institutional-OP,2022-02-16,2022-02-16,2022-03-03,PLN2047,1283743001,1283743001,Family Medicine,In-Network,G43.909,I63.9,,,,,,,0,,70450,Radiology,,,0120,22,Outpatient Hospital,3,882.95,306.7,0.0,306.7,15.0,0.0,321.7,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001715,MBR00000062,Institutional-OP,2022-06-14,2022-06-14,2022-07-05,PLN5568,1644128543,1644128543,Gastroenterology,In-Network,K21.0,Z00.00,,,,,,,0,,99221,E&M,,,0301,22,Outpatient Hospital,1,227.67,98.0,0.0,98.0,0.0,0.0,98.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001716,MBR00000062,Institutional-IP,2021-06-16,2021-06-18,2021-07-24,PLN2486,1205377316,1205377316,Orthopedic Surgery,In-Network,G43.909,E11.9,,,,291,MS-DRG,16,2,Y,90837,Medicine,,,0370,21,Inpatient Hospital,2,521.22,391.79,305.82,85.97,0.0,0.0,85.97,0.0,Pended,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000001717,MBR00000062,Professional,2022-01-26,2022-01-26,2022-02-17,PLN3855,1227362142,1227362142,DME Supplier,In-Network,K57.30,G43.909,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,1,6795.21,5040.4,4137.95,0.0,50.0,852.45,902.45,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001718,MBR00000062,Professional,2021-02-15,2021-02-15,2021-02-26,PLN5453,1727809972,1727809972,Home Health,In-Network,E11.9,M17.11,,,,,,,0,,90460,Medicine,,,,11,Office,3,46.24,20.66,20.66,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001719,MBR00000063,Professional,2022-04-26,2022-04-26,2022-05-14,PLN6553,1795618275,1795618275,Pulmonology,In-Network,I10,Z12.31,,,,,,,0,,33533,Surgery,,,,11,Office,3,14195.72,11712.17,11247.89,464.28,0.0,0.0,464.28,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000001720,MBR00000063,Professional,2021-08-14,2021-08-14,2021-08-24,PLN3131,1542828721,1542828721,Orthopedic Surgery,In-Network,Z00.00,E11.9,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,3,4359.46,3521.06,3258.2,218.65,0.0,44.21,262.86,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001721,MBR00000063,Professional,2021-09-01,2021-09-01,2021-09-17,PLN4419,1845900543,1845900543,ASC,In-Network,G43.909,E11.9,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,2,42.67,31.77,31.77,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001722,MBR00000063,Institutional-OP,2023-06-16,2023-06-16,2023-06-26,PLN2497,1227362142,1227362142,DME Supplier,In-Network,J06.9,Z12.11,,,,,,,0,,85610,Pathology/Lab,,,0740,22,Outpatient Hospital,2,69.43,31.74,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001723,MBR00000063,Professional,2021-06-04,2021-06-04,2021-06-12,PLN2936,1313212303,1313212303,Family Medicine,In-Network,F32.9,R51,,,,,,,0,,99221,E&M,,,,11,Office,1,251.8,116.58,100.12,0.0,0.0,16.46,16.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001724,MBR00000063,Professional,2021-05-13,2021-05-13,2021-06-13,PLN7521,1139906830,1139906830,Endocrinology,Out-of-Network,Z12.31,E11.40,,,,,,,0,,97110,Medicine,,,,11,Office,1,217.48,130.91,0.0,0.0,0.0,7.38,7.38,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001725,MBR00000063,Professional,2021-12-17,2021-12-17,2022-01-16,PLN3829,1935547131,1935547131,Pulmonology,In-Network,R51,I10,,,,,,,0,,99283,E&M,,,,21,Inpatient Hospital,1,601.61,262.26,261.62,0.0,0.0,0.64,0.64,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001726,MBR00000063,Professional,2021-01-26,2021-01-26,2021-03-11,PLN1511,1691062876,1691062876,SNF,In-Network,I25.10,G43.909,,,,,,,0,,99203,E&M,,,,23,Emergency Room,3,302.21,191.48,0.0,191.48,0.0,0.0,191.48,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001727,MBR00000063,Professional,2023-08-10,2023-08-10,2023-08-19,PLN3079,1840431511,1840431511,Geriatrics,Out-of-Network,I10,F32.9,,,,,,,0,,99204,E&M,,,,11,Office,2,578.11,310.91,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001728,MBR00000063,Institutional-IP,2023-12-17,2023-12-21,2023-12-26,PLN5587,1896447406,1896447406,Nephrology,Out-of-Network,E78.5,N40.0,,,,871,MS-DRG,7,4,Y,77067,Radiology,,,0320,21,Inpatient Hospital,3,319.33,163.45,128.45,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000001729,MBR00000063,Institutional-OP,2023-06-01,2023-06-01,2023-06-19,PLN2102,1845900543,1845900543,ASC,In-Network,Z23,E11.9,,,,,,,0,,70553,Radiology,,,0510,22,Outpatient Hospital,1,4590.65,3207.62,2636.6,0.0,0.0,571.02,571.02,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001730,MBR00000063,Institutional-OP,2023-05-26,2023-05-26,2023-06-22,PLN5518,1186826716,1186826716,Physical Therapy,In-Network,F03.90,Z00.00,,,,,,,0,,99406,Medicine,,,0270,22,Outpatient Hospital,2,101.58,61.23,11.23,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001731,MBR00000063,Institutional-OP,2021-04-22,2021-04-22,2021-06-02,PLN7706,1132188260,1132188260,Family Medicine,In-Network,I63.9,I10,,,,,,,0,,45380,Surgery,,,0270,22,Outpatient Hospital,1,2110.85,862.44,862.44,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000001732,MBR00000063,Professional,2022-08-31,2022-08-31,2022-09-19,PLN9831,1313212303,1313212303,Family Medicine,In-Network,Z79.4,F32.9,,,,,,,0,,84443,Pathology/Lab,,,,20,Urgent Care,1,166.93,75.72,60.72,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001733,MBR00000063,Institutional-IP,2021-04-07,2021-04-29,2021-05-15,PLN7367,1245650222,1245650222,Gastroenterology,In-Network,M54.5,E11.40,,,,194,MS-DRG,11,22,N,70450,Radiology,,,0120,21,Inpatient Hospital,3,1735.39,1144.41,893.65,94.84,35.0,120.92,250.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001734,MBR00000063,Institutional-OP,2021-11-26,2021-11-26,2021-12-10,PLN4218,1997536841,1997536841,Family Medicine,Out-of-Network,B97.89,Z00.00,,,,,,,0,,47562,Surgery,,,0730,22,Outpatient Hospital,2,6337.44,1972.22,0.0,451.91,0.0,0.0,451.91,0.0,Denied,CO-15,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001735,MBR00000063,Professional,2022-06-24,2022-06-24,2022-07-28,PLN9958,1575695214,1575695214,SNF,In-Network,Z23,I25.10,,,,,,,0,,93306,Radiology,,,,11,Office,1,2623.67,2194.82,1895.36,299.46,0.0,0.0,299.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001736,MBR00000063,Institutional-OP,2023-01-17,2023-01-17,2023-02-11,PLN9248,1266606767,1266606767,ASC,In-Network,K21.0,I10,,,,,,,0,,99203,E&M,,,0450,22,Outpatient Hospital,3,378.22,207.56,72.75,84.81,50.0,0.0,134.81,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001737,MBR00000063,Institutional-OP,2021-10-31,2021-10-31,2021-11-13,PLN9407,1213165847,1213165847,Critical Access Hospital,In-Network,F32.9,Z12.31,,,,,,,0,,83036,Pathology/Lab,,,0320,22,Outpatient Hospital,3,57.24,44.51,0.0,0.0,50.0,0.0,50.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000001738,MBR00000063,Institutional-IP,2021-10-08,2021-10-12,2021-11-13,PLN4582,1571574052,1571574052,Critical Access Hospital,In-Network,E78.5,J44.1,,,,682,MS-DRG,2,4,N,66984,Surgery,,,0320,21,Inpatient Hospital,3,2591.35,1977.43,1676.66,285.77,15.0,0.0,300.77,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001739,MBR00000063,Professional,2023-06-21,2023-06-21,2023-07-31,PLN6814,1475984649,1475984649,SNF,In-Network,I10,M54.5,,,,,,,0,,87491,Pathology/Lab,,,,31,Skilled Nursing Facility,1,246.85,168.37,0.0,168.37,0.0,0.0,168.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001740,MBR00000063,Professional,2021-09-03,2021-09-03,2021-09-20,PLN1053,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,E11.9,J18.9,,,,,,,0,,27130,Surgery,,,,20,Urgent Care,1,7347.76,5648.58,5209.4,424.18,15.0,0.0,439.18,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001741,MBR00000063,Institutional-IP,2022-06-17,2022-06-18,2022-07-31,PLN2883,1550154147,1550154147,Outpatient Clinic,In-Network,E66.9,M54.5,,,,196,MS-DRG,10,1,Y,99221,E&M,,,0120,21,Inpatient Hospital,3,414.75,166.64,166.64,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001742,MBR00000063,Institutional-OP,2021-11-11,2021-11-11,2021-11-20,PLN2048,1872613201,1872613201,Internal Medicine,In-Network,K21.0,Z12.31,,,,,,,0,,58661,Surgery,,,0730,22,Outpatient Hospital,1,1798.83,1269.62,1069.88,0.0,50.0,149.74,199.74,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001743,MBR00000063,Professional,2023-07-23,2023-07-23,2023-08-02,PLN1737,1450094833,1450094833,Outpatient Clinic,In-Network,R10.9,I50.9,,,,,,,0,,27447,Surgery,,,,11,Office,3,6297.18,3357.16,2973.23,348.93,35.0,0.0,383.93,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001744,MBR00000063,Professional,2022-08-09,2022-08-09,2022-08-26,PLN4955,1840431511,1840431511,Geriatrics,Out-of-Network,M17.11,K21.0,,,,,,,0,,27447,Surgery,,,,20,Urgent Care,1,5423.68,3911.53,3886.53,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001745,MBR00000063,Professional,2021-04-29,2021-04-29,2021-05-10,PLN1316,1896447406,1896447406,Nephrology,Out-of-Network,Z12.31,R05,,,,,,,0,,77067,Radiology,,,,22,Outpatient Hospital,2,854.06,668.48,488.17,180.31,0.0,0.0,180.31,0.0,Adjusted,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000001746,MBR00000063,Professional,2021-06-12,2021-06-12,2021-07-09,PLN3276,1219817751,1219817751,OB/GYN,In-Network,I10,G43.909,,,,,,,0,,99203,E&M,,,,11,Office,1,328.86,158.21,143.21,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001747,MBR00000063,Institutional-OP,2023-11-29,2023-11-29,2023-12-11,PLN9240,1974006077,1974006077,Orthopedic Surgery,In-Network,E11.65,Z00.00,,,,,,,0,,72148,Radiology,,,0320,22,Outpatient Hospital,3,1269.43,636.81,586.81,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001748,MBR00000063,Professional,2023-10-27,2023-10-27,2023-11-06,PLN4164,1780163051,1780163051,SNF,In-Network,E11.9,E66.9,,,,,,,0,,23472,Surgery,,,,21,Inpatient Hospital,3,6792.6,4341.67,4030.28,66.47,0.0,244.92,311.39,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001749,MBR00000063,Professional,2023-04-20,2023-04-20,2023-05-23,PLN9135,1242201429,1242201429,General Acute Care Hospital,In-Network,E11.9,N39.0,,,,,,,0,,99222,E&M,,,,11,Office,2,452.95,210.23,0.0,210.23,0.0,0.0,210.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001750,MBR00000064,Institutional-IP,2021-03-26,2021-03-27,2021-04-28,PLN9522,1645194539,1645194539,SNF,In-Network,E78.5,Z00.00,,,,292,MS-DRG,8,1,Y,78452,Radiology,,,0740,21,Inpatient Hospital,2,4053.54,2725.29,2641.26,59.03,25.0,0.0,84.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001751,MBR00000064,Professional,2023-03-13,2023-03-13,2023-04-23,PLN4455,1780163051,1780163051,SNF,In-Network,J18.9,M81.0,,,,,,,0,,27447,Surgery,,,,11,Office,1,2350.43,1073.31,1073.31,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001752,MBR00000064,Institutional-IP,2022-12-25,2022-12-28,2023-01-16,PLN2371,1213165847,1213165847,Critical Access Hospital,In-Network,J44.1,C50.912,,,,872,MS-DRG,12,3,Y,86900,Pathology/Lab,,,0730,21,Inpatient Hospital,1,29.83,16.81,15.06,0.0,0.0,1.75,1.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001753,MBR00000064,Professional,2023-10-27,2023-10-27,2023-12-03,PLN1171,1780163051,1780163051,SNF,In-Network,I10,J45.20,,,,,,,0,,80053,Pathology/Lab,,,,22,Outpatient Hospital,1,71.85,60.5,35.5,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001754,MBR00000064,Professional,2022-06-17,2022-06-17,2022-07-03,PLN9727,1622771872,1622771872,Pediatrics,In-Network,Z96.641,F41.9,,,,,,,0,,80053,Pathology/Lab,,,,22,Outpatient Hospital,3,55.29,33.94,33.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001755,MBR00000064,Institutional-OP,2022-05-30,2022-05-30,2022-06-23,PLN7897,1745114564,1745114564,Endocrinology,In-Network,I11.9,I48.91,,,,,,,0,,99232,E&M,,,0360,22,Outpatient Hospital,2,267.83,160.31,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001756,MBR00000064,Professional,2022-11-24,2022-11-24,2022-12-02,PLN8996,1780163051,1780163051,SNF,In-Network,Z79.4,Z87.891,,,,,,,0,,85025,Pathology/Lab,,,,22,Outpatient Hospital,1,45.88,27.66,0.0,27.66,25.0,0.0,52.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001757,MBR00000064,Professional,2021-06-13,2021-06-13,2021-06-22,PLN1171,1899127912,1899127912,Neurology,In-Network,I10,F32.9,,,,,,,0,,71046,Radiology,,,,23,Emergency Room,2,190.33,120.34,59.61,0.0,50.0,10.73,60.73,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001758,MBR00000064,Professional,2023-03-28,2023-03-28,2023-05-02,PLN7972,1114982472,1114982472,Orthopedic Surgery,In-Network,Z79.4,I10,,,,,,,0,,97110,Medicine,,,,49,Independent Clinic,2,245.56,147.31,0.0,147.31,35.0,0.0,182.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001759,MBR00000064,Institutional-IP,2022-06-29,2022-07-08,2022-08-12,PLN7130,1186826716,1186826716,Physical Therapy,In-Network,F32.9,E78.5,,,,291,MS-DRG,18,9,Y,93306,Radiology,,,0730,21,Inpatient Hospital,3,1520.58,704.22,489.75,164.47,50.0,0.0,214.47,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001760,MBR00000064,Professional,2021-07-25,2021-07-25,2021-08-04,PLN7693,1475984649,1475984649,SNF,In-Network,Z00.00,I10,,,,,,,0,,99221,E&M,,,,11,Office,3,246.2,113.78,31.81,0.0,75.0,6.97,81.97,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001761,MBR00000064,Professional,2023-06-12,2023-06-12,2023-07-11,PLN5805,1236418230,1236418230,DME Supplier,In-Network,K21.0,Z23,,,,,,,0,,47562,Surgery,,,,50,Federally Qualified Health Center,2,3648.84,2887.97,2837.97,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001762,MBR00000064,Professional,2021-10-17,2021-10-17,2021-10-27,PLN8471,1235381502,1235381502,Cardiology,In-Network,E11.40,I63.9,,,,,,,0,,74177,Radiology,,,,23,Emergency Room,3,2148.55,937.86,887.86,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001763,MBR00000064,Institutional-OP,2023-07-31,2023-07-31,2023-09-02,PLN9678,1390307371,1390307371,DME Supplier,In-Network,E78.5,E11.9,,,,,,,0,,90686,Medicine,,,0270,22,Outpatient Hospital,2,142.41,61.08,0.0,61.08,35.0,0.0,96.08,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000001764,MBR00000064,Institutional-IP,2021-10-26,2021-11-04,2021-12-06,PLN9762,1645194539,1645194539,SNF,In-Network,Z12.31,E66.9,,,,291,MS-DRG,22,9,Y,99213,E&M,,,0730,21,Inpatient Hospital,1,296.23,106.99,0.0,106.99,0.0,0.0,106.99,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001765,MBR00000064,Institutional-OP,2022-06-19,2022-06-19,2022-07-17,PLN6907,1696843572,1696843572,Critical Access Hospital,Out-of-Network,E11.9,Z00.00,,,,,,,0,,47562,Surgery,,,0370,22,Outpatient Hospital,2,3026.0,2204.95,1783.28,371.67,50.0,0.0,421.67,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001766,MBR00000064,Institutional-OP,2022-04-24,2022-04-24,2022-05-20,PLN4184,1186826716,1186826716,Physical Therapy,In-Network,J20.9,F41.9,,,,,,,0,,86900,Pathology/Lab,,,0370,22,Outpatient Hospital,3,46.07,28.71,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001767,MBR00000064,Institutional-OP,2023-03-13,2023-03-13,2023-04-02,PLN5156,1585582070,1585582070,Outpatient Clinic,In-Network,Z79.4,I50.9,,,,,,,0,,93306,Radiology,,,0510,22,Outpatient Hospital,3,2604.01,968.17,0.0,0.0,0.0,2.4,2.4,0.0,Denied,CO-18,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001768,MBR00000064,Professional,2021-07-23,2021-07-23,2021-08-26,PLN8023,1283743001,1283743001,Family Medicine,In-Network,I10,F03.90,,,,,,,0,,33533,Surgery,,,,65,End-Stage Renal Disease,1,15501.48,10067.78,9814.99,0.0,75.0,177.79,252.79,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000001769,MBR00000064,Professional,2021-09-28,2021-09-28,2021-10-21,PLN8268,1366426662,1366426662,Urology,In-Network,E11.9,Z00.00,,,,,,,0,,82043,Pathology/Lab,,,,22,Outpatient Hospital,3,26.45,15.04,0.0,15.04,0.0,0.0,15.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001770,MBR00000064,Institutional-OP,2021-07-30,2021-07-30,2021-08-18,PLN8926,1540044947,1540044947,Pulmonology,Out-of-Network,R51,M81.0,,,,,,,0,,99221,E&M,,,0360,22,Outpatient Hospital,2,315.9,176.86,0.0,176.86,0.0,0.0,176.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001771,MBR00000064,Institutional-OP,2021-09-10,2021-09-10,2021-10-08,PLN5335,1749494482,1749494482,Pediatrics,In-Network,N17.9,K57.30,,,,,,,0,,27447,Surgery,,,0761,22,Outpatient Hospital,3,5783.31,3021.88,2761.99,78.25,15.0,166.64,259.89,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001772,MBR00000064,Institutional-OP,2022-05-11,2022-05-11,2022-05-26,PLN2109,1624202402,1624202402,Orthopedic Surgery,In-Network,R07.9,I10,,,,,,,0,,27447,Surgery,,,0301,22,Outpatient Hospital,1,2526.97,2058.16,1707.28,0.0,0.0,350.88,350.88,0.0,Paid,,,0,,0,0,1,0,0,1,Unbundling,0,0,0,0,0
CLM0000001773,MBR00000064,Institutional-OP,2022-10-04,2022-10-04,2022-11-10,PLN3425,1800011727,1800011727,Clinical Laboratory,Out-of-Network,I10,Z00.00,,,,,,,0,,99284,E&M,,,0370,22,Outpatient Hospital,3,528.89,189.04,189.04,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001774,MBR00000064,Institutional-IP,2023-08-04,2023-08-11,2023-09-04,PLN4359,1915531927,1915531927,Critical Access Hospital,In-Network,R10.9,E11.9,,,,194,MS-DRG,11,7,Y,G0468,Medicine,,,0200,21,Inpatient Hospital,3,424.93,177.87,142.47,35.4,0.0,0.0,35.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001775,MBR00000064,Professional,2022-04-07,2022-04-07,2022-05-02,PLN1552,1717546253,1717546253,Family Medicine,In-Network,J06.9,E11.9,,,,,,,0,,90460,Medicine,,,,23,Emergency Room,1,55.66,17.75,16.67,0.0,0.0,1.08,1.08,0.0,Pended,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001776,MBR00000064,Institutional-OP,2022-03-25,2022-03-25,2022-04-24,PLN3364,1135158374,1135158374,Pulmonology,In-Network,F32.9,I10,,,,,,,0,,70553,Radiology,,,0270,22,Outpatient Hospital,1,2438.76,1995.78,1980.78,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001777,MBR00000064,Professional,2021-06-26,2021-06-26,2021-08-09,PLN2504,1273488618,1273488618,General Acute Care Hospital,In-Network,E78.5,I25.10,,,,,,,0,,27447,Surgery,,,,11,Office,3,5375.06,2334.92,2319.92,0.0,15.0,0.0,15.0,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001778,MBR00000064,Institutional-OP,2021-04-19,2021-04-19,2021-05-04,PLN1163,1198133277,1198133277,SNF,In-Network,E11.40,E11.9,,,,,,,0,,77067,Radiology,,,0740,22,Outpatient Hospital,3,555.23,184.22,184.22,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000001779,MBR00000064,Institutional-OP,2023-04-14,2023-04-14,2023-05-03,PLN6189,1475984649,1475984649,SNF,In-Network,E11.9,E11.65,,,,,,,0,,G0444,Medicine,,,0200,22,Outpatient Hospital,1,92.17,73.34,58.34,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000001780,MBR00000064,Institutional-IP,2022-11-24,2022-12-02,2022-12-29,PLN8688,1780163051,1780163051,SNF,In-Network,Z12.11,F32.9,,,,470,MS-DRG,13,8,Y,97530,Medicine,,,0320,21,Inpatient Hospital,1,256.51,212.21,177.21,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001781,MBR00000064,Professional,2022-08-06,2022-08-06,2022-08-24,PLN4894,1606140917,1606140917,ASC,In-Network,Z12.11,E78.5,,,,,,,0,,23472,Surgery,,,,23,Emergency Room,1,5108.84,3688.33,3492.46,87.95,0.0,107.92,195.87,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001782,MBR00000064,Institutional-IP,2022-05-02,2022-05-07,2022-05-31,PLN2231,1227362142,1227362142,DME Supplier,In-Network,R07.9,F03.90,,,,603,MS-DRG,16,5,Y,80053,Pathology/Lab,,,0450,21,Inpatient Hospital,2,111.82,72.95,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001783,MBR00000065,Institutional-OP,2022-07-24,2022-07-24,2022-08-25,PLN9880,1624202402,1624202402,Orthopedic Surgery,In-Network,J06.9,I25.10,,,,,,,0,,99222,E&M,,,0636,22,Outpatient Hospital,3,483.8,214.84,0.0,214.84,0.0,0.0,214.84,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000001784,MBR00000065,Professional,2023-07-16,2023-07-16,2023-07-31,PLN9320,1109850785,1109850785,ASC,Out-of-Network,M54.5,E11.9,,,,,,,0,,72148,Radiology,,,,11,Office,3,2424.33,1102.46,802.14,81.11,25.0,194.21,300.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001785,MBR00000065,Professional,2021-07-27,2021-07-27,2021-09-03,PLN6425,1284035364,1284035364,Pediatrics,In-Network,E11.9,Z12.31,,,,,,,0,,99203,E&M,,,,11,Office,1,373.42,194.12,167.94,0.0,15.0,11.18,26.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001786,MBR00000065,Institutional-IP,2022-07-01,2022-07-03,2022-07-29,PLN9777,1840431511,1840431511,Geriatrics,Out-of-Network,F41.9,N39.0,,,,196,MS-DRG,13,2,Y,86900,Pathology/Lab,,,0636,21,Inpatient Hospital,3,57.15,34.83,33.98,0.0,0.0,0.85,0.85,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000001787,MBR00000065,Institutional-OP,2021-09-22,2021-09-22,2021-10-16,PLN7591,1528335731,1528335731,Critical Access Hospital,In-Network,E11.9,J18.9,,,,,,,0,,93306,Radiology,,,0636,22,Outpatient Hospital,1,2796.67,1546.29,1119.2,221.12,0.0,205.97,427.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001788,MBR00000065,Institutional-IP,2021-04-25,2021-04-30,2021-06-07,PLN4384,1520687146,1520687146,ASC,In-Network,J44.1,M17.11,,,,690,MS-DRG,20,5,Y,99232,E&M,,,0740,21,Inpatient Hospital,1,239.89,181.78,174.88,2.51,0.0,4.39,6.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001789,MBR00000065,Institutional-IP,2023-01-29,2023-02-01,2023-02-26,PLN5026,1438368327,1438368327,Home Health,In-Network,F03.90,F10.20,,,,682,MS-DRG,10,3,Y,77067,Radiology,,,0450,21,Inpatient Hospital,1,765.31,435.16,307.79,0.0,75.0,52.37,127.37,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000001790,MBR00000065,Professional,2023-02-11,2023-02-11,2023-03-16,PLN2345,1139906830,1139906830,Endocrinology,Out-of-Network,Z00.01,I48.91,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,3,4814.8,3287.68,3237.68,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001791,MBR00000065,Professional,2023-07-22,2023-07-22,2023-07-31,PLN2280,1453283987,1453283987,Critical Access Hospital,In-Network,E78.5,F32.9,,,,,,,0,,99406,Medicine,,,,21,Inpatient Hospital,3,58.3,28.56,0.0,28.56,25.0,0.0,53.56,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001792,MBR00000065,Institutional-OP,2021-01-24,2021-01-24,2021-02-28,PLN6969,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,E78.5,E11.9,,,,,,,0,,27130,Surgery,,,0636,22,Outpatient Hospital,1,5696.57,2867.38,2736.46,55.92,75.0,0.0,130.92,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001793,MBR00000065,Professional,2021-07-14,2021-07-14,2021-07-25,PLN4501,1571574052,1571574052,Critical Access Hospital,In-Network,F32.9,E66.9,,,,,,,0,,99232,E&M,,,,12,Home,3,336.33,250.62,223.97,0.0,25.0,1.65,26.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001794,MBR00000065,Professional,2022-09-22,2022-09-22,2022-11-05,PLN9722,1545347862,1545347862,SNF,In-Network,R07.9,E78.5,,,,,,,0,,84443,Pathology/Lab,,,,23,Emergency Room,2,155.0,96.9,78.53,0.0,0.0,18.37,18.37,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001795,MBR00000065,Professional,2023-06-09,2023-06-09,2023-07-05,PLN5862,1148984206,1148984206,Psychiatry,In-Network,Z12.31,I10,,,,,,,0,,G0439,Medicine,,,,11,Office,3,499.82,279.14,0.0,279.14,0.0,0.0,279.14,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000001796,MBR00000065,Professional,2023-10-27,2023-10-27,2023-11-22,PLN5569,1550154147,1550154147,Outpatient Clinic,In-Network,Z23,K57.30,,,,,,,0,,78452,Radiology,,,,11,Office,1,4408.66,1493.53,1478.53,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001797,MBR00000065,Professional,2023-05-13,2023-05-13,2023-06-09,PLN6652,1795618275,1795618275,Pulmonology,In-Network,I10,E11.9,,,,,,,0,,97530,Medicine,,,,11,Office,1,237.32,191.39,0.0,191.39,0.0,0.0,191.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001798,MBR00000065,Institutional-OP,2023-09-18,2023-09-18,2023-10-17,PLN6033,1542828721,1542828721,Orthopedic Surgery,In-Network,I48.91,I10,,,,,,,0,,45380,Surgery,,,0740,22,Outpatient Hospital,1,1808.21,1116.63,1115.66,0.97,0.0,0.0,0.97,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000001799,MBR00000065,Professional,2023-06-12,2023-06-12,2023-07-15,PLN1040,1337791138,1337791138,Internal Medicine,Out-of-Network,M54.5,I10,,,,,,,0,,99214,E&M,,,,11,Office,1,451.65,281.29,246.29,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001800,MBR00000065,Institutional-IP,2021-12-12,2021-12-27,2022-01-10,PLN7697,1395983630,1395983630,Nephrology,In-Network,Z12.11,E11.9,,,,641,MS-DRG,5,15,Y,G0468,Medicine,,,0900,21,Inpatient Hospital,2,668.59,335.77,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001801,MBR00000065,Professional,2022-09-30,2022-09-30,2022-10-26,PLN1301,1809014947,1809014947,Urology,In-Network,E11.40,Z23,,,,,,,0,,33533,Surgery,,,,81,Independent Laboratory,1,10415.39,7250.69,7061.69,154.0,35.0,0.0,189.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000001802,MBR00000065,Institutional-OP,2022-11-27,2022-11-27,2023-01-05,PLN6067,1609138981,1609138981,Critical Access Hospital,In-Network,E87.6,J20.9,,,,,,,0,,97530,Medicine,,,0510,22,Outpatient Hospital,2,185.33,99.42,49.42,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001803,MBR00000065,Professional,2022-01-21,2022-01-21,2022-02-16,PLN5523,1660288235,1660288235,ASC,In-Network,F32.9,E11.9,,,,,,,0,,G0439,Medicine,,,,21,Inpatient Hospital,3,437.05,189.97,0.0,189.97,0.0,0.0,189.97,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000001804,MBR00000065,Professional,2023-08-28,2023-08-28,2023-09-16,PLN3628,1644128543,1644128543,Gastroenterology,In-Network,R10.9,F03.90,,,,,,,0,,45378,Surgery,,,,12,Home,2,2171.22,1413.62,1064.47,334.15,15.0,0.0,349.15,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000001805,MBR00000065,Professional,2023-04-25,2023-04-25,2023-05-29,PLN9819,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,M54.5,E78.5,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,2,72.73,46.46,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001806,MBR00000065,Institutional-OP,2022-07-20,2022-07-20,2022-08-21,PLN3763,1366426662,1366426662,Urology,In-Network,M54.5,F41.9,,,,,,,0,,81001,Pathology/Lab,,,0761,22,Outpatient Hospital,1,60.04,23.02,0.0,8.83,0.0,0.0,8.83,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001807,MBR00000065,Institutional-IP,2022-06-10,2022-06-13,2022-06-17,PLN9927,1795618275,1795618275,Pulmonology,In-Network,F41.9,G43.909,,,,682,MS-DRG,7,3,Y,45378,Surgery,,,0900,21,Inpatient Hospital,3,2189.15,1326.01,1132.57,0.0,0.0,193.44,193.44,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000001808,MBR00000065,Institutional-IP,2023-05-18,2023-05-24,2023-06-26,PLN5292,1422747896,1422747896,Urology,In-Network,G43.909,Z12.31,,,,194,MS-DRG,10,6,N,27130,Surgery,,,0510,21,Inpatient Hospital,3,5619.79,4504.01,4504.01,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001809,MBR00000065,Professional,2021-08-31,2021-08-31,2021-09-16,PLN2855,1622771872,1622771872,Pediatrics,In-Network,Z12.31,Z23,,,,,,,0,,90460,Medicine,,,,11,Office,3,61.21,31.94,31.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001810,MBR00000066,Professional,2021-08-28,2021-08-28,2021-09-27,PLN2044,1845057593,1845057593,Orthopedic Surgery,In-Network,N39.0,G43.909,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,1,2468.54,1454.53,790.72,493.72,0.0,170.09,663.81,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000001811,MBR00000066,Institutional-OP,2022-03-17,2022-03-17,2022-04-21,PLN6203,1242201429,1242201429,General Acute Care Hospital,In-Network,Z12.11,M54.5,,,,,,,0,,27447,Surgery,,,0510,22,Outpatient Hospital,3,4254.46,1711.95,1140.39,397.77,0.0,173.79,571.56,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001812,MBR00000066,Professional,2021-05-20,2021-05-20,2021-06-26,PLN8024,1242201429,1242201429,General Acute Care Hospital,In-Network,Z12.31,Z12.31,,,,,,,0,,99203,E&M,,,,11,Office,3,281.22,195.29,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001813,MBR00000066,Institutional-OP,2022-05-17,2022-05-17,2022-06-20,PLN9667,1564502315,1564502315,ASC,In-Network,Z12.31,F41.9,,,,,,,0,,45378,Surgery,,,0900,22,Outpatient Hospital,3,2287.61,947.24,947.24,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000001814,MBR00000066,Institutional-OP,2022-04-19,2022-04-19,2022-05-31,PLN6316,1767011137,1767011137,DME Supplier,In-Network,B97.89,E11.9,,,,,,,0,,58661,Surgery,,,0510,22,Outpatient Hospital,3,2443.57,1571.32,1384.88,186.44,0.0,0.0,186.44,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001815,MBR00000066,Institutional-IP,2022-07-08,2022-07-10,2022-08-07,PLN5489,1990090423,1990090423,Orthopedic Surgery,In-Network,E66.9,N17.9,,,,872,MS-DRG,11,2,Y,43239,Surgery,,,0740,21,Inpatient Hospital,3,1514.66,1167.72,653.34,347.98,75.0,91.4,514.38,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001816,MBR00000066,Professional,2022-05-21,2022-05-21,2022-06-30,PLN1477,1283743001,1283743001,Family Medicine,In-Network,Z00.00,I10,,,,,,,0,,83036,Pathology/Lab,,,,20,Urgent Care,2,104.8,58.33,47.03,0.0,0.0,11.3,11.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000001817,MBR00000066,Professional,2023-09-10,2023-09-10,2023-10-12,PLN1200,1125190055,1125190055,Nephrology,In-Network,E78.5,Z12.31,,,,,,,0,,G0444,Medicine,,,,11,Office,3,87.27,40.16,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-97,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000001818,MBR00000066,Professional,2021-10-28,2021-10-28,2021-11-22,PLN4794,1450094833,1450094833,Outpatient Clinic,In-Network,Z23,J20.9,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,3,7330.96,5654.25,5549.16,105.09,0.0,0.0,105.09,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001819,MBR00000066,Institutional-OP,2022-03-27,2022-03-27,2022-04-08,PLN2517,1624802371,1624802371,ASC,Out-of-Network,I10,E11.9,,,,,,,0,,80053,Pathology/Lab,,,0301,22,Outpatient Hospital,3,138.77,54.31,0.0,54.31,35.0,0.0,89.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001820,MBR00000066,Institutional-OP,2023-03-20,2023-03-20,2023-04-03,PLN5644,1135158374,1135158374,Pulmonology,In-Network,Z00.00,G20,,,,,,,0,,70450,Radiology,,,0360,22,Outpatient Hospital,1,827.47,397.2,17.59,378.06,0.0,1.55,379.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001821,MBR00000066,Professional,2021-11-08,2021-11-08,2021-11-16,PLN1192,1609526529,1609526529,Psychiatry,In-Network,E11.9,I10,,,,,,,0,,83036,Pathology/Lab,,,,81,Independent Laboratory,1,113.28,36.95,36.95,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000001822,MBR00000066,Institutional-OP,2022-12-20,2022-12-20,2023-01-25,PLN4672,1997536841,1997536841,Family Medicine,Out-of-Network,K21.0,F41.9,,,,,,,0,,43239,Surgery,,,0301,22,Outpatient Hospital,1,1805.14,973.68,771.63,0.0,75.0,127.05,202.05,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001823,MBR00000066,Professional,2023-11-20,2023-11-20,2024-01-02,PLN3558,1528335731,1528335731,Critical Access Hospital,In-Network,Z23,N40.0,,,,,,,0,,66984,Surgery,,,,81,Independent Laboratory,1,1674.74,570.6,296.09,274.51,0.0,0.0,274.51,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001824,MBR00000066,Professional,2022-02-16,2022-02-16,2022-03-09,PLN8553,1366286000,1366286000,SNF,In-Network,Z23,Z00.00,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,2,3569.38,1750.42,1715.42,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001825,MBR00000066,Professional,2021-09-22,2021-09-22,2021-10-15,PLN8131,1990090423,1990090423,Orthopedic Surgery,In-Network,E11.9,J45.20,,,,,,,0,,83036,Pathology/Lab,,,,22,Outpatient Hospital,3,51.79,33.78,33.03,0.0,0.0,0.75,0.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000001826,MBR00000066,Institutional-OP,2021-07-28,2021-07-28,2021-08-28,PLN5145,1266606767,1266606767,ASC,In-Network,Z12.31,C50.912,,,,,,,0,,99213,E&M,,,0370,22,Outpatient Hospital,1,322.24,213.91,213.91,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001827,MBR00000066,Professional,2021-01-13,2021-01-13,2021-02-17,PLN3032,1337791138,1337791138,Internal Medicine,Out-of-Network,I25.10,J06.9,,,,,,,0,,33533,Surgery,,,,50,Federally Qualified Health Center,2,20069.34,15815.97,12929.07,0.0,0.0,2886.9,2886.9,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000001828,MBR00000066,Professional,2021-11-08,2021-11-08,2021-11-25,PLN8316,1946680931,1946680931,Critical Access Hospital,Out-of-Network,I50.9,F41.9,,,,,,,0,,27447,Surgery,,,,65,End-Stage Renal Disease,3,4393.84,3435.87,2971.6,0.0,0.0,464.27,464.27,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001829,MBR00000066,Professional,2023-07-20,2023-07-20,2023-08-26,PLN6440,1235381502,1235381502,Cardiology,In-Network,E11.40,I10,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,1,66.63,48.45,48.45,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001830,MBR00000066,Professional,2021-10-06,2021-10-06,2021-11-19,PLN2514,1845900543,1845900543,ASC,In-Network,E11.9,M54.5,,,,,,,0,,72148,Radiology,,,,11,Office,2,1922.65,943.0,876.2,0.0,0.0,66.8,66.8,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001831,MBR00000066,Professional,2023-11-12,2023-11-12,2023-12-03,PLN6456,1964402759,1964402759,Outpatient Clinic,In-Network,I10,Z23,,,,,,,0,,45380,Surgery,,,,11,Office,2,2837.86,901.77,889.23,12.54,0.0,0.0,12.54,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000001832,MBR00000066,Professional,2023-11-10,2023-11-10,2023-11-23,PLN4282,1964402759,1964402759,Outpatient Clinic,In-Network,Z87.891,Z23,,,,,,,0,,99204,E&M,,,,11,Office,2,523.99,280.7,102.25,178.45,0.0,0.0,178.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001833,MBR00000066,Institutional-OP,2023-01-17,2023-01-17,2023-02-18,PLN1478,1622771872,1622771872,Pediatrics,In-Network,J06.9,C50.912,,,,,,,0,,99222,E&M,,,0360,22,Outpatient Hospital,3,572.13,305.73,250.68,0.0,25.0,30.05,55.05,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001834,MBR00000066,Institutional-OP,2023-12-11,2023-12-11,2023-12-21,PLN4918,1390307371,1390307371,DME Supplier,In-Network,F32.9,M81.0,,,,,,,0,,45380,Surgery,,,0370,22,Outpatient Hospital,1,2527.16,878.69,633.4,170.29,75.0,0.0,245.29,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000001835,MBR00000066,Professional,2022-03-23,2022-03-23,2022-04-18,PLN9800,1806688928,1806688928,Geriatrics,In-Network,Z87.891,M54.5,,,,,,,0,,99284,E&M,,,,65,End-Stage Renal Disease,1,800.11,245.44,0.0,245.44,35.0,0.0,280.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001836,MBR00000066,Institutional-OP,2023-11-14,2023-11-14,2023-12-22,PLN4440,1531398223,1531398223,OB/GYN,In-Network,E78.5,I10,,,,,,,0,,99233,E&M,,,0360,22,Outpatient Hospital,3,515.68,285.53,0.0,285.53,0.0,0.0,285.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001837,MBR00000066,Institutional-OP,2022-08-19,2022-08-19,2022-09-28,PLN5747,1364429278,1364429278,OB/GYN,In-Network,M54.5,Z00.00,,,,,,,0,,G0444,Medicine,,,0510,22,Outpatient Hospital,1,81.26,64.85,64.85,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000001838,MBR00000066,Institutional-OP,2021-03-30,2021-03-30,2021-04-22,PLN9450,1939033455,1939033455,Pulmonology,In-Network,E78.5,Z00.01,,,,,,,0,,99221,E&M,,,0740,22,Outpatient Hospital,1,200.05,119.93,119.93,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001839,MBR00000066,Professional,2023-07-01,2023-07-01,2023-07-24,PLN3828,1727809972,1727809972,Home Health,In-Network,E78.5,Z12.31,,,,,,,0,,80061,Pathology/Lab,,,,50,Federally Qualified Health Center,1,92.84,43.65,0.0,43.65,0.0,0.0,43.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001840,MBR00000066,Institutional-OP,2023-11-07,2023-11-07,2023-12-12,PLN8907,1242201429,1242201429,General Acute Care Hospital,In-Network,Z00.00,K21.0,,,,,,,0,,93000,Radiology,,,0370,22,Outpatient Hospital,1,72.52,35.99,0.0,35.99,0.0,0.0,35.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001841,MBR00000066,Institutional-IP,2023-08-28,2023-09-06,2023-09-21,PLN9402,1624802371,1624802371,ASC,Out-of-Network,I10,Z12.31,,,,291,MS-DRG,7,9,N,99283,E&M,,,0320,21,Inpatient Hospital,3,505.4,418.62,249.18,169.44,0.0,0.0,169.44,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001842,MBR00000066,Professional,2022-04-02,2022-04-02,2022-04-09,PLN2779,1780163051,1780163051,SNF,In-Network,N18.3,Z79.4,,,,,,,0,,99232,E&M,,,,31,Skilled Nursing Facility,3,381.12,323.01,0.0,185.64,0.0,1.84,187.48,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001843,MBR00000066,Institutional-OP,2021-04-23,2021-04-23,2021-05-29,PLN3242,1511044648,1511044648,Endocrinology,In-Network,Z00.00,M54.5,,,,,,,0,,99233,E&M,,,0360,22,Outpatient Hospital,2,391.22,323.64,0.0,323.64,50.0,0.0,373.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001844,MBR00000066,Professional,2022-10-04,2022-10-04,2022-10-25,PLN1930,1700633438,1700633438,DME Supplier,In-Network,Z23,J06.9,,,,,,,0,,99221,E&M,,,,11,Office,3,249.0,204.79,204.79,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001845,MBR00000066,Institutional-OP,2023-08-09,2023-08-09,2023-08-16,PLN3940,1486164553,1486164553,DME Supplier,In-Network,E78.5,Z00.00,,,,,,,0,,90686,Medicine,,,0450,22,Outpatient Hospital,3,90.76,58.08,23.08,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000001846,MBR00000066,Institutional-IP,2023-07-10,2023-07-11,2023-08-12,PLN8267,1366576336,1366576336,Geriatrics,In-Network,E78.5,Z12.11,,,,195,MS-DRG,4,1,Y,G0468,Medicine,,,0270,21,Inpatient Hospital,3,653.84,330.23,93.03,212.2,25.0,0.0,237.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001847,MBR00000066,Professional,2022-11-07,2022-11-07,2022-12-05,PLN4912,1502838586,1502838586,ASC,In-Network,Z00.00,F41.9,,,,,,,0,,93225,Medicine,,,,12,Home,3,690.75,284.54,246.53,3.01,35.0,0.0,38.01,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001848,MBR00000066,Professional,2023-05-12,2023-05-12,2023-06-12,PLN1487,1780163051,1780163051,SNF,In-Network,I63.9,I10,,,,,,,0,,27447,Surgery,,,,23,Emergency Room,2,5771.56,4600.88,4600.88,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001849,MBR00000067,Institutional-OP,2021-02-05,2021-02-05,2021-03-13,PLN6042,1964402759,1964402759,Outpatient Clinic,In-Network,Z12.31,I10,,,,,,,0,,99214,E&M,,,0450,22,Outpatient Hospital,2,396.7,233.78,195.41,0.0,0.0,38.37,38.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001850,MBR00000067,Professional,2022-11-14,2022-11-14,2022-12-05,PLN4801,1438368327,1438368327,Home Health,In-Network,I63.9,M17.11,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,2,57.35,39.76,0.0,39.76,0.0,0.0,39.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001851,MBR00000067,Institutional-OP,2021-04-29,2021-04-29,2021-05-13,PLN1423,1518055405,1518055405,Urology,In-Network,N20.0,E11.9,,,,,,,0,,99232,E&M,,,0200,22,Outpatient Hospital,2,311.52,169.92,169.92,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000001852,MBR00000067,Institutional-IP,2023-04-01,2023-04-12,2023-05-13,PLN4789,1135158374,1135158374,Pulmonology,In-Network,I10,F32.9,,,,683,MS-DRG,1,11,Y,99233,E&M,,,0740,21,Inpatient Hospital,3,290.58,93.22,84.78,0.0,0.0,8.44,8.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001853,MBR00000067,Professional,2021-02-19,2021-02-19,2021-03-08,PLN9613,1364429278,1364429278,OB/GYN,In-Network,Z12.31,I10,,,,,,,0,,27447,Surgery,,,,11,Office,3,2996.93,2108.33,2018.69,74.64,15.0,0.0,89.64,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001854,MBR00000067,Professional,2022-10-14,2022-10-14,2022-11-21,PLN4919,1800011727,1800011727,Clinical Laboratory,Out-of-Network,I10,M54.5,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,3,156.77,111.04,0.0,0.0,50.0,9.7,59.7,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001855,MBR00000067,Institutional-OP,2023-11-05,2023-11-05,2023-11-24,PLN6946,1545347862,1545347862,SNF,In-Network,S72.001A,C50.912,,,,,,,0,,99232,E&M,,,0270,22,Outpatient Hospital,1,202.13,156.73,110.85,0.0,25.0,20.88,45.88,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001856,MBR00000067,Institutional-OP,2021-05-03,2021-05-03,2021-05-17,PLN4888,1800011727,1800011727,Clinical Laboratory,Out-of-Network,I11.9,Z00.00,,,,,,,0,,58661,Surgery,,,0370,22,Outpatient Hospital,1,4244.43,3341.63,3341.63,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001857,MBR00000067,Professional,2022-04-13,2022-04-13,2022-05-24,PLN7050,1745114564,1745114564,Endocrinology,In-Network,I25.10,E11.9,,,,,,,0,,77067,Radiology,,,,22,Outpatient Hospital,3,350.92,139.37,114.37,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000001858,MBR00000067,Professional,2021-02-14,2021-02-14,2021-03-22,PLN7756,1389336600,1389336600,Critical Access Hospital,In-Network,B97.89,R51,,,,,,,0,,72148,Radiology,,,,23,Emergency Room,1,2301.71,1854.75,1431.92,397.83,25.0,0.0,422.83,0.0,Paid,,,1,,1,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000001859,MBR00000067,Professional,2023-02-23,2023-02-23,2023-04-01,PLN4652,1108115157,1108115157,General Acute Care Hospital,In-Network,C50.912,K21.0,,,,,,,0,,99203,E&M,,,,81,Independent Laboratory,1,233.49,185.77,0.0,0.0,0.0,8.58,8.58,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001860,MBR00000067,Institutional-OP,2023-10-11,2023-10-11,2023-10-21,PLN7772,1556140803,1556140803,Cardiology,In-Network,J20.9,N17.9,,,,,,,0,,99221,E&M,,,0320,22,Outpatient Hospital,2,450.47,285.58,0.0,41.48,50.0,20.25,111.73,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001861,MBR00000067,Professional,2021-01-02,2021-01-02,2021-01-23,PLN7679,1713934949,1713934949,Neurology,In-Network,R07.9,Z00.00,,,,,,,0,,99232,E&M,,,,81,Independent Laboratory,3,295.47,97.58,72.58,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001862,MBR00000067,Professional,2022-08-21,2022-08-21,2022-09-27,PLN7423,1728018911,1728018911,Nephrology,In-Network,F41.9,E87.6,,,,,,,0,,45378,Surgery,,,,31,Skilled Nursing Facility,2,2260.43,1870.46,1753.74,116.72,0.0,0.0,116.72,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000001863,MBR00000067,Professional,2023-05-19,2023-05-19,2023-06-09,PLN3119,1355166277,1355166277,Endocrinology,In-Network,E78.5,I48.91,,,,,,,0,,85025,Pathology/Lab,,,,49,Independent Clinic,1,84.69,58.63,27.47,0.0,25.0,6.16,31.16,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001864,MBR00000067,Institutional-OP,2021-01-28,2021-01-28,2021-02-09,PLN6246,1845900543,1845900543,ASC,In-Network,E11.65,I10,,,,,,,0,,99204,E&M,,,0740,22,Outpatient Hospital,1,377.82,137.99,0.0,137.99,75.0,0.0,212.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001865,MBR00000067,Professional,2022-06-12,2022-06-12,2022-07-10,PLN1020,1997536841,1997536841,Family Medicine,Out-of-Network,J18.9,E78.5,,,,,,,0,,99222,E&M,,,,11,Office,3,259.5,189.37,139.37,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001866,MBR00000067,Institutional-OP,2021-05-22,2021-05-22,2021-06-07,PLN7317,1865904917,1865904917,Outpatient Clinic,In-Network,J06.9,M54.5,,,,,,,0,,85610,Pathology/Lab,,,0761,22,Outpatient Hospital,3,32.51,18.87,0.0,18.87,0.0,0.0,18.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001867,MBR00000067,Professional,2023-10-09,2023-10-09,2023-11-22,PLN3971,1571574052,1571574052,Critical Access Hospital,In-Network,F41.9,F03.90,,,,,,,0,,43239,Surgery,,,,11,Office,2,1426.9,1121.91,721.23,375.68,25.0,0.0,400.68,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001868,MBR00000067,Institutional-IP,2022-07-12,2022-07-14,2022-08-20,PLN5105,1139906830,1139906830,Endocrinology,Out-of-Network,E11.9,K21.0,,,,291,MS-DRG,20,2,Y,43239,Surgery,,,0636,21,Inpatient Hospital,1,1745.18,671.34,312.01,311.09,0.0,48.24,359.33,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001869,MBR00000067,Institutional-IP,2022-07-25,2022-07-30,2022-08-30,PLN9468,1531398223,1531398223,OB/GYN,In-Network,I10,I50.9,,,,690,MS-DRG,24,5,Y,99222,E&M,,,0900,21,Inpatient Hospital,3,462.95,269.59,233.88,0.0,0.0,35.71,35.71,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000001870,MBR00000067,Institutional-OP,2023-12-28,2023-12-28,2024-01-18,PLN7166,1422747896,1422747896,Urology,In-Network,J06.9,R07.9,,,,,,,0,,99213,E&M,,,0900,22,Outpatient Hospital,1,281.37,220.5,198.31,22.19,0.0,0.0,22.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001871,MBR00000067,Institutional-OP,2023-05-14,2023-05-14,2023-05-24,PLN4078,1964402759,1964402759,Outpatient Clinic,In-Network,F41.9,Z23,,,,,,,0,,45380,Surgery,,,0360,22,Outpatient Hospital,3,2892.1,1886.58,0.0,0.0,0.0,87.34,87.34,0.0,Denied,CO-4,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000001872,MBR00000067,Professional,2021-12-10,2021-12-10,2022-01-07,PLN2890,1994661817,1994661817,SNF,Out-of-Network,I10,Z12.31,,,,,,,0,,G0439,Medicine,,,,20,Urgent Care,2,316.26,163.54,138.54,0.0,25.0,0.0,25.0,0.0,Pended,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000001873,MBR00000067,Professional,2022-11-21,2022-11-21,2022-12-15,PLN5008,1540044947,1540044947,Pulmonology,Out-of-Network,I10,E78.5,,,,,,,0,,78452,Radiology,,,,22,Outpatient Hospital,1,4250.68,1876.7,1513.01,60.78,35.0,267.91,363.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001874,MBR00000068,Professional,2021-11-22,2021-11-22,2021-12-23,PLN7303,1114982472,1114982472,Orthopedic Surgery,In-Network,I10,R10.9,,,,,,,0,,99221,E&M,,,,21,Inpatient Hospital,2,246.28,172.7,157.7,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001875,MBR00000068,Professional,2022-07-24,2022-07-24,2022-08-31,PLN6220,1273488618,1273488618,General Acute Care Hospital,In-Network,I63.9,M17.11,,,,,,,0,,83036,Pathology/Lab,,,,49,Independent Clinic,1,55.58,28.69,0.0,28.69,0.0,0.0,28.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000001876,MBR00000068,Institutional-OP,2023-06-09,2023-06-09,2023-07-15,PLN2814,1991459367,1991459367,Neurology,Out-of-Network,G43.909,Z00.00,,,,,,,0,,G0468,Medicine,,,0120,22,Outpatient Hospital,2,531.89,353.09,236.51,81.58,35.0,0.0,116.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001877,MBR00000068,Professional,2023-11-05,2023-11-05,2023-11-12,PLN9153,1530904931,1530904931,Internal Medicine,In-Network,I10,E11.40,,,,,,,0,,99204,E&M,,,,11,Office,1,259.7,135.17,135.17,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001878,MBR00000068,Institutional-OP,2023-11-08,2023-11-08,2023-12-06,PLN7581,1528335731,1528335731,Critical Access Hospital,In-Network,K21.0,N39.0,,,,,,,0,,45380,Surgery,,,0301,22,Outpatient Hospital,2,1153.21,652.16,652.16,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000001879,MBR00000068,Professional,2022-06-27,2022-06-27,2022-08-02,PLN4717,1545347862,1545347862,SNF,In-Network,F41.9,M54.5,,,,,,,0,,58661,Surgery,,,,20,Urgent Care,1,1889.86,674.63,599.67,0.0,0.0,74.96,74.96,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001880,MBR00000068,Institutional-OP,2023-09-08,2023-09-08,2023-10-22,PLN8122,1114982472,1114982472,Orthopedic Surgery,In-Network,J20.9,F41.9,,,,,,,0,,71046,Radiology,,,0301,22,Outpatient Hospital,1,278.44,216.44,0.0,216.44,0.0,0.0,216.44,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001881,MBR00000068,Institutional-OP,2023-09-05,2023-09-05,2023-09-29,PLN1327,1569105090,1569105090,Geriatrics,In-Network,E66.9,N39.0,,,,,,,0,,99213,E&M,,,0730,22,Outpatient Hospital,3,239.82,174.08,124.08,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001882,MBR00000068,Institutional-IP,2022-08-22,2022-08-28,2022-09-30,PLN2839,1125190055,1125190055,Nephrology,In-Network,F41.9,R07.9,,,,196,MS-DRG,18,6,Y,99214,E&M,,,0270,21,Inpatient Hospital,1,456.49,381.04,0.0,381.04,0.0,0.0,381.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001883,MBR00000069,Professional,2021-02-09,2021-02-09,2021-02-25,PLN7894,1124394415,1124394415,Pediatrics,In-Network,Z23,M54.5,,,,,,,0,,93000,Radiology,,,,22,Outpatient Hospital,3,182.96,110.03,0.0,0.0,0.0,15.1,15.1,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001884,MBR00000069,Institutional-OP,2021-05-11,2021-05-11,2021-06-22,PLN3971,1713934949,1713934949,Neurology,In-Network,I48.91,K21.0,,,,,,,0,,47562,Surgery,,,0510,22,Outpatient Hospital,3,5464.24,3855.09,3855.09,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001885,MBR00000069,Institutional-OP,2022-12-21,2022-12-21,2023-01-07,PLN6736,1847081578,1847081578,Urology,Out-of-Network,I10,I10,,,,,,,0,,77067,Radiology,,,0740,22,Outpatient Hospital,1,795.31,283.15,0.0,0.0,0.0,50.85,50.85,0.0,Denied,PR-1,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000001886,MBR00000069,Professional,2023-06-29,2023-06-29,2023-08-07,PLN3056,1453283987,1453283987,Critical Access Hospital,In-Network,R51,E78.5,,,,,,,0,,84443,Pathology/Lab,,,,22,Outpatient Hospital,1,80.05,39.23,0.0,39.23,0.0,0.0,39.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001887,MBR00000069,Institutional-OP,2023-09-26,2023-09-26,2023-10-24,PLN7223,1752470395,1752470395,Home Health,In-Network,R10.9,R51,,,,,,,0,,85610,Pathology/Lab,,,0740,22,Outpatient Hospital,2,67.24,27.52,11.73,0.0,15.0,0.79,15.79,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001888,MBR00000069,Institutional-OP,2021-09-24,2021-09-24,2021-10-26,PLN1063,1132188260,1132188260,Family Medicine,In-Network,J06.9,C50.912,,,,,,,0,,85025,Pathology/Lab,,,0636,22,Outpatient Hospital,2,76.74,33.17,33.17,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001889,MBR00000070,Professional,2023-09-12,2023-09-12,2023-09-30,PLN1079,1355166277,1355166277,Endocrinology,In-Network,I48.91,R51,,,,,,,0,,93225,Medicine,,,,20,Urgent Care,2,907.54,357.59,290.82,0.0,0.0,66.77,66.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001890,MBR00000070,Professional,2023-06-25,2023-06-25,2023-07-17,PLN6732,1520687146,1520687146,ASC,In-Network,R51,I10,,,,,,,0,,93306,Radiology,,,,11,Office,1,1750.55,902.07,887.07,0.0,15.0,0.0,15.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001891,MBR00000070,Professional,2022-06-16,2022-06-16,2022-07-16,PLN1216,1337791138,1337791138,Internal Medicine,Out-of-Network,R07.9,F41.9,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,3,152.69,70.14,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001892,MBR00000070,Professional,2022-02-14,2022-02-14,2022-03-24,PLN5834,1239316214,1239316214,Internal Medicine,In-Network,I10,F32.9,,,,,,,0,,G0439,Medicine,,,,50,Federally Qualified Health Center,3,246.18,139.75,0.0,139.67,50.0,0.0,189.67,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000001893,MBR00000070,Institutional-OP,2022-06-01,2022-06-01,2022-07-14,PLN8060,1245650222,1245650222,Gastroenterology,In-Network,I10,Z12.31,,,,,,,0,,47562,Surgery,,,0370,22,Outpatient Hospital,1,5496.36,4301.81,3834.26,411.63,15.0,40.92,467.55,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001894,MBR00000070,Institutional-OP,2023-01-10,2023-01-10,2023-02-22,PLN6257,1860435061,1860435061,DME Supplier,In-Network,F41.9,F32.9,,,,,,,0,,99203,E&M,,,0370,22,Outpatient Hospital,3,188.32,69.74,49.83,0.0,15.0,4.91,19.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001895,MBR00000070,Professional,2023-06-07,2023-06-07,2023-07-01,PLN4836,1103747954,1103747954,Urology,In-Network,N39.0,M54.5,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,2,128.88,54.99,0.0,54.99,0.0,0.0,54.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001896,MBR00000070,Institutional-IP,2021-07-07,2021-07-09,2021-07-25,PLN5781,1186826716,1186826716,Physical Therapy,In-Network,J06.9,Z00.00,,,,196,MS-DRG,16,2,Y,99221,E&M,,,0360,21,Inpatient Hospital,2,450.4,306.43,270.43,0.0,0.0,36.0,36.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001897,MBR00000070,Professional,2022-01-02,2022-01-02,2022-01-31,PLN7001,1193493783,1193493783,Critical Access Hospital,Out-of-Network,Z12.31,I10,,,,,,,0,,45378,Surgery,,,,12,Home,3,1612.47,624.29,167.31,383.59,35.0,38.39,456.98,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000001898,MBR00000070,Professional,2021-05-12,2021-05-12,2021-06-01,PLN5902,1856686341,1856686341,Geriatrics,In-Network,E78.5,F41.9,,,,,,,0,,87491,Pathology/Lab,,,,20,Urgent Care,1,249.46,118.61,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001899,MBR00000070,Institutional-OP,2023-10-24,2023-10-24,2023-12-07,PLN4430,1767011137,1767011137,DME Supplier,In-Network,Z23,I10,,,,,,,0,,99232,E&M,,,0200,22,Outpatient Hospital,1,204.79,96.53,0.0,67.32,50.0,0.0,117.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001900,MBR00000070,Institutional-IP,2022-03-22,2022-03-25,2022-05-01,PLN7295,1236418230,1236418230,DME Supplier,In-Network,E78.5,E78.5,,,,603,MS-DRG,24,3,U,99203,E&M,,,0320,21,Inpatient Hospital,2,301.2,251.3,0.0,251.3,25.0,0.0,276.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001901,MBR00000070,Professional,2021-10-02,2021-10-02,2021-10-20,PLN8397,1622771872,1622771872,Pediatrics,In-Network,E11.9,N20.0,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,2,143.8,73.22,73.22,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001902,MBR00000070,Professional,2021-08-11,2021-08-11,2021-09-08,PLN6323,1799205295,1799205295,General Acute Care Hospital,In-Network,E78.5,E78.5,,,,,,,0,,23472,Surgery,,,,81,Independent Laboratory,3,6841.04,5551.7,5551.7,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001903,MBR00000070,Institutional-OP,2021-03-23,2021-03-23,2021-05-04,PLN9211,1550154147,1550154147,Outpatient Clinic,In-Network,I25.10,J20.9,,,,,,,0,,45380,Surgery,,,0320,22,Outpatient Hospital,3,1790.89,807.64,792.64,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000001904,MBR00000070,Professional,2022-06-01,2022-06-01,2022-06-24,PLN3320,1795618275,1795618275,Pulmonology,In-Network,M54.5,E78.5,,,,,,,0,,99283,E&M,,,,11,Office,1,306.42,114.71,39.71,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001905,MBR00000070,Professional,2023-04-26,2023-04-26,2023-06-01,PLN6900,1520687146,1520687146,ASC,In-Network,E11.9,I10,,,,,,,0,,66984,Surgery,,,,11,Office,1,1970.87,1228.12,1128.22,0.0,0.0,99.9,99.9,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001906,MBR00000070,Institutional-OP,2021-12-20,2021-12-20,2022-01-27,PLN9461,1691062876,1691062876,SNF,In-Network,M54.5,F10.20,,,,,,,0,,81001,Pathology/Lab,,,0730,22,Outpatient Hospital,2,21.81,16.2,16.2,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001907,MBR00000070,Institutional-OP,2022-03-20,2022-03-20,2022-04-01,PLN2108,1564502315,1564502315,ASC,In-Network,E11.9,I50.9,,,,,,,0,,90837,Medicine,,,0360,22,Outpatient Hospital,2,296.48,187.74,0.0,187.74,0.0,0.0,187.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001908,MBR00000070,Institutional-IP,2022-11-28,2022-12-01,2022-12-25,PLN2089,1266606767,1266606767,ASC,In-Network,Z12.31,E78.5,,,,683,MS-DRG,4,3,U,23472,Surgery,,,0200,21,Inpatient Hospital,1,6294.17,2918.88,2731.87,0.0,15.0,172.01,187.01,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001909,MBR00000071,Professional,2022-01-25,2022-01-25,2022-02-10,PLN5272,1132188260,1132188260,Family Medicine,In-Network,J44.1,I10,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,2,3166.18,2373.58,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-15,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001910,MBR00000071,Institutional-IP,2023-03-21,2023-03-27,2023-04-12,PLN6611,1806688928,1806688928,Geriatrics,In-Network,J44.1,I50.9,,,,292,MS-DRG,7,6,Y,72148,Radiology,,,0510,21,Inpatient Hospital,3,1293.84,989.51,900.72,63.79,25.0,0.0,88.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001911,MBR00000071,Institutional-IP,2021-12-18,2021-12-19,2022-01-12,PLN8606,1434029575,1434029575,Endocrinology,In-Network,Z23,J06.9,,,,690,MS-DRG,6,1,U,99204,E&M,,,0510,21,Inpatient Hospital,3,334.66,187.01,147.1,0.0,25.0,14.91,39.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001912,MBR00000071,Professional,2022-05-04,2022-05-04,2022-06-06,PLN7614,1109850785,1109850785,ASC,Out-of-Network,Z12.11,F41.9,,,,,,,0,,87491,Pathology/Lab,,,,23,Emergency Room,3,134.9,108.6,0.0,83.68,25.0,0.0,108.68,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001913,MBR00000071,Professional,2023-12-10,2023-12-10,2024-01-03,PLN7593,1486164553,1486164553,DME Supplier,In-Network,Z79.4,E11.9,,,,,,,0,,G0439,Medicine,,,,23,Emergency Room,1,472.77,381.75,317.45,0.0,0.0,64.3,64.3,0.0,Paid,,,0,,1,1,0,0,0,0,None,0,0,0,1,0
CLM0000001914,MBR00000071,Professional,2023-07-05,2023-07-05,2023-07-19,PLN2357,1622771872,1622771872,Pediatrics,In-Network,R05,E78.5,,,,,,,0,,99284,E&M,,,,11,Office,2,365.91,239.5,36.12,188.38,15.0,0.0,203.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001915,MBR00000071,Professional,2022-09-18,2022-09-18,2022-10-08,PLN5060,1235381502,1235381502,Cardiology,In-Network,F41.9,R07.9,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,3,2564.81,1116.78,1092.1,0.0,0.0,24.68,24.68,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000001916,MBR00000071,Institutional-OP,2022-03-06,2022-03-06,2022-03-24,PLN6870,1242201429,1242201429,General Acute Care Hospital,In-Network,F32.9,Z23,,,,,,,0,,99232,E&M,,,0270,22,Outpatient Hospital,2,173.98,127.04,0.0,127.04,50.0,0.0,177.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001917,MBR00000071,Institutional-OP,2023-12-23,2023-12-23,2024-01-15,PLN3922,1563980627,1563980627,Critical Access Hospital,In-Network,G43.909,M54.5,,,,,,,0,,99233,E&M,,,0270,22,Outpatient Hospital,3,566.19,443.77,287.89,155.88,0.0,0.0,155.88,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001918,MBR00000071,Professional,2022-05-22,2022-05-22,2022-06-22,PLN2978,1266606767,1266606767,ASC,In-Network,I25.10,F32.9,,,,,,,0,,70553,Radiology,,,,23,Emergency Room,2,4029.08,1926.56,1879.14,0.0,35.0,12.42,47.42,0.0,Pended,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001919,MBR00000072,Professional,2022-01-12,2022-01-12,2022-02-07,PLN4431,1856686341,1856686341,Geriatrics,In-Network,K21.0,Z23,,,,,,,0,,99232,E&M,,,,23,Emergency Room,2,232.57,86.91,36.91,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001920,MBR00000072,Professional,2022-10-15,2022-10-15,2022-11-07,PLN4653,1502838586,1502838586,ASC,In-Network,E78.5,I11.9,,,,,,,0,,99204,E&M,,,,11,Office,2,278.66,151.54,0.0,151.54,0.0,0.0,151.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001921,MBR00000072,Professional,2022-03-30,2022-03-30,2022-04-28,PLN8778,1624802371,1624802371,ASC,Out-of-Network,I10,I10,,,,,,,0,,23472,Surgery,,,,11,Office,1,5876.25,3617.48,3151.45,466.03,0.0,0.0,466.03,0.0,Paid,,,0,,0,0,1,0,0,1,Duplicate,0,0,0,0,0
CLM0000001922,MBR00000072,Professional,2023-09-01,2023-09-01,2023-09-10,PLN5275,1450094833,1450094833,Outpatient Clinic,In-Network,F10.20,I10,,,,,,,0,,70450,Radiology,,,,21,Inpatient Hospital,3,1775.28,1008.87,619.79,0.0,35.0,142.49,177.49,211.59,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001923,MBR00000072,Institutional-OP,2021-08-20,2021-08-20,2021-09-29,PLN5901,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,M54.5,J44.1,,,,,,,0,,99233,E&M,,,0360,22,Outpatient Hospital,1,387.61,327.98,302.98,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001924,MBR00000072,Institutional-OP,2021-02-24,2021-02-24,2021-03-09,PLN6864,1691062876,1691062876,SNF,In-Network,N18.3,N18.3,,,,,,,0,,45380,Surgery,,,0450,22,Outpatient Hospital,1,2101.75,1573.9,1121.58,390.06,15.0,0.0,405.06,47.26,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000001925,MBR00000072,Institutional-OP,2022-04-17,2022-04-17,2022-05-20,PLN3090,1453283987,1453283987,Critical Access Hospital,In-Network,M54.5,Z23,,,,,,,0,,85025,Pathology/Lab,,,0730,22,Outpatient Hospital,2,56.23,46.8,0.0,46.8,25.0,0.0,71.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001926,MBR00000072,Professional,2023-11-05,2023-11-05,2023-11-13,PLN1675,1799205295,1799205295,General Acute Care Hospital,In-Network,F41.9,Z12.31,,,,,,,0,,99233,E&M,,,,11,Office,3,425.28,170.29,145.29,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001927,MBR00000072,Institutional-OP,2021-03-09,2021-03-09,2021-04-05,PLN6752,1935547131,1935547131,Pulmonology,In-Network,J44.1,I10,,,,,,,0,,99214,E&M,,,0270,22,Outpatient Hospital,1,464.32,199.83,174.83,0.0,25.0,0.0,25.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001928,MBR00000072,Institutional-OP,2023-06-04,2023-06-04,2023-07-09,PLN6115,1361302520,1361302520,Critical Access Hospital,In-Network,J20.9,E11.9,,,,,,,0,,27447,Surgery,,,0761,22,Outpatient Hospital,2,4025.18,1246.98,1052.58,81.65,0.0,112.75,194.4,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001929,MBR00000072,Professional,2021-01-01,2021-01-01,2021-02-09,PLN5248,1845900543,1845900543,ASC,In-Network,I10,E78.5,,,,,,,0,,99284,E&M,,,,11,Office,3,373.66,268.93,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001930,MBR00000072,Professional,2022-09-03,2022-09-03,2022-10-05,PLN3994,1244186984,1244186984,Family Medicine,Out-of-Network,E11.9,J20.9,,,,,,,0,,G0444,Medicine,,,,21,Inpatient Hospital,1,71.04,48.82,23.82,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000001931,MBR00000072,Professional,2022-05-12,2022-05-12,2022-06-20,PLN2675,1550154147,1550154147,Outpatient Clinic,In-Network,I10,N18.3,,,,,,,0,,99283,E&M,,,,11,Office,2,544.72,278.14,252.54,0.0,0.0,25.6,25.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001932,MBR00000072,Professional,2021-06-24,2021-06-24,2021-08-06,PLN2527,1856686341,1856686341,Geriatrics,In-Network,J20.9,G43.909,,,,,,,0,,33533,Surgery,,,,81,Independent Laboratory,3,28167.13,14908.49,12380.88,0.0,0.0,2527.61,2527.61,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000001933,MBR00000072,Institutional-OP,2023-03-28,2023-03-28,2023-04-20,PLN9619,1856686341,1856686341,Geriatrics,In-Network,M54.5,Z00.00,,,,,,,0,,99232,E&M,,,0270,22,Outpatient Hospital,2,328.63,171.8,78.73,0.76,75.0,0.0,75.76,17.31,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001934,MBR00000072,Institutional-IP,2021-07-11,2021-07-15,2021-07-31,PLN7547,1817234602,1817234602,Clinical Laboratory,In-Network,E11.9,N39.0,,,,470,MS-DRG,7,4,Y,99233,E&M,,,0270,21,Inpatient Hospital,3,513.01,192.63,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001935,MBR00000072,Institutional-OP,2022-04-24,2022-04-24,2022-05-11,PLN1074,1575695214,1575695214,SNF,In-Network,Z00.00,Z00.00,,,,,,,0,,99233,E&M,,,0360,22,Outpatient Hospital,2,373.59,207.4,172.29,0.0,15.0,0.0,15.0,20.11,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001936,MBR00000072,Institutional-IP,2022-09-04,2022-09-14,2022-09-27,PLN4629,1689639685,1689639685,SNF,In-Network,C50.912,K21.0,,,,683,MS-DRG,15,10,Y,33533,Surgery,,,0510,21,Inpatient Hospital,2,12057.58,8942.02,6970.1,349.5,0.0,0.0,349.5,1622.42,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000001937,MBR00000072,Professional,2022-07-22,2022-07-22,2022-08-31,PLN1546,1609526529,1609526529,Psychiatry,In-Network,Z00.00,Z23,,,,,,,0,,27447,Surgery,,,,65,End-Stage Renal Disease,2,2389.54,1280.98,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001938,MBR00000073,Professional,2021-02-04,2021-02-04,2021-02-20,PLN8183,1644128543,1644128543,Gastroenterology,In-Network,M54.5,N18.3,,,,,,,0,,66984,Surgery,,,,11,Office,1,1693.04,777.0,702.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001939,MBR00000073,Professional,2022-05-03,2022-05-03,2022-06-04,PLN7600,1542828721,1542828721,Orthopedic Surgery,In-Network,E78.5,F41.9,,,,,,,0,,45380,Surgery,,,,11,Office,1,1925.7,1154.01,1154.01,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000001940,MBR00000073,Institutional-OP,2022-12-18,2022-12-18,2022-12-30,PLN2608,1530904931,1530904931,Internal Medicine,In-Network,E78.5,E66.9,,,,,,,0,,99233,E&M,,,0450,22,Outpatient Hospital,3,517.5,224.61,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001941,MBR00000073,Professional,2022-07-31,2022-07-31,2022-09-13,PLN6917,1103747954,1103747954,Urology,In-Network,I10,Z12.31,,,,,,,0,,93306,Radiology,,,,20,Urgent Care,2,2221.59,856.96,727.0,0.0,0.0,129.96,129.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001942,MBR00000073,Professional,2023-03-11,2023-03-11,2023-04-19,PLN5381,1135158374,1135158374,Pulmonology,In-Network,Z87.891,N39.0,,,,,,,0,,66984,Surgery,,,,11,Office,1,2104.97,1249.65,1017.05,0.0,0.0,232.6,232.6,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001943,MBR00000073,Professional,2023-04-30,2023-04-30,2023-05-26,PLN4680,1242201429,1242201429,General Acute Care Hospital,In-Network,E11.9,Z23,,,,,,,0,,27447,Surgery,,,,21,Inpatient Hospital,1,3822.08,2445.51,2445.51,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001944,MBR00000073,Institutional-OP,2021-07-16,2021-07-16,2021-08-13,PLN8959,1118885473,1118885473,ASC,In-Network,J44.1,Z00.00,,,,,,,0,,80053,Pathology/Lab,,,0320,22,Outpatient Hospital,3,153.83,53.83,0.0,53.83,0.0,0.0,53.83,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000001945,MBR00000073,Professional,2023-05-31,2023-05-31,2023-06-25,PLN3304,1644128543,1644128543,Gastroenterology,In-Network,M54.5,N39.0,,,,,,,0,,93225,Medicine,,,,11,Office,2,628.65,319.14,68.21,188.03,50.0,12.9,250.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001946,MBR00000073,Professional,2023-09-07,2023-09-07,2023-10-13,PLN8195,1660288235,1660288235,ASC,In-Network,F32.9,I48.91,,,,,,,0,,G0444,Medicine,,,,22,Outpatient Hospital,3,83.23,59.5,33.25,0.0,25.0,1.25,26.25,0.0,Paid,,,0,,0,1,0,0,0,1,Phantom,0,0,0,0,1
CLM0000001947,MBR00000073,Institutional-OP,2023-07-07,2023-07-07,2023-08-16,PLN2046,1809014947,1809014947,Urology,In-Network,E78.5,N18.3,,,,,,,0,,43239,Surgery,,,0900,22,Outpatient Hospital,1,2216.94,1660.58,1585.58,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001948,MBR00000073,Professional,2023-07-22,2023-07-22,2023-08-17,PLN3224,1817234602,1817234602,Clinical Laboratory,In-Network,Z00.01,Z00.00,,,,,,,0,,99232,E&M,,,,11,Office,3,314.1,145.76,120.76,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001949,MBR00000073,Institutional-IP,2021-08-21,2021-09-04,2021-09-09,PLN7131,1696843572,1696843572,Critical Access Hospital,Out-of-Network,J06.9,K21.0,,,,872,MS-DRG,20,14,Y,76700,Radiology,,,0740,21,Inpatient Hospital,1,1037.48,707.45,672.45,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001950,MBR00000073,Institutional-IP,2022-12-15,2022-12-18,2023-01-03,PLN7900,1514306773,1514306773,Endocrinology,In-Network,I10,E11.65,,,,195,MS-DRG,16,3,Y,99406,Medicine,,,0450,21,Inpatient Hospital,1,71.61,53.78,0.0,53.78,50.0,0.0,103.78,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000001951,MBR00000073,Professional,2022-05-17,2022-05-17,2022-06-10,PLN4685,1168881145,1168881145,Orthopedic Surgery,In-Network,M54.5,Z12.31,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,2,94.71,58.24,58.24,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000001952,MBR00000073,Professional,2023-12-14,2023-12-14,2024-01-17,PLN8411,1500037969,1500037969,Pulmonology,In-Network,F32.9,M54.5,,,,,,,0,,43239,Surgery,,,,11,Office,3,1616.84,1158.48,692.98,440.5,25.0,0.0,465.5,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001953,MBR00000073,Professional,2023-06-29,2023-06-29,2023-08-10,PLN8926,1915531927,1915531927,Critical Access Hospital,In-Network,Z12.31,Z23,,,,,,,0,,86900,Pathology/Lab,,,,23,Emergency Room,1,49.6,18.73,15.9,0.0,0.0,2.83,2.83,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000001954,MBR00000073,Professional,2021-06-26,2021-06-26,2021-07-06,PLN9235,1205377316,1205377316,Orthopedic Surgery,In-Network,R07.9,J18.9,,,,,,,0,,99203,E&M,,,,11,Office,1,294.94,208.03,208.03,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001955,MBR00000073,Institutional-IP,2023-10-29,2023-11-04,2023-11-13,PLN2917,1840431511,1840431511,Geriatrics,Out-of-Network,E11.9,M54.5,,,,292,MS-DRG,13,6,Y,99214,E&M,,,0450,21,Inpatient Hospital,3,464.68,330.81,330.81,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001956,MBR00000073,Professional,2023-02-03,2023-02-03,2023-02-19,PLN9584,1845900543,1845900543,ASC,In-Network,R10.9,E11.9,,,,,,,0,,90837,Medicine,,,,22,Outpatient Hospital,3,475.63,309.38,279.95,0.0,0.0,29.43,29.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001957,MBR00000073,Professional,2022-08-18,2022-08-18,2022-09-30,PLN3208,1125190055,1125190055,Nephrology,In-Network,E78.5,N39.0,,,,,,,0,,G0444,Medicine,,,,20,Urgent Care,2,42.53,20.41,0.0,20.41,75.0,0.0,95.41,0.0,Denied,CO-15,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000001958,MBR00000073,Institutional-IP,2022-05-04,2022-05-06,2022-06-04,PLN3817,1896447406,1896447406,Nephrology,Out-of-Network,J20.9,N40.0,,,,470,MS-DRG,22,2,Y,80053,Pathology/Lab,,,0450,21,Inpatient Hospital,1,139.67,83.85,48.26,0.0,35.0,0.59,35.59,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000001959,MBR00000073,Institutional-OP,2022-06-24,2022-06-24,2022-07-20,PLN9445,1366286000,1366286000,SNF,In-Network,M17.11,M54.5,,,,,,,0,,66984,Surgery,,,0761,22,Outpatient Hospital,2,1691.43,678.86,615.66,0.0,35.0,28.2,63.2,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001960,MBR00000073,Institutional-OP,2023-04-25,2023-04-25,2023-05-10,PLN9658,1915531927,1915531927,Critical Access Hospital,In-Network,Z12.31,Z96.641,,,,,,,0,,99213,E&M,,,0900,22,Outpatient Hospital,2,173.3,102.96,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001961,MBR00000073,Institutional-OP,2023-04-18,2023-04-18,2023-05-05,PLN1525,1433937353,1433937353,Nephrology,In-Network,E78.5,K21.0,,,,,,,0,,99213,E&M,,,0510,22,Outpatient Hospital,2,158.26,119.79,0.0,119.79,0.0,0.0,119.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001962,MBR00000073,Professional,2022-08-28,2022-08-28,2022-10-08,PLN2748,1728018911,1728018911,Nephrology,In-Network,Z23,I10,,,,,,,0,,99221,E&M,,,,11,Office,3,273.23,170.01,152.94,0.0,0.0,17.07,17.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001963,MBR00000073,Professional,2023-12-22,2023-12-22,2024-02-04,PLN9178,1475984649,1475984649,SNF,In-Network,I10,I11.9,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,1,231.11,103.81,0.0,50.34,75.0,0.0,125.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001964,MBR00000073,Institutional-IP,2021-09-12,2021-09-15,2021-10-15,PLN6452,1500037969,1500037969,Pulmonology,In-Network,K21.0,E11.65,,,,291,MS-DRG,22,3,Y,99232,E&M,,,0450,21,Inpatient Hospital,2,376.6,201.02,201.02,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000001965,MBR00000073,Institutional-OP,2022-04-12,2022-04-12,2022-05-12,PLN1705,1716521444,1716521444,Oncology,In-Network,I10,E11.9,,,,,,,0,,99222,E&M,,,0510,22,Outpatient Hospital,1,466.49,282.84,247.74,0.0,0.0,35.1,35.1,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000001966,MBR00000073,Professional,2022-10-18,2022-10-18,2022-11-09,PLN3092,1132188260,1132188260,Family Medicine,In-Network,I25.10,Z23,,,,,,,0,,99406,Medicine,,,,22,Outpatient Hospital,3,58.19,36.81,0.0,36.81,0.0,0.0,36.81,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001967,MBR00000073,Institutional-OP,2021-06-30,2021-06-30,2021-07-07,PLN5987,1205377316,1205377316,Orthopedic Surgery,In-Network,M54.5,F41.9,,,,,,,0,,99204,E&M,,,0761,22,Outpatient Hospital,1,429.94,259.74,259.74,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001968,MBR00000073,Institutional-IP,2022-07-01,2022-07-04,2022-08-12,PLN2652,1364429278,1364429278,OB/GYN,In-Network,I11.9,Z00.00,,,,682,MS-DRG,5,3,Y,99204,E&M,,,0200,21,Inpatient Hospital,3,412.33,313.51,313.51,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001969,MBR00000073,Professional,2023-07-03,2023-07-03,2023-07-27,PLN9075,1799205295,1799205295,General Acute Care Hospital,In-Network,R05,Z96.641,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,3,4815.2,1602.55,1527.55,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001970,MBR00000073,Institutional-OP,2023-01-10,2023-01-10,2023-02-05,PLN6735,1845057593,1845057593,Orthopedic Surgery,In-Network,Z00.00,Z12.31,,,,,,,0,,82043,Pathology/Lab,,,0450,22,Outpatient Hospital,1,36.64,23.22,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001971,MBR00000073,Professional,2023-02-17,2023-02-17,2023-03-13,PLN6415,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,F10.20,I10,,,,,,,0,,27447,Surgery,,,,50,Federally Qualified Health Center,2,5324.44,2943.32,2943.32,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001972,MBR00000073,Institutional-OP,2021-06-27,2021-06-27,2021-07-14,PLN9271,1948810580,1948810580,DME Supplier,In-Network,I10,N39.0,,,,,,,0,,72148,Radiology,,,0730,22,Outpatient Hospital,3,1134.26,434.09,380.03,0.0,0.0,54.06,54.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001973,MBR00000073,Professional,2021-06-08,2021-06-08,2021-06-28,PLN1368,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,F41.9,M81.0,,,,,,,0,,77067,Radiology,,,,50,Federally Qualified Health Center,2,517.83,171.06,171.06,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000001974,MBR00000073,Institutional-IP,2022-04-29,2022-05-01,2022-06-11,PLN6013,1872272835,1872272835,Internal Medicine,In-Network,F10.20,R10.9,,,,470,MS-DRG,9,2,Y,99233,E&M,,,0360,21,Inpatient Hospital,2,359.14,273.55,273.55,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001975,MBR00000073,Institutional-IP,2021-12-21,2021-12-27,2022-01-23,PLN6549,1847081578,1847081578,Urology,Out-of-Network,Z23,I10,,,,871,MS-DRG,10,6,Y,80053,Pathology/Lab,,,0370,21,Inpatient Hospital,3,151.08,122.51,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001976,MBR00000073,Professional,2021-01-12,2021-01-12,2021-02-23,PLN8682,1389336600,1389336600,Critical Access Hospital,In-Network,I50.9,Z00.00,,,,,,,0,,99233,E&M,,,,11,Office,3,240.18,148.72,0.0,148.72,0.0,0.0,148.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001977,MBR00000074,Institutional-OP,2022-08-29,2022-08-29,2022-09-05,PLN8572,1542828721,1542828721,Orthopedic Surgery,In-Network,E11.9,G43.909,,,,,,,0,,85025,Pathology/Lab,,,0320,22,Outpatient Hospital,3,63.98,54.22,34.14,0.0,15.0,5.08,20.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001978,MBR00000074,Professional,2023-04-06,2023-04-06,2023-04-27,PLN6213,1366576336,1366576336,Geriatrics,In-Network,I63.9,E11.9,,,,,,,0,,90686,Medicine,,,,21,Inpatient Hospital,1,77.09,33.95,30.23,0.0,0.0,3.72,3.72,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000001979,MBR00000074,Professional,2023-03-12,2023-03-12,2023-03-20,PLN6832,1609526529,1609526529,Psychiatry,In-Network,E78.5,I10,,,,,,,0,,99222,E&M,,,,11,Office,1,228.75,77.92,42.92,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000001980,MBR00000074,Professional,2021-04-23,2021-04-23,2021-05-31,PLN1588,1840431511,1840431511,Geriatrics,Out-of-Network,E11.9,Z00.00,,,,,,,0,,99284,E&M,,,,11,Office,1,372.43,283.67,233.67,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001981,MBR00000074,Institutional-OP,2023-05-05,2023-05-05,2023-05-14,PLN5641,1132188260,1132188260,Family Medicine,In-Network,Z00.00,Z12.11,,,,,,,0,,G0468,Medicine,,,0370,22,Outpatient Hospital,2,452.66,202.91,0.0,202.91,0.0,0.0,202.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001982,MBR00000074,Institutional-OP,2022-02-21,2022-02-21,2022-04-04,PLN5186,1872613201,1872613201,Internal Medicine,In-Network,N18.3,I50.9,,,,,,,0,,97530,Medicine,,,0740,22,Outpatient Hospital,2,268.87,162.45,87.45,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001983,MBR00000074,Professional,2021-06-20,2021-06-20,2021-07-08,PLN7544,1103747954,1103747954,Urology,In-Network,M17.11,J06.9,,,,,,,0,,43239,Surgery,,,,31,Skilled Nursing Facility,3,2223.32,1056.24,756.26,274.98,25.0,0.0,299.98,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001984,MBR00000074,Institutional-OP,2022-06-01,2022-06-01,2022-06-24,PLN7926,1542828721,1542828721,Orthopedic Surgery,In-Network,M17.11,I25.10,,,,,,,0,,99233,E&M,,,0740,22,Outpatient Hospital,2,385.48,187.91,187.91,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001985,MBR00000074,Institutional-OP,2021-08-26,2021-08-26,2021-10-04,PLN6949,1631954542,1631954542,Oncology,In-Network,F32.9,K57.30,,,,,,,0,,71046,Radiology,,,0270,22,Outpatient Hospital,3,332.47,263.02,216.95,0.0,0.0,46.07,46.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001986,MBR00000075,Professional,2023-01-07,2023-01-07,2023-02-12,PLN8241,1980712759,1980712759,Outpatient Clinic,Out-of-Network,E78.5,R07.9,,,,,,,0,,27130,Surgery,,,,49,Independent Clinic,2,2725.82,1557.92,1283.44,274.48,0.0,0.0,274.48,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001987,MBR00000075,Institutional-OP,2023-03-26,2023-03-26,2023-04-17,PLN7688,1239316214,1239316214,Internal Medicine,In-Network,N18.3,N39.0,,,,,,,0,,45380,Surgery,,,0270,22,Outpatient Hospital,2,1118.2,371.22,321.22,0.0,50.0,0.0,50.0,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000001988,MBR00000075,Professional,2023-03-06,2023-03-06,2023-04-15,PLN7953,1872272835,1872272835,Internal Medicine,In-Network,Z00.00,R10.9,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,3,78.76,50.69,0.0,34.79,0.0,2.76,37.55,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001989,MBR00000075,Institutional-OP,2021-05-08,2021-05-08,2021-06-20,PLN7763,1372918899,1372918899,Family Medicine,In-Network,E11.9,N40.0,,,,,,,0,,99213,E&M,,,0450,22,Outpatient Hospital,1,185.97,155.44,0.0,0.0,0.0,30.66,30.66,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001990,MBR00000075,Institutional-IP,2022-01-17,2022-01-19,2022-01-24,PLN4364,1563980627,1563980627,Critical Access Hospital,In-Network,E11.9,N39.0,,,,871,MS-DRG,7,2,U,86900,Pathology/Lab,,,0900,21,Inpatient Hospital,3,33.99,14.56,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001991,MBR00000075,Institutional-OP,2022-06-30,2022-06-30,2022-08-13,PLN2418,1891849440,1891849440,Oncology,In-Network,I48.91,M54.5,,,,,,,0,,70450,Radiology,,,0120,22,Outpatient Hospital,1,1677.61,1140.38,1107.52,7.86,25.0,0.0,32.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001992,MBR00000075,Professional,2023-12-15,2023-12-15,2024-01-20,PLN7429,1219817751,1219817751,OB/GYN,In-Network,E78.5,R10.9,,,,,,,0,,99232,E&M,,,,11,Office,1,285.49,153.18,0.0,153.18,0.0,0.0,153.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001993,MBR00000075,Professional,2022-08-21,2022-08-21,2022-08-31,PLN3662,1991459367,1991459367,Neurology,Out-of-Network,Z00.00,I10,,,,,,,0,,58661,Surgery,,,,50,Federally Qualified Health Center,3,2890.18,1314.07,1314.07,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001994,MBR00000076,Institutional-OP,2022-12-17,2022-12-17,2023-01-19,PLN8946,1514306773,1514306773,Endocrinology,In-Network,Z96.641,N39.0,,,,,,,0,,47562,Surgery,,,0730,22,Outpatient Hospital,1,2389.3,1923.22,1908.22,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001995,MBR00000076,Institutional-OP,2022-01-07,2022-01-07,2022-01-31,PLN2827,1717546253,1717546253,Family Medicine,In-Network,M54.5,I10,,,,,,,0,,27447,Surgery,,,0900,22,Outpatient Hospital,3,2265.99,729.7,704.7,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001996,MBR00000076,Institutional-IP,2021-11-20,2021-11-21,2021-12-19,PLN9842,1273488618,1273488618,General Acute Care Hospital,In-Network,Z12.31,I10,,,,682,MS-DRG,3,1,Y,23472,Surgery,,,0636,21,Inpatient Hospital,2,3273.89,2664.75,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-4,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001997,MBR00000076,Institutional-IP,2023-05-22,2023-05-23,2023-06-25,PLN6832,1609526529,1609526529,Psychiatry,In-Network,E78.5,Z12.31,,,,682,MS-DRG,3,1,Y,87491,Pathology/Lab,,,0510,21,Inpatient Hospital,2,133.43,46.21,0.0,46.21,0.0,0.0,46.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000001998,MBR00000076,Institutional-IP,2023-07-03,2023-07-11,2023-08-13,PLN9299,1366576336,1366576336,Geriatrics,In-Network,Z00.01,Z23,,,,194,MS-DRG,8,8,Y,23472,Surgery,,,0301,21,Inpatient Hospital,1,2807.71,1936.03,1532.12,403.91,0.0,0.0,403.91,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000001999,MBR00000076,Professional,2021-03-02,2021-03-02,2021-03-15,PLN1670,1939033455,1939033455,Pulmonology,In-Network,M81.0,M81.0,,,,,,,0,,99214,E&M,,,,11,Office,1,219.14,65.94,65.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002000,MBR00000076,Professional,2022-08-13,2022-08-13,2022-09-26,PLN9736,1847081578,1847081578,Urology,Out-of-Network,I25.10,I10,,,,,,,0,,93306,Radiology,,,,31,Skilled Nursing Facility,3,1251.95,981.19,535.26,430.93,15.0,0.0,445.93,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002001,MBR00000076,Professional,2023-05-02,2023-05-02,2023-05-25,PLN7981,1980712759,1980712759,Outpatient Clinic,Out-of-Network,N40.0,E66.9,,,,,,,0,,99284,E&M,,,,49,Independent Clinic,2,859.26,605.25,425.84,179.41,0.0,0.0,179.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002002,MBR00000076,Professional,2021-06-22,2021-06-22,2021-07-17,PLN4309,1284035364,1284035364,Pediatrics,In-Network,F32.9,J45.20,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,2,285.85,92.4,92.4,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002003,MBR00000076,Institutional-OP,2022-12-09,2022-12-09,2022-12-28,PLN7877,1691062876,1691062876,SNF,In-Network,M81.0,F32.9,,,,,,,0,,G0439,Medicine,,,0360,22,Outpatient Hospital,3,399.53,274.14,0.0,274.14,35.0,0.0,309.14,0.0,Denied,CO-119,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000002004,MBR00000076,Professional,2022-06-03,2022-06-03,2022-07-02,PLN2202,1235381502,1235381502,Cardiology,In-Network,E66.9,Z79.4,,,,,,,0,,71046,Radiology,,,,11,Office,3,190.27,129.01,108.54,0.0,0.0,20.47,20.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002005,MBR00000076,Professional,2022-07-10,2022-07-10,2022-08-21,PLN2127,1118885473,1118885473,ASC,In-Network,J06.9,K21.0,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,2,6130.87,3385.36,3315.07,70.29,0.0,0.0,70.29,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002006,MBR00000076,Professional,2022-10-13,2022-10-13,2022-11-21,PLN4248,1910255109,1910255109,DME Supplier,In-Network,E78.5,E78.5,,,,,,,0,,99233,E&M,,,,49,Independent Clinic,2,331.07,263.31,0.0,119.1,0.0,0.0,119.1,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002007,MBR00000076,Institutional-OP,2023-08-14,2023-08-14,2023-09-17,PLN7847,1205377316,1205377316,Orthopedic Surgery,In-Network,E11.9,Z23,,,,,,,0,,23472,Surgery,,,0510,22,Outpatient Hospital,2,4701.7,3774.68,3699.68,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002008,MBR00000076,Professional,2021-04-06,2021-04-06,2021-04-30,PLN6484,1366426662,1366426662,Urology,In-Network,M17.11,M17.11,,,,,,,0,,80053,Pathology/Lab,,,,81,Independent Laboratory,3,61.82,35.25,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002009,MBR00000076,Professional,2021-08-10,2021-08-10,2021-08-30,PLN9096,1114982472,1114982472,Orthopedic Surgery,In-Network,I10,E11.9,,,,,,,0,,84443,Pathology/Lab,,,,22,Outpatient Hospital,3,164.0,49.25,0.0,49.25,50.0,0.0,99.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002010,MBR00000076,Institutional-OP,2022-01-13,2022-01-13,2022-01-29,PLN2071,1745114564,1745114564,Endocrinology,In-Network,F41.9,M54.5,,,,,,,0,,71046,Radiology,,,0270,22,Outpatient Hospital,2,179.19,124.23,0.0,124.23,0.0,0.0,124.23,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002011,MBR00000076,Professional,2023-05-27,2023-05-27,2023-06-11,PLN1318,1585582070,1585582070,Outpatient Clinic,In-Network,I11.9,I10,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,1,60.14,37.88,37.88,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002012,MBR00000076,Institutional-OP,2022-10-11,2022-10-11,2022-10-19,PLN7680,1434029575,1434029575,Endocrinology,In-Network,F41.9,J20.9,,,,,,,0,,66984,Surgery,,,0636,22,Outpatient Hospital,2,1474.64,878.3,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002013,MBR00000076,Professional,2021-07-25,2021-07-25,2021-08-24,PLN2664,1757138478,1757138478,Pediatrics,In-Network,Z12.31,I10,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,3,54.08,30.31,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002014,MBR00000076,Institutional-OP,2021-01-26,2021-01-26,2021-02-13,PLN1803,1366286000,1366286000,SNF,In-Network,Z00.00,M81.0,,,,,,,0,,85610,Pathology/Lab,,,0900,22,Outpatient Hospital,2,33.59,17.69,17.69,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002015,MBR00000076,Professional,2023-12-21,2023-12-21,2024-01-12,PLN5865,1366286000,1366286000,SNF,In-Network,Z00.01,F41.9,,,,,,,0,,78452,Radiology,,,,11,Office,1,6140.72,3301.48,2932.37,274.15,25.0,69.96,369.11,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002016,MBR00000076,Professional,2021-05-31,2021-05-31,2021-06-30,PLN9659,1845900543,1845900543,ASC,In-Network,Z87.891,Z87.891,,,,,,,0,,99233,E&M,,,,11,Office,3,474.93,165.63,0.0,165.63,25.0,0.0,190.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002017,MBR00000076,Professional,2021-02-05,2021-02-05,2021-02-17,PLN3690,1227362142,1227362142,DME Supplier,In-Network,Z87.891,E78.5,,,,,,,0,,80053,Pathology/Lab,,,,81,Independent Laboratory,3,129.47,45.38,45.38,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002018,MBR00000077,Institutional-IP,2022-03-22,2022-03-27,2022-04-30,PLN5027,1364429278,1364429278,OB/GYN,In-Network,M54.5,I48.91,,,,196,MS-DRG,21,5,Y,87491,Pathology/Lab,,,0730,21,Inpatient Hospital,2,127.6,43.6,0.0,43.6,0.0,0.0,43.6,0.0,Adjusted,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000002019,MBR00000077,Institutional-OP,2022-08-29,2022-08-29,2022-10-06,PLN8840,1530904931,1530904931,Internal Medicine,In-Network,F32.9,N17.9,,,,,,,0,,66984,Surgery,,,0900,22,Outpatient Hospital,1,2719.22,1173.8,1067.01,0.0,0.0,106.79,106.79,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002020,MBR00000077,Professional,2021-10-11,2021-10-11,2021-10-29,PLN2215,1366576336,1366576336,Geriatrics,In-Network,J20.9,F41.9,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,2,74.06,24.27,0.0,24.27,0.0,0.0,24.27,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002021,MBR00000077,Institutional-IP,2021-07-03,2021-07-06,2021-08-14,PLN4761,1219817751,1219817751,OB/GYN,In-Network,C50.912,M54.5,,,,683,MS-DRG,3,3,Y,43239,Surgery,,,0510,21,Inpatient Hospital,2,1043.91,884.44,884.44,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002022,MBR00000077,Professional,2021-04-05,2021-04-05,2021-05-09,PLN7982,1219817751,1219817751,OB/GYN,In-Network,F32.9,E11.65,,,,,,,0,,99203,E&M,,,,20,Urgent Care,3,392.91,272.82,247.82,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002023,MBR00000077,Institutional-OP,2022-03-23,2022-03-23,2022-05-03,PLN8907,1606140917,1606140917,ASC,In-Network,Z23,Z12.11,,,,,,,0,,86900,Pathology/Lab,,,0761,22,Outpatient Hospital,2,42.66,24.63,0.0,24.63,0.0,0.0,24.63,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002024,MBR00000077,Institutional-OP,2023-11-09,2023-11-09,2023-11-26,PLN9265,1910255109,1910255109,DME Supplier,In-Network,N39.0,I10,,,,,,,0,,47562,Surgery,,,0200,22,Outpatient Hospital,3,5101.31,2372.98,2076.42,0.0,35.0,261.56,296.56,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002025,MBR00000077,Professional,2021-06-12,2021-06-12,2021-06-26,PLN2280,1948810580,1948810580,DME Supplier,In-Network,M17.11,J18.9,,,,,,,0,,90837,Medicine,,,,22,Outpatient Hospital,2,205.83,162.23,0.0,162.23,0.0,0.0,162.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002026,MBR00000077,Professional,2022-09-20,2022-09-20,2022-10-31,PLN5913,1997536841,1997536841,Family Medicine,Out-of-Network,Z12.31,Z00.00,,,,,,,0,,99203,E&M,,,,21,Inpatient Hospital,3,191.59,90.22,77.17,0.0,0.0,13.05,13.05,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002027,MBR00000077,Institutional-OP,2021-08-01,2021-08-01,2021-08-23,PLN9692,1295371663,1295371663,Critical Access Hospital,In-Network,F41.9,E11.40,,,,,,,0,,97110,Medicine,,,0120,22,Outpatient Hospital,2,280.59,234.86,0.0,0.0,0.0,18.6,18.6,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002028,MBR00000077,Institutional-OP,2023-01-08,2023-01-08,2023-02-17,PLN6761,1463205530,1463205530,Nephrology,In-Network,J06.9,M81.0,,,,,,,0,,99203,E&M,,,0510,22,Outpatient Hospital,2,156.85,97.98,0.0,0.0,0.0,15.01,15.01,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002029,MBR00000077,Institutional-IP,2021-03-08,2021-03-14,2021-03-30,PLN5188,1910255109,1910255109,DME Supplier,In-Network,Z96.641,B97.89,,,,603,MS-DRG,23,6,Y,99233,E&M,,,0510,21,Inpatient Hospital,1,400.42,187.06,183.13,3.93,0.0,0.0,3.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002030,MBR00000078,Professional,2021-08-11,2021-08-11,2021-09-10,PLN6613,1545347862,1545347862,SNF,In-Network,M54.5,I10,,,,,,,0,,27447,Surgery,,,,21,Inpatient Hospital,3,5600.89,1949.3,1404.48,319.77,75.0,150.05,544.82,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002031,MBR00000078,Institutional-OP,2021-01-09,2021-01-09,2021-01-16,PLN1231,1139906830,1139906830,Endocrinology,Out-of-Network,J44.1,Z00.00,,,,,,,0,,99232,E&M,,,0900,22,Outpatient Hospital,3,370.71,254.72,219.72,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002032,MBR00000078,Professional,2022-12-12,2022-12-12,2022-12-26,PLN3611,1660288235,1660288235,ASC,In-Network,E78.5,E78.5,,,,,,,0,,70450,Radiology,,,,31,Skilled Nursing Facility,1,942.83,355.98,234.31,0.0,75.0,46.67,121.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002033,MBR00000078,Institutional-OP,2023-02-27,2023-02-27,2023-04-05,PLN1127,1518055405,1518055405,Urology,In-Network,E66.9,Z12.31,,,,,,,0,,78452,Radiology,,,0360,22,Outpatient Hospital,2,2901.72,1420.4,1200.59,0.0,15.0,204.81,219.81,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002034,MBR00000078,Institutional-OP,2021-07-07,2021-07-07,2021-08-07,PLN2038,1856686341,1856686341,Geriatrics,In-Network,R10.9,Z00.00,,,,,,,0,,80053,Pathology/Lab,,,0301,22,Outpatient Hospital,1,80.44,67.75,67.75,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002035,MBR00000078,Institutional-OP,2022-05-12,2022-05-12,2022-06-03,PLN9455,1689639685,1689639685,SNF,In-Network,Z12.31,Z12.31,,,,,,,0,,90837,Medicine,,,0636,22,Outpatient Hospital,2,383.46,127.26,127.26,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002036,MBR00000078,Institutional-OP,2021-11-18,2021-11-18,2021-12-19,PLN5199,1372918899,1372918899,Family Medicine,In-Network,Z00.00,Z12.31,,,,,,,0,,99204,E&M,,,0510,22,Outpatient Hospital,2,448.47,167.94,7.01,85.93,75.0,0.0,160.93,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002037,MBR00000078,Institutional-OP,2021-02-19,2021-02-19,2021-03-31,PLN5018,1500949740,1500949740,Pediatrics,In-Network,Z87.891,Z12.31,,,,,,,0,,84443,Pathology/Lab,,,0370,22,Outpatient Hospital,3,140.17,75.35,75.35,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002038,MBR00000078,Professional,2021-02-10,2021-02-10,2021-03-02,PLN9701,1865904917,1865904917,Outpatient Clinic,In-Network,J44.1,M54.5,,,,,,,0,,97530,Medicine,,,,23,Emergency Room,3,176.08,59.78,0.0,59.78,50.0,0.0,109.78,0.0,Denied,CO-15,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002039,MBR00000078,Institutional-OP,2023-10-26,2023-10-26,2023-11-02,PLN5943,1295371663,1295371663,Critical Access Hospital,In-Network,N39.0,F32.9,,,,,,,0,,27447,Surgery,,,0450,22,Outpatient Hospital,2,4257.01,2741.72,0.0,190.61,0.0,403.0,593.61,0.0,Denied,CO-15,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002040,MBR00000078,Professional,2022-12-10,2022-12-10,2023-01-05,PLN8672,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,E78.5,Z12.31,,,,,,,0,,45380,Surgery,,,,12,Home,3,1705.97,1302.61,1252.61,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000002041,MBR00000078,Professional,2022-12-30,2022-12-30,2023-02-09,PLN8547,1109850785,1109850785,ASC,Out-of-Network,J18.9,J44.1,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,2,438.81,245.43,245.43,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002042,MBR00000078,Professional,2021-11-20,2021-11-20,2021-12-30,PLN6356,1556140803,1556140803,Cardiology,In-Network,Z87.891,N18.3,,,,,,,0,,G0439,Medicine,,,,22,Outpatient Hospital,1,227.97,138.62,6.0,132.62,0.0,0.0,132.62,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000002043,MBR00000078,Professional,2021-10-17,2021-10-17,2021-11-11,PLN7924,1948810580,1948810580,DME Supplier,In-Network,E78.5,Z23,,,,,,,0,,G0439,Medicine,,,,81,Independent Laboratory,1,360.54,211.4,0.0,211.4,0.0,0.0,211.4,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000002044,MBR00000078,Professional,2023-05-21,2023-05-21,2023-06-30,PLN5389,1644128543,1644128543,Gastroenterology,In-Network,J06.9,Z23,,,,,,,0,,85025,Pathology/Lab,,,,20,Urgent Care,3,82.52,42.75,17.75,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002045,MBR00000078,Professional,2022-04-26,2022-04-26,2022-05-24,PLN3670,1910255109,1910255109,DME Supplier,In-Network,Z12.11,N20.0,,,,,,,0,,99213,E&M,,,,11,Office,1,332.21,269.78,131.29,123.49,15.0,0.0,138.49,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002046,MBR00000078,Professional,2021-04-22,2021-04-22,2021-05-21,PLN6584,1463205530,1463205530,Nephrology,In-Network,E78.5,Z23,,,,,,,0,,23472,Surgery,,,,23,Emergency Room,1,4511.74,1533.91,1184.59,334.32,15.0,0.0,349.32,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002047,MBR00000078,Professional,2022-06-20,2022-06-20,2022-07-10,PLN5743,1366286000,1366286000,SNF,In-Network,E11.9,R05,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,2,176.14,131.16,122.09,0.0,0.0,9.07,9.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002048,MBR00000078,Professional,2022-07-26,2022-07-26,2022-08-13,PLN9050,1809014947,1809014947,Urology,In-Network,Z12.11,E11.9,,,,,,,0,,99213,E&M,,,,49,Independent Clinic,2,276.06,198.64,180.2,0.0,0.0,18.44,18.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002049,MBR00000078,Institutional-IP,2022-09-17,2022-09-18,2022-10-08,PLN5843,1689639685,1689639685,SNF,In-Network,Z87.891,I10,,,,871,MS-DRG,17,1,Y,33533,Surgery,,,0510,21,Inpatient Hospital,3,27032.81,15231.7,12552.55,0.0,0.0,2679.15,2679.15,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002050,MBR00000078,Institutional-IP,2022-08-11,2022-08-21,2022-08-24,PLN4014,1780163051,1780163051,SNF,In-Network,J20.9,G20,,,,291,MS-DRG,13,10,N,99213,E&M,,,0320,21,Inpatient Hospital,1,230.38,170.74,0.0,164.82,50.0,0.0,214.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002051,MBR00000078,Institutional-OP,2023-07-28,2023-07-28,2023-08-17,PLN6059,1364429278,1364429278,OB/GYN,In-Network,C50.912,N18.3,,,,,,,0,,90686,Medicine,,,0370,22,Outpatient Hospital,1,130.24,41.29,0.0,41.29,25.0,0.0,66.29,0.0,Paid,,,0,,0,1,0,0,0,1,Phantom,0,0,0,0,0
CLM0000002052,MBR00000078,Institutional-OP,2021-09-25,2021-09-25,2021-10-30,PLN5113,1645194539,1645194539,SNF,In-Network,E11.9,C50.912,,,,,,,0,,93306,Radiology,,,0636,22,Outpatient Hospital,3,3069.7,1455.44,970.62,321.19,25.0,138.63,484.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002053,MBR00000078,Institutional-IP,2022-10-08,2022-10-11,2022-11-15,PLN1895,1717912431,1717912431,Oncology,In-Network,J20.9,J20.9,,,,871,MS-DRG,4,3,Y,93306,Radiology,,,0730,21,Inpatient Hospital,1,1860.97,1497.41,1440.97,0.0,0.0,56.44,56.44,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000002054,MBR00000078,Professional,2023-08-31,2023-08-31,2023-09-20,PLN6468,1749327647,1749327647,Geriatrics,In-Network,Z23,I11.9,,,,,,,0,,23472,Surgery,,,,11,Office,3,4135.58,3112.39,0.0,0.0,0.0,409.07,409.07,0.0,Denied,CO-15,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002055,MBR00000078,Professional,2023-12-08,2023-12-08,2023-12-15,PLN2106,1219817751,1219817751,OB/GYN,In-Network,G20,Z00.00,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,2,1079.06,888.2,888.2,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000002056,MBR00000078,Professional,2023-11-23,2023-11-23,2024-01-02,PLN9865,1780163051,1780163051,SNF,In-Network,I10,I10,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,3,56.89,38.25,0.0,38.25,75.0,0.0,113.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002057,MBR00000078,Professional,2023-03-07,2023-03-07,2023-03-25,PLN2273,1757138478,1757138478,Pediatrics,In-Network,E11.9,I10,,,,,,,0,,99233,E&M,,,,11,Office,3,405.2,151.23,35.78,115.45,0.0,0.0,115.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002058,MBR00000078,Institutional-OP,2021-04-27,2021-04-27,2021-06-03,PLN4898,1872613201,1872613201,Internal Medicine,In-Network,E11.9,M17.11,,,,,,,0,,74177,Radiology,,,0636,22,Outpatient Hospital,3,1184.3,980.83,886.35,0.0,0.0,94.48,94.48,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002059,MBR00000078,Professional,2023-12-19,2023-12-19,2024-01-21,PLN5812,1847081578,1847081578,Urology,Out-of-Network,E78.5,Z23,,,,,,,0,,47562,Surgery,,,,49,Independent Clinic,2,5487.32,3061.02,2734.89,0.0,35.0,291.13,326.13,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002060,MBR00000078,Institutional-OP,2021-02-05,2021-02-05,2021-03-02,PLN6501,1991459367,1991459367,Neurology,Out-of-Network,I10,Z79.4,,,,,,,0,,58661,Surgery,,,0360,22,Outpatient Hospital,1,3181.81,2693.75,2307.26,0.0,0.0,386.49,386.49,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002061,MBR00000078,Professional,2022-08-27,2022-08-27,2022-09-07,PLN8481,1899127912,1899127912,Neurology,In-Network,N39.0,I10,,,,,,,0,,78452,Radiology,,,,22,Outpatient Hospital,1,6689.44,4350.26,4275.26,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002062,MBR00000078,Institutional-OP,2022-05-05,2022-05-05,2022-05-18,PLN4739,1749494482,1749494482,Pediatrics,In-Network,I50.9,E11.9,,,,,,,0,,99203,E&M,,,0636,22,Outpatient Hospital,1,314.26,230.94,20.15,171.5,35.0,4.29,210.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002063,MBR00000078,Professional,2023-01-13,2023-01-13,2023-01-27,PLN9907,1812060197,1812060197,Oncology,Out-of-Network,Z00.00,Z12.31,,,,,,,0,,27447,Surgery,,,,11,Office,2,3687.81,1625.27,1625.27,0.0,0.0,0.0,0.0,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002064,MBR00000078,Institutional-OP,2023-05-08,2023-05-08,2023-05-25,PLN1932,1872613201,1872613201,Internal Medicine,In-Network,K57.30,J45.20,,,,,,,0,,78452,Radiology,,,0200,22,Outpatient Hospital,3,3636.82,1827.07,1674.62,91.46,25.0,35.99,152.45,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000002065,MBR00000079,Institutional-OP,2023-03-19,2023-03-19,2023-04-01,PLN3198,1135158374,1135158374,Pulmonology,In-Network,S72.001A,E11.65,,,,,,,0,,99232,E&M,,,0270,22,Outpatient Hospital,2,237.13,71.43,62.43,0.0,0.0,9.0,9.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002066,MBR00000079,Professional,2021-09-06,2021-09-06,2021-10-06,PLN1102,1410468316,1410468316,SNF,In-Network,Z00.00,I10,,,,,,,0,,99204,E&M,,,,12,Home,1,380.15,276.23,233.96,0.0,35.0,7.27,42.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002067,MBR00000079,Professional,2023-04-07,2023-04-07,2023-04-16,PLN6073,1236418230,1236418230,DME Supplier,In-Network,Z12.31,K21.0,,,,,,,0,,33533,Surgery,,,,11,Office,2,25265.96,12689.54,12186.5,478.04,25.0,0.0,503.04,0.0,Pended,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002068,MBR00000079,Institutional-IP,2023-04-10,2023-04-15,2023-04-23,PLN6000,1224179551,1224179551,Physical Therapy,In-Network,J20.9,E78.5,,,,470,MS-DRG,13,5,Y,90686,Medicine,,,0761,21,Inpatient Hospital,2,80.88,27.14,27.14,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000002069,MBR00000079,Professional,2021-01-27,2021-01-27,2021-02-20,PLN9224,1691062876,1691062876,SNF,In-Network,Z23,R07.9,,,,,,,0,,93306,Radiology,,,,31,Skilled Nursing Facility,3,1504.07,512.18,357.81,0.0,75.0,79.37,154.37,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002070,MBR00000079,Professional,2022-11-29,2022-11-29,2022-12-12,PLN2399,1696843572,1696843572,Critical Access Hospital,Out-of-Network,F41.9,I10,,,,,,,0,,93306,Radiology,,,,11,Office,1,2421.68,1131.44,850.63,142.49,25.0,113.32,280.81,0.0,Adjusted,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002071,MBR00000079,Institutional-OP,2021-05-20,2021-05-20,2021-06-27,PLN5460,1935547131,1935547131,Pulmonology,In-Network,J20.9,Z00.00,,,,,,,0,,G0444,Medicine,,,0370,22,Outpatient Hospital,3,62.89,52.86,2.83,0.0,50.0,0.03,50.03,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000002072,MBR00000079,Institutional-IP,2022-09-08,2022-09-17,2022-10-01,PLN2565,1125190055,1125190055,Nephrology,In-Network,J44.1,I10,,,,194,MS-DRG,18,9,N,66984,Surgery,,,0120,21,Inpatient Hospital,2,2183.15,670.58,670.58,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002073,MBR00000079,Professional,2021-09-07,2021-09-07,2021-10-14,PLN2169,1752470395,1752470395,Home Health,In-Network,I50.9,R10.9,,,,,,,0,,99283,E&M,,,,49,Independent Clinic,1,371.04,205.8,180.8,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002074,MBR00000079,Professional,2022-01-28,2022-01-28,2022-02-10,PLN2258,1571574052,1571574052,Critical Access Hospital,In-Network,Z51.11,R51,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,3,107.18,75.94,50.94,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002075,MBR00000079,Professional,2021-10-25,2021-10-25,2021-11-29,PLN6859,1860435061,1860435061,DME Supplier,In-Network,N18.3,Z12.31,,,,,,,0,,G0468,Medicine,,,,21,Inpatient Hospital,1,484.93,227.79,216.35,0.0,0.0,11.44,11.44,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002076,MBR00000079,Institutional-OP,2023-08-03,2023-08-03,2023-08-14,PLN5252,1891849440,1891849440,Oncology,In-Network,I10,F32.9,,,,,,,0,,90460,Medicine,,,0270,22,Outpatient Hospital,1,73.43,37.92,0.0,37.92,75.0,0.0,112.92,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002077,MBR00000079,Professional,2023-09-19,2023-09-19,2023-09-28,PLN9031,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,I10,M17.11,,,,,,,0,,99213,E&M,,,,11,Office,1,174.25,84.89,84.89,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002078,MBR00000079,Professional,2023-05-25,2023-05-25,2023-06-12,PLN4712,1845900543,1845900543,ASC,In-Network,N18.3,Z00.00,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,2,16292.3,5323.28,5298.28,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002079,MBR00000079,Professional,2023-03-03,2023-03-03,2023-03-25,PLN5180,1337791138,1337791138,Internal Medicine,Out-of-Network,Z87.891,Z00.00,,,,,,,0,,66984,Surgery,,,,81,Independent Laboratory,3,2018.99,654.99,619.99,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002080,MBR00000079,Institutional-OP,2022-02-02,2022-02-02,2022-03-18,PLN2565,1800011727,1800011727,Clinical Laboratory,Out-of-Network,N40.0,Z12.31,,,,,,,0,,66984,Surgery,,,0200,22,Outpatient Hospital,2,3502.68,2557.15,2184.68,0.0,0.0,372.47,372.47,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002081,MBR00000079,Professional,2021-06-06,2021-06-06,2021-07-20,PLN6202,1313212303,1313212303,Family Medicine,In-Network,F32.9,Z87.891,,,,,,,0,,23472,Surgery,,,,11,Office,3,2795.4,2093.53,1778.52,290.01,25.0,0.0,315.01,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002082,MBR00000079,Institutional-OP,2022-09-15,2022-09-15,2022-10-15,PLN6595,1168246159,1168246159,Internal Medicine,In-Network,I25.10,R10.9,,,,,,,0,,99213,E&M,,,0301,22,Outpatient Hospital,3,126.32,58.54,0.0,58.54,15.0,0.0,73.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002083,MBR00000079,Professional,2022-04-12,2022-04-12,2022-05-19,PLN9037,1872272835,1872272835,Internal Medicine,In-Network,I11.9,Z12.31,,,,,,,0,,99233,E&M,,,,11,Office,1,535.06,450.17,400.17,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002084,MBR00000079,Institutional-OP,2021-11-06,2021-11-06,2021-11-22,PLN6304,1795618275,1795618275,Pulmonology,In-Network,J06.9,I10,,,,,,,0,,99222,E&M,,,0360,22,Outpatient Hospital,1,324.95,111.26,61.26,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002085,MBR00000079,Professional,2021-09-24,2021-09-24,2021-11-01,PLN3009,1974006077,1974006077,Orthopedic Surgery,In-Network,E11.9,F41.9,,,,,,,0,,27130,Surgery,,,,11,Office,3,5423.62,3607.87,3532.87,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002086,MBR00000079,Institutional-OP,2021-06-26,2021-06-26,2021-07-13,PLN8665,1528335731,1528335731,Critical Access Hospital,In-Network,I11.9,E78.5,,,,,,,0,,99204,E&M,,,0200,22,Outpatient Hospital,2,362.77,174.36,0.0,0.0,50.0,0.75,50.75,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002087,MBR00000079,Institutional-OP,2023-06-28,2023-06-28,2023-08-08,PLN9788,1518055405,1518055405,Urology,In-Network,R07.9,E11.9,,,,,,,0,,47562,Surgery,,,0730,22,Outpatient Hospital,1,3121.23,1732.31,1364.78,367.53,0.0,0.0,367.53,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002088,MBR00000079,Professional,2021-12-18,2021-12-18,2022-01-20,PLN5769,1528335731,1528335731,Critical Access Hospital,In-Network,Z00.00,E11.9,,,,,,,0,,99222,E&M,,,,11,Office,2,606.48,306.48,256.48,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002089,MBR00000079,Professional,2023-10-02,2023-10-02,2023-10-26,PLN9628,1968299309,1968299309,Internal Medicine,In-Network,E78.5,I10,,,,,,,0,,70450,Radiology,,,,21,Inpatient Hospital,1,1235.15,397.42,325.87,0.0,0.0,71.55,71.55,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002090,MBR00000079,Institutional-OP,2023-01-04,2023-01-04,2023-02-09,PLN4239,1691062876,1691062876,SNF,In-Network,I50.9,E11.9,,,,,,,0,,97530,Medicine,,,0510,22,Outpatient Hospital,3,224.72,172.73,172.73,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002091,MBR00000080,Professional,2021-06-29,2021-06-29,2021-07-11,PLN8247,1896447406,1896447406,Nephrology,Out-of-Network,I10,E66.9,,,,,,,0,,76700,Radiology,,,,12,Home,1,516.91,381.33,0.0,381.33,0.0,0.0,381.33,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002092,MBR00000080,Institutional-OP,2021-03-10,2021-03-10,2021-03-22,PLN8871,1273488618,1273488618,General Acute Care Hospital,In-Network,Z00.00,E78.5,,,,,,,0,,99213,E&M,,,0761,22,Outpatient Hospital,2,239.54,79.81,79.81,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002093,MBR00000080,Institutional-OP,2022-04-02,2022-04-02,2022-04-30,PLN6249,1361302520,1361302520,Critical Access Hospital,In-Network,Z00.00,R07.9,,,,,,,0,,99283,E&M,,,0360,22,Outpatient Hospital,2,276.12,185.56,185.56,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002094,MBR00000080,Professional,2021-03-31,2021-03-31,2021-04-09,PLN4042,1438368327,1438368327,Home Health,In-Network,J20.9,E66.9,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,2,92.4,45.35,17.93,0.0,25.0,2.42,27.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002095,MBR00000080,Professional,2023-11-10,2023-11-10,2023-12-04,PLN5275,1239316214,1239316214,Internal Medicine,In-Network,E11.9,N39.0,,,,,,,0,,45378,Surgery,,,,20,Urgent Care,1,1678.12,673.41,673.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000002096,MBR00000080,Professional,2023-09-21,2023-09-21,2023-10-21,PLN1759,1585582070,1585582070,Outpatient Clinic,In-Network,E11.9,E66.9,,,,,,,0,,93000,Radiology,,,,11,Office,1,188.05,81.0,46.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002097,MBR00000080,Institutional-IP,2022-12-21,2022-12-25,2023-01-10,PLN9567,1840431511,1840431511,Geriatrics,Out-of-Network,Z00.00,I10,,,,292,MS-DRG,10,4,Y,72148,Radiology,,,0636,21,Inpatient Hospital,3,1709.5,599.64,275.94,273.7,50.0,0.0,323.7,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002098,MBR00000080,Professional,2021-11-17,2021-11-17,2021-11-24,PLN8813,1752470395,1752470395,Home Health,In-Network,E11.65,J44.1,,,,,,,0,,99232,E&M,,,,11,Office,1,260.6,99.44,74.44,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002099,MBR00000080,Institutional-OP,2023-08-09,2023-08-09,2023-09-08,PLN9727,1438368327,1438368327,Home Health,In-Network,E66.9,R10.9,,,,,,,0,,99283,E&M,,,0636,22,Outpatient Hospital,1,229.63,128.23,47.0,0.0,75.0,6.23,81.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002100,MBR00000080,Professional,2022-12-10,2022-12-10,2023-01-09,PLN1554,1687650653,1687650653,Internal Medicine,In-Network,I50.9,N18.3,,,,,,,0,,86900,Pathology/Lab,,,,22,Outpatient Hospital,1,22.21,16.7,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002101,MBR00000080,Institutional-OP,2022-01-27,2022-01-27,2022-02-17,PLN8534,1268679390,1268679390,Critical Access Hospital,In-Network,I10,F41.9,,,,,,,0,,99283,E&M,,,0900,22,Outpatient Hospital,3,506.88,303.58,206.47,0.0,75.0,22.11,97.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002102,MBR00000080,Professional,2023-08-22,2023-08-22,2023-09-17,PLN2384,1624202402,1624202402,Orthopedic Surgery,In-Network,Z12.11,K21.0,,,,,,,0,,27130,Surgery,,,,11,Office,2,2534.06,1517.32,1329.49,137.83,50.0,0.0,187.83,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002103,MBR00000080,Professional,2021-08-18,2021-08-18,2021-09-23,PLN7436,1980712759,1980712759,Outpatient Clinic,Out-of-Network,Z12.11,I10,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,2,898.8,669.49,598.57,0.0,0.0,70.92,70.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002104,MBR00000080,Professional,2022-09-14,2022-09-14,2022-10-18,PLN5875,1752470395,1752470395,Home Health,In-Network,E11.9,Z23,,,,,,,0,,58661,Surgery,,,,11,Office,1,4802.23,3726.52,3676.52,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002105,MBR00000080,Professional,2023-01-27,2023-01-27,2023-02-24,PLN5393,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,E11.40,E11.9,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,2,3834.46,2470.95,2368.42,102.53,0.0,0.0,102.53,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002106,MBR00000080,Professional,2023-09-22,2023-09-22,2023-10-23,PLN8720,1645194539,1645194539,SNF,In-Network,E78.5,I10,,,,,,,0,,74177,Radiology,,,,11,Office,1,2514.39,1390.47,1289.35,101.12,0.0,0.0,101.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002107,MBR00000080,Institutional-OP,2021-05-31,2021-05-31,2021-07-09,PLN1580,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,Z00.00,Z87.891,,,,,,,0,,45380,Surgery,,,0450,22,Outpatient Hospital,1,2806.5,1201.08,1166.08,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000002108,MBR00000080,Professional,2021-11-11,2021-11-11,2021-11-30,PLN2953,1915531927,1915531927,Critical Access Hospital,In-Network,J20.9,J44.1,,,,,,,0,,99232,E&M,,,,12,Home,2,172.93,63.86,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-27,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000002109,MBR00000080,Professional,2023-07-09,2023-07-09,2023-07-28,PLN2919,1355166277,1355166277,Endocrinology,In-Network,N39.0,I63.9,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,1,2303.41,1483.12,1243.41,0.0,75.0,164.71,239.71,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000002110,MBR00000080,Institutional-IP,2022-07-02,2022-07-05,2022-07-19,PLN3856,1500949740,1500949740,Pediatrics,In-Network,Z51.11,G43.909,,,,292,MS-DRG,15,3,Y,66984,Surgery,,,0360,21,Inpatient Hospital,3,3344.77,2609.85,2472.44,0.0,0.0,137.41,137.41,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002111,MBR00000080,Institutional-OP,2023-04-07,2023-04-07,2023-04-25,PLN6851,1872272835,1872272835,Internal Medicine,In-Network,J06.9,F10.20,,,,,,,0,,27447,Surgery,,,0270,22,Outpatient Hospital,1,3698.07,2896.09,2871.09,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002112,MBR00000080,Professional,2023-04-28,2023-04-28,2023-05-30,PLN8110,1450094833,1450094833,Outpatient Clinic,In-Network,C50.912,I10,,,,,,,0,,27130,Surgery,,,,20,Urgent Care,2,5869.58,3127.93,3025.94,0.0,0.0,101.99,101.99,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002113,MBR00000080,Professional,2021-11-30,2021-11-30,2021-12-16,PLN6058,1239316214,1239316214,Internal Medicine,In-Network,Z79.4,Z12.31,,,,,,,0,,47562,Surgery,,,,49,Independent Clinic,3,3444.83,1343.12,1222.95,0.0,0.0,120.17,120.17,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002114,MBR00000080,Professional,2021-12-29,2021-12-29,2022-01-06,PLN1624,1585582070,1585582070,Outpatient Clinic,In-Network,Z00.00,M54.5,,,,,,,0,,45380,Surgery,,,,31,Skilled Nursing Facility,3,2245.08,1794.66,1769.66,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000002115,MBR00000080,Professional,2022-07-01,2022-07-01,2022-08-12,PLN3946,1713934949,1713934949,Neurology,In-Network,M17.11,I10,,,,,,,0,,99214,E&M,,,,49,Independent Clinic,3,335.88,208.17,0.0,208.17,0.0,0.0,208.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002116,MBR00000080,Professional,2021-01-31,2021-01-31,2021-02-25,PLN9950,1935547131,1935547131,Pulmonology,In-Network,F41.9,C50.912,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,1,66.53,33.42,0.0,33.42,50.0,0.0,83.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002117,MBR00000080,Professional,2023-05-26,2023-05-26,2023-06-06,PLN5807,1550154147,1550154147,Outpatient Clinic,In-Network,E11.9,E78.5,,,,,,,0,,27447,Surgery,,,,11,Office,1,6013.59,2203.79,1920.83,247.96,35.0,0.0,282.96,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002118,MBR00000080,Institutional-IP,2021-05-07,2021-05-11,2021-06-03,PLN2169,1366426662,1366426662,Urology,In-Network,E78.5,R10.9,,,,641,MS-DRG,20,4,Y,99221,E&M,,,0740,21,Inpatient Hospital,2,436.72,279.91,217.77,62.14,0.0,0.0,62.14,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000002119,MBR00000080,Institutional-OP,2023-10-21,2023-10-21,2023-11-22,PLN3012,1528335731,1528335731,Critical Access Hospital,In-Network,Z51.11,Z12.31,,,,,,,0,,99204,E&M,,,0510,22,Outpatient Hospital,2,574.52,255.96,70.53,185.43,0.0,0.0,185.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002120,MBR00000080,Professional,2023-05-03,2023-05-03,2023-05-10,PLN2137,1273488618,1273488618,General Acute Care Hospital,In-Network,G43.909,B97.89,,,,,,,0,,58661,Surgery,,,,49,Independent Clinic,1,3405.94,2285.62,2268.13,17.49,0.0,0.0,17.49,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002121,MBR00000080,Professional,2022-01-21,2022-01-21,2022-02-18,PLN4029,1390307371,1390307371,DME Supplier,In-Network,J44.1,E11.65,,,,,,,0,,99222,E&M,,,,11,Office,3,337.63,241.7,216.7,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002122,MBR00000080,Institutional-OP,2021-03-21,2021-03-21,2021-04-23,PLN1777,1687650653,1687650653,Internal Medicine,In-Network,Z12.31,M81.0,,,,,,,0,,99284,E&M,,,0360,22,Outpatient Hospital,2,768.62,330.74,0.0,330.74,50.0,0.0,380.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002123,MBR00000080,Institutional-IP,2023-05-16,2023-05-20,2023-06-11,PLN2220,1135158374,1135158374,Pulmonology,In-Network,K21.0,F41.9,,,,872,MS-DRG,8,4,Y,99213,E&M,,,0200,21,Inpatient Hospital,2,258.55,122.63,0.0,122.63,15.0,0.0,137.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002124,MBR00000080,Institutional-OP,2022-05-07,2022-05-07,2022-05-27,PLN8072,1438368327,1438368327,Home Health,In-Network,N40.0,M54.5,,,,,,,0,,G0444,Medicine,,,0730,22,Outpatient Hospital,2,96.4,54.0,54.0,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000002125,MBR00000080,Institutional-OP,2021-08-01,2021-08-01,2021-08-14,PLN2171,1948810580,1948810580,DME Supplier,In-Network,Z00.01,E11.65,,,,,,,0,,66984,Surgery,,,0120,22,Outpatient Hospital,2,3317.8,1971.53,1583.78,387.75,0.0,0.0,387.75,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002126,MBR00000080,Institutional-IP,2022-04-16,2022-04-23,2022-05-23,PLN4175,1645194539,1645194539,SNF,In-Network,M81.0,E11.40,,,,682,MS-DRG,2,7,Y,90686,Medicine,,,0761,21,Inpatient Hospital,2,77.29,53.32,0.0,53.32,0.0,0.0,53.32,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000002127,MBR00000080,Institutional-OP,2023-09-17,2023-09-17,2023-09-28,PLN8977,1295371663,1295371663,Critical Access Hospital,In-Network,Z12.31,Z00.00,,,,,,,0,,47562,Surgery,,,0360,22,Outpatient Hospital,3,4832.07,1636.56,1548.65,72.91,15.0,0.0,87.91,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002128,MBR00000080,Professional,2023-01-24,2023-01-24,2023-02-04,PLN5298,1266606767,1266606767,ASC,In-Network,B97.89,I25.10,,,,,,,0,,85025,Pathology/Lab,,,,20,Urgent Care,2,61.86,43.85,0.0,43.85,0.0,0.0,43.85,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000002129,MBR00000080,Institutional-OP,2023-01-22,2023-01-22,2023-02-10,PLN6060,1514306773,1514306773,Endocrinology,In-Network,Z79.4,E11.9,,,,,,,0,,58661,Surgery,,,0900,22,Outpatient Hospital,2,4672.24,3761.82,3412.21,274.61,75.0,0.0,349.61,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002130,MBR00000080,Institutional-OP,2022-07-18,2022-07-18,2022-08-29,PLN4493,1205377316,1205377316,Orthopedic Surgery,In-Network,Z00.00,E78.5,,,,,,,0,,99283,E&M,,,0730,22,Outpatient Hospital,1,395.99,259.3,259.3,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002131,MBR00000080,Professional,2021-06-17,2021-06-17,2021-06-30,PLN8074,1795618275,1795618275,Pulmonology,In-Network,Z87.891,J20.9,,,,,,,0,,G0468,Medicine,,,,22,Outpatient Hospital,2,289.36,135.32,120.32,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002132,MBR00000080,Institutional-IP,2023-11-06,2023-11-08,2023-12-15,PLN6484,1817234602,1817234602,Clinical Laboratory,In-Network,Z23,E11.9,,,,470,MS-DRG,18,2,Y,90460,Medicine,,,0900,21,Inpatient Hospital,2,51.18,35.98,19.19,0.0,15.0,1.79,16.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002133,MBR00000080,Professional,2023-03-22,2023-03-22,2023-04-28,PLN1739,1542828721,1542828721,Orthopedic Surgery,In-Network,N18.3,Z00.00,,,,,,,0,,80053,Pathology/Lab,,,,23,Emergency Room,3,77.84,37.0,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-27,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002134,MBR00000080,Professional,2022-07-19,2022-07-19,2022-07-26,PLN7844,1422747896,1422747896,Urology,In-Network,Z23,Z12.31,,,,,,,0,,78452,Radiology,,,,50,Federally Qualified Health Center,1,2571.63,878.28,743.33,119.95,15.0,0.0,134.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002135,MBR00000080,Professional,2023-03-04,2023-03-04,2023-04-14,PLN6076,1125190055,1125190055,Nephrology,In-Network,I50.9,Z00.00,,,,,,,0,,27130,Surgery,,,,11,Office,1,6925.3,2971.88,2795.37,135.16,0.0,41.35,176.51,0.0,Paid,,,1,,0,0,1,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000002136,MBR00000080,Institutional-IP,2022-02-02,2022-02-06,2022-03-08,PLN9114,1545347862,1545347862,SNF,In-Network,I10,Z00.00,,,,291,MS-DRG,20,4,Y,99213,E&M,,,0510,21,Inpatient Hospital,3,260.98,184.42,149.42,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002137,MBR00000081,Professional,2023-03-24,2023-03-24,2023-04-22,PLN5081,1609138981,1609138981,Critical Access Hospital,In-Network,E66.9,I10,,,,,,,0,,27130,Surgery,,,,11,Office,2,3085.87,1551.79,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-15,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002138,MBR00000081,Institutional-IP,2023-11-26,2023-12-03,2023-12-13,PLN9337,1500037969,1500037969,Pulmonology,In-Network,Z12.31,E78.5,,,,872,MS-DRG,11,7,U,83036,Pathology/Lab,,,0120,21,Inpatient Hospital,3,72.55,59.61,59.61,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000002139,MBR00000081,Institutional-IP,2022-01-13,2022-01-21,2022-01-30,PLN6855,1213165847,1213165847,Critical Access Hospital,In-Network,Z00.00,E78.5,,,,603,MS-DRG,4,8,N,47562,Surgery,,,0761,21,Inpatient Hospital,2,3497.76,2593.19,2205.67,0.0,75.0,312.52,387.52,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002140,MBR00000081,Professional,2021-01-10,2021-01-10,2021-02-10,PLN3434,1749494482,1749494482,Pediatrics,In-Network,I10,Z00.00,,,,,,,0,,90686,Medicine,,,,81,Independent Laboratory,2,129.25,51.19,51.19,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000002141,MBR00000081,Professional,2023-03-22,2023-03-22,2023-04-04,PLN8177,1125190055,1125190055,Nephrology,In-Network,M54.5,Z00.00,,,,,,,0,,70450,Radiology,,,,22,Outpatient Hospital,2,1457.25,1094.62,733.97,335.65,25.0,0.0,360.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002142,MBR00000081,Professional,2023-07-23,2023-07-23,2023-09-03,PLN9140,1624802371,1624802371,ASC,Out-of-Network,K21.0,E11.9,,,,,,,0,,99283,E&M,,,,11,Office,3,268.74,224.51,224.51,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002143,MBR00000081,Institutional-IP,2023-06-25,2023-06-29,2023-07-13,PLN8355,1845900543,1845900543,ASC,In-Network,F41.9,Z00.00,,,,641,MS-DRG,9,4,Y,99284,E&M,,,0370,21,Inpatient Hospital,1,322.04,240.61,58.98,156.63,25.0,0.0,181.63,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000002144,MBR00000081,Institutional-OP,2023-12-04,2023-12-04,2023-12-24,PLN4882,1239316214,1239316214,Internal Medicine,In-Network,F41.9,E11.9,,,,,,,0,,99233,E&M,,,0360,22,Outpatient Hospital,2,509.13,361.48,276.85,0.0,35.0,49.63,84.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002145,MBR00000081,Professional,2022-01-16,2022-01-16,2022-01-27,PLN4460,1500949740,1500949740,Pediatrics,In-Network,F03.90,Z00.00,,,,,,,0,,45378,Surgery,,,,21,Inpatient Hospital,2,2509.8,998.58,880.18,118.4,0.0,0.0,118.4,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000002146,MBR00000081,Institutional-IP,2023-10-03,2023-10-05,2023-11-14,PLN8990,1266606767,1266606767,ASC,In-Network,J20.9,Z12.31,,,,194,MS-DRG,19,2,N,97530,Medicine,,,0320,21,Inpatient Hospital,2,307.1,115.89,90.89,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002147,MBR00000081,Institutional-OP,2021-08-16,2021-08-16,2021-09-18,PLN5027,1745114564,1745114564,Endocrinology,In-Network,F32.9,K21.0,,,,,,,0,,G0468,Medicine,,,0510,22,Outpatient Hospital,2,316.83,178.02,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002148,MBR00000081,Institutional-OP,2022-10-05,2022-10-05,2022-10-13,PLN1752,1389336600,1389336600,Critical Access Hospital,In-Network,E78.5,I10,,,,,,,0,,86900,Pathology/Lab,,,0270,22,Outpatient Hospital,3,37.79,16.89,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002149,MBR00000081,Professional,2023-08-31,2023-08-31,2023-10-01,PLN3143,1991459367,1991459367,Neurology,Out-of-Network,E11.40,E78.5,,,,,,,0,,99213,E&M,,,,21,Inpatient Hospital,1,140.73,65.01,0.0,65.01,35.0,0.0,100.01,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002150,MBR00000081,Professional,2023-09-30,2023-09-30,2023-10-11,PLN2242,1872272835,1872272835,Internal Medicine,In-Network,E11.9,F10.20,,,,,,,0,,G0439,Medicine,,,,65,End-Stage Renal Disease,2,619.56,215.43,132.07,83.36,0.0,0.0,83.36,0.0,Paid,,,0,,0,1,0,0,0,1,Upcoding,0,0,0,1,0
CLM0000002151,MBR00000081,Institutional-OP,2022-11-11,2022-11-11,2022-12-25,PLN6749,1168246159,1168246159,Internal Medicine,In-Network,I10,Z12.31,,,,,,,0,,93225,Medicine,,,0320,22,Outpatient Hospital,2,638.44,328.54,328.54,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002152,MBR00000081,Professional,2022-08-21,2022-08-21,2022-09-14,PLN5583,1227362142,1227362142,DME Supplier,In-Network,F41.9,E11.9,,,,,,,0,,76700,Radiology,,,,20,Urgent Care,3,1382.95,628.24,419.55,208.69,0.0,0.0,208.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002153,MBR00000081,Professional,2022-05-20,2022-05-20,2022-06-26,PLN3684,1717912431,1717912431,Oncology,In-Network,M17.11,J44.1,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,2,594.77,474.03,311.01,77.71,35.0,50.31,163.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002154,MBR00000081,Professional,2023-08-08,2023-08-08,2023-09-01,PLN4730,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,Z00.00,I10,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,1,162.02,127.6,127.6,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002155,MBR00000081,Professional,2023-08-22,2023-08-22,2023-09-22,PLN8714,1980712759,1980712759,Outpatient Clinic,Out-of-Network,Z51.11,F32.9,,,,,,,0,,33533,Surgery,,,,11,Office,1,17186.16,13181.62,0.0,56.46,0.0,0.0,56.46,0.0,Denied,CO-11,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002156,MBR00000081,Institutional-IP,2021-09-20,2021-09-21,2021-10-09,PLN2434,1103747954,1103747954,Urology,In-Network,Z23,G43.909,,,,682,MS-DRG,1,1,Y,99232,E&M,,,0370,21,Inpatient Hospital,2,394.94,244.22,150.06,0.0,75.0,19.16,94.16,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002157,MBR00000081,Institutional-OP,2021-05-29,2021-05-29,2021-07-08,PLN3726,1486164553,1486164553,DME Supplier,In-Network,K21.0,B97.89,,,,,,,0,,72148,Radiology,,,0360,22,Outpatient Hospital,3,2733.58,1620.64,1620.64,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002158,MBR00000081,Institutional-OP,2023-06-11,2023-06-11,2023-07-24,PLN8823,1168881145,1168881145,Orthopedic Surgery,In-Network,I10,I11.9,,,,,,,0,,70450,Radiology,,,0450,22,Outpatient Hospital,3,1238.55,487.48,427.0,0.0,15.0,45.48,60.48,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002159,MBR00000081,Institutional-IP,2023-06-07,2023-06-10,2023-07-05,PLN1416,1266606767,1266606767,ASC,In-Network,I63.9,I10,,,,291,MS-DRG,15,3,Y,99406,Medicine,,,0761,21,Inpatient Hospital,2,58.69,21.48,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002160,MBR00000081,Institutional-OP,2021-04-20,2021-04-20,2021-04-29,PLN7185,1438368327,1438368327,Home Health,In-Network,J06.9,I63.9,,,,,,,0,,66984,Surgery,,,0740,22,Outpatient Hospital,2,1656.11,847.9,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-119,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002161,MBR00000081,Institutional-OP,2022-06-22,2022-06-22,2022-07-20,PLN1187,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,I10,Z00.00,,,,,,,0,,99284,E&M,,,0120,22,Outpatient Hospital,1,402.03,183.82,0.0,183.82,0.0,0.0,183.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002162,MBR00000081,Institutional-OP,2022-07-09,2022-07-09,2022-08-15,PLN2738,1609526529,1609526529,Psychiatry,In-Network,Z00.00,E78.5,,,,,,,0,,99204,E&M,,,0740,22,Outpatient Hospital,1,264.89,153.92,0.0,153.92,50.0,0.0,203.92,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002163,MBR00000081,Institutional-OP,2021-02-16,2021-02-16,2021-03-20,PLN4326,1273488618,1273488618,General Acute Care Hospital,In-Network,Z23,F41.9,,,,,,,0,,99214,E&M,,,0120,22,Outpatient Hospital,3,327.2,130.13,105.13,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002164,MBR00000081,Institutional-OP,2022-12-29,2022-12-29,2023-01-28,PLN9575,1433937353,1433937353,Nephrology,In-Network,M54.5,Z12.31,,,,,,,0,,99284,E&M,,,0301,22,Outpatient Hospital,1,744.41,528.46,113.68,389.78,25.0,0.0,414.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002165,MBR00000081,Professional,2023-12-02,2023-12-02,2023-12-12,PLN3702,1132188260,1132188260,Family Medicine,In-Network,Z00.00,Z23,,,,,,,0,,93000,Radiology,,,,21,Inpatient Hospital,2,103.5,85.07,0.0,85.07,25.0,0.0,110.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002166,MBR00000082,Professional,2021-08-20,2021-08-20,2021-09-30,PLN6299,1713934949,1713934949,Neurology,In-Network,J20.9,I48.91,,,,,,,0,,74177,Radiology,,,,50,Federally Qualified Health Center,1,2840.28,1072.27,910.86,0.0,0.0,161.41,161.41,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002167,MBR00000082,Professional,2023-05-02,2023-05-02,2023-05-14,PLN2601,1355166277,1355166277,Endocrinology,In-Network,E78.5,E11.9,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,1,86.4,55.85,55.85,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002168,MBR00000082,Institutional-IP,2021-03-30,2021-04-02,2021-05-10,PLN7604,1609526529,1609526529,Psychiatry,In-Network,F41.9,N18.3,,,,871,MS-DRG,1,3,Y,99283,E&M,,,0320,21,Inpatient Hospital,2,475.42,336.8,0.0,336.8,0.0,0.0,336.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002169,MBR00000082,Institutional-OP,2021-08-24,2021-08-24,2021-09-07,PLN5714,1109850785,1109850785,ASC,Out-of-Network,I10,Z12.11,,,,,,,0,,76700,Radiology,,,0320,22,Outpatient Hospital,2,1021.76,579.04,579.04,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002170,MBR00000082,Institutional-OP,2022-09-11,2022-09-11,2022-10-06,PLN5361,1980712759,1980712759,Outpatient Clinic,Out-of-Network,M54.5,Z00.00,,,,,,,0,,78452,Radiology,,,0320,22,Outpatient Hospital,3,6244.08,4265.96,3773.84,492.12,0.0,0.0,492.12,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002171,MBR00000082,Institutional-OP,2023-10-09,2023-10-09,2023-11-01,PLN8867,1716521444,1716521444,Oncology,In-Network,I11.9,Z00.00,,,,,,,0,,99204,E&M,,,0200,22,Outpatient Hospital,1,569.83,233.91,218.91,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002172,MBR00000082,Institutional-OP,2023-08-28,2023-08-28,2023-09-18,PLN4847,1438368327,1438368327,Home Health,In-Network,J06.9,E11.9,,,,,,,0,,76700,Radiology,,,0730,22,Outpatient Hospital,2,1322.54,866.28,866.28,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002173,MBR00000082,Professional,2023-10-22,2023-10-22,2023-11-06,PLN4543,1845900543,1845900543,ASC,In-Network,Z79.4,Z12.31,,,,,,,0,,99204,E&M,,,,50,Federally Qualified Health Center,2,405.3,280.94,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002174,MBR00000082,Professional,2023-12-18,2023-12-18,2024-01-14,PLN8285,1702692193,1702692193,Physical Therapy,In-Network,I10,Z12.31,,,,,,,0,,99284,E&M,,,,49,Independent Clinic,2,889.99,623.15,546.79,76.36,0.0,0.0,76.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002175,MBR00000082,Institutional-IP,2023-05-27,2023-05-31,2023-06-24,PLN9599,1273488618,1273488618,General Acute Care Hospital,In-Network,I10,E78.5,,,,194,MS-DRG,17,4,Y,23472,Surgery,,,0320,21,Inpatient Hospital,2,4758.86,2594.68,2594.68,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002176,MBR00000082,Professional,2022-02-02,2022-02-02,2022-02-24,PLN3205,1168246159,1168246159,Internal Medicine,In-Network,J45.20,K21.0,,,,,,,0,,77067,Radiology,,,,65,End-Stage Renal Disease,1,342.43,169.47,169.47,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000002177,MBR00000082,Institutional-OP,2021-05-20,2021-05-20,2021-06-15,PLN3587,1968299309,1968299309,Internal Medicine,In-Network,K21.0,J18.9,,,,,,,0,,93000,Radiology,,,0120,22,Outpatient Hospital,2,82.78,30.1,0.0,0.0,25.0,0.13,25.13,0.0,Denied,CO-50,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002178,MBR00000082,Institutional-IP,2023-06-20,2023-06-22,2023-06-29,PLN9284,1366286000,1366286000,SNF,In-Network,K21.0,I10,,,,871,MS-DRG,12,2,Y,86900,Pathology/Lab,,,0730,21,Inpatient Hospital,2,61.02,23.06,23.06,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000002179,MBR00000082,Professional,2021-07-24,2021-07-24,2021-08-12,PLN8575,1295371663,1295371663,Critical Access Hospital,In-Network,E78.5,J20.9,,,,,,,0,,99284,E&M,,,,11,Office,2,890.96,655.34,0.0,394.45,0.0,0.0,394.45,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002180,MBR00000082,Institutional-IP,2022-07-25,2022-07-30,2022-09-05,PLN8550,1422747896,1422747896,Urology,In-Network,N40.0,E11.65,,,,603,MS-DRG,23,5,Y,27447,Surgery,,,0270,21,Inpatient Hospital,1,5942.79,4455.52,4072.93,0.0,0.0,382.59,382.59,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002181,MBR00000082,Institutional-IP,2023-04-06,2023-04-13,2023-04-17,PLN6037,1644128543,1644128543,Gastroenterology,In-Network,R51,N18.3,,,,641,MS-DRG,10,7,Y,76700,Radiology,,,0120,21,Inpatient Hospital,1,1229.93,1002.01,840.34,0.0,75.0,86.67,161.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002182,MBR00000083,Institutional-OP,2021-02-07,2021-02-07,2021-02-19,PLN3606,1213165847,1213165847,Critical Access Hospital,In-Network,Z12.31,F41.9,,,,,,,0,,47562,Surgery,,,0450,22,Outpatient Hospital,3,5248.46,3825.93,3163.35,0.0,0.0,662.58,662.58,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002183,MBR00000083,Institutional-OP,2023-09-28,2023-09-28,2023-10-17,PLN3555,1224179551,1224179551,Physical Therapy,In-Network,I10,E78.5,,,,,,,0,,81001,Pathology/Lab,,,0450,22,Outpatient Hospital,1,56.28,44.24,0.0,44.24,35.0,0.0,79.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002184,MBR00000083,Professional,2021-11-29,2021-11-29,2022-01-01,PLN8011,1856686341,1856686341,Geriatrics,In-Network,F03.90,I48.91,,,,,,,0,,99204,E&M,,,,31,Skilled Nursing Facility,2,378.11,144.59,109.59,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002185,MBR00000083,Institutional-OP,2021-08-24,2021-08-24,2021-10-04,PLN6095,1687650653,1687650653,Internal Medicine,In-Network,Z12.31,E11.9,,,,,,,0,,87491,Pathology/Lab,,,0636,22,Outpatient Hospital,2,184.42,67.81,65.1,0.0,0.0,2.71,2.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002186,MBR00000083,Professional,2022-02-12,2022-02-12,2022-03-11,PLN1018,1845057593,1845057593,Orthopedic Surgery,In-Network,J06.9,I10,,,,,,,0,,87491,Pathology/Lab,,,,23,Emergency Room,2,244.96,144.61,115.63,0.0,15.0,13.98,28.98,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002187,MBR00000083,Professional,2022-05-20,2022-05-20,2022-06-08,PLN1981,1564502315,1564502315,ASC,In-Network,Z12.31,Z12.31,,,,,,,0,,80061,Pathology/Lab,,,,31,Skilled Nursing Facility,1,50.56,41.42,0.0,41.42,0.0,0.0,41.42,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002188,MBR00000083,Professional,2022-05-13,2022-05-13,2022-05-20,PLN2639,1518055405,1518055405,Urology,In-Network,E78.5,E78.5,,,,,,,0,,66984,Surgery,,,,12,Home,2,2620.26,2041.77,1724.0,91.86,0.0,225.91,317.77,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002189,MBR00000083,Institutional-OP,2021-06-19,2021-06-19,2021-07-12,PLN6357,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,E78.5,K21.0,,,,,,,0,,99203,E&M,,,0120,22,Outpatient Hospital,2,238.83,74.68,48.83,25.85,0.0,0.0,25.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002190,MBR00000083,Institutional-OP,2021-07-27,2021-07-27,2021-08-06,PLN9323,1364429278,1364429278,OB/GYN,In-Network,I10,F32.9,,,,,,,0,,99222,E&M,,,0360,22,Outpatient Hospital,2,470.78,370.03,345.01,0.0,25.0,0.02,25.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002191,MBR00000083,Professional,2022-06-08,2022-06-08,2022-07-04,PLN1374,1585582070,1585582070,Outpatient Clinic,In-Network,Z12.31,Z12.31,,,,,,,0,,97110,Medicine,,,,20,Urgent Care,2,289.15,111.07,48.63,39.14,15.0,8.3,62.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002192,MBR00000083,Institutional-OP,2021-09-05,2021-09-05,2021-09-19,PLN3826,1556140803,1556140803,Cardiology,In-Network,E78.5,J45.20,,,,,,,0,,97110,Medicine,,,0761,22,Outpatient Hospital,1,255.6,205.73,0.0,205.73,50.0,0.0,255.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002193,MBR00000083,Institutional-OP,2022-12-05,2022-12-05,2022-12-17,PLN6991,1453936007,1453936007,ASC,In-Network,F32.9,M54.5,,,,,,,0,,99233,E&M,,,0360,22,Outpatient Hospital,2,378.85,238.4,0.0,238.4,0.0,0.0,238.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002194,MBR00000083,Institutional-OP,2023-09-12,2023-09-12,2023-09-30,PLN9427,1935547131,1935547131,Pulmonology,In-Network,I50.9,Z00.00,,,,,,,0,,45378,Surgery,,,0450,22,Outpatient Hospital,3,2074.4,1249.84,750.53,441.66,0.0,57.65,499.31,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000002195,MBR00000083,Professional,2021-01-21,2021-01-21,2021-02-07,PLN7439,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,E11.65,N18.3,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,2,286.89,134.46,134.46,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002196,MBR00000083,Professional,2021-02-09,2021-02-09,2021-03-22,PLN1025,1186826716,1186826716,Physical Therapy,In-Network,Z12.31,Z00.00,,,,,,,0,,99213,E&M,,,,11,Office,3,157.08,117.18,0.0,117.18,25.0,0.0,142.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002197,MBR00000083,Professional,2022-12-06,2022-12-06,2023-01-08,PLN2162,1590915516,1590915516,Physical Therapy,Out-of-Network,E78.5,R05,,,,,,,0,,84443,Pathology/Lab,,,,22,Outpatient Hospital,3,116.94,48.33,0.0,48.33,0.0,0.0,48.33,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002198,MBR00000083,Institutional-OP,2021-02-01,2021-02-01,2021-03-01,PLN2732,1295371663,1295371663,Critical Access Hospital,In-Network,E66.9,I25.10,,,,,,,0,,90686,Medicine,,,0360,22,Outpatient Hospital,3,61.11,38.48,31.19,0.0,0.0,7.29,7.29,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000002199,MBR00000083,Professional,2022-12-02,2022-12-02,2022-12-23,PLN7993,1500037969,1500037969,Pulmonology,In-Network,I25.10,J06.9,,,,,,,0,,33533,Surgery,,,,23,Emergency Room,2,19121.5,12562.92,12397.11,165.81,0.0,0.0,165.81,0.0,Paid,,,1,,1,0,0,1,0,0,None,0,0,0,0,0
CLM0000002200,MBR00000083,Professional,2022-06-21,2022-06-21,2022-07-03,PLN1086,1125190055,1125190055,Nephrology,In-Network,Z51.11,J06.9,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,1,39.79,16.08,0.0,16.08,0.0,0.0,16.08,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002201,MBR00000083,Institutional-OP,2022-05-14,2022-05-14,2022-06-27,PLN6810,1780163051,1780163051,SNF,In-Network,Z00.01,Z12.31,,,,,,,0,,90837,Medicine,,,0740,22,Outpatient Hospital,3,420.92,265.91,243.65,0.0,0.0,22.26,22.26,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002202,MBR00000083,Professional,2022-10-27,2022-10-27,2022-11-26,PLN3570,1590915516,1590915516,Physical Therapy,Out-of-Network,J06.9,E78.5,,,,,,,0,,93306,Radiology,,,,22,Outpatient Hospital,2,1728.7,1121.88,1046.88,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002203,MBR00000083,Institutional-IP,2023-09-08,2023-09-11,2023-10-17,PLN9635,1511044648,1511044648,Endocrinology,In-Network,I10,F32.9,,,,872,MS-DRG,12,3,Y,81001,Pathology/Lab,,,0730,21,Inpatient Hospital,1,37.87,19.46,0.0,19.46,25.0,0.0,44.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002204,MBR00000083,Institutional-OP,2021-05-20,2021-05-20,2021-05-27,PLN8182,1713934949,1713934949,Neurology,In-Network,Z12.31,I10,,,,,,,0,,99233,E&M,,,0301,22,Outpatient Hospital,2,354.2,250.78,0.0,250.78,35.0,0.0,285.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002205,MBR00000083,Professional,2021-05-28,2021-05-28,2021-06-09,PLN1682,1728018911,1728018911,Nephrology,In-Network,I10,M17.11,,,,,,,0,,80061,Pathology/Lab,,,,22,Outpatient Hospital,1,60.61,38.79,38.79,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002206,MBR00000083,Professional,2023-02-02,2023-02-02,2023-03-07,PLN7855,1727809972,1727809972,Home Health,In-Network,M17.11,Z23,,,,,,,0,,99213,E&M,,,,31,Skilled Nursing Facility,1,274.06,178.55,0.0,178.55,0.0,0.0,178.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002207,MBR00000083,Professional,2021-02-26,2021-02-26,2021-03-05,PLN7230,1530904931,1530904931,Internal Medicine,In-Network,I10,Z12.31,,,,,,,0,,81001,Pathology/Lab,,,,21,Inpatient Hospital,1,49.31,24.88,0.0,24.88,15.0,0.0,39.88,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002208,MBR00000083,Institutional-IP,2022-04-15,2022-04-16,2022-05-16,PLN6688,1453283987,1453283987,Critical Access Hospital,In-Network,Z00.01,E11.9,,,,194,MS-DRG,13,1,Y,93225,Medicine,,,0370,21,Inpatient Hospital,1,604.71,496.45,0.0,314.04,75.0,0.0,389.04,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002209,MBR00000083,Professional,2022-06-27,2022-06-27,2022-07-22,PLN1709,1109850785,1109850785,ASC,Out-of-Network,K21.0,Z00.00,,,,,,,0,,99284,E&M,,,,20,Urgent Care,2,414.55,151.35,88.8,62.55,0.0,0.0,62.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002210,MBR00000083,Professional,2022-03-05,2022-03-05,2022-03-28,PLN5712,1168246159,1168246159,Internal Medicine,In-Network,Z00.01,R05,,,,,,,0,,33533,Surgery,,,,21,Inpatient Hospital,2,25593.12,20227.39,20227.39,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002211,MBR00000083,Professional,2022-08-07,2022-08-07,2022-08-30,PLN8805,1997536841,1997536841,Family Medicine,Out-of-Network,J20.9,F41.9,,,,,,,0,,58661,Surgery,,,,81,Independent Laboratory,3,3911.24,2962.28,2927.28,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000002212,MBR00000083,Professional,2021-05-05,2021-05-05,2021-05-13,PLN3800,1453283987,1453283987,Critical Access Hospital,In-Network,E11.9,Z12.11,,,,,,,0,,99203,E&M,,,,11,Office,2,313.68,134.34,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002213,MBR00000083,Institutional-OP,2021-10-20,2021-10-20,2021-11-01,PLN6332,1561134315,1561134315,DME Supplier,In-Network,I10,N18.3,,,,,,,0,,99222,E&M,,,0301,22,Outpatient Hospital,3,641.21,194.2,160.06,0.0,0.0,34.14,34.14,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002214,MBR00000083,Professional,2021-01-06,2021-01-06,2021-01-24,PLN3742,1283743001,1283743001,Family Medicine,In-Network,C50.912,Z00.00,,,,,,,0,,85025,Pathology/Lab,,,,22,Outpatient Hospital,2,85.35,66.24,0.0,0.0,0.0,3.94,3.94,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002215,MBR00000083,Institutional-OP,2023-11-19,2023-11-19,2023-12-20,PLN9523,1865904917,1865904917,Outpatient Clinic,In-Network,Z00.00,I10,,,,,,,0,,G0468,Medicine,,,0120,22,Outpatient Hospital,3,702.42,293.88,177.3,0.0,75.0,41.58,116.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002216,MBR00000083,Institutional-OP,2023-07-01,2023-07-01,2023-07-22,PLN6383,1542828721,1542828721,Orthopedic Surgery,In-Network,I63.9,N39.0,,,,,,,0,,99214,E&M,,,0370,22,Outpatient Hospital,1,398.13,147.49,67.46,0.0,75.0,5.03,80.03,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000002217,MBR00000083,Institutional-OP,2021-10-05,2021-10-05,2021-11-13,PLN3504,1915531927,1915531927,Critical Access Hospital,In-Network,Z00.00,Z00.00,,,,,,,0,,77067,Radiology,,,0450,22,Outpatient Hospital,2,728.65,528.95,366.53,162.42,0.0,0.0,162.42,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000002218,MBR00000084,Institutional-IP,2021-02-09,2021-02-11,2021-02-24,PLN8972,1500037969,1500037969,Pulmonology,In-Network,N18.3,N18.3,,,,194,MS-DRG,23,2,Y,93306,Radiology,,,0270,21,Inpatient Hospital,1,2797.11,1801.17,1801.17,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002219,MBR00000084,Professional,2021-10-23,2021-10-23,2021-11-26,PLN3743,1687650653,1687650653,Internal Medicine,In-Network,M54.5,I63.9,,,,,,,0,,27130,Surgery,,,,49,Independent Clinic,2,7086.28,4563.9,4319.43,169.47,75.0,0.0,244.47,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002220,MBR00000084,Professional,2023-11-13,2023-11-13,2023-11-26,PLN3683,1334916761,1334916761,ASC,In-Network,N18.3,Z23,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,2,445.38,194.81,159.81,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002221,MBR00000084,Professional,2023-06-08,2023-06-08,2023-06-15,PLN6966,1948810580,1948810580,DME Supplier,In-Network,I48.91,E66.9,,,,,,,0,,93225,Medicine,,,,11,Office,2,611.08,505.54,470.54,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002222,MBR00000084,Professional,2022-12-23,2022-12-23,2023-01-23,PLN2302,1800011727,1800011727,Clinical Laboratory,Out-of-Network,I10,R51,,,,,,,0,,45378,Surgery,,,,81,Independent Laboratory,2,2558.06,2008.04,2008.04,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000002223,MBR00000084,Institutional-OP,2023-10-08,2023-10-08,2023-10-30,PLN2757,1939033455,1939033455,Pulmonology,In-Network,B97.89,E11.9,,,,,,,0,,G0444,Medicine,,,0360,22,Outpatient Hospital,2,102.86,35.91,0.0,35.91,15.0,0.0,50.91,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000002224,MBR00000084,Professional,2021-07-13,2021-07-13,2021-08-23,PLN6348,1899127912,1899127912,Neurology,In-Network,I25.10,F41.9,,,,,,,0,,82043,Pathology/Lab,,,,23,Emergency Room,3,70.54,58.3,0.0,58.3,35.0,0.0,93.3,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002225,MBR00000084,Professional,2022-08-11,2022-08-11,2022-09-10,PLN8392,1809014947,1809014947,Urology,In-Network,M54.5,Z23,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,1,45.39,21.95,0.0,21.95,15.0,0.0,36.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002226,MBR00000084,Institutional-OP,2023-05-20,2023-05-20,2023-05-28,PLN5824,1125190055,1125190055,Nephrology,In-Network,E11.40,Z23,,,,,,,0,,99232,E&M,,,0730,22,Outpatient Hospital,3,303.77,252.2,112.0,135.74,0.0,4.46,140.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002227,MBR00000084,Institutional-OP,2021-01-21,2021-01-21,2021-02-28,PLN7511,1728018911,1728018911,Nephrology,In-Network,F10.20,Z00.00,,,,,,,0,,58661,Surgery,,,0370,22,Outpatient Hospital,1,3124.94,1678.17,1472.26,0.0,75.0,130.91,205.91,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002228,MBR00000085,Institutional-OP,2022-04-22,2022-04-22,2022-05-26,PLN4695,1135158374,1135158374,Pulmonology,In-Network,I10,E11.9,,,,,,,0,,99232,E&M,,,0450,22,Outpatient Hospital,2,193.69,105.28,98.06,0.0,0.0,7.22,7.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002229,MBR00000085,Professional,2022-01-25,2022-01-25,2022-03-10,PLN6197,1994661817,1994661817,SNF,Out-of-Network,Z12.31,Z79.4,,,,,,,0,,45380,Surgery,,,,11,Office,1,1274.95,518.28,503.28,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000002230,MBR00000085,Institutional-IP,2021-07-13,2021-07-19,2021-07-25,PLN6859,1366426662,1366426662,Urology,In-Network,R51,R05,,,,682,MS-DRG,16,6,U,90460,Medicine,,,0370,21,Inpatient Hospital,3,27.03,11.46,11.28,0.0,0.0,0.18,0.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002231,MBR00000085,Professional,2021-09-03,2021-09-03,2021-10-11,PLN5520,1590915516,1590915516,Physical Therapy,Out-of-Network,I25.10,Z23,,,,,,,0,,72148,Radiology,,,,11,Office,1,1436.3,615.14,470.49,144.65,0.0,0.0,144.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002232,MBR00000086,Institutional-IP,2023-11-27,2023-12-07,2023-12-22,PLN7906,1689639685,1689639685,SNF,In-Network,F41.9,Z00.00,,,,196,MS-DRG,17,10,Y,66984,Surgery,,,0900,21,Inpatient Hospital,3,2560.27,1675.61,1675.61,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002233,MBR00000086,Institutional-IP,2022-07-14,2022-07-23,2022-08-26,PLN4142,1366576336,1366576336,Geriatrics,In-Network,Z12.31,J18.9,,,,871,MS-DRG,18,9,Y,99214,E&M,,,0510,21,Inpatient Hospital,1,441.91,291.01,1.93,264.08,25.0,0.0,289.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002234,MBR00000086,Institutional-OP,2021-03-31,2021-03-31,2021-04-14,PLN5368,1571574052,1571574052,Critical Access Hospital,In-Network,N39.0,Z87.891,,,,,,,0,,99214,E&M,,,0200,22,Outpatient Hospital,1,290.99,161.3,0.0,91.45,0.0,0.0,91.45,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002235,MBR00000086,Professional,2023-01-18,2023-01-18,2023-02-15,PLN3246,1767011137,1767011137,DME Supplier,In-Network,E11.9,Z23,,,,,,,0,,99283,E&M,,,,20,Urgent Care,2,494.68,253.61,0.77,217.66,35.0,0.18,252.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002236,MBR00000086,Institutional-OP,2022-10-10,2022-10-10,2022-11-17,PLN7545,1717546253,1717546253,Family Medicine,In-Network,I10,E66.9,,,,,,,0,,99284,E&M,,,0360,22,Outpatient Hospital,3,599.95,352.54,270.67,0.0,35.0,46.87,81.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002237,MBR00000086,Professional,2022-03-06,2022-03-06,2022-03-14,PLN7501,1800011727,1800011727,Clinical Laboratory,Out-of-Network,M54.5,N40.0,,,,,,,0,,43239,Surgery,,,,11,Office,3,800.44,427.23,352.23,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002238,MBR00000086,Professional,2022-03-11,2022-03-11,2022-03-21,PLN5079,1590915516,1590915516,Physical Therapy,Out-of-Network,Z00.00,Z12.31,,,,,,,0,,33533,Surgery,,,,11,Office,1,18559.52,7030.79,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-4,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002239,MBR00000086,Institutional-OP,2022-08-12,2022-08-12,2022-08-28,PLN1374,1795618275,1795618275,Pulmonology,In-Network,I25.10,F41.9,,,,,,,0,,23472,Surgery,,,0730,22,Outpatient Hospital,1,4516.44,3771.26,3633.57,137.69,0.0,0.0,137.69,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002240,MBR00000086,Professional,2023-10-15,2023-10-15,2023-11-12,PLN8282,1372918899,1372918899,Family Medicine,In-Network,N18.3,I10,,,,,,,0,,99233,E&M,,,,20,Urgent Care,1,318.13,207.98,163.42,44.56,0.0,0.0,44.56,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002241,MBR00000086,Professional,2023-04-13,2023-04-13,2023-05-22,PLN8944,1660288235,1660288235,ASC,In-Network,G43.909,I10,,,,,,,0,,99284,E&M,,,,11,Office,3,504.35,205.09,90.62,39.47,75.0,0.0,114.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002242,MBR00000086,Professional,2022-03-15,2022-03-15,2022-04-08,PLN3666,1372918899,1372918899,Family Medicine,In-Network,Z00.00,M54.5,,,,,,,0,,33533,Surgery,,,,11,Office,3,13178.19,5681.43,5024.08,0.0,0.0,657.35,657.35,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002243,MBR00000086,Professional,2021-09-27,2021-09-27,2021-10-08,PLN3412,1609138981,1609138981,Critical Access Hospital,In-Network,I10,I10,,,,,,,0,,99204,E&M,,,,20,Urgent Care,1,432.17,341.79,176.06,90.73,75.0,0.0,165.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002244,MBR00000086,Professional,2021-04-30,2021-04-30,2021-06-05,PLN7434,1968299309,1968299309,Internal Medicine,In-Network,I48.91,E66.9,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,1,350.46,141.88,65.89,0.0,75.0,0.99,75.99,0.0,Pended,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000002245,MBR00000086,Institutional-OP,2021-08-03,2021-08-03,2021-08-10,PLN6935,1631954542,1631954542,Oncology,In-Network,J20.9,E78.5,,,,,,,0,,86900,Pathology/Lab,,,0450,22,Outpatient Hospital,3,56.08,36.54,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002246,MBR00000086,Professional,2021-05-31,2021-05-31,2021-07-08,PLN6623,1453936007,1453936007,ASC,In-Network,Z00.00,I63.9,,,,,,,0,,99222,E&M,,,,11,Office,2,345.32,218.47,218.47,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002247,MBR00000087,Institutional-OP,2023-06-02,2023-06-02,2023-06-30,PLN4953,1148984206,1148984206,Psychiatry,In-Network,I50.9,N39.0,,,,,,,0,,58661,Surgery,,,0900,22,Outpatient Hospital,2,2604.09,1512.15,1206.37,221.57,50.0,34.21,305.78,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002248,MBR00000087,Institutional-OP,2022-09-23,2022-09-23,2022-10-25,PLN7400,1366426662,1366426662,Urology,In-Network,E78.5,I25.10,,,,,,,0,,99283,E&M,,,0730,22,Outpatient Hospital,3,342.91,122.26,0.0,122.26,0.0,0.0,122.26,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002249,MBR00000087,Institutional-OP,2021-02-10,2021-02-10,2021-03-15,PLN3736,1696843572,1696843572,Critical Access Hospital,Out-of-Network,E11.9,J20.9,,,,,,,0,,99213,E&M,,,0900,22,Outpatient Hospital,1,149.14,122.56,122.56,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002250,MBR00000087,Institutional-OP,2023-10-12,2023-10-12,2023-10-24,PLN9247,1395983630,1395983630,Nephrology,In-Network,N40.0,I10,,,,,,,0,,84443,Pathology/Lab,,,0200,22,Outpatient Hospital,3,137.04,46.97,0.0,46.97,15.0,0.0,61.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002251,MBR00000087,Institutional-OP,2021-06-14,2021-06-14,2021-07-08,PLN6916,1800011727,1800011727,Clinical Laboratory,Out-of-Network,M54.5,I10,,,,,,,0,,90686,Medicine,,,0360,22,Outpatient Hospital,3,64.55,46.31,46.31,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000002252,MBR00000087,Professional,2022-12-08,2022-12-08,2022-12-27,PLN8973,1609526529,1609526529,Psychiatry,In-Network,E78.5,Z23,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,2,4443.05,2984.8,2959.8,0.0,25.0,0.0,25.0,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002253,MBR00000087,Institutional-OP,2021-01-14,2021-01-14,2021-02-19,PLN1735,1148984206,1148984206,Psychiatry,In-Network,G20,M17.11,,,,,,,0,,99233,E&M,,,0450,22,Outpatient Hospital,3,403.94,201.35,18.91,182.44,0.0,0.0,182.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002254,MBR00000087,Professional,2022-10-07,2022-10-07,2022-10-16,PLN9686,1713934949,1713934949,Neurology,In-Network,I10,F03.90,,,,,,,0,,77067,Radiology,,,,11,Office,1,689.43,561.33,520.07,36.8,0.0,4.46,41.26,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000002255,MBR00000087,Professional,2022-09-01,2022-09-01,2022-10-08,PLN1542,1273488618,1273488618,General Acute Care Hospital,In-Network,J20.9,I10,,,,,,,0,,99222,E&M,,,,11,Office,2,650.72,265.42,265.42,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002256,MBR00000087,Institutional-IP,2023-09-23,2023-09-24,2023-10-24,PLN5692,1502838586,1502838586,ASC,In-Network,Z12.31,Z12.31,,,,195,MS-DRG,2,1,Y,74177,Radiology,,,0120,21,Inpatient Hospital,2,2525.12,1834.32,1763.92,0.0,0.0,70.4,70.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002257,MBR00000087,Professional,2022-10-20,2022-10-20,2022-11-24,PLN8670,1520687146,1520687146,ASC,In-Network,E11.40,K92.1,,,,,,,0,,77067,Radiology,,,,81,Independent Laboratory,1,526.44,414.25,61.75,352.5,0.0,0.0,352.5,0.0,Pended,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000002258,MBR00000087,Institutional-IP,2022-06-20,2022-06-30,2022-07-22,PLN1319,1564502315,1564502315,ASC,In-Network,Z23,J06.9,,,,194,MS-DRG,21,10,Y,86900,Pathology/Lab,,,0510,21,Inpatient Hospital,2,55.91,24.28,9.28,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002259,MBR00000087,Institutional-OP,2022-08-05,2022-08-05,2022-08-15,PLN5266,1366576336,1366576336,Geriatrics,In-Network,R07.9,E11.9,,,,,,,0,,99204,E&M,,,0900,22,Outpatient Hospital,1,313.74,233.15,233.15,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000002260,MBR00000087,Institutional-IP,2022-11-25,2022-11-29,2022-12-15,PLN8000,1749494482,1749494482,Pediatrics,In-Network,M54.5,Z00.00,,,,470,MS-DRG,18,4,Y,43239,Surgery,,,0200,21,Inpatient Hospital,1,1794.62,816.44,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-4,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002261,MBR00000087,Professional,2022-03-30,2022-03-30,2022-04-08,PLN7912,1433937353,1433937353,Nephrology,In-Network,K92.1,E11.9,,,,,,,0,,99232,E&M,,,,11,Office,2,192.52,87.66,0.0,87.66,25.0,0.0,112.66,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002262,MBR00000087,Professional,2023-02-21,2023-02-21,2023-03-26,PLN7669,1716521444,1716521444,Oncology,In-Network,C50.912,Z00.00,,,,,,,0,,78452,Radiology,,,,11,Office,3,4629.74,3409.27,3384.27,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002263,MBR00000087,Professional,2022-08-03,2022-08-03,2022-08-30,PLN2861,1545347862,1545347862,SNF,In-Network,E11.9,G43.909,,,,,,,0,,G0444,Medicine,,,,11,Office,3,78.37,40.22,14.27,0.0,25.0,0.95,25.95,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000002264,MBR00000087,Professional,2023-11-28,2023-11-28,2023-12-17,PLN8428,1463205530,1463205530,Nephrology,In-Network,K21.0,Z12.31,,,,,,,0,,27130,Surgery,,,,11,Office,2,6441.26,3764.0,3764.0,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002265,MBR00000087,Institutional-IP,2021-08-01,2021-08-10,2021-08-08,PLN2149,1168246159,1168246159,Internal Medicine,In-Network,E11.9,N40.0,,,,196,MS-DRG,2,9,Y,66984,Surgery,,,0370,21,Inpatient Hospital,1,3508.62,2051.98,1742.91,0.0,0.0,309.07,309.07,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002266,MBR00000087,Institutional-OP,2023-03-10,2023-03-10,2023-03-20,PLN2060,1125190055,1125190055,Nephrology,In-Network,Z00.00,M17.11,,,,,,,0,,93000,Radiology,,,0360,22,Outpatient Hospital,2,189.94,154.85,154.85,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002267,MBR00000087,Institutional-IP,2023-06-24,2023-07-01,2023-07-30,PLN4079,1809014947,1809014947,Urology,In-Network,Z23,Z00.00,,,,872,MS-DRG,9,7,Y,23472,Surgery,,,0360,21,Inpatient Hospital,3,6922.85,5258.8,4246.49,0.0,75.0,937.31,1012.31,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002268,MBR00000087,Institutional-IP,2023-02-26,2023-02-28,2023-04-06,PLN5578,1148984206,1148984206,Psychiatry,In-Network,Z87.891,J45.20,,,,194,MS-DRG,14,2,Y,99213,E&M,,,0370,21,Inpatient Hospital,3,155.93,68.73,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002269,MBR00000087,Professional,2023-12-10,2023-12-10,2024-01-23,PLN6951,1910255109,1910255109,DME Supplier,In-Network,I10,E11.40,,,,,,,0,,23472,Surgery,,,,12,Home,2,6943.94,2677.81,2044.67,309.77,50.0,273.37,633.14,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002270,MBR00000087,Professional,2022-04-21,2022-04-21,2022-05-20,PLN3145,1624802371,1624802371,ASC,Out-of-Network,J44.1,B97.89,,,,,,,0,,74177,Radiology,,,,11,Office,2,2088.43,683.94,661.1,0.0,0.0,22.84,22.84,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002271,MBR00000087,Institutional-IP,2022-08-15,2022-08-22,2022-09-23,PLN6192,1227362142,1227362142,DME Supplier,In-Network,C50.912,E11.9,,,,291,MS-DRG,18,7,Y,45378,Surgery,,,0270,21,Inpatient Hospital,2,1544.51,828.36,386.34,399.0,35.0,8.02,442.02,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000002272,MBR00000087,Professional,2021-06-18,2021-06-18,2021-07-12,PLN1709,1561134315,1561134315,DME Supplier,In-Network,Z23,K21.0,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,2,34.14,27.9,22.51,0.0,0.0,5.39,5.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002273,MBR00000087,Professional,2022-02-14,2022-02-14,2022-03-19,PLN3617,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,Z12.31,E78.5,,,,,,,0,,78452,Radiology,,,,11,Office,1,6004.19,3684.05,3684.05,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002274,MBR00000087,Institutional-IP,2021-06-24,2021-06-27,2021-07-30,PLN8646,1585582070,1585582070,Outpatient Clinic,In-Network,I25.10,J06.9,,,,194,MS-DRG,14,3,Y,43239,Surgery,,,0730,21,Inpatient Hospital,1,1423.46,745.94,745.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002275,MBR00000088,Professional,2023-05-18,2023-05-18,2023-06-19,PLN9216,1997536841,1997536841,Family Medicine,Out-of-Network,I10,E78.5,,,,,,,0,,97110,Medicine,,,,11,Office,2,270.79,177.56,102.56,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002276,MBR00000088,Professional,2023-05-07,2023-05-07,2023-05-30,PLN9958,1899127912,1899127912,Neurology,In-Network,Z00.00,G43.909,,,,,,,0,,78452,Radiology,,,,11,Office,3,7088.8,3868.84,3843.84,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002277,MBR00000088,Professional,2021-07-31,2021-07-31,2021-08-28,PLN7410,1213165847,1213165847,Critical Access Hospital,In-Network,I10,I10,,,,,,,0,,58661,Surgery,,,,21,Inpatient Hospital,1,4547.4,2647.01,2647.01,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002278,MBR00000088,Professional,2023-05-30,2023-05-30,2023-06-18,PLN9121,1713934949,1713934949,Neurology,In-Network,E11.9,E78.5,,,,,,,0,,45378,Surgery,,,,49,Independent Clinic,2,1700.5,1157.47,963.17,0.0,75.0,119.3,194.3,0.0,Pended,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000002279,MBR00000088,Institutional-OP,2021-12-18,2021-12-18,2022-01-04,PLN4532,1520687146,1520687146,ASC,In-Network,M17.11,R10.9,,,,,,,0,,99203,E&M,,,0320,22,Outpatient Hospital,2,371.51,292.82,0.0,292.82,0.0,0.0,292.82,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000002280,MBR00000088,Professional,2023-03-11,2023-03-11,2023-04-04,PLN8506,1872613201,1872613201,Internal Medicine,In-Network,J06.9,N18.3,,,,,,,0,,78452,Radiology,,,,11,Office,3,5410.99,3019.17,2592.72,114.87,0.0,311.58,426.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002281,MBR00000088,Institutional-OP,2023-10-27,2023-10-27,2023-11-05,PLN7274,1125190055,1125190055,Nephrology,In-Network,R07.9,R07.9,,,,,,,0,,81001,Pathology/Lab,,,0761,22,Outpatient Hospital,2,29.23,14.36,0.0,14.36,50.0,0.0,64.36,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002282,MBR00000088,Professional,2023-06-28,2023-06-28,2023-07-08,PLN1955,1691062876,1691062876,SNF,In-Network,J18.9,Z00.00,,,,,,,0,,99283,E&M,,,,21,Inpatient Hospital,1,259.51,210.36,191.88,18.48,0.0,0.0,18.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002283,MBR00000088,Professional,2021-07-23,2021-07-23,2021-08-13,PLN5108,1486164553,1486164553,DME Supplier,In-Network,N20.0,J20.9,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,2,28.66,22.27,0.0,0.0,0.0,1.18,1.18,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002284,MBR00000088,Professional,2021-07-17,2021-07-17,2021-08-14,PLN7224,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,K21.0,G43.909,,,,,,,0,,93000,Radiology,,,,11,Office,1,71.24,53.9,51.97,1.93,0.0,0.0,1.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002285,MBR00000088,Institutional-OP,2021-05-03,2021-05-03,2021-05-25,PLN8759,1545347862,1545347862,SNF,In-Network,Z00.00,J06.9,,,,,,,0,,99284,E&M,,,0450,22,Outpatient Hospital,2,815.95,327.76,292.76,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002286,MBR00000088,Professional,2023-07-11,2023-07-11,2023-07-18,PLN5097,1935547131,1935547131,Pulmonology,In-Network,I10,I10,,,,,,,0,,99284,E&M,,,,50,Federally Qualified Health Center,3,398.56,294.94,0.0,294.94,0.0,0.0,294.94,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002287,MBR00000088,Institutional-OP,2022-08-22,2022-08-22,2022-10-05,PLN9512,1728018911,1728018911,Nephrology,In-Network,E11.9,Z12.31,,,,,,,0,,G0468,Medicine,,,0301,22,Outpatient Hospital,2,696.51,404.52,312.81,0.0,15.0,76.71,91.71,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002288,MBR00000088,Institutional-OP,2021-06-20,2021-06-20,2021-07-07,PLN7300,1198133277,1198133277,SNF,In-Network,Z87.891,N39.0,,,,,,,0,,99232,E&M,,,0636,22,Outpatient Hospital,2,215.68,84.68,0.0,84.68,50.0,0.0,134.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002289,MBR00000088,Professional,2022-10-06,2022-10-06,2022-10-25,PLN7693,1530904931,1530904931,Internal Medicine,In-Network,K21.0,I10,,,,,,,0,,90460,Medicine,,,,12,Home,1,76.63,61.72,61.72,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002290,MBR00000088,Professional,2022-08-04,2022-08-04,2022-09-03,PLN1940,1531398223,1531398223,OB/GYN,In-Network,E11.9,Z00.00,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,3,61.79,20.28,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002291,MBR00000088,Institutional-IP,2022-10-16,2022-10-26,2022-11-04,PLN2530,1910255109,1910255109,DME Supplier,In-Network,G43.909,E66.9,,,,194,MS-DRG,11,10,Y,80053,Pathology/Lab,,,0270,21,Inpatient Hospital,3,69.63,34.37,31.27,0.0,0.0,3.1,3.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002292,MBR00000088,Institutional-OP,2022-11-27,2022-11-27,2023-01-02,PLN9861,1561134315,1561134315,DME Supplier,In-Network,Z23,F10.20,,,,,,,0,,70450,Radiology,,,0301,22,Outpatient Hospital,3,896.19,701.95,588.06,21.7,0.0,92.19,113.89,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002293,MBR00000088,Professional,2021-06-30,2021-06-30,2021-07-22,PLN9771,1450553056,1450553056,Clinical Laboratory,In-Network,K21.0,J18.9,,,,,,,0,,99203,E&M,,,,23,Emergency Room,3,194.52,159.57,124.57,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002294,MBR00000089,Institutional-OP,2022-03-01,2022-03-01,2022-03-14,PLN6398,1545347862,1545347862,SNF,In-Network,Z23,N39.0,,,,,,,0,,99284,E&M,,,0740,22,Outpatient Hospital,1,417.14,348.26,348.26,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002295,MBR00000089,Institutional-IP,2023-03-01,2023-03-03,2023-04-09,PLN1568,1806688928,1806688928,Geriatrics,In-Network,E11.9,F32.9,,,,872,MS-DRG,13,2,Y,99213,E&M,,,0900,21,Inpatient Hospital,3,287.92,138.45,117.94,0.0,0.0,20.51,20.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002296,MBR00000089,Institutional-OP,2023-09-23,2023-09-23,2023-10-01,PLN6097,1561134315,1561134315,DME Supplier,In-Network,F32.9,N39.0,,,,,,,0,,93000,Radiology,,,0636,22,Outpatient Hospital,1,84.08,56.06,56.06,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002297,MBR00000089,Professional,2021-09-23,2021-09-23,2021-11-02,PLN7964,1114982472,1114982472,Orthopedic Surgery,In-Network,E11.40,I48.91,,,,,,,0,,90837,Medicine,,,,22,Outpatient Hospital,2,347.35,160.85,160.85,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002298,MBR00000089,Professional,2022-09-18,2022-09-18,2022-10-04,PLN2485,1645194539,1645194539,SNF,In-Network,K21.0,K21.0,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,2,586.65,414.55,414.55,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002299,MBR00000089,Professional,2023-11-05,2023-11-05,2023-11-25,PLN7290,1124394415,1124394415,Pediatrics,In-Network,J06.9,I10,,,,,,,0,,99204,E&M,,,,11,Office,1,439.85,280.83,280.83,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002300,MBR00000089,Institutional-OP,2022-10-21,2022-10-21,2022-11-05,PLN3307,1700633438,1700633438,DME Supplier,In-Network,F32.9,J06.9,,,,,,,0,,99203,E&M,,,0636,22,Outpatient Hospital,2,336.56,246.49,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002301,MBR00000089,Professional,2021-09-07,2021-09-07,2021-10-08,PLN1709,1860435061,1860435061,DME Supplier,In-Network,E78.5,M17.11,,,,,,,0,,72148,Radiology,,,,11,Office,2,1233.59,799.03,386.38,296.34,35.0,81.31,412.65,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002302,MBR00000089,Institutional-OP,2022-10-02,2022-10-02,2022-10-30,PLN3161,1132188260,1132188260,Family Medicine,In-Network,Z00.00,N39.0,,,,,,,0,,86900,Pathology/Lab,,,0761,22,Outpatient Hospital,3,55.89,22.07,7.07,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002303,MBR00000090,Professional,2021-01-19,2021-01-19,2021-02-06,PLN5215,1946680931,1946680931,Critical Access Hospital,Out-of-Network,M17.11,R10.9,,,,,,,0,,83036,Pathology/Lab,,,,21,Inpatient Hospital,1,90.12,32.54,31.41,0.0,0.0,1.13,1.13,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000002304,MBR00000090,Professional,2022-06-20,2022-06-20,2022-07-24,PLN4808,1114982472,1114982472,Orthopedic Surgery,In-Network,E11.9,Z23,,,,,,,0,,99284,E&M,,,,21,Inpatient Hospital,1,320.74,173.29,0.0,173.29,0.0,0.0,173.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002305,MBR00000090,Professional,2022-09-14,2022-09-14,2022-10-15,PLN6595,1266606767,1266606767,ASC,In-Network,N39.0,E11.65,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,2,68.04,50.48,25.48,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002306,MBR00000090,Institutional-OP,2021-03-03,2021-03-03,2021-04-10,PLN1856,1514306773,1514306773,Endocrinology,In-Network,Z12.31,Z87.891,,,,,,,0,,66984,Surgery,,,0740,22,Outpatient Hospital,3,2846.47,1116.48,1081.48,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002307,MBR00000090,Professional,2021-08-11,2021-08-11,2021-09-12,PLN1835,1974006077,1974006077,Orthopedic Surgery,In-Network,Z79.4,N40.0,,,,,,,0,,G0468,Medicine,,,,21,Inpatient Hospital,1,265.8,165.7,165.7,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002308,MBR00000090,Institutional-OP,2023-12-19,2023-12-19,2023-12-27,PLN3323,1295371663,1295371663,Critical Access Hospital,In-Network,Z00.00,K21.0,,,,,,,0,,80061,Pathology/Lab,,,0450,22,Outpatient Hospital,2,114.34,70.87,60.36,0.0,0.0,10.51,10.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002309,MBR00000090,Institutional-OP,2022-11-20,2022-11-20,2022-12-29,PLN5395,1103747954,1103747954,Urology,In-Network,J06.9,K57.30,,,,,,,0,,99283,E&M,,,0370,22,Outpatient Hospital,1,642.14,269.66,194.66,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002310,MBR00000090,Institutional-OP,2022-05-18,2022-05-18,2022-06-30,PLN5630,1872272835,1872272835,Internal Medicine,In-Network,M54.5,I48.91,,,,,,,0,,43239,Surgery,,,0730,22,Outpatient Hospital,2,1751.44,794.41,674.48,119.93,0.0,0.0,119.93,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002311,MBR00000090,Institutional-IP,2021-09-08,2021-09-20,2021-10-20,PLN2272,1994661817,1994661817,SNF,Out-of-Network,I48.91,E66.9,,,,683,MS-DRG,9,12,Y,74177,Radiology,,,0636,21,Inpatient Hospital,3,2580.85,1772.61,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-18,,1,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000002312,MBR00000090,Institutional-IP,2021-05-16,2021-05-24,2021-06-08,PLN6907,1910255109,1910255109,DME Supplier,In-Network,I11.9,E78.5,,,,291,MS-DRG,12,8,N,74177,Radiology,,,0360,21,Inpatient Hospital,1,2606.11,2164.29,1898.71,265.58,0.0,0.0,265.58,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002313,MBR00000090,Institutional-IP,2022-04-14,2022-04-16,2022-05-16,PLN5995,1531398223,1531398223,OB/GYN,In-Network,I10,Z12.31,,,,603,MS-DRG,17,2,Y,27447,Surgery,,,0450,21,Inpatient Hospital,2,6281.21,4706.95,4391.2,315.75,0.0,0.0,315.75,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002314,MBR00000090,Professional,2022-08-21,2022-08-21,2022-09-04,PLN8406,1590915516,1590915516,Physical Therapy,Out-of-Network,I10,N39.0,,,,,,,0,,99283,E&M,,,,11,Office,2,330.02,229.47,229.47,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002315,MBR00000090,Professional,2021-07-16,2021-07-16,2021-07-24,PLN8378,1500949740,1500949740,Pediatrics,In-Network,N18.3,F41.9,,,,,,,0,,99222,E&M,,,,20,Urgent Care,1,437.0,266.47,191.47,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002316,MBR00000090,Institutional-OP,2023-05-27,2023-05-27,2023-07-10,PLN9814,1856686341,1856686341,Geriatrics,In-Network,E11.9,R51,,,,,,,0,,43239,Surgery,,,0761,22,Outpatient Hospital,2,1377.29,472.99,351.35,46.64,75.0,0.0,121.64,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002317,MBR00000090,Professional,2022-04-15,2022-04-15,2022-04-25,PLN4647,1540044947,1540044947,Pulmonology,Out-of-Network,Z00.00,M17.11,,,,,,,0,,99232,E&M,,,,11,Office,1,323.14,192.99,0.0,192.99,0.0,0.0,192.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002318,MBR00000090,Professional,2021-03-03,2021-03-03,2021-04-01,PLN6097,1980712759,1980712759,Outpatient Clinic,Out-of-Network,E11.9,Z79.4,,,,,,,0,,66984,Surgery,,,,23,Emergency Room,2,2792.26,1937.57,1681.07,0.0,0.0,256.5,256.5,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002319,MBR00000090,Institutional-IP,2021-05-30,2021-06-06,2021-06-18,PLN5849,1860435061,1860435061,DME Supplier,In-Network,E11.9,G43.909,,,,292,MS-DRG,2,7,N,99232,E&M,,,0730,21,Inpatient Hospital,3,258.18,112.11,0.0,0.0,0.0,6.1,6.1,0.0,Denied,CO-15,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000002320,MBR00000090,Institutional-OP,2023-08-02,2023-08-02,2023-08-23,PLN8059,1245650222,1245650222,Gastroenterology,In-Network,N39.0,J44.1,,,,,,,0,,99283,E&M,,,0270,22,Outpatient Hospital,2,617.64,260.66,206.16,0.0,50.0,4.5,54.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002321,MBR00000090,Professional,2022-01-06,2022-01-06,2022-01-23,PLN4436,1268679390,1268679390,Critical Access Hospital,In-Network,E78.5,R07.9,,,,,,,0,,99284,E&M,,,,11,Office,1,868.21,532.39,436.84,0.0,50.0,45.55,95.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002322,MBR00000090,Institutional-OP,2022-02-13,2022-02-13,2022-03-04,PLN4866,1193493783,1193493783,Critical Access Hospital,Out-of-Network,J06.9,Z12.31,,,,,,,0,,99203,E&M,,,0900,22,Outpatient Hospital,2,172.46,132.41,0.0,132.41,0.0,0.0,132.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002323,MBR00000090,Professional,2021-08-06,2021-08-06,2021-08-23,PLN9928,1687650653,1687650653,Internal Medicine,In-Network,Z23,I63.9,,,,,,,0,,43239,Surgery,,,,11,Office,3,1459.28,1211.71,1196.71,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002324,MBR00000090,Professional,2023-06-04,2023-06-04,2023-06-28,PLN5178,1899127912,1899127912,Neurology,In-Network,E11.9,M81.0,,,,,,,0,,78452,Radiology,,,,11,Office,3,2553.13,1076.07,1021.2,0.0,0.0,54.87,54.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002325,MBR00000090,Institutional-OP,2023-06-13,2023-06-13,2023-07-21,PLN1425,1631954542,1631954542,Oncology,In-Network,G20,J45.20,,,,,,,0,,G0439,Medicine,,,0730,22,Outpatient Hospital,3,472.43,154.97,79.97,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000002326,MBR00000090,Professional,2021-09-23,2021-09-23,2021-10-03,PLN8327,1125190055,1125190055,Nephrology,In-Network,F41.9,I10,,,,,,,0,,27130,Surgery,,,,50,Federally Qualified Health Center,1,6688.51,3639.11,3472.82,61.67,0.0,104.62,166.29,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002327,MBR00000090,Institutional-IP,2023-03-10,2023-03-18,2023-04-19,PLN8580,1168246159,1168246159,Internal Medicine,In-Network,Z51.11,E66.9,,,,603,MS-DRG,2,8,Y,99233,E&M,,,0510,21,Inpatient Hospital,1,435.24,319.79,319.79,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002328,MBR00000090,Institutional-OP,2022-05-11,2022-05-11,2022-06-15,PLN5624,1366426662,1366426662,Urology,In-Network,J45.20,E11.9,,,,,,,0,,47562,Surgery,,,0730,22,Outpatient Hospital,1,3678.84,2431.39,1757.71,443.93,35.0,194.75,673.68,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002329,MBR00000090,Professional,2021-07-02,2021-07-02,2021-07-18,PLN5221,1563980627,1563980627,Critical Access Hospital,In-Network,F32.9,Z12.31,,,,,,,0,,58661,Surgery,,,,65,End-Stage Renal Disease,1,4636.12,1850.01,1678.46,121.55,50.0,0.0,171.55,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002330,MBR00000090,Professional,2023-05-22,2023-05-22,2023-06-16,PLN5312,1239316214,1239316214,Internal Medicine,In-Network,R51,E11.9,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,3,57.01,18.49,0.0,18.49,15.0,0.0,33.49,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002331,MBR00000090,Institutional-OP,2021-04-01,2021-04-01,2021-05-04,PLN8647,1168881145,1168881145,Orthopedic Surgery,In-Network,I10,I10,,,,,,,0,,99233,E&M,,,0370,22,Outpatient Hospital,3,532.66,348.98,298.98,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002332,MBR00000090,Institutional-IP,2023-08-16,2023-08-25,2023-09-03,PLN9149,1749494482,1749494482,Pediatrics,In-Network,Z23,Z23,,,,690,MS-DRG,12,9,Y,82043,Pathology/Lab,,,0360,21,Inpatient Hospital,2,63.83,35.49,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002333,MBR00000090,Institutional-OP,2021-01-29,2021-01-29,2021-02-08,PLN6747,1812060197,1812060197,Oncology,Out-of-Network,K21.0,R07.9,,,,,,,0,,84443,Pathology/Lab,,,0200,22,Outpatient Hospital,2,72.75,26.88,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002334,MBR00000090,Institutional-OP,2021-12-20,2021-12-20,2022-02-01,PLN7811,1135158374,1135158374,Pulmonology,In-Network,E11.9,K21.0,,,,,,,0,,81001,Pathology/Lab,,,0301,22,Outpatient Hospital,2,45.75,23.84,8.84,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002335,MBR00000090,Institutional-IP,2021-09-06,2021-09-08,2021-10-07,PLN3277,1790497490,1790497490,OB/GYN,In-Network,I25.10,J20.9,,,,194,MS-DRG,20,2,N,76700,Radiology,,,0510,21,Inpatient Hospital,3,1040.64,442.41,328.66,63.75,50.0,0.0,113.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002336,MBR00000090,Professional,2021-09-15,2021-09-15,2021-09-24,PLN9509,1728018911,1728018911,Nephrology,In-Network,R05,I63.9,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,3,451.17,331.33,306.33,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000002337,MBR00000090,Professional,2022-06-10,2022-06-10,2022-07-22,PLN1504,1935547131,1935547131,Pulmonology,In-Network,I11.9,R05,,,,,,,0,,76700,Radiology,,,,81,Independent Laboratory,1,1278.44,387.65,335.16,0.0,0.0,52.49,52.49,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002338,MBR00000090,Professional,2023-04-04,2023-04-04,2023-04-24,PLN4126,1994661817,1994661817,SNF,Out-of-Network,N39.0,Z12.11,,,,,,,0,,99221,E&M,,,,49,Independent Clinic,1,229.25,91.57,91.57,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002339,MBR00000090,Professional,2022-03-14,2022-03-14,2022-03-21,PLN3555,1390307371,1390307371,DME Supplier,In-Network,I50.9,E87.6,,,,,,,0,,90460,Medicine,,,,12,Home,1,64.73,22.56,19.45,0.0,0.0,3.11,3.11,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000002340,MBR00000090,Institutional-OP,2022-07-19,2022-07-19,2022-08-24,PLN6021,1609526529,1609526529,Psychiatry,In-Network,N18.3,E66.9,,,,,,,0,,99203,E&M,,,0200,22,Outpatient Hospital,1,237.47,108.07,104.41,0.0,0.0,3.66,3.66,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002341,MBR00000090,Institutional-OP,2023-11-30,2023-11-30,2023-12-29,PLN8685,1531398223,1531398223,OB/GYN,In-Network,E78.5,Z00.00,,,,,,,0,,74177,Radiology,,,0761,22,Outpatient Hospital,1,1700.79,1259.95,1234.95,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002342,MBR00000090,Institutional-OP,2022-06-30,2022-06-30,2022-07-30,PLN8971,1968299309,1968299309,Internal Medicine,In-Network,J06.9,J20.9,,,,,,,0,,90460,Medicine,,,0270,22,Outpatient Hospital,2,72.58,58.57,0.0,58.57,0.0,0.0,58.57,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000002343,MBR00000090,Institutional-OP,2023-05-18,2023-05-18,2023-06-25,PLN9930,1486164553,1486164553,DME Supplier,In-Network,N18.3,M54.5,,,,,,,0,,33533,Surgery,,,0900,22,Outpatient Hospital,3,11766.55,6570.48,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-97,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002344,MBR00000090,Professional,2022-02-26,2022-02-26,2022-03-09,PLN3357,1433937353,1433937353,Nephrology,In-Network,J06.9,Z12.31,,,,,,,0,,99214,E&M,,,,11,Office,2,214.8,174.79,174.79,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002345,MBR00000090,Professional,2021-03-27,2021-03-27,2021-04-27,PLN1616,1135158374,1135158374,Pulmonology,In-Network,J18.9,Z12.31,,,,,,,0,,99233,E&M,,,,23,Emergency Room,1,355.32,150.09,150.09,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002346,MBR00000090,Professional,2021-10-08,2021-10-08,2021-11-08,PLN9664,1865904917,1865904917,Outpatient Clinic,In-Network,I10,E78.5,,,,,,,0,,43239,Surgery,,,,11,Office,1,1443.37,1119.63,802.45,247.42,50.0,19.76,317.18,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002347,MBR00000090,Institutional-IP,2021-06-24,2021-06-25,2021-07-16,PLN5784,1624202402,1624202402,Orthopedic Surgery,In-Network,E11.65,B97.89,,,,871,MS-DRG,12,1,W,99214,E&M,,,0636,21,Inpatient Hospital,1,444.13,275.52,275.52,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,1,Unbundling,0,0,0,0,0
CLM0000002348,MBR00000090,Institutional-OP,2023-09-21,2023-09-21,2023-10-13,PLN4297,1219817751,1219817751,OB/GYN,In-Network,F32.9,E78.5,,,,,,,0,,74177,Radiology,,,0636,22,Outpatient Hospital,1,2178.08,734.92,531.37,188.55,15.0,0.0,203.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002349,MBR00000090,Institutional-OP,2021-01-30,2021-01-30,2021-03-02,PLN7852,1361302520,1361302520,Critical Access Hospital,In-Network,Z12.31,I48.91,,,,,,,0,,78452,Radiology,,,0900,22,Outpatient Hospital,3,5284.35,4136.64,3775.16,0.0,35.0,326.48,361.48,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000002350,MBR00000090,Institutional-OP,2023-06-20,2023-06-20,2023-07-26,PLN2489,1186826716,1186826716,Physical Therapy,In-Network,E66.9,E11.9,,,,,,,0,,99284,E&M,,,0200,22,Outpatient Hospital,3,755.1,237.64,162.64,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002351,MBR00000090,Professional,2021-06-01,2021-06-01,2021-07-03,PLN5577,1980712759,1980712759,Outpatient Clinic,Out-of-Network,N39.0,E11.9,,,,,,,0,,74177,Radiology,,,,11,Office,1,1108.78,546.14,511.14,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002352,MBR00000090,Professional,2021-06-14,2021-06-14,2021-07-02,PLN4117,1284035364,1284035364,Pediatrics,In-Network,I50.9,E66.9,,,,,,,0,,97110,Medicine,,,,22,Outpatient Hospital,3,205.19,132.72,132.72,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002353,MBR00000091,Professional,2022-08-03,2022-08-03,2022-08-14,PLN3637,1990090423,1990090423,Orthopedic Surgery,In-Network,I10,Z23,,,,,,,0,,G0468,Medicine,,,,20,Urgent Care,3,596.99,433.4,433.4,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002354,MBR00000091,Institutional-IP,2021-03-30,2021-04-02,2021-04-18,PLN3919,1696843572,1696843572,Critical Access Hospital,Out-of-Network,I10,K21.0,,,,872,MS-DRG,3,3,Y,99213,E&M,,,0370,21,Inpatient Hospital,2,300.39,103.35,55.28,0.0,35.0,13.07,48.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002355,MBR00000091,Professional,2021-03-26,2021-03-26,2021-04-10,PLN9518,1845900543,1845900543,ASC,In-Network,E87.6,Z00.00,,,,,,,0,,82043,Pathology/Lab,,,,22,Outpatient Hospital,3,27.23,12.12,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002356,MBR00000091,Institutional-OP,2023-04-30,2023-04-30,2023-06-01,PLN6543,1847081578,1847081578,Urology,Out-of-Network,F41.9,Z00.00,,,,,,,0,,85025,Pathology/Lab,,,0761,22,Outpatient Hospital,2,50.65,36.6,36.6,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002357,MBR00000091,Professional,2021-03-07,2021-03-07,2021-04-10,PLN8660,1700633438,1700633438,DME Supplier,In-Network,Z23,F41.9,,,,,,,0,,90460,Medicine,,,,21,Inpatient Hospital,1,37.2,22.96,7.49,0.0,15.0,0.47,15.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002358,MBR00000091,Institutional-OP,2022-10-16,2022-10-16,2022-11-09,PLN5369,1390307371,1390307371,DME Supplier,In-Network,F32.9,I25.10,,,,,,,0,,99284,E&M,,,0510,22,Outpatient Hospital,1,843.73,512.72,0.0,8.31,0.0,85.78,94.09,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002359,MBR00000091,Institutional-OP,2021-05-10,2021-05-10,2021-05-20,PLN1487,1193493783,1193493783,Critical Access Hospital,Out-of-Network,M54.5,Z12.31,,,,,,,0,,71046,Radiology,,,0120,22,Outpatient Hospital,1,200.11,126.03,0.0,126.03,0.0,0.0,126.03,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002360,MBR00000091,Professional,2021-04-04,2021-04-04,2021-05-08,PLN5029,1891849440,1891849440,Oncology,In-Network,I11.9,Z79.4,,,,,,,0,,23472,Surgery,,,,20,Urgent Care,3,7437.92,2914.59,2889.59,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002361,MBR00000091,Institutional-IP,2023-01-04,2023-01-08,2023-02-04,PLN2012,1361302520,1361302520,Critical Access Hospital,In-Network,I10,Z12.31,,,,195,MS-DRG,5,4,Y,85025,Pathology/Lab,,,0730,21,Inpatient Hospital,3,82.67,47.11,47.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002362,MBR00000091,Institutional-OP,2022-03-06,2022-03-06,2022-04-09,PLN4744,1767011137,1767011137,DME Supplier,In-Network,N39.0,K21.0,,,,,,,0,,99284,E&M,,,0510,22,Outpatient Hospital,3,843.64,303.14,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002363,MBR00000091,Institutional-OP,2021-01-22,2021-01-22,2021-03-03,PLN6839,1139906830,1139906830,Endocrinology,Out-of-Network,J06.9,M17.11,,,,,,,0,,66984,Surgery,,,0120,22,Outpatient Hospital,3,3283.0,2661.55,2033.4,245.32,0.0,382.83,628.15,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002364,MBR00000091,Professional,2023-01-17,2023-01-17,2023-02-06,PLN1892,1689639685,1689639685,SNF,In-Network,I10,E78.5,,,,,,,0,,47562,Surgery,,,,50,Federally Qualified Health Center,2,2970.11,2259.13,2016.34,207.79,35.0,0.0,242.79,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002365,MBR00000091,Institutional-IP,2023-11-28,2023-12-06,2023-12-29,PLN9224,1283743001,1283743001,Family Medicine,In-Network,M17.11,F41.9,,,,872,MS-DRG,14,8,Y,99406,Medicine,,,0450,21,Inpatient Hospital,1,39.39,12.77,0.0,12.77,0.0,0.0,12.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002366,MBR00000092,Professional,2022-09-07,2022-09-07,2022-10-13,PLN8559,1500037969,1500037969,Pulmonology,In-Network,I10,Z00.00,,,,,,,0,,83036,Pathology/Lab,,,,81,Independent Laboratory,2,89.16,57.39,0.0,57.39,35.0,0.0,92.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000002367,MBR00000092,Professional,2022-02-21,2022-02-21,2022-03-02,PLN6755,1422747896,1422747896,Urology,In-Network,Z23,N39.0,,,,,,,0,,90460,Medicine,,,,11,Office,3,30.04,10.7,0.0,10.7,25.0,0.0,35.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002368,MBR00000092,Professional,2023-07-13,2023-07-13,2023-08-24,PLN9985,1132188260,1132188260,Family Medicine,In-Network,F41.9,Z23,,,,,,,0,,71046,Radiology,,,,49,Independent Clinic,1,238.77,193.07,0.0,181.08,50.0,0.0,231.08,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002369,MBR00000092,Institutional-IP,2022-01-04,2022-01-09,2022-01-20,PLN9390,1511044648,1511044648,Endocrinology,In-Network,E78.5,E11.9,,,,641,MS-DRG,18,5,Y,99284,E&M,,,0900,21,Inpatient Hospital,3,462.02,280.15,280.15,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000002370,MBR00000092,Professional,2022-11-03,2022-11-03,2022-11-30,PLN1050,1372918899,1372918899,Family Medicine,In-Network,R07.9,I10,,,,,,,0,,78452,Radiology,,,,11,Office,3,7099.91,3422.68,2862.01,485.67,75.0,0.0,560.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002371,MBR00000092,Institutional-IP,2022-06-04,2022-06-06,2022-07-03,PLN7102,1148984206,1148984206,Psychiatry,In-Network,K21.0,N18.3,,,,195,MS-DRG,24,2,N,85610,Pathology/Lab,,,0301,21,Inpatient Hospital,1,48.95,25.76,0.0,25.76,0.0,0.0,25.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002372,MBR00000092,Professional,2023-03-07,2023-03-07,2023-03-19,PLN3567,1757138478,1757138478,Pediatrics,In-Network,Z12.31,Z51.11,,,,,,,0,,99204,E&M,,,,11,Office,2,449.33,176.5,161.5,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002373,MBR00000092,Professional,2022-07-22,2022-07-22,2022-08-11,PLN4925,1590915516,1590915516,Physical Therapy,Out-of-Network,I10,I10,,,,,,,0,,77067,Radiology,,,,11,Office,3,643.07,362.55,327.55,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000002374,MBR00000092,Institutional-OP,2022-06-12,2022-06-12,2022-07-08,PLN6098,1236418230,1236418230,DME Supplier,In-Network,I25.10,E11.65,,,,,,,0,,99232,E&M,,,0900,22,Outpatient Hospital,1,382.18,320.09,12.8,307.29,0.0,0.0,307.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002375,MBR00000092,Professional,2022-04-05,2022-04-05,2022-05-06,PLN2073,1991459367,1991459367,Neurology,Out-of-Network,E11.9,F41.9,,,,,,,0,,99204,E&M,,,,11,Office,1,525.55,420.47,420.47,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002376,MBR00000092,Professional,2021-11-20,2021-11-20,2021-12-30,PLN8863,1268679390,1268679390,Critical Access Hospital,In-Network,I10,Z00.00,,,,,,,0,,45380,Surgery,,,,11,Office,2,2689.34,1807.98,1665.98,0.0,0.0,142.0,142.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000002377,MBR00000092,Professional,2022-06-17,2022-06-17,2022-07-27,PLN1184,1624802371,1624802371,ASC,Out-of-Network,N20.0,F41.9,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,2,2034.28,1471.77,1110.88,335.89,25.0,0.0,360.89,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002378,MBR00000092,Professional,2021-03-08,2021-03-08,2021-03-26,PLN5276,1518055405,1518055405,Urology,In-Network,Z87.891,K92.1,,,,,,,0,,45380,Surgery,,,,11,Office,3,1781.69,1019.51,860.91,0.0,25.0,133.6,158.6,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000002379,MBR00000092,Professional,2022-01-08,2022-01-08,2022-02-11,PLN1801,1540044947,1540044947,Pulmonology,Out-of-Network,Z23,Z12.11,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,3,547.12,169.82,119.82,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002380,MBR00000092,Institutional-OP,2021-03-25,2021-03-25,2021-04-04,PLN7654,1139906830,1139906830,Endocrinology,Out-of-Network,Z00.00,F41.9,,,,,,,0,,84443,Pathology/Lab,,,0320,22,Outpatient Hospital,2,106.8,39.55,0.0,39.55,35.0,0.0,74.55,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000002381,MBR00000092,Institutional-IP,2021-12-19,2021-12-27,2022-01-18,PLN2699,1235381502,1235381502,Cardiology,In-Network,Z79.4,E78.5,,,,641,MS-DRG,21,8,Y,99204,E&M,,,0120,21,Inpatient Hospital,2,548.86,392.34,377.34,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002382,MBR00000092,Professional,2022-01-21,2022-01-21,2022-03-06,PLN9790,1361302520,1361302520,Critical Access Hospital,In-Network,J20.9,J06.9,,,,,,,0,,99406,Medicine,,,,49,Independent Clinic,2,69.43,49.04,48.75,0.0,0.0,0.29,0.29,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000002383,MBR00000092,Professional,2021-01-30,2021-01-30,2021-02-07,PLN7269,1389336600,1389336600,Critical Access Hospital,In-Network,Z23,M54.5,,,,,,,0,,99233,E&M,,,,11,Office,3,450.53,219.17,0.0,171.05,75.0,0.0,246.05,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002384,MBR00000092,Institutional-OP,2021-11-21,2021-11-21,2021-12-04,PLN3701,1168246159,1168246159,Internal Medicine,In-Network,N39.0,F41.9,,,,,,,0,,93306,Radiology,,,0301,22,Outpatient Hospital,3,1634.4,1061.89,795.59,241.3,25.0,0.0,266.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002385,MBR00000092,Professional,2023-01-06,2023-01-06,2023-01-17,PLN2581,1575695214,1575695214,SNF,In-Network,Z96.641,Z12.31,,,,,,,0,,33533,Surgery,,,,81,Independent Laboratory,3,29493.06,13039.93,12553.37,486.56,0.0,0.0,486.56,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002386,MBR00000092,Professional,2023-11-29,2023-11-29,2024-01-09,PLN5156,1749494482,1749494482,Pediatrics,In-Network,Z12.31,K21.0,,,,,,,0,,99284,E&M,,,,20,Urgent Care,1,904.02,285.06,270.06,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002387,MBR00000092,Professional,2022-11-07,2022-11-07,2022-11-19,PLN4694,1896447406,1896447406,Nephrology,Out-of-Network,I50.9,J06.9,,,,,,,0,,76700,Radiology,,,,22,Outpatient Hospital,3,1087.41,729.65,729.65,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002388,MBR00000092,Institutional-OP,2023-02-19,2023-02-19,2023-03-16,PLN9498,1840431511,1840431511,Geriatrics,Out-of-Network,G20,K21.0,,,,,,,0,,99214,E&M,,,0740,22,Outpatient Hospital,2,447.89,269.94,194.94,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002389,MBR00000092,Institutional-OP,2023-01-03,2023-01-03,2023-01-10,PLN5779,1700633438,1700633438,DME Supplier,In-Network,F32.9,J44.1,,,,,,,0,,99213,E&M,,,0270,22,Outpatient Hospital,1,296.27,214.62,158.98,0.0,35.0,20.64,55.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002390,MBR00000092,Professional,2023-11-01,2023-11-01,2023-12-09,PLN7037,1806688928,1806688928,Geriatrics,In-Network,Z12.11,N17.9,,,,,,,0,,70450,Radiology,,,,50,Federally Qualified Health Center,2,735.56,228.51,0.0,228.51,15.0,0.0,243.51,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002391,MBR00000092,Professional,2023-10-28,2023-10-28,2023-12-08,PLN8704,1266606767,1266606767,ASC,In-Network,E11.9,Z23,,,,,,,0,,33533,Surgery,,,,11,Office,2,29162.88,20482.72,20236.55,221.17,25.0,0.0,246.17,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002392,MBR00000092,Institutional-OP,2021-05-06,2021-05-06,2021-06-08,PLN5889,1840431511,1840431511,Geriatrics,Out-of-Network,E11.65,R10.9,,,,,,,0,,G0444,Medicine,,,0740,22,Outpatient Hospital,2,56.79,43.69,0.0,43.69,0.0,0.0,43.69,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000002393,MBR00000092,Professional,2022-06-03,2022-06-03,2022-06-25,PLN9522,1438368327,1438368327,Home Health,In-Network,E78.5,K21.0,,,,,,,0,,33533,Surgery,,,,21,Inpatient Hospital,3,14200.43,5966.16,5588.01,363.15,15.0,0.0,378.15,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002394,MBR00000092,Professional,2023-09-22,2023-09-22,2023-10-11,PLN9475,1778483301,1778483301,Home Health,In-Network,M54.5,N18.3,,,,,,,0,,93225,Medicine,,,,12,Home,3,991.28,423.37,332.05,0.0,35.0,56.32,91.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002395,MBR00000092,Institutional-OP,2023-08-24,2023-08-24,2023-09-23,PLN8563,1245650222,1245650222,Gastroenterology,In-Network,J44.1,J20.9,,,,,,,0,,99204,E&M,,,0270,22,Outpatient Hospital,1,244.03,132.17,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002396,MBR00000092,Professional,2022-08-09,2022-08-09,2022-08-18,PLN9772,1463205530,1463205530,Nephrology,In-Network,N18.3,E11.9,,,,,,,0,,99406,Medicine,,,,11,Office,3,80.27,41.28,0.0,41.28,0.0,0.0,41.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002397,MBR00000093,Professional,2022-05-02,2022-05-02,2022-06-08,PLN6994,1295371663,1295371663,Critical Access Hospital,In-Network,M54.5,Z00.00,,,,,,,0,,99284,E&M,,,,11,Office,1,886.42,542.5,64.45,400.61,75.0,2.44,478.05,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002398,MBR00000093,Institutional-IP,2021-03-05,2021-03-06,2021-04-02,PLN3865,1691062876,1691062876,SNF,In-Network,M54.5,J20.9,,,,291,MS-DRG,11,1,Y,99214,E&M,,,0360,21,Inpatient Hospital,3,469.75,152.94,10.27,141.17,0.0,1.5,142.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002399,MBR00000093,Institutional-IP,2022-06-07,2022-06-14,2022-07-13,PLN9228,1500949740,1500949740,Pediatrics,In-Network,F41.9,R07.9,,,,196,MS-DRG,1,7,Y,66984,Surgery,,,0761,21,Inpatient Hospital,3,3369.6,2300.6,2285.6,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002400,MBR00000093,Professional,2022-07-09,2022-07-09,2022-07-24,PLN3340,1266606767,1266606767,ASC,In-Network,J45.20,K92.1,,,,,,,0,,93000,Radiology,,,,11,Office,1,179.91,101.91,101.91,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002401,MBR00000093,Professional,2022-11-25,2022-11-25,2022-12-03,PLN8399,1239316214,1239316214,Internal Medicine,In-Network,M81.0,Z12.31,,,,,,,0,,70450,Radiology,,,,23,Emergency Room,3,1196.81,994.9,900.28,44.62,50.0,0.0,94.62,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002402,MBR00000093,Professional,2022-07-26,2022-07-26,2022-08-09,PLN3871,1186826716,1186826716,Physical Therapy,In-Network,M54.5,Z23,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,1,3026.18,1515.05,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-50,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000002403,MBR00000093,Professional,2021-08-25,2021-08-25,2021-10-02,PLN5124,1500037969,1500037969,Pulmonology,In-Network,M54.5,F41.9,,,,,,,0,,70553,Radiology,,,,11,Office,1,2223.12,1846.68,1831.68,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002404,MBR00000093,Professional,2023-11-27,2023-11-27,2024-01-04,PLN4677,1450553056,1450553056,Clinical Laboratory,In-Network,Z96.641,F41.9,,,,,,,0,,43239,Surgery,,,,11,Office,3,1161.56,648.55,648.55,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002405,MBR00000093,Professional,2021-08-27,2021-08-27,2021-09-20,PLN8457,1865904917,1865904917,Outpatient Clinic,In-Network,I48.91,I10,,,,,,,0,,99233,E&M,,,,23,Emergency Room,1,277.92,153.21,0.0,153.21,35.0,0.0,188.21,0.0,Pended,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002406,MBR00000093,Professional,2022-02-23,2022-02-23,2022-03-14,PLN7437,1502838586,1502838586,ASC,In-Network,K21.0,M17.11,,,,,,,0,,99221,E&M,,,,11,Office,3,363.86,240.22,44.53,178.79,15.0,1.9,195.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002407,MBR00000093,Professional,2022-07-13,2022-07-13,2022-07-24,PLN3608,1980712759,1980712759,Outpatient Clinic,Out-of-Network,Z87.891,F41.9,,,,,,,0,,76700,Radiology,,,,49,Independent Clinic,1,537.09,250.68,175.68,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002408,MBR00000093,Professional,2021-11-18,2021-11-18,2021-12-30,PLN7277,1899127912,1899127912,Neurology,In-Network,Z12.31,G20,,,,,,,0,,93000,Radiology,,,,11,Office,2,94.44,54.89,54.89,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002409,MBR00000093,Institutional-IP,2021-03-17,2021-03-28,2021-04-02,PLN1239,1283743001,1283743001,Family Medicine,In-Network,Z12.31,E11.9,,,,871,MS-DRG,22,11,Y,33533,Surgery,,,0510,21,Inpatient Hospital,2,19038.84,11094.2,8887.28,194.33,50.0,1962.59,2206.92,0.0,Paid,,,1,,0,0,1,1,1,0,None,0,0,0,0,0
CLM0000002410,MBR00000093,Institutional-IP,2022-11-01,2022-11-09,2022-12-02,PLN7086,1980712759,1980712759,Outpatient Clinic,Out-of-Network,Z23,R05,,,,872,MS-DRG,23,8,Y,23472,Surgery,,,0450,21,Inpatient Hospital,2,4484.8,3485.16,0.0,0.0,75.0,613.94,688.94,0.0,Denied,CO-29,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002411,MBR00000093,Institutional-OP,2021-09-17,2021-09-17,2021-10-15,PLN7436,1168246159,1168246159,Internal Medicine,In-Network,F41.9,E66.9,,,,,,,0,,45380,Surgery,,,0120,22,Outpatient Hospital,2,1075.81,822.6,797.6,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000002412,MBR00000093,Institutional-IP,2023-08-21,2023-08-24,2023-08-30,PLN7358,1757138478,1757138478,Pediatrics,In-Network,Z87.891,E78.5,,,,196,MS-DRG,22,3,Y,99233,E&M,,,0740,21,Inpatient Hospital,3,285.74,140.49,92.7,0.0,35.0,12.79,47.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002413,MBR00000093,Institutional-OP,2023-05-19,2023-05-19,2023-05-27,PLN7321,1968299309,1968299309,Internal Medicine,In-Network,I48.91,F10.20,,,,,,,0,,76700,Radiology,,,0360,22,Outpatient Hospital,1,555.72,234.82,209.82,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002414,MBR00000093,Professional,2022-04-14,2022-04-14,2022-05-12,PLN8575,1800011727,1800011727,Clinical Laboratory,Out-of-Network,N17.9,J44.1,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,3,156.22,101.42,0.0,0.0,15.0,0.55,15.55,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002415,MBR00000093,Institutional-OP,2022-05-23,2022-05-23,2022-06-25,PLN8742,1453936007,1453936007,ASC,In-Network,E11.9,E78.5,,,,,,,0,,99204,E&M,,,0636,22,Outpatient Hospital,3,404.96,251.95,176.95,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002416,MBR00000093,Professional,2023-11-06,2023-11-06,2023-12-04,PLN5859,1590915516,1590915516,Physical Therapy,Out-of-Network,J18.9,F32.9,,,,,,,0,,86900,Pathology/Lab,,,,22,Outpatient Hospital,1,36.57,30.03,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002417,MBR00000093,Institutional-OP,2021-01-30,2021-01-30,2021-03-07,PLN8701,1800011727,1800011727,Clinical Laboratory,Out-of-Network,J45.20,N39.0,,,,,,,0,,66984,Surgery,,,0370,22,Outpatient Hospital,3,3252.3,1578.97,1553.97,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002418,MBR00000093,Institutional-OP,2022-02-19,2022-02-19,2022-03-31,PLN3683,1991459367,1991459367,Neurology,Out-of-Network,E11.9,E11.9,,,,,,,0,,86900,Pathology/Lab,,,0270,22,Outpatient Hospital,1,37.26,30.32,28.42,0.0,0.0,1.9,1.9,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002419,MBR00000094,Professional,2021-03-08,2021-03-08,2021-04-04,PLN5358,1139906830,1139906830,Endocrinology,Out-of-Network,Z12.31,I10,,,,,,,0,,66984,Surgery,,,,11,Office,1,2224.57,1143.11,723.12,394.99,25.0,0.0,419.99,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002420,MBR00000094,Institutional-OP,2021-06-01,2021-06-01,2021-06-24,PLN4540,1366286000,1366286000,SNF,In-Network,Z96.641,Z79.4,,,,,,,0,,99204,E&M,,,0120,22,Outpatient Hospital,2,327.18,103.91,28.91,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002421,MBR00000094,Institutional-IP,2023-10-04,2023-10-12,2023-11-08,PLN6908,1757138478,1757138478,Pediatrics,In-Network,I10,Z12.31,,,,196,MS-DRG,24,8,Y,45378,Surgery,,,0200,21,Inpatient Hospital,3,1170.12,554.91,320.71,168.12,0.0,66.08,234.2,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000002422,MBR00000094,Institutional-OP,2021-04-22,2021-04-22,2021-05-16,PLN2743,1689639685,1689639685,SNF,In-Network,E11.65,G43.909,,,,,,,0,,99203,E&M,,,0740,22,Outpatient Hospital,2,191.41,123.32,123.32,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002423,MBR00000094,Professional,2023-11-14,2023-11-14,2023-12-26,PLN6253,1896447406,1896447406,Nephrology,Out-of-Network,M54.5,E87.6,,,,,,,0,,99213,E&M,,,,22,Outpatient Hospital,1,316.57,133.72,0.0,133.72,0.0,0.0,133.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002424,MBR00000094,Professional,2023-05-09,2023-05-09,2023-05-29,PLN5509,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,J06.9,E78.5,,,,,,,0,,99284,E&M,,,,11,Office,1,627.84,232.79,182.79,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002425,MBR00000094,Institutional-OP,2022-12-04,2022-12-04,2022-12-16,PLN5627,1767011137,1767011137,DME Supplier,In-Network,R10.9,I48.91,,,,,,,0,,90686,Medicine,,,0900,22,Outpatient Hospital,3,138.52,110.87,0.0,110.87,0.0,0.0,110.87,0.0,Denied,CO-15,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000002426,MBR00000094,Professional,2023-03-24,2023-03-24,2023-04-09,PLN4351,1502838586,1502838586,ASC,In-Network,J06.9,F03.90,,,,,,,0,,97110,Medicine,,,,31,Skilled Nursing Facility,1,219.09,114.53,65.28,49.25,0.0,0.0,49.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002427,MBR00000094,Professional,2021-07-22,2021-07-22,2021-09-04,PLN7684,1109850785,1109850785,ASC,Out-of-Network,E78.5,Z23,,,,,,,0,,99283,E&M,,,,12,Home,3,368.58,173.53,0.0,0.0,0.0,33.17,33.17,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002428,MBR00000094,Professional,2021-05-09,2021-05-09,2021-06-05,PLN2976,1366426662,1366426662,Urology,In-Network,Z00.00,E11.9,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,2,642.9,316.38,0.0,316.38,0.0,0.0,316.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002429,MBR00000094,Professional,2022-02-08,2022-02-08,2022-02-15,PLN3545,1727809972,1727809972,Home Health,In-Network,I10,N39.0,,,,,,,0,,33533,Surgery,,,,11,Office,1,11516.1,6450.28,6415.28,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002430,MBR00000094,Institutional-OP,2023-04-18,2023-04-18,2023-04-25,PLN1729,1590915516,1590915516,Physical Therapy,Out-of-Network,M54.5,R05,,,,,,,0,,71046,Radiology,,,0730,22,Outpatient Hospital,3,315.97,210.18,151.6,58.58,0.0,0.0,58.58,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002431,MBR00000094,Institutional-OP,2021-12-01,2021-12-01,2022-01-06,PLN7694,1899127912,1899127912,Neurology,In-Network,K21.0,G43.909,,,,,,,0,,99233,E&M,,,0360,22,Outpatient Hospital,2,357.01,182.52,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002432,MBR00000094,Institutional-OP,2021-07-12,2021-07-12,2021-08-02,PLN2615,1689639685,1689639685,SNF,In-Network,Z12.31,I10,,,,,,,0,,99204,E&M,,,0636,22,Outpatient Hospital,3,513.54,167.23,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002433,MBR00000094,Institutional-OP,2023-05-10,2023-05-10,2023-05-21,PLN1626,1132188260,1132188260,Family Medicine,In-Network,J06.9,E78.5,,,,,,,0,,27447,Surgery,,,0360,22,Outpatient Hospital,3,5487.55,2620.13,2466.2,138.93,15.0,0.0,153.93,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002434,MBR00000094,Institutional-IP,2022-11-26,2022-11-29,2022-12-03,PLN3270,1556140803,1556140803,Cardiology,In-Network,M54.5,I25.10,,,,603,MS-DRG,5,3,Y,99213,E&M,,,0370,21,Inpatient Hospital,3,181.03,113.05,98.05,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002435,MBR00000094,Institutional-OP,2022-08-12,2022-08-12,2022-08-23,PLN1533,1590915516,1590915516,Physical Therapy,Out-of-Network,Z79.4,M54.5,,,,,,,0,,45378,Surgery,,,0730,22,Outpatient Hospital,2,1036.38,414.16,412.62,1.54,0.0,0.0,1.54,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000002436,MBR00000094,Professional,2022-03-28,2022-03-28,2022-05-09,PLN6525,1563980627,1563980627,Critical Access Hospital,In-Network,Z23,I10,,,,,,,0,,G0439,Medicine,,,,11,Office,2,557.34,432.18,150.92,266.26,15.0,0.0,281.26,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000002437,MBR00000095,Institutional-IP,2023-05-04,2023-05-07,2023-05-25,PLN4246,1968299309,1968299309,Internal Medicine,In-Network,K57.30,F10.20,,,,683,MS-DRG,24,3,Y,G0444,Medicine,,,0360,21,Inpatient Hospital,2,86.76,43.36,43.36,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000002438,MBR00000095,Institutional-OP,2023-03-16,2023-03-16,2023-04-11,PLN5230,1645194539,1645194539,SNF,In-Network,B97.89,G43.909,,,,,,,0,,27130,Surgery,,,0900,22,Outpatient Hospital,2,3802.63,2114.53,2114.53,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002439,MBR00000095,Institutional-OP,2022-01-30,2022-01-30,2022-02-24,PLN1430,1502838586,1502838586,ASC,In-Network,E11.9,Z79.4,,,,,,,0,,27130,Surgery,,,0320,22,Outpatient Hospital,1,6609.09,4655.17,0.0,0.0,25.0,760.02,785.02,0.0,Denied,CO-18,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002440,MBR00000095,Institutional-OP,2021-05-22,2021-05-22,2021-07-03,PLN2679,1564502315,1564502315,ASC,In-Network,M54.5,I10,,,,,,,0,,82043,Pathology/Lab,,,0320,22,Outpatient Hospital,2,54.38,24.42,9.42,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002441,MBR00000095,Professional,2023-08-11,2023-08-11,2023-09-22,PLN6871,1242201429,1242201429,General Acute Care Hospital,In-Network,I50.9,I10,,,,,,,0,,G0444,Medicine,,,,20,Urgent Care,2,88.68,70.77,53.44,0.0,15.0,2.33,17.33,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000002442,MBR00000095,Professional,2021-05-30,2021-05-30,2021-06-15,PLN2853,1518055405,1518055405,Urology,In-Network,E11.9,Z12.31,,,,,,,0,,33533,Surgery,,,,21,Inpatient Hospital,2,19488.9,13354.84,13210.07,0.0,35.0,109.77,144.77,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002443,MBR00000095,Institutional-IP,2022-04-15,2022-04-16,2022-04-25,PLN1416,1809014947,1809014947,Urology,In-Network,E66.9,K21.0,,,,291,MS-DRG,17,1,Y,82043,Pathology/Lab,,,0740,21,Inpatient Hospital,2,31.07,23.13,23.13,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002444,MBR00000095,Institutional-OP,2023-09-09,2023-09-09,2023-09-22,PLN2257,1366286000,1366286000,SNF,In-Network,I11.9,R05,,,,,,,0,,47562,Surgery,,,0120,22,Outpatient Hospital,3,2654.92,1526.96,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-27,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002445,MBR00000095,Professional,2022-04-03,2022-04-03,2022-04-13,PLN8324,1438368327,1438368327,Home Health,In-Network,J44.1,S72.001A,,,,,,,0,,66984,Surgery,,,,31,Skilled Nursing Facility,2,2885.81,1467.48,1401.51,0.0,0.0,65.97,65.97,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002446,MBR00000095,Professional,2023-06-30,2023-06-30,2023-07-24,PLN3926,1687650653,1687650653,Internal Medicine,In-Network,I10,E11.9,,,,,,,0,,72148,Radiology,,,,20,Urgent Care,3,2973.01,1104.91,1104.91,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002447,MBR00000095,Professional,2022-06-20,2022-06-20,2022-07-26,PLN4224,1132188260,1132188260,Family Medicine,In-Network,Z00.00,J06.9,,,,,,,0,,33533,Surgery,,,,11,Office,2,25354.27,8105.37,8105.37,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002448,MBR00000096,Professional,2023-03-27,2023-03-27,2023-04-03,PLN8648,1790497490,1790497490,OB/GYN,In-Network,E78.5,F41.9,,,,,,,0,,99222,E&M,,,,49,Independent Clinic,2,429.26,151.0,151.0,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002449,MBR00000096,Professional,2022-10-11,2022-10-11,2022-10-22,PLN5942,1114982472,1114982472,Orthopedic Surgery,In-Network,E11.9,Z00.00,,,,,,,0,,99406,Medicine,,,,23,Emergency Room,2,96.42,54.34,47.25,0.0,0.0,7.09,7.09,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002450,MBR00000096,Professional,2021-11-03,2021-11-03,2021-11-30,PLN2344,1563980627,1563980627,Critical Access Hospital,In-Network,I48.91,M17.11,,,,,,,0,,G0439,Medicine,,,,22,Outpatient Hospital,2,428.69,295.93,0.0,0.0,75.0,26.06,101.06,0.0,Denied,CO-15,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000002451,MBR00000096,Professional,2023-09-07,2023-09-07,2023-10-14,PLN3468,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,F41.9,E11.9,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,2,5512.65,4445.5,4445.5,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002452,MBR00000096,Professional,2022-05-27,2022-05-27,2022-06-11,PLN9399,1899127912,1899127912,Neurology,In-Network,J44.1,E66.9,,,,,,,0,,86900,Pathology/Lab,,,,20,Urgent Care,1,35.43,30.06,14.64,0.0,15.0,0.42,15.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002453,MBR00000096,Institutional-OP,2022-05-17,2022-05-17,2022-06-29,PLN8310,1550154147,1550154147,Outpatient Clinic,In-Network,N18.3,F32.9,,,,,,,0,,99222,E&M,,,0730,22,Outpatient Hospital,2,524.62,299.76,264.76,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002454,MBR00000096,Professional,2022-12-23,2022-12-23,2023-02-04,PLN4724,1361302520,1361302520,Critical Access Hospital,In-Network,Z00.00,I10,,,,,,,0,,72148,Radiology,,,,11,Office,1,2133.99,938.23,923.23,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002455,MBR00000096,Institutional-OP,2023-10-16,2023-10-16,2023-11-19,PLN9200,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,Z87.891,J18.9,,,,,,,0,,43239,Surgery,,,0510,22,Outpatient Hospital,1,2185.91,1230.83,1155.83,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002456,MBR00000096,Professional,2023-08-13,2023-08-13,2023-09-13,PLN8385,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,E66.9,F10.20,,,,,,,0,,99283,E&M,,,,11,Office,1,390.44,321.87,0.0,321.87,50.0,0.0,371.87,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002457,MBR00000096,Professional,2022-03-08,2022-03-08,2022-04-16,PLN4649,1856686341,1856686341,Geriatrics,In-Network,F41.9,Z51.11,,,,,,,0,,45378,Surgery,,,,49,Independent Clinic,2,1749.84,1071.24,730.35,290.89,50.0,0.0,340.89,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000002458,MBR00000096,Professional,2021-09-11,2021-09-11,2021-10-05,PLN8060,1434029575,1434029575,Endocrinology,In-Network,I25.10,I10,,,,,,,0,,99232,E&M,,,,11,Office,2,183.8,128.19,78.19,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002459,MBR00000096,Professional,2021-12-22,2021-12-22,2022-01-19,PLN4796,1872613201,1872613201,Internal Medicine,In-Network,I10,F41.9,,,,,,,0,,99221,E&M,,,,23,Emergency Room,2,386.79,122.22,0.0,122.22,50.0,0.0,172.22,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002460,MBR00000096,Professional,2021-10-15,2021-10-15,2021-11-25,PLN7138,1219817751,1219817751,OB/GYN,In-Network,K21.0,Z00.00,,,,,,,0,,99204,E&M,,,,11,Office,2,588.41,188.35,179.9,0.0,0.0,8.45,8.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002461,MBR00000096,Professional,2021-11-20,2021-11-20,2021-12-06,PLN4367,1334916761,1334916761,ASC,In-Network,R10.9,Z12.11,,,,,,,0,,66984,Surgery,,,,20,Urgent Care,3,3622.56,2805.41,2805.41,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002462,MBR00000096,Professional,2022-04-17,2022-04-17,2022-05-13,PLN5579,1545347862,1545347862,SNF,In-Network,Z87.891,F41.9,,,,,,,0,,27447,Surgery,,,,49,Independent Clinic,2,4136.55,2508.98,2381.07,0.0,75.0,52.91,127.91,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002463,MBR00000096,Institutional-OP,2021-01-24,2021-01-24,2021-02-10,PLN9521,1366286000,1366286000,SNF,In-Network,Z00.00,C50.912,,,,,,,0,,71046,Radiology,,,0270,22,Outpatient Hospital,2,229.69,90.15,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000002464,MBR00000096,Professional,2022-08-07,2022-08-07,2022-09-01,PLN6449,1935547131,1935547131,Pulmonology,In-Network,Z23,E11.9,,,,,,,0,,99284,E&M,,,,11,Office,2,500.59,240.29,37.35,202.94,0.0,0.0,202.94,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000002465,MBR00000096,Professional,2023-07-19,2023-07-19,2023-08-22,PLN1817,1749327647,1749327647,Geriatrics,In-Network,Z00.01,E11.9,,,,,,,0,,47562,Surgery,,,,49,Independent Clinic,1,6521.86,4443.39,4428.39,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002466,MBR00000096,Institutional-OP,2022-04-17,2022-04-17,2022-05-01,PLN9616,1696843572,1696843572,Critical Access Hospital,Out-of-Network,K21.0,F41.9,,,,,,,0,,99213,E&M,,,0730,22,Outpatient Hospital,1,139.24,45.04,30.04,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002467,MBR00000096,Professional,2021-03-28,2021-03-28,2021-04-16,PLN2856,1556140803,1556140803,Cardiology,In-Network,J06.9,N18.3,,,,,,,0,,84443,Pathology/Lab,,,,22,Outpatient Hospital,2,155.44,78.69,3.69,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002468,MBR00000096,Professional,2022-03-03,2022-03-03,2022-04-04,PLN1724,1910255109,1910255109,DME Supplier,In-Network,I25.10,E11.9,,,,,,,0,,93225,Medicine,,,,50,Federally Qualified Health Center,1,709.17,277.73,159.89,67.84,50.0,0.0,117.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002469,MBR00000096,Institutional-IP,2022-01-02,2022-01-12,2022-01-26,PLN2405,1585582070,1585582070,Outpatient Clinic,In-Network,I10,J06.9,,,,292,MS-DRG,14,10,Y,99406,Medicine,,,0450,21,Inpatient Hospital,2,80.53,24.82,24.82,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002470,MBR00000096,Institutional-IP,2022-10-13,2022-10-23,2022-11-03,PLN7621,1790497490,1790497490,OB/GYN,In-Network,R51,E78.5,,,,470,MS-DRG,20,10,Y,58661,Surgery,,,0120,21,Inpatient Hospital,2,3716.46,1834.28,1809.28,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002471,MBR00000096,Institutional-IP,2021-10-02,2021-10-04,2021-10-09,PLN5906,1433937353,1433937353,Nephrology,In-Network,M54.5,Z00.00,,,,470,MS-DRG,13,2,Y,87491,Pathology/Lab,,,0761,21,Inpatient Hospital,2,165.27,60.39,35.39,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002472,MBR00000096,Institutional-OP,2021-11-26,2021-11-26,2021-12-12,PLN4836,1239316214,1239316214,Internal Medicine,In-Network,I10,E11.9,,,,,,,0,,43239,Surgery,,,0510,22,Outpatient Hospital,2,1557.92,732.82,0.0,0.0,50.0,116.85,166.85,0.0,Denied,CO-27,,0,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000002473,MBR00000097,Professional,2023-03-27,2023-03-27,2023-04-16,PLN5019,1514306773,1514306773,Endocrinology,In-Network,Z12.31,I48.91,,,,,,,0,,99233,E&M,,,,50,Federally Qualified Health Center,1,462.69,169.0,169.0,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002474,MBR00000097,Professional,2021-07-12,2021-07-12,2021-08-19,PLN3002,1531398223,1531398223,OB/GYN,In-Network,Z00.00,E66.9,,,,,,,0,,83036,Pathology/Lab,,,,23,Emergency Room,2,118.56,64.02,0.0,64.02,0.0,0.0,64.02,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,1,0,0
CLM0000002475,MBR00000097,Institutional-OP,2023-10-19,2023-10-19,2023-11-07,PLN2272,1896447406,1896447406,Nephrology,Out-of-Network,K21.0,I50.9,,,,,,,0,,99221,E&M,,,0510,22,Outpatient Hospital,3,278.11,112.08,41.57,39.25,25.0,6.26,70.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002476,MBR00000097,Institutional-IP,2021-11-22,2021-11-25,2021-11-30,PLN6952,1799205295,1799205295,General Acute Care Hospital,In-Network,M17.11,I10,,,,292,MS-DRG,24,3,Y,93000,Radiology,,,0761,21,Inpatient Hospital,3,122.4,59.37,59.37,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002477,MBR00000097,Institutional-OP,2023-06-14,2023-06-14,2023-07-11,PLN9677,1840431511,1840431511,Geriatrics,Out-of-Network,K21.0,I10,,,,,,,0,,90460,Medicine,,,0360,22,Outpatient Hospital,3,35.29,26.8,0.0,26.8,0.0,0.0,26.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002478,MBR00000097,Institutional-OP,2021-03-31,2021-03-31,2021-04-11,PLN3947,1939033455,1939033455,Pulmonology,In-Network,Z23,Z23,,,,,,,0,,99213,E&M,,,0450,22,Outpatient Hospital,1,261.1,116.88,116.88,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002479,MBR00000097,Professional,2021-12-17,2021-12-17,2022-01-08,PLN6703,1475984649,1475984649,SNF,In-Network,Z79.4,E11.9,,,,,,,0,,99221,E&M,,,,31,Skilled Nursing Facility,1,430.54,240.23,0.0,240.23,25.0,0.0,265.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002480,MBR00000097,Institutional-IP,2022-02-18,2022-02-20,2022-03-05,PLN1151,1124394415,1124394415,Pediatrics,In-Network,E66.9,Z00.00,,,,194,MS-DRG,23,2,Y,99284,E&M,,,0360,21,Inpatient Hospital,2,642.48,361.71,343.51,0.0,0.0,18.2,18.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002481,MBR00000097,Professional,2022-05-15,2022-05-15,2022-05-23,PLN6240,1939033455,1939033455,Pulmonology,In-Network,N18.3,E11.9,,,,,,,0,,45378,Surgery,,,,12,Home,3,1313.4,724.29,0.0,0.0,25.0,130.74,155.74,0.0,Denied,CO-4,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000002482,MBR00000097,Professional,2021-04-11,2021-04-11,2021-05-08,PLN7977,1713934949,1713934949,Neurology,In-Network,N18.3,F41.9,,,,,,,0,,74177,Radiology,,,,11,Office,3,1857.33,848.16,608.99,239.17,0.0,0.0,239.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002483,MBR00000097,Professional,2021-09-28,2021-09-28,2021-10-27,PLN3821,1125190055,1125190055,Nephrology,In-Network,I10,N18.3,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,2,19472.6,15816.24,15585.56,230.68,0.0,0.0,230.68,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002484,MBR00000097,Professional,2023-08-19,2023-08-19,2023-09-24,PLN3299,1872272835,1872272835,Internal Medicine,In-Network,Z51.11,Z12.31,,,,,,,0,,33533,Surgery,,,,23,Emergency Room,3,14839.76,7722.13,7374.17,272.96,75.0,0.0,347.96,0.0,Paid,,,1,,1,0,0,1,0,0,None,0,0,0,0,0
CLM0000002485,MBR00000097,Institutional-IP,2023-10-09,2023-10-18,2023-10-16,PLN6560,1514306773,1514306773,Endocrinology,In-Network,Z12.31,M54.5,,,,470,MS-DRG,16,9,Y,27130,Surgery,,,0450,21,Inpatient Hospital,3,5212.11,2422.68,2422.68,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002486,MBR00000097,Institutional-IP,2022-04-28,2022-05-06,2022-05-10,PLN5666,1727809972,1727809972,Home Health,In-Network,M81.0,M54.5,,,,194,MS-DRG,5,8,Y,83036,Pathology/Lab,,,0370,21,Inpatient Hospital,3,91.62,28.4,28.4,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000002487,MBR00000097,Institutional-OP,2021-05-11,2021-05-11,2021-05-29,PLN5576,1935547131,1935547131,Pulmonology,In-Network,E78.5,I10,,,,,,,0,,93225,Medicine,,,0370,22,Outpatient Hospital,3,508.87,342.33,0.0,342.33,0.0,0.0,342.33,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002488,MBR00000097,Professional,2021-10-29,2021-10-29,2021-11-10,PLN9603,1193493783,1193493783,Critical Access Hospital,Out-of-Network,Z12.31,B97.89,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,2,1996.63,754.48,754.48,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000002489,MBR00000098,Professional,2023-11-09,2023-11-09,2023-11-18,PLN3381,1422747896,1422747896,Urology,In-Network,Z12.31,J45.20,,,,,,,0,,93306,Radiology,,,,11,Office,2,2562.6,1367.37,1221.72,0.0,25.0,120.65,145.65,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000002490,MBR00000098,Professional,2023-10-04,2023-10-04,2023-10-12,PLN6782,1125190055,1125190055,Nephrology,In-Network,N20.0,I10,,,,,,,0,,86900,Pathology/Lab,,,,22,Outpatient Hospital,3,59.19,27.37,0.0,27.37,50.0,0.0,77.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002491,MBR00000098,Professional,2023-06-10,2023-06-10,2023-07-04,PLN4072,1361302520,1361302520,Critical Access Hospital,In-Network,J20.9,E11.9,,,,,,,0,,74177,Radiology,,,,11,Office,2,1152.81,435.4,50.81,334.59,50.0,0.0,384.59,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002492,MBR00000098,Professional,2023-08-03,2023-08-03,2023-08-10,PLN6607,1590915516,1590915516,Physical Therapy,Out-of-Network,E78.5,Z00.00,,,,,,,0,,G0444,Medicine,,,,23,Emergency Room,2,97.93,51.2,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,1,1,0,0,0,1,Phantom,0,0,0,0,1
CLM0000002493,MBR00000098,Professional,2023-02-19,2023-02-19,2023-03-22,PLN6426,1135158374,1135158374,Pulmonology,In-Network,R51,Z79.4,,,,,,,0,,93306,Radiology,,,,20,Urgent Care,1,1431.88,1008.47,1008.47,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002494,MBR00000098,Institutional-IP,2022-11-14,2022-11-26,2022-12-09,PLN4089,1856686341,1856686341,Geriatrics,In-Network,F41.9,E78.5,,,,682,MS-DRG,21,12,Y,99284,E&M,,,0510,21,Inpatient Hospital,3,618.76,270.07,0.0,0.0,0.0,40.87,40.87,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002495,MBR00000098,Professional,2023-04-28,2023-04-28,2023-05-10,PLN2028,1872272835,1872272835,Internal Medicine,In-Network,K92.1,E11.40,,,,,,,0,,78452,Radiology,,,,65,End-Stage Renal Disease,1,6772.37,4667.83,4592.83,0.0,75.0,0.0,75.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002496,MBR00000098,Institutional-IP,2022-12-09,2022-12-14,2022-12-28,PLN5006,1366576336,1366576336,Geriatrics,In-Network,S72.001A,F32.9,,,,194,MS-DRG,3,5,Y,72148,Radiology,,,0636,21,Inpatient Hospital,3,2818.8,1159.49,1033.91,0.0,0.0,125.58,125.58,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000002497,MBR00000098,Professional,2022-01-07,2022-01-07,2022-02-05,PLN8987,1139906830,1139906830,Endocrinology,Out-of-Network,J18.9,Z12.31,,,,,,,0,,66984,Surgery,,,,21,Inpatient Hospital,3,3169.56,1326.26,937.22,254.57,15.0,119.47,389.04,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002498,MBR00000098,Professional,2022-12-04,2022-12-04,2023-01-16,PLN7101,1235381502,1235381502,Cardiology,In-Network,Z12.31,E66.9,,,,,,,0,,99213,E&M,,,,22,Outpatient Hospital,1,134.45,113.77,113.77,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002499,MBR00000098,Institutional-OP,2021-11-20,2021-11-20,2021-12-12,PLN1872,1266606767,1266606767,ASC,In-Network,Z00.01,I48.91,,,,,,,0,,85025,Pathology/Lab,,,0320,22,Outpatient Hospital,3,53.86,29.95,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002500,MBR00000098,Professional,2022-11-16,2022-11-16,2022-11-28,PLN5380,1148984206,1148984206,Psychiatry,In-Network,J44.1,E11.9,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,1,85.49,64.08,0.0,64.08,25.0,0.0,89.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002501,MBR00000098,Professional,2022-02-22,2022-02-22,2022-03-16,PLN3127,1542828721,1542828721,Orthopedic Surgery,In-Network,E78.5,I10,,,,,,,0,,99214,E&M,,,,11,Office,3,323.73,126.44,0.0,126.44,25.0,0.0,151.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002502,MBR00000098,Institutional-OP,2022-06-18,2022-06-18,2022-07-04,PLN3660,1186826716,1186826716,Physical Therapy,In-Network,C50.912,R10.9,,,,,,,0,,86900,Pathology/Lab,,,0200,22,Outpatient Hospital,1,37.78,22.7,0.0,0.0,50.0,0.0,50.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002503,MBR00000098,Professional,2021-07-18,2021-07-18,2021-08-10,PLN6129,1295371663,1295371663,Critical Access Hospital,In-Network,Z12.31,J45.20,,,,,,,0,,70450,Radiology,,,,11,Office,1,1722.61,1067.42,918.51,148.91,0.0,0.0,148.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002504,MBR00000098,Professional,2023-11-14,2023-11-14,2023-11-21,PLN6654,1125190055,1125190055,Nephrology,In-Network,I10,E11.65,,,,,,,0,,47562,Surgery,,,,11,Office,2,3324.38,2302.74,1810.71,457.03,35.0,0.0,492.03,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002505,MBR00000098,Professional,2023-03-29,2023-03-29,2023-04-05,PLN9104,1800011727,1800011727,Clinical Laboratory,Out-of-Network,M17.11,I10,,,,,,,0,,85610,Pathology/Lab,,,,21,Inpatient Hospital,1,69.3,50.55,0.0,50.55,0.0,0.0,50.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002506,MBR00000099,Institutional-IP,2021-04-28,2021-05-03,2021-05-28,PLN8930,1198133277,1198133277,SNF,In-Network,J44.1,I10,,,,195,MS-DRG,19,5,N,85610,Pathology/Lab,,,0320,21,Inpatient Hospital,3,44.51,19.98,19.98,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002507,MBR00000099,Institutional-IP,2022-06-05,2022-06-09,2022-06-12,PLN8205,1124394415,1124394415,Pediatrics,In-Network,F32.9,K21.0,,,,641,MS-DRG,14,4,Y,93225,Medicine,,,0320,21,Inpatient Hospital,2,913.18,590.39,575.39,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000002508,MBR00000099,Institutional-IP,2022-05-13,2022-05-18,2022-06-06,PLN2672,1540044947,1540044947,Pulmonology,Out-of-Network,M17.11,Z12.31,,,,470,MS-DRG,3,5,Y,99232,E&M,,,0450,21,Inpatient Hospital,3,206.18,140.47,125.47,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000002509,MBR00000099,Institutional-OP,2023-08-28,2023-08-28,2023-09-20,PLN9935,1856686341,1856686341,Geriatrics,In-Network,Z00.01,E11.9,,,,,,,0,,27130,Surgery,,,0120,22,Outpatient Hospital,2,4540.78,3082.01,2579.08,487.93,15.0,0.0,502.93,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002510,MBR00000099,Professional,2023-04-07,2023-04-07,2023-04-24,PLN3936,1564502315,1564502315,ASC,In-Network,I10,Z00.00,,,,,,,0,,99284,E&M,,,,11,Office,1,552.35,232.9,232.9,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000002511,MBR00000099,Professional,2023-08-20,2023-08-20,2023-09-22,PLN2718,1528335731,1528335731,Critical Access Hospital,In-Network,J06.9,N39.0,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,2,82.67,60.74,0.0,0.0,0.0,1.46,1.46,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002512,MBR00000099,Institutional-OP,2022-05-27,2022-05-27,2022-06-11,PLN5317,1103747954,1103747954,Urology,In-Network,Z23,N18.3,,,,,,,0,,43239,Surgery,,,0200,22,Outpatient Hospital,2,1707.94,1135.83,1135.83,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002513,MBR00000099,Professional,2021-06-20,2021-06-20,2021-08-03,PLN7033,1948810580,1948810580,DME Supplier,In-Network,R10.9,I11.9,,,,,,,0,,80053,Pathology/Lab,,,,21,Inpatient Hospital,3,151.55,48.91,48.91,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002514,MBR00000099,Institutional-OP,2023-03-01,2023-03-01,2023-03-31,PLN6344,1872613201,1872613201,Internal Medicine,In-Network,I10,Z12.31,,,,,,,0,,81001,Pathology/Lab,,,0450,22,Outpatient Hospital,3,28.19,17.48,0.0,17.48,0.0,0.0,17.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002515,MBR00000100,Institutional-OP,2021-08-28,2021-08-28,2021-09-27,PLN8858,1624802371,1624802371,ASC,Out-of-Network,M54.5,R07.9,,,,,,,0,,99232,E&M,,,0761,22,Outpatient Hospital,1,402.48,127.15,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000002516,MBR00000100,Institutional-OP,2022-11-29,2022-11-29,2022-12-15,PLN4197,1865904917,1865904917,Outpatient Clinic,In-Network,R05,Z23,,,,,,,0,,90686,Medicine,,,0360,22,Outpatient Hospital,2,59.09,19.05,0.0,19.05,0.0,0.0,19.05,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000002517,MBR00000100,Professional,2022-03-26,2022-03-26,2022-04-16,PLN1240,1511044648,1511044648,Endocrinology,In-Network,M17.11,E87.6,,,,,,,0,,27447,Surgery,,,,11,Office,3,4376.45,1581.66,1556.66,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002518,MBR00000100,Institutional-IP,2022-01-18,2022-01-24,2022-02-14,PLN7487,1964402759,1964402759,Outpatient Clinic,In-Network,Z00.00,M17.11,,,,690,MS-DRG,10,6,Y,90460,Medicine,,,0636,21,Inpatient Hospital,1,36.89,25.52,0.0,25.52,0.0,0.0,25.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002519,MBR00000100,Institutional-OP,2021-05-11,2021-05-11,2021-06-03,PLN8076,1689639685,1689639685,SNF,In-Network,Z12.11,J06.9,,,,,,,0,,99232,E&M,,,0510,22,Outpatient Hospital,3,265.21,142.62,0.0,142.62,0.0,0.0,142.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002520,MBR00000100,Professional,2023-05-27,2023-05-27,2023-06-07,PLN7887,1219817751,1219817751,OB/GYN,In-Network,Z12.31,N17.9,,,,,,,0,,27130,Surgery,,,,11,Office,2,6207.59,4126.89,4126.89,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002521,MBR00000100,Institutional-IP,2023-01-25,2023-02-02,2023-02-05,PLN6413,1809014947,1809014947,Urology,In-Network,F32.9,I25.10,,,,195,MS-DRG,21,8,Y,27447,Surgery,,,0270,21,Inpatient Hospital,3,4142.31,3504.04,3441.64,62.4,0.0,0.0,62.4,0.0,Adjusted,,,1,,0,0,1,0,1,1,Duplicate,0,0,0,0,0
CLM0000002522,MBR00000100,Professional,2022-01-10,2022-01-10,2022-01-29,PLN2452,1193493783,1193493783,Critical Access Hospital,Out-of-Network,E11.9,K21.0,,,,,,,0,,97110,Medicine,,,,23,Emergency Room,2,269.4,219.47,174.31,0.0,25.0,20.16,45.16,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002523,MBR00000100,Professional,2023-03-19,2023-03-19,2023-04-23,PLN4303,1700633438,1700633438,DME Supplier,In-Network,J44.1,K57.30,,,,,,,0,,99222,E&M,,,,11,Office,2,536.42,397.24,322.01,0.0,75.0,0.23,75.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002524,MBR00000100,Institutional-OP,2023-12-17,2023-12-17,2023-12-26,PLN9682,1450094833,1450094833,Outpatient Clinic,In-Network,Z23,E78.5,,,,,,,0,,27130,Surgery,,,0900,22,Outpatient Hospital,1,4989.98,2316.97,1806.46,485.51,25.0,0.0,510.51,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002525,MBR00000100,Institutional-OP,2023-03-01,2023-03-01,2023-04-14,PLN1352,1486164553,1486164553,DME Supplier,In-Network,E66.9,I10,,,,,,,0,,99213,E&M,,,0740,22,Outpatient Hospital,3,320.0,231.98,231.98,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002526,MBR00000100,Professional,2023-11-06,2023-11-06,2023-12-14,PLN8084,1168881145,1168881145,Orthopedic Surgery,In-Network,J20.9,Z12.31,,,,,,,0,,99283,E&M,,,,20,Urgent Care,1,566.26,284.93,0.0,273.72,35.0,0.0,308.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002527,MBR00000100,Professional,2022-05-30,2022-05-30,2022-07-08,PLN5332,1239316214,1239316214,Internal Medicine,In-Network,Z23,J06.9,,,,,,,0,,93000,Radiology,,,,20,Urgent Care,3,186.24,74.27,74.27,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002528,MBR00000100,Institutional-IP,2022-02-17,2022-02-24,2022-03-13,PLN8306,1939033455,1939033455,Pulmonology,In-Network,F03.90,Z51.11,,,,872,MS-DRG,16,7,Y,99222,E&M,,,0200,21,Inpatient Hospital,2,464.13,325.82,290.82,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000002529,MBR00000100,Professional,2023-07-13,2023-07-13,2023-08-03,PLN9481,1135158374,1135158374,Pulmonology,In-Network,I48.91,Z00.01,,,,,,,0,,99284,E&M,,,,11,Office,1,887.68,673.28,266.74,371.54,35.0,0.0,406.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002530,MBR00000100,Institutional-IP,2022-12-27,2022-12-31,2023-01-24,PLN8703,1817234602,1817234602,Clinical Laboratory,In-Network,F41.9,J20.9,,,,603,MS-DRG,8,4,Y,70553,Radiology,,,0450,21,Inpatient Hospital,3,2063.37,1467.69,1417.69,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002531,MBR00000100,Institutional-OP,2022-10-26,2022-10-26,2022-11-29,PLN3306,1390307371,1390307371,DME Supplier,In-Network,F41.9,J20.9,,,,,,,0,,83036,Pathology/Lab,,,0200,22,Outpatient Hospital,3,117.59,59.41,59.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000002532,MBR00000100,Professional,2022-12-04,2022-12-04,2022-12-24,PLN2775,1974006077,1974006077,Orthopedic Surgery,In-Network,F41.9,E11.9,,,,,,,0,,99232,E&M,,,,81,Independent Laboratory,1,272.69,187.2,118.02,19.18,50.0,0.0,69.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002533,MBR00000100,Institutional-OP,2023-12-25,2023-12-25,2024-01-20,PLN3449,1752470395,1752470395,Home Health,In-Network,N39.0,N17.9,,,,,,,0,,99222,E&M,,,0636,22,Outpatient Hospital,3,230.05,87.61,87.61,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002534,MBR00000100,Professional,2023-01-23,2023-01-23,2023-02-12,PLN4388,1585582070,1585582070,Outpatient Clinic,In-Network,Z51.11,M54.5,,,,,,,0,,58661,Surgery,,,,11,Office,1,4289.99,2842.54,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-15,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002535,MBR00000100,Professional,2023-06-12,2023-06-12,2023-07-11,PLN7544,1109850785,1109850785,ASC,Out-of-Network,Z12.31,F41.9,,,,,,,0,,97530,Medicine,,,,11,Office,3,292.82,111.21,0.0,111.21,25.0,0.0,136.21,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000002536,MBR00000100,Institutional-OP,2021-02-09,2021-02-09,2021-02-22,PLN6636,1687650653,1687650653,Internal Medicine,In-Network,M54.5,Z12.11,,,,,,,0,,23472,Surgery,,,0450,22,Outpatient Hospital,1,5466.85,1802.12,1752.12,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002537,MBR00000100,Professional,2023-03-02,2023-03-02,2023-03-23,PLN6884,1994661817,1994661817,SNF,Out-of-Network,J18.9,M81.0,,,,,,,0,,99213,E&M,,,,21,Inpatient Hospital,3,211.42,66.17,31.17,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002538,MBR00000100,Professional,2021-12-14,2021-12-14,2021-12-24,PLN1942,1313212303,1313212303,Family Medicine,In-Network,Z12.11,C50.912,,,,,,,0,,99203,E&M,,,,11,Office,3,370.4,308.75,293.75,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002539,MBR00000100,Institutional-IP,2021-05-16,2021-05-17,2021-06-27,PLN4205,1514306773,1514306773,Endocrinology,In-Network,I10,E78.5,,,,683,MS-DRG,6,1,Y,99214,E&M,,,0200,21,Inpatient Hospital,1,177.94,55.17,20.17,0.0,35.0,0.0,35.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002540,MBR00000100,Professional,2021-10-30,2021-10-30,2021-12-11,PLN6390,1727809972,1727809972,Home Health,In-Network,Z00.00,I10,,,,,,,0,,23472,Surgery,,,,11,Office,1,6931.82,3646.25,2981.27,77.68,75.0,512.3,664.98,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002541,MBR00000100,Professional,2023-07-01,2023-07-01,2023-07-23,PLN3531,1713934949,1713934949,Neurology,In-Network,F10.20,J06.9,,,,,,,0,,99221,E&M,,,,11,Office,1,367.57,264.46,249.46,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000002542,MBR00000100,Institutional-OP,2023-06-15,2023-06-15,2023-07-29,PLN8709,1168246159,1168246159,Internal Medicine,In-Network,I11.9,E78.5,,,,,,,0,,77067,Radiology,,,0450,22,Outpatient Hospital,1,646.27,388.66,0.0,374.85,35.0,0.0,409.85,0.0,Denied,CO-15,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000002543,MBR00000100,Professional,2021-12-01,2021-12-01,2021-12-14,PLN4520,1247341320,1247341320,Urology,Out-of-Network,Z87.891,M81.0,,,,,,,0,,66984,Surgery,,,,23,Emergency Room,2,2676.55,939.94,939.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002544,MBR00000100,Professional,2021-07-30,2021-07-30,2021-09-01,PLN6269,1355166277,1355166277,Endocrinology,In-Network,N39.0,C50.912,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,1,485.91,174.32,0.0,174.32,35.0,0.0,209.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002545,MBR00000100,Professional,2022-04-04,2022-04-04,2022-05-04,PLN5594,1556140803,1556140803,Cardiology,In-Network,E11.9,R07.9,,,,,,,0,,72148,Radiology,,,,21,Inpatient Hospital,2,1406.33,537.65,502.65,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002546,MBR00000100,Institutional-OP,2021-12-30,2021-12-30,2022-01-14,PLN3080,1410468316,1410468316,SNF,In-Network,Z12.11,Z12.31,,,,,,,0,,80061,Pathology/Lab,,,0636,22,Outpatient Hospital,2,96.53,39.8,20.04,0.0,15.0,4.76,19.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002547,MBR00000100,Professional,2022-05-22,2022-05-22,2022-06-30,PLN8477,1109850785,1109850785,ASC,Out-of-Network,E11.65,E78.5,,,,,,,0,,99406,Medicine,,,,12,Home,2,60.32,46.41,0.0,46.41,75.0,0.0,121.41,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000002548,MBR00000100,Institutional-OP,2023-05-09,2023-05-09,2023-05-31,PLN8225,1872272835,1872272835,Internal Medicine,In-Network,G43.909,E66.9,,,,,,,0,,76700,Radiology,,,0320,22,Outpatient Hospital,1,752.93,458.58,0.0,458.58,35.0,0.0,493.58,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002549,MBR00000100,Professional,2021-12-29,2021-12-29,2022-01-25,PLN3667,1550154147,1550154147,Outpatient Clinic,In-Network,N17.9,F41.9,,,,,,,0,,97530,Medicine,,,,23,Emergency Room,3,226.91,107.28,12.42,59.86,35.0,0.0,94.86,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002550,MBR00000100,Institutional-OP,2021-07-09,2021-07-09,2021-08-20,PLN7715,1372918899,1372918899,Family Medicine,In-Network,I63.9,E11.9,,,,,,,0,,99222,E&M,,,0320,22,Outpatient Hospital,3,465.05,237.64,71.11,116.53,50.0,0.0,166.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002551,MBR00000100,Institutional-OP,2021-04-29,2021-04-29,2021-06-04,PLN8957,1236418230,1236418230,DME Supplier,In-Network,Z12.31,M81.0,,,,,,,0,,27447,Surgery,,,0200,22,Outpatient Hospital,3,3506.45,2250.44,2136.3,64.14,50.0,0.0,114.14,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002552,MBR00000100,Institutional-OP,2023-01-21,2023-01-21,2023-01-31,PLN8559,1780163051,1780163051,SNF,In-Network,Z00.00,Z00.00,,,,,,,0,,66984,Surgery,,,0730,22,Outpatient Hospital,1,2806.65,2178.04,2108.74,69.3,0.0,0.0,69.3,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002553,MBR00000100,Institutional-OP,2021-08-07,2021-08-07,2021-09-01,PLN2632,1334916761,1334916761,ASC,In-Network,E11.9,M54.5,,,,,,,0,,77067,Radiology,,,0761,22,Outpatient Hospital,3,327.56,180.07,180.07,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000002554,MBR00000100,Professional,2021-08-29,2021-08-29,2021-09-12,PLN2454,1433937353,1433937353,Nephrology,In-Network,R07.9,G43.909,,,,,,,0,,99221,E&M,,,,50,Federally Qualified Health Center,3,428.54,297.25,297.25,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002555,MBR00000100,Professional,2023-05-30,2023-05-30,2023-06-27,PLN1956,1283743001,1283743001,Family Medicine,In-Network,N39.0,I10,,,,,,,0,,99222,E&M,,,,11,Office,1,289.18,222.31,222.31,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002556,MBR00000100,Professional,2021-04-12,2021-04-12,2021-05-13,PLN7355,1542828721,1542828721,Orthopedic Surgery,In-Network,K21.0,E66.9,,,,,,,0,,47562,Surgery,,,,11,Office,1,6130.48,3032.82,2056.86,420.81,75.0,480.15,975.96,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002557,MBR00000100,Professional,2022-12-16,2022-12-16,2023-01-16,PLN5078,1915531927,1915531927,Critical Access Hospital,In-Network,J06.9,E78.5,,,,,,,0,,77067,Radiology,,,,23,Emergency Room,1,562.03,313.6,278.6,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,1,1,0,0,0,0,None,1,0,0,0,0
CLM0000002558,MBR00000100,Professional,2021-01-13,2021-01-13,2021-02-07,PLN1499,1132188260,1132188260,Family Medicine,In-Network,E78.5,M54.5,,,,,,,0,,80053,Pathology/Lab,,,,12,Home,2,133.62,93.38,43.38,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002559,MBR00000100,Institutional-IP,2023-10-30,2023-11-03,2023-11-06,PLN5908,1502838586,1502838586,ASC,In-Network,Z23,B97.89,,,,603,MS-DRG,24,4,Y,71046,Radiology,,,0450,21,Inpatient Hospital,1,254.05,190.7,140.7,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002560,MBR00000100,Professional,2023-02-21,2023-02-21,2023-03-23,PLN6631,1500949740,1500949740,Pediatrics,In-Network,R10.9,I10,,,,,,,0,,93306,Radiology,,,,20,Urgent Care,2,2323.09,1148.32,1148.32,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002561,MBR00000100,Institutional-OP,2023-06-19,2023-06-19,2023-07-26,PLN2406,1845900543,1845900543,ASC,In-Network,E78.5,E78.5,,,,,,,0,,99284,E&M,,,0120,22,Outpatient Hospital,3,847.06,626.07,0.0,42.09,50.0,0.0,92.09,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002562,MBR00000100,Institutional-OP,2022-12-31,2022-12-31,2023-02-08,PLN6434,1700633438,1700633438,DME Supplier,In-Network,E66.9,F32.9,,,,,,,0,,80053,Pathology/Lab,,,0740,22,Outpatient Hospital,1,71.47,52.23,0.0,52.23,0.0,0.0,52.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002563,MBR00000100,Professional,2022-03-17,2022-03-17,2022-03-24,PLN7222,1609526529,1609526529,Psychiatry,In-Network,I10,Z12.31,,,,,,,0,,70553,Radiology,,,,11,Office,2,4686.66,1839.23,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002564,MBR00000100,Professional,2023-12-26,2023-12-26,2024-01-28,PLN3319,1845057593,1845057593,Orthopedic Surgery,In-Network,Z23,Z23,,,,,,,0,,99221,E&M,,,,11,Office,3,400.12,261.24,186.24,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002565,MBR00000101,Institutional-IP,2023-05-11,2023-05-14,2023-05-27,PLN3703,1266606767,1266606767,ASC,In-Network,I10,N39.0,,,,682,MS-DRG,2,3,N,99222,E&M,,,0740,21,Inpatient Hospital,1,634.74,528.84,225.1,216.07,35.0,52.67,303.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002566,MBR00000101,Professional,2021-04-08,2021-04-08,2021-04-24,PLN4952,1313212303,1313212303,Family Medicine,In-Network,Z23,R51,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,3,394.12,183.57,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002567,MBR00000101,Professional,2022-09-24,2022-09-24,2022-11-06,PLN4727,1193493783,1193493783,Critical Access Hospital,Out-of-Network,K21.0,F41.9,,,,,,,0,,99221,E&M,,,,50,Federally Qualified Health Center,2,214.6,120.41,120.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002568,MBR00000101,Professional,2022-08-18,2022-08-18,2022-09-24,PLN9531,1571574052,1571574052,Critical Access Hospital,In-Network,I10,J20.9,,,,,,,0,,99221,E&M,,,,23,Emergency Room,2,446.65,207.69,207.69,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002569,MBR00000101,Institutional-IP,2021-11-10,2021-11-12,2021-12-12,PLN7389,1800011727,1800011727,Clinical Laboratory,Out-of-Network,N39.0,M17.11,,,,871,MS-DRG,5,2,Y,99406,Medicine,,,0900,21,Inpatient Hospital,3,75.47,52.08,27.08,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002570,MBR00000101,Professional,2022-05-15,2022-05-15,2022-05-28,PLN3509,1500949740,1500949740,Pediatrics,In-Network,Z00.00,I10,,,,,,,0,,47562,Surgery,,,,11,Office,1,4892.36,1574.18,1574.18,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002571,MBR00000101,Professional,2023-12-04,2023-12-04,2023-12-29,PLN7175,1108115157,1108115157,General Acute Care Hospital,In-Network,E11.40,I10,,,,,,,0,,27447,Surgery,,,,11,Office,2,3335.8,2653.49,2463.95,174.54,15.0,0.0,189.54,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002572,MBR00000101,Professional,2021-04-05,2021-04-05,2021-04-24,PLN8150,1569105090,1569105090,Geriatrics,In-Network,Z00.00,F41.9,,,,,,,0,,87491,Pathology/Lab,,,,50,Federally Qualified Health Center,3,122.91,74.64,59.64,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002573,MBR00000101,Professional,2023-10-14,2023-10-14,2023-11-09,PLN9556,1717546253,1717546253,Family Medicine,In-Network,N40.0,J44.1,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,3,1422.66,731.05,696.05,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000002574,MBR00000101,Professional,2023-02-06,2023-02-06,2023-03-03,PLN6735,1856686341,1856686341,Geriatrics,In-Network,F03.90,Z23,,,,,,,0,,43239,Surgery,,,,81,Independent Laboratory,3,827.5,362.96,309.27,0.0,0.0,53.69,53.69,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002575,MBR00000101,Institutional-OP,2021-05-03,2021-05-03,2021-05-27,PLN9961,1135158374,1135158374,Pulmonology,In-Network,J45.20,Z12.31,,,,,,,0,,99214,E&M,,,0301,22,Outpatient Hospital,2,275.08,176.11,152.27,0.0,15.0,8.84,23.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002576,MBR00000101,Institutional-IP,2021-12-01,2021-12-04,2021-12-23,PLN4474,1571574052,1571574052,Critical Access Hospital,In-Network,K21.0,N40.0,,,,682,MS-DRG,22,3,Y,99222,E&M,,,0301,21,Inpatient Hospital,3,586.02,287.78,287.78,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000002577,MBR00000101,Professional,2023-07-09,2023-07-09,2023-08-08,PLN2089,1799205295,1799205295,General Acute Care Hospital,In-Network,N18.3,G43.909,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,1,333.18,262.37,74.54,187.83,0.0,0.0,187.83,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002578,MBR00000101,Institutional-OP,2023-02-10,2023-02-10,2023-02-25,PLN6617,1239316214,1239316214,Internal Medicine,In-Network,J20.9,R05,,,,,,,0,,83036,Pathology/Lab,,,0200,22,Outpatient Hospital,3,44.59,30.83,0.0,30.83,0.0,0.0,30.83,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000002579,MBR00000101,Institutional-IP,2021-03-27,2021-03-30,2021-04-03,PLN7059,1845057593,1845057593,Orthopedic Surgery,In-Network,C50.912,Z79.4,,,,292,MS-DRG,6,3,Y,93000,Radiology,,,0320,21,Inpatient Hospital,3,168.62,80.97,80.97,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002580,MBR00000101,Professional,2021-06-11,2021-06-11,2021-07-23,PLN2133,1520687146,1520687146,ASC,In-Network,I63.9,I50.9,,,,,,,0,,71046,Radiology,,,,20,Urgent Care,2,235.77,198.74,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002581,MBR00000101,Institutional-OP,2023-10-15,2023-10-15,2023-11-14,PLN5213,1817234602,1817234602,Clinical Laboratory,In-Network,N39.0,F32.9,,,,,,,0,,43239,Surgery,,,0301,22,Outpatient Hospital,1,1220.86,985.52,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-11,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002582,MBR00000101,Institutional-OP,2021-06-22,2021-06-22,2021-07-20,PLN7645,1242201429,1242201429,General Acute Care Hospital,In-Network,E11.65,R10.9,,,,,,,0,,47562,Surgery,,,0370,22,Outpatient Hospital,3,4449.61,1980.81,1980.81,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002583,MBR00000101,Professional,2022-11-15,2022-11-15,2022-12-26,PLN1774,1800011727,1800011727,Clinical Laboratory,Out-of-Network,Z12.11,G43.909,,,,,,,0,,93000,Radiology,,,,23,Emergency Room,2,68.41,26.73,0.0,26.73,50.0,0.0,76.73,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002584,MBR00000101,Professional,2023-12-27,2023-12-27,2024-01-08,PLN7646,1575695214,1575695214,SNF,In-Network,I10,I10,,,,,,,0,,47562,Surgery,,,,12,Home,1,4213.62,2485.82,1954.71,496.11,35.0,0.0,531.11,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002585,MBR00000101,Institutional-OP,2021-07-02,2021-07-02,2021-07-25,PLN1135,1696843572,1696843572,Critical Access Hospital,Out-of-Network,I25.10,I48.91,,,,,,,0,,27130,Surgery,,,0320,22,Outpatient Hospital,3,3916.68,2473.49,2422.99,0.0,0.0,50.5,50.5,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002586,MBR00000101,Professional,2021-02-18,2021-02-18,2021-03-20,PLN1498,1438368327,1438368327,Home Health,In-Network,Z12.31,E11.9,,,,,,,0,,99284,E&M,,,,21,Inpatient Hospital,2,692.06,357.58,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002587,MBR00000101,Professional,2023-06-14,2023-06-14,2023-07-03,PLN9795,1997536841,1997536841,Family Medicine,Out-of-Network,E78.5,F10.20,,,,,,,0,,99203,E&M,,,,21,Inpatient Hospital,1,349.13,206.14,0.0,206.14,25.0,0.0,231.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002588,MBR00000101,Institutional-OP,2023-11-07,2023-11-07,2023-11-29,PLN2530,1422747896,1422747896,Urology,In-Network,E11.65,N20.0,,,,,,,0,,76700,Radiology,,,0301,22,Outpatient Hospital,1,1019.57,486.54,113.4,373.14,0.0,0.0,373.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002589,MBR00000101,Institutional-OP,2022-07-19,2022-07-19,2022-08-20,PLN4821,1702692193,1702692193,Physical Therapy,In-Network,M54.5,I10,,,,,,,0,,99232,E&M,,,0450,22,Outpatient Hospital,3,302.92,178.32,65.58,36.85,75.0,0.89,112.74,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002590,MBR00000101,Institutional-IP,2021-09-13,2021-09-16,2021-10-14,PLN1641,1571574052,1571574052,Critical Access Hospital,In-Network,Z12.31,Z12.31,,,,291,MS-DRG,14,3,Y,99214,E&M,,,0730,21,Inpatient Hospital,3,465.93,347.22,48.21,271.66,25.0,2.35,299.01,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000002591,MBR00000101,Professional,2021-03-07,2021-03-07,2021-04-17,PLN7817,1585582070,1585582070,Outpatient Clinic,In-Network,E66.9,I48.91,,,,,,,0,,72148,Radiology,,,,22,Outpatient Hospital,3,2450.99,816.66,753.78,12.88,50.0,0.0,62.88,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002592,MBR00000101,Professional,2023-09-25,2023-09-25,2023-10-04,PLN7718,1198133277,1198133277,SNF,In-Network,E11.9,M81.0,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,2,57.93,33.27,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000002593,MBR00000101,Institutional-OP,2023-05-25,2023-05-25,2023-06-15,PLN5793,1132188260,1132188260,Family Medicine,In-Network,F32.9,M17.11,,,,,,,0,,99213,E&M,,,0301,22,Outpatient Hospital,2,324.5,116.54,43.85,72.69,0.0,0.0,72.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002594,MBR00000101,Institutional-OP,2023-09-09,2023-09-09,2023-09-29,PLN9254,1514306773,1514306773,Endocrinology,In-Network,I10,F41.9,,,,,,,0,,99232,E&M,,,0320,22,Outpatient Hospital,3,204.03,123.87,9.92,113.95,0.0,0.0,113.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002595,MBR00000101,Institutional-OP,2023-05-14,2023-05-14,2023-06-10,PLN6516,1500949740,1500949740,Pediatrics,In-Network,N20.0,Z51.11,,,,,,,0,,74177,Radiology,,,0360,22,Outpatient Hospital,2,1910.2,842.34,707.75,0.0,35.0,99.59,134.59,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000002596,MBR00000101,Professional,2022-04-20,2022-04-20,2022-05-27,PLN5696,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,M54.5,K21.0,,,,,,,0,,99284,E&M,,,,21,Inpatient Hospital,2,822.42,652.67,0.0,0.0,35.0,54.67,89.67,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002597,MBR00000101,Institutional-OP,2022-06-12,2022-06-12,2022-07-21,PLN4474,1109850785,1109850785,ASC,Out-of-Network,E66.9,F03.90,,,,,,,0,,45378,Surgery,,,0360,22,Outpatient Hospital,3,1794.24,1436.54,1226.12,160.42,50.0,0.0,210.42,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000002598,MBR00000101,Professional,2022-02-23,2022-02-23,2022-03-07,PLN6406,1224179551,1224179551,Physical Therapy,In-Network,M54.5,J06.9,,,,,,,0,,33533,Surgery,,,,11,Office,1,25942.66,12635.73,12635.73,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002599,MBR00000101,Professional,2023-03-12,2023-03-12,2023-04-13,PLN3972,1571574052,1571574052,Critical Access Hospital,In-Network,J06.9,J06.9,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,2,47.32,26.33,0.0,0.0,25.0,0.2,25.2,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002600,MBR00000101,Institutional-OP,2021-04-20,2021-04-20,2021-05-19,PLN1016,1139906830,1139906830,Endocrinology,Out-of-Network,E11.9,N18.3,,,,,,,0,,85610,Pathology/Lab,,,0370,22,Outpatient Hospital,3,66.41,30.77,0.0,30.77,25.0,0.0,55.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002601,MBR00000101,Professional,2021-02-13,2021-02-13,2021-03-02,PLN1602,1757138478,1757138478,Pediatrics,In-Network,E78.5,G43.909,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,2,17121.39,6317.62,6110.26,132.36,75.0,0.0,207.36,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002602,MBR00000101,Institutional-IP,2023-11-19,2023-11-21,2023-12-01,PLN8674,1660288235,1660288235,ASC,In-Network,I63.9,I10,,,,872,MS-DRG,17,2,Y,90460,Medicine,,,0360,21,Inpatient Hospital,1,75.85,32.55,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002603,MBR00000101,Institutional-IP,2021-12-15,2021-12-26,2021-12-29,PLN2737,1745114564,1745114564,Endocrinology,In-Network,K21.0,I10,,,,682,MS-DRG,6,11,Y,43239,Surgery,,,0636,21,Inpatient Hospital,2,1469.98,1175.75,1175.75,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000002604,MBR00000101,Institutional-OP,2021-02-07,2021-02-07,2021-02-17,PLN4304,1809014947,1809014947,Urology,In-Network,Z00.00,E66.9,,,,,,,0,,45378,Surgery,,,0510,22,Outpatient Hospital,2,1798.67,1095.57,919.85,85.91,0.0,89.81,175.72,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000002605,MBR00000101,Professional,2023-01-08,2023-01-08,2023-02-16,PLN5915,1935547131,1935547131,Pulmonology,In-Network,N39.0,J20.9,,,,,,,0,,45378,Surgery,,,,11,Office,1,1692.9,1256.1,1231.1,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000002606,MBR00000101,Professional,2022-03-13,2022-03-13,2022-04-10,PLN9859,1389336600,1389336600,Critical Access Hospital,In-Network,F32.9,E11.9,,,,,,,0,,74177,Radiology,,,,11,Office,3,1191.16,428.24,428.24,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002607,MBR00000101,Institutional-IP,2021-09-10,2021-09-13,2021-10-01,PLN6614,1702692193,1702692193,Physical Therapy,In-Network,G43.909,J06.9,,,,641,MS-DRG,22,3,Y,27447,Surgery,,,0270,21,Inpatient Hospital,2,2640.69,1864.16,1466.6,82.87,0.0,314.69,397.56,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002608,MBR00000101,Institutional-OP,2022-04-21,2022-04-21,2022-05-12,PLN7070,1745114564,1745114564,Endocrinology,In-Network,N40.0,E66.9,,,,,,,0,,90460,Medicine,,,0200,22,Outpatient Hospital,3,28.84,14.88,0.0,14.88,25.0,0.0,39.88,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002609,MBR00000101,Institutional-OP,2022-05-09,2022-05-09,2022-06-19,PLN5432,1500037969,1500037969,Pulmonology,In-Network,J20.9,E11.9,,,,,,,0,,80053,Pathology/Lab,,,0730,22,Outpatient Hospital,1,133.32,76.45,61.47,0.0,0.0,14.98,14.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002610,MBR00000101,Professional,2022-11-02,2022-11-02,2022-11-25,PLN6803,1545347862,1545347862,SNF,In-Network,I63.9,N18.3,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,3,2236.97,1708.1,1398.44,284.66,25.0,0.0,309.66,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002611,MBR00000101,Institutional-OP,2023-10-18,2023-10-18,2023-11-12,PLN1048,1980712759,1980712759,Outpatient Clinic,Out-of-Network,K21.0,F32.9,,,,,,,0,,99204,E&M,,,0730,22,Outpatient Hospital,3,512.79,168.99,113.08,0.0,35.0,20.91,55.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002612,MBR00000101,Professional,2023-08-23,2023-08-23,2023-09-05,PLN4003,1186826716,1186826716,Physical Therapy,In-Network,J06.9,Z00.01,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,3,6292.99,3609.25,3559.25,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002613,MBR00000101,Professional,2023-06-25,2023-06-25,2023-08-06,PLN7943,1132188260,1132188260,Family Medicine,In-Network,M54.5,C50.912,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,2,316.48,234.83,127.99,31.84,75.0,0.0,106.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002614,MBR00000101,Professional,2022-06-23,2022-06-23,2022-07-17,PLN1253,1139906830,1139906830,Endocrinology,Out-of-Network,Z51.11,E11.65,,,,,,,0,,66984,Surgery,,,,23,Emergency Room,1,1641.87,611.02,536.02,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002615,MBR00000102,Professional,2022-09-04,2022-09-04,2022-10-03,PLN8717,1475984649,1475984649,SNF,In-Network,E11.9,N40.0,,,,,,,0,,23472,Surgery,,,,11,Office,2,7015.55,4653.2,4578.2,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002616,MBR00000102,Professional,2021-05-25,2021-05-25,2021-06-15,PLN8578,1109850785,1109850785,ASC,Out-of-Network,I10,B97.89,,,,,,,0,,85025,Pathology/Lab,,,,21,Inpatient Hospital,1,96.67,78.02,78.02,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002617,MBR00000102,Professional,2022-09-24,2022-09-24,2022-10-22,PLN3538,1389336600,1389336600,Critical Access Hospital,In-Network,N40.0,E11.9,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,3,87.66,40.86,14.19,0.0,25.0,1.67,26.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002618,MBR00000102,Professional,2023-01-06,2023-01-06,2023-01-25,PLN1369,1767011137,1767011137,DME Supplier,In-Network,E78.5,Z00.00,,,,,,,0,,93306,Radiology,,,,12,Home,2,1898.51,609.98,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002619,MBR00000102,Institutional-OP,2023-08-30,2023-08-30,2023-09-09,PLN5838,1845900543,1845900543,ASC,In-Network,E11.9,Z23,,,,,,,0,,84443,Pathology/Lab,,,0200,22,Outpatient Hospital,1,125.8,104.47,104.47,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002620,MBR00000102,Professional,2021-02-20,2021-02-20,2021-04-02,PLN5494,1935547131,1935547131,Pulmonology,In-Network,E66.9,R07.9,,,,,,,0,,58661,Surgery,,,,49,Independent Clinic,1,2643.75,1046.49,957.87,0.0,0.0,88.62,88.62,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002621,MBR00000102,Institutional-OP,2023-08-04,2023-08-04,2023-09-10,PLN4074,1590915516,1590915516,Physical Therapy,Out-of-Network,I10,G43.909,,,,,,,0,,45380,Surgery,,,0200,22,Outpatient Hospital,2,2179.08,1463.01,1448.01,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000002622,MBR00000102,Institutional-OP,2022-07-22,2022-07-22,2022-08-08,PLN1881,1410468316,1410468316,SNF,In-Network,I50.9,I10,,,,,,,0,,99284,E&M,,,0900,22,Outpatient Hospital,1,581.26,391.23,366.23,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002623,MBR00000102,Professional,2021-04-07,2021-04-07,2021-05-09,PLN3377,1213165847,1213165847,Critical Access Hospital,In-Network,J06.9,J06.9,,,,,,,0,,99283,E&M,,,,23,Emergency Room,1,579.23,442.41,383.26,59.15,0.0,0.0,59.15,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002624,MBR00000102,Institutional-OP,2023-12-27,2023-12-27,2024-02-05,PLN5507,1991459367,1991459367,Neurology,Out-of-Network,Z87.891,I25.10,,,,,,,0,,99213,E&M,,,0120,22,Outpatient Hospital,2,318.55,208.89,208.89,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002625,MBR00000102,Professional,2022-05-25,2022-05-25,2022-07-05,PLN5687,1575695214,1575695214,SNF,In-Network,I48.91,I10,,,,,,,0,,82043,Pathology/Lab,,,,81,Independent Laboratory,3,43.41,21.27,21.27,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002626,MBR00000102,Professional,2022-03-27,2022-03-27,2022-04-04,PLN7584,1438368327,1438368327,Home Health,In-Network,I10,I25.10,,,,,,,0,,90837,Medicine,,,,11,Office,3,516.68,195.84,128.44,67.4,0.0,0.0,67.4,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000002627,MBR00000102,Institutional-OP,2021-07-28,2021-07-28,2021-08-29,PLN6657,1168881145,1168881145,Orthopedic Surgery,In-Network,E66.9,Z12.31,,,,,,,0,,71046,Radiology,,,0320,22,Outpatient Hospital,2,300.88,203.16,153.16,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000002628,MBR00000102,Institutional-IP,2021-03-22,2021-03-23,2021-04-08,PLN3354,1514306773,1514306773,Endocrinology,In-Network,N18.3,E11.65,,,,683,MS-DRG,4,1,Y,99222,E&M,,,0450,21,Inpatient Hospital,1,582.78,378.36,0.0,378.36,0.0,0.0,378.36,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002629,MBR00000102,Professional,2021-04-02,2021-04-02,2021-05-05,PLN2606,1148984206,1148984206,Psychiatry,In-Network,Z51.11,Z23,,,,,,,0,,93000,Radiology,,,,31,Skilled Nursing Facility,3,188.55,83.49,0.0,83.49,0.0,0.0,83.49,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002630,MBR00000102,Institutional-OP,2021-10-20,2021-10-20,2021-11-20,PLN2516,1569105090,1569105090,Geriatrics,In-Network,Z00.00,E78.5,,,,,,,0,,99213,E&M,,,0301,22,Outpatient Hospital,1,165.56,72.04,0.0,72.04,75.0,0.0,147.04,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002631,MBR00000102,Institutional-OP,2021-11-17,2021-11-17,2021-12-04,PLN7393,1450553056,1450553056,Clinical Laboratory,In-Network,N40.0,Z00.00,,,,,,,0,,99406,Medicine,,,0740,22,Outpatient Hospital,1,73.16,53.22,0.0,53.22,25.0,0.0,78.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002632,MBR00000102,Professional,2022-05-23,2022-05-23,2022-07-01,PLN9613,1847081578,1847081578,Urology,Out-of-Network,N20.0,K21.0,,,,,,,0,,85610,Pathology/Lab,,,,22,Outpatient Hospital,2,75.64,64.0,63.22,0.78,0.0,0.0,0.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002633,MBR00000102,Professional,2022-10-31,2022-10-31,2022-11-29,PLN8827,1575695214,1575695214,SNF,In-Network,Z87.891,M17.11,,,,,,,0,,27130,Surgery,,,,21,Inpatient Hospital,3,5265.19,4296.67,4266.86,29.81,0.0,0.0,29.81,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002634,MBR00000102,Institutional-OP,2023-12-23,2023-12-23,2024-01-06,PLN2887,1964402759,1964402759,Outpatient Clinic,In-Network,R07.9,I63.9,,,,,,,0,,27130,Surgery,,,0761,22,Outpatient Hospital,2,2569.2,1967.37,1917.37,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002635,MBR00000102,Institutional-OP,2023-05-20,2023-05-20,2023-07-03,PLN5704,1453936007,1453936007,ASC,In-Network,E78.5,E11.65,,,,,,,0,,87491,Pathology/Lab,,,0200,22,Outpatient Hospital,2,227.2,85.18,9.11,0.0,75.0,1.07,76.07,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002636,MBR00000102,Institutional-IP,2022-06-17,2022-06-28,2022-07-15,PLN8604,1865904917,1865904917,Outpatient Clinic,In-Network,G43.909,M17.11,,,,641,MS-DRG,23,11,Y,97530,Medicine,,,0360,21,Inpatient Hospital,2,299.27,213.49,171.32,0.0,15.0,27.17,42.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002637,MBR00000102,Institutional-OP,2023-09-27,2023-09-27,2023-10-30,PLN9777,1939033455,1939033455,Pulmonology,In-Network,J20.9,E78.5,,,,,,,0,,99203,E&M,,,0900,22,Outpatient Hospital,3,276.66,165.26,150.44,0.0,0.0,14.82,14.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002638,MBR00000102,Professional,2022-09-03,2022-09-03,2022-10-02,PLN7867,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,J06.9,Z12.31,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,1,84.71,50.18,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002639,MBR00000102,Professional,2022-04-09,2022-04-09,2022-04-18,PLN2570,1450553056,1450553056,Clinical Laboratory,In-Network,N18.3,K21.0,,,,,,,0,,71046,Radiology,,,,23,Emergency Room,1,190.82,69.5,8.5,36.0,25.0,0.0,61.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002640,MBR00000102,Institutional-OP,2021-08-27,2021-08-27,2021-09-20,PLN1833,1433937353,1433937353,Nephrology,In-Network,M54.5,Z00.00,,,,,,,0,,99221,E&M,,,0370,22,Outpatient Hospital,1,435.53,166.05,110.54,0.0,50.0,5.51,55.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002641,MBR00000102,Institutional-IP,2022-04-08,2022-04-09,2022-04-28,PLN6379,1135158374,1135158374,Pulmonology,In-Network,Z00.01,K21.0,,,,194,MS-DRG,13,1,Y,99284,E&M,,,0301,21,Inpatient Hospital,3,321.55,138.21,103.21,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002642,MBR00000102,Professional,2021-02-14,2021-02-14,2021-03-27,PLN1941,1556140803,1556140803,Cardiology,In-Network,M81.0,Z12.31,,,,,,,0,,99213,E&M,,,,11,Office,3,199.82,73.35,0.0,73.35,0.0,0.0,73.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002643,MBR00000102,Institutional-IP,2021-06-17,2021-06-20,2021-06-26,PLN4529,1660288235,1660288235,ASC,In-Network,I63.9,Z12.31,,,,683,MS-DRG,17,3,Y,99284,E&M,,,0510,21,Inpatient Hospital,3,597.18,309.75,251.99,0.0,0.0,57.76,57.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002644,MBR00000102,Professional,2023-11-01,2023-11-01,2023-11-11,PLN9101,1716521444,1716521444,Oncology,In-Network,J44.1,J20.9,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,2,6129.72,5113.6,5098.6,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002645,MBR00000102,Professional,2021-08-02,2021-08-02,2021-09-13,PLN7996,1778483301,1778483301,Home Health,In-Network,E66.9,R07.9,,,,,,,0,,99233,E&M,,,,21,Inpatient Hospital,1,279.08,235.98,235.98,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002646,MBR00000102,Institutional-IP,2022-09-13,2022-09-23,2022-09-30,PLN6040,1438368327,1438368327,Home Health,In-Network,M54.5,E11.65,,,,682,MS-DRG,10,10,Y,99222,E&M,,,0740,21,Inpatient Hospital,3,259.49,201.79,0.0,201.79,50.0,0.0,251.79,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002647,MBR00000103,Professional,2021-04-23,2021-04-23,2021-05-02,PLN3527,1964402759,1964402759,Outpatient Clinic,In-Network,K21.0,G43.909,,,,,,,0,,58661,Surgery,,,,81,Independent Laboratory,1,4493.46,2830.03,2830.03,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002648,MBR00000103,Professional,2022-10-21,2022-10-21,2022-12-01,PLN6132,1872272835,1872272835,Internal Medicine,In-Network,J06.9,Z79.4,,,,,,,0,,70450,Radiology,,,,11,Office,2,954.89,626.76,536.97,14.79,75.0,0.0,89.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002649,MBR00000103,Professional,2023-12-05,2023-12-05,2024-01-15,PLN7275,1486164553,1486164553,DME Supplier,In-Network,I25.10,F41.9,,,,,,,0,,45380,Surgery,,,,11,Office,1,2403.8,2021.5,1827.37,194.13,0.0,0.0,194.13,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000002650,MBR00000103,Professional,2022-05-17,2022-05-17,2022-06-12,PLN6559,1569105090,1569105090,Geriatrics,In-Network,Z12.31,I50.9,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,1,23134.35,14186.77,12779.2,217.36,15.0,1175.21,1407.57,0.0,Paid,,,1,,0,0,1,1,0,1,Duplicate,0,0,0,0,0
CLM0000002651,MBR00000103,Institutional-OP,2021-05-20,2021-05-20,2021-06-25,PLN8649,1860435061,1860435061,DME Supplier,In-Network,Z79.4,F41.9,,,,,,,0,,99283,E&M,,,0120,22,Outpatient Hospital,1,633.62,191.36,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002652,MBR00000103,Professional,2021-01-26,2021-01-26,2021-02-04,PLN5065,1910255109,1910255109,DME Supplier,In-Network,E78.5,Z00.01,,,,,,,0,,70553,Radiology,,,,11,Office,1,4574.6,2872.46,2712.98,0.0,15.0,144.48,159.48,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002653,MBR00000103,Professional,2023-04-09,2023-04-09,2023-05-22,PLN7254,1590915516,1590915516,Physical Therapy,Out-of-Network,E11.40,Z87.891,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,3,27.81,8.43,0.0,8.43,15.0,0.0,23.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002654,MBR00000103,Institutional-OP,2021-04-23,2021-04-23,2021-05-01,PLN8263,1114982472,1114982472,Orthopedic Surgery,In-Network,Z51.11,Z23,,,,,,,0,,93306,Radiology,,,0510,22,Outpatient Hospital,2,1444.56,1074.21,1022.18,52.03,0.0,0.0,52.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002655,MBR00000103,Institutional-OP,2021-12-14,2021-12-14,2022-01-22,PLN3066,1108115157,1108115157,General Acute Care Hospital,In-Network,N18.3,M54.5,,,,,,,0,,70553,Radiology,,,0730,22,Outpatient Hospital,1,2134.75,1611.46,1148.01,388.45,75.0,0.0,463.45,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000002656,MBR00000103,Institutional-OP,2023-07-13,2023-07-13,2023-07-25,PLN9950,1390307371,1390307371,DME Supplier,In-Network,E11.9,J44.1,,,,,,,0,,66984,Surgery,,,0510,22,Outpatient Hospital,2,3089.54,1807.71,1634.57,118.44,0.0,54.7,173.14,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002657,MBR00000103,Institutional-OP,2022-08-12,2022-08-12,2022-08-22,PLN9041,1168246159,1168246159,Internal Medicine,In-Network,J44.1,F41.9,,,,,,,0,,58661,Surgery,,,0120,22,Outpatient Hospital,1,3791.74,1513.48,1498.48,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002658,MBR00000103,Institutional-IP,2023-08-14,2023-08-18,2023-08-22,PLN1927,1799205295,1799205295,General Acute Care Hospital,In-Network,N40.0,I10,,,,682,MS-DRG,11,4,Y,93306,Radiology,,,0450,21,Inpatient Hospital,1,1736.3,982.49,932.49,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002659,MBR00000103,Institutional-OP,2023-08-14,2023-08-14,2023-09-12,PLN8954,1609138981,1609138981,Critical Access Hospital,In-Network,F41.9,J44.1,,,,,,,0,,99233,E&M,,,0450,22,Outpatient Hospital,1,405.08,304.98,269.98,0.0,35.0,0.0,35.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002660,MBR00000103,Professional,2022-12-26,2022-12-26,2023-01-24,PLN8102,1224179551,1224179551,Physical Therapy,In-Network,I25.10,N18.3,,,,,,,0,,93225,Medicine,,,,11,Office,3,775.04,540.95,195.65,307.15,25.0,13.15,345.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002661,MBR00000103,Professional,2023-10-23,2023-10-23,2023-11-28,PLN3042,1235381502,1235381502,Cardiology,In-Network,I63.9,Z00.00,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,2,258.32,111.29,0.0,111.29,0.0,0.0,111.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002662,MBR00000103,Professional,2021-02-09,2021-02-09,2021-03-09,PLN6374,1994661817,1994661817,SNF,Out-of-Network,I10,M54.5,,,,,,,0,,33533,Surgery,,,,11,Office,2,22247.74,7820.57,6703.72,133.35,50.0,933.5,1116.85,0.0,Paid,,,0,,0,0,1,1,0,1,Unbundling,0,0,0,0,0
CLM0000002663,MBR00000103,Institutional-OP,2021-09-21,2021-09-21,2021-10-11,PLN5921,1531398223,1531398223,OB/GYN,In-Network,F32.9,I50.9,,,,,,,0,,G0439,Medicine,,,0510,22,Outpatient Hospital,2,295.1,212.21,107.85,16.85,75.0,12.51,104.36,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000002664,MBR00000104,Institutional-IP,2021-10-31,2021-11-03,2021-12-12,PLN1326,1198133277,1198133277,SNF,In-Network,F03.90,I10,,,,872,MS-DRG,14,3,Y,85025,Pathology/Lab,,,0510,21,Inpatient Hospital,3,72.64,42.21,0.0,42.21,50.0,0.0,92.21,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000002665,MBR00000104,Institutional-OP,2023-09-25,2023-09-25,2023-10-31,PLN2860,1624202402,1624202402,Orthopedic Surgery,In-Network,M54.5,S72.001A,,,,,,,0,,99222,E&M,,,0740,22,Outpatient Hospital,1,557.01,245.2,210.2,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002666,MBR00000104,Institutional-IP,2022-11-12,2022-11-14,2022-12-12,PLN7313,1713934949,1713934949,Neurology,In-Network,N17.9,J20.9,,,,195,MS-DRG,2,2,Y,66984,Surgery,,,0270,21,Inpatient Hospital,2,2969.65,2010.07,2010.07,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002667,MBR00000104,Institutional-OP,2021-10-03,2021-10-03,2021-11-10,PLN5162,1563980627,1563980627,Critical Access Hospital,In-Network,J20.9,E78.5,,,,,,,0,,72148,Radiology,,,0636,22,Outpatient Hospital,2,1174.36,638.09,603.09,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002668,MBR00000104,Professional,2021-08-17,2021-08-17,2021-09-17,PLN6077,1780163051,1780163051,SNF,In-Network,E78.5,N20.0,,,,,,,0,,76700,Radiology,,,,20,Urgent Care,3,769.9,582.01,532.01,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002669,MBR00000104,Professional,2023-06-01,2023-06-01,2023-07-07,PLN6782,1590915516,1590915516,Physical Therapy,Out-of-Network,J45.20,J44.1,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,2,305.27,155.69,144.32,0.0,0.0,11.37,11.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002670,MBR00000104,Institutional-IP,2023-07-30,2023-08-04,2023-09-02,PLN4924,1624202402,1624202402,Orthopedic Surgery,In-Network,I10,R51,,,,196,MS-DRG,4,5,Y,87491,Pathology/Lab,,,0636,21,Inpatient Hospital,3,138.71,110.9,110.9,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000002671,MBR00000104,Professional,2021-01-17,2021-01-17,2021-02-19,PLN7675,1244186984,1244186984,Family Medicine,Out-of-Network,J06.9,J45.20,,,,,,,0,,78452,Radiology,,,,49,Independent Clinic,3,2979.42,2120.25,2085.25,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002672,MBR00000104,Institutional-OP,2022-02-05,2022-02-05,2022-02-24,PLN7901,1355166277,1355166277,Endocrinology,In-Network,E11.9,E78.5,,,,,,,0,,77067,Radiology,,,0636,22,Outpatient Hospital,1,455.43,359.83,0.0,198.69,0.0,0.0,198.69,0.0,Denied,CO-50,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000002673,MBR00000104,Professional,2022-08-10,2022-08-10,2022-09-15,PLN2487,1606140917,1606140917,ASC,In-Network,E11.40,M54.5,,,,,,,0,,G0444,Medicine,,,,21,Inpatient Hospital,2,81.06,52.6,52.6,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000002674,MBR00000104,Professional,2021-09-15,2021-09-15,2021-10-25,PLN2780,1205377316,1205377316,Orthopedic Surgery,In-Network,I10,F03.90,,,,,,,0,,47562,Surgery,,,,49,Independent Clinic,2,6587.13,5363.06,4275.57,453.87,0.0,633.62,1087.49,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002675,MBR00000104,Institutional-IP,2023-03-06,2023-03-07,2023-04-12,PLN7870,1980712759,1980712759,Outpatient Clinic,Out-of-Network,I10,Z00.00,,,,195,MS-DRG,11,1,Y,99213,E&M,,,0450,21,Inpatient Hospital,1,290.84,226.43,196.02,0.0,0.0,30.41,30.41,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000002676,MBR00000104,Professional,2023-04-10,2023-04-10,2023-05-13,PLN4359,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,E11.9,F41.9,,,,,,,0,,87491,Pathology/Lab,,,,23,Emergency Room,2,201.61,61.38,10.16,50.97,0.0,0.25,51.22,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002677,MBR00000104,Institutional-IP,2023-07-08,2023-07-21,2023-07-26,PLN1414,1124394415,1124394415,Pediatrics,In-Network,N18.3,K21.0,,,,690,MS-DRG,12,13,Y,43239,Surgery,,,0900,21,Inpatient Hospital,2,1535.46,1292.21,1292.21,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002678,MBR00000104,Professional,2023-05-11,2023-05-11,2023-05-26,PLN4676,1590915516,1590915516,Physical Therapy,Out-of-Network,E11.9,F10.20,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,3,47.58,23.31,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002679,MBR00000104,Professional,2023-07-11,2023-07-11,2023-08-14,PLN1129,1245650222,1245650222,Gastroenterology,In-Network,J06.9,M17.11,,,,,,,0,,66984,Surgery,,,,20,Urgent Care,1,2307.92,1521.36,1290.64,0.0,0.0,230.72,230.72,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002680,MBR00000104,Institutional-OP,2022-02-05,2022-02-05,2022-03-21,PLN5739,1186826716,1186826716,Physical Therapy,In-Network,N39.0,Z00.00,,,,,,,0,,99214,E&M,,,0450,22,Outpatient Hospital,1,248.64,148.62,17.34,106.28,25.0,0.0,131.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002681,MBR00000104,Professional,2021-11-24,2021-11-24,2022-01-01,PLN1007,1531398223,1531398223,OB/GYN,In-Network,J44.1,M17.11,,,,,,,0,,71046,Radiology,,,,20,Urgent Care,3,169.52,100.81,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-18,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002682,MBR00000104,Institutional-IP,2021-12-13,2021-12-18,2022-01-07,PLN4225,1717912431,1717912431,Oncology,In-Network,I25.10,K21.0,,,,291,MS-DRG,3,5,N,93225,Medicine,,,0120,21,Inpatient Hospital,2,575.84,285.33,285.33,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002683,MBR00000104,Professional,2023-07-24,2023-07-24,2023-08-27,PLN7426,1757138478,1757138478,Pediatrics,In-Network,N18.3,Z00.00,,,,,,,0,,99284,E&M,,,,11,Office,3,882.5,422.94,347.94,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002684,MBR00000104,Institutional-IP,2022-12-12,2022-12-13,2023-01-09,PLN7236,1545347862,1545347862,SNF,In-Network,M17.11,Z23,,,,690,MS-DRG,2,1,Y,99284,E&M,,,0636,21,Inpatient Hospital,2,575.77,284.67,284.67,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000002685,MBR00000104,Professional,2021-12-21,2021-12-21,2022-01-20,PLN4968,1948810580,1948810580,DME Supplier,In-Network,E87.6,F41.9,,,,,,,0,,99283,E&M,,,,20,Urgent Care,3,329.59,221.0,221.0,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002686,MBR00000104,Professional,2023-03-01,2023-03-01,2023-03-24,PLN3837,1845057593,1845057593,Orthopedic Surgery,In-Network,M17.11,J44.1,,,,,,,0,,99284,E&M,,,,31,Skilled Nursing Facility,3,699.76,552.46,396.69,155.77,0.0,0.0,155.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002687,MBR00000104,Institutional-OP,2021-09-13,2021-09-13,2021-09-28,PLN4592,1964402759,1964402759,Outpatient Clinic,In-Network,E11.65,M17.11,,,,,,,0,,93306,Radiology,,,0450,22,Outpatient Hospital,3,2863.73,1568.84,1152.1,401.74,15.0,0.0,416.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002688,MBR00000104,Institutional-IP,2021-10-19,2021-10-24,2021-11-23,PLN5536,1132188260,1132188260,Family Medicine,In-Network,M54.5,N39.0,,,,291,MS-DRG,2,5,N,99203,E&M,,,0120,21,Inpatient Hospital,3,168.67,129.78,1.22,128.56,0.0,0.0,128.56,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002689,MBR00000104,Institutional-OP,2021-01-02,2021-01-02,2021-01-17,PLN3748,1239316214,1239316214,Internal Medicine,In-Network,B97.89,J45.20,,,,,,,0,,G0439,Medicine,,,0730,22,Outpatient Hospital,3,440.79,164.45,164.45,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000002690,MBR00000104,Institutional-OP,2023-11-25,2023-11-25,2023-12-20,PLN7672,1224179551,1224179551,Physical Therapy,In-Network,F10.20,M17.11,,,,,,,0,,99284,E&M,,,0120,22,Outpatient Hospital,3,801.63,623.28,388.48,178.6,50.0,6.2,234.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002691,MBR00000104,Institutional-IP,2021-09-16,2021-09-20,2021-09-25,PLN9968,1227362142,1227362142,DME Supplier,In-Network,I25.10,I10,,,,690,MS-DRG,15,4,Y,99232,E&M,,,0120,21,Inpatient Hospital,2,199.32,78.61,78.61,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002692,MBR00000104,Professional,2023-04-04,2023-04-04,2023-05-11,PLN8749,1450553056,1450553056,Clinical Laboratory,In-Network,E78.5,E11.65,,,,,,,0,,43239,Surgery,,,,11,Office,1,1613.54,1165.41,1081.9,0.0,0.0,83.51,83.51,0.0,Paid,,,1,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000002693,MBR00000104,Institutional-OP,2021-05-10,2021-05-10,2021-06-21,PLN2541,1696843572,1696843572,Critical Access Hospital,Out-of-Network,Z00.00,E11.9,,,,,,,0,,27447,Surgery,,,0320,22,Outpatient Hospital,2,2254.35,1338.79,1338.79,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002694,MBR00000104,Professional,2021-02-09,2021-02-09,2021-03-20,PLN3847,1422747896,1422747896,Urology,In-Network,N20.0,I10,,,,,,,0,,80053,Pathology/Lab,,,,50,Federally Qualified Health Center,2,89.38,29.94,29.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002695,MBR00000104,Institutional-OP,2023-01-10,2023-01-10,2023-02-14,PLN2020,1660288235,1660288235,ASC,In-Network,I10,J44.1,,,,,,,0,,93000,Radiology,,,0120,22,Outpatient Hospital,3,124.81,88.6,72.58,0.0,0.0,16.02,16.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002696,MBR00000104,Institutional-IP,2021-04-18,2021-04-28,2021-04-26,PLN4564,1644128543,1644128543,Gastroenterology,In-Network,F32.9,F32.9,,,,682,MS-DRG,5,10,Y,90837,Medicine,,,0270,21,Inpatient Hospital,2,360.09,295.97,0.0,295.97,0.0,0.0,295.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002697,MBR00000104,Professional,2021-06-08,2021-06-08,2021-07-15,PLN2366,1845900543,1845900543,ASC,In-Network,J06.9,B97.89,,,,,,,0,,45380,Surgery,,,,11,Office,2,2453.9,1812.49,1812.46,0.03,0.0,0.0,0.03,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000002698,MBR00000104,Institutional-OP,2021-12-28,2021-12-28,2022-01-14,PLN1824,1410468316,1410468316,SNF,In-Network,J06.9,I25.10,,,,,,,0,,99213,E&M,,,0740,22,Outpatient Hospital,2,292.71,132.2,82.2,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002699,MBR00000104,Institutional-OP,2022-10-03,2022-10-03,2022-10-25,PLN8229,1545347862,1545347862,SNF,In-Network,E78.5,F32.9,,,,,,,0,,90460,Medicine,,,0270,22,Outpatient Hospital,3,62.57,47.29,11.32,0.0,35.0,0.97,35.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002700,MBR00000104,Professional,2021-01-20,2021-01-20,2021-02-20,PLN2983,1283743001,1283743001,Family Medicine,In-Network,J20.9,I10,,,,,,,0,,71046,Radiology,,,,11,Office,2,118.53,98.44,23.44,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002701,MBR00000104,Institutional-IP,2021-05-19,2021-05-27,2021-07-01,PLN3167,1752470395,1752470395,Home Health,In-Network,Z00.00,G20,,,,683,MS-DRG,6,8,Y,66984,Surgery,,,0510,21,Inpatient Hospital,2,1940.82,1220.25,988.39,156.28,25.0,50.58,231.86,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002702,MBR00000104,Professional,2022-01-06,2022-01-06,2022-02-12,PLN1119,1542828721,1542828721,Orthopedic Surgery,In-Network,I10,Z23,,,,,,,0,,27447,Surgery,,,,20,Urgent Care,3,5853.44,4311.09,3973.84,312.25,25.0,0.0,337.25,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002703,MBR00000104,Institutional-IP,2023-02-11,2023-02-16,2023-03-08,PLN9182,1124394415,1124394415,Pediatrics,In-Network,N18.3,E78.5,,,,690,MS-DRG,17,5,Y,99214,E&M,,,0320,21,Inpatient Hospital,1,405.13,276.31,231.65,0.0,25.0,19.66,44.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002704,MBR00000104,Institutional-OP,2021-04-17,2021-04-17,2021-05-16,PLN6456,1244186984,1244186984,Family Medicine,Out-of-Network,I50.9,F32.9,,,,,,,0,,66984,Surgery,,,0730,22,Outpatient Hospital,3,3512.41,1208.23,711.95,446.28,50.0,0.0,496.28,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002705,MBR00000104,Professional,2021-11-09,2021-11-09,2021-12-15,PLN7727,1422747896,1422747896,Urology,In-Network,M17.11,Z00.01,,,,,,,0,,27130,Surgery,,,,20,Urgent Care,2,4353.83,1572.82,1407.06,150.76,15.0,0.0,165.76,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002706,MBR00000104,Professional,2021-07-31,2021-07-31,2021-09-10,PLN9160,1438368327,1438368327,Home Health,In-Network,J45.20,E11.9,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,2,4404.51,2437.84,2437.84,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002707,MBR00000104,Professional,2021-12-05,2021-12-05,2022-01-15,PLN4681,1915531927,1915531927,Critical Access Hospital,In-Network,Z00.00,M17.11,,,,,,,0,,99222,E&M,,,,11,Office,1,479.26,223.56,223.56,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002708,MBR00000104,Institutional-OP,2021-10-10,2021-10-10,2021-10-23,PLN4151,1800011727,1800011727,Clinical Laboratory,Out-of-Network,F32.9,Z87.891,,,,,,,0,,33533,Surgery,,,0301,22,Outpatient Hospital,3,20400.32,17252.2,16788.21,438.99,25.0,0.0,463.99,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002709,MBR00000104,Professional,2022-12-03,2022-12-03,2022-12-15,PLN8695,1450553056,1450553056,Clinical Laboratory,In-Network,E78.5,Z00.00,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,3,130.44,46.68,0.0,46.68,35.0,0.0,81.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002710,MBR00000104,Institutional-IP,2021-03-15,2021-03-16,2021-04-03,PLN2669,1689639685,1689639685,SNF,In-Network,E11.9,M54.5,,,,292,MS-DRG,7,1,Y,G0439,Medicine,,,0200,21,Inpatient Hospital,2,425.78,346.59,0.0,346.59,35.0,0.0,381.59,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000002711,MBR00000104,Institutional-OP,2023-10-26,2023-10-26,2023-12-08,PLN6103,1561134315,1561134315,DME Supplier,In-Network,K57.30,Z00.00,,,,,,,0,,99283,E&M,,,0740,22,Outpatient Hospital,2,461.16,302.45,0.0,302.45,75.0,0.0,377.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002712,MBR00000104,Institutional-OP,2021-09-25,2021-09-25,2021-10-30,PLN3984,1511044648,1511044648,Endocrinology,In-Network,I10,I10,,,,,,,0,,G0444,Medicine,,,0200,22,Outpatient Hospital,2,85.87,67.42,50.35,0.0,15.0,2.07,17.07,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000002713,MBR00000105,Professional,2023-12-22,2023-12-22,2024-01-18,PLN1931,1438368327,1438368327,Home Health,In-Network,F32.9,Z12.31,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,2,23792.81,7768.93,0.0,458.35,35.0,391.8,885.15,0.0,Denied,CO-27,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002714,MBR00000105,Professional,2023-03-10,2023-03-10,2023-03-21,PLN2927,1450094833,1450094833,Outpatient Clinic,In-Network,I10,E11.9,,,,,,,0,,45378,Surgery,,,,11,Office,1,1313.52,625.66,0.0,2.58,0.0,101.2,103.78,0.0,Denied,CO-18,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000002715,MBR00000105,Institutional-OP,2022-01-27,2022-01-27,2022-03-06,PLN8306,1964402759,1964402759,Outpatient Clinic,In-Network,E78.5,G43.909,,,,,,,0,,99204,E&M,,,0900,22,Outpatient Hospital,1,313.14,138.63,88.63,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002716,MBR00000105,Professional,2021-11-28,2021-11-28,2021-12-17,PLN8729,1244186984,1244186984,Family Medicine,Out-of-Network,Z79.4,I10,,,,,,,0,,99214,E&M,,,,23,Emergency Room,2,175.12,142.21,0.0,0.0,0.0,23.64,23.64,0.0,Denied,CO-18,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002717,MBR00000105,Professional,2023-11-03,2023-11-03,2023-11-23,PLN4543,1840431511,1840431511,Geriatrics,Out-of-Network,G43.909,M54.5,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,2,114.38,96.73,0.0,96.73,25.0,0.0,121.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002718,MBR00000105,Professional,2023-12-28,2023-12-28,2024-01-12,PLN3188,1273488618,1273488618,General Acute Care Hospital,In-Network,G43.909,J20.9,,,,,,,0,,66984,Surgery,,,,11,Office,2,2692.76,1900.22,1427.93,472.29,0.0,0.0,472.29,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002719,MBR00000105,Institutional-OP,2022-11-02,2022-11-02,2022-11-13,PLN5748,1809014947,1809014947,Urology,In-Network,E11.9,E11.9,,,,,,,0,,99203,E&M,,,0301,22,Outpatient Hospital,3,235.75,142.99,0.0,142.99,35.0,0.0,177.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002720,MBR00000105,Institutional-OP,2021-02-21,2021-02-21,2021-03-15,PLN4650,1295371663,1295371663,Critical Access Hospital,In-Network,Z00.00,E11.9,,,,,,,0,,93225,Medicine,,,0730,22,Outpatient Hospital,3,710.1,269.53,269.53,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002721,MBR00000105,Professional,2023-09-20,2023-09-20,2023-10-30,PLN9984,1860435061,1860435061,DME Supplier,In-Network,E11.65,J20.9,,,,,,,0,,90686,Medicine,,,,11,Office,1,58.18,39.63,14.63,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000002722,MBR00000105,Professional,2022-06-07,2022-06-07,2022-07-17,PLN4190,1453283987,1453283987,Critical Access Hospital,In-Network,I10,G43.909,,,,,,,0,,45378,Surgery,,,,21,Inpatient Hospital,3,1730.37,1143.88,1068.88,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000002723,MBR00000105,Institutional-OP,2021-01-31,2021-01-31,2021-02-19,PLN8535,1236418230,1236418230,DME Supplier,In-Network,M54.5,F41.9,,,,,,,0,,99283,E&M,,,0510,22,Outpatient Hospital,3,482.72,398.36,383.36,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002724,MBR00000105,Professional,2023-05-29,2023-05-29,2023-06-15,PLN3791,1453283987,1453283987,Critical Access Hospital,In-Network,E66.9,M54.5,,,,,,,0,,33533,Surgery,,,,11,Office,1,23941.32,9920.72,9247.23,0.0,15.0,658.49,673.49,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002725,MBR00000105,Institutional-OP,2021-02-06,2021-02-06,2021-03-22,PLN9768,1114982472,1114982472,Orthopedic Surgery,In-Network,E78.5,K92.1,,,,,,,0,,77067,Radiology,,,0320,22,Outpatient Hospital,1,646.79,453.17,64.42,388.75,0.0,0.0,388.75,0.0,Adjusted,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000002726,MBR00000105,Professional,2022-02-11,2022-02-11,2022-02-21,PLN8118,1980712759,1980712759,Outpatient Clinic,Out-of-Network,F41.9,E66.9,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,1,3873.36,1665.18,0.0,430.11,0.0,0.0,430.11,0.0,Denied,CO-4,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002727,MBR00000105,Professional,2021-03-23,2021-03-23,2021-04-26,PLN9669,1946680931,1946680931,Critical Access Hospital,Out-of-Network,Z12.11,E11.9,,,,,,,0,,27130,Surgery,,,,11,Office,2,6807.78,5727.33,5102.34,199.59,0.0,425.4,624.99,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002728,MBR00000105,Professional,2022-04-24,2022-04-24,2022-05-17,PLN1815,1239316214,1239316214,Internal Medicine,In-Network,R05,E11.65,,,,,,,0,,G0444,Medicine,,,,65,End-Stage Renal Disease,3,93.29,76.35,0.0,76.35,0.0,0.0,76.35,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000002729,MBR00000105,Professional,2023-05-31,2023-05-31,2023-06-24,PLN5088,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,Z12.31,N18.3,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,1,313.62,154.99,154.99,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002730,MBR00000105,Professional,2021-05-22,2021-05-22,2021-06-10,PLN8525,1168246159,1168246159,Internal Medicine,In-Network,F03.90,Z12.31,,,,,,,0,,23472,Surgery,,,,81,Independent Laboratory,3,2687.19,1434.51,1228.12,0.0,0.0,206.39,206.39,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002731,MBR00000105,Institutional-OP,2021-06-01,2021-06-01,2021-06-20,PLN7340,1728018911,1728018911,Nephrology,In-Network,F41.9,Z12.31,,,,,,,0,,97110,Medicine,,,0450,22,Outpatient Hospital,1,113.88,65.79,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002732,MBR00000105,Professional,2023-11-14,2023-11-14,2023-12-16,PLN4232,1622771872,1622771872,Pediatrics,In-Network,M81.0,Z00.00,,,,,,,0,,43239,Surgery,,,,21,Inpatient Hospital,2,1774.16,685.1,672.95,0.0,0.0,12.15,12.15,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002733,MBR00000105,Institutional-IP,2021-07-13,2021-07-18,2021-08-13,PLN1018,1502838586,1502838586,ASC,In-Network,J06.9,I10,,,,196,MS-DRG,4,5,Y,23472,Surgery,,,0761,21,Inpatient Hospital,1,5437.19,2525.8,2525.8,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000002734,MBR00000105,Professional,2021-05-04,2021-05-04,2021-05-23,PLN5505,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,Z12.11,I10,,,,,,,0,,99283,E&M,,,,20,Urgent Care,2,350.46,235.38,0.0,235.38,75.0,0.0,310.38,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002735,MBR00000105,Professional,2022-10-04,2022-10-04,2022-10-31,PLN7074,1564502315,1564502315,ASC,In-Network,M81.0,Z12.31,,,,,,,0,,99203,E&M,,,,12,Home,2,155.73,82.81,82.81,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002736,MBR00000105,Professional,2021-10-30,2021-10-30,2021-11-26,PLN4353,1550154147,1550154147,Outpatient Clinic,In-Network,E78.5,E78.5,,,,,,,0,,74177,Radiology,,,,22,Outpatient Hospital,3,1092.3,718.89,683.89,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002737,MBR00000105,Institutional-IP,2023-11-15,2023-11-17,2023-12-10,PLN1963,1749494482,1749494482,Pediatrics,In-Network,M54.5,E11.65,,,,470,MS-DRG,3,2,Y,84443,Pathology/Lab,,,0320,21,Inpatient Hospital,1,154.4,112.11,0.0,112.11,15.0,0.0,127.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002738,MBR00000105,Professional,2021-06-29,2021-06-29,2021-07-08,PLN8714,1148984206,1148984206,Psychiatry,In-Network,E11.9,E78.5,,,,,,,0,,93306,Radiology,,,,11,Office,3,2140.52,980.21,955.21,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002739,MBR00000105,Institutional-OP,2022-09-13,2022-09-13,2022-10-14,PLN5297,1530904931,1530904931,Internal Medicine,In-Network,Z23,N39.0,,,,,,,0,,78452,Radiology,,,0450,22,Outpatient Hospital,1,5235.25,3737.28,3712.28,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002740,MBR00000105,Professional,2023-10-06,2023-10-06,2023-10-26,PLN8887,1540044947,1540044947,Pulmonology,Out-of-Network,E78.5,J06.9,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,2,3558.05,2542.31,2542.31,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002741,MBR00000105,Professional,2023-03-14,2023-03-14,2023-04-25,PLN8357,1778483301,1778483301,Home Health,In-Network,J06.9,K21.0,,,,,,,0,,93225,Medicine,,,,11,Office,3,482.33,198.17,123.17,0.0,75.0,0.0,75.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002742,MBR00000105,Professional,2021-02-01,2021-02-01,2021-02-12,PLN1511,1453283987,1453283987,Critical Access Hospital,In-Network,K21.0,J06.9,,,,,,,0,,93306,Radiology,,,,11,Office,3,2601.22,813.95,790.71,0.0,0.0,23.24,23.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002743,MBR00000105,Institutional-IP,2021-07-25,2021-08-03,2021-08-12,PLN1762,1528335731,1528335731,Critical Access Hospital,In-Network,J44.1,Z23,,,,194,MS-DRG,15,9,Y,G0468,Medicine,,,0120,21,Inpatient Hospital,3,312.27,241.61,241.61,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000002744,MBR00000105,Professional,2021-05-18,2021-05-18,2021-06-08,PLN9916,1531398223,1531398223,OB/GYN,In-Network,I10,B97.89,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,2,128.89,98.51,98.51,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002745,MBR00000105,Professional,2023-09-29,2023-09-29,2023-10-13,PLN1477,1124394415,1124394415,Pediatrics,In-Network,E11.9,E78.5,,,,,,,0,,45380,Surgery,,,,11,Office,3,1724.93,561.16,165.31,374.08,0.0,21.77,395.85,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000002746,MBR00000105,Professional,2021-08-10,2021-08-10,2021-08-22,PLN9716,1422747896,1422747896,Urology,In-Network,Z00.00,E78.5,,,,,,,0,,77067,Radiology,,,,11,Office,1,790.76,338.28,147.8,140.48,50.0,0.0,190.48,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000002747,MBR00000105,Professional,2021-03-03,2021-03-03,2021-04-12,PLN1059,1840431511,1840431511,Geriatrics,Out-of-Network,M54.5,Z12.31,,,,,,,0,,99213,E&M,,,,23,Emergency Room,3,228.66,115.52,40.52,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002748,MBR00000105,Professional,2022-02-24,2022-02-24,2022-03-16,PLN7822,1245650222,1245650222,Gastroenterology,In-Network,F41.9,R51,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,1,6928.95,5625.05,5595.56,29.49,0.0,0.0,29.49,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002749,MBR00000105,Institutional-IP,2021-11-06,2021-11-07,2021-11-23,PLN1473,1757138478,1757138478,Pediatrics,In-Network,I10,M54.5,,,,195,MS-DRG,11,1,Y,74177,Radiology,,,0636,21,Inpatient Hospital,3,2516.19,811.23,754.83,0.0,50.0,6.4,56.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002750,MBR00000105,Institutional-IP,2021-06-29,2021-07-01,2021-07-12,PLN9470,1334916761,1334916761,ASC,In-Network,Z12.31,M17.11,,,,682,MS-DRG,5,2,Y,99214,E&M,,,0510,21,Inpatient Hospital,1,425.7,355.66,0.0,355.66,15.0,0.0,370.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002751,MBR00000105,Professional,2022-05-12,2022-05-12,2022-06-19,PLN6218,1575695214,1575695214,SNF,In-Network,E11.9,M17.11,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,3,33.4,15.05,0.0,15.05,0.0,0.0,15.05,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002752,MBR00000105,Professional,2023-09-13,2023-09-13,2023-09-20,PLN8063,1545347862,1545347862,SNF,In-Network,F41.9,N17.9,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,3,2998.47,1617.42,1384.1,233.32,0.0,0.0,233.32,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002753,MBR00000105,Professional,2021-09-05,2021-09-05,2021-10-19,PLN6170,1752470395,1752470395,Home Health,In-Network,E11.40,E87.6,,,,,,,0,,93225,Medicine,,,,20,Urgent Care,1,800.25,241.36,183.78,0.0,35.0,22.58,57.58,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000002754,MBR00000105,Institutional-OP,2023-12-11,2023-12-11,2023-12-26,PLN7613,1453283987,1453283987,Critical Access Hospital,In-Network,R07.9,I10,,,,,,,0,,84443,Pathology/Lab,,,0270,22,Outpatient Hospital,1,98.85,36.68,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000002755,MBR00000105,Institutional-OP,2022-12-28,2022-12-28,2023-01-30,PLN3158,1702692193,1702692193,Physical Therapy,In-Network,E78.5,I10,,,,,,,0,,99232,E&M,,,0301,22,Outpatient Hospital,2,220.85,91.72,41.72,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002756,MBR00000106,Professional,2022-02-23,2022-02-23,2022-03-12,PLN7365,1872272835,1872272835,Internal Medicine,In-Network,J20.9,K57.30,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,2,201.14,168.98,136.85,0.0,0.0,32.13,32.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002757,MBR00000106,Institutional-OP,2023-01-14,2023-01-14,2023-01-28,PLN8455,1800011727,1800011727,Clinical Laboratory,Out-of-Network,J20.9,Z23,,,,,,,0,,99232,E&M,,,0900,22,Outpatient Hospital,2,342.04,287.63,287.63,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002758,MBR00000106,Professional,2022-01-17,2022-01-17,2022-02-05,PLN7083,1245650222,1245650222,Gastroenterology,In-Network,J06.9,E66.9,,,,,,,0,,99233,E&M,,,,21,Inpatient Hospital,1,513.92,226.64,0.0,226.64,0.0,0.0,226.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002759,MBR00000106,Professional,2021-08-20,2021-08-20,2021-08-29,PLN8210,1453936007,1453936007,ASC,In-Network,Z51.11,E78.5,,,,,,,0,,99213,E&M,,,,11,Office,3,118.92,93.14,87.8,0.0,0.0,5.34,5.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002760,MBR00000106,Institutional-OP,2021-09-14,2021-09-14,2021-10-08,PLN7690,1717912431,1717912431,Oncology,In-Network,Z23,J06.9,,,,,,,0,,99283,E&M,,,0120,22,Outpatient Hospital,1,618.65,222.28,187.28,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002761,MBR00000106,Institutional-OP,2021-01-10,2021-01-10,2021-02-10,PLN4917,1528335731,1528335731,Critical Access Hospital,In-Network,E78.5,I10,,,,,,,0,,45380,Surgery,,,0120,22,Outpatient Hospital,2,2556.51,1356.6,945.53,411.07,0.0,0.0,411.07,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000002762,MBR00000106,Professional,2022-12-12,2022-12-12,2023-01-21,PLN7979,1939033455,1939033455,Pulmonology,In-Network,R05,I11.9,,,,,,,0,,78452,Radiology,,,,12,Home,2,3568.75,2091.59,2091.59,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002763,MBR00000106,Institutional-IP,2021-03-23,2021-04-03,2021-04-23,PLN8717,1245650222,1245650222,Gastroenterology,In-Network,J06.9,Z12.31,,,,196,MS-DRG,7,11,Y,83036,Pathology/Lab,,,0270,21,Inpatient Hospital,2,97.79,37.48,37.48,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000002764,MBR00000106,Institutional-OP,2021-08-06,2021-08-06,2021-08-31,PLN9183,1273488618,1273488618,General Acute Care Hospital,In-Network,F32.9,F32.9,,,,,,,0,,99406,Medicine,,,0510,22,Outpatient Hospital,1,75.34,47.89,47.09,0.0,0.0,0.8,0.8,0.0,Adjusted,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000002765,MBR00000106,Professional,2021-01-01,2021-01-01,2021-01-08,PLN5621,1745114564,1745114564,Endocrinology,In-Network,I63.9,E11.65,,,,,,,0,,99222,E&M,,,,23,Emergency Room,3,629.01,356.49,341.49,0.0,15.0,0.0,15.0,0.0,Adjusted,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002766,MBR00000106,Professional,2021-03-13,2021-03-13,2021-03-23,PLN1737,1219817751,1219817751,OB/GYN,In-Network,J06.9,E78.5,,,,,,,0,,93225,Medicine,,,,21,Inpatient Hospital,3,795.61,674.04,624.04,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002767,MBR00000106,Professional,2023-09-19,2023-09-19,2023-09-30,PLN2020,1997536841,1997536841,Family Medicine,Out-of-Network,Z12.11,Z23,,,,,,,0,,77067,Radiology,,,,65,End-Stage Renal Disease,2,546.7,236.89,236.89,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000002768,MBR00000106,Institutional-OP,2021-01-27,2021-01-27,2021-02-28,PLN2271,1840431511,1840431511,Geriatrics,Out-of-Network,E11.9,I10,,,,,,,0,,93306,Radiology,,,0900,22,Outpatient Hospital,3,1483.76,1220.23,795.98,424.25,0.0,0.0,424.25,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002769,MBR00000106,Professional,2022-11-12,2022-11-12,2022-11-23,PLN6886,1606140917,1606140917,ASC,In-Network,M17.11,I10,,,,,,,0,,99213,E&M,,,,23,Emergency Room,3,287.78,148.12,113.12,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,1,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000002770,MBR00000106,Professional,2021-12-25,2021-12-25,2022-01-17,PLN9031,1135158374,1135158374,Pulmonology,In-Network,Z12.31,B97.89,,,,,,,0,,45378,Surgery,,,,11,Office,2,2575.28,2108.24,1415.43,477.02,35.0,180.79,692.81,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000002771,MBR00000106,Professional,2021-06-01,2021-06-01,2021-06-17,PLN7276,1590915516,1590915516,Physical Therapy,Out-of-Network,N39.0,E78.5,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,3,6360.14,3780.5,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-18,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002772,MBR00000106,Professional,2021-11-25,2021-11-25,2021-12-19,PLN4772,1964402759,1964402759,Outpatient Clinic,In-Network,I10,Z00.00,,,,,,,0,,58661,Surgery,,,,11,Office,3,3972.78,2203.84,2153.84,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002773,MBR00000106,Institutional-IP,2021-04-12,2021-04-15,2021-05-22,PLN4493,1696843572,1696843572,Critical Access Hospital,Out-of-Network,J44.1,M54.5,,,,683,MS-DRG,2,3,Y,45378,Surgery,,,0636,21,Inpatient Hospital,3,2448.17,809.58,765.37,44.21,0.0,0.0,44.21,0.0,Paid,,,1,,0,1,1,0,1,0,None,0,1,0,0,0
CLM0000002774,MBR00000106,Professional,2021-12-09,2021-12-09,2022-01-19,PLN8149,1109850785,1109850785,ASC,Out-of-Network,N18.3,N18.3,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,2,326.68,228.98,228.98,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002775,MBR00000106,Institutional-OP,2023-06-15,2023-06-15,2023-06-30,PLN8121,1193493783,1193493783,Critical Access Hospital,Out-of-Network,E78.5,N18.3,,,,,,,0,,33533,Surgery,,,0636,22,Outpatient Hospital,3,29143.61,11367.49,9433.88,91.51,50.0,1792.1,1933.61,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002776,MBR00000106,Institutional-OP,2022-11-11,2022-11-11,2022-12-25,PLN7943,1991459367,1991459367,Neurology,Out-of-Network,R51,Z12.31,,,,,,,0,,80053,Pathology/Lab,,,0200,22,Outpatient Hospital,3,102.5,73.19,73.19,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002777,MBR00000106,Professional,2023-06-08,2023-06-08,2023-06-22,PLN3908,1713934949,1713934949,Neurology,In-Network,K57.30,E11.9,,,,,,,0,,99214,E&M,,,,11,Office,1,389.57,249.78,0.0,249.78,0.0,0.0,249.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002778,MBR00000106,Institutional-OP,2023-02-02,2023-02-02,2023-02-18,PLN8181,1872613201,1872613201,Internal Medicine,In-Network,I50.9,I50.9,,,,,,,0,,86900,Pathology/Lab,,,0636,22,Outpatient Hospital,1,45.69,35.15,33.73,0.0,0.0,1.42,1.42,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000002779,MBR00000106,Professional,2023-10-13,2023-10-13,2023-11-14,PLN2302,1606140917,1606140917,ASC,In-Network,E11.65,N20.0,,,,,,,0,,27447,Surgery,,,,11,Office,1,2726.33,1520.55,1445.55,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002780,MBR00000106,Institutional-IP,2021-04-29,2021-05-05,2021-06-11,PLN2720,1717546253,1717546253,Family Medicine,In-Network,Z12.31,F32.9,,,,292,MS-DRG,1,6,Y,90460,Medicine,,,0320,21,Inpatient Hospital,1,39.14,24.93,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-18,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000002781,MBR00000106,Institutional-IP,2021-06-24,2021-06-28,2021-07-26,PLN1630,1991459367,1991459367,Neurology,Out-of-Network,J06.9,Z12.31,,,,603,MS-DRG,15,4,Y,27130,Surgery,,,0320,21,Inpatient Hospital,2,4309.27,2310.41,2102.42,207.99,0.0,0.0,207.99,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002782,MBR00000106,Professional,2022-03-27,2022-03-27,2022-04-09,PLN8110,1500949740,1500949740,Pediatrics,In-Network,E11.9,I63.9,,,,,,,0,,97110,Medicine,,,,11,Office,1,148.97,89.31,0.0,89.31,0.0,0.0,89.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002783,MBR00000106,Professional,2022-07-26,2022-07-26,2022-08-05,PLN6982,1125190055,1125190055,Nephrology,In-Network,M54.5,E78.5,,,,,,,0,,99283,E&M,,,,11,Office,1,259.05,134.36,126.05,0.0,0.0,8.31,8.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002784,MBR00000106,Professional,2023-05-09,2023-05-09,2023-05-17,PLN6081,1245650222,1245650222,Gastroenterology,In-Network,I10,I50.9,,,,,,,0,,99233,E&M,,,,11,Office,2,198.66,138.8,0.0,138.8,0.0,0.0,138.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002785,MBR00000106,Professional,2021-05-14,2021-05-14,2021-06-10,PLN8982,1896447406,1896447406,Nephrology,Out-of-Network,Z23,E11.9,,,,,,,0,,99214,E&M,,,,11,Office,1,283.52,172.66,172.66,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002786,MBR00000106,Institutional-IP,2021-05-02,2021-05-04,2021-05-24,PLN6979,1366426662,1366426662,Urology,In-Network,J20.9,I63.9,,,,195,MS-DRG,1,2,N,G0439,Medicine,,,0510,21,Inpatient Hospital,1,290.19,121.35,0.0,121.35,15.0,0.0,136.35,0.0,Adjusted,,,0,,0,1,0,0,1,0,None,0,0,0,1,0
CLM0000002787,MBR00000106,Professional,2023-05-22,2023-05-22,2023-06-27,PLN9438,1624202402,1624202402,Orthopedic Surgery,In-Network,I10,E11.9,,,,,,,0,,81001,Pathology/Lab,,,,81,Independent Laboratory,2,62.31,51.04,0.0,51.04,35.0,0.0,86.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002788,MBR00000106,Professional,2022-08-25,2022-08-25,2022-09-01,PLN2303,1433937353,1433937353,Nephrology,In-Network,I10,G43.909,,,,,,,0,,99213,E&M,,,,12,Home,3,218.85,106.36,0.0,106.36,0.0,0.0,106.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002789,MBR00000107,Institutional-OP,2022-03-28,2022-03-28,2022-04-16,PLN4084,1224179551,1224179551,Physical Therapy,In-Network,Z87.891,E78.5,,,,,,,0,,99204,E&M,,,0120,22,Outpatient Hospital,1,532.87,354.68,65.73,260.39,25.0,3.56,288.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002790,MBR00000107,Professional,2021-09-01,2021-09-01,2021-10-13,PLN1382,1528335731,1528335731,Critical Access Hospital,In-Network,E11.9,M54.5,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,1,174.49,93.94,0.0,93.94,25.0,0.0,118.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002791,MBR00000107,Institutional-OP,2023-02-01,2023-02-01,2023-02-26,PLN3922,1990090423,1990090423,Orthopedic Surgery,In-Network,F41.9,I10,,,,,,,0,,90686,Medicine,,,0370,22,Outpatient Hospital,2,94.53,79.16,79.16,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000002792,MBR00000107,Institutional-OP,2023-05-29,2023-05-29,2023-07-12,PLN5894,1366426662,1366426662,Urology,In-Network,E66.9,E66.9,,,,,,,0,,99204,E&M,,,0450,22,Outpatient Hospital,1,488.29,313.81,238.81,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002793,MBR00000107,Institutional-IP,2021-02-03,2021-02-08,2021-02-15,PLN3608,1227362142,1227362142,DME Supplier,In-Network,M54.5,E78.5,,,,195,MS-DRG,18,5,Y,99204,E&M,,,0761,21,Inpatient Hospital,1,553.51,284.08,259.08,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002794,MBR00000107,Professional,2021-03-01,2021-03-01,2021-04-12,PLN9403,1453936007,1453936007,ASC,In-Network,Z12.31,E78.5,,,,,,,0,,99406,Medicine,,,,12,Home,3,57.3,34.48,31.96,0.0,0.0,2.52,2.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002795,MBR00000107,Institutional-OP,2023-05-02,2023-05-02,2023-05-14,PLN7922,1372918899,1372918899,Family Medicine,In-Network,Z79.4,I10,,,,,,,0,,27130,Surgery,,,0270,22,Outpatient Hospital,1,4199.55,3476.78,3222.02,254.76,0.0,0.0,254.76,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002796,MBR00000107,Institutional-OP,2023-08-26,2023-08-26,2023-09-23,PLN2899,1205377316,1205377316,Orthopedic Surgery,In-Network,I50.9,I10,,,,,,,0,,99204,E&M,,,0370,22,Outpatient Hospital,1,516.02,348.02,29.76,315.9,0.0,2.36,318.26,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002797,MBR00000107,Institutional-OP,2021-09-09,2021-09-09,2021-09-24,PLN3262,1856686341,1856686341,Geriatrics,In-Network,N18.3,M54.5,,,,,,,0,,93225,Medicine,,,0740,22,Outpatient Hospital,3,490.52,257.33,36.81,220.52,0.0,0.0,220.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002798,MBR00000107,Institutional-OP,2023-02-12,2023-02-12,2023-03-22,PLN4011,1520687146,1520687146,ASC,In-Network,N39.0,Z00.00,,,,,,,0,,80053,Pathology/Lab,,,0636,22,Outpatient Hospital,1,155.59,78.06,11.57,63.94,0.0,2.55,66.49,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002799,MBR00000107,Professional,2023-07-12,2023-07-12,2023-08-08,PLN7274,1268679390,1268679390,Critical Access Hospital,In-Network,N40.0,I25.10,,,,,,,0,,99214,E&M,,,,11,Office,3,400.1,166.42,166.42,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002800,MBR00000107,Professional,2021-05-04,2021-05-04,2021-06-14,PLN2817,1569105090,1569105090,Geriatrics,In-Network,J06.9,I10,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,2,17755.46,9192.75,8799.82,0.0,25.0,367.93,392.93,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002801,MBR00000107,Institutional-OP,2021-07-23,2021-07-23,2021-08-28,PLN9934,1809014947,1809014947,Urology,In-Network,J06.9,E11.65,,,,,,,0,,33533,Surgery,,,0370,22,Outpatient Hospital,2,12879.67,10737.1,10737.1,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002802,MBR00000107,Professional,2021-05-23,2021-05-23,2021-06-01,PLN5169,1609138981,1609138981,Critical Access Hospital,In-Network,J44.1,K21.0,,,,,,,0,,23472,Surgery,,,,21,Inpatient Hospital,3,6348.27,4445.55,3918.33,0.0,0.0,527.22,527.22,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002803,MBR00000107,Professional,2023-05-16,2023-05-16,2023-06-18,PLN3768,1696843572,1696843572,Critical Access Hospital,Out-of-Network,I10,F41.9,,,,,,,0,,76700,Radiology,,,,22,Outpatient Hospital,1,916.94,622.73,0.0,0.0,0.0,16.23,16.23,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002804,MBR00000107,Professional,2023-04-25,2023-04-25,2023-05-02,PLN3049,1224179551,1224179551,Physical Therapy,In-Network,J44.1,E11.9,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,3,305.73,185.68,0.0,185.68,35.0,0.0,220.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002805,MBR00000107,Institutional-OP,2021-05-27,2021-05-27,2021-06-22,PLN6929,1939033455,1939033455,Pulmonology,In-Network,F03.90,I48.91,,,,,,,0,,45378,Surgery,,,0450,22,Outpatient Hospital,1,1102.79,829.4,419.28,385.12,25.0,0.0,410.12,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000002806,MBR00000107,Institutional-OP,2021-07-10,2021-07-10,2021-07-30,PLN7474,1968299309,1968299309,Internal Medicine,In-Network,F32.9,J45.20,,,,,,,0,,43239,Surgery,,,0370,22,Outpatient Hospital,2,864.8,731.77,731.77,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002807,MBR00000107,Institutional-IP,2022-12-28,2023-01-02,2023-01-06,PLN8413,1891849440,1891849440,Oncology,In-Network,Z12.31,Z87.891,,,,603,MS-DRG,2,5,Y,70450,Radiology,,,0636,21,Inpatient Hospital,1,911.36,732.58,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-29,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002808,MBR00000107,Professional,2023-09-10,2023-09-10,2023-10-13,PLN3805,1109850785,1109850785,ASC,Out-of-Network,K21.0,E11.65,,,,,,,0,,99203,E&M,,,,11,Office,2,239.4,95.84,0.0,50.31,50.0,0.0,100.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002809,MBR00000107,Professional,2023-05-04,2023-05-04,2023-05-17,PLN8039,1609138981,1609138981,Critical Access Hospital,In-Network,F03.90,I10,,,,,,,0,,80053,Pathology/Lab,,,,20,Urgent Care,1,77.54,54.6,39.6,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002810,MBR00000107,Professional,2021-07-03,2021-07-03,2021-07-25,PLN1006,1422747896,1422747896,Urology,In-Network,I10,E78.5,,,,,,,0,,77067,Radiology,,,,11,Office,3,477.19,284.12,182.94,64.51,0.0,36.67,101.18,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000002811,MBR00000107,Institutional-OP,2022-02-27,2022-02-27,2022-04-12,PLN5677,1968299309,1968299309,Internal Medicine,In-Network,N18.3,Z12.31,,,,,,,0,,90460,Medicine,,,0761,22,Outpatient Hospital,2,67.67,42.32,5.99,0.0,35.0,1.33,36.33,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002812,MBR00000107,Professional,2021-03-14,2021-03-14,2021-04-12,PLN6889,1847081578,1847081578,Urology,Out-of-Network,I10,Z12.31,,,,,,,0,,33533,Surgery,,,,50,Federally Qualified Health Center,1,11840.64,7111.62,6602.76,433.86,75.0,0.0,508.86,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002813,MBR00000107,Institutional-OP,2021-09-25,2021-09-25,2021-11-01,PLN3070,1364429278,1364429278,OB/GYN,In-Network,E66.9,E78.5,,,,,,,0,,G0468,Medicine,,,0740,22,Outpatient Hospital,3,523.52,420.27,278.52,0.0,75.0,66.75,141.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002814,MBR00000107,Professional,2022-09-09,2022-09-09,2022-09-29,PLN4850,1422747896,1422747896,Urology,In-Network,E11.9,E11.9,,,,,,,0,,99222,E&M,,,,49,Independent Clinic,2,397.53,237.59,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002815,MBR00000107,Institutional-OP,2022-01-13,2022-01-13,2022-02-20,PLN6111,1915531927,1915531927,Critical Access Hospital,In-Network,J44.1,K21.0,,,,,,,0,,90686,Medicine,,,0740,22,Outpatient Hospital,2,82.36,28.95,0.0,0.0,25.0,0.46,25.46,0.0,Denied,CO-18,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000002816,MBR00000107,Institutional-IP,2022-10-27,2022-11-01,2022-11-23,PLN5420,1980712759,1980712759,Outpatient Clinic,Out-of-Network,I25.10,R10.9,,,,872,MS-DRG,15,5,Y,85610,Pathology/Lab,,,0320,21,Inpatient Hospital,1,51.3,38.18,23.18,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002817,MBR00000107,Institutional-OP,2021-11-21,2021-11-21,2021-12-19,PLN6960,1550154147,1550154147,Outpatient Clinic,In-Network,M54.5,E78.5,,,,,,,0,,58661,Surgery,,,0740,22,Outpatient Hospital,2,4707.59,2309.9,2176.21,108.69,25.0,0.0,133.69,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002818,MBR00000107,Institutional-IP,2022-09-10,2022-09-14,2022-10-02,PLN1922,1550154147,1550154147,Outpatient Clinic,In-Network,R05,I10,,,,683,MS-DRG,14,4,Y,99222,E&M,,,0200,21,Inpatient Hospital,1,554.17,182.34,132.34,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002819,MBR00000107,Institutional-OP,2022-11-25,2022-11-25,2022-12-07,PLN1196,1948810580,1948810580,DME Supplier,In-Network,R05,E11.9,,,,,,,0,,85025,Pathology/Lab,,,0730,22,Outpatient Hospital,2,75.04,39.97,0.0,39.97,25.0,0.0,64.97,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002820,MBR00000107,Institutional-OP,2021-08-02,2021-08-02,2021-08-12,PLN6328,1817234602,1817234602,Clinical Laboratory,In-Network,J06.9,E78.5,,,,,,,0,,33533,Surgery,,,0360,22,Outpatient Hospital,3,28917.28,21675.15,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-4,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002821,MBR00000107,Professional,2021-02-18,2021-02-18,2021-03-22,PLN9822,1687650653,1687650653,Internal Medicine,In-Network,J06.9,F41.9,,,,,,,0,,74177,Radiology,,,,23,Emergency Room,1,1669.45,968.49,832.73,0.0,15.0,120.76,135.76,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002822,MBR00000107,Institutional-OP,2022-01-06,2022-01-06,2022-02-12,PLN3287,1114982472,1114982472,Orthopedic Surgery,In-Network,K21.0,N39.0,,,,,,,0,,43239,Surgery,,,0370,22,Outpatient Hospital,3,1891.41,621.16,549.49,0.0,0.0,71.67,71.67,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002823,MBR00000107,Institutional-IP,2021-02-15,2021-02-16,2021-03-28,PLN8548,1624802371,1624802371,ASC,Out-of-Network,Z23,R05,,,,196,MS-DRG,6,1,Y,99203,E&M,,,0200,21,Inpatient Hospital,3,184.16,151.19,0.0,151.19,0.0,0.0,151.19,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000002824,MBR00000107,Professional,2021-06-24,2021-06-24,2021-07-17,PLN5809,1790497490,1790497490,OB/GYN,In-Network,Z23,R07.9,,,,,,,0,,99214,E&M,,,,11,Office,2,181.53,135.59,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002825,MBR00000107,Professional,2021-11-12,2021-11-12,2021-12-05,PLN3737,1968299309,1968299309,Internal Medicine,In-Network,Z00.00,J44.1,,,,,,,0,,90460,Medicine,,,,22,Outpatient Hospital,3,53.68,24.13,24.13,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002826,MBR00000107,Professional,2022-01-06,2022-01-06,2022-01-21,PLN7426,1168246159,1168246159,Internal Medicine,In-Network,Z12.31,I10,,,,,,,0,,99204,E&M,,,,11,Office,2,500.48,347.95,319.8,3.15,25.0,0.0,28.15,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000002827,MBR00000107,Institutional-OP,2021-10-31,2021-10-31,2021-11-19,PLN6538,1624802371,1624802371,ASC,Out-of-Network,K21.0,I10,,,,,,,0,,45378,Surgery,,,0900,22,Outpatient Hospital,2,2036.44,1693.76,1643.76,0.0,50.0,0.0,50.0,0.0,Pended,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000002828,MBR00000107,Institutional-OP,2021-02-28,2021-02-28,2021-04-01,PLN3222,1528335731,1528335731,Critical Access Hospital,In-Network,J06.9,Z23,,,,,,,0,,71046,Radiology,,,0636,22,Outpatient Hospital,2,194.93,78.82,0.0,0.0,35.0,7.63,42.63,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002829,MBR00000108,Professional,2021-07-13,2021-07-13,2021-07-23,PLN7525,1114982472,1114982472,Orthopedic Surgery,In-Network,Z12.31,E11.65,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,3,72.66,58.71,0.0,58.71,50.0,0.0,108.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002830,MBR00000108,Institutional-IP,2023-08-25,2023-08-27,2023-09-20,PLN6824,1239316214,1239316214,Internal Medicine,In-Network,R10.9,E66.9,,,,690,MS-DRG,4,2,Y,99214,E&M,,,0370,21,Inpatient Hospital,3,271.52,109.58,34.13,0.0,75.0,0.45,75.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002831,MBR00000108,Professional,2023-02-24,2023-02-24,2023-03-26,PLN5965,1453936007,1453936007,ASC,In-Network,Z23,K21.0,,,,,,,0,,80053,Pathology/Lab,,,,20,Urgent Care,2,94.82,40.88,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002832,MBR00000108,Professional,2022-05-02,2022-05-02,2022-05-13,PLN3853,1689639685,1689639685,SNF,In-Network,E11.9,E66.9,,,,,,,0,,99232,E&M,,,,50,Federally Qualified Health Center,1,177.45,97.37,47.37,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002833,MBR00000108,Institutional-OP,2021-01-27,2021-01-27,2021-02-14,PLN2300,1450553056,1450553056,Clinical Laboratory,In-Network,F32.9,E11.9,,,,,,,0,,81001,Pathology/Lab,,,0636,22,Outpatient Hospital,1,59.5,18.28,18.28,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002834,MBR00000108,Professional,2022-01-28,2022-01-28,2022-02-24,PLN7151,1284035364,1284035364,Pediatrics,In-Network,E66.9,M17.11,,,,,,,0,,G0444,Medicine,,,,12,Home,1,41.96,24.0,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-18,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000002835,MBR00000108,Professional,2023-10-10,2023-10-10,2023-10-25,PLN3344,1422747896,1422747896,Urology,In-Network,I63.9,E11.9,,,,,,,0,,90460,Medicine,,,,11,Office,3,61.93,29.19,0.0,29.19,0.0,0.0,29.19,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002836,MBR00000108,Professional,2023-06-06,2023-06-06,2023-06-16,PLN9169,1631954542,1631954542,Oncology,In-Network,Z23,K21.0,,,,,,,0,,99284,E&M,,,,31,Skilled Nursing Facility,2,486.28,163.65,140.27,0.0,15.0,8.38,23.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002837,MBR00000108,Professional,2023-04-10,2023-04-10,2023-04-23,PLN4101,1295371663,1295371663,Critical Access Hospital,In-Network,J18.9,Z00.00,,,,,,,0,,58661,Surgery,,,,11,Office,3,2837.61,1606.61,1606.61,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002838,MBR00000109,Professional,2021-09-30,2021-09-30,2021-11-13,PLN7903,1502838586,1502838586,ASC,In-Network,F32.9,N18.3,,,,,,,0,,97110,Medicine,,,,11,Office,3,148.84,87.43,87.43,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002839,MBR00000109,Professional,2022-03-18,2022-03-18,2022-04-05,PLN9653,1242201429,1242201429,General Acute Care Hospital,In-Network,I25.10,K57.30,,,,,,,0,,80053,Pathology/Lab,,,,21,Inpatient Hospital,1,92.03,69.16,0.0,69.16,0.0,0.0,69.16,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002840,MBR00000109,Professional,2021-02-01,2021-02-01,2021-03-06,PLN7443,1806688928,1806688928,Geriatrics,In-Network,E78.5,E11.9,,,,,,,0,,90837,Medicine,,,,11,Office,2,303.95,257.77,113.67,144.1,0.0,0.0,144.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002841,MBR00000109,Institutional-OP,2023-07-30,2023-07-30,2023-09-01,PLN8825,1609526529,1609526529,Psychiatry,In-Network,I10,F03.90,,,,,,,0,,82043,Pathology/Lab,,,0730,22,Outpatient Hospital,3,67.01,53.57,53.57,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002842,MBR00000109,Professional,2021-05-04,2021-05-04,2021-06-13,PLN1026,1624802371,1624802371,ASC,Out-of-Network,E66.9,Z00.00,,,,,,,0,,99406,Medicine,,,,11,Office,2,101.89,40.71,40.66,0.0,0.0,0.05,0.05,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002843,MBR00000109,Institutional-OP,2022-11-08,2022-11-08,2022-12-07,PLN2992,1500037969,1500037969,Pulmonology,In-Network,N39.0,K21.0,,,,,,,0,,99204,E&M,,,0636,22,Outpatient Hospital,2,241.48,186.73,0.0,186.73,0.0,0.0,186.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002844,MBR00000110,Institutional-IP,2021-11-05,2021-11-06,2021-12-11,PLN1691,1590915516,1590915516,Physical Therapy,Out-of-Network,E78.5,E78.5,,,,690,MS-DRG,3,1,Y,99283,E&M,,,0360,21,Inpatient Hospital,3,297.8,211.12,0.0,0.0,35.0,32.11,67.11,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002845,MBR00000110,Professional,2022-09-17,2022-09-17,2022-10-16,PLN1491,1450553056,1450553056,Clinical Laboratory,In-Network,M17.11,Z00.00,,,,,,,0,,81001,Pathology/Lab,,,,23,Emergency Room,2,55.92,42.06,0.0,0.0,50.0,0.0,50.0,0.0,Pended,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002846,MBR00000110,Professional,2023-06-25,2023-06-25,2023-07-09,PLN9534,1745114564,1745114564,Endocrinology,In-Network,E78.5,J44.1,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,3,64.82,28.64,13.64,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002847,MBR00000110,Professional,2021-12-09,2021-12-09,2022-01-19,PLN5422,1125190055,1125190055,Nephrology,In-Network,K92.1,I10,,,,,,,0,,99222,E&M,,,,81,Independent Laboratory,3,498.38,349.96,12.36,311.26,25.0,1.34,337.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002848,MBR00000110,Institutional-OP,2021-01-19,2021-01-19,2021-02-24,PLN3141,1313212303,1313212303,Family Medicine,In-Network,I10,F32.9,,,,,,,0,,80061,Pathology/Lab,,,0450,22,Outpatient Hospital,3,71.29,48.19,43.86,0.0,0.0,4.33,4.33,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002849,MBR00000110,Institutional-OP,2022-12-28,2022-12-28,2023-01-11,PLN5612,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,Z00.00,E11.9,,,,,,,0,,99283,E&M,,,0450,22,Outpatient Hospital,1,316.68,182.79,0.0,182.79,0.0,0.0,182.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002850,MBR00000110,Professional,2022-08-06,2022-08-06,2022-09-12,PLN8420,1845900543,1845900543,ASC,In-Network,J20.9,I10,,,,,,,0,,77067,Radiology,,,,22,Outpatient Hospital,1,842.23,638.5,533.52,0.0,35.0,69.98,104.98,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000002851,MBR00000110,Professional,2021-06-02,2021-06-02,2021-06-29,PLN8996,1845057593,1845057593,Orthopedic Surgery,In-Network,E11.9,I10,,,,,,,0,,58661,Surgery,,,,11,Office,2,2480.31,1122.75,1122.75,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002852,MBR00000110,Professional,2021-02-23,2021-02-23,2021-03-07,PLN4819,1946680931,1946680931,Critical Access Hospital,Out-of-Network,I10,J44.1,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,2,33.06,17.21,1.8,0.0,15.0,0.41,15.41,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002853,MBR00000110,Institutional-IP,2022-07-29,2022-08-04,2022-09-01,PLN9184,1609138981,1609138981,Critical Access Hospital,In-Network,Z00.00,E11.9,,,,603,MS-DRG,19,6,Y,45380,Surgery,,,0636,21,Inpatient Hospital,2,1746.3,908.34,908.34,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000002854,MBR00000110,Professional,2022-11-03,2022-11-03,2022-11-22,PLN4903,1193493783,1193493783,Critical Access Hospital,Out-of-Network,C50.912,Z23,,,,,,,0,,99213,E&M,,,,21,Inpatient Hospital,3,263.67,161.8,0.0,161.8,25.0,0.0,186.8,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000002855,MBR00000110,Professional,2021-05-08,2021-05-08,2021-05-31,PLN3554,1790497490,1790497490,OB/GYN,In-Network,Z12.11,E11.9,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,1,69.45,21.98,6.98,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002856,MBR00000110,Institutional-IP,2022-10-19,2022-10-23,2022-11-26,PLN3229,1109850785,1109850785,ASC,Out-of-Network,N18.3,I10,,,,872,MS-DRG,14,4,Y,G0444,Medicine,,,0360,21,Inpatient Hospital,2,86.96,48.64,0.0,48.64,0.0,0.0,48.64,0.0,Denied,CO-4,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000002857,MBR00000110,Institutional-IP,2022-05-03,2022-05-08,2022-06-10,PLN5229,1687650653,1687650653,Internal Medicine,In-Network,I48.91,Z00.00,,,,872,MS-DRG,18,5,N,72148,Radiology,,,0370,21,Inpatient Hospital,1,2219.18,780.0,633.65,146.35,0.0,0.0,146.35,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002858,MBR00000110,Professional,2021-05-31,2021-05-31,2021-07-09,PLN2191,1691062876,1691062876,SNF,In-Network,E66.9,F41.9,,,,,,,0,,97530,Medicine,,,,11,Office,2,262.84,93.8,93.8,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002859,MBR00000110,Professional,2022-11-06,2022-11-06,2022-11-23,PLN5984,1860435061,1860435061,DME Supplier,In-Network,F10.20,C50.912,,,,,,,0,,99222,E&M,,,,11,Office,2,609.05,439.21,349.28,0.0,35.0,54.93,89.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002860,MBR00000110,Professional,2022-12-08,2022-12-08,2023-01-07,PLN5944,1244186984,1244186984,Family Medicine,Out-of-Network,J06.9,Z12.31,,,,,,,0,,33533,Surgery,,,,21,Inpatient Hospital,3,20873.52,10025.31,9990.31,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002861,MBR00000110,Institutional-OP,2021-06-20,2021-06-20,2021-07-27,PLN5750,1108115157,1108115157,General Acute Care Hospital,In-Network,Z00.00,I10,,,,,,,0,,58661,Surgery,,,0200,22,Outpatient Hospital,3,2486.99,983.77,933.77,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002862,MBR00000110,Professional,2023-01-08,2023-01-08,2023-02-08,PLN6381,1511044648,1511044648,Endocrinology,In-Network,J44.1,K57.30,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,3,110.6,81.07,81.07,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002863,MBR00000110,Professional,2021-09-01,2021-09-01,2021-09-25,PLN3882,1531398223,1531398223,OB/GYN,In-Network,B97.89,R07.9,,,,,,,0,,27447,Surgery,,,,11,Office,2,2814.88,1101.71,1026.71,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002864,MBR00000110,Professional,2022-10-16,2022-10-16,2022-11-18,PLN6340,1609138981,1609138981,Critical Access Hospital,In-Network,K57.30,Z12.11,,,,,,,0,,99214,E&M,,,,81,Independent Laboratory,1,448.68,229.43,167.75,37.82,0.0,23.86,61.68,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000002865,MBR00000110,Institutional-IP,2023-06-10,2023-06-17,2023-07-10,PLN5767,1514306773,1514306773,Endocrinology,In-Network,Z00.00,J44.1,,,,641,MS-DRG,24,7,Y,66984,Surgery,,,0510,21,Inpatient Hospital,1,2317.51,1643.55,1352.15,0.0,0.0,291.4,291.4,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002866,MBR00000110,Institutional-IP,2023-10-24,2023-11-02,2023-11-20,PLN1976,1273488618,1273488618,General Acute Care Hospital,In-Network,R05,Z00.00,,,,196,MS-DRG,20,9,Y,71046,Radiology,,,0370,21,Inpatient Hospital,2,296.58,248.95,202.51,0.0,0.0,46.44,46.44,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002867,MBR00000110,Institutional-OP,2021-10-08,2021-10-08,2021-11-04,PLN2349,1713934949,1713934949,Neurology,In-Network,Z00.00,I10,,,,,,,0,,71046,Radiology,,,0200,22,Outpatient Hospital,3,319.6,220.61,220.61,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002868,MBR00000110,Institutional-IP,2022-01-06,2022-01-15,2022-02-17,PLN6692,1872613201,1872613201,Internal Medicine,In-Network,N39.0,E11.9,,,,871,MS-DRG,11,9,U,84443,Pathology/Lab,,,0270,21,Inpatient Hospital,3,105.39,71.47,21.47,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002869,MBR00000110,Institutional-OP,2021-04-15,2021-04-15,2021-05-18,PLN3146,1500037969,1500037969,Pulmonology,In-Network,S72.001A,J06.9,,,,,,,0,,90460,Medicine,,,0120,22,Outpatient Hospital,2,32.87,14.11,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002870,MBR00000110,Institutional-OP,2023-11-28,2023-11-28,2024-01-09,PLN4908,1545347862,1545347862,SNF,In-Network,E78.5,J06.9,,,,,,,0,,81001,Pathology/Lab,,,0510,22,Outpatient Hospital,1,53.93,36.27,0.0,36.27,0.0,0.0,36.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002871,MBR00000110,Professional,2021-12-29,2021-12-29,2022-01-19,PLN3332,1800011727,1800011727,Clinical Laboratory,Out-of-Network,M17.11,I10,,,,,,,0,,45380,Surgery,,,,23,Emergency Room,3,2281.19,1886.44,1570.37,0.0,0.0,316.07,316.07,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,1,0,0,0
CLM0000002872,MBR00000110,Professional,2023-05-29,2023-05-29,2023-06-26,PLN1316,1752470395,1752470395,Home Health,In-Network,E11.9,I10,,,,,,,0,,G0444,Medicine,,,,22,Outpatient Hospital,3,87.45,28.83,0.0,27.32,75.0,0.0,102.32,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000002873,MBR00000110,Institutional-OP,2023-10-21,2023-10-21,2023-11-01,PLN4596,1366576336,1366576336,Geriatrics,In-Network,I11.9,Z00.01,,,,,,,0,,93000,Radiology,,,0730,22,Outpatient Hospital,2,114.36,56.68,56.68,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002874,MBR00000110,Institutional-OP,2022-06-05,2022-06-05,2022-07-13,PLN5757,1702692193,1702692193,Physical Therapy,In-Network,Z00.00,Z12.31,,,,,,,0,,G0444,Medicine,,,0270,22,Outpatient Hospital,1,36.45,15.69,15.69,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000002875,MBR00000110,Institutional-OP,2023-01-30,2023-01-30,2023-02-24,PLN6427,1410468316,1410468316,SNF,In-Network,J44.1,Z00.00,,,,,,,0,,27447,Surgery,,,0740,22,Outpatient Hospital,2,5451.81,2008.15,1935.32,72.83,0.0,0.0,72.83,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002876,MBR00000110,Professional,2022-06-02,2022-06-02,2022-07-08,PLN7126,1118885473,1118885473,ASC,In-Network,Z00.00,Z00.00,,,,,,,0,,99221,E&M,,,,50,Federally Qualified Health Center,2,436.5,207.29,35.08,172.21,0.0,0.0,172.21,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002877,MBR00000110,Institutional-OP,2022-09-23,2022-09-23,2022-10-14,PLN4988,1283743001,1283743001,Family Medicine,In-Network,Z00.00,J20.9,,,,,,,0,,76700,Radiology,,,0761,22,Outpatient Hospital,3,1347.62,841.93,791.93,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000002878,MBR00000110,Professional,2021-10-01,2021-10-01,2021-11-14,PLN3072,1132188260,1132188260,Family Medicine,In-Network,E11.9,E11.9,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,2,398.36,200.37,200.37,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002879,MBR00000110,Institutional-IP,2023-07-10,2023-07-16,2023-07-25,PLN2103,1606140917,1606140917,ASC,In-Network,Z00.00,F41.9,,,,682,MS-DRG,11,6,Y,90460,Medicine,,,0900,21,Inpatient Hospital,3,42.47,29.06,0.0,29.06,0.0,0.0,29.06,0.0,Paid,,,0,,0,0,0,0,1,1,Unbundling,0,0,0,0,0
CLM0000002880,MBR00000110,Professional,2021-05-15,2021-05-15,2021-06-10,PLN7274,1132188260,1132188260,Family Medicine,In-Network,E11.9,F41.9,,,,,,,0,,71046,Radiology,,,,23,Emergency Room,1,174.35,110.09,60.87,0.01,35.0,14.21,49.22,0.0,Paid,,,0,,1,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000002881,MBR00000110,Professional,2022-12-24,2022-12-24,2023-01-09,PLN6119,1450094833,1450094833,Outpatient Clinic,In-Network,I10,R05,,,,,,,0,,66984,Surgery,,,,49,Independent Clinic,3,2041.55,744.4,366.26,366.77,0.0,11.37,378.14,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002882,MBR00000110,Professional,2023-10-05,2023-10-05,2023-10-15,PLN8470,1840431511,1840431511,Geriatrics,Out-of-Network,R07.9,I10,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,2,487.06,190.52,190.52,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002883,MBR00000110,Professional,2023-06-08,2023-06-08,2023-07-10,PLN8742,1193493783,1193493783,Critical Access Hospital,Out-of-Network,Z00.00,Z23,,,,,,,0,,99233,E&M,,,,11,Office,3,478.13,186.08,0.0,186.08,0.0,0.0,186.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002884,MBR00000110,Professional,2023-04-11,2023-04-11,2023-04-25,PLN1859,1997536841,1997536841,Family Medicine,Out-of-Network,N18.3,M17.11,,,,,,,0,,99233,E&M,,,,12,Home,1,364.87,226.18,0.0,19.42,15.0,0.0,34.42,0.0,Denied,CO-4,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000002885,MBR00000110,Institutional-OP,2022-12-21,2022-12-21,2023-01-31,PLN9136,1450553056,1450553056,Clinical Laboratory,In-Network,M17.11,N39.0,,,,,,,0,,99213,E&M,,,0120,22,Outpatient Hospital,1,215.64,177.68,0.0,143.27,0.0,0.0,143.27,0.0,Denied,CO-27,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000002886,MBR00000110,Institutional-OP,2023-11-02,2023-11-02,2023-11-15,PLN7397,1168246159,1168246159,Internal Medicine,In-Network,E66.9,I25.10,,,,,,,0,,99204,E&M,,,0730,22,Outpatient Hospital,3,434.33,260.13,260.13,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002887,MBR00000110,Institutional-OP,2023-08-05,2023-08-05,2023-09-10,PLN4752,1550154147,1550154147,Outpatient Clinic,In-Network,M54.5,F41.9,,,,,,,0,,77067,Radiology,,,0740,22,Outpatient Hospital,3,430.6,318.47,318.47,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000002888,MBR00000110,Institutional-OP,2021-10-29,2021-10-29,2021-12-06,PLN5563,1135158374,1135158374,Pulmonology,In-Network,I10,E66.9,,,,,,,0,,99213,E&M,,,0301,22,Outpatient Hospital,2,325.81,192.22,0.0,192.22,0.0,0.0,192.22,0.0,Denied,CO-18,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000002889,MBR00000110,Institutional-OP,2022-11-15,2022-11-15,2022-12-23,PLN3206,1847081578,1847081578,Urology,Out-of-Network,I10,I10,,,,,,,0,,47562,Surgery,,,0370,22,Outpatient Hospital,3,3492.14,2002.24,2002.24,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000002890,MBR00000110,Institutional-OP,2022-04-15,2022-04-15,2022-05-09,PLN1765,1915531927,1915531927,Critical Access Hospital,In-Network,I10,Z00.01,,,,,,,0,,77067,Radiology,,,0740,22,Outpatient Hospital,2,863.25,653.68,505.65,13.92,25.0,109.11,148.03,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000002891,MBR00000110,Professional,2021-10-18,2021-10-18,2021-11-13,PLN4591,1186826716,1186826716,Physical Therapy,In-Network,F32.9,I10,,,,,,,0,,99283,E&M,,,,11,Office,3,266.66,116.95,85.24,11.36,0.0,20.35,31.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002892,MBR00000110,Professional,2023-06-15,2023-06-15,2023-07-06,PLN8035,1389336600,1389336600,Critical Access Hospital,In-Network,I25.10,I10,,,,,,,0,,90686,Medicine,,,,22,Outpatient Hospital,1,105.61,40.33,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000002893,MBR00000110,Institutional-OP,2021-02-15,2021-02-15,2021-02-23,PLN8752,1422747896,1422747896,Urology,In-Network,Z79.4,E11.9,,,,,,,0,,58661,Surgery,,,0370,22,Outpatient Hospital,3,4427.05,1585.91,1585.91,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002894,MBR00000111,Professional,2021-05-21,2021-05-21,2021-06-14,PLN9828,1563980627,1563980627,Critical Access Hospital,In-Network,M81.0,J18.9,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,2,55.04,35.23,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002895,MBR00000111,Institutional-OP,2021-04-26,2021-04-26,2021-05-21,PLN6665,1749327647,1749327647,Geriatrics,In-Network,E66.9,I25.10,,,,,,,0,,99222,E&M,,,0370,22,Outpatient Hospital,3,491.01,206.76,0.0,206.76,50.0,0.0,256.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002896,MBR00000111,Institutional-IP,2021-08-10,2021-08-15,2021-09-07,PLN6869,1540044947,1540044947,Pulmonology,Out-of-Network,I10,Z12.31,,,,194,MS-DRG,16,5,Y,99221,E&M,,,0120,21,Inpatient Hospital,2,192.09,67.93,67.93,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002897,MBR00000111,Professional,2022-07-16,2022-07-16,2022-08-01,PLN1544,1135158374,1135158374,Pulmonology,In-Network,J18.9,I63.9,,,,,,,0,,99284,E&M,,,,11,Office,3,444.49,354.52,0.0,354.52,15.0,0.0,369.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002898,MBR00000111,Professional,2023-10-29,2023-10-29,2023-12-08,PLN6660,1847081578,1847081578,Urology,Out-of-Network,Z12.31,N20.0,,,,,,,0,,99283,E&M,,,,11,Office,1,277.63,84.36,59.36,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002899,MBR00000111,Institutional-OP,2023-12-01,2023-12-01,2024-01-03,PLN4476,1561134315,1561134315,DME Supplier,In-Network,E87.6,F32.9,,,,,,,0,,27447,Surgery,,,0270,22,Outpatient Hospital,3,3680.46,2483.21,2448.21,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002900,MBR00000111,Professional,2023-09-13,2023-09-13,2023-10-25,PLN9846,1980712759,1980712759,Outpatient Clinic,Out-of-Network,F32.9,Z00.00,,,,,,,0,,99213,E&M,,,,23,Emergency Room,3,170.67,123.45,98.8,16.09,0.0,8.56,24.65,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002901,MBR00000111,Professional,2023-04-12,2023-04-12,2023-05-04,PLN5211,1364429278,1364429278,OB/GYN,In-Network,J44.1,F32.9,,,,,,,0,,45380,Surgery,,,,23,Emergency Room,3,2961.11,1819.44,1460.03,335.18,0.0,24.23,359.41,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,1,0,0,0
CLM0000002902,MBR00000111,Institutional-IP,2022-05-19,2022-05-22,2022-06-04,PLN6445,1964402759,1964402759,Outpatient Clinic,In-Network,N18.3,J20.9,,,,470,MS-DRG,17,3,Y,99283,E&M,,,0370,21,Inpatient Hospital,3,638.42,527.32,512.32,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002903,MBR00000111,Professional,2023-04-30,2023-04-30,2023-05-27,PLN4366,1757138478,1757138478,Pediatrics,In-Network,J20.9,I10,,,,,,,0,,90460,Medicine,,,,22,Outpatient Hospital,3,40.46,31.71,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002904,MBR00000111,Professional,2021-10-21,2021-10-21,2021-11-02,PLN9823,1390307371,1390307371,DME Supplier,In-Network,F32.9,Z00.00,,,,,,,0,,23472,Surgery,,,,11,Office,1,6598.26,5121.37,4722.65,398.72,0.0,0.0,398.72,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002905,MBR00000111,Institutional-IP,2022-12-28,2023-01-03,2023-01-16,PLN3223,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,R51,F41.9,,,,641,MS-DRG,3,6,Y,85610,Pathology/Lab,,,0740,21,Inpatient Hospital,2,65.79,51.64,51.64,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002906,MBR00000111,Professional,2021-01-10,2021-01-10,2021-01-31,PLN7556,1946680931,1946680931,Critical Access Hospital,Out-of-Network,J06.9,I63.9,,,,,,,0,,97110,Medicine,,,,11,Office,2,167.3,110.87,75.87,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002907,MBR00000111,Institutional-OP,2023-09-17,2023-09-17,2023-10-03,PLN3044,1148984206,1148984206,Psychiatry,In-Network,I48.91,E11.9,,,,,,,0,,90837,Medicine,,,0740,22,Outpatient Hospital,1,258.24,92.34,0.0,92.34,75.0,0.0,167.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002908,MBR00000111,Professional,2023-11-30,2023-11-30,2023-12-23,PLN1860,1728018911,1728018911,Nephrology,In-Network,M54.5,M54.5,,,,,,,0,,72148,Radiology,,,,50,Federally Qualified Health Center,1,2527.32,1161.21,934.99,0.0,0.0,226.22,226.22,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002909,MBR00000111,Institutional-OP,2023-03-17,2023-03-17,2023-04-22,PLN2045,1530904931,1530904931,Internal Medicine,In-Network,Z00.00,R05,,,,,,,0,,45378,Surgery,,,0301,22,Outpatient Hospital,1,1435.68,1077.97,1042.97,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000002910,MBR00000111,Institutional-OP,2021-07-11,2021-07-11,2021-07-23,PLN6839,1132188260,1132188260,Family Medicine,In-Network,M54.5,N18.3,,,,,,,0,,G0468,Medicine,,,0270,22,Outpatient Hospital,3,260.97,162.8,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002911,MBR00000111,Institutional-OP,2021-10-10,2021-10-10,2021-11-20,PLN8749,1213165847,1213165847,Critical Access Hospital,In-Network,I10,J20.9,,,,,,,0,,97530,Medicine,,,0740,22,Outpatient Hospital,3,176.57,73.13,0.0,73.13,15.0,0.0,88.13,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002912,MBR00000111,Institutional-OP,2023-03-22,2023-03-22,2023-04-14,PLN9759,1865904917,1865904917,Outpatient Clinic,In-Network,E78.5,J06.9,,,,,,,0,,83036,Pathology/Lab,,,0636,22,Outpatient Hospital,3,96.2,74.59,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000002913,MBR00000111,Institutional-IP,2022-07-01,2022-07-05,2022-07-09,PLN4406,1840431511,1840431511,Geriatrics,Out-of-Network,Z12.31,Z12.11,,,,470,MS-DRG,15,4,Y,93306,Radiology,,,0450,21,Inpatient Hospital,1,1776.04,1155.4,892.17,263.23,0.0,0.0,263.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002914,MBR00000111,Professional,2022-08-23,2022-08-23,2022-09-14,PLN2365,1389336600,1389336600,Critical Access Hospital,In-Network,Z79.4,G43.909,,,,,,,0,,99214,E&M,,,,31,Skilled Nursing Facility,1,256.83,105.17,0.0,105.17,15.0,0.0,120.17,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000002915,MBR00000111,Institutional-IP,2022-03-19,2022-03-21,2022-04-04,PLN7633,1245650222,1245650222,Gastroenterology,In-Network,I25.10,Z12.31,,,,470,MS-DRG,3,2,Y,93000,Radiology,,,0200,21,Inpatient Hospital,3,87.66,63.23,52.06,0.0,0.0,11.17,11.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002916,MBR00000111,Professional,2023-07-05,2023-07-05,2023-07-21,PLN4039,1236418230,1236418230,DME Supplier,In-Network,Z00.00,Z00.00,,,,,,,0,,99214,E&M,,,,81,Independent Laboratory,2,234.09,89.65,0.0,89.65,75.0,0.0,164.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002917,MBR00000111,Professional,2021-07-01,2021-07-01,2021-08-04,PLN5906,1334916761,1334916761,ASC,In-Network,K21.0,N18.3,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,1,471.69,239.69,239.69,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002918,MBR00000111,Professional,2022-04-29,2022-04-29,2022-06-06,PLN8051,1433937353,1433937353,Nephrology,In-Network,Z00.01,E11.9,,,,,,,0,,33533,Surgery,,,,65,End-Stage Renal Disease,3,24167.34,14288.72,14213.72,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002919,MBR00000111,Institutional-OP,2021-09-01,2021-09-01,2021-09-12,PLN4332,1502838586,1502838586,ASC,In-Network,Z12.31,I10,,,,,,,0,,45378,Surgery,,,0730,22,Outpatient Hospital,3,2395.35,1271.95,1271.95,0.0,0.0,0.0,0.0,0.0,Pended,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000002920,MBR00000111,Professional,2023-01-28,2023-01-28,2023-02-05,PLN6254,1245650222,1245650222,Gastroenterology,In-Network,J06.9,I50.9,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,3,1507.29,1210.84,0.0,0.0,0.0,193.76,193.76,0.0,Denied,CO-4,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002921,MBR00000111,Institutional-IP,2021-11-09,2021-11-10,2021-11-29,PLN5491,1631954542,1631954542,Oncology,In-Network,Z96.641,F03.90,,,,690,MS-DRG,16,1,Y,66984,Surgery,,,0200,21,Inpatient Hospital,1,2420.27,928.37,893.37,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002922,MBR00000111,Professional,2021-11-24,2021-11-24,2021-12-17,PLN4192,1213165847,1213165847,Critical Access Hospital,In-Network,Z00.00,E78.5,,,,,,,0,,99221,E&M,,,,81,Independent Laboratory,3,298.01,181.18,177.94,0.0,0.0,3.24,3.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002923,MBR00000111,Professional,2021-07-10,2021-07-10,2021-07-22,PLN6691,1728018911,1728018911,Nephrology,In-Network,R07.9,Z23,,,,,,,0,,47562,Surgery,,,,81,Independent Laboratory,1,3617.41,1560.3,1347.25,188.05,25.0,0.0,213.05,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002924,MBR00000111,Professional,2023-08-04,2023-08-04,2023-08-24,PLN2951,1946680931,1946680931,Critical Access Hospital,Out-of-Network,N20.0,I10,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,3,29021.99,12783.72,12503.73,254.99,25.0,0.0,279.99,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002925,MBR00000111,Institutional-OP,2021-08-26,2021-08-26,2021-09-30,PLN8363,1395983630,1395983630,Nephrology,In-Network,M54.5,M17.11,,,,,,,0,,72148,Radiology,,,0120,22,Outpatient Hospital,3,1177.97,929.17,904.17,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002926,MBR00000111,Professional,2023-08-10,2023-08-10,2023-09-01,PLN9610,1389336600,1389336600,Critical Access Hospital,In-Network,F41.9,Z00.00,,,,,,,0,,47562,Surgery,,,,11,Office,2,5468.81,3297.22,3071.04,126.88,15.0,84.3,226.18,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002927,MBR00000111,Institutional-OP,2023-10-01,2023-10-01,2023-10-26,PLN1593,1514306773,1514306773,Endocrinology,In-Network,N20.0,M17.11,,,,,,,0,,45380,Surgery,,,0360,22,Outpatient Hospital,3,2046.13,983.88,948.88,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000002928,MBR00000111,Professional,2023-11-22,2023-11-22,2023-12-02,PLN3073,1727809972,1727809972,Home Health,In-Network,Z12.31,Z00.01,,,,,,,0,,G0468,Medicine,,,,12,Home,3,715.14,508.55,489.32,0.0,0.0,19.23,19.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002929,MBR00000111,Professional,2022-01-11,2022-01-11,2022-01-26,PLN7272,1790497490,1790497490,OB/GYN,In-Network,Z23,M54.5,,,,,,,0,,81001,Pathology/Lab,,,,21,Inpatient Hospital,2,23.48,18.18,17.42,0.0,0.0,0.76,0.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002930,MBR00000111,Professional,2022-12-19,2022-12-19,2023-01-06,PLN1479,1219817751,1219817751,OB/GYN,In-Network,Z12.31,E11.65,,,,,,,0,,81001,Pathology/Lab,,,,22,Outpatient Hospital,3,50.0,33.17,28.22,0.0,0.0,4.95,4.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002931,MBR00000111,Professional,2023-06-26,2023-06-26,2023-07-13,PLN3507,1939033455,1939033455,Pulmonology,In-Network,J18.9,Z12.31,,,,,,,0,,70450,Radiology,,,,11,Office,2,1148.17,361.19,361.19,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002932,MBR00000111,Professional,2021-03-27,2021-03-27,2021-05-03,PLN5965,1575695214,1575695214,SNF,In-Network,K21.0,J06.9,,,,,,,0,,99406,Medicine,,,,22,Outpatient Hospital,1,36.65,19.92,11.21,6.84,0.0,1.87,8.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002933,MBR00000111,Professional,2021-03-12,2021-03-12,2021-03-19,PLN5894,1389336600,1389336600,Critical Access Hospital,In-Network,F03.90,E78.5,,,,,,,0,,78452,Radiology,,,,31,Skilled Nursing Facility,2,4563.19,3075.39,0.0,115.65,0.0,0.0,115.65,0.0,Denied,CO-29,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002934,MBR00000111,Institutional-OP,2021-08-15,2021-08-15,2021-09-18,PLN5163,1500037969,1500037969,Pulmonology,In-Network,I10,K21.0,,,,,,,0,,99284,E&M,,,0730,22,Outpatient Hospital,3,596.69,421.85,386.85,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002935,MBR00000111,Institutional-IP,2023-12-12,2023-12-19,2023-12-27,PLN1249,1422747896,1422747896,Urology,In-Network,N39.0,Z23,,,,603,MS-DRG,1,7,N,45380,Surgery,,,0301,21,Inpatient Hospital,2,2566.35,2176.21,1977.93,40.53,0.0,157.75,198.28,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000002936,MBR00000111,Professional,2021-04-09,2021-04-09,2021-04-20,PLN3416,1453283987,1453283987,Critical Access Hospital,In-Network,Z87.891,K21.0,,,,,,,0,,77067,Radiology,,,,11,Office,3,676.96,236.77,150.13,71.64,15.0,0.0,86.64,0.0,Adjusted,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000002937,MBR00000111,Institutional-OP,2023-04-18,2023-04-18,2023-04-26,PLN8877,1283743001,1283743001,Family Medicine,In-Network,Z23,E11.65,,,,,,,0,,G0468,Medicine,,,0740,22,Outpatient Hospital,3,612.22,431.08,406.08,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002938,MBR00000111,Institutional-IP,2023-07-08,2023-07-15,2023-07-19,PLN7723,1609526529,1609526529,Psychiatry,In-Network,K57.30,I10,,,,470,MS-DRG,23,7,Y,33533,Surgery,,,0200,21,Inpatient Hospital,2,24653.25,15163.71,14941.74,221.97,0.0,0.0,221.97,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002939,MBR00000111,Professional,2023-09-20,2023-09-20,2023-10-23,PLN9230,1847081578,1847081578,Urology,Out-of-Network,I10,E66.9,,,,,,,0,,99233,E&M,,,,49,Independent Clinic,1,409.0,133.15,0.0,133.15,25.0,0.0,158.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002940,MBR00000112,Professional,2022-08-02,2022-08-02,2022-08-26,PLN4772,1645194539,1645194539,SNF,In-Network,I10,M17.11,,,,,,,0,,23472,Surgery,,,,11,Office,3,6154.4,2313.33,1822.61,452.52,35.0,3.2,490.72,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002941,MBR00000112,Professional,2022-07-30,2022-07-30,2022-09-12,PLN1055,1795618275,1795618275,Pulmonology,In-Network,Z23,N20.0,,,,,,,0,,47562,Surgery,,,,11,Office,1,4594.1,3375.11,0.0,277.79,35.0,0.0,312.79,0.0,Denied,CO-97,,1,,0,0,1,0,0,1,Unbundling,0,0,0,0,0
CLM0000002942,MBR00000112,Institutional-OP,2023-03-24,2023-03-24,2023-04-12,PLN5098,1860435061,1860435061,DME Supplier,In-Network,M81.0,I48.91,,,,,,,0,,76700,Radiology,,,0636,22,Outpatient Hospital,1,1014.01,354.84,319.84,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002943,MBR00000112,Professional,2022-11-26,2022-11-26,2022-12-24,PLN4126,1132188260,1132188260,Family Medicine,In-Network,Z87.891,N40.0,,,,,,,0,,99233,E&M,,,,31,Skilled Nursing Facility,3,538.22,351.23,342.73,0.0,0.0,8.5,8.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002944,MBR00000112,Professional,2023-05-12,2023-05-12,2023-06-08,PLN2895,1361302520,1361302520,Critical Access Hospital,In-Network,K57.30,Z00.00,,,,,,,0,,23472,Surgery,,,,23,Emergency Room,2,2771.42,1431.55,1038.29,315.88,0.0,77.38,393.26,0.0,Paid,,,1,,1,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000002945,MBR00000112,Professional,2022-01-31,2022-01-31,2022-02-25,PLN2475,1745114564,1745114564,Endocrinology,In-Network,N18.3,E78.5,,,,,,,0,,93225,Medicine,,,,11,Office,1,945.52,766.76,766.76,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002946,MBR00000112,Professional,2023-10-20,2023-10-20,2023-10-29,PLN2277,1247341320,1247341320,Urology,Out-of-Network,R07.9,Z23,,,,,,,0,,23472,Surgery,,,,81,Independent Laboratory,3,7187.3,4323.98,3967.02,356.96,0.0,0.0,356.96,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002947,MBR00000112,Professional,2022-04-19,2022-04-19,2022-04-29,PLN4722,1631954542,1631954542,Oncology,In-Network,N39.0,I48.91,,,,,,,0,,87491,Pathology/Lab,,,,22,Outpatient Hospital,2,214.53,159.38,0.0,159.38,15.0,0.0,174.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002948,MBR00000112,Institutional-IP,2021-09-29,2021-10-04,2021-11-01,PLN9328,1313212303,1313212303,Family Medicine,In-Network,R07.9,K21.0,,,,196,MS-DRG,9,5,W,G0439,Medicine,,,0270,21,Inpatient Hospital,2,578.11,265.78,0.0,265.78,35.0,0.0,300.78,0.0,Pended,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000002949,MBR00000112,Institutional-OP,2023-04-03,2023-04-03,2023-04-28,PLN3282,1266606767,1266606767,ASC,In-Network,I63.9,F32.9,,,,,,,0,,84443,Pathology/Lab,,,0301,22,Outpatient Hospital,1,67.11,24.26,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002950,MBR00000112,Professional,2022-11-11,2022-11-11,2022-12-10,PLN5195,1702692193,1702692193,Physical Therapy,In-Network,F41.9,M54.5,,,,,,,0,,45380,Surgery,,,,11,Office,2,2204.61,1613.97,1456.08,90.77,0.0,67.12,157.89,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000002951,MBR00000113,Professional,2021-02-24,2021-02-24,2021-03-08,PLN4324,1749494482,1749494482,Pediatrics,In-Network,Z00.00,Z12.31,,,,,,,0,,99213,E&M,,,,11,Office,2,198.92,159.74,84.74,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002952,MBR00000113,Professional,2021-07-02,2021-07-02,2021-08-04,PLN5954,1778483301,1778483301,Home Health,In-Network,N20.0,Z23,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,1,57.27,29.19,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002953,MBR00000113,Professional,2021-02-10,2021-02-10,2021-03-10,PLN4649,1284035364,1284035364,Pediatrics,In-Network,F32.9,N18.3,,,,,,,0,,78452,Radiology,,,,50,Federally Qualified Health Center,3,4040.02,3033.85,3018.85,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002954,MBR00000113,Institutional-IP,2022-09-23,2022-09-24,2022-10-27,PLN4542,1728018911,1728018911,Nephrology,In-Network,J18.9,Z23,,,,470,MS-DRG,9,1,Y,27447,Surgery,,,0200,21,Inpatient Hospital,1,5103.69,1694.42,1619.42,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002955,MBR00000113,Institutional-OP,2023-08-17,2023-08-17,2023-08-27,PLN5571,1235381502,1235381502,Cardiology,In-Network,E78.5,I10,,,,,,,0,,85610,Pathology/Lab,,,0450,22,Outpatient Hospital,2,53.13,26.02,0.0,26.02,0.0,0.0,26.02,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002956,MBR00000113,Institutional-OP,2021-12-20,2021-12-20,2021-12-31,PLN6207,1767011137,1767011137,DME Supplier,In-Network,M54.5,Z00.00,,,,,,,0,,78452,Radiology,,,0450,22,Outpatient Hospital,2,2929.92,960.03,935.03,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002957,MBR00000113,Professional,2021-05-01,2021-05-01,2021-05-13,PLN5406,1514306773,1514306773,Endocrinology,In-Network,J06.9,R05,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,2,52.46,19.85,0.0,19.85,0.0,0.0,19.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002958,MBR00000113,Institutional-OP,2023-07-22,2023-07-22,2023-09-03,PLN8200,1205377316,1205377316,Orthopedic Surgery,In-Network,J06.9,E11.9,,,,,,,0,,58661,Surgery,,,0301,22,Outpatient Hospital,2,2759.23,1832.57,1435.53,397.04,0.0,0.0,397.04,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002959,MBR00000113,Institutional-OP,2023-03-01,2023-03-01,2023-04-06,PLN1606,1528335731,1528335731,Critical Access Hospital,In-Network,I25.10,R10.9,,,,,,,0,,76700,Radiology,,,0900,22,Outpatient Hospital,1,1237.94,761.57,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002960,MBR00000113,Professional,2022-08-20,2022-08-20,2022-09-24,PLN9656,1295371663,1295371663,Critical Access Hospital,In-Network,F10.20,Z00.00,,,,,,,0,,45380,Surgery,,,,20,Urgent Care,1,2433.7,2009.05,2009.05,0.0,0.0,0.0,0.0,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000002961,MBR00000113,Institutional-OP,2021-08-07,2021-08-07,2021-08-23,PLN4038,1542828721,1542828721,Orthopedic Surgery,In-Network,J20.9,E78.5,,,,,,,0,,27447,Surgery,,,0360,22,Outpatient Hospital,3,6051.84,3241.7,3226.7,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002962,MBR00000113,Institutional-OP,2023-01-07,2023-01-07,2023-01-17,PLN4615,1728018911,1728018911,Nephrology,In-Network,F32.9,F41.9,,,,,,,0,,80061,Pathology/Lab,,,0510,22,Outpatient Hospital,3,110.13,70.46,64.54,0.0,0.0,5.92,5.92,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002963,MBR00000113,Institutional-OP,2022-02-05,2022-02-05,2022-03-11,PLN5053,1713934949,1713934949,Neurology,In-Network,Z23,M54.5,,,,,,,0,,27447,Surgery,,,0120,22,Outpatient Hospital,2,3010.2,2342.52,2036.59,305.93,0.0,0.0,305.93,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000002964,MBR00000113,Professional,2021-09-26,2021-09-26,2021-10-18,PLN4849,1806688928,1806688928,Geriatrics,In-Network,F41.9,Z12.31,,,,,,,0,,45378,Surgery,,,,31,Skilled Nursing Facility,3,1360.28,617.36,559.33,43.03,15.0,0.0,58.03,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000002965,MBR00000113,Professional,2021-11-18,2021-11-18,2021-11-27,PLN1780,1806688928,1806688928,Geriatrics,In-Network,I10,I63.9,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,2,559.25,417.41,417.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002966,MBR00000113,Institutional-OP,2021-03-09,2021-03-09,2021-03-17,PLN4156,1946680931,1946680931,Critical Access Hospital,Out-of-Network,J18.9,R07.9,,,,,,,0,,80061,Pathology/Lab,,,0730,22,Outpatient Hospital,3,67.11,45.15,0.0,45.15,0.0,0.0,45.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002967,MBR00000113,Professional,2022-06-21,2022-06-21,2022-07-22,PLN7467,1247341320,1247341320,Urology,Out-of-Network,I48.91,N40.0,,,,,,,0,,86900,Pathology/Lab,,,,21,Inpatient Hospital,3,44.68,35.5,0.0,0.0,0.0,4.78,4.78,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002968,MBR00000113,Institutional-OP,2023-04-05,2023-04-05,2023-05-02,PLN8024,1114982472,1114982472,Orthopedic Surgery,In-Network,E11.9,I10,,,,,,,0,,99203,E&M,,,0636,22,Outpatient Hospital,3,318.86,240.39,0.0,240.39,0.0,0.0,240.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002969,MBR00000114,Professional,2023-06-25,2023-06-25,2023-08-03,PLN7385,1717912431,1717912431,Oncology,In-Network,J20.9,E11.9,,,,,,,0,,93306,Radiology,,,,11,Office,2,1364.23,866.86,841.86,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000002970,MBR00000114,Professional,2023-03-04,2023-03-04,2023-04-15,PLN7996,1624802371,1624802371,ASC,Out-of-Network,Z23,Z23,,,,,,,0,,99283,E&M,,,,23,Emergency Room,3,293.74,224.68,138.01,0.0,75.0,11.67,86.67,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002971,MBR00000114,Institutional-OP,2023-08-17,2023-08-17,2023-09-28,PLN2290,1948810580,1948810580,DME Supplier,In-Network,E11.40,B97.89,,,,,,,0,,99204,E&M,,,0200,22,Outpatient Hospital,3,444.9,240.55,190.55,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002972,MBR00000114,Institutional-IP,2023-11-22,2023-11-27,2024-01-04,PLN2481,1939033455,1939033455,Pulmonology,In-Network,Z23,M81.0,,,,195,MS-DRG,10,5,Y,99222,E&M,,,0370,21,Inpatient Hospital,3,467.86,193.22,193.22,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000002973,MBR00000114,Professional,2021-09-01,2021-09-01,2021-09-15,PLN1135,1433937353,1433937353,Nephrology,In-Network,F03.90,E78.5,,,,,,,0,,99213,E&M,,,,11,Office,3,120.61,49.52,0.0,49.52,25.0,0.0,74.52,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002974,MBR00000114,Institutional-OP,2022-04-20,2022-04-20,2022-05-04,PLN1597,1500949740,1500949740,Pediatrics,In-Network,G43.909,F32.9,,,,,,,0,,45378,Surgery,,,0450,22,Outpatient Hospital,2,2131.34,1146.75,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-4,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000002975,MBR00000114,Institutional-OP,2022-01-05,2022-01-05,2022-01-25,PLN1746,1860435061,1860435061,DME Supplier,In-Network,Z12.11,M81.0,,,,,,,0,,99283,E&M,,,0636,22,Outpatient Hospital,1,248.04,141.44,0.0,141.44,25.0,0.0,166.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002976,MBR00000114,Institutional-IP,2023-01-20,2023-01-29,2023-02-01,PLN7058,1502838586,1502838586,ASC,In-Network,E11.65,Z12.31,,,,641,MS-DRG,20,9,Y,99221,E&M,,,0360,21,Inpatient Hospital,3,379.22,300.69,265.69,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002977,MBR00000114,Professional,2023-07-06,2023-07-06,2023-07-16,PLN1220,1899127912,1899127912,Neurology,In-Network,N18.3,M54.5,,,,,,,0,,71046,Radiology,,,,21,Inpatient Hospital,2,154.43,120.16,45.16,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002978,MBR00000114,Institutional-IP,2023-09-02,2023-09-08,2023-09-30,PLN8776,1109850785,1109850785,ASC,Out-of-Network,F41.9,Z00.00,,,,682,MS-DRG,18,6,Y,85025,Pathology/Lab,,,0740,21,Inpatient Hospital,2,67.49,37.74,0.0,37.74,0.0,0.0,37.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002979,MBR00000114,Professional,2021-04-09,2021-04-09,2021-05-12,PLN6586,1313212303,1313212303,Family Medicine,In-Network,F41.9,R07.9,,,,,,,0,,66984,Surgery,,,,23,Emergency Room,1,2793.79,941.81,720.76,221.05,0.0,0.0,221.05,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000002980,MBR00000114,Institutional-OP,2022-07-18,2022-07-18,2022-08-02,PLN1974,1313212303,1313212303,Family Medicine,In-Network,Z00.00,E78.5,,,,,,,0,,99203,E&M,,,0360,22,Outpatient Hospital,2,207.99,129.13,0.0,129.13,15.0,0.0,144.13,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002981,MBR00000114,Institutional-IP,2021-05-09,2021-05-16,2021-05-28,PLN5962,1645194539,1645194539,SNF,In-Network,J45.20,I10,,,,195,MS-DRG,3,7,Y,77067,Radiology,,,0730,21,Inpatient Hospital,3,517.18,340.9,340.9,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000002982,MBR00000114,Professional,2021-12-28,2021-12-28,2022-01-29,PLN8860,1514306773,1514306773,Endocrinology,In-Network,J20.9,E11.40,,,,,,,0,,83036,Pathology/Lab,,,,12,Home,1,86.43,56.71,8.39,12.67,35.0,0.65,48.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000002983,MBR00000114,Professional,2022-06-10,2022-06-10,2022-07-24,PLN2547,1193493783,1193493783,Critical Access Hospital,Out-of-Network,I25.10,E87.6,,,,,,,0,,78452,Radiology,,,,11,Office,1,6444.95,2978.07,2573.13,0.0,0.0,404.94,404.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002984,MBR00000114,Professional,2022-11-10,2022-11-10,2022-12-02,PLN2007,1355166277,1355166277,Endocrinology,In-Network,I10,F32.9,,,,,,,0,,87491,Pathology/Lab,,,,22,Outpatient Hospital,1,197.79,121.97,106.76,0.0,0.0,15.21,15.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002985,MBR00000114,Professional,2023-05-16,2023-05-16,2023-06-25,PLN4010,1366576336,1366576336,Geriatrics,In-Network,E78.5,R51,,,,,,,0,,99222,E&M,,,,11,Office,3,365.18,292.46,258.29,34.17,0.0,0.0,34.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002986,MBR00000114,Institutional-IP,2023-12-26,2024-01-02,2024-01-21,PLN6707,1752470395,1752470395,Home Health,In-Network,E11.9,I10,,,,291,MS-DRG,21,7,N,99221,E&M,,,0730,21,Inpatient Hospital,2,268.89,159.87,0.0,0.0,0.0,29.62,29.62,0.0,Denied,CO-27,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000002987,MBR00000114,Institutional-OP,2022-01-03,2022-01-03,2022-02-13,PLN7146,1609526529,1609526529,Psychiatry,In-Network,E11.9,C50.912,,,,,,,0,,71046,Radiology,,,0636,22,Outpatient Hospital,3,243.28,160.27,160.27,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002988,MBR00000114,Institutional-OP,2022-09-05,2022-09-05,2022-09-26,PLN2801,1939033455,1939033455,Pulmonology,In-Network,N39.0,I48.91,,,,,,,0,,33533,Surgery,,,0450,22,Outpatient Hospital,1,20537.19,7018.29,6943.29,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000002989,MBR00000114,Institutional-IP,2021-03-18,2021-03-20,2021-04-14,PLN1212,1337791138,1337791138,Internal Medicine,Out-of-Network,E11.9,I25.10,,,,872,MS-DRG,19,2,Y,99221,E&M,,,0740,21,Inpatient Hospital,3,446.0,250.89,175.89,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002990,MBR00000114,Institutional-OP,2021-05-03,2021-05-03,2021-06-11,PLN3698,1242201429,1242201429,General Acute Care Hospital,In-Network,K21.0,M54.5,,,,,,,0,,G0439,Medicine,,,0636,22,Outpatient Hospital,3,455.84,264.78,264.78,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000002991,MBR00000114,Institutional-IP,2023-11-26,2023-12-07,2023-12-03,PLN6138,1806688928,1806688928,Geriatrics,In-Network,M54.5,Z23,,,,682,MS-DRG,20,11,Y,27130,Surgery,,,0510,21,Inpatient Hospital,3,3976.21,1587.05,1587.05,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000002992,MBR00000114,Professional,2023-10-25,2023-10-25,2023-12-07,PLN8156,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,M54.5,K21.0,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,2,75.12,60.61,50.48,0.0,0.0,10.13,10.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002993,MBR00000114,Institutional-IP,2023-10-26,2023-11-05,2023-11-26,PLN8737,1245650222,1245650222,Gastroenterology,In-Network,Z87.891,J06.9,,,,291,MS-DRG,22,10,Y,G0444,Medicine,,,0740,21,Inpatient Hospital,3,104.55,41.96,41.96,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000002994,MBR00000114,Professional,2021-10-14,2021-10-14,2021-10-22,PLN7191,1334916761,1334916761,ASC,In-Network,M17.11,I10,,,,,,,0,,99214,E&M,,,,11,Office,1,245.65,171.13,0.0,171.13,15.0,0.0,186.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002995,MBR00000114,Professional,2022-12-15,2022-12-15,2022-12-31,PLN4898,1453936007,1453936007,ASC,In-Network,E78.5,S72.001A,,,,,,,0,,G0439,Medicine,,,,11,Office,3,500.63,342.06,292.06,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000002996,MBR00000114,Institutional-OP,2021-09-08,2021-09-08,2021-10-14,PLN2708,1645194539,1645194539,SNF,In-Network,R10.9,M81.0,,,,,,,0,,83036,Pathology/Lab,,,0740,22,Outpatient Hospital,2,42.19,27.22,0.0,27.22,75.0,0.0,102.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000002997,MBR00000115,Institutional-IP,2023-01-17,2023-01-24,2023-02-16,PLN7426,1585582070,1585582070,Outpatient Clinic,In-Network,J06.9,Z23,,,,872,MS-DRG,19,7,Y,82043,Pathology/Lab,,,0761,21,Inpatient Hospital,1,74.9,26.6,0.0,26.6,50.0,0.0,76.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002998,MBR00000115,Professional,2022-06-15,2022-06-15,2022-06-28,PLN4015,1239316214,1239316214,Internal Medicine,In-Network,E11.65,Z00.00,,,,,,,0,,99232,E&M,,,,21,Inpatient Hospital,1,374.41,223.77,190.4,0.0,0.0,33.37,33.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000002999,MBR00000115,Professional,2023-10-20,2023-10-20,2023-11-10,PLN7855,1872613201,1872613201,Internal Medicine,In-Network,Z79.4,E11.9,,,,,,,0,,99232,E&M,,,,11,Office,3,211.47,142.13,0.0,142.13,35.0,0.0,177.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003000,MBR00000115,Institutional-OP,2022-02-14,2022-02-14,2022-02-22,PLN9836,1556140803,1556140803,Cardiology,In-Network,E11.9,J20.9,,,,,,,0,,33533,Surgery,,,0761,22,Outpatient Hospital,3,10817.58,8973.31,8889.74,33.57,50.0,0.0,83.57,0.0,Paid,,,0,,0,0,1,1,0,1,Duplicate,0,0,0,0,0
CLM0000003001,MBR00000115,Professional,2022-12-07,2022-12-07,2023-01-19,PLN8579,1997536841,1997536841,Family Medicine,Out-of-Network,F41.9,G43.909,,,,,,,0,,99203,E&M,,,,11,Office,2,184.33,117.78,80.59,0.0,25.0,12.19,37.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003002,MBR00000115,Institutional-OP,2022-12-23,2022-12-23,2023-01-31,PLN6777,1337791138,1337791138,Internal Medicine,Out-of-Network,Z00.00,E78.5,,,,,,,0,,80053,Pathology/Lab,,,0450,22,Outpatient Hospital,1,146.77,62.93,27.93,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003003,MBR00000115,Institutional-OP,2023-05-14,2023-05-14,2023-06-25,PLN9509,1860435061,1860435061,DME Supplier,In-Network,J06.9,Z51.11,,,,,,,0,,93225,Medicine,,,0510,22,Outpatient Hospital,1,703.31,553.03,538.03,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003004,MBR00000115,Institutional-IP,2021-02-26,2021-02-27,2021-03-09,PLN6954,1845900543,1845900543,ASC,In-Network,E11.9,E11.9,,,,641,MS-DRG,22,1,Y,97110,Medicine,,,0200,21,Inpatient Hospital,1,196.14,127.4,40.1,86.88,0.0,0.42,87.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003005,MBR00000115,Professional,2022-05-23,2022-05-23,2022-06-22,PLN3714,1689639685,1689639685,SNF,In-Network,I48.91,B97.89,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,2,5279.71,4445.44,4420.44,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003006,MBR00000115,Professional,2022-05-11,2022-05-11,2022-05-30,PLN5372,1475984649,1475984649,SNF,In-Network,E11.9,K21.0,,,,,,,0,,45380,Surgery,,,,11,Office,1,2165.33,1377.37,1126.5,0.0,0.0,250.87,250.87,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000003007,MBR00000116,Professional,2021-09-07,2021-09-07,2021-09-16,PLN7810,1355166277,1355166277,Endocrinology,In-Network,Z00.00,J18.9,,,,,,,0,,99283,E&M,,,,31,Skilled Nursing Facility,1,556.75,461.14,449.52,0.0,0.0,11.62,11.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003008,MBR00000116,Professional,2023-06-01,2023-06-01,2023-06-09,PLN2635,1856686341,1856686341,Geriatrics,In-Network,Z00.00,N39.0,,,,,,,0,,47562,Surgery,,,,12,Home,2,5865.87,2769.04,2345.65,0.0,50.0,373.39,423.39,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003009,MBR00000116,Institutional-OP,2023-07-01,2023-07-01,2023-07-20,PLN7229,1334916761,1334916761,ASC,In-Network,C50.912,J45.20,,,,,,,0,,99221,E&M,,,0200,22,Outpatient Hospital,1,233.06,141.61,5.52,86.09,50.0,0.0,136.09,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003010,MBR00000116,Institutional-OP,2021-03-31,2021-03-31,2021-04-16,PLN3031,1899127912,1899127912,Neurology,In-Network,I10,I10,,,,,,,0,,45378,Surgery,,,0510,22,Outpatient Hospital,1,1815.56,862.57,530.82,331.75,0.0,0.0,331.75,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003011,MBR00000116,Professional,2023-01-20,2023-01-20,2023-02-06,PLN6312,1800011727,1800011727,Clinical Laboratory,Out-of-Network,K21.0,E78.5,,,,,,,0,,99222,E&M,,,,11,Office,1,429.52,153.19,153.19,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003012,MBR00000116,Professional,2023-08-02,2023-08-02,2023-09-11,PLN4808,1366426662,1366426662,Urology,In-Network,E11.9,E11.9,,,,,,,0,,99284,E&M,,,,49,Independent Clinic,1,730.97,577.04,310.85,266.19,0.0,0.0,266.19,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000003013,MBR00000116,Professional,2021-11-14,2021-11-14,2021-11-23,PLN3299,1590915516,1590915516,Physical Therapy,Out-of-Network,E11.9,E11.9,,,,,,,0,,99233,E&M,,,,49,Independent Clinic,2,354.1,279.33,218.24,0.0,50.0,11.09,61.09,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003014,MBR00000116,Professional,2022-11-24,2022-11-24,2022-12-31,PLN2352,1395983630,1395983630,Nephrology,In-Network,F10.20,F10.20,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,2,356.7,118.42,77.88,0.0,25.0,15.54,40.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003015,MBR00000116,Professional,2022-11-14,2022-11-14,2022-12-07,PLN2754,1103747954,1103747954,Urology,In-Network,M17.11,J20.9,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,2,617.12,423.11,361.2,0.0,50.0,11.91,61.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003016,MBR00000116,Institutional-OP,2021-01-21,2021-01-21,2021-01-29,PLN3033,1795618275,1795618275,Pulmonology,In-Network,K21.0,Z12.31,,,,,,,0,,45378,Surgery,,,0740,22,Outpatient Hospital,3,2288.63,1319.32,1272.16,0.0,15.0,32.16,47.16,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003017,MBR00000116,Professional,2023-06-14,2023-06-14,2023-07-26,PLN9508,1450094833,1450094833,Outpatient Clinic,In-Network,R51,R51,,,,,,,0,,78452,Radiology,,,,11,Office,1,7169.42,3075.85,3075.85,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003018,MBR00000116,Professional,2023-04-02,2023-04-02,2023-04-25,PLN1921,1939033455,1939033455,Pulmonology,In-Network,I63.9,I10,,,,,,,0,,90837,Medicine,,,,21,Inpatient Hospital,1,219.9,153.43,153.43,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003019,MBR00000116,Institutional-IP,2021-10-24,2021-10-29,2021-11-20,PLN5231,1939033455,1939033455,Pulmonology,In-Network,K92.1,Z87.891,,,,683,MS-DRG,6,5,N,99233,E&M,,,0761,21,Inpatient Hospital,1,365.64,217.17,167.17,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003020,MBR00000116,Professional,2021-12-10,2021-12-10,2021-12-28,PLN7235,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,I10,M17.11,,,,,,,0,,99213,E&M,,,,11,Office,1,292.53,90.31,90.31,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003021,MBR00000116,Institutional-OP,2023-04-22,2023-04-22,2023-05-11,PLN1797,1219817751,1219817751,OB/GYN,In-Network,I10,E66.9,,,,,,,0,,80061,Pathology/Lab,,,0301,22,Outpatient Hospital,3,111.45,63.28,0.0,63.28,0.0,0.0,63.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003022,MBR00000116,Institutional-OP,2023-05-28,2023-05-28,2023-06-30,PLN8991,1364429278,1364429278,OB/GYN,In-Network,E11.40,J44.1,,,,,,,0,,23472,Surgery,,,0301,22,Outpatient Hospital,2,4881.79,2570.07,0.0,256.02,0.0,166.06,422.08,0.0,Denied,CO-27,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003023,MBR00000116,Professional,2021-03-21,2021-03-21,2021-04-10,PLN9434,1691062876,1691062876,SNF,In-Network,J20.9,M54.5,,,,,,,0,,97110,Medicine,,,,11,Office,1,181.72,125.78,0.0,125.78,25.0,0.0,150.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003024,MBR00000116,Institutional-IP,2022-01-29,2022-02-03,2022-02-05,PLN4000,1691062876,1691062876,SNF,In-Network,N39.0,E11.9,,,,470,MS-DRG,15,5,U,66984,Surgery,,,0120,21,Inpatient Hospital,3,2836.12,1308.59,1308.59,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003025,MBR00000116,Institutional-OP,2022-11-16,2022-11-16,2022-11-24,PLN7385,1795618275,1795618275,Pulmonology,In-Network,F32.9,N39.0,,,,,,,0,,97530,Medicine,,,0900,22,Outpatient Hospital,2,258.92,181.13,181.13,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003026,MBR00000116,Professional,2021-05-20,2021-05-20,2021-06-20,PLN1477,1245650222,1245650222,Gastroenterology,In-Network,I50.9,Z00.00,,,,,,,0,,99204,E&M,,,,11,Office,3,513.53,183.66,143.17,0.0,15.0,25.49,40.49,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003027,MBR00000116,Professional,2023-12-30,2023-12-30,2024-01-19,PLN6500,1716521444,1716521444,Oncology,In-Network,I25.10,F32.9,,,,,,,0,,G0439,Medicine,,,,11,Office,2,290.99,243.09,12.52,230.57,0.0,0.0,230.57,0.0,Pended,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000003028,MBR00000116,Institutional-OP,2021-08-17,2021-08-17,2021-08-24,PLN6401,1915531927,1915531927,Critical Access Hospital,In-Network,I10,I10,,,,,,,0,,33533,Surgery,,,0370,22,Outpatient Hospital,3,18917.92,7794.22,6706.71,230.28,0.0,857.23,1087.51,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000003029,MBR00000116,Professional,2023-08-07,2023-08-07,2023-08-15,PLN9217,1624202402,1624202402,Orthopedic Surgery,In-Network,Z12.31,K21.0,,,,,,,0,,90460,Medicine,,,,22,Outpatient Hospital,3,58.26,41.6,0.0,41.6,0.0,0.0,41.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003030,MBR00000116,Professional,2021-03-12,2021-03-12,2021-04-17,PLN2702,1514306773,1514306773,Endocrinology,In-Network,Z23,E78.5,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,2,551.85,291.14,0.0,60.48,25.0,0.0,85.48,0.0,Denied,CO-18,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000003031,MBR00000116,Professional,2023-08-17,2023-08-17,2023-09-08,PLN1059,1609138981,1609138981,Critical Access Hospital,In-Network,I63.9,N40.0,,,,,,,0,,99233,E&M,,,,11,Office,1,222.56,119.51,119.51,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003032,MBR00000116,Professional,2021-02-13,2021-02-13,2021-03-09,PLN5324,1475984649,1475984649,SNF,In-Network,E78.5,I25.10,,,,,,,0,,77067,Radiology,,,,11,Office,3,678.27,565.82,309.95,255.87,0.0,0.0,255.87,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000003033,MBR00000116,Institutional-OP,2023-01-15,2023-01-15,2023-01-30,PLN7907,1542828721,1542828721,Orthopedic Surgery,In-Network,I63.9,F32.9,,,,,,,0,,99222,E&M,,,0636,22,Outpatient Hospital,1,276.05,168.85,133.85,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003034,MBR00000116,Institutional-OP,2022-01-30,2022-01-30,2022-02-15,PLN9159,1242201429,1242201429,General Acute Care Hospital,In-Network,J20.9,K21.0,,,,,,,0,,93000,Radiology,,,0120,22,Outpatient Hospital,2,114.67,82.86,0.0,0.0,0.0,11.97,11.97,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003035,MBR00000116,Institutional-IP,2022-05-20,2022-05-27,2022-06-09,PLN5068,1590915516,1590915516,Physical Therapy,Out-of-Network,R51,E11.9,,,,470,MS-DRG,7,7,N,99284,E&M,,,0740,21,Inpatient Hospital,1,457.56,337.18,0.0,337.18,0.0,0.0,337.18,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003036,MBR00000116,Professional,2021-04-29,2021-04-29,2021-06-09,PLN4808,1817234602,1817234602,Clinical Laboratory,In-Network,N17.9,R51,,,,,,,0,,23472,Surgery,,,,12,Home,3,3104.27,2264.0,2264.0,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003037,MBR00000116,Institutional-OP,2023-01-12,2023-01-12,2023-02-07,PLN6076,1845057593,1845057593,Orthopedic Surgery,In-Network,M54.5,Z12.31,,,,,,,0,,80053,Pathology/Lab,,,0510,22,Outpatient Hospital,3,70.97,24.94,0.0,24.94,35.0,0.0,59.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003038,MBR00000116,Professional,2022-11-13,2022-11-13,2022-11-26,PLN7076,1689639685,1689639685,SNF,In-Network,N39.0,J06.9,,,,,,,0,,93306,Radiology,,,,22,Outpatient Hospital,2,2445.55,1465.21,992.75,437.46,35.0,0.0,472.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003039,MBR00000116,Professional,2021-12-18,2021-12-18,2022-01-10,PLN6023,1767011137,1767011137,DME Supplier,In-Network,Z87.891,Z12.31,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,3,82.97,64.88,64.88,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000003040,MBR00000116,Professional,2022-06-02,2022-06-02,2022-06-20,PLN9166,1453936007,1453936007,ASC,In-Network,Z00.00,I25.10,,,,,,,0,,47562,Surgery,,,,11,Office,1,6169.0,4095.63,4095.63,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,1,Phantom,0,0,0,0,0
CLM0000003041,MBR00000117,Professional,2022-08-29,2022-08-29,2022-09-08,PLN4511,1168246159,1168246159,Internal Medicine,In-Network,I10,M54.5,,,,,,,0,,85025,Pathology/Lab,,,,22,Outpatient Hospital,3,48.33,21.47,0.0,21.47,15.0,0.0,36.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003042,MBR00000117,Institutional-IP,2023-01-24,2023-02-03,2023-02-01,PLN7468,1410468316,1410468316,SNF,In-Network,I50.9,Z12.31,,,,196,MS-DRG,1,10,Y,45378,Surgery,,,0200,21,Inpatient Hospital,3,1034.27,554.29,479.54,0.0,25.0,49.75,74.75,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003043,MBR00000117,Professional,2022-08-14,2022-08-14,2022-08-28,PLN9535,1997536841,1997536841,Family Medicine,Out-of-Network,R07.9,K21.0,,,,,,,0,,27130,Surgery,,,,11,Office,1,4498.13,2101.51,0.0,89.46,0.0,0.0,89.46,0.0,Denied,CO-4,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003044,MBR00000117,Professional,2021-03-06,2021-03-06,2021-03-14,PLN8465,1571574052,1571574052,Critical Access Hospital,In-Network,Z23,Z12.11,,,,,,,0,,74177,Radiology,,,,11,Office,3,2422.54,1173.25,1064.97,0.0,75.0,33.28,108.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003045,MBR00000117,Professional,2022-08-19,2022-08-19,2022-10-02,PLN9017,1313212303,1313212303,Family Medicine,In-Network,M54.5,I10,,,,,,,0,,23472,Surgery,,,,11,Office,2,3170.0,1724.31,1538.59,185.72,0.0,0.0,185.72,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003046,MBR00000117,Institutional-IP,2022-01-17,2022-02-03,2022-02-02,PLN9926,1366286000,1366286000,SNF,In-Network,I63.9,E11.9,,,,603,MS-DRG,17,17,Y,27447,Surgery,,,0636,21,Inpatient Hospital,1,2198.57,914.32,879.32,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003047,MBR00000117,Professional,2022-03-28,2022-03-28,2022-04-29,PLN4634,1691062876,1691062876,SNF,In-Network,E11.9,E11.9,,,,,,,0,,47562,Surgery,,,,21,Inpatient Hospital,2,5495.94,3553.91,3478.91,0.0,75.0,0.0,75.0,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003048,MBR00000117,Institutional-OP,2022-02-10,2022-02-10,2022-03-26,PLN5320,1186826716,1186826716,Physical Therapy,In-Network,R51,M17.11,,,,,,,0,,78452,Radiology,,,0761,22,Outpatient Hospital,2,2903.37,1431.97,1072.21,344.76,15.0,0.0,359.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003049,MBR00000117,Professional,2022-01-22,2022-01-22,2022-02-16,PLN8962,1935547131,1935547131,Pulmonology,In-Network,I10,M54.5,,,,,,,0,,99222,E&M,,,,11,Office,1,389.54,120.79,45.79,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003050,MBR00000117,Professional,2021-09-16,2021-09-16,2021-10-26,PLN2886,1631954542,1631954542,Oncology,In-Network,E11.9,N40.0,,,,,,,0,,99204,E&M,,,,23,Emergency Room,2,339.41,138.68,138.68,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003051,MBR00000117,Professional,2021-12-28,2021-12-28,2022-01-30,PLN6128,1609138981,1609138981,Critical Access Hospital,In-Network,Z00.00,F41.9,,,,,,,0,,99214,E&M,,,,81,Independent Laboratory,3,163.2,137.53,62.53,0.0,75.0,0.0,75.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003052,MBR00000117,Professional,2023-02-20,2023-02-20,2023-03-07,PLN9965,1809014947,1809014947,Urology,In-Network,Z12.31,Z00.00,,,,,,,0,,G0468,Medicine,,,,11,Office,1,744.92,556.72,0.0,361.11,0.0,0.0,361.11,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003053,MBR00000117,Professional,2021-09-04,2021-09-04,2021-09-22,PLN6415,1716521444,1716521444,Oncology,In-Network,E11.9,I10,,,,,,,0,,81001,Pathology/Lab,,,,22,Outpatient Hospital,3,47.37,27.02,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003054,MBR00000117,Professional,2023-04-12,2023-04-12,2023-05-10,PLN3647,1717912431,1717912431,Oncology,In-Network,K21.0,J06.9,,,,,,,0,,90837,Medicine,,,,11,Office,1,264.92,201.39,0.0,0.0,0.0,10.88,10.88,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003055,MBR00000117,Professional,2022-04-26,2022-04-26,2022-05-15,PLN1951,1556140803,1556140803,Cardiology,In-Network,E11.9,J44.1,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,2,3938.76,1861.59,1747.55,0.0,35.0,79.04,114.04,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003056,MBR00000117,Professional,2022-10-31,2022-10-31,2022-12-05,PLN4338,1550154147,1550154147,Outpatient Clinic,In-Network,R10.9,M17.11,,,,,,,0,,99203,E&M,,,,20,Urgent Care,2,314.05,155.71,0.0,155.71,0.0,0.0,155.71,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003057,MBR00000117,Professional,2021-05-09,2021-05-09,2021-05-20,PLN2586,1118885473,1118885473,ASC,In-Network,J06.9,J44.1,,,,,,,0,,90837,Medicine,,,,20,Urgent Care,3,451.32,264.7,80.08,184.62,0.0,0.0,184.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003058,MBR00000117,Institutional-OP,2021-08-15,2021-08-15,2021-08-26,PLN6443,1809014947,1809014947,Urology,In-Network,F32.9,Z12.31,,,,,,,0,,72148,Radiology,,,0761,22,Outpatient Hospital,1,1809.92,756.55,718.0,13.55,25.0,0.0,38.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003059,MBR00000117,Professional,2023-09-15,2023-09-15,2023-10-08,PLN4218,1410468316,1410468316,SNF,In-Network,K21.0,M54.5,,,,,,,0,,97530,Medicine,,,,31,Skilled Nursing Facility,1,223.55,167.72,167.72,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003060,MBR00000117,Institutional-OP,2023-06-29,2023-06-29,2023-08-01,PLN6046,1749494482,1749494482,Pediatrics,In-Network,I10,J44.1,,,,,,,0,,45380,Surgery,,,0301,22,Outpatient Hospital,1,1760.95,982.84,761.55,176.73,0.0,44.56,221.29,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000003061,MBR00000117,Professional,2021-03-18,2021-03-18,2021-04-03,PLN6624,1590915516,1590915516,Physical Therapy,Out-of-Network,G43.909,J44.1,,,,,,,0,,82043,Pathology/Lab,,,,12,Home,2,27.33,9.67,8.34,0.0,0.0,1.33,1.33,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003062,MBR00000117,Professional,2023-09-17,2023-09-17,2023-09-28,PLN8446,1108115157,1108115157,General Acute Care Hospital,In-Network,I10,I25.10,,,,,,,0,,81001,Pathology/Lab,,,,20,Urgent Care,2,31.62,13.52,13.52,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000003063,MBR00000117,Professional,2023-07-06,2023-07-06,2023-08-19,PLN5032,1948810580,1948810580,DME Supplier,In-Network,E66.9,E78.5,,,,,,,0,,77067,Radiology,,,,23,Emergency Room,3,599.39,366.69,0.0,366.69,35.0,0.0,401.69,0.0,Paid,,,0,,1,1,0,0,0,0,None,1,0,0,0,0
CLM0000003064,MBR00000117,Institutional-OP,2021-05-31,2021-05-31,2021-07-09,PLN4955,1550154147,1550154147,Outpatient Clinic,In-Network,F41.9,Z00.00,,,,,,,0,,99203,E&M,,,0761,22,Outpatient Hospital,2,214.98,135.92,79.98,0.0,50.0,5.94,55.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003065,MBR00000117,Professional,2021-09-22,2021-09-22,2021-10-15,PLN1358,1139906830,1139906830,Endocrinology,Out-of-Network,Z12.31,J20.9,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,2,64.87,46.74,11.74,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003066,MBR00000117,Institutional-OP,2021-07-14,2021-07-14,2021-08-24,PLN1578,1997536841,1997536841,Family Medicine,Out-of-Network,Z87.891,E11.9,,,,,,,0,,66984,Surgery,,,0510,22,Outpatient Hospital,2,3426.5,1785.94,1062.09,466.98,35.0,221.87,723.85,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003067,MBR00000117,Institutional-OP,2023-07-24,2023-07-24,2023-08-27,PLN6008,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,Z12.31,J06.9,,,,,,,0,,80053,Pathology/Lab,,,0510,22,Outpatient Hospital,1,127.56,85.97,85.97,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003068,MBR00000117,Institutional-IP,2023-07-24,2023-07-28,2023-08-24,PLN3621,1997536841,1997536841,Family Medicine,Out-of-Network,I11.9,I25.10,,,,195,MS-DRG,6,4,Y,33533,Surgery,,,0360,21,Inpatient Hospital,3,27169.64,11563.88,11538.88,0.0,25.0,0.0,25.0,0.0,Adjusted,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000003069,MBR00000117,Professional,2023-02-28,2023-02-28,2023-04-12,PLN6171,1235381502,1235381502,Cardiology,In-Network,E78.5,F41.9,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,3,240.89,153.41,99.2,0.0,50.0,4.21,54.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003070,MBR00000118,Professional,2021-10-01,2021-10-01,2021-10-26,PLN1533,1872613201,1872613201,Internal Medicine,In-Network,M54.5,E78.5,,,,,,,0,,45380,Surgery,,,,49,Independent Clinic,3,2543.0,1303.7,1230.46,0.0,50.0,23.24,73.24,0.0,Paid,,,0,,0,0,1,0,0,1,Unbundling,0,1,0,0,0
CLM0000003071,MBR00000118,Professional,2023-10-06,2023-10-06,2023-10-18,PLN6944,1845057593,1845057593,Orthopedic Surgery,In-Network,Z23,E78.5,,,,,,,0,,23472,Surgery,,,,12,Home,3,5850.11,4269.75,4048.92,185.83,35.0,0.0,220.83,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003072,MBR00000118,Institutional-OP,2023-07-17,2023-07-17,2023-08-05,PLN8641,1780163051,1780163051,SNF,In-Network,E78.5,C50.912,,,,,,,0,,93225,Medicine,,,0270,22,Outpatient Hospital,1,569.2,451.56,451.56,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003073,MBR00000118,Institutional-OP,2023-08-11,2023-08-11,2023-09-08,PLN3757,1531398223,1531398223,OB/GYN,In-Network,I48.91,F32.9,,,,,,,0,,82043,Pathology/Lab,,,0900,22,Outpatient Hospital,3,43.57,30.84,26.73,0.0,0.0,4.11,4.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003074,MBR00000118,Professional,2022-01-30,2022-01-30,2022-02-28,PLN2556,1795618275,1795618275,Pulmonology,In-Network,F32.9,N18.3,,,,,,,0,,27130,Surgery,,,,12,Home,3,5351.43,3447.49,2344.9,479.8,0.0,5.52,485.32,617.27,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003075,MBR00000118,Professional,2023-02-07,2023-02-07,2023-02-25,PLN8801,1800011727,1800011727,Clinical Laboratory,Out-of-Network,K21.0,Z12.31,,,,,,,0,,72148,Radiology,,,,11,Office,2,1043.24,386.2,0.0,386.2,35.0,0.0,421.2,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003076,MBR00000118,Professional,2023-01-10,2023-01-10,2023-01-31,PLN1281,1463205530,1463205530,Nephrology,In-Network,Z12.31,N18.3,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,3,2538.64,1669.35,1337.9,316.45,15.0,0.0,331.45,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003077,MBR00000118,Institutional-OP,2021-06-16,2021-06-16,2021-07-22,PLN7572,1800011727,1800011727,Clinical Laboratory,Out-of-Network,S72.001A,Z12.31,,,,,,,0,,71046,Radiology,,,0370,22,Outpatient Hospital,1,256.1,153.07,0.0,153.07,0.0,0.0,153.07,24.3,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003078,MBR00000118,Professional,2022-10-01,2022-10-01,2022-10-08,PLN7643,1564502315,1564502315,ASC,In-Network,N39.0,I48.91,,,,,,,0,,27130,Surgery,,,,11,Office,3,6264.24,1979.64,1801.51,163.13,15.0,0.0,178.13,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003079,MBR00000118,Institutional-IP,2022-08-25,2022-09-08,2022-09-24,PLN4535,1168881145,1168881145,Orthopedic Surgery,In-Network,F32.9,Z00.00,,,,682,MS-DRG,14,14,Y,45378,Surgery,,,0120,21,Inpatient Hospital,3,1014.41,374.02,188.11,110.91,75.0,0.0,185.91,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003080,MBR00000118,Professional,2022-10-03,2022-10-03,2022-10-14,PLN8363,1585582070,1585582070,Outpatient Clinic,In-Network,E11.9,J18.9,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,1,40.95,20.03,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003081,MBR00000118,Institutional-OP,2022-01-08,2022-01-08,2022-01-24,PLN1066,1891849440,1891849440,Oncology,In-Network,Z12.31,N39.0,,,,,,,0,,97110,Medicine,,,0900,22,Outpatient Hospital,1,245.06,138.5,111.3,0.0,15.0,12.2,27.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003082,MBR00000118,Professional,2023-01-03,2023-01-03,2023-02-12,PLN8400,1453936007,1453936007,ASC,In-Network,J06.9,Z87.891,,,,,,,0,,99203,E&M,,,,11,Office,1,244.76,197.47,162.47,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003083,MBR00000118,Professional,2023-08-28,2023-08-28,2023-10-10,PLN6414,1219817751,1219817751,OB/GYN,In-Network,E66.9,E11.9,,,,,,,0,,99222,E&M,,,,21,Inpatient Hospital,3,281.62,114.93,114.93,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003084,MBR00000118,Institutional-OP,2022-10-25,2022-10-25,2022-12-01,PLN6840,1355166277,1355166277,Endocrinology,In-Network,N39.0,F32.9,,,,,,,0,,58661,Surgery,,,0636,22,Outpatient Hospital,2,3760.21,1230.17,0.0,0.0,0.0,0.0,0.0,0.0,Denied,PR-1,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003085,MBR00000118,Institutional-OP,2023-08-14,2023-08-14,2023-09-27,PLN2678,1891849440,1891849440,Oncology,In-Network,E11.9,E66.9,,,,,,,0,,80053,Pathology/Lab,,,0740,22,Outpatient Hospital,1,150.82,106.25,0.0,106.25,15.0,0.0,121.25,20.4,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003086,MBR00000118,Professional,2023-04-25,2023-04-25,2023-05-13,PLN6510,1778483301,1778483301,Home Health,In-Network,I25.10,E11.9,,,,,,,0,,97110,Medicine,,,,21,Inpatient Hospital,3,278.04,194.6,0.0,194.6,0.0,0.0,194.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003087,MBR00000118,Institutional-OP,2021-12-10,2021-12-10,2022-01-13,PLN9000,1575695214,1575695214,SNF,In-Network,J06.9,Z00.00,,,,,,,0,,99221,E&M,,,0636,22,Outpatient Hospital,2,415.86,303.24,303.24,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003088,MBR00000118,Professional,2023-03-17,2023-03-17,2023-04-06,PLN5956,1968299309,1968299309,Internal Medicine,In-Network,E11.9,N40.0,,,,,,,0,,45378,Surgery,,,,11,Office,2,2560.88,1848.71,1663.82,26.21,0.0,158.68,184.89,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003089,MBR00000118,Professional,2023-01-06,2023-01-06,2023-02-04,PLN2617,1749327647,1749327647,Geriatrics,In-Network,I50.9,Z87.891,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,3,229.64,145.27,110.27,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003090,MBR00000118,Professional,2023-10-31,2023-10-31,2023-12-07,PLN4080,1410468316,1410468316,SNF,In-Network,I10,I10,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,3,1170.2,674.23,322.15,352.08,0.0,0.0,352.08,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003091,MBR00000118,Professional,2022-01-06,2022-01-06,2022-01-20,PLN6557,1757138478,1757138478,Pediatrics,In-Network,I25.10,J06.9,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,2,424.08,156.32,0.0,0.0,0.0,0.0,0.0,29.73,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003092,MBR00000118,Institutional-OP,2021-06-29,2021-06-29,2021-07-20,PLN1315,1749327647,1749327647,Geriatrics,In-Network,I50.9,E78.5,,,,,,,0,,80053,Pathology/Lab,,,0200,22,Outpatient Hospital,3,135.12,104.15,104.15,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003093,MBR00000118,Professional,2023-01-13,2023-01-13,2023-02-19,PLN9896,1980712759,1980712759,Outpatient Clinic,Out-of-Network,Z12.31,Z00.00,,,,,,,0,,99203,E&M,,,,11,Office,3,327.59,230.26,190.55,0.0,0.0,5.55,5.55,34.16,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003094,MBR00000118,Professional,2022-11-24,2022-11-24,2022-12-25,PLN7991,1103747954,1103747954,Urology,In-Network,G43.909,M54.5,,,,,,,0,,90686,Medicine,,,,11,Office,3,133.86,100.29,0.0,100.29,0.0,0.0,100.29,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000003095,MBR00000118,Institutional-OP,2022-11-04,2022-11-04,2022-12-16,PLN6710,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,Z00.00,Z12.31,,,,,,,0,,99213,E&M,,,0301,22,Outpatient Hospital,3,115.61,98.24,91.81,0.0,0.0,6.43,6.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003096,MBR00000118,Professional,2023-03-22,2023-03-22,2023-04-29,PLN4718,1295371663,1295371663,Critical Access Hospital,In-Network,F10.20,J45.20,,,,,,,0,,76700,Radiology,,,,11,Office,2,1002.98,837.49,787.49,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003097,MBR00000119,Professional,2022-07-14,2022-07-14,2022-08-02,PLN5950,1124394415,1124394415,Pediatrics,In-Network,Z23,E11.40,,,,,,,0,,93225,Medicine,,,,11,Office,3,859.2,378.71,378.71,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003098,MBR00000119,Professional,2021-02-03,2021-02-03,2021-03-01,PLN5064,1915531927,1915531927,Critical Access Hospital,In-Network,I10,J20.9,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,2,257.86,198.7,0.0,78.84,0.0,0.0,78.84,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003099,MBR00000119,Institutional-OP,2023-08-20,2023-08-20,2023-09-12,PLN6561,1847081578,1847081578,Urology,Out-of-Network,I10,F41.9,,,,,,,0,,45380,Surgery,,,0900,22,Outpatient Hospital,2,1433.0,989.66,0.0,316.42,35.0,0.0,351.42,0.0,Denied,CO-15,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000003100,MBR00000119,Professional,2021-10-31,2021-10-31,2021-11-25,PLN1172,1422747896,1422747896,Urology,In-Network,E78.5,Z12.11,,,,,,,0,,43239,Surgery,,,,11,Office,3,988.73,785.37,661.27,0.0,0.0,124.1,124.1,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003101,MBR00000119,Institutional-OP,2021-09-27,2021-09-27,2021-10-25,PLN5170,1545347862,1545347862,SNF,In-Network,Z23,K21.0,,,,,,,0,,47562,Surgery,,,0636,22,Outpatient Hospital,1,4871.84,4054.99,3161.03,170.67,0.0,723.29,893.96,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003102,MBR00000119,Institutional-OP,2023-06-11,2023-06-11,2023-07-07,PLN8819,1948810580,1948810580,DME Supplier,In-Network,F41.9,I10,,,,,,,0,,45380,Surgery,,,0450,22,Outpatient Hospital,2,2120.04,1066.16,1066.16,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000003103,MBR00000119,Institutional-OP,2023-05-24,2023-05-24,2023-06-14,PLN9134,1717912431,1717912431,Oncology,In-Network,K92.1,E11.9,,,,,,,0,,27130,Surgery,,,0120,22,Outpatient Hospital,2,4351.1,2454.74,2074.67,380.07,0.0,0.0,380.07,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003104,MBR00000119,Institutional-OP,2022-07-08,2022-07-08,2022-07-21,PLN3917,1103747954,1103747954,Urology,In-Network,I10,K21.0,,,,,,,0,,93306,Radiology,,,0761,22,Outpatient Hospital,2,3124.91,1186.27,1171.27,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003105,MBR00000119,Institutional-IP,2023-01-26,2023-01-29,2023-02-25,PLN1501,1205377316,1205377316,Orthopedic Surgery,In-Network,E11.9,B97.89,,,,683,MS-DRG,14,3,Y,47562,Surgery,,,0301,21,Inpatient Hospital,1,5483.54,1666.94,1631.94,0.0,35.0,0.0,35.0,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003106,MBR00000119,Institutional-OP,2021-03-30,2021-03-30,2021-04-27,PLN5964,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,I10,J06.9,,,,,,,0,,93000,Radiology,,,0370,22,Outpatient Hospital,1,134.0,101.66,98.86,0.0,0.0,2.8,2.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003107,MBR00000119,Institutional-IP,2021-11-04,2021-11-12,2021-11-27,PLN8099,1540044947,1540044947,Pulmonology,Out-of-Network,J44.1,I10,,,,603,MS-DRG,19,8,Y,99221,E&M,,,0120,21,Inpatient Hospital,2,388.99,307.2,272.2,0.0,35.0,0.0,35.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003108,MBR00000119,Professional,2021-09-23,2021-09-23,2021-09-30,PLN3652,1453283987,1453283987,Critical Access Hospital,In-Network,N18.3,N40.0,,,,,,,0,,99233,E&M,,,,12,Home,3,344.8,127.13,0.0,127.13,35.0,0.0,162.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003109,MBR00000119,Professional,2022-04-07,2022-04-07,2022-04-30,PLN9769,1268679390,1268679390,Critical Access Hospital,In-Network,K92.1,E11.9,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,1,264.74,100.39,0.0,100.39,50.0,0.0,150.39,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003110,MBR00000119,Institutional-OP,2022-01-27,2022-01-27,2022-03-06,PLN1601,1227362142,1227362142,DME Supplier,In-Network,I50.9,Z12.31,,,,,,,0,,90686,Medicine,,,0636,22,Outpatient Hospital,1,134.72,51.11,0.0,51.11,35.0,0.0,86.11,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000003111,MBR00000119,Professional,2021-03-17,2021-03-17,2021-04-19,PLN7339,1696843572,1696843572,Critical Access Hospital,Out-of-Network,G43.909,G43.909,,,,,,,0,,33533,Surgery,,,,11,Office,2,26539.19,12708.66,12708.66,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000003112,MBR00000119,Institutional-OP,2023-01-25,2023-01-25,2023-02-07,PLN4216,1520687146,1520687146,ASC,In-Network,I10,N39.0,,,,,,,0,,99204,E&M,,,0200,22,Outpatient Hospital,3,459.29,371.84,371.84,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003113,MBR00000119,Institutional-OP,2022-10-17,2022-10-17,2022-11-29,PLN6646,1542828721,1542828721,Orthopedic Surgery,In-Network,E66.9,E78.5,,,,,,,0,,77067,Radiology,,,0370,22,Outpatient Hospital,2,548.39,294.07,244.07,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,0,0,0,1,Phantom,1,0,0,0,0
CLM0000003114,MBR00000119,Professional,2022-02-20,2022-02-20,2022-03-18,PLN8874,1284035364,1284035364,Pediatrics,In-Network,Z00.00,Z00.00,,,,,,,0,,23472,Surgery,,,,21,Inpatient Hospital,2,6506.31,4200.25,4175.25,0.0,25.0,0.0,25.0,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003115,MBR00000119,Professional,2023-08-31,2023-08-31,2023-10-10,PLN7979,1530904931,1530904931,Internal Medicine,In-Network,Z87.891,Z00.00,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,3,6405.95,2941.77,2813.05,63.46,35.0,30.26,128.72,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003116,MBR00000119,Professional,2022-01-31,2022-01-31,2022-02-12,PLN4619,1556140803,1556140803,Cardiology,In-Network,E66.9,E78.5,,,,,,,0,,45380,Surgery,,,,21,Inpatient Hospital,2,1866.17,620.51,503.06,0.0,0.0,117.45,117.45,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000003117,MBR00000119,Professional,2021-05-10,2021-05-10,2021-06-14,PLN5540,1434029575,1434029575,Endocrinology,In-Network,E11.9,I25.10,,,,,,,0,,99284,E&M,,,,23,Emergency Room,2,525.54,286.62,67.57,219.05,0.0,0.0,219.05,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003118,MBR00000120,Institutional-IP,2023-07-18,2023-08-02,2023-07-27,PLN9440,1295371663,1295371663,Critical Access Hospital,In-Network,Z23,E87.6,,,,194,MS-DRG,5,15,Y,90686,Medicine,,,0200,21,Inpatient Hospital,2,129.71,71.81,71.81,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000003119,MBR00000120,Professional,2021-05-25,2021-05-25,2021-06-30,PLN6518,1939033455,1939033455,Pulmonology,In-Network,E11.9,I25.10,,,,,,,0,,99232,E&M,,,,11,Office,2,362.27,194.1,0.0,194.1,15.0,0.0,209.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003120,MBR00000120,Professional,2021-03-20,2021-03-20,2021-04-28,PLN7453,1757138478,1757138478,Pediatrics,In-Network,E66.9,F41.9,,,,,,,0,,45380,Surgery,,,,20,Urgent Care,1,1377.24,588.08,563.08,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000003121,MBR00000120,Professional,2022-06-04,2022-06-04,2022-06-18,PLN1918,1780163051,1780163051,SNF,In-Network,E78.5,I10,,,,,,,0,,78452,Radiology,,,,23,Emergency Room,2,6432.04,3288.83,2912.54,181.08,0.0,195.21,376.29,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003122,MBR00000120,Professional,2022-09-27,2022-09-27,2022-10-29,PLN3559,1780163051,1780163051,SNF,In-Network,M54.5,I10,,,,,,,0,,58661,Surgery,,,,11,Office,1,3227.11,1023.78,558.98,389.8,75.0,0.0,464.8,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003123,MBR00000120,Professional,2021-11-04,2021-11-04,2021-12-08,PLN3466,1224179551,1224179551,Physical Therapy,In-Network,F32.9,N18.3,,,,,,,0,,45380,Surgery,,,,11,Office,3,1968.59,1472.78,1422.78,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000003124,MBR00000120,Professional,2023-07-08,2023-07-08,2023-08-13,PLN6369,1486164553,1486164553,DME Supplier,In-Network,I50.9,J06.9,,,,,,,0,,76700,Radiology,,,,23,Emergency Room,1,825.47,491.77,396.6,0.0,15.0,80.17,95.17,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003125,MBR00000120,Institutional-OP,2021-10-31,2021-10-31,2021-11-14,PLN4331,1239316214,1239316214,Internal Medicine,In-Network,K21.0,I10,,,,,,,0,,80053,Pathology/Lab,,,0740,22,Outpatient Hospital,3,92.32,70.75,0.0,0.0,50.0,1.31,51.31,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003126,MBR00000120,Professional,2023-11-22,2023-11-22,2024-01-02,PLN3550,1247341320,1247341320,Urology,Out-of-Network,Z87.891,E78.5,,,,,,,0,,99283,E&M,,,,20,Urgent Care,3,560.67,427.3,392.3,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003127,MBR00000120,Professional,2022-12-01,2022-12-01,2023-01-10,PLN8928,1168881145,1168881145,Orthopedic Surgery,In-Network,B97.89,I50.9,,,,,,,0,,99222,E&M,,,,23,Emergency Room,1,510.07,345.82,310.82,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003128,MBR00000120,Professional,2021-07-22,2021-07-22,2021-08-15,PLN9315,1135158374,1135158374,Pulmonology,In-Network,E11.9,Z12.31,,,,,,,0,,33533,Surgery,,,,11,Office,3,17840.2,9534.85,9499.85,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000003129,MBR00000120,Institutional-IP,2022-03-26,2022-03-28,2022-04-30,PLN6409,1812060197,1812060197,Oncology,Out-of-Network,E11.9,I10,,,,682,MS-DRG,19,2,Y,27130,Surgery,,,0360,21,Inpatient Hospital,2,5765.48,2361.37,1894.49,451.88,15.0,0.0,466.88,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003130,MBR00000120,Institutional-OP,2021-03-25,2021-03-25,2021-04-24,PLN3674,1235381502,1235381502,Cardiology,In-Network,K21.0,I25.10,,,,,,,0,,81001,Pathology/Lab,,,0761,22,Outpatient Hospital,3,41.17,22.46,0.0,22.46,0.0,0.0,22.46,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003131,MBR00000120,Professional,2023-07-14,2023-07-14,2023-07-23,PLN5711,1410468316,1410468316,SNF,In-Network,I10,N39.0,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,3,389.95,239.87,189.87,0.0,50.0,0.0,50.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003132,MBR00000120,Institutional-IP,2022-12-11,2022-12-18,2022-12-23,PLN3857,1531398223,1531398223,OB/GYN,In-Network,K21.0,I10,,,,603,MS-DRG,19,7,Y,71046,Radiology,,,0301,21,Inpatient Hospital,3,321.03,174.23,0.0,174.23,15.0,0.0,189.23,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003133,MBR00000120,Institutional-OP,2022-04-15,2022-04-15,2022-05-10,PLN2454,1644128543,1644128543,Gastroenterology,In-Network,Z00.01,I25.10,,,,,,,0,,45378,Surgery,,,0370,22,Outpatient Hospital,1,1779.15,1289.82,1289.82,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003134,MBR00000120,Institutional-OP,2023-01-14,2023-01-14,2023-02-22,PLN5836,1757138478,1757138478,Pediatrics,In-Network,E78.5,J44.1,,,,,,,0,,58661,Surgery,,,0740,22,Outpatient Hospital,2,3998.92,3175.92,2908.59,0.0,0.0,267.33,267.33,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003135,MBR00000120,Institutional-IP,2022-11-05,2022-11-08,2022-12-15,PLN5122,1991459367,1991459367,Neurology,Out-of-Network,E11.9,Z12.31,,,,872,MS-DRG,20,3,Y,76700,Radiology,,,0761,21,Inpatient Hospital,2,1125.12,880.96,565.02,315.94,0.0,0.0,315.94,0.0,Paid,,,1,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000003136,MBR00000120,Institutional-IP,2022-10-19,2022-10-26,2022-10-29,PLN7370,1109850785,1109850785,ASC,Out-of-Network,J45.20,E11.65,,,,194,MS-DRG,5,7,Y,99203,E&M,,,0320,21,Inpatient Hospital,2,312.75,172.41,0.0,172.41,0.0,0.0,172.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003137,MBR00000120,Professional,2022-03-12,2022-03-12,2022-04-22,PLN3182,1767011137,1767011137,DME Supplier,In-Network,M54.5,I10,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,3,692.25,542.58,442.5,85.08,15.0,0.0,100.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003138,MBR00000120,Professional,2022-01-20,2022-01-20,2022-03-01,PLN9840,1242201429,1242201429,General Acute Care Hospital,In-Network,I10,N40.0,,,,,,,0,,86900,Pathology/Lab,,,,22,Outpatient Hospital,1,33.69,19.1,0.0,19.1,75.0,0.0,94.1,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003139,MBR00000120,Institutional-OP,2021-10-08,2021-10-08,2021-11-20,PLN1279,1500949740,1500949740,Pediatrics,In-Network,E78.5,E11.9,,,,,,,0,,81001,Pathology/Lab,,,0636,22,Outpatient Hospital,3,60.51,29.72,0.0,29.72,0.0,0.0,29.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003140,MBR00000120,Professional,2023-05-12,2023-05-12,2023-05-23,PLN7143,1571574052,1571574052,Critical Access Hospital,In-Network,Z12.31,E11.9,,,,,,,0,,99284,E&M,,,,49,Independent Clinic,2,477.02,364.51,89.27,266.45,0.0,8.79,275.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003141,MBR00000120,Professional,2022-06-01,2022-06-01,2022-07-15,PLN2316,1273488618,1273488618,General Acute Care Hospital,In-Network,Z12.31,M17.11,,,,,,,0,,93000,Radiology,,,,11,Office,1,152.42,103.58,53.58,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003142,MBR00000120,Institutional-IP,2022-05-29,2022-05-31,2022-07-11,PLN6705,1235381502,1235381502,Cardiology,In-Network,Z00.00,K21.0,,,,470,MS-DRG,2,2,Y,23472,Surgery,,,0200,21,Inpatient Hospital,2,5451.54,2925.54,2751.54,0.0,0.0,174.0,174.0,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003143,MBR00000120,Institutional-OP,2023-02-28,2023-02-28,2023-04-04,PLN9814,1717546253,1717546253,Family Medicine,In-Network,E78.5,E11.9,,,,,,,0,,93306,Radiology,,,0200,22,Outpatient Hospital,1,2155.43,1024.09,745.96,278.13,0.0,0.0,278.13,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003144,MBR00000120,Professional,2022-08-05,2022-08-05,2022-09-04,PLN4650,1845900543,1845900543,ASC,In-Network,E78.5,Z12.11,,,,,,,0,,G0468,Medicine,,,,21,Inpatient Hospital,1,367.79,134.84,54.52,0.0,75.0,5.32,80.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003145,MBR00000120,Institutional-OP,2023-11-10,2023-11-10,2023-12-23,PLN6764,1845057593,1845057593,Orthopedic Surgery,In-Network,I50.9,M54.5,,,,,,,0,,70553,Radiology,,,0510,22,Outpatient Hospital,3,3840.23,1702.12,1551.49,0.0,0.0,150.63,150.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003146,MBR00000121,Professional,2021-09-21,2021-09-21,2021-10-01,PLN2403,1118885473,1118885473,ASC,In-Network,N39.0,E78.5,,,,,,,0,,G0468,Medicine,,,,11,Office,2,292.5,98.57,98.57,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003147,MBR00000121,Institutional-OP,2021-02-16,2021-02-16,2021-02-28,PLN3249,1531398223,1531398223,OB/GYN,In-Network,G20,E11.9,,,,,,,0,,47562,Surgery,,,0370,22,Outpatient Hospital,2,6047.48,3141.72,3116.72,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000003148,MBR00000121,Institutional-OP,2022-04-07,2022-04-07,2022-04-20,PLN3309,1213165847,1213165847,Critical Access Hospital,In-Network,I63.9,Z12.31,,,,,,,0,,99214,E&M,,,0730,22,Outpatient Hospital,1,405.2,204.82,197.04,0.0,0.0,7.78,7.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003149,MBR00000121,Institutional-OP,2022-08-06,2022-08-06,2022-09-13,PLN1714,1168881145,1168881145,Orthopedic Surgery,In-Network,I10,E66.9,,,,,,,0,,99222,E&M,,,0900,22,Outpatient Hospital,1,556.88,303.38,37.69,265.69,0.0,0.0,265.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003150,MBR00000121,Institutional-OP,2023-06-19,2023-06-19,2023-07-24,PLN3435,1273488618,1273488618,General Acute Care Hospital,In-Network,Z00.00,J06.9,,,,,,,0,,93306,Radiology,,,0636,22,Outpatient Hospital,1,1219.83,768.88,617.77,0.0,15.0,136.11,151.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003151,MBR00000121,Institutional-OP,2022-11-28,2022-11-28,2022-12-28,PLN7993,1475984649,1475984649,SNF,In-Network,Z87.891,F41.9,,,,,,,0,,27447,Surgery,,,0636,22,Outpatient Hospital,1,6209.76,4180.36,3041.43,467.88,0.0,671.05,1138.93,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003152,MBR00000121,Institutional-OP,2023-10-26,2023-10-26,2023-11-16,PLN5065,1910255109,1910255109,DME Supplier,In-Network,Z00.00,Z79.4,,,,,,,0,,47562,Surgery,,,0761,22,Outpatient Hospital,3,2727.32,1510.11,1001.54,483.57,25.0,0.0,508.57,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003153,MBR00000121,Professional,2021-04-04,2021-04-04,2021-04-14,PLN9200,1103747954,1103747954,Urology,In-Network,M54.5,I10,,,,,,,0,,85610,Pathology/Lab,,,,22,Outpatient Hospital,2,44.15,33.11,33.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003154,MBR00000121,Professional,2022-08-12,2022-08-12,2022-08-23,PLN2813,1193493783,1193493783,Critical Access Hospital,Out-of-Network,Z00.00,N18.3,,,,,,,0,,70450,Radiology,,,,21,Inpatient Hospital,1,1197.72,528.24,506.9,0.0,0.0,21.34,21.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003155,MBR00000121,Professional,2023-06-27,2023-06-27,2023-07-16,PLN1229,1691062876,1691062876,SNF,In-Network,E78.5,M54.5,,,,,,,0,,86900,Pathology/Lab,,,,81,Independent Laboratory,1,59.41,18.5,18.5,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003156,MBR00000121,Professional,2022-07-04,2022-07-04,2022-07-24,PLN3036,1745114564,1745114564,Endocrinology,In-Network,E78.5,E66.9,,,,,,,0,,99214,E&M,,,,11,Office,1,392.1,171.75,156.75,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003157,MBR00000121,Institutional-IP,2021-10-30,2021-11-01,2021-11-11,PLN6443,1702692193,1702692193,Physical Therapy,In-Network,K92.1,M54.5,,,,682,MS-DRG,7,2,Y,97110,Medicine,,,0761,21,Inpatient Hospital,2,159.31,52.84,52.84,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003158,MBR00000121,Professional,2023-04-22,2023-04-22,2023-05-05,PLN4776,1364429278,1364429278,OB/GYN,In-Network,K21.0,Z00.01,,,,,,,0,,27130,Surgery,,,,50,Federally Qualified Health Center,3,5961.75,4183.88,3536.26,450.44,15.0,182.18,647.62,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003159,MBR00000121,Institutional-OP,2023-08-17,2023-08-17,2023-09-13,PLN1889,1247341320,1247341320,Urology,Out-of-Network,E78.5,M54.5,,,,,,,0,,80053,Pathology/Lab,,,0761,22,Outpatient Hospital,3,74.38,40.2,15.2,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003160,MBR00000121,Professional,2021-10-11,2021-10-11,2021-11-20,PLN4473,1749327647,1749327647,Geriatrics,In-Network,F32.9,Z00.00,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,3,5137.69,2933.31,2659.59,238.72,35.0,0.0,273.72,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003161,MBR00000121,Professional,2022-08-29,2022-08-29,2022-09-25,PLN7611,1463205530,1463205530,Nephrology,In-Network,N39.0,N39.0,,,,,,,0,,99283,E&M,,,,49,Independent Clinic,1,285.53,88.93,88.93,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003162,MBR00000121,Professional,2023-06-01,2023-06-01,2023-07-02,PLN7875,1114982472,1114982472,Orthopedic Surgery,In-Network,E11.9,I10,,,,,,,0,,45380,Surgery,,,,11,Office,1,1327.56,567.55,379.36,173.19,15.0,0.0,188.19,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000003163,MBR00000121,Professional,2021-06-16,2021-06-16,2021-07-06,PLN1699,1268679390,1268679390,Critical Access Hospital,In-Network,I48.91,I10,,,,,,,0,,99213,E&M,,,,11,Office,1,317.06,144.69,128.15,0.0,0.0,16.54,16.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003164,MBR00000121,Professional,2021-01-13,2021-01-13,2021-01-20,PLN6495,1545347862,1545347862,SNF,In-Network,F41.9,F41.9,,,,,,,0,,99232,E&M,,,,11,Office,1,315.39,184.59,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003165,MBR00000121,Institutional-IP,2023-03-21,2023-03-24,2023-03-30,PLN7476,1845057593,1845057593,Orthopedic Surgery,In-Network,J44.1,Z23,,,,195,MS-DRG,16,3,Y,99204,E&M,,,0360,21,Inpatient Hospital,3,244.27,128.65,0.0,128.65,0.0,0.0,128.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003166,MBR00000121,Professional,2023-04-04,2023-04-04,2023-04-11,PLN5508,1716521444,1716521444,Oncology,In-Network,Z00.00,N39.0,,,,,,,0,,45378,Surgery,,,,11,Office,1,1576.43,859.6,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-50,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003167,MBR00000121,Institutional-OP,2021-06-22,2021-06-22,2021-07-31,PLN3662,1790497490,1790497490,OB/GYN,In-Network,I10,K21.0,,,,,,,0,,99233,E&M,,,0301,22,Outpatient Hospital,2,526.94,219.36,0.0,219.36,50.0,0.0,269.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003168,MBR00000121,Professional,2022-10-16,2022-10-16,2022-11-06,PLN6831,1486164553,1486164553,DME Supplier,In-Network,I25.10,R05,,,,,,,0,,90837,Medicine,,,,11,Office,3,269.38,130.0,130.0,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003169,MBR00000121,Institutional-OP,2023-02-28,2023-02-28,2023-04-07,PLN2161,1717912431,1717912431,Oncology,In-Network,J18.9,Z23,,,,,,,0,,99222,E&M,,,0636,22,Outpatient Hospital,3,591.43,285.91,210.91,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003170,MBR00000121,Institutional-OP,2023-11-21,2023-11-21,2023-12-18,PLN6357,1103747954,1103747954,Urology,In-Network,J06.9,F32.9,,,,,,,0,,99406,Medicine,,,0120,22,Outpatient Hospital,2,40.27,21.77,6.77,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000003171,MBR00000121,Professional,2023-06-04,2023-06-04,2023-07-14,PLN3439,1915531927,1915531927,Critical Access Hospital,In-Network,B97.89,N40.0,,,,,,,0,,47562,Surgery,,,,11,Office,1,3473.82,2748.71,2748.71,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003172,MBR00000121,Professional,2021-08-29,2021-08-29,2021-10-07,PLN9831,1872613201,1872613201,Internal Medicine,In-Network,K92.1,I25.10,,,,,,,0,,80061,Pathology/Lab,,,,49,Independent Clinic,3,97.67,76.36,0.0,76.36,0.0,0.0,76.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003173,MBR00000121,Institutional-OP,2022-09-23,2022-09-23,2022-10-24,PLN9093,1364429278,1364429278,OB/GYN,In-Network,F32.9,M54.5,,,,,,,0,,97530,Medicine,,,0761,22,Outpatient Hospital,1,194.59,162.37,108.58,0.0,50.0,3.79,53.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003174,MBR00000121,Institutional-OP,2023-03-14,2023-03-14,2023-04-22,PLN1959,1364429278,1364429278,OB/GYN,In-Network,J44.1,Z12.31,,,,,,,0,,74177,Radiology,,,0320,22,Outpatient Hospital,2,2425.41,1924.75,1421.67,306.14,0.0,196.94,503.08,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003175,MBR00000121,Professional,2021-10-24,2021-10-24,2021-11-20,PLN5875,1284035364,1284035364,Pediatrics,In-Network,I25.10,I10,,,,,,,0,,33533,Surgery,,,,23,Emergency Room,2,26129.51,16086.03,16036.03,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,1,0,0,1,0,0,None,0,0,0,0,0
CLM0000003176,MBR00000121,Institutional-IP,2021-06-28,2021-07-04,2021-07-29,PLN3758,1502838586,1502838586,ASC,In-Network,Z23,Z00.00,,,,470,MS-DRG,15,6,Y,77067,Radiology,,,0450,21,Inpatient Hospital,3,337.34,181.86,181.86,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000003177,MBR00000121,Professional,2022-04-24,2022-04-24,2022-05-06,PLN3984,1872272835,1872272835,Internal Medicine,In-Network,Z12.31,N18.3,,,,,,,0,,G0444,Medicine,,,,11,Office,2,59.34,24.71,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000003178,MBR00000121,Professional,2023-02-27,2023-02-27,2023-03-26,PLN2264,1475984649,1475984649,SNF,In-Network,M81.0,F32.9,,,,,,,0,,99222,E&M,,,,21,Inpatient Hospital,3,618.83,433.94,408.94,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003179,MBR00000121,Professional,2022-08-02,2022-08-02,2022-08-24,PLN3346,1644128543,1644128543,Gastroenterology,In-Network,F41.9,Z23,,,,,,,0,,71046,Radiology,,,,11,Office,3,253.54,172.79,172.79,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003180,MBR00000121,Institutional-OP,2022-10-24,2022-10-24,2022-11-01,PLN1504,1700633438,1700633438,DME Supplier,In-Network,E66.9,Z00.01,,,,,,,0,,45378,Surgery,,,0200,22,Outpatient Hospital,2,1471.42,769.31,324.36,429.95,15.0,0.0,444.95,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003181,MBR00000121,Professional,2022-12-31,2022-12-31,2023-01-30,PLN2710,1990090423,1990090423,Orthopedic Surgery,In-Network,M54.5,F32.9,,,,,,,0,,81001,Pathology/Lab,,,,50,Federally Qualified Health Center,2,45.95,38.88,38.88,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003182,MBR00000121,Professional,2023-11-13,2023-11-13,2023-11-23,PLN7518,1450553056,1450553056,Clinical Laboratory,In-Network,Z00.00,N20.0,,,,,,,0,,99204,E&M,,,,31,Skilled Nursing Facility,3,280.54,88.62,88.62,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003183,MBR00000121,Professional,2022-11-26,2022-11-26,2022-12-15,PLN6333,1728018911,1728018911,Nephrology,In-Network,I10,M54.5,,,,,,,0,,71046,Radiology,,,,21,Inpatient Hospital,1,324.84,217.4,0.0,0.0,35.0,10.47,45.47,0.0,Denied,CO-4,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003184,MBR00000121,Professional,2021-05-28,2021-05-28,2021-06-06,PLN3311,1575695214,1575695214,SNF,In-Network,I10,N18.3,,,,,,,0,,23472,Surgery,,,,11,Office,1,6652.17,2796.46,2796.46,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003185,MBR00000121,Professional,2022-03-15,2022-03-15,2022-04-19,PLN2855,1514306773,1514306773,Endocrinology,In-Network,I50.9,Z23,,,,,,,0,,80053,Pathology/Lab,,,,31,Skilled Nursing Facility,2,88.8,67.36,67.36,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003186,MBR00000122,Professional,2021-07-06,2021-07-06,2021-08-02,PLN5434,1139906830,1139906830,Endocrinology,Out-of-Network,Z00.00,R10.9,,,,,,,0,,99213,E&M,,,,50,Federally Qualified Health Center,2,200.16,129.53,0.0,0.0,25.0,1.65,26.65,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003187,MBR00000122,Institutional-OP,2023-04-11,2023-04-11,2023-05-06,PLN4304,1717546253,1717546253,Family Medicine,In-Network,E66.9,E11.9,,,,,,,0,,87491,Pathology/Lab,,,0200,22,Outpatient Hospital,1,222.55,157.85,0.0,157.85,0.0,0.0,157.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003188,MBR00000122,Institutional-OP,2023-12-28,2023-12-28,2024-01-22,PLN9148,1450094833,1450094833,Outpatient Clinic,In-Network,G43.909,I10,,,,,,,0,,99284,E&M,,,0120,22,Outpatient Hospital,3,693.61,307.64,307.64,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000003189,MBR00000122,Professional,2023-04-25,2023-04-25,2023-05-04,PLN2954,1609526529,1609526529,Psychiatry,In-Network,J06.9,J44.1,,,,,,,0,,90460,Medicine,,,,22,Outpatient Hospital,1,53.96,33.44,0.0,33.44,0.0,0.0,33.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003190,MBR00000122,Professional,2021-09-27,2021-09-27,2021-11-09,PLN6948,1453936007,1453936007,ASC,In-Network,F32.9,J06.9,,,,,,,0,,47562,Surgery,,,,11,Office,2,3151.64,2055.58,1960.48,0.0,0.0,95.1,95.1,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003191,MBR00000122,Professional,2023-02-02,2023-02-02,2023-02-09,PLN9344,1856686341,1856686341,Geriatrics,In-Network,R10.9,I63.9,,,,,,,0,,G0468,Medicine,,,,11,Office,3,536.37,372.87,307.86,0.0,0.0,65.01,65.01,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003192,MBR00000122,Institutional-OP,2021-01-24,2021-01-24,2021-02-28,PLN5828,1644128543,1644128543,Gastroenterology,In-Network,Z12.31,I10,,,,,,,0,,99204,E&M,,,0270,22,Outpatient Hospital,1,571.4,383.33,383.33,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003193,MBR00000122,Professional,2021-10-26,2021-10-26,2021-11-26,PLN5244,1422747896,1422747896,Urology,In-Network,M54.5,Z12.31,,,,,,,0,,G0439,Medicine,,,,22,Outpatient Hospital,1,377.04,167.07,0.0,0.0,0.0,25.79,25.79,0.0,Denied,CO-11,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000003194,MBR00000122,Institutional-OP,2021-11-29,2021-11-29,2022-01-01,PLN6255,1410468316,1410468316,SNF,In-Network,M54.5,Z00.00,,,,,,,0,,58661,Surgery,,,0730,22,Outpatient Hospital,3,4008.9,2682.76,2682.76,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003195,MBR00000122,Professional,2022-05-29,2022-05-29,2022-06-15,PLN2297,1168881145,1168881145,Orthopedic Surgery,In-Network,Z12.11,Z23,,,,,,,0,,99284,E&M,,,,65,End-Stage Renal Disease,1,331.01,260.95,238.49,0.0,0.0,22.46,22.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003196,MBR00000122,Institutional-IP,2021-12-17,2021-12-29,2022-01-20,PLN3420,1860435061,1860435061,DME Supplier,In-Network,I11.9,F10.20,,,,292,MS-DRG,17,12,Y,G0468,Medicine,,,0450,21,Inpatient Hospital,2,648.12,540.08,70.6,377.9,75.0,16.58,469.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003197,MBR00000122,Institutional-IP,2022-04-19,2022-04-22,2022-04-30,PLN5535,1644128543,1644128543,Gastroenterology,In-Network,E66.9,R51,,,,682,MS-DRG,16,3,W,99214,E&M,,,0200,21,Inpatient Hospital,1,380.8,190.45,190.45,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003198,MBR00000122,Institutional-IP,2021-01-11,2021-01-12,2021-02-09,PLN7054,1910255109,1910255109,DME Supplier,In-Network,M54.5,R05,,,,871,MS-DRG,15,1,Y,99222,E&M,,,0120,21,Inpatient Hospital,1,264.64,138.98,63.98,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003199,MBR00000122,Professional,2023-06-14,2023-06-14,2023-06-23,PLN4894,1135158374,1135158374,Pulmonology,In-Network,K57.30,R10.9,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,3,624.45,299.65,0.0,299.65,0.0,0.0,299.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003200,MBR00000122,Professional,2022-03-10,2022-03-10,2022-04-22,PLN8870,1245650222,1245650222,Gastroenterology,In-Network,F41.9,Z23,,,,,,,0,,45380,Surgery,,,,12,Home,3,3088.76,2248.99,2080.42,168.57,0.0,0.0,168.57,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000003201,MBR00000122,Professional,2023-06-04,2023-06-04,2023-07-01,PLN9759,1500037969,1500037969,Pulmonology,In-Network,K21.0,N39.0,,,,,,,0,,78452,Radiology,,,,12,Home,1,5789.59,3126.4,2955.25,102.2,25.0,43.95,171.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003202,MBR00000122,Institutional-OP,2021-03-05,2021-03-05,2021-03-28,PLN7832,1939033455,1939033455,Pulmonology,In-Network,R51,J06.9,,,,,,,0,,47562,Surgery,,,0761,22,Outpatient Hospital,2,5356.91,1741.47,1741.47,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003203,MBR00000122,Professional,2023-08-07,2023-08-07,2023-09-06,PLN1039,1585582070,1585582070,Outpatient Clinic,In-Network,E11.9,Z87.891,,,,,,,0,,71046,Radiology,,,,22,Outpatient Hospital,2,223.0,157.5,132.5,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003204,MBR00000122,Institutional-OP,2022-11-17,2022-11-17,2022-12-17,PLN4431,1108115157,1108115157,General Acute Care Hospital,In-Network,G20,R05,,,,,,,0,,83036,Pathology/Lab,,,0636,22,Outpatient Hospital,1,42.68,33.53,27.72,0.0,0.0,5.81,5.81,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000003205,MBR00000122,Institutional-OP,2021-09-11,2021-09-11,2021-09-21,PLN2846,1486164553,1486164553,DME Supplier,In-Network,E78.5,I10,,,,,,,0,,23472,Surgery,,,0761,22,Outpatient Hospital,1,5316.09,3615.87,3615.87,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003206,MBR00000122,Institutional-IP,2023-04-05,2023-04-14,2023-05-07,PLN6975,1644128543,1644128543,Gastroenterology,In-Network,I63.9,F41.9,,,,872,MS-DRG,11,9,Y,97110,Medicine,,,0761,21,Inpatient Hospital,1,277.11,89.5,0.0,0.0,0.0,14.72,14.72,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003207,MBR00000122,Professional,2023-03-31,2023-03-31,2023-05-10,PLN8839,1284035364,1284035364,Pediatrics,In-Network,N39.0,E78.5,,,,,,,0,,99214,E&M,,,,11,Office,1,355.35,135.14,94.21,0.0,35.0,5.93,40.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003208,MBR00000122,Professional,2023-03-07,2023-03-07,2023-04-17,PLN8436,1571574052,1571574052,Critical Access Hospital,In-Network,E11.9,R05,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,3,75.2,33.21,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003209,MBR00000122,Institutional-OP,2023-08-12,2023-08-12,2023-09-07,PLN1548,1109850785,1109850785,ASC,Out-of-Network,C50.912,N17.9,,,,,,,0,,82043,Pathology/Lab,,,0120,22,Outpatient Hospital,1,73.93,38.8,0.0,0.0,50.0,0.0,50.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003210,MBR00000122,Institutional-OP,2023-11-11,2023-11-11,2023-12-02,PLN4707,1450553056,1450553056,Clinical Laboratory,In-Network,I10,G20,,,,,,,0,,70450,Radiology,,,0730,22,Outpatient Hospital,3,947.48,733.6,718.6,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003211,MBR00000122,Institutional-OP,2021-07-02,2021-07-02,2021-07-18,PLN6653,1410468316,1410468316,SNF,In-Network,I10,J18.9,,,,,,,0,,99284,E&M,,,0301,22,Outpatient Hospital,3,758.93,545.61,307.75,212.86,25.0,0.0,237.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003212,MBR00000122,Professional,2021-11-06,2021-11-06,2021-11-26,PLN8509,1891849440,1891849440,Oncology,In-Network,I10,R07.9,,,,,,,0,,47562,Surgery,,,,23,Emergency Room,2,5327.74,2913.42,2572.73,0.0,0.0,340.69,340.69,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003213,MBR00000122,Institutional-OP,2021-02-13,2021-02-13,2021-02-24,PLN3420,1486164553,1486164553,DME Supplier,In-Network,E66.9,J45.20,,,,,,,0,,99213,E&M,,,0900,22,Outpatient Hospital,1,332.42,212.43,137.43,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003214,MBR00000122,Professional,2021-03-14,2021-03-14,2021-04-04,PLN1711,1872613201,1872613201,Internal Medicine,In-Network,I63.9,I10,,,,,,,0,,99284,E&M,,,,11,Office,2,526.97,392.39,0.0,213.35,15.0,0.0,228.35,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003215,MBR00000122,Institutional-IP,2021-04-26,2021-05-01,2021-05-29,PLN8426,1716521444,1716521444,Oncology,In-Network,J20.9,R07.9,,,,196,MS-DRG,20,5,Y,45378,Surgery,,,0636,21,Inpatient Hospital,1,1061.06,756.55,376.66,336.48,15.0,28.41,379.89,0.0,Paid,,,0,,0,1,1,0,0,1,Phantom,0,1,0,0,0
CLM0000003216,MBR00000122,Professional,2023-01-28,2023-01-28,2023-02-18,PLN4501,1186826716,1186826716,Physical Therapy,In-Network,Z23,N39.0,,,,,,,0,,74177,Radiology,,,,49,Independent Clinic,3,1143.9,803.57,778.57,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000003217,MBR00000122,Professional,2022-10-26,2022-10-26,2022-11-13,PLN1084,1749327647,1749327647,Geriatrics,In-Network,M54.5,E11.9,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,3,82.94,29.38,0.0,29.38,0.0,0.0,29.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000003218,MBR00000123,Institutional-IP,2021-02-08,2021-02-14,2021-03-08,PLN2180,1283743001,1283743001,Family Medicine,In-Network,I10,J20.9,,,,292,MS-DRG,7,6,Y,99203,E&M,,,0360,21,Inpatient Hospital,1,350.25,247.65,0.0,232.41,25.0,0.0,257.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003219,MBR00000123,Professional,2022-04-07,2022-04-07,2022-05-08,PLN7960,1865904917,1865904917,Outpatient Clinic,In-Network,Z00.00,F32.9,,,,,,,0,,G0439,Medicine,,,,22,Outpatient Hospital,3,455.64,360.95,64.5,296.45,0.0,0.0,296.45,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000003220,MBR00000123,Institutional-OP,2021-05-01,2021-05-01,2021-05-08,PLN6965,1245650222,1245650222,Gastroenterology,In-Network,E66.9,N39.0,,,,,,,0,,93000,Radiology,,,0320,22,Outpatient Hospital,1,191.34,61.37,11.37,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003221,MBR00000123,Professional,2021-08-02,2021-08-02,2021-08-28,PLN1764,1778483301,1778483301,Home Health,In-Network,I10,M54.5,,,,,,,0,,70553,Radiology,,,,11,Office,3,4199.27,1925.61,1925.61,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003222,MBR00000123,Institutional-OP,2021-03-02,2021-03-02,2021-04-12,PLN8398,1644128543,1644128543,Gastroenterology,In-Network,Z12.31,K21.0,,,,,,,0,,99284,E&M,,,0730,22,Outpatient Hospital,3,908.27,733.3,530.24,203.06,0.0,0.0,203.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003223,MBR00000123,Professional,2022-08-02,2022-08-02,2022-09-06,PLN4319,1463205530,1463205530,Nephrology,In-Network,I10,M17.11,,,,,,,0,,86900,Pathology/Lab,,,,21,Inpatient Hospital,1,25.66,13.12,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003224,MBR00000123,Professional,2021-03-30,2021-03-30,2021-04-20,PLN3400,1767011137,1767011137,DME Supplier,In-Network,R51,Z12.31,,,,,,,0,,93000,Radiology,,,,22,Outpatient Hospital,1,78.21,39.5,39.5,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003225,MBR00000123,Professional,2023-05-11,2023-05-11,2023-06-02,PLN8354,1148984206,1148984206,Psychiatry,In-Network,M54.5,C50.912,,,,,,,0,,99204,E&M,,,,23,Emergency Room,3,569.0,356.61,0.0,243.33,0.0,0.0,243.33,0.0,Denied,PR-1,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003226,MBR00000123,Institutional-OP,2023-10-18,2023-10-18,2023-11-13,PLN6983,1974006077,1974006077,Orthopedic Surgery,In-Network,K21.0,N39.0,,,,,,,0,,43239,Surgery,,,0270,22,Outpatient Hospital,1,1303.74,765.48,227.39,484.14,0.0,53.95,538.09,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003227,MBR00000123,Institutional-OP,2023-07-27,2023-07-27,2023-08-17,PLN7117,1502838586,1502838586,ASC,In-Network,Z00.00,I63.9,,,,,,,0,,66984,Surgery,,,0270,22,Outpatient Hospital,3,1412.69,1066.82,1066.82,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003228,MBR00000123,Professional,2023-06-21,2023-06-21,2023-08-02,PLN6482,1891849440,1891849440,Oncology,In-Network,N39.0,K21.0,,,,,,,0,,90460,Medicine,,,,21,Inpatient Hospital,2,40.73,12.85,0.0,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003229,MBR00000123,Professional,2023-04-04,2023-04-04,2023-05-04,PLN4530,1997536841,1997536841,Family Medicine,Out-of-Network,J18.9,J45.20,,,,,,,0,,G0439,Medicine,,,,11,Office,3,278.57,189.05,175.64,0.0,0.0,13.41,13.41,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000003230,MBR00000123,Professional,2023-09-25,2023-09-25,2023-10-26,PLN7571,1964402759,1964402759,Outpatient Clinic,In-Network,Z12.31,J18.9,,,,,,,0,,70553,Radiology,,,,11,Office,2,4123.1,2144.48,1536.89,463.45,75.0,69.14,607.59,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003231,MBR00000123,Institutional-IP,2023-08-28,2023-09-05,2023-10-08,PLN2836,1872272835,1872272835,Internal Medicine,In-Network,Z23,E78.5,,,,196,MS-DRG,17,8,Y,27447,Surgery,,,0370,21,Inpatient Hospital,1,6066.13,3337.47,3189.2,73.27,75.0,0.0,148.27,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003232,MBR00000123,Institutional-IP,2021-08-25,2021-08-27,2021-09-16,PLN7812,1609138981,1609138981,Critical Access Hospital,In-Network,J06.9,E11.9,,,,871,MS-DRG,11,2,Y,58661,Surgery,,,0761,21,Inpatient Hospital,1,4242.53,2423.47,2423.47,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003233,MBR00000123,Institutional-OP,2022-10-24,2022-10-24,2022-11-15,PLN7499,1691062876,1691062876,SNF,In-Network,K57.30,J44.1,,,,,,,0,,99204,E&M,,,0360,22,Outpatient Hospital,1,249.49,184.67,0.0,184.67,15.0,0.0,199.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003234,MBR00000123,Professional,2021-12-02,2021-12-02,2021-12-12,PLN9666,1790497490,1790497490,OB/GYN,In-Network,K21.0,F32.9,,,,,,,0,,84443,Pathology/Lab,,,,22,Outpatient Hospital,2,149.74,91.28,0.0,91.28,75.0,0.0,166.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003235,MBR00000124,Professional,2023-07-06,2023-07-06,2023-07-23,PLN7124,1727809972,1727809972,Home Health,In-Network,F03.90,E78.5,,,,,,,0,,27447,Surgery,,,,20,Urgent Care,3,2229.78,971.81,519.56,452.25,0.0,0.0,452.25,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003236,MBR00000124,Professional,2021-01-12,2021-01-12,2021-02-08,PLN9507,1717912431,1717912431,Oncology,In-Network,M54.5,E66.9,,,,,,,0,,78452,Radiology,,,,21,Inpatient Hospital,3,3933.36,1875.0,1840.0,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003237,MBR00000124,Institutional-OP,2022-04-02,2022-04-02,2022-05-16,PLN6071,1660288235,1660288235,ASC,In-Network,I25.10,R07.9,,,,,,,0,,99233,E&M,,,0301,22,Outpatient Hospital,2,239.14,182.2,0.0,182.2,50.0,0.0,232.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003238,MBR00000124,Professional,2022-02-20,2022-02-20,2022-03-13,PLN8415,1266606767,1266606767,ASC,In-Network,F32.9,E78.5,,,,,,,0,,99233,E&M,,,,11,Office,3,527.01,272.8,267.27,0.0,0.0,5.53,5.53,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000003239,MBR00000124,Professional,2023-07-23,2023-07-23,2023-08-25,PLN8155,1622771872,1622771872,Pediatrics,In-Network,Z23,Z00.00,,,,,,,0,,99283,E&M,,,,11,Office,3,349.22,245.22,245.22,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003240,MBR00000124,Institutional-OP,2021-11-19,2021-11-19,2021-12-18,PLN6763,1896447406,1896447406,Nephrology,Out-of-Network,E78.5,E87.6,,,,,,,0,,27447,Surgery,,,0200,22,Outpatient Hospital,2,5938.32,3826.24,0.0,108.3,15.0,0.0,123.3,0.0,Denied,CO-15,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003241,MBR00000124,Institutional-IP,2023-09-08,2023-09-11,2023-10-04,PLN2749,1242201429,1242201429,General Acute Care Hospital,In-Network,E11.9,Z00.00,,,,872,MS-DRG,20,3,Y,47562,Surgery,,,0900,21,Inpatient Hospital,3,2311.85,1058.56,718.19,340.37,0.0,0.0,340.37,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003242,MBR00000124,Professional,2022-06-28,2022-06-28,2022-08-05,PLN6915,1752470395,1752470395,Home Health,In-Network,Z00.00,E78.5,,,,,,,0,,81001,Pathology/Lab,,,,23,Emergency Room,2,41.27,16.64,0.0,16.64,15.0,0.0,31.64,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003243,MBR00000124,Professional,2023-01-22,2023-01-22,2023-02-13,PLN4721,1313212303,1313212303,Family Medicine,In-Network,I11.9,J06.9,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,2,60.14,40.83,25.83,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003244,MBR00000124,Institutional-OP,2022-08-05,2022-08-05,2022-08-23,PLN9888,1283743001,1283743001,Family Medicine,In-Network,Z12.11,M54.5,,,,,,,0,,70553,Radiology,,,0900,22,Outpatient Hospital,3,2428.55,1421.81,1346.81,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003245,MBR00000124,Institutional-OP,2022-04-17,2022-04-17,2022-05-29,PLN9273,1915531927,1915531927,Critical Access Hospital,In-Network,E66.9,J44.1,,,,,,,0,,99204,E&M,,,0761,22,Outpatient Hospital,2,421.08,298.24,298.24,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003246,MBR00000124,Professional,2021-11-30,2021-11-30,2021-12-22,PLN7275,1108115157,1108115157,General Acute Care Hospital,In-Network,I10,Z51.11,,,,,,,0,,70450,Radiology,,,,11,Office,2,956.04,667.69,667.69,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003247,MBR00000124,Professional,2021-11-05,2021-11-05,2021-12-11,PLN7472,1542828721,1542828721,Orthopedic Surgery,In-Network,Z00.00,E11.65,,,,,,,0,,93225,Medicine,,,,20,Urgent Care,2,423.9,209.22,209.22,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003248,MBR00000124,Professional,2022-12-03,2022-12-03,2022-12-12,PLN2658,1239316214,1239316214,Internal Medicine,In-Network,I10,E78.5,,,,,,,0,,45378,Surgery,,,,49,Independent Clinic,2,2385.17,2024.25,2024.25,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003249,MBR00000124,Institutional-IP,2021-12-23,2021-12-24,2022-01-02,PLN4517,1438368327,1438368327,Home Health,In-Network,I63.9,I48.91,,,,196,MS-DRG,4,1,Y,93000,Radiology,,,0301,21,Inpatient Hospital,1,87.08,70.41,35.41,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003250,MBR00000124,Professional,2023-08-05,2023-08-05,2023-08-15,PLN9874,1239316214,1239316214,Internal Medicine,In-Network,I10,K21.0,,,,,,,0,,99204,E&M,,,,11,Office,1,417.61,228.33,193.33,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003251,MBR00000124,Professional,2021-05-25,2021-05-25,2021-06-21,PLN5338,1268679390,1268679390,Critical Access Hospital,In-Network,E11.9,F41.9,,,,,,,0,,99204,E&M,,,,81,Independent Laboratory,3,417.76,206.33,206.33,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003252,MBR00000124,Professional,2021-08-24,2021-08-24,2021-09-08,PLN9556,1817234602,1817234602,Clinical Laboratory,In-Network,G43.909,J06.9,,,,,,,0,,76700,Radiology,,,,49,Independent Clinic,3,517.65,279.66,279.66,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003253,MBR00000124,Institutional-OP,2021-02-21,2021-02-21,2021-03-06,PLN7587,1563980627,1563980627,Critical Access Hospital,In-Network,F41.9,F41.9,,,,,,,0,,90686,Medicine,,,0900,22,Outpatient Hospital,1,134.68,50.73,50.73,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000003254,MBR00000124,Professional,2023-08-04,2023-08-04,2023-09-17,PLN2134,1847081578,1847081578,Urology,Out-of-Network,K21.0,Z79.4,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,3,104.92,66.08,56.61,0.0,0.0,9.47,9.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003255,MBR00000124,Professional,2022-03-30,2022-03-30,2022-04-28,PLN9974,1313212303,1313212303,Family Medicine,In-Network,J20.9,M17.11,,,,,,,0,,85025,Pathology/Lab,,,,22,Outpatient Hospital,2,56.26,45.71,0.0,45.71,15.0,0.0,60.71,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003256,MBR00000124,Professional,2021-02-08,2021-02-08,2021-03-03,PLN7279,1364429278,1364429278,OB/GYN,In-Network,J20.9,F10.20,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,3,31.63,12.87,0.0,12.87,0.0,0.0,12.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003257,MBR00000124,Institutional-OP,2021-02-16,2021-02-16,2021-03-23,PLN1140,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,I63.9,N20.0,,,,,,,0,,77067,Radiology,,,0200,22,Outpatient Hospital,3,363.62,251.88,176.88,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000003258,MBR00000124,Institutional-OP,2023-10-03,2023-10-03,2023-10-26,PLN3518,1542828721,1542828721,Orthopedic Surgery,In-Network,E11.9,I11.9,,,,,,,0,,45380,Surgery,,,0510,22,Outpatient Hospital,2,2024.71,1282.44,1232.44,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000003259,MBR00000124,Institutional-OP,2023-08-23,2023-08-23,2023-09-23,PLN1404,1939033455,1939033455,Pulmonology,In-Network,I10,R07.9,,,,,,,0,,58661,Surgery,,,0270,22,Outpatient Hospital,1,4323.88,1698.64,1673.64,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003260,MBR00000124,Professional,2021-10-31,2021-10-31,2021-12-03,PLN4838,1245650222,1245650222,Gastroenterology,In-Network,E78.5,N40.0,,,,,,,0,,87491,Pathology/Lab,,,,22,Outpatient Hospital,1,253.62,146.1,131.1,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003261,MBR00000124,Professional,2022-12-13,2022-12-13,2023-01-07,PLN3780,1571574052,1571574052,Critical Access Hospital,In-Network,N39.0,J45.20,,,,,,,0,,66984,Surgery,,,,12,Home,2,1291.76,1085.24,894.93,140.31,50.0,0.0,190.31,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003262,MBR00000124,Professional,2021-10-04,2021-10-04,2021-11-03,PLN8632,1644128543,1644128543,Gastroenterology,In-Network,F41.9,F41.9,,,,,,,0,,47562,Surgery,,,,11,Office,2,6582.69,3075.52,3075.52,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003263,MBR00000124,Institutional-OP,2023-07-13,2023-07-13,2023-08-23,PLN9290,1395983630,1395983630,Nephrology,In-Network,N39.0,I10,,,,,,,0,,99406,Medicine,,,0900,22,Outpatient Hospital,2,83.06,68.5,16.27,0.0,50.0,2.23,52.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003264,MBR00000124,Institutional-IP,2023-02-23,2023-02-27,2023-03-10,PLN1353,1745114564,1745114564,Endocrinology,In-Network,F41.9,F10.20,,,,872,MS-DRG,13,4,Y,99233,E&M,,,0360,21,Inpatient Hospital,1,350.2,201.38,180.25,0.0,15.0,6.13,21.13,0.0,Pended,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000003265,MBR00000124,Professional,2022-05-02,2022-05-02,2022-05-10,PLN8362,1540044947,1540044947,Pulmonology,Out-of-Network,F32.9,I10,,,,,,,0,,27447,Surgery,,,,50,Federally Qualified Health Center,2,4263.25,3421.13,0.0,140.3,0.0,0.0,140.3,0.0,Denied,CO-27,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003266,MBR00000124,Professional,2023-10-14,2023-10-14,2023-11-20,PLN2708,1847081578,1847081578,Urology,Out-of-Network,R10.9,F32.9,,,,,,,0,,99213,E&M,,,,23,Emergency Room,2,209.2,172.61,146.96,0.0,0.0,25.65,25.65,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003267,MBR00000124,Professional,2021-09-03,2021-09-03,2021-09-26,PLN8141,1728018911,1728018911,Nephrology,In-Network,Z00.00,R05,,,,,,,0,,43239,Surgery,,,,11,Office,2,1150.48,572.91,146.97,350.94,75.0,0.0,425.94,0.0,Paid,,,0,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000003268,MBR00000124,Institutional-IP,2023-12-28,2023-12-31,2024-01-25,PLN1094,1283743001,1283743001,Family Medicine,In-Network,R10.9,Z79.4,,,,196,MS-DRG,11,3,Y,93225,Medicine,,,0301,21,Inpatient Hospital,1,940.34,659.34,326.61,332.73,0.0,0.0,332.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003269,MBR00000124,Professional,2021-11-14,2021-11-14,2021-12-11,PLN5776,1109850785,1109850785,ASC,Out-of-Network,I25.10,Z23,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,1,227.94,150.59,125.59,0.0,25.0,0.0,25.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003270,MBR00000124,Professional,2023-09-01,2023-09-01,2023-10-02,PLN8699,1244186984,1244186984,Family Medicine,Out-of-Network,Z00.00,E11.9,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,3,50.4,30.89,5.89,0.0,25.0,0.0,25.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003271,MBR00000124,Professional,2023-07-25,2023-07-25,2023-08-04,PLN6565,1609138981,1609138981,Critical Access Hospital,In-Network,Z00.00,N18.3,,,,,,,0,,47562,Surgery,,,,11,Office,1,6040.28,2588.41,2538.41,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003272,MBR00000124,Professional,2022-09-09,2022-09-09,2022-10-22,PLN5852,1125190055,1125190055,Nephrology,In-Network,J20.9,N40.0,,,,,,,0,,45380,Surgery,,,,50,Federally Qualified Health Center,2,1899.61,1168.67,1133.67,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000003273,MBR00000124,Professional,2021-05-14,2021-05-14,2021-06-03,PLN3862,1847081578,1847081578,Urology,Out-of-Network,G43.909,C50.912,,,,,,,0,,G0444,Medicine,,,,81,Independent Laboratory,3,54.89,19.55,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000003274,MBR00000124,Institutional-OP,2023-04-03,2023-04-03,2023-04-29,PLN9759,1847081578,1847081578,Urology,Out-of-Network,F32.9,C50.912,,,,,,,0,,27130,Surgery,,,0740,22,Outpatient Hospital,3,4472.32,3156.87,2330.26,321.7,75.0,429.91,826.61,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003275,MBR00000124,Institutional-IP,2023-02-04,2023-02-07,2023-02-18,PLN1209,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,E78.5,Z00.00,,,,195,MS-DRG,14,3,Y,66984,Surgery,,,0200,21,Inpatient Hospital,2,3532.65,2877.82,2877.82,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003276,MBR00000125,Professional,2023-08-06,2023-08-06,2023-08-14,PLN4857,1749494482,1749494482,Pediatrics,In-Network,Z23,G43.909,,,,,,,0,,74177,Radiology,,,,11,Office,3,2144.22,993.25,745.62,222.63,25.0,0.0,247.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003277,MBR00000125,Professional,2021-09-05,2021-09-05,2021-10-14,PLN9438,1486164553,1486164553,DME Supplier,In-Network,N18.3,K21.0,,,,,,,0,,45380,Surgery,,,,11,Office,2,1373.47,732.18,657.18,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000003278,MBR00000125,Institutional-OP,2021-09-20,2021-09-20,2021-11-03,PLN1652,1687650653,1687650653,Internal Medicine,In-Network,Z96.641,E78.5,,,,,,,0,,66984,Surgery,,,0301,22,Outpatient Hospital,2,3103.1,1418.6,1393.6,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003279,MBR00000125,Institutional-OP,2022-01-22,2022-01-22,2022-03-04,PLN9950,1453936007,1453936007,ASC,In-Network,E78.5,J45.20,,,,,,,0,,93225,Medicine,,,0301,22,Outpatient Hospital,1,353.87,185.24,185.24,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003280,MBR00000126,Institutional-IP,2022-02-08,2022-02-14,2022-02-17,PLN6816,1236418230,1236418230,DME Supplier,In-Network,G43.909,E78.5,,,,195,MS-DRG,3,6,Y,85025,Pathology/Lab,,,0270,21,Inpatient Hospital,1,45.77,23.04,0.0,23.04,0.0,0.0,23.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003281,MBR00000126,Institutional-IP,2021-01-04,2021-01-12,2021-01-13,PLN7388,1845057593,1845057593,Orthopedic Surgery,In-Network,Z00.00,Z12.31,,,,603,MS-DRG,10,8,Y,66984,Surgery,,,0636,21,Inpatient Hospital,3,2735.09,2294.22,1873.48,0.0,0.0,420.74,420.74,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003282,MBR00000126,Institutional-OP,2021-06-18,2021-06-18,2021-06-29,PLN1713,1994661817,1994661817,SNF,Out-of-Network,E78.5,Z12.31,,,,,,,0,,99233,E&M,,,0120,22,Outpatient Hospital,2,229.8,71.6,0.0,71.6,15.0,0.0,86.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003283,MBR00000126,Institutional-OP,2022-06-09,2022-06-09,2022-07-04,PLN2195,1236418230,1236418230,DME Supplier,In-Network,C50.912,E78.5,,,,,,,0,,99204,E&M,,,0120,22,Outpatient Hospital,3,217.39,146.57,0.0,146.57,75.0,0.0,221.57,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003284,MBR00000126,Professional,2023-11-25,2023-11-25,2024-01-05,PLN9238,1139906830,1139906830,Endocrinology,Out-of-Network,E66.9,N18.3,,,,,,,0,,99283,E&M,,,,21,Inpatient Hospital,1,487.61,352.58,262.79,0.0,75.0,14.79,89.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003285,MBR00000126,Professional,2021-05-21,2021-05-21,2021-06-28,PLN4474,1114982472,1114982472,Orthopedic Surgery,In-Network,N39.0,J45.20,,,,,,,0,,90460,Medicine,,,,22,Outpatient Hospital,3,76.36,29.69,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003286,MBR00000126,Professional,2021-09-22,2021-09-22,2021-11-01,PLN5446,1806688928,1806688928,Geriatrics,In-Network,J20.9,E78.5,,,,,,,0,,99213,E&M,,,,11,Office,2,140.94,83.33,69.63,0.0,0.0,13.7,13.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003287,MBR00000126,Institutional-OP,2023-07-31,2023-07-31,2023-08-15,PLN2121,1530904931,1530904931,Internal Medicine,In-Network,I10,J20.9,,,,,,,0,,90837,Medicine,,,0270,22,Outpatient Hospital,1,524.6,251.68,91.57,125.11,35.0,0.0,160.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003288,MBR00000126,Institutional-IP,2021-02-12,2021-02-21,2021-03-22,PLN6083,1239316214,1239316214,Internal Medicine,In-Network,Z23,E66.9,,,,872,MS-DRG,1,9,Y,74177,Radiology,,,0761,21,Inpatient Hospital,1,1931.46,804.49,709.83,0.0,0.0,94.66,94.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003289,MBR00000126,Institutional-OP,2021-04-18,2021-04-18,2021-05-13,PLN3663,1389336600,1389336600,Critical Access Hospital,In-Network,K21.0,Z87.891,,,,,,,0,,45378,Surgery,,,0120,22,Outpatient Hospital,3,2307.81,1171.42,1091.39,65.03,15.0,0.0,80.03,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003290,MBR00000126,Professional,2023-09-02,2023-09-02,2023-09-11,PLN1895,1135158374,1135158374,Pulmonology,In-Network,C50.912,R07.9,,,,,,,0,,85025,Pathology/Lab,,,,12,Home,3,72.8,27.77,12.69,0.0,15.0,0.08,15.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003291,MBR00000126,Professional,2021-10-02,2021-10-02,2021-10-09,PLN1156,1968299309,1968299309,Internal Medicine,In-Network,Z12.31,J44.1,,,,,,,0,,45378,Surgery,,,,11,Office,2,1567.63,1136.24,1136.24,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003292,MBR00000126,Institutional-OP,2021-12-04,2021-12-04,2021-12-16,PLN4400,1749327647,1749327647,Geriatrics,In-Network,Z12.11,R10.9,,,,,,,0,,99204,E&M,,,0740,22,Outpatient Hospital,2,253.85,78.27,0.0,78.27,50.0,0.0,128.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003293,MBR00000126,Institutional-OP,2021-01-17,2021-01-17,2021-02-09,PLN9138,1860435061,1860435061,DME Supplier,In-Network,Z00.01,J44.1,,,,,,,0,,99204,E&M,,,0370,22,Outpatient Hospital,3,452.54,325.65,300.81,0.0,15.0,9.84,24.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003294,MBR00000126,Institutional-OP,2022-03-21,2022-03-21,2022-04-01,PLN2538,1518055405,1518055405,Urology,In-Network,I10,I10,,,,,,,0,,82043,Pathology/Lab,,,0370,22,Outpatient Hospital,2,74.78,25.67,0.0,25.67,0.0,0.0,25.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003295,MBR00000126,Professional,2023-12-24,2023-12-24,2024-01-28,PLN9875,1450094833,1450094833,Outpatient Clinic,In-Network,Z00.00,J06.9,,,,,,,0,,70553,Radiology,,,,22,Outpatient Hospital,1,2554.93,1388.66,1267.69,0.0,0.0,120.97,120.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003296,MBR00000126,Institutional-OP,2023-12-16,2023-12-16,2024-01-28,PLN5834,1395983630,1395983630,Nephrology,In-Network,J06.9,F41.9,,,,,,,0,,47562,Surgery,,,0450,22,Outpatient Hospital,2,4235.01,1879.85,1747.3,132.55,0.0,0.0,132.55,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003297,MBR00000126,Institutional-OP,2022-12-04,2022-12-04,2022-12-23,PLN7119,1453936007,1453936007,ASC,In-Network,Z12.11,M81.0,,,,,,,0,,80061,Pathology/Lab,,,0200,22,Outpatient Hospital,3,87.0,56.63,20.05,36.25,0.0,0.33,36.58,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003298,MBR00000126,Institutional-OP,2023-01-10,2023-01-10,2023-02-18,PLN7351,1244186984,1244186984,Family Medicine,Out-of-Network,E78.5,Z23,,,,,,,0,,33533,Surgery,,,0636,22,Outpatient Hospital,1,12376.74,10277.96,10277.96,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000003299,MBR00000126,Institutional-IP,2022-12-06,2022-12-09,2022-12-30,PLN3495,1186826716,1186826716,Physical Therapy,In-Network,Z23,F41.9,,,,196,MS-DRG,8,3,Y,58661,Surgery,,,0301,21,Inpatient Hospital,1,1744.33,718.01,272.82,373.28,15.0,56.91,445.19,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003300,MBR00000126,Institutional-OP,2023-01-31,2023-01-31,2023-02-10,PLN8954,1545347862,1545347862,SNF,In-Network,Z96.641,E11.9,,,,,,,0,,90460,Medicine,,,0200,22,Outpatient Hospital,1,72.3,47.51,0.0,47.51,25.0,0.0,72.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003301,MBR00000126,Professional,2022-07-23,2022-07-23,2022-08-16,PLN1180,1410468316,1410468316,SNF,In-Network,I10,M54.5,,,,,,,0,,74177,Radiology,,,,11,Office,3,2326.49,1329.46,0.0,21.9,0.0,0.0,21.9,0.0,Denied,CO-4,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003302,MBR00000126,Professional,2021-08-14,2021-08-14,2021-08-24,PLN6289,1795618275,1795618275,Pulmonology,In-Network,R10.9,Z23,,,,,,,0,,93306,Radiology,,,,11,Office,2,3297.18,2403.21,1939.58,0.0,35.0,428.63,463.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003303,MBR00000126,Professional,2023-08-09,2023-08-09,2023-09-07,PLN8185,1968299309,1968299309,Internal Medicine,In-Network,F10.20,R10.9,,,,,,,0,,77067,Radiology,,,,81,Independent Laboratory,3,825.61,497.8,394.3,0.0,35.0,68.5,103.5,0.0,Paid,,,1,,0,1,0,0,0,1,Duplicate,1,0,0,0,0
CLM0000003304,MBR00000126,Professional,2023-08-22,2023-08-22,2023-09-06,PLN6388,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,M54.5,R05,,,,,,,0,,99283,E&M,,,,11,Office,3,611.6,341.9,271.15,35.75,35.0,0.0,70.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003305,MBR00000126,Institutional-OP,2021-06-07,2021-06-07,2021-06-16,PLN3674,1239316214,1239316214,Internal Medicine,In-Network,Z79.4,I50.9,,,,,,,0,,G0444,Medicine,,,0900,22,Outpatient Hospital,3,47.89,35.82,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000003306,MBR00000126,Institutional-IP,2021-04-14,2021-04-16,2021-05-05,PLN2840,1935547131,1935547131,Pulmonology,In-Network,N40.0,I10,,,,195,MS-DRG,3,2,Y,99222,E&M,,,0510,21,Inpatient Hospital,3,463.38,382.6,357.6,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000003307,MBR00000127,Professional,2023-05-19,2023-05-19,2023-06-28,PLN9776,1564502315,1564502315,ASC,In-Network,I25.10,R10.9,,,,,,,0,,58661,Surgery,,,,11,Office,3,2968.96,2441.64,2391.64,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003308,MBR00000127,Institutional-OP,2021-02-22,2021-02-22,2021-03-15,PLN8027,1713934949,1713934949,Neurology,In-Network,I48.91,I10,,,,,,,0,,43239,Surgery,,,0900,22,Outpatient Hospital,2,1730.54,622.02,130.75,488.32,0.0,2.95,491.27,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003309,MBR00000127,Institutional-IP,2023-06-03,2023-06-08,2023-06-24,PLN3606,1790497490,1790497490,OB/GYN,In-Network,F32.9,Z00.00,,,,683,MS-DRG,5,5,Y,G0444,Medicine,,,0320,21,Inpatient Hospital,1,91.89,73.62,0.0,73.62,35.0,0.0,108.62,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000003310,MBR00000127,Professional,2023-12-12,2023-12-12,2024-01-16,PLN5225,1198133277,1198133277,SNF,In-Network,E66.9,Z00.00,,,,,,,0,,70450,Radiology,,,,11,Office,1,1808.42,1175.79,1175.79,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003311,MBR00000127,Institutional-IP,2021-02-09,2021-02-21,2021-02-27,PLN2484,1717912431,1717912431,Oncology,In-Network,Z79.4,Z23,,,,196,MS-DRG,6,12,Y,27447,Surgery,,,0360,21,Inpatient Hospital,1,2476.02,2019.15,2019.15,0.0,0.0,0.0,0.0,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003312,MBR00000127,Professional,2023-05-25,2023-05-25,2023-06-16,PLN3232,1780163051,1780163051,SNF,In-Network,R05,I10,,,,,,,0,,33533,Surgery,,,,11,Office,1,24360.94,16863.02,16523.12,324.9,15.0,0.0,339.9,0.0,Adjusted,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000003313,MBR00000127,Institutional-IP,2021-05-26,2021-05-30,2021-07-04,PLN2185,1244186984,1244186984,Family Medicine,Out-of-Network,M81.0,I10,,,,292,MS-DRG,9,4,Y,99232,E&M,,,0120,21,Inpatient Hospital,3,342.35,139.81,124.81,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003314,MBR00000127,Institutional-OP,2021-11-14,2021-11-14,2021-11-30,PLN8904,1800011727,1800011727,Clinical Laboratory,Out-of-Network,R51,Z23,,,,,,,0,,99204,E&M,,,0636,22,Outpatient Hospital,3,515.15,365.49,303.04,0.0,0.0,62.45,62.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003315,MBR00000127,Professional,2022-08-23,2022-08-23,2022-10-04,PLN7956,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,I10,N17.9,,,,,,,0,,99221,E&M,,,,11,Office,3,233.96,88.57,0.0,88.57,75.0,0.0,163.57,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003316,MBR00000127,Professional,2023-01-15,2023-01-15,2023-02-09,PLN3518,1935547131,1935547131,Pulmonology,In-Network,Z23,R05,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,1,2751.6,1550.0,1277.22,0.0,0.0,272.78,272.78,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003317,MBR00000127,Institutional-IP,2021-04-09,2021-04-15,2021-05-19,PLN9276,1713934949,1713934949,Neurology,In-Network,E78.5,R05,,,,690,MS-DRG,17,6,Y,99222,E&M,,,0360,21,Inpatient Hospital,3,392.28,152.8,145.87,0.84,0.0,6.09,6.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003318,MBR00000127,Institutional-OP,2021-04-30,2021-04-30,2021-05-19,PLN7607,1224179551,1224179551,Physical Therapy,In-Network,E11.9,I48.91,,,,,,,0,,99406,Medicine,,,0200,22,Outpatient Hospital,1,64.66,44.69,0.0,44.69,75.0,0.0,119.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003319,MBR00000127,Professional,2021-11-06,2021-11-06,2021-11-15,PLN6210,1845057593,1845057593,Orthopedic Surgery,In-Network,Z96.641,K21.0,,,,,,,0,,99213,E&M,,,,50,Federally Qualified Health Center,2,288.97,147.68,0.0,147.68,0.0,0.0,147.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003320,MBR00000127,Institutional-OP,2023-01-17,2023-01-17,2023-02-20,PLN7872,1689639685,1689639685,SNF,In-Network,I10,I25.10,,,,,,,0,,81001,Pathology/Lab,,,0270,22,Outpatient Hospital,3,62.77,53.14,51.85,1.29,0.0,0.0,1.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003321,MBR00000127,Institutional-IP,2022-03-19,2022-03-20,2022-04-11,PLN4655,1660288235,1660288235,ASC,In-Network,E78.5,J45.20,,,,196,MS-DRG,11,1,N,G0439,Medicine,,,0270,21,Inpatient Hospital,3,591.69,410.32,410.32,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000003322,MBR00000127,Professional,2021-10-29,2021-10-29,2021-11-21,PLN6690,1109850785,1109850785,ASC,Out-of-Network,F32.9,Z23,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,2,469.84,385.23,385.23,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003323,MBR00000127,Professional,2021-06-22,2021-06-22,2021-07-05,PLN2531,1644128543,1644128543,Gastroenterology,In-Network,I63.9,I50.9,,,,,,,0,,99221,E&M,,,,49,Independent Clinic,3,285.18,239.79,164.79,0.0,75.0,0.0,75.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003324,MBR00000127,Professional,2023-11-27,2023-11-27,2023-12-25,PLN9355,1790497490,1790497490,OB/GYN,In-Network,E11.9,Z12.31,,,,,,,0,,80061,Pathology/Lab,,,,23,Emergency Room,3,117.67,89.54,89.54,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003325,MBR00000128,Professional,2023-02-11,2023-02-11,2023-03-25,PLN3442,1994661817,1994661817,SNF,Out-of-Network,I11.9,Z12.31,,,,,,,0,,93225,Medicine,,,,31,Skilled Nursing Facility,3,615.84,406.23,316.29,0.0,50.0,39.94,89.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003326,MBR00000128,Professional,2023-12-16,2023-12-16,2024-01-13,PLN3342,1569105090,1569105090,Geriatrics,In-Network,Z23,I25.10,,,,,,,0,,66984,Surgery,,,,11,Office,3,1550.08,982.95,947.95,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003327,MBR00000128,Institutional-OP,2022-06-27,2022-06-27,2022-07-31,PLN2017,1994661817,1994661817,SNF,Out-of-Network,I10,Z51.11,,,,,,,0,,58661,Surgery,,,0740,22,Outpatient Hospital,3,3230.27,1897.65,1882.65,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003328,MBR00000128,Institutional-IP,2023-06-16,2023-06-17,2023-07-18,PLN7841,1847081578,1847081578,Urology,Out-of-Network,E11.9,R05,,,,292,MS-DRG,14,1,Y,99232,E&M,,,0900,21,Inpatient Hospital,1,331.48,148.07,0.0,148.07,25.0,0.0,173.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003329,MBR00000128,Professional,2022-12-02,2022-12-02,2023-01-14,PLN7857,1691062876,1691062876,SNF,In-Network,E87.6,Z00.00,,,,,,,0,,85610,Pathology/Lab,,,,22,Outpatient Hospital,1,66.44,47.79,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003330,MBR00000128,Professional,2022-07-30,2022-07-30,2022-09-10,PLN5925,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,I10,Z23,,,,,,,0,,99203,E&M,,,,20,Urgent Care,2,339.62,157.58,122.58,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003331,MBR00000128,Professional,2022-06-04,2022-06-04,2022-07-06,PLN2965,1899127912,1899127912,Neurology,In-Network,Z00.00,Z51.11,,,,,,,0,,99221,E&M,,,,11,Office,3,219.34,103.88,0.0,103.88,35.0,0.0,138.88,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003332,MBR00000128,Institutional-OP,2022-07-02,2022-07-02,2022-07-29,PLN5794,1247341320,1247341320,Urology,Out-of-Network,Z23,N39.0,,,,,,,0,,99283,E&M,,,0270,22,Outpatient Hospital,1,450.34,307.3,307.3,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003333,MBR00000128,Institutional-OP,2022-03-28,2022-03-28,2022-04-29,PLN5918,1463205530,1463205530,Nephrology,In-Network,N39.0,I10,,,,,,,0,,72148,Radiology,,,0301,22,Outpatient Hospital,1,1300.86,783.87,705.32,0.0,25.0,53.55,78.55,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003334,MBR00000129,Institutional-OP,2022-12-02,2022-12-02,2022-12-22,PLN6502,1964402759,1964402759,Outpatient Clinic,In-Network,J06.9,E78.5,,,,,,,0,,58661,Surgery,,,0730,22,Outpatient Hospital,2,2008.59,1496.93,1405.46,0.0,50.0,41.47,91.47,0.0,Paid,,,0,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000003335,MBR00000129,Professional,2022-06-24,2022-06-24,2022-07-31,PLN2185,1910255109,1910255109,DME Supplier,In-Network,I10,Z79.4,,,,,,,0,,80061,Pathology/Lab,,,,21,Inpatient Hospital,1,120.09,62.69,0.0,62.69,0.0,0.0,62.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003336,MBR00000129,Institutional-OP,2023-11-29,2023-11-29,2023-12-21,PLN2329,1809014947,1809014947,Urology,In-Network,M54.5,I48.91,,,,,,,0,,99283,E&M,,,0360,22,Outpatient Hospital,1,334.98,213.63,163.63,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003337,MBR00000129,Institutional-OP,2023-09-12,2023-09-12,2023-10-20,PLN1358,1531398223,1531398223,OB/GYN,In-Network,G43.909,Z51.11,,,,,,,0,,93306,Radiology,,,0450,22,Outpatient Hospital,2,2711.24,1195.2,865.76,294.44,35.0,0.0,329.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003338,MBR00000129,Professional,2022-05-24,2022-05-24,2022-06-05,PLN8328,1991459367,1991459367,Neurology,Out-of-Network,E78.5,Z00.00,,,,,,,0,,G0468,Medicine,,,,11,Office,1,628.82,436.71,361.71,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003339,MBR00000129,Professional,2022-03-10,2022-03-10,2022-03-22,PLN9550,1247341320,1247341320,Urology,Out-of-Network,J20.9,Z23,,,,,,,0,,G0439,Medicine,,,,11,Office,2,313.28,180.07,105.07,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000003340,MBR00000129,Professional,2023-04-12,2023-04-12,2023-04-25,PLN1316,1502838586,1502838586,ASC,In-Network,B97.89,Z23,,,,,,,0,,99213,E&M,,,,21,Inpatient Hospital,3,123.26,38.32,38.32,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003341,MBR00000129,Institutional-OP,2022-12-05,2022-12-05,2023-01-02,PLN9939,1790497490,1790497490,OB/GYN,In-Network,J18.9,E11.9,,,,,,,0,,70450,Radiology,,,0200,22,Outpatient Hospital,3,1025.71,751.7,751.7,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000003342,MBR00000129,Professional,2021-09-11,2021-09-11,2021-10-22,PLN7915,1872272835,1872272835,Internal Medicine,In-Network,M81.0,E78.5,,,,,,,0,,90460,Medicine,,,,11,Office,2,51.99,20.3,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003343,MBR00000129,Professional,2023-07-03,2023-07-03,2023-08-07,PLN3291,1644128543,1644128543,Gastroenterology,In-Network,Z23,E78.5,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,2,105.6,46.28,0.0,7.99,0.0,4.67,12.66,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003344,MBR00000129,Professional,2023-01-18,2023-01-18,2023-02-26,PLN7752,1364429278,1364429278,OB/GYN,In-Network,F32.9,E78.5,,,,,,,0,,97530,Medicine,,,,11,Office,3,171.29,124.08,58.54,61.47,0.0,4.07,65.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003345,MBR00000129,Professional,2022-11-12,2022-11-12,2022-12-01,PLN6825,1856686341,1856686341,Geriatrics,In-Network,J06.9,E78.5,,,,,,,0,,99406,Medicine,,,,20,Urgent Care,1,37.88,16.04,0.0,0.0,75.0,0.0,75.0,0.0,Pended,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000003346,MBR00000130,Institutional-IP,2023-05-07,2023-05-14,2023-05-26,PLN6735,1542828721,1542828721,Orthopedic Surgery,In-Network,F41.9,Z23,,,,292,MS-DRG,22,7,Y,99221,E&M,,,0450,21,Inpatient Hospital,1,327.68,158.02,158.02,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003347,MBR00000130,Professional,2021-09-05,2021-09-05,2021-10-17,PLN9680,1520687146,1520687146,ASC,In-Network,I10,E11.40,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,2,308.8,142.34,67.34,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003348,MBR00000130,Professional,2023-05-26,2023-05-26,2023-06-24,PLN7992,1800011727,1800011727,Clinical Laboratory,Out-of-Network,F32.9,J20.9,,,,,,,0,,85025,Pathology/Lab,,,,12,Home,1,91.51,36.32,36.32,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003349,MBR00000130,Institutional-IP,2021-05-14,2021-05-17,2021-06-23,PLN7148,1550154147,1550154147,Outpatient Clinic,In-Network,F32.9,F41.9,,,,292,MS-DRG,9,3,Y,83036,Pathology/Lab,,,0370,21,Inpatient Hospital,1,52.82,24.0,0.0,24.0,0.0,0.0,24.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000003350,MBR00000130,Institutional-OP,2023-05-19,2023-05-19,2023-06-29,PLN8279,1450553056,1450553056,Clinical Laboratory,In-Network,J20.9,E11.9,,,,,,,0,,99203,E&M,,,0510,22,Outpatient Hospital,3,270.89,121.34,0.0,121.34,0.0,0.0,121.34,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003351,MBR00000130,Professional,2022-10-10,2022-10-10,2022-11-20,PLN6779,1563980627,1563980627,Critical Access Hospital,In-Network,E11.9,E11.9,,,,,,,0,,90460,Medicine,,,,11,Office,3,53.08,42.36,0.0,42.36,0.0,0.0,42.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003352,MBR00000130,Professional,2022-09-30,2022-09-30,2022-10-29,PLN2602,1520687146,1520687146,ASC,In-Network,E11.9,N40.0,,,,,,,0,,45380,Surgery,,,,11,Office,2,2106.33,1284.25,1132.99,151.26,0.0,0.0,151.26,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000003353,MBR00000130,Professional,2023-03-08,2023-03-08,2023-03-15,PLN3556,1622771872,1622771872,Pediatrics,In-Network,M54.5,E78.5,,,,,,,0,,93225,Medicine,,,,11,Office,3,389.13,146.11,136.64,9.47,0.0,0.0,9.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003354,MBR00000130,Professional,2021-12-07,2021-12-07,2021-12-26,PLN9558,1389336600,1389336600,Critical Access Hospital,In-Network,N39.0,J06.9,,,,,,,0,,99283,E&M,,,,12,Home,1,294.69,221.9,171.9,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003355,MBR00000130,Institutional-OP,2023-04-22,2023-04-22,2023-05-28,PLN3237,1939033455,1939033455,Pulmonology,In-Network,J06.9,I10,,,,,,,0,,71046,Radiology,,,0740,22,Outpatient Hospital,3,122.59,69.93,69.93,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003356,MBR00000130,Institutional-OP,2021-01-29,2021-01-29,2021-03-01,PLN5291,1968299309,1968299309,Internal Medicine,In-Network,Z87.891,J45.20,,,,,,,0,,90686,Medicine,,,0301,22,Outpatient Hospital,2,70.59,45.18,0.0,45.18,75.0,0.0,120.18,0.0,Adjusted,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000003357,MBR00000130,Professional,2023-01-30,2023-01-30,2023-02-11,PLN3434,1561134315,1561134315,DME Supplier,In-Network,I25.10,M54.5,,,,,,,0,,72148,Radiology,,,,11,Office,1,1953.83,897.95,872.95,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003358,MBR00000130,Professional,2023-05-20,2023-05-20,2023-06-26,PLN5895,1550154147,1550154147,Outpatient Clinic,In-Network,I10,I10,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,1,396.77,241.49,241.49,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003359,MBR00000130,Professional,2021-01-04,2021-01-04,2021-01-28,PLN8649,1139906830,1139906830,Endocrinology,Out-of-Network,E11.9,I50.9,,,,,,,0,,99232,E&M,,,,11,Office,2,230.87,151.52,136.52,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003360,MBR00000130,Institutional-IP,2023-01-31,2023-02-08,2023-02-10,PLN8406,1991459367,1991459367,Neurology,Out-of-Network,N18.3,R05,,,,196,MS-DRG,24,8,Y,76700,Radiology,,,0270,21,Inpatient Hospital,2,825.72,404.36,404.36,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003361,MBR00000130,Professional,2023-04-28,2023-04-28,2023-05-15,PLN5912,1236418230,1236418230,DME Supplier,In-Network,N39.0,N40.0,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,2,49.24,38.07,0.0,0.0,15.0,3.23,18.23,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003362,MBR00000130,Professional,2022-07-26,2022-07-26,2022-08-07,PLN1800,1518055405,1518055405,Urology,In-Network,J06.9,M54.5,,,,,,,0,,81001,Pathology/Lab,,,,21,Inpatient Hospital,2,46.5,34.6,0.0,34.6,0.0,0.0,34.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003363,MBR00000130,Professional,2022-10-25,2022-10-25,2022-11-12,PLN1799,1749327647,1749327647,Geriatrics,In-Network,I10,I50.9,,,,,,,0,,72148,Radiology,,,,11,Office,2,2330.87,1654.58,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-27,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003364,MBR00000130,Institutional-IP,2021-03-07,2021-03-10,2021-04-04,PLN5356,1590915516,1590915516,Physical Therapy,Out-of-Network,R07.9,J06.9,,,,470,MS-DRG,8,3,Y,45378,Surgery,,,0510,21,Inpatient Hospital,2,1532.31,589.76,589.76,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003365,MBR00000130,Institutional-OP,2023-12-19,2023-12-19,2024-01-30,PLN6601,1295371663,1295371663,Critical Access Hospital,In-Network,E78.5,F41.9,,,,,,,0,,99213,E&M,,,0450,22,Outpatient Hospital,1,167.08,83.29,8.29,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003366,MBR00000130,Professional,2023-11-25,2023-11-25,2023-12-25,PLN7440,1124394415,1124394415,Pediatrics,In-Network,E11.9,Z12.31,,,,,,,0,,93000,Radiology,,,,22,Outpatient Hospital,3,131.89,40.99,40.99,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003367,MBR00000130,Institutional-OP,2023-04-18,2023-04-18,2023-05-19,PLN7824,1366426662,1366426662,Urology,In-Network,E11.65,Z23,,,,,,,0,,70450,Radiology,,,0270,22,Outpatient Hospital,3,1391.94,720.19,685.19,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003368,MBR00000130,Institutional-OP,2021-01-17,2021-01-17,2021-02-05,PLN6185,1366286000,1366286000,SNF,In-Network,E11.9,F32.9,,,,,,,0,,99203,E&M,,,0200,22,Outpatient Hospital,2,211.83,109.32,84.32,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003369,MBR00000130,Professional,2022-04-17,2022-04-17,2022-04-27,PLN8638,1103747954,1103747954,Urology,In-Network,E11.9,Z12.31,,,,,,,0,,90837,Medicine,,,,21,Inpatient Hospital,1,198.53,78.59,0.0,78.59,35.0,0.0,113.59,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000003370,MBR00000130,Institutional-OP,2023-06-15,2023-06-15,2023-06-23,PLN8978,1361302520,1361302520,Critical Access Hospital,In-Network,E66.9,I50.9,,,,,,,0,,74177,Radiology,,,0730,22,Outpatient Hospital,1,2566.96,1588.33,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-29,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003371,MBR00000131,Institutional-IP,2023-01-11,2023-01-13,2023-01-22,PLN5740,1422747896,1422747896,Urology,In-Network,R05,E78.5,,,,690,MS-DRG,18,2,N,80061,Pathology/Lab,,,0761,21,Inpatient Hospital,2,123.88,56.62,43.1,0.0,0.0,0.0,0.0,13.52,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003372,MBR00000131,Professional,2023-09-18,2023-09-18,2023-10-04,PLN7318,1716521444,1716521444,Oncology,In-Network,F41.9,N39.0,,,,,,,0,,71046,Radiology,,,,81,Independent Laboratory,2,267.78,225.49,225.49,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003373,MBR00000131,Institutional-IP,2022-11-06,2022-11-08,2022-11-23,PLN1236,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,J44.1,E78.5,,,,690,MS-DRG,21,2,Y,99233,E&M,,,0120,21,Inpatient Hospital,3,496.36,228.87,183.32,0.0,0.0,45.55,45.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003374,MBR00000131,Professional,2023-02-21,2023-02-21,2023-03-13,PLN6229,1563980627,1563980627,Critical Access Hospital,In-Network,M54.5,Z87.891,,,,,,,0,,90460,Medicine,,,,21,Inpatient Hospital,1,76.93,37.14,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003375,MBR00000131,Professional,2022-01-05,2022-01-05,2022-01-18,PLN8917,1500037969,1500037969,Pulmonology,In-Network,J44.1,J44.1,,,,,,,0,,70450,Radiology,,,,11,Office,1,860.71,318.71,283.71,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003376,MBR00000131,Professional,2023-06-10,2023-06-10,2023-06-27,PLN9873,1542828721,1542828721,Orthopedic Surgery,In-Network,E11.65,Z87.891,,,,,,,0,,72148,Radiology,,,,23,Emergency Room,1,1410.28,994.92,665.03,254.89,75.0,0.0,329.89,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003377,MBR00000131,Institutional-OP,2022-08-08,2022-08-08,2022-08-27,PLN9417,1475984649,1475984649,SNF,In-Network,E11.65,E11.9,,,,,,,0,,66984,Surgery,,,0270,22,Outpatient Hospital,2,2792.77,1753.39,1383.55,0.0,75.0,294.84,369.84,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003378,MBR00000131,Institutional-OP,2023-05-27,2023-05-27,2023-07-03,PLN8406,1687650653,1687650653,Internal Medicine,In-Network,Z00.00,J44.1,,,,,,,0,,87491,Pathology/Lab,,,0740,22,Outpatient Hospital,1,260.42,115.8,31.75,79.4,0.0,4.65,84.05,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003379,MBR00000131,Professional,2021-08-12,2021-08-12,2021-09-10,PLN4859,1103747954,1103747954,Urology,In-Network,Z12.31,F32.9,,,,,,,0,,97530,Medicine,,,,11,Office,3,227.47,107.68,53.79,0.0,35.0,4.89,39.89,14.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003380,MBR00000132,Professional,2021-10-21,2021-10-21,2021-11-15,PLN5164,1717912431,1717912431,Oncology,In-Network,Z87.891,Z12.31,,,,,,,0,,66984,Surgery,,,,11,Office,1,3524.46,1449.09,1449.09,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003381,MBR00000132,Professional,2021-04-07,2021-04-07,2021-04-18,PLN1454,1245650222,1245650222,Gastroenterology,In-Network,N39.0,Z12.31,,,,,,,0,,90460,Medicine,,,,31,Skilled Nursing Facility,2,74.68,30.29,0.0,30.29,0.0,0.0,30.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003382,MBR00000132,Institutional-OP,2023-01-10,2023-01-10,2023-01-25,PLN2010,1284035364,1284035364,Pediatrics,In-Network,B97.89,I25.10,,,,,,,0,,99213,E&M,,,0510,22,Outpatient Hospital,3,298.95,131.47,112.37,0.0,0.0,19.1,19.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003383,MBR00000132,Professional,2023-03-14,2023-03-14,2023-04-01,PLN1598,1687650653,1687650653,Internal Medicine,In-Network,Z12.31,I25.10,,,,,,,0,,66984,Surgery,,,,11,Office,2,2622.63,2049.11,2049.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003384,MBR00000132,Institutional-OP,2021-11-07,2021-11-07,2021-12-06,PLN6830,1531398223,1531398223,OB/GYN,In-Network,N20.0,I48.91,,,,,,,0,,90837,Medicine,,,0761,22,Outpatient Hospital,2,423.63,131.07,96.07,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003385,MBR00000132,Professional,2022-02-25,2022-02-25,2022-03-11,PLN4894,1569105090,1569105090,Geriatrics,In-Network,I10,C50.912,,,,,,,0,,71046,Radiology,,,,81,Independent Laboratory,3,261.01,97.11,97.11,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003386,MBR00000132,Professional,2022-09-16,2022-09-16,2022-10-24,PLN6750,1433937353,1433937353,Nephrology,In-Network,Z00.00,E78.5,,,,,,,0,,99284,E&M,,,,11,Office,1,618.51,231.88,2.93,153.53,75.0,0.42,228.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003387,MBR00000132,Professional,2023-04-08,2023-04-08,2023-04-20,PLN5129,1752470395,1752470395,Home Health,In-Network,R05,E78.5,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,3,1359.13,881.29,881.29,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000003388,MBR00000132,Professional,2021-11-28,2021-11-28,2022-01-04,PLN5659,1500949740,1500949740,Pediatrics,In-Network,F32.9,M54.5,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,2,24.26,19.05,0.0,19.04,50.0,0.0,69.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003389,MBR00000132,Professional,2022-06-19,2022-06-19,2022-06-26,PLN7958,1622771872,1622771872,Pediatrics,In-Network,Z23,R10.9,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,3,1721.01,797.54,686.1,86.44,25.0,0.0,111.44,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003390,MBR00000132,Institutional-OP,2021-07-23,2021-07-23,2021-08-11,PLN6025,1273488618,1273488618,General Acute Care Hospital,In-Network,J20.9,G43.909,,,,,,,0,,99204,E&M,,,0900,22,Outpatient Hospital,3,420.95,220.66,0.0,220.66,0.0,0.0,220.66,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003391,MBR00000132,Professional,2023-06-06,2023-06-06,2023-06-22,PLN2603,1114982472,1114982472,Orthopedic Surgery,In-Network,M54.5,J06.9,,,,,,,0,,85025,Pathology/Lab,,,,22,Outpatient Hospital,2,58.88,23.13,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003392,MBR00000132,Professional,2023-08-15,2023-08-15,2023-09-21,PLN4110,1896447406,1896447406,Nephrology,Out-of-Network,N20.0,Z87.891,,,,,,,0,,99213,E&M,,,,11,Office,1,136.32,57.68,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003393,MBR00000132,Institutional-IP,2023-03-21,2023-03-28,2023-04-11,PLN1439,1103747954,1103747954,Urology,In-Network,I48.91,N39.0,,,,603,MS-DRG,14,7,Y,99222,E&M,,,0636,21,Inpatient Hospital,3,552.39,307.39,307.39,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000003394,MBR00000132,Professional,2023-06-12,2023-06-12,2023-07-10,PLN3067,1713934949,1713934949,Neurology,In-Network,K21.0,J20.9,,,,,,,0,,74177,Radiology,,,,22,Outpatient Hospital,2,2158.98,1687.32,1402.98,0.0,15.0,269.34,284.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003395,MBR00000132,Institutional-IP,2023-04-17,2023-04-21,2023-05-31,PLN2241,1990090423,1990090423,Orthopedic Surgery,In-Network,J06.9,R07.9,,,,683,MS-DRG,6,4,Y,70553,Radiology,,,0740,21,Inpatient Hospital,2,3055.43,2270.28,2195.28,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000003396,MBR00000132,Institutional-OP,2023-07-05,2023-07-05,2023-07-20,PLN9280,1856686341,1856686341,Geriatrics,In-Network,Z00.00,N18.3,,,,,,,0,,99213,E&M,,,0450,22,Outpatient Hospital,3,321.55,204.7,204.7,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003397,MBR00000132,Institutional-OP,2022-04-16,2022-04-16,2022-05-21,PLN5194,1585582070,1585582070,Outpatient Clinic,In-Network,M81.0,R05,,,,,,,0,,74177,Radiology,,,0900,22,Outpatient Hospital,1,1772.86,1071.8,896.02,175.78,0.0,0.0,175.78,0.0,Adjusted,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003398,MBR00000132,Institutional-IP,2021-08-14,2021-08-21,2021-09-17,PLN6275,1728018911,1728018911,Nephrology,In-Network,Z00.00,N39.0,,,,872,MS-DRG,24,7,Y,99233,E&M,,,0730,21,Inpatient Hospital,1,389.99,256.05,191.67,0.0,35.0,29.38,64.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003399,MBR00000132,Professional,2023-11-19,2023-11-19,2023-12-28,PLN3167,1696843572,1696843572,Critical Access Hospital,Out-of-Network,I10,C50.912,,,,,,,0,,93225,Medicine,,,,31,Skilled Nursing Facility,3,919.38,482.87,108.65,299.22,75.0,0.0,374.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003400,MBR00000132,Professional,2021-01-03,2021-01-03,2021-01-30,PLN9785,1410468316,1410468316,SNF,In-Network,I25.10,N39.0,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,3,73.03,37.29,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003401,MBR00000132,Professional,2022-03-20,2022-03-20,2022-04-04,PLN5334,1564502315,1564502315,ASC,In-Network,N40.0,J20.9,,,,,,,0,,85025,Pathology/Lab,,,,20,Urgent Care,3,71.15,43.33,41.32,0.0,0.0,2.01,2.01,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003402,MBR00000132,Professional,2023-03-07,2023-03-07,2023-03-14,PLN1039,1935547131,1935547131,Pulmonology,In-Network,E78.5,E78.5,,,,,,,0,,80061,Pathology/Lab,,,,21,Inpatient Hospital,2,90.49,29.96,0.0,29.96,0.0,0.0,29.96,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000003403,MBR00000132,Professional,2023-05-19,2023-05-19,2023-05-27,PLN5241,1486164553,1486164553,DME Supplier,In-Network,I25.10,K21.0,,,,,,,0,,99204,E&M,,,,12,Home,2,272.15,217.19,217.19,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003404,MBR00000132,Professional,2023-01-21,2023-01-21,2023-02-22,PLN4956,1561134315,1561134315,DME Supplier,In-Network,I11.9,Z12.31,,,,,,,0,,99214,E&M,,,,11,Office,2,169.42,104.52,0.0,104.52,50.0,0.0,154.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003405,MBR00000132,Institutional-OP,2022-06-21,2022-06-21,2022-07-08,PLN4879,1463205530,1463205530,Nephrology,In-Network,Z23,M17.11,,,,,,,0,,27447,Surgery,,,0900,22,Outpatient Hospital,1,5619.82,3435.58,3435.58,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003406,MBR00000132,Institutional-OP,2023-10-08,2023-10-08,2023-11-01,PLN3014,1355166277,1355166277,Endocrinology,In-Network,Z00.00,F32.9,,,,,,,0,,71046,Radiology,,,0636,22,Outpatient Hospital,3,187.98,100.1,25.1,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000003407,MBR00000132,Professional,2021-09-15,2021-09-15,2021-10-16,PLN3769,1609138981,1609138981,Critical Access Hospital,In-Network,E11.9,E11.65,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,3,295.77,230.7,17.39,186.87,25.0,1.44,213.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003408,MBR00000132,Institutional-OP,2021-06-05,2021-06-05,2021-06-24,PLN5959,1644128543,1644128543,Gastroenterology,In-Network,E78.5,Z00.00,,,,,,,0,,99204,E&M,,,0120,22,Outpatient Hospital,2,403.38,140.98,123.6,0.0,0.0,17.38,17.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003409,MBR00000132,Institutional-OP,2022-11-20,2022-11-20,2022-12-03,PLN4640,1691062876,1691062876,SNF,In-Network,I48.91,Z23,,,,,,,0,,97110,Medicine,,,0730,22,Outpatient Hospital,1,154.63,91.56,0.0,91.56,0.0,0.0,91.56,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003410,MBR00000132,Professional,2021-12-17,2021-12-17,2021-12-30,PLN8550,1219817751,1219817751,OB/GYN,In-Network,E78.5,J20.9,,,,,,,0,,99204,E&M,,,,11,Office,1,237.24,113.35,78.35,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003411,MBR00000132,Institutional-OP,2022-05-29,2022-05-29,2022-06-29,PLN3245,1997536841,1997536841,Family Medicine,Out-of-Network,I25.10,F41.9,,,,,,,0,,23472,Surgery,,,0370,22,Outpatient Hospital,1,4948.81,2097.21,1957.34,0.0,0.0,139.87,139.87,0.0,Paid,,,0,,0,0,1,0,0,1,Unbundling,0,0,0,0,0
CLM0000003412,MBR00000132,Institutional-OP,2022-05-16,2022-05-16,2022-06-08,PLN2230,1361302520,1361302520,Critical Access Hospital,In-Network,J20.9,I10,,,,,,,0,,27447,Surgery,,,0301,22,Outpatient Hospital,1,6244.06,4710.07,4710.07,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003413,MBR00000132,Institutional-IP,2021-10-17,2021-10-18,2021-11-14,PLN9187,1361302520,1361302520,Critical Access Hospital,In-Network,F41.9,Z00.00,,,,195,MS-DRG,4,1,N,33533,Surgery,,,0320,21,Inpatient Hospital,3,24403.37,17422.64,14054.56,390.37,0.0,2977.71,3368.08,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000003414,MBR00000132,Institutional-OP,2023-12-30,2023-12-30,2024-01-28,PLN4584,1168881145,1168881145,Orthopedic Surgery,In-Network,I10,E78.5,,,,,,,0,,85025,Pathology/Lab,,,0761,22,Outpatient Hospital,3,64.88,43.69,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000003415,MBR00000132,Professional,2022-02-23,2022-02-23,2022-03-04,PLN3818,1244186984,1244186984,Family Medicine,Out-of-Network,Z12.31,E78.5,,,,,,,0,,23472,Surgery,,,,11,Office,2,3050.45,1197.88,1197.88,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003416,MBR00000132,Institutional-IP,2023-01-05,2023-01-09,2023-02-12,PLN4467,1687650653,1687650653,Internal Medicine,In-Network,E11.9,M54.5,,,,871,MS-DRG,12,4,Y,87491,Pathology/Lab,,,0360,21,Inpatient Hospital,3,172.06,119.09,0.0,119.09,0.0,0.0,119.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003417,MBR00000132,Institutional-OP,2021-06-25,2021-06-25,2021-07-25,PLN5126,1337791138,1337791138,Internal Medicine,Out-of-Network,E11.9,R10.9,,,,,,,0,,90837,Medicine,,,0320,22,Outpatient Hospital,1,239.76,116.58,0.0,116.58,25.0,0.0,141.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003418,MBR00000132,Institutional-IP,2023-12-22,2023-12-25,2024-01-05,PLN5923,1624802371,1624802371,ASC,Out-of-Network,I10,E11.9,,,,871,MS-DRG,2,3,Y,27130,Surgery,,,0510,21,Inpatient Hospital,2,4888.61,3162.22,2959.97,0.0,75.0,127.25,202.25,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003419,MBR00000132,Professional,2023-12-17,2023-12-17,2023-12-29,PLN2159,1561134315,1561134315,DME Supplier,In-Network,I10,Z87.891,,,,,,,0,,66984,Surgery,,,,21,Inpatient Hospital,3,1656.18,979.69,742.52,237.17,0.0,0.0,237.17,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003420,MBR00000132,Institutional-IP,2021-03-17,2021-03-23,2021-04-08,PLN9778,1997536841,1997536841,Family Medicine,Out-of-Network,N18.3,I10,,,,196,MS-DRG,8,6,N,99204,E&M,,,0301,21,Inpatient Hospital,3,215.98,98.59,26.04,72.55,0.0,0.0,72.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003421,MBR00000132,Institutional-OP,2022-12-06,2022-12-06,2023-01-11,PLN7323,1896447406,1896447406,Nephrology,Out-of-Network,E78.5,Z00.00,,,,,,,0,,85610,Pathology/Lab,,,0270,22,Outpatient Hospital,1,74.41,39.14,0.0,39.14,0.0,0.0,39.14,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003422,MBR00000132,Institutional-OP,2022-10-14,2022-10-14,2022-11-23,PLN4488,1745114564,1745114564,Endocrinology,In-Network,E11.9,N18.3,,,,,,,0,,97110,Medicine,,,0120,22,Outpatient Hospital,1,245.17,128.12,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003423,MBR00000132,Professional,2021-07-10,2021-07-10,2021-08-14,PLN5263,1139906830,1139906830,Endocrinology,Out-of-Network,E11.9,E66.9,,,,,,,0,,99204,E&M,,,,23,Emergency Room,2,556.02,323.52,317.91,5.61,0.0,0.0,5.61,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003424,MBR00000132,Professional,2023-04-23,2023-04-23,2023-05-09,PLN2323,1800011727,1800011727,Clinical Laboratory,Out-of-Network,I10,J06.9,,,,,,,0,,G0439,Medicine,,,,11,Office,2,330.57,247.27,204.06,0.0,35.0,8.21,43.21,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000003425,MBR00000132,Professional,2023-04-18,2023-04-18,2023-05-05,PLN8691,1103747954,1103747954,Urology,In-Network,G43.909,N39.0,,,,,,,0,,G0439,Medicine,,,,21,Inpatient Hospital,1,443.64,252.04,252.04,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000003426,MBR00000132,Institutional-IP,2023-07-14,2023-07-22,2023-08-10,PLN7622,1856686341,1856686341,Geriatrics,In-Network,F41.9,J44.1,,,,195,MS-DRG,17,8,Y,70450,Radiology,,,0510,21,Inpatient Hospital,3,1130.88,925.44,882.68,42.76,0.0,0.0,42.76,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003427,MBR00000132,Professional,2022-10-22,2022-10-22,2022-11-12,PLN2829,1518055405,1518055405,Urology,In-Network,K21.0,K21.0,,,,,,,0,,93306,Radiology,,,,21,Inpatient Hospital,1,1793.27,979.28,0.0,78.55,35.0,0.0,113.55,0.0,Denied,CO-18,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000003428,MBR00000132,Institutional-OP,2023-02-14,2023-02-14,2023-03-03,PLN7800,1948810580,1948810580,DME Supplier,In-Network,M54.5,N18.3,,,,,,,0,,86900,Pathology/Lab,,,0730,22,Outpatient Hospital,3,43.18,32.29,7.29,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003429,MBR00000132,Institutional-IP,2023-03-03,2023-03-06,2023-03-26,PLN7405,1244186984,1244186984,Family Medicine,Out-of-Network,Z12.31,Z96.641,,,,292,MS-DRG,15,3,Y,93225,Medicine,,,0900,21,Inpatient Hospital,2,983.71,526.43,188.03,325.05,0.0,13.35,338.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003430,MBR00000133,Professional,2023-04-21,2023-04-21,2023-05-02,PLN1970,1531398223,1531398223,OB/GYN,In-Network,E66.9,I10,,,,,,,0,,76700,Radiology,,,,11,Office,2,873.65,540.76,411.7,0.0,50.0,79.06,129.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003431,MBR00000133,Institutional-OP,2022-10-03,2022-10-03,2022-10-30,PLN6432,1463205530,1463205530,Nephrology,In-Network,Z00.00,J18.9,,,,,,,0,,99214,E&M,,,0360,22,Outpatient Hospital,2,249.79,116.62,0.0,116.62,50.0,0.0,166.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003432,MBR00000133,Professional,2023-03-27,2023-03-27,2023-04-07,PLN7542,1575695214,1575695214,SNF,In-Network,M54.5,B97.89,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,1,44.7,36.74,0.0,36.74,50.0,0.0,86.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000003433,MBR00000133,Professional,2021-03-08,2021-03-08,2021-03-25,PLN5944,1168881145,1168881145,Orthopedic Surgery,In-Network,I25.10,J06.9,,,,,,,0,,99214,E&M,,,,11,Office,2,172.02,93.08,2.47,90.61,0.0,0.0,90.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003434,MBR00000133,Professional,2022-11-08,2022-11-08,2022-12-13,PLN3488,1364429278,1364429278,OB/GYN,In-Network,K21.0,I48.91,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,2,1762.44,766.68,731.68,0.0,35.0,0.0,35.0,0.0,Adjusted,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003435,MBR00000133,Institutional-IP,2021-08-11,2021-08-16,2021-08-28,PLN4295,1910255109,1910255109,DME Supplier,In-Network,F41.9,N18.3,,,,196,MS-DRG,16,5,N,93306,Radiology,,,0450,21,Inpatient Hospital,1,2475.54,1522.29,1214.27,0.0,25.0,283.02,308.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003436,MBR00000133,Institutional-OP,2022-03-22,2022-03-22,2022-03-30,PLN3969,1997536841,1997536841,Family Medicine,Out-of-Network,M81.0,Z23,,,,,,,0,,45378,Surgery,,,0320,22,Outpatient Hospital,2,2317.97,1552.91,1552.91,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003437,MBR00000133,Professional,2023-04-22,2023-04-22,2023-05-27,PLN4243,1660288235,1660288235,ASC,In-Network,F41.9,E78.5,,,,,,,0,,99284,E&M,,,,11,Office,1,521.74,371.47,363.25,0.0,0.0,8.22,8.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003438,MBR00000133,Institutional-OP,2021-05-05,2021-05-05,2021-06-02,PLN2983,1795618275,1795618275,Pulmonology,In-Network,E66.9,E87.6,,,,,,,0,,66984,Surgery,,,0636,22,Outpatient Hospital,1,2855.69,1025.91,661.12,329.79,35.0,0.0,364.79,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003439,MBR00000133,Professional,2023-04-07,2023-04-07,2023-04-19,PLN5741,1728018911,1728018911,Nephrology,In-Network,E11.9,F41.9,,,,,,,0,,23472,Surgery,,,,11,Office,2,2666.42,1013.54,733.5,245.04,35.0,0.0,280.04,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003440,MBR00000133,Professional,2021-10-12,2021-10-12,2021-10-25,PLN5500,1118885473,1118885473,ASC,In-Network,F41.9,Z23,,,,,,,0,,G0444,Medicine,,,,11,Office,3,39.28,17.55,15.1,0.0,0.0,2.45,2.45,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000003441,MBR00000133,Institutional-IP,2023-04-06,2023-04-08,2023-05-10,PLN9281,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,Z00.00,J45.20,,,,194,MS-DRG,16,2,W,99204,E&M,,,0320,21,Inpatient Hospital,1,528.11,312.23,222.35,7.99,50.0,31.89,89.88,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003442,MBR00000133,Institutional-OP,2023-04-20,2023-04-20,2023-05-12,PLN4921,1716521444,1716521444,Oncology,In-Network,J20.9,Z23,,,,,,,0,,90686,Medicine,,,0270,22,Outpatient Hospital,3,67.85,34.99,0.0,34.99,50.0,0.0,84.99,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000003443,MBR00000133,Institutional-OP,2021-01-17,2021-01-17,2021-02-01,PLN6128,1845900543,1845900543,ASC,In-Network,E78.5,Z00.00,,,,,,,0,,47562,Surgery,,,0360,22,Outpatient Hospital,3,5521.52,4654.3,4629.3,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003444,MBR00000133,Institutional-IP,2021-09-13,2021-09-21,2021-10-08,PLN8294,1219817751,1219817751,OB/GYN,In-Network,M17.11,E11.9,,,,194,MS-DRG,24,8,Y,99284,E&M,,,0761,21,Inpatient Hospital,3,816.85,662.15,215.71,396.44,50.0,0.0,446.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003445,MBR00000133,Professional,2023-06-01,2023-06-01,2023-07-14,PLN4844,1530904931,1530904931,Internal Medicine,In-Network,J18.9,I11.9,,,,,,,0,,99214,E&M,,,,31,Skilled Nursing Facility,1,463.54,171.43,27.32,128.35,15.0,0.76,144.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003446,MBR00000133,Professional,2022-01-10,2022-01-10,2022-01-28,PLN8542,1366576336,1366576336,Geriatrics,In-Network,E78.5,Z23,,,,,,,0,,99222,E&M,,,,11,Office,3,314.28,100.44,85.44,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003447,MBR00000133,Professional,2022-04-26,2022-04-26,2022-05-19,PLN7850,1422747896,1422747896,Urology,In-Network,N18.3,G20,,,,,,,0,,43239,Surgery,,,,65,End-Stage Renal Disease,2,2024.27,1489.67,1226.27,188.4,75.0,0.0,263.4,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003448,MBR00000133,Institutional-OP,2021-01-18,2021-01-18,2021-02-18,PLN3345,1366426662,1366426662,Urology,In-Network,I50.9,I63.9,,,,,,,0,,97530,Medicine,,,0370,22,Outpatient Hospital,1,156.65,112.16,0.0,112.16,35.0,0.0,147.16,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003449,MBR00000133,Institutional-IP,2023-01-30,2023-02-01,2023-02-28,PLN8317,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,E66.9,Z00.00,,,,196,MS-DRG,6,2,Y,81001,Pathology/Lab,,,0301,21,Inpatient Hospital,3,29.24,20.6,17.79,0.0,0.0,2.81,2.81,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003450,MBR00000133,Professional,2021-04-13,2021-04-13,2021-05-11,PLN1986,1809014947,1809014947,Urology,In-Network,I10,I50.9,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,3,499.73,368.65,344.49,0.0,0.0,24.16,24.16,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003451,MBR00000133,Professional,2021-10-25,2021-10-25,2021-11-10,PLN1026,1778483301,1778483301,Home Health,In-Network,N39.0,N39.0,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,3,2920.45,2172.26,2172.26,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003452,MBR00000133,Professional,2022-06-07,2022-06-07,2022-06-24,PLN6194,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,R51,J44.1,,,,,,,0,,99233,E&M,,,,81,Independent Laboratory,3,453.81,243.12,101.03,142.09,0.0,0.0,142.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003453,MBR00000133,Institutional-OP,2023-04-23,2023-04-23,2023-05-27,PLN2856,1337791138,1337791138,Internal Medicine,Out-of-Network,Z23,E78.5,,,,,,,0,,99203,E&M,,,0360,22,Outpatient Hospital,2,345.14,166.89,166.89,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003454,MBR00000134,Professional,2022-06-30,2022-06-30,2022-07-28,PLN1251,1717912431,1717912431,Oncology,In-Network,J44.1,I10,,,,,,,0,,99203,E&M,,,,12,Home,1,368.61,298.64,258.35,0.0,15.0,25.29,40.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003455,MBR00000134,Institutional-OP,2023-12-12,2023-12-12,2024-01-10,PLN9757,1273488618,1273488618,General Acute Care Hospital,In-Network,Z23,I10,,,,,,,0,,85610,Pathology/Lab,,,0200,22,Outpatient Hospital,2,32.44,24.56,24.56,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003456,MBR00000134,Professional,2022-07-26,2022-07-26,2022-08-24,PLN2781,1571574052,1571574052,Critical Access Hospital,In-Network,M81.0,Z00.00,,,,,,,0,,93306,Radiology,,,,23,Emergency Room,1,1373.92,478.39,217.18,207.63,25.0,28.58,261.21,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003457,MBR00000134,Institutional-OP,2021-10-05,2021-10-05,2021-11-12,PLN7749,1563980627,1563980627,Critical Access Hospital,In-Network,J18.9,E11.9,,,,,,,0,,99203,E&M,,,0200,22,Outpatient Hospital,3,285.21,141.2,0.0,141.2,0.0,0.0,141.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003458,MBR00000134,Professional,2021-07-28,2021-07-28,2021-09-03,PLN5045,1691062876,1691062876,SNF,In-Network,Z00.01,K21.0,,,,,,,0,,99221,E&M,,,,11,Office,3,356.01,107.52,107.52,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003459,MBR00000134,Professional,2023-05-09,2023-05-09,2023-05-23,PLN5864,1896447406,1896447406,Nephrology,Out-of-Network,G43.909,Z23,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,1,63.96,30.47,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003460,MBR00000134,Professional,2022-05-19,2022-05-19,2022-06-21,PLN3994,1108115157,1108115157,General Acute Care Hospital,In-Network,F41.9,M54.5,,,,,,,0,,99214,E&M,,,,12,Home,1,203.78,140.05,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003461,MBR00000134,Professional,2022-10-25,2022-10-25,2022-11-30,PLN1833,1575695214,1575695214,SNF,In-Network,N39.0,I25.10,,,,,,,0,,99214,E&M,,,,23,Emergency Room,2,378.03,166.11,166.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003462,MBR00000134,Institutional-OP,2022-02-10,2022-02-10,2022-03-14,PLN7835,1168246159,1168246159,Internal Medicine,In-Network,I48.91,J44.1,,,,,,,0,,33533,Surgery,,,0270,22,Outpatient Hospital,3,21148.02,7694.8,7552.11,142.69,0.0,0.0,142.69,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000003463,MBR00000134,Institutional-OP,2021-10-27,2021-10-27,2021-11-10,PLN7642,1132188260,1132188260,Family Medicine,In-Network,I50.9,G20,,,,,,,0,,G0439,Medicine,,,0450,22,Outpatient Hospital,3,324.6,124.38,0.0,124.38,75.0,0.0,199.38,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000003464,MBR00000134,Professional,2022-10-19,2022-10-19,2022-11-14,PLN2619,1438368327,1438368327,Home Health,In-Network,I10,M54.5,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,2,31.88,11.8,11.8,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003465,MBR00000134,Professional,2021-11-19,2021-11-19,2021-12-04,PLN5591,1745114564,1745114564,Endocrinology,In-Network,Z23,E11.65,,,,,,,0,,99222,E&M,,,,23,Emergency Room,3,653.06,308.11,308.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003466,MBR00000134,Professional,2023-12-31,2023-12-31,2024-01-14,PLN9797,1660288235,1660288235,ASC,In-Network,M17.11,J06.9,,,,,,,0,,72148,Radiology,,,,22,Outpatient Hospital,3,2557.63,1624.19,1574.19,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003467,MBR00000134,Institutional-IP,2023-03-13,2023-03-15,2023-04-01,PLN5367,1790497490,1790497490,OB/GYN,In-Network,Z12.31,Z87.891,,,,682,MS-DRG,7,2,Y,85610,Pathology/Lab,,,0270,21,Inpatient Hospital,2,38.95,11.81,11.81,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003468,MBR00000134,Professional,2023-06-17,2023-06-17,2023-06-27,PLN7547,1450553056,1450553056,Clinical Laboratory,In-Network,K21.0,R10.9,,,,,,,0,,27447,Surgery,,,,11,Office,2,2717.37,1998.82,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-11,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003469,MBR00000135,Professional,2021-11-08,2021-11-08,2021-12-10,PLN9211,1575695214,1575695214,SNF,In-Network,F03.90,J06.9,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,2,24954.34,8011.64,0.0,146.96,15.0,297.78,459.74,0.0,Denied,PR-1,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000003470,MBR00000135,Professional,2021-02-02,2021-02-02,2021-03-13,PLN7051,1224179551,1224179551,Physical Therapy,In-Network,M54.5,F32.9,,,,,,,0,,G0439,Medicine,,,,22,Outpatient Hospital,2,351.17,276.24,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-18,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000003471,MBR00000135,Institutional-OP,2021-02-22,2021-02-22,2021-03-20,PLN6756,1168246159,1168246159,Internal Medicine,In-Network,E11.9,E11.9,,,,,,,0,,80053,Pathology/Lab,,,0370,22,Outpatient Hospital,3,54.71,43.23,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003472,MBR00000135,Professional,2023-07-30,2023-07-30,2023-08-20,PLN1482,1865904917,1865904917,Outpatient Clinic,In-Network,S72.001A,F32.9,,,,,,,0,,58661,Surgery,,,,21,Inpatient Hospital,3,3746.93,1972.56,1897.56,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003473,MBR00000135,Institutional-OP,2023-08-15,2023-08-15,2023-08-24,PLN3485,1845900543,1845900543,ASC,In-Network,F41.9,F32.9,,,,,,,0,,99213,E&M,,,0740,22,Outpatient Hospital,2,225.85,118.22,0.0,118.22,0.0,0.0,118.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003474,MBR00000135,Institutional-OP,2023-01-15,2023-01-15,2023-02-05,PLN7709,1910255109,1910255109,DME Supplier,In-Network,E66.9,F10.20,,,,,,,0,,99284,E&M,,,0301,22,Outpatient Hospital,3,444.93,223.57,223.57,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003475,MBR00000135,Professional,2022-10-07,2022-10-07,2022-10-23,PLN7438,1366286000,1366286000,SNF,In-Network,Z12.31,I48.91,,,,,,,0,,99222,E&M,,,,11,Office,3,629.24,333.34,258.22,75.12,0.0,0.0,75.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003476,MBR00000135,Professional,2021-08-18,2021-08-18,2021-09-10,PLN7407,1575695214,1575695214,SNF,In-Network,E11.9,E78.5,,,,,,,0,,77067,Radiology,,,,22,Outpatient Hospital,3,730.38,321.0,321.0,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000003477,MBR00000135,Professional,2023-04-11,2023-04-11,2023-04-29,PLN5175,1135158374,1135158374,Pulmonology,In-Network,Z00.00,I10,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,2,1268.77,811.64,0.0,380.62,25.0,0.0,405.62,0.0,Denied,CO-29,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003478,MBR00000135,Institutional-IP,2022-07-20,2022-07-25,2022-08-26,PLN9218,1283743001,1283743001,Family Medicine,In-Network,E78.5,E11.9,,,,292,MS-DRG,14,5,N,74177,Radiology,,,0740,21,Inpatient Hospital,3,2859.32,2125.25,2100.25,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000003479,MBR00000135,Professional,2022-10-23,2022-10-23,2022-11-06,PLN3438,1935547131,1935547131,Pulmonology,In-Network,N17.9,F32.9,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,2,268.29,112.54,77.54,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003480,MBR00000135,Professional,2021-01-27,2021-01-27,2021-02-21,PLN8081,1268679390,1268679390,Critical Access Hospital,In-Network,K21.0,I11.9,,,,,,,0,,47562,Surgery,,,,31,Skilled Nursing Facility,1,3389.89,1910.17,1910.17,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003481,MBR00000135,Professional,2022-07-20,2022-07-20,2022-07-30,PLN4636,1935547131,1935547131,Pulmonology,In-Network,Z00.00,M17.11,,,,,,,0,,70450,Radiology,,,,20,Urgent Care,2,743.48,560.61,519.54,0.0,35.0,6.07,41.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003482,MBR00000135,Institutional-IP,2023-01-30,2023-02-01,2023-03-10,PLN9325,1795618275,1795618275,Pulmonology,In-Network,Z00.00,E11.9,,,,196,MS-DRG,7,2,Y,G0444,Medicine,,,0301,21,Inpatient Hospital,2,81.04,41.53,0.0,0.0,0.0,4.99,4.99,0.0,Denied,CO-15,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000003483,MBR00000135,Institutional-OP,2023-04-24,2023-04-24,2023-05-18,PLN7821,1990090423,1990090423,Orthopedic Surgery,In-Network,E11.65,J45.20,,,,,,,0,,99214,E&M,,,0301,22,Outpatient Hospital,1,347.42,180.54,180.54,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003484,MBR00000135,Professional,2021-06-09,2021-06-09,2021-06-16,PLN7114,1475984649,1475984649,SNF,In-Network,Z12.31,E66.9,,,,,,,0,,99233,E&M,,,,20,Urgent Care,2,366.16,237.73,228.34,0.0,0.0,9.39,9.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003485,MBR00000135,Institutional-OP,2021-02-05,2021-02-05,2021-03-19,PLN4439,1609526529,1609526529,Psychiatry,In-Network,E11.9,E78.5,,,,,,,0,,90837,Medicine,,,0360,22,Outpatient Hospital,1,333.21,172.46,0.0,172.46,50.0,0.0,222.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003486,MBR00000135,Professional,2023-07-26,2023-07-26,2023-08-17,PLN3867,1355166277,1355166277,Endocrinology,In-Network,G43.909,M17.11,,,,,,,0,,99232,E&M,,,,23,Emergency Room,1,277.63,199.42,184.42,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003487,MBR00000135,Professional,2021-12-08,2021-12-08,2022-01-08,PLN2394,1609526529,1609526529,Psychiatry,In-Network,E11.9,I10,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,3,2493.91,1844.73,1809.73,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003488,MBR00000135,Professional,2022-06-02,2022-06-02,2022-06-25,PLN4448,1872613201,1872613201,Internal Medicine,In-Network,F41.9,E11.40,,,,,,,0,,G0444,Medicine,,,,21,Inpatient Hospital,3,68.23,29.62,28.22,0.0,0.0,1.4,1.4,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000003489,MBR00000135,Institutional-OP,2022-11-19,2022-11-19,2022-11-30,PLN1741,1872272835,1872272835,Internal Medicine,In-Network,M54.5,I10,,,,,,,0,,58661,Surgery,,,0370,22,Outpatient Hospital,2,4618.46,3407.5,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-15,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003490,MBR00000135,Institutional-IP,2022-06-23,2022-06-27,2022-07-07,PLN8396,1872272835,1872272835,Internal Medicine,In-Network,J06.9,S72.001A,,,,872,MS-DRG,24,4,N,93306,Radiology,,,0360,21,Inpatient Hospital,3,2967.38,1326.69,1067.15,259.54,0.0,0.0,259.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003491,MBR00000135,Professional,2023-10-31,2023-10-31,2023-12-10,PLN3745,1990090423,1990090423,Orthopedic Surgery,In-Network,E11.9,F41.9,,,,,,,0,,99284,E&M,,,,11,Office,3,713.65,422.23,114.44,292.79,15.0,0.0,307.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003492,MBR00000135,Professional,2023-07-12,2023-07-12,2023-08-23,PLN9291,1609526529,1609526529,Psychiatry,In-Network,E78.5,J18.9,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,1,126.4,94.36,0.0,94.36,25.0,0.0,119.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003493,MBR00000135,Professional,2022-03-08,2022-03-08,2022-04-16,PLN3687,1564502315,1564502315,ASC,In-Network,I10,J06.9,,,,,,,0,,G0468,Medicine,,,,65,End-Stage Renal Disease,2,740.53,590.73,457.05,118.68,15.0,0.0,133.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003494,MBR00000135,Professional,2021-07-29,2021-07-29,2021-08-18,PLN3877,1569105090,1569105090,Geriatrics,In-Network,Z00.01,F32.9,,,,,,,0,,66984,Surgery,,,,11,Office,3,2975.38,1841.74,1308.72,473.59,0.0,59.43,533.02,0.0,Adjusted,,,1,,0,0,1,0,0,1,Phantom,0,0,0,0,0
CLM0000003495,MBR00000135,Professional,2023-12-04,2023-12-04,2024-01-08,PLN8477,1390307371,1390307371,DME Supplier,In-Network,Z23,I25.10,,,,,,,0,,97110,Medicine,,,,23,Emergency Room,3,124.04,44.33,0.0,44.33,25.0,0.0,69.33,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003496,MBR00000135,Professional,2023-02-15,2023-02-15,2023-03-21,PLN4213,1564502315,1564502315,ASC,In-Network,E11.65,E78.5,,,,,,,0,,99204,E&M,,,,11,Office,1,223.86,143.27,143.27,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003497,MBR00000135,Professional,2023-04-08,2023-04-08,2023-05-05,PLN2303,1245650222,1245650222,Gastroenterology,In-Network,Z23,F41.9,,,,,,,0,,85610,Pathology/Lab,,,,22,Outpatient Hospital,1,66.43,45.15,0.0,45.15,0.0,0.0,45.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003498,MBR00000135,Professional,2022-05-24,2022-05-24,2022-06-28,PLN3032,1193493783,1193493783,Critical Access Hospital,Out-of-Network,E11.9,I11.9,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,1,227.71,173.01,173.01,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003499,MBR00000135,Professional,2022-06-15,2022-06-15,2022-07-03,PLN2110,1434029575,1434029575,Endocrinology,In-Network,F41.9,E78.5,,,,,,,0,,97110,Medicine,,,,11,Office,3,215.67,66.17,44.58,0.0,15.0,6.59,21.59,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003500,MBR00000135,Professional,2021-07-19,2021-07-19,2021-08-12,PLN8006,1800011727,1800011727,Clinical Laboratory,Out-of-Network,I50.9,I10,,,,,,,0,,99284,E&M,,,,11,Office,3,651.29,385.48,370.48,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003501,MBR00000135,Institutional-IP,2022-04-15,2022-04-24,2022-05-26,PLN2861,1964402759,1964402759,Outpatient Clinic,In-Network,Z00.00,F41.9,,,,195,MS-DRG,24,9,Y,76700,Radiology,,,0270,21,Inpatient Hospital,1,545.49,294.83,0.0,294.83,0.0,0.0,294.83,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003502,MBR00000135,Professional,2022-08-18,2022-08-18,2022-09-09,PLN5068,1545347862,1545347862,SNF,In-Network,I10,R05,,,,,,,0,,99233,E&M,,,,11,Office,3,230.8,166.23,0.0,166.23,0.0,0.0,166.23,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003503,MBR00000135,Institutional-IP,2021-05-22,2021-05-27,2021-06-11,PLN7925,1224179551,1224179551,Physical Therapy,In-Network,I48.91,E11.9,,,,682,MS-DRG,8,5,Y,99214,E&M,,,0900,21,Inpatient Hospital,1,232.4,103.03,0.0,103.03,15.0,0.0,118.03,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003504,MBR00000135,Professional,2022-11-27,2022-11-27,2022-12-14,PLN1150,1631954542,1631954542,Oncology,In-Network,J06.9,Z23,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,2,299.35,246.59,6.67,164.92,75.0,0.0,239.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003505,MBR00000135,Professional,2022-11-05,2022-11-05,2022-11-16,PLN3306,1691062876,1691062876,SNF,In-Network,Z51.11,E11.9,,,,,,,0,,99233,E&M,,,,11,Office,1,409.63,240.02,172.5,0.0,35.0,32.52,67.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003506,MBR00000135,Professional,2023-07-10,2023-07-10,2023-07-21,PLN8471,1564502315,1564502315,ASC,In-Network,I10,M54.5,,,,,,,0,,58661,Surgery,,,,11,Office,2,1702.12,749.86,405.63,344.23,0.0,0.0,344.23,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003507,MBR00000135,Professional,2021-02-27,2021-02-27,2021-04-04,PLN4730,1242201429,1242201429,General Acute Care Hospital,In-Network,E66.9,F41.9,,,,,,,0,,85610,Pathology/Lab,,,,21,Inpatient Hospital,1,46.46,19.86,0.0,19.86,0.0,0.0,19.86,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003508,MBR00000136,Institutional-OP,2021-09-05,2021-09-05,2021-09-22,PLN6318,1124394415,1124394415,Pediatrics,In-Network,N18.3,J06.9,,,,,,,0,,99203,E&M,,,0120,22,Outpatient Hospital,3,176.87,108.52,0.0,108.52,0.0,0.0,108.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003509,MBR00000136,Professional,2022-04-15,2022-04-15,2022-04-29,PLN6939,1124394415,1124394415,Pediatrics,In-Network,I10,I10,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,1,333.1,153.72,0.0,153.72,15.0,0.0,168.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003510,MBR00000136,Professional,2023-08-22,2023-08-22,2023-10-01,PLN7312,1410468316,1410468316,SNF,In-Network,Z00.00,J06.9,,,,,,,0,,23472,Surgery,,,,50,Federally Qualified Health Center,2,5136.78,2412.75,2242.03,170.72,0.0,0.0,170.72,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003511,MBR00000136,Professional,2021-09-18,2021-09-18,2021-10-15,PLN3349,1795618275,1795618275,Pulmonology,In-Network,E87.6,E78.5,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,2,1990.26,1548.66,1458.84,89.82,0.0,0.0,89.82,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000003512,MBR00000136,Professional,2023-12-01,2023-12-01,2023-12-19,PLN1886,1545347862,1545347862,SNF,In-Network,Z23,F41.9,,,,,,,0,,23472,Surgery,,,,12,Home,1,6728.46,2947.13,2922.13,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003513,MBR00000137,Institutional-OP,2023-11-14,2023-11-14,2023-12-15,PLN3436,1865904917,1865904917,Outpatient Clinic,In-Network,E11.9,K21.0,,,,,,,0,,71046,Radiology,,,0120,22,Outpatient Hospital,3,132.19,46.83,0.0,46.83,0.0,0.0,46.83,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003514,MBR00000137,Institutional-OP,2021-04-14,2021-04-14,2021-05-07,PLN1627,1727809972,1727809972,Home Health,In-Network,I10,I50.9,,,,,,,0,,90837,Medicine,,,0270,22,Outpatient Hospital,3,254.78,99.22,74.22,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003515,MBR00000137,Professional,2022-02-02,2022-02-02,2022-02-10,PLN5792,1193493783,1193493783,Critical Access Hospital,Out-of-Network,J06.9,E66.9,,,,,,,0,,99221,E&M,,,,11,Office,2,305.08,227.94,152.94,0.0,75.0,0.0,75.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003516,MBR00000137,Professional,2021-10-11,2021-10-11,2021-10-30,PLN8946,1872613201,1872613201,Internal Medicine,In-Network,F32.9,E11.9,,,,,,,0,,72148,Radiology,,,,23,Emergency Room,2,2480.61,1587.55,1123.55,171.86,35.0,257.14,464.0,0.0,Paid,,,0,,1,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000003517,MBR00000137,Professional,2022-06-20,2022-06-20,2022-07-17,PLN9544,1606140917,1606140917,ASC,In-Network,F41.9,N18.3,,,,,,,0,,85610,Pathology/Lab,,,,65,End-Stage Renal Disease,3,70.84,55.76,0.0,55.76,35.0,0.0,90.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003518,MBR00000137,Professional,2023-10-10,2023-10-10,2023-10-27,PLN3695,1313212303,1313212303,Family Medicine,In-Network,S72.001A,I10,,,,,,,0,,27130,Surgery,,,,23,Emergency Room,2,4875.31,4121.2,3122.65,454.52,0.0,544.03,998.55,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003519,MBR00000137,Professional,2022-02-16,2022-02-16,2022-03-28,PLN8999,1910255109,1910255109,DME Supplier,In-Network,I10,N18.3,,,,,,,0,,99232,E&M,,,,11,Office,2,381.23,272.82,257.82,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003520,MBR00000137,Professional,2022-12-27,2022-12-27,2023-01-19,PLN8485,1727809972,1727809972,Home Health,In-Network,J18.9,R07.9,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,3,21792.73,11404.72,11354.72,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000003521,MBR00000137,Professional,2021-05-31,2021-05-31,2021-06-26,PLN7533,1500949740,1500949740,Pediatrics,In-Network,R05,I63.9,,,,,,,0,,81001,Pathology/Lab,,,,31,Skilled Nursing Facility,2,56.23,29.88,29.88,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003522,MBR00000137,Professional,2022-09-17,2022-09-17,2022-10-14,PLN3000,1860435061,1860435061,DME Supplier,In-Network,Z00.00,N18.3,,,,,,,0,,99283,E&M,,,,11,Office,1,375.54,154.07,115.11,0.0,25.0,13.96,38.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003523,MBR00000137,Professional,2022-01-22,2022-01-22,2022-02-28,PLN8568,1644128543,1644128543,Gastroenterology,In-Network,J18.9,Z23,,,,,,,0,,74177,Radiology,,,,11,Office,1,1556.28,1089.6,965.34,0.0,0.0,124.26,124.26,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003524,MBR00000137,Institutional-IP,2023-10-02,2023-10-07,2023-10-29,PLN5080,1563980627,1563980627,Critical Access Hospital,In-Network,Z23,I10,,,,291,MS-DRG,20,5,Y,99283,E&M,,,0270,21,Inpatient Hospital,3,542.04,165.19,150.19,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003525,MBR00000137,Institutional-OP,2023-05-04,2023-05-04,2023-05-30,PLN3205,1575695214,1575695214,SNF,In-Network,E78.5,E78.5,,,,,,,0,,70450,Radiology,,,0200,22,Outpatient Hospital,2,1276.76,1075.7,803.62,197.08,75.0,0.0,272.08,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003526,MBR00000137,Professional,2021-08-24,2021-08-24,2021-09-30,PLN5708,1727809972,1727809972,Home Health,In-Network,Z12.31,E78.5,,,,,,,0,,43239,Surgery,,,,11,Office,2,1619.17,1365.11,760.25,486.95,15.0,102.91,604.86,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003527,MBR00000137,Institutional-OP,2022-11-12,2022-11-12,2022-12-23,PLN1046,1518055405,1518055405,Urology,In-Network,Z23,M17.11,,,,,,,0,,80061,Pathology/Lab,,,0636,22,Outpatient Hospital,1,114.01,73.61,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003528,MBR00000137,Professional,2022-01-10,2022-01-10,2022-02-01,PLN5576,1727809972,1727809972,Home Health,In-Network,I10,I10,,,,,,,0,,99284,E&M,,,,50,Federally Qualified Health Center,3,722.5,445.85,0.0,354.17,75.0,0.0,429.17,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003529,MBR00000137,Professional,2022-04-24,2022-04-24,2022-05-21,PLN8757,1809014947,1809014947,Urology,In-Network,E11.9,Z00.00,,,,,,,0,,90837,Medicine,,,,11,Office,1,261.54,119.18,12.8,81.38,25.0,0.0,106.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003530,MBR00000137,Institutional-IP,2022-05-22,2022-05-26,2022-06-15,PLN5542,1355166277,1355166277,Endocrinology,In-Network,Z00.00,E11.65,,,,196,MS-DRG,4,4,N,71046,Radiology,,,0301,21,Inpatient Hospital,2,143.66,85.81,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-15,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003531,MBR00000137,Professional,2023-06-18,2023-06-18,2023-06-25,PLN3309,1135158374,1135158374,Pulmonology,In-Network,R10.9,I25.10,,,,,,,0,,70553,Radiology,,,,49,Independent Clinic,2,1667.76,894.56,756.62,0.0,25.0,112.94,137.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003532,MBR00000137,Institutional-OP,2021-11-14,2021-11-14,2021-12-09,PLN8837,1186826716,1186826716,Physical Therapy,In-Network,Z96.641,J06.9,,,,,,,0,,86900,Pathology/Lab,,,0636,22,Outpatient Hospital,1,51.73,16.34,0.0,16.34,50.0,0.0,66.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003533,MBR00000137,Institutional-OP,2021-01-05,2021-01-05,2021-01-30,PLN9556,1500037969,1500037969,Pulmonology,In-Network,K21.0,J18.9,,,,,,,0,,99213,E&M,,,0120,22,Outpatient Hospital,3,235.8,167.79,167.79,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003534,MBR00000137,Professional,2021-07-31,2021-07-31,2021-08-23,PLN9209,1749327647,1749327647,Geriatrics,In-Network,J06.9,E78.5,,,,,,,0,,99214,E&M,,,,50,Federally Qualified Health Center,2,274.56,95.95,95.95,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003535,MBR00000137,Professional,2023-06-25,2023-06-25,2023-07-20,PLN1655,1571574052,1571574052,Critical Access Hospital,In-Network,B97.89,Z79.4,,,,,,,0,,99283,E&M,,,,23,Emergency Room,1,272.28,106.94,30.83,0.0,75.0,1.11,76.11,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003536,MBR00000137,Professional,2021-11-21,2021-11-21,2021-12-22,PLN4438,1500949740,1500949740,Pediatrics,In-Network,I11.9,E66.9,,,,,,,0,,99283,E&M,,,,11,Office,2,304.05,156.81,121.81,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003537,MBR00000137,Institutional-OP,2021-03-07,2021-03-07,2021-03-15,PLN3363,1239316214,1239316214,Internal Medicine,In-Network,Z79.4,J18.9,,,,,,,0,,99203,E&M,,,0320,22,Outpatient Hospital,2,307.96,229.41,229.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003538,MBR00000137,Professional,2022-03-15,2022-03-15,2022-04-03,PLN5049,1840431511,1840431511,Geriatrics,Out-of-Network,M17.11,R10.9,,,,,,,0,,93225,Medicine,,,,21,Inpatient Hospital,3,440.95,369.2,0.0,369.2,50.0,0.0,419.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003539,MBR00000137,Institutional-OP,2023-08-11,2023-08-11,2023-09-13,PLN7389,1273488618,1273488618,General Acute Care Hospital,In-Network,J06.9,Z12.31,,,,,,,0,,27447,Surgery,,,0301,22,Outpatient Hospital,2,4429.49,2910.22,2177.81,379.24,0.0,353.17,732.41,0.0,Paid,,,0,,0,0,1,0,0,1,Phantom,0,0,0,0,0
CLM0000003540,MBR00000137,Professional,2023-08-15,2023-08-15,2023-08-27,PLN9748,1434029575,1434029575,Endocrinology,In-Network,N17.9,I10,,,,,,,0,,99284,E&M,,,,11,Office,2,581.92,397.29,397.29,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003541,MBR00000137,Institutional-IP,2023-11-04,2023-11-06,2023-12-04,PLN3499,1337791138,1337791138,Internal Medicine,Out-of-Network,F32.9,Z79.4,,,,194,MS-DRG,20,2,Y,80053,Pathology/Lab,,,0200,21,Inpatient Hospital,3,124.62,58.24,46.97,0.0,0.0,11.27,11.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003542,MBR00000137,Professional,2023-01-19,2023-01-19,2023-02-20,PLN8664,1606140917,1606140917,ASC,In-Network,J44.1,E11.65,,,,,,,0,,43239,Surgery,,,,11,Office,1,2014.82,630.36,212.71,417.65,0.0,0.0,417.65,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003543,MBR00000137,Institutional-OP,2023-06-16,2023-06-16,2023-07-11,PLN2057,1622771872,1622771872,Pediatrics,In-Network,I10,E78.5,,,,,,,0,,99214,E&M,,,0510,22,Outpatient Hospital,3,444.2,223.97,198.97,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003544,MBR00000137,Institutional-IP,2023-04-27,2023-05-07,2023-06-04,PLN5917,1247341320,1247341320,Urology,Out-of-Network,Z00.00,N39.0,,,,291,MS-DRG,16,10,N,97110,Medicine,,,0636,21,Inpatient Hospital,2,287.09,236.07,225.84,10.23,0.0,0.0,10.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003545,MBR00000137,Professional,2021-01-22,2021-01-22,2021-02-14,PLN8481,1475984649,1475984649,SNF,In-Network,N20.0,E11.9,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,3,40.7,18.65,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003546,MBR00000137,Professional,2022-04-03,2022-04-03,2022-04-17,PLN3645,1806688928,1806688928,Geriatrics,In-Network,N18.3,J06.9,,,,,,,0,,70450,Radiology,,,,22,Outpatient Hospital,3,1461.49,1205.15,1205.15,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003547,MBR00000137,Professional,2022-07-31,2022-07-31,2022-08-20,PLN7567,1745114564,1745114564,Endocrinology,In-Network,M17.11,Z12.31,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,3,4822.87,3319.48,3283.54,0.0,0.0,35.94,35.94,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003548,MBR00000137,Professional,2022-05-23,2022-05-23,2022-06-19,PLN4461,1193493783,1193493783,Critical Access Hospital,Out-of-Network,Z00.00,Z00.00,,,,,,,0,,99284,E&M,,,,81,Independent Laboratory,3,635.64,203.83,128.83,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003549,MBR00000137,Institutional-OP,2023-06-27,2023-06-27,2023-08-03,PLN3679,1563980627,1563980627,Critical Access Hospital,In-Network,E78.5,K21.0,,,,,,,0,,23472,Surgery,,,0120,22,Outpatient Hospital,1,5611.4,4071.76,4021.76,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003550,MBR00000137,Professional,2023-12-12,2023-12-12,2023-12-28,PLN1498,1364429278,1364429278,OB/GYN,In-Network,Z23,I25.10,,,,,,,0,,45378,Surgery,,,,11,Office,2,2221.59,1189.76,1062.73,0.0,0.0,127.03,127.03,0.0,Pended,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003551,MBR00000137,Institutional-OP,2022-08-20,2022-08-20,2022-09-28,PLN1756,1990090423,1990090423,Orthopedic Surgery,In-Network,E66.9,G43.909,,,,,,,0,,45378,Surgery,,,0320,22,Outpatient Hospital,1,2378.28,817.29,746.06,0.0,35.0,36.23,71.23,0.0,Paid,,,0,,0,1,1,0,0,1,Unbundling,0,1,0,0,0
CLM0000003552,MBR00000137,Professional,2021-04-16,2021-04-16,2021-05-06,PLN1018,1609138981,1609138981,Critical Access Hospital,In-Network,F41.9,M54.5,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,2,3786.55,3086.62,0.0,6.93,25.0,312.84,344.77,0.0,Denied,CO-15,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003553,MBR00000137,Institutional-OP,2022-01-30,2022-01-30,2022-02-22,PLN2318,1235381502,1235381502,Cardiology,In-Network,M54.5,F10.20,,,,,,,0,,27130,Surgery,,,0200,22,Outpatient Hospital,3,2904.51,2262.87,1930.36,271.69,50.0,10.82,332.51,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003554,MBR00000137,Institutional-OP,2021-08-05,2021-08-05,2021-08-14,PLN4465,1125190055,1125190055,Nephrology,In-Network,I10,M54.5,,,,,,,0,,93306,Radiology,,,0360,22,Outpatient Hospital,2,1611.66,1258.26,1113.47,109.79,35.0,0.0,144.79,0.0,Adjusted,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003555,MBR00000137,Institutional-IP,2022-05-31,2022-06-06,2022-06-29,PLN9734,1242201429,1242201429,General Acute Care Hospital,In-Network,M54.5,Z23,,,,682,MS-DRG,10,6,Y,99221,E&M,,,0360,21,Inpatient Hospital,1,393.86,285.85,285.85,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000003556,MBR00000137,Institutional-OP,2021-09-14,2021-09-14,2021-10-17,PLN2220,1727809972,1727809972,Home Health,In-Network,M54.5,I25.10,,,,,,,0,,99284,E&M,,,0200,22,Outpatient Hospital,3,661.24,437.43,437.43,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003557,MBR00000137,Professional,2021-03-30,2021-03-30,2021-05-07,PLN6161,1700633438,1700633438,DME Supplier,In-Network,Z79.4,N39.0,,,,,,,0,,45380,Surgery,,,,23,Emergency Room,3,2386.08,1605.67,1235.74,344.93,25.0,0.0,369.93,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,1,0,0,0
CLM0000003558,MBR00000137,Institutional-IP,2021-07-07,2021-07-10,2021-07-23,PLN3508,1540044947,1540044947,Pulmonology,Out-of-Network,K92.1,E11.65,,,,195,MS-DRG,16,3,Y,G0468,Medicine,,,0270,21,Inpatient Hospital,1,631.78,445.83,418.66,12.17,15.0,0.0,27.17,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003559,MBR00000137,Professional,2022-06-28,2022-06-28,2022-07-27,PLN7735,1974006077,1974006077,Orthopedic Surgery,In-Network,M54.5,E78.5,,,,,,,0,,90686,Medicine,,,,11,Office,2,70.07,39.26,0.0,39.26,0.0,0.0,39.26,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000003560,MBR00000137,Professional,2021-06-04,2021-06-04,2021-07-18,PLN9643,1245650222,1245650222,Gastroenterology,In-Network,E78.5,B97.89,,,,,,,0,,93306,Radiology,,,,22,Outpatient Hospital,2,2630.08,1752.38,1318.3,384.08,50.0,0.0,434.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003561,MBR00000137,Institutional-IP,2021-01-31,2021-02-06,2021-02-13,PLN3764,1438368327,1438368327,Home Health,In-Network,I11.9,F41.9,,,,682,MS-DRG,19,6,Y,93000,Radiology,,,0761,21,Inpatient Hospital,3,86.94,37.35,12.25,0.0,25.0,0.1,25.1,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003562,MBR00000137,Institutional-OP,2021-11-04,2021-11-04,2021-11-29,PLN1786,1168881145,1168881145,Orthopedic Surgery,In-Network,M54.5,Z00.00,,,,,,,0,,23472,Surgery,,,0200,22,Outpatient Hospital,3,5437.24,1691.4,1389.7,301.7,0.0,0.0,301.7,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003563,MBR00000138,Institutional-OP,2022-12-07,2022-12-07,2023-01-01,PLN9236,1717546253,1717546253,Family Medicine,In-Network,J44.1,J20.9,,,,,,,0,,99284,E&M,,,0120,22,Outpatient Hospital,3,395.65,265.89,213.68,0.0,0.0,52.21,52.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003564,MBR00000138,Institutional-IP,2022-11-22,2022-11-25,2023-01-03,PLN1564,1313212303,1313212303,Family Medicine,In-Network,I10,C50.912,,,,682,MS-DRG,7,3,N,23472,Surgery,,,0120,21,Inpatient Hospital,3,3867.62,2475.35,2460.35,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003565,MBR00000138,Institutional-OP,2022-03-04,2022-03-04,2022-03-17,PLN6367,1575695214,1575695214,SNF,In-Network,E78.5,F32.9,,,,,,,0,,74177,Radiology,,,0320,22,Outpatient Hospital,3,2110.11,1162.51,1162.51,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003566,MBR00000138,Institutional-OP,2022-12-28,2022-12-28,2023-01-21,PLN6329,1752470395,1752470395,Home Health,In-Network,E11.9,Z23,,,,,,,0,,90460,Medicine,,,0370,22,Outpatient Hospital,1,74.51,60.52,36.74,0.0,15.0,8.78,23.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003567,MBR00000138,Institutional-OP,2021-07-29,2021-07-29,2021-08-09,PLN2400,1500949740,1500949740,Pediatrics,In-Network,E11.9,N39.0,,,,,,,0,,58661,Surgery,,,0320,22,Outpatient Hospital,2,2905.46,1950.63,1950.63,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003568,MBR00000138,Professional,2023-03-03,2023-03-03,2023-04-02,PLN7725,1410468316,1410468316,SNF,In-Network,E11.9,M17.11,,,,,,,0,,99214,E&M,,,,81,Independent Laboratory,3,360.24,148.36,148.36,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003569,MBR00000138,Professional,2021-01-20,2021-01-20,2021-02-09,PLN6101,1865904917,1865904917,Outpatient Clinic,In-Network,F41.9,J44.1,,,,,,,0,,99233,E&M,,,,11,Office,2,520.72,190.07,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003570,MBR00000138,Professional,2021-05-28,2021-05-28,2021-07-06,PLN9642,1609526529,1609526529,Psychiatry,In-Network,Z23,E78.5,,,,,,,0,,45378,Surgery,,,,11,Office,3,1411.78,807.33,744.58,0.0,25.0,37.75,62.75,0.0,Pended,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003571,MBR00000138,Institutional-OP,2023-10-07,2023-10-07,2023-11-18,PLN7957,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,E66.9,M54.5,,,,,,,0,,45378,Surgery,,,0740,22,Outpatient Hospital,1,2394.32,1336.34,1336.34,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003572,MBR00000138,Institutional-IP,2022-05-28,2022-05-29,2022-06-17,PLN4423,1948810580,1948810580,DME Supplier,In-Network,E78.5,F10.20,,,,194,MS-DRG,24,1,Y,99406,Medicine,,,0200,21,Inpatient Hospital,3,83.26,33.41,28.46,0.0,0.0,4.95,4.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003573,MBR00000138,Institutional-OP,2022-09-02,2022-09-02,2022-09-25,PLN5787,1990090423,1990090423,Orthopedic Surgery,In-Network,Z12.31,E11.9,,,,,,,0,,99204,E&M,,,0740,22,Outpatient Hospital,3,292.23,127.07,14.41,62.66,50.0,0.0,112.66,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000003574,MBR00000138,Institutional-OP,2022-03-12,2022-03-12,2022-04-24,PLN3876,1860435061,1860435061,DME Supplier,In-Network,E78.5,M54.5,,,,,,,0,,99284,E&M,,,0360,22,Outpatient Hospital,1,603.37,509.53,451.39,43.14,15.0,0.0,58.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003575,MBR00000138,Institutional-IP,2022-12-10,2022-12-17,2022-12-28,PLN7655,1463205530,1463205530,Nephrology,In-Network,Z12.31,K21.0,,,,470,MS-DRG,1,7,Y,99284,E&M,,,0200,21,Inpatient Hospital,3,807.97,293.22,266.35,0.0,0.0,26.87,26.87,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000003576,MBR00000138,Institutional-OP,2023-03-31,2023-03-31,2023-05-14,PLN7413,1168246159,1168246159,Internal Medicine,In-Network,I10,E78.5,,,,,,,0,,71046,Radiology,,,0510,22,Outpatient Hospital,2,216.86,180.42,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003577,MBR00000138,Institutional-IP,2023-05-04,2023-05-16,2023-05-16,PLN5657,1239316214,1239316214,Internal Medicine,In-Network,I10,M54.5,,,,872,MS-DRG,13,12,Y,G0439,Medicine,,,0200,21,Inpatient Hospital,1,522.07,197.79,197.79,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000003578,MBR00000138,Institutional-IP,2021-09-30,2021-10-08,2021-11-12,PLN2676,1390307371,1390307371,DME Supplier,In-Network,Z79.4,I10,,,,872,MS-DRG,2,8,Y,70553,Radiology,,,0120,21,Inpatient Hospital,1,2441.91,1656.84,1370.88,0.0,0.0,285.96,285.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003579,MBR00000138,Professional,2022-11-18,2022-11-18,2022-12-01,PLN5491,1910255109,1910255109,DME Supplier,In-Network,E78.5,F32.9,,,,,,,0,,87491,Pathology/Lab,,,,22,Outpatient Hospital,1,133.5,82.98,82.98,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003580,MBR00000138,Institutional-OP,2023-05-09,2023-05-09,2023-06-13,PLN3301,1974006077,1974006077,Orthopedic Surgery,In-Network,Z00.00,N20.0,,,,,,,0,,77067,Radiology,,,0900,22,Outpatient Hospital,2,754.85,233.85,233.85,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000003581,MBR00000138,Institutional-OP,2022-03-29,2022-03-29,2022-04-09,PLN2927,1502838586,1502838586,ASC,In-Network,F32.9,Z51.11,,,,,,,0,,G0439,Medicine,,,0320,22,Outpatient Hospital,1,410.16,254.85,163.99,0.0,75.0,15.86,90.86,0.0,Adjusted,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000003582,MBR00000138,Institutional-OP,2022-02-23,2022-02-23,2022-03-24,PLN1475,1687650653,1687650653,Internal Medicine,In-Network,E11.9,Z79.4,,,,,,,0,,77067,Radiology,,,0761,22,Outpatient Hospital,2,692.04,402.31,345.45,0.0,0.0,56.86,56.86,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000003583,MBR00000138,Professional,2022-11-19,2022-11-19,2022-12-26,PLN7415,1713934949,1713934949,Neurology,In-Network,E11.65,F41.9,,,,,,,0,,74177,Radiology,,,,11,Office,1,2846.01,2213.63,2138.63,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003584,MBR00000138,Professional,2022-09-21,2022-09-21,2022-10-31,PLN4972,1717912431,1717912431,Oncology,In-Network,R10.9,E66.9,,,,,,,0,,93225,Medicine,,,,11,Office,3,992.19,576.13,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003585,MBR00000138,Institutional-OP,2021-10-04,2021-10-04,2021-10-22,PLN4918,1528335731,1528335731,Critical Access Hospital,In-Network,I10,R07.9,,,,,,,0,,70553,Radiology,,,0320,22,Outpatient Hospital,2,3117.38,1656.54,1656.54,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003586,MBR00000138,Institutional-OP,2023-11-15,2023-11-15,2023-12-09,PLN1772,1865904917,1865904917,Outpatient Clinic,In-Network,Z23,E11.9,,,,,,,0,,99221,E&M,,,0510,22,Outpatient Hospital,1,324.52,142.19,0.0,142.19,0.0,0.0,142.19,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003587,MBR00000138,Institutional-OP,2022-09-07,2022-09-07,2022-10-18,PLN1138,1590915516,1590915516,Physical Therapy,Out-of-Network,Z87.891,F32.9,,,,,,,0,,G0444,Medicine,,,0740,22,Outpatient Hospital,2,57.39,18.38,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000003588,MBR00000138,Institutional-OP,2022-09-11,2022-09-11,2022-10-23,PLN3895,1528335731,1528335731,Critical Access Hospital,In-Network,J44.1,Z51.11,,,,,,,0,,71046,Radiology,,,0370,22,Outpatient Hospital,3,243.39,122.6,122.6,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003589,MBR00000138,Institutional-OP,2021-08-14,2021-08-14,2021-08-21,PLN3623,1434029575,1434029575,Endocrinology,In-Network,E66.9,E66.9,,,,,,,0,,80053,Pathology/Lab,,,0450,22,Outpatient Hospital,3,140.41,69.07,0.0,69.07,0.0,0.0,69.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003590,MBR00000139,Professional,2023-01-10,2023-01-10,2023-02-10,PLN3938,1514306773,1514306773,Endocrinology,In-Network,K21.0,N17.9,,,,,,,0,,27447,Surgery,,,,31,Skilled Nursing Facility,3,2827.65,1930.93,1556.72,0.0,35.0,339.21,374.21,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003591,MBR00000139,Institutional-OP,2023-10-02,2023-10-02,2023-10-18,PLN5322,1563980627,1563980627,Critical Access Hospital,In-Network,I10,Z12.11,,,,,,,0,,90686,Medicine,,,0301,22,Outpatient Hospital,3,57.11,27.86,27.86,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000003592,MBR00000139,Professional,2023-03-07,2023-03-07,2023-03-20,PLN1515,1395983630,1395983630,Nephrology,In-Network,E66.9,Z23,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,3,47.94,14.49,0.0,14.49,0.0,0.0,14.49,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003593,MBR00000139,Institutional-OP,2022-07-12,2022-07-12,2022-08-07,PLN2518,1556140803,1556140803,Cardiology,In-Network,I10,I25.10,,,,,,,0,,72148,Radiology,,,0120,22,Outpatient Hospital,3,2001.7,1130.98,909.95,0.0,75.0,146.03,221.03,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003594,MBR00000139,Professional,2022-11-29,2022-11-29,2023-01-12,PLN4431,1422747896,1422747896,Urology,In-Network,Z12.31,I10,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,1,22.77,13.6,0.0,13.6,0.0,0.0,13.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003595,MBR00000139,Institutional-OP,2021-09-14,2021-09-14,2021-09-21,PLN4026,1235381502,1235381502,Cardiology,In-Network,R10.9,F32.9,,,,,,,0,,84443,Pathology/Lab,,,0740,22,Outpatient Hospital,3,105.56,63.16,13.16,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003596,MBR00000139,Professional,2021-03-08,2021-03-08,2021-04-19,PLN1611,1530904931,1530904931,Internal Medicine,In-Network,I25.10,Z12.31,,,,,,,0,,99406,Medicine,,,,11,Office,3,45.9,17.38,0.0,17.38,0.0,0.0,17.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003597,MBR00000139,Professional,2022-12-02,2022-12-02,2023-01-14,PLN8067,1817234602,1817234602,Clinical Laboratory,In-Network,J06.9,E78.5,,,,,,,0,,74177,Radiology,,,,81,Independent Laboratory,1,2823.47,1602.8,1577.8,0.0,25.0,0.0,25.0,0.0,Adjusted,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000003598,MBR00000139,Institutional-IP,2021-07-19,2021-07-22,2021-08-31,PLN5445,1283743001,1283743001,Family Medicine,In-Network,E11.9,F32.9,,,,641,MS-DRG,13,3,Y,80061,Pathology/Lab,,,0740,21,Inpatient Hospital,1,99.46,32.51,0.0,0.0,0.0,0.0,0.0,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003599,MBR00000139,Institutional-IP,2021-04-09,2021-04-12,2021-05-06,PLN8901,1757138478,1757138478,Pediatrics,In-Network,Z12.31,G43.909,,,,690,MS-DRG,5,3,Y,G0468,Medicine,,,0370,21,Inpatient Hospital,3,574.05,369.34,322.22,0.0,0.0,47.12,47.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003600,MBR00000139,Institutional-OP,2023-04-29,2023-04-29,2023-06-12,PLN6033,1500037969,1500037969,Pulmonology,In-Network,J20.9,E11.9,,,,,,,0,,93000,Radiology,,,0450,22,Outpatient Hospital,1,67.35,42.5,0.0,42.5,35.0,0.0,77.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003601,MBR00000139,Institutional-OP,2022-04-21,2022-04-21,2022-06-02,PLN2612,1872272835,1872272835,Internal Medicine,In-Network,I63.9,E87.6,,,,,,,0,,99203,E&M,,,0120,22,Outpatient Hospital,1,153.58,100.87,0.0,100.87,0.0,0.0,100.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003602,MBR00000139,Institutional-IP,2023-07-24,2023-07-30,2023-09-01,PLN8596,1840431511,1840431511,Geriatrics,Out-of-Network,M17.11,Z00.00,,,,470,MS-DRG,17,6,Y,99233,E&M,,,0730,21,Inpatient Hospital,3,326.86,149.8,0.0,149.8,25.0,0.0,174.8,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003603,MBR00000139,Professional,2023-08-07,2023-08-07,2023-09-04,PLN2740,1545347862,1545347862,SNF,In-Network,C50.912,N18.3,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,3,53.24,24.77,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000003604,MBR00000139,Institutional-OP,2021-05-15,2021-05-15,2021-06-18,PLN3155,1313212303,1313212303,Family Medicine,In-Network,I25.10,R07.9,,,,,,,0,,99233,E&M,,,0761,22,Outpatient Hospital,3,232.56,85.11,85.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003605,MBR00000139,Institutional-OP,2023-04-21,2023-04-21,2023-05-19,PLN3422,1224179551,1224179551,Physical Therapy,In-Network,Z00.00,F03.90,,,,,,,0,,78452,Radiology,,,0761,22,Outpatient Hospital,1,4002.61,2357.14,1858.06,474.08,25.0,0.0,499.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003606,MBR00000139,Institutional-OP,2022-01-02,2022-01-02,2022-01-29,PLN2885,1968299309,1968299309,Internal Medicine,In-Network,E78.5,F32.9,,,,,,,0,,90460,Medicine,,,0636,22,Outpatient Hospital,2,74.33,28.25,28.16,0.0,0.0,0.09,0.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003607,MBR00000139,Professional,2023-02-10,2023-02-10,2023-03-09,PLN9108,1205377316,1205377316,Orthopedic Surgery,In-Network,Z00.00,I10,,,,,,,0,,77067,Radiology,,,,81,Independent Laboratory,1,836.89,564.23,139.32,414.84,0.0,10.07,424.91,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000003608,MBR00000139,Institutional-OP,2021-02-18,2021-02-18,2021-03-11,PLN6952,1500949740,1500949740,Pediatrics,In-Network,Z12.31,Z12.31,,,,,,,0,,99214,E&M,,,0740,22,Outpatient Hospital,1,339.99,135.6,78.83,0.0,50.0,6.77,56.77,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003609,MBR00000139,Professional,2022-05-31,2022-05-31,2022-07-11,PLN4515,1475984649,1475984649,SNF,In-Network,I10,Z87.891,,,,,,,0,,G0468,Medicine,,,,11,Office,2,497.28,405.0,355.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003610,MBR00000139,Institutional-OP,2022-11-20,2022-11-20,2022-12-08,PLN6960,1390307371,1390307371,DME Supplier,In-Network,K57.30,I10,,,,,,,0,,27447,Surgery,,,0730,22,Outpatient Hospital,3,3685.77,1125.02,846.12,278.9,0.0,0.0,278.9,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003611,MBR00000139,Professional,2022-05-05,2022-05-05,2022-05-31,PLN7546,1450553056,1450553056,Clinical Laboratory,In-Network,E11.9,Z12.31,,,,,,,0,,99221,E&M,,,,81,Independent Laboratory,2,451.19,160.65,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003612,MBR00000139,Professional,2022-08-28,2022-08-28,2022-09-18,PLN5827,1644128543,1644128543,Gastroenterology,In-Network,E78.5,E78.5,,,,,,,0,,27447,Surgery,,,,11,Office,2,3074.14,1092.02,0.0,58.34,25.0,0.0,83.34,0.0,Denied,CO-27,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003613,MBR00000139,Professional,2021-01-13,2021-01-13,2021-02-26,PLN6960,1542828721,1542828721,Orthopedic Surgery,In-Network,E87.6,I10,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,1,35.28,21.79,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003614,MBR00000139,Institutional-OP,2021-01-09,2021-01-09,2021-01-21,PLN1362,1545347862,1545347862,SNF,In-Network,M17.11,F10.20,,,,,,,0,,72148,Radiology,,,0450,22,Outpatient Hospital,1,2273.9,813.58,513.12,272.24,0.0,28.22,300.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003615,MBR00000139,Institutional-IP,2022-10-20,2022-10-27,2022-11-04,PLN6165,1108115157,1108115157,General Acute Care Hospital,In-Network,I10,N39.0,,,,641,MS-DRG,18,7,Y,76700,Radiology,,,0320,21,Inpatient Hospital,1,1215.14,910.43,835.82,0.0,0.0,74.61,74.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003616,MBR00000139,Institutional-OP,2022-04-01,2022-04-01,2022-04-30,PLN4383,1545347862,1545347862,SNF,In-Network,F41.9,Z51.11,,,,,,,0,,99214,E&M,,,0360,22,Outpatient Hospital,1,164.86,85.17,35.17,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003617,MBR00000139,Professional,2022-09-24,2022-09-24,2022-10-05,PLN8117,1606140917,1606140917,ASC,In-Network,I48.91,M54.5,,,,,,,0,,27447,Surgery,,,,23,Emergency Room,1,3128.77,1801.14,1748.75,0.0,35.0,17.39,52.39,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003618,MBR00000139,Institutional-OP,2022-01-29,2022-01-29,2022-02-23,PLN9212,1691062876,1691062876,SNF,In-Network,E78.5,R51,,,,,,,0,,74177,Radiology,,,0320,22,Outpatient Hospital,3,1282.68,531.77,456.77,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003619,MBR00000139,Professional,2021-01-06,2021-01-06,2021-02-11,PLN2277,1563980627,1563980627,Critical Access Hospital,In-Network,E11.9,E11.40,,,,,,,0,,99213,E&M,,,,23,Emergency Room,3,134.01,110.69,85.69,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003620,MBR00000139,Professional,2023-02-06,2023-02-06,2023-03-06,PLN3531,1865904917,1865904917,Outpatient Clinic,In-Network,K21.0,N39.0,,,,,,,0,,G0444,Medicine,,,,11,Office,2,87.8,67.5,0.0,67.5,0.0,0.0,67.5,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000003621,MBR00000139,Institutional-OP,2021-05-31,2021-05-31,2021-07-14,PLN1381,1198133277,1198133277,SNF,In-Network,E78.5,I10,,,,,,,0,,99221,E&M,,,0450,22,Outpatient Hospital,2,344.7,116.17,91.17,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003622,MBR00000139,Professional,2023-05-10,2023-05-10,2023-05-25,PLN7200,1590915516,1590915516,Physical Therapy,Out-of-Network,F32.9,Z00.00,,,,,,,0,,99283,E&M,,,,11,Office,3,507.43,250.37,204.1,9.33,0.0,36.94,46.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003623,MBR00000139,Institutional-IP,2021-01-14,2021-01-18,2021-01-26,PLN1780,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,I10,R07.9,,,,682,MS-DRG,22,4,Y,99213,E&M,,,0900,21,Inpatient Hospital,2,167.9,54.5,0.0,54.5,75.0,0.0,129.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003624,MBR00000139,Professional,2023-10-15,2023-10-15,2023-10-22,PLN4706,1990090423,1990090423,Orthopedic Surgery,In-Network,R05,F32.9,,,,,,,0,,99221,E&M,,,,12,Home,3,453.65,308.3,114.92,168.38,25.0,0.0,193.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003625,MBR00000139,Institutional-OP,2021-10-05,2021-10-05,2021-10-17,PLN4159,1860435061,1860435061,DME Supplier,In-Network,R51,E11.9,,,,,,,0,,47562,Surgery,,,0636,22,Outpatient Hospital,3,6423.93,2197.16,2123.15,0.0,15.0,59.01,74.01,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003626,MBR00000140,Professional,2023-09-05,2023-09-05,2023-10-09,PLN5709,1757138478,1757138478,Pediatrics,In-Network,Z23,M54.5,,,,,,,0,,45380,Surgery,,,,11,Office,1,1950.34,596.49,571.49,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000003627,MBR00000140,Professional,2021-01-05,2021-01-05,2021-02-15,PLN7613,1845057593,1845057593,Orthopedic Surgery,In-Network,Z23,R10.9,,,,,,,0,,93225,Medicine,,,,11,Office,1,448.23,234.9,193.48,0.0,35.0,6.42,41.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003628,MBR00000140,Professional,2022-05-08,2022-05-08,2022-06-08,PLN9280,1624802371,1624802371,ASC,Out-of-Network,I10,Z12.11,,,,,,,0,,45378,Surgery,,,,21,Inpatient Hospital,2,1321.12,437.76,286.41,98.97,0.0,52.38,151.35,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003629,MBR00000140,Institutional-OP,2022-04-03,2022-04-03,2022-04-12,PLN5668,1135158374,1135158374,Pulmonology,In-Network,I25.10,E11.9,,,,,,,0,,99284,E&M,,,0510,22,Outpatient Hospital,2,644.07,377.21,217.6,84.61,75.0,0.0,159.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003630,MBR00000140,Professional,2021-06-29,2021-06-29,2021-08-07,PLN8298,1395983630,1395983630,Nephrology,In-Network,E11.9,F32.9,,,,,,,0,,99284,E&M,,,,81,Independent Laboratory,2,764.61,420.56,169.47,176.09,75.0,0.0,251.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003631,MBR00000141,Professional,2022-06-06,2022-06-06,2022-07-17,PLN7825,1717546253,1717546253,Family Medicine,In-Network,N18.3,F10.20,,,,,,,0,,99203,E&M,,,,11,Office,3,158.13,81.92,66.92,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003632,MBR00000141,Professional,2021-08-24,2021-08-24,2021-09-10,PLN4170,1273488618,1273488618,General Acute Care Hospital,In-Network,B97.89,E11.65,,,,,,,0,,99284,E&M,,,,11,Office,3,837.32,645.4,602.36,0.0,0.0,43.04,43.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003633,MBR00000141,Professional,2022-04-24,2022-04-24,2022-05-22,PLN5228,1696843572,1696843572,Critical Access Hospital,Out-of-Network,I10,K21.0,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,2,197.95,86.94,51.94,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003634,MBR00000141,Professional,2022-02-15,2022-02-15,2022-03-31,PLN6479,1283743001,1283743001,Family Medicine,In-Network,E11.9,E66.9,,,,,,,0,,99214,E&M,,,,20,Urgent Care,1,427.44,279.2,229.2,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003635,MBR00000141,Institutional-IP,2021-08-07,2021-08-12,2021-09-16,PLN9495,1728018911,1728018911,Nephrology,In-Network,Z12.31,E66.9,,,,603,MS-DRG,12,5,N,99214,E&M,,,0370,21,Inpatient Hospital,3,336.68,144.4,144.4,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003636,MBR00000141,Professional,2023-05-14,2023-05-14,2023-06-16,PLN2669,1896447406,1896447406,Nephrology,Out-of-Network,Z23,N18.3,,,,,,,0,,90837,Medicine,,,,49,Independent Clinic,2,363.64,182.18,147.18,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003637,MBR00000141,Professional,2022-07-28,2022-07-28,2022-08-09,PLN1421,1847081578,1847081578,Urology,Out-of-Network,N17.9,F41.9,,,,,,,0,,99233,E&M,,,,21,Inpatient Hospital,2,273.51,164.77,0.0,135.85,50.0,0.0,185.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003638,MBR00000141,Institutional-IP,2023-07-08,2023-07-10,2023-07-30,PLN6920,1948810580,1948810580,DME Supplier,In-Network,Z00.00,E66.9,,,,470,MS-DRG,8,2,Y,80053,Pathology/Lab,,,0370,21,Inpatient Hospital,1,115.69,70.39,0.0,70.39,0.0,0.0,70.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003639,MBR00000141,Professional,2023-06-11,2023-06-11,2023-07-20,PLN9980,1752470395,1752470395,Home Health,In-Network,J44.1,C50.912,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,2,266.72,154.01,119.01,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003640,MBR00000141,Institutional-OP,2021-10-15,2021-10-15,2021-11-16,PLN4849,1395983630,1395983630,Nephrology,In-Network,M54.5,I10,,,,,,,0,,78452,Radiology,,,0120,22,Outpatient Hospital,2,5372.82,4123.69,3916.37,157.32,50.0,0.0,207.32,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003641,MBR00000141,Institutional-IP,2021-11-15,2021-11-23,2021-12-17,PLN7639,1564502315,1564502315,ASC,In-Network,Z23,F32.9,,,,690,MS-DRG,1,8,W,99214,E&M,,,0200,21,Inpatient Hospital,1,450.71,264.42,249.42,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003642,MBR00000141,Institutional-OP,2023-11-08,2023-11-08,2023-12-18,PLN7771,1571574052,1571574052,Critical Access Hospital,In-Network,I10,I25.10,,,,,,,0,,99203,E&M,,,0360,22,Outpatient Hospital,2,191.01,113.11,113.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003643,MBR00000141,Professional,2021-12-09,2021-12-09,2021-12-17,PLN3609,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,E66.9,Z12.11,,,,,,,0,,66984,Surgery,,,,31,Skilled Nursing Facility,3,3128.13,2114.92,1394.16,431.11,0.0,289.65,720.76,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003644,MBR00000141,Professional,2021-04-14,2021-04-14,2021-05-23,PLN8327,1702692193,1702692193,Physical Therapy,In-Network,E66.9,F41.9,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,2,192.63,120.52,58.32,0.0,50.0,12.2,62.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003645,MBR00000141,Professional,2022-08-18,2022-08-18,2022-09-05,PLN5679,1390307371,1390307371,DME Supplier,In-Network,Z00.00,Z23,,,,,,,0,,93225,Medicine,,,,11,Office,1,987.95,797.54,797.54,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003646,MBR00000141,Professional,2023-11-25,2023-11-25,2023-12-12,PLN5850,1624802371,1624802371,ASC,Out-of-Network,J20.9,I10,,,,,,,0,,27447,Surgery,,,,11,Office,2,3356.25,2693.38,2434.66,243.72,15.0,0.0,258.72,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003647,MBR00000141,Institutional-OP,2021-09-13,2021-09-13,2021-10-21,PLN5755,1530904931,1530904931,Internal Medicine,In-Network,E78.5,R10.9,,,,,,,0,,77067,Radiology,,,0270,22,Outpatient Hospital,2,807.7,614.25,613.46,0.79,0.0,0.0,0.79,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000003648,MBR00000141,Professional,2022-11-30,2022-11-30,2023-01-07,PLN6354,1114982472,1114982472,Orthopedic Surgery,In-Network,Z00.00,N39.0,,,,,,,0,,76700,Radiology,,,,49,Independent Clinic,1,704.63,574.53,485.37,0.0,0.0,89.16,89.16,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003649,MBR00000141,Professional,2022-01-05,2022-01-05,2022-01-22,PLN9830,1780163051,1780163051,SNF,In-Network,Z23,E11.9,,,,,,,0,,99406,Medicine,,,,22,Outpatient Hospital,2,82.27,29.73,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003650,MBR00000141,Institutional-IP,2022-02-26,2022-03-02,2022-03-17,PLN7641,1438368327,1438368327,Home Health,In-Network,I10,E78.5,,,,690,MS-DRG,8,4,Y,76700,Radiology,,,0761,21,Inpatient Hospital,1,1153.31,443.46,443.46,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003651,MBR00000141,Institutional-IP,2022-05-11,2022-05-13,2022-06-23,PLN3977,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,C50.912,Z00.00,,,,603,MS-DRG,12,2,Y,99221,E&M,,,0301,21,Inpatient Hospital,1,294.63,133.27,83.23,0.0,50.0,0.04,50.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003652,MBR00000141,Institutional-OP,2021-06-06,2021-06-06,2021-07-15,PLN3170,1205377316,1205377316,Orthopedic Surgery,In-Network,E78.5,Z00.00,,,,,,,0,,87491,Pathology/Lab,,,0450,22,Outpatient Hospital,2,160.31,116.81,81.81,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003653,MBR00000141,Professional,2022-02-28,2022-02-28,2022-04-05,PLN2683,1569105090,1569105090,Geriatrics,In-Network,M81.0,J06.9,,,,,,,0,,G0439,Medicine,,,,11,Office,1,632.69,466.6,377.33,0.0,0.0,89.27,89.27,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000003654,MBR00000142,Institutional-OP,2021-10-26,2021-10-26,2021-11-15,PLN9910,1847081578,1847081578,Urology,Out-of-Network,I11.9,Z87.891,,,,,,,0,,81001,Pathology/Lab,,,0270,22,Outpatient Hospital,3,51.82,25.27,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003655,MBR00000142,Institutional-OP,2023-06-15,2023-06-15,2023-07-15,PLN6664,1168246159,1168246159,Internal Medicine,In-Network,E78.5,I50.9,,,,,,,0,,81001,Pathology/Lab,,,0270,22,Outpatient Hospital,1,53.11,28.44,0.0,28.44,0.0,0.0,28.44,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003656,MBR00000142,Institutional-OP,2021-09-07,2021-09-07,2021-10-21,PLN5428,1812060197,1812060197,Oncology,Out-of-Network,J20.9,Z00.00,,,,,,,0,,99283,E&M,,,0730,22,Outpatient Hospital,3,551.04,251.48,0.0,251.48,0.0,0.0,251.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003657,MBR00000142,Professional,2023-07-19,2023-07-19,2023-08-27,PLN4904,1242201429,1242201429,General Acute Care Hospital,In-Network,I11.9,M17.11,,,,,,,0,,47562,Surgery,,,,11,Office,3,3558.24,2034.21,1964.64,69.57,0.0,0.0,69.57,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003658,MBR00000142,Professional,2021-01-19,2021-01-19,2021-02-23,PLN5096,1569105090,1569105090,Geriatrics,In-Network,I10,N40.0,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,3,1033.88,332.93,196.57,98.53,0.0,37.83,136.36,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003659,MBR00000142,Professional,2022-03-18,2022-03-18,2022-04-09,PLN4183,1502838586,1502838586,ASC,In-Network,Z00.00,E11.9,,,,,,,0,,93225,Medicine,,,,12,Home,3,452.64,223.58,0.0,223.58,35.0,0.0,258.58,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003660,MBR00000142,Institutional-OP,2021-10-21,2021-10-21,2021-11-16,PLN4726,1511044648,1511044648,Endocrinology,In-Network,F41.9,I10,,,,,,,0,,99232,E&M,,,0360,22,Outpatient Hospital,3,298.67,234.2,234.2,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003661,MBR00000142,Professional,2022-05-06,2022-05-06,2022-06-19,PLN9177,1514306773,1514306773,Endocrinology,In-Network,F41.9,Z87.891,,,,,,,0,,27447,Surgery,,,,81,Independent Laboratory,2,4025.32,2056.81,1863.28,0.0,50.0,143.53,193.53,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003662,MBR00000142,Professional,2023-04-25,2023-04-25,2023-05-20,PLN5900,1545347862,1545347862,SNF,In-Network,R51,J20.9,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,2,43.11,22.81,22.11,0.0,0.0,0.7,0.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003663,MBR00000142,Professional,2023-11-14,2023-11-14,2023-11-23,PLN8406,1910255109,1910255109,DME Supplier,In-Network,E78.5,M54.5,,,,,,,0,,99213,E&M,,,,21,Inpatient Hospital,2,149.69,97.01,87.66,0.0,0.0,9.35,9.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003664,MBR00000142,Institutional-OP,2023-03-09,2023-03-09,2023-04-02,PLN8142,1531398223,1531398223,OB/GYN,In-Network,E78.5,J20.9,,,,,,,0,,99406,Medicine,,,0450,22,Outpatient Hospital,1,52.68,41.43,0.0,41.43,0.0,0.0,41.43,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003665,MBR00000142,Professional,2022-07-05,2022-07-05,2022-08-10,PLN5330,1845900543,1845900543,ASC,In-Network,F32.9,F10.20,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,1,142.72,115.13,115.13,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003666,MBR00000142,Professional,2022-07-16,2022-07-16,2022-08-18,PLN1077,1575695214,1575695214,SNF,In-Network,E78.5,Z12.31,,,,,,,0,,99233,E&M,,,,11,Office,3,440.29,195.2,145.2,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003667,MBR00000142,Institutional-OP,2023-12-24,2023-12-24,2024-01-19,PLN8966,1530904931,1530904931,Internal Medicine,In-Network,R05,F32.9,,,,,,,0,,93306,Radiology,,,0450,22,Outpatient Hospital,1,2523.97,869.68,705.17,164.51,0.0,0.0,164.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003668,MBR00000142,Institutional-OP,2023-12-22,2023-12-22,2024-01-30,PLN7062,1389336600,1389336600,Critical Access Hospital,In-Network,N18.3,Z23,,,,,,,0,,77067,Radiology,,,0636,22,Outpatient Hospital,3,708.31,508.33,359.97,0.0,75.0,73.36,148.36,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000003669,MBR00000142,Institutional-OP,2023-04-16,2023-04-16,2023-05-20,PLN9414,1450553056,1450553056,Clinical Laboratory,In-Network,M81.0,Z23,,,,,,,0,,99232,E&M,,,0730,22,Outpatient Hospital,1,335.32,165.73,123.64,0.0,25.0,17.09,42.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003670,MBR00000142,Professional,2021-06-29,2021-06-29,2021-07-15,PLN9248,1727809972,1727809972,Home Health,In-Network,I10,I48.91,,,,,,,0,,97110,Medicine,,,,11,Office,1,243.51,85.79,85.79,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003671,MBR00000142,Professional,2021-10-17,2021-10-17,2021-10-24,PLN9684,1948810580,1948810580,DME Supplier,In-Network,I63.9,K21.0,,,,,,,0,,33533,Surgery,,,,21,Inpatient Hospital,1,11381.57,8816.11,7633.77,128.29,0.0,1054.05,1182.34,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000003672,MBR00000142,Professional,2021-10-26,2021-10-26,2021-11-22,PLN2283,1247341320,1247341320,Urology,Out-of-Network,I11.9,K57.30,,,,,,,0,,27130,Surgery,,,,11,Office,2,5610.93,4027.84,3532.07,0.0,25.0,470.77,495.77,0.0,Paid,,,1,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000003673,MBR00000142,Professional,2021-09-08,2021-09-08,2021-10-13,PLN2973,1799205295,1799205295,General Acute Care Hospital,In-Network,Z00.01,M54.5,,,,,,,0,,71046,Radiology,,,,22,Outpatient Hospital,2,310.31,105.31,0.0,105.31,50.0,0.0,155.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003674,MBR00000142,Professional,2023-11-26,2023-11-26,2023-12-22,PLN7227,1800011727,1800011727,Clinical Laboratory,Out-of-Network,E11.40,F32.9,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,3,574.05,418.18,418.18,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003675,MBR00000142,Professional,2021-06-24,2021-06-24,2021-07-26,PLN6219,1799205295,1799205295,General Acute Care Hospital,In-Network,G43.909,I10,,,,,,,0,,71046,Radiology,,,,11,Office,1,119.46,81.39,81.39,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003676,MBR00000143,Professional,2023-07-23,2023-07-23,2023-09-04,PLN8888,1974006077,1974006077,Orthopedic Surgery,In-Network,M17.11,S72.001A,,,,,,,0,,45380,Surgery,,,,23,Emergency Room,1,1909.01,743.72,233.07,475.65,35.0,0.0,510.65,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,1,0,0,0
CLM0000003677,MBR00000143,Professional,2023-06-02,2023-06-02,2023-07-03,PLN5190,1910255109,1910255109,DME Supplier,In-Network,Z12.31,N18.3,,,,,,,0,,93225,Medicine,,,,11,Office,3,512.83,287.07,287.07,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003678,MBR00000143,Institutional-OP,2022-08-02,2022-08-02,2022-08-14,PLN8865,1284035364,1284035364,Pediatrics,In-Network,Z23,R07.9,,,,,,,0,,99406,Medicine,,,0200,22,Outpatient Hospital,3,49.72,28.62,0.0,28.62,15.0,0.0,43.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003679,MBR00000143,Professional,2021-12-03,2021-12-03,2022-01-04,PLN2282,1511044648,1511044648,Endocrinology,In-Network,Z79.4,J44.1,,,,,,,0,,87491,Pathology/Lab,,,,22,Outpatient Hospital,2,206.39,95.07,0.0,84.45,75.0,0.0,159.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003680,MBR00000143,Institutional-OP,2021-10-19,2021-10-19,2021-11-26,PLN1392,1845900543,1845900543,ASC,In-Network,M54.5,I10,,,,,,,0,,99222,E&M,,,0360,22,Outpatient Hospital,2,399.67,241.93,175.02,0.0,25.0,41.91,66.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003681,MBR00000143,Institutional-OP,2023-01-10,2023-01-10,2023-01-21,PLN7040,1132188260,1132188260,Family Medicine,In-Network,N18.3,J20.9,,,,,,,0,,58661,Surgery,,,0270,22,Outpatient Hospital,2,4280.71,3118.58,3083.58,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003682,MBR00000143,Professional,2023-01-05,2023-01-05,2023-01-30,PLN1832,1980712759,1980712759,Outpatient Clinic,Out-of-Network,I25.10,Z00.01,,,,,,,0,,97110,Medicine,,,,11,Office,1,234.38,131.99,125.12,0.0,0.0,6.87,6.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003683,MBR00000143,Professional,2022-08-15,2022-08-15,2022-09-23,PLN9757,1224179551,1224179551,Physical Therapy,In-Network,I25.10,I10,,,,,,,0,,33533,Surgery,,,,20,Urgent Care,2,16892.33,8858.83,8232.24,135.12,35.0,456.47,626.59,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000003684,MBR00000143,Institutional-OP,2022-09-15,2022-09-15,2022-10-08,PLN7586,1817234602,1817234602,Clinical Laboratory,In-Network,M54.5,J06.9,,,,,,,0,,45380,Surgery,,,0730,22,Outpatient Hospital,3,1395.32,980.22,879.62,0.0,15.0,85.6,100.6,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000003685,MBR00000143,Institutional-OP,2023-06-24,2023-06-24,2023-07-19,PLN7316,1389336600,1389336600,Critical Access Hospital,In-Network,N17.9,K21.0,,,,,,,0,,99222,E&M,,,0370,22,Outpatient Hospital,2,270.9,199.1,7.22,176.88,15.0,0.0,191.88,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003686,MBR00000143,Professional,2023-04-07,2023-04-07,2023-05-03,PLN1834,1422747896,1422747896,Urology,In-Network,E11.9,J20.9,,,,,,,0,,99283,E&M,,,,31,Skilled Nursing Facility,1,365.13,116.83,41.73,0.0,75.0,0.1,75.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003687,MBR00000143,Professional,2023-04-03,2023-04-03,2023-04-10,PLN1177,1395983630,1395983630,Nephrology,In-Network,C50.912,I10,,,,,,,0,,99222,E&M,,,,20,Urgent Care,2,406.16,216.62,84.85,106.77,25.0,0.0,131.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003688,MBR00000143,Institutional-OP,2021-11-03,2021-11-03,2021-11-22,PLN5228,1935547131,1935547131,Pulmonology,In-Network,Z00.00,I10,,,,,,,0,,99284,E&M,,,0301,22,Outpatient Hospital,3,374.39,194.73,0.0,194.73,0.0,0.0,194.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003689,MBR00000143,Institutional-IP,2021-03-11,2021-03-18,2021-03-29,PLN6619,1186826716,1186826716,Physical Therapy,In-Network,E66.9,I10,,,,641,MS-DRG,14,7,Y,43239,Surgery,,,0120,21,Inpatient Hospital,3,1503.26,1102.71,925.64,152.07,25.0,0.0,177.07,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003690,MBR00000143,Institutional-IP,2022-05-18,2022-05-19,2022-05-30,PLN6271,1125190055,1125190055,Nephrology,In-Network,N40.0,N39.0,,,,292,MS-DRG,11,1,Y,76700,Radiology,,,0510,21,Inpatient Hospital,2,1282.37,1062.51,921.04,141.47,0.0,0.0,141.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003691,MBR00000143,Professional,2022-01-06,2022-01-06,2022-01-31,PLN3790,1717546253,1717546253,Family Medicine,In-Network,E11.40,R07.9,,,,,,,0,,58661,Surgery,,,,65,End-Stage Renal Disease,3,2575.25,1398.82,0.0,0.0,0.0,29.18,29.18,0.0,Denied,CO-4,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003692,MBR00000143,Institutional-OP,2022-01-02,2022-01-02,2022-01-10,PLN9981,1227362142,1227362142,DME Supplier,In-Network,I10,F32.9,,,,,,,0,,45378,Surgery,,,0740,22,Outpatient Hospital,2,1033.48,322.92,196.48,101.44,25.0,0.0,126.44,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003693,MBR00000143,Institutional-IP,2022-07-24,2022-08-03,2022-09-03,PLN7607,1561134315,1561134315,DME Supplier,In-Network,M81.0,E78.5,,,,194,MS-DRG,10,10,Y,99406,Medicine,,,0900,21,Inpatient Hospital,3,98.95,51.12,51.12,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003694,MBR00000143,Professional,2023-10-11,2023-10-11,2023-11-02,PLN3280,1575695214,1575695214,SNF,In-Network,Z23,E11.9,,,,,,,0,,83036,Pathology/Lab,,,,12,Home,2,67.15,44.05,44.05,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000003695,MBR00000143,Institutional-OP,2023-05-30,2023-05-30,2023-06-10,PLN7736,1219817751,1219817751,OB/GYN,In-Network,E11.9,N17.9,,,,,,,0,,23472,Surgery,,,0120,22,Outpatient Hospital,3,4329.16,2733.4,0.0,212.18,25.0,0.0,237.18,0.0,Denied,CO-4,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003696,MBR00000143,Professional,2023-01-10,2023-01-10,2023-01-18,PLN9863,1812060197,1812060197,Oncology,Out-of-Network,E11.9,N20.0,,,,,,,0,,58661,Surgery,,,,11,Office,1,1995.3,1145.14,925.99,0.0,0.0,219.15,219.15,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003697,MBR00000143,Professional,2023-02-21,2023-02-21,2023-03-05,PLN4152,1410468316,1410468316,SNF,In-Network,E11.65,Z87.891,,,,,,,0,,99406,Medicine,,,,22,Outpatient Hospital,2,78.01,56.27,30.24,0.0,25.0,1.03,26.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003698,MBR00000143,Institutional-IP,2022-03-30,2022-04-03,2022-04-22,PLN1511,1571574052,1571574052,Critical Access Hospital,In-Network,R10.9,F32.9,,,,470,MS-DRG,16,4,Y,99232,E&M,,,0370,21,Inpatient Hospital,2,325.32,189.45,154.45,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000003699,MBR00000143,Institutional-IP,2022-08-25,2022-08-27,2022-09-25,PLN8866,1355166277,1355166277,Endocrinology,In-Network,K21.0,R07.9,,,,682,MS-DRG,20,2,Y,58661,Surgery,,,0120,21,Inpatient Hospital,3,2511.96,1774.24,1462.29,123.83,35.0,153.12,311.95,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003700,MBR00000143,Institutional-OP,2022-04-20,2022-04-20,2022-05-18,PLN8201,1518055405,1518055405,Urology,In-Network,E11.9,F32.9,,,,,,,0,,70553,Radiology,,,0370,22,Outpatient Hospital,1,2768.47,895.22,798.91,0.0,0.0,96.31,96.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003701,MBR00000143,Institutional-IP,2023-06-05,2023-06-13,2023-06-16,PLN6797,1752470395,1752470395,Home Health,In-Network,E78.5,J06.9,,,,292,MS-DRG,3,8,Y,47562,Surgery,,,0510,21,Inpatient Hospital,1,6458.53,2278.18,2243.18,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003702,MBR00000143,Professional,2023-12-21,2023-12-21,2024-01-02,PLN2917,1946680931,1946680931,Critical Access Hospital,Out-of-Network,E11.9,I10,,,,,,,0,,93306,Radiology,,,,11,Office,3,2385.41,1314.1,1264.1,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003703,MBR00000143,Professional,2022-04-22,2022-04-22,2022-06-01,PLN2794,1968299309,1968299309,Internal Medicine,In-Network,Z12.31,I10,,,,,,,0,,99213,E&M,,,,20,Urgent Care,1,289.33,226.73,211.73,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003704,MBR00000143,Professional,2023-03-01,2023-03-01,2023-03-29,PLN6298,1313212303,1313212303,Family Medicine,In-Network,C50.912,E78.5,,,,,,,0,,47562,Surgery,,,,23,Emergency Room,1,3841.88,3223.76,2834.83,313.93,75.0,0.0,388.93,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003705,MBR00000143,Professional,2021-03-02,2021-03-02,2021-03-19,PLN1828,1939033455,1939033455,Pulmonology,In-Network,I10,M54.5,,,,,,,0,,90837,Medicine,,,,22,Outpatient Hospital,1,290.94,185.56,0.0,174.6,75.0,0.0,249.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003706,MBR00000143,Institutional-IP,2022-03-16,2022-03-22,2022-03-28,PLN2995,1948810580,1948810580,DME Supplier,In-Network,K21.0,E11.9,,,,195,MS-DRG,2,6,Y,90837,Medicine,,,0510,21,Inpatient Hospital,1,230.2,165.37,137.82,0.0,0.0,27.55,27.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003707,MBR00000143,Professional,2023-08-12,2023-08-12,2023-09-17,PLN4409,1590915516,1590915516,Physical Therapy,Out-of-Network,E78.5,F32.9,,,,,,,0,,71046,Radiology,,,,11,Office,2,162.36,81.41,66.41,0.0,15.0,0.0,15.0,0.0,Pended,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003708,MBR00000143,Professional,2023-01-22,2023-01-22,2023-02-18,PLN7160,1528335731,1528335731,Critical Access Hospital,In-Network,Z12.31,E11.65,,,,,,,0,,97530,Medicine,,,,21,Inpatient Hospital,1,206.64,150.95,0.0,150.95,75.0,0.0,225.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003709,MBR00000143,Professional,2022-07-31,2022-07-31,2022-08-08,PLN4643,1700633438,1700633438,DME Supplier,In-Network,Z23,N18.3,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,2,63.88,48.45,0.0,48.45,25.0,0.0,73.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000003710,MBR00000143,Professional,2021-08-23,2021-08-23,2021-09-13,PLN1565,1463205530,1463205530,Nephrology,In-Network,Z12.31,I48.91,,,,,,,0,,99233,E&M,,,,11,Office,3,314.23,167.06,164.25,0.0,0.0,2.81,2.81,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003711,MBR00000143,Professional,2023-06-05,2023-06-05,2023-07-17,PLN3063,1103747954,1103747954,Urology,In-Network,J44.1,F10.20,,,,,,,0,,77067,Radiology,,,,11,Office,3,626.92,291.18,291.18,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000003712,MBR00000143,Institutional-IP,2023-11-29,2023-12-04,2024-01-02,PLN5168,1644128543,1644128543,Gastroenterology,In-Network,K21.0,I10,,,,871,MS-DRG,9,5,Y,90460,Medicine,,,0740,21,Inpatient Hospital,2,64.27,47.42,12.42,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003713,MBR00000143,Professional,2022-03-06,2022-03-06,2022-04-07,PLN1079,1213165847,1213165847,Critical Access Hospital,In-Network,Z96.641,J45.20,,,,,,,0,,77067,Radiology,,,,11,Office,2,874.16,272.6,257.6,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000003714,MBR00000143,Institutional-OP,2023-06-06,2023-06-06,2023-07-01,PLN1849,1235381502,1235381502,Cardiology,In-Network,Z23,I10,,,,,,,0,,82043,Pathology/Lab,,,0301,22,Outpatient Hospital,2,30.16,19.09,19.09,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000003715,MBR00000143,Professional,2022-10-07,2022-10-07,2022-10-22,PLN6467,1691062876,1691062876,SNF,In-Network,I10,I50.9,,,,,,,0,,70553,Radiology,,,,22,Outpatient Hospital,2,2828.46,2109.84,2059.84,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003716,MBR00000143,Institutional-OP,2022-03-12,2022-03-12,2022-03-28,PLN4488,1713934949,1713934949,Neurology,In-Network,F41.9,J20.9,,,,,,,0,,99214,E&M,,,0301,22,Outpatient Hospital,3,274.57,227.39,0.0,227.39,0.0,0.0,227.39,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003717,MBR00000143,Institutional-OP,2021-12-29,2021-12-29,2022-01-06,PLN9540,1389336600,1389336600,Critical Access Hospital,In-Network,E66.9,F32.9,,,,,,,0,,99214,E&M,,,0450,22,Outpatient Hospital,2,242.73,160.68,160.68,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003718,MBR00000143,Institutional-OP,2022-07-05,2022-07-05,2022-07-16,PLN5209,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,J20.9,R05,,,,,,,0,,81001,Pathology/Lab,,,0730,22,Outpatient Hospital,2,26.4,11.15,0.0,11.15,0.0,0.0,11.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003719,MBR00000144,Institutional-OP,2022-03-25,2022-03-25,2022-04-30,PLN8147,1410468316,1410468316,SNF,In-Network,B97.89,Z79.4,,,,,,,0,,33533,Surgery,,,0301,22,Outpatient Hospital,3,14600.25,11299.47,11299.47,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000003720,MBR00000144,Professional,2022-11-07,2022-11-07,2022-11-20,PLN6391,1980712759,1980712759,Outpatient Clinic,Out-of-Network,Z12.31,Z12.31,,,,,,,0,,66984,Surgery,,,,11,Office,1,1982.66,1174.9,1174.9,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003721,MBR00000144,Professional,2021-06-11,2021-06-11,2021-07-25,PLN6779,1691062876,1691062876,SNF,In-Network,E11.65,J44.1,,,,,,,0,,66984,Surgery,,,,11,Office,3,2510.65,1985.55,1863.72,0.0,0.0,121.83,121.83,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003722,MBR00000144,Institutional-OP,2022-06-07,2022-06-07,2022-07-13,PLN5071,1716521444,1716521444,Oncology,In-Network,K21.0,F41.9,,,,,,,0,,99203,E&M,,,0360,22,Outpatient Hospital,2,146.46,44.99,0.0,44.99,0.0,0.0,44.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003723,MBR00000144,Professional,2023-03-24,2023-03-24,2023-03-31,PLN6188,1213165847,1213165847,Critical Access Hospital,In-Network,E11.9,E78.5,,,,,,,0,,45380,Surgery,,,,81,Independent Laboratory,1,2093.89,1391.33,1222.26,0.0,0.0,169.07,169.07,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000003724,MBR00000144,Institutional-IP,2023-07-15,2023-07-26,2023-08-07,PLN7355,1410468316,1410468316,SNF,In-Network,E11.9,Z00.00,,,,194,MS-DRG,15,11,Y,33533,Surgery,,,0510,21,Inpatient Hospital,3,28698.01,18370.67,16024.35,211.42,0.0,2134.9,2346.32,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000003725,MBR00000144,Institutional-IP,2021-11-03,2021-11-07,2021-11-21,PLN1300,1450553056,1450553056,Clinical Laboratory,In-Network,M54.5,E87.6,,,,641,MS-DRG,11,4,Y,99214,E&M,,,0301,21,Inpatient Hospital,2,408.04,154.85,0.0,154.85,25.0,0.0,179.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003726,MBR00000144,Professional,2022-10-20,2022-10-20,2022-11-05,PLN9151,1389336600,1389336600,Critical Access Hospital,In-Network,J06.9,J06.9,,,,,,,0,,90686,Medicine,,,,49,Independent Clinic,2,112.74,87.73,52.73,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000003727,MBR00000144,Professional,2021-11-27,2021-11-27,2022-01-10,PLN8819,1531398223,1531398223,OB/GYN,In-Network,J06.9,J45.20,,,,,,,0,,90686,Medicine,,,,11,Office,1,99.06,48.52,0.0,48.52,0.0,0.0,48.52,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000003728,MBR00000144,Institutional-IP,2023-05-16,2023-05-19,2023-05-28,PLN7814,1235381502,1235381502,Cardiology,In-Network,E11.65,E66.9,,,,683,MS-DRG,24,3,W,99284,E&M,,,0270,21,Inpatient Hospital,2,579.99,204.76,182.78,0.0,0.0,21.98,21.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003729,MBR00000144,Institutional-IP,2022-01-23,2022-01-28,2022-02-20,PLN5067,1974006077,1974006077,Orthopedic Surgery,In-Network,Z12.31,M81.0,,,,683,MS-DRG,5,5,W,99233,E&M,,,0450,21,Inpatient Hospital,2,303.35,243.12,168.34,0.0,35.0,39.78,74.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003730,MBR00000144,Institutional-OP,2023-01-08,2023-01-08,2023-02-17,PLN1923,1186826716,1186826716,Physical Therapy,In-Network,J18.9,I25.10,,,,,,,0,,99284,E&M,,,0120,22,Outpatient Hospital,2,684.34,494.98,149.94,297.85,35.0,12.19,345.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003731,MBR00000144,Institutional-IP,2022-04-19,2022-04-20,2022-05-21,PLN1129,1389336600,1389336600,Critical Access Hospital,In-Network,F32.9,E66.9,,,,195,MS-DRG,21,1,Y,93000,Radiology,,,0120,21,Inpatient Hospital,1,126.25,47.08,44.24,0.0,0.0,2.84,2.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003732,MBR00000144,Professional,2021-10-20,2021-10-20,2021-11-10,PLN5298,1609526529,1609526529,Psychiatry,In-Network,I10,E11.9,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,2,5733.23,3794.18,3794.18,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003733,MBR00000144,Professional,2022-09-23,2022-09-23,2022-11-06,PLN9811,1450553056,1450553056,Clinical Laboratory,In-Network,M17.11,I25.10,,,,,,,0,,99233,E&M,,,,21,Inpatient Hospital,2,317.5,137.7,44.11,83.76,0.0,9.83,93.59,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000003734,MBR00000144,Professional,2022-11-15,2022-11-15,2022-12-19,PLN8008,1728018911,1728018911,Nephrology,In-Network,M54.5,I25.10,,,,,,,0,,93306,Radiology,,,,22,Outpatient Hospital,2,1674.78,799.2,665.89,0.0,0.0,133.31,133.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003735,MBR00000144,Professional,2023-01-18,2023-01-18,2023-02-23,PLN2579,1910255109,1910255109,DME Supplier,In-Network,I10,E78.5,,,,,,,0,,33533,Surgery,,,,11,Office,1,25081.11,12503.91,12453.91,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000003736,MBR00000144,Institutional-OP,2023-05-17,2023-05-17,2023-05-30,PLN2302,1450094833,1450094833,Outpatient Clinic,In-Network,I25.10,J20.9,,,,,,,0,,66984,Surgery,,,0120,22,Outpatient Hospital,1,2584.14,1658.88,1258.63,368.53,0.0,31.72,400.25,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003737,MBR00000144,Institutional-IP,2023-01-10,2023-01-18,2023-01-24,PLN3439,1390307371,1390307371,DME Supplier,In-Network,J06.9,N40.0,,,,195,MS-DRG,19,8,N,86900,Pathology/Lab,,,0301,21,Inpatient Hospital,2,53.48,37.44,0.0,37.44,15.0,0.0,52.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003738,MBR00000144,Institutional-OP,2023-07-22,2023-07-22,2023-08-15,PLN4587,1284035364,1284035364,Pediatrics,In-Network,Z23,I10,,,,,,,0,,99233,E&M,,,0740,22,Outpatient Hospital,1,508.68,413.03,0.0,413.03,0.0,0.0,413.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003739,MBR00000144,Professional,2022-04-09,2022-04-09,2022-05-18,PLN7602,1590915516,1590915516,Physical Therapy,Out-of-Network,F41.9,I11.9,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,1,227.2,177.48,7.0,170.48,0.0,0.0,170.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003740,MBR00000144,Professional,2022-07-12,2022-07-12,2022-07-27,PLN7766,1556140803,1556140803,Cardiology,In-Network,F32.9,F41.9,,,,,,,0,,99213,E&M,,,,11,Office,3,222.52,175.62,0.0,175.62,50.0,0.0,225.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003741,MBR00000144,Professional,2022-06-12,2022-06-12,2022-07-14,PLN9921,1948810580,1948810580,DME Supplier,In-Network,Z87.891,G43.909,,,,,,,0,,47562,Surgery,,,,21,Inpatient Hospital,3,6520.31,5145.56,4764.75,380.81,0.0,0.0,380.81,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003742,MBR00000144,Professional,2022-09-26,2022-09-26,2022-10-21,PLN8212,1245650222,1245650222,Gastroenterology,In-Network,F41.9,R05,,,,,,,0,,G0439,Medicine,,,,11,Office,1,580.98,287.69,272.25,0.44,15.0,0.0,15.44,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000003743,MBR00000144,Professional,2021-06-03,2021-06-03,2021-07-13,PLN3131,1631954542,1631954542,Oncology,In-Network,N39.0,I11.9,,,,,,,0,,G0468,Medicine,,,,22,Outpatient Hospital,2,598.42,325.2,250.2,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003744,MBR00000144,Professional,2023-07-25,2023-07-25,2023-08-24,PLN1287,1542828721,1542828721,Orthopedic Surgery,In-Network,J20.9,I25.10,,,,,,,0,,80061,Pathology/Lab,,,,22,Outpatient Hospital,3,95.21,37.73,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003745,MBR00000145,Professional,2022-07-26,2022-07-26,2022-08-05,PLN2287,1817234602,1817234602,Clinical Laboratory,In-Network,R51,Z12.11,,,,,,,0,,70450,Radiology,,,,11,Office,3,797.07,486.05,107.22,303.83,75.0,0.0,378.83,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003746,MBR00000145,Professional,2022-08-29,2022-08-29,2022-09-07,PLN4619,1355166277,1355166277,Endocrinology,In-Network,Z12.31,J20.9,,,,,,,0,,66984,Surgery,,,,11,Office,1,1282.54,664.14,0.0,92.64,0.0,0.0,92.64,0.0,Denied,CO-18,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003747,MBR00000145,Institutional-OP,2023-08-19,2023-08-19,2023-09-24,PLN2884,1624802371,1624802371,ASC,Out-of-Network,K21.0,E11.9,,,,,,,0,,99222,E&M,,,0320,22,Outpatient Hospital,3,561.8,468.67,430.18,0.0,15.0,23.49,38.49,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003748,MBR00000145,Institutional-IP,2022-05-24,2022-06-05,2022-06-21,PLN5961,1284035364,1284035364,Pediatrics,In-Network,Z00.00,N39.0,,,,683,MS-DRG,6,12,Y,33533,Surgery,,,0270,21,Inpatient Hospital,1,13611.15,4398.66,4398.66,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000003749,MBR00000145,Professional,2022-05-20,2022-05-20,2022-06-14,PLN6718,1800011727,1800011727,Clinical Laboratory,Out-of-Network,E11.9,I10,,,,,,,0,,45378,Surgery,,,,11,Office,1,1858.59,1053.73,1053.73,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003750,MBR00000145,Institutional-OP,2022-09-11,2022-09-11,2022-09-18,PLN9483,1389336600,1389336600,Critical Access Hospital,In-Network,Z79.4,E11.65,,,,,,,0,,G0439,Medicine,,,0301,22,Outpatient Hospital,3,480.82,361.6,346.6,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000003751,MBR00000145,Professional,2023-10-25,2023-10-25,2023-11-26,PLN1710,1284035364,1284035364,Pediatrics,In-Network,M54.5,E11.9,,,,,,,0,,99232,E&M,,,,12,Home,2,317.82,210.05,0.0,210.05,0.0,0.0,210.05,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003752,MBR00000145,Professional,2021-10-05,2021-10-05,2021-10-17,PLN6364,1896447406,1896447406,Nephrology,Out-of-Network,Z00.00,E78.5,,,,,,,0,,93306,Radiology,,,,11,Office,1,2274.45,1763.51,1748.51,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003753,MBR00000145,Institutional-IP,2021-06-20,2021-06-22,2021-07-03,PLN5414,1964402759,1964402759,Outpatient Clinic,In-Network,F32.9,M54.5,,,,196,MS-DRG,18,2,Y,84443,Pathology/Lab,,,0270,21,Inpatient Hospital,2,157.27,130.43,0.0,130.43,0.0,0.0,130.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003754,MBR00000145,Professional,2021-04-29,2021-04-29,2021-06-04,PLN4683,1745114564,1745114564,Endocrinology,In-Network,E78.5,E11.9,,,,,,,0,,99232,E&M,,,,11,Office,3,241.09,174.53,140.41,0.0,15.0,19.12,34.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003755,MBR00000145,Institutional-OP,2023-03-18,2023-03-18,2023-04-19,PLN7805,1453283987,1453283987,Critical Access Hospital,In-Network,R51,E11.65,,,,,,,0,,71046,Radiology,,,0270,22,Outpatient Hospital,3,133.47,70.9,0.0,70.9,25.0,0.0,95.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003756,MBR00000145,Professional,2021-01-12,2021-01-12,2021-02-17,PLN4928,1453283987,1453283987,Critical Access Hospital,In-Network,R10.9,Z23,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,2,6724.37,2720.85,2552.02,168.83,0.0,0.0,168.83,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003757,MBR00000145,Professional,2023-02-15,2023-02-15,2023-02-25,PLN9277,1896447406,1896447406,Nephrology,Out-of-Network,Z23,R10.9,,,,,,,0,,99284,E&M,,,,11,Office,2,382.83,178.22,161.82,0.0,0.0,16.4,16.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003758,MBR00000145,Professional,2023-08-27,2023-08-27,2023-10-02,PLN6422,1990090423,1990090423,Orthopedic Surgery,In-Network,E66.9,Z00.00,,,,,,,0,,81001,Pathology/Lab,,,,21,Inpatient Hospital,3,44.58,13.52,0.0,13.52,0.0,0.0,13.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003759,MBR00000145,Professional,2023-01-17,2023-01-17,2023-02-26,PLN7798,1268679390,1268679390,Critical Access Hospital,In-Network,F32.9,E78.5,,,,,,,0,,45378,Surgery,,,,11,Office,2,966.5,304.15,223.95,0.0,50.0,30.2,80.2,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003760,MBR00000145,Professional,2021-07-06,2021-07-06,2021-08-13,PLN1387,1168881145,1168881145,Orthopedic Surgery,In-Network,N39.0,F41.9,,,,,,,0,,66984,Surgery,,,,11,Office,3,2740.86,1813.83,1609.15,204.68,0.0,0.0,204.68,0.0,Paid,,,1,,0,0,1,0,0,1,Unbundling,0,0,0,0,0
CLM0000003761,MBR00000145,Professional,2022-12-27,2022-12-27,2023-01-12,PLN5745,1511044648,1511044648,Endocrinology,In-Network,I10,I25.10,,,,,,,0,,99284,E&M,,,,81,Independent Laboratory,1,519.11,406.83,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003762,MBR00000145,Professional,2022-04-30,2022-04-30,2022-05-22,PLN2234,1847081578,1847081578,Urology,Out-of-Network,E66.9,I10,,,,,,,0,,43239,Surgery,,,,21,Inpatient Hospital,3,1732.18,856.61,848.09,8.52,0.0,0.0,8.52,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003763,MBR00000145,Professional,2021-01-25,2021-01-25,2021-03-05,PLN5979,1845057593,1845057593,Orthopedic Surgery,In-Network,N18.3,G20,,,,,,,0,,99233,E&M,,,,23,Emergency Room,2,363.01,215.84,215.84,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003764,MBR00000145,Institutional-IP,2021-08-05,2021-08-10,2021-09-17,PLN9751,1716521444,1716521444,Oncology,In-Network,Z00.01,E11.9,,,,871,MS-DRG,10,5,Y,82043,Pathology/Lab,,,0301,21,Inpatient Hospital,1,73.63,61.95,56.84,0.0,0.0,5.11,5.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003765,MBR00000145,Institutional-OP,2023-03-24,2023-03-24,2023-04-04,PLN1184,1575695214,1575695214,SNF,In-Network,I48.91,M54.5,,,,,,,0,,80061,Pathology/Lab,,,0900,22,Outpatient Hospital,2,67.6,51.42,51.42,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003766,MBR00000145,Institutional-OP,2022-09-07,2022-09-07,2022-10-11,PLN8597,1990090423,1990090423,Orthopedic Surgery,In-Network,F41.9,J20.9,,,,,,,0,,99214,E&M,,,0270,22,Outpatient Hospital,2,253.99,198.5,123.5,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003767,MBR00000145,Institutional-IP,2022-07-02,2022-07-05,2022-07-31,PLN7400,1696843572,1696843572,Critical Access Hospital,Out-of-Network,Z51.11,Z00.00,,,,641,MS-DRG,1,3,Y,99222,E&M,,,0450,21,Inpatient Hospital,3,387.82,157.0,132.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003768,MBR00000145,Institutional-OP,2023-05-01,2023-05-01,2023-05-20,PLN4097,1585582070,1585582070,Outpatient Clinic,In-Network,Z23,N18.3,,,,,,,0,,97530,Medicine,,,0360,22,Outpatient Hospital,1,123.93,82.87,0.0,82.87,50.0,0.0,132.87,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000003769,MBR00000146,Institutional-IP,2022-07-28,2022-08-07,2022-08-22,PLN1352,1896447406,1896447406,Nephrology,Out-of-Network,G20,E11.9,,,,603,MS-DRG,23,10,Y,27130,Surgery,,,0636,21,Inpatient Hospital,2,6690.19,3665.15,3640.15,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003770,MBR00000146,Institutional-OP,2023-11-27,2023-11-27,2023-12-18,PLN3798,1268679390,1268679390,Critical Access Hospital,In-Network,I10,N40.0,,,,,,,0,,84443,Pathology/Lab,,,0636,22,Outpatient Hospital,1,73.85,24.19,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003771,MBR00000146,Institutional-OP,2021-02-25,2021-02-25,2021-04-09,PLN6616,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,J06.9,Z23,,,,,,,0,,99283,E&M,,,0740,22,Outpatient Hospital,1,307.64,214.53,0.0,185.93,35.0,0.0,220.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003772,MBR00000146,Institutional-OP,2021-11-10,2021-11-10,2021-12-03,PLN5314,1227362142,1227362142,DME Supplier,In-Network,F03.90,I25.10,,,,,,,0,,99213,E&M,,,0636,22,Outpatient Hospital,1,141.83,62.45,0.0,62.45,0.0,0.0,62.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003773,MBR00000146,Institutional-OP,2021-07-26,2021-07-26,2021-09-03,PLN7093,1991459367,1991459367,Neurology,Out-of-Network,Z00.00,F32.9,,,,,,,0,,66984,Surgery,,,0450,22,Outpatient Hospital,1,1570.45,1002.15,967.15,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003774,MBR00000146,Institutional-OP,2022-03-30,2022-03-30,2022-05-12,PLN9960,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,F03.90,E87.6,,,,,,,0,,84443,Pathology/Lab,,,0740,22,Outpatient Hospital,3,110.28,58.97,58.97,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003775,MBR00000146,Professional,2023-09-25,2023-09-25,2023-11-06,PLN7178,1235381502,1235381502,Cardiology,In-Network,Z00.00,J06.9,,,,,,,0,,58661,Surgery,,,,12,Home,2,2245.13,841.91,504.6,238.89,0.0,98.42,337.31,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003776,MBR00000146,Institutional-OP,2022-03-25,2022-03-25,2022-04-05,PLN2418,1935547131,1935547131,Pulmonology,In-Network,K21.0,F32.9,,,,,,,0,,80053,Pathology/Lab,,,0120,22,Outpatient Hospital,1,145.3,91.84,85.05,0.0,0.0,6.79,6.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003777,MBR00000146,Professional,2021-12-12,2021-12-12,2022-01-10,PLN9343,1186826716,1186826716,Physical Therapy,In-Network,J44.1,N39.0,,,,,,,0,,99232,E&M,,,,20,Urgent Care,2,384.83,280.66,0.0,280.66,75.0,0.0,355.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003778,MBR00000146,Professional,2021-04-03,2021-04-03,2021-04-18,PLN7730,1563980627,1563980627,Critical Access Hospital,In-Network,Z12.31,I10,,,,,,,0,,33533,Surgery,,,,21,Inpatient Hospital,1,13714.14,6282.35,6196.48,10.87,75.0,0.0,85.87,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000003779,MBR00000146,Professional,2022-03-08,2022-03-08,2022-04-04,PLN4380,1438368327,1438368327,Home Health,In-Network,E66.9,N39.0,,,,,,,0,,66984,Surgery,,,,11,Office,1,1785.73,1117.11,828.91,41.58,75.0,171.62,288.2,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003780,MBR00000146,Institutional-IP,2021-09-08,2021-09-18,2021-10-08,PLN1919,1624202402,1624202402,Orthopedic Surgery,In-Network,Z12.31,F41.9,,,,683,MS-DRG,11,10,Y,99203,E&M,,,0301,21,Inpatient Hospital,3,218.05,146.65,111.65,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003781,MBR00000147,Professional,2021-07-27,2021-07-27,2021-09-07,PLN6435,1500949740,1500949740,Pediatrics,In-Network,S72.001A,I10,,,,,,,0,,33533,Surgery,,,,11,Office,1,20778.07,11887.78,11887.78,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000003782,MBR00000147,Professional,2021-05-27,2021-05-27,2021-07-09,PLN1671,1245650222,1245650222,Gastroenterology,In-Network,E11.40,N18.3,,,,,,,0,,43239,Surgery,,,,50,Federally Qualified Health Center,2,1505.02,1139.79,642.31,393.51,0.0,103.97,497.48,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003783,MBR00000147,Professional,2022-11-24,2022-11-24,2022-12-09,PLN7537,1135158374,1135158374,Pulmonology,In-Network,M17.11,F32.9,,,,,,,0,,43239,Surgery,,,,23,Emergency Room,2,1346.5,992.85,613.36,379.49,0.0,0.0,379.49,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003784,MBR00000147,Institutional-IP,2023-02-16,2023-02-17,2023-03-26,PLN1321,1752470395,1752470395,Home Health,In-Network,R10.9,I10,,,,195,MS-DRG,15,1,Y,G0439,Medicine,,,0730,21,Inpatient Hospital,2,335.85,138.72,0.0,138.72,50.0,0.0,188.72,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000003785,MBR00000147,Professional,2023-03-23,2023-03-23,2023-04-14,PLN7873,1728018911,1728018911,Nephrology,In-Network,J44.1,J44.1,,,,,,,0,,45378,Surgery,,,,31,Skilled Nursing Facility,2,2370.23,1063.48,789.83,140.95,0.0,132.7,273.65,0.0,Adjusted,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003786,MBR00000147,Institutional-IP,2021-02-28,2021-03-08,2021-03-12,PLN3163,1186826716,1186826716,Physical Therapy,In-Network,E11.40,F41.9,,,,195,MS-DRG,22,8,Y,97110,Medicine,,,0450,21,Inpatient Hospital,1,197.27,136.19,0.0,136.19,0.0,0.0,136.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003787,MBR00000147,Institutional-IP,2023-10-06,2023-10-10,2023-11-10,PLN6003,1364429278,1364429278,OB/GYN,In-Network,M81.0,R05,,,,641,MS-DRG,12,4,Y,93000,Radiology,,,0370,21,Inpatient Hospital,2,81.02,36.33,36.33,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003788,MBR00000147,Institutional-OP,2022-07-10,2022-07-10,2022-07-30,PLN8172,1514306773,1514306773,Endocrinology,In-Network,M17.11,N39.0,,,,,,,0,,83036,Pathology/Lab,,,0730,22,Outpatient Hospital,1,103.43,73.17,38.17,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000003789,MBR00000147,Institutional-IP,2022-09-08,2022-09-09,2022-10-18,PLN6573,1213165847,1213165847,Critical Access Hospital,In-Network,N20.0,E11.9,,,,195,MS-DRG,14,1,Y,70450,Radiology,,,0370,21,Inpatient Hospital,2,1004.25,613.31,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003790,MBR00000147,Professional,2023-08-19,2023-08-19,2023-09-15,PLN8540,1994661817,1994661817,SNF,Out-of-Network,F41.9,I50.9,,,,,,,0,,86900,Pathology/Lab,,,,81,Independent Laboratory,1,54.84,18.1,15.52,0.0,0.0,2.58,2.58,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003791,MBR00000147,Institutional-OP,2021-10-29,2021-10-29,2021-11-11,PLN5094,1530904931,1530904931,Internal Medicine,In-Network,F41.9,E78.5,,,,,,,0,,99232,E&M,,,0360,22,Outpatient Hospital,2,332.78,112.7,0.0,112.7,50.0,0.0,162.7,0.0,Adjusted,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000003792,MBR00000147,Institutional-OP,2022-07-06,2022-07-06,2022-07-14,PLN6287,1283743001,1283743001,Family Medicine,In-Network,S72.001A,E66.9,,,,,,,0,,99283,E&M,,,0740,22,Outpatient Hospital,3,273.38,87.6,0.0,87.6,50.0,0.0,137.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003793,MBR00000147,Professional,2021-03-19,2021-03-19,2021-03-30,PLN7977,1702692193,1702692193,Physical Therapy,In-Network,M17.11,E78.5,,,,,,,0,,93000,Radiology,,,,11,Office,2,107.16,55.33,0.0,55.33,50.0,0.0,105.33,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003794,MBR00000147,Professional,2022-06-24,2022-06-24,2022-07-22,PLN1256,1193493783,1193493783,Critical Access Hospital,Out-of-Network,I10,E11.9,,,,,,,0,,99233,E&M,,,,12,Home,3,437.45,243.33,243.33,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003795,MBR00000147,Professional,2021-10-19,2021-10-19,2021-10-29,PLN3992,1148984206,1148984206,Psychiatry,In-Network,Z23,F32.9,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,2,2187.62,1586.63,1533.07,53.56,0.0,0.0,53.56,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003796,MBR00000147,Institutional-OP,2021-07-19,2021-07-19,2021-09-01,PLN2192,1622771872,1622771872,Pediatrics,In-Network,I25.10,Z12.31,,,,,,,0,,99214,E&M,,,0761,22,Outpatient Hospital,2,296.15,231.9,67.1,149.8,15.0,0.0,164.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003797,MBR00000147,Institutional-OP,2022-11-09,2022-11-09,2022-12-13,PLN4945,1840431511,1840431511,Geriatrics,Out-of-Network,Z00.00,M54.5,,,,,,,0,,77067,Radiology,,,0730,22,Outpatient Hospital,1,623.58,513.6,95.59,343.01,75.0,0.0,418.01,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000003798,MBR00000148,Institutional-OP,2021-05-23,2021-05-23,2021-06-25,PLN4504,1531398223,1531398223,OB/GYN,In-Network,F32.9,J20.9,,,,,,,0,,87491,Pathology/Lab,,,0450,22,Outpatient Hospital,2,105.51,60.65,60.65,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003799,MBR00000148,Institutional-OP,2023-12-03,2023-12-03,2023-12-21,PLN8540,1366426662,1366426662,Urology,In-Network,E11.9,N18.3,,,,,,,0,,43239,Surgery,,,0510,22,Outpatient Hospital,3,785.34,557.87,25.69,457.18,75.0,0.0,532.18,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003800,MBR00000148,Institutional-OP,2021-09-12,2021-09-12,2021-10-02,PLN2589,1624202402,1624202402,Orthopedic Surgery,In-Network,E11.9,M54.5,,,,,,,0,,27447,Surgery,,,0740,22,Outpatient Hospital,3,3130.31,2155.62,2155.62,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003801,MBR00000148,Professional,2021-03-28,2021-03-28,2021-05-09,PLN1431,1247341320,1247341320,Urology,Out-of-Network,Z96.641,I10,,,,,,,0,,70553,Radiology,,,,11,Office,2,3166.71,1475.04,1475.04,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003802,MBR00000148,Professional,2022-05-05,2022-05-05,2022-06-15,PLN4312,1812060197,1812060197,Oncology,Out-of-Network,Z23,J06.9,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,2,54.45,29.25,0.0,29.25,0.0,0.0,29.25,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003803,MBR00000148,Professional,2022-03-02,2022-03-02,2022-04-15,PLN5075,1389336600,1389336600,Critical Access Hospital,In-Network,Z96.641,F32.9,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,1,2383.35,1784.06,1759.06,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000003804,MBR00000148,Professional,2022-12-22,2022-12-22,2023-01-14,PLN2517,1561134315,1561134315,DME Supplier,In-Network,N39.0,N39.0,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,3,382.92,187.96,13.03,124.93,50.0,0.0,174.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003805,MBR00000148,Professional,2023-01-01,2023-01-01,2023-02-10,PLN3722,1463205530,1463205530,Nephrology,In-Network,R51,E66.9,,,,,,,0,,93000,Radiology,,,,22,Outpatient Hospital,1,82.54,32.21,32.21,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003806,MBR00000148,Professional,2022-10-11,2022-10-11,2022-10-24,PLN6211,1590915516,1590915516,Physical Therapy,Out-of-Network,I50.9,Z00.00,,,,,,,0,,45378,Surgery,,,,11,Office,1,2406.22,935.43,0.0,149.37,0.0,0.0,149.37,0.0,Denied,CO-15,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003807,MBR00000148,Institutional-OP,2022-09-22,2022-09-22,2022-10-06,PLN5858,1511044648,1511044648,Endocrinology,In-Network,E78.5,N39.0,,,,,,,0,,58661,Surgery,,,0740,22,Outpatient Hospital,3,4729.25,3146.58,3146.58,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003808,MBR00000148,Professional,2023-05-01,2023-05-01,2023-05-12,PLN8366,1108115157,1108115157,General Acute Care Hospital,In-Network,Z00.00,I10,,,,,,,0,,23472,Surgery,,,,11,Office,2,5093.94,3204.53,3179.53,0.0,25.0,0.0,25.0,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003809,MBR00000148,Institutional-OP,2022-12-15,2022-12-15,2023-01-06,PLN5279,1728018911,1728018911,Nephrology,In-Network,K57.30,N17.9,,,,,,,0,,72148,Radiology,,,0370,22,Outpatient Hospital,3,2603.8,1013.95,0.0,0.0,0.0,52.02,52.02,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003810,MBR00000148,Institutional-OP,2021-06-02,2021-06-02,2021-07-11,PLN6361,1899127912,1899127912,Neurology,In-Network,Z87.891,M17.11,,,,,,,0,,G0444,Medicine,,,0900,22,Outpatient Hospital,3,73.79,40.64,0.0,40.64,75.0,0.0,115.64,0.0,Pended,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000003811,MBR00000148,Professional,2022-05-23,2022-05-23,2022-06-28,PLN6332,1946680931,1946680931,Critical Access Hospital,Out-of-Network,I10,E11.9,,,,,,,0,,99221,E&M,,,,21,Inpatient Hospital,2,182.61,133.19,0.0,133.19,35.0,0.0,168.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003812,MBR00000148,Professional,2023-01-24,2023-01-24,2023-02-20,PLN3473,1727809972,1727809972,Home Health,In-Network,R10.9,I25.10,,,,,,,0,,99283,E&M,,,,81,Independent Laboratory,3,289.76,209.13,186.63,0.0,0.0,22.5,22.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003813,MBR00000148,Professional,2021-10-20,2021-10-20,2021-11-07,PLN7687,1946680931,1946680931,Critical Access Hospital,Out-of-Network,F41.9,F03.90,,,,,,,0,,97110,Medicine,,,,20,Urgent Care,1,198.61,103.28,0.0,103.28,75.0,0.0,178.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003814,MBR00000148,Institutional-OP,2023-08-04,2023-08-04,2023-09-02,PLN9034,1139906830,1139906830,Endocrinology,Out-of-Network,Z00.00,I10,,,,,,,0,,G0444,Medicine,,,0120,22,Outpatient Hospital,1,59.44,42.38,0.0,42.38,0.0,0.0,42.38,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000003815,MBR00000148,Institutional-OP,2022-06-13,2022-06-13,2022-07-22,PLN4732,1624802371,1624802371,ASC,Out-of-Network,Z23,Z23,,,,,,,0,,27130,Surgery,,,0510,22,Outpatient Hospital,2,6069.93,4176.32,4161.32,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003816,MBR00000148,Professional,2021-12-18,2021-12-18,2021-12-29,PLN6250,1915531927,1915531927,Critical Access Hospital,In-Network,G20,F41.9,,,,,,,0,,47562,Surgery,,,,11,Office,2,3566.18,2797.99,0.0,489.12,0.0,193.94,683.06,0.0,Denied,CO-18,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003817,MBR00000148,Institutional-IP,2022-02-22,2022-03-07,2022-03-26,PLN9403,1727809972,1727809972,Home Health,In-Network,E78.5,E11.9,,,,690,MS-DRG,14,13,Y,93306,Radiology,,,0120,21,Inpatient Hospital,2,1301.32,842.49,792.49,0.0,50.0,0.0,50.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003818,MBR00000148,Institutional-OP,2022-11-09,2022-11-09,2022-11-25,PLN4468,1186826716,1186826716,Physical Therapy,In-Network,F10.20,I10,,,,,,,0,,70450,Radiology,,,0450,22,Outpatient Hospital,2,1577.08,847.54,847.54,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003819,MBR00000148,Professional,2023-02-16,2023-02-16,2023-03-27,PLN4389,1453936007,1453936007,ASC,In-Network,E78.5,I10,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,1,186.93,82.07,32.07,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003820,MBR00000148,Institutional-IP,2021-10-08,2021-10-20,2021-10-16,PLN3182,1606140917,1606140917,ASC,In-Network,I10,J06.9,,,,196,MS-DRG,4,12,Y,58661,Surgery,,,0740,21,Inpatient Hospital,1,3479.11,2755.5,2720.5,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003821,MBR00000148,Professional,2021-07-07,2021-07-07,2021-07-21,PLN1074,1717546253,1717546253,Family Medicine,In-Network,I10,N40.0,,,,,,,0,,82043,Pathology/Lab,,,,22,Outpatient Hospital,3,45.18,26.58,23.5,0.0,0.0,3.08,3.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003822,MBR00000148,Professional,2021-04-11,2021-04-11,2021-05-09,PLN9101,1205377316,1205377316,Orthopedic Surgery,In-Network,E87.6,E11.40,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,3,86.79,61.69,26.69,0.0,35.0,0.0,35.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003823,MBR00000148,Institutional-OP,2022-06-28,2022-06-28,2022-07-30,PLN6043,1727809972,1727809972,Home Health,In-Network,I10,E11.9,,,,,,,0,,47562,Surgery,,,0370,22,Outpatient Hospital,1,2768.93,1126.29,1111.29,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003824,MBR00000148,Professional,2023-10-13,2023-10-13,2023-10-22,PLN6501,1268679390,1268679390,Critical Access Hospital,In-Network,R10.9,E66.9,,,,,,,0,,78452,Radiology,,,,11,Office,3,5966.93,3569.51,3225.98,0.0,0.0,343.53,343.53,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003825,MBR00000148,Institutional-OP,2023-11-17,2023-11-17,2023-12-31,PLN3158,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,Z23,E78.5,,,,,,,0,,47562,Surgery,,,0510,22,Outpatient Hospital,2,2828.72,1187.58,0.0,0.0,50.0,0.0,50.0,0.0,Denied,PR-1,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003826,MBR00000148,Institutional-OP,2022-09-05,2022-09-05,2022-10-13,PLN5377,1224179551,1224179551,Physical Therapy,In-Network,I11.9,I10,,,,,,,0,,90686,Medicine,,,0320,22,Outpatient Hospital,1,127.06,71.83,0.0,71.83,0.0,0.0,71.83,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000003827,MBR00000148,Professional,2022-08-06,2022-08-06,2022-08-27,PLN1287,1700633438,1700633438,DME Supplier,In-Network,Z12.31,I25.10,,,,,,,0,,47562,Surgery,,,,23,Emergency Room,2,4198.46,1503.65,1503.65,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003828,MBR00000148,Institutional-OP,2022-07-06,2022-07-06,2022-07-27,PLN8953,1313212303,1313212303,Family Medicine,In-Network,N39.0,M54.5,,,,,,,0,,80053,Pathology/Lab,,,0740,22,Outpatient Hospital,2,58.09,34.04,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003829,MBR00000148,Professional,2021-09-17,2021-09-17,2021-10-27,PLN9043,1817234602,1817234602,Clinical Laboratory,In-Network,Z00.00,Z23,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,2,445.31,238.79,238.79,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003830,MBR00000148,Professional,2022-04-01,2022-04-01,2022-05-09,PLN6696,1948810580,1948810580,DME Supplier,In-Network,E11.9,M54.5,,,,,,,0,,72148,Radiology,,,,22,Outpatient Hospital,3,2757.68,1831.11,1831.11,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003831,MBR00000148,Professional,2023-10-22,2023-10-22,2023-11-25,PLN9657,1622771872,1622771872,Pediatrics,In-Network,Z51.11,F32.9,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,1,163.46,68.3,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003832,MBR00000149,Institutional-OP,2022-11-06,2022-11-06,2022-11-21,PLN2064,1475984649,1475984649,SNF,In-Network,I10,F32.9,,,,,,,0,,76700,Radiology,,,0120,22,Outpatient Hospital,3,555.23,380.44,0.0,380.44,25.0,0.0,405.44,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003833,MBR00000149,Institutional-OP,2021-09-25,2021-09-25,2021-10-24,PLN7994,1757138478,1757138478,Pediatrics,In-Network,K57.30,M54.5,,,,,,,0,,66984,Surgery,,,0200,22,Outpatient Hospital,2,1946.4,1577.22,1248.01,308.09,0.0,21.12,329.21,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003834,MBR00000149,Professional,2021-04-06,2021-04-06,2021-04-25,PLN8447,1563980627,1563980627,Critical Access Hospital,In-Network,I25.10,I10,,,,,,,0,,71046,Radiology,,,,11,Office,3,201.91,136.28,101.28,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003835,MBR00000149,Professional,2023-04-03,2023-04-03,2023-04-29,PLN5781,1980712759,1980712759,Outpatient Clinic,Out-of-Network,E11.65,F32.9,,,,,,,0,,47562,Surgery,,,,23,Emergency Room,3,4694.91,2903.16,2888.16,0.0,15.0,0.0,15.0,0.0,Pended,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003836,MBR00000149,Institutional-OP,2023-09-16,2023-09-16,2023-10-26,PLN6041,1757138478,1757138478,Pediatrics,In-Network,M54.5,R05,,,,,,,0,,83036,Pathology/Lab,,,0360,22,Outpatient Hospital,3,97.21,55.12,0.0,55.12,0.0,0.0,55.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000003837,MBR00000149,Institutional-IP,2021-04-30,2021-05-05,2021-06-08,PLN9789,1486164553,1486164553,DME Supplier,In-Network,N20.0,M54.5,,,,291,MS-DRG,2,5,Y,99203,E&M,,,0360,21,Inpatient Hospital,1,395.9,270.87,0.0,216.53,75.0,0.0,291.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003838,MBR00000149,Professional,2022-02-15,2022-02-15,2022-03-24,PLN3422,1727809972,1727809972,Home Health,In-Network,E66.9,N39.0,,,,,,,0,,99214,E&M,,,,11,Office,1,335.68,283.27,218.48,24.03,15.0,25.76,64.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003839,MBR00000149,Professional,2023-07-23,2023-07-23,2023-07-30,PLN7191,1284035364,1284035364,Pediatrics,In-Network,R07.9,J44.1,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,3,5502.46,3703.22,3629.06,0.0,25.0,49.16,74.16,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003840,MBR00000149,Professional,2021-10-05,2021-10-05,2021-10-19,PLN7566,1355166277,1355166277,Endocrinology,In-Network,I10,E78.5,,,,,,,0,,23472,Surgery,,,,11,Office,2,7469.7,2762.16,2604.31,157.85,0.0,0.0,157.85,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003841,MBR00000149,Professional,2021-07-17,2021-07-17,2021-08-10,PLN2669,1125190055,1125190055,Nephrology,In-Network,E11.9,Z79.4,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,2,349.23,114.16,109.4,0.0,0.0,4.76,4.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003842,MBR00000149,Professional,2022-03-08,2022-03-08,2022-03-22,PLN4938,1219817751,1219817751,OB/GYN,In-Network,E66.9,Z00.00,,,,,,,0,,66984,Surgery,,,,21,Inpatient Hospital,1,3538.53,1236.18,1066.48,0.0,0.0,169.7,169.7,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003843,MBR00000149,Institutional-OP,2022-03-08,2022-03-08,2022-03-26,PLN5312,1295371663,1295371663,Critical Access Hospital,In-Network,M17.11,I10,,,,,,,0,,93306,Radiology,,,0730,22,Outpatient Hospital,3,1909.32,576.44,576.44,0.0,0.0,0.0,0.0,0.0,Pended,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003844,MBR00000149,Institutional-IP,2022-06-12,2022-06-16,2022-07-05,PLN9308,1219817751,1219817751,OB/GYN,In-Network,M54.5,Z00.00,,,,871,MS-DRG,15,4,Y,86900,Pathology/Lab,,,0270,21,Inpatient Hospital,3,52.24,37.27,22.27,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003845,MBR00000149,Professional,2023-11-24,2023-11-24,2023-12-02,PLN3584,1219817751,1219817751,OB/GYN,In-Network,F41.9,R10.9,,,,,,,0,,99221,E&M,,,,50,Federally Qualified Health Center,1,369.38,190.74,190.74,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003846,MBR00000149,Institutional-OP,2023-12-01,2023-12-01,2023-12-30,PLN2251,1168246159,1168246159,Internal Medicine,In-Network,E78.5,Z12.31,,,,,,,0,,99221,E&M,,,0450,22,Outpatient Hospital,1,409.39,175.35,0.0,175.35,0.0,0.0,175.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003847,MBR00000149,Professional,2022-09-27,2022-09-27,2022-10-29,PLN6942,1896447406,1896447406,Nephrology,Out-of-Network,J20.9,F10.20,,,,,,,0,,23472,Surgery,,,,11,Office,2,3552.13,2282.8,1796.51,110.09,50.0,326.2,486.29,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003848,MBR00000149,Institutional-OP,2021-03-24,2021-03-24,2021-04-30,PLN7745,1511044648,1511044648,Endocrinology,In-Network,F41.9,Z12.31,,,,,,,0,,82043,Pathology/Lab,,,0320,22,Outpatient Hospital,2,52.21,41.2,40.17,0.0,0.0,1.03,1.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003849,MBR00000149,Professional,2021-10-17,2021-10-17,2021-11-08,PLN8578,1749494482,1749494482,Pediatrics,In-Network,E78.5,E78.5,,,,,,,0,,45378,Surgery,,,,12,Home,1,903.28,291.66,0.0,291.66,0.0,0.0,291.66,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003850,MBR00000149,Professional,2021-07-17,2021-07-17,2021-08-02,PLN8793,1540044947,1540044947,Pulmonology,Out-of-Network,J06.9,N39.0,,,,,,,0,,80061,Pathology/Lab,,,,31,Skilled Nursing Facility,3,120.92,50.57,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003851,MBR00000149,Professional,2021-01-01,2021-01-01,2021-02-06,PLN9561,1500037969,1500037969,Pulmonology,In-Network,E78.5,Z79.4,,,,,,,0,,90837,Medicine,,,,22,Outpatient Hospital,2,266.78,109.79,83.77,0.0,15.0,11.02,26.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003852,MBR00000149,Professional,2022-02-24,2022-02-24,2022-03-08,PLN2724,1964402759,1964402759,Outpatient Clinic,In-Network,I10,I10,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,2,606.08,199.72,0.0,199.72,0.0,0.0,199.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003853,MBR00000149,Institutional-IP,2021-01-08,2021-01-11,2021-01-23,PLN3083,1994661817,1994661817,SNF,Out-of-Network,I10,K21.0,,,,470,MS-DRG,11,3,Y,70553,Radiology,,,0360,21,Inpatient Hospital,3,3183.91,1170.15,1170.15,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003854,MBR00000149,Institutional-IP,2022-09-21,2022-09-24,2022-10-16,PLN1476,1974006077,1974006077,Orthopedic Surgery,In-Network,G43.909,F03.90,,,,683,MS-DRG,14,3,Y,99204,E&M,,,0320,21,Inpatient Hospital,3,465.36,223.77,0.0,223.77,50.0,0.0,273.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003855,MBR00000149,Professional,2021-10-28,2021-10-28,2021-11-08,PLN9881,1915531927,1915531927,Critical Access Hospital,In-Network,Z12.11,B97.89,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,1,78.82,45.66,45.66,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003856,MBR00000149,Professional,2023-03-05,2023-03-05,2023-03-12,PLN9579,1717546253,1717546253,Family Medicine,In-Network,E11.9,E11.40,,,,,,,0,,27447,Surgery,,,,11,Office,1,4409.57,1985.55,1559.25,391.3,35.0,0.0,426.3,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003857,MBR00000149,Institutional-OP,2022-07-31,2022-07-31,2022-09-01,PLN5165,1716521444,1716521444,Oncology,In-Network,R07.9,R51,,,,,,,0,,74177,Radiology,,,0450,22,Outpatient Hospital,1,2423.69,1998.7,1963.7,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003858,MBR00000150,Institutional-IP,2023-11-08,2023-11-09,2023-11-24,PLN8890,1939033455,1939033455,Pulmonology,In-Network,J44.1,J06.9,,,,194,MS-DRG,4,1,Y,97110,Medicine,,,0510,21,Inpatient Hospital,2,234.54,86.59,0.0,86.59,0.0,0.0,86.59,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003859,MBR00000150,Institutional-OP,2022-06-15,2022-06-15,2022-07-01,PLN2170,1749327647,1749327647,Geriatrics,In-Network,Z00.01,I10,,,,,,,0,,99232,E&M,,,0761,22,Outpatient Hospital,1,313.32,230.08,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003860,MBR00000150,Institutional-OP,2021-06-21,2021-06-21,2021-07-09,PLN6010,1463205530,1463205530,Nephrology,In-Network,M54.5,E78.5,,,,,,,0,,93000,Radiology,,,0120,22,Outpatient Hospital,3,148.49,93.81,0.0,93.81,0.0,0.0,93.81,0.0,Adjusted,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003861,MBR00000150,Institutional-OP,2023-10-07,2023-10-07,2023-11-03,PLN3127,1939033455,1939033455,Pulmonology,In-Network,G43.909,E11.9,,,,,,,0,,43239,Surgery,,,0510,22,Outpatient Hospital,1,838.5,270.83,181.24,0.0,50.0,39.59,89.59,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003862,MBR00000151,Professional,2021-12-05,2021-12-05,2021-12-28,PLN2781,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,N39.0,R51,,,,,,,0,,76700,Radiology,,,,81,Independent Laboratory,1,538.16,198.67,0.0,198.67,0.0,0.0,198.67,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003863,MBR00000151,Institutional-OP,2023-04-17,2023-04-17,2023-04-28,PLN1564,1148984206,1148984206,Psychiatry,In-Network,E11.40,F41.9,,,,,,,0,,99284,E&M,,,0730,22,Outpatient Hospital,1,858.44,449.32,424.32,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003864,MBR00000151,Professional,2023-05-08,2023-05-08,2023-06-19,PLN2602,1713934949,1713934949,Neurology,In-Network,Z12.31,Z23,,,,,,,0,,99221,E&M,,,,21,Inpatient Hospital,2,336.8,232.85,232.85,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003865,MBR00000151,Institutional-IP,2023-10-10,2023-10-17,2023-10-23,PLN6224,1389336600,1389336600,Critical Access Hospital,In-Network,Z12.31,R07.9,,,,291,MS-DRG,17,7,Y,80053,Pathology/Lab,,,0120,21,Inpatient Hospital,3,133.36,105.0,105.0,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003866,MBR00000151,Institutional-OP,2022-12-02,2022-12-02,2023-01-01,PLN9558,1590915516,1590915516,Physical Therapy,Out-of-Network,F03.90,Z23,,,,,,,0,,99232,E&M,,,0120,22,Outpatient Hospital,2,343.74,116.62,91.62,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003867,MBR00000151,Professional,2022-07-15,2022-07-15,2022-07-25,PLN9408,1135158374,1135158374,Pulmonology,In-Network,Z00.00,F32.9,,,,,,,0,,74177,Radiology,,,,20,Urgent Care,3,2599.48,1741.25,1519.67,146.58,75.0,0.0,221.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003868,MBR00000151,Professional,2022-02-26,2022-02-26,2022-03-14,PLN8698,1239316214,1239316214,Internal Medicine,In-Network,R05,E78.5,,,,,,,0,,76700,Radiology,,,,22,Outpatient Hospital,3,1309.31,682.24,347.64,334.6,0.0,0.0,334.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003869,MBR00000151,Professional,2022-05-05,2022-05-05,2022-06-17,PLN7208,1540044947,1540044947,Pulmonology,Out-of-Network,Z12.31,E66.9,,,,,,,0,,99232,E&M,,,,20,Urgent Care,3,189.32,150.63,0.0,150.63,75.0,0.0,225.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003870,MBR00000151,Institutional-OP,2023-05-05,2023-05-05,2023-05-22,PLN6740,1453936007,1453936007,ASC,In-Network,I10,F41.9,,,,,,,0,,43239,Surgery,,,0301,22,Outpatient Hospital,3,1646.9,1008.42,1008.42,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003871,MBR00000151,Professional,2022-09-12,2022-09-12,2022-09-26,PLN5371,1840431511,1840431511,Geriatrics,Out-of-Network,J06.9,J06.9,,,,,,,0,,99203,E&M,,,,12,Home,2,269.84,168.99,0.0,168.99,35.0,0.0,203.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003872,MBR00000151,Institutional-OP,2021-02-23,2021-02-23,2021-03-12,PLN3546,1631954542,1631954542,Oncology,In-Network,E11.65,I10,,,,,,,0,,99283,E&M,,,0200,22,Outpatient Hospital,3,531.26,411.16,336.16,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003873,MBR00000151,Professional,2022-02-12,2022-02-12,2022-03-03,PLN2862,1891849440,1891849440,Oncology,In-Network,J20.9,N39.0,,,,,,,0,,90837,Medicine,,,,11,Office,2,489.44,218.33,0.0,218.33,75.0,0.0,293.33,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003874,MBR00000151,Professional,2023-09-28,2023-09-28,2023-10-24,PLN6163,1245650222,1245650222,Gastroenterology,In-Network,R05,K21.0,,,,,,,0,,70450,Radiology,,,,11,Office,1,1677.66,1058.6,751.24,292.36,15.0,0.0,307.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003875,MBR00000151,Professional,2021-08-19,2021-08-19,2021-09-21,PLN6561,1438368327,1438368327,Home Health,In-Network,J44.1,E11.9,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,3,2142.31,905.1,905.1,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003876,MBR00000151,Institutional-OP,2022-06-02,2022-06-02,2022-07-01,PLN4334,1590915516,1590915516,Physical Therapy,Out-of-Network,I25.10,K21.0,,,,,,,0,,74177,Radiology,,,0636,22,Outpatient Hospital,1,2259.12,1719.56,0.0,0.0,0.0,0.0,0.0,0.0,Denied,PR-1,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003877,MBR00000151,Professional,2023-07-06,2023-07-06,2023-07-13,PLN5434,1500037969,1500037969,Pulmonology,In-Network,J20.9,F41.9,,,,,,,0,,76700,Radiology,,,,11,Office,1,670.85,533.93,0.0,158.17,35.0,0.0,193.17,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003878,MBR00000151,Institutional-OP,2021-11-14,2021-11-14,2021-12-19,PLN9526,1689639685,1689639685,SNF,In-Network,E78.5,Z00.00,,,,,,,0,,99204,E&M,,,0320,22,Outpatient Hospital,2,435.89,224.97,217.14,0.0,0.0,7.83,7.83,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000003879,MBR00000151,Institutional-IP,2023-01-16,2023-01-20,2023-01-24,PLN7825,1390307371,1390307371,DME Supplier,In-Network,J44.1,Z00.00,,,,194,MS-DRG,21,4,Y,27130,Surgery,,,0900,21,Inpatient Hospital,1,3629.3,2954.23,2230.5,460.95,0.0,262.78,723.73,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003880,MBR00000151,Institutional-OP,2023-05-10,2023-05-10,2023-05-21,PLN8585,1994661817,1994661817,SNF,Out-of-Network,I11.9,Z12.31,,,,,,,0,,70553,Radiology,,,0730,22,Outpatient Hospital,2,1683.19,1404.68,1024.7,99.51,25.0,255.47,379.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003881,MBR00000151,Professional,2021-12-23,2021-12-23,2022-02-02,PLN4718,1540044947,1540044947,Pulmonology,Out-of-Network,I11.9,E78.5,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,2,1400.79,580.66,498.92,66.74,15.0,0.0,81.74,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003882,MBR00000151,Professional,2023-09-08,2023-09-08,2023-09-22,PLN9417,1366576336,1366576336,Geriatrics,In-Network,I10,E66.9,,,,,,,0,,99222,E&M,,,,65,End-Stage Renal Disease,2,436.16,276.89,99.78,141.31,25.0,10.8,177.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003883,MBR00000151,Professional,2022-05-04,2022-05-04,2022-06-11,PLN4202,1500037969,1500037969,Pulmonology,In-Network,E78.5,J06.9,,,,,,,0,,23472,Surgery,,,,23,Emergency Room,3,4266.33,1909.34,1717.01,0.0,25.0,167.33,192.33,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003884,MBR00000151,Professional,2021-11-21,2021-11-21,2021-11-28,PLN3867,1806688928,1806688928,Geriatrics,In-Network,I25.10,J44.1,,,,,,,0,,85610,Pathology/Lab,,,,22,Outpatient Hospital,2,73.35,31.86,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003885,MBR00000151,Institutional-IP,2021-09-04,2021-09-09,2021-10-09,PLN6695,1224179551,1224179551,Physical Therapy,In-Network,Z87.891,E66.9,,,,292,MS-DRG,15,5,Y,86900,Pathology/Lab,,,0730,21,Inpatient Hospital,1,31.25,16.38,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003886,MBR00000151,Professional,2021-10-19,2021-10-19,2021-11-01,PLN6942,1438368327,1438368327,Home Health,In-Network,Z23,J20.9,,,,,,,0,,93306,Radiology,,,,65,End-Stage Renal Disease,3,3071.22,1502.53,1452.53,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003887,MBR00000151,Institutional-OP,2022-09-09,2022-09-09,2022-09-19,PLN1332,1266606767,1266606767,ASC,In-Network,E11.40,R51,,,,,,,0,,81001,Pathology/Lab,,,0730,22,Outpatient Hospital,1,48.33,26.99,0.0,26.99,0.0,0.0,26.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003888,MBR00000151,Professional,2021-09-04,2021-09-04,2021-09-22,PLN9732,1991459367,1991459367,Neurology,Out-of-Network,E78.5,Z23,,,,,,,0,,99233,E&M,,,,11,Office,2,379.21,137.94,116.09,0.0,0.0,21.85,21.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003889,MBR00000151,Professional,2022-01-28,2022-01-28,2022-02-16,PLN5110,1696843572,1696843572,Critical Access Hospital,Out-of-Network,Z23,F32.9,,,,,,,0,,99284,E&M,,,,11,Office,3,454.42,237.3,237.3,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003890,MBR00000151,Institutional-IP,2023-02-18,2023-02-19,2023-02-28,PLN8502,1245650222,1245650222,Gastroenterology,In-Network,I48.91,N39.0,,,,682,MS-DRG,24,1,Y,80061,Pathology/Lab,,,0270,21,Inpatient Hospital,2,46.86,15.42,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003891,MBR00000151,Professional,2023-08-17,2023-08-17,2023-09-11,PLN2034,1727809972,1727809972,Home Health,In-Network,I25.10,I10,,,,,,,0,,99203,E&M,,,,50,Federally Qualified Health Center,1,250.67,177.25,140.52,0.0,15.0,21.73,36.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003892,MBR00000151,Professional,2023-01-14,2023-01-14,2023-01-29,PLN5346,1713934949,1713934949,Neurology,In-Network,R05,F32.9,,,,,,,0,,99221,E&M,,,,11,Office,2,284.08,137.71,133.08,4.63,0.0,0.0,4.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003893,MBR00000151,Institutional-OP,2022-08-02,2022-08-02,2022-08-17,PLN9587,1569105090,1569105090,Geriatrics,In-Network,I10,K21.0,,,,,,,0,,99222,E&M,,,0301,22,Outpatient Hospital,2,326.17,167.93,0.0,0.0,0.0,30.44,30.44,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003894,MBR00000151,Professional,2023-02-02,2023-02-02,2023-02-09,PLN7812,1198133277,1198133277,SNF,In-Network,Z00.00,Z12.31,,,,,,,0,,45380,Surgery,,,,11,Office,3,2538.25,1151.66,1126.66,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000003895,MBR00000151,Institutional-IP,2022-03-27,2022-03-29,2022-04-20,PLN2899,1193493783,1193493783,Critical Access Hospital,Out-of-Network,B97.89,J44.1,,,,682,MS-DRG,9,2,Y,58661,Surgery,,,0270,21,Inpatient Hospital,2,3761.73,1573.54,1538.54,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003896,MBR00000151,Professional,2021-10-24,2021-10-24,2021-11-10,PLN2998,1434029575,1434029575,Endocrinology,In-Network,E78.5,F32.9,,,,,,,0,,99221,E&M,,,,49,Independent Clinic,2,251.47,123.59,0.0,123.59,0.0,0.0,123.59,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003897,MBR00000152,Professional,2023-04-01,2023-04-01,2023-04-15,PLN1823,1283743001,1283743001,Family Medicine,In-Network,E11.9,M54.5,,,,,,,0,,45380,Surgery,,,,12,Home,3,2992.46,958.83,943.83,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000003898,MBR00000152,Professional,2021-05-28,2021-05-28,2021-06-12,PLN2670,1865904917,1865904917,Outpatient Clinic,In-Network,J18.9,M54.5,,,,,,,0,,G0444,Medicine,,,,81,Independent Laboratory,3,91.92,61.01,0.0,61.01,0.0,0.0,61.01,0.0,Pended,,,0,,0,1,0,0,0,1,Phantom,0,0,0,0,1
CLM0000003899,MBR00000152,Institutional-OP,2023-09-19,2023-09-19,2023-10-15,PLN3199,1531398223,1531398223,OB/GYN,In-Network,J45.20,Z51.11,,,,,,,0,,99284,E&M,,,0740,22,Outpatient Hospital,1,657.02,395.16,0.0,368.7,35.0,0.0,403.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003900,MBR00000152,Professional,2022-04-15,2022-04-15,2022-05-22,PLN4219,1964402759,1964402759,Outpatient Clinic,In-Network,J45.20,Z12.11,,,,,,,0,,23472,Surgery,,,,23,Emergency Room,3,6756.15,3345.91,2902.34,372.37,50.0,21.2,443.57,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003901,MBR00000152,Professional,2023-06-15,2023-06-15,2023-07-10,PLN4699,1700633438,1700633438,DME Supplier,In-Network,Z12.11,J06.9,,,,,,,0,,45378,Surgery,,,,20,Urgent Care,3,2323.75,1067.25,1017.25,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003902,MBR00000152,Professional,2021-04-19,2021-04-19,2021-05-01,PLN6583,1434029575,1434029575,Endocrinology,In-Network,I10,E78.5,,,,,,,0,,93000,Radiology,,,,23,Emergency Room,3,127.38,94.63,0.0,0.0,0.0,8.98,8.98,0.0,Denied,CO-119,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003903,MBR00000152,Institutional-OP,2022-06-26,2022-06-26,2022-07-24,PLN5808,1247341320,1247341320,Urology,Out-of-Network,S72.001A,F41.9,,,,,,,0,,80053,Pathology/Lab,,,0360,22,Outpatient Hospital,3,153.75,63.21,0.82,47.27,15.0,0.12,62.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003904,MBR00000152,Professional,2022-04-08,2022-04-08,2022-04-22,PLN1176,1168881145,1168881145,Orthopedic Surgery,In-Network,I10,K21.0,,,,,,,0,,90837,Medicine,,,,11,Office,1,406.04,124.94,113.97,0.0,0.0,10.97,10.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003905,MBR00000152,Institutional-IP,2022-01-26,2022-01-29,2022-02-15,PLN2670,1806688928,1806688928,Geriatrics,In-Network,J06.9,E11.9,,,,470,MS-DRG,2,3,Y,27447,Surgery,,,0510,21,Inpatient Hospital,3,2266.63,870.58,835.58,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003906,MBR00000152,Professional,2022-07-15,2022-07-15,2022-08-09,PLN6250,1860435061,1860435061,DME Supplier,In-Network,I10,J06.9,,,,,,,0,,27447,Surgery,,,,11,Office,3,4044.49,2389.01,1645.86,364.98,0.0,378.17,743.15,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003907,MBR00000152,Professional,2022-12-27,2022-12-27,2023-01-12,PLN8756,1717546253,1717546253,Family Medicine,In-Network,J06.9,I10,,,,,,,0,,77067,Radiology,,,,49,Independent Clinic,2,751.15,587.33,587.33,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000003908,MBR00000152,Professional,2023-10-29,2023-10-29,2023-12-09,PLN8106,1872613201,1872613201,Internal Medicine,In-Network,E11.9,Z00.00,,,,,,,0,,G0468,Medicine,,,,11,Office,1,475.35,312.26,287.26,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003909,MBR00000152,Professional,2023-06-14,2023-06-14,2023-07-25,PLN8068,1108115157,1108115157,General Acute Care Hospital,In-Network,Z96.641,I10,,,,,,,0,,99233,E&M,,,,12,Home,1,542.68,184.19,109.19,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003910,MBR00000152,Professional,2021-09-11,2021-09-11,2021-10-18,PLN8059,1531398223,1531398223,OB/GYN,In-Network,N20.0,Z00.00,,,,,,,0,,90837,Medicine,,,,21,Inpatient Hospital,1,451.45,328.29,102.21,226.08,0.0,0.0,226.08,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000003911,MBR00000152,Professional,2023-12-08,2023-12-08,2024-01-16,PLN1714,1575695214,1575695214,SNF,In-Network,I10,E11.9,,,,,,,0,,87491,Pathology/Lab,,,,23,Emergency Room,3,183.59,81.44,48.61,32.83,0.0,0.0,32.83,0.0,Adjusted,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003912,MBR00000152,Institutional-OP,2022-06-30,2022-06-30,2022-08-03,PLN2197,1757138478,1757138478,Pediatrics,In-Network,I10,M54.5,,,,,,,0,,47562,Surgery,,,0636,22,Outpatient Hospital,3,3815.29,2149.36,2149.36,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003913,MBR00000152,Professional,2022-05-16,2022-05-16,2022-06-16,PLN9315,1266606767,1266606767,ASC,In-Network,I10,Z12.31,,,,,,,0,,70553,Radiology,,,,21,Inpatient Hospital,2,2123.34,1374.1,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-29,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003914,MBR00000152,Professional,2021-01-13,2021-01-13,2021-02-04,PLN7814,1757138478,1757138478,Pediatrics,In-Network,J20.9,Z12.11,,,,,,,0,,90460,Medicine,,,,11,Office,3,74.55,42.99,0.0,42.99,0.0,0.0,42.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003915,MBR00000152,Professional,2023-01-02,2023-01-02,2023-02-12,PLN4843,1727809972,1727809972,Home Health,In-Network,N17.9,I10,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,2,219.05,106.14,56.14,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003916,MBR00000152,Professional,2023-08-30,2023-08-30,2023-10-03,PLN3052,1795618275,1795618275,Pulmonology,In-Network,J18.9,Z51.11,,,,,,,0,,G0468,Medicine,,,,50,Federally Qualified Health Center,2,383.69,132.91,128.77,0.0,0.0,4.14,4.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003917,MBR00000152,Professional,2021-11-17,2021-11-17,2021-12-04,PLN5719,1361302520,1361302520,Critical Access Hospital,In-Network,E78.5,Z87.891,,,,,,,0,,99233,E&M,,,,11,Office,2,372.54,127.51,24.83,102.68,0.0,0.0,102.68,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003918,MBR00000152,Professional,2023-08-08,2023-08-08,2023-09-06,PLN9219,1691062876,1691062876,SNF,In-Network,Z12.11,C50.912,,,,,,,0,,99406,Medicine,,,,11,Office,1,70.3,50.34,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003919,MBR00000152,Professional,2021-04-06,2021-04-06,2021-05-20,PLN2615,1727809972,1727809972,Home Health,In-Network,N39.0,E11.9,,,,,,,0,,99203,E&M,,,,65,End-Stage Renal Disease,1,401.88,159.65,0.0,159.65,0.0,0.0,159.65,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003920,MBR00000152,Professional,2023-11-25,2023-11-25,2024-01-02,PLN8063,1224179551,1224179551,Physical Therapy,In-Network,Z79.4,R10.9,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,1,31.57,25.18,0.0,25.18,25.0,0.0,50.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003921,MBR00000152,Professional,2021-10-05,2021-10-05,2021-11-12,PLN8034,1856686341,1856686341,Geriatrics,In-Network,F32.9,E11.9,,,,,,,0,,99213,E&M,,,,11,Office,3,305.03,106.38,106.38,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003922,MBR00000152,Professional,2022-06-12,2022-06-12,2022-07-01,PLN6306,1450553056,1450553056,Clinical Laboratory,In-Network,K21.0,Z00.00,,,,,,,0,,33533,Surgery,,,,65,End-Stage Renal Disease,1,12913.53,5806.39,5806.39,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000003923,MBR00000152,Professional,2021-01-16,2021-01-16,2021-02-23,PLN1090,1168881145,1168881145,Orthopedic Surgery,In-Network,M54.5,I10,,,,,,,0,,99283,E&M,,,,31,Skilled Nursing Facility,1,427.39,253.19,253.19,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003924,MBR00000152,Professional,2023-09-11,2023-09-11,2023-09-29,PLN8507,1799205295,1799205295,General Acute Care Hospital,In-Network,Z00.00,J06.9,,,,,,,0,,99232,E&M,,,,11,Office,3,366.91,204.9,164.76,0.0,25.0,15.14,40.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003925,MBR00000152,Professional,2022-07-12,2022-07-12,2022-07-31,PLN5800,1364429278,1364429278,OB/GYN,In-Network,N18.3,Z12.31,,,,,,,0,,84443,Pathology/Lab,,,,81,Independent Laboratory,2,158.25,105.03,63.52,0.0,35.0,6.51,41.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003926,MBR00000152,Professional,2023-11-29,2023-11-29,2023-12-10,PLN3478,1561134315,1561134315,DME Supplier,In-Network,Z23,F10.20,,,,,,,0,,97530,Medicine,,,,23,Emergency Room,3,313.93,231.26,156.26,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003927,MBR00000152,Professional,2022-02-13,2022-02-13,2022-02-24,PLN1514,1644128543,1644128543,Gastroenterology,In-Network,N39.0,J20.9,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,3,118.58,77.54,61.2,0.0,15.0,1.34,16.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003928,MBR00000152,Institutional-OP,2021-03-07,2021-03-07,2021-04-01,PLN5077,1860435061,1860435061,DME Supplier,In-Network,K21.0,R51,,,,,,,0,,82043,Pathology/Lab,,,0740,22,Outpatient Hospital,2,64.52,26.69,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003929,MBR00000152,Professional,2023-01-13,2023-01-13,2023-01-20,PLN4526,1531398223,1531398223,OB/GYN,In-Network,E78.5,I25.10,,,,,,,0,,99222,E&M,,,,65,End-Stage Renal Disease,1,644.65,229.94,62.82,132.12,35.0,0.0,167.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003930,MBR00000152,Professional,2021-06-28,2021-06-28,2021-07-06,PLN2659,1935547131,1935547131,Pulmonology,In-Network,I10,Z12.31,,,,,,,0,,93306,Radiology,,,,23,Emergency Room,1,2038.43,1621.3,1251.86,202.21,0.0,167.23,369.44,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000003931,MBR00000152,Institutional-OP,2022-11-05,2022-11-05,2022-11-20,PLN1309,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,F10.20,N39.0,,,,,,,0,,27447,Surgery,,,0900,22,Outpatient Hospital,1,3868.75,2084.56,2084.56,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003932,MBR00000152,Professional,2021-02-08,2021-02-08,2021-03-10,PLN3363,1767011137,1767011137,DME Supplier,In-Network,I10,Z12.31,,,,,,,0,,97530,Medicine,,,,21,Inpatient Hospital,2,239.52,164.27,0.0,164.27,0.0,0.0,164.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003933,MBR00000152,Professional,2021-07-03,2021-07-03,2021-07-16,PLN6599,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,I10,R10.9,,,,,,,0,,93306,Radiology,,,,11,Office,3,2971.46,1963.73,1649.23,314.5,0.0,0.0,314.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003934,MBR00000152,Institutional-OP,2022-11-30,2022-11-30,2023-01-08,PLN7374,1696843572,1696843572,Critical Access Hospital,Out-of-Network,Z23,K21.0,,,,,,,0,,97110,Medicine,,,0360,22,Outpatient Hospital,3,154.67,85.99,0.0,85.99,0.0,0.0,85.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003935,MBR00000152,Professional,2023-01-08,2023-01-08,2023-01-29,PLN8691,1899127912,1899127912,Neurology,In-Network,Z12.31,J06.9,,,,,,,0,,G0468,Medicine,,,,11,Office,1,634.55,324.64,0.0,324.64,50.0,0.0,374.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003936,MBR00000152,Institutional-IP,2021-06-16,2021-06-19,2021-07-17,PLN6846,1542828721,1542828721,Orthopedic Surgery,In-Network,J06.9,N18.3,,,,690,MS-DRG,2,3,Y,58661,Surgery,,,0900,21,Inpatient Hospital,1,4319.56,2856.8,2856.8,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003937,MBR00000152,Professional,2021-07-25,2021-07-25,2021-08-19,PLN8849,1713934949,1713934949,Neurology,In-Network,N40.0,N40.0,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,3,89.6,34.16,10.66,8.5,15.0,0.0,23.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000003938,MBR00000152,Professional,2023-07-30,2023-07-30,2023-09-09,PLN3551,1205377316,1205377316,Orthopedic Surgery,In-Network,Z79.4,R10.9,,,,,,,0,,G0444,Medicine,,,,11,Office,1,50.4,33.59,18.59,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000003939,MBR00000152,Professional,2021-01-07,2021-01-07,2021-01-20,PLN8646,1896447406,1896447406,Nephrology,Out-of-Network,E78.5,J44.1,,,,,,,0,,27130,Surgery,,,,11,Office,2,6365.38,4359.49,3885.63,448.86,25.0,0.0,473.86,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003940,MBR00000153,Institutional-OP,2021-09-09,2021-09-09,2021-09-24,PLN6159,1422747896,1422747896,Urology,In-Network,I10,M17.11,,,,,,,0,,85025,Pathology/Lab,,,0120,22,Outpatient Hospital,1,92.86,53.24,0.0,53.24,25.0,0.0,78.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003941,MBR00000153,Professional,2023-11-29,2023-11-29,2023-12-20,PLN2756,1125190055,1125190055,Nephrology,In-Network,I11.9,E78.5,,,,,,,0,,99203,E&M,,,,21,Inpatient Hospital,1,228.72,161.28,161.28,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003942,MBR00000153,Institutional-IP,2022-08-23,2022-08-27,2022-08-31,PLN8117,1518055405,1518055405,Urology,In-Network,E66.9,E11.9,,,,194,MS-DRG,18,4,Y,23472,Surgery,,,0636,21,Inpatient Hospital,2,3559.44,1618.49,1618.49,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003943,MBR00000153,Institutional-OP,2021-01-30,2021-01-30,2021-03-03,PLN4902,1702692193,1702692193,Physical Therapy,In-Network,Z00.00,J06.9,,,,,,,0,,70553,Radiology,,,0320,22,Outpatient Hospital,3,4500.17,3373.37,3373.37,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003944,MBR00000153,Institutional-OP,2023-09-05,2023-09-05,2023-10-06,PLN5819,1514306773,1514306773,Endocrinology,In-Network,N18.3,K21.0,,,,,,,0,,66984,Surgery,,,0761,22,Outpatient Hospital,2,1327.59,531.27,496.27,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003945,MBR00000153,Professional,2022-01-10,2022-01-10,2022-02-07,PLN7754,1609138981,1609138981,Critical Access Hospital,In-Network,B97.89,I63.9,,,,,,,0,,97110,Medicine,,,,20,Urgent Care,3,279.94,170.82,138.52,0.0,0.0,32.3,32.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003946,MBR00000153,Institutional-IP,2023-02-23,2023-02-26,2023-03-15,PLN7020,1585582070,1585582070,Outpatient Clinic,In-Network,R51,K21.0,,,,682,MS-DRG,18,3,Y,93306,Radiology,,,0320,21,Inpatient Hospital,1,2057.79,1424.91,1301.17,0.0,0.0,123.74,123.74,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003947,MBR00000154,Institutional-IP,2022-11-30,2022-12-03,2023-01-05,PLN7374,1660288235,1660288235,ASC,In-Network,E78.5,Z00.01,,,,690,MS-DRG,23,3,Y,47562,Surgery,,,0636,21,Inpatient Hospital,3,5204.97,3250.49,2728.06,262.32,0.0,260.11,522.43,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003948,MBR00000154,Institutional-OP,2022-02-06,2022-02-06,2022-03-09,PLN1628,1186826716,1186826716,Physical Therapy,In-Network,N18.3,M17.11,,,,,,,0,,G0439,Medicine,,,0740,22,Outpatient Hospital,3,371.71,112.71,0.0,73.82,25.0,0.0,98.82,0.0,Denied,PR-1,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000003949,MBR00000154,Institutional-OP,2022-02-10,2022-02-10,2022-03-21,PLN9107,1450553056,1450553056,Clinical Laboratory,In-Network,N18.3,J44.1,,,,,,,0,,80061,Pathology/Lab,,,0370,22,Outpatient Hospital,2,72.86,30.04,30.04,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003950,MBR00000154,Institutional-OP,2022-08-26,2022-08-26,2022-09-02,PLN1190,1366286000,1366286000,SNF,In-Network,I50.9,Z00.00,,,,,,,0,,99214,E&M,,,0301,22,Outpatient Hospital,2,197.43,74.94,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003951,MBR00000154,Institutional-IP,2022-02-22,2022-02-23,2022-03-17,PLN2561,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,R10.9,N18.3,,,,871,MS-DRG,16,1,Y,80053,Pathology/Lab,,,0510,21,Inpatient Hospital,1,115.83,42.56,0.0,42.56,15.0,0.0,57.56,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003952,MBR00000154,Professional,2021-07-10,2021-07-10,2021-08-15,PLN4494,1994661817,1994661817,SNF,Out-of-Network,F41.9,Z12.31,,,,,,,0,,47562,Surgery,,,,65,End-Stage Renal Disease,2,5410.54,3823.16,3748.16,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003953,MBR00000154,Professional,2023-03-03,2023-03-03,2023-03-10,PLN1593,1500037969,1500037969,Pulmonology,In-Network,Z12.31,F32.9,,,,,,,0,,99284,E&M,,,,50,Federally Qualified Health Center,3,396.31,293.77,0.0,293.77,0.0,0.0,293.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003954,MBR00000154,Institutional-IP,2023-01-09,2023-01-11,2023-02-11,PLN6611,1109850785,1109850785,ASC,Out-of-Network,E11.65,I25.10,,,,292,MS-DRG,19,2,Y,93225,Medicine,,,0360,21,Inpatient Hospital,3,858.42,492.85,422.78,0.0,15.0,55.07,70.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003955,MBR00000154,Institutional-IP,2022-10-22,2022-10-24,2022-10-29,PLN8797,1689639685,1689639685,SNF,In-Network,B97.89,K21.0,,,,683,MS-DRG,4,2,Y,47562,Surgery,,,0320,21,Inpatient Hospital,1,3264.12,2398.81,2112.46,261.35,25.0,0.0,286.35,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003956,MBR00000154,Institutional-IP,2023-03-24,2023-03-29,2023-04-25,PLN4911,1540044947,1540044947,Pulmonology,Out-of-Network,I63.9,I63.9,,,,641,MS-DRG,1,5,Y,99214,E&M,,,0900,21,Inpatient Hospital,3,272.13,153.68,153.68,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003957,MBR00000154,Professional,2022-07-22,2022-07-22,2022-08-28,PLN9656,1266606767,1266606767,ASC,In-Network,Z00.00,F41.9,,,,,,,0,,97110,Medicine,,,,11,Office,1,125.09,40.11,0.0,40.11,0.0,0.0,40.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003958,MBR00000154,Professional,2023-10-14,2023-10-14,2023-11-07,PLN7340,1964402759,1964402759,Outpatient Clinic,In-Network,N17.9,F41.9,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,3,557.45,430.87,430.87,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003959,MBR00000154,Institutional-OP,2023-08-29,2023-08-29,2023-09-24,PLN1713,1236418230,1236418230,DME Supplier,In-Network,I10,N39.0,,,,,,,0,,33533,Surgery,,,0370,22,Outpatient Hospital,2,13415.65,9159.69,0.0,141.44,25.0,0.0,166.44,0.0,Denied,CO-97,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000003960,MBR00000154,Professional,2023-12-11,2023-12-11,2023-12-18,PLN6225,1520687146,1520687146,ASC,In-Network,E11.40,J06.9,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,2,3710.11,1255.82,1120.61,0.0,50.0,85.21,135.21,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003961,MBR00000154,Institutional-OP,2021-04-29,2021-04-29,2021-06-08,PLN1237,1687650653,1687650653,Internal Medicine,In-Network,J18.9,E11.9,,,,,,,0,,82043,Pathology/Lab,,,0320,22,Outpatient Hospital,3,31.44,23.62,23.62,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003962,MBR00000154,Institutional-IP,2021-04-22,2021-04-28,2021-04-30,PLN2652,1511044648,1511044648,Endocrinology,In-Network,I10,I10,,,,196,MS-DRG,6,6,Y,99221,E&M,,,0510,21,Inpatient Hospital,2,435.76,355.15,355.15,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003963,MBR00000154,Professional,2022-05-30,2022-05-30,2022-07-06,PLN2638,1689639685,1689639685,SNF,In-Network,Z12.31,E66.9,,,,,,,0,,84443,Pathology/Lab,,,,81,Independent Laboratory,3,142.2,88.55,0.0,33.55,75.0,0.0,108.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003964,MBR00000154,Professional,2023-01-29,2023-01-29,2023-02-12,PLN7059,1974006077,1974006077,Orthopedic Surgery,In-Network,Z23,Z00.00,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,3,77.46,49.63,19.93,0.0,25.0,4.7,29.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003965,MBR00000154,Professional,2021-09-19,2021-09-19,2021-10-10,PLN2564,1463205530,1463205530,Nephrology,In-Network,E11.9,E11.40,,,,,,,0,,27447,Surgery,,,,50,Federally Qualified Health Center,1,6140.83,4317.21,4317.21,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003966,MBR00000154,Institutional-OP,2021-05-07,2021-05-07,2021-05-29,PLN8976,1696843572,1696843572,Critical Access Hospital,Out-of-Network,Z00.00,Z23,,,,,,,0,,81001,Pathology/Lab,,,0301,22,Outpatient Hospital,3,39.43,19.64,0.0,0.0,50.0,0.0,50.0,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003967,MBR00000155,Professional,2021-02-10,2021-02-10,2021-02-18,PLN7790,1872272835,1872272835,Internal Medicine,In-Network,K57.30,Z87.891,,,,,,,0,,99232,E&M,,,,11,Office,3,274.6,127.14,52.14,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003968,MBR00000155,Institutional-OP,2022-08-31,2022-08-31,2022-10-06,PLN7799,1609138981,1609138981,Critical Access Hospital,In-Network,I10,I50.9,,,,,,,0,,90686,Medicine,,,0510,22,Outpatient Hospital,2,67.76,27.57,0.0,27.57,0.0,0.0,27.57,0.0,Denied,CO-15,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000003969,MBR00000155,Institutional-OP,2023-12-09,2023-12-09,2024-01-17,PLN1171,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,N20.0,E78.5,,,,,,,0,,90837,Medicine,,,0120,22,Outpatient Hospital,1,352.05,108.3,108.3,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003970,MBR00000155,Professional,2022-05-24,2022-05-24,2022-07-07,PLN4755,1563980627,1563980627,Critical Access Hospital,In-Network,E11.9,E78.5,,,,,,,0,,70450,Radiology,,,,49,Independent Clinic,2,1446.06,618.13,410.27,207.86,0.0,0.0,207.86,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000003971,MBR00000155,Professional,2023-03-15,2023-03-15,2023-03-25,PLN6526,1946680931,1946680931,Critical Access Hospital,Out-of-Network,J20.9,I25.10,,,,,,,0,,66984,Surgery,,,,11,Office,3,1726.31,950.87,899.3,0.0,0.0,51.57,51.57,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003972,MBR00000155,Professional,2021-02-26,2021-02-26,2021-04-10,PLN5351,1800011727,1800011727,Clinical Laboratory,Out-of-Network,G43.909,Z12.31,,,,,,,0,,43239,Surgery,,,,11,Office,2,843.46,472.68,472.68,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003973,MBR00000155,Professional,2021-08-25,2021-08-25,2021-10-03,PLN4603,1780163051,1780163051,SNF,In-Network,Z23,Z00.00,,,,,,,0,,80061,Pathology/Lab,,,,21,Inpatient Hospital,2,68.02,56.62,21.62,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003974,MBR00000155,Professional,2023-01-15,2023-01-15,2023-02-08,PLN4460,1990090423,1990090423,Orthopedic Surgery,In-Network,E78.5,E11.65,,,,,,,0,,99204,E&M,,,,11,Office,3,236.28,162.21,87.21,0.0,75.0,0.0,75.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003975,MBR00000155,Professional,2022-03-17,2022-03-17,2022-04-24,PLN3931,1500037969,1500037969,Pulmonology,In-Network,I48.91,F32.9,,,,,,,0,,23472,Surgery,,,,11,Office,3,6714.22,3993.42,3454.72,0.0,0.0,538.7,538.7,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003976,MBR00000155,Institutional-OP,2021-01-29,2021-01-29,2021-03-02,PLN4641,1845057593,1845057593,Orthopedic Surgery,In-Network,Z12.31,J45.20,,,,,,,0,,45378,Surgery,,,0730,22,Outpatient Hospital,1,2416.85,1012.74,850.32,127.42,35.0,0.0,162.42,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000003977,MBR00000156,Institutional-IP,2021-09-05,2021-09-10,2021-09-28,PLN1560,1550154147,1550154147,Outpatient Clinic,In-Network,M54.5,Z23,,,,682,MS-DRG,17,5,Y,84443,Pathology/Lab,,,0370,21,Inpatient Hospital,2,95.35,42.41,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000003978,MBR00000156,Institutional-OP,2023-05-19,2023-05-19,2023-06-04,PLN1416,1585582070,1585582070,Outpatient Clinic,In-Network,Z79.4,M54.5,,,,,,,0,,99214,E&M,,,0730,22,Outpatient Hospital,3,237.31,92.25,47.46,44.79,0.0,0.0,44.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003979,MBR00000156,Institutional-IP,2023-01-20,2023-01-23,2023-02-21,PLN5600,1284035364,1284035364,Pediatrics,In-Network,J06.9,J44.1,,,,196,MS-DRG,19,3,Y,99204,E&M,,,0900,21,Inpatient Hospital,3,462.95,191.34,176.34,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000003980,MBR00000156,Institutional-IP,2023-06-06,2023-06-07,2023-06-17,PLN8517,1622771872,1622771872,Pediatrics,In-Network,Z12.31,G43.909,,,,292,MS-DRG,10,1,Y,G0439,Medicine,,,0320,21,Inpatient Hospital,3,556.19,264.0,264.0,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000003981,MBR00000156,Institutional-OP,2022-01-19,2022-01-19,2022-02-07,PLN7255,1433937353,1433937353,Nephrology,In-Network,I10,M54.5,,,,,,,0,,90837,Medicine,,,0510,22,Outpatient Hospital,3,419.9,272.11,218.41,0.0,50.0,3.7,53.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003982,MBR00000156,Professional,2023-10-15,2023-10-15,2023-11-12,PLN2651,1872272835,1872272835,Internal Medicine,In-Network,M17.11,I10,,,,,,,0,,33533,Surgery,,,,31,Skilled Nursing Facility,1,22037.17,13051.54,13036.54,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000003983,MBR00000156,Institutional-IP,2023-10-05,2023-10-06,2023-10-28,PLN2665,1193493783,1193493783,Critical Access Hospital,Out-of-Network,I11.9,Z12.31,,,,470,MS-DRG,3,1,Y,82043,Pathology/Lab,,,0510,21,Inpatient Hospital,2,44.02,21.75,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003984,MBR00000156,Institutional-OP,2022-02-07,2022-02-07,2022-02-28,PLN4517,1752470395,1752470395,Home Health,In-Network,E11.9,Z00.00,,,,,,,0,,99204,E&M,,,0120,22,Outpatient Hospital,2,464.34,348.02,291.22,0.0,0.0,56.8,56.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003985,MBR00000156,Institutional-OP,2021-08-16,2021-08-16,2021-08-23,PLN8147,1847081578,1847081578,Urology,Out-of-Network,F32.9,M54.5,,,,,,,0,,G0439,Medicine,,,0120,22,Outpatient Hospital,3,501.62,330.55,280.06,50.49,0.0,0.0,50.49,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000003986,MBR00000156,Professional,2023-11-20,2023-11-20,2023-11-28,PLN4067,1939033455,1939033455,Pulmonology,In-Network,E11.9,Z23,,,,,,,0,,G0468,Medicine,,,,11,Office,2,363.09,150.7,150.7,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003987,MBR00000156,Institutional-OP,2022-01-19,2022-01-19,2022-01-28,PLN1662,1939033455,1939033455,Pulmonology,In-Network,R51,Z00.00,,,,,,,0,,99214,E&M,,,0270,22,Outpatient Hospital,3,170.32,81.87,69.23,0.0,0.0,12.64,12.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003988,MBR00000156,Professional,2022-06-28,2022-06-28,2022-07-07,PLN2902,1372918899,1372918899,Family Medicine,In-Network,R05,K21.0,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,1,48.61,30.2,30.2,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003989,MBR00000156,Professional,2023-10-18,2023-10-18,2023-11-19,PLN5468,1486164553,1486164553,DME Supplier,In-Network,M54.5,J06.9,,,,,,,0,,99284,E&M,,,,20,Urgent Care,1,515.12,397.26,346.46,0.0,0.0,50.8,50.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003990,MBR00000156,Professional,2021-10-22,2021-10-22,2021-11-26,PLN8584,1752470395,1752470395,Home Health,In-Network,Z00.00,N39.0,,,,,,,0,,45380,Surgery,,,,23,Emergency Room,3,1124.0,379.5,129.36,200.14,50.0,0.0,250.14,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,1,0,0,0
CLM0000003991,MBR00000156,Professional,2023-08-27,2023-08-27,2023-09-18,PLN1130,1453283987,1453283987,Critical Access Hospital,In-Network,N18.3,F03.90,,,,,,,0,,45380,Surgery,,,,49,Independent Clinic,1,1105.61,797.03,613.1,0.0,50.0,133.93,183.93,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000003992,MBR00000156,Professional,2021-06-26,2021-06-26,2021-08-01,PLN1178,1528335731,1528335731,Critical Access Hospital,In-Network,J44.1,M54.5,,,,,,,0,,G0468,Medicine,,,,65,End-Stage Renal Disease,2,328.57,142.67,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003993,MBR00000156,Professional,2021-11-18,2021-11-18,2021-11-25,PLN5469,1700633438,1700633438,DME Supplier,In-Network,N18.3,E11.9,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,2,2933.18,1793.54,1776.53,17.01,0.0,0.0,17.01,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003994,MBR00000156,Professional,2022-03-02,2022-03-02,2022-03-17,PLN4493,1609526529,1609526529,Psychiatry,In-Network,Z23,Z23,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,3,127.3,57.6,0.0,57.6,0.0,0.0,57.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003995,MBR00000156,Institutional-OP,2022-06-13,2022-06-13,2022-06-29,PLN1181,1780163051,1780163051,SNF,In-Network,Z00.00,Z00.00,,,,,,,0,,93306,Radiology,,,0370,22,Outpatient Hospital,3,3173.53,1077.45,958.31,119.14,0.0,0.0,119.14,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003996,MBR00000156,Institutional-OP,2021-09-24,2021-09-24,2021-10-17,PLN2623,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,Z00.00,E11.9,,,,,,,0,,27447,Surgery,,,0200,22,Outpatient Hospital,1,2725.22,869.26,679.35,0.0,50.0,139.91,189.91,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000003997,MBR00000156,Institutional-OP,2023-08-26,2023-08-26,2023-09-24,PLN2154,1219817751,1219817751,OB/GYN,In-Network,I48.91,R05,,,,,,,0,,70450,Radiology,,,0320,22,Outpatient Hospital,2,1438.86,841.28,386.35,379.93,75.0,0.0,454.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003998,MBR00000156,Institutional-IP,2022-12-29,2022-12-31,2023-01-10,PLN2748,1910255109,1910255109,DME Supplier,In-Network,N39.0,I10,,,,470,MS-DRG,16,2,N,99284,E&M,,,0636,21,Inpatient Hospital,1,637.98,483.84,448.84,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000003999,MBR00000156,Institutional-OP,2023-01-05,2023-01-05,2023-01-16,PLN8774,1109850785,1109850785,ASC,Out-of-Network,E11.9,J06.9,,,,,,,0,,43239,Surgery,,,0120,22,Outpatient Hospital,3,1827.48,1251.12,1098.05,153.07,0.0,0.0,153.07,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004000,MBR00000156,Professional,2023-03-13,2023-03-13,2023-04-20,PLN2151,1872272835,1872272835,Internal Medicine,In-Network,R07.9,I10,,,,,,,0,,99213,E&M,,,,11,Office,3,153.68,126.25,0.0,93.38,75.0,0.0,168.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004001,MBR00000156,Professional,2022-11-29,2022-11-29,2023-01-06,PLN8787,1284035364,1284035364,Pediatrics,In-Network,N17.9,Z12.31,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,3,77.59,45.43,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004002,MBR00000156,Professional,2022-12-06,2022-12-06,2023-01-02,PLN6255,1845057593,1845057593,Orthopedic Surgery,In-Network,E66.9,M54.5,,,,,,,0,,90837,Medicine,,,,11,Office,2,465.99,265.5,101.31,139.19,25.0,0.0,164.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004003,MBR00000156,Professional,2022-12-25,2022-12-25,2023-01-11,PLN7309,1696843572,1696843572,Critical Access Hospital,Out-of-Network,N18.3,E66.9,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,2,115.8,40.13,37.61,0.0,0.0,2.52,2.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004004,MBR00000156,Institutional-IP,2023-03-01,2023-03-04,2023-03-22,PLN4323,1389336600,1389336600,Critical Access Hospital,In-Network,N18.3,Z00.00,,,,292,MS-DRG,21,3,Y,90686,Medicine,,,0320,21,Inpatient Hospital,2,140.23,93.42,0.0,0.0,15.0,1.18,16.18,0.0,Denied,CO-11,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000004005,MBR00000156,Professional,2023-10-06,2023-10-06,2023-10-24,PLN5311,1108115157,1108115157,General Acute Care Hospital,In-Network,N39.0,M17.11,,,,,,,0,,99233,E&M,,,,11,Office,2,279.21,190.53,140.53,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004006,MBR00000157,Institutional-OP,2021-08-04,2021-08-04,2021-08-14,PLN3319,1205377316,1205377316,Orthopedic Surgery,In-Network,I10,Z00.00,,,,,,,0,,99284,E&M,,,0200,22,Outpatient Hospital,2,642.53,312.82,202.4,110.42,0.0,0.0,110.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004007,MBR00000157,Professional,2022-07-21,2022-07-21,2022-08-12,PLN2599,1227362142,1227362142,DME Supplier,In-Network,E11.65,E11.65,,,,,,,0,,81001,Pathology/Lab,,,,22,Outpatient Hospital,3,37.34,13.31,0.0,13.31,0.0,0.0,13.31,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000004008,MBR00000157,Professional,2021-07-21,2021-07-21,2021-08-02,PLN3078,1790497490,1790497490,OB/GYN,In-Network,F32.9,Z12.11,,,,,,,0,,99213,E&M,,,,21,Inpatient Hospital,1,301.28,168.32,36.0,103.4,25.0,3.92,132.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004009,MBR00000157,Professional,2021-07-19,2021-07-19,2021-08-08,PLN4876,1135158374,1135158374,Pulmonology,In-Network,N39.0,Z23,,,,,,,0,,45378,Surgery,,,,11,Office,1,1810.35,587.97,0.0,0.0,0.0,52.15,52.15,0.0,Denied,CO-15,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000004010,MBR00000157,Professional,2023-11-07,2023-11-07,2023-11-28,PLN8605,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,G43.909,E78.5,,,,,,,0,,70553,Radiology,,,,11,Office,3,2142.67,1801.98,1733.99,67.99,0.0,0.0,67.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004011,MBR00000157,Institutional-OP,2022-06-02,2022-06-02,2022-06-25,PLN2569,1114982472,1114982472,Orthopedic Surgery,In-Network,M54.5,N39.0,,,,,,,0,,99214,E&M,,,0301,22,Outpatient Hospital,2,254.61,193.94,193.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004012,MBR00000157,Institutional-IP,2023-02-11,2023-02-16,2023-03-26,PLN3354,1968299309,1968299309,Internal Medicine,In-Network,Z87.891,E11.9,,,,641,MS-DRG,17,5,Y,47562,Surgery,,,0370,21,Inpatient Hospital,3,4890.61,3569.73,3018.84,0.0,0.0,550.89,550.89,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004013,MBR00000157,Professional,2023-03-10,2023-03-10,2023-03-25,PLN5455,1809014947,1809014947,Urology,In-Network,E11.9,Z00.00,,,,,,,0,,85610,Pathology/Lab,,,,21,Inpatient Hospital,2,54.35,32.97,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004014,MBR00000157,Institutional-IP,2021-02-04,2021-02-09,2021-02-15,PLN8009,1631954542,1631954542,Oncology,In-Network,F03.90,Z12.31,,,,871,MS-DRG,16,5,Y,66984,Surgery,,,0730,21,Inpatient Hospital,1,3082.68,1051.68,1001.68,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004015,MBR00000157,Professional,2022-06-23,2022-06-23,2022-07-23,PLN6174,1434029575,1434029575,Endocrinology,In-Network,N20.0,M54.5,,,,,,,0,,78452,Radiology,,,,11,Office,2,7345.64,5320.72,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004016,MBR00000157,Professional,2021-07-17,2021-07-17,2021-08-23,PLN3433,1135158374,1135158374,Pulmonology,In-Network,I25.10,E11.9,,,,,,,0,,G0468,Medicine,,,,11,Office,1,467.62,163.44,62.14,53.81,35.0,12.49,101.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004017,MBR00000157,Professional,2021-12-10,2021-12-10,2021-12-22,PLN1920,1518055405,1518055405,Urology,In-Network,M54.5,F32.9,,,,,,,0,,86900,Pathology/Lab,,,,23,Emergency Room,1,41.75,26.99,0.0,26.99,50.0,0.0,76.99,0.0,Denied,CO-50,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004018,MBR00000157,Professional,2021-07-26,2021-07-26,2021-08-17,PLN3062,1946680931,1946680931,Critical Access Hospital,Out-of-Network,Z23,Z12.31,,,,,,,0,,81001,Pathology/Lab,,,,22,Outpatient Hospital,3,44.62,29.41,0.0,1.34,25.0,0.36,26.7,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004019,MBR00000157,Institutional-IP,2022-12-31,2023-01-04,2023-01-26,PLN2801,1806688928,1806688928,Geriatrics,In-Network,K57.30,G43.909,,,,871,MS-DRG,1,4,Y,47562,Surgery,,,0370,21,Inpatient Hospital,2,5319.7,2707.34,2456.65,250.69,0.0,0.0,250.69,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004020,MBR00000157,Institutional-OP,2021-05-25,2021-05-25,2021-06-12,PLN1151,1334916761,1334916761,ASC,In-Network,J06.9,I10,,,,,,,0,,99203,E&M,,,0370,22,Outpatient Hospital,1,206.47,87.2,72.2,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004021,MBR00000157,Professional,2022-05-09,2022-05-09,2022-06-14,PLN3745,1622771872,1622771872,Pediatrics,In-Network,E66.9,Z00.00,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,1,46.08,25.66,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004022,MBR00000158,Institutional-IP,2021-12-01,2021-12-03,2021-12-27,PLN5670,1845057593,1845057593,Orthopedic Surgery,In-Network,E78.5,E11.9,,,,871,MS-DRG,12,2,U,58661,Surgery,,,0320,21,Inpatient Hospital,3,2475.69,1924.98,1924.98,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004023,MBR00000158,Institutional-OP,2023-11-21,2023-11-21,2023-12-06,PLN9911,1273488618,1273488618,General Acute Care Hospital,In-Network,E87.6,M17.11,,,,,,,0,,74177,Radiology,,,0360,22,Outpatient Hospital,1,1791.68,752.34,752.34,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004024,MBR00000158,Professional,2023-05-13,2023-05-13,2023-06-03,PLN9259,1780163051,1780163051,SNF,In-Network,E78.5,I10,,,,,,,0,,45378,Surgery,,,,23,Emergency Room,2,1774.92,650.74,143.76,481.98,25.0,0.0,506.98,0.0,Paid,,,1,,1,1,0,0,0,0,None,0,1,0,0,0
CLM0000004025,MBR00000158,Professional,2022-01-21,2022-01-21,2022-02-05,PLN9716,1500949740,1500949740,Pediatrics,In-Network,J20.9,I48.91,,,,,,,0,,99233,E&M,,,,11,Office,3,372.36,310.28,280.18,30.1,0.0,0.0,30.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004026,MBR00000158,Professional,2021-11-18,2021-11-18,2021-11-30,PLN3244,1313212303,1313212303,Family Medicine,In-Network,I10,J44.1,,,,,,,0,,47562,Surgery,,,,31,Skilled Nursing Facility,1,4740.64,1875.58,0.0,0.0,15.0,244.48,259.48,0.0,Denied,CO-29,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004027,MBR00000158,Professional,2023-02-25,2023-02-25,2023-03-21,PLN1492,1687650653,1687650653,Internal Medicine,In-Network,I11.9,Z23,,,,,,,0,,99233,E&M,,,,23,Emergency Room,3,317.9,140.0,0.0,140.0,0.0,0.0,140.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004028,MBR00000158,Professional,2022-11-23,2022-11-23,2023-01-05,PLN2854,1691062876,1691062876,SNF,In-Network,J20.9,Z12.31,,,,,,,0,,70450,Radiology,,,,11,Office,1,1805.86,1396.81,1009.48,217.97,0.0,169.36,387.33,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004029,MBR00000158,Professional,2022-08-31,2022-08-31,2022-10-12,PLN6684,1361302520,1361302520,Critical Access Hospital,In-Network,N18.3,R05,,,,,,,0,,99283,E&M,,,,11,Office,3,490.12,286.49,243.95,0.0,0.0,42.54,42.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004030,MBR00000158,Professional,2021-03-21,2021-03-21,2021-04-11,PLN1596,1247341320,1247341320,Urology,Out-of-Network,I10,E11.9,,,,,,,0,,99284,E&M,,,,31,Skilled Nursing Facility,2,425.69,267.64,0.0,0.0,0.0,15.6,15.6,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004031,MBR00000158,Institutional-OP,2021-03-26,2021-03-26,2021-04-30,PLN9564,1624802371,1624802371,ASC,Out-of-Network,G43.909,J44.1,,,,,,,0,,45378,Surgery,,,0200,22,Outpatient Hospital,2,2236.42,1488.07,969.13,380.13,0.0,138.81,518.94,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000004032,MBR00000158,Professional,2022-11-28,2022-11-28,2022-12-13,PLN1785,1964402759,1964402759,Outpatient Clinic,In-Network,E78.5,G43.909,,,,,,,0,,93306,Radiology,,,,22,Outpatient Hospital,3,1961.79,911.22,911.22,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004033,MBR00000158,Institutional-OP,2022-05-30,2022-05-30,2022-06-18,PLN5289,1118885473,1118885473,ASC,In-Network,E78.5,N39.0,,,,,,,0,,87491,Pathology/Lab,,,0740,22,Outpatient Hospital,3,143.53,55.93,30.93,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004034,MBR00000158,Professional,2023-06-28,2023-06-28,2023-08-01,PLN7388,1235381502,1235381502,Cardiology,In-Network,F41.9,I25.10,,,,,,,0,,99221,E&M,,,,11,Office,3,395.55,211.5,0.0,211.5,0.0,0.0,211.5,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004035,MBR00000158,Professional,2021-02-01,2021-02-01,2021-02-28,PLN4730,1313212303,1313212303,Family Medicine,In-Network,N39.0,Z23,,,,,,,0,,71046,Radiology,,,,31,Skilled Nursing Facility,1,229.31,192.93,0.0,192.93,75.0,0.0,267.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004036,MBR00000158,Institutional-IP,2021-07-23,2021-07-25,2021-08-31,PLN2578,1186826716,1186826716,Physical Therapy,In-Network,M81.0,I25.10,,,,683,MS-DRG,18,2,Y,77067,Radiology,,,0730,21,Inpatient Hospital,1,328.88,135.64,0.0,135.64,75.0,0.0,210.64,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000004037,MBR00000158,Professional,2023-05-15,2023-05-15,2023-06-18,PLN8749,1268679390,1268679390,Critical Access Hospital,In-Network,J06.9,E66.9,,,,,,,0,,99213,E&M,,,,11,Office,1,255.13,214.51,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004038,MBR00000158,Institutional-OP,2023-12-09,2023-12-09,2024-01-21,PLN7264,1273488618,1273488618,General Acute Care Hospital,In-Network,E87.6,I48.91,,,,,,,0,,99214,E&M,,,0120,22,Outpatient Hospital,2,212.22,110.68,60.68,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004039,MBR00000158,Professional,2023-03-16,2023-03-16,2023-04-27,PLN1789,1556140803,1556140803,Cardiology,In-Network,I10,E11.9,,,,,,,0,,93306,Radiology,,,,49,Independent Clinic,3,2614.71,1288.94,1273.94,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000004040,MBR00000158,Professional,2021-01-14,2021-01-14,2021-01-23,PLN5938,1139906830,1139906830,Endocrinology,Out-of-Network,N39.0,I48.91,,,,,,,0,,27447,Surgery,,,,11,Office,2,4448.94,1598.8,1465.81,117.99,15.0,0.0,132.99,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004041,MBR00000158,Institutional-IP,2021-02-25,2021-03-03,2021-03-20,PLN3668,1361302520,1361302520,Critical Access Hospital,In-Network,M17.11,M17.11,,,,603,MS-DRG,20,6,Y,G0468,Medicine,,,0360,21,Inpatient Hospital,1,415.53,138.64,0.0,138.64,25.0,0.0,163.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004042,MBR00000158,Institutional-IP,2023-08-20,2023-08-28,2023-09-22,PLN3189,1511044648,1511044648,Endocrinology,In-Network,I11.9,E78.5,,,,291,MS-DRG,2,8,Y,71046,Radiology,,,0270,21,Inpatient Hospital,3,308.3,103.59,0.0,103.59,15.0,0.0,118.59,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004043,MBR00000158,Institutional-OP,2022-07-02,2022-07-02,2022-08-10,PLN8414,1624802371,1624802371,ASC,Out-of-Network,E78.5,F41.9,,,,,,,0,,99222,E&M,,,0740,22,Outpatient Hospital,3,331.16,243.21,0.0,243.21,0.0,0.0,243.21,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004044,MBR00000158,Institutional-OP,2022-06-29,2022-06-29,2022-08-06,PLN3729,1236418230,1236418230,DME Supplier,In-Network,M17.11,F32.9,,,,,,,0,,80061,Pathology/Lab,,,0450,22,Outpatient Hospital,3,69.99,55.77,0.0,55.77,0.0,0.0,55.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004045,MBR00000158,Professional,2023-11-19,2023-11-19,2023-12-24,PLN8706,1752470395,1752470395,Home Health,In-Network,Z79.4,I48.91,,,,,,,0,,99284,E&M,,,,11,Office,3,482.24,338.73,323.73,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004046,MBR00000158,Institutional-OP,2021-09-29,2021-09-29,2021-10-14,PLN3270,1108115157,1108115157,General Acute Care Hospital,In-Network,E66.9,N18.3,,,,,,,0,,84443,Pathology/Lab,,,0200,22,Outpatient Hospital,3,124.89,87.35,0.0,87.35,50.0,0.0,137.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004047,MBR00000158,Institutional-OP,2021-11-08,2021-11-08,2021-12-05,PLN7390,1840431511,1840431511,Geriatrics,Out-of-Network,R07.9,K92.1,,,,,,,0,,80061,Pathology/Lab,,,0200,22,Outpatient Hospital,1,77.42,39.75,0.0,39.75,0.0,0.0,39.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004048,MBR00000158,Institutional-IP,2023-01-22,2023-01-27,2023-02-21,PLN3081,1660288235,1660288235,ASC,In-Network,J06.9,E66.9,,,,603,MS-DRG,17,5,N,99214,E&M,,,0370,21,Inpatient Hospital,3,269.18,119.27,0.0,119.27,25.0,0.0,144.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004049,MBR00000158,Professional,2023-09-18,2023-09-18,2023-10-22,PLN1949,1366576336,1366576336,Geriatrics,In-Network,E66.9,R07.9,,,,,,,0,,99283,E&M,,,,49,Independent Clinic,3,535.23,284.58,284.58,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004050,MBR00000158,Institutional-OP,2022-02-05,2022-02-05,2022-02-20,PLN9986,1514306773,1514306773,Endocrinology,In-Network,Z00.01,I63.9,,,,,,,0,,99232,E&M,,,0636,22,Outpatient Hospital,2,399.37,202.25,187.25,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004051,MBR00000158,Institutional-OP,2021-06-15,2021-06-15,2021-07-07,PLN4602,1227362142,1227362142,DME Supplier,In-Network,F41.9,Z00.00,,,,,,,0,,99214,E&M,,,0301,22,Outpatient Hospital,2,308.36,102.1,102.1,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004052,MBR00000158,Professional,2021-03-03,2021-03-03,2021-04-08,PLN7470,1245650222,1245650222,Gastroenterology,In-Network,G43.909,M54.5,,,,,,,0,,99222,E&M,,,,31,Skilled Nursing Facility,1,511.32,215.37,10.06,190.31,15.0,0.0,205.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004053,MBR00000158,Professional,2021-01-08,2021-01-08,2021-02-17,PLN1950,1245650222,1245650222,Gastroenterology,In-Network,J06.9,M54.5,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,1,477.28,162.42,0.0,162.42,35.0,0.0,197.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004054,MBR00000158,Institutional-OP,2022-02-14,2022-02-14,2022-03-05,PLN5106,1235381502,1235381502,Cardiology,In-Network,E11.9,G43.909,,,,,,,0,,66984,Surgery,,,0740,22,Outpatient Hospital,2,2926.4,1745.76,1745.76,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004055,MBR00000158,Institutional-OP,2022-08-04,2022-08-04,2022-08-24,PLN9062,1872272835,1872272835,Internal Medicine,In-Network,Z23,J20.9,,,,,,,0,,G0468,Medicine,,,0510,22,Outpatient Hospital,1,643.73,462.9,361.75,101.15,0.0,0.0,101.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004056,MBR00000158,Professional,2022-06-20,2022-06-20,2022-07-02,PLN2287,1990090423,1990090423,Orthopedic Surgery,In-Network,Z00.00,N20.0,,,,,,,0,,99203,E&M,,,,11,Office,1,327.07,189.29,0.0,189.29,0.0,0.0,189.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004057,MBR00000158,Institutional-OP,2021-09-19,2021-09-19,2021-10-27,PLN8187,1845057593,1845057593,Orthopedic Surgery,In-Network,J20.9,N18.3,,,,,,,0,,23472,Surgery,,,0761,22,Outpatient Hospital,2,7521.92,4635.42,4585.42,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004058,MBR00000158,Professional,2023-01-11,2023-01-11,2023-02-17,PLN8223,1717912431,1717912431,Oncology,In-Network,G20,J20.9,,,,,,,0,,99221,E&M,,,,11,Office,1,427.64,330.21,295.21,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004059,MBR00000159,Professional,2023-08-21,2023-08-21,2023-09-03,PLN3722,1687650653,1687650653,Internal Medicine,In-Network,Z23,K92.1,,,,,,,0,,82043,Pathology/Lab,,,,20,Urgent Care,1,57.22,40.68,0.0,40.68,0.0,0.0,40.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004060,MBR00000159,Institutional-IP,2021-09-12,2021-09-14,2021-10-01,PLN5574,1778483301,1778483301,Home Health,In-Network,Z00.00,Z79.4,,,,194,MS-DRG,5,2,N,90460,Medicine,,,0360,21,Inpatient Hospital,1,45.99,32.6,0.0,32.6,0.0,0.0,32.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004061,MBR00000159,Professional,2023-01-08,2023-01-08,2023-01-30,PLN9024,1569105090,1569105090,Geriatrics,In-Network,Z23,I10,,,,,,,0,,43239,Surgery,,,,11,Office,1,2252.38,1434.09,1429.18,4.91,0.0,0.0,4.91,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004062,MBR00000159,Professional,2022-08-20,2022-08-20,2022-09-18,PLN7793,1410468316,1410468316,SNF,In-Network,I48.91,F41.9,,,,,,,0,,90686,Medicine,,,,20,Urgent Care,3,85.8,45.6,0.0,45.6,15.0,0.0,60.6,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000004063,MBR00000159,Institutional-OP,2023-01-23,2023-01-23,2023-02-15,PLN7088,1366426662,1366426662,Urology,In-Network,E78.5,J45.20,,,,,,,0,,97530,Medicine,,,0761,22,Outpatient Hospital,2,170.36,55.96,0.0,55.96,0.0,0.0,55.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004064,MBR00000159,Professional,2021-01-17,2021-01-17,2021-01-30,PLN2817,1395983630,1395983630,Nephrology,In-Network,C50.912,Z87.891,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,3,1149.72,946.04,721.22,0.0,50.0,174.82,224.82,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000004065,MBR00000159,Professional,2023-01-08,2023-01-08,2023-02-17,PLN6311,1806688928,1806688928,Geriatrics,In-Network,E11.9,Z00.00,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,2,462.36,278.34,10.95,267.39,0.0,0.0,267.39,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000004066,MBR00000159,Professional,2023-03-30,2023-03-30,2023-04-06,PLN9105,1475984649,1475984649,SNF,In-Network,K21.0,Z12.31,,,,,,,0,,99406,Medicine,,,,22,Outpatient Hospital,2,95.5,34.23,0.0,34.23,50.0,0.0,84.23,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004067,MBR00000159,Professional,2023-01-14,2023-01-14,2023-02-16,PLN6225,1186826716,1186826716,Physical Therapy,In-Network,I50.9,I50.9,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,1,38.42,13.86,0.0,13.86,0.0,0.0,13.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004068,MBR00000159,Professional,2023-07-10,2023-07-10,2023-08-20,PLN3981,1168246159,1168246159,Internal Medicine,In-Network,F10.20,I48.91,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,3,108.85,74.93,49.21,25.72,0.0,0.0,25.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004069,MBR00000159,Professional,2023-03-30,2023-03-30,2023-04-30,PLN2192,1845900543,1845900543,ASC,In-Network,M17.11,E66.9,,,,,,,0,,27447,Surgery,,,,21,Inpatient Hospital,2,3094.1,1051.04,976.04,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004070,MBR00000159,Institutional-OP,2023-12-15,2023-12-15,2023-12-26,PLN8028,1186826716,1186826716,Physical Therapy,In-Network,R07.9,Z23,,,,,,,0,,99233,E&M,,,0761,22,Outpatient Hospital,2,572.96,188.46,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004071,MBR00000159,Institutional-IP,2023-01-04,2023-01-07,2023-02-10,PLN5722,1713934949,1713934949,Neurology,In-Network,I10,F10.20,,,,291,MS-DRG,18,3,Y,27130,Surgery,,,0900,21,Inpatient Hospital,2,2649.26,1716.36,1691.36,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000004072,MBR00000159,Institutional-IP,2022-05-04,2022-05-06,2022-05-27,PLN7595,1550154147,1550154147,Outpatient Clinic,In-Network,N39.0,J45.20,,,,195,MS-DRG,5,2,Y,45378,Surgery,,,0510,21,Inpatient Hospital,2,937.34,616.33,605.12,0.0,0.0,11.21,11.21,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000004073,MBR00000159,Professional,2023-07-03,2023-07-03,2023-07-21,PLN6287,1660288235,1660288235,ASC,In-Network,E78.5,J20.9,,,,,,,0,,78452,Radiology,,,,22,Outpatient Hospital,2,5917.27,3498.22,3320.81,127.41,50.0,0.0,177.41,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004074,MBR00000159,Professional,2023-01-31,2023-01-31,2023-02-18,PLN3407,1606140917,1606140917,ASC,In-Network,J45.20,I25.10,,,,,,,0,,99222,E&M,,,,11,Office,3,314.61,195.9,190.11,0.0,0.0,5.79,5.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004075,MBR00000159,Institutional-OP,2022-09-04,2022-09-04,2022-09-11,PLN3999,1453283987,1453283987,Critical Access Hospital,In-Network,N39.0,E11.9,,,,,,,0,,83036,Pathology/Lab,,,0200,22,Outpatient Hospital,1,42.15,32.45,7.45,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000004076,MBR00000159,Institutional-IP,2022-09-26,2022-10-06,2022-10-17,PLN1504,1896447406,1896447406,Nephrology,Out-of-Network,M17.11,E11.9,,,,470,MS-DRG,14,10,N,80053,Pathology/Lab,,,0360,21,Inpatient Hospital,1,117.25,54.02,54.02,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004077,MBR00000159,Institutional-OP,2022-01-20,2022-01-20,2022-02-10,PLN9032,1727809972,1727809972,Home Health,In-Network,R07.9,Z00.00,,,,,,,0,,97530,Medicine,,,0510,22,Outpatient Hospital,2,204.56,78.31,28.31,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004078,MBR00000159,Professional,2022-11-03,2022-11-03,2022-12-11,PLN3475,1845057593,1845057593,Orthopedic Surgery,In-Network,I10,E11.9,,,,,,,0,,80061,Pathology/Lab,,,,50,Federally Qualified Health Center,3,78.04,57.84,42.84,0.0,15.0,0.0,15.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004079,MBR00000159,Institutional-IP,2022-05-27,2022-05-31,2022-07-03,PLN4770,1219817751,1219817751,OB/GYN,In-Network,J06.9,I10,,,,470,MS-DRG,22,4,W,90686,Medicine,,,0301,21,Inpatient Hospital,3,51.58,25.03,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,1,0,None,0,0,0,0,0
CLM0000004080,MBR00000159,Professional,2021-05-24,2021-05-24,2021-07-07,PLN8908,1865904917,1865904917,Outpatient Clinic,In-Network,J06.9,K21.0,,,,,,,0,,99204,E&M,,,,11,Office,2,236.61,89.54,89.54,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004081,MBR00000159,Professional,2022-04-28,2022-04-28,2022-06-11,PLN3085,1856686341,1856686341,Geriatrics,In-Network,I10,Z00.00,,,,,,,0,,90686,Medicine,,,,11,Office,1,132.08,96.06,0.0,0.0,35.0,3.01,38.01,0.0,Denied,CO-11,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000004082,MBR00000159,Institutional-OP,2023-11-07,2023-11-07,2023-12-14,PLN6713,1542828721,1542828721,Orthopedic Surgery,In-Network,J20.9,I11.9,,,,,,,0,,86900,Pathology/Lab,,,0730,22,Outpatient Hospital,1,60.53,39.14,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004083,MBR00000159,Professional,2021-12-31,2021-12-31,2022-01-31,PLN8366,1997536841,1997536841,Family Medicine,Out-of-Network,Z23,R07.9,,,,,,,0,,71046,Radiology,,,,21,Inpatient Hospital,1,187.34,141.92,126.92,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004084,MBR00000159,Professional,2023-01-12,2023-01-12,2023-02-13,PLN2459,1139906830,1139906830,Endocrinology,Out-of-Network,I10,Z23,,,,,,,0,,33533,Surgery,,,,11,Office,2,26414.66,14921.88,13302.65,0.0,0.0,1619.23,1619.23,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000004085,MBR00000159,Professional,2022-03-31,2022-03-31,2022-05-04,PLN1753,1514306773,1514306773,Endocrinology,In-Network,Z00.00,R07.9,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,1,432.32,258.33,258.33,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004086,MBR00000159,Institutional-IP,2021-11-09,2021-11-11,2021-12-15,PLN2397,1994661817,1994661817,SNF,Out-of-Network,Z00.00,F41.9,,,,641,MS-DRG,10,2,Y,99283,E&M,,,0740,21,Inpatient Hospital,2,563.86,335.51,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004087,MBR00000159,Institutional-OP,2022-02-26,2022-02-26,2022-03-19,PLN3380,1213165847,1213165847,Critical Access Hospital,In-Network,M54.5,G20,,,,,,,0,,27130,Surgery,,,0761,22,Outpatient Hospital,1,6987.22,5833.2,5833.2,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004088,MBR00000159,Professional,2023-11-17,2023-11-17,2023-12-30,PLN9014,1717546253,1717546253,Family Medicine,In-Network,N18.3,G43.909,,,,,,,0,,58661,Surgery,,,,11,Office,3,4886.38,2398.4,2328.52,19.88,50.0,0.0,69.88,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004089,MBR00000159,Institutional-OP,2021-05-02,2021-05-02,2021-05-25,PLN5819,1728018911,1728018911,Nephrology,In-Network,E11.9,Z12.31,,,,,,,0,,81001,Pathology/Lab,,,0510,22,Outpatient Hospital,2,33.28,11.28,0.0,0.0,75.0,0.0,75.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004090,MBR00000159,Professional,2023-01-02,2023-01-02,2023-01-30,PLN5819,1125190055,1125190055,Nephrology,In-Network,R05,Z87.891,,,,,,,0,,99214,E&M,,,,11,Office,1,164.03,61.36,0.0,61.36,50.0,0.0,111.36,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000004091,MBR00000159,Institutional-OP,2023-06-29,2023-06-29,2023-08-02,PLN9032,1213165847,1213165847,Critical Access Hospital,In-Network,E11.9,J44.1,,,,,,,0,,99203,E&M,,,0450,22,Outpatient Hospital,3,245.26,97.0,97.0,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004092,MBR00000159,Institutional-OP,2021-07-22,2021-07-22,2021-08-11,PLN4103,1896447406,1896447406,Nephrology,Out-of-Network,E11.9,F10.20,,,,,,,0,,99213,E&M,,,0120,22,Outpatient Hospital,2,269.15,84.19,0.0,58.51,35.0,0.0,93.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004093,MBR00000159,Institutional-OP,2023-04-09,2023-04-09,2023-04-29,PLN3582,1728018911,1728018911,Nephrology,In-Network,Z23,C50.912,,,,,,,0,,90837,Medicine,,,0761,22,Outpatient Hospital,2,297.89,95.84,84.21,0.0,0.0,11.63,11.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004094,MBR00000159,Institutional-OP,2022-11-29,2022-11-29,2022-12-22,PLN8328,1434029575,1434029575,Endocrinology,In-Network,I10,I50.9,,,,,,,0,,99204,E&M,,,0510,22,Outpatient Hospital,3,406.36,145.67,0.0,145.67,0.0,0.0,145.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004095,MBR00000159,Professional,2022-01-05,2022-01-05,2022-01-27,PLN3133,1395983630,1395983630,Nephrology,In-Network,J45.20,K21.0,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,3,1291.97,989.33,749.12,143.92,75.0,21.29,240.21,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004096,MBR00000159,Professional,2021-07-13,2021-07-13,2021-08-13,PLN8147,1631954542,1631954542,Oncology,In-Network,E11.65,Z51.11,,,,,,,0,,66984,Surgery,,,,65,End-Stage Renal Disease,1,2236.95,962.98,887.98,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004097,MBR00000159,Institutional-OP,2023-11-01,2023-11-01,2023-11-29,PLN6652,1168881145,1168881145,Orthopedic Surgery,In-Network,Z23,I48.91,,,,,,,0,,78452,Radiology,,,0270,22,Outpatient Hospital,1,4806.13,3714.89,3482.31,232.58,0.0,0.0,232.58,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000004098,MBR00000159,Institutional-OP,2021-08-04,2021-08-04,2021-09-15,PLN4588,1366576336,1366576336,Geriatrics,In-Network,I11.9,I50.9,,,,,,,0,,99213,E&M,,,0370,22,Outpatient Hospital,3,304.16,117.43,117.43,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004099,MBR00000159,Institutional-IP,2023-11-06,2023-11-11,2023-12-19,PLN9923,1915531927,1915531927,Critical Access Hospital,In-Network,J44.1,I10,,,,683,MS-DRG,22,5,Y,99406,Medicine,,,0370,21,Inpatient Hospital,2,92.18,74.9,0.0,74.9,0.0,0.0,74.9,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004100,MBR00000159,Institutional-OP,2022-12-11,2022-12-11,2023-01-03,PLN9209,1717912431,1717912431,Oncology,In-Network,C50.912,I11.9,,,,,,,0,,45378,Surgery,,,0301,22,Outpatient Hospital,1,2541.49,2027.72,1777.88,0.0,0.0,249.84,249.84,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000004101,MBR00000159,Professional,2023-07-28,2023-07-28,2023-09-03,PLN3740,1434029575,1434029575,Endocrinology,In-Network,J06.9,I63.9,,,,,,,0,,99233,E&M,,,,11,Office,3,292.79,232.87,181.2,51.67,0.0,0.0,51.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004102,MBR00000159,Professional,2021-11-21,2021-11-21,2021-11-30,PLN4794,1520687146,1520687146,ASC,In-Network,E11.9,N39.0,,,,,,,0,,33533,Surgery,,,,11,Office,2,19256.48,12072.12,11190.21,0.0,0.0,881.91,881.91,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000004103,MBR00000159,Professional,2021-02-02,2021-02-02,2021-02-11,PLN6865,1453936007,1453936007,ASC,In-Network,E78.5,R05,,,,,,,0,,93225,Medicine,,,,22,Outpatient Hospital,1,789.63,382.39,312.24,0.0,0.0,70.15,70.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004104,MBR00000159,Institutional-IP,2022-12-19,2022-12-26,2023-01-16,PLN4501,1511044648,1511044648,Endocrinology,In-Network,E78.5,N39.0,,,,603,MS-DRG,8,7,Y,27130,Surgery,,,0450,21,Inpatient Hospital,3,4985.51,3273.35,3033.0,240.35,0.0,0.0,240.35,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004105,MBR00000159,Institutional-IP,2022-02-11,2022-02-19,2022-03-18,PLN8349,1361302520,1361302520,Critical Access Hospital,In-Network,N20.0,N39.0,,,,194,MS-DRG,11,8,Y,23472,Surgery,,,0636,21,Inpatient Hospital,2,4713.51,2008.53,1635.61,0.0,0.0,372.92,372.92,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004106,MBR00000159,Institutional-IP,2022-08-26,2022-08-27,2022-09-11,PLN4076,1561134315,1561134315,DME Supplier,In-Network,I10,E66.9,,,,292,MS-DRG,21,1,Y,90837,Medicine,,,0370,21,Inpatient Hospital,1,234.58,84.8,35.15,49.65,0.0,0.0,49.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004107,MBR00000159,Institutional-IP,2022-05-16,2022-05-19,2022-06-03,PLN4111,1453936007,1453936007,ASC,In-Network,I10,M54.5,,,,872,MS-DRG,16,3,Y,97530,Medicine,,,0360,21,Inpatient Hospital,1,225.97,174.51,0.0,174.51,25.0,0.0,199.51,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000004108,MBR00000159,Professional,2021-12-19,2021-12-19,2022-01-24,PLN2650,1124394415,1124394415,Pediatrics,In-Network,N18.3,E11.65,,,,,,,0,,G0444,Medicine,,,,23,Emergency Room,2,101.05,38.33,0.0,38.33,0.0,0.0,38.33,0.0,Paid,,,0,,1,1,0,0,0,0,None,0,0,0,0,1
CLM0000004109,MBR00000160,Professional,2023-02-26,2023-02-26,2023-03-31,PLN7709,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,J20.9,M81.0,,,,,,,0,,99214,E&M,,,,12,Home,1,395.97,178.66,143.66,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004110,MBR00000160,Professional,2022-07-03,2022-07-03,2022-08-15,PLN9806,1511044648,1511044648,Endocrinology,In-Network,N39.0,R05,,,,,,,0,,77067,Radiology,,,,22,Outpatient Hospital,2,576.47,447.79,412.71,0.0,0.0,35.08,35.08,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000004111,MBR00000160,Professional,2022-11-27,2022-11-27,2023-01-01,PLN6876,1453283987,1453283987,Critical Access Hospital,In-Network,E78.5,J44.1,,,,,,,0,,71046,Radiology,,,,81,Independent Laboratory,1,243.56,182.19,0.0,182.19,0.0,0.0,182.19,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004112,MBR00000160,Institutional-IP,2023-01-07,2023-01-12,2023-01-25,PLN5254,1395983630,1395983630,Nephrology,In-Network,M54.5,Z23,,,,641,MS-DRG,2,5,Y,87491,Pathology/Lab,,,0636,21,Inpatient Hospital,1,115.19,73.95,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004113,MBR00000160,Institutional-OP,2023-01-13,2023-01-13,2023-02-21,PLN7545,1540044947,1540044947,Pulmonology,Out-of-Network,Z12.31,I48.91,,,,,,,0,,43239,Surgery,,,0740,22,Outpatient Hospital,1,1809.21,893.71,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-27,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004114,MBR00000160,Institutional-OP,2021-12-28,2021-12-28,2022-01-26,PLN2366,1563980627,1563980627,Critical Access Hospital,In-Network,Z79.4,Z12.31,,,,,,,0,,27447,Surgery,,,0510,22,Outpatient Hospital,2,4730.04,1554.69,1529.69,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004115,MBR00000160,Professional,2023-04-21,2023-04-21,2023-05-18,PLN9778,1395983630,1395983630,Nephrology,In-Network,E78.5,K21.0,,,,,,,0,,47562,Surgery,,,,31,Skilled Nursing Facility,2,3561.05,2638.89,2638.89,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004116,MBR00000160,Institutional-OP,2021-08-29,2021-08-29,2021-10-09,PLN7827,1974006077,1974006077,Orthopedic Surgery,In-Network,Z96.641,Z87.891,,,,,,,0,,86900,Pathology/Lab,,,0730,22,Outpatient Hospital,3,62.0,22.05,0.0,22.05,35.0,0.0,57.05,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004117,MBR00000160,Institutional-IP,2023-11-05,2023-11-12,2023-11-19,PLN8050,1590915516,1590915516,Physical Therapy,Out-of-Network,F32.9,I63.9,,,,603,MS-DRG,7,7,Y,74177,Radiology,,,0730,21,Inpatient Hospital,1,1434.16,782.71,433.5,334.21,15.0,0.0,349.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004118,MBR00000160,Professional,2023-06-06,2023-06-06,2023-06-28,PLN9988,1114982472,1114982472,Orthopedic Surgery,In-Network,R05,M54.5,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,2,184.16,154.85,139.85,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004119,MBR00000160,Institutional-OP,2022-08-27,2022-08-27,2022-10-09,PLN3739,1139906830,1139906830,Endocrinology,Out-of-Network,R51,N40.0,,,,,,,0,,71046,Radiology,,,0740,22,Outpatient Hospital,2,220.38,140.71,0.0,140.71,0.0,0.0,140.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004120,MBR00000160,Institutional-OP,2021-07-17,2021-07-17,2021-08-05,PLN6960,1366286000,1366286000,SNF,In-Network,J20.9,J20.9,,,,,,,0,,97530,Medicine,,,0270,22,Outpatient Hospital,2,301.59,95.93,0.0,0.0,75.0,3.72,78.72,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004121,MBR00000160,Professional,2023-09-17,2023-09-17,2023-09-25,PLN2849,1644128543,1644128543,Gastroenterology,In-Network,M81.0,J44.1,,,,,,,0,,93225,Medicine,,,,11,Office,3,573.71,174.41,141.27,0.0,0.0,33.14,33.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004122,MBR00000160,Institutional-IP,2022-08-31,2022-09-03,2022-09-24,PLN2897,1575695214,1575695214,SNF,In-Network,Z12.31,M17.11,,,,470,MS-DRG,21,3,N,99213,E&M,,,0740,21,Inpatient Hospital,3,239.54,173.54,0.0,173.54,50.0,0.0,223.54,0.0,Denied,CO-15,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000004123,MBR00000160,Professional,2023-06-12,2023-06-12,2023-07-19,PLN1270,1366426662,1366426662,Urology,In-Network,I10,I10,,,,,,,0,,99283,E&M,,,,23,Emergency Room,1,352.12,184.87,159.87,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004124,MBR00000160,Professional,2021-01-31,2021-01-31,2021-03-03,PLN4556,1702692193,1702692193,Physical Therapy,In-Network,G43.909,I50.9,,,,,,,0,,90686,Medicine,,,,49,Independent Clinic,1,60.22,28.21,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000004125,MBR00000160,Professional,2022-01-06,2022-01-06,2022-01-22,PLN6654,1564502315,1564502315,ASC,In-Network,Z00.00,Z12.31,,,,,,,0,,74177,Radiology,,,,11,Office,3,1690.1,985.13,691.63,286.3,0.0,7.2,293.5,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004126,MBR00000160,Professional,2021-11-25,2021-11-25,2022-01-07,PLN4617,1242201429,1242201429,General Acute Care Hospital,In-Network,Z87.891,I11.9,,,,,,,0,,99213,E&M,,,,23,Emergency Room,2,293.08,142.43,117.43,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004127,MBR00000160,Institutional-OP,2023-06-10,2023-06-10,2023-06-19,PLN4466,1125190055,1125190055,Nephrology,In-Network,E11.9,I10,,,,,,,0,,45378,Surgery,,,0301,22,Outpatient Hospital,2,1567.35,1119.53,0.0,258.46,35.0,0.0,293.46,0.0,Denied,CO-11,,0,,0,1,1,0,0,1,Unbundling,0,1,0,0,0
CLM0000004128,MBR00000160,Professional,2022-05-24,2022-05-24,2022-06-11,PLN2595,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,E11.9,N20.0,,,,,,,0,,33533,Surgery,,,,11,Office,1,21685.98,14642.1,11694.11,322.81,0.0,2625.18,2947.99,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000004129,MBR00000160,Institutional-IP,2021-05-09,2021-05-15,2021-06-04,PLN2895,1910255109,1910255109,DME Supplier,In-Network,M54.5,E11.9,,,,682,MS-DRG,17,6,W,99204,E&M,,,0320,21,Inpatient Hospital,2,486.12,224.39,0.0,177.04,25.0,0.0,202.04,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004130,MBR00000160,Institutional-OP,2022-11-05,2022-11-05,2022-11-24,PLN6697,1433937353,1433937353,Nephrology,In-Network,R51,E78.5,,,,,,,0,,99406,Medicine,,,0510,22,Outpatient Hospital,1,72.43,59.18,0.0,59.18,35.0,0.0,94.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004131,MBR00000160,Institutional-OP,2021-06-23,2021-06-23,2021-07-30,PLN5336,1337791138,1337791138,Internal Medicine,Out-of-Network,Z87.891,J20.9,,,,,,,0,,66984,Surgery,,,0450,22,Outpatient Hospital,1,1975.06,1652.69,1356.72,0.0,0.0,295.97,295.97,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004132,MBR00000160,Professional,2022-05-05,2022-05-05,2022-06-07,PLN1715,1968299309,1968299309,Internal Medicine,In-Network,N40.0,F41.9,,,,,,,0,,27447,Surgery,,,,21,Inpatient Hospital,3,6261.78,3844.06,3469.94,339.12,35.0,0.0,374.12,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004133,MBR00000160,Professional,2023-12-23,2023-12-23,2024-02-05,PLN7695,1749327647,1749327647,Geriatrics,In-Network,I48.91,Z87.891,,,,,,,0,,97530,Medicine,,,,23,Emergency Room,1,163.42,73.38,23.38,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004134,MBR00000160,Professional,2022-04-21,2022-04-21,2022-05-09,PLN2796,1511044648,1511044648,Endocrinology,In-Network,E66.9,M17.11,,,,,,,0,,90460,Medicine,,,,21,Inpatient Hospital,2,35.2,21.01,0.0,21.01,25.0,0.0,46.01,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004135,MBR00000160,Professional,2022-04-15,2022-04-15,2022-05-02,PLN8628,1198133277,1198133277,SNF,In-Network,I10,M54.5,,,,,,,0,,99284,E&M,,,,11,Office,3,791.07,557.3,355.45,201.85,0.0,0.0,201.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004136,MBR00000160,Professional,2021-02-14,2021-02-14,2021-03-03,PLN1204,1609138981,1609138981,Critical Access Hospital,In-Network,R10.9,C50.912,,,,,,,0,,99232,E&M,,,,49,Independent Clinic,2,138.55,102.38,102.38,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004137,MBR00000160,Institutional-IP,2022-05-20,2022-05-24,2022-06-06,PLN6791,1531398223,1531398223,OB/GYN,In-Network,M54.5,F41.9,,,,871,MS-DRG,2,4,N,99232,E&M,,,0370,21,Inpatient Hospital,2,264.83,202.88,202.88,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004138,MBR00000160,Institutional-IP,2023-11-15,2023-11-26,2023-12-04,PLN8570,1450094833,1450094833,Outpatient Clinic,In-Network,J20.9,N18.3,,,,690,MS-DRG,8,11,Y,99221,E&M,,,0900,21,Inpatient Hospital,1,266.92,192.6,162.84,0.0,0.0,29.76,29.76,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000004139,MBR00000160,Professional,2023-11-08,2023-11-08,2023-12-10,PLN2090,1687650653,1687650653,Internal Medicine,In-Network,F10.20,Z87.891,,,,,,,0,,66984,Surgery,,,,12,Home,3,1885.09,1383.68,1383.68,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004140,MBR00000160,Professional,2023-11-21,2023-11-21,2023-12-23,PLN6069,1780163051,1780163051,SNF,In-Network,S72.001A,N18.3,,,,,,,0,,86900,Pathology/Lab,,,,23,Emergency Room,2,40.43,20.29,0.0,20.29,0.0,0.0,20.29,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004141,MBR00000160,Institutional-OP,2022-02-01,2022-02-01,2022-03-03,PLN5597,1689639685,1689639685,SNF,In-Network,F32.9,Z12.31,,,,,,,0,,99233,E&M,,,0200,22,Outpatient Hospital,3,390.34,193.99,158.99,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004142,MBR00000160,Institutional-OP,2021-03-13,2021-03-13,2021-03-29,PLN3112,1563980627,1563980627,Critical Access Hospital,In-Network,N39.0,N40.0,,,,,,,0,,99283,E&M,,,0270,22,Outpatient Hospital,3,401.99,234.28,219.28,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000004143,MBR00000160,Institutional-IP,2021-09-17,2021-09-19,2021-10-17,PLN1514,1193493783,1193493783,Critical Access Hospital,Out-of-Network,E78.5,F41.9,,,,683,MS-DRG,24,2,Y,43239,Surgery,,,0200,21,Inpatient Hospital,2,2141.89,1640.68,1375.95,0.0,75.0,189.73,264.73,0.0,Paid,,,1,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000004144,MBR00000160,Institutional-IP,2021-08-20,2021-09-05,2021-08-30,PLN2200,1812060197,1812060197,Oncology,Out-of-Network,Z00.00,I10,,,,641,MS-DRG,15,16,Y,99284,E&M,,,0761,21,Inpatient Hospital,3,916.53,513.57,463.57,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004145,MBR00000160,Institutional-IP,2021-03-27,2021-04-06,2021-04-30,PLN8198,1749494482,1749494482,Pediatrics,In-Network,K21.0,I10,,,,871,MS-DRG,6,10,Y,99233,E&M,,,0360,21,Inpatient Hospital,3,225.31,138.17,103.17,0.0,35.0,0.0,35.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004146,MBR00000160,Professional,2023-02-16,2023-02-16,2023-03-11,PLN6500,1518055405,1518055405,Urology,In-Network,M17.11,E11.9,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,2,2084.96,1000.11,591.62,264.72,25.0,118.77,408.49,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004147,MBR00000160,Institutional-OP,2022-07-27,2022-07-27,2022-08-04,PLN9040,1968299309,1968299309,Internal Medicine,In-Network,F41.9,K57.30,,,,,,,0,,93000,Radiology,,,0636,22,Outpatient Hospital,2,135.65,53.52,53.52,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004148,MBR00000160,Professional,2023-03-02,2023-03-02,2023-03-24,PLN9483,1713934949,1713934949,Neurology,In-Network,Z00.00,N18.3,,,,,,,0,,71046,Radiology,,,,11,Office,3,213.92,169.54,20.79,98.75,50.0,0.0,148.75,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004149,MBR00000161,Institutional-IP,2021-08-07,2021-08-11,2021-09-02,PLN2938,1713934949,1713934949,Neurology,In-Network,J20.9,Z12.31,,,,682,MS-DRG,22,4,Y,45380,Surgery,,,0360,21,Inpatient Hospital,1,2607.29,1146.6,637.89,484.66,0.0,24.05,508.71,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000004150,MBR00000161,Professional,2023-02-02,2023-02-02,2023-03-18,PLN3288,1910255109,1910255109,DME Supplier,In-Network,Z12.31,M81.0,,,,,,,0,,71046,Radiology,,,,22,Outpatient Hospital,2,273.59,161.57,161.57,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004151,MBR00000161,Institutional-OP,2021-03-12,2021-03-12,2021-03-21,PLN7086,1968299309,1968299309,Internal Medicine,In-Network,E78.5,G43.909,,,,,,,0,,G0468,Medicine,,,0900,22,Outpatient Hospital,2,658.79,551.93,551.93,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004152,MBR00000161,Institutional-OP,2023-03-02,2023-03-02,2023-04-01,PLN4305,1702692193,1702692193,Physical Therapy,In-Network,M81.0,F32.9,,,,,,,0,,83036,Pathology/Lab,,,0510,22,Outpatient Hospital,2,50.42,29.29,29.29,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000004153,MBR00000161,Institutional-OP,2023-06-10,2023-06-10,2023-07-21,PLN5641,1564502315,1564502315,ASC,In-Network,E11.9,E66.9,,,,,,,0,,70450,Radiology,,,0740,22,Outpatient Hospital,3,686.9,363.66,54.08,274.58,35.0,0.0,309.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004154,MBR00000161,Professional,2021-10-05,2021-10-05,2021-10-17,PLN7046,1896447406,1896447406,Nephrology,Out-of-Network,R07.9,C50.912,,,,,,,0,,86900,Pathology/Lab,,,,50,Federally Qualified Health Center,2,50.19,23.03,23.03,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004155,MBR00000161,Institutional-IP,2021-12-26,2021-12-28,2022-01-28,PLN5615,1247341320,1247341320,Urology,Out-of-Network,Z87.891,F32.9,,,,196,MS-DRG,14,2,Y,99284,E&M,,,0301,21,Inpatient Hospital,1,714.55,328.81,67.2,261.61,0.0,0.0,261.61,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004156,MBR00000161,Institutional-IP,2022-04-22,2022-04-23,2022-05-23,PLN5891,1433937353,1433937353,Nephrology,In-Network,E11.9,I50.9,,,,641,MS-DRG,3,1,Y,97110,Medicine,,,0450,21,Inpatient Hospital,3,266.66,201.84,147.16,0.0,25.0,29.68,54.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004157,MBR00000161,Institutional-OP,2022-09-27,2022-09-27,2022-10-15,PLN8649,1689639685,1689639685,SNF,In-Network,E11.9,Z00.00,,,,,,,0,,74177,Radiology,,,0450,22,Outpatient Hospital,2,2552.64,1420.04,0.0,380.13,35.0,0.0,415.13,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004158,MBR00000161,Professional,2022-08-03,2022-08-03,2022-08-15,PLN7387,1590915516,1590915516,Physical Therapy,Out-of-Network,Z12.31,F32.9,,,,,,,0,,70553,Radiology,,,,22,Outpatient Hospital,3,3106.68,1391.57,1366.57,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004159,MBR00000161,Professional,2021-04-25,2021-04-25,2021-06-02,PLN3328,1700633438,1700633438,DME Supplier,In-Network,I63.9,M54.5,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,2,36.44,26.62,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004160,MBR00000162,Institutional-IP,2022-02-19,2022-02-22,2022-03-13,PLN3694,1132188260,1132188260,Family Medicine,In-Network,Z12.31,E11.9,,,,470,MS-DRG,18,3,Y,99214,E&M,,,0740,21,Inpatient Hospital,3,309.93,201.13,186.13,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004161,MBR00000162,Professional,2022-07-08,2022-07-08,2022-08-16,PLN6412,1227362142,1227362142,DME Supplier,In-Network,J44.1,F41.9,,,,,,,0,,99222,E&M,,,,11,Office,3,329.86,199.89,183.37,0.0,0.0,16.52,16.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004162,MBR00000162,Institutional-IP,2022-11-04,2022-11-09,2022-11-30,PLN7852,1283743001,1283743001,Family Medicine,In-Network,N40.0,M54.5,,,,871,MS-DRG,1,5,Y,77067,Radiology,,,0636,21,Inpatient Hospital,3,398.76,185.69,160.69,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000004163,MBR00000162,Professional,2022-11-23,2022-11-23,2022-12-10,PLN5360,1752470395,1752470395,Home Health,In-Network,E11.9,I10,,,,,,,0,,77067,Radiology,,,,65,End-Stage Renal Disease,3,763.97,242.72,227.08,15.64,0.0,0.0,15.64,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000004164,MBR00000162,Institutional-OP,2022-12-31,2022-12-31,2023-01-25,PLN5700,1809014947,1809014947,Urology,In-Network,M54.5,J45.20,,,,,,,0,,G0444,Medicine,,,0270,22,Outpatient Hospital,1,49.79,28.43,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000004165,MBR00000162,Professional,2022-05-08,2022-05-08,2022-06-20,PLN7805,1118885473,1118885473,ASC,In-Network,Z23,Z00.00,,,,,,,0,,45380,Surgery,,,,11,Office,1,1486.36,975.35,975.35,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000004166,MBR00000162,Institutional-OP,2022-07-05,2022-07-05,2022-07-27,PLN8673,1990090423,1990090423,Orthopedic Surgery,In-Network,M81.0,E66.9,,,,,,,0,,99233,E&M,,,0740,22,Outpatient Hospital,2,241.19,113.79,52.14,46.65,15.0,0.0,61.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004167,MBR00000162,Professional,2022-01-05,2022-01-05,2022-02-02,PLN3230,1691062876,1691062876,SNF,In-Network,J45.20,N40.0,,,,,,,0,,27447,Surgery,,,,23,Emergency Room,1,3287.03,1941.31,1482.85,408.46,50.0,0.0,458.46,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004168,MBR00000162,Professional,2021-10-25,2021-10-25,2021-12-06,PLN7844,1717912431,1717912431,Oncology,In-Network,I11.9,Z12.31,,,,,,,0,,66984,Surgery,,,,11,Office,1,1331.76,930.96,835.8,0.0,0.0,95.16,95.16,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004169,MBR00000162,Professional,2021-12-07,2021-12-07,2021-12-20,PLN8022,1812060197,1812060197,Oncology,Out-of-Network,Z12.31,J06.9,,,,,,,0,,71046,Radiology,,,,11,Office,3,140.37,59.12,59.12,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004170,MBR00000162,Institutional-OP,2022-04-26,2022-04-26,2022-06-07,PLN4447,1948810580,1948810580,DME Supplier,In-Network,M17.11,N18.3,,,,,,,0,,77067,Radiology,,,0120,22,Outpatient Hospital,3,597.16,282.27,0.0,259.49,75.0,0.0,334.49,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000004171,MBR00000162,Professional,2021-04-30,2021-04-30,2021-05-25,PLN3002,1540044947,1540044947,Pulmonology,Out-of-Network,I25.10,I10,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,2,526.08,396.26,0.0,382.79,35.0,0.0,417.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004172,MBR00000162,Professional,2021-08-28,2021-08-28,2021-09-21,PLN8742,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,R10.9,J18.9,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,3,7528.19,3938.1,3888.1,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004173,MBR00000162,Professional,2021-05-07,2021-05-07,2021-05-31,PLN8624,1935547131,1935547131,Pulmonology,In-Network,J20.9,J06.9,,,,,,,0,,93000,Radiology,,,,11,Office,2,103.95,74.34,0.0,74.34,0.0,0.0,74.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004174,MBR00000162,Institutional-OP,2022-03-24,2022-03-24,2022-04-12,PLN8731,1361302520,1361302520,Critical Access Hospital,In-Network,E78.5,I10,,,,,,,0,,93225,Medicine,,,0320,22,Outpatient Hospital,1,601.66,448.65,401.8,0.0,0.0,46.85,46.85,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004175,MBR00000162,Professional,2022-06-27,2022-06-27,2022-08-06,PLN1714,1239316214,1239316214,Internal Medicine,In-Network,E78.5,G43.909,,,,,,,0,,45380,Surgery,,,,21,Inpatient Hospital,3,1521.43,526.33,54.65,456.68,15.0,0.0,471.68,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000004176,MBR00000162,Institutional-IP,2021-06-28,2021-07-03,2021-07-05,PLN5398,1453283987,1453283987,Critical Access Hospital,In-Network,S72.001A,E11.9,,,,871,MS-DRG,23,5,N,85610,Pathology/Lab,,,0761,21,Inpatient Hospital,3,51.26,34.38,0.0,34.38,75.0,0.0,109.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004177,MBR00000162,Professional,2021-06-02,2021-06-02,2021-06-12,PLN6429,1118885473,1118885473,ASC,In-Network,M17.11,J06.9,,,,,,,0,,43239,Surgery,,,,65,End-Stage Renal Disease,1,1747.21,846.98,471.22,375.76,0.0,0.0,375.76,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004178,MBR00000162,Professional,2022-07-30,2022-07-30,2022-08-09,PLN6546,1891849440,1891849440,Oncology,In-Network,Z12.31,E78.5,,,,,,,0,,43239,Surgery,,,,11,Office,1,2035.41,1548.26,1197.7,335.56,15.0,0.0,350.56,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004179,MBR00000162,Professional,2021-09-02,2021-09-02,2021-09-26,PLN6455,1609526529,1609526529,Psychiatry,In-Network,R10.9,E78.5,,,,,,,0,,70553,Radiology,,,,22,Outpatient Hospital,3,2480.2,989.24,989.24,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004180,MBR00000162,Institutional-IP,2023-08-09,2023-08-11,2023-08-29,PLN8979,1361302520,1361302520,Critical Access Hospital,In-Network,M17.11,Z79.4,,,,196,MS-DRG,19,2,Y,G0439,Medicine,,,0301,21,Inpatient Hospital,3,587.85,462.23,6.04,441.19,15.0,0.0,456.19,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000004181,MBR00000162,Professional,2021-06-30,2021-06-30,2021-07-21,PLN6601,1118885473,1118885473,ASC,In-Network,I10,K21.0,,,,,,,0,,47562,Surgery,,,,11,Office,2,5098.65,1857.1,1782.1,0.0,75.0,0.0,75.0,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004182,MBR00000162,Institutional-OP,2022-06-12,2022-06-12,2022-06-20,PLN9218,1514306773,1514306773,Endocrinology,In-Network,F41.9,S72.001A,,,,,,,0,,45378,Surgery,,,0270,22,Outpatient Hospital,1,2438.82,1852.29,1810.52,41.77,0.0,0.0,41.77,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000004183,MBR00000162,Professional,2023-05-29,2023-05-29,2023-06-21,PLN7925,1118885473,1118885473,ASC,In-Network,E11.9,I48.91,,,,,,,0,,99283,E&M,,,,23,Emergency Room,1,323.81,145.76,0.0,90.66,0.0,0.0,90.66,0.0,Denied,CO-15,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004184,MBR00000162,Institutional-IP,2021-04-24,2021-04-30,2021-05-03,PLN8670,1899127912,1899127912,Neurology,In-Network,I25.10,R10.9,,,,682,MS-DRG,18,6,Y,93306,Radiology,,,0320,21,Inpatient Hospital,1,1859.42,618.93,401.98,181.95,35.0,0.0,216.95,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004185,MBR00000162,Professional,2022-05-08,2022-05-08,2022-05-30,PLN3904,1727809972,1727809972,Home Health,In-Network,J20.9,J06.9,,,,,,,0,,27130,Surgery,,,,20,Urgent Care,1,2610.25,1105.59,1055.59,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004186,MBR00000162,Professional,2022-06-01,2022-06-01,2022-06-11,PLN8782,1245650222,1245650222,Gastroenterology,In-Network,I11.9,J20.9,,,,,,,0,,99203,E&M,,,,12,Home,3,264.71,115.0,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004187,MBR00000162,Institutional-OP,2022-08-29,2022-08-29,2022-09-07,PLN3351,1283743001,1283743001,Family Medicine,In-Network,Z12.31,E66.9,,,,,,,0,,93000,Radiology,,,0360,22,Outpatient Hospital,3,113.65,58.63,0.0,58.63,35.0,0.0,93.63,0.0,Denied,CO-4,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000004188,MBR00000162,Institutional-OP,2023-08-28,2023-08-28,2023-09-16,PLN4947,1812060197,1812060197,Oncology,Out-of-Network,E78.5,E66.9,,,,,,,0,,93306,Radiology,,,0510,22,Outpatient Hospital,1,3211.18,1621.15,1340.9,280.25,0.0,0.0,280.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004189,MBR00000162,Institutional-IP,2022-10-01,2022-10-06,2022-10-15,PLN1467,1915531927,1915531927,Critical Access Hospital,In-Network,I10,F10.20,,,,603,MS-DRG,21,5,Y,99233,E&M,,,0450,21,Inpatient Hospital,2,495.18,230.15,198.04,0.0,15.0,17.11,32.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004190,MBR00000162,Institutional-OP,2022-02-17,2022-02-17,2022-02-24,PLN2056,1514306773,1514306773,Endocrinology,In-Network,Z00.00,E78.5,,,,,,,0,,76700,Radiology,,,0360,22,Outpatient Hospital,3,1407.94,1129.24,838.88,290.36,0.0,0.0,290.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004191,MBR00000162,Professional,2022-03-11,2022-03-11,2022-04-03,PLN1139,1390307371,1390307371,DME Supplier,In-Network,I48.91,F41.9,,,,,,,0,,80061,Pathology/Lab,,,,21,Inpatient Hospital,1,113.08,79.33,0.0,79.33,0.0,0.0,79.33,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004192,MBR00000162,Institutional-OP,2022-11-15,2022-11-15,2022-11-22,PLN5095,1364429278,1364429278,OB/GYN,In-Network,N40.0,Z12.31,,,,,,,0,,23472,Surgery,,,0761,22,Outpatient Hospital,3,4332.93,1943.68,1896.92,21.76,25.0,0.0,46.76,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004193,MBR00000162,Professional,2021-11-23,2021-11-23,2021-12-09,PLN7243,1389336600,1389336600,Critical Access Hospital,In-Network,R10.9,I10,,,,,,,0,,80053,Pathology/Lab,,,,21,Inpatient Hospital,3,114.03,53.35,38.35,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000004194,MBR00000162,Institutional-OP,2023-01-20,2023-01-20,2023-02-27,PLN2316,1812060197,1812060197,Oncology,Out-of-Network,I25.10,E78.5,,,,,,,0,,45378,Surgery,,,0200,22,Outpatient Hospital,3,2078.55,1540.23,0.0,199.57,0.0,0.0,199.57,0.0,Denied,CO-15,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000004195,MBR00000162,Institutional-OP,2022-02-23,2022-02-23,2022-03-26,PLN2155,1313212303,1313212303,Family Medicine,In-Network,E11.9,Z23,,,,,,,0,,99214,E&M,,,0360,22,Outpatient Hospital,1,392.51,118.71,0.0,118.71,75.0,0.0,193.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004196,MBR00000162,Professional,2021-03-08,2021-03-08,2021-03-31,PLN3956,1434029575,1434029575,Endocrinology,In-Network,M54.5,E11.9,,,,,,,0,,99283,E&M,,,,12,Home,2,518.5,367.52,352.52,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004197,MBR00000162,Institutional-IP,2022-08-09,2022-08-20,2022-09-15,PLN8401,1361302520,1361302520,Critical Access Hospital,In-Network,N18.3,I10,,,,682,MS-DRG,17,11,Y,99214,E&M,,,0900,21,Inpatient Hospital,3,207.26,120.11,120.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004198,MBR00000162,Institutional-OP,2021-10-03,2021-10-03,2021-10-16,PLN7313,1990090423,1990090423,Orthopedic Surgery,In-Network,J44.1,N40.0,,,,,,,0,,70450,Radiology,,,0370,22,Outpatient Hospital,2,1088.21,846.16,700.19,130.0,15.0,0.97,145.97,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004199,MBR00000163,Professional,2022-01-28,2022-01-28,2022-02-08,PLN2561,1856686341,1856686341,Geriatrics,In-Network,Z00.00,F10.20,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,1,173.0,144.12,144.09,0.0,0.0,0.03,0.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004200,MBR00000163,Professional,2021-12-21,2021-12-21,2022-01-23,PLN4807,1910255109,1910255109,DME Supplier,In-Network,R07.9,F41.9,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,2,4179.6,1419.08,1384.08,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004201,MBR00000163,Institutional-IP,2021-05-30,2021-06-05,2021-06-14,PLN1601,1103747954,1103747954,Urology,In-Network,R51,E66.9,,,,292,MS-DRG,23,6,Y,80061,Pathology/Lab,,,0270,21,Inpatient Hospital,3,112.96,56.98,21.98,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000004202,MBR00000163,Professional,2021-11-13,2021-11-13,2021-12-07,PLN2625,1531398223,1531398223,OB/GYN,In-Network,M81.0,R07.9,,,,,,,0,,99204,E&M,,,,23,Emergency Room,1,347.29,170.37,0.0,170.37,25.0,0.0,195.37,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004203,MBR00000163,Professional,2023-09-28,2023-09-28,2023-11-02,PLN9282,1364429278,1364429278,OB/GYN,In-Network,E11.9,I10,,,,,,,0,,99233,E&M,,,,49,Independent Clinic,1,216.14,165.22,140.22,0.0,25.0,0.0,25.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004204,MBR00000163,Institutional-OP,2021-12-17,2021-12-17,2022-01-05,PLN5378,1691062876,1691062876,SNF,In-Network,J06.9,E66.9,,,,,,,0,,83036,Pathology/Lab,,,0510,22,Outpatient Hospital,2,121.68,81.54,69.0,0.0,0.0,12.54,12.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000004205,MBR00000163,Institutional-OP,2023-03-13,2023-03-13,2023-03-26,PLN4312,1845057593,1845057593,Orthopedic Surgery,In-Network,Z87.891,Z00.00,,,,,,,0,,99203,E&M,,,0740,22,Outpatient Hospital,2,187.32,146.27,121.27,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004206,MBR00000163,Professional,2022-03-24,2022-03-24,2022-04-24,PLN8609,1974006077,1974006077,Orthopedic Surgery,In-Network,Z23,I10,,,,,,,0,,99233,E&M,,,,21,Inpatient Hospital,2,321.43,151.38,0.0,151.38,75.0,0.0,226.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004207,MBR00000164,Institutional-OP,2021-03-14,2021-03-14,2021-04-23,PLN3189,1585582070,1585582070,Outpatient Clinic,In-Network,M54.5,E78.5,,,,,,,0,,27447,Surgery,,,0270,22,Outpatient Hospital,3,2463.26,929.14,860.5,43.64,25.0,0.0,68.64,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004208,MBR00000164,Professional,2023-07-07,2023-07-07,2023-08-06,PLN3649,1500949740,1500949740,Pediatrics,In-Network,K21.0,M17.11,,,,,,,0,,93225,Medicine,,,,81,Independent Laboratory,2,916.87,617.68,567.68,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004209,MBR00000164,Professional,2023-09-19,2023-09-19,2023-10-04,PLN4618,1780163051,1780163051,SNF,In-Network,Z00.00,F41.9,,,,,,,0,,47562,Surgery,,,,11,Office,3,3695.81,1622.66,1147.84,399.82,75.0,0.0,474.82,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004210,MBR00000164,Professional,2021-09-16,2021-09-16,2021-10-12,PLN9958,1980712759,1980712759,Outpatient Clinic,Out-of-Network,I10,E11.9,,,,,,,0,,99283,E&M,,,,11,Office,3,328.69,250.22,200.22,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004211,MBR00000164,Professional,2021-07-06,2021-07-06,2021-08-06,PLN2639,1520687146,1520687146,ASC,In-Network,Z00.00,J44.1,,,,,,,0,,78452,Radiology,,,,11,Office,1,6418.09,4534.96,4534.96,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004212,MBR00000165,Institutional-IP,2023-10-17,2023-10-24,2023-11-30,PLN9796,1545347862,1545347862,SNF,In-Network,E11.9,F03.90,,,,470,MS-DRG,22,7,Y,27130,Surgery,,,0270,21,Inpatient Hospital,2,5240.3,2766.81,2751.81,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004213,MBR00000165,Professional,2021-04-18,2021-04-18,2021-05-03,PLN8411,1660288235,1660288235,ASC,In-Network,F41.9,Z79.4,,,,,,,0,,99214,E&M,,,,12,Home,3,450.74,181.16,155.78,0.0,0.0,25.38,25.38,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004214,MBR00000165,Professional,2023-09-01,2023-09-01,2023-09-29,PLN2064,1450553056,1450553056,Clinical Laboratory,In-Network,E66.9,Z23,,,,,,,0,,27130,Surgery,,,,11,Office,3,6180.97,3001.1,2986.1,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004215,MBR00000165,Institutional-IP,2021-07-09,2021-07-17,2021-07-25,PLN8530,1295371663,1295371663,Critical Access Hospital,In-Network,I10,R05,,,,871,MS-DRG,13,8,Y,70450,Radiology,,,0200,21,Inpatient Hospital,3,895.24,543.64,543.64,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004216,MBR00000165,Institutional-IP,2023-08-08,2023-08-09,2023-08-24,PLN2205,1799205295,1799205295,General Acute Care Hospital,In-Network,J06.9,M54.5,,,,690,MS-DRG,22,1,Y,G0468,Medicine,,,0450,21,Inpatient Hospital,2,381.65,212.71,212.71,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004217,MBR00000165,Institutional-IP,2023-10-19,2023-10-23,2023-11-24,PLN2520,1550154147,1550154147,Outpatient Clinic,In-Network,Z00.00,R05,,,,682,MS-DRG,23,4,Y,85610,Pathology/Lab,,,0730,21,Inpatient Hospital,1,51.19,31.97,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,1,1,Upcoding,0,0,0,0,0
CLM0000004218,MBR00000165,Institutional-IP,2021-09-20,2021-09-21,2021-10-06,PLN8328,1948810580,1948810580,DME Supplier,In-Network,F41.9,Z12.31,,,,682,MS-DRG,21,1,Y,85025,Pathology/Lab,,,0900,21,Inpatient Hospital,1,69.15,56.62,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004219,MBR00000165,Institutional-OP,2021-08-31,2021-08-31,2021-09-15,PLN2922,1845900543,1845900543,ASC,In-Network,Z00.00,R10.9,,,,,,,0,,G0439,Medicine,,,0320,22,Outpatient Hospital,1,423.11,344.12,279.77,0.0,15.0,49.35,64.35,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000004220,MBR00000165,Institutional-OP,2021-04-27,2021-04-27,2021-05-28,PLN8955,1213165847,1213165847,Critical Access Hospital,In-Network,J06.9,J06.9,,,,,,,0,,27130,Surgery,,,0761,22,Outpatient Hospital,3,5110.57,3141.0,2998.17,117.83,25.0,0.0,142.83,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004221,MBR00000165,Institutional-OP,2023-05-12,2023-05-12,2023-06-07,PLN3593,1817234602,1817234602,Clinical Laboratory,In-Network,E66.9,E78.5,,,,,,,0,,76700,Radiology,,,0120,22,Outpatient Hospital,2,1463.49,663.44,604.13,0.0,35.0,24.31,59.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004222,MBR00000165,Institutional-OP,2022-01-18,2022-01-18,2022-02-27,PLN1127,1227362142,1227362142,DME Supplier,In-Network,R10.9,E66.9,,,,,,,0,,G0439,Medicine,,,0370,22,Outpatient Hospital,3,399.27,148.74,134.22,14.52,0.0,0.0,14.52,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000004223,MBR00000165,Institutional-OP,2022-12-06,2022-12-06,2023-01-07,PLN6367,1994661817,1994661817,SNF,Out-of-Network,M54.5,G43.909,,,,,,,0,,72148,Radiology,,,0510,22,Outpatient Hospital,2,1798.33,589.96,589.96,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004224,MBR00000165,Professional,2022-11-04,2022-11-04,2022-11-29,PLN1134,1283743001,1283743001,Family Medicine,In-Network,Z23,J20.9,,,,,,,0,,99284,E&M,,,,65,End-Stage Renal Disease,2,795.05,314.07,0.0,314.07,35.0,0.0,349.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004225,MBR00000165,Professional,2022-07-22,2022-07-22,2022-08-20,PLN7323,1114982472,1114982472,Orthopedic Surgery,In-Network,N40.0,M17.11,,,,,,,0,,90837,Medicine,,,,22,Outpatient Hospital,1,482.85,278.78,278.78,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004226,MBR00000165,Professional,2021-09-23,2021-09-23,2021-10-20,PLN3116,1545347862,1545347862,SNF,In-Network,G43.909,F32.9,,,,,,,0,,45378,Surgery,,,,81,Independent Laboratory,3,1413.9,487.92,462.92,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000004227,MBR00000165,Professional,2022-02-05,2022-02-05,2022-03-21,PLN8820,1450094833,1450094833,Outpatient Clinic,In-Network,M54.5,Z00.00,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,2,418.82,144.67,144.67,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004228,MBR00000165,Institutional-IP,2022-07-03,2022-07-04,2022-08-04,PLN8867,1148984206,1148984206,Psychiatry,In-Network,R05,F41.9,,,,683,MS-DRG,5,1,Y,70553,Radiology,,,0370,21,Inpatient Hospital,3,4252.66,2738.4,2738.4,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004229,MBR00000165,Professional,2021-04-12,2021-04-12,2021-04-28,PLN9849,1899127912,1899127912,Neurology,In-Network,E78.5,N18.3,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,1,3523.08,1418.46,1383.46,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004230,MBR00000165,Institutional-IP,2022-03-19,2022-03-22,2022-04-05,PLN3028,1463205530,1463205530,Nephrology,In-Network,R10.9,I10,,,,690,MS-DRG,17,3,N,58661,Surgery,,,0636,21,Inpatient Hospital,3,2462.16,1286.58,1271.58,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004231,MBR00000165,Institutional-OP,2023-02-18,2023-02-18,2023-03-08,PLN2002,1939033455,1939033455,Pulmonology,In-Network,N17.9,E11.9,,,,,,,0,,99221,E&M,,,0510,22,Outpatient Hospital,2,365.15,163.79,148.79,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004232,MBR00000165,Professional,2022-04-07,2022-04-07,2022-04-29,PLN4588,1132188260,1132188260,Family Medicine,In-Network,B97.89,E11.9,,,,,,,0,,99233,E&M,,,,50,Federally Qualified Health Center,2,476.29,261.62,261.62,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004233,MBR00000165,Institutional-OP,2022-03-09,2022-03-09,2022-04-20,PLN1944,1242201429,1242201429,General Acute Care Hospital,In-Network,I10,N39.0,,,,,,,0,,99221,E&M,,,0900,22,Outpatient Hospital,1,373.25,279.59,279.59,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004234,MBR00000165,Institutional-OP,2023-07-10,2023-07-10,2023-07-20,PLN1491,1713934949,1713934949,Neurology,In-Network,E11.9,E11.9,,,,,,,0,,99204,E&M,,,0450,22,Outpatient Hospital,1,217.68,164.77,0.0,164.77,25.0,0.0,189.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004235,MBR00000165,Institutional-OP,2022-08-09,2022-08-09,2022-08-29,PLN9128,1284035364,1284035364,Pediatrics,In-Network,M54.5,E11.9,,,,,,,0,,27447,Surgery,,,0370,22,Outpatient Hospital,2,5022.17,1529.8,1322.61,207.19,0.0,0.0,207.19,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004236,MBR00000165,Professional,2023-03-19,2023-03-19,2023-04-06,PLN1068,1660288235,1660288235,ASC,In-Network,J18.9,E78.5,,,,,,,0,,81001,Pathology/Lab,,,,49,Independent Clinic,2,60.62,27.0,27.0,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004237,MBR00000165,Institutional-OP,2021-02-26,2021-02-26,2021-03-22,PLN9198,1268679390,1268679390,Critical Access Hospital,In-Network,Z23,Z79.4,,,,,,,0,,99233,E&M,,,0636,22,Outpatient Hospital,3,333.06,214.11,0.0,214.11,0.0,0.0,214.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004238,MBR00000165,Professional,2023-10-14,2023-10-14,2023-11-04,PLN9611,1103747954,1103747954,Urology,In-Network,E11.9,Z23,,,,,,,0,,76700,Radiology,,,,11,Office,3,648.28,370.58,296.6,0.0,15.0,58.98,73.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004239,MBR00000165,Institutional-OP,2023-04-30,2023-04-30,2023-06-05,PLN5657,1244186984,1244186984,Family Medicine,Out-of-Network,J06.9,E11.9,,,,,,,0,,90460,Medicine,,,0200,22,Outpatient Hospital,1,57.6,47.82,0.0,47.82,75.0,0.0,122.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004240,MBR00000165,Professional,2023-06-25,2023-06-25,2023-07-24,PLN1811,1135158374,1135158374,Pulmonology,In-Network,Z23,F32.9,,,,,,,0,,47562,Surgery,,,,11,Office,1,3013.17,1517.17,1219.9,0.0,50.0,247.27,297.27,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004241,MBR00000165,Professional,2023-01-29,2023-01-29,2023-02-28,PLN9822,1168246159,1168246159,Internal Medicine,In-Network,E66.9,J06.9,,,,,,,0,,99406,Medicine,,,,49,Independent Clinic,3,50.86,32.62,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004242,MBR00000165,Professional,2022-08-13,2022-08-13,2022-09-21,PLN3569,1727809972,1727809972,Home Health,In-Network,N20.0,E11.40,,,,,,,0,,70450,Radiology,,,,22,Outpatient Hospital,3,693.05,370.83,0.0,370.83,35.0,0.0,405.83,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004243,MBR00000166,Institutional-OP,2022-08-03,2022-08-03,2022-09-08,PLN7496,1213165847,1213165847,Critical Access Hospital,In-Network,Z23,F10.20,,,,,,,0,,90837,Medicine,,,0740,22,Outpatient Hospital,2,270.81,163.05,162.21,0.0,0.0,0.84,0.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004244,MBR00000166,Institutional-OP,2022-11-15,2022-11-15,2022-11-26,PLN9166,1795618275,1795618275,Pulmonology,In-Network,Z00.00,M54.5,,,,,,,0,,99213,E&M,,,0270,22,Outpatient Hospital,2,251.77,92.0,91.33,0.0,0.0,0.67,0.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004245,MBR00000166,Institutional-IP,2022-06-28,2022-07-03,2022-07-28,PLN9096,1569105090,1569105090,Geriatrics,In-Network,E11.65,I10,,,,690,MS-DRG,22,5,Y,72148,Radiology,,,0370,21,Inpatient Hospital,1,1466.85,838.82,696.95,0.0,50.0,91.87,141.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004246,MBR00000166,Institutional-OP,2023-03-10,2023-03-10,2023-04-12,PLN7388,1800011727,1800011727,Clinical Laboratory,Out-of-Network,F41.9,E11.9,,,,,,,0,,99214,E&M,,,0900,22,Outpatient Hospital,3,332.46,163.25,0.0,163.25,0.0,0.0,163.25,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004247,MBR00000166,Professional,2022-01-05,2022-01-05,2022-02-13,PLN7248,1980712759,1980712759,Outpatient Clinic,Out-of-Network,E78.5,I48.91,,,,,,,0,,99406,Medicine,,,,11,Office,2,89.33,37.0,37.0,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004248,MBR00000166,Institutional-OP,2023-04-23,2023-04-23,2023-05-23,PLN2118,1450553056,1450553056,Clinical Laboratory,In-Network,J06.9,E78.5,,,,,,,0,,45378,Surgery,,,0740,22,Outpatient Hospital,1,1696.22,909.38,820.14,0.0,75.0,14.24,89.24,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000004249,MBR00000166,Professional,2022-01-10,2022-01-10,2022-02-03,PLN9504,1337791138,1337791138,Internal Medicine,Out-of-Network,F41.9,I10,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,2,527.95,374.03,116.34,218.05,25.0,14.64,257.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004250,MBR00000166,Institutional-OP,2022-06-06,2022-06-06,2022-06-30,PLN2557,1790497490,1790497490,OB/GYN,In-Network,I10,J44.1,,,,,,,0,,27447,Surgery,,,0320,22,Outpatient Hospital,3,3027.79,2571.35,2571.35,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004251,MBR00000166,Institutional-OP,2021-03-16,2021-03-16,2021-03-31,PLN4465,1856686341,1856686341,Geriatrics,In-Network,N18.3,J44.1,,,,,,,0,,99283,E&M,,,0740,22,Outpatient Hospital,3,636.89,490.77,465.77,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004252,MBR00000166,Professional,2023-09-13,2023-09-13,2023-10-10,PLN4670,1205377316,1205377316,Orthopedic Surgery,In-Network,R10.9,J06.9,,,,,,,0,,99213,E&M,,,,11,Office,2,160.4,133.98,83.98,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004253,MBR00000166,Professional,2023-01-22,2023-01-22,2023-02-11,PLN2505,1139906830,1139906830,Endocrinology,Out-of-Network,R07.9,I10,,,,,,,0,,27130,Surgery,,,,50,Federally Qualified Health Center,3,5678.95,2622.02,2620.7,1.32,0.0,0.0,1.32,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004254,MBR00000166,Institutional-IP,2021-10-01,2021-10-10,2021-11-09,PLN2128,1213165847,1213165847,Critical Access Hospital,In-Network,I50.9,J20.9,,,,194,MS-DRG,22,9,N,99213,E&M,,,0900,21,Inpatient Hospital,3,231.99,158.36,143.36,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004255,MBR00000166,Institutional-OP,2021-02-19,2021-02-19,2021-03-28,PLN8455,1563980627,1563980627,Critical Access Hospital,In-Network,M54.5,J20.9,,,,,,,0,,99232,E&M,,,0900,22,Outpatient Hospital,1,212.6,156.32,128.96,0.0,0.0,27.36,27.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004256,MBR00000166,Institutional-IP,2023-07-22,2023-07-24,2023-09-02,PLN4716,1103747954,1103747954,Urology,In-Network,R51,E78.5,,,,196,MS-DRG,16,2,Y,23472,Surgery,,,0740,21,Inpatient Hospital,2,3692.34,1600.52,1348.47,252.05,0.0,0.0,252.05,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004257,MBR00000166,Institutional-OP,2021-01-02,2021-01-02,2021-02-04,PLN4005,1865904917,1865904917,Outpatient Clinic,In-Network,K21.0,I11.9,,,,,,,0,,99221,E&M,,,0450,22,Outpatient Hospital,1,180.74,116.92,18.72,95.56,0.0,2.64,98.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004258,MBR00000167,Institutional-OP,2022-06-12,2022-06-12,2022-07-22,PLN9479,1795618275,1795618275,Pulmonology,In-Network,F32.9,J06.9,,,,,,,0,,77067,Radiology,,,0270,22,Outpatient Hospital,2,755.58,286.82,271.82,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000004259,MBR00000167,Professional,2021-02-03,2021-02-03,2021-02-14,PLN7568,1645194539,1645194539,SNF,In-Network,Z23,F32.9,,,,,,,0,,99283,E&M,,,,23,Emergency Room,1,291.94,239.68,93.6,121.08,25.0,0.0,146.08,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004260,MBR00000167,Professional,2023-01-30,2023-01-30,2023-02-10,PLN3670,1434029575,1434029575,Endocrinology,In-Network,N40.0,J44.1,,,,,,,0,,70450,Radiology,,,,23,Emergency Room,1,1380.12,1133.5,760.85,205.01,0.0,167.64,372.65,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004261,MBR00000167,Institutional-IP,2021-08-11,2021-08-18,2021-09-08,PLN2320,1575695214,1575695214,SNF,In-Network,M81.0,G43.909,,,,641,MS-DRG,10,7,Y,47562,Surgery,,,0740,21,Inpatient Hospital,2,3104.2,1198.25,1198.25,0.0,0.0,0.0,0.0,0.0,Pended,,,1,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000004262,MBR00000167,Professional,2022-04-13,2022-04-13,2022-05-01,PLN7782,1990090423,1990090423,Orthopedic Surgery,In-Network,J20.9,K92.1,,,,,,,0,,58661,Surgery,,,,11,Office,3,3459.76,2357.17,2065.65,0.0,0.0,291.52,291.52,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004263,MBR00000167,Institutional-OP,2022-09-17,2022-09-17,2022-10-15,PLN4055,1118885473,1118885473,ASC,In-Network,Z23,E11.9,,,,,,,0,,27447,Surgery,,,0900,22,Outpatient Hospital,2,2575.49,2155.24,1999.66,0.0,75.0,80.58,155.58,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004264,MBR00000167,Professional,2022-02-10,2022-02-10,2022-02-21,PLN8484,1227362142,1227362142,DME Supplier,In-Network,M54.5,G20,,,,,,,0,,23472,Surgery,,,,11,Office,3,4521.28,1538.65,1538.65,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004265,MBR00000167,Institutional-OP,2023-01-16,2023-01-16,2023-02-27,PLN1687,1571574052,1571574052,Critical Access Hospital,In-Network,N18.3,Z12.31,,,,,,,0,,47562,Surgery,,,0510,22,Outpatient Hospital,2,5138.09,3770.77,3695.77,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004266,MBR00000167,Professional,2022-07-11,2022-07-11,2022-07-31,PLN5037,1227362142,1227362142,DME Supplier,In-Network,E11.9,Z12.31,,,,,,,0,,47562,Surgery,,,,11,Office,3,5828.62,3365.63,2884.28,481.35,0.0,0.0,481.35,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004267,MBR00000167,Institutional-OP,2022-04-06,2022-04-06,2022-05-07,PLN6763,1450094833,1450094833,Outpatient Clinic,In-Network,F41.9,I63.9,,,,,,,0,,33533,Surgery,,,0900,22,Outpatient Hospital,3,28541.56,13858.25,13784.57,23.68,50.0,0.0,73.68,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000004268,MBR00000167,Professional,2021-12-19,2021-12-19,2022-01-31,PLN8615,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,Z00.00,J06.9,,,,,,,0,,47562,Surgery,,,,20,Urgent Care,2,6091.15,3007.21,2869.18,113.03,25.0,0.0,138.03,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004269,MBR00000167,Institutional-IP,2022-03-24,2022-03-31,2022-04-12,PLN3935,1542828721,1542828721,Orthopedic Surgery,In-Network,F10.20,M81.0,,,,871,MS-DRG,17,7,Y,99214,E&M,,,0510,21,Inpatient Hospital,1,235.96,117.76,117.76,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004270,MBR00000167,Professional,2021-12-18,2021-12-18,2022-01-23,PLN6791,1313212303,1313212303,Family Medicine,In-Network,M54.5,I48.91,,,,,,,0,,27130,Surgery,,,,12,Home,1,3465.74,1399.6,1384.6,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004271,MBR00000167,Institutional-OP,2022-09-24,2022-09-24,2022-10-08,PLN6279,1569105090,1569105090,Geriatrics,In-Network,E78.5,M17.11,,,,,,,0,,66984,Surgery,,,0360,22,Outpatient Hospital,1,1884.91,594.53,559.53,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004272,MBR00000167,Professional,2023-04-18,2023-04-18,2023-05-01,PLN6226,1236418230,1236418230,DME Supplier,In-Network,N17.9,E11.9,,,,,,,0,,83036,Pathology/Lab,,,,22,Outpatient Hospital,2,120.37,72.49,0.0,72.49,75.0,0.0,147.49,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000004273,MBR00000167,Institutional-IP,2022-10-16,2022-10-20,2022-11-21,PLN3066,1186826716,1186826716,Physical Therapy,In-Network,M54.5,E78.5,,,,195,MS-DRG,23,4,Y,47562,Surgery,,,0900,21,Inpatient Hospital,2,6572.76,3771.88,0.0,92.63,0.0,0.0,92.63,0.0,Denied,CO-119,,1,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000004274,MBR00000167,Institutional-OP,2021-02-05,2021-02-05,2021-03-07,PLN5319,1689639685,1689639685,SNF,In-Network,F41.9,F10.20,,,,,,,0,,82043,Pathology/Lab,,,0301,22,Outpatient Hospital,2,76.3,52.65,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004275,MBR00000167,Professional,2023-07-15,2023-07-15,2023-08-18,PLN6663,1193493783,1193493783,Critical Access Hospital,Out-of-Network,Z23,Z12.31,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,2,97.79,50.82,50.82,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000004276,MBR00000167,Professional,2023-05-11,2023-05-11,2023-06-11,PLN9060,1125190055,1125190055,Nephrology,In-Network,F10.20,F32.9,,,,,,,0,,27130,Surgery,,,,11,Office,2,4571.62,3593.01,3099.03,0.0,35.0,458.98,493.98,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004277,MBR00000167,Professional,2023-06-16,2023-06-16,2023-06-29,PLN9053,1244186984,1244186984,Family Medicine,Out-of-Network,E78.5,I10,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,3,2020.15,1420.32,1420.32,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004278,MBR00000167,Institutional-IP,2021-02-24,2021-03-03,2021-03-03,PLN3765,1518055405,1518055405,Urology,In-Network,F41.9,Z12.31,,,,291,MS-DRG,1,7,Y,47562,Surgery,,,0450,21,Inpatient Hospital,3,6068.93,3968.77,3953.77,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004279,MBR00000167,Professional,2023-06-21,2023-06-21,2023-07-09,PLN7748,1450553056,1450553056,Clinical Laboratory,In-Network,F41.9,E78.5,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,3,498.45,281.08,242.97,0.0,25.0,13.11,38.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004280,MBR00000167,Professional,2022-05-27,2022-05-27,2022-06-30,PLN6065,1139906830,1139906830,Endocrinology,Out-of-Network,M17.11,Z23,,,,,,,0,,90686,Medicine,,,,22,Outpatient Hospital,1,78.28,30.09,0.0,0.0,35.0,0.0,35.0,0.0,Pended,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000004281,MBR00000167,Professional,2023-07-14,2023-07-14,2023-08-02,PLN7280,1948810580,1948810580,DME Supplier,In-Network,N39.0,E66.9,,,,,,,0,,82043,Pathology/Lab,,,,22,Outpatient Hospital,3,76.18,25.01,0.0,25.01,0.0,0.0,25.01,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004282,MBR00000167,Professional,2023-05-06,2023-05-06,2023-05-28,PLN2482,1994661817,1994661817,SNF,Out-of-Network,E78.5,F41.9,,,,,,,0,,99222,E&M,,,,49,Independent Clinic,3,491.59,338.24,0.0,234.38,25.0,0.0,259.38,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004283,MBR00000167,Professional,2023-08-22,2023-08-22,2023-09-17,PLN2110,1865904917,1865904917,Outpatient Clinic,In-Network,K21.0,J18.9,,,,,,,0,,77067,Radiology,,,,11,Office,2,873.79,310.2,275.2,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000004284,MBR00000167,Professional,2021-05-14,2021-05-14,2021-06-10,PLN8535,1528335731,1528335731,Critical Access Hospital,In-Network,J44.1,K21.0,,,,,,,0,,80053,Pathology/Lab,,,,22,Outpatient Hospital,1,119.98,43.14,0.0,43.14,0.0,0.0,43.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004285,MBR00000167,Institutional-IP,2022-09-01,2022-09-05,2022-10-10,PLN3323,1337791138,1337791138,Internal Medicine,Out-of-Network,Z87.891,Z00.01,,,,682,MS-DRG,6,4,Y,99221,E&M,,,0450,21,Inpatient Hospital,3,452.92,210.53,210.53,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000004286,MBR00000167,Institutional-IP,2023-03-09,2023-03-10,2023-04-15,PLN7793,1434029575,1434029575,Endocrinology,In-Network,F41.9,E11.9,,,,195,MS-DRG,17,1,Y,27447,Surgery,,,0320,21,Inpatient Hospital,2,4316.3,3474.61,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004287,MBR00000167,Professional,2022-10-14,2022-10-14,2022-11-08,PLN5357,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,E11.40,I48.91,,,,,,,0,,99221,E&M,,,,11,Office,1,399.39,270.82,0.0,270.82,0.0,0.0,270.82,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004288,MBR00000167,Institutional-OP,2023-06-08,2023-06-08,2023-07-05,PLN1276,1502838586,1502838586,ASC,In-Network,J20.9,I10,,,,,,,0,,66984,Surgery,,,0510,22,Outpatient Hospital,1,2470.92,1695.85,1695.85,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004289,MBR00000167,Professional,2023-03-08,2023-03-08,2023-04-05,PLN4812,1114982472,1114982472,Orthopedic Surgery,In-Network,M81.0,G20,,,,,,,0,,99284,E&M,,,,20,Urgent Care,3,874.32,628.34,270.18,358.16,0.0,0.0,358.16,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004290,MBR00000167,Institutional-OP,2021-02-09,2021-02-09,2021-02-21,PLN6114,1974006077,1974006077,Orthopedic Surgery,In-Network,F41.9,I63.9,,,,,,,0,,99203,E&M,,,0320,22,Outpatient Hospital,3,229.3,168.42,0.0,168.42,35.0,0.0,203.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004291,MBR00000167,Institutional-IP,2021-08-06,2021-08-09,2021-09-04,PLN2633,1575695214,1575695214,SNF,In-Network,J06.9,E66.9,,,,194,MS-DRG,12,3,Y,99284,E&M,,,0320,21,Inpatient Hospital,1,639.58,541.95,92.0,449.95,0.0,0.0,449.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004292,MBR00000167,Professional,2022-11-26,2022-11-26,2022-12-25,PLN1871,1860435061,1860435061,DME Supplier,In-Network,F32.9,J06.9,,,,,,,0,,93225,Medicine,,,,11,Office,3,459.82,159.34,0.0,159.34,0.0,0.0,159.34,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004293,MBR00000167,Institutional-OP,2022-01-30,2022-01-30,2022-03-12,PLN6495,1395983630,1395983630,Nephrology,In-Network,J20.9,I10,,,,,,,0,,99222,E&M,,,0900,22,Outpatient Hospital,1,580.58,208.4,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004294,MBR00000167,Professional,2022-01-26,2022-01-26,2022-02-25,PLN8329,1103747954,1103747954,Urology,In-Network,Z23,E66.9,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,2,367.35,306.33,306.33,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004295,MBR00000167,Institutional-OP,2023-09-27,2023-09-27,2023-11-09,PLN8971,1564502315,1564502315,ASC,In-Network,N40.0,I25.10,,,,,,,0,,77067,Radiology,,,0636,22,Outpatient Hospital,2,305.45,170.58,135.58,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000004296,MBR00000167,Institutional-IP,2021-04-09,2021-04-12,2021-04-16,PLN6222,1845057593,1845057593,Orthopedic Surgery,In-Network,E78.5,E78.5,,,,872,MS-DRG,6,3,Y,76700,Radiology,,,0200,21,Inpatient Hospital,3,708.99,563.57,186.72,369.07,0.0,7.78,376.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004297,MBR00000167,Professional,2022-07-27,2022-07-27,2022-08-15,PLN8240,1227362142,1227362142,DME Supplier,In-Network,K21.0,E78.5,,,,,,,0,,99222,E&M,,,,12,Home,3,623.36,372.52,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004298,MBR00000167,Professional,2021-12-08,2021-12-08,2021-12-25,PLN6292,1273488618,1273488618,General Acute Care Hospital,In-Network,Z23,Z12.31,,,,,,,0,,27447,Surgery,,,,11,Office,3,3947.85,2691.08,0.0,207.79,15.0,0.0,222.79,0.0,Denied,CO-4,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004299,MBR00000167,Institutional-OP,2021-02-26,2021-02-26,2021-03-10,PLN4725,1224179551,1224179551,Physical Therapy,In-Network,F41.9,K21.0,,,,,,,0,,58661,Surgery,,,0270,22,Outpatient Hospital,2,2089.28,1240.25,1076.3,0.0,25.0,138.95,163.95,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004300,MBR00000167,Professional,2022-02-15,2022-02-15,2022-03-01,PLN2056,1284035364,1284035364,Pediatrics,In-Network,J06.9,F32.9,,,,,,,0,,99213,E&M,,,,21,Inpatient Hospital,2,247.92,202.26,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000004301,MBR00000167,Professional,2022-03-21,2022-03-21,2022-04-22,PLN7184,1390307371,1390307371,DME Supplier,In-Network,E78.5,Z12.11,,,,,,,0,,80061,Pathology/Lab,,,,21,Inpatient Hospital,3,127.77,46.28,0.0,0.0,75.0,0.0,75.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004302,MBR00000167,Institutional-OP,2022-05-13,2022-05-13,2022-06-22,PLN7679,1806688928,1806688928,Geriatrics,In-Network,M17.11,M17.11,,,,,,,0,,97110,Medicine,,,0636,22,Outpatient Hospital,2,245.77,85.34,0.0,85.34,75.0,0.0,160.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004303,MBR00000167,Professional,2021-06-26,2021-06-26,2021-07-25,PLN3881,1108115157,1108115157,General Acute Care Hospital,In-Network,I10,Z12.11,,,,,,,0,,99232,E&M,,,,11,Office,2,307.17,241.41,0.0,0.0,50.0,26.64,76.64,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004304,MBR00000167,Professional,2023-03-09,2023-03-09,2023-03-23,PLN9709,1645194539,1645194539,SNF,In-Network,E11.9,I10,,,,,,,0,,99221,E&M,,,,11,Office,1,341.12,135.55,120.55,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004305,MBR00000167,Professional,2022-01-26,2022-01-26,2022-03-07,PLN4054,1266606767,1266606767,ASC,In-Network,M54.5,M17.11,,,,,,,0,,23472,Surgery,,,,21,Inpatient Hospital,3,5209.37,4153.19,4138.19,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004306,MBR00000167,Institutional-IP,2022-09-20,2022-09-23,2022-10-13,PLN4715,1198133277,1198133277,SNF,In-Network,E11.9,E66.9,,,,603,MS-DRG,19,3,N,97530,Medicine,,,0270,21,Inpatient Hospital,2,195.18,58.8,0.0,58.8,15.0,0.0,73.8,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000004307,MBR00000167,Institutional-IP,2022-08-20,2022-08-21,2022-09-16,PLN8887,1745114564,1745114564,Endocrinology,In-Network,I10,N18.3,,,,603,MS-DRG,21,1,Y,85025,Pathology/Lab,,,0740,21,Inpatient Hospital,3,51.33,42.62,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004308,MBR00000168,Institutional-IP,2022-09-11,2022-09-16,2022-10-22,PLN4447,1247341320,1247341320,Urology,Out-of-Network,E66.9,N18.3,,,,292,MS-DRG,23,5,Y,82043,Pathology/Lab,,,0200,21,Inpatient Hospital,3,53.9,20.35,20.35,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004309,MBR00000168,Institutional-OP,2022-07-08,2022-07-08,2022-08-09,PLN3458,1434029575,1434029575,Endocrinology,In-Network,I10,I10,,,,,,,0,,93225,Medicine,,,0120,22,Outpatient Hospital,1,402.06,157.36,142.36,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004310,MBR00000168,Professional,2021-11-26,2021-11-26,2021-12-21,PLN5871,1935547131,1935547131,Pulmonology,In-Network,J44.1,J06.9,,,,,,,0,,99233,E&M,,,,11,Office,2,206.7,85.84,23.65,37.19,25.0,0.0,62.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004311,MBR00000168,Professional,2022-06-22,2022-06-22,2022-07-17,PLN3444,1702692193,1702692193,Physical Therapy,In-Network,E78.5,J44.1,,,,,,,0,,97110,Medicine,,,,11,Office,3,218.5,161.96,0.0,161.96,35.0,0.0,196.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004312,MBR00000168,Professional,2022-08-04,2022-08-04,2022-09-14,PLN3349,1644128543,1644128543,Gastroenterology,In-Network,I10,F41.9,,,,,,,0,,G0439,Medicine,,,,22,Outpatient Hospital,1,365.13,183.15,175.98,0.0,0.0,7.17,7.17,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000004313,MBR00000168,Professional,2021-01-21,2021-01-21,2021-03-04,PLN5699,1561134315,1561134315,DME Supplier,In-Network,Z23,G20,,,,,,,0,,78452,Radiology,,,,50,Federally Qualified Health Center,2,6375.64,3481.36,2791.46,12.11,0.0,677.79,689.9,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004314,MBR00000168,Professional,2023-03-04,2023-03-04,2023-03-27,PLN2677,1433937353,1433937353,Nephrology,In-Network,I10,I48.91,,,,,,,0,,45378,Surgery,,,,11,Office,2,2231.37,1094.8,1094.8,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000004315,MBR00000168,Professional,2022-05-03,2022-05-03,2022-06-14,PLN5336,1198133277,1198133277,SNF,In-Network,Z12.31,N39.0,,,,,,,0,,90686,Medicine,,,,11,Office,1,133.68,68.14,0.0,68.14,0.0,0.0,68.14,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000004316,MBR00000168,Institutional-OP,2021-11-17,2021-11-17,2021-12-22,PLN8859,1717546253,1717546253,Family Medicine,In-Network,J06.9,N18.3,,,,,,,0,,99284,E&M,,,0200,22,Outpatient Hospital,1,613.86,320.86,245.86,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004317,MBR00000168,Professional,2021-02-01,2021-02-01,2021-03-14,PLN6651,1915531927,1915531927,Critical Access Hospital,In-Network,N40.0,K21.0,,,,,,,0,,99214,E&M,,,,81,Independent Laboratory,1,426.52,307.68,0.0,307.68,35.0,0.0,342.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004318,MBR00000168,Institutional-OP,2021-11-30,2021-11-30,2022-01-11,PLN6703,1561134315,1561134315,DME Supplier,In-Network,E78.5,K21.0,,,,,,,0,,99284,E&M,,,0301,22,Outpatient Hospital,2,720.3,440.72,425.72,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004319,MBR00000168,Institutional-OP,2022-03-20,2022-03-20,2022-04-07,PLN8384,1186826716,1186826716,Physical Therapy,In-Network,J20.9,G43.909,,,,,,,0,,43239,Surgery,,,0740,22,Outpatient Hospital,2,2159.43,1583.89,1583.89,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004320,MBR00000168,Professional,2023-07-06,2023-07-06,2023-07-21,PLN6275,1334916761,1334916761,ASC,In-Network,I10,F32.9,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,1,49.96,30.7,0.0,30.7,0.0,0.0,30.7,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004321,MBR00000168,Institutional-OP,2022-12-10,2022-12-10,2023-01-04,PLN4241,1860435061,1860435061,DME Supplier,In-Network,E87.6,I10,,,,,,,0,,23472,Surgery,,,0320,22,Outpatient Hospital,1,6048.47,1995.3,1995.3,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004322,MBR00000168,Institutional-OP,2022-04-04,2022-04-04,2022-05-15,PLN3991,1530904931,1530904931,Internal Medicine,In-Network,J06.9,Z00.01,,,,,,,0,,76700,Radiology,,,0761,22,Outpatient Hospital,3,744.71,577.92,509.01,0.0,15.0,53.91,68.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004323,MBR00000168,Professional,2021-05-18,2021-05-18,2021-06-17,PLN6355,1284035364,1284035364,Pediatrics,In-Network,I10,Z00.00,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,3,3205.23,1334.54,1100.93,218.02,0.0,15.59,233.61,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004324,MBR00000168,Institutional-IP,2021-10-28,2021-10-29,2021-11-13,PLN1655,1847081578,1847081578,Urology,Out-of-Network,J06.9,Z00.00,,,,194,MS-DRG,4,1,Y,99232,E&M,,,0450,21,Inpatient Hospital,3,332.01,147.8,0.0,147.8,0.0,0.0,147.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004325,MBR00000168,Professional,2023-10-01,2023-10-01,2023-10-26,PLN5333,1434029575,1434029575,Endocrinology,In-Network,I11.9,R10.9,,,,,,,0,,99232,E&M,,,,11,Office,2,307.94,162.4,127.4,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004326,MBR00000168,Professional,2021-05-20,2021-05-20,2021-06-03,PLN5941,1872272835,1872272835,Internal Medicine,In-Network,J44.1,F41.9,,,,,,,0,,99221,E&M,,,,11,Office,3,200.07,149.78,149.78,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004327,MBR00000168,Institutional-OP,2022-11-22,2022-11-22,2022-12-25,PLN3183,1990090423,1990090423,Orthopedic Surgery,In-Network,I10,E66.9,,,,,,,0,,80053,Pathology/Lab,,,0730,22,Outpatient Hospital,3,102.17,46.94,46.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004328,MBR00000168,Institutional-IP,2022-07-21,2022-07-29,2022-08-09,PLN9731,1564502315,1564502315,ASC,In-Network,I10,M54.5,,,,871,MS-DRG,5,8,Y,99283,E&M,,,0301,21,Inpatient Hospital,1,639.88,203.27,0.0,0.0,25.0,16.24,41.24,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004329,MBR00000168,Professional,2021-08-27,2021-08-27,2021-09-03,PLN6498,1606140917,1606140917,ASC,In-Network,C50.912,E78.5,,,,,,,0,,27130,Surgery,,,,11,Office,1,7311.24,5505.59,4736.19,0.0,75.0,694.4,769.4,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004330,MBR00000168,Institutional-IP,2023-08-15,2023-08-20,2023-09-20,PLN4040,1266606767,1266606767,ASC,In-Network,K92.1,Z87.891,,,,690,MS-DRG,14,5,Y,71046,Radiology,,,0761,21,Inpatient Hospital,1,322.5,192.3,165.43,26.87,0.0,0.0,26.87,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004331,MBR00000168,Institutional-OP,2022-03-08,2022-03-08,2022-04-12,PLN7434,1500037969,1500037969,Pulmonology,In-Network,Z12.31,F32.9,,,,,,,0,,33533,Surgery,,,0900,22,Outpatient Hospital,3,28875.64,11343.01,11343.01,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000004332,MBR00000168,Professional,2022-12-26,2022-12-26,2023-01-28,PLN7094,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,Z23,R05,,,,,,,0,,71046,Radiology,,,,11,Office,2,264.23,202.09,0.0,202.09,50.0,0.0,252.09,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004333,MBR00000168,Professional,2021-04-17,2021-04-17,2021-05-20,PLN2300,1561134315,1561134315,DME Supplier,In-Network,Z00.00,G43.909,,,,,,,0,,45380,Surgery,,,,49,Independent Clinic,1,2391.46,1878.75,1527.37,0.0,0.0,351.38,351.38,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000004334,MBR00000168,Professional,2023-11-24,2023-11-24,2023-12-09,PLN4404,1540044947,1540044947,Pulmonology,Out-of-Network,I10,N39.0,,,,,,,0,,66984,Surgery,,,,11,Office,2,3375.99,1900.6,1875.6,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004335,MBR00000168,Institutional-OP,2021-01-25,2021-01-25,2021-02-24,PLN4112,1518055405,1518055405,Urology,In-Network,I10,E66.9,,,,,,,0,,70553,Radiology,,,0636,22,Outpatient Hospital,3,3041.98,2332.35,2282.35,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004336,MBR00000168,Professional,2021-12-06,2021-12-06,2022-01-08,PLN4223,1284035364,1284035364,Pediatrics,In-Network,E78.5,N39.0,,,,,,,0,,99213,E&M,,,,22,Outpatient Hospital,3,183.61,93.14,0.0,20.51,75.0,0.0,95.51,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004337,MBR00000168,Professional,2023-09-30,2023-09-30,2023-10-08,PLN7482,1817234602,1817234602,Clinical Laboratory,In-Network,Z00.00,Z23,,,,,,,0,,58661,Surgery,,,,20,Urgent Care,3,4491.52,3541.65,3092.99,0.0,50.0,398.66,448.66,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004338,MBR00000168,Institutional-IP,2022-11-30,2022-12-09,2022-12-08,PLN9178,1198133277,1198133277,SNF,In-Network,Z87.891,I10,,,,683,MS-DRG,5,9,Y,66984,Surgery,,,0360,21,Inpatient Hospital,1,1492.1,707.63,413.83,293.8,0.0,0.0,293.8,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004339,MBR00000168,Professional,2023-01-10,2023-01-10,2023-01-29,PLN9992,1840431511,1840431511,Geriatrics,Out-of-Network,E78.5,J06.9,,,,,,,0,,45380,Surgery,,,,11,Office,1,1878.91,1550.56,1515.56,0.0,35.0,0.0,35.0,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000004340,MBR00000168,Professional,2021-12-11,2021-12-11,2022-01-16,PLN6032,1809014947,1809014947,Urology,In-Network,E78.5,J44.1,,,,,,,0,,90686,Medicine,,,,11,Office,3,133.34,94.63,82.33,0.0,0.0,12.3,12.3,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000004341,MBR00000168,Institutional-OP,2023-05-04,2023-05-04,2023-06-04,PLN4796,1749494482,1749494482,Pediatrics,In-Network,Z12.11,E11.40,,,,,,,0,,97530,Medicine,,,0900,22,Outpatient Hospital,3,274.77,201.99,0.0,201.99,0.0,0.0,201.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004342,MBR00000168,Institutional-OP,2023-10-18,2023-10-18,2023-11-09,PLN2343,1313212303,1313212303,Family Medicine,In-Network,J06.9,J18.9,,,,,,,0,,70553,Radiology,,,0360,22,Outpatient Hospital,3,2842.29,2364.21,1960.18,117.53,0.0,286.5,404.03,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004343,MBR00000168,Professional,2022-11-13,2022-11-13,2022-12-03,PLN5251,1778483301,1778483301,Home Health,In-Network,Z00.00,N18.3,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,2,112.82,78.52,63.52,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004344,MBR00000168,Institutional-OP,2021-08-28,2021-08-28,2021-09-10,PLN4840,1631954542,1631954542,Oncology,In-Network,E78.5,E11.9,,,,,,,0,,90686,Medicine,,,0761,22,Outpatient Hospital,3,87.89,35.25,35.25,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000004345,MBR00000168,Professional,2023-09-20,2023-09-20,2023-10-01,PLN5208,1974006077,1974006077,Orthopedic Surgery,In-Network,F41.9,Z87.891,,,,,,,0,,43239,Surgery,,,,11,Office,1,1914.57,1504.64,1475.72,28.92,0.0,0.0,28.92,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004346,MBR00000168,Professional,2021-01-05,2021-01-05,2021-02-02,PLN3667,1991459367,1991459367,Neurology,Out-of-Network,F41.9,F32.9,,,,,,,0,,45380,Surgery,,,,23,Emergency Room,2,1675.82,1032.6,997.6,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,1,0,0,0
CLM0000004347,MBR00000168,Professional,2023-09-09,2023-09-09,2023-10-15,PLN2820,1624202402,1624202402,Orthopedic Surgery,In-Network,F41.9,I50.9,,,,,,,0,,45380,Surgery,,,,11,Office,2,2090.49,1642.39,0.0,414.97,0.0,0.0,414.97,0.0,Denied,PR-1,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000004348,MBR00000168,Professional,2021-01-11,2021-01-11,2021-02-20,PLN2422,1235381502,1235381502,Cardiology,In-Network,J06.9,M54.5,,,,,,,0,,90686,Medicine,,,,11,Office,2,76.85,34.07,0.0,0.0,75.0,0.0,75.0,0.0,Pended,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000004349,MBR00000168,Institutional-IP,2021-03-05,2021-03-09,2021-03-20,PLN6540,1366576336,1366576336,Geriatrics,In-Network,N39.0,F41.9,,,,683,MS-DRG,14,4,Y,78452,Radiology,,,0360,21,Inpatient Hospital,3,6463.01,2571.19,2285.8,260.39,25.0,0.0,285.39,0.0,Paid,,,1,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000004350,MBR00000168,Professional,2021-02-16,2021-02-16,2021-03-01,PLN5084,1561134315,1561134315,DME Supplier,In-Network,I63.9,F32.9,,,,,,,0,,70553,Radiology,,,,11,Office,3,4646.87,1436.97,1436.97,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004351,MBR00000169,Professional,2021-07-27,2021-07-27,2021-09-02,PLN7235,1245650222,1245650222,Gastroenterology,In-Network,J06.9,M54.5,,,,,,,0,,66984,Surgery,,,,11,Office,3,1473.87,895.51,0.0,147.39,25.0,53.83,226.22,0.0,Denied,CO-15,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004352,MBR00000169,Institutional-OP,2023-03-08,2023-03-08,2023-04-21,PLN7212,1463205530,1463205530,Nephrology,In-Network,N39.0,J20.9,,,,,,,0,,70553,Radiology,,,0301,22,Outpatient Hospital,1,3013.6,1040.22,1008.04,0.0,0.0,32.18,32.18,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000004353,MBR00000169,Professional,2022-03-10,2022-03-10,2022-04-15,PLN9854,1239316214,1239316214,Internal Medicine,In-Network,K92.1,Z23,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,3,506.96,323.28,22.13,226.15,75.0,0.0,301.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004354,MBR00000169,Professional,2021-03-28,2021-03-28,2021-04-24,PLN4353,1609138981,1609138981,Critical Access Hospital,In-Network,E78.5,Z12.31,,,,,,,0,,43239,Surgery,,,,11,Office,2,1276.81,684.54,609.27,0.0,15.0,60.27,75.27,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004355,MBR00000169,Professional,2022-01-09,2022-01-09,2022-01-22,PLN9538,1561134315,1561134315,DME Supplier,In-Network,I10,I10,,,,,,,0,,99204,E&M,,,,11,Office,1,292.25,241.73,191.73,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004356,MBR00000169,Institutional-OP,2023-12-29,2023-12-29,2024-02-07,PLN1474,1268679390,1268679390,Critical Access Hospital,In-Network,E78.5,F41.9,,,,,,,0,,99221,E&M,,,0900,22,Outpatient Hospital,3,178.21,70.82,70.82,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004357,MBR00000169,Professional,2022-07-30,2022-07-30,2022-08-18,PLN8780,1752470395,1752470395,Home Health,In-Network,F32.9,Z12.31,,,,,,,0,,99232,E&M,,,,11,Office,2,266.31,145.77,137.54,0.0,0.0,8.23,8.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004358,MBR00000169,Professional,2023-03-10,2023-03-10,2023-04-09,PLN8523,1585582070,1585582070,Outpatient Clinic,In-Network,F03.90,M54.5,,,,,,,0,,99214,E&M,,,,11,Office,1,264.08,219.54,68.61,150.93,0.0,0.0,150.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004359,MBR00000169,Institutional-OP,2021-10-19,2021-10-19,2021-11-02,PLN1573,1644128543,1644128543,Gastroenterology,In-Network,S72.001A,M17.11,,,,,,,0,,47562,Surgery,,,0120,22,Outpatient Hospital,3,2391.13,1818.53,0.0,0.0,0.0,171.13,171.13,0.0,Denied,CO-15,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004360,MBR00000169,Professional,2022-07-25,2022-07-25,2022-08-19,PLN5784,1585582070,1585582070,Outpatient Clinic,In-Network,C50.912,F32.9,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,3,465.84,210.22,210.22,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004361,MBR00000169,Institutional-OP,2023-05-24,2023-05-24,2023-06-18,PLN9806,1571574052,1571574052,Critical Access Hospital,In-Network,M54.5,N39.0,,,,,,,0,,45378,Surgery,,,0740,22,Outpatient Hospital,2,2013.68,1648.17,1600.71,47.46,0.0,0.0,47.46,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000004362,MBR00000169,Institutional-IP,2023-01-09,2023-01-15,2023-02-09,PLN5033,1528335731,1528335731,Critical Access Hospital,In-Network,Z23,E11.65,,,,195,MS-DRG,17,6,N,23472,Surgery,,,0450,21,Inpatient Hospital,3,7484.25,5615.45,0.0,388.93,0.0,0.0,388.93,0.0,Denied,CO-4,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004363,MBR00000169,Institutional-OP,2021-01-09,2021-01-09,2021-01-17,PLN3971,1410468316,1410468316,SNF,In-Network,E78.5,I10,,,,,,,0,,99222,E&M,,,0270,22,Outpatient Hospital,2,427.17,139.95,0.0,139.95,0.0,0.0,139.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004364,MBR00000169,Professional,2022-10-27,2022-10-27,2022-11-24,PLN7500,1689639685,1689639685,SNF,In-Network,J06.9,E11.9,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,2,4472.17,1616.47,1616.47,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004365,MBR00000169,Institutional-OP,2023-05-17,2023-05-17,2023-06-27,PLN9888,1980712759,1980712759,Outpatient Clinic,Out-of-Network,E11.40,E78.5,,,,,,,0,,27447,Surgery,,,0360,22,Outpatient Hospital,2,2828.71,2079.42,1719.85,163.87,15.0,180.7,359.57,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004366,MBR00000169,Professional,2021-05-29,2021-05-29,2021-06-22,PLN6899,1563980627,1563980627,Critical Access Hospital,In-Network,Z12.31,E11.9,,,,,,,0,,G0468,Medicine,,,,20,Urgent Care,1,620.6,485.08,99.08,361.0,25.0,0.0,386.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004367,MBR00000169,Professional,2022-03-07,2022-03-07,2022-04-06,PLN6636,1450094833,1450094833,Outpatient Clinic,In-Network,F32.9,E78.5,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,2,910.59,724.08,674.08,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000004368,MBR00000169,Institutional-OP,2022-12-08,2022-12-08,2022-12-19,PLN6250,1780163051,1780163051,SNF,In-Network,M54.5,K57.30,,,,,,,0,,99204,E&M,,,0730,22,Outpatient Hospital,3,567.01,383.17,358.17,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004369,MBR00000169,Professional,2021-01-06,2021-01-06,2021-01-17,PLN1105,1295371663,1295371663,Critical Access Hospital,In-Network,I48.91,I10,,,,,,,0,,78452,Radiology,,,,22,Outpatient Hospital,2,3684.24,2303.03,1539.45,489.66,0.0,273.92,763.58,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004370,MBR00000169,Professional,2023-02-18,2023-02-18,2023-03-26,PLN1453,1361302520,1361302520,Critical Access Hospital,In-Network,I25.10,Z23,,,,,,,0,,90460,Medicine,,,,11,Office,3,32.75,20.87,5.87,0.0,15.0,0.0,15.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004371,MBR00000170,Institutional-IP,2023-07-17,2023-07-25,2023-08-20,PLN5179,1236418230,1236418230,DME Supplier,In-Network,Z12.31,F03.90,,,,871,MS-DRG,22,8,Y,G0444,Medicine,,,0510,21,Inpatient Hospital,3,74.75,37.64,0.0,37.64,0.0,0.0,37.64,0.0,Paid,,,0,,0,1,0,0,1,1,Upcoding,0,0,0,0,1
CLM0000004372,MBR00000170,Professional,2022-07-31,2022-07-31,2022-08-07,PLN1120,1860435061,1860435061,DME Supplier,In-Network,M17.11,J20.9,,,,,,,0,,58661,Surgery,,,,11,Office,3,3641.61,3053.35,2905.15,113.2,35.0,0.0,148.2,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004373,MBR00000170,Professional,2022-05-05,2022-05-05,2022-06-07,PLN4902,1845057593,1845057593,Orthopedic Surgery,In-Network,F41.9,I11.9,,,,,,,0,,99214,E&M,,,,11,Office,3,355.74,248.64,0.0,248.64,0.0,0.0,248.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004374,MBR00000170,Professional,2021-04-11,2021-04-11,2021-04-18,PLN7023,1752470395,1752470395,Home Health,In-Network,N18.3,I10,,,,,,,0,,77067,Radiology,,,,31,Skilled Nursing Facility,2,432.59,189.26,170.72,0.0,15.0,3.54,18.54,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000004375,MBR00000170,Professional,2023-03-05,2023-03-05,2023-04-16,PLN9903,1500949740,1500949740,Pediatrics,In-Network,Z12.31,N40.0,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,3,231.83,175.86,0.0,74.73,0.0,18.57,93.3,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004376,MBR00000170,Institutional-IP,2023-10-30,2023-11-02,2023-11-20,PLN7847,1778483301,1778483301,Home Health,In-Network,F32.9,E66.9,,,,196,MS-DRG,21,3,Y,77067,Radiology,,,0120,21,Inpatient Hospital,1,338.71,153.01,128.01,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000004377,MBR00000170,Institutional-OP,2023-08-20,2023-08-20,2023-09-08,PLN3670,1530904931,1530904931,Internal Medicine,In-Network,N39.0,Z12.11,,,,,,,0,,27130,Surgery,,,0370,22,Outpatient Hospital,1,7281.29,5953.01,0.0,0.0,0.0,1188.62,1188.62,0.0,Denied,CO-4,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004378,MBR00000170,Professional,2022-08-25,2022-08-25,2022-09-15,PLN6790,1295371663,1295371663,Critical Access Hospital,In-Network,I10,I10,,,,,,,0,,43239,Surgery,,,,23,Emergency Room,3,1493.3,985.48,626.73,346.79,0.0,11.96,358.75,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004379,MBR00000170,Professional,2021-02-07,2021-02-07,2021-02-23,PLN4639,1974006077,1974006077,Orthopedic Surgery,In-Network,N18.3,N39.0,,,,,,,0,,33533,Surgery,,,,11,Office,1,14880.84,7171.53,7096.53,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000004380,MBR00000170,Professional,2021-11-10,2021-11-10,2021-12-13,PLN2754,1193493783,1193493783,Critical Access Hospital,Out-of-Network,R05,E78.5,,,,,,,0,,99284,E&M,,,,21,Inpatient Hospital,2,685.02,386.75,386.75,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004381,MBR00000170,Professional,2021-10-15,2021-10-15,2021-11-21,PLN8608,1545347862,1545347862,SNF,In-Network,Z00.00,N18.3,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,2,17966.99,9624.78,9568.23,56.55,0.0,0.0,56.55,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000004382,MBR00000170,Professional,2021-01-09,2021-01-09,2021-01-27,PLN9898,1717546253,1717546253,Family Medicine,In-Network,E11.9,Z12.31,,,,,,,0,,85610,Pathology/Lab,,,,20,Urgent Care,2,31.12,22.82,0.0,22.82,0.0,0.0,22.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004383,MBR00000170,Institutional-IP,2021-05-11,2021-05-22,2021-06-03,PLN3130,1687650653,1687650653,Internal Medicine,In-Network,J06.9,F41.9,,,,196,MS-DRG,9,11,Y,78452,Radiology,,,0370,21,Inpatient Hospital,3,3647.13,1907.28,1872.28,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004384,MBR00000170,Professional,2022-09-22,2022-09-22,2022-10-29,PLN4267,1433937353,1433937353,Nephrology,In-Network,N39.0,Z00.00,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,2,479.35,349.55,334.55,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004385,MBR00000170,Institutional-OP,2021-04-18,2021-04-18,2021-04-25,PLN4650,1114982472,1114982472,Orthopedic Surgery,In-Network,I50.9,Z23,,,,,,,0,,93000,Radiology,,,0120,22,Outpatient Hospital,2,167.35,98.28,83.28,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004386,MBR00000170,Professional,2021-02-12,2021-02-12,2021-03-08,PLN8188,1109850785,1109850785,ASC,Out-of-Network,K21.0,E66.9,,,,,,,0,,58661,Surgery,,,,11,Office,1,3200.6,2601.93,2601.93,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004387,MBR00000170,Professional,2023-11-02,2023-11-02,2023-12-05,PLN6386,1540044947,1540044947,Pulmonology,Out-of-Network,F41.9,F41.9,,,,,,,0,,99283,E&M,,,,21,Inpatient Hospital,1,451.58,298.8,0.0,298.8,0.0,0.0,298.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004388,MBR00000170,Professional,2022-10-25,2022-10-25,2022-12-04,PLN9521,1845057593,1845057593,Orthopedic Surgery,In-Network,Z12.11,S72.001A,,,,,,,0,,99204,E&M,,,,23,Emergency Room,2,377.96,196.58,37.02,159.56,0.0,0.0,159.56,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004389,MBR00000170,Professional,2023-06-02,2023-06-02,2023-06-14,PLN9996,1364429278,1364429278,OB/GYN,In-Network,J06.9,Z12.31,,,,,,,0,,97110,Medicine,,,,21,Inpatient Hospital,3,134.83,74.78,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004390,MBR00000170,Institutional-IP,2021-09-30,2021-10-04,2021-10-17,PLN8983,1245650222,1245650222,Gastroenterology,In-Network,Z79.4,G43.909,,,,682,MS-DRG,20,4,Y,93306,Radiology,,,0270,21,Inpatient Hospital,3,2088.09,1411.29,1391.49,19.8,0.0,0.0,19.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004391,MBR00000170,Institutional-IP,2022-02-04,2022-02-06,2022-03-11,PLN5666,1236418230,1236418230,DME Supplier,In-Network,E66.9,Z12.31,,,,292,MS-DRG,22,2,Y,99233,E&M,,,0450,21,Inpatient Hospital,2,362.37,270.25,180.7,89.55,0.0,0.0,89.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004392,MBR00000170,Institutional-OP,2022-10-31,2022-10-31,2022-12-05,PLN3902,1847081578,1847081578,Urology,Out-of-Network,Z12.31,I10,,,,,,,0,,23472,Surgery,,,0120,22,Outpatient Hospital,1,6392.87,2974.21,2974.21,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004393,MBR00000170,Professional,2023-01-23,2023-01-23,2023-02-09,PLN7628,1990090423,1990090423,Orthopedic Surgery,In-Network,Z00.00,M81.0,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,1,248.81,100.37,82.69,0.0,0.0,17.68,17.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004394,MBR00000170,Professional,2022-02-08,2022-02-08,2022-03-20,PLN1451,1266606767,1266606767,ASC,In-Network,N20.0,Z00.00,,,,,,,0,,99222,E&M,,,,49,Independent Clinic,2,337.72,150.57,150.57,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004395,MBR00000170,Institutional-OP,2023-10-04,2023-10-04,2023-11-06,PLN8132,1284035364,1284035364,Pediatrics,In-Network,J06.9,M54.5,,,,,,,0,,90837,Medicine,,,0636,22,Outpatient Hospital,3,376.7,198.17,198.17,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004396,MBR00000170,Institutional-OP,2023-02-10,2023-02-10,2023-03-03,PLN4714,1745114564,1745114564,Endocrinology,In-Network,K21.0,R10.9,,,,,,,0,,99406,Medicine,,,0360,22,Outpatient Hospital,2,51.06,18.18,0.0,18.18,25.0,0.0,43.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004397,MBR00000170,Professional,2021-08-30,2021-08-30,2021-09-21,PLN2958,1109850785,1109850785,ASC,Out-of-Network,Z00.00,I10,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,1,39.96,33.75,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000004398,MBR00000170,Professional,2021-04-18,2021-04-18,2021-05-20,PLN8025,1372918899,1372918899,Family Medicine,In-Network,C50.912,B97.89,,,,,,,0,,99221,E&M,,,,31,Skilled Nursing Facility,1,303.52,147.76,0.0,147.76,25.0,0.0,172.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004399,MBR00000170,Professional,2021-01-16,2021-01-16,2021-02-09,PLN6648,1817234602,1817234602,Clinical Laboratory,In-Network,J06.9,I10,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,1,266.01,224.3,0.0,224.3,50.0,0.0,274.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004400,MBR00000170,Professional,2023-07-14,2023-07-14,2023-08-04,PLN7318,1242201429,1242201429,General Acute Care Hospital,In-Network,I25.10,E11.9,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,3,259.25,185.37,185.37,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004401,MBR00000170,Institutional-IP,2023-06-22,2023-06-24,2023-08-04,PLN7679,1245650222,1245650222,Gastroenterology,In-Network,Z00.00,J44.1,,,,603,MS-DRG,14,2,Y,99232,E&M,,,0636,21,Inpatient Hospital,1,294.19,110.18,95.18,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004402,MBR00000170,Professional,2022-06-09,2022-06-09,2022-07-23,PLN8708,1463205530,1463205530,Nephrology,In-Network,I10,Z00.00,,,,,,,0,,90686,Medicine,,,,21,Inpatient Hospital,2,124.76,51.94,0.0,51.94,35.0,0.0,86.94,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000004403,MBR00000170,Institutional-OP,2023-03-03,2023-03-03,2023-03-23,PLN2880,1687650653,1687650653,Internal Medicine,In-Network,E66.9,Z87.891,,,,,,,0,,99204,E&M,,,0636,22,Outpatient Hospital,2,389.13,216.94,0.0,216.94,0.0,0.0,216.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004404,MBR00000170,Professional,2023-08-26,2023-08-26,2023-09-21,PLN9170,1450553056,1450553056,Clinical Laboratory,In-Network,N39.0,R05,,,,,,,0,,85610,Pathology/Lab,,,,22,Outpatient Hospital,3,27.07,18.65,0.0,18.65,0.0,0.0,18.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004405,MBR00000170,Institutional-OP,2021-06-25,2021-06-25,2021-07-28,PLN5519,1939033455,1939033455,Pulmonology,In-Network,I48.91,J06.9,,,,,,,0,,45378,Surgery,,,0370,22,Outpatient Hospital,3,2058.19,1310.68,1235.68,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000004406,MBR00000170,Professional,2023-12-10,2023-12-10,2023-12-21,PLN7386,1540044947,1540044947,Pulmonology,Out-of-Network,I10,N18.3,,,,,,,0,,82043,Pathology/Lab,,,,31,Skilled Nursing Facility,1,44.77,28.3,0.0,28.3,25.0,0.0,53.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004407,MBR00000170,Institutional-IP,2022-06-21,2022-06-25,2022-06-30,PLN5438,1845057593,1845057593,Orthopedic Surgery,In-Network,J06.9,J06.9,,,,194,MS-DRG,1,4,Y,81001,Pathology/Lab,,,0270,21,Inpatient Hospital,3,40.48,27.9,0.0,27.9,0.0,0.0,27.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004408,MBR00000170,Institutional-OP,2022-04-25,2022-04-25,2022-05-15,PLN2927,1366426662,1366426662,Urology,In-Network,S72.001A,G43.909,,,,,,,0,,99233,E&M,,,0360,22,Outpatient Hospital,1,543.52,273.02,252.78,0.0,15.0,5.24,20.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004409,MBR00000170,Professional,2021-06-25,2021-06-25,2021-07-10,PLN8361,1840431511,1840431511,Geriatrics,Out-of-Network,I25.10,N39.0,,,,,,,0,,45378,Surgery,,,,11,Office,3,1626.87,1043.57,1043.57,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000004410,MBR00000170,Professional,2023-01-07,2023-01-07,2023-01-27,PLN8879,1609526529,1609526529,Psychiatry,In-Network,K21.0,F32.9,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,2,2938.49,2391.95,2356.95,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000004411,MBR00000170,Professional,2022-10-22,2022-10-22,2022-12-04,PLN2324,1198133277,1198133277,SNF,In-Network,E11.9,Z00.00,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,2,209.85,63.92,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004412,MBR00000170,Professional,2021-02-02,2021-02-02,2021-02-15,PLN9386,1213165847,1213165847,Critical Access Hospital,In-Network,J20.9,K21.0,,,,,,,0,,99203,E&M,,,,49,Independent Clinic,2,321.2,221.15,206.15,0.0,15.0,0.0,15.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004413,MBR00000170,Institutional-OP,2022-12-11,2022-12-11,2022-12-27,PLN9591,1780163051,1780163051,SNF,In-Network,I50.9,F32.9,,,,,,,0,,85610,Pathology/Lab,,,0761,22,Outpatient Hospital,2,48.35,22.71,0.0,22.71,0.0,0.0,22.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004414,MBR00000170,Institutional-IP,2021-06-04,2021-06-08,2021-06-28,PLN2388,1644128543,1644128543,Gastroenterology,In-Network,I10,J06.9,,,,603,MS-DRG,4,4,Y,66984,Surgery,,,0636,21,Inpatient Hospital,2,3529.11,2790.12,2259.34,495.78,35.0,0.0,530.78,0.0,Paid,,,1,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000004415,MBR00000170,Institutional-OP,2021-10-30,2021-10-30,2021-11-08,PLN3772,1896447406,1896447406,Nephrology,Out-of-Network,Z23,F41.9,,,,,,,0,,66984,Surgery,,,0510,22,Outpatient Hospital,2,3047.16,2421.56,2421.56,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004416,MBR00000170,Professional,2022-11-01,2022-11-01,2022-11-25,PLN7340,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,Z00.00,J06.9,,,,,,,0,,76700,Radiology,,,,11,Office,3,749.9,230.01,178.83,0.0,15.0,36.18,51.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004417,MBR00000170,Institutional-OP,2023-05-06,2023-05-06,2023-06-05,PLN6745,1244186984,1244186984,Family Medicine,Out-of-Network,Z12.11,E11.9,,,,,,,0,,27130,Surgery,,,0200,22,Outpatient Hospital,2,4725.85,3947.71,3429.47,0.0,0.0,518.24,518.24,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004418,MBR00000170,Institutional-IP,2021-05-27,2021-06-01,2021-06-24,PLN7824,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,Z96.641,I10,,,,683,MS-DRG,5,5,Y,87491,Pathology/Lab,,,0360,21,Inpatient Hospital,3,248.46,75.72,21.64,0.0,50.0,4.08,54.08,0.0,Adjusted,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000004419,MBR00000170,Professional,2022-06-03,2022-06-03,2022-07-02,PLN3256,1500037969,1500037969,Pulmonology,In-Network,Z12.31,E11.9,,,,,,,0,,99213,E&M,,,,11,Office,2,259.33,144.36,114.86,0.0,25.0,4.5,29.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004420,MBR00000170,Institutional-OP,2021-11-09,2021-11-09,2021-12-19,PLN2444,1528335731,1528335731,Critical Access Hospital,In-Network,E66.9,I10,,,,,,,0,,99283,E&M,,,0730,22,Outpatient Hospital,3,589.5,229.03,0.0,229.03,50.0,0.0,279.03,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004421,MBR00000171,Professional,2023-02-13,2023-02-13,2023-02-23,PLN3423,1125190055,1125190055,Nephrology,In-Network,N39.0,Z00.00,,,,,,,0,,90837,Medicine,,,,11,Office,2,289.74,178.3,0.0,178.3,0.0,0.0,178.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004422,MBR00000171,Professional,2023-06-26,2023-06-26,2023-08-06,PLN5117,1991459367,1991459367,Neurology,Out-of-Network,Z12.11,I50.9,,,,,,,0,,93225,Medicine,,,,11,Office,3,841.15,468.38,65.4,402.98,0.0,0.0,402.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004423,MBR00000171,Institutional-OP,2022-12-02,2022-12-02,2023-01-11,PLN7230,1717912431,1717912431,Oncology,In-Network,F32.9,Z12.31,,,,,,,0,,99213,E&M,,,0360,22,Outpatient Hospital,3,143.83,73.34,55.51,0.0,15.0,2.83,17.83,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004424,MBR00000171,Professional,2023-05-21,2023-05-21,2023-06-03,PLN9555,1991459367,1991459367,Neurology,Out-of-Network,E11.9,M54.5,,,,,,,0,,70450,Radiology,,,,11,Office,2,1644.12,1309.28,1309.28,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004425,MBR00000171,Professional,2022-05-09,2022-05-09,2022-06-12,PLN5454,1247341320,1247341320,Urology,Out-of-Network,Z51.11,K21.0,,,,,,,0,,87491,Pathology/Lab,,,,20,Urgent Care,1,184.25,104.02,69.02,0.0,35.0,0.0,35.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004426,MBR00000171,Professional,2022-10-17,2022-10-17,2022-11-01,PLN9095,1198133277,1198133277,SNF,In-Network,R10.9,Z87.891,,,,,,,0,,99233,E&M,,,,21,Inpatient Hospital,3,218.75,86.36,84.81,0.0,0.0,1.55,1.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004427,MBR00000171,Institutional-OP,2021-11-17,2021-11-17,2021-12-04,PLN8447,1530904931,1530904931,Internal Medicine,In-Network,N39.0,Z12.31,,,,,,,0,,99233,E&M,,,0510,22,Outpatient Hospital,2,300.26,199.21,109.84,88.96,0.0,0.41,89.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004428,MBR00000171,Professional,2023-12-19,2023-12-19,2024-01-15,PLN9519,1713934949,1713934949,Neurology,In-Network,E78.5,E87.6,,,,,,,0,,78452,Radiology,,,,11,Office,1,4922.15,2784.16,2746.29,0.0,0.0,37.87,37.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004429,MBR00000171,Professional,2021-08-12,2021-08-12,2021-08-29,PLN1612,1896447406,1896447406,Nephrology,Out-of-Network,I48.91,Z12.31,,,,,,,0,,86900,Pathology/Lab,,,,49,Independent Clinic,2,42.96,17.94,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004430,MBR00000171,Professional,2023-10-06,2023-10-06,2023-10-26,PLN5922,1795618275,1795618275,Pulmonology,In-Network,Z12.31,F32.9,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,3,52.31,22.05,22.05,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004431,MBR00000171,Professional,2023-03-28,2023-03-28,2023-05-05,PLN6797,1450553056,1450553056,Clinical Laboratory,In-Network,E66.9,E66.9,,,,,,,0,,99232,E&M,,,,11,Office,2,284.22,208.46,108.9,0.0,75.0,24.56,99.56,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000004432,MBR00000171,Professional,2023-12-17,2023-12-17,2023-12-26,PLN8822,1806688928,1806688928,Geriatrics,In-Network,G20,E78.5,,,,,,,0,,72148,Radiology,,,,11,Office,3,2557.2,2077.67,1756.99,320.68,0.0,0.0,320.68,0.0,Paid,,,1,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000004433,MBR00000171,Institutional-OP,2022-12-04,2022-12-04,2022-12-29,PLN9583,1910255109,1910255109,DME Supplier,In-Network,Z23,J45.20,,,,,,,0,,99213,E&M,,,0900,22,Outpatient Hospital,1,291.6,171.1,104.47,0.0,50.0,16.63,66.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004434,MBR00000172,Institutional-OP,2022-01-21,2022-01-21,2022-01-29,PLN7792,1148984206,1148984206,Psychiatry,In-Network,Z00.00,Z87.891,,,,,,,0,,93306,Radiology,,,0730,22,Outpatient Hospital,1,2466.76,1664.78,1664.78,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004435,MBR00000172,Institutional-OP,2021-11-04,2021-11-04,2021-12-06,PLN8235,1691062876,1691062876,SNF,In-Network,Z00.00,J06.9,,,,,,,0,,45378,Surgery,,,0301,22,Outpatient Hospital,2,1272.28,469.47,375.78,0.0,0.0,93.69,93.69,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000004436,MBR00000172,Institutional-OP,2021-07-16,2021-07-16,2021-08-26,PLN2707,1530904931,1530904931,Internal Medicine,In-Network,E11.40,Z12.31,,,,,,,0,,70450,Radiology,,,0120,22,Outpatient Hospital,3,1407.74,771.58,547.24,149.34,75.0,0.0,224.34,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004437,MBR00000172,Professional,2023-11-25,2023-11-25,2023-12-20,PLN4066,1946680931,1946680931,Critical Access Hospital,Out-of-Network,I48.91,E66.9,,,,,,,0,,66984,Surgery,,,,11,Office,1,2317.66,1278.98,1253.98,0.0,25.0,0.0,25.0,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004438,MBR00000172,Professional,2021-04-27,2021-04-27,2021-05-26,PLN1521,1186826716,1186826716,Physical Therapy,In-Network,J06.9,I63.9,,,,,,,0,,66984,Surgery,,,,21,Inpatient Hospital,2,1445.18,555.47,505.47,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004439,MBR00000172,Professional,2023-06-07,2023-06-07,2023-07-21,PLN1163,1689639685,1689639685,SNF,In-Network,K57.30,J44.1,,,,,,,0,,58661,Surgery,,,,11,Office,1,3214.49,1012.52,962.52,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004440,MBR00000172,Professional,2023-02-04,2023-02-04,2023-02-28,PLN2959,1991459367,1991459367,Neurology,Out-of-Network,K57.30,J06.9,,,,,,,0,,99204,E&M,,,,12,Home,1,520.73,348.96,0.0,348.96,50.0,0.0,398.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004441,MBR00000172,Institutional-IP,2021-05-19,2021-05-23,2021-07-02,PLN9946,1545347862,1545347862,SNF,In-Network,R05,J20.9,,,,641,MS-DRG,2,4,Y,99232,E&M,,,0636,21,Inpatient Hospital,2,253.24,127.4,127.4,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004442,MBR00000172,Professional,2023-09-30,2023-09-30,2023-10-31,PLN9078,1247341320,1247341320,Urology,Out-of-Network,F32.9,Z00.00,,,,,,,0,,70450,Radiology,,,,22,Outpatient Hospital,3,1061.65,540.89,540.89,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004443,MBR00000172,Institutional-OP,2021-06-28,2021-06-28,2021-08-07,PLN4763,1550154147,1550154147,Outpatient Clinic,In-Network,E66.9,E78.5,,,,,,,0,,99283,E&M,,,0636,22,Outpatient Hospital,2,304.79,251.21,0.0,251.21,15.0,0.0,266.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004444,MBR00000172,Professional,2021-06-26,2021-06-26,2021-08-05,PLN1930,1727809972,1727809972,Home Health,In-Network,Z00.00,N20.0,,,,,,,0,,58661,Surgery,,,,12,Home,2,3470.66,1368.18,1092.24,106.06,0.0,169.88,275.94,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004445,MBR00000172,Professional,2022-08-19,2022-08-19,2022-09-25,PLN6264,1645194539,1645194539,SNF,In-Network,I10,E11.9,,,,,,,0,,99284,E&M,,,,11,Office,2,474.1,350.87,114.18,217.68,0.0,19.01,236.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004446,MBR00000172,Institutional-OP,2021-04-23,2021-04-23,2021-04-30,PLN2311,1717546253,1717546253,Family Medicine,In-Network,J44.1,M17.11,,,,,,,0,,99204,E&M,,,0320,22,Outpatient Hospital,2,446.47,354.6,329.6,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004447,MBR00000172,Professional,2021-04-23,2021-04-23,2021-05-06,PLN4888,1125190055,1125190055,Nephrology,In-Network,Z12.31,I10,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,1,157.9,111.61,0.0,111.61,0.0,0.0,111.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004448,MBR00000172,Professional,2022-11-15,2022-11-15,2022-12-25,PLN1084,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,Z00.00,I50.9,,,,,,,0,,99214,E&M,,,,81,Independent Laboratory,3,274.3,133.8,0.0,133.8,0.0,0.0,133.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004449,MBR00000172,Professional,2023-11-22,2023-11-22,2023-12-02,PLN4537,1896447406,1896447406,Nephrology,Out-of-Network,I10,E78.5,,,,,,,0,,82043,Pathology/Lab,,,,49,Independent Clinic,2,64.84,32.55,0.0,32.55,50.0,0.0,82.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004450,MBR00000172,Professional,2021-02-28,2021-02-28,2021-03-11,PLN9625,1968299309,1968299309,Internal Medicine,In-Network,E78.5,J06.9,,,,,,,0,,72148,Radiology,,,,22,Outpatient Hospital,3,1076.25,404.25,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-11,,1,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000004451,MBR00000172,Professional,2022-11-30,2022-11-30,2022-12-16,PLN6799,1366286000,1366286000,SNF,In-Network,F41.9,F32.9,,,,,,,0,,99232,E&M,,,,11,Office,1,164.47,53.48,0.0,53.48,35.0,0.0,88.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004452,MBR00000172,Institutional-OP,2022-10-21,2022-10-21,2022-10-28,PLN9026,1865904917,1865904917,Outpatient Clinic,In-Network,R51,E66.9,,,,,,,0,,99213,E&M,,,0450,22,Outpatient Hospital,3,325.88,148.06,0.0,148.06,0.0,0.0,148.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004453,MBR00000172,Institutional-OP,2021-03-14,2021-03-14,2021-04-14,PLN5176,1939033455,1939033455,Pulmonology,In-Network,E78.5,E66.9,,,,,,,0,,99232,E&M,,,0370,22,Outpatient Hospital,2,140.32,67.39,0.0,67.39,0.0,0.0,67.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004454,MBR00000172,Institutional-OP,2021-06-13,2021-06-13,2021-06-23,PLN5802,1334916761,1334916761,ASC,In-Network,F32.9,J06.9,,,,,,,0,,84443,Pathology/Lab,,,0636,22,Outpatient Hospital,1,153.51,61.29,46.29,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004455,MBR00000173,Institutional-OP,2022-05-01,2022-05-01,2022-05-21,PLN2229,1540044947,1540044947,Pulmonology,Out-of-Network,E66.9,J44.1,,,,,,,0,,99283,E&M,,,0450,22,Outpatient Hospital,3,375.3,275.45,204.6,0.0,25.0,45.85,70.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004456,MBR00000173,Professional,2023-01-30,2023-01-30,2023-03-08,PLN8717,1571574052,1571574052,Critical Access Hospital,In-Network,E66.9,J06.9,,,,,,,0,,90686,Medicine,,,,11,Office,1,78.31,47.35,0.0,47.35,75.0,0.0,122.35,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000004457,MBR00000173,Institutional-OP,2021-09-01,2021-09-01,2021-09-17,PLN5726,1511044648,1511044648,Endocrinology,In-Network,J06.9,E78.5,,,,,,,0,,70450,Radiology,,,0301,22,Outpatient Hospital,1,1475.85,570.99,478.37,0.0,50.0,42.62,92.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004458,MBR00000173,Professional,2022-04-21,2022-04-21,2022-05-07,PLN5421,1606140917,1606140917,ASC,In-Network,E11.65,K21.0,,,,,,,0,,93225,Medicine,,,,21,Inpatient Hospital,2,897.07,296.54,0.0,296.54,25.0,0.0,321.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004459,MBR00000173,Professional,2022-06-22,2022-06-22,2022-07-15,PLN8646,1575695214,1575695214,SNF,In-Network,N17.9,E11.9,,,,,,,0,,99213,E&M,,,,21,Inpatient Hospital,1,209.26,175.23,175.23,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004460,MBR00000173,Institutional-OP,2023-02-19,2023-02-19,2023-04-04,PLN8664,1355166277,1355166277,Endocrinology,In-Network,E66.9,J06.9,,,,,,,0,,90837,Medicine,,,0360,22,Outpatient Hospital,3,180.06,115.71,115.71,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004461,MBR00000173,Professional,2021-09-28,2021-09-28,2021-11-08,PLN9308,1631954542,1631954542,Oncology,In-Network,J06.9,I10,,,,,,,0,,G0439,Medicine,,,,20,Urgent Care,2,598.22,181.87,0.0,181.87,0.0,0.0,181.87,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000004462,MBR00000173,Professional,2023-01-25,2023-01-25,2023-02-09,PLN2198,1689639685,1689639685,SNF,In-Network,I50.9,I25.10,,,,,,,0,,99204,E&M,,,,31,Skilled Nursing Facility,3,555.9,248.86,201.36,0.0,0.0,47.5,47.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004463,MBR00000173,Institutional-OP,2023-06-30,2023-06-30,2023-08-04,PLN4666,1946680931,1946680931,Critical Access Hospital,Out-of-Network,I50.9,K92.1,,,,,,,0,,97110,Medicine,,,0450,22,Outpatient Hospital,3,217.83,144.41,0.0,144.41,0.0,0.0,144.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004464,MBR00000173,Professional,2022-10-01,2022-10-01,2022-11-11,PLN6037,1410468316,1410468316,SNF,In-Network,E11.9,R07.9,,,,,,,0,,43239,Surgery,,,,11,Office,2,1139.78,884.84,834.84,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004465,MBR00000173,Professional,2023-03-01,2023-03-01,2023-03-18,PLN4009,1531398223,1531398223,OB/GYN,In-Network,M17.11,R10.9,,,,,,,0,,99232,E&M,,,,11,Office,2,394.06,314.94,220.16,0.0,75.0,19.78,94.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004466,MBR00000173,Professional,2021-07-03,2021-07-03,2021-07-23,PLN8051,1410468316,1410468316,SNF,In-Network,Z12.31,I48.91,,,,,,,0,,58661,Surgery,,,,23,Emergency Room,1,3083.26,2005.18,1812.96,0.0,50.0,142.22,192.22,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004467,MBR00000173,Institutional-IP,2023-09-20,2023-09-22,2023-10-13,PLN2130,1727809972,1727809972,Home Health,In-Network,Z23,F41.9,,,,872,MS-DRG,23,2,W,99221,E&M,,,0270,21,Inpatient Hospital,2,427.81,138.39,0.0,124.94,35.0,0.0,159.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004468,MBR00000174,Professional,2021-11-26,2021-11-26,2021-12-09,PLN6251,1745114564,1745114564,Endocrinology,In-Network,Z00.00,F10.20,,,,,,,0,,74177,Radiology,,,,22,Outpatient Hospital,1,1441.69,504.68,0.0,220.49,35.0,0.0,255.49,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004469,MBR00000174,Professional,2021-08-05,2021-08-05,2021-08-26,PLN1214,1530904931,1530904931,Internal Medicine,In-Network,I10,E11.9,,,,,,,0,,74177,Radiology,,,,21,Inpatient Hospital,1,2705.73,1062.0,1038.87,0.0,0.0,23.13,23.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004470,MBR00000174,Professional,2022-08-24,2022-08-24,2022-09-18,PLN2833,1168881145,1168881145,Orthopedic Surgery,In-Network,I10,F32.9,,,,,,,0,,47562,Surgery,,,,12,Home,3,5565.03,2668.89,2367.05,0.0,0.0,301.84,301.84,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004471,MBR00000174,Professional,2022-02-27,2022-02-27,2022-03-19,PLN9929,1767011137,1767011137,DME Supplier,In-Network,B97.89,R07.9,,,,,,,0,,66984,Surgery,,,,11,Office,2,2331.65,1803.06,1647.71,0.0,0.0,155.35,155.35,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004472,MBR00000174,Professional,2022-05-21,2022-05-21,2022-06-27,PLN4351,1806688928,1806688928,Geriatrics,In-Network,I10,J20.9,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,3,169.81,133.91,133.91,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004473,MBR00000174,Professional,2023-06-01,2023-06-01,2023-07-14,PLN9196,1910255109,1910255109,DME Supplier,In-Network,Z12.31,N18.3,,,,,,,0,,71046,Radiology,,,,12,Home,1,197.3,98.07,0.0,98.07,0.0,0.0,98.07,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004474,MBR00000174,Professional,2022-08-10,2022-08-10,2022-09-07,PLN8114,1795618275,1795618275,Pulmonology,In-Network,J18.9,N18.3,,,,,,,0,,99284,E&M,,,,11,Office,3,843.36,396.26,233.09,163.17,0.0,0.0,163.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004475,MBR00000174,Professional,2022-02-14,2022-02-14,2022-02-22,PLN7191,1366426662,1366426662,Urology,In-Network,K21.0,M81.0,,,,,,,0,,27130,Surgery,,,,11,Office,1,5773.22,3248.94,0.0,209.75,0.0,0.0,209.75,0.0,Denied,CO-29,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004476,MBR00000174,Professional,2023-05-27,2023-05-27,2023-06-10,PLN3746,1622771872,1622771872,Pediatrics,In-Network,J44.1,Z12.31,,,,,,,0,,47562,Surgery,,,,23,Emergency Room,2,3582.87,1638.27,1342.42,295.85,0.0,0.0,295.85,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004477,MBR00000174,Professional,2022-02-20,2022-02-20,2022-03-09,PLN8007,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,K57.30,M54.5,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,3,116.17,94.64,0.0,81.68,35.0,0.0,116.68,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004478,MBR00000174,Institutional-OP,2023-11-16,2023-11-16,2023-11-24,PLN3305,1990090423,1990090423,Orthopedic Surgery,In-Network,K21.0,R10.9,,,,,,,0,,72148,Radiology,,,0360,22,Outpatient Hospital,3,2844.05,1502.2,1120.37,332.99,0.0,48.84,381.83,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004479,MBR00000174,Professional,2023-12-16,2023-12-16,2024-01-23,PLN6835,1948810580,1948810580,DME Supplier,In-Network,K21.0,Z12.11,,,,,,,0,,97110,Medicine,,,,20,Urgent Care,1,179.44,140.79,0.0,140.79,0.0,0.0,140.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004480,MBR00000174,Professional,2022-05-29,2022-05-29,2022-06-20,PLN4870,1224179551,1224179551,Physical Therapy,In-Network,E78.5,J20.9,,,,,,,0,,77067,Radiology,,,,11,Office,2,430.08,134.18,0.0,134.18,0.0,0.0,134.18,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000004481,MBR00000174,Professional,2023-04-25,2023-04-25,2023-05-19,PLN2797,1767011137,1767011137,DME Supplier,In-Network,J20.9,Z23,,,,,,,0,,47562,Surgery,,,,20,Urgent Care,1,5979.17,2630.23,2308.61,246.62,75.0,0.0,321.62,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004482,MBR00000174,Institutional-IP,2023-02-15,2023-02-17,2023-03-22,PLN3159,1910255109,1910255109,DME Supplier,In-Network,C50.912,S72.001A,,,,682,MS-DRG,13,2,N,93225,Medicine,,,0370,21,Inpatient Hospital,3,695.7,446.03,118.4,252.63,75.0,0.0,327.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004483,MBR00000174,Professional,2023-08-01,2023-08-01,2023-09-14,PLN6882,1422747896,1422747896,Urology,In-Network,J06.9,K57.30,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,3,2237.6,1657.81,1657.81,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000004484,MBR00000174,Institutional-IP,2022-05-21,2022-05-28,2022-06-07,PLN2499,1530904931,1530904931,Internal Medicine,In-Network,Z00.00,Z23,,,,871,MS-DRG,5,7,Y,99221,E&M,,,0900,21,Inpatient Hospital,3,432.67,214.35,209.88,1.3,0.0,3.17,4.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004485,MBR00000174,Institutional-IP,2022-03-22,2022-03-23,2022-04-15,PLN3506,1213165847,1213165847,Critical Access Hospital,In-Network,E78.5,I50.9,,,,291,MS-DRG,6,1,Y,93000,Radiology,,,0301,21,Inpatient Hospital,2,116.99,59.62,59.62,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004486,MBR00000174,Professional,2021-10-30,2021-10-30,2021-12-03,PLN9958,1716521444,1716521444,Oncology,In-Network,M54.5,Z00.01,,,,,,,0,,99203,E&M,,,,81,Independent Laboratory,2,331.68,232.72,0.0,232.72,50.0,0.0,282.72,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004487,MBR00000174,Professional,2022-10-04,2022-10-04,2022-11-12,PLN9752,1168881145,1168881145,Orthopedic Surgery,In-Network,I10,E78.5,,,,,,,0,,45378,Surgery,,,,11,Office,1,2393.26,971.57,731.87,0.0,75.0,164.7,239.7,0.0,Adjusted,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000004488,MBR00000174,Institutional-OP,2022-11-06,2022-11-06,2022-11-20,PLN8898,1453283987,1453283987,Critical Access Hospital,In-Network,Z87.891,Z12.31,,,,,,,0,,99222,E&M,,,0320,22,Outpatient Hospital,2,488.9,158.04,143.04,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004489,MBR00000174,Professional,2022-05-09,2022-05-09,2022-05-28,PLN1964,1948810580,1948810580,DME Supplier,In-Network,M81.0,E66.9,,,,,,,0,,99221,E&M,,,,23,Emergency Room,1,337.19,127.38,127.38,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004490,MBR00000174,Professional,2021-12-06,2021-12-06,2022-01-05,PLN4019,1148984206,1148984206,Psychiatry,In-Network,I10,M17.11,,,,,,,0,,99232,E&M,,,,81,Independent Laboratory,2,268.79,188.59,163.59,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004491,MBR00000174,Professional,2022-05-09,2022-05-09,2022-06-12,PLN1422,1500037969,1500037969,Pulmonology,In-Network,F41.9,N40.0,,,,,,,0,,93306,Radiology,,,,23,Emergency Room,2,1337.15,928.56,928.56,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004492,MBR00000174,Professional,2022-07-04,2022-07-04,2022-08-09,PLN5155,1590915516,1590915516,Physical Therapy,Out-of-Network,J06.9,K21.0,,,,,,,0,,66984,Surgery,,,,23,Emergency Room,2,1947.5,730.69,695.69,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004493,MBR00000174,Institutional-OP,2021-05-20,2021-05-20,2021-06-08,PLN3353,1284035364,1284035364,Pediatrics,In-Network,J20.9,E78.5,,,,,,,0,,23472,Surgery,,,0636,22,Outpatient Hospital,3,4576.33,1793.42,1290.59,477.83,25.0,0.0,502.83,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004494,MBR00000174,Professional,2022-12-24,2022-12-24,2023-01-19,PLN4200,1395983630,1395983630,Nephrology,In-Network,Z12.31,Z12.11,,,,,,,0,,71046,Radiology,,,,23,Emergency Room,1,169.38,133.64,133.64,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004495,MBR00000174,Professional,2023-07-12,2023-07-12,2023-08-23,PLN9049,1716521444,1716521444,Oncology,In-Network,R10.9,N18.3,,,,,,,0,,99233,E&M,,,,49,Independent Clinic,2,301.72,217.29,0.0,217.29,0.0,0.0,217.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004496,MBR00000174,Institutional-IP,2021-12-19,2021-12-21,2022-01-12,PLN8937,1856686341,1856686341,Geriatrics,In-Network,Z12.31,F32.9,,,,872,MS-DRG,3,2,Y,72148,Radiology,,,0900,21,Inpatient Hospital,2,2725.8,1473.53,1473.53,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000004497,MBR00000174,Institutional-OP,2022-03-04,2022-03-04,2022-04-04,PLN1567,1840431511,1840431511,Geriatrics,Out-of-Network,E66.9,J20.9,,,,,,,0,,33533,Surgery,,,0301,22,Outpatient Hospital,3,21737.15,13026.44,11201.66,0.0,0.0,1824.78,1824.78,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000004498,MBR00000174,Professional,2021-04-12,2021-04-12,2021-05-02,PLN6157,1514306773,1514306773,Endocrinology,In-Network,I10,C50.912,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,1,387.13,310.19,310.19,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004499,MBR00000174,Institutional-IP,2022-09-30,2022-10-05,2022-11-12,PLN4437,1556140803,1556140803,Cardiology,In-Network,I48.91,N18.3,,,,603,MS-DRG,21,5,Y,77067,Radiology,,,0120,21,Inpatient Hospital,2,560.3,242.69,196.72,0.0,15.0,30.97,45.97,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000004500,MBR00000174,Professional,2022-04-14,2022-04-14,2022-05-10,PLN1930,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,Z23,Z12.31,,,,,,,0,,99213,E&M,,,,21,Inpatient Hospital,1,251.6,111.89,86.89,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004501,MBR00000174,Institutional-IP,2023-07-28,2023-07-31,2023-08-25,PLN2807,1540044947,1540044947,Pulmonology,Out-of-Network,Z79.4,Z23,,,,470,MS-DRG,17,3,Y,71046,Radiology,,,0636,21,Inpatient Hospital,2,238.9,156.21,156.21,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004502,MBR00000174,Professional,2023-09-21,2023-09-21,2023-10-26,PLN5967,1585582070,1585582070,Outpatient Clinic,In-Network,R07.9,F32.9,,,,,,,0,,99213,E&M,,,,22,Outpatient Hospital,2,319.66,165.56,165.56,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004503,MBR00000174,Professional,2023-04-27,2023-04-27,2023-05-31,PLN4059,1910255109,1910255109,DME Supplier,In-Network,R10.9,I10,,,,,,,0,,99204,E&M,,,,50,Federally Qualified Health Center,2,250.06,119.56,0.0,0.0,25.0,0.0,25.0,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004504,MBR00000174,Institutional-OP,2021-08-19,2021-08-19,2021-08-29,PLN4305,1691062876,1691062876,SNF,In-Network,F03.90,Z51.11,,,,,,,0,,99221,E&M,,,0636,22,Outpatient Hospital,3,249.15,179.14,82.24,96.9,0.0,0.0,96.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004505,MBR00000174,Institutional-IP,2021-08-06,2021-08-10,2021-08-18,PLN6611,1799205295,1799205295,General Acute Care Hospital,In-Network,E78.5,I48.91,,,,196,MS-DRG,15,4,Y,58661,Surgery,,,0761,21,Inpatient Hospital,3,4101.16,1242.62,867.31,375.31,0.0,0.0,375.31,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004506,MBR00000174,Professional,2022-06-16,2022-06-16,2022-07-10,PLN7722,1752470395,1752470395,Home Health,In-Network,E78.5,N40.0,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,2,65.61,35.41,0.0,35.41,0.0,0.0,35.41,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004507,MBR00000174,Institutional-OP,2022-11-09,2022-11-09,2022-12-01,PLN7200,1531398223,1531398223,OB/GYN,In-Network,Z00.01,F41.9,,,,,,,0,,45378,Surgery,,,0636,22,Outpatient Hospital,3,1088.36,499.91,499.91,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000004508,MBR00000174,Professional,2021-02-04,2021-02-04,2021-03-16,PLN2527,1915531927,1915531927,Critical Access Hospital,In-Network,K57.30,Z23,,,,,,,0,,27130,Surgery,,,,21,Inpatient Hospital,3,5196.28,4262.96,4262.96,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004509,MBR00000174,Institutional-IP,2022-06-27,2022-06-29,2022-07-24,PLN5253,1891849440,1891849440,Oncology,In-Network,F41.9,E66.9,,,,196,MS-DRG,16,2,Y,43239,Surgery,,,0730,21,Inpatient Hospital,2,1150.02,663.41,598.48,0.0,0.0,64.93,64.93,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004510,MBR00000174,Institutional-IP,2021-04-05,2021-04-08,2021-05-19,PLN2448,1717912431,1717912431,Oncology,In-Network,E78.5,J06.9,,,,194,MS-DRG,19,3,Y,97530,Medicine,,,0120,21,Inpatient Hospital,1,283.51,208.62,133.62,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004511,MBR00000174,Institutional-OP,2021-10-12,2021-10-12,2021-11-01,PLN2519,1531398223,1531398223,OB/GYN,In-Network,Z12.31,J20.9,,,,,,,0,,85025,Pathology/Lab,,,0510,22,Outpatient Hospital,3,82.5,59.25,8.01,0.0,50.0,1.24,51.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004512,MBR00000174,Professional,2022-01-29,2022-01-29,2022-02-09,PLN7213,1433937353,1433937353,Nephrology,In-Network,M54.5,Z23,,,,,,,0,,G0468,Medicine,,,,12,Home,3,532.85,407.47,407.47,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004513,MBR00000174,Institutional-IP,2021-02-14,2021-02-20,2021-03-13,PLN8853,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,F41.9,E11.40,,,,682,MS-DRG,22,6,Y,81001,Pathology/Lab,,,0636,21,Inpatient Hospital,2,47.55,17.33,0.0,17.33,0.0,0.0,17.33,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004514,MBR00000174,Institutional-IP,2021-10-15,2021-10-19,2021-11-20,PLN3509,1778483301,1778483301,Home Health,In-Network,E66.9,Z87.891,,,,682,MS-DRG,24,4,Y,27130,Surgery,,,0270,21,Inpatient Hospital,1,6993.98,5676.62,5651.62,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004515,MBR00000174,Professional,2022-11-21,2022-11-21,2022-12-02,PLN9152,1749494482,1749494482,Pediatrics,In-Network,J06.9,Z12.11,,,,,,,0,,71046,Radiology,,,,21,Inpatient Hospital,2,114.74,61.66,0.0,61.66,25.0,0.0,86.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004516,MBR00000174,Institutional-OP,2023-12-29,2023-12-29,2024-02-06,PLN7565,1795618275,1795618275,Pulmonology,In-Network,Z23,Z12.11,,,,,,,0,,72148,Radiology,,,0900,22,Outpatient Hospital,3,2253.79,911.07,815.41,95.66,0.0,0.0,95.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004517,MBR00000174,Professional,2023-05-04,2023-05-04,2023-06-11,PLN6021,1475984649,1475984649,SNF,In-Network,Z00.00,E11.9,,,,,,,0,,G0444,Medicine,,,,49,Independent Clinic,3,41.05,22.63,7.63,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000004518,MBR00000175,Professional,2021-12-02,2021-12-02,2021-12-14,PLN9648,1860435061,1860435061,DME Supplier,In-Network,Z00.00,I50.9,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,1,152.42,112.54,90.82,0.0,0.0,21.72,21.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004519,MBR00000175,Institutional-IP,2023-10-29,2023-11-04,2023-11-25,PLN1298,1239316214,1239316214,Internal Medicine,In-Network,F10.20,F41.9,,,,196,MS-DRG,16,6,Y,45378,Surgery,,,0200,21,Inpatient Hospital,3,1519.02,932.57,581.24,316.33,35.0,0.0,351.33,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000004520,MBR00000175,Professional,2022-04-27,2022-04-27,2022-05-09,PLN4585,1124394415,1124394415,Pediatrics,In-Network,I10,J44.1,,,,,,,0,,70553,Radiology,,,,11,Office,2,2426.23,1556.91,1228.95,312.96,15.0,0.0,327.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004521,MBR00000175,Institutional-OP,2022-01-24,2022-01-24,2022-03-02,PLN4997,1752470395,1752470395,Home Health,In-Network,I11.9,F41.9,,,,,,,0,,G0468,Medicine,,,0730,22,Outpatient Hospital,2,260.49,120.12,84.96,0.0,35.0,0.16,35.16,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004522,MBR00000175,Professional,2023-07-17,2023-07-17,2023-08-17,PLN6191,1994661817,1994661817,SNF,Out-of-Network,Z12.31,Z12.31,,,,,,,0,,99214,E&M,,,,49,Independent Clinic,3,165.46,127.83,0.0,69.14,75.0,0.0,144.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004523,MBR00000175,Professional,2022-03-14,2022-03-14,2022-04-27,PLN9049,1569105090,1569105090,Geriatrics,In-Network,F10.20,M17.11,,,,,,,0,,97110,Medicine,,,,23,Emergency Room,2,291.52,180.58,165.58,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004524,MBR00000175,Institutional-IP,2023-03-20,2023-03-24,2023-04-21,PLN8550,1108115157,1108115157,General Acute Care Hospital,In-Network,I10,F41.9,,,,292,MS-DRG,3,4,Y,66984,Surgery,,,0636,21,Inpatient Hospital,1,3138.39,1823.98,1379.35,290.46,75.0,79.17,444.63,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004525,MBR00000175,Institutional-OP,2021-06-28,2021-06-28,2021-08-06,PLN4238,1644128543,1644128543,Gastroenterology,In-Network,J44.1,I10,,,,,,,0,,58661,Surgery,,,0301,22,Outpatient Hospital,1,4708.04,3505.21,3416.32,0.0,50.0,38.89,88.89,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004526,MBR00000175,Institutional-IP,2021-12-30,2022-01-10,2022-01-26,PLN4403,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,N40.0,K21.0,,,,292,MS-DRG,1,11,Y,99232,E&M,,,0360,21,Inpatient Hospital,1,240.84,139.81,138.33,0.0,0.0,1.48,1.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004527,MBR00000175,Professional,2023-12-15,2023-12-15,2024-01-27,PLN3795,1974006077,1974006077,Orthopedic Surgery,In-Network,E11.9,I10,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,3,1694.48,834.55,834.55,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000004528,MBR00000176,Professional,2021-09-25,2021-09-25,2021-11-02,PLN9786,1450094833,1450094833,Outpatient Clinic,In-Network,J20.9,E87.6,,,,,,,0,,43239,Surgery,,,,20,Urgent Care,1,1879.68,1561.89,1486.89,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004529,MBR00000176,Institutional-OP,2023-07-20,2023-07-20,2023-08-09,PLN3153,1193493783,1193493783,Critical Access Hospital,Out-of-Network,I48.91,Z00.00,,,,,,,0,,99203,E&M,,,0360,22,Outpatient Hospital,3,319.63,141.21,0.0,141.21,0.0,0.0,141.21,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004530,MBR00000176,Institutional-OP,2022-05-26,2022-05-26,2022-06-20,PLN8471,1727809972,1727809972,Home Health,In-Network,I10,E78.5,,,,,,,0,,99222,E&M,,,0761,22,Outpatient Hospital,2,644.01,272.96,237.96,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004531,MBR00000176,Institutional-IP,2023-11-15,2023-11-16,2023-12-14,PLN4670,1450553056,1450553056,Clinical Laboratory,In-Network,F32.9,J06.9,,,,872,MS-DRG,24,1,Y,99283,E&M,,,0360,21,Inpatient Hospital,2,312.61,211.61,211.61,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004532,MBR00000176,Institutional-IP,2022-04-01,2022-04-10,2022-05-08,PLN1674,1118885473,1118885473,ASC,In-Network,N39.0,N17.9,,,,291,MS-DRG,11,9,Y,99283,E&M,,,0761,21,Inpatient Hospital,3,463.99,241.45,0.0,241.45,35.0,0.0,276.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004533,MBR00000176,Professional,2022-06-27,2022-06-27,2022-07-22,PLN1418,1799205295,1799205295,General Acute Care Hospital,In-Network,C50.912,J18.9,,,,,,,0,,78452,Radiology,,,,11,Office,2,5360.86,2024.85,2024.85,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000004534,MBR00000176,Professional,2022-03-09,2022-03-09,2022-03-21,PLN7265,1366286000,1366286000,SNF,In-Network,M54.5,E11.9,,,,,,,0,,99204,E&M,,,,11,Office,1,482.16,190.91,120.19,0.0,50.0,20.72,70.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004535,MBR00000176,Professional,2021-08-18,2021-08-18,2021-09-16,PLN5193,1860435061,1860435061,DME Supplier,In-Network,K21.0,J06.9,,,,,,,0,,G0444,Medicine,,,,22,Outpatient Hospital,3,102.77,61.66,0.0,27.1,75.0,0.0,102.1,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000004536,MBR00000176,Professional,2023-07-13,2023-07-13,2023-08-11,PLN1433,1355166277,1355166277,Endocrinology,In-Network,Z00.01,J44.1,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,3,7291.32,5620.41,5620.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004537,MBR00000176,Professional,2022-09-20,2022-09-20,2022-10-03,PLN1341,1266606767,1266606767,ASC,In-Network,Z87.891,I11.9,,,,,,,0,,47562,Surgery,,,,11,Office,2,5535.3,4696.19,4450.6,245.59,0.0,0.0,245.59,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004538,MBR00000177,Institutional-IP,2022-07-08,2022-07-14,2022-07-31,PLN1161,1561134315,1561134315,DME Supplier,In-Network,Z00.00,E78.5,,,,872,MS-DRG,8,6,Y,90686,Medicine,,,0761,21,Inpatient Hospital,1,87.4,64.12,0.0,64.12,75.0,0.0,139.12,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000004539,MBR00000177,Professional,2022-02-12,2022-02-12,2022-03-20,PLN1234,1563980627,1563980627,Critical Access Hospital,In-Network,I10,E66.9,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,1,392.5,160.74,85.74,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004540,MBR00000177,Professional,2023-04-26,2023-04-26,2023-05-09,PLN5176,1713934949,1713934949,Neurology,In-Network,E78.5,E11.65,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,1,206.63,139.06,0.0,139.06,25.0,0.0,164.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004541,MBR00000177,Institutional-OP,2022-01-16,2022-01-16,2022-02-19,PLN3920,1514306773,1514306773,Endocrinology,In-Network,E78.5,Z87.891,,,,,,,0,,23472,Surgery,,,0761,22,Outpatient Hospital,1,4516.95,1849.07,1655.48,178.59,15.0,0.0,193.59,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004542,MBR00000177,Professional,2021-09-18,2021-09-18,2021-10-15,PLN5974,1575695214,1575695214,SNF,In-Network,J06.9,E11.9,,,,,,,0,,71046,Radiology,,,,11,Office,3,277.16,107.39,61.92,0.0,35.0,10.47,45.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004543,MBR00000177,Institutional-OP,2021-04-01,2021-04-01,2021-05-10,PLN7090,1749494482,1749494482,Pediatrics,In-Network,E78.5,Z00.00,,,,,,,0,,97110,Medicine,,,0450,22,Outpatient Hospital,1,284.48,111.78,86.78,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004544,MBR00000177,Institutional-OP,2023-08-15,2023-08-15,2023-08-29,PLN4622,1198133277,1198133277,SNF,In-Network,B97.89,F41.9,,,,,,,0,,99213,E&M,,,0200,22,Outpatient Hospital,3,247.21,95.9,95.9,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004545,MBR00000177,Institutional-OP,2021-03-22,2021-03-22,2021-04-08,PLN2750,1561134315,1561134315,DME Supplier,In-Network,M81.0,N18.3,,,,,,,0,,76700,Radiology,,,0320,22,Outpatient Hospital,2,1139.0,381.61,346.61,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000004546,MBR00000177,Institutional-OP,2023-07-15,2023-07-15,2023-08-09,PLN5465,1227362142,1227362142,DME Supplier,In-Network,I10,F41.9,,,,,,,0,,81001,Pathology/Lab,,,0450,22,Outpatient Hospital,3,49.79,25.59,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004547,MBR00000177,Institutional-OP,2022-02-19,2022-02-19,2022-03-02,PLN3815,1148984206,1148984206,Psychiatry,In-Network,E78.5,M54.5,,,,,,,0,,45380,Surgery,,,0900,22,Outpatient Hospital,3,2323.38,1081.74,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-15,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000004548,MBR00000177,Professional,2021-01-03,2021-01-03,2021-02-03,PLN5408,1410468316,1410468316,SNF,In-Network,M17.11,Z23,,,,,,,0,,99203,E&M,,,,23,Emergency Room,3,273.73,220.24,0.0,220.24,0.0,0.0,220.24,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004549,MBR00000177,Institutional-IP,2023-10-12,2023-10-14,2023-11-19,PLN4433,1935547131,1935547131,Pulmonology,In-Network,I10,G20,,,,641,MS-DRG,1,2,Y,99283,E&M,,,0510,21,Inpatient Hospital,1,564.73,436.38,356.98,64.4,15.0,0.0,79.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004550,MBR00000177,Institutional-OP,2023-03-23,2023-03-23,2023-04-02,PLN9028,1865904917,1865904917,Outpatient Clinic,In-Network,Z00.00,I10,,,,,,,0,,33533,Surgery,,,0360,22,Outpatient Hospital,2,11922.02,5095.4,4581.29,479.11,35.0,0.0,514.11,0.0,Adjusted,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000004551,MBR00000177,Professional,2023-03-03,2023-03-03,2023-03-31,PLN5148,1968299309,1968299309,Internal Medicine,In-Network,Z12.11,Z00.00,,,,,,,0,,76700,Radiology,,,,50,Federally Qualified Health Center,3,1189.94,692.88,0.0,0.0,35.0,90.32,125.32,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004552,MBR00000177,Institutional-IP,2022-08-23,2022-08-31,2022-09-30,PLN6106,1817234602,1817234602,Clinical Laboratory,In-Network,Z79.4,I10,,,,196,MS-DRG,11,8,N,27130,Surgery,,,0120,21,Inpatient Hospital,1,3406.54,2004.36,1929.36,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004553,MBR00000177,Professional,2023-04-13,2023-04-13,2023-04-24,PLN5712,1624202402,1624202402,Orthopedic Surgery,In-Network,N17.9,E78.5,,,,,,,0,,99233,E&M,,,,23,Emergency Room,3,500.01,260.1,260.1,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004554,MBR00000178,Institutional-IP,2021-05-26,2021-05-28,2021-06-04,PLN6185,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,I48.91,J20.9,,,,682,MS-DRG,8,2,Y,99284,E&M,,,0900,21,Inpatient Hospital,1,692.69,372.25,266.43,105.82,0.0,0.0,105.82,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000004555,MBR00000178,Professional,2021-09-14,2021-09-14,2021-10-01,PLN3619,1268679390,1268679390,Critical Access Hospital,In-Network,M17.11,G43.909,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,1,1392.49,480.25,429.16,15.61,0.0,35.48,51.09,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004556,MBR00000178,Institutional-IP,2022-08-19,2022-08-23,2022-08-27,PLN4785,1687650653,1687650653,Internal Medicine,In-Network,C50.912,J20.9,,,,291,MS-DRG,9,4,Y,99221,E&M,,,0450,21,Inpatient Hospital,2,282.56,179.35,0.0,179.35,75.0,0.0,254.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004557,MBR00000178,Professional,2023-03-16,2023-03-16,2023-04-29,PLN4351,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,F32.9,J44.1,,,,,,,0,,99233,E&M,,,,11,Office,1,282.78,163.9,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004558,MBR00000178,Professional,2022-10-07,2022-10-07,2022-11-18,PLN2464,1575695214,1575695214,SNF,In-Network,E11.9,I10,,,,,,,0,,78452,Radiology,,,,22,Outpatient Hospital,1,4190.49,2378.06,2343.06,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004559,MBR00000178,Professional,2022-03-21,2022-03-21,2022-03-30,PLN5442,1108115157,1108115157,General Acute Care Hospital,In-Network,Z12.31,E78.5,,,,,,,0,,47562,Surgery,,,,31,Skilled Nursing Facility,2,2968.24,2404.41,2105.78,201.41,25.0,72.22,298.63,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004560,MBR00000178,Institutional-OP,2023-01-06,2023-01-06,2023-02-01,PLN8758,1168246159,1168246159,Internal Medicine,In-Network,I25.10,Z87.891,,,,,,,0,,72148,Radiology,,,0761,22,Outpatient Hospital,1,1676.03,1288.83,1253.83,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004561,MBR00000178,Institutional-OP,2021-03-07,2021-03-07,2021-04-16,PLN7675,1860435061,1860435061,DME Supplier,In-Network,E11.9,J06.9,,,,,,,0,,47562,Surgery,,,0510,22,Outpatient Hospital,1,4300.45,2197.26,2122.26,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004562,MBR00000178,Professional,2022-07-11,2022-07-11,2022-07-28,PLN9836,1550154147,1550154147,Outpatient Clinic,In-Network,E66.9,E11.9,,,,,,,0,,99204,E&M,,,,11,Office,1,291.24,170.2,68.45,92.86,0.0,8.89,101.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004563,MBR00000178,Professional,2022-03-09,2022-03-09,2022-04-10,PLN4740,1702692193,1702692193,Physical Therapy,In-Network,N39.0,Z23,,,,,,,0,,99204,E&M,,,,11,Office,2,206.93,105.69,0.0,105.69,25.0,0.0,130.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004564,MBR00000178,Institutional-OP,2022-06-30,2022-06-30,2022-07-17,PLN3537,1224179551,1224179551,Physical Therapy,In-Network,J45.20,M54.5,,,,,,,0,,99213,E&M,,,0636,22,Outpatient Hospital,3,292.06,177.39,126.53,0.0,35.0,15.86,50.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004565,MBR00000178,Institutional-IP,2021-05-24,2021-05-28,2021-06-05,PLN8232,1860435061,1860435061,DME Supplier,In-Network,M54.5,Z00.00,,,,292,MS-DRG,17,4,Y,G0468,Medicine,,,0636,21,Inpatient Hospital,3,654.33,518.02,518.02,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000004566,MBR00000178,Professional,2023-09-17,2023-09-17,2023-10-23,PLN5862,1511044648,1511044648,Endocrinology,In-Network,E78.5,R05,,,,,,,0,,97530,Medicine,,,,11,Office,2,295.9,179.52,179.52,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004567,MBR00000178,Institutional-IP,2023-07-24,2023-07-26,2023-08-04,PLN6561,1511044648,1511044648,Endocrinology,In-Network,E11.9,E11.9,,,,690,MS-DRG,14,2,Y,99283,E&M,,,0761,21,Inpatient Hospital,3,290.14,237.74,162.74,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004568,MBR00000178,Institutional-OP,2023-10-30,2023-10-30,2023-12-11,PLN5750,1795618275,1795618275,Pulmonology,In-Network,Z23,Z51.11,,,,,,,0,,97530,Medicine,,,0370,22,Outpatient Hospital,1,135.02,102.85,102.85,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000004569,MBR00000178,Professional,2023-07-10,2023-07-10,2023-08-03,PLN4416,1273488618,1273488618,General Acute Care Hospital,In-Network,F41.9,Z12.31,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,3,291.15,135.29,0.0,135.29,0.0,0.0,135.29,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004570,MBR00000178,Professional,2022-12-29,2022-12-29,2023-01-12,PLN1025,1812060197,1812060197,Oncology,Out-of-Network,Z12.31,Z23,,,,,,,0,,74177,Radiology,,,,11,Office,1,1121.64,640.94,426.62,139.32,75.0,0.0,214.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004571,MBR00000178,Professional,2021-11-11,2021-11-11,2021-11-24,PLN5100,1687650653,1687650653,Internal Medicine,In-Network,E66.9,N39.0,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,3,5901.04,3178.35,3178.35,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004572,MBR00000178,Institutional-OP,2021-05-05,2021-05-05,2021-06-18,PLN4530,1475984649,1475984649,SNF,In-Network,Z12.31,I10,,,,,,,0,,76700,Radiology,,,0450,22,Outpatient Hospital,2,1153.89,410.17,410.17,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004573,MBR00000178,Institutional-OP,2022-11-02,2022-11-02,2022-11-27,PLN4580,1135158374,1135158374,Pulmonology,In-Network,R05,N20.0,,,,,,,0,,80061,Pathology/Lab,,,0200,22,Outpatient Hospital,1,68.85,31.54,0.0,31.54,0.0,0.0,31.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004574,MBR00000178,Professional,2023-11-03,2023-11-03,2023-12-05,PLN4589,1561134315,1561134315,DME Supplier,In-Network,E78.5,J20.9,,,,,,,0,,G0468,Medicine,,,,23,Emergency Room,2,608.54,333.49,280.64,35.73,0.0,17.12,52.85,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004575,MBR00000178,Institutional-OP,2022-02-03,2022-02-03,2022-03-17,PLN2304,1434029575,1434029575,Endocrinology,In-Network,F41.9,F10.20,,,,,,,0,,90460,Medicine,,,0761,22,Outpatient Hospital,2,40.66,30.87,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004576,MBR00000178,Professional,2023-12-24,2023-12-24,2024-01-29,PLN2716,1109850785,1109850785,ASC,Out-of-Network,Z12.11,Z23,,,,,,,0,,99213,E&M,,,,21,Inpatient Hospital,1,282.28,227.76,227.76,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004577,MBR00000178,Institutional-OP,2021-06-18,2021-06-18,2021-07-28,PLN6336,1847081578,1847081578,Urology,Out-of-Network,I50.9,I10,,,,,,,0,,85025,Pathology/Lab,,,0120,22,Outpatient Hospital,2,53.44,27.81,0.0,27.81,0.0,0.0,27.81,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004578,MBR00000178,Institutional-OP,2021-11-07,2021-11-07,2021-12-19,PLN3348,1366426662,1366426662,Urology,In-Network,Z23,K92.1,,,,,,,0,,23472,Surgery,,,0301,22,Outpatient Hospital,2,4843.57,1631.08,1631.08,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004579,MBR00000178,Institutional-OP,2022-12-13,2022-12-13,2022-12-30,PLN9869,1687650653,1687650653,Internal Medicine,In-Network,Z23,E11.9,,,,,,,0,,99221,E&M,,,0636,22,Outpatient Hospital,2,419.36,330.3,184.31,70.99,75.0,0.0,145.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004580,MBR00000178,Institutional-IP,2022-06-24,2022-07-01,2022-07-24,PLN6168,1109850785,1109850785,ASC,Out-of-Network,I10,M54.5,,,,292,MS-DRG,18,7,Y,27447,Surgery,,,0200,21,Inpatient Hospital,3,5313.61,3357.77,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-50,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004581,MBR00000178,Professional,2023-04-13,2023-04-13,2023-05-02,PLN5262,1624202402,1624202402,Orthopedic Surgery,In-Network,J44.1,I50.9,,,,,,,0,,66984,Surgery,,,,21,Inpatient Hospital,1,1616.78,1256.15,1256.15,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004582,MBR00000178,Professional,2022-01-13,2022-01-13,2022-02-22,PLN1169,1899127912,1899127912,Neurology,In-Network,K21.0,E11.9,,,,,,,0,,76700,Radiology,,,,22,Outpatient Hospital,1,869.46,306.09,306.09,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004583,MBR00000178,Professional,2023-04-29,2023-04-29,2023-06-05,PLN1375,1224179551,1224179551,Physical Therapy,In-Network,K57.30,K21.0,,,,,,,0,,93000,Radiology,,,,22,Outpatient Hospital,1,102.11,76.56,0.0,76.56,35.0,0.0,111.56,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004584,MBR00000178,Institutional-OP,2021-11-26,2021-11-26,2021-12-23,PLN4839,1475984649,1475984649,SNF,In-Network,Z23,Z00.01,,,,,,,0,,47562,Surgery,,,0370,22,Outpatient Hospital,3,4194.61,1306.5,871.31,420.19,15.0,0.0,435.19,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004585,MBR00000178,Professional,2021-06-13,2021-06-13,2021-07-03,PLN1433,1660288235,1660288235,ASC,In-Network,Z12.31,N39.0,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,2,130.69,102.55,18.36,84.19,0.0,0.0,84.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004586,MBR00000178,Professional,2022-09-15,2022-09-15,2022-10-05,PLN4658,1453936007,1453936007,ASC,In-Network,E11.9,E11.9,,,,,,,0,,99221,E&M,,,,11,Office,2,168.35,139.74,139.74,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004587,MBR00000178,Professional,2022-07-16,2022-07-16,2022-08-22,PLN1567,1514306773,1514306773,Endocrinology,In-Network,Z12.11,R10.9,,,,,,,0,,G0439,Medicine,,,,31,Skilled Nursing Facility,3,619.33,405.56,370.56,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000004588,MBR00000178,Professional,2022-09-13,2022-09-13,2022-10-25,PLN1777,1205377316,1205377316,Orthopedic Surgery,In-Network,N20.0,R07.9,,,,,,,0,,85610,Pathology/Lab,,,,23,Emergency Room,2,74.47,44.02,0.0,44.02,35.0,0.0,79.02,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004589,MBR00000178,Professional,2021-01-27,2021-01-27,2021-03-04,PLN3925,1389336600,1389336600,Critical Access Hospital,In-Network,J06.9,J44.1,,,,,,,0,,43239,Surgery,,,,81,Independent Laboratory,2,1293.85,819.75,819.75,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004590,MBR00000178,Professional,2022-03-27,2022-03-27,2022-04-10,PLN6548,1716521444,1716521444,Oncology,In-Network,F41.9,J18.9,,,,,,,0,,70553,Radiology,,,,11,Office,1,3223.02,2318.41,0.0,459.4,0.0,0.0,459.4,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004591,MBR00000178,Professional,2021-04-09,2021-04-09,2021-04-17,PLN7574,1148984206,1148984206,Psychiatry,In-Network,K92.1,N40.0,,,,,,,0,,27130,Surgery,,,,31,Skilled Nursing Facility,3,5536.69,4103.17,4078.17,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004592,MBR00000178,Professional,2023-06-01,2023-06-01,2023-06-17,PLN4664,1139906830,1139906830,Endocrinology,Out-of-Network,F41.9,E78.5,,,,,,,0,,99284,E&M,,,,11,Office,2,452.36,202.98,165.96,37.02,0.0,0.0,37.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004593,MBR00000178,Professional,2021-03-30,2021-03-30,2021-04-14,PLN7286,1717546253,1717546253,Family Medicine,In-Network,Z12.11,E11.9,,,,,,,0,,G0444,Medicine,,,,22,Outpatient Hospital,2,92.59,40.48,0.0,40.48,15.0,0.0,55.48,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000004594,MBR00000178,Institutional-OP,2023-10-18,2023-10-18,2023-11-24,PLN7730,1745114564,1745114564,Endocrinology,In-Network,E66.9,Z12.31,,,,,,,0,,66984,Surgery,,,0301,22,Outpatient Hospital,2,1855.19,964.41,806.22,34.65,25.0,98.54,158.19,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004595,MBR00000178,Institutional-IP,2021-03-04,2021-03-10,2021-03-17,PLN2063,1273488618,1273488618,General Acute Care Hospital,In-Network,J18.9,Z00.00,,,,470,MS-DRG,3,6,Y,80061,Pathology/Lab,,,0450,21,Inpatient Hospital,2,73.81,40.82,40.82,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004596,MBR00000178,Institutional-IP,2022-10-31,2022-11-03,2022-12-08,PLN9408,1716521444,1716521444,Oncology,In-Network,J44.1,Z00.00,,,,292,MS-DRG,19,3,Y,87491,Pathology/Lab,,,0270,21,Inpatient Hospital,3,112.95,52.21,0.0,52.21,0.0,0.0,52.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004597,MBR00000178,Institutional-OP,2022-01-01,2022-01-01,2022-01-13,PLN1913,1245650222,1245650222,Gastroenterology,In-Network,E11.9,E11.9,,,,,,,0,,85610,Pathology/Lab,,,0270,22,Outpatient Hospital,2,34.18,17.21,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004598,MBR00000178,Institutional-IP,2021-05-02,2021-05-16,2021-06-03,PLN1469,1268679390,1268679390,Critical Access Hospital,In-Network,I10,I10,,,,641,MS-DRG,21,14,N,99214,E&M,,,0301,21,Inpatient Hospital,1,345.74,292.77,0.0,292.77,50.0,0.0,342.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004599,MBR00000178,Institutional-IP,2022-01-27,2022-02-03,2022-02-20,PLN4721,1644128543,1644128543,Gastroenterology,In-Network,F03.90,Z00.00,,,,196,MS-DRG,13,7,Y,85610,Pathology/Lab,,,0200,21,Inpatient Hospital,3,75.64,47.58,47.58,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004600,MBR00000178,Professional,2021-02-13,2021-02-13,2021-03-27,PLN7060,1224179551,1224179551,Physical Therapy,In-Network,E11.9,I25.10,,,,,,,0,,27447,Surgery,,,,11,Office,2,2465.03,1415.82,1365.82,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000004601,MBR00000178,Professional,2023-02-04,2023-02-04,2023-02-20,PLN3734,1337791138,1337791138,Internal Medicine,Out-of-Network,E11.9,J06.9,,,,,,,0,,99406,Medicine,,,,23,Emergency Room,2,45.69,25.89,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004602,MBR00000178,Professional,2023-08-12,2023-08-12,2023-09-15,PLN6481,1749494482,1749494482,Pediatrics,In-Network,K92.1,J45.20,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,1,18756.89,10241.79,10241.79,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000004603,MBR00000178,Institutional-OP,2021-12-28,2021-12-28,2022-02-02,PLN9444,1752470395,1752470395,Home Health,In-Network,Z00.00,K21.0,,,,,,,0,,78452,Radiology,,,0450,22,Outpatient Hospital,3,5268.88,1598.23,1548.23,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004604,MBR00000179,Professional,2022-04-26,2022-04-26,2022-06-07,PLN9493,1433937353,1433937353,Nephrology,In-Network,E11.65,R10.9,,,,,,,0,,27130,Surgery,,,,11,Office,1,4181.22,1562.2,1208.89,353.31,0.0,0.0,353.31,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004605,MBR00000179,Professional,2021-06-03,2021-06-03,2021-06-13,PLN1832,1990090423,1990090423,Orthopedic Surgery,In-Network,N18.3,Z12.31,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,2,108.07,74.54,0.0,74.54,0.0,0.0,74.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004606,MBR00000179,Institutional-OP,2022-06-12,2022-06-12,2022-07-05,PLN8910,1645194539,1645194539,SNF,In-Network,Z00.00,E11.9,,,,,,,0,,90460,Medicine,,,0900,22,Outpatient Hospital,2,70.71,54.29,54.26,0.0,0.0,0.03,0.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004607,MBR00000179,Professional,2023-11-03,2023-11-03,2023-11-26,PLN6978,1624202402,1624202402,Orthopedic Surgery,In-Network,I10,I48.91,,,,,,,0,,23472,Surgery,,,,11,Office,2,5758.48,3273.06,3238.06,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004608,MBR00000179,Institutional-IP,2022-08-13,2022-08-15,2022-08-25,PLN8875,1948810580,1948810580,DME Supplier,In-Network,Z23,N18.3,,,,682,MS-DRG,20,2,Y,27130,Surgery,,,0730,21,Inpatient Hospital,3,6845.95,5574.7,5309.9,264.8,0.0,0.0,264.8,0.0,Paid,,,1,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000004609,MBR00000179,Institutional-OP,2023-08-17,2023-08-17,2023-09-26,PLN8152,1974006077,1974006077,Orthopedic Surgery,In-Network,E11.9,M54.5,,,,,,,0,,82043,Pathology/Lab,,,0450,22,Outpatient Hospital,1,57.61,21.77,0.0,21.77,50.0,0.0,71.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004610,MBR00000179,Professional,2023-05-05,2023-05-05,2023-06-15,PLN6593,1395983630,1395983630,Nephrology,In-Network,I10,E66.9,,,,,,,0,,47562,Surgery,,,,11,Office,2,4165.17,1259.73,1112.27,0.0,25.0,122.46,147.46,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004611,MBR00000179,Professional,2021-05-17,2021-05-17,2021-05-30,PLN9288,1224179551,1224179551,Physical Therapy,In-Network,S72.001A,F32.9,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,3,436.57,263.56,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004612,MBR00000179,Professional,2021-02-27,2021-02-27,2021-03-29,PLN4867,1571574052,1571574052,Critical Access Hospital,In-Network,R51,R07.9,,,,,,,0,,G0468,Medicine,,,,23,Emergency Room,2,548.95,220.63,164.96,20.85,15.0,19.82,55.67,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004613,MBR00000179,Institutional-OP,2022-02-02,2022-02-02,2022-02-23,PLN6439,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,I10,N39.0,,,,,,,0,,99283,E&M,,,0761,22,Outpatient Hospital,3,257.09,114.93,0.0,114.93,75.0,0.0,189.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004614,MBR00000179,Institutional-OP,2023-10-27,2023-10-27,2023-11-22,PLN4160,1609138981,1609138981,Critical Access Hospital,In-Network,J20.9,I25.10,,,,,,,0,,G0439,Medicine,,,0510,22,Outpatient Hospital,3,338.7,188.99,71.83,117.16,0.0,0.0,117.16,0.0,Paid,,,0,,0,1,0,0,0,1,Upcoding,0,0,0,1,0
CLM0000004615,MBR00000179,Institutional-OP,2021-07-04,2021-07-04,2021-08-05,PLN6549,1266606767,1266606767,ASC,In-Network,E78.5,Z23,,,,,,,0,,99214,E&M,,,0120,22,Outpatient Hospital,1,432.64,176.27,170.55,5.72,0.0,0.0,5.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004616,MBR00000179,Professional,2021-02-18,2021-02-18,2021-03-29,PLN7296,1366426662,1366426662,Urology,In-Network,M54.5,Z12.31,,,,,,,0,,78452,Radiology,,,,11,Office,1,7343.75,2652.0,0.0,288.31,0.0,26.24,314.55,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004617,MBR00000179,Professional,2023-11-17,2023-11-17,2023-12-02,PLN3821,1856686341,1856686341,Geriatrics,In-Network,Z00.01,Z00.00,,,,,,,0,,43239,Surgery,,,,81,Independent Laboratory,2,1591.08,513.98,0.0,75.89,0.0,0.0,75.89,0.0,Denied,CO-15,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004618,MBR00000179,Institutional-IP,2021-08-05,2021-08-17,2021-08-18,PLN3125,1717546253,1717546253,Family Medicine,In-Network,Z00.00,Z23,,,,291,MS-DRG,18,12,Y,77067,Radiology,,,0200,21,Inpatient Hospital,3,673.18,378.36,363.36,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000004619,MBR00000179,Institutional-OP,2022-01-25,2022-01-25,2022-02-23,PLN4190,1696843572,1696843572,Critical Access Hospital,Out-of-Network,I11.9,K92.1,,,,,,,0,,70553,Radiology,,,0636,22,Outpatient Hospital,1,4016.95,3225.74,2571.74,448.14,0.0,205.86,654.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004620,MBR00000179,Professional,2023-05-05,2023-05-05,2023-05-21,PLN4273,1372918899,1372918899,Family Medicine,In-Network,Z23,J06.9,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,1,635.13,441.46,319.75,121.71,0.0,0.0,121.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004621,MBR00000179,Professional,2021-04-18,2021-04-18,2021-05-13,PLN8079,1245650222,1245650222,Gastroenterology,In-Network,J20.9,E66.9,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,3,794.01,498.34,498.34,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004622,MBR00000179,Professional,2021-07-07,2021-07-07,2021-08-01,PLN5077,1463205530,1463205530,Nephrology,In-Network,R10.9,J45.20,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,3,145.98,51.35,51.35,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004623,MBR00000179,Professional,2023-03-07,2023-03-07,2023-04-18,PLN8412,1812060197,1812060197,Oncology,Out-of-Network,K21.0,E78.5,,,,,,,0,,99233,E&M,,,,11,Office,1,407.44,259.6,0.0,0.0,0.0,24.15,24.15,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004624,MBR00000179,Institutional-IP,2021-01-08,2021-01-12,2021-01-15,PLN3997,1817234602,1817234602,Clinical Laboratory,In-Network,C50.912,E78.5,,,,690,MS-DRG,14,4,Y,47562,Surgery,,,0301,21,Inpatient Hospital,1,2986.16,1924.44,1874.44,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004625,MBR00000179,Institutional-OP,2023-02-19,2023-02-19,2023-03-18,PLN4313,1313212303,1313212303,Family Medicine,In-Network,Z12.31,S72.001A,,,,,,,0,,99283,E&M,,,0120,22,Outpatient Hospital,2,614.04,209.38,0.0,209.38,0.0,0.0,209.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004626,MBR00000179,Professional,2022-08-17,2022-08-17,2022-08-27,PLN8705,1366286000,1366286000,SNF,In-Network,J20.9,J20.9,,,,,,,0,,43239,Surgery,,,,81,Independent Laboratory,2,1790.18,1232.66,0.0,180.39,15.0,0.0,195.39,0.0,Denied,CO-15,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004627,MBR00000179,Professional,2021-09-21,2021-09-21,2021-10-02,PLN3348,1990090423,1990090423,Orthopedic Surgery,In-Network,Z23,E66.9,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,1,279.53,163.23,28.3,109.93,25.0,0.0,134.93,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000004628,MBR00000179,Professional,2022-11-03,2022-11-03,2022-12-06,PLN7288,1757138478,1757138478,Pediatrics,In-Network,E78.5,Z87.891,,,,,,,0,,70450,Radiology,,,,50,Federally Qualified Health Center,3,658.47,557.05,462.43,94.62,0.0,0.0,94.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004629,MBR00000179,Professional,2021-12-19,2021-12-19,2022-01-10,PLN3689,1168881145,1168881145,Orthopedic Surgery,In-Network,E11.9,M54.5,,,,,,,0,,80053,Pathology/Lab,,,,23,Emergency Room,1,109.58,41.45,36.73,0.0,0.0,4.72,4.72,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004630,MBR00000179,Professional,2023-11-06,2023-11-06,2023-12-01,PLN8957,1702692193,1702692193,Physical Therapy,In-Network,N18.3,K21.0,,,,,,,0,,99284,E&M,,,,21,Inpatient Hospital,1,835.56,303.49,0.0,303.49,0.0,0.0,303.49,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000004631,MBR00000179,Professional,2022-03-31,2022-03-31,2022-04-15,PLN7582,1372918899,1372918899,Family Medicine,In-Network,N39.0,Z00.00,,,,,,,0,,93306,Radiology,,,,20,Urgent Care,2,3013.16,2014.95,0.0,79.65,0.0,0.0,79.65,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004632,MBR00000179,Professional,2023-03-31,2023-03-31,2023-04-12,PLN8352,1235381502,1235381502,Cardiology,In-Network,I10,F32.9,,,,,,,0,,66984,Surgery,,,,81,Independent Laboratory,3,3611.42,2296.12,1916.66,0.0,75.0,304.46,379.46,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004633,MBR00000179,Institutional-OP,2021-10-21,2021-10-21,2021-11-20,PLN2556,1520687146,1520687146,ASC,In-Network,I50.9,Z12.31,,,,,,,0,,99233,E&M,,,0270,22,Outpatient Hospital,1,271.45,121.89,71.6,0.0,35.0,15.29,50.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004634,MBR00000179,Institutional-IP,2023-07-02,2023-07-03,2023-07-10,PLN2630,1974006077,1974006077,Orthopedic Surgery,In-Network,Z23,N39.0,,,,872,MS-DRG,18,1,Y,87491,Pathology/Lab,,,0510,21,Inpatient Hospital,2,230.73,141.25,121.02,0.0,0.0,20.23,20.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004635,MBR00000179,Institutional-IP,2021-11-13,2021-11-26,2021-12-10,PLN5659,1337791138,1337791138,Internal Medicine,Out-of-Network,I25.10,F10.20,,,,871,MS-DRG,9,13,Y,99222,E&M,,,0120,21,Inpatient Hospital,2,571.46,480.59,129.88,300.71,50.0,0.0,350.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004636,MBR00000179,Professional,2022-07-11,2022-07-11,2022-08-09,PLN4555,1372918899,1372918899,Family Medicine,In-Network,F03.90,I10,,,,,,,0,,70553,Radiology,,,,22,Outpatient Hospital,1,4034.54,1591.14,1556.14,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004637,MBR00000179,Professional,2023-05-28,2023-05-28,2023-06-19,PLN5212,1564502315,1564502315,ASC,In-Network,E78.5,M54.5,,,,,,,0,,99406,Medicine,,,,21,Inpatient Hospital,1,62.01,39.51,38.67,0.0,0.0,0.84,0.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004638,MBR00000179,Professional,2023-10-12,2023-10-12,2023-10-20,PLN5874,1752470395,1752470395,Home Health,In-Network,J44.1,N39.0,,,,,,,0,,93306,Radiology,,,,11,Office,3,2341.4,844.68,794.68,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004639,MBR00000179,Professional,2023-04-04,2023-04-04,2023-05-05,PLN3619,1334916761,1334916761,ASC,In-Network,G20,E11.9,,,,,,,0,,45380,Surgery,,,,81,Independent Laboratory,2,2573.29,1892.72,1877.72,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000004640,MBR00000179,Professional,2023-01-01,2023-01-01,2023-02-11,PLN3433,1361302520,1361302520,Critical Access Hospital,In-Network,N18.3,Z00.00,,,,,,,0,,27447,Surgery,,,,11,Office,2,2445.97,1428.06,1393.06,0.0,35.0,0.0,35.0,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004641,MBR00000179,Professional,2023-01-29,2023-01-29,2023-02-28,PLN2904,1118885473,1118885473,ASC,In-Network,E11.40,Z00.00,,,,,,,0,,90837,Medicine,,,,11,Office,1,389.06,149.39,149.39,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004642,MBR00000179,Institutional-OP,2022-03-21,2022-03-21,2022-04-01,PLN2851,1899127912,1899127912,Neurology,In-Network,Z12.31,E11.9,,,,,,,0,,71046,Radiology,,,0450,22,Outpatient Hospital,3,262.33,122.33,122.33,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004643,MBR00000179,Institutional-OP,2023-01-23,2023-01-23,2023-02-15,PLN3373,1520687146,1520687146,ASC,In-Network,M54.5,Z23,,,,,,,0,,33533,Surgery,,,0301,22,Outpatient Hospital,3,19897.67,14774.45,14774.45,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000004644,MBR00000179,Institutional-OP,2022-09-22,2022-09-22,2022-11-02,PLN8435,1691062876,1691062876,SNF,In-Network,Z87.891,F41.9,,,,,,,0,,43239,Surgery,,,0301,22,Outpatient Hospital,1,2113.5,1129.82,701.03,428.79,0.0,0.0,428.79,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004645,MBR00000179,Institutional-IP,2022-07-26,2022-08-10,2022-08-20,PLN8859,1752470395,1752470395,Home Health,In-Network,F41.9,K92.1,,,,291,MS-DRG,8,15,Y,84443,Pathology/Lab,,,0450,21,Inpatient Hospital,3,162.06,133.52,45.59,12.93,75.0,0.0,87.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004646,MBR00000179,Institutional-IP,2021-12-10,2021-12-14,2021-12-31,PLN5878,1790497490,1790497490,OB/GYN,In-Network,E11.9,E78.5,,,,872,MS-DRG,13,4,Y,99232,E&M,,,0301,21,Inpatient Hospital,1,376.64,217.36,170.43,0.0,15.0,31.93,46.93,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000004647,MBR00000179,Institutional-IP,2022-01-20,2022-01-29,2022-01-27,PLN4581,1434029575,1434029575,Endocrinology,In-Network,J06.9,Z12.31,,,,682,MS-DRG,11,9,Y,80061,Pathology/Lab,,,0370,21,Inpatient Hospital,2,116.04,68.67,43.67,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004648,MBR00000179,Institutional-IP,2021-05-16,2021-05-21,2021-06-19,PLN2573,1872272835,1872272835,Internal Medicine,In-Network,E11.65,J06.9,,,,196,MS-DRG,11,5,Y,74177,Radiology,,,0370,21,Inpatient Hospital,3,2264.6,895.16,641.69,228.47,25.0,0.0,253.47,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004649,MBR00000179,Professional,2023-02-28,2023-02-28,2023-04-02,PLN7316,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,Z79.4,Z23,,,,,,,0,,99203,E&M,,,,65,End-Stage Renal Disease,1,392.74,309.21,309.21,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004650,MBR00000179,Institutional-OP,2021-01-25,2021-01-25,2021-02-22,PLN1556,1434029575,1434029575,Endocrinology,In-Network,J44.1,J20.9,,,,,,,0,,85025,Pathology/Lab,,,0510,22,Outpatient Hospital,1,54.47,38.83,38.64,0.0,0.0,0.19,0.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004651,MBR00000180,Institutional-OP,2021-05-08,2021-05-08,2021-06-12,PLN2795,1865904917,1865904917,Outpatient Clinic,In-Network,K57.30,K21.0,,,,,,,0,,93000,Radiology,,,0510,22,Outpatient Hospital,1,189.31,69.06,69.06,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004652,MBR00000180,Professional,2021-11-17,2021-11-17,2021-12-21,PLN9672,1453936007,1453936007,ASC,In-Network,F32.9,Z00.00,,,,,,,0,,78452,Radiology,,,,11,Office,1,3823.37,1495.9,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004653,MBR00000180,Professional,2021-06-04,2021-06-04,2021-06-26,PLN1615,1224179551,1224179551,Physical Therapy,In-Network,E66.9,N39.0,,,,,,,0,,72148,Radiology,,,,81,Independent Laboratory,1,1397.88,821.33,432.7,388.63,0.0,0.0,388.63,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004654,MBR00000180,Institutional-OP,2023-04-01,2023-04-01,2023-04-10,PLN7133,1645194539,1645194539,SNF,In-Network,I10,E11.9,,,,,,,0,,90686,Medicine,,,0320,22,Outpatient Hospital,1,134.7,98.1,87.81,0.0,0.0,10.29,10.29,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000004655,MBR00000180,Institutional-OP,2021-05-19,2021-05-19,2021-07-01,PLN9603,1856686341,1856686341,Geriatrics,In-Network,N20.0,N40.0,,,,,,,0,,23472,Surgery,,,0320,22,Outpatient Hospital,2,7000.08,4955.1,3135.65,389.91,0.0,0.0,389.91,1429.54,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004656,MBR00000180,Professional,2022-05-15,2022-05-15,2022-05-30,PLN1854,1795618275,1795618275,Pulmonology,In-Network,I63.9,J06.9,,,,,,,0,,81001,Pathology/Lab,,,,81,Independent Laboratory,3,31.79,10.87,0.0,10.87,0.0,0.0,10.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004657,MBR00000180,Professional,2023-03-14,2023-03-14,2023-04-16,PLN9166,1213165847,1213165847,Critical Access Hospital,In-Network,K57.30,R07.9,,,,,,,0,,27447,Surgery,,,,11,Office,3,3678.51,2500.03,1766.68,0.0,50.0,0.0,50.0,683.35,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004658,MBR00000180,Professional,2022-10-08,2022-10-08,2022-10-30,PLN9955,1896447406,1896447406,Nephrology,Out-of-Network,E87.6,E78.5,,,,,,,0,,80053,Pathology/Lab,,,,20,Urgent Care,2,68.66,57.3,0.0,57.3,0.0,0.0,57.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004659,MBR00000180,Professional,2022-10-10,2022-10-10,2022-11-19,PLN9336,1778483301,1778483301,Home Health,In-Network,E66.9,J06.9,,,,,,,0,,82043,Pathology/Lab,,,,12,Home,1,36.25,22.92,0.0,22.92,0.0,0.0,22.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004660,MBR00000180,Professional,2022-01-12,2022-01-12,2022-02-15,PLN8500,1980712759,1980712759,Outpatient Clinic,Out-of-Network,Z12.31,I10,,,,,,,0,,G0468,Medicine,,,,21,Inpatient Hospital,3,436.56,263.78,0.0,0.0,75.0,0.0,75.0,71.47,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004661,MBR00000180,Professional,2022-05-08,2022-05-08,2022-06-18,PLN1805,1817234602,1817234602,Clinical Laboratory,In-Network,R07.9,I10,,,,,,,0,,74177,Radiology,,,,50,Federally Qualified Health Center,1,1286.95,831.47,701.41,115.06,15.0,0.0,130.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004662,MBR00000180,Professional,2023-04-20,2023-04-20,2023-04-28,PLN8326,1390307371,1390307371,DME Supplier,In-Network,I10,M17.11,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,2,3215.3,1929.19,1168.03,493.67,0.0,267.49,761.16,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004663,MBR00000180,Professional,2022-06-06,2022-06-06,2022-06-26,PLN8200,1915531927,1915531927,Critical Access Hospital,In-Network,F03.90,J20.9,,,,,,,0,,G0444,Medicine,,,,11,Office,1,59.1,24.95,7.38,0.0,15.0,0.0,15.0,2.57,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000004664,MBR00000180,Institutional-OP,2023-02-06,2023-02-06,2023-03-04,PLN6875,1450094833,1450094833,Outpatient Clinic,In-Network,J20.9,N39.0,,,,,,,0,,76700,Radiology,,,0450,22,Outpatient Hospital,2,1277.79,776.15,364.28,336.87,75.0,0.0,411.87,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004665,MBR00000180,Professional,2023-06-26,2023-06-26,2023-07-17,PLN3814,1767011137,1767011137,DME Supplier,In-Network,Z23,I10,,,,,,,0,,78452,Radiology,,,,23,Emergency Room,1,6750.2,4744.78,4709.78,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004666,MBR00000180,Professional,2021-09-26,2021-09-26,2021-10-23,PLN1609,1717546253,1717546253,Family Medicine,In-Network,Z23,I10,,,,,,,0,,86900,Pathology/Lab,,,,12,Home,2,33.16,20.68,19.44,0.0,0.0,0.0,0.0,1.24,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004667,MBR00000180,Professional,2021-05-14,2021-05-14,2021-06-05,PLN2053,1453936007,1453936007,ASC,In-Network,E11.9,E78.5,,,,,,,0,,45380,Surgery,,,,11,Office,2,2961.92,1663.92,1027.06,447.3,25.0,164.56,636.86,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000004668,MBR00000180,Institutional-OP,2022-05-23,2022-05-23,2022-07-04,PLN7761,1860435061,1860435061,DME Supplier,In-Network,E11.65,Z00.01,,,,,,,0,,85025,Pathology/Lab,,,0761,22,Outpatient Hospital,3,33.99,23.05,0.0,0.0,50.0,0.0,50.0,1.27,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004669,MBR00000180,Professional,2022-02-24,2022-02-24,2022-03-15,PLN4668,1118885473,1118885473,ASC,In-Network,I50.9,E78.5,,,,,,,0,,97530,Medicine,,,,11,Office,1,169.91,131.29,131.29,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004670,MBR00000180,Institutional-IP,2021-06-14,2021-06-15,2021-07-22,PLN1904,1624202402,1624202402,Orthopedic Surgery,In-Network,E78.5,R05,,,,194,MS-DRG,12,1,Y,83036,Pathology/Lab,,,0900,21,Inpatient Hospital,2,89.17,26.97,0.0,26.97,0.0,0.0,26.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000004671,MBR00000180,Professional,2023-04-13,2023-04-13,2023-05-12,PLN9520,1799205295,1799205295,General Acute Care Hospital,In-Network,E78.5,I11.9,,,,,,,0,,80053,Pathology/Lab,,,,22,Outpatient Hospital,1,146.67,115.23,40.23,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004672,MBR00000180,Professional,2022-11-15,2022-11-15,2022-12-23,PLN1555,1817234602,1817234602,Clinical Laboratory,In-Network,E11.9,I10,,,,,,,0,,84443,Pathology/Lab,,,,49,Independent Clinic,3,168.57,99.03,74.03,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004673,MBR00000180,Institutional-OP,2022-12-22,2022-12-22,2023-01-26,PLN5581,1809014947,1809014947,Urology,In-Network,E78.5,R51,,,,,,,0,,70450,Radiology,,,0740,22,Outpatient Hospital,1,1552.49,808.79,622.47,141.66,0.0,44.66,186.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004674,MBR00000180,Professional,2023-02-16,2023-02-16,2023-03-21,PLN9860,1453936007,1453936007,ASC,In-Network,K21.0,E11.65,,,,,,,0,,71046,Radiology,,,,11,Office,1,206.54,142.1,0.0,142.1,0.0,0.0,142.1,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004675,MBR00000180,Professional,2022-04-22,2022-04-22,2022-05-31,PLN7904,1660288235,1660288235,ASC,In-Network,J44.1,Z12.31,,,,,,,0,,90837,Medicine,,,,11,Office,3,488.14,413.01,0.0,388.47,75.0,0.0,463.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004676,MBR00000180,Professional,2022-07-13,2022-07-13,2022-08-14,PLN5759,1518055405,1518055405,Urology,In-Network,I10,E11.65,,,,,,,0,,70553,Radiology,,,,50,Federally Qualified Health Center,2,1690.11,779.9,412.13,367.77,0.0,0.0,367.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004677,MBR00000180,Professional,2021-09-03,2021-09-03,2021-10-12,PLN1401,1438368327,1438368327,Home Health,In-Network,I50.9,F41.9,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,2,168.14,124.11,107.42,0.0,0.0,16.69,16.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004678,MBR00000180,Institutional-OP,2023-03-12,2023-03-12,2023-04-17,PLN7117,1186826716,1186826716,Physical Therapy,In-Network,N20.0,I10,,,,,,,0,,99221,E&M,,,0740,22,Outpatient Hospital,2,361.56,288.0,288.0,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004679,MBR00000180,Institutional-IP,2023-11-03,2023-11-08,2023-11-18,PLN6836,1168881145,1168881145,Orthopedic Surgery,In-Network,F10.20,E11.9,,,,603,MS-DRG,17,5,Y,99283,E&M,,,0360,21,Inpatient Hospital,2,303.68,125.27,75.49,0.0,25.0,13.04,38.04,11.74,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004680,MBR00000180,Institutional-OP,2023-08-15,2023-08-15,2023-09-23,PLN2475,1186826716,1186826716,Physical Therapy,In-Network,Z00.00,Z87.891,,,,,,,0,,93000,Radiology,,,0120,22,Outpatient Hospital,1,191.92,149.67,76.85,0.0,50.0,0.28,50.28,22.54,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004681,MBR00000180,Professional,2022-03-23,2022-03-23,2022-04-02,PLN5661,1757138478,1757138478,Pediatrics,In-Network,E66.9,J06.9,,,,,,,0,,99284,E&M,,,,23,Emergency Room,2,640.72,519.87,0.0,451.0,0.0,0.0,451.0,102.78,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004682,MBR00000180,Professional,2021-02-24,2021-02-24,2021-03-05,PLN6942,1778483301,1778483301,Home Health,In-Network,Z00.00,Z00.01,,,,,,,0,,93225,Medicine,,,,22,Outpatient Hospital,3,435.87,274.88,0.0,274.88,0.0,0.0,274.88,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004683,MBR00000181,Institutional-OP,2023-08-20,2023-08-20,2023-09-21,PLN9460,1438368327,1438368327,Home Health,In-Network,I10,E66.9,,,,,,,0,,99232,E&M,,,0301,22,Outpatient Hospital,3,390.39,159.34,159.34,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004684,MBR00000181,Professional,2022-09-22,2022-09-22,2022-10-05,PLN5052,1148984206,1148984206,Psychiatry,In-Network,E11.9,N39.0,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,1,34.41,12.05,10.38,0.0,0.0,1.67,1.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004685,MBR00000181,Institutional-OP,2023-05-02,2023-05-02,2023-06-07,PLN6725,1410468316,1410468316,SNF,In-Network,F41.9,J44.1,,,,,,,0,,90837,Medicine,,,0900,22,Outpatient Hospital,1,276.96,174.86,174.86,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004686,MBR00000181,Institutional-IP,2021-11-26,2021-12-04,2021-12-15,PLN3545,1745114564,1745114564,Endocrinology,In-Network,E66.9,R07.9,,,,683,MS-DRG,16,8,Y,90837,Medicine,,,0730,21,Inpatient Hospital,1,225.55,92.3,92.3,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000004687,MBR00000181,Professional,2023-08-02,2023-08-02,2023-08-13,PLN7647,1511044648,1511044648,Endocrinology,In-Network,E66.9,J06.9,,,,,,,0,,99214,E&M,,,,11,Office,2,440.81,179.25,179.25,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004688,MBR00000181,Institutional-OP,2023-07-07,2023-07-07,2023-07-18,PLN6538,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,M54.5,F10.20,,,,,,,0,,43239,Surgery,,,0270,22,Outpatient Hospital,1,1922.11,1104.53,1089.53,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004689,MBR00000181,Professional,2021-01-19,2021-01-19,2021-02-18,PLN9460,1283743001,1283743001,Family Medicine,In-Network,F41.9,E78.5,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,2,157.03,80.47,0.0,80.47,35.0,0.0,115.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004690,MBR00000181,Institutional-IP,2022-09-11,2022-09-16,2022-09-19,PLN9376,1624202402,1624202402,Orthopedic Surgery,In-Network,I10,I63.9,,,,871,MS-DRG,9,5,Y,97110,Medicine,,,0360,21,Inpatient Hospital,1,181.34,81.04,0.0,81.04,0.0,0.0,81.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004691,MBR00000181,Professional,2022-06-07,2022-06-07,2022-07-04,PLN1190,1500949740,1500949740,Pediatrics,In-Network,Z00.01,Z12.31,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,1,1981.24,1369.5,869.88,464.62,35.0,0.0,499.62,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000004692,MBR00000181,Institutional-IP,2022-12-22,2022-12-27,2023-01-10,PLN1276,1114982472,1114982472,Orthopedic Surgery,In-Network,E11.9,E11.65,,,,690,MS-DRG,5,5,Y,99283,E&M,,,0320,21,Inpatient Hospital,1,517.33,280.48,205.48,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004693,MBR00000181,Professional,2021-10-12,2021-10-12,2021-11-17,PLN9818,1366286000,1366286000,SNF,In-Network,E11.9,F10.20,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,3,2252.94,1328.03,1328.03,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004694,MBR00000181,Professional,2021-04-18,2021-04-18,2021-05-11,PLN1856,1463205530,1463205530,Nephrology,In-Network,N20.0,N18.3,,,,,,,0,,23472,Surgery,,,,11,Office,2,5449.07,2052.68,0.0,24.58,15.0,0.0,39.58,0.0,Denied,CO-50,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004695,MBR00000181,Institutional-OP,2021-10-28,2021-10-28,2021-11-25,PLN8043,1366576336,1366576336,Geriatrics,In-Network,E11.9,Z23,,,,,,,0,,86900,Pathology/Lab,,,0270,22,Outpatient Hospital,3,32.83,25.85,25.85,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004696,MBR00000181,Professional,2022-07-30,2022-07-30,2022-09-02,PLN2425,1980712759,1980712759,Outpatient Clinic,Out-of-Network,I10,I10,,,,,,,0,,97110,Medicine,,,,31,Skilled Nursing Facility,1,125.39,41.02,0.0,41.02,15.0,0.0,56.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004697,MBR00000181,Professional,2021-10-23,2021-10-23,2021-11-06,PLN1258,1450094833,1450094833,Outpatient Clinic,In-Network,E11.40,I50.9,,,,,,,0,,27447,Surgery,,,,11,Office,2,3164.54,2354.61,1989.11,340.5,25.0,0.0,365.5,0.0,Paid,,,0,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000004698,MBR00000181,Professional,2022-05-24,2022-05-24,2022-07-05,PLN7165,1135158374,1135158374,Pulmonology,In-Network,Z12.31,I10,,,,,,,0,,90686,Medicine,,,,20,Urgent Care,1,52.85,19.95,19.95,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000004699,MBR00000181,Institutional-IP,2022-03-03,2022-03-08,2022-04-03,PLN2540,1235381502,1235381502,Cardiology,In-Network,Z00.00,E66.9,,,,872,MS-DRG,9,5,Y,70553,Radiology,,,0510,21,Inpatient Hospital,2,2066.19,1379.9,1276.62,0.0,50.0,53.28,103.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004700,MBR00000181,Professional,2023-01-31,2023-01-31,2023-03-12,PLN4766,1896447406,1896447406,Nephrology,Out-of-Network,E78.5,F32.9,,,,,,,0,,27130,Surgery,,,,21,Inpatient Hospital,2,4990.24,1614.21,1544.46,44.75,25.0,0.0,69.75,0.0,Paid,,,1,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000004701,MBR00000181,Institutional-IP,2022-03-26,2022-04-05,2022-04-26,PLN4803,1799205295,1799205295,General Acute Care Hospital,In-Network,Z23,M54.5,,,,196,MS-DRG,12,10,Y,99214,E&M,,,0761,21,Inpatient Hospital,1,163.65,50.64,0.0,50.64,0.0,0.0,50.64,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000004702,MBR00000181,Institutional-IP,2021-06-08,2021-06-11,2021-07-19,PLN5863,1295371663,1295371663,Critical Access Hospital,In-Network,I63.9,E11.9,,,,690,MS-DRG,11,3,Y,23472,Surgery,,,0200,21,Inpatient Hospital,2,3125.49,1264.28,1264.28,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004703,MBR00000181,Institutional-OP,2022-11-26,2022-11-26,2022-12-23,PLN9034,1622771872,1622771872,Pediatrics,In-Network,I50.9,Z00.00,,,,,,,0,,45380,Surgery,,,0200,22,Outpatient Hospital,3,1170.29,734.24,719.24,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000004704,MBR00000181,Institutional-OP,2021-08-21,2021-08-21,2021-09-10,PLN7593,1964402759,1964402759,Outpatient Clinic,In-Network,N39.0,R05,,,,,,,0,,99283,E&M,,,0301,22,Outpatient Hospital,3,446.27,141.36,116.36,0.0,25.0,0.0,25.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004705,MBR00000181,Institutional-OP,2021-11-25,2021-11-25,2021-12-14,PLN1023,1438368327,1438368327,Home Health,In-Network,Z00.00,N18.3,,,,,,,0,,G0444,Medicine,,,0636,22,Outpatient Hospital,1,37.69,17.33,15.43,0.0,0.0,1.9,1.9,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000004706,MBR00000181,Professional,2023-02-13,2023-02-13,2023-03-12,PLN3034,1334916761,1334916761,ASC,In-Network,E11.9,G43.909,,,,,,,0,,99222,E&M,,,,50,Federally Qualified Health Center,2,449.92,366.55,136.71,229.84,0.0,0.0,229.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004707,MBR00000181,Institutional-OP,2021-10-26,2021-10-26,2021-11-07,PLN6622,1563980627,1563980627,Critical Access Hospital,In-Network,K57.30,I11.9,,,,,,,0,,90837,Medicine,,,0301,22,Outpatient Hospital,2,391.24,240.48,88.27,95.27,50.0,6.94,152.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004708,MBR00000181,Professional,2021-03-09,2021-03-09,2021-04-10,PLN6274,1991459367,1991459367,Neurology,Out-of-Network,E11.9,E11.9,,,,,,,0,,99283,E&M,,,,11,Office,3,317.61,162.08,0.0,162.08,50.0,0.0,212.08,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004709,MBR00000181,Professional,2022-01-30,2022-01-30,2022-02-17,PLN8124,1896447406,1896447406,Nephrology,Out-of-Network,Z00.00,Z12.31,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,3,431.79,142.36,91.55,0.0,50.0,0.81,50.81,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004710,MBR00000181,Professional,2022-03-01,2022-03-01,2022-03-14,PLN2513,1800011727,1800011727,Clinical Laboratory,Out-of-Network,E11.9,F41.9,,,,,,,0,,85025,Pathology/Lab,,,,21,Inpatient Hospital,2,96.64,31.46,0.0,31.46,0.0,0.0,31.46,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004711,MBR00000181,Professional,2023-01-22,2023-01-22,2023-01-30,PLN1376,1896447406,1896447406,Nephrology,Out-of-Network,N40.0,E78.5,,,,,,,0,,97110,Medicine,,,,11,Office,1,282.7,172.81,97.33,25.48,50.0,0.0,75.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004712,MBR00000181,Professional,2023-02-16,2023-02-16,2023-04-01,PLN1132,1994661817,1994661817,SNF,Out-of-Network,G20,Z12.31,,,,,,,0,,99204,E&M,,,,11,Office,2,557.48,473.0,429.65,0.0,0.0,43.35,43.35,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004713,MBR00000181,Professional,2021-01-01,2021-01-01,2021-01-26,PLN8585,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,Z23,F41.9,,,,,,,0,,99232,E&M,,,,49,Independent Clinic,2,159.26,59.7,0.0,40.97,75.0,0.0,115.97,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004714,MBR00000181,Institutional-IP,2023-04-09,2023-04-17,2023-04-27,PLN2891,1702692193,1702692193,Physical Therapy,In-Network,E11.9,N39.0,,,,195,MS-DRG,19,8,N,74177,Radiology,,,0510,21,Inpatient Hospital,2,1598.38,683.48,633.48,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004715,MBR00000181,Institutional-OP,2023-03-29,2023-03-29,2023-04-30,PLN2424,1283743001,1283743001,Family Medicine,In-Network,E66.9,I10,,,,,,,0,,G0468,Medicine,,,0510,22,Outpatient Hospital,2,385.87,320.56,320.56,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004716,MBR00000181,Professional,2021-07-09,2021-07-09,2021-08-15,PLN4919,1575695214,1575695214,SNF,In-Network,I10,G43.909,,,,,,,0,,23472,Surgery,,,,11,Office,3,3625.2,3006.33,2422.25,467.58,0.0,116.5,584.08,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004717,MBR00000181,Professional,2022-01-07,2022-01-07,2022-02-01,PLN2321,1542828721,1542828721,Orthopedic Surgery,In-Network,M54.5,J06.9,,,,,,,0,,93306,Radiology,,,,22,Outpatient Hospital,1,2414.01,1426.13,1401.13,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004718,MBR00000181,Professional,2023-04-20,2023-04-20,2023-05-19,PLN5469,1717912431,1717912431,Oncology,In-Network,M54.5,J20.9,,,,,,,0,,66984,Surgery,,,,31,Skilled Nursing Facility,1,3277.6,2000.79,1642.18,323.61,35.0,0.0,358.61,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004719,MBR00000181,Professional,2022-09-23,2022-09-23,2022-11-04,PLN2583,1542828721,1542828721,Orthopedic Surgery,In-Network,M54.5,J44.1,,,,,,,0,,99222,E&M,,,,11,Office,1,605.35,387.68,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004720,MBR00000181,Institutional-OP,2022-01-07,2022-01-07,2022-02-02,PLN7272,1450553056,1450553056,Clinical Laboratory,In-Network,Z12.31,J06.9,,,,,,,0,,99213,E&M,,,0200,22,Outpatient Hospital,2,162.36,59.37,59.37,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000004721,MBR00000181,Professional,2023-04-14,2023-04-14,2023-04-30,PLN4007,1624202402,1624202402,Orthopedic Surgery,In-Network,E66.9,I50.9,,,,,,,0,,71046,Radiology,,,,11,Office,1,195.62,94.98,94.98,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004722,MBR00000181,Professional,2022-11-23,2022-11-23,2022-12-07,PLN1931,1767011137,1767011137,DME Supplier,In-Network,E11.9,K21.0,,,,,,,0,,97530,Medicine,,,,11,Office,1,273.21,83.06,0.0,83.06,0.0,0.0,83.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004723,MBR00000181,Professional,2022-07-14,2022-07-14,2022-07-22,PLN2537,1609138981,1609138981,Critical Access Hospital,In-Network,M54.5,Z12.31,,,,,,,0,,99213,E&M,,,,11,Office,2,282.74,129.77,129.77,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004724,MBR00000181,Professional,2021-01-07,2021-01-07,2021-01-30,PLN7541,1644128543,1644128543,Gastroenterology,In-Network,J44.1,I10,,,,,,,0,,74177,Radiology,,,,21,Inpatient Hospital,2,2627.05,1453.58,1438.58,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004725,MBR00000181,Professional,2022-12-10,2022-12-10,2022-12-25,PLN1319,1124394415,1124394415,Pediatrics,In-Network,M81.0,Z00.00,,,,,,,0,,84443,Pathology/Lab,,,,81,Independent Laboratory,2,73.84,23.82,0.0,23.82,75.0,0.0,98.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004726,MBR00000181,Institutional-OP,2021-07-17,2021-07-17,2021-08-05,PLN4372,1284035364,1284035364,Pediatrics,In-Network,I25.10,F03.90,,,,,,,0,,99222,E&M,,,0301,22,Outpatient Hospital,2,277.99,132.86,0.0,132.86,0.0,0.0,132.86,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004727,MBR00000181,Institutional-OP,2023-10-05,2023-10-05,2023-10-15,PLN4819,1749327647,1749327647,Geriatrics,In-Network,M54.5,J06.9,,,,,,,0,,45378,Surgery,,,0740,22,Outpatient Hospital,1,2209.09,981.35,431.06,475.29,75.0,0.0,550.29,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000004728,MBR00000181,Professional,2021-07-26,2021-07-26,2021-08-28,PLN2088,1531398223,1531398223,OB/GYN,In-Network,Z00.00,N39.0,,,,,,,0,,90837,Medicine,,,,81,Independent Laboratory,2,430.33,338.72,275.98,1.74,25.0,36.0,62.74,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000004729,MBR00000181,Institutional-IP,2021-02-02,2021-02-04,2021-02-20,PLN9550,1355166277,1355166277,Endocrinology,In-Network,F32.9,N39.0,,,,683,MS-DRG,3,2,Y,58661,Surgery,,,0301,21,Inpatient Hospital,1,4342.67,1508.22,1473.22,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004730,MBR00000181,Institutional-OP,2022-02-16,2022-02-16,2022-02-27,PLN3094,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,J20.9,F41.9,,,,,,,0,,99222,E&M,,,0740,22,Outpatient Hospital,2,641.87,299.72,249.72,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004731,MBR00000181,Professional,2022-01-18,2022-01-18,2022-02-12,PLN5328,1334916761,1334916761,ASC,In-Network,M54.5,E78.5,,,,,,,0,,99204,E&M,,,,20,Urgent Care,3,586.32,456.2,0.0,456.2,35.0,0.0,491.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004732,MBR00000182,Institutional-OP,2022-01-21,2022-01-21,2022-03-03,PLN6415,1266606767,1266606767,ASC,In-Network,J44.1,J06.9,,,,,,,0,,72148,Radiology,,,0270,22,Outpatient Hospital,1,2002.12,1173.46,869.09,279.37,25.0,0.0,304.37,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004733,MBR00000182,Institutional-IP,2023-10-12,2023-10-20,2023-10-30,PLN8416,1689639685,1689639685,SNF,In-Network,Z79.4,E11.9,,,,682,MS-DRG,10,8,Y,27130,Surgery,,,0360,21,Inpatient Hospital,1,6495.54,2892.75,2728.11,0.0,0.0,164.64,164.64,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004734,MBR00000182,Institutional-OP,2021-10-28,2021-10-28,2021-11-14,PLN2813,1609138981,1609138981,Critical Access Hospital,In-Network,Z00.00,E11.9,,,,,,,0,,90460,Medicine,,,0636,22,Outpatient Hospital,1,45.96,31.48,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004735,MBR00000182,Professional,2023-07-06,2023-07-06,2023-07-21,PLN9208,1590915516,1590915516,Physical Therapy,Out-of-Network,F10.20,K21.0,,,,,,,0,,78452,Radiology,,,,11,Office,3,6639.67,3668.18,3618.18,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004736,MBR00000182,Institutional-OP,2021-06-28,2021-06-28,2021-07-14,PLN4724,1542828721,1542828721,Orthopedic Surgery,In-Network,I25.10,Z87.891,,,,,,,0,,99221,E&M,,,0740,22,Outpatient Hospital,2,374.78,115.99,0.0,115.99,0.0,0.0,115.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004737,MBR00000182,Institutional-OP,2022-11-07,2022-11-07,2022-11-24,PLN9313,1812060197,1812060197,Oncology,Out-of-Network,J06.9,E11.9,,,,,,,0,,99284,E&M,,,0301,22,Outpatient Hospital,2,653.1,391.82,259.41,132.41,0.0,0.0,132.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004738,MBR00000182,Institutional-IP,2021-05-24,2021-05-29,2021-06-08,PLN2981,1364429278,1364429278,OB/GYN,In-Network,G43.909,I10,,,,196,MS-DRG,11,5,Y,90837,Medicine,,,0120,21,Inpatient Hospital,2,302.05,101.33,0.0,101.33,50.0,0.0,151.33,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004739,MBR00000182,Professional,2021-09-09,2021-09-09,2021-09-20,PLN8336,1795618275,1795618275,Pulmonology,In-Network,Z87.891,I48.91,,,,,,,0,,80053,Pathology/Lab,,,,31,Skilled Nursing Facility,3,140.92,51.19,51.19,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004740,MBR00000182,Professional,2021-06-12,2021-06-12,2021-06-22,PLN9395,1700633438,1700633438,DME Supplier,In-Network,N40.0,Z12.31,,,,,,,0,,71046,Radiology,,,,20,Urgent Care,1,278.23,194.2,0.0,194.2,0.0,0.0,194.2,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004741,MBR00000182,Institutional-OP,2021-12-28,2021-12-28,2022-01-08,PLN7328,1609138981,1609138981,Critical Access Hospital,In-Network,E78.5,N39.0,,,,,,,0,,47562,Surgery,,,0200,22,Outpatient Hospital,2,4894.42,3390.15,3131.42,44.64,0.0,214.09,258.73,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004742,MBR00000182,Institutional-IP,2022-05-19,2022-05-22,2022-06-09,PLN2291,1410468316,1410468316,SNF,In-Network,J20.9,F41.9,,,,195,MS-DRG,23,3,U,99233,E&M,,,0370,21,Inpatient Hospital,3,416.79,214.38,189.38,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004743,MBR00000182,Institutional-OP,2023-07-29,2023-07-29,2023-09-04,PLN3747,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,F41.9,G43.909,,,,,,,0,,70553,Radiology,,,0200,22,Outpatient Hospital,1,2115.12,899.51,864.51,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004744,MBR00000182,Professional,2023-04-09,2023-04-09,2023-05-16,PLN5151,1915531927,1915531927,Critical Access Hospital,In-Network,M54.5,M81.0,,,,,,,0,,99233,E&M,,,,11,Office,3,405.66,128.15,37.93,90.22,0.0,0.0,90.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004745,MBR00000182,Professional,2023-02-04,2023-02-04,2023-02-28,PLN5573,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,I10,R51,,,,,,,0,,82043,Pathology/Lab,,,,22,Outpatient Hospital,3,35.49,25.02,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004746,MBR00000182,Institutional-OP,2022-06-20,2022-06-20,2022-07-26,PLN8972,1689639685,1689639685,SNF,In-Network,R07.9,Z23,,,,,,,0,,90460,Medicine,,,0200,22,Outpatient Hospital,3,35.8,24.46,0.0,24.46,50.0,0.0,74.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004747,MBR00000182,Institutional-OP,2021-11-09,2021-11-09,2021-12-12,PLN2525,1511044648,1511044648,Endocrinology,In-Network,I10,Z00.00,,,,,,,0,,99406,Medicine,,,0360,22,Outpatient Hospital,1,64.91,46.72,46.72,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004748,MBR00000182,Professional,2021-11-21,2021-11-21,2021-12-02,PLN9067,1696843572,1696843572,Critical Access Hospital,Out-of-Network,K21.0,J20.9,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,2,610.62,219.47,0.0,219.47,35.0,0.0,254.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004749,MBR00000182,Institutional-OP,2021-05-25,2021-05-25,2021-06-13,PLN8157,1840431511,1840431511,Geriatrics,Out-of-Network,E78.5,M54.5,,,,,,,0,,45378,Surgery,,,0636,22,Outpatient Hospital,2,1859.53,609.95,594.95,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000004750,MBR00000182,Professional,2022-12-29,2022-12-29,2023-01-09,PLN2571,1728018911,1728018911,Nephrology,In-Network,E66.9,E78.5,,,,,,,0,,70450,Radiology,,,,21,Inpatient Hospital,1,1374.2,565.83,89.72,426.11,50.0,0.0,476.11,0.0,Pended,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004751,MBR00000182,Professional,2023-05-05,2023-05-05,2023-06-09,PLN6460,1244186984,1244186984,Family Medicine,Out-of-Network,F41.9,E66.9,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,3,4554.9,3362.3,2828.86,498.44,35.0,0.0,533.44,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004752,MBR00000182,Professional,2022-08-23,2022-08-23,2022-09-22,PLN3302,1540044947,1540044947,Pulmonology,Out-of-Network,I10,M54.5,,,,,,,0,,93000,Radiology,,,,11,Office,3,104.13,40.24,40.24,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004753,MBR00000182,Professional,2022-09-23,2022-09-23,2022-10-06,PLN5710,1366286000,1366286000,SNF,In-Network,I10,N39.0,,,,,,,0,,27130,Surgery,,,,23,Emergency Room,2,3376.16,2132.36,2082.36,0.0,50.0,0.0,50.0,0.0,Pended,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004754,MBR00000182,Institutional-IP,2022-02-12,2022-02-14,2022-02-19,PLN8033,1624802371,1624802371,ASC,Out-of-Network,M54.5,I10,,,,603,MS-DRG,9,2,N,99222,E&M,,,0270,21,Inpatient Hospital,1,644.67,420.99,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004755,MBR00000182,Professional,2023-11-21,2023-11-21,2023-12-18,PLN9403,1689639685,1689639685,SNF,In-Network,N39.0,Z79.4,,,,,,,0,,99203,E&M,,,,21,Inpatient Hospital,1,247.82,180.69,174.31,0.0,0.0,6.38,6.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004756,MBR00000182,Institutional-OP,2023-08-30,2023-08-30,2023-09-06,PLN8774,1108115157,1108115157,General Acute Care Hospital,In-Network,J44.1,F41.9,,,,,,,0,,74177,Radiology,,,0200,22,Outpatient Hospital,1,1956.57,591.56,500.42,0.0,0.0,91.14,91.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004757,MBR00000182,Professional,2022-03-22,2022-03-22,2022-04-21,PLN6510,1361302520,1361302520,Critical Access Hospital,In-Network,K92.1,J06.9,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,3,42.67,27.61,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004758,MBR00000182,Institutional-IP,2023-04-07,2023-04-11,2023-04-17,PLN4701,1631954542,1631954542,Oncology,In-Network,M54.5,E78.5,,,,292,MS-DRG,11,4,Y,99214,E&M,,,0360,21,Inpatient Hospital,3,323.62,261.67,193.89,0.0,35.0,32.78,67.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004759,MBR00000182,Professional,2022-01-18,2022-01-18,2022-02-04,PLN9733,1366576336,1366576336,Geriatrics,In-Network,I48.91,E11.9,,,,,,,0,,66984,Surgery,,,,81,Independent Laboratory,3,3525.01,1941.98,1891.98,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004760,MBR00000182,Professional,2021-05-16,2021-05-16,2021-06-17,PLN4776,1198133277,1198133277,SNF,In-Network,E11.9,J20.9,,,,,,,0,,99213,E&M,,,,11,Office,3,271.01,192.42,192.42,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004761,MBR00000182,Institutional-IP,2021-11-15,2021-11-17,2021-12-25,PLN1137,1244186984,1244186984,Family Medicine,Out-of-Network,E87.6,E11.9,,,,196,MS-DRG,16,2,Y,90460,Medicine,,,0730,21,Inpatient Hospital,1,64.59,33.24,0.0,33.24,50.0,0.0,83.24,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004762,MBR00000182,Institutional-OP,2023-07-03,2023-07-03,2023-08-07,PLN3969,1453283987,1453283987,Critical Access Hospital,In-Network,Z12.31,J06.9,,,,,,,0,,43239,Surgery,,,0270,22,Outpatient Hospital,3,2065.86,768.26,236.43,456.83,75.0,0.0,531.83,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004763,MBR00000182,Institutional-OP,2022-06-12,2022-06-12,2022-06-21,PLN1636,1717546253,1717546253,Family Medicine,In-Network,M81.0,Z12.31,,,,,,,0,,45380,Surgery,,,0320,22,Outpatient Hospital,1,2940.98,1441.81,1406.81,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000004764,MBR00000182,Professional,2023-08-06,2023-08-06,2023-08-28,PLN3974,1800011727,1800011727,Clinical Laboratory,Out-of-Network,E11.9,Z23,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,3,132.85,90.64,58.44,0.0,25.0,7.2,32.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004765,MBR00000182,Professional,2021-12-20,2021-12-20,2022-01-29,PLN7753,1716521444,1716521444,Oncology,In-Network,K21.0,M54.5,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,3,371.56,130.32,80.32,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004766,MBR00000182,Professional,2022-05-19,2022-05-19,2022-07-02,PLN8494,1915531927,1915531927,Critical Access Hospital,In-Network,N39.0,I48.91,,,,,,,0,,99284,E&M,,,,20,Urgent Care,2,902.21,485.25,410.84,0.0,0.0,74.41,74.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004767,MBR00000182,Professional,2021-03-22,2021-03-22,2021-04-28,PLN3904,1219817751,1219817751,OB/GYN,In-Network,J20.9,K21.0,,,,,,,0,,90686,Medicine,,,,11,Office,3,74.63,24.82,9.82,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000004768,MBR00000182,Professional,2023-05-06,2023-05-06,2023-06-06,PLN4210,1528335731,1528335731,Critical Access Hospital,In-Network,E11.40,I10,,,,,,,0,,70450,Radiology,,,,23,Emergency Room,2,1410.0,1101.12,1051.12,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004769,MBR00000182,Institutional-OP,2021-12-08,2021-12-08,2022-01-05,PLN3540,1564502315,1564502315,ASC,In-Network,I25.10,I25.10,,,,,,,0,,66984,Surgery,,,0450,22,Outpatient Hospital,3,1976.7,1571.15,1203.48,367.67,0.0,0.0,367.67,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004770,MBR00000182,Institutional-IP,2021-04-10,2021-04-14,2021-04-17,PLN7866,1518055405,1518055405,Urology,In-Network,E11.9,E78.5,,,,690,MS-DRG,14,4,Y,70450,Radiology,,,0270,21,Inpatient Hospital,1,893.7,477.34,477.34,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000004771,MBR00000182,Professional,2021-08-28,2021-08-28,2021-10-09,PLN3077,1790497490,1790497490,OB/GYN,In-Network,E78.5,E78.5,,,,,,,0,,70553,Radiology,,,,50,Federally Qualified Health Center,1,2076.53,1047.17,745.59,301.58,0.0,0.0,301.58,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004772,MBR00000182,Institutional-OP,2022-12-30,2022-12-30,2023-01-20,PLN7474,1563980627,1563980627,Critical Access Hospital,In-Network,Z12.31,Z12.31,,,,,,,0,,99284,E&M,,,0270,22,Outpatient Hospital,3,645.39,480.87,480.87,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004773,MBR00000182,Institutional-IP,2023-06-12,2023-06-14,2023-07-26,PLN5350,1624202402,1624202402,Orthopedic Surgery,In-Network,J06.9,I25.10,,,,603,MS-DRG,15,2,Y,90460,Medicine,,,0740,21,Inpatient Hospital,1,60.97,47.66,0.0,47.66,0.0,0.0,47.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004774,MBR00000182,Professional,2023-11-12,2023-11-12,2023-12-14,PLN3539,1717912431,1717912431,Oncology,In-Network,Z23,I10,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,3,1818.13,1177.47,734.26,349.18,75.0,19.03,443.21,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000004775,MBR00000182,Institutional-OP,2021-09-15,2021-09-15,2021-09-28,PLN4979,1790497490,1790497490,OB/GYN,In-Network,K21.0,Z23,,,,,,,0,,33533,Surgery,,,0200,22,Outpatient Hospital,3,14949.58,11785.09,10054.33,436.85,50.0,1243.91,1730.76,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000004776,MBR00000182,Institutional-IP,2022-10-09,2022-10-15,2022-11-17,PLN5261,1609138981,1609138981,Critical Access Hospital,In-Network,R07.9,E66.9,,,,195,MS-DRG,6,6,Y,99203,E&M,,,0270,21,Inpatient Hospital,2,280.33,162.77,162.77,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004777,MBR00000182,Professional,2022-05-18,2022-05-18,2022-06-24,PLN9811,1450094833,1450094833,Outpatient Clinic,In-Network,Z23,Z12.31,,,,,,,0,,27130,Surgery,,,,11,Office,1,4167.76,1585.9,1291.47,219.43,75.0,0.0,294.43,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004778,MBR00000182,Professional,2023-02-23,2023-02-23,2023-04-08,PLN9008,1219817751,1219817751,OB/GYN,In-Network,K92.1,I48.91,,,,,,,0,,72148,Radiology,,,,11,Office,1,1420.71,1204.4,1204.4,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004779,MBR00000182,Professional,2023-01-07,2023-01-07,2023-02-06,PLN6405,1812060197,1812060197,Oncology,Out-of-Network,I63.9,M54.5,,,,,,,0,,58661,Surgery,,,,11,Office,2,2188.06,1733.62,1142.1,433.32,0.0,158.2,591.52,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004780,MBR00000183,Professional,2021-03-18,2021-03-18,2021-04-17,PLN4524,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,J44.1,Z23,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,2,81.54,60.98,0.0,60.98,0.0,0.0,60.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000004781,MBR00000183,Institutional-OP,2021-06-13,2021-06-13,2021-07-06,PLN4845,1366576336,1366576336,Geriatrics,In-Network,G43.909,F32.9,,,,,,,0,,23472,Surgery,,,0360,22,Outpatient Hospital,1,4739.61,3764.37,3541.27,198.1,25.0,0.0,223.1,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004782,MBR00000183,Professional,2022-10-09,2022-10-09,2022-11-15,PLN3215,1205377316,1205377316,Orthopedic Surgery,In-Network,M81.0,E11.9,,,,,,,0,,77067,Radiology,,,,20,Urgent Care,3,457.32,137.81,102.41,0.0,25.0,10.4,35.4,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000004783,MBR00000183,Professional,2022-08-05,2022-08-05,2022-09-03,PLN2705,1609138981,1609138981,Critical Access Hospital,In-Network,M54.5,E66.9,,,,,,,0,,99203,E&M,,,,11,Office,3,220.11,186.47,0.0,186.47,35.0,0.0,221.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004784,MBR00000183,Institutional-OP,2023-08-28,2023-08-28,2023-09-13,PLN2162,1644128543,1644128543,Gastroenterology,In-Network,N20.0,Z00.00,,,,,,,0,,97530,Medicine,,,0510,22,Outpatient Hospital,2,201.11,108.53,42.33,42.25,15.0,8.95,66.2,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004785,MBR00000183,Institutional-OP,2023-07-17,2023-07-17,2023-08-28,PLN4236,1946680931,1946680931,Critical Access Hospital,Out-of-Network,M54.5,M17.11,,,,,,,0,,84443,Pathology/Lab,,,0730,22,Outpatient Hospital,3,89.92,28.43,0.0,28.43,75.0,0.0,103.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004786,MBR00000183,Institutional-OP,2021-03-06,2021-03-06,2021-04-05,PLN1946,1717546253,1717546253,Family Medicine,In-Network,Z12.31,F10.20,,,,,,,0,,99283,E&M,,,0636,22,Outpatient Hospital,3,408.28,267.73,0.0,267.73,75.0,0.0,342.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004787,MBR00000183,Institutional-OP,2022-10-02,2022-10-02,2022-10-25,PLN6148,1757138478,1757138478,Pediatrics,In-Network,I50.9,E11.9,,,,,,,0,,99222,E&M,,,0761,22,Outpatient Hospital,3,320.49,113.81,113.81,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004788,MBR00000183,Institutional-OP,2022-03-22,2022-03-22,2022-04-05,PLN7602,1283743001,1283743001,Family Medicine,In-Network,J06.9,I48.91,,,,,,,0,,99203,E&M,,,0320,22,Outpatient Hospital,1,301.76,138.14,126.9,0.0,0.0,11.24,11.24,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004789,MBR00000183,Institutional-OP,2022-06-13,2022-06-13,2022-07-17,PLN9243,1361302520,1361302520,Critical Access Hospital,In-Network,Z00.00,E78.5,,,,,,,0,,99232,E&M,,,0120,22,Outpatient Hospital,1,370.22,177.27,0.0,177.27,15.0,0.0,192.27,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004790,MBR00000183,Professional,2021-03-12,2021-03-12,2021-03-28,PLN2814,1247341320,1247341320,Urology,Out-of-Network,I10,N20.0,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,1,106.71,84.19,0.0,84.19,0.0,0.0,84.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004791,MBR00000183,Professional,2023-07-08,2023-07-08,2023-08-08,PLN4447,1896447406,1896447406,Nephrology,Out-of-Network,M54.5,M54.5,,,,,,,0,,99214,E&M,,,,81,Independent Laboratory,3,437.9,295.25,259.83,0.0,0.0,35.42,35.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004792,MBR00000183,Professional,2021-06-30,2021-06-30,2021-08-08,PLN6287,1273488618,1273488618,General Acute Care Hospital,In-Network,E11.9,J06.9,,,,,,,0,,99214,E&M,,,,50,Federally Qualified Health Center,2,448.93,372.38,0.0,372.38,0.0,0.0,372.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004793,MBR00000183,Professional,2023-11-04,2023-11-04,2023-11-23,PLN6020,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,I10,K57.30,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,1,3224.39,1008.99,916.06,92.93,0.0,0.0,92.93,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004794,MBR00000183,Professional,2023-10-17,2023-10-17,2023-10-26,PLN4372,1585582070,1585582070,Outpatient Clinic,In-Network,I10,K21.0,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,1,178.64,136.27,60.83,73.88,0.0,1.56,75.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004795,MBR00000183,Professional,2023-06-18,2023-06-18,2023-07-08,PLN8168,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,J44.1,I48.91,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,3,377.65,149.25,0.0,149.25,50.0,0.0,199.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004796,MBR00000183,Professional,2021-05-09,2021-05-09,2021-05-31,PLN2106,1434029575,1434029575,Endocrinology,In-Network,I10,E78.5,,,,,,,0,,82043,Pathology/Lab,,,,21,Inpatient Hospital,3,35.95,17.07,17.07,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004797,MBR00000183,Institutional-IP,2022-03-24,2022-03-25,2022-04-09,PLN7719,1511044648,1511044648,Endocrinology,In-Network,I48.91,F41.9,,,,196,MS-DRG,16,1,N,90837,Medicine,,,0360,21,Inpatient Hospital,2,192.3,148.13,148.13,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004798,MBR00000183,Professional,2021-01-27,2021-01-27,2021-02-13,PLN4689,1696843572,1696843572,Critical Access Hospital,Out-of-Network,E66.9,E11.40,,,,,,,0,,23472,Surgery,,,,11,Office,2,3261.83,1075.41,1000.41,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004799,MBR00000183,Professional,2022-11-01,2022-11-01,2022-11-08,PLN5027,1575695214,1575695214,SNF,In-Network,E11.65,N39.0,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,3,97.05,82.02,7.02,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000004800,MBR00000184,Institutional-IP,2023-08-05,2023-08-08,2023-09-09,PLN8057,1361302520,1361302520,Critical Access Hospital,In-Network,E11.9,J18.9,,,,872,MS-DRG,15,3,Y,87491,Pathology/Lab,,,0740,21,Inpatient Hospital,1,227.57,148.93,123.93,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004801,MBR00000184,Professional,2022-07-31,2022-07-31,2022-09-06,PLN2995,1700633438,1700633438,DME Supplier,In-Network,J20.9,E11.40,,,,,,,0,,99233,E&M,,,,31,Skilled Nursing Facility,2,440.58,247.55,197.55,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004802,MBR00000184,Professional,2021-01-26,2021-01-26,2021-02-08,PLN4515,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,Z12.31,E11.65,,,,,,,0,,87491,Pathology/Lab,,,,23,Emergency Room,2,149.33,124.97,0.0,124.97,25.0,0.0,149.97,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004803,MBR00000184,Professional,2021-11-29,2021-11-29,2021-12-15,PLN7707,1644128543,1644128543,Gastroenterology,In-Network,R10.9,Z87.891,,,,,,,0,,84443,Pathology/Lab,,,,49,Independent Clinic,2,86.0,54.79,0.0,54.79,75.0,0.0,129.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004804,MBR00000184,Institutional-IP,2021-07-06,2021-07-08,2021-07-25,PLN8844,1500037969,1500037969,Pulmonology,In-Network,Z00.00,I10,,,,690,MS-DRG,12,2,Y,86900,Pathology/Lab,,,0301,21,Inpatient Hospital,2,37.95,16.35,0.0,16.35,0.0,0.0,16.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004805,MBR00000184,Institutional-OP,2022-04-22,2022-04-22,2022-05-27,PLN5586,1809014947,1809014947,Urology,In-Network,E11.9,E11.9,,,,,,,0,,23472,Surgery,,,0636,22,Outpatient Hospital,1,4097.58,2696.02,2661.02,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004806,MBR00000184,Professional,2022-02-12,2022-02-12,2022-03-23,PLN8772,1809014947,1809014947,Urology,In-Network,Z12.31,I48.91,,,,,,,0,,47562,Surgery,,,,12,Home,3,6192.59,2134.4,1338.74,474.96,75.0,245.7,795.66,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004807,MBR00000184,Institutional-OP,2023-06-28,2023-06-28,2023-07-11,PLN2679,1968299309,1968299309,Internal Medicine,In-Network,J45.20,E11.40,,,,,,,0,,99232,E&M,,,0761,22,Outpatient Hospital,2,358.27,285.34,0.0,285.34,75.0,0.0,360.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004808,MBR00000184,Institutional-OP,2021-08-31,2021-08-31,2021-09-28,PLN6311,1860435061,1860435061,DME Supplier,In-Network,Z00.00,E78.5,,,,,,,0,,80053,Pathology/Lab,,,0510,22,Outpatient Hospital,1,64.88,42.56,0.0,42.56,25.0,0.0,67.56,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004809,MBR00000184,Institutional-OP,2021-11-26,2021-11-26,2021-12-24,PLN1760,1745114564,1745114564,Endocrinology,In-Network,Z00.00,N40.0,,,,,,,0,,80061,Pathology/Lab,,,0360,22,Outpatient Hospital,2,101.15,66.32,51.32,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004810,MBR00000184,Institutional-OP,2021-09-18,2021-09-18,2021-10-18,PLN9303,1991459367,1991459367,Neurology,Out-of-Network,Z12.31,Z00.00,,,,,,,0,,76700,Radiology,,,0510,22,Outpatient Hospital,3,940.39,516.33,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004811,MBR00000185,Institutional-IP,2023-09-02,2023-09-08,2023-10-07,PLN2204,1556140803,1556140803,Cardiology,In-Network,E87.6,I10,,,,683,MS-DRG,6,6,Y,83036,Pathology/Lab,,,0270,21,Inpatient Hospital,2,91.45,68.3,53.3,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000004812,MBR00000185,Professional,2021-11-19,2021-11-19,2021-12-12,PLN9138,1422747896,1422747896,Urology,In-Network,E78.5,Z12.31,,,,,,,0,,99222,E&M,,,,49,Independent Clinic,2,441.5,318.74,92.73,226.01,0.0,0.0,226.01,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004813,MBR00000185,Professional,2023-12-22,2023-12-22,2024-01-14,PLN2354,1268679390,1268679390,Critical Access Hospital,In-Network,B97.89,I10,,,,,,,0,,66984,Surgery,,,,49,Independent Clinic,2,1742.95,1078.33,1063.33,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004814,MBR00000185,Professional,2022-12-31,2022-12-31,2023-02-13,PLN3579,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,Z12.11,Z12.31,,,,,,,0,,33533,Surgery,,,,11,Office,3,17963.02,10251.94,10201.94,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,1,1,0,1,Unbundling,0,0,0,0,0
CLM0000004815,MBR00000185,Professional,2021-12-02,2021-12-02,2021-12-20,PLN5951,1410468316,1410468316,SNF,In-Network,E11.65,Z00.00,,,,,,,0,,93000,Radiology,,,,11,Office,1,187.83,100.37,12.21,53.16,35.0,0.0,88.16,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004816,MBR00000185,Institutional-OP,2022-10-13,2022-10-13,2022-11-22,PLN2115,1564502315,1564502315,ASC,In-Network,I10,M17.11,,,,,,,0,,99204,E&M,,,0200,22,Outpatient Hospital,1,481.72,372.07,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004817,MBR00000185,Professional,2021-05-15,2021-05-15,2021-05-30,PLN8996,1103747954,1103747954,Urology,In-Network,I11.9,E78.5,,,,,,,0,,99203,E&M,,,,20,Urgent Care,3,153.09,124.31,89.01,0.0,15.0,20.3,35.3,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004818,MBR00000185,Professional,2023-09-17,2023-09-17,2023-10-02,PLN1800,1860435061,1860435061,DME Supplier,In-Network,E78.5,N39.0,,,,,,,0,,99222,E&M,,,,11,Office,1,484.92,326.78,33.44,253.13,35.0,5.21,293.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004819,MBR00000185,Institutional-OP,2023-11-15,2023-11-15,2023-11-25,PLN2778,1622771872,1622771872,Pediatrics,In-Network,F41.9,J06.9,,,,,,,0,,45378,Surgery,,,0301,22,Outpatient Hospital,3,1244.0,1044.8,994.8,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000004820,MBR00000185,Professional,2021-11-18,2021-11-18,2021-12-06,PLN5989,1872613201,1872613201,Internal Medicine,In-Network,J44.1,E78.5,,,,,,,0,,G0444,Medicine,,,,20,Urgent Care,3,84.39,69.92,0.0,69.92,0.0,0.0,69.92,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000004821,MBR00000185,Professional,2021-07-07,2021-07-07,2021-08-17,PLN1535,1313212303,1313212303,Family Medicine,In-Network,Z87.891,I10,,,,,,,0,,99204,E&M,,,,11,Office,1,323.2,202.95,165.86,0.0,0.0,37.09,37.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004822,MBR00000185,Professional,2022-04-15,2022-04-15,2022-05-22,PLN3474,1422747896,1422747896,Urology,In-Network,Z12.11,K21.0,,,,,,,0,,90837,Medicine,,,,11,Office,3,489.86,277.52,194.32,0.0,75.0,8.2,83.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004823,MBR00000185,Professional,2023-04-25,2023-04-25,2023-05-06,PLN5245,1453936007,1453936007,ASC,In-Network,I11.9,I10,,,,,,,0,,72148,Radiology,,,,50,Federally Qualified Health Center,2,1346.29,789.65,738.87,0.0,0.0,50.78,50.78,0.0,Paid,,,1,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000004824,MBR00000185,Professional,2022-11-18,2022-11-18,2022-12-11,PLN2998,1645194539,1645194539,SNF,In-Network,E78.5,E87.6,,,,,,,0,,90460,Medicine,,,,31,Skilled Nursing Facility,2,67.23,35.75,0.0,35.75,0.0,0.0,35.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004825,MBR00000185,Professional,2021-02-12,2021-02-12,2021-02-21,PLN2156,1502838586,1502838586,ASC,In-Network,I10,Z23,,,,,,,0,,80061,Pathology/Lab,,,,22,Outpatient Hospital,2,52.76,40.02,0.0,40.02,0.0,0.0,40.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004826,MBR00000185,Institutional-IP,2021-01-10,2021-01-16,2021-01-18,PLN1244,1518055405,1518055405,Urology,In-Network,R07.9,E11.9,,,,641,MS-DRG,12,6,Y,33533,Surgery,,,0301,21,Inpatient Hospital,1,18697.13,12907.82,12907.82,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,1,0,1,Phantom,0,0,0,0,0
CLM0000004827,MBR00000185,Professional,2021-09-15,2021-09-15,2021-10-28,PLN2165,1946680931,1946680931,Critical Access Hospital,Out-of-Network,I10,I10,,,,,,,0,,66984,Surgery,,,,65,End-Stage Renal Disease,2,2793.98,1754.86,0.0,10.27,75.0,0.0,85.27,0.0,Denied,PR-1,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004828,MBR00000185,Institutional-IP,2023-04-07,2023-04-14,2023-04-29,PLN5202,1767011137,1767011137,DME Supplier,In-Network,N39.0,I10,,,,683,MS-DRG,11,7,Y,99213,E&M,,,0740,21,Inpatient Hospital,1,220.46,164.37,156.23,0.0,0.0,8.14,8.14,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004829,MBR00000185,Professional,2021-10-12,2021-10-12,2021-11-19,PLN5108,1247341320,1247341320,Urology,Out-of-Network,I10,E11.9,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,3,3968.32,2503.44,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004830,MBR00000185,Professional,2023-09-07,2023-09-07,2023-09-25,PLN2107,1236418230,1236418230,DME Supplier,In-Network,J06.9,J45.20,,,,,,,0,,47562,Surgery,,,,20,Urgent Care,1,3350.58,2681.63,2451.54,230.09,0.0,0.0,230.09,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004831,MBR00000185,Professional,2021-11-22,2021-11-22,2021-12-01,PLN8464,1891849440,1891849440,Oncology,In-Network,N39.0,Z00.00,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,3,62.61,19.28,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004832,MBR00000185,Institutional-OP,2023-09-05,2023-09-05,2023-10-09,PLN1254,1148984206,1148984206,Psychiatry,In-Network,Z87.891,F41.9,,,,,,,0,,74177,Radiology,,,0360,22,Outpatient Hospital,3,1709.93,1021.75,906.84,114.91,0.0,0.0,114.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004833,MBR00000185,Institutional-IP,2023-10-04,2023-10-05,2023-10-17,PLN1684,1433937353,1433937353,Nephrology,In-Network,I11.9,J06.9,,,,292,MS-DRG,4,1,N,99213,E&M,,,0360,21,Inpatient Hospital,2,233.27,167.9,38.27,129.63,0.0,0.0,129.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004834,MBR00000185,Professional,2023-03-08,2023-03-08,2023-04-15,PLN4691,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,R07.9,I48.91,,,,,,,0,,99233,E&M,,,,12,Home,1,555.86,421.12,352.12,0.0,0.0,69.0,69.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004835,MBR00000185,Institutional-IP,2021-07-11,2021-07-16,2021-08-23,PLN6965,1213165847,1213165847,Critical Access Hospital,In-Network,F32.9,N18.3,,,,872,MS-DRG,12,5,Y,87491,Pathology/Lab,,,0761,21,Inpatient Hospital,1,118.97,66.36,66.36,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004836,MBR00000185,Professional,2021-03-20,2021-03-20,2021-04-17,PLN3793,1550154147,1550154147,Outpatient Clinic,In-Network,Z23,Z00.00,,,,,,,0,,47562,Surgery,,,,11,Office,1,4577.95,2061.47,2046.47,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004837,MBR00000185,Institutional-OP,2021-07-10,2021-07-10,2021-07-26,PLN1938,1124394415,1124394415,Pediatrics,In-Network,N39.0,Z12.31,,,,,,,0,,99213,E&M,,,0450,22,Outpatient Hospital,3,296.05,125.13,110.13,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004838,MBR00000185,Institutional-OP,2022-11-24,2022-11-24,2022-12-03,PLN3849,1132188260,1132188260,Family Medicine,In-Network,M54.5,K21.0,,,,,,,0,,87491,Pathology/Lab,,,0301,22,Outpatient Hospital,3,196.38,99.06,83.83,0.0,0.0,15.23,15.23,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004839,MBR00000185,Professional,2023-01-28,2023-01-28,2023-02-10,PLN6573,1561134315,1561134315,DME Supplier,In-Network,E78.5,G43.909,,,,,,,0,,58661,Surgery,,,,11,Office,3,2732.25,2192.18,2192.18,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004840,MBR00000185,Professional,2023-12-16,2023-12-16,2023-12-29,PLN6195,1361302520,1361302520,Critical Access Hospital,In-Network,R07.9,J44.1,,,,,,,0,,99213,E&M,,,,20,Urgent Care,2,300.5,180.88,0.0,0.0,25.0,0.0,25.0,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004841,MBR00000185,Professional,2023-11-09,2023-11-09,2023-12-02,PLN5050,1463205530,1463205530,Nephrology,In-Network,F32.9,K21.0,,,,,,,0,,99203,E&M,,,,12,Home,2,340.04,238.2,73.23,89.97,75.0,0.0,164.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004842,MBR00000185,Institutional-OP,2021-12-04,2021-12-04,2022-01-14,PLN2229,1997536841,1997536841,Family Medicine,Out-of-Network,Z00.00,E66.9,,,,,,,0,,99284,E&M,,,0740,22,Outpatient Hospital,1,509.53,272.68,0.0,272.68,0.0,0.0,272.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004843,MBR00000186,Professional,2022-03-03,2022-03-03,2022-04-03,PLN2007,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,M17.11,M54.5,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,1,163.15,111.78,96.88,0.0,0.0,14.9,14.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004844,MBR00000186,Professional,2023-04-26,2023-04-26,2023-05-08,PLN6872,1571574052,1571574052,Critical Access Hospital,In-Network,Z23,Z23,,,,,,,0,,83036,Pathology/Lab,,,,21,Inpatient Hospital,2,92.66,77.27,27.27,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000004845,MBR00000186,Institutional-OP,2023-04-27,2023-04-27,2023-05-07,PLN7719,1334916761,1334916761,ASC,In-Network,E11.9,E66.9,,,,,,,0,,70450,Radiology,,,0270,22,Outpatient Hospital,2,1762.91,1088.73,1031.37,0.0,0.0,57.36,57.36,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004846,MBR00000186,Professional,2021-12-10,2021-12-10,2021-12-24,PLN1375,1235381502,1235381502,Cardiology,In-Network,C50.912,J06.9,,,,,,,0,,G0439,Medicine,,,,81,Independent Laboratory,2,637.39,526.67,526.67,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,1,Unbundling,0,0,0,1,0
CLM0000004847,MBR00000186,Institutional-OP,2021-02-03,2021-02-03,2021-02-27,PLN1899,1561134315,1561134315,DME Supplier,In-Network,I10,Z12.11,,,,,,,0,,99283,E&M,,,0450,22,Outpatient Hospital,1,585.29,439.63,439.63,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004848,MBR00000186,Professional,2021-04-16,2021-04-16,2021-05-16,PLN7824,1687650653,1687650653,Internal Medicine,In-Network,N18.3,E11.65,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,1,3083.6,1329.08,1329.08,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004849,MBR00000186,Institutional-OP,2023-06-22,2023-06-22,2023-07-05,PLN8565,1389336600,1389336600,Critical Access Hospital,In-Network,E66.9,Z87.891,,,,,,,0,,70450,Radiology,,,0450,22,Outpatient Hospital,1,1331.41,567.25,202.04,340.21,25.0,0.0,365.21,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004850,MBR00000186,Institutional-OP,2022-01-17,2022-01-17,2022-03-02,PLN9545,1500037969,1500037969,Pulmonology,In-Network,Z23,R05,,,,,,,0,,77067,Radiology,,,0301,22,Outpatient Hospital,1,665.23,522.28,99.89,405.48,0.0,16.91,422.39,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000004851,MBR00000186,Professional,2023-03-04,2023-03-04,2023-03-20,PLN7609,1896447406,1896447406,Nephrology,Out-of-Network,F41.9,C50.912,,,,,,,0,,47562,Surgery,,,,11,Office,2,2701.08,1178.03,888.15,74.32,15.0,200.56,289.88,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004852,MBR00000186,Professional,2023-05-28,2023-05-28,2023-06-13,PLN1353,1799205295,1799205295,General Acute Care Hospital,In-Network,J20.9,Z00.00,,,,,,,0,,99232,E&M,,,,21,Inpatient Hospital,3,269.91,115.35,0.0,115.35,0.0,0.0,115.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004853,MBR00000186,Professional,2023-09-09,2023-09-09,2023-09-23,PLN1073,1132188260,1132188260,Family Medicine,In-Network,J44.1,E78.5,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,2,202.2,103.65,0.0,103.65,0.0,0.0,103.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004854,MBR00000186,Institutional-IP,2022-06-23,2022-06-28,2022-07-23,PLN1072,1434029575,1434029575,Endocrinology,In-Network,I11.9,M54.5,,,,690,MS-DRG,19,5,Y,83036,Pathology/Lab,,,0360,21,Inpatient Hospital,3,113.09,75.9,0.0,0.0,35.0,7.06,42.06,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000004855,MBR00000186,Professional,2022-11-30,2022-11-30,2022-12-11,PLN7006,1139906830,1139906830,Endocrinology,Out-of-Network,K57.30,E78.5,,,,,,,0,,87491,Pathology/Lab,,,,12,Home,2,214.74,98.38,98.38,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004856,MBR00000186,Institutional-OP,2021-08-03,2021-08-03,2021-09-16,PLN9572,1800011727,1800011727,Clinical Laboratory,Out-of-Network,E11.9,Z23,,,,,,,0,,99204,E&M,,,0370,22,Outpatient Hospital,2,237.99,166.19,0.0,166.19,50.0,0.0,216.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004857,MBR00000186,Institutional-OP,2023-10-28,2023-10-28,2023-11-09,PLN3814,1717546253,1717546253,Family Medicine,In-Network,N39.0,E11.9,,,,,,,0,,81001,Pathology/Lab,,,0900,22,Outpatient Hospital,3,28.07,11.12,0.0,11.12,75.0,0.0,86.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004858,MBR00000186,Institutional-OP,2023-08-26,2023-08-26,2023-09-05,PLN2523,1571574052,1571574052,Critical Access Hospital,In-Network,I10,N39.0,,,,,,,0,,80061,Pathology/Lab,,,0320,22,Outpatient Hospital,2,104.0,83.42,58.42,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004859,MBR00000186,Professional,2022-03-03,2022-03-03,2022-03-30,PLN4294,1891849440,1891849440,Oncology,In-Network,Z12.31,J18.9,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,3,528.54,231.01,0.0,231.01,25.0,0.0,256.01,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000004860,MBR00000186,Professional,2022-02-07,2022-02-07,2022-03-22,PLN3174,1245650222,1245650222,Gastroenterology,In-Network,M54.5,I10,,,,,,,0,,70553,Radiology,,,,20,Urgent Care,1,3367.2,1464.7,1319.27,0.0,50.0,95.43,145.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004861,MBR00000186,Professional,2023-03-14,2023-03-14,2023-03-31,PLN6140,1239316214,1239316214,Internal Medicine,In-Network,J06.9,Z23,,,,,,,0,,99203,E&M,,,,12,Home,2,365.78,167.61,167.61,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004862,MBR00000186,Professional,2022-03-30,2022-03-30,2022-04-25,PLN3716,1266606767,1266606767,ASC,In-Network,J20.9,K21.0,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,1,55.4,42.45,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004863,MBR00000186,Professional,2023-03-06,2023-03-06,2023-04-02,PLN1675,1244186984,1244186984,Family Medicine,Out-of-Network,J44.1,K21.0,,,,,,,0,,99222,E&M,,,,23,Emergency Room,2,321.93,114.25,0.0,114.25,0.0,0.0,114.25,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004864,MBR00000186,Professional,2021-04-09,2021-04-09,2021-05-03,PLN4482,1980712759,1980712759,Outpatient Clinic,Out-of-Network,M54.5,Z12.31,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,1,118.2,63.19,11.61,0.0,50.0,1.58,51.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000004865,MBR00000186,Institutional-IP,2021-10-22,2021-10-23,2021-11-20,PLN5518,1284035364,1284035364,Pediatrics,In-Network,F03.90,Z12.31,,,,196,MS-DRG,3,1,Y,93000,Radiology,,,0270,21,Inpatient Hospital,2,82.75,60.69,60.69,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004866,MBR00000186,Professional,2023-05-05,2023-05-05,2023-05-13,PLN2926,1125190055,1125190055,Nephrology,In-Network,E66.9,F32.9,,,,,,,0,,99283,E&M,,,,11,Office,2,350.75,112.18,0.0,112.18,35.0,0.0,147.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004867,MBR00000187,Professional,2023-10-06,2023-10-06,2023-11-17,PLN2346,1168881145,1168881145,Orthopedic Surgery,In-Network,E11.65,E66.9,,,,,,,0,,99406,Medicine,,,,11,Office,2,62.13,36.53,21.53,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004868,MBR00000187,Professional,2021-01-29,2021-01-29,2021-03-02,PLN1561,1696843572,1696843572,Critical Access Hospital,Out-of-Network,J06.9,E11.9,,,,,,,0,,80061,Pathology/Lab,,,,22,Outpatient Hospital,1,90.41,28.12,28.12,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004869,MBR00000187,Institutional-OP,2023-05-04,2023-05-04,2023-06-02,PLN3827,1840431511,1840431511,Geriatrics,Out-of-Network,E11.9,J45.20,,,,,,,0,,93306,Radiology,,,0270,22,Outpatient Hospital,3,1812.58,1063.9,893.62,0.0,0.0,170.28,170.28,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004870,MBR00000187,Institutional-OP,2021-03-17,2021-03-17,2021-04-01,PLN9212,1284035364,1284035364,Pediatrics,In-Network,I10,J45.20,,,,,,,0,,47562,Surgery,,,0510,22,Outpatient Hospital,1,3402.08,2470.9,2455.9,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,1,Phantom,0,0,0,0,0
CLM0000004871,MBR00000187,Institutional-IP,2023-08-07,2023-08-11,2023-09-11,PLN6996,1745114564,1745114564,Endocrinology,In-Network,E11.9,N18.3,,,,603,MS-DRG,16,4,Y,70450,Radiology,,,0270,21,Inpatient Hospital,1,924.06,624.63,589.63,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004872,MBR00000187,Professional,2021-10-05,2021-10-05,2021-10-19,PLN8331,1689639685,1689639685,SNF,In-Network,Z12.11,Z12.11,,,,,,,0,,77067,Radiology,,,,22,Outpatient Hospital,3,555.01,180.44,0.0,180.44,15.0,0.0,195.44,0.0,Adjusted,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000004873,MBR00000187,Institutional-IP,2022-02-02,2022-02-07,2022-02-17,PLN6911,1361302520,1361302520,Critical Access Hospital,In-Network,E78.5,M54.5,,,,195,MS-DRG,3,5,Y,99222,E&M,,,0370,21,Inpatient Hospital,1,638.62,256.94,206.94,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000004874,MBR00000187,Institutional-IP,2023-02-25,2023-03-05,2023-03-28,PLN9077,1284035364,1284035364,Pediatrics,In-Network,E78.5,F32.9,,,,194,MS-DRG,1,8,Y,23472,Surgery,,,0320,21,Inpatient Hospital,3,7542.38,2725.18,2700.18,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004875,MBR00000187,Professional,2023-07-11,2023-07-11,2023-08-17,PLN6028,1313212303,1313212303,Family Medicine,In-Network,F41.9,Z87.891,,,,,,,0,,99406,Medicine,,,,22,Outpatient Hospital,2,72.93,38.61,3.61,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004876,MBR00000187,Professional,2022-03-30,2022-03-30,2022-04-11,PLN6424,1247341320,1247341320,Urology,Out-of-Network,K21.0,Z12.31,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,1,27.76,16.5,0.0,16.5,50.0,0.0,66.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004877,MBR00000187,Institutional-OP,2021-12-11,2021-12-11,2022-01-02,PLN3066,1540044947,1540044947,Pulmonology,Out-of-Network,R07.9,C50.912,,,,,,,0,,99214,E&M,,,0740,22,Outpatient Hospital,3,405.25,189.66,189.66,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004878,MBR00000187,Professional,2023-12-10,2023-12-10,2024-01-22,PLN5492,1968299309,1968299309,Internal Medicine,In-Network,I10,R10.9,,,,,,,0,,97110,Medicine,,,,31,Skilled Nursing Facility,2,166.76,111.16,0.0,111.16,25.0,0.0,136.16,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004879,MBR00000187,Professional,2023-11-23,2023-11-23,2023-12-21,PLN4606,1530904931,1530904931,Internal Medicine,In-Network,E66.9,J20.9,,,,,,,0,,99232,E&M,,,,11,Office,1,171.79,54.54,39.54,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004880,MBR00000187,Professional,2022-07-28,2022-07-28,2022-09-10,PLN8979,1948810580,1948810580,DME Supplier,In-Network,E78.5,E11.9,,,,,,,0,,93306,Radiology,,,,31,Skilled Nursing Facility,1,3005.46,1086.99,632.36,419.63,35.0,0.0,454.63,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004881,MBR00000187,Institutional-OP,2021-01-27,2021-01-27,2021-03-05,PLN8287,1545347862,1545347862,SNF,In-Network,Z23,I10,,,,,,,0,,27447,Surgery,,,0120,22,Outpatient Hospital,2,2266.26,787.71,736.35,51.36,0.0,0.0,51.36,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004882,MBR00000187,Professional,2023-11-28,2023-11-28,2023-12-18,PLN6692,1865904917,1865904917,Outpatient Clinic,In-Network,N39.0,E11.9,,,,,,,0,,99214,E&M,,,,31,Skilled Nursing Facility,1,178.72,112.0,62.27,0.0,35.0,14.73,49.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004883,MBR00000187,Institutional-OP,2022-11-10,2022-11-10,2022-11-26,PLN4474,1860435061,1860435061,DME Supplier,In-Network,N39.0,E11.9,,,,,,,0,,45380,Surgery,,,0740,22,Outpatient Hospital,3,1807.26,579.51,96.6,474.43,0.0,8.48,482.91,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000004884,MBR00000187,Institutional-OP,2022-08-29,2022-08-29,2022-09-23,PLN1995,1563980627,1563980627,Critical Access Hospital,In-Network,I10,G20,,,,,,,0,,99214,E&M,,,0370,22,Outpatient Hospital,2,229.05,100.21,100.21,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004885,MBR00000187,Institutional-OP,2021-05-03,2021-05-03,2021-06-01,PLN3186,1702692193,1702692193,Physical Therapy,In-Network,Z12.31,I10,,,,,,,0,,93225,Medicine,,,0636,22,Outpatient Hospital,2,803.28,676.67,676.67,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004886,MBR00000187,Professional,2023-12-24,2023-12-24,2024-01-11,PLN5507,1361302520,1361302520,Critical Access Hospital,In-Network,J44.1,I11.9,,,,,,,0,,G0439,Medicine,,,,81,Independent Laboratory,2,641.79,299.16,264.16,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000004887,MBR00000187,Professional,2023-02-27,2023-02-27,2023-04-02,PLN8868,1224179551,1224179551,Physical Therapy,In-Network,I50.9,I48.91,,,,,,,0,,99213,E&M,,,,11,Office,3,217.16,94.84,77.4,0.0,0.0,17.44,17.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004888,MBR00000187,Institutional-OP,2021-08-27,2021-08-27,2021-09-05,PLN9830,1899127912,1899127912,Neurology,In-Network,N18.3,I50.9,,,,,,,0,,93225,Medicine,,,0270,22,Outpatient Hospital,1,941.04,568.67,568.67,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000004889,MBR00000187,Institutional-OP,2022-02-03,2022-02-03,2022-02-24,PLN4578,1364429278,1364429278,OB/GYN,In-Network,J06.9,N18.3,,,,,,,0,,97110,Medicine,,,0320,22,Outpatient Hospital,3,234.45,71.13,34.92,28.67,0.0,7.54,36.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004890,MBR00000187,Institutional-OP,2022-01-12,2022-01-12,2022-02-03,PLN2927,1224179551,1224179551,Physical Therapy,In-Network,J20.9,Z00.00,,,,,,,0,,99283,E&M,,,0740,22,Outpatient Hospital,3,284.96,108.23,83.23,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004891,MBR00000187,Institutional-OP,2023-08-12,2023-08-12,2023-08-27,PLN4025,1438368327,1438368327,Home Health,In-Network,R05,E11.65,,,,,,,0,,99221,E&M,,,0301,22,Outpatient Hospital,2,418.12,311.55,256.85,29.7,25.0,0.0,54.7,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000004892,MBR00000187,Institutional-IP,2022-06-05,2022-06-08,2022-07-11,PLN2176,1283743001,1283743001,Family Medicine,In-Network,R51,M54.5,,,,872,MS-DRG,2,3,Y,27447,Surgery,,,0450,21,Inpatient Hospital,3,5440.94,2310.21,1741.34,136.43,0.0,432.44,568.87,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004893,MBR00000187,Professional,2023-08-14,2023-08-14,2023-08-26,PLN2216,1135158374,1135158374,Pulmonology,In-Network,E11.9,I10,,,,,,,0,,66984,Surgery,,,,21,Inpatient Hospital,2,2001.38,765.11,242.13,461.95,25.0,36.03,522.98,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004894,MBR00000187,Professional,2023-01-24,2023-01-24,2023-02-05,PLN7071,1198133277,1198133277,SNF,In-Network,Z12.31,E66.9,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,1,5107.49,1769.69,1405.68,349.01,15.0,0.0,364.01,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004895,MBR00000187,Professional,2022-02-08,2022-02-08,2022-03-11,PLN7042,1817234602,1817234602,Clinical Laboratory,In-Network,K21.0,J06.9,,,,,,,0,,58661,Surgery,,,,21,Inpatient Hospital,3,2296.53,1253.91,897.14,281.77,75.0,0.0,356.77,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004896,MBR00000187,Professional,2022-03-21,2022-03-21,2022-05-01,PLN3298,1205377316,1205377316,Orthopedic Surgery,In-Network,I10,I25.10,,,,,,,0,,81001,Pathology/Lab,,,,22,Outpatient Hospital,1,25.6,20.37,20.37,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004897,MBR00000187,Professional,2023-06-06,2023-06-06,2023-07-04,PLN5140,1390307371,1390307371,DME Supplier,In-Network,M81.0,I10,,,,,,,0,,93000,Radiology,,,,11,Office,3,101.28,45.25,0.0,45.25,35.0,0.0,80.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004898,MBR00000187,Professional,2022-07-01,2022-07-01,2022-07-15,PLN2439,1609526529,1609526529,Psychiatry,In-Network,Z23,I10,,,,,,,0,,58661,Surgery,,,,23,Emergency Room,1,4018.13,2383.45,2189.29,0.0,25.0,169.16,194.16,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004899,MBR00000187,Professional,2023-01-16,2023-01-16,2023-02-15,PLN4651,1757138478,1757138478,Pediatrics,In-Network,I10,E78.5,,,,,,,0,,45378,Surgery,,,,12,Home,3,945.41,680.72,234.02,417.05,0.0,29.65,446.7,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000004900,MBR00000187,Professional,2021-05-15,2021-05-15,2021-05-22,PLN5122,1609526529,1609526529,Psychiatry,In-Network,E66.9,Z00.00,,,,,,,0,,93225,Medicine,,,,11,Office,2,644.53,228.83,0.0,228.83,50.0,0.0,278.83,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004901,MBR00000187,Institutional-IP,2022-04-13,2022-04-15,2022-05-24,PLN7462,1702692193,1702692193,Physical Therapy,In-Network,E11.9,N18.3,,,,470,MS-DRG,3,2,Y,99221,E&M,,,0730,21,Inpatient Hospital,1,324.1,211.39,184.48,0.0,0.0,26.91,26.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004902,MBR00000187,Institutional-IP,2022-09-24,2022-09-25,2022-11-01,PLN6419,1571574052,1571574052,Critical Access Hospital,In-Network,Z00.00,Z12.31,,,,641,MS-DRG,1,1,Y,99203,E&M,,,0120,21,Inpatient Hospital,3,271.6,92.32,41.94,41.89,0.0,8.49,50.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004903,MBR00000187,Institutional-IP,2022-01-11,2022-01-13,2022-02-22,PLN1269,1910255109,1910255109,DME Supplier,In-Network,E66.9,F32.9,,,,292,MS-DRG,12,2,Y,45380,Surgery,,,0270,21,Inpatient Hospital,2,2567.95,1125.17,1124.36,0.0,0.0,0.81,0.81,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000004904,MBR00000188,Institutional-OP,2023-07-18,2023-07-18,2023-08-08,PLN3585,1990090423,1990090423,Orthopedic Surgery,In-Network,Z12.31,M54.5,,,,,,,0,,86900,Pathology/Lab,,,0900,22,Outpatient Hospital,3,29.98,21.65,21.65,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004905,MBR00000188,Professional,2021-08-19,2021-08-19,2021-09-30,PLN2809,1968299309,1968299309,Internal Medicine,In-Network,E78.5,J06.9,,,,,,,0,,99204,E&M,,,,23,Emergency Room,1,585.44,234.69,234.69,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000004906,MBR00000188,Professional,2023-07-20,2023-07-20,2023-08-21,PLN9319,1865904917,1865904917,Outpatient Clinic,In-Network,M54.5,C50.912,,,,,,,0,,93306,Radiology,,,,22,Outpatient Hospital,1,2224.57,1890.83,1875.83,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004907,MBR00000188,Professional,2021-03-11,2021-03-11,2021-03-19,PLN4533,1410468316,1410468316,SNF,In-Network,I10,F41.9,,,,,,,0,,43239,Surgery,,,,11,Office,2,1914.17,1037.83,903.82,134.01,0.0,0.0,134.01,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004908,MBR00000188,Professional,2022-04-13,2022-04-13,2022-04-20,PLN9817,1334916761,1334916761,ASC,In-Network,Z00.00,I10,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,2,3475.19,1667.69,1617.69,0.0,50.0,0.0,50.0,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004909,MBR00000188,Institutional-IP,2022-07-21,2022-07-26,2022-08-16,PLN6461,1364429278,1364429278,OB/GYN,In-Network,Z12.31,M54.5,,,,871,MS-DRG,15,5,Y,83036,Pathology/Lab,,,0301,21,Inpatient Hospital,2,62.15,33.01,0.0,33.01,0.0,0.0,33.01,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000004910,MBR00000188,Institutional-OP,2021-10-05,2021-10-05,2021-11-10,PLN5071,1799205295,1799205295,General Acute Care Hospital,In-Network,E78.5,M54.5,,,,,,,0,,99221,E&M,,,0636,22,Outpatient Hospital,1,451.41,155.88,130.88,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004911,MBR00000188,Professional,2022-08-15,2022-08-15,2022-08-31,PLN5881,1660288235,1660288235,ASC,In-Network,Z12.11,N39.0,,,,,,,0,,74177,Radiology,,,,49,Independent Clinic,3,2211.13,812.33,0.0,0.0,0.0,9.63,9.63,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004912,MBR00000188,Institutional-OP,2023-09-14,2023-09-14,2023-10-16,PLN2693,1108115157,1108115157,General Acute Care Hospital,In-Network,E11.65,K21.0,,,,,,,0,,76700,Radiology,,,0360,22,Outpatient Hospital,1,762.62,387.16,0.0,387.16,0.0,0.0,387.16,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004913,MBR00000188,Professional,2022-05-02,2022-05-02,2022-06-05,PLN1339,1148984206,1148984206,Psychiatry,In-Network,Z87.891,Z23,,,,,,,0,,83036,Pathology/Lab,,,,21,Inpatient Hospital,1,83.22,60.0,60.0,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000004914,MBR00000188,Professional,2022-08-14,2022-08-14,2022-09-08,PLN4801,1856686341,1856686341,Geriatrics,In-Network,M17.11,Z23,,,,,,,0,,97110,Medicine,,,,22,Outpatient Hospital,1,159.23,47.94,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004915,MBR00000188,Institutional-OP,2023-11-07,2023-11-07,2023-12-20,PLN9791,1545347862,1545347862,SNF,In-Network,C50.912,Z79.4,,,,,,,0,,99232,E&M,,,0740,22,Outpatient Hospital,3,338.42,130.06,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004916,MBR00000188,Institutional-OP,2023-10-09,2023-10-09,2023-10-26,PLN8845,1355166277,1355166277,Endocrinology,In-Network,N39.0,I10,,,,,,,0,,99203,E&M,,,0370,22,Outpatient Hospital,1,349.54,128.01,93.01,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004917,MBR00000189,Institutional-IP,2021-01-15,2021-01-24,2021-02-01,PLN8674,1860435061,1860435061,DME Supplier,In-Network,N20.0,K21.0,,,,195,MS-DRG,9,9,Y,99222,E&M,,,0320,21,Inpatient Hospital,1,397.53,219.16,194.16,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004918,MBR00000189,Institutional-IP,2023-03-07,2023-03-11,2023-03-27,PLN4926,1390307371,1390307371,DME Supplier,In-Network,N18.3,N20.0,,,,872,MS-DRG,2,4,N,90837,Medicine,,,0740,21,Inpatient Hospital,3,416.79,220.95,0.0,220.95,35.0,0.0,255.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004919,MBR00000189,Professional,2023-07-21,2023-07-21,2023-07-30,PLN3135,1799205295,1799205295,General Acute Care Hospital,In-Network,J44.1,I48.91,,,,,,,0,,76700,Radiology,,,,11,Office,3,707.94,454.61,439.61,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004920,MBR00000189,Institutional-IP,2023-10-29,2023-10-31,2023-11-20,PLN7779,1103747954,1103747954,Urology,In-Network,Z00.00,E11.9,,,,292,MS-DRG,9,2,Y,90686,Medicine,,,0370,21,Inpatient Hospital,2,81.12,38.91,3.24,0.0,35.0,0.67,35.67,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000004921,MBR00000189,Institutional-IP,2023-05-27,2023-06-01,2023-07-02,PLN2503,1313212303,1313212303,Family Medicine,In-Network,N40.0,Z00.00,,,,470,MS-DRG,2,5,Y,97530,Medicine,,,0900,21,Inpatient Hospital,2,240.97,95.67,0.0,95.67,50.0,0.0,145.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004922,MBR00000189,Professional,2021-04-01,2021-04-01,2021-05-07,PLN9205,1389336600,1389336600,Critical Access Hospital,In-Network,J06.9,Z23,,,,,,,0,,97530,Medicine,,,,31,Skilled Nursing Facility,2,160.53,105.1,0.0,105.1,75.0,0.0,180.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004923,MBR00000189,Professional,2023-04-11,2023-04-11,2023-05-14,PLN9245,1227362142,1227362142,DME Supplier,In-Network,I48.91,Z00.00,,,,,,,0,,99222,E&M,,,,11,Office,1,520.8,351.02,326.02,0.0,25.0,0.0,25.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004924,MBR00000189,Institutional-OP,2023-07-14,2023-07-14,2023-08-16,PLN3122,1550154147,1550154147,Outpatient Clinic,In-Network,K92.1,I25.10,,,,,,,0,,58661,Surgery,,,0740,22,Outpatient Hospital,3,2152.04,1333.48,1333.48,0.0,0.0,0.0,0.0,0.0,Adjusted,,,1,,0,0,1,0,0,1,Duplicate,0,0,0,0,0
CLM0000004925,MBR00000189,Professional,2022-07-29,2022-07-29,2022-08-27,PLN6465,1845057593,1845057593,Orthopedic Surgery,In-Network,Z00.00,E78.5,,,,,,,0,,99221,E&M,,,,11,Office,1,356.28,230.17,0.0,230.17,0.0,0.0,230.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004926,MBR00000189,Institutional-OP,2021-01-23,2021-01-23,2021-02-25,PLN4816,1806688928,1806688928,Geriatrics,In-Network,M54.5,I25.10,,,,,,,0,,23472,Surgery,,,0450,22,Outpatient Hospital,3,4056.69,2091.12,2041.12,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004927,MBR00000189,Professional,2021-07-28,2021-07-28,2021-09-01,PLN1893,1991459367,1991459367,Neurology,Out-of-Network,R05,Z79.4,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,2,4216.98,1599.34,1202.36,212.94,15.0,169.04,396.98,0.0,Paid,,,0,,0,0,1,0,0,1,Phantom,0,0,0,0,0
CLM0000004928,MBR00000189,Professional,2021-10-29,2021-10-29,2021-11-13,PLN8966,1273488618,1273488618,General Acute Care Hospital,In-Network,I10,E11.9,,,,,,,0,,99406,Medicine,,,,11,Office,3,75.28,61.41,0.0,61.41,75.0,0.0,136.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004929,MBR00000189,Institutional-IP,2023-08-03,2023-08-07,2023-08-11,PLN5330,1799205295,1799205295,General Acute Care Hospital,In-Network,J18.9,M54.5,,,,603,MS-DRG,4,4,Y,71046,Radiology,,,0301,21,Inpatient Hospital,2,135.76,47.88,47.88,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004930,MBR00000189,Institutional-IP,2021-05-18,2021-05-28,2021-06-16,PLN6745,1502838586,1502838586,ASC,In-Network,J06.9,F41.9,,,,603,MS-DRG,1,10,Y,80061,Pathology/Lab,,,0636,21,Inpatient Hospital,2,97.77,72.18,58.97,0.0,0.0,13.21,13.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004931,MBR00000189,Professional,2023-03-27,2023-03-27,2023-04-28,PLN7984,1168246159,1168246159,Internal Medicine,In-Network,F32.9,C50.912,,,,,,,0,,80061,Pathology/Lab,,,,12,Home,2,118.73,66.18,16.18,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004932,MBR00000189,Professional,2021-07-16,2021-07-16,2021-07-30,PLN7420,1899127912,1899127912,Neurology,In-Network,R05,E78.5,,,,,,,0,,33533,Surgery,,,,20,Urgent Care,1,28643.19,16852.04,16852.04,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000004933,MBR00000189,Professional,2023-07-01,2023-07-01,2023-07-29,PLN4632,1283743001,1283743001,Family Medicine,In-Network,J44.1,E11.9,,,,,,,0,,23472,Surgery,,,,11,Office,1,6102.89,2682.57,2204.12,428.45,50.0,0.0,478.45,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004934,MBR00000189,Institutional-OP,2021-01-13,2021-01-13,2021-02-08,PLN6471,1295371663,1295371663,Critical Access Hospital,In-Network,E78.5,Z96.641,,,,,,,0,,86900,Pathology/Lab,,,0320,22,Outpatient Hospital,3,51.69,39.1,0.0,39.1,0.0,0.0,39.1,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004935,MBR00000189,Professional,2021-09-16,2021-09-16,2021-10-04,PLN7875,1727809972,1727809972,Home Health,In-Network,G43.909,Z12.31,,,,,,,0,,45378,Surgery,,,,23,Emergency Room,2,2508.68,1889.83,1839.83,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,1,1,0,0,0,0,None,0,1,0,0,0
CLM0000004936,MBR00000189,Professional,2021-04-22,2021-04-22,2021-06-04,PLN9952,1334916761,1334916761,ASC,In-Network,E11.9,J44.1,,,,,,,0,,66984,Surgery,,,,20,Urgent Care,2,3506.4,2362.44,2327.44,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004937,MBR00000189,Professional,2022-08-31,2022-08-31,2022-09-22,PLN9573,1334916761,1334916761,ASC,In-Network,Z00.00,Z23,,,,,,,0,,99203,E&M,,,,11,Office,3,301.9,140.17,140.17,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004938,MBR00000189,Professional,2023-05-06,2023-05-06,2023-06-18,PLN5873,1450094833,1450094833,Outpatient Clinic,In-Network,N18.3,F41.9,,,,,,,0,,78452,Radiology,,,,65,End-Stage Renal Disease,2,3113.92,1463.72,1463.72,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000004939,MBR00000189,Professional,2022-04-01,2022-04-01,2022-05-12,PLN1472,1644128543,1644128543,Gastroenterology,In-Network,G20,I11.9,,,,,,,0,,33533,Surgery,,,,21,Inpatient Hospital,3,21504.72,14660.13,13680.5,84.4,0.0,895.23,979.63,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000004940,MBR00000189,Professional,2022-08-08,2022-08-08,2022-08-20,PLN1751,1556140803,1556140803,Cardiology,In-Network,G43.909,I25.10,,,,,,,0,,99406,Medicine,,,,11,Office,2,60.0,18.71,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004941,MBR00000189,Institutional-OP,2022-12-02,2022-12-02,2022-12-18,PLN6307,1337791138,1337791138,Internal Medicine,Out-of-Network,F32.9,M17.11,,,,,,,0,,58661,Surgery,,,0200,22,Outpatient Hospital,2,4768.69,4045.29,4045.29,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004942,MBR00000189,Institutional-OP,2022-05-14,2022-05-14,2022-06-27,PLN2331,1644128543,1644128543,Gastroenterology,In-Network,I10,K21.0,,,,,,,0,,45378,Surgery,,,0510,22,Outpatient Hospital,1,2178.85,712.08,637.08,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000004943,MBR00000189,Professional,2023-04-05,2023-04-05,2023-04-19,PLN2905,1463205530,1463205530,Nephrology,In-Network,Z12.31,E11.65,,,,,,,0,,99284,E&M,,,,11,Office,3,694.5,389.34,0.0,389.34,0.0,0.0,389.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004944,MBR00000189,Professional,2021-11-07,2021-11-07,2021-12-15,PLN9527,1540044947,1540044947,Pulmonology,Out-of-Network,Z23,E78.5,,,,,,,0,,45380,Surgery,,,,21,Inpatient Hospital,1,1612.29,1225.84,971.38,254.46,0.0,0.0,254.46,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000004945,MBR00000189,Institutional-OP,2021-07-10,2021-07-10,2021-07-27,PLN5812,1845900543,1845900543,ASC,In-Network,Z12.11,Z00.00,,,,,,,0,,87491,Pathology/Lab,,,0270,22,Outpatient Hospital,3,147.16,91.87,16.87,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004946,MBR00000189,Professional,2021-07-25,2021-07-25,2021-08-05,PLN7035,1224179551,1224179551,Physical Therapy,In-Network,F41.9,K57.30,,,,,,,0,,72148,Radiology,,,,22,Outpatient Hospital,2,1566.71,853.0,606.14,246.86,0.0,0.0,246.86,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004947,MBR00000189,Professional,2021-07-10,2021-07-10,2021-08-02,PLN2131,1687650653,1687650653,Internal Medicine,In-Network,M81.0,J20.9,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,3,432.33,215.04,0.0,212.72,35.0,0.0,247.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004948,MBR00000189,Institutional-IP,2021-02-11,2021-02-17,2021-03-13,PLN5764,1193493783,1193493783,Critical Access Hospital,Out-of-Network,Z00.00,R07.9,,,,690,MS-DRG,4,6,Y,45378,Surgery,,,0740,21,Inpatient Hospital,3,1662.42,691.56,672.27,0.0,0.0,19.29,19.29,0.0,Paid,,,1,,0,1,1,0,1,0,None,0,1,0,0,0
CLM0000004949,MBR00000189,Professional,2021-02-17,2021-02-17,2021-04-01,PLN3253,1148984206,1148984206,Psychiatry,In-Network,F41.9,I50.9,,,,,,,0,,58661,Surgery,,,,21,Inpatient Hospital,1,3409.45,2464.87,0.0,495.24,0.0,0.0,495.24,0.0,Denied,CO-18,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004950,MBR00000189,Professional,2021-02-27,2021-02-27,2021-03-09,PLN2317,1125190055,1125190055,Nephrology,In-Network,E11.9,N40.0,,,,,,,0,,93306,Radiology,,,,22,Outpatient Hospital,3,1449.36,989.33,885.5,103.83,0.0,0.0,103.83,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004951,MBR00000189,Institutional-OP,2021-06-22,2021-06-22,2021-07-13,PLN7622,1727809972,1727809972,Home Health,In-Network,Z00.01,K21.0,,,,,,,0,,86900,Pathology/Lab,,,0510,22,Outpatient Hospital,2,39.98,30.29,0.0,30.29,0.0,0.0,30.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004952,MBR00000189,Institutional-IP,2022-11-26,2022-11-27,2022-12-21,PLN8663,1514306773,1514306773,Endocrinology,In-Network,E11.9,Z12.11,,,,690,MS-DRG,19,1,Y,97530,Medicine,,,0730,21,Inpatient Hospital,3,287.09,207.03,0.0,207.03,0.0,0.0,207.03,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004953,MBR00000189,Institutional-IP,2021-09-20,2021-09-27,2021-10-18,PLN2612,1865904917,1865904917,Outpatient Clinic,In-Network,Z00.00,Z79.4,,,,292,MS-DRG,21,7,Y,99213,E&M,,,0740,21,Inpatient Hospital,2,137.76,50.71,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004954,MBR00000189,Professional,2022-10-03,2022-10-03,2022-11-16,PLN3045,1845057593,1845057593,Orthopedic Surgery,In-Network,I10,E78.5,,,,,,,0,,99221,E&M,,,,11,Office,3,156.24,48.07,48.07,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004955,MBR00000190,Professional,2021-03-21,2021-03-21,2021-04-18,PLN4796,1511044648,1511044648,Endocrinology,In-Network,Z12.31,E11.9,,,,,,,0,,27447,Surgery,,,,31,Skilled Nursing Facility,2,4674.15,1895.71,1674.07,221.64,0.0,0.0,221.64,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004956,MBR00000190,Institutional-OP,2023-05-27,2023-05-27,2023-07-08,PLN2017,1728018911,1728018911,Nephrology,In-Network,Z23,M54.5,,,,,,,0,,74177,Radiology,,,0740,22,Outpatient Hospital,3,1455.91,452.86,235.06,167.8,50.0,0.0,217.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004957,MBR00000190,Institutional-OP,2022-01-25,2022-01-25,2022-03-04,PLN3689,1757138478,1757138478,Pediatrics,In-Network,J45.20,I10,,,,,,,0,,84443,Pathology/Lab,,,0360,22,Outpatient Hospital,2,126.02,98.66,79.92,0.0,0.0,18.74,18.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004958,MBR00000190,Institutional-OP,2022-04-29,2022-04-29,2022-06-08,PLN3541,1790497490,1790497490,OB/GYN,In-Network,R10.9,E11.9,,,,,,,0,,82043,Pathology/Lab,,,0200,22,Outpatient Hospital,1,32.97,16.2,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004959,MBR00000190,Professional,2023-01-10,2023-01-10,2023-01-21,PLN2319,1780163051,1780163051,SNF,In-Network,J20.9,I10,,,,,,,0,,23472,Surgery,,,,31,Skilled Nursing Facility,2,7503.92,6147.36,4991.24,273.94,75.0,807.18,1156.12,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004960,MBR00000190,Institutional-OP,2023-12-29,2023-12-29,2024-02-08,PLN4727,1295371663,1295371663,Critical Access Hospital,In-Network,E66.9,Z12.31,,,,,,,0,,83036,Pathology/Lab,,,0730,22,Outpatient Hospital,1,95.49,35.46,0.0,35.46,35.0,0.0,70.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000004961,MBR00000190,Professional,2023-05-19,2023-05-19,2023-06-12,PLN9646,1644128543,1644128543,Gastroenterology,In-Network,E78.5,M54.5,,,,,,,0,,70553,Radiology,,,,49,Independent Clinic,1,2674.22,1779.69,1779.69,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004962,MBR00000190,Institutional-IP,2022-03-16,2022-03-25,2022-03-23,PLN9451,1691062876,1691062876,SNF,In-Network,K57.30,N40.0,,,,683,MS-DRG,24,9,Y,99221,E&M,,,0900,21,Inpatient Hospital,1,418.0,144.9,0.0,144.9,0.0,0.0,144.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004963,MBR00000190,Institutional-IP,2022-01-14,2022-01-23,2022-02-09,PLN2452,1422747896,1422747896,Urology,In-Network,E11.9,Z12.31,,,,683,MS-DRG,10,9,N,99406,Medicine,,,0200,21,Inpatient Hospital,1,88.18,60.52,58.58,0.0,0.0,1.94,1.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004964,MBR00000190,Professional,2022-01-06,2022-01-06,2022-02-19,PLN1147,1590915516,1590915516,Physical Therapy,Out-of-Network,E78.5,J44.1,,,,,,,0,,99222,E&M,,,,49,Independent Clinic,3,298.58,92.49,0.0,92.49,35.0,0.0,127.49,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004965,MBR00000190,Professional,2021-04-02,2021-04-02,2021-04-27,PLN4263,1974006077,1974006077,Orthopedic Surgery,In-Network,I10,E11.40,,,,,,,0,,99204,E&M,,,,11,Office,3,572.45,198.62,198.62,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004966,MBR00000191,Institutional-OP,2022-01-05,2022-01-05,2022-02-11,PLN4342,1227362142,1227362142,DME Supplier,In-Network,R10.9,E78.5,,,,,,,0,,45378,Surgery,,,0900,22,Outpatient Hospital,2,1006.11,446.68,36.86,409.82,0.0,0.0,409.82,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000004967,MBR00000191,Institutional-OP,2023-04-12,2023-04-12,2023-05-15,PLN5090,1689639685,1689639685,SNF,In-Network,J06.9,Z23,,,,,,,0,,45380,Surgery,,,0740,22,Outpatient Hospital,1,3050.17,1857.78,1332.42,490.36,35.0,0.0,525.36,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000004968,MBR00000191,Professional,2021-10-30,2021-10-30,2021-11-25,PLN8904,1948810580,1948810580,DME Supplier,In-Network,E11.9,N18.3,,,,,,,0,,23472,Surgery,,,,11,Office,1,3650.69,2116.88,1868.5,0.0,25.0,223.38,248.38,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004969,MBR00000191,Professional,2022-03-05,2022-03-05,2022-04-18,PLN1283,1713934949,1713934949,Neurology,In-Network,E11.9,M17.11,,,,,,,0,,82043,Pathology/Lab,,,,12,Home,1,30.27,19.69,0.0,19.69,35.0,0.0,54.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004970,MBR00000191,Institutional-IP,2021-03-17,2021-03-20,2021-03-26,PLN8310,1790497490,1790497490,OB/GYN,In-Network,F41.9,Z23,,,,872,MS-DRG,12,3,Y,99204,E&M,,,0301,21,Inpatient Hospital,3,425.82,317.75,267.75,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000004971,MBR00000191,Professional,2021-10-03,2021-10-03,2021-10-13,PLN1229,1624202402,1624202402,Orthopedic Surgery,In-Network,F32.9,E78.5,,,,,,,0,,87491,Pathology/Lab,,,,21,Inpatient Hospital,1,165.41,56.99,56.99,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004972,MBR00000191,Professional,2021-03-17,2021-03-17,2021-03-30,PLN1003,1991459367,1991459367,Neurology,Out-of-Network,M17.11,R10.9,,,,,,,0,,27130,Surgery,,,,21,Inpatient Hospital,3,4429.58,2640.3,2501.9,113.4,25.0,0.0,138.4,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004973,MBR00000191,Professional,2022-05-31,2022-05-31,2022-06-13,PLN9447,1899127912,1899127912,Neurology,In-Network,F10.20,N39.0,,,,,,,0,,99203,E&M,,,,21,Inpatient Hospital,1,375.94,168.06,144.02,0.0,0.0,24.04,24.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004974,MBR00000191,Professional,2021-11-22,2021-11-22,2021-12-29,PLN1226,1997536841,1997536841,Family Medicine,Out-of-Network,Z87.891,N20.0,,,,,,,0,,90837,Medicine,,,,49,Independent Clinic,2,182.94,104.92,104.92,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004975,MBR00000191,Professional,2023-11-29,2023-11-29,2023-12-16,PLN9753,1284035364,1284035364,Pediatrics,In-Network,F41.9,F32.9,,,,,,,0,,93225,Medicine,,,,49,Independent Clinic,2,527.46,181.37,63.47,82.9,35.0,0.0,117.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004976,MBR00000191,Institutional-OP,2022-10-08,2022-10-08,2022-11-15,PLN4903,1752470395,1752470395,Home Health,In-Network,N39.0,I10,,,,,,,0,,58661,Surgery,,,0900,22,Outpatient Hospital,3,2474.26,1324.33,1205.18,119.15,0.0,0.0,119.15,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004977,MBR00000191,Institutional-OP,2022-02-13,2022-02-13,2022-02-28,PLN7499,1540044947,1540044947,Pulmonology,Out-of-Network,I11.9,M81.0,,,,,,,0,,27447,Surgery,,,0120,22,Outpatient Hospital,3,2907.45,1444.57,1394.57,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004978,MBR00000191,Professional,2022-08-12,2022-08-12,2022-09-12,PLN3695,1812060197,1812060197,Oncology,Out-of-Network,E78.5,Z51.11,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,1,291.59,235.14,175.3,59.3,0.0,0.54,59.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004979,MBR00000191,Professional,2023-11-17,2023-11-17,2023-12-21,PLN3826,1453283987,1453283987,Critical Access Hospital,In-Network,J06.9,Z00.00,,,,,,,0,,23472,Surgery,,,,31,Skilled Nursing Facility,2,3956.71,1381.45,1108.44,0.0,0.0,273.01,273.01,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004980,MBR00000191,Institutional-IP,2021-07-17,2021-07-22,2021-08-28,PLN3511,1198133277,1198133277,SNF,In-Network,K21.0,E11.9,,,,603,MS-DRG,6,5,N,99283,E&M,,,0761,21,Inpatient Hospital,3,288.94,102.74,0.0,102.74,35.0,0.0,137.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004981,MBR00000191,Professional,2021-10-05,2021-10-05,2021-10-17,PLN9710,1609138981,1609138981,Critical Access Hospital,In-Network,M17.11,E78.5,,,,,,,0,,43239,Surgery,,,,11,Office,2,1096.85,602.89,311.63,276.26,15.0,0.0,291.26,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004982,MBR00000191,Institutional-OP,2022-08-21,2022-08-21,2022-09-09,PLN9228,1514306773,1514306773,Endocrinology,In-Network,R10.9,R07.9,,,,,,,0,,99204,E&M,,,0320,22,Outpatient Hospital,3,425.31,350.27,145.96,154.31,50.0,0.0,204.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004983,MBR00000191,Professional,2021-04-26,2021-04-26,2021-05-04,PLN5309,1366286000,1366286000,SNF,In-Network,J06.9,N17.9,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,3,1196.88,873.65,873.65,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000004984,MBR00000191,Institutional-IP,2022-07-24,2022-07-25,2022-08-25,PLN9789,1717546253,1717546253,Family Medicine,In-Network,F32.9,K21.0,,,,682,MS-DRG,15,1,Y,99232,E&M,,,0900,21,Inpatient Hospital,2,387.78,184.8,134.8,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004985,MBR00000191,Professional,2021-06-22,2021-06-22,2021-07-31,PLN1830,1702692193,1702692193,Physical Therapy,In-Network,J44.1,C50.912,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,2,2664.74,1846.92,1426.82,420.1,0.0,0.0,420.1,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004986,MBR00000191,Institutional-OP,2023-08-05,2023-08-05,2023-08-12,PLN1838,1994661817,1994661817,SNF,Out-of-Network,Z87.891,I10,,,,,,,0,,99222,E&M,,,0200,22,Outpatient Hospital,3,471.37,161.99,0.0,161.99,0.0,0.0,161.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004987,MBR00000191,Institutional-OP,2023-04-28,2023-04-28,2023-05-14,PLN4105,1564502315,1564502315,ASC,In-Network,Z00.00,J20.9,,,,,,,0,,99232,E&M,,,0510,22,Outpatient Hospital,2,349.95,294.12,219.12,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004988,MBR00000191,Professional,2021-02-23,2021-02-23,2021-03-15,PLN5826,1727809972,1727809972,Home Health,In-Network,R05,I48.91,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,3,1895.81,757.06,742.06,0.0,15.0,0.0,15.0,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004989,MBR00000191,Institutional-OP,2022-08-12,2022-08-12,2022-09-22,PLN3634,1266606767,1266606767,ASC,In-Network,I10,E11.9,,,,,,,0,,83036,Pathology/Lab,,,0301,22,Outpatient Hospital,3,44.68,17.46,0.0,17.46,0.0,0.0,17.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000004990,MBR00000191,Professional,2021-08-18,2021-08-18,2021-10-01,PLN9596,1395983630,1395983630,Nephrology,In-Network,E11.9,I10,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,2,3857.43,1180.9,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-50,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000004991,MBR00000191,Professional,2022-09-30,2022-09-30,2022-10-10,PLN3721,1780163051,1780163051,SNF,In-Network,G43.909,I25.10,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,3,54.16,25.01,0.0,25.01,75.0,0.0,100.01,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004992,MBR00000191,Institutional-OP,2022-08-20,2022-08-20,2022-09-06,PLN4397,1809014947,1809014947,Urology,In-Network,E11.9,R07.9,,,,,,,0,,97530,Medicine,,,0450,22,Outpatient Hospital,3,299.63,100.77,0.0,100.77,0.0,0.0,100.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004993,MBR00000191,Institutional-IP,2023-11-26,2023-11-29,2023-12-24,PLN3074,1891849440,1891849440,Oncology,In-Network,I10,I11.9,,,,195,MS-DRG,23,3,Y,90460,Medicine,,,0270,21,Inpatient Hospital,1,61.75,50.11,50.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004994,MBR00000191,Professional,2021-07-14,2021-07-14,2021-07-21,PLN5953,1390307371,1390307371,DME Supplier,In-Network,Z00.01,E78.5,,,,,,,0,,99233,E&M,,,,50,Federally Qualified Health Center,2,344.73,171.01,116.11,16.61,35.0,3.29,54.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004995,MBR00000191,Professional,2022-07-07,2022-07-07,2022-07-20,PLN6741,1872272835,1872272835,Internal Medicine,In-Network,K21.0,F41.9,,,,,,,0,,G0444,Medicine,,,,11,Office,1,75.36,44.58,0.0,44.58,0.0,0.0,44.58,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000004996,MBR00000191,Professional,2023-11-24,2023-11-24,2023-12-02,PLN8865,1235381502,1235381502,Cardiology,In-Network,B97.89,J44.1,,,,,,,0,,G0444,Medicine,,,,49,Independent Clinic,2,88.54,39.02,0.0,39.02,15.0,0.0,54.02,0.0,Denied,CO-4,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000004997,MBR00000191,Professional,2021-05-09,2021-05-09,2021-06-15,PLN9332,1561134315,1561134315,DME Supplier,In-Network,Z12.31,Z00.00,,,,,,,0,,99203,E&M,,,,11,Office,1,254.26,97.28,79.42,15.01,0.0,2.85,17.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004998,MBR00000191,Professional,2021-10-06,2021-10-06,2021-11-14,PLN7897,1752470395,1752470395,Home Health,In-Network,Z00.00,N39.0,,,,,,,0,,97530,Medicine,,,,11,Office,3,293.08,98.57,21.86,0.0,75.0,1.71,76.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000004999,MBR00000191,Professional,2023-02-26,2023-02-26,2023-03-13,PLN9131,1609526529,1609526529,Psychiatry,In-Network,Z23,J44.1,,,,,,,0,,G0439,Medicine,,,,20,Urgent Care,2,354.57,197.07,172.07,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000005000,MBR00000191,Professional,2021-04-29,2021-04-29,2021-06-10,PLN6241,1994661817,1994661817,SNF,Out-of-Network,Z00.00,I10,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,2,128.11,62.25,56.19,0.0,0.0,6.06,6.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005001,MBR00000191,Institutional-IP,2021-08-16,2021-08-19,2021-09-03,PLN5566,1727809972,1727809972,Home Health,In-Network,E78.5,E66.9,,,,690,MS-DRG,7,3,Y,76700,Radiology,,,0370,21,Inpatient Hospital,1,1182.81,716.07,716.07,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000005002,MBR00000191,Institutional-OP,2023-11-15,2023-11-15,2023-12-18,PLN6409,1500949740,1500949740,Pediatrics,In-Network,Z12.11,N39.0,,,,,,,0,,90460,Medicine,,,0120,22,Outpatient Hospital,2,71.25,56.94,0.0,0.0,50.0,0.08,50.08,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005003,MBR00000191,Institutional-OP,2022-09-29,2022-09-29,2022-10-16,PLN2908,1800011727,1800011727,Clinical Laboratory,Out-of-Network,J06.9,F03.90,,,,,,,0,,99221,E&M,,,0450,22,Outpatient Hospital,3,443.57,370.48,0.0,347.46,75.0,0.0,422.46,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000005004,MBR00000191,Professional,2021-03-03,2021-03-03,2021-03-27,PLN6630,1219817751,1219817751,OB/GYN,In-Network,I50.9,N39.0,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,1,47.66,38.55,35.6,0.0,0.0,2.95,2.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005005,MBR00000191,Professional,2023-07-25,2023-07-25,2023-08-25,PLN6927,1865904917,1865904917,Outpatient Clinic,In-Network,K21.0,Z23,,,,,,,0,,90837,Medicine,,,,20,Urgent Care,2,460.48,214.84,1.89,187.71,25.0,0.24,212.95,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005006,MBR00000191,Professional,2022-07-28,2022-07-28,2022-08-26,PLN5506,1273488618,1273488618,General Acute Care Hospital,In-Network,Z00.00,M54.5,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,2,3779.5,1259.63,1133.73,0.0,50.0,75.9,125.9,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005007,MBR00000191,Professional,2022-06-07,2022-06-07,2022-07-18,PLN7364,1361302520,1361302520,Critical Access Hospital,In-Network,E11.9,Z00.01,,,,,,,0,,99222,E&M,,,,20,Urgent Care,2,309.72,183.26,158.26,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005008,MBR00000191,Professional,2023-12-23,2023-12-23,2024-01-11,PLN8330,1997536841,1997536841,Family Medicine,Out-of-Network,J44.1,E78.5,,,,,,,0,,23472,Surgery,,,,31,Skilled Nursing Facility,2,5122.0,3323.17,3323.17,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005009,MBR00000191,Professional,2021-12-11,2021-12-11,2022-01-02,PLN1388,1840431511,1840431511,Geriatrics,Out-of-Network,Z12.31,F32.9,,,,,,,0,,97530,Medicine,,,,12,Home,1,243.96,89.51,14.51,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005010,MBR00000192,Institutional-IP,2022-02-19,2022-02-26,2022-03-20,PLN4484,1624802371,1624802371,ASC,Out-of-Network,E78.5,N40.0,,,,603,MS-DRG,13,7,Y,83036,Pathology/Lab,,,0740,21,Inpatient Hospital,3,53.84,37.26,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000005011,MBR00000192,Institutional-OP,2022-09-23,2022-09-23,2022-11-06,PLN1105,1660288235,1660288235,ASC,In-Network,M17.11,E66.9,,,,,,,0,,33533,Surgery,,,0450,22,Outpatient Hospital,2,28871.65,9497.0,8004.01,88.68,15.0,1389.31,1492.99,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000005012,MBR00000192,Professional,2021-09-22,2021-09-22,2021-10-04,PLN9961,1728018911,1728018911,Nephrology,In-Network,J06.9,R07.9,,,,,,,0,,99204,E&M,,,,20,Urgent Care,3,551.1,236.06,236.06,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005013,MBR00000192,Professional,2021-05-20,2021-05-20,2021-06-05,PLN5125,1910255109,1910255109,DME Supplier,In-Network,Z23,G43.909,,,,,,,0,,93306,Radiology,,,,49,Independent Clinic,2,3270.15,2682.24,2049.35,284.17,25.0,323.72,632.89,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005014,MBR00000192,Institutional-OP,2021-06-01,2021-06-01,2021-07-06,PLN2668,1366576336,1366576336,Geriatrics,In-Network,E11.65,Z23,,,,,,,0,,99232,E&M,,,0120,22,Outpatient Hospital,3,213.9,152.81,0.0,152.81,0.0,0.0,152.81,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005015,MBR00000192,Institutional-OP,2021-12-03,2021-12-03,2022-01-04,PLN7505,1964402759,1964402759,Outpatient Clinic,In-Network,E78.5,I10,,,,,,,0,,90460,Medicine,,,0450,22,Outpatient Hospital,2,50.48,36.92,36.92,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005016,MBR00000192,Professional,2021-03-29,2021-03-29,2021-04-16,PLN6011,1438368327,1438368327,Home Health,In-Network,N39.0,E78.5,,,,,,,0,,23472,Surgery,,,,11,Office,3,7013.56,5550.15,5550.15,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005017,MBR00000192,Institutional-IP,2022-07-07,2022-07-14,2022-08-15,PLN5411,1809014947,1809014947,Urology,In-Network,E11.9,Z12.31,,,,641,MS-DRG,16,7,Y,71046,Radiology,,,0636,21,Inpatient Hospital,3,242.56,116.95,81.95,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005018,MBR00000192,Professional,2023-12-24,2023-12-24,2024-01-12,PLN2097,1295371663,1295371663,Critical Access Hospital,In-Network,Z79.4,R07.9,,,,,,,0,,G0468,Medicine,,,,11,Office,1,673.09,428.92,428.92,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005019,MBR00000192,Institutional-IP,2021-10-06,2021-10-18,2021-11-06,PLN8757,1168881145,1168881145,Orthopedic Surgery,In-Network,I25.10,E11.40,,,,603,MS-DRG,24,12,Y,82043,Pathology/Lab,,,0120,21,Inpatient Hospital,3,26.42,17.69,17.69,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005020,MBR00000193,Institutional-OP,2021-02-14,2021-02-14,2021-03-03,PLN4379,1542828721,1542828721,Orthopedic Surgery,In-Network,I11.9,F32.9,,,,,,,0,,66984,Surgery,,,0450,22,Outpatient Hospital,1,2517.82,1656.08,1433.47,0.0,0.0,222.61,222.61,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005021,MBR00000193,Professional,2021-02-12,2021-02-12,2021-02-27,PLN3146,1990090423,1990090423,Orthopedic Surgery,In-Network,N40.0,Z00.00,,,,,,,0,,93306,Radiology,,,,11,Office,1,3122.67,1283.06,1241.88,41.18,0.0,0.0,41.18,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005022,MBR00000193,Professional,2021-07-02,2021-07-02,2021-07-27,PLN5486,1135158374,1135158374,Pulmonology,In-Network,I25.10,Z23,,,,,,,0,,G0468,Medicine,,,,22,Outpatient Hospital,3,636.34,211.13,161.13,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005023,MBR00000193,Institutional-IP,2022-10-03,2022-10-15,2022-11-16,PLN8688,1450094833,1450094833,Outpatient Clinic,In-Network,N18.3,M54.5,,,,292,MS-DRG,2,12,Y,97530,Medicine,,,0730,21,Inpatient Hospital,1,126.77,63.45,0.0,63.45,75.0,0.0,138.45,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005024,MBR00000193,Institutional-IP,2022-05-31,2022-06-06,2022-06-14,PLN2298,1366576336,1366576336,Geriatrics,In-Network,J06.9,M54.5,,,,195,MS-DRG,18,6,Y,45378,Surgery,,,0761,21,Inpatient Hospital,3,2279.42,1829.7,1814.7,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000005025,MBR00000193,Institutional-OP,2022-03-16,2022-03-16,2022-04-26,PLN2063,1644128543,1644128543,Gastroenterology,In-Network,E78.5,Z87.891,,,,,,,0,,23472,Surgery,,,0740,22,Outpatient Hospital,2,4155.25,2699.99,2195.45,0.0,0.0,504.54,504.54,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005026,MBR00000193,Professional,2023-04-07,2023-04-07,2023-05-09,PLN8648,1135158374,1135158374,Pulmonology,In-Network,M17.11,E11.40,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,2,58.59,29.53,0.0,29.53,0.0,0.0,29.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005027,MBR00000193,Institutional-OP,2022-03-04,2022-03-04,2022-03-17,PLN5534,1337791138,1337791138,Internal Medicine,Out-of-Network,F32.9,Z00.00,,,,,,,0,,99283,E&M,,,0200,22,Outpatient Hospital,1,378.29,190.79,190.79,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005028,MBR00000193,Institutional-OP,2022-11-06,2022-11-06,2022-11-20,PLN7799,1239316214,1239316214,Internal Medicine,In-Network,Z00.01,Z12.11,,,,,,,0,,66984,Surgery,,,0740,22,Outpatient Hospital,3,3362.14,2115.44,1985.01,130.43,0.0,0.0,130.43,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005029,MBR00000193,Institutional-IP,2023-12-28,2024-01-01,2024-01-21,PLN4195,1817234602,1817234602,Clinical Laboratory,In-Network,N39.0,R07.9,,,,871,MS-DRG,13,4,Y,99204,E&M,,,0200,21,Inpatient Hospital,2,537.59,442.65,348.86,57.45,0.0,36.34,93.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005030,MBR00000194,Professional,2021-07-05,2021-07-05,2021-07-22,PLN1661,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,Z00.00,Z51.11,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,1,73.43,33.87,33.87,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005031,MBR00000194,Professional,2021-05-03,2021-05-03,2021-06-06,PLN7084,1800011727,1800011727,Clinical Laboratory,Out-of-Network,I10,E78.5,,,,,,,0,,99203,E&M,,,,50,Federally Qualified Health Center,1,280.96,149.34,128.47,0.0,0.0,20.87,20.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005032,MBR00000194,Institutional-IP,2021-08-27,2021-09-01,2021-09-21,PLN3069,1700633438,1700633438,DME Supplier,In-Network,Z00.00,M54.5,,,,682,MS-DRG,20,5,N,43239,Surgery,,,0320,21,Inpatient Hospital,2,1615.04,1369.52,1344.52,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,1,Unbundling,0,0,0,0,0
CLM0000005033,MBR00000194,Professional,2021-06-18,2021-06-18,2021-07-16,PLN4748,1757138478,1757138478,Pediatrics,In-Network,R05,F41.9,,,,,,,0,,G0468,Medicine,,,,11,Office,3,319.77,191.51,108.08,83.43,0.0,0.0,83.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005034,MBR00000194,Professional,2023-06-28,2023-06-28,2023-07-14,PLN3140,1224179551,1224179551,Physical Therapy,In-Network,Z23,K21.0,,,,,,,0,,27130,Surgery,,,,12,Home,3,5620.45,3228.23,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-29,,0,,0,0,1,0,0,1,Phantom,0,0,0,0,0
CLM0000005035,MBR00000194,Professional,2023-08-18,2023-08-18,2023-09-16,PLN6780,1542828721,1542828721,Orthopedic Surgery,In-Network,E66.9,E11.9,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,2,119.77,79.33,0.0,79.33,75.0,0.0,154.33,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000005036,MBR00000194,Institutional-OP,2022-09-06,2022-09-06,2022-10-11,PLN6114,1132188260,1132188260,Family Medicine,In-Network,E78.5,E78.5,,,,,,,0,,99221,E&M,,,0636,22,Outpatient Hospital,1,412.35,295.72,219.51,61.21,15.0,0.0,76.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005037,MBR00000194,Institutional-IP,2021-05-23,2021-05-28,2021-06-01,PLN3224,1872272835,1872272835,Internal Medicine,In-Network,R07.9,Z12.11,,,,683,MS-DRG,5,5,Y,99233,E&M,,,0370,21,Inpatient Hospital,2,342.25,173.87,173.87,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005038,MBR00000194,Institutional-OP,2023-07-22,2023-07-22,2023-08-13,PLN6830,1366576336,1366576336,Geriatrics,In-Network,F41.9,Z12.31,,,,,,,0,,99221,E&M,,,0510,22,Outpatient Hospital,2,230.76,175.78,175.78,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000005039,MBR00000194,Institutional-OP,2023-10-02,2023-10-02,2023-11-04,PLN7951,1745114564,1745114564,Endocrinology,In-Network,G20,E11.9,,,,,,,0,,87491,Pathology/Lab,,,0370,22,Outpatient Hospital,1,150.27,64.71,49.71,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005040,MBR00000194,Institutional-OP,2022-03-23,2022-03-23,2022-04-26,PLN3955,1514306773,1514306773,Endocrinology,In-Network,M17.11,Z00.00,,,,,,,0,,70553,Radiology,,,0740,22,Outpatient Hospital,3,4183.54,1433.76,1034.98,323.78,75.0,0.0,398.78,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005041,MBR00000194,Professional,2023-01-06,2023-01-06,2023-02-14,PLN3239,1450553056,1450553056,Clinical Laboratory,In-Network,E11.9,I25.10,,,,,,,0,,85610,Pathology/Lab,,,,31,Skilled Nursing Facility,3,54.25,32.47,0.0,32.47,0.0,0.0,32.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005042,MBR00000194,Professional,2022-10-29,2022-10-29,2022-11-25,PLN1759,1550154147,1550154147,Outpatient Clinic,In-Network,J20.9,F32.9,,,,,,,0,,99283,E&M,,,,20,Urgent Care,3,324.35,203.63,0.0,203.63,25.0,0.0,228.63,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005043,MBR00000194,Institutional-OP,2022-08-02,2022-08-02,2022-09-04,PLN7132,1749327647,1749327647,Geriatrics,In-Network,E11.9,Z12.31,,,,,,,0,,99284,E&M,,,0636,22,Outpatient Hospital,2,683.99,321.36,0.0,270.46,15.0,0.0,285.46,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005044,MBR00000194,Institutional-OP,2022-01-22,2022-01-22,2022-03-04,PLN6182,1974006077,1974006077,Orthopedic Surgery,In-Network,E11.9,F41.9,,,,,,,0,,27447,Surgery,,,0370,22,Outpatient Hospital,3,3543.5,1617.47,1542.47,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005045,MBR00000194,Institutional-OP,2021-11-01,2021-11-01,2021-12-15,PLN2268,1103747954,1103747954,Urology,In-Network,J06.9,I10,,,,,,,0,,99204,E&M,,,0320,22,Outpatient Hospital,1,440.41,245.7,210.7,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005046,MBR00000194,Professional,2021-10-29,2021-10-29,2021-12-12,PLN4181,1463205530,1463205530,Nephrology,In-Network,Z23,K21.0,,,,,,,0,,27447,Surgery,,,,21,Inpatient Hospital,2,3627.78,2061.54,1885.48,176.06,0.0,0.0,176.06,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005047,MBR00000194,Institutional-OP,2022-01-29,2022-01-29,2022-02-19,PLN9753,1757138478,1757138478,Pediatrics,In-Network,F32.9,F10.20,,,,,,,0,,90460,Medicine,,,0510,22,Outpatient Hospital,1,64.57,47.42,32.42,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005048,MBR00000194,Professional,2023-04-13,2023-04-13,2023-05-09,PLN1794,1245650222,1245650222,Gastroenterology,In-Network,J44.1,I10,,,,,,,0,,93000,Radiology,,,,12,Home,1,129.11,83.86,72.4,0.0,0.0,11.46,11.46,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005049,MBR00000194,Professional,2023-06-24,2023-06-24,2023-07-30,PLN6298,1235381502,1235381502,Cardiology,In-Network,I11.9,N40.0,,,,,,,0,,45380,Surgery,,,,11,Office,3,2173.45,1653.12,1320.33,158.64,0.0,174.15,332.79,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000005050,MBR00000194,Professional,2021-05-05,2021-05-05,2021-06-09,PLN2501,1514306773,1514306773,Endocrinology,In-Network,F41.9,E78.5,,,,,,,0,,99204,E&M,,,,21,Inpatient Hospital,2,219.41,148.91,113.91,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005051,MBR00000194,Professional,2021-03-04,2021-03-04,2021-04-15,PLN3380,1696843572,1696843572,Critical Access Hospital,Out-of-Network,N40.0,F32.9,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,3,2993.89,1271.35,715.74,492.4,0.0,63.21,555.61,0.0,Paid,,,1,,0,0,1,0,0,1,Duplicate,0,1,0,0,0
CLM0000005052,MBR00000194,Professional,2022-06-08,2022-06-08,2022-07-03,PLN3312,1313212303,1313212303,Family Medicine,In-Network,F41.9,E78.5,,,,,,,0,,71046,Radiology,,,,11,Office,3,125.46,94.86,0.0,94.86,0.0,0.0,94.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005053,MBR00000194,Institutional-OP,2023-04-22,2023-04-22,2023-05-09,PLN1064,1713934949,1713934949,Neurology,In-Network,E78.5,E11.65,,,,,,,0,,45378,Surgery,,,0900,22,Outpatient Hospital,2,1120.26,478.82,321.6,157.22,0.0,0.0,157.22,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000005054,MBR00000194,Professional,2022-09-07,2022-09-07,2022-10-20,PLN3438,1847081578,1847081578,Urology,Out-of-Network,E78.5,Z87.891,,,,,,,0,,27447,Surgery,,,,11,Office,2,2570.4,1581.21,1489.95,0.0,15.0,76.26,91.26,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005055,MBR00000194,Institutional-OP,2023-06-26,2023-06-26,2023-07-05,PLN1088,1542828721,1542828721,Orthopedic Surgery,In-Network,I63.9,I25.10,,,,,,,0,,G0439,Medicine,,,0510,22,Outpatient Hospital,1,308.65,133.4,0.0,133.4,0.0,0.0,133.4,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000005056,MBR00000194,Professional,2023-02-21,2023-02-21,2023-03-26,PLN3769,1514306773,1514306773,Endocrinology,In-Network,I10,E11.9,,,,,,,0,,99214,E&M,,,,11,Office,1,295.6,172.58,144.44,0.0,15.0,13.14,28.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005057,MBR00000194,Professional,2023-02-13,2023-02-13,2023-03-24,PLN2666,1939033455,1939033455,Pulmonology,In-Network,Z23,M54.5,,,,,,,0,,47562,Surgery,,,,12,Home,3,2485.11,1272.34,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-11,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005058,MBR00000194,Professional,2022-08-13,2022-08-13,2022-09-16,PLN5488,1624802371,1624802371,ASC,Out-of-Network,E11.65,E66.9,,,,,,,0,,99284,E&M,,,,11,Office,1,514.85,301.21,276.21,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005059,MBR00000194,Professional,2021-03-01,2021-03-01,2021-03-21,PLN4569,1606140917,1606140917,ASC,In-Network,Z23,Z23,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,3,5304.09,3046.57,2680.35,366.22,0.0,0.0,366.22,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005060,MBR00000194,Professional,2021-07-16,2021-07-16,2021-08-06,PLN2376,1749327647,1749327647,Geriatrics,In-Network,Z00.00,R07.9,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,2,360.32,191.67,127.76,0.0,35.0,28.91,63.91,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005061,MBR00000194,Professional,2023-03-25,2023-03-25,2023-04-06,PLN8531,1575695214,1575695214,SNF,In-Network,E11.9,Z23,,,,,,,0,,33533,Surgery,,,,21,Inpatient Hospital,3,11323.2,8279.69,7680.97,296.62,25.0,277.1,598.72,0.0,Adjusted,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000005062,MBR00000194,Professional,2021-12-05,2021-12-05,2022-01-15,PLN4050,1872272835,1872272835,Internal Medicine,In-Network,Z00.00,N39.0,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,2,6453.86,4724.23,4301.72,422.51,0.0,0.0,422.51,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005063,MBR00000194,Professional,2023-03-03,2023-03-03,2023-03-12,PLN3457,1847081578,1847081578,Urology,Out-of-Network,Z23,N18.3,,,,,,,0,,87491,Pathology/Lab,,,,49,Independent Clinic,1,156.25,83.0,76.04,0.0,0.0,6.96,6.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005064,MBR00000194,Institutional-IP,2022-01-07,2022-01-10,2022-01-19,PLN8562,1139906830,1139906830,Endocrinology,Out-of-Network,J06.9,I10,,,,291,MS-DRG,11,3,Y,G0444,Medicine,,,0301,21,Inpatient Hospital,2,92.62,71.17,33.51,0.0,35.0,2.66,37.66,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000005065,MBR00000194,Professional,2021-01-15,2021-01-15,2021-02-17,PLN2461,1242201429,1242201429,General Acute Care Hospital,In-Network,Z00.01,F41.9,,,,,,,0,,33533,Surgery,,,,23,Emergency Room,1,18195.7,9108.23,8698.39,409.84,0.0,0.0,409.84,0.0,Paid,,,0,,1,0,0,1,0,0,None,0,0,0,0,0
CLM0000005066,MBR00000194,Professional,2023-01-11,2023-01-11,2023-01-28,PLN2468,1980712759,1980712759,Outpatient Clinic,Out-of-Network,F10.20,E11.9,,,,,,,0,,82043,Pathology/Lab,,,,21,Inpatient Hospital,1,73.04,45.09,10.09,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005067,MBR00000194,Professional,2023-09-05,2023-09-05,2023-09-25,PLN2570,1856686341,1856686341,Geriatrics,In-Network,I10,E11.9,,,,,,,0,,43239,Surgery,,,,23,Emergency Room,3,2076.75,751.2,588.18,113.02,50.0,0.0,163.02,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005068,MBR00000195,Professional,2022-05-04,2022-05-04,2022-06-04,PLN8115,1355166277,1355166277,Endocrinology,In-Network,I10,F41.9,,,,,,,0,,99233,E&M,,,,65,End-Stage Renal Disease,1,316.02,240.85,0.0,240.85,35.0,0.0,275.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005069,MBR00000195,Institutional-OP,2021-05-25,2021-05-25,2021-06-18,PLN5805,1168881145,1168881145,Orthopedic Surgery,In-Network,J45.20,Z23,,,,,,,0,,99283,E&M,,,0200,22,Outpatient Hospital,3,478.51,188.87,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005070,MBR00000195,Professional,2022-03-30,2022-03-30,2022-04-14,PLN8334,1273488618,1273488618,General Acute Care Hospital,In-Network,M17.11,I25.10,,,,,,,0,,23472,Surgery,,,,11,Office,3,4877.38,3143.5,2847.14,296.36,0.0,0.0,296.36,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005071,MBR00000195,Institutional-IP,2023-11-19,2023-11-20,2023-12-18,PLN1167,1935547131,1935547131,Pulmonology,In-Network,J44.1,Z87.891,,,,194,MS-DRG,16,1,N,80061,Pathology/Lab,,,0320,21,Inpatient Hospital,2,85.43,69.92,54.92,0.0,15.0,0.0,15.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005072,MBR00000195,Institutional-OP,2021-12-15,2021-12-15,2022-01-24,PLN3416,1728018911,1728018911,Nephrology,In-Network,I25.10,E11.65,,,,,,,0,,78452,Radiology,,,0740,22,Outpatient Hospital,3,4649.49,2266.23,1892.81,348.42,25.0,0.0,373.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005073,MBR00000195,Professional,2021-03-19,2021-03-19,2021-04-28,PLN7433,1245650222,1245650222,Gastroenterology,In-Network,I10,E11.9,,,,,,,0,,99213,E&M,,,,11,Office,1,255.11,106.2,31.2,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005074,MBR00000196,Institutional-OP,2023-04-21,2023-04-21,2023-05-15,PLN9650,1530904931,1530904931,Internal Medicine,In-Network,E11.9,J06.9,,,,,,,0,,87491,Pathology/Lab,,,0510,22,Outpatient Hospital,1,160.69,96.16,0.0,0.0,75.0,4.16,79.16,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005075,MBR00000196,Institutional-OP,2021-09-18,2021-09-18,2021-09-27,PLN3185,1624202402,1624202402,Orthopedic Surgery,In-Network,E78.5,I11.9,,,,,,,0,,99284,E&M,,,0120,22,Outpatient Hospital,3,714.34,548.53,92.22,456.31,0.0,0.0,456.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005076,MBR00000196,Institutional-OP,2021-02-10,2021-02-10,2021-03-09,PLN6021,1244186984,1244186984,Family Medicine,Out-of-Network,E78.5,R07.9,,,,,,,0,,99222,E&M,,,0761,22,Outpatient Hospital,1,359.32,283.56,188.18,0.0,50.0,45.38,95.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005077,MBR00000196,Institutional-OP,2023-01-26,2023-01-26,2023-02-05,PLN7994,1108115157,1108115157,General Acute Care Hospital,In-Network,I11.9,R07.9,,,,,,,0,,99204,E&M,,,0200,22,Outpatient Hospital,2,554.79,235.28,235.28,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005078,MBR00000196,Professional,2022-01-06,2022-01-06,2022-01-23,PLN5340,1561134315,1561134315,DME Supplier,In-Network,Z00.00,N18.3,,,,,,,0,,70450,Radiology,,,,23,Emergency Room,2,1715.53,1432.88,1159.6,258.28,15.0,0.0,273.28,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005079,MBR00000196,Professional,2021-05-31,2021-05-31,2021-07-13,PLN5054,1139906830,1139906830,Endocrinology,Out-of-Network,Z00.00,J20.9,,,,,,,0,,99204,E&M,,,,11,Office,3,473.14,294.2,60.15,234.05,0.0,0.0,234.05,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005080,MBR00000196,Professional,2021-03-01,2021-03-01,2021-04-02,PLN3341,1609526529,1609526529,Psychiatry,In-Network,R07.9,N39.0,,,,,,,0,,90460,Medicine,,,,11,Office,1,55.66,36.37,33.87,0.0,0.0,2.5,2.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005081,MBR00000196,Institutional-IP,2021-07-22,2021-08-01,2021-08-10,PLN9222,1689639685,1689639685,SNF,In-Network,E87.6,I50.9,,,,194,MS-DRG,1,10,Y,99283,E&M,,,0900,21,Inpatient Hospital,3,494.11,215.88,48.93,162.08,0.0,4.87,166.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005082,MBR00000196,Professional,2021-06-13,2021-06-13,2021-07-23,PLN6239,1845900543,1845900543,ASC,In-Network,Z23,Z00.00,,,,,,,0,,93225,Medicine,,,,22,Outpatient Hospital,1,591.74,293.72,278.39,0.0,0.0,15.33,15.33,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000005083,MBR00000197,Professional,2021-01-13,2021-01-13,2021-01-28,PLN8971,1571574052,1571574052,Critical Access Hospital,In-Network,J06.9,I10,,,,,,,0,,99283,E&M,,,,21,Inpatient Hospital,3,400.71,144.41,144.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005084,MBR00000197,Institutional-OP,2022-02-10,2022-02-10,2022-03-16,PLN9472,1865904917,1865904917,Outpatient Clinic,In-Network,I25.10,E11.9,,,,,,,0,,90837,Medicine,,,0761,22,Outpatient Hospital,3,355.68,252.96,0.0,252.96,0.0,0.0,252.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005085,MBR00000197,Professional,2023-06-24,2023-06-24,2023-07-05,PLN1040,1205377316,1205377316,Orthopedic Surgery,In-Network,E11.9,K21.0,,,,,,,0,,99214,E&M,,,,11,Office,3,257.29,127.25,0.0,127.25,0.0,0.0,127.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005086,MBR00000197,Professional,2022-03-10,2022-03-10,2022-04-13,PLN2843,1198133277,1198133277,SNF,In-Network,I63.9,E11.9,,,,,,,0,,99232,E&M,,,,21,Inpatient Hospital,3,211.22,134.33,0.0,71.79,75.0,0.0,146.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005087,MBR00000197,Professional,2021-02-11,2021-02-11,2021-03-16,PLN3652,1700633438,1700633438,DME Supplier,In-Network,E11.9,I10,,,,,,,0,,99233,E&M,,,,11,Office,3,398.74,289.2,279.72,0.0,0.0,9.48,9.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005088,MBR00000197,Institutional-IP,2023-08-24,2023-08-27,2023-09-21,PLN7029,1235381502,1235381502,Cardiology,In-Network,Z12.31,Z12.31,,,,196,MS-DRG,23,3,Y,27130,Surgery,,,0900,21,Inpatient Hospital,2,5702.84,3605.86,0.0,0.0,0.0,48.78,48.78,0.0,Denied,CO-50,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005089,MBR00000197,Professional,2022-11-24,2022-11-24,2023-01-06,PLN4740,1896447406,1896447406,Nephrology,Out-of-Network,N39.0,Z96.641,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,3,81.56,31.91,0.0,31.91,50.0,0.0,81.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000005090,MBR00000197,Professional,2023-11-22,2023-11-22,2023-12-02,PLN3675,1514306773,1514306773,Endocrinology,In-Network,I50.9,M17.11,,,,,,,0,,90837,Medicine,,,,23,Emergency Room,1,252.73,93.28,0.0,93.28,0.0,0.0,93.28,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005091,MBR00000197,Institutional-OP,2022-09-30,2022-09-30,2022-10-30,PLN2086,1486164553,1486164553,DME Supplier,In-Network,Z00.01,E78.5,,,,,,,0,,66984,Surgery,,,0740,22,Outpatient Hospital,2,2165.9,1179.11,1179.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005092,MBR00000197,Professional,2022-06-07,2022-06-07,2022-06-24,PLN6376,1168881145,1168881145,Orthopedic Surgery,In-Network,J44.1,Z12.31,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,1,381.18,205.12,0.0,205.12,0.0,0.0,205.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005093,MBR00000197,Professional,2022-07-14,2022-07-14,2022-07-29,PLN8487,1135158374,1135158374,Pulmonology,In-Network,Z12.31,J44.1,,,,,,,0,,99204,E&M,,,,21,Inpatient Hospital,2,510.48,246.1,246.1,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005094,MBR00000197,Institutional-IP,2021-01-08,2021-01-16,2021-02-16,PLN5022,1433937353,1433937353,Nephrology,In-Network,K21.0,N18.3,,,,196,MS-DRG,21,8,Y,93225,Medicine,,,0450,21,Inpatient Hospital,3,839.04,278.25,243.25,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005095,MBR00000197,Professional,2022-02-15,2022-02-15,2022-02-27,PLN5716,1242201429,1242201429,General Acute Care Hospital,In-Network,Z12.31,Z00.00,,,,,,,0,,99221,E&M,,,,11,Office,3,354.49,141.95,125.46,0.0,0.0,16.49,16.49,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005096,MBR00000197,Professional,2022-04-29,2022-04-29,2022-06-01,PLN6844,1334916761,1334916761,ASC,In-Network,I10,J06.9,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,3,14753.55,8770.41,7087.76,0.0,0.0,1682.65,1682.65,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000005097,MBR00000197,Institutional-IP,2021-11-25,2021-11-27,2021-12-09,PLN5974,1124394415,1124394415,Pediatrics,In-Network,Z23,C50.912,,,,603,MS-DRG,10,2,N,99203,E&M,,,0120,21,Inpatient Hospital,1,245.7,201.5,0.0,201.5,0.0,0.0,201.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005098,MBR00000197,Institutional-IP,2023-07-06,2023-07-07,2023-08-13,PLN3344,1502838586,1502838586,ASC,In-Network,Z12.31,F03.90,,,,603,MS-DRG,10,1,Y,45380,Surgery,,,0320,21,Inpatient Hospital,3,2207.8,936.74,500.45,436.29,0.0,0.0,436.29,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000005099,MBR00000197,Professional,2023-11-14,2023-11-14,2023-12-06,PLN9135,1939033455,1939033455,Pulmonology,In-Network,M54.5,E11.9,,,,,,,0,,99204,E&M,,,,11,Office,3,579.23,185.61,15.86,94.75,75.0,0.0,169.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005100,MBR00000197,Institutional-OP,2022-06-08,2022-06-08,2022-06-28,PLN5180,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,C50.912,E78.5,,,,,,,0,,81001,Pathology/Lab,,,0730,22,Outpatient Hospital,1,29.05,11.36,11.24,0.0,0.0,0.12,0.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005101,MBR00000197,Institutional-OP,2023-05-10,2023-05-10,2023-05-23,PLN7882,1935547131,1935547131,Pulmonology,In-Network,Z00.00,I48.91,,,,,,,0,,99214,E&M,,,0450,22,Outpatient Hospital,2,348.95,218.59,0.0,218.59,35.0,0.0,253.59,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000005102,MBR00000197,Institutional-IP,2021-09-02,2021-09-03,2021-09-19,PLN5243,1687650653,1687650653,Internal Medicine,In-Network,F32.9,I25.10,,,,291,MS-DRG,17,1,Y,G0468,Medicine,,,0270,21,Inpatient Hospital,1,457.58,183.26,45.07,53.5,75.0,9.69,138.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005103,MBR00000197,Institutional-IP,2023-10-08,2023-10-13,2023-11-19,PLN5077,1896447406,1896447406,Nephrology,Out-of-Network,E11.9,J06.9,,,,683,MS-DRG,11,5,Y,81001,Pathology/Lab,,,0301,21,Inpatient Hospital,3,38.9,14.77,0.0,14.77,50.0,0.0,64.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005104,MBR00000197,Institutional-OP,2023-02-10,2023-02-10,2023-03-08,PLN7222,1390307371,1390307371,DME Supplier,In-Network,J20.9,I11.9,,,,,,,0,,99221,E&M,,,0301,22,Outpatient Hospital,1,380.57,290.54,26.24,249.3,15.0,0.0,264.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005105,MBR00000197,Professional,2023-03-15,2023-03-15,2023-03-29,PLN5473,1631954542,1631954542,Oncology,In-Network,F41.9,F32.9,,,,,,,0,,99213,E&M,,,,50,Federally Qualified Health Center,1,258.27,160.15,125.15,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005106,MBR00000197,Professional,2022-10-14,2022-10-14,2022-11-25,PLN5960,1752470395,1752470395,Home Health,In-Network,I10,J44.1,,,,,,,0,,99203,E&M,,,,11,Office,1,278.41,227.38,0.0,227.38,0.0,0.0,227.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005107,MBR00000197,Professional,2023-06-27,2023-06-27,2023-07-31,PLN8164,1247341320,1247341320,Urology,Out-of-Network,S72.001A,F32.9,,,,,,,0,,66984,Surgery,,,,81,Independent Laboratory,1,1410.22,1010.42,1010.42,0.0,0.0,0.0,0.0,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005108,MBR00000197,Professional,2022-08-08,2022-08-08,2022-08-29,PLN1899,1542828721,1542828721,Orthopedic Surgery,In-Network,F32.9,I10,,,,,,,0,,81001,Pathology/Lab,,,,22,Outpatient Hospital,2,25.39,11.96,11.16,0.0,0.0,0.8,0.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005109,MBR00000197,Institutional-OP,2023-11-22,2023-11-22,2023-12-23,PLN2129,1475984649,1475984649,SNF,In-Network,N20.0,N39.0,,,,,,,0,,27130,Surgery,,,0510,22,Outpatient Hospital,2,5044.14,3117.31,2632.97,0.0,35.0,449.34,484.34,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005110,MBR00000198,Professional,2022-12-27,2022-12-27,2023-01-23,PLN5008,1575695214,1575695214,SNF,In-Network,N20.0,Z23,,,,,,,0,,66984,Surgery,,,,11,Office,1,3296.35,1592.22,1561.6,30.62,0.0,0.0,30.62,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005111,MBR00000198,Professional,2022-05-12,2022-05-12,2022-06-12,PLN8274,1899127912,1899127912,Neurology,In-Network,E11.9,Z00.00,,,,,,,0,,90460,Medicine,,,,65,End-Stage Renal Disease,1,51.61,16.03,0.0,16.03,25.0,0.0,41.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005112,MBR00000198,Professional,2021-08-17,2021-08-17,2021-09-09,PLN9279,1550154147,1550154147,Outpatient Clinic,In-Network,N17.9,I10,,,,,,,0,,66984,Surgery,,,,11,Office,3,2622.27,1415.3,944.0,396.3,75.0,0.0,471.3,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005113,MBR00000198,Institutional-IP,2023-09-21,2023-09-24,2023-10-13,PLN3643,1590915516,1590915516,Physical Therapy,Out-of-Network,E11.65,R51,,,,195,MS-DRG,4,3,Y,99284,E&M,,,0120,21,Inpatient Hospital,1,923.67,769.47,633.06,136.41,0.0,0.0,136.41,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000005114,MBR00000198,Institutional-OP,2021-03-03,2021-03-03,2021-03-24,PLN1465,1717912431,1717912431,Oncology,In-Network,E78.5,M81.0,,,,,,,0,,99204,E&M,,,0320,22,Outpatient Hospital,2,299.34,221.1,0.0,221.1,25.0,0.0,246.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005115,MBR00000198,Professional,2021-02-17,2021-02-17,2021-03-18,PLN7310,1896447406,1896447406,Nephrology,Out-of-Network,E66.9,Z00.00,,,,,,,0,,90460,Medicine,,,,11,Office,1,53.1,16.16,16.16,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005116,MBR00000198,Institutional-OP,2021-02-03,2021-02-03,2021-02-18,PLN4403,1590915516,1590915516,Physical Therapy,Out-of-Network,E78.5,N18.3,,,,,,,0,,66984,Surgery,,,0120,22,Outpatient Hospital,2,3107.56,1539.01,1514.01,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005117,MBR00000198,Professional,2021-04-29,2021-04-29,2021-05-21,PLN5344,1500949740,1500949740,Pediatrics,In-Network,F41.9,I25.10,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,1,61.01,41.36,41.36,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005118,MBR00000198,Institutional-OP,2021-09-28,2021-09-28,2021-10-22,PLN9987,1334916761,1334916761,ASC,In-Network,M54.5,F41.9,,,,,,,0,,93306,Radiology,,,0120,22,Outpatient Hospital,1,2940.55,1979.58,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005119,MBR00000198,Institutional-OP,2022-06-21,2022-06-21,2022-08-01,PLN8842,1994661817,1994661817,SNF,Out-of-Network,E66.9,I10,,,,,,,0,,99222,E&M,,,0636,22,Outpatient Hospital,3,460.31,199.7,0.0,199.7,50.0,0.0,249.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005120,MBR00000198,Professional,2021-10-30,2021-10-30,2021-12-02,PLN4950,1689639685,1689639685,SNF,In-Network,R05,R10.9,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,1,444.34,231.71,216.71,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005121,MBR00000198,Institutional-OP,2022-05-13,2022-05-13,2022-06-17,PLN4357,1702692193,1702692193,Physical Therapy,In-Network,I10,F32.9,,,,,,,0,,99214,E&M,,,0270,22,Outpatient Hospital,1,413.64,291.4,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005122,MBR00000198,Professional,2022-05-06,2022-05-06,2022-06-03,PLN4571,1840431511,1840431511,Geriatrics,Out-of-Network,I25.10,I50.9,,,,,,,0,,99233,E&M,,,,11,Office,3,333.54,274.5,224.5,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005123,MBR00000198,Professional,2022-04-25,2022-04-25,2022-05-27,PLN6710,1186826716,1186826716,Physical Therapy,In-Network,I10,K92.1,,,,,,,0,,93306,Radiology,,,,49,Independent Clinic,1,2880.48,1376.96,1351.96,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005124,MBR00000198,Professional,2021-03-07,2021-03-07,2021-03-19,PLN8096,1915531927,1915531927,Critical Access Hospital,In-Network,N17.9,Z12.11,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,3,44.1,15.52,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005125,MBR00000198,Professional,2022-08-12,2022-08-12,2022-09-13,PLN9908,1569105090,1569105090,Geriatrics,In-Network,E11.9,I10,,,,,,,0,,74177,Radiology,,,,22,Outpatient Hospital,1,1591.75,1028.39,953.39,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005126,MBR00000198,Institutional-OP,2021-11-25,2021-11-25,2021-12-08,PLN6820,1990090423,1990090423,Orthopedic Surgery,In-Network,Z00.00,M54.5,,,,,,,0,,97110,Medicine,,,0320,22,Outpatient Hospital,2,188.55,99.89,99.89,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005127,MBR00000198,Institutional-OP,2022-08-13,2022-08-13,2022-08-29,PLN3346,1502838586,1502838586,ASC,In-Network,J18.9,F32.9,,,,,,,0,,90837,Medicine,,,0270,22,Outpatient Hospital,2,497.09,305.73,268.59,0.0,0.0,37.14,37.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005128,MBR00000198,Institutional-IP,2021-03-08,2021-03-12,2021-04-18,PLN5595,1125190055,1125190055,Nephrology,In-Network,K21.0,J20.9,,,,194,MS-DRG,1,4,Y,G0444,Medicine,,,0450,21,Inpatient Hospital,2,76.26,35.2,0.0,35.2,25.0,0.0,60.2,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000005129,MBR00000198,Institutional-OP,2023-08-12,2023-08-12,2023-09-19,PLN6457,1366426662,1366426662,Urology,In-Network,E78.5,R07.9,,,,,,,0,,81001,Pathology/Lab,,,0270,22,Outpatient Hospital,2,59.77,37.47,0.0,37.47,15.0,0.0,52.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005130,MBR00000198,Professional,2023-03-02,2023-03-02,2023-04-08,PLN1614,1948810580,1948810580,DME Supplier,In-Network,N18.3,F41.9,,,,,,,0,,27447,Surgery,,,,49,Independent Clinic,2,6038.69,2325.67,2064.65,236.02,25.0,0.0,261.02,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005131,MBR00000198,Professional,2022-01-14,2022-01-14,2022-02-15,PLN9718,1132188260,1132188260,Family Medicine,In-Network,I48.91,C50.912,,,,,,,0,,33533,Surgery,,,,49,Independent Clinic,2,23107.97,7677.78,7588.03,89.75,0.0,0.0,89.75,0.0,Adjusted,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000005132,MBR00000198,Institutional-OP,2022-01-29,2022-01-29,2022-02-16,PLN7732,1511044648,1511044648,Endocrinology,In-Network,I10,E78.5,,,,,,,0,,99232,E&M,,,0360,22,Outpatient Hospital,2,154.69,119.65,69.65,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005133,MBR00000198,Professional,2021-12-13,2021-12-13,2022-01-10,PLN1923,1266606767,1266606767,ASC,In-Network,Z23,M54.5,,,,,,,0,,G0468,Medicine,,,,11,Office,1,714.89,226.34,0.0,226.34,0.0,0.0,226.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005134,MBR00000198,Institutional-OP,2023-12-22,2023-12-22,2024-01-30,PLN2895,1542828721,1542828721,Orthopedic Surgery,In-Network,F41.9,E11.9,,,,,,,0,,99284,E&M,,,0370,22,Outpatient Hospital,3,775.51,400.12,303.91,0.0,75.0,21.21,96.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005135,MBR00000198,Professional,2023-02-08,2023-02-08,2023-03-16,PLN5748,1800011727,1800011727,Clinical Laboratory,Out-of-Network,J44.1,Z23,,,,,,,0,,99284,E&M,,,,81,Independent Laboratory,3,568.87,299.9,299.9,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005136,MBR00000198,Professional,2022-05-19,2022-05-19,2022-06-03,PLN1144,1713934949,1713934949,Neurology,In-Network,N18.3,J44.1,,,,,,,0,,99233,E&M,,,,11,Office,2,370.73,206.91,206.91,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005137,MBR00000198,Professional,2022-12-12,2022-12-12,2023-01-14,PLN1639,1847081578,1847081578,Urology,Out-of-Network,F41.9,Z12.31,,,,,,,0,,99284,E&M,,,,12,Home,2,333.68,272.64,88.9,133.74,50.0,0.0,183.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005138,MBR00000198,Professional,2021-03-12,2021-03-12,2021-04-21,PLN2808,1395983630,1395983630,Nephrology,In-Network,K21.0,Z23,,,,,,,0,,90837,Medicine,,,,21,Inpatient Hospital,3,480.67,246.0,206.34,0.0,0.0,39.66,39.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005139,MBR00000198,Professional,2023-06-28,2023-06-28,2023-07-17,PLN9524,1939033455,1939033455,Pulmonology,In-Network,Z00.00,M17.11,,,,,,,0,,G0444,Medicine,,,,31,Skilled Nursing Facility,3,99.92,64.79,0.0,64.79,0.0,0.0,64.79,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000005140,MBR00000198,Professional,2022-10-15,2022-10-15,2022-11-20,PLN5567,1372918899,1372918899,Family Medicine,In-Network,J06.9,Z12.31,,,,,,,0,,99221,E&M,,,,11,Office,2,189.11,106.11,31.11,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005141,MBR00000198,Professional,2021-12-05,2021-12-05,2022-01-18,PLN2983,1624202402,1624202402,Orthopedic Surgery,In-Network,J20.9,N39.0,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,2,132.92,87.6,62.6,0.0,25.0,0.0,25.0,0.0,Adjusted,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000005142,MBR00000198,Institutional-OP,2023-01-29,2023-01-29,2023-02-16,PLN8230,1268679390,1268679390,Critical Access Hospital,In-Network,Z23,E78.5,,,,,,,0,,93000,Radiology,,,0510,22,Outpatient Hospital,3,133.45,111.61,111.61,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005143,MBR00000198,Professional,2021-01-08,2021-01-08,2021-02-09,PLN6673,1313212303,1313212303,Family Medicine,In-Network,R10.9,Z12.31,,,,,,,0,,99213,E&M,,,,65,End-Stage Renal Disease,3,147.12,117.9,92.9,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005144,MBR00000198,Professional,2022-06-21,2022-06-21,2022-07-22,PLN8460,1235381502,1235381502,Cardiology,In-Network,Z12.11,Z12.31,,,,,,,0,,99283,E&M,,,,23,Emergency Room,3,507.8,409.3,384.3,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005145,MBR00000198,Professional,2023-10-31,2023-10-31,2023-11-25,PLN4657,1717912431,1717912431,Oncology,In-Network,M54.5,I25.10,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,1,2255.01,1669.26,1443.55,0.0,0.0,225.71,225.71,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000005146,MBR00000198,Professional,2023-04-12,2023-04-12,2023-05-12,PLN6286,1438368327,1438368327,Home Health,In-Network,E11.9,N39.0,,,,,,,0,,99222,E&M,,,,81,Independent Laboratory,1,466.15,303.11,35.27,252.84,15.0,0.0,267.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005147,MBR00000198,Professional,2021-02-18,2021-02-18,2021-03-01,PLN7792,1700633438,1700633438,DME Supplier,In-Network,E11.9,E11.65,,,,,,,0,,72148,Radiology,,,,11,Office,2,1350.27,866.07,841.07,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005148,MBR00000198,Professional,2022-10-08,2022-10-08,2022-10-28,PLN7228,1540044947,1540044947,Pulmonology,Out-of-Network,E78.5,J44.1,,,,,,,0,,99213,E&M,,,,49,Independent Clinic,3,324.95,202.75,167.75,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005149,MBR00000198,Professional,2023-01-15,2023-01-15,2023-02-09,PLN3268,1453936007,1453936007,ASC,In-Network,Z12.11,F41.9,,,,,,,0,,99406,Medicine,,,,11,Office,1,69.45,28.81,0.0,28.81,15.0,0.0,43.81,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005150,MBR00000198,Institutional-OP,2022-07-31,2022-07-31,2022-09-11,PLN3500,1268679390,1268679390,Critical Access Hospital,In-Network,E11.9,E78.5,,,,,,,0,,81001,Pathology/Lab,,,0301,22,Outpatient Hospital,1,60.92,45.16,0.0,45.16,0.0,0.0,45.16,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005151,MBR00000198,Professional,2021-12-19,2021-12-19,2022-01-03,PLN7739,1389336600,1389336600,Critical Access Hospital,In-Network,J06.9,Z23,,,,,,,0,,43239,Surgery,,,,21,Inpatient Hospital,1,1343.09,914.51,831.05,0.0,0.0,83.46,83.46,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005152,MBR00000199,Professional,2023-01-14,2023-01-14,2023-02-16,PLN8247,1631954542,1631954542,Oncology,In-Network,J20.9,Z00.00,,,,,,,0,,45378,Surgery,,,,50,Federally Qualified Health Center,3,1852.64,1242.25,1242.25,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000005153,MBR00000199,Institutional-OP,2022-04-09,2022-04-09,2022-05-01,PLN4703,1847081578,1847081578,Urology,Out-of-Network,J20.9,Z12.31,,,,,,,0,,33533,Surgery,,,0900,22,Outpatient Hospital,2,20610.07,14112.04,14050.92,61.12,0.0,0.0,61.12,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000005154,MBR00000199,Professional,2023-11-05,2023-11-05,2023-12-06,PLN9067,1790497490,1790497490,OB/GYN,In-Network,K21.0,J20.9,,,,,,,0,,90686,Medicine,,,,11,Office,1,65.33,45.19,0.0,45.19,50.0,0.0,95.19,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000005155,MBR00000199,Professional,2023-07-07,2023-07-07,2023-08-08,PLN5253,1500037969,1500037969,Pulmonology,In-Network,E11.65,I25.10,,,,,,,0,,27447,Surgery,,,,50,Federally Qualified Health Center,2,6014.23,2342.6,2317.6,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005156,MBR00000199,Professional,2023-09-23,2023-09-23,2023-10-11,PLN2951,1717912431,1717912431,Oncology,In-Network,Z79.4,Z00.00,,,,,,,0,,90686,Medicine,,,,31,Skilled Nursing Facility,2,112.91,89.32,0.0,89.32,75.0,0.0,164.32,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000005157,MBR00000199,Institutional-IP,2022-04-05,2022-04-11,2022-04-30,PLN8669,1728018911,1728018911,Nephrology,In-Network,F41.9,E78.5,,,,196,MS-DRG,14,6,Y,86900,Pathology/Lab,,,0370,21,Inpatient Hospital,3,56.15,22.97,22.97,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005158,MBR00000199,Institutional-OP,2023-01-12,2023-01-12,2023-01-19,PLN8236,1422747896,1422747896,Urology,In-Network,Z12.31,Z00.01,,,,,,,0,,81001,Pathology/Lab,,,0740,22,Outpatient Hospital,1,23.17,15.02,5.01,10.01,0.0,0.0,10.01,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005159,MBR00000199,Professional,2021-06-08,2021-06-08,2021-06-22,PLN7715,1213165847,1213165847,Critical Access Hospital,In-Network,M17.11,I10,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,1,29.58,17.01,1.82,0.0,15.0,0.19,15.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005160,MBR00000199,Institutional-OP,2023-04-04,2023-04-04,2023-05-06,PLN9741,1872272835,1872272835,Internal Medicine,In-Network,I25.10,C50.912,,,,,,,0,,72148,Radiology,,,0636,22,Outpatient Hospital,1,1803.77,754.64,636.45,118.19,0.0,0.0,118.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005161,MBR00000199,Professional,2023-04-07,2023-04-07,2023-05-16,PLN6711,1219817751,1219817751,OB/GYN,In-Network,E11.9,F32.9,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,2,6501.13,5206.53,4650.78,30.52,0.0,525.23,555.75,0.0,Paid,,,0,,0,0,1,0,0,1,Unbundling,0,0,0,0,0
CLM0000005162,MBR00000199,Institutional-OP,2023-04-30,2023-04-30,2023-06-13,PLN2774,1273488618,1273488618,General Acute Care Hospital,In-Network,S72.001A,I48.91,,,,,,,0,,99213,E&M,,,0120,22,Outpatient Hospital,1,303.34,156.44,156.44,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005163,MBR00000199,Professional,2021-01-23,2021-01-23,2021-03-01,PLN4322,1840431511,1840431511,Geriatrics,Out-of-Network,J18.9,E11.9,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,1,2304.17,1729.14,1729.14,0.0,0.0,0.0,0.0,0.0,Pended,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000005164,MBR00000199,Institutional-OP,2022-05-15,2022-05-15,2022-06-27,PLN6765,1575695214,1575695214,SNF,In-Network,E78.5,N20.0,,,,,,,0,,84443,Pathology/Lab,,,0510,22,Outpatient Hospital,3,153.79,80.14,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005165,MBR00000199,Professional,2021-10-28,2021-10-28,2021-11-25,PLN6768,1691062876,1691062876,SNF,In-Network,I11.9,M54.5,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,3,703.18,569.48,569.48,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005166,MBR00000200,Professional,2023-09-29,2023-09-29,2023-10-07,PLN5741,1366426662,1366426662,Urology,In-Network,M17.11,J44.1,,,,,,,0,,58661,Surgery,,,,49,Independent Clinic,1,3901.85,1233.68,1233.68,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005167,MBR00000200,Professional,2022-08-13,2022-08-13,2022-09-14,PLN7109,1168246159,1168246159,Internal Medicine,In-Network,R10.9,M17.11,,,,,,,0,,99204,E&M,,,,21,Inpatient Hospital,1,356.63,282.67,255.97,26.7,0.0,0.0,26.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005168,MBR00000200,Institutional-OP,2022-11-01,2022-11-01,2022-12-10,PLN7329,1366286000,1366286000,SNF,In-Network,E11.65,K21.0,,,,,,,0,,43239,Surgery,,,0320,22,Outpatient Hospital,2,2099.74,1709.18,1709.18,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005169,MBR00000200,Professional,2022-04-25,2022-04-25,2022-05-28,PLN6004,1531398223,1531398223,OB/GYN,In-Network,Z87.891,N39.0,,,,,,,0,,99204,E&M,,,,11,Office,2,337.65,258.39,0.0,258.39,0.0,0.0,258.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005170,MBR00000200,Professional,2021-05-05,2021-05-05,2021-06-14,PLN6341,1609138981,1609138981,Critical Access Hospital,In-Network,E11.9,M17.11,,,,,,,0,,93306,Radiology,,,,11,Office,1,1981.1,1217.22,1210.69,6.53,0.0,0.0,6.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005171,MBR00000200,Institutional-OP,2022-11-11,2022-11-11,2022-11-25,PLN2745,1767011137,1767011137,DME Supplier,In-Network,E78.5,M17.11,,,,,,,0,,74177,Radiology,,,0761,22,Outpatient Hospital,2,1298.57,1094.54,1069.54,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005172,MBR00000200,Institutional-OP,2022-10-31,2022-10-31,2022-11-15,PLN7032,1422747896,1422747896,Urology,In-Network,J44.1,I50.9,,,,,,,0,,58661,Surgery,,,0320,22,Outpatient Hospital,1,1813.12,871.37,790.58,45.79,35.0,0.0,80.79,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005173,MBR00000200,Institutional-IP,2022-02-22,2022-02-25,2022-03-06,PLN4123,1840431511,1840431511,Geriatrics,Out-of-Network,E66.9,E11.65,,,,196,MS-DRG,20,3,Y,99233,E&M,,,0450,21,Inpatient Hospital,2,281.37,190.93,106.03,18.6,50.0,16.3,84.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005174,MBR00000200,Professional,2022-11-21,2022-11-21,2022-12-14,PLN4284,1450094833,1450094833,Outpatient Clinic,In-Network,R07.9,M17.11,,,,,,,0,,99283,E&M,,,,21,Inpatient Hospital,3,267.24,163.77,88.77,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005175,MBR00000200,Professional,2022-03-04,2022-03-04,2022-04-01,PLN3846,1660288235,1660288235,ASC,In-Network,Z12.31,R07.9,,,,,,,0,,99233,E&M,,,,50,Federally Qualified Health Center,3,399.0,156.8,112.51,0.0,35.0,9.29,44.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005176,MBR00000200,Institutional-OP,2022-12-24,2022-12-24,2023-02-04,PLN3313,1622771872,1622771872,Pediatrics,In-Network,Z87.891,Z96.641,,,,,,,0,,G0439,Medicine,,,0761,22,Outpatient Hospital,3,353.22,219.58,219.58,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000005177,MBR00000200,Professional,2022-01-17,2022-01-17,2022-01-26,PLN8545,1518055405,1518055405,Urology,In-Network,E11.9,Z00.00,,,,,,,0,,99233,E&M,,,,11,Office,3,349.54,180.93,119.1,61.83,0.0,0.0,61.83,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005178,MBR00000200,Institutional-OP,2023-04-27,2023-04-27,2023-05-08,PLN1990,1236418230,1236418230,DME Supplier,In-Network,Z87.891,E11.40,,,,,,,0,,47562,Surgery,,,0740,22,Outpatient Hospital,3,4311.33,1616.49,1509.58,106.91,0.0,0.0,106.91,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005179,MBR00000200,Institutional-IP,2023-08-30,2023-09-02,2023-10-02,PLN7897,1817234602,1817234602,Clinical Laboratory,In-Network,Z23,Z79.4,,,,871,MS-DRG,4,3,Y,27130,Surgery,,,0370,21,Inpatient Hospital,1,4041.07,1887.32,1634.1,218.22,35.0,0.0,253.22,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005180,MBR00000200,Institutional-OP,2022-06-15,2022-06-15,2022-07-21,PLN4870,1268679390,1268679390,Critical Access Hospital,In-Network,J20.9,I25.10,,,,,,,0,,93000,Radiology,,,0301,22,Outpatient Hospital,1,88.29,26.63,1.61,0.0,25.0,0.02,25.02,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005181,MBR00000200,Institutional-IP,2021-01-19,2021-01-29,2021-02-13,PLN2858,1148984206,1148984206,Psychiatry,In-Network,N39.0,N18.3,,,,872,MS-DRG,17,10,N,81001,Pathology/Lab,,,0761,21,Inpatient Hospital,3,26.08,21.93,0.0,21.93,15.0,0.0,36.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005182,MBR00000201,Professional,2023-01-17,2023-01-17,2023-02-24,PLN7037,1168881145,1168881145,Orthopedic Surgery,In-Network,I63.9,M54.5,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,3,2105.79,656.06,656.06,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005183,MBR00000201,Institutional-OP,2023-10-26,2023-10-26,2023-11-18,PLN8903,1946680931,1946680931,Critical Access Hospital,Out-of-Network,K21.0,E78.5,,,,,,,0,,43239,Surgery,,,0120,22,Outpatient Hospital,1,1293.34,714.18,587.34,0.0,25.0,101.84,126.84,0.0,Paid,,,1,,0,0,1,0,0,1,Duplicate,0,0,0,0,0
CLM0000005184,MBR00000201,Institutional-OP,2023-02-17,2023-02-17,2023-03-09,PLN6489,1847081578,1847081578,Urology,Out-of-Network,E11.9,M54.5,,,,,,,0,,90686,Medicine,,,0360,22,Outpatient Hospital,3,88.88,28.15,0.0,28.15,75.0,0.0,103.15,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000005185,MBR00000201,Institutional-OP,2022-01-28,2022-01-28,2022-02-19,PLN2041,1244186984,1244186984,Family Medicine,Out-of-Network,J44.1,B97.89,,,,,,,0,,99213,E&M,,,0761,22,Outpatient Hospital,2,297.66,160.81,85.81,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005186,MBR00000201,Professional,2022-09-10,2022-09-10,2022-09-17,PLN6056,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,J44.1,I25.10,,,,,,,0,,23472,Surgery,,,,49,Independent Clinic,2,4470.65,3020.3,3020.3,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005187,MBR00000201,Professional,2022-02-04,2022-02-04,2022-02-13,PLN1585,1563980627,1563980627,Critical Access Hospital,In-Network,M54.5,I10,,,,,,,0,,99283,E&M,,,,23,Emergency Room,3,545.56,340.12,290.12,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005188,MBR00000201,Institutional-OP,2023-04-28,2023-04-28,2023-05-28,PLN2766,1366426662,1366426662,Urology,In-Network,E11.9,C50.912,,,,,,,0,,99214,E&M,,,0270,22,Outpatient Hospital,3,228.81,134.64,55.7,3.94,75.0,0.0,78.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005189,MBR00000201,Institutional-IP,2023-03-06,2023-03-07,2023-03-27,PLN4037,1500949740,1500949740,Pediatrics,In-Network,R05,G43.909,,,,690,MS-DRG,3,1,Y,99204,E&M,,,0740,21,Inpatient Hospital,1,232.28,86.62,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005190,MBR00000201,Professional,2022-11-16,2022-11-16,2022-12-17,PLN3484,1366576336,1366576336,Geriatrics,In-Network,I10,J44.1,,,,,,,0,,99233,E&M,,,,23,Emergency Room,3,494.74,281.68,266.68,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005191,MBR00000201,Professional,2022-03-02,2022-03-02,2022-04-02,PLN6078,1244186984,1244186984,Family Medicine,Out-of-Network,I10,E11.9,,,,,,,0,,70553,Radiology,,,,11,Office,1,3400.68,1350.41,904.35,222.09,0.0,223.97,446.06,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005192,MBR00000201,Professional,2021-07-08,2021-07-08,2021-08-02,PLN4648,1728018911,1728018911,Nephrology,In-Network,I25.10,N18.3,,,,,,,0,,83036,Pathology/Lab,,,,50,Federally Qualified Health Center,1,53.87,31.78,31.78,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000005193,MBR00000201,Professional,2022-11-07,2022-11-07,2022-11-16,PLN8116,1624802371,1624802371,ASC,Out-of-Network,Z23,E66.9,,,,,,,0,,90460,Medicine,,,,50,Federally Qualified Health Center,2,50.44,23.89,0.0,23.89,0.0,0.0,23.89,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005194,MBR00000201,Professional,2022-01-05,2022-01-05,2022-02-05,PLN9634,1273488618,1273488618,General Acute Care Hospital,In-Network,F32.9,I10,,,,,,,0,,G0439,Medicine,,,,11,Office,2,556.52,311.32,311.32,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000005195,MBR00000201,Institutional-OP,2023-09-17,2023-09-17,2023-10-12,PLN5079,1103747954,1103747954,Urology,In-Network,E11.9,N39.0,,,,,,,0,,97530,Medicine,,,0636,22,Outpatient Hospital,1,313.8,124.25,0.0,124.25,25.0,0.0,149.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005196,MBR00000201,Institutional-IP,2021-03-11,2021-03-19,2021-04-05,PLN6974,1500037969,1500037969,Pulmonology,In-Network,M54.5,E11.9,,,,470,MS-DRG,5,8,Y,47562,Surgery,,,0510,21,Inpatient Hospital,2,3894.88,1764.15,1399.5,0.52,25.0,339.13,364.65,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005197,MBR00000201,Professional,2023-07-16,2023-07-16,2023-08-15,PLN4331,1103747954,1103747954,Urology,In-Network,E78.5,N39.0,,,,,,,0,,58661,Surgery,,,,21,Inpatient Hospital,1,3017.37,1892.35,1452.48,414.87,25.0,0.0,439.87,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005198,MBR00000201,Institutional-IP,2023-05-04,2023-05-10,2023-06-05,PLN8407,1242201429,1242201429,General Acute Care Hospital,In-Network,J20.9,K21.0,,,,683,MS-DRG,9,6,Y,27447,Surgery,,,0450,21,Inpatient Hospital,2,5436.29,2328.9,1928.26,125.55,0.0,275.09,400.64,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005199,MBR00000201,Professional,2022-07-19,2022-07-19,2022-08-10,PLN4699,1749327647,1749327647,Geriatrics,In-Network,Z12.31,F10.20,,,,,,,0,,97110,Medicine,,,,23,Emergency Room,3,111.95,64.78,64.71,0.0,0.0,0.07,0.07,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005200,MBR00000201,Institutional-OP,2023-12-24,2023-12-24,2024-01-06,PLN1376,1749327647,1749327647,Geriatrics,In-Network,E78.5,F32.9,,,,,,,0,,74177,Radiology,,,0450,22,Outpatient Hospital,3,2079.23,1657.43,1574.35,0.0,50.0,33.08,83.08,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005201,MBR00000201,Institutional-OP,2023-02-24,2023-02-24,2023-03-20,PLN1445,1727809972,1727809972,Home Health,In-Network,G43.909,R10.9,,,,,,,0,,84443,Pathology/Lab,,,0761,22,Outpatient Hospital,2,124.38,37.35,37.35,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005202,MBR00000201,Professional,2021-02-15,2021-02-15,2021-03-23,PLN3804,1366576336,1366576336,Geriatrics,In-Network,Z87.891,R07.9,,,,,,,0,,99283,E&M,,,,11,Office,3,295.85,204.52,204.52,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005203,MBR00000201,Institutional-OP,2022-03-06,2022-03-06,2022-04-13,PLN7370,1135158374,1135158374,Pulmonology,In-Network,E11.9,E66.9,,,,,,,0,,G0439,Medicine,,,0740,22,Outpatient Hospital,3,423.55,268.55,243.55,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000005204,MBR00000201,Professional,2023-07-10,2023-07-10,2023-08-10,PLN7655,1227362142,1227362142,DME Supplier,In-Network,N39.0,J20.9,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,1,7296.88,6038.45,5988.45,0.0,50.0,0.0,50.0,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005205,MBR00000201,Institutional-OP,2023-04-30,2023-04-30,2023-06-10,PLN8502,1780163051,1780163051,SNF,In-Network,M54.5,I10,,,,,,,0,,70553,Radiology,,,0900,22,Outpatient Hospital,3,4099.23,3436.37,3436.37,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005206,MBR00000201,Institutional-OP,2021-06-25,2021-06-25,2021-07-29,PLN3742,1198133277,1198133277,SNF,In-Network,Z00.00,K21.0,,,,,,,0,,85610,Pathology/Lab,,,0301,22,Outpatient Hospital,3,51.57,38.59,0.0,38.59,35.0,0.0,73.59,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005207,MBR00000201,Institutional-OP,2021-07-06,2021-07-06,2021-08-18,PLN1740,1935547131,1935547131,Pulmonology,In-Network,E78.5,Z87.891,,,,,,,0,,99233,E&M,,,0450,22,Outpatient Hospital,2,487.56,375.36,201.29,50.94,75.0,48.13,174.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005208,MBR00000201,Professional,2023-10-09,2023-10-09,2023-11-07,PLN3255,1915531927,1915531927,Critical Access Hospital,In-Network,M17.11,F41.9,,,,,,,0,,99284,E&M,,,,11,Office,3,529.38,329.43,291.3,0.0,35.0,3.13,38.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005209,MBR00000201,Professional,2021-02-19,2021-02-19,2021-03-05,PLN2905,1528335731,1528335731,Critical Access Hospital,In-Network,B97.89,I11.9,,,,,,,0,,90686,Medicine,,,,23,Emergency Room,3,63.2,33.23,33.23,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,1,0,0,0,0,None,0,0,0,0,0
CLM0000005210,MBR00000201,Professional,2023-11-06,2023-11-06,2023-11-26,PLN6023,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,I10,Z12.31,,,,,,,0,,99214,E&M,,,,11,Office,2,270.76,186.26,182.35,0.0,0.0,3.91,3.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005211,MBR00000201,Professional,2022-08-16,2022-08-16,2022-09-25,PLN3324,1948810580,1948810580,DME Supplier,In-Network,E78.5,Z51.11,,,,,,,0,,99203,E&M,,,,11,Office,1,182.14,70.97,70.97,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005212,MBR00000201,Professional,2023-06-04,2023-06-04,2023-06-26,PLN4871,1990090423,1990090423,Orthopedic Surgery,In-Network,R10.9,R05,,,,,,,0,,97110,Medicine,,,,21,Inpatient Hospital,2,196.0,133.44,90.31,0.0,35.0,8.13,43.13,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005213,MBR00000201,Professional,2021-08-24,2021-08-24,2021-09-12,PLN6951,1991459367,1991459367,Neurology,Out-of-Network,F41.9,J44.1,,,,,,,0,,23472,Surgery,,,,31,Skilled Nursing Facility,2,7581.56,4710.67,4710.67,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005214,MBR00000201,Institutional-IP,2022-01-12,2022-01-16,2022-02-18,PLN7307,1974006077,1974006077,Orthopedic Surgery,In-Network,K57.30,K57.30,,,,682,MS-DRG,21,4,Y,93225,Medicine,,,0761,21,Inpatient Hospital,3,858.83,343.91,0.0,343.91,50.0,0.0,393.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005215,MBR00000201,Professional,2023-03-09,2023-03-09,2023-03-20,PLN2614,1450553056,1450553056,Clinical Laboratory,In-Network,M17.11,E11.9,,,,,,,0,,G0468,Medicine,,,,11,Office,3,602.16,288.33,288.33,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005216,MBR00000201,Professional,2021-06-27,2021-06-27,2021-07-29,PLN5818,1645194539,1645194539,SNF,In-Network,F03.90,J06.9,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,2,390.55,158.86,8.96,147.88,0.0,2.02,149.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005217,MBR00000201,Institutional-OP,2021-04-21,2021-04-21,2021-05-24,PLN8815,1899127912,1899127912,Neurology,In-Network,N40.0,I10,,,,,,,0,,99221,E&M,,,0450,22,Outpatient Hospital,1,202.74,77.93,0.0,77.93,15.0,0.0,92.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005218,MBR00000201,Professional,2022-10-29,2022-10-29,2022-11-08,PLN4648,1795618275,1795618275,Pulmonology,In-Network,Z12.31,Z23,,,,,,,0,,99203,E&M,,,,11,Office,3,317.87,164.1,139.1,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005219,MBR00000201,Institutional-IP,2021-01-10,2021-01-15,2021-02-22,PLN1225,1778483301,1778483301,Home Health,In-Network,C50.912,I10,,,,603,MS-DRG,21,5,Y,99203,E&M,,,0510,21,Inpatient Hospital,3,171.29,137.79,137.79,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005220,MBR00000201,Institutional-OP,2023-10-26,2023-10-26,2023-12-05,PLN5775,1502838586,1502838586,ASC,In-Network,I10,I10,,,,,,,0,,99204,E&M,,,0301,22,Outpatient Hospital,3,411.97,167.38,117.38,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005221,MBR00000201,Professional,2023-01-10,2023-01-10,2023-02-04,PLN9222,1186826716,1186826716,Physical Therapy,In-Network,J18.9,Z00.00,,,,,,,0,,90686,Medicine,,,,11,Office,3,132.04,47.21,0.0,47.21,35.0,0.0,82.21,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000005222,MBR00000201,Professional,2023-02-21,2023-02-21,2023-03-29,PLN3132,1717546253,1717546253,Family Medicine,In-Network,E78.5,J18.9,,,,,,,0,,97530,Medicine,,,,11,Office,2,291.08,241.7,40.24,126.46,75.0,0.0,201.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005223,MBR00000201,Institutional-OP,2022-07-03,2022-07-03,2022-07-15,PLN1596,1840431511,1840431511,Geriatrics,Out-of-Network,M17.11,Z23,,,,,,,0,,58661,Surgery,,,0510,22,Outpatient Hospital,2,3181.3,1752.95,1752.95,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005224,MBR00000201,Professional,2022-11-15,2022-11-15,2022-12-23,PLN9738,1355166277,1355166277,Endocrinology,In-Network,Z12.31,N18.3,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,3,1773.57,828.69,828.69,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005225,MBR00000201,Professional,2023-11-09,2023-11-09,2023-12-09,PLN3646,1542828721,1542828721,Orthopedic Surgery,In-Network,I10,G43.909,,,,,,,0,,23472,Surgery,,,,50,Federally Qualified Health Center,1,7362.05,4732.83,4682.83,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005226,MBR00000201,Institutional-OP,2021-01-06,2021-01-06,2021-02-05,PLN6158,1313212303,1313212303,Family Medicine,In-Network,I10,M17.11,,,,,,,0,,86900,Pathology/Lab,,,0900,22,Outpatient Hospital,1,44.02,34.95,0.0,34.95,0.0,0.0,34.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005227,MBR00000201,Institutional-OP,2021-09-28,2021-09-28,2021-10-12,PLN2113,1219817751,1219817751,OB/GYN,In-Network,M54.5,R10.9,,,,,,,0,,99221,E&M,,,0320,22,Outpatient Hospital,2,355.87,266.14,191.14,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005228,MBR00000201,Professional,2023-02-03,2023-02-03,2023-02-12,PLN2984,1135158374,1135158374,Pulmonology,In-Network,I10,E11.65,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,1,651.55,273.98,273.98,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005229,MBR00000201,Professional,2021-05-15,2021-05-15,2021-05-29,PLN9741,1935547131,1935547131,Pulmonology,In-Network,Z00.00,N18.3,,,,,,,0,,99284,E&M,,,,11,Office,3,385.68,242.92,0.0,208.85,35.0,0.0,243.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005230,MBR00000201,Institutional-OP,2021-09-26,2021-09-26,2021-10-28,PLN1871,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,E87.6,I10,,,,,,,0,,77067,Radiology,,,0320,22,Outpatient Hospital,3,767.18,409.96,358.35,0.0,25.0,26.61,51.61,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000005231,MBR00000201,Professional,2021-01-26,2021-01-26,2021-03-07,PLN9588,1550154147,1550154147,Outpatient Clinic,In-Network,N40.0,Z00.00,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,3,73.63,47.8,0.0,38.88,25.0,0.0,63.88,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005232,MBR00000202,Institutional-IP,2021-03-02,2021-03-11,2021-03-12,PLN4297,1103747954,1103747954,Urology,In-Network,J20.9,E11.65,,,,195,MS-DRG,3,9,Y,90686,Medicine,,,0120,21,Inpatient Hospital,2,62.84,23.1,23.1,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000005233,MBR00000202,Professional,2022-05-02,2022-05-02,2022-06-08,PLN5755,1899127912,1899127912,Neurology,In-Network,E11.65,F03.90,,,,,,,0,,99221,E&M,,,,11,Office,3,451.71,343.43,326.91,0.0,0.0,16.52,16.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005234,MBR00000202,Professional,2022-12-24,2022-12-24,2023-01-06,PLN3874,1571574052,1571574052,Critical Access Hospital,In-Network,Z23,I25.10,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,1,3630.62,2712.34,2268.95,143.32,50.0,250.07,443.39,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005235,MBR00000202,Professional,2021-04-21,2021-04-21,2021-05-25,PLN9073,1780163051,1780163051,SNF,In-Network,Z87.891,N20.0,,,,,,,0,,27447,Surgery,,,,81,Independent Laboratory,3,3088.14,1966.14,1349.24,478.38,25.0,113.52,616.9,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005236,MBR00000202,Institutional-OP,2023-12-12,2023-12-12,2023-12-30,PLN4318,1624202402,1624202402,Orthopedic Surgery,In-Network,F32.9,K57.30,,,,,,,0,,99221,E&M,,,0360,22,Outpatient Hospital,1,332.05,116.92,0.0,116.92,25.0,0.0,141.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005237,MBR00000202,Professional,2023-04-30,2023-04-30,2023-06-07,PLN7674,1624802371,1624802371,ASC,Out-of-Network,Z12.31,R10.9,,,,,,,0,,84443,Pathology/Lab,,,,49,Independent Clinic,1,114.11,90.93,0.0,90.93,35.0,0.0,125.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005238,MBR00000202,Institutional-OP,2022-12-27,2022-12-27,2023-01-03,PLN2360,1268679390,1268679390,Critical Access Hospital,In-Network,K21.0,I50.9,,,,,,,0,,45378,Surgery,,,0370,22,Outpatient Hospital,2,2234.76,1521.76,1332.71,189.05,0.0,0.0,189.05,0.0,Paid,,,0,,0,1,1,0,0,1,Phantom,0,1,0,0,0
CLM0000005239,MBR00000202,Institutional-OP,2021-03-20,2021-03-20,2021-04-28,PLN1427,1840431511,1840431511,Geriatrics,Out-of-Network,J45.20,Z12.11,,,,,,,0,,93306,Radiology,,,0120,22,Outpatient Hospital,3,3257.27,1520.95,1266.32,0.0,0.0,254.63,254.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005240,MBR00000202,Institutional-OP,2022-07-23,2022-07-23,2022-08-25,PLN7517,1438368327,1438368327,Home Health,In-Network,E11.9,I25.10,,,,,,,0,,45380,Surgery,,,0120,22,Outpatient Hospital,3,3097.01,2010.8,1621.77,389.03,0.0,0.0,389.03,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000005241,MBR00000202,Institutional-OP,2023-10-06,2023-10-06,2023-11-14,PLN7761,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,Z00.00,F41.9,,,,,,,0,,27130,Surgery,,,0900,22,Outpatient Hospital,2,5224.84,2904.06,2627.14,123.08,25.0,128.84,276.92,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005242,MBR00000202,Professional,2021-09-18,2021-09-18,2021-10-27,PLN8768,1872272835,1872272835,Internal Medicine,In-Network,J18.9,Z00.00,,,,,,,0,,99204,E&M,,,,11,Office,3,489.98,321.89,0.0,321.89,25.0,0.0,346.89,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005243,MBR00000202,Professional,2022-08-16,2022-08-16,2022-09-11,PLN3502,1860435061,1860435061,DME Supplier,In-Network,Z23,R51,,,,,,,0,,90460,Medicine,,,,21,Inpatient Hospital,1,76.47,47.17,45.98,0.0,0.0,1.19,1.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005244,MBR00000202,Professional,2022-09-10,2022-09-10,2022-10-16,PLN7393,1935547131,1935547131,Pulmonology,In-Network,E78.5,M54.5,,,,,,,0,,99222,E&M,,,,11,Office,1,228.94,95.78,0.0,95.78,35.0,0.0,130.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005245,MBR00000202,Professional,2023-02-02,2023-02-02,2023-02-23,PLN8693,1790497490,1790497490,OB/GYN,In-Network,Z00.00,Z12.31,,,,,,,0,,71046,Radiology,,,,20,Urgent Care,1,144.85,80.13,25.89,54.24,0.0,0.0,54.24,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005246,MBR00000202,Professional,2023-10-03,2023-10-03,2023-10-19,PLN5545,1606140917,1606140917,ASC,In-Network,Z12.31,Z87.891,,,,,,,0,,90837,Medicine,,,,23,Emergency Room,2,334.49,199.57,199.57,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005247,MBR00000202,Institutional-OP,2021-05-24,2021-05-24,2021-07-03,PLN8053,1103747954,1103747954,Urology,In-Network,Z87.891,J06.9,,,,,,,0,,99233,E&M,,,0370,22,Outpatient Hospital,1,493.98,275.97,206.56,0.0,50.0,19.41,69.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005248,MBR00000202,Institutional-OP,2021-03-10,2021-03-10,2021-04-20,PLN9407,1717546253,1717546253,Family Medicine,In-Network,Z12.11,N39.0,,,,,,,0,,66984,Surgery,,,0510,22,Outpatient Hospital,2,2097.89,1254.75,1239.75,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005249,MBR00000202,Professional,2021-04-09,2021-04-09,2021-05-21,PLN7950,1500037969,1500037969,Pulmonology,In-Network,I25.10,J45.20,,,,,,,0,,80053,Pathology/Lab,,,,31,Skilled Nursing Facility,2,95.69,30.99,30.99,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005250,MBR00000202,Professional,2021-10-20,2021-10-20,2021-10-31,PLN5578,1691062876,1691062876,SNF,In-Network,E66.9,K21.0,,,,,,,0,,99283,E&M,,,,65,End-Stage Renal Disease,2,611.9,483.09,447.32,0.0,0.0,35.77,35.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005251,MBR00000202,Institutional-IP,2022-01-23,2022-01-26,2022-02-07,PLN2144,1780163051,1780163051,SNF,In-Network,E11.9,Z00.00,,,,872,MS-DRG,12,3,Y,99213,E&M,,,0320,21,Inpatient Hospital,1,117.38,60.31,0.0,60.31,0.0,0.0,60.31,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005252,MBR00000202,Institutional-OP,2023-08-20,2023-08-20,2023-09-18,PLN7203,1433937353,1433937353,Nephrology,In-Network,Z12.31,Z12.31,,,,,,,0,,99221,E&M,,,0450,22,Outpatient Hospital,1,227.74,151.48,151.48,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005253,MBR00000202,Institutional-OP,2022-07-24,2022-07-24,2022-08-16,PLN7455,1103747954,1103747954,Urology,In-Network,J06.9,I25.10,,,,,,,0,,99203,E&M,,,0270,22,Outpatient Hospital,2,400.84,249.06,174.06,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005254,MBR00000202,Professional,2023-03-27,2023-03-27,2023-04-19,PLN5990,1283743001,1283743001,Family Medicine,In-Network,E11.9,Z00.00,,,,,,,0,,99203,E&M,,,,49,Independent Clinic,3,194.97,156.37,18.7,137.67,0.0,0.0,137.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005255,MBR00000202,Professional,2022-09-23,2022-09-23,2022-10-03,PLN6284,1847081578,1847081578,Urology,Out-of-Network,N18.3,Z00.00,,,,,,,0,,71046,Radiology,,,,65,End-Stage Renal Disease,3,277.37,212.73,187.73,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005256,MBR00000202,Institutional-OP,2023-11-09,2023-11-09,2023-11-19,PLN2975,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,Z00.01,J06.9,,,,,,,0,,99213,E&M,,,0270,22,Outpatient Hospital,2,132.85,96.17,21.17,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005257,MBR00000202,Professional,2021-12-28,2021-12-28,2022-01-10,PLN1770,1899127912,1899127912,Neurology,In-Network,E11.9,Z12.31,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,1,30.3,18.51,0.0,18.51,0.0,0.0,18.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005258,MBR00000202,Institutional-OP,2023-01-03,2023-01-03,2023-01-29,PLN7173,1542828721,1542828721,Orthopedic Surgery,In-Network,R05,Z51.11,,,,,,,0,,23472,Surgery,,,0730,22,Outpatient Hospital,3,4387.31,2557.7,2497.49,35.21,25.0,0.0,60.21,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005259,MBR00000202,Professional,2021-10-26,2021-10-26,2021-11-30,PLN3503,1609526529,1609526529,Psychiatry,In-Network,N39.0,M54.5,,,,,,,0,,74177,Radiology,,,,11,Office,3,2054.93,1009.2,860.41,148.79,0.0,0.0,148.79,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005260,MBR00000202,Professional,2021-09-13,2021-09-13,2021-10-17,PLN7432,1696843572,1696843572,Critical Access Hospital,Out-of-Network,Z12.31,F41.9,,,,,,,0,,27130,Surgery,,,,11,Office,2,5712.06,2795.59,2442.9,139.3,0.0,213.39,352.69,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005261,MBR00000202,Institutional-IP,2023-12-11,2023-12-14,2023-12-20,PLN6300,1865904917,1865904917,Outpatient Clinic,In-Network,N39.0,N40.0,,,,292,MS-DRG,8,3,Y,76700,Radiology,,,0761,21,Inpatient Hospital,2,768.5,300.74,61.14,239.6,0.0,0.0,239.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005262,MBR00000202,Institutional-OP,2021-01-27,2021-01-27,2021-02-12,PLN2098,1687650653,1687650653,Internal Medicine,In-Network,F41.9,J06.9,,,,,,,0,,85025,Pathology/Lab,,,0270,22,Outpatient Hospital,2,59.38,29.31,27.61,0.0,0.0,1.7,1.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005263,MBR00000202,Professional,2021-10-26,2021-10-26,2021-11-26,PLN7041,1125190055,1125190055,Nephrology,In-Network,J18.9,J06.9,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,1,440.97,321.36,59.21,262.15,0.0,0.0,262.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005264,MBR00000202,Institutional-OP,2022-02-27,2022-02-27,2022-03-29,PLN2871,1899127912,1899127912,Neurology,In-Network,J18.9,E11.9,,,,,,,0,,90686,Medicine,,,0740,22,Outpatient Hospital,2,63.3,38.58,38.58,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000005265,MBR00000202,Institutional-OP,2021-06-01,2021-06-01,2021-06-29,PLN2552,1915531927,1915531927,Critical Access Hospital,In-Network,J44.1,I11.9,,,,,,,0,,76700,Radiology,,,0900,22,Outpatient Hospital,3,504.04,283.82,174.48,80.99,0.0,28.35,109.34,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005266,MBR00000202,Institutional-OP,2023-04-26,2023-04-26,2023-06-07,PLN1997,1717912431,1717912431,Oncology,In-Network,K21.0,E11.9,,,,,,,0,,72148,Radiology,,,0270,22,Outpatient Hospital,2,1916.49,1451.81,0.0,226.79,15.0,0.0,241.79,0.0,Denied,CO-27,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005267,MBR00000202,Institutional-OP,2022-01-29,2022-01-29,2022-03-12,PLN7589,1227362142,1227362142,DME Supplier,In-Network,N18.3,M17.11,,,,,,,0,,58661,Surgery,,,0360,22,Outpatient Hospital,2,4782.73,3187.95,2956.07,83.71,50.0,98.17,231.88,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005268,MBR00000202,Institutional-OP,2022-05-18,2022-05-18,2022-06-21,PLN4003,1531398223,1531398223,OB/GYN,In-Network,E11.9,K21.0,,,,,,,0,,99203,E&M,,,0636,22,Outpatient Hospital,2,366.3,195.32,0.0,195.32,0.0,0.0,195.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005269,MBR00000202,Institutional-OP,2021-11-29,2021-11-29,2021-12-28,PLN3284,1366286000,1366286000,SNF,In-Network,R51,F41.9,,,,,,,0,,66984,Surgery,,,0740,22,Outpatient Hospital,2,1896.14,737.17,737.17,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005270,MBR00000202,Institutional-IP,2023-09-04,2023-09-08,2023-09-16,PLN3917,1915531927,1915531927,Critical Access Hospital,In-Network,E11.9,C50.912,,,,292,MS-DRG,23,4,Y,99284,E&M,,,0270,21,Inpatient Hospital,2,407.87,337.82,293.86,16.96,0.0,27.0,43.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005271,MBR00000202,Institutional-OP,2022-04-07,2022-04-07,2022-04-23,PLN9198,1422747896,1422747896,Urology,In-Network,I25.10,I10,,,,,,,0,,27447,Surgery,,,0761,22,Outpatient Hospital,1,4023.75,1716.97,1666.97,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005272,MBR00000202,Institutional-OP,2023-05-13,2023-05-13,2023-05-22,PLN3484,1366576336,1366576336,Geriatrics,In-Network,I48.91,Z12.31,,,,,,,0,,99406,Medicine,,,0761,22,Outpatient Hospital,1,104.01,73.76,0.0,73.76,0.0,0.0,73.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005273,MBR00000202,Institutional-IP,2022-11-14,2022-11-16,2022-12-10,PLN2013,1606140917,1606140917,ASC,In-Network,Z12.31,J44.1,,,,871,MS-DRG,24,2,Y,27130,Surgery,,,0301,21,Inpatient Hospital,2,6171.39,1922.69,1670.72,0.0,75.0,176.97,251.97,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005274,MBR00000202,Professional,2023-11-13,2023-11-13,2023-12-03,PLN7615,1631954542,1631954542,Oncology,In-Network,E78.5,E11.9,,,,,,,0,,99232,E&M,,,,21,Inpatient Hospital,1,356.16,259.59,120.64,138.95,0.0,0.0,138.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005275,MBR00000202,Professional,2022-10-23,2022-10-23,2022-11-09,PLN3606,1609526529,1609526529,Psychiatry,In-Network,Z00.00,I63.9,,,,,,,0,,23472,Surgery,,,,20,Urgent Care,2,4366.83,3016.44,2970.61,30.83,15.0,0.0,45.83,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005276,MBR00000202,Institutional-OP,2023-12-16,2023-12-16,2024-01-03,PLN8077,1994661817,1994661817,SNF,Out-of-Network,E11.9,J20.9,,,,,,,0,,43239,Surgery,,,0450,22,Outpatient Hospital,1,1237.98,806.26,791.26,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005277,MBR00000202,Institutional-OP,2023-02-04,2023-02-04,2023-03-12,PLN3768,1812060197,1812060197,Oncology,Out-of-Network,J44.1,I10,,,,,,,0,,99406,Medicine,,,0450,22,Outpatient Hospital,2,37.08,15.81,15.81,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005278,MBR00000202,Professional,2021-03-06,2021-03-06,2021-04-01,PLN1759,1806688928,1806688928,Geriatrics,In-Network,R07.9,Z23,,,,,,,0,,66984,Surgery,,,,11,Office,1,2551.56,2023.16,1973.16,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005279,MBR00000202,Institutional-OP,2021-06-21,2021-06-21,2021-08-02,PLN7340,1899127912,1899127912,Neurology,In-Network,Z23,I25.10,,,,,,,0,,86900,Pathology/Lab,,,0730,22,Outpatient Hospital,3,41.44,20.52,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005280,MBR00000203,Professional,2023-05-15,2023-05-15,2023-05-22,PLN5830,1372918899,1372918899,Family Medicine,In-Network,E66.9,R10.9,,,,,,,0,,47562,Surgery,,,,21,Inpatient Hospital,2,3214.36,1443.53,1428.53,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005281,MBR00000203,Professional,2021-02-20,2021-02-20,2021-04-05,PLN2096,1717912431,1717912431,Oncology,In-Network,F32.9,M54.5,,,,,,,0,,99222,E&M,,,,81,Independent Laboratory,1,278.97,105.67,0.0,105.67,0.0,0.0,105.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005282,MBR00000203,Institutional-OP,2021-07-28,2021-07-28,2021-08-05,PLN7358,1689639685,1689639685,SNF,In-Network,N40.0,Z12.31,,,,,,,0,,72148,Radiology,,,0450,22,Outpatient Hospital,3,2286.74,1380.84,1365.84,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005283,MBR00000203,Institutional-OP,2023-05-16,2023-05-16,2023-06-08,PLN1352,1361302520,1361302520,Critical Access Hospital,In-Network,F10.20,G43.909,,,,,,,0,,99232,E&M,,,0761,22,Outpatient Hospital,2,263.97,192.57,0.0,0.0,0.0,0.0,0.0,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005284,MBR00000203,Institutional-IP,2022-01-24,2022-02-02,2022-02-15,PLN4279,1590915516,1590915516,Physical Therapy,Out-of-Network,J44.1,J20.9,,,,291,MS-DRG,6,9,N,87491,Pathology/Lab,,,0200,21,Inpatient Hospital,3,209.13,84.1,84.1,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000005285,MBR00000203,Institutional-OP,2021-08-26,2021-08-26,2021-09-13,PLN3880,1103747954,1103747954,Urology,In-Network,E78.5,N40.0,,,,,,,0,,G0444,Medicine,,,0900,22,Outpatient Hospital,2,48.41,27.57,27.57,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000005286,MBR00000203,Institutional-OP,2021-08-05,2021-08-05,2021-08-27,PLN3772,1193493783,1193493783,Critical Access Hospital,Out-of-Network,I25.10,F32.9,,,,,,,0,,33533,Surgery,,,0270,22,Outpatient Hospital,3,11441.0,9058.69,7378.17,92.03,0.0,1588.49,1680.52,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000005287,MBR00000203,Institutional-OP,2021-12-12,2021-12-12,2022-01-13,PLN6419,1847081578,1847081578,Urology,Out-of-Network,G43.909,E78.5,,,,,,,0,,99203,E&M,,,0450,22,Outpatient Hospital,1,182.43,127.65,122.55,0.0,0.0,5.1,5.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005288,MBR00000203,Institutional-OP,2023-07-07,2023-07-07,2023-07-14,PLN1724,1109850785,1109850785,ASC,Out-of-Network,G20,E78.5,,,,,,,0,,99221,E&M,,,0270,22,Outpatient Hospital,1,366.77,160.06,125.06,0.0,35.0,0.0,35.0,0.0,Adjusted,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000005289,MBR00000203,Professional,2022-05-14,2022-05-14,2022-05-25,PLN6487,1964402759,1964402759,Outpatient Clinic,In-Network,N39.0,F10.20,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,2,21.73,11.34,0.0,11.34,0.0,0.0,11.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005290,MBR00000203,Professional,2023-11-11,2023-11-11,2023-12-09,PLN8577,1205377316,1205377316,Orthopedic Surgery,In-Network,I63.9,M54.5,,,,,,,0,,99283,E&M,,,,11,Office,2,501.33,180.62,180.62,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005291,MBR00000203,Professional,2023-02-24,2023-02-24,2023-04-03,PLN5598,1994661817,1994661817,SNF,Out-of-Network,M54.5,F41.9,,,,,,,0,,27447,Surgery,,,,11,Office,3,3902.24,1326.31,1291.31,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,1,Duplicate,0,0,0,0,0
CLM0000005292,MBR00000203,Professional,2021-10-21,2021-10-21,2021-10-31,PLN8217,1295371663,1295371663,Critical Access Hospital,In-Network,N40.0,E11.9,,,,,,,0,,97110,Medicine,,,,22,Outpatient Hospital,2,276.86,190.87,115.87,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005293,MBR00000203,Professional,2021-06-29,2021-06-29,2021-08-12,PLN9045,1139906830,1139906830,Endocrinology,Out-of-Network,N18.3,Z00.00,,,,,,,0,,82043,Pathology/Lab,,,,22,Outpatient Hospital,2,53.86,19.4,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005294,MBR00000203,Professional,2023-10-31,2023-10-31,2023-12-13,PLN5375,1687650653,1687650653,Internal Medicine,In-Network,Z12.31,E11.9,,,,,,,0,,99221,E&M,,,,11,Office,3,383.93,253.39,0.0,253.39,75.0,0.0,328.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005295,MBR00000203,Professional,2023-09-16,2023-09-16,2023-10-13,PLN9491,1239316214,1239316214,Internal Medicine,In-Network,F32.9,F10.20,,,,,,,0,,81001,Pathology/Lab,,,,22,Outpatient Hospital,2,44.89,35.11,35.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005296,MBR00000203,Institutional-IP,2021-05-15,2021-05-22,2021-06-20,PLN8855,1660288235,1660288235,ASC,In-Network,C50.912,R07.9,,,,641,MS-DRG,16,7,Y,99284,E&M,,,0270,21,Inpatient Hospital,1,681.27,237.67,0.0,237.67,0.0,0.0,237.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005297,MBR00000204,Professional,2021-12-19,2021-12-19,2022-01-02,PLN4086,1891849440,1891849440,Oncology,In-Network,M17.11,J18.9,,,,,,,0,,33533,Surgery,,,,81,Independent Laboratory,3,14728.56,6181.99,6181.99,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000005298,MBR00000204,Professional,2023-03-25,2023-03-25,2023-04-19,PLN4475,1757138478,1757138478,Pediatrics,In-Network,J20.9,E78.5,,,,,,,0,,58661,Surgery,,,,11,Office,1,2849.0,923.27,695.9,29.07,75.0,123.3,227.37,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005299,MBR00000204,Professional,2023-12-13,2023-12-13,2024-01-03,PLN6430,1845057593,1845057593,Orthopedic Surgery,In-Network,Z79.4,M17.11,,,,,,,0,,43239,Surgery,,,,49,Independent Clinic,3,2003.21,1287.69,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-15,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005300,MBR00000204,Professional,2023-09-17,2023-09-17,2023-10-11,PLN3568,1103747954,1103747954,Urology,In-Network,R05,I10,,,,,,,0,,93000,Radiology,,,,81,Independent Laboratory,3,190.27,85.08,0.0,85.08,75.0,0.0,160.08,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005301,MBR00000204,Institutional-IP,2021-11-09,2021-11-11,2021-12-20,PLN1714,1687650653,1687650653,Internal Medicine,In-Network,I10,Z12.31,,,,195,MS-DRG,10,2,Y,97530,Medicine,,,0740,21,Inpatient Hospital,1,189.1,117.53,70.47,47.06,0.0,0.0,47.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005302,MBR00000204,Institutional-OP,2023-09-10,2023-09-10,2023-09-20,PLN7621,1644128543,1644128543,Gastroenterology,In-Network,E11.9,I10,,,,,,,0,,99204,E&M,,,0730,22,Outpatient Hospital,2,405.83,291.02,250.24,0.0,25.0,15.78,40.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005303,MBR00000204,Institutional-OP,2023-03-06,2023-03-06,2023-03-17,PLN9975,1564502315,1564502315,ASC,In-Network,N20.0,N18.3,,,,,,,0,,77067,Radiology,,,0320,22,Outpatient Hospital,3,448.45,225.23,0.0,225.23,15.0,0.0,240.23,0.0,Adjusted,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000005304,MBR00000204,Institutional-IP,2022-05-22,2022-05-26,2022-06-01,PLN6289,1845900543,1845900543,ASC,In-Network,E11.9,E78.5,,,,690,MS-DRG,11,4,Y,99203,E&M,,,0900,21,Inpatient Hospital,1,191.9,74.28,0.0,74.28,0.0,0.0,74.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005305,MBR00000204,Institutional-OP,2022-02-17,2022-02-17,2022-03-14,PLN2295,1118885473,1118885473,ASC,In-Network,E66.9,I10,,,,,,,0,,47562,Surgery,,,0450,22,Outpatient Hospital,3,4762.12,1623.24,1399.42,158.92,15.0,49.9,223.82,0.0,Paid,,,1,,0,0,1,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000005306,MBR00000205,Institutional-OP,2023-06-10,2023-06-10,2023-07-10,PLN8406,1463205530,1463205530,Nephrology,In-Network,N39.0,N39.0,,,,,,,0,,85025,Pathology/Lab,,,0740,22,Outpatient Hospital,1,38.16,23.84,0.0,23.84,0.0,0.0,23.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005307,MBR00000205,Professional,2023-07-06,2023-07-06,2023-08-02,PLN9592,1845057593,1845057593,Orthopedic Surgery,In-Network,M54.5,R07.9,,,,,,,0,,99214,E&M,,,,50,Federally Qualified Health Center,1,389.59,130.8,47.78,77.45,0.0,5.57,83.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005308,MBR00000205,Professional,2023-09-29,2023-09-29,2023-10-19,PLN1837,1528335731,1528335731,Critical Access Hospital,In-Network,E11.65,N39.0,,,,,,,0,,99204,E&M,,,,11,Office,1,246.35,167.56,0.0,167.56,0.0,0.0,167.56,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005309,MBR00000206,Institutional-IP,2022-05-22,2022-05-26,2022-06-08,PLN8215,1847081578,1847081578,Urology,Out-of-Network,N40.0,F32.9,,,,291,MS-DRG,1,4,Y,45380,Surgery,,,0740,21,Inpatient Hospital,3,1193.69,396.48,347.18,0.0,0.0,49.3,49.3,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000005310,MBR00000206,Institutional-IP,2021-10-20,2021-10-28,2021-11-10,PLN6388,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,E11.9,J06.9,,,,196,MS-DRG,2,8,Y,23472,Surgery,,,0370,21,Inpatient Hospital,3,3693.83,1680.41,1460.56,0.0,75.0,144.85,219.85,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005311,MBR00000206,Institutional-OP,2023-08-12,2023-08-12,2023-09-16,PLN4810,1486164553,1486164553,DME Supplier,In-Network,Z00.00,Z00.00,,,,,,,0,,33533,Surgery,,,0200,22,Outpatient Hospital,2,27680.74,20516.53,16640.24,344.39,25.0,3506.9,3876.29,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000005312,MBR00000206,Professional,2021-11-28,2021-11-28,2021-12-13,PLN2266,1245650222,1245650222,Gastroenterology,In-Network,I48.91,E11.9,,,,,,,0,,72148,Radiology,,,,22,Outpatient Hospital,3,1251.35,927.25,726.39,0.0,35.0,165.86,200.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005313,MBR00000206,Institutional-OP,2023-04-06,2023-04-06,2023-05-13,PLN7555,1696843572,1696843572,Critical Access Hospital,Out-of-Network,G43.909,J06.9,,,,,,,0,,83036,Pathology/Lab,,,0320,22,Outpatient Hospital,2,89.7,40.94,0.0,9.05,75.0,0.0,84.05,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000005314,MBR00000206,Professional,2022-07-12,2022-07-12,2022-07-26,PLN6123,1691062876,1691062876,SNF,In-Network,I10,E78.5,,,,,,,0,,74177,Radiology,,,,22,Outpatient Hospital,1,1840.35,1044.54,1044.54,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005315,MBR00000206,Institutional-OP,2022-10-04,2022-10-04,2022-10-19,PLN4458,1702692193,1702692193,Physical Therapy,In-Network,Z00.00,R51,,,,,,,0,,86900,Pathology/Lab,,,0636,22,Outpatient Hospital,3,47.38,30.18,30.18,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005316,MBR00000206,Professional,2021-08-18,2021-08-18,2021-10-01,PLN1518,1622771872,1622771872,Pediatrics,In-Network,K21.0,Z23,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,3,3822.16,2348.99,2313.99,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005317,MBR00000206,Professional,2021-10-01,2021-10-01,2021-10-31,PLN5532,1450094833,1450094833,Outpatient Clinic,In-Network,I25.10,Z23,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,1,4793.55,3771.27,3696.27,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005318,MBR00000206,Professional,2022-12-16,2022-12-16,2022-12-31,PLN7541,1915531927,1915531927,Critical Access Hospital,In-Network,C50.912,J06.9,,,,,,,0,,99284,E&M,,,,11,Office,2,914.87,541.78,526.78,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005319,MBR00000206,Professional,2021-10-12,2021-10-12,2021-10-20,PLN6117,1915531927,1915531927,Critical Access Hospital,In-Network,I63.9,E11.9,,,,,,,0,,99406,Medicine,,,,22,Outpatient Hospital,1,57.22,36.54,36.54,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005320,MBR00000206,Professional,2023-01-03,2023-01-03,2023-01-20,PLN9471,1433937353,1433937353,Nephrology,In-Network,K21.0,E78.5,,,,,,,0,,71046,Radiology,,,,21,Inpatient Hospital,1,152.93,102.12,0.0,102.12,0.0,0.0,102.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005321,MBR00000206,Institutional-OP,2023-12-22,2023-12-22,2024-01-04,PLN2313,1389336600,1389336600,Critical Access Hospital,In-Network,J44.1,J18.9,,,,,,,0,,99214,E&M,,,0360,22,Outpatient Hospital,3,172.05,88.04,53.04,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005322,MBR00000206,Professional,2021-04-01,2021-04-01,2021-04-15,PLN6466,1624202402,1624202402,Orthopedic Surgery,In-Network,F32.9,I50.9,,,,,,,0,,71046,Radiology,,,,22,Outpatient Hospital,1,252.41,192.33,142.33,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005323,MBR00000207,Professional,2023-10-11,2023-10-11,2023-10-30,PLN6599,1717912431,1717912431,Oncology,In-Network,J20.9,Z00.00,,,,,,,0,,27130,Surgery,,,,21,Inpatient Hospital,3,3125.61,1220.29,1139.75,0.0,75.0,5.54,80.54,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005324,MBR00000207,Professional,2021-07-07,2021-07-07,2021-08-01,PLN2132,1186826716,1186826716,Physical Therapy,In-Network,I11.9,C50.912,,,,,,,0,,45378,Surgery,,,,12,Home,1,2387.07,1648.92,1308.12,0.0,75.0,265.8,340.8,0.0,Paid,,,0,,0,1,1,0,0,1,Phantom,0,1,0,0,0
CLM0000005325,MBR00000207,Institutional-IP,2021-06-01,2021-06-02,2021-06-15,PLN9838,1514306773,1514306773,Endocrinology,In-Network,Z00.00,M54.5,,,,291,MS-DRG,14,1,Y,93000,Radiology,,,0370,21,Inpatient Hospital,2,143.32,55.55,0.0,55.55,0.0,0.0,55.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005326,MBR00000207,Professional,2023-07-03,2023-07-03,2023-08-09,PLN4478,1366576336,1366576336,Geriatrics,In-Network,N39.0,Z00.00,,,,,,,0,,99233,E&M,,,,21,Inpatient Hospital,1,498.77,210.96,0.0,210.96,0.0,0.0,210.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005327,MBR00000207,Professional,2021-08-12,2021-08-12,2021-09-19,PLN9501,1422747896,1422747896,Urology,In-Network,E11.9,J45.20,,,,,,,0,,G0444,Medicine,,,,21,Inpatient Hospital,1,84.97,62.68,59.1,0.0,0.0,3.58,3.58,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000005328,MBR00000207,Institutional-OP,2022-12-11,2022-12-11,2023-01-15,PLN7130,1518055405,1518055405,Urology,In-Network,E11.65,I63.9,,,,,,,0,,45380,Surgery,,,0200,22,Outpatient Hospital,2,2607.87,1697.79,1697.79,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000005329,MBR00000207,Professional,2021-04-27,2021-04-27,2021-06-09,PLN9857,1245650222,1245650222,Gastroenterology,In-Network,J18.9,J06.9,,,,,,,0,,70553,Radiology,,,,12,Home,2,4671.5,3009.74,3009.74,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000005330,MBR00000207,Institutional-OP,2021-04-05,2021-04-05,2021-04-30,PLN1911,1799205295,1799205295,General Acute Care Hospital,In-Network,E11.9,M17.11,,,,,,,0,,99284,E&M,,,0270,22,Outpatient Hospital,2,679.75,338.76,0.0,338.76,15.0,0.0,353.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005331,MBR00000207,Professional,2021-08-09,2021-08-09,2021-09-18,PLN9690,1193493783,1193493783,Critical Access Hospital,Out-of-Network,N40.0,J44.1,,,,,,,0,,99406,Medicine,,,,11,Office,3,57.31,47.04,0.0,0.0,75.0,0.0,75.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005332,MBR00000207,Institutional-IP,2022-07-25,2022-07-31,2022-08-01,PLN3004,1856686341,1856686341,Geriatrics,In-Network,K21.0,N20.0,,,,871,MS-DRG,6,6,Y,74177,Radiology,,,0200,21,Inpatient Hospital,2,2120.41,1012.78,997.78,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005333,MBR00000207,Institutional-IP,2021-11-14,2021-11-27,2021-11-26,PLN8538,1125190055,1125190055,Nephrology,In-Network,B97.89,I10,,,,603,MS-DRG,5,13,Y,99233,E&M,,,0636,21,Inpatient Hospital,2,398.35,153.9,78.9,0.0,75.0,0.0,75.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005334,MBR00000207,Professional,2021-09-02,2021-09-02,2021-10-10,PLN4425,1691062876,1691062876,SNF,In-Network,E66.9,E11.9,,,,,,,0,,33533,Surgery,,,,23,Emergency Room,2,14258.52,6915.57,6865.57,0.0,50.0,0.0,50.0,0.0,Adjusted,,,0,,1,0,0,1,0,0,None,0,0,0,0,0
CLM0000005335,MBR00000207,Institutional-IP,2023-07-07,2023-07-11,2023-08-14,PLN9709,1475984649,1475984649,SNF,In-Network,I48.91,M17.11,,,,196,MS-DRG,9,4,Y,99233,E&M,,,0120,21,Inpatient Hospital,2,314.95,120.14,120.14,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005336,MBR00000208,Professional,2021-07-10,2021-07-10,2021-08-13,PLN4161,1660288235,1660288235,ASC,In-Network,I10,Z12.31,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,2,3794.47,3182.53,3132.53,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005337,MBR00000208,Professional,2021-04-15,2021-04-15,2021-05-28,PLN7535,1564502315,1564502315,ASC,In-Network,N20.0,E66.9,,,,,,,0,,58661,Surgery,,,,11,Office,3,3193.45,2582.53,2293.45,74.93,0.0,214.15,289.08,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005338,MBR00000208,Institutional-OP,2021-05-01,2021-05-01,2021-05-20,PLN8350,1502838586,1502838586,ASC,In-Network,M81.0,E11.9,,,,,,,0,,81001,Pathology/Lab,,,0200,22,Outpatient Hospital,2,34.65,25.13,25.13,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005339,MBR00000208,Institutional-OP,2023-08-24,2023-08-24,2023-09-11,PLN7866,1422747896,1422747896,Urology,In-Network,E66.9,C50.912,,,,,,,0,,78452,Radiology,,,0636,22,Outpatient Hospital,3,5333.35,3741.38,3156.25,0.0,15.0,570.13,585.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005340,MBR00000208,Professional,2022-06-05,2022-06-05,2022-06-27,PLN7230,1453936007,1453936007,ASC,In-Network,N40.0,I10,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,2,1631.07,565.14,565.14,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000005341,MBR00000208,Institutional-IP,2023-12-01,2023-12-02,2024-01-04,PLN9174,1205377316,1205377316,Orthopedic Surgery,In-Network,Z51.11,I50.9,,,,690,MS-DRG,1,1,Y,99222,E&M,,,0301,21,Inpatient Hospital,3,657.28,336.13,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-11,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000005342,MBR00000208,Professional,2023-06-03,2023-06-03,2023-07-01,PLN3014,1514306773,1514306773,Endocrinology,In-Network,N18.3,Z12.31,,,,,,,0,,90460,Medicine,,,,22,Outpatient Hospital,1,64.94,29.93,17.01,12.92,0.0,0.0,12.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005343,MBR00000208,Professional,2021-11-05,2021-11-05,2021-11-16,PLN3630,1520687146,1520687146,ASC,In-Network,Z00.00,Z12.31,,,,,,,0,,33533,Surgery,,,,81,Independent Laboratory,1,13186.06,4581.29,4521.32,9.97,50.0,0.0,59.97,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000005344,MBR00000208,Professional,2023-05-16,2023-05-16,2023-06-11,PLN8750,1355166277,1355166277,Endocrinology,In-Network,F41.9,Z00.00,,,,,,,0,,99204,E&M,,,,11,Office,3,338.55,258.25,258.25,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005345,MBR00000208,Institutional-IP,2022-05-15,2022-05-22,2022-06-27,PLN5177,1239316214,1239316214,Internal Medicine,In-Network,E11.9,K21.0,,,,603,MS-DRG,8,7,U,99221,E&M,,,0450,21,Inpatient Hospital,1,234.48,190.28,0.0,186.69,35.0,0.0,221.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005346,MBR00000208,Institutional-OP,2022-09-06,2022-09-06,2022-09-30,PLN6496,1205377316,1205377316,Orthopedic Surgery,In-Network,Z23,I10,,,,,,,0,,99203,E&M,,,0450,22,Outpatient Hospital,2,205.32,139.16,89.16,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005347,MBR00000208,Professional,2022-08-03,2022-08-03,2022-08-27,PLN2528,1691062876,1691062876,SNF,In-Network,Z23,M54.5,,,,,,,0,,27130,Surgery,,,,11,Office,2,3666.26,1466.64,1390.68,36.03,0.0,39.93,75.96,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005348,MBR00000208,Institutional-OP,2023-04-11,2023-04-11,2023-05-08,PLN5986,1135158374,1135158374,Pulmonology,In-Network,J44.1,K57.30,,,,,,,0,,86900,Pathology/Lab,,,0120,22,Outpatient Hospital,2,25.62,19.87,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005349,MBR00000208,Institutional-OP,2021-08-14,2021-08-14,2021-09-12,PLN4180,1935547131,1935547131,Pulmonology,In-Network,Z79.4,Z23,,,,,,,0,,58661,Surgery,,,0450,22,Outpatient Hospital,3,2727.94,1915.92,1915.92,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005350,MBR00000208,Professional,2021-03-07,2021-03-07,2021-04-14,PLN5903,1438368327,1438368327,Home Health,In-Network,F03.90,I10,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,3,2384.88,825.92,733.92,0.0,0.0,92.0,92.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005351,MBR00000208,Professional,2023-03-13,2023-03-13,2023-04-05,PLN9405,1757138478,1757138478,Pediatrics,In-Network,I63.9,M17.11,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,3,65.03,44.24,30.38,13.86,0.0,0.0,13.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005352,MBR00000208,Institutional-IP,2023-11-11,2023-11-14,2023-12-24,PLN5296,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,Z00.00,I10,,,,196,MS-DRG,17,3,Y,23472,Surgery,,,0120,21,Inpatient Hospital,3,3575.11,1237.24,1099.33,0.0,50.0,87.91,137.91,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005353,MBR00000208,Professional,2022-09-28,2022-09-28,2022-10-23,PLN1758,1148984206,1148984206,Psychiatry,In-Network,N40.0,E11.65,,,,,,,0,,84443,Pathology/Lab,,,,49,Independent Clinic,1,74.72,36.64,36.64,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005354,MBR00000208,Professional,2021-05-09,2021-05-09,2021-05-22,PLN9033,1910255109,1910255109,DME Supplier,In-Network,R10.9,E78.5,,,,,,,0,,45378,Surgery,,,,23,Emergency Room,3,2202.21,710.21,357.8,352.41,0.0,0.0,352.41,0.0,Paid,,,0,,1,1,0,0,0,0,None,0,1,0,0,0
CLM0000005355,MBR00000208,Professional,2021-05-03,2021-05-03,2021-05-28,PLN4743,1502838586,1502838586,ASC,In-Network,I48.91,R10.9,,,,,,,0,,45380,Surgery,,,,11,Office,3,2608.07,1872.2,1407.52,449.68,15.0,0.0,464.68,0.0,Paid,,,0,,0,0,1,0,0,1,Upcoding,0,1,0,0,0
CLM0000005356,MBR00000208,Professional,2022-08-20,2022-08-20,2022-10-02,PLN7374,1609138981,1609138981,Critical Access Hospital,In-Network,I10,E11.9,,,,,,,0,,27130,Surgery,,,,11,Office,1,4546.82,2810.53,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-18,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005357,MBR00000208,Professional,2023-09-09,2023-09-09,2023-10-03,PLN6426,1990090423,1990090423,Orthopedic Surgery,In-Network,Z12.11,F41.9,,,,,,,0,,90837,Medicine,,,,23,Emergency Room,1,481.16,264.02,4.22,209.8,50.0,0.0,259.8,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005358,MBR00000208,Institutional-IP,2022-11-04,2022-11-10,2022-12-17,PLN9853,1624202402,1624202402,Orthopedic Surgery,In-Network,F32.9,S72.001A,,,,641,MS-DRG,2,6,Y,99284,E&M,,,0370,21,Inpatient Hospital,3,569.9,422.07,173.18,159.96,50.0,38.93,248.89,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005359,MBR00000208,Institutional-OP,2021-11-27,2021-11-27,2022-01-07,PLN1376,1696843572,1696843572,Critical Access Hospital,Out-of-Network,J20.9,K21.0,,,,,,,0,,90686,Medicine,,,0900,22,Outpatient Hospital,2,99.68,73.44,0.0,73.44,0.0,0.0,73.44,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000005360,MBR00000208,Institutional-OP,2022-11-11,2022-11-11,2022-12-24,PLN6857,1124394415,1124394415,Pediatrics,In-Network,Z23,E11.9,,,,,,,0,,71046,Radiology,,,0360,22,Outpatient Hospital,3,287.02,180.5,0.0,180.5,35.0,0.0,215.5,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005361,MBR00000208,Institutional-OP,2021-06-21,2021-06-21,2021-07-20,PLN1647,1224179551,1224179551,Physical Therapy,In-Network,K92.1,Z12.31,,,,,,,0,,90837,Medicine,,,0450,22,Outpatient Hospital,2,225.56,67.93,0.0,67.93,0.0,0.0,67.93,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000005362,MBR00000208,Professional,2022-06-09,2022-06-09,2022-06-29,PLN4723,1224179551,1224179551,Physical Therapy,In-Network,E87.6,J20.9,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,3,217.26,184.12,0.0,184.12,15.0,0.0,199.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005363,MBR00000208,Professional,2023-12-12,2023-12-12,2024-01-12,PLN5074,1991459367,1991459367,Neurology,Out-of-Network,E66.9,J20.9,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,1,1967.77,1576.05,1442.72,0.0,0.0,133.33,133.33,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000005364,MBR00000209,Professional,2022-11-21,2022-11-21,2022-12-20,PLN1707,1139906830,1139906830,Endocrinology,Out-of-Network,E11.9,E11.9,,,,,,,0,,99232,E&M,,,,23,Emergency Room,3,233.12,130.92,106.94,0.0,0.0,23.98,23.98,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005365,MBR00000209,Institutional-OP,2021-04-23,2021-04-23,2021-05-13,PLN4730,1845057593,1845057593,Orthopedic Surgery,In-Network,I10,Z79.4,,,,,,,0,,99284,E&M,,,0900,22,Outpatient Hospital,2,461.38,359.53,359.53,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005366,MBR00000209,Professional,2021-08-09,2021-08-09,2021-09-10,PLN2650,1540044947,1540044947,Pulmonology,Out-of-Network,I11.9,E11.9,,,,,,,0,,27130,Surgery,,,,11,Office,1,6464.02,3180.08,2840.64,0.0,0.0,339.44,339.44,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005367,MBR00000209,Professional,2021-03-07,2021-03-07,2021-04-11,PLN7734,1767011137,1767011137,DME Supplier,In-Network,I63.9,I11.9,,,,,,,0,,99232,E&M,,,,21,Inpatient Hospital,3,295.46,119.82,116.41,0.0,0.0,3.41,3.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005368,MBR00000209,Institutional-OP,2022-03-17,2022-03-17,2022-03-31,PLN6422,1334916761,1334916761,ASC,In-Network,Z51.11,Z87.891,,,,,,,0,,71046,Radiology,,,0270,22,Outpatient Hospital,1,308.34,151.17,0.0,151.17,15.0,0.0,166.17,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005369,MBR00000209,Professional,2021-09-18,2021-09-18,2021-09-25,PLN4182,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,I48.91,N18.3,,,,,,,0,,74177,Radiology,,,,11,Office,1,1828.08,1349.62,1349.62,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005370,MBR00000209,Institutional-OP,2023-12-09,2023-12-09,2024-01-11,PLN3611,1609526529,1609526529,Psychiatry,In-Network,I10,K21.0,,,,,,,0,,97110,Medicine,,,0761,22,Outpatient Hospital,3,216.57,70.13,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005371,MBR00000210,Professional,2021-12-16,2021-12-16,2022-01-16,PLN4279,1624802371,1624802371,ASC,Out-of-Network,F32.9,Z00.00,,,,,,,0,,97110,Medicine,,,,11,Office,3,271.03,216.26,187.85,0.0,0.0,28.41,28.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005372,MBR00000210,Professional,2021-02-08,2021-02-08,2021-03-04,PLN1099,1974006077,1974006077,Orthopedic Surgery,In-Network,I10,M54.5,,,,,,,0,,99232,E&M,,,,11,Office,1,252.5,200.04,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005373,MBR00000210,Institutional-OP,2022-04-21,2022-04-21,2022-05-30,PLN7806,1227362142,1227362142,DME Supplier,In-Network,E78.5,F03.90,,,,,,,0,,90460,Medicine,,,0900,22,Outpatient Hospital,1,63.65,22.85,22.85,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005374,MBR00000210,Professional,2023-03-19,2023-03-19,2023-05-01,PLN2526,1518055405,1518055405,Urology,In-Network,I10,R51,,,,,,,0,,99203,E&M,,,,11,Office,1,202.08,103.82,31.84,19.1,50.0,2.88,71.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005375,MBR00000210,Professional,2023-01-21,2023-01-21,2023-02-08,PLN9383,1590915516,1590915516,Physical Therapy,Out-of-Network,F41.9,I10,,,,,,,0,,83036,Pathology/Lab,,,,21,Inpatient Hospital,2,43.23,31.82,31.82,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000005376,MBR00000210,Institutional-IP,2023-12-06,2023-12-19,2023-12-19,PLN5181,1361302520,1361302520,Critical Access Hospital,In-Network,M17.11,Z96.641,,,,196,MS-DRG,4,13,Y,93306,Radiology,,,0761,21,Inpatient Hospital,1,2498.17,2082.88,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-11,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005377,MBR00000210,Institutional-IP,2022-02-05,2022-02-08,2022-03-09,PLN8304,1749327647,1749327647,Geriatrics,In-Network,E66.9,M54.5,,,,470,MS-DRG,11,3,Y,45378,Surgery,,,0360,21,Inpatient Hospital,1,1446.68,1083.31,971.13,0.0,0.0,112.18,112.18,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000005378,MBR00000210,Professional,2022-07-27,2022-07-27,2022-08-21,PLN5675,1757138478,1757138478,Pediatrics,In-Network,Z12.31,G43.909,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,3,30.3,11.74,0.0,11.74,0.0,0.0,11.74,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005379,MBR00000210,Professional,2022-09-05,2022-09-05,2022-09-20,PLN8896,1198133277,1198133277,SNF,In-Network,K57.30,I63.9,,,,,,,0,,43239,Surgery,,,,11,Office,2,2232.35,1044.8,1009.8,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005380,MBR00000210,Professional,2021-01-27,2021-01-27,2021-03-08,PLN2338,1545347862,1545347862,SNF,In-Network,I10,E11.9,,,,,,,0,,58661,Surgery,,,,11,Office,1,2436.81,1217.04,1216.72,0.32,0.0,0.0,0.32,0.0,Paid,,,1,,0,0,1,0,0,1,Unbundling,0,0,0,0,0
CLM0000005381,MBR00000210,Professional,2021-01-07,2021-01-07,2021-01-22,PLN5832,1283743001,1283743001,Family Medicine,In-Network,B97.89,I10,,,,,,,0,,70553,Radiology,,,,12,Home,3,4466.65,2003.9,0.0,0.0,0.0,0.0,0.0,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005382,MBR00000210,Professional,2023-05-22,2023-05-22,2023-06-09,PLN3652,1198133277,1198133277,SNF,In-Network,F41.9,F41.9,,,,,,,0,,99284,E&M,,,,31,Skilled Nursing Facility,3,707.97,404.49,64.57,339.92,0.0,0.0,339.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005383,MBR00000210,Professional,2022-02-26,2022-02-26,2022-03-30,PLN9019,1268679390,1268679390,Critical Access Hospital,In-Network,Z12.31,N18.3,,,,,,,0,,99221,E&M,,,,11,Office,2,196.56,120.56,45.56,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005384,MBR00000210,Institutional-OP,2023-01-24,2023-01-24,2023-01-31,PLN6863,1856686341,1856686341,Geriatrics,In-Network,Z79.4,J20.9,,,,,,,0,,70553,Radiology,,,0761,22,Outpatient Hospital,2,4342.76,2808.68,2808.68,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005385,MBR00000210,Institutional-IP,2023-11-01,2023-11-03,2023-11-09,PLN6978,1236418230,1236418230,DME Supplier,In-Network,Z00.00,M17.11,,,,872,MS-DRG,12,2,Y,99222,E&M,,,0120,21,Inpatient Hospital,2,273.85,101.6,0.0,101.6,25.0,0.0,126.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005386,MBR00000210,Professional,2021-09-25,2021-09-25,2021-10-22,PLN6062,1910255109,1910255109,DME Supplier,In-Network,J44.1,R07.9,,,,,,,0,,99283,E&M,,,,49,Independent Clinic,1,497.92,180.19,153.52,0.0,25.0,1.67,26.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005387,MBR00000210,Professional,2023-04-29,2023-04-29,2023-05-19,PLN4949,1542828721,1542828721,Orthopedic Surgery,In-Network,M81.0,I10,,,,,,,0,,99222,E&M,,,,81,Independent Laboratory,3,382.1,270.46,150.73,84.18,0.0,35.55,119.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005388,MBR00000210,Professional,2021-08-23,2021-08-23,2021-09-21,PLN5652,1799205295,1799205295,General Acute Care Hospital,In-Network,F41.9,Z12.11,,,,,,,0,,85025,Pathology/Lab,,,,22,Outpatient Hospital,3,46.92,38.94,38.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005389,MBR00000210,Professional,2023-03-23,2023-03-23,2023-04-28,PLN5481,1283743001,1283743001,Family Medicine,In-Network,M17.11,I10,,,,,,,0,,33533,Surgery,,,,11,Office,2,18803.23,10606.35,9981.59,0.0,35.0,589.76,624.76,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000005390,MBR00000210,Institutional-OP,2021-06-25,2021-06-25,2021-07-08,PLN2595,1575695214,1575695214,SNF,In-Network,J20.9,R10.9,,,,,,,0,,80053,Pathology/Lab,,,0370,22,Outpatient Hospital,1,71.36,53.14,0.0,53.14,15.0,0.0,68.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005391,MBR00000210,Professional,2021-11-30,2021-11-30,2021-12-07,PLN1971,1806688928,1806688928,Geriatrics,In-Network,Z12.31,N40.0,,,,,,,0,,76700,Radiology,,,,21,Inpatient Hospital,3,1388.65,498.19,423.19,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005392,MBR00000210,Institutional-OP,2022-05-30,2022-05-30,2022-06-13,PLN2176,1689639685,1689639685,SNF,In-Network,G43.909,F10.20,,,,,,,0,,58661,Surgery,,,0370,22,Outpatient Hospital,3,3685.67,1546.76,1511.76,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005393,MBR00000210,Institutional-IP,2022-06-19,2022-06-27,2022-06-28,PLN3130,1974006077,1974006077,Orthopedic Surgery,In-Network,Z00.01,I63.9,,,,196,MS-DRG,7,8,Y,97110,Medicine,,,0761,21,Inpatient Hospital,2,206.43,167.32,132.32,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005394,MBR00000210,Institutional-OP,2021-02-03,2021-02-03,2021-02-28,PLN9312,1422747896,1422747896,Urology,In-Network,J06.9,I10,,,,,,,0,,76700,Radiology,,,0900,22,Outpatient Hospital,1,1173.16,902.91,553.1,334.81,15.0,0.0,349.81,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005395,MBR00000210,Institutional-OP,2023-07-14,2023-07-14,2023-08-15,PLN9169,1812060197,1812060197,Oncology,Out-of-Network,I10,K21.0,,,,,,,0,,99284,E&M,,,0301,22,Outpatient Hospital,1,863.92,471.92,471.92,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005396,MBR00000211,Institutional-OP,2021-01-07,2021-01-07,2021-01-16,PLN9298,1609138981,1609138981,Critical Access Hospital,In-Network,E11.9,J06.9,,,,,,,0,,90686,Medicine,,,0761,22,Outpatient Hospital,3,115.87,97.53,60.65,0.0,35.0,1.88,36.88,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000005397,MBR00000211,Institutional-IP,2023-08-22,2023-08-27,2023-09-06,PLN5362,1273488618,1273488618,General Acute Care Hospital,In-Network,J44.1,M54.5,,,,196,MS-DRG,11,5,Y,58661,Surgery,,,0120,21,Inpatient Hospital,1,4741.95,3531.18,3146.31,49.99,0.0,334.88,384.87,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005398,MBR00000211,Professional,2021-08-14,2021-08-14,2021-09-21,PLN1872,1964402759,1964402759,Outpatient Clinic,In-Network,E11.40,N39.0,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,3,1953.71,1096.5,1096.5,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005399,MBR00000211,Institutional-IP,2023-02-18,2023-02-20,2023-03-04,PLN5939,1224179551,1224179551,Physical Therapy,In-Network,F10.20,I25.10,,,,641,MS-DRG,19,2,Y,43239,Surgery,,,0120,21,Inpatient Hospital,3,2210.58,930.13,475.04,440.09,15.0,0.0,455.09,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005400,MBR00000211,Professional,2023-02-19,2023-02-19,2023-03-14,PLN5101,1295371663,1295371663,Critical Access Hospital,In-Network,I48.91,Z87.891,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,3,105.49,54.77,0.0,54.77,0.0,0.0,54.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005401,MBR00000211,Professional,2022-05-15,2022-05-15,2022-06-12,PLN5554,1108115157,1108115157,General Acute Care Hospital,In-Network,M54.5,N18.3,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,2,1484.92,902.11,902.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000005402,MBR00000211,Institutional-OP,2022-08-12,2022-08-12,2022-09-20,PLN7033,1561134315,1561134315,DME Supplier,In-Network,N18.3,E11.9,,,,,,,0,,45380,Surgery,,,0301,22,Outpatient Hospital,1,2342.81,925.8,661.55,44.83,75.0,144.42,264.25,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000005403,MBR00000211,Institutional-IP,2021-03-22,2021-04-03,2021-05-04,PLN5811,1450553056,1450553056,Clinical Laboratory,In-Network,E78.5,M54.5,,,,682,MS-DRG,23,12,Y,74177,Radiology,,,0270,21,Inpatient Hospital,2,2263.6,945.27,855.47,89.8,0.0,0.0,89.8,0.0,Paid,,,1,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000005404,MBR00000211,Professional,2023-09-14,2023-09-14,2023-09-23,PLN7803,1778483301,1778483301,Home Health,In-Network,Z12.31,G20,,,,,,,0,,45380,Surgery,,,,11,Office,2,1894.97,1002.03,543.34,443.69,15.0,0.0,458.69,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000005405,MBR00000211,Institutional-OP,2021-05-11,2021-05-11,2021-06-09,PLN9766,1645194539,1645194539,SNF,In-Network,F41.9,Z87.891,,,,,,,0,,99214,E&M,,,0761,22,Outpatient Hospital,3,331.43,147.54,120.22,0.0,0.0,27.32,27.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005406,MBR00000211,Professional,2022-12-22,2022-12-22,2023-01-04,PLN1752,1964402759,1964402759,Outpatient Clinic,In-Network,N39.0,F41.9,,,,,,,0,,72148,Radiology,,,,11,Office,1,1235.33,614.6,599.6,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005407,MBR00000211,Institutional-OP,2021-01-01,2021-01-01,2021-02-09,PLN2109,1118885473,1118885473,ASC,In-Network,K92.1,E11.9,,,,,,,0,,99232,E&M,,,0510,22,Outpatient Hospital,2,204.46,163.96,82.21,0.0,75.0,6.75,81.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005408,MBR00000211,Institutional-OP,2023-03-28,2023-03-28,2023-04-13,PLN4259,1125190055,1125190055,Nephrology,In-Network,C50.912,E66.9,,,,,,,0,,93225,Medicine,,,0270,22,Outpatient Hospital,2,345.96,230.27,230.27,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005409,MBR00000211,Professional,2022-01-29,2022-01-29,2022-02-26,PLN6567,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,E78.5,E11.9,,,,,,,0,,84443,Pathology/Lab,,,,23,Emergency Room,2,86.12,56.74,0.0,56.74,75.0,0.0,131.74,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005410,MBR00000211,Professional,2022-06-12,2022-06-12,2022-07-06,PLN7969,1361302520,1361302520,Critical Access Hospital,In-Network,F32.9,R05,,,,,,,0,,58661,Surgery,,,,65,End-Stage Renal Disease,3,4728.28,3511.42,3476.42,0.0,35.0,0.0,35.0,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005411,MBR00000211,Institutional-OP,2021-01-26,2021-01-26,2021-02-07,PLN5685,1689639685,1689639685,SNF,In-Network,Z79.4,E78.5,,,,,,,0,,99214,E&M,,,0200,22,Outpatient Hospital,2,255.36,153.86,78.86,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005412,MBR00000211,Professional,2021-08-28,2021-08-28,2021-09-24,PLN7004,1752470395,1752470395,Home Health,In-Network,Z23,K21.0,,,,,,,0,,27447,Surgery,,,,12,Home,3,4438.53,2546.7,2214.11,0.0,25.0,307.59,332.59,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005413,MBR00000211,Institutional-OP,2022-04-22,2022-04-22,2022-05-31,PLN4177,1389336600,1389336600,Critical Access Hospital,In-Network,M54.5,E11.9,,,,,,,0,,70553,Radiology,,,0320,22,Outpatient Hospital,2,3460.62,1466.89,1391.89,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005414,MBR00000211,Professional,2023-02-25,2023-02-25,2023-03-24,PLN6357,1749327647,1749327647,Geriatrics,In-Network,R05,I10,,,,,,,0,,G0439,Medicine,,,,50,Federally Qualified Health Center,2,523.88,445.13,445.13,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000005415,MBR00000211,Professional,2022-10-17,2022-10-17,2022-11-25,PLN5564,1235381502,1235381502,Cardiology,In-Network,N40.0,E11.9,,,,,,,0,,83036,Pathology/Lab,,,,31,Skilled Nursing Facility,3,78.07,54.44,39.44,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000005416,MBR00000211,Institutional-IP,2021-10-13,2021-10-18,2021-11-12,PLN3236,1872272835,1872272835,Internal Medicine,In-Network,B97.89,J20.9,,,,291,MS-DRG,23,5,N,85025,Pathology/Lab,,,0740,21,Inpatient Hospital,2,42.31,28.56,28.56,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005417,MBR00000211,Professional,2022-10-15,2022-10-15,2022-10-29,PLN4562,1390307371,1390307371,DME Supplier,In-Network,E87.6,G43.909,,,,,,,0,,99204,E&M,,,,23,Emergency Room,3,443.96,215.5,214.29,0.0,0.0,1.21,1.21,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005418,MBR00000211,Professional,2021-09-02,2021-09-02,2021-10-14,PLN5565,1103747954,1103747954,Urology,In-Network,C50.912,F41.9,,,,,,,0,,99222,E&M,,,,23,Emergency Room,1,508.47,208.04,0.0,0.0,35.0,24.22,59.22,0.0,Denied,CO-29,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005419,MBR00000211,Institutional-IP,2022-09-01,2022-09-07,2022-09-28,PLN1077,1109850785,1109850785,ASC,Out-of-Network,E11.9,Z79.4,,,,194,MS-DRG,3,6,Y,81001,Pathology/Lab,,,0636,21,Inpatient Hospital,3,38.52,26.32,1.32,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005420,MBR00000211,Professional,2022-08-15,2022-08-15,2022-09-26,PLN3575,1395983630,1395983630,Nephrology,In-Network,F32.9,I10,,,,,,,0,,66984,Surgery,,,,11,Office,1,3652.71,1959.74,1959.74,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005421,MBR00000211,Professional,2021-09-05,2021-09-05,2021-10-12,PLN3753,1540044947,1540044947,Pulmonology,Out-of-Network,E78.5,R10.9,,,,,,,0,,90686,Medicine,,,,22,Outpatient Hospital,2,86.47,55.1,0.0,55.1,50.0,0.0,105.1,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000005422,MBR00000211,Institutional-OP,2021-08-08,2021-08-08,2021-09-02,PLN2798,1563980627,1563980627,Critical Access Hospital,In-Network,M54.5,I25.10,,,,,,,0,,99233,E&M,,,0270,22,Outpatient Hospital,2,207.67,75.73,0.0,75.73,0.0,0.0,75.73,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000005423,MBR00000211,Professional,2022-07-23,2022-07-23,2022-08-26,PLN4883,1700633438,1700633438,DME Supplier,In-Network,I48.91,J06.9,,,,,,,0,,77067,Radiology,,,,81,Independent Laboratory,2,386.34,296.19,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000005424,MBR00000211,Institutional-IP,2022-10-05,2022-10-08,2022-10-13,PLN8186,1935547131,1935547131,Pulmonology,In-Network,M54.5,N39.0,,,,470,MS-DRG,9,3,Y,33533,Surgery,,,0301,21,Inpatient Hospital,1,28702.48,20765.18,19702.21,0.0,50.0,1012.97,1062.97,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000005425,MBR00000211,Institutional-IP,2023-12-09,2023-12-15,2024-01-13,PLN4068,1139906830,1139906830,Endocrinology,Out-of-Network,I10,E78.5,,,,872,MS-DRG,24,6,Y,87491,Pathology/Lab,,,0450,21,Inpatient Hospital,1,218.67,159.92,0.0,159.92,0.0,0.0,159.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005426,MBR00000211,Institutional-IP,2022-06-27,2022-07-01,2022-07-28,PLN9195,1840431511,1840431511,Geriatrics,Out-of-Network,J06.9,F10.20,,,,871,MS-DRG,7,4,Y,99214,E&M,,,0270,21,Inpatient Hospital,1,422.9,302.88,244.01,0.0,35.0,23.87,58.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005427,MBR00000211,Professional,2022-05-02,2022-05-02,2022-05-10,PLN6753,1812060197,1812060197,Oncology,Out-of-Network,F10.20,Z23,,,,,,,0,,99222,E&M,,,,23,Emergency Room,3,649.2,276.3,276.3,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005428,MBR00000211,Institutional-OP,2022-06-05,2022-06-05,2022-07-12,PLN1070,1713934949,1713934949,Neurology,In-Network,F32.9,J44.1,,,,,,,0,,43239,Surgery,,,0360,22,Outpatient Hospital,1,1831.89,569.11,562.34,0.0,0.0,6.77,6.77,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005429,MBR00000211,Professional,2023-08-16,2023-08-16,2023-09-04,PLN7188,1186826716,1186826716,Physical Therapy,In-Network,Z00.00,I50.9,,,,,,,0,,93306,Radiology,,,,50,Federally Qualified Health Center,1,1510.03,946.36,785.78,0.0,50.0,110.58,160.58,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005430,MBR00000211,Institutional-OP,2021-12-03,2021-12-03,2022-01-07,PLN2710,1790497490,1790497490,OB/GYN,In-Network,N18.3,I11.9,,,,,,,0,,99233,E&M,,,0301,22,Outpatient Hospital,1,519.14,310.16,272.76,37.4,0.0,0.0,37.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005431,MBR00000211,Institutional-OP,2022-02-22,2022-02-22,2022-03-15,PLN6757,1500949740,1500949740,Pediatrics,In-Network,I10,Z12.31,,,,,,,0,,97110,Medicine,,,0510,22,Outpatient Hospital,3,141.54,81.52,81.52,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005432,MBR00000211,Institutional-OP,2022-02-08,2022-02-08,2022-03-20,PLN5659,1571574052,1571574052,Critical Access Hospital,In-Network,I10,N18.3,,,,,,,0,,84443,Pathology/Lab,,,0200,22,Outpatient Hospital,3,144.48,76.54,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005433,MBR00000211,Professional,2022-11-14,2022-11-14,2022-12-23,PLN8022,1915531927,1915531927,Critical Access Hospital,In-Network,Z23,M54.5,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,1,216.77,137.79,137.79,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005434,MBR00000211,Professional,2023-02-05,2023-02-05,2023-02-20,PLN3515,1561134315,1561134315,DME Supplier,In-Network,C50.912,M54.5,,,,,,,0,,86900,Pathology/Lab,,,,22,Outpatient Hospital,3,35.67,21.29,0.0,21.29,75.0,0.0,96.29,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005435,MBR00000212,Professional,2022-06-12,2022-06-12,2022-06-29,PLN6059,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,Z00.00,E78.5,,,,,,,0,,G0444,Medicine,,,,23,Emergency Room,3,71.67,51.27,0.0,51.27,0.0,0.0,51.27,0.0,Paid,,,0,,1,1,0,0,0,0,None,0,0,0,0,1
CLM0000005436,MBR00000212,Institutional-IP,2021-10-16,2021-10-18,2021-11-10,PLN7475,1700633438,1700633438,DME Supplier,In-Network,E11.9,J06.9,,,,682,MS-DRG,18,2,Y,99233,E&M,,,0370,21,Inpatient Hospital,1,463.06,359.43,271.59,52.84,35.0,0.0,87.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005437,MBR00000212,Professional,2023-01-25,2023-01-25,2023-03-10,PLN7229,1364429278,1364429278,OB/GYN,In-Network,E11.9,N39.0,,,,,,,0,,90686,Medicine,,,,22,Outpatient Hospital,3,132.78,52.56,19.81,7.75,25.0,0.0,32.75,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000005438,MBR00000212,Professional,2021-10-29,2021-10-29,2021-11-23,PLN9519,1609526529,1609526529,Psychiatry,In-Network,E66.9,E11.9,,,,,,,0,,78452,Radiology,,,,11,Office,3,2804.83,1719.25,1445.17,0.0,75.0,199.08,274.08,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005439,MBR00000212,Professional,2023-09-10,2023-09-10,2023-09-23,PLN2904,1700633438,1700633438,DME Supplier,In-Network,E11.9,K92.1,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,2,231.45,136.28,0.0,0.0,0.0,0.0,0.0,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005440,MBR00000212,Professional,2022-11-15,2022-11-15,2022-12-06,PLN4737,1531398223,1531398223,OB/GYN,In-Network,J20.9,E66.9,,,,,,,0,,93306,Radiology,,,,11,Office,2,2774.21,1746.21,1321.69,409.52,15.0,0.0,424.52,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005441,MBR00000212,Professional,2022-04-28,2022-04-28,2022-05-17,PLN4778,1361302520,1361302520,Critical Access Hospital,In-Network,I10,Z12.31,,,,,,,0,,99222,E&M,,,,11,Office,3,584.48,232.74,0.0,232.74,35.0,0.0,267.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005442,MBR00000212,Professional,2021-09-13,2021-09-13,2021-10-27,PLN4205,1313212303,1313212303,Family Medicine,In-Network,Z79.4,Z12.31,,,,,,,0,,74177,Radiology,,,,12,Home,2,1976.02,800.99,652.28,0.0,0.0,148.71,148.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005443,MBR00000212,Professional,2023-04-10,2023-04-10,2023-05-13,PLN5700,1571574052,1571574052,Critical Access Hospital,In-Network,E11.9,E78.5,,,,,,,0,,71046,Radiology,,,,11,Office,2,242.04,114.71,0.0,0.0,75.0,4.66,79.66,0.0,Denied,CO-11,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005444,MBR00000212,Professional,2022-10-30,2022-10-30,2022-12-12,PLN1905,1227362142,1227362142,DME Supplier,In-Network,F41.9,K21.0,,,,,,,0,,80053,Pathology/Lab,,,,22,Outpatient Hospital,3,65.67,37.0,22.0,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005445,MBR00000212,Professional,2023-08-25,2023-08-25,2023-10-04,PLN6362,1213165847,1213165847,Critical Access Hospital,In-Network,J06.9,I25.10,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,1,67.8,32.22,0.0,32.22,0.0,0.0,32.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005446,MBR00000212,Institutional-IP,2023-02-13,2023-02-25,2023-03-05,PLN5047,1872272835,1872272835,Internal Medicine,In-Network,K21.0,E11.9,,,,194,MS-DRG,10,12,Y,93306,Radiology,,,0761,21,Inpatient Hospital,1,1457.98,751.28,676.28,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005447,MBR00000212,Institutional-OP,2023-05-15,2023-05-15,2023-06-19,PLN1434,1689639685,1689639685,SNF,In-Network,E11.9,N39.0,,,,,,,0,,45378,Surgery,,,0740,22,Outpatient Hospital,3,1933.68,683.9,683.9,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000005448,MBR00000212,Professional,2021-04-11,2021-04-11,2021-05-12,PLN4596,1531398223,1531398223,OB/GYN,In-Network,Z00.00,Z00.00,,,,,,,0,,66984,Surgery,,,,11,Office,2,1962.32,1162.9,851.91,58.93,75.0,177.06,310.99,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005449,MBR00000212,Institutional-OP,2021-01-27,2021-01-27,2021-02-19,PLN8336,1453936007,1453936007,ASC,In-Network,F32.9,I10,,,,,,,0,,G0444,Medicine,,,0761,22,Outpatient Hospital,2,43.99,17.8,0.0,17.8,25.0,0.0,42.8,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000005450,MBR00000212,Professional,2022-12-22,2022-12-22,2023-01-31,PLN3987,1125190055,1125190055,Nephrology,In-Network,I11.9,Z23,,,,,,,0,,85610,Pathology/Lab,,,,20,Urgent Care,1,38.02,28.6,0.0,28.6,35.0,0.0,63.6,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000005451,MBR00000212,Institutional-IP,2021-01-01,2021-01-10,2021-02-04,PLN8098,1366576336,1366576336,Geriatrics,In-Network,E66.9,I50.9,,,,196,MS-DRG,3,9,Y,85025,Pathology/Lab,,,0761,21,Inpatient Hospital,2,34.5,20.42,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005452,MBR00000212,Professional,2023-09-03,2023-09-03,2023-09-14,PLN2507,1239316214,1239316214,Internal Medicine,In-Network,J45.20,N40.0,,,,,,,0,,99222,E&M,,,,21,Inpatient Hospital,2,334.29,158.26,71.01,0.0,75.0,12.25,87.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005453,MBR00000212,Institutional-OP,2023-08-25,2023-08-25,2023-09-08,PLN9349,1355166277,1355166277,Endocrinology,In-Network,E78.5,I10,,,,,,,0,,33533,Surgery,,,0900,22,Outpatient Hospital,2,18686.44,8902.31,8700.28,202.03,0.0,0.0,202.03,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000005454,MBR00000212,Institutional-OP,2022-10-03,2022-10-03,2022-11-09,PLN7057,1556140803,1556140803,Cardiology,In-Network,J20.9,I10,,,,,,,0,,45380,Surgery,,,0320,22,Outpatient Hospital,2,2263.95,951.4,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-18,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000005455,MBR00000212,Institutional-IP,2023-03-10,2023-03-18,2023-03-20,PLN8704,1660288235,1660288235,ASC,In-Network,M81.0,I10,,,,683,MS-DRG,13,8,Y,G0444,Medicine,,,0200,21,Inpatient Hospital,1,46.88,24.61,24.61,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,1,1,Phantom,0,0,0,0,1
CLM0000005456,MBR00000212,Professional,2022-04-08,2022-04-08,2022-05-06,PLN2972,1749494482,1749494482,Pediatrics,In-Network,J06.9,J20.9,,,,,,,0,,66984,Surgery,,,,31,Skilled Nursing Facility,2,1947.81,1504.35,1504.35,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005457,MBR00000212,Institutional-OP,2023-11-16,2023-11-16,2023-12-16,PLN4079,1974006077,1974006077,Orthopedic Surgery,In-Network,I10,Z12.31,,,,,,,0,,G0439,Medicine,,,0730,22,Outpatient Hospital,3,508.24,282.24,0.0,0.0,50.0,25.97,75.97,0.0,Denied,CO-15,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000005458,MBR00000212,Professional,2021-02-09,2021-02-09,2021-03-04,PLN4774,1132188260,1132188260,Family Medicine,In-Network,I10,Z79.4,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,1,86.31,55.9,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005459,MBR00000212,Professional,2021-11-17,2021-11-17,2021-11-24,PLN3408,1939033455,1939033455,Pulmonology,In-Network,Z12.11,M17.11,,,,,,,0,,93225,Medicine,,,,12,Home,2,551.67,424.87,132.72,267.96,0.0,24.19,292.15,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005460,MBR00000212,Institutional-OP,2023-02-04,2023-02-04,2023-02-22,PLN9701,1395983630,1395983630,Nephrology,In-Network,Z79.4,Z87.891,,,,,,,0,,99214,E&M,,,0320,22,Outpatient Hospital,3,336.35,222.91,222.91,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005461,MBR00000212,Institutional-IP,2023-05-13,2023-05-19,2023-06-10,PLN9455,1389336600,1389336600,Critical Access Hospital,In-Network,Z23,Z23,,,,194,MS-DRG,9,6,Y,90837,Medicine,,,0370,21,Inpatient Hospital,3,344.25,115.81,113.21,2.6,0.0,0.0,2.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005462,MBR00000212,Institutional-OP,2021-09-23,2021-09-23,2021-10-11,PLN1153,1205377316,1205377316,Orthopedic Surgery,In-Network,I48.91,N39.0,,,,,,,0,,47562,Surgery,,,0360,22,Outpatient Hospital,2,3931.77,2069.15,2069.15,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005463,MBR00000212,Institutional-OP,2023-05-28,2023-05-28,2023-06-17,PLN1698,1273488618,1273488618,General Acute Care Hospital,In-Network,Z87.891,Z23,,,,,,,0,,99233,E&M,,,0200,22,Outpatient Hospital,3,454.15,182.27,148.14,0.0,0.0,34.13,34.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005464,MBR00000212,Institutional-OP,2022-05-20,2022-05-20,2022-06-03,PLN7222,1453936007,1453936007,ASC,In-Network,F41.9,E78.5,,,,,,,0,,93306,Radiology,,,0636,22,Outpatient Hospital,1,1757.25,868.36,868.36,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005465,MBR00000212,Professional,2023-07-28,2023-07-28,2023-08-22,PLN2311,1713934949,1713934949,Neurology,In-Network,Z00.00,Z12.31,,,,,,,0,,G0439,Medicine,,,,65,End-Stage Renal Disease,2,387.68,248.02,211.07,0.0,15.0,21.95,36.95,0.0,Adjusted,,,0,,0,1,0,0,0,1,Identity_Theft,0,0,0,1,0
CLM0000005466,MBR00000212,Professional,2021-10-20,2021-10-20,2021-11-06,PLN9987,1364429278,1364429278,OB/GYN,In-Network,E11.65,I10,,,,,,,0,,81001,Pathology/Lab,,,,65,End-Stage Renal Disease,1,44.41,17.31,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005467,MBR00000212,Professional,2023-01-28,2023-01-28,2023-03-04,PLN9438,1812060197,1812060197,Oncology,Out-of-Network,Z23,Z12.31,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,1,82.3,43.25,43.25,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005468,MBR00000212,Institutional-IP,2021-08-16,2021-08-23,2021-09-17,PLN1239,1283743001,1283743001,Family Medicine,In-Network,E11.9,N18.3,,,,292,MS-DRG,8,7,Y,97530,Medicine,,,0636,21,Inpatient Hospital,1,178.33,118.62,43.62,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005469,MBR00000213,Institutional-IP,2021-06-01,2021-06-06,2021-06-09,PLN9173,1125190055,1125190055,Nephrology,In-Network,N39.0,M81.0,,,,871,MS-DRG,21,5,Y,93225,Medicine,,,0370,21,Inpatient Hospital,3,969.93,538.03,418.07,78.34,0.0,41.62,119.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005470,MBR00000213,Institutional-IP,2023-02-12,2023-02-17,2023-03-15,PLN6837,1389336600,1389336600,Critical Access Hospital,In-Network,E11.9,E11.40,,,,195,MS-DRG,21,5,Y,86900,Pathology/Lab,,,0200,21,Inpatient Hospital,2,32.5,21.54,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005471,MBR00000213,Institutional-OP,2023-01-16,2023-01-16,2023-02-04,PLN3473,1609526529,1609526529,Psychiatry,In-Network,E11.65,M17.11,,,,,,,0,,84443,Pathology/Lab,,,0740,22,Outpatient Hospital,3,103.09,87.22,68.67,0.0,15.0,3.55,18.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005472,MBR00000213,Professional,2021-11-18,2021-11-18,2021-12-28,PLN7290,1991459367,1991459367,Neurology,Out-of-Network,Z23,Z51.11,,,,,,,0,,27130,Surgery,,,,31,Skilled Nursing Facility,1,3028.5,1397.72,935.01,454.47,0.0,8.24,462.71,0.0,Paid,,,0,,0,0,1,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000005473,MBR00000213,Professional,2022-10-24,2022-10-24,2022-11-02,PLN3182,1239316214,1239316214,Internal Medicine,In-Network,F10.20,J06.9,,,,,,,0,,45380,Surgery,,,,21,Inpatient Hospital,1,3087.92,2386.89,2386.89,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000005474,MBR00000213,Institutional-OP,2023-10-28,2023-10-28,2023-12-09,PLN9772,1224179551,1224179551,Physical Therapy,In-Network,E78.5,M81.0,,,,,,,0,,23472,Surgery,,,0270,22,Outpatient Hospital,1,6770.42,3485.92,2944.81,0.0,15.0,526.11,541.11,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005475,MBR00000213,Professional,2022-01-01,2022-01-01,2022-02-09,PLN9380,1518055405,1518055405,Urology,In-Network,F32.9,E11.9,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,3,2336.49,1913.25,1187.74,498.48,0.0,227.03,725.51,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005476,MBR00000213,Professional,2022-07-04,2022-07-04,2022-07-23,PLN2879,1227362142,1227362142,DME Supplier,In-Network,Z00.00,N39.0,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,3,36.49,28.11,0.0,0.0,50.0,0.0,50.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005477,MBR00000213,Institutional-OP,2021-08-17,2021-08-17,2021-09-27,PLN2634,1109850785,1109850785,ASC,Out-of-Network,Z00.00,M54.5,,,,,,,0,,90686,Medicine,,,0301,22,Outpatient Hospital,2,87.59,61.34,61.34,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000005478,MBR00000214,Professional,2022-07-22,2022-07-22,2022-08-14,PLN6757,1728018911,1728018911,Nephrology,In-Network,E11.9,G43.909,,,,,,,0,,99204,E&M,,,,21,Inpatient Hospital,1,371.46,230.92,0.0,230.92,25.0,0.0,255.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005479,MBR00000214,Professional,2023-08-28,2023-08-28,2023-09-22,PLN6801,1717546253,1717546253,Family Medicine,In-Network,J06.9,I25.10,,,,,,,0,,87491,Pathology/Lab,,,,22,Outpatient Hospital,3,160.25,81.47,49.08,0.0,25.0,7.39,32.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005480,MBR00000214,Institutional-OP,2022-11-28,2022-11-28,2023-01-11,PLN6776,1563980627,1563980627,Critical Access Hospital,In-Network,I10,I48.91,,,,,,,0,,72148,Radiology,,,0301,22,Outpatient Hospital,3,1842.4,934.24,751.6,107.64,75.0,0.0,182.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005481,MBR00000214,Professional,2021-06-05,2021-06-05,2021-07-02,PLN6990,1109850785,1109850785,ASC,Out-of-Network,F32.9,E11.9,,,,,,,0,,80053,Pathology/Lab,,,,31,Skilled Nursing Facility,2,87.87,63.67,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005482,MBR00000214,Institutional-OP,2023-03-22,2023-03-22,2023-04-08,PLN5810,1186826716,1186826716,Physical Therapy,In-Network,I25.10,K57.30,,,,,,,0,,47562,Surgery,,,0370,22,Outpatient Hospital,2,3181.18,1576.87,1143.48,408.39,25.0,0.0,433.39,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005483,MBR00000214,Institutional-OP,2022-04-08,2022-04-08,2022-05-11,PLN3827,1817234602,1817234602,Clinical Laboratory,In-Network,M81.0,Z23,,,,,,,0,,93306,Radiology,,,0360,22,Outpatient Hospital,1,1729.38,1404.2,1257.33,146.87,0.0,0.0,146.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005484,MBR00000214,Professional,2021-01-20,2021-01-20,2021-02-02,PLN4731,1475984649,1475984649,SNF,In-Network,F32.9,Z12.31,,,,,,,0,,93000,Radiology,,,,22,Outpatient Hospital,1,103.3,31.22,0.0,31.22,75.0,0.0,106.22,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005485,MBR00000214,Institutional-OP,2022-11-13,2022-11-13,2022-12-22,PLN5791,1433937353,1433937353,Nephrology,In-Network,M54.5,M54.5,,,,,,,0,,78452,Radiology,,,0200,22,Outpatient Hospital,2,5163.27,3864.03,3210.38,0.0,0.0,653.65,653.65,0.0,Pended,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005486,MBR00000214,Professional,2021-11-24,2021-11-24,2021-12-21,PLN3300,1564502315,1564502315,ASC,In-Network,R51,Z00.00,,,,,,,0,,G0439,Medicine,,,,49,Independent Clinic,1,254.73,182.98,55.96,127.02,0.0,0.0,127.02,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000005487,MBR00000214,Professional,2023-12-01,2023-12-01,2024-01-08,PLN3083,1125190055,1125190055,Nephrology,In-Network,E78.5,K21.0,,,,,,,0,,99203,E&M,,,,21,Inpatient Hospital,2,184.31,107.26,0.0,107.26,35.0,0.0,142.26,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005488,MBR00000214,Institutional-IP,2023-12-26,2023-12-29,2024-01-27,PLN9931,1687650653,1687650653,Internal Medicine,In-Network,Z23,I10,,,,871,MS-DRG,7,3,Y,99284,E&M,,,0270,21,Inpatient Hospital,2,651.1,510.67,0.0,487.8,35.0,0.0,522.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005489,MBR00000214,Institutional-IP,2023-01-05,2023-01-11,2023-01-24,PLN7510,1361302520,1361302520,Critical Access Hospital,In-Network,Z12.31,I50.9,,,,196,MS-DRG,8,6,Y,76700,Radiology,,,0270,21,Inpatient Hospital,2,811.67,262.51,247.51,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005490,MBR00000214,Professional,2022-11-23,2022-11-23,2022-12-05,PLN8918,1433937353,1433937353,Nephrology,In-Network,I10,R05,,,,,,,0,,58661,Surgery,,,,23,Emergency Room,2,3541.59,1987.25,1562.61,424.64,0.0,0.0,424.64,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005491,MBR00000214,Professional,2021-11-30,2021-11-30,2022-01-13,PLN2337,1896447406,1896447406,Nephrology,Out-of-Network,G43.909,I25.10,,,,,,,0,,45380,Surgery,,,,21,Inpatient Hospital,1,2781.95,849.89,849.89,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000005492,MBR00000214,Professional,2021-03-19,2021-03-19,2021-04-22,PLN5652,1700633438,1700633438,DME Supplier,In-Network,E11.9,K21.0,,,,,,,0,,33533,Surgery,,,,11,Office,1,27152.31,11718.63,11718.63,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000005493,MBR00000214,Professional,2021-03-08,2021-03-08,2021-03-27,PLN8242,1109850785,1109850785,ASC,Out-of-Network,M54.5,E78.5,,,,,,,0,,85610,Pathology/Lab,,,,22,Outpatient Hospital,3,32.59,23.64,23.64,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005494,MBR00000214,Professional,2022-05-23,2022-05-23,2022-06-02,PLN8533,1795618275,1795618275,Pulmonology,In-Network,Z00.00,Z12.31,,,,,,,0,,99222,E&M,,,,11,Office,3,334.09,170.92,170.92,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005495,MBR00000214,Institutional-OP,2021-12-14,2021-12-14,2022-01-26,PLN1963,1575695214,1575695214,SNF,In-Network,M54.5,E78.5,,,,,,,0,,27447,Surgery,,,0900,22,Outpatient Hospital,2,5093.73,2594.86,2594.86,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005496,MBR00000214,Institutional-OP,2023-11-18,2023-11-18,2023-12-20,PLN5313,1135158374,1135158374,Pulmonology,In-Network,K21.0,E78.5,,,,,,,0,,78452,Radiology,,,0120,22,Outpatient Hospital,2,5101.87,2738.52,2385.58,302.94,50.0,0.0,352.94,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005497,MBR00000214,Professional,2021-11-17,2021-11-17,2021-11-29,PLN9054,1563980627,1563980627,Critical Access Hospital,In-Network,E11.9,M54.5,,,,,,,0,,23472,Surgery,,,,11,Office,1,3028.3,2054.6,2054.6,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005498,MBR00000214,Professional,2021-08-24,2021-08-24,2021-09-14,PLN3337,1550154147,1550154147,Outpatient Clinic,In-Network,Z00.00,J44.1,,,,,,,0,,99283,E&M,,,,11,Office,3,605.45,390.44,0.0,390.44,75.0,0.0,465.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005499,MBR00000214,Professional,2023-06-16,2023-06-16,2023-07-27,PLN7940,1531398223,1531398223,OB/GYN,In-Network,E66.9,F32.9,,,,,,,0,,G0468,Medicine,,,,11,Office,1,586.63,448.34,448.34,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005500,MBR00000214,Professional,2023-07-05,2023-07-05,2023-07-13,PLN9741,1198133277,1198133277,SNF,In-Network,E11.65,R05,,,,,,,0,,27130,Surgery,,,,11,Office,1,2597.66,1681.61,1504.75,0.0,25.0,151.86,176.86,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005501,MBR00000214,Institutional-IP,2022-02-17,2022-02-24,2022-03-28,PLN8824,1500949740,1500949740,Pediatrics,In-Network,J45.20,N40.0,,,,195,MS-DRG,19,7,N,G0444,Medicine,,,0120,21,Inpatient Hospital,1,54.57,44.19,0.0,44.19,35.0,0.0,79.19,0.0,Adjusted,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000005502,MBR00000214,Institutional-OP,2021-03-31,2021-03-31,2021-04-18,PLN3677,1283743001,1283743001,Family Medicine,In-Network,I10,Z87.891,,,,,,,0,,90837,Medicine,,,0450,22,Outpatient Hospital,3,518.56,391.73,341.96,0.0,15.0,34.77,49.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005503,MBR00000214,Professional,2021-04-18,2021-04-18,2021-04-29,PLN9970,1728018911,1728018911,Nephrology,In-Network,M17.11,R05,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,1,417.11,165.4,14.8,150.6,0.0,0.0,150.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005504,MBR00000214,Institutional-OP,2022-07-25,2022-07-25,2022-08-01,PLN9393,1590915516,1590915516,Physical Therapy,Out-of-Network,E11.9,F41.9,,,,,,,0,,72148,Radiology,,,0370,22,Outpatient Hospital,2,1448.71,598.04,598.04,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005505,MBR00000214,Institutional-OP,2023-08-11,2023-08-11,2023-08-18,PLN9449,1224179551,1224179551,Physical Therapy,In-Network,F32.9,R07.9,,,,,,,0,,99222,E&M,,,0740,22,Outpatient Hospital,2,305.51,99.78,24.78,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005506,MBR00000214,Professional,2022-02-28,2022-02-28,2022-04-08,PLN7025,1186826716,1186826716,Physical Therapy,In-Network,J18.9,E78.5,,,,,,,0,,99213,E&M,,,,22,Outpatient Hospital,1,141.65,103.44,0.0,103.44,50.0,0.0,153.44,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005507,MBR00000214,Institutional-OP,2021-01-20,2021-01-20,2021-02-28,PLN9175,1799205295,1799205295,General Acute Care Hospital,In-Network,I10,Z23,,,,,,,0,,77067,Radiology,,,0360,22,Outpatient Hospital,1,704.36,355.97,355.97,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000005508,MBR00000214,Professional,2022-02-15,2022-02-15,2022-03-14,PLN2449,1540044947,1540044947,Pulmonology,Out-of-Network,F41.9,Z79.4,,,,,,,0,,23472,Surgery,,,,11,Office,1,6248.16,4614.51,4042.14,0.0,0.0,572.37,572.37,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005509,MBR00000214,Institutional-OP,2021-01-04,2021-01-04,2021-02-17,PLN3481,1542828721,1542828721,Orthopedic Surgery,In-Network,E11.9,M81.0,,,,,,,0,,99406,Medicine,,,0200,22,Outpatient Hospital,1,84.84,58.72,43.72,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005510,MBR00000214,Institutional-IP,2022-04-09,2022-04-13,2022-04-25,PLN4491,1749327647,1749327647,Geriatrics,In-Network,I10,E78.5,,,,871,MS-DRG,7,4,Y,70450,Radiology,,,0120,21,Inpatient Hospital,2,1706.71,1303.32,1192.75,110.57,0.0,0.0,110.57,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005511,MBR00000214,Professional,2022-06-04,2022-06-04,2022-06-26,PLN9853,1564502315,1564502315,ASC,In-Network,E11.65,J44.1,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,1,57.59,32.87,32.87,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005512,MBR00000214,Professional,2023-03-12,2023-03-12,2023-03-29,PLN7415,1994661817,1994661817,SNF,Out-of-Network,E11.9,F03.90,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,1,29.52,22.1,0.0,22.1,0.0,0.0,22.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005513,MBR00000214,Institutional-IP,2021-03-17,2021-03-22,2021-04-29,PLN7282,1355166277,1355166277,Endocrinology,In-Network,N39.0,Z00.00,,,,470,MS-DRG,1,5,Y,99284,E&M,,,0730,21,Inpatient Hospital,3,423.13,343.04,343.04,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005514,MBR00000214,Institutional-OP,2022-06-11,2022-06-11,2022-07-15,PLN1356,1624802371,1624802371,ASC,Out-of-Network,G43.909,C50.912,,,,,,,0,,23472,Surgery,,,0761,22,Outpatient Hospital,1,3350.22,2460.15,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-119,,0,,0,0,1,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000005515,MBR00000214,Institutional-OP,2021-07-13,2021-07-13,2021-08-02,PLN6353,1780163051,1780163051,SNF,In-Network,E78.5,J06.9,,,,,,,0,,93000,Radiology,,,0510,22,Outpatient Hospital,2,110.09,43.35,0.0,0.31,50.0,0.0,50.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005516,MBR00000214,Professional,2022-05-26,2022-05-26,2022-06-19,PLN5207,1910255109,1910255109,DME Supplier,In-Network,I10,R10.9,,,,,,,0,,80053,Pathology/Lab,,,,31,Skilled Nursing Facility,3,91.55,38.71,0.0,38.71,0.0,0.0,38.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005517,MBR00000214,Institutional-OP,2023-12-15,2023-12-15,2024-01-24,PLN3016,1716521444,1716521444,Oncology,In-Network,Z00.00,I10,,,,,,,0,,82043,Pathology/Lab,,,0636,22,Outpatient Hospital,2,69.45,40.68,15.68,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005518,MBR00000214,Professional,2023-03-23,2023-03-23,2023-04-28,PLN1521,1689639685,1689639685,SNF,In-Network,M54.5,K21.0,,,,,,,0,,99406,Medicine,,,,31,Skilled Nursing Facility,3,71.18,40.37,34.21,0.0,0.0,6.16,6.16,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005519,MBR00000214,Professional,2023-07-14,2023-07-14,2023-08-11,PLN6571,1242201429,1242201429,General Acute Care Hospital,In-Network,N20.0,N40.0,,,,,,,0,,77067,Radiology,,,,65,End-Stage Renal Disease,2,704.33,475.37,463.06,0.0,0.0,12.31,12.31,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000005520,MBR00000214,Professional,2021-02-12,2021-02-12,2021-03-14,PLN8313,1585582070,1585582070,Outpatient Clinic,In-Network,I11.9,I10,,,,,,,0,,99233,E&M,,,,20,Urgent Care,2,246.73,113.06,10.94,87.12,15.0,0.0,102.12,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005521,MBR00000214,Institutional-OP,2023-04-17,2023-04-17,2023-05-18,PLN9138,1205377316,1205377316,Orthopedic Surgery,In-Network,E78.5,I63.9,,,,,,,0,,99204,E&M,,,0450,22,Outpatient Hospital,3,260.28,181.59,0.0,44.41,75.0,3.01,122.42,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005522,MBR00000214,Institutional-IP,2023-08-07,2023-08-09,2023-08-26,PLN3362,1749327647,1749327647,Geriatrics,In-Network,E78.5,E78.5,,,,603,MS-DRG,4,2,Y,77067,Radiology,,,0320,21,Inpatient Hospital,1,344.35,248.58,213.58,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000005523,MBR00000214,Professional,2023-01-05,2023-01-05,2023-02-15,PLN7435,1168246159,1168246159,Internal Medicine,In-Network,K21.0,Z00.00,,,,,,,0,,74177,Radiology,,,,11,Office,2,1303.74,926.34,565.95,360.39,0.0,0.0,360.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005524,MBR00000214,Institutional-IP,2023-05-07,2023-05-16,2023-05-21,PLN4013,1528335731,1528335731,Critical Access Hospital,In-Network,E66.9,K21.0,,,,641,MS-DRG,15,9,Y,99213,E&M,,,0320,21,Inpatient Hospital,1,168.19,107.35,0.0,107.35,50.0,0.0,157.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005525,MBR00000214,Institutional-OP,2021-02-22,2021-02-22,2021-03-18,PLN5851,1872613201,1872613201,Internal Medicine,In-Network,J20.9,Z00.00,,,,,,,0,,45378,Surgery,,,0200,22,Outpatient Hospital,3,1889.62,1378.78,1221.96,81.82,75.0,0.0,156.82,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000005526,MBR00000214,Professional,2023-03-20,2023-03-20,2023-04-07,PLN2296,1872272835,1872272835,Internal Medicine,In-Network,E11.65,R10.9,,,,,,,0,,97530,Medicine,,,,11,Office,3,244.58,186.28,165.68,0.0,0.0,20.6,20.6,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005527,MBR00000214,Professional,2023-07-05,2023-07-05,2023-07-31,PLN3450,1556140803,1556140803,Cardiology,In-Network,Z00.00,F32.9,,,,,,,0,,99213,E&M,,,,11,Office,2,277.52,94.82,79.82,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005528,MBR00000215,Professional,2021-09-10,2021-09-10,2021-10-10,PLN8989,1700633438,1700633438,DME Supplier,In-Network,E87.6,E87.6,,,,,,,0,,23472,Surgery,,,,11,Office,3,6567.45,3690.74,3209.0,108.69,75.0,298.05,481.74,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005529,MBR00000215,Professional,2022-05-31,2022-05-31,2022-07-09,PLN4467,1213165847,1213165847,Critical Access Hospital,In-Network,N39.0,K21.0,,,,,,,0,,78452,Radiology,,,,22,Outpatient Hospital,1,3447.06,1344.24,1256.71,52.53,35.0,0.0,87.53,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005530,MBR00000215,Professional,2022-04-08,2022-04-08,2022-04-28,PLN8851,1453936007,1453936007,ASC,In-Network,F41.9,R10.9,,,,,,,0,,97110,Medicine,,,,22,Outpatient Hospital,2,116.55,97.21,0.0,97.21,75.0,0.0,172.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005531,MBR00000215,Institutional-OP,2021-04-18,2021-04-18,2021-05-16,PLN3444,1994661817,1994661817,SNF,Out-of-Network,E11.9,N39.0,,,,,,,0,,99214,E&M,,,0730,22,Outpatient Hospital,3,288.95,131.77,67.69,64.08,0.0,0.0,64.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005532,MBR00000215,Professional,2021-05-21,2021-05-21,2021-06-23,PLN8729,1518055405,1518055405,Urology,In-Network,I10,J06.9,,,,,,,0,,84443,Pathology/Lab,,,,22,Outpatient Hospital,1,175.9,60.88,45.88,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005533,MBR00000215,Institutional-OP,2021-11-26,2021-11-26,2021-12-28,PLN5372,1812060197,1812060197,Oncology,Out-of-Network,M54.5,Z12.31,,,,,,,0,,27130,Surgery,,,0370,22,Outpatient Hospital,3,4915.36,3330.18,3295.18,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005534,MBR00000215,Institutional-OP,2021-04-30,2021-04-30,2021-05-12,PLN1384,1168246159,1168246159,Internal Medicine,In-Network,R07.9,E11.9,,,,,,,0,,99204,E&M,,,0301,22,Outpatient Hospital,1,516.18,249.4,174.4,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005535,MBR00000215,Professional,2022-07-04,2022-07-04,2022-07-16,PLN6200,1545347862,1545347862,SNF,In-Network,J20.9,R05,,,,,,,0,,99213,E&M,,,,22,Outpatient Hospital,3,309.58,114.15,79.15,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005536,MBR00000215,Professional,2021-03-03,2021-03-03,2021-04-16,PLN8489,1910255109,1910255109,DME Supplier,In-Network,E78.5,E11.40,,,,,,,0,,99406,Medicine,,,,11,Office,3,73.82,45.27,45.27,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005537,MBR00000215,Professional,2021-01-15,2021-01-15,2021-02-07,PLN3322,1631954542,1631954542,Oncology,In-Network,I10,Z00.00,,,,,,,0,,99203,E&M,,,,81,Independent Laboratory,2,194.76,74.91,74.91,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005538,MBR00000215,Institutional-IP,2022-11-21,2022-12-02,2022-12-23,PLN5671,1475984649,1475984649,SNF,In-Network,Z12.31,E11.9,,,,292,MS-DRG,24,11,N,99222,E&M,,,0301,21,Inpatient Hospital,2,558.84,214.89,180.05,34.84,0.0,0.0,34.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005539,MBR00000215,Professional,2021-10-04,2021-10-04,2021-10-27,PLN9616,1622771872,1622771872,Pediatrics,In-Network,N18.3,E11.9,,,,,,,0,,82043,Pathology/Lab,,,,22,Outpatient Hospital,1,56.46,25.67,22.56,0.0,0.0,3.11,3.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005540,MBR00000215,Institutional-IP,2022-02-18,2022-02-21,2022-02-26,PLN7856,1247341320,1247341320,Urology,Out-of-Network,Z12.11,F32.9,,,,690,MS-DRG,4,3,Y,90686,Medicine,,,0450,21,Inpatient Hospital,3,143.68,72.79,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000005541,MBR00000215,Institutional-OP,2022-01-03,2022-01-03,2022-02-08,PLN7159,1865904917,1865904917,Outpatient Clinic,In-Network,E78.5,E78.5,,,,,,,0,,99204,E&M,,,0270,22,Outpatient Hospital,1,437.45,369.05,353.83,0.0,0.0,15.22,15.22,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000005542,MBR00000215,Institutional-OP,2022-05-29,2022-05-29,2022-06-28,PLN1170,1645194539,1645194539,SNF,In-Network,E11.9,E11.40,,,,,,,0,,97530,Medicine,,,0320,22,Outpatient Hospital,1,296.85,105.96,70.96,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005543,MBR00000215,Professional,2022-05-23,2022-05-23,2022-06-11,PLN1481,1366576336,1366576336,Geriatrics,In-Network,M54.5,J06.9,,,,,,,0,,99406,Medicine,,,,12,Home,1,66.6,21.01,21.01,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005544,MBR00000215,Institutional-OP,2021-05-26,2021-05-26,2021-06-11,PLN6018,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,F32.9,I25.10,,,,,,,0,,99233,E&M,,,0270,22,Outpatient Hospital,2,573.51,400.74,400.74,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005545,MBR00000215,Institutional-OP,2021-01-03,2021-01-03,2021-01-30,PLN2879,1622771872,1622771872,Pediatrics,In-Network,N40.0,M81.0,,,,,,,0,,99222,E&M,,,0370,22,Outpatient Hospital,2,415.27,282.91,0.0,282.91,50.0,0.0,332.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005546,MBR00000215,Institutional-IP,2022-05-01,2022-05-08,2022-05-28,PLN5780,1631954542,1631954542,Oncology,In-Network,E78.5,Z00.00,,,,641,MS-DRG,3,7,Y,27447,Surgery,,,0120,21,Inpatient Hospital,1,3074.42,975.65,975.65,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005547,MBR00000215,Professional,2022-09-12,2022-09-12,2022-10-15,PLN9852,1812060197,1812060197,Oncology,Out-of-Network,R51,Z79.4,,,,,,,0,,72148,Radiology,,,,81,Independent Laboratory,3,2033.89,1303.43,1143.58,0.0,50.0,109.85,159.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005548,MBR00000215,Institutional-OP,2023-04-22,2023-04-22,2023-05-23,PLN7634,1812060197,1812060197,Oncology,Out-of-Network,J44.1,G43.909,,,,,,,0,,99233,E&M,,,0370,22,Outpatient Hospital,3,204.27,157.59,157.59,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005549,MBR00000215,Institutional-OP,2021-08-05,2021-08-05,2021-09-14,PLN4905,1896447406,1896447406,Nephrology,Out-of-Network,I10,R05,,,,,,,0,,76700,Radiology,,,0360,22,Outpatient Hospital,3,1210.62,396.45,0.0,0.0,35.0,16.15,51.15,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005550,MBR00000215,Institutional-IP,2021-04-02,2021-04-05,2021-04-09,PLN1695,1186826716,1186826716,Physical Therapy,In-Network,I10,Z12.11,,,,196,MS-DRG,18,3,Y,97110,Medicine,,,0900,21,Inpatient Hospital,2,243.6,170.39,170.39,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005551,MBR00000215,Institutional-OP,2022-10-16,2022-10-16,2022-10-24,PLN2571,1433937353,1433937353,Nephrology,In-Network,N39.0,J20.9,,,,,,,0,,27130,Surgery,,,0360,22,Outpatient Hospital,1,6698.99,5490.9,5087.32,328.58,75.0,0.0,403.58,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005552,MBR00000215,Professional,2023-09-16,2023-09-16,2023-10-14,PLN6963,1366426662,1366426662,Urology,In-Network,M81.0,I50.9,,,,,,,0,,99232,E&M,,,,20,Urgent Care,2,328.5,255.61,255.61,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005553,MBR00000215,Professional,2021-09-19,2021-09-19,2021-10-30,PLN4683,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,N39.0,N20.0,,,,,,,0,,99203,E&M,,,,23,Emergency Room,3,147.53,66.8,66.8,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005554,MBR00000215,Institutional-OP,2021-04-04,2021-04-04,2021-04-15,PLN8891,1450553056,1450553056,Clinical Laboratory,In-Network,M81.0,E66.9,,,,,,,0,,70450,Radiology,,,0301,22,Outpatient Hospital,2,1686.9,1116.97,1116.97,0.0,0.0,0.0,0.0,0.0,Adjusted,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005555,MBR00000215,Institutional-OP,2022-03-17,2022-03-17,2022-04-06,PLN8926,1569105090,1569105090,Geriatrics,In-Network,Z12.31,I25.10,,,,,,,0,,72148,Radiology,,,0636,22,Outpatient Hospital,2,2063.82,897.65,823.86,0.0,0.0,73.79,73.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005556,MBR00000215,Professional,2022-09-07,2022-09-07,2022-10-18,PLN1178,1103747954,1103747954,Urology,In-Network,J06.9,I10,,,,,,,0,,99203,E&M,,,,50,Federally Qualified Health Center,2,299.09,224.63,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005557,MBR00000215,Professional,2022-11-14,2022-11-14,2022-12-25,PLN4873,1550154147,1550154147,Outpatient Clinic,In-Network,Z00.00,M54.5,,,,,,,0,,70553,Radiology,,,,23,Emergency Room,3,2906.06,1717.14,1372.48,80.97,0.0,263.69,344.66,0.0,Pended,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005558,MBR00000215,Professional,2021-05-04,2021-05-04,2021-05-22,PLN7931,1186826716,1186826716,Physical Therapy,In-Network,J06.9,E87.6,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,2,2286.51,1468.78,1314.27,154.51,0.0,0.0,154.51,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005559,MBR00000215,Professional,2022-12-20,2022-12-20,2023-01-22,PLN1404,1450094833,1450094833,Outpatient Clinic,In-Network,J20.9,Z12.31,,,,,,,0,,99213,E&M,,,,23,Emergency Room,3,196.65,93.18,78.18,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005560,MBR00000215,Institutional-OP,2022-01-11,2022-01-11,2022-01-18,PLN1237,1997536841,1997536841,Family Medicine,Out-of-Network,R51,K57.30,,,,,,,0,,78452,Radiology,,,0761,22,Outpatient Hospital,2,6362.8,4655.26,4498.88,0.0,75.0,81.38,156.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005561,MBR00000215,Professional,2021-02-03,2021-02-03,2021-02-18,PLN1555,1845900543,1845900543,ASC,In-Network,F41.9,J44.1,,,,,,,0,,93000,Radiology,,,,49,Independent Clinic,2,66.37,25.49,0.0,25.49,35.0,0.0,60.49,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005562,MBR00000216,Institutional-OP,2023-10-07,2023-10-07,2023-11-06,PLN4968,1245650222,1245650222,Gastroenterology,In-Network,M54.5,F10.20,,,,,,,0,,99213,E&M,,,0370,22,Outpatient Hospital,3,153.67,106.66,27.16,0.0,75.0,4.5,79.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005563,MBR00000216,Professional,2022-08-09,2022-08-09,2022-08-31,PLN3508,1103747954,1103747954,Urology,In-Network,M17.11,E78.5,,,,,,,0,,83036,Pathology/Lab,,,,22,Outpatient Hospital,1,102.24,70.68,0.0,69.38,35.0,0.0,104.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000005564,MBR00000216,Institutional-IP,2021-12-01,2021-12-09,2021-12-08,PLN6478,1283743001,1283743001,Family Medicine,In-Network,E11.65,Z23,,,,872,MS-DRG,11,8,N,99203,E&M,,,0200,21,Inpatient Hospital,3,246.09,94.92,94.92,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005565,MBR00000216,Professional,2023-06-14,2023-06-14,2023-07-13,PLN5434,1585582070,1585582070,Outpatient Clinic,In-Network,I10,I11.9,,,,,,,0,,99213,E&M,,,,11,Office,1,206.6,107.48,0.0,107.48,50.0,0.0,157.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005566,MBR00000216,Institutional-OP,2023-05-23,2023-05-23,2023-06-17,PLN1514,1845057593,1845057593,Orthopedic Surgery,In-Network,G43.909,I25.10,,,,,,,0,,43239,Surgery,,,0320,22,Outpatient Hospital,2,1709.82,1268.06,1268.06,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005567,MBR00000216,Professional,2021-08-15,2021-08-15,2021-09-19,PLN8156,1366576336,1366576336,Geriatrics,In-Network,N39.0,M17.11,,,,,,,0,,23472,Surgery,,,,23,Emergency Room,2,3026.89,2231.91,2112.06,0.0,15.0,104.85,119.85,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005568,MBR00000216,Professional,2023-11-18,2023-11-18,2023-12-03,PLN8331,1108115157,1108115157,General Acute Care Hospital,In-Network,F32.9,R51,,,,,,,0,,93306,Radiology,,,,81,Independent Laboratory,3,2647.18,2133.36,0.0,310.69,0.0,0.0,310.69,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005569,MBR00000216,Institutional-IP,2022-08-06,2022-08-10,2022-09-08,PLN8757,1994661817,1994661817,SNF,Out-of-Network,E11.40,F41.9,,,,641,MS-DRG,1,4,Y,47562,Surgery,,,0200,21,Inpatient Hospital,2,5664.8,4627.35,4627.35,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005570,MBR00000216,Professional,2021-10-15,2021-10-15,2021-11-22,PLN3951,1689639685,1689639685,SNF,In-Network,I48.91,Z12.31,,,,,,,0,,99204,E&M,,,,21,Inpatient Hospital,1,359.61,289.13,206.94,0.0,75.0,7.19,82.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005571,MBR00000216,Professional,2022-05-06,2022-05-06,2022-06-08,PLN5146,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,E66.9,E11.9,,,,,,,0,,93225,Medicine,,,,23,Emergency Room,2,798.01,543.45,206.19,337.26,0.0,0.0,337.26,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005572,MBR00000216,Institutional-OP,2021-07-25,2021-07-25,2021-08-16,PLN4533,1569105090,1569105090,Geriatrics,In-Network,E66.9,N18.3,,,,,,,0,,99213,E&M,,,0360,22,Outpatient Hospital,3,213.33,87.74,62.39,0.0,15.0,10.35,25.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005573,MBR00000216,Institutional-OP,2023-07-20,2023-07-20,2023-08-13,PLN2385,1266606767,1266606767,ASC,In-Network,K21.0,C50.912,,,,,,,0,,99283,E&M,,,0510,22,Outpatient Hospital,2,399.8,120.2,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005574,MBR00000216,Professional,2021-10-22,2021-10-22,2021-11-18,PLN1814,1606140917,1606140917,ASC,In-Network,Z00.00,F32.9,,,,,,,0,,43239,Surgery,,,,12,Home,3,815.75,576.38,0.0,91.67,50.0,74.67,216.34,0.0,Denied,CO-4,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005575,MBR00000216,Institutional-OP,2022-04-26,2022-04-26,2022-06-02,PLN4974,1242201429,1242201429,General Acute Care Hospital,In-Network,M54.5,J44.1,,,,,,,0,,99221,E&M,,,0120,22,Outpatient Hospital,2,449.63,141.83,125.74,0.0,0.0,16.09,16.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005576,MBR00000216,Professional,2021-03-16,2021-03-16,2021-04-13,PLN2416,1728018911,1728018911,Nephrology,In-Network,C50.912,M17.11,,,,,,,0,,77067,Radiology,,,,22,Outpatient Hospital,2,578.2,222.62,222.62,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000005577,MBR00000216,Professional,2023-10-31,2023-10-31,2023-11-11,PLN9682,1545347862,1545347862,SNF,In-Network,I10,Z00.00,,,,,,,0,,71046,Radiology,,,,22,Outpatient Hospital,2,304.75,200.98,200.98,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005578,MBR00000216,Professional,2021-11-28,2021-11-28,2021-12-17,PLN5156,1728018911,1728018911,Nephrology,In-Network,Z12.11,F41.9,,,,,,,0,,27130,Surgery,,,,23,Emergency Room,1,4491.69,2760.0,2226.55,0.0,0.0,533.45,533.45,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005579,MBR00000216,Professional,2022-12-16,2022-12-16,2023-01-23,PLN5408,1545347862,1545347862,SNF,In-Network,Z00.00,E87.6,,,,,,,0,,58661,Surgery,,,,11,Office,1,2574.72,1689.63,1689.63,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005580,MBR00000216,Professional,2022-01-22,2022-01-22,2022-02-26,PLN3566,1364429278,1364429278,OB/GYN,In-Network,J20.9,Z12.31,,,,,,,0,,72148,Radiology,,,,11,Office,2,2501.4,1709.49,1223.29,486.2,0.0,0.0,486.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005581,MBR00000216,Institutional-IP,2022-09-07,2022-09-16,2022-10-06,PLN6274,1991459367,1991459367,Neurology,Out-of-Network,Z12.31,M17.11,,,,195,MS-DRG,3,9,Y,78452,Radiology,,,0200,21,Inpatient Hospital,1,6238.8,4887.6,4807.97,52.72,0.0,26.91,79.63,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005582,MBR00000216,Professional,2022-09-06,2022-09-06,2022-10-08,PLN4111,1109850785,1109850785,ASC,Out-of-Network,N40.0,N39.0,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,1,441.12,250.76,215.76,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005583,MBR00000216,Professional,2021-11-16,2021-11-16,2021-12-25,PLN8781,1556140803,1556140803,Cardiology,In-Network,N18.3,E11.65,,,,,,,0,,99214,E&M,,,,11,Office,1,399.24,197.32,184.95,0.0,0.0,12.37,12.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005584,MBR00000216,Professional,2022-04-19,2022-04-19,2022-05-23,PLN8337,1389336600,1389336600,Critical Access Hospital,In-Network,E78.5,K57.30,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,1,323.78,220.82,170.82,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005585,MBR00000216,Professional,2022-10-16,2022-10-16,2022-11-21,PLN8298,1860435061,1860435061,DME Supplier,In-Network,Z12.31,K57.30,,,,,,,0,,77067,Radiology,,,,22,Outpatient Hospital,2,302.87,166.12,0.0,166.12,25.0,0.0,191.12,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000005586,MBR00000216,Institutional-IP,2021-08-26,2021-09-02,2021-09-14,PLN9398,1236418230,1236418230,DME Supplier,In-Network,E78.5,E66.9,,,,194,MS-DRG,8,7,Y,33533,Surgery,,,0900,21,Inpatient Hospital,3,13498.38,4110.93,4035.93,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000005587,MBR00000216,Professional,2021-05-24,2021-05-24,2021-06-24,PLN5948,1453283987,1453283987,Critical Access Hospital,In-Network,J06.9,E78.5,,,,,,,0,,74177,Radiology,,,,12,Home,3,2069.7,869.96,0.0,241.82,0.0,101.39,343.21,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005588,MBR00000216,Professional,2021-07-15,2021-07-15,2021-08-07,PLN5726,1453283987,1453283987,Critical Access Hospital,In-Network,I10,I10,,,,,,,0,,99214,E&M,,,,11,Office,2,340.24,211.93,0.0,211.93,0.0,0.0,211.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005589,MBR00000216,Professional,2022-04-01,2022-04-01,2022-04-18,PLN7173,1702692193,1702692193,Physical Therapy,In-Network,I10,E11.65,,,,,,,0,,90837,Medicine,,,,11,Office,1,405.52,282.74,247.74,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005590,MBR00000216,Professional,2021-08-23,2021-08-23,2021-09-06,PLN3318,1717912431,1717912431,Oncology,In-Network,K92.1,N40.0,,,,,,,0,,77067,Radiology,,,,11,Office,1,664.14,392.66,317.66,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000005591,MBR00000216,Institutional-OP,2021-11-08,2021-11-08,2021-12-01,PLN1016,1860435061,1860435061,DME Supplier,In-Network,J06.9,I10,,,,,,,0,,99214,E&M,,,0740,22,Outpatient Hospital,3,195.85,69.8,19.8,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005592,MBR00000216,Institutional-IP,2023-01-21,2023-01-31,2023-02-08,PLN4974,1997536841,1997536841,Family Medicine,Out-of-Network,Z12.31,I50.9,,,,690,MS-DRG,1,10,Y,99203,E&M,,,0301,21,Inpatient Hospital,2,388.31,257.06,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000005593,MBR00000216,Institutional-IP,2023-01-04,2023-01-06,2023-01-20,PLN9021,1727809972,1727809972,Home Health,In-Network,I10,J18.9,,,,872,MS-DRG,21,2,Y,99406,Medicine,,,0450,21,Inpatient Hospital,3,67.07,35.05,30.58,0.0,0.0,4.47,4.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005594,MBR00000216,Professional,2023-10-31,2023-10-31,2023-11-19,PLN9352,1840431511,1840431511,Geriatrics,Out-of-Network,K21.0,N39.0,,,,,,,0,,99222,E&M,,,,23,Emergency Room,2,548.79,233.4,233.4,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005595,MBR00000216,Professional,2023-04-17,2023-04-17,2023-04-29,PLN5849,1994661817,1994661817,SNF,Out-of-Network,M54.5,Z51.11,,,,,,,0,,99233,E&M,,,,11,Office,2,479.73,242.5,207.5,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005596,MBR00000216,Institutional-IP,2022-04-10,2022-04-13,2022-05-03,PLN7094,1800011727,1800011727,Clinical Laboratory,Out-of-Network,Z12.31,R05,,,,603,MS-DRG,11,3,Y,83036,Pathology/Lab,,,0636,21,Inpatient Hospital,3,59.19,40.03,0.0,0.0,75.0,0.0,75.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000005597,MBR00000216,Institutional-OP,2023-10-14,2023-10-14,2023-10-31,PLN7700,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,Z12.31,I10,,,,,,,0,,G0468,Medicine,,,0450,22,Outpatient Hospital,3,461.57,282.55,247.55,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005598,MBR00000216,Professional,2023-10-06,2023-10-06,2023-10-30,PLN1822,1563980627,1563980627,Critical Access Hospital,In-Network,Z12.31,I10,,,,,,,0,,27130,Surgery,,,,11,Office,2,2782.83,1289.93,1289.93,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005599,MBR00000216,Institutional-IP,2021-09-01,2021-09-06,2021-09-25,PLN1239,1727809972,1727809972,Home Health,In-Network,I50.9,Z12.31,,,,871,MS-DRG,21,5,Y,99214,E&M,,,0450,21,Inpatient Hospital,2,170.6,131.9,131.9,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000005600,MBR00000216,Professional,2021-07-07,2021-07-07,2021-07-22,PLN3510,1148984206,1148984206,Psychiatry,In-Network,K92.1,R07.9,,,,,,,0,,77067,Radiology,,,,23,Emergency Room,1,386.52,290.36,275.36,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,1,1,0,0,0,0,None,1,0,0,0,0
CLM0000005601,MBR00000217,Institutional-OP,2023-08-27,2023-08-27,2023-09-26,PLN8679,1313212303,1313212303,Family Medicine,In-Network,K92.1,I10,,,,,,,0,,99214,E&M,,,0900,22,Outpatient Hospital,1,198.22,64.09,64.09,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005602,MBR00000217,Professional,2023-09-02,2023-09-02,2023-09-15,PLN8563,1124394415,1124394415,Pediatrics,In-Network,N39.0,N39.0,,,,,,,0,,G0444,Medicine,,,,23,Emergency Room,1,85.49,62.39,0.0,0.0,25.0,1.48,26.48,0.0,Denied,CO-4,,0,,1,1,0,0,0,0,None,0,0,0,0,1
CLM0000005603,MBR00000217,Professional,2023-07-16,2023-07-16,2023-08-26,PLN8693,1453936007,1453936007,ASC,In-Network,M54.5,Z12.31,,,,,,,0,,99406,Medicine,,,,11,Office,2,70.05,42.9,42.9,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005604,MBR00000217,Professional,2022-05-20,2022-05-20,2022-06-11,PLN7194,1511044648,1511044648,Endocrinology,In-Network,Z23,I25.10,,,,,,,0,,90837,Medicine,,,,21,Inpatient Hospital,3,314.07,105.44,65.58,0.0,25.0,14.86,39.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005605,MBR00000217,Institutional-OP,2023-08-03,2023-08-03,2023-09-12,PLN4386,1361302520,1361302520,Critical Access Hospital,In-Network,J18.9,E78.5,,,,,,,0,,99214,E&M,,,0740,22,Outpatient Hospital,1,213.61,118.68,118.68,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005606,MBR00000217,Institutional-OP,2023-04-23,2023-04-23,2023-05-11,PLN3660,1865904917,1865904917,Outpatient Clinic,In-Network,F10.20,E11.9,,,,,,,0,,97530,Medicine,,,0510,22,Outpatient Hospital,1,189.52,57.25,32.25,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005607,MBR00000218,Institutional-OP,2023-03-22,2023-03-22,2023-05-04,PLN7366,1434029575,1434029575,Endocrinology,In-Network,R10.9,M17.11,,,,,,,0,,70450,Radiology,,,0120,22,Outpatient Hospital,2,1586.05,1319.91,1151.15,0.0,0.0,168.76,168.76,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005608,MBR00000218,Institutional-OP,2022-10-22,2022-10-22,2022-11-17,PLN3425,1224179551,1224179551,Physical Therapy,In-Network,N20.0,F41.9,,,,,,,0,,99283,E&M,,,0360,22,Outpatient Hospital,3,613.71,427.39,113.54,289.2,0.0,24.65,313.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005609,MBR00000218,Professional,2021-10-21,2021-10-21,2021-11-12,PLN6112,1545347862,1545347862,SNF,In-Network,Z87.891,F41.9,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,2,108.95,85.59,85.59,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005610,MBR00000218,Professional,2023-03-30,2023-03-30,2023-04-14,PLN5772,1812060197,1812060197,Oncology,Out-of-Network,I10,I11.9,,,,,,,0,,G0444,Medicine,,,,21,Inpatient Hospital,2,85.26,49.77,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000005611,MBR00000218,Institutional-OP,2023-08-20,2023-08-20,2023-09-02,PLN6443,1585582070,1585582070,Outpatient Clinic,In-Network,Z12.11,Z23,,,,,,,0,,58661,Surgery,,,0270,22,Outpatient Hospital,3,4405.25,3533.93,3499.19,34.74,0.0,0.0,34.74,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005612,MBR00000218,Professional,2023-08-27,2023-08-27,2023-09-16,PLN8213,1660288235,1660288235,ASC,In-Network,I10,J45.20,,,,,,,0,,76700,Radiology,,,,11,Office,3,884.98,371.77,371.77,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005613,MBR00000219,Professional,2022-10-19,2022-10-19,2022-11-09,PLN3634,1168881145,1168881145,Orthopedic Surgery,In-Network,Z23,E66.9,,,,,,,0,,66984,Surgery,,,,49,Independent Clinic,3,1952.47,1258.9,1223.9,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005614,MBR00000219,Professional,2021-02-13,2021-02-13,2021-02-20,PLN2169,1168881145,1168881145,Orthopedic Surgery,In-Network,E66.9,I10,,,,,,,0,,70553,Radiology,,,,11,Office,3,2766.05,1004.46,979.46,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005615,MBR00000219,Professional,2023-03-22,2023-03-22,2023-04-22,PLN3718,1809014947,1809014947,Urology,In-Network,F32.9,J06.9,,,,,,,0,,43239,Surgery,,,,11,Office,1,1403.51,1107.35,0.0,312.69,15.0,0.0,327.69,0.0,Denied,CO-11,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005616,MBR00000219,Professional,2021-10-05,2021-10-05,2021-10-31,PLN2440,1915531927,1915531927,Critical Access Hospital,In-Network,E11.9,Z23,,,,,,,0,,99233,E&M,,,,49,Independent Clinic,3,472.45,165.97,165.97,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005617,MBR00000219,Institutional-IP,2021-08-13,2021-08-19,2021-09-04,PLN8159,1948810580,1948810580,DME Supplier,In-Network,F32.9,I50.9,,,,195,MS-DRG,20,6,N,99232,E&M,,,0200,21,Inpatient Hospital,2,212.11,130.79,0.0,130.79,35.0,0.0,165.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005618,MBR00000219,Institutional-IP,2021-03-28,2021-03-31,2021-04-27,PLN6753,1410468316,1410468316,SNF,In-Network,C50.912,E11.9,,,,291,MS-DRG,5,3,Y,83036,Pathology/Lab,,,0761,21,Inpatient Hospital,3,53.9,32.72,32.72,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000005619,MBR00000219,Professional,2021-06-22,2021-06-22,2021-07-11,PLN4749,1700633438,1700633438,DME Supplier,In-Network,Z23,Z23,,,,,,,0,,99233,E&M,,,,11,Office,1,413.37,162.28,93.54,53.74,15.0,0.0,68.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005620,MBR00000219,Professional,2022-06-21,2022-06-21,2022-08-02,PLN3419,1236418230,1236418230,DME Supplier,In-Network,F32.9,I50.9,,,,,,,0,,33533,Surgery,,,,11,Office,1,10596.37,6366.14,0.0,80.83,35.0,0.0,115.83,0.0,Denied,CO-50,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000005621,MBR00000219,Institutional-OP,2021-10-31,2021-10-31,2021-11-18,PLN2992,1168881145,1168881145,Orthopedic Surgery,In-Network,Z23,I48.91,,,,,,,0,,97110,Medicine,,,0510,22,Outpatient Hospital,1,196.66,104.2,69.2,0.0,35.0,0.0,35.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005622,MBR00000219,Institutional-OP,2022-02-23,2022-02-23,2022-03-06,PLN8367,1915531927,1915531927,Critical Access Hospital,In-Network,E78.5,I50.9,,,,,,,0,,85610,Pathology/Lab,,,0360,22,Outpatient Hospital,3,62.12,20.09,18.63,0.0,0.0,1.46,1.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005623,MBR00000219,Institutional-OP,2022-07-14,2022-07-14,2022-08-21,PLN5220,1139906830,1139906830,Endocrinology,Out-of-Network,E11.9,F32.9,,,,,,,0,,93000,Radiology,,,0730,22,Outpatient Hospital,2,99.25,69.99,0.0,69.99,75.0,0.0,144.99,0.0,Denied,CO-27,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005624,MBR00000219,Professional,2022-08-01,2022-08-01,2022-08-15,PLN6359,1108115157,1108115157,General Acute Care Hospital,In-Network,Z87.891,J18.9,,,,,,,0,,99232,E&M,,,,31,Skilled Nursing Facility,2,142.15,68.68,0.0,68.68,0.0,0.0,68.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005625,MBR00000219,Institutional-OP,2022-04-02,2022-04-02,2022-04-27,PLN6336,1563980627,1563980627,Critical Access Hospital,In-Network,Z23,I25.10,,,,,,,0,,99232,E&M,,,0740,22,Outpatient Hospital,2,372.31,144.67,144.67,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005626,MBR00000219,Institutional-OP,2022-05-11,2022-05-11,2022-05-31,PLN1989,1713934949,1713934949,Neurology,In-Network,F32.9,Z51.11,,,,,,,0,,99232,E&M,,,0636,22,Outpatient Hospital,3,234.61,81.56,46.56,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005627,MBR00000219,Professional,2023-08-30,2023-08-30,2023-09-22,PLN8980,1205377316,1205377316,Orthopedic Surgery,In-Network,M81.0,Z87.891,,,,,,,0,,90837,Medicine,,,,23,Emergency Room,3,295.07,200.18,200.18,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005628,MBR00000219,Institutional-IP,2021-11-06,2021-11-09,2021-12-17,PLN7380,1968299309,1968299309,Internal Medicine,In-Network,I10,N18.3,,,,641,MS-DRG,14,3,Y,70450,Radiology,,,0636,21,Inpatient Hospital,2,1466.38,778.32,634.32,105.09,0.0,38.91,144.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005629,MBR00000219,Professional,2021-01-15,2021-01-15,2021-02-18,PLN4595,1242201429,1242201429,General Acute Care Hospital,In-Network,K21.0,N18.3,,,,,,,0,,45378,Surgery,,,,49,Independent Clinic,3,1193.43,989.16,954.16,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000005630,MBR00000219,Institutional-IP,2023-05-27,2023-05-30,2023-07-02,PLN8809,1434029575,1434029575,Endocrinology,In-Network,J06.9,Z23,,,,292,MS-DRG,9,3,Y,G0468,Medicine,,,0510,21,Inpatient Hospital,3,599.44,495.08,222.71,217.76,0.0,54.61,272.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005631,MBR00000219,Institutional-OP,2021-03-29,2021-03-29,2021-04-30,PLN9415,1390307371,1390307371,DME Supplier,In-Network,F41.9,I25.10,,,,,,,0,,43239,Surgery,,,0900,22,Outpatient Hospital,1,1695.53,689.1,664.1,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,1,Duplicate,0,0,0,0,0
CLM0000005632,MBR00000219,Professional,2023-04-29,2023-04-29,2023-05-29,PLN6054,1545347862,1545347862,SNF,In-Network,Z87.891,I11.9,,,,,,,0,,27447,Surgery,,,,49,Independent Clinic,3,3043.16,1079.58,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005633,MBR00000219,Professional,2021-12-23,2021-12-23,2022-01-09,PLN1169,1799205295,1799205295,General Acute Care Hospital,In-Network,R51,B97.89,,,,,,,0,,99283,E&M,,,,12,Home,2,377.03,216.86,181.86,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000005634,MBR00000219,Professional,2023-07-11,2023-07-11,2023-07-29,PLN4472,1561134315,1561134315,DME Supplier,In-Network,G20,I10,,,,,,,0,,99283,E&M,,,,11,Office,3,608.77,244.56,0.0,244.56,0.0,0.0,244.56,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005635,MBR00000219,Institutional-OP,2021-07-03,2021-07-03,2021-07-10,PLN9918,1752470395,1752470395,Home Health,In-Network,R05,M54.5,,,,,,,0,,78452,Radiology,,,0730,22,Outpatient Hospital,3,5931.89,3263.64,3228.64,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005636,MBR00000219,Institutional-OP,2021-06-30,2021-06-30,2021-08-10,PLN9684,1752470395,1752470395,Home Health,In-Network,Z00.00,E11.9,,,,,,,0,,99233,E&M,,,0360,22,Outpatient Hospital,1,513.6,188.83,0.0,188.83,15.0,0.0,203.83,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005637,MBR00000219,Professional,2022-03-22,2022-03-22,2022-04-11,PLN4434,1585582070,1585582070,Outpatient Clinic,In-Network,E78.5,I48.91,,,,,,,0,,99283,E&M,,,,81,Independent Laboratory,2,402.05,218.95,0.0,218.95,0.0,0.0,218.95,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005638,MBR00000219,Institutional-OP,2022-04-04,2022-04-04,2022-04-20,PLN5455,1273488618,1273488618,General Acute Care Hospital,In-Network,M81.0,J20.9,,,,,,,0,,90837,Medicine,,,0510,22,Outpatient Hospital,2,398.55,145.54,145.54,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005639,MBR00000219,Professional,2023-02-25,2023-02-25,2023-03-07,PLN2060,1795618275,1795618275,Pulmonology,In-Network,F10.20,K57.30,,,,,,,0,,93306,Radiology,,,,11,Office,3,1815.98,1532.27,1532.27,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005640,MBR00000219,Professional,2022-12-10,2022-12-10,2023-01-09,PLN4227,1997536841,1997536841,Family Medicine,Out-of-Network,E78.5,I10,,,,,,,0,,97110,Medicine,,,,11,Office,1,187.29,70.37,0.0,70.37,25.0,0.0,95.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005641,MBR00000219,Professional,2023-12-24,2023-12-24,2023-12-31,PLN1826,1103747954,1103747954,Urology,In-Network,Z23,N18.3,,,,,,,0,,99213,E&M,,,,11,Office,1,327.31,125.32,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005642,MBR00000219,Institutional-OP,2023-01-12,2023-01-12,2023-01-29,PLN3945,1334916761,1334916761,ASC,In-Network,N39.0,F41.9,,,,,,,0,,G0444,Medicine,,,0740,22,Outpatient Hospital,1,80.83,31.25,31.25,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000005643,MBR00000219,Institutional-OP,2021-08-10,2021-08-10,2021-09-04,PLN2274,1609526529,1609526529,Psychiatry,In-Network,J18.9,I25.10,,,,,,,0,,83036,Pathology/Lab,,,0900,22,Outpatient Hospital,2,60.16,29.94,29.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000005644,MBR00000219,Institutional-OP,2021-04-07,2021-04-07,2021-05-05,PLN9559,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,G43.909,E66.9,,,,,,,0,,23472,Surgery,,,0360,22,Outpatient Hospital,1,6148.09,2421.92,1796.03,207.04,0.0,418.85,625.89,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005645,MBR00000219,Institutional-OP,2021-10-19,2021-10-19,2021-11-11,PLN7970,1438368327,1438368327,Home Health,In-Network,E11.9,E66.9,,,,,,,0,,90837,Medicine,,,0120,22,Outpatient Hospital,2,522.98,285.33,237.84,0.0,0.0,47.49,47.49,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005646,MBR00000219,Professional,2023-12-13,2023-12-13,2023-12-30,PLN8426,1964402759,1964402759,Outpatient Clinic,In-Network,Z00.00,Z00.00,,,,,,,0,,99222,E&M,,,,11,Office,2,531.59,280.21,255.21,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005647,MBR00000219,Professional,2023-04-22,2023-04-22,2023-05-18,PLN1204,1752470395,1752470395,Home Health,In-Network,N17.9,Z51.11,,,,,,,0,,G0439,Medicine,,,,12,Home,2,485.33,346.81,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-27,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000005648,MBR00000219,Institutional-IP,2023-03-23,2023-03-31,2023-04-24,PLN9366,1946680931,1946680931,Critical Access Hospital,Out-of-Network,E78.5,E11.40,,,,196,MS-DRG,8,8,Y,70450,Radiology,,,0450,21,Inpatient Hospital,1,1369.46,942.63,485.4,457.23,0.0,0.0,457.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005649,MBR00000219,Professional,2021-10-25,2021-10-25,2021-11-14,PLN7051,1239316214,1239316214,Internal Medicine,In-Network,E66.9,C50.912,,,,,,,0,,27130,Surgery,,,,11,Office,2,6048.72,4836.09,4786.09,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005650,MBR00000219,Professional,2022-05-29,2022-05-29,2022-07-08,PLN2863,1284035364,1284035364,Pediatrics,In-Network,I63.9,I10,,,,,,,0,,97110,Medicine,,,,22,Outpatient Hospital,3,292.55,237.55,209.38,0.0,0.0,28.17,28.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005651,MBR00000219,Professional,2023-02-10,2023-02-10,2023-03-21,PLN5949,1205377316,1205377316,Orthopedic Surgery,In-Network,R10.9,Z23,,,,,,,0,,99204,E&M,,,,11,Office,1,204.46,92.74,0.0,92.74,0.0,0.0,92.74,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005652,MBR00000219,Professional,2023-11-03,2023-11-03,2023-12-01,PLN6545,1991459367,1991459367,Neurology,Out-of-Network,J06.9,Z12.31,,,,,,,0,,77067,Radiology,,,,23,Emergency Room,2,387.38,164.79,159.27,0.0,0.0,5.52,5.52,0.0,Paid,,,1,,1,1,0,0,0,0,None,1,0,0,0,0
CLM0000005653,MBR00000219,Professional,2022-10-01,2022-10-01,2022-10-20,PLN5168,1193493783,1193493783,Critical Access Hospital,Out-of-Network,K21.0,N20.0,,,,,,,0,,45378,Surgery,,,,49,Independent Clinic,3,2081.04,1557.03,1475.33,46.7,35.0,0.0,81.7,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000005654,MBR00000219,Professional,2021-01-24,2021-01-24,2021-03-04,PLN1545,1390307371,1390307371,DME Supplier,In-Network,I25.10,E78.5,,,,,,,0,,99214,E&M,,,,11,Office,2,179.65,88.15,67.45,0.0,15.0,5.7,20.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005655,MBR00000219,Institutional-OP,2023-07-26,2023-07-26,2023-08-08,PLN9365,1434029575,1434029575,Endocrinology,In-Network,I10,R05,,,,,,,0,,99222,E&M,,,0370,22,Outpatient Hospital,1,574.84,434.53,393.1,0.0,35.0,6.43,41.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005656,MBR00000219,Professional,2023-10-20,2023-10-20,2023-10-27,PLN8729,1948810580,1948810580,DME Supplier,In-Network,E78.5,C50.912,,,,,,,0,,99283,E&M,,,,23,Emergency Room,1,333.93,279.27,0.0,70.0,50.0,0.0,120.0,0.0,Denied,CO-97,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005657,MBR00000219,Institutional-OP,2021-02-06,2021-02-06,2021-03-20,PLN1626,1569105090,1569105090,Geriatrics,In-Network,E78.5,J06.9,,,,,,,0,,99214,E&M,,,0900,22,Outpatient Hospital,3,402.42,218.39,193.46,0.0,15.0,9.93,24.93,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005658,MBR00000219,Professional,2022-03-06,2022-03-06,2022-04-12,PLN6510,1840431511,1840431511,Geriatrics,Out-of-Network,I10,E11.9,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,2,121.93,95.12,95.12,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005659,MBR00000219,Institutional-OP,2023-12-09,2023-12-09,2024-01-19,PLN2991,1752470395,1752470395,Home Health,In-Network,M54.5,E78.5,,,,,,,0,,97530,Medicine,,,0510,22,Outpatient Hospital,2,150.85,78.89,0.0,78.89,0.0,0.0,78.89,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005660,MBR00000219,Professional,2023-11-11,2023-11-11,2023-11-27,PLN3341,1713934949,1713934949,Neurology,In-Network,E78.5,J06.9,,,,,,,0,,78452,Radiology,,,,11,Office,1,6930.96,3998.39,3973.39,0.0,25.0,0.0,25.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005661,MBR00000219,Professional,2023-11-22,2023-11-22,2023-12-11,PLN4860,1193493783,1193493783,Critical Access Hospital,Out-of-Network,M81.0,J20.9,,,,,,,0,,72148,Radiology,,,,11,Office,2,1237.44,908.68,833.68,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005662,MBR00000219,Professional,2023-12-05,2023-12-05,2024-01-14,PLN9875,1132188260,1132188260,Family Medicine,In-Network,Z51.11,Z00.00,,,,,,,0,,45378,Surgery,,,,20,Urgent Care,2,1354.08,1036.9,728.19,308.71,0.0,0.0,308.71,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000005663,MBR00000220,Professional,2021-01-25,2021-01-25,2021-02-19,PLN7417,1366286000,1366286000,SNF,In-Network,E11.65,N18.3,,,,,,,0,,99233,E&M,,,,11,Office,2,307.74,93.64,93.64,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005664,MBR00000220,Institutional-OP,2021-06-15,2021-06-15,2021-06-25,PLN7061,1372918899,1372918899,Family Medicine,In-Network,F10.20,K57.30,,,,,,,0,,83036,Pathology/Lab,,,0320,22,Outpatient Hospital,1,71.07,23.83,0.0,23.83,35.0,0.0,58.83,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000005665,MBR00000220,Professional,2022-07-01,2022-07-01,2022-07-22,PLN9095,1749327647,1749327647,Geriatrics,In-Network,Z12.31,E11.9,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,2,255.21,176.18,176.18,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005666,MBR00000220,Professional,2022-10-23,2022-10-23,2022-11-12,PLN7703,1717546253,1717546253,Family Medicine,In-Network,J20.9,J06.9,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,3,2282.66,1181.66,893.72,0.0,75.0,212.94,287.94,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005667,MBR00000220,Institutional-IP,2022-03-16,2022-03-19,2022-04-02,PLN9848,1752470395,1752470395,Home Health,In-Network,E11.9,R07.9,,,,683,MS-DRG,19,3,Y,99283,E&M,,,0270,21,Inpatient Hospital,1,408.16,264.53,25.25,188.19,50.0,1.09,239.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005668,MBR00000220,Institutional-IP,2021-10-21,2021-10-22,2021-11-27,PLN4071,1910255109,1910255109,DME Supplier,In-Network,E78.5,G43.909,,,,291,MS-DRG,15,1,Y,78452,Radiology,,,0730,21,Inpatient Hospital,1,6743.33,3358.29,3239.59,0.0,25.0,93.7,118.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005669,MBR00000220,Professional,2021-10-06,2021-10-06,2021-11-14,PLN3976,1991459367,1991459367,Neurology,Out-of-Network,Z87.891,Z00.00,,,,,,,0,,80061,Pathology/Lab,,,,50,Federally Qualified Health Center,3,48.76,39.17,0.0,39.17,0.0,0.0,39.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005670,MBR00000220,Professional,2022-10-23,2022-10-23,2022-11-18,PLN8898,1757138478,1757138478,Pediatrics,In-Network,B97.89,E78.5,,,,,,,0,,99221,E&M,,,,11,Office,3,326.42,197.86,81.33,116.53,0.0,0.0,116.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005671,MBR00000220,Institutional-IP,2023-12-07,2023-12-14,2023-12-16,PLN2675,1948810580,1948810580,DME Supplier,In-Network,J06.9,I10,,,,196,MS-DRG,9,7,Y,99233,E&M,,,0270,21,Inpatient Hospital,2,430.94,236.33,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005672,MBR00000220,Professional,2023-06-24,2023-06-24,2023-07-16,PLN3895,1224179551,1224179551,Physical Therapy,In-Network,J20.9,E11.9,,,,,,,0,,43239,Surgery,,,,11,Office,3,1201.87,948.37,933.37,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005673,MBR00000220,Institutional-IP,2021-07-11,2021-07-15,2021-08-08,PLN8307,1518055405,1518055405,Urology,In-Network,I10,C50.912,,,,292,MS-DRG,5,4,Y,23472,Surgery,,,0900,21,Inpatient Hospital,3,6672.16,2276.81,1974.89,0.0,0.0,301.92,301.92,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005674,MBR00000220,Professional,2021-06-12,2021-06-12,2021-07-15,PLN5504,1872613201,1872613201,Internal Medicine,In-Network,M17.11,Z12.31,,,,,,,0,,99203,E&M,,,,11,Office,1,387.58,263.03,0.0,263.03,35.0,0.0,298.03,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005675,MBR00000220,Institutional-OP,2021-10-16,2021-10-16,2021-11-29,PLN8083,1135158374,1135158374,Pulmonology,In-Network,E11.9,J06.9,,,,,,,0,,76700,Radiology,,,0450,22,Outpatient Hospital,3,837.62,363.47,323.92,0.0,35.0,4.55,39.55,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005676,MBR00000220,Institutional-IP,2023-03-14,2023-03-17,2023-04-02,PLN7472,1809014947,1809014947,Urology,In-Network,F41.9,I10,,,,871,MS-DRG,15,3,Y,90460,Medicine,,,0270,21,Inpatient Hospital,3,69.0,28.39,0.0,28.39,35.0,0.0,63.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005677,MBR00000220,Institutional-IP,2021-01-10,2021-01-14,2021-01-28,PLN6918,1778483301,1778483301,Home Health,In-Network,J06.9,C50.912,,,,195,MS-DRG,9,4,Y,70450,Radiology,,,0636,21,Inpatient Hospital,1,914.17,507.12,0.0,61.42,0.0,75.47,136.89,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005678,MBR00000220,Institutional-OP,2023-02-11,2023-02-11,2023-03-09,PLN2567,1622771872,1622771872,Pediatrics,In-Network,Z00.00,M54.5,,,,,,,0,,99204,E&M,,,0370,22,Outpatient Hospital,1,296.91,226.84,191.84,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000005679,MBR00000220,Institutional-OP,2022-09-28,2022-09-28,2022-10-17,PLN2643,1500037969,1500037969,Pulmonology,In-Network,I50.9,F41.9,,,,,,,0,,99283,E&M,,,0301,22,Outpatient Hospital,2,458.09,243.74,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005680,MBR00000220,Institutional-OP,2022-12-24,2022-12-24,2023-01-28,PLN8197,1186826716,1186826716,Physical Therapy,In-Network,N18.3,I10,,,,,,,0,,97110,Medicine,,,0370,22,Outpatient Hospital,2,205.91,66.3,0.0,66.3,50.0,0.0,116.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005681,MBR00000220,Institutional-IP,2023-08-01,2023-08-04,2023-08-22,PLN1402,1991459367,1991459367,Neurology,Out-of-Network,E66.9,R05,,,,194,MS-DRG,20,3,W,99203,E&M,,,0200,21,Inpatient Hospital,1,378.54,214.39,164.39,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000005682,MBR00000220,Institutional-OP,2022-10-10,2022-10-10,2022-10-23,PLN8237,1361302520,1361302520,Critical Access Hospital,In-Network,B97.89,F03.90,,,,,,,0,,90686,Medicine,,,0740,22,Outpatient Hospital,1,94.0,47.97,0.0,47.97,75.0,0.0,122.97,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000005683,MBR00000220,Professional,2022-11-12,2022-11-12,2022-12-04,PLN5595,1622771872,1622771872,Pediatrics,In-Network,E78.5,Z79.4,,,,,,,0,,43239,Surgery,,,,11,Office,3,1626.2,1026.26,0.0,401.48,25.0,67.67,494.15,0.0,Denied,CO-27,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005684,MBR00000220,Institutional-OP,2022-06-10,2022-06-10,2022-07-16,PLN2171,1239316214,1239316214,Internal Medicine,In-Network,N40.0,E66.9,,,,,,,0,,99214,E&M,,,0120,22,Outpatient Hospital,1,269.08,148.87,0.0,148.87,0.0,0.0,148.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005685,MBR00000221,Institutional-IP,2022-12-15,2022-12-23,2022-12-25,PLN7057,1569105090,1569105090,Geriatrics,In-Network,Z23,J45.20,,,,291,MS-DRG,22,8,U,99204,E&M,,,0120,21,Inpatient Hospital,1,290.2,144.13,113.99,30.14,0.0,0.0,30.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005686,MBR00000221,Institutional-IP,2022-02-21,2022-03-03,2022-03-22,PLN3127,1148984206,1148984206,Psychiatry,In-Network,E78.5,N39.0,,,,872,MS-DRG,13,10,Y,74177,Radiology,,,0636,21,Inpatient Hospital,3,2319.4,1873.89,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-29,,1,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000005687,MBR00000221,Institutional-OP,2021-03-14,2021-03-14,2021-04-23,PLN4513,1800011727,1800011727,Clinical Laboratory,Out-of-Network,E66.9,F03.90,,,,,,,0,,99204,E&M,,,0320,22,Outpatient Hospital,2,228.47,147.8,0.0,147.8,75.0,0.0,222.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005688,MBR00000221,Institutional-OP,2021-01-28,2021-01-28,2021-03-05,PLN2708,1946680931,1946680931,Critical Access Hospital,Out-of-Network,R05,E87.6,,,,,,,0,,97110,Medicine,,,0740,22,Outpatient Hospital,2,270.47,185.8,0.0,185.8,0.0,0.0,185.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005689,MBR00000221,Institutional-OP,2023-02-22,2023-02-22,2023-03-05,PLN4045,1118885473,1118885473,ASC,In-Network,M54.5,F41.9,,,,,,,0,,99213,E&M,,,0636,22,Outpatient Hospital,3,313.95,136.57,136.57,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005690,MBR00000221,Institutional-OP,2022-11-29,2022-11-29,2022-12-09,PLN7944,1114982472,1114982472,Orthopedic Surgery,In-Network,M81.0,I10,,,,,,,0,,58661,Surgery,,,0636,22,Outpatient Hospital,3,3380.29,1935.37,1935.37,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005691,MBR00000221,Institutional-IP,2022-03-24,2022-03-29,2022-04-15,PLN1054,1463205530,1463205530,Nephrology,In-Network,C50.912,J20.9,,,,291,MS-DRG,23,5,Y,45378,Surgery,,,0270,21,Inpatient Hospital,1,1032.14,452.26,121.99,280.27,50.0,0.0,330.27,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000005692,MBR00000221,Professional,2023-03-29,2023-03-29,2023-05-03,PLN7781,1434029575,1434029575,Endocrinology,In-Network,I10,Z79.4,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,2,35.47,21.37,21.37,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000005693,MBR00000221,Professional,2022-06-03,2022-06-03,2022-07-06,PLN3960,1438368327,1438368327,Home Health,In-Network,J44.1,M17.11,,,,,,,0,,G0439,Medicine,,,,11,Office,3,247.35,88.75,13.75,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000005694,MBR00000221,Professional,2021-10-07,2021-10-07,2021-10-27,PLN1141,1268679390,1268679390,Critical Access Hospital,In-Network,F32.9,E11.65,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,2,155.97,127.5,0.0,78.52,50.0,0.0,128.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005695,MBR00000221,Professional,2022-10-03,2022-10-03,2022-10-24,PLN7049,1531398223,1531398223,OB/GYN,In-Network,Z12.31,I10,,,,,,,0,,27130,Surgery,,,,21,Inpatient Hospital,2,5664.15,2121.96,2121.96,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005696,MBR00000221,Institutional-IP,2022-02-18,2022-02-24,2022-03-04,PLN7176,1295371663,1295371663,Critical Access Hospital,In-Network,N39.0,I10,,,,690,MS-DRG,10,6,Y,70450,Radiology,,,0730,21,Inpatient Hospital,3,656.49,310.64,189.16,0.0,75.0,46.48,121.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005697,MBR00000221,Institutional-OP,2023-12-05,2023-12-05,2023-12-27,PLN5119,1168246159,1168246159,Internal Medicine,In-Network,E11.40,Z23,,,,,,,0,,97110,Medicine,,,0370,22,Outpatient Hospital,2,151.21,57.14,0.0,57.14,50.0,0.0,107.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005698,MBR00000221,Professional,2023-03-01,2023-03-01,2023-04-09,PLN7495,1213165847,1213165847,Critical Access Hospital,In-Network,I48.91,N39.0,,,,,,,0,,80053,Pathology/Lab,,,,49,Independent Clinic,1,116.65,54.17,54.17,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005699,MBR00000221,Institutional-OP,2023-03-31,2023-03-31,2023-05-09,PLN8633,1752470395,1752470395,Home Health,In-Network,E11.9,E11.9,,,,,,,0,,99233,E&M,,,0740,22,Outpatient Hospital,1,510.12,179.02,179.02,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000005700,MBR00000221,Institutional-OP,2023-01-24,2023-01-24,2023-03-05,PLN8272,1366426662,1366426662,Urology,In-Network,E11.9,I10,,,,,,,0,,93225,Medicine,,,0320,22,Outpatient Hospital,2,795.07,636.51,353.63,257.88,25.0,0.0,282.88,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005701,MBR00000221,Institutional-OP,2023-01-19,2023-01-19,2023-02-11,PLN3715,1767011137,1767011137,DME Supplier,In-Network,J06.9,N20.0,,,,,,,0,,27130,Surgery,,,0120,22,Outpatient Hospital,3,5475.06,2682.89,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005702,MBR00000221,Professional,2023-04-27,2023-04-27,2023-06-08,PLN7965,1891849440,1891849440,Oncology,In-Network,Z00.00,N40.0,,,,,,,0,,47562,Surgery,,,,49,Independent Clinic,1,3043.96,1828.81,1788.42,0.0,0.0,40.39,40.39,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005703,MBR00000221,Professional,2022-04-18,2022-04-18,2022-05-09,PLN5698,1856686341,1856686341,Geriatrics,In-Network,Z12.31,M54.5,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,2,494.41,308.67,273.67,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005704,MBR00000221,Institutional-IP,2023-06-19,2023-06-23,2023-07-05,PLN5298,1865904917,1865904917,Outpatient Clinic,In-Network,E11.65,I10,,,,292,MS-DRG,23,4,Y,90686,Medicine,,,0636,21,Inpatient Hospital,3,76.66,31.29,0.0,31.29,0.0,0.0,31.29,0.0,Paid,,,0,,0,1,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000005705,MBR00000221,Institutional-OP,2021-02-07,2021-02-07,2021-03-20,PLN4214,1168881145,1168881145,Orthopedic Surgery,In-Network,N39.0,I10,,,,,,,0,,90837,Medicine,,,0270,22,Outpatient Hospital,1,440.42,369.19,2.05,367.14,0.0,0.0,367.14,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005706,MBR00000222,Institutional-OP,2022-12-31,2022-12-31,2023-01-26,PLN9223,1114982472,1114982472,Orthopedic Surgery,In-Network,G43.909,M54.5,,,,,,,0,,90686,Medicine,,,0900,22,Outpatient Hospital,2,85.4,67.44,17.4,0.0,50.0,0.04,50.04,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000005707,MBR00000222,Institutional-OP,2022-08-13,2022-08-13,2022-08-23,PLN3161,1910255109,1910255109,DME Supplier,In-Network,Z87.891,E11.9,,,,,,,0,,99284,E&M,,,0270,22,Outpatient Hospital,1,588.98,242.85,167.85,0.0,75.0,0.0,75.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005708,MBR00000222,Professional,2021-01-10,2021-01-10,2021-01-24,PLN8531,1556140803,1556140803,Cardiology,In-Network,Z12.31,Z00.00,,,,,,,0,,99203,E&M,,,,11,Office,1,374.78,307.9,0.0,307.9,0.0,0.0,307.9,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005709,MBR00000222,Professional,2022-12-25,2022-12-25,2023-01-11,PLN5919,1500949740,1500949740,Pediatrics,In-Network,B97.89,F10.20,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,2,182.24,150.28,123.09,0.0,15.0,12.19,27.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005710,MBR00000222,Institutional-OP,2021-01-03,2021-01-03,2021-02-07,PLN4255,1575695214,1575695214,SNF,In-Network,I11.9,E11.9,,,,,,,0,,99283,E&M,,,0370,22,Outpatient Hospital,3,480.28,300.74,135.53,66.99,75.0,23.22,165.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005711,MBR00000222,Professional,2023-02-11,2023-02-11,2023-03-11,PLN3730,1994661817,1994661817,SNF,Out-of-Network,Z00.00,G20,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,3,4239.81,1467.24,1323.78,0.0,0.0,143.46,143.46,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005712,MBR00000222,Institutional-OP,2022-07-29,2022-07-29,2022-08-21,PLN4031,1622771872,1622771872,Pediatrics,In-Network,Z12.31,R10.9,,,,,,,0,,47562,Surgery,,,0120,22,Outpatient Hospital,1,3289.04,1039.97,886.56,153.41,0.0,0.0,153.41,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005713,MBR00000222,Institutional-OP,2022-10-28,2022-10-28,2022-12-06,PLN2351,1717912431,1717912431,Oncology,In-Network,E66.9,F41.9,,,,,,,0,,G0468,Medicine,,,0301,22,Outpatient Hospital,3,456.18,274.87,0.0,274.87,0.0,0.0,274.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005714,MBR00000222,Institutional-OP,2022-10-30,2022-10-30,2022-12-03,PLN6246,1624202402,1624202402,Orthopedic Surgery,In-Network,N18.3,E11.9,,,,,,,0,,33533,Surgery,,,0450,22,Outpatient Hospital,1,16204.93,9939.33,0.0,20.9,0.0,0.0,20.9,0.0,Denied,CO-50,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000005715,MBR00000222,Institutional-OP,2021-11-25,2021-11-25,2021-12-17,PLN4906,1564502315,1564502315,ASC,In-Network,J45.20,J44.1,,,,,,,0,,99232,E&M,,,0370,22,Outpatient Hospital,1,337.56,266.42,232.14,0.0,0.0,34.28,34.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005716,MBR00000222,Professional,2022-11-13,2022-11-13,2022-12-07,PLN4704,1450553056,1450553056,Clinical Laboratory,In-Network,E11.9,B97.89,,,,,,,0,,99214,E&M,,,,11,Office,2,352.72,245.98,51.53,158.63,35.0,0.82,194.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005717,MBR00000222,Professional,2021-08-31,2021-08-31,2021-09-30,PLN4834,1103747954,1103747954,Urology,In-Network,Z79.4,N40.0,,,,,,,0,,78452,Radiology,,,,11,Office,1,4849.4,2512.02,2425.62,11.4,75.0,0.0,86.4,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005718,MBR00000222,Institutional-IP,2023-04-11,2023-04-14,2023-04-22,PLN3377,1410468316,1410468316,SNF,In-Network,F32.9,I10,,,,872,MS-DRG,8,3,Y,93306,Radiology,,,0730,21,Inpatient Hospital,2,3005.82,2126.34,0.0,41.08,0.0,0.0,41.08,0.0,Denied,PR-1,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005719,MBR00000222,Institutional-OP,2021-04-09,2021-04-09,2021-04-27,PLN7796,1511044648,1511044648,Endocrinology,In-Network,J20.9,E66.9,,,,,,,0,,33533,Surgery,,,0730,22,Outpatient Hospital,2,16275.46,11411.59,11396.59,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000005720,MBR00000222,Institutional-OP,2021-06-05,2021-06-05,2021-07-14,PLN3594,1569105090,1569105090,Geriatrics,In-Network,E11.9,J20.9,,,,,,,0,,86900,Pathology/Lab,,,0301,22,Outpatient Hospital,3,30.2,15.25,0.0,15.25,35.0,0.0,50.25,0.0,Adjusted,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000005721,MBR00000222,Professional,2023-02-09,2023-02-09,2023-03-10,PLN5264,1266606767,1266606767,ASC,In-Network,N18.3,E78.5,,,,,,,0,,99233,E&M,,,,11,Office,1,495.67,290.15,275.15,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005722,MBR00000222,Institutional-IP,2021-03-05,2021-03-09,2021-03-31,PLN7127,1745114564,1745114564,Endocrinology,In-Network,E78.5,I10,,,,872,MS-DRG,11,4,Y,74177,Radiology,,,0636,21,Inpatient Hospital,3,1597.42,1027.27,879.28,132.99,15.0,0.0,147.99,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005723,MBR00000222,Professional,2023-11-30,2023-11-30,2024-01-11,PLN2007,1935547131,1935547131,Pulmonology,In-Network,E11.9,N39.0,,,,,,,0,,93306,Radiology,,,,11,Office,2,2026.87,875.67,0.0,394.51,0.0,0.0,394.51,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005724,MBR00000222,Professional,2021-02-03,2021-02-03,2021-02-23,PLN9197,1964402759,1964402759,Outpatient Clinic,In-Network,E66.9,I50.9,,,,,,,0,,90686,Medicine,,,,20,Urgent Care,1,103.73,45.54,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-15,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000005725,MBR00000222,Institutional-OP,2022-07-29,2022-07-29,2022-08-29,PLN5213,1644128543,1644128543,Gastroenterology,In-Network,E11.9,M54.5,,,,,,,0,,99232,E&M,,,0370,22,Outpatient Hospital,1,398.22,228.65,0.0,214.75,25.0,0.0,239.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005726,MBR00000222,Professional,2023-12-14,2023-12-14,2024-01-19,PLN4306,1856686341,1856686341,Geriatrics,In-Network,Z23,Z00.01,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,3,1298.65,1005.41,1005.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005727,MBR00000222,Professional,2023-01-08,2023-01-08,2023-01-16,PLN2311,1518055405,1518055405,Urology,In-Network,Z12.31,I10,,,,,,,0,,58661,Surgery,,,,11,Office,3,3731.05,2574.88,2399.14,140.74,35.0,0.0,175.74,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005728,MBR00000222,Professional,2022-11-24,2022-11-24,2022-12-19,PLN7603,1702692193,1702692193,Physical Therapy,In-Network,M17.11,Z00.00,,,,,,,0,,27130,Surgery,,,,11,Office,1,6934.19,2861.82,0.0,0.0,0.0,333.95,333.95,0.0,Denied,CO-18,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005729,MBR00000222,Institutional-OP,2023-01-29,2023-01-29,2023-02-07,PLN9426,1622771872,1622771872,Pediatrics,In-Network,Z23,F32.9,,,,,,,0,,99233,E&M,,,0320,22,Outpatient Hospital,3,303.21,97.8,0.0,73.12,50.0,0.0,123.12,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005730,MBR00000222,Professional,2023-02-13,2023-02-13,2023-03-09,PLN9785,1717912431,1717912431,Oncology,In-Network,Z12.11,I10,,,,,,,0,,27130,Surgery,,,,23,Emergency Room,1,6338.89,5166.13,5166.13,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005731,MBR00000222,Professional,2021-06-26,2021-06-26,2021-07-22,PLN9007,1139906830,1139906830,Endocrinology,Out-of-Network,J18.9,K21.0,,,,,,,0,,99222,E&M,,,,21,Inpatient Hospital,2,550.31,262.38,211.98,0.0,15.0,35.4,50.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005732,MBR00000223,Professional,2021-12-05,2021-12-05,2022-01-03,PLN6916,1997536841,1997536841,Family Medicine,Out-of-Network,R05,E78.5,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,2,5373.68,3116.23,2843.3,247.93,25.0,0.0,272.93,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005733,MBR00000223,Institutional-IP,2021-07-30,2021-08-03,2021-08-20,PLN2922,1856686341,1856686341,Geriatrics,In-Network,I10,E78.5,,,,194,MS-DRG,18,4,Y,93225,Medicine,,,0450,21,Inpatient Hospital,1,874.96,281.35,0.0,281.35,50.0,0.0,331.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005734,MBR00000223,Professional,2021-08-20,2021-08-20,2021-09-05,PLN2156,1227362142,1227362142,DME Supplier,In-Network,J44.1,E78.5,,,,,,,0,,99284,E&M,,,,12,Home,2,588.02,305.17,305.17,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005735,MBR00000223,Institutional-OP,2021-08-16,2021-08-16,2021-09-01,PLN3144,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,E87.6,I10,,,,,,,0,,99222,E&M,,,0740,22,Outpatient Hospital,1,286.88,127.21,112.21,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005736,MBR00000223,Institutional-OP,2022-11-30,2022-11-30,2022-12-30,PLN1564,1624802371,1624802371,ASC,Out-of-Network,Z12.11,Z23,,,,,,,0,,99222,E&M,,,0360,22,Outpatient Hospital,2,454.17,377.84,287.67,0.0,35.0,55.17,90.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005737,MBR00000223,Professional,2023-10-19,2023-10-19,2023-11-05,PLN7115,1542828721,1542828721,Orthopedic Surgery,In-Network,K21.0,E78.5,,,,,,,0,,82043,Pathology/Lab,,,,21,Inpatient Hospital,1,35.51,17.38,0.0,17.38,25.0,0.0,42.38,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005738,MBR00000223,Professional,2022-09-05,2022-09-05,2022-09-21,PLN6153,1364429278,1364429278,OB/GYN,In-Network,B97.89,C50.912,,,,,,,0,,78452,Radiology,,,,22,Outpatient Hospital,1,3223.73,1266.88,850.54,416.34,0.0,0.0,416.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005739,MBR00000223,Professional,2021-01-18,2021-01-18,2021-02-19,PLN2683,1713934949,1713934949,Neurology,In-Network,I10,N17.9,,,,,,,0,,99203,E&M,,,,21,Inpatient Hospital,3,264.45,181.98,131.98,0.0,50.0,0.0,50.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005740,MBR00000223,Professional,2023-01-29,2023-01-29,2023-02-23,PLN2041,1728018911,1728018911,Nephrology,In-Network,Z00.00,E11.9,,,,,,,0,,47562,Surgery,,,,81,Independent Laboratory,2,3447.56,1763.68,1763.68,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005741,MBR00000223,Professional,2022-08-16,2022-08-16,2022-08-26,PLN7048,1475984649,1475984649,SNF,In-Network,F41.9,I10,,,,,,,0,,99283,E&M,,,,12,Home,1,388.98,284.52,249.52,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000005742,MBR00000223,Institutional-OP,2023-05-02,2023-05-02,2023-06-06,PLN3492,1606140917,1606140917,ASC,In-Network,Z23,M54.5,,,,,,,0,,76700,Radiology,,,0740,22,Outpatient Hospital,2,690.77,217.0,167.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005743,MBR00000223,Professional,2022-02-18,2022-02-18,2022-03-06,PLN5009,1283743001,1283743001,Family Medicine,In-Network,R51,M54.5,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,3,836.96,425.98,425.98,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005744,MBR00000223,Professional,2022-04-15,2022-04-15,2022-05-14,PLN1303,1219817751,1219817751,OB/GYN,In-Network,Z00.00,E78.5,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,3,100.66,31.28,15.25,0.0,15.0,1.03,16.03,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,1,0,0
CLM0000005745,MBR00000223,Professional,2022-12-23,2022-12-23,2023-01-22,PLN9175,1355166277,1355166277,Endocrinology,In-Network,Z23,N18.3,,,,,,,0,,47562,Surgery,,,,81,Independent Laboratory,3,5047.59,1626.59,1626.59,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005746,MBR00000223,Professional,2023-02-14,2023-02-14,2023-03-01,PLN6393,1198133277,1198133277,SNF,In-Network,J06.9,E78.5,,,,,,,0,,66984,Surgery,,,,11,Office,3,1506.06,718.12,510.5,207.62,0.0,0.0,207.62,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005747,MBR00000223,Professional,2021-08-30,2021-08-30,2021-09-24,PLN8395,1696843572,1696843572,Critical Access Hospital,Out-of-Network,Z87.891,E11.9,,,,,,,0,,80061,Pathology/Lab,,,,20,Urgent Care,2,73.14,27.15,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005748,MBR00000223,Professional,2022-10-05,2022-10-05,2022-10-22,PLN7679,1109850785,1109850785,ASC,Out-of-Network,Z00.00,Z12.31,,,,,,,0,,43239,Surgery,,,,11,Office,3,1722.36,1023.55,834.09,104.35,25.0,60.11,189.46,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005749,MBR00000223,Institutional-OP,2023-11-19,2023-11-19,2023-12-11,PLN9931,1198133277,1198133277,SNF,In-Network,K92.1,M81.0,,,,,,,0,,33533,Surgery,,,0370,22,Outpatient Hospital,2,14157.72,11890.13,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-119,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000005750,MBR00000223,Professional,2021-03-12,2021-03-12,2021-04-09,PLN8811,1139906830,1139906830,Endocrinology,Out-of-Network,R10.9,I50.9,,,,,,,0,,45380,Surgery,,,,12,Home,1,2779.02,2215.79,2200.79,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000005751,MBR00000223,Professional,2021-12-29,2021-12-29,2022-01-17,PLN7419,1817234602,1817234602,Clinical Laboratory,In-Network,F41.9,Z51.11,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,3,7069.52,4047.32,3592.67,404.65,50.0,0.0,454.65,0.0,Paid,,,0,,0,0,1,0,0,1,Duplicate,0,0,0,0,0
CLM0000005752,MBR00000223,Institutional-OP,2022-08-08,2022-08-08,2022-08-20,PLN6064,1749327647,1749327647,Geriatrics,In-Network,I10,I10,,,,,,,0,,99214,E&M,,,0510,22,Outpatient Hospital,2,335.37,181.7,181.7,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005753,MBR00000223,Institutional-IP,2023-10-11,2023-10-16,2023-11-18,PLN2006,1845057593,1845057593,Orthopedic Surgery,In-Network,Z00.00,K92.1,,,,470,MS-DRG,12,5,Y,99284,E&M,,,0270,21,Inpatient Hospital,2,398.65,316.85,316.85,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005754,MBR00000223,Institutional-OP,2023-11-27,2023-11-27,2023-12-18,PLN4864,1198133277,1198133277,SNF,In-Network,E11.9,R05,,,,,,,0,,70450,Radiology,,,0450,22,Outpatient Hospital,3,886.4,569.59,544.59,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005755,MBR00000224,Professional,2022-10-08,2022-10-08,2022-11-14,PLN4753,1242201429,1242201429,General Acute Care Hospital,In-Network,I10,K92.1,,,,,,,0,,99204,E&M,,,,11,Office,1,212.11,151.62,114.93,0.0,35.0,1.69,36.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005756,MBR00000224,Professional,2022-08-22,2022-08-22,2022-09-22,PLN4038,1530904931,1530904931,Internal Medicine,In-Network,F32.9,Z00.00,,,,,,,0,,72148,Radiology,,,,81,Independent Laboratory,3,1578.1,941.3,941.3,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005757,MBR00000224,Professional,2022-03-30,2022-03-30,2022-04-13,PLN6470,1453936007,1453936007,ASC,In-Network,E78.5,J06.9,,,,,,,0,,99232,E&M,,,,21,Inpatient Hospital,2,352.42,149.02,99.02,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005758,MBR00000224,Institutional-OP,2022-05-03,2022-05-03,2022-06-13,PLN9541,1372918899,1372918899,Family Medicine,In-Network,I10,I11.9,,,,,,,0,,93306,Radiology,,,0120,22,Outpatient Hospital,3,1798.35,880.2,844.89,0.0,0.0,35.31,35.31,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005759,MBR00000224,Institutional-OP,2023-03-15,2023-03-15,2023-04-17,PLN1403,1606140917,1606140917,ASC,In-Network,E66.9,N39.0,,,,,,,0,,99221,E&M,,,0450,22,Outpatient Hospital,1,399.47,326.07,257.47,0.0,35.0,33.6,68.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005760,MBR00000224,Professional,2022-08-20,2022-08-20,2022-10-03,PLN4708,1366576336,1366576336,Geriatrics,In-Network,I25.10,C50.912,,,,,,,0,,33533,Surgery,,,,49,Independent Clinic,1,27035.21,16084.73,16084.73,0.0,0.0,0.0,0.0,0.0,Adjusted,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000005761,MBR00000224,Professional,2022-08-29,2022-08-29,2022-10-05,PLN6238,1273488618,1273488618,General Acute Care Hospital,In-Network,J44.1,Z23,,,,,,,0,,82043,Pathology/Lab,,,,20,Urgent Care,3,69.74,34.2,0.0,34.2,35.0,0.0,69.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005762,MBR00000224,Professional,2023-07-14,2023-07-14,2023-08-25,PLN4891,1980712759,1980712759,Outpatient Clinic,Out-of-Network,M17.11,E78.5,,,,,,,0,,47562,Surgery,,,,20,Urgent Care,1,5913.6,1804.72,1725.18,79.54,0.0,0.0,79.54,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005763,MBR00000224,Professional,2021-06-01,2021-06-01,2021-07-06,PLN8262,1997536841,1997536841,Family Medicine,Out-of-Network,F03.90,M54.5,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,2,46.19,23.77,23.21,0.0,0.0,0.56,0.56,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005764,MBR00000224,Professional,2023-11-15,2023-11-15,2023-12-17,PLN1623,1205377316,1205377316,Orthopedic Surgery,In-Network,M17.11,M81.0,,,,,,,0,,45378,Surgery,,,,23,Emergency Room,2,1957.87,911.81,493.26,418.55,0.0,0.0,418.55,0.0,Paid,,,0,,1,1,0,0,0,0,None,0,1,0,0,0
CLM0000005765,MBR00000224,Institutional-OP,2023-02-11,2023-02-11,2023-03-25,PLN2003,1530904931,1530904931,Internal Medicine,In-Network,I10,I10,,,,,,,0,,85610,Pathology/Lab,,,0636,22,Outpatient Hospital,2,47.89,25.34,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005766,MBR00000224,Professional,2022-10-05,2022-10-05,2022-11-03,PLN4179,1453283987,1453283987,Critical Access Hospital,In-Network,M54.5,F41.9,,,,,,,0,,97530,Medicine,,,,23,Emergency Room,2,154.47,87.65,0.0,87.65,50.0,0.0,137.65,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005767,MBR00000224,Professional,2022-09-27,2022-09-27,2022-10-24,PLN6015,1691062876,1691062876,SNF,In-Network,F32.9,K57.30,,,,,,,0,,99232,E&M,,,,49,Independent Clinic,3,381.3,248.4,233.4,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005768,MBR00000224,Institutional-IP,2022-09-24,2022-10-02,2022-10-02,PLN3086,1118885473,1118885473,ASC,In-Network,I10,F03.90,,,,603,MS-DRG,4,8,Y,99232,E&M,,,0301,21,Inpatient Hospital,1,392.92,316.35,211.93,0.0,75.0,29.42,104.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005769,MBR00000224,Professional,2022-09-12,2022-09-12,2022-10-11,PLN4758,1242201429,1242201429,General Acute Care Hospital,In-Network,R10.9,E66.9,,,,,,,0,,90837,Medicine,,,,22,Outpatient Hospital,3,309.83,189.61,7.16,182.45,0.0,0.0,182.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005770,MBR00000224,Institutional-OP,2022-01-19,2022-01-19,2022-02-28,PLN6073,1571574052,1571574052,Critical Access Hospital,In-Network,E11.9,I10,,,,,,,0,,99204,E&M,,,0320,22,Outpatient Hospital,3,532.92,418.92,0.0,418.92,25.0,0.0,443.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005771,MBR00000224,Professional,2023-03-20,2023-03-20,2023-04-14,PLN1559,1245650222,1245650222,Gastroenterology,In-Network,I48.91,I25.10,,,,,,,0,,99204,E&M,,,,21,Inpatient Hospital,1,592.34,498.03,423.03,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005772,MBR00000224,Institutional-OP,2021-10-04,2021-10-04,2021-11-15,PLN4446,1542828721,1542828721,Orthopedic Surgery,In-Network,Z00.01,J06.9,,,,,,,0,,99204,E&M,,,0740,22,Outpatient Hospital,3,574.35,185.57,123.75,0.0,35.0,26.82,61.82,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000005773,MBR00000224,Professional,2022-12-17,2022-12-17,2023-01-10,PLN6571,1530904931,1530904931,Internal Medicine,In-Network,Z23,I11.9,,,,,,,0,,99233,E&M,,,,11,Office,2,296.23,98.18,83.15,0.0,0.0,15.03,15.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005774,MBR00000224,Professional,2022-07-31,2022-07-31,2022-08-15,PLN8265,1528335731,1528335731,Critical Access Hospital,In-Network,E78.5,J20.9,,,,,,,0,,78452,Radiology,,,,11,Office,2,2628.19,2130.46,2046.53,83.93,0.0,0.0,83.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005775,MBR00000224,Professional,2022-02-06,2022-02-06,2022-02-23,PLN1747,1355166277,1355166277,Endocrinology,In-Network,E11.9,R05,,,,,,,0,,99222,E&M,,,,11,Office,2,310.38,105.05,105.05,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005776,MBR00000224,Institutional-OP,2023-05-31,2023-05-31,2023-07-07,PLN3350,1840431511,1840431511,Geriatrics,Out-of-Network,E66.9,I10,,,,,,,0,,G0439,Medicine,,,0636,22,Outpatient Hospital,3,296.66,119.97,101.14,18.83,0.0,0.0,18.83,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000005777,MBR00000224,Professional,2021-12-15,2021-12-15,2022-01-03,PLN6088,1717546253,1717546253,Family Medicine,In-Network,Z79.4,E66.9,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,1,2544.47,967.11,724.39,242.72,0.0,0.0,242.72,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005778,MBR00000224,Professional,2022-12-24,2022-12-24,2023-01-03,PLN2891,1410468316,1410468316,SNF,In-Network,K57.30,E78.5,,,,,,,0,,72148,Radiology,,,,20,Urgent Care,2,1755.07,1066.9,967.84,99.06,0.0,0.0,99.06,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005779,MBR00000224,Professional,2021-10-02,2021-10-02,2021-11-04,PLN5497,1716521444,1716521444,Oncology,In-Network,Z12.31,F41.9,,,,,,,0,,99214,E&M,,,,11,Office,3,412.81,240.47,19.46,196.01,25.0,0.0,221.01,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005780,MBR00000224,Professional,2021-08-08,2021-08-08,2021-09-11,PLN8850,1691062876,1691062876,SNF,In-Network,I50.9,E66.9,,,,,,,0,,77067,Radiology,,,,22,Outpatient Hospital,3,499.42,180.68,50.06,115.62,15.0,0.0,130.62,0.0,Paid,,,0,,0,1,0,0,0,1,Upcoding,1,0,0,0,0
CLM0000005781,MBR00000224,Institutional-OP,2022-09-22,2022-09-22,2022-10-10,PLN6078,1563980627,1563980627,Critical Access Hospital,In-Network,I25.10,E11.9,,,,,,,0,,99233,E&M,,,0730,22,Outpatient Hospital,2,540.12,345.32,330.32,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005782,MBR00000224,Institutional-OP,2023-12-05,2023-12-05,2024-01-01,PLN7310,1812060197,1812060197,Oncology,Out-of-Network,E78.5,I10,,,,,,,0,,99406,Medicine,,,0636,22,Outpatient Hospital,2,83.0,25.6,25.6,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005783,MBR00000224,Institutional-IP,2021-11-25,2021-11-30,2022-01-02,PLN4847,1645194539,1645194539,SNF,In-Network,K57.30,Z00.00,,,,292,MS-DRG,8,5,Y,85610,Pathology/Lab,,,0761,21,Inpatient Hospital,3,30.7,23.54,23.54,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005784,MBR00000224,Professional,2021-05-06,2021-05-06,2021-05-31,PLN3672,1135158374,1135158374,Pulmonology,In-Network,F03.90,N39.0,,,,,,,0,,99232,E&M,,,,81,Independent Laboratory,2,398.41,165.8,0.0,165.8,15.0,0.0,180.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005785,MBR00000224,Institutional-IP,2021-05-12,2021-05-15,2021-05-29,PLN1197,1935547131,1935547131,Pulmonology,In-Network,G43.909,G43.909,,,,682,MS-DRG,2,3,U,27447,Surgery,,,0120,21,Inpatient Hospital,1,3309.15,1397.89,0.0,285.45,0.0,0.0,285.45,0.0,Denied,CO-11,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005786,MBR00000224,Institutional-IP,2022-06-23,2022-07-01,2022-07-03,PLN8370,1520687146,1520687146,ASC,In-Network,I10,R51,,,,683,MS-DRG,23,8,Y,66984,Surgery,,,0450,21,Inpatient Hospital,2,2959.6,2009.37,1350.92,405.22,25.0,228.23,658.45,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005787,MBR00000224,Professional,2023-05-08,2023-05-08,2023-05-31,PLN8439,1872613201,1872613201,Internal Medicine,In-Network,E11.9,C50.912,,,,,,,0,,33533,Surgery,,,,11,Office,3,25745.94,15383.7,13841.04,436.73,25.0,1080.93,1542.66,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000005788,MBR00000224,Professional,2023-02-19,2023-02-19,2023-03-12,PLN7727,1372918899,1372918899,Family Medicine,In-Network,I10,N18.3,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,2,37.11,24.67,24.67,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005789,MBR00000224,Institutional-IP,2021-08-17,2021-08-24,2021-09-05,PLN1276,1450094833,1450094833,Outpatient Clinic,In-Network,E11.9,F32.9,,,,470,MS-DRG,5,7,Y,G0439,Medicine,,,0740,21,Inpatient Hospital,1,598.85,231.04,38.75,183.45,0.0,8.84,192.29,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000005790,MBR00000224,Institutional-OP,2023-07-04,2023-07-04,2023-08-12,PLN1928,1575695214,1575695214,SNF,In-Network,I48.91,E78.5,,,,,,,0,,70450,Radiology,,,0740,22,Outpatient Hospital,3,1592.53,788.85,773.85,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005791,MBR00000224,Professional,2021-06-30,2021-06-30,2021-08-05,PLN2018,1247341320,1247341320,Urology,Out-of-Network,J06.9,E78.5,,,,,,,0,,72148,Radiology,,,,11,Office,3,2525.5,1217.94,983.51,0.0,0.0,234.43,234.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005792,MBR00000224,Institutional-OP,2022-09-05,2022-09-05,2022-09-13,PLN6866,1273488618,1273488618,General Acute Care Hospital,In-Network,Z23,F10.20,,,,,,,0,,99283,E&M,,,0730,22,Outpatient Hospital,2,598.21,498.62,463.62,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005793,MBR00000224,Institutional-OP,2023-07-19,2023-07-19,2023-08-23,PLN7283,1450094833,1450094833,Outpatient Clinic,In-Network,E11.9,J06.9,,,,,,,0,,99214,E&M,,,0370,22,Outpatient Hospital,3,269.52,194.28,0.0,194.28,0.0,0.0,194.28,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005794,MBR00000224,Institutional-OP,2023-06-04,2023-06-04,2023-06-20,PLN9290,1644128543,1644128543,Gastroenterology,In-Network,Z00.00,Z23,,,,,,,0,,99232,E&M,,,0370,22,Outpatient Hospital,1,330.96,273.08,223.08,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005795,MBR00000224,Institutional-OP,2023-02-08,2023-02-08,2023-03-19,PLN2919,1109850785,1109850785,ASC,Out-of-Network,J06.9,K57.30,,,,,,,0,,99203,E&M,,,0120,22,Outpatient Hospital,1,267.75,167.45,122.44,0.0,15.0,30.01,45.01,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005796,MBR00000224,Professional,2021-12-29,2021-12-29,2022-01-19,PLN9182,1622771872,1622771872,Pediatrics,In-Network,Z12.31,I63.9,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,1,125.62,85.3,0.0,85.3,15.0,0.0,100.3,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005797,MBR00000224,Professional,2023-04-19,2023-04-19,2023-04-27,PLN6086,1561134315,1561134315,DME Supplier,In-Network,J20.9,I50.9,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,1,376.7,164.37,140.54,0.0,15.0,8.83,23.83,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005798,MBR00000224,Institutional-OP,2022-02-28,2022-02-28,2022-03-08,PLN4816,1645194539,1645194539,SNF,In-Network,I10,K21.0,,,,,,,0,,83036,Pathology/Lab,,,0740,22,Outpatient Hospital,3,93.07,33.7,33.7,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000005799,MBR00000224,Institutional-OP,2022-01-19,2022-01-19,2022-02-14,PLN9890,1124394415,1124394415,Pediatrics,In-Network,E11.9,M54.5,,,,,,,0,,99214,E&M,,,0370,22,Outpatient Hospital,2,424.76,255.34,230.34,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005800,MBR00000224,Professional,2022-08-07,2022-08-07,2022-08-19,PLN3525,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,F41.9,C50.912,,,,,,,0,,82043,Pathology/Lab,,,,21,Inpatient Hospital,2,38.6,26.93,11.93,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005801,MBR00000224,Institutional-IP,2022-11-08,2022-11-12,2022-11-19,PLN1181,1899127912,1899127912,Neurology,In-Network,M54.5,Z79.4,,,,682,MS-DRG,1,4,Y,77067,Radiology,,,0120,21,Inpatient Hospital,2,316.63,207.95,207.95,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000005802,MBR00000224,Institutional-OP,2021-08-18,2021-08-18,2021-09-23,PLN7939,1790497490,1790497490,OB/GYN,In-Network,J06.9,F32.9,,,,,,,0,,33533,Surgery,,,0301,22,Outpatient Hospital,1,23143.71,18590.71,14814.22,309.56,0.0,3466.93,3776.49,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000005803,MBR00000224,Professional,2023-10-18,2023-10-18,2023-11-18,PLN8721,1390307371,1390307371,DME Supplier,In-Network,Z00.01,M54.5,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,1,29.71,14.9,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005804,MBR00000224,Professional,2023-08-08,2023-08-08,2023-08-17,PLN5575,1571574052,1571574052,Critical Access Hospital,In-Network,Z12.31,I10,,,,,,,0,,93306,Radiology,,,,11,Office,3,1696.81,673.95,542.31,0.0,0.0,131.64,131.64,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005805,MBR00000225,Professional,2021-11-06,2021-11-06,2021-11-13,PLN8082,1990090423,1990090423,Orthopedic Surgery,In-Network,E87.6,J20.9,,,,,,,0,,80053,Pathology/Lab,,,,20,Urgent Care,3,72.0,27.45,2.45,0.0,25.0,0.0,25.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005806,MBR00000225,Professional,2021-09-22,2021-09-22,2021-10-08,PLN3252,1139906830,1139906830,Endocrinology,Out-of-Network,R51,F32.9,,,,,,,0,,85025,Pathology/Lab,,,,31,Skilled Nursing Facility,2,55.91,17.94,14.91,3.03,0.0,0.0,3.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005807,MBR00000225,Institutional-IP,2021-03-17,2021-03-24,2021-04-26,PLN4259,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,I11.9,J44.1,,,,683,MS-DRG,13,7,Y,99222,E&M,,,0740,21,Inpatient Hospital,1,660.51,398.7,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005808,MBR00000225,Professional,2022-03-21,2022-03-21,2022-04-03,PLN1798,1545347862,1545347862,SNF,In-Network,G20,Z00.00,,,,,,,0,,93000,Radiology,,,,23,Emergency Room,3,153.55,73.85,0.0,73.85,15.0,0.0,88.85,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005809,MBR00000225,Institutional-OP,2021-07-07,2021-07-07,2021-08-10,PLN3331,1847081578,1847081578,Urology,Out-of-Network,F10.20,J44.1,,,,,,,0,,23472,Surgery,,,0120,22,Outpatient Hospital,3,2823.24,1527.26,1360.44,166.82,0.0,0.0,166.82,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005810,MBR00000225,Professional,2023-10-16,2023-10-16,2023-11-27,PLN9416,1542828721,1542828721,Orthopedic Surgery,In-Network,E11.9,E66.9,,,,,,,0,,87491,Pathology/Lab,,,,22,Outpatient Hospital,2,258.2,134.26,123.39,10.85,0.0,0.02,10.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005811,MBR00000225,Institutional-OP,2023-09-10,2023-09-10,2023-10-11,PLN2184,1108115157,1108115157,General Acute Care Hospital,In-Network,I10,I25.10,,,,,,,0,,99284,E&M,,,0450,22,Outpatient Hospital,1,900.79,536.33,410.33,0.0,75.0,51.0,126.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005812,MBR00000225,Professional,2023-06-27,2023-06-27,2023-07-04,PLN6489,1563980627,1563980627,Critical Access Hospital,In-Network,I25.10,E78.5,,,,,,,0,,99204,E&M,,,,11,Office,3,483.25,257.99,202.75,47.39,0.0,7.85,55.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005813,MBR00000225,Institutional-OP,2021-11-05,2021-11-05,2021-12-19,PLN7446,1236418230,1236418230,DME Supplier,In-Network,N39.0,J45.20,,,,,,,0,,99204,E&M,,,0730,22,Outpatient Hospital,1,509.38,369.97,309.17,0.0,0.0,60.8,60.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005814,MBR00000225,Professional,2023-01-26,2023-01-26,2023-02-13,PLN2212,1518055405,1518055405,Urology,In-Network,E11.65,N18.3,,,,,,,0,,27130,Surgery,,,,11,Office,1,3334.55,1740.85,1324.45,326.01,50.0,40.39,416.4,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005815,MBR00000225,Institutional-IP,2022-06-22,2022-06-28,2022-08-02,PLN6431,1948810580,1948810580,DME Supplier,In-Network,I10,M81.0,,,,603,MS-DRG,23,6,N,99284,E&M,,,0450,21,Inpatient Hospital,1,644.56,540.91,112.62,419.77,0.0,8.52,428.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005816,MBR00000225,Professional,2021-10-27,2021-10-27,2021-12-04,PLN8276,1847081578,1847081578,Urology,Out-of-Network,Z23,E11.9,,,,,,,0,,71046,Radiology,,,,11,Office,2,213.99,120.83,45.83,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005817,MBR00000225,Professional,2022-08-09,2022-08-09,2022-08-28,PLN5565,1991459367,1991459367,Neurology,Out-of-Network,M17.11,I10,,,,,,,0,,99203,E&M,,,,50,Federally Qualified Health Center,2,312.48,139.98,139.98,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005818,MBR00000225,Professional,2021-07-01,2021-07-01,2021-08-12,PLN1303,1530904931,1530904931,Internal Medicine,In-Network,N18.3,R51,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,1,476.6,352.84,0.0,352.84,0.0,0.0,352.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005819,MBR00000225,Professional,2023-11-18,2023-11-18,2023-12-15,PLN8387,1745114564,1745114564,Endocrinology,In-Network,J06.9,R51,,,,,,,0,,99214,E&M,,,,49,Independent Clinic,2,241.89,118.15,103.15,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005820,MBR00000225,Institutional-OP,2021-06-29,2021-06-29,2021-07-30,PLN8575,1939033455,1939033455,Pulmonology,In-Network,I10,I10,,,,,,,0,,27130,Surgery,,,0730,22,Outpatient Hospital,1,3891.63,2158.53,2158.53,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005821,MBR00000225,Professional,2021-11-27,2021-11-27,2021-12-28,PLN5621,1702692193,1702692193,Physical Therapy,In-Network,Z51.11,Z12.11,,,,,,,0,,99233,E&M,,,,11,Office,1,529.84,238.13,0.0,238.13,0.0,0.0,238.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005822,MBR00000225,Institutional-OP,2021-08-31,2021-08-31,2021-10-02,PLN6070,1545347862,1545347862,SNF,In-Network,E66.9,E11.65,,,,,,,0,,99283,E&M,,,0370,22,Outpatient Hospital,3,339.29,251.02,0.0,251.02,0.0,0.0,251.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005823,MBR00000225,Professional,2022-07-25,2022-07-25,2022-08-12,PLN5542,1236418230,1236418230,DME Supplier,In-Network,I10,Z23,,,,,,,0,,99213,E&M,,,,11,Office,3,191.29,116.83,116.83,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005824,MBR00000226,Professional,2023-01-06,2023-01-06,2023-01-31,PLN8419,1500949740,1500949740,Pediatrics,In-Network,J18.9,E11.9,,,,,,,0,,86900,Pathology/Lab,,,,81,Independent Laboratory,3,50.86,24.07,7.32,0.0,15.0,1.75,16.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005825,MBR00000226,Institutional-OP,2023-11-16,2023-11-16,2023-12-07,PLN4726,1530904931,1530904931,Internal Medicine,In-Network,I10,K21.0,,,,,,,0,,99222,E&M,,,0370,22,Outpatient Hospital,2,541.14,378.34,0.0,378.34,75.0,0.0,453.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005826,MBR00000226,Professional,2022-03-02,2022-03-02,2022-04-01,PLN1049,1660288235,1660288235,ASC,In-Network,E78.5,Z12.31,,,,,,,0,,99283,E&M,,,,20,Urgent Care,3,383.16,155.27,155.27,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005827,MBR00000226,Institutional-OP,2021-08-09,2021-08-09,2021-09-11,PLN9303,1422747896,1422747896,Urology,In-Network,F41.9,Z87.891,,,,,,,0,,99214,E&M,,,0270,22,Outpatient Hospital,1,464.03,237.81,109.9,127.91,0.0,0.0,127.91,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005828,MBR00000226,Professional,2021-01-24,2021-01-24,2021-02-28,PLN7877,1795618275,1795618275,Pulmonology,In-Network,E78.5,E66.9,,,,,,,0,,99221,E&M,,,,21,Inpatient Hospital,3,260.11,123.85,0.0,123.85,0.0,0.0,123.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005829,MBR00000226,Institutional-IP,2022-10-17,2022-10-24,2022-11-25,PLN2446,1910255109,1910255109,DME Supplier,In-Network,J06.9,F32.9,,,,641,MS-DRG,4,7,Y,99233,E&M,,,0320,21,Inpatient Hospital,3,297.5,216.79,216.79,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005830,MBR00000226,Institutional-OP,2023-12-09,2023-12-09,2023-12-19,PLN8245,1702692193,1702692193,Physical Therapy,In-Network,F41.9,E66.9,,,,,,,0,,47562,Surgery,,,0900,22,Outpatient Hospital,1,2620.67,1849.53,1808.34,24.83,0.0,16.36,41.19,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005831,MBR00000226,Professional,2021-03-11,2021-03-11,2021-04-23,PLN5756,1622771872,1622771872,Pediatrics,In-Network,Z87.891,M17.11,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,3,94.33,67.26,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005832,MBR00000226,Institutional-IP,2023-12-27,2023-12-31,2024-01-29,PLN5568,1948810580,1948810580,DME Supplier,In-Network,J06.9,J20.9,,,,641,MS-DRG,22,4,Y,71046,Radiology,,,0320,21,Inpatient Hospital,2,250.44,83.35,8.35,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005833,MBR00000226,Professional,2021-10-15,2021-10-15,2021-11-28,PLN7790,1935547131,1935547131,Pulmonology,In-Network,I25.10,E78.5,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,3,1054.35,691.79,691.79,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000005834,MBR00000226,Institutional-OP,2023-09-22,2023-09-22,2023-10-11,PLN2650,1530904931,1530904931,Internal Medicine,In-Network,J06.9,K21.0,,,,,,,0,,80061,Pathology/Lab,,,0636,22,Outpatient Hospital,3,45.7,19.6,19.6,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005835,MBR00000226,Professional,2021-03-17,2021-03-17,2021-04-02,PLN1248,1939033455,1939033455,Pulmonology,In-Network,I11.9,I11.9,,,,,,,0,,33533,Surgery,,,,81,Independent Laboratory,3,17828.39,14796.84,13961.84,0.0,15.0,820.0,835.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000005836,MBR00000226,Professional,2023-09-04,2023-09-04,2023-10-03,PLN9427,1946680931,1946680931,Critical Access Hospital,Out-of-Network,M17.11,I10,,,,,,,0,,45378,Surgery,,,,12,Home,1,1740.6,1037.98,0.0,276.95,0.0,138.71,415.66,0.0,Denied,CO-15,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000005837,MBR00000226,Professional,2021-12-28,2021-12-28,2022-01-06,PLN7718,1915531927,1915531927,Critical Access Hospital,In-Network,S72.001A,I10,,,,,,,0,,77067,Radiology,,,,11,Office,2,456.38,360.3,360.3,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000005838,MBR00000226,Institutional-IP,2021-10-28,2021-10-29,2021-11-15,PLN2012,1660288235,1660288235,ASC,In-Network,E78.5,K21.0,,,,292,MS-DRG,1,1,Y,70450,Radiology,,,0450,21,Inpatient Hospital,1,712.08,441.69,441.69,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005839,MBR00000226,Institutional-OP,2021-08-15,2021-08-15,2021-09-14,PLN8161,1313212303,1313212303,Family Medicine,In-Network,E11.9,N20.0,,,,,,,0,,45380,Surgery,,,0320,22,Outpatient Hospital,2,2550.17,1202.85,1202.85,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000005840,MBR00000226,Institutional-OP,2021-05-27,2021-05-27,2021-06-11,PLN2708,1245650222,1245650222,Gastroenterology,In-Network,Z12.31,F32.9,,,,,,,0,,99203,E&M,,,0270,22,Outpatient Hospital,1,226.11,179.87,144.87,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005841,MBR00000226,Institutional-OP,2023-05-25,2023-05-25,2023-06-23,PLN1585,1840431511,1840431511,Geriatrics,Out-of-Network,E66.9,M54.5,,,,,,,0,,70450,Radiology,,,0370,22,Outpatient Hospital,1,898.56,504.67,240.29,189.38,75.0,0.0,264.38,0.0,Pended,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005842,MBR00000226,Institutional-OP,2021-03-17,2021-03-17,2021-04-01,PLN4692,1168881145,1168881145,Orthopedic Surgery,In-Network,G43.909,Z12.11,,,,,,,0,,43239,Surgery,,,0730,22,Outpatient Hospital,1,1367.19,414.32,389.07,10.25,15.0,0.0,25.25,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005843,MBR00000226,Institutional-OP,2022-05-23,2022-05-23,2022-06-20,PLN5757,1132188260,1132188260,Family Medicine,In-Network,E66.9,Z23,,,,,,,0,,93000,Radiology,,,0200,22,Outpatient Hospital,2,116.79,59.59,58.1,0.0,0.0,1.49,1.49,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005844,MBR00000226,Professional,2023-11-05,2023-11-05,2023-11-16,PLN9438,1313212303,1313212303,Family Medicine,In-Network,M17.11,J06.9,,,,,,,0,,47562,Surgery,,,,12,Home,1,3726.37,3065.37,2708.87,356.5,0.0,0.0,356.5,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005845,MBR00000226,Professional,2022-03-20,2022-03-20,2022-04-10,PLN8093,1590915516,1590915516,Physical Therapy,Out-of-Network,Z00.00,E78.5,,,,,,,0,,84443,Pathology/Lab,,,,21,Inpatient Hospital,3,152.03,48.1,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005846,MBR00000226,Institutional-IP,2023-06-25,2023-06-26,2023-07-10,PLN6146,1103747954,1103747954,Urology,In-Network,E78.5,F32.9,,,,292,MS-DRG,22,1,Y,G0444,Medicine,,,0730,21,Inpatient Hospital,2,85.04,33.13,0.0,33.13,0.0,0.0,33.13,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000005847,MBR00000226,Professional,2023-01-29,2023-01-29,2023-02-26,PLN4423,1645194539,1645194539,SNF,In-Network,J06.9,Z00.00,,,,,,,0,,93225,Medicine,,,,11,Office,3,365.56,135.45,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005848,MBR00000226,Institutional-OP,2023-05-21,2023-05-21,2023-06-02,PLN6030,1236418230,1236418230,DME Supplier,In-Network,E78.5,E78.5,,,,,,,0,,99213,E&M,,,0370,22,Outpatient Hospital,2,190.71,121.38,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005849,MBR00000226,Professional,2023-11-04,2023-11-04,2023-11-21,PLN4585,1486164553,1486164553,DME Supplier,In-Network,K21.0,I25.10,,,,,,,0,,47562,Surgery,,,,50,Federally Qualified Health Center,2,4773.44,3548.03,3062.7,450.33,35.0,0.0,485.33,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005850,MBR00000226,Professional,2021-04-18,2021-04-18,2021-05-05,PLN9125,1186826716,1186826716,Physical Therapy,In-Network,J20.9,I10,,,,,,,0,,47562,Surgery,,,,23,Emergency Room,2,5922.31,1802.33,1802.33,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005851,MBR00000226,Institutional-OP,2021-11-27,2021-11-27,2021-12-06,PLN4309,1540044947,1540044947,Pulmonology,Out-of-Network,J44.1,F41.9,,,,,,,0,,99204,E&M,,,0636,22,Outpatient Hospital,3,328.14,247.65,232.65,0.0,15.0,0.0,15.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005852,MBR00000226,Professional,2021-12-18,2021-12-18,2022-01-17,PLN7072,1372918899,1372918899,Family Medicine,In-Network,E11.9,Z23,,,,,,,0,,85025,Pathology/Lab,,,,22,Outpatient Hospital,3,35.38,13.39,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005853,MBR00000226,Institutional-OP,2021-03-15,2021-03-15,2021-03-28,PLN2389,1239316214,1239316214,Internal Medicine,In-Network,F32.9,I10,,,,,,,0,,93000,Radiology,,,0636,22,Outpatient Hospital,2,173.1,86.88,74.24,0.0,0.0,12.64,12.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005854,MBR00000226,Institutional-OP,2021-04-27,2021-04-27,2021-05-17,PLN7698,1713934949,1713934949,Neurology,In-Network,E11.9,R07.9,,,,,,,0,,70450,Radiology,,,0301,22,Outpatient Hospital,3,1480.21,1046.35,940.41,105.94,0.0,0.0,105.94,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005855,MBR00000226,Institutional-IP,2021-05-01,2021-05-14,2021-06-05,PLN8319,1390307371,1390307371,DME Supplier,In-Network,F32.9,J06.9,,,,603,MS-DRG,24,13,Y,G0468,Medicine,,,0120,21,Inpatient Hospital,3,536.22,435.46,392.0,0.0,0.0,43.46,43.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005856,MBR00000226,Institutional-OP,2023-11-06,2023-11-06,2023-11-30,PLN7473,1563980627,1563980627,Critical Access Hospital,In-Network,Z23,F41.9,,,,,,,0,,93000,Radiology,,,0360,22,Outpatient Hospital,2,140.26,116.47,0.0,0.0,35.0,0.95,35.95,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005857,MBR00000226,Professional,2023-07-28,2023-07-28,2023-08-15,PLN1286,1205377316,1205377316,Orthopedic Surgery,In-Network,E11.9,F32.9,,,,,,,0,,99406,Medicine,,,,11,Office,2,87.99,37.9,0.0,37.9,0.0,0.0,37.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005858,MBR00000226,Professional,2022-10-07,2022-10-07,2022-10-29,PLN9834,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,R10.9,I10,,,,,,,0,,78452,Radiology,,,,22,Outpatient Hospital,2,5067.57,4280.64,4105.14,0.0,75.0,100.5,175.5,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005859,MBR00000226,Institutional-OP,2023-07-16,2023-07-16,2023-08-25,PLN4091,1896447406,1896447406,Nephrology,Out-of-Network,E11.9,J20.9,,,,,,,0,,99233,E&M,,,0900,22,Outpatient Hospital,3,432.89,323.06,323.06,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005860,MBR00000226,Professional,2022-01-12,2022-01-12,2022-02-04,PLN3574,1224179551,1224179551,Physical Therapy,In-Network,J44.1,E11.9,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,2,593.22,338.58,296.6,0.0,0.0,41.98,41.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005861,MBR00000226,Professional,2022-06-05,2022-06-05,2022-07-06,PLN1844,1395983630,1395983630,Nephrology,In-Network,J44.1,N18.3,,,,,,,0,,90460,Medicine,,,,11,Office,2,37.67,24.37,0.0,24.37,0.0,0.0,24.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005862,MBR00000226,Professional,2023-08-26,2023-08-26,2023-09-18,PLN6141,1556140803,1556140803,Cardiology,In-Network,J20.9,I10,,,,,,,0,,45378,Surgery,,,,11,Office,1,1991.08,1279.0,1279.0,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000005863,MBR00000226,Institutional-IP,2021-06-11,2021-06-12,2021-06-26,PLN9508,1687650653,1687650653,Internal Medicine,In-Network,E11.65,Z79.4,,,,292,MS-DRG,17,1,Y,45380,Surgery,,,0301,21,Inpatient Hospital,2,2680.69,2115.11,1939.0,0.0,0.0,176.11,176.11,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000005864,MBR00000226,Institutional-OP,2021-06-10,2021-06-10,2021-07-14,PLN1835,1520687146,1520687146,ASC,In-Network,N18.3,F03.90,,,,,,,0,,93306,Radiology,,,0900,22,Outpatient Hospital,2,1462.56,758.27,527.48,205.79,25.0,0.0,230.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005865,MBR00000226,Professional,2022-07-31,2022-07-31,2022-08-27,PLN3676,1817234602,1817234602,Clinical Laboratory,In-Network,K92.1,E11.40,,,,,,,0,,45378,Surgery,,,,20,Urgent Care,1,2488.5,1906.36,1612.13,294.23,0.0,0.0,294.23,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000005866,MBR00000226,Professional,2021-10-04,2021-10-04,2021-10-15,PLN4058,1389336600,1389336600,Critical Access Hospital,In-Network,Z00.00,Z96.641,,,,,,,0,,99213,E&M,,,,31,Skilled Nursing Facility,2,177.8,130.27,0.0,130.27,75.0,0.0,205.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005867,MBR00000226,Institutional-OP,2023-01-02,2023-01-02,2023-01-11,PLN6403,1422747896,1422747896,Urology,In-Network,Z12.31,K21.0,,,,,,,0,,47562,Surgery,,,0900,22,Outpatient Hospital,3,5644.28,2150.96,2150.96,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005868,MBR00000226,Professional,2022-11-28,2022-11-28,2022-12-07,PLN8949,1899127912,1899127912,Neurology,In-Network,N39.0,I10,,,,,,,0,,93306,Radiology,,,,22,Outpatient Hospital,3,2504.08,1411.77,1224.3,137.47,50.0,0.0,187.47,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005869,MBR00000226,Professional,2021-12-30,2021-12-30,2022-01-30,PLN3017,1590915516,1590915516,Physical Therapy,Out-of-Network,E78.5,Z12.31,,,,,,,0,,93306,Radiology,,,,11,Office,3,2341.05,1773.83,1671.07,0.0,0.0,102.76,102.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005870,MBR00000226,Professional,2021-05-07,2021-05-07,2021-06-01,PLN2678,1872272835,1872272835,Internal Medicine,In-Network,E11.9,Z12.31,,,,,,,0,,G0468,Medicine,,,,11,Office,3,716.47,597.08,550.44,0.0,0.0,46.64,46.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005871,MBR00000226,Institutional-OP,2021-04-01,2021-04-01,2021-05-08,PLN2995,1530904931,1530904931,Internal Medicine,In-Network,J06.9,E66.9,,,,,,,0,,86900,Pathology/Lab,,,0301,22,Outpatient Hospital,3,39.25,13.56,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005872,MBR00000226,Professional,2022-05-01,2022-05-01,2022-05-27,PLN9927,1531398223,1531398223,OB/GYN,In-Network,K21.0,C50.912,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,3,40.7,34.05,34.05,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005873,MBR00000226,Professional,2021-12-19,2021-12-19,2022-01-27,PLN5027,1910255109,1910255109,DME Supplier,In-Network,S72.001A,E11.9,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,2,181.67,141.92,0.0,112.25,75.0,0.0,187.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005874,MBR00000227,Professional,2021-02-07,2021-02-07,2021-03-09,PLN9949,1530904931,1530904931,Internal Medicine,In-Network,I10,E11.9,,,,,,,0,,99283,E&M,,,,11,Office,1,604.55,408.58,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005875,MBR00000227,Professional,2023-01-27,2023-01-27,2023-03-09,PLN2475,1139906830,1139906830,Endocrinology,Out-of-Network,Z23,Z12.31,,,,,,,0,,G0468,Medicine,,,,23,Emergency Room,3,744.37,375.92,50.07,314.76,0.0,11.09,325.85,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005876,MBR00000227,Institutional-OP,2023-11-15,2023-11-15,2023-12-24,PLN6930,1355166277,1355166277,Endocrinology,In-Network,I10,I11.9,,,,,,,0,,G0444,Medicine,,,0636,22,Outpatient Hospital,2,101.55,80.19,5.13,0.0,75.0,0.06,75.06,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000005877,MBR00000227,Institutional-OP,2023-12-08,2023-12-08,2023-12-23,PLN4248,1702692193,1702692193,Physical Therapy,In-Network,J45.20,E11.9,,,,,,,0,,99222,E&M,,,0761,22,Outpatient Hospital,1,599.04,268.98,253.98,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005878,MBR00000228,Institutional-IP,2021-05-09,2021-05-10,2021-05-31,PLN5871,1132188260,1132188260,Family Medicine,In-Network,Z00.00,K92.1,,,,195,MS-DRG,11,1,Y,85025,Pathology/Lab,,,0301,21,Inpatient Hospital,2,64.65,23.25,23.25,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005879,MBR00000228,Professional,2021-07-28,2021-07-28,2021-08-17,PLN7183,1609138981,1609138981,Critical Access Hospital,In-Network,I10,C50.912,,,,,,,0,,27130,Surgery,,,,11,Office,2,3886.0,1177.67,1162.67,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005880,MBR00000228,Professional,2022-04-19,2022-04-19,2022-04-26,PLN4663,1812060197,1812060197,Oncology,Out-of-Network,M54.5,M81.0,,,,,,,0,,86900,Pathology/Lab,,,,31,Skilled Nursing Facility,2,60.8,31.85,31.76,0.0,0.0,0.09,0.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005881,MBR00000228,Institutional-IP,2023-09-29,2023-10-01,2023-10-29,PLN9213,1700633438,1700633438,DME Supplier,In-Network,E11.9,J44.1,,,,470,MS-DRG,18,2,Y,99283,E&M,,,0320,21,Inpatient Hospital,1,285.04,180.29,130.29,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005882,MBR00000228,Professional,2022-09-22,2022-09-22,2022-10-14,PLN5123,1767011137,1767011137,DME Supplier,In-Network,M17.11,E11.9,,,,,,,0,,97530,Medicine,,,,23,Emergency Room,2,115.74,48.8,0.0,48.8,0.0,0.0,48.8,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005883,MBR00000228,Institutional-IP,2022-05-16,2022-05-23,2022-06-01,PLN8974,1915531927,1915531927,Critical Access Hospital,In-Network,Z00.00,E11.9,,,,872,MS-DRG,18,7,Y,97110,Medicine,,,0301,21,Inpatient Hospital,1,205.91,67.49,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005884,MBR00000228,Professional,2023-10-11,2023-10-11,2023-11-10,PLN4216,1645194539,1645194539,SNF,In-Network,F32.9,R10.9,,,,,,,0,,86900,Pathology/Lab,,,,31,Skilled Nursing Facility,2,46.52,14.7,14.7,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000005885,MBR00000228,Institutional-OP,2022-12-28,2022-12-28,2023-01-12,PLN2502,1125190055,1125190055,Nephrology,In-Network,I10,N39.0,,,,,,,0,,99283,E&M,,,0301,22,Outpatient Hospital,1,511.48,358.22,333.22,0.0,25.0,0.0,25.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005886,MBR00000228,Professional,2023-12-15,2023-12-15,2024-01-28,PLN6116,1242201429,1242201429,General Acute Care Hospital,In-Network,J44.1,M17.11,,,,,,,0,,99233,E&M,,,,11,Office,3,353.02,180.88,145.88,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005887,MBR00000228,Professional,2023-08-04,2023-08-04,2023-08-13,PLN6282,1590915516,1590915516,Physical Therapy,Out-of-Network,I10,N39.0,,,,,,,0,,27447,Surgery,,,,50,Federally Qualified Health Center,1,5610.76,3642.57,3478.23,0.0,0.0,164.34,164.34,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005888,MBR00000228,Professional,2023-12-30,2023-12-30,2024-01-31,PLN9048,1295371663,1295371663,Critical Access Hospital,In-Network,I10,J06.9,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,2,248.72,118.2,81.14,0.0,25.0,12.06,37.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005889,MBR00000228,Professional,2022-09-03,2022-09-03,2022-09-15,PLN9110,1239316214,1239316214,Internal Medicine,In-Network,E66.9,Z87.891,,,,,,,0,,99232,E&M,,,,11,Office,1,361.71,138.93,133.12,0.0,0.0,5.81,5.81,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005890,MBR00000228,Professional,2022-02-15,2022-02-15,2022-03-07,PLN5839,1486164553,1486164553,DME Supplier,In-Network,R05,G20,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,2,603.81,209.51,184.51,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005891,MBR00000228,Professional,2021-03-09,2021-03-09,2021-03-30,PLN2884,1168881145,1168881145,Orthopedic Surgery,In-Network,M54.5,E11.9,,,,,,,0,,45378,Surgery,,,,21,Inpatient Hospital,2,2431.74,730.92,520.77,173.42,0.0,36.73,210.15,0.0,Paid,,,1,,0,1,1,0,0,1,Unbundling,0,1,0,0,0
CLM0000005892,MBR00000228,Institutional-OP,2023-03-11,2023-03-11,2023-03-19,PLN2252,1609138981,1609138981,Critical Access Hospital,In-Network,I25.10,I10,,,,,,,0,,G0439,Medicine,,,0120,22,Outpatient Hospital,2,474.69,260.87,185.36,60.51,15.0,0.0,75.51,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000005893,MBR00000228,Professional,2021-10-19,2021-10-19,2021-11-27,PLN9639,1438368327,1438368327,Home Health,In-Network,M17.11,Z12.31,,,,,,,0,,93225,Medicine,,,,11,Office,1,406.79,145.69,0.0,145.69,0.0,0.0,145.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005894,MBR00000228,Professional,2021-01-13,2021-01-13,2021-02-07,PLN3553,1500949740,1500949740,Pediatrics,In-Network,N40.0,R05,,,,,,,0,,90460,Medicine,,,,20,Urgent Care,2,36.98,30.46,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005895,MBR00000228,Professional,2023-05-30,2023-05-30,2023-07-04,PLN4979,1283743001,1283743001,Family Medicine,In-Network,N39.0,G43.909,,,,,,,0,,47562,Surgery,,,,31,Skilled Nursing Facility,2,3101.07,1567.64,1567.64,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005896,MBR00000228,Professional,2022-04-10,2022-04-10,2022-05-06,PLN5711,1463205530,1463205530,Nephrology,In-Network,J20.9,Z87.891,,,,,,,0,,97110,Medicine,,,,23,Emergency Room,1,197.23,155.27,120.27,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005897,MBR00000228,Institutional-OP,2022-08-29,2022-08-29,2022-10-01,PLN8665,1946680931,1946680931,Critical Access Hospital,Out-of-Network,I48.91,Z00.00,,,,,,,0,,G0439,Medicine,,,0900,22,Outpatient Hospital,3,290.8,100.12,0.0,100.12,75.0,0.0,175.12,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000005898,MBR00000228,Professional,2023-05-09,2023-05-09,2023-06-08,PLN3518,1247341320,1247341320,Urology,Out-of-Network,N39.0,E78.5,,,,,,,0,,G0444,Medicine,,,,11,Office,1,57.43,20.89,5.57,0.32,15.0,0.0,15.32,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000005899,MBR00000229,Institutional-OP,2021-12-27,2021-12-27,2022-01-31,PLN7870,1800011727,1800011727,Clinical Laboratory,Out-of-Network,N39.0,Z12.31,,,,,,,0,,23472,Surgery,,,0120,22,Outpatient Hospital,2,3776.46,2164.02,2075.2,0.0,0.0,88.82,88.82,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005900,MBR00000229,Institutional-IP,2023-06-14,2023-06-15,2023-07-17,PLN1807,1205377316,1205377316,Orthopedic Surgery,In-Network,Z23,G43.909,,,,872,MS-DRG,13,1,Y,99284,E&M,,,0270,21,Inpatient Hospital,2,797.1,593.32,114.47,439.15,25.0,14.7,478.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005901,MBR00000229,Professional,2022-10-01,2022-10-01,2022-11-03,PLN1378,1433937353,1433937353,Nephrology,In-Network,E66.9,J06.9,,,,,,,0,,87491,Pathology/Lab,,,,81,Independent Laboratory,1,206.27,146.35,146.35,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005902,MBR00000229,Professional,2022-09-14,2022-09-14,2022-10-01,PLN3847,1268679390,1268679390,Critical Access Hospital,In-Network,E78.5,E11.40,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,3,509.35,216.5,201.5,0.0,15.0,0.0,15.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005903,MBR00000229,Professional,2021-10-22,2021-10-22,2021-12-01,PLN2742,1213165847,1213165847,Critical Access Hospital,In-Network,N39.0,E11.65,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,2,800.84,413.97,297.88,81.09,35.0,0.0,116.09,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005904,MBR00000229,Professional,2023-05-14,2023-05-14,2023-06-09,PLN5673,1355166277,1355166277,Endocrinology,In-Network,J44.1,I10,,,,,,,0,,66984,Surgery,,,,81,Independent Laboratory,3,2953.44,1856.09,1841.09,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005905,MBR00000229,Professional,2021-09-21,2021-09-21,2021-10-15,PLN7428,1716521444,1716521444,Oncology,In-Network,N39.0,I10,,,,,,,0,,93225,Medicine,,,,23,Emergency Room,2,349.33,162.9,145.47,17.43,0.0,0.0,17.43,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005906,MBR00000229,Institutional-IP,2022-11-09,2022-11-10,2022-11-26,PLN2975,1239316214,1239316214,Internal Medicine,In-Network,E78.5,I10,,,,683,MS-DRG,21,1,Y,43239,Surgery,,,0200,21,Inpatient Hospital,2,1337.36,519.8,24.7,470.1,25.0,0.0,495.1,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005907,MBR00000229,Institutional-OP,2023-06-27,2023-06-27,2023-07-14,PLN5710,1757138478,1757138478,Pediatrics,In-Network,F41.9,E11.9,,,,,,,0,,99214,E&M,,,0270,22,Outpatient Hospital,2,162.37,88.42,0.0,88.42,0.0,0.0,88.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005908,MBR00000229,Professional,2021-05-08,2021-05-08,2021-06-19,PLN2672,1809014947,1809014947,Urology,In-Network,Z12.31,I11.9,,,,,,,0,,74177,Radiology,,,,11,Office,3,2445.3,1362.9,933.29,429.61,0.0,0.0,429.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005909,MBR00000229,Institutional-IP,2022-03-15,2022-03-20,2022-04-03,PLN4632,1528335731,1528335731,Critical Access Hospital,In-Network,E66.9,N20.0,,,,603,MS-DRG,15,5,Y,99214,E&M,,,0900,21,Inpatient Hospital,2,235.74,99.3,93.03,0.0,0.0,6.27,6.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005910,MBR00000229,Institutional-OP,2023-01-12,2023-01-12,2023-02-06,PLN3651,1372918899,1372918899,Family Medicine,In-Network,Z12.31,Z23,,,,,,,0,,99222,E&M,,,0740,22,Outpatient Hospital,1,486.09,244.75,244.75,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005911,MBR00000229,Professional,2021-10-28,2021-10-28,2021-11-14,PLN2891,1205377316,1205377316,Orthopedic Surgery,In-Network,N20.0,E11.9,,,,,,,0,,99203,E&M,,,,81,Independent Laboratory,1,154.91,60.6,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005912,MBR00000229,Professional,2021-01-31,2021-01-31,2021-03-05,PLN7921,1997536841,1997536841,Family Medicine,Out-of-Network,I11.9,E11.9,,,,,,,0,,70553,Radiology,,,,50,Federally Qualified Health Center,3,1664.6,970.93,970.93,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005913,MBR00000229,Professional,2022-03-25,2022-03-25,2022-04-29,PLN8303,1366286000,1366286000,SNF,In-Network,N17.9,F32.9,,,,,,,0,,99232,E&M,,,,65,End-Stage Renal Disease,3,386.83,289.89,289.89,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005914,MBR00000229,Professional,2022-06-28,2022-06-28,2022-07-16,PLN8600,1475984649,1475984649,SNF,In-Network,Z12.31,F41.9,,,,,,,0,,78452,Radiology,,,,21,Inpatient Hospital,3,6958.1,2970.1,2407.02,0.0,0.0,563.08,563.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005915,MBR00000229,Professional,2023-10-06,2023-10-06,2023-10-28,PLN1756,1132188260,1132188260,Family Medicine,In-Network,Z00.00,E78.5,,,,,,,0,,72148,Radiology,,,,23,Emergency Room,2,1495.72,1201.14,1056.83,144.31,0.0,0.0,144.31,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005916,MBR00000229,Professional,2023-06-03,2023-06-03,2023-06-16,PLN2429,1728018911,1728018911,Nephrology,In-Network,N18.3,Z12.31,,,,,,,0,,27447,Surgery,,,,11,Office,1,6112.56,2235.23,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-18,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005917,MBR00000229,Institutional-OP,2021-07-17,2021-07-17,2021-08-03,PLN3452,1915531927,1915531927,Critical Access Hospital,In-Network,I10,E11.9,,,,,,,0,,99204,E&M,,,0200,22,Outpatient Hospital,3,244.79,203.02,0.0,203.02,0.0,0.0,203.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005918,MBR00000229,Professional,2021-10-31,2021-10-31,2021-12-04,PLN9562,1935547131,1935547131,Pulmonology,In-Network,R10.9,E78.5,,,,,,,0,,99283,E&M,,,,12,Home,2,300.25,248.6,248.6,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005919,MBR00000229,Institutional-OP,2021-07-22,2021-07-22,2021-08-18,PLN1921,1556140803,1556140803,Cardiology,In-Network,K21.0,E11.9,,,,,,,0,,27130,Surgery,,,0360,22,Outpatient Hospital,1,4700.01,2855.89,2745.04,95.85,15.0,0.0,110.85,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005920,MBR00000229,Professional,2023-09-25,2023-09-25,2023-10-26,PLN9361,1752470395,1752470395,Home Health,In-Network,Z51.11,J44.1,,,,,,,0,,99203,E&M,,,,11,Office,3,306.32,206.25,206.25,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005921,MBR00000229,Professional,2022-01-23,2022-01-23,2022-03-01,PLN1363,1939033455,1939033455,Pulmonology,In-Network,J45.20,I10,,,,,,,0,,47562,Surgery,,,,23,Emergency Room,1,3832.58,2799.01,2799.01,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005922,MBR00000229,Professional,2023-09-03,2023-09-03,2023-10-07,PLN8523,1727809972,1727809972,Home Health,In-Network,R10.9,J06.9,,,,,,,0,,93306,Radiology,,,,12,Home,2,2110.46,861.58,826.58,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005923,MBR00000229,Professional,2021-03-08,2021-03-08,2021-03-31,PLN5587,1778483301,1778483301,Home Health,In-Network,I10,N40.0,,,,,,,0,,45378,Surgery,,,,11,Office,3,1102.98,532.2,309.86,222.34,0.0,0.0,222.34,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000005924,MBR00000229,Professional,2022-09-04,2022-09-04,2022-10-08,PLN3567,1631954542,1631954542,Oncology,In-Network,E11.40,I25.10,,,,,,,0,,45380,Surgery,,,,23,Emergency Room,1,3030.81,1455.63,1455.63,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,1,0,0,0
CLM0000005925,MBR00000229,Professional,2021-03-24,2021-03-24,2021-04-13,PLN2692,1235381502,1235381502,Cardiology,In-Network,Z12.31,R07.9,,,,,,,0,,90837,Medicine,,,,20,Urgent Care,1,224.89,104.93,0.0,104.93,75.0,0.0,179.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005926,MBR00000229,Institutional-IP,2022-08-31,2022-09-01,2022-10-05,PLN8540,1713934949,1713934949,Neurology,In-Network,I48.91,Z23,,,,872,MS-DRG,7,1,Y,77067,Radiology,,,0510,21,Inpatient Hospital,1,337.12,156.09,141.09,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000005927,MBR00000229,Professional,2021-01-13,2021-01-13,2021-02-12,PLN7245,1847081578,1847081578,Urology,Out-of-Network,J18.9,Z00.00,,,,,,,0,,99232,E&M,,,,49,Independent Clinic,2,177.37,118.27,101.48,0.0,0.0,16.79,16.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005928,MBR00000229,Professional,2021-06-21,2021-06-21,2021-07-15,PLN1056,1840431511,1840431511,Geriatrics,Out-of-Network,E11.9,F32.9,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,3,314.72,160.48,146.27,4.6,0.0,9.61,14.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005929,MBR00000229,Professional,2021-06-10,2021-06-10,2021-07-07,PLN4843,1561134315,1561134315,DME Supplier,In-Network,M54.5,E11.9,,,,,,,0,,90837,Medicine,,,,21,Inpatient Hospital,3,213.44,98.64,98.13,0.0,0.0,0.51,0.51,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000005930,MBR00000229,Professional,2023-02-16,2023-02-16,2023-03-06,PLN6035,1511044648,1511044648,Endocrinology,In-Network,J44.1,I10,,,,,,,0,,G0439,Medicine,,,,11,Office,2,343.73,240.93,193.92,0.0,0.0,47.01,47.01,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000005931,MBR00000229,Professional,2022-12-03,2022-12-03,2022-12-25,PLN3994,1245650222,1245650222,Gastroenterology,In-Network,F32.9,Z00.00,,,,,,,0,,43239,Surgery,,,,11,Office,2,861.14,640.4,640.4,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005932,MBR00000229,Professional,2022-09-04,2022-09-04,2022-09-25,PLN7470,1245650222,1245650222,Gastroenterology,In-Network,Z87.891,I25.10,,,,,,,0,,97530,Medicine,,,,12,Home,1,150.25,56.5,56.5,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005933,MBR00000229,Professional,2021-08-04,2021-08-04,2021-09-04,PLN4887,1198133277,1198133277,SNF,In-Network,I10,M54.5,,,,,,,0,,72148,Radiology,,,,22,Outpatient Hospital,2,1436.52,807.87,807.87,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005934,MBR00000229,Professional,2021-10-19,2021-10-19,2021-11-09,PLN2783,1974006077,1974006077,Orthopedic Surgery,In-Network,E78.5,J06.9,,,,,,,0,,99232,E&M,,,,11,Office,1,140.8,65.75,15.75,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005935,MBR00000229,Institutional-OP,2022-02-18,2022-02-18,2022-03-05,PLN8839,1540044947,1540044947,Pulmonology,Out-of-Network,E11.65,M54.5,,,,,,,0,,81001,Pathology/Lab,,,0200,22,Outpatient Hospital,1,25.31,15.69,0.0,15.69,50.0,0.0,65.69,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005936,MBR00000229,Institutional-OP,2023-12-08,2023-12-08,2023-12-30,PLN8870,1389336600,1389336600,Critical Access Hospital,In-Network,Z00.00,C50.912,,,,,,,0,,47562,Surgery,,,0761,22,Outpatient Hospital,2,5255.24,2828.0,0.0,348.97,0.0,165.59,514.56,0.0,Denied,CO-119,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005937,MBR00000229,Professional,2023-02-12,2023-02-12,2023-03-19,PLN1639,1434029575,1434029575,Endocrinology,In-Network,K21.0,E11.9,,,,,,,0,,71046,Radiology,,,,21,Inpatient Hospital,3,283.19,175.57,140.57,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005938,MBR00000229,Professional,2021-02-04,2021-02-04,2021-03-06,PLN6483,1716521444,1716521444,Oncology,In-Network,N39.0,F32.9,,,,,,,0,,90837,Medicine,,,,11,Office,2,260.03,190.04,0.0,190.04,0.0,0.0,190.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005939,MBR00000229,Institutional-OP,2021-02-04,2021-02-04,2021-03-16,PLN9832,1752470395,1752470395,Home Health,In-Network,R51,J45.20,,,,,,,0,,33533,Surgery,,,0301,22,Outpatient Hospital,3,24013.04,12612.76,12537.76,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000005940,MBR00000229,Professional,2022-01-16,2022-01-16,2022-02-26,PLN2004,1644128543,1644128543,Gastroenterology,In-Network,Z12.11,Z00.00,,,,,,,0,,74177,Radiology,,,,11,Office,2,1751.88,1005.59,1005.59,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005941,MBR00000230,Professional,2021-08-17,2021-08-17,2021-09-13,PLN3174,1809014947,1809014947,Urology,In-Network,G43.909,K21.0,,,,,,,0,,81001,Pathology/Lab,,,,12,Home,1,35.65,16.72,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005942,MBR00000230,Institutional-IP,2022-03-22,2022-03-29,2022-04-07,PLN4791,1518055405,1518055405,Urology,In-Network,N39.0,M17.11,,,,196,MS-DRG,3,7,N,82043,Pathology/Lab,,,0450,21,Inpatient Hospital,1,61.76,21.57,21.57,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005943,MBR00000230,Professional,2023-12-27,2023-12-27,2024-01-25,PLN6477,1948810580,1948810580,DME Supplier,In-Network,N39.0,E78.5,,,,,,,0,,71046,Radiology,,,,11,Office,3,293.59,126.77,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005944,MBR00000230,Professional,2021-08-03,2021-08-03,2021-09-08,PLN8210,1502838586,1502838586,ASC,In-Network,E78.5,F10.20,,,,,,,0,,99214,E&M,,,,11,Office,1,345.34,147.67,0.0,109.84,50.0,0.0,159.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005945,MBR00000230,Professional,2022-10-16,2022-10-16,2022-11-21,PLN8430,1366426662,1366426662,Urology,In-Network,I48.91,M17.11,,,,,,,0,,97530,Medicine,,,,49,Independent Clinic,1,214.52,122.03,59.55,0.0,50.0,12.48,62.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005946,MBR00000230,Professional,2022-06-13,2022-06-13,2022-07-11,PLN5983,1799205295,1799205295,General Acute Care Hospital,In-Network,J06.9,Z87.891,,,,,,,0,,71046,Radiology,,,,31,Skilled Nursing Facility,2,215.3,142.98,84.1,43.88,15.0,0.0,58.88,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005947,MBR00000230,Professional,2022-12-24,2022-12-24,2023-01-02,PLN3236,1453283987,1453283987,Critical Access Hospital,In-Network,E11.9,I10,,,,,,,0,,23472,Surgery,,,,11,Office,2,4212.78,2216.19,2166.19,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005948,MBR00000231,Professional,2022-08-22,2022-08-22,2022-09-07,PLN2137,1244186984,1244186984,Family Medicine,Out-of-Network,E78.5,N39.0,,,,,,,0,,80061,Pathology/Lab,,,,12,Home,2,114.92,63.1,19.7,8.4,35.0,0.0,43.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005949,MBR00000231,Institutional-IP,2022-07-20,2022-08-01,2022-08-27,PLN4238,1148984206,1148984206,Psychiatry,In-Network,J06.9,I10,,,,690,MS-DRG,18,12,N,45380,Surgery,,,0120,21,Inpatient Hospital,1,2611.48,1551.93,1551.93,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000005950,MBR00000231,Professional,2021-10-30,2021-10-30,2021-11-24,PLN6675,1502838586,1502838586,ASC,In-Network,E66.9,Z12.31,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,2,505.97,234.49,0.0,234.49,15.0,0.0,249.49,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005951,MBR00000231,Professional,2023-11-24,2023-11-24,2024-01-04,PLN1294,1702692193,1702692193,Physical Therapy,In-Network,Z23,E78.5,,,,,,,0,,99213,E&M,,,,22,Outpatient Hospital,3,305.66,226.83,0.0,59.19,0.0,22.96,82.15,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005952,MBR00000231,Professional,2021-10-20,2021-10-20,2021-11-01,PLN8893,1645194539,1645194539,SNF,In-Network,E78.5,Z12.31,,,,,,,0,,93225,Medicine,,,,22,Outpatient Hospital,2,944.66,528.87,513.87,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005953,MBR00000231,Institutional-OP,2021-06-08,2021-06-08,2021-06-18,PLN6797,1700633438,1700633438,DME Supplier,In-Network,E11.9,Z00.00,,,,,,,0,,87491,Pathology/Lab,,,0120,22,Outpatient Hospital,3,247.09,136.39,49.49,86.9,0.0,0.0,86.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005954,MBR00000231,Professional,2021-04-16,2021-04-16,2021-05-13,PLN9394,1530904931,1530904931,Internal Medicine,In-Network,N39.0,I11.9,,,,,,,0,,27447,Surgery,,,,49,Independent Clinic,1,5155.15,3114.09,2868.68,0.0,25.0,220.41,245.41,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005955,MBR00000231,Professional,2021-03-15,2021-03-15,2021-04-25,PLN4442,1361302520,1361302520,Critical Access Hospital,In-Network,Z23,E87.6,,,,,,,0,,85025,Pathology/Lab,,,,23,Emergency Room,3,56.84,28.48,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-27,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005956,MBR00000231,Institutional-IP,2022-01-22,2022-01-23,2022-03-03,PLN8811,1372918899,1372918899,Family Medicine,In-Network,J44.1,I10,,,,291,MS-DRG,4,1,Y,97530,Medicine,,,0200,21,Inpatient Hospital,3,253.52,89.95,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005957,MBR00000231,Professional,2023-06-13,2023-06-13,2023-07-20,PLN1330,1433937353,1433937353,Nephrology,In-Network,F10.20,I10,,,,,,,0,,80053,Pathology/Lab,,,,49,Independent Clinic,3,148.35,80.25,54.85,0.0,25.0,0.4,25.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005958,MBR00000232,Professional,2021-06-19,2021-06-19,2021-07-07,PLN2501,1757138478,1757138478,Pediatrics,In-Network,J18.9,J06.9,,,,,,,0,,G0468,Medicine,,,,12,Home,1,335.23,249.09,0.0,249.09,0.0,0.0,249.09,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000005959,MBR00000232,Professional,2021-01-05,2021-01-05,2021-01-14,PLN6191,1563980627,1563980627,Critical Access Hospital,In-Network,Z23,I10,,,,,,,0,,G0439,Medicine,,,,12,Home,2,259.57,218.95,193.57,0.0,0.0,25.38,25.38,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000005960,MBR00000232,Institutional-OP,2022-08-04,2022-08-04,2022-08-17,PLN5433,1266606767,1266606767,ASC,In-Network,J20.9,J06.9,,,,,,,0,,71046,Radiology,,,0730,22,Outpatient Hospital,1,252.25,190.26,0.0,190.26,0.0,0.0,190.26,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005961,MBR00000232,Institutional-IP,2022-09-07,2022-09-15,2022-10-12,PLN6662,1148984206,1148984206,Psychiatry,In-Network,M54.5,Z87.891,,,,291,MS-DRG,22,8,Y,70450,Radiology,,,0730,21,Inpatient Hospital,1,1270.87,563.04,357.42,136.98,50.0,18.64,205.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005962,MBR00000232,Professional,2022-09-09,2022-09-09,2022-10-13,PLN7383,1438368327,1438368327,Home Health,In-Network,K21.0,E11.9,,,,,,,0,,99406,Medicine,,,,49,Independent Clinic,1,55.05,23.21,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005963,MBR00000232,Institutional-OP,2021-01-02,2021-01-02,2021-01-27,PLN8328,1434029575,1434029575,Endocrinology,In-Network,I63.9,I48.91,,,,,,,0,,93225,Medicine,,,0301,22,Outpatient Hospital,1,574.23,443.37,228.18,215.19,0.0,0.0,215.19,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005964,MBR00000232,Institutional-IP,2021-08-11,2021-08-17,2021-08-29,PLN3686,1148984206,1148984206,Psychiatry,In-Network,E66.9,R51,,,,291,MS-DRG,4,6,Y,66984,Surgery,,,0320,21,Inpatient Hospital,1,1810.01,1209.84,1198.41,0.0,0.0,11.43,11.43,0.0,Paid,,,0,,0,0,1,0,0,1,Phantom,0,0,0,0,0
CLM0000005965,MBR00000232,Professional,2022-01-17,2022-01-17,2022-01-27,PLN9319,1500037969,1500037969,Pulmonology,In-Network,K57.30,Z00.00,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,2,512.11,353.11,0.0,353.11,15.0,0.0,368.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005966,MBR00000232,Professional,2023-03-21,2023-03-21,2023-05-02,PLN9909,1273488618,1273488618,General Acute Care Hospital,In-Network,E78.5,N39.0,,,,,,,0,,99283,E&M,,,,23,Emergency Room,3,548.68,234.6,234.6,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000005967,MBR00000232,Professional,2022-12-14,2022-12-14,2023-01-22,PLN8102,1994661817,1994661817,SNF,Out-of-Network,F10.20,Z12.31,,,,,,,0,,99284,E&M,,,,11,Office,3,441.51,194.15,0.0,194.15,75.0,0.0,269.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005968,MBR00000232,Professional,2023-06-11,2023-06-11,2023-07-05,PLN6027,1799205295,1799205295,General Acute Care Hospital,In-Network,M54.5,N39.0,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,1,295.42,169.91,0.0,169.91,0.0,0.0,169.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005969,MBR00000232,Institutional-OP,2022-08-23,2022-08-23,2022-09-07,PLN3449,1991459367,1991459367,Neurology,Out-of-Network,Z12.31,Z00.00,,,,,,,0,,84443,Pathology/Lab,,,0301,22,Outpatient Hospital,1,78.56,37.74,0.0,37.74,35.0,0.0,72.74,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000005970,MBR00000232,Professional,2022-03-18,2022-03-18,2022-04-27,PLN7812,1242201429,1242201429,General Acute Care Hospital,In-Network,I25.10,F32.9,,,,,,,0,,33533,Surgery,,,,11,Office,3,11287.32,5687.47,0.0,32.92,50.0,420.94,503.86,0.0,Denied,CO-11,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000005971,MBR00000232,Professional,2022-09-06,2022-09-06,2022-09-14,PLN3943,1899127912,1899127912,Neurology,In-Network,I25.10,E78.5,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,3,869.4,735.54,595.94,139.6,0.0,0.0,139.6,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005972,MBR00000232,Professional,2022-02-26,2022-02-26,2022-04-05,PLN5986,1500949740,1500949740,Pediatrics,In-Network,N40.0,Z12.11,,,,,,,0,,99203,E&M,,,,11,Office,3,244.55,124.1,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005973,MBR00000232,Professional,2021-06-22,2021-06-22,2021-07-29,PLN3266,1295371663,1295371663,Critical Access Hospital,In-Network,E66.9,I10,,,,,,,0,,27447,Surgery,,,,12,Home,2,5491.85,4242.32,4207.32,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005974,MBR00000232,Institutional-OP,2022-09-23,2022-09-23,2022-10-10,PLN4716,1511044648,1511044648,Endocrinology,In-Network,Z96.641,I10,,,,,,,0,,99213,E&M,,,0320,22,Outpatient Hospital,2,188.09,140.35,58.15,0.0,75.0,7.2,82.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005975,MBR00000232,Professional,2021-11-19,2021-11-19,2021-12-05,PLN1449,1284035364,1284035364,Pediatrics,In-Network,Z87.891,Z12.31,,,,,,,0,,76700,Radiology,,,,11,Office,3,1169.55,673.51,329.6,275.49,0.0,68.42,343.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005976,MBR00000232,Professional,2021-10-17,2021-10-17,2021-10-28,PLN4158,1563980627,1563980627,Critical Access Hospital,In-Network,J44.1,I10,,,,,,,0,,90460,Medicine,,,,11,Office,1,54.77,44.92,0.0,44.92,0.0,0.0,44.92,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000005977,MBR00000233,Institutional-IP,2023-02-17,2023-03-01,2023-02-27,PLN1543,1778483301,1778483301,Home Health,In-Network,Z00.00,I25.10,,,,196,MS-DRG,12,12,Y,G0444,Medicine,,,0370,21,Inpatient Hospital,2,63.91,32.97,17.97,0.0,15.0,0.0,15.0,0.0,Adjusted,,,0,,0,1,0,0,1,0,None,0,0,0,0,1
CLM0000005978,MBR00000233,Institutional-OP,2021-03-14,2021-03-14,2021-04-23,PLN7039,1337791138,1337791138,Internal Medicine,Out-of-Network,I10,I11.9,,,,,,,0,,99232,E&M,,,0510,22,Outpatient Hospital,2,182.68,98.03,83.03,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005979,MBR00000233,Professional,2021-01-26,2021-01-26,2021-02-08,PLN8195,1856686341,1856686341,Geriatrics,In-Network,I10,I25.10,,,,,,,0,,70450,Radiology,,,,31,Skilled Nursing Facility,3,841.05,337.31,0.0,337.31,75.0,0.0,412.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005980,MBR00000233,Professional,2022-01-25,2022-01-25,2022-03-09,PLN6057,1486164553,1486164553,DME Supplier,In-Network,E11.9,K21.0,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,3,349.09,224.72,224.72,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005981,MBR00000233,Institutional-OP,2022-10-14,2022-10-14,2022-10-31,PLN8765,1410468316,1410468316,SNF,In-Network,K57.30,N18.3,,,,,,,0,,43239,Surgery,,,0200,22,Outpatient Hospital,3,1268.53,579.56,522.22,0.0,35.0,22.34,57.34,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005982,MBR00000233,Professional,2023-07-09,2023-07-09,2023-07-22,PLN1032,1139906830,1139906830,Endocrinology,Out-of-Network,E11.65,I10,,,,,,,0,,45378,Surgery,,,,21,Inpatient Hospital,1,2090.38,1138.28,1138.28,0.0,0.0,0.0,0.0,0.0,Adjusted,,,1,,0,1,1,0,0,1,Upcoding,0,1,0,0,0
CLM0000005983,MBR00000233,Institutional-IP,2022-07-21,2022-07-23,2022-09-02,PLN7703,1702692193,1702692193,Physical Therapy,In-Network,J44.1,B97.89,,,,603,MS-DRG,9,2,Y,99203,E&M,,,0730,21,Inpatient Hospital,3,298.51,230.23,215.23,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005984,MBR00000233,Institutional-IP,2021-10-11,2021-10-18,2021-11-23,PLN1864,1366286000,1366286000,SNF,In-Network,I10,J45.20,,,,683,MS-DRG,16,7,Y,27130,Surgery,,,0360,21,Inpatient Hospital,1,5761.06,4224.09,4189.09,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005985,MBR00000233,Institutional-OP,2022-01-12,2022-01-12,2022-02-16,PLN3198,1622771872,1622771872,Pediatrics,In-Network,K21.0,I10,,,,,,,0,,71046,Radiology,,,0270,22,Outpatient Hospital,3,263.72,94.61,0.0,94.61,25.0,0.0,119.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005986,MBR00000233,Institutional-OP,2022-02-19,2022-02-19,2022-03-16,PLN7341,1749327647,1749327647,Geriatrics,In-Network,I50.9,E11.9,,,,,,,0,,70553,Radiology,,,0320,22,Outpatient Hospital,3,3005.01,2145.54,1884.97,0.0,0.0,260.57,260.57,0.0,Paid,,,1,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000005987,MBR00000233,Institutional-OP,2022-01-02,2022-01-02,2022-01-13,PLN9565,1809014947,1809014947,Urology,In-Network,Z23,J20.9,,,,,,,0,,99214,E&M,,,0636,22,Outpatient Hospital,3,288.62,188.23,188.23,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005988,MBR00000233,Professional,2023-01-03,2023-01-03,2023-01-21,PLN3705,1687650653,1687650653,Internal Medicine,In-Network,E11.9,R07.9,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,2,362.04,257.03,242.03,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005989,MBR00000233,Institutional-OP,2023-05-25,2023-05-25,2023-06-17,PLN3839,1168246159,1168246159,Internal Medicine,In-Network,G43.909,I25.10,,,,,,,0,,80053,Pathology/Lab,,,0360,22,Outpatient Hospital,3,151.76,48.4,10.76,0.0,35.0,2.64,37.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005990,MBR00000233,Institutional-IP,2023-02-16,2023-02-20,2023-03-06,PLN2580,1872272835,1872272835,Internal Medicine,In-Network,I10,M54.5,,,,194,MS-DRG,24,4,Y,70450,Radiology,,,0301,21,Inpatient Hospital,1,1335.1,831.87,678.02,43.09,0.0,110.76,153.85,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005991,MBR00000233,Professional,2022-02-23,2022-02-23,2022-03-21,PLN9143,1273488618,1273488618,General Acute Care Hospital,In-Network,I25.10,M54.5,,,,,,,0,,45380,Surgery,,,,11,Office,3,2825.05,1015.47,604.99,260.36,15.0,135.12,410.48,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000005992,MBR00000233,Institutional-OP,2021-11-11,2021-11-11,2021-12-16,PLN2118,1247341320,1247341320,Urology,Out-of-Network,I11.9,E78.5,,,,,,,0,,72148,Radiology,,,0636,22,Outpatient Hospital,1,1457.49,993.55,732.84,260.71,0.0,0.0,260.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005993,MBR00000233,Institutional-OP,2021-03-29,2021-03-29,2021-04-29,PLN7815,1514306773,1514306773,Endocrinology,In-Network,Z00.00,R10.9,,,,,,,0,,97530,Medicine,,,0730,22,Outpatient Hospital,2,125.29,42.35,42.35,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005994,MBR00000233,Institutional-OP,2023-05-24,2023-05-24,2023-06-23,PLN5971,1502838586,1502838586,ASC,In-Network,I10,I48.91,,,,,,,0,,33533,Surgery,,,0510,22,Outpatient Hospital,3,22425.6,8099.49,8099.49,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000005995,MBR00000233,Professional,2023-11-20,2023-11-20,2023-12-16,PLN4518,1500949740,1500949740,Pediatrics,In-Network,N39.0,M81.0,,,,,,,0,,27447,Surgery,,,,65,End-Stage Renal Disease,2,3704.11,1434.91,1434.91,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005996,MBR00000233,Professional,2021-03-02,2021-03-02,2021-04-10,PLN7385,1606140917,1606140917,ASC,In-Network,Z12.31,Z00.00,,,,,,,0,,27447,Surgery,,,,21,Inpatient Hospital,2,4818.83,3032.74,2628.7,0.0,0.0,404.04,404.04,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005997,MBR00000233,Institutional-OP,2021-05-23,2021-05-23,2021-06-30,PLN4578,1450553056,1450553056,Clinical Laboratory,In-Network,Z87.891,Z23,,,,,,,0,,93306,Radiology,,,0120,22,Outpatient Hospital,2,1448.66,818.89,768.89,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000005998,MBR00000233,Institutional-OP,2021-08-23,2021-08-23,2021-09-12,PLN1965,1795618275,1795618275,Pulmonology,In-Network,Z12.31,I48.91,,,,,,,0,,43239,Surgery,,,0730,22,Outpatient Hospital,2,1377.57,876.83,876.83,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000005999,MBR00000233,Professional,2023-05-24,2023-05-24,2023-07-07,PLN6689,1540044947,1540044947,Pulmonology,Out-of-Network,I10,I10,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,2,241.96,122.35,122.35,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006000,MBR00000233,Professional,2021-08-25,2021-08-25,2021-10-04,PLN3466,1239316214,1239316214,Internal Medicine,In-Network,N39.0,E11.9,,,,,,,0,,99204,E&M,,,,11,Office,2,315.0,208.44,0.0,28.6,0.0,11.98,40.58,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006001,MBR00000233,Institutional-IP,2021-01-16,2021-01-18,2021-02-05,PLN4829,1198133277,1198133277,SNF,In-Network,E66.9,E66.9,,,,470,MS-DRG,22,2,N,99222,E&M,,,0200,21,Inpatient Hospital,3,651.7,338.41,214.3,109.11,15.0,0.0,124.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006002,MBR00000233,Professional,2022-01-03,2022-01-03,2022-01-19,PLN9118,1899127912,1899127912,Neurology,In-Network,M54.5,J20.9,,,,,,,0,,99204,E&M,,,,21,Inpatient Hospital,3,430.1,243.37,188.45,0.0,35.0,19.92,54.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006003,MBR00000233,Institutional-IP,2022-02-04,2022-02-09,2022-03-03,PLN6750,1313212303,1313212303,Family Medicine,In-Network,Z12.31,N39.0,,,,682,MS-DRG,7,5,Y,99221,E&M,,,0900,21,Inpatient Hospital,3,389.34,308.17,0.0,308.17,0.0,0.0,308.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006004,MBR00000233,Institutional-OP,2022-03-09,2022-03-09,2022-03-21,PLN8453,1860435061,1860435061,DME Supplier,In-Network,J06.9,Z23,,,,,,,0,,99284,E&M,,,0450,22,Outpatient Hospital,3,531.95,246.03,246.03,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006005,MBR00000233,Professional,2022-07-19,2022-07-19,2022-07-27,PLN5331,1790497490,1790497490,OB/GYN,In-Network,Z12.31,Z12.31,,,,,,,0,,90686,Medicine,,,,21,Inpatient Hospital,1,94.92,63.49,52.06,0.0,0.0,11.43,11.43,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000006006,MBR00000233,Institutional-OP,2021-09-22,2021-09-22,2021-11-01,PLN9346,1520687146,1520687146,ASC,In-Network,I10,F03.90,,,,,,,0,,81001,Pathology/Lab,,,0200,22,Outpatient Hospital,1,39.14,15.22,0.0,15.22,15.0,0.0,30.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006007,MBR00000233,Professional,2021-02-02,2021-02-02,2021-03-18,PLN8377,1273488618,1273488618,General Acute Care Hospital,In-Network,F41.9,I10,,,,,,,0,,66984,Surgery,,,,49,Independent Clinic,1,3074.01,2226.75,1976.62,29.51,75.0,145.62,250.13,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006008,MBR00000233,Professional,2021-04-28,2021-04-28,2021-05-13,PLN1197,1531398223,1531398223,OB/GYN,In-Network,E87.6,N39.0,,,,,,,0,,99213,E&M,,,,11,Office,1,147.8,56.78,56.78,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006009,MBR00000233,Professional,2023-03-15,2023-03-15,2023-04-17,PLN7210,1899127912,1899127912,Neurology,In-Network,K57.30,I25.10,,,,,,,0,,80061,Pathology/Lab,,,,12,Home,2,87.58,66.35,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006010,MBR00000233,Institutional-IP,2022-12-24,2023-01-09,2023-01-22,PLN9370,1980712759,1980712759,Outpatient Clinic,Out-of-Network,Z87.891,F41.9,,,,194,MS-DRG,16,16,Y,97110,Medicine,,,0370,21,Inpatient Hospital,1,110.47,35.72,35.72,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006011,MBR00000233,Institutional-OP,2021-10-13,2021-10-13,2021-10-25,PLN3896,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,E66.9,E66.9,,,,,,,0,,33533,Surgery,,,0900,22,Outpatient Hospital,3,25065.7,11508.09,11508.09,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000006012,MBR00000233,Professional,2023-10-28,2023-10-28,2023-11-26,PLN2428,1974006077,1974006077,Orthopedic Surgery,In-Network,N39.0,Z00.00,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,1,1162.56,778.88,630.28,123.6,25.0,0.0,148.6,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006013,MBR00000233,Institutional-OP,2022-08-16,2022-08-16,2022-09-27,PLN8376,1242201429,1242201429,General Acute Care Hospital,In-Network,Z00.01,M54.5,,,,,,,0,,90460,Medicine,,,0761,22,Outpatient Hospital,1,48.14,16.95,0.0,16.95,25.0,0.0,41.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006014,MBR00000233,Professional,2023-05-23,2023-05-23,2023-06-03,PLN9151,1511044648,1511044648,Endocrinology,In-Network,E66.9,G43.909,,,,,,,0,,43239,Surgery,,,,23,Emergency Room,2,1260.76,1014.45,939.45,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006015,MBR00000233,Institutional-OP,2023-05-18,2023-05-18,2023-06-21,PLN2006,1193493783,1193493783,Critical Access Hospital,Out-of-Network,K21.0,Z00.00,,,,,,,0,,97530,Medicine,,,0320,22,Outpatient Hospital,3,176.72,101.74,63.8,37.94,0.0,0.0,37.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006016,MBR00000233,Institutional-IP,2021-11-25,2021-11-30,2021-12-05,PLN3221,1590915516,1590915516,Physical Therapy,Out-of-Network,E11.9,R51,,,,641,MS-DRG,2,5,Y,99213,E&M,,,0900,21,Inpatient Hospital,1,139.48,74.12,49.12,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006017,MBR00000233,Professional,2022-10-10,2022-10-10,2022-10-20,PLN5062,1118885473,1118885473,ASC,In-Network,N40.0,M54.5,,,,,,,0,,G0468,Medicine,,,,49,Independent Clinic,3,625.74,381.03,151.79,204.24,25.0,0.0,229.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006018,MBR00000233,Professional,2022-10-12,2022-10-12,2022-10-26,PLN8801,1422747896,1422747896,Urology,In-Network,I63.9,I25.10,,,,,,,0,,99222,E&M,,,,11,Office,2,327.32,256.57,256.57,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006019,MBR00000233,Professional,2022-05-14,2022-05-14,2022-06-20,PLN5543,1799205295,1799205295,General Acute Care Hospital,In-Network,F41.9,Z00.00,,,,,,,0,,82043,Pathology/Lab,,,,49,Independent Clinic,1,51.76,22.65,22.65,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006020,MBR00000233,Professional,2022-11-27,2022-11-27,2023-01-05,PLN9961,1915531927,1915531927,Critical Access Hospital,In-Network,M54.5,N39.0,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,3,27996.22,15293.44,12492.78,0.0,0.0,2800.66,2800.66,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000006021,MBR00000233,Institutional-OP,2022-01-04,2022-01-04,2022-01-16,PLN5965,1716521444,1716521444,Oncology,In-Network,M54.5,E11.9,,,,,,,0,,85025,Pathology/Lab,,,0740,22,Outpatient Hospital,2,68.8,26.83,23.73,0.0,0.0,3.1,3.1,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006022,MBR00000233,Institutional-OP,2021-04-18,2021-04-18,2021-05-02,PLN5323,1245650222,1245650222,Gastroenterology,In-Network,N40.0,J06.9,,,,,,,0,,99213,E&M,,,0636,22,Outpatient Hospital,2,231.14,185.69,0.0,185.69,0.0,0.0,185.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006023,MBR00000233,Professional,2021-02-19,2021-02-19,2021-03-05,PLN4036,1518055405,1518055405,Urology,In-Network,Z00.01,R10.9,,,,,,,0,,70450,Radiology,,,,22,Outpatient Hospital,1,794.68,670.64,267.73,367.91,35.0,0.0,402.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006024,MBR00000233,Professional,2022-05-05,2022-05-05,2022-06-14,PLN2517,1542828721,1542828721,Orthopedic Surgery,In-Network,E78.5,E11.65,,,,,,,0,,58661,Surgery,,,,11,Office,3,3875.62,1920.44,1920.44,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006025,MBR00000233,Professional,2023-09-27,2023-09-27,2023-10-30,PLN4877,1994661817,1994661817,SNF,Out-of-Network,I10,K21.0,,,,,,,0,,99232,E&M,,,,31,Skilled Nursing Facility,1,218.6,145.7,130.7,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006026,MBR00000233,Institutional-OP,2021-08-23,2021-08-23,2021-09-13,PLN1389,1817234602,1817234602,Clinical Laboratory,In-Network,Z00.00,N20.0,,,,,,,0,,43239,Surgery,,,0900,22,Outpatient Hospital,3,1429.34,984.48,558.19,426.29,0.0,0.0,426.29,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006027,MBR00000234,Institutional-OP,2022-10-11,2022-10-11,2022-11-14,PLN2823,1590915516,1590915516,Physical Therapy,Out-of-Network,E66.9,I10,,,,,,,0,,90460,Medicine,,,0740,22,Outpatient Hospital,2,48.4,23.91,23.91,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006028,MBR00000234,Professional,2021-06-29,2021-06-29,2021-08-06,PLN3215,1518055405,1518055405,Urology,In-Network,Z23,Z12.31,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,2,49.22,39.21,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006029,MBR00000234,Professional,2022-11-23,2022-11-23,2022-12-16,PLN4165,1569105090,1569105090,Geriatrics,In-Network,E66.9,C50.912,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,3,253.23,145.28,145.28,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006030,MBR00000234,Professional,2021-07-21,2021-07-21,2021-08-22,PLN5696,1660288235,1660288235,ASC,In-Network,I10,Z00.00,,,,,,,0,,G0439,Medicine,,,,22,Outpatient Hospital,2,498.11,380.46,317.21,0.0,50.0,13.25,63.25,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000006031,MBR00000234,Professional,2022-04-28,2022-04-28,2022-05-30,PLN6776,1389336600,1389336600,Critical Access Hospital,In-Network,Z00.00,I48.91,,,,,,,0,,85025,Pathology/Lab,,,,22,Outpatient Hospital,3,87.98,52.16,0.0,52.16,15.0,0.0,67.16,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006032,MBR00000234,Professional,2023-06-05,2023-06-05,2023-06-22,PLN9899,1845057593,1845057593,Orthopedic Surgery,In-Network,Z23,F32.9,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,2,272.48,188.49,183.14,0.0,0.0,5.35,5.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006033,MBR00000234,Professional,2022-02-13,2022-02-13,2022-03-06,PLN3949,1366576336,1366576336,Geriatrics,In-Network,Z23,E11.9,,,,,,,0,,97530,Medicine,,,,21,Inpatient Hospital,3,182.37,90.92,0.0,90.92,75.0,0.0,165.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006034,MBR00000234,Institutional-OP,2023-10-20,2023-10-20,2023-11-23,PLN8653,1767011137,1767011137,DME Supplier,In-Network,J45.20,J44.1,,,,,,,0,,47562,Surgery,,,0200,22,Outpatient Hospital,3,3808.53,2411.5,2411.5,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006035,MBR00000234,Professional,2021-02-21,2021-02-21,2021-04-01,PLN1407,1463205530,1463205530,Nephrology,In-Network,E11.9,F41.9,,,,,,,0,,27130,Surgery,,,,11,Office,1,2912.44,2378.87,0.0,0.0,35.0,163.88,198.88,0.0,Denied,CO-11,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006036,MBR00000234,Institutional-OP,2021-04-02,2021-04-02,2021-04-26,PLN3957,1242201429,1242201429,General Acute Care Hospital,In-Network,J18.9,I10,,,,,,,0,,99204,E&M,,,0450,22,Outpatient Hospital,2,324.23,204.83,189.83,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006037,MBR00000234,Institutional-OP,2021-07-05,2021-07-05,2021-08-11,PLN4547,1840431511,1840431511,Geriatrics,Out-of-Network,R51,F10.20,,,,,,,0,,90460,Medicine,,,0360,22,Outpatient Hospital,1,48.21,22.59,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006038,MBR00000234,Professional,2021-09-24,2021-09-24,2021-11-05,PLN5590,1990090423,1990090423,Orthopedic Surgery,In-Network,I48.91,Z23,,,,,,,0,,45380,Surgery,,,,49,Independent Clinic,2,2748.28,1886.63,1674.81,0.0,0.0,211.82,211.82,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006039,MBR00000234,Professional,2022-04-11,2022-04-11,2022-04-21,PLN4104,1812060197,1812060197,Oncology,Out-of-Network,I11.9,E11.9,,,,,,,0,,71046,Radiology,,,,31,Skilled Nursing Facility,2,123.82,89.11,64.11,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006040,MBR00000234,Professional,2023-09-28,2023-09-28,2023-11-07,PLN9196,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,I10,G43.909,,,,,,,0,,93306,Radiology,,,,12,Home,2,2164.76,1693.34,1693.34,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006041,MBR00000234,Institutional-OP,2021-09-22,2021-09-22,2021-10-26,PLN3765,1994661817,1994661817,SNF,Out-of-Network,M17.11,E78.5,,,,,,,0,,84443,Pathology/Lab,,,0320,22,Outpatient Hospital,3,107.37,68.4,0.0,68.4,15.0,0.0,83.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006042,MBR00000234,Professional,2022-01-26,2022-01-26,2022-03-11,PLN5370,1366286000,1366286000,SNF,In-Network,F32.9,J06.9,,,,,,,0,,99214,E&M,,,,49,Independent Clinic,2,462.16,217.24,0.0,217.24,15.0,0.0,232.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006043,MBR00000234,Institutional-OP,2021-02-18,2021-02-18,2021-02-25,PLN5339,1284035364,1284035364,Pediatrics,In-Network,I63.9,J20.9,,,,,,,0,,47562,Surgery,,,0320,22,Outpatient Hospital,3,6494.56,4077.92,4002.92,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006044,MBR00000234,Institutional-OP,2023-02-22,2023-02-22,2023-03-27,PLN9478,1689639685,1689639685,SNF,In-Network,J18.9,K21.0,,,,,,,0,,99233,E&M,,,0301,22,Outpatient Hospital,3,556.85,270.84,78.55,130.45,50.0,11.84,192.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006045,MBR00000234,Professional,2022-08-21,2022-08-21,2022-10-02,PLN7640,1453283987,1453283987,Critical Access Hospital,In-Network,I48.91,I10,,,,,,,0,,99204,E&M,,,,11,Office,2,339.33,195.06,145.06,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006046,MBR00000234,Professional,2021-02-19,2021-02-19,2021-03-04,PLN8212,1334916761,1334916761,ASC,In-Network,M54.5,Z96.641,,,,,,,0,,33533,Surgery,,,,12,Home,1,15499.03,6692.46,6403.37,289.09,0.0,0.0,289.09,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000006047,MBR00000234,Professional,2022-05-24,2022-05-24,2022-06-13,PLN2486,1990090423,1990090423,Orthopedic Surgery,In-Network,M17.11,M54.5,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,2,3242.45,1575.95,0.0,186.58,15.0,0.0,201.58,0.0,Denied,CO-4,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006048,MBR00000234,Professional,2021-08-28,2021-08-28,2021-09-29,PLN7622,1244186984,1244186984,Family Medicine,Out-of-Network,E87.6,I10,,,,,,,0,,45378,Surgery,,,,81,Independent Laboratory,1,2450.49,1810.5,1810.5,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000006049,MBR00000235,Professional,2022-04-07,2022-04-07,2022-05-04,PLN9651,1118885473,1118885473,ASC,In-Network,I10,I10,,,,,,,0,,27447,Surgery,,,,21,Inpatient Hospital,1,3353.74,2029.04,2029.04,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006050,MBR00000235,Institutional-OP,2021-11-08,2021-11-08,2021-12-05,PLN7415,1118885473,1118885473,ASC,In-Network,Z00.00,R05,,,,,,,0,,33533,Surgery,,,0740,22,Outpatient Hospital,3,24159.29,15622.53,14434.74,0.0,25.0,1162.79,1187.79,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000006051,MBR00000235,Professional,2023-05-09,2023-05-09,2023-05-27,PLN1188,1689639685,1689639685,SNF,In-Network,Z23,Z12.31,,,,,,,0,,99213,E&M,,,,65,End-Stage Renal Disease,3,159.26,109.44,64.22,0.0,35.0,10.22,45.22,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006052,MBR00000235,Professional,2021-03-04,2021-03-04,2021-04-03,PLN4059,1872613201,1872613201,Internal Medicine,In-Network,G20,Z87.891,,,,,,,0,,77067,Radiology,,,,11,Office,1,442.2,211.52,0.0,211.52,25.0,0.0,236.52,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000006053,MBR00000235,Institutional-OP,2022-10-19,2022-10-19,2022-10-27,PLN7593,1227362142,1227362142,DME Supplier,In-Network,F41.9,Z00.00,,,,,,,0,,93225,Medicine,,,0450,22,Outpatient Hospital,2,755.62,324.27,324.27,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006054,MBR00000235,Institutional-IP,2023-05-19,2023-05-24,2023-06-20,PLN5349,1817234602,1817234602,Clinical Laboratory,In-Network,E11.9,E87.6,,,,603,MS-DRG,19,5,N,23472,Surgery,,,0270,21,Inpatient Hospital,1,5892.71,2257.36,1721.34,388.84,0.0,147.18,536.02,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006055,MBR00000235,Professional,2021-01-02,2021-01-02,2021-01-15,PLN3996,1799205295,1799205295,General Acute Care Hospital,In-Network,R07.9,R07.9,,,,,,,0,,99283,E&M,,,,50,Federally Qualified Health Center,2,355.53,139.19,135.65,0.0,0.0,3.54,3.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006056,MBR00000235,Professional,2023-09-18,2023-09-18,2023-10-11,PLN4070,1545347862,1545347862,SNF,In-Network,Z00.00,E11.9,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,1,1644.33,693.43,235.37,441.06,0.0,17.0,458.06,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000006057,MBR00000235,Institutional-IP,2023-04-15,2023-04-18,2023-04-29,PLN2828,1295371663,1295371663,Critical Access Hospital,In-Network,F10.20,Z12.31,,,,603,MS-DRG,9,3,Y,99284,E&M,,,0450,21,Inpatient Hospital,1,603.82,264.0,229.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006058,MBR00000235,Professional,2021-11-02,2021-11-02,2021-11-17,PLN9967,1590915516,1590915516,Physical Therapy,Out-of-Network,M81.0,Z00.00,,,,,,,0,,66984,Surgery,,,,49,Independent Clinic,3,3661.0,2613.64,2234.02,0.0,15.0,364.62,379.62,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006059,MBR00000235,Professional,2022-06-13,2022-06-13,2022-07-19,PLN3519,1778483301,1778483301,Home Health,In-Network,F32.9,Z12.11,,,,,,,0,,99213,E&M,,,,11,Office,2,255.51,115.44,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006060,MBR00000235,Institutional-IP,2023-01-16,2023-01-28,2023-02-11,PLN2392,1542828721,1542828721,Orthopedic Surgery,In-Network,E11.9,J44.1,,,,641,MS-DRG,8,12,Y,99221,E&M,,,0900,21,Inpatient Hospital,2,251.47,200.79,150.79,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006061,MBR00000235,Institutional-IP,2022-07-20,2022-07-31,2022-09-02,PLN4632,1609138981,1609138981,Critical Access Hospital,In-Network,E78.5,Z00.01,,,,194,MS-DRG,12,11,N,97110,Medicine,,,0730,21,Inpatient Hospital,3,129.44,65.97,0.0,65.97,0.0,0.0,65.97,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000006062,MBR00000235,Professional,2023-04-09,2023-04-09,2023-04-24,PLN9016,1139906830,1139906830,Endocrinology,Out-of-Network,J06.9,F41.9,,,,,,,0,,23472,Surgery,,,,11,Office,1,7204.77,4385.7,4385.7,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006063,MBR00000235,Professional,2023-09-02,2023-09-02,2023-09-21,PLN8216,1939033455,1939033455,Pulmonology,In-Network,I10,M81.0,,,,,,,0,,99203,E&M,,,,11,Office,3,188.95,84.69,0.0,84.69,50.0,0.0,134.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006064,MBR00000235,Institutional-IP,2022-01-28,2022-01-30,2022-02-14,PLN4691,1713934949,1713934949,Neurology,In-Network,I25.10,B97.89,,,,194,MS-DRG,15,2,Y,99221,E&M,,,0740,21,Inpatient Hospital,3,454.02,262.38,179.27,83.11,0.0,0.0,83.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006065,MBR00000235,Professional,2021-04-30,2021-04-30,2021-06-06,PLN1276,1438368327,1438368327,Home Health,In-Network,I10,E11.9,,,,,,,0,,G0444,Medicine,,,,11,Office,3,57.22,18.63,18.63,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000006066,MBR00000235,Institutional-OP,2022-04-18,2022-04-18,2022-05-16,PLN9589,1528335731,1528335731,Critical Access Hospital,In-Network,J45.20,Z12.31,,,,,,,0,,84443,Pathology/Lab,,,0301,22,Outpatient Hospital,2,113.35,41.54,6.0,0.0,35.0,0.54,35.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006067,MBR00000235,Professional,2022-10-19,2022-10-19,2022-11-14,PLN9162,1355166277,1355166277,Endocrinology,In-Network,J20.9,Z23,,,,,,,0,,99214,E&M,,,,49,Independent Clinic,1,354.85,184.31,150.25,0.0,0.0,34.06,34.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006068,MBR00000235,Institutional-OP,2023-04-29,2023-04-29,2023-05-15,PLN9344,1757138478,1757138478,Pediatrics,In-Network,I10,N39.0,,,,,,,0,,27130,Surgery,,,0740,22,Outpatient Hospital,1,5284.4,3436.88,2967.04,434.84,35.0,0.0,469.84,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006069,MBR00000235,Institutional-OP,2021-11-05,2021-11-05,2021-11-24,PLN1534,1948810580,1948810580,DME Supplier,In-Network,N18.3,G43.909,,,,,,,0,,85610,Pathology/Lab,,,0740,22,Outpatient Hospital,3,31.46,25.01,0.01,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006070,MBR00000235,Professional,2023-10-14,2023-10-14,2023-10-21,PLN3625,1366286000,1366286000,SNF,In-Network,M54.5,I11.9,,,,,,,0,,77067,Radiology,,,,20,Urgent Care,2,425.94,309.84,309.84,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000006071,MBR00000235,Institutional-IP,2021-02-10,2021-02-20,2021-02-19,PLN7181,1390307371,1390307371,DME Supplier,In-Network,I10,Z79.4,,,,194,MS-DRG,13,10,Y,77067,Radiology,,,0761,21,Inpatient Hospital,2,762.91,549.48,549.48,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000006072,MBR00000235,Professional,2022-09-28,2022-09-28,2022-10-11,PLN9157,1752470395,1752470395,Home Health,In-Network,Z23,Z12.31,,,,,,,0,,27447,Surgery,,,,23,Emergency Room,3,4476.45,2785.54,2469.22,0.0,0.0,316.32,316.32,0.0,Paid,,,0,,1,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000006073,MBR00000235,Institutional-IP,2022-04-24,2022-04-26,2022-05-18,PLN2819,1205377316,1205377316,Orthopedic Surgery,In-Network,E11.9,R07.9,,,,195,MS-DRG,24,2,Y,86900,Pathology/Lab,,,0200,21,Inpatient Hospital,1,62.84,33.48,31.35,0.0,0.0,2.13,2.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006074,MBR00000235,Institutional-OP,2023-01-31,2023-01-31,2023-02-12,PLN2953,1569105090,1569105090,Geriatrics,In-Network,I25.10,E66.9,,,,,,,0,,81001,Pathology/Lab,,,0636,22,Outpatient Hospital,2,54.71,44.19,0.0,44.19,15.0,0.0,59.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006075,MBR00000235,Institutional-OP,2021-11-07,2021-11-07,2021-12-18,PLN4757,1749327647,1749327647,Geriatrics,In-Network,Z23,E11.9,,,,,,,0,,85025,Pathology/Lab,,,0510,22,Outpatient Hospital,3,95.42,30.62,30.62,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006076,MBR00000235,Professional,2023-10-18,2023-10-18,2023-11-06,PLN6626,1247341320,1247341320,Urology,Out-of-Network,Z00.00,K57.30,,,,,,,0,,99222,E&M,,,,65,End-Stage Renal Disease,1,482.48,153.53,128.53,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006077,MBR00000235,Institutional-OP,2021-01-02,2021-01-02,2021-01-09,PLN4656,1716521444,1716521444,Oncology,In-Network,E66.9,E11.9,,,,,,,0,,45378,Surgery,,,0301,22,Outpatient Hospital,3,1581.04,1223.75,748.43,475.32,0.0,0.0,475.32,0.0,Paid,,,0,,0,1,1,0,0,1,Unbundling,0,1,0,0,0
CLM0000006078,MBR00000235,Institutional-OP,2023-06-13,2023-06-13,2023-07-26,PLN1519,1450553056,1450553056,Clinical Laboratory,In-Network,Z23,F32.9,,,,,,,0,,43239,Surgery,,,0900,22,Outpatient Hospital,3,1792.96,1407.01,1407.01,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006079,MBR00000235,Professional,2022-06-24,2022-06-24,2022-07-12,PLN1570,1860435061,1860435061,DME Supplier,In-Network,Z23,C50.912,,,,,,,0,,23472,Surgery,,,,11,Office,3,5045.03,2183.03,1935.92,247.11,0.0,0.0,247.11,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006080,MBR00000235,Institutional-OP,2022-07-19,2022-07-19,2022-08-07,PLN9870,1713934949,1713934949,Neurology,In-Network,E78.5,Z12.31,,,,,,,0,,99214,E&M,,,0301,22,Outpatient Hospital,1,417.59,235.84,235.84,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006081,MBR00000235,Professional,2021-12-07,2021-12-07,2021-12-16,PLN3684,1422747896,1422747896,Urology,In-Network,Z79.4,Z87.891,,,,,,,0,,70553,Radiology,,,,50,Federally Qualified Health Center,1,2423.88,1117.25,1117.25,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006082,MBR00000235,Institutional-OP,2022-03-05,2022-03-05,2022-03-20,PLN6252,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,N18.3,F32.9,,,,,,,0,,76700,Radiology,,,0301,22,Outpatient Hospital,2,538.37,287.2,229.74,7.46,50.0,0.0,57.46,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006083,MBR00000235,Institutional-OP,2022-04-21,2022-04-21,2022-05-12,PLN5657,1716521444,1716521444,Oncology,In-Network,Z12.31,F32.9,,,,,,,0,,43239,Surgery,,,0320,22,Outpatient Hospital,2,1468.26,870.35,820.35,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006084,MBR00000235,Professional,2021-12-07,2021-12-07,2021-12-26,PLN2714,1644128543,1644128543,Gastroenterology,In-Network,F41.9,N18.3,,,,,,,0,,70553,Radiology,,,,11,Office,3,2511.43,1887.03,1384.28,477.75,25.0,0.0,502.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006085,MBR00000235,Professional,2021-01-13,2021-01-13,2021-02-22,PLN2199,1860435061,1860435061,DME Supplier,In-Network,N40.0,Z12.31,,,,,,,0,,90686,Medicine,,,,11,Office,3,95.89,31.35,0.0,31.35,0.0,0.0,31.35,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000006086,MBR00000235,Institutional-OP,2022-03-15,2022-03-15,2022-04-05,PLN6271,1780163051,1780163051,SNF,In-Network,Z00.00,I10,,,,,,,0,,99204,E&M,,,0510,22,Outpatient Hospital,3,361.84,246.53,196.53,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006087,MBR00000235,Professional,2022-03-16,2022-03-16,2022-04-26,PLN1990,1434029575,1434029575,Endocrinology,In-Network,Z00.00,I10,,,,,,,0,,77067,Radiology,,,,81,Independent Laboratory,1,431.17,149.21,134.21,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000006088,MBR00000235,Professional,2023-03-02,2023-03-02,2023-03-25,PLN5234,1767011137,1767011137,DME Supplier,In-Network,Z87.891,I10,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,3,166.73,141.64,0.0,141.64,0.0,0.0,141.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006089,MBR00000236,Professional,2022-05-31,2022-05-31,2022-07-02,PLN9690,1109850785,1109850785,ASC,Out-of-Network,F32.9,E78.5,,,,,,,0,,66984,Surgery,,,,23,Emergency Room,1,3039.32,1739.7,1739.7,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006090,MBR00000236,Professional,2022-08-25,2022-08-25,2022-09-17,PLN9829,1571574052,1571574052,Critical Access Hospital,In-Network,I10,I25.10,,,,,,,0,,58661,Surgery,,,,49,Independent Clinic,2,4801.56,2927.92,2470.59,457.33,0.0,0.0,457.33,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006091,MBR00000236,Professional,2022-05-26,2022-05-26,2022-07-05,PLN6226,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,M17.11,I10,,,,,,,0,,23472,Surgery,,,,49,Independent Clinic,3,5152.41,3328.42,2529.62,366.34,0.0,432.46,798.8,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006092,MBR00000236,Professional,2022-04-10,2022-04-10,2022-05-10,PLN5496,1486164553,1486164553,DME Supplier,In-Network,Z12.31,J18.9,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,2,88.62,71.47,46.47,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006093,MBR00000236,Institutional-OP,2023-02-25,2023-02-25,2023-03-07,PLN9071,1550154147,1550154147,Outpatient Clinic,In-Network,E78.5,K92.1,,,,,,,0,,97530,Medicine,,,0761,22,Outpatient Hospital,3,227.94,89.1,0.0,89.1,0.0,0.0,89.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006094,MBR00000236,Institutional-OP,2023-01-10,2023-01-10,2023-02-01,PLN2378,1563980627,1563980627,Critical Access Hospital,In-Network,E66.9,Z12.31,,,,,,,0,,78452,Radiology,,,0900,22,Outpatient Hospital,3,3090.55,1773.61,1679.62,78.99,15.0,0.0,93.99,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006095,MBR00000236,Institutional-OP,2023-12-22,2023-12-22,2024-01-13,PLN4901,1453936007,1453936007,ASC,In-Network,I10,I10,,,,,,,0,,77067,Radiology,,,0301,22,Outpatient Hospital,3,587.52,312.12,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-18,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000006096,MBR00000236,Professional,2022-06-29,2022-06-29,2022-07-13,PLN4220,1366576336,1366576336,Geriatrics,In-Network,I25.10,M54.5,,,,,,,0,,97530,Medicine,,,,11,Office,2,306.31,237.19,133.79,0.0,75.0,28.4,103.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006097,MBR00000236,Institutional-IP,2021-01-31,2021-02-03,2021-03-15,PLN8370,1806688928,1806688928,Geriatrics,In-Network,M54.5,K21.0,,,,196,MS-DRG,13,3,Y,45380,Surgery,,,0900,21,Inpatient Hospital,1,2660.87,1458.34,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-18,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006098,MBR00000236,Professional,2022-10-03,2022-10-03,2022-11-05,PLN5490,1486164553,1486164553,DME Supplier,In-Network,K57.30,Z12.31,,,,,,,0,,47562,Surgery,,,,31,Skilled Nursing Facility,3,6231.31,3766.91,3570.65,196.26,0.0,0.0,196.26,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006099,MBR00000236,Institutional-IP,2022-03-10,2022-03-11,2022-03-19,PLN4819,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,K21.0,J06.9,,,,683,MS-DRG,20,1,Y,99204,E&M,,,0320,21,Inpatient Hospital,2,292.27,181.28,175.88,0.0,0.0,5.4,5.4,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006100,MBR00000236,Institutional-OP,2021-04-15,2021-04-15,2021-05-24,PLN9740,1935547131,1935547131,Pulmonology,In-Network,J06.9,N20.0,,,,,,,0,,99232,E&M,,,0510,22,Outpatient Hospital,1,142.94,57.18,57.18,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006101,MBR00000236,Professional,2023-07-28,2023-07-28,2023-08-24,PLN5415,1745114564,1745114564,Endocrinology,In-Network,F41.9,F32.9,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,2,24695.15,19802.09,19727.09,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000006102,MBR00000236,Institutional-OP,2022-11-25,2022-11-25,2022-12-15,PLN6529,1606140917,1606140917,ASC,In-Network,F32.9,I10,,,,,,,0,,99232,E&M,,,0636,22,Outpatient Hospital,1,351.13,193.52,193.52,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006103,MBR00000236,Institutional-OP,2022-11-17,2022-11-17,2022-12-09,PLN3523,1749327647,1749327647,Geriatrics,In-Network,N20.0,N18.3,,,,,,,0,,77067,Radiology,,,0761,22,Outpatient Hospital,1,491.64,274.4,274.4,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000006104,MBR00000236,Professional,2022-11-28,2022-11-28,2022-12-27,PLN4555,1453936007,1453936007,ASC,In-Network,J18.9,J06.9,,,,,,,0,,97530,Medicine,,,,11,Office,1,215.5,173.71,148.71,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000006105,MBR00000236,Institutional-OP,2023-12-14,2023-12-14,2024-01-02,PLN9944,1540044947,1540044947,Pulmonology,Out-of-Network,Z87.891,K57.30,,,,,,,0,,77067,Radiology,,,0270,22,Outpatient Hospital,1,535.68,213.57,0.0,213.57,0.0,0.0,213.57,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000006106,MBR00000236,Institutional-OP,2023-01-24,2023-01-24,2023-02-25,PLN2048,1450553056,1450553056,Clinical Laboratory,In-Network,E11.40,Z00.01,,,,,,,0,,G0468,Medicine,,,0510,22,Outpatient Hospital,1,581.32,317.64,230.29,0.0,75.0,12.35,87.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006107,MBR00000236,Professional,2023-02-21,2023-02-21,2023-03-22,PLN5474,1778483301,1778483301,Home Health,In-Network,I10,E11.9,,,,,,,0,,99406,Medicine,,,,11,Office,1,96.99,44.76,19.76,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006108,MBR00000236,Professional,2023-04-03,2023-04-03,2023-05-04,PLN3720,1817234602,1817234602,Clinical Laboratory,In-Network,F41.9,R07.9,,,,,,,0,,70450,Radiology,,,,11,Office,2,1461.3,1157.05,1157.05,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006109,MBR00000236,Institutional-OP,2023-03-05,2023-03-05,2023-04-09,PLN7253,1795618275,1795618275,Pulmonology,In-Network,Z12.11,I48.91,,,,,,,0,,99232,E&M,,,0360,22,Outpatient Hospital,2,281.05,140.36,0.0,115.86,50.0,0.0,165.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006110,MBR00000236,Institutional-OP,2023-02-10,2023-02-10,2023-03-13,PLN4098,1135158374,1135158374,Pulmonology,In-Network,S72.001A,I10,,,,,,,0,,99214,E&M,,,0740,22,Outpatient Hospital,2,393.09,271.82,0.0,271.82,75.0,0.0,346.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006111,MBR00000236,Professional,2021-03-25,2021-03-25,2021-04-30,PLN2787,1609138981,1609138981,Critical Access Hospital,In-Network,E11.9,E66.9,,,,,,,0,,45380,Surgery,,,,31,Skilled Nursing Facility,1,2531.03,1285.41,1270.41,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006112,MBR00000236,Professional,2022-03-17,2022-03-17,2022-04-22,PLN8230,1571574052,1571574052,Critical Access Hospital,In-Network,E78.5,I10,,,,,,,0,,99222,E&M,,,,23,Emergency Room,3,256.19,197.66,182.66,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006113,MBR00000236,Professional,2021-10-29,2021-10-29,2021-11-22,PLN6595,1545347862,1545347862,SNF,In-Network,I10,Z00.00,,,,,,,0,,43239,Surgery,,,,23,Emergency Room,2,1949.06,1236.22,783.71,417.51,35.0,0.0,452.51,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006114,MBR00000236,Professional,2023-09-03,2023-09-03,2023-09-15,PLN1046,1193493783,1193493783,Critical Access Hospital,Out-of-Network,G43.909,I48.91,,,,,,,0,,99406,Medicine,,,,22,Outpatient Hospital,1,98.16,30.91,28.3,0.0,0.0,2.61,2.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006115,MBR00000236,Professional,2022-10-02,2022-10-02,2022-10-24,PLN2898,1434029575,1434029575,Endocrinology,In-Network,N18.3,J06.9,,,,,,,0,,90837,Medicine,,,,11,Office,1,208.76,123.27,123.27,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006116,MBR00000236,Professional,2022-07-19,2022-07-19,2022-08-07,PLN7133,1749494482,1749494482,Pediatrics,In-Network,I25.10,R51,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,3,137.43,50.48,0.41,0.0,50.0,0.07,50.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006117,MBR00000236,Institutional-OP,2022-07-27,2022-07-27,2022-08-06,PLN8841,1624202402,1624202402,Orthopedic Surgery,In-Network,R05,E78.5,,,,,,,0,,72148,Radiology,,,0740,22,Outpatient Hospital,1,1037.1,562.42,532.46,0.0,0.0,29.96,29.96,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006118,MBR00000236,Professional,2023-01-18,2023-01-18,2023-02-27,PLN6277,1284035364,1284035364,Pediatrics,In-Network,Z12.31,N18.3,,,,,,,0,,99406,Medicine,,,,23,Emergency Room,2,70.85,32.22,32.22,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006119,MBR00000236,Institutional-IP,2023-04-16,2023-04-17,2023-05-27,PLN1572,1778483301,1778483301,Home Health,In-Network,R10.9,J18.9,,,,291,MS-DRG,14,1,Y,G0468,Medicine,,,0200,21,Inpatient Hospital,2,554.59,463.03,429.73,0.0,15.0,18.3,33.3,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000006120,MBR00000236,Institutional-IP,2021-08-09,2021-08-12,2021-09-03,PLN8812,1749327647,1749327647,Geriatrics,In-Network,F41.9,E66.9,,,,682,MS-DRG,24,3,Y,84443,Pathology/Lab,,,0370,21,Inpatient Hospital,3,91.57,72.06,0.0,72.06,15.0,0.0,87.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006121,MBR00000236,Institutional-OP,2023-12-25,2023-12-25,2024-01-19,PLN6727,1702692193,1702692193,Physical Therapy,In-Network,Z00.00,I10,,,,,,,0,,93306,Radiology,,,0120,22,Outpatient Hospital,1,1425.75,580.19,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006122,MBR00000236,Institutional-OP,2023-04-15,2023-04-15,2023-04-30,PLN2661,1410468316,1410468316,SNF,In-Network,R07.9,E11.9,,,,,,,0,,43239,Surgery,,,0320,22,Outpatient Hospital,1,1188.76,851.92,0.0,82.73,0.0,0.0,82.73,0.0,Denied,CO-18,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006123,MBR00000236,Institutional-OP,2021-08-15,2021-08-15,2021-09-26,PLN9713,1687650653,1687650653,Internal Medicine,In-Network,R10.9,K57.30,,,,,,,0,,43239,Surgery,,,0740,22,Outpatient Hospital,3,2024.81,766.54,508.78,257.76,0.0,0.0,257.76,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006124,MBR00000236,Professional,2022-10-26,2022-10-26,2022-12-09,PLN3439,1817234602,1817234602,Clinical Laboratory,In-Network,B97.89,Z23,,,,,,,0,,43239,Surgery,,,,50,Federally Qualified Health Center,2,1546.45,1011.51,1011.51,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006125,MBR00000236,Professional,2022-04-15,2022-04-15,2022-05-28,PLN3693,1434029575,1434029575,Endocrinology,In-Network,E66.9,J44.1,,,,,,,0,,99284,E&M,,,,11,Office,1,500.94,265.15,203.04,0.0,50.0,12.11,62.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006126,MBR00000236,Professional,2022-02-17,2022-02-17,2022-04-01,PLN3565,1219817751,1219817751,OB/GYN,In-Network,Z23,Z12.31,,,,,,,0,,99213,E&M,,,,11,Office,1,299.32,172.48,25.28,97.2,50.0,0.0,147.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006127,MBR00000236,Professional,2023-08-08,2023-08-08,2023-08-22,PLN3463,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,Z23,K21.0,,,,,,,0,,84443,Pathology/Lab,,,,22,Outpatient Hospital,1,170.74,134.5,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006128,MBR00000236,Professional,2021-11-09,2021-11-09,2021-12-12,PLN3457,1550154147,1550154147,Outpatient Clinic,In-Network,J06.9,I10,,,,,,,0,,70450,Radiology,,,,21,Inpatient Hospital,2,1375.45,751.7,701.7,0.0,50.0,0.0,50.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006129,MBR00000236,Professional,2023-07-07,2023-07-07,2023-08-14,PLN7017,1520687146,1520687146,ASC,In-Network,E11.9,M81.0,,,,,,,0,,47562,Surgery,,,,11,Office,1,3055.53,1260.64,1260.64,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006130,MBR00000236,Professional,2022-11-29,2022-11-29,2023-01-07,PLN2336,1817234602,1817234602,Clinical Laboratory,In-Network,R05,J18.9,,,,,,,0,,27447,Surgery,,,,31,Skilled Nursing Facility,2,4270.12,2485.58,2060.65,409.93,15.0,0.0,424.93,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006131,MBR00000236,Professional,2023-06-14,2023-06-14,2023-07-20,PLN5662,1213165847,1213165847,Critical Access Hospital,In-Network,N39.0,I25.10,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,1,3688.18,2311.14,1792.11,344.41,0.0,174.62,519.03,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006132,MBR00000236,Institutional-IP,2023-03-28,2023-04-01,2023-04-22,PLN5050,1812060197,1812060197,Oncology,Out-of-Network,E11.9,I10,,,,470,MS-DRG,4,4,Y,99233,E&M,,,0900,21,Inpatient Hospital,3,223.73,94.0,89.75,0.0,0.0,4.25,4.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006133,MBR00000237,Institutional-OP,2022-11-11,2022-11-11,2022-11-28,PLN4194,1631954542,1631954542,Oncology,In-Network,I48.91,E11.9,,,,,,,0,,99203,E&M,,,0900,22,Outpatient Hospital,1,400.69,150.83,0.0,150.83,0.0,0.0,150.83,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006134,MBR00000237,Professional,2021-07-28,2021-07-28,2021-08-27,PLN1571,1518055405,1518055405,Urology,In-Network,J44.1,Z00.00,,,,,,,0,,47562,Surgery,,,,21,Inpatient Hospital,2,2672.74,1873.83,1510.01,0.0,50.0,313.82,363.82,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006135,MBR00000237,Professional,2023-12-24,2023-12-24,2024-01-05,PLN9046,1687650653,1687650653,Internal Medicine,In-Network,M54.5,Z23,,,,,,,0,,78452,Radiology,,,,22,Outpatient Hospital,1,4049.75,1902.25,1902.25,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000006136,MBR00000237,Professional,2022-12-05,2022-12-05,2022-12-29,PLN9518,1502838586,1502838586,ASC,In-Network,R07.9,M54.5,,,,,,,0,,99284,E&M,,,,11,Office,2,486.44,320.64,320.64,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006137,MBR00000237,Professional,2022-01-27,2022-01-27,2022-02-10,PLN9047,1284035364,1284035364,Pediatrics,In-Network,J20.9,F41.9,,,,,,,0,,99222,E&M,,,,11,Office,1,350.76,164.3,164.3,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006138,MBR00000237,Institutional-OP,2021-10-08,2021-10-08,2021-11-09,PLN9008,1450553056,1450553056,Clinical Laboratory,In-Network,J44.1,J45.20,,,,,,,0,,99221,E&M,,,0900,22,Outpatient Hospital,3,222.02,92.71,92.71,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006139,MBR00000237,Professional,2021-05-08,2021-05-08,2021-05-15,PLN5495,1713934949,1713934949,Neurology,In-Network,Z00.00,E11.65,,,,,,,0,,85610,Pathology/Lab,,,,20,Urgent Care,2,54.25,19.46,0.0,19.46,0.0,0.0,19.46,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006140,MBR00000237,Professional,2021-12-12,2021-12-12,2021-12-26,PLN2640,1624202402,1624202402,Orthopedic Surgery,In-Network,J44.1,M54.5,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,1,134.13,109.52,93.91,0.0,0.0,15.61,15.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006141,MBR00000237,Institutional-OP,2021-05-26,2021-05-26,2021-06-04,PLN8832,1511044648,1511044648,Endocrinology,In-Network,E78.5,K92.1,,,,,,,0,,33533,Surgery,,,0510,22,Outpatient Hospital,1,14153.79,9755.52,9755.52,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,1,Unbundling,0,0,0,0,0
CLM0000006142,MBR00000237,Professional,2023-08-31,2023-08-31,2023-09-11,PLN3187,1114982472,1114982472,Orthopedic Surgery,In-Network,J18.9,M54.5,,,,,,,0,,G0444,Medicine,,,,11,Office,2,90.64,31.91,0.0,31.91,15.0,0.0,46.91,0.0,Denied,CO-15,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000006143,MBR00000237,Institutional-IP,2022-04-23,2022-04-25,2022-05-21,PLN8419,1545347862,1545347862,SNF,In-Network,Z00.00,M54.5,,,,196,MS-DRG,1,2,Y,66984,Surgery,,,0900,21,Inpatient Hospital,3,2618.77,920.81,701.24,144.57,75.0,0.0,219.57,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006144,MBR00000237,Professional,2022-11-17,2022-11-17,2022-12-24,PLN5076,1757138478,1757138478,Pediatrics,In-Network,M54.5,Z12.31,,,,,,,0,,71046,Radiology,,,,23,Emergency Room,1,331.68,127.43,102.43,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006145,MBR00000237,Professional,2023-06-01,2023-06-01,2023-07-06,PLN4354,1752470395,1752470395,Home Health,In-Network,Z12.31,I50.9,,,,,,,0,,58661,Surgery,,,,11,Office,1,3377.65,1929.45,1879.45,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006146,MBR00000237,Professional,2023-11-19,2023-11-19,2023-12-07,PLN4475,1542828721,1542828721,Orthopedic Surgery,In-Network,R10.9,E11.9,,,,,,,0,,93225,Medicine,,,,11,Office,2,910.0,498.69,461.97,0.0,0.0,36.72,36.72,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006147,MBR00000237,Institutional-OP,2022-05-11,2022-05-11,2022-06-07,PLN8549,1361302520,1361302520,Critical Access Hospital,In-Network,E78.5,E11.9,,,,,,,0,,99213,E&M,,,0636,22,Outpatient Hospital,1,192.64,130.87,115.87,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006148,MBR00000237,Professional,2021-02-27,2021-02-27,2021-03-29,PLN1753,1563980627,1563980627,Critical Access Hospital,In-Network,I10,J06.9,,,,,,,0,,99222,E&M,,,,11,Office,2,536.54,347.91,332.91,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006149,MBR00000237,Professional,2022-11-01,2022-11-01,2022-11-18,PLN4448,1103747954,1103747954,Urology,In-Network,J18.9,E66.9,,,,,,,0,,76700,Radiology,,,,22,Outpatient Hospital,3,724.94,544.35,484.43,0.0,0.0,59.92,59.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006150,MBR00000237,Institutional-IP,2023-11-03,2023-11-06,2023-12-14,PLN6064,1273488618,1273488618,General Acute Care Hospital,In-Network,N17.9,G20,,,,690,MS-DRG,7,3,Y,74177,Radiology,,,0450,21,Inpatient Hospital,3,1129.28,543.55,473.73,44.82,25.0,0.0,69.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006151,MBR00000237,Institutional-IP,2022-01-28,2022-02-01,2022-02-13,PLN4565,1767011137,1767011137,DME Supplier,In-Network,I48.91,N39.0,,,,292,MS-DRG,24,4,Y,87491,Pathology/Lab,,,0301,21,Inpatient Hospital,2,215.17,167.21,167.21,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006152,MBR00000237,Professional,2021-04-23,2021-04-23,2021-06-03,PLN4519,1313212303,1313212303,Family Medicine,In-Network,S72.001A,R51,,,,,,,0,,47562,Surgery,,,,11,Office,1,5350.96,3469.66,3051.3,343.36,75.0,0.0,418.36,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006153,MBR00000237,Institutional-OP,2023-02-22,2023-02-22,2023-03-01,PLN1855,1935547131,1935547131,Pulmonology,In-Network,K92.1,E78.5,,,,,,,0,,99284,E&M,,,0730,22,Outpatient Hospital,3,652.19,276.28,43.49,217.79,15.0,0.0,232.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006154,MBR00000237,Institutional-IP,2022-11-11,2022-11-17,2022-12-20,PLN5570,1108115157,1108115157,General Acute Care Hospital,In-Network,N20.0,N18.3,,,,470,MS-DRG,11,6,Y,58661,Surgery,,,0301,21,Inpatient Hospital,3,4370.29,3547.1,3497.1,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006155,MBR00000237,Institutional-OP,2021-06-17,2021-06-17,2021-06-26,PLN5121,1273488618,1273488618,General Acute Care Hospital,In-Network,M54.5,R51,,,,,,,0,,87491,Pathology/Lab,,,0120,22,Outpatient Hospital,2,211.7,159.97,124.97,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006156,MBR00000238,Professional,2021-01-04,2021-01-04,2021-01-16,PLN3611,1235381502,1235381502,Cardiology,In-Network,J06.9,F32.9,,,,,,,0,,99284,E&M,,,,11,Office,2,624.26,211.32,185.9,0.0,0.0,25.42,25.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006157,MBR00000238,Institutional-IP,2022-07-24,2022-07-29,2022-08-18,PLN5754,1500037969,1500037969,Pulmonology,In-Network,I10,F41.9,,,,291,MS-DRG,8,5,W,97530,Medicine,,,0320,21,Inpatient Hospital,3,225.59,147.93,0.0,147.93,15.0,0.0,162.93,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000006158,MBR00000238,Professional,2021-06-12,2021-06-12,2021-07-21,PLN5917,1935547131,1935547131,Pulmonology,In-Network,Z51.11,Z00.00,,,,,,,0,,99233,E&M,,,,11,Office,2,489.49,284.29,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006159,MBR00000238,Professional,2021-07-22,2021-07-22,2021-08-16,PLN9296,1132188260,1132188260,Family Medicine,In-Network,R10.9,E87.6,,,,,,,0,,33533,Surgery,,,,11,Office,2,14644.87,11688.31,11501.77,0.0,0.0,186.54,186.54,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000006160,MBR00000238,Professional,2021-12-05,2021-12-05,2021-12-18,PLN1604,1463205530,1463205530,Nephrology,In-Network,Z23,I10,,,,,,,0,,81001,Pathology/Lab,,,,20,Urgent Care,2,31.79,16.16,0.0,16.16,0.0,0.0,16.16,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006161,MBR00000238,Professional,2022-05-29,2022-05-29,2022-06-10,PLN5131,1168246159,1168246159,Internal Medicine,In-Network,N18.3,E78.5,,,,,,,0,,27130,Surgery,,,,21,Inpatient Hospital,1,3945.85,1891.58,1891.58,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006162,MBR00000238,Institutional-OP,2023-06-15,2023-06-15,2023-06-26,PLN3696,1389336600,1389336600,Critical Access Hospital,In-Network,E11.9,Z79.4,,,,,,,0,,76700,Radiology,,,0120,22,Outpatient Hospital,2,1140.08,346.42,64.35,282.07,0.0,0.0,282.07,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006163,MBR00000238,Institutional-OP,2022-04-17,2022-04-17,2022-05-27,PLN6908,1125190055,1125190055,Nephrology,In-Network,G20,F32.9,,,,,,,0,,97110,Medicine,,,0900,22,Outpatient Hospital,1,281.19,123.28,88.28,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006164,MBR00000238,Professional,2023-07-05,2023-07-05,2023-07-26,PLN8514,1575695214,1575695214,SNF,In-Network,Z00.00,I48.91,,,,,,,0,,99221,E&M,,,,49,Independent Clinic,2,175.41,120.78,0.0,120.78,25.0,0.0,145.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006165,MBR00000238,Professional,2022-10-24,2022-10-24,2022-11-27,PLN6192,1856686341,1856686341,Geriatrics,In-Network,G43.909,E66.9,,,,,,,0,,99214,E&M,,,,49,Independent Clinic,2,228.53,113.25,88.25,0.0,25.0,0.0,25.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006166,MBR00000238,Professional,2022-03-07,2022-03-07,2022-04-19,PLN4294,1865904917,1865904917,Outpatient Clinic,In-Network,N39.0,Z51.11,,,,,,,0,,71046,Radiology,,,,23,Emergency Room,2,154.39,131.02,109.8,0.0,0.0,21.22,21.22,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006167,MBR00000238,Institutional-IP,2022-07-12,2022-07-21,2022-07-24,PLN7529,1556140803,1556140803,Cardiology,In-Network,Z23,Z12.31,,,,470,MS-DRG,23,9,Y,99406,Medicine,,,0761,21,Inpatient Hospital,1,41.04,34.01,30.26,0.0,0.0,3.75,3.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006168,MBR00000238,Professional,2021-06-04,2021-06-04,2021-06-21,PLN4279,1475984649,1475984649,SNF,In-Network,R51,E11.9,,,,,,,0,,47562,Surgery,,,,12,Home,3,5614.22,3902.93,3198.32,273.12,35.0,396.49,704.61,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006169,MBR00000238,Institutional-OP,2023-12-05,2023-12-05,2023-12-15,PLN1758,1205377316,1205377316,Orthopedic Surgery,In-Network,F41.9,R05,,,,,,,0,,43239,Surgery,,,0360,22,Outpatient Hospital,1,2226.36,1290.89,896.32,394.57,0.0,0.0,394.57,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006170,MBR00000238,Professional,2021-11-27,2021-11-27,2022-01-10,PLN2986,1284035364,1284035364,Pediatrics,In-Network,F32.9,E11.9,,,,,,,0,,99213,E&M,,,,22,Outpatient Hospital,1,254.04,136.65,52.17,66.34,15.0,3.14,84.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006171,MBR00000238,Institutional-OP,2023-09-13,2023-09-13,2023-09-21,PLN8226,1242201429,1242201429,General Acute Care Hospital,In-Network,Z12.31,Z87.891,,,,,,,0,,27447,Surgery,,,0360,22,Outpatient Hospital,2,4338.69,2347.33,2272.33,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006172,MBR00000238,Institutional-OP,2022-12-08,2022-12-08,2023-01-09,PLN8718,1968299309,1968299309,Internal Medicine,In-Network,E78.5,N39.0,,,,,,,0,,99214,E&M,,,0301,22,Outpatient Hospital,1,442.1,314.87,314.87,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006173,MBR00000238,Professional,2021-11-19,2021-11-19,2021-12-06,PLN5724,1438368327,1438368327,Home Health,In-Network,I10,R10.9,,,,,,,0,,47562,Surgery,,,,11,Office,1,6144.91,3081.22,3066.22,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006174,MBR00000238,Institutional-OP,2022-06-17,2022-06-17,2022-07-13,PLN8714,1716521444,1716521444,Oncology,In-Network,N39.0,E11.9,,,,,,,0,,84443,Pathology/Lab,,,0900,22,Outpatient Hospital,2,104.84,88.44,88.44,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006175,MBR00000238,Institutional-OP,2021-05-13,2021-05-13,2021-06-13,PLN2802,1644128543,1644128543,Gastroenterology,In-Network,J20.9,F10.20,,,,,,,0,,85610,Pathology/Lab,,,0900,22,Outpatient Hospital,3,34.77,22.47,22.47,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006176,MBR00000238,Professional,2022-11-06,2022-11-06,2022-11-24,PLN5598,1847081578,1847081578,Urology,Out-of-Network,E11.9,E78.5,,,,,,,0,,43239,Surgery,,,,81,Independent Laboratory,2,1146.38,792.56,671.13,121.43,0.0,0.0,121.43,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006177,MBR00000238,Professional,2021-03-12,2021-03-12,2021-04-21,PLN8698,1860435061,1860435061,DME Supplier,In-Network,B97.89,E11.9,,,,,,,0,,66984,Surgery,,,,21,Inpatient Hospital,2,3149.86,2492.48,2492.48,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006178,MBR00000238,Institutional-IP,2022-12-01,2022-12-06,2023-01-12,PLN8561,1511044648,1511044648,Endocrinology,In-Network,Z23,F41.9,,,,291,MS-DRG,11,5,Y,74177,Radiology,,,0730,21,Inpatient Hospital,3,2412.89,1867.7,1867.7,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006179,MBR00000238,Professional,2021-08-05,2021-08-05,2021-08-20,PLN4271,1571574052,1571574052,Critical Access Hospital,In-Network,K21.0,N39.0,,,,,,,0,,97530,Medicine,,,,49,Independent Clinic,1,209.38,135.66,0.0,73.47,0.0,0.0,73.47,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006180,MBR00000238,Institutional-OP,2021-05-21,2021-05-21,2021-07-02,PLN6101,1186826716,1186826716,Physical Therapy,In-Network,E11.40,I10,,,,,,,0,,85025,Pathology/Lab,,,0270,22,Outpatient Hospital,1,39.93,18.91,0.0,18.91,0.0,0.0,18.91,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006181,MBR00000238,Professional,2021-09-01,2021-09-01,2021-09-17,PLN4997,1872613201,1872613201,Internal Medicine,In-Network,M81.0,I10,,,,,,,0,,45378,Surgery,,,,21,Inpatient Hospital,1,2277.64,1601.49,1586.49,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,1,0,0,1,Upcoding,0,1,0,0,0
CLM0000006182,MBR00000238,Institutional-OP,2021-04-08,2021-04-08,2021-05-04,PLN5255,1168246159,1168246159,Internal Medicine,In-Network,J18.9,R05,,,,,,,0,,93225,Medicine,,,0120,22,Outpatient Hospital,1,714.62,407.32,407.32,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006183,MBR00000238,Institutional-IP,2023-09-01,2023-09-07,2023-09-09,PLN9769,1500037969,1500037969,Pulmonology,In-Network,Z12.31,K21.0,,,,683,MS-DRG,1,6,Y,G0444,Medicine,,,0761,21,Inpatient Hospital,1,61.38,20.46,20.46,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,1,Unbundling,0,0,0,0,1
CLM0000006184,MBR00000238,Professional,2023-10-22,2023-10-22,2023-11-20,PLN7547,1891849440,1891849440,Oncology,In-Network,F32.9,Z87.891,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,1,60.2,35.38,32.64,0.0,0.0,2.74,2.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006185,MBR00000238,Professional,2023-10-10,2023-10-10,2023-10-24,PLN4196,1550154147,1550154147,Outpatient Clinic,In-Network,N40.0,J06.9,,,,,,,0,,97530,Medicine,,,,21,Inpatient Hospital,2,145.6,67.75,67.75,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000006186,MBR00000238,Institutional-OP,2023-02-26,2023-02-26,2023-03-05,PLN6077,1660288235,1660288235,ASC,In-Network,K21.0,N39.0,,,,,,,0,,G0468,Medicine,,,0900,22,Outpatient Hospital,3,399.75,149.33,0.0,149.33,0.0,0.0,149.33,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006187,MBR00000238,Professional,2021-09-10,2021-09-10,2021-10-20,PLN3856,1295371663,1295371663,Critical Access Hospital,In-Network,J20.9,Z00.00,,,,,,,0,,76700,Radiology,,,,11,Office,3,783.99,549.44,474.44,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006188,MBR00000238,Professional,2023-04-11,2023-04-11,2023-05-21,PLN6632,1860435061,1860435061,DME Supplier,In-Network,R51,I10,,,,,,,0,,99204,E&M,,,,11,Office,3,568.56,177.24,127.24,0.0,50.0,0.0,50.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006189,MBR00000238,Institutional-OP,2023-04-11,2023-04-11,2023-04-27,PLN5058,1872272835,1872272835,Internal Medicine,In-Network,J20.9,I11.9,,,,,,,0,,80053,Pathology/Lab,,,0270,22,Outpatient Hospital,3,145.55,76.69,0.0,76.69,15.0,0.0,91.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006190,MBR00000238,Professional,2021-09-17,2021-09-17,2021-10-21,PLN9027,1550154147,1550154147,Outpatient Clinic,In-Network,E66.9,E11.9,,,,,,,0,,99203,E&M,,,,11,Office,1,313.37,110.39,110.39,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006191,MBR00000238,Institutional-OP,2023-07-05,2023-07-05,2023-07-30,PLN4399,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,N17.9,F41.9,,,,,,,0,,66984,Surgery,,,0301,22,Outpatient Hospital,2,2326.83,995.38,980.38,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006192,MBR00000238,Professional,2023-12-28,2023-12-28,2024-01-23,PLN2257,1702692193,1702692193,Physical Therapy,In-Network,Z79.4,R10.9,,,,,,,0,,66984,Surgery,,,,11,Office,3,1591.85,511.61,456.61,55.0,0.0,0.0,55.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006193,MBR00000238,Institutional-OP,2022-02-18,2022-02-18,2022-03-23,PLN4636,1991459367,1991459367,Neurology,Out-of-Network,I10,K21.0,,,,,,,0,,85025,Pathology/Lab,,,0510,22,Outpatient Hospital,2,88.53,55.45,0.0,55.45,0.0,0.0,55.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006194,MBR00000238,Institutional-IP,2022-10-07,2022-10-16,2022-10-15,PLN5931,1500949740,1500949740,Pediatrics,In-Network,I48.91,I10,,,,683,MS-DRG,21,9,Y,33533,Surgery,,,0450,21,Inpatient Hospital,3,11053.65,8047.39,8012.39,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000006195,MBR00000238,Professional,2023-08-13,2023-08-13,2023-09-21,PLN3744,1372918899,1372918899,Family Medicine,In-Network,Z79.4,E78.5,,,,,,,0,,70450,Radiology,,,,81,Independent Laboratory,3,634.7,287.17,52.02,235.15,0.0,0.0,235.15,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006196,MBR00000238,Professional,2021-10-15,2021-10-15,2021-11-05,PLN9585,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,M17.11,F41.9,,,,,,,0,,G0439,Medicine,,,,22,Outpatient Hospital,3,409.81,239.7,164.7,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000006197,MBR00000238,Professional,2023-12-19,2023-12-19,2024-01-16,PLN3044,1997536841,1997536841,Family Medicine,Out-of-Network,M54.5,F41.9,,,,,,,0,,99232,E&M,,,,81,Independent Laboratory,2,288.47,127.27,127.27,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006198,MBR00000238,Institutional-IP,2021-11-29,2021-12-07,2021-12-06,PLN3838,1968299309,1968299309,Internal Medicine,In-Network,Z23,E66.9,,,,641,MS-DRG,4,8,N,77067,Radiology,,,0740,21,Inpatient Hospital,2,664.8,446.68,421.68,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000006199,MBR00000238,Professional,2023-11-26,2023-11-26,2023-12-10,PLN6660,1245650222,1245650222,Gastroenterology,In-Network,K21.0,J20.9,,,,,,,0,,72148,Radiology,,,,23,Emergency Room,2,2115.42,1384.11,1127.74,0.0,15.0,241.37,256.37,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006200,MBR00000238,Professional,2021-09-14,2021-09-14,2021-10-06,PLN8345,1727809972,1727809972,Home Health,In-Network,I50.9,C50.912,,,,,,,0,,76700,Radiology,,,,11,Office,3,951.65,572.88,572.88,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006201,MBR00000238,Institutional-IP,2023-03-24,2023-03-30,2023-04-16,PLN9751,1974006077,1974006077,Orthopedic Surgery,In-Network,R07.9,M54.5,,,,641,MS-DRG,7,6,Y,99406,Medicine,,,0730,21,Inpatient Hospital,1,67.4,25.57,25.57,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006202,MBR00000238,Institutional-OP,2022-07-30,2022-07-30,2022-08-13,PLN7024,1980712759,1980712759,Outpatient Clinic,Out-of-Network,J06.9,G43.909,,,,,,,0,,43239,Surgery,,,0730,22,Outpatient Hospital,3,1155.05,441.21,0.0,0.0,15.0,84.57,99.57,0.0,Denied,CO-50,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006203,MBR00000238,Professional,2022-02-11,2022-02-11,2022-03-09,PLN2040,1198133277,1198133277,SNF,In-Network,Z23,E78.5,,,,,,,0,,99214,E&M,,,,12,Home,2,226.05,113.24,113.24,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006204,MBR00000238,Institutional-IP,2022-04-26,2022-05-02,2022-06-05,PLN4039,1728018911,1728018911,Nephrology,In-Network,J18.9,C50.912,,,,194,MS-DRG,2,6,Y,72148,Radiology,,,0320,21,Inpatient Hospital,2,1509.18,1086.65,979.75,0.0,35.0,71.9,106.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006205,MBR00000239,Institutional-OP,2021-09-06,2021-09-06,2021-10-05,PLN1461,1700633438,1700633438,DME Supplier,In-Network,E11.40,I50.9,,,,,,,0,,45380,Surgery,,,0761,22,Outpatient Hospital,1,1132.92,521.81,521.81,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006206,MBR00000239,Professional,2023-01-06,2023-01-06,2023-01-16,PLN1904,1964402759,1964402759,Outpatient Clinic,In-Network,Z23,J06.9,,,,,,,0,,97530,Medicine,,,,11,Office,3,154.0,99.98,0.0,79.88,0.0,1.84,81.72,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006207,MBR00000239,Institutional-OP,2023-12-24,2023-12-24,2024-01-25,PLN3526,1727809972,1727809972,Home Health,In-Network,Z23,J06.9,,,,,,,0,,87491,Pathology/Lab,,,0636,22,Outpatient Hospital,1,109.98,91.29,0.0,91.29,0.0,0.0,91.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006208,MBR00000239,Institutional-IP,2022-10-04,2022-10-08,2022-10-19,PLN3799,1124394415,1124394415,Pediatrics,In-Network,K57.30,E66.9,,,,291,MS-DRG,5,4,Y,99283,E&M,,,0360,21,Inpatient Hospital,1,589.53,477.8,452.8,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006209,MBR00000239,Institutional-IP,2021-10-30,2021-11-10,2021-11-21,PLN9272,1389336600,1389336600,Critical Access Hospital,In-Network,E11.9,I25.10,,,,871,MS-DRG,8,11,Y,27447,Surgery,,,0200,21,Inpatient Hospital,3,4840.28,2317.2,0.0,0.0,0.0,0.0,0.0,0.0,Denied,PR-1,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006210,MBR00000239,Institutional-OP,2023-01-04,2023-01-04,2023-01-29,PLN9942,1242201429,1242201429,General Acute Care Hospital,In-Network,E78.5,N18.3,,,,,,,0,,99233,E&M,,,0200,22,Outpatient Hospital,3,298.51,147.44,0.0,147.44,35.0,0.0,182.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006211,MBR00000239,Professional,2022-04-26,2022-04-26,2022-05-14,PLN4299,1915531927,1915531927,Critical Access Hospital,In-Network,J45.20,Z12.11,,,,,,,0,,90686,Medicine,,,,81,Independent Laboratory,3,111.21,93.01,0.0,93.01,15.0,0.0,108.01,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000006212,MBR00000240,Institutional-IP,2023-10-06,2023-10-09,2023-10-21,PLN6321,1749494482,1749494482,Pediatrics,In-Network,M81.0,E11.9,,,,194,MS-DRG,10,3,Y,99214,E&M,,,0200,21,Inpatient Hospital,2,416.85,255.53,221.89,0.0,15.0,18.64,33.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006213,MBR00000240,Institutional-IP,2021-10-17,2021-10-28,2021-11-25,PLN1472,1687650653,1687650653,Internal Medicine,In-Network,E11.9,F32.9,,,,641,MS-DRG,16,11,Y,27447,Surgery,,,0301,21,Inpatient Hospital,1,5797.47,3615.14,3590.14,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006214,MBR00000240,Professional,2022-07-22,2022-07-22,2022-08-11,PLN2134,1910255109,1910255109,DME Supplier,In-Network,Z00.01,I10,,,,,,,0,,99283,E&M,,,,11,Office,2,539.04,294.61,294.61,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006215,MBR00000240,Professional,2022-06-28,2022-06-28,2022-07-13,PLN7719,1872272835,1872272835,Internal Medicine,In-Network,E66.9,E11.9,,,,,,,0,,27447,Surgery,,,,23,Emergency Room,2,3675.68,1309.07,932.42,376.65,0.0,0.0,376.65,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006216,MBR00000240,Institutional-OP,2023-08-28,2023-08-28,2023-09-08,PLN8404,1502838586,1502838586,ASC,In-Network,I11.9,N18.3,,,,,,,0,,84443,Pathology/Lab,,,0510,22,Outpatient Hospital,1,87.25,27.41,0.0,27.41,50.0,0.0,77.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006217,MBR00000240,Professional,2021-05-01,2021-05-01,2021-05-09,PLN9878,1463205530,1463205530,Nephrology,In-Network,E78.5,I10,,,,,,,0,,99213,E&M,,,,23,Emergency Room,2,321.6,196.44,0.0,196.44,75.0,0.0,271.44,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006218,MBR00000240,Professional,2022-11-08,2022-11-08,2022-12-06,PLN8797,1800011727,1800011727,Clinical Laboratory,Out-of-Network,K21.0,I10,,,,,,,0,,99214,E&M,,,,31,Skilled Nursing Facility,3,203.92,100.64,55.89,0.0,35.0,9.75,44.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006219,MBR00000240,Professional,2023-06-05,2023-06-05,2023-06-18,PLN8212,1622771872,1622771872,Pediatrics,In-Network,M54.5,E11.9,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,3,61.69,36.85,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006220,MBR00000240,Professional,2022-01-31,2022-01-31,2022-03-11,PLN4294,1609138981,1609138981,Critical Access Hospital,In-Network,E78.5,F32.9,,,,,,,0,,99221,E&M,,,,11,Office,1,429.69,347.56,322.56,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006221,MBR00000241,Professional,2022-07-08,2022-07-08,2022-07-16,PLN2094,1780163051,1780163051,SNF,In-Network,M17.11,Z12.11,,,,,,,0,,23472,Surgery,,,,11,Office,1,5106.77,4137.81,3381.64,405.96,0.0,350.21,756.17,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006222,MBR00000241,Professional,2021-11-19,2021-11-19,2021-12-01,PLN6449,1728018911,1728018911,Nephrology,In-Network,E78.5,M17.11,,,,,,,0,,99213,E&M,,,,22,Outpatient Hospital,3,216.69,93.32,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006223,MBR00000241,Professional,2022-04-05,2022-04-05,2022-05-15,PLN8725,1266606767,1266606767,ASC,In-Network,E78.5,K21.0,,,,,,,0,,74177,Radiology,,,,11,Office,1,1159.62,938.07,0.0,0.0,0.0,137.29,137.29,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006224,MBR00000241,Professional,2023-11-07,2023-11-07,2023-12-16,PLN1107,1242201429,1242201429,General Acute Care Hospital,In-Network,N39.0,M54.5,,,,,,,0,,97110,Medicine,,,,22,Outpatient Hospital,3,280.85,88.27,88.27,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006225,MBR00000241,Institutional-OP,2022-02-02,2022-02-02,2022-02-19,PLN3360,1313212303,1313212303,Family Medicine,In-Network,I10,Z12.31,,,,,,,0,,27130,Surgery,,,0450,22,Outpatient Hospital,3,4908.87,3349.94,2982.32,0.0,50.0,317.62,367.62,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006226,MBR00000241,Institutional-OP,2021-08-10,2021-08-10,2021-09-18,PLN3100,1569105090,1569105090,Geriatrics,In-Network,N20.0,Z79.4,,,,,,,0,,99406,Medicine,,,0740,22,Outpatient Hospital,1,37.11,16.15,0.0,16.15,0.0,0.0,16.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006227,MBR00000241,Professional,2022-09-27,2022-09-27,2022-10-28,PLN2500,1355166277,1355166277,Endocrinology,In-Network,E66.9,Z00.00,,,,,,,0,,99203,E&M,,,,11,Office,2,226.76,94.6,0.0,0.0,0.0,5.88,5.88,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006228,MBR00000241,Professional,2022-05-30,2022-05-30,2022-07-03,PLN1920,1364429278,1364429278,OB/GYN,In-Network,F41.9,I50.9,,,,,,,0,,93225,Medicine,,,,20,Urgent Care,1,719.94,387.68,139.62,233.06,15.0,0.0,248.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006229,MBR00000241,Professional,2023-05-04,2023-05-04,2023-06-09,PLN8413,1991459367,1991459367,Neurology,Out-of-Network,N40.0,M54.5,,,,,,,0,,58661,Surgery,,,,81,Independent Laboratory,1,3193.67,1280.83,1280.83,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006230,MBR00000241,Professional,2021-02-09,2021-02-09,2021-03-13,PLN5859,1847081578,1847081578,Urology,Out-of-Network,J45.20,F41.9,,,,,,,0,,99213,E&M,,,,11,Office,3,184.55,137.29,122.29,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006231,MBR00000241,Institutional-OP,2023-09-16,2023-09-16,2023-10-08,PLN9843,1247341320,1247341320,Urology,Out-of-Network,F32.9,F32.9,,,,,,,0,,72148,Radiology,,,0900,22,Outpatient Hospital,3,1916.25,796.82,436.46,335.36,25.0,0.0,360.36,0.0,Adjusted,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006232,MBR00000241,Institutional-IP,2023-02-08,2023-02-11,2023-02-21,PLN3018,1124394415,1124394415,Pediatrics,In-Network,E11.65,E11.9,,,,641,MS-DRG,12,3,Y,99213,E&M,,,0510,21,Inpatient Hospital,1,190.61,161.21,0.0,161.21,15.0,0.0,176.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006233,MBR00000241,Professional,2023-07-11,2023-07-11,2023-08-05,PLN6622,1990090423,1990090423,Orthopedic Surgery,In-Network,Z12.31,K21.0,,,,,,,0,,99214,E&M,,,,11,Office,3,446.8,312.02,253.08,0.0,0.0,58.94,58.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006234,MBR00000241,Institutional-OP,2022-03-23,2022-03-23,2022-04-06,PLN5535,1227362142,1227362142,DME Supplier,In-Network,Z00.01,Z23,,,,,,,0,,23472,Surgery,,,0900,22,Outpatient Hospital,2,3647.51,2218.12,1981.07,0.0,0.0,237.05,237.05,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006235,MBR00000241,Institutional-OP,2022-05-03,2022-05-03,2022-05-16,PLN8353,1865904917,1865904917,Outpatient Clinic,In-Network,I10,I10,,,,,,,0,,99214,E&M,,,0761,22,Outpatient Hospital,1,287.62,114.55,114.55,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006236,MBR00000241,Professional,2022-01-02,2022-01-02,2022-01-19,PLN4928,1891849440,1891849440,Oncology,In-Network,M81.0,M54.5,,,,,,,0,,43239,Surgery,,,,12,Home,1,2093.39,1532.68,1277.54,0.0,25.0,230.14,255.14,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006237,MBR00000241,Institutional-IP,2023-07-03,2023-07-07,2023-07-30,PLN5385,1109850785,1109850785,ASC,Out-of-Network,F41.9,E66.9,,,,291,MS-DRG,10,4,Y,99406,Medicine,,,0636,21,Inpatient Hospital,3,64.23,40.11,40.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006238,MBR00000241,Professional,2021-03-19,2021-03-19,2021-04-05,PLN9880,1990090423,1990090423,Orthopedic Surgery,In-Network,K21.0,E78.5,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,1,271.41,115.0,109.47,0.0,0.0,5.53,5.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006239,MBR00000241,Institutional-IP,2022-08-02,2022-08-08,2022-08-09,PLN1422,1540044947,1540044947,Pulmonology,Out-of-Network,I25.10,Z12.11,,,,291,MS-DRG,16,6,Y,43239,Surgery,,,0270,21,Inpatient Hospital,1,1532.55,561.49,526.49,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006240,MBR00000241,Professional,2021-10-12,2021-10-12,2021-11-03,PLN8310,1390307371,1390307371,DME Supplier,In-Network,E78.5,Z00.00,,,,,,,0,,70450,Radiology,,,,23,Emergency Room,3,1502.12,1267.54,1252.54,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006241,MBR00000241,Professional,2022-11-30,2022-11-30,2023-01-06,PLN7656,1990090423,1990090423,Orthopedic Surgery,In-Network,Z00.01,Z00.00,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,3,18736.8,11569.37,11544.37,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000006242,MBR00000241,Professional,2023-11-22,2023-11-22,2023-12-31,PLN9879,1564502315,1564502315,ASC,In-Network,Z23,Z96.641,,,,,,,0,,78452,Radiology,,,,21,Inpatient Hospital,3,3326.66,2090.8,2055.8,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006243,MBR00000241,Professional,2023-01-09,2023-01-09,2023-01-25,PLN1631,1817234602,1817234602,Clinical Laboratory,In-Network,E11.9,I10,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,2,573.56,271.65,224.6,0.0,0.0,47.05,47.05,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006244,MBR00000241,Professional,2021-02-18,2021-02-18,2021-03-27,PLN2003,1284035364,1284035364,Pediatrics,In-Network,K57.30,E11.9,,,,,,,0,,33533,Surgery,,,,49,Independent Clinic,3,23838.78,10584.26,10130.09,100.38,0.0,353.79,454.17,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000006245,MBR00000241,Institutional-OP,2022-03-14,2022-03-14,2022-04-24,PLN2331,1542828721,1542828721,Orthopedic Surgery,In-Network,Z23,I48.91,,,,,,,0,,93306,Radiology,,,0761,22,Outpatient Hospital,2,3033.91,1484.94,1224.39,0.0,0.0,260.55,260.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006246,MBR00000241,Professional,2021-02-04,2021-02-04,2021-03-17,PLN2640,1193493783,1193493783,Critical Access Hospital,Out-of-Network,I10,I10,,,,,,,0,,93000,Radiology,,,,11,Office,3,105.56,41.24,0.0,41.24,50.0,0.0,91.24,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006247,MBR00000241,Institutional-OP,2022-06-17,2022-06-17,2022-07-24,PLN1953,1860435061,1860435061,DME Supplier,In-Network,I10,N18.3,,,,,,,0,,99232,E&M,,,0301,22,Outpatient Hospital,2,216.22,148.08,0.0,148.08,25.0,0.0,173.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006248,MBR00000241,Professional,2021-07-10,2021-07-10,2021-08-15,PLN6854,1486164553,1486164553,DME Supplier,In-Network,J06.9,Z00.00,,,,,,,0,,99213,E&M,,,,21,Inpatient Hospital,2,114.24,84.48,28.65,0.0,50.0,5.83,55.83,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006249,MBR00000241,Institutional-OP,2023-01-29,2023-01-29,2023-03-08,PLN7330,1389336600,1389336600,Critical Access Hospital,In-Network,E87.6,I63.9,,,,,,,0,,74177,Radiology,,,0320,22,Outpatient Hospital,2,1041.41,609.36,574.36,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006250,MBR00000241,Professional,2022-08-08,2022-08-08,2022-08-30,PLN8911,1872272835,1872272835,Internal Medicine,In-Network,K21.0,J20.9,,,,,,,0,,99222,E&M,,,,11,Office,1,416.77,349.02,0.0,195.25,50.0,15.03,260.28,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006251,MBR00000241,Professional,2021-12-04,2021-12-04,2022-01-12,PLN7958,1118885473,1118885473,ASC,In-Network,I10,E78.5,,,,,,,0,,43239,Surgery,,,,11,Office,3,1899.95,1161.25,1161.25,0.0,0.0,0.0,0.0,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006252,MBR00000241,Professional,2023-07-28,2023-07-28,2023-08-16,PLN7255,1410468316,1410468316,SNF,In-Network,N39.0,M54.5,,,,,,,0,,45380,Surgery,,,,20,Urgent Care,3,1250.21,570.67,519.25,0.0,0.0,51.42,51.42,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006253,MBR00000241,Professional,2023-03-29,2023-03-29,2023-04-15,PLN2276,1644128543,1644128543,Gastroenterology,In-Network,N18.3,Z23,,,,,,,0,,23472,Surgery,,,,65,End-Stage Renal Disease,1,3209.33,1560.5,1109.62,450.88,0.0,0.0,450.88,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006254,MBR00000241,Professional,2022-11-18,2022-11-18,2022-12-24,PLN1160,1227362142,1227362142,DME Supplier,In-Network,F10.20,E11.9,,,,,,,0,,99213,E&M,,,,21,Inpatient Hospital,2,197.99,114.03,0.0,114.03,0.0,0.0,114.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006255,MBR00000241,Institutional-IP,2022-01-23,2022-02-03,2022-02-08,PLN8881,1245650222,1245650222,Gastroenterology,In-Network,J20.9,I11.9,,,,682,MS-DRG,24,11,Y,45380,Surgery,,,0636,21,Inpatient Hospital,3,2616.27,1970.31,1802.34,117.97,50.0,0.0,167.97,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006256,MBR00000242,Professional,2021-10-26,2021-10-26,2021-12-04,PLN8067,1687650653,1687650653,Internal Medicine,In-Network,J06.9,Z23,,,,,,,0,,45380,Surgery,,,,21,Inpatient Hospital,2,1273.99,1075.92,593.38,415.62,0.0,66.92,482.54,0.0,Paid,,,0,,0,0,1,0,0,1,Identity_Theft,0,1,0,0,0
CLM0000006257,MBR00000242,Professional,2022-10-04,2022-10-04,2022-10-12,PLN1902,1845057593,1845057593,Orthopedic Surgery,In-Network,J45.20,E11.9,,,,,,,0,,99213,E&M,,,,22,Outpatient Hospital,2,249.46,80.8,80.8,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006258,MBR00000242,Professional,2023-05-16,2023-05-16,2023-05-25,PLN5392,1364429278,1364429278,OB/GYN,In-Network,E11.9,E78.5,,,,,,,0,,43239,Surgery,,,,11,Office,2,1309.46,752.75,463.73,274.02,15.0,0.0,289.02,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006259,MBR00000242,Institutional-IP,2023-07-07,2023-07-15,2023-07-29,PLN7277,1193493783,1193493783,Critical Access Hospital,Out-of-Network,Z12.11,E11.9,,,,690,MS-DRG,5,8,Y,83036,Pathology/Lab,,,0510,21,Inpatient Hospital,3,60.65,21.21,0.0,21.21,0.0,0.0,21.21,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000006260,MBR00000242,Professional,2023-05-02,2023-05-02,2023-05-29,PLN2075,1915531927,1915531927,Critical Access Hospital,In-Network,E11.9,E11.9,,,,,,,0,,93225,Medicine,,,,22,Outpatient Hospital,3,985.69,404.56,0.0,0.0,0.0,56.8,56.8,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006261,MBR00000242,Professional,2021-01-26,2021-01-26,2021-02-14,PLN1564,1337791138,1337791138,Internal Medicine,Out-of-Network,F32.9,E11.9,,,,,,,0,,99406,Medicine,,,,21,Inpatient Hospital,3,94.71,60.05,35.05,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006262,MBR00000242,Professional,2023-12-15,2023-12-15,2024-01-16,PLN8264,1974006077,1974006077,Orthopedic Surgery,In-Network,I10,I10,,,,,,,0,,72148,Radiology,,,,31,Skilled Nursing Facility,1,1409.54,474.85,21.08,453.77,0.0,0.0,453.77,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006263,MBR00000242,Institutional-OP,2021-09-21,2021-09-21,2021-10-21,PLN1841,1563980627,1563980627,Critical Access Hospital,In-Network,K57.30,K57.30,,,,,,,0,,99221,E&M,,,0301,22,Outpatient Hospital,3,287.68,183.21,0.0,0.0,75.0,11.42,86.42,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006264,MBR00000242,Institutional-OP,2021-01-12,2021-01-12,2021-01-20,PLN1809,1575695214,1575695214,SNF,In-Network,F41.9,I10,,,,,,,0,,82043,Pathology/Lab,,,0510,22,Outpatient Hospital,3,40.18,30.1,0.0,30.1,0.0,0.0,30.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006265,MBR00000242,Professional,2022-09-07,2022-09-07,2022-09-25,PLN8077,1590915516,1590915516,Physical Therapy,Out-of-Network,N17.9,Z00.00,,,,,,,0,,66984,Surgery,,,,20,Urgent Care,2,2440.88,788.12,788.12,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006266,MBR00000242,Professional,2022-05-14,2022-05-14,2022-06-11,PLN1291,1193493783,1193493783,Critical Access Hospital,Out-of-Network,E66.9,I48.91,,,,,,,0,,99203,E&M,,,,11,Office,1,197.18,93.02,76.72,0.0,0.0,16.3,16.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006267,MBR00000242,Professional,2021-04-27,2021-04-27,2021-06-04,PLN8443,1840431511,1840431511,Geriatrics,Out-of-Network,I10,E78.5,,,,,,,0,,23472,Surgery,,,,11,Office,3,2906.97,1444.03,0.0,462.78,0.0,0.0,462.78,0.0,Denied,CO-4,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006268,MBR00000242,Professional,2021-08-23,2021-08-23,2021-09-18,PLN1603,1366426662,1366426662,Urology,In-Network,Z12.31,J06.9,,,,,,,0,,99284,E&M,,,,21,Inpatient Hospital,1,609.7,256.61,39.1,202.51,15.0,0.0,217.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006269,MBR00000242,Institutional-OP,2021-08-14,2021-08-14,2021-09-18,PLN5937,1337791138,1337791138,Internal Medicine,Out-of-Network,R07.9,N39.0,,,,,,,0,,47562,Surgery,,,0761,22,Outpatient Hospital,1,5151.83,3489.75,3121.71,368.04,0.0,0.0,368.04,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006270,MBR00000242,Institutional-OP,2022-04-27,2022-04-27,2022-05-16,PLN4673,1283743001,1283743001,Family Medicine,In-Network,J20.9,J20.9,,,,,,,0,,82043,Pathology/Lab,,,0510,22,Outpatient Hospital,3,46.35,29.21,0.0,29.21,0.0,0.0,29.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006271,MBR00000242,Professional,2023-04-01,2023-04-01,2023-05-11,PLN9406,1631954542,1631954542,Oncology,In-Network,S72.001A,M54.5,,,,,,,0,,99213,E&M,,,,11,Office,1,154.33,81.12,67.83,0.0,0.0,13.29,13.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006272,MBR00000242,Institutional-IP,2023-01-17,2023-01-31,2023-02-27,PLN9339,1606140917,1606140917,ASC,In-Network,G43.909,S72.001A,,,,292,MS-DRG,9,14,N,99203,E&M,,,0510,21,Inpatient Hospital,2,300.22,132.97,57.97,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006273,MBR00000242,Professional,2021-01-29,2021-01-29,2021-03-06,PLN8320,1364429278,1364429278,OB/GYN,In-Network,C50.912,E66.9,,,,,,,0,,99284,E&M,,,,11,Office,1,809.61,412.74,367.13,0.0,25.0,20.61,45.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006274,MBR00000242,Institutional-OP,2021-07-10,2021-07-10,2021-08-15,PLN9556,1980712759,1980712759,Outpatient Clinic,Out-of-Network,F41.9,M54.5,,,,,,,0,,99222,E&M,,,0636,22,Outpatient Hospital,1,370.12,263.19,238.19,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006275,MBR00000242,Institutional-IP,2022-10-30,2022-11-02,2022-11-18,PLN2913,1606140917,1606140917,ASC,In-Network,I50.9,E11.9,,,,683,MS-DRG,14,3,Y,93000,Radiology,,,0301,21,Inpatient Hospital,1,178.77,137.12,102.12,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006276,MBR00000242,Institutional-OP,2023-05-30,2023-05-30,2023-06-09,PLN2924,1193493783,1193493783,Critical Access Hospital,Out-of-Network,R07.9,F41.9,,,,,,,0,,99221,E&M,,,0370,22,Outpatient Hospital,3,198.99,90.08,15.08,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006277,MBR00000242,Professional,2021-02-07,2021-02-07,2021-02-15,PLN9068,1696843572,1696843572,Critical Access Hospital,Out-of-Network,Z87.891,I10,,,,,,,0,,43239,Surgery,,,,11,Office,3,1363.8,1106.35,898.63,0.0,15.0,192.72,207.72,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006278,MBR00000242,Professional,2022-01-03,2022-01-03,2022-01-10,PLN3471,1713934949,1713934949,Neurology,In-Network,R10.9,Z23,,,,,,,0,,70450,Radiology,,,,11,Office,1,685.34,259.0,259.0,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006279,MBR00000242,Professional,2021-05-07,2021-05-07,2021-06-11,PLN1661,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,E11.9,M54.5,,,,,,,0,,99213,E&M,,,,11,Office,1,271.3,101.6,0.0,101.6,35.0,0.0,136.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006280,MBR00000242,Professional,2022-06-16,2022-06-16,2022-06-29,PLN8191,1364429278,1364429278,OB/GYN,In-Network,M81.0,M54.5,,,,,,,0,,99214,E&M,,,,31,Skilled Nursing Facility,3,449.7,303.9,165.81,115.19,0.0,22.9,138.09,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006281,MBR00000242,Professional,2022-03-04,2022-03-04,2022-03-21,PLN8151,1224179551,1224179551,Physical Therapy,In-Network,N39.0,I10,,,,,,,0,,G0468,Medicine,,,,65,End-Stage Renal Disease,3,546.19,273.39,165.28,83.11,25.0,0.0,108.11,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006282,MBR00000242,Institutional-IP,2021-07-10,2021-07-12,2021-08-08,PLN5745,1896447406,1896447406,Nephrology,Out-of-Network,Z12.31,F32.9,,,,641,MS-DRG,4,2,Y,99233,E&M,,,0320,21,Inpatient Hospital,1,360.86,163.13,163.13,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006283,MBR00000242,Institutional-IP,2023-11-23,2023-11-28,2023-12-06,PLN9998,1700633438,1700633438,DME Supplier,In-Network,K21.0,N18.3,,,,195,MS-DRG,1,5,Y,93225,Medicine,,,0510,21,Inpatient Hospital,3,715.43,409.08,394.08,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006284,MBR00000242,Institutional-IP,2023-04-16,2023-04-17,2023-05-27,PLN4383,1450094833,1450094833,Outpatient Clinic,In-Network,J44.1,N18.3,,,,470,MS-DRG,19,1,Y,90460,Medicine,,,0740,21,Inpatient Hospital,2,64.75,49.93,49.93,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006285,MBR00000242,Institutional-IP,2022-08-21,2022-09-01,2022-09-30,PLN2957,1227362142,1227362142,DME Supplier,In-Network,J45.20,M81.0,,,,470,MS-DRG,11,11,Y,G0468,Medicine,,,0200,21,Inpatient Hospital,3,470.46,343.91,0.0,0.0,50.0,31.49,81.49,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006286,MBR00000242,Professional,2023-04-19,2023-04-19,2023-05-16,PLN8563,1434029575,1434029575,Endocrinology,In-Network,K21.0,Z12.31,,,,,,,0,,33533,Surgery,,,,21,Inpatient Hospital,3,26654.75,19244.72,18816.18,428.54,0.0,0.0,428.54,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000006287,MBR00000242,Professional,2021-12-08,2021-12-08,2021-12-28,PLN8913,1624802371,1624802371,ASC,Out-of-Network,I10,I10,,,,,,,0,,85025,Pathology/Lab,,,,50,Federally Qualified Health Center,1,55.02,35.27,10.27,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006288,MBR00000242,Professional,2023-10-21,2023-10-21,2023-11-30,PLN4231,1366426662,1366426662,Urology,In-Network,J45.20,E78.5,,,,,,,0,,99214,E&M,,,,11,Office,1,263.99,143.3,143.3,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006289,MBR00000242,Institutional-OP,2022-03-27,2022-03-27,2022-04-23,PLN8831,1609138981,1609138981,Critical Access Hospital,In-Network,Z23,F41.9,,,,,,,0,,99222,E&M,,,0740,22,Outpatient Hospital,3,600.66,282.83,247.83,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000006290,MBR00000242,Professional,2022-02-27,2022-02-27,2022-04-09,PLN5266,1590915516,1590915516,Physical Therapy,Out-of-Network,G43.909,E11.9,,,,,,,0,,27130,Surgery,,,,11,Office,2,6277.45,3857.35,3857.35,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006291,MBR00000242,Professional,2022-09-15,2022-09-15,2022-10-22,PLN1613,1713934949,1713934949,Neurology,In-Network,I25.10,Z23,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,2,146.64,108.52,107.4,0.0,0.0,1.12,1.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006292,MBR00000242,Professional,2022-09-26,2022-09-26,2022-11-09,PLN6893,1545347862,1545347862,SNF,In-Network,J06.9,I10,,,,,,,0,,87491,Pathology/Lab,,,,65,End-Stage Renal Disease,2,174.77,109.07,89.48,0.0,0.0,19.59,19.59,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006293,MBR00000242,Institutional-IP,2022-11-10,2022-11-19,2022-11-26,PLN6271,1390307371,1390307371,DME Supplier,In-Network,E78.5,N39.0,,,,641,MS-DRG,11,9,Y,23472,Surgery,,,0636,21,Inpatient Hospital,3,7095.84,2293.97,2191.34,102.63,0.0,0.0,102.63,0.0,Paid,,,0,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000006294,MBR00000242,Institutional-OP,2023-07-01,2023-07-01,2023-07-08,PLN6587,1556140803,1556140803,Cardiology,In-Network,K21.0,F41.9,,,,,,,0,,99232,E&M,,,0370,22,Outpatient Hospital,2,267.62,179.86,159.91,0.0,0.0,19.95,19.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006295,MBR00000242,Institutional-OP,2021-10-21,2021-10-21,2021-11-18,PLN2607,1800011727,1800011727,Clinical Laboratory,Out-of-Network,I63.9,G43.909,,,,,,,0,,80053,Pathology/Lab,,,0730,22,Outpatient Hospital,2,54.59,30.05,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006296,MBR00000242,Professional,2023-02-14,2023-02-14,2023-03-27,PLN4241,1872613201,1872613201,Internal Medicine,In-Network,B97.89,J44.1,,,,,,,0,,23472,Surgery,,,,49,Independent Clinic,1,5528.58,3638.55,3144.66,493.89,0.0,0.0,493.89,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006297,MBR00000242,Professional,2021-08-05,2021-08-05,2021-08-22,PLN9965,1502838586,1502838586,ASC,In-Network,J45.20,E11.9,,,,,,,0,,27130,Surgery,,,,21,Inpatient Hospital,1,2853.82,2322.74,1693.66,234.22,25.0,369.86,629.08,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006298,MBR00000242,Professional,2021-09-21,2021-09-21,2021-10-23,PLN3832,1860435061,1860435061,DME Supplier,In-Network,I10,N40.0,,,,,,,0,,74177,Radiology,,,,11,Office,2,1361.64,1001.62,986.62,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006299,MBR00000242,Institutional-OP,2022-06-27,2022-06-27,2022-08-09,PLN2022,1752470395,1752470395,Home Health,In-Network,I10,I10,,,,,,,0,,81001,Pathology/Lab,,,0730,22,Outpatient Hospital,2,23.71,9.57,0.0,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006300,MBR00000242,Professional,2022-07-29,2022-07-29,2022-08-27,PLN7993,1749494482,1749494482,Pediatrics,In-Network,E11.9,J44.1,,,,,,,0,,99222,E&M,,,,11,Office,1,612.53,297.54,181.7,101.14,0.0,14.7,115.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006301,MBR00000242,Professional,2022-12-08,2022-12-08,2022-12-28,PLN1659,1511044648,1511044648,Endocrinology,In-Network,I11.9,N18.3,,,,,,,0,,99213,E&M,,,,81,Independent Laboratory,1,239.66,202.93,0.0,202.93,25.0,0.0,227.93,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000006302,MBR00000243,Professional,2021-06-02,2021-06-02,2021-07-01,PLN7264,1946680931,1946680931,Critical Access Hospital,Out-of-Network,Z12.31,E11.9,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,3,549.14,182.51,132.51,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006303,MBR00000243,Professional,2023-06-14,2023-06-14,2023-07-26,PLN6284,1390307371,1390307371,DME Supplier,In-Network,G43.909,I10,,,,,,,0,,45380,Surgery,,,,11,Office,3,1980.02,630.13,86.64,447.65,75.0,20.84,543.49,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006304,MBR00000243,Institutional-OP,2022-09-03,2022-09-03,2022-09-20,PLN8286,1213165847,1213165847,Critical Access Hospital,In-Network,Z12.11,I10,,,,,,,0,,81001,Pathology/Lab,,,0740,22,Outpatient Hospital,3,41.95,13.97,0.0,13.97,35.0,0.0,48.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006305,MBR00000243,Professional,2022-10-12,2022-10-12,2022-10-30,PLN1553,1809014947,1809014947,Urology,In-Network,J20.9,N18.3,,,,,,,0,,93000,Radiology,,,,50,Federally Qualified Health Center,2,79.43,57.48,57.48,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006306,MBR00000243,Institutional-OP,2023-03-30,2023-03-30,2023-04-29,PLN4662,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,Z00.00,M54.5,,,,,,,0,,99283,E&M,,,0740,22,Outpatient Hospital,1,401.12,250.47,250.47,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006307,MBR00000243,Professional,2023-01-29,2023-01-29,2023-03-01,PLN2985,1561134315,1561134315,DME Supplier,In-Network,Z12.31,J45.20,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,2,63.14,25.83,25.48,0.0,0.0,0.35,0.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006308,MBR00000243,Professional,2022-04-15,2022-04-15,2022-04-25,PLN4089,1990090423,1990090423,Orthopedic Surgery,In-Network,Z87.891,J44.1,,,,,,,0,,99203,E&M,,,,81,Independent Laboratory,3,300.69,207.4,0.0,207.4,15.0,0.0,222.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006309,MBR00000243,Institutional-OP,2022-06-14,2022-06-14,2022-07-11,PLN9370,1245650222,1245650222,Gastroenterology,In-Network,E78.5,Z00.00,,,,,,,0,,99203,E&M,,,0450,22,Outpatient Hospital,2,205.08,148.63,0.0,148.63,0.0,0.0,148.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006310,MBR00000243,Professional,2021-09-12,2021-09-12,2021-10-22,PLN5299,1845057593,1845057593,Orthopedic Surgery,In-Network,F32.9,M54.5,,,,,,,0,,99406,Medicine,,,,11,Office,3,94.86,66.28,0.0,66.28,35.0,0.0,101.28,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006311,MBR00000244,Institutional-OP,2022-09-13,2022-09-13,2022-10-18,PLN5702,1717912431,1717912431,Oncology,In-Network,Z00.00,Z00.00,,,,,,,0,,27447,Surgery,,,0510,22,Outpatient Hospital,2,3876.91,1796.65,0.0,327.39,0.0,0.0,327.39,0.0,Denied,CO-27,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006312,MBR00000244,Professional,2021-08-11,2021-08-11,2021-08-23,PLN6608,1948810580,1948810580,DME Supplier,In-Network,Z96.641,J44.1,,,,,,,0,,33533,Surgery,,,,12,Home,2,14546.12,6448.78,0.0,304.38,50.0,0.0,354.38,0.0,Denied,CO-15,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000006313,MBR00000244,Professional,2022-11-27,2022-11-27,2022-12-24,PLN4813,1935547131,1935547131,Pulmonology,In-Network,R05,R07.9,,,,,,,0,,99283,E&M,,,,11,Office,3,465.02,196.98,0.0,196.98,0.0,0.0,196.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006314,MBR00000244,Professional,2022-04-03,2022-04-03,2022-04-13,PLN9675,1114982472,1114982472,Orthopedic Surgery,In-Network,I25.10,J18.9,,,,,,,0,,99221,E&M,,,,11,Office,1,287.38,146.81,93.08,38.73,15.0,0.0,53.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006315,MBR00000244,Institutional-OP,2021-09-16,2021-09-16,2021-09-29,PLN2558,1410468316,1410468316,SNF,In-Network,F41.9,E11.9,,,,,,,0,,99283,E&M,,,0200,22,Outpatient Hospital,2,298.77,102.58,0.0,102.58,0.0,0.0,102.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006316,MBR00000244,Institutional-IP,2022-06-06,2022-06-08,2022-07-17,PLN4582,1717546253,1717546253,Family Medicine,In-Network,M54.5,I10,,,,292,MS-DRG,6,2,Y,85025,Pathology/Lab,,,0301,21,Inpatient Hospital,2,88.77,54.75,0.0,54.75,0.0,0.0,54.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006317,MBR00000244,Institutional-IP,2023-10-20,2023-10-25,2023-11-07,PLN4418,1812060197,1812060197,Oncology,Out-of-Network,I10,E87.6,,,,603,MS-DRG,21,5,Y,80053,Pathology/Lab,,,0360,21,Inpatient Hospital,3,116.65,50.51,0.51,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006318,MBR00000244,Institutional-OP,2022-09-08,2022-09-08,2022-09-24,PLN6812,1103747954,1103747954,Urology,In-Network,R10.9,I10,,,,,,,0,,47562,Surgery,,,0360,22,Outpatient Hospital,3,5683.75,3398.88,2361.28,448.53,75.0,514.07,1037.6,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006319,MBR00000244,Professional,2022-01-14,2022-01-14,2022-02-01,PLN9577,1964402759,1964402759,Outpatient Clinic,In-Network,F41.9,Z87.891,,,,,,,0,,85025,Pathology/Lab,,,,22,Outpatient Hospital,3,86.36,27.03,0.0,27.03,35.0,0.0,62.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006320,MBR00000244,Institutional-OP,2022-05-08,2022-05-08,2022-06-09,PLN2284,1717912431,1717912431,Oncology,In-Network,I10,E11.9,,,,,,,0,,99233,E&M,,,0636,22,Outpatient Hospital,2,350.25,156.81,49.37,107.44,0.0,0.0,107.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006321,MBR00000244,Professional,2022-10-25,2022-10-25,2022-11-23,PLN7928,1799205295,1799205295,General Acute Care Hospital,In-Network,Z79.4,Z23,,,,,,,0,,58661,Surgery,,,,23,Emergency Room,2,4719.35,1476.75,0.0,367.81,50.0,187.15,604.96,0.0,Denied,CO-27,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006322,MBR00000244,Institutional-OP,2021-06-18,2021-06-18,2021-06-25,PLN6977,1438368327,1438368327,Home Health,In-Network,I11.9,Z00.00,,,,,,,0,,G0468,Medicine,,,0740,22,Outpatient Hospital,1,287.23,134.14,134.14,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006323,MBR00000244,Institutional-OP,2022-09-07,2022-09-07,2022-09-21,PLN7640,1247341320,1247341320,Urology,Out-of-Network,Z23,I10,,,,,,,0,,99221,E&M,,,0270,22,Outpatient Hospital,3,227.57,111.41,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006324,MBR00000244,Professional,2021-02-06,2021-02-06,2021-03-09,PLN3680,1247341320,1247341320,Urology,Out-of-Network,G43.909,Z00.00,,,,,,,0,,G0439,Medicine,,,,11,Office,1,307.14,167.81,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-4,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000006325,MBR00000244,Institutional-OP,2023-07-24,2023-07-24,2023-08-03,PLN3193,1438368327,1438368327,Home Health,In-Network,J45.20,F32.9,,,,,,,0,,99284,E&M,,,0301,22,Outpatient Hospital,3,430.96,172.27,0.0,172.27,25.0,0.0,197.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006326,MBR00000244,Institutional-OP,2022-10-30,2022-10-30,2022-12-05,PLN3888,1872613201,1872613201,Internal Medicine,In-Network,I10,E78.5,,,,,,,0,,90460,Medicine,,,0301,22,Outpatient Hospital,1,65.61,50.83,50.83,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006327,MBR00000244,Professional,2021-05-05,2021-05-05,2021-06-12,PLN5351,1872613201,1872613201,Internal Medicine,In-Network,E66.9,N39.0,,,,,,,0,,99233,E&M,,,,11,Office,3,230.59,168.17,10.32,82.85,75.0,0.0,157.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006328,MBR00000244,Institutional-OP,2022-05-26,2022-05-26,2022-07-05,PLN8440,1434029575,1434029575,Endocrinology,In-Network,F32.9,Z12.31,,,,,,,0,,99232,E&M,,,0761,22,Outpatient Hospital,3,195.64,148.12,123.12,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006329,MBR00000244,Professional,2023-08-27,2023-08-27,2023-09-22,PLN7240,1389336600,1389336600,Critical Access Hospital,In-Network,M17.11,F10.20,,,,,,,0,,77067,Radiology,,,,22,Outpatient Hospital,3,414.46,248.97,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000006330,MBR00000244,Institutional-OP,2023-11-23,2023-11-23,2023-12-30,PLN2706,1713934949,1713934949,Neurology,In-Network,I10,I10,,,,,,,0,,99284,E&M,,,0636,22,Outpatient Hospital,2,793.25,511.73,260.0,187.05,50.0,14.68,251.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006331,MBR00000244,Institutional-OP,2021-05-31,2021-05-31,2021-07-10,PLN1919,1767011137,1767011137,DME Supplier,In-Network,E11.9,E66.9,,,,,,,0,,99283,E&M,,,0320,22,Outpatient Hospital,1,587.71,268.82,193.82,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006332,MBR00000244,Professional,2021-10-24,2021-10-24,2021-11-11,PLN4272,1845900543,1845900543,ASC,In-Network,J20.9,J06.9,,,,,,,0,,23472,Surgery,,,,21,Inpatient Hospital,3,3217.01,1561.77,1508.77,53.0,0.0,0.0,53.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006333,MBR00000244,Professional,2021-06-08,2021-06-08,2021-07-04,PLN1967,1337791138,1337791138,Internal Medicine,Out-of-Network,E11.9,E78.5,,,,,,,0,,23472,Surgery,,,,12,Home,1,3170.46,2334.13,1811.91,0.0,75.0,447.22,522.22,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006334,MBR00000244,Professional,2022-02-08,2022-02-08,2022-02-27,PLN3126,1108115157,1108115157,General Acute Care Hospital,In-Network,I25.10,K21.0,,,,,,,0,,99221,E&M,,,,11,Office,3,156.47,94.99,0.0,94.99,25.0,0.0,119.99,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006335,MBR00000244,Institutional-OP,2023-08-03,2023-08-03,2023-08-10,PLN3392,1235381502,1235381502,Cardiology,In-Network,Z12.31,N18.3,,,,,,,0,,81001,Pathology/Lab,,,0120,22,Outpatient Hospital,2,47.57,33.99,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006336,MBR00000244,Institutional-OP,2023-02-13,2023-02-13,2023-02-26,PLN3211,1366426662,1366426662,Urology,In-Network,I48.91,J20.9,,,,,,,0,,99204,E&M,,,0370,22,Outpatient Hospital,3,388.23,207.54,68.07,104.47,35.0,0.0,139.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006337,MBR00000244,Institutional-OP,2021-10-09,2021-10-09,2021-11-06,PLN6270,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,Z23,E78.5,,,,,,,0,,99233,E&M,,,0200,22,Outpatient Hospital,3,498.01,418.91,127.71,241.2,50.0,0.0,291.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006338,MBR00000244,Institutional-OP,2021-12-23,2021-12-23,2022-01-08,PLN1840,1450094833,1450094833,Outpatient Clinic,In-Network,I50.9,F41.9,,,,,,,0,,78452,Radiology,,,0301,22,Outpatient Hospital,3,6590.94,3448.24,3298.76,149.48,0.0,0.0,149.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006339,MBR00000245,Institutional-IP,2022-11-01,2022-11-04,2022-12-05,PLN5161,1518055405,1518055405,Urology,In-Network,I10,Z12.31,,,,292,MS-DRG,3,3,Y,90460,Medicine,,,0761,21,Inpatient Hospital,2,39.34,29.81,22.51,0.0,0.0,0.11,0.11,7.19,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006340,MBR00000245,Professional,2022-10-16,2022-10-16,2022-11-17,PLN7106,1561134315,1561134315,DME Supplier,In-Network,M81.0,I10,,,,,,,0,,27130,Surgery,,,,11,Office,3,4153.54,1633.74,1137.29,471.45,25.0,0.0,496.45,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006341,MBR00000245,Institutional-OP,2022-05-23,2022-05-23,2022-06-07,PLN2040,1696843572,1696843572,Critical Access Hospital,Out-of-Network,Z00.00,I50.9,,,,,,,0,,58661,Surgery,,,0370,22,Outpatient Hospital,2,2318.75,844.78,715.83,0.0,0.0,8.57,8.57,120.38,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006342,MBR00000245,Professional,2022-04-07,2022-04-07,2022-05-04,PLN6659,1609526529,1609526529,Psychiatry,In-Network,I10,M17.11,,,,,,,0,,43239,Surgery,,,,21,Inpatient Hospital,3,1219.2,895.89,831.99,0.0,25.0,38.9,63.9,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006343,MBR00000245,Professional,2023-10-21,2023-10-21,2023-11-11,PLN1666,1337791138,1337791138,Internal Medicine,Out-of-Network,J06.9,J06.9,,,,,,,0,,99221,E&M,,,,11,Office,2,374.52,214.42,167.49,46.93,0.0,0.0,46.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006344,MBR00000245,Professional,2022-07-06,2022-07-06,2022-07-20,PLN4031,1219817751,1219817751,OB/GYN,In-Network,I48.91,Z79.4,,,,,,,0,,58661,Surgery,,,,11,Office,1,3038.07,1052.98,1002.98,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006345,MBR00000245,Professional,2023-05-07,2023-05-07,2023-05-15,PLN8567,1700633438,1700633438,DME Supplier,In-Network,Z00.00,F10.20,,,,,,,0,,45378,Surgery,,,,11,Office,2,2027.82,713.79,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-11,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000006346,MBR00000245,Institutional-IP,2023-11-18,2023-11-28,2023-12-06,PLN4752,1645194539,1645194539,SNF,In-Network,I50.9,N39.0,,,,292,MS-DRG,4,10,Y,99406,Medicine,,,0740,21,Inpatient Hospital,3,73.63,41.77,30.96,0.0,0.0,0.0,0.0,10.81,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006347,MBR00000245,Professional,2022-01-02,2022-01-02,2022-02-10,PLN7232,1590915516,1590915516,Physical Therapy,Out-of-Network,E11.9,E11.40,,,,,,,0,,47562,Surgery,,,,12,Home,1,6055.02,4327.15,3125.95,142.49,0.0,352.18,494.67,706.53,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006348,MBR00000245,Professional,2023-05-03,2023-05-03,2023-06-08,PLN1419,1575695214,1575695214,SNF,In-Network,J45.20,E11.9,,,,,,,0,,99221,E&M,,,,11,Office,3,326.87,100.07,0.0,100.07,0.0,0.0,100.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006349,MBR00000245,Professional,2023-06-10,2023-06-10,2023-06-20,PLN4091,1860435061,1860435061,DME Supplier,In-Network,Z23,Z23,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,3,195.0,99.8,61.89,0.0,25.0,0.0,25.0,12.91,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006350,MBR00000245,Professional,2021-08-29,2021-08-29,2021-09-19,PLN5082,1860435061,1860435061,DME Supplier,In-Network,I10,Z00.00,,,,,,,0,,90460,Medicine,,,,11,Office,2,71.62,32.04,0.0,32.04,15.0,0.0,47.04,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006351,MBR00000245,Professional,2021-09-05,2021-09-05,2021-10-15,PLN3146,1372918899,1372918899,Family Medicine,In-Network,M17.11,I10,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,3,61.62,35.26,0.0,0.0,75.0,0.0,75.0,10.34,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006352,MBR00000245,Institutional-OP,2021-06-26,2021-06-26,2021-07-06,PLN8910,1124394415,1124394415,Pediatrics,In-Network,Z23,E66.9,,,,,,,0,,74177,Radiology,,,0200,22,Outpatient Hospital,1,1702.21,1431.73,1396.73,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006353,MBR00000245,Professional,2022-11-06,2022-11-06,2022-12-07,PLN6756,1313212303,1313212303,Family Medicine,In-Network,N39.0,J44.1,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,2,3602.26,1802.97,1304.13,445.57,0.0,0.0,445.57,53.27,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006354,MBR00000245,Institutional-OP,2023-04-14,2023-04-14,2023-05-22,PLN8779,1410468316,1410468316,SNF,In-Network,I48.91,I10,,,,,,,0,,74177,Radiology,,,0450,22,Outpatient Hospital,2,2232.05,1356.53,1321.53,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006355,MBR00000245,Professional,2023-04-03,2023-04-03,2023-05-03,PLN8836,1125190055,1125190055,Nephrology,In-Network,M81.0,M17.11,,,,,,,0,,G0468,Medicine,,,,23,Emergency Room,1,549.77,430.02,242.12,155.72,0.0,32.18,187.9,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006356,MBR00000245,Professional,2022-03-01,2022-03-01,2022-03-16,PLN9412,1273488618,1273488618,General Acute Care Hospital,In-Network,E11.9,I10,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,2,4695.49,3265.46,3079.49,135.97,50.0,0.0,185.97,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006357,MBR00000245,Institutional-IP,2023-02-09,2023-02-12,2023-03-08,PLN3270,1790497490,1790497490,OB/GYN,In-Network,E11.9,E78.5,,,,470,MS-DRG,8,3,Y,86900,Pathology/Lab,,,0900,21,Inpatient Hospital,1,34.79,25.19,0.0,25.19,0.0,0.0,25.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006358,MBR00000245,Professional,2021-02-02,2021-02-02,2021-02-25,PLN6099,1244186984,1244186984,Family Medicine,Out-of-Network,E11.9,J45.20,,,,,,,0,,93225,Medicine,,,,11,Office,1,760.61,311.49,287.46,0.0,0.0,0.0,0.0,24.03,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006359,MBR00000245,Professional,2022-12-21,2022-12-21,2023-01-12,PLN7738,1227362142,1227362142,DME Supplier,In-Network,M54.5,Z23,,,,,,,0,,99222,E&M,,,,11,Office,1,275.69,160.27,0.0,160.27,0.0,0.0,160.27,34.63,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000006360,MBR00000245,Professional,2022-06-04,2022-06-04,2022-06-11,PLN4925,1268679390,1268679390,Critical Access Hospital,In-Network,J18.9,M17.11,,,,,,,0,,66984,Surgery,,,,21,Inpatient Hospital,2,2498.73,2041.14,1480.33,0.0,50.0,0.0,50.0,510.81,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006361,MBR00000245,Institutional-OP,2023-06-28,2023-06-28,2023-07-07,PLN5673,1395983630,1395983630,Nephrology,In-Network,N39.0,Z00.00,,,,,,,0,,85025,Pathology/Lab,,,0900,22,Outpatient Hospital,1,97.38,45.74,20.74,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006362,MBR00000245,Institutional-OP,2023-11-26,2023-11-26,2023-12-27,PLN4304,1550154147,1550154147,Outpatient Clinic,In-Network,E87.6,Z23,,,,,,,0,,99221,E&M,,,0320,22,Outpatient Hospital,2,429.97,200.12,185.68,0.0,0.0,0.0,0.0,14.44,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006363,MBR00000245,Professional,2022-09-02,2022-09-02,2022-09-20,PLN4530,1631954542,1631954542,Oncology,In-Network,G43.909,Z23,,,,,,,0,,45380,Surgery,,,,11,Office,3,1648.54,566.67,348.13,167.15,35.0,0.0,202.15,16.39,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006364,MBR00000245,Institutional-IP,2022-11-12,2022-11-15,2022-11-30,PLN1674,1389336600,1389336600,Critical Access Hospital,In-Network,N18.3,E66.9,,,,292,MS-DRG,20,3,Y,23472,Surgery,,,0761,21,Inpatient Hospital,1,4667.79,2893.5,2433.09,410.41,50.0,0.0,460.41,0.0,Paid,,,0,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000006365,MBR00000246,Professional,2023-10-14,2023-10-14,2023-11-01,PLN4744,1689639685,1689639685,SNF,In-Network,F32.9,I10,,,,,,,0,,93225,Medicine,,,,11,Office,3,923.44,535.11,520.11,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000006366,MBR00000246,Institutional-OP,2022-01-11,2022-01-11,2022-01-27,PLN2991,1313212303,1313212303,Family Medicine,In-Network,E78.5,J06.9,,,,,,,0,,93306,Radiology,,,0510,22,Outpatient Hospital,3,2512.41,1964.33,1914.33,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000006367,MBR00000246,Institutional-OP,2021-06-08,2021-06-08,2021-07-17,PLN3103,1717546253,1717546253,Family Medicine,In-Network,J06.9,I10,,,,,,,0,,27447,Surgery,,,0301,22,Outpatient Hospital,2,3238.72,1815.42,1486.14,314.28,15.0,0.0,329.28,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006368,MBR00000246,Professional,2022-07-09,2022-07-09,2022-08-14,PLN1490,1531398223,1531398223,OB/GYN,In-Network,I10,F41.9,,,,,,,0,,58661,Surgery,,,,50,Federally Qualified Health Center,3,2603.34,1631.12,1582.67,48.45,0.0,0.0,48.45,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006369,MBR00000246,Professional,2022-01-25,2022-01-25,2022-03-10,PLN4901,1609138981,1609138981,Critical Access Hospital,In-Network,E11.9,E11.9,,,,,,,0,,74177,Radiology,,,,22,Outpatient Hospital,1,993.67,669.54,234.76,434.78,0.0,0.0,434.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006370,MBR00000246,Institutional-OP,2022-11-27,2022-11-27,2023-01-10,PLN5175,1273488618,1273488618,General Acute Care Hospital,In-Network,R05,I10,,,,,,,0,,97530,Medicine,,,0450,22,Outpatient Hospital,3,286.7,196.11,0.0,196.11,0.0,0.0,196.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006371,MBR00000246,Professional,2023-05-08,2023-05-08,2023-05-19,PLN7748,1728018911,1728018911,Nephrology,In-Network,E66.9,E78.5,,,,,,,0,,99214,E&M,,,,11,Office,1,195.93,166.27,138.1,0.0,25.0,3.17,28.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006372,MBR00000246,Institutional-OP,2022-07-06,2022-07-06,2022-07-20,PLN6445,1872613201,1872613201,Internal Medicine,In-Network,Z00.00,F41.9,,,,,,,0,,86900,Pathology/Lab,,,0120,22,Outpatient Hospital,1,34.91,14.21,0.0,0.0,35.0,0.0,35.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006373,MBR00000246,Institutional-IP,2021-12-04,2021-12-06,2021-12-31,PLN8375,1948810580,1948810580,DME Supplier,In-Network,E11.9,Z23,,,,194,MS-DRG,6,2,Y,99214,E&M,,,0900,21,Inpatient Hospital,1,272.67,127.4,107.06,0.0,0.0,20.34,20.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006374,MBR00000246,Institutional-OP,2022-09-11,2022-09-11,2022-10-08,PLN8423,1219817751,1219817751,OB/GYN,In-Network,F10.20,I11.9,,,,,,,0,,84443,Pathology/Lab,,,0270,22,Outpatient Hospital,2,162.96,113.44,64.38,24.06,25.0,0.0,49.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006375,MBR00000246,Professional,2022-05-01,2022-05-01,2022-06-02,PLN3514,1109850785,1109850785,ASC,Out-of-Network,I25.10,I10,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,2,22.35,13.42,0.0,13.42,35.0,0.0,48.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006376,MBR00000246,Institutional-OP,2021-07-23,2021-07-23,2021-08-15,PLN9979,1561134315,1561134315,DME Supplier,In-Network,Z12.31,Z87.891,,,,,,,0,,71046,Radiology,,,0270,22,Outpatient Hospital,2,142.81,72.29,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006377,MBR00000246,Professional,2023-04-27,2023-04-27,2023-05-07,PLN2337,1266606767,1266606767,ASC,In-Network,F10.20,N39.0,,,,,,,0,,99283,E&M,,,,81,Independent Laboratory,2,608.37,246.34,246.34,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006378,MBR00000246,Institutional-IP,2021-12-30,2021-12-31,2022-01-31,PLN7495,1809014947,1809014947,Urology,In-Network,N40.0,M54.5,,,,195,MS-DRG,21,1,Y,97110,Medicine,,,0320,21,Inpatient Hospital,1,144.79,69.39,59.62,0.0,0.0,9.77,9.77,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000006379,MBR00000246,Institutional-OP,2022-08-13,2022-08-13,2022-09-13,PLN2850,1361302520,1361302520,Critical Access Hospital,In-Network,Z23,M17.11,,,,,,,0,,43239,Surgery,,,0301,22,Outpatient Hospital,3,1056.06,863.98,828.98,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006380,MBR00000246,Institutional-IP,2023-09-22,2023-09-23,2023-10-05,PLN1188,1991459367,1991459367,Neurology,Out-of-Network,J18.9,I10,,,,690,MS-DRG,12,1,Y,90460,Medicine,,,0320,21,Inpatient Hospital,2,54.64,33.15,33.15,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006381,MBR00000246,Institutional-OP,2021-07-25,2021-07-25,2021-08-26,PLN2564,1991459367,1991459367,Neurology,Out-of-Network,K57.30,R10.9,,,,,,,0,,99233,E&M,,,0636,22,Outpatient Hospital,3,286.51,205.28,198.51,0.0,0.0,6.77,6.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006382,MBR00000246,Professional,2022-04-13,2022-04-13,2022-05-21,PLN1158,1550154147,1550154147,Outpatient Clinic,In-Network,K21.0,E66.9,,,,,,,0,,45378,Surgery,,,,12,Home,1,2049.14,927.51,360.71,458.72,75.0,33.08,566.8,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000006383,MBR00000246,Professional,2021-07-11,2021-07-11,2021-08-11,PLN3723,1450094833,1450094833,Outpatient Clinic,In-Network,J18.9,J18.9,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,3,604.28,351.43,15.34,284.31,50.0,1.78,336.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006384,MBR00000246,Institutional-IP,2022-04-24,2022-04-27,2022-06-03,PLN7105,1840431511,1840431511,Geriatrics,Out-of-Network,Z00.00,Z12.11,,,,196,MS-DRG,19,3,N,99232,E&M,,,0450,21,Inpatient Hospital,3,379.38,152.23,0.0,152.23,0.0,0.0,152.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006385,MBR00000246,Professional,2021-11-26,2021-11-26,2022-01-03,PLN5367,1198133277,1198133277,SNF,In-Network,J20.9,R10.9,,,,,,,0,,23472,Surgery,,,,65,End-Stage Renal Disease,1,6853.61,4177.81,3733.82,443.99,0.0,0.0,443.99,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006386,MBR00000246,Professional,2023-09-30,2023-09-30,2023-10-24,PLN4491,1749494482,1749494482,Pediatrics,In-Network,N40.0,E11.9,,,,,,,0,,81001,Pathology/Lab,,,,21,Inpatient Hospital,1,60.07,22.9,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006387,MBR00000246,Institutional-OP,2021-11-28,2021-11-28,2021-12-25,PLN3759,1213165847,1213165847,Critical Access Hospital,In-Network,F41.9,N17.9,,,,,,,0,,72148,Radiology,,,0730,22,Outpatient Hospital,1,2819.3,2141.22,1661.93,479.29,0.0,0.0,479.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006388,MBR00000246,Institutional-IP,2022-11-04,2022-11-08,2022-11-27,PLN7599,1702692193,1702692193,Physical Therapy,In-Network,E78.5,Z79.4,,,,603,MS-DRG,14,4,Y,76700,Radiology,,,0900,21,Inpatient Hospital,2,700.82,259.84,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006389,MBR00000246,Professional,2021-05-30,2021-05-30,2021-07-09,PLN9411,1235381502,1235381502,Cardiology,In-Network,J20.9,E78.5,,,,,,,0,,99204,E&M,,,,23,Emergency Room,2,442.38,329.21,179.24,114.97,35.0,0.0,149.97,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006390,MBR00000246,Professional,2022-05-15,2022-05-15,2022-05-24,PLN6619,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,M17.11,N39.0,,,,,,,0,,87491,Pathology/Lab,,,,81,Independent Laboratory,3,154.79,52.39,52.39,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006391,MBR00000246,Professional,2023-07-03,2023-07-03,2023-08-16,PLN5556,1198133277,1198133277,SNF,In-Network,E66.9,J20.9,,,,,,,0,,27447,Surgery,,,,20,Urgent Care,3,3781.69,3050.54,3015.54,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006392,MBR00000246,Institutional-IP,2023-01-06,2023-01-09,2023-01-13,PLN6765,1691062876,1691062876,SNF,In-Network,E66.9,F32.9,,,,194,MS-DRG,13,3,Y,78452,Radiology,,,0510,21,Inpatient Hospital,2,4034.48,3081.4,3081.4,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000006393,MBR00000246,Institutional-OP,2021-11-06,2021-11-06,2021-11-20,PLN1744,1896447406,1896447406,Nephrology,Out-of-Network,Z87.891,E78.5,,,,,,,0,,80061,Pathology/Lab,,,0730,22,Outpatient Hospital,1,99.51,67.98,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006394,MBR00000246,Professional,2023-12-01,2023-12-01,2024-01-09,PLN6893,1702692193,1702692193,Physical Therapy,In-Network,E11.40,N18.3,,,,,,,0,,99203,E&M,,,,50,Federally Qualified Health Center,2,231.14,154.39,0.0,154.39,0.0,0.0,154.39,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006395,MBR00000246,Professional,2023-05-29,2023-05-29,2023-06-24,PLN2184,1749327647,1749327647,Geriatrics,In-Network,N39.0,E66.9,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,3,1223.72,630.74,0.0,177.43,75.0,70.75,323.18,0.0,Denied,CO-18,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006396,MBR00000246,Institutional-OP,2022-03-17,2022-03-17,2022-04-14,PLN6993,1364429278,1364429278,OB/GYN,In-Network,E78.5,Z00.01,,,,,,,0,,G0444,Medicine,,,0320,22,Outpatient Hospital,1,63.35,53.7,0.0,53.7,35.0,0.0,88.7,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000006397,MBR00000246,Professional,2023-12-02,2023-12-02,2023-12-12,PLN2511,1564502315,1564502315,ASC,In-Network,J06.9,K21.0,,,,,,,0,,99213,E&M,,,,65,End-Stage Renal Disease,3,286.64,86.66,51.66,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006398,MBR00000246,Institutional-IP,2021-07-25,2021-08-04,2021-09-01,PLN6303,1502838586,1502838586,ASC,In-Network,I10,B97.89,,,,470,MS-DRG,11,10,Y,47562,Surgery,,,0636,21,Inpatient Hospital,1,5343.18,1742.39,1742.39,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000006399,MBR00000246,Professional,2021-12-30,2021-12-30,2022-01-18,PLN5386,1799205295,1799205295,General Acute Care Hospital,In-Network,E11.9,Z12.11,,,,,,,0,,93225,Medicine,,,,11,Office,1,498.47,346.46,0.0,346.46,25.0,0.0,371.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006400,MBR00000246,Institutional-OP,2023-10-16,2023-10-16,2023-11-07,PLN8195,1295371663,1295371663,Critical Access Hospital,In-Network,Z23,K21.0,,,,,,,0,,99221,E&M,,,0636,22,Outpatient Hospital,2,418.76,263.09,0.0,263.09,0.0,0.0,263.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006401,MBR00000246,Institutional-OP,2023-11-29,2023-11-29,2023-12-24,PLN7634,1716521444,1716521444,Oncology,In-Network,F32.9,Z23,,,,,,,0,,76700,Radiology,,,0636,22,Outpatient Hospital,3,568.05,251.43,86.99,163.79,0.0,0.65,164.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006402,MBR00000246,Professional,2023-06-21,2023-06-21,2023-06-30,PLN8885,1268679390,1268679390,Critical Access Hospital,In-Network,J45.20,F32.9,,,,,,,0,,93000,Radiology,,,,49,Independent Clinic,3,107.12,54.93,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006403,MBR00000246,Professional,2021-07-29,2021-07-29,2021-09-10,PLN3155,1463205530,1463205530,Nephrology,In-Network,I48.91,R05,,,,,,,0,,99222,E&M,,,,20,Urgent Care,2,265.0,166.78,116.78,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006404,MBR00000247,Professional,2021-08-28,2021-08-28,2021-09-12,PLN1428,1434029575,1434029575,Endocrinology,In-Network,K57.30,I10,,,,,,,0,,99222,E&M,,,,12,Home,3,477.68,251.65,205.95,0.0,0.0,45.7,45.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006405,MBR00000247,Professional,2022-12-10,2022-12-10,2022-12-17,PLN5892,1990090423,1990090423,Orthopedic Surgery,In-Network,I10,J18.9,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,2,58.68,19.61,0.0,19.61,75.0,0.0,94.61,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006406,MBR00000247,Professional,2021-03-03,2021-03-03,2021-03-23,PLN5456,1564502315,1564502315,ASC,In-Network,Z00.00,B97.89,,,,,,,0,,99283,E&M,,,,11,Office,2,256.63,82.01,82.01,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006407,MBR00000247,Professional,2023-12-22,2023-12-22,2024-01-08,PLN8831,1295371663,1295371663,Critical Access Hospital,In-Network,Z00.00,E11.65,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,3,133.99,72.9,0.0,60.32,50.0,0.0,110.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006408,MBR00000247,Institutional-OP,2023-10-28,2023-10-28,2023-12-09,PLN4797,1500037969,1500037969,Pulmonology,In-Network,F32.9,B97.89,,,,,,,0,,97530,Medicine,,,0270,22,Outpatient Hospital,2,268.84,150.8,0.0,0.0,0.0,2.38,2.38,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006409,MBR00000247,Professional,2023-06-05,2023-06-05,2023-06-27,PLN7854,1795618275,1795618275,Pulmonology,In-Network,I10,E11.65,,,,,,,0,,99283,E&M,,,,12,Home,1,469.08,313.16,279.42,33.74,0.0,0.0,33.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006410,MBR00000247,Professional,2023-11-27,2023-11-27,2024-01-04,PLN3459,1198133277,1198133277,SNF,In-Network,I10,N20.0,,,,,,,0,,99233,E&M,,,,11,Office,3,527.33,443.67,370.34,0.0,0.0,73.33,73.33,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006411,MBR00000247,Institutional-OP,2021-09-09,2021-09-09,2021-09-16,PLN8886,1530904931,1530904931,Internal Medicine,In-Network,I10,Z12.11,,,,,,,0,,86900,Pathology/Lab,,,0900,22,Outpatient Hospital,1,42.52,14.59,0.0,14.59,35.0,0.0,49.59,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006412,MBR00000247,Professional,2023-08-23,2023-08-23,2023-09-17,PLN3223,1624802371,1624802371,ASC,Out-of-Network,Z87.891,J44.1,,,,,,,0,,74177,Radiology,,,,65,End-Stage Renal Disease,3,1706.94,774.94,608.02,91.92,75.0,0.0,166.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006413,MBR00000247,Professional,2021-10-09,2021-10-09,2021-10-26,PLN4088,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,Z00.01,I25.10,,,,,,,0,,23472,Surgery,,,,12,Home,2,3241.63,2010.28,1736.16,0.0,35.0,239.12,274.12,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006414,MBR00000247,Institutional-OP,2021-05-13,2021-05-13,2021-06-07,PLN6229,1213165847,1213165847,Critical Access Hospital,In-Network,I10,Z96.641,,,,,,,0,,66984,Surgery,,,0270,22,Outpatient Hospital,2,2630.72,1292.5,1059.39,42.94,0.0,190.17,233.11,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006415,MBR00000247,Institutional-OP,2021-10-15,2021-10-15,2021-10-29,PLN8679,1799205295,1799205295,General Acute Care Hospital,In-Network,I10,C50.912,,,,,,,0,,90837,Medicine,,,0900,22,Outpatient Hospital,1,246.98,114.23,114.23,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006416,MBR00000247,Professional,2023-04-29,2023-04-29,2023-05-28,PLN4867,1433937353,1433937353,Nephrology,In-Network,J06.9,I25.10,,,,,,,0,,85610,Pathology/Lab,,,,21,Inpatient Hospital,1,60.46,28.35,0.0,28.35,0.0,0.0,28.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006417,MBR00000247,Institutional-OP,2023-10-30,2023-10-30,2023-11-26,PLN3771,1745114564,1745114564,Endocrinology,In-Network,J44.1,Z87.891,,,,,,,0,,71046,Radiology,,,0301,22,Outpatient Hospital,1,275.56,115.26,0.0,115.26,50.0,0.0,165.26,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006418,MBR00000247,Professional,2022-11-02,2022-11-02,2022-11-21,PLN2361,1609526529,1609526529,Psychiatry,In-Network,M54.5,Z12.31,,,,,,,0,,33533,Surgery,,,,49,Independent Clinic,3,17842.01,11403.15,10663.53,463.56,50.0,226.06,739.62,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000006419,MBR00000247,Professional,2021-09-26,2021-09-26,2021-10-15,PLN7481,1372918899,1372918899,Family Medicine,In-Network,Z23,Z00.01,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,1,327.37,212.36,0.0,138.38,75.0,0.0,213.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006420,MBR00000247,Professional,2022-10-20,2022-10-20,2022-12-02,PLN2593,1700633438,1700633438,DME Supplier,In-Network,I10,E78.5,,,,,,,0,,93306,Radiology,,,,11,Office,2,2767.68,1906.41,1831.41,0.0,75.0,0.0,75.0,0.0,Adjusted,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006421,MBR00000247,Professional,2022-07-13,2022-07-13,2022-08-24,PLN6973,1500949740,1500949740,Pediatrics,In-Network,E78.5,Z12.31,,,,,,,0,,99222,E&M,,,,23,Emergency Room,1,467.19,174.24,0.0,174.24,15.0,0.0,189.24,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006422,MBR00000247,Professional,2022-07-22,2022-07-22,2022-08-23,PLN9332,1799205295,1799205295,General Acute Care Hospital,In-Network,Z00.00,M54.5,,,,,,,0,,99233,E&M,,,,21,Inpatient Hospital,1,299.64,119.53,0.0,119.53,35.0,0.0,154.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006423,MBR00000247,Professional,2022-01-19,2022-01-19,2022-02-05,PLN1325,1227362142,1227362142,DME Supplier,In-Network,J44.1,F32.9,,,,,,,0,,99222,E&M,,,,49,Independent Clinic,3,583.83,495.26,460.26,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006424,MBR00000247,Institutional-IP,2021-06-01,2021-06-11,2021-07-04,PLN1393,1997536841,1997536841,Family Medicine,Out-of-Network,E66.9,J45.20,,,,292,MS-DRG,21,10,Y,G0439,Medicine,,,0120,21,Inpatient Hospital,1,588.24,256.08,0.0,208.48,50.0,0.0,258.48,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000006425,MBR00000247,Professional,2022-01-31,2022-01-31,2022-03-09,PLN2985,1799205295,1799205295,General Acute Care Hospital,In-Network,I11.9,I25.10,,,,,,,0,,71046,Radiology,,,,21,Inpatient Hospital,1,237.11,151.04,0.0,151.04,0.0,0.0,151.04,0.0,Paid,,,1,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000006426,MBR00000247,Institutional-OP,2023-09-02,2023-09-02,2023-10-09,PLN7571,1198133277,1198133277,SNF,In-Network,J06.9,Z00.00,,,,,,,0,,87491,Pathology/Lab,,,0200,22,Outpatient Hospital,1,103.1,35.88,0.0,35.88,50.0,0.0,85.88,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006427,MBR00000247,Professional,2022-03-23,2022-03-23,2022-04-26,PLN2954,1239316214,1239316214,Internal Medicine,In-Network,E66.9,Z12.31,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,3,385.1,272.23,215.01,0.0,50.0,7.22,57.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006428,MBR00000248,Institutional-IP,2021-01-23,2021-01-26,2021-03-08,PLN7589,1935547131,1935547131,Pulmonology,In-Network,F32.9,E78.5,,,,871,MS-DRG,1,3,Y,45380,Surgery,,,0740,21,Inpatient Hospital,3,3061.46,1152.24,1137.24,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,0,1,0,None,0,1,0,0,0
CLM0000006429,MBR00000248,Professional,2022-01-13,2022-01-13,2022-02-01,PLN5640,1845057593,1845057593,Orthopedic Surgery,In-Network,E11.9,F03.90,,,,,,,0,,74177,Radiology,,,,21,Inpatient Hospital,1,2489.7,1294.31,1107.81,186.5,0.0,0.0,186.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006430,MBR00000248,Professional,2022-05-20,2022-05-20,2022-06-01,PLN5397,1817234602,1817234602,Clinical Laboratory,In-Network,Z12.31,M54.5,,,,,,,0,,90686,Medicine,,,,23,Emergency Room,1,125.2,52.74,0.0,52.74,0.0,0.0,52.74,0.0,Denied,CO-119,,0,,1,1,0,0,0,0,None,0,0,0,0,0
CLM0000006431,MBR00000248,Institutional-IP,2022-10-19,2022-10-21,2022-10-30,PLN5961,1968299309,1968299309,Internal Medicine,In-Network,E78.5,N20.0,,,,603,MS-DRG,24,2,Y,70450,Radiology,,,0636,21,Inpatient Hospital,1,1304.83,697.72,481.38,216.34,0.0,0.0,216.34,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006432,MBR00000248,Professional,2022-12-04,2022-12-04,2023-01-08,PLN7168,1968299309,1968299309,Internal Medicine,In-Network,F03.90,Z00.00,,,,,,,0,,99203,E&M,,,,11,Office,2,209.58,170.04,170.04,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006433,MBR00000248,Institutional-IP,2022-04-11,2022-04-12,2022-04-26,PLN8602,1809014947,1809014947,Urology,In-Network,B97.89,N39.0,,,,682,MS-DRG,18,1,Y,80061,Pathology/Lab,,,0370,21,Inpatient Hospital,2,63.59,28.13,13.51,14.62,0.0,0.0,14.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006434,MBR00000248,Institutional-IP,2021-06-06,2021-06-08,2021-07-19,PLN4108,1702692193,1702692193,Physical Therapy,In-Network,F41.9,E11.40,,,,872,MS-DRG,7,2,Y,45378,Surgery,,,0360,21,Inpatient Hospital,1,1652.68,656.18,656.18,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000006435,MBR00000248,Institutional-IP,2022-04-28,2022-04-30,2022-05-23,PLN2517,1109850785,1109850785,ASC,Out-of-Network,I48.91,F41.9,,,,196,MS-DRG,4,2,Y,99203,E&M,,,0636,21,Inpatient Hospital,2,147.18,50.36,25.36,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000006436,MBR00000248,Institutional-IP,2021-01-04,2021-01-06,2021-01-11,PLN6845,1114982472,1114982472,Orthopedic Surgery,In-Network,E11.9,F32.9,,,,292,MS-DRG,2,2,Y,87491,Pathology/Lab,,,0761,21,Inpatient Hospital,2,244.19,99.2,91.66,0.0,0.0,7.54,7.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006437,MBR00000248,Institutional-OP,2022-07-09,2022-07-09,2022-07-24,PLN2482,1910255109,1910255109,DME Supplier,In-Network,J18.9,J06.9,,,,,,,0,,74177,Radiology,,,0360,22,Outpatient Hospital,1,1387.41,1013.64,984.76,0.0,25.0,3.88,28.88,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006438,MBR00000248,Professional,2022-05-03,2022-05-03,2022-06-04,PLN5301,1395983630,1395983630,Nephrology,In-Network,Z00.00,M81.0,,,,,,,0,,45378,Surgery,,,,81,Independent Laboratory,2,1848.17,767.42,518.55,198.87,50.0,0.0,248.87,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000006439,MBR00000248,Institutional-OP,2022-01-26,2022-01-26,2022-02-05,PLN4770,1717912431,1717912431,Oncology,In-Network,E78.5,R10.9,,,,,,,0,,82043,Pathology/Lab,,,0900,22,Outpatient Hospital,3,60.51,49.83,0.0,49.83,0.0,0.0,49.83,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006440,MBR00000248,Professional,2022-12-26,2022-12-26,2023-01-21,PLN8828,1561134315,1561134315,DME Supplier,In-Network,C50.912,E78.5,,,,,,,0,,97530,Medicine,,,,49,Independent Clinic,1,175.9,80.55,0.0,80.55,0.0,0.0,80.55,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000006441,MBR00000248,Professional,2023-04-07,2023-04-07,2023-05-07,PLN8011,1609526529,1609526529,Psychiatry,In-Network,M54.5,R07.9,,,,,,,0,,76700,Radiology,,,,23,Emergency Room,3,1338.92,585.54,470.84,0.0,50.0,64.7,114.7,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006442,MBR00000248,Institutional-OP,2021-10-16,2021-10-16,2021-11-04,PLN4073,1585582070,1585582070,Outpatient Clinic,In-Network,Z12.31,I10,,,,,,,0,,80061,Pathology/Lab,,,0120,22,Outpatient Hospital,3,49.14,36.97,36.97,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006443,MBR00000248,Professional,2022-07-06,2022-07-06,2022-08-04,PLN3810,1939033455,1939033455,Pulmonology,In-Network,I11.9,M17.11,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,2,4101.41,2585.96,2585.96,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006444,MBR00000248,Institutional-OP,2022-07-13,2022-07-13,2022-07-24,PLN4726,1790497490,1790497490,OB/GYN,In-Network,Z23,Z23,,,,,,,0,,90686,Medicine,,,0320,22,Outpatient Hospital,1,94.27,51.97,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000006445,MBR00000248,Institutional-IP,2022-07-12,2022-07-15,2022-08-19,PLN5488,1242201429,1242201429,General Acute Care Hospital,In-Network,Z00.00,I10,,,,872,MS-DRG,9,3,Y,87491,Pathology/Lab,,,0740,21,Inpatient Hospital,2,127.1,50.31,35.31,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006446,MBR00000248,Institutional-OP,2022-03-18,2022-03-18,2022-04-01,PLN4534,1872272835,1872272835,Internal Medicine,In-Network,E78.5,N18.3,,,,,,,0,,93225,Medicine,,,0270,22,Outpatient Hospital,2,551.56,380.74,0.0,335.19,50.0,0.0,385.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006447,MBR00000248,Professional,2021-08-18,2021-08-18,2021-09-12,PLN8188,1518055405,1518055405,Urology,In-Network,G43.909,N39.0,,,,,,,0,,90686,Medicine,,,,11,Office,3,63.93,41.23,0.0,41.23,50.0,0.0,91.23,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000006448,MBR00000248,Institutional-IP,2021-07-07,2021-07-12,2021-08-16,PLN2554,1585582070,1585582070,Outpatient Clinic,In-Network,M54.5,J20.9,,,,195,MS-DRG,6,5,Y,58661,Surgery,,,0900,21,Inpatient Hospital,1,1722.41,1414.03,1389.03,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006449,MBR00000249,Professional,2021-02-03,2021-02-03,2021-03-18,PLN6862,1974006077,1974006077,Orthopedic Surgery,In-Network,R05,I50.9,,,,,,,0,,97530,Medicine,,,,11,Office,3,243.98,202.45,202.45,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006450,MBR00000249,Professional,2021-02-27,2021-02-27,2021-04-01,PLN2403,1609526529,1609526529,Psychiatry,In-Network,E11.9,F41.9,,,,,,,0,,43239,Surgery,,,,11,Office,2,811.37,511.6,511.6,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006451,MBR00000249,Institutional-IP,2023-06-06,2023-06-08,2023-06-20,PLN5628,1193493783,1193493783,Critical Access Hospital,Out-of-Network,J20.9,M54.5,,,,682,MS-DRG,2,2,Y,85610,Pathology/Lab,,,0510,21,Inpatient Hospital,2,75.71,34.37,34.37,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006452,MBR00000249,Institutional-OP,2021-03-18,2021-03-18,2021-04-17,PLN9449,1939033455,1939033455,Pulmonology,In-Network,I10,J18.9,,,,,,,0,,82043,Pathology/Lab,,,0450,22,Outpatient Hospital,1,38.72,30.73,0.0,30.73,35.0,0.0,65.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006453,MBR00000249,Institutional-OP,2023-07-26,2023-07-26,2023-09-04,PLN9651,1132188260,1132188260,Family Medicine,In-Network,I10,E11.65,,,,,,,0,,G0444,Medicine,,,0301,22,Outpatient Hospital,3,102.38,40.56,0.0,40.56,0.0,0.0,40.56,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000006454,MBR00000249,Institutional-OP,2023-09-09,2023-09-09,2023-10-19,PLN3487,1366426662,1366426662,Urology,In-Network,I10,N39.0,,,,,,,0,,83036,Pathology/Lab,,,0320,22,Outpatient Hospital,2,116.28,73.35,58.35,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000006455,MBR00000249,Institutional-OP,2021-09-22,2021-09-22,2021-10-31,PLN4579,1700633438,1700633438,DME Supplier,In-Network,E11.9,N18.3,,,,,,,0,,83036,Pathology/Lab,,,0900,22,Outpatient Hospital,2,74.83,29.79,0.0,0.0,0.0,0.32,0.32,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000006456,MBR00000249,Professional,2022-05-01,2022-05-01,2022-05-10,PLN8709,1645194539,1645194539,SNF,In-Network,K21.0,F32.9,,,,,,,0,,90837,Medicine,,,,12,Home,1,392.11,217.21,158.09,0.0,25.0,34.12,59.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006457,MBR00000249,Professional,2022-01-30,2022-01-30,2022-02-17,PLN8100,1118885473,1118885473,ASC,In-Network,K92.1,J44.1,,,,,,,0,,G0468,Medicine,,,,21,Inpatient Hospital,2,461.44,177.5,102.5,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006458,MBR00000249,Institutional-OP,2022-03-08,2022-03-08,2022-03-31,PLN3899,1273488618,1273488618,General Acute Care Hospital,In-Network,F03.90,E78.5,,,,,,,0,,70553,Radiology,,,0320,22,Outpatient Hospital,1,2615.88,2209.93,1951.85,0.0,0.0,258.08,258.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006459,MBR00000249,Institutional-IP,2022-01-28,2022-02-01,2022-02-06,PLN1179,1563980627,1563980627,Critical Access Hospital,In-Network,J44.1,E66.9,,,,690,MS-DRG,22,4,N,80061,Pathology/Lab,,,0510,21,Inpatient Hospital,3,130.98,51.5,16.5,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006460,MBR00000249,Professional,2022-01-10,2022-01-10,2022-02-02,PLN9753,1395983630,1395983630,Nephrology,In-Network,E78.5,Z87.891,,,,,,,0,,99214,E&M,,,,11,Office,3,433.46,273.26,0.0,273.26,25.0,0.0,298.26,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006461,MBR00000249,Professional,2023-01-20,2023-01-20,2023-02-27,PLN3832,1856686341,1856686341,Geriatrics,In-Network,E11.9,Z87.891,,,,,,,0,,45378,Surgery,,,,11,Office,3,1390.66,641.93,566.93,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000006462,MBR00000250,Professional,2022-03-28,2022-03-28,2022-04-12,PLN3221,1806688928,1806688928,Geriatrics,In-Network,Z23,E11.40,,,,,,,0,,93225,Medicine,,,,22,Outpatient Hospital,3,532.54,430.83,64.4,287.29,75.0,4.14,366.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006463,MBR00000250,Institutional-OP,2021-07-25,2021-07-25,2021-08-11,PLN7914,1964402759,1964402759,Outpatient Clinic,In-Network,E78.5,F32.9,,,,,,,0,,99204,E&M,,,0301,22,Outpatient Hospital,1,477.62,382.85,373.44,0.0,0.0,9.41,9.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006464,MBR00000250,Professional,2022-02-19,2022-02-19,2022-04-02,PLN5734,1132188260,1132188260,Family Medicine,In-Network,J44.1,Z00.01,,,,,,,0,,97530,Medicine,,,,11,Office,2,148.45,114.89,114.89,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006465,MBR00000250,Institutional-IP,2023-12-08,2023-12-13,2024-01-15,PLN1166,1103747954,1103747954,Urology,In-Network,J20.9,M54.5,,,,291,MS-DRG,5,5,Y,82043,Pathology/Lab,,,0450,21,Inpatient Hospital,3,57.12,36.18,0.0,36.18,25.0,0.0,61.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006466,MBR00000250,Institutional-OP,2023-12-18,2023-12-18,2024-01-11,PLN4569,1691062876,1691062876,SNF,In-Network,N40.0,R05,,,,,,,0,,99283,E&M,,,0740,22,Outpatient Hospital,2,310.92,157.62,0.0,157.62,50.0,0.0,207.62,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006467,MBR00000250,Institutional-OP,2021-03-09,2021-03-09,2021-04-09,PLN5425,1624802371,1624802371,ASC,Out-of-Network,I10,J20.9,,,,,,,0,,90460,Medicine,,,0200,22,Outpatient Hospital,3,45.07,29.69,4.69,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006468,MBR00000250,Professional,2022-09-23,2022-09-23,2022-10-22,PLN9622,1511044648,1511044648,Endocrinology,In-Network,I10,J20.9,,,,,,,0,,66984,Surgery,,,,23,Emergency Room,3,1780.56,617.63,617.63,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006469,MBR00000250,Institutional-OP,2023-12-03,2023-12-03,2023-12-20,PLN1872,1696843572,1696843572,Critical Access Hospital,Out-of-Network,N20.0,I63.9,,,,,,,0,,58661,Surgery,,,0320,22,Outpatient Hospital,1,3023.81,924.97,924.97,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006470,MBR00000250,Institutional-IP,2021-08-01,2021-08-03,2021-08-29,PLN5553,1806688928,1806688928,Geriatrics,In-Network,Z23,Z00.01,,,,683,MS-DRG,11,2,Y,33533,Surgery,,,0740,21,Inpatient Hospital,3,19620.31,11132.6,9123.74,215.0,75.0,1718.86,2008.86,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000006471,MBR00000250,Professional,2021-03-17,2021-03-17,2021-03-26,PLN6979,1856686341,1856686341,Geriatrics,In-Network,I11.9,E11.9,,,,,,,0,,99214,E&M,,,,23,Emergency Room,1,366.05,187.12,184.77,0.0,0.0,2.35,2.35,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006472,MBR00000250,Professional,2021-08-21,2021-08-21,2021-10-03,PLN4137,1915531927,1915531927,Critical Access Hospital,In-Network,Z23,I10,,,,,,,0,,93000,Radiology,,,,11,Office,3,123.16,95.58,95.58,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006473,MBR00000250,Professional,2021-12-14,2021-12-14,2021-12-23,PLN6612,1964402759,1964402759,Outpatient Clinic,In-Network,Z12.31,I48.91,,,,,,,0,,43239,Surgery,,,,11,Office,3,2042.24,1417.04,935.53,364.79,75.0,41.72,481.51,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006474,MBR00000250,Professional,2023-10-21,2023-10-21,2023-11-01,PLN3455,1514306773,1514306773,Endocrinology,In-Network,F32.9,J06.9,,,,,,,0,,90686,Medicine,,,,22,Outpatient Hospital,2,58.76,47.16,0.0,47.16,25.0,0.0,72.16,0.0,Denied,CO-4,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000006475,MBR00000250,Professional,2021-10-02,2021-10-02,2021-10-25,PLN5088,1713934949,1713934949,Neurology,In-Network,I10,I10,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,1,44.7,15.41,15.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006476,MBR00000250,Professional,2021-12-30,2021-12-30,2022-01-08,PLN7049,1660288235,1660288235,ASC,In-Network,R05,E11.9,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,2,2092.35,1449.53,1449.53,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006477,MBR00000250,Institutional-OP,2021-10-12,2021-10-12,2021-11-11,PLN3510,1563980627,1563980627,Critical Access Hospital,In-Network,E78.5,J06.9,,,,,,,0,,90460,Medicine,,,0370,22,Outpatient Hospital,3,29.12,17.29,0.0,0.0,25.0,0.0,25.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006478,MBR00000250,Professional,2022-03-05,2022-03-05,2022-03-22,PLN4157,1366426662,1366426662,Urology,In-Network,E78.5,I48.91,,,,,,,0,,97530,Medicine,,,,21,Inpatient Hospital,3,270.85,81.29,6.29,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000006479,MBR00000250,Professional,2023-12-26,2023-12-26,2024-01-16,PLN1201,1355166277,1355166277,Endocrinology,In-Network,M54.5,Z12.31,,,,,,,0,,71046,Radiology,,,,11,Office,1,114.19,37.69,0.0,0.0,0.0,3.35,3.35,0.0,Denied,CO-18,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006480,MBR00000250,Institutional-IP,2021-04-02,2021-04-07,2021-05-06,PLN4900,1227362142,1227362142,DME Supplier,In-Network,I10,F32.9,,,,194,MS-DRG,13,5,Y,G0439,Medicine,,,0730,21,Inpatient Hospital,3,384.66,322.6,214.72,107.88,0.0,0.0,107.88,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000006481,MBR00000250,Institutional-OP,2022-05-17,2022-05-17,2022-06-16,PLN9166,1847081578,1847081578,Urology,Out-of-Network,N18.3,Z00.00,,,,,,,0,,47562,Surgery,,,0450,22,Outpatient Hospital,2,5995.5,2606.38,2324.25,282.13,0.0,0.0,282.13,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006482,MBR00000250,Institutional-OP,2022-11-04,2022-11-04,2022-11-25,PLN3127,1135158374,1135158374,Pulmonology,In-Network,I10,G43.909,,,,,,,0,,99203,E&M,,,0370,22,Outpatient Hospital,1,192.65,70.75,0.0,70.75,0.0,0.0,70.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006483,MBR00000250,Institutional-OP,2021-05-11,2021-05-11,2021-05-23,PLN9794,1205377316,1205377316,Orthopedic Surgery,In-Network,J44.1,Z12.11,,,,,,,0,,47562,Surgery,,,0450,22,Outpatient Hospital,1,2924.87,1808.9,1808.9,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006484,MBR00000250,Institutional-OP,2021-02-18,2021-02-18,2021-02-25,PLN4779,1812060197,1812060197,Oncology,Out-of-Network,E78.5,J06.9,,,,,,,0,,33533,Surgery,,,0120,22,Outpatient Hospital,3,15875.63,5874.3,0.0,136.94,0.0,0.0,136.94,0.0,Denied,CO-97,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000006485,MBR00000250,Professional,2023-12-12,2023-12-12,2023-12-22,PLN8228,1450094833,1450094833,Outpatient Clinic,In-Network,S72.001A,R51,,,,,,,0,,33533,Surgery,,,,11,Office,3,17586.14,11556.06,9428.54,0.0,15.0,2112.52,2127.52,0.0,Paid,,,0,,0,0,1,1,0,1,Duplicate,0,0,0,0,0
CLM0000006486,MBR00000250,Professional,2021-10-22,2021-10-22,2021-11-20,PLN7844,1545347862,1545347862,SNF,In-Network,F32.9,N17.9,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,2,355.98,179.55,179.01,0.0,0.0,0.54,0.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006487,MBR00000250,Professional,2021-09-23,2021-09-23,2021-10-08,PLN6135,1571574052,1571574052,Critical Access Hospital,In-Network,K57.30,J06.9,,,,,,,0,,99232,E&M,,,,21,Inpatient Hospital,1,260.68,186.0,163.11,0.0,0.0,22.89,22.89,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006488,MBR00000250,Institutional-OP,2022-01-17,2022-01-17,2022-02-12,PLN4341,1475984649,1475984649,SNF,In-Network,Z00.00,E11.9,,,,,,,0,,45380,Surgery,,,0636,22,Outpatient Hospital,3,2803.81,1540.8,1515.8,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006489,MBR00000250,Professional,2021-03-21,2021-03-21,2021-03-29,PLN9974,1542828721,1542828721,Orthopedic Surgery,In-Network,E11.65,J06.9,,,,,,,0,,86900,Pathology/Lab,,,,65,End-Stage Renal Disease,3,58.57,42.49,0.0,42.49,0.0,0.0,42.49,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006490,MBR00000250,Institutional-IP,2021-06-10,2021-06-20,2021-06-23,PLN5695,1450553056,1450553056,Clinical Laboratory,In-Network,J20.9,R07.9,,,,291,MS-DRG,3,10,Y,99214,E&M,,,0740,21,Inpatient Hospital,2,427.81,273.48,130.95,107.53,35.0,0.0,142.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006491,MBR00000250,Professional,2021-01-27,2021-01-27,2021-03-04,PLN7845,1450553056,1450553056,Clinical Laboratory,In-Network,I10,E78.5,,,,,,,0,,99283,E&M,,,,49,Independent Clinic,3,571.43,404.52,354.57,0.0,0.0,49.95,49.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006492,MBR00000250,Institutional-OP,2022-08-09,2022-08-09,2022-08-26,PLN8662,1244186984,1244186984,Family Medicine,Out-of-Network,I10,F32.9,,,,,,,0,,99283,E&M,,,0360,22,Outpatient Hospital,3,559.63,444.75,444.75,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006493,MBR00000250,Professional,2022-05-23,2022-05-23,2022-06-20,PLN1562,1239316214,1239316214,Internal Medicine,In-Network,I50.9,I10,,,,,,,0,,58661,Surgery,,,,23,Emergency Room,2,2876.18,1786.01,1761.01,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006494,MBR00000250,Institutional-OP,2021-10-28,2021-10-28,2021-11-28,PLN8237,1948810580,1948810580,DME Supplier,In-Network,M54.5,E11.9,,,,,,,0,,99204,E&M,,,0200,22,Outpatient Hospital,3,529.21,251.63,251.63,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006495,MBR00000250,Institutional-OP,2023-10-03,2023-10-03,2023-10-18,PLN3642,1569105090,1569105090,Geriatrics,In-Network,Z12.31,R51,,,,,,,0,,45378,Surgery,,,0370,22,Outpatient Hospital,2,1264.27,827.18,511.01,301.17,15.0,0.0,316.17,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000006496,MBR00000250,Professional,2021-12-01,2021-12-01,2022-01-14,PLN1246,1395983630,1395983630,Nephrology,In-Network,G43.909,R07.9,,,,,,,0,,78452,Radiology,,,,12,Home,3,6862.54,3171.84,3171.84,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006497,MBR00000250,Institutional-OP,2021-01-19,2021-01-19,2021-01-30,PLN2886,1585582070,1585582070,Outpatient Clinic,In-Network,Z23,Z23,,,,,,,0,,80061,Pathology/Lab,,,0740,22,Outpatient Hospital,2,120.74,63.99,0.0,53.21,35.0,0.0,88.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006498,MBR00000250,Professional,2021-04-20,2021-04-20,2021-05-23,PLN2481,1109850785,1109850785,ASC,Out-of-Network,Z23,G43.909,,,,,,,0,,47562,Surgery,,,,11,Office,2,5410.71,2366.28,2338.73,2.55,25.0,0.0,27.55,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006499,MBR00000250,Professional,2023-03-06,2023-03-06,2023-03-22,PLN3572,1389336600,1389336600,Critical Access Hospital,In-Network,Z12.31,G43.909,,,,,,,0,,81001,Pathology/Lab,,,,12,Home,3,53.81,33.6,0.0,33.6,0.0,0.0,33.6,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006500,MBR00000250,Professional,2022-08-07,2022-08-07,2022-09-07,PLN2049,1752470395,1752470395,Home Health,In-Network,E78.5,E78.5,,,,,,,0,,74177,Radiology,,,,11,Office,2,2739.26,1341.08,820.06,446.02,75.0,0.0,521.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006501,MBR00000251,Institutional-IP,2021-10-13,2021-10-18,2021-11-18,PLN1537,1500037969,1500037969,Pulmonology,In-Network,R07.9,Z87.891,,,,872,MS-DRG,4,5,Y,47562,Surgery,,,0450,21,Inpatient Hospital,2,5870.04,2210.57,2175.57,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006502,MBR00000251,Professional,2021-09-28,2021-09-28,2021-11-03,PLN7396,1463205530,1463205530,Nephrology,In-Network,G20,Z96.641,,,,,,,0,,93000,Radiology,,,,81,Independent Laboratory,3,142.86,91.99,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006503,MBR00000251,Institutional-OP,2021-08-28,2021-08-28,2021-10-02,PLN4438,1355166277,1355166277,Endocrinology,In-Network,J06.9,I48.91,,,,,,,0,,99213,E&M,,,0761,22,Outpatient Hospital,2,325.04,263.73,201.27,0.0,25.0,0.0,25.0,37.46,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006504,MBR00000251,Institutional-OP,2022-04-07,2022-04-07,2022-04-24,PLN8833,1713934949,1713934949,Neurology,In-Network,Z23,N39.0,,,,,,,0,,99232,E&M,,,0450,22,Outpatient Hospital,3,245.79,86.59,51.59,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006505,MBR00000251,Professional,2023-02-10,2023-02-10,2023-03-11,PLN4715,1840431511,1840431511,Geriatrics,Out-of-Network,F03.90,J44.1,,,,,,,0,,43239,Surgery,,,,11,Office,1,2064.14,1752.65,1424.08,0.0,0.0,257.66,257.66,70.91,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006506,MBR00000251,Professional,2022-11-30,2022-11-30,2022-12-17,PLN8597,1450553056,1450553056,Clinical Laboratory,In-Network,I50.9,E66.9,,,,,,,0,,99213,E&M,,,,11,Office,3,272.55,196.64,0.0,0.0,0.0,0.0,0.0,25.09,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006507,MBR00000251,Professional,2023-03-30,2023-03-30,2023-04-21,PLN8239,1728018911,1728018911,Nephrology,In-Network,E11.9,J18.9,,,,,,,0,,23472,Surgery,,,,11,Office,3,7308.01,3806.28,3241.49,0.0,25.0,539.79,564.79,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006508,MBR00000251,Professional,2021-02-15,2021-02-15,2021-03-24,PLN8132,1453283987,1453283987,Critical Access Hospital,In-Network,Z96.641,R10.9,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,3,79.41,56.26,0.0,56.26,15.0,0.0,71.26,4.31,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006509,MBR00000251,Institutional-OP,2022-09-05,2022-09-05,2022-10-13,PLN4203,1964402759,1964402759,Outpatient Clinic,In-Network,R07.9,E66.9,,,,,,,0,,71046,Radiology,,,0320,22,Outpatient Hospital,3,192.89,163.57,163.57,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000006510,MBR00000251,Professional,2023-04-18,2023-04-18,2023-04-29,PLN8814,1872613201,1872613201,Internal Medicine,In-Network,J06.9,Z12.31,,,,,,,0,,99213,E&M,,,,49,Independent Clinic,1,198.51,110.36,95.36,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006511,MBR00000251,Institutional-OP,2021-08-10,2021-08-10,2021-09-21,PLN1733,1860435061,1860435061,DME Supplier,In-Network,K57.30,E11.65,,,,,,,0,,99232,E&M,,,0636,22,Outpatient Hospital,2,324.43,130.94,96.25,0.0,0.0,10.48,10.48,24.21,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006512,MBR00000251,Institutional-OP,2022-10-01,2022-10-01,2022-11-09,PLN6447,1438368327,1438368327,Home Health,In-Network,K21.0,I10,,,,,,,0,,G0444,Medicine,,,0740,22,Outpatient Hospital,1,73.75,26.77,26.77,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000006513,MBR00000251,Professional,2021-01-07,2021-01-07,2021-01-23,PLN6666,1624802371,1624802371,ASC,Out-of-Network,I63.9,E66.9,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,2,2275.41,1815.41,1815.41,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006514,MBR00000251,Institutional-IP,2023-09-24,2023-09-25,2023-10-16,PLN3344,1840431511,1840431511,Geriatrics,Out-of-Network,M54.5,Z12.31,,,,641,MS-DRG,14,1,Y,99213,E&M,,,0370,21,Inpatient Hospital,3,195.94,156.07,156.07,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006515,MBR00000251,Institutional-OP,2023-03-19,2023-03-19,2023-04-23,PLN2021,1433937353,1433937353,Nephrology,In-Network,E78.5,Z23,,,,,,,0,,71046,Radiology,,,0360,22,Outpatient Hospital,1,297.27,199.48,174.48,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006516,MBR00000251,Institutional-IP,2022-11-14,2022-11-25,2022-11-21,PLN5348,1713934949,1713934949,Neurology,In-Network,F32.9,Z23,,,,690,MS-DRG,3,11,Y,97110,Medicine,,,0761,21,Inpatient Hospital,3,221.71,174.96,0.0,174.96,0.0,0.0,174.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006517,MBR00000251,Professional,2022-10-19,2022-10-19,2022-10-29,PLN6813,1727809972,1727809972,Home Health,In-Network,E11.9,R10.9,,,,,,,0,,76700,Radiology,,,,11,Office,1,1148.24,940.79,860.44,0.0,0.0,80.35,80.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006518,MBR00000251,Institutional-OP,2023-01-04,2023-01-04,2023-01-12,PLN7812,1193493783,1193493783,Critical Access Hospital,Out-of-Network,N39.0,N20.0,,,,,,,0,,70450,Radiology,,,0636,22,Outpatient Hospital,1,773.98,520.2,470.2,0.0,50.0,0.0,50.0,0.0,Pended,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006519,MBR00000251,Institutional-OP,2022-04-08,2022-04-08,2022-05-13,PLN8719,1389336600,1389336600,Critical Access Hospital,In-Network,F32.9,N39.0,,,,,,,0,,G0444,Medicine,,,0636,22,Outpatient Hospital,3,69.5,21.0,0.0,0.0,0.0,0.0,0.0,1.18,Denied,PR-1,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000006520,MBR00000251,Institutional-OP,2023-11-25,2023-11-25,2023-12-15,PLN8976,1609526529,1609526529,Psychiatry,In-Network,I10,F32.9,,,,,,,0,,99232,E&M,,,0761,22,Outpatient Hospital,1,372.79,177.16,165.72,0.0,0.0,0.0,0.0,11.44,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006521,MBR00000251,Institutional-OP,2021-08-22,2021-08-22,2021-09-22,PLN4206,1606140917,1606140917,ASC,In-Network,Z96.641,N39.0,,,,,,,0,,93000,Radiology,,,0510,22,Outpatient Hospital,2,179.44,73.78,53.12,9.11,0.0,11.55,20.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006522,MBR00000251,Institutional-OP,2023-06-07,2023-06-07,2023-06-17,PLN7713,1817234602,1817234602,Clinical Laboratory,In-Network,I10,J44.1,,,,,,,0,,99221,E&M,,,0370,22,Outpatient Hospital,2,435.82,266.31,191.31,0.0,75.0,0.0,75.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006523,MBR00000251,Institutional-IP,2023-04-15,2023-04-17,2023-05-11,PLN4503,1997536841,1997536841,Family Medicine,Out-of-Network,N17.9,Z12.31,,,,871,MS-DRG,8,2,W,74177,Radiology,,,0360,21,Inpatient Hospital,3,2637.29,1684.83,1498.24,186.59,0.0,0.0,186.59,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006524,MBR00000251,Professional,2023-07-07,2023-07-07,2023-08-16,PLN7599,1450094833,1450094833,Outpatient Clinic,In-Network,N39.0,Z23,,,,,,,0,,77067,Radiology,,,,23,Emergency Room,3,467.67,385.14,74.42,292.32,0.0,18.4,310.72,0.0,Paid,,,1,,1,1,0,0,0,0,None,1,0,0,0,0
CLM0000006525,MBR00000251,Institutional-OP,2021-03-19,2021-03-19,2021-04-18,PLN4511,1806688928,1806688928,Geriatrics,In-Network,F41.9,N18.3,,,,,,,0,,97110,Medicine,,,0200,22,Outpatient Hospital,2,180.47,147.23,0.0,147.23,0.0,0.0,147.23,16.97,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006526,MBR00000251,Professional,2022-05-03,2022-05-03,2022-05-10,PLN4767,1717912431,1717912431,Oncology,In-Network,Z51.11,E11.9,,,,,,,0,,70553,Radiology,,,,81,Independent Laboratory,1,3777.75,1269.86,1234.86,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000006527,MBR00000251,Institutional-OP,2022-12-05,2022-12-05,2022-12-23,PLN8334,1727809972,1727809972,Home Health,In-Network,E78.5,N18.3,,,,,,,0,,71046,Radiology,,,0200,22,Outpatient Hospital,2,162.41,115.83,115.83,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006528,MBR00000252,Professional,2022-11-09,2022-11-09,2022-12-15,PLN4342,1571574052,1571574052,Critical Access Hospital,In-Network,Z23,R05,,,,,,,0,,45378,Surgery,,,,21,Inpatient Hospital,3,2220.64,1234.13,1184.13,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000006529,MBR00000252,Institutional-IP,2023-01-24,2023-02-01,2023-03-09,PLN5260,1245650222,1245650222,Gastroenterology,In-Network,I10,C50.912,,,,871,MS-DRG,11,8,Y,99204,E&M,,,0900,21,Inpatient Hospital,2,462.69,359.73,0.0,336.62,25.0,0.0,361.62,0.0,Pended,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000006530,MBR00000252,Institutional-OP,2022-11-26,2022-11-26,2022-12-25,PLN6617,1186826716,1186826716,Physical Therapy,In-Network,G43.909,N39.0,,,,,,,0,,43239,Surgery,,,0740,22,Outpatient Hospital,3,1631.31,496.84,496.84,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006531,MBR00000252,Institutional-OP,2021-09-02,2021-09-02,2021-09-16,PLN7992,1511044648,1511044648,Endocrinology,In-Network,E66.9,Z23,,,,,,,0,,99284,E&M,,,0370,22,Outpatient Hospital,2,911.57,516.76,179.79,311.97,25.0,0.0,336.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006532,MBR00000252,Professional,2023-06-26,2023-06-26,2023-07-18,PLN3332,1239316214,1239316214,Internal Medicine,In-Network,F32.9,E78.5,,,,,,,0,,93306,Radiology,,,,49,Independent Clinic,2,2689.93,1329.79,1109.41,220.38,0.0,0.0,220.38,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006533,MBR00000252,Institutional-IP,2022-06-14,2022-06-15,2022-07-16,PLN2133,1193493783,1193493783,Critical Access Hospital,Out-of-Network,Z23,Z12.31,,,,470,MS-DRG,16,1,Y,99221,E&M,,,0450,21,Inpatient Hospital,2,176.8,101.44,0.0,101.44,15.0,0.0,116.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006534,MBR00000252,Professional,2023-11-29,2023-11-29,2023-12-10,PLN4379,1514306773,1514306773,Endocrinology,In-Network,R10.9,I10,,,,,,,0,,99214,E&M,,,,12,Home,2,172.2,122.51,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006535,MBR00000252,Professional,2022-07-24,2022-07-24,2022-08-11,PLN3956,1168881145,1168881145,Orthopedic Surgery,In-Network,K21.0,J45.20,,,,,,,0,,80061,Pathology/Lab,,,,20,Urgent Care,2,119.1,82.62,82.62,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006536,MBR00000252,Professional,2022-08-12,2022-08-12,2022-09-23,PLN9876,1114982472,1114982472,Orthopedic Surgery,In-Network,N39.0,R07.9,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,2,3506.92,1494.33,1413.73,80.6,0.0,0.0,80.6,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006537,MBR00000252,Institutional-OP,2022-10-10,2022-10-10,2022-10-28,PLN6688,1865904917,1865904917,Outpatient Clinic,In-Network,Z79.4,N18.3,,,,,,,0,,77067,Radiology,,,0740,22,Outpatient Hospital,3,431.63,166.13,84.07,0.0,75.0,7.06,82.06,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000006538,MBR00000252,Institutional-OP,2023-08-12,2023-08-12,2023-09-03,PLN8398,1645194539,1645194539,SNF,In-Network,J06.9,J44.1,,,,,,,0,,74177,Radiology,,,0270,22,Outpatient Hospital,2,2032.56,1216.32,1216.32,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006539,MBR00000252,Institutional-IP,2023-09-14,2023-09-23,2023-09-26,PLN9319,1717912431,1717912431,Oncology,In-Network,I50.9,Z23,,,,470,MS-DRG,3,9,Y,45380,Surgery,,,0761,21,Inpatient Hospital,1,2435.54,1760.7,0.0,116.93,75.0,0.0,191.93,0.0,Denied,CO-11,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006540,MBR00000252,Institutional-OP,2022-10-03,2022-10-03,2022-11-04,PLN2314,1168881145,1168881145,Orthopedic Surgery,In-Network,J06.9,M54.5,,,,,,,0,,99284,E&M,,,0301,22,Outpatient Hospital,2,658.15,559.09,0.0,354.18,0.0,35.2,389.38,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006541,MBR00000252,Professional,2022-08-22,2022-08-22,2022-10-02,PLN8953,1235381502,1235381502,Cardiology,In-Network,E11.9,E11.9,,,,,,,0,,84443,Pathology/Lab,,,,22,Outpatient Hospital,2,148.34,44.52,44.52,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006542,MBR00000252,Professional,2021-03-01,2021-03-01,2021-03-21,PLN3118,1622771872,1622771872,Pediatrics,In-Network,E11.9,Z00.01,,,,,,,0,,66984,Surgery,,,,21,Inpatient Hospital,1,2414.28,1113.75,1078.75,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006543,MBR00000252,Institutional-OP,2021-03-15,2021-03-15,2021-04-08,PLN2022,1939033455,1939033455,Pulmonology,In-Network,N17.9,E66.9,,,,,,,0,,99284,E&M,,,0730,22,Outpatient Hospital,3,855.32,646.31,586.44,0.0,0.0,59.87,59.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006544,MBR00000252,Institutional-OP,2023-03-18,2023-03-18,2023-04-19,PLN9987,1103747954,1103747954,Urology,In-Network,F10.20,Z23,,,,,,,0,,80053,Pathology/Lab,,,0270,22,Outpatient Hospital,1,124.42,72.87,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006545,MBR00000252,Institutional-OP,2022-01-13,2022-01-13,2022-02-26,PLN3533,1569105090,1569105090,Geriatrics,In-Network,E11.9,M54.5,,,,,,,0,,81001,Pathology/Lab,,,0370,22,Outpatient Hospital,2,42.29,15.09,0.0,15.09,25.0,0.0,40.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006546,MBR00000252,Professional,2022-04-24,2022-04-24,2022-06-07,PLN1241,1219817751,1219817751,OB/GYN,In-Network,Z12.31,Z00.00,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,1,105.72,44.42,44.42,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000006547,MBR00000252,Professional,2022-11-20,2022-11-20,2022-12-19,PLN1403,1514306773,1514306773,Endocrinology,In-Network,I10,E11.9,,,,,,,0,,80061,Pathology/Lab,,,,12,Home,1,46.85,23.44,23.44,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006548,MBR00000252,Professional,2021-08-31,2021-08-31,2021-09-08,PLN7368,1569105090,1569105090,Geriatrics,In-Network,Z23,E11.9,,,,,,,0,,99203,E&M,,,,11,Office,3,394.36,334.76,261.26,0.0,15.0,58.5,73.5,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006549,MBR00000252,Institutional-OP,2021-12-31,2021-12-31,2022-02-02,PLN4605,1817234602,1817234602,Clinical Laboratory,In-Network,N18.3,I10,,,,,,,0,,82043,Pathology/Lab,,,0200,22,Outpatient Hospital,1,42.09,25.7,21.61,0.0,0.0,4.09,4.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006550,MBR00000252,Professional,2021-02-17,2021-02-17,2021-03-31,PLN4969,1980712759,1980712759,Outpatient Clinic,Out-of-Network,K21.0,R07.9,,,,,,,0,,99214,E&M,,,,49,Independent Clinic,2,192.91,101.52,101.52,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006551,MBR00000252,Professional,2023-04-21,2023-04-21,2023-06-04,PLN4001,1366286000,1366286000,SNF,In-Network,I10,Z00.00,,,,,,,0,,43239,Surgery,,,,20,Urgent Care,3,1287.4,877.17,877.17,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006552,MBR00000252,Institutional-IP,2022-07-11,2022-07-15,2022-08-22,PLN5015,1268679390,1268679390,Critical Access Hospital,In-Network,E78.5,J20.9,,,,603,MS-DRG,2,4,Y,99232,E&M,,,0900,21,Inpatient Hospital,1,329.24,159.01,125.65,22.83,0.0,10.53,33.36,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000006553,MBR00000252,Professional,2021-07-27,2021-07-27,2021-09-09,PLN6428,1268679390,1268679390,Critical Access Hospital,In-Network,F32.9,E78.5,,,,,,,0,,99283,E&M,,,,49,Independent Clinic,3,278.15,132.63,0.0,132.63,0.0,0.0,132.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006554,MBR00000252,Professional,2022-10-15,2022-10-15,2022-11-20,PLN9628,1860435061,1860435061,DME Supplier,In-Network,E11.9,E78.5,,,,,,,0,,93000,Radiology,,,,65,End-Stage Renal Disease,2,107.91,40.16,25.16,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006555,MBR00000252,Institutional-OP,2021-06-06,2021-06-06,2021-06-19,PLN6932,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,I50.9,I10,,,,,,,0,,77067,Radiology,,,0120,22,Outpatient Hospital,1,457.11,274.76,52.17,172.59,50.0,0.0,222.59,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000006556,MBR00000252,Professional,2023-05-05,2023-05-05,2023-06-12,PLN1820,1806688928,1806688928,Geriatrics,In-Network,I25.10,Z79.4,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,1,27.09,20.33,0.0,20.33,0.0,0.0,20.33,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006557,MBR00000252,Institutional-IP,2021-09-10,2021-09-17,2021-10-23,PLN3746,1550154147,1550154147,Outpatient Clinic,In-Network,I50.9,J06.9,,,,470,MS-DRG,3,7,Y,99221,E&M,,,0761,21,Inpatient Hospital,3,201.22,116.84,81.84,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006558,MBR00000252,Institutional-OP,2021-10-24,2021-10-24,2021-11-29,PLN8471,1997536841,1997536841,Family Medicine,Out-of-Network,G43.909,M17.11,,,,,,,0,,27447,Surgery,,,0270,22,Outpatient Hospital,2,4219.73,3563.26,3488.26,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006559,MBR00000252,Professional,2023-08-18,2023-08-18,2023-09-29,PLN4561,1390307371,1390307371,DME Supplier,In-Network,Z96.641,Z23,,,,,,,0,,76700,Radiology,,,,22,Outpatient Hospital,2,593.72,386.09,386.09,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006560,MBR00000252,Professional,2023-03-25,2023-03-25,2023-04-01,PLN8257,1812060197,1812060197,Oncology,Out-of-Network,M17.11,R05,,,,,,,0,,45380,Surgery,,,,21,Inpatient Hospital,1,2894.49,1729.4,1654.4,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006561,MBR00000252,Institutional-IP,2023-01-16,2023-01-18,2023-02-08,PLN8457,1213165847,1213165847,Critical Access Hospital,In-Network,M81.0,E11.9,,,,872,MS-DRG,13,2,Y,99283,E&M,,,0320,21,Inpatient Hospital,2,270.35,156.37,156.37,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006562,MBR00000252,Institutional-IP,2022-10-22,2022-10-23,2022-11-13,PLN7363,1689639685,1689639685,SNF,In-Network,F32.9,E66.9,,,,603,MS-DRG,24,1,Y,99283,E&M,,,0360,21,Inpatient Hospital,3,269.89,92.63,0.0,92.63,0.0,0.0,92.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006563,MBR00000252,Institutional-OP,2022-07-24,2022-07-24,2022-08-14,PLN1579,1899127912,1899127912,Neurology,In-Network,E11.9,J18.9,,,,,,,0,,99213,E&M,,,0370,22,Outpatient Hospital,2,183.65,154.22,154.22,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006564,MBR00000253,Professional,2021-07-30,2021-07-30,2021-08-28,PLN9335,1542828721,1542828721,Orthopedic Surgery,In-Network,Z12.31,I63.9,,,,,,,0,,27447,Surgery,,,,11,Office,1,4709.05,3647.75,3647.75,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006565,MBR00000253,Institutional-OP,2021-11-25,2021-11-25,2021-12-09,PLN1320,1389336600,1389336600,Critical Access Hospital,In-Network,F41.9,N20.0,,,,,,,0,,99221,E&M,,,0270,22,Outpatient Hospital,2,374.47,144.06,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006566,MBR00000253,Professional,2023-11-21,2023-11-21,2023-12-14,PLN5046,1542828721,1542828721,Orthopedic Surgery,In-Network,M81.0,J20.9,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,3,147.39,123.71,48.71,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006567,MBR00000253,Professional,2023-10-03,2023-10-03,2023-11-04,PLN5140,1475984649,1475984649,SNF,In-Network,I25.10,I50.9,,,,,,,0,,86900,Pathology/Lab,,,,21,Inpatient Hospital,2,29.44,11.54,0.0,11.54,25.0,0.0,36.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006568,MBR00000253,Professional,2023-03-07,2023-03-07,2023-04-13,PLN5748,1780163051,1780163051,SNF,In-Network,Z00.00,J20.9,,,,,,,0,,99204,E&M,,,,23,Emergency Room,1,300.37,101.87,101.87,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006569,MBR00000253,Professional,2023-09-01,2023-09-01,2023-10-04,PLN7540,1896447406,1896447406,Nephrology,Out-of-Network,E11.9,K57.30,,,,,,,0,,99284,E&M,,,,11,Office,3,860.87,480.96,416.04,14.92,50.0,0.0,64.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006570,MBR00000253,Professional,2023-05-31,2023-05-31,2023-06-30,PLN7738,1872613201,1872613201,Internal Medicine,In-Network,E78.5,N18.3,,,,,,,0,,99203,E&M,,,,11,Office,1,263.9,111.61,0.0,111.61,75.0,0.0,186.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006571,MBR00000253,Professional,2022-03-14,2022-03-14,2022-03-27,PLN4309,1540044947,1540044947,Pulmonology,Out-of-Network,E78.5,K92.1,,,,,,,0,,G0468,Medicine,,,,22,Outpatient Hospital,1,653.48,226.41,201.41,0.0,25.0,0.0,25.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006572,MBR00000253,Professional,2023-02-23,2023-02-23,2023-03-27,PLN2832,1860435061,1860435061,DME Supplier,In-Network,G43.909,E11.9,,,,,,,0,,99221,E&M,,,,11,Office,3,413.65,183.41,108.41,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006573,MBR00000253,Institutional-IP,2023-04-05,2023-04-08,2023-05-01,PLN7978,1990090423,1990090423,Orthopedic Surgery,In-Network,I10,Z00.00,,,,682,MS-DRG,17,3,Y,90460,Medicine,,,0200,21,Inpatient Hospital,2,59.64,30.04,0.0,30.04,0.0,0.0,30.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006574,MBR00000253,Professional,2021-06-01,2021-06-01,2021-06-25,PLN1580,1514306773,1514306773,Endocrinology,In-Network,M54.5,Z12.31,,,,,,,0,,G0468,Medicine,,,,23,Emergency Room,3,484.0,287.39,212.39,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006575,MBR00000253,Professional,2023-09-28,2023-09-28,2023-11-07,PLN4802,1438368327,1438368327,Home Health,In-Network,N39.0,K21.0,,,,,,,0,,99284,E&M,,,,20,Urgent Care,3,886.28,711.36,299.99,411.37,0.0,0.0,411.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006576,MBR00000253,Professional,2022-06-24,2022-06-24,2022-07-11,PLN9908,1186826716,1186826716,Physical Therapy,In-Network,E11.40,E66.9,,,,,,,0,,90837,Medicine,,,,11,Office,2,231.68,134.06,0.0,134.06,0.0,0.0,134.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006577,MBR00000253,Institutional-OP,2021-12-10,2021-12-10,2022-01-09,PLN1711,1531398223,1531398223,OB/GYN,In-Network,R51,E11.9,,,,,,,0,,58661,Surgery,,,0200,22,Outpatient Hospital,2,2280.99,1936.62,1861.62,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006578,MBR00000253,Institutional-OP,2022-06-04,2022-06-04,2022-07-09,PLN3079,1564502315,1564502315,ASC,In-Network,M54.5,I25.10,,,,,,,0,,27130,Surgery,,,0761,22,Outpatient Hospital,3,4907.64,3072.38,2780.04,292.34,0.0,0.0,292.34,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006579,MBR00000253,Professional,2021-12-26,2021-12-26,2022-01-16,PLN2952,1974006077,1974006077,Orthopedic Surgery,In-Network,J06.9,F32.9,,,,,,,0,,90686,Medicine,,,,12,Home,3,74.63,57.09,57.09,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000006580,MBR00000253,Institutional-OP,2021-12-31,2021-12-31,2022-02-01,PLN6532,1244186984,1244186984,Family Medicine,Out-of-Network,Z00.01,K21.0,,,,,,,0,,78452,Radiology,,,0120,22,Outpatient Hospital,3,6413.58,3793.38,0.0,468.5,0.0,0.0,468.5,0.0,Denied,PR-1,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006581,MBR00000253,Institutional-IP,2022-08-21,2022-08-27,2022-09-03,PLN9420,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,G20,E11.9,,,,603,MS-DRG,21,6,Y,93306,Radiology,,,0200,21,Inpatient Hospital,2,1823.7,848.78,833.78,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006582,MBR00000253,Institutional-OP,2023-12-29,2023-12-29,2024-01-26,PLN2271,1860435061,1860435061,DME Supplier,In-Network,Z87.891,E11.9,,,,,,,0,,45378,Surgery,,,0320,22,Outpatient Hospital,2,2421.57,2057.79,2057.79,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000006583,MBR00000253,Professional,2022-03-24,2022-03-24,2022-04-29,PLN4939,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,N18.3,I48.91,,,,,,,0,,58661,Surgery,,,,11,Office,2,4139.91,2760.26,2611.49,148.77,0.0,0.0,148.77,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006584,MBR00000253,Professional,2021-08-24,2021-08-24,2021-09-27,PLN1497,1239316214,1239316214,Internal Medicine,In-Network,E11.65,Z00.00,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,2,149.23,123.18,79.3,0.0,25.0,18.88,43.88,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006585,MBR00000253,Institutional-OP,2023-04-14,2023-04-14,2023-05-28,PLN5208,1531398223,1531398223,OB/GYN,In-Network,Z87.891,G43.909,,,,,,,0,,99222,E&M,,,0730,22,Outpatient Hospital,1,472.37,307.78,0.0,307.78,0.0,0.0,307.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006586,MBR00000253,Institutional-IP,2021-11-19,2021-11-24,2021-12-26,PLN8940,1239316214,1239316214,Internal Medicine,In-Network,E66.9,Z12.31,,,,292,MS-DRG,18,5,Y,G0468,Medicine,,,0450,21,Inpatient Hospital,3,723.78,225.14,200.14,0.0,25.0,0.0,25.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006587,MBR00000253,Institutional-OP,2022-08-11,2022-08-11,2022-09-11,PLN4437,1997536841,1997536841,Family Medicine,Out-of-Network,E11.65,Z12.31,,,,,,,0,,86900,Pathology/Lab,,,0370,22,Outpatient Hospital,3,58.32,40.58,0.0,40.58,0.0,0.0,40.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006588,MBR00000253,Institutional-OP,2021-10-05,2021-10-05,2021-10-20,PLN3059,1205377316,1205377316,Orthopedic Surgery,In-Network,K21.0,E11.9,,,,,,,0,,99203,E&M,,,0740,22,Outpatient Hospital,3,201.29,170.08,77.61,76.89,0.0,15.58,92.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006589,MBR00000253,Professional,2021-08-20,2021-08-20,2021-09-15,PLN2945,1609526529,1609526529,Psychiatry,In-Network,R10.9,J06.9,,,,,,,0,,86900,Pathology/Lab,,,,23,Emergency Room,2,22.09,14.07,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006590,MBR00000253,Institutional-IP,2021-10-03,2021-10-05,2021-10-12,PLN8452,1168881145,1168881145,Orthopedic Surgery,In-Network,R10.9,N20.0,,,,683,MS-DRG,4,2,Y,99284,E&M,,,0730,21,Inpatient Hospital,1,845.94,557.76,514.3,0.0,15.0,28.46,43.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006591,MBR00000254,Professional,2022-01-26,2022-01-26,2022-03-02,PLN4649,1355166277,1355166277,Endocrinology,In-Network,E78.5,E78.5,,,,,,,0,,85025,Pathology/Lab,,,,22,Outpatient Hospital,3,35.26,14.71,0.0,14.71,0.0,0.0,14.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006592,MBR00000254,Institutional-IP,2023-11-13,2023-11-19,2023-11-26,PLN1570,1696843572,1696843572,Critical Access Hospital,Out-of-Network,J45.20,E78.5,,,,291,MS-DRG,4,6,Y,85025,Pathology/Lab,,,0636,21,Inpatient Hospital,3,74.73,56.84,56.84,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000006593,MBR00000254,Institutional-IP,2023-01-06,2023-01-13,2023-02-01,PLN5088,1840431511,1840431511,Geriatrics,Out-of-Network,M54.5,I48.91,,,,872,MS-DRG,11,7,Y,99233,E&M,,,0320,21,Inpatient Hospital,1,511.65,154.47,80.0,74.47,0.0,0.0,74.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006594,MBR00000254,Institutional-IP,2023-02-01,2023-02-03,2023-02-19,PLN6409,1556140803,1556140803,Cardiology,In-Network,E11.9,E11.9,,,,641,MS-DRG,12,2,Y,43239,Surgery,,,0636,21,Inpatient Hospital,2,799.1,573.13,523.13,0.0,50.0,0.0,50.0,0.0,Adjusted,,,0,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000006595,MBR00000254,Professional,2021-02-28,2021-02-28,2021-04-05,PLN6433,1540044947,1540044947,Pulmonology,Out-of-Network,E11.9,I25.10,,,,,,,0,,77067,Radiology,,,,12,Home,1,436.38,195.9,160.9,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000006596,MBR00000254,Institutional-OP,2021-01-12,2021-01-12,2021-02-10,PLN3948,1689639685,1689639685,SNF,In-Network,I10,G43.909,,,,,,,0,,85025,Pathology/Lab,,,0200,22,Outpatient Hospital,2,85.5,36.46,0.0,36.46,0.0,0.0,36.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006597,MBR00000254,Professional,2022-01-10,2022-01-10,2022-02-20,PLN6626,1939033455,1939033455,Pulmonology,In-Network,M54.5,Z51.11,,,,,,,0,,99283,E&M,,,,12,Home,3,528.68,393.49,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006598,MBR00000254,Professional,2023-08-30,2023-08-30,2023-10-06,PLN5101,1511044648,1511044648,Endocrinology,In-Network,I11.9,I10,,,,,,,0,,27447,Surgery,,,,31,Skilled Nursing Facility,1,3319.36,1605.3,1456.3,0.0,0.0,149.0,149.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006599,MBR00000254,Professional,2021-01-18,2021-01-18,2021-02-19,PLN3070,1268679390,1268679390,Critical Access Hospital,In-Network,J06.9,K21.0,,,,,,,0,,58661,Surgery,,,,21,Inpatient Hospital,2,2679.67,1388.22,1166.19,0.0,25.0,197.03,222.03,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006600,MBR00000254,Professional,2023-04-19,2023-04-19,2023-04-28,PLN4940,1103747954,1103747954,Urology,In-Network,R07.9,Z00.00,,,,,,,0,,70553,Radiology,,,,11,Office,3,4553.43,2331.98,2331.98,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006601,MBR00000254,Professional,2023-06-18,2023-06-18,2023-08-01,PLN6452,1518055405,1518055405,Urology,In-Network,I10,F32.9,,,,,,,0,,45380,Surgery,,,,21,Inpatient Hospital,1,1358.92,877.34,0.0,0.0,15.0,0.0,15.0,0.0,Denied,PR-1,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006602,MBR00000254,Professional,2021-11-01,2021-11-01,2021-11-11,PLN7387,1845900543,1845900543,ASC,In-Network,I10,M54.5,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,1,4150.36,3289.81,3289.81,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006603,MBR00000254,Professional,2021-05-09,2021-05-09,2021-05-18,PLN3662,1366286000,1366286000,SNF,In-Network,I10,E66.9,,,,,,,0,,99232,E&M,,,,11,Office,1,244.82,184.2,0.0,166.85,50.0,0.0,216.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006604,MBR00000254,Professional,2021-06-18,2021-06-18,2021-06-27,PLN3167,1422747896,1422747896,Urology,In-Network,N39.0,E11.65,,,,,,,0,,90460,Medicine,,,,11,Office,3,51.97,35.09,17.15,0.0,15.0,2.94,17.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006605,MBR00000254,Professional,2021-03-26,2021-03-26,2021-04-23,PLN4523,1109850785,1109850785,ASC,Out-of-Network,J45.20,G43.909,,,,,,,0,,99221,E&M,,,,11,Office,3,282.38,204.27,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006606,MBR00000254,Institutional-OP,2023-07-13,2023-07-13,2023-08-13,PLN1608,1135158374,1135158374,Pulmonology,In-Network,E11.9,I10,,,,,,,0,,27130,Surgery,,,0120,22,Outpatient Hospital,2,3511.55,1241.66,1226.66,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006607,MBR00000254,Professional,2023-05-12,2023-05-12,2023-06-14,PLN3970,1994661817,1994661817,SNF,Out-of-Network,J06.9,Z23,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,3,500.64,416.32,381.32,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000006608,MBR00000254,Professional,2023-01-07,2023-01-07,2023-02-05,PLN7451,1125190055,1125190055,Nephrology,In-Network,S72.001A,Z23,,,,,,,0,,99221,E&M,,,,23,Emergency Room,1,332.71,156.02,0.0,0.0,50.0,5.35,55.35,0.0,Denied,CO-4,,0,,1,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000006609,MBR00000254,Institutional-IP,2021-04-09,2021-04-12,2021-05-09,PLN9537,1313212303,1313212303,Family Medicine,In-Network,N39.0,I10,,,,195,MS-DRG,12,3,N,93306,Radiology,,,0270,21,Inpatient Hospital,2,2346.37,853.14,581.45,271.69,0.0,0.0,271.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006610,MBR00000254,Institutional-IP,2023-11-07,2023-11-12,2023-12-02,PLN3936,1946680931,1946680931,Critical Access Hospital,Out-of-Network,J06.9,E78.5,,,,470,MS-DRG,9,5,Y,99221,E&M,,,0120,21,Inpatient Hospital,2,437.6,351.88,351.34,0.54,0.0,0.0,0.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006611,MBR00000254,Professional,2023-01-20,2023-01-20,2023-03-02,PLN9844,1990090423,1990090423,Orthopedic Surgery,In-Network,E78.5,E78.5,,,,,,,0,,74177,Radiology,,,,21,Inpatient Hospital,2,2242.2,994.26,866.98,127.28,0.0,0.0,127.28,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006612,MBR00000254,Professional,2023-06-26,2023-06-26,2023-07-07,PLN2855,1124394415,1124394415,Pediatrics,In-Network,I50.9,J06.9,,,,,,,0,,71046,Radiology,,,,12,Home,2,214.03,81.47,0.0,0.0,0.0,9.29,9.29,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006613,MBR00000254,Institutional-IP,2022-02-20,2022-02-28,2022-03-22,PLN1575,1790497490,1790497490,OB/GYN,In-Network,M54.5,Z79.4,,,,690,MS-DRG,18,8,Y,G0444,Medicine,,,0370,21,Inpatient Hospital,1,92.93,78.51,43.51,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000006614,MBR00000254,Professional,2021-08-05,2021-08-05,2021-08-23,PLN9901,1219817751,1219817751,OB/GYN,In-Network,K21.0,G43.909,,,,,,,0,,66984,Surgery,,,,23,Emergency Room,2,3461.76,1075.34,894.7,0.0,0.0,180.64,180.64,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006615,MBR00000254,Professional,2023-06-19,2023-06-19,2023-07-16,PLN4090,1812060197,1812060197,Oncology,Out-of-Network,M81.0,Z79.4,,,,,,,0,,99283,E&M,,,,31,Skilled Nursing Facility,1,301.82,205.47,0.0,205.47,15.0,0.0,220.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006616,MBR00000254,Institutional-OP,2021-02-26,2021-02-26,2021-03-10,PLN3717,1511044648,1511044648,Endocrinology,In-Network,Z12.31,F10.20,,,,,,,0,,33533,Surgery,,,0370,22,Outpatient Hospital,1,17915.82,9217.57,9217.57,0.0,0.0,0.0,0.0,0.0,Pended,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000006617,MBR00000255,Professional,2021-07-20,2021-07-20,2021-07-31,PLN7655,1645194539,1645194539,SNF,In-Network,J18.9,E11.9,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,1,492.01,368.96,368.96,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006618,MBR00000255,Professional,2021-06-18,2021-06-18,2021-07-05,PLN3478,1511044648,1511044648,Endocrinology,In-Network,B97.89,B97.89,,,,,,,0,,43239,Surgery,,,,12,Home,1,1809.96,608.89,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-11,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006619,MBR00000255,Professional,2021-04-03,2021-04-03,2021-04-22,PLN4382,1433937353,1433937353,Nephrology,In-Network,Z12.31,K21.0,,,,,,,0,,45380,Surgery,,,,11,Office,2,1423.35,675.28,573.98,0.0,0.0,101.3,101.3,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006620,MBR00000255,Institutional-OP,2022-08-27,2022-08-27,2022-10-02,PLN8394,1840431511,1840431511,Geriatrics,Out-of-Network,Z12.31,M81.0,,,,,,,0,,23472,Surgery,,,0200,22,Outpatient Hospital,3,4990.4,2160.37,2138.53,6.84,15.0,0.0,21.84,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006621,MBR00000255,Professional,2021-09-08,2021-09-08,2021-10-15,PLN2915,1366576336,1366576336,Geriatrics,In-Network,N18.3,R51,,,,,,,0,,83036,Pathology/Lab,,,,22,Outpatient Hospital,1,77.66,28.69,28.69,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000006622,MBR00000255,Professional,2023-11-24,2023-11-24,2023-12-14,PLN2266,1645194539,1645194539,SNF,In-Network,M17.11,E66.9,,,,,,,0,,45378,Surgery,,,,21,Inpatient Hospital,2,1397.44,865.35,0.0,0.0,0.0,0.0,0.0,0.0,Denied,PR-1,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000006623,MBR00000255,Professional,2023-10-18,2023-10-18,2023-11-12,PLN9554,1997536841,1997536841,Family Medicine,Out-of-Network,F41.9,J20.9,,,,,,,0,,85025,Pathology/Lab,,,,20,Urgent Care,2,50.6,24.0,21.87,0.0,0.0,2.13,2.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006624,MBR00000255,Professional,2021-07-04,2021-07-04,2021-07-19,PLN5961,1355166277,1355166277,Endocrinology,In-Network,R10.9,F41.9,,,,,,,0,,81001,Pathology/Lab,,,,31,Skilled Nursing Facility,2,49.08,25.39,22.67,0.0,0.0,2.72,2.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006625,MBR00000255,Professional,2023-06-27,2023-06-27,2023-07-22,PLN3945,1550154147,1550154147,Outpatient Clinic,In-Network,I10,N39.0,,,,,,,0,,43239,Surgery,,,,11,Office,1,2019.07,1334.14,930.22,378.92,25.0,0.0,403.92,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006626,MBR00000255,Professional,2021-02-12,2021-02-12,2021-03-15,PLN3733,1389336600,1389336600,Critical Access Hospital,In-Network,I10,I63.9,,,,,,,0,,33533,Surgery,,,,21,Inpatient Hospital,3,27442.7,9356.14,9059.83,246.31,50.0,0.0,296.31,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000006627,MBR00000255,Professional,2021-11-09,2021-11-09,2021-12-13,PLN1301,1168246159,1168246159,Internal Medicine,In-Network,Z00.00,Z12.31,,,,,,,0,,99221,E&M,,,,31,Skilled Nursing Facility,1,163.75,120.91,120.91,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006628,MBR00000256,Professional,2022-12-24,2022-12-24,2023-01-08,PLN8974,1389336600,1389336600,Critical Access Hospital,In-Network,E66.9,M54.5,,,,,,,0,,84443,Pathology/Lab,,,,23,Emergency Room,3,98.62,51.21,0.0,51.21,0.0,0.0,51.21,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006629,MBR00000256,Institutional-OP,2021-08-14,2021-08-14,2021-09-17,PLN6928,1284035364,1284035364,Pediatrics,In-Network,Z12.31,Z23,,,,,,,0,,85610,Pathology/Lab,,,0120,22,Outpatient Hospital,3,63.61,28.28,28.28,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006630,MBR00000256,Institutional-IP,2021-03-27,2021-04-01,2021-05-07,PLN2556,1840431511,1840431511,Geriatrics,Out-of-Network,N18.3,E78.5,,,,641,MS-DRG,19,5,Y,99283,E&M,,,0360,21,Inpatient Hospital,1,464.6,347.49,347.49,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006631,MBR00000256,Professional,2021-06-21,2021-06-21,2021-07-20,PLN5324,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,R51,I25.10,,,,,,,0,,99283,E&M,,,,20,Urgent Care,1,597.58,259.23,259.23,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006632,MBR00000256,Professional,2022-12-23,2022-12-23,2023-01-07,PLN4324,1644128543,1644128543,Gastroenterology,In-Network,Z00.00,I48.91,,,,,,,0,,86900,Pathology/Lab,,,,21,Inpatient Hospital,1,60.23,39.06,31.4,0.0,0.0,7.66,7.66,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000006633,MBR00000256,Institutional-OP,2021-08-31,2021-08-31,2021-09-20,PLN7033,1896447406,1896447406,Nephrology,Out-of-Network,I10,Z00.00,,,,,,,0,,99203,E&M,,,0730,22,Outpatient Hospital,1,172.1,70.02,70.02,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006634,MBR00000256,Institutional-OP,2021-09-27,2021-09-27,2021-10-20,PLN1244,1622771872,1622771872,Pediatrics,In-Network,I63.9,E78.5,,,,,,,0,,82043,Pathology/Lab,,,0450,22,Outpatient Hospital,3,31.49,19.12,15.73,0.0,0.0,3.39,3.39,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000006635,MBR00000256,Professional,2021-08-13,2021-08-13,2021-09-16,PLN2098,1809014947,1809014947,Urology,In-Network,Z23,Z23,,,,,,,0,,99203,E&M,,,,12,Home,2,295.07,153.52,0.0,153.52,25.0,0.0,178.52,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000006636,MBR00000256,Professional,2023-08-24,2023-08-24,2023-09-13,PLN8135,1224179551,1224179551,Physical Therapy,In-Network,E78.5,I50.9,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,2,2366.91,1832.21,1365.04,394.37,0.0,72.8,467.17,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006637,MBR00000256,Professional,2023-08-31,2023-08-31,2023-09-23,PLN8101,1205377316,1205377316,Orthopedic Surgery,In-Network,I25.10,Z23,,,,,,,0,,99283,E&M,,,,11,Office,2,340.57,176.88,145.48,31.4,0.0,0.0,31.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006638,MBR00000256,Professional,2023-06-01,2023-06-01,2023-06-21,PLN2049,1749494482,1749494482,Pediatrics,In-Network,E11.65,E11.9,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,1,474.34,321.07,69.64,234.07,0.0,17.36,251.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006639,MBR00000256,Professional,2021-01-22,2021-01-22,2021-02-16,PLN5599,1528335731,1528335731,Critical Access Hospital,In-Network,I10,I10,,,,,,,0,,76700,Radiology,,,,50,Federally Qualified Health Center,2,1110.98,933.81,644.59,239.22,50.0,0.0,289.22,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006640,MBR00000256,Professional,2021-10-02,2021-10-02,2021-10-09,PLN9655,1991459367,1991459367,Neurology,Out-of-Network,I63.9,F32.9,,,,,,,0,,97110,Medicine,,,,22,Outpatient Hospital,1,150.76,45.42,44.66,0.0,0.0,0.76,0.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006641,MBR00000256,Institutional-OP,2023-08-22,2023-08-22,2023-09-25,PLN3473,1856686341,1856686341,Geriatrics,In-Network,I48.91,Z00.00,,,,,,,0,,93000,Radiology,,,0320,22,Outpatient Hospital,3,77.85,27.17,11.5,0.0,15.0,0.67,15.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006642,MBR00000256,Professional,2022-08-30,2022-08-30,2022-10-06,PLN5347,1727809972,1727809972,Home Health,In-Network,Z12.31,G43.909,,,,,,,0,,99233,E&M,,,,11,Office,1,538.89,330.98,295.98,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006643,MBR00000256,Professional,2021-02-15,2021-02-15,2021-03-19,PLN3385,1840431511,1840431511,Geriatrics,Out-of-Network,I10,N17.9,,,,,,,0,,70450,Radiology,,,,11,Office,3,1435.79,626.63,163.18,463.45,0.0,0.0,463.45,0.0,Pended,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000006644,MBR00000256,Professional,2021-09-30,2021-09-30,2021-10-12,PLN5618,1840431511,1840431511,Geriatrics,Out-of-Network,Z87.891,I10,,,,,,,0,,99232,E&M,,,,20,Urgent Care,2,365.79,110.96,31.11,79.85,0.0,0.0,79.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006645,MBR00000256,Institutional-IP,2023-06-25,2023-07-03,2023-08-05,PLN8763,1244186984,1244186984,Family Medicine,Out-of-Network,F41.9,F32.9,,,,682,MS-DRG,11,8,Y,45378,Surgery,,,0370,21,Inpatient Hospital,3,1197.85,981.37,976.38,4.99,0.0,0.0,4.99,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000006646,MBR00000256,Professional,2023-08-21,2023-08-21,2023-08-28,PLN8965,1752470395,1752470395,Home Health,In-Network,E78.5,E87.6,,,,,,,0,,99284,E&M,,,,11,Office,2,394.4,180.16,135.88,0.0,15.0,29.28,44.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006647,MBR00000256,Institutional-IP,2022-04-12,2022-04-19,2022-05-24,PLN4070,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,E11.9,S72.001A,,,,603,MS-DRG,24,7,Y,85610,Pathology/Lab,,,0740,21,Inpatient Hospital,1,63.63,53.97,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006648,MBR00000256,Institutional-IP,2021-06-15,2021-06-16,2021-07-17,PLN1642,1899127912,1899127912,Neurology,In-Network,Z87.891,I48.91,,,,603,MS-DRG,10,1,Y,G0439,Medicine,,,0120,21,Inpatient Hospital,1,411.08,170.71,120.71,0.0,50.0,0.0,50.0,0.0,Pended,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000006649,MBR00000256,Professional,2021-03-26,2021-03-26,2021-04-10,PLN6171,1660288235,1660288235,ASC,In-Network,I10,I10,,,,,,,0,,93000,Radiology,,,,21,Inpatient Hospital,3,182.53,147.66,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-29,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006650,MBR00000256,Professional,2021-09-04,2021-09-04,2021-09-24,PLN3744,1590915516,1590915516,Physical Therapy,Out-of-Network,M54.5,E78.5,,,,,,,0,,27447,Surgery,,,,20,Urgent Care,2,5607.54,1693.76,1217.98,278.52,50.0,147.26,475.78,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006651,MBR00000256,Institutional-OP,2023-05-25,2023-05-25,2023-06-27,PLN8210,1915531927,1915531927,Critical Access Hospital,In-Network,E11.65,E11.40,,,,,,,0,,80053,Pathology/Lab,,,0450,22,Outpatient Hospital,2,86.28,54.53,1.8,2.73,50.0,0.0,52.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006652,MBR00000256,Institutional-OP,2023-06-25,2023-06-25,2023-07-22,PLN1799,1817234602,1817234602,Clinical Laboratory,In-Network,E11.40,E11.9,,,,,,,0,,66984,Surgery,,,0730,22,Outpatient Hospital,1,3345.05,2372.77,2010.68,362.09,0.0,0.0,362.09,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006653,MBR00000256,Professional,2021-10-08,2021-10-08,2021-10-29,PLN1798,1372918899,1372918899,Family Medicine,In-Network,E11.9,I10,,,,,,,0,,66984,Surgery,,,,21,Inpatient Hospital,1,1491.49,1016.63,1016.63,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006654,MBR00000256,Institutional-IP,2023-12-07,2023-12-12,2024-01-17,PLN2115,1550154147,1550154147,Outpatient Clinic,In-Network,J44.1,E78.5,,,,196,MS-DRG,16,5,Y,99213,E&M,,,0900,21,Inpatient Hospital,3,117.43,85.97,85.97,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006655,MBR00000256,Professional,2023-08-20,2023-08-20,2023-09-13,PLN5092,1205377316,1205377316,Orthopedic Surgery,In-Network,Z12.31,I10,,,,,,,0,,G0439,Medicine,,,,20,Urgent Care,3,370.17,287.41,212.41,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,0,0,0,1,Upcoding,0,0,0,1,0
CLM0000006656,MBR00000256,Professional,2023-12-18,2023-12-18,2024-01-05,PLN2036,1213165847,1213165847,Critical Access Hospital,In-Network,E11.9,F41.9,,,,,,,0,,99283,E&M,,,,50,Federally Qualified Health Center,3,631.01,307.15,50.14,231.4,25.0,0.61,257.01,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006657,MBR00000256,Professional,2023-04-04,2023-04-04,2023-04-20,PLN8604,1205377316,1205377316,Orthopedic Surgery,In-Network,Z12.31,N18.3,,,,,,,0,,90837,Medicine,,,,11,Office,3,401.37,253.05,166.33,36.72,50.0,0.0,86.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006658,MBR00000256,Institutional-OP,2022-09-20,2022-09-20,2022-10-09,PLN2262,1193493783,1193493783,Critical Access Hospital,Out-of-Network,E66.9,M54.5,,,,,,,0,,83036,Pathology/Lab,,,0320,22,Outpatient Hospital,1,91.55,63.37,0.0,63.37,0.0,0.0,63.37,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,1,0,0
CLM0000006659,MBR00000256,Institutional-OP,2023-12-12,2023-12-12,2024-01-15,PLN8047,1778483301,1778483301,Home Health,In-Network,E78.5,E11.9,,,,,,,0,,86900,Pathology/Lab,,,0270,22,Outpatient Hospital,3,41.72,32.2,0.0,32.2,15.0,0.0,47.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006660,MBR00000256,Institutional-IP,2023-01-25,2023-01-30,2023-03-02,PLN8907,1284035364,1284035364,Pediatrics,In-Network,K57.30,F41.9,,,,196,MS-DRG,6,5,Y,23472,Surgery,,,0120,21,Inpatient Hospital,2,2817.47,880.91,880.91,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000006661,MBR00000256,Institutional-OP,2023-06-30,2023-06-30,2023-08-04,PLN8657,1749494482,1749494482,Pediatrics,In-Network,Z00.00,Z79.4,,,,,,,0,,99284,E&M,,,0900,22,Outpatient Hospital,1,620.3,194.54,0.0,194.54,35.0,0.0,229.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006662,MBR00000256,Professional,2022-03-18,2022-03-18,2022-03-30,PLN3160,1767011137,1767011137,DME Supplier,In-Network,G43.909,E66.9,,,,,,,0,,45378,Surgery,,,,23,Emergency Room,3,2076.36,1757.79,1602.71,0.0,0.0,155.08,155.08,0.0,Paid,,,1,,1,1,0,0,0,0,None,0,1,0,0,0
CLM0000006663,MBR00000256,Institutional-OP,2021-09-21,2021-09-21,2021-10-27,PLN2202,1247341320,1247341320,Urology,Out-of-Network,F32.9,Z00.00,,,,,,,0,,85025,Pathology/Lab,,,0450,22,Outpatient Hospital,1,72.37,26.66,26.66,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006664,MBR00000256,Professional,2022-09-20,2022-09-20,2022-10-22,PLN5943,1545347862,1545347862,SNF,In-Network,G43.909,Z00.00,,,,,,,0,,33533,Surgery,,,,11,Office,2,20838.53,9203.73,7869.82,0.0,0.0,1333.91,1333.91,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000006665,MBR00000256,Institutional-OP,2022-03-25,2022-03-25,2022-04-27,PLN6934,1585582070,1585582070,Outpatient Clinic,In-Network,I11.9,R07.9,,,,,,,0,,99222,E&M,,,0900,22,Outpatient Hospital,2,428.42,194.66,0.0,194.66,25.0,0.0,219.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006666,MBR00000256,Professional,2022-01-20,2022-01-20,2022-02-12,PLN7285,1899127912,1899127912,Neurology,In-Network,I11.9,E11.9,,,,,,,0,,70450,Radiology,,,,22,Outpatient Hospital,3,1590.99,837.16,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-50,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006667,MBR00000256,Professional,2023-02-02,2023-02-02,2023-02-14,PLN2432,1366286000,1366286000,SNF,In-Network,E66.9,E78.5,,,,,,,0,,99204,E&M,,,,11,Office,1,369.44,261.76,251.2,0.0,0.0,10.56,10.56,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006668,MBR00000256,Institutional-IP,2022-10-31,2022-11-05,2022-11-11,PLN6641,1124394415,1124394415,Pediatrics,In-Network,E11.9,I10,,,,603,MS-DRG,17,5,Y,80053,Pathology/Lab,,,0761,21,Inpatient Hospital,2,130.25,106.25,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006669,MBR00000256,Professional,2021-12-13,2021-12-13,2021-12-26,PLN5666,1103747954,1103747954,Urology,In-Network,N40.0,J06.9,,,,,,,0,,70450,Radiology,,,,23,Emergency Room,2,1238.92,742.82,351.13,314.63,25.0,52.06,391.69,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006670,MBR00000256,Professional,2021-09-22,2021-09-22,2021-11-02,PLN4591,1438368327,1438368327,Home Health,In-Network,Z12.11,N40.0,,,,,,,0,,99204,E&M,,,,11,Office,3,553.03,340.35,0.0,340.35,0.0,0.0,340.35,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006671,MBR00000256,Institutional-IP,2022-08-22,2022-08-30,2022-10-02,PLN6073,1896447406,1896447406,Nephrology,Out-of-Network,J06.9,Z00.00,,,,291,MS-DRG,14,8,Y,99204,E&M,,,0510,21,Inpatient Hospital,1,251.38,130.37,0.0,130.37,0.0,0.0,130.37,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006672,MBR00000256,Institutional-OP,2021-12-25,2021-12-25,2022-01-28,PLN9499,1860435061,1860435061,DME Supplier,In-Network,J06.9,E78.5,,,,,,,0,,84443,Pathology/Lab,,,0450,22,Outpatient Hospital,3,148.8,93.55,93.55,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006673,MBR00000256,Professional,2021-09-18,2021-09-18,2021-10-31,PLN7056,1935547131,1935547131,Pulmonology,In-Network,F41.9,N18.3,,,,,,,0,,99203,E&M,,,,11,Office,3,171.69,55.41,5.41,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000006674,MBR00000256,Professional,2021-09-01,2021-09-01,2021-10-03,PLN6412,1236418230,1236418230,DME Supplier,In-Network,G43.909,Z23,,,,,,,0,,74177,Radiology,,,,11,Office,2,2753.82,1640.14,1141.94,498.2,0.0,0.0,498.2,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006675,MBR00000256,Institutional-IP,2022-12-27,2023-01-02,2023-02-04,PLN3159,1689639685,1689639685,SNF,In-Network,E11.9,E66.9,,,,871,MS-DRG,13,6,Y,72148,Radiology,,,0370,21,Inpatient Hospital,2,2681.24,2172.9,2172.9,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000006676,MBR00000256,Professional,2022-03-31,2022-03-31,2022-04-16,PLN8604,1205377316,1205377316,Orthopedic Surgery,In-Network,I10,Z00.00,,,,,,,0,,78452,Radiology,,,,12,Home,2,4282.07,3117.0,3117.0,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006677,MBR00000256,Professional,2022-01-10,2022-01-10,2022-01-26,PLN1784,1717546253,1717546253,Family Medicine,In-Network,Z23,E78.5,,,,,,,0,,99203,E&M,,,,11,Office,2,344.2,176.47,0.0,176.47,25.0,0.0,201.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006678,MBR00000257,Institutional-IP,2021-05-07,2021-05-08,2021-06-03,PLN1019,1980712759,1980712759,Outpatient Clinic,Out-of-Network,K21.0,S72.001A,,,,292,MS-DRG,10,1,Y,45380,Surgery,,,0301,21,Inpatient Hospital,2,1232.48,904.0,879.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006679,MBR00000257,Institutional-OP,2021-03-02,2021-03-02,2021-04-05,PLN2112,1390307371,1390307371,DME Supplier,In-Network,Z00.00,I10,,,,,,,0,,85025,Pathology/Lab,,,0270,22,Outpatient Hospital,2,75.82,32.97,17.97,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006680,MBR00000257,Professional,2023-01-31,2023-01-31,2023-02-15,PLN6628,1564502315,1564502315,ASC,In-Network,R51,I10,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,2,59.46,41.1,39.46,0.0,0.0,1.64,1.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006681,MBR00000257,Institutional-IP,2023-11-26,2023-12-01,2023-12-20,PLN1433,1542828721,1542828721,Orthopedic Surgery,In-Network,J20.9,K21.0,,,,292,MS-DRG,22,5,Y,27130,Surgery,,,0120,21,Inpatient Hospital,1,2616.44,1148.37,933.32,165.05,50.0,0.0,215.05,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006682,MBR00000257,Professional,2021-12-22,2021-12-22,2022-01-21,PLN1974,1800011727,1800011727,Clinical Laboratory,Out-of-Network,I10,Z23,,,,,,,0,,99284,E&M,,,,81,Independent Laboratory,1,551.69,388.87,281.8,77.96,0.0,29.11,107.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006683,MBR00000257,Institutional-OP,2023-07-14,2023-07-14,2023-08-08,PLN1271,1450553056,1450553056,Clinical Laboratory,In-Network,E11.65,E11.9,,,,,,,0,,47562,Surgery,,,0320,22,Outpatient Hospital,3,3292.15,1417.94,1174.35,218.59,25.0,0.0,243.59,0.0,Paid,,,0,,0,0,1,0,0,1,Duplicate,0,0,0,0,0
CLM0000006684,MBR00000257,Institutional-OP,2022-10-21,2022-10-21,2022-11-08,PLN4913,1366576336,1366576336,Geriatrics,In-Network,Z23,F32.9,,,,,,,0,,78452,Radiology,,,0761,22,Outpatient Hospital,3,4852.34,2365.4,2146.42,0.0,0.0,218.98,218.98,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006685,MBR00000257,Professional,2021-11-29,2021-11-29,2021-12-25,PLN5159,1896447406,1896447406,Nephrology,Out-of-Network,C50.912,J44.1,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,3,156.37,71.34,71.34,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006686,MBR00000257,Professional,2022-09-13,2022-09-13,2022-10-24,PLN4373,1132188260,1132188260,Family Medicine,In-Network,E87.6,Z87.891,,,,,,,0,,86900,Pathology/Lab,,,,12,Home,1,37.08,28.89,27.85,0.0,0.0,1.04,1.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006687,MBR00000257,Institutional-OP,2021-05-22,2021-05-22,2021-06-27,PLN8402,1624802371,1624802371,ASC,Out-of-Network,F32.9,M54.5,,,,,,,0,,45378,Surgery,,,0510,22,Outpatient Hospital,2,1506.86,1127.46,606.93,445.53,75.0,0.0,520.53,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000006688,MBR00000257,Institutional-IP,2022-01-05,2022-01-07,2022-01-13,PLN6077,1631954542,1631954542,Oncology,In-Network,I10,I25.10,,,,871,MS-DRG,22,2,Y,70450,Radiology,,,0301,21,Inpatient Hospital,1,1184.73,820.62,801.34,0.0,0.0,19.28,19.28,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000006689,MBR00000257,Institutional-IP,2023-03-17,2023-03-24,2023-04-12,PLN6164,1239316214,1239316214,Internal Medicine,In-Network,F41.9,R07.9,,,,292,MS-DRG,23,7,Y,66984,Surgery,,,0450,21,Inpatient Hospital,1,1879.19,793.49,409.96,358.53,25.0,0.0,383.53,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006690,MBR00000257,Professional,2023-07-22,2023-07-22,2023-09-01,PLN3680,1244186984,1244186984,Family Medicine,Out-of-Network,J20.9,Z00.01,,,,,,,0,,99233,E&M,,,,23,Emergency Room,1,508.36,299.5,241.28,0.0,25.0,33.22,58.22,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006691,MBR00000257,Professional,2021-08-30,2021-08-30,2021-10-02,PLN4976,1716521444,1716521444,Oncology,In-Network,M54.5,J44.1,,,,,,,0,,99214,E&M,,,,81,Independent Laboratory,2,204.76,152.23,134.41,0.0,0.0,17.82,17.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006692,MBR00000257,Professional,2023-09-25,2023-09-25,2023-11-07,PLN7725,1865904917,1865904917,Outpatient Clinic,In-Network,C50.912,N39.0,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,3,51.68,32.08,15.96,0.0,15.0,1.12,16.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006693,MBR00000257,Professional,2022-10-25,2022-10-25,2022-11-18,PLN6222,1395983630,1395983630,Nephrology,In-Network,E11.9,J18.9,,,,,,,0,,81001,Pathology/Lab,,,,50,Federally Qualified Health Center,1,28.67,12.49,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006694,MBR00000257,Professional,2021-09-09,2021-09-09,2021-10-20,PLN8121,1860435061,1860435061,DME Supplier,In-Network,E66.9,R05,,,,,,,0,,80061,Pathology/Lab,,,,49,Independent Clinic,2,89.8,38.5,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006695,MBR00000257,Professional,2023-05-04,2023-05-04,2023-06-02,PLN5000,1980712759,1980712759,Outpatient Clinic,Out-of-Network,E78.5,E11.9,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,2,3321.86,2278.68,1941.45,262.23,75.0,0.0,337.23,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006696,MBR00000257,Institutional-OP,2023-08-23,2023-08-23,2023-08-31,PLN1153,1268679390,1268679390,Critical Access Hospital,In-Network,I25.10,M54.5,,,,,,,0,,43239,Surgery,,,0761,22,Outpatient Hospital,1,1515.45,1010.38,774.02,65.17,0.0,171.19,236.36,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006697,MBR00000257,Professional,2021-10-26,2021-10-26,2021-12-03,PLN6518,1103747954,1103747954,Urology,In-Network,Z12.31,Z00.00,,,,,,,0,,99203,E&M,,,,20,Urgent Care,3,187.36,62.07,0.0,62.07,50.0,0.0,112.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006698,MBR00000257,Institutional-OP,2021-04-26,2021-04-26,2021-05-30,PLN9590,1520687146,1520687146,ASC,In-Network,E11.9,I11.9,,,,,,,0,,70450,Radiology,,,0301,22,Outpatient Hospital,2,653.1,246.86,231.86,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006699,MBR00000257,Professional,2021-11-08,2021-11-08,2021-11-16,PLN3431,1749327647,1749327647,Geriatrics,In-Network,E78.5,E66.9,,,,,,,0,,43239,Surgery,,,,11,Office,1,1622.41,731.86,716.86,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006700,MBR00000257,Professional,2023-04-09,2023-04-09,2023-05-13,PLN1243,1795618275,1795618275,Pulmonology,In-Network,I50.9,Z12.31,,,,,,,0,,27130,Surgery,,,,11,Office,2,5147.03,2822.34,2787.34,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006701,MBR00000257,Professional,2021-03-09,2021-03-09,2021-03-17,PLN6564,1845057593,1845057593,Orthopedic Surgery,In-Network,I11.9,F03.90,,,,,,,0,,27130,Surgery,,,,11,Office,1,6931.28,2287.65,2287.65,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006702,MBR00000257,Institutional-OP,2021-11-13,2021-11-13,2021-12-06,PLN8112,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,Z12.31,Z87.891,,,,,,,0,,99213,E&M,,,0761,22,Outpatient Hospital,2,311.48,165.96,135.65,0.0,0.0,30.31,30.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006703,MBR00000257,Institutional-IP,2021-12-17,2021-12-27,2022-01-01,PLN5808,1486164553,1486164553,DME Supplier,In-Network,R10.9,G20,,,,196,MS-DRG,17,10,W,45380,Surgery,,,0270,21,Inpatient Hospital,2,2427.17,1847.44,1619.07,0.0,15.0,213.37,228.37,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006704,MBR00000257,Professional,2021-01-19,2021-01-19,2021-02-13,PLN1486,1313212303,1313212303,Family Medicine,In-Network,Z23,S72.001A,,,,,,,0,,23472,Surgery,,,,23,Emergency Room,1,2964.03,2324.74,2087.63,187.11,50.0,0.0,237.11,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006705,MBR00000257,Institutional-OP,2022-10-17,2022-10-17,2022-11-30,PLN6982,1247341320,1247341320,Urology,Out-of-Network,E11.40,E11.9,,,,,,,0,,99283,E&M,,,0510,22,Outpatient Hospital,3,446.25,204.13,184.64,0.0,0.0,19.49,19.49,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006706,MBR00000257,Professional,2023-06-02,2023-06-02,2023-07-11,PLN4166,1696843572,1696843572,Critical Access Hospital,Out-of-Network,Z00.00,Z23,,,,,,,0,,33533,Surgery,,,,11,Office,3,13364.01,9639.41,9435.33,204.08,0.0,0.0,204.08,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000006707,MBR00000257,Professional,2021-06-20,2021-06-20,2021-07-05,PLN6702,1799205295,1799205295,General Acute Care Hospital,In-Network,F32.9,J06.9,,,,,,,0,,97110,Medicine,,,,11,Office,2,121.83,85.88,70.88,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006708,MBR00000257,Institutional-OP,2023-08-29,2023-08-29,2023-10-03,PLN6479,1475984649,1475984649,SNF,In-Network,I48.91,G43.909,,,,,,,0,,33533,Surgery,,,0740,22,Outpatient Hospital,2,26941.03,18487.31,18206.28,281.03,0.0,0.0,281.03,0.0,Adjusted,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000006709,MBR00000257,Professional,2023-11-10,2023-11-10,2023-12-23,PLN3336,1475984649,1475984649,SNF,In-Network,J06.9,K21.0,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,1,1426.12,1072.82,1072.82,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006710,MBR00000258,Institutional-IP,2023-08-12,2023-08-13,2023-09-02,PLN9056,1946680931,1946680931,Critical Access Hospital,Out-of-Network,I11.9,F41.9,,,,292,MS-DRG,13,1,Y,77067,Radiology,,,0301,21,Inpatient Hospital,1,762.75,587.55,572.31,15.24,0.0,0.0,15.24,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000006711,MBR00000258,Institutional-OP,2023-03-03,2023-03-03,2023-03-29,PLN4124,1224179551,1224179551,Physical Therapy,In-Network,R51,N39.0,,,,,,,0,,45380,Surgery,,,0301,22,Outpatient Hospital,1,1512.99,956.27,799.21,0.0,25.0,132.06,157.06,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006712,MBR00000258,Institutional-IP,2022-05-06,2022-05-08,2022-06-16,PLN6981,1125190055,1125190055,Nephrology,In-Network,J06.9,E78.5,,,,603,MS-DRG,12,2,Y,99283,E&M,,,0636,21,Inpatient Hospital,2,292.86,204.54,176.04,0.0,0.0,28.5,28.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006713,MBR00000258,Professional,2021-08-12,2021-08-12,2021-08-24,PLN8052,1845057593,1845057593,Orthopedic Surgery,In-Network,Z00.00,J06.9,,,,,,,0,,84443,Pathology/Lab,,,,31,Skilled Nursing Facility,3,118.6,36.6,0.0,36.6,0.0,0.0,36.6,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006714,MBR00000258,Professional,2023-09-27,2023-09-27,2023-10-22,PLN4850,1561134315,1561134315,DME Supplier,In-Network,I10,E66.9,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,3,29.16,11.06,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006715,MBR00000258,Institutional-OP,2022-08-05,2022-08-05,2022-08-24,PLN1520,1575695214,1575695214,SNF,In-Network,Z00.00,J20.9,,,,,,,0,,80053,Pathology/Lab,,,0761,22,Outpatient Hospital,3,132.54,44.92,0.0,44.92,0.0,0.0,44.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006716,MBR00000258,Professional,2022-05-10,2022-05-10,2022-05-31,PLN9051,1205377316,1205377316,Orthopedic Surgery,In-Network,M17.11,C50.912,,,,,,,0,,99221,E&M,,,,23,Emergency Room,3,444.5,205.33,205.33,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006717,MBR00000258,Professional,2022-03-05,2022-03-05,2022-03-21,PLN8330,1968299309,1968299309,Internal Medicine,In-Network,I10,I10,,,,,,,0,,93000,Radiology,,,,81,Independent Laboratory,2,137.37,58.72,0.0,58.72,0.0,0.0,58.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006718,MBR00000259,Institutional-OP,2021-08-27,2021-08-27,2021-09-03,PLN4513,1727809972,1727809972,Home Health,In-Network,F41.9,E11.9,,,,,,,0,,45380,Surgery,,,0636,22,Outpatient Hospital,2,1579.4,1263.88,1263.88,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006719,MBR00000259,Institutional-OP,2022-02-23,2022-02-23,2022-04-01,PLN6908,1247341320,1247341320,Urology,Out-of-Network,I10,E78.5,,,,,,,0,,71046,Radiology,,,0370,22,Outpatient Hospital,3,295.27,134.46,0.0,134.46,35.0,0.0,169.46,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006720,MBR00000259,Professional,2023-05-25,2023-05-25,2023-06-11,PLN8412,1366426662,1366426662,Urology,In-Network,F03.90,E11.9,,,,,,,0,,84443,Pathology/Lab,,,,65,End-Stage Renal Disease,1,100.09,35.75,35.75,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006721,MBR00000259,Institutional-OP,2022-09-06,2022-09-06,2022-10-06,PLN4792,1778483301,1778483301,Home Health,In-Network,Z23,N18.3,,,,,,,0,,23472,Surgery,,,0301,22,Outpatient Hospital,3,4722.69,2420.43,0.0,476.13,0.0,0.0,476.13,0.0,Denied,CO-18,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006722,MBR00000259,Professional,2022-03-10,2022-03-10,2022-03-21,PLN8546,1974006077,1974006077,Orthopedic Surgery,In-Network,G43.909,Z87.891,,,,,,,0,,81001,Pathology/Lab,,,,22,Outpatient Hospital,3,35.61,19.72,17.25,0.0,0.0,2.47,2.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006723,MBR00000259,Institutional-OP,2021-04-29,2021-04-29,2021-05-23,PLN2554,1139906830,1139906830,Endocrinology,Out-of-Network,I25.10,E11.9,,,,,,,0,,70450,Radiology,,,0270,22,Outpatient Hospital,2,1712.09,1309.88,899.72,385.16,25.0,0.0,410.16,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006724,MBR00000259,Institutional-IP,2022-03-31,2022-04-09,2022-04-15,PLN6079,1899127912,1899127912,Neurology,In-Network,M54.5,Z00.00,,,,871,MS-DRG,3,9,Y,85610,Pathology/Lab,,,0636,21,Inpatient Hospital,2,31.49,18.36,18.36,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006725,MBR00000259,Professional,2021-08-24,2021-08-24,2021-09-10,PLN9436,1716521444,1716521444,Oncology,In-Network,N40.0,N18.3,,,,,,,0,,84443,Pathology/Lab,,,,20,Urgent Care,3,69.7,24.92,0.0,24.92,0.0,0.0,24.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006726,MBR00000259,Professional,2022-03-12,2022-03-12,2022-03-21,PLN3169,1645194539,1645194539,SNF,In-Network,I10,E11.40,,,,,,,0,,82043,Pathology/Lab,,,,81,Independent Laboratory,3,43.09,21.28,21.28,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006727,MBR00000259,Professional,2021-06-13,2021-06-13,2021-07-23,PLN8476,1514306773,1514306773,Endocrinology,In-Network,Z87.891,J06.9,,,,,,,0,,93000,Radiology,,,,50,Federally Qualified Health Center,1,148.68,121.22,0.0,121.22,75.0,0.0,196.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006728,MBR00000260,Professional,2023-11-04,2023-11-04,2023-11-26,PLN6694,1438368327,1438368327,Home Health,In-Network,I10,J44.1,,,,,,,0,,70553,Radiology,,,,21,Inpatient Hospital,2,1775.67,1486.54,1486.54,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006729,MBR00000260,Institutional-OP,2021-07-10,2021-07-10,2021-07-18,PLN4331,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,Z12.31,Z00.00,,,,,,,0,,99283,E&M,,,0270,22,Outpatient Hospital,3,447.12,269.47,244.47,0.0,25.0,0.0,25.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006730,MBR00000260,Professional,2021-05-16,2021-05-16,2021-05-26,PLN4390,1334916761,1334916761,ASC,In-Network,I11.9,J20.9,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,2,6041.53,3520.6,3520.6,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006731,MBR00000260,Institutional-OP,2022-12-19,2022-12-19,2022-12-31,PLN9081,1395983630,1395983630,Nephrology,In-Network,I10,J20.9,,,,,,,0,,90460,Medicine,,,0900,22,Outpatient Hospital,2,55.93,22.42,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006732,MBR00000260,Professional,2022-01-12,2022-01-12,2022-02-21,PLN4615,1609526529,1609526529,Psychiatry,In-Network,E11.9,J20.9,,,,,,,0,,99204,E&M,,,,21,Inpatient Hospital,2,371.91,178.78,83.58,40.04,35.0,20.16,95.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006733,MBR00000260,Professional,2023-12-27,2023-12-27,2024-02-02,PLN4010,1622771872,1622771872,Pediatrics,In-Network,Z00.00,F41.9,,,,,,,0,,33533,Surgery,,,,11,Office,1,23772.0,12221.18,12017.72,0.0,25.0,178.46,203.46,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000006734,MBR00000260,Institutional-IP,2022-03-19,2022-03-22,2022-04-14,PLN4756,1550154147,1550154147,Outpatient Clinic,In-Network,M17.11,E78.5,,,,871,MS-DRG,16,3,Y,93306,Radiology,,,0450,21,Inpatient Hospital,2,2916.86,1463.24,1413.24,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006735,MBR00000260,Institutional-IP,2022-12-14,2022-12-18,2023-01-16,PLN8994,1235381502,1235381502,Cardiology,In-Network,N40.0,F03.90,,,,683,MS-DRG,22,4,U,99284,E&M,,,0450,21,Inpatient Hospital,3,713.69,392.5,392.5,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006736,MBR00000260,Professional,2023-07-03,2023-07-03,2023-08-02,PLN2756,1486164553,1486164553,DME Supplier,In-Network,Z00.00,Z00.00,,,,,,,0,,99284,E&M,,,,21,Inpatient Hospital,2,572.92,230.98,199.3,0.0,0.0,31.68,31.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006737,MBR00000260,Professional,2023-12-15,2023-12-15,2024-01-06,PLN7750,1727809972,1727809972,Home Health,In-Network,F32.9,M54.5,,,,,,,0,,93225,Medicine,,,,23,Emergency Room,1,429.11,313.62,263.62,0.0,50.0,0.0,50.0,0.0,Pended,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006738,MBR00000260,Professional,2023-06-06,2023-06-06,2023-06-13,PLN1756,1118885473,1118885473,ASC,In-Network,K92.1,E78.5,,,,,,,0,,99222,E&M,,,,11,Office,3,406.23,263.16,218.25,0.0,0.0,44.91,44.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006739,MBR00000260,Institutional-IP,2022-09-24,2022-09-27,2022-10-01,PLN9346,1845057593,1845057593,Orthopedic Surgery,In-Network,Z79.4,E66.9,,,,682,MS-DRG,8,3,Y,99214,E&M,,,0120,21,Inpatient Hospital,2,321.12,194.7,0.0,194.7,0.0,0.0,194.7,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006740,MBR00000260,Institutional-OP,2023-06-11,2023-06-11,2023-07-15,PLN6616,1780163051,1780163051,SNF,In-Network,M81.0,M54.5,,,,,,,0,,70553,Radiology,,,0301,22,Outpatient Hospital,1,3545.03,1422.6,1347.6,0.0,75.0,0.0,75.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006741,MBR00000260,Institutional-OP,2021-11-07,2021-11-07,2021-11-26,PLN1518,1872272835,1872272835,Internal Medicine,In-Network,Z12.31,Z12.31,,,,,,,0,,80053,Pathology/Lab,,,0510,22,Outpatient Hospital,3,103.46,33.64,33.64,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006742,MBR00000260,Institutional-OP,2023-08-11,2023-08-11,2023-08-30,PLN6134,1609138981,1609138981,Critical Access Hospital,In-Network,Z23,I10,,,,,,,0,,99283,E&M,,,0730,22,Outpatient Hospital,3,604.77,338.85,338.85,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006743,MBR00000260,Institutional-IP,2023-08-14,2023-08-18,2023-09-27,PLN7367,1590915516,1590915516,Physical Therapy,Out-of-Network,F32.9,I10,,,,690,MS-DRG,3,4,N,33533,Surgery,,,0761,21,Inpatient Hospital,2,29089.16,16780.65,14402.42,234.27,0.0,2143.96,2378.23,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000006744,MBR00000260,Institutional-OP,2022-02-25,2022-02-25,2022-03-10,PLN9723,1609138981,1609138981,Critical Access Hospital,In-Network,F32.9,N18.3,,,,,,,0,,80053,Pathology/Lab,,,0270,22,Outpatient Hospital,2,103.02,62.73,0.0,62.73,15.0,0.0,77.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006745,MBR00000260,Institutional-OP,2021-03-15,2021-03-15,2021-03-25,PLN7865,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,N40.0,N39.0,,,,,,,0,,99204,E&M,,,0320,22,Outpatient Hospital,3,266.88,96.14,0.0,96.14,25.0,0.0,121.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006746,MBR00000260,Professional,2023-01-20,2023-01-20,2023-03-04,PLN7699,1434029575,1434029575,Endocrinology,In-Network,R07.9,E11.9,,,,,,,0,,99214,E&M,,,,23,Emergency Room,2,205.61,62.48,0.0,62.48,25.0,0.0,87.48,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006747,MBR00000260,Professional,2021-04-23,2021-04-23,2021-05-20,PLN1710,1806688928,1806688928,Geriatrics,In-Network,E11.65,I10,,,,,,,0,,99284,E&M,,,,23,Emergency Room,2,667.17,424.47,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-97,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006748,MBR00000260,Institutional-OP,2021-01-20,2021-01-20,2021-02-19,PLN4572,1139906830,1139906830,Endocrinology,Out-of-Network,F41.9,R05,,,,,,,0,,97110,Medicine,,,0740,22,Outpatient Hospital,3,105.43,84.35,0.0,84.35,15.0,0.0,99.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006749,MBR00000260,Institutional-OP,2023-11-04,2023-11-04,2023-12-04,PLN7942,1205377316,1205377316,Orthopedic Surgery,In-Network,I25.10,I25.10,,,,,,,0,,80061,Pathology/Lab,,,0636,22,Outpatient Hospital,1,61.3,27.02,0.0,27.02,35.0,0.0,62.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006750,MBR00000260,Institutional-OP,2022-09-14,2022-09-14,2022-10-28,PLN7392,1660288235,1660288235,ASC,In-Network,Z00.00,E66.9,,,,,,,0,,45380,Surgery,,,0450,22,Outpatient Hospital,1,2666.8,1669.51,1552.68,87.27,0.0,29.56,116.83,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006751,MBR00000260,Professional,2022-12-13,2022-12-13,2023-01-12,PLN4147,1450553056,1450553056,Clinical Laboratory,In-Network,E78.5,E11.9,,,,,,,0,,90686,Medicine,,,,11,Office,1,58.75,22.33,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000006752,MBR00000260,Institutional-OP,2023-08-23,2023-08-23,2023-09-21,PLN1065,1609138981,1609138981,Critical Access Hospital,In-Network,I10,F41.9,,,,,,,0,,99221,E&M,,,0200,22,Outpatient Hospital,1,199.95,96.37,96.37,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006753,MBR00000260,Professional,2023-10-15,2023-10-15,2023-10-26,PLN9809,1806688928,1806688928,Geriatrics,In-Network,I50.9,E11.9,,,,,,,0,,99233,E&M,,,,21,Inpatient Hospital,2,573.63,209.07,180.74,0.0,25.0,3.33,28.33,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006754,MBR00000260,Professional,2023-11-14,2023-11-14,2023-12-21,PLN4256,1845900543,1845900543,ASC,In-Network,I48.91,I10,,,,,,,0,,45380,Surgery,,,,20,Urgent Care,1,2424.23,1080.36,1030.36,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006755,MBR00000260,Professional,2021-05-26,2021-05-26,2021-06-04,PLN3882,1500037969,1500037969,Pulmonology,In-Network,J45.20,M54.5,,,,,,,0,,85025,Pathology/Lab,,,,20,Urgent Care,2,84.22,55.83,55.83,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006756,MBR00000260,Institutional-IP,2021-12-21,2021-12-25,2022-01-03,PLN4829,1213165847,1213165847,Critical Access Hospital,In-Network,F41.9,Z00.00,,,,291,MS-DRG,7,4,Y,99284,E&M,,,0636,21,Inpatient Hospital,1,663.18,263.3,85.51,143.63,15.0,19.16,177.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006757,MBR00000260,Professional,2023-04-22,2023-04-22,2023-05-17,PLN1097,1660288235,1660288235,ASC,In-Network,Z12.31,K57.30,,,,,,,0,,45378,Surgery,,,,50,Federally Qualified Health Center,3,1912.51,1320.99,897.38,423.61,0.0,0.0,423.61,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000006758,MBR00000260,Institutional-IP,2021-02-01,2021-02-06,2021-02-09,PLN4486,1450553056,1450553056,Clinical Laboratory,In-Network,I10,E78.5,,,,871,MS-DRG,5,5,Y,99214,E&M,,,0270,21,Inpatient Hospital,2,305.01,145.8,0.0,145.8,50.0,0.0,195.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006759,MBR00000260,Institutional-OP,2021-09-15,2021-09-15,2021-09-24,PLN6239,1219817751,1219817751,OB/GYN,In-Network,R05,I10,,,,,,,0,,84443,Pathology/Lab,,,0730,22,Outpatient Hospital,1,84.12,63.53,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006760,MBR00000260,Professional,2022-07-18,2022-07-18,2022-08-06,PLN3977,1948810580,1948810580,DME Supplier,In-Network,I10,F41.9,,,,,,,0,,99284,E&M,,,,23,Emergency Room,3,897.18,465.88,0.0,123.21,0.0,50.21,173.42,0.0,Denied,CO-15,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006761,MBR00000260,Professional,2022-01-11,2022-01-11,2022-01-29,PLN8724,1450553056,1450553056,Clinical Laboratory,In-Network,M54.5,I63.9,,,,,,,0,,45380,Surgery,,,,49,Independent Clinic,1,2892.97,1959.99,1477.24,185.82,0.0,296.93,482.75,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006762,MBR00000260,Institutional-IP,2021-07-09,2021-07-17,2021-07-18,PLN4007,1390307371,1390307371,DME Supplier,In-Network,I10,Z12.11,,,,871,MS-DRG,19,8,Y,99204,E&M,,,0450,21,Inpatient Hospital,3,276.75,158.32,108.32,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006763,MBR00000260,Institutional-OP,2023-09-12,2023-09-12,2023-10-05,PLN9641,1268679390,1268679390,Critical Access Hospital,In-Network,E66.9,Z00.00,,,,,,,0,,47562,Surgery,,,0636,22,Outpatient Hospital,2,5519.66,2873.3,2798.3,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006764,MBR00000260,Institutional-OP,2022-05-06,2022-05-06,2022-05-20,PLN1781,1103747954,1103747954,Urology,In-Network,Z23,I11.9,,,,,,,0,,99283,E&M,,,0120,22,Outpatient Hospital,2,331.87,114.73,114.73,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006765,MBR00000260,Professional,2022-03-27,2022-03-27,2022-04-17,PLN4649,1606140917,1606140917,ASC,In-Network,M54.5,J06.9,,,,,,,0,,93225,Medicine,,,,21,Inpatient Hospital,1,855.66,373.94,207.58,166.36,0.0,0.0,166.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006766,MBR00000260,Institutional-IP,2022-12-21,2022-12-26,2022-12-30,PLN9075,1410468316,1410468316,SNF,In-Network,J18.9,Z87.891,,,,872,MS-DRG,8,5,Y,70553,Radiology,,,0301,21,Inpatient Hospital,2,3928.51,2628.66,2406.86,0.0,15.0,206.8,221.8,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000006767,MBR00000260,Institutional-OP,2023-01-05,2023-01-05,2023-02-16,PLN4117,1609526529,1609526529,Psychiatry,In-Network,I25.10,N40.0,,,,,,,0,,77067,Radiology,,,0450,22,Outpatient Hospital,3,672.51,380.06,240.72,126.54,0.0,12.8,139.34,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000006768,MBR00000260,Professional,2022-06-24,2022-06-24,2022-07-21,PLN7670,1463205530,1463205530,Nephrology,In-Network,I25.10,R05,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,3,2173.38,1722.79,1636.78,86.01,0.0,0.0,86.01,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000006769,MBR00000260,Institutional-IP,2023-08-30,2023-08-31,2023-09-20,PLN4387,1266606767,1266606767,ASC,In-Network,Z00.00,E78.5,,,,196,MS-DRG,21,1,Y,99213,E&M,,,0200,21,Inpatient Hospital,3,290.07,206.42,116.37,0.0,75.0,15.05,90.05,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000006770,MBR00000260,Professional,2021-11-21,2021-11-21,2022-01-02,PLN8656,1569105090,1569105090,Geriatrics,In-Network,E11.9,C50.912,,,,,,,0,,58661,Surgery,,,,11,Office,3,3422.15,1059.74,1059.74,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006771,MBR00000261,Institutional-IP,2023-08-12,2023-08-24,2023-08-29,PLN7010,1295371663,1295371663,Critical Access Hospital,In-Network,Z23,M17.11,,,,292,MS-DRG,3,12,N,99222,E&M,,,0120,21,Inpatient Hospital,3,276.03,176.37,156.05,0.0,15.0,5.32,20.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006772,MBR00000261,Professional,2023-08-09,2023-08-09,2023-08-28,PLN4085,1569105090,1569105090,Geriatrics,In-Network,J45.20,J06.9,,,,,,,0,,66984,Surgery,,,,20,Urgent Care,3,2556.28,785.19,785.19,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006773,MBR00000261,Professional,2021-01-10,2021-01-10,2021-02-22,PLN8460,1590915516,1590915516,Physical Therapy,Out-of-Network,E11.9,E66.9,,,,,,,0,,99204,E&M,,,,31,Skilled Nursing Facility,3,490.99,404.92,404.92,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006774,MBR00000261,Professional,2023-04-07,2023-04-07,2023-05-08,PLN6871,1364429278,1364429278,OB/GYN,In-Network,M54.5,K57.30,,,,,,,0,,70450,Radiology,,,,21,Inpatient Hospital,3,1047.49,599.97,599.97,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006775,MBR00000261,Professional,2021-06-23,2021-06-23,2021-07-14,PLN6903,1569105090,1569105090,Geriatrics,In-Network,I10,J20.9,,,,,,,0,,86900,Pathology/Lab,,,,22,Outpatient Hospital,2,60.24,36.28,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006776,MBR00000261,Professional,2022-06-16,2022-06-16,2022-06-29,PLN6187,1511044648,1511044648,Endocrinology,In-Network,F41.9,E66.9,,,,,,,0,,27130,Surgery,,,,11,Office,2,4835.05,2324.7,2285.22,39.48,0.0,0.0,39.48,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006777,MBR00000261,Professional,2023-10-03,2023-10-03,2023-11-03,PLN4853,1780163051,1780163051,SNF,In-Network,Z00.00,J44.1,,,,,,,0,,99204,E&M,,,,11,Office,1,319.11,152.72,134.47,0.0,0.0,18.25,18.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006778,MBR00000262,Professional,2021-08-03,2021-08-03,2021-08-19,PLN5822,1148984206,1148984206,Psychiatry,In-Network,M81.0,Z79.4,,,,,,,0,,93306,Radiology,,,,49,Independent Clinic,1,3134.58,2190.44,1724.06,466.38,0.0,0.0,466.38,0.0,Pended,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006779,MBR00000262,Professional,2022-09-08,2022-09-08,2022-10-10,PLN1399,1631954542,1631954542,Oncology,In-Network,N17.9,N18.3,,,,,,,0,,G0444,Medicine,,,,11,Office,2,69.33,37.46,0.0,37.46,50.0,0.0,87.46,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000006780,MBR00000262,Professional,2023-05-02,2023-05-02,2023-05-20,PLN7430,1372918899,1372918899,Family Medicine,In-Network,F41.9,G43.909,,,,,,,0,,90837,Medicine,,,,11,Office,1,202.02,69.5,0.0,69.5,0.0,0.0,69.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006781,MBR00000262,Professional,2022-06-10,2022-06-10,2022-06-21,PLN7351,1899127912,1899127912,Neurology,In-Network,K92.1,Z00.00,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,1,3556.62,2139.9,2064.9,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006782,MBR00000262,Institutional-OP,2021-03-27,2021-03-27,2021-05-01,PLN7537,1752470395,1752470395,Home Health,In-Network,Z00.00,Z12.31,,,,,,,0,,58661,Surgery,,,0761,22,Outpatient Hospital,2,2280.87,772.39,435.28,337.11,0.0,0.0,337.11,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006783,MBR00000262,Professional,2021-03-13,2021-03-13,2021-03-25,PLN6445,1809014947,1809014947,Urology,In-Network,E78.5,E78.5,,,,,,,0,,99284,E&M,,,,11,Office,3,854.69,571.43,318.96,177.47,75.0,0.0,252.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006784,MBR00000262,Institutional-IP,2022-07-22,2022-07-27,2022-09-01,PLN5210,1749494482,1749494482,Pediatrics,In-Network,I10,Z79.4,,,,641,MS-DRG,23,5,Y,G0468,Medicine,,,0450,21,Inpatient Hospital,2,407.89,206.18,156.18,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006785,MBR00000262,Professional,2021-01-28,2021-01-28,2021-02-28,PLN4499,1564502315,1564502315,ASC,In-Network,M54.5,Z12.31,,,,,,,0,,99214,E&M,,,,20,Urgent Care,3,310.02,93.38,0.0,93.38,0.0,0.0,93.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006786,MBR00000262,Professional,2021-01-17,2021-01-17,2021-02-22,PLN9781,1860435061,1860435061,DME Supplier,In-Network,E78.5,Z00.00,,,,,,,0,,78452,Radiology,,,,20,Urgent Care,2,4445.56,2191.27,2191.27,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006787,MBR00000262,Institutional-OP,2023-11-10,2023-11-10,2023-12-08,PLN4667,1980712759,1980712759,Outpatient Clinic,Out-of-Network,M17.11,E11.9,,,,,,,0,,58661,Surgery,,,0360,22,Outpatient Hospital,2,3179.33,2591.31,2591.31,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000006788,MBR00000262,Institutional-IP,2022-08-07,2022-08-09,2022-09-01,PLN5306,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,M81.0,G20,,,,603,MS-DRG,9,2,N,99214,E&M,,,0450,21,Inpatient Hospital,2,321.01,203.74,203.74,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000006789,MBR00000262,Institutional-IP,2022-06-03,2022-06-09,2022-06-17,PLN1299,1990090423,1990090423,Orthopedic Surgery,In-Network,R10.9,K57.30,,,,872,MS-DRG,1,6,U,45380,Surgery,,,0320,21,Inpatient Hospital,2,1807.16,1133.37,1083.37,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006790,MBR00000262,Professional,2021-04-20,2021-04-20,2021-05-18,PLN2863,1997536841,1997536841,Family Medicine,Out-of-Network,Z23,Z23,,,,,,,0,,93306,Radiology,,,,20,Urgent Care,3,1518.94,1141.11,867.78,82.2,0.0,191.13,273.33,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006791,MBR00000262,Professional,2023-05-12,2023-05-12,2023-06-24,PLN3456,1518055405,1518055405,Urology,In-Network,G43.909,M17.11,,,,,,,0,,99213,E&M,,,,23,Emergency Room,3,279.95,178.81,176.07,0.0,0.0,2.74,2.74,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006792,MBR00000262,Professional,2022-07-13,2022-07-13,2022-08-06,PLN4714,1224179551,1224179551,Physical Therapy,In-Network,E66.9,Z87.891,,,,,,,0,,99222,E&M,,,,50,Federally Qualified Health Center,3,400.64,236.16,235.37,0.79,0.0,0.0,0.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006793,MBR00000262,Professional,2021-08-29,2021-08-29,2021-09-27,PLN2365,1622771872,1622771872,Pediatrics,In-Network,E78.5,Z00.00,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,3,1987.47,1569.09,1257.64,0.0,0.0,311.45,311.45,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006794,MBR00000262,Institutional-OP,2023-04-05,2023-04-05,2023-04-14,PLN4767,1500037969,1500037969,Pulmonology,In-Network,J20.9,M54.5,,,,,,,0,,G0444,Medicine,,,0450,22,Outpatient Hospital,3,66.99,21.36,0.0,21.36,75.0,0.0,96.36,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000006795,MBR00000262,Professional,2021-09-17,2021-09-17,2021-10-06,PLN7095,1780163051,1780163051,SNF,In-Network,G43.909,I10,,,,,,,0,,97530,Medicine,,,,21,Inpatient Hospital,3,314.29,227.49,0.0,168.38,35.0,0.0,203.38,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006796,MBR00000262,Professional,2022-07-05,2022-07-05,2022-08-10,PLN6397,1550154147,1550154147,Outpatient Clinic,In-Network,Z12.31,J06.9,,,,,,,0,,45380,Surgery,,,,20,Urgent Care,1,3073.79,2445.3,2018.03,0.0,0.0,427.27,427.27,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006797,MBR00000262,Professional,2022-09-06,2022-09-06,2022-10-04,PLN9995,1660288235,1660288235,ASC,In-Network,N18.3,E11.9,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,3,72.78,23.03,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006798,MBR00000262,Professional,2021-11-02,2021-11-02,2021-12-06,PLN5162,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,N39.0,Z12.31,,,,,,,0,,80053,Pathology/Lab,,,,22,Outpatient Hospital,2,108.88,86.07,0.0,86.07,0.0,0.0,86.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006799,MBR00000262,Professional,2023-08-18,2023-08-18,2023-09-17,PLN3726,1609526529,1609526529,Psychiatry,In-Network,Z23,N20.0,,,,,,,0,,90460,Medicine,,,,11,Office,1,32.91,10.5,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006800,MBR00000262,Professional,2023-02-10,2023-02-10,2023-02-20,PLN4396,1500037969,1500037969,Pulmonology,In-Network,J45.20,F32.9,,,,,,,0,,74177,Radiology,,,,21,Inpatient Hospital,1,2006.71,841.23,791.23,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006801,MBR00000262,Institutional-OP,2021-11-12,2021-11-12,2021-12-06,PLN9639,1528335731,1528335731,Critical Access Hospital,In-Network,Z12.31,I10,,,,,,,0,,99213,E&M,,,0900,22,Outpatient Hospital,1,201.85,161.85,0.0,161.85,50.0,0.0,211.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006802,MBR00000262,Institutional-IP,2021-06-21,2021-06-27,2021-07-16,PLN5804,1364429278,1364429278,OB/GYN,In-Network,Z00.01,E11.9,,,,641,MS-DRG,10,6,Y,G0439,Medicine,,,0761,21,Inpatient Hospital,1,251.63,88.72,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-15,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000006803,MBR00000262,Professional,2021-12-27,2021-12-27,2022-02-08,PLN1763,1571574052,1571574052,Critical Access Hospital,In-Network,J44.1,Z00.00,,,,,,,0,,58661,Surgery,,,,20,Urgent Care,1,3240.89,1149.88,1149.88,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006804,MBR00000262,Professional,2022-05-25,2022-05-25,2022-06-13,PLN8406,1564502315,1564502315,ASC,In-Network,Z12.31,Z23,,,,,,,0,,99284,E&M,,,,11,Office,1,771.76,566.09,566.09,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006805,MBR00000262,Institutional-IP,2022-08-26,2022-08-27,2022-09-20,PLN3440,1500949740,1500949740,Pediatrics,In-Network,I10,Z12.31,,,,196,MS-DRG,14,1,Y,23472,Surgery,,,0360,21,Inpatient Hospital,3,5909.78,4953.2,4620.38,332.82,0.0,0.0,332.82,0.0,Paid,,,0,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000006806,MBR00000262,Professional,2022-03-15,2022-03-15,2022-03-24,PLN6254,1609526529,1609526529,Psychiatry,In-Network,I48.91,E11.9,,,,,,,0,,93225,Medicine,,,,11,Office,1,869.14,725.67,725.67,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006807,MBR00000262,Institutional-OP,2021-02-13,2021-02-13,2021-02-23,PLN9276,1716521444,1716521444,Oncology,In-Network,I10,E78.5,,,,,,,0,,76700,Radiology,,,0761,22,Outpatient Hospital,1,1401.92,442.67,422.74,0.0,0.0,19.93,19.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006808,MBR00000262,Institutional-IP,2023-01-11,2023-01-17,2023-02-10,PLN4145,1361302520,1361302520,Critical Access Hospital,In-Network,Z00.00,M17.11,,,,690,MS-DRG,24,6,Y,70553,Radiology,,,0370,21,Inpatient Hospital,1,3999.92,2761.75,2429.97,0.0,0.0,331.78,331.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006809,MBR00000262,Professional,2022-02-19,2022-02-19,2022-03-13,PLN6361,1244186984,1244186984,Family Medicine,Out-of-Network,N39.0,E66.9,,,,,,,0,,33533,Surgery,,,,11,Office,3,21911.52,6610.96,6585.96,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000006810,MBR00000263,Institutional-OP,2022-01-03,2022-01-03,2022-02-01,PLN1369,1518055405,1518055405,Urology,In-Network,J45.20,Z12.31,,,,,,,0,,80053,Pathology/Lab,,,0761,22,Outpatient Hospital,3,120.92,83.25,29.02,0.04,50.0,4.19,54.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006811,MBR00000263,Professional,2022-09-02,2022-09-02,2022-09-11,PLN7688,1946680931,1946680931,Critical Access Hospital,Out-of-Network,M54.5,E11.9,,,,,,,0,,99214,E&M,,,,11,Office,3,345.96,276.07,256.32,19.75,0.0,0.0,19.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006812,MBR00000263,Professional,2023-07-04,2023-07-04,2023-07-19,PLN6975,1486164553,1486164553,DME Supplier,In-Network,E78.5,I10,,,,,,,0,,99233,E&M,,,,11,Office,2,289.68,124.9,124.9,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006813,MBR00000263,Institutional-IP,2021-01-06,2021-01-14,2021-01-28,PLN5851,1295371663,1295371663,Critical Access Hospital,In-Network,I48.91,J06.9,,,,682,MS-DRG,24,8,Y,99406,Medicine,,,0301,21,Inpatient Hospital,2,45.39,23.68,21.25,0.0,0.0,2.43,2.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006814,MBR00000263,Professional,2023-11-19,2023-11-19,2023-12-13,PLN9107,1571574052,1571574052,Critical Access Hospital,In-Network,I25.10,I10,,,,,,,0,,27130,Surgery,,,,23,Emergency Room,3,5537.5,2273.25,1947.53,325.72,0.0,0.0,325.72,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006815,MBR00000263,Professional,2022-11-30,2022-11-30,2023-01-10,PLN1273,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,E11.9,E11.9,,,,,,,0,,93225,Medicine,,,,50,Federally Qualified Health Center,1,992.58,400.17,250.21,99.96,50.0,0.0,149.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006816,MBR00000263,Institutional-OP,2022-08-22,2022-08-22,2022-09-14,PLN3214,1266606767,1266606767,ASC,In-Network,N39.0,R07.9,,,,,,,0,,99233,E&M,,,0900,22,Outpatient Hospital,1,301.82,242.3,242.3,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006817,MBR00000263,Institutional-OP,2021-02-25,2021-02-25,2021-04-07,PLN1745,1531398223,1531398223,OB/GYN,In-Network,F41.9,J44.1,,,,,,,0,,80053,Pathology/Lab,,,0200,22,Outpatient Hospital,1,138.1,53.45,0.0,0.0,15.0,0.62,15.62,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006818,MBR00000263,Professional,2023-02-18,2023-02-18,2023-03-19,PLN7097,1433937353,1433937353,Nephrology,In-Network,Z00.00,F03.90,,,,,,,0,,99204,E&M,,,,21,Inpatient Hospital,2,393.68,244.21,117.47,109.32,0.0,17.42,126.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006819,MBR00000263,Institutional-OP,2023-02-28,2023-02-28,2023-03-12,PLN4585,1865904917,1865904917,Outpatient Clinic,In-Network,I10,N39.0,,,,,,,0,,99213,E&M,,,0900,22,Outpatient Hospital,2,246.4,83.37,0.0,83.37,0.0,0.0,83.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006820,MBR00000263,Professional,2022-09-06,2022-09-06,2022-10-07,PLN6883,1410468316,1410468316,SNF,In-Network,N18.3,E66.9,,,,,,,0,,99222,E&M,,,,21,Inpatient Hospital,1,438.23,242.11,139.3,0.0,75.0,27.81,102.81,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006821,MBR00000263,Institutional-OP,2023-05-28,2023-05-28,2023-06-28,PLN3074,1511044648,1511044648,Endocrinology,In-Network,I10,J06.9,,,,,,,0,,99214,E&M,,,0370,22,Outpatient Hospital,1,257.63,190.88,0.0,190.88,15.0,0.0,205.88,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006822,MBR00000263,Professional,2023-07-08,2023-07-08,2023-07-30,PLN3533,1840431511,1840431511,Geriatrics,Out-of-Network,C50.912,E11.9,,,,,,,0,,97530,Medicine,,,,11,Office,2,296.68,102.92,74.31,0.0,15.0,13.61,28.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006823,MBR00000263,Professional,2023-07-08,2023-07-08,2023-07-16,PLN4207,1239316214,1239316214,Internal Medicine,In-Network,F41.9,N39.0,,,,,,,0,,70450,Radiology,,,,11,Office,1,1027.82,495.93,168.99,292.3,15.0,19.64,326.94,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000006824,MBR00000263,Institutional-IP,2021-12-24,2021-12-25,2022-02-02,PLN4501,1624202402,1624202402,Orthopedic Surgery,In-Network,Z12.31,R10.9,,,,641,MS-DRG,12,1,Y,G0468,Medicine,,,0730,21,Inpatient Hospital,1,319.6,117.39,0.0,117.39,0.0,0.0,117.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006825,MBR00000263,Professional,2023-01-08,2023-01-08,2023-02-08,PLN7193,1103747954,1103747954,Urology,In-Network,Z00.01,E66.9,,,,,,,0,,99203,E&M,,,,11,Office,2,230.57,140.09,0.0,0.0,0.0,20.34,20.34,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006826,MBR00000263,Institutional-OP,2021-03-04,2021-03-04,2021-03-19,PLN1379,1891849440,1891849440,Oncology,In-Network,E66.9,E11.9,,,,,,,0,,81001,Pathology/Lab,,,0740,22,Outpatient Hospital,3,48.85,40.99,13.27,0.0,25.0,2.72,27.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006827,MBR00000263,Professional,2022-09-07,2022-09-07,2022-09-14,PLN9151,1372918899,1372918899,Family Medicine,In-Network,J44.1,Z00.01,,,,,,,0,,99204,E&M,,,,23,Emergency Room,3,393.86,175.54,175.54,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006828,MBR00000263,Institutional-OP,2021-06-09,2021-06-09,2021-07-14,PLN9245,1644128543,1644128543,Gastroenterology,In-Network,J18.9,F32.9,,,,,,,0,,99233,E&M,,,0200,22,Outpatient Hospital,2,290.31,105.58,0.0,105.58,0.0,0.0,105.58,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006829,MBR00000263,Professional,2021-12-03,2021-12-03,2022-01-08,PLN7857,1410468316,1410468316,SNF,In-Network,K21.0,E78.5,,,,,,,0,,97530,Medicine,,,,20,Urgent Care,3,306.82,124.54,124.54,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006830,MBR00000263,Professional,2023-01-11,2023-01-11,2023-01-30,PLN1695,1334916761,1334916761,ASC,In-Network,Z00.00,Z23,,,,,,,0,,99221,E&M,,,,23,Emergency Room,1,328.23,108.12,0.0,108.12,35.0,0.0,143.12,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006831,MBR00000263,Professional,2022-04-10,2022-04-10,2022-05-09,PLN2545,1103747954,1103747954,Urology,In-Network,N18.3,J44.1,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,1,128.04,53.41,11.54,41.87,0.0,0.0,41.87,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000006832,MBR00000263,Professional,2023-08-04,2023-08-04,2023-08-28,PLN6756,1778483301,1778483301,Home Health,In-Network,E11.9,J20.9,,,,,,,0,,90460,Medicine,,,,22,Outpatient Hospital,1,59.47,31.59,31.59,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006833,MBR00000264,Institutional-IP,2021-04-06,2021-04-17,2021-04-13,PLN4627,1118885473,1118885473,ASC,In-Network,B97.89,E66.9,,,,470,MS-DRG,13,11,Y,99284,E&M,,,0370,21,Inpatient Hospital,1,342.82,131.75,95.29,0.0,25.0,11.46,36.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006834,MBR00000264,Institutional-IP,2023-12-01,2023-12-08,2024-01-11,PLN1537,1103747954,1103747954,Urology,In-Network,E78.5,R07.9,,,,641,MS-DRG,13,7,Y,93225,Medicine,,,0200,21,Inpatient Hospital,1,810.83,246.35,133.65,112.7,0.0,0.0,112.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006835,MBR00000264,Institutional-OP,2023-02-14,2023-02-14,2023-03-01,PLN7014,1514306773,1514306773,Endocrinology,In-Network,Z87.891,J18.9,,,,,,,0,,27447,Surgery,,,0636,22,Outpatient Hospital,2,3869.5,2295.3,1925.91,94.16,50.0,225.23,369.39,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006836,MBR00000264,Professional,2022-04-17,2022-04-17,2022-05-28,PLN7964,1227362142,1227362142,DME Supplier,In-Network,I10,I10,,,,,,,0,,93000,Radiology,,,,49,Independent Clinic,3,140.93,64.88,0.0,64.88,75.0,0.0,139.88,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006837,MBR00000264,Professional,2021-01-28,2021-01-28,2021-02-12,PLN4038,1915531927,1915531927,Critical Access Hospital,In-Network,F41.9,I10,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,3,118.05,89.26,0.0,89.26,0.0,0.0,89.26,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006838,MBR00000264,Professional,2021-02-15,2021-02-15,2021-02-25,PLN6689,1410468316,1410468316,SNF,In-Network,I10,N39.0,,,,,,,0,,77067,Radiology,,,,11,Office,2,806.42,472.76,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-119,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000006839,MBR00000264,Institutional-IP,2022-03-29,2022-04-02,2022-04-25,PLN2215,1606140917,1606140917,ASC,In-Network,E78.5,I10,,,,683,MS-DRG,21,4,Y,97110,Medicine,,,0370,21,Inpatient Hospital,2,108.0,60.25,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006840,MBR00000264,Institutional-OP,2022-09-19,2022-09-19,2022-09-30,PLN7779,1691062876,1691062876,SNF,In-Network,J20.9,N18.3,,,,,,,0,,90686,Medicine,,,0636,22,Outpatient Hospital,2,107.82,84.66,0.0,84.66,50.0,0.0,134.66,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000006841,MBR00000264,Professional,2022-07-09,2022-07-09,2022-08-11,PLN7652,1245650222,1245650222,Gastroenterology,In-Network,J44.1,I10,,,,,,,0,,99283,E&M,,,,11,Office,3,249.84,115.22,115.22,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006842,MBR00000264,Professional,2021-11-22,2021-11-22,2021-12-09,PLN9406,1273488618,1273488618,General Acute Care Hospital,In-Network,M54.5,E11.9,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,2,59.57,35.6,0.0,35.6,50.0,0.0,85.6,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006843,MBR00000264,Professional,2022-12-13,2022-12-13,2023-01-03,PLN4916,1135158374,1135158374,Pulmonology,In-Network,I10,Z12.31,,,,,,,0,,45380,Surgery,,,,21,Inpatient Hospital,1,1997.78,1134.1,1088.66,0.0,0.0,45.44,45.44,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006844,MBR00000264,Professional,2022-11-04,2022-11-04,2022-12-01,PLN4282,1540044947,1540044947,Pulmonology,Out-of-Network,K21.0,E66.9,,,,,,,0,,99233,E&M,,,,11,Office,2,489.75,166.49,119.1,0.0,35.0,12.39,47.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006845,MBR00000264,Institutional-IP,2022-01-11,2022-01-16,2022-01-20,PLN2986,1463205530,1463205530,Nephrology,In-Network,Z00.00,I25.10,,,,641,MS-DRG,5,5,Y,33533,Surgery,,,0761,21,Inpatient Hospital,3,12750.15,6266.79,6071.3,0.0,0.0,195.49,195.49,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000006846,MBR00000265,Professional,2021-12-23,2021-12-23,2022-01-26,PLN1683,1840431511,1840431511,Geriatrics,Out-of-Network,F10.20,J06.9,,,,,,,0,,99232,E&M,,,,11,Office,1,145.44,98.39,95.82,0.0,0.0,2.57,2.57,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006847,MBR00000265,Institutional-OP,2022-04-30,2022-04-30,2022-06-03,PLN7051,1540044947,1540044947,Pulmonology,Out-of-Network,M17.11,M54.5,,,,,,,0,,45380,Surgery,,,0730,22,Outpatient Hospital,2,2030.38,1694.27,1368.62,275.65,50.0,0.0,325.65,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006848,MBR00000265,Professional,2023-03-25,2023-03-25,2023-04-21,PLN6414,1500949740,1500949740,Pediatrics,In-Network,I48.91,I10,,,,,,,0,,99284,E&M,,,,11,Office,1,394.9,249.37,224.37,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006849,MBR00000265,Professional,2022-10-06,2022-10-06,2022-11-06,PLN6797,1520687146,1520687146,ASC,In-Network,I11.9,K92.1,,,,,,,0,,99204,E&M,,,,11,Office,1,396.22,127.0,0.0,127.0,50.0,0.0,177.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006850,MBR00000265,Professional,2021-05-20,2021-05-20,2021-06-06,PLN5357,1571574052,1571574052,Critical Access Hospital,In-Network,J06.9,Z23,,,,,,,0,,G0468,Medicine,,,,11,Office,1,292.5,162.97,112.97,0.0,50.0,0.0,50.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006851,MBR00000265,Professional,2023-10-08,2023-10-08,2023-11-21,PLN2422,1247341320,1247341320,Urology,Out-of-Network,N39.0,Z12.31,,,,,,,0,,90686,Medicine,,,,22,Outpatient Hospital,3,132.42,53.84,0.0,53.84,0.0,0.0,53.84,0.0,Denied,PR-1,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000006852,MBR00000265,Institutional-OP,2021-08-10,2021-08-10,2021-09-07,PLN6345,1569105090,1569105090,Geriatrics,In-Network,J44.1,J06.9,,,,,,,0,,78452,Radiology,,,0730,22,Outpatient Hospital,1,3591.27,1932.67,1699.24,0.0,15.0,218.43,233.43,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006853,MBR00000265,Institutional-OP,2023-01-06,2023-01-06,2023-01-17,PLN4552,1624802371,1624802371,ASC,Out-of-Network,I25.10,E11.9,,,,,,,0,,G0444,Medicine,,,0510,22,Outpatient Hospital,3,64.49,52.56,0.0,52.56,75.0,0.0,127.56,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000006854,MBR00000265,Professional,2021-01-19,2021-01-19,2021-01-28,PLN9134,1847081578,1847081578,Urology,Out-of-Network,J44.1,E78.5,,,,,,,0,,58661,Surgery,,,,50,Federally Qualified Health Center,1,2526.18,2013.94,1963.94,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006855,MBR00000265,Professional,2021-10-06,2021-10-06,2021-10-14,PLN9120,1728018911,1728018911,Nephrology,In-Network,R10.9,G20,,,,,,,0,,47562,Surgery,,,,11,Office,2,5132.18,2539.47,2201.8,19.37,0.0,318.3,337.67,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006856,MBR00000265,Institutional-OP,2022-09-11,2022-09-11,2022-10-14,PLN3677,1795618275,1795618275,Pulmonology,In-Network,F41.9,J18.9,,,,,,,0,,33533,Surgery,,,0761,22,Outpatient Hospital,1,12883.09,10279.6,10279.6,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000006857,MBR00000265,Institutional-IP,2023-07-17,2023-07-23,2023-07-28,PLN5690,1475984649,1475984649,SNF,In-Network,G20,E11.9,,,,872,MS-DRG,13,6,Y,99233,E&M,,,0900,21,Inpatient Hospital,2,315.69,103.71,75.95,0.0,15.0,12.76,27.76,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000006858,MBR00000265,Institutional-IP,2022-09-09,2022-09-12,2022-10-15,PLN9284,1872613201,1872613201,Internal Medicine,In-Network,J44.1,J06.9,,,,871,MS-DRG,8,3,Y,43239,Surgery,,,0200,21,Inpatient Hospital,2,1220.22,964.14,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-97,,0,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000006859,MBR00000265,Professional,2021-03-02,2021-03-02,2021-03-15,PLN1072,1239316214,1239316214,Internal Medicine,In-Network,I48.91,E78.5,,,,,,,0,,47562,Surgery,,,,11,Office,2,6610.89,4532.41,4532.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006860,MBR00000265,Institutional-IP,2023-11-13,2023-11-22,2023-12-04,PLN3855,1702692193,1702692193,Physical Therapy,In-Network,J06.9,I10,,,,603,MS-DRG,3,9,N,43239,Surgery,,,0510,21,Inpatient Hospital,2,2030.6,1642.75,1197.87,444.88,0.0,0.0,444.88,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006861,MBR00000265,Professional,2021-10-26,2021-10-26,2021-11-15,PLN8860,1334916761,1334916761,ASC,In-Network,J06.9,Z23,,,,,,,0,,23472,Surgery,,,,20,Urgent Care,2,3976.77,2010.75,2010.75,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006862,MBR00000265,Professional,2022-02-04,2022-02-04,2022-03-07,PLN2116,1124394415,1124394415,Pediatrics,In-Network,R10.9,Z23,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,1,4884.73,3010.22,3010.22,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006863,MBR00000265,Institutional-OP,2021-04-29,2021-04-29,2021-05-07,PLN4021,1434029575,1434029575,Endocrinology,In-Network,E66.9,I10,,,,,,,0,,87491,Pathology/Lab,,,0900,22,Outpatient Hospital,2,236.27,181.5,0.0,181.5,0.0,0.0,181.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006864,MBR00000265,Professional,2023-02-02,2023-02-02,2023-02-21,PLN2954,1114982472,1114982472,Orthopedic Surgery,In-Network,F32.9,E11.9,,,,,,,0,,G0439,Medicine,,,,11,Office,1,530.87,331.58,331.58,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000006865,MBR00000265,Professional,2022-05-05,2022-05-05,2022-05-27,PLN2064,1224179551,1224179551,Physical Therapy,In-Network,F41.9,E78.5,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,2,102.33,43.52,0.0,43.52,0.0,0.0,43.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000006866,MBR00000265,Professional,2021-08-29,2021-08-29,2021-09-08,PLN7713,1749494482,1749494482,Pediatrics,In-Network,E11.9,K92.1,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,2,7282.66,4924.83,4109.05,0.0,75.0,740.78,815.78,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006867,MBR00000265,Professional,2022-11-29,2022-11-29,2022-12-24,PLN4400,1135158374,1135158374,Pulmonology,In-Network,E11.9,M17.11,,,,,,,0,,99233,E&M,,,,23,Emergency Room,3,497.09,200.23,40.97,124.26,35.0,0.0,159.26,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006868,MBR00000265,Institutional-OP,2021-08-03,2021-08-03,2021-08-28,PLN4076,1717912431,1717912431,Oncology,In-Network,E11.9,Z12.31,,,,,,,0,,99406,Medicine,,,0450,22,Outpatient Hospital,3,38.6,16.18,13.79,0.0,0.0,2.39,2.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006869,MBR00000265,Professional,2022-08-05,2022-08-05,2022-08-16,PLN5672,1946680931,1946680931,Critical Access Hospital,Out-of-Network,R10.9,F32.9,,,,,,,0,,99203,E&M,,,,11,Office,3,253.91,96.48,73.97,0.0,15.0,7.51,22.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006870,MBR00000265,Professional,2022-12-28,2022-12-28,2023-02-05,PLN6020,1847081578,1847081578,Urology,Out-of-Network,E11.9,E11.9,,,,,,,0,,99233,E&M,,,,12,Home,2,431.96,157.29,132.29,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006871,MBR00000265,Institutional-OP,2023-06-08,2023-06-08,2023-06-25,PLN1734,1438368327,1438368327,Home Health,In-Network,E78.5,Z00.00,,,,,,,0,,99221,E&M,,,0270,22,Outpatient Hospital,2,453.1,220.72,170.72,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006872,MBR00000265,Professional,2023-01-31,2023-01-31,2023-02-09,PLN4687,1872613201,1872613201,Internal Medicine,In-Network,M17.11,J20.9,,,,,,,0,,66984,Surgery,,,,11,Office,2,2490.18,1755.59,1183.29,414.2,25.0,133.1,572.3,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006873,MBR00000265,Professional,2022-09-14,2022-09-14,2022-10-02,PLN2517,1806688928,1806688928,Geriatrics,In-Network,K21.0,E11.9,,,,,,,0,,99204,E&M,,,,31,Skilled Nursing Facility,3,563.16,393.77,350.99,0.0,0.0,42.78,42.78,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000006874,MBR00000265,Professional,2021-02-07,2021-02-07,2021-03-19,PLN6314,1422747896,1422747896,Urology,In-Network,I48.91,K21.0,,,,,,,0,,99213,E&M,,,,65,End-Stage Renal Disease,3,157.39,94.23,94.23,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006875,MBR00000265,Professional,2021-09-12,2021-09-12,2021-09-28,PLN6570,1542828721,1542828721,Orthopedic Surgery,In-Network,M54.5,E11.9,,,,,,,0,,99221,E&M,,,,11,Office,2,276.72,221.25,131.83,14.42,75.0,0.0,89.42,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000006876,MBR00000265,Professional,2022-09-25,2022-09-25,2022-10-29,PLN1570,1939033455,1939033455,Pulmonology,In-Network,J06.9,E11.9,,,,,,,0,,93306,Radiology,,,,11,Office,3,1623.64,736.38,686.38,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006877,MBR00000265,Institutional-IP,2022-08-11,2022-08-18,2022-08-31,PLN6826,1689639685,1689639685,SNF,In-Network,F32.9,I25.10,,,,690,MS-DRG,12,7,Y,85025,Pathology/Lab,,,0510,21,Inpatient Hospital,2,80.16,35.78,0.0,35.78,15.0,0.0,50.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006878,MBR00000265,Professional,2022-08-08,2022-08-08,2022-09-10,PLN6218,1891849440,1891849440,Oncology,In-Network,J44.1,I25.10,,,,,,,0,,90837,Medicine,,,,11,Office,1,444.01,317.28,0.0,317.28,35.0,0.0,352.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006879,MBR00000265,Institutional-IP,2023-03-17,2023-03-20,2023-04-16,PLN3998,1148984206,1148984206,Psychiatry,In-Network,J45.20,K92.1,,,,641,MS-DRG,24,3,Y,99214,E&M,,,0301,21,Inpatient Hospital,1,239.52,166.1,118.7,0.0,25.0,22.4,47.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006880,MBR00000265,Institutional-OP,2023-09-18,2023-09-18,2023-10-17,PLN9451,1585582070,1585582070,Outpatient Clinic,In-Network,I25.10,E11.9,,,,,,,0,,70450,Radiology,,,0900,22,Outpatient Hospital,2,1387.71,668.1,269.48,321.62,50.0,27.0,398.62,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006881,MBR00000265,Professional,2022-07-05,2022-07-05,2022-08-02,PLN7919,1812060197,1812060197,Oncology,Out-of-Network,C50.912,N20.0,,,,,,,0,,99204,E&M,,,,49,Independent Clinic,3,486.03,390.73,174.35,201.38,15.0,0.0,216.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006882,MBR00000265,Professional,2021-05-28,2021-05-28,2021-07-03,PLN5784,1284035364,1284035364,Pediatrics,In-Network,R51,M54.5,,,,,,,0,,70553,Radiology,,,,22,Outpatient Hospital,1,4669.32,3493.75,3041.99,451.76,0.0,0.0,451.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006883,MBR00000265,Professional,2022-04-29,2022-04-29,2022-05-16,PLN9456,1103747954,1103747954,Urology,In-Network,Z00.00,I11.9,,,,,,,0,,99284,E&M,,,,49,Independent Clinic,3,349.88,156.12,121.12,0.0,35.0,0.0,35.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006884,MBR00000265,Professional,2021-10-04,2021-10-04,2021-10-12,PLN2871,1235381502,1235381502,Cardiology,In-Network,E11.9,I10,,,,,,,0,,23472,Surgery,,,,50,Federally Qualified Health Center,2,5862.9,3231.07,3229.51,1.56,0.0,0.0,1.56,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006885,MBR00000265,Professional,2022-08-03,2022-08-03,2022-09-16,PLN1118,1114982472,1114982472,Orthopedic Surgery,In-Network,Z00.00,Z00.01,,,,,,,0,,27447,Surgery,,,,23,Emergency Room,1,5132.0,2278.06,2278.06,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006886,MBR00000265,Professional,2022-10-08,2022-10-08,2022-10-21,PLN5706,1295371663,1295371663,Critical Access Hospital,In-Network,R05,Z12.11,,,,,,,0,,99406,Medicine,,,,20,Urgent Care,3,63.13,27.42,27.42,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006887,MBR00000265,Professional,2022-08-24,2022-08-24,2022-10-05,PLN9970,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,M54.5,Z23,,,,,,,0,,99214,E&M,,,,20,Urgent Care,2,232.13,186.04,171.04,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006888,MBR00000265,Professional,2022-09-29,2022-09-29,2022-11-03,PLN3127,1624802371,1624802371,ASC,Out-of-Network,I25.10,E11.9,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,2,63.42,40.57,0.0,40.57,0.0,0.0,40.57,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006889,MBR00000265,Professional,2021-12-07,2021-12-07,2021-12-22,PLN7862,1450553056,1450553056,Clinical Laboratory,In-Network,F41.9,N18.3,,,,,,,0,,83036,Pathology/Lab,,,,50,Federally Qualified Health Center,3,107.82,40.79,0.0,40.79,0.0,0.0,40.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000006890,MBR00000265,Institutional-IP,2021-07-13,2021-07-17,2021-08-01,PLN9448,1687650653,1687650653,Internal Medicine,In-Network,N40.0,I10,,,,871,MS-DRG,17,4,Y,27130,Surgery,,,0730,21,Inpatient Hospital,2,3003.12,1082.1,693.48,388.62,0.0,0.0,388.62,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006891,MBR00000265,Professional,2023-07-25,2023-07-25,2023-09-01,PLN7759,1716521444,1716521444,Oncology,In-Network,M54.5,Z23,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,3,65.71,33.63,0.0,33.63,15.0,0.0,48.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006892,MBR00000265,Institutional-OP,2022-03-16,2022-03-16,2022-04-29,PLN5050,1542828721,1542828721,Orthopedic Surgery,In-Network,Z00.00,E11.40,,,,,,,0,,47562,Surgery,,,0740,22,Outpatient Hospital,3,5372.73,2641.38,2641.38,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000006893,MBR00000265,Institutional-IP,2021-08-16,2021-08-20,2021-08-26,PLN4532,1606140917,1606140917,ASC,In-Network,J06.9,C50.912,,,,292,MS-DRG,12,4,Y,74177,Radiology,,,0320,21,Inpatient Hospital,3,2350.81,1934.24,1899.24,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006894,MBR00000265,Professional,2023-12-26,2023-12-26,2024-02-08,PLN2366,1990090423,1990090423,Orthopedic Surgery,In-Network,F41.9,M81.0,,,,,,,0,,99213,E&M,,,,11,Office,3,129.74,97.0,88.52,0.0,0.0,8.48,8.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006895,MBR00000265,Institutional-IP,2021-02-05,2021-02-16,2021-03-20,PLN4120,1968299309,1968299309,Internal Medicine,In-Network,E78.5,I63.9,,,,683,MS-DRG,7,11,Y,81001,Pathology/Lab,,,0740,21,Inpatient Hospital,2,55.28,46.54,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006896,MBR00000266,Professional,2022-01-15,2022-01-15,2022-02-26,PLN1998,1500037969,1500037969,Pulmonology,In-Network,E11.9,G43.909,,,,,,,0,,23472,Surgery,,,,11,Office,3,5766.86,4686.83,3462.28,482.56,0.0,741.99,1224.55,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006897,MBR00000266,Institutional-IP,2023-03-23,2023-04-03,2023-04-06,PLN6147,1118885473,1118885473,ASC,In-Network,Z12.31,E11.65,,,,603,MS-DRG,4,11,U,93225,Medicine,,,0200,21,Inpatient Hospital,2,377.22,272.37,251.27,0.0,0.0,21.1,21.1,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000006898,MBR00000266,Professional,2022-03-26,2022-03-26,2022-04-26,PLN4916,1438368327,1438368327,Home Health,In-Network,Z00.00,I50.9,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,2,5690.73,3562.55,2882.77,0.0,25.0,654.78,679.78,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006899,MBR00000266,Professional,2023-07-12,2023-07-12,2023-08-06,PLN5007,1994661817,1994661817,SNF,Out-of-Network,R07.9,M54.5,,,,,,,0,,G0439,Medicine,,,,11,Office,2,498.27,256.67,221.67,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,0,1,Upcoding,0,0,0,1,0
CLM0000006900,MBR00000266,Professional,2022-01-28,2022-01-28,2022-02-11,PLN5842,1800011727,1800011727,Clinical Laboratory,Out-of-Network,Z12.31,Z12.31,,,,,,,0,,99283,E&M,,,,23,Emergency Room,1,517.98,388.11,133.64,204.47,50.0,0.0,254.47,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006901,MBR00000266,Institutional-IP,2022-12-05,2022-12-14,2022-12-16,PLN2318,1283743001,1283743001,Family Medicine,In-Network,M54.5,N18.3,,,,641,MS-DRG,20,9,Y,99283,E&M,,,0270,21,Inpatient Hospital,3,635.93,263.34,228.34,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006902,MBR00000266,Institutional-OP,2022-04-14,2022-04-14,2022-05-21,PLN7138,1205377316,1205377316,Orthopedic Surgery,In-Network,Z12.31,M81.0,,,,,,,0,,84443,Pathology/Lab,,,0120,22,Outpatient Hospital,1,98.9,72.97,0.0,72.97,0.0,0.0,72.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006903,MBR00000266,Professional,2022-05-29,2022-05-29,2022-06-12,PLN9852,1717912431,1717912431,Oncology,In-Network,I10,E11.9,,,,,,,0,,97110,Medicine,,,,21,Inpatient Hospital,3,257.65,132.05,127.84,0.0,0.0,4.21,4.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006904,MBR00000266,Professional,2022-06-30,2022-06-30,2022-07-22,PLN6105,1727809972,1727809972,Home Health,In-Network,K21.0,I10,,,,,,,0,,45378,Surgery,,,,11,Office,2,2529.56,1815.86,1815.86,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000006905,MBR00000267,Professional,2023-12-04,2023-12-04,2023-12-20,PLN9793,1563980627,1563980627,Critical Access Hospital,In-Network,R51,Z00.01,,,,,,,0,,99203,E&M,,,,11,Office,1,203.38,113.98,38.98,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006906,MBR00000267,Professional,2023-04-13,2023-04-13,2023-04-24,PLN2195,1334916761,1334916761,ASC,In-Network,J06.9,I10,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,1,23208.22,12727.76,11377.18,76.32,0.0,1274.26,1350.58,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000006907,MBR00000267,Professional,2022-02-10,2022-02-10,2022-03-13,PLN5930,1118885473,1118885473,ASC,In-Network,J18.9,N39.0,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,3,41.93,33.44,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006908,MBR00000267,Institutional-IP,2022-04-02,2022-04-07,2022-04-28,PLN4146,1631954542,1631954542,Oncology,In-Network,I48.91,J18.9,,,,195,MS-DRG,17,5,Y,47562,Surgery,,,0370,21,Inpatient Hospital,2,5265.71,2103.58,1927.87,140.71,35.0,0.0,175.71,0.0,Paid,,,1,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000006909,MBR00000267,Institutional-IP,2022-03-21,2022-03-25,2022-04-11,PLN6749,1757138478,1757138478,Pediatrics,In-Network,J44.1,Z12.31,,,,196,MS-DRG,14,4,Y,80061,Pathology/Lab,,,0636,21,Inpatient Hospital,2,99.86,34.31,34.31,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000006910,MBR00000267,Institutional-OP,2023-03-18,2023-03-18,2023-04-12,PLN8420,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,F03.90,J20.9,,,,,,,0,,43239,Surgery,,,0730,22,Outpatient Hospital,3,1496.38,852.45,852.45,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006911,MBR00000267,Professional,2022-10-10,2022-10-10,2022-11-05,PLN6678,1390307371,1390307371,DME Supplier,In-Network,I10,M17.11,,,,,,,0,,99214,E&M,,,,11,Office,2,321.07,118.01,112.32,0.0,0.0,5.69,5.69,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000006912,MBR00000267,Institutional-OP,2022-08-09,2022-08-09,2022-08-30,PLN8884,1453283987,1453283987,Critical Access Hospital,In-Network,Z12.31,Z00.00,,,,,,,0,,76700,Radiology,,,0636,22,Outpatient Hospital,2,658.44,353.7,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006913,MBR00000267,Institutional-OP,2022-04-17,2022-04-17,2022-04-26,PLN3813,1997536841,1997536841,Family Medicine,Out-of-Network,E78.5,E78.5,,,,,,,0,,99222,E&M,,,0320,22,Outpatient Hospital,1,627.81,192.67,0.0,192.67,0.0,0.0,192.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006914,MBR00000267,Professional,2022-03-13,2022-03-13,2022-04-23,PLN5234,1812060197,1812060197,Oncology,Out-of-Network,N39.0,F41.9,,,,,,,0,,27447,Surgery,,,,11,Office,2,3652.81,2256.5,1562.01,355.15,0.0,339.34,694.49,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006915,MBR00000267,Institutional-OP,2022-09-01,2022-09-01,2022-09-11,PLN3469,1564502315,1564502315,ASC,In-Network,M54.5,J20.9,,,,,,,0,,90460,Medicine,,,0740,22,Outpatient Hospital,1,52.0,31.46,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006916,MBR00000267,Professional,2023-06-30,2023-06-30,2023-08-08,PLN3949,1899127912,1899127912,Neurology,In-Network,R51,Z00.00,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,3,416.87,140.55,0.0,140.55,75.0,0.0,215.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006917,MBR00000267,Professional,2023-11-25,2023-11-25,2023-12-08,PLN8136,1219817751,1219817751,OB/GYN,In-Network,I10,K57.30,,,,,,,0,,47562,Surgery,,,,20,Urgent Care,3,3798.13,2123.24,1672.83,190.9,50.0,209.51,450.41,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006918,MBR00000267,Institutional-OP,2021-03-08,2021-03-08,2021-03-23,PLN9350,1845900543,1845900543,ASC,In-Network,R10.9,G20,,,,,,,0,,99233,E&M,,,0510,22,Outpatient Hospital,1,234.5,113.1,17.41,70.69,25.0,0.0,95.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006919,MBR00000267,Professional,2021-09-18,2021-09-18,2021-10-23,PLN6929,1475984649,1475984649,SNF,In-Network,E78.5,S72.001A,,,,,,,0,,99283,E&M,,,,21,Inpatient Hospital,1,274.99,209.39,0.0,199.65,25.0,0.0,224.65,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006920,MBR00000268,Institutional-OP,2023-01-21,2023-01-21,2023-02-27,PLN4359,1390307371,1390307371,DME Supplier,In-Network,E66.9,F32.9,,,,,,,0,,23472,Surgery,,,0320,22,Outpatient Hospital,2,4821.98,2540.75,2178.23,287.52,75.0,0.0,362.52,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006921,MBR00000268,Institutional-OP,2021-06-12,2021-06-12,2021-06-30,PLN1160,1235381502,1235381502,Cardiology,In-Network,M54.5,Z79.4,,,,,,,0,,99222,E&M,,,0301,22,Outpatient Hospital,2,543.73,236.72,236.72,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006922,MBR00000268,Institutional-OP,2022-10-31,2022-10-31,2022-12-14,PLN3216,1644128543,1644128543,Gastroenterology,In-Network,F32.9,M81.0,,,,,,,0,,99204,E&M,,,0740,22,Outpatient Hospital,1,264.48,102.81,102.81,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006923,MBR00000268,Institutional-IP,2022-04-09,2022-04-11,2022-05-03,PLN2978,1395983630,1395983630,Nephrology,In-Network,G43.909,Z12.11,,,,195,MS-DRG,6,2,Y,81001,Pathology/Lab,,,0636,21,Inpatient Hospital,1,61.4,46.58,41.28,0.0,0.0,5.3,5.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006924,MBR00000268,Institutional-IP,2021-07-28,2021-08-02,2021-08-29,PLN9432,1550154147,1550154147,Outpatient Clinic,In-Network,F41.9,E66.9,,,,682,MS-DRG,23,5,N,99213,E&M,,,0636,21,Inpatient Hospital,1,253.2,100.54,98.61,0.0,0.0,1.93,1.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006925,MBR00000268,Professional,2022-07-06,2022-07-06,2022-08-04,PLN9939,1114982472,1114982472,Orthopedic Surgery,In-Network,I63.9,I10,,,,,,,0,,77067,Radiology,,,,20,Urgent Care,2,795.46,631.14,0.0,482.78,0.0,6.29,489.07,0.0,Denied,CO-4,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000006926,MBR00000268,Professional,2022-07-12,2022-07-12,2022-08-02,PLN3196,1575695214,1575695214,SNF,In-Network,N39.0,I10,,,,,,,0,,58661,Surgery,,,,11,Office,2,4075.92,2045.1,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-27,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006927,MBR00000268,Institutional-OP,2023-02-20,2023-02-20,2023-03-10,PLN8771,1486164553,1486164553,DME Supplier,In-Network,Z00.00,F32.9,,,,,,,0,,23472,Surgery,,,0450,22,Outpatient Hospital,2,4426.13,2234.85,1941.65,293.2,0.0,0.0,293.2,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006928,MBR00000268,Professional,2023-06-24,2023-06-24,2023-08-02,PLN6926,1361302520,1361302520,Critical Access Hospital,In-Network,M81.0,Z87.891,,,,,,,0,,23472,Surgery,,,,23,Emergency Room,3,5943.67,4005.21,3504.36,0.0,0.0,500.85,500.85,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006929,MBR00000268,Professional,2023-11-12,2023-11-12,2023-11-28,PLN4902,1244186984,1244186984,Family Medicine,Out-of-Network,F41.9,E66.9,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,3,6623.48,2059.3,1615.32,443.98,0.0,0.0,443.98,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006930,MBR00000268,Institutional-OP,2022-04-26,2022-04-26,2022-05-16,PLN2701,1696843572,1696843572,Critical Access Hospital,Out-of-Network,M17.11,Z00.00,,,,,,,0,,99203,E&M,,,0636,22,Outpatient Hospital,1,143.62,66.79,53.49,0.0,0.0,13.3,13.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006931,MBR00000269,Professional,2023-01-25,2023-01-25,2023-02-22,PLN6839,1118885473,1118885473,ASC,In-Network,J06.9,E78.5,,,,,,,0,,G0439,Medicine,,,,22,Outpatient Hospital,3,639.44,444.8,444.8,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000006932,MBR00000269,Institutional-OP,2023-05-12,2023-05-12,2023-05-28,PLN6439,1518055405,1518055405,Urology,In-Network,G43.909,E78.5,,,,,,,0,,99203,E&M,,,0740,22,Outpatient Hospital,2,386.61,304.4,229.4,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006933,MBR00000269,Professional,2023-12-17,2023-12-17,2024-01-09,PLN7809,1727809972,1727809972,Home Health,In-Network,E11.65,G43.909,,,,,,,0,,70553,Radiology,,,,23,Emergency Room,2,2669.09,1677.22,1208.82,418.4,50.0,0.0,468.4,0.0,Paid,,,0,,1,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000006934,MBR00000269,Professional,2022-12-14,2022-12-14,2023-01-27,PLN8761,1817234602,1817234602,Clinical Laboratory,In-Network,J45.20,N39.0,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,2,41.97,14.45,0.0,14.45,25.0,0.0,39.45,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006935,MBR00000269,Institutional-IP,2021-09-27,2021-09-30,2021-10-19,PLN8872,1313212303,1313212303,Family Medicine,In-Network,M54.5,M81.0,,,,682,MS-DRG,3,3,Y,99221,E&M,,,0360,21,Inpatient Hospital,2,281.73,221.73,221.73,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006936,MBR00000269,Professional,2022-01-10,2022-01-10,2022-02-06,PLN4584,1135158374,1135158374,Pulmonology,In-Network,E11.9,G43.909,,,,,,,0,,99232,E&M,,,,11,Office,2,253.95,199.24,199.24,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006937,MBR00000270,Institutional-OP,2021-08-17,2021-08-17,2021-09-10,PLN6440,1244186984,1244186984,Family Medicine,Out-of-Network,F41.9,F41.9,,,,,,,0,,90686,Medicine,,,0761,22,Outpatient Hospital,3,70.07,51.82,16.82,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000006938,MBR00000270,Professional,2021-08-05,2021-08-05,2021-08-31,PLN4992,1817234602,1817234602,Clinical Laboratory,In-Network,G43.909,E11.9,,,,,,,0,,99213,E&M,,,,49,Independent Clinic,2,268.45,141.11,0.0,141.11,25.0,0.0,166.11,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006939,MBR00000270,Professional,2021-12-02,2021-12-02,2021-12-12,PLN2898,1389336600,1389336600,Critical Access Hospital,In-Network,F41.9,K21.0,,,,,,,0,,58661,Surgery,,,,21,Inpatient Hospital,2,2453.1,1414.56,1414.56,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006940,MBR00000270,Institutional-OP,2022-06-30,2022-06-30,2022-07-25,PLN5933,1463205530,1463205530,Nephrology,In-Network,G20,E11.9,,,,,,,0,,99283,E&M,,,0510,22,Outpatient Hospital,2,281.41,135.51,0.0,135.51,0.0,0.0,135.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006941,MBR00000271,Professional,2023-05-12,2023-05-12,2023-05-24,PLN1186,1148984206,1148984206,Psychiatry,In-Network,Z12.11,K21.0,,,,,,,0,,27130,Surgery,,,,20,Urgent Care,1,2530.54,1111.32,0.0,0.0,0.0,0.0,0.0,0.0,Denied,PR-1,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006942,MBR00000271,Professional,2021-11-15,2021-11-15,2021-11-22,PLN1370,1364429278,1364429278,OB/GYN,In-Network,E11.40,I10,,,,,,,0,,99213,E&M,,,,22,Outpatient Hospital,2,122.27,77.44,0.0,77.44,15.0,0.0,92.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006943,MBR00000271,Professional,2021-07-24,2021-07-24,2021-08-19,PLN1406,1235381502,1235381502,Cardiology,In-Network,I10,E11.9,,,,,,,0,,97110,Medicine,,,,12,Home,2,250.79,122.92,102.28,0.0,0.0,20.64,20.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006944,MBR00000271,Institutional-OP,2021-05-19,2021-05-19,2021-05-28,PLN8438,1366576336,1366576336,Geriatrics,In-Network,E11.9,E78.5,,,,,,,0,,23472,Surgery,,,0301,22,Outpatient Hospital,1,5596.36,2012.9,1268.0,472.83,0.0,272.07,744.9,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006945,MBR00000271,Institutional-OP,2021-08-03,2021-08-03,2021-09-11,PLN1764,1946680931,1946680931,Critical Access Hospital,Out-of-Network,Z23,F32.9,,,,,,,0,,80061,Pathology/Lab,,,0450,22,Outpatient Hospital,1,48.78,15.11,0.0,15.11,35.0,0.0,50.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006946,MBR00000271,Professional,2022-04-19,2022-04-19,2022-05-06,PLN2115,1433937353,1433937353,Nephrology,In-Network,R51,Z00.01,,,,,,,0,,47562,Surgery,,,,11,Office,1,6449.67,4066.62,4016.62,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006947,MBR00000271,Professional,2022-03-27,2022-03-27,2022-04-04,PLN8687,1624802371,1624802371,ASC,Out-of-Network,I48.91,N18.3,,,,,,,0,,23472,Surgery,,,,11,Office,2,4345.3,2728.3,2231.34,496.96,0.0,0.0,496.96,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006948,MBR00000271,Institutional-OP,2022-03-13,2022-03-13,2022-03-29,PLN6540,1809014947,1809014947,Urology,In-Network,I10,E78.5,,,,,,,0,,71046,Radiology,,,0370,22,Outpatient Hospital,2,312.51,114.35,64.35,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006949,MBR00000271,Institutional-OP,2021-12-14,2021-12-14,2021-12-21,PLN1292,1696843572,1696843572,Critical Access Hospital,Out-of-Network,E78.5,E66.9,,,,,,,0,,93000,Radiology,,,0360,22,Outpatient Hospital,3,140.51,110.75,58.13,37.62,15.0,0.0,52.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006950,MBR00000272,Professional,2022-05-12,2022-05-12,2022-06-09,PLN9608,1556140803,1556140803,Cardiology,In-Network,R51,I10,,,,,,,0,,90686,Medicine,,,,11,Office,1,121.21,48.76,13.76,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000006951,MBR00000272,Institutional-IP,2022-12-09,2022-12-13,2023-01-11,PLN5623,1564502315,1564502315,ASC,In-Network,E11.9,Z00.00,,,,682,MS-DRG,18,4,Y,23472,Surgery,,,0730,21,Inpatient Hospital,3,7354.96,3873.62,3798.62,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006952,MBR00000272,Professional,2021-02-18,2021-02-18,2021-03-12,PLN6031,1974006077,1974006077,Orthopedic Surgery,In-Network,N39.0,E11.9,,,,,,,0,,43239,Surgery,,,,11,Office,2,2138.66,1801.9,1674.07,92.83,35.0,0.0,127.83,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006953,MBR00000272,Professional,2023-09-02,2023-09-02,2023-09-09,PLN2582,1860435061,1860435061,DME Supplier,In-Network,G43.909,N39.0,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,2,172.9,79.58,64.58,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006954,MBR00000272,Institutional-IP,2021-12-01,2021-12-02,2022-01-14,PLN5081,1103747954,1103747954,Urology,In-Network,Z12.31,J44.1,,,,690,MS-DRG,19,1,Y,58661,Surgery,,,0270,21,Inpatient Hospital,1,1863.88,778.49,738.63,0.0,0.0,39.86,39.86,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006955,MBR00000272,Institutional-IP,2021-06-01,2021-06-11,2021-06-22,PLN9261,1872272835,1872272835,Internal Medicine,In-Network,E78.5,M81.0,,,,291,MS-DRG,14,10,Y,99214,E&M,,,0740,21,Inpatient Hospital,1,466.13,341.21,0.0,310.18,75.0,0.0,385.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006956,MBR00000272,Professional,2021-07-11,2021-07-11,2021-08-22,PLN3086,1845057593,1845057593,Orthopedic Surgery,In-Network,R07.9,N18.3,,,,,,,0,,99284,E&M,,,,23,Emergency Room,1,547.18,403.96,0.0,403.96,35.0,0.0,438.96,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006957,MBR00000272,Institutional-OP,2022-08-22,2022-08-22,2022-09-13,PLN1540,1268679390,1268679390,Critical Access Hospital,In-Network,Z00.00,I10,,,,,,,0,,45378,Surgery,,,0450,22,Outpatient Hospital,1,1496.28,773.41,723.41,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000006958,MBR00000273,Professional,2022-07-25,2022-07-25,2022-08-03,PLN8258,1109850785,1109850785,ASC,Out-of-Network,J44.1,Z79.4,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,3,451.5,337.39,337.39,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006959,MBR00000273,Institutional-OP,2021-04-07,2021-04-07,2021-05-21,PLN5181,1645194539,1645194539,SNF,In-Network,I63.9,Z00.00,,,,,,,0,,99283,E&M,,,0900,22,Outpatient Hospital,3,543.5,414.01,414.01,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006960,MBR00000273,Professional,2022-07-01,2022-07-01,2022-07-13,PLN5614,1135158374,1135158374,Pulmonology,In-Network,E78.5,Z87.891,,,,,,,0,,99283,E&M,,,,11,Office,2,475.73,153.85,145.39,0.0,0.0,8.46,8.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006961,MBR00000273,Institutional-OP,2021-08-31,2021-08-31,2021-09-18,PLN5664,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,E11.9,F32.9,,,,,,,0,,99214,E&M,,,0360,22,Outpatient Hospital,1,399.36,280.58,205.58,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006962,MBR00000273,Professional,2023-09-25,2023-09-25,2023-10-27,PLN9892,1899127912,1899127912,Neurology,In-Network,E11.65,F32.9,,,,,,,0,,90460,Medicine,,,,21,Inpatient Hospital,1,29.0,20.7,20.7,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006963,MBR00000274,Professional,2021-12-05,2021-12-05,2021-12-24,PLN2280,1245650222,1245650222,Gastroenterology,In-Network,M54.5,J18.9,,,,,,,0,,70553,Radiology,,,,22,Outpatient Hospital,2,4247.34,3253.74,0.0,449.36,25.0,0.0,474.36,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006964,MBR00000274,Institutional-IP,2023-12-31,2024-01-09,2024-01-24,PLN3101,1168246159,1168246159,Internal Medicine,In-Network,J06.9,Z00.00,,,,871,MS-DRG,5,9,Y,27447,Surgery,,,0270,21,Inpatient Hospital,3,4375.24,3267.12,3000.7,266.42,0.0,0.0,266.42,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006965,MBR00000274,Professional,2022-09-27,2022-09-27,2022-10-23,PLN2474,1168881145,1168881145,Orthopedic Surgery,In-Network,E11.9,E78.5,,,,,,,0,,84443,Pathology/Lab,,,,12,Home,3,100.02,37.1,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006966,MBR00000274,Professional,2023-11-23,2023-11-23,2023-12-06,PLN7655,1284035364,1284035364,Pediatrics,In-Network,Z12.11,R10.9,,,,,,,0,,74177,Radiology,,,,11,Office,1,1378.19,523.86,523.86,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006967,MBR00000274,Institutional-OP,2022-08-31,2022-08-31,2022-09-21,PLN8668,1968299309,1968299309,Internal Medicine,In-Network,J18.9,Z00.00,,,,,,,0,,99213,E&M,,,0320,22,Outpatient Hospital,1,244.31,107.63,78.34,0.0,25.0,4.29,29.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006968,MBR00000274,Professional,2021-05-18,2021-05-18,2021-06-09,PLN6567,1364429278,1364429278,OB/GYN,In-Network,I10,E87.6,,,,,,,0,,71046,Radiology,,,,31,Skilled Nursing Facility,3,274.15,182.49,147.49,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006969,MBR00000274,Institutional-OP,2022-12-06,2022-12-06,2022-12-24,PLN2807,1860435061,1860435061,DME Supplier,In-Network,Z23,K21.0,,,,,,,0,,97110,Medicine,,,0636,22,Outpatient Hospital,1,251.21,184.65,184.65,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006970,MBR00000274,Professional,2022-06-08,2022-06-08,2022-07-04,PLN6361,1366286000,1366286000,SNF,In-Network,Z96.641,R05,,,,,,,0,,99232,E&M,,,,11,Office,3,264.26,161.56,0.0,161.56,0.0,0.0,161.56,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006971,MBR00000274,Professional,2023-06-16,2023-06-16,2023-06-23,PLN5745,1717546253,1717546253,Family Medicine,In-Network,E66.9,Z00.00,,,,,,,0,,90837,Medicine,,,,11,Office,3,229.83,110.1,35.1,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006972,MBR00000274,Professional,2022-03-05,2022-03-05,2022-03-31,PLN3785,1609138981,1609138981,Critical Access Hospital,In-Network,J06.9,F10.20,,,,,,,0,,45380,Surgery,,,,11,Office,3,2030.27,1690.0,1569.77,120.23,0.0,0.0,120.23,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006973,MBR00000274,Professional,2021-07-25,2021-07-25,2021-08-11,PLN1959,1590915516,1590915516,Physical Therapy,Out-of-Network,Z87.891,N39.0,,,,,,,0,,45380,Surgery,,,,21,Inpatient Hospital,3,2045.4,1655.94,1332.18,0.0,0.0,323.76,323.76,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006974,MBR00000274,Professional,2021-05-05,2021-05-05,2021-05-15,PLN2156,1295371663,1295371663,Critical Access Hospital,In-Network,Z12.31,E11.9,,,,,,,0,,99213,E&M,,,,22,Outpatient Hospital,2,117.15,45.28,0.0,45.28,35.0,0.0,80.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006975,MBR00000274,Professional,2023-03-26,2023-03-26,2023-04-24,PLN5424,1622771872,1622771872,Pediatrics,In-Network,I10,F41.9,,,,,,,0,,99203,E&M,,,,11,Office,3,280.05,143.2,143.2,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006976,MBR00000274,Professional,2021-09-12,2021-09-12,2021-09-20,PLN5480,1205377316,1205377316,Orthopedic Surgery,In-Network,R05,R51,,,,,,,0,,45378,Surgery,,,,12,Home,1,1917.21,1057.74,1057.74,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000006977,MBR00000274,Professional,2023-01-01,2023-01-01,2023-01-11,PLN3944,1213165847,1213165847,Critical Access Hospital,In-Network,N39.0,E78.5,,,,,,,0,,G0439,Medicine,,,,23,Emergency Room,3,512.06,218.11,0.0,218.11,0.0,0.0,218.11,0.0,Denied,CO-4,,0,,1,1,0,0,0,0,None,0,0,0,1,0
CLM0000006978,MBR00000274,Institutional-IP,2021-05-28,2021-05-29,2021-06-20,PLN4271,1422747896,1422747896,Urology,In-Network,I10,I10,,,,194,MS-DRG,11,1,Y,87491,Pathology/Lab,,,0900,21,Inpatient Hospital,3,99.04,64.52,0.0,64.52,25.0,0.0,89.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006979,MBR00000274,Professional,2021-03-29,2021-03-29,2021-04-13,PLN3430,1817234602,1817234602,Clinical Laboratory,In-Network,F41.9,Z12.31,,,,,,,0,,99406,Medicine,,,,11,Office,3,51.14,19.49,19.49,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006980,MBR00000274,Professional,2023-02-17,2023-02-17,2023-04-01,PLN9759,1518055405,1518055405,Urology,In-Network,F41.9,Z00.00,,,,,,,0,,80061,Pathology/Lab,,,,65,End-Stage Renal Disease,1,96.82,79.1,0.0,21.86,0.0,0.0,21.86,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006981,MBR00000274,Professional,2022-01-13,2022-01-13,2022-02-15,PLN5747,1531398223,1531398223,OB/GYN,In-Network,J45.20,E11.9,,,,,,,0,,85610,Pathology/Lab,,,,20,Urgent Care,2,66.54,48.06,33.06,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006982,MBR00000274,Institutional-OP,2022-09-14,2022-09-14,2022-10-07,PLN3593,1571574052,1571574052,Critical Access Hospital,In-Network,Z00.00,N39.0,,,,,,,0,,99204,E&M,,,0360,22,Outpatient Hospital,3,270.43,157.47,0.0,157.47,0.0,0.0,157.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006983,MBR00000274,Professional,2021-01-31,2021-01-31,2021-02-27,PLN6173,1689639685,1689639685,SNF,In-Network,I50.9,J06.9,,,,,,,0,,97110,Medicine,,,,23,Emergency Room,1,177.97,116.97,108.35,0.0,0.0,8.62,8.62,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000006984,MBR00000274,Institutional-OP,2021-07-25,2021-07-25,2021-09-07,PLN3665,1268679390,1268679390,Critical Access Hospital,In-Network,N40.0,I63.9,,,,,,,0,,81001,Pathology/Lab,,,0200,22,Outpatient Hospital,2,43.47,16.58,16.58,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006985,MBR00000274,Professional,2021-04-09,2021-04-09,2021-04-16,PLN7550,1609138981,1609138981,Critical Access Hospital,In-Network,I48.91,Z79.4,,,,,,,0,,70450,Radiology,,,,11,Office,1,1246.05,1031.21,0.0,0.0,0.0,0.0,0.0,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006986,MBR00000274,Institutional-OP,2021-11-03,2021-11-03,2021-12-08,PLN4475,1545347862,1545347862,SNF,In-Network,I48.91,F41.9,,,,,,,0,,84443,Pathology/Lab,,,0636,22,Outpatient Hospital,1,136.17,102.74,0.0,102.74,15.0,0.0,117.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006987,MBR00000275,Professional,2021-11-07,2021-11-07,2021-12-10,PLN4388,1935547131,1935547131,Pulmonology,In-Network,Z87.891,E11.9,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,3,41.38,25.71,0.0,25.71,75.0,0.0,100.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006988,MBR00000275,Professional,2022-02-15,2022-02-15,2022-03-21,PLN7556,1689639685,1689639685,SNF,In-Network,E78.5,E78.5,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,2,274.26,90.41,0.0,90.41,35.0,0.0,125.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006989,MBR00000275,Professional,2021-09-24,2021-09-24,2021-10-28,PLN3782,1780163051,1780163051,SNF,In-Network,Z00.00,J44.1,,,,,,,0,,99213,E&M,,,,11,Office,1,164.97,132.85,0.0,132.85,0.0,0.0,132.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006990,MBR00000275,Institutional-OP,2022-05-16,2022-05-16,2022-06-29,PLN9792,1702692193,1702692193,Physical Therapy,In-Network,I11.9,Z00.00,,,,,,,0,,G0439,Medicine,,,0900,22,Outpatient Hospital,1,233.81,164.71,0.0,164.71,0.0,0.0,164.71,0.0,Denied,CO-18,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000006991,MBR00000275,Professional,2023-09-13,2023-09-13,2023-09-29,PLN9947,1946680931,1946680931,Critical Access Hospital,Out-of-Network,E11.9,K57.30,,,,,,,0,,45380,Surgery,,,,11,Office,1,2758.75,952.32,819.47,0.0,35.0,97.85,132.85,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000006992,MBR00000275,Institutional-OP,2021-04-05,2021-04-05,2021-05-10,PLN9525,1757138478,1757138478,Pediatrics,In-Network,Z23,K21.0,,,,,,,0,,99203,E&M,,,0120,22,Outpatient Hospital,2,249.25,155.3,0.0,155.3,50.0,0.0,205.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006993,MBR00000275,Professional,2023-09-06,2023-09-06,2023-10-02,PLN7698,1103747954,1103747954,Urology,In-Network,I10,Z12.11,,,,,,,0,,93000,Radiology,,,,20,Urgent Care,3,104.67,39.51,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006994,MBR00000275,Institutional-IP,2022-03-28,2022-03-31,2022-04-06,PLN8719,1295371663,1295371663,Critical Access Hospital,In-Network,J06.9,K21.0,,,,470,MS-DRG,3,3,Y,58661,Surgery,,,0270,21,Inpatient Hospital,1,4601.51,1686.33,1598.67,0.0,25.0,62.66,87.66,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000006995,MBR00000275,Institutional-OP,2022-09-25,2022-09-25,2022-11-06,PLN6996,1948810580,1948810580,DME Supplier,In-Network,J06.9,M54.5,,,,,,,0,,84443,Pathology/Lab,,,0270,22,Outpatient Hospital,1,105.77,61.87,61.87,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006996,MBR00000275,Professional,2023-01-06,2023-01-06,2023-02-12,PLN7064,1687650653,1687650653,Internal Medicine,In-Network,M54.5,E78.5,,,,,,,0,,78452,Radiology,,,,11,Office,1,5618.95,4215.02,4165.02,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006997,MBR00000275,Institutional-IP,2023-03-16,2023-03-17,2023-04-23,PLN6796,1242201429,1242201429,General Acute Care Hospital,In-Network,E78.5,Z00.00,,,,291,MS-DRG,3,1,Y,90686,Medicine,,,0730,21,Inpatient Hospital,1,55.93,35.56,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000006998,MBR00000275,Institutional-OP,2023-10-31,2023-10-31,2023-11-27,PLN6521,1511044648,1511044648,Endocrinology,In-Network,K21.0,Z12.31,,,,,,,0,,86900,Pathology/Lab,,,0360,22,Outpatient Hospital,3,39.13,16.48,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000006999,MBR00000275,Professional,2023-12-31,2023-12-31,2024-02-01,PLN7079,1799205295,1799205295,General Acute Care Hospital,In-Network,I11.9,Z12.31,,,,,,,0,,72148,Radiology,,,,11,Office,3,1241.91,512.97,8.46,489.51,15.0,0.0,504.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007000,MBR00000275,Professional,2021-04-18,2021-04-18,2021-05-14,PLN9812,1168246159,1168246159,Internal Medicine,In-Network,F32.9,M54.5,,,,,,,0,,58661,Surgery,,,,12,Home,2,4893.49,2457.56,2422.56,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007001,MBR00000275,Professional,2022-03-26,2022-03-26,2022-05-01,PLN2926,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,J45.20,Z23,,,,,,,0,,99213,E&M,,,,50,Federally Qualified Health Center,3,284.17,153.12,0.0,153.12,0.0,0.0,153.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007002,MBR00000275,Institutional-OP,2022-08-14,2022-08-14,2022-08-21,PLN1358,1687650653,1687650653,Internal Medicine,In-Network,Z12.31,E78.5,,,,,,,0,,99221,E&M,,,0120,22,Outpatient Hospital,1,248.4,192.3,142.88,0.0,25.0,24.42,49.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007003,MBR00000275,Professional,2022-07-27,2022-07-27,2022-08-16,PLN7748,1247341320,1247341320,Urology,Out-of-Network,M54.5,E78.5,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,1,116.24,85.79,10.79,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000007004,MBR00000275,Institutional-IP,2023-12-22,2024-01-03,2024-01-25,PLN9362,1500949740,1500949740,Pediatrics,In-Network,Z00.00,J06.9,,,,603,MS-DRG,1,12,Y,80061,Pathology/Lab,,,0200,21,Inpatient Hospital,2,129.1,66.76,66.76,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007005,MBR00000275,Professional,2022-12-15,2022-12-15,2023-01-08,PLN2362,1390307371,1390307371,DME Supplier,In-Network,I25.10,F32.9,,,,,,,0,,99203,E&M,,,,12,Home,2,231.38,167.61,167.61,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007006,MBR00000275,Institutional-OP,2022-03-17,2022-03-17,2022-04-09,PLN9648,1132188260,1132188260,Family Medicine,In-Network,E11.40,R10.9,,,,,,,0,,78452,Radiology,,,0450,22,Outpatient Hospital,1,5311.21,4112.52,4087.52,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007007,MBR00000275,Institutional-IP,2023-10-06,2023-10-11,2023-11-06,PLN2702,1799205295,1799205295,General Acute Care Hospital,In-Network,E11.9,F32.9,,,,641,MS-DRG,9,5,Y,45378,Surgery,,,0740,21,Inpatient Hospital,3,1630.41,936.02,861.02,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000007008,MBR00000275,Professional,2023-03-12,2023-03-12,2023-03-23,PLN5075,1168246159,1168246159,Internal Medicine,In-Network,E11.65,E66.9,,,,,,,0,,85025,Pathology/Lab,,,,21,Inpatient Hospital,1,86.45,62.23,34.45,0.0,25.0,2.78,27.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007009,MBR00000275,Institutional-OP,2023-05-23,2023-05-23,2023-07-05,PLN7128,1108115157,1108115157,General Acute Care Hospital,In-Network,C50.912,I48.91,,,,,,,0,,85025,Pathology/Lab,,,0636,22,Outpatient Hospital,1,35.42,16.6,16.6,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007010,MBR00000275,Institutional-OP,2022-11-19,2022-11-19,2022-12-27,PLN7992,1511044648,1511044648,Endocrinology,In-Network,Z12.31,E78.5,,,,,,,0,,58661,Surgery,,,0900,22,Outpatient Hospital,3,1801.61,664.94,664.94,0.0,0.0,0.0,0.0,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007011,MBR00000275,Professional,2021-03-12,2021-03-12,2021-04-15,PLN2079,1434029575,1434029575,Endocrinology,In-Network,E78.5,E11.9,,,,,,,0,,93306,Radiology,,,,11,Office,2,3253.74,2352.3,2352.3,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007012,MBR00000275,Professional,2023-11-29,2023-11-29,2023-12-24,PLN5109,1273488618,1273488618,General Acute Care Hospital,In-Network,I10,Z00.00,,,,,,,0,,23472,Surgery,,,,49,Independent Clinic,1,5452.14,4243.26,4243.26,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007013,MBR00000275,Professional,2023-02-20,2023-02-20,2023-03-14,PLN5929,1108115157,1108115157,General Acute Care Hospital,In-Network,J06.9,Z12.31,,,,,,,0,,66984,Surgery,,,,11,Office,2,2146.76,692.09,659.31,0.0,0.0,32.78,32.78,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007014,MBR00000275,Professional,2021-06-13,2021-06-13,2021-06-27,PLN8457,1438368327,1438368327,Home Health,In-Network,F10.20,E11.9,,,,,,,0,,85610,Pathology/Lab,,,,23,Emergency Room,2,51.1,33.53,0.0,33.53,50.0,0.0,83.53,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007015,MBR00000275,Professional,2021-10-03,2021-10-03,2021-11-05,PLN9960,1946680931,1946680931,Critical Access Hospital,Out-of-Network,Z23,E87.6,,,,,,,0,,99233,E&M,,,,20,Urgent Care,3,500.57,286.82,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007016,MBR00000275,Professional,2022-01-09,2022-01-09,2022-02-20,PLN8020,1236418230,1236418230,DME Supplier,In-Network,R10.9,I10,,,,,,,0,,99232,E&M,,,,11,Office,2,186.59,126.44,88.78,0.0,35.0,2.66,37.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007017,MBR00000275,Professional,2021-10-07,2021-10-07,2021-11-15,PLN5294,1806688928,1806688928,Geriatrics,In-Network,I48.91,E66.9,,,,,,,0,,93000,Radiology,,,,22,Outpatient Hospital,2,124.27,55.72,0.0,55.72,15.0,0.0,70.72,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007018,MBR00000276,Professional,2022-11-11,2022-11-11,2022-12-01,PLN8615,1899127912,1899127912,Neurology,In-Network,E11.9,E78.5,,,,,,,0,,86900,Pathology/Lab,,,,22,Outpatient Hospital,1,55.19,44.0,29.0,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007019,MBR00000276,Professional,2022-08-23,2022-08-23,2022-09-13,PLN7851,1946680931,1946680931,Critical Access Hospital,Out-of-Network,E78.5,K21.0,,,,,,,0,,76700,Radiology,,,,11,Office,2,917.42,494.16,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007020,MBR00000276,Professional,2021-08-21,2021-08-21,2021-09-03,PLN1623,1114982472,1114982472,Orthopedic Surgery,In-Network,N18.3,I10,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,3,572.6,188.43,188.43,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007021,MBR00000276,Professional,2023-02-02,2023-02-02,2023-03-05,PLN1029,1728018911,1728018911,Nephrology,In-Network,N18.3,Z79.4,,,,,,,0,,33533,Surgery,,,,11,Office,3,22885.03,8189.74,0.0,0.0,0.0,612.2,612.2,0.0,Denied,CO-15,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000007022,MBR00000276,Professional,2021-11-11,2021-11-11,2021-12-06,PLN5701,1717546253,1717546253,Family Medicine,In-Network,J20.9,Z12.31,,,,,,,0,,66984,Surgery,,,,31,Skilled Nursing Facility,3,2081.86,1759.89,1744.89,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007023,MBR00000276,Professional,2021-06-24,2021-06-24,2021-07-26,PLN5394,1313212303,1313212303,Family Medicine,In-Network,M54.5,F32.9,,,,,,,0,,93225,Medicine,,,,22,Outpatient Hospital,3,959.19,679.22,504.76,124.46,50.0,0.0,174.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007024,MBR00000276,Institutional-OP,2023-11-14,2023-11-14,2023-12-19,PLN9459,1778483301,1778483301,Home Health,In-Network,B97.89,Z12.31,,,,,,,0,,71046,Radiology,,,0320,22,Outpatient Hospital,1,239.75,72.91,0.0,72.91,50.0,0.0,122.91,0.0,Denied,PR-1,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007025,MBR00000276,Institutional-IP,2021-12-11,2021-12-15,2022-01-06,PLN8969,1273488618,1273488618,General Acute Care Hospital,In-Network,Z12.31,Z51.11,,,,603,MS-DRG,8,4,Y,45378,Surgery,,,0360,21,Inpatient Hospital,3,1966.87,1043.37,435.18,492.26,25.0,90.93,608.19,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000007026,MBR00000276,Institutional-OP,2021-09-12,2021-09-12,2021-10-12,PLN5829,1366426662,1366426662,Urology,In-Network,J44.1,I25.10,,,,,,,0,,27130,Surgery,,,0740,22,Outpatient Hospital,3,3134.8,2537.8,0.0,439.93,25.0,0.0,464.93,0.0,Denied,PR-1,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007027,MBR00000276,Institutional-OP,2023-02-24,2023-02-24,2023-04-09,PLN1813,1569105090,1569105090,Geriatrics,In-Network,Z00.00,N39.0,,,,,,,0,,66984,Surgery,,,0120,22,Outpatient Hospital,1,2217.24,1169.91,669.07,396.7,25.0,79.14,500.84,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007028,MBR00000276,Institutional-IP,2023-04-17,2023-04-20,2023-05-28,PLN1473,1540044947,1540044947,Pulmonology,Out-of-Network,J20.9,E11.9,,,,470,MS-DRG,20,3,Y,99204,E&M,,,0270,21,Inpatient Hospital,1,342.69,190.57,0.0,190.57,0.0,0.0,190.57,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007029,MBR00000276,Institutional-OP,2021-06-16,2021-06-16,2021-07-22,PLN4515,1193493783,1193493783,Critical Access Hospital,Out-of-Network,I10,F32.9,,,,,,,0,,86900,Pathology/Lab,,,0370,22,Outpatient Hospital,1,25.98,7.94,0.0,7.94,0.0,0.0,7.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007030,MBR00000276,Professional,2021-03-03,2021-03-03,2021-04-04,PLN7793,1575695214,1575695214,SNF,In-Network,Z12.31,Z00.00,,,,,,,0,,58661,Surgery,,,,20,Urgent Care,1,2547.33,1939.76,1883.09,0.0,0.0,56.67,56.67,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007031,MBR00000276,Institutional-IP,2023-07-20,2023-07-24,2023-08-08,PLN1055,1366426662,1366426662,Urology,In-Network,Z00.00,F41.9,,,,291,MS-DRG,18,4,Y,99213,E&M,,,0270,21,Inpatient Hospital,2,240.31,127.44,77.44,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007032,MBR00000276,Professional,2022-07-06,2022-07-06,2022-08-03,PLN1325,1790497490,1790497490,OB/GYN,In-Network,Z00.01,E11.9,,,,,,,0,,47562,Surgery,,,,11,Office,2,6005.87,4796.32,4419.74,0.0,15.0,361.58,376.58,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007033,MBR00000276,Institutional-IP,2022-05-15,2022-05-23,2022-05-23,PLN6519,1935547131,1935547131,Pulmonology,In-Network,I10,K57.30,,,,292,MS-DRG,22,8,N,85025,Pathology/Lab,,,0360,21,Inpatient Hospital,3,95.93,29.19,3.84,25.35,0.0,0.0,25.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007034,MBR00000276,Professional,2022-04-06,2022-04-06,2022-05-01,PLN2333,1520687146,1520687146,ASC,In-Network,M54.5,E11.9,,,,,,,0,,99284,E&M,,,,11,Office,1,862.9,264.73,214.73,0.0,35.0,15.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007035,MBR00000276,Institutional-OP,2022-10-04,2022-10-04,2022-10-11,PLN1877,1817234602,1817234602,Clinical Laboratory,In-Network,F41.9,F32.9,,,,,,,0,,86900,Pathology/Lab,,,0360,22,Outpatient Hospital,3,36.45,21.11,0.0,21.11,50.0,0.0,71.11,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000007036,MBR00000276,Professional,2023-01-08,2023-01-08,2023-01-23,PLN9153,1717912431,1717912431,Oncology,In-Network,Z00.00,Z00.00,,,,,,,0,,58661,Surgery,,,,21,Inpatient Hospital,2,4323.34,1599.06,0.0,260.67,50.0,0.0,310.67,0.0,Denied,CO-18,,0,,0,0,1,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000007037,MBR00000276,Institutional-OP,2021-03-30,2021-03-30,2021-05-12,PLN5276,1168246159,1168246159,Internal Medicine,In-Network,R51,J18.9,,,,,,,0,,99284,E&M,,,0360,22,Outpatient Hospital,2,832.97,572.22,510.33,0.0,0.0,61.89,61.89,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007038,MBR00000277,Institutional-OP,2021-10-18,2021-10-18,2021-11-28,PLN1757,1946680931,1946680931,Critical Access Hospital,Out-of-Network,Z00.00,I10,,,,,,,0,,G0439,Medicine,,,0450,22,Outpatient Hospital,3,634.99,226.81,0.0,192.37,25.0,0.0,217.37,0.0,Denied,CO-97,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000007039,MBR00000277,Institutional-OP,2023-11-12,2023-11-12,2023-11-25,PLN8735,1500037969,1500037969,Pulmonology,In-Network,R07.9,J45.20,,,,,,,0,,99232,E&M,,,0301,22,Outpatient Hospital,2,371.93,115.54,0.0,115.54,0.0,0.0,115.54,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000007040,MBR00000277,Professional,2021-07-02,2021-07-02,2021-07-31,PLN4120,1224179551,1224179551,Physical Therapy,In-Network,Z00.00,Z23,,,,,,,0,,99213,E&M,,,,23,Emergency Room,2,137.97,91.67,0.0,91.67,75.0,0.0,166.67,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007041,MBR00000277,Professional,2023-09-21,2023-09-21,2023-10-17,PLN9683,1713934949,1713934949,Neurology,In-Network,E78.5,K21.0,,,,,,,0,,45378,Surgery,,,,23,Emergency Room,2,2415.94,804.55,415.52,389.03,0.0,0.0,389.03,0.0,Paid,,,0,,1,1,0,0,0,0,None,0,1,0,0,0
CLM0000007042,MBR00000277,Institutional-IP,2022-03-16,2022-03-25,2022-04-22,PLN1703,1727809972,1727809972,Home Health,In-Network,I48.91,Z12.11,,,,683,MS-DRG,5,9,N,99233,E&M,,,0510,21,Inpatient Hospital,2,202.05,88.96,88.96,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007043,MBR00000277,Professional,2021-07-28,2021-07-28,2021-08-08,PLN4043,1717546253,1717546253,Family Medicine,In-Network,Z00.00,N40.0,,,,,,,0,,99233,E&M,,,,81,Independent Laboratory,2,390.75,242.82,242.82,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007044,MBR00000277,Professional,2022-10-14,2022-10-14,2022-11-09,PLN2527,1542828721,1542828721,Orthopedic Surgery,In-Network,F10.20,J06.9,,,,,,,0,,72148,Radiology,,,,11,Office,1,2409.95,1213.14,664.46,444.16,0.0,104.52,548.68,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007045,MBR00000277,Institutional-IP,2022-12-28,2022-12-30,2023-01-21,PLN3888,1622771872,1622771872,Pediatrics,In-Network,F41.9,R51,,,,871,MS-DRG,15,2,Y,99204,E&M,,,0320,21,Inpatient Hospital,1,429.22,194.63,169.63,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007046,MBR00000277,Institutional-OP,2022-01-19,2022-01-19,2022-02-27,PLN3171,1745114564,1745114564,Endocrinology,In-Network,F41.9,E11.9,,,,,,,0,,G0468,Medicine,,,0761,22,Outpatient Hospital,1,467.26,349.09,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007047,MBR00000277,Professional,2023-05-19,2023-05-19,2023-06-21,PLN9328,1700633438,1700633438,DME Supplier,In-Network,I10,J44.1,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,2,140.1,81.06,42.69,0.0,35.0,3.37,38.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007048,MBR00000277,Professional,2021-03-11,2021-03-11,2021-04-11,PLN8860,1450094833,1450094833,Outpatient Clinic,In-Network,E11.9,J18.9,,,,,,,0,,90837,Medicine,,,,11,Office,3,352.69,223.98,177.68,0.0,15.0,31.3,46.3,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007049,MBR00000277,Institutional-IP,2021-05-14,2021-05-16,2021-06-01,PLN8958,1569105090,1569105090,Geriatrics,In-Network,M81.0,J06.9,,,,603,MS-DRG,24,2,Y,71046,Radiology,,,0270,21,Inpatient Hospital,1,289.98,116.89,0.0,116.89,15.0,0.0,131.89,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007050,MBR00000277,Institutional-IP,2022-11-12,2022-11-16,2022-12-22,PLN9835,1475984649,1475984649,SNF,In-Network,Z00.00,E66.9,,,,683,MS-DRG,4,4,Y,43239,Surgery,,,0740,21,Inpatient Hospital,3,884.87,518.42,503.42,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007051,MBR00000277,Institutional-OP,2022-09-25,2022-09-25,2022-11-02,PLN4245,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,Z23,F41.9,,,,,,,0,,71046,Radiology,,,0730,22,Outpatient Hospital,3,148.88,125.37,97.19,28.18,0.0,0.0,28.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007052,MBR00000277,Institutional-OP,2023-02-05,2023-02-05,2023-03-11,PLN5122,1778483301,1778483301,Home Health,In-Network,J06.9,G20,,,,,,,0,,74177,Radiology,,,0301,22,Outpatient Hospital,1,2127.89,1797.92,1797.92,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000007053,MBR00000278,Professional,2023-07-21,2023-07-21,2023-08-23,PLN5996,1389336600,1389336600,Critical Access Hospital,In-Network,E11.9,E11.9,,,,,,,0,,86900,Pathology/Lab,,,,20,Urgent Care,3,45.31,19.44,0.0,0.0,0.0,2.72,2.72,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007054,MBR00000278,Institutional-IP,2023-10-16,2023-10-17,2023-11-29,PLN8882,1434029575,1434029575,Endocrinology,In-Network,Z23,Z96.641,,,,470,MS-DRG,9,1,U,99203,E&M,,,0270,21,Inpatient Hospital,1,185.11,72.25,22.25,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007055,MBR00000278,Institutional-OP,2022-07-09,2022-07-09,2022-07-25,PLN5832,1273488618,1273488618,General Acute Care Hospital,In-Network,I10,N39.0,,,,,,,0,,99214,E&M,,,0761,22,Outpatient Hospital,2,437.23,316.5,0.0,0.0,25.0,36.58,61.58,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007056,MBR00000278,Professional,2022-07-03,2022-07-03,2022-07-29,PLN3978,1500037969,1500037969,Pulmonology,In-Network,I10,E78.5,,,,,,,0,,93306,Radiology,,,,50,Federally Qualified Health Center,2,1417.16,948.73,913.73,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007057,MBR00000278,Professional,2023-10-09,2023-10-09,2023-10-25,PLN6635,1361302520,1361302520,Critical Access Hospital,In-Network,J20.9,E11.9,,,,,,,0,,99232,E&M,,,,49,Independent Clinic,3,182.26,71.33,71.33,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007058,MBR00000278,Institutional-IP,2023-11-19,2023-11-21,2023-11-29,PLN9557,1486164553,1486164553,DME Supplier,In-Network,J20.9,Z12.31,,,,683,MS-DRG,16,2,Y,97110,Medicine,,,0761,21,Inpatient Hospital,3,250.65,202.05,177.05,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000007059,MBR00000278,Professional,2021-02-22,2021-02-22,2021-03-21,PLN8116,1806688928,1806688928,Geriatrics,In-Network,R51,Z23,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,1,229.32,179.69,179.69,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007060,MBR00000278,Institutional-OP,2022-07-08,2022-07-08,2022-08-09,PLN6246,1550154147,1550154147,Outpatient Clinic,In-Network,N39.0,E78.5,,,,,,,0,,71046,Radiology,,,0900,22,Outpatient Hospital,2,201.63,118.19,103.19,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007061,MBR00000278,Professional,2023-10-04,2023-10-04,2023-11-11,PLN1779,1148984206,1148984206,Psychiatry,In-Network,E78.5,I25.10,,,,,,,0,,82043,Pathology/Lab,,,,50,Federally Qualified Health Center,3,76.84,56.55,56.55,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007062,MBR00000278,Professional,2021-02-25,2021-02-25,2021-04-06,PLN3672,1590915516,1590915516,Physical Therapy,Out-of-Network,Z12.31,E11.65,,,,,,,0,,99233,E&M,,,,23,Emergency Room,1,365.89,157.86,157.86,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007063,MBR00000278,Institutional-OP,2023-12-07,2023-12-07,2024-01-04,PLN5900,1109850785,1109850785,ASC,Out-of-Network,I50.9,Z00.00,,,,,,,0,,70553,Radiology,,,0900,22,Outpatient Hospital,3,1928.36,1204.84,1179.84,0.0,25.0,0.0,25.0,0.0,Adjusted,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007064,MBR00000278,Professional,2023-04-01,2023-04-01,2023-04-29,PLN8596,1236418230,1236418230,DME Supplier,In-Network,E78.5,Z00.01,,,,,,,0,,G0444,Medicine,,,,50,Federally Qualified Health Center,1,99.74,55.36,0.0,55.36,0.0,0.0,55.36,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000007065,MBR00000278,Professional,2021-06-20,2021-06-20,2021-08-01,PLN5281,1132188260,1132188260,Family Medicine,In-Network,N40.0,E11.9,,,,,,,0,,97530,Medicine,,,,11,Office,3,226.94,171.71,171.71,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007066,MBR00000278,Professional,2022-12-03,2022-12-03,2022-12-21,PLN8973,1450553056,1450553056,Clinical Laboratory,In-Network,I10,M17.11,,,,,,,0,,99232,E&M,,,,21,Inpatient Hospital,3,202.6,161.2,125.33,35.87,0.0,0.0,35.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007067,MBR00000278,Institutional-OP,2022-04-17,2022-04-17,2022-05-18,PLN6401,1974006077,1974006077,Orthopedic Surgery,In-Network,N18.3,F10.20,,,,,,,0,,99284,E&M,,,0740,22,Outpatient Hospital,1,369.98,267.47,252.47,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007068,MBR00000278,Institutional-OP,2022-01-02,2022-01-02,2022-02-06,PLN7889,1450094833,1450094833,Outpatient Clinic,In-Network,E11.65,E78.5,,,,,,,0,,66984,Surgery,,,0900,22,Outpatient Hospital,3,2302.88,1037.07,861.5,0.0,0.0,175.57,175.57,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007069,MBR00000278,Professional,2022-11-11,2022-11-11,2022-12-07,PLN4051,1453283987,1453283987,Critical Access Hospital,In-Network,M54.5,E78.5,,,,,,,0,,99284,E&M,,,,11,Office,2,884.61,275.31,0.0,275.31,35.0,0.0,310.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007070,MBR00000278,Institutional-OP,2023-03-17,2023-03-17,2023-04-24,PLN6177,1717546253,1717546253,Family Medicine,In-Network,F41.9,Z00.00,,,,,,,0,,99284,E&M,,,0761,22,Outpatient Hospital,2,624.23,514.48,39.59,439.89,35.0,0.0,474.89,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007071,MBR00000278,Institutional-OP,2023-09-06,2023-09-06,2023-10-05,PLN9634,1135158374,1135158374,Pulmonology,In-Network,Z12.31,E78.5,,,,,,,0,,58661,Surgery,,,0320,22,Outpatient Hospital,2,3187.72,1765.44,1658.46,106.98,0.0,0.0,106.98,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007072,MBR00000278,Professional,2022-04-03,2022-04-03,2022-04-28,PLN4796,1575695214,1575695214,SNF,In-Network,E11.9,R10.9,,,,,,,0,,99283,E&M,,,,50,Federally Qualified Health Center,3,412.11,160.98,0.0,160.98,25.0,0.0,185.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007073,MBR00000278,Professional,2021-06-24,2021-06-24,2021-07-08,PLN4888,1268679390,1268679390,Critical Access Hospital,In-Network,I10,M54.5,,,,,,,0,,99284,E&M,,,,11,Office,3,482.34,352.66,301.15,51.51,0.0,0.0,51.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007074,MBR00000278,Institutional-OP,2023-08-04,2023-08-04,2023-09-06,PLN9205,1108115157,1108115157,General Acute Care Hospital,In-Network,M54.5,Z96.641,,,,,,,0,,G0468,Medicine,,,0636,22,Outpatient Hospital,1,476.15,356.58,281.58,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007075,MBR00000278,Professional,2022-01-01,2022-01-01,2022-01-17,PLN1320,1809014947,1809014947,Urology,In-Network,Z12.31,G43.909,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,1,116.3,63.33,0.0,63.33,0.0,0.0,63.33,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007076,MBR00000278,Professional,2023-04-12,2023-04-12,2023-05-17,PLN9690,1795618275,1795618275,Pulmonology,In-Network,E66.9,N17.9,,,,,,,0,,45380,Surgery,,,,11,Office,1,2843.7,2184.87,2134.87,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000007077,MBR00000278,Professional,2023-05-24,2023-05-24,2023-06-01,PLN9058,1540044947,1540044947,Pulmonology,Out-of-Network,I50.9,I10,,,,,,,0,,99213,E&M,,,,23,Emergency Room,1,170.67,122.41,116.24,0.0,0.0,6.17,6.17,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007078,MBR00000278,Institutional-IP,2021-03-06,2021-03-11,2021-03-24,PLN1901,1624202402,1624202402,Orthopedic Surgery,In-Network,F03.90,K21.0,,,,683,MS-DRG,5,5,Y,45380,Surgery,,,0450,21,Inpatient Hospital,1,1738.24,918.85,455.38,463.47,0.0,0.0,463.47,0.0,Paid,,,0,,0,0,1,0,0,1,Duplicate,0,1,0,0,0
CLM0000007079,MBR00000278,Professional,2022-03-25,2022-03-25,2022-04-21,PLN9507,1860435061,1860435061,DME Supplier,In-Network,B97.89,Z12.31,,,,,,,0,,76700,Radiology,,,,11,Office,3,1122.03,396.58,227.63,168.95,0.0,0.0,168.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007080,MBR00000278,Professional,2021-04-03,2021-04-03,2021-04-11,PLN7867,1806688928,1806688928,Geriatrics,In-Network,J20.9,F41.9,,,,,,,0,,99283,E&M,,,,11,Office,1,416.66,210.21,185.21,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007081,MBR00000278,Professional,2022-10-25,2022-10-25,2022-11-07,PLN5465,1109850785,1109850785,ASC,Out-of-Network,J18.9,E11.65,,,,,,,0,,93306,Radiology,,,,11,Office,1,2994.26,2461.83,0.0,0.0,0.0,342.4,342.4,0.0,Denied,CO-15,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007082,MBR00000278,Institutional-OP,2023-05-21,2023-05-21,2023-07-03,PLN8514,1745114564,1745114564,Endocrinology,In-Network,F41.9,I10,,,,,,,0,,27130,Surgery,,,0120,22,Outpatient Hospital,1,2646.24,1606.31,1606.31,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007083,MBR00000279,Professional,2022-09-06,2022-09-06,2022-09-23,PLN9154,1242201429,1242201429,General Acute Care Hospital,In-Network,Z79.4,Z12.11,,,,,,,0,,74177,Radiology,,,,11,Office,1,1526.94,842.59,842.59,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007084,MBR00000279,Professional,2021-12-21,2021-12-21,2022-01-16,PLN3433,1186826716,1186826716,Physical Therapy,In-Network,N39.0,F41.9,,,,,,,0,,27447,Surgery,,,,11,Office,3,3938.77,1616.09,1204.81,396.28,15.0,0.0,411.28,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007085,MBR00000279,Professional,2023-12-02,2023-12-02,2023-12-21,PLN1850,1997536841,1997536841,Family Medicine,Out-of-Network,I50.9,E78.5,,,,,,,0,,66984,Surgery,,,,31,Skilled Nursing Facility,3,2407.62,1148.03,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-97,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007086,MBR00000279,Professional,2021-04-04,2021-04-04,2021-04-27,PLN3628,1132188260,1132188260,Family Medicine,In-Network,Z23,N17.9,,,,,,,0,,99203,E&M,,,,12,Home,3,400.0,212.99,212.99,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007087,MBR00000279,Institutional-OP,2021-06-04,2021-06-04,2021-07-04,PLN6327,1266606767,1266606767,ASC,In-Network,G43.909,G20,,,,,,,0,,99203,E&M,,,0900,22,Outpatient Hospital,2,215.9,159.15,0.0,159.15,15.0,0.0,174.15,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007088,MBR00000279,Professional,2022-02-05,2022-02-05,2022-02-23,PLN7247,1124394415,1124394415,Pediatrics,In-Network,J20.9,R07.9,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,2,2372.51,748.69,0.0,401.33,15.0,0.0,416.33,0.0,Denied,CO-97,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000007089,MBR00000279,Institutional-IP,2023-11-05,2023-11-11,2023-11-21,PLN4364,1244186984,1244186984,Family Medicine,Out-of-Network,E11.9,M17.11,,,,291,MS-DRG,23,6,Y,58661,Surgery,,,0636,21,Inpatient Hospital,2,2184.89,1720.16,1152.32,492.84,75.0,0.0,567.84,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007090,MBR00000279,Professional,2023-09-07,2023-09-07,2023-09-27,PLN4785,1865904917,1865904917,Outpatient Clinic,In-Network,M17.11,K21.0,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,1,62.24,44.96,44.96,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007091,MBR00000279,Institutional-OP,2022-09-10,2022-09-10,2022-09-30,PLN2747,1696843572,1696843572,Critical Access Hospital,Out-of-Network,M54.5,E11.9,,,,,,,0,,99233,E&M,,,0450,22,Outpatient Hospital,1,495.51,188.45,138.45,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007092,MBR00000279,Institutional-OP,2023-11-09,2023-11-09,2023-11-30,PLN4161,1531398223,1531398223,OB/GYN,In-Network,J44.1,J18.9,,,,,,,0,,93306,Radiology,,,0450,22,Outpatient Hospital,3,1597.23,1004.44,931.24,0.0,0.0,73.2,73.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007093,MBR00000279,Professional,2023-09-18,2023-09-18,2023-10-23,PLN7155,1727809972,1727809972,Home Health,In-Network,K21.0,N18.3,,,,,,,0,,66984,Surgery,,,,21,Inpatient Hospital,2,1533.25,1294.7,1294.7,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007094,MBR00000279,Institutional-OP,2022-10-05,2022-10-05,2022-11-04,PLN2034,1518055405,1518055405,Urology,In-Network,M17.11,J06.9,,,,,,,0,,99233,E&M,,,0120,22,Outpatient Hospital,2,407.28,340.48,340.48,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007095,MBR00000279,Institutional-OP,2021-05-10,2021-05-10,2021-06-07,PLN3890,1531398223,1531398223,OB/GYN,In-Network,M17.11,I11.9,,,,,,,0,,99222,E&M,,,0740,22,Outpatient Hospital,1,524.06,368.09,287.71,0.0,15.0,65.38,80.38,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000007096,MBR00000279,Institutional-OP,2023-09-13,2023-09-13,2023-10-04,PLN5843,1700633438,1700633438,DME Supplier,In-Network,E78.5,F41.9,,,,,,,0,,27447,Surgery,,,0730,22,Outpatient Hospital,2,5941.27,4969.49,4969.49,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007097,MBR00000279,Institutional-OP,2022-12-04,2022-12-04,2022-12-14,PLN1041,1767011137,1767011137,DME Supplier,In-Network,J44.1,E11.65,,,,,,,0,,70450,Radiology,,,0450,22,Outpatient Hospital,3,1360.26,769.72,694.72,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007098,MBR00000279,Institutional-OP,2021-06-04,2021-06-04,2021-07-02,PLN9842,1840431511,1840431511,Geriatrics,Out-of-Network,R05,K21.0,,,,,,,0,,93225,Medicine,,,0510,22,Outpatient Hospital,2,594.69,385.2,204.47,130.73,50.0,0.0,180.73,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007099,MBR00000279,Professional,2023-07-09,2023-07-09,2023-08-04,PLN8985,1186826716,1186826716,Physical Therapy,In-Network,Z12.31,Z00.00,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,3,610.0,348.42,0.0,292.44,75.0,0.0,367.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007100,MBR00000279,Professional,2022-03-13,2022-03-13,2022-03-26,PLN8963,1450094833,1450094833,Outpatient Clinic,In-Network,I48.91,E78.5,,,,,,,0,,85025,Pathology/Lab,,,,20,Urgent Care,1,63.53,48.77,33.77,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007101,MBR00000279,Institutional-OP,2023-05-12,2023-05-12,2023-06-09,PLN5554,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,I10,N18.3,,,,,,,0,,99232,E&M,,,0370,22,Outpatient Hospital,2,183.96,86.87,36.87,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007102,MBR00000279,Institutional-OP,2021-10-14,2021-10-14,2021-11-08,PLN9666,1520687146,1520687146,ASC,In-Network,F41.9,J45.20,,,,,,,0,,70450,Radiology,,,0120,22,Outpatient Hospital,3,1773.56,674.29,247.83,396.56,25.0,4.9,426.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007103,MBR00000279,Professional,2021-01-11,2021-01-11,2021-01-25,PLN2020,1438368327,1438368327,Home Health,In-Network,I10,I10,,,,,,,0,,99283,E&M,,,,23,Emergency Room,2,418.0,243.86,193.86,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007104,MBR00000279,Institutional-IP,2022-05-12,2022-05-16,2022-06-05,PLN5260,1520687146,1520687146,ASC,In-Network,I48.91,M17.11,,,,195,MS-DRG,16,4,Y,70450,Radiology,,,0730,21,Inpatient Hospital,2,1044.45,522.21,522.21,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007105,MBR00000279,Professional,2022-05-11,2022-05-11,2022-06-08,PLN2673,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,Z00.00,E78.5,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,2,598.08,449.75,0.0,449.75,0.0,0.0,449.75,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007106,MBR00000279,Professional,2023-08-04,2023-08-04,2023-08-14,PLN2550,1438368327,1438368327,Home Health,In-Network,G43.909,F41.9,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,1,2218.2,1290.2,1230.74,24.46,35.0,0.0,59.46,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007107,MBR00000279,Professional,2021-05-07,2021-05-07,2021-05-23,PLN2436,1980712759,1980712759,Outpatient Clinic,Out-of-Network,E78.5,I10,,,,,,,0,,74177,Radiology,,,,49,Independent Clinic,2,1533.02,530.32,530.32,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000007108,MBR00000279,Professional,2023-09-27,2023-09-27,2023-11-01,PLN7627,1193493783,1193493783,Critical Access Hospital,Out-of-Network,E11.9,N39.0,,,,,,,0,,27130,Surgery,,,,81,Independent Laboratory,3,3719.37,2575.3,2025.74,117.15,25.0,407.41,549.56,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007109,MBR00000279,Institutional-OP,2021-06-17,2021-06-17,2021-07-17,PLN2399,1691062876,1691062876,SNF,In-Network,Z12.11,Z00.00,,,,,,,0,,99221,E&M,,,0900,22,Outpatient Hospital,3,339.31,131.27,98.02,0.0,15.0,18.25,33.25,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007110,MBR00000279,Professional,2023-10-21,2023-10-21,2023-11-17,PLN3171,1564502315,1564502315,ASC,In-Network,Z23,E78.5,,,,,,,0,,71046,Radiology,,,,11,Office,2,244.55,128.83,111.15,0.0,0.0,17.68,17.68,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007111,MBR00000279,Institutional-IP,2023-02-13,2023-02-15,2023-03-09,PLN4234,1390307371,1390307371,DME Supplier,In-Network,E11.9,E78.5,,,,470,MS-DRG,8,2,Y,70553,Radiology,,,0360,21,Inpatient Hospital,3,4091.92,1829.25,1794.25,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007112,MBR00000279,Institutional-IP,2022-01-30,2022-02-06,2022-03-09,PLN8782,1434029575,1434029575,Endocrinology,In-Network,E78.5,I10,,,,872,MS-DRG,21,7,Y,80053,Pathology/Lab,,,0900,21,Inpatient Hospital,1,151.55,82.34,0.0,82.34,0.0,0.0,82.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007113,MBR00000279,Institutional-OP,2023-11-14,2023-11-14,2023-11-24,PLN5068,1124394415,1124394415,Pediatrics,In-Network,Z23,J45.20,,,,,,,0,,97110,Medicine,,,0301,22,Outpatient Hospital,1,104.51,85.66,10.66,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007114,MBR00000279,Professional,2022-01-29,2022-01-29,2022-03-05,PLN1352,1631954542,1631954542,Oncology,In-Network,E11.65,Z87.891,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,1,356.82,205.47,0.0,0.0,0.0,6.16,6.16,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007115,MBR00000279,Professional,2022-11-26,2022-11-26,2023-01-09,PLN6591,1366576336,1366576336,Geriatrics,In-Network,Z00.00,Z00.01,,,,,,,0,,70553,Radiology,,,,11,Office,3,1956.34,883.23,868.23,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007116,MBR00000279,Institutional-IP,2021-01-18,2021-01-22,2021-02-19,PLN8121,1780163051,1780163051,SNF,In-Network,G43.909,J18.9,,,,682,MS-DRG,1,4,Y,33533,Surgery,,,0200,21,Inpatient Hospital,1,16563.91,10611.36,10542.8,0.0,0.0,68.56,68.56,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000007117,MBR00000279,Institutional-OP,2021-04-23,2021-04-23,2021-05-18,PLN4936,1148984206,1148984206,Psychiatry,In-Network,E78.5,F41.9,,,,,,,0,,99232,E&M,,,0120,22,Outpatient Hospital,1,203.14,141.05,141.05,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007118,MBR00000279,Professional,2022-01-22,2022-01-22,2022-01-31,PLN5388,1390307371,1390307371,DME Supplier,In-Network,Z79.4,N18.3,,,,,,,0,,87491,Pathology/Lab,,,,49,Independent Clinic,1,212.43,178.83,178.83,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007119,MBR00000279,Professional,2021-09-25,2021-09-25,2021-10-02,PLN1623,1994661817,1994661817,SNF,Out-of-Network,J06.9,I10,,,,,,,0,,66984,Surgery,,,,11,Office,2,3242.23,1257.0,1011.31,0.0,15.0,230.69,245.69,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007120,MBR00000280,Institutional-OP,2021-09-07,2021-09-07,2021-10-03,PLN5805,1295371663,1295371663,Critical Access Hospital,In-Network,Z00.00,I10,,,,,,,0,,G0444,Medicine,,,0200,22,Outpatient Hospital,1,83.22,41.55,0.0,41.55,0.0,0.0,41.55,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000007121,MBR00000280,Professional,2022-02-19,2022-02-19,2022-03-20,PLN3624,1702692193,1702692193,Physical Therapy,In-Network,C50.912,F41.9,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,1,511.45,333.11,0.0,128.36,0.0,0.0,128.36,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007122,MBR00000280,Professional,2022-10-29,2022-10-29,2022-11-18,PLN5792,1135158374,1135158374,Pulmonology,In-Network,I10,E11.9,,,,,,,0,,99221,E&M,,,,31,Skilled Nursing Facility,2,391.14,283.06,27.68,255.38,0.0,0.0,255.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007123,MBR00000280,Institutional-OP,2021-05-18,2021-05-18,2021-05-29,PLN8056,1103747954,1103747954,Urology,In-Network,F41.9,C50.912,,,,,,,0,,43239,Surgery,,,0510,22,Outpatient Hospital,2,1481.38,1016.75,1016.75,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007124,MBR00000280,Institutional-OP,2023-04-04,2023-04-04,2023-05-07,PLN6058,1795618275,1795618275,Pulmonology,In-Network,E66.9,Z23,,,,,,,0,,81001,Pathology/Lab,,,0120,22,Outpatient Hospital,1,27.62,17.26,17.26,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007125,MBR00000280,Professional,2023-07-18,2023-07-18,2023-08-27,PLN9781,1198133277,1198133277,SNF,In-Network,R51,Z12.31,,,,,,,0,,27447,Surgery,,,,12,Home,2,3920.61,2005.82,1928.45,56.63,0.0,20.74,77.37,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007126,MBR00000280,Institutional-OP,2023-07-05,2023-07-05,2023-08-11,PLN7527,1334916761,1334916761,ASC,In-Network,E11.9,I25.10,,,,,,,0,,47562,Surgery,,,0301,22,Outpatient Hospital,1,3680.19,2980.11,0.0,0.0,75.0,222.48,297.48,0.0,Denied,CO-11,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007127,MBR00000280,Professional,2021-08-01,2021-08-01,2021-09-14,PLN7149,1860435061,1860435061,DME Supplier,In-Network,E66.9,J20.9,,,,,,,0,,93000,Radiology,,,,11,Office,1,75.49,56.07,5.03,0.0,50.0,1.04,51.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007128,MBR00000280,Institutional-OP,2023-08-23,2023-08-23,2023-09-25,PLN4312,1366576336,1366576336,Geriatrics,In-Network,I48.91,E11.9,,,,,,,0,,33533,Surgery,,,0200,22,Outpatient Hospital,2,24580.85,15270.63,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-15,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000007129,MBR00000280,Institutional-IP,2021-05-22,2021-05-27,2021-05-29,PLN3739,1702692193,1702692193,Physical Therapy,In-Network,R51,I10,,,,292,MS-DRG,18,5,Y,93000,Radiology,,,0636,21,Inpatient Hospital,2,137.09,42.61,41.64,0.0,0.0,0.97,0.97,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000007130,MBR00000280,Professional,2021-04-28,2021-04-28,2021-05-27,PLN3847,1910255109,1910255109,DME Supplier,In-Network,E66.9,J44.1,,,,,,,0,,80053,Pathology/Lab,,,,22,Outpatient Hospital,2,114.96,91.84,91.84,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007131,MBR00000280,Institutional-OP,2023-03-06,2023-03-06,2023-03-17,PLN8890,1355166277,1355166277,Endocrinology,In-Network,Z12.31,I50.9,,,,,,,0,,97110,Medicine,,,0200,22,Outpatient Hospital,3,185.61,59.24,44.24,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007132,MBR00000280,Institutional-OP,2023-04-13,2023-04-13,2023-04-21,PLN6836,1486164553,1486164553,DME Supplier,In-Network,B97.89,I10,,,,,,,0,,99203,E&M,,,0301,22,Outpatient Hospital,3,304.35,236.64,120.23,86.58,15.0,14.83,116.41,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000007133,MBR00000280,Professional,2021-05-19,2021-05-19,2021-06-07,PLN1428,1795618275,1795618275,Pulmonology,In-Network,Z00.00,J18.9,,,,,,,0,,93000,Radiology,,,,21,Inpatient Hospital,3,144.42,97.78,90.82,0.0,0.0,6.96,6.96,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007134,MBR00000280,Institutional-OP,2022-04-01,2022-04-01,2022-04-13,PLN6974,1148984206,1148984206,Psychiatry,In-Network,J06.9,K21.0,,,,,,,0,,72148,Radiology,,,0740,22,Outpatient Hospital,1,1567.93,525.78,253.72,247.06,25.0,0.0,272.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007135,MBR00000280,Institutional-OP,2022-03-26,2022-03-26,2022-05-02,PLN5371,1500037969,1500037969,Pulmonology,In-Network,M54.5,I48.91,,,,,,,0,,99221,E&M,,,0510,22,Outpatient Hospital,3,194.69,71.9,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007136,MBR00000280,Professional,2023-03-03,2023-03-03,2023-04-12,PLN5307,1224179551,1224179551,Physical Therapy,In-Network,F41.9,Z12.31,,,,,,,0,,90837,Medicine,,,,23,Emergency Room,3,334.77,282.34,257.34,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007137,MBR00000280,Professional,2022-07-19,2022-07-19,2022-08-31,PLN1569,1800011727,1800011727,Clinical Laboratory,Out-of-Network,E11.9,Z12.11,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,1,62.36,35.71,35.71,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000007138,MBR00000280,Professional,2022-10-20,2022-10-20,2022-11-17,PLN2687,1749494482,1749494482,Pediatrics,In-Network,I10,K21.0,,,,,,,0,,99213,E&M,,,,11,Office,3,247.09,133.76,0.0,133.76,25.0,0.0,158.76,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007139,MBR00000280,Institutional-OP,2021-03-29,2021-03-29,2021-05-01,PLN1529,1980712759,1980712759,Outpatient Clinic,Out-of-Network,E66.9,E11.9,,,,,,,0,,90837,Medicine,,,0730,22,Outpatient Hospital,2,411.15,170.98,29.64,116.34,25.0,0.0,141.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007140,MBR00000280,Professional,2023-12-06,2023-12-06,2024-01-08,PLN9652,1213165847,1213165847,Critical Access Hospital,In-Network,J44.1,E87.6,,,,,,,0,,99283,E&M,,,,21,Inpatient Hospital,2,441.13,176.64,0.0,176.64,0.0,0.0,176.64,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007141,MBR00000280,Professional,2022-09-01,2022-09-01,2022-09-08,PLN8510,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,F41.9,I25.10,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,1,274.52,83.83,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007142,MBR00000280,Institutional-IP,2023-01-03,2023-01-05,2023-02-11,PLN7812,1778483301,1778483301,Home Health,In-Network,I48.91,I10,,,,641,MS-DRG,18,2,Y,99283,E&M,,,0510,21,Inpatient Hospital,2,278.11,127.22,102.22,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007143,MBR00000280,Professional,2022-06-10,2022-06-10,2022-07-05,PLN8432,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,R07.9,S72.001A,,,,,,,0,,99204,E&M,,,,11,Office,1,537.58,360.31,80.92,229.39,50.0,0.0,279.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007144,MBR00000280,Professional,2021-09-27,2021-09-27,2021-10-25,PLN6195,1800011727,1800011727,Clinical Laboratory,Out-of-Network,E11.9,E11.65,,,,,,,0,,99222,E&M,,,,11,Office,3,278.47,184.51,134.51,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007145,MBR00000280,Professional,2023-01-02,2023-01-02,2023-01-23,PLN7048,1438368327,1438368327,Home Health,In-Network,J06.9,Z23,,,,,,,0,,90686,Medicine,,,,11,Office,3,77.45,54.04,23.27,0.0,25.0,5.77,30.77,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000007146,MBR00000280,Professional,2021-11-12,2021-11-12,2021-11-29,PLN4896,1337791138,1337791138,Internal Medicine,Out-of-Network,R10.9,N39.0,,,,,,,0,,97110,Medicine,,,,22,Outpatient Hospital,2,119.69,82.14,0.0,82.14,0.0,0.0,82.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007147,MBR00000280,Institutional-OP,2021-08-28,2021-08-28,2021-10-03,PLN5595,1571574052,1571574052,Critical Access Hospital,In-Network,N39.0,E78.5,,,,,,,0,,72148,Radiology,,,0270,22,Outpatient Hospital,2,2172.66,1208.03,1019.76,0.0,50.0,138.27,188.27,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007148,MBR00000280,Professional,2022-08-28,2022-08-28,2022-09-29,PLN2971,1514306773,1514306773,Endocrinology,In-Network,Z23,Z00.00,,,,,,,0,,58661,Surgery,,,,11,Office,2,4848.97,3961.84,3182.19,434.06,25.0,320.59,779.65,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007149,MBR00000280,Professional,2022-01-26,2022-01-26,2022-02-13,PLN5867,1561134315,1561134315,DME Supplier,In-Network,I10,F41.9,,,,,,,0,,87491,Pathology/Lab,,,,22,Outpatient Hospital,2,130.4,42.85,34.6,0.0,0.0,8.25,8.25,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000007150,MBR00000280,Professional,2023-09-07,2023-09-07,2023-10-12,PLN5494,1108115157,1108115157,General Acute Care Hospital,In-Network,N20.0,E11.9,,,,,,,0,,27447,Surgery,,,,11,Office,1,4330.61,2615.24,2615.24,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007151,MBR00000280,Institutional-OP,2022-12-24,2022-12-24,2023-02-04,PLN6150,1528335731,1528335731,Critical Access Hospital,In-Network,N39.0,I10,,,,,,,0,,90837,Medicine,,,0270,22,Outpatient Hospital,2,499.68,383.27,383.27,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007152,MBR00000280,Professional,2022-02-13,2022-02-13,2022-03-02,PLN6181,1266606767,1266606767,ASC,In-Network,G20,Z12.31,,,,,,,0,,99232,E&M,,,,11,Office,3,300.27,149.09,0.0,149.09,0.0,0.0,149.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007153,MBR00000280,Professional,2021-02-08,2021-02-08,2021-03-11,PLN5969,1148984206,1148984206,Psychiatry,In-Network,J44.1,E11.9,,,,,,,0,,99222,E&M,,,,11,Office,2,266.94,155.07,0.0,155.07,0.0,0.0,155.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007154,MBR00000280,Institutional-OP,2022-01-09,2022-01-09,2022-02-11,PLN1316,1502838586,1502838586,ASC,In-Network,E78.5,N40.0,,,,,,,0,,43239,Surgery,,,0200,22,Outpatient Hospital,3,2148.41,1474.95,1459.95,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007155,MBR00000280,Professional,2021-05-07,2021-05-07,2021-06-05,PLN2320,1749327647,1749327647,Geriatrics,In-Network,Z51.11,J06.9,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,1,36.65,27.74,0.0,27.74,0.0,0.0,27.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007156,MBR00000280,Institutional-IP,2021-08-29,2021-09-04,2021-10-05,PLN9935,1236418230,1236418230,DME Supplier,In-Network,J06.9,I10,,,,690,MS-DRG,7,6,Y,70450,Radiology,,,0360,21,Inpatient Hospital,2,1772.18,757.33,722.33,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007157,MBR00000280,Professional,2021-11-07,2021-11-07,2021-12-11,PLN2381,1434029575,1434029575,Endocrinology,In-Network,C50.912,I10,,,,,,,0,,66984,Surgery,,,,11,Office,2,1613.15,756.92,756.92,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007158,MBR00000280,Institutional-OP,2022-12-16,2022-12-16,2023-01-13,PLN5153,1644128543,1644128543,Gastroenterology,In-Network,E78.5,K21.0,,,,,,,0,,99213,E&M,,,0360,22,Outpatient Hospital,2,312.59,95.83,0.0,95.83,35.0,0.0,130.83,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007159,MBR00000280,Institutional-IP,2021-04-27,2021-05-02,2021-06-02,PLN1671,1624802371,1624802371,ASC,Out-of-Network,Z96.641,E78.5,,,,195,MS-DRG,10,5,Y,93000,Radiology,,,0761,21,Inpatient Hospital,1,184.68,134.99,96.86,0.0,15.0,23.13,38.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007160,MBR00000280,Institutional-OP,2021-06-27,2021-06-27,2021-07-13,PLN7420,1433937353,1433937353,Nephrology,In-Network,F32.9,N18.3,,,,,,,0,,93000,Radiology,,,0730,22,Outpatient Hospital,1,157.28,68.08,0.0,68.08,0.0,0.0,68.08,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007161,MBR00000280,Institutional-OP,2021-02-13,2021-02-13,2021-03-13,PLN6481,1752470395,1752470395,Home Health,In-Network,J06.9,Z00.00,,,,,,,0,,99222,E&M,,,0270,22,Outpatient Hospital,1,538.48,257.43,254.36,0.0,0.0,3.07,3.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007162,MBR00000280,Institutional-OP,2023-10-02,2023-10-02,2023-11-13,PLN6299,1372918899,1372918899,Family Medicine,In-Network,E11.65,E11.65,,,,,,,0,,86900,Pathology/Lab,,,0761,22,Outpatient Hospital,3,60.04,19.41,16.45,0.0,0.0,2.96,2.96,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007163,MBR00000280,Professional,2023-12-18,2023-12-18,2024-01-19,PLN7753,1800011727,1800011727,Clinical Laboratory,Out-of-Network,G20,Z12.11,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,3,81.17,44.88,43.43,0.0,0.0,1.45,1.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007164,MBR00000280,Institutional-OP,2021-11-23,2021-11-23,2021-12-11,PLN4180,1569105090,1569105090,Geriatrics,In-Network,S72.001A,Z79.4,,,,,,,0,,45378,Surgery,,,0360,22,Outpatient Hospital,3,2379.34,1888.81,1675.27,0.0,50.0,163.54,213.54,0.0,Paid,,,0,,0,1,1,0,0,1,Upcoding,0,1,0,0,0
CLM0000007165,MBR00000280,Institutional-IP,2022-05-15,2022-05-23,2022-05-22,PLN1159,1767011137,1767011137,DME Supplier,In-Network,F41.9,E11.65,,,,682,MS-DRG,9,8,Y,99221,E&M,,,0761,21,Inpatient Hospital,2,354.6,141.48,0.0,20.12,15.0,6.89,42.01,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007166,MBR00000280,Professional,2021-11-26,2021-11-26,2021-12-14,PLN5504,1434029575,1434029575,Endocrinology,In-Network,E78.5,E11.9,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,1,4125.02,3098.85,2617.35,269.2,0.0,212.3,481.5,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007167,MBR00000280,Professional,2022-08-08,2022-08-08,2022-08-20,PLN8558,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,I10,E78.5,,,,,,,0,,70553,Radiology,,,,23,Emergency Room,1,1683.42,811.14,696.07,115.07,0.0,0.0,115.07,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007168,MBR00000280,Professional,2022-08-27,2022-08-27,2022-09-07,PLN5896,1244186984,1244186984,Family Medicine,Out-of-Network,Z00.00,I10,,,,,,,0,,99406,Medicine,,,,22,Outpatient Hospital,2,88.23,31.33,25.71,0.0,0.0,5.62,5.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007169,MBR00000281,Institutional-OP,2021-10-07,2021-10-07,2021-10-30,PLN9306,1511044648,1511044648,Endocrinology,In-Network,R10.9,C50.912,,,,,,,0,,99284,E&M,,,0270,22,Outpatient Hospital,2,610.99,491.7,434.43,0.0,0.0,57.27,57.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007170,MBR00000281,Institutional-OP,2022-12-08,2022-12-08,2022-12-21,PLN2349,1236418230,1236418230,DME Supplier,In-Network,E11.65,J18.9,,,,,,,0,,86900,Pathology/Lab,,,0200,22,Outpatient Hospital,3,54.94,42.09,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007171,MBR00000281,Institutional-OP,2021-01-09,2021-01-09,2021-02-17,PLN6907,1644128543,1644128543,Gastroenterology,In-Network,J20.9,I10,,,,,,,0,,23472,Surgery,,,0270,22,Outpatient Hospital,1,4890.47,2741.66,0.0,481.04,0.0,0.0,481.04,0.0,Denied,CO-15,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007172,MBR00000281,Institutional-OP,2022-12-07,2022-12-07,2023-01-08,PLN7723,1644128543,1644128543,Gastroenterology,In-Network,I25.10,J18.9,,,,,,,0,,99214,E&M,,,0270,22,Outpatient Hospital,3,193.78,139.9,80.09,59.81,0.0,0.0,59.81,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007173,MBR00000281,Institutional-IP,2023-04-03,2023-04-11,2023-04-20,PLN1575,1700633438,1700633438,DME Supplier,In-Network,Z00.00,J20.9,,,,641,MS-DRG,14,8,Y,82043,Pathology/Lab,,,0740,21,Inpatient Hospital,1,54.76,23.07,0.0,23.07,35.0,0.0,58.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007174,MBR00000281,Institutional-OP,2021-02-27,2021-02-27,2021-03-07,PLN7219,1205377316,1205377316,Orthopedic Surgery,In-Network,E78.5,E11.40,,,,,,,0,,71046,Radiology,,,0730,22,Outpatient Hospital,3,251.78,114.79,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-15,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007175,MBR00000281,Professional,2023-03-04,2023-03-04,2023-04-16,PLN2593,1974006077,1974006077,Orthopedic Surgery,In-Network,R51,N20.0,,,,,,,0,,99232,E&M,,,,11,Office,3,259.11,189.34,189.34,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007176,MBR00000282,Professional,2023-03-19,2023-03-19,2023-04-01,PLN7971,1125190055,1125190055,Nephrology,In-Network,F41.9,Z12.31,,,,,,,0,,77067,Radiology,,,,23,Emergency Room,3,393.32,122.39,107.39,0.0,15.0,0.0,15.0,0.0,Adjusted,,,0,,1,1,0,0,0,0,None,1,0,0,0,0
CLM0000007177,MBR00000282,Institutional-IP,2023-12-01,2023-12-10,2023-12-14,PLN3934,1812060197,1812060197,Oncology,Out-of-Network,I25.10,E66.9,,,,470,MS-DRG,4,9,Y,72148,Radiology,,,0761,21,Inpatient Hospital,2,1224.45,380.29,368.85,0.0,0.0,11.44,11.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007178,MBR00000282,Institutional-OP,2023-06-02,2023-06-02,2023-06-10,PLN5305,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,M54.5,I10,,,,,,,0,,33533,Surgery,,,0730,22,Outpatient Hospital,1,15605.65,9626.62,7930.19,456.63,0.0,1239.8,1696.43,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000007179,MBR00000282,Institutional-OP,2021-01-24,2021-01-24,2021-02-01,PLN5645,1124394415,1124394415,Pediatrics,In-Network,I10,N39.0,,,,,,,0,,99203,E&M,,,0270,22,Outpatient Hospital,2,320.72,243.61,69.74,173.87,0.0,0.0,173.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007180,MBR00000282,Institutional-OP,2021-03-31,2021-03-31,2021-05-10,PLN4078,1891849440,1891849440,Oncology,In-Network,J06.9,F32.9,,,,,,,0,,G0444,Medicine,,,0740,22,Outpatient Hospital,2,69.92,29.41,11.59,0.0,15.0,2.82,17.82,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000007181,MBR00000282,Institutional-OP,2021-05-31,2021-05-31,2021-06-15,PLN5231,1500037969,1500037969,Pulmonology,In-Network,Z12.31,Z23,,,,,,,0,,G0439,Medicine,,,0740,22,Outpatient Hospital,2,442.06,151.44,147.5,0.0,0.0,3.94,3.94,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000007182,MBR00000282,Professional,2022-09-29,2022-09-29,2022-10-21,PLN2663,1364429278,1364429278,OB/GYN,In-Network,J20.9,E11.65,,,,,,,0,,G0468,Medicine,,,,65,End-Stage Renal Disease,2,462.66,168.45,97.26,0.0,50.0,21.19,71.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007183,MBR00000282,Professional,2023-02-19,2023-02-19,2023-03-25,PLN8237,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,E11.40,N39.0,,,,,,,0,,71046,Radiology,,,,50,Federally Qualified Health Center,1,274.05,158.49,137.66,0.0,15.0,5.83,20.83,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007184,MBR00000282,Professional,2022-12-22,2022-12-22,2023-01-10,PLN7133,1845057593,1845057593,Orthopedic Surgery,In-Network,M54.5,N18.3,,,,,,,0,,99284,E&M,,,,21,Inpatient Hospital,2,864.02,260.36,260.36,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007185,MBR00000282,Institutional-IP,2021-12-28,2021-12-31,2022-01-24,PLN7463,1778483301,1778483301,Home Health,In-Network,Z51.11,G43.909,,,,291,MS-DRG,23,3,Y,71046,Radiology,,,0510,21,Inpatient Hospital,1,229.4,185.74,120.68,65.06,0.0,0.0,65.06,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007186,MBR00000282,Professional,2021-08-08,2021-08-08,2021-09-05,PLN9311,1219817751,1219817751,OB/GYN,In-Network,Z00.00,E78.5,,,,,,,0,,85610,Pathology/Lab,,,,23,Emergency Room,1,74.28,31.82,0.0,31.82,0.0,0.0,31.82,0.0,Denied,CO-4,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007187,MBR00000282,Professional,2021-03-11,2021-03-11,2021-03-18,PLN4739,1994661817,1994661817,SNF,Out-of-Network,F32.9,Z00.00,,,,,,,0,,90837,Medicine,,,,11,Office,2,266.43,214.68,179.68,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007188,MBR00000282,Professional,2022-02-14,2022-02-14,2022-03-13,PLN4384,1752470395,1752470395,Home Health,In-Network,K21.0,E11.9,,,,,,,0,,93000,Radiology,,,,81,Independent Laboratory,3,153.53,77.24,55.62,0.0,15.0,6.62,21.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007189,MBR00000282,Institutional-OP,2021-11-26,2021-11-26,2021-12-21,PLN7240,1520687146,1520687146,ASC,In-Network,J06.9,I10,,,,,,,0,,23472,Surgery,,,0320,22,Outpatient Hospital,3,7355.62,3011.75,2379.25,114.86,50.0,467.64,632.5,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007190,MBR00000282,Professional,2021-11-29,2021-11-29,2021-12-24,PLN6950,1540044947,1540044947,Pulmonology,Out-of-Network,Z12.31,N40.0,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,2,7498.77,2893.02,2298.16,48.83,0.0,546.03,594.86,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007191,MBR00000282,Institutional-IP,2021-04-07,2021-04-09,2021-05-17,PLN6380,1645194539,1645194539,SNF,In-Network,E11.9,E11.9,,,,470,MS-DRG,12,2,Y,76700,Radiology,,,0900,21,Inpatient Hospital,2,585.68,479.05,479.05,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007192,MBR00000282,Professional,2021-11-15,2021-11-15,2021-12-29,PLN4193,1935547131,1935547131,Pulmonology,In-Network,Z12.31,M54.5,,,,,,,0,,87491,Pathology/Lab,,,,81,Independent Laboratory,2,190.73,129.98,0.0,50.45,15.0,0.0,65.45,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007193,MBR00000282,Institutional-IP,2023-07-07,2023-07-09,2023-08-18,PLN4239,1716521444,1716521444,Oncology,In-Network,K57.30,E78.5,,,,871,MS-DRG,7,2,N,97110,Medicine,,,0301,21,Inpatient Hospital,1,122.75,84.74,78.57,0.0,0.0,6.17,6.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007194,MBR00000283,Institutional-OP,2021-09-21,2021-09-21,2021-10-29,PLN9090,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,Z00.00,E66.9,,,,,,,0,,99204,E&M,,,0360,22,Outpatient Hospital,1,322.5,133.32,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007195,MBR00000283,Professional,2023-08-19,2023-08-19,2023-09-25,PLN9553,1242201429,1242201429,General Acute Care Hospital,In-Network,Z12.31,E66.9,,,,,,,0,,99221,E&M,,,,11,Office,2,347.8,225.06,150.06,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007196,MBR00000283,Institutional-OP,2021-04-05,2021-04-05,2021-04-22,PLN5390,1520687146,1520687146,ASC,In-Network,M81.0,E11.9,,,,,,,0,,84443,Pathology/Lab,,,0510,22,Outpatient Hospital,1,180.0,62.34,56.54,0.0,0.0,5.8,5.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007197,MBR00000283,Institutional-IP,2022-11-29,2022-12-06,2023-01-08,PLN6107,1994661817,1994661817,SNF,Out-of-Network,Z23,E78.5,,,,194,MS-DRG,8,7,N,27130,Surgery,,,0370,21,Inpatient Hospital,1,6764.76,2524.61,2386.72,0.0,25.0,112.89,137.89,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007198,MBR00000283,Professional,2021-04-29,2021-04-29,2021-06-10,PLN8355,1434029575,1434029575,Endocrinology,In-Network,M54.5,E11.9,,,,,,,0,,99233,E&M,,,,12,Home,3,347.75,110.19,60.19,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007199,MBR00000283,Institutional-OP,2022-02-27,2022-02-27,2022-03-09,PLN3156,1109850785,1109850785,ASC,Out-of-Network,Z23,I11.9,,,,,,,0,,99233,E&M,,,0320,22,Outpatient Hospital,3,322.4,204.25,129.25,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007200,MBR00000283,Institutional-OP,2023-11-11,2023-11-11,2023-11-19,PLN8605,1284035364,1284035364,Pediatrics,In-Network,K57.30,N39.0,,,,,,,0,,99222,E&M,,,0370,22,Outpatient Hospital,2,488.93,387.0,0.0,0.0,50.0,0.0,50.0,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007201,MBR00000283,Professional,2023-04-22,2023-04-22,2023-05-30,PLN3054,1125190055,1125190055,Nephrology,In-Network,R51,Z00.00,,,,,,,0,,47562,Surgery,,,,23,Emergency Room,1,2380.22,1678.76,1663.76,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007202,MBR00000283,Professional,2022-07-17,2022-07-17,2022-08-26,PLN2380,1700633438,1700633438,DME Supplier,In-Network,R51,Z12.31,,,,,,,0,,99213,E&M,,,,11,Office,3,264.87,94.28,0.0,94.28,0.0,0.0,94.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007203,MBR00000283,Professional,2022-11-23,2022-11-23,2022-12-07,PLN8560,1749327647,1749327647,Geriatrics,In-Network,Z23,Z51.11,,,,,,,0,,93225,Medicine,,,,12,Home,1,399.45,135.81,113.03,0.0,0.0,22.78,22.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007204,MBR00000283,Professional,2022-12-25,2022-12-25,2023-01-12,PLN6989,1337791138,1337791138,Internal Medicine,Out-of-Network,E11.9,E78.5,,,,,,,0,,58661,Surgery,,,,12,Home,1,1798.26,819.95,362.83,457.12,0.0,0.0,457.12,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007205,MBR00000283,Professional,2023-05-18,2023-05-18,2023-06-25,PLN7306,1767011137,1767011137,DME Supplier,In-Network,E66.9,R05,,,,,,,0,,87491,Pathology/Lab,,,,22,Outpatient Hospital,1,133.45,72.62,0.0,72.62,75.0,0.0,147.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007206,MBR00000283,Institutional-IP,2022-10-12,2022-10-17,2022-11-06,PLN3021,1856686341,1856686341,Geriatrics,In-Network,K92.1,K21.0,,,,195,MS-DRG,22,5,Y,45380,Surgery,,,0320,21,Inpatient Hospital,3,1591.42,650.52,0.0,0.0,0.0,48.61,48.61,0.0,Denied,CO-50,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000007207,MBR00000283,Institutional-OP,2022-07-14,2022-07-14,2022-08-22,PLN2972,1716521444,1716521444,Oncology,In-Network,J06.9,N39.0,,,,,,,0,,97530,Medicine,,,0900,22,Outpatient Hospital,2,263.73,83.93,11.54,72.39,0.0,0.0,72.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007208,MBR00000284,Professional,2021-03-24,2021-03-24,2021-04-29,PLN3102,1790497490,1790497490,OB/GYN,In-Network,J20.9,E66.9,,,,,,,0,,66984,Surgery,,,,21,Inpatient Hospital,3,2957.13,2137.11,2137.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007209,MBR00000284,Institutional-OP,2023-11-16,2023-11-16,2023-12-11,PLN7637,1186826716,1186826716,Physical Therapy,In-Network,M54.5,I50.9,,,,,,,0,,45378,Surgery,,,0200,22,Outpatient Hospital,2,1009.54,746.57,453.92,217.65,75.0,0.0,292.65,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000007210,MBR00000284,Institutional-IP,2022-09-12,2022-09-15,2022-10-21,PLN8860,1118885473,1118885473,ASC,In-Network,Z00.00,I25.10,,,,470,MS-DRG,8,3,Y,83036,Pathology/Lab,,,0450,21,Inpatient Hospital,1,73.75,38.88,0.0,38.88,25.0,0.0,63.88,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,1,0,0
CLM0000007211,MBR00000284,Institutional-IP,2021-11-14,2021-11-20,2021-12-27,PLN9960,1244186984,1244186984,Family Medicine,Out-of-Network,E78.5,Z12.31,,,,871,MS-DRG,2,6,Y,70450,Radiology,,,0370,21,Inpatient Hospital,1,1414.44,912.51,641.49,185.09,0.0,85.93,271.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007212,MBR00000284,Institutional-OP,2021-05-28,2021-05-28,2021-06-26,PLN5603,1860435061,1860435061,DME Supplier,In-Network,Z96.641,M81.0,,,,,,,0,,27447,Surgery,,,0320,22,Outpatient Hospital,2,2805.41,938.96,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-119,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007213,MBR00000284,Professional,2022-10-24,2022-10-24,2022-11-30,PLN6629,1948810580,1948810580,DME Supplier,In-Network,Z51.11,E66.9,,,,,,,0,,99204,E&M,,,,11,Office,3,431.59,196.94,0.0,196.94,15.0,0.0,211.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007214,MBR00000284,Institutional-IP,2023-05-07,2023-05-08,2023-06-12,PLN2875,1486164553,1486164553,DME Supplier,In-Network,Z12.31,K57.30,,,,292,MS-DRG,18,1,Y,99221,E&M,,,0270,21,Inpatient Hospital,3,292.2,127.75,102.75,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007215,MBR00000284,Professional,2023-06-04,2023-06-04,2023-06-13,PLN7050,1125190055,1125190055,Nephrology,In-Network,Z23,Z12.31,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,3,457.53,150.39,124.12,0.0,0.0,26.27,26.27,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007216,MBR00000284,Professional,2023-08-29,2023-08-29,2023-09-27,PLN1569,1660288235,1660288235,ASC,In-Network,Z12.31,I11.9,,,,,,,0,,99233,E&M,,,,50,Federally Qualified Health Center,3,556.73,401.38,213.0,188.38,0.0,0.0,188.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007217,MBR00000284,Professional,2023-09-06,2023-09-06,2023-10-03,PLN6276,1997536841,1997536841,Family Medicine,Out-of-Network,Z23,E78.5,,,,,,,0,,23472,Surgery,,,,23,Emergency Room,3,5611.24,3255.0,3180.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007218,MBR00000285,Professional,2022-11-14,2022-11-14,2022-12-09,PLN3784,1114982472,1114982472,Orthopedic Surgery,In-Network,Z23,E11.9,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,1,28606.21,15484.25,13471.38,349.64,0.0,1663.23,2012.87,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000007219,MBR00000285,Professional,2023-11-03,2023-11-03,2023-12-03,PLN8511,1716521444,1716521444,Oncology,In-Network,Z00.00,Z87.891,,,,,,,0,,78452,Radiology,,,,81,Independent Laboratory,3,2850.82,972.8,972.8,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007220,MBR00000285,Professional,2021-03-23,2021-03-23,2021-04-23,PLN7310,1847081578,1847081578,Urology,Out-of-Network,Z96.641,I48.91,,,,,,,0,,33533,Surgery,,,,11,Office,3,26939.22,16917.31,15721.64,0.0,15.0,1180.67,1195.67,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000007221,MBR00000285,Professional,2022-03-09,2022-03-09,2022-03-27,PLN3715,1500037969,1500037969,Pulmonology,In-Network,E66.9,Z00.00,,,,,,,0,,99204,E&M,,,,11,Office,2,316.87,187.39,0.0,187.39,0.0,0.0,187.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007222,MBR00000285,Professional,2022-06-14,2022-06-14,2022-07-27,PLN5788,1168246159,1168246159,Internal Medicine,In-Network,R51,J06.9,,,,,,,0,,58661,Surgery,,,,31,Skilled Nursing Facility,2,2761.79,1709.28,1580.43,93.85,35.0,0.0,128.85,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007223,MBR00000285,Professional,2023-02-05,2023-02-05,2023-02-25,PLN3646,1991459367,1991459367,Neurology,Out-of-Network,J18.9,F41.9,,,,,,,0,,80053,Pathology/Lab,,,,22,Outpatient Hospital,2,70.29,36.68,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007224,MBR00000285,Professional,2021-11-24,2021-11-24,2021-12-17,PLN9076,1235381502,1235381502,Cardiology,In-Network,N40.0,K92.1,,,,,,,0,,23472,Surgery,,,,11,Office,3,4519.05,2237.25,2162.25,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007225,MBR00000285,Institutional-IP,2021-11-14,2021-11-18,2021-11-24,PLN1176,1571574052,1571574052,Critical Access Hospital,In-Network,Z79.4,Z00.00,,,,291,MS-DRG,3,4,U,47562,Surgery,,,0510,21,Inpatient Hospital,3,4623.47,1555.03,1192.11,0.0,75.0,287.92,362.92,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007226,MBR00000285,Institutional-IP,2023-09-17,2023-09-28,2023-10-16,PLN8376,1453283987,1453283987,Critical Access Hospital,In-Network,M17.11,N40.0,,,,682,MS-DRG,2,11,Y,27447,Surgery,,,0370,21,Inpatient Hospital,1,4899.56,3536.84,3501.84,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007227,MBR00000285,Institutional-OP,2022-12-13,2022-12-13,2022-12-27,PLN5379,1463205530,1463205530,Nephrology,In-Network,I10,R10.9,,,,,,,0,,71046,Radiology,,,0761,22,Outpatient Hospital,3,210.82,117.61,42.61,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007228,MBR00000285,Institutional-OP,2022-11-27,2022-11-27,2022-12-20,PLN5582,1486164553,1486164553,DME Supplier,In-Network,I10,R10.9,,,,,,,0,,83036,Pathology/Lab,,,0320,22,Outpatient Hospital,3,119.49,50.65,0.0,50.65,0.0,0.0,50.65,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000007229,MBR00000285,Institutional-OP,2021-07-21,2021-07-21,2021-08-16,PLN8187,1645194539,1645194539,SNF,In-Network,F32.9,E11.9,,,,,,,0,,93306,Radiology,,,0900,22,Outpatient Hospital,1,2476.31,982.74,982.74,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007230,MBR00000285,Institutional-IP,2022-07-02,2022-07-05,2022-07-26,PLN1775,1186826716,1186826716,Physical Therapy,In-Network,G43.909,N18.3,,,,292,MS-DRG,7,3,Y,76700,Radiology,,,0320,21,Inpatient Hospital,2,766.21,361.03,0.0,361.03,50.0,0.0,411.03,0.0,Paid,,,1,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000007231,MBR00000285,Professional,2022-04-07,2022-04-07,2022-05-06,PLN2194,1800011727,1800011727,Clinical Laboratory,Out-of-Network,Z00.00,F41.9,,,,,,,0,,45378,Surgery,,,,65,End-Stage Renal Disease,2,2018.39,1660.44,1660.44,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000007232,MBR00000285,Professional,2022-11-11,2022-11-11,2022-12-20,PLN1884,1518055405,1518055405,Urology,In-Network,N39.0,N18.3,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,3,150.37,82.91,51.27,31.64,0.0,0.0,31.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007233,MBR00000285,Institutional-OP,2023-10-05,2023-10-05,2023-10-26,PLN1516,1247341320,1247341320,Urology,Out-of-Network,K57.30,N39.0,,,,,,,0,,90460,Medicine,,,0360,22,Outpatient Hospital,2,28.22,15.57,15.29,0.0,0.0,0.28,0.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007234,MBR00000285,Institutional-OP,2021-11-01,2021-11-01,2021-11-22,PLN6787,1687650653,1687650653,Internal Medicine,In-Network,I10,R05,,,,,,,0,,99221,E&M,,,0301,22,Outpatient Hospital,2,378.62,145.46,95.46,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007235,MBR00000285,Professional,2023-06-07,2023-06-07,2023-07-08,PLN5579,1511044648,1511044648,Endocrinology,In-Network,Z23,I50.9,,,,,,,0,,93225,Medicine,,,,21,Inpatient Hospital,1,379.9,295.64,238.19,0.0,15.0,42.45,57.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007236,MBR00000285,Professional,2022-11-25,2022-11-25,2022-12-30,PLN9203,1585582070,1585582070,Outpatient Clinic,In-Network,N20.0,N39.0,,,,,,,0,,99283,E&M,,,,11,Office,3,437.75,227.89,0.0,227.89,0.0,0.0,227.89,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007237,MBR00000285,Professional,2022-06-28,2022-06-28,2022-07-23,PLN1917,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,J06.9,J45.20,,,,,,,0,,99203,E&M,,,,11,Office,3,138.53,48.47,0.0,48.47,75.0,0.0,123.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007238,MBR00000285,Professional,2023-11-07,2023-11-07,2023-12-16,PLN8159,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,Z00.00,R10.9,,,,,,,0,,74177,Radiology,,,,11,Office,2,1280.54,456.73,368.2,0.0,0.0,88.53,88.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007239,MBR00000285,Professional,2021-06-10,2021-06-10,2021-06-30,PLN1334,1939033455,1939033455,Pulmonology,In-Network,M17.11,I10,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,2,2720.26,1295.7,1295.7,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007240,MBR00000285,Professional,2023-01-13,2023-01-13,2023-02-17,PLN8548,1860435061,1860435061,DME Supplier,In-Network,E11.40,J44.1,,,,,,,0,,G0439,Medicine,,,,49,Independent Clinic,2,387.9,156.65,156.65,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000007241,MBR00000285,Professional,2022-03-13,2022-03-13,2022-04-09,PLN6368,1997536841,1997536841,Family Medicine,Out-of-Network,E11.9,R10.9,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,1,2453.72,1382.16,1003.66,378.5,0.0,0.0,378.5,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007242,MBR00000285,Institutional-OP,2023-01-17,2023-01-17,2023-01-27,PLN7384,1337791138,1337791138,Internal Medicine,Out-of-Network,E11.9,E66.9,,,,,,,0,,78452,Radiology,,,0761,22,Outpatient Hospital,3,3532.35,2129.86,1618.37,440.32,15.0,56.17,511.49,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007243,MBR00000285,Institutional-OP,2021-06-01,2021-06-01,2021-07-14,PLN8936,1752470395,1752470395,Home Health,In-Network,E78.5,K57.30,,,,,,,0,,99214,E&M,,,0740,22,Outpatient Hospital,1,438.35,333.73,0.0,333.73,0.0,0.0,333.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007244,MBR00000285,Institutional-OP,2023-03-18,2023-03-18,2023-04-27,PLN3427,1569105090,1569105090,Geriatrics,In-Network,N39.0,N18.3,,,,,,,0,,27130,Surgery,,,0301,22,Outpatient Hospital,1,5304.97,2508.92,2453.17,0.0,0.0,55.75,55.75,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007245,MBR00000285,Professional,2021-03-17,2021-03-17,2021-04-16,PLN4400,1700633438,1700633438,DME Supplier,In-Network,E66.9,Z12.31,,,,,,,0,,72148,Radiology,,,,11,Office,2,2612.02,1348.92,1226.83,0.0,50.0,72.09,122.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007246,MBR00000285,Professional,2022-01-17,2022-01-17,2022-02-13,PLN9016,1511044648,1511044648,Endocrinology,In-Network,J45.20,Z00.00,,,,,,,0,,99283,E&M,,,,50,Federally Qualified Health Center,3,480.96,223.35,0.0,223.35,0.0,0.0,223.35,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007247,MBR00000286,Institutional-IP,2023-09-20,2023-09-24,2023-10-01,PLN3042,1434029575,1434029575,Endocrinology,In-Network,E66.9,Z23,,,,195,MS-DRG,16,4,Y,76700,Radiology,,,0370,21,Inpatient Hospital,2,607.39,501.22,501.22,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007248,MBR00000286,Institutional-IP,2022-11-24,2022-12-01,2022-12-11,PLN7150,1295371663,1295371663,Critical Access Hospital,In-Network,Z23,N18.3,,,,641,MS-DRG,8,7,Y,90460,Medicine,,,0761,21,Inpatient Hospital,3,57.84,46.09,21.09,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007249,MBR00000286,Institutional-OP,2022-06-23,2022-06-23,2022-07-26,PLN6545,1994661817,1994661817,SNF,Out-of-Network,Z79.4,R51,,,,,,,0,,99204,E&M,,,0301,22,Outpatient Hospital,3,322.27,135.09,0.0,135.09,75.0,0.0,210.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007250,MBR00000286,Professional,2021-12-29,2021-12-29,2022-02-07,PLN6259,1186826716,1186826716,Physical Therapy,In-Network,J44.1,M54.5,,,,,,,0,,93000,Radiology,,,,11,Office,1,151.26,100.0,0.0,100.0,25.0,0.0,125.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007251,MBR00000286,Professional,2021-04-08,2021-04-08,2021-05-09,PLN2148,1622771872,1622771872,Pediatrics,In-Network,F41.9,J44.1,,,,,,,0,,74177,Radiology,,,,22,Outpatient Hospital,2,1959.42,728.31,636.1,92.21,0.0,0.0,92.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007252,MBR00000286,Professional,2021-05-02,2021-05-02,2021-05-13,PLN2888,1295371663,1295371663,Critical Access Hospital,In-Network,J44.1,N39.0,,,,,,,0,,84443,Pathology/Lab,,,,65,End-Stage Renal Disease,3,177.36,125.66,125.66,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007253,MBR00000286,Professional,2023-02-24,2023-02-24,2023-03-21,PLN7253,1872272835,1872272835,Internal Medicine,In-Network,E78.5,E11.9,,,,,,,0,,99284,E&M,,,,11,Office,1,617.71,464.61,62.39,402.22,0.0,0.0,402.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007254,MBR00000286,Professional,2021-10-28,2021-10-28,2021-11-23,PLN3231,1500949740,1500949740,Pediatrics,In-Network,J44.1,Z23,,,,,,,0,,80053,Pathology/Lab,,,,20,Urgent Care,1,141.9,61.59,61.19,0.0,0.0,0.4,0.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007255,MBR00000286,Professional,2021-03-23,2021-03-23,2021-04-02,PLN9947,1245650222,1245650222,Gastroenterology,In-Network,I50.9,M54.5,,,,,,,0,,74177,Radiology,,,,11,Office,3,1146.16,956.94,956.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007256,MBR00000286,Professional,2022-04-25,2022-04-25,2022-05-04,PLN9578,1935547131,1935547131,Pulmonology,In-Network,Z00.00,C50.912,,,,,,,0,,27130,Surgery,,,,49,Independent Clinic,2,3158.8,2390.67,1956.54,419.13,15.0,0.0,434.13,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007257,MBR00000286,Professional,2022-03-10,2022-03-10,2022-03-18,PLN3065,1118885473,1118885473,ASC,In-Network,N18.3,K21.0,,,,,,,0,,77067,Radiology,,,,11,Office,3,385.11,220.79,185.79,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,0,1,Duplicate,1,0,0,0,0
CLM0000007258,MBR00000286,Institutional-IP,2023-11-15,2023-11-24,2023-12-09,PLN6361,1266606767,1266606767,ASC,In-Network,I10,F41.9,,,,470,MS-DRG,16,9,N,80061,Pathology/Lab,,,0370,21,Inpatient Hospital,1,122.97,43.45,0.0,43.45,0.0,0.0,43.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007259,MBR00000286,Professional,2021-09-10,2021-09-10,2021-10-21,PLN5027,1809014947,1809014947,Urology,In-Network,J06.9,J45.20,,,,,,,0,,85610,Pathology/Lab,,,,22,Outpatient Hospital,2,35.33,18.29,18.02,0.0,0.0,0.27,0.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007260,MBR00000286,Institutional-OP,2021-10-20,2021-10-20,2021-11-26,PLN5055,1168246159,1168246159,Internal Medicine,In-Network,E78.5,Z23,,,,,,,0,,99233,E&M,,,0761,22,Outpatient Hospital,2,555.11,312.09,271.82,0.0,25.0,15.27,40.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007261,MBR00000286,Institutional-IP,2021-06-30,2021-07-06,2021-08-04,PLN1541,1606140917,1606140917,ASC,In-Network,I11.9,I50.9,,,,682,MS-DRG,5,6,Y,45378,Surgery,,,0301,21,Inpatient Hospital,3,2216.92,1687.83,1662.83,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000007262,MBR00000287,Professional,2021-07-26,2021-07-26,2021-08-19,PLN2208,1840431511,1840431511,Geriatrics,Out-of-Network,J06.9,I10,,,,,,,0,,76700,Radiology,,,,23,Emergency Room,1,847.62,456.81,361.51,45.3,50.0,0.0,95.3,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007263,MBR00000287,Professional,2022-08-08,2022-08-08,2022-08-15,PLN3807,1713934949,1713934949,Neurology,In-Network,E66.9,E78.5,,,,,,,0,,99222,E&M,,,,49,Independent Clinic,1,556.87,171.34,0.0,171.34,15.0,0.0,186.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007264,MBR00000287,Professional,2021-09-02,2021-09-02,2021-09-19,PLN4466,1268679390,1268679390,Critical Access Hospital,In-Network,J06.9,I48.91,,,,,,,0,,66984,Surgery,,,,11,Office,3,2421.47,1211.77,1176.77,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007265,MBR00000287,Professional,2023-02-28,2023-02-28,2023-03-24,PLN3235,1569105090,1569105090,Geriatrics,In-Network,E11.9,F41.9,,,,,,,0,,99233,E&M,,,,31,Skilled Nursing Facility,2,353.35,175.66,0.0,175.66,0.0,0.0,175.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007266,MBR00000287,Institutional-IP,2023-06-15,2023-06-22,2023-07-12,PLN7737,1433937353,1433937353,Nephrology,In-Network,E78.5,I25.10,,,,603,MS-DRG,7,7,Y,47562,Surgery,,,0730,21,Inpatient Hospital,3,6112.26,4074.98,3959.48,0.0,50.0,65.5,115.5,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007267,MBR00000287,Institutional-OP,2022-06-18,2022-06-18,2022-07-24,PLN6343,1247341320,1247341320,Urology,Out-of-Network,Z12.31,F41.9,,,,,,,0,,85610,Pathology/Lab,,,0370,22,Outpatient Hospital,1,33.24,14.44,0.0,14.44,35.0,0.0,49.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007268,MBR00000287,Professional,2021-09-20,2021-09-20,2021-10-19,PLN1734,1974006077,1974006077,Orthopedic Surgery,In-Network,E66.9,E11.9,,,,,,,0,,80061,Pathology/Lab,,,,22,Outpatient Hospital,1,59.29,22.79,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007269,MBR00000287,Professional,2023-06-18,2023-06-18,2023-07-30,PLN4740,1337791138,1337791138,Internal Medicine,Out-of-Network,F32.9,I63.9,,,,,,,0,,78452,Radiology,,,,31,Skilled Nursing Facility,3,3608.5,1900.71,1575.06,0.0,25.0,300.65,325.65,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007270,MBR00000287,Institutional-OP,2023-11-25,2023-11-25,2023-12-29,PLN4827,1125190055,1125190055,Nephrology,In-Network,G43.909,K21.0,,,,,,,0,,99214,E&M,,,0450,22,Outpatient Hospital,1,367.94,233.02,147.79,0.0,75.0,10.23,85.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007271,MBR00000288,Professional,2023-10-02,2023-10-02,2023-11-04,PLN6561,1696843572,1696843572,Critical Access Hospital,Out-of-Network,M81.0,J18.9,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,2,70.36,31.83,2.43,0.0,25.0,0.0,25.0,4.4,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000007272,MBR00000288,Professional,2023-10-05,2023-10-05,2023-10-25,PLN6572,1687650653,1687650653,Internal Medicine,In-Network,E78.5,B97.89,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,1,65.85,35.74,35.74,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007273,MBR00000288,Professional,2023-06-03,2023-06-03,2023-06-19,PLN9111,1463205530,1463205530,Nephrology,In-Network,E78.5,G43.909,,,,,,,0,,99204,E&M,,,,11,Office,3,273.32,187.23,0.0,187.23,50.0,0.0,237.23,41.06,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007274,MBR00000288,Professional,2023-03-20,2023-03-20,2023-04-04,PLN7716,1745114564,1745114564,Endocrinology,In-Network,E11.9,Z12.31,,,,,,,0,,71046,Radiology,,,,22,Outpatient Hospital,1,265.48,170.63,170.63,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007275,MBR00000288,Professional,2023-11-14,2023-11-14,2023-11-23,PLN4620,1205377316,1205377316,Orthopedic Surgery,In-Network,Z87.891,J44.1,,,,,,,0,,47562,Surgery,,,,11,Office,2,6563.94,1978.24,0.0,0.0,35.0,99.96,134.96,0.0,Denied,CO-97,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007276,MBR00000288,Institutional-OP,2022-01-07,2022-01-07,2022-01-26,PLN2624,1395983630,1395983630,Nephrology,In-Network,E66.9,F32.9,,,,,,,0,,76700,Radiology,,,0450,22,Outpatient Hospital,3,1428.79,478.16,374.32,68.84,35.0,0.0,103.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007277,MBR00000288,Institutional-IP,2023-10-15,2023-10-18,2023-11-27,PLN7972,1135158374,1135158374,Pulmonology,In-Network,J20.9,E11.9,,,,196,MS-DRG,20,3,Y,70450,Radiology,,,0900,21,Inpatient Hospital,2,1567.18,878.37,461.73,269.01,35.0,112.63,416.64,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007278,MBR00000288,Professional,2021-01-23,2021-01-23,2021-02-04,PLN8151,1434029575,1434029575,Endocrinology,In-Network,Z00.00,I25.10,,,,,,,0,,99213,E&M,,,,11,Office,1,207.37,71.67,0.0,71.67,25.0,0.0,96.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007279,MBR00000288,Institutional-OP,2023-07-01,2023-07-01,2023-08-07,PLN6865,1395983630,1395983630,Nephrology,In-Network,Z87.891,M17.11,,,,,,,0,,99203,E&M,,,0360,22,Outpatient Hospital,2,151.83,113.57,63.57,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007280,MBR00000288,Professional,2022-01-01,2022-01-01,2022-01-10,PLN5586,1691062876,1691062876,SNF,In-Network,K21.0,J20.9,,,,,,,0,,85025,Pathology/Lab,,,,50,Federally Qualified Health Center,3,76.15,48.29,0.0,48.29,15.0,0.0,63.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007281,MBR00000288,Professional,2021-11-17,2021-11-17,2021-12-04,PLN2939,1691062876,1691062876,SNF,In-Network,J06.9,I10,,,,,,,0,,66984,Surgery,,,,11,Office,3,1268.24,409.91,85.94,197.58,75.0,20.98,293.56,30.41,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007282,MBR00000288,Institutional-OP,2023-01-10,2023-01-10,2023-02-10,PLN8859,1268679390,1268679390,Critical Access Hospital,In-Network,E78.5,J44.1,,,,,,,0,,82043,Pathology/Lab,,,0301,22,Outpatient Hospital,1,65.71,39.16,0.0,39.16,15.0,0.0,54.16,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007283,MBR00000288,Institutional-IP,2021-07-10,2021-07-15,2021-07-17,PLN8128,1502838586,1502838586,ASC,In-Network,F32.9,Z00.00,,,,690,MS-DRG,1,5,Y,99221,E&M,,,0200,21,Inpatient Hospital,1,246.42,123.47,0.0,123.47,25.0,0.0,148.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007284,MBR00000288,Institutional-OP,2023-12-25,2023-12-25,2024-02-06,PLN3890,1716521444,1716521444,Oncology,In-Network,Z79.4,I10,,,,,,,0,,97110,Medicine,,,0370,22,Outpatient Hospital,2,272.37,87.31,12.16,0.0,75.0,0.15,75.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007285,MBR00000288,Professional,2023-03-08,2023-03-08,2023-04-21,PLN6008,1186826716,1186826716,Physical Therapy,In-Network,M17.11,M81.0,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,1,1421.89,1102.06,980.87,0.0,0.0,121.19,121.19,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000007286,MBR00000289,Professional,2021-01-22,2021-01-22,2021-03-06,PLN7420,1410468316,1410468316,SNF,In-Network,F32.9,F41.9,,,,,,,0,,33533,Surgery,,,,11,Office,1,21961.6,7782.11,7310.86,471.25,0.0,0.0,471.25,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000007287,MBR00000289,Institutional-OP,2023-07-15,2023-07-15,2023-07-24,PLN2624,1964402759,1964402759,Outpatient Clinic,In-Network,F10.20,I25.10,,,,,,,0,,99233,E&M,,,0740,22,Outpatient Hospital,2,203.44,166.27,91.27,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007288,MBR00000289,Professional,2021-04-29,2021-04-29,2021-05-18,PLN3338,1700633438,1700633438,DME Supplier,In-Network,Z51.11,J06.9,,,,,,,0,,86900,Pathology/Lab,,,,20,Urgent Care,3,58.19,39.2,0.0,39.2,0.0,0.0,39.2,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000007289,MBR00000289,Institutional-OP,2023-06-21,2023-06-21,2023-07-11,PLN7539,1752470395,1752470395,Home Health,In-Network,Z00.00,J20.9,,,,,,,0,,78452,Radiology,,,0270,22,Outpatient Hospital,3,6428.07,4034.92,3837.23,172.69,25.0,0.0,197.69,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007290,MBR00000289,Institutional-OP,2023-06-10,2023-06-10,2023-07-05,PLN8787,1860435061,1860435061,DME Supplier,In-Network,Z12.31,Z00.00,,,,,,,0,,90686,Medicine,,,0360,22,Outpatient Hospital,1,105.02,67.38,0.0,67.38,50.0,0.0,117.38,0.0,Pended,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000007291,MBR00000289,Professional,2022-12-06,2022-12-06,2023-01-18,PLN7711,1366426662,1366426662,Urology,In-Network,F41.9,Z00.00,,,,,,,0,,33533,Surgery,,,,11,Office,1,12076.34,8993.44,7681.09,437.94,0.0,874.41,1312.35,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000007292,MBR00000289,Institutional-OP,2022-10-20,2022-10-20,2022-11-20,PLN6341,1366426662,1366426662,Urology,In-Network,I48.91,R05,,,,,,,0,,80061,Pathology/Lab,,,0301,22,Outpatient Hospital,3,105.12,54.93,0.0,54.93,0.0,0.0,54.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007293,MBR00000289,Institutional-OP,2023-06-28,2023-06-28,2023-07-30,PLN7589,1313212303,1313212303,Family Medicine,In-Network,I10,Z23,,,,,,,0,,27130,Surgery,,,0370,22,Outpatient Hospital,1,6426.81,2017.75,1820.78,146.97,50.0,0.0,196.97,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007294,MBR00000289,Institutional-OP,2023-07-21,2023-07-21,2023-08-20,PLN4209,1631954542,1631954542,Oncology,In-Network,F03.90,M81.0,,,,,,,0,,45378,Surgery,,,0360,22,Outpatient Hospital,2,2399.93,1745.58,1250.33,495.25,0.0,0.0,495.25,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000007295,MBR00000289,Professional,2023-02-14,2023-02-14,2023-03-05,PLN5803,1980712759,1980712759,Outpatient Clinic,Out-of-Network,I10,F32.9,,,,,,,0,,G0439,Medicine,,,,11,Office,1,489.92,150.33,135.33,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000007296,MBR00000289,Institutional-IP,2021-07-07,2021-07-13,2021-07-16,PLN7301,1609526529,1609526529,Psychiatry,In-Network,G43.909,Z12.31,,,,872,MS-DRG,13,6,Y,99284,E&M,,,0301,21,Inpatient Hospital,1,461.91,164.26,0.0,103.13,75.0,0.0,178.13,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000007297,MBR00000289,Professional,2022-12-30,2022-12-30,2023-01-14,PLN7777,1531398223,1531398223,OB/GYN,In-Network,M81.0,Z12.31,,,,,,,0,,99213,E&M,,,,49,Independent Clinic,1,323.95,151.56,126.56,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007298,MBR00000289,Professional,2021-08-09,2021-08-09,2021-09-12,PLN3078,1198133277,1198133277,SNF,In-Network,Z00.00,Z12.31,,,,,,,0,,71046,Radiology,,,,11,Office,2,234.12,185.72,163.32,0.0,0.0,22.4,22.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007299,MBR00000289,Institutional-OP,2021-02-21,2021-02-21,2021-03-30,PLN9690,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,K92.1,F32.9,,,,,,,0,,81001,Pathology/Lab,,,0740,22,Outpatient Hospital,2,25.16,7.61,0.0,7.61,0.0,0.0,7.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007300,MBR00000289,Institutional-OP,2021-06-16,2021-06-16,2021-06-25,PLN8100,1799205295,1799205295,General Acute Care Hospital,In-Network,E66.9,J06.9,,,,,,,0,,99214,E&M,,,0450,22,Outpatient Hospital,3,459.55,162.41,121.13,0.0,25.0,16.28,41.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007301,MBR00000289,Professional,2022-05-20,2022-05-20,2022-06-08,PLN7333,1502838586,1502838586,ASC,In-Network,I10,E11.40,,,,,,,0,,84443,Pathology/Lab,,,,22,Outpatient Hospital,2,172.63,108.64,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007302,MBR00000289,Institutional-IP,2023-11-22,2023-11-24,2023-12-05,PLN1600,1168246159,1168246159,Internal Medicine,In-Network,E11.9,I10,,,,291,MS-DRG,18,2,Y,90837,Medicine,,,0320,21,Inpatient Hospital,2,265.72,112.88,0.0,112.88,35.0,0.0,147.88,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007303,MBR00000289,Institutional-OP,2021-02-07,2021-02-07,2021-02-27,PLN1593,1799205295,1799205295,General Acute Care Hospital,In-Network,G20,M54.5,,,,,,,0,,27447,Surgery,,,0270,22,Outpatient Hospital,2,2253.14,1024.91,1024.91,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007304,MBR00000289,Institutional-IP,2021-03-23,2021-03-26,2021-04-25,PLN5080,1334916761,1334916761,ASC,In-Network,Z12.11,Z00.00,,,,292,MS-DRG,1,3,Y,90837,Medicine,,,0740,21,Inpatient Hospital,2,248.05,156.14,156.14,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000007305,MBR00000289,Professional,2021-04-12,2021-04-12,2021-05-20,PLN8162,1366576336,1366576336,Geriatrics,In-Network,F41.9,N18.3,,,,,,,0,,99204,E&M,,,,11,Office,3,420.33,167.35,167.35,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007306,MBR00000289,Professional,2021-07-28,2021-07-28,2021-08-28,PLN9300,1806688928,1806688928,Geriatrics,In-Network,I10,Z12.31,,,,,,,0,,70553,Radiology,,,,11,Office,2,1687.57,1145.06,1120.06,0.0,25.0,0.0,25.0,0.0,Adjusted,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007307,MBR00000289,Professional,2022-08-16,2022-08-16,2022-09-21,PLN3477,1239316214,1239316214,Internal Medicine,In-Network,Z23,M17.11,,,,,,,0,,90460,Medicine,,,,20,Urgent Care,3,75.66,46.94,0.0,9.09,50.0,0.0,59.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007308,MBR00000289,Institutional-OP,2023-06-19,2023-06-19,2023-07-20,PLN1278,1980712759,1980712759,Outpatient Clinic,Out-of-Network,J06.9,E11.65,,,,,,,0,,45378,Surgery,,,0200,22,Outpatient Hospital,1,1187.59,674.78,674.78,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000007309,MBR00000289,Professional,2021-02-21,2021-02-21,2021-03-09,PLN4500,1645194539,1645194539,SNF,In-Network,J44.1,N20.0,,,,,,,0,,83036,Pathology/Lab,,,,49,Independent Clinic,2,117.76,66.14,0.0,66.14,0.0,0.0,66.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000007310,MBR00000289,Professional,2023-05-31,2023-05-31,2023-07-09,PLN7194,1799205295,1799205295,General Acute Care Hospital,In-Network,E11.65,E11.9,,,,,,,0,,70553,Radiology,,,,11,Office,1,3965.43,2994.42,2678.89,265.53,50.0,0.0,315.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007311,MBR00000289,Institutional-OP,2023-09-27,2023-09-27,2023-10-15,PLN7961,1660288235,1660288235,ASC,In-Network,N18.3,K21.0,,,,,,,0,,99283,E&M,,,0636,22,Outpatient Hospital,3,640.5,319.12,304.12,0.0,15.0,0.0,15.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007312,MBR00000289,Institutional-OP,2021-03-28,2021-03-28,2021-05-01,PLN5210,1991459367,1991459367,Neurology,Out-of-Network,K57.30,Z23,,,,,,,0,,99406,Medicine,,,0730,22,Outpatient Hospital,3,40.67,22.32,0.0,22.32,0.0,0.0,22.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007313,MBR00000289,Institutional-OP,2022-05-09,2022-05-09,2022-06-17,PLN3962,1631954542,1631954542,Oncology,In-Network,Z00.00,Z23,,,,,,,0,,66984,Surgery,,,0761,22,Outpatient Hospital,1,1484.02,654.46,654.46,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007314,MBR00000289,Institutional-OP,2023-06-12,2023-06-12,2023-07-08,PLN3419,1114982472,1114982472,Orthopedic Surgery,In-Network,M54.5,Z51.11,,,,,,,0,,99213,E&M,,,0200,22,Outpatient Hospital,1,320.9,150.86,0.0,150.86,15.0,0.0,165.86,0.0,Denied,CO-119,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000007315,MBR00000289,Institutional-IP,2023-02-06,2023-02-12,2023-03-12,PLN9049,1609138981,1609138981,Critical Access Hospital,In-Network,Z23,K57.30,,,,195,MS-DRG,8,6,Y,99233,E&M,,,0301,21,Inpatient Hospital,1,208.87,156.86,115.08,41.78,0.0,0.0,41.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007316,MBR00000289,Institutional-OP,2021-07-22,2021-07-22,2021-08-31,PLN9805,1749494482,1749494482,Pediatrics,In-Network,N40.0,E11.9,,,,,,,0,,86900,Pathology/Lab,,,0120,22,Outpatient Hospital,3,30.3,20.18,20.04,0.0,0.0,0.14,0.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007317,MBR00000289,Institutional-IP,2021-06-11,2021-06-18,2021-06-29,PLN1069,1366426662,1366426662,Urology,In-Network,M17.11,I25.10,,,,195,MS-DRG,6,7,Y,86900,Pathology/Lab,,,0360,21,Inpatient Hospital,1,30.21,24.7,24.7,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007318,MBR00000289,Institutional-IP,2022-05-04,2022-05-07,2022-06-17,PLN3875,1520687146,1520687146,ASC,In-Network,K57.30,I50.9,,,,641,MS-DRG,1,3,U,74177,Radiology,,,0370,21,Inpatient Hospital,2,1975.45,623.66,498.84,124.82,0.0,0.0,124.82,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007319,MBR00000289,Professional,2023-07-18,2023-07-18,2023-08-21,PLN5706,1728018911,1728018911,Nephrology,In-Network,Z23,J06.9,,,,,,,0,,99232,E&M,,,,11,Office,1,360.42,256.66,0.0,256.66,50.0,0.0,306.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007320,MBR00000289,Professional,2023-11-05,2023-11-05,2023-12-02,PLN8762,1845057593,1845057593,Orthopedic Surgery,In-Network,Z51.11,I10,,,,,,,0,,80053,Pathology/Lab,,,,49,Independent Clinic,1,127.43,102.61,0.0,0.0,15.0,6.01,21.01,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007321,MBR00000289,Professional,2022-06-08,2022-06-08,2022-06-26,PLN5714,1103747954,1103747954,Urology,In-Network,N39.0,E66.9,,,,,,,0,,74177,Radiology,,,,22,Outpatient Hospital,2,1505.24,917.21,435.16,482.05,0.0,0.0,482.05,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007322,MBR00000289,Institutional-OP,2022-08-03,2022-08-03,2022-09-08,PLN4679,1778483301,1778483301,Home Health,In-Network,I10,F32.9,,,,,,,0,,99222,E&M,,,0301,22,Outpatient Hospital,3,450.31,212.75,137.76,0.0,50.0,24.99,74.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007323,MBR00000289,Professional,2022-09-04,2022-09-04,2022-09-13,PLN9484,1997536841,1997536841,Family Medicine,Out-of-Network,E66.9,Z23,,,,,,,0,,27447,Surgery,,,,11,Office,1,5437.31,3522.87,3103.88,343.99,75.0,0.0,418.99,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007324,MBR00000289,Professional,2022-06-21,2022-06-21,2022-07-11,PLN7168,1856686341,1856686341,Geriatrics,In-Network,E11.9,Z00.00,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,3,967.34,347.17,310.27,0.0,0.0,36.9,36.9,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007325,MBR00000289,Institutional-OP,2022-12-12,2022-12-12,2023-01-07,PLN9713,1284035364,1284035364,Pediatrics,In-Network,N40.0,Z51.11,,,,,,,0,,85025,Pathology/Lab,,,0510,22,Outpatient Hospital,3,46.51,16.26,0.0,16.26,0.0,0.0,16.26,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007326,MBR00000289,Institutional-OP,2021-10-27,2021-10-27,2021-12-02,PLN3065,1631954542,1631954542,Oncology,In-Network,N39.0,E78.5,,,,,,,0,,33533,Surgery,,,0270,22,Outpatient Hospital,1,15779.2,13163.06,13088.06,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000007327,MBR00000289,Institutional-OP,2022-08-15,2022-08-15,2022-08-26,PLN1635,1847081578,1847081578,Urology,Out-of-Network,F32.9,N39.0,,,,,,,0,,93306,Radiology,,,0270,22,Outpatient Hospital,2,2273.98,1671.94,0.0,0.0,50.0,295.41,345.41,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007328,MBR00000289,Institutional-OP,2022-11-03,2022-11-03,2022-11-28,PLN1844,1361302520,1361302520,Critical Access Hospital,In-Network,N39.0,I10,,,,,,,0,,90460,Medicine,,,0200,22,Outpatient Hospital,1,75.76,43.43,0.0,43.43,0.0,0.0,43.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007329,MBR00000289,Professional,2022-09-09,2022-09-09,2022-10-10,PLN1817,1847081578,1847081578,Urology,Out-of-Network,I11.9,Z12.31,,,,,,,0,,47562,Surgery,,,,11,Office,1,6540.32,5203.49,4200.67,0.0,15.0,987.82,1002.82,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007330,MBR00000289,Professional,2023-12-04,2023-12-04,2024-01-16,PLN7351,1227362142,1227362142,DME Supplier,In-Network,I25.10,J06.9,,,,,,,0,,97110,Medicine,,,,22,Outpatient Hospital,1,265.41,127.19,68.55,0.0,50.0,8.64,58.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007331,MBR00000289,Institutional-OP,2023-03-27,2023-03-27,2023-04-07,PLN1559,1514306773,1514306773,Endocrinology,In-Network,Z00.00,E11.9,,,,,,,0,,27447,Surgery,,,0450,22,Outpatient Hospital,3,3095.96,2595.07,2580.07,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007332,MBR00000289,Institutional-OP,2023-03-15,2023-03-15,2023-03-22,PLN5469,1224179551,1224179551,Physical Therapy,In-Network,Z00.01,Z00.00,,,,,,,0,,58661,Surgery,,,0270,22,Outpatient Hospital,2,4882.39,1658.6,1658.6,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007333,MBR00000289,Professional,2023-06-03,2023-06-03,2023-06-27,PLN9266,1486164553,1486164553,DME Supplier,In-Network,Z23,I10,,,,,,,0,,99284,E&M,,,,11,Office,3,753.4,487.69,404.64,0.0,15.0,68.05,83.05,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007334,MBR00000289,Professional,2022-08-01,2022-08-01,2022-08-10,PLN6199,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,F41.9,K21.0,,,,,,,0,,86900,Pathology/Lab,,,,23,Emergency Room,1,62.66,19.44,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-50,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007335,MBR00000289,Professional,2021-12-02,2021-12-02,2021-12-12,PLN5178,1118885473,1118885473,ASC,In-Network,E66.9,E11.9,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,1,75.59,49.26,43.68,0.0,0.0,5.58,5.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007336,MBR00000290,Professional,2022-08-10,2022-08-10,2022-09-01,PLN2383,1968299309,1968299309,Internal Medicine,In-Network,Z12.31,Z12.11,,,,,,,0,,99233,E&M,,,,23,Emergency Room,2,331.15,253.17,253.17,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007337,MBR00000290,Professional,2023-10-07,2023-10-07,2023-10-27,PLN9026,1395983630,1395983630,Nephrology,In-Network,E11.9,R05,,,,,,,0,,90837,Medicine,,,,21,Inpatient Hospital,3,190.88,153.13,0.0,153.13,0.0,0.0,153.13,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007338,MBR00000290,Professional,2023-08-21,2023-08-21,2023-09-21,PLN6919,1511044648,1511044648,Endocrinology,In-Network,E87.6,J06.9,,,,,,,0,,45380,Surgery,,,,12,Home,2,2354.04,1830.93,1830.93,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000007339,MBR00000290,Professional,2022-01-23,2022-01-23,2022-02-22,PLN9227,1691062876,1691062876,SNF,In-Network,I10,Z79.4,,,,,,,0,,74177,Radiology,,,,22,Outpatient Hospital,3,2764.42,2126.37,2126.37,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007340,MBR00000290,Institutional-IP,2022-06-13,2022-06-21,2022-07-02,PLN7132,1148984206,1148984206,Psychiatry,In-Network,F32.9,I10,,,,195,MS-DRG,2,8,Y,G0468,Medicine,,,0900,21,Inpatient Hospital,2,278.05,204.69,127.16,0.0,50.0,27.53,77.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007341,MBR00000290,Institutional-IP,2021-10-26,2021-10-30,2021-11-30,PLN8868,1450094833,1450094833,Outpatient Clinic,In-Network,I10,F41.9,,,,872,MS-DRG,13,4,Y,58661,Surgery,,,0200,21,Inpatient Hospital,3,3503.97,1587.11,1537.11,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007342,MBR00000290,Professional,2021-01-14,2021-01-14,2021-02-19,PLN2908,1910255109,1910255109,DME Supplier,In-Network,J06.9,E78.5,,,,,,,0,,G0439,Medicine,,,,11,Office,2,291.93,188.37,173.37,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000007343,MBR00000290,Professional,2021-12-08,2021-12-08,2021-12-19,PLN5719,1749327647,1749327647,Geriatrics,In-Network,Z79.4,I63.9,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,3,74.37,60.66,60.66,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000007344,MBR00000291,Professional,2021-04-21,2021-04-21,2021-05-15,PLN4233,1865904917,1865904917,Outpatient Clinic,In-Network,Z12.11,E78.5,,,,,,,0,,33533,Surgery,,,,21,Inpatient Hospital,2,23873.0,11858.92,11780.39,78.53,0.0,0.0,78.53,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000007345,MBR00000291,Institutional-IP,2022-01-28,2022-01-29,2022-02-21,PLN5596,1434029575,1434029575,Endocrinology,In-Network,J20.9,I10,,,,291,MS-DRG,17,1,Y,27130,Surgery,,,0301,21,Inpatient Hospital,3,2849.36,1083.21,1068.21,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007346,MBR00000291,Professional,2021-02-28,2021-02-28,2021-04-01,PLN6335,1283743001,1283743001,Family Medicine,In-Network,M54.5,G43.909,,,,,,,0,,74177,Radiology,,,,22,Outpatient Hospital,3,2811.92,2014.64,1769.5,245.14,0.0,0.0,245.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007347,MBR00000291,Institutional-OP,2021-12-14,2021-12-14,2022-01-26,PLN6015,1132188260,1132188260,Family Medicine,In-Network,Z12.31,J44.1,,,,,,,0,,97110,Medicine,,,0730,22,Outpatient Hospital,2,124.3,105.42,105.42,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007348,MBR00000291,Professional,2023-02-22,2023-02-22,2023-03-27,PLN4132,1689639685,1689639685,SNF,In-Network,E78.5,J06.9,,,,,,,0,,G0444,Medicine,,,,11,Office,2,61.86,18.94,0.0,18.94,35.0,0.0,53.94,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000007349,MBR00000291,Institutional-OP,2023-07-13,2023-07-13,2023-07-29,PLN6382,1168881145,1168881145,Orthopedic Surgery,In-Network,E66.9,J18.9,,,,,,,0,,99232,E&M,,,0900,22,Outpatient Hospital,2,252.71,144.54,144.54,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007350,MBR00000291,Professional,2023-08-30,2023-08-30,2023-10-08,PLN3444,1450094833,1450094833,Outpatient Clinic,In-Network,N40.0,J44.1,,,,,,,0,,93000,Radiology,,,,22,Outpatient Hospital,3,90.1,27.21,2.21,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007351,MBR00000291,Institutional-IP,2022-09-07,2022-09-10,2022-10-10,PLN6603,1205377316,1205377316,Orthopedic Surgery,In-Network,J06.9,I10,,,,871,MS-DRG,8,3,Y,99406,Medicine,,,0636,21,Inpatient Hospital,2,48.05,29.99,0.0,0.0,15.0,0.55,15.55,0.0,Denied,CO-27,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000007352,MBR00000291,Institutional-IP,2022-08-22,2022-08-23,2022-09-21,PLN5249,1563980627,1563980627,Critical Access Hospital,In-Network,I10,E11.9,,,,872,MS-DRG,6,1,Y,99203,E&M,,,0510,21,Inpatient Hospital,3,167.05,56.01,41.01,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007353,MBR00000291,Professional,2023-11-26,2023-11-26,2023-12-06,PLN1298,1433937353,1433937353,Nephrology,In-Network,N39.0,K21.0,,,,,,,0,,45378,Surgery,,,,11,Office,2,2167.51,1477.77,1195.13,0.0,0.0,282.64,282.64,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000007354,MBR00000291,Professional,2022-09-01,2022-09-01,2022-09-12,PLN6597,1205377316,1205377316,Orthopedic Surgery,In-Network,E66.9,I25.10,,,,,,,0,,85610,Pathology/Lab,,,,81,Independent Laboratory,1,32.0,13.62,0.0,13.62,75.0,0.0,88.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007355,MBR00000291,Professional,2021-04-02,2021-04-02,2021-05-11,PLN2903,1806688928,1806688928,Geriatrics,In-Network,J20.9,Z00.00,,,,,,,0,,58661,Surgery,,,,11,Office,3,4038.8,2949.42,2417.56,210.12,0.0,321.74,531.86,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007356,MBR00000291,Professional,2023-10-22,2023-10-22,2023-11-25,PLN4673,1337791138,1337791138,Internal Medicine,Out-of-Network,N39.0,E11.9,,,,,,,0,,99233,E&M,,,,11,Office,3,325.84,239.87,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007357,MBR00000291,Institutional-OP,2022-11-04,2022-11-04,2022-11-17,PLN5013,1244186984,1244186984,Family Medicine,Out-of-Network,Z87.891,Z12.31,,,,,,,0,,99214,E&M,,,0740,22,Outpatient Hospital,2,455.38,373.28,246.08,74.03,35.0,18.17,127.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007358,MBR00000291,Institutional-IP,2022-12-31,2023-01-08,2023-01-21,PLN3543,1556140803,1556140803,Cardiology,In-Network,I10,I11.9,,,,194,MS-DRG,10,8,Y,77067,Radiology,,,0270,21,Inpatient Hospital,1,689.84,477.41,446.13,0.0,0.0,31.28,31.28,0.0,Paid,,,0,,0,1,0,0,0,1,Duplicate,1,0,0,0,0
CLM0000007359,MBR00000291,Institutional-OP,2021-04-16,2021-04-16,2021-05-13,PLN3562,1790497490,1790497490,OB/GYN,In-Network,N18.3,F41.9,,,,,,,0,,93225,Medicine,,,0510,22,Outpatient Hospital,1,549.41,238.8,238.8,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007360,MBR00000291,Professional,2022-05-30,2022-05-30,2022-06-21,PLN1661,1660288235,1660288235,ASC,In-Network,Z12.31,F32.9,,,,,,,0,,99233,E&M,,,,11,Office,2,439.18,211.62,182.85,0.0,15.0,13.77,28.77,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007361,MBR00000291,Professional,2022-05-18,2022-05-18,2022-05-28,PLN2483,1713934949,1713934949,Neurology,In-Network,I10,I10,,,,,,,0,,45380,Surgery,,,,11,Office,3,1332.16,969.56,969.56,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000007362,MBR00000291,Institutional-OP,2023-06-12,2023-06-12,2023-06-23,PLN1761,1717546253,1717546253,Family Medicine,In-Network,Z00.00,F41.9,,,,,,,0,,99213,E&M,,,0200,22,Outpatient Hospital,1,166.97,95.17,95.17,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007363,MBR00000291,Professional,2022-02-24,2022-02-24,2022-03-09,PLN4322,1585582070,1585582070,Outpatient Clinic,In-Network,N18.3,Z12.11,,,,,,,0,,80053,Pathology/Lab,,,,21,Inpatient Hospital,2,74.72,53.57,28.57,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007364,MBR00000291,Professional,2022-01-11,2022-01-11,2022-02-20,PLN2511,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,Z12.11,F03.90,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,3,138.63,110.34,0.0,110.34,25.0,0.0,135.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007365,MBR00000291,Professional,2023-01-16,2023-01-16,2023-01-30,PLN8531,1622771872,1622771872,Pediatrics,In-Network,I10,F41.9,,,,,,,0,,87491,Pathology/Lab,,,,20,Urgent Care,3,101.25,68.69,43.45,0.0,25.0,0.24,25.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007366,MBR00000291,Professional,2021-01-18,2021-01-18,2021-01-28,PLN3277,1939033455,1939033455,Pulmonology,In-Network,F41.9,E87.6,,,,,,,0,,72148,Radiology,,,,11,Office,3,2006.16,695.92,620.92,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007367,MBR00000291,Institutional-OP,2023-03-28,2023-03-28,2023-04-26,PLN4883,1528335731,1528335731,Critical Access Hospital,In-Network,K57.30,E78.5,,,,,,,0,,85025,Pathology/Lab,,,0270,22,Outpatient Hospital,3,72.57,47.11,47.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007368,MBR00000291,Professional,2021-01-09,2021-01-09,2021-02-19,PLN4145,1840431511,1840431511,Geriatrics,Out-of-Network,K92.1,N18.3,,,,,,,0,,86900,Pathology/Lab,,,,31,Skilled Nursing Facility,2,55.36,35.16,0.0,35.16,75.0,0.0,110.16,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007369,MBR00000291,Professional,2021-09-18,2021-09-18,2021-10-22,PLN6780,1800011727,1800011727,Clinical Laboratory,Out-of-Network,E78.5,M54.5,,,,,,,0,,78452,Radiology,,,,49,Independent Clinic,3,2913.99,1104.45,953.8,9.48,75.0,66.17,150.65,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007370,MBR00000291,Professional,2022-06-29,2022-06-29,2022-07-11,PLN3481,1235381502,1235381502,Cardiology,In-Network,J18.9,M17.11,,,,,,,0,,85610,Pathology/Lab,,,,22,Outpatient Hospital,3,75.27,41.74,0.0,0.0,0.0,6.52,6.52,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007371,MBR00000291,Professional,2021-08-01,2021-08-01,2021-09-07,PLN5404,1366426662,1366426662,Urology,In-Network,Z00.00,Z87.891,,,,,,,0,,99203,E&M,,,,11,Office,1,296.91,136.7,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007372,MBR00000291,Professional,2021-02-08,2021-02-08,2021-02-24,PLN3962,1872613201,1872613201,Internal Medicine,In-Network,N40.0,Z12.31,,,,,,,0,,66984,Surgery,,,,49,Independent Clinic,3,1851.1,1313.27,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-18,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007373,MBR00000291,Professional,2022-04-05,2022-04-05,2022-05-09,PLN7982,1361302520,1361302520,Critical Access Hospital,In-Network,E11.65,R05,,,,,,,0,,76700,Radiology,,,,23,Emergency Room,3,584.47,199.22,144.62,0.0,25.0,29.6,54.6,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007374,MBR00000291,Professional,2023-02-14,2023-02-14,2023-03-20,PLN4011,1355166277,1355166277,Endocrinology,In-Network,I25.10,E11.9,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,1,48.21,17.2,0.0,17.2,15.0,0.0,32.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007375,MBR00000291,Professional,2021-09-22,2021-09-22,2021-10-21,PLN9725,1561134315,1561134315,DME Supplier,In-Network,I10,C50.912,,,,,,,0,,99214,E&M,,,,11,Office,2,364.09,222.12,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007376,MBR00000291,Institutional-OP,2021-10-28,2021-10-28,2021-11-04,PLN1306,1644128543,1644128543,Gastroenterology,In-Network,Z23,R10.9,,,,,,,0,,47562,Surgery,,,0730,22,Outpatient Hospital,1,2845.19,2031.19,2031.19,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007377,MBR00000291,Professional,2023-01-11,2023-01-11,2023-02-20,PLN9917,1475984649,1475984649,SNF,In-Network,I10,Z23,,,,,,,0,,58661,Surgery,,,,11,Office,2,2683.95,1806.63,1606.27,200.36,0.0,0.0,200.36,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007378,MBR00000291,Institutional-OP,2023-11-04,2023-11-04,2023-12-14,PLN7115,1624202402,1624202402,Orthopedic Surgery,In-Network,Z12.31,I11.9,,,,,,,0,,97530,Medicine,,,0370,22,Outpatient Hospital,3,128.41,95.17,95.17,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007379,MBR00000291,Professional,2022-07-21,2022-07-21,2022-09-03,PLN6517,1624202402,1624202402,Orthopedic Surgery,In-Network,R05,I48.91,,,,,,,0,,33533,Surgery,,,,11,Office,1,27161.19,11921.2,11906.2,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000007380,MBR00000291,Professional,2022-09-05,2022-09-05,2022-09-12,PLN8780,1132188260,1132188260,Family Medicine,In-Network,I10,I50.9,,,,,,,0,,99214,E&M,,,,20,Urgent Care,2,237.12,141.7,55.49,0.0,75.0,11.21,86.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007381,MBR00000291,Institutional-OP,2023-06-25,2023-06-25,2023-08-02,PLN8694,1486164553,1486164553,DME Supplier,In-Network,E11.9,I10,,,,,,,0,,90686,Medicine,,,0270,22,Outpatient Hospital,3,94.35,66.39,0.0,66.39,0.0,0.0,66.39,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000007382,MBR00000291,Professional,2021-03-14,2021-03-14,2021-04-07,PLN5876,1749327647,1749327647,Geriatrics,In-Network,G43.909,F41.9,,,,,,,0,,33533,Surgery,,,,11,Office,2,22749.55,9153.46,9128.46,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000007383,MBR00000291,Professional,2023-12-11,2023-12-11,2024-01-01,PLN3545,1847081578,1847081578,Urology,Out-of-Network,J06.9,F41.9,,,,,,,0,,G0444,Medicine,,,,11,Office,3,49.33,25.64,25.64,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000007384,MBR00000291,Professional,2022-06-06,2022-06-06,2022-07-07,PLN8730,1118885473,1118885473,ASC,In-Network,E78.5,Z96.641,,,,,,,0,,99213,E&M,,,,22,Outpatient Hospital,2,265.04,158.2,108.2,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007385,MBR00000291,Professional,2022-02-19,2022-02-19,2022-03-07,PLN8902,1696843572,1696843572,Critical Access Hospital,Out-of-Network,Z12.31,F41.9,,,,,,,0,,93225,Medicine,,,,11,Office,2,687.14,570.83,556.19,0.0,0.0,14.64,14.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007386,MBR00000291,Institutional-IP,2022-11-08,2022-11-13,2022-12-03,PLN8086,1486164553,1486164553,DME Supplier,In-Network,R51,M54.5,,,,641,MS-DRG,12,5,Y,G0439,Medicine,,,0740,21,Inpatient Hospital,3,514.45,414.49,407.6,0.0,0.0,6.89,6.89,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000007387,MBR00000291,Institutional-IP,2023-09-26,2023-09-29,2023-11-02,PLN8390,1139906830,1139906830,Endocrinology,Out-of-Network,J45.20,E78.5,,,,690,MS-DRG,7,3,Y,99204,E&M,,,0120,21,Inpatient Hospital,2,491.81,155.33,155.33,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007388,MBR00000291,Professional,2023-10-24,2023-10-24,2023-11-21,PLN5251,1717912431,1717912431,Oncology,In-Network,M54.5,Z12.11,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,3,201.34,100.9,0.0,100.9,75.0,0.0,175.9,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007389,MBR00000291,Professional,2023-05-02,2023-05-02,2023-06-07,PLN4261,1224179551,1224179551,Physical Therapy,In-Network,E11.9,N18.3,,,,,,,0,,33533,Surgery,,,,11,Office,3,10367.18,6659.92,6138.03,486.89,35.0,0.0,521.89,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000007390,MBR00000291,Professional,2022-06-14,2022-06-14,2022-07-03,PLN2535,1109850785,1109850785,ASC,Out-of-Network,Z87.891,F32.9,,,,,,,0,,99233,E&M,,,,20,Urgent Care,2,261.02,197.23,0.0,197.23,0.0,0.0,197.23,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007391,MBR00000291,Professional,2021-06-13,2021-06-13,2021-06-25,PLN3693,1749327647,1749327647,Geriatrics,In-Network,N40.0,C50.912,,,,,,,0,,83036,Pathology/Lab,,,,21,Inpatient Hospital,1,88.19,71.37,0.0,71.37,50.0,0.0,121.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000007392,MBR00000291,Institutional-OP,2021-07-28,2021-07-28,2021-08-12,PLN5607,1245650222,1245650222,Gastroenterology,In-Network,I10,Z23,,,,,,,0,,99232,E&M,,,0730,22,Outpatient Hospital,3,280.58,91.51,0.0,91.51,0.0,0.0,91.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007393,MBR00000291,Institutional-OP,2023-07-05,2023-07-05,2023-08-10,PLN8975,1453936007,1453936007,ASC,In-Network,F41.9,Z51.11,,,,,,,0,,99221,E&M,,,0370,22,Outpatient Hospital,1,404.48,339.99,339.99,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007394,MBR00000292,Professional,2021-05-17,2021-05-17,2021-06-01,PLN7273,1915531927,1915531927,Critical Access Hospital,In-Network,I10,N18.3,,,,,,,0,,70450,Radiology,,,,11,Office,1,787.22,490.76,77.57,413.19,0.0,0.0,413.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007395,MBR00000292,Professional,2022-06-12,2022-06-12,2022-06-19,PLN2620,1433937353,1433937353,Nephrology,In-Network,E11.9,E11.9,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,2,30.24,12.93,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007396,MBR00000292,Institutional-OP,2022-03-23,2022-03-23,2022-04-27,PLN7376,1700633438,1700633438,DME Supplier,In-Network,F41.9,Z12.31,,,,,,,0,,99221,E&M,,,0900,22,Outpatient Hospital,3,337.24,250.05,225.05,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007397,MBR00000292,Professional,2023-02-16,2023-02-16,2023-03-14,PLN2193,1806688928,1806688928,Geriatrics,In-Network,E78.5,F32.9,,,,,,,0,,99221,E&M,,,,11,Office,1,340.54,116.62,0.0,116.62,0.0,0.0,116.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007398,MBR00000292,Institutional-OP,2022-01-11,2022-01-11,2022-02-15,PLN8807,1713934949,1713934949,Neurology,In-Network,F41.9,C50.912,,,,,,,0,,70553,Radiology,,,0301,22,Outpatient Hospital,3,4076.07,2818.98,2782.36,36.62,0.0,0.0,36.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007399,MBR00000292,Institutional-OP,2023-02-09,2023-02-09,2023-03-12,PLN8403,1268679390,1268679390,Critical Access Hospital,In-Network,M54.5,J06.9,,,,,,,0,,99284,E&M,,,0370,22,Outpatient Hospital,3,504.78,424.73,374.73,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007400,MBR00000292,Professional,2022-07-11,2022-07-11,2022-08-06,PLN3779,1990090423,1990090423,Orthopedic Surgery,In-Network,Z12.31,Z12.11,,,,,,,0,,74177,Radiology,,,,11,Office,3,1027.73,851.68,523.37,328.31,0.0,0.0,328.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007401,MBR00000292,Institutional-OP,2023-08-29,2023-08-29,2023-09-09,PLN1034,1749327647,1749327647,Geriatrics,In-Network,Z12.31,N39.0,,,,,,,0,,74177,Radiology,,,0450,22,Outpatient Hospital,1,2701.13,843.52,820.51,0.0,0.0,23.01,23.01,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007402,MBR00000292,Professional,2021-07-24,2021-07-24,2021-08-25,PLN3772,1915531927,1915531927,Critical Access Hospital,In-Network,E11.9,S72.001A,,,,,,,0,,27130,Surgery,,,,81,Independent Laboratory,1,4186.48,2282.34,2136.97,145.37,0.0,0.0,145.37,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007403,MBR00000292,Professional,2023-04-14,2023-04-14,2023-05-10,PLN6059,1390307371,1390307371,DME Supplier,In-Network,F32.9,I10,,,,,,,0,,82043,Pathology/Lab,,,,50,Federally Qualified Health Center,3,52.77,23.33,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007404,MBR00000292,Institutional-OP,2023-03-02,2023-03-02,2023-03-17,PLN8574,1691062876,1691062876,SNF,In-Network,E11.9,N39.0,,,,,,,0,,99233,E&M,,,0510,22,Outpatient Hospital,1,264.42,198.71,0.0,198.71,25.0,0.0,223.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007405,MBR00000292,Institutional-OP,2023-06-22,2023-06-22,2023-07-19,PLN4924,1795618275,1795618275,Pulmonology,In-Network,J44.1,E11.40,,,,,,,0,,99233,E&M,,,0900,22,Outpatient Hospital,3,278.6,226.05,61.8,164.25,0.0,0.0,164.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007406,MBR00000293,Professional,2022-06-21,2022-06-21,2022-06-29,PLN6266,1713934949,1713934949,Neurology,In-Network,C50.912,E78.5,,,,,,,0,,99204,E&M,,,,11,Office,1,593.12,361.67,127.03,199.49,35.0,0.15,234.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007407,MBR00000293,Institutional-OP,2021-12-18,2021-12-18,2022-01-07,PLN3747,1550154147,1550154147,Outpatient Clinic,In-Network,K57.30,I48.91,,,,,,,0,,97110,Medicine,,,0450,22,Outpatient Hospital,1,127.18,44.01,0.0,44.01,0.0,0.0,44.01,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007408,MBR00000293,Professional,2022-07-21,2022-07-21,2022-08-14,PLN1830,1486164553,1486164553,DME Supplier,In-Network,B97.89,Z87.891,,,,,,,0,,99233,E&M,,,,11,Office,3,512.6,377.31,377.31,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007409,MBR00000293,Institutional-OP,2023-12-02,2023-12-02,2023-12-13,PLN5582,1361302520,1361302520,Critical Access Hospital,In-Network,M54.5,J06.9,,,,,,,0,,33533,Surgery,,,0900,22,Outpatient Hospital,3,23791.67,11300.1,10946.14,353.96,0.0,0.0,353.96,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000007410,MBR00000293,Institutional-OP,2021-08-02,2021-08-02,2021-09-04,PLN6999,1135158374,1135158374,Pulmonology,In-Network,B97.89,E66.9,,,,,,,0,,99203,E&M,,,0730,22,Outpatient Hospital,3,344.84,252.6,252.6,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007411,MBR00000293,Institutional-OP,2022-12-26,2022-12-26,2023-01-20,PLN6408,1622771872,1622771872,Pediatrics,In-Network,I63.9,E78.5,,,,,,,0,,85025,Pathology/Lab,,,0761,22,Outpatient Hospital,1,43.59,14.63,14.63,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007412,MBR00000293,Professional,2021-09-03,2021-09-03,2021-10-02,PLN9492,1809014947,1809014947,Urology,In-Network,Z23,M54.5,,,,,,,0,,99284,E&M,,,,31,Skilled Nursing Facility,2,668.77,322.48,322.48,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007413,MBR00000293,Professional,2023-04-28,2023-04-28,2023-05-05,PLN8247,1168881145,1168881145,Orthopedic Surgery,In-Network,M54.5,K21.0,,,,,,,0,,77067,Radiology,,,,11,Office,2,309.42,247.05,212.05,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000007414,MBR00000293,Institutional-OP,2022-04-09,2022-04-09,2022-04-18,PLN1678,1980712759,1980712759,Outpatient Clinic,Out-of-Network,I10,E11.9,,,,,,,0,,99222,E&M,,,0740,22,Outpatient Hospital,1,508.49,191.84,19.93,136.91,35.0,0.0,171.91,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007415,MBR00000293,Professional,2023-07-30,2023-07-30,2023-08-07,PLN7591,1590915516,1590915516,Physical Therapy,Out-of-Network,F03.90,R05,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,1,126.44,100.89,100.89,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007416,MBR00000293,Institutional-OP,2021-06-28,2021-06-28,2021-07-24,PLN5759,1438368327,1438368327,Home Health,In-Network,N39.0,Z12.31,,,,,,,0,,97110,Medicine,,,0320,22,Outpatient Hospital,3,107.44,84.26,34.26,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007417,MBR00000293,Professional,2021-05-16,2021-05-16,2021-05-27,PLN1427,1891849440,1891849440,Oncology,In-Network,E11.9,Z96.641,,,,,,,0,,47562,Surgery,,,,21,Inpatient Hospital,3,6633.5,2767.83,2370.0,0.0,50.0,347.83,397.83,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007418,MBR00000293,Professional,2023-11-08,2023-11-08,2023-12-13,PLN1345,1139906830,1139906830,Endocrinology,Out-of-Network,F10.20,N39.0,,,,,,,0,,99232,E&M,,,,23,Emergency Room,1,156.86,77.4,37.14,0.0,35.0,5.26,40.26,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007419,MBR00000293,Professional,2022-01-04,2022-01-04,2022-02-11,PLN9094,1355166277,1355166277,Endocrinology,In-Network,S72.001A,K21.0,,,,,,,0,,27447,Surgery,,,,11,Office,2,3362.54,1445.91,1445.91,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007420,MBR00000293,Professional,2021-04-03,2021-04-03,2021-05-14,PLN2587,1366576336,1366576336,Geriatrics,In-Network,J44.1,Z12.11,,,,,,,0,,99283,E&M,,,,12,Home,3,384.58,307.18,0.0,307.18,0.0,0.0,307.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007421,MBR00000293,Professional,2023-07-05,2023-07-05,2023-07-16,PLN7442,1283743001,1283743001,Family Medicine,In-Network,M54.5,Z12.11,,,,,,,0,,90686,Medicine,,,,11,Office,3,95.16,77.51,0.0,77.51,0.0,0.0,77.51,0.0,Paid,,,0,,0,1,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000007422,MBR00000293,Professional,2022-03-30,2022-03-30,2022-04-30,PLN4672,1644128543,1644128543,Gastroenterology,In-Network,E11.9,S72.001A,,,,,,,0,,90460,Medicine,,,,23,Emergency Room,2,44.82,13.87,0.0,13.87,0.0,0.0,13.87,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007423,MBR00000293,Institutional-OP,2023-10-07,2023-10-07,2023-11-10,PLN9997,1752470395,1752470395,Home Health,In-Network,C50.912,C50.912,,,,,,,0,,99283,E&M,,,0270,22,Outpatient Hospital,2,546.44,411.24,334.52,76.72,0.0,0.0,76.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007424,MBR00000293,Professional,2022-04-25,2022-04-25,2022-05-14,PLN4429,1727809972,1727809972,Home Health,In-Network,C50.912,J20.9,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,3,134.03,100.86,24.44,0.0,75.0,1.42,76.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007425,MBR00000293,Institutional-IP,2023-04-08,2023-04-14,2023-04-27,PLN9123,1561134315,1561134315,DME Supplier,In-Network,F32.9,E11.9,,,,683,MS-DRG,22,6,Y,83036,Pathology/Lab,,,0636,21,Inpatient Hospital,2,55.94,27.25,22.71,0.0,0.0,4.54,4.54,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,1,0,0
CLM0000007426,MBR00000293,Professional,2022-09-26,2022-09-26,2022-11-08,PLN4890,1109850785,1109850785,ASC,Out-of-Network,J18.9,E78.5,,,,,,,0,,83036,Pathology/Lab,,,,21,Inpatient Hospital,2,86.07,69.16,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000007427,MBR00000293,Institutional-IP,2022-06-13,2022-06-16,2022-07-24,PLN7413,1872613201,1872613201,Internal Medicine,In-Network,E11.9,J20.9,,,,470,MS-DRG,17,3,Y,99221,E&M,,,0360,21,Inpatient Hospital,2,293.36,177.9,24.23,78.67,75.0,0.0,153.67,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007428,MBR00000293,Professional,2022-06-17,2022-06-17,2022-07-14,PLN4851,1631954542,1631954542,Oncology,In-Network,N39.0,E11.9,,,,,,,0,,80061,Pathology/Lab,,,,22,Outpatient Hospital,1,72.58,39.33,33.39,0.0,0.0,5.94,5.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007429,MBR00000293,Institutional-OP,2021-10-02,2021-10-02,2021-10-16,PLN8468,1283743001,1283743001,Family Medicine,In-Network,J06.9,I25.10,,,,,,,0,,58661,Surgery,,,0320,22,Outpatient Hospital,2,2382.27,937.31,514.97,356.8,50.0,15.54,422.34,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007430,MBR00000293,Professional,2023-03-18,2023-03-18,2023-04-23,PLN9674,1135158374,1135158374,Pulmonology,In-Network,J45.20,J20.9,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,1,49.46,17.65,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007431,MBR00000293,Professional,2022-07-29,2022-07-29,2022-08-19,PLN4096,1500037969,1500037969,Pulmonology,In-Network,E78.5,E11.65,,,,,,,0,,45378,Surgery,,,,11,Office,1,2537.08,2154.56,2154.56,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000007432,MBR00000293,Professional,2021-01-02,2021-01-02,2021-01-15,PLN3115,1767011137,1767011137,DME Supplier,In-Network,E11.9,J44.1,,,,,,,0,,G0444,Medicine,,,,20,Urgent Care,2,41.51,19.23,19.23,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000007433,MBR00000293,Professional,2022-03-12,2022-03-12,2022-04-24,PLN8393,1717546253,1717546253,Family Medicine,In-Network,I10,F03.90,,,,,,,0,,99203,E&M,,,,11,Office,2,193.02,117.7,116.07,0.0,0.0,1.63,1.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007434,MBR00000293,Professional,2022-03-21,2022-03-21,2022-04-01,PLN5712,1475984649,1475984649,SNF,In-Network,J45.20,E78.5,,,,,,,0,,99214,E&M,,,,11,Office,2,437.33,182.51,167.51,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007435,MBR00000293,Institutional-IP,2023-08-28,2023-09-01,2023-09-05,PLN9657,1500949740,1500949740,Pediatrics,In-Network,J45.20,J20.9,,,,871,MS-DRG,23,4,Y,99214,E&M,,,0636,21,Inpatient Hospital,2,230.81,72.04,69.52,0.0,0.0,2.52,2.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007436,MBR00000293,Professional,2022-04-13,2022-04-13,2022-05-12,PLN1280,1186826716,1186826716,Physical Therapy,In-Network,M81.0,N18.3,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,3,382.42,165.34,131.48,22.06,0.0,11.8,33.86,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007437,MBR00000293,Institutional-OP,2022-09-14,2022-09-14,2022-10-11,PLN8171,1268679390,1268679390,Critical Access Hospital,In-Network,F41.9,J06.9,,,,,,,0,,43239,Surgery,,,0510,22,Outpatient Hospital,1,1652.16,1206.22,1206.22,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007438,MBR00000293,Professional,2021-04-01,2021-04-01,2021-04-11,PLN5972,1463205530,1463205530,Nephrology,In-Network,K21.0,K21.0,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,1,33.87,20.11,20.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007439,MBR00000293,Institutional-IP,2022-03-06,2022-03-08,2022-04-12,PLN7239,1757138478,1757138478,Pediatrics,In-Network,Z87.891,J06.9,,,,291,MS-DRG,8,2,Y,99214,E&M,,,0636,21,Inpatient Hospital,3,171.38,136.59,122.35,0.0,0.0,14.24,14.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007440,MBR00000293,Professional,2021-11-08,2021-11-08,2021-12-06,PLN3599,1193493783,1193493783,Critical Access Hospital,Out-of-Network,I10,I48.91,,,,,,,0,,99233,E&M,,,,81,Independent Laboratory,3,272.57,173.07,0.0,173.07,0.0,0.0,173.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007441,MBR00000293,Institutional-OP,2022-06-30,2022-06-30,2022-08-08,PLN9168,1727809972,1727809972,Home Health,In-Network,I10,R05,,,,,,,0,,74177,Radiology,,,0200,22,Outpatient Hospital,3,2533.71,1892.85,1530.82,337.03,25.0,0.0,362.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007442,MBR00000293,Institutional-OP,2023-09-11,2023-09-11,2023-10-08,PLN8979,1716521444,1716521444,Oncology,In-Network,M54.5,E11.9,,,,,,,0,,85025,Pathology/Lab,,,0200,22,Outpatient Hospital,1,36.39,25.67,25.67,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007443,MBR00000293,Professional,2023-10-20,2023-10-20,2023-11-11,PLN7467,1168881145,1168881145,Orthopedic Surgery,In-Network,M54.5,I25.10,,,,,,,0,,70553,Radiology,,,,20,Urgent Care,1,3714.02,1273.2,1090.27,0.0,0.0,182.93,182.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007444,MBR00000293,Professional,2021-11-11,2021-11-11,2021-11-25,PLN6837,1790497490,1790497490,OB/GYN,In-Network,F41.9,G20,,,,,,,0,,81001,Pathology/Lab,,,,81,Independent Laboratory,1,38.13,20.04,20.04,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007445,MBR00000293,Institutional-IP,2022-11-03,2022-11-15,2022-12-07,PLN1327,1780163051,1780163051,SNF,In-Network,Z23,I25.10,,,,194,MS-DRG,1,12,Y,80061,Pathology/Lab,,,0900,21,Inpatient Hospital,3,61.86,35.66,0.0,35.66,0.0,0.0,35.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007446,MBR00000293,Professional,2023-11-12,2023-11-12,2023-12-07,PLN4611,1542828721,1542828721,Orthopedic Surgery,In-Network,N18.3,E78.5,,,,,,,0,,99232,E&M,,,,12,Home,1,198.0,127.22,0.0,55.63,0.0,4.95,60.58,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007447,MBR00000293,Professional,2021-09-08,2021-09-08,2021-10-14,PLN3222,1806688928,1806688928,Geriatrics,In-Network,N40.0,G43.909,,,,,,,0,,99221,E&M,,,,11,Office,3,259.84,193.29,0.0,193.29,15.0,0.0,208.29,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000007448,MBR00000293,Professional,2022-04-25,2022-04-25,2022-05-31,PLN7448,1563980627,1563980627,Critical Access Hospital,In-Network,I63.9,E78.5,,,,,,,0,,97110,Medicine,,,,22,Outpatient Hospital,3,216.74,123.79,116.75,0.0,0.0,7.04,7.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007449,MBR00000293,Professional,2022-07-02,2022-07-02,2022-08-06,PLN7127,1242201429,1242201429,General Acute Care Hospital,In-Network,E78.5,F41.9,,,,,,,0,,87491,Pathology/Lab,,,,22,Outpatient Hospital,2,225.57,141.79,126.6,0.0,0.0,15.19,15.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007450,MBR00000293,Institutional-OP,2021-01-04,2021-01-04,2021-01-14,PLN8744,1366576336,1366576336,Geriatrics,In-Network,Z23,J45.20,,,,,,,0,,90686,Medicine,,,0320,22,Outpatient Hospital,2,102.76,79.43,66.89,0.0,0.0,12.54,12.54,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000007451,MBR00000293,Professional,2022-05-25,2022-05-25,2022-07-08,PLN5374,1453936007,1453936007,ASC,In-Network,I10,M54.5,,,,,,,0,,G0468,Medicine,,,,20,Urgent Care,1,421.26,150.16,0.0,0.0,35.0,8.9,43.9,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007452,MBR00000293,Professional,2021-05-13,2021-05-13,2021-05-29,PLN8745,1974006077,1974006077,Orthopedic Surgery,In-Network,J20.9,R05,,,,,,,0,,99213,E&M,,,,11,Office,2,182.81,76.34,33.48,0.0,35.0,7.86,42.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007453,MBR00000293,Professional,2021-12-06,2021-12-06,2021-12-31,PLN2907,1542828721,1542828721,Orthopedic Surgery,In-Network,Z00.00,J18.9,,,,,,,0,,93000,Radiology,,,,11,Office,1,163.43,102.27,0.0,102.27,0.0,0.0,102.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007454,MBR00000293,Professional,2021-05-07,2021-05-07,2021-05-25,PLN4643,1717546253,1717546253,Family Medicine,In-Network,Z51.11,E78.5,,,,,,,0,,81001,Pathology/Lab,,,,22,Outpatient Hospital,3,23.0,12.41,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007455,MBR00000293,Institutional-IP,2023-03-18,2023-03-21,2023-04-30,PLN6772,1564502315,1564502315,ASC,In-Network,F41.9,R05,,,,195,MS-DRG,14,3,Y,70450,Radiology,,,0450,21,Inpatient Hospital,2,858.07,634.85,219.31,415.54,0.0,0.0,415.54,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007456,MBR00000294,Institutional-OP,2023-07-04,2023-07-04,2023-08-12,PLN8340,1915531927,1915531927,Critical Access Hospital,In-Network,N18.3,I10,,,,,,,0,,99221,E&M,,,0761,22,Outpatient Hospital,2,331.22,182.83,0.0,182.83,0.0,0.0,182.83,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007457,MBR00000294,Institutional-OP,2021-10-21,2021-10-21,2021-11-24,PLN6801,1696843572,1696843572,Critical Access Hospital,Out-of-Network,E78.5,Z00.01,,,,,,,0,,93306,Radiology,,,0450,22,Outpatient Hospital,2,2499.98,2111.68,1694.8,366.88,50.0,0.0,416.88,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007458,MBR00000294,Professional,2021-02-14,2021-02-14,2021-03-22,PLN2016,1860435061,1860435061,DME Supplier,In-Network,Z00.00,Z87.891,,,,,,,0,,47562,Surgery,,,,23,Emergency Room,2,5216.45,2840.87,2399.55,0.0,15.0,0.0,15.0,426.32,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007459,MBR00000294,Professional,2022-06-24,2022-06-24,2022-07-10,PLN1655,1606140917,1606140917,ASC,In-Network,Z79.4,N39.0,,,,,,,0,,93000,Radiology,,,,31,Skilled Nursing Facility,2,87.0,30.67,24.25,0.0,0.0,0.0,0.0,6.42,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007460,MBR00000294,Professional,2021-05-06,2021-05-06,2021-05-14,PLN6618,1968299309,1968299309,Internal Medicine,In-Network,F41.9,E78.5,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,1,157.22,87.92,87.92,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007461,MBR00000294,Institutional-IP,2022-04-28,2022-04-29,2022-05-13,PLN8256,1563980627,1563980627,Critical Access Hospital,In-Network,E78.5,R10.9,,,,195,MS-DRG,6,1,Y,99214,E&M,,,0320,21,Inpatient Hospital,3,443.43,325.49,325.49,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007462,MBR00000294,Institutional-OP,2022-08-19,2022-08-19,2022-10-02,PLN6288,1689639685,1689639685,SNF,In-Network,N40.0,F10.20,,,,,,,0,,47562,Surgery,,,0320,22,Outpatient Hospital,1,5151.88,1695.21,1335.18,335.03,25.0,0.0,360.03,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007463,MBR00000294,Institutional-OP,2022-05-27,2022-05-27,2022-06-09,PLN2969,1475984649,1475984649,SNF,In-Network,J06.9,N39.0,,,,,,,0,,99232,E&M,,,0270,22,Outpatient Hospital,2,211.78,109.82,95.52,0.0,0.0,14.3,14.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007464,MBR00000294,Institutional-OP,2022-07-26,2022-07-26,2022-08-12,PLN6025,1780163051,1780163051,SNF,In-Network,K21.0,E66.9,,,,,,,0,,77067,Radiology,,,0270,22,Outpatient Hospital,1,755.73,407.2,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000007465,MBR00000295,Professional,2022-09-13,2022-09-13,2022-10-18,PLN5760,1395983630,1395983630,Nephrology,In-Network,E11.65,J20.9,,,,,,,0,,99232,E&M,,,,11,Office,3,277.84,228.85,147.06,81.79,0.0,0.0,81.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007466,MBR00000295,Institutional-OP,2021-06-29,2021-06-29,2021-08-05,PLN8247,1422747896,1422747896,Urology,In-Network,E11.40,E11.65,,,,,,,0,,99233,E&M,,,0301,22,Outpatient Hospital,2,485.87,170.44,53.29,117.15,0.0,0.0,117.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007467,MBR00000295,Institutional-OP,2023-01-19,2023-01-19,2023-02-18,PLN9604,1806688928,1806688928,Geriatrics,In-Network,C50.912,J44.1,,,,,,,0,,80061,Pathology/Lab,,,0320,22,Outpatient Hospital,1,77.03,29.56,3.71,0.0,25.0,0.85,25.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007468,MBR00000295,Professional,2023-01-02,2023-01-02,2023-01-26,PLN8151,1139906830,1139906830,Endocrinology,Out-of-Network,Z00.00,I10,,,,,,,0,,99213,E&M,,,,12,Home,1,232.75,132.12,132.12,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007469,MBR00000295,Professional,2021-06-06,2021-06-06,2021-07-13,PLN7444,1563980627,1563980627,Critical Access Hospital,In-Network,J44.1,E11.9,,,,,,,0,,27130,Surgery,,,,11,Office,1,2894.47,2296.43,2263.11,0.0,25.0,8.32,33.32,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007470,MBR00000295,Institutional-OP,2022-04-21,2022-04-21,2022-05-19,PLN7691,1687650653,1687650653,Internal Medicine,In-Network,N18.3,E11.65,,,,,,,0,,80053,Pathology/Lab,,,0636,22,Outpatient Hospital,3,110.45,59.98,48.4,0.0,0.0,11.58,11.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007471,MBR00000295,Professional,2021-11-12,2021-11-12,2021-12-04,PLN4392,1696843572,1696843572,Critical Access Hospital,Out-of-Network,I10,Z23,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,1,45.15,34.11,0.0,34.11,25.0,0.0,59.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000007472,MBR00000295,Professional,2022-03-12,2022-03-12,2022-04-25,PLN1768,1125190055,1125190055,Nephrology,In-Network,J18.9,K57.30,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,1,67.06,29.53,0.0,29.53,15.0,0.0,44.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007473,MBR00000295,Professional,2023-04-27,2023-04-27,2023-05-19,PLN5233,1434029575,1434029575,Endocrinology,In-Network,M54.5,N39.0,,,,,,,0,,93000,Radiology,,,,81,Independent Laboratory,2,173.99,69.08,55.23,9.25,0.0,4.6,13.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007474,MBR00000295,Institutional-IP,2022-10-16,2022-10-22,2022-11-28,PLN4703,1108115157,1108115157,General Acute Care Hospital,In-Network,J44.1,I10,,,,196,MS-DRG,20,6,Y,93306,Radiology,,,0270,21,Inpatient Hospital,2,2922.51,2257.56,2257.56,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007475,MBR00000295,Institutional-OP,2023-09-21,2023-09-21,2023-10-15,PLN1746,1540044947,1540044947,Pulmonology,Out-of-Network,E11.9,C50.912,,,,,,,0,,77067,Radiology,,,0200,22,Outpatient Hospital,2,539.4,283.94,250.07,33.87,0.0,0.0,33.87,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000007476,MBR00000295,Institutional-OP,2022-09-16,2022-09-16,2022-10-08,PLN3723,1108115157,1108115157,General Acute Care Hospital,In-Network,I10,J18.9,,,,,,,0,,66984,Surgery,,,0510,22,Outpatient Hospital,1,2254.98,1669.68,1287.15,307.53,75.0,0.0,382.53,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007477,MBR00000295,Institutional-OP,2021-02-18,2021-02-18,2021-03-28,PLN8779,1563980627,1563980627,Critical Access Hospital,In-Network,M54.5,K21.0,,,,,,,0,,58661,Surgery,,,0761,22,Outpatient Hospital,1,2221.62,1717.37,0.0,0.0,15.0,31.02,46.02,0.0,Denied,CO-27,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007478,MBR00000295,Professional,2023-02-18,2023-02-18,2023-03-20,PLN4835,1689639685,1689639685,SNF,In-Network,E11.9,R05,,,,,,,0,,99204,E&M,,,,11,Office,1,528.43,264.01,0.0,264.01,50.0,0.0,314.01,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007479,MBR00000295,Institutional-OP,2021-03-22,2021-03-22,2021-03-30,PLN2739,1114982472,1114982472,Orthopedic Surgery,In-Network,N20.0,J18.9,,,,,,,0,,81001,Pathology/Lab,,,0301,22,Outpatient Hospital,3,29.72,9.22,0.0,9.22,0.0,0.0,9.22,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007480,MBR00000295,Professional,2022-01-10,2022-01-10,2022-01-31,PLN6438,1556140803,1556140803,Cardiology,In-Network,E11.65,I48.91,,,,,,,0,,45378,Surgery,,,,81,Independent Laboratory,3,1022.78,754.76,739.76,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000007481,MBR00000295,Professional,2023-10-20,2023-10-20,2023-11-22,PLN3829,1540044947,1540044947,Pulmonology,Out-of-Network,Z00.00,F32.9,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,3,48.6,24.01,0.0,24.01,0.0,0.0,24.01,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007482,MBR00000295,Institutional-OP,2023-12-20,2023-12-20,2024-01-18,PLN6937,1575695214,1575695214,SNF,In-Network,M54.5,C50.912,,,,,,,0,,27447,Surgery,,,0120,22,Outpatient Hospital,3,5908.91,4191.21,3540.24,427.21,50.0,173.76,650.97,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007483,MBR00000295,Institutional-OP,2021-06-11,2021-06-11,2021-07-22,PLN3005,1660288235,1660288235,ASC,In-Network,R07.9,E78.5,,,,,,,0,,77067,Radiology,,,0270,22,Outpatient Hospital,3,811.72,484.07,330.76,118.31,35.0,0.0,153.31,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000007484,MBR00000295,Institutional-IP,2023-12-15,2023-12-26,2023-12-24,PLN9060,1752470395,1752470395,Home Health,In-Network,I25.10,E78.5,,,,641,MS-DRG,15,11,Y,G0444,Medicine,,,0730,21,Inpatient Hospital,1,99.52,68.32,53.32,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000007485,MBR00000295,Professional,2023-12-09,2023-12-09,2024-01-11,PLN3300,1219817751,1219817751,OB/GYN,In-Network,F41.9,I25.10,,,,,,,0,,99204,E&M,,,,31,Skilled Nursing Facility,3,268.87,156.07,121.07,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007486,MBR00000295,Professional,2023-08-20,2023-08-20,2023-09-22,PLN2937,1450094833,1450094833,Outpatient Clinic,In-Network,N39.0,N40.0,,,,,,,0,,99221,E&M,,,,65,End-Stage Renal Disease,1,439.37,233.1,15.0,183.1,35.0,0.0,218.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007487,MBR00000295,Institutional-IP,2023-06-26,2023-06-27,2023-07-31,PLN2467,1334916761,1334916761,ASC,In-Network,Z23,Z12.31,,,,292,MS-DRG,13,1,Y,99203,E&M,,,0301,21,Inpatient Hospital,2,160.33,91.64,16.02,0.0,75.0,0.62,75.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007488,MBR00000295,Professional,2021-03-24,2021-03-24,2021-04-25,PLN1877,1790497490,1790497490,OB/GYN,In-Network,M54.5,F41.9,,,,,,,0,,G0439,Medicine,,,,22,Outpatient Hospital,1,555.71,395.54,304.53,0.0,50.0,41.01,91.01,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000007489,MBR00000295,Professional,2021-05-13,2021-05-13,2021-06-07,PLN5200,1660288235,1660288235,ASC,In-Network,I10,Z00.00,,,,,,,0,,99232,E&M,,,,23,Emergency Room,1,312.26,150.44,0.0,51.04,35.0,9.31,95.35,0.0,Denied,PR-1,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007490,MBR00000295,Institutional-OP,2022-11-04,2022-11-04,2022-12-06,PLN9351,1361302520,1361302520,Critical Access Hospital,In-Network,Z87.891,F32.9,,,,,,,0,,80061,Pathology/Lab,,,0900,22,Outpatient Hospital,2,77.57,60.33,0.0,60.33,0.0,0.0,60.33,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007491,MBR00000295,Professional,2021-04-23,2021-04-23,2021-05-29,PLN3940,1453936007,1453936007,ASC,In-Network,E11.9,E78.5,,,,,,,0,,99233,E&M,,,,11,Office,3,482.49,244.59,137.29,0.0,75.0,32.3,107.3,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007492,MBR00000295,Professional,2021-10-02,2021-10-02,2021-11-02,PLN4541,1847081578,1847081578,Urology,Out-of-Network,E78.5,Z12.31,,,,,,,0,,97530,Medicine,,,,11,Office,3,173.11,128.34,53.34,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007493,MBR00000295,Professional,2023-12-07,2023-12-07,2023-12-19,PLN7468,1239316214,1239316214,Internal Medicine,In-Network,R51,J06.9,,,,,,,0,,99204,E&M,,,,11,Office,2,204.02,85.34,0.0,85.34,35.0,0.0,120.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007494,MBR00000295,Professional,2023-09-24,2023-09-24,2023-10-07,PLN2682,1450094833,1450094833,Outpatient Clinic,In-Network,E78.5,Z23,,,,,,,0,,99213,E&M,,,,21,Inpatient Hospital,3,176.89,58.56,50.63,0.0,0.0,7.93,7.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007495,MBR00000295,Professional,2021-10-07,2021-10-07,2021-10-21,PLN3885,1644128543,1644128543,Gastroenterology,In-Network,J06.9,K57.30,,,,,,,0,,97110,Medicine,,,,12,Home,2,265.2,86.88,0.0,12.15,75.0,0.0,87.15,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007496,MBR00000295,Professional,2022-08-13,2022-08-13,2022-09-24,PLN2363,1865904917,1865904917,Outpatient Clinic,In-Network,E78.5,E78.5,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,2,171.07,91.65,91.65,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007497,MBR00000295,Professional,2022-08-13,2022-08-13,2022-09-09,PLN9318,1939033455,1939033455,Pulmonology,In-Network,E11.9,Z12.31,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,2,16672.24,14105.8,14105.8,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000007498,MBR00000295,Professional,2021-10-15,2021-10-15,2021-11-23,PLN8538,1410468316,1410468316,SNF,In-Network,I50.9,E78.5,,,,,,,0,,70553,Radiology,,,,22,Outpatient Hospital,3,3007.88,2452.26,2427.26,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007499,MBR00000296,Professional,2021-09-16,2021-09-16,2021-10-01,PLN9141,1283743001,1283743001,Family Medicine,In-Network,M17.11,K21.0,,,,,,,0,,99203,E&M,,,,11,Office,2,268.88,189.51,0.0,189.51,0.0,0.0,189.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007500,MBR00000296,Institutional-OP,2022-04-24,2022-04-24,2022-05-03,PLN3298,1366426662,1366426662,Urology,In-Network,E11.9,R07.9,,,,,,,0,,90837,Medicine,,,0120,22,Outpatient Hospital,3,214.08,68.65,0.0,68.65,0.0,0.0,68.65,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000007501,MBR00000296,Professional,2022-10-20,2022-10-20,2022-11-14,PLN1245,1767011137,1767011137,DME Supplier,In-Network,E78.5,I63.9,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,2,110.22,93.5,0.0,93.5,25.0,0.0,118.5,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000007502,MBR00000296,Institutional-IP,2023-05-31,2023-06-07,2023-06-25,PLN7218,1974006077,1974006077,Orthopedic Surgery,In-Network,N39.0,E78.5,,,,641,MS-DRG,13,7,Y,90460,Medicine,,,0636,21,Inpatient Hospital,1,35.78,22.48,0.0,22.48,0.0,0.0,22.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007503,MBR00000296,Institutional-IP,2023-07-09,2023-07-13,2023-07-17,PLN2165,1528335731,1528335731,Critical Access Hospital,In-Network,F03.90,J44.1,,,,641,MS-DRG,19,4,Y,86900,Pathology/Lab,,,0120,21,Inpatient Hospital,3,34.57,18.2,0.0,18.2,0.0,0.0,18.2,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000007504,MBR00000296,Professional,2021-01-23,2021-01-23,2021-02-19,PLN6811,1606140917,1606140917,ASC,In-Network,J06.9,I11.9,,,,,,,0,,72148,Radiology,,,,22,Outpatient Hospital,2,1819.15,1159.6,1134.6,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007505,MBR00000296,Professional,2022-12-21,2022-12-21,2023-01-06,PLN1518,1689639685,1689639685,SNF,In-Network,J20.9,I10,,,,,,,0,,23472,Surgery,,,,11,Office,1,3452.17,1738.65,1506.63,182.02,50.0,0.0,232.02,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007506,MBR00000296,Institutional-OP,2022-11-06,2022-11-06,2022-11-30,PLN2077,1948810580,1948810580,DME Supplier,In-Network,R10.9,N17.9,,,,,,,0,,90686,Medicine,,,0200,22,Outpatient Hospital,3,127.82,80.85,0.0,80.85,0.0,0.0,80.85,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000007507,MBR00000296,Professional,2021-02-21,2021-02-21,2021-03-31,PLN8837,1749327647,1749327647,Geriatrics,In-Network,E11.9,K92.1,,,,,,,0,,58661,Surgery,,,,11,Office,3,3328.19,1156.47,1156.47,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007508,MBR00000296,Institutional-IP,2023-07-03,2023-07-10,2023-07-19,PLN6397,1717912431,1717912431,Oncology,In-Network,E11.65,R07.9,,,,682,MS-DRG,2,7,Y,97110,Medicine,,,0270,21,Inpatient Hospital,2,223.87,121.18,121.18,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007509,MBR00000296,Institutional-IP,2022-10-14,2022-10-17,2022-10-26,PLN6119,1585582070,1585582070,Outpatient Clinic,In-Network,K21.0,I11.9,,,,641,MS-DRG,20,3,Y,99232,E&M,,,0900,21,Inpatient Hospital,2,237.71,175.11,175.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000007510,MBR00000296,Institutional-OP,2023-02-27,2023-02-27,2023-03-18,PLN9569,1622771872,1622771872,Pediatrics,In-Network,I10,I10,,,,,,,0,,93306,Radiology,,,0120,22,Outpatient Hospital,2,2904.0,1250.61,1143.86,0.0,50.0,56.75,106.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007511,MBR00000296,Professional,2022-12-25,2022-12-25,2023-01-22,PLN4841,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,N20.0,J20.9,,,,,,,0,,74177,Radiology,,,,81,Independent Laboratory,3,1836.64,797.01,797.01,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007512,MBR00000296,Professional,2022-01-02,2022-01-02,2022-01-11,PLN4712,1713934949,1713934949,Neurology,In-Network,I48.91,I10,,,,,,,0,,99221,E&M,,,,12,Home,3,446.74,185.74,83.37,95.7,0.0,6.67,102.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007513,MBR00000296,Professional,2021-08-08,2021-08-08,2021-09-01,PLN6372,1361302520,1361302520,Critical Access Hospital,In-Network,E78.5,E11.9,,,,,,,0,,99213,E&M,,,,50,Federally Qualified Health Center,3,310.07,158.64,0.0,158.64,0.0,0.0,158.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007514,MBR00000296,Institutional-OP,2022-02-18,2022-02-18,2022-03-15,PLN2794,1800011727,1800011727,Clinical Laboratory,Out-of-Network,J20.9,Z79.4,,,,,,,0,,86900,Pathology/Lab,,,0740,22,Outpatient Hospital,3,44.01,30.78,0.0,30.78,15.0,0.0,45.78,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007515,MBR00000296,Professional,2023-04-15,2023-04-15,2023-05-12,PLN4787,1219817751,1219817751,OB/GYN,In-Network,M54.5,E87.6,,,,,,,0,,45378,Surgery,,,,20,Urgent Care,2,2301.57,1039.52,1004.52,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000007516,MBR00000296,Institutional-OP,2022-11-29,2022-11-29,2022-12-22,PLN1384,1500037969,1500037969,Pulmonology,In-Network,E11.9,E78.5,,,,,,,0,,72148,Radiology,,,0320,22,Outpatient Hospital,1,1105.24,600.04,405.49,144.55,50.0,0.0,194.55,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007517,MBR00000296,Institutional-OP,2022-11-18,2022-11-18,2022-11-27,PLN7759,1728018911,1728018911,Nephrology,In-Network,Z96.641,J18.9,,,,,,,0,,58661,Surgery,,,0270,22,Outpatient Hospital,1,4300.06,2359.1,2359.1,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007518,MBR00000296,Professional,2021-05-23,2021-05-23,2021-06-15,PLN4155,1809014947,1809014947,Urology,In-Network,I25.10,E11.9,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,3,157.59,88.35,47.99,0.0,35.0,5.36,40.36,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000007519,MBR00000296,Professional,2021-01-11,2021-01-11,2021-01-20,PLN5110,1219817751,1219817751,OB/GYN,In-Network,M54.5,E78.5,,,,,,,0,,99204,E&M,,,,20,Urgent Care,2,333.42,180.44,177.19,0.0,0.0,3.25,3.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007520,MBR00000296,Institutional-OP,2023-01-02,2023-01-02,2023-01-23,PLN2963,1500037969,1500037969,Pulmonology,In-Network,S72.001A,Z00.00,,,,,,,0,,66984,Surgery,,,0510,22,Outpatient Hospital,3,2191.69,725.85,658.65,17.2,50.0,0.0,67.2,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007521,MBR00000296,Professional,2023-11-07,2023-11-07,2023-12-02,PLN5917,1502838586,1502838586,ASC,In-Network,E78.5,I48.91,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,1,148.75,90.27,0.0,90.27,50.0,0.0,140.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007522,MBR00000296,Professional,2022-01-28,2022-01-28,2022-03-11,PLN4541,1991459367,1991459367,Neurology,Out-of-Network,I10,E11.9,,,,,,,0,,99221,E&M,,,,11,Office,1,278.82,131.69,81.69,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007523,MBR00000296,Professional,2022-05-03,2022-05-03,2022-05-20,PLN6833,1410468316,1410468316,SNF,In-Network,I10,Z00.00,,,,,,,0,,99222,E&M,,,,23,Emergency Room,3,431.16,324.93,324.93,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007524,MBR00000296,Professional,2023-11-15,2023-11-15,2023-12-05,PLN8615,1817234602,1817234602,Clinical Laboratory,In-Network,R10.9,J06.9,,,,,,,0,,85025,Pathology/Lab,,,,22,Outpatient Hospital,2,82.79,26.5,0.0,26.5,25.0,0.0,51.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007525,MBR00000296,Professional,2021-09-12,2021-09-12,2021-10-14,PLN6317,1450553056,1450553056,Clinical Laboratory,In-Network,M54.5,J06.9,,,,,,,0,,99233,E&M,,,,11,Office,3,280.16,142.73,117.73,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007526,MBR00000296,Institutional-OP,2022-07-26,2022-07-26,2022-08-11,PLN3947,1193493783,1193493783,Critical Access Hospital,Out-of-Network,M54.5,E11.65,,,,,,,0,,90837,Medicine,,,0360,22,Outpatient Hospital,3,235.97,98.0,98.0,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007527,MBR00000296,Institutional-IP,2021-04-05,2021-04-14,2021-04-18,PLN3970,1124394415,1124394415,Pediatrics,In-Network,N39.0,M54.5,,,,195,MS-DRG,4,9,Y,99233,E&M,,,0320,21,Inpatient Hospital,2,492.66,279.55,194.17,0.0,75.0,10.38,85.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007528,MBR00000296,Professional,2021-10-16,2021-10-16,2021-11-19,PLN2136,1752470395,1752470395,Home Health,In-Network,J20.9,Z23,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,1,101.82,45.96,10.96,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007529,MBR00000296,Professional,2022-02-14,2022-02-14,2022-03-21,PLN8369,1364429278,1364429278,OB/GYN,In-Network,E78.5,Z00.00,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,2,433.18,214.35,214.35,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007530,MBR00000296,Professional,2023-01-21,2023-01-21,2023-02-18,PLN4205,1847081578,1847081578,Urology,Out-of-Network,R10.9,I48.91,,,,,,,0,,76700,Radiology,,,,11,Office,1,939.19,322.86,0.0,0.0,0.0,0.0,0.0,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007531,MBR00000296,Institutional-IP,2021-12-04,2021-12-07,2021-12-15,PLN2589,1946680931,1946680931,Critical Access Hospital,Out-of-Network,J06.9,Z12.31,,,,292,MS-DRG,8,3,Y,93000,Radiology,,,0270,21,Inpatient Hospital,3,141.34,52.15,0.0,52.15,75.0,0.0,127.15,0.0,Pended,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007532,MBR00000296,Professional,2022-05-20,2022-05-20,2022-06-02,PLN8768,1910255109,1910255109,DME Supplier,In-Network,I10,J06.9,,,,,,,0,,99221,E&M,,,,20,Urgent Care,2,410.44,181.73,42.78,135.52,0.0,3.43,138.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007533,MBR00000296,Institutional-OP,2021-11-23,2021-11-23,2021-12-10,PLN7811,1556140803,1556140803,Cardiology,In-Network,J45.20,E11.9,,,,,,,0,,99222,E&M,,,0740,22,Outpatient Hospital,2,557.08,375.17,340.17,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007534,MBR00000296,Institutional-OP,2021-06-04,2021-06-04,2021-07-04,PLN5068,1268679390,1268679390,Critical Access Hospital,In-Network,E11.9,Z00.01,,,,,,,0,,97110,Medicine,,,0370,22,Outpatient Hospital,3,149.81,74.13,0.0,74.13,0.0,0.0,74.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007535,MBR00000296,Institutional-OP,2023-05-19,2023-05-19,2023-06-14,PLN4577,1219817751,1219817751,OB/GYN,In-Network,B97.89,N18.3,,,,,,,0,,99233,E&M,,,0120,22,Outpatient Hospital,1,487.02,282.01,282.01,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000007536,MBR00000296,Professional,2023-01-07,2023-01-07,2023-02-08,PLN3324,1569105090,1569105090,Geriatrics,In-Network,K92.1,Z00.00,,,,,,,0,,99283,E&M,,,,12,Home,3,325.69,105.69,0.0,105.69,50.0,0.0,155.69,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000007537,MBR00000296,Institutional-IP,2022-12-09,2022-12-10,2023-01-04,PLN5915,1845900543,1845900543,ASC,In-Network,I48.91,M17.11,,,,690,MS-DRG,15,1,Y,93306,Radiology,,,0900,21,Inpatient Hospital,2,1154.72,805.76,805.76,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000007538,MBR00000296,Professional,2022-10-01,2022-10-01,2022-10-12,PLN4956,1644128543,1644128543,Gastroenterology,In-Network,I10,N17.9,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,2,243.02,151.88,118.59,0.0,15.0,18.29,33.29,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000007539,MBR00000296,Institutional-OP,2021-05-26,2021-05-26,2021-07-06,PLN1192,1809014947,1809014947,Urology,In-Network,Z00.00,K21.0,,,,,,,0,,80061,Pathology/Lab,,,0370,22,Outpatient Hospital,2,50.73,37.03,37.03,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007540,MBR00000296,Institutional-OP,2022-07-19,2022-07-19,2022-07-29,PLN2538,1390307371,1390307371,DME Supplier,In-Network,I10,F32.9,,,,,,,0,,47562,Surgery,,,0450,22,Outpatient Hospital,2,6279.61,1931.55,1906.55,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007541,MBR00000296,Institutional-OP,2023-02-15,2023-02-15,2023-03-11,PLN3684,1224179551,1224179551,Physical Therapy,In-Network,E78.5,J06.9,,,,,,,0,,43239,Surgery,,,0200,22,Outpatient Hospital,1,912.17,615.38,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007542,MBR00000296,Institutional-IP,2022-06-26,2022-06-27,2022-07-07,PLN2724,1247341320,1247341320,Urology,Out-of-Network,Z79.4,N18.3,,,,195,MS-DRG,17,1,Y,99232,E&M,,,0450,21,Inpatient Hospital,2,139.83,96.43,0.0,78.25,50.0,0.0,128.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007543,MBR00000297,Institutional-IP,2023-03-04,2023-03-08,2023-03-30,PLN2252,1395983630,1395983630,Nephrology,In-Network,M54.5,Z00.00,,,,291,MS-DRG,15,4,Y,99213,E&M,,,0900,21,Inpatient Hospital,2,264.48,133.07,0.0,133.07,50.0,0.0,183.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007544,MBR00000297,Professional,2021-12-27,2021-12-27,2022-01-22,PLN3564,1687650653,1687650653,Internal Medicine,In-Network,Z00.00,E11.9,,,,,,,0,,99203,E&M,,,,12,Home,1,321.99,225.29,0.0,0.0,25.0,5.2,30.2,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007545,MBR00000297,Professional,2022-07-18,2022-07-18,2022-08-21,PLN9406,1132188260,1132188260,Family Medicine,In-Network,Z12.31,R07.9,,,,,,,0,,85610,Pathology/Lab,,,,21,Inpatient Hospital,1,69.28,55.8,0.0,55.8,15.0,0.0,70.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007546,MBR00000297,Institutional-OP,2022-02-21,2022-02-21,2022-03-22,PLN3186,1745114564,1745114564,Endocrinology,In-Network,F41.9,Z87.891,,,,,,,0,,33533,Surgery,,,0370,22,Outpatient Hospital,1,26871.72,12022.94,12022.94,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,1,0,1,Unbundling,0,0,0,0,0
CLM0000007547,MBR00000297,Institutional-OP,2023-12-27,2023-12-27,2024-01-16,PLN3083,1795618275,1795618275,Pulmonology,In-Network,Z00.00,Z12.31,,,,,,,0,,99406,Medicine,,,0270,22,Outpatient Hospital,2,86.16,41.86,6.86,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007548,MBR00000297,Institutional-OP,2021-07-16,2021-07-16,2021-08-12,PLN2718,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,N40.0,M17.11,,,,,,,0,,99203,E&M,,,0320,22,Outpatient Hospital,3,222.38,74.87,0.0,0.0,0.0,3.74,3.74,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007549,MBR00000297,Institutional-OP,2021-11-07,2021-11-07,2021-12-04,PLN5532,1114982472,1114982472,Orthopedic Surgery,In-Network,E11.9,R05,,,,,,,0,,43239,Surgery,,,0360,22,Outpatient Hospital,3,1719.57,1255.99,1255.99,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007550,MBR00000297,Professional,2023-01-16,2023-01-16,2023-02-23,PLN2327,1590915516,1590915516,Physical Therapy,Out-of-Network,F41.9,M17.11,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,1,454.36,316.96,316.96,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007551,MBR00000297,Institutional-OP,2021-03-06,2021-03-06,2021-03-18,PLN3419,1219817751,1219817751,OB/GYN,In-Network,Z79.4,I25.10,,,,,,,0,,58661,Surgery,,,0900,22,Outpatient Hospital,3,3462.76,1314.74,946.0,368.74,0.0,0.0,368.74,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007552,MBR00000297,Institutional-IP,2022-07-16,2022-07-23,2022-08-09,PLN1938,1745114564,1745114564,Endocrinology,In-Network,N39.0,F41.9,,,,682,MS-DRG,11,7,W,99222,E&M,,,0636,21,Inpatient Hospital,3,375.8,280.78,255.78,0.0,25.0,0.0,25.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007553,MBR00000297,Professional,2021-02-01,2021-02-01,2021-03-10,PLN4929,1114982472,1114982472,Orthopedic Surgery,In-Network,N17.9,I25.10,,,,,,,0,,27447,Surgery,,,,11,Office,2,2583.38,1890.03,1768.91,0.0,0.0,121.12,121.12,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007554,MBR00000297,Professional,2022-08-01,2022-08-01,2022-08-22,PLN4346,1395983630,1395983630,Nephrology,In-Network,K92.1,I63.9,,,,,,,0,,77067,Radiology,,,,22,Outpatient Hospital,2,347.56,211.14,25.62,135.52,50.0,0.0,185.52,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000007555,MBR00000297,Institutional-IP,2021-12-18,2021-12-27,2021-12-27,PLN5166,1845057593,1845057593,Orthopedic Surgery,In-Network,I10,Z23,,,,683,MS-DRG,12,9,Y,80061,Pathology/Lab,,,0761,21,Inpatient Hospital,3,128.74,104.3,29.3,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000007556,MBR00000297,Professional,2021-07-27,2021-07-27,2021-09-07,PLN6397,1125190055,1125190055,Nephrology,In-Network,Z00.00,I48.91,,,,,,,0,,74177,Radiology,,,,11,Office,3,2104.36,1129.32,0.0,130.02,35.0,70.09,235.11,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007557,MBR00000297,Institutional-OP,2022-06-30,2022-06-30,2022-07-23,PLN9073,1622771872,1622771872,Pediatrics,In-Network,F03.90,J44.1,,,,,,,0,,66984,Surgery,,,0120,22,Outpatient Hospital,2,2250.59,1203.15,883.54,152.48,25.0,142.13,319.61,0.0,Pended,,,1,,0,0,1,0,0,1,Duplicate,0,0,0,0,0
CLM0000007558,MBR00000297,Institutional-OP,2021-12-29,2021-12-29,2022-01-31,PLN2092,1118885473,1118885473,ASC,In-Network,K21.0,I10,,,,,,,0,,45380,Surgery,,,0120,22,Outpatient Hospital,2,1778.01,1003.59,992.11,0.0,0.0,11.48,11.48,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000007559,MBR00000297,Institutional-OP,2021-03-27,2021-03-27,2021-04-12,PLN9884,1475984649,1475984649,SNF,In-Network,R07.9,E11.9,,,,,,,0,,66984,Surgery,,,0450,22,Outpatient Hospital,1,1814.24,1048.51,814.39,234.12,0.0,0.0,234.12,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007560,MBR00000297,Professional,2022-08-07,2022-08-07,2022-08-23,PLN6196,1463205530,1463205530,Nephrology,In-Network,Z12.31,N17.9,,,,,,,0,,77067,Radiology,,,,11,Office,2,530.42,229.77,176.98,0.0,35.0,17.79,52.79,0.0,Paid,,,1,,0,1,0,0,0,1,Upcoding,1,0,0,0,0
CLM0000007561,MBR00000297,Professional,2022-09-12,2022-09-12,2022-10-15,PLN5710,1687650653,1687650653,Internal Medicine,In-Network,N20.0,J06.9,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,2,69.12,50.97,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007562,MBR00000297,Institutional-IP,2022-12-26,2023-01-02,2023-01-25,PLN7128,1561134315,1561134315,DME Supplier,In-Network,N20.0,E78.5,,,,682,MS-DRG,4,7,Y,97530,Medicine,,,0450,21,Inpatient Hospital,1,248.78,114.08,81.94,0.0,25.0,7.14,32.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007563,MBR00000297,Institutional-OP,2023-09-14,2023-09-14,2023-10-19,PLN1264,1896447406,1896447406,Nephrology,Out-of-Network,E11.9,J06.9,,,,,,,0,,99233,E&M,,,0740,22,Outpatient Hospital,1,216.73,67.54,66.19,0.0,0.0,1.35,1.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007564,MBR00000297,Professional,2023-02-09,2023-02-09,2023-03-04,PLN2704,1564502315,1564502315,ASC,In-Network,Z12.31,J20.9,,,,,,,0,,G0468,Medicine,,,,11,Office,1,611.63,401.67,339.05,0.0,0.0,62.62,62.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007565,MBR00000297,Professional,2023-05-23,2023-05-23,2023-06-20,PLN4801,1108115157,1108115157,General Acute Care Hospital,In-Network,M54.5,Z12.31,,,,,,,0,,70450,Radiology,,,,11,Office,2,1312.39,1040.71,1015.71,0.0,25.0,0.0,25.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007566,MBR00000297,Institutional-OP,2022-12-11,2022-12-11,2023-01-19,PLN5343,1606140917,1606140917,ASC,In-Network,E78.5,E78.5,,,,,,,0,,23472,Surgery,,,0900,22,Outpatient Hospital,3,5341.94,4188.54,3327.62,100.27,0.0,760.65,860.92,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007567,MBR00000297,Professional,2023-01-07,2023-01-07,2023-01-17,PLN3434,1713934949,1713934949,Neurology,In-Network,E11.9,F32.9,,,,,,,0,,99222,E&M,,,,50,Federally Qualified Health Center,1,375.84,128.77,128.77,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007568,MBR00000297,Institutional-OP,2023-05-19,2023-05-19,2023-06-30,PLN9954,1845057593,1845057593,Orthopedic Surgery,In-Network,Z00.00,E66.9,,,,,,,0,,93000,Radiology,,,0740,22,Outpatient Hospital,1,192.11,142.39,101.32,0.0,25.0,16.07,41.07,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007569,MBR00000297,Institutional-OP,2022-12-26,2022-12-26,2023-01-23,PLN6921,1691062876,1691062876,SNF,In-Network,F03.90,E11.9,,,,,,,0,,76700,Radiology,,,0636,22,Outpatient Hospital,3,787.15,366.81,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007570,MBR00000297,Institutional-OP,2022-07-04,2022-07-04,2022-07-19,PLN2871,1395983630,1395983630,Nephrology,In-Network,E11.9,M54.5,,,,,,,0,,90837,Medicine,,,0370,22,Outpatient Hospital,3,496.21,195.5,0.0,0.0,0.0,0.0,0.0,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007571,MBR00000297,Institutional-OP,2023-03-11,2023-03-11,2023-04-22,PLN2580,1434029575,1434029575,Endocrinology,In-Network,I63.9,N39.0,,,,,,,0,,45380,Surgery,,,0730,22,Outpatient Hospital,2,1227.25,920.16,920.16,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000007572,MBR00000297,Institutional-OP,2023-11-24,2023-11-24,2024-01-01,PLN1050,1550154147,1550154147,Outpatient Clinic,In-Network,E11.9,F10.20,,,,,,,0,,66984,Surgery,,,0270,22,Outpatient Hospital,3,1690.16,621.06,610.89,0.0,0.0,10.17,10.17,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007573,MBR00000297,Professional,2022-06-26,2022-06-26,2022-08-09,PLN3451,1410468316,1410468316,SNF,In-Network,K92.1,Z87.891,,,,,,,0,,70450,Radiology,,,,23,Emergency Room,3,1270.66,718.61,697.44,0.0,0.0,21.17,21.17,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007574,MBR00000297,Professional,2021-09-05,2021-09-05,2021-10-14,PLN6253,1891849440,1891849440,Oncology,In-Network,Z23,Z00.00,,,,,,,0,,80061,Pathology/Lab,,,,22,Outpatient Hospital,1,59.36,19.66,19.66,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007575,MBR00000297,Professional,2022-03-16,2022-03-16,2022-04-18,PLN8453,1991459367,1991459367,Neurology,Out-of-Network,Z12.31,J06.9,,,,,,,0,,99406,Medicine,,,,11,Office,1,97.08,60.4,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007576,MBR00000297,Professional,2021-01-16,2021-01-16,2021-02-02,PLN8228,1334916761,1334916761,ASC,In-Network,E66.9,E11.9,,,,,,,0,,83036,Pathology/Lab,,,,22,Outpatient Hospital,2,87.44,30.97,0.0,9.94,50.0,0.0,59.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000007577,MBR00000297,Institutional-IP,2021-12-02,2021-12-05,2021-12-19,PLN4133,1125190055,1125190055,Nephrology,In-Network,Z23,I10,,,,196,MS-DRG,2,3,Y,99283,E&M,,,0900,21,Inpatient Hospital,3,499.76,161.22,118.15,0.0,35.0,8.07,43.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007578,MBR00000297,Professional,2023-08-30,2023-08-30,2023-09-14,PLN8827,1702692193,1702692193,Physical Therapy,In-Network,Z23,Z23,,,,,,,0,,58661,Surgery,,,,11,Office,1,3758.95,2743.7,0.0,263.2,50.0,287.92,601.12,0.0,Denied,PR-1,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007579,MBR00000297,Professional,2021-04-20,2021-04-20,2021-05-28,PLN3494,1806688928,1806688928,Geriatrics,In-Network,E78.5,J20.9,,,,,,,0,,45380,Surgery,,,,23,Emergency Room,3,2285.75,1736.88,1491.92,244.96,0.0,0.0,244.96,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,1,0,0,0
CLM0000007580,MBR00000297,Institutional-OP,2023-08-31,2023-08-31,2023-10-12,PLN1233,1235381502,1235381502,Cardiology,In-Network,N18.3,E66.9,,,,,,,0,,G0444,Medicine,,,0320,22,Outpatient Hospital,2,76.65,49.49,47.02,0.0,0.0,2.47,2.47,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000007581,MBR00000297,Professional,2022-09-08,2022-09-08,2022-09-24,PLN2227,1334916761,1334916761,ASC,In-Network,J44.1,N17.9,,,,,,,0,,45380,Surgery,,,,23,Emergency Room,2,3001.75,1533.32,1016.58,441.74,75.0,0.0,516.74,0.0,Paid,,,0,,1,0,0,0,0,1,Phantom,0,1,0,0,0
CLM0000007582,MBR00000297,Professional,2021-12-15,2021-12-15,2022-01-07,PLN4117,1268679390,1268679390,Critical Access Hospital,In-Network,Z12.31,J06.9,,,,,,,0,,99213,E&M,,,,11,Office,2,238.46,197.67,0.0,197.67,0.0,0.0,197.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007583,MBR00000297,Institutional-IP,2022-06-02,2022-06-04,2022-07-02,PLN8387,1575695214,1575695214,SNF,In-Network,Z00.01,E11.9,,,,603,MS-DRG,23,2,Y,85025,Pathology/Lab,,,0370,21,Inpatient Hospital,2,67.25,39.52,0.0,39.52,0.0,0.0,39.52,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007584,MBR00000297,Professional,2023-08-21,2023-08-21,2023-09-07,PLN9629,1946680931,1946680931,Critical Access Hospital,Out-of-Network,Z00.00,J20.9,,,,,,,0,,66984,Surgery,,,,50,Federally Qualified Health Center,3,1526.74,793.38,793.38,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007585,MBR00000297,Professional,2021-05-11,2021-05-11,2021-05-27,PLN1074,1702692193,1702692193,Physical Therapy,In-Network,E66.9,K21.0,,,,,,,0,,66984,Surgery,,,,20,Urgent Care,1,2514.22,1866.96,1866.96,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007586,MBR00000297,Professional,2022-09-12,2022-09-12,2022-10-16,PLN7200,1799205295,1799205295,General Acute Care Hospital,In-Network,Z87.891,N39.0,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,1,113.61,75.0,0.0,75.0,0.0,0.0,75.0,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007587,MBR00000297,Institutional-OP,2021-10-21,2021-10-21,2021-11-23,PLN1454,1193493783,1193493783,Critical Access Hospital,Out-of-Network,Z23,E66.9,,,,,,,0,,90686,Medicine,,,0636,22,Outpatient Hospital,3,84.87,67.85,16.14,0.0,50.0,1.71,51.71,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000007588,MBR00000297,Institutional-IP,2022-08-16,2022-08-22,2022-09-06,PLN2495,1660288235,1660288235,ASC,In-Network,I25.10,M54.5,,,,641,MS-DRG,12,6,Y,86900,Pathology/Lab,,,0730,21,Inpatient Hospital,1,45.62,34.7,0.0,34.7,0.0,0.0,34.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007589,MBR00000297,Institutional-IP,2023-05-12,2023-05-13,2023-06-17,PLN6734,1434029575,1434029575,Endocrinology,In-Network,N39.0,J06.9,,,,872,MS-DRG,8,1,Y,99221,E&M,,,0450,21,Inpatient Hospital,2,394.18,288.9,288.9,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007590,MBR00000297,Professional,2023-10-06,2023-10-06,2023-11-10,PLN3153,1245650222,1245650222,Gastroenterology,In-Network,K21.0,J20.9,,,,,,,0,,99222,E&M,,,,49,Independent Clinic,3,553.05,371.12,371.12,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007591,MBR00000298,Institutional-OP,2021-10-07,2021-10-07,2021-10-20,PLN1239,1609526529,1609526529,Psychiatry,In-Network,I50.9,K21.0,,,,,,,0,,97530,Medicine,,,0636,22,Outpatient Hospital,3,289.67,223.14,0.0,223.14,75.0,0.0,298.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007592,MBR00000298,Professional,2022-12-28,2022-12-28,2023-02-10,PLN8121,1135158374,1135158374,Pulmonology,In-Network,F32.9,J06.9,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,1,705.58,537.05,295.58,181.62,15.0,44.85,241.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007593,MBR00000298,Institutional-IP,2022-04-12,2022-04-14,2022-05-26,PLN4610,1390307371,1390307371,DME Supplier,In-Network,E11.65,E11.9,,,,690,MS-DRG,2,2,W,99203,E&M,,,0200,21,Inpatient Hospital,1,160.88,89.69,64.69,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007594,MBR00000298,Professional,2022-07-05,2022-07-05,2022-08-08,PLN4290,1799205295,1799205295,General Acute Care Hospital,In-Network,E11.9,I11.9,,,,,,,0,,90837,Medicine,,,,50,Federally Qualified Health Center,2,386.96,214.9,186.88,13.02,15.0,0.0,28.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007595,MBR00000298,Professional,2021-06-26,2021-06-26,2021-07-22,PLN9231,1645194539,1645194539,SNF,In-Network,G43.909,Z87.891,,,,,,,0,,66984,Surgery,,,,11,Office,2,1706.99,1134.2,738.0,371.2,25.0,0.0,396.2,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007596,MBR00000298,Professional,2023-07-28,2023-07-28,2023-08-11,PLN4338,1438368327,1438368327,Home Health,In-Network,E78.5,N18.3,,,,,,,0,,99221,E&M,,,,20,Urgent Care,2,291.05,131.96,0.0,131.96,0.0,0.0,131.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007597,MBR00000298,Professional,2021-07-05,2021-07-05,2021-07-12,PLN3419,1691062876,1691062876,SNF,In-Network,R10.9,Z23,,,,,,,0,,93306,Radiology,,,,20,Urgent Care,2,3102.06,2489.14,2076.57,362.57,50.0,0.0,412.57,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007598,MBR00000298,Professional,2021-02-13,2021-02-13,2021-02-25,PLN8648,1752470395,1752470395,Home Health,In-Network,Z51.11,R51,,,,,,,0,,66984,Surgery,,,,11,Office,1,1459.03,953.98,953.98,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000007599,MBR00000298,Professional,2023-04-09,2023-04-09,2023-05-06,PLN2169,1186826716,1186826716,Physical Therapy,In-Network,Z00.00,N39.0,,,,,,,0,,23472,Surgery,,,,12,Home,2,6508.4,2410.69,2365.95,44.74,0.0,0.0,44.74,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007600,MBR00000298,Institutional-OP,2022-03-21,2022-03-21,2022-04-26,PLN7369,1124394415,1124394415,Pediatrics,In-Network,N40.0,E11.9,,,,,,,0,,74177,Radiology,,,0636,22,Outpatient Hospital,3,1644.76,1296.18,1296.18,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007601,MBR00000298,Institutional-IP,2021-03-15,2021-03-27,2021-04-20,PLN2361,1780163051,1780163051,SNF,In-Network,I25.10,M54.5,,,,470,MS-DRG,6,12,Y,99406,Medicine,,,0636,21,Inpatient Hospital,1,87.74,41.61,0.0,41.61,25.0,0.0,66.61,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007602,MBR00000298,Institutional-IP,2023-01-16,2023-01-17,2023-01-24,PLN6808,1872613201,1872613201,Internal Medicine,In-Network,Z87.891,M54.5,,,,195,MS-DRG,6,1,U,99283,E&M,,,0761,21,Inpatient Hospital,2,301.26,224.71,157.73,0.0,50.0,16.98,66.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007603,MBR00000298,Professional,2021-11-09,2021-11-09,2021-12-20,PLN6943,1364429278,1364429278,OB/GYN,In-Network,E11.9,Z00.00,,,,,,,0,,99232,E&M,,,,20,Urgent Care,3,164.33,66.5,66.5,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007604,MBR00000298,Professional,2023-12-05,2023-12-05,2023-12-14,PLN5456,1245650222,1245650222,Gastroenterology,In-Network,M81.0,E78.5,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,3,54.09,42.89,0.0,42.89,75.0,0.0,117.89,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000007605,MBR00000298,Institutional-OP,2023-12-11,2023-12-11,2023-12-23,PLN6390,1366576336,1366576336,Geriatrics,In-Network,I10,E11.9,,,,,,,0,,99204,E&M,,,0370,22,Outpatient Hospital,2,452.8,149.89,0.0,149.89,0.0,0.0,149.89,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007606,MBR00000298,Professional,2022-08-26,2022-08-26,2022-09-18,PLN4220,1239316214,1239316214,Internal Medicine,In-Network,R05,E78.5,,,,,,,0,,G0439,Medicine,,,,22,Outpatient Hospital,1,622.67,261.95,211.95,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000007607,MBR00000298,Institutional-OP,2022-06-06,2022-06-06,2022-07-10,PLN1849,1644128543,1644128543,Gastroenterology,In-Network,E78.5,J20.9,,,,,,,0,,58661,Surgery,,,0270,22,Outpatient Hospital,1,2886.64,1421.63,1406.63,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007608,MBR00000298,Institutional-IP,2022-05-03,2022-05-09,2022-06-10,PLN6114,1109850785,1109850785,ASC,Out-of-Network,I10,J06.9,,,,603,MS-DRG,8,6,Y,78452,Radiology,,,0450,21,Inpatient Hospital,1,4746.94,3813.53,3111.8,304.75,50.0,346.98,701.73,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000007609,MBR00000298,Professional,2022-10-26,2022-10-26,2022-11-14,PLN6137,1361302520,1361302520,Critical Access Hospital,In-Network,G43.909,Z00.00,,,,,,,0,,99204,E&M,,,,11,Office,1,463.76,317.49,267.49,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007610,MBR00000298,Institutional-OP,2023-09-23,2023-09-23,2023-10-27,PLN4991,1569105090,1569105090,Geriatrics,In-Network,M54.5,R51,,,,,,,0,,45378,Surgery,,,0510,22,Outpatient Hospital,1,1174.58,468.1,468.1,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000007611,MBR00000298,Institutional-OP,2022-12-03,2022-12-03,2022-12-29,PLN3618,1778483301,1778483301,Home Health,In-Network,E11.9,I10,,,,,,,0,,78452,Radiology,,,0270,22,Outpatient Hospital,1,2539.74,2136.68,1996.9,139.78,0.0,0.0,139.78,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000007612,MBR00000298,Institutional-OP,2021-04-19,2021-04-19,2021-06-01,PLN2036,1812060197,1812060197,Oncology,Out-of-Network,K21.0,J06.9,,,,,,,0,,97530,Medicine,,,0270,22,Outpatient Hospital,3,275.02,124.0,74.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007613,MBR00000298,Professional,2021-08-03,2021-08-03,2021-09-16,PLN8008,1235381502,1235381502,Cardiology,In-Network,J06.9,E11.65,,,,,,,0,,45380,Surgery,,,,23,Emergency Room,3,2047.8,1284.32,1063.45,220.87,0.0,0.0,220.87,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,1,0,0,0
CLM0000007614,MBR00000298,Professional,2022-11-21,2022-11-21,2022-12-31,PLN6605,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,E11.9,E87.6,,,,,,,0,,G0444,Medicine,,,,11,Office,2,101.66,33.69,33.69,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000007615,MBR00000298,Institutional-IP,2022-02-09,2022-02-16,2022-02-22,PLN2144,1268679390,1268679390,Critical Access Hospital,In-Network,I25.10,K21.0,,,,291,MS-DRG,7,7,N,99203,E&M,,,0360,21,Inpatient Hospital,3,166.51,126.85,0.0,126.85,0.0,0.0,126.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007616,MBR00000298,Professional,2022-06-09,2022-06-09,2022-07-19,PLN2814,1372918899,1372918899,Family Medicine,In-Network,J06.9,E11.9,,,,,,,0,,99233,E&M,,,,21,Inpatient Hospital,2,269.41,207.0,98.52,73.48,35.0,0.0,108.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007617,MBR00000298,Professional,2022-03-15,2022-03-15,2022-03-28,PLN1500,1780163051,1780163051,SNF,In-Network,Z00.00,K21.0,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,3,68.79,38.98,38.98,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007618,MBR00000298,Institutional-IP,2022-10-15,2022-10-22,2022-10-31,PLN1482,1475984649,1475984649,SNF,In-Network,E11.9,E78.5,,,,196,MS-DRG,8,7,Y,80053,Pathology/Lab,,,0370,21,Inpatient Hospital,2,151.52,83.13,0.0,83.13,75.0,0.0,158.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007619,MBR00000298,Professional,2021-09-10,2021-09-10,2021-10-22,PLN5162,1273488618,1273488618,General Acute Care Hospital,In-Network,E78.5,J18.9,,,,,,,0,,99203,E&M,,,,23,Emergency Room,1,355.37,264.67,264.67,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007620,MBR00000298,Institutional-OP,2021-03-22,2021-03-22,2021-04-09,PLN6351,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,J20.9,M54.5,,,,,,,0,,99284,E&M,,,0370,22,Outpatient Hospital,1,912.24,348.15,273.15,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007621,MBR00000298,Institutional-OP,2021-09-14,2021-09-14,2021-10-18,PLN6772,1372918899,1372918899,Family Medicine,In-Network,F41.9,Z12.31,,,,,,,0,,80053,Pathology/Lab,,,0360,22,Outpatient Hospital,2,151.21,109.41,0.0,109.41,50.0,0.0,159.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007622,MBR00000298,Professional,2023-01-02,2023-01-02,2023-01-10,PLN8286,1717546253,1717546253,Family Medicine,In-Network,R07.9,N39.0,,,,,,,0,,99221,E&M,,,,11,Office,3,219.15,171.12,0.0,171.12,0.0,0.0,171.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007623,MBR00000298,Professional,2022-10-28,2022-10-28,2022-11-15,PLN2009,1569105090,1569105090,Geriatrics,In-Network,J06.9,Z00.00,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,2,5824.25,3762.9,3234.22,0.0,35.0,493.68,528.68,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007624,MBR00000298,Professional,2023-06-06,2023-06-06,2023-06-28,PLN4216,1717546253,1717546253,Family Medicine,In-Network,F03.90,N18.3,,,,,,,0,,90686,Medicine,,,,65,End-Stage Renal Disease,1,122.86,54.21,0.0,54.21,35.0,0.0,89.21,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000007625,MBR00000298,Professional,2021-04-29,2021-04-29,2021-06-07,PLN3065,1390307371,1390307371,DME Supplier,In-Network,F41.9,Z23,,,,,,,0,,74177,Radiology,,,,22,Outpatient Hospital,2,1554.13,709.39,594.18,0.0,0.0,115.21,115.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007626,MBR00000298,Professional,2021-06-05,2021-06-05,2021-07-10,PLN3136,1812060197,1812060197,Oncology,Out-of-Network,M17.11,N17.9,,,,,,,0,,90686,Medicine,,,,11,Office,3,98.23,55.39,40.39,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000007627,MBR00000298,Institutional-OP,2021-05-22,2021-05-22,2021-06-24,PLN9919,1531398223,1531398223,OB/GYN,In-Network,N39.0,F32.9,,,,,,,0,,99232,E&M,,,0636,22,Outpatient Hospital,3,281.93,209.11,184.11,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007628,MBR00000298,Professional,2022-09-09,2022-09-09,2022-10-18,PLN7223,1606140917,1606140917,ASC,In-Network,I10,Z00.00,,,,,,,0,,33533,Surgery,,,,11,Office,2,15449.15,6149.5,6074.5,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000007629,MBR00000298,Professional,2022-09-20,2022-09-20,2022-10-19,PLN3908,1395983630,1395983630,Nephrology,In-Network,E78.5,J44.1,,,,,,,0,,99221,E&M,,,,11,Office,2,247.03,76.64,76.64,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007630,MBR00000298,Professional,2021-06-24,2021-06-24,2021-07-28,PLN5834,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,M17.11,E66.9,,,,,,,0,,43239,Surgery,,,,49,Independent Clinic,3,1963.43,1641.05,1641.05,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007631,MBR00000298,Professional,2022-05-08,2022-05-08,2022-06-06,PLN4062,1135158374,1135158374,Pulmonology,In-Network,Z23,Z00.00,,,,,,,0,,87491,Pathology/Lab,,,,22,Outpatient Hospital,2,150.39,78.93,63.93,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007632,MBR00000298,Institutional-OP,2021-02-26,2021-02-26,2021-03-06,PLN9626,1702692193,1702692193,Physical Therapy,In-Network,J06.9,J18.9,,,,,,,0,,G0444,Medicine,,,0730,22,Outpatient Hospital,1,62.59,43.83,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000007633,MBR00000298,Institutional-OP,2022-11-02,2022-11-02,2022-12-13,PLN8858,1872272835,1872272835,Internal Medicine,In-Network,G43.909,N40.0,,,,,,,0,,99232,E&M,,,0370,22,Outpatient Hospital,3,386.93,243.72,210.5,0.0,25.0,8.22,33.22,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000007634,MBR00000299,Professional,2022-09-17,2022-09-17,2022-10-03,PLN8562,1935547131,1935547131,Pulmonology,In-Network,I50.9,M17.11,,,,,,,0,,66984,Surgery,,,,11,Office,3,3333.49,2397.77,1891.17,481.6,25.0,0.0,506.6,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007635,MBR00000299,Professional,2021-01-30,2021-01-30,2021-03-04,PLN2596,1135158374,1135158374,Pulmonology,In-Network,N39.0,F41.9,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,2,1640.97,568.17,476.72,91.45,0.0,0.0,91.45,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007636,MBR00000299,Institutional-OP,2021-04-07,2021-04-07,2021-04-17,PLN6963,1273488618,1273488618,General Acute Care Hospital,In-Network,I50.9,K21.0,,,,,,,0,,99221,E&M,,,0730,22,Outpatient Hospital,1,196.01,142.17,0.0,142.17,0.0,0.0,142.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007637,MBR00000299,Institutional-IP,2023-02-11,2023-02-13,2023-03-02,PLN4037,1135158374,1135158374,Pulmonology,In-Network,E66.9,F41.9,,,,682,MS-DRG,2,2,Y,99232,E&M,,,0370,21,Inpatient Hospital,2,208.78,163.45,0.0,163.45,0.0,0.0,163.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007638,MBR00000299,Professional,2023-09-12,2023-09-12,2023-10-06,PLN4807,1227362142,1227362142,DME Supplier,In-Network,F32.9,M54.5,,,,,,,0,,80053,Pathology/Lab,,,,31,Skilled Nursing Facility,2,125.07,41.85,0.0,0.0,15.0,0.0,15.0,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007639,MBR00000299,Professional,2023-07-20,2023-07-20,2023-08-02,PLN1720,1899127912,1899127912,Neurology,In-Network,G43.909,Z00.00,,,,,,,0,,93225,Medicine,,,,23,Emergency Room,1,569.92,323.66,281.46,0.0,0.0,42.2,42.2,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007640,MBR00000299,Professional,2022-09-13,2022-09-13,2022-10-20,PLN2562,1114982472,1114982472,Orthopedic Surgery,In-Network,Z00.00,F32.9,,,,,,,0,,99284,E&M,,,,23,Emergency Room,1,593.34,454.37,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-18,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007641,MBR00000299,Professional,2022-07-28,2022-07-28,2022-09-03,PLN1705,1696843572,1696843572,Critical Access Hospital,Out-of-Network,Z00.00,I48.91,,,,,,,0,,99406,Medicine,,,,11,Office,2,36.58,23.28,23.28,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007642,MBR00000299,Professional,2023-06-05,2023-06-05,2023-06-19,PLN9056,1224179551,1224179551,Physical Therapy,In-Network,I25.10,Z00.00,,,,,,,0,,80053,Pathology/Lab,,,,21,Inpatient Hospital,2,99.59,41.85,14.9,0.0,25.0,1.95,26.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007643,MBR00000299,Institutional-IP,2023-07-10,2023-07-11,2023-08-14,PLN8728,1717912431,1717912431,Oncology,In-Network,J44.1,Z00.00,,,,683,MS-DRG,7,1,Y,99203,E&M,,,0636,21,Inpatient Hospital,1,211.14,85.88,9.15,0.0,75.0,1.73,76.73,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000007644,MBR00000299,Professional,2023-09-20,2023-09-20,2023-10-21,PLN3170,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,Z23,I10,,,,,,,0,,72148,Radiology,,,,22,Outpatient Hospital,3,1703.22,768.05,733.05,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000007645,MBR00000299,Institutional-IP,2022-03-14,2022-03-15,2022-04-06,PLN6383,1991459367,1991459367,Neurology,Out-of-Network,N18.3,Z23,,,,470,MS-DRG,24,1,Y,27447,Surgery,,,0301,21,Inpatient Hospital,1,2386.39,1483.75,1228.24,0.0,0.0,255.51,255.51,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007646,MBR00000299,Institutional-OP,2022-06-06,2022-06-06,2022-07-01,PLN1582,1502838586,1502838586,ASC,In-Network,Z12.31,F32.9,,,,,,,0,,99204,E&M,,,0360,22,Outpatient Hospital,3,397.81,280.77,205.77,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000007647,MBR00000299,Institutional-OP,2021-03-28,2021-03-28,2021-04-24,PLN3111,1609138981,1609138981,Critical Access Hospital,In-Network,C50.912,E66.9,,,,,,,0,,99222,E&M,,,0730,22,Outpatient Hospital,2,497.51,310.86,0.0,310.86,0.0,0.0,310.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007648,MBR00000299,Institutional-IP,2021-07-11,2021-07-15,2021-08-03,PLN5653,1227362142,1227362142,DME Supplier,In-Network,J06.9,Z00.00,,,,291,MS-DRG,13,4,N,71046,Radiology,,,0200,21,Inpatient Hospital,1,202.72,117.9,117.9,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007649,MBR00000299,Professional,2022-02-18,2022-02-18,2022-03-21,PLN3392,1531398223,1531398223,OB/GYN,In-Network,J20.9,I48.91,,,,,,,0,,99221,E&M,,,,12,Home,1,181.47,91.78,91.78,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000007650,MBR00000299,Institutional-OP,2023-06-06,2023-06-06,2023-06-19,PLN9433,1227362142,1227362142,DME Supplier,In-Network,E11.40,Z87.891,,,,,,,0,,82043,Pathology/Lab,,,0120,22,Outpatient Hospital,3,46.26,15.89,0.0,15.89,0.0,0.0,15.89,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007651,MBR00000299,Institutional-OP,2022-05-04,2022-05-04,2022-05-19,PLN7055,1809014947,1809014947,Urology,In-Network,F32.9,F32.9,,,,,,,0,,74177,Radiology,,,0900,22,Outpatient Hospital,3,1541.95,1200.46,0.0,413.42,15.0,0.0,428.42,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007652,MBR00000299,Professional,2022-10-06,2022-10-06,2022-11-03,PLN8079,1915531927,1915531927,Critical Access Hospital,In-Network,N39.0,I10,,,,,,,0,,74177,Radiology,,,,22,Outpatient Hospital,2,1728.22,675.5,675.5,0.0,0.0,0.0,0.0,0.0,Adjusted,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007653,MBR00000299,Institutional-OP,2023-08-06,2023-08-06,2023-08-15,PLN5699,1118885473,1118885473,ASC,In-Network,Z12.31,Z12.31,,,,,,,0,,33533,Surgery,,,0370,22,Outpatient Hospital,2,25227.54,15034.06,15034.06,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000007654,MBR00000299,Institutional-OP,2022-06-05,2022-06-05,2022-07-18,PLN7749,1910255109,1910255109,DME Supplier,In-Network,Z00.00,I10,,,,,,,0,,70553,Radiology,,,0270,22,Outpatient Hospital,1,4593.67,3668.91,3618.91,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007655,MBR00000299,Institutional-IP,2022-01-02,2022-01-05,2022-02-10,PLN8093,1168881145,1168881145,Orthopedic Surgery,In-Network,R51,J06.9,,,,871,MS-DRG,4,3,Y,90837,Medicine,,,0360,21,Inpatient Hospital,2,390.73,140.19,140.19,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000007656,MBR00000299,Professional,2023-03-11,2023-03-11,2023-03-22,PLN8881,1395983630,1395983630,Nephrology,In-Network,F03.90,N39.0,,,,,,,0,,76700,Radiology,,,,11,Office,1,886.07,462.36,410.42,26.31,0.0,25.63,51.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007657,MBR00000299,Institutional-IP,2021-12-12,2021-12-18,2022-01-19,PLN5256,1946680931,1946680931,Critical Access Hospital,Out-of-Network,F10.20,J06.9,,,,682,MS-DRG,10,6,Y,99203,E&M,,,0370,21,Inpatient Hospital,2,268.81,98.06,63.06,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007658,MBR00000299,Professional,2022-03-02,2022-03-02,2022-03-18,PLN8928,1910255109,1910255109,DME Supplier,In-Network,J45.20,J20.9,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,1,238.72,166.88,9.41,157.47,0.0,0.0,157.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007659,MBR00000299,Professional,2023-08-31,2023-08-31,2023-09-13,PLN5255,1702692193,1702692193,Physical Therapy,In-Network,Z12.31,E87.6,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,2,26845.39,17620.52,15063.86,0.0,35.0,2521.66,2556.66,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000007660,MBR00000299,Professional,2022-04-24,2022-04-24,2022-05-26,PLN8158,1186826716,1186826716,Physical Therapy,In-Network,C50.912,I10,,,,,,,0,,90460,Medicine,,,,23,Emergency Room,3,69.38,35.65,0.0,35.65,0.0,0.0,35.65,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007661,MBR00000299,Institutional-OP,2021-10-02,2021-10-02,2021-11-13,PLN6318,1245650222,1245650222,Gastroenterology,In-Network,I10,K57.30,,,,,,,0,,47562,Surgery,,,0120,22,Outpatient Hospital,2,6347.26,4656.87,4631.87,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007662,MBR00000299,Institutional-IP,2023-07-03,2023-07-05,2023-07-18,PLN7146,1266606767,1266606767,ASC,In-Network,J44.1,I10,,,,291,MS-DRG,17,2,Y,99232,E&M,,,0450,21,Inpatient Hospital,3,372.36,310.72,28.44,282.28,0.0,0.0,282.28,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007663,MBR00000299,Professional,2022-12-05,2022-12-05,2022-12-23,PLN6511,1502838586,1502838586,ASC,In-Network,E11.65,F41.9,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,1,271.25,187.15,0.0,170.09,25.0,0.0,195.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007664,MBR00000299,Professional,2023-04-21,2023-04-21,2023-05-13,PLN4049,1334916761,1334916761,ASC,In-Network,G43.909,I50.9,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,2,1650.29,1378.71,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-29,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007665,MBR00000299,Professional,2021-12-24,2021-12-24,2022-01-03,PLN7982,1366576336,1366576336,Geriatrics,In-Network,E11.9,G43.909,,,,,,,0,,27447,Surgery,,,,21,Inpatient Hospital,2,4063.68,2199.58,2091.17,108.41,0.0,0.0,108.41,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007666,MBR00000299,Professional,2023-05-07,2023-05-07,2023-06-01,PLN3920,1295371663,1295371663,Critical Access Hospital,In-Network,N17.9,N40.0,,,,,,,0,,99233,E&M,,,,11,Office,2,404.18,197.81,197.81,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007667,MBR00000300,Professional,2023-11-08,2023-11-08,2023-12-22,PLN2471,1860435061,1860435061,DME Supplier,In-Network,J20.9,Z87.891,,,,,,,0,,G0444,Medicine,,,,21,Inpatient Hospital,3,74.07,30.32,0.0,30.32,25.0,0.0,55.32,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000007668,MBR00000300,Professional,2021-06-29,2021-06-29,2021-07-24,PLN2280,1540044947,1540044947,Pulmonology,Out-of-Network,R07.9,Z00.00,,,,,,,0,,76700,Radiology,,,,11,Office,1,1309.96,914.5,914.5,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007669,MBR00000300,Professional,2021-07-27,2021-07-27,2021-08-12,PLN9478,1561134315,1561134315,DME Supplier,In-Network,E78.5,F32.9,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,1,55.87,46.24,0.0,46.24,50.0,0.0,96.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007670,MBR00000300,Professional,2022-09-10,2022-09-10,2022-09-26,PLN3657,1845900543,1845900543,ASC,In-Network,J06.9,M54.5,,,,,,,0,,99284,E&M,,,,21,Inpatient Hospital,2,582.04,291.75,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007671,MBR00000300,Institutional-OP,2023-03-04,2023-03-04,2023-03-22,PLN5363,1114982472,1114982472,Orthopedic Surgery,In-Network,R05,R51,,,,,,,0,,47562,Surgery,,,0636,22,Outpatient Hospital,2,4487.8,2209.26,2203.79,0.0,0.0,5.47,5.47,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007672,MBR00000300,Professional,2021-01-01,2021-01-01,2021-01-18,PLN5750,1283743001,1283743001,Family Medicine,In-Network,E66.9,Z00.01,,,,,,,0,,43239,Surgery,,,,21,Inpatient Hospital,1,1597.97,552.83,477.83,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007673,MBR00000300,Institutional-OP,2022-08-26,2022-08-26,2022-09-19,PLN5888,1809014947,1809014947,Urology,In-Network,Z12.31,E11.9,,,,,,,0,,93000,Radiology,,,0730,22,Outpatient Hospital,1,153.08,117.44,111.53,0.0,0.0,5.91,5.91,0.0,Paid,,,1,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000007674,MBR00000300,Professional,2021-05-20,2021-05-20,2021-07-02,PLN8530,1749494482,1749494482,Pediatrics,In-Network,E78.5,Z87.891,,,,,,,0,,45380,Surgery,,,,23,Emergency Room,2,2128.9,965.73,890.73,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,1,0,0,0
CLM0000007675,MBR00000300,Professional,2023-12-08,2023-12-08,2023-12-23,PLN3232,1817234602,1817234602,Clinical Laboratory,In-Network,Z12.31,E11.9,,,,,,,0,,99214,E&M,,,,11,Office,2,404.83,131.13,0.0,131.13,0.0,0.0,131.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007676,MBR00000300,Professional,2023-03-07,2023-03-07,2023-04-08,PLN9409,1361302520,1361302520,Critical Access Hospital,In-Network,I63.9,J18.9,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,2,103.29,55.38,0.0,55.38,50.0,0.0,105.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007677,MBR00000300,Professional,2023-12-25,2023-12-25,2024-01-31,PLN7304,1545347862,1545347862,SNF,In-Network,F41.9,Z23,,,,,,,0,,76700,Radiology,,,,12,Home,3,1099.56,618.09,509.77,73.32,35.0,0.0,108.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007678,MBR00000300,Professional,2021-08-27,2021-08-27,2021-09-23,PLN9845,1198133277,1198133277,SNF,In-Network,E11.9,I50.9,,,,,,,0,,58661,Surgery,,,,81,Independent Laboratory,3,4731.51,3488.76,3413.76,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007679,MBR00000300,Institutional-OP,2023-05-20,2023-05-20,2023-06-22,PLN8450,1366576336,1366576336,Geriatrics,In-Network,Z12.31,Z00.00,,,,,,,0,,97110,Medicine,,,0730,22,Outpatient Hospital,3,175.29,122.34,122.34,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007680,MBR00000300,Professional,2022-02-23,2022-02-23,2022-03-20,PLN5415,1531398223,1531398223,OB/GYN,In-Network,Z23,Z87.891,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,2,174.04,131.97,131.97,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007681,MBR00000300,Professional,2021-04-24,2021-04-24,2021-05-17,PLN9400,1624802371,1624802371,ASC,Out-of-Network,M54.5,E78.5,,,,,,,0,,47562,Surgery,,,,11,Office,2,5535.29,3899.5,3824.5,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007682,MBR00000300,Professional,2022-06-10,2022-06-10,2022-07-22,PLN7623,1752470395,1752470395,Home Health,In-Network,I11.9,I50.9,,,,,,,0,,85610,Pathology/Lab,,,,49,Independent Clinic,1,64.15,21.05,0.0,21.05,0.0,0.0,21.05,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007683,MBR00000300,Professional,2022-05-29,2022-05-29,2022-07-03,PLN8735,1702692193,1702692193,Physical Therapy,In-Network,N20.0,Z12.31,,,,,,,0,,80053,Pathology/Lab,,,,22,Outpatient Hospital,1,107.19,79.12,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007684,MBR00000300,Institutional-IP,2022-07-02,2022-07-19,2022-08-01,PLN1503,1946680931,1946680931,Critical Access Hospital,Out-of-Network,F41.9,F03.90,,,,196,MS-DRG,24,17,N,66984,Surgery,,,0450,21,Inpatient Hospital,3,1732.74,1164.06,779.74,342.81,0.0,41.51,384.32,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007685,MBR00000300,Professional,2023-07-25,2023-07-25,2023-09-05,PLN9597,1778483301,1778483301,Home Health,In-Network,R07.9,K21.0,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,1,530.75,341.22,307.39,0.0,0.0,33.83,33.83,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007686,MBR00000300,Professional,2021-11-02,2021-11-02,2021-11-23,PLN4927,1337791138,1337791138,Internal Medicine,Out-of-Network,M81.0,M54.5,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,2,403.23,260.58,260.58,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007687,MBR00000300,Institutional-OP,2022-12-01,2022-12-01,2022-12-27,PLN9010,1609138981,1609138981,Critical Access Hospital,In-Network,C50.912,J06.9,,,,,,,0,,70450,Radiology,,,0370,22,Outpatient Hospital,3,1509.93,853.38,823.31,0.0,0.0,30.07,30.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007688,MBR00000300,Professional,2021-08-07,2021-08-07,2021-09-19,PLN2154,1283743001,1283743001,Family Medicine,In-Network,E11.9,Z23,,,,,,,0,,27447,Surgery,,,,11,Office,1,3529.36,2566.24,2069.63,496.61,0.0,0.0,496.61,0.0,Paid,,,1,,0,0,1,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000007689,MBR00000300,Professional,2023-08-21,2023-08-21,2023-10-03,PLN5398,1997536841,1997536841,Family Medicine,Out-of-Network,J18.9,I25.10,,,,,,,0,,27447,Surgery,,,,23,Emergency Room,2,3076.26,1405.51,1405.51,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007690,MBR00000300,Institutional-IP,2022-05-17,2022-05-23,2022-06-05,PLN6632,1283743001,1283743001,Family Medicine,In-Network,J45.20,Z00.00,,,,194,MS-DRG,8,6,Y,23472,Surgery,,,0301,21,Inpatient Hospital,3,3641.39,1694.15,1520.2,37.43,75.0,61.52,173.95,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007691,MBR00000300,Professional,2023-05-26,2023-05-26,2023-07-06,PLN3171,1860435061,1860435061,DME Supplier,In-Network,E66.9,Z87.891,,,,,,,0,,99283,E&M,,,,21,Inpatient Hospital,3,382.67,122.99,0.0,122.99,0.0,0.0,122.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007692,MBR00000300,Institutional-OP,2021-10-22,2021-10-22,2021-11-27,PLN3795,1856686341,1856686341,Geriatrics,In-Network,N39.0,Z79.4,,,,,,,0,,70553,Radiology,,,0740,22,Outpatient Hospital,3,2430.29,1922.49,1283.23,405.81,35.0,198.45,639.26,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007693,MBR00000300,Institutional-OP,2021-12-09,2021-12-09,2022-01-03,PLN3162,1717546253,1717546253,Family Medicine,In-Network,Z00.00,E11.9,,,,,,,0,,66984,Surgery,,,0730,22,Outpatient Hospital,1,2448.84,1069.7,760.68,284.02,25.0,0.0,309.02,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007694,MBR00000300,Professional,2023-12-13,2023-12-13,2023-12-29,PLN3476,1168246159,1168246159,Internal Medicine,In-Network,M54.5,I10,,,,,,,0,,99203,E&M,,,,11,Office,2,177.53,150.67,0.0,0.0,25.0,0.0,25.0,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007695,MBR00000300,Professional,2021-08-02,2021-08-02,2021-08-13,PLN4394,1631954542,1631954542,Oncology,In-Network,K21.0,I11.9,,,,,,,0,,97530,Medicine,,,,50,Federally Qualified Health Center,3,207.37,153.31,137.96,15.35,0.0,0.0,15.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007696,MBR00000300,Professional,2022-09-07,2022-09-07,2022-09-25,PLN3230,1205377316,1205377316,Orthopedic Surgery,In-Network,I10,J44.1,,,,,,,0,,33533,Surgery,,,,11,Office,1,21293.52,16006.08,0.0,174.91,50.0,2959.33,3184.24,0.0,Denied,PR-1,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000007697,MBR00000300,Institutional-OP,2021-12-20,2021-12-20,2022-01-25,PLN1190,1564502315,1564502315,ASC,In-Network,E78.5,G43.909,,,,,,,0,,99284,E&M,,,0510,22,Outpatient Hospital,1,333.87,124.47,5.79,118.68,0.0,0.0,118.68,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007698,MBR00000300,Professional,2022-03-04,2022-03-04,2022-04-14,PLN4510,1219817751,1219817751,OB/GYN,In-Network,Z87.891,J44.1,,,,,,,0,,80053,Pathology/Lab,,,,21,Inpatient Hospital,3,95.27,60.55,60.55,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007699,MBR00000300,Institutional-IP,2023-02-02,2023-02-04,2023-03-01,PLN5026,1564502315,1564502315,ASC,In-Network,K57.30,E11.9,,,,682,MS-DRG,11,2,Y,84443,Pathology/Lab,,,0730,21,Inpatient Hospital,2,161.97,57.56,57.56,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007700,MBR00000300,Professional,2023-05-07,2023-05-07,2023-06-17,PLN2686,1609138981,1609138981,Critical Access Hospital,In-Network,G43.909,M81.0,,,,,,,0,,99232,E&M,,,,23,Emergency Room,3,215.02,87.92,37.92,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007701,MBR00000300,Institutional-OP,2022-06-11,2022-06-11,2022-07-06,PLN6214,1545347862,1545347862,SNF,In-Network,N18.3,F41.9,,,,,,,0,,G0444,Medicine,,,0270,22,Outpatient Hospital,2,97.6,82.4,67.4,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000007702,MBR00000300,Institutional-OP,2022-11-30,2022-11-30,2022-12-12,PLN2706,1563980627,1563980627,Critical Access Hospital,In-Network,E11.9,E11.9,,,,,,,0,,76700,Radiology,,,0761,22,Outpatient Hospital,2,570.7,255.79,180.79,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007703,MBR00000300,Professional,2021-02-18,2021-02-18,2021-03-27,PLN2362,1125190055,1125190055,Nephrology,In-Network,M17.11,I25.10,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,3,524.79,361.66,0.0,361.66,0.0,0.0,361.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007704,MBR00000300,Professional,2021-09-14,2021-09-14,2021-09-26,PLN7069,1542828721,1542828721,Orthopedic Surgery,In-Network,E66.9,N17.9,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,3,118.38,71.25,46.25,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007705,MBR00000300,Professional,2023-03-25,2023-03-25,2023-04-29,PLN5258,1780163051,1780163051,SNF,In-Network,E78.5,I48.91,,,,,,,0,,76700,Radiology,,,,11,Office,2,1222.68,596.07,561.07,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007706,MBR00000300,Institutional-IP,2022-12-31,2023-01-05,2023-02-11,PLN4307,1713934949,1713934949,Neurology,In-Network,K57.30,Z87.891,,,,292,MS-DRG,12,5,N,90460,Medicine,,,0761,21,Inpatient Hospital,3,52.88,41.41,41.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007707,MBR00000301,Professional,2021-02-18,2021-02-18,2021-03-12,PLN1099,1571574052,1571574052,Critical Access Hospital,In-Network,J06.9,E11.9,,,,,,,0,,G0439,Medicine,,,,21,Inpatient Hospital,1,301.56,230.14,0.0,230.14,0.0,0.0,230.14,48.32,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000007708,MBR00000301,Institutional-IP,2023-09-03,2023-09-09,2023-10-12,PLN7472,1974006077,1974006077,Orthopedic Surgery,In-Network,J44.1,Z23,,,,683,MS-DRG,1,6,U,72148,Radiology,,,0900,21,Inpatient Hospital,2,2661.6,1995.16,0.0,0.0,50.0,0.0,50.0,68.31,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007709,MBR00000301,Institutional-OP,2022-03-25,2022-03-25,2022-04-10,PLN4703,1644128543,1644128543,Gastroenterology,In-Network,E66.9,E66.9,,,,,,,0,,78452,Radiology,,,0900,22,Outpatient Hospital,2,6833.98,5668.07,5618.07,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007710,MBR00000301,Institutional-OP,2021-11-29,2021-11-29,2022-01-04,PLN6000,1745114564,1745114564,Endocrinology,In-Network,K57.30,M81.0,,,,,,,0,,99232,E&M,,,0301,22,Outpatient Hospital,2,331.11,174.78,0.0,174.78,25.0,0.0,199.78,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007711,MBR00000301,Institutional-OP,2022-05-22,2022-05-22,2022-06-16,PLN7661,1778483301,1778483301,Home Health,In-Network,F41.9,G20,,,,,,,0,,85610,Pathology/Lab,,,0450,22,Outpatient Hospital,2,45.93,22.78,22.78,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007712,MBR00000301,Institutional-IP,2022-03-09,2022-03-19,2022-03-31,PLN3437,1389336600,1389336600,Critical Access Hospital,In-Network,F41.9,B97.89,,,,195,MS-DRG,17,10,Y,80053,Pathology/Lab,,,0270,21,Inpatient Hospital,2,74.55,56.07,0.0,56.07,35.0,0.0,91.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007713,MBR00000301,Professional,2022-07-05,2022-07-05,2022-07-18,PLN6018,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,B97.89,M54.5,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,3,126.74,70.42,26.1,0.0,25.0,3.9,28.9,15.42,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007714,MBR00000301,Professional,2021-06-29,2021-06-29,2021-07-12,PLN2035,1135158374,1135158374,Pulmonology,In-Network,F41.9,I25.10,,,,,,,0,,99222,E&M,,,,11,Office,2,561.34,458.92,354.31,0.0,0.0,0.0,0.0,104.61,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007715,MBR00000301,Institutional-IP,2021-06-02,2021-06-08,2021-07-11,PLN3724,1728018911,1728018911,Nephrology,In-Network,Z00.00,J20.9,,,,194,MS-DRG,18,6,Y,93306,Radiology,,,0360,21,Inpatient Hospital,1,1673.53,516.91,42.17,424.74,50.0,0.0,474.74,0.0,Adjusted,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007716,MBR00000301,Institutional-IP,2023-12-20,2023-12-22,2024-01-20,PLN5811,1872272835,1872272835,Internal Medicine,In-Network,F41.9,Z23,,,,872,MS-DRG,24,2,Y,G0444,Medicine,,,0270,21,Inpatient Hospital,1,78.63,46.46,0.0,0.0,50.0,0.0,50.0,7.89,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000007717,MBR00000301,Institutional-OP,2023-03-30,2023-03-30,2023-04-11,PLN8458,1939033455,1939033455,Pulmonology,In-Network,N18.3,N39.0,,,,,,,0,,81001,Pathology/Lab,,,0740,22,Outpatient Hospital,2,55.52,19.23,0.0,19.23,35.0,0.0,54.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007718,MBR00000301,Professional,2022-01-31,2022-01-31,2022-03-12,PLN4783,1778483301,1778483301,Home Health,In-Network,J18.9,E11.40,,,,,,,0,,66984,Surgery,,,,11,Office,1,2431.25,1996.13,1846.96,149.17,0.0,0.0,149.17,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007719,MBR00000301,Professional,2023-07-20,2023-07-20,2023-07-27,PLN8500,1268679390,1268679390,Critical Access Hospital,In-Network,Z12.31,R10.9,,,,,,,0,,99283,E&M,,,,11,Office,3,492.93,258.2,0.0,37.09,0.0,29.92,67.01,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007720,MBR00000301,Professional,2023-05-21,2023-05-21,2023-06-08,PLN1594,1946680931,1946680931,Critical Access Hospital,Out-of-Network,J20.9,F32.9,,,,,,,0,,G0439,Medicine,,,,11,Office,3,341.26,266.62,191.62,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000007721,MBR00000301,Professional,2023-02-04,2023-02-04,2023-02-16,PLN3890,1219817751,1219817751,OB/GYN,In-Network,N18.3,E11.9,,,,,,,0,,74177,Radiology,,,,11,Office,1,1768.73,983.89,833.74,0.0,15.0,135.15,150.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007722,MBR00000301,Professional,2023-03-01,2023-03-01,2023-04-12,PLN8716,1148984206,1148984206,Psychiatry,In-Network,M17.11,E66.9,,,,,,,0,,86900,Pathology/Lab,,,,81,Independent Laboratory,1,39.4,28.85,23.76,5.09,0.0,0.0,5.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007723,MBR00000301,Professional,2023-11-08,2023-11-08,2023-11-28,PLN5983,1994661817,1994661817,SNF,Out-of-Network,E11.9,Z51.11,,,,,,,0,,99213,E&M,,,,31,Skilled Nursing Facility,3,237.81,111.75,78.56,0.0,0.0,0.0,0.0,33.19,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007724,MBR00000301,Professional,2023-07-03,2023-07-03,2023-08-03,PLN7787,1224179551,1224179551,Physical Therapy,In-Network,C50.912,J20.9,,,,,,,0,,70553,Radiology,,,,23,Emergency Room,1,3385.09,1590.83,1540.83,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007725,MBR00000301,Professional,2021-10-09,2021-10-09,2021-11-21,PLN8124,1139906830,1139906830,Endocrinology,Out-of-Network,Z79.4,F41.9,,,,,,,0,,97110,Medicine,,,,50,Federally Qualified Health Center,1,187.5,138.9,113.9,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007726,MBR00000301,Professional,2023-03-07,2023-03-07,2023-04-02,PLN3101,1702692193,1702692193,Physical Therapy,In-Network,I10,I10,,,,,,,0,,74177,Radiology,,,,11,Office,3,1043.91,334.55,334.55,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007727,MBR00000301,Institutional-OP,2021-06-25,2021-06-25,2021-07-22,PLN7791,1125190055,1125190055,Nephrology,In-Network,I48.91,J06.9,,,,,,,0,,43239,Surgery,,,0450,22,Outpatient Hospital,1,1554.46,642.52,617.52,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007728,MBR00000301,Institutional-OP,2022-07-05,2022-07-05,2022-07-13,PLN5782,1939033455,1939033455,Pulmonology,In-Network,N18.3,Z00.00,,,,,,,0,,99284,E&M,,,0200,22,Outpatient Hospital,1,584.93,222.75,0.0,222.75,75.0,0.0,297.75,6.53,Denied,CO-15,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000007729,MBR00000301,Professional,2021-03-15,2021-03-15,2021-04-13,PLN3916,1239316214,1239316214,Internal Medicine,In-Network,E78.5,E78.5,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,2,313.89,211.42,162.55,0.0,0.0,26.17,26.17,22.7,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007730,MBR00000301,Institutional-OP,2021-07-05,2021-07-05,2021-07-22,PLN2831,1571574052,1571574052,Critical Access Hospital,In-Network,I48.91,I10,,,,,,,0,,99233,E&M,,,0510,22,Outpatient Hospital,2,266.5,144.85,0.0,144.85,0.0,0.0,144.85,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007731,MBR00000301,Professional,2023-03-02,2023-03-02,2023-04-10,PLN4164,1609138981,1609138981,Critical Access Hospital,In-Network,I10,F32.9,,,,,,,0,,23472,Surgery,,,,49,Independent Clinic,1,7673.76,5960.86,5421.64,0.0,0.0,539.22,539.22,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007732,MBR00000301,Institutional-OP,2022-02-11,2022-02-11,2022-03-17,PLN1040,1689639685,1689639685,SNF,In-Network,J06.9,E11.9,,,,,,,0,,70450,Radiology,,,0270,22,Outpatient Hospital,2,1738.76,910.46,762.35,0.0,0.0,0.0,0.0,148.11,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000007733,MBR00000301,Institutional-IP,2021-06-27,2021-07-09,2021-08-09,PLN8467,1109850785,1109850785,ASC,Out-of-Network,K57.30,N17.9,,,,603,MS-DRG,20,12,Y,90837,Medicine,,,0900,21,Inpatient Hospital,1,437.76,330.78,310.75,0.0,0.0,20.03,20.03,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000007734,MBR00000301,Professional,2023-12-09,2023-12-09,2024-01-18,PLN4113,1865904917,1865904917,Outpatient Clinic,In-Network,I10,I10,,,,,,,0,,G0439,Medicine,,,,23,Emergency Room,1,367.24,167.42,167.42,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,1,0,0,0,0,None,0,0,0,1,0
CLM0000007735,MBR00000301,Professional,2023-10-25,2023-10-25,2023-11-03,PLN9630,1542828721,1542828721,Orthopedic Surgery,In-Network,R51,E78.5,,,,,,,0,,99213,E&M,,,,22,Outpatient Hospital,1,236.75,133.99,119.12,0.0,0.0,14.87,14.87,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000007736,MBR00000301,Institutional-OP,2021-09-08,2021-09-08,2021-09-21,PLN4669,1757138478,1757138478,Pediatrics,In-Network,J44.1,I10,,,,,,,0,,99213,E&M,,,0900,22,Outpatient Hospital,2,227.85,128.54,118.03,0.0,0.0,10.51,10.51,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000007737,MBR00000301,Institutional-OP,2022-10-18,2022-10-18,2022-11-15,PLN8560,1198133277,1198133277,SNF,In-Network,Z00.00,J20.9,,,,,,,0,,99284,E&M,,,0761,22,Outpatient Hospital,1,773.91,536.69,0.0,2.04,0.0,0.0,2.04,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007738,MBR00000301,Professional,2021-11-18,2021-11-18,2021-12-02,PLN4701,1717546253,1717546253,Family Medicine,In-Network,I10,Z23,,,,,,,0,,58661,Surgery,,,,11,Office,2,3084.23,2153.62,2103.62,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007739,MBR00000301,Institutional-IP,2023-05-31,2023-06-06,2023-06-26,PLN3677,1511044648,1511044648,Endocrinology,In-Network,Z00.00,I10,,,,603,MS-DRG,9,6,Y,71046,Radiology,,,0200,21,Inpatient Hospital,1,221.17,109.36,57.48,0.0,25.0,0.0,25.0,26.88,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007740,MBR00000301,Professional,2023-01-24,2023-01-24,2023-02-18,PLN9000,1590915516,1590915516,Physical Therapy,Out-of-Network,I48.91,I25.10,,,,,,,0,,45378,Surgery,,,,21,Inpatient Hospital,3,2197.61,1460.49,1460.49,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000007741,MBR00000301,Institutional-OP,2022-04-21,2022-04-21,2022-06-02,PLN6143,1450094833,1450094833,Outpatient Clinic,In-Network,E11.9,N39.0,,,,,,,0,,82043,Pathology/Lab,,,0200,22,Outpatient Hospital,3,47.84,26.53,1.53,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007742,MBR00000302,Professional,2023-10-17,2023-10-17,2023-11-19,PLN9368,1790497490,1790497490,OB/GYN,In-Network,J20.9,E11.9,,,,,,,0,,99284,E&M,,,,11,Office,1,782.17,566.73,268.15,283.83,0.0,14.75,298.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007743,MBR00000302,Professional,2023-03-16,2023-03-16,2023-03-30,PLN4927,1109850785,1109850785,ASC,Out-of-Network,S72.001A,I11.9,,,,,,,0,,72148,Radiology,,,,81,Independent Laboratory,3,2354.51,1940.11,1915.61,24.5,0.0,0.0,24.5,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007744,MBR00000302,Professional,2021-06-15,2021-06-15,2021-07-04,PLN3599,1168881145,1168881145,Orthopedic Surgery,In-Network,R05,Z79.4,,,,,,,0,,G0468,Medicine,,,,21,Inpatient Hospital,3,552.28,230.81,180.81,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007745,MBR00000302,Institutional-IP,2022-05-01,2022-05-04,2022-06-02,PLN2456,1845057593,1845057593,Orthopedic Surgery,In-Network,E66.9,N18.3,,,,195,MS-DRG,5,3,Y,99233,E&M,,,0450,21,Inpatient Hospital,3,340.44,212.08,137.08,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007746,MBR00000302,Professional,2023-06-28,2023-06-28,2023-07-17,PLN9440,1799205295,1799205295,General Acute Care Hospital,In-Network,F32.9,B97.89,,,,,,,0,,99406,Medicine,,,,11,Office,1,87.8,69.91,62.76,0.0,0.0,7.15,7.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007747,MBR00000302,Institutional-OP,2022-08-13,2022-08-13,2022-09-09,PLN5310,1606140917,1606140917,ASC,In-Network,I10,J18.9,,,,,,,0,,87491,Pathology/Lab,,,0370,22,Outpatient Hospital,2,204.62,136.48,0.0,136.48,0.0,0.0,136.48,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007748,MBR00000302,Institutional-OP,2021-04-20,2021-04-20,2021-05-15,PLN6835,1891849440,1891849440,Oncology,In-Network,J06.9,F41.9,,,,,,,0,,47562,Surgery,,,0730,22,Outpatient Hospital,3,5804.74,1875.25,1800.25,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007749,MBR00000302,Professional,2023-04-28,2023-04-28,2023-05-09,PLN8389,1550154147,1550154147,Outpatient Clinic,In-Network,J06.9,Z12.11,,,,,,,0,,43239,Surgery,,,,81,Independent Laboratory,1,1362.94,714.51,566.33,0.0,25.0,123.18,148.18,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007750,MBR00000303,Institutional-OP,2022-06-11,2022-06-11,2022-06-25,PLN7547,1453936007,1453936007,ASC,In-Network,N20.0,K21.0,,,,,,,0,,99221,E&M,,,0450,22,Outpatient Hospital,2,235.58,111.9,30.47,56.43,25.0,0.0,81.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007751,MBR00000303,Institutional-OP,2021-09-18,2021-09-18,2021-10-13,PLN6080,1872272835,1872272835,Internal Medicine,In-Network,F10.20,I10,,,,,,,0,,72148,Radiology,,,0320,22,Outpatient Hospital,2,1075.2,857.59,741.94,0.0,25.0,90.65,115.65,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007752,MBR00000303,Institutional-IP,2023-06-13,2023-06-18,2023-07-23,PLN5566,1660288235,1660288235,ASC,In-Network,J06.9,Z12.31,,,,641,MS-DRG,18,5,Y,78452,Radiology,,,0900,21,Inpatient Hospital,2,5140.24,3075.64,3075.64,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007753,MBR00000303,Professional,2023-08-27,2023-08-27,2023-09-22,PLN1523,1689639685,1689639685,SNF,In-Network,E78.5,Z12.31,,,,,,,0,,99213,E&M,,,,11,Office,3,279.92,113.29,0.0,113.29,75.0,0.0,188.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007754,MBR00000303,Professional,2022-10-06,2022-10-06,2022-11-16,PLN1101,1355166277,1355166277,Endocrinology,In-Network,E11.9,J06.9,,,,,,,0,,45380,Surgery,,,,20,Urgent Care,2,2392.18,1364.82,1286.16,0.0,50.0,28.66,78.66,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000007755,MBR00000303,Institutional-OP,2023-02-24,2023-02-24,2023-03-06,PLN7456,1355166277,1355166277,Endocrinology,In-Network,E78.5,Z00.00,,,,,,,0,,G0444,Medicine,,,0761,22,Outpatient Hospital,1,83.45,54.83,19.83,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000007756,MBR00000303,Institutional-IP,2021-09-21,2021-09-25,2021-09-28,PLN2359,1872613201,1872613201,Internal Medicine,In-Network,Z12.31,J20.9,,,,291,MS-DRG,12,4,Y,90837,Medicine,,,0450,21,Inpatient Hospital,2,288.08,146.49,139.26,0.0,0.0,7.23,7.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007757,MBR00000303,Institutional-IP,2023-03-29,2023-04-02,2023-04-29,PLN9833,1856686341,1856686341,Geriatrics,In-Network,E66.9,E78.5,,,,291,MS-DRG,1,4,Y,87491,Pathology/Lab,,,0900,21,Inpatient Hospital,1,256.79,97.61,69.92,0.0,25.0,2.69,27.69,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000007758,MBR00000303,Professional,2023-09-18,2023-09-18,2023-10-10,PLN4767,1749494482,1749494482,Pediatrics,In-Network,N39.0,M54.5,,,,,,,0,,99221,E&M,,,,31,Skilled Nursing Facility,3,162.16,85.25,35.25,0.0,50.0,0.0,50.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007759,MBR00000303,Professional,2021-09-18,2021-09-18,2021-10-08,PLN3709,1114982472,1114982472,Orthopedic Surgery,In-Network,N18.3,E78.5,,,,,,,0,,45380,Surgery,,,,11,Office,2,1258.28,458.02,458.02,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000007760,MBR00000303,Professional,2023-10-30,2023-10-30,2023-11-18,PLN3961,1840431511,1840431511,Geriatrics,Out-of-Network,I10,E78.5,,,,,,,0,,74177,Radiology,,,,22,Outpatient Hospital,2,2417.89,1891.72,1719.54,52.74,75.0,44.44,172.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007761,MBR00000303,Institutional-IP,2021-04-09,2021-04-20,2021-04-30,PLN6379,1284035364,1284035364,Pediatrics,In-Network,E78.5,N20.0,,,,196,MS-DRG,8,11,N,99233,E&M,,,0370,21,Inpatient Hospital,2,299.28,186.68,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007762,MBR00000303,Institutional-OP,2022-05-04,2022-05-04,2022-06-14,PLN2287,1800011727,1800011727,Clinical Laboratory,Out-of-Network,F41.9,E78.5,,,,,,,0,,99406,Medicine,,,0900,22,Outpatient Hospital,3,47.73,16.23,16.23,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007763,MBR00000303,Professional,2021-03-21,2021-03-21,2021-05-04,PLN7010,1946680931,1946680931,Critical Access Hospital,Out-of-Network,Z12.31,R51,,,,,,,0,,72148,Radiology,,,,11,Office,1,1710.94,1126.37,1049.47,51.9,25.0,0.0,76.9,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007764,MBR00000303,Professional,2022-05-05,2022-05-05,2022-06-17,PLN5440,1390307371,1390307371,DME Supplier,In-Network,Z00.00,S72.001A,,,,,,,0,,99284,E&M,,,,11,Office,1,325.21,176.79,0.0,176.79,0.0,0.0,176.79,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007765,MBR00000303,Professional,2022-12-10,2022-12-10,2023-01-07,PLN3016,1389336600,1389336600,Critical Access Hospital,In-Network,N18.3,E78.5,,,,,,,0,,G0444,Medicine,,,,22,Outpatient Hospital,2,76.03,32.66,32.66,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000007766,MBR00000303,Professional,2023-08-12,2023-08-12,2023-09-09,PLN9501,1780163051,1780163051,SNF,In-Network,J20.9,Z00.00,,,,,,,0,,77067,Radiology,,,,11,Office,2,555.36,227.02,227.02,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000007767,MBR00000303,Professional,2021-06-14,2021-06-14,2021-07-13,PLN6218,1242201429,1242201429,General Acute Care Hospital,In-Network,K21.0,K92.1,,,,,,,0,,86900,Pathology/Lab,,,,31,Skilled Nursing Facility,1,30.24,9.09,9.09,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007768,MBR00000303,Professional,2023-08-30,2023-08-30,2023-09-28,PLN6205,1845057593,1845057593,Orthopedic Surgery,In-Network,Z96.641,E11.9,,,,,,,0,,72148,Radiology,,,,22,Outpatient Hospital,1,2555.3,1248.87,873.58,325.29,50.0,0.0,375.29,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007769,MBR00000303,Institutional-OP,2023-12-31,2023-12-31,2024-02-06,PLN2117,1939033455,1939033455,Pulmonology,In-Network,J45.20,Z12.31,,,,,,,0,,90837,Medicine,,,0270,22,Outpatient Hospital,2,432.06,344.14,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007770,MBR00000303,Professional,2021-03-14,2021-03-14,2021-04-24,PLN4873,1284035364,1284035364,Pediatrics,In-Network,E66.9,I63.9,,,,,,,0,,90460,Medicine,,,,22,Outpatient Hospital,3,60.79,30.31,24.77,0.0,0.0,5.54,5.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007771,MBR00000303,Institutional-OP,2023-11-19,2023-11-19,2023-12-18,PLN9172,1511044648,1511044648,Endocrinology,In-Network,Z00.00,K21.0,,,,,,,0,,90686,Medicine,,,0270,22,Outpatient Hospital,1,140.5,98.22,0.0,98.22,0.0,0.0,98.22,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000007772,MBR00000303,Institutional-OP,2023-09-20,2023-09-20,2023-10-08,PLN1224,1486164553,1486164553,DME Supplier,In-Network,Z23,I10,,,,,,,0,,97110,Medicine,,,0510,22,Outpatient Hospital,3,160.26,50.63,30.74,4.89,15.0,0.0,19.89,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007773,MBR00000303,Professional,2021-02-01,2021-02-01,2021-03-12,PLN9827,1980712759,1980712759,Outpatient Clinic,Out-of-Network,I48.91,Z23,,,,,,,0,,70553,Radiology,,,,11,Office,3,2545.87,1543.96,1149.25,394.71,0.0,0.0,394.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007774,MBR00000303,Institutional-OP,2021-03-11,2021-03-11,2021-04-09,PLN1105,1125190055,1125190055,Nephrology,In-Network,R05,J18.9,,,,,,,0,,90686,Medicine,,,0120,22,Outpatient Hospital,2,123.68,87.73,0.0,87.73,50.0,0.0,137.73,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000007775,MBR00000303,Professional,2023-03-05,2023-03-05,2023-03-18,PLN3567,1872272835,1872272835,Internal Medicine,In-Network,R07.9,I10,,,,,,,0,,43239,Surgery,,,,11,Office,1,1084.97,839.6,839.6,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007776,MBR00000303,Professional,2022-04-05,2022-04-05,2022-04-28,PLN8866,1817234602,1817234602,Clinical Laboratory,In-Network,M17.11,E11.65,,,,,,,0,,99221,E&M,,,,23,Emergency Room,1,441.05,217.79,0.0,0.0,15.0,4.9,19.9,0.0,Denied,PR-1,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007777,MBR00000303,Professional,2021-10-13,2021-10-13,2021-10-31,PLN6501,1242201429,1242201429,General Acute Care Hospital,In-Network,K92.1,E78.5,,,,,,,0,,43239,Surgery,,,,11,Office,1,1144.61,493.14,0.0,0.0,75.0,81.96,156.96,0.0,Denied,PR-1,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007778,MBR00000304,Professional,2022-03-19,2022-03-19,2022-04-15,PLN2225,1284035364,1284035364,Pediatrics,In-Network,I10,E66.9,,,,,,,0,,99283,E&M,,,,11,Office,2,292.09,148.35,148.35,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007779,MBR00000304,Institutional-IP,2022-01-09,2022-01-12,2022-02-07,PLN9957,1530904931,1530904931,Internal Medicine,In-Network,M54.5,K21.0,,,,603,MS-DRG,22,3,N,99284,E&M,,,0510,21,Inpatient Hospital,1,577.74,223.7,0.0,223.7,0.0,0.0,223.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007780,MBR00000304,Institutional-OP,2023-12-04,2023-12-04,2024-01-16,PLN8358,1528335731,1528335731,Critical Access Hospital,In-Network,Z12.31,E11.40,,,,,,,0,,78452,Radiology,,,0360,22,Outpatient Hospital,3,2658.59,1575.87,1243.3,0.0,25.0,307.57,332.57,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007781,MBR00000304,Institutional-IP,2021-09-21,2021-09-28,2021-10-21,PLN5593,1463205530,1463205530,Nephrology,In-Network,Z23,Z51.11,,,,194,MS-DRG,6,7,Y,99284,E&M,,,0636,21,Inpatient Hospital,3,720.63,252.32,0.0,252.32,0.0,0.0,252.32,21.11,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007782,MBR00000304,Institutional-IP,2021-04-07,2021-04-11,2021-05-09,PLN1401,1809014947,1809014947,Urology,In-Network,I48.91,J06.9,,,,683,MS-DRG,8,4,Y,99221,E&M,,,0301,21,Inpatient Hospital,2,383.94,228.51,228.51,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007783,MBR00000304,Institutional-OP,2023-06-29,2023-06-29,2023-07-31,PLN5117,1812060197,1812060197,Oncology,Out-of-Network,I10,F41.9,,,,,,,0,,99284,E&M,,,0270,22,Outpatient Hospital,2,537.48,276.7,218.32,0.0,0.0,0.0,0.0,58.38,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007784,MBR00000304,Institutional-OP,2023-07-09,2023-07-09,2023-08-06,PLN4131,1571574052,1571574052,Critical Access Hospital,In-Network,J18.9,R10.9,,,,,,,0,,77067,Radiology,,,0120,22,Outpatient Hospital,1,487.08,387.8,247.17,140.63,0.0,0.0,140.63,0.0,Pended,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000007785,MBR00000304,Institutional-OP,2023-09-06,2023-09-06,2023-10-02,PLN1334,1752470395,1752470395,Home Health,In-Network,C50.912,I10,,,,,,,0,,45378,Surgery,,,0120,22,Outpatient Hospital,2,2074.98,1494.48,1376.08,0.0,0.0,0.0,0.0,118.4,Paid,,,0,,0,1,1,0,0,1,Unbundling,0,1,0,0,0
CLM0000007786,MBR00000304,Institutional-IP,2023-11-30,2023-12-02,2024-01-03,PLN8793,1860435061,1860435061,DME Supplier,In-Network,E87.6,E78.5,,,,292,MS-DRG,10,2,N,47562,Surgery,,,0370,21,Inpatient Hospital,3,4486.69,1673.03,1673.03,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007787,MBR00000304,Professional,2021-02-14,2021-02-14,2021-02-27,PLN2130,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,I11.9,J20.9,,,,,,,0,,86900,Pathology/Lab,,,,22,Outpatient Hospital,2,41.1,33.55,0.0,33.55,35.0,0.0,68.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007788,MBR00000304,Professional,2023-04-23,2023-04-23,2023-06-03,PLN5269,1198133277,1198133277,SNF,In-Network,J18.9,J06.9,,,,,,,0,,99283,E&M,,,,12,Home,1,411.3,307.52,272.52,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007789,MBR00000304,Professional,2021-10-23,2021-10-23,2021-11-14,PLN5002,1361302520,1361302520,Critical Access Hospital,In-Network,M17.11,Z12.31,,,,,,,0,,80061,Pathology/Lab,,,,21,Inpatient Hospital,3,121.21,87.38,36.46,0.0,50.0,0.0,50.0,0.92,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007790,MBR00000304,Professional,2022-04-07,2022-04-07,2022-05-11,PLN6257,1125190055,1125190055,Nephrology,In-Network,I48.91,E11.9,,,,,,,0,,99214,E&M,,,,11,Office,1,167.72,78.22,0.0,78.22,0.0,0.0,78.22,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007791,MBR00000304,Institutional-OP,2022-05-07,2022-05-07,2022-05-15,PLN5288,1767011137,1767011137,DME Supplier,In-Network,I10,E78.5,,,,,,,0,,99222,E&M,,,0740,22,Outpatient Hospital,2,468.96,308.39,280.39,0.0,0.0,0.0,0.0,28.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007792,MBR00000304,Institutional-OP,2023-12-16,2023-12-16,2024-01-02,PLN2589,1530904931,1530904931,Internal Medicine,In-Network,I50.9,I63.9,,,,,,,0,,27447,Surgery,,,0320,22,Outpatient Hospital,1,4184.96,2544.55,1924.56,0.0,0.0,427.09,427.09,192.9,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007793,MBR00000304,Institutional-OP,2022-07-26,2022-07-26,2022-08-04,PLN4664,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,R05,J20.9,,,,,,,0,,G0468,Medicine,,,0270,22,Outpatient Hospital,3,394.3,129.57,0.0,129.57,75.0,0.0,204.57,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007794,MBR00000304,Professional,2021-09-01,2021-09-01,2021-10-10,PLN4058,1132188260,1132188260,Family Medicine,In-Network,E78.5,Z23,,,,,,,0,,87491,Pathology/Lab,,,,20,Urgent Care,2,136.83,99.0,0.0,99.0,0.0,0.0,99.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007795,MBR00000304,Professional,2021-04-06,2021-04-06,2021-05-05,PLN2109,1361302520,1361302520,Critical Access Hospital,In-Network,Z00.00,I10,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,1,116.86,98.46,0.0,98.46,75.0,0.0,173.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007796,MBR00000304,Professional,2022-10-07,2022-10-07,2022-10-15,PLN9762,1575695214,1575695214,SNF,In-Network,J06.9,N18.3,,,,,,,0,,99233,E&M,,,,11,Office,2,204.82,94.31,39.48,54.83,0.0,0.0,54.83,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007797,MBR00000304,Institutional-OP,2023-06-28,2023-06-28,2023-07-31,PLN3613,1193493783,1193493783,Critical Access Hospital,Out-of-Network,Z12.31,I10,,,,,,,0,,99222,E&M,,,0450,22,Outpatient Hospital,2,424.47,247.77,145.19,0.0,15.0,21.33,36.33,66.25,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007798,MBR00000304,Institutional-IP,2023-02-17,2023-02-23,2023-03-08,PLN4178,1757138478,1757138478,Pediatrics,In-Network,J44.1,Z12.31,,,,292,MS-DRG,2,6,Y,70553,Radiology,,,0360,21,Inpatient Hospital,3,4377.12,3198.52,3015.48,183.04,0.0,0.0,183.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007799,MBR00000304,Institutional-OP,2023-10-20,2023-10-20,2023-11-08,PLN9358,1450553056,1450553056,Clinical Laboratory,In-Network,E66.9,Z00.00,,,,,,,0,,76700,Radiology,,,0740,22,Outpatient Hospital,3,1243.04,992.26,434.94,482.32,75.0,0.0,557.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007800,MBR00000304,Institutional-OP,2021-02-15,2021-02-15,2021-03-19,PLN7157,1713934949,1713934949,Neurology,In-Network,Z12.31,G43.909,,,,,,,0,,45380,Surgery,,,0740,22,Outpatient Hospital,2,1628.74,492.06,401.49,90.57,0.0,0.0,90.57,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000007801,MBR00000305,Professional,2022-03-18,2022-03-18,2022-04-01,PLN8120,1422747896,1422747896,Urology,In-Network,E78.5,N17.9,,,,,,,0,,G0444,Medicine,,,,49,Independent Clinic,2,39.81,25.22,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-27,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000007802,MBR00000305,Professional,2022-11-01,2022-11-01,2022-11-28,PLN4097,1624202402,1624202402,Orthopedic Surgery,In-Network,M17.11,N39.0,,,,,,,0,,99406,Medicine,,,,11,Office,1,63.26,43.06,0.0,43.06,0.0,0.0,43.06,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007803,MBR00000305,Institutional-OP,2023-07-28,2023-07-28,2023-09-02,PLN5351,1964402759,1964402759,Outpatient Clinic,In-Network,R05,Z23,,,,,,,0,,99221,E&M,,,0450,22,Outpatient Hospital,3,248.81,153.29,0.0,153.29,50.0,0.0,203.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007804,MBR00000305,Professional,2021-12-09,2021-12-09,2021-12-16,PLN7041,1696843572,1696843572,Critical Access Hospital,Out-of-Network,E11.9,E11.9,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,2,189.64,94.43,94.43,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007805,MBR00000305,Professional,2023-01-11,2023-01-11,2023-02-08,PLN9812,1486164553,1486164553,DME Supplier,In-Network,N39.0,Z23,,,,,,,0,,G0444,Medicine,,,,11,Office,1,55.39,32.57,0.0,0.0,0.0,1.34,1.34,0.0,Denied,CO-4,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000007806,MBR00000305,Professional,2021-08-16,2021-08-16,2021-09-10,PLN8759,1124394415,1124394415,Pediatrics,In-Network,Z00.00,Z23,,,,,,,0,,81001,Pathology/Lab,,,,49,Independent Clinic,3,61.96,30.76,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007807,MBR00000305,Institutional-IP,2022-10-10,2022-10-12,2022-10-22,PLN8849,1790497490,1790497490,OB/GYN,In-Network,M54.5,N18.3,,,,194,MS-DRG,14,2,N,99221,E&M,,,0360,21,Inpatient Hospital,1,447.81,362.64,238.41,0.0,15.0,8.96,23.96,100.27,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007808,MBR00000305,Institutional-OP,2023-04-29,2023-04-29,2023-06-06,PLN2513,1438368327,1438368327,Home Health,In-Network,J06.9,R51,,,,,,,0,,97110,Medicine,,,0200,22,Outpatient Hospital,2,144.71,106.4,91.4,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007809,MBR00000305,Professional,2023-06-16,2023-06-16,2023-07-24,PLN8961,1334916761,1334916761,ASC,In-Network,I10,E11.9,,,,,,,0,,70553,Radiology,,,,11,Office,1,2396.56,1517.46,661.01,220.48,0.0,197.45,417.93,438.52,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007810,MBR00000305,Professional,2022-05-10,2022-05-10,2022-05-20,PLN6618,1108115157,1108115157,General Acute Care Hospital,In-Network,I10,J06.9,,,,,,,0,,74177,Radiology,,,,22,Outpatient Hospital,3,2615.41,1323.34,1248.34,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007811,MBR00000305,Institutional-OP,2022-06-02,2022-06-02,2022-06-30,PLN3530,1540044947,1540044947,Pulmonology,Out-of-Network,M54.5,I25.10,,,,,,,0,,84443,Pathology/Lab,,,0370,22,Outpatient Hospital,2,155.11,65.61,0.0,65.61,15.0,0.0,80.61,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000007812,MBR00000305,Professional,2023-08-24,2023-08-24,2023-09-26,PLN3319,1622771872,1622771872,Pediatrics,In-Network,Z12.31,E78.5,,,,,,,0,,99204,E&M,,,,21,Inpatient Hospital,3,503.91,227.67,184.81,0.0,0.0,42.86,42.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007813,MBR00000305,Institutional-OP,2022-08-23,2022-08-23,2022-09-18,PLN5704,1624802371,1624802371,ASC,Out-of-Network,R05,I10,,,,,,,0,,45378,Surgery,,,0360,22,Outpatient Hospital,1,1849.06,968.99,941.15,0.0,0.0,0.0,0.0,27.84,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000007814,MBR00000305,Institutional-OP,2022-01-19,2022-01-19,2022-02-28,PLN3638,1475984649,1475984649,SNF,In-Network,Z00.01,I10,,,,,,,0,,66984,Surgery,,,0200,22,Outpatient Hospital,3,2410.68,1284.41,1259.41,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007815,MBR00000305,Professional,2021-10-28,2021-10-28,2021-12-07,PLN3636,1450553056,1450553056,Clinical Laboratory,In-Network,G20,J20.9,,,,,,,0,,33533,Surgery,,,,49,Independent Clinic,3,12013.3,5412.62,5412.62,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000007816,MBR00000305,Professional,2023-02-19,2023-02-19,2023-03-01,PLN1930,1109850785,1109850785,ASC,Out-of-Network,Z00.00,N18.3,,,,,,,0,,99222,E&M,,,,11,Office,3,629.84,283.57,98.06,180.15,0.0,5.36,185.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007817,MBR00000305,Professional,2023-02-19,2023-02-19,2023-03-02,PLN9119,1502838586,1502838586,ASC,In-Network,J06.9,I25.10,,,,,,,0,,47562,Surgery,,,,11,Office,3,6112.53,3665.76,3506.77,56.98,50.0,0.0,106.98,52.01,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007818,MBR00000305,Professional,2022-08-12,2022-08-12,2022-09-11,PLN3758,1108115157,1108115157,General Acute Care Hospital,In-Network,E78.5,E66.9,,,,,,,0,,99222,E&M,,,,23,Emergency Room,2,386.33,278.73,94.1,105.9,75.0,0.0,180.9,3.73,Pended,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007819,MBR00000305,Professional,2021-06-24,2021-06-24,2021-08-03,PLN6008,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,J06.9,I10,,,,,,,0,,74177,Radiology,,,,23,Emergency Room,2,1341.18,610.83,241.62,369.21,0.0,0.0,369.21,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007820,MBR00000305,Professional,2021-06-26,2021-06-26,2021-07-06,PLN2707,1946680931,1946680931,Critical Access Hospital,Out-of-Network,M81.0,E78.5,,,,,,,0,,90460,Medicine,,,,11,Office,1,49.8,37.79,0.0,37.79,0.0,0.0,37.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007821,MBR00000305,Professional,2021-09-24,2021-09-24,2021-10-27,PLN3656,1564502315,1564502315,ASC,In-Network,M17.11,F41.9,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,2,131.31,83.08,0.0,83.08,0.0,0.0,83.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007822,MBR00000305,Institutional-OP,2021-01-14,2021-01-14,2021-02-07,PLN4744,1624202402,1624202402,Orthopedic Surgery,In-Network,I10,E11.9,,,,,,,0,,66984,Surgery,,,0270,22,Outpatient Hospital,1,2360.36,1265.79,1029.65,233.41,0.0,2.73,236.14,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007823,MBR00000305,Professional,2022-06-10,2022-06-10,2022-07-03,PLN7551,1542828721,1542828721,Orthopedic Surgery,In-Network,Z12.31,Z87.891,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,2,3339.14,2345.69,2339.0,0.0,0.0,6.69,6.69,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007824,MBR00000305,Professional,2022-03-31,2022-03-31,2022-04-18,PLN5764,1585582070,1585582070,Outpatient Clinic,In-Network,I25.10,Z23,,,,,,,0,,71046,Radiology,,,,11,Office,3,239.53,100.17,0.0,100.17,0.0,0.0,100.17,29.38,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007825,MBR00000305,Professional,2022-02-26,2022-02-26,2022-03-16,PLN8132,1590915516,1590915516,Physical Therapy,Out-of-Network,E66.9,N18.3,,,,,,,0,,99406,Medicine,,,,11,Office,2,70.57,44.66,37.54,0.0,0.0,0.0,0.0,7.12,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007826,MBR00000305,Institutional-IP,2023-10-21,2023-10-23,2023-10-30,PLN7995,1511044648,1511044648,Endocrinology,In-Network,J44.1,E78.5,,,,690,MS-DRG,20,2,Y,90686,Medicine,,,0120,21,Inpatient Hospital,3,119.54,81.7,52.91,0.0,25.0,0.0,25.0,3.79,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000007827,MBR00000305,Professional,2021-09-20,2021-09-20,2021-10-31,PLN2322,1716521444,1716521444,Oncology,In-Network,E11.9,E11.9,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,3,74.57,62.2,0.0,62.2,25.0,0.0,87.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007828,MBR00000305,Professional,2023-06-05,2023-06-05,2023-07-14,PLN5618,1691062876,1691062876,SNF,In-Network,J20.9,E11.9,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,2,5598.84,3234.65,0.0,488.68,0.0,0.0,488.68,752.8,Denied,CO-15,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007829,MBR00000305,Institutional-OP,2021-07-30,2021-07-30,2021-08-24,PLN8392,1108115157,1108115157,General Acute Care Hospital,In-Network,N39.0,F41.9,,,,,,,0,,99283,E&M,,,0636,22,Outpatient Hospital,2,625.13,394.13,344.13,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007830,MBR00000305,Institutional-OP,2022-11-01,2022-11-01,2022-11-13,PLN2453,1622771872,1622771872,Pediatrics,In-Network,Z79.4,E11.9,,,,,,,0,,99283,E&M,,,0730,22,Outpatient Hospital,3,390.51,259.35,165.85,78.5,15.0,0.0,93.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007831,MBR00000306,Institutional-IP,2023-08-01,2023-08-07,2023-08-13,PLN4241,1896447406,1896447406,Nephrology,Out-of-Network,E78.5,M17.11,,,,871,MS-DRG,19,6,U,99283,E&M,,,0200,21,Inpatient Hospital,3,257.75,93.96,29.65,0.0,35.0,2.87,37.87,26.44,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007832,MBR00000306,Institutional-OP,2023-07-07,2023-07-07,2023-08-19,PLN5917,1366286000,1366286000,SNF,In-Network,E11.65,N18.3,,,,,,,0,,47562,Surgery,,,0301,22,Outpatient Hospital,3,2830.45,2282.29,1928.43,0.0,0.0,174.91,174.91,178.95,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007833,MBR00000306,Professional,2022-10-09,2022-10-09,2022-10-21,PLN7908,1530904931,1530904931,Internal Medicine,In-Network,E11.9,Z79.4,,,,,,,0,,99214,E&M,,,,23,Emergency Room,3,224.09,153.52,103.52,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007834,MBR00000306,Professional,2021-08-15,2021-08-15,2021-08-30,PLN9710,1700633438,1700633438,DME Supplier,In-Network,Z00.00,I10,,,,,,,0,,74177,Radiology,,,,20,Urgent Care,2,2419.56,1295.75,798.98,0.0,25.0,243.62,268.62,228.15,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007835,MBR00000306,Professional,2022-02-18,2022-02-18,2022-03-06,PLN3878,1899127912,1899127912,Neurology,In-Network,C50.912,N17.9,,,,,,,0,,99233,E&M,,,,81,Independent Laboratory,2,308.28,106.76,76.75,0.0,0.0,9.59,9.59,20.42,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007836,MBR00000306,Institutional-OP,2022-04-10,2022-04-10,2022-05-22,PLN4123,1475984649,1475984649,SNF,In-Network,N20.0,F32.9,,,,,,,0,,84443,Pathology/Lab,,,0301,22,Outpatient Hospital,1,88.49,49.41,19.96,0.0,15.0,0.0,15.0,14.45,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007837,MBR00000306,Institutional-OP,2023-07-16,2023-07-16,2023-08-28,PLN9257,1964402759,1964402759,Outpatient Clinic,In-Network,N20.0,K21.0,,,,,,,0,,43239,Surgery,,,0730,22,Outpatient Hospital,3,2112.85,1436.37,1436.37,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007838,MBR00000306,Institutional-IP,2022-02-18,2022-02-28,2022-03-13,PLN1060,1991459367,1991459367,Neurology,Out-of-Network,J18.9,E11.40,,,,683,MS-DRG,10,10,Y,90460,Medicine,,,0320,21,Inpatient Hospital,3,71.32,34.41,0.0,34.41,25.0,0.0,59.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007839,MBR00000306,Professional,2023-06-23,2023-06-23,2023-07-03,PLN9262,1219817751,1219817751,OB/GYN,In-Network,K21.0,F32.9,,,,,,,0,,99213,E&M,,,,11,Office,1,123.69,78.18,78.18,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007840,MBR00000306,Institutional-OP,2023-11-09,2023-11-09,2023-12-20,PLN1914,1795618275,1795618275,Pulmonology,In-Network,M54.5,E87.6,,,,,,,0,,99204,E&M,,,0761,22,Outpatient Hospital,2,456.56,195.83,0.0,195.83,25.0,0.0,220.83,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007841,MBR00000306,Institutional-IP,2021-05-02,2021-05-04,2021-05-31,PLN9795,1564502315,1564502315,ASC,In-Network,R51,J06.9,,,,682,MS-DRG,11,2,Y,80061,Pathology/Lab,,,0320,21,Inpatient Hospital,2,79.06,28.9,16.92,0.0,0.0,5.49,5.49,6.49,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007842,MBR00000306,Professional,2023-10-22,2023-10-22,2023-11-15,PLN3945,1193493783,1193493783,Critical Access Hospital,Out-of-Network,F41.9,E66.9,,,,,,,0,,93000,Radiology,,,,22,Outpatient Hospital,3,101.31,80.13,40.09,31.85,0.0,8.19,40.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007843,MBR00000306,Professional,2022-09-14,2022-09-14,2022-10-07,PLN5457,1717912431,1717912431,Oncology,In-Network,E11.65,R10.9,,,,,,,0,,99283,E&M,,,,11,Office,1,397.98,164.78,0.0,164.78,0.0,0.0,164.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007844,MBR00000306,Professional,2022-10-20,2022-10-20,2022-11-10,PLN8857,1198133277,1198133277,SNF,In-Network,J20.9,I10,,,,,,,0,,99406,Medicine,,,,22,Outpatient Hospital,2,76.77,49.71,47.24,0.0,0.0,0.0,0.0,2.47,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007845,MBR00000306,Professional,2021-12-01,2021-12-01,2021-12-29,PLN9525,1475984649,1475984649,SNF,In-Network,Z96.641,F32.9,,,,,,,0,,93306,Radiology,,,,11,Office,3,3040.97,1995.65,1645.73,238.22,0.0,111.7,349.92,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007846,MBR00000306,Institutional-OP,2022-01-01,2022-01-01,2022-01-29,PLN9404,1606140917,1606140917,ASC,In-Network,G43.909,Z96.641,,,,,,,0,,27130,Surgery,,,0320,22,Outpatient Hospital,2,5222.21,3993.21,3710.91,0.0,0.0,0.0,0.0,282.3,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007847,MBR00000306,Professional,2022-08-16,2022-08-16,2022-09-23,PLN9900,1542828721,1542828721,Orthopedic Surgery,In-Network,Z23,J06.9,,,,,,,0,,83036,Pathology/Lab,,,,22,Outpatient Hospital,1,109.56,55.81,0.0,55.81,75.0,0.0,130.81,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000007848,MBR00000306,Institutional-IP,2021-08-06,2021-08-12,2021-09-01,PLN8312,1205377316,1205377316,Orthopedic Surgery,In-Network,R07.9,G43.909,,,,603,MS-DRG,1,6,Y,77067,Radiology,,,0636,21,Inpatient Hospital,2,389.65,175.3,95.69,0.0,35.0,0.0,35.0,44.61,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000007849,MBR00000306,Professional,2023-02-26,2023-02-26,2023-03-12,PLN1691,1631954542,1631954542,Oncology,In-Network,I10,Z12.31,,,,,,,0,,99221,E&M,,,,49,Independent Clinic,1,242.63,84.92,0.0,84.92,50.0,0.0,134.92,18.57,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007850,MBR00000306,Professional,2023-01-01,2023-01-01,2023-01-12,PLN7031,1114982472,1114982472,Orthopedic Surgery,In-Network,E11.9,Z23,,,,,,,0,,93225,Medicine,,,,11,Office,2,889.6,653.76,628.76,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007851,MBR00000306,Institutional-OP,2021-01-10,2021-01-10,2021-01-22,PLN4864,1334916761,1334916761,ASC,In-Network,J06.9,K21.0,,,,,,,0,,86900,Pathology/Lab,,,0730,22,Outpatient Hospital,2,36.34,29.31,0.0,29.31,75.0,0.0,104.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007852,MBR00000306,Institutional-IP,2021-08-19,2021-08-25,2021-09-09,PLN1161,1198133277,1198133277,SNF,In-Network,M54.5,E78.5,,,,195,MS-DRG,15,6,Y,70553,Radiology,,,0320,21,Inpatient Hospital,3,2220.78,1153.74,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-27,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000007853,MBR00000306,Institutional-OP,2022-07-17,2022-07-17,2022-07-28,PLN2727,1530904931,1530904931,Internal Medicine,In-Network,E66.9,K21.0,,,,,,,0,,23472,Surgery,,,0370,22,Outpatient Hospital,3,6950.04,3198.42,1435.92,484.44,0.0,383.87,868.31,894.19,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007854,MBR00000306,Institutional-IP,2023-03-24,2023-03-27,2023-04-12,PLN7761,1531398223,1531398223,OB/GYN,In-Network,E78.5,N39.0,,,,682,MS-DRG,4,3,Y,83036,Pathology/Lab,,,0510,21,Inpatient Hospital,1,43.7,19.45,0.0,19.45,35.0,0.0,54.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000007855,MBR00000306,Institutional-OP,2021-11-16,2021-11-16,2021-12-29,PLN9291,1806688928,1806688928,Geriatrics,In-Network,I63.9,R51,,,,,,,0,,99203,E&M,,,0270,22,Outpatient Hospital,1,318.03,254.74,0.0,254.74,35.0,0.0,289.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007856,MBR00000306,Professional,2023-08-30,2023-08-30,2023-09-10,PLN6925,1752470395,1752470395,Home Health,In-Network,J06.9,I10,,,,,,,0,,97530,Medicine,,,,12,Home,2,184.92,95.48,45.48,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007857,MBR00000306,Institutional-IP,2022-08-08,2022-08-12,2022-08-18,PLN1416,1556140803,1556140803,Cardiology,In-Network,M54.5,N18.3,,,,682,MS-DRG,19,4,Y,90460,Medicine,,,0761,21,Inpatient Hospital,3,40.21,28.24,0.0,28.24,75.0,0.0,103.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007858,MBR00000306,Professional,2022-08-14,2022-08-14,2022-09-18,PLN1178,1799205295,1799205295,General Acute Care Hospital,In-Network,C50.912,E78.5,,,,,,,0,,45378,Surgery,,,,20,Urgent Care,2,2567.2,1646.89,1646.89,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000007859,MBR00000307,Institutional-OP,2021-05-01,2021-05-01,2021-05-22,PLN8248,1845057593,1845057593,Orthopedic Surgery,In-Network,E11.9,R51,,,,,,,0,,77067,Radiology,,,0740,22,Outpatient Hospital,1,628.47,357.55,0.0,357.55,50.0,0.0,407.55,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000007860,MBR00000307,Institutional-IP,2022-11-19,2022-11-22,2022-12-03,PLN2107,1915531927,1915531927,Critical Access Hospital,In-Network,I10,Z51.11,,,,683,MS-DRG,4,3,Y,71046,Radiology,,,0740,21,Inpatient Hospital,1,308.29,140.29,65.29,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007861,MBR00000307,Professional,2023-06-15,2023-06-15,2023-07-28,PLN5840,1313212303,1313212303,Family Medicine,In-Network,I10,Z23,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,1,41.81,29.28,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007862,MBR00000307,Professional,2021-08-20,2021-08-20,2021-09-15,PLN5444,1224179551,1224179551,Physical Therapy,In-Network,E11.9,E66.9,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,3,116.3,62.87,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007863,MBR00000307,Institutional-OP,2022-08-19,2022-08-19,2022-09-05,PLN9410,1644128543,1644128543,Gastroenterology,In-Network,I25.10,J20.9,,,,,,,0,,83036,Pathology/Lab,,,0761,22,Outpatient Hospital,3,62.48,23.37,0.0,0.0,75.0,0.0,75.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000007864,MBR00000307,Professional,2021-01-07,2021-01-07,2021-02-14,PLN5990,1780163051,1780163051,SNF,In-Network,Z00.00,Z23,,,,,,,0,,80053,Pathology/Lab,,,,31,Skilled Nursing Facility,1,94.66,51.7,51.7,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007865,MBR00000307,Institutional-IP,2021-08-20,2021-08-22,2021-09-12,PLN3661,1500037969,1500037969,Pulmonology,In-Network,K21.0,Z12.31,,,,690,MS-DRG,5,2,Y,99283,E&M,,,0450,21,Inpatient Hospital,1,375.4,297.78,297.78,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007866,MBR00000307,Institutional-OP,2021-03-19,2021-03-19,2021-04-17,PLN5097,1434029575,1434029575,Endocrinology,In-Network,C50.912,I10,,,,,,,0,,43239,Surgery,,,0200,22,Outpatient Hospital,1,1305.9,744.77,633.92,0.0,25.0,85.85,110.85,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007867,MBR00000307,Professional,2023-04-23,2023-04-23,2023-05-01,PLN4823,1219817751,1219817751,OB/GYN,In-Network,J18.9,J44.1,,,,,,,0,,90837,Medicine,,,,11,Office,2,359.06,273.98,0.0,273.98,50.0,0.0,323.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007868,MBR00000307,Institutional-IP,2023-12-27,2024-01-03,2024-02-06,PLN1827,1563980627,1563980627,Critical Access Hospital,In-Network,J44.1,F32.9,,,,292,MS-DRG,19,7,Y,70553,Radiology,,,0320,21,Inpatient Hospital,3,1672.44,896.97,0.0,0.0,35.0,0.0,35.0,0.0,Denied,PR-1,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007869,MBR00000307,Institutional-OP,2021-02-11,2021-02-11,2021-03-25,PLN4854,1935547131,1935547131,Pulmonology,In-Network,E78.5,I10,,,,,,,0,,84443,Pathology/Lab,,,0730,22,Outpatient Hospital,3,135.32,42.4,0.0,42.4,0.0,0.0,42.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007870,MBR00000307,Professional,2023-02-08,2023-02-08,2023-03-07,PLN6619,1389336600,1389336600,Critical Access Hospital,In-Network,E11.40,K57.30,,,,,,,0,,45380,Surgery,,,,11,Office,2,1304.67,735.03,589.49,0.0,0.0,145.54,145.54,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000007871,MBR00000307,Professional,2022-10-12,2022-10-12,2022-11-22,PLN8211,1313212303,1313212303,Family Medicine,In-Network,Z12.31,J20.9,,,,,,,0,,47562,Surgery,,,,31,Skilled Nursing Facility,1,3388.56,1065.92,1065.92,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007872,MBR00000307,Institutional-IP,2023-02-08,2023-02-09,2023-03-14,PLN8623,1390307371,1390307371,DME Supplier,In-Network,N40.0,Z12.11,,,,194,MS-DRG,2,1,Y,99233,E&M,,,0301,21,Inpatient Hospital,1,415.67,173.74,0.0,173.74,0.0,0.0,173.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007873,MBR00000307,Institutional-IP,2022-07-04,2022-07-07,2022-07-25,PLN1648,1284035364,1284035364,Pediatrics,In-Network,M54.5,Z23,,,,690,MS-DRG,10,3,N,93306,Radiology,,,0730,21,Inpatient Hospital,1,3208.49,1288.13,1142.8,110.33,35.0,0.0,145.33,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007874,MBR00000307,Institutional-OP,2023-12-22,2023-12-22,2024-01-22,PLN1665,1899127912,1899127912,Neurology,In-Network,E66.9,I10,,,,,,,0,,78452,Radiology,,,0730,22,Outpatient Hospital,2,6390.63,2753.27,2264.16,378.55,25.0,85.56,489.11,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007875,MBR00000307,Institutional-IP,2021-02-13,2021-02-22,2021-03-22,PLN9411,1500949740,1500949740,Pediatrics,In-Network,J44.1,I63.9,,,,682,MS-DRG,6,9,Y,97110,Medicine,,,0636,21,Inpatient Hospital,2,156.77,67.5,8.6,33.9,25.0,0.0,58.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007876,MBR00000307,Institutional-IP,2021-06-13,2021-06-16,2021-07-24,PLN6282,1361302520,1361302520,Critical Access Hospital,In-Network,I10,J18.9,,,,690,MS-DRG,13,3,Y,27130,Surgery,,,0900,21,Inpatient Hospital,3,7307.64,5651.53,5475.47,151.06,25.0,0.0,176.06,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007877,MBR00000307,Professional,2021-10-01,2021-10-01,2021-10-21,PLN2854,1550154147,1550154147,Outpatient Clinic,In-Network,E66.9,E11.9,,,,,,,0,,45378,Surgery,,,,11,Office,1,993.41,505.34,505.34,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000007878,MBR00000307,Professional,2023-05-07,2023-05-07,2023-06-10,PLN7381,1757138478,1757138478,Pediatrics,In-Network,Z12.31,J06.9,,,,,,,0,,58661,Surgery,,,,11,Office,1,1749.84,1286.23,1286.23,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007879,MBR00000307,Institutional-IP,2021-03-26,2021-03-27,2021-05-07,PLN8283,1450094833,1450094833,Outpatient Clinic,In-Network,F10.20,Z23,,,,196,MS-DRG,17,1,Y,90837,Medicine,,,0510,21,Inpatient Hospital,3,247.07,81.42,66.51,0.0,0.0,14.91,14.91,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000007880,MBR00000307,Professional,2021-05-16,2021-05-16,2021-06-17,PLN4632,1990090423,1990090423,Orthopedic Surgery,In-Network,J20.9,Z87.891,,,,,,,0,,74177,Radiology,,,,11,Office,2,1666.79,592.88,493.52,0.0,75.0,24.36,99.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007881,MBR00000307,Institutional-OP,2023-03-13,2023-03-13,2023-04-18,PLN7837,1227362142,1227362142,DME Supplier,In-Network,I10,E11.9,,,,,,,0,,27130,Surgery,,,0360,22,Outpatient Hospital,1,6740.73,2659.0,2348.61,0.0,0.0,310.39,310.39,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007882,MBR00000307,Professional,2022-04-04,2022-04-04,2022-04-22,PLN3557,1991459367,1991459367,Neurology,Out-of-Network,I25.10,Z12.31,,,,,,,0,,99222,E&M,,,,21,Inpatient Hospital,2,595.61,278.74,0.0,278.74,35.0,0.0,313.74,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007883,MBR00000307,Professional,2023-02-12,2023-02-12,2023-02-25,PLN9158,1860435061,1860435061,DME Supplier,In-Network,J20.9,E66.9,,,,,,,0,,G0468,Medicine,,,,11,Office,2,526.13,165.51,0.0,165.51,0.0,0.0,165.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007884,MBR00000308,Institutional-OP,2022-02-06,2022-02-06,2022-02-15,PLN1070,1500949740,1500949740,Pediatrics,In-Network,Z23,Z00.00,,,,,,,0,,78452,Radiology,,,0510,22,Outpatient Hospital,3,4560.51,1429.18,1222.42,0.0,0.0,206.76,206.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007885,MBR00000308,Professional,2021-04-08,2021-04-08,2021-05-08,PLN9737,1135158374,1135158374,Pulmonology,In-Network,F10.20,N18.3,,,,,,,0,,99284,E&M,,,,65,End-Stage Renal Disease,1,364.46,240.45,91.74,112.98,15.0,20.73,148.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007886,MBR00000308,Professional,2022-10-16,2022-10-16,2022-11-28,PLN6157,1364429278,1364429278,OB/GYN,In-Network,I10,Z23,,,,,,,0,,99232,E&M,,,,20,Urgent Care,2,205.97,173.7,173.7,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007887,MBR00000308,Institutional-OP,2021-04-30,2021-04-30,2021-06-10,PLN4427,1717546253,1717546253,Family Medicine,In-Network,I10,E78.5,,,,,,,0,,70450,Radiology,,,0360,22,Outpatient Hospital,3,1241.98,777.7,777.7,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007888,MBR00000308,Institutional-OP,2022-06-09,2022-06-09,2022-07-21,PLN2690,1453283987,1453283987,Critical Access Hospital,In-Network,E11.9,Z12.31,,,,,,,0,,76700,Radiology,,,0450,22,Outpatient Hospital,2,671.67,415.7,380.7,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007889,MBR00000308,Professional,2023-08-22,2023-08-22,2023-09-07,PLN7181,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,F03.90,I10,,,,,,,0,,45380,Surgery,,,,11,Office,2,2377.65,773.15,758.15,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000007890,MBR00000308,Professional,2021-07-20,2021-07-20,2021-08-14,PLN6174,1139906830,1139906830,Endocrinology,Out-of-Network,I10,F32.9,,,,,,,0,,99222,E&M,,,,11,Office,3,582.11,400.82,299.57,0.0,35.0,66.25,101.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007891,MBR00000308,Institutional-IP,2021-08-08,2021-08-13,2021-08-20,PLN3192,1550154147,1550154147,Outpatient Clinic,In-Network,F10.20,M54.5,,,,470,MS-DRG,11,5,Y,77067,Radiology,,,0270,21,Inpatient Hospital,2,374.38,260.64,0.0,260.64,0.0,0.0,260.64,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000007892,MBR00000308,Professional,2023-11-05,2023-11-05,2023-12-01,PLN3945,1334916761,1334916761,ASC,In-Network,I48.91,E78.5,,,,,,,0,,99233,E&M,,,,11,Office,2,413.48,217.94,142.94,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007893,MBR00000308,Professional,2021-11-29,2021-11-29,2021-12-26,PLN1763,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,N18.3,Z00.00,,,,,,,0,,66984,Surgery,,,,11,Office,2,2307.14,1684.3,1634.3,0.0,50.0,0.0,50.0,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007894,MBR00000308,Professional,2022-02-12,2022-02-12,2022-03-21,PLN1400,1872272835,1872272835,Internal Medicine,In-Network,F41.9,R51,,,,,,,0,,93225,Medicine,,,,11,Office,1,660.01,387.14,387.14,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007895,MBR00000308,Institutional-OP,2023-01-20,2023-01-20,2023-02-04,PLN7055,1438368327,1438368327,Home Health,In-Network,J06.9,F32.9,,,,,,,0,,43239,Surgery,,,0740,22,Outpatient Hospital,1,890.92,283.77,0.0,283.77,0.0,0.0,283.77,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007896,MBR00000308,Professional,2021-05-21,2021-05-21,2021-05-28,PLN9945,1624202402,1624202402,Orthopedic Surgery,In-Network,E11.9,E78.5,,,,,,,0,,99214,E&M,,,,23,Emergency Room,3,370.39,112.26,0.0,112.26,15.0,0.0,127.26,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007897,MBR00000308,Institutional-OP,2021-03-08,2021-03-08,2021-03-23,PLN5190,1847081578,1847081578,Urology,Out-of-Network,G43.909,F03.90,,,,,,,0,,33533,Surgery,,,0370,22,Outpatient Hospital,1,23111.68,7896.49,7686.98,174.51,35.0,0.0,209.51,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000007898,MBR00000308,Professional,2023-07-13,2023-07-13,2023-08-08,PLN6913,1713934949,1713934949,Neurology,In-Network,F41.9,Z12.31,,,,,,,0,,99221,E&M,,,,23,Emergency Room,2,250.26,92.0,0.0,92.0,15.0,0.0,107.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007899,MBR00000308,Institutional-IP,2023-11-04,2023-11-13,2023-11-20,PLN3598,1132188260,1132188260,Family Medicine,In-Network,Z23,E78.5,,,,690,MS-DRG,20,9,Y,86900,Pathology/Lab,,,0761,21,Inpatient Hospital,1,39.46,28.96,28.92,0.0,0.0,0.04,0.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007900,MBR00000308,Professional,2023-12-17,2023-12-17,2024-01-15,PLN5611,1125190055,1125190055,Nephrology,In-Network,J06.9,J20.9,,,,,,,0,,66984,Surgery,,,,21,Inpatient Hospital,3,3329.86,2724.77,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-97,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007901,MBR00000308,Professional,2021-01-26,2021-01-26,2021-02-03,PLN1390,1118885473,1118885473,ASC,In-Network,I10,Z23,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,2,18552.17,6271.83,5782.0,489.83,0.0,0.0,489.83,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000007902,MBR00000308,Institutional-IP,2022-08-04,2022-08-07,2022-08-26,PLN7491,1696843572,1696843572,Critical Access Hospital,Out-of-Network,Z00.00,E11.9,,,,292,MS-DRG,20,3,Y,45378,Surgery,,,0200,21,Inpatient Hospital,1,2581.5,1741.98,0.0,0.0,75.0,323.43,398.43,0.0,Denied,CO-50,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000007903,MBR00000308,Professional,2023-07-19,2023-07-19,2023-08-06,PLN1016,1198133277,1198133277,SNF,In-Network,E78.5,I10,,,,,,,0,,99284,E&M,,,,23,Emergency Room,3,884.09,551.23,551.23,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007904,MBR00000308,Institutional-OP,2023-07-14,2023-07-14,2023-08-19,PLN7455,1717912431,1717912431,Oncology,In-Network,I11.9,Z87.891,,,,,,,0,,45378,Surgery,,,0510,22,Outpatient Hospital,2,2549.61,903.67,0.0,0.0,0.0,78.82,78.82,0.0,Denied,CO-18,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000007905,MBR00000308,Institutional-OP,2022-01-31,2022-01-31,2022-03-09,PLN3090,1366286000,1366286000,SNF,In-Network,B97.89,K21.0,,,,,,,0,,66984,Surgery,,,0120,22,Outpatient Hospital,2,1275.39,655.99,640.99,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007906,MBR00000308,Professional,2022-06-21,2022-06-21,2022-07-30,PLN4267,1434029575,1434029575,Endocrinology,In-Network,I10,E78.5,,,,,,,0,,70450,Radiology,,,,11,Office,3,1670.35,1045.51,0.0,186.05,0.0,0.0,186.05,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007907,MBR00000308,Institutional-IP,2021-06-14,2021-06-16,2021-07-16,PLN3334,1691062876,1691062876,SNF,In-Network,N39.0,Z12.31,,,,683,MS-DRG,21,2,Y,71046,Radiology,,,0510,21,Inpatient Hospital,3,239.18,84.37,84.37,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007908,MBR00000308,Institutional-OP,2021-06-02,2021-06-02,2021-06-23,PLN6334,1872272835,1872272835,Internal Medicine,In-Network,J06.9,I10,,,,,,,0,,99283,E&M,,,0200,22,Outpatient Hospital,3,247.39,100.4,0.0,100.4,0.0,0.0,100.4,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007909,MBR00000308,Professional,2022-02-18,2022-02-18,2022-03-30,PLN5769,1114982472,1114982472,Orthopedic Surgery,In-Network,K21.0,E78.5,,,,,,,0,,97530,Medicine,,,,20,Urgent Care,2,229.68,114.56,0.0,114.56,0.0,0.0,114.56,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007910,MBR00000308,Professional,2021-09-10,2021-09-10,2021-10-07,PLN5455,1809014947,1809014947,Urology,In-Network,Z00.00,E11.9,,,,,,,0,,99203,E&M,,,,11,Office,2,344.14,106.01,31.01,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000007911,MBR00000308,Institutional-OP,2023-12-02,2023-12-02,2024-01-01,PLN4101,1530904931,1530904931,Internal Medicine,In-Network,N39.0,I50.9,,,,,,,0,,90460,Medicine,,,0270,22,Outpatient Hospital,1,49.44,32.64,32.64,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007912,MBR00000309,Professional,2021-03-29,2021-03-29,2021-05-09,PLN2629,1563980627,1563980627,Critical Access Hospital,In-Network,F41.9,Z12.31,,,,,,,0,,58661,Surgery,,,,11,Office,2,4186.68,1915.99,1915.99,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007913,MBR00000309,Institutional-IP,2022-08-03,2022-08-08,2022-09-04,PLN1492,1939033455,1939033455,Pulmonology,In-Network,J20.9,M54.5,,,,291,MS-DRG,6,5,Y,66984,Surgery,,,0900,21,Inpatient Hospital,1,3304.67,1121.19,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007914,MBR00000309,Professional,2022-09-02,2022-09-02,2022-09-22,PLN9046,1590915516,1590915516,Physical Therapy,Out-of-Network,I10,K57.30,,,,,,,0,,66984,Surgery,,,,49,Independent Clinic,2,2351.09,834.4,533.83,300.57,0.0,0.0,300.57,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007915,MBR00000309,Institutional-IP,2021-03-06,2021-03-09,2021-04-05,PLN5711,1691062876,1691062876,SNF,In-Network,N18.3,J06.9,,,,872,MS-DRG,21,3,Y,74177,Radiology,,,0120,21,Inpatient Hospital,1,2027.48,859.67,824.67,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007916,MBR00000309,Professional,2022-04-28,2022-04-28,2022-06-04,PLN6700,1125190055,1125190055,Nephrology,In-Network,Z23,N40.0,,,,,,,0,,99283,E&M,,,,11,Office,2,537.98,271.93,271.93,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007917,MBR00000309,Professional,2023-10-28,2023-10-28,2023-11-17,PLN8376,1556140803,1556140803,Cardiology,In-Network,F32.9,Z23,,,,,,,0,,74177,Radiology,,,,12,Home,3,985.0,632.15,238.82,393.33,0.0,0.0,393.33,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007918,MBR00000309,Institutional-OP,2021-04-30,2021-04-30,2021-05-13,PLN5299,1273488618,1273488618,General Acute Care Hospital,In-Network,F03.90,K21.0,,,,,,,0,,45380,Surgery,,,0730,22,Outpatient Hospital,3,2735.95,2144.09,1806.59,0.0,50.0,287.5,337.5,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000007919,MBR00000309,Professional,2021-06-07,2021-06-07,2021-07-07,PLN4674,1939033455,1939033455,Pulmonology,In-Network,Z12.31,J20.9,,,,,,,0,,80061,Pathology/Lab,,,,22,Outpatient Hospital,3,54.45,44.65,0.0,44.65,75.0,0.0,119.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007920,MBR00000309,Professional,2021-06-30,2021-06-30,2021-07-20,PLN6390,1689639685,1689639685,SNF,In-Network,E78.5,F32.9,,,,,,,0,,74177,Radiology,,,,81,Independent Laboratory,3,2274.54,1544.45,1172.98,271.57,0.0,99.9,371.47,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007921,MBR00000309,Institutional-OP,2021-03-01,2021-03-01,2021-03-27,PLN6832,1727809972,1727809972,Home Health,In-Network,N39.0,I10,,,,,,,0,,86900,Pathology/Lab,,,0360,22,Outpatient Hospital,1,33.61,21.16,21.16,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007922,MBR00000309,Professional,2023-08-28,2023-08-28,2023-09-04,PLN9419,1244186984,1244186984,Family Medicine,Out-of-Network,E78.5,Z00.00,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,3,305.25,96.9,96.9,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007923,MBR00000309,Professional,2021-02-19,2021-02-19,2021-03-20,PLN6636,1845900543,1845900543,ASC,In-Network,F41.9,I10,,,,,,,0,,66984,Surgery,,,,11,Office,3,3631.15,1121.57,1121.57,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007924,MBR00000310,Institutional-IP,2021-11-04,2021-11-05,2021-12-02,PLN5482,1186826716,1186826716,Physical Therapy,In-Network,E11.65,N40.0,,,,871,MS-DRG,12,1,Y,99283,E&M,,,0360,21,Inpatient Hospital,1,288.56,109.42,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007925,MBR00000310,Institutional-OP,2023-06-24,2023-06-24,2023-07-20,PLN3985,1337791138,1337791138,Internal Medicine,Out-of-Network,M17.11,J45.20,,,,,,,0,,99203,E&M,,,0301,22,Outpatient Hospital,3,293.08,102.54,0.0,102.54,50.0,0.0,152.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007926,MBR00000310,Professional,2023-12-26,2023-12-26,2024-01-24,PLN4141,1585582070,1585582070,Outpatient Clinic,In-Network,F41.9,E11.9,,,,,,,0,,27447,Surgery,,,,11,Office,1,2250.27,1250.16,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007927,MBR00000310,Institutional-OP,2021-06-17,2021-06-17,2021-07-31,PLN5975,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,E11.9,E11.9,,,,,,,0,,71046,Radiology,,,0320,22,Outpatient Hospital,1,322.32,178.56,178.56,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007928,MBR00000310,Institutional-IP,2022-01-30,2022-02-06,2022-03-14,PLN3776,1244186984,1244186984,Family Medicine,Out-of-Network,E11.9,M54.5,,,,194,MS-DRG,7,7,Y,87491,Pathology/Lab,,,0301,21,Inpatient Hospital,3,257.08,217.86,217.86,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007929,MBR00000310,Professional,2021-07-15,2021-07-15,2021-08-28,PLN7776,1713934949,1713934949,Neurology,In-Network,C50.912,M54.5,,,,,,,0,,93000,Radiology,,,,22,Outpatient Hospital,3,123.05,99.46,81.34,0.0,0.0,18.12,18.12,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007930,MBR00000310,Institutional-OP,2021-07-30,2021-07-30,2021-09-05,PLN7236,1528335731,1528335731,Critical Access Hospital,In-Network,E78.5,J44.1,,,,,,,0,,99213,E&M,,,0510,22,Outpatient Hospital,2,186.53,70.69,0.0,70.69,50.0,0.0,120.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007931,MBR00000311,Professional,2023-10-31,2023-10-31,2023-11-26,PLN8709,1891849440,1891849440,Oncology,In-Network,J06.9,E78.5,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,3,4762.87,3851.47,0.0,323.32,0.0,0.0,323.32,0.0,Denied,CO-29,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007932,MBR00000311,Institutional-OP,2022-01-05,2022-01-05,2022-01-14,PLN6061,1247341320,1247341320,Urology,Out-of-Network,M17.11,J44.1,,,,,,,0,,82043,Pathology/Lab,,,0900,22,Outpatient Hospital,1,65.62,50.07,0.0,50.07,25.0,0.0,75.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007933,MBR00000311,Institutional-IP,2022-11-01,2022-11-10,2022-11-17,PLN5168,1590915516,1590915516,Physical Therapy,Out-of-Network,F32.9,Z12.31,,,,872,MS-DRG,8,9,N,83036,Pathology/Lab,,,0510,21,Inpatient Hospital,1,117.0,81.64,81.64,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000007934,MBR00000311,Professional,2021-06-21,2021-06-21,2021-08-04,PLN7582,1520687146,1520687146,ASC,In-Network,E78.5,J18.9,,,,,,,0,,70553,Radiology,,,,11,Office,1,2921.89,1651.88,1651.88,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007935,MBR00000311,Professional,2021-11-09,2021-11-09,2021-12-18,PLN7500,1994661817,1994661817,SNF,Out-of-Network,I10,I48.91,,,,,,,0,,99284,E&M,,,,12,Home,2,564.37,459.49,0.0,389.43,75.0,0.0,464.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007936,MBR00000311,Professional,2022-01-31,2022-01-31,2022-03-07,PLN7935,1964402759,1964402759,Outpatient Clinic,In-Network,R05,Z00.01,,,,,,,0,,45380,Surgery,,,,81,Independent Laboratory,2,2107.83,855.79,417.72,363.07,75.0,0.0,438.07,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000007937,MBR00000311,Professional,2022-10-05,2022-10-05,2022-10-15,PLN5907,1219817751,1219817751,OB/GYN,In-Network,E66.9,K21.0,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,1,191.29,63.89,63.89,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007938,MBR00000311,Institutional-OP,2023-09-13,2023-09-13,2023-10-20,PLN6932,1139906830,1139906830,Endocrinology,Out-of-Network,E66.9,J20.9,,,,,,,0,,74177,Radiology,,,0510,22,Outpatient Hospital,1,1006.36,730.7,0.0,18.61,25.0,0.0,43.61,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007939,MBR00000311,Institutional-OP,2021-09-24,2021-09-24,2021-10-05,PLN8136,1118885473,1118885473,ASC,In-Network,I10,I25.10,,,,,,,0,,27130,Surgery,,,0120,22,Outpatient Hospital,2,6717.65,3801.73,3222.97,0.0,15.0,563.76,578.76,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007940,MBR00000311,Institutional-OP,2022-12-08,2022-12-08,2023-01-18,PLN6672,1268679390,1268679390,Critical Access Hospital,In-Network,F32.9,Z12.31,,,,,,,0,,99213,E&M,,,0510,22,Outpatient Hospital,1,210.83,117.6,41.99,0.0,75.0,0.61,75.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007941,MBR00000311,Professional,2022-06-26,2022-06-26,2022-07-04,PLN3747,1845900543,1845900543,ASC,In-Network,B97.89,J06.9,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,3,376.32,192.82,192.82,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007942,MBR00000311,Professional,2023-05-21,2023-05-21,2023-06-27,PLN9599,1585582070,1585582070,Outpatient Clinic,In-Network,R51,K57.30,,,,,,,0,,99284,E&M,,,,11,Office,2,791.09,670.85,670.85,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007943,MBR00000311,Institutional-OP,2022-01-02,2022-01-02,2022-01-25,PLN6950,1224179551,1224179551,Physical Therapy,In-Network,Z00.00,N17.9,,,,,,,0,,83036,Pathology/Lab,,,0740,22,Outpatient Hospital,1,73.67,38.83,12.85,0.0,25.0,0.98,25.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000007944,MBR00000311,Professional,2022-04-09,2022-04-09,2022-04-28,PLN7335,1624202402,1624202402,Orthopedic Surgery,In-Network,Z00.00,Z00.01,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,3,344.76,146.03,0.0,146.03,15.0,0.0,161.03,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007945,MBR00000311,Professional,2022-11-13,2022-11-13,2022-12-09,PLN5625,1372918899,1372918899,Family Medicine,In-Network,F32.9,M17.11,,,,,,,0,,23472,Surgery,,,,23,Emergency Room,2,7592.58,4109.73,4059.73,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007946,MBR00000311,Professional,2022-05-01,2022-05-01,2022-06-04,PLN5182,1500949740,1500949740,Pediatrics,In-Network,E11.9,E11.9,,,,,,,0,,74177,Radiology,,,,50,Federally Qualified Health Center,3,2525.41,1583.12,1541.98,41.14,0.0,0.0,41.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007947,MBR00000311,Institutional-OP,2023-04-11,2023-04-11,2023-05-05,PLN5910,1817234602,1817234602,Clinical Laboratory,In-Network,E11.9,E66.9,,,,,,,0,,82043,Pathology/Lab,,,0730,22,Outpatient Hospital,2,64.49,20.95,20.95,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007948,MBR00000311,Institutional-OP,2021-01-16,2021-01-16,2021-02-19,PLN6608,1745114564,1745114564,Endocrinology,In-Network,F41.9,J20.9,,,,,,,0,,93225,Medicine,,,0301,22,Outpatient Hospital,2,434.17,219.66,0.0,219.66,0.0,0.0,219.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007949,MBR00000311,Professional,2022-01-17,2022-01-17,2022-03-01,PLN5974,1948810580,1948810580,DME Supplier,In-Network,Z00.00,Z12.31,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,1,297.35,144.76,0.0,144.76,0.0,0.0,144.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007950,MBR00000311,Institutional-OP,2021-07-11,2021-07-11,2021-08-18,PLN7466,1283743001,1283743001,Family Medicine,In-Network,M17.11,Z12.31,,,,,,,0,,99221,E&M,,,0900,22,Outpatient Hospital,2,441.62,273.01,226.99,21.02,25.0,0.0,46.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007951,MBR00000311,Institutional-OP,2021-06-07,2021-06-07,2021-07-06,PLN8120,1865904917,1865904917,Outpatient Clinic,In-Network,J06.9,N18.3,,,,,,,0,,84443,Pathology/Lab,,,0761,22,Outpatient Hospital,2,115.57,72.87,0.0,72.87,0.0,0.0,72.87,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007952,MBR00000311,Institutional-IP,2021-02-28,2021-03-08,2021-04-13,PLN9776,1691062876,1691062876,SNF,In-Network,Z12.31,K21.0,,,,291,MS-DRG,18,8,Y,27130,Surgery,,,0450,21,Inpatient Hospital,1,2725.62,1421.86,1132.95,0.0,50.0,238.91,288.91,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007953,MBR00000311,Professional,2022-01-25,2022-01-25,2022-02-28,PLN2104,1139906830,1139906830,Endocrinology,Out-of-Network,K92.1,Z23,,,,,,,0,,43239,Surgery,,,,11,Office,3,2028.4,1489.25,1258.65,230.6,0.0,0.0,230.6,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007954,MBR00000311,Professional,2021-08-27,2021-08-27,2021-10-01,PLN3332,1361302520,1361302520,Critical Access Hospital,In-Network,F32.9,R10.9,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,1,96.36,65.99,30.99,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007955,MBR00000312,Professional,2023-04-11,2023-04-11,2023-05-25,PLN1297,1624202402,1624202402,Orthopedic Surgery,In-Network,R07.9,I10,,,,,,,0,,90460,Medicine,,,,11,Office,2,44.98,36.9,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000007956,MBR00000312,Institutional-IP,2022-07-04,2022-07-07,2022-07-14,PLN5265,1660288235,1660288235,ASC,In-Network,Z00.00,I10,,,,872,MS-DRG,1,3,Y,99203,E&M,,,0636,21,Inpatient Hospital,2,235.26,161.39,136.39,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007957,MBR00000312,Institutional-IP,2023-05-12,2023-05-20,2023-06-16,PLN4516,1242201429,1242201429,General Acute Care Hospital,In-Network,I25.10,M54.5,,,,690,MS-DRG,9,8,Y,76700,Radiology,,,0900,21,Inpatient Hospital,2,808.71,639.03,530.98,108.05,0.0,0.0,108.05,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007958,MBR00000312,Professional,2023-08-28,2023-08-28,2023-09-29,PLN7992,1609138981,1609138981,Critical Access Hospital,In-Network,F41.9,F32.9,,,,,,,0,,74177,Radiology,,,,11,Office,3,2421.39,1147.54,0.0,0.0,75.0,179.62,254.62,0.0,Denied,CO-11,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007959,MBR00000312,Professional,2023-05-11,2023-05-11,2023-05-30,PLN7492,1283743001,1283743001,Family Medicine,In-Network,R10.9,F41.9,,,,,,,0,,71046,Radiology,,,,20,Urgent Care,2,146.65,118.84,43.84,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007960,MBR00000312,Professional,2022-04-06,2022-04-06,2022-05-15,PLN5374,1361302520,1361302520,Critical Access Hospital,In-Network,I10,G43.909,,,,,,,0,,45378,Surgery,,,,20,Urgent Care,1,1163.04,816.95,816.95,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000007961,MBR00000312,Institutional-OP,2023-12-04,2023-12-04,2023-12-28,PLN1883,1948810580,1948810580,DME Supplier,In-Network,N39.0,E11.9,,,,,,,0,,90837,Medicine,,,0636,22,Outpatient Hospital,2,336.61,159.82,158.92,0.9,0.0,0.0,0.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007962,MBR00000312,Professional,2022-02-26,2022-02-26,2022-03-08,PLN6268,1569105090,1569105090,Geriatrics,In-Network,I10,F32.9,,,,,,,0,,99222,E&M,,,,11,Office,2,647.8,404.68,0.0,0.0,25.0,0.0,25.0,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007963,MBR00000312,Institutional-OP,2023-06-23,2023-06-23,2023-07-27,PLN2761,1502838586,1502838586,ASC,In-Network,Z51.11,F32.9,,,,,,,0,,G0444,Medicine,,,0200,22,Outpatient Hospital,3,39.83,32.42,29.59,0.0,0.0,2.83,2.83,0.0,Pended,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000007964,MBR00000312,Institutional-OP,2021-07-09,2021-07-09,2021-07-27,PLN4185,1366426662,1366426662,Urology,In-Network,J06.9,R05,,,,,,,0,,70553,Radiology,,,0900,22,Outpatient Hospital,3,4130.22,2934.84,2529.96,369.88,35.0,0.0,404.88,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007965,MBR00000312,Institutional-OP,2023-11-27,2023-11-27,2024-01-01,PLN3090,1193493783,1193493783,Critical Access Hospital,Out-of-Network,E78.5,F10.20,,,,,,,0,,97530,Medicine,,,0370,22,Outpatient Hospital,2,307.37,204.75,168.94,0.0,0.0,35.81,35.81,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000007966,MBR00000312,Professional,2021-11-29,2021-11-29,2022-01-11,PLN3811,1453936007,1453936007,ASC,In-Network,G43.909,E87.6,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,2,26.83,20.42,0.0,20.42,15.0,0.0,35.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007967,MBR00000312,Institutional-OP,2022-11-18,2022-11-18,2022-12-23,PLN7724,1856686341,1856686341,Geriatrics,In-Network,E11.9,I63.9,,,,,,,0,,72148,Radiology,,,0450,22,Outpatient Hospital,3,1454.59,637.45,146.17,456.28,35.0,0.0,491.28,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007968,MBR00000312,Institutional-OP,2022-01-23,2022-01-23,2022-02-05,PLN8547,1702692193,1702692193,Physical Therapy,In-Network,I10,Z12.31,,,,,,,0,,99213,E&M,,,0301,22,Outpatient Hospital,2,126.29,107.06,28.51,0.0,75.0,3.55,78.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007969,MBR00000312,Institutional-OP,2021-09-09,2021-09-09,2021-09-24,PLN2101,1514306773,1514306773,Endocrinology,In-Network,E78.5,F32.9,,,,,,,0,,72148,Radiology,,,0370,22,Outpatient Hospital,1,2089.72,641.29,641.29,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007970,MBR00000312,Professional,2021-12-27,2021-12-27,2022-01-12,PLN2871,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,M54.5,I63.9,,,,,,,0,,99203,E&M,,,,11,Office,2,390.16,317.71,134.69,148.02,35.0,0.0,183.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007971,MBR00000312,Professional,2022-10-28,2022-10-28,2022-11-09,PLN1854,1812060197,1812060197,Oncology,Out-of-Network,J06.9,E66.9,,,,,,,0,,45378,Surgery,,,,11,Office,1,2343.23,1345.93,1073.63,197.3,75.0,0.0,272.3,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000007972,MBR00000312,Professional,2021-05-03,2021-05-03,2021-05-13,PLN5514,1749327647,1749327647,Geriatrics,In-Network,Z00.00,R07.9,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,2,5471.74,4531.43,3895.26,203.88,25.0,407.29,636.17,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007973,MBR00000312,Professional,2021-08-05,2021-08-05,2021-08-20,PLN7288,1689639685,1689639685,SNF,In-Network,I48.91,Z00.00,,,,,,,0,,97110,Medicine,,,,23,Emergency Room,2,286.3,105.55,0.0,105.55,75.0,0.0,180.55,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000007974,MBR00000312,Institutional-OP,2023-10-05,2023-10-05,2023-10-31,PLN1654,1575695214,1575695214,SNF,In-Network,I50.9,E78.5,,,,,,,0,,G0468,Medicine,,,0370,22,Outpatient Hospital,2,486.4,384.51,384.51,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007975,MBR00000312,Professional,2021-04-04,2021-04-04,2021-05-18,PLN5563,1372918899,1372918899,Family Medicine,In-Network,Z87.891,I10,,,,,,,0,,86900,Pathology/Lab,,,,49,Independent Clinic,2,62.33,40.56,0.0,40.56,25.0,0.0,65.56,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007976,MBR00000312,Institutional-OP,2023-03-03,2023-03-03,2023-04-05,PLN3800,1899127912,1899127912,Neurology,In-Network,E78.5,I10,,,,,,,0,,99204,E&M,,,0301,22,Outpatient Hospital,3,283.64,232.49,232.49,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007977,MBR00000312,Institutional-IP,2021-11-26,2021-12-05,2021-12-12,PLN5537,1645194539,1645194539,SNF,In-Network,F32.9,J20.9,,,,641,MS-DRG,2,9,Y,23472,Surgery,,,0761,21,Inpatient Hospital,2,6680.22,2042.36,1967.36,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007978,MBR00000312,Professional,2021-12-16,2021-12-16,2022-01-09,PLN3438,1390307371,1390307371,DME Supplier,In-Network,K21.0,N20.0,,,,,,,0,,99284,E&M,,,,11,Office,1,360.95,228.25,0.0,228.25,0.0,0.0,228.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007979,MBR00000312,Professional,2022-02-02,2022-02-02,2022-03-08,PLN1983,1108115157,1108115157,General Acute Care Hospital,In-Network,Z00.01,N40.0,,,,,,,0,,99406,Medicine,,,,11,Office,3,36.27,25.28,0.24,0.0,25.0,0.04,25.04,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007980,MBR00000312,Professional,2022-02-24,2022-02-24,2022-03-07,PLN6078,1948810580,1948810580,DME Supplier,In-Network,Z23,N39.0,,,,,,,0,,99221,E&M,,,,21,Inpatient Hospital,3,304.87,209.53,209.53,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007981,MBR00000312,Professional,2023-02-16,2023-02-16,2023-03-27,PLN3230,1531398223,1531398223,OB/GYN,In-Network,J18.9,E66.9,,,,,,,0,,74177,Radiology,,,,65,End-Stage Renal Disease,3,2472.91,2030.02,1586.73,443.29,0.0,0.0,443.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007982,MBR00000312,Institutional-OP,2023-06-01,2023-06-01,2023-06-16,PLN7615,1361302520,1361302520,Critical Access Hospital,In-Network,N18.3,J44.1,,,,,,,0,,27130,Surgery,,,0730,22,Outpatient Hospital,3,2748.02,1097.02,1022.02,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007983,MBR00000313,Professional,2022-02-02,2022-02-02,2022-02-09,PLN7169,1273488618,1273488618,General Acute Care Hospital,In-Network,J44.1,Z12.31,,,,,,,0,,99213,E&M,,,,22,Outpatient Hospital,2,287.28,167.67,167.67,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007984,MBR00000313,Professional,2021-07-07,2021-07-07,2021-08-06,PLN8338,1118885473,1118885473,ASC,In-Network,Z12.31,J44.1,,,,,,,0,,71046,Radiology,,,,11,Office,1,317.93,215.46,128.51,0.0,75.0,11.95,86.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007985,MBR00000313,Professional,2021-01-04,2021-01-04,2021-01-16,PLN5007,1717912431,1717912431,Oncology,In-Network,C50.912,Z12.31,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,2,1810.76,984.46,934.46,0.0,50.0,0.0,50.0,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007986,MBR00000313,Institutional-IP,2023-03-05,2023-03-11,2023-03-18,PLN2587,1268679390,1268679390,Critical Access Hospital,In-Network,E78.5,M54.5,,,,872,MS-DRG,14,6,W,58661,Surgery,,,0740,21,Inpatient Hospital,3,1938.42,899.84,583.64,281.2,35.0,0.0,316.2,0.0,Paid,,,0,,0,0,1,0,0,1,Duplicate,0,0,0,0,0
CLM0000007987,MBR00000313,Institutional-IP,2023-10-02,2023-10-10,2023-10-25,PLN7886,1713934949,1713934949,Neurology,In-Network,J06.9,M54.5,,,,683,MS-DRG,4,8,Y,99203,E&M,,,0510,21,Inpatient Hospital,1,354.76,200.3,133.59,0.0,35.0,31.71,66.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007988,MBR00000313,Institutional-OP,2021-02-07,2021-02-07,2021-02-25,PLN4136,1545347862,1545347862,SNF,In-Network,E78.5,N20.0,,,,,,,0,,43239,Surgery,,,0120,22,Outpatient Hospital,3,1015.52,633.9,0.0,0.0,0.0,0.0,0.0,0.0,Denied,PR-1,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007989,MBR00000313,Professional,2022-10-08,2022-10-08,2022-11-19,PLN6966,1245650222,1245650222,Gastroenterology,In-Network,I63.9,I10,,,,,,,0,,90686,Medicine,,,,11,Office,1,65.8,49.63,0.0,49.63,75.0,0.0,124.63,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000007990,MBR00000313,Professional,2021-08-28,2021-08-28,2021-09-18,PLN7841,1780163051,1780163051,SNF,In-Network,K21.0,K92.1,,,,,,,0,,47562,Surgery,,,,11,Office,3,4585.0,2194.31,2001.56,117.24,25.0,50.51,192.75,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007991,MBR00000313,Institutional-OP,2021-08-19,2021-08-19,2021-09-17,PLN9048,1994661817,1994661817,SNF,Out-of-Network,Z00.00,Z23,,,,,,,0,,77067,Radiology,,,0301,22,Outpatient Hospital,1,649.2,356.3,331.3,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000007992,MBR00000313,Professional,2023-06-27,2023-06-27,2023-07-14,PLN3413,1845057593,1845057593,Orthopedic Surgery,In-Network,E11.9,F41.9,,,,,,,0,,27447,Surgery,,,,11,Office,3,3357.23,1375.8,867.01,493.79,15.0,0.0,508.79,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007993,MBR00000313,Professional,2021-10-04,2021-10-04,2021-11-07,PLN5550,1213165847,1213165847,Critical Access Hospital,In-Network,G43.909,K57.30,,,,,,,0,,99204,E&M,,,,11,Office,2,412.58,261.38,0.0,256.72,0.0,0.0,256.72,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007994,MBR00000313,Institutional-OP,2021-11-29,2021-11-29,2022-01-03,PLN7367,1590915516,1590915516,Physical Therapy,Out-of-Network,I63.9,E78.5,,,,,,,0,,43239,Surgery,,,0761,22,Outpatient Hospital,3,1038.17,640.05,386.39,172.87,0.0,80.79,253.66,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007995,MBR00000314,Institutional-IP,2021-05-16,2021-05-22,2021-06-24,PLN7531,1475984649,1475984649,SNF,In-Network,N39.0,M17.11,,,,682,MS-DRG,10,6,Y,99222,E&M,,,0120,21,Inpatient Hospital,2,239.79,148.95,119.26,0.0,0.0,29.69,29.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007996,MBR00000314,Professional,2023-09-17,2023-09-17,2023-10-07,PLN5311,1891849440,1891849440,Oncology,In-Network,I25.10,N17.9,,,,,,,0,,74177,Radiology,,,,11,Office,2,1120.0,421.11,371.11,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007997,MBR00000314,Institutional-OP,2023-09-20,2023-09-20,2023-10-05,PLN7222,1980712759,1980712759,Outpatient Clinic,Out-of-Network,Z23,E11.9,,,,,,,0,,97110,Medicine,,,0360,22,Outpatient Hospital,2,181.44,109.93,0.0,109.93,35.0,0.0,144.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000007998,MBR00000314,Professional,2023-09-27,2023-09-27,2023-10-15,PLN6649,1606140917,1606140917,ASC,In-Network,I10,J06.9,,,,,,,0,,23472,Surgery,,,,11,Office,3,3562.55,2574.47,2386.56,187.91,0.0,0.0,187.91,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000007999,MBR00000314,Professional,2021-09-10,2021-09-10,2021-09-25,PLN4168,1749494482,1749494482,Pediatrics,In-Network,E78.5,N18.3,,,,,,,0,,93306,Radiology,,,,12,Home,1,2531.53,1053.58,1018.58,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008000,MBR00000314,Professional,2021-07-25,2021-07-25,2021-08-15,PLN2982,1295371663,1295371663,Critical Access Hospital,In-Network,N39.0,M54.5,,,,,,,0,,99213,E&M,,,,49,Independent Clinic,3,233.29,96.1,88.4,0.0,0.0,7.7,7.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008001,MBR00000314,Professional,2023-10-28,2023-10-28,2023-11-17,PLN4797,1696843572,1696843572,Critical Access Hospital,Out-of-Network,J20.9,E78.5,,,,,,,0,,66984,Surgery,,,,23,Emergency Room,3,2717.51,1915.93,1890.93,0.0,25.0,0.0,25.0,0.0,Pended,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008002,MBR00000314,Professional,2022-11-03,2022-11-03,2022-11-25,PLN1831,1575695214,1575695214,SNF,In-Network,I10,Z87.891,,,,,,,0,,77067,Radiology,,,,22,Outpatient Hospital,2,363.8,281.37,232.44,0.0,15.0,33.93,48.93,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000008003,MBR00000314,Institutional-OP,2021-10-17,2021-10-17,2021-10-31,PLN5626,1563980627,1563980627,Critical Access Hospital,In-Network,Z12.31,F03.90,,,,,,,0,,81001,Pathology/Lab,,,0761,22,Outpatient Hospital,1,59.39,43.53,0.0,43.53,0.0,0.0,43.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008004,MBR00000314,Institutional-OP,2021-02-21,2021-02-21,2021-02-28,PLN9792,1845900543,1845900543,ASC,In-Network,J06.9,M54.5,,,,,,,0,,93000,Radiology,,,0636,22,Outpatient Hospital,3,175.4,86.92,0.0,86.92,0.0,0.0,86.92,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008005,MBR00000314,Institutional-OP,2023-05-26,2023-05-26,2023-07-02,PLN5439,1268679390,1268679390,Critical Access Hospital,In-Network,M81.0,E11.9,,,,,,,0,,99283,E&M,,,0510,22,Outpatient Hospital,1,377.8,202.63,0.0,202.63,25.0,0.0,227.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008006,MBR00000314,Institutional-OP,2023-05-29,2023-05-29,2023-06-16,PLN8575,1606140917,1606140917,ASC,In-Network,E11.9,I50.9,,,,,,,0,,87491,Pathology/Lab,,,0370,22,Outpatient Hospital,3,165.58,96.92,80.02,0.0,0.0,16.9,16.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008007,MBR00000314,Professional,2021-01-12,2021-01-12,2021-01-24,PLN5525,1511044648,1511044648,Endocrinology,In-Network,M17.11,I25.10,,,,,,,0,,80061,Pathology/Lab,,,,21,Inpatient Hospital,1,84.55,44.9,0.0,44.9,15.0,0.0,59.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008008,MBR00000314,Professional,2022-06-08,2022-06-08,2022-07-19,PLN9332,1716521444,1716521444,Oncology,In-Network,E11.9,J18.9,,,,,,,0,,45380,Surgery,,,,12,Home,1,1946.96,603.83,453.54,0.0,50.0,100.29,150.29,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000008009,MBR00000315,Professional,2022-06-14,2022-06-14,2022-07-08,PLN5146,1366286000,1366286000,SNF,In-Network,E11.9,R10.9,,,,,,,0,,93306,Radiology,,,,12,Home,3,2038.34,978.63,953.63,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008010,MBR00000315,Professional,2022-05-24,2022-05-24,2022-06-08,PLN7688,1550154147,1550154147,Outpatient Clinic,In-Network,E11.9,E11.9,,,,,,,0,,71046,Radiology,,,,21,Inpatient Hospital,3,223.02,165.4,165.4,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008011,MBR00000315,Professional,2022-02-09,2022-02-09,2022-02-26,PLN7630,1727809972,1727809972,Home Health,In-Network,E78.5,N40.0,,,,,,,0,,47562,Surgery,,,,50,Federally Qualified Health Center,1,4999.08,2201.23,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008012,MBR00000315,Professional,2021-12-26,2021-12-26,2022-01-26,PLN8709,1624802371,1624802371,ASC,Out-of-Network,E11.9,E11.9,,,,,,,0,,78452,Radiology,,,,22,Outpatient Hospital,2,4706.98,3446.02,2596.35,335.74,25.0,488.93,849.67,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008013,MBR00000315,Institutional-OP,2022-01-02,2022-01-02,2022-01-12,PLN1780,1337791138,1337791138,Internal Medicine,Out-of-Network,M54.5,E11.9,,,,,,,0,,93306,Radiology,,,0900,22,Outpatient Hospital,2,1684.14,1290.73,1255.73,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008014,MBR00000315,Professional,2023-10-05,2023-10-05,2023-10-14,PLN8982,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,J20.9,E11.65,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,3,439.91,300.22,297.93,2.29,0.0,0.0,2.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008015,MBR00000315,Institutional-OP,2023-12-23,2023-12-23,2024-01-07,PLN8594,1575695214,1575695214,SNF,In-Network,E66.9,Z23,,,,,,,0,,99204,E&M,,,0510,22,Outpatient Hospital,2,328.13,201.09,192.82,0.0,0.0,8.27,8.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008016,MBR00000315,Professional,2021-05-03,2021-05-03,2021-05-28,PLN6149,1817234602,1817234602,Clinical Laboratory,In-Network,C50.912,Z00.00,,,,,,,0,,27130,Surgery,,,,81,Independent Laboratory,1,2975.36,1816.17,1793.1,8.07,15.0,0.0,23.07,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008017,MBR00000315,Professional,2023-03-01,2023-03-01,2023-03-10,PLN1146,1645194539,1645194539,SNF,In-Network,E78.5,E78.5,,,,,,,0,,45380,Surgery,,,,23,Emergency Room,2,1895.57,952.45,896.6,0.0,0.0,55.85,55.85,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,1,0,0,0
CLM0000008018,MBR00000315,Institutional-IP,2022-09-20,2022-10-03,2022-10-03,PLN8603,1422747896,1422747896,Urology,In-Network,Z23,M54.5,,,,194,MS-DRG,13,13,Y,G0439,Medicine,,,0636,21,Inpatient Hospital,3,473.88,279.61,0.0,279.61,0.0,0.0,279.61,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000008019,MBR00000315,Professional,2021-10-08,2021-10-08,2021-11-15,PLN4008,1247341320,1247341320,Urology,Out-of-Network,K21.0,Z00.00,,,,,,,0,,93225,Medicine,,,,22,Outpatient Hospital,3,511.71,236.44,186.44,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008020,MBR00000315,Professional,2021-07-23,2021-07-23,2021-08-31,PLN4225,1109850785,1109850785,ASC,Out-of-Network,E78.5,J06.9,,,,,,,0,,76700,Radiology,,,,11,Office,1,1454.38,977.29,962.29,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008021,MBR00000316,Institutional-IP,2023-04-04,2023-04-09,2023-04-19,PLN6149,1644128543,1644128543,Gastroenterology,In-Network,N40.0,M54.5,,,,196,MS-DRG,17,5,Y,99284,E&M,,,0761,21,Inpatient Hospital,3,861.81,500.02,500.02,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008022,MBR00000316,Institutional-IP,2022-02-04,2022-02-09,2022-02-25,PLN8548,1624802371,1624802371,ASC,Out-of-Network,Z51.11,N39.0,,,,603,MS-DRG,1,5,Y,99214,E&M,,,0360,21,Inpatient Hospital,1,239.71,163.82,104.7,0.0,50.0,9.12,59.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008023,MBR00000316,Professional,2021-05-22,2021-05-22,2021-06-04,PLN7442,1702692193,1702692193,Physical Therapy,In-Network,Z23,F41.9,,,,,,,0,,99204,E&M,,,,65,End-Stage Renal Disease,1,558.06,407.6,407.6,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008024,MBR00000316,Professional,2023-11-28,2023-11-28,2024-01-07,PLN1280,1624202402,1624202402,Orthopedic Surgery,In-Network,M54.5,I10,,,,,,,0,,27447,Surgery,,,,21,Inpatient Hospital,2,3083.18,1975.0,1975.0,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008025,MBR00000316,Professional,2023-10-11,2023-10-11,2023-10-23,PLN6273,1991459367,1991459367,Neurology,Out-of-Network,Z00.00,G43.909,,,,,,,0,,70553,Radiology,,,,11,Office,2,4191.12,1617.88,1160.07,382.81,75.0,0.0,457.81,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008026,MBR00000316,Professional,2022-04-04,2022-04-04,2022-05-13,PLN2218,1809014947,1809014947,Urology,In-Network,E78.5,R07.9,,,,,,,0,,90460,Medicine,,,,21,Inpatient Hospital,3,37.0,21.91,0.0,21.91,0.0,0.0,21.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008027,MBR00000316,Institutional-OP,2022-04-12,2022-04-12,2022-05-06,PLN5459,1531398223,1531398223,OB/GYN,In-Network,E78.5,Z79.4,,,,,,,0,,99233,E&M,,,0740,22,Outpatient Hospital,3,329.55,229.89,179.89,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008028,MBR00000316,Professional,2022-04-06,2022-04-06,2022-05-07,PLN6501,1284035364,1284035364,Pediatrics,In-Network,R07.9,I10,,,,,,,0,,99204,E&M,,,,81,Independent Laboratory,3,514.15,307.97,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008029,MBR00000316,Professional,2021-07-28,2021-07-28,2021-08-24,PLN6616,1433937353,1433937353,Nephrology,In-Network,E78.5,N39.0,,,,,,,0,,99221,E&M,,,,11,Office,3,313.38,95.1,72.52,22.58,0.0,0.0,22.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008030,MBR00000316,Institutional-IP,2021-04-26,2021-04-30,2021-05-24,PLN5296,1717912431,1717912431,Oncology,In-Network,E78.5,I10,,,,690,MS-DRG,9,4,Y,27447,Surgery,,,0450,21,Inpatient Hospital,2,2830.74,1433.03,934.07,473.96,25.0,0.0,498.96,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008031,MBR00000316,Institutional-OP,2021-10-26,2021-10-26,2021-11-15,PLN7429,1114982472,1114982472,Orthopedic Surgery,In-Network,J06.9,E78.5,,,,,,,0,,99203,E&M,,,0730,22,Outpatient Hospital,3,379.01,263.96,0.0,263.96,15.0,0.0,278.96,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008032,MBR00000316,Professional,2022-02-28,2022-02-28,2022-03-09,PLN5174,1799205295,1799205295,General Acute Care Hospital,In-Network,Z12.31,E87.6,,,,,,,0,,80053,Pathology/Lab,,,,22,Outpatient Hospital,3,104.94,37.27,0.0,37.27,0.0,0.0,37.27,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000008033,MBR00000316,Institutional-IP,2021-06-19,2021-06-20,2021-07-25,PLN9148,1219817751,1219817751,OB/GYN,In-Network,N18.3,I10,,,,682,MS-DRG,15,1,Y,70553,Radiology,,,0740,21,Inpatient Hospital,1,3393.37,2108.55,2108.55,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000008034,MBR00000316,Institutional-IP,2021-02-08,2021-02-09,2021-02-15,PLN3861,1812060197,1812060197,Oncology,Out-of-Network,E11.9,R10.9,,,,872,MS-DRG,6,1,Y,85610,Pathology/Lab,,,0740,21,Inpatient Hospital,1,68.97,26.19,0.0,26.19,15.0,0.0,41.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008035,MBR00000316,Professional,2023-10-16,2023-10-16,2023-11-09,PLN8329,1571574052,1571574052,Critical Access Hospital,In-Network,F32.9,J06.9,,,,,,,0,,90837,Medicine,,,,22,Outpatient Hospital,3,315.23,217.24,167.24,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008036,MBR00000316,Professional,2023-08-19,2023-08-19,2023-10-02,PLN9240,1757138478,1757138478,Pediatrics,In-Network,C50.912,N18.3,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,1,71.28,43.29,8.29,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008037,MBR00000316,Institutional-OP,2021-12-01,2021-12-01,2021-12-22,PLN7797,1745114564,1745114564,Endocrinology,In-Network,I50.9,F41.9,,,,,,,0,,85610,Pathology/Lab,,,0120,22,Outpatient Hospital,3,74.82,61.47,0.0,61.47,15.0,0.0,76.47,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008038,MBR00000316,Professional,2022-11-04,2022-11-04,2022-12-06,PLN2926,1500949740,1500949740,Pediatrics,In-Network,I10,N39.0,,,,,,,0,,70553,Radiology,,,,22,Outpatient Hospital,2,1850.45,564.13,63.82,485.31,15.0,0.0,500.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008039,MBR00000316,Professional,2021-06-06,2021-06-06,2021-07-07,PLN4038,1749494482,1749494482,Pediatrics,In-Network,E78.5,J44.1,,,,,,,0,,99214,E&M,,,,11,Office,3,334.88,162.87,162.87,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008040,MBR00000317,Institutional-IP,2023-10-12,2023-10-19,2023-10-24,PLN9877,1563980627,1563980627,Critical Access Hospital,In-Network,M81.0,Z12.31,,,,871,MS-DRG,8,7,Y,99283,E&M,,,0450,21,Inpatient Hospital,1,390.63,198.78,198.78,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008041,MBR00000317,Professional,2023-06-10,2023-06-10,2023-06-23,PLN1255,1935547131,1935547131,Pulmonology,In-Network,Z00.00,E11.9,,,,,,,0,,97530,Medicine,,,,11,Office,2,164.18,101.8,0.0,101.8,0.0,0.0,101.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008042,MBR00000317,Professional,2021-07-12,2021-07-12,2021-08-10,PLN5596,1283743001,1283743001,Family Medicine,In-Network,I10,N40.0,,,,,,,0,,23472,Surgery,,,,11,Office,2,3038.99,2497.84,0.0,213.81,50.0,0.0,263.81,0.0,Denied,PR-1,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008043,MBR00000317,Professional,2021-08-22,2021-08-22,2021-09-10,PLN3707,1752470395,1752470395,Home Health,In-Network,E78.5,J18.9,,,,,,,0,,47562,Surgery,,,,12,Home,3,6056.41,4373.48,4338.48,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008044,MBR00000317,Professional,2021-12-31,2021-12-31,2022-01-12,PLN1216,1205377316,1205377316,Orthopedic Surgery,In-Network,F32.9,J20.9,,,,,,,0,,99283,E&M,,,,49,Independent Clinic,3,530.49,390.32,390.32,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008045,MBR00000317,Institutional-IP,2021-04-14,2021-04-17,2021-05-02,PLN1167,1422747896,1422747896,Urology,In-Network,F32.9,B97.89,,,,683,MS-DRG,14,3,Y,99233,E&M,,,0360,21,Inpatient Hospital,1,385.14,164.34,0.0,164.34,35.0,0.0,199.34,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008046,MBR00000317,Professional,2022-01-15,2022-01-15,2022-01-29,PLN6320,1809014947,1809014947,Urology,In-Network,K57.30,Z00.00,,,,,,,0,,27130,Surgery,,,,11,Office,3,6518.07,2649.52,2470.71,0.0,50.0,128.81,178.81,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008047,MBR00000317,Professional,2023-01-02,2023-01-02,2023-01-15,PLN5864,1540044947,1540044947,Pulmonology,Out-of-Network,J18.9,R05,,,,,,,0,,93000,Radiology,,,,11,Office,3,124.45,65.25,0.0,65.25,0.0,0.0,65.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008048,MBR00000317,Institutional-IP,2023-03-07,2023-03-11,2023-04-14,PLN9317,1361302520,1361302520,Critical Access Hospital,In-Network,Z00.01,E78.5,,,,682,MS-DRG,4,4,N,90837,Medicine,,,0450,21,Inpatient Hospital,1,514.12,240.11,240.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008049,MBR00000317,Institutional-OP,2021-01-09,2021-01-09,2021-01-17,PLN9571,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,Z12.11,R07.9,,,,,,,0,,58661,Surgery,,,0120,22,Outpatient Hospital,2,2161.9,1544.62,1494.62,0.0,50.0,0.0,50.0,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008050,MBR00000317,Professional,2022-01-21,2022-01-21,2022-02-25,PLN7541,1235381502,1235381502,Cardiology,In-Network,Z00.00,F41.9,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,3,3030.0,1680.09,1680.09,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000008051,MBR00000318,Professional,2023-07-01,2023-07-01,2023-07-15,PLN7808,1968299309,1968299309,Internal Medicine,In-Network,Z12.31,C50.912,,,,,,,0,,90460,Medicine,,,,20,Urgent Care,1,73.31,52.73,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000008052,MBR00000318,Professional,2023-08-12,2023-08-12,2023-08-30,PLN4372,1511044648,1511044648,Endocrinology,In-Network,F10.20,E11.40,,,,,,,0,,83036,Pathology/Lab,,,,20,Urgent Care,3,116.91,42.3,0.0,42.3,50.0,0.0,92.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000008053,MBR00000318,Institutional-OP,2022-09-09,2022-09-09,2022-10-12,PLN7230,1660288235,1660288235,ASC,In-Network,R10.9,I63.9,,,,,,,0,,99222,E&M,,,0510,22,Outpatient Hospital,2,271.1,214.34,179.34,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000008054,MBR00000318,Professional,2023-03-17,2023-03-17,2023-04-21,PLN7153,1453283987,1453283987,Critical Access Hospital,In-Network,M17.11,Z12.31,,,,,,,0,,G0444,Medicine,,,,21,Inpatient Hospital,2,59.37,34.47,34.47,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000008055,MBR00000318,Professional,2021-09-28,2021-09-28,2021-10-29,PLN6189,1545347862,1545347862,SNF,In-Network,Z00.00,Z79.4,,,,,,,0,,99232,E&M,,,,21,Inpatient Hospital,2,342.15,289.18,264.18,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008056,MBR00000318,Institutional-IP,2023-08-09,2023-08-19,2023-09-11,PLN9230,1806688928,1806688928,Geriatrics,In-Network,Z12.31,F41.9,,,,196,MS-DRG,21,10,N,71046,Radiology,,,0360,21,Inpatient Hospital,2,225.9,127.99,0.0,127.99,35.0,0.0,162.99,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008057,MBR00000318,Institutional-OP,2022-06-03,2022-06-03,2022-06-30,PLN8624,1631954542,1631954542,Oncology,In-Network,I11.9,Z23,,,,,,,0,,90686,Medicine,,,0900,22,Outpatient Hospital,1,128.21,55.19,0.0,55.19,0.0,0.0,55.19,0.0,Denied,CO-50,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000008058,MBR00000318,Institutional-OP,2023-01-28,2023-01-28,2023-02-25,PLN2566,1800011727,1800011727,Clinical Laboratory,Out-of-Network,Z12.31,Z87.891,,,,,,,0,,99222,E&M,,,0270,22,Outpatient Hospital,3,454.86,177.91,177.91,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008059,MBR00000318,Professional,2021-10-15,2021-10-15,2021-11-08,PLN5923,1561134315,1561134315,DME Supplier,In-Network,R05,E78.5,,,,,,,0,,71046,Radiology,,,,12,Home,3,153.19,99.34,99.34,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008060,MBR00000318,Institutional-OP,2021-07-09,2021-07-09,2021-07-24,PLN8903,1994661817,1994661817,SNF,Out-of-Network,M54.5,I25.10,,,,,,,0,,43239,Surgery,,,0740,22,Outpatient Hospital,2,1121.85,828.26,0.0,187.79,35.0,0.0,222.79,0.0,Denied,CO-15,,1,,0,0,1,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000008061,MBR00000318,Professional,2022-08-07,2022-08-07,2022-09-15,PLN4186,1778483301,1778483301,Home Health,In-Network,R10.9,I48.91,,,,,,,0,,23472,Surgery,,,,23,Emergency Room,3,7170.94,5776.82,5751.82,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008062,MBR00000318,Institutional-OP,2022-07-27,2022-07-27,2022-08-15,PLN3046,1896447406,1896447406,Nephrology,Out-of-Network,I10,E66.9,,,,,,,0,,99204,E&M,,,0120,22,Outpatient Hospital,3,351.62,138.34,22.19,101.15,15.0,0.0,116.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008063,MBR00000318,Professional,2022-09-18,2022-09-18,2022-10-21,PLN9840,1569105090,1569105090,Geriatrics,In-Network,I11.9,F41.9,,,,,,,0,,93225,Medicine,,,,22,Outpatient Hospital,1,643.3,260.27,260.27,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008064,MBR00000318,Institutional-OP,2023-06-04,2023-06-04,2023-07-08,PLN6163,1450094833,1450094833,Outpatient Clinic,In-Network,F32.9,E78.5,,,,,,,0,,99204,E&M,,,0270,22,Outpatient Hospital,1,519.5,283.93,258.93,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008065,MBR00000318,Institutional-OP,2023-04-25,2023-04-25,2023-06-05,PLN2225,1948810580,1948810580,DME Supplier,In-Network,C50.912,E78.5,,,,,,,0,,99221,E&M,,,0900,22,Outpatient Hospital,2,411.12,177.29,177.29,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008066,MBR00000318,Institutional-OP,2021-11-27,2021-11-27,2021-12-26,PLN3442,1631954542,1631954542,Oncology,In-Network,E11.9,M17.11,,,,,,,0,,99221,E&M,,,0120,22,Outpatient Hospital,3,255.82,190.46,165.46,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008067,MBR00000318,Institutional-IP,2022-05-26,2022-05-27,2022-06-25,PLN2528,1284035364,1284035364,Pediatrics,In-Network,I10,B97.89,,,,872,MS-DRG,19,1,N,99284,E&M,,,0301,21,Inpatient Hospital,1,402.04,192.8,0.0,192.8,25.0,0.0,217.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008068,MBR00000318,Professional,2021-04-04,2021-04-04,2021-04-12,PLN7751,1235381502,1235381502,Cardiology,In-Network,E11.9,E11.9,,,,,,,0,,71046,Radiology,,,,11,Office,1,137.86,72.96,72.96,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008069,MBR00000318,Professional,2023-05-12,2023-05-12,2023-05-25,PLN2225,1660288235,1660288235,ASC,In-Network,J18.9,Z23,,,,,,,0,,99213,E&M,,,,11,Office,3,308.31,94.11,93.38,0.73,0.0,0.0,0.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008070,MBR00000318,Professional,2021-05-29,2021-05-29,2021-07-11,PLN7990,1624802371,1624802371,ASC,Out-of-Network,Z00.00,K21.0,,,,,,,0,,90460,Medicine,,,,11,Office,1,54.19,17.72,0.0,17.72,0.0,0.0,17.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008071,MBR00000318,Institutional-OP,2021-03-17,2021-03-17,2021-04-19,PLN4650,1915531927,1915531927,Critical Access Hospital,In-Network,G43.909,E78.5,,,,,,,0,,85025,Pathology/Lab,,,0761,22,Outpatient Hospital,1,58.03,35.97,30.79,0.0,0.0,5.18,5.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008072,MBR00000318,Professional,2022-07-24,2022-07-24,2022-08-18,PLN2519,1644128543,1644128543,Gastroenterology,In-Network,Z12.31,Z00.00,,,,,,,0,,93306,Radiology,,,,11,Office,1,2023.74,1561.75,1422.65,104.1,35.0,0.0,139.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008073,MBR00000318,Professional,2023-10-06,2023-10-06,2023-11-06,PLN1210,1198133277,1198133277,SNF,In-Network,K21.0,Z12.31,,,,,,,0,,99232,E&M,,,,11,Office,3,326.71,178.57,172.45,0.0,0.0,6.12,6.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008074,MBR00000318,Professional,2022-02-17,2022-02-17,2022-03-13,PLN4023,1687650653,1687650653,Internal Medicine,In-Network,Z23,N18.3,,,,,,,0,,93225,Medicine,,,,65,End-Stage Renal Disease,3,515.78,407.23,392.23,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008075,MBR00000318,Institutional-OP,2021-07-23,2021-07-23,2021-08-04,PLN2372,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,R05,M54.5,,,,,,,0,,99204,E&M,,,0360,22,Outpatient Hospital,2,463.84,150.46,96.26,54.2,0.0,0.0,54.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008076,MBR00000318,Professional,2021-07-21,2021-07-21,2021-08-15,PLN7795,1845900543,1845900543,ASC,In-Network,Z23,J44.1,,,,,,,0,,93225,Medicine,,,,11,Office,3,625.53,494.71,494.71,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008077,MBR00000318,Professional,2023-07-06,2023-07-06,2023-07-22,PLN6734,1103747954,1103747954,Urology,In-Network,R07.9,N40.0,,,,,,,0,,27130,Surgery,,,,12,Home,2,4317.05,2685.53,2555.86,0.0,75.0,54.67,129.67,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008078,MBR00000319,Professional,2022-12-25,2022-12-25,2023-01-15,PLN9425,1125190055,1125190055,Nephrology,In-Network,J20.9,J06.9,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,2,44.16,21.49,0.0,21.49,0.0,0.0,21.49,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008079,MBR00000319,Professional,2022-06-26,2022-06-26,2022-07-30,PLN5038,1899127912,1899127912,Neurology,In-Network,E11.9,I25.10,,,,,,,0,,87491,Pathology/Lab,,,,22,Outpatient Hospital,2,208.03,73.9,23.9,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000008080,MBR00000319,Professional,2023-10-13,2023-10-13,2023-11-22,PLN5629,1575695214,1575695214,SNF,In-Network,S72.001A,E78.5,,,,,,,0,,58661,Surgery,,,,11,Office,3,3302.09,1420.51,1359.22,61.29,0.0,0.0,61.29,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008081,MBR00000319,Professional,2021-04-25,2021-04-25,2021-05-02,PLN1301,1749494482,1749494482,Pediatrics,In-Network,Z23,R51,,,,,,,0,,45378,Surgery,,,,11,Office,3,2161.53,1632.47,1632.47,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000008082,MBR00000319,Institutional-IP,2022-11-06,2022-11-11,2022-12-05,PLN4756,1749494482,1749494482,Pediatrics,In-Network,N18.3,Z12.11,,,,871,MS-DRG,14,5,Y,99203,E&M,,,0740,21,Inpatient Hospital,2,228.3,192.1,0.0,192.1,25.0,0.0,217.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008083,MBR00000319,Professional,2022-01-29,2022-01-29,2022-03-14,PLN3924,1273488618,1273488618,General Acute Care Hospital,In-Network,N39.0,M17.11,,,,,,,0,,66984,Surgery,,,,23,Emergency Room,3,1877.1,636.73,140.21,496.52,0.0,0.0,496.52,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008084,MBR00000319,Institutional-OP,2021-09-13,2021-09-13,2021-10-10,PLN9734,1514306773,1514306773,Endocrinology,In-Network,Z79.4,M54.5,,,,,,,0,,99406,Medicine,,,0270,22,Outpatient Hospital,3,72.71,28.07,0.0,28.07,0.0,0.0,28.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008085,MBR00000319,Professional,2023-10-03,2023-10-03,2023-11-14,PLN7170,1980712759,1980712759,Outpatient Clinic,Out-of-Network,E11.9,B97.89,,,,,,,0,,58661,Surgery,,,,49,Independent Clinic,3,2829.2,1422.4,1422.4,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008086,MBR00000319,Professional,2023-11-14,2023-11-14,2023-12-27,PLN8037,1168246159,1168246159,Internal Medicine,In-Network,I10,J06.9,,,,,,,0,,77067,Radiology,,,,11,Office,2,822.01,688.61,688.61,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000008087,MBR00000319,Institutional-OP,2023-07-04,2023-07-04,2023-07-20,PLN9316,1935547131,1935547131,Pulmonology,In-Network,R07.9,N39.0,,,,,,,0,,99204,E&M,,,0450,22,Outpatient Hospital,1,450.72,167.83,167.83,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008088,MBR00000319,Institutional-OP,2021-06-12,2021-06-12,2021-06-27,PLN1280,1244186984,1244186984,Family Medicine,Out-of-Network,Z23,R10.9,,,,,,,0,,99204,E&M,,,0900,22,Outpatient Hospital,2,376.56,307.18,307.18,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008089,MBR00000319,Professional,2023-03-02,2023-03-02,2023-03-15,PLN6550,1486164553,1486164553,DME Supplier,In-Network,N18.3,N18.3,,,,,,,0,,99283,E&M,,,,11,Office,2,582.29,271.64,196.64,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000008090,MBR00000319,Professional,2022-01-28,2022-01-28,2022-02-13,PLN3144,1757138478,1757138478,Pediatrics,In-Network,I63.9,E78.5,,,,,,,0,,93225,Medicine,,,,11,Office,2,962.09,536.7,536.7,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008091,MBR00000319,Professional,2022-02-20,2022-02-20,2022-04-02,PLN8174,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,Z12.31,Z00.00,,,,,,,0,,70553,Radiology,,,,11,Office,2,3000.53,1388.36,1355.77,0.0,0.0,32.59,32.59,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008092,MBR00000319,Institutional-IP,2021-08-01,2021-08-02,2021-08-10,PLN9935,1948810580,1948810580,DME Supplier,In-Network,Z23,Z79.4,,,,690,MS-DRG,1,1,N,80053,Pathology/Lab,,,0360,21,Inpatient Hospital,3,120.41,83.14,83.14,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008093,MBR00000319,Professional,2022-10-07,2022-10-07,2022-11-02,PLN5184,1132188260,1132188260,Family Medicine,In-Network,Z12.31,Z12.31,,,,,,,0,,80061,Pathology/Lab,,,,22,Outpatient Hospital,1,75.86,25.89,0.0,25.89,25.0,0.0,50.89,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008094,MBR00000320,Professional,2023-07-28,2023-07-28,2023-09-07,PLN3810,1860435061,1860435061,DME Supplier,In-Network,R51,Z12.31,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,1,311.75,238.13,192.4,0.0,15.0,30.73,45.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008095,MBR00000320,Professional,2021-09-12,2021-09-12,2021-10-07,PLN5637,1283743001,1283743001,Family Medicine,In-Network,R10.9,E11.9,,,,,,,0,,47562,Surgery,,,,11,Office,2,4674.03,2673.75,2223.62,400.13,50.0,0.0,450.13,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008096,MBR00000320,Professional,2022-08-12,2022-08-12,2022-09-09,PLN7326,1964402759,1964402759,Outpatient Clinic,In-Network,R05,J44.1,,,,,,,0,,99406,Medicine,,,,11,Office,2,55.23,20.2,5.2,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008097,MBR00000320,Institutional-OP,2022-12-11,2022-12-11,2023-01-24,PLN4834,1410468316,1410468316,SNF,In-Network,M54.5,K57.30,,,,,,,0,,83036,Pathology/Lab,,,0761,22,Outpatient Hospital,1,107.18,47.65,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000008098,MBR00000320,Professional,2022-11-22,2022-11-22,2022-12-10,PLN1356,1571574052,1571574052,Critical Access Hospital,In-Network,F41.9,Z00.00,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,2,119.73,43.03,0.0,43.03,0.0,0.0,43.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008099,MBR00000320,Institutional-OP,2021-10-13,2021-10-13,2021-10-30,PLN6188,1540044947,1540044947,Pulmonology,Out-of-Network,R07.9,M17.11,,,,,,,0,,72148,Radiology,,,0761,22,Outpatient Hospital,3,2663.58,1627.59,913.33,491.02,0.0,223.24,714.26,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008100,MBR00000320,Professional,2021-02-01,2021-02-01,2021-02-11,PLN1710,1295371663,1295371663,Critical Access Hospital,In-Network,N17.9,F32.9,,,,,,,0,,99283,E&M,,,,11,Office,1,279.44,226.42,226.42,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008101,MBR00000320,Institutional-OP,2023-06-27,2023-06-27,2023-08-01,PLN8697,1752470395,1752470395,Home Health,In-Network,Z00.00,N18.3,,,,,,,0,,23472,Surgery,,,0120,22,Outpatient Hospital,2,6909.54,3005.91,2980.91,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008102,MBR00000320,Institutional-OP,2022-10-16,2022-10-16,2022-11-03,PLN5653,1745114564,1745114564,Endocrinology,In-Network,I10,G43.909,,,,,,,0,,99221,E&M,,,0450,22,Outpatient Hospital,2,419.15,339.58,339.58,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008103,MBR00000320,Professional,2023-02-11,2023-02-11,2023-03-21,PLN2416,1845057593,1845057593,Orthopedic Surgery,In-Network,E78.5,K21.0,,,,,,,0,,72148,Radiology,,,,11,Office,2,1653.61,726.43,540.59,135.84,50.0,0.0,185.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008104,MBR00000320,Professional,2022-08-06,2022-08-06,2022-09-15,PLN4658,1438368327,1438368327,Home Health,In-Network,J18.9,E66.9,,,,,,,0,,99284,E&M,,,,21,Inpatient Hospital,3,824.01,320.53,0.0,320.53,50.0,0.0,370.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008105,MBR00000320,Professional,2022-02-27,2022-02-27,2022-04-09,PLN4196,1205377316,1205377316,Orthopedic Surgery,In-Network,M54.5,I10,,,,,,,0,,27130,Surgery,,,,20,Urgent Care,1,3573.32,2764.47,2476.82,0.0,35.0,252.65,287.65,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008106,MBR00000320,Institutional-OP,2021-10-03,2021-10-03,2021-11-16,PLN2778,1502838586,1502838586,ASC,In-Network,E11.9,E11.9,,,,,,,0,,99213,E&M,,,0200,22,Outpatient Hospital,2,211.98,126.94,55.29,71.65,0.0,0.0,71.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008107,MBR00000320,Professional,2022-12-24,2022-12-24,2023-01-08,PLN3868,1114982472,1114982472,Orthopedic Surgery,In-Network,E66.9,E66.9,,,,,,,0,,90460,Medicine,,,,11,Office,1,56.38,27.77,0.0,27.77,15.0,0.0,42.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008108,MBR00000320,Institutional-OP,2023-06-30,2023-06-30,2023-08-01,PLN2555,1696843572,1696843572,Critical Access Hospital,Out-of-Network,J06.9,Z12.31,,,,,,,0,,99283,E&M,,,0270,22,Outpatient Hospital,1,644.1,440.21,440.21,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008109,MBR00000320,Institutional-OP,2021-12-23,2021-12-23,2022-01-30,PLN5161,1564502315,1564502315,ASC,In-Network,I10,E11.40,,,,,,,0,,45378,Surgery,,,0450,22,Outpatient Hospital,3,1580.07,872.31,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-97,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000008110,MBR00000320,Professional,2021-01-27,2021-01-27,2021-03-03,PLN8050,1997536841,1997536841,Family Medicine,Out-of-Network,J44.1,E78.5,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,1,1428.69,482.02,482.02,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000008111,MBR00000320,Institutional-IP,2021-06-20,2021-06-29,2021-07-05,PLN9926,1148984206,1148984206,Psychiatry,In-Network,F03.90,J06.9,,,,291,MS-DRG,17,9,Y,99232,E&M,,,0360,21,Inpatient Hospital,2,385.09,256.15,145.84,105.93,0.0,4.38,110.31,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000008112,MBR00000320,Institutional-OP,2022-09-27,2022-09-27,2022-10-10,PLN9792,1193493783,1193493783,Critical Access Hospital,Out-of-Network,J20.9,E78.5,,,,,,,0,,87491,Pathology/Lab,,,0200,22,Outpatient Hospital,1,147.13,99.06,24.06,0.0,75.0,0.0,75.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008113,MBR00000320,Institutional-OP,2021-09-15,2021-09-15,2021-10-24,PLN8532,1968299309,1968299309,Internal Medicine,In-Network,J45.20,Z23,,,,,,,0,,99214,E&M,,,0450,22,Outpatient Hospital,1,411.0,236.19,199.37,0.0,35.0,1.82,36.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008114,MBR00000320,Professional,2023-06-11,2023-06-11,2023-06-21,PLN9549,1631954542,1631954542,Oncology,In-Network,I63.9,E66.9,,,,,,,0,,66984,Surgery,,,,23,Emergency Room,1,3593.77,2181.87,2118.06,0.0,15.0,48.81,63.81,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008115,MBR00000320,Professional,2021-10-25,2021-10-25,2021-11-28,PLN6029,1847081578,1847081578,Urology,Out-of-Network,E11.9,N18.3,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,3,238.17,74.55,0.0,74.55,0.0,0.0,74.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008116,MBR00000320,Professional,2022-06-25,2022-06-25,2022-08-02,PLN1302,1186826716,1186826716,Physical Therapy,In-Network,J06.9,Z23,,,,,,,0,,47562,Surgery,,,,11,Office,2,3276.09,1475.27,1185.67,227.74,0.0,61.86,289.6,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008117,MBR00000320,Professional,2021-09-06,2021-09-06,2021-09-15,PLN4814,1434029575,1434029575,Endocrinology,In-Network,I10,I48.91,,,,,,,0,,71046,Radiology,,,,11,Office,3,119.38,48.57,48.57,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000008118,MBR00000320,Professional,2022-05-13,2022-05-13,2022-05-22,PLN5565,1453936007,1453936007,ASC,In-Network,J20.9,Z87.891,,,,,,,0,,87491,Pathology/Lab,,,,23,Emergency Room,2,248.03,185.53,128.59,37.85,0.0,19.09,56.94,0.0,Adjusted,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008119,MBR00000320,Institutional-OP,2023-01-13,2023-01-13,2023-02-15,PLN1043,1645194539,1645194539,SNF,In-Network,K21.0,I25.10,,,,,,,0,,58661,Surgery,,,0900,22,Outpatient Hospital,3,4660.34,1876.27,1801.27,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008120,MBR00000320,Professional,2023-05-22,2023-05-22,2023-06-01,PLN3025,1845900543,1845900543,ASC,In-Network,J18.9,E78.5,,,,,,,0,,45380,Surgery,,,,11,Office,2,1592.29,1145.18,1088.01,0.0,0.0,57.17,57.17,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000008121,MBR00000320,Professional,2023-03-21,2023-03-21,2023-04-07,PLN4695,1980712759,1980712759,Outpatient Clinic,Out-of-Network,N39.0,K92.1,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,2,2826.22,1742.48,1655.1,0.0,25.0,62.38,87.38,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008122,MBR00000320,Professional,2022-07-10,2022-07-10,2022-07-18,PLN9256,1514306773,1514306773,Endocrinology,In-Network,I10,E11.9,,,,,,,0,,99213,E&M,,,,31,Skilled Nursing Facility,2,127.79,65.68,0.0,65.68,0.0,0.0,65.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008123,MBR00000320,Institutional-OP,2022-05-16,2022-05-16,2022-06-27,PLN1127,1800011727,1800011727,Clinical Laboratory,Out-of-Network,E11.9,R05,,,,,,,0,,76700,Radiology,,,0301,22,Outpatient Hospital,2,1064.47,755.03,669.09,85.94,0.0,0.0,85.94,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008124,MBR00000320,Professional,2021-12-23,2021-12-23,2022-01-10,PLN4820,1266606767,1266606767,ASC,In-Network,F41.9,I25.10,,,,,,,0,,27447,Surgery,,,,11,Office,1,5141.18,2813.78,2813.78,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008125,MBR00000320,Professional,2023-12-18,2023-12-18,2024-01-01,PLN3402,1530904931,1530904931,Internal Medicine,In-Network,E11.9,B97.89,,,,,,,0,,99213,E&M,,,,50,Federally Qualified Health Center,3,173.77,122.25,0.0,122.25,0.0,0.0,122.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008126,MBR00000320,Institutional-IP,2023-03-15,2023-03-22,2023-04-16,PLN4768,1716521444,1716521444,Oncology,In-Network,Z00.00,R10.9,,,,194,MS-DRG,23,7,Y,G0468,Medicine,,,0761,21,Inpatient Hospital,2,352.34,265.52,187.41,78.11,0.0,0.0,78.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008127,MBR00000320,Professional,2023-09-03,2023-09-03,2023-09-22,PLN9430,1749494482,1749494482,Pediatrics,In-Network,K57.30,Z12.31,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,1,3934.3,1776.79,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-11,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008128,MBR00000320,Professional,2023-03-21,2023-03-21,2023-04-06,PLN3028,1450094833,1450094833,Outpatient Clinic,In-Network,F32.9,J06.9,,,,,,,0,,99213,E&M,,,,11,Office,3,325.13,244.81,159.24,0.0,50.0,35.57,85.57,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008129,MBR00000320,Institutional-IP,2021-04-06,2021-04-08,2021-05-13,PLN3891,1205377316,1205377316,Orthopedic Surgery,In-Network,I25.10,K21.0,,,,195,MS-DRG,18,2,Y,23472,Surgery,,,0900,21,Inpatient Hospital,3,3014.85,1712.29,1697.29,0.0,15.0,0.0,15.0,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008130,MBR00000320,Institutional-IP,2021-10-18,2021-10-27,2021-11-14,PLN4430,1778483301,1778483301,Home Health,In-Network,Z12.31,I10,,,,872,MS-DRG,3,9,Y,85610,Pathology/Lab,,,0200,21,Inpatient Hospital,2,40.16,27.93,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008131,MBR00000320,Professional,2022-05-20,2022-05-20,2022-06-29,PLN9637,1433937353,1433937353,Nephrology,In-Network,R07.9,N39.0,,,,,,,0,,99233,E&M,,,,11,Office,3,200.21,166.17,166.17,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008132,MBR00000320,Professional,2021-12-11,2021-12-11,2022-01-21,PLN8308,1939033455,1939033455,Pulmonology,In-Network,G20,J06.9,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,2,397.92,162.81,0.0,162.81,0.0,0.0,162.81,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008133,MBR00000320,Institutional-OP,2023-09-22,2023-09-22,2023-10-14,PLN3602,1450553056,1450553056,Clinical Laboratory,In-Network,M54.5,J45.20,,,,,,,0,,90837,Medicine,,,0200,22,Outpatient Hospital,3,508.51,344.9,0.0,344.9,25.0,0.0,369.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008134,MBR00000320,Professional,2022-06-23,2022-06-23,2022-07-21,PLN1878,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,E11.9,E11.9,,,,,,,0,,74177,Radiology,,,,21,Inpatient Hospital,3,2710.56,2252.25,2227.25,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008135,MBR00000320,Institutional-OP,2021-08-30,2021-08-30,2021-10-12,PLN6772,1891849440,1891849440,Oncology,In-Network,Z79.4,I10,,,,,,,0,,23472,Surgery,,,0320,22,Outpatient Hospital,2,5835.53,2068.88,1630.96,422.92,15.0,0.0,437.92,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008136,MBR00000320,Professional,2022-10-17,2022-10-17,2022-11-24,PLN3996,1585582070,1585582070,Outpatient Clinic,In-Network,J20.9,E78.5,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,3,26.76,13.97,0.0,13.97,0.0,0.0,13.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008137,MBR00000320,Professional,2022-02-19,2022-02-19,2022-03-23,PLN1935,1800011727,1800011727,Clinical Laboratory,Out-of-Network,E66.9,E11.9,,,,,,,0,,99232,E&M,,,,81,Independent Laboratory,1,156.83,65.18,40.18,0.0,25.0,0.0,25.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008138,MBR00000320,Institutional-IP,2021-05-21,2021-05-30,2021-07-03,PLN8603,1500949740,1500949740,Pediatrics,In-Network,F41.9,F10.20,,,,682,MS-DRG,23,9,Y,77067,Radiology,,,0320,21,Inpatient Hospital,2,475.37,322.55,0.0,0.0,35.0,3.98,38.98,0.0,Denied,CO-15,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000008139,MBR00000320,Professional,2023-11-03,2023-11-03,2023-12-17,PLN3533,1109850785,1109850785,ASC,Out-of-Network,K57.30,Z00.00,,,,,,,0,,99222,E&M,,,,21,Inpatient Hospital,3,575.0,183.79,183.79,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008140,MBR00000321,Professional,2023-11-02,2023-11-02,2023-11-11,PLN7544,1103747954,1103747954,Urology,In-Network,E11.65,K21.0,,,,,,,0,,99222,E&M,,,,11,Office,2,441.51,364.91,358.23,6.68,0.0,0.0,6.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008141,MBR00000321,Professional,2023-04-30,2023-04-30,2023-05-20,PLN5070,1434029575,1434029575,Endocrinology,In-Network,J06.9,E78.5,,,,,,,0,,99221,E&M,,,,31,Skilled Nursing Facility,3,348.28,141.59,0.0,141.59,0.0,0.0,141.59,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008142,MBR00000321,Institutional-OP,2021-12-11,2021-12-11,2021-12-18,PLN8876,1355166277,1355166277,Endocrinology,In-Network,N40.0,R10.9,,,,,,,0,,99232,E&M,,,0730,22,Outpatient Hospital,3,362.83,259.94,0.0,0.0,0.0,0.0,0.0,0.0,Denied,PR-1,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000008143,MBR00000321,Professional,2023-07-01,2023-07-01,2023-07-29,PLN9289,1313212303,1313212303,Family Medicine,In-Network,J06.9,R07.9,,,,,,,0,,82043,Pathology/Lab,,,,23,Emergency Room,3,29.58,24.77,24.77,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008144,MBR00000321,Professional,2021-11-12,2021-11-12,2021-12-02,PLN9716,1453936007,1453936007,ASC,In-Network,E78.5,M81.0,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,3,3752.41,1953.78,1894.97,0.0,25.0,33.81,58.81,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008145,MBR00000321,Professional,2023-08-22,2023-08-22,2023-09-11,PLN1899,1283743001,1283743001,Family Medicine,In-Network,E78.5,E78.5,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,1,443.21,279.1,0.0,279.1,25.0,0.0,304.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008146,MBR00000321,Professional,2023-08-27,2023-08-27,2023-10-05,PLN4595,1118885473,1118885473,ASC,In-Network,E78.5,E78.5,,,,,,,0,,97110,Medicine,,,,81,Independent Laboratory,2,276.63,213.15,213.15,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008147,MBR00000321,Professional,2021-07-07,2021-07-07,2021-08-18,PLN4986,1609526529,1609526529,Psychiatry,In-Network,E11.65,Z00.00,,,,,,,0,,23472,Surgery,,,,23,Emergency Room,3,5968.56,2519.01,0.0,0.0,50.0,4.37,54.37,0.0,Denied,CO-4,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008148,MBR00000321,Institutional-OP,2021-12-11,2021-12-11,2022-01-22,PLN3351,1502838586,1502838586,ASC,In-Network,E11.9,R51,,,,,,,0,,99221,E&M,,,0370,22,Outpatient Hospital,3,446.34,300.67,217.69,0.0,75.0,7.98,82.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008149,MBR00000321,Institutional-OP,2023-02-05,2023-02-05,2023-03-03,PLN7541,1531398223,1531398223,OB/GYN,In-Network,J06.9,E11.40,,,,,,,0,,58661,Surgery,,,0636,22,Outpatient Hospital,2,2912.62,2327.19,2327.19,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008150,MBR00000321,Institutional-OP,2021-09-14,2021-09-14,2021-09-23,PLN9966,1964402759,1964402759,Outpatient Clinic,In-Network,F32.9,E11.9,,,,,,,0,,99232,E&M,,,0510,22,Outpatient Hospital,3,225.42,86.12,0.0,86.12,0.0,0.0,86.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008151,MBR00000321,Professional,2023-05-30,2023-05-30,2023-06-27,PLN7290,1475984649,1475984649,SNF,In-Network,Z23,F41.9,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,3,2707.42,1683.02,1453.08,204.94,25.0,0.0,229.94,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008152,MBR00000321,Professional,2023-01-14,2023-01-14,2023-02-25,PLN7894,1364429278,1364429278,OB/GYN,In-Network,I10,J20.9,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,2,4506.35,3598.71,2977.04,0.0,0.0,621.67,621.67,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008153,MBR00000321,Professional,2021-09-05,2021-09-05,2021-10-09,PLN5460,1946680931,1946680931,Critical Access Hospital,Out-of-Network,Z87.891,N39.0,,,,,,,0,,93225,Medicine,,,,20,Urgent Care,1,568.93,482.24,482.24,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008154,MBR00000321,Professional,2023-04-30,2023-04-30,2023-05-30,PLN4033,1273488618,1273488618,General Acute Care Hospital,In-Network,I25.10,F41.9,,,,,,,0,,70553,Radiology,,,,81,Independent Laboratory,3,3016.84,1829.58,1829.58,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008155,MBR00000321,Institutional-IP,2021-02-17,2021-02-18,2021-03-14,PLN5939,1946680931,1946680931,Critical Access Hospital,Out-of-Network,B97.89,N18.3,,,,292,MS-DRG,8,1,N,77067,Radiology,,,0450,21,Inpatient Hospital,1,691.74,395.32,47.9,336.96,0.0,10.46,347.42,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000008156,MBR00000321,Professional,2022-02-25,2022-02-25,2022-03-21,PLN1767,1872272835,1872272835,Internal Medicine,In-Network,J18.9,Z79.4,,,,,,,0,,93225,Medicine,,,,22,Outpatient Hospital,3,366.99,155.29,125.24,0.0,0.0,30.05,30.05,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008157,MBR00000321,Professional,2021-07-15,2021-07-15,2021-07-29,PLN8715,1799205295,1799205295,General Acute Care Hospital,In-Network,J20.9,E78.5,,,,,,,0,,99222,E&M,,,,11,Office,3,645.73,329.62,120.83,208.79,0.0,0.0,208.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008158,MBR00000321,Institutional-OP,2021-01-01,2021-01-01,2021-02-01,PLN4891,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,E11.9,Z12.31,,,,,,,0,,33533,Surgery,,,0900,22,Outpatient Hospital,3,13298.81,9413.83,8190.83,0.0,75.0,1148.0,1223.0,0.0,Pended,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000008159,MBR00000321,Institutional-OP,2023-03-23,2023-03-23,2023-04-29,PLN7041,1247341320,1247341320,Urology,Out-of-Network,E11.9,Z23,,,,,,,0,,93306,Radiology,,,0900,22,Outpatient Hospital,2,3320.52,2066.29,0.0,0.0,0.0,315.3,315.3,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008160,MBR00000321,Institutional-OP,2021-06-17,2021-06-17,2021-06-24,PLN6719,1514306773,1514306773,Endocrinology,In-Network,F32.9,I10,,,,,,,0,,45380,Surgery,,,0730,22,Outpatient Hospital,1,1681.69,1280.72,1280.72,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000008161,MBR00000321,Professional,2023-01-31,2023-01-31,2023-02-09,PLN3183,1520687146,1520687146,ASC,In-Network,F41.9,N18.3,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,2,225.42,114.69,9.35,104.22,0.0,1.12,105.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008162,MBR00000321,Institutional-OP,2021-03-24,2021-03-24,2021-04-06,PLN2470,1550154147,1550154147,Outpatient Clinic,In-Network,E78.5,F32.9,,,,,,,0,,99284,E&M,,,0120,22,Outpatient Hospital,3,760.07,501.04,289.94,171.08,35.0,5.02,211.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008163,MBR00000321,Professional,2023-09-04,2023-09-04,2023-09-19,PLN5049,1389336600,1389336600,Critical Access Hospital,In-Network,E78.5,I10,,,,,,,0,,99213,E&M,,,,11,Office,2,159.78,65.29,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008164,MBR00000321,Professional,2023-12-07,2023-12-07,2024-01-05,PLN9791,1749327647,1749327647,Geriatrics,In-Network,E11.9,J06.9,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,3,423.15,146.52,33.23,73.38,35.0,4.91,113.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008165,MBR00000321,Professional,2021-12-14,2021-12-14,2022-01-25,PLN9424,1702692193,1702692193,Physical Therapy,In-Network,E78.5,R07.9,,,,,,,0,,70450,Radiology,,,,11,Office,2,1597.88,590.75,574.98,15.77,0.0,0.0,15.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008166,MBR00000321,Institutional-IP,2022-06-17,2022-06-18,2022-07-19,PLN4929,1450553056,1450553056,Clinical Laboratory,In-Network,Z00.00,I63.9,,,,690,MS-DRG,19,1,Y,84443,Pathology/Lab,,,0450,21,Inpatient Hospital,3,149.26,109.36,109.36,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008167,MBR00000321,Professional,2022-11-12,2022-11-12,2022-12-13,PLN4976,1334916761,1334916761,ASC,In-Network,J20.9,I25.10,,,,,,,0,,76700,Radiology,,,,11,Office,1,1339.81,1129.52,1094.52,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008168,MBR00000321,Institutional-OP,2022-10-08,2022-10-08,2022-10-16,PLN3912,1856686341,1856686341,Geriatrics,In-Network,J20.9,Z00.00,,,,,,,0,,G0468,Medicine,,,0730,22,Outpatient Hospital,3,388.6,328.55,303.55,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008169,MBR00000321,Professional,2021-01-30,2021-01-30,2021-03-03,PLN7303,1809014947,1809014947,Urology,In-Network,K21.0,Z79.4,,,,,,,0,,97110,Medicine,,,,49,Independent Clinic,1,223.28,169.0,169.0,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008170,MBR00000321,Institutional-OP,2023-12-09,2023-12-09,2023-12-20,PLN7205,1125190055,1125190055,Nephrology,In-Network,Z87.891,Z00.00,,,,,,,0,,99203,E&M,,,0761,22,Outpatient Hospital,3,246.17,195.82,195.82,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008171,MBR00000321,Professional,2023-10-21,2023-10-21,2023-11-04,PLN2522,1227362142,1227362142,DME Supplier,In-Network,M17.11,R07.9,,,,,,,0,,71046,Radiology,,,,11,Office,1,193.75,130.52,0.0,130.52,0.0,0.0,130.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008172,MBR00000321,Institutional-OP,2022-06-17,2022-06-17,2022-07-06,PLN3811,1390307371,1390307371,DME Supplier,In-Network,M81.0,I25.10,,,,,,,0,,86900,Pathology/Lab,,,0320,22,Outpatient Hospital,1,56.08,30.75,0.0,30.75,0.0,0.0,30.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008173,MBR00000321,Institutional-OP,2022-08-31,2022-08-31,2022-10-06,PLN9889,1313212303,1313212303,Family Medicine,In-Network,I10,E11.9,,,,,,,0,,99222,E&M,,,0900,22,Outpatient Hospital,1,411.85,317.72,0.0,0.0,0.0,20.19,20.19,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008174,MBR00000321,Institutional-IP,2021-07-06,2021-07-09,2021-07-23,PLN8353,1624802371,1624802371,ASC,Out-of-Network,N17.9,Z12.31,,,,683,MS-DRG,9,3,Y,45378,Surgery,,,0270,21,Inpatient Hospital,3,1217.35,441.87,301.69,50.53,35.0,54.65,140.18,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000008175,MBR00000321,Institutional-OP,2023-03-31,2023-03-31,2023-04-13,PLN3508,1198133277,1198133277,SNF,In-Network,M54.5,I50.9,,,,,,,0,,80061,Pathology/Lab,,,0761,22,Outpatient Hospital,1,129.92,51.31,46.99,0.0,0.0,4.32,4.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008176,MBR00000321,Institutional-IP,2022-07-18,2022-07-23,2022-07-28,PLN2436,1980712759,1980712759,Outpatient Clinic,Out-of-Network,K21.0,I10,,,,872,MS-DRG,23,5,N,27447,Surgery,,,0370,21,Inpatient Hospital,3,3698.23,1985.79,1970.79,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008177,MBR00000321,Professional,2021-11-07,2021-11-07,2021-11-18,PLN1572,1872272835,1872272835,Internal Medicine,In-Network,I10,F41.9,,,,,,,0,,66984,Surgery,,,,49,Independent Clinic,2,3434.47,2315.73,2177.4,63.33,75.0,0.0,138.33,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008178,MBR00000321,Institutional-IP,2021-12-03,2021-12-15,2021-12-16,PLN8842,1366576336,1366576336,Geriatrics,In-Network,E11.9,Z00.00,,,,683,MS-DRG,17,12,Y,23472,Surgery,,,0510,21,Inpatient Hospital,2,4891.12,3456.92,3378.85,0.0,15.0,63.07,78.07,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008179,MBR00000321,Institutional-IP,2021-03-31,2021-04-02,2021-05-05,PLN7701,1500949740,1500949740,Pediatrics,In-Network,R10.9,R07.9,,,,641,MS-DRG,14,2,Y,99233,E&M,,,0450,21,Inpatient Hospital,3,377.78,237.66,119.45,68.21,50.0,0.0,118.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008180,MBR00000321,Professional,2023-05-14,2023-05-14,2023-06-20,PLN4501,1994661817,1994661817,SNF,Out-of-Network,I10,I48.91,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,1,617.87,380.51,350.06,0.0,0.0,30.45,30.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008181,MBR00000321,Professional,2021-03-10,2021-03-10,2021-03-30,PLN5183,1118885473,1118885473,ASC,In-Network,F41.9,I10,,,,,,,0,,99203,E&M,,,,11,Office,1,356.48,191.41,191.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008182,MBR00000321,Professional,2022-09-10,2022-09-10,2022-10-03,PLN6363,1500949740,1500949740,Pediatrics,In-Network,Z12.31,J44.1,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,1,1442.89,790.77,755.77,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000008183,MBR00000321,Professional,2023-06-12,2023-06-12,2023-07-13,PLN5006,1540044947,1540044947,Pulmonology,Out-of-Network,Z12.31,F41.9,,,,,,,0,,23472,Surgery,,,,23,Emergency Room,1,4273.24,1909.54,1644.35,0.0,15.0,250.19,265.19,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008184,MBR00000321,Institutional-OP,2021-02-27,2021-02-27,2021-03-15,PLN3821,1410468316,1410468316,SNF,In-Network,J45.20,Z12.31,,,,,,,0,,G0439,Medicine,,,0370,22,Outpatient Hospital,3,393.04,276.83,0.0,276.83,75.0,0.0,351.83,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000008185,MBR00000322,Institutional-OP,2021-06-16,2021-06-16,2021-07-22,PLN1131,1590915516,1590915516,Physical Therapy,Out-of-Network,J44.1,F41.9,,,,,,,0,,G0439,Medicine,,,0761,22,Outpatient Hospital,1,517.24,171.01,121.01,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000008186,MBR00000322,Institutional-IP,2023-04-15,2023-04-21,2023-05-27,PLN3398,1845900543,1845900543,ASC,In-Network,J44.1,M54.5,,,,292,MS-DRG,13,6,Y,23472,Surgery,,,0320,21,Inpatient Hospital,2,5618.34,4761.68,4726.68,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008187,MBR00000322,Professional,2023-06-22,2023-06-22,2023-08-03,PLN7875,1795618275,1795618275,Pulmonology,In-Network,E11.9,E11.9,,,,,,,0,,90460,Medicine,,,,11,Office,3,55.02,26.51,26.51,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008188,MBR00000322,Professional,2021-03-30,2021-03-30,2021-04-20,PLN8036,1334916761,1334916761,ASC,In-Network,I10,R10.9,,,,,,,0,,99222,E&M,,,,11,Office,2,524.92,295.24,293.99,0.35,0.0,0.9,1.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008189,MBR00000322,Professional,2021-10-18,2021-10-18,2021-11-16,PLN1622,1749494482,1749494482,Pediatrics,In-Network,N18.3,E11.9,,,,,,,0,,99222,E&M,,,,23,Emergency Room,1,287.05,168.0,168.0,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008190,MBR00000322,Professional,2022-10-26,2022-10-26,2022-11-02,PLN5452,1283743001,1283743001,Family Medicine,In-Network,E11.9,K21.0,,,,,,,0,,45380,Surgery,,,,11,Office,2,2330.59,1054.56,1054.56,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000008191,MBR00000322,Institutional-OP,2022-08-16,2022-08-16,2022-09-09,PLN2378,1717546253,1717546253,Family Medicine,In-Network,E11.9,I11.9,,,,,,,0,,23472,Surgery,,,0636,22,Outpatient Hospital,3,4810.61,2987.76,2575.26,412.5,0.0,0.0,412.5,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008192,MBR00000322,Professional,2022-07-20,2022-07-20,2022-07-29,PLN1162,1716521444,1716521444,Oncology,In-Network,E78.5,Z00.00,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,2,4836.23,3953.79,3373.29,322.56,15.0,242.94,580.5,0.0,Paid,,,1,,0,0,1,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000008193,MBR00000322,Professional,2021-10-14,2021-10-14,2021-11-23,PLN6107,1845057593,1845057593,Orthopedic Surgery,In-Network,E11.9,I10,,,,,,,0,,99283,E&M,,,,21,Inpatient Hospital,1,499.9,212.01,212.01,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008194,MBR00000322,Professional,2022-08-14,2022-08-14,2022-08-26,PLN9259,1530904931,1530904931,Internal Medicine,In-Network,R10.9,Z87.891,,,,,,,0,,93000,Radiology,,,,22,Outpatient Hospital,1,101.07,85.65,73.55,0.0,0.0,12.1,12.1,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008195,MBR00000322,Institutional-OP,2021-02-24,2021-02-24,2021-03-31,PLN8664,1687650653,1687650653,Internal Medicine,In-Network,J20.9,N39.0,,,,,,,0,,99221,E&M,,,0740,22,Outpatient Hospital,3,441.88,251.81,36.03,190.78,25.0,0.0,215.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008196,MBR00000322,Professional,2023-08-14,2023-08-14,2023-09-27,PLN4728,1438368327,1438368327,Home Health,In-Network,Z12.31,E66.9,,,,,,,0,,45378,Surgery,,,,81,Independent Laboratory,1,989.22,298.69,298.69,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000008197,MBR00000322,Professional,2022-08-17,2022-08-17,2022-08-25,PLN4528,1550154147,1550154147,Outpatient Clinic,In-Network,F41.9,F41.9,,,,,,,0,,90460,Medicine,,,,11,Office,2,54.82,22.75,0.0,22.75,35.0,0.0,57.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008198,MBR00000322,Professional,2022-02-13,2022-02-13,2022-03-24,PLN2292,1520687146,1520687146,ASC,In-Network,J20.9,R07.9,,,,,,,0,,99406,Medicine,,,,31,Skilled Nursing Facility,2,87.27,51.79,51.79,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008199,MBR00000322,Professional,2022-02-06,2022-02-06,2022-02-25,PLN6709,1366286000,1366286000,SNF,In-Network,J06.9,E11.9,,,,,,,0,,27130,Surgery,,,,11,Office,1,5444.35,2492.37,2223.69,253.68,15.0,0.0,268.68,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008200,MBR00000322,Institutional-IP,2022-02-10,2022-02-14,2022-03-08,PLN3267,1590915516,1590915516,Physical Therapy,Out-of-Network,I63.9,F41.9,,,,641,MS-DRG,14,4,Y,33533,Surgery,,,0200,21,Inpatient Hospital,3,27224.29,17664.15,17501.94,147.21,15.0,0.0,162.21,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000008201,MBR00000322,Institutional-IP,2022-04-22,2022-04-24,2022-05-14,PLN1975,1530904931,1530904931,Internal Medicine,In-Network,F32.9,Z51.11,,,,194,MS-DRG,24,2,Y,86900,Pathology/Lab,,,0301,21,Inpatient Hospital,2,38.01,28.88,3.88,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008202,MBR00000322,Institutional-IP,2021-07-31,2021-08-03,2021-09-12,PLN1213,1422747896,1422747896,Urology,In-Network,E11.9,I10,,,,194,MS-DRG,4,3,Y,84443,Pathology/Lab,,,0301,21,Inpatient Hospital,3,162.87,65.88,0.0,65.88,35.0,0.0,100.88,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008203,MBR00000322,Professional,2022-10-21,2022-10-21,2022-10-29,PLN1320,1974006077,1974006077,Orthopedic Surgery,In-Network,N39.0,J20.9,,,,,,,0,,99222,E&M,,,,11,Office,2,384.61,320.89,0.0,55.56,35.0,0.0,90.56,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008204,MBR00000322,Institutional-OP,2021-07-21,2021-07-21,2021-08-11,PLN1472,1242201429,1242201429,General Acute Care Hospital,In-Network,E11.65,E78.5,,,,,,,0,,33533,Surgery,,,0636,22,Outpatient Hospital,1,25407.9,11769.32,11769.32,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000008205,MBR00000322,Institutional-OP,2021-12-10,2021-12-10,2022-01-22,PLN8509,1518055405,1518055405,Urology,In-Network,Z23,I25.10,,,,,,,0,,27447,Surgery,,,0320,22,Outpatient Hospital,3,4403.83,3438.24,3363.24,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008206,MBR00000322,Institutional-OP,2023-08-12,2023-08-12,2023-08-21,PLN4826,1545347862,1545347862,SNF,In-Network,I63.9,I10,,,,,,,0,,43239,Surgery,,,0270,22,Outpatient Hospital,2,842.19,477.12,139.87,337.25,0.0,0.0,337.25,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008207,MBR00000322,Professional,2022-09-10,2022-09-10,2022-10-03,PLN8788,1266606767,1266606767,ASC,In-Network,Z12.31,J20.9,,,,,,,0,,99232,E&M,,,,11,Office,3,309.28,131.13,115.21,0.0,0.0,15.92,15.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008208,MBR00000322,Institutional-OP,2023-09-16,2023-09-16,2023-10-05,PLN7207,1124394415,1124394415,Pediatrics,In-Network,Z23,I25.10,,,,,,,0,,70450,Radiology,,,0510,22,Outpatient Hospital,3,1302.01,553.37,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-50,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008209,MBR00000322,Institutional-OP,2022-12-22,2022-12-22,2023-02-01,PLN7692,1530904931,1530904931,Internal Medicine,In-Network,R51,I25.10,,,,,,,0,,77067,Radiology,,,0200,22,Outpatient Hospital,3,459.45,166.99,0.0,166.99,0.0,0.0,166.99,0.0,Denied,CO-97,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000008210,MBR00000322,Professional,2023-05-08,2023-05-08,2023-05-26,PLN4576,1242201429,1242201429,General Acute Care Hospital,In-Network,E11.9,I10,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,3,59.95,46.9,46.9,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008211,MBR00000323,Professional,2021-04-09,2021-04-09,2021-04-25,PLN1978,1434029575,1434029575,Endocrinology,In-Network,Z12.31,M54.5,,,,,,,0,,74177,Radiology,,,,22,Outpatient Hospital,3,2397.77,1096.54,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008212,MBR00000323,Professional,2022-07-07,2022-07-07,2022-07-19,PLN6982,1361302520,1361302520,Critical Access Hospital,In-Network,Z00.00,E78.5,,,,,,,0,,99221,E&M,,,,11,Office,2,214.14,112.53,0.0,112.53,50.0,0.0,162.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008213,MBR00000323,Institutional-OP,2022-01-19,2022-01-19,2022-02-19,PLN9316,1609526529,1609526529,Psychiatry,In-Network,N40.0,K21.0,,,,,,,0,,99222,E&M,,,0636,22,Outpatient Hospital,2,552.08,195.63,168.43,0.0,0.0,27.2,27.2,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000008214,MBR00000323,Professional,2021-01-19,2021-01-19,2021-02-03,PLN3578,1247341320,1247341320,Urology,Out-of-Network,J06.9,B97.89,,,,,,,0,,45378,Surgery,,,,11,Office,2,2442.28,933.87,537.21,371.66,25.0,0.0,396.66,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000008215,MBR00000323,Institutional-IP,2021-04-09,2021-04-10,2021-05-16,PLN2376,1757138478,1757138478,Pediatrics,In-Network,C50.912,Z12.31,,,,196,MS-DRG,19,1,Y,66984,Surgery,,,0450,21,Inpatient Hospital,3,3427.83,1641.76,1591.76,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008216,MBR00000323,Institutional-OP,2021-07-27,2021-07-27,2021-08-30,PLN3817,1295371663,1295371663,Critical Access Hospital,In-Network,K21.0,B97.89,,,,,,,0,,72148,Radiology,,,0120,22,Outpatient Hospital,1,1166.34,756.22,637.45,0.0,50.0,68.77,118.77,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008217,MBR00000323,Institutional-OP,2021-01-08,2021-01-08,2021-02-12,PLN4224,1575695214,1575695214,SNF,In-Network,J18.9,Z51.11,,,,,,,0,,99222,E&M,,,0761,22,Outpatient Hospital,3,648.11,454.63,447.46,0.0,0.0,7.17,7.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008218,MBR00000323,Professional,2022-04-24,2022-04-24,2022-06-01,PLN6325,1609526529,1609526529,Psychiatry,In-Network,R07.9,M54.5,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,1,3416.89,1394.22,1369.22,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008219,MBR00000323,Institutional-OP,2021-02-26,2021-02-26,2021-03-29,PLN2709,1790497490,1790497490,OB/GYN,In-Network,E66.9,J20.9,,,,,,,0,,99232,E&M,,,0360,22,Outpatient Hospital,3,332.96,262.45,262.45,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008220,MBR00000323,Professional,2023-06-22,2023-06-22,2023-07-06,PLN4724,1990090423,1990090423,Orthopedic Surgery,In-Network,I10,E11.9,,,,,,,0,,76700,Radiology,,,,20,Urgent Care,3,917.12,454.75,248.73,121.91,75.0,9.11,206.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008221,MBR00000323,Institutional-OP,2022-10-11,2022-10-11,2022-11-01,PLN3448,1569105090,1569105090,Geriatrics,In-Network,R05,F32.9,,,,,,,0,,99222,E&M,,,0740,22,Outpatient Hospital,3,612.15,433.04,332.06,0.0,50.0,50.98,100.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008222,MBR00000323,Professional,2023-11-21,2023-11-21,2023-12-25,PLN7953,1622771872,1622771872,Pediatrics,In-Network,J06.9,E66.9,,,,,,,0,,27130,Surgery,,,,20,Urgent Care,2,4175.25,1525.85,1456.17,8.73,35.0,25.95,69.68,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008223,MBR00000323,Professional,2021-04-03,2021-04-03,2021-04-21,PLN9634,1168881145,1168881145,Orthopedic Surgery,In-Network,M81.0,Z00.00,,,,,,,0,,83036,Pathology/Lab,,,,12,Home,3,117.61,70.13,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000008224,MBR00000324,Professional,2021-03-29,2021-03-29,2021-04-14,PLN3513,1284035364,1284035364,Pediatrics,In-Network,F32.9,K57.30,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,2,84.18,65.78,0.0,65.78,25.0,0.0,90.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000008225,MBR00000324,Institutional-OP,2023-08-10,2023-08-10,2023-08-26,PLN5990,1974006077,1974006077,Orthopedic Surgery,In-Network,I10,N39.0,,,,,,,0,,43239,Surgery,,,0510,22,Outpatient Hospital,3,1575.87,922.45,539.79,382.66,0.0,0.0,382.66,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008226,MBR00000324,Institutional-IP,2022-03-06,2022-03-08,2022-03-22,PLN9843,1205377316,1205377316,Orthopedic Surgery,In-Network,G43.909,N18.3,,,,683,MS-DRG,19,2,Y,23472,Surgery,,,0320,21,Inpatient Hospital,2,5608.3,3096.66,3071.66,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008227,MBR00000324,Professional,2023-04-12,2023-04-12,2023-05-18,PLN5154,1700633438,1700633438,DME Supplier,In-Network,K21.0,F41.9,,,,,,,0,,99213,E&M,,,,12,Home,3,187.16,109.41,63.08,0.0,35.0,1.7,36.7,9.63,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008228,MBR00000324,Professional,2021-07-27,2021-07-27,2021-08-10,PLN3127,1114982472,1114982472,Orthopedic Surgery,In-Network,R05,E11.9,,,,,,,0,,83036,Pathology/Lab,,,,21,Inpatient Hospital,2,112.4,53.39,0.0,53.39,0.0,0.0,53.39,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000008229,MBR00000324,Institutional-IP,2021-01-10,2021-01-19,2021-01-17,PLN1968,1899127912,1899127912,Neurology,In-Network,E78.5,M54.5,,,,683,MS-DRG,6,9,Y,27130,Surgery,,,0510,21,Inpatient Hospital,1,3275.24,1267.53,1238.84,0.0,15.0,13.69,28.69,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008230,MBR00000324,Professional,2022-06-30,2022-06-30,2022-08-06,PLN3985,1609526529,1609526529,Psychiatry,In-Network,I50.9,F32.9,,,,,,,0,,99214,E&M,,,,11,Office,2,345.21,216.2,138.31,0.0,75.0,0.0,75.0,2.89,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008231,MBR00000324,Professional,2022-09-20,2022-09-20,2022-11-01,PLN2670,1268679390,1268679390,Critical Access Hospital,In-Network,F32.9,E78.5,,,,,,,0,,23472,Surgery,,,,20,Urgent Care,2,5315.87,3404.45,2184.99,482.06,75.0,0.0,557.06,662.4,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008232,MBR00000324,Institutional-OP,2021-05-02,2021-05-02,2021-06-04,PLN1423,1389336600,1389336600,Critical Access Hospital,In-Network,N39.0,I25.10,,,,,,,0,,99222,E&M,,,0730,22,Outpatient Hospital,1,437.1,151.38,104.94,0.0,0.0,10.87,10.87,35.57,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008233,MBR00000324,Professional,2021-01-12,2021-01-12,2021-02-12,PLN7811,1540044947,1540044947,Pulmonology,Out-of-Network,J06.9,Z00.00,,,,,,,0,,83036,Pathology/Lab,,,,23,Emergency Room,1,89.65,50.23,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,1,0,0
CLM0000008234,MBR00000324,Professional,2021-08-21,2021-08-21,2021-09-04,PLN2654,1727809972,1727809972,Home Health,In-Network,M54.5,Z87.891,,,,,,,0,,99213,E&M,,,,12,Home,1,200.86,74.8,46.99,0.0,25.0,0.0,25.0,2.81,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008235,MBR00000324,Professional,2021-04-30,2021-04-30,2021-06-09,PLN1241,1125190055,1125190055,Nephrology,In-Network,M81.0,N39.0,,,,,,,0,,23472,Surgery,,,,81,Independent Laboratory,3,4746.79,3409.89,2910.57,464.32,35.0,0.0,499.32,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008236,MBR00000324,Institutional-IP,2023-12-27,2024-01-03,2024-01-08,PLN6196,1997536841,1997536841,Family Medicine,Out-of-Network,J44.1,R07.9,,,,291,MS-DRG,22,7,Y,72148,Radiology,,,0200,21,Inpatient Hospital,1,2769.2,1811.69,1331.79,0.0,0.0,0.0,0.0,479.9,Paid,,,1,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000008237,MBR00000324,Institutional-IP,2023-12-19,2023-12-23,2024-01-26,PLN2293,1530904931,1530904931,Internal Medicine,In-Network,G43.909,F41.9,,,,195,MS-DRG,23,4,Y,99221,E&M,,,0510,21,Inpatient Hospital,1,337.18,265.09,0.0,239.14,50.0,0.0,289.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008238,MBR00000324,Professional,2021-01-18,2021-01-18,2021-02-03,PLN8647,1531398223,1531398223,OB/GYN,In-Network,R10.9,Z00.00,,,,,,,0,,47562,Surgery,,,,23,Emergency Room,3,5410.52,3830.58,2630.16,491.15,75.0,634.27,1200.42,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008239,MBR00000324,Professional,2022-05-16,2022-05-16,2022-06-04,PLN1715,1910255109,1910255109,DME Supplier,In-Network,G43.909,F10.20,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,1,16166.77,10749.86,10714.86,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000008240,MBR00000324,Professional,2022-02-26,2022-02-26,2022-03-15,PLN4767,1520687146,1520687146,ASC,In-Network,I50.9,R10.9,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,3,54.57,35.19,15.13,0.0,15.0,3.36,18.36,1.7,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008241,MBR00000324,Professional,2021-01-30,2021-01-30,2021-03-08,PLN4783,1749494482,1749494482,Pediatrics,In-Network,I48.91,N18.3,,,,,,,0,,93225,Medicine,,,,81,Independent Laboratory,2,954.23,553.07,103.5,449.57,0.0,0.0,449.57,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008242,MBR00000324,Professional,2022-12-31,2022-12-31,2023-01-21,PLN7493,1124394415,1124394415,Pediatrics,In-Network,E78.5,M54.5,,,,,,,0,,99222,E&M,,,,21,Inpatient Hospital,1,336.64,258.1,74.06,133.35,50.0,0.69,184.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008243,MBR00000324,Professional,2023-07-21,2023-07-21,2023-08-23,PLN1905,1717912431,1717912431,Oncology,In-Network,F41.9,N39.0,,,,,,,0,,99233,E&M,,,,12,Home,3,273.2,147.95,0.0,99.57,15.0,0.0,114.57,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008244,MBR00000324,Institutional-IP,2022-11-01,2022-11-06,2022-11-16,PLN5471,1235381502,1235381502,Cardiology,In-Network,E11.40,F03.90,,,,683,MS-DRG,10,5,Y,76700,Radiology,,,0761,21,Inpatient Hospital,2,654.88,398.18,267.92,0.0,50.0,0.0,50.0,80.26,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008245,MBR00000324,Professional,2023-10-02,2023-10-02,2023-11-02,PLN2310,1148984206,1148984206,Psychiatry,In-Network,J20.9,Z12.31,,,,,,,0,,97110,Medicine,,,,21,Inpatient Hospital,2,215.35,158.93,158.93,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008246,MBR00000324,Institutional-OP,2022-11-30,2022-11-30,2022-12-13,PLN1151,1609138981,1609138981,Critical Access Hospital,In-Network,M54.5,Z12.31,,,,,,,0,,G0468,Medicine,,,0320,22,Outpatient Hospital,2,370.77,280.7,230.52,0.0,0.0,50.18,50.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008247,MBR00000324,Institutional-OP,2022-08-24,2022-08-24,2022-10-02,PLN8011,1717912431,1717912431,Oncology,In-Network,Z12.31,E66.9,,,,,,,0,,97110,Medicine,,,0120,22,Outpatient Hospital,2,172.0,96.96,0.0,0.0,35.0,0.0,35.0,13.67,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008248,MBR00000325,Professional,2023-11-04,2023-11-04,2023-12-01,PLN9910,1364429278,1364429278,OB/GYN,In-Network,E11.9,I10,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,1,142.0,109.42,59.42,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008249,MBR00000325,Institutional-IP,2023-02-13,2023-02-17,2023-02-22,PLN3981,1475984649,1475984649,SNF,In-Network,I48.91,Z87.891,,,,196,MS-DRG,21,4,Y,99233,E&M,,,0360,21,Inpatient Hospital,2,237.12,143.79,143.79,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008250,MBR00000325,Institutional-IP,2023-04-18,2023-04-21,2023-05-31,PLN1025,1563980627,1563980627,Critical Access Hospital,In-Network,R51,R07.9,,,,641,MS-DRG,20,3,Y,83036,Pathology/Lab,,,0270,21,Inpatient Hospital,2,68.82,35.98,0.0,35.98,0.0,0.0,35.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000008251,MBR00000325,Professional,2023-05-05,2023-05-05,2023-05-16,PLN4474,1475984649,1475984649,SNF,In-Network,Z79.4,E11.9,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,3,389.57,323.07,0.0,0.0,75.0,8.3,83.3,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008252,MBR00000325,Professional,2021-02-04,2021-02-04,2021-03-14,PLN7824,1806688928,1806688928,Geriatrics,In-Network,M81.0,R10.9,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,3,3236.83,2215.32,1987.76,0.0,75.0,152.56,227.56,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008253,MBR00000325,Institutional-OP,2023-03-16,2023-03-16,2023-04-19,PLN8880,1795618275,1795618275,Pulmonology,In-Network,I63.9,F10.20,,,,,,,0,,76700,Radiology,,,0270,22,Outpatient Hospital,1,525.01,255.03,255.03,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008254,MBR00000325,Professional,2023-03-31,2023-03-31,2023-04-28,PLN4908,1247341320,1247341320,Urology,Out-of-Network,E78.5,M17.11,,,,,,,0,,93306,Radiology,,,,23,Emergency Room,3,2400.76,1172.33,1172.33,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008255,MBR00000325,Institutional-IP,2022-06-26,2022-06-29,2022-07-21,PLN5593,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,I10,N39.0,,,,470,MS-DRG,1,3,Y,99204,E&M,,,0320,21,Inpatient Hospital,1,307.87,249.35,178.11,0.0,35.0,36.24,71.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008256,MBR00000325,Institutional-IP,2022-09-10,2022-09-22,2022-10-23,PLN9715,1622771872,1622771872,Pediatrics,In-Network,N18.3,E11.9,,,,292,MS-DRG,9,12,Y,81001,Pathology/Lab,,,0301,21,Inpatient Hospital,2,33.48,16.15,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008257,MBR00000325,Professional,2023-07-01,2023-07-01,2023-08-07,PLN1185,1910255109,1910255109,DME Supplier,In-Network,R05,I25.10,,,,,,,0,,99233,E&M,,,,23,Emergency Room,3,468.34,285.91,148.3,112.58,0.0,25.03,137.61,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008258,MBR00000325,Professional,2021-06-05,2021-06-05,2021-06-12,PLN8172,1935547131,1935547131,Pulmonology,In-Network,E78.5,Z00.00,,,,,,,0,,90837,Medicine,,,,11,Office,1,455.83,205.51,205.51,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008259,MBR00000325,Institutional-OP,2022-08-01,2022-08-01,2022-08-25,PLN5235,1213165847,1213165847,Critical Access Hospital,In-Network,E66.9,E78.5,,,,,,,0,,33533,Surgery,,,0320,22,Outpatient Hospital,3,28495.84,19335.44,0.0,0.0,15.0,2684.69,2699.69,0.0,Denied,CO-18,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000008260,MBR00000325,Professional,2023-04-24,2023-04-24,2023-06-06,PLN6796,1450553056,1450553056,Clinical Laboratory,In-Network,I63.9,K21.0,,,,,,,0,,33533,Surgery,,,,23,Emergency Room,3,16476.8,9778.57,9703.57,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,1,0,0,1,0,0,None,0,0,0,0,0
CLM0000008261,MBR00000325,Professional,2021-10-12,2021-10-12,2021-11-14,PLN5020,1550154147,1550154147,Outpatient Clinic,In-Network,Z12.31,K57.30,,,,,,,0,,99283,E&M,,,,31,Skilled Nursing Facility,3,223.44,118.82,118.82,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008262,MBR00000325,Professional,2021-10-16,2021-10-16,2021-11-09,PLN2091,1168246159,1168246159,Internal Medicine,In-Network,E78.5,I10,,,,,,,0,,90837,Medicine,,,,23,Emergency Room,1,242.67,173.17,123.1,0.0,25.0,25.07,50.07,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008263,MBR00000325,Institutional-OP,2021-01-05,2021-01-05,2021-01-30,PLN6008,1717912431,1717912431,Oncology,In-Network,E78.5,Z00.00,,,,,,,0,,85025,Pathology/Lab,,,0730,22,Outpatient Hospital,3,63.23,26.3,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008264,MBR00000325,Institutional-IP,2021-12-08,2021-12-15,2021-12-31,PLN1499,1609526529,1609526529,Psychiatry,In-Network,E78.5,Z00.00,,,,872,MS-DRG,9,7,W,76700,Radiology,,,0270,21,Inpatient Hospital,3,724.46,557.74,493.57,64.17,0.0,0.0,64.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008265,MBR00000325,Professional,2022-01-28,2022-01-28,2022-02-14,PLN1024,1948810580,1948810580,DME Supplier,In-Network,E11.9,E66.9,,,,,,,0,,81001,Pathology/Lab,,,,49,Independent Clinic,2,46.24,15.62,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008266,MBR00000325,Institutional-OP,2023-11-09,2023-11-09,2023-11-17,PLN6938,1235381502,1235381502,Cardiology,In-Network,F41.9,M54.5,,,,,,,0,,G0439,Medicine,,,0360,22,Outpatient Hospital,2,530.5,200.31,0.0,200.31,25.0,0.0,225.31,0.0,Pended,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000008267,MBR00000325,Institutional-OP,2021-04-01,2021-04-01,2021-05-13,PLN2098,1990090423,1990090423,Orthopedic Surgery,In-Network,E11.65,I10,,,,,,,0,,66984,Surgery,,,0301,22,Outpatient Hospital,2,3615.66,2186.15,0.0,140.29,0.0,0.0,140.29,0.0,Denied,CO-29,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008268,MBR00000325,Professional,2022-12-09,2022-12-09,2023-01-05,PLN4944,1313212303,1313212303,Family Medicine,In-Network,M17.11,M81.0,,,,,,,0,,99406,Medicine,,,,49,Independent Clinic,1,71.28,39.97,0.0,39.97,50.0,0.0,89.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008269,MBR00000325,Institutional-OP,2021-03-11,2021-03-11,2021-03-30,PLN5742,1118885473,1118885473,ASC,In-Network,R10.9,Z12.31,,,,,,,0,,99203,E&M,,,0450,22,Outpatient Hospital,1,255.79,138.74,0.0,138.74,0.0,0.0,138.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008270,MBR00000325,Professional,2023-05-26,2023-05-26,2023-06-04,PLN6002,1125190055,1125190055,Nephrology,In-Network,I50.9,J20.9,,,,,,,0,,80053,Pathology/Lab,,,,23,Emergency Room,1,67.16,56.44,0.0,56.44,0.0,0.0,56.44,0.0,Denied,CO-18,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008271,MBR00000325,Professional,2022-05-29,2022-05-29,2022-06-05,PLN8328,1561134315,1561134315,DME Supplier,In-Network,N40.0,K21.0,,,,,,,0,,71046,Radiology,,,,11,Office,1,307.74,137.29,0.0,0.0,50.0,4.1,54.1,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008272,MBR00000325,Professional,2022-04-12,2022-04-12,2022-05-02,PLN2780,1609526529,1609526529,Psychiatry,In-Network,Z23,R05,,,,,,,0,,G0439,Medicine,,,,11,Office,1,299.08,194.35,0.0,194.35,0.0,0.0,194.35,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000008273,MBR00000325,Professional,2023-10-31,2023-10-31,2023-12-10,PLN5050,1840431511,1840431511,Geriatrics,Out-of-Network,Z00.00,E78.5,,,,,,,0,,90686,Medicine,,,,12,Home,1,51.11,31.66,29.07,0.0,0.0,2.59,2.59,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000008274,MBR00000325,Institutional-OP,2023-04-01,2023-04-01,2023-04-18,PLN5078,1500037969,1500037969,Pulmonology,In-Network,F32.9,M17.11,,,,,,,0,,90460,Medicine,,,0370,22,Outpatient Hospital,3,37.44,16.09,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008275,MBR00000325,Professional,2021-04-26,2021-04-26,2021-05-13,PLN8338,1389336600,1389336600,Critical Access Hospital,In-Network,I48.91,Z00.00,,,,,,,0,,70450,Radiology,,,,21,Inpatient Hospital,2,1540.16,940.54,905.54,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008276,MBR00000325,Institutional-IP,2021-10-19,2021-10-20,2021-11-13,PLN9390,1242201429,1242201429,General Acute Care Hospital,In-Network,E78.5,F32.9,,,,194,MS-DRG,22,1,Y,70553,Radiology,,,0761,21,Inpatient Hospital,1,3909.37,3304.83,3254.83,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008277,MBR00000325,Professional,2021-10-27,2021-10-27,2021-11-08,PLN5338,1124394415,1124394415,Pediatrics,In-Network,E66.9,E78.5,,,,,,,0,,43239,Surgery,,,,11,Office,1,872.7,343.71,332.48,0.0,0.0,11.23,11.23,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008278,MBR00000325,Professional,2022-10-30,2022-10-30,2022-11-15,PLN9408,1213165847,1213165847,Critical Access Hospital,In-Network,N18.3,Z23,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,2,11332.68,4517.23,4471.3,45.93,0.0,0.0,45.93,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000008279,MBR00000325,Institutional-OP,2023-06-28,2023-06-28,2023-08-08,PLN2946,1645194539,1645194539,SNF,In-Network,J06.9,R07.9,,,,,,,0,,82043,Pathology/Lab,,,0370,22,Outpatient Hospital,2,69.36,31.41,0.0,31.41,50.0,0.0,81.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008280,MBR00000325,Institutional-OP,2022-11-30,2022-11-30,2022-12-26,PLN8460,1812060197,1812060197,Oncology,Out-of-Network,J06.9,K21.0,,,,,,,0,,99283,E&M,,,0120,22,Outpatient Hospital,2,520.05,310.51,265.61,22.59,0.0,22.31,44.9,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008281,MBR00000325,Professional,2022-03-17,2022-03-17,2022-03-25,PLN1304,1563980627,1563980627,Critical Access Hospital,In-Network,M17.11,J20.9,,,,,,,0,,99284,E&M,,,,81,Independent Laboratory,3,624.84,349.7,103.48,171.22,75.0,0.0,246.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008282,MBR00000325,Professional,2023-03-29,2023-03-29,2023-05-08,PLN8051,1700633438,1700633438,DME Supplier,In-Network,J20.9,I10,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,3,2024.49,1457.26,1457.26,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008283,MBR00000325,Professional,2023-04-11,2023-04-11,2023-05-20,PLN8918,1124394415,1124394415,Pediatrics,In-Network,Z12.31,M17.11,,,,,,,0,,86900,Pathology/Lab,,,,81,Independent Laboratory,2,31.39,25.29,0.0,25.29,0.0,0.0,25.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008284,MBR00000325,Institutional-OP,2021-03-30,2021-03-30,2021-05-05,PLN4858,1224179551,1224179551,Physical Therapy,In-Network,N39.0,E78.5,,,,,,,0,,99233,E&M,,,0636,22,Outpatient Hospital,1,205.27,141.23,141.23,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008285,MBR00000325,Professional,2022-08-17,2022-08-17,2022-09-08,PLN3467,1799205295,1799205295,General Acute Care Hospital,In-Network,Z00.00,G43.909,,,,,,,0,,99232,E&M,,,,12,Home,3,366.75,222.72,0.0,160.04,75.0,0.0,235.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008286,MBR00000325,Professional,2023-02-18,2023-02-18,2023-03-06,PLN5729,1910255109,1910255109,DME Supplier,In-Network,N39.0,I50.9,,,,,,,0,,90837,Medicine,,,,11,Office,3,429.84,156.87,127.28,0.0,0.0,29.59,29.59,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008287,MBR00000325,Institutional-IP,2022-10-24,2022-10-29,2022-12-06,PLN2603,1800011727,1800011727,Clinical Laboratory,Out-of-Network,R51,E66.9,,,,291,MS-DRG,5,5,Y,47562,Surgery,,,0301,21,Inpatient Hospital,3,2855.9,1186.99,1108.8,0.0,75.0,3.19,78.19,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008288,MBR00000325,Institutional-OP,2021-09-26,2021-09-26,2021-10-05,PLN5613,1749327647,1749327647,Geriatrics,In-Network,Z12.31,E78.5,,,,,,,0,,45378,Surgery,,,0761,22,Outpatient Hospital,1,1961.98,1401.81,1401.81,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,1,1,0,0,1,Duplicate,0,1,0,0,0
CLM0000008289,MBR00000325,Professional,2021-06-26,2021-06-26,2021-08-08,PLN3468,1806688928,1806688928,Geriatrics,In-Network,F41.9,E87.6,,,,,,,0,,99222,E&M,,,,11,Office,1,274.35,173.66,0.0,173.66,50.0,0.0,223.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008290,MBR00000325,Institutional-OP,2021-11-15,2021-11-15,2021-11-23,PLN2194,1389336600,1389336600,Critical Access Hospital,In-Network,I48.91,M54.5,,,,,,,0,,70553,Radiology,,,0761,22,Outpatient Hospital,2,2363.0,727.83,699.59,0.0,0.0,28.24,28.24,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008291,MBR00000325,Professional,2022-01-21,2022-01-21,2022-02-19,PLN2706,1545347862,1545347862,SNF,In-Network,E78.5,K21.0,,,,,,,0,,93000,Radiology,,,,22,Outpatient Hospital,3,180.49,116.43,87.33,13.84,0.0,15.26,29.1,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008292,MBR00000325,Institutional-IP,2023-10-07,2023-10-20,2023-11-03,PLN1029,1624202402,1624202402,Orthopedic Surgery,In-Network,M54.5,J06.9,,,,292,MS-DRG,15,13,N,99222,E&M,,,0360,21,Inpatient Hospital,2,539.06,288.85,0.0,288.85,15.0,0.0,303.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008293,MBR00000325,Professional,2022-11-12,2022-11-12,2022-12-02,PLN5128,1778483301,1778483301,Home Health,In-Network,J20.9,K57.30,,,,,,,0,,76700,Radiology,,,,22,Outpatient Hospital,3,698.11,529.34,446.48,0.0,25.0,57.86,82.86,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008294,MBR00000325,Institutional-OP,2023-07-05,2023-07-05,2023-07-16,PLN3158,1475984649,1475984649,SNF,In-Network,Z51.11,E78.5,,,,,,,0,,G0439,Medicine,,,0200,22,Outpatient Hospital,2,381.18,197.3,185.98,0.0,0.0,11.32,11.32,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000008295,MBR00000325,Institutional-OP,2021-01-30,2021-01-30,2021-02-24,PLN4299,1689639685,1689639685,SNF,In-Network,F03.90,E11.9,,,,,,,0,,45378,Surgery,,,0450,22,Outpatient Hospital,1,2300.41,1327.74,1158.08,0.0,0.0,169.66,169.66,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000008296,MBR00000325,Institutional-OP,2023-05-09,2023-05-09,2023-06-17,PLN5888,1268679390,1268679390,Critical Access Hospital,In-Network,E11.9,E11.40,,,,,,,0,,99221,E&M,,,0761,22,Outpatient Hospital,3,317.84,203.98,203.98,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008297,MBR00000325,Professional,2021-07-26,2021-07-26,2021-09-01,PLN6212,1366286000,1366286000,SNF,In-Network,I11.9,Z23,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,2,33.79,21.72,0.0,21.72,0.0,0.0,21.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008298,MBR00000326,Institutional-OP,2022-09-12,2022-09-12,2022-09-25,PLN6593,1990090423,1990090423,Orthopedic Surgery,In-Network,I10,R05,,,,,,,0,,99233,E&M,,,0320,22,Outpatient Hospital,3,333.54,274.45,274.45,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008299,MBR00000326,Professional,2022-02-28,2022-02-28,2022-03-20,PLN3520,1812060197,1812060197,Oncology,Out-of-Network,E11.9,E66.9,,,,,,,0,,99221,E&M,,,,11,Office,3,433.79,241.9,241.9,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008300,MBR00000326,Professional,2023-08-04,2023-08-04,2023-09-09,PLN5974,1939033455,1939033455,Pulmonology,In-Network,G43.909,N39.0,,,,,,,0,,80061,Pathology/Lab,,,,23,Emergency Room,1,63.08,47.52,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008301,MBR00000326,Professional,2023-01-09,2023-01-09,2023-01-30,PLN9021,1606140917,1606140917,ASC,In-Network,F03.90,Z23,,,,,,,0,,G0439,Medicine,,,,22,Outpatient Hospital,2,398.2,295.96,239.66,56.3,0.0,0.0,56.3,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000008302,MBR00000326,Institutional-OP,2022-05-20,2022-05-20,2022-05-28,PLN6124,1964402759,1964402759,Outpatient Clinic,In-Network,I10,Z12.31,,,,,,,0,,47562,Surgery,,,0450,22,Outpatient Hospital,1,3493.88,2578.6,2524.7,53.9,0.0,0.0,53.9,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008303,MBR00000326,Professional,2022-07-12,2022-07-12,2022-08-20,PLN7498,1872272835,1872272835,Internal Medicine,In-Network,J06.9,E11.9,,,,,,,0,,93306,Radiology,,,,50,Federally Qualified Health Center,1,2917.5,947.84,655.25,257.59,35.0,0.0,292.59,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008304,MBR00000326,Institutional-IP,2023-02-14,2023-02-23,2023-03-08,PLN7295,1132188260,1132188260,Family Medicine,In-Network,Z12.31,K57.30,,,,291,MS-DRG,7,9,Y,70553,Radiology,,,0761,21,Inpatient Hospital,1,4044.7,2231.33,2196.33,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008305,MBR00000326,Institutional-IP,2023-02-27,2023-03-02,2023-03-15,PLN3340,1366426662,1366426662,Urology,In-Network,F41.9,Z23,,,,194,MS-DRG,17,3,U,81001,Pathology/Lab,,,0370,21,Inpatient Hospital,1,44.04,31.17,0.0,31.17,0.0,0.0,31.17,0.0,Denied,PR-1,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000008306,MBR00000326,Institutional-OP,2022-09-20,2022-09-20,2022-10-31,PLN1789,1687650653,1687650653,Internal Medicine,In-Network,F32.9,E11.9,,,,,,,0,,99283,E&M,,,0370,22,Outpatient Hospital,1,240.17,131.18,0.0,131.18,15.0,0.0,146.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008307,MBR00000326,Institutional-IP,2023-03-07,2023-03-09,2023-04-05,PLN8364,1540044947,1540044947,Pulmonology,Out-of-Network,I25.10,Z12.31,,,,641,MS-DRG,23,2,Y,99204,E&M,,,0730,21,Inpatient Hospital,3,469.48,286.24,261.24,0.0,25.0,0.0,25.0,0.0,Pended,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000008308,MBR00000326,Institutional-IP,2023-05-15,2023-05-21,2023-06-18,PLN9355,1717546253,1717546253,Family Medicine,In-Network,I10,F32.9,,,,871,MS-DRG,19,6,Y,82043,Pathology/Lab,,,0636,21,Inpatient Hospital,1,54.02,44.21,0.0,44.21,0.0,0.0,44.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008309,MBR00000326,Professional,2021-02-04,2021-02-04,2021-02-27,PLN5513,1530904931,1530904931,Internal Medicine,In-Network,Z23,N39.0,,,,,,,0,,97110,Medicine,,,,22,Outpatient Hospital,1,203.41,135.1,31.25,96.68,0.0,7.17,103.85,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008310,MBR00000326,Institutional-IP,2022-02-06,2022-02-11,2022-03-07,PLN8449,1974006077,1974006077,Orthopedic Surgery,In-Network,N40.0,G43.909,,,,292,MS-DRG,13,5,U,G0468,Medicine,,,0510,21,Inpatient Hospital,1,430.51,337.51,212.57,41.51,75.0,8.43,124.94,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000008311,MBR00000326,Professional,2023-09-15,2023-09-15,2023-10-27,PLN5306,1109850785,1109850785,ASC,Out-of-Network,I10,F03.90,,,,,,,0,,80053,Pathology/Lab,,,,22,Outpatient Hospital,1,73.08,43.75,43.75,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008312,MBR00000326,Institutional-OP,2021-12-18,2021-12-18,2021-12-28,PLN1190,1745114564,1745114564,Endocrinology,In-Network,Z00.00,I10,,,,,,,0,,97530,Medicine,,,0636,22,Outpatient Hospital,3,111.29,39.18,0.0,39.18,0.0,0.0,39.18,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008313,MBR00000326,Institutional-OP,2023-06-22,2023-06-22,2023-07-25,PLN7852,1213165847,1213165847,Critical Access Hospital,In-Network,M54.5,M54.5,,,,,,,0,,99232,E&M,,,0320,22,Outpatient Hospital,3,276.68,186.62,175.39,0.0,0.0,11.23,11.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008314,MBR00000326,Professional,2022-08-25,2022-08-25,2022-09-19,PLN1476,1939033455,1939033455,Pulmonology,In-Network,J20.9,N18.3,,,,,,,0,,99233,E&M,,,,11,Office,1,209.58,121.85,0.0,121.85,25.0,0.0,146.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008315,MBR00000326,Professional,2021-10-24,2021-10-24,2021-11-24,PLN7941,1313212303,1313212303,Family Medicine,In-Network,K57.30,I10,,,,,,,0,,99233,E&M,,,,11,Office,1,458.06,307.38,257.38,0.0,50.0,0.0,50.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008316,MBR00000326,Professional,2022-01-19,2022-01-19,2022-01-27,PLN5073,1806688928,1806688928,Geriatrics,In-Network,Z00.00,E11.9,,,,,,,0,,78452,Radiology,,,,81,Independent Laboratory,1,3064.47,2094.36,2094.36,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000008317,MBR00000326,Institutional-OP,2022-06-15,2022-06-15,2022-07-25,PLN8277,1865904917,1865904917,Outpatient Clinic,In-Network,J06.9,Z79.4,,,,,,,0,,45378,Surgery,,,0730,22,Outpatient Hospital,3,2410.28,1633.67,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000008318,MBR00000326,Institutional-OP,2021-05-17,2021-05-17,2021-06-19,PLN3509,1990090423,1990090423,Orthopedic Surgery,In-Network,Z51.11,Z00.00,,,,,,,0,,90460,Medicine,,,0761,22,Outpatient Hospital,1,40.79,29.92,0.0,29.92,0.0,0.0,29.92,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008319,MBR00000326,Professional,2021-12-04,2021-12-04,2022-01-16,PLN7423,1800011727,1800011727,Clinical Laboratory,Out-of-Network,Z87.891,K57.30,,,,,,,0,,99214,E&M,,,,11,Office,3,188.6,151.23,0.0,151.23,0.0,0.0,151.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008320,MBR00000326,Institutional-OP,2023-01-16,2023-01-16,2023-01-30,PLN1604,1239316214,1239316214,Internal Medicine,In-Network,J44.1,Z79.4,,,,,,,0,,99232,E&M,,,0370,22,Outpatient Hospital,3,302.49,203.15,188.15,0.0,15.0,0.0,15.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008321,MBR00000326,Professional,2023-09-20,2023-09-20,2023-11-02,PLN4948,1691062876,1691062876,SNF,In-Network,Z00.00,J06.9,,,,,,,0,,99222,E&M,,,,21,Inpatient Hospital,3,536.48,304.22,0.0,304.22,50.0,0.0,354.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008322,MBR00000326,Institutional-OP,2023-11-07,2023-11-07,2023-12-06,PLN5155,1366286000,1366286000,SNF,In-Network,F41.9,J06.9,,,,,,,0,,99284,E&M,,,0301,22,Outpatient Hospital,1,380.11,241.13,241.13,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008323,MBR00000326,Institutional-OP,2022-02-24,2022-02-24,2022-03-08,PLN5598,1606140917,1606140917,ASC,In-Network,E11.40,E11.9,,,,,,,0,,45378,Surgery,,,0360,22,Outpatient Hospital,1,1312.48,853.81,778.81,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000008324,MBR00000326,Professional,2023-05-20,2023-05-20,2023-06-10,PLN7613,1219817751,1219817751,OB/GYN,In-Network,M17.11,Z00.00,,,,,,,0,,43239,Surgery,,,,11,Office,1,1199.2,527.12,489.27,0.0,35.0,2.85,37.85,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008325,MBR00000326,Institutional-OP,2022-03-10,2022-03-10,2022-04-08,PLN2125,1845900543,1845900543,ASC,In-Network,E66.9,Z87.891,,,,,,,0,,99213,E&M,,,0200,22,Outpatient Hospital,2,251.2,151.68,0.0,151.68,0.0,0.0,151.68,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008326,MBR00000327,Professional,2023-06-03,2023-06-03,2023-06-10,PLN8795,1390307371,1390307371,DME Supplier,In-Network,F32.9,M81.0,,,,,,,0,,78452,Radiology,,,,11,Office,1,3984.59,3021.17,2946.17,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008327,MBR00000327,Professional,2023-09-26,2023-09-26,2023-10-03,PLN6654,1520687146,1520687146,ASC,In-Network,M54.5,I10,,,,,,,0,,99214,E&M,,,,81,Independent Laboratory,3,215.63,84.65,59.65,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008328,MBR00000327,Institutional-OP,2022-05-04,2022-05-04,2022-06-17,PLN2609,1609526529,1609526529,Psychiatry,In-Network,J06.9,E78.5,,,,,,,0,,99232,E&M,,,0730,22,Outpatient Hospital,2,394.01,150.83,75.83,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008329,MBR00000327,Professional,2022-10-20,2022-10-20,2022-10-28,PLN3690,1860435061,1860435061,DME Supplier,In-Network,M81.0,E78.5,,,,,,,0,,27447,Surgery,,,,49,Independent Clinic,3,3547.03,2542.35,2225.77,266.58,50.0,0.0,316.58,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008330,MBR00000327,Professional,2023-08-08,2023-08-08,2023-09-11,PLN9796,1865904917,1865904917,Outpatient Clinic,In-Network,F41.9,Z12.31,,,,,,,0,,G0444,Medicine,,,,31,Skilled Nursing Facility,1,39.15,32.67,32.67,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000008331,MBR00000327,Professional,2021-05-31,2021-05-31,2021-07-14,PLN1279,1450553056,1450553056,Clinical Laboratory,In-Network,J06.9,Z23,,,,,,,0,,90837,Medicine,,,,11,Office,1,391.96,242.2,207.2,0.0,35.0,0.0,35.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008332,MBR00000327,Institutional-IP,2021-09-28,2021-10-03,2021-10-14,PLN8640,1702692193,1702692193,Physical Therapy,In-Network,K21.0,Z23,,,,603,MS-DRG,2,5,Y,99204,E&M,,,0740,21,Inpatient Hospital,2,302.9,141.81,108.24,0.0,15.0,18.57,33.57,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008333,MBR00000327,Institutional-OP,2022-11-17,2022-11-17,2022-12-25,PLN2730,1563980627,1563980627,Critical Access Hospital,In-Network,J45.20,Z51.11,,,,,,,0,,99283,E&M,,,0301,22,Outpatient Hospital,3,340.48,240.84,187.46,53.38,0.0,0.0,53.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008334,MBR00000327,Institutional-OP,2021-07-16,2021-07-16,2021-08-27,PLN2892,1364429278,1364429278,OB/GYN,In-Network,E78.5,I10,,,,,,,0,,72148,Radiology,,,0360,22,Outpatient Hospital,2,2045.24,1541.72,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008335,MBR00000327,Institutional-OP,2023-05-20,2023-05-20,2023-06-30,PLN1978,1609526529,1609526529,Psychiatry,In-Network,I10,E11.9,,,,,,,0,,93225,Medicine,,,0360,22,Outpatient Hospital,3,378.61,140.97,0.0,140.97,0.0,0.0,140.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008336,MBR00000327,Institutional-OP,2021-10-19,2021-10-19,2021-11-06,PLN9453,1219817751,1219817751,OB/GYN,In-Network,K21.0,E78.5,,,,,,,0,,33533,Surgery,,,0301,22,Outpatient Hospital,3,18631.33,10044.87,8788.2,0.0,0.0,1256.67,1256.67,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000008337,MBR00000327,Institutional-IP,2022-01-05,2022-01-10,2022-01-13,PLN7894,1135158374,1135158374,Pulmonology,In-Network,E78.5,I10,,,,292,MS-DRG,20,5,Y,77067,Radiology,,,0360,21,Inpatient Hospital,1,722.06,522.1,285.68,236.42,0.0,0.0,236.42,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000008338,MBR00000327,Institutional-OP,2023-06-07,2023-06-07,2023-07-12,PLN6391,1939033455,1939033455,Pulmonology,In-Network,I25.10,E11.9,,,,,,,0,,70553,Radiology,,,0761,22,Outpatient Hospital,1,3674.11,2307.77,1546.92,372.6,50.0,338.25,760.85,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008339,MBR00000327,Professional,2022-08-01,2022-08-01,2022-09-07,PLN6726,1780163051,1780163051,SNF,In-Network,J45.20,Z00.01,,,,,,,0,,72148,Radiology,,,,22,Outpatient Hospital,1,2648.91,2057.02,1888.76,168.26,0.0,0.0,168.26,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008340,MBR00000327,Institutional-OP,2023-05-16,2023-05-16,2023-06-21,PLN9816,1631954542,1631954542,Oncology,In-Network,E78.5,F03.90,,,,,,,0,,90837,Medicine,,,0510,22,Outpatient Hospital,2,194.58,81.47,81.47,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008341,MBR00000327,Professional,2022-11-18,2022-11-18,2022-12-28,PLN9205,1622771872,1622771872,Pediatrics,In-Network,Z23,I10,,,,,,,0,,72148,Radiology,,,,21,Inpatient Hospital,1,1907.82,1564.84,1514.84,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008342,MBR00000327,Professional,2022-07-18,2022-07-18,2022-08-10,PLN2958,1994661817,1994661817,SNF,Out-of-Network,E11.40,E11.9,,,,,,,0,,99233,E&M,,,,20,Urgent Care,3,478.38,297.74,122.3,118.98,50.0,6.46,175.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008343,MBR00000327,Professional,2022-07-13,2022-07-13,2022-07-31,PLN1405,1520687146,1520687146,ASC,In-Network,K21.0,I63.9,,,,,,,0,,G0444,Medicine,,,,81,Independent Laboratory,2,63.84,28.61,28.61,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000008344,MBR00000327,Professional,2023-05-30,2023-05-30,2023-07-04,PLN8990,1109850785,1109850785,ASC,Out-of-Network,Z23,J06.9,,,,,,,0,,43239,Surgery,,,,21,Inpatient Hospital,2,1114.18,774.35,774.35,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008345,MBR00000327,Institutional-OP,2023-12-31,2023-12-31,2024-01-07,PLN6260,1213165847,1213165847,Critical Access Hospital,In-Network,Z23,E78.5,,,,,,,0,,99232,E&M,,,0120,22,Outpatient Hospital,3,140.16,99.94,99.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008346,MBR00000327,Professional,2021-01-27,2021-01-27,2021-02-05,PLN9425,1530904931,1530904931,Internal Medicine,In-Network,N18.3,I10,,,,,,,0,,70450,Radiology,,,,11,Office,1,657.61,331.51,297.47,0.0,0.0,34.04,34.04,0.0,Pended,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008347,MBR00000327,Institutional-OP,2022-07-09,2022-07-09,2022-07-25,PLN5313,1845900543,1845900543,ASC,In-Network,M54.5,N39.0,,,,,,,0,,97530,Medicine,,,0636,22,Outpatient Hospital,1,144.5,83.05,70.43,0.0,0.0,12.62,12.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008348,MBR00000327,Professional,2023-05-08,2023-05-08,2023-05-27,PLN5104,1563980627,1563980627,Critical Access Hospital,In-Network,I48.91,I10,,,,,,,0,,78452,Radiology,,,,11,Office,3,6900.4,4381.22,4130.86,250.36,0.0,0.0,250.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008349,MBR00000327,Institutional-IP,2022-12-06,2022-12-11,2023-01-12,PLN9392,1845900543,1845900543,ASC,In-Network,I10,F32.9,,,,682,MS-DRG,24,5,N,99213,E&M,,,0900,21,Inpatient Hospital,2,239.64,197.0,122.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008350,MBR00000327,Professional,2022-06-14,2022-06-14,2022-07-20,PLN5951,1139906830,1139906830,Endocrinology,Out-of-Network,I10,R07.9,,,,,,,0,,33533,Surgery,,,,11,Office,1,16077.34,10109.72,10049.82,59.9,0.0,0.0,59.9,0.0,Pended,,,0,,0,0,1,1,0,1,Duplicate,0,0,0,0,0
CLM0000008351,MBR00000327,Institutional-OP,2023-05-19,2023-05-19,2023-05-31,PLN1874,1268679390,1268679390,Critical Access Hospital,In-Network,E11.9,F41.9,,,,,,,0,,87491,Pathology/Lab,,,0200,22,Outpatient Hospital,1,209.35,88.34,0.0,88.34,0.0,0.0,88.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008352,MBR00000327,Professional,2022-05-28,2022-05-28,2022-06-07,PLN1025,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,I63.9,E66.9,,,,,,,0,,23472,Surgery,,,,50,Federally Qualified Health Center,2,5211.45,4405.68,4405.68,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008353,MBR00000327,Institutional-IP,2021-05-30,2021-06-02,2021-06-18,PLN6863,1395983630,1395983630,Nephrology,In-Network,Z12.31,J20.9,,,,682,MS-DRG,22,3,Y,99213,E&M,,,0301,21,Inpatient Hospital,1,267.77,208.77,187.27,0.0,0.0,21.5,21.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008354,MBR00000327,Institutional-OP,2021-10-26,2021-10-26,2021-12-07,PLN1286,1227362142,1227362142,DME Supplier,In-Network,I25.10,M54.5,,,,,,,0,,97110,Medicine,,,0450,22,Outpatient Hospital,1,154.45,73.1,73.1,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008355,MBR00000327,Institutional-OP,2021-02-18,2021-02-18,2021-03-25,PLN4394,1606140917,1606140917,ASC,In-Network,F03.90,R10.9,,,,,,,0,,99283,E&M,,,0900,22,Outpatient Hospital,3,493.65,186.36,0.0,186.36,0.0,0.0,186.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008356,MBR00000327,Institutional-OP,2023-02-08,2023-02-08,2023-02-20,PLN6787,1422747896,1422747896,Urology,In-Network,I10,J45.20,,,,,,,0,,99233,E&M,,,0510,22,Outpatient Hospital,3,550.06,420.91,370.91,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008357,MBR00000327,Professional,2023-12-02,2023-12-02,2024-01-10,PLN7963,1500949740,1500949740,Pediatrics,In-Network,R07.9,J06.9,,,,,,,0,,77067,Radiology,,,,50,Federally Qualified Health Center,2,724.29,272.55,0.0,272.55,35.0,0.0,307.55,0.0,Adjusted,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000008358,MBR00000327,Professional,2022-02-20,2022-02-20,2022-04-03,PLN3653,1395983630,1395983630,Nephrology,In-Network,Z87.891,N20.0,,,,,,,0,,27130,Surgery,,,,11,Office,1,3626.93,1806.44,1647.0,159.44,0.0,0.0,159.44,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008359,MBR00000327,Professional,2023-03-13,2023-03-13,2023-03-25,PLN6014,1840431511,1840431511,Geriatrics,Out-of-Network,E11.9,E11.40,,,,,,,0,,97110,Medicine,,,,49,Independent Clinic,2,260.37,215.57,213.42,0.0,0.0,2.15,2.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008360,MBR00000327,Professional,2023-12-12,2023-12-12,2024-01-07,PLN5474,1800011727,1800011727,Clinical Laboratory,Out-of-Network,E11.40,Z23,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,1,74.61,29.18,26.04,0.0,0.0,3.14,3.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008361,MBR00000328,Professional,2022-03-07,2022-03-07,2022-04-10,PLN4679,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,E66.9,E78.5,,,,,,,0,,66984,Surgery,,,,11,Office,1,2045.2,1340.08,1340.08,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008362,MBR00000328,Institutional-OP,2023-08-25,2023-08-25,2023-09-03,PLN6519,1273488618,1273488618,General Acute Care Hospital,In-Network,Z12.31,Z00.00,,,,,,,0,,58661,Surgery,,,0120,22,Outpatient Hospital,2,2474.62,1229.42,1229.42,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008363,MBR00000328,Institutional-OP,2021-01-20,2021-01-20,2021-03-04,PLN3898,1103747954,1103747954,Urology,In-Network,E66.9,Z00.00,,,,,,,0,,81001,Pathology/Lab,,,0370,22,Outpatient Hospital,1,61.16,40.25,0.0,0.0,0.0,7.27,7.27,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008364,MBR00000328,Institutional-OP,2023-01-13,2023-01-13,2023-01-26,PLN7125,1728018911,1728018911,Nephrology,In-Network,J20.9,I10,,,,,,,0,,84443,Pathology/Lab,,,0900,22,Outpatient Hospital,3,93.51,49.5,44.22,0.0,0.0,5.28,5.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008365,MBR00000328,Institutional-OP,2021-07-02,2021-07-02,2021-08-14,PLN2300,1422747896,1422747896,Urology,In-Network,K57.30,E11.9,,,,,,,0,,76700,Radiology,,,0450,22,Outpatient Hospital,1,1118.71,896.98,820.0,76.98,0.0,0.0,76.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008366,MBR00000328,Professional,2023-05-06,2023-05-06,2023-06-02,PLN9033,1845900543,1845900543,ASC,In-Network,I25.10,K57.30,,,,,,,0,,77067,Radiology,,,,11,Office,3,678.85,531.46,437.17,16.81,35.0,42.48,94.29,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000008367,MBR00000328,Professional,2021-01-11,2021-01-11,2021-02-10,PLN1955,1590915516,1590915516,Physical Therapy,Out-of-Network,M81.0,J06.9,,,,,,,0,,G0468,Medicine,,,,49,Independent Clinic,3,258.18,108.47,79.88,0.0,15.0,13.59,28.59,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008368,MBR00000328,Institutional-OP,2023-07-01,2023-07-01,2023-07-30,PLN1146,1395983630,1395983630,Nephrology,In-Network,E66.9,E11.65,,,,,,,0,,99283,E&M,,,0900,22,Outpatient Hospital,2,367.18,309.51,0.0,309.51,0.0,0.0,309.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008369,MBR00000328,Professional,2022-03-11,2022-03-11,2022-03-26,PLN7372,1717546253,1717546253,Family Medicine,In-Network,M81.0,B97.89,,,,,,,0,,99232,E&M,,,,11,Office,2,223.09,147.98,147.98,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008370,MBR00000328,Professional,2021-09-17,2021-09-17,2021-10-08,PLN2552,1514306773,1514306773,Endocrinology,In-Network,Z12.31,N39.0,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,1,1557.87,850.45,850.45,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008371,MBR00000328,Institutional-OP,2022-08-31,2022-08-31,2022-09-12,PLN4716,1845057593,1845057593,Orthopedic Surgery,In-Network,K21.0,E66.9,,,,,,,0,,27130,Surgery,,,0510,22,Outpatient Hospital,3,3153.53,1185.86,1185.86,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008372,MBR00000328,Professional,2023-12-20,2023-12-20,2024-01-17,PLN8649,1168881145,1168881145,Orthopedic Surgery,In-Network,Z96.641,E78.5,,,,,,,0,,99203,E&M,,,,20,Urgent Care,2,168.5,108.86,108.86,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008373,MBR00000328,Professional,2021-06-25,2021-06-25,2021-07-18,PLN2935,1132188260,1132188260,Family Medicine,In-Network,R10.9,E11.9,,,,,,,0,,76700,Radiology,,,,49,Independent Clinic,3,628.41,352.09,0.0,352.09,0.0,0.0,352.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008374,MBR00000328,Professional,2021-12-06,2021-12-06,2022-01-07,PLN1102,1780163051,1780163051,SNF,In-Network,C50.912,I48.91,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,1,1434.56,1106.33,849.49,0.0,50.0,206.84,256.84,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000008375,MBR00000328,Institutional-OP,2022-12-02,2022-12-02,2023-01-02,PLN5568,1355166277,1355166277,Endocrinology,In-Network,Z23,K21.0,,,,,,,0,,99221,E&M,,,0450,22,Outpatient Hospital,2,213.29,134.34,134.34,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008376,MBR00000328,Professional,2021-04-13,2021-04-13,2021-05-01,PLN8658,1540044947,1540044947,Pulmonology,Out-of-Network,Z51.11,K21.0,,,,,,,0,,G0444,Medicine,,,,11,Office,1,44.72,24.38,0.0,24.38,0.0,0.0,24.38,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000008377,MBR00000328,Institutional-IP,2023-11-11,2023-11-12,2023-12-04,PLN5395,1687650653,1687650653,Internal Medicine,In-Network,Z00.00,J06.9,,,,196,MS-DRG,6,1,Y,47562,Surgery,,,0510,21,Inpatient Hospital,1,4737.83,3693.33,0.0,337.3,0.0,0.0,337.3,0.0,Denied,CO-11,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008378,MBR00000328,Professional,2022-07-28,2022-07-28,2022-08-19,PLN8471,1563980627,1563980627,Critical Access Hospital,In-Network,I48.91,F32.9,,,,,,,0,,33533,Surgery,,,,11,Office,3,15037.39,5548.41,5548.41,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000008379,MBR00000328,Institutional-OP,2023-12-21,2023-12-21,2024-01-11,PLN7895,1689639685,1689639685,SNF,In-Network,F41.9,M54.5,,,,,,,0,,83036,Pathology/Lab,,,0761,22,Outpatient Hospital,3,46.75,22.45,22.45,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000008380,MBR00000329,Institutional-OP,2022-03-31,2022-03-31,2022-05-10,PLN6224,1395983630,1395983630,Nephrology,In-Network,E87.6,R05,,,,,,,0,,27447,Surgery,,,0900,22,Outpatient Hospital,3,5326.1,2943.93,2943.93,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008381,MBR00000329,Professional,2023-07-02,2023-07-02,2023-07-11,PLN3225,1550154147,1550154147,Outpatient Clinic,In-Network,F32.9,R10.9,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,2,2917.55,1464.31,1354.49,0.0,0.0,109.82,109.82,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008382,MBR00000329,Institutional-OP,2021-12-29,2021-12-29,2022-01-08,PLN8692,1235381502,1235381502,Cardiology,In-Network,E78.5,I10,,,,,,,0,,84443,Pathology/Lab,,,0370,22,Outpatient Hospital,3,165.72,92.97,92.97,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008383,MBR00000329,Professional,2022-05-02,2022-05-02,2022-06-02,PLN5955,1800011727,1800011727,Clinical Laboratory,Out-of-Network,E66.9,Z87.891,,,,,,,0,,90460,Medicine,,,,11,Office,1,39.84,21.23,6.23,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008384,MBR00000329,Professional,2022-01-15,2022-01-15,2022-02-14,PLN2233,1645194539,1645194539,SNF,In-Network,J06.9,E11.9,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,1,62.8,33.2,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008385,MBR00000329,Professional,2022-08-23,2022-08-23,2022-09-24,PLN9860,1800011727,1800011727,Clinical Laboratory,Out-of-Network,F41.9,Z87.891,,,,,,,0,,99406,Medicine,,,,22,Outpatient Hospital,3,66.77,44.75,9.33,0.0,35.0,0.42,35.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008386,MBR00000329,Professional,2021-09-02,2021-09-02,2021-09-28,PLN2302,1366426662,1366426662,Urology,In-Network,E66.9,E11.9,,,,,,,0,,G0444,Medicine,,,,23,Emergency Room,2,78.9,47.68,0.0,47.68,15.0,0.0,62.68,0.0,Paid,,,0,,1,1,0,0,0,0,None,0,0,0,0,1
CLM0000008387,MBR00000329,Institutional-OP,2022-07-06,2022-07-06,2022-07-20,PLN8928,1124394415,1124394415,Pediatrics,In-Network,Z00.00,E78.5,,,,,,,0,,80053,Pathology/Lab,,,0900,22,Outpatient Hospital,2,86.42,35.1,31.45,0.0,0.0,3.65,3.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008388,MBR00000329,Institutional-OP,2023-07-09,2023-07-09,2023-08-19,PLN9856,1520687146,1520687146,ASC,In-Network,J06.9,E78.5,,,,,,,0,,85610,Pathology/Lab,,,0510,22,Outpatient Hospital,3,28.53,20.86,20.86,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008389,MBR00000329,Institutional-OP,2021-06-20,2021-06-20,2021-07-23,PLN2422,1337791138,1337791138,Internal Medicine,Out-of-Network,E66.9,E66.9,,,,,,,0,,23472,Surgery,,,0270,22,Outpatient Hospital,2,6812.88,5351.47,5250.77,25.7,75.0,0.0,100.7,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008390,MBR00000329,Professional,2023-05-19,2023-05-19,2023-05-28,PLN9796,1450094833,1450094833,Outpatient Clinic,In-Network,E87.6,J06.9,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,1,1241.18,425.17,425.17,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008391,MBR00000329,Institutional-OP,2023-07-25,2023-07-25,2023-09-07,PLN2607,1717912431,1717912431,Oncology,In-Network,I10,R07.9,,,,,,,0,,78452,Radiology,,,0730,22,Outpatient Hospital,1,5265.03,4451.73,3583.25,350.06,50.0,468.42,868.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008392,MBR00000329,Institutional-IP,2021-02-08,2021-02-14,2021-03-21,PLN2999,1631954542,1631954542,Oncology,In-Network,E78.5,Z12.31,,,,872,MS-DRG,2,6,Y,27447,Surgery,,,0200,21,Inpatient Hospital,2,5377.83,3900.67,3900.67,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008393,MBR00000329,Professional,2023-01-10,2023-01-10,2023-02-10,PLN5517,1193493783,1193493783,Critical Access Hospital,Out-of-Network,J06.9,E11.9,,,,,,,0,,43239,Surgery,,,,31,Skilled Nursing Facility,1,922.9,500.56,301.73,161.28,0.0,37.55,198.83,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008394,MBR00000329,Institutional-OP,2022-06-16,2022-06-16,2022-07-05,PLN4706,1644128543,1644128543,Gastroenterology,In-Network,I11.9,E11.9,,,,,,,0,,84443,Pathology/Lab,,,0270,22,Outpatient Hospital,2,79.31,58.14,58.14,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008395,MBR00000329,Institutional-OP,2022-11-30,2022-11-30,2023-01-10,PLN8146,1660288235,1660288235,ASC,In-Network,J20.9,E11.9,,,,,,,0,,80061,Pathology/Lab,,,0450,22,Outpatient Hospital,1,77.24,34.79,0.0,34.79,0.0,0.0,34.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008396,MBR00000329,Institutional-OP,2021-11-19,2021-11-19,2022-01-01,PLN7541,1235381502,1235381502,Cardiology,In-Network,E78.5,I25.10,,,,,,,0,,99284,E&M,,,0120,22,Outpatient Hospital,3,605.21,251.07,0.0,251.07,0.0,0.0,251.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008397,MBR00000329,Institutional-OP,2021-08-30,2021-08-30,2021-09-08,PLN3027,1475984649,1475984649,SNF,In-Network,I63.9,M54.5,,,,,,,0,,77067,Radiology,,,0510,22,Outpatient Hospital,2,837.8,284.4,0.0,284.4,0.0,0.0,284.4,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000008398,MBR00000329,Professional,2021-11-11,2021-11-11,2021-12-16,PLN5223,1198133277,1198133277,SNF,In-Network,Z87.891,E78.5,,,,,,,0,,G0444,Medicine,,,,11,Office,1,60.34,42.53,7.53,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000008399,MBR00000329,Institutional-OP,2021-06-17,2021-06-17,2021-07-15,PLN6913,1372918899,1372918899,Family Medicine,In-Network,Z87.891,N20.0,,,,,,,0,,93225,Medicine,,,0370,22,Outpatient Hospital,3,865.69,603.34,528.34,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008400,MBR00000329,Institutional-OP,2022-03-21,2022-03-21,2022-04-17,PLN9452,1717546253,1717546253,Family Medicine,In-Network,N18.3,E66.9,,,,,,,0,,99214,E&M,,,0360,22,Outpatient Hospital,3,247.56,91.31,0.0,91.31,25.0,0.0,116.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008401,MBR00000329,Institutional-IP,2023-08-14,2023-08-19,2023-09-05,PLN6218,1891849440,1891849440,Oncology,In-Network,E78.5,E78.5,,,,470,MS-DRG,23,5,Y,85610,Pathology/Lab,,,0740,21,Inpatient Hospital,3,53.53,25.81,0.81,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008402,MBR00000329,Professional,2023-05-03,2023-05-03,2023-06-13,PLN3298,1891849440,1891849440,Oncology,In-Network,Z12.31,J18.9,,,,,,,0,,G0439,Medicine,,,,22,Outpatient Hospital,1,375.69,261.79,0.0,261.79,0.0,0.0,261.79,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000008403,MBR00000329,Professional,2021-07-16,2021-07-16,2021-07-29,PLN9442,1946680931,1946680931,Critical Access Hospital,Out-of-Network,J44.1,I10,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,2,419.54,185.14,182.25,0.0,0.0,2.89,2.89,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008404,MBR00000329,Professional,2022-09-04,2022-09-04,2022-09-20,PLN6982,1799205295,1799205295,General Acute Care Hospital,In-Network,E78.5,J06.9,,,,,,,0,,97530,Medicine,,,,50,Federally Qualified Health Center,3,194.33,110.63,32.33,78.3,0.0,0.0,78.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008405,MBR00000330,Professional,2021-03-22,2021-03-22,2021-04-11,PLN6674,1511044648,1511044648,Endocrinology,In-Network,E78.5,R10.9,,,,,,,0,,27447,Surgery,,,,81,Independent Laboratory,2,4496.41,1509.6,1021.8,412.8,75.0,0.0,487.8,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008406,MBR00000330,Institutional-OP,2021-03-07,2021-03-07,2021-03-18,PLN9238,1124394415,1124394415,Pediatrics,In-Network,R51,E11.40,,,,,,,0,,85610,Pathology/Lab,,,0636,22,Outpatient Hospital,3,69.93,32.27,0.0,32.27,35.0,0.0,67.27,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000008407,MBR00000330,Institutional-OP,2022-11-17,2022-11-17,2022-12-03,PLN9119,1364429278,1364429278,OB/GYN,In-Network,E11.65,G20,,,,,,,0,,99203,E&M,,,0510,22,Outpatient Hospital,1,378.3,155.0,155.0,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008408,MBR00000330,Institutional-OP,2021-11-28,2021-11-28,2021-12-26,PLN6539,1168881145,1168881145,Orthopedic Surgery,In-Network,I48.91,K21.0,,,,,,,0,,99233,E&M,,,0450,22,Outpatient Hospital,1,443.49,371.18,371.18,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008409,MBR00000330,Professional,2023-02-11,2023-02-11,2023-03-20,PLN6821,1422747896,1422747896,Urology,In-Network,N40.0,F10.20,,,,,,,0,,33533,Surgery,,,,81,Independent Laboratory,3,17768.64,12614.89,10975.19,363.15,50.0,1226.55,1639.7,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000008410,MBR00000330,Institutional-IP,2021-06-20,2021-06-22,2021-07-11,PLN5733,1749327647,1749327647,Geriatrics,In-Network,E78.5,I10,,,,291,MS-DRG,23,2,N,99233,E&M,,,0450,21,Inpatient Hospital,1,559.55,343.63,343.63,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008411,MBR00000330,Professional,2021-05-11,2021-05-11,2021-05-30,PLN2272,1716521444,1716521444,Oncology,In-Network,J20.9,E78.5,,,,,,,0,,71046,Radiology,,,,11,Office,2,310.54,115.74,0.0,115.74,0.0,0.0,115.74,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008412,MBR00000330,Professional,2023-02-22,2023-02-22,2023-03-03,PLN5465,1624802371,1624802371,ASC,Out-of-Network,N39.0,I25.10,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,2,338.61,207.0,48.56,149.16,0.0,9.28,158.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008413,MBR00000330,Professional,2021-08-15,2021-08-15,2021-09-16,PLN5172,1806688928,1806688928,Geriatrics,In-Network,E11.9,I25.10,,,,,,,0,,99204,E&M,,,,11,Office,1,419.47,286.16,286.16,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008414,MBR00000330,Institutional-OP,2021-03-05,2021-03-05,2021-03-31,PLN4588,1118885473,1118885473,ASC,In-Network,J44.1,E11.9,,,,,,,0,,78452,Radiology,,,0370,22,Outpatient Hospital,1,3909.42,1411.17,0.0,0.0,0.0,116.16,116.16,0.0,Denied,CO-29,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008415,MBR00000330,Institutional-OP,2023-05-14,2023-05-14,2023-06-11,PLN4110,1691062876,1691062876,SNF,In-Network,M54.5,J44.1,,,,,,,0,,27447,Surgery,,,0510,22,Outpatient Hospital,1,3651.19,2370.05,0.0,377.22,15.0,0.0,392.22,0.0,Denied,CO-27,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008416,MBR00000330,Institutional-OP,2023-02-12,2023-02-12,2023-03-22,PLN6851,1609138981,1609138981,Critical Access Hospital,In-Network,Z00.00,Z23,,,,,,,0,,99233,E&M,,,0740,22,Outpatient Hospital,1,434.91,312.29,176.9,110.39,25.0,0.0,135.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008417,MBR00000330,Professional,2023-10-15,2023-10-15,2023-11-13,PLN1459,1845900543,1845900543,ASC,In-Network,I11.9,N40.0,,,,,,,0,,99233,E&M,,,,21,Inpatient Hospital,2,363.85,216.58,106.27,91.07,0.0,19.24,110.31,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008418,MBR00000330,Professional,2022-10-18,2022-10-18,2022-11-07,PLN1015,1563980627,1563980627,Critical Access Hospital,In-Network,E78.5,F41.9,,,,,,,0,,27447,Surgery,,,,11,Office,2,3245.52,1866.49,1478.7,387.79,0.0,0.0,387.79,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008419,MBR00000330,Institutional-IP,2022-06-06,2022-06-18,2022-06-24,PLN1852,1624802371,1624802371,ASC,Out-of-Network,J06.9,N39.0,,,,195,MS-DRG,12,12,Y,45380,Surgery,,,0270,21,Inpatient Hospital,2,2153.58,1029.16,1029.16,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000008420,MBR00000331,Institutional-IP,2023-01-05,2023-01-11,2023-02-10,PLN2409,1696843572,1696843572,Critical Access Hospital,Out-of-Network,J44.1,B97.89,,,,871,MS-DRG,2,6,Y,G0468,Medicine,,,0200,21,Inpatient Hospital,2,390.3,198.34,173.34,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008421,MBR00000331,Institutional-OP,2023-05-18,2023-05-18,2023-05-30,PLN6897,1948810580,1948810580,DME Supplier,In-Network,E78.5,I11.9,,,,,,,0,,80061,Pathology/Lab,,,0510,22,Outpatient Hospital,1,105.86,77.38,73.38,0.0,0.0,4.0,4.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008422,MBR00000331,Professional,2022-11-20,2022-11-20,2022-12-19,PLN3941,1606140917,1606140917,ASC,In-Network,E11.40,F10.20,,,,,,,0,,99203,E&M,,,,11,Office,1,344.06,154.9,129.9,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008423,MBR00000331,Professional,2021-12-16,2021-12-16,2022-01-16,PLN5853,1575695214,1575695214,SNF,In-Network,Z00.00,E78.5,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,1,208.98,152.89,148.86,0.0,0.0,4.03,4.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008424,MBR00000331,Institutional-OP,2023-09-02,2023-09-02,2023-09-25,PLN7597,1778483301,1778483301,Home Health,In-Network,E66.9,E78.5,,,,,,,0,,G0439,Medicine,,,0740,22,Outpatient Hospital,1,393.12,179.87,179.87,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000008425,MBR00000331,Professional,2023-02-10,2023-02-10,2023-03-16,PLN8244,1273488618,1273488618,General Acute Care Hospital,In-Network,Z00.00,F32.9,,,,,,,0,,93225,Medicine,,,,22,Outpatient Hospital,1,782.35,575.96,78.67,497.29,0.0,0.0,497.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008426,MBR00000331,Professional,2023-08-19,2023-08-19,2023-09-17,PLN2139,1728018911,1728018911,Nephrology,In-Network,I10,C50.912,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,2,58.9,41.1,41.1,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008427,MBR00000331,Institutional-OP,2022-09-03,2022-09-03,2022-10-12,PLN7751,1236418230,1236418230,DME Supplier,In-Network,I10,I50.9,,,,,,,0,,80061,Pathology/Lab,,,0301,22,Outpatient Hospital,3,132.35,108.6,108.6,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008428,MBR00000331,Institutional-OP,2022-05-08,2022-05-08,2022-05-23,PLN7894,1355166277,1355166277,Endocrinology,In-Network,J06.9,Z23,,,,,,,0,,47562,Surgery,,,0740,22,Outpatient Hospital,2,5897.82,2874.9,0.0,420.55,0.0,0.0,420.55,0.0,Denied,CO-4,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008429,MBR00000331,Institutional-OP,2023-07-13,2023-07-13,2023-07-25,PLN2807,1974006077,1974006077,Orthopedic Surgery,In-Network,I63.9,E78.5,,,,,,,0,,99204,E&M,,,0370,22,Outpatient Hospital,1,404.08,135.84,87.48,48.36,0.0,0.0,48.36,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000008430,MBR00000331,Professional,2022-11-01,2022-11-01,2022-11-14,PLN8770,1717546253,1717546253,Family Medicine,In-Network,E11.9,M17.11,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,1,19795.92,9107.85,9107.85,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000008431,MBR00000331,Institutional-IP,2023-04-30,2023-05-04,2023-05-21,PLN8726,1696843572,1696843572,Critical Access Hospital,Out-of-Network,F32.9,Z12.31,,,,195,MS-DRG,6,4,W,85025,Pathology/Lab,,,0360,21,Inpatient Hospital,1,66.82,27.94,27.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008432,MBR00000331,Professional,2023-09-02,2023-09-02,2023-10-09,PLN2668,1749494482,1749494482,Pediatrics,In-Network,F41.9,I10,,,,,,,0,,43239,Surgery,,,,23,Emergency Room,3,1544.57,653.3,522.08,131.22,0.0,0.0,131.22,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008433,MBR00000331,Institutional-IP,2021-11-08,2021-11-19,2021-11-28,PLN7544,1840431511,1840431511,Geriatrics,Out-of-Network,E11.9,E66.9,,,,872,MS-DRG,4,11,W,27130,Surgery,,,0761,21,Inpatient Hospital,3,2996.1,2057.97,1890.04,132.93,35.0,0.0,167.93,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008434,MBR00000331,Institutional-IP,2021-07-31,2021-08-06,2021-08-24,PLN1506,1247341320,1247341320,Urology,Out-of-Network,F41.9,R51,,,,196,MS-DRG,8,6,Y,99213,E&M,,,0270,21,Inpatient Hospital,2,202.46,62.51,0.0,62.51,0.0,0.0,62.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008435,MBR00000331,Professional,2021-06-13,2021-06-13,2021-06-26,PLN9875,1364429278,1364429278,OB/GYN,In-Network,E66.9,I10,,,,,,,0,,80061,Pathology/Lab,,,,23,Emergency Room,2,67.88,35.45,0.0,35.45,0.0,0.0,35.45,0.0,Paid,,,0,,1,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000008436,MBR00000331,Professional,2022-10-19,2022-10-19,2022-11-08,PLN3131,1609526529,1609526529,Psychiatry,In-Network,G43.909,R07.9,,,,,,,0,,74177,Radiology,,,,65,End-Stage Renal Disease,1,1758.02,697.39,651.39,0.0,0.0,46.0,46.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008437,MBR00000331,Professional,2023-06-04,2023-06-04,2023-07-13,PLN7668,1514306773,1514306773,Endocrinology,In-Network,M54.5,Z51.11,,,,,,,0,,33533,Surgery,,,,20,Urgent Care,3,15996.32,13210.26,13135.26,0.0,75.0,0.0,75.0,0.0,Pended,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000008438,MBR00000331,Professional,2023-12-05,2023-12-05,2024-01-05,PLN7485,1186826716,1186826716,Physical Therapy,In-Network,E11.9,I10,,,,,,,0,,58661,Surgery,,,,49,Independent Clinic,3,4622.95,1422.27,1422.27,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008439,MBR00000331,Professional,2021-02-05,2021-02-05,2021-02-16,PLN5914,1390307371,1390307371,DME Supplier,In-Network,F32.9,I10,,,,,,,0,,71046,Radiology,,,,22,Outpatient Hospital,3,145.99,115.23,74.6,0.0,25.0,15.63,40.63,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008440,MBR00000331,Institutional-OP,2021-01-02,2021-01-02,2021-02-08,PLN7652,1337791138,1337791138,Internal Medicine,Out-of-Network,E11.9,F41.9,,,,,,,0,,99204,E&M,,,0730,22,Outpatient Hospital,2,540.38,361.02,0.0,210.27,35.0,0.0,245.27,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008441,MBR00000331,Professional,2023-01-14,2023-01-14,2023-01-31,PLN3553,1528335731,1528335731,Critical Access Hospital,In-Network,I10,Z79.4,,,,,,,0,,99222,E&M,,,,11,Office,1,456.72,310.98,310.98,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008442,MBR00000331,Professional,2021-10-23,2021-10-23,2021-11-08,PLN6991,1422747896,1422747896,Urology,In-Network,Z00.00,F41.9,,,,,,,0,,99283,E&M,,,,50,Federally Qualified Health Center,1,534.56,182.42,0.0,182.42,35.0,0.0,217.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008443,MBR00000331,Institutional-IP,2022-06-06,2022-06-12,2022-07-18,PLN4683,1213165847,1213165847,Critical Access Hospital,In-Network,Z00.00,E66.9,,,,194,MS-DRG,20,6,Y,99284,E&M,,,0900,21,Inpatient Hospital,2,837.34,559.8,545.28,0.0,0.0,14.52,14.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008444,MBR00000331,Institutional-OP,2021-03-28,2021-03-28,2021-04-17,PLN4517,1266606767,1266606767,ASC,In-Network,I11.9,I10,,,,,,,0,,99233,E&M,,,0301,22,Outpatient Hospital,2,315.81,166.54,152.63,0.0,0.0,13.91,13.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008445,MBR00000332,Professional,2021-03-24,2021-03-24,2021-04-02,PLN2084,1910255109,1910255109,DME Supplier,In-Network,M54.5,E11.9,,,,,,,0,,99213,E&M,,,,11,Office,1,149.24,95.09,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008446,MBR00000332,Professional,2022-08-02,2022-08-02,2022-09-11,PLN8172,1520687146,1520687146,ASC,In-Network,Z00.00,E11.65,,,,,,,0,,90686,Medicine,,,,12,Home,1,137.39,58.98,0.0,58.98,0.0,0.0,58.98,0.0,Denied,CO-11,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000008447,MBR00000332,Professional,2023-01-24,2023-01-24,2023-02-19,PLN8908,1266606767,1266606767,ASC,In-Network,I25.10,F32.9,,,,,,,0,,99213,E&M,,,,21,Inpatient Hospital,3,166.79,73.4,0.0,73.4,0.0,0.0,73.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008448,MBR00000332,Professional,2023-08-29,2023-08-29,2023-09-22,PLN6954,1689639685,1689639685,SNF,In-Network,F41.9,E78.5,,,,,,,0,,82043,Pathology/Lab,,,,23,Emergency Room,1,38.68,15.75,15.75,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008449,MBR00000332,Professional,2022-06-13,2022-06-13,2022-07-03,PLN1656,1438368327,1438368327,Home Health,In-Network,J20.9,E66.9,,,,,,,0,,93306,Radiology,,,,22,Outpatient Hospital,1,2144.0,1282.55,1214.08,0.0,0.0,68.47,68.47,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008450,MBR00000332,Institutional-IP,2022-12-08,2022-12-10,2023-01-01,PLN5510,1991459367,1991459367,Neurology,Out-of-Network,N39.0,I10,,,,603,MS-DRG,18,2,Y,99233,E&M,,,0360,21,Inpatient Hospital,3,247.84,112.55,111.89,0.0,0.0,0.66,0.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008451,MBR00000332,Professional,2023-07-31,2023-07-31,2023-08-15,PLN5296,1266606767,1266606767,ASC,In-Network,Z12.31,E78.5,,,,,,,0,,45380,Surgery,,,,20,Urgent Care,1,1765.11,676.22,601.22,0.0,75.0,0.0,75.0,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000008452,MBR00000332,Professional,2022-04-18,2022-04-18,2022-05-25,PLN2238,1103747954,1103747954,Urology,In-Network,J18.9,R05,,,,,,,0,,93306,Radiology,,,,21,Inpatient Hospital,1,2311.94,1316.62,1301.62,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008453,MBR00000332,Institutional-IP,2021-08-17,2021-08-20,2021-09-02,PLN8169,1531398223,1531398223,OB/GYN,In-Network,M54.5,R07.9,,,,470,MS-DRG,12,3,Y,99214,E&M,,,0761,21,Inpatient Hospital,1,428.62,348.8,342.04,0.0,0.0,6.76,6.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008454,MBR00000333,Professional,2023-06-23,2023-06-23,2023-07-20,PLN7404,1500037969,1500037969,Pulmonology,In-Network,J45.20,M54.5,,,,,,,0,,99203,E&M,,,,49,Independent Clinic,1,156.19,123.16,0.0,0.0,0.0,5.88,5.88,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008455,MBR00000333,Institutional-OP,2021-01-03,2021-01-03,2021-01-30,PLN7718,1696843572,1696843572,Critical Access Hospital,Out-of-Network,I25.10,E78.5,,,,,,,0,,99204,E&M,,,0450,22,Outpatient Hospital,2,560.92,467.66,355.87,0.0,25.0,86.79,111.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008456,MBR00000333,Institutional-IP,2021-10-30,2021-11-01,2021-11-26,PLN7734,1845900543,1845900543,ASC,In-Network,F41.9,Z12.31,,,,683,MS-DRG,7,2,N,81001,Pathology/Lab,,,0301,21,Inpatient Hospital,2,41.27,26.33,11.33,0.0,15.0,0.0,15.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008457,MBR00000333,Institutional-IP,2021-05-23,2021-05-26,2021-06-28,PLN5488,1964402759,1964402759,Outpatient Clinic,In-Network,M54.5,E11.9,,,,195,MS-DRG,19,3,Y,99204,E&M,,,0360,21,Inpatient Hospital,3,526.46,291.43,257.9,33.53,0.0,0.0,33.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008458,MBR00000333,Professional,2022-12-06,2022-12-06,2022-12-24,PLN9275,1486164553,1486164553,DME Supplier,In-Network,N39.0,Z00.00,,,,,,,0,,93306,Radiology,,,,22,Outpatient Hospital,3,3047.84,2137.19,2112.19,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008459,MBR00000333,Professional,2021-10-23,2021-10-23,2021-12-05,PLN7988,1749327647,1749327647,Geriatrics,In-Network,F41.9,N39.0,,,,,,,0,,99221,E&M,,,,12,Home,1,311.49,175.59,125.59,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008460,MBR00000333,Professional,2022-01-13,2022-01-13,2022-02-22,PLN3577,1891849440,1891849440,Oncology,In-Network,F32.9,N20.0,,,,,,,0,,70450,Radiology,,,,11,Office,3,1671.83,1187.18,1183.4,3.78,0.0,0.0,3.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008461,MBR00000333,Institutional-OP,2022-12-16,2022-12-16,2023-01-25,PLN8850,1284035364,1284035364,Pediatrics,In-Network,I11.9,I10,,,,,,,0,,99203,E&M,,,0120,22,Outpatient Hospital,2,178.91,89.6,74.6,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008462,MBR00000333,Professional,2021-11-21,2021-11-21,2021-11-30,PLN2046,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,E78.5,Z00.01,,,,,,,0,,27130,Surgery,,,,31,Skilled Nursing Facility,3,6763.67,5422.75,5372.75,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008463,MBR00000333,Professional,2022-02-02,2022-02-02,2022-02-22,PLN9524,1717912431,1717912431,Oncology,In-Network,Z23,E78.5,,,,,,,0,,85610,Pathology/Lab,,,,23,Emergency Room,1,69.61,21.58,21.58,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008464,MBR00000333,Institutional-OP,2022-07-01,2022-07-01,2022-07-26,PLN9104,1767011137,1767011137,DME Supplier,In-Network,E78.5,Z00.00,,,,,,,0,,85610,Pathology/Lab,,,0301,22,Outpatient Hospital,2,54.8,35.79,0.0,35.79,15.0,0.0,50.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008465,MBR00000333,Professional,2021-05-10,2021-05-10,2021-06-02,PLN8113,1438368327,1438368327,Home Health,In-Network,Z00.00,I10,,,,,,,0,,45380,Surgery,,,,11,Office,3,2379.87,1452.13,1335.69,116.44,0.0,0.0,116.44,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000008466,MBR00000333,Institutional-IP,2023-10-22,2023-10-30,2023-11-25,PLN2303,1514306773,1514306773,Endocrinology,In-Network,E78.5,E78.5,,,,292,MS-DRG,10,8,Y,99221,E&M,,,0301,21,Inpatient Hospital,2,377.85,319.05,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008467,MBR00000333,Institutional-OP,2023-12-11,2023-12-11,2024-01-17,PLN1181,1361302520,1361302520,Critical Access Hospital,In-Network,R51,E11.9,,,,,,,0,,81001,Pathology/Lab,,,0270,22,Outpatient Hospital,1,62.76,31.09,26.16,0.0,0.0,4.93,4.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008468,MBR00000333,Professional,2023-02-20,2023-02-20,2023-03-15,PLN8195,1273488618,1273488618,General Acute Care Hospital,In-Network,E11.9,K21.0,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,2,4754.09,1642.51,1567.51,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008469,MBR00000333,Professional,2021-04-29,2021-04-29,2021-05-25,PLN6558,1502838586,1502838586,ASC,In-Network,Z12.31,E11.9,,,,,,,0,,99213,E&M,,,,22,Outpatient Hospital,2,215.03,74.02,74.02,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008470,MBR00000333,Institutional-OP,2022-06-02,2022-06-02,2022-06-19,PLN1681,1865904917,1865904917,Outpatient Clinic,In-Network,Z00.00,I48.91,,,,,,,0,,99406,Medicine,,,0450,22,Outpatient Hospital,2,58.98,41.21,0.0,25.22,75.0,0.0,100.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008471,MBR00000333,Professional,2022-01-24,2022-01-24,2022-02-20,PLN1813,1502838586,1502838586,ASC,In-Network,K21.0,E11.9,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,2,3624.02,1147.16,1147.16,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008472,MBR00000333,Institutional-OP,2021-07-02,2021-07-02,2021-07-28,PLN6166,1224179551,1224179551,Physical Therapy,In-Network,C50.912,I25.10,,,,,,,0,,99406,Medicine,,,0200,22,Outpatient Hospital,3,55.17,38.48,0.0,38.48,75.0,0.0,113.48,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008473,MBR00000333,Professional,2023-08-18,2023-08-18,2023-08-30,PLN6533,1193493783,1193493783,Critical Access Hospital,Out-of-Network,M17.11,F32.9,,,,,,,0,,45380,Surgery,,,,11,Office,1,2450.68,1551.83,1536.83,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000008474,MBR00000333,Professional,2022-03-31,2022-03-31,2022-05-10,PLN5843,1193493783,1193493783,Critical Access Hospital,Out-of-Network,J44.1,M81.0,,,,,,,0,,23472,Surgery,,,,12,Home,3,2842.6,1325.36,953.92,371.44,0.0,0.0,371.44,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008475,MBR00000333,Professional,2022-12-16,2022-12-16,2023-01-15,PLN4006,1242201429,1242201429,General Acute Care Hospital,In-Network,E66.9,N18.3,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,2,24000.2,9719.69,9719.69,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000008476,MBR00000333,Institutional-OP,2023-01-27,2023-01-27,2023-02-26,PLN8758,1213165847,1213165847,Critical Access Hospital,In-Network,S72.001A,F32.9,,,,,,,0,,58661,Surgery,,,0730,22,Outpatient Hospital,3,4732.31,3269.66,3269.66,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008477,MBR00000333,Professional,2021-12-17,2021-12-17,2022-01-25,PLN2094,1564502315,1564502315,ASC,In-Network,J06.9,R05,,,,,,,0,,58661,Surgery,,,,21,Inpatient Hospital,2,2460.36,2052.63,1345.63,435.44,50.0,221.56,707.0,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008478,MBR00000333,Professional,2022-01-17,2022-01-17,2022-02-23,PLN8782,1531398223,1531398223,OB/GYN,In-Network,I25.10,E87.6,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,2,81.82,65.85,53.68,0.0,0.0,12.17,12.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008479,MBR00000333,Professional,2023-11-29,2023-11-29,2024-01-10,PLN7247,1569105090,1569105090,Geriatrics,In-Network,K21.0,N17.9,,,,,,,0,,99222,E&M,,,,20,Urgent Care,2,620.27,465.68,414.94,0.0,15.0,35.74,50.74,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000008480,MBR00000333,Professional,2023-06-22,2023-06-22,2023-07-02,PLN9547,1213165847,1213165847,Critical Access Hospital,In-Network,J06.9,E11.9,,,,,,,0,,99284,E&M,,,,11,Office,2,903.27,316.74,298.56,0.0,0.0,18.18,18.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008481,MBR00000333,Professional,2022-07-03,2022-07-03,2022-07-25,PLN7470,1186826716,1186826716,Physical Therapy,In-Network,J44.1,E11.65,,,,,,,0,,G0444,Medicine,,,,11,Office,2,87.55,43.46,8.46,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000008482,MBR00000333,Institutional-OP,2022-08-08,2022-08-08,2022-08-17,PLN7308,1193493783,1193493783,Critical Access Hospital,Out-of-Network,K21.0,J44.1,,,,,,,0,,90686,Medicine,,,0900,22,Outpatient Hospital,3,71.82,58.29,49.94,0.0,0.0,8.35,8.35,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000008483,MBR00000333,Institutional-IP,2021-01-09,2021-01-10,2021-02-15,PLN6590,1434029575,1434029575,Endocrinology,In-Network,Z00.00,K92.1,,,,683,MS-DRG,17,1,Y,33533,Surgery,,,0900,21,Inpatient Hospital,3,19985.53,14924.38,14924.38,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000008484,MBR00000333,Professional,2021-08-12,2021-08-12,2021-08-27,PLN2183,1132188260,1132188260,Family Medicine,In-Network,Z12.31,J44.1,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,1,423.29,202.79,103.87,0.0,75.0,23.92,98.92,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000008485,MBR00000333,Professional,2021-01-07,2021-01-07,2021-02-10,PLN5582,1624202402,1624202402,Orthopedic Surgery,In-Network,I50.9,I10,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,2,425.84,246.46,155.47,53.72,15.0,22.27,90.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008486,MBR00000333,Professional,2023-06-02,2023-06-02,2023-07-02,PLN3559,1361302520,1361302520,Critical Access Hospital,In-Network,Z12.31,Z23,,,,,,,0,,71046,Radiology,,,,21,Inpatient Hospital,3,162.68,72.46,62.81,0.0,0.0,9.65,9.65,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008487,MBR00000333,Professional,2023-10-28,2023-10-28,2023-11-11,PLN3393,1847081578,1847081578,Urology,Out-of-Network,F32.9,F41.9,,,,,,,0,,80053,Pathology/Lab,,,,49,Independent Clinic,3,57.56,38.32,38.26,0.0,0.0,0.06,0.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008488,MBR00000333,Professional,2021-06-27,2021-06-27,2021-08-09,PLN7414,1139906830,1139906830,Endocrinology,Out-of-Network,Z00.00,N39.0,,,,,,,0,,84443,Pathology/Lab,,,,12,Home,1,109.67,74.3,0.0,74.3,15.0,0.0,89.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008489,MBR00000334,Institutional-OP,2021-11-04,2021-11-04,2021-11-23,PLN9444,1550154147,1550154147,Outpatient Clinic,In-Network,E66.9,E78.5,,,,,,,0,,97110,Medicine,,,0636,22,Outpatient Hospital,2,258.24,212.68,0.0,212.68,75.0,0.0,287.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008490,MBR00000334,Professional,2022-01-21,2022-01-21,2022-02-17,PLN6394,1865904917,1865904917,Outpatient Clinic,In-Network,N39.0,G20,,,,,,,0,,66984,Surgery,,,,11,Office,1,1336.02,409.53,409.53,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008491,MBR00000334,Professional,2023-06-09,2023-06-09,2023-06-22,PLN7162,1125190055,1125190055,Nephrology,In-Network,E11.9,S72.001A,,,,,,,0,,90460,Medicine,,,,22,Outpatient Hospital,2,44.66,19.8,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008492,MBR00000334,Institutional-IP,2022-03-22,2022-03-30,2022-04-17,PLN7090,1337791138,1337791138,Internal Medicine,Out-of-Network,G20,J18.9,,,,196,MS-DRG,3,8,Y,70450,Radiology,,,0370,21,Inpatient Hospital,2,1574.68,875.7,0.0,101.29,50.0,0.0,151.29,0.0,Denied,CO-4,,1,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000008493,MBR00000334,Professional,2021-02-17,2021-02-17,2021-03-23,PLN9385,1644128543,1644128543,Gastroenterology,In-Network,I10,E78.5,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,1,79.99,52.99,0.0,52.99,25.0,0.0,77.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008494,MBR00000334,Institutional-OP,2022-10-04,2022-10-04,2022-10-16,PLN8113,1845900543,1845900543,ASC,In-Network,R05,C50.912,,,,,,,0,,78452,Radiology,,,0730,22,Outpatient Hospital,3,2594.02,1926.42,1818.73,0.0,50.0,57.69,107.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008495,MBR00000334,Institutional-OP,2021-06-10,2021-06-10,2021-07-10,PLN1886,1845900543,1845900543,ASC,In-Network,I11.9,Z51.11,,,,,,,0,,99283,E&M,,,0370,22,Outpatient Hospital,1,500.82,176.75,0.0,10.97,15.0,0.0,25.97,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008496,MBR00000334,Professional,2022-12-08,2022-12-08,2022-12-26,PLN2872,1545347862,1545347862,SNF,In-Network,K21.0,N18.3,,,,,,,0,,90460,Medicine,,,,49,Independent Clinic,3,28.35,16.67,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008497,MBR00000334,Institutional-OP,2023-07-28,2023-07-28,2023-08-17,PLN2620,1475984649,1475984649,SNF,In-Network,E66.9,N18.3,,,,,,,0,,99233,E&M,,,0636,22,Outpatient Hospital,1,510.45,379.01,340.71,0.0,0.0,38.3,38.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008498,MBR00000334,Professional,2021-03-16,2021-03-16,2021-03-24,PLN3938,1606140917,1606140917,ASC,In-Network,E66.9,E11.9,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,2,224.56,83.02,0.0,83.02,0.0,0.0,83.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008499,MBR00000334,Professional,2023-12-25,2023-12-25,2024-01-12,PLN9440,1745114564,1745114564,Endocrinology,In-Network,E78.5,J06.9,,,,,,,0,,G0468,Medicine,,,,11,Office,2,293.49,157.84,69.24,0.0,75.0,13.6,88.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008500,MBR00000334,Institutional-IP,2022-12-28,2023-01-01,2023-02-07,PLN5791,1227362142,1227362142,DME Supplier,In-Network,I10,M17.11,,,,603,MS-DRG,17,4,N,99233,E&M,,,0730,21,Inpatient Hospital,3,366.3,168.98,118.98,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008501,MBR00000334,Institutional-OP,2021-02-26,2021-02-26,2021-04-07,PLN4626,1266606767,1266606767,ASC,In-Network,Z12.31,R05,,,,,,,0,,G0439,Medicine,,,0120,22,Outpatient Hospital,2,255.59,114.89,0.0,114.89,0.0,0.0,114.89,0.0,Pended,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000008502,MBR00000334,Professional,2021-08-29,2021-08-29,2021-10-08,PLN8684,1845057593,1845057593,Orthopedic Surgery,In-Network,Z12.31,G43.909,,,,,,,0,,G0468,Medicine,,,,49,Independent Clinic,3,628.21,284.94,284.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008503,MBR00000334,Professional,2021-07-03,2021-07-03,2021-07-15,PLN4091,1139906830,1139906830,Endocrinology,Out-of-Network,F32.9,J06.9,,,,,,,0,,74177,Radiology,,,,21,Inpatient Hospital,1,2391.12,843.34,664.45,0.0,15.0,163.89,178.89,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008504,MBR00000334,Institutional-OP,2023-08-26,2023-08-26,2023-10-06,PLN2454,1118885473,1118885473,ASC,In-Network,Z00.00,Z79.4,,,,,,,0,,99406,Medicine,,,0320,22,Outpatient Hospital,1,37.29,13.67,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008505,MBR00000334,Institutional-IP,2023-03-03,2023-03-07,2023-04-01,PLN9898,1997536841,1997536841,Family Medicine,Out-of-Network,F41.9,F41.9,,,,291,MS-DRG,20,4,Y,80061,Pathology/Lab,,,0450,21,Inpatient Hospital,3,87.48,70.85,37.1,0.0,25.0,8.75,33.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008506,MBR00000334,Professional,2022-02-13,2022-02-13,2022-03-02,PLN6897,1475984649,1475984649,SNF,In-Network,Z23,M54.5,,,,,,,0,,74177,Radiology,,,,11,Office,2,1444.32,1053.05,965.99,72.06,15.0,0.0,87.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008507,MBR00000334,Professional,2022-08-03,2022-08-03,2022-08-10,PLN1069,1812060197,1812060197,Oncology,Out-of-Network,I63.9,J06.9,,,,,,,0,,76700,Radiology,,,,11,Office,3,1096.54,431.15,332.05,0.0,50.0,49.1,99.1,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008508,MBR00000334,Institutional-IP,2022-01-17,2022-01-20,2022-02-20,PLN6624,1236418230,1236418230,DME Supplier,In-Network,Z12.31,M81.0,,,,195,MS-DRG,14,3,U,87491,Pathology/Lab,,,0740,21,Inpatient Hospital,1,108.18,64.43,0.0,64.43,0.0,0.0,64.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008509,MBR00000334,Institutional-IP,2022-03-21,2022-03-24,2022-04-08,PLN4121,1148984206,1148984206,Psychiatry,In-Network,M17.11,Z51.11,,,,871,MS-DRG,15,3,Y,99213,E&M,,,0320,21,Inpatient Hospital,3,308.53,222.04,44.45,100.87,75.0,1.72,177.59,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008510,MBR00000334,Professional,2022-11-30,2022-11-30,2023-01-02,PLN9437,1268679390,1268679390,Critical Access Hospital,In-Network,Z12.31,J06.9,,,,,,,0,,93306,Radiology,,,,12,Home,2,2486.76,1164.15,0.0,88.01,35.0,202.23,325.24,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008511,MBR00000334,Professional,2021-08-01,2021-08-01,2021-08-15,PLN4021,1103747954,1103747954,Urology,In-Network,N39.0,E11.9,,,,,,,0,,99213,E&M,,,,50,Federally Qualified Health Center,1,330.25,111.99,35.91,0.0,75.0,1.08,76.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008512,MBR00000334,Professional,2023-04-12,2023-04-12,2023-05-21,PLN2599,1939033455,1939033455,Pulmonology,In-Network,J06.9,N39.0,,,,,,,0,,90460,Medicine,,,,49,Independent Clinic,2,32.96,18.54,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008513,MBR00000334,Institutional-OP,2023-11-02,2023-11-02,2023-11-10,PLN5020,1561134315,1561134315,DME Supplier,In-Network,N39.0,E66.9,,,,,,,0,,82043,Pathology/Lab,,,0636,22,Outpatient Hospital,1,29.48,22.97,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008514,MBR00000334,Institutional-OP,2023-12-03,2023-12-03,2023-12-23,PLN9427,1313212303,1313212303,Family Medicine,In-Network,Z12.31,I10,,,,,,,0,,99222,E&M,,,0301,22,Outpatient Hospital,2,318.18,145.79,68.54,0.0,75.0,2.25,77.25,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008515,MBR00000334,Institutional-IP,2021-07-08,2021-07-17,2021-07-21,PLN4890,1990090423,1990090423,Orthopedic Surgery,In-Network,F32.9,F41.9,,,,196,MS-DRG,12,9,Y,G0444,Medicine,,,0360,21,Inpatient Hospital,3,102.77,62.71,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000008516,MBR00000334,Institutional-IP,2022-03-27,2022-04-02,2022-04-05,PLN1941,1530904931,1530904931,Internal Medicine,In-Network,F32.9,Z00.00,,,,690,MS-DRG,4,6,Y,90837,Medicine,,,0510,21,Inpatient Hospital,3,408.98,157.38,0.0,157.38,0.0,0.0,157.38,0.0,Denied,CO-29,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000008517,MBR00000334,Professional,2021-10-18,2021-10-18,2021-10-31,PLN8064,1939033455,1939033455,Pulmonology,In-Network,E66.9,I25.10,,,,,,,0,,74177,Radiology,,,,11,Office,3,1024.94,395.29,337.94,42.35,15.0,0.0,57.35,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008518,MBR00000334,Institutional-OP,2022-11-27,2022-11-27,2022-12-17,PLN3055,1606140917,1606140917,ASC,In-Network,Z12.31,E11.9,,,,,,,0,,99204,E&M,,,0200,22,Outpatient Hospital,2,548.21,390.85,340.85,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008519,MBR00000334,Institutional-OP,2021-12-22,2021-12-22,2022-01-18,PLN1633,1366576336,1366576336,Geriatrics,In-Network,I10,M54.5,,,,,,,0,,90686,Medicine,,,0270,22,Outpatient Hospital,3,107.75,46.78,0.0,46.78,0.0,0.0,46.78,0.0,Paid,,,0,,0,1,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000008520,MBR00000334,Institutional-OP,2022-03-09,2022-03-09,2022-04-07,PLN8047,1845057593,1845057593,Orthopedic Surgery,In-Network,E11.40,J06.9,,,,,,,0,,G0468,Medicine,,,0900,22,Outpatient Hospital,2,351.2,171.04,0.0,171.04,0.0,0.0,171.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008521,MBR00000334,Institutional-OP,2021-06-01,2021-06-01,2021-06-30,PLN7037,1186826716,1186826716,Physical Therapy,In-Network,F41.9,F41.9,,,,,,,0,,99283,E&M,,,0360,22,Outpatient Hospital,1,388.49,309.23,262.75,0.0,25.0,21.48,46.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008522,MBR00000334,Institutional-OP,2022-09-06,2022-09-06,2022-09-15,PLN8717,1645194539,1645194539,SNF,In-Network,Z87.891,M17.11,,,,,,,0,,23472,Surgery,,,0320,22,Outpatient Hospital,1,6311.27,4133.57,4118.57,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008523,MBR00000334,Professional,2022-08-11,2022-08-11,2022-09-22,PLN8602,1812060197,1812060197,Oncology,Out-of-Network,Z23,Z12.31,,,,,,,0,,G0468,Medicine,,,,11,Office,3,552.16,313.74,78.57,185.17,50.0,0.0,235.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008524,MBR00000334,Professional,2022-08-27,2022-08-27,2022-09-22,PLN3169,1511044648,1511044648,Endocrinology,In-Network,J44.1,K21.0,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,1,28.68,16.7,1.7,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008525,MBR00000334,Professional,2022-01-09,2022-01-09,2022-02-21,PLN1751,1915531927,1915531927,Critical Access Hospital,In-Network,E78.5,Z23,,,,,,,0,,90686,Medicine,,,,22,Outpatient Hospital,3,54.95,23.45,0.0,23.45,0.0,0.0,23.45,0.0,Paid,,,0,,0,1,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000008526,MBR00000334,Professional,2023-04-08,2023-04-08,2023-05-15,PLN4900,1872613201,1872613201,Internal Medicine,In-Network,E66.9,J18.9,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,3,49.69,27.71,2.71,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008527,MBR00000334,Institutional-OP,2022-10-28,2022-10-28,2022-11-20,PLN4216,1193493783,1193493783,Critical Access Hospital,Out-of-Network,E78.5,I10,,,,,,,0,,99284,E&M,,,0200,22,Outpatient Hospital,2,724.09,505.56,0.0,101.81,0.0,0.0,101.81,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008528,MBR00000334,Professional,2021-07-13,2021-07-13,2021-08-03,PLN9564,1806688928,1806688928,Geriatrics,In-Network,M17.11,M81.0,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,2,90.14,55.29,0.0,55.29,15.0,0.0,70.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008529,MBR00000335,Professional,2022-02-07,2022-02-07,2022-03-03,PLN6953,1453936007,1453936007,ASC,In-Network,J06.9,G43.909,,,,,,,0,,58661,Surgery,,,,11,Office,2,2579.23,1783.79,1574.23,0.0,0.0,209.56,209.56,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008530,MBR00000335,Professional,2022-12-25,2022-12-25,2023-01-14,PLN4984,1434029575,1434029575,Endocrinology,In-Network,E11.9,Z12.31,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,3,66.48,47.05,18.92,0.0,25.0,3.13,28.13,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008531,MBR00000335,Professional,2021-05-08,2021-05-08,2021-05-26,PLN4029,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,E11.9,K57.30,,,,,,,0,,45380,Surgery,,,,23,Emergency Room,1,3074.43,1452.59,1258.24,0.0,0.0,194.35,194.35,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,1,0,0,0
CLM0000008532,MBR00000335,Professional,2022-01-21,2022-01-21,2022-02-12,PLN5509,1752470395,1752470395,Home Health,In-Network,J20.9,Z12.31,,,,,,,0,,93225,Medicine,,,,11,Office,3,396.82,260.97,56.64,169.33,35.0,0.0,204.33,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008533,MBR00000335,Professional,2023-08-14,2023-08-14,2023-09-20,PLN6989,1103747954,1103747954,Urology,In-Network,F41.9,I10,,,,,,,0,,93306,Radiology,,,,23,Emergency Room,1,2894.21,1743.61,1743.61,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008534,MBR00000335,Professional,2022-04-29,2022-04-29,2022-05-24,PLN1738,1948810580,1948810580,DME Supplier,In-Network,Z87.891,I10,,,,,,,0,,45378,Surgery,,,,49,Independent Clinic,2,1829.62,899.36,702.68,177.12,0.0,19.56,196.68,0.0,Pended,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000008535,MBR00000335,Professional,2022-07-13,2022-07-13,2022-07-25,PLN7138,1891849440,1891849440,Oncology,In-Network,K92.1,I10,,,,,,,0,,99214,E&M,,,,12,Home,2,311.65,156.01,0.0,156.01,0.0,0.0,156.01,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008536,MBR00000335,Institutional-IP,2023-01-17,2023-01-19,2023-01-30,PLN8307,1135158374,1135158374,Pulmonology,In-Network,Z00.00,R07.9,,,,603,MS-DRG,6,2,Y,87491,Pathology/Lab,,,0450,21,Inpatient Hospital,3,131.26,109.94,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008537,MBR00000335,Institutional-IP,2021-12-19,2021-12-23,2022-01-14,PLN9188,1528335731,1528335731,Critical Access Hospital,In-Network,M81.0,E78.5,,,,291,MS-DRG,8,4,N,G0468,Medicine,,,0730,21,Inpatient Hospital,1,752.36,566.28,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008538,MBR00000335,Professional,2023-06-24,2023-06-24,2023-08-05,PLN8757,1132188260,1132188260,Family Medicine,In-Network,G20,I10,,,,,,,0,,90460,Medicine,,,,22,Outpatient Hospital,2,37.66,25.29,25.29,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008539,MBR00000335,Institutional-OP,2021-01-18,2021-01-18,2021-02-08,PLN9494,1450553056,1450553056,Clinical Laboratory,In-Network,Z87.891,N39.0,,,,,,,0,,G0468,Medicine,,,0636,22,Outpatient Hospital,2,746.03,500.73,500.73,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008540,MBR00000336,Professional,2022-06-02,2022-06-02,2022-06-17,PLN2684,1872272835,1872272835,Internal Medicine,In-Network,M17.11,J18.9,,,,,,,0,,99233,E&M,,,,11,Office,1,466.58,384.03,74.61,309.42,0.0,0.0,309.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008541,MBR00000336,Institutional-IP,2022-10-17,2022-10-19,2022-11-08,PLN8520,1366426662,1366426662,Urology,In-Network,R10.9,E11.40,,,,292,MS-DRG,16,2,Y,93000,Radiology,,,0370,21,Inpatient Hospital,1,172.72,63.95,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008542,MBR00000336,Institutional-OP,2021-09-19,2021-09-19,2021-10-23,PLN7685,1812060197,1812060197,Oncology,Out-of-Network,K57.30,I25.10,,,,,,,0,,85610,Pathology/Lab,,,0120,22,Outpatient Hospital,2,43.68,18.13,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008543,MBR00000336,Institutional-OP,2023-05-07,2023-05-07,2023-06-08,PLN5464,1689639685,1689639685,SNF,In-Network,M54.5,I10,,,,,,,0,,99221,E&M,,,0301,22,Outpatient Hospital,3,291.65,219.86,4.47,215.39,0.0,0.0,215.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008544,MBR00000336,Professional,2021-03-28,2021-03-28,2021-04-23,PLN7526,1790497490,1790497490,OB/GYN,In-Network,K21.0,I10,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,1,6561.13,4848.95,4688.57,160.38,0.0,0.0,160.38,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008545,MBR00000336,Professional,2022-12-13,2022-12-13,2022-12-29,PLN8304,1236418230,1236418230,DME Supplier,In-Network,N39.0,R51,,,,,,,0,,84443,Pathology/Lab,,,,22,Outpatient Hospital,2,171.64,135.17,0.0,135.17,0.0,0.0,135.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008546,MBR00000336,Institutional-OP,2022-11-25,2022-11-25,2022-12-10,PLN9526,1968299309,1968299309,Internal Medicine,In-Network,I10,C50.912,,,,,,,0,,93225,Medicine,,,0730,22,Outpatient Hospital,2,555.98,429.75,0.0,372.81,75.0,0.0,447.81,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008547,MBR00000336,Institutional-IP,2023-05-13,2023-05-26,2023-06-11,PLN3200,1689639685,1689639685,SNF,In-Network,E11.9,I10,,,,690,MS-DRG,12,13,N,99204,E&M,,,0900,21,Inpatient Hospital,1,364.12,138.9,18.44,120.46,0.0,0.0,120.46,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000008548,MBR00000336,Institutional-OP,2021-08-15,2021-08-15,2021-09-19,PLN9898,1891849440,1891849440,Oncology,In-Network,F32.9,Z79.4,,,,,,,0,,84443,Pathology/Lab,,,0120,22,Outpatient Hospital,2,69.92,27.24,0.0,27.24,75.0,0.0,102.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008549,MBR00000336,Professional,2021-06-19,2021-06-19,2021-07-01,PLN8078,1935547131,1935547131,Pulmonology,In-Network,E78.5,Z12.31,,,,,,,0,,58661,Surgery,,,,12,Home,2,4017.11,1787.45,1655.6,131.85,0.0,0.0,131.85,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008550,MBR00000336,Institutional-OP,2022-09-28,2022-09-28,2022-10-17,PLN6448,1125190055,1125190055,Nephrology,In-Network,J20.9,M54.5,,,,,,,0,,47562,Surgery,,,0740,22,Outpatient Hospital,3,5556.24,2648.44,2648.44,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008551,MBR00000336,Institutional-OP,2023-12-01,2023-12-01,2023-12-28,PLN2809,1563980627,1563980627,Critical Access Hospital,In-Network,M81.0,Z00.00,,,,,,,0,,99283,E&M,,,0761,22,Outpatient Hospital,3,535.68,206.28,0.0,206.28,75.0,0.0,281.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008552,MBR00000336,Institutional-OP,2023-05-10,2023-05-10,2023-06-14,PLN1842,1896447406,1896447406,Nephrology,Out-of-Network,M81.0,I11.9,,,,,,,0,,84443,Pathology/Lab,,,0740,22,Outpatient Hospital,1,75.53,38.89,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008553,MBR00000336,Institutional-OP,2021-08-20,2021-08-20,2021-09-15,PLN8455,1856686341,1856686341,Geriatrics,In-Network,E11.9,J06.9,,,,,,,0,,99203,E&M,,,0636,22,Outpatient Hospital,3,144.5,101.28,101.28,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008554,MBR00000336,Professional,2022-03-23,2022-03-23,2022-04-04,PLN1854,1213165847,1213165847,Critical Access Hospital,In-Network,E11.9,I10,,,,,,,0,,81001,Pathology/Lab,,,,12,Home,1,51.35,33.37,33.37,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008555,MBR00000336,Professional,2021-10-20,2021-10-20,2021-11-29,PLN9760,1124394415,1124394415,Pediatrics,In-Network,N18.3,F10.20,,,,,,,0,,99203,E&M,,,,49,Independent Clinic,2,186.81,138.4,123.4,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008556,MBR00000336,Institutional-IP,2023-05-04,2023-05-12,2023-05-31,PLN7968,1700633438,1700633438,DME Supplier,In-Network,M54.5,E78.5,,,,196,MS-DRG,12,8,Y,27447,Surgery,,,0636,21,Inpatient Hospital,2,4405.49,1465.64,1390.64,0.0,75.0,0.0,75.0,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008557,MBR00000336,Institutional-IP,2022-07-16,2022-07-19,2022-07-27,PLN2479,1778483301,1778483301,Home Health,In-Network,Z12.11,N18.3,,,,194,MS-DRG,24,3,Y,81001,Pathology/Lab,,,0730,21,Inpatient Hospital,2,38.83,11.83,11.83,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008558,MBR00000336,Professional,2022-04-25,2022-04-25,2022-05-20,PLN6471,1800011727,1800011727,Clinical Laboratory,Out-of-Network,J44.1,G20,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,1,4345.61,3494.01,3042.49,376.52,75.0,0.0,451.52,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008559,MBR00000336,Professional,2021-01-06,2021-01-06,2021-01-28,PLN5436,1236418230,1236418230,DME Supplier,In-Network,E11.9,E11.9,,,,,,,0,,99203,E&M,,,,11,Office,2,321.92,157.45,148.41,0.0,0.0,9.04,9.04,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000008560,MBR00000336,Institutional-IP,2022-11-25,2022-12-02,2023-01-04,PLN1987,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,I10,N39.0,,,,195,MS-DRG,13,7,W,85025,Pathology/Lab,,,0510,21,Inpatient Hospital,1,91.25,36.65,10.63,0.0,25.0,1.02,26.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008561,MBR00000336,Professional,2022-04-30,2022-04-30,2022-05-16,PLN5356,1691062876,1691062876,SNF,In-Network,E11.65,I10,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,3,4834.88,2006.17,1971.17,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008562,MBR00000336,Institutional-OP,2021-02-13,2021-02-13,2021-03-12,PLN3365,1980712759,1980712759,Outpatient Clinic,Out-of-Network,J06.9,S72.001A,,,,,,,0,,33533,Surgery,,,0510,22,Outpatient Hospital,2,24609.35,13021.92,13002.11,19.81,0.0,0.0,19.81,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000008563,MBR00000336,Institutional-OP,2021-08-03,2021-08-03,2021-09-12,PLN3460,1518055405,1518055405,Urology,In-Network,I10,J06.9,,,,,,,0,,93306,Radiology,,,0320,22,Outpatient Hospital,1,3289.31,2232.77,2182.77,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008564,MBR00000336,Professional,2023-03-07,2023-03-07,2023-04-15,PLN6146,1865904917,1865904917,Outpatient Clinic,In-Network,E11.9,F41.9,,,,,,,0,,78452,Radiology,,,,11,Office,3,4458.32,2330.5,2245.47,85.03,0.0,0.0,85.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008565,MBR00000336,Institutional-OP,2023-04-01,2023-04-01,2023-04-14,PLN4932,1585582070,1585582070,Outpatient Clinic,In-Network,G43.909,E11.65,,,,,,,0,,G0444,Medicine,,,0270,22,Outpatient Hospital,2,84.12,55.09,25.38,0.0,25.0,4.71,29.71,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000008566,MBR00000337,Professional,2022-06-25,2022-06-25,2022-07-14,PLN7486,1475984649,1475984649,SNF,In-Network,K21.0,R05,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,3,343.33,112.8,112.8,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008567,MBR00000337,Professional,2023-04-10,2023-04-10,2023-05-23,PLN9497,1337791138,1337791138,Internal Medicine,Out-of-Network,Z12.31,J06.9,,,,,,,0,,93000,Radiology,,,,22,Outpatient Hospital,2,73.29,48.83,0.0,48.83,35.0,0.0,83.83,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008568,MBR00000337,Institutional-OP,2023-03-20,2023-03-20,2023-04-02,PLN9600,1284035364,1284035364,Pediatrics,In-Network,K21.0,Z12.31,,,,,,,0,,99283,E&M,,,0120,22,Outpatient Hospital,1,302.17,146.95,114.48,0.0,25.0,7.47,32.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008569,MBR00000337,Professional,2022-11-06,2022-11-06,2022-12-14,PLN7907,1896447406,1896447406,Nephrology,Out-of-Network,N18.3,F32.9,,,,,,,0,,99283,E&M,,,,11,Office,3,418.87,212.07,212.07,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008570,MBR00000337,Professional,2021-08-17,2021-08-17,2021-09-22,PLN3405,1389336600,1389336600,Critical Access Hospital,In-Network,M81.0,Z00.00,,,,,,,0,,81001,Pathology/Lab,,,,22,Outpatient Hospital,1,38.13,24.66,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008571,MBR00000337,Institutional-OP,2022-04-07,2022-04-07,2022-04-27,PLN7389,1242201429,1242201429,General Acute Care Hospital,In-Network,Z12.31,M54.5,,,,,,,0,,90837,Medicine,,,0450,22,Outpatient Hospital,1,200.64,113.81,48.27,61.77,0.0,3.77,65.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008572,MBR00000337,Professional,2023-06-13,2023-06-13,2023-07-10,PLN3982,1606140917,1606140917,ASC,In-Network,E11.9,E78.5,,,,,,,0,,45378,Surgery,,,,23,Emergency Room,2,2315.13,1674.05,1674.05,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,1,1,0,0,0,0,None,0,1,0,0,0
CLM0000008573,MBR00000337,Professional,2021-12-06,2021-12-06,2022-01-07,PLN6326,1139906830,1139906830,Endocrinology,Out-of-Network,M81.0,F41.9,,,,,,,0,,58661,Surgery,,,,65,End-Stage Renal Disease,1,2325.5,1294.74,1089.77,204.97,0.0,0.0,204.97,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008574,MBR00000337,Professional,2022-12-24,2022-12-24,2023-01-11,PLN8636,1219817751,1219817751,OB/GYN,In-Network,E78.5,E78.5,,,,,,,0,,70553,Radiology,,,,21,Inpatient Hospital,1,2547.19,1874.12,1807.65,66.47,0.0,0.0,66.47,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008575,MBR00000338,Professional,2023-06-26,2023-06-26,2023-07-28,PLN6718,1450553056,1450553056,Clinical Laboratory,In-Network,R05,I50.9,,,,,,,0,,76700,Radiology,,,,49,Independent Clinic,1,1011.39,511.12,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008576,MBR00000338,Professional,2022-08-07,2022-08-07,2022-09-10,PLN5922,1968299309,1968299309,Internal Medicine,In-Network,G43.909,E11.9,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,2,22.71,18.61,0.0,0.0,75.0,0.0,75.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008577,MBR00000338,Institutional-OP,2022-07-10,2022-07-10,2022-08-17,PLN1791,1422747896,1422747896,Urology,In-Network,Z00.00,F32.9,,,,,,,0,,27447,Surgery,,,0120,22,Outpatient Hospital,3,2483.18,890.22,573.8,258.18,0.0,58.24,316.42,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008578,MBR00000338,Professional,2021-07-25,2021-07-25,2021-08-29,PLN4798,1696843572,1696843572,Critical Access Hospital,Out-of-Network,E78.5,J06.9,,,,,,,0,,70450,Radiology,,,,12,Home,2,1480.27,511.13,414.05,0.0,15.0,82.08,97.08,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008579,MBR00000338,Professional,2022-06-28,2022-06-28,2022-07-31,PLN1670,1935547131,1935547131,Pulmonology,In-Network,Z23,N18.3,,,,,,,0,,99221,E&M,,,,11,Office,1,270.77,222.01,0.0,222.01,15.0,0.0,237.01,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008580,MBR00000338,Institutional-IP,2021-02-15,2021-02-17,2021-03-03,PLN7818,1366576336,1366576336,Geriatrics,In-Network,N40.0,E78.5,,,,195,MS-DRG,19,2,Y,86900,Pathology/Lab,,,0730,21,Inpatient Hospital,3,46.35,35.2,0.0,35.2,25.0,0.0,60.2,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008581,MBR00000338,Professional,2021-05-05,2021-05-05,2021-05-26,PLN3860,1132188260,1132188260,Family Medicine,In-Network,I10,E11.9,,,,,,,0,,71046,Radiology,,,,22,Outpatient Hospital,1,218.66,157.78,11.54,146.24,0.0,0.0,146.24,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008582,MBR00000338,Professional,2022-08-17,2022-08-17,2022-09-13,PLN4057,1390307371,1390307371,DME Supplier,In-Network,N17.9,I25.10,,,,,,,0,,93000,Radiology,,,,81,Independent Laboratory,2,143.72,92.85,77.85,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008583,MBR00000338,Institutional-OP,2021-08-28,2021-08-28,2021-09-08,PLN9170,1865904917,1865904917,Outpatient Clinic,In-Network,I50.9,E11.9,,,,,,,0,,99203,E&M,,,0370,22,Outpatient Hospital,2,330.59,164.31,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008584,MBR00000338,Institutional-OP,2022-01-16,2022-01-16,2022-02-25,PLN6684,1355166277,1355166277,Endocrinology,In-Network,I25.10,M54.5,,,,,,,0,,99204,E&M,,,0360,22,Outpatient Hospital,3,212.17,84.03,49.03,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008585,MBR00000338,Institutional-IP,2022-01-30,2022-02-02,2022-02-07,PLN5928,1717546253,1717546253,Family Medicine,In-Network,J20.9,E78.5,,,,682,MS-DRG,11,3,Y,99214,E&M,,,0320,21,Inpatient Hospital,1,399.09,270.75,205.32,15.43,50.0,0.0,65.43,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000008586,MBR00000338,Professional,2022-06-03,2022-06-03,2022-07-08,PLN6486,1948810580,1948810580,DME Supplier,In-Network,Z00.01,Z96.641,,,,,,,0,,99283,E&M,,,,11,Office,2,592.5,500.1,500.1,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008587,MBR00000338,Institutional-OP,2023-02-05,2023-02-05,2023-02-13,PLN8776,1964402759,1964402759,Outpatient Clinic,In-Network,F03.90,I50.9,,,,,,,0,,43239,Surgery,,,0900,22,Outpatient Hospital,2,1884.68,987.91,0.0,0.0,0.0,163.82,163.82,0.0,Denied,CO-4,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008588,MBR00000338,Institutional-IP,2022-05-04,2022-05-15,2022-05-27,PLN7681,1980712759,1980712759,Outpatient Clinic,Out-of-Network,R51,J44.1,,,,871,MS-DRG,13,11,Y,58661,Surgery,,,0510,21,Inpatient Hospital,1,2900.74,2222.84,2187.84,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000008589,MBR00000338,Professional,2023-07-15,2023-07-15,2023-08-26,PLN4003,1125190055,1125190055,Nephrology,In-Network,E66.9,I10,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,3,263.02,206.23,120.95,0.0,75.0,10.28,85.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008590,MBR00000338,Professional,2022-06-12,2022-06-12,2022-07-17,PLN2298,1273488618,1273488618,General Acute Care Hospital,In-Network,J06.9,Z23,,,,,,,0,,58661,Surgery,,,,50,Federally Qualified Health Center,2,4647.38,2473.5,2067.67,62.03,0.0,343.8,405.83,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008591,MBR00000338,Professional,2023-12-24,2023-12-24,2024-01-03,PLN5069,1168881145,1168881145,Orthopedic Surgery,In-Network,I10,Z00.00,,,,,,,0,,66984,Surgery,,,,20,Urgent Care,3,2171.34,1175.81,1078.92,0.0,0.0,96.89,96.89,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008592,MBR00000338,Institutional-OP,2023-12-31,2023-12-31,2024-01-31,PLN3612,1644128543,1644128543,Gastroenterology,In-Network,Z23,N39.0,,,,,,,0,,99213,E&M,,,0320,22,Outpatient Hospital,3,250.86,110.64,95.35,0.0,0.0,15.29,15.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008593,MBR00000338,Institutional-IP,2022-04-14,2022-04-18,2022-05-15,PLN4600,1752470395,1752470395,Home Health,In-Network,Z12.11,I10,,,,641,MS-DRG,24,4,N,99284,E&M,,,0120,21,Inpatient Hospital,2,861.15,276.79,70.04,206.75,0.0,0.0,206.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008594,MBR00000338,Professional,2023-04-19,2023-04-19,2023-05-25,PLN7248,1622771872,1622771872,Pediatrics,In-Network,Z12.11,Z00.00,,,,,,,0,,84443,Pathology/Lab,,,,20,Urgent Care,3,83.01,56.9,0.0,56.9,0.0,0.0,56.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008595,MBR00000338,Professional,2022-05-12,2022-05-12,2022-06-04,PLN5550,1124394415,1124394415,Pediatrics,In-Network,E11.9,J06.9,,,,,,,0,,G0444,Medicine,,,,11,Office,2,46.96,37.08,0.0,0.0,50.0,0.0,50.0,0.0,Pended,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000008596,MBR00000338,Institutional-OP,2023-08-17,2023-08-17,2023-09-11,PLN5139,1103747954,1103747954,Urology,In-Network,E11.9,J18.9,,,,,,,0,,99222,E&M,,,0301,22,Outpatient Hospital,2,236.35,82.13,80.73,0.0,0.0,1.4,1.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008597,MBR00000338,Professional,2023-04-19,2023-04-19,2023-05-08,PLN6758,1463205530,1463205530,Nephrology,In-Network,K21.0,E78.5,,,,,,,0,,23472,Surgery,,,,81,Independent Laboratory,3,7561.13,3246.96,3221.96,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008598,MBR00000338,Institutional-OP,2022-01-06,2022-01-06,2022-01-28,PLN4452,1227362142,1227362142,DME Supplier,In-Network,N39.0,Z12.31,,,,,,,0,,99221,E&M,,,0270,22,Outpatient Hospital,3,354.93,284.37,284.37,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000008599,MBR00000338,Institutional-OP,2021-12-18,2021-12-18,2022-01-18,PLN6059,1717546253,1717546253,Family Medicine,In-Network,J20.9,N39.0,,,,,,,0,,99233,E&M,,,0320,22,Outpatient Hospital,3,523.45,303.33,49.78,203.55,50.0,0.0,253.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008600,MBR00000338,Institutional-OP,2023-08-23,2023-08-23,2023-09-26,PLN2097,1139906830,1139906830,Endocrinology,Out-of-Network,R05,E78.5,,,,,,,0,,99213,E&M,,,0360,22,Outpatient Hospital,1,247.88,79.79,4.79,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008601,MBR00000338,Professional,2022-08-15,2022-08-15,2022-09-13,PLN9148,1563980627,1563980627,Critical Access Hospital,In-Network,J20.9,Z12.11,,,,,,,0,,27130,Surgery,,,,11,Office,2,6142.26,3278.49,3278.49,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008602,MBR00000338,Institutional-OP,2023-01-31,2023-01-31,2023-02-12,PLN6291,1561134315,1561134315,DME Supplier,In-Network,I25.10,I10,,,,,,,0,,27130,Surgery,,,0270,22,Outpatient Hospital,2,6125.76,4382.79,3983.27,364.52,35.0,0.0,399.52,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008603,MBR00000338,Professional,2023-01-12,2023-01-12,2023-02-19,PLN5281,1502838586,1502838586,ASC,In-Network,K21.0,M17.11,,,,,,,0,,27130,Surgery,,,,11,Office,3,3036.93,1484.41,1484.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008604,MBR00000338,Institutional-OP,2021-07-01,2021-07-01,2021-07-10,PLN2869,1872613201,1872613201,Internal Medicine,In-Network,F32.9,E11.65,,,,,,,0,,33533,Surgery,,,0200,22,Outpatient Hospital,1,12616.15,8292.5,8277.5,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000008605,MBR00000338,Professional,2021-09-16,2021-09-16,2021-10-05,PLN2290,1213165847,1213165847,Critical Access Hospital,In-Network,I25.10,K92.1,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,3,3456.93,1847.37,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-119,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008606,MBR00000338,Institutional-IP,2023-09-13,2023-09-22,2023-10-13,PLN6760,1845900543,1845900543,ASC,In-Network,J18.9,K92.1,,,,683,MS-DRG,12,9,Y,23472,Surgery,,,0636,21,Inpatient Hospital,3,3215.69,1210.75,1132.22,78.53,0.0,0.0,78.53,0.0,Paid,,,0,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000008607,MBR00000338,Professional,2021-11-03,2021-11-03,2021-12-15,PLN5791,1273488618,1273488618,General Acute Care Hospital,In-Network,R07.9,E78.5,,,,,,,0,,99283,E&M,,,,20,Urgent Care,1,291.42,155.18,140.18,0.0,15.0,0.0,15.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008608,MBR00000338,Institutional-OP,2023-08-09,2023-08-09,2023-09-04,PLN1740,1295371663,1295371663,Critical Access Hospital,In-Network,R10.9,J18.9,,,,,,,0,,99213,E&M,,,0761,22,Outpatient Hospital,1,291.71,96.51,96.51,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008609,MBR00000338,Professional,2022-01-26,2022-01-26,2022-02-15,PLN4366,1135158374,1135158374,Pulmonology,In-Network,K21.0,M54.5,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,1,433.44,151.06,0.0,151.06,35.0,0.0,186.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008610,MBR00000338,Professional,2023-07-17,2023-07-17,2023-08-18,PLN6535,1585582070,1585582070,Outpatient Clinic,In-Network,E11.9,Z96.641,,,,,,,0,,72148,Radiology,,,,11,Office,1,1356.62,877.85,852.85,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008611,MBR00000338,Institutional-OP,2022-09-25,2022-09-25,2022-10-28,PLN8163,1528335731,1528335731,Critical Access Hospital,In-Network,F03.90,Z87.891,,,,,,,0,,23472,Surgery,,,0270,22,Outpatient Hospital,1,7278.64,5482.73,5447.73,0.0,35.0,0.0,35.0,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008612,MBR00000338,Professional,2021-04-19,2021-04-19,2021-05-05,PLN8653,1716521444,1716521444,Oncology,In-Network,G43.909,Z00.00,,,,,,,0,,99213,E&M,,,,11,Office,3,214.53,67.56,0.0,67.56,0.0,0.0,67.56,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008613,MBR00000338,Professional,2021-10-24,2021-10-24,2021-11-12,PLN6511,1948810580,1948810580,DME Supplier,In-Network,M54.5,I10,,,,,,,0,,99204,E&M,,,,50,Federally Qualified Health Center,1,567.69,298.14,298.14,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008614,MBR00000338,Professional,2023-11-10,2023-11-10,2023-11-20,PLN8081,1946680931,1946680931,Critical Access Hospital,Out-of-Network,J44.1,R05,,,,,,,0,,76700,Radiology,,,,11,Office,3,641.94,320.72,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-4,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008615,MBR00000338,Institutional-OP,2021-08-16,2021-08-16,2021-09-15,PLN3389,1502838586,1502838586,ASC,In-Network,E78.5,J20.9,,,,,,,0,,93225,Medicine,,,0730,22,Outpatient Hospital,1,356.89,169.19,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008616,MBR00000338,Institutional-IP,2021-09-07,2021-09-08,2021-09-30,PLN4317,1571574052,1571574052,Critical Access Hospital,In-Network,E66.9,I48.91,,,,194,MS-DRG,20,1,Y,99284,E&M,,,0320,21,Inpatient Hospital,1,845.44,337.63,293.28,32.68,0.0,11.67,44.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008617,MBR00000338,Institutional-IP,2021-06-13,2021-06-15,2021-06-20,PLN8374,1530904931,1530904931,Internal Medicine,In-Network,J06.9,S72.001A,,,,871,MS-DRG,3,2,Y,77067,Radiology,,,0120,21,Inpatient Hospital,2,473.19,374.67,319.42,0.0,0.0,55.25,55.25,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000008618,MBR00000338,Institutional-OP,2022-10-30,2022-10-30,2022-11-06,PLN5925,1847081578,1847081578,Urology,Out-of-Network,E78.5,Z00.00,,,,,,,0,,99213,E&M,,,0510,22,Outpatient Hospital,1,232.48,135.85,135.85,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008619,MBR00000338,Institutional-OP,2023-06-06,2023-06-06,2023-06-16,PLN2124,1198133277,1198133277,SNF,In-Network,Z79.4,I10,,,,,,,0,,99232,E&M,,,0730,22,Outpatient Hospital,1,235.18,154.45,0.0,0.13,0.0,0.0,0.13,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008620,MBR00000338,Professional,2023-10-23,2023-10-23,2023-11-12,PLN3230,1716521444,1716521444,Oncology,In-Network,E11.9,R10.9,,,,,,,0,,99283,E&M,,,,11,Office,2,625.57,201.92,201.92,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008621,MBR00000338,Professional,2023-08-29,2023-08-29,2023-10-04,PLN8371,1939033455,1939033455,Pulmonology,In-Network,J20.9,N18.3,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,1,1391.39,955.11,776.7,128.41,50.0,0.0,178.41,0.0,Paid,,,0,,0,0,1,0,0,1,Duplicate,0,0,0,0,0
CLM0000008622,MBR00000338,Institutional-IP,2023-08-26,2023-09-01,2023-09-02,PLN2109,1609526529,1609526529,Psychiatry,In-Network,E78.5,E11.65,,,,195,MS-DRG,4,6,Y,99213,E&M,,,0320,21,Inpatient Hospital,3,189.64,65.07,61.75,0.0,0.0,3.32,3.32,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008623,MBR00000338,Institutional-IP,2023-09-18,2023-09-21,2023-10-18,PLN8134,1631954542,1631954542,Oncology,In-Network,M54.5,M54.5,,,,683,MS-DRG,11,3,Y,27447,Surgery,,,0200,21,Inpatient Hospital,3,4428.05,3122.65,2401.45,281.15,15.0,425.05,721.2,0.0,Paid,,,0,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000008624,MBR00000338,Professional,2022-09-14,2022-09-14,2022-10-02,PLN7542,1530904931,1530904931,Internal Medicine,In-Network,I10,E11.9,,,,,,,0,,97530,Medicine,,,,21,Inpatient Hospital,1,312.21,205.35,106.48,98.87,0.0,0.0,98.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008625,MBR00000339,Institutional-OP,2023-06-19,2023-06-19,2023-07-11,PLN1073,1702692193,1702692193,Physical Therapy,In-Network,Z00.00,Z12.31,,,,,,,0,,99283,E&M,,,0320,22,Outpatient Hospital,1,261.71,93.03,0.0,93.03,0.0,0.0,93.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008626,MBR00000339,Professional,2022-11-27,2022-11-27,2022-12-21,PLN3591,1899127912,1899127912,Neurology,In-Network,N18.3,E11.9,,,,,,,0,,70450,Radiology,,,,12,Home,2,650.34,248.11,163.41,84.7,0.0,0.0,84.7,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008627,MBR00000339,Professional,2021-05-31,2021-05-31,2021-06-18,PLN7013,1696843572,1696843572,Critical Access Hospital,Out-of-Network,J20.9,Z12.31,,,,,,,0,,99203,E&M,,,,11,Office,3,342.74,206.26,191.26,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008628,MBR00000339,Professional,2021-01-27,2021-01-27,2021-02-15,PLN3156,1790497490,1790497490,OB/GYN,In-Network,R10.9,R51,,,,,,,0,,78452,Radiology,,,,11,Office,2,3969.99,2510.02,2069.93,440.09,0.0,0.0,440.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008629,MBR00000339,Institutional-OP,2021-04-18,2021-04-18,2021-05-31,PLN2141,1453936007,1453936007,ASC,In-Network,Z23,I63.9,,,,,,,0,,80061,Pathology/Lab,,,0320,22,Outpatient Hospital,3,77.64,33.63,0.0,33.63,0.0,0.0,33.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008630,MBR00000339,Professional,2022-01-14,2022-01-14,2022-02-19,PLN9281,1575695214,1575695214,SNF,In-Network,Z00.00,N40.0,,,,,,,0,,99214,E&M,,,,11,Office,2,417.24,182.95,182.95,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008631,MBR00000340,Professional,2022-07-01,2022-07-01,2022-07-08,PLN5682,1790497490,1790497490,OB/GYN,In-Network,F41.9,Z00.00,,,,,,,0,,45380,Surgery,,,,11,Office,3,1840.5,1552.69,1552.69,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000008632,MBR00000340,Professional,2022-12-01,2022-12-01,2022-12-11,PLN3191,1749494482,1749494482,Pediatrics,In-Network,Z00.00,F32.9,,,,,,,0,,47562,Surgery,,,,11,Office,1,5249.16,3398.37,3398.37,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,1,Phantom,0,0,0,0,0
CLM0000008633,MBR00000340,Institutional-OP,2022-07-25,2022-07-25,2022-08-26,PLN3016,1514306773,1514306773,Endocrinology,In-Network,E11.9,E11.9,,,,,,,0,,G0439,Medicine,,,0730,22,Outpatient Hospital,1,321.85,162.35,130.4,0.0,0.0,31.95,31.95,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000008634,MBR00000340,Professional,2022-02-06,2022-02-06,2022-03-09,PLN8454,1434029575,1434029575,Endocrinology,In-Network,K21.0,Z12.31,,,,,,,0,,99284,E&M,,,,21,Inpatient Hospital,3,757.07,258.88,225.51,0.0,0.0,33.37,33.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008635,MBR00000340,Professional,2023-03-14,2023-03-14,2023-04-16,PLN4161,1295371663,1295371663,Critical Access Hospital,In-Network,E78.5,Z00.00,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,2,2016.07,1257.92,942.79,280.13,35.0,0.0,315.13,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000008636,MBR00000340,Institutional-OP,2023-08-02,2023-08-02,2023-09-12,PLN8896,1840431511,1840431511,Geriatrics,Out-of-Network,J06.9,E11.65,,,,,,,0,,99233,E&M,,,0636,22,Outpatient Hospital,3,437.64,288.16,150.19,133.02,0.0,4.95,137.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008637,MBR00000340,Institutional-IP,2021-09-02,2021-09-03,2021-09-30,PLN4849,1609526529,1609526529,Psychiatry,In-Network,M81.0,M54.5,,,,683,MS-DRG,17,1,Y,76700,Radiology,,,0510,21,Inpatient Hospital,3,1205.87,814.91,659.53,0.0,0.0,155.38,155.38,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000008638,MBR00000340,Professional,2021-10-14,2021-10-14,2021-11-26,PLN7753,1891849440,1891849440,Oncology,In-Network,J06.9,I25.10,,,,,,,0,,27447,Surgery,,,,23,Emergency Room,3,4154.79,1725.7,1675.7,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008639,MBR00000340,Professional,2023-10-17,2023-10-17,2023-11-16,PLN3821,1717546253,1717546253,Family Medicine,In-Network,I10,I48.91,,,,,,,0,,45378,Surgery,,,,11,Office,1,1245.07,624.04,472.88,151.16,0.0,0.0,151.16,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000008640,MBR00000340,Institutional-IP,2023-11-29,2023-11-30,2024-01-03,PLN3723,1872272835,1872272835,Internal Medicine,In-Network,Z23,E78.5,,,,641,MS-DRG,21,1,Y,99233,E&M,,,0450,21,Inpatient Hospital,2,390.52,215.59,0.0,215.59,0.0,0.0,215.59,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008641,MBR00000340,Professional,2021-12-06,2021-12-06,2021-12-25,PLN5359,1540044947,1540044947,Pulmonology,Out-of-Network,Z00.01,I10,,,,,,,0,,47562,Surgery,,,,23,Emergency Room,3,2503.82,1046.6,1034.21,0.0,0.0,12.39,12.39,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008642,MBR00000340,Professional,2022-07-12,2022-07-12,2022-07-31,PLN7046,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,E11.9,B97.89,,,,,,,0,,G0468,Medicine,,,,22,Outpatient Hospital,1,658.22,443.21,368.21,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008643,MBR00000340,Professional,2022-09-25,2022-09-25,2022-11-06,PLN5545,1575695214,1575695214,SNF,In-Network,M54.5,K21.0,,,,,,,0,,71046,Radiology,,,,11,Office,3,301.77,148.65,148.65,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008644,MBR00000340,Institutional-OP,2022-11-27,2022-11-27,2022-12-09,PLN4218,1687650653,1687650653,Internal Medicine,In-Network,I10,E11.9,,,,,,,0,,93225,Medicine,,,0200,22,Outpatient Hospital,2,401.16,186.99,161.99,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000008645,MBR00000340,Institutional-OP,2023-08-05,2023-08-05,2023-08-12,PLN3948,1531398223,1531398223,OB/GYN,In-Network,K21.0,M17.11,,,,,,,0,,93306,Radiology,,,0740,22,Outpatient Hospital,1,2370.68,1462.16,1431.72,15.44,15.0,0.0,30.44,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008646,MBR00000340,Institutional-IP,2021-04-26,2021-05-01,2021-06-08,PLN7640,1273488618,1273488618,General Acute Care Hospital,In-Network,Z23,E78.5,,,,196,MS-DRG,6,5,Y,74177,Radiology,,,0510,21,Inpatient Hospital,2,1578.24,632.89,505.66,0.0,15.0,112.23,127.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008647,MBR00000340,Professional,2022-07-28,2022-07-28,2022-08-23,PLN2898,1114982472,1114982472,Orthopedic Surgery,In-Network,E11.9,Z79.4,,,,,,,0,,90460,Medicine,,,,23,Emergency Room,1,43.72,31.25,0.0,31.25,0.0,0.0,31.25,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008648,MBR00000340,Professional,2021-08-26,2021-08-26,2021-09-14,PLN3669,1696843572,1696843572,Critical Access Hospital,Out-of-Network,I25.10,E11.65,,,,,,,0,,45378,Surgery,,,,81,Independent Laboratory,1,1275.77,956.97,0.0,498.56,75.0,0.0,573.56,0.0,Denied,CO-18,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000008649,MBR00000340,Institutional-OP,2023-04-06,2023-04-06,2023-04-21,PLN1834,1717912431,1717912431,Oncology,In-Network,C50.912,E11.9,,,,,,,0,,83036,Pathology/Lab,,,0301,22,Outpatient Hospital,1,73.92,55.97,54.47,0.0,0.0,1.5,1.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000008650,MBR00000340,Institutional-IP,2022-10-16,2022-10-26,2022-11-26,PLN9829,1910255109,1910255109,DME Supplier,In-Network,I25.10,I50.9,,,,603,MS-DRG,5,10,Y,99204,E&M,,,0900,21,Inpatient Hospital,1,543.34,233.75,233.75,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008651,MBR00000340,Professional,2023-04-01,2023-04-01,2023-04-25,PLN6960,1242201429,1242201429,General Acute Care Hospital,In-Network,F32.9,N39.0,,,,,,,0,,99283,E&M,,,,11,Office,1,488.01,204.42,169.42,0.0,35.0,0.0,35.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008652,MBR00000340,Institutional-OP,2023-09-19,2023-09-19,2023-11-01,PLN4275,1964402759,1964402759,Outpatient Clinic,In-Network,I11.9,M17.11,,,,,,,0,,23472,Surgery,,,0900,22,Outpatient Hospital,3,7688.2,2600.77,2464.67,136.1,0.0,0.0,136.1,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008653,MBR00000340,Professional,2023-05-16,2023-05-16,2023-06-08,PLN4661,1295371663,1295371663,Critical Access Hospital,In-Network,Z23,M54.5,,,,,,,0,,66984,Surgery,,,,11,Office,2,2219.8,731.41,433.08,223.33,75.0,0.0,298.33,0.0,Paid,,,0,,0,0,1,0,0,1,Phantom,0,0,0,0,0
CLM0000008654,MBR00000340,Professional,2023-07-25,2023-07-25,2023-08-12,PLN6580,1687650653,1687650653,Internal Medicine,In-Network,F41.9,Z12.31,,,,,,,0,,99222,E&M,,,,21,Inpatient Hospital,3,553.59,310.64,242.83,0.0,35.0,32.81,67.81,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008655,MBR00000340,Professional,2023-06-08,2023-06-08,2023-06-17,PLN7906,1767011137,1767011137,DME Supplier,In-Network,I10,Z00.00,,,,,,,0,,27130,Surgery,,,,12,Home,2,3184.54,2558.05,2558.05,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008656,MBR00000340,Institutional-OP,2022-11-16,2022-11-16,2022-12-16,PLN1905,1717546253,1717546253,Family Medicine,In-Network,F32.9,Z79.4,,,,,,,0,,76700,Radiology,,,0636,22,Outpatient Hospital,3,836.03,529.67,514.67,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008657,MBR00000340,Institutional-OP,2022-03-06,2022-03-06,2022-03-16,PLN3404,1283743001,1283743001,Family Medicine,In-Network,F41.9,Z23,,,,,,,0,,76700,Radiology,,,0370,22,Outpatient Hospital,1,1056.19,702.45,702.45,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000008658,MBR00000340,Professional,2022-01-04,2022-01-04,2022-01-26,PLN2547,1438368327,1438368327,Home Health,In-Network,I48.91,I25.10,,,,,,,0,,99222,E&M,,,,20,Urgent Care,3,468.75,148.62,34.03,79.59,35.0,0.0,114.59,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008659,MBR00000340,Professional,2022-02-03,2022-02-03,2022-03-15,PLN5798,1242201429,1242201429,General Acute Care Hospital,In-Network,E78.5,E66.9,,,,,,,0,,97530,Medicine,,,,11,Office,3,208.64,100.89,92.63,0.0,0.0,8.26,8.26,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008660,MBR00000340,Institutional-OP,2022-10-28,2022-10-28,2022-12-01,PLN6077,1235381502,1235381502,Cardiology,In-Network,I10,Z00.01,,,,,,,0,,78452,Radiology,,,0900,22,Outpatient Hospital,2,6896.73,5167.97,4708.85,234.68,0.0,224.44,459.12,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008661,MBR00000340,Professional,2023-05-30,2023-05-30,2023-06-10,PLN4541,1606140917,1606140917,ASC,In-Network,Z00.01,I11.9,,,,,,,0,,99283,E&M,,,,50,Federally Qualified Health Center,2,450.98,260.96,0.0,260.96,0.0,0.0,260.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008662,MBR00000340,Professional,2022-02-06,2022-02-06,2022-02-26,PLN6348,1148984206,1148984206,Psychiatry,In-Network,E11.9,F10.20,,,,,,,0,,99204,E&M,,,,11,Office,3,556.94,292.23,0.0,292.23,0.0,0.0,292.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008663,MBR00000340,Institutional-OP,2022-09-27,2022-09-27,2022-10-29,PLN3146,1125190055,1125190055,Nephrology,In-Network,E11.9,F32.9,,,,,,,0,,90460,Medicine,,,0120,22,Outpatient Hospital,3,26.52,12.82,10.39,0.0,0.0,2.43,2.43,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008664,MBR00000340,Institutional-OP,2022-03-30,2022-03-30,2022-04-12,PLN6311,1687650653,1687650653,Internal Medicine,In-Network,R05,E11.9,,,,,,,0,,66984,Surgery,,,0200,22,Outpatient Hospital,1,3323.58,1150.22,1150.22,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008665,MBR00000340,Professional,2022-10-28,2022-10-28,2022-11-24,PLN4660,1531398223,1531398223,OB/GYN,In-Network,K21.0,Z00.00,,,,,,,0,,99221,E&M,,,,11,Office,1,197.24,68.25,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008666,MBR00000340,Professional,2023-06-16,2023-06-16,2023-06-28,PLN5233,1450094833,1450094833,Outpatient Clinic,In-Network,N17.9,E11.9,,,,,,,0,,99214,E&M,,,,11,Office,3,345.38,176.67,126.67,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008667,MBR00000340,Institutional-OP,2022-03-28,2022-03-28,2022-04-30,PLN4618,1564502315,1564502315,ASC,In-Network,Z23,E11.9,,,,,,,0,,99284,E&M,,,0761,22,Outpatient Hospital,1,720.42,355.25,355.25,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000008668,MBR00000340,Professional,2022-03-11,2022-03-11,2022-04-06,PLN1126,1946680931,1946680931,Critical Access Hospital,Out-of-Network,Z00.00,N39.0,,,,,,,0,,84443,Pathology/Lab,,,,21,Inpatient Hospital,3,171.08,86.5,86.5,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008669,MBR00000340,Institutional-IP,2021-08-09,2021-08-15,2021-09-11,PLN9052,1410468316,1410468316,SNF,In-Network,E78.5,J44.1,,,,871,MS-DRG,18,6,Y,70450,Radiology,,,0730,21,Inpatient Hospital,2,987.54,756.75,242.73,397.33,75.0,41.69,514.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008670,MBR00000340,Institutional-OP,2022-07-01,2022-07-01,2022-08-01,PLN4978,1806688928,1806688928,Geriatrics,In-Network,E11.9,E11.40,,,,,,,0,,47562,Surgery,,,0450,22,Outpatient Hospital,2,3354.25,2793.52,2768.52,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008671,MBR00000340,Institutional-IP,2022-05-16,2022-05-20,2022-06-16,PLN7426,1645194539,1645194539,SNF,In-Network,I50.9,M54.5,,,,603,MS-DRG,18,4,Y,45378,Surgery,,,0270,21,Inpatient Hospital,1,2426.14,1053.19,619.05,359.14,75.0,0.0,434.14,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000008672,MBR00000340,Professional,2021-06-25,2021-06-25,2021-07-26,PLN6922,1236418230,1236418230,DME Supplier,In-Network,E11.9,R10.9,,,,,,,0,,93225,Medicine,,,,11,Office,3,573.36,286.81,168.28,37.92,75.0,5.61,118.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008673,MBR00000340,Institutional-OP,2023-11-28,2023-11-28,2023-12-30,PLN6776,1531398223,1531398223,OB/GYN,In-Network,Z12.31,F10.20,,,,,,,0,,74177,Radiology,,,0360,22,Outpatient Hospital,2,2373.76,1025.14,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008674,MBR00000340,Institutional-OP,2023-07-31,2023-07-31,2023-08-10,PLN9229,1500949740,1500949740,Pediatrics,In-Network,F41.9,Z87.891,,,,,,,0,,82043,Pathology/Lab,,,0900,22,Outpatient Hospital,1,29.35,15.61,0.0,15.61,25.0,0.0,40.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008675,MBR00000340,Institutional-OP,2021-11-15,2021-11-15,2021-12-26,PLN6126,1799205295,1799205295,General Acute Care Hospital,In-Network,Z23,I10,,,,,,,0,,99204,E&M,,,0636,22,Outpatient Hospital,3,221.67,118.58,0.0,118.58,25.0,0.0,143.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008676,MBR00000340,Professional,2023-11-01,2023-11-01,2023-11-18,PLN5563,1845057593,1845057593,Orthopedic Surgery,In-Network,E11.9,N18.3,,,,,,,0,,99406,Medicine,,,,81,Independent Laboratory,2,90.0,74.42,63.73,0.0,0.0,10.69,10.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008677,MBR00000340,Institutional-OP,2021-10-25,2021-10-25,2021-11-24,PLN4980,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,Z23,I25.10,,,,,,,0,,87491,Pathology/Lab,,,0740,22,Outpatient Hospital,3,93.55,34.36,0.0,34.36,0.0,0.0,34.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008678,MBR00000340,Professional,2022-04-04,2022-04-04,2022-05-06,PLN7806,1273488618,1273488618,General Acute Care Hospital,In-Network,Z23,Z79.4,,,,,,,0,,99213,E&M,,,,11,Office,1,186.38,83.02,83.02,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008679,MBR00000341,Professional,2021-05-24,2021-05-24,2021-06-13,PLN9792,1644128543,1644128543,Gastroenterology,In-Network,E78.5,J20.9,,,,,,,0,,93225,Medicine,,,,11,Office,1,459.98,183.58,0.0,183.58,75.0,0.0,258.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008680,MBR00000341,Professional,2022-11-02,2022-11-02,2022-11-30,PLN9133,1717546253,1717546253,Family Medicine,In-Network,J20.9,Z12.11,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,1,3726.6,2995.3,2945.3,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008681,MBR00000341,Professional,2022-06-11,2022-06-11,2022-07-10,PLN1545,1800011727,1800011727,Clinical Laboratory,Out-of-Network,N39.0,E11.9,,,,,,,0,,99203,E&M,,,,21,Inpatient Hospital,3,219.28,157.77,0.0,157.77,50.0,0.0,207.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008682,MBR00000341,Professional,2021-10-20,2021-10-20,2021-10-27,PLN4261,1817234602,1817234602,Clinical Laboratory,In-Network,I25.10,I10,,,,,,,0,,23472,Surgery,,,,20,Urgent Care,2,4022.25,2444.61,2355.38,89.23,0.0,0.0,89.23,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008683,MBR00000341,Institutional-OP,2021-11-12,2021-11-12,2021-11-28,PLN9456,1569105090,1569105090,Geriatrics,In-Network,I10,E11.65,,,,,,,0,,85025,Pathology/Lab,,,0510,22,Outpatient Hospital,2,89.2,28.88,0.0,28.88,25.0,0.0,53.88,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008684,MBR00000341,Professional,2023-10-22,2023-10-22,2023-11-22,PLN7478,1689639685,1689639685,SNF,In-Network,Z12.31,J45.20,,,,,,,0,,45378,Surgery,,,,11,Office,2,935.56,753.69,595.48,158.21,0.0,0.0,158.21,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000008685,MBR00000341,Professional,2023-01-23,2023-01-23,2023-02-10,PLN2871,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,R10.9,E11.9,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,1,1090.08,683.31,683.31,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008686,MBR00000341,Institutional-OP,2021-06-17,2021-06-17,2021-07-14,PLN7647,1531398223,1531398223,OB/GYN,In-Network,E11.9,Z00.00,,,,,,,0,,66984,Surgery,,,0510,22,Outpatient Hospital,2,2737.63,2297.9,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-97,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008687,MBR00000342,Professional,2021-05-28,2021-05-28,2021-06-04,PLN5569,1809014947,1809014947,Urology,In-Network,E66.9,K21.0,,,,,,,0,,90686,Medicine,,,,21,Inpatient Hospital,1,58.66,39.92,0.0,39.92,35.0,0.0,74.92,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000008688,MBR00000342,Institutional-IP,2021-03-18,2021-03-22,2021-04-24,PLN7391,1361302520,1361302520,Critical Access Hospital,In-Network,Z12.31,J18.9,,,,292,MS-DRG,7,4,Y,99204,E&M,,,0370,21,Inpatient Hospital,2,491.81,397.03,0.0,397.03,0.0,0.0,397.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008689,MBR00000342,Institutional-OP,2021-09-28,2021-09-28,2021-11-04,PLN6453,1778483301,1778483301,Home Health,In-Network,M17.11,F32.9,,,,,,,0,,99213,E&M,,,0200,22,Outpatient Hospital,3,292.69,120.36,0.0,120.36,0.0,0.0,120.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008690,MBR00000342,Professional,2023-03-20,2023-03-20,2023-05-01,PLN6797,1717546253,1717546253,Family Medicine,In-Network,N18.3,E11.9,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,3,152.46,125.03,96.0,0.0,25.0,4.03,29.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008691,MBR00000342,Professional,2021-03-09,2021-03-09,2021-03-24,PLN9325,1991459367,1991459367,Neurology,Out-of-Network,F41.9,F32.9,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,3,527.66,272.23,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-29,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000008692,MBR00000342,Professional,2021-09-30,2021-09-30,2021-10-31,PLN5543,1245650222,1245650222,Gastroenterology,In-Network,M54.5,Z23,,,,,,,0,,33533,Surgery,,,,11,Office,2,25477.28,10594.41,10579.41,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000008693,MBR00000342,Institutional-IP,2021-02-15,2021-02-18,2021-03-16,PLN4171,1946680931,1946680931,Critical Access Hospital,Out-of-Network,F03.90,E11.9,,,,872,MS-DRG,12,3,N,90460,Medicine,,,0120,21,Inpatient Hospital,1,34.05,18.01,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000008694,MBR00000342,Professional,2022-12-13,2022-12-13,2022-12-30,PLN3713,1245650222,1245650222,Gastroenterology,In-Network,Z87.891,F32.9,,,,,,,0,,99232,E&M,,,,11,Office,1,146.08,101.28,0.0,101.28,50.0,0.0,151.28,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008695,MBR00000342,Institutional-OP,2023-06-11,2023-06-11,2023-07-13,PLN3648,1139906830,1139906830,Endocrinology,Out-of-Network,K21.0,Z00.00,,,,,,,0,,99203,E&M,,,0450,22,Outpatient Hospital,3,268.07,153.41,49.7,103.71,0.0,0.0,103.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008696,MBR00000342,Institutional-IP,2022-08-03,2022-08-10,2022-09-13,PLN4049,1366576336,1366576336,Geriatrics,In-Network,R51,E11.65,,,,195,MS-DRG,13,7,N,47562,Surgery,,,0320,21,Inpatient Hospital,2,5538.71,1770.9,1474.82,0.0,0.0,296.08,296.08,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008697,MBR00000342,Institutional-IP,2023-09-19,2023-09-21,2023-10-25,PLN6033,1168246159,1168246159,Internal Medicine,In-Network,Z12.31,C50.912,,,,603,MS-DRG,21,2,N,87491,Pathology/Lab,,,0761,21,Inpatient Hospital,1,104.16,39.58,0.0,39.58,50.0,0.0,89.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008698,MBR00000342,Institutional-OP,2023-01-24,2023-01-24,2023-02-04,PLN5140,1486164553,1486164553,DME Supplier,In-Network,J18.9,N20.0,,,,,,,0,,23472,Surgery,,,0120,22,Outpatient Hospital,2,7336.8,4609.3,4574.3,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000008699,MBR00000342,Professional,2023-04-17,2023-04-17,2023-05-20,PLN8654,1219817751,1219817751,OB/GYN,In-Network,I11.9,E87.6,,,,,,,0,,87491,Pathology/Lab,,,,22,Outpatient Hospital,2,186.36,99.93,24.93,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008700,MBR00000342,Institutional-OP,2021-12-10,2021-12-10,2021-12-25,PLN3513,1139906830,1139906830,Endocrinology,Out-of-Network,I11.9,Z23,,,,,,,0,,99222,E&M,,,0510,22,Outpatient Hospital,1,336.93,147.97,38.2,109.32,0.0,0.45,109.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008701,MBR00000342,Institutional-OP,2023-08-06,2023-08-06,2023-09-12,PLN1558,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,I10,Z23,,,,,,,0,,99204,E&M,,,0320,22,Outpatient Hospital,1,514.06,165.34,0.0,165.34,0.0,0.0,165.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008702,MBR00000342,Institutional-IP,2022-11-23,2022-11-29,2022-12-22,PLN3905,1114982472,1114982472,Orthopedic Surgery,In-Network,F10.20,E78.5,,,,470,MS-DRG,10,6,Y,84443,Pathology/Lab,,,0740,21,Inpatient Hospital,2,80.09,28.38,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008703,MBR00000342,Institutional-IP,2021-04-05,2021-04-12,2021-04-24,PLN4468,1224179551,1224179551,Physical Therapy,In-Network,Z12.31,E11.65,,,,196,MS-DRG,10,7,W,43239,Surgery,,,0370,21,Inpatient Hospital,2,805.41,484.82,0.0,105.81,35.0,0.0,140.81,0.0,Denied,CO-27,,1,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000008704,MBR00000342,Professional,2021-04-01,2021-04-01,2021-04-14,PLN7818,1545347862,1545347862,SNF,In-Network,G43.909,Z00.00,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,2,2607.67,1521.01,1203.33,199.09,0.0,118.59,317.68,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008705,MBR00000342,Institutional-OP,2023-09-11,2023-09-11,2023-09-28,PLN8489,1856686341,1856686341,Geriatrics,In-Network,J44.1,Z12.11,,,,,,,0,,99406,Medicine,,,0450,22,Outpatient Hospital,2,79.33,42.36,42.36,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008706,MBR00000342,Institutional-IP,2021-10-29,2021-10-30,2021-12-04,PLN6154,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,E78.5,Z87.891,,,,641,MS-DRG,3,1,Y,99284,E&M,,,0900,21,Inpatient Hospital,3,746.93,351.23,304.51,0.0,0.0,46.72,46.72,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000008707,MBR00000342,Institutional-OP,2022-05-26,2022-05-26,2022-07-05,PLN6320,1433937353,1433937353,Nephrology,In-Network,J06.9,S72.001A,,,,,,,0,,78452,Radiology,,,0370,22,Outpatient Hospital,1,3999.01,1463.13,1243.61,0.0,0.0,219.52,219.52,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008708,MBR00000342,Institutional-OP,2023-04-13,2023-04-13,2023-04-22,PLN7622,1453936007,1453936007,ASC,In-Network,E11.9,G43.909,,,,,,,0,,87491,Pathology/Lab,,,0301,22,Outpatient Hospital,1,90.05,62.65,0.0,62.65,25.0,0.0,87.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008709,MBR00000342,Professional,2023-04-22,2023-04-22,2023-05-08,PLN8502,1500037969,1500037969,Pulmonology,In-Network,J06.9,R51,,,,,,,0,,27130,Surgery,,,,12,Home,2,5389.18,3318.66,3001.32,317.34,0.0,0.0,317.34,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008710,MBR00000342,Institutional-OP,2021-01-30,2021-01-30,2021-02-15,PLN6426,1550154147,1550154147,Outpatient Clinic,In-Network,Z12.31,E66.9,,,,,,,0,,99214,E&M,,,0761,22,Outpatient Hospital,3,318.7,95.99,88.36,0.0,0.0,7.63,7.63,0.0,Adjusted,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000008711,MBR00000342,Professional,2022-11-06,2022-11-06,2022-12-13,PLN3039,1590915516,1590915516,Physical Therapy,Out-of-Network,Z23,E78.5,,,,,,,0,,99222,E&M,,,,11,Office,2,430.11,349.47,349.47,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008712,MBR00000342,Professional,2023-09-27,2023-09-27,2023-10-06,PLN5304,1935547131,1935547131,Pulmonology,In-Network,F32.9,Z87.891,,,,,,,0,,76700,Radiology,,,,11,Office,1,1066.19,327.13,314.26,0.0,0.0,12.87,12.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008713,MBR00000342,Professional,2022-01-19,2022-01-19,2022-02-25,PLN6161,1575695214,1575695214,SNF,In-Network,F32.9,R10.9,,,,,,,0,,99233,E&M,,,,23,Emergency Room,3,338.83,272.21,0.0,272.21,0.0,0.0,272.21,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008714,MBR00000342,Professional,2022-08-18,2022-08-18,2022-09-14,PLN3192,1606140917,1606140917,ASC,In-Network,J20.9,B97.89,,,,,,,0,,99283,E&M,,,,81,Independent Laboratory,1,611.4,435.88,385.88,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008715,MBR00000342,Institutional-IP,2021-10-17,2021-10-22,2021-10-26,PLN4999,1193493783,1193493783,Critical Access Hospital,Out-of-Network,E11.65,R05,,,,194,MS-DRG,22,5,Y,43239,Surgery,,,0761,21,Inpatient Hospital,3,2108.25,1392.57,1200.52,0.0,50.0,142.05,192.05,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008716,MBR00000342,Professional,2023-03-01,2023-03-01,2023-03-27,PLN6005,1556140803,1556140803,Cardiology,In-Network,I10,J18.9,,,,,,,0,,74177,Radiology,,,,31,Skilled Nursing Facility,2,2027.91,1386.25,1048.21,206.3,0.0,131.74,338.04,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008717,MBR00000342,Institutional-IP,2021-05-10,2021-05-27,2021-06-19,PLN1313,1713934949,1713934949,Neurology,In-Network,K92.1,J44.1,,,,872,MS-DRG,5,17,Y,90686,Medicine,,,0200,21,Inpatient Hospital,2,80.47,49.54,49.54,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000008718,MBR00000342,Institutional-OP,2022-07-23,2022-07-23,2022-08-25,PLN2106,1410468316,1410468316,SNF,In-Network,M54.5,N39.0,,,,,,,0,,87491,Pathology/Lab,,,0200,22,Outpatient Hospital,1,125.73,105.43,30.33,69.1,0.0,6.0,75.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008719,MBR00000342,Institutional-OP,2022-03-28,2022-03-28,2022-04-11,PLN6278,1968299309,1968299309,Internal Medicine,In-Network,I10,I10,,,,,,,0,,74177,Radiology,,,0761,22,Outpatient Hospital,3,1999.43,730.27,689.74,40.53,0.0,0.0,40.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008720,MBR00000342,Professional,2022-12-04,2022-12-04,2022-12-16,PLN7028,1500037969,1500037969,Pulmonology,In-Network,I10,E78.5,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,1,488.55,322.42,322.42,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008721,MBR00000342,Institutional-OP,2022-06-26,2022-06-26,2022-07-28,PLN2955,1745114564,1745114564,Endocrinology,In-Network,F10.20,I10,,,,,,,0,,99283,E&M,,,0360,22,Outpatient Hospital,1,436.81,203.21,59.13,144.08,0.0,0.0,144.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008722,MBR00000342,Institutional-OP,2023-12-11,2023-12-11,2024-01-10,PLN1071,1660288235,1660288235,ASC,In-Network,F41.9,I10,,,,,,,0,,99233,E&M,,,0200,22,Outpatient Hospital,2,556.35,455.08,455.08,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008723,MBR00000342,Institutional-OP,2023-12-13,2023-12-13,2024-01-05,PLN2300,1168246159,1168246159,Internal Medicine,In-Network,E11.9,I10,,,,,,,0,,76700,Radiology,,,0900,22,Outpatient Hospital,1,793.65,387.44,224.44,138.0,25.0,0.0,163.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008724,MBR00000342,Professional,2021-11-08,2021-11-08,2021-11-21,PLN1608,1689639685,1689639685,SNF,In-Network,R10.9,F41.9,,,,,,,0,,71046,Radiology,,,,31,Skilled Nursing Facility,3,157.13,56.69,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008725,MBR00000342,Institutional-IP,2021-02-10,2021-02-11,2021-02-25,PLN3549,1518055405,1518055405,Urology,In-Network,I25.10,Z12.31,,,,194,MS-DRG,11,1,Y,99203,E&M,,,0730,21,Inpatient Hospital,3,306.41,208.69,181.49,0.0,0.0,27.2,27.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008726,MBR00000343,Professional,2022-06-24,2022-06-24,2022-07-14,PLN3213,1872613201,1872613201,Internal Medicine,In-Network,J44.1,Z51.11,,,,,,,0,,77067,Radiology,,,,49,Independent Clinic,2,496.7,407.66,64.83,317.83,25.0,0.0,342.83,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000008727,MBR00000343,Professional,2022-10-09,2022-10-09,2022-11-20,PLN4926,1809014947,1809014947,Urology,In-Network,E11.9,R05,,,,,,,0,,86900,Pathology/Lab,,,,49,Independent Clinic,3,39.25,22.78,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008728,MBR00000343,Professional,2023-04-04,2023-04-04,2023-05-07,PLN7199,1691062876,1691062876,SNF,In-Network,E78.5,M17.11,,,,,,,0,,93306,Radiology,,,,22,Outpatient Hospital,3,2916.23,1124.19,1124.19,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008729,MBR00000343,Institutional-OP,2022-07-29,2022-07-29,2022-08-09,PLN6136,1531398223,1531398223,OB/GYN,In-Network,Z23,F32.9,,,,,,,0,,99406,Medicine,,,0270,22,Outpatient Hospital,1,52.78,22.05,0.0,22.05,0.0,0.0,22.05,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008730,MBR00000343,Professional,2022-10-05,2022-10-05,2022-10-17,PLN2294,1168246159,1168246159,Internal Medicine,In-Network,E11.9,Z00.01,,,,,,,0,,99232,E&M,,,,11,Office,3,290.81,244.35,215.43,0.0,0.0,28.92,28.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008731,MBR00000343,Professional,2021-01-26,2021-01-26,2021-02-04,PLN6504,1865904917,1865904917,Outpatient Clinic,In-Network,R05,J06.9,,,,,,,0,,76700,Radiology,,,,50,Federally Qualified Health Center,2,1372.59,796.55,384.76,396.79,15.0,0.0,411.79,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000008732,MBR00000343,Institutional-IP,2023-04-16,2023-04-20,2023-05-16,PLN7157,1845900543,1845900543,ASC,In-Network,I10,N18.3,,,,292,MS-DRG,2,4,Y,99214,E&M,,,0200,21,Inpatient Hospital,1,231.67,89.62,0.0,89.62,35.0,0.0,124.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008733,MBR00000343,Professional,2021-12-28,2021-12-28,2022-02-02,PLN1898,1135158374,1135158374,Pulmonology,In-Network,Z12.31,M81.0,,,,,,,0,,99213,E&M,,,,11,Office,1,268.87,227.92,202.92,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008734,MBR00000343,Professional,2022-02-25,2022-02-25,2022-03-10,PLN3411,1980712759,1980712759,Outpatient Clinic,Out-of-Network,M54.5,I50.9,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,1,261.92,150.18,67.79,0.0,75.0,7.39,82.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008735,MBR00000343,Institutional-OP,2022-04-09,2022-04-09,2022-05-06,PLN3634,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,K21.0,E66.9,,,,,,,0,,66984,Surgery,,,0450,22,Outpatient Hospital,3,2171.86,1240.53,0.0,260.44,50.0,83.02,393.46,0.0,Denied,CO-97,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008736,MBR00000343,Institutional-OP,2021-03-20,2021-03-20,2021-04-26,PLN4225,1124394415,1124394415,Pediatrics,In-Network,Z23,E11.9,,,,,,,0,,99233,E&M,,,0200,22,Outpatient Hospital,1,311.14,158.32,0.0,158.32,0.0,0.0,158.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008737,MBR00000343,Institutional-OP,2022-06-26,2022-06-26,2022-08-03,PLN6135,1550154147,1550154147,Outpatient Clinic,In-Network,E11.9,M81.0,,,,,,,0,,93225,Medicine,,,0450,22,Outpatient Hospital,1,548.23,316.07,0.0,303.29,15.0,0.0,318.29,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008738,MBR00000343,Institutional-OP,2022-02-22,2022-02-22,2022-03-21,PLN4286,1168246159,1168246159,Internal Medicine,In-Network,Z00.00,Z00.00,,,,,,,0,,45378,Surgery,,,0120,22,Outpatient Hospital,2,2112.44,1685.68,1238.31,297.58,0.0,149.79,447.37,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000008739,MBR00000343,Professional,2021-09-13,2021-09-13,2021-10-19,PLN3583,1891849440,1891849440,Oncology,In-Network,E66.9,N39.0,,,,,,,0,,84443,Pathology/Lab,,,,22,Outpatient Hospital,3,138.11,107.41,32.41,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008740,MBR00000343,Professional,2021-09-27,2021-09-27,2021-10-13,PLN9231,1313212303,1313212303,Family Medicine,In-Network,I50.9,Z00.00,,,,,,,0,,77067,Radiology,,,,49,Independent Clinic,2,304.95,160.13,128.37,0.0,0.0,31.76,31.76,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000008741,MBR00000343,Professional,2021-02-07,2021-02-07,2021-03-22,PLN9314,1198133277,1198133277,SNF,In-Network,K21.0,J06.9,,,,,,,0,,99406,Medicine,,,,11,Office,1,76.36,43.53,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008742,MBR00000343,Institutional-OP,2023-08-31,2023-08-31,2023-09-12,PLN9863,1410468316,1410468316,SNF,In-Network,I50.9,J20.9,,,,,,,0,,99222,E&M,,,0636,22,Outpatient Hospital,2,515.0,266.97,53.34,213.63,0.0,0.0,213.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008743,MBR00000343,Professional,2021-11-18,2021-11-18,2021-12-18,PLN7703,1974006077,1974006077,Orthopedic Surgery,In-Network,E66.9,Z87.891,,,,,,,0,,99233,E&M,,,,20,Urgent Care,1,436.3,258.36,214.71,0.0,0.0,43.65,43.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008744,MBR00000343,Professional,2023-08-16,2023-08-16,2023-08-24,PLN9934,1991459367,1991459367,Neurology,Out-of-Network,E11.9,F32.9,,,,,,,0,,84443,Pathology/Lab,,,,20,Urgent Care,1,126.94,77.06,77.06,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008745,MBR00000343,Institutional-OP,2023-07-05,2023-07-05,2023-07-13,PLN6605,1795618275,1795618275,Pulmonology,In-Network,Z79.4,B97.89,,,,,,,0,,80053,Pathology/Lab,,,0510,22,Outpatient Hospital,2,70.84,26.55,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008746,MBR00000343,Institutional-IP,2022-05-16,2022-05-18,2022-05-29,PLN8223,1790497490,1790497490,OB/GYN,In-Network,Z12.31,F32.9,,,,690,MS-DRG,12,2,Y,99203,E&M,,,0360,21,Inpatient Hospital,1,258.1,218.38,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008747,MBR00000343,Professional,2023-06-04,2023-06-04,2023-07-17,PLN5074,1840431511,1840431511,Geriatrics,Out-of-Network,R10.9,Z12.31,,,,,,,0,,27447,Surgery,,,,11,Office,3,3229.34,2459.74,2384.74,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008748,MBR00000343,Institutional-OP,2021-08-20,2021-08-20,2021-09-08,PLN7965,1103747954,1103747954,Urology,In-Network,J20.9,I10,,,,,,,0,,45378,Surgery,,,0740,22,Outpatient Hospital,1,1318.46,667.93,343.6,324.33,0.0,0.0,324.33,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000008749,MBR00000343,Institutional-IP,2021-07-17,2021-07-18,2021-08-19,PLN9676,1550154147,1550154147,Outpatient Clinic,In-Network,C50.912,K92.1,,,,195,MS-DRG,22,1,Y,G0468,Medicine,,,0900,21,Inpatient Hospital,1,551.3,255.92,255.92,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008750,MBR00000343,Institutional-OP,2023-09-12,2023-09-12,2023-10-04,PLN9277,1213165847,1213165847,Critical Access Hospital,In-Network,F41.9,B97.89,,,,,,,0,,76700,Radiology,,,0900,22,Outpatient Hospital,1,663.24,285.05,0.0,285.05,0.0,0.0,285.05,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008751,MBR00000343,Professional,2022-12-09,2022-12-09,2022-12-26,PLN2263,1717546253,1717546253,Family Medicine,In-Network,E78.5,K21.0,,,,,,,0,,90460,Medicine,,,,81,Independent Laboratory,1,44.88,19.8,0.0,0.0,25.0,0.0,25.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008752,MBR00000343,Professional,2023-01-25,2023-01-25,2023-02-20,PLN1016,1571574052,1571574052,Critical Access Hospital,In-Network,Z87.891,J18.9,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,3,3024.61,1410.7,0.0,343.48,0.0,0.0,343.48,0.0,Denied,CO-4,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008753,MBR00000343,Professional,2023-10-09,2023-10-09,2023-11-04,PLN6070,1915531927,1915531927,Critical Access Hospital,In-Network,J06.9,N18.3,,,,,,,0,,99283,E&M,,,,31,Skilled Nursing Facility,1,547.96,398.84,341.44,0.0,0.0,57.4,57.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008754,MBR00000343,Professional,2021-01-16,2021-01-16,2021-01-26,PLN1894,1125190055,1125190055,Nephrology,In-Network,I25.10,J44.1,,,,,,,0,,84443,Pathology/Lab,,,,22,Outpatient Hospital,2,168.42,79.37,79.37,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008755,MBR00000343,Professional,2021-07-08,2021-07-08,2021-08-02,PLN6018,1266606767,1266606767,ASC,In-Network,Z00.00,R07.9,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,3,85.79,30.6,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008756,MBR00000343,Professional,2023-11-20,2023-11-20,2023-12-24,PLN8248,1247341320,1247341320,Urology,Out-of-Network,E66.9,E78.5,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,1,1379.14,940.61,0.0,0.0,0.0,0.0,0.0,0.0,Denied,PR-1,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000008757,MBR00000343,Professional,2021-05-21,2021-05-21,2021-05-29,PLN5188,1606140917,1606140917,ASC,In-Network,I10,K21.0,,,,,,,0,,99284,E&M,,,,11,Office,3,476.1,368.71,126.88,179.47,50.0,12.36,241.83,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008758,MBR00000344,Professional,2022-05-07,2022-05-07,2022-05-26,PLN3329,1899127912,1899127912,Neurology,In-Network,N18.3,M17.11,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,1,251.61,114.07,81.2,18.31,0.0,14.56,32.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008759,MBR00000344,Professional,2021-01-25,2021-01-25,2021-03-03,PLN2220,1980712759,1980712759,Outpatient Clinic,Out-of-Network,Z51.11,M54.5,,,,,,,0,,93306,Radiology,,,,11,Office,2,2983.18,2167.35,2152.35,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000008760,MBR00000344,Professional,2021-12-23,2021-12-23,2022-02-01,PLN5750,1910255109,1910255109,DME Supplier,In-Network,M17.11,E78.5,,,,,,,0,,99221,E&M,,,,11,Office,3,159.71,76.52,1.31,0.0,75.0,0.21,75.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008761,MBR00000344,Professional,2021-07-08,2021-07-08,2021-07-16,PLN2690,1571574052,1571574052,Critical Access Hospital,In-Network,F41.9,J06.9,,,,,,,0,,99222,E&M,,,,23,Emergency Room,3,567.34,306.62,281.62,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008762,MBR00000344,Professional,2021-10-08,2021-10-08,2021-10-25,PLN8528,1236418230,1236418230,DME Supplier,In-Network,F32.9,Z00.01,,,,,,,0,,77067,Radiology,,,,21,Inpatient Hospital,2,786.83,405.6,334.84,70.76,0.0,0.0,70.76,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000008763,MBR00000344,Professional,2023-06-11,2023-06-11,2023-07-16,PLN3757,1410468316,1410468316,SNF,In-Network,E78.5,I10,,,,,,,0,,77067,Radiology,,,,49,Independent Clinic,2,626.5,281.9,256.9,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000008764,MBR00000344,Institutional-OP,2021-10-29,2021-10-29,2021-11-08,PLN7720,1410468316,1410468316,SNF,In-Network,Z00.00,E11.9,,,,,,,0,,27447,Surgery,,,0761,22,Outpatient Hospital,2,2375.83,786.04,529.86,239.51,0.0,16.67,256.18,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008765,MBR00000344,Professional,2023-06-11,2023-06-11,2023-07-07,PLN1433,1337791138,1337791138,Internal Medicine,Out-of-Network,I48.91,I48.91,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,3,185.97,136.42,136.42,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008766,MBR00000344,Institutional-OP,2023-09-07,2023-09-07,2023-10-05,PLN1447,1702692193,1702692193,Physical Therapy,In-Network,Z00.01,J06.9,,,,,,,0,,47562,Surgery,,,0900,22,Outpatient Hospital,3,3619.77,2607.85,2532.85,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008767,MBR00000344,Professional,2022-08-15,2022-08-15,2022-08-24,PLN3235,1847081578,1847081578,Urology,Out-of-Network,E11.65,G43.909,,,,,,,0,,66984,Surgery,,,,11,Office,2,2013.8,851.82,419.06,407.76,25.0,0.0,432.76,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008768,MBR00000344,Professional,2022-08-13,2022-08-13,2022-09-10,PLN7359,1500949740,1500949740,Pediatrics,In-Network,R05,E11.65,,,,,,,0,,90837,Medicine,,,,23,Emergency Room,1,309.14,208.16,186.93,0.0,0.0,21.23,21.23,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008769,MBR00000344,Professional,2022-01-01,2022-01-01,2022-02-13,PLN6138,1799205295,1799205295,General Acute Care Hospital,In-Network,I63.9,N39.0,,,,,,,0,,99213,E&M,,,,11,Office,1,125.39,48.03,0.0,48.03,75.0,0.0,123.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008770,MBR00000344,Professional,2023-01-01,2023-01-01,2023-01-19,PLN6318,1434029575,1434029575,Endocrinology,In-Network,J06.9,E78.5,,,,,,,0,,99283,E&M,,,,11,Office,2,319.22,99.88,81.75,18.13,0.0,0.0,18.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008771,MBR00000344,Institutional-OP,2023-06-03,2023-06-03,2023-06-18,PLN7674,1108115157,1108115157,General Acute Care Hospital,In-Network,M54.5,G43.909,,,,,,,0,,47562,Surgery,,,0740,22,Outpatient Hospital,1,4513.21,2448.84,1614.23,424.73,75.0,334.88,834.61,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008772,MBR00000344,Institutional-OP,2023-08-04,2023-08-04,2023-09-09,PLN6549,1410468316,1410468316,SNF,In-Network,E78.5,Z00.00,,,,,,,0,,43239,Surgery,,,0301,22,Outpatient Hospital,2,1292.79,846.02,821.02,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008773,MBR00000344,Professional,2021-08-02,2021-08-02,2021-08-27,PLN1578,1872613201,1872613201,Internal Medicine,In-Network,Z12.31,Z87.891,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,2,137.66,62.77,0.0,62.77,0.0,0.0,62.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008774,MBR00000344,Professional,2023-01-22,2023-01-22,2023-02-11,PLN8611,1990090423,1990090423,Orthopedic Surgery,In-Network,Z00.00,J20.9,,,,,,,0,,45380,Surgery,,,,81,Independent Laboratory,3,2822.14,2055.91,2055.91,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000008775,MBR00000344,Institutional-OP,2021-06-03,2021-06-03,2021-06-26,PLN6477,1817234602,1817234602,Clinical Laboratory,In-Network,Z00.00,E66.9,,,,,,,0,,77067,Radiology,,,0120,22,Outpatient Hospital,3,355.78,188.32,163.32,0.0,25.0,0.0,25.0,0.0,Pended,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000008776,MBR00000344,Institutional-IP,2022-06-21,2022-06-22,2022-08-04,PLN4158,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,N39.0,J18.9,,,,872,MS-DRG,2,1,Y,77067,Radiology,,,0270,21,Inpatient Hospital,2,776.25,539.09,514.09,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,0,0,0,1,Identity_Theft,1,0,0,0,0
CLM0000008777,MBR00000344,Professional,2021-04-08,2021-04-08,2021-05-20,PLN7341,1433937353,1433937353,Nephrology,In-Network,N39.0,J20.9,,,,,,,0,,66984,Surgery,,,,23,Emergency Room,2,3529.12,2729.81,2143.35,0.0,75.0,511.46,586.46,0.0,Paid,,,0,,1,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000008778,MBR00000344,Professional,2022-08-26,2022-08-26,2022-09-04,PLN8599,1687650653,1687650653,Internal Medicine,In-Network,Z12.31,I48.91,,,,,,,0,,83036,Pathology/Lab,,,,23,Emergency Room,2,69.13,31.01,0.0,31.01,25.0,0.0,56.01,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,1,0,0
CLM0000008779,MBR00000344,Professional,2023-07-22,2023-07-22,2023-08-24,PLN5574,1168881145,1168881145,Orthopedic Surgery,In-Network,I10,I10,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,3,388.1,182.37,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008780,MBR00000344,Professional,2023-06-14,2023-06-14,2023-07-26,PLN1469,1205377316,1205377316,Orthopedic Surgery,In-Network,J18.9,M54.5,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,2,131.71,92.92,42.92,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008781,MBR00000344,Professional,2023-02-22,2023-02-22,2023-03-25,PLN2202,1395983630,1395983630,Nephrology,In-Network,N39.0,N39.0,,,,,,,0,,74177,Radiology,,,,49,Independent Clinic,3,1621.6,848.73,470.74,284.01,0.0,93.98,377.99,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008782,MBR00000344,Professional,2022-09-25,2022-09-25,2022-10-17,PLN4264,1502838586,1502838586,ASC,In-Network,I48.91,I48.91,,,,,,,0,,G0468,Medicine,,,,49,Independent Clinic,1,743.34,547.21,472.21,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000008783,MBR00000344,Institutional-IP,2022-11-15,2022-11-27,2022-12-16,PLN5844,1896447406,1896447406,Nephrology,Out-of-Network,E11.9,I10,,,,603,MS-DRG,18,12,Y,99221,E&M,,,0740,21,Inpatient Hospital,1,367.39,190.5,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008784,MBR00000344,Professional,2021-04-20,2021-04-20,2021-05-08,PLN7941,1530904931,1530904931,Internal Medicine,In-Network,J20.9,Z87.891,,,,,,,0,,99214,E&M,,,,31,Skilled Nursing Facility,3,169.09,52.85,52.85,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008785,MBR00000344,Professional,2023-03-08,2023-03-08,2023-03-27,PLN5317,1689639685,1689639685,SNF,In-Network,E11.9,Z23,,,,,,,0,,99214,E&M,,,,11,Office,2,322.28,139.19,139.19,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008786,MBR00000344,Professional,2023-01-17,2023-01-17,2023-03-01,PLN3536,1366426662,1366426662,Urology,In-Network,Z12.11,E11.9,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,2,265.21,82.52,28.8,0.0,50.0,3.72,53.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008787,MBR00000344,Institutional-IP,2021-06-07,2021-06-12,2021-06-16,PLN5712,1242201429,1242201429,General Acute Care Hospital,In-Network,R51,E78.5,,,,194,MS-DRG,22,5,Y,90837,Medicine,,,0270,21,Inpatient Hospital,3,373.71,192.33,0.0,192.33,35.0,0.0,227.33,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008788,MBR00000345,Professional,2022-11-24,2022-11-24,2023-01-03,PLN8521,1716521444,1716521444,Oncology,In-Network,J06.9,I10,,,,,,,0,,70450,Radiology,,,,11,Office,1,1532.32,1242.54,0.0,343.8,50.0,0.0,393.8,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008789,MBR00000345,Professional,2022-02-26,2022-02-26,2022-03-07,PLN3380,1139906830,1139906830,Endocrinology,Out-of-Network,I10,E78.5,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,2,4572.23,2506.17,2183.36,280.2,0.0,42.61,322.81,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008790,MBR00000345,Professional,2022-07-12,2022-07-12,2022-08-10,PLN7594,1364429278,1364429278,OB/GYN,In-Network,I10,N39.0,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,2,28.36,16.81,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008791,MBR00000345,Professional,2023-06-11,2023-06-11,2023-06-24,PLN4642,1450553056,1450553056,Clinical Laboratory,In-Network,I10,M54.5,,,,,,,0,,99232,E&M,,,,49,Independent Clinic,3,244.56,205.72,0.0,205.72,0.0,0.0,205.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008792,MBR00000345,Professional,2021-12-19,2021-12-19,2022-01-15,PLN9127,1713934949,1713934949,Neurology,In-Network,J44.1,R10.9,,,,,,,0,,23472,Surgery,,,,11,Office,2,4229.65,1451.88,1416.88,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008793,MBR00000345,Professional,2023-10-01,2023-10-01,2023-11-11,PLN2565,1463205530,1463205530,Nephrology,In-Network,I10,M17.11,,,,,,,0,,43239,Surgery,,,,12,Home,1,1145.24,593.26,550.6,0.0,15.0,27.66,42.66,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008794,MBR00000345,Professional,2022-04-02,2022-04-02,2022-05-13,PLN5654,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,I10,E78.5,,,,,,,0,,G0439,Medicine,,,,11,Office,3,340.69,113.17,102.44,0.0,0.0,10.73,10.73,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000008795,MBR00000345,Professional,2022-07-16,2022-07-16,2022-08-27,PLN9654,1631954542,1631954542,Oncology,In-Network,E78.5,B97.89,,,,,,,0,,43239,Surgery,,,,20,Urgent Care,3,1030.62,369.29,369.29,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008796,MBR00000345,Professional,2021-02-01,2021-02-01,2021-03-12,PLN3953,1236418230,1236418230,DME Supplier,In-Network,Z79.4,Z23,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,2,3619.01,1829.55,1671.94,0.0,15.0,142.61,157.61,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008797,MBR00000345,Professional,2021-05-14,2021-05-14,2021-05-26,PLN4566,1542828721,1542828721,Orthopedic Surgery,In-Network,I10,J44.1,,,,,,,0,,97530,Medicine,,,,21,Inpatient Hospital,3,237.9,166.77,166.77,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008798,MBR00000345,Professional,2021-11-05,2021-11-05,2021-12-14,PLN9241,1696843572,1696843572,Critical Access Hospital,Out-of-Network,I10,F41.9,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,1,47.83,16.26,0.0,0.0,50.0,0.0,50.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000008799,MBR00000345,Institutional-OP,2023-12-08,2023-12-08,2024-01-05,PLN4422,1717546253,1717546253,Family Medicine,In-Network,Z12.31,I63.9,,,,,,,0,,80053,Pathology/Lab,,,0270,22,Outpatient Hospital,2,131.1,41.58,0.0,41.58,25.0,0.0,66.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008800,MBR00000345,Institutional-IP,2021-10-12,2021-10-17,2021-11-04,PLN8576,1283743001,1283743001,Family Medicine,In-Network,Z12.31,E78.5,,,,292,MS-DRG,18,5,Y,99213,E&M,,,0270,21,Inpatient Hospital,2,178.99,110.08,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008801,MBR00000345,Institutional-IP,2022-03-09,2022-03-11,2022-04-06,PLN2691,1422747896,1422747896,Urology,In-Network,I10,Z00.00,,,,292,MS-DRG,21,2,W,99232,E&M,,,0270,21,Inpatient Hospital,3,285.11,170.52,155.52,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008802,MBR00000345,Professional,2023-07-25,2023-07-25,2023-08-28,PLN6940,1273488618,1273488618,General Acute Care Hospital,In-Network,M81.0,Z23,,,,,,,0,,99214,E&M,,,,12,Home,3,416.27,285.75,41.0,244.2,0.0,0.55,244.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008803,MBR00000345,Institutional-OP,2021-12-16,2021-12-16,2021-12-28,PLN1242,1450094833,1450094833,Outpatient Clinic,In-Network,N20.0,Z23,,,,,,,0,,86900,Pathology/Lab,,,0270,22,Outpatient Hospital,3,44.71,14.18,0.0,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008804,MBR00000345,Institutional-IP,2023-06-10,2023-06-12,2023-06-22,PLN4058,1752470395,1752470395,Home Health,In-Network,E11.9,M54.5,,,,470,MS-DRG,8,2,Y,93225,Medicine,,,0120,21,Inpatient Hospital,1,458.22,270.15,270.15,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008805,MBR00000345,Professional,2021-05-12,2021-05-12,2021-06-25,PLN3190,1103747954,1103747954,Urology,In-Network,I10,I50.9,,,,,,,0,,78452,Radiology,,,,11,Office,2,7060.81,4384.06,3904.29,284.72,0.0,195.05,479.77,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008806,MBR00000345,Institutional-OP,2021-05-26,2021-05-26,2021-06-27,PLN7937,1410468316,1410468316,SNF,In-Network,I10,Z87.891,,,,,,,0,,G0468,Medicine,,,0120,22,Outpatient Hospital,3,562.4,437.07,0.0,46.99,75.0,0.0,121.99,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008807,MBR00000345,Professional,2021-01-14,2021-01-14,2021-02-02,PLN1751,1997536841,1997536841,Family Medicine,Out-of-Network,Z00.00,I10,,,,,,,0,,66984,Surgery,,,,21,Inpatient Hospital,1,3428.51,1470.14,0.0,93.72,50.0,0.0,143.72,0.0,Denied,CO-97,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008808,MBR00000345,Institutional-OP,2021-05-17,2021-05-17,2021-05-27,PLN5347,1390307371,1390307371,DME Supplier,In-Network,E66.9,Z12.31,,,,,,,0,,99203,E&M,,,0510,22,Outpatient Hospital,2,225.97,142.25,92.35,0.0,35.0,14.9,49.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008809,MBR00000345,Professional,2022-10-24,2022-10-24,2022-12-05,PLN4301,1660288235,1660288235,ASC,In-Network,F32.9,I10,,,,,,,0,,85610,Pathology/Lab,,,,22,Outpatient Hospital,3,48.15,30.37,28.31,0.0,0.0,2.06,2.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008810,MBR00000345,Institutional-OP,2021-04-10,2021-04-10,2021-05-17,PLN7300,1556140803,1556140803,Cardiology,In-Network,J06.9,E78.5,,,,,,,0,,97530,Medicine,,,0740,22,Outpatient Hospital,1,219.37,74.14,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008811,MBR00000345,Institutional-OP,2022-11-02,2022-11-02,2022-12-10,PLN6431,1242201429,1242201429,General Acute Care Hospital,In-Network,E11.9,J20.9,,,,,,,0,,99406,Medicine,,,0761,22,Outpatient Hospital,2,38.1,28.98,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008812,MBR00000345,Professional,2022-10-19,2022-10-19,2022-11-11,PLN5195,1899127912,1899127912,Neurology,In-Network,I10,F41.9,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,2,407.32,296.45,246.45,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008813,MBR00000345,Institutional-OP,2021-09-14,2021-09-14,2021-10-08,PLN1162,1716521444,1716521444,Oncology,In-Network,I10,F10.20,,,,,,,0,,90837,Medicine,,,0730,22,Outpatient Hospital,1,412.43,306.53,30.33,195.03,75.0,6.17,276.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008814,MBR00000345,Professional,2021-02-10,2021-02-10,2021-02-17,PLN9953,1453283987,1453283987,Critical Access Hospital,In-Network,K21.0,F32.9,,,,,,,0,,45378,Surgery,,,,11,Office,3,1555.71,479.03,48.14,405.89,25.0,0.0,430.89,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000008815,MBR00000345,Institutional-IP,2021-06-27,2021-06-30,2021-07-06,PLN9478,1624802371,1624802371,ASC,Out-of-Network,K21.0,I50.9,,,,683,MS-DRG,3,3,Y,58661,Surgery,,,0740,21,Inpatient Hospital,2,3362.27,1135.97,903.13,232.84,0.0,0.0,232.84,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008816,MBR00000345,Professional,2021-06-06,2021-06-06,2021-07-08,PLN6638,1645194539,1645194539,SNF,In-Network,I10,N20.0,,,,,,,0,,27447,Surgery,,,,11,Office,1,5254.57,1662.22,1429.44,22.14,0.0,210.64,232.78,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008817,MBR00000345,Professional,2022-08-02,2022-08-02,2022-08-25,PLN7062,1609526529,1609526529,Psychiatry,In-Network,E11.9,K21.0,,,,,,,0,,99204,E&M,,,,11,Office,2,585.18,418.84,417.5,0.0,0.0,1.34,1.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008818,MBR00000345,Professional,2023-10-17,2023-10-17,2023-10-26,PLN3004,1910255109,1910255109,DME Supplier,In-Network,E66.9,N18.3,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,3,2106.23,1156.41,1081.41,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008819,MBR00000345,Institutional-IP,2022-04-22,2022-04-25,2022-05-05,PLN9811,1624802371,1624802371,ASC,Out-of-Network,N39.0,C50.912,,,,683,MS-DRG,11,3,Y,76700,Radiology,,,0900,21,Inpatient Hospital,1,1409.07,684.41,598.73,0.0,25.0,60.68,85.68,0.0,Pended,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008820,MBR00000345,Institutional-IP,2022-11-25,2022-11-29,2022-12-11,PLN9438,1242201429,1242201429,General Acute Care Hospital,In-Network,I10,F32.9,,,,194,MS-DRG,14,4,Y,G0439,Medicine,,,0730,21,Inpatient Hospital,1,401.57,255.0,246.95,0.0,0.0,8.05,8.05,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000008821,MBR00000345,Professional,2021-11-29,2021-11-29,2022-01-07,PLN7209,1450553056,1450553056,Clinical Laboratory,In-Network,K21.0,R07.9,,,,,,,0,,G0439,Medicine,,,,81,Independent Laboratory,2,348.0,115.11,14.72,85.39,15.0,0.0,100.39,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000008822,MBR00000345,Professional,2021-04-11,2021-04-11,2021-05-01,PLN2251,1550154147,1550154147,Outpatient Clinic,In-Network,E66.9,J44.1,,,,,,,0,,99213,E&M,,,,11,Office,3,248.71,173.82,173.82,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008823,MBR00000345,Professional,2021-08-27,2021-08-27,2021-10-08,PLN5029,1518055405,1518055405,Urology,In-Network,J06.9,R05,,,,,,,0,,99222,E&M,,,,11,Office,1,407.26,321.85,286.85,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008824,MBR00000345,Institutional-IP,2022-06-09,2022-06-14,2022-07-11,PLN1263,1235381502,1235381502,Cardiology,In-Network,N40.0,F41.9,,,,195,MS-DRG,23,5,Y,99213,E&M,,,0730,21,Inpatient Hospital,2,313.34,157.35,82.35,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000008825,MBR00000345,Professional,2023-07-30,2023-07-30,2023-08-17,PLN4276,1948810580,1948810580,DME Supplier,In-Network,E66.9,E11.9,,,,,,,0,,66984,Surgery,,,,23,Emergency Room,2,3207.85,2088.36,1912.23,176.13,0.0,0.0,176.13,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008826,MBR00000345,Professional,2021-09-30,2021-09-30,2021-10-10,PLN6909,1235381502,1235381502,Cardiology,In-Network,J06.9,E66.9,,,,,,,0,,45378,Surgery,,,,21,Inpatient Hospital,3,2593.9,920.07,829.2,0.0,0.0,90.87,90.87,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000008827,MBR00000345,Institutional-OP,2023-12-14,2023-12-14,2024-01-27,PLN5327,1244186984,1244186984,Family Medicine,Out-of-Network,R51,I10,,,,,,,0,,43239,Surgery,,,0900,22,Outpatient Hospital,1,1138.72,733.96,698.96,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008828,MBR00000345,Institutional-OP,2022-12-01,2022-12-01,2022-12-09,PLN6628,1812060197,1812060197,Oncology,Out-of-Network,E78.5,Z12.11,,,,,,,0,,99204,E&M,,,0740,22,Outpatient Hospital,2,235.8,144.29,144.29,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008829,MBR00000345,Professional,2022-01-25,2022-01-25,2022-02-03,PLN4386,1438368327,1438368327,Home Health,In-Network,I10,R07.9,,,,,,,0,,99213,E&M,,,,20,Urgent Care,3,296.81,203.43,168.43,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000008830,MBR00000345,Professional,2022-11-13,2022-11-13,2022-12-17,PLN5281,1168881145,1168881145,Orthopedic Surgery,In-Network,N40.0,M54.5,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,2,165.33,100.61,69.43,0.0,25.0,6.18,31.18,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008831,MBR00000345,Institutional-IP,2023-02-04,2023-02-10,2023-03-08,PLN6989,1561134315,1561134315,DME Supplier,In-Network,I10,F03.90,,,,682,MS-DRG,18,6,Y,81001,Pathology/Lab,,,0270,21,Inpatient Hospital,2,54.09,39.24,39.24,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008832,MBR00000345,Professional,2023-01-22,2023-01-22,2023-02-26,PLN2699,1450094833,1450094833,Outpatient Clinic,In-Network,E11.9,R05,,,,,,,0,,84443,Pathology/Lab,,,,22,Outpatient Hospital,2,66.31,23.82,23.82,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008833,MBR00000345,Professional,2023-08-06,2023-08-06,2023-08-19,PLN1979,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,K21.0,M54.5,,,,,,,0,,99203,E&M,,,,21,Inpatient Hospital,3,223.49,187.26,137.26,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008834,MBR00000345,Institutional-OP,2022-12-26,2022-12-26,2023-01-13,PLN4206,1295371663,1295371663,Critical Access Hospital,In-Network,F32.9,K57.30,,,,,,,0,,66984,Surgery,,,0270,22,Outpatient Hospital,3,1309.41,608.98,538.29,0.0,0.0,70.69,70.69,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008835,MBR00000345,Professional,2021-01-30,2021-01-30,2021-02-06,PLN5688,1606140917,1606140917,ASC,In-Network,Z12.31,M17.11,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,1,192.83,126.2,0.0,126.2,50.0,0.0,176.2,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008836,MBR00000345,Professional,2022-02-18,2022-02-18,2022-03-20,PLN6725,1531398223,1531398223,OB/GYN,In-Network,M81.0,Z23,,,,,,,0,,97110,Medicine,,,,12,Home,3,121.66,52.25,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008837,MBR00000346,Professional,2023-09-22,2023-09-22,2023-10-08,PLN6026,1337791138,1337791138,Internal Medicine,Out-of-Network,Z00.00,F41.9,,,,,,,0,,97110,Medicine,,,,49,Independent Clinic,2,296.15,184.86,109.86,0.0,75.0,0.0,75.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008838,MBR00000346,Institutional-OP,2021-08-15,2021-08-15,2021-09-14,PLN5291,1780163051,1780163051,SNF,In-Network,I10,R07.9,,,,,,,0,,93225,Medicine,,,0636,22,Outpatient Hospital,3,589.76,376.31,0.0,376.31,0.0,0.0,376.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008839,MBR00000346,Institutional-OP,2022-07-01,2022-07-01,2022-07-19,PLN2486,1295371663,1295371663,Critical Access Hospital,In-Network,J44.1,J44.1,,,,,,,0,,78452,Radiology,,,0900,22,Outpatient Hospital,1,4363.07,2955.28,2590.72,314.56,50.0,0.0,364.56,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008840,MBR00000346,Professional,2022-07-02,2022-07-02,2022-08-01,PLN7264,1809014947,1809014947,Urology,In-Network,C50.912,K21.0,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,3,247.04,157.11,82.11,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008841,MBR00000346,Institutional-OP,2022-09-02,2022-09-02,2022-09-17,PLN9071,1872272835,1872272835,Internal Medicine,In-Network,E78.5,E11.65,,,,,,,0,,G0444,Medicine,,,0120,22,Outpatient Hospital,1,98.73,56.25,6.25,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000008842,MBR00000346,Institutional-OP,2023-08-10,2023-08-10,2023-09-18,PLN5799,1609138981,1609138981,Critical Access Hospital,In-Network,E78.5,J18.9,,,,,,,0,,72148,Radiology,,,0450,22,Outpatient Hospital,3,1044.77,559.46,477.91,0.0,0.0,81.55,81.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008843,MBR00000346,Institutional-OP,2022-08-15,2022-08-15,2022-09-21,PLN8157,1528335731,1528335731,Critical Access Hospital,In-Network,R10.9,J06.9,,,,,,,0,,99283,E&M,,,0450,22,Outpatient Hospital,2,512.29,345.81,277.92,0.0,35.0,32.89,67.89,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008844,MBR00000346,Professional,2021-01-01,2021-01-01,2021-02-02,PLN1403,1236418230,1236418230,DME Supplier,In-Network,Z23,K92.1,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,1,401.92,267.2,159.53,57.67,50.0,0.0,107.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008845,MBR00000346,Professional,2021-09-24,2021-09-24,2021-10-12,PLN8123,1778483301,1778483301,Home Health,In-Network,N39.0,I25.10,,,,,,,0,,74177,Radiology,,,,81,Independent Laboratory,1,1320.76,664.83,629.83,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008846,MBR00000346,Institutional-OP,2022-11-22,2022-11-22,2022-12-16,PLN3479,1518055405,1518055405,Urology,In-Network,K21.0,I11.9,,,,,,,0,,70553,Radiology,,,0740,22,Outpatient Hospital,1,1843.21,1277.11,1152.2,0.0,35.0,89.91,124.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008847,MBR00000346,Professional,2023-05-07,2023-05-07,2023-05-16,PLN3287,1717912431,1717912431,Oncology,In-Network,R51,N39.0,,,,,,,0,,47562,Surgery,,,,11,Office,2,5786.93,3636.45,3551.84,84.61,0.0,0.0,84.61,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008848,MBR00000346,Professional,2022-12-10,2022-12-10,2023-01-10,PLN6322,1728018911,1728018911,Nephrology,In-Network,C50.912,I10,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,2,525.08,368.94,368.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008849,MBR00000346,Institutional-IP,2023-03-13,2023-03-15,2023-03-24,PLN7381,1809014947,1809014947,Urology,In-Network,I10,Z12.31,,,,683,MS-DRG,8,2,Y,99204,E&M,,,0900,21,Inpatient Hospital,3,458.8,305.17,257.41,0.0,25.0,22.76,47.76,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000008850,MBR00000346,Institutional-IP,2021-09-21,2021-09-25,2021-10-31,PLN5173,1273488618,1273488618,General Acute Care Hospital,In-Network,C50.912,G43.909,,,,195,MS-DRG,9,4,Y,G0468,Medicine,,,0301,21,Inpatient Hospital,1,660.99,367.02,0.0,346.12,50.0,0.0,396.12,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008851,MBR00000346,Professional,2021-04-15,2021-04-15,2021-05-05,PLN8360,1749327647,1749327647,Geriatrics,In-Network,N18.3,J20.9,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,2,362.27,250.18,205.22,0.0,0.0,44.96,44.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008852,MBR00000346,Professional,2023-11-05,2023-11-05,2023-11-28,PLN7570,1198133277,1198133277,SNF,In-Network,I48.91,F03.90,,,,,,,0,,87491,Pathology/Lab,,,,81,Independent Laboratory,2,94.09,67.61,0.0,67.61,15.0,0.0,82.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008853,MBR00000346,Institutional-IP,2022-09-09,2022-09-15,2022-10-17,PLN2465,1124394415,1124394415,Pediatrics,In-Network,Z12.31,S72.001A,,,,683,MS-DRG,20,6,Y,76700,Radiology,,,0120,21,Inpatient Hospital,1,1360.4,1145.67,1110.67,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000008854,MBR00000346,Professional,2023-03-20,2023-03-20,2023-05-03,PLN5109,1780163051,1780163051,SNF,In-Network,R51,M54.5,,,,,,,0,,99232,E&M,,,,11,Office,2,363.94,230.68,0.0,230.68,0.0,0.0,230.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008855,MBR00000346,Professional,2023-11-14,2023-11-14,2023-12-20,PLN3992,1696843572,1696843572,Critical Access Hospital,Out-of-Network,Z79.4,J45.20,,,,,,,0,,23472,Surgery,,,,11,Office,2,4840.01,3135.22,2629.36,490.86,15.0,0.0,505.86,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008856,MBR00000346,Professional,2021-07-19,2021-07-19,2021-07-31,PLN6990,1514306773,1514306773,Endocrinology,In-Network,K92.1,K92.1,,,,,,,0,,86900,Pathology/Lab,,,,21,Inpatient Hospital,1,30.13,12.51,0.0,12.51,0.0,0.0,12.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008857,MBR00000346,Professional,2023-08-12,2023-08-12,2023-09-08,PLN1983,1896447406,1896447406,Nephrology,Out-of-Network,E87.6,Z12.31,,,,,,,0,,71046,Radiology,,,,22,Outpatient Hospital,1,181.17,110.63,110.63,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008858,MBR00000346,Professional,2022-02-06,2022-02-06,2022-03-08,PLN9258,1812060197,1812060197,Oncology,Out-of-Network,Z12.31,J06.9,,,,,,,0,,90837,Medicine,,,,20,Urgent Care,1,317.76,218.63,193.63,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008859,MBR00000346,Institutional-OP,2022-11-17,2022-11-17,2022-12-04,PLN8907,1571574052,1571574052,Critical Access Hospital,In-Network,M81.0,K21.0,,,,,,,0,,G0444,Medicine,,,0740,22,Outpatient Hospital,2,96.82,52.19,0.0,52.19,15.0,0.0,67.19,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000008860,MBR00000346,Professional,2022-02-28,2022-02-28,2022-04-02,PLN4450,1502838586,1502838586,ASC,In-Network,G43.909,Z00.00,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,1,25.22,16.53,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008861,MBR00000346,Professional,2021-08-06,2021-08-06,2021-08-20,PLN6835,1990090423,1990090423,Orthopedic Surgery,In-Network,M17.11,Z23,,,,,,,0,,83036,Pathology/Lab,,,,49,Independent Clinic,1,120.56,44.72,29.72,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000008862,MBR00000346,Professional,2023-08-21,2023-08-21,2023-09-06,PLN3426,1609138981,1609138981,Critical Access Hospital,In-Network,M54.5,N39.0,,,,,,,0,,99233,E&M,,,,11,Office,2,533.79,249.44,0.0,249.44,0.0,0.0,249.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008863,MBR00000346,Professional,2022-01-16,2022-01-16,2022-02-19,PLN3278,1528335731,1528335731,Critical Access Hospital,In-Network,E11.9,Z12.11,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,1,157.72,109.48,44.36,60.41,0.0,4.71,65.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008864,MBR00000346,Professional,2021-01-28,2021-01-28,2021-02-12,PLN9735,1108115157,1108115157,General Acute Care Hospital,In-Network,N18.3,F03.90,,,,,,,0,,70450,Radiology,,,,22,Outpatient Hospital,3,1656.76,1342.74,974.96,317.78,50.0,0.0,367.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008865,MBR00000346,Institutional-OP,2021-06-14,2021-06-14,2021-06-25,PLN9240,1528335731,1528335731,Critical Access Hospital,In-Network,Z23,Z00.00,,,,,,,0,,27447,Surgery,,,0360,22,Outpatient Hospital,1,4041.93,2342.05,1935.09,406.96,0.0,0.0,406.96,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008866,MBR00000346,Institutional-IP,2023-11-19,2023-11-23,2023-12-03,PLN7344,1757138478,1757138478,Pediatrics,In-Network,R07.9,Z79.4,,,,682,MS-DRG,12,4,Y,87491,Pathology/Lab,,,0761,21,Inpatient Hospital,1,206.1,74.82,47.92,0.0,25.0,1.9,26.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008867,MBR00000346,Professional,2023-06-20,2023-06-20,2023-07-22,PLN2774,1564502315,1564502315,ASC,In-Network,N18.3,I10,,,,,,,0,,27447,Surgery,,,,21,Inpatient Hospital,3,2894.5,1487.46,1410.67,0.0,25.0,51.79,76.79,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008868,MBR00000346,Professional,2022-12-29,2022-12-29,2023-01-31,PLN1062,1780163051,1780163051,SNF,In-Network,J06.9,R51,,,,,,,0,,80061,Pathology/Lab,,,,20,Urgent Care,2,67.71,57.47,0.0,57.47,0.0,0.0,57.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008869,MBR00000346,Professional,2023-05-03,2023-05-03,2023-06-10,PLN8265,1968299309,1968299309,Internal Medicine,In-Network,Z00.00,K21.0,,,,,,,0,,85610,Pathology/Lab,,,,23,Emergency Room,1,57.23,24.81,0.0,24.81,0.0,0.0,24.81,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008870,MBR00000346,Professional,2022-12-12,2022-12-12,2023-01-02,PLN9985,1974006077,1974006077,Orthopedic Surgery,In-Network,I10,I10,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,2,114.25,84.64,84.64,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008871,MBR00000346,Professional,2023-09-24,2023-09-24,2023-10-02,PLN9995,1865904917,1865904917,Outpatient Clinic,In-Network,Z23,N20.0,,,,,,,0,,27447,Surgery,,,,50,Federally Qualified Health Center,2,5971.59,3669.1,3669.1,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008872,MBR00000346,Professional,2021-04-20,2021-04-20,2021-05-13,PLN3418,1395983630,1395983630,Nephrology,In-Network,I10,I10,,,,,,,0,,99213,E&M,,,,11,Office,1,178.66,144.92,0.0,144.92,75.0,0.0,219.92,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008873,MBR00000346,Professional,2021-03-11,2021-03-11,2021-04-06,PLN7359,1563980627,1563980627,Critical Access Hospital,In-Network,N39.0,I10,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,3,32.31,19.36,0.0,19.36,75.0,0.0,94.36,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008874,MBR00000346,Professional,2023-01-31,2023-01-31,2023-03-08,PLN4976,1795618275,1795618275,Pulmonology,In-Network,E11.65,Z12.31,,,,,,,0,,66984,Surgery,,,,11,Office,3,3004.37,2239.78,2224.78,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008875,MBR00000346,Institutional-OP,2023-11-23,2023-11-23,2023-12-21,PLN8907,1790497490,1790497490,OB/GYN,In-Network,N17.9,M54.5,,,,,,,0,,G0468,Medicine,,,0636,22,Outpatient Hospital,2,348.67,223.47,199.73,0.0,0.0,23.74,23.74,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008876,MBR00000347,Professional,2022-09-29,2022-09-29,2022-10-08,PLN7252,1749327647,1749327647,Geriatrics,In-Network,K21.0,I10,,,,,,,0,,97530,Medicine,,,,11,Office,2,163.15,60.43,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008877,MBR00000347,Institutional-OP,2023-11-25,2023-11-25,2023-12-13,PLN7976,1713934949,1713934949,Neurology,In-Network,J20.9,J45.20,,,,,,,0,,90837,Medicine,,,0370,22,Outpatient Hospital,1,431.55,253.15,0.0,50.03,0.0,0.0,50.03,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008878,MBR00000347,Professional,2022-03-16,2022-03-16,2022-04-14,PLN6814,1935547131,1935547131,Pulmonology,In-Network,E11.9,N39.0,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,2,2993.31,1705.26,1660.61,9.65,35.0,0.0,44.65,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008879,MBR00000347,Institutional-OP,2023-01-09,2023-01-09,2023-01-23,PLN3653,1716521444,1716521444,Oncology,In-Network,I63.9,I48.91,,,,,,,0,,97530,Medicine,,,0301,22,Outpatient Hospital,1,214.87,164.51,130.14,23.87,0.0,10.5,34.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008880,MBR00000347,Institutional-IP,2022-07-12,2022-07-18,2022-08-16,PLN1450,1355166277,1355166277,Endocrinology,In-Network,Z23,Z23,,,,292,MS-DRG,10,6,Y,99232,E&M,,,0200,21,Inpatient Hospital,1,241.28,197.43,0.0,197.43,15.0,0.0,212.43,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008881,MBR00000347,Institutional-OP,2023-08-24,2023-08-24,2023-09-15,PLN8217,1434029575,1434029575,Endocrinology,In-Network,Z87.891,E11.9,,,,,,,0,,72148,Radiology,,,0730,22,Outpatient Hospital,2,2240.48,1550.25,1525.25,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008882,MBR00000347,Institutional-IP,2022-12-10,2022-12-12,2023-01-20,PLN6421,1186826716,1186826716,Physical Therapy,In-Network,J18.9,F41.9,,,,683,MS-DRG,8,2,Y,97530,Medicine,,,0360,21,Inpatient Hospital,1,293.45,156.09,156.09,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008883,MBR00000347,Professional,2022-04-26,2022-04-26,2022-05-30,PLN9488,1168881145,1168881145,Orthopedic Surgery,In-Network,Z00.00,I48.91,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,1,279.27,121.7,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008884,MBR00000347,Professional,2021-09-25,2021-09-25,2021-11-08,PLN6792,1118885473,1118885473,ASC,In-Network,K21.0,J44.1,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,3,53.71,24.86,0.0,24.86,50.0,0.0,74.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008885,MBR00000347,Institutional-OP,2021-12-10,2021-12-10,2021-12-17,PLN4070,1991459367,1991459367,Neurology,Out-of-Network,R10.9,F41.9,,,,,,,0,,71046,Radiology,,,0761,22,Outpatient Hospital,1,323.24,133.3,0.0,133.3,0.0,0.0,133.3,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008886,MBR00000347,Professional,2021-03-23,2021-03-23,2021-04-26,PLN7174,1749494482,1749494482,Pediatrics,In-Network,G43.909,I10,,,,,,,0,,99232,E&M,,,,81,Independent Laboratory,1,184.04,70.9,0.0,70.9,15.0,0.0,85.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008887,MBR00000347,Institutional-OP,2021-06-19,2021-06-19,2021-07-11,PLN3659,1910255109,1910255109,DME Supplier,In-Network,F41.9,F32.9,,,,,,,0,,99213,E&M,,,0740,22,Outpatient Hospital,3,185.86,64.54,49.54,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008888,MBR00000347,Institutional-OP,2022-07-12,2022-07-12,2022-07-31,PLN3792,1609138981,1609138981,Critical Access Hospital,In-Network,E78.5,J44.1,,,,,,,0,,99232,E&M,,,0200,22,Outpatient Hospital,2,325.88,201.84,0.0,201.84,50.0,0.0,251.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008889,MBR00000347,Professional,2021-02-04,2021-02-04,2021-02-20,PLN5834,1266606767,1266606767,ASC,In-Network,I10,Z12.31,,,,,,,0,,84443,Pathology/Lab,,,,31,Skilled Nursing Facility,1,145.41,123.06,121.54,0.0,0.0,1.52,1.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008890,MBR00000347,Institutional-OP,2022-06-01,2022-06-01,2022-06-17,PLN7339,1935547131,1935547131,Pulmonology,In-Network,E11.9,J44.1,,,,,,,0,,86900,Pathology/Lab,,,0120,22,Outpatient Hospital,1,58.46,38.84,0.0,38.84,0.0,0.0,38.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008891,MBR00000347,Professional,2021-02-15,2021-02-15,2021-03-18,PLN7034,1856686341,1856686341,Geriatrics,In-Network,K57.30,Z12.11,,,,,,,0,,97110,Medicine,,,,11,Office,1,274.52,225.24,0.0,225.24,75.0,0.0,300.24,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008892,MBR00000347,Professional,2021-06-27,2021-06-27,2021-07-14,PLN5194,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,M54.5,E11.9,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,2,62.51,36.13,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008893,MBR00000347,Institutional-IP,2023-01-28,2023-01-30,2023-02-20,PLN3105,1609526529,1609526529,Psychiatry,In-Network,I10,E11.9,,,,292,MS-DRG,14,2,Y,81001,Pathology/Lab,,,0730,21,Inpatient Hospital,3,37.09,24.42,24.42,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008894,MBR00000347,Institutional-OP,2021-02-01,2021-02-01,2021-03-16,PLN6508,1242201429,1242201429,General Acute Care Hospital,In-Network,E78.5,E78.5,,,,,,,0,,27447,Surgery,,,0450,22,Outpatient Hospital,1,6098.76,2465.71,2439.18,26.53,0.0,0.0,26.53,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008895,MBR00000347,Professional,2022-01-04,2022-01-04,2022-02-14,PLN6818,1631954542,1631954542,Oncology,In-Network,E78.5,E11.65,,,,,,,0,,99233,E&M,,,,49,Independent Clinic,2,215.37,65.94,65.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008896,MBR00000347,Professional,2021-07-28,2021-07-28,2021-08-28,PLN1393,1865904917,1865904917,Outpatient Clinic,In-Network,J06.9,F41.9,,,,,,,0,,43239,Surgery,,,,11,Office,1,1447.73,508.25,508.25,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008897,MBR00000347,Institutional-IP,2021-03-01,2021-03-07,2021-03-24,PLN7395,1213165847,1213165847,Critical Access Hospital,In-Network,Z00.00,I10,,,,872,MS-DRG,8,6,Y,99221,E&M,,,0761,21,Inpatient Hospital,2,249.64,124.5,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008898,MBR00000347,Institutional-OP,2021-08-16,2021-08-16,2021-09-29,PLN4238,1717912431,1717912431,Oncology,In-Network,M54.5,E11.65,,,,,,,0,,87491,Pathology/Lab,,,0636,22,Outpatient Hospital,2,97.67,81.69,81.69,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008899,MBR00000347,Institutional-IP,2021-05-03,2021-05-08,2021-05-25,PLN5488,1660288235,1660288235,ASC,In-Network,Z96.641,N39.0,,,,641,MS-DRG,3,5,Y,43239,Surgery,,,0120,21,Inpatient Hospital,1,2016.13,1046.96,712.63,279.93,0.0,54.4,334.33,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008900,MBR00000347,Professional,2021-03-30,2021-03-30,2021-05-04,PLN6652,1366426662,1366426662,Urology,In-Network,Z23,C50.912,,,,,,,0,,82043,Pathology/Lab,,,,22,Outpatient Hospital,1,39.26,13.17,0.0,13.17,75.0,0.0,88.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008901,MBR00000347,Professional,2022-12-30,2022-12-30,2023-01-16,PLN5912,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,M54.5,E11.9,,,,,,,0,,90837,Medicine,,,,11,Office,2,431.0,176.32,0.0,176.32,0.0,0.0,176.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008902,MBR00000347,Professional,2021-05-17,2021-05-17,2021-05-29,PLN9778,1561134315,1561134315,DME Supplier,In-Network,Z87.891,E11.40,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,3,2755.03,1597.36,1527.45,51.19,0.0,18.72,69.91,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008903,MBR00000347,Professional,2023-10-25,2023-10-25,2023-12-04,PLN3936,1148984206,1148984206,Psychiatry,In-Network,I10,I10,,,,,,,0,,99222,E&M,,,,49,Independent Clinic,3,637.74,406.67,406.67,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008904,MBR00000347,Institutional-OP,2022-06-17,2022-06-17,2022-07-28,PLN7087,1236418230,1236418230,DME Supplier,In-Network,E66.9,Z12.11,,,,,,,0,,99214,E&M,,,0761,22,Outpatient Hospital,1,427.3,340.98,340.98,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008905,MBR00000347,Professional,2022-03-23,2022-03-23,2022-04-30,PLN7589,1434029575,1434029575,Endocrinology,In-Network,N39.0,Z12.31,,,,,,,0,,83036,Pathology/Lab,,,,20,Urgent Care,3,114.98,85.53,0.0,85.53,35.0,0.0,120.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000008906,MBR00000347,Professional,2023-08-17,2023-08-17,2023-09-28,PLN4311,1845057593,1845057593,Orthopedic Surgery,In-Network,N39.0,E11.9,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,3,379.69,198.98,183.98,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008907,MBR00000347,Institutional-OP,2023-05-02,2023-05-02,2023-06-04,PLN8414,1463205530,1463205530,Nephrology,In-Network,I10,I10,,,,,,,0,,45378,Surgery,,,0370,22,Outpatient Hospital,3,1231.85,842.25,767.25,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000008908,MBR00000347,Professional,2022-04-06,2022-04-06,2022-05-16,PLN1788,1193493783,1193493783,Critical Access Hospital,Out-of-Network,Z12.31,E66.9,,,,,,,0,,93306,Radiology,,,,22,Outpatient Hospital,2,2215.96,1189.51,748.44,363.12,0.0,77.95,441.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008909,MBR00000347,Institutional-OP,2023-12-03,2023-12-03,2023-12-31,PLN7826,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,K92.1,G43.909,,,,,,,0,,43239,Surgery,,,0450,22,Outpatient Hospital,1,1311.22,821.56,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008910,MBR00000347,Professional,2022-08-05,2022-08-05,2022-08-21,PLN9511,1132188260,1132188260,Family Medicine,In-Network,E11.9,F32.9,,,,,,,0,,99233,E&M,,,,81,Independent Laboratory,2,256.82,179.58,179.58,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008911,MBR00000347,Professional,2023-02-15,2023-02-15,2023-03-17,PLN4633,1860435061,1860435061,DME Supplier,In-Network,E78.5,R10.9,,,,,,,0,,23472,Surgery,,,,11,Office,1,4357.63,1611.1,1611.1,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008912,MBR00000347,Institutional-OP,2023-11-28,2023-11-28,2023-12-14,PLN9577,1799205295,1799205295,General Acute Care Hospital,In-Network,F32.9,I10,,,,,,,0,,47562,Surgery,,,0320,22,Outpatient Hospital,3,6292.03,2984.4,0.0,0.0,0.0,303.59,303.59,0.0,Denied,CO-97,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008913,MBR00000347,Institutional-OP,2023-03-03,2023-03-03,2023-03-10,PLN1663,1575695214,1575695214,SNF,In-Network,Z00.00,M54.5,,,,,,,0,,71046,Radiology,,,0510,22,Outpatient Hospital,2,280.62,138.11,138.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008914,MBR00000347,Institutional-IP,2022-10-10,2022-10-17,2022-10-21,PLN5506,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,Z87.891,Z00.00,,,,683,MS-DRG,9,7,N,58661,Surgery,,,0301,21,Inpatient Hospital,2,3389.81,1619.51,1219.97,324.54,75.0,0.0,399.54,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008915,MBR00000347,Professional,2022-11-06,2022-11-06,2022-12-04,PLN3362,1219817751,1219817751,OB/GYN,In-Network,N39.0,E78.5,,,,,,,0,,85025,Pathology/Lab,,,,22,Outpatient Hospital,2,55.06,42.12,42.12,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000008916,MBR00000347,Professional,2022-12-18,2022-12-18,2023-01-24,PLN4550,1224179551,1224179551,Physical Therapy,In-Network,R05,Z00.00,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,3,410.31,344.8,309.8,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008917,MBR00000347,Institutional-OP,2023-12-07,2023-12-07,2024-01-18,PLN4705,1624802371,1624802371,ASC,Out-of-Network,I10,E11.9,,,,,,,0,,47562,Surgery,,,0360,22,Outpatient Hospital,2,6613.15,3071.12,3036.12,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008918,MBR00000347,Institutional-IP,2023-02-07,2023-02-14,2023-03-07,PLN9709,1545347862,1545347862,SNF,In-Network,I10,I10,,,,292,MS-DRG,20,7,N,85610,Pathology/Lab,,,0270,21,Inpatient Hospital,2,36.25,11.45,11.45,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000008919,MBR00000347,Professional,2021-11-25,2021-11-25,2021-12-11,PLN1721,1790497490,1790497490,OB/GYN,In-Network,E11.9,J20.9,,,,,,,0,,99284,E&M,,,,11,Office,1,453.05,323.87,298.87,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008920,MBR00000347,Professional,2021-01-25,2021-01-25,2021-03-04,PLN6613,1563980627,1563980627,Critical Access Hospital,In-Network,Z23,Z23,,,,,,,0,,99284,E&M,,,,11,Office,1,816.26,437.38,1.33,401.05,35.0,0.0,436.05,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008921,MBR00000347,Professional,2023-05-08,2023-05-08,2023-06-19,PLN9542,1845900543,1845900543,ASC,In-Network,B97.89,Z12.31,,,,,,,0,,93306,Radiology,,,,11,Office,3,2274.66,1325.43,1325.43,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008922,MBR00000347,Professional,2022-06-19,2022-06-19,2022-07-06,PLN6768,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,J20.9,M17.11,,,,,,,0,,23472,Surgery,,,,11,Office,3,5806.79,3187.07,3187.07,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008923,MBR00000347,Institutional-OP,2022-03-31,2022-03-31,2022-05-06,PLN4204,1806688928,1806688928,Geriatrics,In-Network,E11.9,I10,,,,,,,0,,G0468,Medicine,,,0510,22,Outpatient Hospital,1,476.92,173.92,173.92,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000008924,MBR00000347,Professional,2023-10-21,2023-10-21,2023-11-15,PLN9275,1799205295,1799205295,General Acute Care Hospital,In-Network,E11.9,E11.9,,,,,,,0,,81001,Pathology/Lab,,,,12,Home,2,22.77,16.41,0.0,16.41,75.0,0.0,91.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008925,MBR00000347,Professional,2021-06-20,2021-06-20,2021-07-28,PLN1104,1631954542,1631954542,Oncology,In-Network,F32.9,J20.9,,,,,,,0,,66984,Surgery,,,,11,Office,1,1660.62,1319.01,0.0,0.0,25.0,82.96,107.96,0.0,Denied,PR-1,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008926,MBR00000348,Institutional-OP,2021-02-11,2021-02-11,2021-03-13,PLN8690,1590915516,1590915516,Physical Therapy,Out-of-Network,E11.9,E11.40,,,,,,,0,,99233,E&M,,,0730,22,Outpatient Hospital,3,439.5,255.44,255.44,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008927,MBR00000348,Institutional-OP,2023-03-21,2023-03-21,2023-04-12,PLN2472,1219817751,1219817751,OB/GYN,In-Network,Z12.31,E66.9,,,,,,,0,,99232,E&M,,,0320,22,Outpatient Hospital,2,245.93,142.17,142.17,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008928,MBR00000348,Institutional-OP,2023-10-09,2023-10-09,2023-10-31,PLN4580,1845900543,1845900543,ASC,In-Network,J44.1,E66.9,,,,,,,0,,45378,Surgery,,,0900,22,Outpatient Hospital,1,1005.92,408.61,67.57,341.04,0.0,0.0,341.04,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000008929,MBR00000348,Institutional-OP,2023-06-28,2023-06-28,2023-07-07,PLN8689,1948810580,1948810580,DME Supplier,In-Network,K21.0,K21.0,,,,,,,0,,99233,E&M,,,0510,22,Outpatient Hospital,3,536.05,419.62,43.04,376.58,0.0,0.0,376.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008930,MBR00000348,Institutional-OP,2023-08-12,2023-08-12,2023-09-08,PLN5330,1571574052,1571574052,Critical Access Hospital,In-Network,Z12.31,Z23,,,,,,,0,,99233,E&M,,,0370,22,Outpatient Hospital,3,454.96,310.26,0.0,0.0,0.0,34.11,34.11,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008931,MBR00000348,Professional,2023-08-04,2023-08-04,2023-08-16,PLN5301,1780163051,1780163051,SNF,In-Network,F32.9,I25.10,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,1,70.9,49.53,34.53,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008932,MBR00000348,Institutional-OP,2023-01-21,2023-01-21,2023-02-12,PLN7293,1268679390,1268679390,Critical Access Hospital,In-Network,J20.9,M81.0,,,,,,,0,,74177,Radiology,,,0360,22,Outpatient Hospital,2,2091.69,1126.76,958.61,0.0,15.0,153.15,168.15,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008933,MBR00000348,Professional,2023-10-07,2023-10-07,2023-10-19,PLN2081,1660288235,1660288235,ASC,In-Network,J44.1,I10,,,,,,,0,,99284,E&M,,,,11,Office,3,757.82,621.62,621.62,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008934,MBR00000348,Professional,2022-01-09,2022-01-09,2022-02-15,PLN8699,1540044947,1540044947,Pulmonology,Out-of-Network,Z00.00,Z00.01,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,2,487.33,372.29,372.29,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008935,MBR00000348,Professional,2023-03-27,2023-03-27,2023-04-10,PLN9497,1899127912,1899127912,Neurology,In-Network,Z79.4,F10.20,,,,,,,0,,45380,Surgery,,,,20,Urgent Care,1,1277.39,532.74,532.74,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000008936,MBR00000348,Professional,2021-04-11,2021-04-11,2021-05-23,PLN3690,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,N39.0,J20.9,,,,,,,0,,99213,E&M,,,,11,Office,3,159.9,108.09,33.09,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008937,MBR00000348,Institutional-OP,2022-08-01,2022-08-01,2022-08-21,PLN2752,1139906830,1139906830,Endocrinology,Out-of-Network,E78.5,F41.9,,,,,,,0,,58661,Surgery,,,0120,22,Outpatient Hospital,3,1889.52,1253.76,1218.76,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008938,MBR00000348,Institutional-OP,2021-11-15,2021-11-15,2021-12-20,PLN2017,1453283987,1453283987,Critical Access Hospital,In-Network,E78.5,J18.9,,,,,,,0,,99283,E&M,,,0200,22,Outpatient Hospital,1,458.69,334.36,270.83,0.0,25.0,38.53,63.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008939,MBR00000349,Professional,2023-10-25,2023-10-25,2023-12-02,PLN1997,1109850785,1109850785,ASC,Out-of-Network,E78.5,Z12.11,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,1,18181.28,7019.28,7019.28,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000008940,MBR00000349,Institutional-OP,2022-04-23,2022-04-23,2022-05-19,PLN8901,1500949740,1500949740,Pediatrics,In-Network,S72.001A,E11.9,,,,,,,0,,93306,Radiology,,,0270,22,Outpatient Hospital,2,1677.48,998.01,932.39,0.0,0.0,65.62,65.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008941,MBR00000349,Institutional-OP,2021-08-18,2021-08-18,2021-08-27,PLN4031,1716521444,1716521444,Oncology,In-Network,G43.909,Z12.31,,,,,,,0,,76700,Radiology,,,0370,22,Outpatient Hospital,2,964.61,546.67,546.67,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008942,MBR00000349,Professional,2022-09-16,2022-09-16,2022-10-22,PLN7121,1556140803,1556140803,Cardiology,In-Network,Z23,J44.1,,,,,,,0,,47562,Surgery,,,,23,Emergency Room,2,3796.02,1437.51,1241.56,195.95,0.0,0.0,195.95,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000008943,MBR00000349,Institutional-OP,2021-03-26,2021-03-26,2021-04-12,PLN7417,1812060197,1812060197,Oncology,Out-of-Network,Z00.00,J06.9,,,,,,,0,,78452,Radiology,,,0450,22,Outpatient Hospital,1,7302.34,5301.47,4931.5,334.97,35.0,0.0,369.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008944,MBR00000349,Professional,2021-05-19,2021-05-19,2021-06-21,PLN5317,1689639685,1689639685,SNF,In-Network,M54.5,Z23,,,,,,,0,,70553,Radiology,,,,22,Outpatient Hospital,3,4121.11,1305.83,1082.85,190.84,0.0,32.14,222.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008945,MBR00000349,Professional,2022-04-18,2022-04-18,2022-05-08,PLN3645,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,I10,E78.5,,,,,,,0,,47562,Surgery,,,,11,Office,3,6520.35,2244.19,0.0,0.0,0.0,136.51,136.51,0.0,Denied,CO-119,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008946,MBR00000349,Professional,2022-11-22,2022-11-22,2023-01-02,PLN8612,1700633438,1700633438,DME Supplier,In-Network,N18.3,N18.3,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,1,386.34,267.33,0.0,267.33,15.0,0.0,282.33,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008947,MBR00000349,Institutional-OP,2022-09-30,2022-09-30,2022-11-03,PLN2895,1118885473,1118885473,ASC,In-Network,J44.1,I10,,,,,,,0,,78452,Radiology,,,0270,22,Outpatient Hospital,2,6323.98,5090.59,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008948,MBR00000349,Professional,2021-03-02,2021-03-02,2021-04-15,PLN3820,1964402759,1964402759,Outpatient Clinic,In-Network,J06.9,F41.9,,,,,,,0,,99204,E&M,,,,65,End-Stage Renal Disease,2,309.67,105.72,0.0,105.72,0.0,0.0,105.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008949,MBR00000349,Professional,2023-01-15,2023-01-15,2023-02-07,PLN6682,1389336600,1389336600,Critical Access Hospital,In-Network,G20,F41.9,,,,,,,0,,99232,E&M,,,,11,Office,2,360.65,215.83,215.83,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008950,MBR00000349,Institutional-IP,2021-03-05,2021-03-06,2021-03-19,PLN9059,1968299309,1968299309,Internal Medicine,In-Network,E11.40,E11.9,,,,871,MS-DRG,10,1,Y,99283,E&M,,,0450,21,Inpatient Hospital,2,493.48,314.02,242.41,0.0,15.0,56.61,71.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008951,MBR00000349,Institutional-OP,2023-06-12,2023-06-12,2023-06-25,PLN9873,1186826716,1186826716,Physical Therapy,In-Network,F41.9,Z00.00,,,,,,,0,,27447,Surgery,,,0370,22,Outpatient Hospital,2,4342.04,2364.38,2314.38,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008952,MBR00000349,Institutional-OP,2021-02-12,2021-02-12,2021-03-07,PLN5514,1700633438,1700633438,DME Supplier,In-Network,F41.9,E11.9,,,,,,,0,,97530,Medicine,,,0761,22,Outpatient Hospital,1,262.46,147.5,0.0,147.5,25.0,0.0,172.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008953,MBR00000349,Professional,2021-01-30,2021-01-30,2021-03-07,PLN5186,1337791138,1337791138,Internal Medicine,Out-of-Network,Z12.31,Z00.00,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,2,1967.8,1080.23,1080.23,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000008954,MBR00000349,Institutional-OP,2022-07-21,2022-07-21,2022-08-07,PLN9135,1372918899,1372918899,Family Medicine,In-Network,E87.6,Z00.00,,,,,,,0,,27447,Surgery,,,0200,22,Outpatient Hospital,3,4588.1,3484.37,3484.37,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008955,MBR00000349,Institutional-IP,2023-05-29,2023-06-02,2023-07-02,PLN1222,1235381502,1235381502,Cardiology,In-Network,I10,J20.9,,,,195,MS-DRG,14,4,Y,93000,Radiology,,,0730,21,Inpatient Hospital,2,142.54,114.14,112.58,0.0,0.0,1.56,1.56,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008956,MBR00000349,Professional,2023-04-18,2023-04-18,2023-05-14,PLN7120,1148984206,1148984206,Psychiatry,In-Network,J44.1,N20.0,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,2,786.12,267.72,267.72,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008957,MBR00000349,Institutional-IP,2022-10-20,2022-10-22,2022-12-02,PLN6968,1114982472,1114982472,Orthopedic Surgery,In-Network,K21.0,J06.9,,,,292,MS-DRG,15,2,U,90686,Medicine,,,0370,21,Inpatient Hospital,3,112.08,40.21,0.0,40.21,50.0,0.0,90.21,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000008958,MBR00000349,Professional,2021-07-15,2021-07-15,2021-08-05,PLN2565,1757138478,1757138478,Pediatrics,In-Network,J06.9,E66.9,,,,,,,0,,G0468,Medicine,,,,21,Inpatient Hospital,2,622.09,344.22,0.0,0.0,25.0,14.04,39.04,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008959,MBR00000349,Institutional-OP,2023-11-10,2023-11-10,2023-11-28,PLN1085,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,Z12.31,M54.5,,,,,,,0,,72148,Radiology,,,0370,22,Outpatient Hospital,3,2319.84,1524.3,1351.12,0.0,0.0,173.18,173.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008960,MBR00000349,Professional,2021-01-23,2021-01-23,2021-02-12,PLN5515,1395983630,1395983630,Nephrology,In-Network,K21.0,K21.0,,,,,,,0,,99204,E&M,,,,11,Office,2,258.95,169.82,134.82,0.0,35.0,0.0,35.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008961,MBR00000349,Professional,2022-01-16,2022-01-16,2022-02-20,PLN9167,1556140803,1556140803,Cardiology,In-Network,J06.9,F41.9,,,,,,,0,,90460,Medicine,,,,11,Office,3,60.35,45.62,45.62,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008962,MBR00000349,Institutional-OP,2023-04-06,2023-04-06,2023-04-23,PLN6036,1727809972,1727809972,Home Health,In-Network,I10,E11.40,,,,,,,0,,99221,E&M,,,0636,22,Outpatient Hospital,3,454.91,361.71,0.0,234.9,0.0,0.0,234.9,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008963,MBR00000349,Institutional-OP,2022-11-07,2022-11-07,2022-11-25,PLN2856,1364429278,1364429278,OB/GYN,In-Network,R07.9,J44.1,,,,,,,0,,99283,E&M,,,0740,22,Outpatient Hospital,1,315.09,176.94,176.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008964,MBR00000349,Professional,2023-05-16,2023-05-16,2023-06-15,PLN4574,1840431511,1840431511,Geriatrics,Out-of-Network,F41.9,J20.9,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,1,107.94,81.43,73.17,0.0,0.0,8.26,8.26,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000008965,MBR00000349,Institutional-OP,2023-04-20,2023-04-20,2023-05-06,PLN1916,1434029575,1434029575,Endocrinology,In-Network,G43.909,J06.9,,,,,,,0,,85025,Pathology/Lab,,,0270,22,Outpatient Hospital,2,61.98,34.98,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008966,MBR00000349,Institutional-OP,2023-10-26,2023-10-26,2023-12-06,PLN1879,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,Z23,E66.9,,,,,,,0,,99284,E&M,,,0761,22,Outpatient Hospital,3,593.28,497.9,0.0,367.53,0.0,16.62,384.15,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008967,MBR00000349,Professional,2022-07-20,2022-07-20,2022-08-12,PLN9264,1631954542,1631954542,Oncology,In-Network,I10,J45.20,,,,,,,0,,71046,Radiology,,,,12,Home,3,278.19,144.67,69.67,0.0,75.0,0.0,75.0,0.0,Pended,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008968,MBR00000349,Institutional-IP,2023-06-18,2023-06-25,2023-07-29,PLN5230,1531398223,1531398223,OB/GYN,In-Network,Z00.00,Z23,,,,470,MS-DRG,14,7,Y,90460,Medicine,,,0761,21,Inpatient Hospital,3,37.53,17.54,17.54,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,1,Upcoding,0,0,0,0,0
CLM0000008969,MBR00000349,Professional,2021-06-20,2021-06-20,2021-07-11,PLN5394,1205377316,1205377316,Orthopedic Surgery,In-Network,J06.9,I10,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,3,74.16,53.34,0.0,53.34,0.0,0.0,53.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008970,MBR00000349,Institutional-OP,2021-07-10,2021-07-10,2021-07-31,PLN7459,1749494482,1749494482,Pediatrics,In-Network,Z00.00,I11.9,,,,,,,0,,99222,E&M,,,0761,22,Outpatient Hospital,3,436.84,160.6,160.6,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008971,MBR00000349,Professional,2021-02-24,2021-02-24,2021-04-03,PLN3995,1896447406,1896447406,Nephrology,Out-of-Network,N20.0,Z87.891,,,,,,,0,,47562,Surgery,,,,81,Independent Laboratory,1,5606.82,4386.16,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-97,,0,,0,0,1,0,0,1,Phantom,0,0,0,0,0
CLM0000008972,MBR00000349,Institutional-OP,2021-08-12,2021-08-12,2021-08-24,PLN8679,1511044648,1511044648,Endocrinology,In-Network,E11.9,Z12.31,,,,,,,0,,97110,Medicine,,,0510,22,Outpatient Hospital,1,142.72,105.88,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000008973,MBR00000349,Professional,2021-05-02,2021-05-02,2021-06-07,PLN1723,1575695214,1575695214,SNF,In-Network,I10,E11.9,,,,,,,0,,27447,Surgery,,,,49,Independent Clinic,1,5701.75,4138.39,4123.39,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008974,MBR00000349,Professional,2023-06-22,2023-06-22,2023-07-25,PLN2561,1757138478,1757138478,Pediatrics,In-Network,E66.9,N40.0,,,,,,,0,,G0444,Medicine,,,,11,Office,1,65.88,33.06,0.0,33.06,0.0,0.0,33.06,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000008975,MBR00000350,Institutional-OP,2022-06-26,2022-06-26,2022-07-10,PLN1818,1450094833,1450094833,Outpatient Clinic,In-Network,M81.0,R07.9,,,,,,,0,,99284,E&M,,,0120,22,Outpatient Hospital,3,574.02,353.64,264.95,0.0,50.0,38.69,88.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008976,MBR00000350,Professional,2022-05-02,2022-05-02,2022-05-20,PLN3822,1974006077,1974006077,Orthopedic Surgery,In-Network,J45.20,Z12.31,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,1,273.73,228.9,156.07,59.04,0.0,13.79,72.83,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008977,MBR00000350,Institutional-OP,2022-12-02,2022-12-02,2023-01-10,PLN7792,1778483301,1778483301,Home Health,In-Network,E11.9,I10,,,,,,,0,,99213,E&M,,,0270,22,Outpatient Hospital,2,301.78,112.86,37.65,0.0,75.0,0.21,75.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008978,MBR00000350,Professional,2022-01-29,2022-01-29,2022-02-17,PLN4717,1193493783,1193493783,Critical Access Hospital,Out-of-Network,Z00.00,I10,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,1,421.05,196.42,0.0,196.42,25.0,0.0,221.42,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008979,MBR00000350,Professional,2022-09-17,2022-09-17,2022-10-03,PLN7246,1872272835,1872272835,Internal Medicine,In-Network,E11.65,R10.9,,,,,,,0,,G0444,Medicine,,,,11,Office,2,82.28,64.37,0.0,64.37,15.0,0.0,79.37,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000008980,MBR00000351,Institutional-OP,2021-01-04,2021-01-04,2021-01-29,PLN7757,1575695214,1575695214,SNF,In-Network,F10.20,R10.9,,,,,,,0,,99221,E&M,,,0450,22,Outpatient Hospital,1,358.04,240.9,0.0,240.9,75.0,0.0,315.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008981,MBR00000351,Professional,2023-02-20,2023-02-20,2023-03-04,PLN4890,1896447406,1896447406,Nephrology,Out-of-Network,J06.9,J44.1,,,,,,,0,,80053,Pathology/Lab,,,,22,Outpatient Hospital,3,113.94,41.4,41.4,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008982,MBR00000351,Institutional-IP,2023-08-13,2023-08-14,2023-09-06,PLN7650,1691062876,1691062876,SNF,In-Network,R10.9,E78.5,,,,871,MS-DRG,24,1,Y,70450,Radiology,,,0320,21,Inpatient Hospital,2,1142.84,724.1,724.1,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008983,MBR00000351,Professional,2021-02-12,2021-02-12,2021-03-10,PLN4858,1645194539,1645194539,SNF,In-Network,I48.91,J20.9,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,3,3024.76,1337.49,802.79,319.91,25.0,189.79,534.7,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008984,MBR00000351,Institutional-IP,2021-03-30,2021-04-04,2021-04-25,PLN2905,1542828721,1542828721,Orthopedic Surgery,In-Network,E78.5,K21.0,,,,641,MS-DRG,1,5,Y,45380,Surgery,,,0761,21,Inpatient Hospital,2,1328.36,1051.45,1051.45,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000008985,MBR00000351,Institutional-IP,2021-05-30,2021-05-31,2021-07-12,PLN9603,1860435061,1860435061,DME Supplier,In-Network,E11.65,K92.1,,,,292,MS-DRG,23,1,Y,71046,Radiology,,,0360,21,Inpatient Hospital,2,215.15,146.72,0.0,146.72,0.0,0.0,146.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008986,MBR00000351,Professional,2022-10-28,2022-10-28,2022-11-08,PLN4776,1845900543,1845900543,ASC,In-Network,Z00.00,M17.11,,,,,,,0,,45380,Surgery,,,,11,Office,3,2738.09,1596.95,1596.95,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000008987,MBR00000351,Professional,2023-04-14,2023-04-14,2023-05-04,PLN6590,1114982472,1114982472,Orthopedic Surgery,In-Network,J06.9,M17.11,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,1,87.18,47.6,0.0,47.6,0.0,0.0,47.6,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008988,MBR00000351,Professional,2023-06-21,2023-06-21,2023-07-24,PLN9503,1450094833,1450094833,Outpatient Clinic,In-Network,I10,I11.9,,,,,,,0,,99233,E&M,,,,11,Office,3,543.18,354.08,162.33,188.0,0.0,3.75,191.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008989,MBR00000351,Institutional-OP,2023-05-06,2023-05-06,2023-05-23,PLN6626,1896447406,1896447406,Nephrology,Out-of-Network,Z23,I10,,,,,,,0,,99203,E&M,,,0370,22,Outpatient Hospital,1,323.33,264.27,229.27,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008990,MBR00000351,Professional,2022-09-24,2022-09-24,2022-10-22,PLN1694,1990090423,1990090423,Orthopedic Surgery,In-Network,E11.9,N40.0,,,,,,,0,,78452,Radiology,,,,11,Office,1,4094.6,1713.9,1638.9,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008991,MBR00000351,Professional,2023-02-09,2023-02-09,2023-03-14,PLN8582,1520687146,1520687146,ASC,In-Network,Z87.891,B97.89,,,,,,,0,,33533,Surgery,,,,11,Office,3,20419.99,11354.52,11354.52,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000008992,MBR00000351,Professional,2021-11-03,2021-11-03,2021-12-14,PLN3072,1745114564,1745114564,Endocrinology,In-Network,E66.9,I10,,,,,,,0,,99214,E&M,,,,11,Office,1,328.29,178.0,0.0,178.0,0.0,0.0,178.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008993,MBR00000351,Institutional-OP,2023-03-28,2023-03-28,2023-05-03,PLN4600,1268679390,1268679390,Critical Access Hospital,In-Network,I10,M54.5,,,,,,,0,,76700,Radiology,,,0740,22,Outpatient Hospital,2,809.71,675.34,675.34,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008994,MBR00000351,Professional,2021-07-20,2021-07-20,2021-08-18,PLN7759,1366576336,1366576336,Geriatrics,In-Network,E78.5,M54.5,,,,,,,0,,83036,Pathology/Lab,,,,21,Inpatient Hospital,3,100.66,43.29,27.68,0.0,15.0,0.61,15.61,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000008995,MBR00000351,Professional,2023-11-21,2023-11-21,2023-12-08,PLN1565,1590915516,1590915516,Physical Therapy,Out-of-Network,I25.10,Z51.11,,,,,,,0,,71046,Radiology,,,,11,Office,3,271.85,124.3,0.0,124.3,50.0,0.0,174.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008996,MBR00000351,Institutional-OP,2021-02-15,2021-02-15,2021-03-27,PLN7843,1361302520,1361302520,Critical Access Hospital,In-Network,I10,I25.10,,,,,,,0,,45380,Surgery,,,0120,22,Outpatient Hospital,1,2512.41,2109.93,2059.93,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000008997,MBR00000351,Institutional-OP,2023-10-31,2023-10-31,2023-12-06,PLN2663,1500949740,1500949740,Pediatrics,In-Network,M54.5,J44.1,,,,,,,0,,93000,Radiology,,,0270,22,Outpatient Hospital,3,136.95,85.03,0.0,85.03,0.0,0.0,85.03,0.0,Denied,CO-4,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000008998,MBR00000351,Institutional-OP,2022-05-20,2022-05-20,2022-06-21,PLN4394,1518055405,1518055405,Urology,In-Network,I10,I25.10,,,,,,,0,,27447,Surgery,,,0370,22,Outpatient Hospital,3,5552.83,4277.34,4250.84,0.0,0.0,26.5,26.5,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000008999,MBR00000351,Institutional-IP,2022-12-07,2022-12-08,2023-01-12,PLN7850,1896447406,1896447406,Nephrology,Out-of-Network,J20.9,E78.5,,,,603,MS-DRG,20,1,Y,78452,Radiology,,,0740,21,Inpatient Hospital,2,4347.0,3526.47,3526.47,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009000,MBR00000351,Professional,2021-06-24,2021-06-24,2021-07-31,PLN1908,1550154147,1550154147,Outpatient Clinic,In-Network,R05,I10,,,,,,,0,,66984,Surgery,,,,11,Office,1,3002.11,1112.41,1112.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009001,MBR00000351,Professional,2021-12-16,2021-12-16,2021-12-24,PLN3847,1910255109,1910255109,DME Supplier,In-Network,F41.9,Z00.00,,,,,,,0,,80061,Pathology/Lab,,,,22,Outpatient Hospital,1,107.66,85.73,0.0,85.73,35.0,0.0,120.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009002,MBR00000351,Professional,2023-08-03,2023-08-03,2023-09-15,PLN4591,1964402759,1964402759,Outpatient Clinic,In-Network,M17.11,Z23,,,,,,,0,,G0444,Medicine,,,,22,Outpatient Hospital,3,55.81,41.71,23.04,0.0,15.0,3.67,18.67,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000009003,MBR00000351,Institutional-IP,2021-01-16,2021-01-17,2021-01-23,PLN3460,1915531927,1915531927,Critical Access Hospital,In-Network,E11.65,E11.40,,,,470,MS-DRG,4,1,Y,85610,Pathology/Lab,,,0301,21,Inpatient Hospital,1,60.34,18.73,0.0,18.73,75.0,0.0,93.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009004,MBR00000351,Professional,2021-07-29,2021-07-29,2021-08-08,PLN7074,1845057593,1845057593,Orthopedic Surgery,In-Network,N20.0,E66.9,,,,,,,0,,93000,Radiology,,,,11,Office,1,89.38,56.18,0.0,0.0,35.0,1.32,36.32,0.0,Denied,CO-27,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009005,MBR00000351,Professional,2022-11-23,2022-11-23,2022-12-23,PLN7768,1366576336,1366576336,Geriatrics,In-Network,J44.1,E11.9,,,,,,,0,,99213,E&M,,,,11,Office,3,185.47,111.93,0.0,111.93,0.0,0.0,111.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009006,MBR00000351,Institutional-IP,2023-05-31,2023-06-03,2023-06-07,PLN4711,1475984649,1475984649,SNF,In-Network,I10,Z23,,,,641,MS-DRG,12,3,Y,99232,E&M,,,0740,21,Inpatient Hospital,2,291.48,123.75,0.0,123.75,35.0,0.0,158.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009007,MBR00000352,Institutional-OP,2022-04-18,2022-04-18,2022-05-09,PLN7117,1266606767,1266606767,ASC,In-Network,Z00.00,F32.9,,,,,,,0,,99232,E&M,,,0120,22,Outpatient Hospital,3,258.85,143.47,67.48,0.0,75.0,0.99,75.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009008,MBR00000352,Professional,2021-04-06,2021-04-06,2021-04-27,PLN4842,1915531927,1915531927,Critical Access Hospital,In-Network,I10,K21.0,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,2,1709.53,738.95,738.95,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009009,MBR00000352,Institutional-OP,2021-06-10,2021-06-10,2021-07-01,PLN8012,1713934949,1713934949,Neurology,In-Network,I10,Z12.31,,,,,,,0,,99214,E&M,,,0740,22,Outpatient Hospital,2,406.69,311.13,311.13,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009010,MBR00000352,Professional,2023-09-02,2023-09-02,2023-09-19,PLN7275,1569105090,1569105090,Geriatrics,In-Network,F32.9,Z12.31,,,,,,,0,,99232,E&M,,,,11,Office,1,322.53,103.88,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009011,MBR00000352,Institutional-IP,2021-08-24,2021-08-27,2021-10-02,PLN7175,1213165847,1213165847,Critical Access Hospital,In-Network,E78.5,K21.0,,,,195,MS-DRG,21,3,Y,99213,E&M,,,0740,21,Inpatient Hospital,1,163.63,118.59,0.0,118.59,35.0,0.0,153.59,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009012,MBR00000352,Institutional-OP,2022-09-26,2022-09-26,2022-10-17,PLN4786,1124394415,1124394415,Pediatrics,In-Network,N18.3,N18.3,,,,,,,0,,97530,Medicine,,,0270,22,Outpatient Hospital,3,171.4,73.16,0.0,73.16,15.0,0.0,88.16,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009013,MBR00000352,Professional,2023-10-23,2023-10-23,2023-11-20,PLN5366,1453936007,1453936007,ASC,In-Network,Z12.31,N39.0,,,,,,,0,,99203,E&M,,,,21,Inpatient Hospital,2,284.79,206.0,0.0,191.92,25.0,0.0,216.92,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009014,MBR00000352,Institutional-OP,2022-02-16,2022-02-16,2022-03-05,PLN6507,1389336600,1389336600,Critical Access Hospital,In-Network,E66.9,Z23,,,,,,,0,,47562,Surgery,,,0270,22,Outpatient Hospital,2,6351.79,4976.66,4750.47,226.19,0.0,0.0,226.19,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009015,MBR00000353,Institutional-OP,2021-03-14,2021-03-14,2021-03-23,PLN8312,1624202402,1624202402,Orthopedic Surgery,In-Network,I10,F41.9,,,,,,,0,,99406,Medicine,,,0450,22,Outpatient Hospital,3,38.39,30.47,30.47,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009016,MBR00000353,Institutional-OP,2023-06-10,2023-06-10,2023-07-18,PLN8706,1118885473,1118885473,ASC,In-Network,M17.11,K21.0,,,,,,,0,,99232,E&M,,,0761,22,Outpatient Hospital,2,256.78,133.96,0.0,119.31,15.0,0.0,134.31,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000009017,MBR00000353,Professional,2023-05-13,2023-05-13,2023-06-07,PLN6545,1571574052,1571574052,Critical Access Hospital,In-Network,G43.909,E11.9,,,,,,,0,,99203,E&M,,,,11,Office,2,167.5,59.63,34.63,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009018,MBR00000353,Professional,2022-12-14,2022-12-14,2023-01-06,PLN2695,1717912431,1717912431,Oncology,In-Network,J20.9,Z00.00,,,,,,,0,,93000,Radiology,,,,11,Office,3,87.9,65.91,0.0,65.91,0.0,0.0,65.91,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009019,MBR00000353,Professional,2023-09-15,2023-09-15,2023-09-26,PLN5413,1700633438,1700633438,DME Supplier,In-Network,I10,F41.9,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,3,97.62,45.54,0.0,20.16,75.0,0.0,95.16,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000009020,MBR00000353,Institutional-OP,2023-04-30,2023-04-30,2023-05-21,PLN9565,1198133277,1198133277,SNF,In-Network,N18.3,Z87.891,,,,,,,0,,93225,Medicine,,,0730,22,Outpatient Hospital,2,701.23,561.61,290.2,194.38,35.0,42.03,271.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009021,MBR00000353,Professional,2023-01-24,2023-01-24,2023-02-01,PLN1466,1227362142,1227362142,DME Supplier,In-Network,R51,I10,,,,,,,0,,70450,Radiology,,,,11,Office,2,1342.6,544.22,271.41,272.81,0.0,0.0,272.81,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009022,MBR00000353,Professional,2022-01-01,2022-01-01,2022-02-06,PLN8931,1790497490,1790497490,OB/GYN,In-Network,F10.20,M54.5,,,,,,,0,,99203,E&M,,,,11,Office,3,174.62,81.21,28.22,0.0,50.0,2.99,52.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009023,MBR00000353,Institutional-OP,2021-03-09,2021-03-09,2021-04-07,PLN5348,1856686341,1856686341,Geriatrics,In-Network,I10,J06.9,,,,,,,0,,99213,E&M,,,0450,22,Outpatient Hospital,3,121.54,75.61,0.0,75.61,50.0,0.0,125.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009024,MBR00000353,Professional,2023-03-06,2023-03-06,2023-04-13,PLN6014,1571574052,1571574052,Critical Access Hospital,In-Network,J06.9,E66.9,,,,,,,0,,58661,Surgery,,,,23,Emergency Room,2,2818.73,1665.94,1665.94,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009025,MBR00000353,Professional,2023-07-16,2023-07-16,2023-08-19,PLN1667,1268679390,1268679390,Critical Access Hospital,In-Network,Z79.4,I11.9,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,3,486.87,313.27,232.01,81.26,0.0,0.0,81.26,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009026,MBR00000353,Institutional-OP,2023-02-01,2023-02-01,2023-03-01,PLN9967,1511044648,1511044648,Endocrinology,In-Network,I10,F32.9,,,,,,,0,,99284,E&M,,,0360,22,Outpatient Hospital,3,352.34,245.02,105.88,92.96,25.0,21.18,139.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009027,MBR00000353,Professional,2022-12-17,2022-12-17,2023-01-12,PLN6593,1865904917,1865904917,Outpatient Clinic,In-Network,Z87.891,E78.5,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,2,38.25,21.72,6.72,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009028,MBR00000353,Professional,2023-02-26,2023-02-26,2023-03-12,PLN2531,1991459367,1991459367,Neurology,Out-of-Network,R07.9,J44.1,,,,,,,0,,85610,Pathology/Lab,,,,22,Outpatient Hospital,2,34.91,28.2,0.0,28.2,35.0,0.0,63.2,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009029,MBR00000353,Professional,2021-10-31,2021-10-31,2021-11-10,PLN2714,1540044947,1540044947,Pulmonology,Out-of-Network,Z23,E11.40,,,,,,,0,,99221,E&M,,,,11,Office,3,328.86,217.49,186.77,0.0,0.0,30.72,30.72,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000009030,MBR00000353,Professional,2021-05-09,2021-05-09,2021-06-06,PLN7813,1245650222,1245650222,Gastroenterology,In-Network,Z12.31,J18.9,,,,,,,0,,27130,Surgery,,,,11,Office,1,6760.12,2236.26,1947.72,0.0,0.0,288.54,288.54,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009031,MBR00000353,Professional,2022-11-21,2022-11-21,2023-01-03,PLN3090,1716521444,1716521444,Oncology,In-Network,F41.9,Z12.31,,,,,,,0,,97110,Medicine,,,,21,Inpatient Hospital,2,201.3,164.89,0.0,164.89,0.0,0.0,164.89,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009032,MBR00000353,Institutional-OP,2023-10-30,2023-10-30,2023-12-07,PLN8217,1609526529,1609526529,Psychiatry,In-Network,Z23,E78.5,,,,,,,0,,76700,Radiology,,,0900,22,Outpatient Hospital,3,1194.71,418.27,0.0,0.0,0.0,11.28,11.28,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009033,MBR00000353,Professional,2021-05-30,2021-05-30,2021-06-13,PLN3451,1438368327,1438368327,Home Health,In-Network,F32.9,I10,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,1,92.97,76.02,1.02,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009034,MBR00000353,Professional,2021-03-19,2021-03-19,2021-04-25,PLN8146,1795618275,1795618275,Pulmonology,In-Network,Z23,I10,,,,,,,0,,70450,Radiology,,,,20,Urgent Care,2,1804.34,582.53,146.7,385.83,50.0,0.0,435.83,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009035,MBR00000353,Institutional-OP,2023-02-14,2023-02-14,2023-03-23,PLN6550,1422747896,1422747896,Urology,In-Network,F32.9,M17.11,,,,,,,0,,27130,Surgery,,,0320,22,Outpatient Hospital,2,4347.96,2394.1,2344.1,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009036,MBR00000353,Institutional-OP,2022-04-08,2022-04-08,2022-05-08,PLN1824,1727809972,1727809972,Home Health,In-Network,I10,I50.9,,,,,,,0,,87491,Pathology/Lab,,,0900,22,Outpatient Hospital,3,93.88,54.03,54.03,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009037,MBR00000353,Institutional-IP,2023-09-16,2023-09-27,2023-10-19,PLN2922,1395983630,1395983630,Nephrology,In-Network,I10,F41.9,,,,603,MS-DRG,18,11,Y,99214,E&M,,,0761,21,Inpatient Hospital,1,427.89,210.96,175.96,0.0,35.0,0.0,35.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009038,MBR00000353,Institutional-OP,2022-06-01,2022-06-01,2022-07-14,PLN4615,1193493783,1193493783,Critical Access Hospital,Out-of-Network,M54.5,E78.5,,,,,,,0,,76700,Radiology,,,0450,22,Outpatient Hospital,2,1390.83,589.17,589.17,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009039,MBR00000353,Professional,2022-07-26,2022-07-26,2022-08-29,PLN9676,1896447406,1896447406,Nephrology,Out-of-Network,Z12.31,M54.5,,,,,,,0,,27447,Surgery,,,,23,Emergency Room,3,4295.28,2112.62,2112.62,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009040,MBR00000353,Institutional-IP,2021-03-09,2021-03-15,2021-04-15,PLN1424,1799205295,1799205295,General Acute Care Hospital,In-Network,E11.40,B97.89,,,,682,MS-DRG,8,6,Y,G0468,Medicine,,,0900,21,Inpatient Hospital,3,275.22,139.5,0.0,139.5,0.0,0.0,139.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009041,MBR00000353,Institutional-OP,2023-11-09,2023-11-09,2023-12-13,PLN6375,1799205295,1799205295,General Acute Care Hospital,In-Network,J06.9,Z23,,,,,,,0,,70553,Radiology,,,0740,22,Outpatient Hospital,1,2558.41,1095.54,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-29,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009042,MBR00000354,Institutional-IP,2021-12-29,2022-01-01,2022-01-06,PLN1187,1727809972,1727809972,Home Health,In-Network,E11.9,E11.9,,,,291,MS-DRG,9,3,Y,99232,E&M,,,0370,21,Inpatient Hospital,2,270.88,143.87,97.09,29.73,0.0,17.05,46.78,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000009043,MBR00000354,Professional,2022-04-25,2022-04-25,2022-05-06,PLN4488,1644128543,1644128543,Gastroenterology,In-Network,Z87.891,B97.89,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,2,36.27,23.42,18.77,0.0,0.0,4.65,4.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009044,MBR00000354,Institutional-OP,2022-11-20,2022-11-20,2023-01-01,PLN8448,1624802371,1624802371,ASC,Out-of-Network,E78.5,J20.9,,,,,,,0,,47562,Surgery,,,0510,22,Outpatient Hospital,2,4589.49,2117.83,1702.99,389.84,25.0,0.0,414.84,0.0,Paid,,,1,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000009045,MBR00000354,Professional,2023-07-29,2023-07-29,2023-09-07,PLN7469,1247341320,1247341320,Urology,Out-of-Network,Z12.11,I10,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,1,91.13,73.09,0.0,73.09,50.0,0.0,123.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009046,MBR00000354,Professional,2023-05-21,2023-05-21,2023-07-04,PLN7769,1910255109,1910255109,DME Supplier,In-Network,Z00.00,M81.0,,,,,,,0,,99284,E&M,,,,11,Office,2,340.86,260.42,208.44,0.0,0.0,51.98,51.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009047,MBR00000354,Institutional-OP,2023-04-28,2023-04-28,2023-05-12,PLN4808,1193493783,1193493783,Critical Access Hospital,Out-of-Network,F41.9,N18.3,,,,,,,0,,23472,Surgery,,,0636,22,Outpatient Hospital,2,3212.39,2591.25,2563.69,0.0,0.0,27.56,27.56,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009048,MBR00000354,Professional,2021-04-26,2021-04-26,2021-06-05,PLN2851,1366426662,1366426662,Urology,In-Network,E11.9,M81.0,,,,,,,0,,70450,Radiology,,,,11,Office,2,1111.92,457.66,346.08,0.0,35.0,76.58,111.58,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009049,MBR00000354,Professional,2021-04-07,2021-04-07,2021-04-28,PLN3240,1114982472,1114982472,Orthopedic Surgery,In-Network,Z87.891,I25.10,,,,,,,0,,99233,E&M,,,,21,Inpatient Hospital,3,503.83,404.28,395.65,0.0,0.0,8.63,8.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009050,MBR00000354,Professional,2023-06-30,2023-06-30,2023-07-16,PLN5268,1410468316,1410468316,SNF,In-Network,N39.0,F03.90,,,,,,,0,,45380,Surgery,,,,50,Federally Qualified Health Center,3,2176.39,1062.97,0.0,479.98,50.0,47.6,577.58,0.0,Denied,CO-97,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000009051,MBR00000354,Professional,2023-09-27,2023-09-27,2023-11-02,PLN9553,1518055405,1518055405,Urology,In-Network,E11.9,I50.9,,,,,,,0,,97530,Medicine,,,,23,Emergency Room,3,246.42,120.89,0.0,120.89,15.0,0.0,135.89,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009052,MBR00000354,Professional,2022-11-14,2022-11-14,2022-11-24,PLN4161,1896447406,1896447406,Nephrology,Out-of-Network,F32.9,M17.11,,,,,,,0,,99233,E&M,,,,23,Emergency Room,1,259.97,135.71,0.0,135.71,0.0,0.0,135.71,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009053,MBR00000354,Institutional-OP,2023-09-24,2023-09-24,2023-11-06,PLN4668,1245650222,1245650222,Gastroenterology,In-Network,I48.91,Z51.11,,,,,,,0,,58661,Surgery,,,0510,22,Outpatient Hospital,1,2708.16,1663.0,0.0,414.5,50.0,0.0,464.5,0.0,Denied,CO-18,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009054,MBR00000354,Institutional-IP,2021-12-14,2021-12-17,2021-12-22,PLN1706,1767011137,1767011137,DME Supplier,In-Network,I11.9,Z23,,,,871,MS-DRG,23,3,Y,85610,Pathology/Lab,,,0301,21,Inpatient Hospital,2,73.43,25.12,0.0,25.12,0.0,0.0,25.12,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009055,MBR00000354,Institutional-OP,2022-01-20,2022-01-20,2022-02-27,PLN9245,1660288235,1660288235,ASC,In-Network,E11.9,Z12.31,,,,,,,0,,99221,E&M,,,0730,22,Outpatient Hospital,2,377.3,310.13,0.0,310.13,25.0,0.0,335.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009056,MBR00000354,Professional,2021-07-06,2021-07-06,2021-08-13,PLN7341,1569105090,1569105090,Geriatrics,In-Network,Z00.00,Z00.00,,,,,,,0,,99284,E&M,,,,23,Emergency Room,3,863.37,292.16,210.59,81.57,0.0,0.0,81.57,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009057,MBR00000354,Professional,2023-05-19,2023-05-19,2023-06-22,PLN1509,1964402759,1964402759,Outpatient Clinic,In-Network,J20.9,I10,,,,,,,0,,27447,Surgery,,,,11,Office,1,4719.83,1657.86,1582.6,75.26,0.0,0.0,75.26,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009058,MBR00000354,Institutional-OP,2023-01-04,2023-01-04,2023-01-31,PLN6218,1622771872,1622771872,Pediatrics,In-Network,Z23,F41.9,,,,,,,0,,90460,Medicine,,,0900,22,Outpatient Hospital,2,37.59,22.97,7.97,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009059,MBR00000354,Professional,2021-09-03,2021-09-03,2021-10-09,PLN8769,1899127912,1899127912,Neurology,In-Network,J18.9,Z00.00,,,,,,,0,,72148,Radiology,,,,23,Emergency Room,3,2543.27,1142.01,1067.01,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009060,MBR00000354,Professional,2023-12-31,2023-12-31,2024-01-30,PLN3413,1865904917,1865904917,Outpatient Clinic,In-Network,C50.912,K21.0,,,,,,,0,,99406,Medicine,,,,12,Home,2,72.1,38.47,23.47,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009061,MBR00000354,Institutional-OP,2021-02-03,2021-02-03,2021-02-28,PLN7092,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,I10,Z00.01,,,,,,,0,,G0439,Medicine,,,0730,22,Outpatient Hospital,1,378.85,216.28,216.28,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000009062,MBR00000354,Professional,2023-04-24,2023-04-24,2023-05-21,PLN4108,1556140803,1556140803,Cardiology,In-Network,E78.5,E78.5,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,3,1946.27,1030.99,617.47,215.44,75.0,123.08,413.52,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009063,MBR00000354,Professional,2021-08-16,2021-08-16,2021-09-15,PLN2693,1540044947,1540044947,Pulmonology,Out-of-Network,Z00.00,N39.0,,,,,,,0,,99221,E&M,,,,23,Emergency Room,1,328.85,101.81,26.52,40.29,35.0,0.0,75.29,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009064,MBR00000354,Professional,2023-05-09,2023-05-09,2023-06-16,PLN4320,1361302520,1361302520,Critical Access Hospital,In-Network,E11.65,Z12.11,,,,,,,0,,99221,E&M,,,,20,Urgent Care,2,275.36,91.73,78.34,13.39,0.0,0.0,13.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009065,MBR00000354,Institutional-IP,2022-06-14,2022-06-21,2022-07-28,PLN7942,1990090423,1990090423,Orthopedic Surgery,In-Network,N39.0,I10,,,,641,MS-DRG,2,7,Y,83036,Pathology/Lab,,,0320,21,Inpatient Hospital,1,70.25,37.05,0.0,37.05,0.0,0.0,37.05,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000009066,MBR00000354,Professional,2021-09-14,2021-09-14,2021-09-22,PLN8384,1313212303,1313212303,Family Medicine,In-Network,E11.40,E78.5,,,,,,,0,,70450,Radiology,,,,11,Office,3,865.72,563.57,434.71,113.86,15.0,0.0,128.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009067,MBR00000354,Institutional-IP,2021-03-05,2021-03-07,2021-04-16,PLN2262,1817234602,1817234602,Clinical Laboratory,In-Network,J06.9,N20.0,,,,292,MS-DRG,5,2,Y,99221,E&M,,,0761,21,Inpatient Hospital,1,235.92,162.55,162.55,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009068,MBR00000354,Institutional-OP,2022-11-12,2022-11-12,2022-12-03,PLN3755,1948810580,1948810580,DME Supplier,In-Network,K21.0,I10,,,,,,,0,,85610,Pathology/Lab,,,0200,22,Outpatient Hospital,2,45.31,25.78,0.0,25.78,15.0,0.0,40.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009069,MBR00000354,Institutional-IP,2021-06-25,2021-06-26,2021-07-12,PLN7992,1109850785,1109850785,ASC,Out-of-Network,J20.9,E87.6,,,,196,MS-DRG,23,1,Y,99283,E&M,,,0320,21,Inpatient Hospital,2,583.58,311.49,311.49,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009070,MBR00000354,Professional,2022-05-08,2022-05-08,2022-05-17,PLN4079,1795618275,1795618275,Pulmonology,In-Network,J20.9,E78.5,,,,,,,0,,71046,Radiology,,,,31,Skilled Nursing Facility,1,281.77,163.1,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009071,MBR00000354,Professional,2023-11-07,2023-11-07,2023-12-05,PLN5546,1840431511,1840431511,Geriatrics,Out-of-Network,E78.5,F32.9,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,3,2636.97,2195.62,2129.47,0.0,50.0,16.15,66.15,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009072,MBR00000354,Institutional-OP,2023-08-30,2023-08-30,2023-09-14,PLN8000,1896447406,1896447406,Nephrology,Out-of-Network,M54.5,E66.9,,,,,,,0,,81001,Pathology/Lab,,,0360,22,Outpatient Hospital,2,62.72,35.09,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009073,MBR00000354,Institutional-OP,2022-06-25,2022-06-25,2022-07-28,PLN7420,1283743001,1283743001,Family Medicine,In-Network,E11.9,N20.0,,,,,,,0,,77067,Radiology,,,0360,22,Outpatient Hospital,2,770.78,594.58,569.58,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000009074,MBR00000354,Professional,2023-03-13,2023-03-13,2023-03-22,PLN8760,1135158374,1135158374,Pulmonology,In-Network,G43.909,Z00.00,,,,,,,0,,86900,Pathology/Lab,,,,21,Inpatient Hospital,3,54.74,45.52,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009075,MBR00000354,Professional,2023-06-21,2023-06-21,2023-07-09,PLN6454,1817234602,1817234602,Clinical Laboratory,In-Network,Z87.891,J06.9,,,,,,,0,,99232,E&M,,,,11,Office,2,218.23,101.19,26.19,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009076,MBR00000354,Institutional-IP,2022-10-27,2022-10-28,2022-11-05,PLN5064,1860435061,1860435061,DME Supplier,In-Network,K21.0,Z23,,,,871,MS-DRG,19,1,Y,23472,Surgery,,,0360,21,Inpatient Hospital,2,4438.84,2205.91,0.0,0.0,0.0,0.0,0.0,0.0,Denied,PR-1,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009077,MBR00000354,Institutional-OP,2021-08-15,2021-08-15,2021-09-23,PLN9982,1575695214,1575695214,SNF,In-Network,E11.40,F41.9,,,,,,,0,,99214,E&M,,,0200,22,Outpatient Hospital,3,416.47,294.77,294.77,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009078,MBR00000354,Institutional-OP,2023-06-08,2023-06-08,2023-06-28,PLN4291,1511044648,1511044648,Endocrinology,In-Network,J06.9,I10,,,,,,,0,,66984,Surgery,,,0370,22,Outpatient Hospital,3,1614.92,1112.87,1017.23,0.0,0.0,95.64,95.64,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009079,MBR00000354,Institutional-IP,2021-04-07,2021-04-24,2021-05-11,PLN5476,1366576336,1366576336,Geriatrics,In-Network,I10,Z23,,,,196,MS-DRG,1,17,Y,99222,E&M,,,0510,21,Inpatient Hospital,3,515.29,219.96,89.85,130.11,0.0,0.0,130.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009080,MBR00000354,Professional,2022-07-27,2022-07-27,2022-08-19,PLN6976,1915531927,1915531927,Critical Access Hospital,In-Network,Z12.31,N18.3,,,,,,,0,,G0468,Medicine,,,,31,Skilled Nursing Facility,1,486.38,313.16,0.0,313.16,15.0,0.0,328.16,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009081,MBR00000354,Institutional-OP,2023-05-05,2023-05-05,2023-06-14,PLN7923,1691062876,1691062876,SNF,In-Network,I10,M81.0,,,,,,,0,,27130,Surgery,,,0450,22,Outpatient Hospital,3,6810.91,3861.21,3369.86,239.3,0.0,252.05,491.35,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009082,MBR00000354,Institutional-OP,2022-09-17,2022-09-17,2022-10-27,PLN5721,1542828721,1542828721,Orthopedic Surgery,In-Network,E11.9,Z12.11,,,,,,,0,,33533,Surgery,,,0370,22,Outpatient Hospital,1,24719.89,19795.93,19527.35,268.58,0.0,0.0,268.58,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000009083,MBR00000354,Professional,2022-01-17,2022-01-17,2022-02-25,PLN8323,1780163051,1780163051,SNF,In-Network,Z12.31,E11.9,,,,,,,0,,58661,Surgery,,,,65,End-Stage Renal Disease,3,3693.04,3117.41,3096.72,20.69,0.0,0.0,20.69,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009084,MBR00000355,Professional,2022-04-01,2022-04-01,2022-04-23,PLN5568,1500949740,1500949740,Pediatrics,In-Network,B97.89,I11.9,,,,,,,0,,33533,Surgery,,,,12,Home,1,27559.11,10471.64,10161.14,310.5,0.0,0.0,310.5,0.0,Adjusted,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000009085,MBR00000355,Professional,2022-05-19,2022-05-19,2022-06-02,PLN2460,1713934949,1713934949,Neurology,In-Network,J06.9,Z23,,,,,,,0,,77067,Radiology,,,,22,Outpatient Hospital,2,803.06,323.09,323.09,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000009086,MBR00000355,Professional,2023-03-26,2023-03-26,2023-05-09,PLN9707,1236418230,1236418230,DME Supplier,In-Network,R10.9,R51,,,,,,,0,,G0444,Medicine,,,,11,Office,1,101.18,50.4,50.4,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000009087,MBR00000355,Institutional-OP,2023-12-23,2023-12-23,2024-01-17,PLN9015,1716521444,1716521444,Oncology,In-Network,M54.5,J18.9,,,,,,,0,,43239,Surgery,,,0200,22,Outpatient Hospital,2,983.41,756.47,663.02,0.0,50.0,43.45,93.45,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009088,MBR00000355,Professional,2023-05-03,2023-05-03,2023-05-20,PLN6573,1749494482,1749494482,Pediatrics,In-Network,N39.0,E78.5,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,1,105.95,89.7,39.7,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009089,MBR00000355,Institutional-OP,2021-12-13,2021-12-13,2022-01-05,PLN4447,1702692193,1702692193,Physical Therapy,In-Network,I25.10,I11.9,,,,,,,0,,27447,Surgery,,,0200,22,Outpatient Hospital,3,5100.42,3375.28,3325.28,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009090,MBR00000355,Professional,2021-05-02,2021-05-02,2021-05-25,PLN9165,1550154147,1550154147,Outpatient Clinic,In-Network,E78.5,Z00.00,,,,,,,0,,47562,Surgery,,,,11,Office,3,4351.58,3389.93,2959.85,430.08,0.0,0.0,430.08,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009091,MBR00000355,Professional,2022-06-03,2022-06-03,2022-06-24,PLN4156,1530904931,1530904931,Internal Medicine,In-Network,J06.9,Z79.4,,,,,,,0,,90837,Medicine,,,,23,Emergency Room,2,437.37,225.6,186.85,38.75,0.0,0.0,38.75,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009092,MBR00000355,Institutional-IP,2023-07-29,2023-08-01,2023-08-31,PLN9149,1840431511,1840431511,Geriatrics,Out-of-Network,K21.0,M17.11,,,,641,MS-DRG,12,3,Y,99232,E&M,,,0636,21,Inpatient Hospital,3,252.49,114.67,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009093,MBR00000355,Professional,2022-11-27,2022-11-27,2022-12-23,PLN6735,1939033455,1939033455,Pulmonology,In-Network,R05,Z12.31,,,,,,,0,,23472,Surgery,,,,12,Home,3,3281.04,1234.72,1043.45,0.0,0.0,191.27,191.27,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009094,MBR00000355,Institutional-IP,2021-12-19,2021-12-28,2021-12-30,PLN2888,1561134315,1561134315,DME Supplier,In-Network,J18.9,Z23,,,,641,MS-DRG,6,9,Y,83036,Pathology/Lab,,,0370,21,Inpatient Hospital,3,84.41,32.26,27.99,0.0,0.0,4.27,4.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000009095,MBR00000355,Professional,2021-04-08,2021-04-08,2021-05-01,PLN3345,1550154147,1550154147,Outpatient Clinic,In-Network,E78.5,E78.5,,,,,,,0,,93306,Radiology,,,,22,Outpatient Hospital,3,1273.49,658.56,457.4,201.16,0.0,0.0,201.16,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009096,MBR00000355,Institutional-OP,2021-10-04,2021-10-04,2021-11-13,PLN4196,1790497490,1790497490,OB/GYN,In-Network,Z79.4,E11.9,,,,,,,0,,99203,E&M,,,0270,22,Outpatient Hospital,1,358.72,128.6,125.07,0.0,0.0,3.53,3.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009097,MBR00000355,Institutional-OP,2023-02-24,2023-02-24,2023-03-23,PLN5384,1124394415,1124394415,Pediatrics,In-Network,J44.1,R10.9,,,,,,,0,,99221,E&M,,,0320,22,Outpatient Hospital,2,170.96,69.23,0.0,69.23,0.0,0.0,69.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009098,MBR00000355,Professional,2023-01-04,2023-01-04,2023-01-25,PLN6875,1125190055,1125190055,Nephrology,In-Network,F32.9,I10,,,,,,,0,,G0444,Medicine,,,,11,Office,2,100.09,80.18,22.05,57.8,0.0,0.33,58.13,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000009099,MBR00000355,Professional,2022-05-10,2022-05-10,2022-05-29,PLN7867,1453936007,1453936007,ASC,In-Network,N17.9,J20.9,,,,,,,0,,27447,Surgery,,,,50,Federally Qualified Health Center,3,3044.86,2144.37,1615.05,454.32,75.0,0.0,529.32,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009100,MBR00000355,Institutional-OP,2022-01-01,2022-01-01,2022-01-26,PLN8843,1845057593,1845057593,Orthopedic Surgery,In-Network,F32.9,N39.0,,,,,,,0,,66984,Surgery,,,0370,22,Outpatient Hospital,2,2833.62,1193.77,983.33,135.44,75.0,0.0,210.44,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009101,MBR00000355,Professional,2021-07-11,2021-07-11,2021-08-04,PLN7576,1410468316,1410468316,SNF,In-Network,E78.5,N39.0,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,1,595.36,209.46,79.38,130.08,0.0,0.0,130.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009102,MBR00000355,Professional,2023-12-01,2023-12-01,2024-01-04,PLN8567,1389336600,1389336600,Critical Access Hospital,In-Network,K21.0,I10,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,3,3437.57,1722.46,0.0,132.71,0.0,0.0,132.71,0.0,Denied,CO-15,,0,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000009103,MBR00000355,Institutional-OP,2022-04-17,2022-04-17,2022-04-30,PLN8590,1994661817,1994661817,SNF,Out-of-Network,E78.5,F41.9,,,,,,,0,,23472,Surgery,,,0636,22,Outpatient Hospital,1,5016.46,1833.11,1818.11,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000009104,MBR00000355,Professional,2023-04-21,2023-04-21,2023-05-06,PLN8558,1997536841,1997536841,Family Medicine,Out-of-Network,Z23,R51,,,,,,,0,,82043,Pathology/Lab,,,,12,Home,1,30.49,9.57,0.0,9.57,0.0,0.0,9.57,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009105,MBR00000355,Institutional-IP,2022-05-20,2022-05-21,2022-05-29,PLN4010,1450553056,1450553056,Clinical Laboratory,In-Network,F32.9,E11.9,,,,292,MS-DRG,14,1,Y,99214,E&M,,,0900,21,Inpatient Hospital,1,347.86,260.34,0.0,142.88,25.0,0.0,167.88,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009106,MBR00000355,Professional,2022-09-16,2022-09-16,2022-10-18,PLN9149,1767011137,1767011137,DME Supplier,In-Network,R10.9,Z12.31,,,,,,,0,,78452,Radiology,,,,50,Federally Qualified Health Center,1,5114.56,4191.09,3659.41,481.68,50.0,0.0,531.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009107,MBR00000355,Institutional-OP,2022-12-03,2022-12-03,2022-12-12,PLN3801,1806688928,1806688928,Geriatrics,In-Network,F32.9,B97.89,,,,,,,0,,G0468,Medicine,,,0510,22,Outpatient Hospital,1,336.87,194.58,0.0,194.58,0.0,0.0,194.58,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009108,MBR00000356,Institutional-IP,2022-01-25,2022-02-02,2022-02-14,PLN5461,1696843572,1696843572,Critical Access Hospital,Out-of-Network,N20.0,R51,,,,195,MS-DRG,18,8,Y,99222,E&M,,,0360,21,Inpatient Hospital,1,339.82,261.43,220.99,0.0,15.0,25.44,40.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009109,MBR00000356,Professional,2023-10-24,2023-10-24,2023-12-01,PLN3951,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,E66.9,J20.9,,,,,,,0,,87491,Pathology/Lab,,,,21,Inpatient Hospital,3,237.43,125.54,123.5,0.0,0.0,2.04,2.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009110,MBR00000356,Institutional-IP,2022-05-16,2022-05-20,2022-05-23,PLN9520,1728018911,1728018911,Nephrology,In-Network,F41.9,K57.30,,,,291,MS-DRG,7,4,Y,99233,E&M,,,0270,21,Inpatient Hospital,3,401.75,332.0,231.15,0.0,50.0,50.85,100.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009111,MBR00000356,Professional,2023-04-18,2023-04-18,2023-04-29,PLN6058,1910255109,1910255109,DME Supplier,In-Network,J06.9,I11.9,,,,,,,0,,45378,Surgery,,,,11,Office,2,1585.29,1160.74,1136.26,0.0,0.0,24.48,24.48,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000009112,MBR00000356,Professional,2023-10-01,2023-10-01,2023-10-20,PLN4030,1366286000,1366286000,SNF,In-Network,K21.0,I10,,,,,,,0,,58661,Surgery,,,,11,Office,3,4188.98,3186.09,3151.09,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009113,MBR00000356,Institutional-OP,2022-02-23,2022-02-23,2022-04-03,PLN5256,1135158374,1135158374,Pulmonology,In-Network,Z00.01,E11.9,,,,,,,0,,82043,Pathology/Lab,,,0270,22,Outpatient Hospital,3,58.45,23.9,23.9,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009114,MBR00000356,Institutional-OP,2021-09-14,2021-09-14,2021-09-28,PLN2796,1590915516,1590915516,Physical Therapy,Out-of-Network,E78.5,N39.0,,,,,,,0,,G0444,Medicine,,,0740,22,Outpatient Hospital,1,54.32,36.37,0.0,36.37,0.0,0.0,36.37,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000009115,MBR00000356,Institutional-OP,2023-11-28,2023-11-28,2023-12-18,PLN3735,1994661817,1994661817,SNF,Out-of-Network,E11.9,Z87.891,,,,,,,0,,83036,Pathology/Lab,,,0270,22,Outpatient Hospital,2,92.1,78.07,43.07,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000009116,MBR00000356,Institutional-OP,2023-05-11,2023-05-11,2023-05-23,PLN9779,1486164553,1486164553,DME Supplier,In-Network,I10,F10.20,,,,,,,0,,99283,E&M,,,0510,22,Outpatient Hospital,1,377.14,301.74,301.74,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009117,MBR00000356,Professional,2023-05-16,2023-05-16,2023-05-29,PLN1852,1334916761,1334916761,ASC,In-Network,F32.9,F41.9,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,3,105.19,86.52,0.0,86.52,15.0,0.0,101.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000009118,MBR00000356,Institutional-IP,2023-11-02,2023-11-04,2023-11-24,PLN4079,1514306773,1514306773,Endocrinology,In-Network,E78.5,Z00.00,,,,682,MS-DRG,23,2,Y,99222,E&M,,,0730,21,Inpatient Hospital,2,478.78,402.3,402.3,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000009119,MBR00000356,Institutional-IP,2021-01-31,2021-02-02,2021-03-15,PLN7844,1840431511,1840431511,Geriatrics,Out-of-Network,F32.9,Z12.31,,,,292,MS-DRG,6,2,Y,93000,Radiology,,,0450,21,Inpatient Hospital,3,68.54,35.81,16.69,0.0,15.0,4.12,19.12,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009120,MBR00000356,Professional,2023-11-01,2023-11-01,2023-11-23,PLN7893,1235381502,1235381502,Cardiology,In-Network,F41.9,E66.9,,,,,,,0,,99284,E&M,,,,11,Office,3,493.33,199.17,0.0,199.17,15.0,0.0,214.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009121,MBR00000356,Professional,2021-05-08,2021-05-08,2021-05-30,PLN4900,1295371663,1295371663,Critical Access Hospital,In-Network,J20.9,J20.9,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,1,128.47,56.32,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009122,MBR00000356,Professional,2021-06-09,2021-06-09,2021-06-17,PLN7211,1550154147,1550154147,Outpatient Clinic,In-Network,Z23,Z00.00,,,,,,,0,,93225,Medicine,,,,11,Office,1,555.19,332.59,304.99,12.6,15.0,0.0,27.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009123,MBR00000356,Professional,2021-08-27,2021-08-27,2021-09-23,PLN2664,1239316214,1239316214,Internal Medicine,In-Network,F41.9,G43.909,,,,,,,0,,70553,Radiology,,,,23,Emergency Room,2,2299.61,1651.11,0.0,0.0,0.0,46.43,46.43,0.0,Denied,CO-27,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009124,MBR00000356,Institutional-OP,2021-05-05,2021-05-05,2021-06-17,PLN2681,1799205295,1799205295,General Acute Care Hospital,In-Network,E78.5,J44.1,,,,,,,0,,99283,E&M,,,0360,22,Outpatient Hospital,1,562.5,282.37,258.29,0.0,15.0,9.08,24.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009125,MBR00000356,Professional,2021-04-02,2021-04-02,2021-04-26,PLN4864,1840431511,1840431511,Geriatrics,Out-of-Network,N39.0,E78.5,,,,,,,0,,99233,E&M,,,,12,Home,1,569.47,237.27,149.37,46.5,15.0,26.4,87.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009126,MBR00000356,Institutional-OP,2021-05-18,2021-05-18,2021-05-28,PLN9083,1395983630,1395983630,Nephrology,In-Network,E78.5,Z51.11,,,,,,,0,,99204,E&M,,,0761,22,Outpatient Hospital,2,224.23,69.03,0.0,69.03,0.0,0.0,69.03,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009127,MBR00000357,Institutional-OP,2022-06-16,2022-06-16,2022-07-23,PLN1397,1124394415,1124394415,Pediatrics,In-Network,K21.0,Z23,,,,,,,0,,43239,Surgery,,,0761,22,Outpatient Hospital,2,944.41,450.16,375.16,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009128,MBR00000357,Institutional-OP,2022-02-12,2022-02-12,2022-03-04,PLN5159,1994661817,1994661817,SNF,Out-of-Network,Z87.891,N40.0,,,,,,,0,,47562,Surgery,,,0740,22,Outpatient Hospital,2,2984.4,1268.17,1268.17,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,1,Phantom,0,0,0,0,0
CLM0000009129,MBR00000357,Institutional-OP,2022-01-09,2022-01-09,2022-02-05,PLN5929,1239316214,1239316214,Internal Medicine,In-Network,E78.5,J06.9,,,,,,,0,,99233,E&M,,,0730,22,Outpatient Hospital,3,239.39,195.4,0.0,195.4,35.0,0.0,230.4,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009130,MBR00000357,Institutional-OP,2021-07-08,2021-07-08,2021-07-19,PLN2366,1410468316,1410468316,SNF,In-Network,I50.9,J20.9,,,,,,,0,,87491,Pathology/Lab,,,0370,22,Outpatient Hospital,3,114.06,91.32,41.32,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009131,MBR00000357,Professional,2023-12-02,2023-12-02,2023-12-23,PLN2327,1450094833,1450094833,Outpatient Clinic,In-Network,R07.9,J45.20,,,,,,,0,,27130,Surgery,,,,11,Office,3,2584.29,1183.2,1081.34,0.0,15.0,86.86,101.86,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009132,MBR00000357,Institutional-OP,2021-12-31,2021-12-31,2022-02-11,PLN2416,1847081578,1847081578,Urology,Out-of-Network,C50.912,N18.3,,,,,,,0,,74177,Radiology,,,0636,22,Outpatient Hospital,3,1469.24,728.63,728.63,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009133,MBR00000357,Institutional-IP,2022-06-02,2022-06-07,2022-06-18,PLN3239,1193493783,1193493783,Critical Access Hospital,Out-of-Network,I48.91,J20.9,,,,291,MS-DRG,24,5,N,93306,Radiology,,,0900,21,Inpatient Hospital,3,1795.76,805.99,777.47,28.52,0.0,0.0,28.52,0.0,Paid,,,1,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000009134,MBR00000357,Institutional-OP,2021-06-05,2021-06-05,2021-07-07,PLN9147,1390307371,1390307371,DME Supplier,In-Network,I50.9,J20.9,,,,,,,0,,99203,E&M,,,0761,22,Outpatient Hospital,1,260.42,127.08,109.78,0.0,0.0,17.3,17.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009135,MBR00000357,Institutional-IP,2021-08-21,2021-08-22,2021-09-04,PLN6808,1624802371,1624802371,ASC,Out-of-Network,M54.5,G43.909,,,,682,MS-DRG,8,1,N,70450,Radiology,,,0360,21,Inpatient Hospital,3,920.0,475.26,397.47,52.79,25.0,0.0,77.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009136,MBR00000357,Professional,2021-09-14,2021-09-14,2021-10-17,PLN7163,1644128543,1644128543,Gastroenterology,In-Network,Z00.01,M81.0,,,,,,,0,,66984,Surgery,,,,49,Independent Clinic,1,1968.13,833.44,833.44,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009137,MBR00000357,Institutional-OP,2023-11-29,2023-11-29,2024-01-07,PLN9293,1696843572,1696843572,Critical Access Hospital,Out-of-Network,I10,Z79.4,,,,,,,0,,45380,Surgery,,,0120,22,Outpatient Hospital,3,1181.99,387.08,0.0,340.91,75.0,0.0,415.91,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000009138,MBR00000357,Institutional-OP,2021-07-13,2021-07-13,2021-08-08,PLN9084,1556140803,1556140803,Cardiology,In-Network,Z23,C50.912,,,,,,,0,,93000,Radiology,,,0200,22,Outpatient Hospital,3,182.09,132.57,0.0,132.57,0.0,0.0,132.57,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009139,MBR00000357,Professional,2022-07-17,2022-07-17,2022-07-26,PLN1866,1186826716,1186826716,Physical Therapy,In-Network,E11.9,J06.9,,,,,,,0,,99204,E&M,,,,11,Office,2,249.67,102.92,102.03,0.0,0.0,0.89,0.89,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009140,MBR00000357,Institutional-IP,2022-08-19,2022-08-22,2022-09-15,PLN4200,1696843572,1696843572,Critical Access Hospital,Out-of-Network,F41.9,E11.9,,,,196,MS-DRG,7,3,Y,99284,E&M,,,0320,21,Inpatient Hospital,1,455.13,349.66,349.66,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009141,MBR00000357,Institutional-IP,2021-03-22,2021-03-30,2021-03-29,PLN1297,1968299309,1968299309,Internal Medicine,In-Network,J18.9,E78.5,,,,641,MS-DRG,17,8,Y,23472,Surgery,,,0370,21,Inpatient Hospital,2,3976.84,3244.42,3244.42,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009142,MBR00000357,Institutional-IP,2022-01-20,2022-01-26,2022-01-29,PLN1435,1486164553,1486164553,DME Supplier,In-Network,E11.9,F32.9,,,,195,MS-DRG,7,6,Y,99222,E&M,,,0120,21,Inpatient Hospital,2,598.83,365.55,208.12,144.11,0.0,13.32,157.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009143,MBR00000357,Institutional-OP,2021-03-30,2021-03-30,2021-04-07,PLN3299,1799205295,1799205295,General Acute Care Hospital,In-Network,Z12.11,F10.20,,,,,,,0,,99213,E&M,,,0636,22,Outpatient Hospital,2,216.01,129.64,0.0,129.64,0.0,0.0,129.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009144,MBR00000357,Institutional-IP,2021-07-11,2021-07-18,2021-08-06,PLN5695,1193493783,1193493783,Critical Access Hospital,Out-of-Network,K21.0,F32.9,,,,196,MS-DRG,9,7,U,80061,Pathology/Lab,,,0740,21,Inpatient Hospital,2,75.28,31.04,0.0,31.04,75.0,0.0,106.04,0.0,Denied,CO-18,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000009145,MBR00000357,Institutional-OP,2023-01-10,2023-01-10,2023-02-04,PLN8595,1235381502,1235381502,Cardiology,In-Network,R10.9,M54.5,,,,,,,0,,77067,Radiology,,,0900,22,Outpatient Hospital,1,479.31,258.43,258.43,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000009146,MBR00000357,Professional,2022-09-15,2022-09-15,2022-10-07,PLN8520,1727809972,1727809972,Home Health,In-Network,N18.3,N39.0,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,3,274.37,150.64,115.64,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000009147,MBR00000357,Professional,2022-06-26,2022-06-26,2022-08-03,PLN9656,1486164553,1486164553,DME Supplier,In-Network,I25.10,Z12.31,,,,,,,0,,66984,Surgery,,,,11,Office,3,1510.25,1124.41,1124.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009148,MBR00000357,Professional,2021-08-22,2021-08-22,2021-09-18,PLN8315,1800011727,1800011727,Clinical Laboratory,Out-of-Network,Z12.11,N39.0,,,,,,,0,,97110,Medicine,,,,11,Office,3,281.59,139.34,64.34,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009149,MBR00000357,Professional,2022-11-15,2022-11-15,2022-11-22,PLN2800,1980712759,1980712759,Outpatient Clinic,Out-of-Network,B97.89,F32.9,,,,,,,0,,97110,Medicine,,,,23,Emergency Room,3,179.88,86.26,0.0,86.26,35.0,0.0,121.26,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009150,MBR00000357,Institutional-OP,2023-09-18,2023-09-18,2023-10-05,PLN3734,1236418230,1236418230,DME Supplier,In-Network,G43.909,I25.10,,,,,,,0,,23472,Surgery,,,0730,22,Outpatient Hospital,3,4434.13,3734.97,2907.83,287.44,0.0,539.7,827.14,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009151,MBR00000357,Institutional-IP,2023-07-20,2023-07-31,2023-08-18,PLN3967,1103747954,1103747954,Urology,In-Network,I10,F03.90,,,,470,MS-DRG,18,11,Y,G0468,Medicine,,,0740,21,Inpatient Hospital,1,576.46,346.0,346.0,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009152,MBR00000357,Professional,2021-07-09,2021-07-09,2021-08-10,PLN8336,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,I10,J20.9,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,1,31.39,22.08,18.91,0.0,0.0,3.17,3.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009153,MBR00000357,Professional,2023-01-17,2023-01-17,2023-02-07,PLN2296,1696843572,1696843572,Critical Access Hospital,Out-of-Network,Z00.00,J20.9,,,,,,,0,,99221,E&M,,,,11,Office,2,336.59,219.93,0.0,219.93,0.0,0.0,219.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009154,MBR00000357,Institutional-OP,2021-09-25,2021-09-25,2021-10-12,PLN6950,1691062876,1691062876,SNF,In-Network,I10,M17.11,,,,,,,0,,99221,E&M,,,0761,22,Outpatient Hospital,2,390.08,250.71,0.0,250.71,25.0,0.0,275.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009155,MBR00000357,Professional,2023-08-02,2023-08-02,2023-09-09,PLN4651,1266606767,1266606767,ASC,In-Network,N39.0,I11.9,,,,,,,0,,99213,E&M,,,,81,Independent Laboratory,2,274.28,162.78,155.8,0.0,0.0,6.98,6.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009156,MBR00000357,Professional,2022-06-02,2022-06-02,2022-06-12,PLN2848,1872272835,1872272835,Internal Medicine,In-Network,E78.5,E11.65,,,,,,,0,,99233,E&M,,,,11,Office,2,384.55,160.05,0.0,160.05,0.0,0.0,160.05,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009157,MBR00000357,Institutional-IP,2023-03-25,2023-03-26,2023-04-27,PLN5306,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,G43.909,I10,,,,683,MS-DRG,19,1,Y,58661,Surgery,,,0636,21,Inpatient Hospital,3,2842.67,1267.01,1267.01,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009158,MBR00000357,Institutional-OP,2022-08-14,2022-08-14,2022-09-09,PLN8797,1193493783,1193493783,Critical Access Hospital,Out-of-Network,K57.30,E78.5,,,,,,,0,,72148,Radiology,,,0730,22,Outpatient Hospital,3,2172.32,1710.2,1228.4,431.8,50.0,0.0,481.8,0.0,Adjusted,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009159,MBR00000357,Professional,2023-01-09,2023-01-09,2023-01-29,PLN7623,1575695214,1575695214,SNF,In-Network,M54.5,I10,,,,,,,0,,99221,E&M,,,,11,Office,2,382.25,246.53,109.12,136.43,0.0,0.98,137.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009160,MBR00000357,Professional,2023-10-21,2023-10-21,2023-11-25,PLN4549,1511044648,1511044648,Endocrinology,In-Network,F03.90,Z00.00,,,,,,,0,,77067,Radiology,,,,11,Office,3,459.76,325.14,120.7,129.44,75.0,0.0,204.44,0.0,Paid,,,1,,0,1,0,0,0,1,Duplicate,1,0,0,0,0
CLM0000009161,MBR00000357,Professional,2021-05-28,2021-05-28,2021-06-04,PLN7174,1800011727,1800011727,Clinical Laboratory,Out-of-Network,Z96.641,E66.9,,,,,,,0,,99203,E&M,,,,11,Office,1,173.23,141.87,0.0,141.87,0.0,0.0,141.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009162,MBR00000357,Professional,2023-09-17,2023-09-17,2023-09-24,PLN7649,1389336600,1389336600,Critical Access Hospital,In-Network,M17.11,J06.9,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,1,310.83,132.66,57.66,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009163,MBR00000357,Professional,2022-06-13,2022-06-13,2022-07-17,PLN1875,1186826716,1186826716,Physical Therapy,In-Network,E66.9,E11.9,,,,,,,0,,99203,E&M,,,,11,Office,3,182.33,154.22,68.61,46.58,35.0,4.03,85.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009164,MBR00000357,Professional,2021-06-05,2021-06-05,2021-06-18,PLN4420,1713934949,1713934949,Neurology,In-Network,R51,F41.9,,,,,,,0,,99204,E&M,,,,11,Office,1,347.94,160.05,160.05,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000009165,MBR00000357,Professional,2022-04-20,2022-04-20,2022-04-27,PLN6845,1752470395,1752470395,Home Health,In-Network,E78.5,E11.9,,,,,,,0,,70553,Radiology,,,,22,Outpatient Hospital,3,2249.5,965.11,705.12,259.99,0.0,0.0,259.99,0.0,Paid,,,1,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000009166,MBR00000358,Professional,2021-03-03,2021-03-03,2021-04-06,PLN2488,1213165847,1213165847,Critical Access Hospital,In-Network,F32.9,Z00.00,,,,,,,0,,99214,E&M,,,,23,Emergency Room,3,304.05,117.93,0.0,117.93,0.0,0.0,117.93,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009167,MBR00000358,Institutional-OP,2022-08-16,2022-08-16,2022-09-17,PLN3841,1990090423,1990090423,Orthopedic Surgery,In-Network,F32.9,K21.0,,,,,,,0,,97110,Medicine,,,0510,22,Outpatient Hospital,2,221.15,154.03,122.64,0.0,25.0,6.39,31.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009168,MBR00000358,Professional,2022-06-02,2022-06-02,2022-07-12,PLN5787,1564502315,1564502315,ASC,In-Network,F41.9,E11.9,,,,,,,0,,93225,Medicine,,,,23,Emergency Room,3,630.77,390.37,365.37,0.0,25.0,0.0,25.0,0.0,Adjusted,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009169,MBR00000358,Professional,2022-03-05,2022-03-05,2022-04-04,PLN2137,1622771872,1622771872,Pediatrics,In-Network,B97.89,Z00.00,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,2,399.0,328.74,328.74,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009170,MBR00000358,Professional,2022-05-02,2022-05-02,2022-06-14,PLN3143,1198133277,1198133277,SNF,In-Network,Z12.31,I50.9,,,,,,,0,,84443,Pathology/Lab,,,,12,Home,3,68.96,28.89,0.0,28.89,50.0,0.0,78.89,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009171,MBR00000358,Professional,2022-11-11,2022-11-11,2022-11-26,PLN2594,1717912431,1717912431,Oncology,In-Network,M54.5,B97.89,,,,,,,0,,93306,Radiology,,,,11,Office,2,1709.78,828.93,787.74,0.0,25.0,16.19,41.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009172,MBR00000358,Institutional-OP,2023-06-25,2023-06-25,2023-08-04,PLN5740,1235381502,1235381502,Cardiology,In-Network,R05,I10,,,,,,,0,,27447,Surgery,,,0320,22,Outpatient Hospital,1,3018.11,1227.02,1029.05,0.0,25.0,172.97,197.97,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009173,MBR00000358,Professional,2022-03-06,2022-03-06,2022-03-29,PLN7775,1645194539,1645194539,SNF,In-Network,I48.91,F41.9,,,,,,,0,,99222,E&M,,,,23,Emergency Room,2,556.96,274.13,274.13,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009174,MBR00000358,Institutional-OP,2021-01-19,2021-01-19,2021-02-27,PLN2671,1790497490,1790497490,OB/GYN,In-Network,Z23,E11.9,,,,,,,0,,72148,Radiology,,,0636,22,Outpatient Hospital,1,1579.24,809.01,809.01,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009175,MBR00000358,Institutional-IP,2022-09-03,2022-09-06,2022-09-17,PLN5087,1767011137,1767011137,DME Supplier,In-Network,K21.0,Z00.00,,,,641,MS-DRG,13,3,Y,90460,Medicine,,,0270,21,Inpatient Hospital,1,44.59,13.97,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009176,MBR00000358,Professional,2023-11-01,2023-11-01,2023-12-08,PLN4334,1168881145,1168881145,Orthopedic Surgery,In-Network,Z00.00,M54.5,,,,,,,0,,99213,E&M,,,,11,Office,3,200.14,91.94,91.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009177,MBR00000358,Institutional-OP,2022-03-09,2022-03-09,2022-04-20,PLN7456,1872272835,1872272835,Internal Medicine,In-Network,N39.0,M81.0,,,,,,,0,,97530,Medicine,,,0510,22,Outpatient Hospital,1,253.42,194.55,194.55,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009178,MBR00000358,Professional,2021-05-15,2021-05-15,2021-06-21,PLN9938,1800011727,1800011727,Clinical Laboratory,Out-of-Network,R07.9,Z23,,,,,,,0,,77067,Radiology,,,,49,Independent Clinic,2,581.12,211.33,211.33,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000009179,MBR00000358,Professional,2023-09-15,2023-09-15,2023-10-12,PLN5384,1486164553,1486164553,DME Supplier,In-Network,N18.3,Z12.31,,,,,,,0,,99283,E&M,,,,11,Office,2,307.1,218.79,193.79,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009180,MBR00000358,Professional,2022-04-05,2022-04-05,2022-04-17,PLN3270,1800011727,1800011727,Clinical Laboratory,Out-of-Network,R05,I25.10,,,,,,,0,,23472,Surgery,,,,11,Office,2,3541.04,1335.36,1075.81,0.0,15.0,244.55,259.55,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009181,MBR00000358,Institutional-IP,2022-02-13,2022-02-23,2022-03-24,PLN3005,1114982472,1114982472,Orthopedic Surgery,In-Network,Z12.31,E66.9,,,,871,MS-DRG,24,10,N,99221,E&M,,,0450,21,Inpatient Hospital,1,249.42,169.07,169.07,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009182,MBR00000358,Institutional-OP,2021-11-20,2021-11-20,2021-12-16,PLN2751,1366286000,1366286000,SNF,In-Network,N39.0,J06.9,,,,,,,0,,93000,Radiology,,,0730,22,Outpatient Hospital,2,120.34,47.23,0.0,47.23,75.0,0.0,122.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009183,MBR00000358,Institutional-IP,2023-03-12,2023-03-15,2023-03-25,PLN3878,1283743001,1283743001,Family Medicine,In-Network,M17.11,E78.5,,,,470,MS-DRG,21,3,Y,99214,E&M,,,0730,21,Inpatient Hospital,1,275.19,190.75,0.0,0.0,0.0,6.41,6.41,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009184,MBR00000358,Institutional-OP,2021-06-09,2021-06-09,2021-07-08,PLN4236,1872613201,1872613201,Internal Medicine,In-Network,Z00.00,I10,,,,,,,0,,58661,Surgery,,,0730,22,Outpatient Hospital,1,3570.51,1514.86,1464.86,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009185,MBR00000358,Institutional-OP,2022-11-04,2022-11-04,2022-12-13,PLN9603,1433937353,1433937353,Nephrology,In-Network,F03.90,J45.20,,,,,,,0,,99214,E&M,,,0636,22,Outpatient Hospital,3,385.15,120.72,120.72,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009186,MBR00000358,Professional,2022-01-17,2022-01-17,2022-01-25,PLN2593,1389336600,1389336600,Critical Access Hospital,In-Network,E11.9,Z12.11,,,,,,,0,,90460,Medicine,,,,81,Independent Laboratory,1,64.38,33.87,0.0,33.87,35.0,0.0,68.87,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009187,MBR00000358,Institutional-OP,2022-02-27,2022-02-27,2022-04-04,PLN7148,1372918899,1372918899,Family Medicine,In-Network,F03.90,M81.0,,,,,,,0,,99284,E&M,,,0761,22,Outpatient Hospital,1,559.77,207.23,192.23,0.0,15.0,0.0,15.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009188,MBR00000358,Professional,2021-08-25,2021-08-25,2021-10-04,PLN2648,1239316214,1239316214,Internal Medicine,In-Network,Z23,Z12.31,,,,,,,0,,43239,Surgery,,,,11,Office,3,1465.78,501.69,163.54,338.15,0.0,0.0,338.15,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009189,MBR00000358,Institutional-OP,2023-06-04,2023-06-04,2023-07-10,PLN3345,1990090423,1990090423,Orthopedic Surgery,In-Network,E11.40,Z23,,,,,,,0,,99203,E&M,,,0200,22,Outpatient Hospital,2,389.98,259.37,177.97,0.0,75.0,6.4,81.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009190,MBR00000358,Professional,2022-05-12,2022-05-12,2022-06-23,PLN8884,1103747954,1103747954,Urology,In-Network,K57.30,I10,,,,,,,0,,70450,Radiology,,,,11,Office,2,1366.17,844.65,844.65,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009191,MBR00000358,Professional,2023-10-13,2023-10-13,2023-11-10,PLN6869,1946680931,1946680931,Critical Access Hospital,Out-of-Network,Z51.11,I10,,,,,,,0,,99203,E&M,,,,11,Office,3,297.28,209.97,194.18,0.0,0.0,15.79,15.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009192,MBR00000358,Professional,2023-06-26,2023-06-26,2023-07-03,PLN1182,1438368327,1438368327,Home Health,In-Network,G43.909,E78.5,,,,,,,0,,78452,Radiology,,,,11,Office,2,5320.3,1838.8,1698.74,65.06,75.0,0.0,140.06,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009193,MBR00000358,Professional,2023-04-13,2023-04-13,2023-05-01,PLN4237,1660288235,1660288235,ASC,In-Network,E78.5,E78.5,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,1,152.18,66.18,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009194,MBR00000358,Institutional-OP,2022-05-08,2022-05-08,2022-06-17,PLN9130,1364429278,1364429278,OB/GYN,In-Network,E78.5,Z12.11,,,,,,,0,,90686,Medicine,,,0636,22,Outpatient Hospital,2,60.19,38.04,13.04,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000009195,MBR00000359,Professional,2023-11-05,2023-11-05,2023-12-14,PLN7789,1964402759,1964402759,Outpatient Clinic,In-Network,I25.10,E11.65,,,,,,,0,,78452,Radiology,,,,11,Office,1,3853.63,2908.74,2908.74,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009196,MBR00000359,Professional,2022-10-03,2022-10-03,2022-10-12,PLN8608,1247341320,1247341320,Urology,Out-of-Network,E11.9,Z12.31,,,,,,,0,,G0444,Medicine,,,,31,Skilled Nursing Facility,3,93.49,48.69,0.0,48.69,0.0,0.0,48.69,0.0,Paid,,,0,,0,1,0,0,0,1,Upcoding,0,0,0,0,1
CLM0000009197,MBR00000359,Institutional-OP,2022-04-23,2022-04-23,2022-04-30,PLN2155,1135158374,1135158374,Pulmonology,In-Network,E11.9,Z00.00,,,,,,,0,,99214,E&M,,,0360,22,Outpatient Hospital,1,304.78,170.7,162.19,0.0,0.0,8.51,8.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009198,MBR00000359,Institutional-IP,2022-01-16,2022-01-21,2022-02-06,PLN2063,1283743001,1283743001,Family Medicine,In-Network,F41.9,Z00.01,,,,194,MS-DRG,11,5,Y,45378,Surgery,,,0636,21,Inpatient Hospital,1,2062.87,1007.55,925.5,34.48,0.0,47.57,82.05,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000009199,MBR00000359,Institutional-IP,2023-09-28,2023-10-05,2023-10-27,PLN6727,1366286000,1366286000,SNF,In-Network,N39.0,M81.0,,,,682,MS-DRG,12,7,W,78452,Radiology,,,0200,21,Inpatient Hospital,2,3349.93,2365.02,1885.4,479.62,0.0,0.0,479.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009200,MBR00000359,Institutional-OP,2021-10-06,2021-10-06,2021-10-24,PLN5092,1700633438,1700633438,DME Supplier,In-Network,M81.0,Z00.00,,,,,,,0,,93000,Radiology,,,0320,22,Outpatient Hospital,2,127.82,43.74,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009201,MBR00000359,Professional,2023-08-18,2023-08-18,2023-08-26,PLN7303,1968299309,1968299309,Internal Medicine,In-Network,J18.9,Z51.11,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,3,86.22,67.64,50.45,0.0,15.0,2.19,17.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009202,MBR00000359,Professional,2021-09-08,2021-09-08,2021-10-18,PLN5649,1132188260,1132188260,Family Medicine,In-Network,J44.1,F41.9,,,,,,,0,,99233,E&M,,,,20,Urgent Care,2,564.07,454.62,0.0,294.94,0.0,0.0,294.94,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009203,MBR00000359,Professional,2023-04-15,2023-04-15,2023-05-25,PLN9316,1224179551,1224179551,Physical Therapy,In-Network,K21.0,J18.9,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,3,96.27,44.37,0.0,44.37,35.0,0.0,79.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009204,MBR00000359,Professional,2021-11-05,2021-11-05,2021-12-01,PLN4185,1531398223,1531398223,OB/GYN,In-Network,I63.9,I25.10,,,,,,,0,,74177,Radiology,,,,11,Office,2,1622.87,1158.7,1158.7,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009205,MBR00000359,Professional,2023-07-04,2023-07-04,2023-08-01,PLN5653,1364429278,1364429278,OB/GYN,In-Network,Z12.31,M17.11,,,,,,,0,,90460,Medicine,,,,11,Office,2,42.03,23.61,23.61,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009206,MBR00000359,Institutional-IP,2023-07-04,2023-07-10,2023-07-16,PLN6052,1624802371,1624802371,ASC,Out-of-Network,J20.9,J06.9,,,,292,MS-DRG,24,6,N,85610,Pathology/Lab,,,0200,21,Inpatient Hospital,3,48.15,24.88,0.0,24.88,0.0,0.0,24.88,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009207,MBR00000359,Professional,2023-03-11,2023-03-11,2023-03-28,PLN3454,1700633438,1700633438,DME Supplier,In-Network,Z12.31,F32.9,,,,,,,0,,58661,Surgery,,,,81,Independent Laboratory,1,4122.81,1634.55,1479.51,80.04,75.0,0.0,155.04,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009208,MBR00000359,Institutional-IP,2023-12-23,2023-12-25,2024-01-23,PLN3996,1689639685,1689639685,SNF,In-Network,I10,I10,,,,690,MS-DRG,15,2,Y,99283,E&M,,,0370,21,Inpatient Hospital,3,244.44,205.37,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009209,MBR00000359,Institutional-OP,2022-07-15,2022-07-15,2022-08-22,PLN7554,1896447406,1896447406,Nephrology,Out-of-Network,F41.9,M54.5,,,,,,,0,,71046,Radiology,,,0510,22,Outpatient Hospital,3,317.92,225.98,0.0,225.98,0.0,0.0,225.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009210,MBR00000359,Professional,2023-07-08,2023-07-08,2023-07-23,PLN6877,1717912431,1717912431,Oncology,In-Network,M54.5,Z12.31,,,,,,,0,,66984,Surgery,,,,11,Office,2,3323.05,2538.01,2538.01,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009211,MBR00000359,Professional,2022-08-28,2022-08-28,2022-10-04,PLN8973,1389336600,1389336600,Critical Access Hospital,In-Network,I50.9,K21.0,,,,,,,0,,G0468,Medicine,,,,11,Office,1,293.78,175.41,175.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009212,MBR00000359,Professional,2021-02-12,2021-02-12,2021-03-18,PLN8162,1946680931,1946680931,Critical Access Hospital,Out-of-Network,E66.9,Z12.31,,,,,,,0,,99233,E&M,,,,11,Office,3,325.86,193.31,0.0,193.31,35.0,0.0,228.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009213,MBR00000360,Institutional-OP,2022-04-03,2022-04-03,2022-04-25,PLN3784,1865904917,1865904917,Outpatient Clinic,In-Network,Z79.4,Z23,,,,,,,0,,76700,Radiology,,,0120,22,Outpatient Hospital,3,994.16,764.09,689.09,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009214,MBR00000360,Professional,2021-02-05,2021-02-05,2021-03-17,PLN7567,1389336600,1389336600,Critical Access Hospital,In-Network,I25.10,Z12.31,,,,,,,0,,97110,Medicine,,,,22,Outpatient Hospital,2,213.86,114.11,0.0,114.11,25.0,0.0,139.11,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009215,MBR00000360,Institutional-OP,2022-12-29,2022-12-29,2023-01-21,PLN2063,1891849440,1891849440,Oncology,In-Network,Z00.00,K21.0,,,,,,,0,,99284,E&M,,,0761,22,Outpatient Hospital,2,708.79,595.18,540.98,0.0,35.0,19.2,54.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009216,MBR00000360,Professional,2021-06-16,2021-06-16,2021-07-30,PLN1227,1355166277,1355166277,Endocrinology,In-Network,Z00.00,F41.9,,,,,,,0,,99284,E&M,,,,12,Home,3,624.62,423.45,423.45,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009217,MBR00000360,Institutional-IP,2021-12-22,2021-12-26,2022-01-03,PLN3834,1235381502,1235381502,Cardiology,In-Network,I10,M54.5,,,,470,MS-DRG,5,4,N,99214,E&M,,,0270,21,Inpatient Hospital,1,409.47,245.6,210.6,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009218,MBR00000360,Professional,2023-08-13,2023-08-13,2023-08-22,PLN3833,1410468316,1410468316,SNF,In-Network,E11.9,F41.9,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,3,387.32,303.03,288.03,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009219,MBR00000360,Professional,2023-03-21,2023-03-21,2023-04-29,PLN4666,1622771872,1622771872,Pediatrics,In-Network,F41.9,I10,,,,,,,0,,99214,E&M,,,,11,Office,3,286.05,120.35,120.35,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009220,MBR00000360,Professional,2022-01-03,2022-01-03,2022-01-15,PLN8464,1799205295,1799205295,General Acute Care Hospital,In-Network,M54.5,K57.30,,,,,,,0,,93000,Radiology,,,,21,Inpatient Hospital,3,138.16,44.79,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009221,MBR00000360,Institutional-IP,2022-07-08,2022-07-12,2022-07-29,PLN2066,1500037969,1500037969,Pulmonology,In-Network,I10,J06.9,,,,196,MS-DRG,19,4,Y,27130,Surgery,,,0636,21,Inpatient Hospital,2,6704.17,3489.66,3439.66,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009222,MBR00000360,Professional,2022-09-29,2022-09-29,2022-10-13,PLN8969,1609526529,1609526529,Psychiatry,In-Network,Z12.31,M17.11,,,,,,,0,,99221,E&M,,,,11,Office,2,392.56,152.95,0.0,152.95,0.0,0.0,152.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009223,MBR00000360,Institutional-OP,2022-01-22,2022-01-22,2022-02-20,PLN7893,1899127912,1899127912,Neurology,In-Network,Z00.00,B97.89,,,,,,,0,,27447,Surgery,,,0200,22,Outpatient Hospital,3,3238.47,1198.4,926.84,0.0,75.0,196.56,271.56,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009224,MBR00000360,Professional,2023-04-02,2023-04-02,2023-05-06,PLN9861,1266606767,1266606767,ASC,In-Network,Z12.31,I10,,,,,,,0,,47562,Surgery,,,,20,Urgent Care,3,2431.86,786.39,771.39,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009225,MBR00000360,Institutional-OP,2021-06-11,2021-06-11,2021-07-24,PLN6697,1606140917,1606140917,ASC,In-Network,Z00.00,M17.11,,,,,,,0,,93000,Radiology,,,0636,22,Outpatient Hospital,3,145.06,112.56,0.0,112.56,75.0,0.0,187.56,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009226,MBR00000360,Institutional-OP,2022-04-12,2022-04-12,2022-05-10,PLN3601,1224179551,1224179551,Physical Therapy,In-Network,Z00.00,Z00.00,,,,,,,0,,99203,E&M,,,0301,22,Outpatient Hospital,2,246.95,134.45,0.0,134.45,75.0,0.0,209.45,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000009227,MBR00000360,Professional,2021-10-07,2021-10-07,2021-11-20,PLN7034,1728018911,1728018911,Nephrology,In-Network,E78.5,B97.89,,,,,,,0,,99213,E&M,,,,11,Office,3,118.55,55.41,39.7,0.0,15.0,0.71,15.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009228,MBR00000360,Professional,2023-01-14,2023-01-14,2023-02-02,PLN6283,1337791138,1337791138,Internal Medicine,Out-of-Network,M17.11,J06.9,,,,,,,0,,99213,E&M,,,,11,Office,1,117.04,93.57,0.0,93.57,0.0,0.0,93.57,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009229,MBR00000360,Institutional-IP,2022-12-03,2022-12-06,2022-12-21,PLN4926,1313212303,1313212303,Family Medicine,In-Network,E78.5,Z23,,,,682,MS-DRG,7,3,Y,99233,E&M,,,0740,21,Inpatient Hospital,1,542.51,246.08,246.08,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009230,MBR00000360,Professional,2023-06-03,2023-06-03,2023-06-20,PLN5376,1644128543,1644128543,Gastroenterology,In-Network,E11.9,Z23,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,2,25.37,7.95,7.34,0.0,0.0,0.61,0.61,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000009231,MBR00000360,Professional,2022-02-09,2022-02-09,2022-03-25,PLN2668,1991459367,1991459367,Neurology,Out-of-Network,N18.3,N20.0,,,,,,,0,,99232,E&M,,,,21,Inpatient Hospital,2,354.38,242.54,0.0,242.54,0.0,0.0,242.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009232,MBR00000360,Professional,2021-09-10,2021-09-10,2021-10-05,PLN8771,1531398223,1531398223,OB/GYN,In-Network,J44.1,Z23,,,,,,,0,,99283,E&M,,,,31,Skilled Nursing Facility,1,537.07,211.37,0.0,181.4,50.0,0.0,231.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009233,MBR00000360,Institutional-IP,2021-02-06,2021-02-09,2021-03-15,PLN8755,1856686341,1856686341,Geriatrics,In-Network,Z87.891,R07.9,,,,682,MS-DRG,8,3,Y,33533,Surgery,,,0636,21,Inpatient Hospital,1,21239.74,16686.41,16611.41,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,1,0,1,Identity_Theft,0,0,0,0,0
CLM0000009234,MBR00000360,Professional,2023-08-01,2023-08-01,2023-08-19,PLN8651,1713934949,1713934949,Neurology,In-Network,Z23,R05,,,,,,,0,,80061,Pathology/Lab,,,,21,Inpatient Hospital,3,115.45,83.76,83.76,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009235,MBR00000360,Institutional-OP,2021-12-28,2021-12-28,2022-01-29,PLN4598,1696843572,1696843572,Critical Access Hospital,Out-of-Network,Z00.01,Z51.11,,,,,,,0,,85610,Pathology/Lab,,,0320,22,Outpatient Hospital,3,57.61,20.34,0.0,0.0,50.0,0.0,50.0,0.0,Pended,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000009236,MBR00000360,Professional,2023-04-07,2023-04-07,2023-04-30,PLN2933,1355166277,1355166277,Endocrinology,In-Network,I10,I10,,,,,,,0,,87491,Pathology/Lab,,,,22,Outpatient Hospital,1,180.58,142.03,142.03,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009237,MBR00000360,Professional,2022-02-06,2022-02-06,2022-03-21,PLN9526,1433937353,1433937353,Nephrology,In-Network,Z12.11,K21.0,,,,,,,0,,93000,Radiology,,,,50,Federally Qualified Health Center,2,73.42,31.2,31.2,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009238,MBR00000360,Professional,2021-12-30,2021-12-30,2022-01-07,PLN5707,1778483301,1778483301,Home Health,In-Network,J44.1,M54.5,,,,,,,0,,93306,Radiology,,,,11,Office,2,1460.4,447.95,244.79,128.16,75.0,0.0,203.16,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009239,MBR00000360,Institutional-OP,2021-09-14,2021-09-14,2021-10-23,PLN8978,1806688928,1806688928,Geriatrics,In-Network,E11.9,F41.9,,,,,,,0,,G0468,Medicine,,,0120,22,Outpatient Hospital,2,606.6,243.84,243.84,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000009240,MBR00000360,Institutional-OP,2023-05-06,2023-05-06,2023-05-27,PLN2723,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,E11.9,I10,,,,,,,0,,99222,E&M,,,0360,22,Outpatient Hospital,1,528.97,227.04,0.0,227.04,25.0,0.0,252.04,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000009241,MBR00000360,Professional,2021-11-10,2021-11-10,2021-11-22,PLN9461,1622771872,1622771872,Pediatrics,In-Network,E11.9,E11.40,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,3,5266.98,2677.7,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-18,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009242,MBR00000361,Institutional-OP,2021-11-21,2021-11-21,2021-11-28,PLN7086,1752470395,1752470395,Home Health,In-Network,K21.0,E11.9,,,,,,,0,,76700,Radiology,,,0510,22,Outpatient Hospital,1,1167.62,514.49,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009243,MBR00000361,Professional,2023-02-11,2023-02-11,2023-02-26,PLN8560,1337791138,1337791138,Internal Medicine,Out-of-Network,Z12.11,Z51.11,,,,,,,0,,70553,Radiology,,,,21,Inpatient Hospital,2,3359.38,2183.08,2183.08,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009244,MBR00000361,Professional,2022-07-22,2022-07-22,2022-08-22,PLN2406,1124394415,1124394415,Pediatrics,In-Network,F03.90,Z12.31,,,,,,,0,,97530,Medicine,,,,20,Urgent Care,3,254.05,130.26,80.26,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009245,MBR00000361,Professional,2023-03-29,2023-03-29,2023-04-09,PLN8637,1125190055,1125190055,Nephrology,In-Network,E11.40,Z79.4,,,,,,,0,,87491,Pathology/Lab,,,,20,Urgent Care,3,170.84,93.55,53.36,40.19,0.0,0.0,40.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009246,MBR00000361,Institutional-OP,2021-04-24,2021-04-24,2021-06-07,PLN7444,1660288235,1660288235,ASC,In-Network,J06.9,M81.0,,,,,,,0,,78452,Radiology,,,0636,22,Outpatient Hospital,1,4494.26,3030.16,2995.16,0.0,35.0,0.0,35.0,0.0,Adjusted,,,1,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000009247,MBR00000361,Professional,2023-11-16,2023-11-16,2023-12-20,PLN3958,1691062876,1691062876,SNF,In-Network,M54.5,E11.9,,,,,,,0,,99284,E&M,,,,11,Office,2,340.06,205.39,0.0,205.39,15.0,0.0,220.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009248,MBR00000361,Institutional-IP,2021-09-17,2021-09-19,2021-10-24,PLN8510,1622771872,1622771872,Pediatrics,In-Network,J18.9,J20.9,,,,683,MS-DRG,2,2,Y,93225,Medicine,,,0900,21,Inpatient Hospital,3,840.13,359.41,309.41,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009249,MBR00000361,Professional,2021-05-10,2021-05-10,2021-05-30,PLN4578,1564502315,1564502315,ASC,In-Network,E11.9,Z23,,,,,,,0,,23472,Surgery,,,,11,Office,3,4518.72,3539.18,3153.18,386.0,0.0,0.0,386.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009250,MBR00000361,Institutional-OP,2021-04-30,2021-04-30,2021-06-13,PLN2867,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,J06.9,E11.9,,,,,,,0,,87491,Pathology/Lab,,,0730,22,Outpatient Hospital,1,244.48,80.84,65.84,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009251,MBR00000361,Institutional-OP,2021-12-08,2021-12-08,2022-01-05,PLN2734,1186826716,1186826716,Physical Therapy,In-Network,Z23,N18.3,,,,,,,0,,47562,Surgery,,,0200,22,Outpatient Hospital,1,3746.83,2273.6,2258.6,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009252,MBR00000361,Professional,2022-04-09,2022-04-09,2022-04-26,PLN6455,1778483301,1778483301,Home Health,In-Network,E78.5,E11.65,,,,,,,0,,74177,Radiology,,,,21,Inpatient Hospital,2,1939.19,1005.43,1005.43,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009253,MBR00000361,Institutional-IP,2021-03-26,2021-04-04,2021-04-14,PLN1228,1757138478,1757138478,Pediatrics,In-Network,I48.91,Z87.891,,,,682,MS-DRG,9,9,W,47562,Surgery,,,0761,21,Inpatient Hospital,1,5863.42,4311.82,4271.07,40.75,0.0,0.0,40.75,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009254,MBR00000361,Institutional-IP,2022-11-13,2022-11-21,2022-12-21,PLN5339,1247341320,1247341320,Urology,Out-of-Network,Z00.00,E66.9,,,,195,MS-DRG,16,8,Y,27130,Surgery,,,0450,21,Inpatient Hospital,3,7001.78,5930.26,5237.24,0.0,50.0,643.02,693.02,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009255,MBR00000361,Institutional-OP,2022-11-03,2022-11-03,2022-12-15,PLN7437,1273488618,1273488618,General Acute Care Hospital,In-Network,Z00.00,Z87.891,,,,,,,0,,27447,Surgery,,,0636,22,Outpatient Hospital,2,5616.85,3508.61,3041.05,417.56,50.0,0.0,467.56,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009256,MBR00000361,Professional,2023-05-01,2023-05-01,2023-05-13,PLN1352,1561134315,1561134315,DME Supplier,In-Network,Z00.00,M54.5,,,,,,,0,,80053,Pathology/Lab,,,,22,Outpatient Hospital,3,136.34,72.35,0.0,72.35,0.0,0.0,72.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009257,MBR00000361,Professional,2021-01-18,2021-01-18,2021-02-16,PLN4317,1334916761,1334916761,ASC,In-Network,J44.1,E11.40,,,,,,,0,,78452,Radiology,,,,22,Outpatient Hospital,2,3678.38,2121.65,2121.65,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009258,MBR00000361,Professional,2021-04-16,2021-04-16,2021-05-23,PLN8205,1865904917,1865904917,Outpatient Clinic,In-Network,M54.5,Z00.01,,,,,,,0,,23472,Surgery,,,,11,Office,2,2940.19,1668.41,1668.41,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,1,Phantom,0,0,0,0,0
CLM0000009259,MBR00000361,Institutional-IP,2021-08-13,2021-08-25,2021-08-30,PLN7182,1749327647,1749327647,Geriatrics,In-Network,F41.9,E78.5,,,,871,MS-DRG,5,12,Y,23472,Surgery,,,0320,21,Inpatient Hospital,2,4320.41,3039.5,2457.61,0.0,50.0,531.89,581.89,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009260,MBR00000361,Professional,2022-04-25,2022-04-25,2022-05-13,PLN5937,1556140803,1556140803,Cardiology,In-Network,F41.9,I11.9,,,,,,,0,,66984,Surgery,,,,11,Office,1,1760.24,533.35,299.63,233.72,0.0,0.0,233.72,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009261,MBR00000361,Professional,2022-10-05,2022-10-05,2022-10-31,PLN5134,1168881145,1168881145,Orthopedic Surgery,In-Network,E11.9,E11.40,,,,,,,0,,80061,Pathology/Lab,,,,20,Urgent Care,3,117.96,88.96,73.96,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009262,MBR00000361,Institutional-OP,2021-08-10,2021-08-10,2021-09-23,PLN6679,1702692193,1702692193,Physical Therapy,In-Network,Z79.4,J18.9,,,,,,,0,,43239,Surgery,,,0200,22,Outpatient Hospital,3,2232.87,1267.94,1157.85,0.0,75.0,35.09,110.09,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009263,MBR00000361,Institutional-OP,2022-01-28,2022-01-28,2022-02-28,PLN8398,1148984206,1148984206,Psychiatry,In-Network,I10,F10.20,,,,,,,0,,66984,Surgery,,,0370,22,Outpatient Hospital,1,1435.09,834.37,698.24,136.13,0.0,0.0,136.13,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009264,MBR00000361,Professional,2022-07-17,2022-07-17,2022-07-28,PLN1751,1118885473,1118885473,ASC,In-Network,M17.11,I10,,,,,,,0,,99213,E&M,,,,50,Federally Qualified Health Center,2,268.81,203.9,153.9,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009265,MBR00000361,Professional,2022-08-20,2022-08-20,2022-09-20,PLN3621,1800011727,1800011727,Clinical Laboratory,Out-of-Network,I50.9,E11.9,,,,,,,0,,99222,E&M,,,,11,Office,3,541.04,171.1,146.1,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009266,MBR00000361,Professional,2022-07-31,2022-07-31,2022-08-13,PLN5684,1749494482,1749494482,Pediatrics,In-Network,E11.9,I10,,,,,,,0,,84443,Pathology/Lab,,,,65,End-Stage Renal Disease,2,70.5,56.95,47.79,0.0,0.0,9.16,9.16,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009267,MBR00000361,Professional,2022-12-03,2022-12-03,2022-12-23,PLN5929,1502838586,1502838586,ASC,In-Network,Z87.891,I10,,,,,,,0,,85025,Pathology/Lab,,,,31,Skilled Nursing Facility,2,81.42,27.11,0.0,27.11,15.0,0.0,42.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009268,MBR00000361,Professional,2023-04-08,2023-04-08,2023-04-21,PLN9742,1242201429,1242201429,General Acute Care Hospital,In-Network,E11.9,I48.91,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,3,7619.9,3983.24,3260.76,0.0,50.0,672.48,722.48,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009269,MBR00000361,Professional,2023-07-08,2023-07-08,2023-07-15,PLN4061,1644128543,1644128543,Gastroenterology,In-Network,F32.9,E11.9,,,,,,,0,,99204,E&M,,,,50,Federally Qualified Health Center,1,298.61,240.09,190.09,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009270,MBR00000361,Professional,2023-11-24,2023-11-24,2023-12-15,PLN6830,1198133277,1198133277,SNF,In-Network,E11.65,M54.5,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,2,61.92,49.38,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009271,MBR00000361,Institutional-OP,2022-03-07,2022-03-07,2022-04-11,PLN9130,1109850785,1109850785,ASC,Out-of-Network,I10,E78.5,,,,,,,0,,97110,Medicine,,,0761,22,Outpatient Hospital,1,159.89,75.77,50.77,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009272,MBR00000361,Professional,2021-12-26,2021-12-26,2022-01-22,PLN6384,1219817751,1219817751,OB/GYN,In-Network,M17.11,Z12.31,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,2,63.76,21.47,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009273,MBR00000361,Professional,2021-11-02,2021-11-02,2021-11-25,PLN2596,1125190055,1125190055,Nephrology,In-Network,I10,G20,,,,,,,0,,27447,Surgery,,,,11,Office,2,5016.16,3175.22,3140.22,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009274,MBR00000361,Professional,2022-01-19,2022-01-19,2022-01-30,PLN8353,1372918899,1372918899,Family Medicine,In-Network,Z12.31,K92.1,,,,,,,0,,43239,Surgery,,,,11,Office,3,1494.05,1049.85,823.9,225.95,0.0,0.0,225.95,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009275,MBR00000361,Institutional-OP,2022-08-13,2022-08-13,2022-09-15,PLN4260,1645194539,1645194539,SNF,In-Network,J06.9,Z00.00,,,,,,,0,,93225,Medicine,,,0636,22,Outpatient Hospital,1,590.21,470.84,428.9,0.0,25.0,16.94,41.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009276,MBR00000361,Professional,2022-10-24,2022-10-24,2022-11-12,PLN3310,1530904931,1530904931,Internal Medicine,In-Network,E11.9,I25.10,,,,,,,0,,99222,E&M,,,,11,Office,1,582.34,185.88,0.0,185.88,0.0,0.0,185.88,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009277,MBR00000361,Professional,2021-03-18,2021-03-18,2021-04-22,PLN4868,1433937353,1433937353,Nephrology,In-Network,I10,I25.10,,,,,,,0,,99204,E&M,,,,11,Office,1,244.03,112.71,96.0,0.0,0.0,16.71,16.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009278,MBR00000361,Professional,2023-12-30,2023-12-30,2024-02-02,PLN8305,1520687146,1520687146,ASC,In-Network,E11.9,J44.1,,,,,,,0,,93225,Medicine,,,,11,Office,1,934.71,691.55,665.18,26.37,0.0,0.0,26.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009279,MBR00000361,Professional,2021-02-15,2021-02-15,2021-03-27,PLN7047,1337791138,1337791138,Internal Medicine,Out-of-Network,C50.912,E11.9,,,,,,,0,,77067,Radiology,,,,11,Office,3,538.29,398.27,363.27,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000009280,MBR00000361,Professional,2022-03-16,2022-03-16,2022-04-13,PLN5079,1696843572,1696843572,Critical Access Hospital,Out-of-Network,G20,I10,,,,,,,0,,93306,Radiology,,,,11,Office,3,2390.35,1476.8,1476.8,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009281,MBR00000362,Institutional-IP,2022-05-11,2022-05-16,2022-06-03,PLN5634,1366426662,1366426662,Urology,In-Network,R10.9,Z12.31,,,,682,MS-DRG,20,5,Y,99222,E&M,,,0370,21,Inpatient Hospital,3,488.34,163.25,163.25,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009282,MBR00000362,Professional,2022-01-14,2022-01-14,2022-01-29,PLN9613,1564502315,1564502315,ASC,In-Network,Z00.01,E11.65,,,,,,,0,,80053,Pathology/Lab,,,,22,Outpatient Hospital,2,137.24,85.45,74.22,0.0,0.0,11.23,11.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009283,MBR00000362,Institutional-IP,2021-08-27,2021-09-02,2021-09-06,PLN1298,1935547131,1935547131,Pulmonology,In-Network,J44.1,F41.9,,,,291,MS-DRG,10,6,Y,93000,Radiology,,,0761,21,Inpatient Hospital,3,82.16,61.93,61.93,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009284,MBR00000362,Professional,2022-08-04,2022-08-04,2022-09-04,PLN3381,1247341320,1247341320,Urology,Out-of-Network,G43.909,N18.3,,,,,,,0,,43239,Surgery,,,,23,Emergency Room,2,1068.47,332.68,186.02,146.66,0.0,0.0,146.66,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009285,MBR00000362,Institutional-IP,2021-01-08,2021-01-14,2021-01-24,PLN4347,1273488618,1273488618,General Acute Care Hospital,In-Network,Z23,J20.9,,,,195,MS-DRG,13,6,Y,71046,Radiology,,,0730,21,Inpatient Hospital,2,228.12,95.04,0.0,95.04,0.0,0.0,95.04,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009286,MBR00000363,Institutional-OP,2023-03-25,2023-03-25,2023-04-05,PLN7821,1245650222,1245650222,Gastroenterology,In-Network,Z96.641,K21.0,,,,,,,0,,90460,Medicine,,,0636,22,Outpatient Hospital,2,59.82,45.87,0.0,45.87,35.0,0.0,80.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009287,MBR00000363,Professional,2023-01-14,2023-01-14,2023-02-10,PLN4779,1486164553,1486164553,DME Supplier,In-Network,J06.9,Z87.891,,,,,,,0,,97530,Medicine,,,,23,Emergency Room,2,142.18,60.98,60.98,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009288,MBR00000363,Institutional-OP,2023-04-25,2023-04-25,2023-05-28,PLN6176,1531398223,1531398223,OB/GYN,In-Network,I50.9,E11.9,,,,,,,0,,99284,E&M,,,0761,22,Outpatient Hospital,3,481.73,159.89,115.64,0.0,25.0,19.25,44.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009289,MBR00000363,Professional,2023-06-13,2023-06-13,2023-07-24,PLN6313,1500949740,1500949740,Pediatrics,In-Network,Z79.4,G43.909,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,1,267.79,186.26,128.73,0.0,35.0,22.53,57.53,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009290,MBR00000363,Institutional-OP,2023-08-30,2023-08-30,2023-10-09,PLN7409,1645194539,1645194539,SNF,In-Network,E11.40,Z23,,,,,,,0,,45380,Surgery,,,0450,22,Outpatient Hospital,3,2705.8,1964.71,1737.91,226.8,0.0,0.0,226.8,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000009291,MBR00000363,Professional,2021-06-11,2021-06-11,2021-07-02,PLN5359,1780163051,1780163051,SNF,In-Network,Z00.00,Z00.00,,,,,,,0,,74177,Radiology,,,,11,Office,1,1706.98,887.17,800.11,0.0,0.0,87.06,87.06,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009292,MBR00000363,Institutional-OP,2023-07-04,2023-07-04,2023-07-14,PLN3363,1964402759,1964402759,Outpatient Clinic,In-Network,E11.9,E66.9,,,,,,,0,,99406,Medicine,,,0900,22,Outpatient Hospital,3,100.38,69.94,18.76,0.0,50.0,1.18,51.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009293,MBR00000363,Professional,2022-09-10,2022-09-10,2022-10-11,PLN6565,1433937353,1433937353,Nephrology,In-Network,F41.9,N40.0,,,,,,,0,,93000,Radiology,,,,23,Emergency Room,1,107.46,66.01,51.01,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009294,MBR00000363,Professional,2021-05-16,2021-05-16,2021-05-24,PLN2993,1896447406,1896447406,Nephrology,Out-of-Network,M81.0,N40.0,,,,,,,0,,84443,Pathology/Lab,,,,20,Urgent Care,1,79.1,34.45,29.91,0.0,0.0,4.54,4.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009295,MBR00000363,Professional,2023-12-14,2023-12-14,2024-01-04,PLN9143,1542828721,1542828721,Orthopedic Surgery,In-Network,E11.65,M54.5,,,,,,,0,,87491,Pathology/Lab,,,,22,Outpatient Hospital,3,107.38,56.78,49.81,0.0,0.0,6.97,6.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009296,MBR00000364,Professional,2023-06-08,2023-06-08,2023-06-24,PLN2821,1872272835,1872272835,Internal Medicine,In-Network,Z12.31,I48.91,,,,,,,0,,58661,Surgery,,,,31,Skilled Nursing Facility,2,3943.25,2506.78,2331.45,175.33,0.0,0.0,175.33,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009297,MBR00000364,Institutional-IP,2021-10-22,2021-10-25,2021-11-26,PLN7214,1606140917,1606140917,ASC,In-Network,Z51.11,Z23,,,,690,MS-DRG,21,3,Y,27130,Surgery,,,0301,21,Inpatient Hospital,3,5857.9,4494.7,4459.7,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009298,MBR00000364,Institutional-IP,2023-09-03,2023-09-07,2023-10-04,PLN8508,1564502315,1564502315,ASC,In-Network,E78.5,Z23,,,,690,MS-DRG,14,4,Y,77067,Radiology,,,0450,21,Inpatient Hospital,3,716.04,309.18,244.82,0.0,15.0,49.36,64.36,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000009299,MBR00000364,Professional,2023-03-12,2023-03-12,2023-04-01,PLN7422,1500037969,1500037969,Pulmonology,In-Network,Z51.11,M54.5,,,,,,,0,,70553,Radiology,,,,49,Independent Clinic,1,2831.22,1052.03,696.51,196.67,35.0,123.85,355.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009300,MBR00000364,Institutional-IP,2022-05-05,2022-05-06,2022-06-16,PLN5672,1486164553,1486164553,DME Supplier,In-Network,N17.9,E11.65,,,,641,MS-DRG,15,1,Y,45378,Surgery,,,0900,21,Inpatient Hospital,2,1533.72,1192.67,1117.67,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000009301,MBR00000364,Professional,2021-06-27,2021-06-27,2021-07-15,PLN9809,1606140917,1606140917,ASC,In-Network,R07.9,E11.9,,,,,,,0,,66984,Surgery,,,,11,Office,3,1275.29,1050.56,1025.56,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009302,MBR00000365,Institutional-OP,2023-03-12,2023-03-12,2023-04-03,PLN7457,1717546253,1717546253,Family Medicine,In-Network,Z79.4,Z12.31,,,,,,,0,,99222,E&M,,,0360,22,Outpatient Hospital,2,390.5,128.37,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009303,MBR00000365,Professional,2023-10-18,2023-10-18,2023-11-04,PLN4652,1168881145,1168881145,Orthopedic Surgery,In-Network,N40.0,E11.9,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,1,184.89,153.32,118.32,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009304,MBR00000365,Professional,2021-07-31,2021-07-31,2021-08-22,PLN4068,1108115157,1108115157,General Acute Care Hospital,In-Network,F32.9,E78.5,,,,,,,0,,99204,E&M,,,,21,Inpatient Hospital,1,434.02,307.34,0.0,307.34,0.0,0.0,307.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009305,MBR00000365,Professional,2021-01-01,2021-01-01,2021-01-14,PLN3806,1702692193,1702692193,Physical Therapy,In-Network,J20.9,Z23,,,,,,,0,,70450,Radiology,,,,23,Emergency Room,1,715.83,578.14,553.14,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009306,MBR00000365,Professional,2021-09-09,2021-09-09,2021-10-22,PLN2987,1242201429,1242201429,General Acute Care Hospital,In-Network,F32.9,E11.65,,,,,,,0,,27130,Surgery,,,,11,Office,1,6793.23,2130.63,1651.18,454.45,25.0,0.0,479.45,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009307,MBR00000365,Institutional-OP,2021-11-19,2021-11-19,2021-12-21,PLN6757,1899127912,1899127912,Neurology,In-Network,F32.9,Z12.31,,,,,,,0,,99406,Medicine,,,0761,22,Outpatient Hospital,2,72.17,59.05,0.0,59.05,0.0,0.0,59.05,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009308,MBR00000365,Institutional-OP,2022-02-20,2022-02-20,2022-03-02,PLN6500,1486164553,1486164553,DME Supplier,In-Network,E11.9,K21.0,,,,,,,0,,99221,E&M,,,0200,22,Outpatient Hospital,3,402.59,160.89,85.89,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009309,MBR00000365,Professional,2023-12-06,2023-12-06,2024-01-16,PLN6627,1433937353,1433937353,Nephrology,In-Network,J06.9,Z23,,,,,,,0,,90686,Medicine,,,,65,End-Stage Renal Disease,3,106.46,36.57,0.0,36.57,15.0,0.0,51.57,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000009310,MBR00000365,Professional,2023-11-21,2023-11-21,2023-12-26,PLN7743,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,I10,I10,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,3,4966.12,3841.55,3841.55,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009311,MBR00000365,Professional,2023-01-05,2023-01-05,2023-02-17,PLN3339,1168881145,1168881145,Orthopedic Surgery,In-Network,E11.65,E11.9,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,2,220.92,162.96,133.35,0.0,25.0,4.61,29.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009312,MBR00000365,Institutional-IP,2021-08-27,2021-08-30,2021-10-07,PLN8629,1860435061,1860435061,DME Supplier,In-Network,E78.5,E11.9,,,,194,MS-DRG,5,3,Y,99203,E&M,,,0761,21,Inpatient Hospital,1,166.25,90.79,56.61,34.18,0.0,0.0,34.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009313,MBR00000365,Professional,2021-08-20,2021-08-20,2021-08-28,PLN4738,1622771872,1622771872,Pediatrics,In-Network,E11.9,G20,,,,,,,0,,45378,Surgery,,,,21,Inpatient Hospital,3,1139.13,872.92,872.92,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000009314,MBR00000365,Institutional-OP,2021-03-31,2021-03-31,2021-04-24,PLN4698,1991459367,1991459367,Neurology,Out-of-Network,M81.0,Z23,,,,,,,0,,99283,E&M,,,0370,22,Outpatient Hospital,3,608.56,478.33,408.43,0.0,15.0,54.9,69.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009315,MBR00000365,Institutional-IP,2023-05-17,2023-05-22,2023-06-22,PLN5385,1337791138,1337791138,Internal Medicine,Out-of-Network,Z96.641,E66.9,,,,196,MS-DRG,8,5,Y,27130,Surgery,,,0450,21,Inpatient Hospital,2,3248.8,991.1,966.1,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009316,MBR00000365,Professional,2021-08-30,2021-08-30,2021-09-10,PLN1685,1660288235,1660288235,ASC,In-Network,Z00.00,Z23,,,,,,,0,,45378,Surgery,,,,21,Inpatient Hospital,1,2506.28,836.58,811.58,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000009317,MBR00000365,Institutional-OP,2023-09-11,2023-09-11,2023-10-06,PLN4329,1108115157,1108115157,General Acute Care Hospital,In-Network,E87.6,Z00.00,,,,,,,0,,66984,Surgery,,,0450,22,Outpatient Hospital,2,1524.52,948.4,913.4,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009318,MBR00000365,Professional,2022-10-20,2022-10-20,2022-11-27,PLN9709,1569105090,1569105090,Geriatrics,In-Network,Z00.00,Z00.00,,,,,,,0,,90460,Medicine,,,,23,Emergency Room,1,58.38,18.87,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-18,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009319,MBR00000365,Institutional-IP,2022-06-18,2022-06-27,2022-07-29,PLN8938,1644128543,1644128543,Gastroenterology,In-Network,Z87.891,M54.5,,,,292,MS-DRG,11,9,Y,81001,Pathology/Lab,,,0636,21,Inpatient Hospital,1,55.13,35.93,35.93,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009320,MBR00000365,Professional,2023-10-15,2023-10-15,2023-11-20,PLN2296,1687650653,1687650653,Internal Medicine,In-Network,E87.6,Z51.11,,,,,,,0,,99283,E&M,,,,12,Home,1,534.03,261.28,0.0,0.0,50.0,11.37,61.37,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009321,MBR00000365,Professional,2021-06-20,2021-06-20,2021-07-31,PLN1790,1486164553,1486164553,DME Supplier,In-Network,E11.9,I25.10,,,,,,,0,,33533,Surgery,,,,11,Office,2,25492.71,14704.45,14669.45,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000009322,MBR00000365,Professional,2022-05-23,2022-05-23,2022-06-14,PLN5318,1313212303,1313212303,Family Medicine,In-Network,B97.89,M17.11,,,,,,,0,,23472,Surgery,,,,65,End-Stage Renal Disease,3,4475.07,3599.48,3226.2,373.28,0.0,0.0,373.28,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009323,MBR00000365,Institutional-IP,2021-10-11,2021-10-15,2021-10-18,PLN3681,1542828721,1542828721,Orthopedic Surgery,In-Network,E11.65,E78.5,,,,682,MS-DRG,9,4,Y,99406,Medicine,,,0450,21,Inpatient Hospital,1,99.76,70.73,0.0,70.73,25.0,0.0,95.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009324,MBR00000365,Professional,2021-07-18,2021-07-18,2021-08-27,PLN6988,1433937353,1433937353,Nephrology,In-Network,E11.40,Z23,,,,,,,0,,74177,Radiology,,,,50,Federally Qualified Health Center,2,1993.44,992.56,721.85,270.71,0.0,0.0,270.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009325,MBR00000365,Institutional-OP,2023-10-30,2023-10-30,2023-12-12,PLN6196,1609526529,1609526529,Psychiatry,In-Network,E11.9,K21.0,,,,,,,0,,97530,Medicine,,,0120,22,Outpatient Hospital,3,149.46,118.95,93.95,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009326,MBR00000365,Professional,2022-10-25,2022-10-25,2022-11-20,PLN3516,1433937353,1433937353,Nephrology,In-Network,I10,I25.10,,,,,,,0,,45380,Surgery,,,,23,Emergency Room,3,2923.86,1652.67,1577.67,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,1,0,0,0
CLM0000009327,MBR00000365,Professional,2021-06-26,2021-06-26,2021-07-19,PLN4045,1433937353,1433937353,Nephrology,In-Network,K21.0,Z00.00,,,,,,,0,,93000,Radiology,,,,12,Home,1,171.47,87.35,52.35,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009328,MBR00000365,Institutional-IP,2021-04-28,2021-05-02,2021-05-06,PLN4819,1475984649,1475984649,SNF,In-Network,F32.9,N39.0,,,,871,MS-DRG,2,4,Y,99222,E&M,,,0370,21,Inpatient Hospital,1,498.27,407.13,0.0,407.13,0.0,0.0,407.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009329,MBR00000365,Professional,2021-12-08,2021-12-08,2022-01-18,PLN7771,1575695214,1575695214,SNF,In-Network,E66.9,J44.1,,,,,,,0,,99203,E&M,,,,11,Office,2,248.41,77.36,27.36,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009330,MBR00000365,Professional,2023-07-02,2023-07-02,2023-08-12,PLN7655,1994661817,1994661817,SNF,Out-of-Network,E78.5,M54.5,,,,,,,0,,70450,Radiology,,,,49,Independent Clinic,1,1617.0,974.04,646.73,327.31,0.0,0.0,327.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009331,MBR00000365,Professional,2021-06-09,2021-06-09,2021-07-05,PLN5594,1236418230,1236418230,DME Supplier,In-Network,Z00.00,J06.9,,,,,,,0,,70553,Radiology,,,,11,Office,2,4046.17,3297.41,3297.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009332,MBR00000365,Professional,2023-03-24,2023-03-24,2023-04-22,PLN1424,1564502315,1564502315,ASC,In-Network,F41.9,Z79.4,,,,,,,0,,93225,Medicine,,,,21,Inpatient Hospital,1,685.87,558.41,0.0,485.14,75.0,0.0,560.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009333,MBR00000365,Professional,2021-04-26,2021-04-26,2021-05-14,PLN4267,1624202402,1624202402,Orthopedic Surgery,In-Network,K21.0,M54.5,,,,,,,0,,74177,Radiology,,,,11,Office,3,1445.04,557.43,0.0,354.15,0.0,0.0,354.15,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009334,MBR00000366,Professional,2022-01-04,2022-01-04,2022-02-16,PLN6305,1806688928,1806688928,Geriatrics,In-Network,Z23,Z23,,,,,,,0,,99283,E&M,,,,11,Office,3,530.13,397.86,133.02,229.84,35.0,0.0,264.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009335,MBR00000366,Institutional-IP,2022-07-26,2022-07-31,2022-09-04,PLN8554,1840431511,1840431511,Geriatrics,Out-of-Network,F32.9,Z79.4,,,,470,MS-DRG,13,5,Y,23472,Surgery,,,0360,21,Inpatient Hospital,2,6843.35,3459.8,2939.47,0.0,75.0,445.33,520.33,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009336,MBR00000366,Institutional-OP,2021-05-22,2021-05-22,2021-06-22,PLN5748,1752470395,1752470395,Home Health,In-Network,N18.3,N20.0,,,,,,,0,,99221,E&M,,,0900,22,Outpatient Hospital,1,210.38,152.23,152.23,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009337,MBR00000366,Professional,2022-03-11,2022-03-11,2022-04-10,PLN3305,1935547131,1935547131,Pulmonology,In-Network,E11.65,I10,,,,,,,0,,70553,Radiology,,,,22,Outpatient Hospital,2,2050.9,620.64,545.64,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009338,MBR00000366,Institutional-OP,2021-10-21,2021-10-21,2021-11-11,PLN7357,1935547131,1935547131,Pulmonology,In-Network,E11.9,M54.5,,,,,,,0,,99222,E&M,,,0740,22,Outpatient Hospital,2,561.68,176.19,100.72,57.93,0.0,17.54,75.47,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009339,MBR00000366,Professional,2021-02-20,2021-02-20,2021-04-05,PLN6020,1545347862,1545347862,SNF,In-Network,E11.9,Z00.00,,,,,,,0,,27447,Surgery,,,,23,Emergency Room,3,5725.93,2374.18,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-27,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009340,MBR00000366,Professional,2021-01-02,2021-01-02,2021-01-25,PLN3497,1609526529,1609526529,Psychiatry,In-Network,G43.909,F41.9,,,,,,,0,,99221,E&M,,,,11,Office,1,247.37,152.6,102.6,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009341,MBR00000366,Professional,2021-06-08,2021-06-08,2021-07-03,PLN7053,1702692193,1702692193,Physical Therapy,In-Network,J06.9,Z23,,,,,,,0,,70450,Radiology,,,,22,Outpatient Hospital,1,1332.17,1088.9,1038.9,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009342,MBR00000366,Professional,2023-03-31,2023-03-31,2023-04-07,PLN5568,1812060197,1812060197,Oncology,Out-of-Network,J18.9,E66.9,,,,,,,0,,77067,Radiology,,,,11,Office,3,366.94,274.29,239.29,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000009343,MBR00000366,Professional,2021-02-11,2021-02-11,2021-03-04,PLN2485,1795618275,1795618275,Pulmonology,In-Network,E11.9,R07.9,,,,,,,0,,99214,E&M,,,,81,Independent Laboratory,3,403.82,160.46,135.46,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009344,MBR00000366,Professional,2022-07-08,2022-07-08,2022-08-14,PLN9798,1390307371,1390307371,DME Supplier,In-Network,N40.0,I10,,,,,,,0,,99222,E&M,,,,11,Office,1,581.44,233.78,183.78,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009345,MBR00000366,Professional,2021-01-27,2021-01-27,2021-02-25,PLN3686,1817234602,1817234602,Clinical Laboratory,In-Network,I10,F03.90,,,,,,,0,,27447,Surgery,,,,20,Urgent Care,2,2855.43,2250.59,1971.82,253.77,25.0,0.0,278.77,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009346,MBR00000366,Professional,2021-08-25,2021-08-25,2021-09-30,PLN9643,1118885473,1118885473,ASC,In-Network,E78.5,E11.9,,,,,,,0,,97530,Medicine,,,,11,Office,2,262.91,186.13,0.0,186.13,35.0,0.0,221.13,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000009347,MBR00000366,Professional,2021-07-15,2021-07-15,2021-08-07,PLN6189,1840431511,1840431511,Geriatrics,Out-of-Network,I10,Z23,,,,,,,0,,G0439,Medicine,,,,11,Office,1,386.52,238.89,0.0,238.89,15.0,0.0,253.89,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000009348,MBR00000366,Professional,2022-01-08,2022-01-08,2022-02-21,PLN7973,1108115157,1108115157,General Acute Care Hospital,In-Network,F32.9,N17.9,,,,,,,0,,23472,Surgery,,,,20,Urgent Care,1,5275.1,1723.44,1665.65,0.0,0.0,57.79,57.79,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009349,MBR00000366,Professional,2023-03-26,2023-03-26,2023-04-29,PLN6057,1795618275,1795618275,Pulmonology,In-Network,G43.909,M54.5,,,,,,,0,,80053,Pathology/Lab,,,,22,Outpatient Hospital,3,148.01,56.4,46.34,10.06,0.0,0.0,10.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009350,MBR00000366,Institutional-IP,2022-04-07,2022-04-08,2022-05-09,PLN7722,1224179551,1224179551,Physical Therapy,In-Network,N39.0,Z00.00,,,,291,MS-DRG,2,1,Y,99284,E&M,,,0761,21,Inpatient Hospital,1,842.82,517.32,482.32,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009351,MBR00000366,Professional,2021-01-17,2021-01-17,2021-01-30,PLN4983,1224179551,1224179551,Physical Therapy,In-Network,I10,Z00.00,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,1,284.46,217.55,217.55,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009352,MBR00000367,Professional,2021-06-08,2021-06-08,2021-07-08,PLN8693,1135158374,1135158374,Pulmonology,In-Network,R51,J06.9,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,3,87.56,57.46,0.0,57.46,35.0,0.0,92.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009353,MBR00000367,Professional,2021-11-30,2021-11-30,2022-01-13,PLN4183,1717546253,1717546253,Family Medicine,In-Network,Z00.00,N17.9,,,,,,,0,,93225,Medicine,,,,11,Office,3,514.01,294.03,219.03,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009354,MBR00000367,Institutional-IP,2021-11-01,2021-11-07,2021-11-12,PLN7575,1186826716,1186826716,Physical Therapy,In-Network,I50.9,Z12.31,,,,291,MS-DRG,20,6,Y,99204,E&M,,,0200,21,Inpatient Hospital,1,259.72,209.1,0.0,209.1,50.0,0.0,259.1,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000009355,MBR00000367,Institutional-IP,2022-09-11,2022-09-13,2022-10-06,PLN9110,1475984649,1475984649,SNF,In-Network,E11.65,I10,,,,690,MS-DRG,4,2,Y,82043,Pathology/Lab,,,0320,21,Inpatient Hospital,3,45.7,14.97,0.0,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009356,MBR00000367,Institutional-OP,2022-01-20,2022-01-20,2022-02-10,PLN9805,1540044947,1540044947,Pulmonology,Out-of-Network,Z96.641,I11.9,,,,,,,0,,99232,E&M,,,0761,22,Outpatient Hospital,1,268.57,101.58,101.58,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009357,MBR00000367,Professional,2023-03-26,2023-03-26,2023-04-29,PLN8395,1939033455,1939033455,Pulmonology,In-Network,G20,E78.5,,,,,,,0,,58661,Surgery,,,,21,Inpatient Hospital,3,3463.6,1482.26,1457.26,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009358,MBR00000367,Institutional-IP,2021-10-04,2021-10-06,2021-11-17,PLN6365,1266606767,1266606767,ASC,In-Network,I10,I63.9,,,,872,MS-DRG,2,2,Y,80053,Pathology/Lab,,,0120,21,Inpatient Hospital,2,72.76,22.19,22.19,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009359,MBR00000367,Professional,2023-01-13,2023-01-13,2023-02-08,PLN7871,1132188260,1132188260,Family Medicine,In-Network,B97.89,M54.5,,,,,,,0,,23472,Surgery,,,,11,Office,3,5041.01,2745.23,2745.23,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009360,MBR00000367,Institutional-OP,2021-04-21,2021-04-21,2021-05-02,PLN7839,1689639685,1689639685,SNF,In-Network,I10,F32.9,,,,,,,0,,82043,Pathology/Lab,,,0120,22,Outpatient Hospital,2,35.82,18.45,17.6,0.0,0.0,0.85,0.85,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000009361,MBR00000367,Institutional-OP,2023-12-19,2023-12-19,2024-01-09,PLN1408,1168881145,1168881145,Orthopedic Surgery,In-Network,J20.9,B97.89,,,,,,,0,,99222,E&M,,,0360,22,Outpatient Hospital,3,388.28,146.12,0.0,146.12,75.0,0.0,221.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009362,MBR00000367,Professional,2023-12-17,2023-12-17,2023-12-27,PLN6137,1334916761,1334916761,ASC,In-Network,I10,Z00.01,,,,,,,0,,93000,Radiology,,,,81,Independent Laboratory,3,140.56,46.6,0.0,46.6,0.0,0.0,46.6,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009363,MBR00000367,Institutional-OP,2021-10-29,2021-10-29,2021-11-15,PLN9049,1845900543,1845900543,ASC,In-Network,M54.5,I10,,,,,,,0,,85610,Pathology/Lab,,,0900,22,Outpatient Hospital,2,44.63,15.37,0.0,15.37,50.0,0.0,65.37,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009364,MBR00000367,Professional,2021-09-14,2021-09-14,2021-09-26,PLN3823,1915531927,1915531927,Critical Access Hospital,In-Network,Z79.4,M17.11,,,,,,,0,,99214,E&M,,,,11,Office,1,164.47,90.36,90.36,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009365,MBR00000367,Institutional-OP,2021-01-01,2021-01-01,2021-01-19,PLN6411,1865904917,1865904917,Outpatient Clinic,In-Network,R10.9,E78.5,,,,,,,0,,99222,E&M,,,0360,22,Outpatient Hospital,1,524.39,365.02,365.02,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009366,MBR00000367,Professional,2023-12-05,2023-12-05,2023-12-30,PLN9186,1865904917,1865904917,Outpatient Clinic,In-Network,J06.9,I10,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,2,318.18,120.4,38.75,0.0,75.0,6.65,81.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009367,MBR00000367,Professional,2021-02-11,2021-02-11,2021-03-25,PLN6507,1364429278,1364429278,OB/GYN,In-Network,E78.5,Z00.00,,,,,,,0,,23472,Surgery,,,,11,Office,2,3324.45,2352.32,1833.16,171.91,15.0,332.25,519.16,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009368,MBR00000367,Institutional-IP,2021-01-03,2021-01-09,2021-02-11,PLN8373,1295371663,1295371663,Critical Access Hospital,In-Network,M81.0,F32.9,,,,194,MS-DRG,4,6,Y,99233,E&M,,,0301,21,Inpatient Hospital,1,229.82,90.27,0.0,90.27,0.0,0.0,90.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009369,MBR00000367,Professional,2021-04-17,2021-04-17,2021-05-19,PLN2213,1856686341,1856686341,Geriatrics,In-Network,I25.10,Z12.31,,,,,,,0,,47562,Surgery,,,,11,Office,2,3968.0,2446.89,2431.89,0.0,15.0,0.0,15.0,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009370,MBR00000367,Institutional-OP,2021-11-19,2021-11-19,2021-12-22,PLN7827,1245650222,1245650222,Gastroenterology,In-Network,Z96.641,R10.9,,,,,,,0,,99233,E&M,,,0120,22,Outpatient Hospital,2,554.52,263.83,263.83,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000009371,MBR00000367,Professional,2023-12-04,2023-12-04,2024-01-04,PLN2411,1518055405,1518055405,Urology,In-Network,J06.9,E11.9,,,,,,,0,,90460,Medicine,,,,22,Outpatient Hospital,1,44.94,16.33,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009372,MBR00000367,Professional,2021-07-02,2021-07-02,2021-07-23,PLN8786,1696843572,1696843572,Critical Access Hospital,Out-of-Network,I10,E78.5,,,,,,,0,,90686,Medicine,,,,81,Independent Laboratory,3,144.88,102.94,0.0,102.94,0.0,0.0,102.94,0.0,Adjusted,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000009373,MBR00000367,Professional,2022-09-17,2022-09-17,2022-10-03,PLN3103,1135158374,1135158374,Pulmonology,In-Network,N39.0,E11.65,,,,,,,0,,23472,Surgery,,,,81,Independent Laboratory,1,6299.39,3608.11,3435.07,173.04,0.0,0.0,173.04,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009374,MBR00000367,Institutional-OP,2022-12-14,2022-12-14,2022-12-31,PLN7331,1284035364,1284035364,Pediatrics,In-Network,F41.9,F32.9,,,,,,,0,,G0468,Medicine,,,0450,22,Outpatient Hospital,2,739.74,418.04,230.64,98.38,35.0,54.02,187.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009375,MBR00000367,Institutional-OP,2023-05-26,2023-05-26,2023-06-27,PLN1985,1219817751,1219817751,OB/GYN,In-Network,E87.6,M54.5,,,,,,,0,,93225,Medicine,,,0510,22,Outpatient Hospital,3,903.8,505.14,455.14,0.0,50.0,0.0,50.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009376,MBR00000367,Professional,2023-02-05,2023-02-05,2023-03-04,PLN3573,1453936007,1453936007,ASC,In-Network,Z12.31,J44.1,,,,,,,0,,70450,Radiology,,,,22,Outpatient Hospital,3,1598.13,690.27,419.61,201.96,25.0,43.7,270.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009377,MBR00000367,Professional,2023-12-15,2023-12-15,2024-01-23,PLN4078,1696843572,1696843572,Critical Access Hospital,Out-of-Network,Z00.00,I10,,,,,,,0,,27447,Surgery,,,,50,Federally Qualified Health Center,3,2888.55,1463.34,1375.84,87.5,0.0,0.0,87.5,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009378,MBR00000367,Professional,2022-12-26,2022-12-26,2023-01-12,PLN4517,1450094833,1450094833,Outpatient Clinic,In-Network,I10,F41.9,,,,,,,0,,90460,Medicine,,,,23,Emergency Room,2,42.25,26.36,0.0,26.36,75.0,0.0,101.36,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009379,MBR00000367,Professional,2023-07-14,2023-07-14,2023-08-03,PLN4732,1556140803,1556140803,Cardiology,In-Network,M17.11,Z12.11,,,,,,,0,,99284,E&M,,,,11,Office,2,732.37,224.44,224.44,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009380,MBR00000367,Institutional-OP,2021-12-17,2021-12-17,2022-01-07,PLN8780,1716521444,1716521444,Oncology,In-Network,J06.9,Z79.4,,,,,,,0,,23472,Surgery,,,0360,22,Outpatient Hospital,2,4311.99,3647.65,3415.61,4.8,0.0,227.24,232.04,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009381,MBR00000367,Institutional-OP,2022-03-23,2022-03-23,2022-04-28,PLN3587,1946680931,1946680931,Critical Access Hospital,Out-of-Network,Z12.31,J06.9,,,,,,,0,,70553,Radiology,,,0740,22,Outpatient Hospital,1,3429.07,1194.31,687.94,429.59,0.0,76.78,506.37,0.0,Paid,,,1,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000009382,MBR00000367,Institutional-IP,2023-03-19,2023-03-22,2023-03-28,PLN4774,1799205295,1799205295,General Acute Care Hospital,In-Network,N17.9,R07.9,,,,683,MS-DRG,9,3,Y,99232,E&M,,,0360,21,Inpatient Hospital,3,163.17,133.21,2.61,130.6,0.0,0.0,130.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009383,MBR00000367,Professional,2023-08-18,2023-08-18,2023-09-01,PLN2496,1213165847,1213165847,Critical Access Hospital,In-Network,C50.912,I63.9,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,1,384.28,322.46,272.46,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009384,MBR00000367,Institutional-OP,2021-01-06,2021-01-06,2021-02-07,PLN3713,1609138981,1609138981,Critical Access Hospital,In-Network,N17.9,E11.9,,,,,,,0,,93306,Radiology,,,0360,22,Outpatient Hospital,3,2765.52,2307.99,1907.71,0.0,35.0,365.28,400.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009385,MBR00000367,Institutional-OP,2022-04-20,2022-04-20,2022-05-11,PLN9579,1872613201,1872613201,Internal Medicine,In-Network,I10,R10.9,,,,,,,0,,99204,E&M,,,0200,22,Outpatient Hospital,1,505.07,403.79,403.03,0.76,0.0,0.0,0.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009386,MBR00000367,Institutional-OP,2023-05-29,2023-05-29,2023-07-08,PLN9060,1856686341,1856686341,Geriatrics,In-Network,Z23,F41.9,,,,,,,0,,90837,Medicine,,,0740,22,Outpatient Hospital,1,313.16,202.07,129.46,72.61,0.0,0.0,72.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009387,MBR00000367,Institutional-IP,2021-05-05,2021-05-07,2021-05-30,PLN4371,1609526529,1609526529,Psychiatry,In-Network,J44.1,R10.9,,,,196,MS-DRG,8,2,Y,90686,Medicine,,,0270,21,Inpatient Hospital,3,120.54,55.1,0.0,38.76,50.0,0.0,88.76,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000009388,MBR00000367,Professional,2022-01-22,2022-01-22,2022-03-06,PLN3326,1433937353,1433937353,Nephrology,In-Network,Z12.31,N39.0,,,,,,,0,,47562,Surgery,,,,11,Office,3,4725.0,2377.54,2377.54,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009389,MBR00000367,Institutional-OP,2022-08-24,2022-08-24,2022-09-05,PLN1848,1132188260,1132188260,Family Medicine,In-Network,J45.20,Z12.31,,,,,,,0,,99283,E&M,,,0730,22,Outpatient Hospital,2,367.52,282.08,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009390,MBR00000367,Professional,2021-04-01,2021-04-01,2021-05-08,PLN1982,1528335731,1528335731,Critical Access Hospital,In-Network,J45.20,I10,,,,,,,0,,99233,E&M,,,,50,Federally Qualified Health Center,3,222.18,91.4,0.0,91.4,0.0,0.0,91.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009391,MBR00000367,Professional,2023-09-30,2023-09-30,2023-10-14,PLN8223,1531398223,1531398223,OB/GYN,In-Network,F32.9,F32.9,,,,,,,0,,74177,Radiology,,,,11,Office,3,1083.34,386.88,14.98,346.9,25.0,0.0,371.9,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009392,MBR00000368,Professional,2022-02-07,2022-02-07,2022-02-17,PLN6971,1132188260,1132188260,Family Medicine,In-Network,J45.20,Z00.00,,,,,,,0,,99214,E&M,,,,65,End-Stage Renal Disease,2,209.89,78.59,43.59,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009393,MBR00000368,Institutional-IP,2023-05-10,2023-05-21,2023-06-01,PLN9339,1520687146,1520687146,ASC,In-Network,R10.9,C50.912,,,,603,MS-DRG,5,11,Y,66984,Surgery,,,0740,21,Inpatient Hospital,3,3180.1,2559.48,2559.48,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009394,MBR00000368,Institutional-OP,2022-04-14,2022-04-14,2022-04-22,PLN9713,1767011137,1767011137,DME Supplier,In-Network,N18.3,Z23,,,,,,,0,,99283,E&M,,,0360,22,Outpatient Hospital,3,268.68,149.86,0.0,149.86,50.0,0.0,199.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009395,MBR00000368,Institutional-OP,2022-03-17,2022-03-17,2022-04-08,PLN9433,1550154147,1550154147,Outpatient Clinic,In-Network,Z12.31,Z00.00,,,,,,,0,,70450,Radiology,,,0320,22,Outpatient Hospital,3,1186.12,964.41,781.08,0.0,0.0,183.33,183.33,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009396,MBR00000368,Institutional-OP,2023-11-24,2023-11-24,2024-01-03,PLN6560,1575695214,1575695214,SNF,In-Network,I10,K21.0,,,,,,,0,,90460,Medicine,,,0450,22,Outpatient Hospital,2,31.35,19.62,4.31,0.0,15.0,0.31,15.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009397,MBR00000368,Institutional-IP,2023-07-26,2023-07-28,2023-08-25,PLN1911,1372918899,1372918899,Family Medicine,In-Network,Z23,N18.3,,,,641,MS-DRG,6,2,Y,90460,Medicine,,,0636,21,Inpatient Hospital,3,62.02,33.25,6.85,0.0,25.0,1.4,26.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009398,MBR00000368,Institutional-OP,2022-07-19,2022-07-19,2022-08-12,PLN7697,1702692193,1702692193,Physical Therapy,In-Network,E66.9,I10,,,,,,,0,,99284,E&M,,,0900,22,Outpatient Hospital,2,365.03,163.48,0.0,163.48,75.0,0.0,238.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009399,MBR00000368,Professional,2022-05-24,2022-05-24,2022-07-06,PLN4125,1219817751,1219817751,OB/GYN,In-Network,N39.0,I10,,,,,,,0,,99213,E&M,,,,21,Inpatient Hospital,3,250.13,121.72,0.0,121.72,15.0,0.0,136.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009400,MBR00000368,Professional,2023-05-05,2023-05-05,2023-05-26,PLN8890,1991459367,1991459367,Neurology,Out-of-Network,E66.9,J18.9,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,1,142.43,68.64,53.64,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009401,MBR00000368,Professional,2023-01-20,2023-01-20,2023-02-28,PLN1121,1148984206,1148984206,Psychiatry,In-Network,Z87.891,I10,,,,,,,0,,99232,E&M,,,,11,Office,3,184.95,84.03,69.03,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009402,MBR00000368,Institutional-OP,2023-12-09,2023-12-09,2023-12-29,PLN3852,1284035364,1284035364,Pediatrics,In-Network,E66.9,Z00.00,,,,,,,0,,47562,Surgery,,,0740,22,Outpatient Hospital,1,3244.75,1246.88,796.84,450.04,0.0,0.0,450.04,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009403,MBR00000368,Institutional-OP,2021-12-31,2021-12-31,2022-02-03,PLN4660,1334916761,1334916761,ASC,In-Network,E11.9,J45.20,,,,,,,0,,93306,Radiology,,,0761,22,Outpatient Hospital,3,3250.59,1264.91,1264.91,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009404,MBR00000368,Institutional-OP,2021-05-04,2021-05-04,2021-05-12,PLN7130,1991459367,1991459367,Neurology,Out-of-Network,G43.909,Z23,,,,,,,0,,23472,Surgery,,,0320,22,Outpatient Hospital,2,3236.04,1936.41,1515.47,420.94,0.0,0.0,420.94,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009405,MBR00000368,Institutional-OP,2021-08-02,2021-08-02,2021-09-03,PLN2311,1935547131,1935547131,Pulmonology,In-Network,Z12.31,K57.30,,,,,,,0,,47562,Surgery,,,0900,22,Outpatient Hospital,2,5818.79,3979.51,3122.62,69.69,25.0,762.2,856.89,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009406,MBR00000368,Professional,2022-08-01,2022-08-01,2022-08-28,PLN3275,1860435061,1860435061,DME Supplier,In-Network,G43.909,E78.5,,,,,,,0,,43239,Surgery,,,,11,Office,3,1834.07,571.37,571.37,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009407,MBR00000368,Institutional-OP,2021-12-10,2021-12-10,2021-12-30,PLN1279,1103747954,1103747954,Urology,In-Network,F41.9,Z12.11,,,,,,,0,,99214,E&M,,,0510,22,Outpatient Hospital,3,227.75,113.0,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009408,MBR00000368,Professional,2023-06-06,2023-06-06,2023-07-08,PLN6162,1337791138,1337791138,Internal Medicine,Out-of-Network,J06.9,E78.5,,,,,,,0,,33533,Surgery,,,,21,Inpatient Hospital,3,27312.04,12520.12,12047.72,472.4,0.0,0.0,472.4,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000009409,MBR00000368,Institutional-OP,2023-08-17,2023-08-17,2023-09-11,PLN4818,1749327647,1749327647,Geriatrics,In-Network,G43.909,J18.9,,,,,,,0,,82043,Pathology/Lab,,,0270,22,Outpatient Hospital,3,29.96,18.65,18.65,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009410,MBR00000368,Institutional-OP,2021-07-24,2021-07-24,2021-09-03,PLN9197,1434029575,1434029575,Endocrinology,In-Network,Z00.00,Z12.11,,,,,,,0,,80061,Pathology/Lab,,,0740,22,Outpatient Hospital,1,94.01,63.74,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009411,MBR00000368,Professional,2023-12-20,2023-12-20,2024-01-24,PLN3216,1700633438,1700633438,DME Supplier,In-Network,I48.91,Z23,,,,,,,0,,70553,Radiology,,,,11,Office,1,2109.5,1474.25,1424.25,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009412,MBR00000368,Professional,2022-11-23,2022-11-23,2022-12-29,PLN2796,1193493783,1193493783,Critical Access Hospital,Out-of-Network,N39.0,Z00.00,,,,,,,0,,23472,Surgery,,,,11,Office,2,5449.09,3297.4,2861.59,385.81,50.0,0.0,435.81,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009413,MBR00000368,Professional,2021-10-16,2021-10-16,2021-10-24,PLN6946,1361302520,1361302520,Critical Access Hospital,In-Network,E78.5,E78.5,,,,,,,0,,47562,Surgery,,,,11,Office,2,4784.0,2266.63,2143.46,0.0,0.0,123.17,123.17,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009414,MBR00000368,Institutional-OP,2021-08-09,2021-08-09,2021-09-20,PLN7144,1561134315,1561134315,DME Supplier,In-Network,N39.0,N40.0,,,,,,,0,,80061,Pathology/Lab,,,0200,22,Outpatient Hospital,1,45.68,37.31,0.0,37.31,75.0,0.0,112.31,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009415,MBR00000368,Institutional-IP,2021-07-01,2021-07-03,2021-07-21,PLN8710,1168246159,1168246159,Internal Medicine,In-Network,E11.9,J20.9,,,,690,MS-DRG,9,2,Y,58661,Surgery,,,0761,21,Inpatient Hospital,3,4239.49,1957.89,1957.89,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009416,MBR00000368,Professional,2022-05-31,2022-05-31,2022-07-10,PLN3776,1295371663,1295371663,Critical Access Hospital,In-Network,N18.3,E66.9,,,,,,,0,,99233,E&M,,,,21,Inpatient Hospital,1,267.47,144.24,94.24,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009417,MBR00000368,Institutional-OP,2021-03-19,2021-03-19,2021-04-13,PLN7839,1168881145,1168881145,Orthopedic Surgery,In-Network,E11.9,E11.9,,,,,,,0,,74177,Radiology,,,0636,22,Outpatient Hospital,2,1186.88,783.26,758.26,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009418,MBR00000369,Professional,2021-05-24,2021-05-24,2021-07-02,PLN4796,1224179551,1224179551,Physical Therapy,In-Network,R51,Z12.31,,,,,,,0,,99213,E&M,,,,50,Federally Qualified Health Center,3,282.98,184.43,145.7,0.0,15.0,23.73,38.73,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009419,MBR00000369,Professional,2023-04-06,2023-04-06,2023-04-26,PLN2091,1355166277,1355166277,Endocrinology,In-Network,I48.91,E11.9,,,,,,,0,,99406,Medicine,,,,23,Emergency Room,1,47.45,27.95,27.95,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009420,MBR00000369,Institutional-OP,2022-06-20,2022-06-20,2022-07-11,PLN3122,1556140803,1556140803,Cardiology,In-Network,N17.9,E11.9,,,,,,,0,,47562,Surgery,,,0270,22,Outpatient Hospital,2,6537.33,2845.99,2711.8,119.19,15.0,0.0,134.19,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009421,MBR00000369,Professional,2022-08-02,2022-08-02,2022-08-31,PLN7975,1860435061,1860435061,DME Supplier,In-Network,Z87.891,J06.9,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,1,442.72,362.81,362.81,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009422,MBR00000369,Professional,2021-12-22,2021-12-22,2022-01-02,PLN6722,1361302520,1361302520,Critical Access Hospital,In-Network,Z12.31,Z23,,,,,,,0,,93000,Radiology,,,,22,Outpatient Hospital,1,77.13,38.1,38.1,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009423,MBR00000369,Institutional-OP,2022-09-01,2022-09-01,2022-09-19,PLN7080,1946680931,1946680931,Critical Access Hospital,Out-of-Network,F32.9,E11.9,,,,,,,0,,80053,Pathology/Lab,,,0120,22,Outpatient Hospital,1,110.96,76.08,0.0,76.08,0.0,0.0,76.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009424,MBR00000369,Professional,2022-01-11,2022-01-11,2022-01-18,PLN9847,1361302520,1361302520,Critical Access Hospital,In-Network,Z87.891,I10,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,3,46.47,24.37,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009425,MBR00000369,Professional,2021-02-19,2021-02-19,2021-03-21,PLN2372,1103747954,1103747954,Urology,In-Network,N18.3,F32.9,,,,,,,0,,99204,E&M,,,,11,Office,3,236.51,94.52,59.52,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009426,MBR00000369,Professional,2022-09-15,2022-09-15,2022-10-22,PLN7507,1713934949,1713934949,Neurology,In-Network,M17.11,Z87.891,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,3,2495.91,1024.88,999.88,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000009427,MBR00000369,Institutional-OP,2021-03-30,2021-03-30,2021-05-01,PLN8222,1994661817,1994661817,SNF,Out-of-Network,N39.0,R05,,,,,,,0,,77067,Radiology,,,0370,22,Outpatient Hospital,1,479.57,217.14,217.14,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000009428,MBR00000369,Professional,2023-01-25,2023-01-25,2023-03-08,PLN9731,1334916761,1334916761,ASC,In-Network,J44.1,Z23,,,,,,,0,,80061,Pathology/Lab,,,,21,Inpatient Hospital,2,51.78,18.83,18.83,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009429,MBR00000369,Institutional-OP,2023-09-29,2023-09-29,2023-11-02,PLN5783,1389336600,1389336600,Critical Access Hospital,In-Network,J20.9,K21.0,,,,,,,0,,45380,Surgery,,,0450,22,Outpatient Hospital,3,3031.44,1983.4,1983.4,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000009430,MBR00000369,Institutional-IP,2023-01-01,2023-01-04,2023-01-13,PLN9857,1964402759,1964402759,Outpatient Clinic,In-Network,Z12.31,N39.0,,,,292,MS-DRG,23,3,Y,99213,E&M,,,0120,21,Inpatient Hospital,2,159.36,125.99,8.19,117.8,0.0,0.0,117.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009431,MBR00000369,Professional,2022-09-24,2022-09-24,2022-10-12,PLN7777,1717912431,1717912431,Oncology,In-Network,I25.10,N17.9,,,,,,,0,,45380,Surgery,,,,11,Office,3,1817.39,1166.81,1131.81,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000009432,MBR00000369,Professional,2023-11-22,2023-11-22,2023-12-31,PLN4639,1186826716,1186826716,Physical Therapy,In-Network,F41.9,G43.909,,,,,,,0,,71046,Radiology,,,,21,Inpatient Hospital,3,224.99,163.43,0.0,58.8,35.0,0.0,93.8,0.0,Denied,CO-15,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009433,MBR00000369,Professional,2021-08-29,2021-08-29,2021-10-03,PLN1092,1767011137,1767011137,DME Supplier,In-Network,F32.9,I10,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,1,244.63,130.65,54.2,0.0,75.0,1.45,76.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009434,MBR00000369,Institutional-OP,2023-04-28,2023-04-28,2023-05-14,PLN2208,1236418230,1236418230,DME Supplier,In-Network,Z12.31,E11.9,,,,,,,0,,93225,Medicine,,,0200,22,Outpatient Hospital,2,905.12,412.36,366.09,46.27,0.0,0.0,46.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009435,MBR00000369,Professional,2021-08-16,2021-08-16,2021-08-26,PLN9461,1939033455,1939033455,Pulmonology,In-Network,R05,J44.1,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,2,397.53,162.96,147.96,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009436,MBR00000369,Institutional-IP,2021-01-01,2021-01-05,2021-02-13,PLN7527,1896447406,1896447406,Nephrology,Out-of-Network,E66.9,J18.9,,,,194,MS-DRG,17,4,Y,99203,E&M,,,0761,21,Inpatient Hospital,3,292.85,188.88,0.0,188.88,0.0,0.0,188.88,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009437,MBR00000369,Institutional-OP,2021-09-21,2021-09-21,2021-10-17,PLN8385,1856686341,1856686341,Geriatrics,In-Network,Z00.00,Z12.31,,,,,,,0,,99233,E&M,,,0636,22,Outpatient Hospital,2,460.45,142.69,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009438,MBR00000369,Professional,2022-07-05,2022-07-05,2022-07-25,PLN3369,1749327647,1749327647,Geriatrics,In-Network,R05,K21.0,,,,,,,0,,99213,E&M,,,,22,Outpatient Hospital,1,321.03,117.78,34.24,0.0,75.0,8.54,83.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009439,MBR00000369,Institutional-OP,2021-03-11,2021-03-11,2021-04-11,PLN6502,1847081578,1847081578,Urology,Out-of-Network,E66.9,I10,,,,,,,0,,80053,Pathology/Lab,,,0510,22,Outpatient Hospital,1,132.0,96.47,0.0,96.47,0.0,0.0,96.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009440,MBR00000370,Professional,2021-11-02,2021-11-02,2021-11-14,PLN8494,1410468316,1410468316,SNF,In-Network,I48.91,B97.89,,,,,,,0,,83036,Pathology/Lab,,,,81,Independent Laboratory,1,57.16,42.29,42.29,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000009441,MBR00000370,Institutional-IP,2021-02-24,2021-03-03,2021-03-20,PLN9729,1438368327,1438368327,Home Health,In-Network,R10.9,Z12.11,,,,683,MS-DRG,10,7,Y,99283,E&M,,,0301,21,Inpatient Hospital,2,543.76,370.36,358.22,0.0,0.0,12.14,12.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009442,MBR00000370,Professional,2021-09-24,2021-09-24,2021-10-03,PLN6807,1132188260,1132188260,Family Medicine,In-Network,K21.0,Z51.11,,,,,,,0,,90460,Medicine,,,,21,Inpatient Hospital,2,54.77,23.94,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009443,MBR00000370,Professional,2023-02-28,2023-02-28,2023-04-05,PLN7737,1531398223,1531398223,OB/GYN,In-Network,I10,G20,,,,,,,0,,93000,Radiology,,,,11,Office,3,179.46,97.63,82.63,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009444,MBR00000370,Institutional-OP,2021-06-16,2021-06-16,2021-07-15,PLN7070,1728018911,1728018911,Nephrology,In-Network,I10,Z12.11,,,,,,,0,,58661,Surgery,,,0320,22,Outpatient Hospital,3,4740.83,1782.55,1540.19,0.0,75.0,167.36,242.36,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009445,MBR00000370,Professional,2021-10-16,2021-10-16,2021-11-22,PLN5399,1433937353,1433937353,Nephrology,In-Network,Z12.31,Z23,,,,,,,0,,99204,E&M,,,,11,Office,1,572.11,363.41,363.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009446,MBR00000370,Institutional-OP,2021-05-29,2021-05-29,2021-06-05,PLN5162,1284035364,1284035364,Pediatrics,In-Network,E78.5,F32.9,,,,,,,0,,99406,Medicine,,,0730,22,Outpatient Hospital,1,79.93,47.6,0.0,47.6,15.0,0.0,62.6,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000009447,MBR00000370,Institutional-IP,2022-02-25,2022-03-02,2022-03-09,PLN8437,1935547131,1935547131,Pulmonology,In-Network,I10,I10,,,,196,MS-DRG,21,5,Y,70450,Radiology,,,0510,21,Inpatient Hospital,2,1492.62,1162.42,1021.86,140.56,0.0,0.0,140.56,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009448,MBR00000370,Institutional-IP,2023-04-14,2023-04-15,2023-05-27,PLN5044,1518055405,1518055405,Urology,In-Network,Z00.00,E78.5,,,,603,MS-DRG,22,1,Y,99214,E&M,,,0270,21,Inpatient Hospital,2,286.84,206.8,206.8,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009449,MBR00000370,Professional,2022-08-12,2022-08-12,2022-09-06,PLN2623,1125190055,1125190055,Nephrology,In-Network,F32.9,I10,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,1,2333.07,1041.53,852.07,0.0,35.0,154.46,189.46,0.0,Adjusted,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000009450,MBR00000370,Institutional-OP,2021-08-08,2021-08-08,2021-09-13,PLN7781,1749494482,1749494482,Pediatrics,In-Network,Z23,G43.909,,,,,,,0,,99204,E&M,,,0636,22,Outpatient Hospital,2,213.63,72.56,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009451,MBR00000370,Institutional-OP,2021-12-17,2021-12-17,2021-12-27,PLN7306,1749327647,1749327647,Geriatrics,In-Network,E11.9,Z12.31,,,,,,,0,,99204,E&M,,,0761,22,Outpatient Hospital,3,394.25,221.83,221.83,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009452,MBR00000370,Professional,2023-01-04,2023-01-04,2023-02-06,PLN4226,1812060197,1812060197,Oncology,Out-of-Network,G43.909,G20,,,,,,,0,,99284,E&M,,,,23,Emergency Room,2,849.92,580.2,523.19,0.0,0.0,57.01,57.01,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009453,MBR00000370,Professional,2022-06-09,2022-06-09,2022-06-28,PLN1728,1935547131,1935547131,Pulmonology,In-Network,J20.9,S72.001A,,,,,,,0,,45380,Surgery,,,,11,Office,2,3005.65,1531.58,1531.58,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000009454,MBR00000370,Institutional-OP,2022-05-19,2022-05-19,2022-06-04,PLN7128,1118885473,1118885473,ASC,In-Network,N39.0,Z12.11,,,,,,,0,,87491,Pathology/Lab,,,0120,22,Outpatient Hospital,2,237.37,201.06,0.0,201.06,0.0,0.0,201.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009455,MBR00000370,Professional,2023-08-06,2023-08-06,2023-09-12,PLN1038,1990090423,1990090423,Orthopedic Surgery,In-Network,J06.9,Z00.00,,,,,,,0,,77067,Radiology,,,,11,Office,1,309.13,193.68,0.0,0.0,0.0,0.0,0.0,0.0,Denied,PR-1,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000009456,MBR00000370,Professional,2023-06-16,2023-06-16,2023-07-09,PLN3324,1644128543,1644128543,Gastroenterology,In-Network,N40.0,E66.9,,,,,,,0,,93000,Radiology,,,,21,Inpatient Hospital,2,151.55,123.79,0.0,0.0,50.0,7.34,57.34,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009457,MBR00000370,Institutional-OP,2021-09-25,2021-09-25,2021-11-08,PLN6187,1372918899,1372918899,Family Medicine,In-Network,I10,Z23,,,,,,,0,,99214,E&M,,,0450,22,Outpatient Hospital,2,348.1,275.54,275.54,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009458,MBR00000370,Professional,2023-02-11,2023-02-11,2023-03-08,PLN7278,1139906830,1139906830,Endocrinology,Out-of-Network,E78.5,I10,,,,,,,0,,99233,E&M,,,,20,Urgent Care,3,200.93,118.38,118.38,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009459,MBR00000370,Institutional-OP,2023-05-17,2023-05-17,2023-06-16,PLN8502,1585582070,1585582070,Outpatient Clinic,In-Network,M54.5,J18.9,,,,,,,0,,47562,Surgery,,,0636,22,Outpatient Hospital,3,3556.87,2835.86,2835.86,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009460,MBR00000370,Professional,2023-09-13,2023-09-13,2023-10-12,PLN6903,1227362142,1227362142,DME Supplier,In-Network,M81.0,I10,,,,,,,0,,97530,Medicine,,,,11,Office,1,120.48,68.72,0.0,68.72,50.0,0.0,118.72,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000009461,MBR00000370,Professional,2021-10-17,2021-10-17,2021-11-24,PLN3871,1964402759,1964402759,Outpatient Clinic,In-Network,I10,I63.9,,,,,,,0,,70553,Radiology,,,,22,Outpatient Hospital,3,3280.72,2424.77,2202.37,0.0,0.0,222.4,222.4,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009462,MBR00000370,Professional,2023-03-09,2023-03-09,2023-04-02,PLN2052,1899127912,1899127912,Neurology,In-Network,N20.0,I63.9,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,1,368.4,218.27,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009463,MBR00000370,Professional,2021-07-24,2021-07-24,2021-08-29,PLN1349,1910255109,1910255109,DME Supplier,In-Network,I10,J20.9,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,2,524.23,395.69,306.73,0.0,50.0,38.96,88.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009464,MBR00000370,Institutional-OP,2022-05-02,2022-05-02,2022-05-14,PLN8956,1622771872,1622771872,Pediatrics,In-Network,E78.5,E78.5,,,,,,,0,,99283,E&M,,,0301,22,Outpatient Hospital,1,266.07,182.71,167.71,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009465,MBR00000370,Institutional-IP,2021-03-21,2021-03-24,2021-04-03,PLN6896,1193493783,1193493783,Critical Access Hospital,Out-of-Network,N18.3,K57.30,,,,194,MS-DRG,24,3,Y,99221,E&M,,,0320,21,Inpatient Hospital,2,308.07,152.12,146.93,0.0,0.0,5.19,5.19,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000009466,MBR00000370,Institutional-OP,2022-10-24,2022-10-24,2022-11-24,PLN2295,1809014947,1809014947,Urology,In-Network,E78.5,Z87.891,,,,,,,0,,70553,Radiology,,,0730,22,Outpatient Hospital,2,2838.28,1335.42,986.64,348.78,0.0,0.0,348.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009467,MBR00000370,Professional,2023-01-20,2023-01-20,2023-02-13,PLN2158,1366286000,1366286000,SNF,In-Network,I63.9,Z00.00,,,,,,,0,,99233,E&M,,,,11,Office,2,393.85,285.69,285.69,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000009468,MBR00000370,Institutional-OP,2022-05-05,2022-05-05,2022-06-01,PLN7222,1213165847,1213165847,Critical Access Hospital,In-Network,K21.0,E78.5,,,,,,,0,,99232,E&M,,,0450,22,Outpatient Hospital,1,360.17,298.86,298.86,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009469,MBR00000370,Institutional-OP,2022-03-27,2022-03-27,2022-04-29,PLN2580,1749327647,1749327647,Geriatrics,In-Network,M17.11,E78.5,,,,,,,0,,77067,Radiology,,,0370,22,Outpatient Hospital,1,843.91,434.09,434.09,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000009470,MBR00000370,Professional,2021-09-23,2021-09-23,2021-11-02,PLN6296,1799205295,1799205295,General Acute Care Hospital,In-Network,E87.6,Z51.11,,,,,,,0,,99284,E&M,,,,11,Office,1,350.42,270.0,0.0,270.0,50.0,0.0,320.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009471,MBR00000370,Professional,2023-04-24,2023-04-24,2023-06-05,PLN6128,1366426662,1366426662,Urology,In-Network,I10,N17.9,,,,,,,0,,99283,E&M,,,,31,Skilled Nursing Facility,1,337.72,208.34,193.34,0.0,15.0,0.0,15.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009472,MBR00000370,Professional,2023-09-24,2023-09-24,2023-10-26,PLN6025,1974006077,1974006077,Orthopedic Surgery,In-Network,E78.5,N39.0,,,,,,,0,,97110,Medicine,,,,11,Office,3,282.37,224.06,49.9,174.16,0.0,0.0,174.16,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009473,MBR00000370,Professional,2021-05-26,2021-05-26,2021-06-20,PLN4927,1530904931,1530904931,Internal Medicine,In-Network,E78.5,I10,,,,,,,0,,80061,Pathology/Lab,,,,22,Outpatient Hospital,2,100.73,82.39,82.39,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009474,MBR00000370,Institutional-OP,2021-10-30,2021-10-30,2021-11-11,PLN3650,1872613201,1872613201,Internal Medicine,In-Network,J18.9,N18.3,,,,,,,0,,80061,Pathology/Lab,,,0761,22,Outpatient Hospital,2,107.93,80.38,80.38,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009475,MBR00000370,Institutional-OP,2022-10-23,2022-10-23,2022-11-11,PLN2394,1193493783,1193493783,Critical Access Hospital,Out-of-Network,E66.9,F41.9,,,,,,,0,,99221,E&M,,,0270,22,Outpatient Hospital,2,280.82,103.41,78.41,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009476,MBR00000370,Professional,2022-02-05,2022-02-05,2022-02-18,PLN5967,1205377316,1205377316,Orthopedic Surgery,In-Network,E78.5,E78.5,,,,,,,0,,90686,Medicine,,,,22,Outpatient Hospital,1,62.21,36.02,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-119,,0,,0,1,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000009477,MBR00000370,Professional,2021-01-15,2021-01-15,2021-01-27,PLN2340,1502838586,1502838586,ASC,In-Network,I10,E11.40,,,,,,,0,,27130,Surgery,,,,21,Inpatient Hospital,3,4372.47,3549.97,3076.82,448.15,25.0,0.0,473.15,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009478,MBR00000370,Professional,2021-01-23,2021-01-23,2021-03-02,PLN5627,1242201429,1242201429,General Acute Care Hospital,In-Network,N40.0,J45.20,,,,,,,0,,99222,E&M,,,,11,Office,3,251.11,154.92,124.42,30.5,0.0,0.0,30.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009479,MBR00000370,Institutional-OP,2021-09-14,2021-09-14,2021-09-23,PLN2330,1542828721,1542828721,Orthopedic Surgery,In-Network,I48.91,E78.5,,,,,,,0,,27130,Surgery,,,0740,22,Outpatient Hospital,1,3172.31,1126.83,0.0,302.16,25.0,82.14,409.3,0.0,Denied,CO-119,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009480,MBR00000370,Institutional-IP,2023-11-26,2023-12-07,2023-12-16,PLN3046,1780163051,1780163051,SNF,In-Network,Z23,R10.9,,,,195,MS-DRG,1,11,Y,99221,E&M,,,0120,21,Inpatient Hospital,1,323.29,205.99,0.0,205.99,50.0,0.0,255.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009481,MBR00000370,Institutional-IP,2022-10-30,2022-11-03,2022-11-29,PLN9314,1624802371,1624802371,ASC,Out-of-Network,I10,E11.9,,,,196,MS-DRG,6,4,Y,27447,Surgery,,,0450,21,Inpatient Hospital,2,4182.86,3393.79,3040.66,0.0,0.0,353.13,353.13,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009482,MBR00000370,Institutional-IP,2021-10-07,2021-10-08,2021-11-07,PLN1901,1273488618,1273488618,General Acute Care Hospital,In-Network,I10,I10,,,,470,MS-DRG,14,1,Y,99213,E&M,,,0370,21,Inpatient Hospital,3,192.72,107.92,0.0,107.92,25.0,0.0,132.92,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009483,MBR00000370,Institutional-OP,2021-03-03,2021-03-03,2021-03-14,PLN9276,1716521444,1716521444,Oncology,In-Network,Z12.31,K21.0,,,,,,,0,,99233,E&M,,,0636,22,Outpatient Hospital,2,430.08,331.52,87.74,168.78,75.0,0.0,243.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009484,MBR00000370,Professional,2023-04-09,2023-04-09,2023-05-04,PLN3792,1486164553,1486164553,DME Supplier,In-Network,Z23,F32.9,,,,,,,0,,99203,E&M,,,,11,Office,3,299.18,92.85,57.85,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009485,MBR00000370,Professional,2022-02-18,2022-02-18,2022-03-30,PLN5016,1284035364,1284035364,Pediatrics,In-Network,Z87.891,J18.9,,,,,,,0,,99233,E&M,,,,81,Independent Laboratory,2,464.49,299.75,299.75,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000009486,MBR00000370,Institutional-IP,2022-03-08,2022-03-17,2022-03-19,PLN3917,1896447406,1896447406,Nephrology,Out-of-Network,Z23,I10,,,,291,MS-DRG,13,9,Y,45378,Surgery,,,0120,21,Inpatient Hospital,2,1543.58,1295.65,1041.94,158.47,50.0,45.24,253.71,0.0,Paid,,,0,,0,1,1,0,1,0,None,0,1,0,0,0
CLM0000009487,MBR00000370,Institutional-OP,2022-09-08,2022-09-08,2022-09-29,PLN1403,1118885473,1118885473,ASC,In-Network,E66.9,F41.9,,,,,,,0,,97110,Medicine,,,0730,22,Outpatient Hospital,1,239.63,89.55,89.55,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009488,MBR00000370,Institutional-OP,2021-09-08,2021-09-08,2021-09-19,PLN7579,1691062876,1691062876,SNF,In-Network,J06.9,M17.11,,,,,,,0,,99284,E&M,,,0200,22,Outpatient Hospital,2,808.04,475.99,475.99,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009489,MBR00000371,Institutional-OP,2023-03-08,2023-03-08,2023-04-08,PLN6653,1239316214,1239316214,Internal Medicine,In-Network,Z87.891,F32.9,,,,,,,0,,80053,Pathology/Lab,,,0301,22,Outpatient Hospital,3,152.03,54.01,54.01,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009490,MBR00000371,Institutional-OP,2021-12-10,2021-12-10,2022-01-19,PLN8716,1767011137,1767011137,DME Supplier,In-Network,E11.9,Z23,,,,,,,0,,87491,Pathology/Lab,,,0320,22,Outpatient Hospital,1,108.44,57.34,0.0,57.34,0.0,0.0,57.34,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009491,MBR00000371,Professional,2023-02-12,2023-02-12,2023-02-27,PLN8600,1856686341,1856686341,Geriatrics,In-Network,I10,F32.9,,,,,,,0,,93306,Radiology,,,,11,Office,3,2735.64,1927.82,1927.82,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009492,MBR00000371,Institutional-IP,2022-07-21,2022-07-22,2022-07-29,PLN4228,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,E11.9,I25.10,,,,641,MS-DRG,24,1,Y,47562,Surgery,,,0120,21,Inpatient Hospital,1,2803.5,2172.46,2172.46,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009493,MBR00000371,Institutional-OP,2021-06-12,2021-06-12,2021-07-07,PLN7396,1239316214,1239316214,Internal Medicine,In-Network,J44.1,N39.0,,,,,,,0,,58661,Surgery,,,0370,22,Outpatient Hospital,2,2991.88,2333.7,2157.2,0.0,0.0,176.5,176.5,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009494,MBR00000371,Professional,2022-11-14,2022-11-14,2022-12-15,PLN8785,1475984649,1475984649,SNF,In-Network,K21.0,J20.9,,,,,,,0,,90460,Medicine,,,,31,Skilled Nursing Facility,2,49.52,36.23,0.0,36.23,0.0,0.0,36.23,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009495,MBR00000371,Institutional-IP,2021-03-24,2021-03-28,2021-04-06,PLN6861,1213165847,1213165847,Critical Access Hospital,In-Network,N18.3,E78.5,,,,603,MS-DRG,21,4,Y,97530,Medicine,,,0510,21,Inpatient Hospital,1,121.34,93.63,93.63,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009496,MBR00000371,Professional,2023-02-22,2023-02-22,2023-03-04,PLN9504,1463205530,1463205530,Nephrology,In-Network,E78.5,J06.9,,,,,,,0,,85025,Pathology/Lab,,,,12,Home,2,61.55,34.24,0.0,34.24,50.0,0.0,84.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009497,MBR00000371,Institutional-OP,2022-02-17,2022-02-17,2022-03-14,PLN8206,1624802371,1624802371,ASC,Out-of-Network,J20.9,Z12.31,,,,,,,0,,90686,Medicine,,,0450,22,Outpatient Hospital,3,76.53,56.42,21.42,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000009498,MBR00000371,Professional,2023-01-05,2023-01-05,2023-02-18,PLN9843,1609138981,1609138981,Critical Access Hospital,In-Network,R10.9,Z00.00,,,,,,,0,,85610,Pathology/Lab,,,,22,Outpatient Hospital,1,42.55,31.27,16.27,0.0,15.0,0.0,15.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009499,MBR00000371,Professional,2021-09-21,2021-09-21,2021-10-24,PLN2694,1520687146,1520687146,ASC,In-Network,Z12.31,N39.0,,,,,,,0,,87491,Pathology/Lab,,,,21,Inpatient Hospital,3,185.34,114.97,79.97,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009500,MBR00000371,Institutional-IP,2022-03-22,2022-03-26,2022-04-22,PLN2903,1366426662,1366426662,Urology,In-Network,Z12.31,Z51.11,,,,641,MS-DRG,22,4,N,99204,E&M,,,0370,21,Inpatient Hospital,1,468.52,147.23,38.24,93.99,15.0,0.0,108.99,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000009501,MBR00000371,Institutional-IP,2021-12-01,2021-12-06,2021-12-15,PLN7711,1242201429,1242201429,General Acute Care Hospital,In-Network,F41.9,Z79.4,,,,292,MS-DRG,6,5,U,45380,Surgery,,,0900,21,Inpatient Hospital,3,2865.75,1291.61,1256.61,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000009502,MBR00000371,Professional,2021-10-02,2021-10-02,2021-11-11,PLN9211,1845057593,1845057593,Orthopedic Surgery,In-Network,M81.0,N39.0,,,,,,,0,,99222,E&M,,,,81,Independent Laboratory,2,546.94,313.04,208.44,79.6,25.0,0.0,104.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009503,MBR00000371,Professional,2022-01-11,2022-01-11,2022-01-22,PLN2695,1717546253,1717546253,Family Medicine,In-Network,E87.6,J44.1,,,,,,,0,,82043,Pathology/Lab,,,,23,Emergency Room,3,65.7,44.66,19.66,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009504,MBR00000371,Institutional-OP,2021-02-28,2021-02-28,2021-04-06,PLN5598,1767011137,1767011137,DME Supplier,In-Network,I50.9,I11.9,,,,,,,0,,58661,Surgery,,,0900,22,Outpatient Hospital,3,4124.38,1422.87,1097.72,275.15,50.0,0.0,325.15,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009505,MBR00000371,Institutional-OP,2022-03-11,2022-03-11,2022-04-18,PLN7801,1500037969,1500037969,Pulmonology,In-Network,E11.9,I11.9,,,,,,,0,,80061,Pathology/Lab,,,0900,22,Outpatient Hospital,1,53.75,26.5,11.5,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009506,MBR00000371,Institutional-IP,2021-05-15,2021-05-25,2021-06-15,PLN1261,1530904931,1530904931,Internal Medicine,In-Network,N40.0,J45.20,,,,641,MS-DRG,11,10,Y,27130,Surgery,,,0900,21,Inpatient Hospital,1,4272.35,2073.05,2073.05,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009507,MBR00000371,Professional,2022-07-22,2022-07-22,2022-08-03,PLN4601,1108115157,1108115157,General Acute Care Hospital,In-Network,E11.9,Z00.00,,,,,,,0,,99284,E&M,,,,21,Inpatient Hospital,3,660.19,249.16,180.52,0.0,50.0,18.64,68.64,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000009508,MBR00000371,Institutional-OP,2021-04-10,2021-04-10,2021-04-22,PLN9540,1757138478,1757138478,Pediatrics,In-Network,Z00.00,J44.1,,,,,,,0,,99406,Medicine,,,0320,22,Outpatient Hospital,3,63.82,34.83,34.83,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009509,MBR00000371,Institutional-IP,2021-01-11,2021-01-23,2021-01-25,PLN1254,1644128543,1644128543,Gastroenterology,In-Network,I10,J18.9,,,,291,MS-DRG,7,12,Y,45380,Surgery,,,0761,21,Inpatient Hospital,3,2758.59,1961.35,0.0,0.0,0.0,178.33,178.33,0.0,Denied,CO-50,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000009510,MBR00000371,Professional,2022-04-26,2022-04-26,2022-06-07,PLN4485,1486164553,1486164553,DME Supplier,In-Network,I11.9,Z12.31,,,,,,,0,,99232,E&M,,,,12,Home,3,276.32,234.22,234.22,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009511,MBR00000371,Professional,2021-11-23,2021-11-23,2022-01-04,PLN1435,1812060197,1812060197,Oncology,Out-of-Network,Z87.891,M54.5,,,,,,,0,,66984,Surgery,,,,65,End-Stage Renal Disease,2,1403.53,1053.65,0.0,0.0,0.0,58.0,58.0,0.0,Denied,PR-1,,0,,0,0,1,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000009512,MBR00000371,Professional,2023-08-19,2023-08-19,2023-09-05,PLN4307,1283743001,1283743001,Family Medicine,In-Network,I10,I10,,,,,,,0,,99222,E&M,,,,11,Office,1,301.66,231.88,0.0,231.88,25.0,0.0,256.88,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009513,MBR00000371,Professional,2021-10-17,2021-10-17,2021-11-08,PLN9013,1622771872,1622771872,Pediatrics,In-Network,Z23,M54.5,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,1,499.98,252.1,167.97,0.0,50.0,34.13,84.13,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009514,MBR00000371,Institutional-IP,2022-03-14,2022-03-19,2022-03-23,PLN4255,1845057593,1845057593,Orthopedic Surgery,In-Network,N17.9,E78.5,,,,603,MS-DRG,11,5,Y,99203,E&M,,,0730,21,Inpatient Hospital,2,367.67,273.35,0.0,273.35,35.0,0.0,308.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009515,MBR00000371,Professional,2021-09-16,2021-09-16,2021-10-14,PLN1840,1550154147,1550154147,Outpatient Clinic,In-Network,Z87.891,I10,,,,,,,0,,97110,Medicine,,,,22,Outpatient Hospital,3,296.83,198.51,28.75,134.76,35.0,0.0,169.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009516,MBR00000371,Professional,2023-09-01,2023-09-01,2023-09-25,PLN2496,1990090423,1990090423,Orthopedic Surgery,In-Network,E11.9,F32.9,,,,,,,0,,80053,Pathology/Lab,,,,22,Outpatient Hospital,3,133.64,64.29,0.0,23.94,0.0,0.0,23.94,0.0,Denied,CO-15,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000009517,MBR00000371,Professional,2023-05-14,2023-05-14,2023-06-26,PLN9152,1910255109,1910255109,DME Supplier,In-Network,E11.40,I10,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,3,53.62,27.78,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009518,MBR00000371,Institutional-IP,2021-07-08,2021-07-09,2021-08-21,PLN9092,1486164553,1486164553,DME Supplier,In-Network,I25.10,R51,,,,194,MS-DRG,6,1,Y,47562,Surgery,,,0450,21,Inpatient Hospital,1,3779.1,2783.23,2783.23,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009519,MBR00000371,Institutional-IP,2021-10-03,2021-10-04,2021-10-11,PLN9928,1219817751,1219817751,OB/GYN,In-Network,N39.0,I10,,,,871,MS-DRG,3,1,W,27447,Surgery,,,0900,21,Inpatient Hospital,1,5015.2,2077.11,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-15,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009520,MBR00000371,Professional,2021-07-24,2021-07-24,2021-09-03,PLN6887,1939033455,1939033455,Pulmonology,In-Network,I25.10,F32.9,,,,,,,0,,99222,E&M,,,,11,Office,3,427.19,301.09,301.09,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009521,MBR00000371,Professional,2021-06-15,2021-06-15,2021-07-05,PLN8953,1910255109,1910255109,DME Supplier,In-Network,I50.9,J06.9,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,2,4196.15,2461.82,2146.2,315.62,0.0,0.0,315.62,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009522,MBR00000371,Professional,2021-09-21,2021-09-21,2021-10-18,PLN6830,1186826716,1186826716,Physical Therapy,In-Network,E11.9,E78.5,,,,,,,0,,71046,Radiology,,,,21,Inpatient Hospital,2,120.06,47.22,47.22,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009523,MBR00000371,Institutional-IP,2023-07-22,2023-08-11,2023-07-29,PLN6901,1355166277,1355166277,Endocrinology,In-Network,Z00.00,M54.5,,,,682,MS-DRG,6,20,Y,80061,Pathology/Lab,,,0301,21,Inpatient Hospital,1,99.43,52.74,52.74,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009524,MBR00000371,Professional,2022-05-18,2022-05-18,2022-06-08,PLN6375,1520687146,1520687146,ASC,In-Network,K21.0,E11.40,,,,,,,0,,G0439,Medicine,,,,50,Federally Qualified Health Center,3,347.44,225.5,0.0,225.5,50.0,0.0,275.5,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000009525,MBR00000371,Professional,2022-02-24,2022-02-24,2022-03-18,PLN4943,1990090423,1990090423,Orthopedic Surgery,In-Network,F41.9,K21.0,,,,,,,0,,80061,Pathology/Lab,,,,22,Outpatient Hospital,2,98.87,58.84,0.0,58.84,0.0,0.0,58.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009526,MBR00000371,Professional,2021-07-28,2021-07-28,2021-09-04,PLN4988,1108115157,1108115157,General Acute Care Hospital,In-Network,F10.20,Z00.00,,,,,,,0,,97110,Medicine,,,,11,Office,2,275.85,83.68,54.79,0.0,25.0,3.89,28.89,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009527,MBR00000371,Professional,2021-07-21,2021-07-21,2021-08-06,PLN5920,1660288235,1660288235,ASC,In-Network,R51,E66.9,,,,,,,0,,97110,Medicine,,,,50,Federally Qualified Health Center,3,225.21,169.17,80.55,73.62,15.0,0.0,88.62,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009528,MBR00000371,Professional,2022-08-31,2022-08-31,2022-09-13,PLN4461,1872613201,1872613201,Internal Medicine,In-Network,N18.3,N39.0,,,,,,,0,,99204,E&M,,,,11,Office,3,408.81,285.98,246.52,0.0,0.0,39.46,39.46,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009529,MBR00000371,Institutional-IP,2023-04-03,2023-04-05,2023-04-15,PLN6341,1453283987,1453283987,Critical Access Hospital,In-Network,I25.10,I10,,,,682,MS-DRG,15,2,Y,99204,E&M,,,0636,21,Inpatient Hospital,2,327.26,151.9,0.0,151.9,0.0,0.0,151.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009530,MBR00000371,Professional,2022-09-03,2022-09-03,2022-10-07,PLN3590,1438368327,1438368327,Home Health,In-Network,J44.1,F41.9,,,,,,,0,,58661,Surgery,,,,11,Office,2,4672.23,2922.0,2398.0,44.06,0.0,479.94,524.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009531,MBR00000371,Institutional-IP,2022-12-21,2022-12-30,2023-02-03,PLN3395,1847081578,1847081578,Urology,Out-of-Network,Z12.31,I10,,,,690,MS-DRG,6,9,U,99213,E&M,,,0320,21,Inpatient Hospital,3,136.67,90.32,51.96,0.0,35.0,3.36,38.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009532,MBR00000371,Professional,2021-10-14,2021-10-14,2021-11-09,PLN5620,1899127912,1899127912,Neurology,In-Network,M54.5,J20.9,,,,,,,0,,85610,Pathology/Lab,,,,20,Urgent Care,3,36.03,15.07,0.0,15.07,75.0,0.0,90.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009533,MBR00000371,Institutional-OP,2023-11-02,2023-11-02,2023-12-08,PLN9248,1530904931,1530904931,Internal Medicine,In-Network,K21.0,M54.5,,,,,,,0,,45380,Surgery,,,0636,22,Outpatient Hospital,3,2931.77,1778.34,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-4,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000009534,MBR00000371,Professional,2023-06-20,2023-06-20,2023-07-16,PLN5770,1812060197,1812060197,Oncology,Out-of-Network,N39.0,Z12.31,,,,,,,0,,99213,E&M,,,,12,Home,3,276.96,101.36,101.36,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009535,MBR00000371,Institutional-IP,2023-08-20,2023-08-29,2023-09-04,PLN1261,1660288235,1660288235,ASC,In-Network,Z79.4,K21.0,,,,195,MS-DRG,19,9,Y,47562,Surgery,,,0370,21,Inpatient Hospital,1,2300.38,1495.09,1495.09,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000009536,MBR00000371,Professional,2023-01-02,2023-01-02,2023-02-04,PLN9981,1502838586,1502838586,ASC,In-Network,I10,E11.9,,,,,,,0,,72148,Radiology,,,,23,Emergency Room,3,1846.84,1431.28,1059.42,371.86,0.0,0.0,371.86,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009537,MBR00000371,Professional,2023-01-31,2023-01-31,2023-02-15,PLN5592,1799205295,1799205295,General Acute Care Hospital,In-Network,J44.1,C50.912,,,,,,,0,,47562,Surgery,,,,11,Office,1,5693.37,1983.69,1511.48,118.84,0.0,353.37,472.21,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009538,MBR00000371,Institutional-OP,2021-03-19,2021-03-19,2021-04-18,PLN2822,1915531927,1915531927,Critical Access Hospital,In-Network,E66.9,R05,,,,,,,0,,43239,Surgery,,,0761,22,Outpatient Hospital,1,2223.91,1813.4,1798.4,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009539,MBR00000372,Professional,2021-06-26,2021-06-26,2021-08-02,PLN5339,1520687146,1520687146,ASC,In-Network,K21.0,E11.9,,,,,,,0,,27130,Surgery,,,,20,Urgent Care,2,6361.88,2475.3,2400.3,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009540,MBR00000372,Professional,2021-05-26,2021-05-26,2021-06-07,PLN6439,1219817751,1219817751,OB/GYN,In-Network,Z12.31,Z23,,,,,,,0,,99203,E&M,,,,11,Office,3,241.22,134.55,7.17,92.38,35.0,0.0,127.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009541,MBR00000372,Professional,2022-06-14,2022-06-14,2022-07-07,PLN5556,1752470395,1752470395,Home Health,In-Network,K21.0,Z00.00,,,,,,,0,,47562,Surgery,,,,11,Office,2,5898.22,2803.91,2803.91,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009542,MBR00000372,Institutional-OP,2022-10-06,2022-10-06,2022-11-18,PLN9088,1235381502,1235381502,Cardiology,In-Network,S72.001A,F41.9,,,,,,,0,,85025,Pathology/Lab,,,0761,22,Outpatient Hospital,2,87.94,33.41,30.37,0.0,0.0,3.04,3.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009543,MBR00000372,Institutional-OP,2021-05-11,2021-05-11,2021-05-18,PLN3222,1790497490,1790497490,OB/GYN,In-Network,I10,E66.9,,,,,,,0,,G0468,Medicine,,,0900,22,Outpatient Hospital,1,370.88,188.09,172.17,9.66,0.0,6.26,15.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009544,MBR00000372,Institutional-OP,2023-04-03,2023-04-03,2023-05-13,PLN8700,1124394415,1124394415,Pediatrics,In-Network,N18.3,I10,,,,,,,0,,99221,E&M,,,0301,22,Outpatient Hospital,3,433.93,220.47,166.98,0.0,50.0,3.49,53.49,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009545,MBR00000372,Professional,2022-08-25,2022-08-25,2022-09-21,PLN8502,1609526529,1609526529,Psychiatry,In-Network,F41.9,I10,,,,,,,0,,90460,Medicine,,,,11,Office,1,44.75,37.34,0.0,37.34,25.0,0.0,62.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009546,MBR00000372,Professional,2022-10-15,2022-10-15,2022-11-20,PLN6236,1563980627,1563980627,Critical Access Hospital,In-Network,E11.9,J18.9,,,,,,,0,,23472,Surgery,,,,11,Office,1,3907.46,2403.9,0.0,0.0,0.0,464.39,464.39,0.0,Denied,CO-11,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009547,MBR00000372,Institutional-OP,2023-10-01,2023-10-01,2023-11-13,PLN9622,1511044648,1511044648,Endocrinology,In-Network,E78.5,J44.1,,,,,,,0,,85025,Pathology/Lab,,,0740,22,Outpatient Hospital,2,93.96,43.39,17.28,0.0,25.0,1.11,26.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009548,MBR00000372,Professional,2022-10-03,2022-10-03,2022-10-22,PLN3849,1809014947,1809014947,Urology,In-Network,E78.5,E11.9,,,,,,,0,,93306,Radiology,,,,22,Outpatient Hospital,1,2663.89,933.15,883.15,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009549,MBR00000372,Professional,2021-01-05,2021-01-05,2021-01-25,PLN7318,1845900543,1845900543,ASC,In-Network,J20.9,I10,,,,,,,0,,83036,Pathology/Lab,,,,81,Independent Laboratory,2,110.3,76.78,0.0,76.78,0.0,0.0,76.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000009550,MBR00000372,Institutional-OP,2023-04-22,2023-04-22,2023-05-04,PLN5819,1514306773,1514306773,Endocrinology,In-Network,J18.9,Z12.31,,,,,,,0,,99284,E&M,,,0320,22,Outpatient Hospital,2,589.48,484.69,439.48,0.0,25.0,20.21,45.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009551,MBR00000373,Professional,2023-08-18,2023-08-18,2023-09-09,PLN6346,1645194539,1645194539,SNF,In-Network,Z12.31,Z00.00,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,3,343.69,110.81,92.25,0.0,0.0,18.56,18.56,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009552,MBR00000373,Institutional-OP,2021-04-02,2021-04-02,2021-04-18,PLN4616,1337791138,1337791138,Internal Medicine,Out-of-Network,E11.9,E78.5,,,,,,,0,,99204,E&M,,,0200,22,Outpatient Hospital,3,584.61,489.9,0.0,0.0,50.0,21.84,71.84,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009553,MBR00000373,Institutional-OP,2022-08-14,2022-08-14,2022-09-11,PLN6171,1745114564,1745114564,Endocrinology,In-Network,K21.0,I10,,,,,,,0,,99203,E&M,,,0200,22,Outpatient Hospital,1,317.0,104.8,104.8,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009554,MBR00000373,Institutional-OP,2022-05-30,2022-05-30,2022-06-23,PLN8591,1364429278,1364429278,OB/GYN,In-Network,I10,Z23,,,,,,,0,,76700,Radiology,,,0270,22,Outpatient Hospital,2,1349.63,745.06,691.71,53.35,0.0,0.0,53.35,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009555,MBR00000373,Institutional-IP,2021-06-15,2021-06-22,2021-07-22,PLN4489,1410468316,1410468316,SNF,In-Network,K21.0,I63.9,,,,292,MS-DRG,15,7,Y,45378,Surgery,,,0636,21,Inpatient Hospital,3,2487.51,1790.48,1470.55,319.93,0.0,0.0,319.93,0.0,Pended,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000009556,MBR00000373,Professional,2021-10-30,2021-10-30,2021-12-03,PLN8909,1806688928,1806688928,Geriatrics,In-Network,K21.0,Z00.00,,,,,,,0,,76700,Radiology,,,,22,Outpatient Hospital,1,1078.83,905.47,830.47,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009557,MBR00000373,Institutional-IP,2023-07-27,2023-08-08,2023-08-31,PLN8997,1434029575,1434029575,Endocrinology,In-Network,J06.9,M81.0,,,,641,MS-DRG,1,12,Y,97530,Medicine,,,0730,21,Inpatient Hospital,2,311.78,107.89,107.89,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009558,MBR00000373,Institutional-OP,2022-03-05,2022-03-05,2022-04-06,PLN9935,1236418230,1236418230,DME Supplier,In-Network,N20.0,M54.5,,,,,,,0,,99233,E&M,,,0636,22,Outpatient Hospital,2,504.43,389.24,358.52,0.0,0.0,30.72,30.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009559,MBR00000373,Institutional-OP,2022-08-11,2022-08-11,2022-08-23,PLN1460,1974006077,1974006077,Orthopedic Surgery,In-Network,F41.9,E78.5,,,,,,,0,,99233,E&M,,,0301,22,Outpatient Hospital,3,312.31,155.63,0.0,155.63,0.0,0.0,155.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009560,MBR00000373,Institutional-OP,2023-05-01,2023-05-01,2023-05-21,PLN2731,1511044648,1511044648,Endocrinology,In-Network,Z12.11,I11.9,,,,,,,0,,99283,E&M,,,0360,22,Outpatient Hospital,1,455.36,358.28,283.28,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009561,MBR00000373,Institutional-OP,2022-05-06,2022-05-06,2022-06-17,PLN8470,1422747896,1422747896,Urology,In-Network,I10,J20.9,,,,,,,0,,85025,Pathology/Lab,,,0370,22,Outpatient Hospital,1,65.89,55.42,0.0,55.42,0.0,0.0,55.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009562,MBR00000374,Institutional-IP,2023-09-03,2023-09-09,2023-09-20,PLN9893,1118885473,1118885473,ASC,In-Network,R10.9,Z00.00,,,,682,MS-DRG,12,6,Y,99222,E&M,,,0270,21,Inpatient Hospital,2,391.89,215.79,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009563,MBR00000374,Institutional-OP,2022-07-02,2022-07-02,2022-07-25,PLN5971,1780163051,1780163051,SNF,In-Network,J20.9,Z79.4,,,,,,,0,,43239,Surgery,,,0270,22,Outpatient Hospital,3,1570.24,1277.21,1030.96,0.0,25.0,221.25,246.25,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009564,MBR00000374,Professional,2023-12-16,2023-12-16,2024-01-22,PLN2620,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,N20.0,N39.0,,,,,,,0,,27447,Surgery,,,,23,Emergency Room,2,5464.95,3163.22,3088.22,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009565,MBR00000374,Institutional-OP,2021-06-11,2021-06-11,2021-07-06,PLN7059,1997536841,1997536841,Family Medicine,Out-of-Network,I25.10,I48.91,,,,,,,0,,99232,E&M,,,0200,22,Outpatient Hospital,3,296.55,148.11,123.11,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009566,MBR00000374,Institutional-OP,2023-08-31,2023-08-31,2023-09-23,PLN1588,1845900543,1845900543,ASC,In-Network,R10.9,I10,,,,,,,0,,90686,Medicine,,,0761,22,Outpatient Hospital,3,138.3,70.72,0.0,70.72,25.0,0.0,95.72,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000009567,MBR00000374,Professional,2021-05-04,2021-05-04,2021-06-12,PLN2866,1422747896,1422747896,Urology,In-Network,J06.9,E11.9,,,,,,,0,,90460,Medicine,,,,11,Office,2,56.66,22.02,0.0,22.02,0.0,0.0,22.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009568,MBR00000374,Institutional-IP,2023-06-10,2023-06-12,2023-07-09,PLN8594,1244186984,1244186984,Family Medicine,Out-of-Network,J44.1,R07.9,,,,871,MS-DRG,15,2,Y,87491,Pathology/Lab,,,0900,21,Inpatient Hospital,1,158.54,104.12,27.34,0.0,75.0,1.78,76.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009569,MBR00000374,Professional,2022-12-26,2022-12-26,2023-01-21,PLN5245,1434029575,1434029575,Endocrinology,In-Network,Z00.00,E78.5,,,,,,,0,,45380,Surgery,,,,65,End-Stage Renal Disease,3,2610.19,1384.06,915.91,468.15,0.0,0.0,468.15,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000009570,MBR00000374,Institutional-OP,2022-09-05,2022-09-05,2022-09-30,PLN1845,1389336600,1389336600,Critical Access Hospital,In-Network,I25.10,F32.9,,,,,,,0,,93306,Radiology,,,0200,22,Outpatient Hospital,3,1603.76,939.38,864.38,0.0,75.0,0.0,75.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009571,MBR00000374,Professional,2023-08-23,2023-08-23,2023-09-10,PLN7724,1545347862,1545347862,SNF,In-Network,M54.5,K21.0,,,,,,,0,,99203,E&M,,,,23,Emergency Room,3,282.91,237.47,0.0,237.47,0.0,0.0,237.47,0.0,Denied,CO-18,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009572,MBR00000374,Professional,2022-12-03,2022-12-03,2022-12-19,PLN2887,1561134315,1561134315,DME Supplier,In-Network,E66.9,N39.0,,,,,,,0,,87491,Pathology/Lab,,,,23,Emergency Room,3,232.1,143.43,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-29,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009573,MBR00000374,Professional,2023-01-31,2023-01-31,2023-02-11,PLN4138,1528335731,1528335731,Critical Access Hospital,In-Network,F32.9,J18.9,,,,,,,0,,99233,E&M,,,,31,Skilled Nursing Facility,1,536.55,271.72,83.57,113.15,75.0,0.0,188.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009574,MBR00000374,Professional,2023-04-06,2023-04-06,2023-04-25,PLN1598,1334916761,1334916761,ASC,In-Network,F32.9,E11.9,,,,,,,0,,93000,Radiology,,,,81,Independent Laboratory,3,88.91,53.38,0.0,53.38,75.0,0.0,128.38,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009575,MBR00000374,Institutional-OP,2023-07-10,2023-07-10,2023-08-10,PLN5713,1244186984,1244186984,Family Medicine,Out-of-Network,E11.40,R51,,,,,,,0,,99214,E&M,,,0301,22,Outpatient Hospital,1,435.94,294.55,272.6,0.0,15.0,6.95,21.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009576,MBR00000374,Professional,2021-09-12,2021-09-12,2021-10-24,PLN3703,1757138478,1757138478,Pediatrics,In-Network,K57.30,Z00.00,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,2,47.44,32.07,0.0,0.0,35.0,0.0,35.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009577,MBR00000374,Professional,2023-07-15,2023-07-15,2023-08-25,PLN1644,1968299309,1968299309,Internal Medicine,In-Network,R10.9,F32.9,,,,,,,0,,27447,Surgery,,,,23,Emergency Room,1,2990.97,1404.75,943.45,461.3,0.0,0.0,461.3,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009578,MBR00000374,Institutional-OP,2022-10-07,2022-10-07,2022-10-28,PLN5838,1242201429,1242201429,General Acute Care Hospital,In-Network,I10,J45.20,,,,,,,0,,99284,E&M,,,0510,22,Outpatient Hospital,1,325.83,145.12,0.0,145.12,0.0,0.0,145.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009579,MBR00000375,Professional,2021-02-05,2021-02-05,2021-02-14,PLN2241,1564502315,1564502315,ASC,In-Network,E87.6,K21.0,,,,,,,0,,99232,E&M,,,,49,Independent Clinic,1,235.43,148.92,113.92,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009580,MBR00000375,Professional,2023-10-03,2023-10-03,2023-11-08,PLN1456,1691062876,1691062876,SNF,In-Network,E78.5,F41.9,,,,,,,0,,99232,E&M,,,,12,Home,2,251.08,192.37,192.37,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009581,MBR00000375,Professional,2023-04-25,2023-04-25,2023-05-26,PLN5560,1366576336,1366576336,Geriatrics,In-Network,S72.001A,Z00.01,,,,,,,0,,93225,Medicine,,,,23,Emergency Room,2,507.86,177.52,177.52,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009582,MBR00000375,Institutional-OP,2023-09-04,2023-09-04,2023-10-03,PLN9413,1717546253,1717546253,Family Medicine,In-Network,F32.9,Z12.31,,,,,,,0,,99214,E&M,,,0370,22,Outpatient Hospital,3,163.53,83.26,83.26,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009583,MBR00000375,Institutional-OP,2023-04-26,2023-04-26,2023-05-31,PLN4423,1205377316,1205377316,Orthopedic Surgery,In-Network,K21.0,E78.5,,,,,,,0,,23472,Surgery,,,0270,22,Outpatient Hospital,3,4963.07,2247.06,1878.08,0.0,35.0,333.98,368.98,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009584,MBR00000375,Institutional-IP,2022-01-14,2022-01-15,2022-02-23,PLN3531,1463205530,1463205530,Nephrology,In-Network,E11.9,R05,,,,683,MS-DRG,13,1,U,99221,E&M,,,0761,21,Inpatient Hospital,3,434.06,275.38,179.38,96.0,0.0,0.0,96.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009585,MBR00000375,Professional,2022-01-19,2022-01-19,2022-02-28,PLN3805,1948810580,1948810580,DME Supplier,In-Network,I10,M17.11,,,,,,,0,,72148,Radiology,,,,21,Inpatient Hospital,3,2862.95,2097.27,2082.27,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009586,MBR00000375,Professional,2021-10-30,2021-10-30,2021-11-10,PLN8410,1624202402,1624202402,Orthopedic Surgery,In-Network,J20.9,M54.5,,,,,,,0,,87491,Pathology/Lab,,,,22,Outpatient Hospital,3,174.44,115.39,100.39,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009587,MBR00000376,Institutional-IP,2022-03-25,2022-04-07,2022-05-03,PLN5352,1245650222,1245650222,Gastroenterology,In-Network,I10,E11.40,,,,871,MS-DRG,2,13,N,90460,Medicine,,,0450,21,Inpatient Hospital,3,72.08,30.15,0.0,30.15,0.0,0.0,30.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009588,MBR00000376,Professional,2021-02-08,2021-02-08,2021-02-18,PLN8601,1531398223,1531398223,OB/GYN,In-Network,J44.1,N40.0,,,,,,,0,,58661,Surgery,,,,11,Office,3,1974.13,1277.5,1262.5,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009589,MBR00000376,Professional,2023-03-28,2023-03-28,2023-05-03,PLN7257,1687650653,1687650653,Internal Medicine,In-Network,Z00.00,E11.40,,,,,,,0,,45378,Surgery,,,,31,Skilled Nursing Facility,1,2363.88,1706.1,1706.1,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000009590,MBR00000376,Professional,2023-04-04,2023-04-04,2023-04-27,PLN4634,1891849440,1891849440,Oncology,In-Network,E11.9,I25.10,,,,,,,0,,99203,E&M,,,,11,Office,3,285.66,143.58,143.58,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009591,MBR00000376,Institutional-OP,2023-12-17,2023-12-17,2024-01-14,PLN4021,1727809972,1727809972,Home Health,In-Network,Z23,Z00.00,,,,,,,0,,82043,Pathology/Lab,,,0120,22,Outpatient Hospital,3,29.92,18.01,18.01,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009592,MBR00000376,Institutional-IP,2022-08-26,2022-08-27,2022-09-10,PLN6172,1540044947,1540044947,Pulmonology,Out-of-Network,I10,I11.9,,,,872,MS-DRG,19,1,Y,90460,Medicine,,,0636,21,Inpatient Hospital,2,29.65,11.01,9.75,0.0,0.0,1.26,1.26,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009593,MBR00000376,Professional,2023-12-18,2023-12-18,2023-12-26,PLN4318,1283743001,1283743001,Family Medicine,In-Network,I10,E66.9,,,,,,,0,,45380,Surgery,,,,11,Office,1,1121.24,532.18,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-11,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000009594,MBR00000376,Institutional-OP,2021-08-18,2021-08-18,2021-09-01,PLN2283,1569105090,1569105090,Geriatrics,In-Network,C50.912,N39.0,,,,,,,0,,87491,Pathology/Lab,,,0360,22,Outpatient Hospital,2,146.17,96.5,0.0,96.5,25.0,0.0,121.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009595,MBR00000376,Professional,2022-06-03,2022-06-03,2022-06-11,PLN7332,1660288235,1660288235,ASC,In-Network,E78.5,I10,,,,,,,0,,87491,Pathology/Lab,,,,49,Independent Clinic,2,183.53,111.53,0.0,111.53,0.0,0.0,111.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009596,MBR00000376,Institutional-OP,2023-05-07,2023-05-07,2023-06-11,PLN5312,1511044648,1511044648,Endocrinology,In-Network,E11.9,E87.6,,,,,,,0,,84443,Pathology/Lab,,,0730,22,Outpatient Hospital,1,155.5,131.07,0.0,131.07,0.0,0.0,131.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009597,MBR00000376,Professional,2023-05-15,2023-05-15,2023-06-12,PLN4751,1571574052,1571574052,Critical Access Hospital,In-Network,Z23,J44.1,,,,,,,0,,70450,Radiology,,,,11,Office,1,1340.68,703.28,578.49,0.0,25.0,99.79,124.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009598,MBR00000376,Institutional-OP,2023-04-28,2023-04-28,2023-06-03,PLN2572,1717546253,1717546253,Family Medicine,In-Network,Z79.4,Z00.00,,,,,,,0,,43239,Surgery,,,0730,22,Outpatient Hospital,1,1523.92,1126.8,1009.11,0.0,15.0,102.69,117.69,0.0,Paid,,,1,,0,0,1,0,0,1,Phantom,0,0,0,0,0
CLM0000009599,MBR00000376,Professional,2022-05-26,2022-05-26,2022-07-09,PLN8090,1410468316,1410468316,SNF,In-Network,E11.9,F41.9,,,,,,,0,,76700,Radiology,,,,22,Outpatient Hospital,2,736.21,623.58,598.58,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009600,MBR00000376,Institutional-OP,2021-03-22,2021-03-22,2021-04-03,PLN5671,1542828721,1542828721,Orthopedic Surgery,In-Network,C50.912,E11.40,,,,,,,0,,99203,E&M,,,0370,22,Outpatient Hospital,3,298.43,158.17,158.17,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009601,MBR00000376,Institutional-OP,2023-08-07,2023-08-07,2023-09-11,PLN8069,1749327647,1749327647,Geriatrics,In-Network,I50.9,I25.10,,,,,,,0,,G0439,Medicine,,,0740,22,Outpatient Hospital,3,636.88,233.4,218.4,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000009602,MBR00000376,Professional,2022-02-22,2022-02-22,2022-03-17,PLN3169,1242201429,1242201429,General Acute Care Hospital,In-Network,Z12.31,Z87.891,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,3,571.08,477.04,36.45,365.59,75.0,0.0,440.59,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009603,MBR00000376,Professional,2022-12-13,2022-12-13,2023-01-22,PLN7507,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,R05,K21.0,,,,,,,0,,99203,E&M,,,,65,End-Stage Renal Disease,2,242.07,90.03,0.0,90.03,0.0,0.0,90.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009604,MBR00000376,Institutional-OP,2021-05-26,2021-05-26,2021-07-01,PLN7237,1219817751,1219817751,OB/GYN,In-Network,J20.9,F32.9,,,,,,,0,,72148,Radiology,,,0510,22,Outpatient Hospital,3,1972.71,1146.24,919.62,226.62,0.0,0.0,226.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009605,MBR00000376,Professional,2023-10-23,2023-10-23,2023-12-05,PLN1843,1366576336,1366576336,Geriatrics,In-Network,E66.9,G43.909,,,,,,,0,,58661,Surgery,,,,11,Office,2,3023.47,1166.3,1003.08,138.22,25.0,0.0,163.22,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009606,MBR00000376,Professional,2021-10-09,2021-10-09,2021-11-05,PLN2390,1997536841,1997536841,Family Medicine,Out-of-Network,Z23,I10,,,,,,,0,,99222,E&M,,,,23,Emergency Room,2,475.43,399.86,0.0,365.33,50.0,0.0,415.33,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009607,MBR00000377,Institutional-IP,2023-12-28,2024-01-02,2024-02-10,PLN2983,1109850785,1109850785,ASC,Out-of-Network,G43.909,J06.9,,,,872,MS-DRG,19,5,Y,70450,Radiology,,,0510,21,Inpatient Hospital,1,1115.33,353.59,0.0,353.59,0.0,0.0,353.59,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009608,MBR00000377,Professional,2023-02-23,2023-02-23,2023-04-06,PLN4876,1361302520,1361302520,Critical Access Hospital,In-Network,I25.10,K57.30,,,,,,,0,,70450,Radiology,,,,21,Inpatient Hospital,2,889.9,283.49,248.49,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009609,MBR00000377,Professional,2021-12-28,2021-12-28,2022-01-13,PLN2002,1910255109,1910255109,DME Supplier,In-Network,E11.9,E11.9,,,,,,,0,,66984,Surgery,,,,11,Office,3,1750.41,847.73,797.73,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009610,MBR00000377,Institutional-IP,2022-02-09,2022-02-13,2022-03-16,PLN2503,1980712759,1980712759,Outpatient Clinic,Out-of-Network,S72.001A,E78.5,,,,195,MS-DRG,3,4,Y,76700,Radiology,,,0200,21,Inpatient Hospital,3,1305.09,1008.38,913.83,94.55,0.0,0.0,94.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009611,MBR00000377,Professional,2023-12-09,2023-12-09,2023-12-27,PLN4016,1713934949,1713934949,Neurology,In-Network,E66.9,Z12.31,,,,,,,0,,99283,E&M,,,,65,End-Stage Renal Disease,1,435.05,140.98,140.98,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009612,MBR00000377,Professional,2022-10-13,2022-10-13,2022-11-21,PLN9997,1528335731,1528335731,Critical Access Hospital,In-Network,M17.11,R10.9,,,,,,,0,,90837,Medicine,,,,11,Office,3,224.18,68.31,33.31,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009613,MBR00000377,Professional,2023-01-29,2023-01-29,2023-03-04,PLN4847,1609526529,1609526529,Psychiatry,In-Network,F03.90,E11.9,,,,,,,0,,G0439,Medicine,,,,11,Office,3,455.14,151.66,142.66,0.0,0.0,9.0,9.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000009614,MBR00000377,Institutional-OP,2022-11-02,2022-11-02,2022-12-16,PLN9197,1569105090,1569105090,Geriatrics,In-Network,E11.9,I25.10,,,,,,,0,,72148,Radiology,,,0200,22,Outpatient Hospital,2,2356.27,1396.27,1165.43,180.84,50.0,0.0,230.84,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009615,MBR00000377,Professional,2021-09-18,2021-09-18,2021-10-28,PLN6223,1968299309,1968299309,Internal Medicine,In-Network,Z87.891,E78.5,,,,,,,0,,77067,Radiology,,,,81,Independent Laboratory,3,400.5,252.32,217.32,0.0,35.0,0.0,35.0,0.0,Adjusted,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000009616,MBR00000377,Institutional-IP,2021-05-26,2021-05-29,2021-06-27,PLN4337,1518055405,1518055405,Urology,In-Network,Z23,J06.9,,,,292,MS-DRG,6,3,U,83036,Pathology/Lab,,,0301,21,Inpatient Hospital,3,121.56,63.8,17.7,21.1,25.0,0.0,46.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000009617,MBR00000377,Institutional-IP,2021-01-04,2021-01-05,2021-01-27,PLN7572,1910255109,1910255109,DME Supplier,In-Network,R10.9,I10,,,,603,MS-DRG,15,1,Y,G0468,Medicine,,,0270,21,Inpatient Hospital,1,337.6,208.74,158.07,0.0,25.0,25.67,50.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009618,MBR00000377,Institutional-OP,2022-03-20,2022-03-20,2022-04-01,PLN6087,1840431511,1840431511,Geriatrics,Out-of-Network,J20.9,J45.20,,,,,,,0,,99221,E&M,,,0320,22,Outpatient Hospital,2,311.27,111.14,36.14,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009619,MBR00000377,Professional,2023-01-19,2023-01-19,2023-02-20,PLN2554,1717546253,1717546253,Family Medicine,In-Network,K92.1,Z23,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,1,1334.35,496.62,453.25,0.0,0.0,43.37,43.37,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009620,MBR00000377,Professional,2021-11-27,2021-11-27,2022-01-04,PLN9843,1910255109,1910255109,DME Supplier,In-Network,I10,M54.5,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,2,6481.93,4519.74,4519.74,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009621,MBR00000377,Professional,2021-09-01,2021-09-01,2021-09-27,PLN2105,1313212303,1313212303,Family Medicine,In-Network,Z23,I10,,,,,,,0,,99284,E&M,,,,11,Office,1,388.8,222.97,222.97,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009622,MBR00000377,Institutional-IP,2022-03-02,2022-03-07,2022-04-02,PLN7737,1799205295,1799205295,General Acute Care Hospital,In-Network,C50.912,J44.1,,,,690,MS-DRG,13,5,Y,45380,Surgery,,,0360,21,Inpatient Hospital,2,2523.99,2015.03,1986.49,0.0,0.0,28.54,28.54,0.0,Paid,,,1,,0,0,1,0,1,0,None,0,1,0,0,0
CLM0000009623,MBR00000377,Institutional-OP,2021-09-11,2021-09-11,2021-10-18,PLN6993,1840431511,1840431511,Geriatrics,Out-of-Network,J06.9,Z12.31,,,,,,,0,,93225,Medicine,,,0120,22,Outpatient Hospital,3,539.25,337.17,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009624,MBR00000377,Professional,2022-04-22,2022-04-22,2022-05-16,PLN6254,1453936007,1453936007,ASC,In-Network,Z12.31,K21.0,,,,,,,0,,99204,E&M,,,,12,Home,2,403.05,256.38,92.79,152.12,0.0,11.47,163.59,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009625,MBR00000377,Institutional-OP,2022-08-28,2022-08-28,2022-09-09,PLN8498,1244186984,1244186984,Family Medicine,Out-of-Network,K21.0,F32.9,,,,,,,0,,99283,E&M,,,0301,22,Outpatient Hospital,2,549.73,237.0,0.0,237.0,75.0,0.0,312.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009626,MBR00000377,Professional,2021-10-26,2021-10-26,2021-11-26,PLN9360,1964402759,1964402759,Outpatient Clinic,In-Network,I10,K21.0,,,,,,,0,,77067,Radiology,,,,50,Federally Qualified Health Center,1,849.59,662.46,662.46,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000009627,MBR00000377,Professional,2021-02-03,2021-02-03,2021-02-26,PLN9376,1450094833,1450094833,Outpatient Clinic,In-Network,J20.9,Z00.00,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,3,420.98,327.12,277.12,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000009628,MBR00000377,Institutional-IP,2021-04-22,2021-05-05,2021-05-31,PLN6709,1564502315,1564502315,ASC,In-Network,E66.9,M17.11,,,,682,MS-DRG,18,13,Y,99213,E&M,,,0320,21,Inpatient Hospital,1,297.54,91.39,86.25,0.0,0.0,5.14,5.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009629,MBR00000377,Professional,2022-04-01,2022-04-01,2022-05-05,PLN6067,1687650653,1687650653,Internal Medicine,In-Network,I25.10,Z00.00,,,,,,,0,,90837,Medicine,,,,22,Outpatient Hospital,1,255.47,160.21,0.0,160.21,0.0,0.0,160.21,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000009630,MBR00000377,Institutional-OP,2021-07-14,2021-07-14,2021-08-20,PLN2057,1295371663,1295371663,Critical Access Hospital,In-Network,F32.9,R07.9,,,,,,,0,,66984,Surgery,,,0510,22,Outpatient Hospital,1,1402.82,1093.01,1093.01,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009631,MBR00000377,Institutional-IP,2023-05-26,2023-05-28,2023-06-30,PLN6083,1528335731,1528335731,Critical Access Hospital,In-Network,E11.9,Z79.4,,,,291,MS-DRG,5,2,Y,99203,E&M,,,0301,21,Inpatient Hospital,1,361.22,265.17,214.98,0.0,0.0,50.19,50.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009632,MBR00000377,Professional,2021-06-30,2021-06-30,2021-07-09,PLN4965,1109850785,1109850785,ASC,Out-of-Network,I10,I10,,,,,,,0,,43239,Surgery,,,,49,Independent Clinic,3,1243.39,603.78,118.39,483.02,0.0,2.37,485.39,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009633,MBR00000377,Professional,2021-01-30,2021-01-30,2021-03-01,PLN8442,1713934949,1713934949,Neurology,In-Network,Z00.00,J20.9,,,,,,,0,,99233,E&M,,,,11,Office,3,509.6,262.58,187.58,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000009634,MBR00000377,Institutional-OP,2022-11-10,2022-11-10,2022-11-22,PLN3114,1528335731,1528335731,Critical Access Hospital,In-Network,M81.0,Z00.01,,,,,,,0,,99233,E&M,,,0120,22,Outpatient Hospital,3,536.17,246.0,152.16,93.84,0.0,0.0,93.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009635,MBR00000377,Institutional-OP,2022-11-15,2022-11-15,2022-12-13,PLN9541,1422747896,1422747896,Urology,In-Network,Z00.00,E11.9,,,,,,,0,,77067,Radiology,,,0761,22,Outpatient Hospital,3,657.65,497.08,497.08,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000009636,MBR00000377,Professional,2023-01-06,2023-01-06,2023-02-11,PLN7357,1395983630,1395983630,Nephrology,In-Network,Z51.11,Z12.31,,,,,,,0,,99221,E&M,,,,11,Office,3,260.71,121.48,5.25,115.25,0.0,0.98,116.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009637,MBR00000377,Professional,2021-06-23,2021-06-23,2021-07-13,PLN5540,1205377316,1205377316,Orthopedic Surgery,In-Network,M54.5,E78.5,,,,,,,0,,93225,Medicine,,,,11,Office,1,435.49,316.12,281.12,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000009638,MBR00000377,Institutional-IP,2023-01-16,2023-01-18,2023-02-03,PLN5119,1556140803,1556140803,Cardiology,In-Network,R07.9,I10,,,,195,MS-DRG,15,2,Y,99221,E&M,,,0301,21,Inpatient Hospital,2,208.29,165.67,0.0,165.67,0.0,0.0,165.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009639,MBR00000377,Professional,2023-08-03,2023-08-03,2023-09-04,PLN3531,1366576336,1366576336,Geriatrics,In-Network,I10,I48.91,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,2,356.9,242.42,57.38,122.76,50.0,12.28,185.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009640,MBR00000377,Professional,2022-10-25,2022-10-25,2022-11-09,PLN4541,1644128543,1644128543,Gastroenterology,In-Network,F10.20,R07.9,,,,,,,0,,84443,Pathology/Lab,,,,22,Outpatient Hospital,1,121.19,55.6,0.0,55.6,25.0,0.0,80.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009641,MBR00000377,Professional,2022-03-04,2022-03-04,2022-04-05,PLN2282,1295371663,1295371663,Critical Access Hospital,In-Network,F03.90,E78.5,,,,,,,0,,G0468,Medicine,,,,11,Office,1,589.79,297.99,297.99,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009642,MBR00000377,Professional,2022-06-12,2022-06-12,2022-07-08,PLN3969,1213165847,1213165847,Critical Access Hospital,In-Network,E78.5,J45.20,,,,,,,0,,99284,E&M,,,,20,Urgent Care,3,361.89,284.18,0.0,284.18,0.0,0.0,284.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009643,MBR00000377,Professional,2023-06-09,2023-06-09,2023-06-24,PLN1290,1968299309,1968299309,Internal Medicine,In-Network,E11.40,I10,,,,,,,0,,71046,Radiology,,,,22,Outpatient Hospital,2,170.94,137.29,98.95,0.0,15.0,23.34,38.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009644,MBR00000377,Professional,2021-06-06,2021-06-06,2021-06-15,PLN4274,1364429278,1364429278,OB/GYN,In-Network,E11.9,R07.9,,,,,,,0,,85610,Pathology/Lab,,,,22,Outpatient Hospital,2,35.94,21.94,21.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009645,MBR00000377,Professional,2023-03-04,2023-03-04,2023-04-17,PLN3835,1245650222,1245650222,Gastroenterology,In-Network,I10,J06.9,,,,,,,0,,90686,Medicine,,,,81,Independent Laboratory,3,139.68,79.94,0.0,79.94,15.0,0.0,94.94,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000009646,MBR00000377,Professional,2021-10-23,2021-10-23,2021-11-07,PLN6063,1991459367,1991459367,Neurology,Out-of-Network,I11.9,R05,,,,,,,0,,99213,E&M,,,,12,Home,3,168.26,102.13,0.0,102.13,0.0,0.0,102.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009647,MBR00000377,Institutional-OP,2023-08-20,2023-08-20,2023-09-20,PLN5044,1475984649,1475984649,SNF,In-Network,E11.9,R05,,,,,,,0,,99406,Medicine,,,0370,22,Outpatient Hospital,2,39.44,24.5,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009648,MBR00000377,Professional,2021-06-03,2021-06-03,2021-06-26,PLN1660,1946680931,1946680931,Critical Access Hospital,Out-of-Network,Z00.00,J06.9,,,,,,,0,,99283,E&M,,,,65,End-Stage Renal Disease,2,265.72,150.93,100.93,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009649,MBR00000377,Professional,2022-07-20,2022-07-20,2022-08-11,PLN1327,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,M54.5,Z00.00,,,,,,,0,,84443,Pathology/Lab,,,,81,Independent Laboratory,1,125.22,53.66,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009650,MBR00000377,Institutional-OP,2022-03-15,2022-03-15,2022-03-27,PLN6533,1500949740,1500949740,Pediatrics,In-Network,J45.20,Z23,,,,,,,0,,99233,E&M,,,0740,22,Outpatient Hospital,3,206.47,143.89,143.89,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009651,MBR00000377,Institutional-OP,2022-06-17,2022-06-17,2022-07-20,PLN7327,1511044648,1511044648,Endocrinology,In-Network,E66.9,E78.5,,,,,,,0,,78452,Radiology,,,0320,22,Outpatient Hospital,2,3834.99,2628.91,2578.91,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009652,MBR00000377,Institutional-OP,2022-02-23,2022-02-23,2022-03-04,PLN4814,1186826716,1186826716,Physical Therapy,In-Network,Z12.31,E11.40,,,,,,,0,,27130,Surgery,,,0900,22,Outpatient Hospital,3,5336.24,1815.99,1765.99,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009653,MBR00000377,Professional,2021-02-10,2021-02-10,2021-03-25,PLN8435,1716521444,1716521444,Oncology,In-Network,M54.5,G43.909,,,,,,,0,,47562,Surgery,,,,65,End-Stage Renal Disease,3,2684.31,905.36,870.36,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009654,MBR00000377,Institutional-IP,2023-07-29,2023-08-14,2023-08-16,PLN6344,1606140917,1606140917,ASC,In-Network,N39.0,J44.1,,,,292,MS-DRG,14,16,Y,27447,Surgery,,,0730,21,Inpatient Hospital,3,4210.3,2437.96,2213.31,224.65,0.0,0.0,224.65,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009655,MBR00000377,Institutional-IP,2022-08-08,2022-08-10,2022-08-15,PLN9730,1135158374,1135158374,Pulmonology,In-Network,M81.0,K21.0,,,,603,MS-DRG,17,2,Y,80061,Pathology/Lab,,,0740,21,Inpatient Hospital,3,114.49,72.47,0.0,72.47,0.0,0.0,72.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009656,MBR00000377,Institutional-OP,2022-10-20,2022-10-20,2022-11-21,PLN2674,1809014947,1809014947,Urology,In-Network,I10,M54.5,,,,,,,0,,43239,Surgery,,,0761,22,Outpatient Hospital,2,1931.93,1521.37,1073.95,447.42,0.0,0.0,447.42,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009657,MBR00000378,Professional,2022-07-26,2022-07-26,2022-08-23,PLN3819,1727809972,1727809972,Home Health,In-Network,Z12.31,G43.909,,,,,,,0,,93225,Medicine,,,,22,Outpatient Hospital,3,473.27,200.62,200.62,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009658,MBR00000378,Professional,2022-08-03,2022-08-03,2022-09-09,PLN4451,1247341320,1247341320,Urology,Out-of-Network,I50.9,Z23,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,2,277.24,149.1,0.0,0.0,50.0,9.55,59.55,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009659,MBR00000378,Professional,2022-10-27,2022-10-27,2022-11-04,PLN5903,1434029575,1434029575,Endocrinology,In-Network,Z00.00,N40.0,,,,,,,0,,99232,E&M,,,,11,Office,1,364.4,171.6,156.6,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009660,MBR00000378,Institutional-IP,2022-04-05,2022-04-10,2022-04-29,PLN9128,1118885473,1118885473,ASC,In-Network,F32.9,K21.0,,,,872,MS-DRG,2,5,Y,99233,E&M,,,0120,21,Inpatient Hospital,2,474.71,399.35,138.52,260.83,0.0,0.0,260.83,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009661,MBR00000378,Professional,2021-05-24,2021-05-24,2021-06-24,PLN3168,1860435061,1860435061,DME Supplier,In-Network,Z87.891,J18.9,,,,,,,0,,90686,Medicine,,,,11,Office,3,87.48,58.2,47.46,0.0,0.0,10.74,10.74,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000009662,MBR00000378,Professional,2021-02-02,2021-02-02,2021-03-03,PLN8615,1716521444,1716521444,Oncology,In-Network,K21.0,I10,,,,,,,0,,71046,Radiology,,,,22,Outpatient Hospital,2,291.74,180.94,180.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009663,MBR00000378,Institutional-IP,2022-08-15,2022-08-21,2022-09-22,PLN5110,1224179551,1224179551,Physical Therapy,In-Network,F32.9,N39.0,,,,603,MS-DRG,24,6,Y,70553,Radiology,,,0270,21,Inpatient Hospital,2,1815.62,611.0,536.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009664,MBR00000378,Institutional-OP,2021-07-23,2021-07-23,2021-08-20,PLN5745,1245650222,1245650222,Gastroenterology,In-Network,I48.91,I10,,,,,,,0,,97530,Medicine,,,0301,22,Outpatient Hospital,1,147.23,100.37,100.37,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009665,MBR00000378,Institutional-OP,2022-05-13,2022-05-13,2022-06-07,PLN6104,1799205295,1799205295,General Acute Care Hospital,In-Network,I25.10,Z23,,,,,,,0,,43239,Surgery,,,0120,22,Outpatient Hospital,2,1704.26,861.56,738.74,117.24,0.0,5.58,122.82,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009666,MBR00000378,Institutional-IP,2022-10-25,2022-10-28,2022-11-08,PLN4268,1139906830,1139906830,Endocrinology,Out-of-Network,E66.9,Z79.4,,,,291,MS-DRG,10,3,Y,45380,Surgery,,,0761,21,Inpatient Hospital,1,2287.77,1485.88,1015.64,248.41,50.0,171.83,470.24,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000009667,MBR00000378,Professional,2022-10-15,2022-10-15,2022-10-23,PLN1714,1213165847,1213165847,Critical Access Hospital,In-Network,I25.10,E78.5,,,,,,,0,,99213,E&M,,,,50,Federally Qualified Health Center,3,253.08,86.63,0.0,86.63,0.0,0.0,86.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009668,MBR00000378,Institutional-OP,2021-07-04,2021-07-04,2021-07-18,PLN6187,1717912431,1717912431,Oncology,In-Network,E78.5,Z00.00,,,,,,,0,,99232,E&M,,,0636,22,Outpatient Hospital,2,325.23,199.1,152.81,0.0,15.0,31.29,46.29,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000009669,MBR00000378,Professional,2022-12-25,2022-12-25,2023-02-06,PLN5561,1511044648,1511044648,Endocrinology,In-Network,I25.10,K57.30,,,,,,,0,,45378,Surgery,,,,11,Office,3,1538.6,626.1,551.1,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000009670,MBR00000378,Professional,2023-10-28,2023-10-28,2023-11-05,PLN4913,1817234602,1817234602,Clinical Laboratory,In-Network,E78.5,I10,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,2,473.67,388.87,278.72,12.01,75.0,23.14,110.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009671,MBR00000378,Professional,2022-01-31,2022-01-31,2022-03-02,PLN3049,1997536841,1997536841,Family Medicine,Out-of-Network,E11.9,F32.9,,,,,,,0,,G0439,Medicine,,,,22,Outpatient Hospital,2,487.22,182.57,0.0,182.57,0.0,0.0,182.57,0.0,Denied,CO-97,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000009672,MBR00000378,Institutional-IP,2021-05-10,2021-05-13,2021-06-21,PLN2682,1609138981,1609138981,Critical Access Hospital,In-Network,F41.9,F41.9,,,,603,MS-DRG,16,3,Y,58661,Surgery,,,0900,21,Inpatient Hospital,1,4790.68,2103.85,2103.85,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009673,MBR00000378,Professional,2022-07-06,2022-07-06,2022-07-20,PLN6420,1268679390,1268679390,Critical Access Hospital,In-Network,B97.89,E78.5,,,,,,,0,,G0444,Medicine,,,,22,Outpatient Hospital,3,65.8,34.97,34.97,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000009674,MBR00000378,Professional,2022-11-07,2022-11-07,2022-12-05,PLN9496,1856686341,1856686341,Geriatrics,In-Network,I25.10,Z00.00,,,,,,,0,,83036,Pathology/Lab,,,,22,Outpatient Hospital,2,47.21,26.62,1.62,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000009675,MBR00000379,Professional,2022-03-09,2022-03-09,2022-03-24,PLN5963,1872272835,1872272835,Internal Medicine,In-Network,E11.65,E11.9,,,,,,,0,,70553,Radiology,,,,20,Urgent Care,3,4015.59,3166.1,2662.31,57.87,75.0,0.0,132.87,370.92,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009676,MBR00000379,Institutional-IP,2022-10-19,2022-10-27,2022-11-17,PLN7701,1213165847,1213165847,Critical Access Hospital,In-Network,K21.0,I10,,,,470,MS-DRG,6,8,Y,80061,Pathology/Lab,,,0370,21,Inpatient Hospital,1,81.89,63.08,0.0,63.08,0.0,0.0,63.08,15.84,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009677,MBR00000379,Institutional-OP,2023-04-19,2023-04-19,2023-05-13,PLN4353,1691062876,1691062876,SNF,In-Network,F41.9,I10,,,,,,,0,,80061,Pathology/Lab,,,0320,22,Outpatient Hospital,2,63.8,26.27,24.54,0.0,0.0,0.0,0.0,1.73,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009678,MBR00000379,Professional,2022-09-25,2022-09-25,2022-10-04,PLN6856,1847081578,1847081578,Urology,Out-of-Network,E78.5,I10,,,,,,,0,,45380,Surgery,,,,12,Home,1,1240.54,730.46,682.29,0.0,0.0,48.17,48.17,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000009679,MBR00000379,Professional,2023-05-23,2023-05-23,2023-06-19,PLN4802,1193493783,1193493783,Critical Access Hospital,Out-of-Network,E11.9,E66.9,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,3,57.96,44.87,29.87,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009680,MBR00000379,Institutional-OP,2021-06-09,2021-06-09,2021-06-16,PLN2386,1422747896,1422747896,Urology,In-Network,Z00.00,Z12.31,,,,,,,0,,G0439,Medicine,,,0120,22,Outpatient Hospital,1,624.46,367.09,269.69,0.0,35.0,62.4,97.4,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000009681,MBR00000379,Professional,2021-11-17,2021-11-17,2021-12-03,PLN3655,1135158374,1135158374,Pulmonology,In-Network,G20,J06.9,,,,,,,0,,80053,Pathology/Lab,,,,22,Outpatient Hospital,3,130.72,60.75,57.4,0.0,0.0,0.0,0.0,3.35,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009682,MBR00000379,Professional,2022-09-01,2022-09-01,2022-10-13,PLN4257,1528335731,1528335731,Critical Access Hospital,In-Network,Z23,I25.10,,,,,,,0,,93000,Radiology,,,,11,Office,3,106.66,59.44,48.46,0.0,0.0,0.0,0.0,10.98,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009683,MBR00000379,Institutional-IP,2021-10-12,2021-10-13,2021-10-27,PLN2929,1125190055,1125190055,Nephrology,In-Network,I25.10,Z00.00,,,,195,MS-DRG,22,1,Y,82043,Pathology/Lab,,,0900,21,Inpatient Hospital,3,60.64,22.96,0.0,22.96,0.0,0.0,22.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009684,MBR00000379,Institutional-OP,2023-12-25,2023-12-25,2024-01-21,PLN9989,1556140803,1556140803,Cardiology,In-Network,F41.9,F32.9,,,,,,,0,,99204,E&M,,,0510,22,Outpatient Hospital,3,341.31,192.35,0.0,192.35,0.0,0.0,192.35,18.53,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009685,MBR00000379,Institutional-OP,2023-01-13,2023-01-13,2023-01-25,PLN8304,1687650653,1687650653,Internal Medicine,In-Network,I10,F41.9,,,,,,,0,,45380,Surgery,,,0370,22,Outpatient Hospital,3,1439.78,851.68,568.6,212.48,0.0,70.6,283.08,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000009686,MBR00000379,Professional,2022-03-28,2022-03-28,2022-05-07,PLN9942,1812060197,1812060197,Oncology,Out-of-Network,Z00.00,Z51.11,,,,,,,0,,77067,Radiology,,,,11,Office,2,768.04,318.54,318.54,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,1,Phantom,1,0,0,0,0
CLM0000009687,MBR00000379,Institutional-OP,2023-04-28,2023-04-28,2023-05-17,PLN3725,1108115157,1108115157,General Acute Care Hospital,In-Network,R10.9,I10,,,,,,,0,,99204,E&M,,,0270,22,Outpatient Hospital,2,495.48,245.31,245.31,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009688,MBR00000379,Professional,2023-12-13,2023-12-13,2024-01-26,PLN1477,1689639685,1689639685,SNF,In-Network,M54.5,Z12.31,,,,,,,0,,78452,Radiology,,,,49,Independent Clinic,2,6717.94,3060.38,2677.58,0.0,0.0,382.8,382.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009689,MBR00000379,Institutional-OP,2021-01-12,2021-01-12,2021-02-11,PLN4951,1502838586,1502838586,ASC,In-Network,Z23,I10,,,,,,,0,,82043,Pathology/Lab,,,0301,22,Outpatient Hospital,3,70.85,58.64,51.43,0.0,0.0,7.21,7.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009690,MBR00000379,Professional,2022-09-02,2022-09-02,2022-09-18,PLN7199,1806688928,1806688928,Geriatrics,In-Network,Z12.31,F41.9,,,,,,,0,,99232,E&M,,,,11,Office,3,342.4,111.75,98.91,0.0,0.0,0.0,0.0,12.84,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009691,MBR00000379,Professional,2022-04-14,2022-04-14,2022-05-21,PLN8707,1968299309,1968299309,Internal Medicine,In-Network,Z00.00,I10,,,,,,,0,,70553,Radiology,,,,22,Outpatient Hospital,1,3725.53,2673.3,0.0,123.51,0.0,0.0,123.51,0.0,Denied,CO-18,,1,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000009692,MBR00000379,Professional,2023-04-07,2023-04-07,2023-04-18,PLN7439,1609138981,1609138981,Critical Access Hospital,In-Network,E11.65,N18.3,,,,,,,0,,99284,E&M,,,,21,Inpatient Hospital,2,347.49,144.64,144.64,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009693,MBR00000379,Professional,2021-12-03,2021-12-03,2022-01-12,PLN5221,1500949740,1500949740,Pediatrics,In-Network,N17.9,Z79.4,,,,,,,0,,99213,E&M,,,,11,Office,1,145.3,73.11,43.39,0.0,15.0,0.0,15.0,14.72,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000009694,MBR00000379,Professional,2021-12-23,2021-12-23,2022-01-24,PLN7803,1571574052,1571574052,Critical Access Hospital,In-Network,E11.9,J20.9,,,,,,,0,,99203,E&M,,,,11,Office,1,207.24,141.08,129.92,0.0,0.0,11.16,11.16,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000009695,MBR00000379,Institutional-OP,2023-04-20,2023-04-20,2023-05-24,PLN7150,1809014947,1809014947,Urology,In-Network,E78.5,J06.9,,,,,,,0,,99213,E&M,,,0740,22,Outpatient Hospital,1,130.72,101.18,86.18,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009696,MBR00000379,Institutional-OP,2023-09-03,2023-09-03,2023-10-11,PLN1671,1395983630,1395983630,Nephrology,In-Network,N18.3,E78.5,,,,,,,0,,90686,Medicine,,,0740,22,Outpatient Hospital,3,70.42,22.07,0.0,22.07,25.0,0.0,47.07,1.49,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000009697,MBR00000379,Professional,2021-06-07,2021-06-07,2021-07-11,PLN6157,1236418230,1236418230,DME Supplier,In-Network,I10,E11.9,,,,,,,0,,76700,Radiology,,,,20,Urgent Care,3,661.57,240.84,240.84,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009698,MBR00000379,Institutional-OP,2022-11-05,2022-11-05,2022-12-06,PLN5561,1660288235,1660288235,ASC,In-Network,M54.5,S72.001A,,,,,,,0,,99213,E&M,,,0301,22,Outpatient Hospital,1,330.37,166.09,131.09,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009699,MBR00000380,Institutional-OP,2023-05-03,2023-05-03,2023-05-19,PLN7582,1453283987,1453283987,Critical Access Hospital,In-Network,F41.9,J06.9,,,,,,,0,,G0439,Medicine,,,0320,22,Outpatient Hospital,2,562.29,323.34,273.34,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000009700,MBR00000380,Institutional-OP,2021-06-30,2021-06-30,2021-07-15,PLN2925,1806688928,1806688928,Geriatrics,In-Network,K21.0,Z51.11,,,,,,,0,,66984,Surgery,,,0320,22,Outpatient Hospital,1,1398.24,1165.63,683.54,434.91,25.0,22.18,482.09,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009701,MBR00000380,Professional,2022-12-26,2022-12-26,2023-01-26,PLN2756,1991459367,1991459367,Neurology,Out-of-Network,E11.40,Z12.11,,,,,,,0,,78452,Radiology,,,,11,Office,1,2793.11,1681.28,1681.28,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009702,MBR00000380,Professional,2023-12-09,2023-12-09,2023-12-24,PLN4466,1438368327,1438368327,Home Health,In-Network,F32.9,E11.9,,,,,,,0,,85610,Pathology/Lab,,,,22,Outpatient Hospital,2,63.31,38.78,21.34,0.0,15.0,2.44,17.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009703,MBR00000380,Institutional-OP,2023-07-13,2023-07-13,2023-08-02,PLN9708,1236418230,1236418230,DME Supplier,In-Network,E11.9,Z51.11,,,,,,,0,,86900,Pathology/Lab,,,0370,22,Outpatient Hospital,2,31.6,24.49,24.49,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009704,MBR00000380,Institutional-IP,2021-08-01,2021-08-11,2021-08-18,PLN4601,1227362142,1227362142,DME Supplier,In-Network,K21.0,E66.9,,,,872,MS-DRG,4,10,Y,70450,Radiology,,,0200,21,Inpatient Hospital,1,1706.68,1013.51,1013.51,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009705,MBR00000380,Professional,2023-12-21,2023-12-21,2024-01-27,PLN5060,1563980627,1563980627,Critical Access Hospital,In-Network,I10,N18.3,,,,,,,0,,77067,Radiology,,,,11,Office,1,852.24,375.48,0.0,368.77,25.0,0.0,393.77,0.0,Denied,CO-15,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000009706,MBR00000380,Professional,2022-01-26,2022-01-26,2022-02-22,PLN5484,1227362142,1227362142,DME Supplier,In-Network,Z00.00,E66.9,,,,,,,0,,99213,E&M,,,,11,Office,3,269.4,111.04,105.27,0.0,0.0,5.77,5.77,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009707,MBR00000380,Professional,2022-06-06,2022-06-06,2022-07-14,PLN2733,1242201429,1242201429,General Acute Care Hospital,In-Network,M54.5,E78.5,,,,,,,0,,99204,E&M,,,,23,Emergency Room,2,326.36,185.41,27.94,157.47,0.0,0.0,157.47,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009708,MBR00000380,Professional,2021-11-16,2021-11-16,2021-12-13,PLN5912,1531398223,1531398223,OB/GYN,In-Network,Z12.31,N18.3,,,,,,,0,,99214,E&M,,,,11,Office,3,422.32,197.09,166.25,0.0,0.0,30.84,30.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009709,MBR00000380,Professional,2023-02-05,2023-02-05,2023-03-07,PLN8936,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,F41.9,E78.5,,,,,,,0,,27130,Surgery,,,,11,Office,2,4003.21,1752.25,1717.25,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009710,MBR00000380,Institutional-IP,2021-05-18,2021-05-23,2021-06-09,PLN1052,1980712759,1980712759,Outpatient Clinic,Out-of-Network,J06.9,J45.20,,,,470,MS-DRG,1,5,Y,90686,Medicine,,,0120,21,Inpatient Hospital,1,101.46,53.88,5.64,48.24,0.0,0.0,48.24,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000009711,MBR00000380,Professional,2023-02-17,2023-02-17,2023-03-22,PLN1703,1660288235,1660288235,ASC,In-Network,K57.30,N39.0,,,,,,,0,,99222,E&M,,,,11,Office,1,254.75,118.21,0.0,118.21,0.0,0.0,118.21,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009712,MBR00000380,Professional,2021-03-02,2021-03-02,2021-04-15,PLN8892,1186826716,1186826716,Physical Therapy,In-Network,I10,E11.9,,,,,,,0,,90460,Medicine,,,,11,Office,2,51.76,30.03,0.0,30.03,0.0,0.0,30.03,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009713,MBR00000380,Professional,2023-07-14,2023-07-14,2023-08-06,PLN3341,1624802371,1624802371,ASC,Out-of-Network,G43.909,M17.11,,,,,,,0,,99203,E&M,,,,11,Office,1,211.92,170.76,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009714,MBR00000380,Professional,2021-12-23,2021-12-23,2022-01-20,PLN5949,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,J44.1,N40.0,,,,,,,0,,83036,Pathology/Lab,,,,22,Outpatient Hospital,2,104.27,57.35,42.35,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000009715,MBR00000380,Professional,2022-07-22,2022-07-22,2022-08-28,PLN5561,1224179551,1224179551,Physical Therapy,In-Network,J45.20,G20,,,,,,,0,,99232,E&M,,,,49,Independent Clinic,3,301.01,121.8,0.0,121.8,0.0,0.0,121.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009716,MBR00000380,Professional,2021-09-07,2021-09-07,2021-10-05,PLN2702,1410468316,1410468316,SNF,In-Network,J20.9,Z00.00,,,,,,,0,,66984,Surgery,,,,49,Independent Clinic,3,2421.1,1304.78,842.96,436.82,25.0,0.0,461.82,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009717,MBR00000380,Institutional-OP,2021-04-28,2021-04-28,2021-05-07,PLN7797,1355166277,1355166277,Endocrinology,In-Network,F10.20,J18.9,,,,,,,0,,82043,Pathology/Lab,,,0120,22,Outpatient Hospital,2,59.36,40.05,0.0,40.05,75.0,0.0,115.05,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009718,MBR00000380,Professional,2021-01-26,2021-01-26,2021-02-25,PLN4571,1702692193,1702692193,Physical Therapy,In-Network,J06.9,N39.0,,,,,,,0,,90460,Medicine,,,,21,Inpatient Hospital,3,42.06,32.73,0.0,32.73,0.0,0.0,32.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009719,MBR00000380,Professional,2023-12-09,2023-12-09,2024-01-12,PLN4456,1422747896,1422747896,Urology,In-Network,Z12.31,E11.65,,,,,,,0,,99221,E&M,,,,20,Urgent Care,1,187.36,122.2,28.14,44.06,50.0,0.0,94.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009720,MBR00000380,Professional,2021-05-30,2021-05-30,2021-06-13,PLN3146,1148984206,1148984206,Psychiatry,In-Network,E78.5,N39.0,,,,,,,0,,83036,Pathology/Lab,,,,31,Skilled Nursing Facility,2,71.33,44.12,44.12,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000009721,MBR00000380,Institutional-IP,2021-03-04,2021-03-10,2021-03-18,PLN3366,1872272835,1872272835,Internal Medicine,In-Network,M17.11,J06.9,,,,195,MS-DRG,15,6,Y,90686,Medicine,,,0200,21,Inpatient Hospital,3,108.54,60.13,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-27,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000009722,MBR00000380,Professional,2022-07-17,2022-07-17,2022-08-15,PLN4009,1899127912,1899127912,Neurology,In-Network,E11.9,Z00.00,,,,,,,0,,47562,Surgery,,,,11,Office,3,2941.6,1782.2,0.0,0.0,0.0,292.14,292.14,0.0,Denied,CO-11,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009723,MBR00000380,Institutional-OP,2023-11-20,2023-11-20,2023-12-24,PLN5352,1245650222,1245650222,Gastroenterology,In-Network,I10,J06.9,,,,,,,0,,99204,E&M,,,0636,22,Outpatient Hospital,3,400.64,300.92,300.92,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009724,MBR00000380,Professional,2021-04-01,2021-04-01,2021-05-12,PLN3075,1590915516,1590915516,Physical Therapy,Out-of-Network,I10,K21.0,,,,,,,0,,77067,Radiology,,,,11,Office,3,747.84,350.27,0.0,350.27,75.0,0.0,425.27,0.0,Denied,CO-97,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000009725,MBR00000380,Professional,2021-10-07,2021-10-07,2021-11-14,PLN8794,1236418230,1236418230,DME Supplier,In-Network,N39.0,Z00.00,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,1,617.5,434.74,398.07,4.97,0.0,31.7,36.67,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000009726,MBR00000380,Professional,2022-09-01,2022-09-01,2022-10-08,PLN4287,1219817751,1219817751,OB/GYN,In-Network,J06.9,R51,,,,,,,0,,99221,E&M,,,,65,End-Stage Renal Disease,1,256.89,179.26,164.26,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009727,MBR00000380,Institutional-IP,2022-06-24,2022-06-26,2022-08-01,PLN9363,1700633438,1700633438,DME Supplier,In-Network,C50.912,E78.5,,,,603,MS-DRG,24,2,Y,70450,Radiology,,,0761,21,Inpatient Hospital,1,1269.91,883.66,790.24,0.0,0.0,93.42,93.42,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009728,MBR00000380,Institutional-IP,2021-06-09,2021-06-19,2021-07-09,PLN7384,1609526529,1609526529,Psychiatry,In-Network,J44.1,Z12.31,,,,641,MS-DRG,22,10,Y,45378,Surgery,,,0360,21,Inpatient Hospital,1,1497.22,933.92,356.48,488.52,15.0,73.92,577.44,0.0,Paid,,,0,,0,1,1,0,1,0,None,0,1,0,0,0
CLM0000009729,MBR00000380,Institutional-OP,2023-11-07,2023-11-07,2023-11-16,PLN6283,1687650653,1687650653,Internal Medicine,In-Network,R10.9,N17.9,,,,,,,0,,45378,Surgery,,,0761,22,Outpatient Hospital,3,1940.74,710.48,675.48,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000009730,MBR00000380,Professional,2022-01-28,2022-01-28,2022-02-12,PLN6656,1590915516,1590915516,Physical Therapy,Out-of-Network,E11.40,I10,,,,,,,0,,G0468,Medicine,,,,11,Office,1,292.16,237.15,0.0,237.15,25.0,0.0,262.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009731,MBR00000380,Professional,2023-01-11,2023-01-11,2023-01-18,PLN6391,1872272835,1872272835,Internal Medicine,In-Network,Z00.00,Z12.31,,,,,,,0,,99222,E&M,,,,81,Independent Laboratory,1,252.13,211.95,41.19,167.29,0.0,3.47,170.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009732,MBR00000380,Institutional-IP,2022-05-17,2022-05-28,2022-06-23,PLN1869,1500949740,1500949740,Pediatrics,In-Network,E11.9,Z12.31,,,,292,MS-DRG,18,11,N,27130,Surgery,,,0120,21,Inpatient Hospital,1,5293.48,4185.94,4185.94,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009733,MBR00000380,Professional,2022-10-04,2022-10-04,2022-10-27,PLN3152,1148984206,1148984206,Psychiatry,In-Network,E11.9,N39.0,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,3,56.0,45.03,0.0,45.03,0.0,0.0,45.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009734,MBR00000380,Institutional-IP,2023-09-18,2023-09-20,2023-10-28,PLN6471,1463205530,1463205530,Nephrology,In-Network,E87.6,Z23,,,,470,MS-DRG,2,2,Y,72148,Radiology,,,0450,21,Inpatient Hospital,1,1844.89,1432.01,1298.74,0.0,75.0,58.27,133.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009735,MBR00000380,Professional,2021-12-23,2021-12-23,2022-02-02,PLN5178,1964402759,1964402759,Outpatient Clinic,In-Network,I10,E66.9,,,,,,,0,,77067,Radiology,,,,31,Skilled Nursing Facility,1,579.26,247.28,172.28,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000009736,MBR00000380,Professional,2023-06-11,2023-06-11,2023-06-24,PLN7025,1561134315,1561134315,DME Supplier,In-Network,E78.5,N39.0,,,,,,,0,,81001,Pathology/Lab,,,,22,Outpatient Hospital,2,39.8,15.51,15.51,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009737,MBR00000380,Institutional-OP,2021-11-17,2021-11-17,2021-12-18,PLN8097,1590915516,1590915516,Physical Therapy,Out-of-Network,Z00.00,Z23,,,,,,,0,,27447,Surgery,,,0120,22,Outpatient Hospital,1,2769.25,982.07,795.34,86.95,25.0,74.78,186.73,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009738,MBR00000380,Professional,2021-12-14,2021-12-14,2022-01-11,PLN9832,1528335731,1528335731,Critical Access Hospital,In-Network,F41.9,I25.10,,,,,,,0,,45378,Surgery,,,,23,Emergency Room,1,2501.93,876.38,814.32,0.0,15.0,47.06,62.06,0.0,Adjusted,,,1,,1,1,0,0,0,0,None,0,1,0,0,0
CLM0000009739,MBR00000380,Institutional-OP,2021-02-05,2021-02-05,2021-02-20,PLN6471,1247341320,1247341320,Urology,Out-of-Network,Z00.00,B97.89,,,,,,,0,,45380,Surgery,,,0900,22,Outpatient Hospital,3,1436.31,1022.61,898.9,123.71,0.0,0.0,123.71,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000009740,MBR00000381,Institutional-OP,2022-01-15,2022-01-15,2022-02-11,PLN6156,1865904917,1865904917,Outpatient Clinic,In-Network,E11.65,G20,,,,,,,0,,99221,E&M,,,0320,22,Outpatient Hospital,1,261.46,121.95,6.95,100.0,15.0,0.0,115.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009741,MBR00000381,Professional,2022-10-05,2022-10-05,2022-11-14,PLN4112,1569105090,1569105090,Geriatrics,In-Network,F32.9,I10,,,,,,,0,,58661,Surgery,,,,11,Office,2,3102.88,1492.59,1061.31,178.58,15.0,237.7,431.28,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009742,MBR00000381,Professional,2022-12-02,2022-12-02,2023-01-04,PLN5972,1812060197,1812060197,Oncology,Out-of-Network,J45.20,I63.9,,,,,,,0,,33533,Surgery,,,,11,Office,1,23878.96,17071.96,17071.96,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000009743,MBR00000381,Professional,2022-04-16,2022-04-16,2022-05-12,PLN3623,1108115157,1108115157,General Acute Care Hospital,In-Network,N20.0,M54.5,,,,,,,0,,23472,Surgery,,,,21,Inpatient Hospital,1,3170.7,1285.29,1046.63,146.48,75.0,17.18,238.66,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009744,MBR00000381,Professional,2022-01-26,2022-01-26,2022-02-10,PLN4918,1244186984,1244186984,Family Medicine,Out-of-Network,Z79.4,M54.5,,,,,,,0,,G0444,Medicine,,,,11,Office,2,53.04,33.01,0.0,33.01,50.0,0.0,83.01,0.0,Pended,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000009745,MBR00000381,Professional,2021-09-03,2021-09-03,2021-09-19,PLN6575,1590915516,1590915516,Physical Therapy,Out-of-Network,Z23,F32.9,,,,,,,0,,27447,Surgery,,,,11,Office,3,5658.6,3723.75,3013.35,0.0,50.0,660.4,710.4,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009746,MBR00000381,Professional,2023-09-18,2023-09-18,2023-10-24,PLN8869,1313212303,1313212303,Family Medicine,In-Network,I10,C50.912,,,,,,,0,,43239,Surgery,,,,49,Independent Clinic,1,1760.72,845.63,768.25,27.38,50.0,0.0,77.38,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009747,MBR00000381,Institutional-IP,2022-02-25,2022-02-28,2022-03-23,PLN3028,1910255109,1910255109,DME Supplier,In-Network,I10,E78.5,,,,470,MS-DRG,12,3,Y,58661,Surgery,,,0320,21,Inpatient Hospital,3,1760.3,994.0,994.0,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009748,MBR00000381,Professional,2021-12-02,2021-12-02,2021-12-15,PLN1802,1132188260,1132188260,Family Medicine,In-Network,G43.909,K21.0,,,,,,,0,,99204,E&M,,,,11,Office,3,489.63,276.47,276.47,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009749,MBR00000381,Professional,2023-10-28,2023-10-28,2023-12-04,PLN2720,1520687146,1520687146,ASC,In-Network,I10,I10,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,3,3646.42,2336.66,1939.72,0.0,0.0,396.94,396.94,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009750,MBR00000381,Professional,2022-11-29,2022-11-29,2022-12-06,PLN6519,1219817751,1219817751,OB/GYN,In-Network,Z23,Z23,,,,,,,0,,G0444,Medicine,,,,21,Inpatient Hospital,2,90.33,53.5,0.0,53.5,0.0,0.0,53.5,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000009751,MBR00000381,Institutional-OP,2023-07-18,2023-07-18,2023-08-15,PLN7759,1500037969,1500037969,Pulmonology,In-Network,Z12.31,B97.89,,,,,,,0,,99233,E&M,,,0200,22,Outpatient Hospital,2,238.0,119.43,84.43,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000009752,MBR00000381,Professional,2022-03-02,2022-03-02,2022-03-17,PLN9863,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,Z00.00,E78.5,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,2,4361.47,3441.43,3441.43,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009753,MBR00000381,Institutional-OP,2022-04-17,2022-04-17,2022-05-27,PLN8506,1752470395,1752470395,Home Health,In-Network,M54.5,E11.65,,,,,,,0,,66984,Surgery,,,0761,22,Outpatient Hospital,2,2415.3,1779.44,1495.73,0.0,15.0,268.71,283.71,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009754,MBR00000381,Institutional-OP,2023-03-10,2023-03-10,2023-03-28,PLN2340,1109850785,1109850785,ASC,Out-of-Network,E78.5,Z12.31,,,,,,,0,,77067,Radiology,,,0730,22,Outpatient Hospital,2,817.73,522.02,0.0,91.12,15.0,0.0,106.12,0.0,Denied,CO-11,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000009755,MBR00000381,Institutional-OP,2023-12-10,2023-12-10,2023-12-21,PLN7468,1545347862,1545347862,SNF,In-Network,I10,Z00.00,,,,,,,0,,66984,Surgery,,,0200,22,Outpatient Hospital,1,3553.0,1995.83,1995.83,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009756,MBR00000381,Institutional-IP,2023-05-14,2023-05-18,2023-06-20,PLN2558,1997536841,1997536841,Family Medicine,Out-of-Network,R07.9,Z00.00,,,,682,MS-DRG,15,4,N,99213,E&M,,,0740,21,Inpatient Hospital,1,207.5,116.37,0.0,116.37,15.0,0.0,131.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009757,MBR00000381,Institutional-OP,2022-05-22,2022-05-22,2022-06-29,PLN3459,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,N18.3,G43.909,,,,,,,0,,45378,Surgery,,,0301,22,Outpatient Hospital,2,1819.3,1006.64,870.23,121.41,15.0,0.0,136.41,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000009758,MBR00000381,Professional,2022-10-17,2022-10-17,2022-11-19,PLN9592,1337791138,1337791138,Internal Medicine,Out-of-Network,Z23,Z12.31,,,,,,,0,,99214,E&M,,,,11,Office,3,291.35,190.01,115.01,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009759,MBR00000381,Institutional-IP,2022-01-18,2022-01-20,2022-02-14,PLN8705,1800011727,1800011727,Clinical Laboratory,Out-of-Network,E66.9,I25.10,,,,683,MS-DRG,13,2,Y,99213,E&M,,,0301,21,Inpatient Hospital,3,168.85,123.47,88.47,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009760,MBR00000381,Professional,2022-05-15,2022-05-15,2022-05-25,PLN7593,1518055405,1518055405,Urology,In-Network,N39.0,E11.9,,,,,,,0,,99213,E&M,,,,11,Office,1,190.76,84.5,77.79,0.0,0.0,6.71,6.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009761,MBR00000381,Professional,2022-03-01,2022-03-01,2022-03-17,PLN8958,1242201429,1242201429,General Acute Care Hospital,In-Network,E78.5,I10,,,,,,,0,,99222,E&M,,,,11,Office,3,593.0,399.28,364.28,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009762,MBR00000381,Institutional-OP,2021-04-19,2021-04-19,2021-05-04,PLN9030,1486164553,1486164553,DME Supplier,In-Network,N40.0,G43.909,,,,,,,0,,99203,E&M,,,0761,22,Outpatient Hospital,3,366.97,238.51,223.51,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009763,MBR00000381,Professional,2023-08-16,2023-08-16,2023-09-14,PLN4200,1563980627,1563980627,Critical Access Hospital,In-Network,M54.5,N39.0,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,2,572.08,308.24,0.0,308.24,35.0,0.0,343.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009764,MBR00000381,Professional,2021-05-30,2021-05-30,2021-07-06,PLN9255,1118885473,1118885473,ASC,In-Network,M81.0,K57.30,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,2,2528.73,915.04,880.04,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009765,MBR00000381,Professional,2021-10-21,2021-10-21,2021-12-01,PLN9407,1219817751,1219817751,OB/GYN,In-Network,Z00.00,E11.65,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,1,534.07,334.19,334.19,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009766,MBR00000381,Professional,2021-10-05,2021-10-05,2021-11-04,PLN6970,1235381502,1235381502,Cardiology,In-Network,E11.9,J06.9,,,,,,,0,,47562,Surgery,,,,11,Office,1,5248.12,1687.28,1541.02,71.26,75.0,0.0,146.26,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009767,MBR00000382,Institutional-OP,2021-09-01,2021-09-01,2021-09-29,PLN4648,1245650222,1245650222,Gastroenterology,In-Network,N39.0,I10,,,,,,,0,,99284,E&M,,,0120,22,Outpatient Hospital,2,915.3,759.5,444.11,293.64,0.0,21.75,315.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009768,MBR00000382,Institutional-OP,2022-06-29,2022-06-29,2022-08-09,PLN7718,1236418230,1236418230,DME Supplier,In-Network,E66.9,J44.1,,,,,,,0,,80053,Pathology/Lab,,,0320,22,Outpatient Hospital,2,57.42,36.67,21.67,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009769,MBR00000382,Professional,2023-11-18,2023-11-18,2023-12-07,PLN4406,1806688928,1806688928,Geriatrics,In-Network,J18.9,J06.9,,,,,,,0,,99233,E&M,,,,21,Inpatient Hospital,1,211.47,89.15,89.15,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009770,MBR00000382,Professional,2021-12-26,2021-12-26,2022-02-05,PLN4855,1645194539,1645194539,SNF,In-Network,R10.9,I10,,,,,,,0,,85610,Pathology/Lab,,,,21,Inpatient Hospital,2,34.55,24.02,0.0,24.02,0.0,0.0,24.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009771,MBR00000382,Professional,2023-03-16,2023-03-16,2023-03-29,PLN4922,1990090423,1990090423,Orthopedic Surgery,In-Network,E11.9,J20.9,,,,,,,0,,99284,E&M,,,,20,Urgent Care,1,892.5,549.99,549.99,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009772,MBR00000382,Institutional-IP,2023-03-14,2023-03-20,2023-04-16,PLN2622,1520687146,1520687146,ASC,In-Network,R51,K21.0,,,,195,MS-DRG,5,6,Y,G0439,Medicine,,,0900,21,Inpatient Hospital,2,396.99,245.62,0.0,245.62,0.0,0.0,245.62,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000009773,MBR00000382,Professional,2023-04-17,2023-04-17,2023-05-26,PLN5471,1749494482,1749494482,Pediatrics,In-Network,I10,Z23,,,,,,,0,,81001,Pathology/Lab,,,,22,Outpatient Hospital,3,35.92,21.54,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009774,MBR00000382,Institutional-OP,2022-11-13,2022-11-13,2022-12-14,PLN8264,1236418230,1236418230,DME Supplier,In-Network,E11.9,E11.65,,,,,,,0,,97530,Medicine,,,0370,22,Outpatient Hospital,1,198.32,144.34,139.48,0.0,0.0,4.86,4.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009775,MBR00000382,Institutional-IP,2023-03-22,2023-03-24,2023-05-05,PLN6140,1355166277,1355166277,Endocrinology,In-Network,F41.9,Z12.31,,,,291,MS-DRG,10,2,Y,99214,E&M,,,0510,21,Inpatient Hospital,1,197.85,139.28,139.28,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000009776,MBR00000382,Professional,2023-04-14,2023-04-14,2023-05-07,PLN9085,1540044947,1540044947,Pulmonology,Out-of-Network,E11.9,I50.9,,,,,,,0,,72148,Radiology,,,,11,Office,2,2671.2,1403.65,1403.65,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009777,MBR00000382,Professional,2023-01-18,2023-01-18,2023-02-02,PLN9356,1372918899,1372918899,Family Medicine,In-Network,Z00.00,I10,,,,,,,0,,99283,E&M,,,,23,Emergency Room,2,427.95,297.28,297.28,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009778,MBR00000382,Professional,2022-09-04,2022-09-04,2022-09-22,PLN7091,1606140917,1606140917,ASC,In-Network,J44.1,G43.909,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,1,1742.56,831.32,781.32,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000009779,MBR00000382,Institutional-OP,2021-04-10,2021-04-10,2021-05-03,PLN3231,1563980627,1563980627,Critical Access Hospital,In-Network,E78.5,E78.5,,,,,,,0,,97530,Medicine,,,0900,22,Outpatient Hospital,1,274.16,158.08,0.0,158.08,35.0,0.0,193.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009780,MBR00000382,Institutional-IP,2022-07-11,2022-07-22,2022-07-18,PLN1781,1745114564,1745114564,Endocrinology,In-Network,R51,I10,,,,291,MS-DRG,7,11,N,27130,Surgery,,,0320,21,Inpatient Hospital,2,3392.52,1406.13,1406.13,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009781,MBR00000382,Institutional-OP,2023-04-06,2023-04-06,2023-04-19,PLN6226,1809014947,1809014947,Urology,In-Network,E11.40,Z00.00,,,,,,,0,,71046,Radiology,,,0761,22,Outpatient Hospital,1,172.08,68.95,0.0,68.95,0.0,0.0,68.95,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009782,MBR00000382,Professional,2022-01-10,2022-01-10,2022-02-11,PLN7327,1168881145,1168881145,Orthopedic Surgery,In-Network,R51,K92.1,,,,,,,0,,45380,Surgery,,,,23,Emergency Room,3,1675.62,579.23,445.87,118.36,15.0,0.0,133.36,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,1,0,0,0
CLM0000009783,MBR00000382,Institutional-OP,2021-09-30,2021-09-30,2021-11-13,PLN1738,1872613201,1872613201,Internal Medicine,In-Network,F32.9,E87.6,,,,,,,0,,45380,Surgery,,,0510,22,Outpatient Hospital,1,1617.54,1052.32,853.54,163.78,35.0,0.0,198.78,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000009784,MBR00000382,Professional,2022-10-13,2022-10-13,2022-10-27,PLN4459,1236418230,1236418230,DME Supplier,In-Network,Z23,M54.5,,,,,,,0,,99214,E&M,,,,11,Office,3,269.19,206.5,131.5,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009785,MBR00000382,Professional,2021-05-25,2021-05-25,2021-06-05,PLN4665,1500037969,1500037969,Pulmonology,In-Network,Z00.01,K21.0,,,,,,,0,,99406,Medicine,,,,22,Outpatient Hospital,3,88.5,53.52,0.0,53.52,0.0,0.0,53.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009786,MBR00000382,Professional,2023-02-27,2023-02-27,2023-03-31,PLN5067,1545347862,1545347862,SNF,In-Network,M54.5,F03.90,,,,,,,0,,78452,Radiology,,,,11,Office,2,6590.56,3425.73,3059.94,230.24,50.0,85.55,365.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009787,MBR00000382,Professional,2023-12-13,2023-12-13,2024-01-13,PLN5376,1125190055,1125190055,Nephrology,In-Network,M54.5,Z12.31,,,,,,,0,,G0439,Medicine,,,,21,Inpatient Hospital,1,263.79,166.63,136.95,0.0,0.0,29.68,29.68,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000009788,MBR00000382,Professional,2022-06-15,2022-06-15,2022-07-27,PLN8234,1752470395,1752470395,Home Health,In-Network,J44.1,F32.9,,,,,,,0,,70553,Radiology,,,,81,Independent Laboratory,2,1743.78,1341.52,945.58,395.94,0.0,0.0,395.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009789,MBR00000382,Professional,2021-01-31,2021-01-31,2021-02-13,PLN6109,1860435061,1860435061,DME Supplier,In-Network,J44.1,E78.5,,,,,,,0,,99204,E&M,,,,23,Emergency Room,3,287.36,185.12,132.36,35.25,0.0,17.51,52.76,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009790,MBR00000382,Institutional-IP,2021-10-25,2021-10-29,2021-12-02,PLN2684,1486164553,1486164553,DME Supplier,In-Network,I10,E11.9,,,,195,MS-DRG,3,4,Y,45380,Surgery,,,0120,21,Inpatient Hospital,2,2897.71,2269.97,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000009791,MBR00000382,Institutional-OP,2021-02-04,2021-02-04,2021-03-04,PLN9361,1295371663,1295371663,Critical Access Hospital,In-Network,I10,E11.9,,,,,,,0,,99204,E&M,,,0761,22,Outpatient Hospital,1,296.47,107.87,107.87,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009792,MBR00000382,Institutional-OP,2022-05-18,2022-05-18,2022-06-04,PLN6719,1244186984,1244186984,Family Medicine,Out-of-Network,Z00.00,R07.9,,,,,,,0,,90686,Medicine,,,0761,22,Outpatient Hospital,1,129.2,45.02,0.0,45.02,0.0,0.0,45.02,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000009793,MBR00000382,Institutional-OP,2021-12-06,2021-12-06,2022-01-06,PLN4670,1767011137,1767011137,DME Supplier,In-Network,Z12.31,G43.909,,,,,,,0,,99232,E&M,,,0360,22,Outpatient Hospital,3,162.95,58.43,0.0,58.43,35.0,0.0,93.43,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009794,MBR00000382,Institutional-OP,2023-04-27,2023-04-27,2023-05-22,PLN1901,1422747896,1422747896,Urology,In-Network,J06.9,J44.1,,,,,,,0,,45380,Surgery,,,0320,22,Outpatient Hospital,3,1448.11,953.39,768.73,184.66,0.0,0.0,184.66,0.0,Paid,,,1,,0,0,1,0,0,1,Upcoding,0,1,0,0,0
CLM0000009795,MBR00000382,Institutional-OP,2023-07-14,2023-07-14,2023-08-13,PLN4096,1910255109,1910255109,DME Supplier,In-Network,B97.89,K21.0,,,,,,,0,,97530,Medicine,,,0740,22,Outpatient Hospital,1,194.84,96.94,71.94,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009796,MBR00000382,Professional,2022-04-22,2022-04-22,2022-05-16,PLN2264,1687650653,1687650653,Internal Medicine,In-Network,M81.0,E78.5,,,,,,,0,,99221,E&M,,,,11,Office,1,343.12,115.91,0.0,115.91,0.0,0.0,115.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009797,MBR00000382,Institutional-OP,2023-12-07,2023-12-07,2024-01-16,PLN2314,1453283987,1453283987,Critical Access Hospital,In-Network,E11.9,Z79.4,,,,,,,0,,86900,Pathology/Lab,,,0200,22,Outpatient Hospital,3,41.16,30.42,26.74,0.0,0.0,3.68,3.68,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009798,MBR00000382,Professional,2022-05-08,2022-05-08,2022-06-01,PLN7367,1845057593,1845057593,Orthopedic Surgery,In-Network,I10,J18.9,,,,,,,0,,76700,Radiology,,,,11,Office,3,704.9,536.92,55.57,418.82,50.0,12.53,481.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009799,MBR00000382,Professional,2021-05-10,2021-05-10,2021-06-09,PLN6270,1486164553,1486164553,DME Supplier,In-Network,J45.20,E78.5,,,,,,,0,,58661,Surgery,,,,20,Urgent Care,3,2143.81,1055.02,912.04,0.0,0.0,142.98,142.98,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009800,MBR00000382,Institutional-IP,2023-09-22,2023-09-25,2023-10-06,PLN8759,1856686341,1856686341,Geriatrics,In-Network,E11.65,I10,,,,603,MS-DRG,12,3,Y,99283,E&M,,,0761,21,Inpatient Hospital,3,355.19,228.46,228.46,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009801,MBR00000382,Professional,2022-03-10,2022-03-10,2022-04-06,PLN2120,1245650222,1245650222,Gastroenterology,In-Network,F32.9,Z12.31,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,1,143.57,112.46,0.0,54.64,25.0,1.54,81.18,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009802,MBR00000382,Professional,2023-08-28,2023-08-28,2023-09-30,PLN2868,1696843572,1696843572,Critical Access Hospital,Out-of-Network,E11.40,Z79.4,,,,,,,0,,99233,E&M,,,,11,Office,2,219.76,166.9,82.88,84.02,0.0,0.0,84.02,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000009803,MBR00000382,Professional,2023-03-16,2023-03-16,2023-04-03,PLN9893,1247341320,1247341320,Urology,Out-of-Network,Z00.01,Z87.891,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,2,156.86,113.13,78.13,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009804,MBR00000382,Institutional-OP,2023-10-26,2023-10-26,2023-11-18,PLN3067,1556140803,1556140803,Cardiology,In-Network,I10,E78.5,,,,,,,0,,70450,Radiology,,,0450,22,Outpatient Hospital,3,851.72,342.33,307.37,0.0,0.0,34.96,34.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009805,MBR00000382,Institutional-OP,2022-12-08,2022-12-08,2023-01-19,PLN6295,1361302520,1361302520,Critical Access Hospital,In-Network,J44.1,I10,,,,,,,0,,99283,E&M,,,0730,22,Outpatient Hospital,3,502.96,252.92,0.0,99.74,0.0,10.57,110.31,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009806,MBR00000382,Professional,2022-10-12,2022-10-12,2022-11-07,PLN7754,1571574052,1571574052,Critical Access Hospital,In-Network,G43.909,I48.91,,,,,,,0,,70450,Radiology,,,,22,Outpatient Hospital,1,1428.3,480.86,430.86,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009807,MBR00000382,Professional,2021-09-13,2021-09-13,2021-09-23,PLN1071,1644128543,1644128543,Gastroenterology,In-Network,F03.90,J06.9,,,,,,,0,,70553,Radiology,,,,11,Office,3,3506.23,1877.01,1564.68,0.0,0.0,312.33,312.33,0.0,Paid,,,1,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000009808,MBR00000382,Institutional-IP,2021-11-02,2021-11-10,2021-11-19,PLN4141,1139906830,1139906830,Endocrinology,Out-of-Network,F32.9,I48.91,,,,641,MS-DRG,16,8,Y,47562,Surgery,,,0360,21,Inpatient Hospital,3,4135.21,2535.86,2507.1,13.76,15.0,0.0,28.76,0.0,Pended,,,0,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000009809,MBR00000382,Professional,2021-12-27,2021-12-27,2022-01-31,PLN1806,1795618275,1795618275,Pulmonology,In-Network,M17.11,G43.909,,,,,,,0,,83036,Pathology/Lab,,,,23,Emergency Room,3,70.75,52.74,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,1,0,0
CLM0000009810,MBR00000382,Professional,2021-12-06,2021-12-06,2022-01-14,PLN4375,1438368327,1438368327,Home Health,In-Network,J06.9,R10.9,,,,,,,0,,93225,Medicine,,,,11,Office,2,372.02,135.21,135.21,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009811,MBR00000382,Professional,2022-10-13,2022-10-13,2022-11-24,PLN5036,1168881145,1168881145,Orthopedic Surgery,In-Network,E78.5,Z12.31,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,3,38.45,14.05,14.05,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009812,MBR00000382,Institutional-OP,2023-08-11,2023-08-11,2023-08-18,PLN2944,1727809972,1727809972,Home Health,In-Network,J20.9,K21.0,,,,,,,0,,99233,E&M,,,0730,22,Outpatient Hospital,3,308.37,151.28,137.03,0.0,0.0,14.25,14.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009813,MBR00000382,Professional,2021-02-08,2021-02-08,2021-03-07,PLN9116,1556140803,1556140803,Cardiology,In-Network,E11.9,Z79.4,,,,,,,0,,66984,Surgery,,,,50,Federally Qualified Health Center,1,2272.73,1110.04,1060.04,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009814,MBR00000382,Professional,2022-11-09,2022-11-09,2022-12-10,PLN3353,1800011727,1800011727,Clinical Laboratory,Out-of-Network,Z79.4,Z23,,,,,,,0,,97530,Medicine,,,,21,Inpatient Hospital,2,247.12,195.84,195.84,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000009815,MBR00000382,Professional,2023-04-11,2023-04-11,2023-05-16,PLN8186,1631954542,1631954542,Oncology,In-Network,F32.9,I50.9,,,,,,,0,,47562,Surgery,,,,11,Office,2,3802.88,2750.02,2561.0,189.02,0.0,0.0,189.02,0.0,Adjusted,,,0,,0,0,1,0,0,1,Duplicate,0,0,0,0,0
CLM0000009816,MBR00000382,Professional,2022-05-01,2022-05-01,2022-06-03,PLN9832,1865904917,1865904917,Outpatient Clinic,In-Network,S72.001A,Z23,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,3,411.02,210.25,0.0,210.25,0.0,0.0,210.25,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009817,MBR00000383,Professional,2021-10-29,2021-10-29,2021-12-08,PLN5475,1590915516,1590915516,Physical Therapy,Out-of-Network,Z79.4,J44.1,,,,,,,0,,99233,E&M,,,,11,Office,3,558.95,180.32,145.32,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009818,MBR00000383,Institutional-IP,2022-04-19,2022-04-23,2022-04-30,PLN1532,1590915516,1590915516,Physical Therapy,Out-of-Network,J20.9,M17.11,,,,195,MS-DRG,11,4,U,85610,Pathology/Lab,,,0200,21,Inpatient Hospital,1,33.55,15.53,15.53,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009819,MBR00000383,Institutional-OP,2023-06-27,2023-06-27,2023-08-01,PLN1667,1964402759,1964402759,Outpatient Clinic,In-Network,G43.909,Z96.641,,,,,,,0,,99221,E&M,,,0301,22,Outpatient Hospital,1,410.38,341.71,341.71,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009820,MBR00000383,Professional,2023-09-29,2023-09-29,2023-10-15,PLN8741,1891849440,1891849440,Oncology,In-Network,K92.1,Z00.01,,,,,,,0,,66984,Surgery,,,,81,Independent Laboratory,1,1917.57,988.22,988.22,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009821,MBR00000383,Professional,2023-01-19,2023-01-19,2023-01-27,PLN3599,1860435061,1860435061,DME Supplier,In-Network,J06.9,J45.20,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,2,2035.02,618.5,618.5,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,1,Upcoding,0,1,0,0,0
CLM0000009822,MBR00000383,Professional,2022-06-16,2022-06-16,2022-07-15,PLN3593,1500037969,1500037969,Pulmonology,In-Network,E11.65,G43.909,,,,,,,0,,93225,Medicine,,,,22,Outpatient Hospital,2,461.3,223.12,153.09,0.0,35.0,35.03,70.03,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009823,MBR00000383,Institutional-OP,2022-12-08,2022-12-08,2023-01-04,PLN6593,1273488618,1273488618,General Acute Care Hospital,In-Network,R51,J20.9,,,,,,,0,,78452,Radiology,,,0636,22,Outpatient Hospital,3,3542.04,1957.43,0.0,72.7,35.0,0.0,107.7,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009824,MBR00000383,Professional,2023-01-12,2023-01-12,2023-02-13,PLN1335,1745114564,1745114564,Endocrinology,In-Network,Z00.00,M17.11,,,,,,,0,,G0468,Medicine,,,,11,Office,2,317.32,265.39,215.39,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009825,MBR00000383,Institutional-OP,2023-04-21,2023-04-21,2023-05-07,PLN9256,1486164553,1486164553,DME Supplier,In-Network,F32.9,J18.9,,,,,,,0,,99232,E&M,,,0320,22,Outpatient Hospital,1,233.76,147.62,147.62,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000009826,MBR00000383,Institutional-OP,2021-06-08,2021-06-08,2021-07-22,PLN8003,1268679390,1268679390,Critical Access Hospital,In-Network,I10,E66.9,,,,,,,0,,90686,Medicine,,,0270,22,Outpatient Hospital,1,64.06,51.7,0.0,51.7,0.0,0.0,51.7,0.0,Pended,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000009827,MBR00000383,Institutional-OP,2021-03-24,2021-03-24,2021-04-22,PLN9498,1948810580,1948810580,DME Supplier,In-Network,M54.5,Z23,,,,,,,0,,99214,E&M,,,0730,22,Outpatient Hospital,2,314.26,94.68,79.68,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009828,MBR00000383,Institutional-OP,2022-01-14,2022-01-14,2022-02-20,PLN3525,1644128543,1644128543,Gastroenterology,In-Network,E66.9,Z87.891,,,,,,,0,,99203,E&M,,,0730,22,Outpatient Hospital,1,366.04,191.29,0.0,191.29,15.0,0.0,206.29,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000009829,MBR00000383,Professional,2021-10-12,2021-10-12,2021-11-06,PLN9108,1395983630,1395983630,Nephrology,In-Network,E11.9,I10,,,,,,,0,,90460,Medicine,,,,81,Independent Laboratory,1,70.44,59.31,0.0,59.31,0.0,0.0,59.31,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009830,MBR00000383,Institutional-IP,2022-11-05,2022-11-11,2022-12-08,PLN9705,1767011137,1767011137,DME Supplier,In-Network,Z00.00,Z12.31,,,,195,MS-DRG,14,6,Y,45378,Surgery,,,0900,21,Inpatient Hospital,2,2469.51,1489.35,1414.35,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000009831,MBR00000383,Institutional-OP,2022-07-26,2022-07-26,2022-09-02,PLN8084,1865904917,1865904917,Outpatient Clinic,In-Network,Z23,Z79.4,,,,,,,0,,23472,Surgery,,,0740,22,Outpatient Hospital,3,5032.68,1956.42,1621.62,101.76,35.0,198.04,334.8,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009832,MBR00000383,Institutional-IP,2023-10-03,2023-10-10,2023-10-30,PLN2814,1108115157,1108115157,General Acute Care Hospital,In-Network,I48.91,I25.10,,,,292,MS-DRG,15,7,N,71046,Radiology,,,0120,21,Inpatient Hospital,3,123.52,69.87,19.87,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009833,MBR00000383,Institutional-OP,2023-05-01,2023-05-01,2023-05-15,PLN3659,1997536841,1997536841,Family Medicine,Out-of-Network,I10,F41.9,,,,,,,0,,83036,Pathology/Lab,,,0200,22,Outpatient Hospital,2,83.04,33.8,15.74,0.0,15.0,3.06,18.06,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000009834,MBR00000383,Institutional-OP,2021-06-11,2021-06-11,2021-06-26,PLN6304,1689639685,1689639685,SNF,In-Network,I25.10,E78.5,,,,,,,0,,27447,Surgery,,,0360,22,Outpatient Hospital,2,4011.48,2310.9,2275.9,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009835,MBR00000383,Institutional-IP,2023-07-19,2023-07-20,2023-08-28,PLN3892,1644128543,1644128543,Gastroenterology,In-Network,J18.9,E11.9,,,,690,MS-DRG,13,1,Y,80053,Pathology/Lab,,,0900,21,Inpatient Hospital,3,156.26,84.0,82.19,0.0,0.0,1.81,1.81,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009836,MBR00000383,Institutional-IP,2023-04-24,2023-05-08,2023-05-29,PLN4863,1915531927,1915531927,Critical Access Hospital,In-Network,J20.9,I25.10,,,,641,MS-DRG,19,14,Y,74177,Radiology,,,0120,21,Inpatient Hospital,2,1867.23,1472.65,1422.65,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009837,MBR00000383,Institutional-IP,2022-02-23,2022-03-03,2022-03-05,PLN3200,1295371663,1295371663,Critical Access Hospital,In-Network,R10.9,Z12.31,,,,872,MS-DRG,4,8,N,G0444,Medicine,,,0270,21,Inpatient Hospital,2,86.17,51.57,51.57,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000009838,MBR00000383,Professional,2021-03-05,2021-03-05,2021-04-11,PLN1473,1135158374,1135158374,Pulmonology,In-Network,N40.0,G43.909,,,,,,,0,,93225,Medicine,,,,11,Office,2,986.24,568.04,545.9,22.14,0.0,0.0,22.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009839,MBR00000383,Professional,2023-05-20,2023-05-20,2023-06-21,PLN8163,1186826716,1186826716,Physical Therapy,In-Network,Z12.31,F41.9,,,,,,,0,,77067,Radiology,,,,49,Independent Clinic,1,696.04,327.47,291.81,0.0,15.0,20.66,35.66,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000009840,MBR00000383,Institutional-IP,2021-07-31,2021-08-02,2021-09-05,PLN9291,1284035364,1284035364,Pediatrics,In-Network,Z51.11,J44.1,,,,872,MS-DRG,4,2,Y,84443,Pathology/Lab,,,0740,21,Inpatient Hospital,3,165.57,78.43,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009841,MBR00000383,Institutional-OP,2021-08-30,2021-08-30,2021-09-07,PLN4430,1845900543,1845900543,ASC,In-Network,N39.0,Z00.00,,,,,,,0,,99213,E&M,,,0360,22,Outpatient Hospital,2,325.43,262.14,219.37,0.0,0.0,42.77,42.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009842,MBR00000383,Institutional-OP,2022-05-31,2022-05-31,2022-06-14,PLN1673,1475984649,1475984649,SNF,In-Network,I11.9,M54.5,,,,,,,0,,80061,Pathology/Lab,,,0301,22,Outpatient Hospital,1,119.4,62.56,62.56,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009843,MBR00000383,Professional,2021-04-01,2021-04-01,2021-04-09,PLN3320,1475984649,1475984649,SNF,In-Network,N20.0,E78.5,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,3,259.53,204.71,154.71,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009844,MBR00000383,Institutional-OP,2022-03-14,2022-03-14,2022-04-21,PLN2340,1631954542,1631954542,Oncology,In-Network,I10,J20.9,,,,,,,0,,23472,Surgery,,,0510,22,Outpatient Hospital,1,4532.93,2409.98,1937.83,0.0,25.0,447.15,472.15,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009845,MBR00000383,Professional,2021-09-28,2021-09-28,2021-10-20,PLN5019,1511044648,1511044648,Endocrinology,In-Network,E11.9,R05,,,,,,,0,,45378,Surgery,,,,20,Urgent Care,2,2016.92,1383.84,840.73,493.11,50.0,0.0,543.11,0.0,Adjusted,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000009846,MBR00000383,Institutional-IP,2021-02-28,2021-03-03,2021-03-11,PLN4740,1395983630,1395983630,Nephrology,In-Network,K21.0,E11.65,,,,291,MS-DRG,2,3,Y,70450,Radiology,,,0301,21,Inpatient Hospital,2,1811.1,1459.04,1374.93,0.0,35.0,49.11,84.11,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009847,MBR00000383,Institutional-OP,2023-09-16,2023-09-16,2023-10-28,PLN3728,1545347862,1545347862,SNF,In-Network,Z12.31,F10.20,,,,,,,0,,99233,E&M,,,0370,22,Outpatient Hospital,1,324.44,254.4,254.4,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009848,MBR00000383,Institutional-OP,2021-10-13,2021-10-13,2021-11-09,PLN2785,1244186984,1244186984,Family Medicine,Out-of-Network,E78.5,N40.0,,,,,,,0,,99204,E&M,,,0120,22,Outpatient Hospital,1,298.22,192.27,192.27,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009849,MBR00000383,Institutional-IP,2022-08-19,2022-08-23,2022-10-02,PLN7727,1752470395,1752470395,Home Health,In-Network,N20.0,I10,,,,872,MS-DRG,11,4,Y,90460,Medicine,,,0740,21,Inpatient Hospital,1,65.34,39.73,0.0,39.73,0.0,0.0,39.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009850,MBR00000383,Institutional-IP,2023-06-14,2023-06-22,2023-06-26,PLN3389,1997536841,1997536841,Family Medicine,Out-of-Network,F32.9,F32.9,,,,470,MS-DRG,23,8,Y,99222,E&M,,,0320,21,Inpatient Hospital,1,257.04,78.98,60.27,18.71,0.0,0.0,18.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009851,MBR00000383,Professional,2022-06-12,2022-06-12,2022-06-23,PLN1915,1334916761,1334916761,ASC,In-Network,J06.9,I50.9,,,,,,,0,,93000,Radiology,,,,21,Inpatient Hospital,1,155.1,121.16,0.0,121.16,15.0,0.0,136.16,0.0,Paid,,,1,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000009852,MBR00000383,Institutional-OP,2021-11-17,2021-11-17,2021-12-11,PLN1803,1273488618,1273488618,General Acute Care Hospital,In-Network,I10,N39.0,,,,,,,0,,43239,Surgery,,,0120,22,Outpatient Hospital,1,1699.48,642.08,515.0,127.08,0.0,0.0,127.08,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009853,MBR00000383,Professional,2023-03-25,2023-03-25,2023-04-16,PLN1688,1219817751,1219817751,OB/GYN,In-Network,J18.9,Z00.01,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,2,683.03,335.07,324.17,0.0,0.0,10.9,10.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009854,MBR00000383,Professional,2023-01-28,2023-01-28,2023-03-13,PLN4664,1910255109,1910255109,DME Supplier,In-Network,R10.9,F32.9,,,,,,,0,,99284,E&M,,,,11,Office,2,553.18,387.92,0.0,0.0,35.0,47.42,82.42,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009855,MBR00000383,Institutional-OP,2021-01-12,2021-01-12,2021-01-23,PLN5530,1644128543,1644128543,Gastroenterology,In-Network,R51,N39.0,,,,,,,0,,85025,Pathology/Lab,,,0360,22,Outpatient Hospital,3,36.86,21.28,21.28,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009856,MBR00000383,Professional,2023-06-16,2023-06-16,2023-07-09,PLN7007,1749494482,1749494482,Pediatrics,In-Network,Z12.31,I10,,,,,,,0,,99221,E&M,,,,50,Federally Qualified Health Center,2,338.96,105.99,0.0,105.99,75.0,0.0,180.99,0.0,Pended,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000009857,MBR00000384,Institutional-IP,2021-05-10,2021-05-16,2021-06-12,PLN2647,1795618275,1795618275,Pulmonology,In-Network,Z12.31,Z12.31,,,,470,MS-DRG,21,6,Y,99284,E&M,,,0320,21,Inpatient Hospital,2,485.15,174.72,69.58,90.91,0.0,14.23,105.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009858,MBR00000384,Professional,2023-03-19,2023-03-19,2023-04-30,PLN1536,1939033455,1939033455,Pulmonology,In-Network,N20.0,Z12.31,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,1,82.24,58.16,52.41,0.0,0.0,5.75,5.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000009859,MBR00000384,Professional,2021-04-20,2021-04-20,2021-05-01,PLN7836,1463205530,1463205530,Nephrology,In-Network,Z00.01,I10,,,,,,,0,,99406,Medicine,,,,22,Outpatient Hospital,1,81.21,47.54,0.0,0.0,25.0,2.81,27.81,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009860,MBR00000384,Professional,2021-03-13,2021-03-13,2021-03-27,PLN5889,1545347862,1545347862,SNF,In-Network,E11.9,M17.11,,,,,,,0,,78452,Radiology,,,,11,Office,2,3586.83,2240.37,1870.52,369.85,0.0,0.0,369.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009861,MBR00000384,Professional,2021-05-14,2021-05-14,2021-06-13,PLN1995,1198133277,1198133277,SNF,In-Network,I10,I10,,,,,,,0,,58661,Surgery,,,,12,Home,3,2114.02,744.5,719.5,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009862,MBR00000384,Professional,2023-03-23,2023-03-23,2023-04-16,PLN7339,1689639685,1689639685,SNF,In-Network,I25.10,I10,,,,,,,0,,45380,Surgery,,,,49,Independent Clinic,1,1638.84,627.23,546.92,0.0,0.0,80.31,80.31,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000009863,MBR00000384,Institutional-IP,2022-05-12,2022-05-13,2022-05-27,PLN1151,1475984649,1475984649,SNF,In-Network,Z23,N18.3,,,,683,MS-DRG,20,1,Y,87491,Pathology/Lab,,,0200,21,Inpatient Hospital,3,199.22,96.15,0.0,96.15,0.0,0.0,96.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009864,MBR00000384,Institutional-IP,2022-10-21,2022-10-26,2022-11-02,PLN7074,1800011727,1800011727,Clinical Laboratory,Out-of-Network,E11.65,Z51.11,,,,470,MS-DRG,8,5,Y,99283,E&M,,,0301,21,Inpatient Hospital,3,531.64,177.74,173.51,0.0,0.0,4.23,4.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009865,MBR00000384,Professional,2021-11-04,2021-11-04,2021-11-15,PLN5459,1717546253,1717546253,Family Medicine,In-Network,E11.9,Z00.00,,,,,,,0,,99284,E&M,,,,49,Independent Clinic,2,356.45,227.19,0.0,227.19,0.0,0.0,227.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009866,MBR00000384,Institutional-OP,2021-05-12,2021-05-12,2021-06-17,PLN7448,1410468316,1410468316,SNF,In-Network,F10.20,F32.9,,,,,,,0,,86900,Pathology/Lab,,,0120,22,Outpatient Hospital,2,33.18,10.24,8.93,0.0,0.0,1.31,1.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009867,MBR00000384,Institutional-OP,2023-05-11,2023-05-11,2023-05-27,PLN3543,1899127912,1899127912,Neurology,In-Network,Z23,I10,,,,,,,0,,93225,Medicine,,,0270,22,Outpatient Hospital,2,959.1,644.17,0.0,232.33,0.0,0.0,232.33,0.0,Denied,CO-27,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000009868,MBR00000384,Institutional-IP,2023-07-01,2023-07-04,2023-07-09,PLN1143,1609138981,1609138981,Critical Access Hospital,In-Network,I10,R07.9,,,,196,MS-DRG,23,3,Y,G0439,Medicine,,,0636,21,Inpatient Hospital,3,289.66,121.27,0.0,121.27,0.0,0.0,121.27,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000009869,MBR00000384,Institutional-IP,2023-07-08,2023-07-11,2023-08-02,PLN5833,1486164553,1486164553,DME Supplier,In-Network,J06.9,E78.5,,,,641,MS-DRG,7,3,Y,23472,Surgery,,,0270,21,Inpatient Hospital,2,7238.78,4355.58,4079.87,0.0,0.0,275.71,275.71,0.0,Paid,,,0,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000009870,MBR00000384,Institutional-IP,2021-03-13,2021-03-15,2021-03-26,PLN4075,1790497490,1790497490,OB/GYN,In-Network,Z00.00,K21.0,,,,470,MS-DRG,5,2,N,G0444,Medicine,,,0200,21,Inpatient Hospital,3,36.56,16.83,16.83,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000009871,MBR00000384,Professional,2023-10-10,2023-10-10,2023-11-09,PLN9193,1247341320,1247341320,Urology,Out-of-Network,K21.0,E78.5,,,,,,,0,,99204,E&M,,,,11,Office,2,419.24,165.84,0.0,165.84,0.0,0.0,165.84,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009872,MBR00000384,Professional,2022-08-17,2022-08-17,2022-08-28,PLN3379,1486164553,1486164553,DME Supplier,In-Network,Z12.31,E66.9,,,,,,,0,,99203,E&M,,,,11,Office,1,363.43,274.28,274.28,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009873,MBR00000384,Professional,2021-08-03,2021-08-03,2021-08-24,PLN9331,1450094833,1450094833,Outpatient Clinic,In-Network,I10,F41.9,,,,,,,0,,45380,Surgery,,,,11,Office,3,3000.53,1607.1,1582.1,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000009874,MBR00000384,Institutional-OP,2021-08-06,2021-08-06,2021-09-02,PLN9531,1389336600,1389336600,Critical Access Hospital,In-Network,Z79.4,B97.89,,,,,,,0,,72148,Radiology,,,0761,22,Outpatient Hospital,1,1888.77,1275.59,1275.59,0.0,0.0,0.0,0.0,0.0,Adjusted,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009875,MBR00000384,Professional,2022-07-05,2022-07-05,2022-08-16,PLN8151,1990090423,1990090423,Orthopedic Surgery,In-Network,F32.9,J06.9,,,,,,,0,,99213,E&M,,,,11,Office,3,324.87,166.32,0.0,166.32,50.0,0.0,216.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009876,MBR00000385,Institutional-OP,2022-10-23,2022-10-23,2022-10-31,PLN4654,1795618275,1795618275,Pulmonology,In-Network,I25.10,E11.65,,,,,,,0,,70553,Radiology,,,0301,22,Outpatient Hospital,2,4648.0,1514.5,877.6,431.29,15.0,190.61,636.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009877,MBR00000385,Professional,2021-02-23,2021-02-23,2021-03-12,PLN1151,1186826716,1186826716,Physical Therapy,In-Network,Z23,Z12.31,,,,,,,0,,99233,E&M,,,,11,Office,3,286.11,232.28,0.0,232.28,0.0,0.0,232.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009878,MBR00000385,Professional,2022-06-28,2022-06-28,2022-07-06,PLN2971,1809014947,1809014947,Urology,In-Network,I11.9,I10,,,,,,,0,,97110,Medicine,,,,50,Federally Qualified Health Center,2,111.88,68.21,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009879,MBR00000385,Professional,2021-09-20,2021-09-20,2021-10-17,PLN7403,1118885473,1118885473,ASC,In-Network,N20.0,N39.0,,,,,,,0,,93306,Radiology,,,,11,Office,3,2677.56,906.06,0.0,303.07,0.0,0.0,303.07,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009880,MBR00000385,Institutional-OP,2023-10-03,2023-10-03,2023-10-21,PLN9324,1872613201,1872613201,Internal Medicine,In-Network,M54.5,E11.9,,,,,,,0,,G0439,Medicine,,,0900,22,Outpatient Hospital,2,401.0,323.28,117.97,183.39,0.0,21.92,205.31,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000009881,MBR00000385,Professional,2022-11-05,2022-11-05,2022-11-16,PLN6024,1114982472,1114982472,Orthopedic Surgery,In-Network,Z79.4,Z12.31,,,,,,,0,,72148,Radiology,,,,21,Inpatient Hospital,1,2333.2,1714.57,1382.49,0.0,0.0,332.08,332.08,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009882,MBR00000385,Institutional-IP,2022-02-12,2022-02-13,2022-03-02,PLN7616,1550154147,1550154147,Outpatient Clinic,In-Network,M81.0,E11.9,,,,196,MS-DRG,11,1,N,85610,Pathology/Lab,,,0320,21,Inpatient Hospital,1,27.7,18.95,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009883,MBR00000385,Institutional-IP,2022-04-08,2022-04-15,2022-05-06,PLN4320,1103747954,1103747954,Urology,In-Network,R07.9,E11.9,,,,683,MS-DRG,13,7,Y,90837,Medicine,,,0370,21,Inpatient Hospital,3,218.87,141.7,0.0,141.7,50.0,0.0,191.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009884,MBR00000385,Professional,2023-07-06,2023-07-06,2023-07-20,PLN9466,1856686341,1856686341,Geriatrics,In-Network,G20,N18.3,,,,,,,0,,23472,Surgery,,,,11,Office,1,5496.5,3035.87,2592.92,367.95,75.0,0.0,442.95,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009885,MBR00000385,Institutional-OP,2023-01-27,2023-01-27,2023-02-12,PLN1596,1433937353,1433937353,Nephrology,In-Network,E78.5,I10,,,,,,,0,,45380,Surgery,,,0730,22,Outpatient Hospital,3,1642.46,1325.94,1325.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000009886,MBR00000385,Institutional-OP,2022-03-01,2022-03-01,2022-04-04,PLN2474,1990090423,1990090423,Orthopedic Surgery,In-Network,M54.5,R51,,,,,,,0,,27130,Surgery,,,0200,22,Outpatient Hospital,1,4550.45,2366.63,2366.63,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009887,MBR00000385,Institutional-IP,2023-07-08,2023-07-11,2023-07-18,PLN3472,1845057593,1845057593,Orthopedic Surgery,In-Network,R10.9,Z23,,,,603,MS-DRG,5,3,Y,27447,Surgery,,,0301,21,Inpatient Hospital,3,4031.76,2842.94,2380.61,0.0,0.0,462.33,462.33,0.0,Paid,,,0,,0,0,1,0,0,1,Unbundling,0,0,0,0,0
CLM0000009888,MBR00000385,Professional,2022-11-12,2022-11-12,2022-12-01,PLN5595,1757138478,1757138478,Pediatrics,In-Network,E78.5,Z12.11,,,,,,,0,,99204,E&M,,,,20,Urgent Care,3,451.75,350.0,335.0,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009889,MBR00000385,Institutional-OP,2021-03-07,2021-03-07,2021-04-15,PLN8353,1609526529,1609526529,Psychiatry,In-Network,F32.9,E78.5,,,,,,,0,,97530,Medicine,,,0320,22,Outpatient Hospital,1,208.67,131.23,118.89,0.0,0.0,12.34,12.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009890,MBR00000385,Institutional-OP,2022-11-22,2022-11-22,2022-12-23,PLN9349,1213165847,1213165847,Critical Access Hospital,In-Network,Z12.31,I50.9,,,,,,,0,,45378,Surgery,,,0360,22,Outpatient Hospital,2,2279.68,1275.52,0.0,0.0,50.0,0.0,50.0,0.0,Denied,PR-1,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000009891,MBR00000385,Institutional-OP,2023-10-25,2023-10-25,2023-11-16,PLN5062,1691062876,1691062876,SNF,In-Network,Z23,M17.11,,,,,,,0,,77067,Radiology,,,0120,22,Outpatient Hospital,1,345.73,130.12,95.12,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000009892,MBR00000385,Professional,2023-08-04,2023-08-04,2023-09-01,PLN6852,1585582070,1585582070,Outpatient Clinic,In-Network,I10,Z23,,,,,,,0,,99283,E&M,,,,11,Office,3,261.13,174.96,0.0,136.45,50.0,0.0,186.45,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009893,MBR00000385,Institutional-OP,2021-02-16,2021-02-16,2021-03-02,PLN8506,1438368327,1438368327,Home Health,In-Network,Z12.31,E78.5,,,,,,,0,,90686,Medicine,,,0120,22,Outpatient Hospital,1,103.09,50.24,0.0,50.24,25.0,0.0,75.24,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000009894,MBR00000386,Institutional-OP,2023-08-24,2023-08-24,2023-09-03,PLN7680,1334916761,1334916761,ASC,In-Network,M54.5,E11.9,,,,,,,0,,99232,E&M,,,0320,22,Outpatient Hospital,2,361.41,305.03,0.0,305.03,0.0,0.0,305.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009895,MBR00000386,Professional,2023-12-11,2023-12-11,2024-01-21,PLN1120,1545347862,1545347862,SNF,In-Network,F32.9,N17.9,,,,,,,0,,47562,Surgery,,,,11,Office,1,5927.8,4837.85,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009896,MBR00000386,Institutional-OP,2021-06-28,2021-06-28,2021-08-09,PLN7004,1410468316,1410468316,SNF,In-Network,I48.91,N17.9,,,,,,,0,,93225,Medicine,,,0761,22,Outpatient Hospital,3,509.39,228.72,157.41,0.0,35.0,36.31,71.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009897,MBR00000386,Professional,2022-11-30,2022-11-30,2022-12-07,PLN3089,1395983630,1395983630,Nephrology,In-Network,N18.3,M54.5,,,,,,,0,,99214,E&M,,,,11,Office,2,400.28,245.69,220.69,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009898,MBR00000386,Professional,2023-04-07,2023-04-07,2023-04-25,PLN7584,1609526529,1609526529,Psychiatry,In-Network,E66.9,E78.5,,,,,,,0,,83036,Pathology/Lab,,,,20,Urgent Care,3,69.96,29.05,0.0,29.05,75.0,0.0,104.05,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000009899,MBR00000386,Institutional-IP,2021-02-17,2021-02-20,2021-03-16,PLN6778,1968299309,1968299309,Internal Medicine,In-Network,E11.9,Z23,,,,683,MS-DRG,3,3,Y,87491,Pathology/Lab,,,0636,21,Inpatient Hospital,2,186.98,124.38,49.38,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009900,MBR00000386,Professional,2023-06-26,2023-06-26,2023-08-09,PLN2684,1219817751,1219817751,OB/GYN,In-Network,Z79.4,Z23,,,,,,,0,,47562,Surgery,,,,11,Office,2,2662.67,2219.19,2219.19,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009901,MBR00000386,Professional,2022-03-08,2022-03-08,2022-03-21,PLN5281,1186826716,1186826716,Physical Therapy,In-Network,Z00.00,Z12.31,,,,,,,0,,43239,Surgery,,,,49,Independent Clinic,3,1305.44,442.92,377.14,33.35,0.0,32.43,65.78,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009902,MBR00000386,Institutional-IP,2021-11-24,2021-11-29,2021-12-21,PLN6844,1727809972,1727809972,Home Health,In-Network,Z23,J44.1,,,,195,MS-DRG,16,5,Y,87491,Pathology/Lab,,,0730,21,Inpatient Hospital,3,249.14,113.99,66.0,9.38,35.0,3.61,47.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009903,MBR00000386,Institutional-OP,2021-10-10,2021-10-10,2021-10-30,PLN7860,1528335731,1528335731,Critical Access Hospital,In-Network,E78.5,C50.912,,,,,,,0,,97110,Medicine,,,0270,22,Outpatient Hospital,1,225.62,143.45,0.0,143.45,0.0,0.0,143.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009904,MBR00000386,Professional,2022-07-08,2022-07-08,2022-07-17,PLN1236,1564502315,1564502315,ASC,In-Network,Z12.11,J06.9,,,,,,,0,,99221,E&M,,,,49,Independent Clinic,2,255.29,89.21,89.21,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009905,MBR00000386,Professional,2023-05-25,2023-05-25,2023-06-20,PLN5791,1749494482,1749494482,Pediatrics,In-Network,Z12.31,F32.9,,,,,,,0,,99203,E&M,,,,11,Office,2,235.01,150.53,150.53,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009906,MBR00000386,Professional,2023-06-19,2023-06-19,2023-07-11,PLN6403,1372918899,1372918899,Family Medicine,In-Network,E11.9,Z00.00,,,,,,,0,,99284,E&M,,,,31,Skilled Nursing Facility,3,345.44,257.94,212.44,0.0,0.0,45.5,45.5,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000009907,MBR00000386,Professional,2021-09-04,2021-09-04,2021-09-22,PLN6182,1991459367,1991459367,Neurology,Out-of-Network,I10,J44.1,,,,,,,0,,97110,Medicine,,,,22,Outpatient Hospital,2,148.46,83.65,33.65,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009908,MBR00000386,Institutional-OP,2023-06-25,2023-06-25,2023-07-09,PLN2658,1964402759,1964402759,Outpatient Clinic,In-Network,E78.5,J06.9,,,,,,,0,,93306,Radiology,,,0730,22,Outpatient Hospital,1,2614.76,994.11,886.51,0.0,0.0,107.6,107.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009909,MBR00000386,Professional,2023-06-24,2023-06-24,2023-07-06,PLN9598,1486164553,1486164553,DME Supplier,In-Network,J06.9,I10,,,,,,,0,,33533,Surgery,,,,11,Office,1,13627.72,6736.75,6718.35,18.4,0.0,0.0,18.4,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000009910,MBR00000386,Institutional-IP,2021-03-09,2021-03-10,2021-04-09,PLN4127,1168881145,1168881145,Orthopedic Surgery,In-Network,Z12.31,Z00.00,,,,872,MS-DRG,8,1,Y,99233,E&M,,,0270,21,Inpatient Hospital,1,234.55,91.42,91.42,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000009911,MBR00000386,Professional,2021-12-09,2021-12-09,2022-01-19,PLN8651,1219817751,1219817751,OB/GYN,In-Network,F41.9,E78.5,,,,,,,0,,27447,Surgery,,,,21,Inpatient Hospital,1,4452.13,3504.02,3504.02,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009912,MBR00000386,Institutional-OP,2021-01-17,2021-01-17,2021-02-05,PLN4503,1148984206,1148984206,Psychiatry,In-Network,F41.9,M17.11,,,,,,,0,,78452,Radiology,,,0636,22,Outpatient Hospital,2,4872.66,2964.52,2706.33,258.19,0.0,0.0,258.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009913,MBR00000386,Professional,2023-12-20,2023-12-20,2024-01-12,PLN8912,1915531927,1915531927,Critical Access Hospital,In-Network,J44.1,E11.9,,,,,,,0,,99204,E&M,,,,23,Emergency Room,3,221.67,155.23,0.0,155.23,25.0,0.0,180.23,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009914,MBR00000386,Institutional-OP,2022-06-02,2022-06-02,2022-07-10,PLN8219,1687650653,1687650653,Internal Medicine,In-Network,E66.9,I10,,,,,,,0,,47562,Surgery,,,0360,22,Outpatient Hospital,1,6485.55,3930.77,3930.77,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000009915,MBR00000386,Institutional-IP,2021-10-24,2021-10-28,2021-11-01,PLN1995,1575695214,1575695214,SNF,In-Network,I11.9,N18.3,,,,871,MS-DRG,17,4,Y,99221,E&M,,,0510,21,Inpatient Hospital,3,385.04,321.29,276.7,0.0,25.0,19.59,44.59,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009916,MBR00000386,Institutional-OP,2023-09-07,2023-09-07,2023-10-03,PLN1288,1433937353,1433937353,Nephrology,In-Network,Z12.31,I25.10,,,,,,,0,,80061,Pathology/Lab,,,0740,22,Outpatient Hospital,3,101.96,84.72,34.72,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009917,MBR00000386,Professional,2023-01-21,2023-01-21,2023-03-02,PLN9494,1227362142,1227362142,DME Supplier,In-Network,J06.9,Z23,,,,,,,0,,99222,E&M,,,,21,Inpatient Hospital,3,446.18,251.74,45.42,131.32,75.0,0.0,206.32,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000009918,MBR00000386,Institutional-OP,2023-10-27,2023-10-27,2023-12-07,PLN1745,1691062876,1691062876,SNF,In-Network,I11.9,S72.001A,,,,,,,0,,93225,Medicine,,,0370,22,Outpatient Hospital,2,753.39,265.7,0.0,265.7,0.0,0.0,265.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009919,MBR00000386,Professional,2023-05-27,2023-05-27,2023-07-10,PLN4941,1935547131,1935547131,Pulmonology,In-Network,J20.9,I25.10,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,3,198.63,139.8,139.8,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009920,MBR00000386,Institutional-IP,2023-11-13,2023-11-19,2023-11-20,PLN7545,1125190055,1125190055,Nephrology,In-Network,M54.5,E66.9,,,,872,MS-DRG,23,6,Y,99204,E&M,,,0450,21,Inpatient Hospital,1,296.59,200.19,175.1,0.0,0.0,25.09,25.09,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009921,MBR00000386,Institutional-IP,2021-08-26,2021-08-30,2021-09-11,PLN1622,1624202402,1624202402,Orthopedic Surgery,In-Network,E78.5,R51,,,,603,MS-DRG,2,4,Y,47562,Surgery,,,0270,21,Inpatient Hospital,2,5355.26,3084.1,3049.1,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009922,MBR00000386,Professional,2021-08-12,2021-08-12,2021-09-16,PLN6033,1990090423,1990090423,Orthopedic Surgery,In-Network,E66.9,M17.11,,,,,,,0,,99283,E&M,,,,21,Inpatient Hospital,3,636.93,249.2,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009923,MBR00000386,Professional,2021-03-24,2021-03-24,2021-05-04,PLN3975,1702692193,1702692193,Physical Therapy,In-Network,F03.90,Z23,,,,,,,0,,70450,Radiology,,,,22,Outpatient Hospital,1,1191.22,900.5,721.87,103.63,75.0,0.0,178.63,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009924,MBR00000386,Professional,2022-01-11,2022-01-11,2022-02-04,PLN6470,1148984206,1148984206,Psychiatry,In-Network,Z23,M17.11,,,,,,,0,,78452,Radiology,,,,11,Office,1,7135.77,2549.72,2016.56,252.89,0.0,280.27,533.16,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009925,MBR00000386,Institutional-OP,2022-08-27,2022-08-27,2022-09-18,PLN9634,1622771872,1622771872,Pediatrics,In-Network,Z23,E78.5,,,,,,,0,,87491,Pathology/Lab,,,0301,22,Outpatient Hospital,1,151.85,65.73,65.73,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009926,MBR00000386,Professional,2022-09-11,2022-09-11,2022-10-25,PLN7570,1514306773,1514306773,Endocrinology,In-Network,G43.909,I10,,,,,,,0,,70553,Radiology,,,,21,Inpatient Hospital,3,2497.21,1579.33,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009927,MBR00000386,Professional,2023-01-12,2023-01-12,2023-02-03,PLN2045,1713934949,1713934949,Neurology,In-Network,Z12.31,I10,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,3,446.14,249.25,249.25,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009928,MBR00000386,Institutional-OP,2023-03-14,2023-03-14,2023-03-30,PLN2715,1624802371,1624802371,ASC,Out-of-Network,K92.1,I10,,,,,,,0,,27447,Surgery,,,0900,22,Outpatient Hospital,3,4763.84,3622.99,3523.68,99.31,0.0,0.0,99.31,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009929,MBR00000386,Institutional-OP,2023-06-14,2023-06-14,2023-07-28,PLN6876,1716521444,1716521444,Oncology,In-Network,Z00.00,F41.9,,,,,,,0,,93225,Medicine,,,0900,22,Outpatient Hospital,3,641.19,488.51,213.71,249.8,25.0,0.0,274.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009930,MBR00000386,Professional,2022-07-24,2022-07-24,2022-08-12,PLN6566,1114982472,1114982472,Orthopedic Surgery,In-Network,F41.9,I25.10,,,,,,,0,,99203,E&M,,,,11,Office,2,147.96,55.58,0.0,55.58,0.0,0.0,55.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009931,MBR00000386,Professional,2021-10-26,2021-10-26,2021-11-22,PLN1186,1109850785,1109850785,ASC,Out-of-Network,Z79.4,I11.9,,,,,,,0,,99214,E&M,,,,12,Home,1,332.85,202.98,133.37,0.0,50.0,19.61,69.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009932,MBR00000386,Institutional-IP,2022-04-27,2022-04-28,2022-05-23,PLN1694,1915531927,1915531927,Critical Access Hospital,In-Network,R07.9,M17.11,,,,292,MS-DRG,14,1,Y,99222,E&M,,,0900,21,Inpatient Hospital,3,384.14,128.29,0.0,128.29,0.0,0.0,128.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009933,MBR00000386,Institutional-OP,2023-08-14,2023-08-14,2023-09-05,PLN1284,1687650653,1687650653,Internal Medicine,In-Network,J44.1,E11.9,,,,,,,0,,84443,Pathology/Lab,,,0636,22,Outpatient Hospital,1,156.46,113.28,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009934,MBR00000386,Professional,2023-06-13,2023-06-13,2023-07-20,PLN8876,1198133277,1198133277,SNF,In-Network,N39.0,E66.9,,,,,,,0,,90460,Medicine,,,,21,Inpatient Hospital,2,44.44,20.94,0.0,20.94,0.0,0.0,20.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009935,MBR00000386,Professional,2023-09-30,2023-09-30,2023-10-31,PLN9708,1872613201,1872613201,Internal Medicine,In-Network,G43.909,E11.40,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,1,384.63,283.84,268.84,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009936,MBR00000386,Institutional-OP,2022-08-15,2022-08-15,2022-09-17,PLN7395,1213165847,1213165847,Critical Access Hospital,In-Network,E66.9,E78.5,,,,,,,0,,99284,E&M,,,0370,22,Outpatient Hospital,1,861.09,535.49,535.49,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009937,MBR00000386,Professional,2023-05-04,2023-05-04,2023-05-11,PLN8832,1334916761,1334916761,ASC,In-Network,Z00.00,E87.6,,,,,,,0,,G0444,Medicine,,,,65,End-Stage Renal Disease,1,83.57,53.75,38.75,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000009938,MBR00000386,Institutional-OP,2022-03-29,2022-03-29,2022-04-18,PLN3838,1502838586,1502838586,ASC,In-Network,N18.3,J18.9,,,,,,,0,,71046,Radiology,,,0900,22,Outpatient Hospital,2,232.26,181.06,181.06,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009939,MBR00000386,Institutional-OP,2021-01-09,2021-01-09,2021-02-22,PLN8782,1687650653,1687650653,Internal Medicine,In-Network,C50.912,Z23,,,,,,,0,,66984,Surgery,,,0730,22,Outpatient Hospital,1,2838.92,1146.67,1096.67,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009940,MBR00000386,Institutional-OP,2023-03-26,2023-03-26,2023-05-05,PLN8569,1520687146,1520687146,ASC,In-Network,R51,Z00.00,,,,,,,0,,78452,Radiology,,,0370,22,Outpatient Hospital,2,5543.17,3315.92,3300.92,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009941,MBR00000386,Professional,2021-04-06,2021-04-06,2021-04-17,PLN6986,1727809972,1727809972,Home Health,In-Network,E78.5,G43.909,,,,,,,0,,99203,E&M,,,,11,Office,1,374.91,119.9,84.9,0.0,35.0,0.0,35.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009942,MBR00000386,Professional,2022-11-27,2022-11-27,2022-12-08,PLN4023,1438368327,1438368327,Home Health,In-Network,R05,Z12.11,,,,,,,0,,85610,Pathology/Lab,,,,22,Outpatient Hospital,1,38.16,27.21,0.0,27.21,35.0,0.0,62.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009943,MBR00000386,Institutional-IP,2023-12-29,2024-01-07,2024-01-10,PLN5177,1530904931,1530904931,Internal Medicine,In-Network,J44.1,I10,,,,196,MS-DRG,12,9,Y,99222,E&M,,,0200,21,Inpatient Hospital,2,318.35,161.53,149.77,0.0,0.0,11.76,11.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009944,MBR00000387,Professional,2021-01-29,2021-01-29,2021-02-17,PLN6612,1530904931,1530904931,Internal Medicine,In-Network,J06.9,R07.9,,,,,,,0,,93306,Radiology,,,,11,Office,1,2615.41,981.66,931.66,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009945,MBR00000387,Professional,2023-03-15,2023-03-15,2023-03-25,PLN1745,1193493783,1193493783,Critical Access Hospital,Out-of-Network,E11.40,E11.9,,,,,,,0,,58661,Surgery,,,,31,Skilled Nursing Facility,1,4882.16,2280.49,2280.49,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000009946,MBR00000387,Professional,2023-08-09,2023-08-09,2023-09-21,PLN6409,1891849440,1891849440,Oncology,In-Network,Z12.31,N39.0,,,,,,,0,,27447,Surgery,,,,11,Office,3,2867.05,2253.01,1741.84,486.17,25.0,0.0,511.17,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009947,MBR00000387,Professional,2022-11-18,2022-11-18,2023-01-01,PLN7122,1872272835,1872272835,Internal Medicine,In-Network,F03.90,N39.0,,,,,,,0,,27447,Surgery,,,,11,Office,1,5659.26,2121.48,0.0,0.0,0.0,258.47,258.47,0.0,Denied,CO-11,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009948,MBR00000387,Professional,2023-01-26,2023-01-26,2023-02-23,PLN2382,1422747896,1422747896,Urology,In-Network,N39.0,E11.9,,,,,,,0,,90686,Medicine,,,,81,Independent Laboratory,1,137.22,42.18,39.69,0.0,0.0,2.49,2.49,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000009949,MBR00000387,Professional,2023-09-14,2023-09-14,2023-10-12,PLN6685,1609526529,1609526529,Psychiatry,In-Network,I25.10,Z00.00,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,2,2771.05,1818.87,1793.87,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009950,MBR00000387,Professional,2023-05-02,2023-05-02,2023-06-09,PLN7534,1728018911,1728018911,Nephrology,In-Network,E66.9,I10,,,,,,,0,,99221,E&M,,,,21,Inpatient Hospital,2,351.0,206.13,157.78,48.35,0.0,0.0,48.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009951,MBR00000387,Institutional-IP,2021-02-13,2021-02-15,2021-03-01,PLN5103,1809014947,1809014947,Urology,In-Network,R51,M54.5,,,,291,MS-DRG,16,2,Y,99204,E&M,,,0510,21,Inpatient Hospital,1,478.0,279.35,252.99,0.0,25.0,1.36,26.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009952,MBR00000387,Professional,2023-04-28,2023-04-28,2023-05-24,PLN9249,1575695214,1575695214,SNF,In-Network,Z96.641,I10,,,,,,,0,,99284,E&M,,,,21,Inpatient Hospital,1,750.86,226.71,0.0,226.71,0.0,0.0,226.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009953,MBR00000387,Institutional-IP,2023-04-10,2023-04-14,2023-05-15,PLN7342,1990090423,1990090423,Orthopedic Surgery,In-Network,F41.9,M17.11,,,,194,MS-DRG,18,4,Y,87491,Pathology/Lab,,,0900,21,Inpatient Hospital,3,101.09,58.99,58.99,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009954,MBR00000387,Institutional-OP,2021-09-07,2021-09-07,2021-09-14,PLN5315,1728018911,1728018911,Nephrology,In-Network,Z87.891,F41.9,,,,,,,0,,99233,E&M,,,0636,22,Outpatient Hospital,1,563.15,337.72,337.72,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009955,MBR00000387,Institutional-OP,2022-12-18,2022-12-18,2023-01-01,PLN8235,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,N40.0,J06.9,,,,,,,0,,99232,E&M,,,0450,22,Outpatient Hospital,2,283.69,141.89,87.77,53.18,0.0,0.94,54.12,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000009956,MBR00000387,Institutional-OP,2023-07-11,2023-07-11,2023-08-03,PLN2399,1186826716,1186826716,Physical Therapy,In-Network,J06.9,E11.9,,,,,,,0,,90460,Medicine,,,0900,22,Outpatient Hospital,3,42.05,32.46,15.2,0.0,15.0,2.26,17.26,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009957,MBR00000387,Institutional-OP,2023-07-18,2023-07-18,2023-08-07,PLN1234,1964402759,1964402759,Outpatient Clinic,In-Network,Z23,K21.0,,,,,,,0,,82043,Pathology/Lab,,,0370,22,Outpatient Hospital,2,48.26,14.66,0.0,14.66,0.0,0.0,14.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009958,MBR00000387,Professional,2023-08-12,2023-08-12,2023-08-31,PLN5498,1752470395,1752470395,Home Health,In-Network,E66.9,K57.30,,,,,,,0,,66984,Surgery,,,,31,Skilled Nursing Facility,3,2124.21,1799.71,1724.71,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009959,MBR00000387,Professional,2023-05-02,2023-05-02,2023-06-14,PLN9394,1563980627,1563980627,Critical Access Hospital,In-Network,N39.0,K21.0,,,,,,,0,,93306,Radiology,,,,21,Inpatient Hospital,2,2065.89,1079.87,1006.88,0.0,0.0,72.99,72.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009960,MBR00000387,Institutional-OP,2021-05-14,2021-05-14,2021-05-22,PLN9373,1244186984,1244186984,Family Medicine,Out-of-Network,E11.9,E78.5,,,,,,,0,,47562,Surgery,,,0510,22,Outpatient Hospital,2,5868.05,2097.51,1836.06,261.45,0.0,0.0,261.45,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009961,MBR00000387,Institutional-OP,2022-06-15,2022-06-15,2022-07-24,PLN6676,1364429278,1364429278,OB/GYN,In-Network,E87.6,Z00.00,,,,,,,0,,93306,Radiology,,,0360,22,Outpatient Hospital,2,2288.84,1224.95,1142.74,82.21,0.0,0.0,82.21,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009962,MBR00000387,Professional,2021-09-13,2021-09-13,2021-10-19,PLN6640,1561134315,1561134315,DME Supplier,In-Network,F41.9,Z79.4,,,,,,,0,,90460,Medicine,,,,20,Urgent Care,1,33.04,17.72,17.72,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009963,MBR00000387,Institutional-OP,2021-03-19,2021-03-19,2021-04-03,PLN9693,1168881145,1168881145,Orthopedic Surgery,In-Network,I63.9,F32.9,,,,,,,0,,82043,Pathology/Lab,,,0301,22,Outpatient Hospital,1,49.6,21.04,21.04,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000009964,MBR00000387,Institutional-OP,2021-10-16,2021-10-16,2021-11-06,PLN8349,1564502315,1564502315,ASC,In-Network,I10,Z12.31,,,,,,,0,,45378,Surgery,,,0740,22,Outpatient Hospital,2,1151.49,779.15,729.15,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000009965,MBR00000387,Institutional-OP,2023-09-23,2023-09-23,2023-10-03,PLN7282,1644128543,1644128543,Gastroenterology,In-Network,K57.30,E11.65,,,,,,,0,,99222,E&M,,,0761,22,Outpatient Hospital,1,246.24,171.73,0.0,171.73,0.0,0.0,171.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009966,MBR00000387,Professional,2022-10-17,2022-10-17,2022-11-09,PLN8110,1227362142,1227362142,DME Supplier,In-Network,E78.5,E11.9,,,,,,,0,,99284,E&M,,,,21,Inpatient Hospital,2,537.44,426.93,391.93,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009967,MBR00000387,Professional,2023-04-17,2023-04-17,2023-05-10,PLN7578,1910255109,1910255109,DME Supplier,In-Network,Z23,Z23,,,,,,,0,,45378,Surgery,,,,11,Office,2,2560.81,1951.44,1582.11,0.0,50.0,319.33,369.33,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000009968,MBR00000387,Professional,2022-07-05,2022-07-05,2022-07-16,PLN4013,1530904931,1530904931,Internal Medicine,In-Network,M54.5,K21.0,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,1,311.16,243.17,177.8,0.0,35.0,30.37,65.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009969,MBR00000387,Professional,2022-01-26,2022-01-26,2022-02-21,PLN2976,1994661817,1994661817,SNF,Out-of-Network,I25.10,I10,,,,,,,0,,G0468,Medicine,,,,22,Outpatient Hospital,3,512.86,302.05,302.05,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009970,MBR00000387,Professional,2022-06-13,2022-06-13,2022-07-24,PLN1011,1438368327,1438368327,Home Health,In-Network,Z23,J06.9,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,2,1491.35,609.71,413.87,145.84,50.0,0.0,195.84,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000009971,MBR00000387,Professional,2023-12-14,2023-12-14,2024-01-27,PLN3114,1997536841,1997536841,Family Medicine,Out-of-Network,K21.0,G43.909,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,1,223.76,127.61,0.0,127.61,50.0,0.0,177.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009972,MBR00000387,Institutional-OP,2021-11-11,2021-11-11,2021-12-12,PLN1413,1624202402,1624202402,Orthopedic Surgery,In-Network,F32.9,Z23,,,,,,,0,,99222,E&M,,,0740,22,Outpatient Hospital,3,302.48,98.63,97.64,0.0,0.0,0.99,0.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009973,MBR00000387,Professional,2021-12-07,2021-12-07,2022-01-12,PLN7738,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,K21.0,Z12.31,,,,,,,0,,99233,E&M,,,,11,Office,2,504.51,410.26,363.76,0.0,0.0,46.5,46.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009974,MBR00000387,Institutional-IP,2023-07-17,2023-07-23,2023-07-27,PLN9771,1450094833,1450094833,Outpatient Clinic,In-Network,J06.9,Z12.31,,,,194,MS-DRG,2,6,N,33533,Surgery,,,0200,21,Inpatient Hospital,1,22777.56,14464.96,14121.84,308.12,35.0,0.0,343.12,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000009975,MBR00000387,Professional,2022-02-10,2022-02-10,2022-03-10,PLN3111,1795618275,1795618275,Pulmonology,In-Network,E11.9,N39.0,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,2,4054.4,3189.51,2939.91,0.0,25.0,224.6,249.6,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009976,MBR00000387,Institutional-OP,2023-09-17,2023-09-17,2023-10-24,PLN7096,1817234602,1817234602,Clinical Laboratory,In-Network,M17.11,J45.20,,,,,,,0,,93000,Radiology,,,0761,22,Outpatient Hospital,3,70.35,27.71,23.31,0.0,0.0,4.4,4.4,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009977,MBR00000387,Institutional-OP,2023-12-04,2023-12-04,2023-12-20,PLN5676,1168881145,1168881145,Orthopedic Surgery,In-Network,N39.0,F32.9,,,,,,,0,,33533,Surgery,,,0510,22,Outpatient Hospital,3,13983.84,5347.31,4863.75,408.56,75.0,0.0,483.56,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000009978,MBR00000387,Institutional-IP,2021-03-14,2021-03-19,2021-04-08,PLN7706,1514306773,1514306773,Endocrinology,In-Network,I10,E11.40,,,,292,MS-DRG,6,5,U,93000,Radiology,,,0301,21,Inpatient Hospital,2,84.61,26.05,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000009979,MBR00000387,Professional,2023-01-02,2023-01-02,2023-01-16,PLN8800,1132188260,1132188260,Family Medicine,In-Network,K21.0,R05,,,,,,,0,,45380,Surgery,,,,65,End-Stage Renal Disease,1,3090.72,1801.41,1309.5,491.91,0.0,0.0,491.91,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000009980,MBR00000388,Professional,2021-04-14,2021-04-14,2021-05-07,PLN6110,1219817751,1219817751,OB/GYN,In-Network,Z23,E87.6,,,,,,,0,,47562,Surgery,,,,23,Emergency Room,2,4523.49,3226.69,2867.67,359.02,0.0,0.0,359.02,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009981,MBR00000388,Institutional-IP,2023-08-21,2023-08-22,2023-09-21,PLN3210,1935547131,1935547131,Pulmonology,In-Network,M54.5,E78.5,,,,292,MS-DRG,21,1,Y,99284,E&M,,,0761,21,Inpatient Hospital,1,339.17,269.67,254.67,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009982,MBR00000388,Institutional-OP,2021-05-07,2021-05-07,2021-05-24,PLN7941,1186826716,1186826716,Physical Therapy,In-Network,Z51.11,J20.9,,,,,,,0,,86900,Pathology/Lab,,,0270,22,Outpatient Hospital,3,58.2,30.84,0.0,30.84,75.0,0.0,105.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009983,MBR00000388,Institutional-OP,2023-08-31,2023-08-31,2023-09-26,PLN7251,1991459367,1991459367,Neurology,Out-of-Network,E11.9,J44.1,,,,,,,0,,66984,Surgery,,,0636,22,Outpatient Hospital,1,2800.95,1719.47,1416.03,0.0,75.0,228.44,303.44,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009984,MBR00000388,Professional,2023-04-23,2023-04-23,2023-06-02,PLN2462,1410468316,1410468316,SNF,In-Network,E78.5,Z00.00,,,,,,,0,,99283,E&M,,,,11,Office,1,607.89,257.08,0.0,257.08,35.0,0.0,292.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009985,MBR00000388,Professional,2022-08-11,2022-08-11,2022-09-17,PLN2632,1991459367,1991459367,Neurology,Out-of-Network,Z12.31,Z00.00,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,1,12890.11,5713.05,0.0,244.06,0.0,0.0,244.06,0.0,Denied,CO-15,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000009986,MBR00000388,Professional,2021-08-16,2021-08-16,2021-09-27,PLN7063,1847081578,1847081578,Urology,Out-of-Network,E78.5,Z12.11,,,,,,,0,,45380,Surgery,,,,11,Office,3,1573.66,899.17,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000009987,MBR00000388,Professional,2021-10-20,2021-10-20,2021-11-28,PLN5055,1364429278,1364429278,OB/GYN,In-Network,R51,E78.5,,,,,,,0,,99283,E&M,,,,23,Emergency Room,3,604.15,493.72,458.72,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000009988,MBR00000388,Institutional-IP,2022-04-18,2022-04-22,2022-05-22,PLN6396,1124394415,1124394415,Pediatrics,In-Network,J20.9,E66.9,,,,641,MS-DRG,2,4,Y,78452,Radiology,,,0320,21,Inpatient Hospital,3,4529.88,2053.91,1834.59,144.32,75.0,0.0,219.32,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000009989,MBR00000388,Professional,2023-07-17,2023-07-17,2023-08-16,PLN8377,1569105090,1569105090,Geriatrics,In-Network,F03.90,I10,,,,,,,0,,45380,Surgery,,,,11,Office,3,2323.75,709.12,577.03,0.0,0.0,132.09,132.09,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000009990,MBR00000388,Institutional-OP,2023-09-10,2023-09-10,2023-09-18,PLN6187,1717546253,1717546253,Family Medicine,In-Network,N39.0,E11.9,,,,,,,0,,23472,Surgery,,,0200,22,Outpatient Hospital,3,3063.05,1768.26,1768.26,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009991,MBR00000388,Professional,2022-07-04,2022-07-04,2022-07-26,PLN1919,1224179551,1224179551,Physical Therapy,In-Network,Z12.31,Z00.00,,,,,,,0,,27447,Surgery,,,,11,Office,3,6119.15,3608.55,3608.55,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009992,MBR00000388,Professional,2021-09-12,2021-09-12,2021-09-29,PLN2953,1717912431,1717912431,Oncology,In-Network,F32.9,C50.912,,,,,,,0,,77067,Radiology,,,,22,Outpatient Hospital,2,816.94,291.41,216.41,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000009993,MBR00000388,Professional,2022-09-10,2022-09-10,2022-10-14,PLN7876,1910255109,1910255109,DME Supplier,In-Network,E11.9,E11.9,,,,,,,0,,81001,Pathology/Lab,,,,22,Outpatient Hospital,3,46.82,23.48,23.48,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009994,MBR00000388,Institutional-OP,2023-06-30,2023-06-30,2023-08-12,PLN1892,1366286000,1366286000,SNF,In-Network,E78.5,Z79.4,,,,,,,0,,27130,Surgery,,,0360,22,Outpatient Hospital,1,5609.63,2338.08,2288.08,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000009995,MBR00000388,Institutional-OP,2022-08-16,2022-08-16,2022-09-21,PLN4878,1372918899,1372918899,Family Medicine,In-Network,E11.9,I48.91,,,,,,,0,,45378,Surgery,,,0450,22,Outpatient Hospital,1,1680.42,1054.47,606.32,413.15,35.0,0.0,448.15,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000009996,MBR00000388,Institutional-OP,2023-09-03,2023-09-03,2023-09-15,PLN6746,1438368327,1438368327,Home Health,In-Network,I10,Z12.31,,,,,,,0,,70553,Radiology,,,0740,22,Outpatient Hospital,2,2778.27,2159.86,2144.86,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009997,MBR00000388,Professional,2021-01-11,2021-01-11,2021-01-26,PLN5600,1795618275,1795618275,Pulmonology,In-Network,E11.9,Z23,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,1,256.12,172.76,147.76,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009998,MBR00000388,Professional,2022-07-04,2022-07-04,2022-07-19,PLN7264,1139906830,1139906830,Endocrinology,Out-of-Network,E78.5,N39.0,,,,,,,0,,86900,Pathology/Lab,,,,21,Inpatient Hospital,3,31.63,22.83,0.0,22.83,0.0,0.0,22.83,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000009999,MBR00000388,Institutional-OP,2021-02-20,2021-02-20,2021-03-18,PLN2112,1364429278,1364429278,OB/GYN,In-Network,E66.9,F10.20,,,,,,,0,,99203,E&M,,,0120,22,Outpatient Hospital,2,222.65,161.64,0.0,161.64,0.0,0.0,161.64,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010000,MBR00000388,Institutional-OP,2022-11-01,2022-11-01,2022-12-09,PLN7555,1997536841,1997536841,Family Medicine,Out-of-Network,C50.912,M81.0,,,,,,,0,,99283,E&M,,,0636,22,Outpatient Hospital,1,399.85,121.07,105.64,0.0,0.0,15.43,15.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010001,MBR00000388,Professional,2022-11-06,2022-11-06,2022-12-11,PLN4499,1438368327,1438368327,Home Health,In-Network,Z00.00,N39.0,,,,,,,0,,G0439,Medicine,,,,23,Emergency Room,2,574.26,330.72,0.0,330.72,15.0,0.0,345.72,0.0,Paid,,,0,,1,1,0,0,0,0,None,0,0,0,1,0
CLM0000010002,MBR00000388,Professional,2021-12-08,2021-12-08,2022-01-09,PLN1366,1590915516,1590915516,Physical Therapy,Out-of-Network,I48.91,G43.909,,,,,,,0,,71046,Radiology,,,,23,Emergency Room,2,125.21,57.59,22.35,0.0,35.0,0.24,35.24,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010003,MBR00000388,Professional,2023-05-20,2023-05-20,2023-06-30,PLN4854,1752470395,1752470395,Home Health,In-Network,Z00.00,R10.9,,,,,,,0,,45380,Surgery,,,,11,Office,2,2117.06,1458.28,1458.28,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000010004,MBR00000388,Institutional-IP,2023-11-08,2023-11-13,2023-12-13,PLN3422,1780163051,1780163051,SNF,In-Network,Z12.31,E78.5,,,,690,MS-DRG,6,5,Y,84443,Pathology/Lab,,,0900,21,Inpatient Hospital,1,93.89,70.19,0.0,70.19,50.0,0.0,120.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010005,MBR00000388,Professional,2022-05-16,2022-05-16,2022-06-02,PLN2034,1389336600,1389336600,Critical Access Hospital,In-Network,C50.912,I10,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,3,1884.95,782.38,732.38,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000010006,MBR00000388,Professional,2022-04-22,2022-04-22,2022-06-05,PLN8237,1865904917,1865904917,Outpatient Clinic,In-Network,M54.5,I10,,,,,,,0,,45380,Surgery,,,,11,Office,2,2321.25,1879.83,1419.96,114.06,50.0,295.81,459.87,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000010007,MBR00000388,Professional,2021-07-28,2021-07-28,2021-08-11,PLN6027,1337791138,1337791138,Internal Medicine,Out-of-Network,J06.9,M54.5,,,,,,,0,,81001,Pathology/Lab,,,,81,Independent Laboratory,2,40.93,32.46,0.0,32.46,0.0,0.0,32.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010008,MBR00000388,Institutional-IP,2021-01-31,2021-02-02,2021-02-28,PLN2821,1242201429,1242201429,General Acute Care Hospital,In-Network,M54.5,I10,,,,871,MS-DRG,12,2,Y,43239,Surgery,,,0301,21,Inpatient Hospital,2,967.9,714.69,413.96,300.73,0.0,0.0,300.73,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010009,MBR00000388,Professional,2022-03-22,2022-03-22,2022-04-16,PLN1998,1948810580,1948810580,DME Supplier,In-Network,F32.9,E87.6,,,,,,,0,,23472,Surgery,,,,20,Urgent Care,3,4634.14,3687.09,3687.09,0.0,0.0,0.0,0.0,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010010,MBR00000388,Professional,2022-04-29,2022-04-29,2022-05-08,PLN1474,1990090423,1990090423,Orthopedic Surgery,In-Network,N18.3,N39.0,,,,,,,0,,99284,E&M,,,,11,Office,3,419.59,129.37,0.0,129.37,0.0,0.0,129.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010011,MBR00000388,Institutional-IP,2023-04-22,2023-04-24,2023-05-23,PLN2126,1389336600,1389336600,Critical Access Hospital,In-Network,M17.11,C50.912,,,,683,MS-DRG,7,2,Y,85610,Pathology/Lab,,,0120,21,Inpatient Hospital,3,65.21,29.68,0.0,29.68,0.0,0.0,29.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010012,MBR00000388,Professional,2023-08-02,2023-08-02,2023-09-09,PLN4079,1364429278,1364429278,OB/GYN,In-Network,Z12.31,J45.20,,,,,,,0,,43239,Surgery,,,,11,Office,2,1819.35,635.87,600.87,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010013,MBR00000388,Professional,2021-04-29,2021-04-29,2021-05-28,PLN8265,1935547131,1935547131,Pulmonology,In-Network,I10,E78.5,,,,,,,0,,93000,Radiology,,,,50,Federally Qualified Health Center,1,160.44,136.08,101.08,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010014,MBR00000388,Professional,2021-06-17,2021-06-17,2021-07-20,PLN9159,1366426662,1366426662,Urology,In-Network,E78.5,M81.0,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,2,3741.59,1944.03,0.0,457.21,50.0,0.0,507.21,0.0,Denied,CO-11,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010015,MBR00000388,Professional,2022-09-06,2022-09-06,2022-09-20,PLN6181,1757138478,1757138478,Pediatrics,In-Network,F03.90,I50.9,,,,,,,0,,93306,Radiology,,,,22,Outpatient Hospital,2,2920.07,2362.07,2327.07,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010016,MBR00000388,Professional,2022-02-16,2022-02-16,2022-03-19,PLN6115,1531398223,1531398223,OB/GYN,In-Network,C50.912,E11.9,,,,,,,0,,23472,Surgery,,,,11,Office,1,3857.7,2384.75,2105.34,114.93,0.0,164.48,279.41,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010017,MBR00000388,Professional,2023-02-08,2023-02-08,2023-03-15,PLN1651,1168246159,1168246159,Internal Medicine,In-Network,I10,I10,,,,,,,0,,G0444,Medicine,,,,22,Outpatient Hospital,2,91.69,70.93,0.0,0.0,15.0,8.14,23.14,0.0,Denied,CO-27,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000010018,MBR00000388,Professional,2021-12-20,2021-12-20,2022-01-29,PLN6724,1778483301,1778483301,Home Health,In-Network,Z23,Z00.00,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,3,156.01,67.74,0.0,67.74,75.0,0.0,142.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010019,MBR00000388,Institutional-OP,2022-04-01,2022-04-01,2022-04-09,PLN6949,1561134315,1561134315,DME Supplier,In-Network,M54.5,E66.9,,,,,,,0,,99222,E&M,,,0270,22,Outpatient Hospital,2,344.01,124.32,123.62,0.0,0.0,0.7,0.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010020,MBR00000388,Institutional-OP,2022-05-02,2022-05-02,2022-06-09,PLN6428,1717912431,1717912431,Oncology,In-Network,G20,E11.40,,,,,,,0,,G0444,Medicine,,,0730,22,Outpatient Hospital,1,75.36,27.71,27.71,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000010021,MBR00000388,Professional,2022-10-21,2022-10-21,2022-11-03,PLN5259,1606140917,1606140917,ASC,In-Network,E11.40,M54.5,,,,,,,0,,23472,Surgery,,,,21,Inpatient Hospital,3,4618.17,3288.88,3288.88,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010022,MBR00000388,Institutional-IP,2021-03-18,2021-03-25,2021-04-08,PLN6479,1800011727,1800011727,Clinical Laboratory,Out-of-Network,Z12.31,N39.0,,,,603,MS-DRG,7,7,Y,43239,Surgery,,,0200,21,Inpatient Hospital,2,1977.11,1060.13,927.57,0.0,75.0,57.56,132.56,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010023,MBR00000388,Professional,2023-08-26,2023-08-26,2023-09-08,PLN2499,1186826716,1186826716,Physical Therapy,In-Network,F41.9,I10,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,3,69.2,31.12,31.12,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000010024,MBR00000388,Institutional-OP,2022-01-07,2022-01-07,2022-01-18,PLN6398,1609526529,1609526529,Psychiatry,In-Network,M54.5,I48.91,,,,,,,0,,43239,Surgery,,,0270,22,Outpatient Hospital,2,1992.91,1390.27,822.62,435.91,0.0,131.74,567.65,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010025,MBR00000388,Professional,2021-08-22,2021-08-22,2021-09-28,PLN7266,1502838586,1502838586,ASC,In-Network,J06.9,Z00.00,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,2,72.05,31.93,0.0,31.93,25.0,0.0,56.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010026,MBR00000388,Professional,2022-12-03,2022-12-03,2022-12-12,PLN5471,1453283987,1453283987,Critical Access Hospital,In-Network,F32.9,I10,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,1,4658.9,3610.29,3467.34,117.95,25.0,0.0,142.95,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010027,MBR00000388,Professional,2021-05-28,2021-05-28,2021-06-16,PLN7704,1780163051,1780163051,SNF,In-Network,E11.65,R10.9,,,,,,,0,,82043,Pathology/Lab,,,,20,Urgent Care,3,54.75,18.87,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010028,MBR00000388,Professional,2022-10-09,2022-10-09,2022-11-01,PLN3283,1702692193,1702692193,Physical Therapy,In-Network,I25.10,Z23,,,,,,,0,,45378,Surgery,,,,11,Office,2,2311.94,1102.09,1027.09,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000010029,MBR00000388,Professional,2021-03-08,2021-03-08,2021-04-04,PLN2096,1205377316,1205377316,Orthopedic Surgery,In-Network,E78.5,N39.0,,,,,,,0,,99222,E&M,,,,65,End-Stage Renal Disease,2,480.32,220.19,0.0,220.19,50.0,0.0,270.19,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010030,MBR00000389,Professional,2021-10-16,2021-10-16,2021-11-15,PLN9381,1974006077,1974006077,Orthopedic Surgery,In-Network,E11.65,E78.5,,,,,,,0,,76700,Radiology,,,,20,Urgent Care,3,1083.83,869.97,869.97,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010031,MBR00000389,Institutional-IP,2023-03-07,2023-03-12,2023-03-24,PLN5400,1728018911,1728018911,Nephrology,In-Network,E78.5,I10,,,,641,MS-DRG,2,5,Y,70553,Radiology,,,0370,21,Inpatient Hospital,3,3575.51,1984.49,1984.49,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010032,MBR00000389,Professional,2022-02-12,2022-02-12,2022-02-25,PLN6958,1865904917,1865904917,Outpatient Clinic,In-Network,K21.0,Z87.891,,,,,,,0,,99233,E&M,,,,11,Office,1,291.81,186.28,111.28,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010033,MBR00000389,Professional,2023-09-14,2023-09-14,2023-10-04,PLN2965,1702692193,1702692193,Physical Therapy,In-Network,I10,R05,,,,,,,0,,93306,Radiology,,,,31,Skilled Nursing Facility,1,1420.43,1104.7,811.1,243.6,50.0,0.0,293.6,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010034,MBR00000389,Institutional-OP,2022-01-25,2022-01-25,2022-02-25,PLN6834,1939033455,1939033455,Pulmonology,In-Network,J06.9,J20.9,,,,,,,0,,99406,Medicine,,,0636,22,Outpatient Hospital,3,48.61,34.1,34.1,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010035,MBR00000389,Professional,2023-01-26,2023-01-26,2023-02-26,PLN4129,1935547131,1935547131,Pulmonology,In-Network,J20.9,E11.9,,,,,,,0,,66984,Surgery,,,,11,Office,1,2686.72,1406.52,1103.08,303.44,0.0,0.0,303.44,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010036,MBR00000389,Professional,2021-02-02,2021-02-02,2021-03-14,PLN8152,1980712759,1980712759,Outpatient Clinic,Out-of-Network,R07.9,K92.1,,,,,,,0,,43239,Surgery,,,,20,Urgent Care,1,1126.65,604.34,529.34,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010037,MBR00000390,Professional,2023-12-06,2023-12-06,2023-12-31,PLN2771,1284035364,1284035364,Pediatrics,In-Network,Z00.00,Z23,,,,,,,0,,99284,E&M,,,,11,Office,3,926.32,735.68,345.86,364.82,25.0,0.0,389.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010038,MBR00000390,Professional,2022-11-06,2022-11-06,2022-11-19,PLN6414,1749327647,1749327647,Geriatrics,In-Network,E11.65,E66.9,,,,,,,0,,99213,E&M,,,,11,Office,1,145.87,102.49,67.49,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000010039,MBR00000390,Institutional-OP,2023-02-15,2023-02-15,2023-03-29,PLN4253,1550154147,1550154147,Outpatient Clinic,In-Network,F41.9,Z51.11,,,,,,,0,,99232,E&M,,,0120,22,Outpatient Hospital,3,349.69,123.07,123.07,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010040,MBR00000390,Professional,2021-12-23,2021-12-23,2022-01-24,PLN4156,1563980627,1563980627,Critical Access Hospital,In-Network,J18.9,S72.001A,,,,,,,0,,33533,Surgery,,,,11,Office,3,24372.66,17317.05,17097.03,220.02,0.0,0.0,220.02,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000010041,MBR00000390,Professional,2021-11-12,2021-11-12,2021-12-09,PLN7275,1235381502,1235381502,Cardiology,In-Network,I10,E11.65,,,,,,,0,,99214,E&M,,,,31,Skilled Nursing Facility,3,457.61,183.69,168.69,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010042,MBR00000390,Institutional-OP,2022-04-24,2022-04-24,2022-05-08,PLN1688,1896447406,1896447406,Nephrology,Out-of-Network,I25.10,Z12.11,,,,,,,0,,47562,Surgery,,,0900,22,Outpatient Hospital,2,3394.98,2524.11,0.0,366.9,0.0,0.0,366.9,0.0,Denied,CO-27,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010043,MBR00000390,Institutional-OP,2021-10-07,2021-10-07,2021-10-28,PLN3179,1716521444,1716521444,Oncology,In-Network,E78.5,Z96.641,,,,,,,0,,G0439,Medicine,,,0636,22,Outpatient Hospital,1,568.83,347.53,347.53,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000010044,MBR00000390,Institutional-OP,2021-01-23,2021-01-23,2021-02-09,PLN7216,1994661817,1994661817,SNF,Out-of-Network,Z23,R10.9,,,,,,,0,,23472,Surgery,,,0360,22,Outpatient Hospital,2,5295.17,3576.9,3544.09,32.81,0.0,0.0,32.81,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010045,MBR00000390,Professional,2023-01-01,2023-01-01,2023-02-02,PLN6628,1540044947,1540044947,Pulmonology,Out-of-Network,Z00.00,E78.5,,,,,,,0,,27130,Surgery,,,,11,Office,3,4046.32,2588.24,2588.24,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010046,MBR00000390,Professional,2023-02-24,2023-02-24,2023-03-21,PLN8626,1749327647,1749327647,Geriatrics,In-Network,F32.9,E11.9,,,,,,,0,,78452,Radiology,,,,23,Emergency Room,2,5055.12,2424.65,2126.58,0.0,35.0,263.07,298.07,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010047,MBR00000390,Institutional-OP,2023-01-11,2023-01-11,2023-01-26,PLN6436,1990090423,1990090423,Orthopedic Surgery,In-Network,J06.9,J45.20,,,,,,,0,,90460,Medicine,,,0301,22,Outpatient Hospital,1,54.81,43.49,0.0,43.49,15.0,0.0,58.49,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010048,MBR00000390,Professional,2022-08-30,2022-08-30,2022-09-06,PLN4904,1845900543,1845900543,ASC,In-Network,R51,I10,,,,,,,0,,99283,E&M,,,,12,Home,1,275.49,229.94,181.13,37.94,0.0,10.87,48.81,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010049,MBR00000390,Institutional-OP,2022-07-28,2022-07-28,2022-08-16,PLN3320,1716521444,1716521444,Oncology,In-Network,J18.9,I25.10,,,,,,,0,,93225,Medicine,,,0730,22,Outpatient Hospital,2,797.89,531.52,501.23,30.29,0.0,0.0,30.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010050,MBR00000390,Institutional-IP,2023-12-16,2023-12-18,2024-01-20,PLN1075,1872272835,1872272835,Internal Medicine,In-Network,Z12.31,G43.909,,,,871,MS-DRG,4,2,Y,82043,Pathology/Lab,,,0761,21,Inpatient Hospital,2,35.94,15.13,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010051,MBR00000390,Institutional-OP,2022-07-31,2022-07-31,2022-08-09,PLN7512,1990090423,1990090423,Orthopedic Surgery,In-Network,Z23,J06.9,,,,,,,0,,27447,Surgery,,,0200,22,Outpatient Hospital,3,4173.92,2054.49,1874.92,0.0,50.0,129.57,179.57,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010052,MBR00000390,Professional,2023-02-12,2023-02-12,2023-03-08,PLN6377,1564502315,1564502315,ASC,In-Network,E11.9,Z23,,,,,,,0,,85610,Pathology/Lab,,,,22,Outpatient Hospital,1,53.54,16.68,13.65,0.0,0.0,3.03,3.03,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000010053,MBR00000390,Institutional-OP,2022-04-02,2022-04-02,2022-05-12,PLN2367,1366426662,1366426662,Urology,In-Network,M17.11,I10,,,,,,,0,,90837,Medicine,,,0360,22,Outpatient Hospital,3,198.8,109.15,109.15,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010054,MBR00000390,Institutional-OP,2021-02-06,2021-02-06,2021-03-16,PLN4033,1968299309,1968299309,Internal Medicine,In-Network,J20.9,Z00.00,,,,,,,0,,99406,Medicine,,,0301,22,Outpatient Hospital,1,62.6,47.34,22.34,0.0,25.0,0.0,25.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010055,MBR00000390,Institutional-OP,2022-01-19,2022-01-19,2022-02-07,PLN6137,1132188260,1132188260,Family Medicine,In-Network,J06.9,E11.40,,,,,,,0,,47562,Surgery,,,0360,22,Outpatient Hospital,3,5058.55,3333.49,2873.57,459.92,0.0,0.0,459.92,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010056,MBR00000390,Institutional-OP,2023-03-01,2023-03-01,2023-03-21,PLN7535,1749327647,1749327647,Geriatrics,In-Network,E11.9,E78.5,,,,,,,0,,93225,Medicine,,,0360,22,Outpatient Hospital,3,401.74,182.79,117.55,40.04,0.0,25.2,65.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010057,MBR00000390,Institutional-OP,2022-11-26,2022-11-26,2022-12-09,PLN1030,1266606767,1266606767,ASC,In-Network,E78.5,Z23,,,,,,,0,,81001,Pathology/Lab,,,0450,22,Outpatient Hospital,3,28.6,8.77,0.0,8.77,0.0,0.0,8.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010058,MBR00000390,Institutional-IP,2023-01-30,2023-02-05,2023-02-11,PLN6291,1530904931,1530904931,Internal Medicine,In-Network,E11.9,I10,,,,292,MS-DRG,13,6,Y,99232,E&M,,,0360,21,Inpatient Hospital,1,392.03,181.71,0.0,0.0,0.0,23.06,23.06,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010059,MBR00000390,Institutional-IP,2023-03-30,2023-04-02,2023-05-02,PLN6659,1590915516,1590915516,Physical Therapy,Out-of-Network,I10,E11.9,,,,194,MS-DRG,11,3,Y,99284,E&M,,,0301,21,Inpatient Hospital,2,695.68,234.71,149.31,0.0,75.0,10.4,85.4,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010060,MBR00000390,Institutional-OP,2021-08-28,2021-08-28,2021-09-16,PLN8529,1696843572,1696843572,Critical Access Hospital,Out-of-Network,E66.9,F32.9,,,,,,,0,,33533,Surgery,,,0740,22,Outpatient Hospital,2,26572.01,18849.66,17731.77,458.46,0.0,659.43,1117.89,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000010061,MBR00000390,Institutional-OP,2023-06-10,2023-06-10,2023-07-17,PLN6337,1518055405,1518055405,Urology,In-Network,I11.9,E11.9,,,,,,,0,,93000,Radiology,,,0900,22,Outpatient Hospital,3,124.26,101.06,92.49,0.0,0.0,8.57,8.57,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000010062,MBR00000390,Institutional-IP,2023-02-22,2023-02-25,2023-03-16,PLN2051,1450553056,1450553056,Clinical Laboratory,In-Network,N40.0,E11.9,,,,292,MS-DRG,18,3,Y,90686,Medicine,,,0200,21,Inpatient Hospital,1,63.7,27.2,0.0,27.2,35.0,0.0,62.2,0.0,Paid,,,0,,0,1,0,0,1,0,None,0,0,0,0,0
CLM0000010063,MBR00000390,Institutional-IP,2021-12-04,2021-12-07,2022-01-08,PLN9358,1974006077,1974006077,Orthopedic Surgery,In-Network,Z12.31,N20.0,,,,690,MS-DRG,6,3,Y,99213,E&M,,,0450,21,Inpatient Hospital,1,245.35,117.37,0.0,117.37,25.0,0.0,142.37,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000010064,MBR00000390,Institutional-OP,2022-07-06,2022-07-06,2022-07-24,PLN2224,1390307371,1390307371,DME Supplier,In-Network,R10.9,I25.10,,,,,,,0,,99283,E&M,,,0636,22,Outpatient Hospital,2,252.95,163.33,108.95,0.0,50.0,4.38,54.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010065,MBR00000390,Professional,2023-07-29,2023-07-29,2023-08-31,PLN3156,1355166277,1355166277,Endocrinology,In-Network,E78.5,Z12.31,,,,,,,0,,84443,Pathology/Lab,,,,12,Home,3,78.89,28.44,0.0,28.44,15.0,0.0,43.44,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010066,MBR00000390,Institutional-OP,2021-07-03,2021-07-03,2021-08-15,PLN1027,1366286000,1366286000,SNF,In-Network,E11.9,N40.0,,,,,,,0,,27447,Surgery,,,0450,22,Outpatient Hospital,3,3397.86,2341.06,2291.06,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010067,MBR00000390,Institutional-IP,2021-11-28,2021-11-30,2021-12-06,PLN6951,1514306773,1514306773,Endocrinology,In-Network,I48.91,Z12.31,,,,641,MS-DRG,22,2,Y,93306,Radiology,,,0360,21,Inpatient Hospital,1,2367.21,1389.32,866.07,349.33,25.0,148.92,523.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010068,MBR00000390,Institutional-OP,2021-07-30,2021-07-30,2021-09-08,PLN5838,1242201429,1242201429,General Acute Care Hospital,In-Network,Z00.00,Z23,,,,,,,0,,45378,Surgery,,,0301,22,Outpatient Hospital,3,960.3,806.61,806.61,0.0,0.0,0.0,0.0,0.0,Adjusted,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000010069,MBR00000390,Professional,2021-11-30,2021-11-30,2022-01-13,PLN1657,1514306773,1514306773,Endocrinology,In-Network,Z00.00,J06.9,,,,,,,0,,99203,E&M,,,,11,Office,3,240.05,85.41,60.41,0.0,25.0,0.0,25.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010070,MBR00000390,Professional,2021-08-13,2021-08-13,2021-09-09,PLN3981,1728018911,1728018911,Nephrology,In-Network,N40.0,G43.909,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,1,485.07,165.84,0.0,165.84,0.0,0.0,165.84,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000010071,MBR00000390,Professional,2023-06-02,2023-06-02,2023-06-26,PLN4563,1609138981,1609138981,Critical Access Hospital,In-Network,I10,Z12.31,,,,,,,0,,45380,Surgery,,,,11,Office,1,2089.37,780.42,209.45,457.85,75.0,38.12,570.97,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000010072,MBR00000390,Institutional-IP,2023-12-22,2023-12-24,2024-02-02,PLN3193,1334916761,1334916761,ASC,In-Network,F41.9,J20.9,,,,683,MS-DRG,13,2,Y,99222,E&M,,,0370,21,Inpatient Hospital,3,467.92,270.53,91.19,158.09,0.0,21.25,179.34,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000010073,MBR00000390,Institutional-OP,2023-11-28,2023-11-28,2024-01-10,PLN3692,1749494482,1749494482,Pediatrics,In-Network,F32.9,N39.0,,,,,,,0,,99203,E&M,,,0200,22,Outpatient Hospital,2,385.65,239.69,0.0,239.69,15.0,0.0,254.69,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010074,MBR00000390,Institutional-IP,2022-01-28,2022-02-08,2022-02-18,PLN5444,1891849440,1891849440,Oncology,In-Network,J45.20,J06.9,,,,603,MS-DRG,2,11,Y,45378,Surgery,,,0200,21,Inpatient Hospital,1,2596.29,1394.76,1369.76,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000010075,MBR00000390,Institutional-IP,2023-10-18,2023-10-22,2023-11-02,PLN4350,1245650222,1245650222,Gastroenterology,In-Network,J06.9,F41.9,,,,194,MS-DRG,21,4,Y,G0439,Medicine,,,0120,21,Inpatient Hospital,2,579.65,365.3,200.91,164.39,0.0,0.0,164.39,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000010076,MBR00000390,Professional,2021-03-31,2021-03-31,2021-04-19,PLN5243,1745114564,1745114564,Endocrinology,In-Network,Z23,F41.9,,,,,,,0,,78452,Radiology,,,,23,Emergency Room,1,5427.4,4080.72,3743.46,302.26,35.0,0.0,337.26,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010077,MBR00000390,Institutional-IP,2021-05-02,2021-05-05,2021-05-25,PLN9258,1266606767,1266606767,ASC,In-Network,F41.9,I11.9,,,,683,MS-DRG,18,3,Y,99232,E&M,,,0320,21,Inpatient Hospital,2,225.72,176.21,176.21,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010078,MBR00000390,Institutional-OP,2021-12-23,2021-12-23,2022-01-27,PLN5054,1728018911,1728018911,Nephrology,In-Network,F41.9,M17.11,,,,,,,0,,70450,Radiology,,,0320,22,Outpatient Hospital,3,1321.58,511.36,421.21,90.15,0.0,0.0,90.15,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010079,MBR00000391,Institutional-OP,2021-11-12,2021-11-12,2021-12-09,PLN6063,1486164553,1486164553,DME Supplier,In-Network,N39.0,Z23,,,,,,,0,,86900,Pathology/Lab,,,0761,22,Outpatient Hospital,1,51.64,27.39,12.39,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010080,MBR00000391,Professional,2023-10-02,2023-10-02,2023-10-16,PLN9797,1103747954,1103747954,Urology,In-Network,E87.6,M81.0,,,,,,,0,,90837,Medicine,,,,11,Office,3,316.46,112.51,62.51,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010081,MBR00000391,Professional,2023-04-13,2023-04-13,2023-05-06,PLN2391,1531398223,1531398223,OB/GYN,In-Network,Z87.891,E78.5,,,,,,,0,,90460,Medicine,,,,11,Office,2,52.45,25.62,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010082,MBR00000391,Institutional-OP,2023-04-05,2023-04-05,2023-05-10,PLN1249,1434029575,1434029575,Endocrinology,In-Network,G20,Z12.31,,,,,,,0,,70450,Radiology,,,0730,22,Outpatient Hospital,1,1220.35,820.55,820.55,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010083,MBR00000391,Professional,2023-06-02,2023-06-02,2023-06-25,PLN5509,1702692193,1702692193,Physical Therapy,In-Network,M54.5,I10,,,,,,,0,,58661,Surgery,,,,21,Inpatient Hospital,1,4167.4,2379.61,2379.61,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010084,MBR00000391,Institutional-IP,2023-03-06,2023-03-10,2023-03-16,PLN8169,1872613201,1872613201,Internal Medicine,In-Network,I48.91,J20.9,,,,690,MS-DRG,1,4,Y,93306,Radiology,,,0270,21,Inpatient Hospital,3,1382.98,475.57,475.57,0.0,0.0,0.0,0.0,0.0,Adjusted,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010085,MBR00000391,Institutional-OP,2022-07-07,2022-07-07,2022-07-22,PLN1327,1800011727,1800011727,Clinical Laboratory,Out-of-Network,Z12.11,I10,,,,,,,0,,99214,E&M,,,0270,22,Outpatient Hospital,2,422.37,168.27,107.75,0.0,35.0,25.52,60.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010086,MBR00000391,Institutional-OP,2021-03-06,2021-03-06,2021-03-20,PLN2064,1939033455,1939033455,Pulmonology,In-Network,Z12.31,E66.9,,,,,,,0,,86900,Pathology/Lab,,,0270,22,Outpatient Hospital,2,38.15,24.52,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010087,MBR00000391,Professional,2021-01-18,2021-01-18,2021-02-01,PLN8561,1799205295,1799205295,General Acute Care Hospital,In-Network,E78.5,I10,,,,,,,0,,99221,E&M,,,,11,Office,2,331.04,131.5,116.5,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010088,MBR00000391,Professional,2023-12-05,2023-12-05,2024-01-18,PLN4176,1689639685,1689639685,SNF,In-Network,I25.10,M54.5,,,,,,,0,,70553,Radiology,,,,11,Office,1,1691.56,1191.94,1176.94,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010089,MBR00000391,Institutional-IP,2022-07-04,2022-07-05,2022-07-16,PLN4255,1247341320,1247341320,Urology,Out-of-Network,I25.10,J20.9,,,,292,MS-DRG,13,1,Y,58661,Surgery,,,0320,21,Inpatient Hospital,2,3090.84,2316.05,2014.6,301.45,0.0,0.0,301.45,0.0,Paid,,,0,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000010090,MBR00000391,Institutional-OP,2023-11-10,2023-11-10,2023-11-24,PLN2177,1556140803,1556140803,Cardiology,In-Network,F32.9,J45.20,,,,,,,0,,99222,E&M,,,0200,22,Outpatient Hospital,3,465.68,220.04,205.04,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010091,MBR00000391,Professional,2021-02-04,2021-02-04,2021-03-12,PLN6061,1856686341,1856686341,Geriatrics,In-Network,E66.9,Z00.00,,,,,,,0,,80053,Pathology/Lab,,,,21,Inpatient Hospital,1,129.23,98.73,63.73,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010092,MBR00000391,Professional,2022-11-28,2022-11-28,2023-01-05,PLN1701,1994661817,1994661817,SNF,Out-of-Network,E11.9,J44.1,,,,,,,0,,G0468,Medicine,,,,21,Inpatient Hospital,2,494.25,213.2,163.2,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010093,MBR00000391,Institutional-IP,2021-11-05,2021-11-11,2021-11-19,PLN8297,1767011137,1767011137,DME Supplier,In-Network,Z12.11,F32.9,,,,683,MS-DRG,22,6,Y,93306,Radiology,,,0120,21,Inpatient Hospital,2,2375.59,1828.09,1778.09,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010094,MBR00000391,Professional,2022-02-03,2022-02-03,2022-02-27,PLN1992,1575695214,1575695214,SNF,In-Network,F10.20,E78.5,,,,,,,0,,80053,Pathology/Lab,,,,20,Urgent Care,3,122.48,74.69,0.0,74.69,0.0,0.0,74.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010095,MBR00000391,Professional,2022-12-21,2022-12-21,2023-01-22,PLN4058,1132188260,1132188260,Family Medicine,In-Network,Z23,E11.9,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,2,131.99,47.31,12.31,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010096,MBR00000391,Institutional-OP,2022-06-27,2022-06-27,2022-08-10,PLN9202,1103747954,1103747954,Urology,In-Network,Z00.00,Z00.00,,,,,,,0,,99213,E&M,,,0740,22,Outpatient Hospital,1,279.34,221.8,43.36,103.44,75.0,0.0,178.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010097,MBR00000391,Professional,2021-05-28,2021-05-28,2021-06-09,PLN1804,1631954542,1631954542,Oncology,In-Network,E11.65,F10.20,,,,,,,0,,74177,Radiology,,,,11,Office,3,2432.56,1265.19,1119.4,145.79,0.0,0.0,145.79,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010098,MBR00000391,Professional,2023-12-31,2023-12-31,2024-02-01,PLN5390,1103747954,1103747954,Urology,In-Network,Z00.00,N40.0,,,,,,,0,,93225,Medicine,,,,20,Urgent Care,3,654.67,197.09,85.55,111.54,0.0,0.0,111.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010099,MBR00000391,Professional,2023-02-20,2023-02-20,2023-04-03,PLN5546,1790497490,1790497490,OB/GYN,In-Network,F41.9,I10,,,,,,,0,,99222,E&M,,,,20,Urgent Care,1,570.76,290.45,265.45,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010100,MBR00000391,Professional,2022-01-30,2022-01-30,2022-02-12,PLN4683,1125190055,1125190055,Nephrology,In-Network,I25.10,N39.0,,,,,,,0,,78452,Radiology,,,,11,Office,1,4341.62,2332.02,2282.02,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010101,MBR00000391,Professional,2022-11-12,2022-11-12,2022-11-30,PLN3348,1991459367,1991459367,Neurology,Out-of-Network,E11.40,J06.9,,,,,,,0,,33533,Surgery,,,,11,Office,2,27809.75,18740.52,17395.75,0.0,0.0,1344.77,1344.77,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000010102,MBR00000391,Professional,2021-06-15,2021-06-15,2021-07-15,PLN7378,1609526529,1609526529,Psychiatry,In-Network,Z23,I10,,,,,,,0,,58661,Surgery,,,,11,Office,1,2555.27,1236.6,1236.6,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010103,MBR00000391,Professional,2022-04-16,2022-04-16,2022-04-26,PLN1049,1790497490,1790497490,OB/GYN,In-Network,E11.65,E78.5,,,,,,,0,,99203,E&M,,,,11,Office,3,178.58,129.5,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010104,MBR00000391,Institutional-IP,2022-04-11,2022-04-14,2022-05-01,PLN7010,1939033455,1939033455,Pulmonology,In-Network,Z00.01,Z00.00,,,,196,MS-DRG,4,3,Y,99221,E&M,,,0740,21,Inpatient Hospital,2,289.25,244.61,19.53,171.61,50.0,3.47,225.08,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010105,MBR00000391,Professional,2022-02-12,2022-02-12,2022-03-15,PLN5501,1910255109,1910255109,DME Supplier,In-Network,F41.9,F41.9,,,,,,,0,,99406,Medicine,,,,11,Office,1,41.28,18.29,0.0,18.29,0.0,0.0,18.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010106,MBR00000391,Institutional-IP,2022-06-14,2022-06-18,2022-07-15,PLN4989,1295371663,1295371663,Critical Access Hospital,In-Network,I10,I10,,,,470,MS-DRG,18,4,Y,99284,E&M,,,0900,21,Inpatient Hospital,2,803.24,247.4,0.0,247.4,0.0,0.0,247.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010107,MBR00000391,Institutional-OP,2023-09-29,2023-09-29,2023-10-28,PLN2873,1168246159,1168246159,Internal Medicine,In-Network,I10,J06.9,,,,,,,0,,33533,Surgery,,,0900,22,Outpatient Hospital,3,23405.9,17388.66,17388.66,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000010108,MBR00000391,Institutional-OP,2021-01-08,2021-01-08,2021-02-07,PLN5730,1422747896,1422747896,Urology,In-Network,M54.5,M54.5,,,,,,,0,,99406,Medicine,,,0270,22,Outpatient Hospital,2,101.74,54.51,19.51,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010109,MBR00000391,Professional,2022-08-29,2022-08-29,2022-09-18,PLN3963,1696843572,1696843572,Critical Access Hospital,Out-of-Network,J06.9,Z12.31,,,,,,,0,,99232,E&M,,,,11,Office,1,234.6,141.31,0.0,141.31,50.0,0.0,191.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010110,MBR00000391,Professional,2023-10-28,2023-10-28,2023-11-20,PLN5114,1757138478,1757138478,Pediatrics,In-Network,Z23,N18.3,,,,,,,0,,86900,Pathology/Lab,,,,21,Inpatient Hospital,2,32.68,20.76,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010111,MBR00000391,Institutional-IP,2023-09-01,2023-09-06,2023-09-23,PLN9809,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,F41.9,F32.9,,,,470,MS-DRG,6,5,Y,G0444,Medicine,,,0636,21,Inpatient Hospital,2,47.4,23.98,0.0,23.98,35.0,0.0,58.98,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000010112,MBR00000391,Professional,2023-09-10,2023-09-10,2023-09-28,PLN1443,1193493783,1193493783,Critical Access Hospital,Out-of-Network,N39.0,K21.0,,,,,,,0,,99406,Medicine,,,,11,Office,1,61.68,48.25,40.67,0.0,0.0,7.58,7.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010113,MBR00000391,Institutional-OP,2022-03-28,2022-03-28,2022-04-30,PLN8197,1193493783,1193493783,Critical Access Hospital,Out-of-Network,E11.9,E66.9,,,,,,,0,,97530,Medicine,,,0900,22,Outpatient Hospital,3,114.28,86.14,0.0,86.14,0.0,0.0,86.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010114,MBR00000392,Institutional-IP,2022-09-14,2022-09-18,2022-09-22,PLN1982,1422747896,1422747896,Urology,In-Network,E78.5,J06.9,,,,641,MS-DRG,24,4,Y,G0444,Medicine,,,0360,21,Inpatient Hospital,3,102.32,77.98,0.0,77.98,0.0,0.0,77.98,0.0,Paid,,,0,,0,1,0,0,0,1,Phantom,0,0,0,0,1
CLM0000010115,MBR00000392,Professional,2022-10-14,2022-10-14,2022-11-18,PLN5003,1749327647,1749327647,Geriatrics,In-Network,K21.0,F32.9,,,,,,,0,,99222,E&M,,,,11,Office,3,466.34,237.42,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010116,MBR00000392,Professional,2023-07-07,2023-07-07,2023-08-14,PLN5915,1645194539,1645194539,SNF,In-Network,J20.9,I48.91,,,,,,,0,,90686,Medicine,,,,11,Office,2,79.22,58.25,58.25,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,1,Phantom,0,0,0,0,0
CLM0000010117,MBR00000392,Institutional-OP,2023-11-12,2023-11-12,2023-12-23,PLN1497,1186826716,1186826716,Physical Therapy,In-Network,N40.0,J06.9,,,,,,,0,,45380,Surgery,,,0730,22,Outpatient Hospital,3,2120.1,1408.01,1268.29,139.72,0.0,0.0,139.72,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000010118,MBR00000392,Institutional-IP,2021-10-07,2021-10-11,2021-10-17,PLN7442,1500037969,1500037969,Pulmonology,In-Network,Z23,J20.9,,,,603,MS-DRG,4,4,Y,99213,E&M,,,0370,21,Inpatient Hospital,3,255.92,94.32,0.0,94.32,0.0,0.0,94.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010119,MBR00000392,Institutional-OP,2021-05-16,2021-05-16,2021-06-22,PLN3584,1410468316,1410468316,SNF,In-Network,M54.5,J20.9,,,,,,,0,,G0444,Medicine,,,0370,22,Outpatient Hospital,3,86.56,41.79,0.0,0.0,0.0,3.86,3.86,0.0,Denied,CO-4,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000010120,MBR00000392,Institutional-OP,2021-10-18,2021-10-18,2021-11-25,PLN6261,1795618275,1795618275,Pulmonology,In-Network,N39.0,E11.9,,,,,,,0,,99213,E&M,,,0120,22,Outpatient Hospital,1,188.96,98.92,98.92,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010121,MBR00000392,Professional,2021-10-15,2021-10-15,2021-11-25,PLN5016,1540044947,1540044947,Pulmonology,Out-of-Network,R05,N39.0,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,1,491.84,369.09,344.09,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010122,MBR00000392,Professional,2021-11-25,2021-11-25,2021-12-11,PLN4809,1585582070,1585582070,Outpatient Clinic,In-Network,N18.3,E11.9,,,,,,,0,,99221,E&M,,,,12,Home,3,438.64,224.55,189.55,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010123,MBR00000393,Institutional-IP,2023-10-01,2023-10-08,2023-10-22,PLN3306,1186826716,1186826716,Physical Therapy,In-Network,Z23,I10,,,,641,MS-DRG,8,7,Y,47562,Surgery,,,0200,21,Inpatient Hospital,2,6631.98,4025.73,3434.87,56.09,25.0,509.77,590.86,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010124,MBR00000393,Professional,2021-08-24,2021-08-24,2021-09-15,PLN3794,1899127912,1899127912,Neurology,In-Network,Z00.00,M81.0,,,,,,,0,,27447,Surgery,,,,11,Office,1,4910.06,3848.38,3751.77,96.61,0.0,0.0,96.61,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010125,MBR00000393,Institutional-IP,2022-04-08,2022-04-14,2022-05-15,PLN9986,1624202402,1624202402,Orthopedic Surgery,In-Network,F32.9,G20,,,,682,MS-DRG,21,6,W,99233,E&M,,,0360,21,Inpatient Hospital,2,271.15,201.46,0.0,201.46,50.0,0.0,251.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010126,MBR00000393,Professional,2022-01-27,2022-01-27,2022-02-09,PLN5539,1486164553,1486164553,DME Supplier,In-Network,Z00.01,M81.0,,,,,,,0,,84443,Pathology/Lab,,,,21,Inpatient Hospital,1,97.53,46.21,0.0,46.21,0.0,0.0,46.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010127,MBR00000393,Institutional-OP,2021-10-25,2021-10-25,2021-12-05,PLN8323,1717912431,1717912431,Oncology,In-Network,K21.0,N18.3,,,,,,,0,,G0468,Medicine,,,0761,22,Outpatient Hospital,2,621.12,252.94,177.94,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010128,MBR00000393,Institutional-OP,2021-08-04,2021-08-04,2021-09-17,PLN6577,1450094833,1450094833,Outpatient Clinic,In-Network,E78.5,Z12.31,,,,,,,0,,99222,E&M,,,0120,22,Outpatient Hospital,3,262.76,195.7,195.7,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010129,MBR00000393,Professional,2023-12-29,2023-12-29,2024-02-02,PLN2044,1500949740,1500949740,Pediatrics,In-Network,Z12.31,N39.0,,,,,,,0,,27447,Surgery,,,,11,Office,2,5678.39,2744.48,2744.48,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010130,MBR00000393,Institutional-OP,2022-11-17,2022-11-17,2022-12-19,PLN1667,1799205295,1799205295,General Acute Care Hospital,In-Network,I10,Z00.01,,,,,,,0,,G0444,Medicine,,,0200,22,Outpatient Hospital,1,76.22,46.54,21.54,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000010131,MBR00000393,Institutional-OP,2021-04-22,2021-04-22,2021-05-10,PLN2326,1569105090,1569105090,Geriatrics,In-Network,J18.9,R05,,,,,,,0,,99222,E&M,,,0510,22,Outpatient Hospital,3,577.48,236.11,161.11,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010132,MBR00000393,Institutional-OP,2022-12-19,2022-12-19,2023-01-24,PLN6988,1609526529,1609526529,Psychiatry,In-Network,Z23,F10.20,,,,,,,0,,99284,E&M,,,0761,22,Outpatient Hospital,2,719.38,387.39,387.39,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010133,MBR00000393,Professional,2022-11-01,2022-11-01,2022-11-28,PLN4947,1696843572,1696843572,Critical Access Hospital,Out-of-Network,Z23,G43.909,,,,,,,0,,23472,Surgery,,,,11,Office,3,2662.35,1289.28,1016.15,248.13,25.0,0.0,273.13,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010134,MBR00000393,Professional,2022-01-29,2022-01-29,2022-02-17,PLN6252,1974006077,1974006077,Orthopedic Surgery,In-Network,E11.9,F32.9,,,,,,,0,,99213,E&M,,,,23,Emergency Room,1,230.94,92.09,66.1,0.0,25.0,0.99,25.99,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010135,MBR00000393,Institutional-IP,2023-05-13,2023-05-15,2023-05-31,PLN5341,1530904931,1530904931,Internal Medicine,In-Network,Z96.641,E78.5,,,,871,MS-DRG,12,2,N,99232,E&M,,,0200,21,Inpatient Hospital,2,190.5,130.47,0.0,130.47,0.0,0.0,130.47,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000010136,MBR00000393,Professional,2023-05-29,2023-05-29,2023-06-19,PLN3339,1556140803,1556140803,Cardiology,In-Network,Z23,I25.10,,,,,,,0,,99406,Medicine,,,,22,Outpatient Hospital,2,43.95,30.03,0.0,30.03,50.0,0.0,80.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010137,MBR00000393,Institutional-IP,2023-05-12,2023-05-17,2023-06-15,PLN1310,1609526529,1609526529,Psychiatry,In-Network,I10,F41.9,,,,196,MS-DRG,5,5,Y,99232,E&M,,,0120,21,Inpatient Hospital,1,288.85,93.91,93.91,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010138,MBR00000393,Professional,2022-12-01,2022-12-01,2023-01-11,PLN7844,1168881145,1168881145,Orthopedic Surgery,In-Network,M54.5,E78.5,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,1,4739.73,3199.99,3199.99,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010139,MBR00000393,Institutional-OP,2022-04-29,2022-04-29,2022-05-20,PLN2757,1696843572,1696843572,Critical Access Hospital,Out-of-Network,Z87.891,I25.10,,,,,,,0,,99233,E&M,,,0900,22,Outpatient Hospital,3,326.09,227.06,0.0,227.06,50.0,0.0,277.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010140,MBR00000393,Institutional-OP,2021-08-15,2021-08-15,2021-09-13,PLN3104,1434029575,1434029575,Endocrinology,In-Network,E78.5,R07.9,,,,,,,0,,27447,Surgery,,,0320,22,Outpatient Hospital,3,3552.39,2543.92,2128.06,206.96,25.0,183.9,415.86,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010141,MBR00000393,Professional,2021-02-18,2021-02-18,2021-04-03,PLN6045,1790497490,1790497490,OB/GYN,In-Network,C50.912,E11.9,,,,,,,0,,99232,E&M,,,,11,Office,1,163.47,65.47,0.0,65.47,25.0,0.0,90.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010142,MBR00000393,Professional,2023-10-03,2023-10-03,2023-11-12,PLN4784,1609138981,1609138981,Critical Access Hospital,In-Network,M17.11,I10,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,2,644.01,340.09,6.03,334.06,0.0,0.0,334.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010143,MBR00000393,Professional,2023-07-10,2023-07-10,2023-07-30,PLN6880,1745114564,1745114564,Endocrinology,In-Network,J06.9,I10,,,,,,,0,,77067,Radiology,,,,23,Emergency Room,1,785.07,440.97,265.78,162.59,0.0,12.6,175.19,0.0,Paid,,,0,,1,1,0,0,0,0,None,1,0,0,0,0
CLM0000010144,MBR00000393,Institutional-OP,2021-08-09,2021-08-09,2021-09-11,PLN2930,1295371663,1295371663,Critical Access Hospital,In-Network,I63.9,G43.909,,,,,,,0,,23472,Surgery,,,0120,22,Outpatient Hospital,3,4175.87,1272.33,1197.33,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010145,MBR00000393,Professional,2023-05-29,2023-05-29,2023-06-06,PLN7118,1247341320,1247341320,Urology,Out-of-Network,Z12.31,I63.9,,,,,,,0,,99232,E&M,,,,11,Office,3,361.61,222.32,147.32,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010146,MBR00000393,Institutional-OP,2021-02-22,2021-02-22,2021-03-16,PLN9560,1422747896,1422747896,Urology,In-Network,I50.9,C50.912,,,,,,,0,,G0439,Medicine,,,0636,22,Outpatient Hospital,2,513.46,170.43,145.43,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000010147,MBR00000394,Institutional-OP,2021-09-17,2021-09-17,2021-10-15,PLN8179,1899127912,1899127912,Neurology,In-Network,F32.9,E78.5,,,,,,,0,,G0444,Medicine,,,0740,22,Outpatient Hospital,1,47.5,29.9,0.0,29.9,0.0,0.0,29.9,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000010148,MBR00000394,Professional,2021-06-14,2021-06-14,2021-07-11,PLN7300,1186826716,1186826716,Physical Therapy,In-Network,J06.9,J20.9,,,,,,,0,,76700,Radiology,,,,23,Emergency Room,1,715.98,605.43,0.0,148.59,75.0,0.0,223.59,0.0,Denied,PR-1,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010149,MBR00000394,Institutional-OP,2022-01-08,2022-01-08,2022-01-26,PLN1408,1860435061,1860435061,DME Supplier,In-Network,E78.5,Z00.00,,,,,,,0,,99204,E&M,,,0510,22,Outpatient Hospital,1,354.0,140.4,0.0,140.4,50.0,0.0,190.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010150,MBR00000394,Professional,2021-12-17,2021-12-17,2022-01-04,PLN1564,1283743001,1283743001,Family Medicine,In-Network,I25.10,F41.9,,,,,,,0,,90460,Medicine,,,,11,Office,1,59.38,25.16,0.0,25.16,0.0,0.0,25.16,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010151,MBR00000394,Professional,2022-07-16,2022-07-16,2022-08-19,PLN1606,1236418230,1236418230,DME Supplier,In-Network,Z23,J18.9,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,1,20428.48,17066.04,16525.92,465.12,75.0,0.0,540.12,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000010152,MBR00000394,Institutional-OP,2022-05-18,2022-05-18,2022-06-27,PLN8740,1585582070,1585582070,Outpatient Clinic,In-Network,N18.3,Z79.4,,,,,,,0,,45380,Surgery,,,0120,22,Outpatient Hospital,3,2698.36,982.03,957.03,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000010153,MBR00000394,Professional,2021-05-05,2021-05-05,2021-06-09,PLN8424,1935547131,1935547131,Pulmonology,In-Network,N39.0,N18.3,,,,,,,0,,85610,Pathology/Lab,,,,50,Federally Qualified Health Center,3,28.76,14.64,0.0,0.0,0.0,2.4,2.4,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010154,MBR00000394,Professional,2021-06-14,2021-06-14,2021-07-23,PLN9595,1500949740,1500949740,Pediatrics,In-Network,C50.912,E66.9,,,,,,,0,,80053,Pathology/Lab,,,,23,Emergency Room,2,68.53,38.69,0.0,38.69,35.0,0.0,73.69,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010155,MBR00000394,Institutional-IP,2023-06-18,2023-06-19,2023-07-29,PLN4735,1361302520,1361302520,Critical Access Hospital,In-Network,I10,J06.9,,,,194,MS-DRG,8,1,N,43239,Surgery,,,0120,21,Inpatient Hospital,2,1743.15,1017.77,1017.77,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000010156,MBR00000394,Institutional-IP,2022-08-24,2022-08-30,2022-09-05,PLN7928,1915531927,1915531927,Critical Access Hospital,In-Network,J06.9,Z12.31,,,,603,MS-DRG,23,6,Y,58661,Surgery,,,0200,21,Inpatient Hospital,1,3975.54,2912.68,2256.51,339.37,0.0,316.8,656.17,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010157,MBR00000394,Institutional-IP,2023-10-07,2023-10-09,2023-10-16,PLN7445,1590915516,1590915516,Physical Therapy,Out-of-Network,F32.9,F32.9,,,,196,MS-DRG,22,2,Y,99406,Medicine,,,0360,21,Inpatient Hospital,2,50.33,23.43,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010158,MBR00000394,Professional,2021-05-24,2021-05-24,2021-06-02,PLN8959,1700633438,1700633438,DME Supplier,In-Network,E11.65,J45.20,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,3,2882.06,1143.55,931.36,0.0,0.0,212.19,212.19,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000010159,MBR00000394,Institutional-IP,2021-12-04,2021-12-09,2021-12-22,PLN9095,1390307371,1390307371,DME Supplier,In-Network,J06.9,K57.30,,,,871,MS-DRG,9,5,Y,85610,Pathology/Lab,,,0270,21,Inpatient Hospital,1,62.17,30.96,0.0,30.96,0.0,0.0,30.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010160,MBR00000394,Professional,2021-06-22,2021-06-22,2021-07-07,PLN7863,1242201429,1242201429,General Acute Care Hospital,In-Network,Z23,I63.9,,,,,,,0,,99213,E&M,,,,22,Outpatient Hospital,3,151.6,62.04,56.51,0.0,0.0,5.53,5.53,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010161,MBR00000394,Professional,2023-10-09,2023-10-09,2023-10-23,PLN7132,1717912431,1717912431,Oncology,In-Network,K57.30,N18.3,,,,,,,0,,78452,Radiology,,,,11,Office,3,5948.97,3705.08,3326.2,303.88,75.0,0.0,378.88,0.0,Paid,,,1,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000010162,MBR00000394,Professional,2021-06-23,2021-06-23,2021-07-03,PLN6621,1915531927,1915531927,Critical Access Hospital,In-Network,I10,Z00.01,,,,,,,0,,99204,E&M,,,,20,Urgent Care,1,293.63,204.61,0.0,204.61,0.0,0.0,204.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010163,MBR00000394,Institutional-IP,2023-05-27,2023-05-31,2023-07-04,PLN3949,1809014947,1809014947,Urology,In-Network,E11.65,J20.9,,,,683,MS-DRG,18,4,Y,23472,Surgery,,,0360,21,Inpatient Hospital,1,3472.73,1949.12,1781.08,18.11,15.0,134.93,168.04,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010164,MBR00000394,Institutional-OP,2021-07-30,2021-07-30,2021-08-25,PLN3158,1571574052,1571574052,Critical Access Hospital,In-Network,M81.0,E78.5,,,,,,,0,,27447,Surgery,,,0450,22,Outpatient Hospital,1,6032.03,4920.42,4920.42,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010165,MBR00000394,Professional,2023-03-08,2023-03-08,2023-03-28,PLN4676,1872272835,1872272835,Internal Medicine,In-Network,E11.9,K21.0,,,,,,,0,,70553,Radiology,,,,23,Emergency Room,2,1852.0,857.16,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010166,MBR00000394,Professional,2022-05-14,2022-05-14,2022-06-01,PLN7502,1295371663,1295371663,Critical Access Hospital,In-Network,E78.5,N39.0,,,,,,,0,,99233,E&M,,,,49,Independent Clinic,2,304.01,171.56,0.0,171.56,75.0,0.0,246.56,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010167,MBR00000394,Institutional-OP,2023-11-28,2023-11-28,2024-01-07,PLN5722,1561134315,1561134315,DME Supplier,In-Network,F32.9,G43.909,,,,,,,0,,99284,E&M,,,0270,22,Outpatient Hospital,3,524.93,201.02,0.0,0.0,15.0,21.75,36.75,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010168,MBR00000394,Professional,2021-03-18,2021-03-18,2021-04-13,PLN9916,1295371663,1295371663,Critical Access Hospital,In-Network,C50.912,M54.5,,,,,,,0,,99214,E&M,,,,65,End-Stage Renal Disease,3,357.42,132.06,12.28,119.69,0.0,0.09,119.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010169,MBR00000394,Professional,2021-12-22,2021-12-22,2022-01-23,PLN3335,1812060197,1812060197,Oncology,Out-of-Network,I63.9,I11.9,,,,,,,0,,58661,Surgery,,,,21,Inpatient Hospital,2,4647.63,1444.39,1444.39,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010170,MBR00000394,Institutional-IP,2023-03-03,2023-03-12,2023-03-13,PLN7629,1752470395,1752470395,Home Health,In-Network,M54.5,R10.9,,,,872,MS-DRG,19,9,Y,99222,E&M,,,0730,21,Inpatient Hospital,3,402.69,293.64,67.91,225.73,0.0,0.0,225.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010171,MBR00000394,Professional,2023-09-30,2023-09-30,2023-10-19,PLN8791,1545347862,1545347862,SNF,In-Network,J06.9,M81.0,,,,,,,0,,83036,Pathology/Lab,,,,81,Independent Laboratory,3,97.65,61.68,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000010172,MBR00000394,Professional,2022-08-14,2022-08-14,2022-08-27,PLN2911,1295371663,1295371663,Critical Access Hospital,In-Network,J06.9,Z00.00,,,,,,,0,,84443,Pathology/Lab,,,,23,Emergency Room,3,108.26,85.85,0.0,0.0,0.0,0.0,0.0,0.0,Denied,PR-1,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010173,MBR00000395,Institutional-OP,2021-04-18,2021-04-18,2021-05-05,PLN2724,1268679390,1268679390,Critical Access Hospital,In-Network,I10,E11.9,,,,,,,0,,99284,E&M,,,0370,22,Outpatient Hospital,2,831.89,316.52,316.52,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010174,MBR00000395,Professional,2022-11-21,2022-11-21,2022-12-11,PLN7011,1717546253,1717546253,Family Medicine,In-Network,Z12.31,R10.9,,,,,,,0,,71046,Radiology,,,,22,Outpatient Hospital,2,296.7,203.19,149.67,0.0,50.0,3.52,53.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010175,MBR00000395,Institutional-OP,2022-06-08,2022-06-08,2022-06-18,PLN7677,1946680931,1946680931,Critical Access Hospital,Out-of-Network,K57.30,F10.20,,,,,,,0,,27447,Surgery,,,0320,22,Outpatient Hospital,1,4979.27,2660.58,2606.79,53.79,0.0,0.0,53.79,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010176,MBR00000395,Institutional-OP,2023-04-29,2023-04-29,2023-06-11,PLN7039,1273488618,1273488618,General Acute Care Hospital,In-Network,Z23,E11.9,,,,,,,0,,99233,E&M,,,0120,22,Outpatient Hospital,1,318.39,253.7,253.7,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010177,MBR00000396,Professional,2022-08-28,2022-08-28,2022-10-06,PLN6220,1752470395,1752470395,Home Health,In-Network,Z00.00,J20.9,,,,,,,0,,76700,Radiology,,,,11,Office,2,658.6,252.61,252.61,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010178,MBR00000396,Institutional-OP,2023-09-11,2023-09-11,2023-10-08,PLN6639,1518055405,1518055405,Urology,In-Network,I10,Z00.00,,,,,,,0,,83036,Pathology/Lab,,,0200,22,Outpatient Hospital,1,73.15,49.75,49.75,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000010179,MBR00000396,Institutional-IP,2021-05-15,2021-05-17,2021-06-10,PLN7526,1847081578,1847081578,Urology,Out-of-Network,R10.9,E66.9,,,,291,MS-DRG,12,2,Y,85025,Pathology/Lab,,,0120,21,Inpatient Hospital,1,67.81,51.69,0.0,51.69,0.0,0.0,51.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010180,MBR00000396,Institutional-OP,2022-11-15,2022-11-15,2022-12-02,PLN3064,1295371663,1295371663,Critical Access Hospital,In-Network,Z12.31,F41.9,,,,,,,0,,47562,Surgery,,,0740,22,Outpatient Hospital,1,3802.11,1890.75,1578.99,0.0,25.0,286.76,311.76,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010181,MBR00000396,Institutional-OP,2023-03-19,2023-03-19,2023-04-21,PLN8336,1186826716,1186826716,Physical Therapy,In-Network,G43.909,F41.9,,,,,,,0,,99221,E&M,,,0900,22,Outpatient Hospital,3,240.07,108.4,0.0,108.4,35.0,0.0,143.4,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010182,MBR00000396,Professional,2022-03-21,2022-03-21,2022-03-29,PLN4019,1148984206,1148984206,Psychiatry,In-Network,I48.91,I10,,,,,,,0,,97530,Medicine,,,,81,Independent Laboratory,2,162.85,136.18,121.03,0.0,0.0,15.15,15.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010183,MBR00000396,Institutional-IP,2022-06-05,2022-06-12,2022-06-16,PLN3035,1946680931,1946680931,Critical Access Hospital,Out-of-Network,J18.9,Z00.00,,,,683,MS-DRG,24,7,Y,G0439,Medicine,,,0900,21,Inpatient Hospital,2,508.07,337.81,337.81,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000010184,MBR00000396,Institutional-IP,2023-02-01,2023-02-06,2023-02-10,PLN4906,1856686341,1856686341,Geriatrics,In-Network,J06.9,B97.89,,,,470,MS-DRG,4,5,Y,99214,E&M,,,0320,21,Inpatient Hospital,1,422.19,269.4,0.0,269.4,0.0,0.0,269.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010185,MBR00000396,Institutional-OP,2022-05-14,2022-05-14,2022-05-28,PLN4423,1500949740,1500949740,Pediatrics,In-Network,J44.1,I50.9,,,,,,,0,,99283,E&M,,,0740,22,Outpatient Hospital,2,439.08,265.15,0.0,265.15,0.0,0.0,265.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010186,MBR00000396,Professional,2022-03-06,2022-03-06,2022-04-14,PLN8385,1939033455,1939033455,Pulmonology,In-Network,Z23,E11.9,,,,,,,0,,87491,Pathology/Lab,,,,50,Federally Qualified Health Center,1,213.55,72.94,64.37,0.0,0.0,8.57,8.57,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010187,MBR00000396,Institutional-OP,2022-09-29,2022-09-29,2022-10-28,PLN9720,1780163051,1780163051,SNF,In-Network,E78.5,Z00.00,,,,,,,0,,66984,Surgery,,,0730,22,Outpatient Hospital,1,1766.38,1356.27,1356.27,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010188,MBR00000396,Professional,2023-05-31,2023-05-31,2023-06-17,PLN3224,1817234602,1817234602,Clinical Laboratory,In-Network,E66.9,J44.1,,,,,,,0,,81001,Pathology/Lab,,,,20,Urgent Care,1,25.95,11.23,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010189,MBR00000396,Institutional-OP,2021-05-28,2021-05-28,2021-06-11,PLN7756,1108115157,1108115157,General Acute Care Hospital,In-Network,N18.3,F03.90,,,,,,,0,,99221,E&M,,,0320,22,Outpatient Hospital,3,245.46,199.36,149.87,0.0,35.0,14.49,49.49,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010190,MBR00000396,Professional,2023-08-16,2023-08-16,2023-09-20,PLN6921,1205377316,1205377316,Orthopedic Surgery,In-Network,F41.9,F41.9,,,,,,,0,,33533,Surgery,,,,12,Home,1,13326.03,7690.9,7513.67,162.23,15.0,0.0,177.23,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000010191,MBR00000396,Professional,2021-08-08,2021-08-08,2021-08-26,PLN5906,1687650653,1687650653,Internal Medicine,In-Network,G43.909,K21.0,,,,,,,0,,43239,Surgery,,,,11,Office,1,935.33,475.6,0.0,148.62,25.0,0.0,173.62,0.0,Denied,CO-50,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010192,MBR00000397,Professional,2021-04-18,2021-04-18,2021-05-30,PLN9410,1728018911,1728018911,Nephrology,In-Network,I50.9,Z00.01,,,,,,,0,,71046,Radiology,,,,21,Inpatient Hospital,2,239.28,190.52,190.52,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010193,MBR00000397,Institutional-OP,2021-07-17,2021-07-17,2021-07-24,PLN2784,1749494482,1749494482,Pediatrics,In-Network,R10.9,F41.9,,,,,,,0,,86900,Pathology/Lab,,,0450,22,Outpatient Hospital,3,29.26,22.73,21.59,0.0,0.0,1.14,1.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010194,MBR00000397,Institutional-OP,2021-03-25,2021-03-25,2021-04-15,PLN1277,1991459367,1991459367,Neurology,Out-of-Network,C50.912,F10.20,,,,,,,0,,90460,Medicine,,,0900,22,Outpatient Hospital,3,57.85,22.59,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000010195,MBR00000397,Professional,2023-11-09,2023-11-09,2023-12-05,PLN7112,1622771872,1622771872,Pediatrics,In-Network,F41.9,J06.9,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,2,22244.8,18675.44,18651.07,24.37,0.0,0.0,24.37,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000010196,MBR00000397,Institutional-OP,2021-11-16,2021-11-16,2021-12-17,PLN1775,1795618275,1795618275,Pulmonology,In-Network,E11.9,Z00.00,,,,,,,0,,99232,E&M,,,0200,22,Outpatient Hospital,1,138.29,45.93,30.93,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010197,MBR00000397,Professional,2023-04-27,2023-04-27,2023-05-29,PLN4027,1806688928,1806688928,Geriatrics,In-Network,F41.9,S72.001A,,,,,,,0,,90686,Medicine,,,,22,Outpatient Hospital,3,138.27,61.53,0.0,32.87,75.0,0.0,107.87,0.0,Denied,CO-18,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000010198,MBR00000397,Professional,2021-07-19,2021-07-19,2021-08-10,PLN6648,1450553056,1450553056,Clinical Laboratory,In-Network,E78.5,Z00.01,,,,,,,0,,71046,Radiology,,,,11,Office,3,135.49,79.85,4.66,0.0,75.0,0.19,75.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010199,MBR00000397,Professional,2022-08-03,2022-08-03,2022-08-19,PLN3232,1268679390,1268679390,Critical Access Hospital,In-Network,I25.10,Z12.31,,,,,,,0,,97110,Medicine,,,,11,Office,3,111.26,38.91,38.91,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010200,MBR00000397,Professional,2022-04-12,2022-04-12,2022-05-01,PLN2774,1390307371,1390307371,DME Supplier,In-Network,J44.1,K21.0,,,,,,,0,,87491,Pathology/Lab,,,,50,Federally Qualified Health Center,1,243.64,146.84,0.0,146.84,25.0,0.0,171.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010201,MBR00000397,Professional,2022-12-24,2022-12-24,2023-01-14,PLN1524,1434029575,1434029575,Endocrinology,In-Network,E11.9,Z87.891,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,3,1110.75,673.67,623.67,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010202,MBR00000397,Professional,2023-12-19,2023-12-19,2024-01-19,PLN1958,1631954542,1631954542,Oncology,In-Network,F10.20,F03.90,,,,,,,0,,99221,E&M,,,,11,Office,3,309.36,103.93,0.0,0.0,0.0,0.92,0.92,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010203,MBR00000397,Professional,2022-12-13,2022-12-13,2022-12-22,PLN3978,1236418230,1236418230,DME Supplier,In-Network,E78.5,M17.11,,,,,,,0,,99204,E&M,,,,21,Inpatient Hospital,3,426.34,147.06,0.0,147.06,0.0,0.0,147.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010204,MBR00000397,Professional,2023-02-08,2023-02-08,2023-03-21,PLN9323,1198133277,1198133277,SNF,In-Network,Z79.4,E66.9,,,,,,,0,,72148,Radiology,,,,11,Office,3,1192.02,896.72,435.33,461.39,0.0,0.0,461.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010205,MBR00000397,Professional,2021-10-15,2021-10-15,2021-11-11,PLN2853,1865904917,1865904917,Outpatient Clinic,In-Network,Z00.00,I50.9,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,1,70.63,42.24,7.24,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010206,MBR00000397,Institutional-IP,2021-05-14,2021-05-17,2021-05-28,PLN2543,1745114564,1745114564,Endocrinology,In-Network,C50.912,M54.5,,,,470,MS-DRG,8,3,Y,99214,E&M,,,0301,21,Inpatient Hospital,1,277.74,210.43,169.74,0.0,0.0,40.69,40.69,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010207,MBR00000397,Professional,2021-04-05,2021-04-05,2021-04-26,PLN8163,1571574052,1571574052,Critical Access Hospital,In-Network,N39.0,I10,,,,,,,0,,72148,Radiology,,,,11,Office,3,1917.14,1596.66,1581.66,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010208,MBR00000397,Professional,2021-11-25,2021-11-25,2021-12-08,PLN4767,1585582070,1585582070,Outpatient Clinic,In-Network,E78.5,K57.30,,,,,,,0,,99203,E&M,,,,11,Office,1,304.7,156.84,156.84,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010209,MBR00000397,Professional,2022-08-31,2022-08-31,2022-09-24,PLN3987,1273488618,1273488618,General Acute Care Hospital,In-Network,I10,Z00.01,,,,,,,0,,99213,E&M,,,,11,Office,2,286.17,117.57,44.72,65.47,0.0,7.38,72.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010210,MBR00000397,Institutional-IP,2021-03-08,2021-03-10,2021-03-27,PLN8977,1891849440,1891849440,Oncology,In-Network,N17.9,Z00.00,,,,291,MS-DRG,18,2,Y,99204,E&M,,,0270,21,Inpatient Hospital,1,405.96,145.09,95.09,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000010211,MBR00000397,Institutional-OP,2021-10-16,2021-10-16,2021-11-07,PLN5451,1702692193,1702692193,Physical Therapy,In-Network,Z00.00,Z87.891,,,,,,,0,,99232,E&M,,,0360,22,Outpatient Hospital,1,181.88,98.3,17.17,45.7,35.0,0.43,81.13,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010212,MBR00000397,Professional,2022-11-23,2022-11-23,2022-12-05,PLN8788,1845057593,1845057593,Orthopedic Surgery,In-Network,I10,Z12.31,,,,,,,0,,99284,E&M,,,,11,Office,3,718.11,283.94,0.0,283.94,25.0,0.0,308.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010213,MBR00000397,Institutional-IP,2023-08-15,2023-08-20,2023-09-11,PLN1408,1518055405,1518055405,Urology,In-Network,K92.1,Z87.891,,,,682,MS-DRG,20,5,Y,85025,Pathology/Lab,,,0370,21,Inpatient Hospital,3,67.59,22.82,0.0,22.82,75.0,0.0,97.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010214,MBR00000397,Institutional-OP,2023-12-20,2023-12-20,2024-01-31,PLN2011,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,G43.909,E11.9,,,,,,,0,,90686,Medicine,,,0730,22,Outpatient Hospital,3,102.28,35.77,0.0,35.77,0.0,0.0,35.77,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000010215,MBR00000397,Institutional-OP,2021-09-16,2021-09-16,2021-09-29,PLN2557,1563980627,1563980627,Critical Access Hospital,In-Network,E66.9,E11.40,,,,,,,0,,G0439,Medicine,,,0301,22,Outpatient Hospital,1,544.72,183.0,0.0,183.0,0.0,0.0,183.0,0.0,Paid,,,0,,0,1,0,0,0,1,Upcoding,0,0,0,1,0
CLM0000010216,MBR00000397,Professional,2021-04-22,2021-04-22,2021-05-07,PLN1236,1531398223,1531398223,OB/GYN,In-Network,I11.9,J18.9,,,,,,,0,,33533,Surgery,,,,49,Independent Clinic,3,27823.6,20699.45,18977.56,205.7,35.0,1481.19,1721.89,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000010217,MBR00000397,Institutional-OP,2022-09-20,2022-09-20,2022-10-26,PLN2259,1717912431,1717912431,Oncology,In-Network,J06.9,Z87.891,,,,,,,0,,93225,Medicine,,,0730,22,Outpatient Hospital,2,573.65,446.69,446.69,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010218,MBR00000397,Professional,2023-10-25,2023-10-25,2023-12-05,PLN6130,1806688928,1806688928,Geriatrics,In-Network,F10.20,E11.9,,,,,,,0,,99232,E&M,,,,49,Independent Clinic,1,314.3,200.35,39.4,160.95,0.0,0.0,160.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010219,MBR00000397,Professional,2022-04-06,2022-04-06,2022-04-18,PLN1876,1434029575,1434029575,Endocrinology,In-Network,Z00.00,E11.9,,,,,,,0,,93306,Radiology,,,,11,Office,2,2843.61,1475.75,1460.75,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010220,MBR00000397,Institutional-IP,2023-09-18,2023-09-22,2023-11-01,PLN2401,1193493783,1193493783,Critical Access Hospital,Out-of-Network,R07.9,J20.9,,,,196,MS-DRG,4,4,Y,77067,Radiology,,,0120,21,Inpatient Hospital,1,441.14,260.04,90.41,119.63,50.0,0.0,169.63,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000010221,MBR00000397,Professional,2023-03-25,2023-03-25,2023-05-08,PLN5351,1545347862,1545347862,SNF,In-Network,J44.1,I10,,,,,,,0,,27447,Surgery,,,,11,Office,1,4544.5,2368.54,2368.54,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010222,MBR00000397,Institutional-OP,2023-09-12,2023-09-12,2023-09-24,PLN7633,1891849440,1891849440,Oncology,In-Network,R05,Z23,,,,,,,0,,99284,E&M,,,0740,22,Outpatient Hospital,3,890.07,462.24,462.24,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010223,MBR00000397,Professional,2023-11-08,2023-11-08,2023-12-16,PLN5055,1806688928,1806688928,Geriatrics,In-Network,J20.9,R07.9,,,,,,,0,,23472,Surgery,,,,11,Office,1,6456.84,2180.69,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-27,,1,,0,0,1,0,0,1,Phantom,0,0,0,0,0
CLM0000010224,MBR00000397,Professional,2021-04-28,2021-04-28,2021-05-14,PLN1672,1915531927,1915531927,Critical Access Hospital,In-Network,J44.1,E78.5,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,1,171.4,94.06,0.0,94.06,0.0,0.0,94.06,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010225,MBR00000397,Professional,2022-03-27,2022-03-27,2022-04-23,PLN9712,1540044947,1540044947,Pulmonology,Out-of-Network,R10.9,J06.9,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,1,47.7,19.27,4.27,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010226,MBR00000397,Institutional-OP,2021-02-24,2021-02-24,2021-03-04,PLN9863,1609138981,1609138981,Critical Access Hospital,In-Network,Z23,Z51.11,,,,,,,0,,97530,Medicine,,,0270,22,Outpatient Hospital,1,178.3,92.34,80.49,0.0,0.0,11.85,11.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010227,MBR00000397,Professional,2021-02-18,2021-02-18,2021-03-24,PLN3945,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,J06.9,K21.0,,,,,,,0,,99284,E&M,,,,11,Office,3,857.04,703.28,523.07,145.21,35.0,0.0,180.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010228,MBR00000397,Professional,2022-06-05,2022-06-05,2022-06-16,PLN6217,1334916761,1334916761,ASC,In-Network,S72.001A,E78.5,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,2,39.67,26.55,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010229,MBR00000397,Institutional-OP,2022-12-26,2022-12-26,2023-02-01,PLN1377,1313212303,1313212303,Family Medicine,In-Network,Z12.11,C50.912,,,,,,,0,,90686,Medicine,,,0370,22,Outpatient Hospital,3,60.65,27.6,26.25,0.0,0.0,1.35,1.35,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000010230,MBR00000397,Professional,2023-08-29,2023-08-29,2023-09-21,PLN6017,1108115157,1108115157,General Acute Care Hospital,In-Network,K21.0,E11.9,,,,,,,0,,99232,E&M,,,,65,End-Stage Renal Disease,3,313.22,219.2,219.2,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010231,MBR00000397,Professional,2021-05-22,2021-05-22,2021-06-13,PLN8909,1545347862,1545347862,SNF,In-Network,E78.5,I10,,,,,,,0,,71046,Radiology,,,,81,Independent Laboratory,3,323.52,228.75,40.29,188.46,0.0,0.0,188.46,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010232,MBR00000397,Institutional-IP,2021-02-06,2021-02-13,2021-03-22,PLN3995,1891849440,1891849440,Oncology,In-Network,I10,Z23,,,,470,MS-DRG,14,7,Y,99222,E&M,,,0900,21,Inpatient Hospital,2,481.5,382.4,182.47,155.32,25.0,19.61,199.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010233,MBR00000397,Professional,2021-04-25,2021-04-25,2021-05-14,PLN5840,1780163051,1780163051,SNF,In-Network,N18.3,Z23,,,,,,,0,,99203,E&M,,,,21,Inpatient Hospital,2,173.27,77.05,0.0,77.05,50.0,0.0,127.05,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010234,MBR00000397,Professional,2023-10-12,2023-10-12,2023-11-25,PLN5460,1609138981,1609138981,Critical Access Hospital,In-Network,E66.9,R05,,,,,,,0,,72148,Radiology,,,,11,Office,2,2705.71,964.18,964.18,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010235,MBR00000397,Professional,2022-12-26,2022-12-26,2023-01-23,PLN4409,1991459367,1991459367,Neurology,Out-of-Network,I10,I11.9,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,3,245.3,152.44,0.0,152.44,0.0,0.0,152.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010236,MBR00000397,Professional,2022-06-12,2022-06-12,2022-06-23,PLN2625,1691062876,1691062876,SNF,In-Network,Z23,Z00.00,,,,,,,0,,90837,Medicine,,,,11,Office,2,250.64,163.48,0.0,163.48,15.0,0.0,178.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010237,MBR00000397,Professional,2021-04-23,2021-04-23,2021-05-26,PLN4448,1812060197,1812060197,Oncology,Out-of-Network,Z12.31,K57.30,,,,,,,0,,99406,Medicine,,,,65,End-Stage Renal Disease,3,94.45,59.68,24.68,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010238,MBR00000397,Institutional-OP,2022-02-11,2022-02-11,2022-02-24,PLN3336,1575695214,1575695214,SNF,In-Network,J06.9,E66.9,,,,,,,0,,99233,E&M,,,0320,22,Outpatient Hospital,1,480.59,186.14,161.14,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010239,MBR00000397,Professional,2021-05-22,2021-05-22,2021-06-26,PLN9885,1749327647,1749327647,Geriatrics,In-Network,J20.9,I10,,,,,,,0,,99222,E&M,,,,11,Office,3,607.35,212.48,152.9,0.0,35.0,24.58,59.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010240,MBR00000397,Professional,2021-02-02,2021-02-02,2021-03-02,PLN6693,1812060197,1812060197,Oncology,Out-of-Network,I10,F41.9,,,,,,,0,,99203,E&M,,,,11,Office,1,315.41,198.79,155.42,0.0,35.0,8.37,43.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010241,MBR00000397,Professional,2022-04-26,2022-04-26,2022-06-04,PLN5308,1899127912,1899127912,Neurology,In-Network,F41.9,F41.9,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,1,2979.51,1850.12,1637.02,7.37,35.0,170.73,213.1,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010242,MBR00000398,Institutional-OP,2022-07-05,2022-07-05,2022-07-29,PLN7846,1284035364,1284035364,Pediatrics,In-Network,Z00.00,E11.9,,,,,,,0,,27447,Surgery,,,0636,22,Outpatient Hospital,2,3678.1,2180.92,0.0,185.18,0.0,0.0,185.18,0.0,Denied,CO-15,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010243,MBR00000398,Institutional-OP,2022-05-11,2022-05-11,2022-06-19,PLN9623,1860435061,1860435061,DME Supplier,In-Network,E66.9,M54.5,,,,,,,0,,78452,Radiology,,,0636,22,Outpatient Hospital,3,3285.6,1664.74,1379.3,235.44,50.0,0.0,285.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010244,MBR00000398,Professional,2023-08-13,2023-08-13,2023-09-11,PLN2534,1799205295,1799205295,General Acute Care Hospital,In-Network,M17.11,I10,,,,,,,0,,33533,Surgery,,,,11,Office,1,12080.2,10060.07,9862.88,197.19,0.0,0.0,197.19,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000010245,MBR00000398,Institutional-OP,2023-09-28,2023-09-28,2023-10-25,PLN2548,1872613201,1872613201,Internal Medicine,In-Network,K21.0,J20.9,,,,,,,0,,99204,E&M,,,0301,22,Outpatient Hospital,2,293.17,120.6,0.0,120.6,50.0,0.0,170.6,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010246,MBR00000398,Professional,2021-05-14,2021-05-14,2021-05-24,PLN7166,1132188260,1132188260,Family Medicine,In-Network,K92.1,J06.9,,,,,,,0,,83036,Pathology/Lab,,,,23,Emergency Room,1,50.5,18.62,0.0,18.62,0.0,0.0,18.62,0.0,Denied,CO-4,,0,,1,0,0,0,0,0,None,0,0,1,0,0
CLM0000010247,MBR00000398,Professional,2021-10-30,2021-10-30,2021-11-11,PLN3160,1752470395,1752470395,Home Health,In-Network,I10,F41.9,,,,,,,0,,33533,Surgery,,,,21,Inpatient Hospital,3,26251.17,9681.45,8300.31,50.9,25.0,1305.24,1381.14,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000010248,MBR00000398,Professional,2022-07-03,2022-07-03,2022-07-19,PLN5244,1125190055,1125190055,Nephrology,In-Network,I11.9,F32.9,,,,,,,0,,76700,Radiology,,,,23,Emergency Room,1,1025.03,641.34,606.34,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010249,MBR00000398,Institutional-IP,2022-03-16,2022-03-25,2022-04-01,PLN8759,1337791138,1337791138,Internal Medicine,Out-of-Network,Z00.00,F32.9,,,,683,MS-DRG,11,9,N,87491,Pathology/Lab,,,0450,21,Inpatient Hospital,2,171.16,132.08,0.0,132.08,15.0,0.0,147.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010250,MBR00000398,Professional,2022-04-23,2022-04-23,2022-05-17,PLN5421,1109850785,1109850785,ASC,Out-of-Network,E78.5,I10,,,,,,,0,,99232,E&M,,,,11,Office,1,238.12,120.31,105.31,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000010251,MBR00000398,Professional,2023-02-14,2023-02-14,2023-03-11,PLN1497,1366286000,1366286000,SNF,In-Network,Z00.00,Z00.00,,,,,,,0,,74177,Radiology,,,,11,Office,1,2388.59,1867.23,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010252,MBR00000398,Institutional-OP,2021-07-17,2021-07-17,2021-08-18,PLN7562,1728018911,1728018911,Nephrology,In-Network,R51,J20.9,,,,,,,0,,G0468,Medicine,,,0510,22,Outpatient Hospital,1,285.71,210.79,171.85,0.0,25.0,13.94,38.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010253,MBR00000398,Institutional-OP,2023-06-25,2023-06-25,2023-08-03,PLN8003,1109850785,1109850785,ASC,Out-of-Network,F41.9,Z23,,,,,,,0,,99232,E&M,,,0740,22,Outpatient Hospital,3,167.2,58.98,0.0,58.98,0.0,0.0,58.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010254,MBR00000398,Institutional-OP,2021-10-17,2021-10-17,2021-10-30,PLN4294,1273488618,1273488618,General Acute Care Hospital,In-Network,Z23,Z12.31,,,,,,,0,,76700,Radiology,,,0320,22,Outpatient Hospital,3,1415.17,735.73,735.73,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010255,MBR00000398,Institutional-IP,2022-01-18,2022-01-21,2022-02-07,PLN6497,1500037969,1500037969,Pulmonology,In-Network,E78.5,M54.5,,,,683,MS-DRG,4,3,Y,99284,E&M,,,0636,21,Inpatient Hospital,1,394.31,247.38,232.38,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010256,MBR00000399,Institutional-IP,2021-08-31,2021-09-03,2021-10-13,PLN7896,1542828721,1542828721,Orthopedic Surgery,In-Network,Z00.01,N20.0,,,,641,MS-DRG,11,3,Y,66984,Surgery,,,0200,21,Inpatient Hospital,3,1758.94,1407.14,1159.2,107.36,0.0,140.58,247.94,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010257,MBR00000399,Professional,2022-11-23,2022-11-23,2022-12-28,PLN8229,1935547131,1935547131,Pulmonology,In-Network,E11.9,N18.3,,,,,,,0,,84443,Pathology/Lab,,,,22,Outpatient Hospital,1,78.62,42.38,42.38,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010258,MBR00000399,Professional,2023-02-01,2023-02-01,2023-03-11,PLN3691,1556140803,1556140803,Cardiology,In-Network,J06.9,E11.65,,,,,,,0,,84443,Pathology/Lab,,,,49,Independent Clinic,1,77.87,57.01,0.0,57.01,0.0,0.0,57.01,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010259,MBR00000399,Institutional-OP,2022-11-15,2022-11-15,2022-12-09,PLN2589,1964402759,1964402759,Outpatient Clinic,In-Network,Z00.00,E66.9,,,,,,,0,,99406,Medicine,,,0450,22,Outpatient Hospital,3,85.51,68.98,0.0,68.98,15.0,0.0,83.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010260,MBR00000399,Professional,2022-06-25,2022-06-25,2022-07-20,PLN4268,1817234602,1817234602,Clinical Laboratory,In-Network,E11.9,M17.11,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,2,228.13,157.62,107.62,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010261,MBR00000399,Institutional-OP,2021-11-29,2021-11-29,2021-12-25,PLN6956,1745114564,1745114564,Endocrinology,In-Network,N17.9,E78.5,,,,,,,0,,90837,Medicine,,,0120,22,Outpatient Hospital,2,388.97,246.23,141.89,35.42,35.0,33.92,104.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010262,MBR00000399,Professional,2023-01-24,2023-01-24,2023-02-14,PLN2266,1795618275,1795618275,Pulmonology,In-Network,F41.9,F03.90,,,,,,,0,,99232,E&M,,,,11,Office,2,245.71,81.89,0.0,76.33,15.0,0.0,91.33,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010263,MBR00000399,Professional,2021-05-10,2021-05-10,2021-06-14,PLN4466,1438368327,1438368327,Home Health,In-Network,Z12.31,Z23,,,,,,,0,,81001,Pathology/Lab,,,,23,Emergency Room,2,31.43,18.13,0.0,0.0,0.0,0.26,0.26,0.0,Denied,CO-11,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010264,MBR00000399,Professional,2021-12-08,2021-12-08,2022-01-04,PLN6813,1266606767,1266606767,ASC,In-Network,E66.9,E11.9,,,,,,,0,,74177,Radiology,,,,21,Inpatient Hospital,1,1209.9,567.2,331.39,160.81,75.0,0.0,235.81,0.0,Adjusted,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010265,MBR00000399,Institutional-OP,2023-01-18,2023-01-18,2023-02-18,PLN9561,1606140917,1606140917,ASC,In-Network,K92.1,E11.9,,,,,,,0,,99222,E&M,,,0320,22,Outpatient Hospital,3,503.06,177.94,177.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010266,MBR00000399,Professional,2023-01-28,2023-01-28,2023-02-28,PLN8614,1717912431,1717912431,Oncology,In-Network,E11.40,J06.9,,,,,,,0,,45378,Surgery,,,,23,Emergency Room,3,2117.88,909.05,0.0,0.0,50.0,116.09,166.09,0.0,Denied,CO-27,,1,,1,1,0,0,0,0,None,0,1,0,0,0
CLM0000010267,MBR00000399,Institutional-IP,2021-10-21,2021-10-22,2021-11-10,PLN6032,1550154147,1550154147,Outpatient Clinic,In-Network,Z12.31,I48.91,,,,871,MS-DRG,6,1,Y,45380,Surgery,,,0360,21,Inpatient Hospital,2,2912.27,1911.73,1403.81,279.94,0.0,227.98,507.92,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000010268,MBR00000399,Professional,2022-01-09,2022-01-09,2022-01-19,PLN3521,1168881145,1168881145,Orthopedic Surgery,In-Network,E78.5,I10,,,,,,,0,,71046,Radiology,,,,21,Inpatient Hospital,3,232.14,72.26,72.26,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010269,MBR00000399,Institutional-IP,2021-12-15,2021-12-21,2021-12-22,PLN2041,1450094833,1450094833,Outpatient Clinic,In-Network,N17.9,F32.9,,,,194,MS-DRG,1,6,Y,45378,Surgery,,,0450,21,Inpatient Hospital,3,1416.87,568.92,533.92,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000010270,MBR00000399,Institutional-IP,2023-08-30,2023-09-05,2023-10-07,PLN3343,1242201429,1242201429,General Acute Care Hospital,In-Network,I10,I25.10,,,,196,MS-DRG,18,6,Y,97530,Medicine,,,0900,21,Inpatient Hospital,1,157.17,102.54,52.54,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010271,MBR00000399,Institutional-OP,2022-09-19,2022-09-19,2022-10-17,PLN2863,1946680931,1946680931,Critical Access Hospital,Out-of-Network,M54.5,R10.9,,,,,,,0,,99203,E&M,,,0510,22,Outpatient Hospital,3,310.73,169.33,129.14,0.0,35.0,5.19,40.19,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000010272,MBR00000399,Professional,2021-05-10,2021-05-10,2021-06-18,PLN5309,1500037969,1500037969,Pulmonology,In-Network,R05,M54.5,,,,,,,0,,70450,Radiology,,,,23,Emergency Room,3,642.19,362.71,282.65,80.06,0.0,0.0,80.06,0.0,Pended,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010273,MBR00000399,Professional,2021-06-26,2021-06-26,2021-07-16,PLN8342,1845057593,1845057593,Orthopedic Surgery,In-Network,Z12.31,F41.9,,,,,,,0,,99221,E&M,,,,11,Office,2,349.28,140.56,0.0,140.56,0.0,0.0,140.56,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010274,MBR00000399,Professional,2021-03-17,2021-03-17,2021-04-25,PLN5000,1790497490,1790497490,OB/GYN,In-Network,E11.65,G43.909,,,,,,,0,,90460,Medicine,,,,11,Office,2,74.3,23.11,23.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010275,MBR00000399,Professional,2021-09-22,2021-09-22,2021-10-18,PLN5821,1545347862,1545347862,SNF,In-Network,Z00.01,I10,,,,,,,0,,47562,Surgery,,,,81,Independent Laboratory,3,6408.42,3683.29,3517.0,166.29,0.0,0.0,166.29,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010276,MBR00000399,Institutional-OP,2021-09-01,2021-09-01,2021-09-12,PLN9226,1563980627,1563980627,Critical Access Hospital,In-Network,I25.10,E78.5,,,,,,,0,,99203,E&M,,,0301,22,Outpatient Hospital,3,287.37,162.16,162.16,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010277,MBR00000399,Professional,2022-05-04,2022-05-04,2022-06-13,PLN5145,1219817751,1219817751,OB/GYN,In-Network,E87.6,Z00.00,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,1,431.43,345.77,206.75,139.02,0.0,0.0,139.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010278,MBR00000399,Institutional-OP,2023-03-30,2023-03-30,2023-04-16,PLN8893,1860435061,1860435061,DME Supplier,In-Network,M81.0,Z00.00,,,,,,,0,,99214,E&M,,,0900,22,Outpatient Hospital,3,244.96,79.15,0.0,79.15,75.0,0.0,154.15,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010279,MBR00000399,Professional,2023-08-20,2023-08-20,2023-09-29,PLN8673,1266606767,1266606767,ASC,In-Network,F10.20,E78.5,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,3,323.37,130.39,105.39,0.0,25.0,0.0,25.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010280,MBR00000399,Institutional-OP,2022-09-04,2022-09-04,2022-09-17,PLN6312,1531398223,1531398223,OB/GYN,In-Network,J44.1,E66.9,,,,,,,0,,45378,Surgery,,,0900,22,Outpatient Hospital,3,1456.95,612.43,612.43,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000010281,MBR00000399,Institutional-IP,2023-04-26,2023-05-06,2023-05-12,PLN2086,1168246159,1168246159,Internal Medicine,In-Network,Z12.31,M54.5,,,,682,MS-DRG,16,10,Y,99232,E&M,,,0740,21,Inpatient Hospital,2,306.27,113.2,0.0,0.0,0.0,20.38,20.38,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010282,MBR00000399,Institutional-OP,2022-12-19,2022-12-19,2023-01-21,PLN5341,1806688928,1806688928,Geriatrics,In-Network,E78.5,N39.0,,,,,,,0,,33533,Surgery,,,0761,22,Outpatient Hospital,3,13274.02,9165.62,9000.9,164.72,0.0,0.0,164.72,0.0,Adjusted,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000010283,MBR00000399,Professional,2021-12-14,2021-12-14,2022-01-19,PLN9760,1780163051,1780163051,SNF,In-Network,E66.9,F41.9,,,,,,,0,,99284,E&M,,,,11,Office,3,384.7,181.07,149.64,0.0,0.0,31.43,31.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010284,MBR00000399,Institutional-IP,2022-11-02,2022-11-04,2022-11-11,PLN5862,1845057593,1845057593,Orthopedic Surgery,In-Network,E11.9,E78.5,,,,641,MS-DRG,17,2,Y,71046,Radiology,,,0740,21,Inpatient Hospital,2,314.46,238.87,0.0,238.87,75.0,0.0,313.87,0.0,Denied,CO-11,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000010285,MBR00000399,Professional,2021-11-27,2021-11-27,2022-01-07,PLN5634,1939033455,1939033455,Pulmonology,In-Network,Z23,N18.3,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,1,292.62,144.55,0.0,144.55,0.0,0.0,144.55,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010286,MBR00000399,Professional,2021-12-05,2021-12-05,2022-01-09,PLN2384,1366286000,1366286000,SNF,In-Network,F32.9,Z00.01,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,3,333.48,190.16,75.69,89.47,25.0,0.0,114.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010287,MBR00000399,Institutional-OP,2023-12-18,2023-12-18,2024-01-05,PLN5620,1193493783,1193493783,Critical Access Hospital,Out-of-Network,E78.5,N39.0,,,,,,,0,,85610,Pathology/Lab,,,0370,22,Outpatient Hospital,3,31.48,21.57,0.0,21.57,0.0,0.0,21.57,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010288,MBR00000399,Professional,2023-09-25,2023-09-25,2023-10-07,PLN5635,1542828721,1542828721,Orthopedic Surgery,In-Network,E66.9,K92.1,,,,,,,0,,97110,Medicine,,,,22,Outpatient Hospital,2,152.47,120.55,70.55,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010289,MBR00000399,Institutional-OP,2022-12-17,2022-12-17,2023-01-25,PLN1730,1778483301,1778483301,Home Health,In-Network,I11.9,J06.9,,,,,,,0,,27447,Surgery,,,0270,22,Outpatient Hospital,2,4162.56,1406.05,1353.71,0.0,0.0,52.34,52.34,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010290,MBR00000400,Professional,2022-10-12,2022-10-12,2022-11-12,PLN2495,1433937353,1433937353,Nephrology,In-Network,I10,Z23,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,2,2814.22,1957.41,1642.44,279.97,35.0,0.0,314.97,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010291,MBR00000400,Professional,2023-01-21,2023-01-21,2023-03-05,PLN1565,1366286000,1366286000,SNF,In-Network,Z00.00,Z12.31,,,,,,,0,,27130,Surgery,,,,11,Office,3,3458.74,1078.98,685.24,225.07,25.0,143.67,393.74,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010292,MBR00000400,Institutional-IP,2023-04-05,2023-04-10,2023-05-08,PLN2302,1500949740,1500949740,Pediatrics,In-Network,I48.91,I25.10,,,,690,MS-DRG,3,5,Y,45378,Surgery,,,0120,21,Inpatient Hospital,3,1716.57,994.29,436.3,490.5,0.0,67.49,557.99,0.0,Adjusted,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000010293,MBR00000400,Professional,2021-03-02,2021-03-02,2021-03-25,PLN3137,1283743001,1283743001,Family Medicine,In-Network,Z12.31,I50.9,,,,,,,0,,99283,E&M,,,,11,Office,3,293.25,175.47,125.47,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010294,MBR00000400,Institutional-IP,2022-01-28,2022-02-01,2022-02-23,PLN7103,1590915516,1590915516,Physical Therapy,Out-of-Network,E11.9,J44.1,,,,196,MS-DRG,7,4,N,71046,Radiology,,,0301,21,Inpatient Hospital,3,152.37,97.48,0.0,97.48,0.0,0.0,97.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010295,MBR00000400,Institutional-OP,2021-04-25,2021-04-25,2021-05-15,PLN8036,1860435061,1860435061,DME Supplier,In-Network,J06.9,S72.001A,,,,,,,0,,99222,E&M,,,0740,22,Outpatient Hospital,3,448.15,274.65,274.65,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010296,MBR00000400,Professional,2022-08-03,2022-08-03,2022-09-13,PLN6728,1856686341,1856686341,Geriatrics,In-Network,Z23,E11.9,,,,,,,0,,47562,Surgery,,,,11,Office,2,3740.28,1617.37,1552.43,64.94,0.0,0.0,64.94,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010297,MBR00000400,Professional,2021-11-19,2021-11-19,2021-11-27,PLN8545,1946680931,1946680931,Critical Access Hospital,Out-of-Network,K21.0,K21.0,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,2,5479.22,4163.23,4148.23,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010298,MBR00000400,Professional,2021-12-28,2021-12-28,2022-01-04,PLN4298,1809014947,1809014947,Urology,In-Network,Z23,F32.9,,,,,,,0,,83036,Pathology/Lab,,,,31,Skilled Nursing Facility,3,67.84,36.08,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000010299,MBR00000400,Professional,2023-07-12,2023-07-12,2023-07-28,PLN2045,1500037969,1500037969,Pulmonology,In-Network,N18.3,Z23,,,,,,,0,,83036,Pathology/Lab,,,,12,Home,1,71.23,45.66,45.66,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000010300,MBR00000400,Institutional-OP,2021-08-12,2021-08-12,2021-09-07,PLN4167,1295371663,1295371663,Critical Access Hospital,In-Network,G43.909,F41.9,,,,,,,0,,99213,E&M,,,0270,22,Outpatient Hospital,1,182.67,104.18,69.18,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010301,MBR00000400,Institutional-OP,2023-09-25,2023-09-25,2023-10-10,PLN4258,1463205530,1463205530,Nephrology,In-Network,Z00.00,E11.65,,,,,,,0,,72148,Radiology,,,0120,22,Outpatient Hospital,3,2239.58,1304.82,1086.92,192.9,25.0,0.0,217.9,0.0,Paid,,,1,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000010302,MBR00000400,Professional,2022-04-06,2022-04-06,2022-05-07,PLN4540,1434029575,1434029575,Endocrinology,In-Network,M54.5,K57.30,,,,,,,0,,99214,E&M,,,,11,Office,3,258.95,140.67,140.67,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010303,MBR00000400,Professional,2021-07-29,2021-07-29,2021-08-25,PLN4344,1752470395,1752470395,Home Health,In-Network,Z00.00,I25.10,,,,,,,0,,99213,E&M,,,,49,Independent Clinic,3,290.72,94.8,94.8,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010304,MBR00000400,Professional,2021-06-06,2021-06-06,2021-06-20,PLN9072,1198133277,1198133277,SNF,In-Network,C50.912,K21.0,,,,,,,0,,47562,Surgery,,,,65,End-Stage Renal Disease,2,4481.62,2414.09,2414.09,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010305,MBR00000400,Professional,2023-02-22,2023-02-22,2023-03-23,PLN3391,1355166277,1355166277,Endocrinology,In-Network,Z12.31,R10.9,,,,,,,0,,99203,E&M,,,,20,Urgent Care,2,246.27,204.17,179.17,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010306,MBR00000400,Professional,2023-09-16,2023-09-16,2023-10-18,PLN6590,1700633438,1700633438,DME Supplier,In-Network,G20,I50.9,,,,,,,0,,97530,Medicine,,,,49,Independent Clinic,3,121.02,87.69,87.69,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000010307,MBR00000400,Institutional-OP,2023-08-16,2023-08-16,2023-09-17,PLN1713,1997536841,1997536841,Family Medicine,Out-of-Network,K92.1,E11.9,,,,,,,0,,78452,Radiology,,,0450,22,Outpatient Hospital,2,5779.42,3943.16,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010308,MBR00000400,Professional,2021-07-06,2021-07-06,2021-07-20,PLN1444,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,F32.9,C50.912,,,,,,,0,,93306,Radiology,,,,11,Office,3,2878.9,1052.29,928.82,0.0,0.0,123.47,123.47,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010309,MBR00000401,Institutional-OP,2023-08-21,2023-08-21,2023-09-21,PLN7527,1242201429,1242201429,General Acute Care Hospital,In-Network,B97.89,I10,,,,,,,0,,99222,E&M,,,0740,22,Outpatient Hospital,1,622.9,331.01,331.01,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010310,MBR00000401,Professional,2021-09-04,2021-09-04,2021-10-18,PLN9454,1717912431,1717912431,Oncology,In-Network,M54.5,I10,,,,,,,0,,90460,Medicine,,,,22,Outpatient Hospital,3,41.91,30.09,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010311,MBR00000401,Institutional-OP,2022-05-18,2022-05-18,2022-06-01,PLN9299,1372918899,1372918899,Family Medicine,In-Network,Z23,Z00.01,,,,,,,0,,99214,E&M,,,0740,22,Outpatient Hospital,2,311.56,101.98,101.98,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010312,MBR00000401,Institutional-OP,2021-01-07,2021-01-07,2021-02-05,PLN7080,1624202402,1624202402,Orthopedic Surgery,In-Network,I10,I10,,,,,,,0,,99222,E&M,,,0730,22,Outpatient Hospital,3,454.35,166.38,0.0,166.38,35.0,0.0,201.38,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000010313,MBR00000401,Institutional-OP,2021-10-11,2021-10-11,2021-10-26,PLN6879,1569105090,1569105090,Geriatrics,In-Network,E11.65,E66.9,,,,,,,0,,97110,Medicine,,,0200,22,Outpatient Hospital,1,185.77,94.56,0.0,94.56,75.0,0.0,169.56,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010314,MBR00000401,Professional,2021-12-17,2021-12-17,2022-01-21,PLN6790,1500037969,1500037969,Pulmonology,In-Network,E78.5,M17.11,,,,,,,0,,93306,Radiology,,,,11,Office,1,1497.61,1056.19,1013.88,0.0,25.0,0.0,25.0,17.31,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010315,MBR00000401,Professional,2023-11-14,2023-11-14,2023-12-14,PLN5194,1193493783,1193493783,Critical Access Hospital,Out-of-Network,E11.40,N40.0,,,,,,,0,,93000,Radiology,,,,11,Office,1,167.57,69.69,16.73,0.0,50.0,2.96,52.96,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010316,MBR00000401,Professional,2021-11-01,2021-11-01,2021-11-30,PLN3873,1125190055,1125190055,Nephrology,In-Network,I63.9,J20.9,,,,,,,0,,G0439,Medicine,,,,11,Office,1,405.48,203.59,179.25,0.0,0.0,24.34,24.34,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000010317,MBR00000401,Professional,2021-10-30,2021-10-30,2021-11-24,PLN1478,1118885473,1118885473,ASC,In-Network,F32.9,N40.0,,,,,,,0,,43239,Surgery,,,,11,Office,2,2204.09,1059.23,975.0,9.23,75.0,0.0,84.23,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010318,MBR00000401,Institutional-IP,2021-10-27,2021-11-02,2021-12-06,PLN6276,1860435061,1860435061,DME Supplier,In-Network,E78.5,Z00.01,,,,291,MS-DRG,13,6,Y,99232,E&M,,,0636,21,Inpatient Hospital,3,348.64,208.69,178.76,0.0,0.0,0.0,0.0,29.93,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010319,MBR00000402,Institutional-OP,2021-10-04,2021-10-04,2021-10-19,PLN4675,1691062876,1691062876,SNF,In-Network,E11.9,J18.9,,,,,,,0,,99213,E&M,,,0320,22,Outpatient Hospital,2,135.92,79.9,4.9,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000010320,MBR00000402,Institutional-IP,2022-08-15,2022-08-18,2022-08-23,PLN2870,1910255109,1910255109,DME Supplier,In-Network,I10,J06.9,,,,872,MS-DRG,23,3,Y,99233,E&M,,,0636,21,Inpatient Hospital,2,486.01,340.89,305.89,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000010321,MBR00000402,Professional,2021-08-14,2021-08-14,2021-09-27,PLN7669,1433937353,1433937353,Nephrology,In-Network,E11.9,K57.30,,,,,,,0,,85610,Pathology/Lab,,,,49,Independent Clinic,3,30.67,12.94,12.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010322,MBR00000402,Professional,2021-11-15,2021-11-15,2021-12-13,PLN7730,1856686341,1856686341,Geriatrics,In-Network,N39.0,F41.9,,,,,,,0,,99222,E&M,,,,21,Inpatient Hospital,3,369.93,263.92,30.51,233.41,0.0,0.0,233.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010323,MBR00000402,Institutional-IP,2022-08-07,2022-08-10,2022-08-30,PLN7415,1438368327,1438368327,Home Health,In-Network,I10,I10,,,,196,MS-DRG,16,3,Y,99204,E&M,,,0370,21,Inpatient Hospital,2,399.69,312.16,312.16,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010324,MBR00000402,Professional,2023-04-09,2023-04-09,2023-05-16,PLN5017,1224179551,1224179551,Physical Therapy,In-Network,N17.9,R05,,,,,,,0,,83036,Pathology/Lab,,,,23,Emergency Room,1,53.29,17.44,0.0,17.44,15.0,0.0,32.44,0.0,Denied,CO-4,,0,,1,0,0,0,0,0,None,0,0,1,0,0
CLM0000010325,MBR00000402,Professional,2021-04-28,2021-04-28,2021-06-07,PLN6821,1585582070,1585582070,Outpatient Clinic,In-Network,I11.9,E78.5,,,,,,,0,,90837,Medicine,,,,65,End-Stage Renal Disease,2,507.88,261.72,0.0,261.72,0.0,0.0,261.72,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010326,MBR00000402,Professional,2022-01-17,2022-01-17,2022-02-14,PLN5727,1696843572,1696843572,Critical Access Hospital,Out-of-Network,E11.9,E11.9,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,1,57.62,23.07,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000010327,MBR00000402,Institutional-OP,2022-09-17,2022-09-17,2022-10-10,PLN3940,1366576336,1366576336,Geriatrics,In-Network,K21.0,J44.1,,,,,,,0,,23472,Surgery,,,0900,22,Outpatient Hospital,2,7435.41,4168.57,3681.92,0.0,15.0,471.65,486.65,0.0,Paid,,,0,,0,0,1,0,0,1,Duplicate,0,0,0,0,0
CLM0000010328,MBR00000402,Professional,2023-10-01,2023-10-01,2023-10-08,PLN2625,1438368327,1438368327,Home Health,In-Network,E78.5,J45.20,,,,,,,0,,99233,E&M,,,,23,Emergency Room,1,226.7,164.84,141.7,0.0,0.0,23.14,23.14,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010329,MBR00000402,Institutional-OP,2023-10-31,2023-10-31,2023-12-05,PLN7084,1148984206,1148984206,Psychiatry,In-Network,F32.9,E66.9,,,,,,,0,,86900,Pathology/Lab,,,0200,22,Outpatient Hospital,1,38.35,22.06,22.06,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010330,MBR00000402,Professional,2023-08-14,2023-08-14,2023-09-02,PLN2101,1168881145,1168881145,Orthopedic Surgery,In-Network,C50.912,E11.9,,,,,,,0,,76700,Radiology,,,,12,Home,3,744.7,291.61,236.78,54.83,0.0,0.0,54.83,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010331,MBR00000402,Institutional-IP,2022-07-07,2022-07-21,2022-08-05,PLN7576,1205377316,1205377316,Orthopedic Surgery,In-Network,N18.3,Z87.891,,,,872,MS-DRG,15,14,Y,99283,E&M,,,0730,21,Inpatient Hospital,3,558.45,204.97,0.0,204.97,50.0,0.0,254.97,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010332,MBR00000402,Institutional-OP,2021-04-18,2021-04-18,2021-05-16,PLN6384,1609526529,1609526529,Psychiatry,In-Network,K21.0,E11.9,,,,,,,0,,90686,Medicine,,,0636,22,Outpatient Hospital,3,142.53,103.91,0.0,103.91,15.0,0.0,118.91,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000010333,MBR00000402,Institutional-OP,2023-11-24,2023-11-24,2023-12-15,PLN6358,1337791138,1337791138,Internal Medicine,Out-of-Network,I10,F32.9,,,,,,,0,,70450,Radiology,,,0200,22,Outpatient Hospital,2,1172.53,366.88,0.0,309.74,0.0,5.08,314.82,0.0,Denied,CO-119,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010334,MBR00000402,Professional,2022-11-12,2022-11-12,2022-12-21,PLN4601,1872613201,1872613201,Internal Medicine,In-Network,E11.9,I10,,,,,,,0,,71046,Radiology,,,,11,Office,2,236.1,196.96,0.0,196.96,50.0,0.0,246.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010335,MBR00000402,Professional,2023-09-19,2023-09-19,2023-10-30,PLN6555,1422747896,1422747896,Urology,In-Network,F03.90,Z23,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,3,27778.7,9030.05,7719.45,0.0,50.0,1260.6,1310.6,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000010336,MBR00000402,Professional,2023-10-06,2023-10-06,2023-10-19,PLN2329,1644128543,1644128543,Gastroenterology,In-Network,I11.9,N20.0,,,,,,,0,,99204,E&M,,,,49,Independent Clinic,1,320.41,136.44,0.0,136.44,25.0,0.0,161.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010337,MBR00000402,Professional,2023-05-18,2023-05-18,2023-05-25,PLN8785,1500949740,1500949740,Pediatrics,In-Network,J20.9,E78.5,,,,,,,0,,77067,Radiology,,,,22,Outpatient Hospital,3,741.28,379.82,53.28,282.56,35.0,8.98,326.54,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000010338,MBR00000402,Professional,2022-04-06,2022-04-06,2022-05-16,PLN9102,1540044947,1540044947,Pulmonology,Out-of-Network,E11.9,J18.9,,,,,,,0,,33533,Surgery,,,,11,Office,2,10483.0,7350.01,7079.32,0.0,35.0,235.69,270.69,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000010339,MBR00000402,Institutional-IP,2022-10-28,2022-11-01,2022-11-22,PLN4440,1968299309,1968299309,Internal Medicine,In-Network,F32.9,E78.5,,,,470,MS-DRG,11,4,Y,99204,E&M,,,0301,21,Inpatient Hospital,3,256.5,195.42,33.25,162.17,0.0,0.0,162.17,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000010340,MBR00000402,Professional,2023-01-27,2023-01-27,2023-02-23,PLN5283,1609138981,1609138981,Critical Access Hospital,In-Network,F41.9,Z00.00,,,,,,,0,,99221,E&M,,,,11,Office,3,344.22,130.81,105.81,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010341,MBR00000402,Institutional-OP,2023-08-23,2023-08-23,2023-09-12,PLN8361,1186826716,1186826716,Physical Therapy,In-Network,K21.0,K21.0,,,,,,,0,,93225,Medicine,,,0360,22,Outpatient Hospital,2,629.97,411.27,0.0,411.27,25.0,0.0,436.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010342,MBR00000402,Institutional-OP,2021-09-05,2021-09-05,2021-09-20,PLN4209,1186826716,1186826716,Physical Therapy,In-Network,J06.9,E78.5,,,,,,,0,,G0439,Medicine,,,0730,22,Outpatient Hospital,2,308.34,142.51,0.0,142.51,0.0,0.0,142.51,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000010343,MBR00000402,Institutional-OP,2022-08-31,2022-08-31,2022-10-04,PLN7312,1974006077,1974006077,Orthopedic Surgery,In-Network,E87.6,E11.9,,,,,,,0,,99284,E&M,,,0730,22,Outpatient Hospital,3,454.48,363.5,0.0,0.0,0.0,0.0,0.0,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010344,MBR00000402,Institutional-IP,2022-10-15,2022-10-20,2022-11-27,PLN9144,1244186984,1244186984,Family Medicine,Out-of-Network,E11.40,I10,,,,683,MS-DRG,5,5,N,99204,E&M,,,0510,21,Inpatient Hospital,2,230.0,143.45,128.45,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010345,MBR00000402,Professional,2021-08-15,2021-08-15,2021-08-27,PLN5240,1364429278,1364429278,OB/GYN,In-Network,R07.9,F41.9,,,,,,,0,,85610,Pathology/Lab,,,,22,Outpatient Hospital,2,33.45,14.41,3.16,11.25,0.0,0.0,11.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010346,MBR00000402,Professional,2022-03-17,2022-03-17,2022-04-20,PLN8657,1500037969,1500037969,Pulmonology,In-Network,N20.0,Z96.641,,,,,,,0,,78452,Radiology,,,,22,Outpatient Hospital,3,6339.91,2483.85,2000.07,0.0,75.0,408.78,483.78,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010347,MBR00000402,Professional,2023-10-11,2023-10-11,2023-10-21,PLN5096,1891849440,1891849440,Oncology,In-Network,I10,J06.9,,,,,,,0,,43239,Surgery,,,,11,Office,3,2232.73,1853.65,1778.65,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010348,MBR00000402,Institutional-OP,2021-01-18,2021-01-18,2021-01-25,PLN2083,1545347862,1545347862,SNF,In-Network,E11.9,J20.9,,,,,,,0,,66984,Surgery,,,0450,22,Outpatient Hospital,1,1593.57,1242.18,1167.18,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010349,MBR00000402,Professional,2022-07-04,2022-07-04,2022-07-20,PLN3219,1910255109,1910255109,DME Supplier,In-Network,C50.912,Z00.00,,,,,,,0,,G0468,Medicine,,,,11,Office,2,433.74,226.73,226.68,0.05,0.0,0.0,0.05,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010350,MBR00000402,Professional,2022-10-30,2022-10-30,2022-11-27,PLN5356,1915531927,1915531927,Critical Access Hospital,In-Network,F41.9,E11.65,,,,,,,0,,99203,E&M,,,,49,Independent Clinic,1,213.41,85.03,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010351,MBR00000402,Institutional-OP,2023-09-21,2023-09-21,2023-10-25,PLN2492,1245650222,1245650222,Gastroenterology,In-Network,Z12.11,I48.91,,,,,,,0,,80061,Pathology/Lab,,,0510,22,Outpatient Hospital,2,114.62,83.19,0.0,83.19,25.0,0.0,108.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010352,MBR00000402,Professional,2021-11-07,2021-11-07,2021-11-15,PLN8335,1800011727,1800011727,Clinical Laboratory,Out-of-Network,I10,M54.5,,,,,,,0,,27130,Surgery,,,,11,Office,1,6785.81,2917.39,2464.19,453.2,0.0,0.0,453.2,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010353,MBR00000402,Institutional-OP,2022-03-07,2022-03-07,2022-04-13,PLN9420,1245650222,1245650222,Gastroenterology,In-Network,Z23,E78.5,,,,,,,0,,99232,E&M,,,0120,22,Outpatient Hospital,1,178.22,137.85,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010354,MBR00000402,Institutional-OP,2021-03-30,2021-03-30,2021-04-14,PLN4040,1389336600,1389336600,Critical Access Hospital,In-Network,K21.0,Z12.31,,,,,,,0,,80053,Pathology/Lab,,,0301,22,Outpatient Hospital,2,84.68,70.08,70.08,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010355,MBR00000402,Professional,2022-01-03,2022-01-03,2022-01-21,PLN8526,1780163051,1780163051,SNF,In-Network,E78.5,R07.9,,,,,,,0,,G0444,Medicine,,,,50,Federally Qualified Health Center,2,90.92,54.11,39.11,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000010356,MBR00000402,Institutional-IP,2023-12-29,2024-01-07,2024-02-11,PLN2131,1511044648,1511044648,Endocrinology,In-Network,M54.5,N39.0,,,,872,MS-DRG,24,9,N,85025,Pathology/Lab,,,0200,21,Inpatient Hospital,3,86.98,55.12,0.0,55.12,0.0,0.0,55.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010357,MBR00000402,Professional,2023-04-19,2023-04-19,2023-05-16,PLN3355,1103747954,1103747954,Urology,In-Network,N39.0,I10,,,,,,,0,,93306,Radiology,,,,49,Independent Clinic,2,2656.04,923.74,898.74,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010358,MBR00000402,Professional,2022-04-15,2022-04-15,2022-05-06,PLN4138,1609138981,1609138981,Critical Access Hospital,In-Network,F10.20,J18.9,,,,,,,0,,84443,Pathology/Lab,,,,21,Inpatient Hospital,2,122.72,75.14,36.05,33.83,0.0,5.26,39.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010359,MBR00000402,Institutional-OP,2022-11-26,2022-11-26,2022-12-18,PLN1671,1860435061,1860435061,DME Supplier,In-Network,E78.5,I48.91,,,,,,,0,,99213,E&M,,,0200,22,Outpatient Hospital,1,132.13,76.37,0.0,76.37,0.0,0.0,76.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010360,MBR00000402,Professional,2023-11-23,2023-11-23,2023-12-01,PLN5199,1865904917,1865904917,Outpatient Clinic,In-Network,Z00.00,E11.9,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,1,356.81,225.54,175.54,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010361,MBR00000402,Institutional-OP,2022-04-27,2022-04-27,2022-05-08,PLN6291,1219817751,1219817751,OB/GYN,In-Network,I48.91,E78.5,,,,,,,0,,90837,Medicine,,,0320,22,Outpatient Hospital,1,287.33,200.39,200.39,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010362,MBR00000402,Institutional-OP,2021-11-19,2021-11-19,2021-11-26,PLN9550,1556140803,1556140803,Cardiology,In-Network,E11.65,E78.5,,,,,,,0,,72148,Radiology,,,0450,22,Outpatient Hospital,2,2481.13,1328.28,1131.92,0.0,0.0,196.36,196.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010363,MBR00000402,Institutional-IP,2023-08-21,2023-08-23,2023-10-02,PLN2828,1545347862,1545347862,SNF,In-Network,F32.9,M54.5,,,,641,MS-DRG,5,2,Y,47562,Surgery,,,0636,21,Inpatient Hospital,2,5206.0,2562.02,2562.02,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010364,MBR00000402,Professional,2023-07-21,2023-07-21,2023-09-01,PLN3517,1812060197,1812060197,Oncology,Out-of-Network,N18.3,F03.90,,,,,,,0,,78452,Radiology,,,,11,Office,2,7144.49,2964.61,2840.16,0.0,25.0,99.45,124.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010365,MBR00000402,Professional,2022-07-20,2022-07-20,2022-08-08,PLN7446,1219817751,1219817751,OB/GYN,In-Network,M54.5,Z87.891,,,,,,,0,,66984,Surgery,,,,11,Office,3,1864.54,748.22,748.22,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010366,MBR00000402,Professional,2021-01-13,2021-01-13,2021-01-21,PLN2009,1860435061,1860435061,DME Supplier,In-Network,I10,N17.9,,,,,,,0,,97530,Medicine,,,,11,Office,2,188.55,145.18,70.18,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010367,MBR00000402,Professional,2021-01-15,2021-01-15,2021-02-23,PLN3343,1227362142,1227362142,DME Supplier,In-Network,M81.0,N39.0,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,3,422.16,158.09,0.0,158.09,35.0,0.0,193.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010368,MBR00000402,Professional,2021-05-09,2021-05-09,2021-05-22,PLN6297,1124394415,1124394415,Pediatrics,In-Network,M54.5,F10.20,,,,,,,0,,99203,E&M,,,,11,Office,1,206.25,72.5,37.5,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010369,MBR00000403,Professional,2023-01-30,2023-01-30,2023-02-26,PLN7907,1520687146,1520687146,ASC,In-Network,N20.0,E11.9,,,,,,,0,,99203,E&M,,,,11,Office,2,402.35,278.42,133.7,69.72,75.0,0.0,144.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010370,MBR00000403,Institutional-IP,2021-07-12,2021-07-16,2021-07-30,PLN8906,1896447406,1896447406,Nephrology,Out-of-Network,E11.40,Z23,,,,872,MS-DRG,17,4,W,97530,Medicine,,,0900,21,Inpatient Hospital,1,176.39,118.37,83.37,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010371,MBR00000403,Professional,2021-03-11,2021-03-11,2021-04-09,PLN1027,1450094833,1450094833,Outpatient Clinic,In-Network,J06.9,F41.9,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,1,23690.67,17811.88,17328.13,483.75,0.0,0.0,483.75,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000010372,MBR00000403,Professional,2023-01-17,2023-01-17,2023-02-12,PLN4205,1530904931,1530904931,Internal Medicine,In-Network,I10,F41.9,,,,,,,0,,99406,Medicine,,,,11,Office,1,36.15,12.01,0.0,12.01,0.0,0.0,12.01,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010373,MBR00000403,Institutional-IP,2022-06-11,2022-06-22,2022-07-12,PLN3716,1689639685,1689639685,SNF,In-Network,N40.0,Z00.00,,,,641,MS-DRG,12,11,Y,99204,E&M,,,0730,21,Inpatient Hospital,1,403.23,202.28,202.28,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010374,MBR00000403,Professional,2022-08-04,2022-08-04,2022-08-17,PLN1756,1245650222,1245650222,Gastroenterology,In-Network,C50.912,I25.10,,,,,,,0,,99204,E&M,,,,21,Inpatient Hospital,1,209.26,98.95,83.95,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010375,MBR00000403,Professional,2021-07-30,2021-07-30,2021-08-13,PLN9079,1891849440,1891849440,Oncology,In-Network,Z00.00,Z00.00,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,1,55.21,21.85,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010376,MBR00000403,Professional,2021-08-24,2021-08-24,2021-09-06,PLN4102,1644128543,1644128543,Gastroenterology,In-Network,N39.0,I10,,,,,,,0,,45378,Surgery,,,,11,Office,1,1630.32,630.03,553.87,0.0,35.0,41.16,76.16,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000010377,MBR00000403,Professional,2021-09-22,2021-09-22,2021-10-03,PLN4344,1132188260,1132188260,Family Medicine,In-Network,Z23,Z23,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,3,43.67,35.37,10.37,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000010378,MBR00000403,Professional,2022-12-07,2022-12-07,2023-01-14,PLN7340,1564502315,1564502315,ASC,In-Network,Z00.00,E66.9,,,,,,,0,,76700,Radiology,,,,11,Office,3,1021.46,378.81,0.0,378.81,0.0,0.0,378.81,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010379,MBR00000403,Professional,2023-12-09,2023-12-09,2023-12-23,PLN7902,1273488618,1273488618,General Acute Care Hospital,In-Network,E78.5,I10,,,,,,,0,,77067,Radiology,,,,65,End-Stage Renal Disease,1,377.09,227.69,131.44,0.0,75.0,21.25,96.25,0.0,Adjusted,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000010380,MBR00000403,Professional,2023-09-30,2023-09-30,2023-10-28,PLN7286,1891849440,1891849440,Oncology,In-Network,I10,M54.5,,,,,,,0,,58661,Surgery,,,,20,Urgent Care,1,1960.84,632.45,0.0,0.0,25.0,37.11,62.11,0.0,Denied,CO-119,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010381,MBR00000403,Professional,2021-05-05,2021-05-05,2021-06-16,PLN5120,1239316214,1239316214,Internal Medicine,In-Network,Z23,K21.0,,,,,,,0,,85610,Pathology/Lab,,,,21,Inpatient Hospital,2,57.62,47.08,0.0,47.08,0.0,0.0,47.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010382,MBR00000403,Professional,2023-01-15,2023-01-15,2023-02-06,PLN3647,1860435061,1860435061,DME Supplier,In-Network,J20.9,I10,,,,,,,0,,93306,Radiology,,,,11,Office,3,1976.93,665.06,640.09,9.97,15.0,0.0,24.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010383,MBR00000403,Institutional-OP,2023-04-10,2023-04-10,2023-05-10,PLN7089,1239316214,1239316214,Internal Medicine,In-Network,E11.9,Z12.31,,,,,,,0,,27447,Surgery,,,0740,22,Outpatient Hospital,2,3474.17,1208.44,790.84,394.93,0.0,22.67,417.6,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010384,MBR00000403,Institutional-IP,2021-02-14,2021-02-20,2021-02-24,PLN1374,1453936007,1453936007,ASC,In-Network,M54.5,Z00.00,,,,292,MS-DRG,24,6,Y,76700,Radiology,,,0320,21,Inpatient Hospital,2,1414.24,492.98,412.4,0.0,35.0,45.58,80.58,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010385,MBR00000403,Professional,2022-11-30,2022-11-30,2022-12-27,PLN1289,1713934949,1713934949,Neurology,In-Network,Z87.891,Z12.11,,,,,,,0,,99283,E&M,,,,65,End-Stage Renal Disease,2,267.18,200.36,0.0,200.36,0.0,0.0,200.36,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010386,MBR00000403,Institutional-OP,2022-05-02,2022-05-02,2022-05-29,PLN5376,1114982472,1114982472,Orthopedic Surgery,In-Network,F10.20,Z00.00,,,,,,,0,,99214,E&M,,,0200,22,Outpatient Hospital,1,244.78,160.72,141.27,0.0,15.0,4.45,19.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010387,MBR00000403,Institutional-OP,2021-08-02,2021-08-02,2021-08-30,PLN1699,1109850785,1109850785,ASC,Out-of-Network,F41.9,K21.0,,,,,,,0,,99232,E&M,,,0360,22,Outpatient Hospital,1,260.57,214.1,0.0,0.0,50.0,1.87,51.87,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010388,MBR00000403,Institutional-IP,2023-05-15,2023-05-16,2023-05-29,PLN3341,1334916761,1334916761,ASC,In-Network,I25.10,Z00.00,,,,291,MS-DRG,10,1,Y,81001,Pathology/Lab,,,0740,21,Inpatient Hospital,1,23.4,9.13,0.0,9.13,75.0,0.0,84.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010389,MBR00000403,Professional,2023-10-22,2023-10-22,2023-11-21,PLN9133,1757138478,1757138478,Pediatrics,In-Network,J06.9,E66.9,,,,,,,0,,72148,Radiology,,,,22,Outpatient Hospital,2,2023.47,843.34,687.59,52.93,0.0,102.82,155.75,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010390,MBR00000403,Professional,2022-10-18,2022-10-18,2022-11-05,PLN2996,1606140917,1606140917,ASC,In-Network,N17.9,M17.11,,,,,,,0,,99204,E&M,,,,11,Office,3,502.7,268.11,253.11,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010391,MBR00000403,Professional,2021-08-09,2021-08-09,2021-09-04,PLN2288,1847081578,1847081578,Urology,Out-of-Network,Z12.31,E11.40,,,,,,,0,,84443,Pathology/Lab,,,,22,Outpatient Hospital,1,150.25,107.53,59.92,0.0,35.0,12.61,47.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010392,MBR00000403,Professional,2022-04-15,2022-04-15,2022-05-23,PLN9938,1118885473,1118885473,ASC,In-Network,Z12.31,R10.9,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,1,280.27,183.57,128.34,0.0,35.0,20.23,55.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010393,MBR00000403,Institutional-OP,2022-07-19,2022-07-19,2022-08-10,PLN3358,1520687146,1520687146,ASC,In-Network,Z00.00,Z12.11,,,,,,,0,,99214,E&M,,,0761,22,Outpatient Hospital,3,462.37,189.28,139.62,49.66,0.0,0.0,49.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010394,MBR00000403,Institutional-OP,2023-09-16,2023-09-16,2023-10-19,PLN6581,1124394415,1124394415,Pediatrics,In-Network,Z12.31,Z12.31,,,,,,,0,,99233,E&M,,,0510,22,Outpatient Hospital,1,214.28,157.56,157.56,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010395,MBR00000403,Professional,2023-05-16,2023-05-16,2023-06-18,PLN4805,1717912431,1717912431,Oncology,In-Network,J44.1,I25.10,,,,,,,0,,70450,Radiology,,,,11,Office,2,1690.32,1308.59,1258.59,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010396,MBR00000403,Institutional-OP,2023-01-05,2023-01-05,2023-01-16,PLN3509,1390307371,1390307371,DME Supplier,In-Network,J45.20,J18.9,,,,,,,0,,99233,E&M,,,0761,22,Outpatient Hospital,3,336.27,283.27,72.09,210.18,0.0,1.0,211.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010397,MBR00000403,Institutional-OP,2023-04-17,2023-04-17,2023-05-01,PLN7788,1817234602,1817234602,Clinical Laboratory,In-Network,I25.10,I10,,,,,,,0,,70553,Radiology,,,0301,22,Outpatient Hospital,2,3343.2,1502.51,1467.51,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010398,MBR00000403,Institutional-IP,2023-01-31,2023-02-02,2023-02-20,PLN8721,1236418230,1236418230,DME Supplier,In-Network,E11.9,E11.9,,,,470,MS-DRG,23,2,W,90686,Medicine,,,0740,21,Inpatient Hospital,1,64.56,37.4,0.0,37.4,0.0,0.0,37.4,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000010399,MBR00000403,Institutional-OP,2021-12-17,2021-12-17,2021-12-25,PLN6989,1745114564,1745114564,Endocrinology,In-Network,E66.9,E78.5,,,,,,,0,,27130,Surgery,,,0360,22,Outpatient Hospital,3,4083.03,1779.97,1477.75,241.24,15.0,45.98,302.22,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010400,MBR00000403,Professional,2021-05-27,2021-05-27,2021-07-04,PLN6560,1948810580,1948810580,DME Supplier,In-Network,J06.9,K92.1,,,,,,,0,,97110,Medicine,,,,12,Home,1,199.46,84.95,0.0,84.95,25.0,0.0,109.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010401,MBR00000403,Professional,2023-07-09,2023-07-09,2023-07-19,PLN3166,1687650653,1687650653,Internal Medicine,In-Network,I25.10,E66.9,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,1,234.26,140.61,140.61,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010402,MBR00000403,Institutional-OP,2022-08-30,2022-08-30,2022-10-13,PLN2837,1125190055,1125190055,Nephrology,In-Network,E78.5,E66.9,,,,,,,0,,70553,Radiology,,,0370,22,Outpatient Hospital,2,2600.99,827.65,827.65,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010403,MBR00000403,Professional,2023-11-20,2023-11-20,2023-12-11,PLN2673,1896447406,1896447406,Nephrology,Out-of-Network,F32.9,Z23,,,,,,,0,,97110,Medicine,,,,22,Outpatient Hospital,3,133.19,50.14,0.0,50.14,0.0,0.0,50.14,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010404,MBR00000403,Institutional-OP,2023-01-16,2023-01-16,2023-01-28,PLN4297,1910255109,1910255109,DME Supplier,In-Network,I10,C50.912,,,,,,,0,,33533,Surgery,,,0301,22,Outpatient Hospital,1,11762.34,6575.72,6575.72,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000010405,MBR00000403,Institutional-OP,2022-06-04,2022-06-04,2022-06-20,PLN4648,1295371663,1295371663,Critical Access Hospital,In-Network,R10.9,Z12.31,,,,,,,0,,84443,Pathology/Lab,,,0761,22,Outpatient Hospital,3,122.67,68.12,0.0,68.12,0.0,0.0,68.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010406,MBR00000403,Institutional-OP,2022-12-10,2022-12-10,2023-01-01,PLN9423,1125190055,1125190055,Nephrology,In-Network,Z23,B97.89,,,,,,,0,,72148,Radiology,,,0900,22,Outpatient Hospital,2,2881.86,1932.9,1490.83,442.07,0.0,0.0,442.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010407,MBR00000403,Professional,2022-12-16,2022-12-16,2022-12-25,PLN6358,1295371663,1295371663,Critical Access Hospital,In-Network,I25.10,F32.9,,,,,,,0,,99284,E&M,,,,11,Office,1,685.71,268.21,0.0,0.0,35.0,27.73,62.73,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010408,MBR00000404,Institutional-IP,2023-12-11,2023-12-12,2024-01-21,PLN8690,1475984649,1475984649,SNF,In-Network,Z00.00,E11.65,,,,872,MS-DRG,13,1,Y,93225,Medicine,,,0120,21,Inpatient Hospital,2,388.46,294.76,244.76,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010409,MBR00000404,Professional,2022-02-04,2022-02-04,2022-02-14,PLN3767,1540044947,1540044947,Pulmonology,Out-of-Network,F41.9,I11.9,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,2,429.97,299.26,299.26,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010410,MBR00000404,Institutional-OP,2022-02-21,2022-02-21,2022-03-23,PLN8773,1702692193,1702692193,Physical Therapy,In-Network,C50.912,E78.5,,,,,,,0,,83036,Pathology/Lab,,,0200,22,Outpatient Hospital,2,57.67,22.97,22.97,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000010411,MBR00000404,Professional,2022-01-23,2022-01-23,2022-02-19,PLN7325,1355166277,1355166277,Endocrinology,In-Network,N18.3,Z23,,,,,,,0,,99222,E&M,,,,20,Urgent Care,3,494.59,247.39,197.39,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010412,MBR00000404,Institutional-IP,2021-04-29,2021-05-04,2021-05-08,PLN1658,1767011137,1767011137,DME Supplier,In-Network,Z23,Z23,,,,682,MS-DRG,4,5,Y,43239,Surgery,,,0510,21,Inpatient Hospital,2,980.59,820.32,444.13,197.04,75.0,104.15,376.19,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010413,MBR00000405,Institutional-OP,2022-05-30,2022-05-30,2022-07-02,PLN9590,1511044648,1511044648,Endocrinology,In-Network,K21.0,Z12.31,,,,,,,0,,70553,Radiology,,,0301,22,Outpatient Hospital,3,2767.96,2189.14,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010414,MBR00000405,Professional,2022-05-03,2022-05-03,2022-06-02,PLN4720,1856686341,1856686341,Geriatrics,In-Network,Z79.4,M17.11,,,,,,,0,,71046,Radiology,,,,11,Office,3,240.2,90.91,75.98,14.43,0.0,0.5,14.93,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010415,MBR00000405,Professional,2021-08-04,2021-08-04,2021-08-16,PLN7905,1135158374,1135158374,Pulmonology,In-Network,I10,J45.20,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,1,25.81,19.31,0.0,19.31,35.0,0.0,54.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010416,MBR00000405,Professional,2023-06-12,2023-06-12,2023-06-24,PLN7321,1434029575,1434029575,Endocrinology,In-Network,Z12.31,I63.9,,,,,,,0,,99283,E&M,,,,23,Emergency Room,2,516.27,199.38,0.0,195.58,50.0,0.0,245.58,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010417,MBR00000405,Institutional-IP,2023-01-25,2023-01-26,2023-03-03,PLN1466,1790497490,1790497490,OB/GYN,In-Network,F41.9,I11.9,,,,682,MS-DRG,2,1,N,58661,Surgery,,,0740,21,Inpatient Hospital,2,2626.85,1511.32,1042.05,454.27,15.0,0.0,469.27,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010418,MBR00000405,Institutional-OP,2021-09-22,2021-09-22,2021-09-30,PLN1793,1395983630,1395983630,Nephrology,In-Network,E78.5,E11.9,,,,,,,0,,78452,Radiology,,,0370,22,Outpatient Hospital,2,4222.08,3055.48,2770.12,210.36,75.0,0.0,285.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010419,MBR00000405,Institutional-OP,2021-07-01,2021-07-01,2021-07-10,PLN5728,1974006077,1974006077,Orthopedic Surgery,In-Network,Z00.00,Z12.31,,,,,,,0,,27130,Surgery,,,0200,22,Outpatient Hospital,1,5999.37,4627.95,4512.62,40.33,75.0,0.0,115.33,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010420,MBR00000405,Professional,2022-11-08,2022-11-08,2022-11-27,PLN4036,1799205295,1799205295,General Acute Care Hospital,In-Network,M17.11,Z23,,,,,,,0,,27130,Surgery,,,,23,Emergency Room,1,4040.17,1627.88,1149.03,478.85,0.0,0.0,478.85,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010421,MBR00000405,Professional,2021-01-06,2021-01-06,2021-02-07,PLN5997,1273488618,1273488618,General Acute Care Hospital,In-Network,I25.10,N18.3,,,,,,,0,,99203,E&M,,,,11,Office,2,142.61,57.07,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010422,MBR00000405,Professional,2021-06-15,2021-06-15,2021-07-20,PLN2654,1845900543,1845900543,ASC,In-Network,Z23,I50.9,,,,,,,0,,70553,Radiology,,,,23,Emergency Room,1,1879.0,1289.38,1289.38,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010423,MBR00000405,Professional,2022-04-27,2022-04-27,2022-05-27,PLN3169,1713934949,1713934949,Neurology,In-Network,Z23,I48.91,,,,,,,0,,58661,Surgery,,,,12,Home,2,4548.91,3458.48,3458.48,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010424,MBR00000405,Institutional-OP,2023-12-21,2023-12-21,2024-01-31,PLN6037,1702692193,1702692193,Physical Therapy,In-Network,Z23,Z00.00,,,,,,,0,,99232,E&M,,,0360,22,Outpatient Hospital,1,311.24,224.8,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010425,MBR00000405,Professional,2021-03-25,2021-03-25,2021-04-06,PLN4130,1118885473,1118885473,ASC,In-Network,I10,N18.3,,,,,,,0,,45380,Surgery,,,,23,Emergency Room,1,2283.86,1912.13,1877.13,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,1,0,0,0
CLM0000010426,MBR00000405,Professional,2022-08-02,2022-08-02,2022-09-12,PLN4300,1355166277,1355166277,Endocrinology,In-Network,R51,E11.9,,,,,,,0,,58661,Surgery,,,,11,Office,2,4367.07,1390.24,1390.24,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010427,MBR00000405,Institutional-IP,2022-09-08,2022-09-18,2022-09-22,PLN5437,1991459367,1991459367,Neurology,Out-of-Network,Z12.31,E11.9,,,,195,MS-DRG,19,10,Y,76700,Radiology,,,0450,21,Inpatient Hospital,3,1450.8,477.75,477.75,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010428,MBR00000405,Professional,2021-10-03,2021-10-03,2021-11-11,PLN2402,1872613201,1872613201,Internal Medicine,In-Network,Z00.00,I48.91,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,1,430.32,364.62,364.62,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010429,MBR00000405,Institutional-OP,2022-07-24,2022-07-24,2022-09-03,PLN4707,1542828721,1542828721,Orthopedic Surgery,In-Network,I48.91,K57.30,,,,,,,0,,99213,E&M,,,0730,22,Outpatient Hospital,2,286.14,152.83,50.33,102.5,0.0,0.0,102.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010430,MBR00000405,Professional,2022-11-26,2022-11-26,2022-12-24,PLN9794,1139906830,1139906830,Endocrinology,Out-of-Network,E78.5,I25.10,,,,,,,0,,27130,Surgery,,,,31,Skilled Nursing Facility,1,3243.76,2269.48,2219.48,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010431,MBR00000405,Professional,2021-05-31,2021-05-31,2021-07-05,PLN7010,1891849440,1891849440,Oncology,In-Network,F10.20,Z00.00,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,1,185.34,70.84,0.0,70.84,75.0,0.0,145.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010432,MBR00000405,Professional,2023-11-11,2023-11-11,2023-12-18,PLN7117,1235381502,1235381502,Cardiology,In-Network,F32.9,J06.9,,,,,,,0,,99203,E&M,,,,50,Federally Qualified Health Center,3,252.96,127.79,0.0,127.79,50.0,0.0,177.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010433,MBR00000405,Professional,2021-09-27,2021-09-27,2021-10-31,PLN1308,1103747954,1103747954,Urology,In-Network,R05,R10.9,,,,,,,0,,99284,E&M,,,,50,Federally Qualified Health Center,1,533.42,452.13,452.13,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010434,MBR00000405,Institutional-OP,2022-02-08,2022-02-08,2022-02-27,PLN2634,1939033455,1939033455,Pulmonology,In-Network,J06.9,N18.3,,,,,,,0,,80053,Pathology/Lab,,,0360,22,Outpatient Hospital,3,92.48,67.14,0.0,67.14,15.0,0.0,82.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010435,MBR00000405,Institutional-IP,2021-01-27,2021-02-11,2021-03-05,PLN1223,1268679390,1268679390,Critical Access Hospital,In-Network,I25.10,E66.9,,,,872,MS-DRG,13,15,N,81001,Pathology/Lab,,,0636,21,Inpatient Hospital,3,38.08,28.69,3.1,0.0,25.0,0.59,25.59,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010436,MBR00000405,Professional,2022-10-12,2022-10-12,2022-10-24,PLN7535,1213165847,1213165847,Critical Access Hospital,In-Network,E11.9,F41.9,,,,,,,0,,45380,Surgery,,,,11,Office,1,2378.38,1327.12,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-97,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000010437,MBR00000405,Institutional-IP,2022-10-13,2022-10-14,2022-11-18,PLN2308,1266606767,1266606767,ASC,In-Network,E78.5,E78.5,,,,682,MS-DRG,4,1,Y,86900,Pathology/Lab,,,0301,21,Inpatient Hospital,2,21.71,8.4,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010438,MBR00000405,Professional,2021-05-08,2021-05-08,2021-06-05,PLN4668,1845057593,1845057593,Orthopedic Surgery,In-Network,I10,N39.0,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,3,89.27,73.69,73.69,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010439,MBR00000405,Institutional-OP,2021-11-17,2021-11-17,2021-12-09,PLN5462,1244186984,1244186984,Family Medicine,Out-of-Network,F32.9,E66.9,,,,,,,0,,99221,E&M,,,0301,22,Outpatient Hospital,2,359.61,107.99,0.0,107.99,0.0,0.0,107.99,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000010440,MBR00000405,Professional,2023-04-20,2023-04-20,2023-05-18,PLN3278,1700633438,1700633438,DME Supplier,In-Network,F41.9,B97.89,,,,,,,0,,78452,Radiology,,,,11,Office,3,5373.78,4259.11,4224.11,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010441,MBR00000405,Institutional-OP,2023-02-20,2023-02-20,2023-03-08,PLN4261,1334916761,1334916761,ASC,In-Network,Z00.00,N39.0,,,,,,,0,,99222,E&M,,,0320,22,Outpatient Hospital,1,421.51,176.69,141.69,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010442,MBR00000405,Institutional-IP,2021-12-03,2021-12-04,2021-12-28,PLN7419,1361302520,1361302520,Critical Access Hospital,In-Network,Z12.31,Z12.11,,,,195,MS-DRG,10,1,W,27130,Surgery,,,0360,21,Inpatient Hospital,1,3299.85,2784.24,2494.98,0.0,0.0,289.26,289.26,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010443,MBR00000405,Institutional-IP,2022-11-21,2022-12-03,2022-12-16,PLN2012,1389336600,1389336600,Critical Access Hospital,In-Network,J20.9,I48.91,,,,683,MS-DRG,4,12,Y,66984,Surgery,,,0900,21,Inpatient Hospital,3,2309.25,822.51,822.51,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010444,MBR00000405,Professional,2023-03-30,2023-03-30,2023-04-24,PLN5868,1964402759,1964402759,Outpatient Clinic,In-Network,E11.65,I48.91,,,,,,,0,,43239,Surgery,,,,11,Office,1,1815.86,568.48,139.94,428.54,0.0,0.0,428.54,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010445,MBR00000405,Professional,2022-02-14,2022-02-14,2022-02-21,PLN3345,1644128543,1644128543,Gastroenterology,In-Network,K21.0,B97.89,,,,,,,0,,90686,Medicine,,,,11,Office,1,105.52,34.8,34.8,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000010446,MBR00000405,Professional,2021-07-12,2021-07-12,2021-07-19,PLN3847,1717912431,1717912431,Oncology,In-Network,E11.65,I10,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,3,31.34,14.74,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010447,MBR00000405,Institutional-OP,2021-01-24,2021-01-24,2021-02-24,PLN8657,1689639685,1689639685,SNF,In-Network,F41.9,Z00.00,,,,,,,0,,93306,Radiology,,,0450,22,Outpatient Hospital,3,2123.64,1618.57,1568.57,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010448,MBR00000405,Institutional-IP,2023-11-12,2023-11-14,2023-12-14,PLN6498,1631954542,1631954542,Oncology,In-Network,J06.9,I10,,,,683,MS-DRG,23,2,Y,99232,E&M,,,0636,21,Inpatient Hospital,2,246.39,145.23,117.3,0.0,0.0,27.93,27.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010449,MBR00000405,Institutional-IP,2021-12-17,2021-12-25,2022-01-08,PLN1625,1550154147,1550154147,Outpatient Clinic,In-Network,G43.909,J20.9,,,,641,MS-DRG,13,8,N,99284,E&M,,,0320,21,Inpatient Hospital,1,369.04,169.33,0.0,169.33,15.0,0.0,184.33,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000010450,MBR00000405,Professional,2023-06-02,2023-06-02,2023-06-26,PLN1774,1700633438,1700633438,DME Supplier,In-Network,E11.9,Z51.11,,,,,,,0,,71046,Radiology,,,,11,Office,1,139.38,59.99,22.09,0.0,35.0,2.9,37.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010451,MBR00000405,Professional,2021-12-22,2021-12-22,2022-01-10,PLN7984,1896447406,1896447406,Nephrology,Out-of-Network,J44.1,Z00.00,,,,,,,0,,90837,Medicine,,,,11,Office,2,247.27,81.95,0.0,81.95,25.0,0.0,106.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010452,MBR00000405,Professional,2023-02-19,2023-02-19,2023-03-18,PLN2470,1540044947,1540044947,Pulmonology,Out-of-Network,Z12.31,F32.9,,,,,,,0,,99221,E&M,,,,49,Independent Clinic,1,430.43,347.2,330.5,0.0,0.0,16.7,16.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010453,MBR00000405,Institutional-IP,2021-12-31,2022-01-03,2022-01-12,PLN8553,1806688928,1806688928,Geriatrics,In-Network,N39.0,J44.1,,,,292,MS-DRG,11,3,Y,99406,Medicine,,,0200,21,Inpatient Hospital,3,85.15,50.29,0.0,50.29,0.0,0.0,50.29,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000010454,MBR00000405,Professional,2022-10-28,2022-10-28,2022-11-25,PLN1256,1313212303,1313212303,Family Medicine,In-Network,E11.65,N18.3,,,,,,,0,,47562,Surgery,,,,11,Office,3,3264.27,2422.32,1897.01,74.23,0.0,451.08,525.31,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010455,MBR00000405,Institutional-OP,2023-11-11,2023-11-11,2023-12-01,PLN3950,1334916761,1334916761,ASC,In-Network,Z23,Z23,,,,,,,0,,58661,Surgery,,,0270,22,Outpatient Hospital,3,4687.62,1868.05,1868.05,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010456,MBR00000405,Professional,2023-04-06,2023-04-06,2023-04-16,PLN2621,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,R07.9,E11.9,,,,,,,0,,72148,Radiology,,,,20,Urgent Care,1,2432.02,1978.01,1768.86,0.0,0.0,209.15,209.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010457,MBR00000405,Institutional-IP,2021-06-30,2021-07-12,2021-08-10,PLN4399,1817234602,1817234602,Clinical Laboratory,In-Network,Z12.31,Z00.00,,,,871,MS-DRG,16,12,Y,90686,Medicine,,,0270,21,Inpatient Hospital,3,116.69,49.96,49.96,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000010458,MBR00000405,Professional,2022-07-28,2022-07-28,2022-09-08,PLN9503,1283743001,1283743001,Family Medicine,In-Network,E11.9,I10,,,,,,,0,,99283,E&M,,,,21,Inpatient Hospital,1,637.01,248.95,248.95,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010459,MBR00000405,Institutional-OP,2021-10-23,2021-10-23,2021-11-11,PLN4499,1847081578,1847081578,Urology,Out-of-Network,M17.11,Z00.00,,,,,,,0,,90460,Medicine,,,0900,22,Outpatient Hospital,1,48.84,30.03,0.0,30.03,0.0,0.0,30.03,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010460,MBR00000405,Institutional-OP,2021-08-29,2021-08-29,2021-09-18,PLN9359,1266606767,1266606767,ASC,In-Network,E66.9,F41.9,,,,,,,0,,99233,E&M,,,0450,22,Outpatient Hospital,1,396.76,141.42,104.72,0.0,25.0,11.7,36.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010461,MBR00000405,Professional,2023-07-01,2023-07-01,2023-07-22,PLN7593,1622771872,1622771872,Pediatrics,In-Network,I10,K21.0,,,,,,,0,,83036,Pathology/Lab,,,,12,Home,2,96.71,67.46,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000010462,MBR00000405,Professional,2023-12-12,2023-12-12,2023-12-28,PLN7136,1395983630,1395983630,Nephrology,In-Network,Z12.31,N18.3,,,,,,,0,,84443,Pathology/Lab,,,,21,Inpatient Hospital,1,173.78,141.35,0.0,141.35,25.0,0.0,166.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010463,MBR00000406,Institutional-OP,2023-10-11,2023-10-11,2023-10-28,PLN6606,1631954542,1631954542,Oncology,In-Network,F41.9,E11.65,,,,,,,0,,47562,Surgery,,,0320,22,Outpatient Hospital,1,6098.01,3809.23,3809.23,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010464,MBR00000406,Institutional-IP,2023-07-08,2023-07-15,2023-08-09,PLN4834,1780163051,1780163051,SNF,In-Network,J06.9,Z12.31,,,,682,MS-DRG,13,7,Y,27130,Surgery,,,0761,21,Inpatient Hospital,2,5783.6,4040.27,4005.27,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000010465,MBR00000406,Professional,2022-05-28,2022-05-28,2022-06-21,PLN7586,1899127912,1899127912,Neurology,In-Network,N39.0,J20.9,,,,,,,0,,97530,Medicine,,,,11,Office,2,288.6,151.24,130.42,0.0,0.0,20.82,20.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010466,MBR00000406,Institutional-OP,2022-07-31,2022-07-31,2022-08-25,PLN5143,1968299309,1968299309,Internal Medicine,In-Network,E66.9,E11.9,,,,,,,0,,80053,Pathology/Lab,,,0120,22,Outpatient Hospital,3,89.79,51.26,26.26,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010467,MBR00000406,Professional,2022-08-15,2022-08-15,2022-09-19,PLN3701,1453283987,1453283987,Critical Access Hospital,In-Network,Z23,K21.0,,,,,,,0,,97530,Medicine,,,,20,Urgent Care,3,217.67,87.16,0.0,12.96,75.0,0.0,87.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010468,MBR00000406,Professional,2023-03-18,2023-03-18,2023-03-27,PLN4023,1696843572,1696843572,Critical Access Hospital,Out-of-Network,Z00.00,F10.20,,,,,,,0,,99283,E&M,,,,11,Office,3,546.91,283.53,283.53,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010469,MBR00000406,Institutional-OP,2021-02-27,2021-02-27,2021-03-31,PLN9449,1717546253,1717546253,Family Medicine,In-Network,M17.11,J44.1,,,,,,,0,,27130,Surgery,,,0301,22,Outpatient Hospital,2,2650.23,1623.6,1588.6,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010470,MBR00000406,Institutional-OP,2023-06-25,2023-06-25,2023-08-07,PLN2147,1372918899,1372918899,Family Medicine,In-Network,J20.9,M54.5,,,,,,,0,,99221,E&M,,,0370,22,Outpatient Hospital,1,385.45,187.14,0.0,187.14,0.0,0.0,187.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010471,MBR00000406,Professional,2023-06-04,2023-06-04,2023-06-25,PLN4636,1624202402,1624202402,Orthopedic Surgery,In-Network,F32.9,M54.5,,,,,,,0,,27447,Surgery,,,,23,Emergency Room,2,4592.7,3027.69,2473.19,117.33,15.0,422.17,554.5,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010472,MBR00000406,Professional,2023-12-26,2023-12-26,2024-01-30,PLN3821,1990090423,1990090423,Orthopedic Surgery,In-Network,Z79.4,J20.9,,,,,,,0,,90686,Medicine,,,,22,Outpatient Hospital,2,117.69,64.43,64.43,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000010473,MBR00000406,Professional,2022-10-14,2022-10-14,2022-11-04,PLN3261,1224179551,1224179551,Physical Therapy,In-Network,K92.1,K57.30,,,,,,,0,,74177,Radiology,,,,21,Inpatient Hospital,2,2631.92,1592.55,1496.66,17.23,0.0,78.66,95.89,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010474,MBR00000406,Institutional-OP,2022-05-16,2022-05-16,2022-06-10,PLN6238,1569105090,1569105090,Geriatrics,In-Network,I10,K21.0,,,,,,,0,,82043,Pathology/Lab,,,0636,22,Outpatient Hospital,3,49.16,15.41,0.0,15.41,0.0,0.0,15.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010475,MBR00000406,Institutional-OP,2022-06-09,2022-06-09,2022-06-23,PLN2164,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,E66.9,Z12.31,,,,,,,0,,99284,E&M,,,0200,22,Outpatient Hospital,3,478.5,373.92,373.92,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010476,MBR00000406,Institutional-OP,2022-11-11,2022-11-11,2022-11-30,PLN4932,1575695214,1575695214,SNF,In-Network,N39.0,Z79.4,,,,,,,0,,66984,Surgery,,,0200,22,Outpatient Hospital,3,3587.11,1370.78,0.0,0.0,75.0,220.69,295.69,0.0,Denied,PR-1,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010477,MBR00000406,Professional,2021-11-28,2021-11-28,2021-12-21,PLN2196,1500037969,1500037969,Pulmonology,In-Network,I63.9,Z00.00,,,,,,,0,,93225,Medicine,,,,23,Emergency Room,3,946.38,693.48,210.39,483.09,0.0,0.0,483.09,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010478,MBR00000406,Professional,2023-05-01,2023-05-01,2023-05-29,PLN1154,1453936007,1453936007,ASC,In-Network,J20.9,M54.5,,,,,,,0,,45378,Surgery,,,,11,Office,3,1537.49,1079.54,1054.54,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000010479,MBR00000406,Institutional-IP,2022-05-01,2022-05-10,2022-05-11,PLN5957,1528335731,1528335731,Critical Access Hospital,In-Network,K57.30,M54.5,,,,871,MS-DRG,14,9,Y,27130,Surgery,,,0270,21,Inpatient Hospital,1,2713.94,1516.95,1294.82,207.13,15.0,0.0,222.13,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010480,MBR00000406,Professional,2021-11-05,2021-11-05,2021-12-02,PLN6032,1935547131,1935547131,Pulmonology,In-Network,E66.9,J44.1,,,,,,,0,,99213,E&M,,,,21,Inpatient Hospital,1,195.52,65.7,30.7,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010481,MBR00000406,Professional,2023-03-17,2023-03-17,2023-04-15,PLN6361,1622771872,1622771872,Pediatrics,In-Network,J06.9,E66.9,,,,,,,0,,87491,Pathology/Lab,,,,21,Inpatient Hospital,1,109.34,66.64,0.0,66.64,0.0,0.0,66.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010482,MBR00000406,Professional,2022-01-04,2022-01-04,2022-02-08,PLN1824,1700633438,1700633438,DME Supplier,In-Network,K21.0,Z23,,,,,,,0,,99203,E&M,,,,23,Emergency Room,2,141.11,55.37,33.29,0.0,15.0,7.08,22.08,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010483,MBR00000406,Institutional-OP,2021-03-30,2021-03-30,2021-04-26,PLN7380,1514306773,1514306773,Endocrinology,In-Network,J20.9,J44.1,,,,,,,0,,70450,Radiology,,,0270,22,Outpatient Hospital,1,1189.78,901.16,599.71,183.36,75.0,43.09,301.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010484,MBR00000406,Institutional-IP,2022-07-26,2022-07-29,2022-08-24,PLN7388,1313212303,1313212303,Family Medicine,In-Network,N39.0,J20.9,,,,195,MS-DRG,22,3,Y,99204,E&M,,,0636,21,Inpatient Hospital,2,308.98,184.24,134.24,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010485,MBR00000406,Institutional-OP,2022-07-09,2022-07-09,2022-08-14,PLN6900,1948810580,1948810580,DME Supplier,In-Network,I10,N18.3,,,,,,,0,,23472,Surgery,,,0900,22,Outpatient Hospital,3,5043.08,2687.03,2687.03,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010486,MBR00000406,Professional,2021-11-16,2021-11-16,2021-12-15,PLN6848,1361302520,1361302520,Critical Access Hospital,In-Network,Z00.00,Z00.00,,,,,,,0,,43239,Surgery,,,,31,Skilled Nursing Facility,3,1566.87,1070.45,972.27,83.18,15.0,0.0,98.18,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010487,MBR00000406,Institutional-OP,2021-02-07,2021-02-07,2021-03-23,PLN5480,1806688928,1806688928,Geriatrics,In-Network,J06.9,F32.9,,,,,,,0,,33533,Surgery,,,0761,22,Outpatient Hospital,2,21872.85,18580.3,0.0,252.78,25.0,0.0,277.78,0.0,Denied,CO-11,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000010488,MBR00000406,Professional,2022-06-05,2022-06-05,2022-07-18,PLN2712,1778483301,1778483301,Home Health,In-Network,F32.9,R10.9,,,,,,,0,,99284,E&M,,,,11,Office,1,425.33,250.3,0.0,233.1,50.0,0.0,283.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010489,MBR00000406,Professional,2023-04-26,2023-04-26,2023-05-08,PLN6370,1728018911,1728018911,Nephrology,In-Network,N39.0,E11.9,,,,,,,0,,74177,Radiology,,,,22,Outpatient Hospital,2,2177.23,1731.24,1716.24,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010490,MBR00000406,Institutional-IP,2023-05-28,2023-06-03,2023-06-06,PLN2197,1795618275,1795618275,Pulmonology,In-Network,F32.9,Z79.4,,,,196,MS-DRG,17,6,Y,99203,E&M,,,0636,21,Inpatient Hospital,3,345.86,108.86,46.59,35.07,25.0,2.2,62.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010491,MBR00000406,Institutional-OP,2021-08-20,2021-08-20,2021-08-27,PLN9424,1244186984,1244186984,Family Medicine,Out-of-Network,I10,E11.65,,,,,,,0,,47562,Surgery,,,0370,22,Outpatient Hospital,2,4672.32,2738.33,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-18,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010492,MBR00000406,Professional,2022-04-17,2022-04-17,2022-05-03,PLN1873,1790497490,1790497490,OB/GYN,In-Network,E66.9,N20.0,,,,,,,0,,99203,E&M,,,,11,Office,2,389.12,155.14,129.11,0.0,25.0,1.03,26.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010493,MBR00000406,Institutional-OP,2023-09-17,2023-09-17,2023-10-21,PLN3252,1935547131,1935547131,Pulmonology,In-Network,E11.65,Z23,,,,,,,0,,99233,E&M,,,0200,22,Outpatient Hospital,1,389.23,297.54,297.54,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010494,MBR00000406,Institutional-IP,2022-01-13,2022-01-16,2022-02-13,PLN2164,1778483301,1778483301,Home Health,In-Network,F03.90,S72.001A,,,,291,MS-DRG,1,3,Y,70450,Radiology,,,0301,21,Inpatient Hospital,2,1813.96,902.97,770.23,0.0,15.0,117.74,132.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010495,MBR00000406,Institutional-IP,2022-06-06,2022-06-10,2022-06-26,PLN1624,1563980627,1563980627,Critical Access Hospital,In-Network,N17.9,Z23,,,,872,MS-DRG,17,4,U,93225,Medicine,,,0301,21,Inpatient Hospital,3,693.27,398.66,395.06,0.0,0.0,3.6,3.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010496,MBR00000406,Institutional-OP,2023-01-15,2023-01-15,2023-02-15,PLN1816,1696843572,1696843572,Critical Access Hospital,Out-of-Network,E66.9,E78.5,,,,,,,0,,90686,Medicine,,,0270,22,Outpatient Hospital,2,128.79,98.1,0.0,98.1,35.0,0.0,133.1,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000010497,MBR00000406,Institutional-OP,2022-05-16,2022-05-16,2022-06-12,PLN9081,1337791138,1337791138,Internal Medicine,Out-of-Network,K21.0,F41.9,,,,,,,0,,99284,E&M,,,0761,22,Outpatient Hospital,2,883.48,722.1,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010498,MBR00000406,Institutional-IP,2023-07-11,2023-07-12,2023-07-18,PLN3344,1968299309,1968299309,Internal Medicine,In-Network,E78.5,Z87.891,,,,683,MS-DRG,18,1,Y,76700,Radiology,,,0636,21,Inpatient Hospital,1,666.98,258.24,243.24,0.0,15.0,0.0,15.0,0.0,Adjusted,,,1,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000010499,MBR00000406,Professional,2022-01-30,2022-01-30,2022-03-09,PLN9554,1571574052,1571574052,Critical Access Hospital,In-Network,J44.1,E11.9,,,,,,,0,,G0468,Medicine,,,,12,Home,1,642.99,264.91,264.91,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010500,MBR00000406,Professional,2022-06-23,2022-06-23,2022-07-23,PLN7569,1366426662,1366426662,Urology,In-Network,E11.9,J06.9,,,,,,,0,,33533,Surgery,,,,23,Emergency Room,1,26291.91,17188.53,16947.36,241.17,0.0,0.0,241.17,0.0,Paid,,,0,,1,0,0,1,0,0,None,0,0,0,0,0
CLM0000010501,MBR00000406,Institutional-OP,2022-07-20,2022-07-20,2022-08-22,PLN9398,1795618275,1795618275,Pulmonology,In-Network,R51,I11.9,,,,,,,0,,80061,Pathology/Lab,,,0360,22,Outpatient Hospital,3,61.84,49.92,0.0,49.92,0.0,0.0,49.92,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010502,MBR00000406,Institutional-OP,2023-03-27,2023-03-27,2023-05-06,PLN7684,1542828721,1542828721,Orthopedic Surgery,In-Network,J44.1,K21.0,,,,,,,0,,99284,E&M,,,0510,22,Outpatient Hospital,2,596.22,274.33,0.0,274.33,50.0,0.0,324.33,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010503,MBR00000406,Institutional-OP,2022-01-06,2022-01-06,2022-02-01,PLN1121,1896447406,1896447406,Nephrology,Out-of-Network,I25.10,N39.0,,,,,,,0,,G0444,Medicine,,,0120,22,Outpatient Hospital,2,88.65,46.57,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000010504,MBR00000406,Institutional-OP,2021-10-29,2021-10-29,2021-12-03,PLN8368,1795618275,1795618275,Pulmonology,In-Network,I25.10,Z12.31,,,,,,,0,,76700,Radiology,,,0301,22,Outpatient Hospital,2,605.64,239.83,0.0,239.83,0.0,0.0,239.83,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010505,MBR00000406,Institutional-IP,2022-01-30,2022-02-08,2022-03-12,PLN4959,1433937353,1433937353,Nephrology,In-Network,M17.11,J45.20,,,,682,MS-DRG,13,9,Y,77067,Radiology,,,0450,21,Inpatient Hospital,1,458.06,365.84,0.0,172.2,50.0,0.13,222.33,0.0,Denied,CO-4,,0,,0,1,0,0,1,0,None,1,0,0,0,0
CLM0000010506,MBR00000406,Institutional-OP,2021-09-12,2021-09-12,2021-10-12,PLN3794,1563980627,1563980627,Critical Access Hospital,In-Network,M17.11,C50.912,,,,,,,0,,93306,Radiology,,,0301,22,Outpatient Hospital,2,1499.64,1149.26,994.79,154.47,0.0,0.0,154.47,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010507,MBR00000406,Professional,2021-08-03,2021-08-03,2021-08-25,PLN2701,1125190055,1125190055,Nephrology,In-Network,Z00.00,E11.40,,,,,,,0,,90837,Medicine,,,,31,Skilled Nursing Facility,3,274.92,171.41,143.8,0.0,0.0,27.61,27.61,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000010508,MBR00000406,Professional,2023-06-17,2023-06-17,2023-07-30,PLN4452,1235381502,1235381502,Cardiology,In-Network,E78.5,J06.9,,,,,,,0,,33533,Surgery,,,,11,Office,2,20147.55,7566.04,6642.14,0.0,0.0,923.9,923.9,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000010509,MBR00000406,Institutional-IP,2022-01-14,2022-01-24,2022-02-17,PLN8580,1865904917,1865904917,Outpatient Clinic,In-Network,I11.9,I10,,,,291,MS-DRG,15,10,Y,99222,E&M,,,0636,21,Inpatient Hospital,2,302.49,192.04,0.0,192.04,0.0,0.0,192.04,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000010510,MBR00000406,Professional,2021-10-23,2021-10-23,2021-12-05,PLN7174,1767011137,1767011137,DME Supplier,In-Network,N40.0,J18.9,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,1,2406.35,1471.18,1450.17,0.0,15.0,6.01,21.01,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010511,MBR00000406,Institutional-IP,2023-06-08,2023-06-09,2023-07-09,PLN7870,1716521444,1716521444,Oncology,In-Network,I10,I50.9,,,,871,MS-DRG,5,1,Y,97110,Medicine,,,0200,21,Inpatient Hospital,1,141.61,73.19,73.19,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000010512,MBR00000406,Institutional-OP,2023-05-14,2023-05-14,2023-06-18,PLN4114,1227362142,1227362142,DME Supplier,In-Network,E78.5,I63.9,,,,,,,0,,97110,Medicine,,,0270,22,Outpatient Hospital,2,279.11,111.4,71.78,0.0,35.0,4.62,39.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010513,MBR00000407,Institutional-OP,2021-09-27,2021-09-27,2021-10-06,PLN1977,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,F41.9,Z00.00,,,,,,,0,,99283,E&M,,,0200,22,Outpatient Hospital,1,385.73,323.03,0.0,291.75,15.0,0.0,306.75,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010514,MBR00000407,Institutional-OP,2021-11-30,2021-11-30,2022-01-03,PLN4500,1247341320,1247341320,Urology,Out-of-Network,E11.40,I25.10,,,,,,,0,,99222,E&M,,,0636,22,Outpatient Hospital,1,423.9,259.65,234.65,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010515,MBR00000407,Institutional-OP,2023-06-19,2023-06-19,2023-07-20,PLN9956,1198133277,1198133277,SNF,In-Network,Z00.01,I10,,,,,,,0,,83036,Pathology/Lab,,,0636,22,Outpatient Hospital,2,51.36,29.28,0.0,29.28,0.0,0.0,29.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000010516,MBR00000407,Institutional-OP,2021-11-01,2021-11-01,2021-11-12,PLN7350,1717546253,1717546253,Family Medicine,In-Network,Z12.31,F41.9,,,,,,,0,,77067,Radiology,,,0761,22,Outpatient Hospital,3,631.17,257.2,232.2,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000010517,MBR00000407,Institutional-IP,2023-08-02,2023-08-05,2023-08-14,PLN3876,1139906830,1139906830,Endocrinology,Out-of-Network,E11.9,J45.20,,,,470,MS-DRG,20,3,Y,70450,Radiology,,,0450,21,Inpatient Hospital,1,849.27,618.67,580.74,0.0,0.0,37.93,37.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010518,MBR00000407,Professional,2022-11-08,2022-11-08,2022-11-28,PLN6666,1109850785,1109850785,ASC,Out-of-Network,Z12.31,J18.9,,,,,,,0,,93000,Radiology,,,,11,Office,3,136.42,113.06,63.06,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010519,MBR00000407,Institutional-OP,2022-12-31,2022-12-31,2023-01-13,PLN5485,1530904931,1530904931,Internal Medicine,In-Network,I10,E11.9,,,,,,,0,,99232,E&M,,,0900,22,Outpatient Hospital,2,281.6,221.15,0.0,0.0,75.0,2.55,77.55,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010520,MBR00000407,Professional,2022-08-08,2022-08-08,2022-09-11,PLN4148,1991459367,1991459367,Neurology,Out-of-Network,E78.5,J44.1,,,,,,,0,,27447,Surgery,,,,11,Office,2,4328.26,3424.15,3424.15,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000010521,MBR00000407,Institutional-OP,2021-02-03,2021-02-03,2021-03-12,PLN5393,1235381502,1235381502,Cardiology,In-Network,I25.10,F41.9,,,,,,,0,,45380,Surgery,,,0740,22,Outpatient Hospital,2,1964.3,910.39,910.39,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000010522,MBR00000407,Professional,2023-06-22,2023-06-22,2023-08-04,PLN2430,1372918899,1372918899,Family Medicine,In-Network,F10.20,E78.5,,,,,,,0,,71046,Radiology,,,,11,Office,1,147.08,60.97,0.0,0.0,0.0,0.0,0.0,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010523,MBR00000407,Professional,2022-09-07,2022-09-07,2022-09-29,PLN4399,1520687146,1520687146,ASC,In-Network,Z12.31,Z12.31,,,,,,,0,,93306,Radiology,,,,49,Independent Clinic,1,1906.48,1455.86,1128.36,185.1,0.0,142.4,327.5,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000010524,MBR00000407,Professional,2021-07-09,2021-07-09,2021-08-14,PLN2531,1135158374,1135158374,Pulmonology,In-Network,Z23,K21.0,,,,,,,0,,81001,Pathology/Lab,,,,23,Emergency Room,3,37.06,14.86,0.0,0.0,75.0,0.0,75.0,0.0,Denied,PR-1,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010525,MBR00000407,Institutional-OP,2023-07-02,2023-07-02,2023-08-15,PLN1659,1809014947,1809014947,Urology,In-Network,N18.3,N18.3,,,,,,,0,,23472,Surgery,,,0510,22,Outpatient Hospital,3,6345.95,2384.45,2384.45,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010526,MBR00000407,Institutional-OP,2021-11-18,2021-11-18,2021-12-29,PLN3630,1244186984,1244186984,Family Medicine,Out-of-Network,E78.5,Z12.31,,,,,,,0,,77067,Radiology,,,0730,22,Outpatient Hospital,3,868.0,457.06,457.06,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000010527,MBR00000407,Professional,2022-02-05,2022-02-05,2022-03-17,PLN5128,1186826716,1186826716,Physical Therapy,In-Network,Z23,I10,,,,,,,0,,99203,E&M,,,,11,Office,1,327.04,267.79,228.64,0.0,35.0,4.15,39.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010528,MBR00000407,Professional,2022-12-01,2022-12-01,2022-12-22,PLN6433,1968299309,1968299309,Internal Medicine,In-Network,I10,F41.9,,,,,,,0,,74177,Radiology,,,,11,Office,1,1832.55,1442.34,1229.58,0.0,25.0,187.76,212.76,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010529,MBR00000408,Institutional-OP,2021-11-06,2021-11-06,2021-12-11,PLN5465,1856686341,1856686341,Geriatrics,In-Network,Z87.891,N39.0,,,,,,,0,,58661,Surgery,,,0320,22,Outpatient Hospital,2,2610.28,1262.37,1212.37,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010530,MBR00000408,Professional,2021-01-08,2021-01-08,2021-01-22,PLN5651,1968299309,1968299309,Internal Medicine,In-Network,E11.9,I10,,,,,,,0,,45380,Surgery,,,,23,Emergency Room,3,1424.0,847.64,766.5,0.0,0.0,81.14,81.14,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,1,0,0,0
CLM0000010531,MBR00000408,Institutional-OP,2021-12-18,2021-12-18,2021-12-27,PLN9101,1366576336,1366576336,Geriatrics,In-Network,M17.11,E66.9,,,,,,,0,,77067,Radiology,,,0730,22,Outpatient Hospital,3,383.21,177.38,0.0,177.38,0.0,0.0,177.38,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000010532,MBR00000408,Institutional-OP,2023-01-19,2023-01-19,2023-02-14,PLN5773,1728018911,1728018911,Nephrology,In-Network,R07.9,Z87.891,,,,,,,0,,99221,E&M,,,0740,22,Outpatient Hospital,1,201.3,129.5,39.33,40.17,50.0,0.0,90.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010533,MBR00000408,Institutional-OP,2022-04-09,2022-04-09,2022-04-16,PLN9685,1540044947,1540044947,Pulmonology,Out-of-Network,E11.9,E11.9,,,,,,,0,,84443,Pathology/Lab,,,0636,22,Outpatient Hospital,3,130.3,64.79,0.0,64.79,0.0,0.0,64.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010534,MBR00000408,Professional,2023-02-20,2023-02-20,2023-03-12,PLN3509,1817234602,1817234602,Clinical Laboratory,In-Network,E11.65,M81.0,,,,,,,0,,90686,Medicine,,,,11,Office,1,99.79,55.58,30.58,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000010535,MBR00000408,Institutional-OP,2021-03-18,2021-03-18,2021-04-04,PLN4969,1847081578,1847081578,Urology,Out-of-Network,M81.0,I25.10,,,,,,,0,,99204,E&M,,,0200,22,Outpatient Hospital,2,530.5,425.29,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010536,MBR00000408,Institutional-OP,2021-10-09,2021-10-09,2021-10-26,PLN1179,1550154147,1550154147,Outpatient Clinic,In-Network,J44.1,Z23,,,,,,,0,,27447,Surgery,,,0370,22,Outpatient Hospital,1,3922.71,3083.9,2789.27,214.77,25.0,54.86,294.63,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010537,MBR00000408,Professional,2021-09-18,2021-09-18,2021-10-19,PLN8315,1757138478,1757138478,Pediatrics,In-Network,J06.9,E66.9,,,,,,,0,,97530,Medicine,,,,11,Office,1,177.05,92.91,92.91,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010538,MBR00000408,Institutional-OP,2021-03-12,2021-03-12,2021-04-14,PLN8758,1450553056,1450553056,Clinical Laboratory,In-Network,E11.9,F32.9,,,,,,,0,,99284,E&M,,,0270,22,Outpatient Hospital,3,325.41,174.73,98.96,0.0,75.0,0.77,75.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010539,MBR00000408,Professional,2022-12-10,2022-12-10,2023-01-21,PLN8021,1135158374,1135158374,Pulmonology,In-Network,Z79.4,E78.5,,,,,,,0,,99214,E&M,,,,11,Office,3,234.54,112.42,37.42,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010540,MBR00000408,Institutional-OP,2021-08-19,2021-08-19,2021-09-12,PLN9890,1872272835,1872272835,Internal Medicine,In-Network,J06.9,Z00.00,,,,,,,0,,82043,Pathology/Lab,,,0900,22,Outpatient Hospital,3,72.03,45.72,0.0,45.72,75.0,0.0,120.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010541,MBR00000408,Professional,2022-06-02,2022-06-02,2022-06-10,PLN9898,1475984649,1475984649,SNF,In-Network,F10.20,E66.9,,,,,,,0,,45380,Surgery,,,,20,Urgent Care,2,1397.66,1120.8,1120.8,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000010542,MBR00000408,Professional,2023-12-21,2023-12-21,2024-01-01,PLN6079,1135158374,1135158374,Pulmonology,In-Network,E66.9,Z23,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,1,1002.08,326.74,0.0,326.74,0.0,0.0,326.74,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010543,MBR00000408,Professional,2021-09-28,2021-09-28,2021-10-27,PLN9224,1790497490,1790497490,OB/GYN,In-Network,I63.9,Z23,,,,,,,0,,43239,Surgery,,,,50,Federally Qualified Health Center,1,1508.75,750.85,364.76,386.09,0.0,0.0,386.09,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010544,MBR00000408,Institutional-OP,2021-08-02,2021-08-02,2021-08-15,PLN8476,1148984206,1148984206,Psychiatry,In-Network,E66.9,E66.9,,,,,,,0,,93225,Medicine,,,0200,22,Outpatient Hospital,1,643.35,544.34,459.19,0.0,0.0,85.15,85.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010545,MBR00000408,Institutional-IP,2023-10-17,2023-10-18,2023-11-27,PLN2956,1268679390,1268679390,Critical Access Hospital,In-Network,R05,Z12.31,,,,603,MS-DRG,15,1,Y,99283,E&M,,,0510,21,Inpatient Hospital,2,310.71,125.19,90.19,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010546,MBR00000408,Professional,2022-01-27,2022-01-27,2022-03-09,PLN6755,1860435061,1860435061,DME Supplier,In-Network,R10.9,Z00.01,,,,,,,0,,45380,Surgery,,,,11,Office,3,1546.61,1029.08,735.74,218.34,75.0,0.0,293.34,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000010547,MBR00000408,Professional,2021-11-20,2021-11-20,2021-12-30,PLN3904,1132188260,1132188260,Family Medicine,In-Network,F41.9,J06.9,,,,,,,0,,43239,Surgery,,,,11,Office,3,2084.66,770.5,551.66,143.84,75.0,0.0,218.84,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010548,MBR00000408,Institutional-OP,2023-02-27,2023-02-27,2023-03-31,PLN7091,1528335731,1528335731,Critical Access Hospital,In-Network,Z23,J06.9,,,,,,,0,,G0444,Medicine,,,0510,22,Outpatient Hospital,2,102.23,43.09,12.44,30.65,0.0,0.0,30.65,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000010549,MBR00000408,Professional,2021-05-22,2021-05-22,2021-06-08,PLN5104,1847081578,1847081578,Urology,Out-of-Network,I10,G43.909,,,,,,,0,,99203,E&M,,,,21,Inpatient Hospital,2,205.33,161.98,0.0,161.98,0.0,0.0,161.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010550,MBR00000408,Institutional-IP,2022-02-19,2022-02-20,2022-03-05,PLN7589,1778483301,1778483301,Home Health,In-Network,M54.5,M54.5,,,,682,MS-DRG,1,1,Y,97530,Medicine,,,0740,21,Inpatient Hospital,2,140.22,100.13,83.76,0.0,0.0,16.37,16.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010551,MBR00000408,Institutional-IP,2021-08-07,2021-08-10,2021-09-13,PLN3250,1502838586,1502838586,ASC,In-Network,E11.9,E11.9,,,,682,MS-DRG,21,3,Y,45378,Surgery,,,0200,21,Inpatient Hospital,1,960.15,803.8,778.8,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000010552,MBR00000408,Institutional-OP,2023-09-04,2023-09-04,2023-09-25,PLN8569,1410468316,1410468316,SNF,In-Network,E66.9,I10,,,,,,,0,,45380,Surgery,,,0370,22,Outpatient Hospital,1,3055.62,1321.98,0.0,0.0,25.0,0.0,25.0,0.0,Denied,PR-1,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000010553,MBR00000408,Institutional-IP,2021-11-21,2021-11-25,2021-12-02,PLN7125,1727809972,1727809972,Home Health,In-Network,E66.9,J06.9,,,,871,MS-DRG,3,4,Y,74177,Radiology,,,0740,21,Inpatient Hospital,3,1726.84,899.84,899.84,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010554,MBR00000408,Institutional-OP,2022-09-13,2022-09-13,2022-09-21,PLN3253,1450553056,1450553056,Clinical Laboratory,In-Network,E78.5,I11.9,,,,,,,0,,27447,Surgery,,,0370,22,Outpatient Hospital,1,5355.99,2616.01,2616.01,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010555,MBR00000408,Professional,2022-07-27,2022-07-27,2022-09-02,PLN3745,1284035364,1284035364,Pediatrics,In-Network,F10.20,I10,,,,,,,0,,99233,E&M,,,,11,Office,1,389.16,177.52,49.28,117.66,0.0,10.58,128.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010556,MBR00000408,Professional,2022-06-24,2022-06-24,2022-07-27,PLN4990,1486164553,1486164553,DME Supplier,In-Network,J44.1,R10.9,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,1,39.97,31.93,6.93,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010557,MBR00000408,Professional,2021-03-14,2021-03-14,2021-04-25,PLN4617,1224179551,1224179551,Physical Therapy,In-Network,J20.9,J20.9,,,,,,,0,,99284,E&M,,,,11,Office,3,923.4,334.41,334.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010558,MBR00000408,Professional,2021-10-15,2021-10-15,2021-11-21,PLN1566,1896447406,1896447406,Nephrology,Out-of-Network,F10.20,M17.11,,,,,,,0,,93225,Medicine,,,,11,Office,3,518.53,433.3,358.3,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010559,MBR00000408,Institutional-IP,2023-07-26,2023-07-30,2023-09-06,PLN4129,1450553056,1450553056,Clinical Laboratory,In-Network,F10.20,M81.0,,,,872,MS-DRG,15,4,Y,99406,Medicine,,,0761,21,Inpatient Hospital,3,91.04,31.82,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010560,MBR00000408,Institutional-IP,2022-08-24,2022-08-26,2022-10-04,PLN2931,1631954542,1631954542,Oncology,In-Network,M81.0,Z00.00,,,,194,MS-DRG,17,2,Y,27130,Surgery,,,0450,21,Inpatient Hospital,3,6231.64,4544.67,4469.67,0.0,75.0,0.0,75.0,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010561,MBR00000408,Institutional-OP,2023-08-19,2023-08-19,2023-10-02,PLN4261,1528335731,1528335731,Critical Access Hospital,In-Network,N39.0,I11.9,,,,,,,0,,99203,E&M,,,0320,22,Outpatient Hospital,3,257.43,83.1,0.0,83.1,75.0,0.0,158.1,0.0,Adjusted,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000010562,MBR00000409,Institutional-OP,2022-09-05,2022-09-05,2022-09-15,PLN9951,1800011727,1800011727,Clinical Laboratory,Out-of-Network,J06.9,N40.0,,,,,,,0,,99232,E&M,,,0360,22,Outpatient Hospital,3,340.31,160.84,160.84,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010563,MBR00000409,Professional,2021-12-15,2021-12-15,2021-12-23,PLN6768,1799205295,1799205295,General Acute Care Hospital,In-Network,E78.5,M81.0,,,,,,,0,,G0468,Medicine,,,,49,Independent Clinic,3,646.78,359.21,359.21,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010564,MBR00000409,Institutional-IP,2022-01-14,2022-01-20,2022-02-16,PLN4249,1872272835,1872272835,Internal Medicine,In-Network,M17.11,E78.5,,,,682,MS-DRG,17,6,Y,99233,E&M,,,0370,21,Inpatient Hospital,2,266.72,91.65,56.65,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010565,MBR00000409,Institutional-OP,2023-04-29,2023-04-29,2023-05-13,PLN7334,1700633438,1700633438,DME Supplier,In-Network,R07.9,I25.10,,,,,,,0,,45380,Surgery,,,0510,22,Outpatient Hospital,3,1184.68,435.89,39.37,392.79,0.0,3.73,396.52,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000010566,MBR00000409,Institutional-OP,2021-09-18,2021-09-18,2021-09-26,PLN1852,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,E11.65,J20.9,,,,,,,0,,80053,Pathology/Lab,,,0450,22,Outpatient Hospital,1,94.5,61.27,26.27,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010567,MBR00000409,Professional,2022-10-19,2022-10-19,2022-11-06,PLN7783,1247341320,1247341320,Urology,Out-of-Network,Z79.4,Z12.31,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,3,520.48,188.01,188.01,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010568,MBR00000410,Institutional-IP,2023-10-22,2023-10-25,2023-11-07,PLN2955,1235381502,1235381502,Cardiology,In-Network,Z23,I10,,,,195,MS-DRG,15,3,Y,43239,Surgery,,,0510,21,Inpatient Hospital,3,1488.79,1208.33,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-29,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010569,MBR00000410,Professional,2023-07-15,2023-07-15,2023-08-21,PLN2243,1799205295,1799205295,General Acute Care Hospital,In-Network,E78.5,C50.912,,,,,,,0,,74177,Radiology,,,,11,Office,3,1340.18,521.48,0.0,0.0,0.0,41.6,41.6,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010570,MBR00000410,Professional,2022-03-01,2022-03-01,2022-03-25,PLN4074,1245650222,1245650222,Gastroenterology,In-Network,J18.9,F41.9,,,,,,,0,,72148,Radiology,,,,12,Home,3,1560.28,1089.99,916.8,93.04,0.0,80.15,173.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010571,MBR00000410,Institutional-IP,2021-10-31,2021-11-07,2021-12-06,PLN3911,1799205295,1799205295,General Acute Care Hospital,In-Network,I63.9,I10,,,,872,MS-DRG,5,7,Y,43239,Surgery,,,0320,21,Inpatient Hospital,1,1859.48,1382.11,1289.09,0.0,15.0,78.02,93.02,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010572,MBR00000410,Professional,2022-11-12,2022-11-12,2022-12-15,PLN2726,1980712759,1980712759,Outpatient Clinic,Out-of-Network,F32.9,Z51.11,,,,,,,0,,45378,Surgery,,,,11,Office,1,1645.74,830.76,478.86,351.9,0.0,0.0,351.9,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000010573,MBR00000410,Professional,2022-10-31,2022-10-31,2022-12-09,PLN9079,1114982472,1114982472,Orthopedic Surgery,In-Network,Z00.00,I10,,,,,,,0,,99213,E&M,,,,50,Federally Qualified Health Center,1,297.76,242.36,192.36,0.0,50.0,0.0,50.0,0.0,Pended,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000010574,MBR00000410,Institutional-OP,2023-03-03,2023-03-03,2023-03-25,PLN4590,1700633438,1700633438,DME Supplier,In-Network,N17.9,R51,,,,,,,0,,72148,Radiology,,,0450,22,Outpatient Hospital,1,2609.91,1384.78,1369.78,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010575,MBR00000410,Professional,2021-03-21,2021-03-21,2021-05-04,PLN1779,1433937353,1433937353,Nephrology,In-Network,Z12.31,N40.0,,,,,,,0,,99233,E&M,,,,21,Inpatient Hospital,1,203.91,95.78,60.78,0.0,35.0,0.0,35.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010576,MBR00000410,Professional,2022-08-15,2022-08-15,2022-08-30,PLN7750,1168881145,1168881145,Orthopedic Surgery,In-Network,N39.0,E66.9,,,,,,,0,,45380,Surgery,,,,11,Office,2,2135.53,1479.46,1479.46,0.0,0.0,0.0,0.0,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000010577,MBR00000410,Institutional-IP,2021-01-11,2021-01-14,2021-02-19,PLN6139,1847081578,1847081578,Urology,Out-of-Network,F41.9,F32.9,,,,196,MS-DRG,14,3,Y,99284,E&M,,,0636,21,Inpatient Hospital,1,373.1,182.72,0.0,182.72,0.0,0.0,182.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010578,MBR00000410,Institutional-IP,2023-12-22,2023-12-24,2024-01-17,PLN1655,1518055405,1518055405,Urology,In-Network,Z12.11,F32.9,,,,682,MS-DRG,18,2,Y,99213,E&M,,,0730,21,Inpatient Hospital,1,308.08,217.12,111.72,58.44,35.0,11.96,105.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010579,MBR00000410,Institutional-IP,2023-08-16,2023-08-17,2023-09-21,PLN6226,1974006077,1974006077,Orthopedic Surgery,In-Network,I10,I10,,,,195,MS-DRG,5,1,Y,27447,Surgery,,,0510,21,Inpatient Hospital,2,2772.0,1191.16,903.83,237.33,50.0,0.0,287.33,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010580,MBR00000410,Institutional-OP,2023-03-22,2023-03-22,2023-04-17,PLN7322,1935547131,1935547131,Pulmonology,In-Network,K21.0,R10.9,,,,,,,0,,66984,Surgery,,,0200,22,Outpatient Hospital,1,1301.99,561.27,561.27,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,1,Phantom,0,0,0,0,0
CLM0000010581,MBR00000410,Professional,2021-11-19,2021-11-19,2021-11-27,PLN1917,1564502315,1564502315,ASC,In-Network,Z23,M54.5,,,,,,,0,,43239,Surgery,,,,21,Inpatient Hospital,3,1084.06,539.31,462.14,77.17,0.0,0.0,77.17,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010582,MBR00000410,Professional,2023-03-29,2023-03-29,2023-04-25,PLN1379,1247341320,1247341320,Urology,Out-of-Network,E78.5,J20.9,,,,,,,0,,99204,E&M,,,,23,Emergency Room,3,406.35,272.08,264.04,0.0,0.0,8.04,8.04,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010583,MBR00000410,Professional,2022-05-03,2022-05-03,2022-05-23,PLN3141,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,E78.5,Z12.31,,,,,,,0,,G0444,Medicine,,,,11,Office,3,63.34,51.26,0.0,51.26,0.0,0.0,51.26,0.0,Paid,,,0,,0,1,0,0,0,1,Phantom,0,0,0,0,1
CLM0000010584,MBR00000410,Professional,2022-12-12,2022-12-12,2022-12-26,PLN7063,1563980627,1563980627,Critical Access Hospital,In-Network,J06.9,E11.9,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,1,325.34,235.1,0.0,235.1,35.0,0.0,270.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010585,MBR00000410,Professional,2021-09-11,2021-09-11,2021-09-24,PLN4976,1727809972,1727809972,Home Health,In-Network,E87.6,I63.9,,,,,,,0,,99213,E&M,,,,81,Independent Laboratory,1,271.82,134.5,99.5,0.0,35.0,0.0,35.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010586,MBR00000410,Institutional-OP,2022-06-04,2022-06-04,2022-06-21,PLN7132,1313212303,1313212303,Family Medicine,In-Network,E11.65,E78.5,,,,,,,0,,81001,Pathology/Lab,,,0450,22,Outpatient Hospital,2,43.06,23.01,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010587,MBR00000410,Professional,2023-08-19,2023-08-19,2023-09-15,PLN4936,1585582070,1585582070,Outpatient Clinic,In-Network,R05,M54.5,,,,,,,0,,G0439,Medicine,,,,81,Independent Laboratory,1,253.32,147.41,147.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000010588,MBR00000410,Professional,2021-07-27,2021-07-27,2021-08-17,PLN8291,1590915516,1590915516,Physical Therapy,Out-of-Network,F10.20,E11.9,,,,,,,0,,99204,E&M,,,,11,Office,2,491.9,167.19,103.37,61.79,0.0,2.03,63.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010589,MBR00000410,Institutional-OP,2022-02-26,2022-02-26,2022-03-24,PLN4050,1355166277,1355166277,Endocrinology,In-Network,E78.5,Z12.11,,,,,,,0,,99232,E&M,,,0900,22,Outpatient Hospital,1,232.97,133.54,0.0,133.54,15.0,0.0,148.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010590,MBR00000410,Institutional-OP,2021-11-16,2021-11-16,2021-12-09,PLN2054,1550154147,1550154147,Outpatient Clinic,In-Network,Z12.31,M17.11,,,,,,,0,,76700,Radiology,,,0360,22,Outpatient Hospital,2,1251.93,700.43,654.95,0.0,25.0,20.48,45.48,0.0,Pended,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010591,MBR00000410,Institutional-OP,2021-07-16,2021-07-16,2021-08-22,PLN1274,1109850785,1109850785,ASC,Out-of-Network,Z23,F41.9,,,,,,,0,,27130,Surgery,,,0730,22,Outpatient Hospital,2,6689.38,4212.3,4102.62,34.68,75.0,0.0,109.68,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010592,MBR00000410,Professional,2022-03-11,2022-03-11,2022-04-13,PLN6539,1550154147,1550154147,Outpatient Clinic,In-Network,J06.9,Z00.01,,,,,,,0,,99232,E&M,,,,11,Office,3,230.69,174.95,159.95,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010593,MBR00000410,Professional,2022-10-28,2022-10-28,2022-11-25,PLN5454,1531398223,1531398223,OB/GYN,In-Network,Z12.31,J20.9,,,,,,,0,,99233,E&M,,,,81,Independent Laboratory,3,477.84,387.11,387.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010594,MBR00000410,Institutional-IP,2021-03-01,2021-03-09,2021-04-06,PLN5381,1799205295,1799205295,General Acute Care Hospital,In-Network,I10,R10.9,,,,292,MS-DRG,15,8,N,97530,Medicine,,,0761,21,Inpatient Hospital,2,181.29,142.75,0.0,108.94,75.0,0.0,183.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010595,MBR00000410,Professional,2021-08-13,2021-08-13,2021-08-21,PLN2963,1990090423,1990090423,Orthopedic Surgery,In-Network,Z00.00,I10,,,,,,,0,,99221,E&M,,,,12,Home,3,241.58,144.91,0.0,144.91,75.0,0.0,219.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010596,MBR00000410,Professional,2023-06-14,2023-06-14,2023-06-27,PLN8733,1355166277,1355166277,Endocrinology,In-Network,E78.5,E78.5,,,,,,,0,,76700,Radiology,,,,22,Outpatient Hospital,2,1113.32,911.32,876.32,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010597,MBR00000410,Institutional-OP,2021-10-13,2021-10-13,2021-11-20,PLN6829,1660288235,1660288235,ASC,In-Network,I10,N39.0,,,,,,,0,,85610,Pathology/Lab,,,0320,22,Outpatient Hospital,1,44.11,37.06,22.06,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010598,MBR00000410,Professional,2022-01-03,2022-01-03,2022-02-16,PLN6489,1840431511,1840431511,Geriatrics,Out-of-Network,E11.9,I10,,,,,,,0,,99232,E&M,,,,11,Office,1,195.75,70.3,64.3,0.0,0.0,6.0,6.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010599,MBR00000410,Professional,2023-01-07,2023-01-07,2023-02-17,PLN8675,1235381502,1235381502,Cardiology,In-Network,F41.9,J44.1,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,1,190.42,71.18,34.26,0.0,35.0,1.92,36.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010600,MBR00000410,Professional,2023-03-29,2023-03-29,2023-04-12,PLN1238,1284035364,1284035364,Pediatrics,In-Network,I10,I50.9,,,,,,,0,,78452,Radiology,,,,22,Outpatient Hospital,1,3215.74,2040.42,1560.43,134.12,0.0,345.87,479.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010601,MBR00000410,Institutional-OP,2023-11-17,2023-11-17,2023-12-16,PLN4668,1135158374,1135158374,Pulmonology,In-Network,Z12.31,E11.9,,,,,,,0,,58661,Surgery,,,0301,22,Outpatient Hospital,1,1698.95,1255.64,944.82,257.41,35.0,18.41,310.82,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010602,MBR00000410,Professional,2021-06-23,2021-06-23,2021-07-28,PLN8760,1644128543,1644128543,Gastroenterology,In-Network,C50.912,M54.5,,,,,,,0,,99203,E&M,,,,21,Inpatient Hospital,2,192.5,122.66,0.0,122.66,0.0,0.0,122.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010603,MBR00000410,Professional,2023-04-07,2023-04-07,2023-05-12,PLN5656,1224179551,1224179551,Physical Therapy,In-Network,N17.9,R51,,,,,,,0,,90460,Medicine,,,,22,Outpatient Hospital,1,50.04,28.45,13.45,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010604,MBR00000410,Institutional-OP,2023-03-04,2023-03-04,2023-03-15,PLN9967,1148984206,1148984206,Psychiatry,In-Network,J06.9,I25.10,,,,,,,0,,90837,Medicine,,,0301,22,Outpatient Hospital,1,328.35,211.23,211.23,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010605,MBR00000410,Professional,2021-05-16,2021-05-16,2021-06-02,PLN1603,1502838586,1502838586,ASC,In-Network,F41.9,G43.909,,,,,,,0,,33533,Surgery,,,,11,Office,3,23467.5,10941.4,10713.48,177.92,50.0,0.0,227.92,0.0,Adjusted,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000010606,MBR00000410,Institutional-OP,2023-08-18,2023-08-18,2023-09-29,PLN2607,1268679390,1268679390,Critical Access Hospital,In-Network,Z23,M81.0,,,,,,,0,,45380,Surgery,,,0636,22,Outpatient Hospital,1,3043.38,2085.78,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000010607,MBR00000410,Professional,2021-12-09,2021-12-09,2022-01-15,PLN7504,1865904917,1865904917,Outpatient Clinic,In-Network,F41.9,E11.9,,,,,,,0,,45378,Surgery,,,,21,Inpatient Hospital,1,1276.16,1034.52,959.18,0.0,0.0,75.34,75.34,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000010608,MBR00000410,Institutional-OP,2022-04-09,2022-04-09,2022-04-29,PLN8916,1247341320,1247341320,Urology,Out-of-Network,Z12.31,E11.65,,,,,,,0,,G0439,Medicine,,,0370,22,Outpatient Hospital,1,230.32,186.69,0.0,186.69,35.0,0.0,221.69,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000010609,MBR00000410,Professional,2023-05-23,2023-05-23,2023-06-07,PLN3281,1295371663,1295371663,Critical Access Hospital,In-Network,E78.5,N17.9,,,,,,,0,,93225,Medicine,,,,20,Urgent Care,1,515.42,386.15,0.0,386.15,35.0,0.0,421.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010610,MBR00000410,Professional,2022-07-28,2022-07-28,2022-08-13,PLN8138,1660288235,1660288235,ASC,In-Network,F41.9,Z00.01,,,,,,,0,,99284,E&M,,,,50,Federally Qualified Health Center,1,554.39,348.55,348.55,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010611,MBR00000410,Professional,2021-10-29,2021-10-29,2021-11-30,PLN3955,1395983630,1395983630,Nephrology,In-Network,Z23,Z12.31,,,,,,,0,,72148,Radiology,,,,22,Outpatient Hospital,3,2129.32,1084.83,1084.83,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010612,MBR00000410,Institutional-OP,2021-12-19,2021-12-19,2022-01-17,PLN5851,1795618275,1795618275,Pulmonology,In-Network,F03.90,E11.9,,,,,,,0,,27130,Surgery,,,0450,22,Outpatient Hospital,2,6625.93,3831.81,3831.81,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,1,Duplicate,0,0,0,0,0
CLM0000010613,MBR00000410,Professional,2023-03-22,2023-03-22,2023-04-14,PLN4929,1752470395,1752470395,Home Health,In-Network,E78.5,Z00.00,,,,,,,0,,99232,E&M,,,,12,Home,1,237.86,106.56,106.56,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010614,MBR00000410,Institutional-OP,2021-07-20,2021-07-20,2021-08-13,PLN6536,1865904917,1865904917,Outpatient Clinic,In-Network,I10,M54.5,,,,,,,0,,99284,E&M,,,0740,22,Outpatient Hospital,2,563.61,344.4,294.4,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010615,MBR00000410,Institutional-IP,2022-06-01,2022-06-11,2022-07-12,PLN6455,1361302520,1361302520,Critical Access Hospital,In-Network,J18.9,Z23,,,,194,MS-DRG,24,10,Y,99284,E&M,,,0636,21,Inpatient Hospital,2,441.25,356.76,306.76,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010616,MBR00000410,Institutional-OP,2023-03-30,2023-03-30,2023-04-09,PLN2426,1872613201,1872613201,Internal Medicine,In-Network,I10,I25.10,,,,,,,0,,45378,Surgery,,,0636,22,Outpatient Hospital,2,2269.89,1416.69,1341.69,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000010617,MBR00000410,Institutional-IP,2023-08-27,2023-08-31,2023-09-10,PLN4960,1410468316,1410468316,SNF,In-Network,Z12.31,E11.9,,,,690,MS-DRG,3,4,Y,93306,Radiology,,,0761,21,Inpatient Hospital,3,3267.15,1886.89,1886.89,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000010618,MBR00000411,Professional,2023-06-24,2023-06-24,2023-07-06,PLN1703,1561134315,1561134315,DME Supplier,In-Network,M54.5,G43.909,,,,,,,0,,77067,Radiology,,,,20,Urgent Care,1,507.55,294.38,0.0,294.38,0.0,0.0,294.38,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000010619,MBR00000411,Institutional-IP,2022-01-29,2022-02-09,2022-03-02,PLN7758,1273488618,1273488618,General Acute Care Hospital,In-Network,M81.0,Z12.11,,,,194,MS-DRG,22,11,Y,G0439,Medicine,,,0301,21,Inpatient Hospital,1,391.91,127.25,0.0,127.25,25.0,0.0,152.25,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000010620,MBR00000411,Professional,2021-08-06,2021-08-06,2021-09-12,PLN9689,1809014947,1809014947,Urology,In-Network,Z00.01,Z12.31,,,,,,,0,,93000,Radiology,,,,21,Inpatient Hospital,2,75.04,48.13,0.0,48.13,0.0,0.0,48.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010621,MBR00000411,Institutional-OP,2023-10-21,2023-10-21,2023-11-01,PLN6640,1915531927,1915531927,Critical Access Hospital,In-Network,K21.0,E11.9,,,,,,,0,,99221,E&M,,,0200,22,Outpatient Hospital,3,293.63,170.96,0.0,170.96,0.0,0.0,170.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010622,MBR00000411,Institutional-OP,2022-10-17,2022-10-17,2022-11-09,PLN3375,1606140917,1606140917,ASC,In-Network,Z96.641,I10,,,,,,,0,,70553,Radiology,,,0636,22,Outpatient Hospital,3,2746.59,1920.68,1830.98,54.7,35.0,0.0,89.7,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010623,MBR00000411,Professional,2022-03-23,2022-03-23,2022-04-21,PLN8155,1283743001,1283743001,Family Medicine,In-Network,J20.9,E11.40,,,,,,,0,,99204,E&M,,,,31,Skilled Nursing Facility,3,512.8,224.09,197.4,0.0,0.0,26.69,26.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010624,MBR00000411,Institutional-OP,2023-09-15,2023-09-15,2023-10-26,PLN8098,1132188260,1132188260,Family Medicine,In-Network,I10,I25.10,,,,,,,0,,99284,E&M,,,0761,22,Outpatient Hospital,1,469.79,250.16,250.16,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010625,MBR00000411,Professional,2023-03-07,2023-03-07,2023-04-04,PLN5180,1812060197,1812060197,Oncology,Out-of-Network,J20.9,Z23,,,,,,,0,,G0439,Medicine,,,,20,Urgent Care,2,595.61,438.78,438.78,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000010626,MBR00000411,Institutional-IP,2022-06-06,2022-06-11,2022-07-06,PLN2751,1422747896,1422747896,Urology,In-Network,I50.9,M54.5,,,,603,MS-DRG,15,5,Y,99233,E&M,,,0740,21,Inpatient Hospital,3,554.18,303.3,291.57,0.0,0.0,11.73,11.73,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000010627,MBR00000411,Institutional-OP,2021-08-02,2021-08-02,2021-08-11,PLN7015,1227362142,1227362142,DME Supplier,In-Network,Z12.31,E66.9,,,,,,,0,,58661,Surgery,,,0636,22,Outpatient Hospital,3,2558.87,2090.33,0.0,430.61,75.0,255.05,760.66,0.0,Denied,CO-15,,1,,0,0,1,0,0,1,Duplicate,0,0,0,0,0
CLM0000010628,MBR00000411,Professional,2021-03-31,2021-03-31,2021-05-06,PLN5741,1268679390,1268679390,Critical Access Hospital,In-Network,E78.5,N40.0,,,,,,,0,,99406,Medicine,,,,20,Urgent Care,1,89.72,52.87,30.65,0.0,15.0,7.22,22.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010629,MBR00000411,Professional,2022-08-05,2022-08-05,2022-08-15,PLN8261,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,Z12.31,E78.5,,,,,,,0,,93306,Radiology,,,,23,Emergency Room,2,1512.94,1000.53,985.53,0.0,15.0,0.0,15.0,0.0,Adjusted,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010630,MBR00000411,Institutional-OP,2021-05-06,2021-05-06,2021-06-11,PLN5988,1125190055,1125190055,Nephrology,In-Network,M54.5,Z23,,,,,,,0,,45378,Surgery,,,0740,22,Outpatient Hospital,2,1798.09,643.51,643.51,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000010631,MBR00000411,Professional,2021-12-06,2021-12-06,2021-12-14,PLN2570,1135158374,1135158374,Pulmonology,In-Network,J20.9,Z12.11,,,,,,,0,,47562,Surgery,,,,81,Independent Laboratory,2,6584.67,3512.6,3512.6,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010632,MBR00000411,Professional,2023-01-17,2023-01-17,2023-01-30,PLN8864,1691062876,1691062876,SNF,In-Network,E11.65,E66.9,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,2,417.28,190.3,141.43,0.0,25.0,23.87,48.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010633,MBR00000411,Institutional-OP,2021-01-14,2021-01-14,2021-02-11,PLN4644,1186826716,1186826716,Physical Therapy,In-Network,J06.9,Z00.00,,,,,,,0,,90837,Medicine,,,0510,22,Outpatient Hospital,3,317.46,114.46,89.92,0.0,15.0,9.54,24.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010634,MBR00000411,Professional,2023-12-20,2023-12-20,2024-01-10,PLN6698,1585582070,1585582070,Outpatient Clinic,In-Network,I10,F32.9,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,3,69.68,51.28,0.0,51.28,0.0,0.0,51.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010635,MBR00000411,Professional,2022-04-24,2022-04-24,2022-06-07,PLN4777,1624802371,1624802371,ASC,Out-of-Network,F32.9,Z00.00,,,,,,,0,,90837,Medicine,,,,49,Independent Clinic,2,240.66,186.02,0.0,186.02,0.0,0.0,186.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010636,MBR00000411,Institutional-OP,2023-08-11,2023-08-11,2023-09-04,PLN7062,1337791138,1337791138,Internal Medicine,Out-of-Network,I10,N39.0,,,,,,,0,,80053,Pathology/Lab,,,0320,22,Outpatient Hospital,2,152.23,115.74,0.0,115.74,0.0,0.0,115.74,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000010637,MBR00000411,Institutional-IP,2021-07-08,2021-07-10,2021-08-21,PLN8693,1689639685,1689639685,SNF,In-Network,Z12.31,B97.89,,,,194,MS-DRG,1,2,Y,27130,Surgery,,,0730,21,Inpatient Hospital,3,4571.23,2167.6,2117.6,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010638,MBR00000411,Institutional-IP,2022-05-20,2022-05-26,2022-05-29,PLN1023,1590915516,1590915516,Physical Therapy,Out-of-Network,I50.9,Z00.00,,,,690,MS-DRG,11,6,Y,99233,E&M,,,0510,21,Inpatient Hospital,1,463.34,158.75,64.74,87.25,0.0,6.76,94.01,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010639,MBR00000411,Professional,2023-11-16,2023-11-16,2023-12-08,PLN5593,1556140803,1556140803,Cardiology,In-Network,N18.3,Z23,,,,,,,0,,G0439,Medicine,,,,11,Office,3,352.46,215.42,215.42,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000010640,MBR00000411,Institutional-OP,2022-11-24,2022-11-24,2022-12-22,PLN8186,1790497490,1790497490,OB/GYN,In-Network,N39.0,F32.9,,,,,,,0,,99222,E&M,,,0510,22,Outpatient Hospital,1,644.21,520.47,381.79,0.0,50.0,88.68,138.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010641,MBR00000411,Professional,2023-06-05,2023-06-05,2023-07-18,PLN7207,1268679390,1268679390,Critical Access Hospital,In-Network,I10,E11.9,,,,,,,0,,45378,Surgery,,,,49,Independent Clinic,1,1420.94,812.46,812.46,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000010642,MBR00000411,Professional,2023-01-21,2023-01-21,2023-02-22,PLN7431,1475984649,1475984649,SNF,In-Network,R07.9,I10,,,,,,,0,,74177,Radiology,,,,11,Office,1,2180.55,1502.45,1487.45,0.0,15.0,0.0,15.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010643,MBR00000411,Professional,2023-03-21,2023-03-21,2023-04-27,PLN8945,1531398223,1531398223,OB/GYN,In-Network,G20,E11.9,,,,,,,0,,86900,Pathology/Lab,,,,23,Emergency Room,1,31.21,21.99,6.99,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010644,MBR00000411,Institutional-OP,2022-02-03,2022-02-03,2022-02-21,PLN3244,1235381502,1235381502,Cardiology,In-Network,E66.9,M54.5,,,,,,,0,,80061,Pathology/Lab,,,0510,22,Outpatient Hospital,1,126.39,71.62,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010645,MBR00000411,Professional,2022-05-12,2022-05-12,2022-06-16,PLN9920,1410468316,1410468316,SNF,In-Network,Z12.31,Z23,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,2,17268.64,11502.99,11502.99,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000010646,MBR00000412,Professional,2021-02-24,2021-02-24,2021-03-04,PLN5917,1361302520,1361302520,Critical Access Hospital,In-Network,Z12.31,J45.20,,,,,,,0,,99214,E&M,,,,11,Office,2,223.82,168.45,143.45,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010647,MBR00000412,Professional,2021-10-11,2021-10-11,2021-11-13,PLN1441,1790497490,1790497490,OB/GYN,In-Network,F41.9,Z12.11,,,,,,,0,,27447,Surgery,,,,11,Office,3,2943.81,1091.01,1066.01,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010648,MBR00000412,Institutional-IP,2021-03-12,2021-03-15,2021-03-22,PLN7193,1148984206,1148984206,Psychiatry,In-Network,Z23,J44.1,,,,682,MS-DRG,1,3,N,G0439,Medicine,,,0450,21,Inpatient Hospital,2,506.59,231.92,156.92,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000010649,MBR00000412,Professional,2021-12-22,2021-12-22,2022-01-28,PLN9166,1540044947,1540044947,Pulmonology,Out-of-Network,J06.9,Z00.00,,,,,,,0,,99214,E&M,,,,11,Office,1,399.03,249.88,249.88,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010650,MBR00000412,Institutional-IP,2023-03-06,2023-03-07,2023-04-08,PLN2765,1809014947,1809014947,Urology,In-Network,Z87.891,Z12.31,,,,292,MS-DRG,17,1,Y,45380,Surgery,,,0740,21,Inpatient Hospital,2,1667.13,996.8,0.0,28.77,35.0,77.78,141.55,0.0,Denied,CO-15,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000010651,MBR00000412,Professional,2021-08-12,2021-08-12,2021-09-18,PLN2124,1872272835,1872272835,Internal Medicine,In-Network,R10.9,G43.909,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,2,394.97,212.24,0.0,212.24,0.0,0.0,212.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010652,MBR00000412,Professional,2022-06-08,2022-06-08,2022-07-01,PLN1125,1948810580,1948810580,DME Supplier,In-Network,N18.3,K21.0,,,,,,,0,,83036,Pathology/Lab,,,,22,Outpatient Hospital,3,113.21,56.83,0.0,14.42,50.0,0.0,64.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000010653,MBR00000412,Professional,2022-08-28,2022-08-28,2022-09-29,PLN8273,1980712759,1980712759,Outpatient Clinic,Out-of-Network,Z00.00,I10,,,,,,,0,,74177,Radiology,,,,21,Inpatient Hospital,2,1623.81,1166.58,1166.58,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000010654,MBR00000412,Institutional-OP,2021-06-29,2021-06-29,2021-08-01,PLN2171,1239316214,1239316214,Internal Medicine,In-Network,Z00.00,N17.9,,,,,,,0,,81001,Pathology/Lab,,,0761,22,Outpatient Hospital,3,26.73,18.48,18.48,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010655,MBR00000412,Institutional-IP,2023-06-08,2023-06-16,2023-07-03,PLN8119,1186826716,1186826716,Physical Therapy,In-Network,E11.9,E11.65,,,,603,MS-DRG,22,8,Y,99221,E&M,,,0510,21,Inpatient Hospital,1,207.3,88.05,37.96,0.0,50.0,0.09,50.09,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010656,MBR00000412,Professional,2023-04-25,2023-04-25,2023-05-14,PLN1648,1845900543,1845900543,ASC,In-Network,Z00.00,E11.9,,,,,,,0,,70450,Radiology,,,,49,Independent Clinic,2,1642.87,1293.05,797.87,495.18,0.0,0.0,495.18,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010657,MBR00000412,Professional,2021-07-25,2021-07-25,2021-08-18,PLN9376,1135158374,1135158374,Pulmonology,In-Network,I10,R05,,,,,,,0,,99203,E&M,,,,23,Emergency Room,2,205.13,171.08,47.61,120.2,0.0,3.27,123.47,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010658,MBR00000412,Professional,2021-02-09,2021-02-09,2021-02-22,PLN2195,1114982472,1114982472,Orthopedic Surgery,In-Network,Z00.00,I50.9,,,,,,,0,,45378,Surgery,,,,11,Office,2,1430.98,824.37,824.37,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000010659,MBR00000412,Professional,2021-01-05,2021-01-05,2021-01-24,PLN5405,1840431511,1840431511,Geriatrics,Out-of-Network,Z23,R05,,,,,,,0,,86900,Pathology/Lab,,,,50,Federally Qualified Health Center,1,36.69,26.12,0.0,26.12,0.0,0.0,26.12,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010660,MBR00000412,Institutional-OP,2021-11-17,2021-11-17,2021-12-23,PLN7203,1235381502,1235381502,Cardiology,In-Network,Z00.00,K57.30,,,,,,,0,,66984,Surgery,,,0900,22,Outpatient Hospital,1,2580.44,1769.62,1769.62,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010661,MBR00000412,Professional,2021-05-18,2021-05-18,2021-06-23,PLN5509,1125190055,1125190055,Nephrology,In-Network,R07.9,Z00.00,,,,,,,0,,90686,Medicine,,,,50,Federally Qualified Health Center,1,122.05,42.75,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000010662,MBR00000412,Institutional-OP,2021-01-20,2021-01-20,2021-02-02,PLN6468,1990090423,1990090423,Orthopedic Surgery,In-Network,F32.9,N39.0,,,,,,,0,,80061,Pathology/Lab,,,0370,22,Outpatient Hospital,2,66.57,49.16,0.0,49.16,0.0,0.0,49.16,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010663,MBR00000412,Professional,2022-05-20,2022-05-20,2022-06-08,PLN7374,1990090423,1990090423,Orthopedic Surgery,In-Network,G20,Z12.31,,,,,,,0,,45380,Surgery,,,,11,Office,1,2013.45,864.46,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-50,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000010664,MBR00000412,Professional,2022-07-29,2022-07-29,2022-08-22,PLN1131,1845057593,1845057593,Orthopedic Surgery,In-Network,M17.11,J06.9,,,,,,,0,,27447,Surgery,,,,21,Inpatient Hospital,3,3972.25,1593.38,1518.38,0.0,75.0,0.0,75.0,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010665,MBR00000412,Professional,2021-01-21,2021-01-21,2021-02-05,PLN9219,1563980627,1563980627,Critical Access Hospital,In-Network,F41.9,Z23,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,2,26.35,8.13,8.13,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010666,MBR00000412,Professional,2022-10-18,2022-10-18,2022-10-25,PLN4823,1622771872,1622771872,Pediatrics,In-Network,F41.9,F32.9,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,1,45.21,20.4,20.05,0.0,0.0,0.35,0.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010667,MBR00000412,Institutional-OP,2022-03-18,2022-03-18,2022-04-16,PLN6170,1366576336,1366576336,Geriatrics,In-Network,E11.65,K92.1,,,,,,,0,,66984,Surgery,,,0730,22,Outpatient Hospital,3,1610.96,795.62,795.62,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010668,MBR00000412,Professional,2021-08-08,2021-08-08,2021-08-24,PLN3904,1337791138,1337791138,Internal Medicine,Out-of-Network,J06.9,I10,,,,,,,0,,99213,E&M,,,,50,Federally Qualified Health Center,3,136.96,70.45,0.0,0.0,0.0,9.89,9.89,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010669,MBR00000412,Institutional-OP,2021-05-02,2021-05-02,2021-05-29,PLN5518,1660288235,1660288235,ASC,In-Network,N39.0,F41.9,,,,,,,0,,58661,Surgery,,,0270,22,Outpatient Hospital,2,4788.59,2777.99,2161.02,337.14,0.0,279.83,616.97,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010670,MBR00000412,Professional,2023-04-12,2023-04-12,2023-05-12,PLN8111,1631954542,1631954542,Oncology,In-Network,I10,S72.001A,,,,,,,0,,45380,Surgery,,,,21,Inpatient Hospital,2,1759.61,1005.79,884.83,0.0,25.0,95.96,120.96,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000010671,MBR00000412,Professional,2021-04-29,2021-04-29,2021-06-03,PLN4938,1227362142,1227362142,DME Supplier,In-Network,Z79.4,F41.9,,,,,,,0,,G0444,Medicine,,,,22,Outpatient Hospital,2,97.73,50.01,50.01,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000010672,MBR00000412,Professional,2021-08-08,2021-08-08,2021-08-15,PLN7548,1205377316,1205377316,Orthopedic Surgery,In-Network,J06.9,E11.9,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,1,55.49,35.4,35.4,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000010673,MBR00000412,Professional,2023-02-20,2023-02-20,2023-03-31,PLN7604,1500949740,1500949740,Pediatrics,In-Network,I10,J20.9,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,2,54.05,41.33,35.54,0.0,0.0,5.79,5.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010674,MBR00000412,Professional,2022-11-21,2022-11-21,2022-11-29,PLN5317,1514306773,1514306773,Endocrinology,In-Network,I50.9,Z00.00,,,,,,,0,,99214,E&M,,,,23,Emergency Room,2,465.0,154.09,154.09,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010675,MBR00000412,Professional,2023-12-31,2023-12-31,2024-02-10,PLN4339,1500037969,1500037969,Pulmonology,In-Network,Z12.31,E78.5,,,,,,,0,,99213,E&M,,,,11,Office,1,296.46,168.22,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010676,MBR00000412,Institutional-OP,2021-02-14,2021-02-14,2021-03-04,PLN7929,1244186984,1244186984,Family Medicine,Out-of-Network,Z00.01,F32.9,,,,,,,0,,99406,Medicine,,,0370,22,Outpatient Hospital,1,71.96,22.39,0.0,22.39,75.0,0.0,97.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010677,MBR00000412,Institutional-IP,2021-08-01,2021-08-02,2021-09-11,PLN6394,1284035364,1284035364,Pediatrics,In-Network,G43.909,E11.9,,,,682,MS-DRG,13,1,Y,99283,E&M,,,0320,21,Inpatient Hospital,2,566.37,322.63,307.63,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010678,MBR00000412,Professional,2022-12-26,2022-12-26,2023-01-30,PLN4215,1939033455,1939033455,Pulmonology,In-Network,I50.9,E11.9,,,,,,,0,,70553,Radiology,,,,11,Office,3,4200.35,1379.99,1288.75,65.98,0.0,25.26,91.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010679,MBR00000412,Institutional-OP,2021-09-09,2021-09-09,2021-10-04,PLN4910,1624202402,1624202402,Orthopedic Surgery,In-Network,Z12.31,Z12.31,,,,,,,0,,85610,Pathology/Lab,,,0360,22,Outpatient Hospital,2,53.39,23.63,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010680,MBR00000412,Professional,2022-02-22,2022-02-22,2022-03-26,PLN7600,1224179551,1224179551,Physical Therapy,In-Network,J20.9,K57.30,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,3,3540.66,1651.36,1616.36,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010681,MBR00000412,Institutional-OP,2021-11-21,2021-11-21,2021-12-08,PLN8235,1295371663,1295371663,Critical Access Hospital,In-Network,Z00.00,Z00.00,,,,,,,0,,99221,E&M,,,0270,22,Outpatient Hospital,3,228.74,119.56,0.0,119.56,0.0,0.0,119.56,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010682,MBR00000413,Institutional-OP,2023-06-05,2023-06-05,2023-07-05,PLN8815,1717546253,1717546253,Family Medicine,In-Network,J06.9,K57.30,,,,,,,0,,43239,Surgery,,,0270,22,Outpatient Hospital,3,1927.89,1628.7,1603.7,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010683,MBR00000413,Professional,2023-05-10,2023-05-10,2023-05-18,PLN7895,1860435061,1860435061,DME Supplier,In-Network,E11.65,Z12.11,,,,,,,0,,90686,Medicine,,,,21,Inpatient Hospital,1,141.1,100.08,100.08,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000010684,MBR00000413,Institutional-OP,2023-06-02,2023-06-02,2023-06-13,PLN1710,1186826716,1186826716,Physical Therapy,In-Network,E11.9,J20.9,,,,,,,0,,77067,Radiology,,,0450,22,Outpatient Hospital,3,451.71,347.45,332.45,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000010685,MBR00000413,Professional,2022-07-08,2022-07-08,2022-07-23,PLN6349,1809014947,1809014947,Urology,In-Network,G43.909,K57.30,,,,,,,0,,90460,Medicine,,,,23,Emergency Room,2,73.51,58.95,58.95,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010686,MBR00000413,Professional,2022-06-19,2022-06-19,2022-06-30,PLN5707,1631954542,1631954542,Oncology,In-Network,N39.0,F32.9,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,1,509.97,234.59,60.91,173.68,0.0,0.0,173.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010687,MBR00000413,Institutional-IP,2022-09-17,2022-09-19,2022-10-16,PLN5309,1236418230,1236418230,DME Supplier,In-Network,R07.9,Z00.00,,,,871,MS-DRG,15,2,Y,99233,E&M,,,0730,21,Inpatient Hospital,2,366.77,124.4,124.4,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010688,MBR00000413,Institutional-OP,2021-03-15,2021-03-15,2021-04-23,PLN8269,1575695214,1575695214,SNF,In-Network,F32.9,E11.9,,,,,,,0,,70450,Radiology,,,0360,22,Outpatient Hospital,2,683.67,296.26,286.29,0.0,0.0,9.97,9.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010689,MBR00000413,Professional,2022-08-22,2022-08-22,2022-09-29,PLN1634,1213165847,1213165847,Critical Access Hospital,In-Network,Z23,I11.9,,,,,,,0,,99203,E&M,,,,11,Office,2,158.24,129.78,0.0,0.0,0.0,12.8,12.8,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010690,MBR00000413,Professional,2021-10-30,2021-10-30,2021-12-12,PLN2757,1193493783,1193493783,Critical Access Hospital,Out-of-Network,I63.9,E66.9,,,,,,,0,,93306,Radiology,,,,49,Independent Clinic,2,2678.37,1880.6,1880.6,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010691,MBR00000413,Professional,2023-10-24,2023-10-24,2023-11-05,PLN3477,1266606767,1266606767,ASC,In-Network,F41.9,E11.40,,,,,,,0,,45380,Surgery,,,,11,Office,1,1626.03,1026.45,1026.45,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000010692,MBR00000413,Professional,2021-07-21,2021-07-21,2021-08-21,PLN6719,1585582070,1585582070,Outpatient Clinic,In-Network,Z23,E78.5,,,,,,,0,,99232,E&M,,,,12,Home,2,365.27,305.39,107.6,197.58,0.0,0.21,197.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010693,MBR00000413,Professional,2021-02-08,2021-02-08,2021-03-17,PLN2324,1571574052,1571574052,Critical Access Hospital,In-Network,E78.5,E11.9,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,1,299.88,161.27,161.27,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010694,MBR00000414,Professional,2023-11-21,2023-11-21,2024-01-01,PLN8749,1910255109,1910255109,DME Supplier,In-Network,E78.5,E11.9,,,,,,,0,,93000,Radiology,,,,22,Outpatient Hospital,3,117.58,87.37,0.0,87.37,0.0,0.0,87.37,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010695,MBR00000414,Institutional-OP,2021-06-22,2021-06-22,2021-07-10,PLN3150,1114982472,1114982472,Orthopedic Surgery,In-Network,E11.9,E66.9,,,,,,,0,,99204,E&M,,,0200,22,Outpatient Hospital,1,391.27,229.95,194.95,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010696,MBR00000414,Institutional-OP,2022-07-21,2022-07-21,2022-08-01,PLN4213,1168246159,1168246159,Internal Medicine,In-Network,M81.0,E11.9,,,,,,,0,,85025,Pathology/Lab,,,0636,22,Outpatient Hospital,2,66.34,50.35,0.0,50.35,75.0,0.0,125.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010697,MBR00000414,Institutional-OP,2022-02-23,2022-02-23,2022-03-17,PLN8480,1247341320,1247341320,Urology,Out-of-Network,E66.9,N18.3,,,,,,,0,,99284,E&M,,,0360,22,Outpatient Hospital,3,910.9,704.36,679.36,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000010698,MBR00000414,Professional,2021-10-22,2021-10-22,2021-11-13,PLN6520,1540044947,1540044947,Pulmonology,Out-of-Network,E78.5,R05,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,1,340.86,123.31,0.0,123.31,15.0,0.0,138.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010699,MBR00000414,Professional,2022-06-19,2022-06-19,2022-07-31,PLN4975,1809014947,1809014947,Urology,In-Network,Z00.00,E66.9,,,,,,,0,,80061,Pathology/Lab,,,,22,Outpatient Hospital,3,118.89,63.47,38.47,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010700,MBR00000414,Professional,2023-03-14,2023-03-14,2023-04-24,PLN4355,1475984649,1475984649,SNF,In-Network,Z12.31,E78.5,,,,,,,0,,90837,Medicine,,,,11,Office,2,448.29,222.36,139.91,82.45,0.0,0.0,82.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010701,MBR00000414,Institutional-IP,2021-05-05,2021-05-10,2021-05-23,PLN3201,1438368327,1438368327,Home Health,In-Network,F32.9,M54.5,,,,292,MS-DRG,18,5,Y,99284,E&M,,,0636,21,Inpatient Hospital,1,595.94,392.25,286.29,0.0,75.0,30.96,105.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010702,MBR00000414,Institutional-IP,2022-12-26,2022-12-30,2023-01-20,PLN4024,1410468316,1410468316,SNF,In-Network,E11.9,I25.10,,,,194,MS-DRG,11,4,Y,G0444,Medicine,,,0450,21,Inpatient Hospital,2,90.72,47.25,0.0,47.25,15.0,0.0,62.25,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000010703,MBR00000414,Professional,2023-09-06,2023-09-06,2023-09-24,PLN8830,1860435061,1860435061,DME Supplier,In-Network,J06.9,E78.5,,,,,,,0,,27447,Surgery,,,,49,Independent Clinic,3,3723.61,2679.09,2508.03,171.06,0.0,0.0,171.06,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010704,MBR00000414,Institutional-OP,2021-11-14,2021-11-14,2021-12-15,PLN1009,1242201429,1242201429,General Acute Care Hospital,In-Network,N39.0,Z23,,,,,,,0,,99222,E&M,,,0200,22,Outpatient Hospital,3,308.65,157.69,82.69,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010705,MBR00000414,Professional,2023-01-13,2023-01-13,2023-01-23,PLN9090,1624202402,1624202402,Orthopedic Surgery,In-Network,K21.0,I10,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,1,915.52,457.96,319.09,103.87,35.0,0.0,138.87,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000010706,MBR00000414,Professional,2023-10-05,2023-10-05,2023-10-26,PLN5181,1372918899,1372918899,Family Medicine,In-Network,I10,Z23,,,,,,,0,,45378,Surgery,,,,81,Independent Laboratory,2,1851.99,824.14,713.36,0.0,75.0,35.78,110.78,0.0,Adjusted,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000010707,MBR00000414,Professional,2023-10-18,2023-10-18,2023-11-17,PLN9798,1812060197,1812060197,Oncology,Out-of-Network,G43.909,I10,,,,,,,0,,99204,E&M,,,,11,Office,1,449.82,253.53,203.53,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010708,MBR00000414,Professional,2022-12-11,2022-12-11,2023-01-24,PLN8597,1103747954,1103747954,Urology,In-Network,I10,Z12.31,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,3,81.75,52.68,0.0,52.68,0.0,0.0,52.68,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010709,MBR00000414,Professional,2023-10-28,2023-10-28,2023-11-14,PLN9375,1727809972,1727809972,Home Health,In-Network,J20.9,Z96.641,,,,,,,0,,99222,E&M,,,,20,Urgent Care,3,267.42,172.59,70.69,101.9,0.0,0.0,101.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010710,MBR00000414,Institutional-OP,2023-05-02,2023-05-02,2023-05-09,PLN3447,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,M17.11,K21.0,,,,,,,0,,97530,Medicine,,,0270,22,Outpatient Hospital,1,312.01,176.43,101.43,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000010711,MBR00000414,Institutional-IP,2022-07-16,2022-07-21,2022-08-21,PLN4522,1550154147,1550154147,Outpatient Clinic,In-Network,Z23,Z12.11,,,,872,MS-DRG,6,5,Y,43239,Surgery,,,0450,21,Inpatient Hospital,3,968.39,757.87,757.87,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010712,MBR00000414,Professional,2021-05-18,2021-05-18,2021-06-30,PLN5186,1109850785,1109850785,ASC,Out-of-Network,E66.9,J18.9,,,,,,,0,,97530,Medicine,,,,11,Office,2,136.06,58.49,14.41,44.08,0.0,0.0,44.08,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010713,MBR00000414,Professional,2023-07-24,2023-07-24,2023-08-26,PLN6920,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,Z79.4,I50.9,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,3,1183.87,560.71,447.37,0.0,35.0,78.34,113.34,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010714,MBR00000414,Professional,2021-11-10,2021-11-10,2021-11-26,PLN2469,1891849440,1891849440,Oncology,In-Network,N17.9,F41.9,,,,,,,0,,99221,E&M,,,,12,Home,3,306.3,173.09,158.09,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010715,MBR00000414,Institutional-OP,2023-03-18,2023-03-18,2023-04-26,PLN1150,1334916761,1334916761,ASC,In-Network,J06.9,N18.3,,,,,,,0,,23472,Surgery,,,0301,22,Outpatient Hospital,2,2676.41,1465.24,1265.38,199.86,0.0,0.0,199.86,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010716,MBR00000414,Institutional-OP,2022-12-08,2022-12-08,2023-01-14,PLN3311,1337791138,1337791138,Internal Medicine,Out-of-Network,R10.9,Z12.31,,,,,,,0,,66984,Surgery,,,0301,22,Outpatient Hospital,3,1459.02,922.43,860.06,0.0,25.0,37.37,62.37,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010717,MBR00000414,Professional,2022-01-30,2022-01-30,2022-02-17,PLN7043,1757138478,1757138478,Pediatrics,In-Network,F41.9,K21.0,,,,,,,0,,33533,Surgery,,,,11,Office,2,26030.9,10822.79,10822.79,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000010718,MBR00000414,Institutional-OP,2023-04-29,2023-04-29,2023-05-27,PLN5140,1337791138,1337791138,Internal Medicine,Out-of-Network,Z23,K21.0,,,,,,,0,,83036,Pathology/Lab,,,0320,22,Outpatient Hospital,3,116.47,50.37,35.37,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000010719,MBR00000414,Professional,2022-12-21,2022-12-21,2023-01-26,PLN7834,1564502315,1564502315,ASC,In-Network,N18.3,F41.9,,,,,,,0,,93000,Radiology,,,,11,Office,2,189.43,124.48,124.48,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010720,MBR00000414,Institutional-OP,2023-03-28,2023-03-28,2023-04-24,PLN5923,1980712759,1980712759,Outpatient Clinic,Out-of-Network,N17.9,K21.0,,,,,,,0,,G0468,Medicine,,,0120,22,Outpatient Hospital,2,457.87,376.88,361.88,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000010721,MBR00000414,Professional,2023-11-10,2023-11-10,2023-12-17,PLN3896,1410468316,1410468316,SNF,In-Network,K57.30,F10.20,,,,,,,0,,70450,Radiology,,,,65,End-Stage Renal Disease,1,1376.71,971.29,509.51,461.78,0.0,0.0,461.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010722,MBR00000414,Institutional-OP,2021-10-28,2021-10-28,2021-11-12,PLN9744,1114982472,1114982472,Orthopedic Surgery,In-Network,E11.9,E78.5,,,,,,,0,,77067,Radiology,,,0270,22,Outpatient Hospital,3,327.7,225.85,225.85,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000010723,MBR00000414,Institutional-OP,2023-04-17,2023-04-17,2023-05-25,PLN4608,1700633438,1700633438,DME Supplier,In-Network,I10,J06.9,,,,,,,0,,99222,E&M,,,0740,22,Outpatient Hospital,2,513.77,276.16,274.49,0.0,0.0,1.67,1.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010724,MBR00000414,Professional,2021-02-13,2021-02-13,2021-02-20,PLN6406,1125190055,1125190055,Nephrology,In-Network,E78.5,Z23,,,,,,,0,,76700,Radiology,,,,11,Office,2,1177.87,492.0,0.0,467.82,25.0,0.0,492.82,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010725,MBR00000414,Professional,2023-02-16,2023-02-16,2023-03-18,PLN9440,1500037969,1500037969,Pulmonology,In-Network,R10.9,I63.9,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,3,44.92,30.09,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000010726,MBR00000414,Professional,2021-06-20,2021-06-20,2021-07-28,PLN4500,1518055405,1518055405,Urology,In-Network,Z12.11,I11.9,,,,,,,0,,99203,E&M,,,,11,Office,2,217.33,158.84,108.84,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010727,MBR00000414,Professional,2021-08-31,2021-08-31,2021-09-15,PLN8382,1991459367,1991459367,Neurology,Out-of-Network,Z23,F10.20,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,3,551.02,251.51,0.0,251.51,50.0,0.0,301.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010728,MBR00000414,Professional,2021-08-03,2021-08-03,2021-08-15,PLN6501,1366576336,1366576336,Geriatrics,In-Network,Z12.31,G43.909,,,,,,,0,,99204,E&M,,,,81,Independent Laboratory,2,556.74,191.88,190.5,0.0,0.0,1.38,1.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010729,MBR00000414,Professional,2023-06-30,2023-06-30,2023-07-24,PLN3368,1463205530,1463205530,Nephrology,In-Network,Z87.891,E66.9,,,,,,,0,,70450,Radiology,,,,11,Office,2,898.26,744.37,404.85,264.52,75.0,0.0,339.52,0.0,Adjusted,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010730,MBR00000414,Professional,2022-02-14,2022-02-14,2022-03-19,PLN7429,1728018911,1728018911,Nephrology,In-Network,E11.9,C50.912,,,,,,,0,,74177,Radiology,,,,11,Office,2,2186.45,1749.37,1496.19,233.83,0.0,19.35,253.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010731,MBR00000414,Professional,2022-03-03,2022-03-03,2022-03-22,PLN8492,1691062876,1691062876,SNF,In-Network,E11.9,Z23,,,,,,,0,,23472,Surgery,,,,11,Office,1,3932.3,3111.96,2659.15,0.0,15.0,437.81,452.81,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010732,MBR00000414,Institutional-OP,2022-01-31,2022-01-31,2022-03-12,PLN9255,1631954542,1631954542,Oncology,In-Network,I50.9,E11.9,,,,,,,0,,99221,E&M,,,0301,22,Outpatient Hospital,3,250.15,125.39,0.0,125.39,15.0,0.0,140.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010733,MBR00000414,Professional,2022-11-15,2022-11-15,2022-12-12,PLN8116,1702692193,1702692193,Physical Therapy,In-Network,E11.9,I63.9,,,,,,,0,,99233,E&M,,,,11,Office,3,309.69,172.42,0.0,172.42,0.0,0.0,172.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010734,MBR00000414,Professional,2023-10-01,2023-10-01,2023-10-11,PLN8638,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,I48.91,Z51.11,,,,,,,0,,23472,Surgery,,,,50,Federally Qualified Health Center,3,4698.15,2021.97,1559.02,437.95,25.0,0.0,462.95,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010735,MBR00000414,Professional,2023-01-13,2023-01-13,2023-02-09,PLN5332,1337791138,1337791138,Internal Medicine,Out-of-Network,R51,Z23,,,,,,,0,,27130,Surgery,,,,23,Emergency Room,2,4066.27,2773.68,2675.23,98.45,0.0,0.0,98.45,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010736,MBR00000414,Institutional-OP,2021-04-21,2021-04-21,2021-05-02,PLN1463,1213165847,1213165847,Critical Access Hospital,In-Network,I10,E11.9,,,,,,,0,,72148,Radiology,,,0730,22,Outpatient Hospital,2,1593.01,1322.43,859.89,462.54,0.0,0.0,462.54,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010737,MBR00000414,Professional,2022-07-19,2022-07-19,2022-08-07,PLN1713,1991459367,1991459367,Neurology,Out-of-Network,N39.0,Z12.11,,,,,,,0,,90686,Medicine,,,,11,Office,3,109.08,40.61,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000010738,MBR00000415,Professional,2021-04-28,2021-04-28,2021-05-21,PLN9252,1366286000,1366286000,SNF,In-Network,G43.909,J20.9,,,,,,,0,,78452,Radiology,,,,21,Inpatient Hospital,3,6695.4,4262.17,4236.08,26.09,0.0,0.0,26.09,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010739,MBR00000415,Professional,2021-07-01,2021-07-01,2021-07-24,PLN2484,1809014947,1809014947,Urology,In-Network,N39.0,N40.0,,,,,,,0,,33533,Surgery,,,,12,Home,3,11526.49,6535.32,6403.79,131.53,0.0,0.0,131.53,0.0,Pended,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000010740,MBR00000415,Professional,2021-08-04,2021-08-04,2021-08-16,PLN7932,1752470395,1752470395,Home Health,In-Network,R05,Z00.00,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,2,3559.66,1119.57,1104.57,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,0,0,1,Phantom,0,0,0,0,0
CLM0000010741,MBR00000415,Institutional-OP,2023-02-03,2023-02-03,2023-02-26,PLN8737,1193493783,1193493783,Critical Access Hospital,Out-of-Network,Z12.31,F32.9,,,,,,,0,,23472,Surgery,,,0900,22,Outpatient Hospital,2,4377.27,2158.29,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-18,,0,,0,0,1,0,0,1,Phantom,0,0,0,0,0
CLM0000010742,MBR00000415,Professional,2023-08-17,2023-08-17,2023-09-23,PLN8569,1168881145,1168881145,Orthopedic Surgery,In-Network,J45.20,E78.5,,,,,,,0,,74177,Radiology,,,,23,Emergency Room,3,2106.53,1615.72,1600.72,0.0,15.0,0.0,15.0,0.0,Adjusted,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010743,MBR00000415,Professional,2021-09-28,2021-09-28,2021-10-07,PLN2391,1891849440,1891849440,Oncology,In-Network,J20.9,E11.9,,,,,,,0,,72148,Radiology,,,,20,Urgent Care,1,1201.53,536.8,461.8,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010744,MBR00000416,Professional,2023-10-29,2023-10-29,2023-11-12,PLN2185,1242201429,1242201429,General Acute Care Hospital,In-Network,E11.9,J06.9,,,,,,,0,,99203,E&M,,,,11,Office,1,151.5,127.76,0.0,127.76,25.0,0.0,152.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010745,MBR00000416,Professional,2021-10-18,2021-10-18,2021-11-20,PLN5366,1790497490,1790497490,OB/GYN,In-Network,J44.1,S72.001A,,,,,,,0,,81001,Pathology/Lab,,,,49,Independent Clinic,1,28.17,20.75,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010746,MBR00000416,Professional,2021-12-03,2021-12-03,2021-12-18,PLN8011,1899127912,1899127912,Neurology,In-Network,K21.0,Z00.00,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,2,33.42,14.84,14.84,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010747,MBR00000416,Professional,2021-05-19,2021-05-19,2021-06-05,PLN9759,1865904917,1865904917,Outpatient Clinic,In-Network,Z00.00,G43.909,,,,,,,0,,97110,Medicine,,,,22,Outpatient Hospital,2,159.88,60.44,0.0,60.44,0.0,0.0,60.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010748,MBR00000416,Institutional-OP,2021-02-21,2021-02-21,2021-03-22,PLN1557,1486164553,1486164553,DME Supplier,In-Network,E66.9,F32.9,,,,,,,0,,90460,Medicine,,,0270,22,Outpatient Hospital,2,43.84,18.52,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010749,MBR00000416,Professional,2022-11-10,2022-11-10,2022-11-29,PLN9894,1872272835,1872272835,Internal Medicine,In-Network,Z12.31,M54.5,,,,,,,0,,99203,E&M,,,,21,Inpatient Hospital,3,393.61,290.96,290.96,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010750,MBR00000416,Professional,2022-03-23,2022-03-23,2022-04-18,PLN5281,1817234602,1817234602,Clinical Laboratory,In-Network,E11.9,K57.30,,,,,,,0,,66984,Surgery,,,,11,Office,1,1802.53,783.52,405.95,377.57,0.0,0.0,377.57,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010751,MBR00000416,Institutional-IP,2021-05-09,2021-05-13,2021-05-24,PLN8083,1790497490,1790497490,OB/GYN,In-Network,I25.10,N40.0,,,,641,MS-DRG,7,4,Y,99232,E&M,,,0510,21,Inpatient Hospital,3,249.83,117.78,34.93,0.0,75.0,7.85,82.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010752,MBR00000416,Institutional-OP,2022-09-11,2022-09-11,2022-10-10,PLN6597,1631954542,1631954542,Oncology,In-Network,I48.91,N18.3,,,,,,,0,,87491,Pathology/Lab,,,0200,22,Outpatient Hospital,3,196.13,72.25,0.0,72.25,75.0,0.0,147.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010753,MBR00000417,Professional,2022-01-14,2022-01-14,2022-01-27,PLN1900,1990090423,1990090423,Orthopedic Surgery,In-Network,J44.1,E78.5,,,,,,,0,,90837,Medicine,,,,22,Outpatient Hospital,3,316.21,216.7,201.7,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000010754,MBR00000417,Institutional-OP,2022-03-07,2022-03-07,2022-03-28,PLN8605,1148984206,1148984206,Psychiatry,In-Network,N18.3,R07.9,,,,,,,0,,23472,Surgery,,,0510,22,Outpatient Hospital,1,4776.75,2673.32,2427.45,0.0,0.0,245.87,245.87,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010755,MBR00000417,Institutional-OP,2023-09-02,2023-09-02,2023-10-11,PLN2730,1502838586,1502838586,ASC,In-Network,F41.9,R10.9,,,,,,,0,,99213,E&M,,,0510,22,Outpatient Hospital,2,205.69,145.37,116.79,0.0,15.0,13.58,28.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010756,MBR00000417,Institutional-OP,2022-03-18,2022-03-18,2022-03-29,PLN5933,1571574052,1571574052,Critical Access Hospital,In-Network,F32.9,I50.9,,,,,,,0,,33533,Surgery,,,0320,22,Outpatient Hospital,2,28871.99,14121.02,14121.02,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000010757,MBR00000417,Professional,2022-05-12,2022-05-12,2022-06-17,PLN1949,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,E78.5,E78.5,,,,,,,0,,99213,E&M,,,,11,Office,2,137.96,108.24,0.0,108.24,75.0,0.0,183.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010758,MBR00000417,Institutional-OP,2023-01-23,2023-01-23,2023-02-23,PLN2824,1389336600,1389336600,Critical Access Hospital,In-Network,Z23,E11.40,,,,,,,0,,99222,E&M,,,0510,22,Outpatient Hospital,2,384.02,208.99,100.98,53.14,50.0,4.87,108.01,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010759,MBR00000417,Institutional-OP,2023-09-07,2023-09-07,2023-09-14,PLN5699,1716521444,1716521444,Oncology,In-Network,M54.5,Z00.00,,,,,,,0,,99283,E&M,,,0761,22,Outpatient Hospital,2,545.64,339.86,0.0,0.0,75.0,42.18,117.18,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010760,MBR00000417,Institutional-IP,2023-03-20,2023-03-22,2023-03-27,PLN6537,1899127912,1899127912,Neurology,In-Network,E87.6,K92.1,,,,196,MS-DRG,5,2,Y,99214,E&M,,,0730,21,Inpatient Hospital,2,460.89,259.5,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010761,MBR00000417,Institutional-IP,2022-06-24,2022-06-25,2022-07-28,PLN7935,1514306773,1514306773,Endocrinology,In-Network,M54.5,Z23,,,,195,MS-DRG,4,1,N,90686,Medicine,,,0120,21,Inpatient Hospital,2,76.05,24.49,24.49,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000010762,MBR00000418,Professional,2021-12-01,2021-12-01,2022-01-06,PLN7990,1284035364,1284035364,Pediatrics,In-Network,N40.0,F41.9,,,,,,,0,,99213,E&M,,,,65,End-Stage Renal Disease,1,234.41,86.16,0.0,86.16,0.0,0.0,86.16,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010763,MBR00000418,Institutional-IP,2021-07-15,2021-07-18,2021-07-25,PLN2477,1313212303,1313212303,Family Medicine,In-Network,N18.3,Z12.31,,,,195,MS-DRG,6,3,Y,99204,E&M,,,0510,21,Inpatient Hospital,2,242.98,126.1,0.0,126.1,15.0,0.0,141.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010764,MBR00000418,Institutional-OP,2021-05-16,2021-05-16,2021-06-23,PLN3966,1132188260,1132188260,Family Medicine,In-Network,E11.9,F41.9,,,,,,,0,,99222,E&M,,,0120,22,Outpatient Hospital,2,604.94,187.37,165.84,0.0,0.0,21.53,21.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010765,MBR00000418,Institutional-OP,2023-04-12,2023-04-12,2023-04-21,PLN7165,1511044648,1511044648,Endocrinology,In-Network,I10,E11.9,,,,,,,0,,27447,Surgery,,,0761,22,Outpatient Hospital,3,3477.27,2922.97,2897.97,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010766,MBR00000418,Professional,2023-03-18,2023-03-18,2023-03-27,PLN2700,1860435061,1860435061,DME Supplier,In-Network,I10,Z23,,,,,,,0,,99284,E&M,,,,11,Office,2,556.94,385.02,370.02,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010767,MBR00000418,Institutional-OP,2022-01-23,2022-01-23,2022-02-09,PLN2517,1696843572,1696843572,Critical Access Hospital,Out-of-Network,F32.9,J20.9,,,,,,,0,,99204,E&M,,,0636,22,Outpatient Hospital,3,221.45,153.21,72.27,0.0,75.0,5.94,80.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010768,MBR00000418,Professional,2023-10-25,2023-10-25,2023-12-07,PLN4345,1518055405,1518055405,Urology,In-Network,E11.9,I11.9,,,,,,,0,,90686,Medicine,,,,11,Office,1,112.42,37.63,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000010769,MBR00000418,Institutional-OP,2023-11-25,2023-11-25,2023-12-13,PLN9754,1860435061,1860435061,DME Supplier,In-Network,E11.9,E11.9,,,,,,,0,,76700,Radiology,,,0900,22,Outpatient Hospital,2,570.06,403.66,0.0,403.66,0.0,0.0,403.66,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010770,MBR00000418,Institutional-IP,2022-11-11,2022-11-12,2022-12-20,PLN1487,1236418230,1236418230,DME Supplier,In-Network,E66.9,J06.9,,,,291,MS-DRG,20,1,Y,99221,E&M,,,0740,21,Inpatient Hospital,3,293.47,145.03,0.0,145.03,15.0,0.0,160.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010771,MBR00000418,Institutional-IP,2021-10-15,2021-10-21,2021-11-27,PLN6927,1702692193,1702692193,Physical Therapy,In-Network,F41.9,E11.9,,,,194,MS-DRG,3,6,Y,27130,Surgery,,,0120,21,Inpatient Hospital,3,5742.97,3776.6,0.0,287.17,15.0,497.7,799.87,0.0,Denied,CO-18,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010772,MBR00000418,Institutional-IP,2022-07-09,2022-07-11,2022-07-26,PLN1969,1520687146,1520687146,ASC,In-Network,J06.9,F32.9,,,,470,MS-DRG,8,2,Y,43239,Surgery,,,0360,21,Inpatient Hospital,2,2046.24,1214.33,1106.32,0.0,0.0,108.01,108.01,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010773,MBR00000418,Institutional-OP,2023-06-20,2023-06-20,2023-07-10,PLN9850,1974006077,1974006077,Orthopedic Surgery,In-Network,I10,E11.9,,,,,,,0,,23472,Surgery,,,0636,22,Outpatient Hospital,1,6226.82,3216.66,2998.88,0.0,0.0,217.78,217.78,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010774,MBR00000418,Professional,2022-07-10,2022-07-10,2022-08-14,PLN8322,1284035364,1284035364,Pediatrics,In-Network,E78.5,I10,,,,,,,0,,99284,E&M,,,,11,Office,3,436.81,366.76,269.2,97.56,0.0,0.0,97.56,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010775,MBR00000418,Professional,2022-06-25,2022-06-25,2022-07-07,PLN9891,1542828721,1542828721,Orthopedic Surgery,In-Network,E11.9,K21.0,,,,,,,0,,23472,Surgery,,,,21,Inpatient Hospital,2,4997.12,3709.85,3332.52,342.33,35.0,0.0,377.33,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010776,MBR00000418,Institutional-OP,2022-08-07,2022-08-07,2022-08-16,PLN8124,1242201429,1242201429,General Acute Care Hospital,In-Network,Z00.00,I10,,,,,,,0,,G0468,Medicine,,,0370,22,Outpatient Hospital,2,362.61,192.78,0.0,192.78,0.0,0.0,192.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010777,MBR00000418,Professional,2023-07-12,2023-07-12,2023-08-06,PLN1295,1283743001,1283743001,Family Medicine,In-Network,F03.90,J20.9,,,,,,,0,,80053,Pathology/Lab,,,,20,Urgent Care,1,101.33,79.89,79.89,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010778,MBR00000418,Institutional-IP,2022-03-26,2022-03-30,2022-04-19,PLN5339,1689639685,1689639685,SNF,In-Network,J20.9,Z00.00,,,,641,MS-DRG,22,4,Y,99203,E&M,,,0301,21,Inpatient Hospital,3,161.74,81.99,31.47,0.0,50.0,0.52,50.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010779,MBR00000418,Professional,2021-07-20,2021-07-20,2021-08-19,PLN1758,1728018911,1728018911,Nephrology,In-Network,E66.9,E11.65,,,,,,,0,,82043,Pathology/Lab,,,,12,Home,3,72.52,27.64,0.0,27.64,15.0,0.0,42.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010780,MBR00000418,Institutional-OP,2022-07-17,2022-07-17,2022-07-29,PLN7491,1702692193,1702692193,Physical Therapy,In-Network,I50.9,Z00.00,,,,,,,0,,43239,Surgery,,,0301,22,Outpatient Hospital,3,2026.45,803.36,803.36,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010781,MBR00000418,Institutional-OP,2022-11-25,2022-11-25,2022-12-03,PLN1923,1135158374,1135158374,Pulmonology,In-Network,Z00.00,M17.11,,,,,,,0,,82043,Pathology/Lab,,,0200,22,Outpatient Hospital,3,52.4,30.06,30.06,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010782,MBR00000418,Professional,2023-10-21,2023-10-21,2023-11-09,PLN5566,1845900543,1845900543,ASC,In-Network,K21.0,I10,,,,,,,0,,45378,Surgery,,,,49,Independent Clinic,2,1849.11,789.74,645.23,0.0,0.0,144.51,144.51,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000010783,MBR00000418,Institutional-IP,2021-05-04,2021-05-12,2021-06-09,PLN9650,1948810580,1948810580,DME Supplier,In-Network,I10,Z87.891,,,,871,MS-DRG,2,8,Y,86900,Pathology/Lab,,,0730,21,Inpatient Hospital,1,43.56,20.15,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010784,MBR00000418,Professional,2023-10-30,2023-10-30,2023-11-06,PLN5863,1124394415,1124394415,Pediatrics,In-Network,Z12.31,Z12.31,,,,,,,0,,76700,Radiology,,,,12,Home,1,1147.4,640.62,640.62,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010785,MBR00000418,Institutional-IP,2023-06-02,2023-06-07,2023-06-22,PLN8788,1500037969,1500037969,Pulmonology,In-Network,Z00.00,J06.9,,,,603,MS-DRG,8,5,Y,72148,Radiology,,,0740,21,Inpatient Hospital,1,2469.58,834.57,630.73,203.84,0.0,0.0,203.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010786,MBR00000418,Professional,2023-02-17,2023-02-17,2023-03-31,PLN4007,1450553056,1450553056,Clinical Laboratory,In-Network,E66.9,Z87.891,,,,,,,0,,99406,Medicine,,,,21,Inpatient Hospital,2,91.32,54.97,53.23,0.0,0.0,1.74,1.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010787,MBR00000418,Professional,2021-09-16,2021-09-16,2021-09-30,PLN6911,1550154147,1550154147,Outpatient Clinic,In-Network,J20.9,N18.3,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,1,71.16,36.9,0.0,0.0,50.0,0.0,50.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010788,MBR00000419,Professional,2021-08-14,2021-08-14,2021-09-23,PLN8567,1915531927,1915531927,Critical Access Hospital,In-Network,I48.91,Z23,,,,,,,0,,43239,Surgery,,,,11,Office,3,1322.74,653.15,571.02,0.0,15.0,67.13,82.13,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010789,MBR00000419,Professional,2022-04-14,2022-04-14,2022-05-08,PLN9645,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,J44.1,E78.5,,,,,,,0,,76700,Radiology,,,,23,Emergency Room,3,1315.04,519.93,485.43,0.0,0.0,34.5,34.5,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010790,MBR00000419,Institutional-OP,2021-07-19,2021-07-19,2021-07-27,PLN8934,1395983630,1395983630,Nephrology,In-Network,I10,J06.9,,,,,,,0,,45380,Surgery,,,0636,22,Outpatient Hospital,2,1313.89,1073.24,533.9,389.91,50.0,99.43,539.34,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000010791,MBR00000419,Professional,2022-12-20,2022-12-20,2023-01-08,PLN4774,1556140803,1556140803,Cardiology,In-Network,N18.3,Z00.00,,,,,,,0,,78452,Radiology,,,,65,End-Stage Renal Disease,3,4790.49,1607.35,1411.7,0.0,25.0,170.65,195.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010792,MBR00000419,Institutional-OP,2023-04-04,2023-04-04,2023-04-30,PLN8404,1974006077,1974006077,Orthopedic Surgery,In-Network,I10,J20.9,,,,,,,0,,99214,E&M,,,0270,22,Outpatient Hospital,2,234.81,170.83,170.83,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010793,MBR00000419,Institutional-OP,2022-06-08,2022-06-08,2022-06-27,PLN2235,1475984649,1475984649,SNF,In-Network,Z00.00,N20.0,,,,,,,0,,93306,Radiology,,,0320,22,Outpatient Hospital,1,1893.41,1363.58,1152.11,211.47,0.0,0.0,211.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010794,MBR00000419,Institutional-IP,2023-01-28,2023-01-31,2023-02-15,PLN1900,1778483301,1778483301,Home Health,In-Network,J06.9,F32.9,,,,195,MS-DRG,22,3,Y,85610,Pathology/Lab,,,0761,21,Inpatient Hospital,1,47.21,33.92,0.0,33.92,15.0,0.0,48.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010795,MBR00000419,Institutional-OP,2023-05-03,2023-05-03,2023-06-10,PLN9384,1463205530,1463205530,Nephrology,In-Network,Z12.31,M54.5,,,,,,,0,,23472,Surgery,,,0360,22,Outpatient Hospital,3,6252.59,3122.19,3047.19,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010796,MBR00000419,Institutional-OP,2023-09-27,2023-09-27,2023-10-05,PLN4992,1745114564,1745114564,Endocrinology,In-Network,Z87.891,F32.9,,,,,,,0,,72148,Radiology,,,0900,22,Outpatient Hospital,1,1256.72,927.16,927.16,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010797,MBR00000419,Institutional-OP,2023-01-24,2023-01-24,2023-02-10,PLN7223,1511044648,1511044648,Endocrinology,In-Network,N18.3,Z87.891,,,,,,,0,,99203,E&M,,,0730,22,Outpatient Hospital,1,234.43,146.28,130.09,0.0,0.0,16.19,16.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010798,MBR00000420,Institutional-IP,2021-09-13,2021-09-24,2021-09-21,PLN3941,1865904917,1865904917,Outpatient Clinic,In-Network,M17.11,Z12.31,,,,195,MS-DRG,6,11,Y,80061,Pathology/Lab,,,0200,21,Inpatient Hospital,1,95.24,38.29,38.29,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010799,MBR00000420,Professional,2021-05-23,2021-05-23,2021-06-10,PLN7447,1266606767,1266606767,ASC,In-Network,R05,E78.5,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,1,1989.9,1224.45,1149.45,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010800,MBR00000420,Institutional-OP,2023-10-27,2023-10-27,2023-12-08,PLN5115,1247341320,1247341320,Urology,Out-of-Network,M54.5,I10,,,,,,,0,,23472,Surgery,,,0510,22,Outpatient Hospital,3,5927.91,3135.91,2690.25,0.0,35.0,410.66,445.66,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010801,MBR00000420,Institutional-OP,2023-04-27,2023-04-27,2023-05-30,PLN1057,1935547131,1935547131,Pulmonology,In-Network,J20.9,K21.0,,,,,,,0,,99222,E&M,,,0200,22,Outpatient Hospital,1,467.5,303.49,249.63,0.0,0.0,53.86,53.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010802,MBR00000420,Professional,2023-07-20,2023-07-20,2023-08-15,PLN2929,1948810580,1948810580,DME Supplier,In-Network,M54.5,Z00.01,,,,,,,0,,99203,E&M,,,,49,Independent Clinic,1,211.87,139.73,139.73,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010803,MBR00000420,Professional,2022-04-09,2022-04-09,2022-05-13,PLN3762,1790497490,1790497490,OB/GYN,In-Network,I10,E11.9,,,,,,,0,,99213,E&M,,,,23,Emergency Room,2,327.23,205.03,170.03,0.0,35.0,0.0,35.0,0.0,Adjusted,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010804,MBR00000420,Professional,2021-06-22,2021-06-22,2021-07-14,PLN7239,1767011137,1767011137,DME Supplier,In-Network,E66.9,M54.5,,,,,,,0,,66984,Surgery,,,,11,Office,1,3030.89,2017.4,1982.4,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010805,MBR00000420,Institutional-OP,2022-10-17,2022-10-17,2022-10-31,PLN1197,1361302520,1361302520,Critical Access Hospital,In-Network,J20.9,E11.9,,,,,,,0,,99283,E&M,,,0740,22,Outpatient Hospital,3,267.59,110.04,0.0,110.04,35.0,0.0,145.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010806,MBR00000420,Institutional-OP,2022-12-02,2022-12-02,2022-12-26,PLN8600,1817234602,1817234602,Clinical Laboratory,In-Network,N18.3,M54.5,,,,,,,0,,93000,Radiology,,,0120,22,Outpatient Hospital,2,93.74,61.01,0.0,33.65,35.0,0.0,68.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010807,MBR00000420,Professional,2021-08-26,2021-08-26,2021-10-08,PLN4510,1749327647,1749327647,Geriatrics,In-Network,E11.9,E78.5,,,,,,,0,,99222,E&M,,,,23,Emergency Room,2,506.49,352.48,163.43,174.05,15.0,0.0,189.05,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010808,MBR00000420,Professional,2022-05-30,2022-05-30,2022-07-11,PLN3967,1545347862,1545347862,SNF,In-Network,E66.9,I48.91,,,,,,,0,,74177,Radiology,,,,11,Office,2,2023.78,1570.61,952.57,473.19,0.0,144.85,618.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010809,MBR00000420,Institutional-OP,2022-04-09,2022-04-09,2022-04-30,PLN2355,1219817751,1219817751,OB/GYN,In-Network,F32.9,J20.9,,,,,,,0,,23472,Surgery,,,0636,22,Outpatient Hospital,3,5556.94,4426.87,4426.87,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010810,MBR00000420,Professional,2021-10-12,2021-10-12,2021-10-19,PLN5372,1757138478,1757138478,Pediatrics,In-Network,Z12.31,F32.9,,,,,,,0,,99283,E&M,,,,23,Emergency Room,3,385.54,324.57,324.57,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010811,MBR00000420,Institutional-OP,2023-06-14,2023-06-14,2023-07-21,PLN4676,1946680931,1946680931,Critical Access Hospital,Out-of-Network,J06.9,Z00.00,,,,,,,0,,45378,Surgery,,,0200,22,Outpatient Hospital,2,2531.14,1481.73,1164.83,316.9,0.0,0.0,316.9,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000010812,MBR00000420,Professional,2022-06-16,2022-06-16,2022-07-05,PLN4810,1313212303,1313212303,Family Medicine,In-Network,E78.5,Z00.00,,,,,,,0,,45378,Surgery,,,,11,Office,2,1200.3,851.98,826.98,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000010813,MBR00000420,Professional,2023-10-12,2023-10-12,2023-11-03,PLN6416,1948810580,1948810580,DME Supplier,In-Network,J06.9,G20,,,,,,,0,,99221,E&M,,,,21,Inpatient Hospital,2,216.34,173.0,173.0,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010814,MBR00000420,Professional,2021-01-02,2021-01-02,2021-01-10,PLN9843,1500037969,1500037969,Pulmonology,In-Network,I10,E66.9,,,,,,,0,,33533,Surgery,,,,23,Emergency Room,1,16618.01,13833.21,13570.72,227.49,35.0,0.0,262.49,0.0,Paid,,,1,,1,0,0,1,0,0,None,0,0,0,0,0
CLM0000010815,MBR00000420,Professional,2023-10-25,2023-10-25,2023-11-17,PLN6315,1689639685,1689639685,SNF,In-Network,J06.9,I10,,,,,,,0,,77067,Radiology,,,,50,Federally Qualified Health Center,2,772.71,460.03,385.03,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000010816,MBR00000420,Institutional-IP,2022-12-26,2022-12-27,2023-01-06,PLN7931,1980712759,1980712759,Outpatient Clinic,Out-of-Network,Z00.00,E87.6,,,,872,MS-DRG,7,1,Y,93000,Radiology,,,0320,21,Inpatient Hospital,1,183.46,96.16,46.16,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010817,MBR00000420,Professional,2023-02-06,2023-02-06,2023-03-12,PLN6747,1283743001,1283743001,Family Medicine,In-Network,E11.9,E11.40,,,,,,,0,,G0468,Medicine,,,,23,Emergency Room,3,420.33,188.26,133.83,19.43,35.0,0.0,54.43,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010818,MBR00000420,Institutional-OP,2021-11-12,2021-11-12,2021-11-28,PLN4340,1609526529,1609526529,Psychiatry,In-Network,J44.1,Z87.891,,,,,,,0,,86900,Pathology/Lab,,,0761,22,Outpatient Hospital,1,30.38,20.43,0.0,20.43,25.0,0.0,45.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010819,MBR00000420,Institutional-OP,2021-03-28,2021-03-28,2021-05-11,PLN4222,1366286000,1366286000,SNF,In-Network,N39.0,F41.9,,,,,,,0,,45380,Surgery,,,0200,22,Outpatient Hospital,2,2528.63,1205.3,1100.47,0.0,50.0,54.83,104.83,0.0,Paid,,,1,,0,0,1,0,0,1,Duplicate,0,1,0,0,0
CLM0000010820,MBR00000420,Institutional-OP,2021-09-11,2021-09-11,2021-10-18,PLN8145,1366426662,1366426662,Urology,In-Network,M54.5,E11.9,,,,,,,0,,99233,E&M,,,0370,22,Outpatient Hospital,2,498.28,336.61,175.19,161.42,0.0,0.0,161.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010821,MBR00000420,Professional,2022-04-30,2022-04-30,2022-06-05,PLN3055,1948810580,1948810580,DME Supplier,In-Network,Z12.11,K57.30,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,1,2466.33,1771.9,1721.9,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000010822,MBR00000420,Professional,2022-01-06,2022-01-06,2022-02-15,PLN6140,1268679390,1268679390,Critical Access Hospital,In-Network,Z00.00,J06.9,,,,,,,0,,G0444,Medicine,,,,23,Emergency Room,1,42.51,31.19,0.0,31.19,0.0,0.0,31.19,0.0,Paid,,,0,,1,1,0,0,0,0,None,0,0,0,0,1
CLM0000010823,MBR00000420,Professional,2021-07-31,2021-07-31,2021-09-06,PLN1377,1727809972,1727809972,Home Health,In-Network,J44.1,E11.9,,,,,,,0,,90837,Medicine,,,,81,Independent Laboratory,1,320.65,212.9,0.0,0.0,0.0,26.9,26.9,0.0,Denied,CO-29,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000010824,MBR00000420,Institutional-IP,2021-01-14,2021-01-15,2021-02-03,PLN5370,1660288235,1660288235,ASC,In-Network,N18.3,J20.9,,,,683,MS-DRG,19,1,Y,86900,Pathology/Lab,,,0120,21,Inpatient Hospital,1,48.33,22.32,22.32,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010825,MBR00000420,Professional,2023-02-03,2023-02-03,2023-03-09,PLN3257,1531398223,1531398223,OB/GYN,In-Network,F32.9,R05,,,,,,,0,,99203,E&M,,,,11,Office,1,140.92,43.81,8.81,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010826,MBR00000420,Institutional-OP,2023-01-01,2023-01-01,2023-02-06,PLN4704,1361302520,1361302520,Critical Access Hospital,In-Network,E11.9,I63.9,,,,,,,0,,99214,E&M,,,0120,22,Outpatient Hospital,3,164.22,52.68,17.68,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010827,MBR00000420,Institutional-IP,2021-06-26,2021-07-06,2021-07-22,PLN9137,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,F32.9,F10.20,,,,641,MS-DRG,24,10,Y,G0468,Medicine,,,0730,21,Inpatient Hospital,1,481.14,220.18,133.86,0.0,75.0,11.32,86.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010828,MBR00000420,Professional,2023-05-08,2023-05-08,2023-05-24,PLN7471,1800011727,1800011727,Clinical Laboratory,Out-of-Network,F41.9,Z23,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,2,24.31,8.9,0.0,8.9,0.0,0.0,8.9,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000010829,MBR00000420,Professional,2023-12-07,2023-12-07,2023-12-19,PLN1727,1239316214,1239316214,Internal Medicine,In-Network,I10,C50.912,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,3,6139.64,2540.19,2540.19,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010830,MBR00000420,Institutional-IP,2023-12-31,2024-01-01,2024-01-09,PLN6518,1891849440,1891849440,Oncology,In-Network,E11.9,Z96.641,,,,690,MS-DRG,10,1,Y,47562,Surgery,,,0636,21,Inpatient Hospital,3,4147.62,1536.47,1179.75,168.68,50.0,138.04,356.72,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010831,MBR00000420,Institutional-OP,2021-08-02,2021-08-02,2021-08-22,PLN9081,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,E78.5,E66.9,,,,,,,0,,99221,E&M,,,0120,22,Outpatient Hospital,3,358.35,117.55,0.0,117.55,0.0,0.0,117.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010832,MBR00000420,Professional,2022-04-13,2022-04-13,2022-05-17,PLN2466,1790497490,1790497490,OB/GYN,In-Network,M54.5,N18.3,,,,,,,0,,33533,Surgery,,,,81,Independent Laboratory,2,29580.55,24692.53,24677.53,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000010833,MBR00000420,Institutional-IP,2021-02-27,2021-03-05,2021-03-18,PLN9297,1624802371,1624802371,ASC,Out-of-Network,I10,J20.9,,,,196,MS-DRG,4,6,Y,71046,Radiology,,,0900,21,Inpatient Hospital,1,138.99,66.53,31.53,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010834,MBR00000420,Professional,2021-01-14,2021-01-14,2021-02-15,PLN1003,1366576336,1366576336,Geriatrics,In-Network,E11.9,E66.9,,,,,,,0,,99222,E&M,,,,11,Office,2,590.72,339.83,296.43,0.0,0.0,43.4,43.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010835,MBR00000420,Institutional-OP,2023-07-13,2023-07-13,2023-07-30,PLN8546,1872613201,1872613201,Internal Medicine,In-Network,I25.10,F32.9,,,,,,,0,,47562,Surgery,,,0730,22,Outpatient Hospital,1,2890.37,1386.02,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-27,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010836,MBR00000420,Institutional-IP,2023-11-27,2023-11-29,2023-12-11,PLN7750,1799205295,1799205295,General Acute Care Hospital,In-Network,Z87.891,E11.9,,,,292,MS-DRG,10,2,Y,45378,Surgery,,,0730,21,Inpatient Hospital,3,2528.34,1310.56,1133.54,0.0,0.0,177.02,177.02,0.0,Paid,,,0,,0,1,1,0,0,1,Duplicate,0,1,0,0,0
CLM0000010837,MBR00000420,Institutional-OP,2021-08-10,2021-08-10,2021-09-13,PLN7192,1224179551,1224179551,Physical Therapy,In-Network,N40.0,E78.5,,,,,,,0,,90686,Medicine,,,0120,22,Outpatient Hospital,2,119.29,37.05,37.05,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000010838,MBR00000420,Professional,2022-05-23,2022-05-23,2022-07-06,PLN6615,1865904917,1865904917,Outpatient Clinic,In-Network,N39.0,K92.1,,,,,,,0,,80061,Pathology/Lab,,,,81,Independent Laboratory,1,67.06,53.15,0.0,32.51,25.0,0.0,57.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010839,MBR00000420,Institutional-OP,2021-01-27,2021-01-27,2021-02-24,PLN7545,1778483301,1778483301,Home Health,In-Network,Z12.31,Z00.00,,,,,,,0,,99406,Medicine,,,0900,22,Outpatient Hospital,1,47.53,23.9,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010840,MBR00000420,Institutional-OP,2023-06-13,2023-06-13,2023-07-03,PLN3088,1242201429,1242201429,General Acute Care Hospital,In-Network,E11.9,E78.5,,,,,,,0,,27130,Surgery,,,0636,22,Outpatient Hospital,3,5304.69,3570.9,3162.16,0.0,25.0,383.74,408.74,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010841,MBR00000420,Professional,2022-08-24,2022-08-24,2022-09-17,PLN5255,1800011727,1800011727,Clinical Laboratory,Out-of-Network,E11.65,Z51.11,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,1,346.43,184.53,0.0,184.53,50.0,0.0,234.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010842,MBR00000421,Institutional-IP,2021-11-16,2021-11-22,2021-12-09,PLN7106,1790497490,1790497490,OB/GYN,In-Network,Z23,N39.0,,,,470,MS-DRG,22,6,Y,85025,Pathology/Lab,,,0270,21,Inpatient Hospital,3,96.9,53.08,15.46,0.0,35.0,2.62,37.62,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000010843,MBR00000421,Professional,2023-11-28,2023-11-28,2023-12-25,PLN2606,1139906830,1139906830,Endocrinology,Out-of-Network,M17.11,M54.5,,,,,,,0,,47562,Surgery,,,,20,Urgent Care,2,5594.52,3113.85,0.0,430.67,0.0,260.18,690.85,0.0,Denied,CO-15,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010844,MBR00000421,Institutional-OP,2021-05-29,2021-05-29,2021-06-05,PLN6434,1872613201,1872613201,Internal Medicine,In-Network,K21.0,Z87.891,,,,,,,0,,74177,Radiology,,,0900,22,Outpatient Hospital,1,2632.35,948.45,867.84,0.0,35.0,45.61,80.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010845,MBR00000421,Institutional-OP,2021-10-20,2021-10-20,2021-10-31,PLN1213,1749327647,1749327647,Geriatrics,In-Network,F32.9,N18.3,,,,,,,0,,87491,Pathology/Lab,,,0200,22,Outpatient Hospital,3,101.07,65.56,12.96,0.0,50.0,2.6,52.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010846,MBR00000421,Professional,2023-03-30,2023-03-30,2023-04-28,PLN1024,1540044947,1540044947,Pulmonology,Out-of-Network,Z23,J20.9,,,,,,,0,,71046,Radiology,,,,11,Office,1,282.89,159.51,0.0,159.51,0.0,0.0,159.51,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010847,MBR00000421,Professional,2022-03-24,2022-03-24,2022-04-06,PLN9601,1227362142,1227362142,DME Supplier,In-Network,Z12.31,E11.9,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,3,52.69,26.93,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010848,MBR00000421,Institutional-OP,2023-02-07,2023-02-07,2023-03-21,PLN7410,1757138478,1757138478,Pediatrics,In-Network,I50.9,R51,,,,,,,0,,99283,E&M,,,0320,22,Outpatient Hospital,1,405.66,301.97,0.0,301.97,0.0,0.0,301.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010849,MBR00000421,Institutional-OP,2021-09-17,2021-09-17,2021-10-09,PLN2173,1334916761,1334916761,ASC,In-Network,E11.9,Z12.31,,,,,,,0,,99221,E&M,,,0270,22,Outpatient Hospital,2,266.31,112.75,93.05,0.0,0.0,19.7,19.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010850,MBR00000421,Professional,2022-12-22,2022-12-22,2023-01-17,PLN6414,1968299309,1968299309,Internal Medicine,In-Network,Z23,G43.909,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,3,2019.73,857.68,646.01,211.67,0.0,0.0,211.67,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010851,MBR00000421,Institutional-OP,2022-09-03,2022-09-03,2022-09-10,PLN6670,1235381502,1235381502,Cardiology,In-Network,I10,M17.11,,,,,,,0,,66984,Surgery,,,0761,22,Outpatient Hospital,3,3570.34,2873.14,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-50,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010852,MBR00000421,Professional,2021-02-21,2021-02-21,2021-04-02,PLN8566,1749327647,1749327647,Geriatrics,In-Network,E11.65,I10,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,2,118.46,41.4,0.0,41.4,0.0,0.0,41.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010853,MBR00000421,Professional,2021-12-20,2021-12-20,2022-01-24,PLN3948,1806688928,1806688928,Geriatrics,In-Network,Z12.11,Z12.31,,,,,,,0,,85610,Pathology/Lab,,,,21,Inpatient Hospital,3,39.18,32.29,0.0,32.29,15.0,0.0,47.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010854,MBR00000421,Institutional-OP,2021-11-22,2021-11-22,2022-01-05,PLN9977,1910255109,1910255109,DME Supplier,In-Network,F41.9,J06.9,,,,,,,0,,70450,Radiology,,,0510,22,Outpatient Hospital,3,1409.62,957.33,907.33,0.0,50.0,0.0,50.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010855,MBR00000421,Institutional-OP,2022-10-10,2022-10-10,2022-11-15,PLN6835,1186826716,1186826716,Physical Therapy,In-Network,M54.5,Z12.31,,,,,,,0,,81001,Pathology/Lab,,,0200,22,Outpatient Hospital,1,44.88,31.77,0.0,31.77,0.0,0.0,31.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010856,MBR00000421,Professional,2022-04-25,2022-04-25,2022-05-15,PLN3799,1713934949,1713934949,Neurology,In-Network,F32.9,Z00.01,,,,,,,0,,76700,Radiology,,,,49,Independent Clinic,1,1273.52,419.48,419.48,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010857,MBR00000421,Professional,2022-06-08,2022-06-08,2022-07-14,PLN4819,1571574052,1571574052,Critical Access Hospital,In-Network,M54.5,Z51.11,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,2,290.43,244.36,206.34,0.0,25.0,13.02,38.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010858,MBR00000421,Professional,2021-07-05,2021-07-05,2021-08-18,PLN9251,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,Z23,B97.89,,,,,,,0,,87491,Pathology/Lab,,,,20,Urgent Care,1,182.95,99.99,0.0,99.99,0.0,0.0,99.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010859,MBR00000421,Professional,2023-10-15,2023-10-15,2023-11-23,PLN6151,1910255109,1910255109,DME Supplier,In-Network,I11.9,J45.20,,,,,,,0,,77067,Radiology,,,,22,Outpatient Hospital,1,577.65,193.43,193.43,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000010860,MBR00000421,Institutional-OP,2023-04-01,2023-04-01,2023-04-23,PLN2828,1974006077,1974006077,Orthopedic Surgery,In-Network,R10.9,E11.9,,,,,,,0,,76700,Radiology,,,0370,22,Outpatient Hospital,1,725.21,446.72,0.0,446.72,0.0,0.0,446.72,0.0,Denied,CO-18,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010861,MBR00000421,Professional,2023-01-04,2023-01-04,2023-02-06,PLN2331,1727809972,1727809972,Home Health,In-Network,J44.1,C50.912,,,,,,,0,,83036,Pathology/Lab,,,,22,Outpatient Hospital,1,84.86,42.85,0.0,42.85,0.0,0.0,42.85,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000010862,MBR00000421,Professional,2021-10-29,2021-10-29,2021-12-09,PLN4946,1520687146,1520687146,ASC,In-Network,Z00.00,E78.5,,,,,,,0,,99232,E&M,,,,11,Office,2,364.88,248.2,138.62,109.58,0.0,0.0,109.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010863,MBR00000421,Institutional-OP,2023-01-18,2023-01-18,2023-02-07,PLN8181,1749494482,1749494482,Pediatrics,In-Network,M54.5,Z00.00,,,,,,,0,,99203,E&M,,,0450,22,Outpatient Hospital,1,318.5,131.19,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010864,MBR00000421,Professional,2021-09-15,2021-09-15,2021-09-25,PLN4685,1800011727,1800011727,Clinical Laboratory,Out-of-Network,E11.9,F32.9,,,,,,,0,,76700,Radiology,,,,22,Outpatient Hospital,3,1279.11,393.43,393.43,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010865,MBR00000421,Professional,2022-06-17,2022-06-17,2022-07-20,PLN6809,1545347862,1545347862,SNF,In-Network,I25.10,Z12.31,,,,,,,0,,99203,E&M,,,,11,Office,1,284.66,95.08,0.0,95.08,0.0,0.0,95.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010866,MBR00000421,Institutional-IP,2021-10-21,2021-10-24,2021-10-28,PLN4458,1390307371,1390307371,DME Supplier,In-Network,E78.5,N20.0,,,,641,MS-DRG,2,3,Y,99221,E&M,,,0510,21,Inpatient Hospital,3,427.75,222.27,147.27,0.0,75.0,0.0,75.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010867,MBR00000421,Professional,2021-11-28,2021-11-28,2021-12-17,PLN4800,1790497490,1790497490,OB/GYN,In-Network,E78.5,E66.9,,,,,,,0,,90686,Medicine,,,,11,Office,3,88.14,36.19,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000010868,MBR00000422,Professional,2022-12-13,2022-12-13,2023-01-07,PLN8178,1364429278,1364429278,OB/GYN,In-Network,R51,E66.9,,,,,,,0,,99406,Medicine,,,,21,Inpatient Hospital,3,77.02,58.23,0.0,58.23,25.0,0.0,83.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010869,MBR00000422,Institutional-IP,2021-12-10,2021-12-17,2022-01-11,PLN7824,1366286000,1366286000,SNF,In-Network,R05,Z12.31,,,,683,MS-DRG,7,7,Y,45378,Surgery,,,0360,21,Inpatient Hospital,3,1907.4,763.6,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000010870,MBR00000422,Institutional-OP,2023-03-11,2023-03-11,2023-04-03,PLN9475,1716521444,1716521444,Oncology,In-Network,E11.9,Z00.00,,,,,,,0,,99221,E&M,,,0900,22,Outpatient Hospital,1,202.61,75.39,0.0,75.39,0.0,0.0,75.39,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000010871,MBR00000422,Institutional-OP,2022-07-06,2022-07-06,2022-08-01,PLN2893,1891849440,1891849440,Oncology,In-Network,N18.3,E11.9,,,,,,,0,,84443,Pathology/Lab,,,0301,22,Outpatient Hospital,1,161.08,71.47,0.0,40.18,75.0,0.0,115.18,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010872,MBR00000422,Professional,2023-12-11,2023-12-11,2023-12-24,PLN1297,1224179551,1224179551,Physical Therapy,In-Network,F03.90,E66.9,,,,,,,0,,86900,Pathology/Lab,,,,22,Outpatient Hospital,3,59.05,46.59,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010873,MBR00000422,Institutional-IP,2021-07-30,2021-08-07,2021-08-18,PLN3845,1757138478,1757138478,Pediatrics,In-Network,Z12.11,I25.10,,,,641,MS-DRG,15,8,Y,27447,Surgery,,,0510,21,Inpatient Hospital,1,4285.67,2908.53,2893.53,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010874,MBR00000422,Institutional-IP,2023-11-01,2023-11-03,2023-12-11,PLN7652,1213165847,1213165847,Critical Access Hospital,In-Network,J18.9,K21.0,,,,196,MS-DRG,2,2,Y,82043,Pathology/Lab,,,0730,21,Inpatient Hospital,1,50.52,21.64,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010875,MBR00000423,Professional,2021-05-26,2021-05-26,2021-06-12,PLN1731,1453936007,1453936007,ASC,In-Network,Z12.31,I10,,,,,,,0,,99204,E&M,,,,11,Office,3,422.95,224.88,224.88,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010876,MBR00000423,Professional,2022-08-25,2022-08-25,2022-09-26,PLN6162,1168246159,1168246159,Internal Medicine,In-Network,M17.11,F41.9,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,1,4460.33,1777.06,1416.78,285.28,75.0,0.0,360.28,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010877,MBR00000423,Institutional-IP,2022-02-12,2022-02-18,2022-02-28,PLN7374,1691062876,1691062876,SNF,In-Network,F41.9,F41.9,,,,682,MS-DRG,15,6,Y,99204,E&M,,,0740,21,Inpatient Hospital,3,255.32,83.45,0.0,83.45,75.0,0.0,158.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010878,MBR00000423,Professional,2023-04-04,2023-04-04,2023-04-18,PLN3801,1624802371,1624802371,ASC,Out-of-Network,Z23,E11.40,,,,,,,0,,99406,Medicine,,,,49,Independent Clinic,3,46.3,16.08,0.0,16.08,0.0,0.0,16.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010879,MBR00000424,Institutional-OP,2021-05-23,2021-05-23,2021-07-06,PLN6803,1475984649,1475984649,SNF,In-Network,K57.30,I48.91,,,,,,,0,,58661,Surgery,,,0360,22,Outpatient Hospital,2,2682.97,1413.71,0.0,0.0,25.0,12.18,37.18,0.0,Denied,CO-29,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010880,MBR00000424,Professional,2021-10-06,2021-10-06,2021-11-13,PLN8763,1624202402,1624202402,Orthopedic Surgery,In-Network,J44.1,I10,,,,,,,0,,99284,E&M,,,,23,Emergency Room,1,926.01,307.74,53.78,253.96,0.0,0.0,253.96,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010881,MBR00000424,Professional,2021-09-10,2021-09-10,2021-10-19,PLN9748,1168246159,1168246159,Internal Medicine,In-Network,R07.9,E78.5,,,,,,,0,,99232,E&M,,,,81,Independent Laboratory,1,234.53,110.22,0.0,110.22,35.0,0.0,145.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010882,MBR00000424,Institutional-OP,2023-10-06,2023-10-06,2023-10-14,PLN1186,1295371663,1295371663,Critical Access Hospital,In-Network,Z12.31,I48.91,,,,,,,0,,99283,E&M,,,0370,22,Outpatient Hospital,1,488.67,311.18,289.01,0.0,0.0,22.17,22.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010883,MBR00000424,Institutional-OP,2022-08-09,2022-08-09,2022-08-19,PLN5124,1186826716,1186826716,Physical Therapy,In-Network,Z79.4,Z79.4,,,,,,,0,,99232,E&M,,,0120,22,Outpatient Hospital,3,360.18,233.56,233.56,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010884,MBR00000424,Professional,2021-06-29,2021-06-29,2021-08-07,PLN2463,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,I25.10,E78.5,,,,,,,0,,45380,Surgery,,,,12,Home,2,2210.43,892.45,439.59,435.05,0.0,17.81,452.86,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000010885,MBR00000424,Institutional-OP,2023-05-16,2023-05-16,2023-06-15,PLN9717,1799205295,1799205295,General Acute Care Hospital,In-Network,Z23,E66.9,,,,,,,0,,99232,E&M,,,0510,22,Outpatient Hospital,2,160.86,125.21,0.0,125.21,0.0,0.0,125.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010886,MBR00000424,Institutional-OP,2021-11-09,2021-11-09,2021-12-22,PLN7769,1809014947,1809014947,Urology,In-Network,E87.6,F41.9,,,,,,,0,,82043,Pathology/Lab,,,0360,22,Outpatient Hospital,2,60.5,22.6,22.6,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010887,MBR00000424,Professional,2021-09-04,2021-09-04,2021-10-03,PLN9205,1809014947,1809014947,Urology,In-Network,M81.0,Z00.00,,,,,,,0,,66984,Surgery,,,,50,Federally Qualified Health Center,3,2328.22,1673.81,1673.81,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010888,MBR00000425,Institutional-IP,2022-06-26,2022-06-29,2022-07-17,PLN6860,1284035364,1284035364,Pediatrics,In-Network,J20.9,F10.20,,,,470,MS-DRG,9,3,Y,97530,Medicine,,,0636,21,Inpatient Hospital,1,228.84,169.78,169.78,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010889,MBR00000425,Institutional-OP,2023-05-17,2023-05-17,2023-06-03,PLN7951,1236418230,1236418230,DME Supplier,In-Network,I11.9,J45.20,,,,,,,0,,85610,Pathology/Lab,,,0320,22,Outpatient Hospital,2,61.32,23.99,0.0,23.99,50.0,0.0,73.99,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010890,MBR00000425,Professional,2023-07-09,2023-07-09,2023-07-28,PLN5704,1624802371,1624802371,ASC,Out-of-Network,M81.0,Z23,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,3,30.91,19.85,19.85,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010891,MBR00000425,Institutional-OP,2021-01-18,2021-01-18,2021-02-23,PLN8973,1244186984,1244186984,Family Medicine,Out-of-Network,F41.9,K21.0,,,,,,,0,,99233,E&M,,,0900,22,Outpatient Hospital,3,222.38,173.69,0.0,173.69,50.0,0.0,223.69,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010892,MBR00000425,Institutional-OP,2023-09-11,2023-09-11,2023-10-20,PLN3684,1475984649,1475984649,SNF,In-Network,Z00.00,E78.5,,,,,,,0,,47562,Surgery,,,0301,22,Outpatient Hospital,3,6316.77,2602.61,2034.99,468.94,0.0,98.68,567.62,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010893,MBR00000425,Professional,2023-12-28,2023-12-28,2024-01-12,PLN4570,1689639685,1689639685,SNF,In-Network,N18.3,E78.5,,,,,,,0,,90837,Medicine,,,,21,Inpatient Hospital,1,437.26,152.54,0.0,152.54,0.0,0.0,152.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010894,MBR00000425,Professional,2021-12-18,2021-12-18,2022-01-03,PLN6428,1561134315,1561134315,DME Supplier,In-Network,E78.5,R07.9,,,,,,,0,,86900,Pathology/Lab,,,,31,Skilled Nursing Facility,3,50.71,21.22,18.28,0.0,0.0,2.94,2.94,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010895,MBR00000425,Institutional-OP,2022-07-21,2022-07-21,2022-08-16,PLN5254,1434029575,1434029575,Endocrinology,In-Network,J20.9,Z12.11,,,,,,,0,,33533,Surgery,,,0301,22,Outpatient Hospital,3,21182.15,15806.13,15806.13,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000010896,MBR00000425,Professional,2022-02-17,2022-02-17,2022-03-23,PLN1508,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,Z00.00,I10,,,,,,,0,,45378,Surgery,,,,49,Independent Clinic,1,1795.0,836.15,688.02,0.0,50.0,98.13,148.13,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000010897,MBR00000425,Professional,2022-06-06,2022-06-06,2022-06-25,PLN9546,1395983630,1395983630,Nephrology,In-Network,E66.9,E11.65,,,,,,,0,,23472,Surgery,,,,81,Independent Laboratory,3,6507.89,4719.43,4719.43,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010898,MBR00000425,Institutional-OP,2022-12-16,2022-12-16,2023-01-22,PLN9036,1606140917,1606140917,ASC,In-Network,F10.20,I10,,,,,,,0,,85025,Pathology/Lab,,,0360,22,Outpatient Hospital,1,35.9,17.77,17.77,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010899,MBR00000425,Institutional-IP,2022-12-14,2022-12-23,2023-01-23,PLN3808,1433937353,1433937353,Nephrology,In-Network,N40.0,N39.0,,,,194,MS-DRG,24,9,Y,G0439,Medicine,,,0360,21,Inpatient Hospital,1,536.34,412.43,0.0,412.43,35.0,0.0,447.43,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000010900,MBR00000425,Professional,2022-06-04,2022-06-04,2022-06-13,PLN9714,1410468316,1410468316,SNF,In-Network,I48.91,M81.0,,,,,,,0,,72148,Radiology,,,,22,Outpatient Hospital,3,2845.16,1468.29,1418.29,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010901,MBR00000425,Professional,2022-06-05,2022-06-05,2022-07-12,PLN2654,1575695214,1575695214,SNF,In-Network,I10,E11.9,,,,,,,0,,99406,Medicine,,,,11,Office,2,90.92,62.77,0.0,62.77,75.0,0.0,137.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010902,MBR00000425,Institutional-OP,2022-06-19,2022-06-19,2022-07-04,PLN2390,1284035364,1284035364,Pediatrics,In-Network,F32.9,J06.9,,,,,,,0,,81001,Pathology/Lab,,,0730,22,Outpatient Hospital,1,61.65,42.08,0.0,6.04,50.0,0.0,56.04,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010903,MBR00000425,Institutional-OP,2022-03-23,2022-03-23,2022-04-25,PLN9495,1213165847,1213165847,Critical Access Hospital,In-Network,N40.0,B97.89,,,,,,,0,,81001,Pathology/Lab,,,0730,22,Outpatient Hospital,1,41.24,13.01,0.0,13.01,0.0,0.0,13.01,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010904,MBR00000425,Professional,2021-05-15,2021-05-15,2021-05-25,PLN5142,1283743001,1283743001,Family Medicine,In-Network,N18.3,E78.5,,,,,,,0,,27447,Surgery,,,,20,Urgent Care,1,5784.31,2390.49,0.0,452.99,0.0,0.0,452.99,0.0,Denied,CO-15,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010905,MBR00000425,Professional,2022-02-11,2022-02-11,2022-02-26,PLN6499,1585582070,1585582070,Outpatient Clinic,In-Network,F32.9,Z12.31,,,,,,,0,,45378,Surgery,,,,11,Office,2,2093.1,628.38,613.38,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000010906,MBR00000425,Professional,2023-02-23,2023-02-23,2023-03-19,PLN7703,1109850785,1109850785,ASC,Out-of-Network,J06.9,E78.5,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,3,26758.66,20767.39,20767.39,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,1,Phantom,0,0,0,0,0
CLM0000010907,MBR00000425,Professional,2023-12-07,2023-12-07,2024-01-02,PLN5143,1125190055,1125190055,Nephrology,In-Network,K21.0,E78.5,,,,,,,0,,58661,Surgery,,,,49,Independent Clinic,2,1851.25,1484.14,0.0,0.0,35.0,288.9,323.9,0.0,Denied,PR-1,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010908,MBR00000425,Professional,2023-06-09,2023-06-09,2023-07-11,PLN8642,1997536841,1997536841,Family Medicine,Out-of-Network,Z00.00,I48.91,,,,,,,0,,93000,Radiology,,,,81,Independent Laboratory,1,66.17,30.78,0.0,30.78,0.0,0.0,30.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010909,MBR00000425,Institutional-IP,2023-08-02,2023-08-07,2023-08-27,PLN4123,1540044947,1540044947,Pulmonology,Out-of-Network,Z00.00,J06.9,,,,470,MS-DRG,18,5,Y,45378,Surgery,,,0761,21,Inpatient Hospital,2,2239.73,1005.72,873.37,132.35,0.0,0.0,132.35,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000010910,MBR00000425,Professional,2023-05-08,2023-05-08,2023-05-22,PLN6874,1103747954,1103747954,Urology,In-Network,E78.5,I10,,,,,,,0,,99213,E&M,,,,11,Office,3,232.61,109.38,0.0,109.38,0.0,0.0,109.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010911,MBR00000425,Institutional-OP,2022-07-05,2022-07-05,2022-08-15,PLN6362,1542828721,1542828721,Orthopedic Surgery,In-Network,N39.0,I48.91,,,,,,,0,,45378,Surgery,,,0270,22,Outpatient Hospital,3,1071.01,333.22,271.46,0.0,15.0,46.76,61.76,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000010912,MBR00000425,Institutional-OP,2023-01-17,2023-01-17,2023-02-27,PLN3719,1168246159,1168246159,Internal Medicine,In-Network,J06.9,M54.5,,,,,,,0,,66984,Surgery,,,0320,22,Outpatient Hospital,3,1702.35,827.39,0.0,0.0,75.0,32.64,107.64,0.0,Denied,CO-97,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010913,MBR00000425,Institutional-OP,2023-07-05,2023-07-05,2023-07-27,PLN2041,1845900543,1845900543,ASC,In-Network,M17.11,Z00.00,,,,,,,0,,66984,Surgery,,,0761,22,Outpatient Hospital,1,1631.07,888.96,888.96,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010914,MBR00000425,Professional,2021-09-02,2021-09-02,2021-09-15,PLN6469,1645194539,1645194539,SNF,In-Network,R51,E66.9,,,,,,,0,,99204,E&M,,,,65,End-Stage Renal Disease,1,288.24,99.93,99.93,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010915,MBR00000425,Institutional-IP,2021-06-13,2021-06-20,2021-07-23,PLN6045,1994661817,1994661817,SNF,Out-of-Network,I10,I11.9,,,,683,MS-DRG,6,7,Y,80061,Pathology/Lab,,,0120,21,Inpatient Hospital,3,132.46,48.12,0.0,48.12,0.0,0.0,48.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010916,MBR00000425,Professional,2021-10-19,2021-10-19,2021-11-08,PLN3937,1125190055,1125190055,Nephrology,In-Network,F41.9,Z12.11,,,,,,,0,,97530,Medicine,,,,50,Federally Qualified Health Center,1,219.06,105.36,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010917,MBR00000426,Professional,2022-08-03,2022-08-03,2022-08-31,PLN7373,1806688928,1806688928,Geriatrics,In-Network,R10.9,N18.3,,,,,,,0,,99284,E&M,,,,21,Inpatient Hospital,1,914.15,474.96,414.28,60.68,0.0,0.0,60.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010918,MBR00000426,Institutional-OP,2023-05-11,2023-05-11,2023-06-24,PLN2014,1205377316,1205377316,Orthopedic Surgery,In-Network,Z00.01,E11.9,,,,,,,0,,97110,Medicine,,,0450,22,Outpatient Hospital,1,140.63,106.0,0.0,106.0,0.0,0.0,106.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010919,MBR00000426,Institutional-OP,2022-05-08,2022-05-08,2022-06-21,PLN4182,1283743001,1283743001,Family Medicine,In-Network,F41.9,F03.90,,,,,,,0,,99283,E&M,,,0270,22,Outpatient Hospital,2,422.31,322.82,322.82,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010920,MBR00000426,Institutional-OP,2023-12-13,2023-12-13,2024-01-17,PLN3671,1366426662,1366426662,Urology,In-Network,C50.912,I10,,,,,,,0,,99284,E&M,,,0320,22,Outpatient Hospital,2,636.3,476.51,0.0,0.0,75.0,5.4,80.4,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010921,MBR00000426,Professional,2021-12-22,2021-12-22,2022-01-05,PLN2496,1366576336,1366576336,Geriatrics,In-Network,I10,J18.9,,,,,,,0,,81001,Pathology/Lab,,,,12,Home,1,55.55,36.11,36.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010922,MBR00000426,Institutional-IP,2022-05-21,2022-05-27,2022-07-03,PLN8287,1812060197,1812060197,Oncology,Out-of-Network,F10.20,I63.9,,,,871,MS-DRG,23,6,Y,93225,Medicine,,,0270,21,Inpatient Hospital,2,357.13,295.14,0.0,194.79,0.0,0.0,194.79,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010923,MBR00000426,Professional,2023-10-03,2023-10-03,2023-10-22,PLN5158,1268679390,1268679390,Critical Access Hospital,In-Network,I11.9,R51,,,,,,,0,,80061,Pathology/Lab,,,,12,Home,1,84.45,45.23,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010924,MBR00000426,Institutional-IP,2021-07-06,2021-07-10,2021-07-14,PLN1084,1915531927,1915531927,Critical Access Hospital,In-Network,J06.9,J20.9,,,,195,MS-DRG,5,4,Y,99283,E&M,,,0510,21,Inpatient Hospital,2,317.79,219.66,219.66,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000010925,MBR00000426,Professional,2023-07-01,2023-07-01,2023-07-17,PLN3035,1168881145,1168881145,Orthopedic Surgery,In-Network,E11.9,Z12.11,,,,,,,0,,99232,E&M,,,,11,Office,3,348.21,237.56,162.56,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000010926,MBR00000426,Institutional-OP,2021-06-15,2021-06-15,2021-07-15,PLN6665,1528335731,1528335731,Critical Access Hospital,In-Network,I10,Z00.00,,,,,,,0,,97110,Medicine,,,0900,22,Outpatient Hospital,2,188.96,64.35,29.35,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000010927,MBR00000426,Institutional-OP,2023-09-21,2023-09-21,2023-10-16,PLN8515,1334916761,1334916761,ASC,In-Network,E78.5,Z00.00,,,,,,,0,,99284,E&M,,,0450,22,Outpatient Hospital,3,319.15,230.67,0.0,214.21,50.0,0.0,264.21,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000010928,MBR00000426,Professional,2021-12-20,2021-12-20,2022-01-10,PLN1738,1268679390,1268679390,Critical Access Hospital,In-Network,J06.9,N40.0,,,,,,,0,,99213,E&M,,,,21,Inpatient Hospital,3,132.95,77.69,0.0,77.69,0.0,0.0,77.69,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010929,MBR00000426,Institutional-OP,2022-11-27,2022-11-27,2022-12-12,PLN3331,1780163051,1780163051,SNF,In-Network,F32.9,J45.20,,,,,,,0,,82043,Pathology/Lab,,,0636,22,Outpatient Hospital,2,34.99,24.67,0.0,24.67,0.0,0.0,24.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010930,MBR00000426,Institutional-OP,2023-02-19,2023-02-19,2023-03-03,PLN5619,1702692193,1702692193,Physical Therapy,In-Network,F32.9,I10,,,,,,,0,,99203,E&M,,,0740,22,Outpatient Hospital,3,143.37,92.13,0.0,92.13,50.0,0.0,142.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010931,MBR00000426,Institutional-IP,2022-02-16,2022-02-19,2022-03-16,PLN8379,1716521444,1716521444,Oncology,In-Network,G20,M54.5,,,,195,MS-DRG,24,3,N,66984,Surgery,,,0301,21,Inpatient Hospital,3,2041.45,1309.11,877.7,381.41,50.0,0.0,431.41,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010932,MBR00000426,Professional,2022-08-26,2022-08-26,2022-09-29,PLN1668,1193493783,1193493783,Critical Access Hospital,Out-of-Network,N17.9,N20.0,,,,,,,0,,90837,Medicine,,,,49,Independent Clinic,1,492.53,397.53,277.22,120.31,0.0,0.0,120.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010933,MBR00000426,Professional,2023-04-09,2023-04-09,2023-05-07,PLN2988,1749494482,1749494482,Pediatrics,In-Network,E78.5,I63.9,,,,,,,0,,72148,Radiology,,,,11,Office,2,2273.9,1356.97,1331.97,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010934,MBR00000426,Professional,2023-08-18,2023-08-18,2023-09-19,PLN6979,1935547131,1935547131,Pulmonology,In-Network,N40.0,E78.5,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,1,1557.39,670.72,419.96,250.76,0.0,0.0,250.76,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000010935,MBR00000426,Professional,2021-04-29,2021-04-29,2021-05-26,PLN1022,1713934949,1713934949,Neurology,In-Network,J20.9,K57.30,,,,,,,0,,47562,Surgery,,,,11,Office,3,2700.62,842.81,821.98,0.0,0.0,20.83,20.83,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010936,MBR00000426,Institutional-OP,2022-06-27,2022-06-27,2022-08-06,PLN1875,1713934949,1713934949,Neurology,In-Network,E11.65,E78.5,,,,,,,0,,23472,Surgery,,,0270,22,Outpatient Hospital,2,3993.94,1994.45,1900.08,69.37,25.0,0.0,94.37,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010937,MBR00000426,Professional,2023-07-24,2023-07-24,2023-08-08,PLN5507,1872613201,1872613201,Internal Medicine,In-Network,G43.909,J06.9,,,,,,,0,,99406,Medicine,,,,11,Office,2,90.77,43.86,0.0,43.86,0.0,0.0,43.86,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010938,MBR00000426,Professional,2022-09-01,2022-09-01,2022-10-07,PLN7646,1991459367,1991459367,Neurology,Out-of-Network,E66.9,I25.10,,,,,,,0,,93306,Radiology,,,,11,Office,2,1534.18,1202.68,975.37,0.0,15.0,212.31,227.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010939,MBR00000426,Institutional-OP,2021-02-01,2021-02-01,2021-02-10,PLN8885,1118885473,1118885473,ASC,In-Network,I10,Z23,,,,,,,0,,80053,Pathology/Lab,,,0301,22,Outpatient Hospital,3,130.83,47.76,47.76,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010940,MBR00000426,Institutional-IP,2021-05-18,2021-05-24,2021-06-21,PLN9631,1745114564,1745114564,Endocrinology,In-Network,M81.0,K21.0,,,,292,MS-DRG,4,6,Y,G0439,Medicine,,,0730,21,Inpatient Hospital,3,571.01,194.69,158.42,0.0,35.0,1.27,36.27,0.0,Adjusted,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000010941,MBR00000426,Professional,2023-06-15,2023-06-15,2023-07-24,PLN2756,1502838586,1502838586,ASC,In-Network,E11.9,Z23,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,2,5915.81,2295.68,2136.06,0.0,0.0,159.62,159.62,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010942,MBR00000426,Institutional-OP,2022-04-09,2022-04-09,2022-05-18,PLN4866,1745114564,1745114564,Endocrinology,In-Network,G43.909,F32.9,,,,,,,0,,99222,E&M,,,0120,22,Outpatient Hospital,3,458.31,242.25,242.25,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010943,MBR00000426,Professional,2023-02-10,2023-02-10,2023-03-06,PLN8794,1239316214,1239316214,Internal Medicine,In-Network,Z12.11,I48.91,,,,,,,0,,G0444,Medicine,,,,11,Office,2,53.28,26.98,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-50,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000010944,MBR00000426,Institutional-OP,2023-09-05,2023-09-05,2023-10-06,PLN3235,1606140917,1606140917,ASC,In-Network,I25.10,G20,,,,,,,0,,99214,E&M,,,0900,22,Outpatient Hospital,3,363.53,264.83,239.83,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010945,MBR00000426,Professional,2021-04-07,2021-04-07,2021-05-11,PLN5490,1242201429,1242201429,General Acute Care Hospital,In-Network,N17.9,Z00.00,,,,,,,0,,99203,E&M,,,,11,Office,3,280.64,229.78,229.78,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010946,MBR00000426,Professional,2022-05-14,2022-05-14,2022-06-12,PLN8202,1561134315,1561134315,DME Supplier,In-Network,F10.20,E11.65,,,,,,,0,,45378,Surgery,,,,11,Office,2,920.3,311.96,139.32,166.9,0.0,5.74,172.64,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000010947,MBR00000426,Institutional-OP,2021-06-10,2021-06-10,2021-07-14,PLN1469,1395983630,1395983630,Nephrology,In-Network,G43.909,K57.30,,,,,,,0,,G0444,Medicine,,,0636,22,Outpatient Hospital,2,103.52,44.46,44.46,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000010948,MBR00000426,Professional,2023-07-12,2023-07-12,2023-08-19,PLN4785,1542828721,1542828721,Orthopedic Surgery,In-Network,Z12.31,I50.9,,,,,,,0,,77067,Radiology,,,,49,Independent Clinic,2,735.23,467.33,104.16,348.17,15.0,0.0,363.17,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000010949,MBR00000426,Professional,2022-05-11,2022-05-11,2022-05-18,PLN6952,1450094833,1450094833,Outpatient Clinic,In-Network,Z00.00,E11.9,,,,,,,0,,87491,Pathology/Lab,,,,21,Inpatient Hospital,1,95.61,64.48,39.48,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010950,MBR00000426,Professional,2023-08-18,2023-08-18,2023-09-09,PLN6208,1193493783,1193493783,Critical Access Hospital,Out-of-Network,R05,J18.9,,,,,,,0,,99203,E&M,,,,11,Office,1,245.15,84.69,84.69,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010951,MBR00000426,Professional,2021-11-25,2021-11-25,2021-12-16,PLN7921,1713934949,1713934949,Neurology,In-Network,G43.909,M81.0,,,,,,,0,,47562,Surgery,,,,21,Inpatient Hospital,2,4929.17,4022.11,4001.13,20.98,0.0,0.0,20.98,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010952,MBR00000426,Institutional-OP,2021-06-09,2021-06-09,2021-06-17,PLN8720,1109850785,1109850785,ASC,Out-of-Network,N39.0,I10,,,,,,,0,,99222,E&M,,,0510,22,Outpatient Hospital,2,607.98,253.96,149.48,0.0,75.0,29.48,104.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010953,MBR00000426,Professional,2023-08-08,2023-08-08,2023-09-03,PLN7362,1717546253,1717546253,Family Medicine,In-Network,Z00.00,R07.9,,,,,,,0,,99222,E&M,,,,23,Emergency Room,3,499.77,351.75,0.0,351.75,0.0,0.0,351.75,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010954,MBR00000426,Professional,2022-11-03,2022-11-03,2022-11-25,PLN6710,1453283987,1453283987,Critical Access Hospital,In-Network,I10,E11.9,,,,,,,0,,71046,Radiology,,,,50,Federally Qualified Health Center,3,157.1,56.91,0.0,56.91,0.0,0.0,56.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010955,MBR00000426,Institutional-OP,2021-07-31,2021-07-31,2021-09-04,PLN2878,1696843572,1696843572,Critical Access Hospital,Out-of-Network,G43.909,B97.89,,,,,,,0,,99213,E&M,,,0200,22,Outpatient Hospital,3,256.48,191.36,0.0,191.36,15.0,0.0,206.36,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010956,MBR00000426,Professional,2023-01-31,2023-01-31,2023-02-13,PLN1383,1790497490,1790497490,OB/GYN,In-Network,E11.9,F32.9,,,,,,,0,,97110,Medicine,,,,11,Office,1,201.39,109.43,33.26,0.0,75.0,1.17,76.17,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010957,MBR00000426,Professional,2022-04-02,2022-04-02,2022-05-10,PLN6706,1528335731,1528335731,Critical Access Hospital,In-Network,J06.9,I10,,,,,,,0,,70450,Radiology,,,,11,Office,1,1148.53,862.5,463.54,383.96,15.0,0.0,398.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010958,MBR00000426,Professional,2021-02-21,2021-02-21,2021-03-10,PLN3202,1564502315,1564502315,ASC,In-Network,E66.9,Z87.891,,,,,,,0,,27447,Surgery,,,,21,Inpatient Hospital,1,4726.18,1730.65,1730.65,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010959,MBR00000427,Institutional-OP,2021-10-13,2021-10-13,2021-11-09,PLN4329,1727809972,1727809972,Home Health,In-Network,J06.9,J20.9,,,,,,,0,,45380,Surgery,,,0761,22,Outpatient Hospital,1,2900.1,2448.11,2448.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000010960,MBR00000427,Professional,2023-04-02,2023-04-02,2023-05-15,PLN9250,1124394415,1124394415,Pediatrics,In-Network,F32.9,C50.912,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,2,1421.55,1048.44,1013.44,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010961,MBR00000427,Institutional-IP,2021-05-20,2021-05-23,2021-05-28,PLN6556,1948810580,1948810580,DME Supplier,In-Network,Z12.31,Z23,,,,292,MS-DRG,9,3,N,23472,Surgery,,,0636,21,Inpatient Hospital,2,4646.38,3670.16,3130.41,0.0,15.0,524.75,539.75,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010962,MBR00000427,Institutional-IP,2022-01-05,2022-01-16,2022-01-21,PLN8586,1124394415,1124394415,Pediatrics,In-Network,F32.9,Z12.31,,,,683,MS-DRG,8,11,Y,71046,Radiology,,,0320,21,Inpatient Hospital,3,234.93,108.35,93.31,0.0,0.0,15.04,15.04,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000010963,MBR00000427,Professional,2021-10-12,2021-10-12,2021-11-10,PLN6186,1395983630,1395983630,Nephrology,In-Network,E11.65,I10,,,,,,,0,,70553,Radiology,,,,81,Independent Laboratory,1,3298.71,1105.48,0.0,465.4,0.0,17.35,482.75,0.0,Denied,CO-18,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010964,MBR00000427,Institutional-OP,2023-03-14,2023-03-14,2023-04-18,PLN4009,1716521444,1716521444,Oncology,In-Network,E11.9,F41.9,,,,,,,0,,43239,Surgery,,,0370,22,Outpatient Hospital,1,2004.24,1016.8,866.42,150.38,0.0,0.0,150.38,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010965,MBR00000427,Institutional-OP,2023-07-31,2023-07-31,2023-08-16,PLN7702,1313212303,1313212303,Family Medicine,In-Network,I25.10,Z00.00,,,,,,,0,,99406,Medicine,,,0270,22,Outpatient Hospital,2,77.96,33.71,33.71,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010966,MBR00000427,Institutional-IP,2023-05-13,2023-05-19,2023-05-27,PLN4182,1108115157,1108115157,General Acute Care Hospital,In-Network,I25.10,K21.0,,,,194,MS-DRG,20,6,Y,33533,Surgery,,,0900,21,Inpatient Hospital,2,11557.7,4521.68,4521.68,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000010967,MBR00000427,Institutional-OP,2023-02-23,2023-02-23,2023-03-02,PLN3991,1935547131,1935547131,Pulmonology,In-Network,E66.9,F32.9,,,,,,,0,,80061,Pathology/Lab,,,0370,22,Outpatient Hospital,1,81.39,67.39,67.39,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010968,MBR00000427,Professional,2021-04-09,2021-04-09,2021-05-21,PLN1453,1227362142,1227362142,DME Supplier,In-Network,M54.5,E11.9,,,,,,,0,,45380,Surgery,,,,81,Independent Laboratory,3,2163.41,1403.97,1246.34,132.63,25.0,0.0,157.63,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000010969,MBR00000427,Professional,2023-09-29,2023-09-29,2023-11-10,PLN4757,1366576336,1366576336,Geriatrics,In-Network,K57.30,M81.0,,,,,,,0,,99203,E&M,,,,11,Office,2,291.4,159.03,140.99,0.0,0.0,18.04,18.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010970,MBR00000427,Institutional-IP,2021-06-27,2021-07-04,2021-07-20,PLN8677,1550154147,1550154147,Outpatient Clinic,In-Network,F41.9,K21.0,,,,871,MS-DRG,5,7,Y,G0468,Medicine,,,0740,21,Inpatient Hospital,2,426.75,350.87,331.16,0.0,15.0,4.71,19.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010971,MBR00000427,Professional,2022-03-20,2022-03-20,2022-04-23,PLN1035,1531398223,1531398223,OB/GYN,In-Network,Z00.00,N39.0,,,,,,,0,,86900,Pathology/Lab,,,,23,Emergency Room,3,54.44,30.07,24.21,0.0,0.0,5.86,5.86,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000010972,MBR00000427,Professional,2023-06-26,2023-06-26,2023-08-01,PLN3530,1433937353,1433937353,Nephrology,In-Network,Z12.31,E11.65,,,,,,,0,,99221,E&M,,,,49,Independent Clinic,1,401.93,290.66,278.62,0.0,0.0,12.04,12.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010973,MBR00000427,Professional,2021-09-21,2021-09-21,2021-10-12,PLN4799,1817234602,1817234602,Clinical Laboratory,In-Network,R07.9,I25.10,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,1,1946.39,1190.99,1115.99,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010974,MBR00000428,Professional,2021-08-26,2021-08-26,2021-09-11,PLN5360,1716521444,1716521444,Oncology,In-Network,Z12.31,Z00.00,,,,,,,0,,G0439,Medicine,,,,11,Office,3,490.85,171.36,171.36,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,1,Unbundling,0,0,0,1,0
CLM0000010975,MBR00000428,Institutional-OP,2021-01-29,2021-01-29,2021-02-06,PLN5513,1273488618,1273488618,General Acute Care Hospital,In-Network,Z79.4,N39.0,,,,,,,0,,82043,Pathology/Lab,,,0740,22,Outpatient Hospital,1,46.69,36.66,0.0,36.66,35.0,0.0,71.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010976,MBR00000428,Professional,2022-01-28,2022-01-28,2022-02-21,PLN5385,1268679390,1268679390,Critical Access Hospital,In-Network,N20.0,E11.9,,,,,,,0,,74177,Radiology,,,,22,Outpatient Hospital,2,2456.81,999.57,914.83,0.0,0.0,84.74,84.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010977,MBR00000428,Institutional-IP,2022-06-27,2022-06-30,2022-07-17,PLN7346,1219817751,1219817751,OB/GYN,In-Network,E66.9,C50.912,,,,872,MS-DRG,7,3,Y,84443,Pathology/Lab,,,0301,21,Inpatient Hospital,3,97.4,41.23,0.0,41.23,15.0,0.0,56.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010978,MBR00000428,Professional,2022-05-27,2022-05-27,2022-07-01,PLN4133,1696843572,1696843572,Critical Access Hospital,Out-of-Network,E78.5,K21.0,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,1,2010.37,1074.48,1074.48,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010979,MBR00000428,Institutional-IP,2021-02-13,2021-02-18,2021-03-18,PLN7874,1168881145,1168881145,Orthopedic Surgery,In-Network,E11.9,I25.10,,,,603,MS-DRG,18,5,Y,87491,Pathology/Lab,,,0320,21,Inpatient Hospital,3,126.07,71.79,51.0,0.0,15.0,5.79,20.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010980,MBR00000428,Professional,2021-08-13,2021-08-13,2021-09-26,PLN2148,1244186984,1244186984,Family Medicine,Out-of-Network,I10,N39.0,,,,,,,0,,90460,Medicine,,,,11,Office,3,74.48,37.74,12.74,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010981,MBR00000428,Professional,2021-01-05,2021-01-05,2021-02-17,PLN3015,1239316214,1239316214,Internal Medicine,In-Network,M54.5,E11.9,,,,,,,0,,99284,E&M,,,,11,Office,3,692.95,316.44,199.4,70.75,15.0,31.29,117.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010982,MBR00000428,Professional,2021-09-04,2021-09-04,2021-10-15,PLN4295,1540044947,1540044947,Pulmonology,Out-of-Network,F41.9,K21.0,,,,,,,0,,90686,Medicine,,,,31,Skilled Nursing Facility,3,60.5,41.65,0.0,41.65,50.0,0.0,91.65,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000010983,MBR00000428,Professional,2022-10-25,2022-10-25,2022-11-28,PLN7751,1590915516,1590915516,Physical Therapy,Out-of-Network,F41.9,Z79.4,,,,,,,0,,99406,Medicine,,,,11,Office,2,104.59,53.77,0.0,53.77,0.0,0.0,53.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010984,MBR00000428,Professional,2021-01-10,2021-01-10,2021-02-08,PLN2550,1687650653,1687650653,Internal Medicine,In-Network,N18.3,M54.5,,,,,,,0,,47562,Surgery,,,,11,Office,2,6379.0,2149.72,2149.72,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010985,MBR00000428,Institutional-IP,2021-06-30,2021-07-06,2021-07-11,PLN8559,1364429278,1364429278,OB/GYN,In-Network,Z79.4,J06.9,,,,291,MS-DRG,15,6,Y,G0468,Medicine,,,0200,21,Inpatient Hospital,1,434.3,305.56,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010986,MBR00000428,Institutional-OP,2022-08-19,2022-08-19,2022-09-26,PLN7606,1696843572,1696843572,Critical Access Hospital,Out-of-Network,I10,R10.9,,,,,,,0,,99284,E&M,,,0301,22,Outpatient Hospital,2,546.3,433.78,418.78,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010987,MBR00000428,Institutional-IP,2022-09-05,2022-09-07,2022-09-18,PLN9921,1372918899,1372918899,Family Medicine,In-Network,J06.9,M81.0,,,,683,MS-DRG,1,2,Y,70553,Radiology,,,0761,21,Inpatient Hospital,2,1900.14,839.81,466.6,323.21,50.0,0.0,373.21,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000010988,MBR00000428,Professional,2023-09-09,2023-09-09,2023-09-19,PLN3436,1994661817,1994661817,SNF,Out-of-Network,J18.9,Z12.31,,,,,,,0,,27447,Surgery,,,,81,Independent Laboratory,1,5503.62,2497.33,1986.29,17.95,0.0,493.09,511.04,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000010989,MBR00000428,Institutional-IP,2022-09-21,2022-10-02,2022-10-26,PLN3455,1283743001,1283743001,Family Medicine,In-Network,K57.30,Z23,,,,682,MS-DRG,24,11,Y,33533,Surgery,,,0450,21,Inpatient Hospital,1,19124.42,7852.25,7788.61,63.64,0.0,0.0,63.64,0.0,Paid,,,0,,0,0,1,1,1,0,None,0,0,0,0,0
CLM0000010990,MBR00000428,Professional,2023-10-11,2023-10-11,2023-11-02,PLN7330,1186826716,1186826716,Physical Therapy,In-Network,E66.9,S72.001A,,,,,,,0,,G0439,Medicine,,,,11,Office,1,464.36,362.0,337.36,24.64,0.0,0.0,24.64,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000010991,MBR00000428,Institutional-IP,2023-03-04,2023-03-06,2023-04-10,PLN6063,1135158374,1135158374,Pulmonology,In-Network,I11.9,N40.0,,,,603,MS-DRG,11,2,Y,71046,Radiology,,,0320,21,Inpatient Hospital,2,244.78,80.44,65.44,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010992,MBR00000428,Institutional-IP,2022-08-26,2022-08-28,2022-09-11,PLN6957,1125190055,1125190055,Nephrology,In-Network,M81.0,I10,,,,682,MS-DRG,13,2,Y,90460,Medicine,,,0730,21,Inpatient Hospital,1,71.21,30.61,15.46,0.0,15.0,0.15,15.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010993,MBR00000428,Professional,2022-02-24,2022-02-24,2022-03-24,PLN4650,1434029575,1434029575,Endocrinology,In-Network,I11.9,F41.9,,,,,,,0,,99283,E&M,,,,31,Skilled Nursing Facility,3,624.84,391.0,391.0,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010994,MBR00000428,Institutional-OP,2021-05-02,2021-05-02,2021-06-14,PLN2132,1139906830,1139906830,Endocrinology,Out-of-Network,R10.9,I10,,,,,,,0,,87491,Pathology/Lab,,,0370,22,Outpatient Hospital,2,197.01,111.8,111.8,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010995,MBR00000428,Professional,2023-02-12,2023-02-12,2023-03-24,PLN1056,1800011727,1800011727,Clinical Laboratory,Out-of-Network,K21.0,I25.10,,,,,,,0,,99233,E&M,,,,11,Office,2,200.9,139.15,103.71,17.31,15.0,3.13,35.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010996,MBR00000428,Professional,2023-10-25,2023-10-25,2023-11-30,PLN5196,1691062876,1691062876,SNF,In-Network,Z87.891,Z12.31,,,,,,,0,,99213,E&M,,,,20,Urgent Care,3,243.85,83.99,0.0,83.99,50.0,0.0,133.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000010997,MBR00000428,Institutional-IP,2022-02-05,2022-02-11,2022-03-15,PLN6943,1569105090,1569105090,Geriatrics,In-Network,Z23,E11.9,,,,690,MS-DRG,12,6,N,90686,Medicine,,,0636,21,Inpatient Hospital,3,100.2,43.91,8.91,0.0,35.0,0.0,35.0,0.0,Adjusted,,,0,,0,1,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000010998,MBR00000428,Institutional-OP,2022-01-25,2022-01-25,2022-02-02,PLN3433,1247341320,1247341320,Urology,Out-of-Network,R05,Z12.31,,,,,,,0,,77067,Radiology,,,0370,22,Outpatient Hospital,3,347.73,131.4,106.4,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,0,0,0,1,Unbundling,1,0,0,0,0
CLM0000010999,MBR00000428,Institutional-OP,2021-04-18,2021-04-18,2021-04-27,PLN4856,1795618275,1795618275,Pulmonology,In-Network,G43.909,R51,,,,,,,0,,99284,E&M,,,0636,22,Outpatient Hospital,2,460.27,171.21,156.21,0.0,15.0,0.0,15.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011000,MBR00000428,Professional,2022-10-17,2022-10-17,2022-11-10,PLN1168,1645194539,1645194539,SNF,In-Network,Z96.641,I10,,,,,,,0,,27447,Surgery,,,,20,Urgent Care,3,5097.86,3667.0,2904.51,443.66,50.0,268.83,762.49,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011001,MBR00000428,Institutional-IP,2021-12-06,2021-12-11,2022-01-09,PLN9534,1700633438,1700633438,DME Supplier,In-Network,E11.9,F32.9,,,,682,MS-DRG,14,5,Y,74177,Radiology,,,0761,21,Inpatient Hospital,3,1386.11,1143.69,677.7,465.99,0.0,0.0,465.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011002,MBR00000428,Institutional-OP,2021-01-12,2021-01-12,2021-01-25,PLN9697,1856686341,1856686341,Geriatrics,In-Network,M54.5,I10,,,,,,,0,,93225,Medicine,,,0360,22,Outpatient Hospital,3,851.32,266.31,251.31,0.0,15.0,0.0,15.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011003,MBR00000428,Professional,2021-01-09,2021-01-09,2021-01-23,PLN3932,1624202402,1624202402,Orthopedic Surgery,In-Network,Z12.31,I10,,,,,,,0,,99222,E&M,,,,11,Office,3,316.68,152.15,102.15,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011004,MBR00000428,Professional,2022-01-03,2022-01-03,2022-01-23,PLN4388,1915531927,1915531927,Critical Access Hospital,In-Network,R10.9,Z00.00,,,,,,,0,,99222,E&M,,,,11,Office,2,511.38,392.12,51.04,266.08,75.0,0.0,341.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011005,MBR00000428,Professional,2022-05-22,2022-05-22,2022-06-25,PLN6345,1514306773,1514306773,Endocrinology,In-Network,F10.20,Z12.31,,,,,,,0,,82043,Pathology/Lab,,,,49,Independent Clinic,1,52.6,29.52,0.0,29.52,0.0,0.0,29.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011006,MBR00000428,Institutional-OP,2022-05-16,2022-05-16,2022-06-28,PLN1027,1433937353,1433937353,Nephrology,In-Network,C50.912,N39.0,,,,,,,0,,45378,Surgery,,,0270,22,Outpatient Hospital,1,2366.07,927.23,897.93,29.3,0.0,0.0,29.3,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000011007,MBR00000428,Professional,2023-03-22,2023-03-22,2023-04-24,PLN6371,1899127912,1899127912,Neurology,In-Network,E78.5,N39.0,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,3,135.14,42.27,0.0,42.27,0.0,0.0,42.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011008,MBR00000428,Institutional-OP,2022-08-02,2022-08-02,2022-08-14,PLN1189,1624202402,1624202402,Orthopedic Surgery,In-Network,Z00.00,E11.9,,,,,,,0,,99283,E&M,,,0740,22,Outpatient Hospital,1,239.09,99.02,0.0,99.02,0.0,0.0,99.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011009,MBR00000428,Professional,2023-05-10,2023-05-10,2023-06-23,PLN1940,1453936007,1453936007,ASC,In-Network,I11.9,R10.9,,,,,,,0,,70553,Radiology,,,,23,Emergency Room,2,2180.79,1077.23,1052.23,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011010,MBR00000428,Professional,2021-11-22,2021-11-22,2021-12-07,PLN6887,1531398223,1531398223,OB/GYN,In-Network,M54.5,E78.5,,,,,,,0,,99233,E&M,,,,11,Office,1,444.29,134.25,134.25,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011011,MBR00000428,Professional,2021-09-12,2021-09-12,2021-10-03,PLN8064,1450094833,1450094833,Outpatient Clinic,In-Network,E11.9,F10.20,,,,,,,0,,27447,Surgery,,,,12,Home,3,6123.31,3398.04,3373.04,0.0,25.0,0.0,25.0,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011012,MBR00000428,Professional,2022-08-14,2022-08-14,2022-09-16,PLN9911,1974006077,1974006077,Orthopedic Surgery,In-Network,S72.001A,F32.9,,,,,,,0,,G0439,Medicine,,,,50,Federally Qualified Health Center,3,281.59,221.17,0.0,221.17,0.0,0.0,221.17,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000011013,MBR00000429,Institutional-OP,2021-04-26,2021-04-26,2021-05-17,PLN9957,1691062876,1691062876,SNF,In-Network,E11.9,E11.9,,,,,,,0,,99222,E&M,,,0740,22,Outpatient Hospital,2,387.2,141.16,116.16,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011014,MBR00000429,Professional,2023-04-18,2023-04-18,2023-05-17,PLN6296,1713934949,1713934949,Neurology,In-Network,I10,I10,,,,,,,0,,99283,E&M,,,,11,Office,3,459.27,180.06,180.06,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000011015,MBR00000429,Professional,2021-07-23,2021-07-23,2021-08-27,PLN2251,1809014947,1809014947,Urology,In-Network,F41.9,I10,,,,,,,0,,86900,Pathology/Lab,,,,22,Outpatient Hospital,3,61.91,23.57,0.0,0.0,15.0,0.77,15.77,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011016,MBR00000429,Institutional-OP,2023-09-30,2023-09-30,2023-11-07,PLN7543,1691062876,1691062876,SNF,In-Network,E78.5,M17.11,,,,,,,0,,99283,E&M,,,0761,22,Outpatient Hospital,3,433.11,361.5,337.8,0.0,0.0,23.7,23.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011017,MBR00000429,Professional,2023-12-14,2023-12-14,2024-01-25,PLN3126,1728018911,1728018911,Nephrology,In-Network,N17.9,J18.9,,,,,,,0,,78452,Radiology,,,,49,Independent Clinic,2,6209.35,4875.53,4875.53,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011018,MBR00000429,Institutional-IP,2022-08-12,2022-08-21,2022-09-18,PLN4846,1366426662,1366426662,Urology,In-Network,J45.20,I10,,,,871,MS-DRG,7,9,Y,77067,Radiology,,,0301,21,Inpatient Hospital,2,561.61,207.64,0.0,207.64,0.0,0.0,207.64,0.0,Denied,CO-15,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000011019,MBR00000429,Professional,2021-12-08,2021-12-08,2022-01-13,PLN5033,1148984206,1148984206,Psychiatry,In-Network,E11.9,N20.0,,,,,,,0,,93225,Medicine,,,,23,Emergency Room,2,612.56,337.4,170.9,137.99,25.0,3.51,166.5,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011020,MBR00000429,Institutional-OP,2022-01-06,2022-01-06,2022-02-10,PLN6466,1219817751,1219817751,OB/GYN,In-Network,E11.9,R07.9,,,,,,,0,,99284,E&M,,,0730,22,Outpatient Hospital,1,727.68,471.07,265.16,205.91,0.0,0.0,205.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011021,MBR00000430,Professional,2022-04-16,2022-04-16,2022-05-10,PLN8028,1283743001,1283743001,Family Medicine,In-Network,F41.9,E11.9,,,,,,,0,,90837,Medicine,,,,21,Inpatient Hospital,2,397.65,332.46,307.46,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011022,MBR00000430,Professional,2022-06-09,2022-06-09,2022-06-30,PLN2623,1872613201,1872613201,Internal Medicine,In-Network,E78.5,Z23,,,,,,,0,,93000,Radiology,,,,11,Office,3,86.35,32.75,29.88,0.0,0.0,2.87,2.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011023,MBR00000430,Institutional-IP,2021-03-24,2021-03-25,2021-04-20,PLN9227,1186826716,1186826716,Physical Therapy,In-Network,E66.9,I11.9,,,,194,MS-DRG,15,1,Y,93225,Medicine,,,0761,21,Inpatient Hospital,3,430.65,318.46,234.3,84.16,0.0,0.0,84.16,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011024,MBR00000430,Professional,2021-08-05,2021-08-05,2021-09-15,PLN4328,1687650653,1687650653,Internal Medicine,In-Network,Z12.31,J45.20,,,,,,,0,,47562,Surgery,,,,12,Home,1,6379.4,4745.22,3922.28,0.0,0.0,822.94,822.94,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011025,MBR00000430,Professional,2023-05-15,2023-05-15,2023-06-12,PLN6937,1108115157,1108115157,General Acute Care Hospital,In-Network,I10,E78.5,,,,,,,0,,99214,E&M,,,,11,Office,2,352.22,239.23,0.0,160.65,50.0,0.0,210.65,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011026,MBR00000430,Professional,2021-02-27,2021-02-27,2021-03-25,PLN5926,1366426662,1366426662,Urology,In-Network,E11.9,E66.9,,,,,,,0,,G0439,Medicine,,,,11,Office,1,308.77,163.7,136.61,14.08,0.0,13.01,27.09,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000011027,MBR00000430,Professional,2022-05-07,2022-05-07,2022-06-17,PLN8547,1245650222,1245650222,Gastroenterology,In-Network,Z12.31,R51,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,2,2810.18,2379.57,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-4,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011028,MBR00000430,Institutional-IP,2023-08-17,2023-08-19,2023-09-29,PLN6987,1433937353,1433937353,Nephrology,In-Network,Z12.31,E87.6,,,,641,MS-DRG,16,2,Y,45380,Surgery,,,0370,21,Inpatient Hospital,2,2840.22,2266.89,1505.91,441.23,0.0,319.75,760.98,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000011029,MBR00000430,Professional,2021-04-06,2021-04-06,2021-05-14,PLN9545,1266606767,1266606767,ASC,In-Network,F32.9,M17.11,,,,,,,0,,27447,Surgery,,,,23,Emergency Room,1,5487.44,2799.05,2024.84,274.36,0.0,499.85,774.21,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011030,MBR00000430,Institutional-OP,2023-10-11,2023-10-11,2023-10-19,PLN9305,1691062876,1691062876,SNF,In-Network,K57.30,E78.5,,,,,,,0,,99283,E&M,,,0636,22,Outpatient Hospital,3,425.65,252.04,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011031,MBR00000430,Professional,2022-06-02,2022-06-02,2022-06-25,PLN2900,1622771872,1622771872,Pediatrics,In-Network,E66.9,F32.9,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,3,379.58,124.28,108.19,0.0,0.0,16.09,16.09,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011032,MBR00000430,Institutional-IP,2022-04-09,2022-04-13,2022-05-21,PLN8764,1245650222,1245650222,Gastroenterology,In-Network,I10,Z87.891,,,,683,MS-DRG,13,4,Y,90460,Medicine,,,0740,21,Inpatient Hospital,2,37.83,12.2,0.0,12.2,15.0,0.0,27.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011033,MBR00000430,Professional,2023-02-21,2023-02-21,2023-03-05,PLN6920,1896447406,1896447406,Nephrology,Out-of-Network,I10,E11.9,,,,,,,0,,76700,Radiology,,,,21,Inpatient Hospital,1,1445.48,1055.71,735.91,248.83,0.0,70.97,319.8,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011034,MBR00000430,Professional,2023-05-02,2023-05-02,2023-06-15,PLN3253,1242201429,1242201429,General Acute Care Hospital,In-Network,N18.3,Z87.891,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,1,2222.58,1102.09,949.87,137.22,15.0,0.0,152.22,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000011035,MBR00000430,Institutional-IP,2022-06-02,2022-06-11,2022-06-21,PLN1557,1569105090,1569105090,Geriatrics,In-Network,J06.9,F32.9,,,,195,MS-DRG,21,9,Y,99284,E&M,,,0510,21,Inpatient Hospital,2,542.91,361.38,361.38,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011036,MBR00000430,Institutional-IP,2021-04-02,2021-04-04,2021-04-14,PLN3514,1717546253,1717546253,Family Medicine,In-Network,F32.9,I25.10,,,,641,MS-DRG,5,2,Y,90837,Medicine,,,0450,21,Inpatient Hospital,1,198.08,121.86,97.85,0.0,0.0,24.01,24.01,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000011037,MBR00000430,Institutional-OP,2023-11-27,2023-11-27,2023-12-14,PLN4006,1390307371,1390307371,DME Supplier,In-Network,E11.65,E66.9,,,,,,,0,,90686,Medicine,,,0360,22,Outpatient Hospital,3,59.09,46.03,0.0,46.03,0.0,0.0,46.03,0.0,Adjusted,,,0,,0,1,0,0,0,1,Phantom,0,0,0,0,0
CLM0000011038,MBR00000430,Professional,2021-01-10,2021-01-10,2021-02-09,PLN4253,1563980627,1563980627,Critical Access Hospital,In-Network,R05,B97.89,,,,,,,0,,99284,E&M,,,,11,Office,2,444.7,274.7,224.7,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011039,MBR00000430,Institutional-OP,2023-08-13,2023-08-13,2023-08-31,PLN8781,1486164553,1486164553,DME Supplier,In-Network,I10,Z23,,,,,,,0,,86900,Pathology/Lab,,,0301,22,Outpatient Hospital,2,41.01,23.38,0.0,23.38,0.0,0.0,23.38,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000011040,MBR00000430,Institutional-OP,2022-04-21,2022-04-21,2022-05-27,PLN1330,1609526529,1609526529,Psychiatry,In-Network,Z12.31,C50.912,,,,,,,0,,93225,Medicine,,,0636,22,Outpatient Hospital,1,357.71,234.16,234.16,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000011041,MBR00000430,Institutional-OP,2022-07-18,2022-07-18,2022-08-13,PLN2065,1990090423,1990090423,Orthopedic Surgery,In-Network,E11.9,I25.10,,,,,,,0,,G0468,Medicine,,,0900,22,Outpatient Hospital,3,498.84,175.52,140.73,0.0,25.0,9.79,34.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011042,MBR00000430,Professional,2023-04-18,2023-04-18,2023-05-31,PLN5040,1891849440,1891849440,Oncology,In-Network,N39.0,Z23,,,,,,,0,,72148,Radiology,,,,11,Office,2,2842.8,1095.95,837.62,208.33,50.0,0.0,258.33,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011043,MBR00000430,Professional,2023-10-27,2023-10-27,2023-11-27,PLN6546,1268679390,1268679390,Critical Access Hospital,In-Network,Z12.31,K21.0,,,,,,,0,,45380,Surgery,,,,11,Office,1,2659.7,1802.5,1726.77,75.73,0.0,0.0,75.73,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000011044,MBR00000430,Institutional-OP,2021-06-14,2021-06-14,2021-07-20,PLN8299,1193493783,1193493783,Critical Access Hospital,Out-of-Network,J06.9,K21.0,,,,,,,0,,99213,E&M,,,0450,22,Outpatient Hospital,2,331.68,204.34,181.78,0.0,0.0,22.56,22.56,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011045,MBR00000430,Professional,2023-06-08,2023-06-08,2023-06-29,PLN5998,1355166277,1355166277,Endocrinology,In-Network,Z23,E66.9,,,,,,,0,,23472,Surgery,,,,23,Emergency Room,1,6533.09,3403.96,3066.85,337.11,0.0,0.0,337.11,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011046,MBR00000430,Institutional-OP,2022-12-25,2022-12-25,2023-02-04,PLN7322,1124394415,1124394415,Pediatrics,In-Network,I10,E78.5,,,,,,,0,,90460,Medicine,,,0120,22,Outpatient Hospital,1,48.77,16.85,16.85,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011047,MBR00000430,Professional,2022-02-08,2022-02-08,2022-02-27,PLN9770,1500037969,1500037969,Pulmonology,In-Network,E11.40,F10.20,,,,,,,0,,99283,E&M,,,,31,Skilled Nursing Facility,2,339.97,125.87,75.87,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011048,MBR00000430,Institutional-OP,2022-04-12,2022-04-12,2022-05-08,PLN1333,1520687146,1520687146,ASC,In-Network,Z51.11,E11.9,,,,,,,0,,99203,E&M,,,0320,22,Outpatient Hospital,2,397.99,152.98,77.98,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011049,MBR00000430,Professional,2023-04-25,2023-04-25,2023-05-17,PLN2514,1518055405,1518055405,Urology,In-Network,I25.10,F41.9,,,,,,,0,,83036,Pathology/Lab,,,,49,Independent Clinic,2,87.18,30.85,30.85,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000011050,MBR00000430,Institutional-OP,2021-06-03,2021-06-03,2021-06-29,PLN9120,1103747954,1103747954,Urology,In-Network,N17.9,N18.3,,,,,,,0,,97110,Medicine,,,0360,22,Outpatient Hospital,2,173.9,131.16,131.16,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011051,MBR00000430,Institutional-IP,2022-07-08,2022-07-10,2022-07-19,PLN3617,1745114564,1745114564,Endocrinology,In-Network,Z23,I25.10,,,,603,MS-DRG,6,2,Y,99284,E&M,,,0200,21,Inpatient Hospital,1,819.01,627.43,602.43,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011052,MBR00000430,Professional,2023-03-02,2023-03-02,2023-03-26,PLN3286,1575695214,1575695214,SNF,In-Network,E66.9,Z00.00,,,,,,,0,,99203,E&M,,,,23,Emergency Room,3,362.0,164.63,157.08,0.0,0.0,7.55,7.55,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011053,MBR00000430,Professional,2022-08-14,2022-08-14,2022-09-05,PLN4972,1422747896,1422747896,Urology,In-Network,M17.11,J06.9,,,,,,,0,,47562,Surgery,,,,81,Independent Laboratory,3,4460.9,1727.86,1727.86,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011054,MBR00000430,Professional,2022-05-06,2022-05-06,2022-06-15,PLN9431,1974006077,1974006077,Orthopedic Surgery,In-Network,E11.9,Z23,,,,,,,0,,93225,Medicine,,,,22,Outpatient Hospital,3,636.87,341.44,341.44,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011055,MBR00000430,Institutional-OP,2022-07-25,2022-07-25,2022-08-16,PLN2982,1717912431,1717912431,Oncology,In-Network,M17.11,I11.9,,,,,,,0,,99221,E&M,,,0510,22,Outpatient Hospital,1,426.02,361.86,361.86,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011056,MBR00000430,Professional,2022-07-15,2022-07-15,2022-08-14,PLN8464,1935547131,1935547131,Pulmonology,In-Network,F32.9,I11.9,,,,,,,0,,99284,E&M,,,,81,Independent Laboratory,1,516.42,172.2,0.0,172.2,50.0,0.0,222.2,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011057,MBR00000430,Institutional-IP,2023-05-31,2023-06-03,2023-06-13,PLN7241,1845057593,1845057593,Orthopedic Surgery,In-Network,F32.9,M54.5,,,,690,MS-DRG,21,3,Y,90460,Medicine,,,0730,21,Inpatient Hospital,2,71.22,57.03,57.03,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011058,MBR00000430,Professional,2023-06-18,2023-06-18,2023-06-30,PLN3175,1372918899,1372918899,Family Medicine,In-Network,R10.9,Z79.4,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,2,26330.34,14948.2,14913.2,0.0,35.0,0.0,35.0,0.0,Adjusted,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000011059,MBR00000430,Institutional-OP,2023-10-03,2023-10-03,2023-10-13,PLN9029,1135158374,1135158374,Pulmonology,In-Network,M54.5,N39.0,,,,,,,0,,93306,Radiology,,,0120,22,Outpatient Hospital,1,1521.47,846.29,846.29,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011060,MBR00000430,Professional,2021-03-20,2021-03-20,2021-05-03,PLN1086,1752470395,1752470395,Home Health,In-Network,R07.9,M54.5,,,,,,,0,,45378,Surgery,,,,49,Independent Clinic,1,1143.62,411.82,396.82,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000011061,MBR00000430,Institutional-OP,2021-12-16,2021-12-16,2022-01-26,PLN1999,1193493783,1193493783,Critical Access Hospital,Out-of-Network,E66.9,I48.91,,,,,,,0,,71046,Radiology,,,0450,22,Outpatient Hospital,2,137.68,66.16,66.16,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011062,MBR00000430,Institutional-IP,2023-08-19,2023-08-31,2023-09-18,PLN1511,1266606767,1266606767,ASC,In-Network,E78.5,Z00.01,,,,292,MS-DRG,3,12,Y,45380,Surgery,,,0761,21,Inpatient Hospital,2,2904.07,1148.53,656.91,476.62,15.0,0.0,491.62,0.0,Paid,,,1,,0,0,1,0,1,0,None,0,1,0,0,0
CLM0000011063,MBR00000430,Institutional-OP,2022-12-04,2022-12-04,2022-12-13,PLN4265,1799205295,1799205295,General Acute Care Hospital,In-Network,I48.91,M54.5,,,,,,,0,,99213,E&M,,,0636,22,Outpatient Hospital,2,261.4,200.99,200.99,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011064,MBR00000430,Institutional-OP,2022-02-17,2022-02-17,2022-02-26,PLN9396,1799205295,1799205295,General Acute Care Hospital,In-Network,I10,I10,,,,,,,0,,99284,E&M,,,0761,22,Outpatient Hospital,1,483.84,309.91,262.62,0.0,0.0,47.29,47.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011065,MBR00000430,Professional,2022-11-20,2022-11-20,2023-01-03,PLN6187,1696843572,1696843572,Critical Access Hospital,Out-of-Network,F32.9,Z00.01,,,,,,,0,,99283,E&M,,,,12,Home,3,439.64,323.42,229.36,94.06,0.0,0.0,94.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011066,MBR00000431,Professional,2022-05-23,2022-05-23,2022-06-29,PLN5314,1475984649,1475984649,SNF,In-Network,Z12.31,Z87.891,,,,,,,0,,99283,E&M,,,,11,Office,2,364.33,270.67,267.3,0.0,0.0,3.37,3.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011067,MBR00000431,Professional,2023-08-30,2023-08-30,2023-09-21,PLN1123,1366576336,1366576336,Geriatrics,In-Network,I10,E11.9,,,,,,,0,,99284,E&M,,,,11,Office,2,889.42,569.29,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011068,MBR00000431,Professional,2022-09-04,2022-09-04,2022-10-13,PLN8835,1463205530,1463205530,Nephrology,In-Network,J06.9,Z00.00,,,,,,,0,,93225,Medicine,,,,50,Federally Qualified Health Center,2,537.65,361.35,11.3,300.05,50.0,0.0,350.05,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011069,MBR00000431,Professional,2022-05-05,2022-05-05,2022-05-19,PLN6383,1575695214,1575695214,SNF,In-Network,Z12.31,K21.0,,,,,,,0,,99222,E&M,,,,81,Independent Laboratory,2,315.43,222.95,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011070,MBR00000431,Institutional-OP,2022-11-14,2022-11-14,2022-11-28,PLN2435,1410468316,1410468316,SNF,In-Network,K57.30,N18.3,,,,,,,0,,97110,Medicine,,,0450,22,Outpatient Hospital,1,192.77,130.97,18.52,37.45,75.0,0.0,112.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011071,MBR00000431,Professional,2021-07-28,2021-07-28,2021-08-23,PLN1685,1450094833,1450094833,Outpatient Clinic,In-Network,I63.9,E11.9,,,,,,,0,,90686,Medicine,,,,11,Office,3,50.49,27.87,12.87,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000011072,MBR00000431,Institutional-IP,2023-04-24,2023-05-03,2023-05-20,PLN2510,1717912431,1717912431,Oncology,In-Network,Z00.00,K21.0,,,,682,MS-DRG,14,9,Y,66984,Surgery,,,0370,21,Inpatient Hospital,2,3316.53,1940.01,1409.74,455.27,75.0,0.0,530.27,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011073,MBR00000431,Professional,2021-08-11,2021-08-11,2021-09-07,PLN7428,1910255109,1910255109,DME Supplier,In-Network,Z12.31,I10,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,3,308.54,261.25,225.42,0.0,0.0,35.83,35.83,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011074,MBR00000431,Professional,2021-01-26,2021-01-26,2021-02-25,PLN2600,1450094833,1450094833,Outpatient Clinic,In-Network,R10.9,E78.5,,,,,,,0,,97530,Medicine,,,,21,Inpatient Hospital,2,250.1,212.11,162.11,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011075,MBR00000431,Professional,2021-02-26,2021-02-26,2021-03-12,PLN5440,1749327647,1749327647,Geriatrics,In-Network,Z00.00,Z23,,,,,,,0,,85610,Pathology/Lab,,,,21,Inpatient Hospital,1,42.6,26.94,0.0,26.94,0.0,0.0,26.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011076,MBR00000431,Professional,2021-03-14,2021-03-14,2021-04-17,PLN2597,1644128543,1644128543,Gastroenterology,In-Network,Z00.01,F03.90,,,,,,,0,,66984,Surgery,,,,21,Inpatient Hospital,2,2544.44,1000.86,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-27,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011077,MBR00000431,Institutional-OP,2021-04-21,2021-04-21,2021-05-04,PLN3484,1540044947,1540044947,Pulmonology,Out-of-Network,J20.9,Z23,,,,,,,0,,99232,E&M,,,0730,22,Outpatient Hospital,3,202.07,73.04,0.0,73.04,0.0,0.0,73.04,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011078,MBR00000431,Institutional-OP,2021-02-25,2021-02-25,2021-03-07,PLN4426,1364429278,1364429278,OB/GYN,In-Network,N39.0,Z23,,,,,,,0,,97110,Medicine,,,0636,22,Outpatient Hospital,3,279.88,138.12,111.54,0.0,0.0,26.58,26.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011079,MBR00000431,Professional,2021-11-26,2021-11-26,2021-12-28,PLN1515,1205377316,1205377316,Orthopedic Surgery,In-Network,Z00.00,N40.0,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,1,74.81,54.98,0.0,54.98,0.0,0.0,54.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011080,MBR00000431,Institutional-OP,2023-11-19,2023-11-19,2023-12-03,PLN6563,1239316214,1239316214,Internal Medicine,In-Network,M54.5,Z00.00,,,,,,,0,,99233,E&M,,,0730,22,Outpatient Hospital,2,527.57,249.56,91.57,157.99,0.0,0.0,157.99,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000011081,MBR00000431,Professional,2021-04-23,2021-04-23,2021-05-03,PLN5378,1334916761,1334916761,ASC,In-Network,E66.9,E11.65,,,,,,,0,,99213,E&M,,,,20,Urgent Care,1,117.65,52.51,52.51,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011082,MBR00000431,Professional,2023-01-11,2023-01-11,2023-01-31,PLN8903,1236418230,1236418230,DME Supplier,In-Network,J06.9,Z00.00,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,1,40.89,27.17,0.0,12.47,35.0,0.0,47.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011083,MBR00000431,Professional,2023-08-12,2023-08-12,2023-08-24,PLN2426,1757138478,1757138478,Pediatrics,In-Network,R05,Z12.31,,,,,,,0,,G0439,Medicine,,,,50,Federally Qualified Health Center,1,468.25,242.93,1.09,241.84,0.0,0.0,241.84,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000011084,MBR00000431,Professional,2023-06-06,2023-06-06,2023-07-12,PLN9823,1438368327,1438368327,Home Health,In-Network,F32.9,F41.9,,,,,,,0,,66984,Surgery,,,,12,Home,2,2235.53,1350.72,1350.72,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011085,MBR00000431,Institutional-OP,2022-02-01,2022-02-01,2022-02-18,PLN3684,1224179551,1224179551,Physical Therapy,In-Network,E66.9,Z12.11,,,,,,,0,,99283,E&M,,,0450,22,Outpatient Hospital,2,368.44,266.01,266.01,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011086,MBR00000431,Institutional-OP,2021-02-27,2021-02-27,2021-03-28,PLN9964,1767011137,1767011137,DME Supplier,In-Network,I48.91,I10,,,,,,,0,,99221,E&M,,,0730,22,Outpatient Hospital,2,358.03,261.37,80.18,181.19,0.0,0.0,181.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011087,MBR00000431,Institutional-IP,2022-02-08,2022-02-10,2022-02-15,PLN8950,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,F41.9,Z23,,,,682,MS-DRG,12,2,Y,72148,Radiology,,,0761,21,Inpatient Hospital,3,2957.49,1771.25,1736.25,0.0,35.0,0.0,35.0,0.0,Pended,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000011088,MBR00000431,Professional,2022-10-21,2022-10-21,2022-11-06,PLN9961,1644128543,1644128543,Gastroenterology,In-Network,E66.9,M17.11,,,,,,,0,,99284,E&M,,,,49,Independent Clinic,2,430.09,342.4,342.4,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011089,MBR00000431,Professional,2023-04-10,2023-04-10,2023-05-18,PLN8090,1433937353,1433937353,Nephrology,In-Network,G20,K57.30,,,,,,,0,,99233,E&M,,,,11,Office,3,378.59,291.49,137.11,141.58,0.0,12.8,154.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011090,MBR00000431,Professional,2021-06-05,2021-06-05,2021-07-09,PLN4069,1585582070,1585582070,Outpatient Clinic,In-Network,Z12.11,F32.9,,,,,,,0,,99213,E&M,,,,81,Independent Laboratory,3,156.72,55.94,0.0,55.94,25.0,0.0,80.94,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011091,MBR00000431,Professional,2021-11-26,2021-11-26,2022-01-04,PLN6709,1453936007,1453936007,ASC,In-Network,Z12.31,F32.9,,,,,,,0,,70450,Radiology,,,,22,Outpatient Hospital,1,629.85,423.36,423.36,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011092,MBR00000431,Institutional-IP,2022-10-21,2022-10-26,2022-11-15,PLN4672,1896447406,1896447406,Nephrology,Out-of-Network,F10.20,Z23,,,,196,MS-DRG,19,5,Y,58661,Surgery,,,0320,21,Inpatient Hospital,1,2226.41,1498.95,1185.95,313.0,0.0,0.0,313.0,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011093,MBR00000431,Professional,2023-02-23,2023-02-23,2023-03-12,PLN8051,1980712759,1980712759,Outpatient Clinic,Out-of-Network,K21.0,M54.5,,,,,,,0,,99406,Medicine,,,,11,Office,1,43.52,18.94,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011094,MBR00000431,Professional,2021-12-07,2021-12-07,2022-01-13,PLN9691,1778483301,1778483301,Home Health,In-Network,G43.909,I10,,,,,,,0,,99232,E&M,,,,11,Office,1,208.19,94.9,0.0,94.9,0.0,0.0,94.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011095,MBR00000431,Institutional-IP,2023-06-20,2023-06-27,2023-07-02,PLN3628,1964402759,1964402759,Outpatient Clinic,In-Network,R51,I10,,,,683,MS-DRG,8,7,Y,97530,Medicine,,,0360,21,Inpatient Hospital,2,195.64,120.94,37.72,0.0,75.0,8.22,83.22,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011096,MBR00000431,Professional,2023-05-28,2023-05-28,2023-06-08,PLN4088,1660288235,1660288235,ASC,In-Network,Z00.00,I50.9,,,,,,,0,,47562,Surgery,,,,11,Office,3,6175.96,5089.76,5014.76,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011097,MBR00000431,Institutional-IP,2022-01-30,2022-02-06,2022-02-13,PLN9581,1193493783,1193493783,Critical Access Hospital,Out-of-Network,N40.0,F41.9,,,,641,MS-DRG,13,7,Y,97110,Medicine,,,0320,21,Inpatient Hospital,3,279.53,116.31,0.0,116.31,50.0,0.0,166.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011098,MBR00000431,Institutional-OP,2022-08-11,2022-08-11,2022-09-04,PLN5168,1946680931,1946680931,Critical Access Hospital,Out-of-Network,M54.5,I48.91,,,,,,,0,,99203,E&M,,,0740,22,Outpatient Hospital,3,191.05,148.2,137.13,0.0,0.0,11.07,11.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011099,MBR00000431,Institutional-IP,2022-06-08,2022-06-13,2022-06-19,PLN8403,1997536841,1997536841,Family Medicine,Out-of-Network,N18.3,K21.0,,,,292,MS-DRG,3,5,Y,99204,E&M,,,0636,21,Inpatient Hospital,1,236.26,106.64,98.64,0.0,0.0,8.0,8.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011100,MBR00000431,Institutional-OP,2023-01-03,2023-01-03,2023-01-27,PLN3294,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,E11.9,Z00.00,,,,,,,0,,27130,Surgery,,,0320,22,Outpatient Hospital,1,7049.08,4591.58,4566.58,0.0,25.0,0.0,25.0,0.0,Pended,,,0,,0,0,1,0,0,1,Unbundling,0,0,0,0,0
CLM0000011101,MBR00000431,Institutional-IP,2021-12-19,2021-12-21,2022-01-27,PLN3015,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,Z23,F32.9,,,,603,MS-DRG,3,2,Y,99233,E&M,,,0900,21,Inpatient Hospital,3,365.64,176.0,67.31,83.69,25.0,0.0,108.69,0.0,Adjusted,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000011102,MBR00000431,Institutional-OP,2021-12-27,2021-12-27,2022-01-25,PLN7476,1806688928,1806688928,Geriatrics,In-Network,N18.3,N39.0,,,,,,,0,,99214,E&M,,,0740,22,Outpatient Hospital,1,329.41,243.18,65.14,162.57,15.0,0.47,178.04,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011103,MBR00000431,Institutional-IP,2022-04-09,2022-04-11,2022-05-09,PLN2063,1631954542,1631954542,Oncology,In-Network,M54.5,I10,,,,291,MS-DRG,18,2,Y,23472,Surgery,,,0761,21,Inpatient Hospital,3,4414.35,3137.21,3087.21,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011104,MBR00000431,Institutional-OP,2021-08-25,2021-08-25,2021-09-03,PLN5739,1540044947,1540044947,Pulmonology,Out-of-Network,Z23,Z00.01,,,,,,,0,,93000,Radiology,,,0900,22,Outpatient Hospital,1,187.13,143.66,0.0,143.66,35.0,0.0,178.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011105,MBR00000431,Professional,2022-09-28,2022-09-28,2022-10-07,PLN6877,1964402759,1964402759,Outpatient Clinic,In-Network,Z00.00,M81.0,,,,,,,0,,78452,Radiology,,,,31,Skilled Nursing Facility,3,7113.01,5775.57,5424.7,300.87,50.0,0.0,350.87,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011106,MBR00000431,Professional,2023-11-16,2023-11-16,2023-11-27,PLN1884,1366426662,1366426662,Urology,In-Network,I10,R05,,,,,,,0,,99221,E&M,,,,23,Emergency Room,1,437.57,158.88,0.0,158.88,0.0,0.0,158.88,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011107,MBR00000431,Professional,2022-01-18,2022-01-18,2022-02-01,PLN2489,1563980627,1563980627,Critical Access Hospital,In-Network,N18.3,I25.10,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,3,97.99,45.28,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000011108,MBR00000431,Institutional-IP,2023-08-01,2023-08-06,2023-09-05,PLN4358,1520687146,1520687146,ASC,In-Network,E78.5,E66.9,,,,641,MS-DRG,3,5,Y,33533,Surgery,,,0740,21,Inpatient Hospital,3,24205.22,8539.38,7249.65,0.0,75.0,1214.73,1289.73,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000011109,MBR00000431,Professional,2022-05-24,2022-05-24,2022-06-13,PLN9488,1948810580,1948810580,DME Supplier,In-Network,Z00.00,I10,,,,,,,0,,87491,Pathology/Lab,,,,12,Home,1,124.58,91.76,91.76,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011110,MBR00000431,Institutional-OP,2021-07-01,2021-07-01,2021-07-30,PLN4262,1514306773,1514306773,Endocrinology,In-Network,J06.9,Z51.11,,,,,,,0,,99232,E&M,,,0320,22,Outpatient Hospital,3,225.28,107.29,103.6,0.0,0.0,3.69,3.69,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011111,MBR00000431,Institutional-IP,2022-06-28,2022-06-30,2022-07-21,PLN7635,1946680931,1946680931,Critical Access Hospital,Out-of-Network,M54.5,R07.9,,,,690,MS-DRG,7,2,Y,99283,E&M,,,0320,21,Inpatient Hospital,2,332.57,240.64,0.0,240.64,0.0,0.0,240.64,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000011112,MBR00000431,Professional,2022-07-01,2022-07-01,2022-07-26,PLN9911,1139906830,1139906830,Endocrinology,Out-of-Network,E11.9,Z00.00,,,,,,,0,,77067,Radiology,,,,20,Urgent Care,2,586.36,483.26,408.26,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000011113,MBR00000431,Professional,2021-01-27,2021-01-27,2021-02-03,PLN9644,1395983630,1395983630,Nephrology,In-Network,I10,J44.1,,,,,,,0,,99284,E&M,,,,81,Independent Laboratory,2,342.47,215.39,0.0,215.39,0.0,0.0,215.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011114,MBR00000431,Institutional-OP,2022-06-09,2022-06-09,2022-06-25,PLN9533,1767011137,1767011137,DME Supplier,In-Network,Z00.00,Z12.31,,,,,,,0,,99204,E&M,,,0730,22,Outpatient Hospital,1,544.24,302.7,243.03,0.0,0.0,59.67,59.67,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011115,MBR00000431,Institutional-OP,2021-06-29,2021-06-29,2021-07-22,PLN5677,1713934949,1713934949,Neurology,In-Network,J44.1,K21.0,,,,,,,0,,99406,Medicine,,,0270,22,Outpatient Hospital,2,104.54,40.28,0.0,40.28,75.0,0.0,115.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011116,MBR00000432,Institutional-IP,2023-05-20,2023-06-02,2023-06-17,PLN8898,1585582070,1585582070,Outpatient Clinic,In-Network,C50.912,Z96.641,,,,690,MS-DRG,14,13,Y,27447,Surgery,,,0900,21,Inpatient Hospital,2,4423.29,2633.97,2383.89,140.34,35.0,74.74,250.08,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011117,MBR00000432,Professional,2022-08-16,2022-08-16,2022-09-11,PLN5325,1148984206,1148984206,Psychiatry,In-Network,E11.9,I10,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,1,38.51,17.68,0.0,3.08,35.0,0.0,38.08,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011118,MBR00000432,Institutional-OP,2021-11-30,2021-11-30,2021-12-31,PLN8907,1135158374,1135158374,Pulmonology,In-Network,J06.9,F41.9,,,,,,,0,,82043,Pathology/Lab,,,0370,22,Outpatient Hospital,2,64.06,51.37,51.37,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011119,MBR00000432,Institutional-OP,2021-01-03,2021-01-03,2021-01-23,PLN6593,1757138478,1757138478,Pediatrics,In-Network,R05,Z12.31,,,,,,,0,,99214,E&M,,,0510,22,Outpatient Hospital,1,310.7,226.95,226.95,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011120,MBR00000432,Institutional-OP,2022-09-18,2022-09-18,2022-09-27,PLN6389,1896447406,1896447406,Nephrology,Out-of-Network,I11.9,K21.0,,,,,,,0,,45378,Surgery,,,0740,22,Outpatient Hospital,2,1722.26,1407.15,1382.15,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000011121,MBR00000432,Institutional-IP,2023-02-11,2023-02-17,2023-03-15,PLN6751,1355166277,1355166277,Endocrinology,In-Network,J20.9,I10,,,,470,MS-DRG,8,6,Y,70450,Radiology,,,0370,21,Inpatient Hospital,3,1542.93,1273.91,1273.91,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011122,MBR00000432,Professional,2022-04-10,2022-04-10,2022-05-01,PLN2737,1132188260,1132188260,Family Medicine,In-Network,E78.5,I11.9,,,,,,,0,,84443,Pathology/Lab,,,,23,Emergency Room,1,64.55,45.05,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011123,MBR00000432,Institutional-OP,2023-09-19,2023-09-19,2023-10-03,PLN8502,1103747954,1103747954,Urology,In-Network,N20.0,J06.9,,,,,,,0,,99406,Medicine,,,0900,22,Outpatient Hospital,3,86.04,40.39,0.0,40.39,0.0,0.0,40.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011124,MBR00000432,Professional,2021-08-03,2021-08-03,2021-08-13,PLN3146,1542828721,1542828721,Orthopedic Surgery,In-Network,Z12.31,I10,,,,,,,0,,99213,E&M,,,,21,Inpatient Hospital,1,148.31,68.69,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011125,MBR00000432,Professional,2023-04-07,2023-04-07,2023-05-08,PLN9770,1103747954,1103747954,Urology,In-Network,Z23,Z00.01,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,2,97.26,40.68,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011126,MBR00000432,Institutional-IP,2022-06-27,2022-06-28,2022-07-24,PLN5122,1242201429,1242201429,General Acute Care Hospital,In-Network,F32.9,K21.0,,,,690,MS-DRG,9,1,Y,66984,Surgery,,,0200,21,Inpatient Hospital,2,2166.34,1722.25,1354.34,184.8,50.0,133.11,367.91,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011127,MBR00000432,Professional,2021-12-10,2021-12-10,2021-12-22,PLN9339,1974006077,1974006077,Orthopedic Surgery,In-Network,E11.9,F41.9,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,3,6594.42,4215.51,4084.47,83.38,35.0,12.66,131.04,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011128,MBR00000432,Institutional-OP,2021-11-12,2021-11-12,2021-12-15,PLN5249,1790497490,1790497490,OB/GYN,In-Network,R51,N40.0,,,,,,,0,,99233,E&M,,,0740,22,Outpatient Hospital,3,505.78,267.17,0.0,267.17,0.0,0.0,267.17,0.0,Denied,CO-97,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000011129,MBR00000432,Institutional-IP,2022-05-08,2022-05-13,2022-05-21,PLN1123,1891849440,1891849440,Oncology,In-Network,F32.9,F03.90,,,,690,MS-DRG,9,5,Y,90460,Medicine,,,0510,21,Inpatient Hospital,1,35.24,16.61,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011130,MBR00000432,Professional,2021-03-30,2021-03-30,2021-04-14,PLN4955,1974006077,1974006077,Orthopedic Surgery,In-Network,K57.30,F10.20,,,,,,,0,,74177,Radiology,,,,21,Inpatient Hospital,2,1261.82,914.64,736.07,0.0,0.0,178.57,178.57,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011131,MBR00000432,Institutional-IP,2022-12-14,2022-12-23,2023-01-20,PLN9716,1767011137,1767011137,DME Supplier,In-Network,J06.9,J06.9,,,,690,MS-DRG,22,9,Y,78452,Radiology,,,0636,21,Inpatient Hospital,1,3704.88,2698.38,2423.16,0.0,15.0,260.22,275.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011132,MBR00000432,Institutional-OP,2022-03-24,2022-03-24,2022-04-23,PLN4318,1390307371,1390307371,DME Supplier,In-Network,I10,M54.5,,,,,,,0,,90837,Medicine,,,0320,22,Outpatient Hospital,1,415.21,280.06,20.09,244.33,15.0,0.64,259.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011133,MBR00000432,Institutional-OP,2023-01-16,2023-01-16,2023-02-13,PLN5505,1511044648,1511044648,Endocrinology,In-Network,R07.9,N39.0,,,,,,,0,,99232,E&M,,,0360,22,Outpatient Hospital,1,360.53,136.26,50.02,0.0,75.0,11.24,86.24,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011134,MBR00000432,Professional,2022-07-19,2022-07-19,2022-08-03,PLN7696,1700633438,1700633438,DME Supplier,In-Network,F41.9,I25.10,,,,,,,0,,86900,Pathology/Lab,,,,23,Emergency Room,3,41.45,17.48,14.96,0.0,0.0,2.52,2.52,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011135,MBR00000432,Professional,2023-12-07,2023-12-07,2024-01-14,PLN7716,1366286000,1366286000,SNF,In-Network,Z79.4,Z23,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,1,25274.06,21147.99,20496.3,0.0,50.0,601.69,651.69,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000011136,MBR00000432,Professional,2021-04-01,2021-04-01,2021-05-14,PLN9139,1590915516,1590915516,Physical Therapy,Out-of-Network,Z23,I10,,,,,,,0,,45378,Surgery,,,,21,Inpatient Hospital,1,1288.81,953.0,953.0,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000011137,MBR00000432,Institutional-OP,2022-06-24,2022-06-24,2022-07-06,PLN4272,1500949740,1500949740,Pediatrics,In-Network,I10,E78.5,,,,,,,0,,80061,Pathology/Lab,,,0370,22,Outpatient Hospital,3,118.12,54.95,0.0,54.95,0.0,0.0,54.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011138,MBR00000432,Institutional-IP,2022-08-11,2022-08-16,2022-08-24,PLN7950,1606140917,1606140917,ASC,In-Network,J44.1,E66.9,,,,871,MS-DRG,19,5,Y,99221,E&M,,,0320,21,Inpatient Hospital,3,373.8,157.49,157.49,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011139,MBR00000432,Professional,2021-10-01,2021-10-01,2021-11-10,PLN7437,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,E11.9,Z23,,,,,,,0,,G0444,Medicine,,,,49,Independent Clinic,1,88.86,72.26,0.0,72.26,0.0,0.0,72.26,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000011140,MBR00000432,Professional,2023-01-07,2023-01-07,2023-01-29,PLN4837,1845057593,1845057593,Orthopedic Surgery,In-Network,R07.9,M54.5,,,,,,,0,,66984,Surgery,,,,21,Inpatient Hospital,1,1577.73,771.22,709.09,62.13,0.0,0.0,62.13,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011141,MBR00000432,Institutional-OP,2022-02-01,2022-02-01,2022-03-12,PLN6041,1790497490,1790497490,OB/GYN,In-Network,Z23,Z23,,,,,,,0,,47562,Surgery,,,0450,22,Outpatient Hospital,3,2701.03,1561.08,1333.11,152.97,75.0,0.0,227.97,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011142,MBR00000432,Institutional-OP,2023-04-17,2023-04-17,2023-05-22,PLN3550,1817234602,1817234602,Clinical Laboratory,In-Network,Z23,N18.3,,,,,,,0,,27130,Surgery,,,0900,22,Outpatient Hospital,2,4900.17,3900.14,3733.71,0.0,0.0,166.43,166.43,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011143,MBR00000432,Professional,2023-10-08,2023-10-08,2023-11-20,PLN7043,1624802371,1624802371,ASC,Out-of-Network,N40.0,Z00.01,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,2,339.11,232.32,217.39,0.0,0.0,14.93,14.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011144,MBR00000432,Professional,2023-07-24,2023-07-24,2023-09-05,PLN2903,1585582070,1585582070,Outpatient Clinic,In-Network,M54.5,I10,,,,,,,0,,72148,Radiology,,,,11,Office,1,1590.72,1080.5,901.5,0.0,50.0,129.0,179.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011145,MBR00000432,Professional,2022-11-24,2022-11-24,2022-12-06,PLN2214,1856686341,1856686341,Geriatrics,In-Network,I10,I48.91,,,,,,,0,,72148,Radiology,,,,11,Office,1,1321.25,574.26,81.46,447.87,35.0,9.93,492.8,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011146,MBR00000432,Institutional-OP,2023-02-26,2023-02-26,2023-03-19,PLN9188,1518055405,1518055405,Urology,In-Network,E11.9,K21.0,,,,,,,0,,99204,E&M,,,0636,22,Outpatient Hospital,1,264.95,192.23,49.45,92.78,50.0,0.0,142.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011147,MBR00000432,Institutional-IP,2023-08-05,2023-08-17,2023-08-29,PLN4001,1410468316,1410468316,SNF,In-Network,K21.0,N20.0,,,,196,MS-DRG,11,12,Y,99284,E&M,,,0636,21,Inpatient Hospital,3,502.66,356.43,281.43,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011148,MBR00000432,Institutional-OP,2023-12-10,2023-12-10,2023-12-28,PLN6361,1283743001,1283743001,Family Medicine,In-Network,I10,Z12.31,,,,,,,0,,85610,Pathology/Lab,,,0450,22,Outpatient Hospital,2,70.9,38.43,23.43,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011149,MBR00000432,Professional,2023-03-04,2023-03-04,2023-03-26,PLN8913,1410468316,1410468316,SNF,In-Network,G43.909,R05,,,,,,,0,,45380,Surgery,,,,11,Office,1,1861.11,991.46,920.15,0.0,0.0,71.31,71.31,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000011150,MBR00000432,Professional,2023-09-27,2023-09-27,2023-10-25,PLN3120,1609526529,1609526529,Psychiatry,In-Network,B97.89,F10.20,,,,,,,0,,72148,Radiology,,,,11,Office,3,1320.52,792.66,792.66,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011151,MBR00000433,Professional,2023-11-24,2023-11-24,2024-01-05,PLN8791,1990090423,1990090423,Orthopedic Surgery,In-Network,I10,R05,,,,,,,0,,58661,Surgery,,,,11,Office,2,2842.83,2279.54,1982.87,29.3,25.0,242.37,296.67,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011152,MBR00000433,Professional,2021-07-12,2021-07-12,2021-08-13,PLN1520,1389336600,1389336600,Critical Access Hospital,In-Network,Z23,J18.9,,,,,,,0,,99203,E&M,,,,21,Inpatient Hospital,2,229.57,123.31,98.31,0.0,25.0,0.0,25.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011153,MBR00000433,Professional,2022-07-03,2022-07-03,2022-08-13,PLN9362,1266606767,1266606767,ASC,In-Network,J06.9,Z23,,,,,,,0,,93306,Radiology,,,,12,Home,1,1219.5,977.94,853.13,0.0,35.0,89.81,124.81,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011154,MBR00000433,Professional,2022-01-27,2022-01-27,2022-02-26,PLN1015,1500037969,1500037969,Pulmonology,In-Network,I25.10,E78.5,,,,,,,0,,99233,E&M,,,,11,Office,2,302.41,205.18,167.77,2.41,35.0,0.0,37.41,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011155,MBR00000433,Professional,2023-11-07,2023-11-07,2023-12-02,PLN4052,1865904917,1865904917,Outpatient Clinic,In-Network,K21.0,I10,,,,,,,0,,82043,Pathology/Lab,,,,50,Federally Qualified Health Center,2,28.54,11.39,0.0,11.39,15.0,0.0,26.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011156,MBR00000433,Institutional-OP,2023-03-26,2023-03-26,2023-04-23,PLN9756,1245650222,1245650222,Gastroenterology,In-Network,Z12.11,Z00.00,,,,,,,0,,45380,Surgery,,,0120,22,Outpatient Hospital,3,1528.58,903.03,903.03,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000011157,MBR00000433,Professional,2023-08-29,2023-08-29,2023-10-02,PLN8113,1109850785,1109850785,ASC,Out-of-Network,E11.40,B97.89,,,,,,,0,,66984,Surgery,,,,31,Skilled Nursing Facility,2,1667.94,598.5,573.18,0.0,0.0,25.32,25.32,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011158,MBR00000433,Professional,2022-01-18,2022-01-18,2022-01-30,PLN9464,1749327647,1749327647,Geriatrics,In-Network,J06.9,E66.9,,,,,,,0,,93306,Radiology,,,,22,Outpatient Hospital,2,2864.23,2015.18,1965.18,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011159,MBR00000433,Professional,2023-07-13,2023-07-13,2023-07-27,PLN7250,1749327647,1749327647,Geriatrics,In-Network,E11.9,Z12.31,,,,,,,0,,87491,Pathology/Lab,,,,22,Outpatient Hospital,3,165.23,56.05,47.06,0.0,0.0,8.99,8.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011160,MBR00000433,Professional,2021-03-30,2021-03-30,2021-05-02,PLN6441,1645194539,1645194539,SNF,In-Network,E11.9,E78.5,,,,,,,0,,83036,Pathology/Lab,,,,49,Independent Clinic,1,60.18,23.13,0.0,23.13,25.0,0.0,48.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000011161,MBR00000433,Institutional-IP,2023-10-26,2023-10-31,2023-12-04,PLN1061,1139906830,1139906830,Endocrinology,Out-of-Network,N18.3,Z23,,,,195,MS-DRG,15,5,Y,99214,E&M,,,0510,21,Inpatient Hospital,1,314.42,191.23,0.0,191.23,50.0,0.0,241.23,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011162,MBR00000433,Institutional-IP,2021-09-09,2021-09-15,2021-10-10,PLN2503,1550154147,1550154147,Outpatient Clinic,In-Network,E11.9,Z23,,,,690,MS-DRG,14,6,Y,99213,E&M,,,0370,21,Inpatient Hospital,1,321.43,241.09,0.0,0.0,50.0,17.37,67.37,0.0,Denied,CO-11,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000011163,MBR00000433,Institutional-IP,2022-07-30,2022-08-02,2022-09-12,PLN9050,1631954542,1631954542,Oncology,In-Network,E66.9,Z96.641,,,,872,MS-DRG,17,3,Y,99232,E&M,,,0360,21,Inpatient Hospital,2,143.34,83.56,8.56,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011164,MBR00000433,Institutional-OP,2023-02-24,2023-02-24,2023-03-15,PLN5338,1845900543,1845900543,ASC,In-Network,F41.9,J45.20,,,,,,,0,,76700,Radiology,,,0320,22,Outpatient Hospital,3,893.27,699.52,228.4,468.74,0.0,2.38,471.12,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011165,MBR00000433,Professional,2023-03-25,2023-03-25,2023-04-20,PLN4737,1502838586,1502838586,ASC,In-Network,Z00.00,E78.5,,,,,,,0,,99213,E&M,,,,11,Office,3,200.85,164.75,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011166,MBR00000433,Professional,2021-08-21,2021-08-21,2021-08-28,PLN5202,1453283987,1453283987,Critical Access Hospital,In-Network,Z79.4,E66.9,,,,,,,0,,86900,Pathology/Lab,,,,22,Outpatient Hospital,1,34.95,29.26,2.86,26.4,0.0,0.0,26.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011167,MBR00000433,Professional,2022-09-01,2022-09-01,2022-09-24,PLN5727,1856686341,1856686341,Geriatrics,In-Network,E78.5,I10,,,,,,,0,,23472,Surgery,,,,20,Urgent Care,2,5255.09,3062.96,2479.35,96.32,15.0,472.29,583.61,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011168,MBR00000433,Professional,2022-08-04,2022-08-04,2022-08-14,PLN2994,1910255109,1910255109,DME Supplier,In-Network,J45.20,C50.912,,,,,,,0,,43239,Surgery,,,,22,Outpatient Hospital,3,1966.41,1250.61,971.46,0.0,75.0,204.15,279.15,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011169,MBR00000433,Professional,2023-05-01,2023-05-01,2023-06-07,PLN1476,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,C50.912,Z00.00,,,,,,,0,,72148,Radiology,,,,49,Independent Clinic,3,2680.47,1697.1,1596.37,100.73,0.0,0.0,100.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011170,MBR00000433,Institutional-OP,2021-12-18,2021-12-18,2022-01-23,PLN1406,1268679390,1268679390,Critical Access Hospital,In-Network,J20.9,J06.9,,,,,,,0,,71046,Radiology,,,0370,22,Outpatient Hospital,2,195.18,149.59,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011171,MBR00000433,Institutional-OP,2023-04-17,2023-04-17,2023-05-26,PLN2847,1410468316,1410468316,SNF,In-Network,I10,J20.9,,,,,,,0,,99233,E&M,,,0510,22,Outpatient Hospital,3,441.26,227.7,0.0,0.0,75.0,16.29,91.29,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011172,MBR00000433,Professional,2022-11-06,2022-11-06,2022-12-01,PLN4063,1915531927,1915531927,Critical Access Hospital,In-Network,F32.9,Z12.31,,,,,,,0,,23472,Surgery,,,,23,Emergency Room,3,3554.31,2160.47,2085.47,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011173,MBR00000433,Professional,2023-04-11,2023-04-11,2023-05-24,PLN8975,1745114564,1745114564,Endocrinology,In-Network,N18.3,I10,,,,,,,0,,83036,Pathology/Lab,,,,20,Urgent Care,3,98.24,65.58,0.0,65.58,0.0,0.0,65.58,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000011174,MBR00000433,Institutional-OP,2023-08-17,2023-08-17,2023-09-11,PLN7932,1118885473,1118885473,ASC,In-Network,Z51.11,Z23,,,,,,,0,,70450,Radiology,,,0510,22,Outpatient Hospital,3,1601.8,844.78,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011175,MBR00000433,Institutional-OP,2022-04-15,2022-04-15,2022-05-22,PLN3281,1606140917,1606140917,ASC,In-Network,F10.20,F41.9,,,,,,,0,,99214,E&M,,,0730,22,Outpatient Hospital,1,195.91,159.14,159.14,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011176,MBR00000433,Institutional-IP,2022-04-19,2022-04-23,2022-04-29,PLN1628,1799205295,1799205295,General Acute Care Hospital,In-Network,R10.9,E11.9,,,,690,MS-DRG,10,4,Y,99406,Medicine,,,0200,21,Inpatient Hospital,2,77.99,41.33,41.33,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000011177,MBR00000433,Professional,2023-05-22,2023-05-22,2023-06-12,PLN7534,1800011727,1800011727,Clinical Laboratory,Out-of-Network,Z87.891,Z23,,,,,,,0,,G0444,Medicine,,,,20,Urgent Care,3,48.32,30.06,0.0,30.06,25.0,0.0,55.06,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000011178,MBR00000433,Professional,2023-05-07,2023-05-07,2023-05-27,PLN3469,1790497490,1790497490,OB/GYN,In-Network,F41.9,I10,,,,,,,0,,66984,Surgery,,,,81,Independent Laboratory,2,3259.77,2014.39,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-11,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011179,MBR00000433,Institutional-OP,2023-08-18,2023-08-18,2023-09-28,PLN3099,1268679390,1268679390,Critical Access Hospital,In-Network,E78.5,Z12.31,,,,,,,0,,23472,Surgery,,,0510,22,Outpatient Hospital,3,4167.34,2664.09,0.0,0.0,15.0,128.02,143.02,0.0,Denied,PR-1,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011180,MBR00000433,Professional,2022-08-26,2022-08-26,2022-09-23,PLN9753,1564502315,1564502315,ASC,In-Network,F41.9,E78.5,,,,,,,0,,90460,Medicine,,,,21,Inpatient Hospital,1,32.17,18.05,0.0,18.05,0.0,0.0,18.05,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011181,MBR00000433,Professional,2022-11-28,2022-11-28,2022-12-05,PLN1747,1245650222,1245650222,Gastroenterology,In-Network,Z23,E11.9,,,,,,,0,,99213,E&M,,,,23,Emergency Room,1,319.5,103.61,0.0,103.61,35.0,0.0,138.61,0.0,Paid,,,0,,1,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000011182,MBR00000433,Professional,2021-03-06,2021-03-06,2021-03-21,PLN2035,1899127912,1899127912,Neurology,In-Network,I10,K21.0,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,3,38.63,13.17,0.0,13.17,0.0,0.0,13.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011183,MBR00000433,Institutional-IP,2022-05-13,2022-05-19,2022-06-09,PLN4459,1910255109,1910255109,DME Supplier,In-Network,E11.9,E11.9,,,,683,MS-DRG,18,6,Y,77067,Radiology,,,0301,21,Inpatient Hospital,3,585.04,410.49,353.11,0.0,50.0,7.38,57.38,0.0,Paid,,,0,,0,1,0,0,1,0,None,1,0,0,0,0
CLM0000011184,MBR00000433,Institutional-IP,2021-09-27,2021-10-02,2021-11-02,PLN1376,1266606767,1266606767,ASC,In-Network,G43.909,I10,,,,871,MS-DRG,24,5,Y,93000,Radiology,,,0636,21,Inpatient Hospital,2,80.42,28.11,0.0,28.11,50.0,0.0,78.11,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000011185,MBR00000433,Professional,2023-07-24,2023-07-24,2023-09-05,PLN7933,1622771872,1622771872,Pediatrics,In-Network,Z12.31,M54.5,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,3,441.22,179.27,179.27,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011186,MBR00000433,Professional,2021-05-15,2021-05-15,2021-06-10,PLN4681,1631954542,1631954542,Oncology,In-Network,M54.5,Z12.31,,,,,,,0,,99284,E&M,,,,11,Office,1,794.39,388.88,212.81,176.07,0.0,0.0,176.07,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011187,MBR00000433,Professional,2023-05-03,2023-05-03,2023-05-29,PLN8003,1514306773,1514306773,Endocrinology,In-Network,I10,Z00.00,,,,,,,0,,58661,Surgery,,,,50,Federally Qualified Health Center,2,2128.39,1035.28,722.86,242.87,0.0,69.55,312.42,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011188,MBR00000433,Institutional-OP,2023-07-06,2023-07-06,2023-08-16,PLN2381,1990090423,1990090423,Orthopedic Surgery,In-Network,G43.909,C50.912,,,,,,,0,,47562,Surgery,,,0636,22,Outpatient Hospital,1,5603.37,2811.55,2440.5,0.0,35.0,336.05,371.05,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011189,MBR00000433,Institutional-OP,2022-05-30,2022-05-30,2022-06-08,PLN9479,1689639685,1689639685,SNF,In-Network,J06.9,I10,,,,,,,0,,33533,Surgery,,,0200,22,Outpatient Hospital,1,11141.6,5888.75,5641.51,247.24,0.0,0.0,247.24,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000011190,MBR00000433,Professional,2023-01-02,2023-01-02,2023-01-29,PLN4869,1118885473,1118885473,ASC,In-Network,F32.9,N18.3,,,,,,,0,,87491,Pathology/Lab,,,,22,Outpatient Hospital,3,147.19,55.07,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011191,MBR00000434,Professional,2022-09-27,2022-09-27,2022-10-27,PLN4754,1361302520,1361302520,Critical Access Hospital,In-Network,E66.9,Z23,,,,,,,0,,99284,E&M,,,,11,Office,1,818.65,283.08,212.26,45.82,25.0,0.0,70.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011192,MBR00000434,Institutional-OP,2023-01-25,2023-01-25,2023-03-02,PLN8563,1366576336,1366576336,Geriatrics,In-Network,N39.0,J06.9,,,,,,,0,,70553,Radiology,,,0510,22,Outpatient Hospital,1,2771.34,1947.32,1710.69,161.63,75.0,0.0,236.63,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011193,MBR00000434,Institutional-OP,2023-01-21,2023-01-21,2023-02-12,PLN9437,1795618275,1795618275,Pulmonology,In-Network,Z23,I10,,,,,,,0,,99213,E&M,,,0270,22,Outpatient Hospital,2,161.67,63.05,28.05,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011194,MBR00000434,Institutional-OP,2021-10-05,2021-10-05,2021-10-21,PLN8421,1891849440,1891849440,Oncology,In-Network,I25.10,E11.9,,,,,,,0,,58661,Surgery,,,0740,22,Outpatient Hospital,1,2993.73,2350.65,1937.19,413.46,0.0,0.0,413.46,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011195,MBR00000434,Professional,2023-01-24,2023-01-24,2023-02-27,PLN8475,1799205295,1799205295,General Acute Care Hospital,In-Network,I11.9,J20.9,,,,,,,0,,66984,Surgery,,,,11,Office,3,2813.21,1063.06,988.06,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011196,MBR00000434,Professional,2023-09-15,2023-09-15,2023-10-04,PLN5632,1366286000,1366286000,SNF,In-Network,J20.9,I25.10,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,2,6402.58,3833.15,3755.68,0.0,75.0,2.47,77.47,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011197,MBR00000434,Institutional-OP,2021-12-07,2021-12-07,2022-01-10,PLN1373,1660288235,1660288235,ASC,In-Network,J06.9,Z23,,,,,,,0,,83036,Pathology/Lab,,,0636,22,Outpatient Hospital,1,70.65,56.15,0.0,56.15,0.0,0.0,56.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000011198,MBR00000434,Professional,2021-12-02,2021-12-02,2022-01-07,PLN4877,1273488618,1273488618,General Acute Care Hospital,In-Network,C50.912,E11.9,,,,,,,0,,45378,Surgery,,,,11,Office,3,1066.44,521.51,468.16,0.0,50.0,3.35,53.35,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000011199,MBR00000434,Professional,2021-11-17,2021-11-17,2021-12-02,PLN2875,1511044648,1511044648,Endocrinology,In-Network,N18.3,J06.9,,,,,,,0,,70450,Radiology,,,,22,Outpatient Hospital,2,1690.41,1289.74,1160.73,0.0,0.0,129.01,129.01,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011200,MBR00000434,Institutional-OP,2023-09-26,2023-09-26,2023-10-22,PLN4220,1609138981,1609138981,Critical Access Hospital,In-Network,I11.9,Z12.31,,,,,,,0,,90686,Medicine,,,0120,22,Outpatient Hospital,3,109.63,44.24,0.0,44.24,0.0,0.0,44.24,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000011201,MBR00000434,Institutional-IP,2023-08-30,2023-09-04,2023-09-29,PLN4172,1840431511,1840431511,Geriatrics,Out-of-Network,I10,N39.0,,,,194,MS-DRG,14,5,N,27447,Surgery,,,0360,21,Inpatient Hospital,1,4922.59,2761.62,2761.62,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000011202,MBR00000434,Professional,2022-01-16,2022-01-16,2022-02-14,PLN3815,1236418230,1236418230,DME Supplier,In-Network,N20.0,E66.9,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,1,19828.57,7943.12,7753.0,140.12,50.0,0.0,190.12,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000011203,MBR00000434,Institutional-OP,2023-10-24,2023-10-24,2023-11-13,PLN1794,1624802371,1624802371,ASC,Out-of-Network,G43.909,J44.1,,,,,,,0,,43239,Surgery,,,0730,22,Outpatient Hospital,1,1439.07,1109.07,983.38,100.69,25.0,0.0,125.69,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011204,MBR00000434,Institutional-IP,2023-04-14,2023-04-23,2023-04-24,PLN3708,1148984206,1148984206,Psychiatry,In-Network,N18.3,Z00.00,,,,690,MS-DRG,13,9,Y,87491,Pathology/Lab,,,0510,21,Inpatient Hospital,1,182.03,100.53,100.53,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011205,MBR00000434,Professional,2022-03-17,2022-03-17,2022-04-23,PLN9105,1366426662,1366426662,Urology,In-Network,N40.0,E11.9,,,,,,,0,,99221,E&M,,,,23,Emergency Room,1,205.42,135.76,0.0,135.76,0.0,0.0,135.76,0.0,Denied,CO-4,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011206,MBR00000434,Professional,2023-06-23,2023-06-23,2023-07-15,PLN9547,1606140917,1606140917,ASC,In-Network,I10,F41.9,,,,,,,0,,G0439,Medicine,,,,20,Urgent Care,1,491.27,324.4,29.53,292.45,0.0,2.42,294.87,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000011207,MBR00000434,Institutional-IP,2023-09-28,2023-10-03,2023-10-27,PLN8128,1624202402,1624202402,Orthopedic Surgery,In-Network,E11.9,R07.9,,,,194,MS-DRG,13,5,Y,99213,E&M,,,0200,21,Inpatient Hospital,2,241.73,143.75,143.75,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000011208,MBR00000434,Institutional-IP,2023-08-10,2023-08-15,2023-08-26,PLN6352,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,I10,I10,,,,196,MS-DRG,10,5,Y,90837,Medicine,,,0730,21,Inpatient Hospital,1,440.67,326.22,0.0,326.22,0.0,0.0,326.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011209,MBR00000434,Professional,2022-05-31,2022-05-31,2022-06-19,PLN9326,1799205295,1799205295,General Acute Care Hospital,In-Network,F41.9,Z12.31,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,2,75.42,36.05,19.11,0.0,15.0,1.94,16.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011210,MBR00000434,Professional,2021-08-26,2021-08-26,2021-10-08,PLN8390,1865904917,1865904917,Outpatient Clinic,In-Network,F32.9,N39.0,,,,,,,0,,99221,E&M,,,,23,Emergency Room,2,199.36,125.52,125.52,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011211,MBR00000434,Professional,2021-07-03,2021-07-03,2021-08-16,PLN5742,1193493783,1193493783,Critical Access Hospital,Out-of-Network,R05,J20.9,,,,,,,0,,70553,Radiology,,,,11,Office,2,3989.19,3300.94,3100.24,0.0,0.0,200.7,200.7,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011212,MBR00000434,Professional,2023-06-25,2023-06-25,2023-07-14,PLN9568,1528335731,1528335731,Critical Access Hospital,In-Network,E78.5,E11.40,,,,,,,0,,99221,E&M,,,,21,Inpatient Hospital,1,290.78,209.39,0.0,209.39,0.0,0.0,209.39,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011213,MBR00000434,Institutional-OP,2023-03-14,2023-03-14,2023-04-16,PLN9794,1475984649,1475984649,SNF,In-Network,E11.65,N39.0,,,,,,,0,,99214,E&M,,,0370,22,Outpatient Hospital,2,339.52,236.98,0.0,236.98,0.0,0.0,236.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011214,MBR00000434,Professional,2023-02-16,2023-02-16,2023-03-03,PLN9161,1624802371,1624802371,ASC,Out-of-Network,E78.5,Z00.00,,,,,,,0,,77067,Radiology,,,,22,Outpatient Hospital,3,382.51,147.62,97.62,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000011215,MBR00000434,Institutional-OP,2021-02-20,2021-02-20,2021-03-05,PLN9796,1752470395,1752470395,Home Health,In-Network,M81.0,K21.0,,,,,,,0,,93000,Radiology,,,0320,22,Outpatient Hospital,3,160.9,54.7,0.0,54.7,50.0,0.0,104.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011216,MBR00000434,Professional,2023-11-24,2023-11-24,2024-01-06,PLN9593,1124394415,1124394415,Pediatrics,In-Network,I10,E11.9,,,,,,,0,,45378,Surgery,,,,49,Independent Clinic,2,2039.51,996.72,996.72,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000011217,MBR00000434,Professional,2021-05-05,2021-05-05,2021-06-06,PLN1743,1500037969,1500037969,Pulmonology,In-Network,Z12.31,E66.9,,,,,,,0,,97110,Medicine,,,,21,Inpatient Hospital,2,242.91,106.48,83.66,0.0,15.0,7.82,22.82,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011218,MBR00000434,Professional,2022-09-28,2022-09-28,2022-10-10,PLN3141,1224179551,1224179551,Physical Therapy,In-Network,J06.9,E78.5,,,,,,,0,,70450,Radiology,,,,65,End-Stage Renal Disease,1,1679.15,1022.65,923.87,0.0,75.0,23.78,98.78,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011219,MBR00000434,Institutional-OP,2023-10-28,2023-10-28,2023-11-29,PLN7138,1372918899,1372918899,Family Medicine,In-Network,J45.20,G20,,,,,,,0,,70450,Radiology,,,0320,22,Outpatient Hospital,3,744.5,469.94,437.71,29.54,0.0,2.69,32.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011220,MBR00000434,Professional,2021-09-23,2021-09-23,2021-10-29,PLN2248,1500949740,1500949740,Pediatrics,In-Network,N39.0,I10,,,,,,,0,,71046,Radiology,,,,21,Inpatient Hospital,2,227.92,146.34,96.34,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000011221,MBR00000434,Professional,2022-07-21,2022-07-21,2022-08-19,PLN2125,1809014947,1809014947,Urology,In-Network,K21.0,I25.10,,,,,,,0,,45378,Surgery,,,,11,Office,3,1658.61,1124.12,1109.12,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000011222,MBR00000434,Professional,2023-07-10,2023-07-10,2023-08-23,PLN1932,1817234602,1817234602,Clinical Laboratory,In-Network,Z12.31,Z87.891,,,,,,,0,,99222,E&M,,,,23,Emergency Room,2,574.0,199.27,199.27,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011223,MBR00000434,Institutional-IP,2021-10-19,2021-10-26,2021-11-07,PLN9087,1860435061,1860435061,DME Supplier,In-Network,M54.5,Z00.00,,,,292,MS-DRG,8,7,Y,93306,Radiology,,,0510,21,Inpatient Hospital,2,1389.83,756.88,278.8,478.08,0.0,0.0,478.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011224,MBR00000434,Professional,2021-04-22,2021-04-22,2021-05-03,PLN5929,1622771872,1622771872,Pediatrics,In-Network,R10.9,F41.9,,,,,,,0,,84443,Pathology/Lab,,,,12,Home,2,162.54,133.41,108.41,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011225,MBR00000434,Professional,2022-06-11,2022-06-11,2022-07-06,PLN1367,1991459367,1991459367,Neurology,Out-of-Network,J20.9,M17.11,,,,,,,0,,G0444,Medicine,,,,22,Outpatient Hospital,1,100.33,59.64,24.64,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000011226,MBR00000434,Professional,2023-05-21,2023-05-21,2023-06-28,PLN6849,1334916761,1334916761,ASC,In-Network,Z12.31,N18.3,,,,,,,0,,99283,E&M,,,,65,End-Stage Renal Disease,3,509.07,332.72,50.38,282.34,0.0,0.0,282.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011227,MBR00000434,Institutional-OP,2022-09-26,2022-09-26,2022-11-07,PLN2386,1845057593,1845057593,Orthopedic Surgery,In-Network,K92.1,I10,,,,,,,0,,81001,Pathology/Lab,,,0270,22,Outpatient Hospital,1,26.36,18.38,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011228,MBR00000434,Institutional-OP,2022-04-30,2022-04-30,2022-05-08,PLN2248,1224179551,1224179551,Physical Therapy,In-Network,I10,Z00.00,,,,,,,0,,99232,E&M,,,0120,22,Outpatient Hospital,3,399.28,282.37,113.07,119.3,50.0,0.0,169.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011229,MBR00000434,Institutional-OP,2022-12-01,2022-12-01,2022-12-20,PLN7732,1125190055,1125190055,Nephrology,In-Network,N18.3,E11.9,,,,,,,0,,99233,E&M,,,0360,22,Outpatient Hospital,2,359.73,285.62,237.57,0.0,25.0,23.05,48.05,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011230,MBR00000434,Professional,2021-02-26,2021-02-26,2021-04-02,PLN8106,1700633438,1700633438,DME Supplier,In-Network,I10,E11.9,,,,,,,0,,99204,E&M,,,,11,Office,3,422.21,312.23,287.23,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011231,MBR00000434,Professional,2022-01-17,2022-01-17,2022-02-16,PLN2339,1799205295,1799205295,General Acute Care Hospital,In-Network,I63.9,I25.10,,,,,,,0,,90460,Medicine,,,,22,Outpatient Hospital,1,35.75,14.66,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011232,MBR00000434,Professional,2023-08-20,2023-08-20,2023-09-29,PLN5185,1453936007,1453936007,ASC,In-Network,I11.9,Z00.00,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,3,50.7,16.22,0.0,16.22,50.0,0.0,66.22,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011233,MBR00000434,Institutional-OP,2022-03-01,2022-03-01,2022-04-09,PLN4970,1994661817,1994661817,SNF,Out-of-Network,E11.9,E11.9,,,,,,,0,,27447,Surgery,,,0636,22,Outpatient Hospital,1,3698.54,2762.4,2321.31,416.09,25.0,0.0,441.09,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011234,MBR00000434,Institutional-OP,2023-11-23,2023-11-23,2023-12-10,PLN4624,1213165847,1213165847,Critical Access Hospital,In-Network,K92.1,E11.9,,,,,,,0,,93225,Medicine,,,0761,22,Outpatient Hospital,2,537.14,298.52,298.52,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011235,MBR00000434,Institutional-IP,2022-08-25,2022-08-28,2022-09-15,PLN2384,1778483301,1778483301,Home Health,In-Network,R05,E66.9,,,,470,MS-DRG,15,3,W,99284,E&M,,,0370,21,Inpatient Hospital,2,713.23,455.73,455.73,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011236,MBR00000434,Professional,2023-10-20,2023-10-20,2023-11-27,PLN4383,1795618275,1795618275,Pulmonology,In-Network,N40.0,J06.9,,,,,,,0,,27447,Surgery,,,,20,Urgent Care,3,3371.76,2005.05,0.0,0.0,0.0,391.73,391.73,0.0,Denied,CO-27,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011237,MBR00000434,Professional,2022-11-18,2022-11-18,2022-12-31,PLN6770,1500949740,1500949740,Pediatrics,In-Network,I48.91,E11.65,,,,,,,0,,99222,E&M,,,,81,Independent Laboratory,1,496.82,416.48,131.11,250.37,35.0,0.0,285.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011238,MBR00000434,Professional,2022-04-04,2022-04-04,2022-04-26,PLN4136,1847081578,1847081578,Urology,Out-of-Network,G43.909,E66.9,,,,,,,0,,58661,Surgery,,,,11,Office,3,3557.41,2762.99,2295.99,467.0,0.0,0.0,467.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011239,MBR00000434,Professional,2023-10-06,2023-10-06,2023-10-27,PLN6490,1132188260,1132188260,Family Medicine,In-Network,Z12.31,Z87.891,,,,,,,0,,99232,E&M,,,,11,Office,2,336.43,216.55,189.03,0.0,25.0,2.52,27.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011240,MBR00000434,Professional,2021-10-23,2021-10-23,2021-11-21,PLN1067,1590915516,1590915516,Physical Therapy,Out-of-Network,J06.9,I10,,,,,,,0,,93225,Medicine,,,,11,Office,1,637.7,264.01,0.0,264.01,0.0,0.0,264.01,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011241,MBR00000435,Professional,2022-03-06,2022-03-06,2022-04-01,PLN9251,1609138981,1609138981,Critical Access Hospital,In-Network,Z23,I50.9,,,,,,,0,,99283,E&M,,,,23,Emergency Room,3,558.6,356.82,0.0,356.82,35.0,0.0,391.82,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011242,MBR00000435,Professional,2023-03-03,2023-03-03,2023-03-28,PLN9748,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,E11.9,K92.1,,,,,,,0,,99283,E&M,,,,81,Independent Laboratory,1,402.86,329.49,329.49,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011243,MBR00000435,Professional,2023-08-16,2023-08-16,2023-09-28,PLN9934,1135158374,1135158374,Pulmonology,In-Network,F41.9,M54.5,,,,,,,0,,99204,E&M,,,,21,Inpatient Hospital,2,356.67,134.45,134.45,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011244,MBR00000435,Institutional-OP,2021-07-31,2021-07-31,2021-09-09,PLN8123,1728018911,1728018911,Nephrology,In-Network,E11.9,K57.30,,,,,,,0,,45380,Surgery,,,0636,22,Outpatient Hospital,3,1171.92,753.27,753.27,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000011245,MBR00000436,Institutional-OP,2023-12-24,2023-12-24,2024-02-03,PLN8074,1606140917,1606140917,ASC,In-Network,F32.9,G43.909,,,,,,,0,,99284,E&M,,,0740,22,Outpatient Hospital,3,644.56,518.61,0.0,464.62,75.0,0.0,539.62,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011246,MBR00000436,Institutional-OP,2022-04-17,2022-04-17,2022-04-30,PLN3368,1645194539,1645194539,SNF,In-Network,F41.9,Z87.891,,,,,,,0,,86900,Pathology/Lab,,,0301,22,Outpatient Hospital,2,27.77,9.05,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011247,MBR00000436,Institutional-OP,2022-01-07,2022-01-07,2022-01-17,PLN7555,1716521444,1716521444,Oncology,In-Network,Z00.00,N39.0,,,,,,,0,,45378,Surgery,,,0450,22,Outpatient Hospital,2,2140.83,1107.0,1032.0,0.0,75.0,0.0,75.0,0.0,Pended,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000011248,MBR00000436,Professional,2021-05-21,2021-05-21,2021-06-05,PLN7751,1687650653,1687650653,Internal Medicine,In-Network,I10,M54.5,,,,,,,0,,90686,Medicine,,,,22,Outpatient Hospital,3,103.99,49.43,49.43,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000011249,MBR00000436,Professional,2021-01-30,2021-01-30,2021-02-18,PLN8994,1757138478,1757138478,Pediatrics,In-Network,I25.10,J06.9,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,3,199.54,94.89,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011250,MBR00000436,Professional,2022-09-03,2022-09-03,2022-10-03,PLN1082,1717546253,1717546253,Family Medicine,In-Network,E11.40,M81.0,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,2,1845.22,620.72,567.27,0.0,0.0,53.45,53.45,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000011251,MBR00000436,Professional,2022-10-24,2022-10-24,2022-11-11,PLN4042,1687650653,1687650653,Internal Medicine,In-Network,J20.9,E66.9,,,,,,,0,,G0468,Medicine,,,,21,Inpatient Hospital,2,539.75,376.93,279.86,0.0,50.0,47.07,97.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011252,MBR00000436,Institutional-OP,2021-04-13,2021-04-13,2021-05-13,PLN4203,1716521444,1716521444,Oncology,In-Network,R10.9,J06.9,,,,,,,0,,27130,Surgery,,,0320,22,Outpatient Hospital,1,2774.53,1350.69,1325.69,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011253,MBR00000436,Professional,2023-09-17,2023-09-17,2023-10-31,PLN4364,1500037969,1500037969,Pulmonology,In-Network,J45.20,J44.1,,,,,,,0,,47562,Surgery,,,,49,Independent Clinic,2,4672.9,1766.71,1622.36,0.0,0.0,144.35,144.35,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011254,MBR00000437,Institutional-OP,2022-08-19,2022-08-19,2022-09-23,PLN3145,1660288235,1660288235,ASC,In-Network,M17.11,E11.65,,,,,,,0,,99213,E&M,,,0301,22,Outpatient Hospital,1,322.35,272.67,272.67,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011255,MBR00000437,Institutional-IP,2021-02-28,2021-03-05,2021-04-05,PLN3286,1717912431,1717912431,Oncology,In-Network,I25.10,E11.9,,,,871,MS-DRG,22,5,Y,70450,Radiology,,,0900,21,Inpatient Hospital,3,1136.0,816.38,766.38,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011256,MBR00000437,Professional,2023-07-11,2023-07-11,2023-07-31,PLN1901,1564502315,1564502315,ASC,In-Network,I25.10,J44.1,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,2,7645.29,3597.18,3319.14,263.04,15.0,0.0,278.04,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011257,MBR00000437,Institutional-OP,2021-08-04,2021-08-04,2021-09-08,PLN4610,1268679390,1268679390,Critical Access Hospital,In-Network,E11.9,J06.9,,,,,,,0,,93000,Radiology,,,0636,22,Outpatient Hospital,1,151.33,58.36,51.04,0.0,0.0,7.32,7.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011258,MBR00000437,Institutional-OP,2023-01-07,2023-01-07,2023-01-16,PLN8239,1910255109,1910255109,DME Supplier,In-Network,I10,E11.9,,,,,,,0,,90686,Medicine,,,0730,22,Outpatient Hospital,2,75.75,60.55,0.0,60.55,0.0,0.0,60.55,0.0,Paid,,,0,,0,1,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000011259,MBR00000437,Institutional-IP,2023-01-11,2023-01-19,2023-01-31,PLN7783,1395983630,1395983630,Nephrology,In-Network,Z23,Z23,,,,641,MS-DRG,14,8,Y,70553,Radiology,,,0450,21,Inpatient Hospital,2,2641.29,1959.62,1910.72,33.9,15.0,0.0,48.9,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011260,MBR00000437,Professional,2023-06-07,2023-06-07,2023-06-21,PLN8174,1433937353,1433937353,Nephrology,In-Network,J06.9,J06.9,,,,,,,0,,99283,E&M,,,,65,End-Stage Renal Disease,1,306.49,159.24,109.24,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011261,MBR00000438,Professional,2023-06-06,2023-06-06,2023-07-08,PLN7739,1205377316,1205377316,Orthopedic Surgery,In-Network,Z23,F32.9,,,,,,,0,,66984,Surgery,,,,11,Office,3,1383.7,1054.02,580.15,438.87,35.0,0.0,473.87,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011262,MBR00000438,Professional,2023-12-16,2023-12-16,2023-12-26,PLN3416,1631954542,1631954542,Oncology,In-Network,I10,J06.9,,,,,,,0,,83036,Pathology/Lab,,,,81,Independent Laboratory,2,65.7,46.06,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000011263,MBR00000438,Institutional-OP,2021-04-05,2021-04-05,2021-05-10,PLN6778,1795618275,1795618275,Pulmonology,In-Network,N40.0,E11.65,,,,,,,0,,76700,Radiology,,,0730,22,Outpatient Hospital,3,592.38,185.13,0.0,0.0,0.0,0.0,0.0,0.0,Denied,PR-1,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011264,MBR00000438,Professional,2022-02-04,2022-02-04,2022-02-26,PLN9436,1991459367,1991459367,Neurology,Out-of-Network,M54.5,R05,,,,,,,0,,99203,E&M,,,,21,Inpatient Hospital,1,238.16,155.9,130.9,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011265,MBR00000438,Institutional-OP,2022-02-03,2022-02-03,2022-03-11,PLN8047,1361302520,1361302520,Critical Access Hospital,In-Network,I25.10,I48.91,,,,,,,0,,43239,Surgery,,,0360,22,Outpatient Hospital,1,1960.07,1453.82,1089.6,364.22,0.0,0.0,364.22,0.0,Adjusted,,,0,,0,0,1,0,0,1,Duplicate,0,0,0,0,0
CLM0000011266,MBR00000438,Professional,2022-02-16,2022-02-16,2022-03-27,PLN9258,1790497490,1790497490,OB/GYN,In-Network,E78.5,N39.0,,,,,,,0,,23472,Surgery,,,,11,Office,2,3317.52,2194.54,1970.66,56.32,25.0,142.56,223.88,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011267,MBR00000438,Institutional-OP,2021-09-19,2021-09-19,2021-10-25,PLN8613,1103747954,1103747954,Urology,In-Network,E78.5,M17.11,,,,,,,0,,43239,Surgery,,,0636,22,Outpatient Hospital,3,2125.63,1338.25,0.0,0.0,15.0,155.21,170.21,0.0,Denied,CO-27,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011268,MBR00000438,Professional,2021-09-14,2021-09-14,2021-10-26,PLN7972,1795618275,1795618275,Pulmonology,In-Network,E78.5,Z96.641,,,,,,,0,,G0439,Medicine,,,,22,Outpatient Hospital,3,453.07,273.47,223.47,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000011269,MBR00000438,Institutional-OP,2023-11-23,2023-11-23,2023-12-16,PLN6545,1845900543,1845900543,ASC,In-Network,J20.9,I25.10,,,,,,,0,,90460,Medicine,,,0730,22,Outpatient Hospital,2,72.48,30.15,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011270,MBR00000438,Professional,2023-09-12,2023-09-12,2023-10-22,PLN7755,1334916761,1334916761,ASC,In-Network,E11.9,Z00.00,,,,,,,0,,83036,Pathology/Lab,,,,50,Federally Qualified Health Center,3,69.61,45.01,10.01,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000011271,MBR00000438,Institutional-OP,2023-01-18,2023-01-18,2023-01-25,PLN6226,1528335731,1528335731,Critical Access Hospital,In-Network,E11.40,Z23,,,,,,,0,,90837,Medicine,,,0730,22,Outpatient Hospital,2,272.61,120.48,114.55,5.93,0.0,0.0,5.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011272,MBR00000438,Institutional-OP,2022-08-31,2022-08-31,2022-09-09,PLN5438,1224179551,1224179551,Physical Therapy,In-Network,I25.10,J06.9,,,,,,,0,,93225,Medicine,,,0320,22,Outpatient Hospital,1,851.1,371.56,316.44,0.0,0.0,55.12,55.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011273,MBR00000438,Professional,2022-06-05,2022-06-05,2022-07-12,PLN3442,1939033455,1939033455,Pulmonology,In-Network,G43.909,E11.40,,,,,,,0,,47562,Surgery,,,,20,Urgent Care,1,6062.58,2593.11,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011274,MBR00000438,Professional,2023-01-17,2023-01-17,2023-03-01,PLN1720,1109850785,1109850785,ASC,Out-of-Network,J06.9,I50.9,,,,,,,0,,43239,Surgery,,,,11,Office,3,2132.82,1189.88,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-18,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011275,MBR00000438,Institutional-OP,2023-08-03,2023-08-03,2023-09-09,PLN5258,1622771872,1622771872,Pediatrics,In-Network,G20,E78.5,,,,,,,0,,99221,E&M,,,0510,22,Outpatient Hospital,3,442.19,244.82,0.0,244.82,0.0,0.0,244.82,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011276,MBR00000438,Institutional-OP,2022-04-12,2022-04-12,2022-05-18,PLN5583,1390307371,1390307371,DME Supplier,In-Network,M54.5,J06.9,,,,,,,0,,99283,E&M,,,0200,22,Outpatient Hospital,3,361.08,246.46,159.27,52.19,35.0,0.0,87.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011277,MBR00000438,Institutional-OP,2022-08-12,2022-08-12,2022-09-14,PLN7432,1997536841,1997536841,Family Medicine,Out-of-Network,E66.9,Z12.11,,,,,,,0,,99213,E&M,,,0120,22,Outpatient Hospital,3,200.14,104.17,89.17,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011278,MBR00000438,Professional,2023-09-26,2023-09-26,2023-10-21,PLN9233,1696843572,1696843572,Critical Access Hospital,Out-of-Network,E11.9,C50.912,,,,,,,0,,99283,E&M,,,,21,Inpatient Hospital,2,602.65,344.4,0.0,338.82,50.0,0.0,388.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011279,MBR00000438,Professional,2023-09-25,2023-09-25,2023-11-05,PLN2423,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,E66.9,E11.9,,,,,,,0,,99214,E&M,,,,11,Office,1,468.2,206.34,146.86,0.0,35.0,24.48,59.48,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011280,MBR00000438,Professional,2021-09-09,2021-09-09,2021-09-20,PLN9042,1219817751,1219817751,OB/GYN,In-Network,Z00.01,F41.9,,,,,,,0,,23472,Surgery,,,,81,Independent Laboratory,3,4724.8,3404.34,3050.12,354.22,0.0,0.0,354.22,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011281,MBR00000438,Institutional-OP,2021-09-19,2021-09-19,2021-11-01,PLN7199,1590915516,1590915516,Physical Therapy,Out-of-Network,E11.9,E11.9,,,,,,,0,,71046,Radiology,,,0270,22,Outpatient Hospital,1,227.52,74.7,0.0,74.7,0.0,0.0,74.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011282,MBR00000438,Professional,2021-08-12,2021-08-12,2021-08-29,PLN1762,1247341320,1247341320,Urology,Out-of-Network,Z00.00,N20.0,,,,,,,0,,90686,Medicine,,,,12,Home,3,95.93,35.26,0.0,35.26,75.0,0.0,110.26,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000011283,MBR00000438,Professional,2021-01-30,2021-01-30,2021-03-13,PLN6350,1780163051,1780163051,SNF,In-Network,E66.9,J20.9,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,1,408.85,212.86,0.0,212.86,25.0,0.0,237.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011284,MBR00000438,Institutional-OP,2023-01-31,2023-01-31,2023-02-25,PLN2365,1114982472,1114982472,Orthopedic Surgery,In-Network,I25.10,Z12.31,,,,,,,0,,78452,Radiology,,,0200,22,Outpatient Hospital,3,5894.38,2900.71,2900.71,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011285,MBR00000438,Institutional-IP,2022-04-15,2022-04-21,2022-05-29,PLN8051,1502838586,1502838586,ASC,In-Network,E11.9,Z23,,,,292,MS-DRG,10,6,Y,47562,Surgery,,,0636,21,Inpatient Hospital,3,2699.31,1568.28,0.0,304.08,25.0,160.03,489.11,0.0,Denied,CO-50,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011286,MBR00000438,Institutional-IP,2021-02-04,2021-02-10,2021-02-15,PLN3348,1806688928,1806688928,Geriatrics,In-Network,N39.0,N39.0,,,,603,MS-DRG,5,6,Y,78452,Radiology,,,0270,21,Inpatient Hospital,3,4154.3,1412.94,1348.32,0.0,25.0,39.62,64.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011287,MBR00000438,Institutional-OP,2021-08-12,2021-08-12,2021-09-12,PLN5483,1749494482,1749494482,Pediatrics,In-Network,E11.40,F32.9,,,,,,,0,,99283,E&M,,,0900,22,Outpatient Hospital,2,444.78,229.94,41.14,163.8,25.0,0.0,188.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011288,MBR00000438,Professional,2022-08-06,2022-08-06,2022-09-16,PLN8576,1395983630,1395983630,Nephrology,In-Network,R10.9,E11.9,,,,,,,0,,82043,Pathology/Lab,,,,21,Inpatient Hospital,3,63.38,46.41,46.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011289,MBR00000438,Professional,2023-07-05,2023-07-05,2023-07-31,PLN8191,1244186984,1244186984,Family Medicine,Out-of-Network,Z23,M17.11,,,,,,,0,,43239,Surgery,,,,11,Office,1,2207.53,1293.17,1133.36,159.81,0.0,0.0,159.81,0.0,Paid,,,1,,0,0,1,0,0,1,Phantom,0,0,0,0,0
CLM0000011290,MBR00000439,Institutional-OP,2022-12-27,2022-12-27,2023-01-20,PLN6611,1717912431,1717912431,Oncology,In-Network,G43.909,E11.9,,,,,,,0,,85025,Pathology/Lab,,,0900,22,Outpatient Hospital,2,42.6,14.7,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011291,MBR00000439,Institutional-OP,2022-08-07,2022-08-07,2022-09-14,PLN5062,1780163051,1780163051,SNF,In-Network,F32.9,E11.40,,,,,,,0,,45378,Surgery,,,0270,22,Outpatient Hospital,3,1273.32,618.65,357.71,225.94,35.0,0.0,260.94,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000011292,MBR00000439,Professional,2021-07-24,2021-07-24,2021-08-05,PLN8077,1856686341,1856686341,Geriatrics,In-Network,Z23,E66.9,,,,,,,0,,G0439,Medicine,,,,21,Inpatient Hospital,3,226.09,137.13,25.25,111.88,0.0,0.0,111.88,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000011293,MBR00000439,Professional,2021-11-13,2021-11-13,2021-12-25,PLN6757,1531398223,1531398223,OB/GYN,In-Network,I10,E78.5,,,,,,,0,,74177,Radiology,,,,22,Outpatient Hospital,3,1173.65,591.78,502.94,0.0,0.0,88.84,88.84,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011294,MBR00000439,Professional,2023-05-07,2023-05-07,2023-05-23,PLN1871,1991459367,1991459367,Neurology,Out-of-Network,I10,M54.5,,,,,,,0,,90460,Medicine,,,,11,Office,3,41.5,17.77,0.0,17.77,35.0,0.0,52.77,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000011295,MBR00000439,Professional,2023-04-28,2023-04-28,2023-05-29,PLN6681,1450094833,1450094833,Outpatient Clinic,In-Network,Z00.00,I10,,,,,,,0,,33533,Surgery,,,,11,Office,3,13960.56,6263.86,6228.86,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,1,0,1,Phantom,0,0,0,0,0
CLM0000011296,MBR00000439,Professional,2023-08-09,2023-08-09,2023-09-02,PLN5172,1700633438,1700633438,DME Supplier,In-Network,J44.1,Z12.31,,,,,,,0,,99233,E&M,,,,11,Office,3,510.76,195.08,148.88,0.0,15.0,31.2,46.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011297,MBR00000439,Professional,2022-07-31,2022-07-31,2022-08-11,PLN8998,1800011727,1800011727,Clinical Laboratory,Out-of-Network,E11.9,N40.0,,,,,,,0,,27447,Surgery,,,,11,Office,1,5547.94,3022.91,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-4,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011298,MBR00000439,Institutional-IP,2021-10-27,2021-10-28,2021-11-30,PLN5000,1700633438,1700633438,DME Supplier,In-Network,I25.10,K57.30,,,,641,MS-DRG,15,1,Y,99232,E&M,,,0730,21,Inpatient Hospital,3,275.61,84.15,71.9,0.0,0.0,12.25,12.25,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011299,MBR00000439,Professional,2022-07-05,2022-07-05,2022-07-30,PLN8267,1915531927,1915531927,Critical Access Hospital,In-Network,N40.0,F32.9,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,2,262.2,193.0,50.58,131.25,0.0,11.17,142.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011300,MBR00000439,Institutional-OP,2023-09-09,2023-09-09,2023-09-25,PLN3013,1899127912,1899127912,Neurology,In-Network,Z00.00,Z96.641,,,,,,,0,,66984,Surgery,,,0450,22,Outpatient Hospital,1,2162.41,1001.18,785.44,0.0,75.0,140.74,215.74,0.0,Paid,,,1,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000011301,MBR00000439,Institutional-IP,2021-07-17,2021-07-20,2021-08-13,PLN9226,1571574052,1571574052,Critical Access Hospital,In-Network,E78.5,Z00.01,,,,682,MS-DRG,9,3,Y,33533,Surgery,,,0370,21,Inpatient Hospital,1,12157.07,9903.19,9853.19,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000011302,MBR00000439,Professional,2023-07-17,2023-07-17,2023-08-17,PLN8272,1531398223,1531398223,OB/GYN,In-Network,E11.9,I25.10,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,3,208.22,70.02,59.2,0.0,0.0,10.82,10.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011303,MBR00000439,Institutional-OP,2023-12-26,2023-12-26,2024-01-13,PLN5488,1361302520,1361302520,Critical Access Hospital,In-Network,N18.3,E11.9,,,,,,,0,,99284,E&M,,,0320,22,Outpatient Hospital,3,924.34,724.2,594.07,0.0,15.0,115.13,130.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011304,MBR00000439,Institutional-IP,2023-06-17,2023-06-20,2023-07-18,PLN2355,1502838586,1502838586,ASC,In-Network,I10,E66.9,,,,195,MS-DRG,12,3,N,74177,Radiology,,,0761,21,Inpatient Hospital,2,2047.8,694.84,606.56,0.0,75.0,13.28,88.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011305,MBR00000439,Institutional-OP,2022-12-23,2022-12-23,2023-01-07,PLN1538,1198133277,1198133277,SNF,In-Network,J20.9,E11.9,,,,,,,0,,90686,Medicine,,,0301,22,Outpatient Hospital,1,116.47,83.67,83.67,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000011306,MBR00000439,Institutional-OP,2022-03-25,2022-03-25,2022-05-08,PLN6593,1550154147,1550154147,Outpatient Clinic,In-Network,I25.10,R51,,,,,,,0,,99213,E&M,,,0730,22,Outpatient Hospital,1,279.06,177.55,18.21,122.5,35.0,1.84,159.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011307,MBR00000439,Institutional-OP,2023-07-26,2023-07-26,2023-08-02,PLN3229,1687650653,1687650653,Internal Medicine,In-Network,J44.1,I10,,,,,,,0,,99214,E&M,,,0900,22,Outpatient Hospital,1,213.25,141.71,0.0,141.71,75.0,0.0,216.71,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011308,MBR00000439,Institutional-OP,2021-06-26,2021-06-26,2021-07-25,PLN2530,1745114564,1745114564,Endocrinology,In-Network,Z12.31,J06.9,,,,,,,0,,85610,Pathology/Lab,,,0270,22,Outpatient Hospital,3,71.54,35.39,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011309,MBR00000439,Institutional-OP,2023-04-12,2023-04-12,2023-05-03,PLN1924,1790497490,1790497490,OB/GYN,In-Network,E11.40,I10,,,,,,,0,,78452,Radiology,,,0120,22,Outpatient Hospital,2,7205.76,2277.65,2252.65,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011310,MBR00000439,Professional,2022-03-16,2022-03-16,2022-04-11,PLN3710,1284035364,1284035364,Pediatrics,In-Network,E78.5,Z23,,,,,,,0,,90837,Medicine,,,,11,Office,1,385.03,230.37,75.05,155.32,0.0,0.0,155.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011311,MBR00000439,Institutional-IP,2022-07-05,2022-07-07,2022-08-09,PLN9032,1752470395,1752470395,Home Health,In-Network,E78.5,F32.9,,,,871,MS-DRG,11,2,N,99213,E&M,,,0301,21,Inpatient Hospital,2,195.46,104.78,96.25,0.0,0.0,8.53,8.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011312,MBR00000439,Institutional-IP,2022-05-23,2022-06-01,2022-06-05,PLN9676,1800011727,1800011727,Clinical Laboratory,Out-of-Network,E11.65,M54.5,,,,603,MS-DRG,1,9,Y,97530,Medicine,,,0730,21,Inpatient Hospital,1,294.04,140.49,118.74,0.0,0.0,21.75,21.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011313,MBR00000439,Institutional-OP,2021-01-11,2021-01-11,2021-02-04,PLN5929,1453936007,1453936007,ASC,In-Network,R51,J44.1,,,,,,,0,,99213,E&M,,,0200,22,Outpatient Hospital,3,241.81,120.98,0.0,120.59,0.0,0.0,120.59,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011314,MBR00000439,Professional,2023-12-17,2023-12-17,2024-01-06,PLN8547,1752470395,1752470395,Home Health,In-Network,M17.11,M54.5,,,,,,,0,,99233,E&M,,,,23,Emergency Room,1,555.97,427.06,427.06,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011315,MBR00000439,Professional,2023-01-01,2023-01-01,2023-02-12,PLN2842,1118885473,1118885473,ASC,In-Network,K21.0,J20.9,,,,,,,0,,23472,Surgery,,,,49,Independent Clinic,3,5287.05,2049.77,1625.27,63.88,50.0,310.62,424.5,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011316,MBR00000439,Professional,2022-10-20,2022-10-20,2022-11-19,PLN1960,1778483301,1778483301,Home Health,In-Network,G43.909,J44.1,,,,,,,0,,90460,Medicine,,,,11,Office,2,40.53,30.9,0.0,30.9,35.0,0.0,65.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011317,MBR00000439,Professional,2021-04-21,2021-04-21,2021-04-28,PLN9189,1606140917,1606140917,ASC,In-Network,M17.11,R51,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,2,182.7,61.28,41.65,0.0,15.0,4.63,19.63,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011318,MBR00000439,Professional,2023-05-03,2023-05-03,2023-05-17,PLN2925,1865904917,1865904917,Outpatient Clinic,In-Network,N39.0,N17.9,,,,,,,0,,76700,Radiology,,,,22,Outpatient Hospital,1,653.09,460.43,0.0,212.86,0.0,10.46,223.32,0.0,Denied,CO-18,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011319,MBR00000440,Institutional-IP,2023-11-19,2023-11-25,2023-12-19,PLN4335,1108115157,1108115157,General Acute Care Hospital,In-Network,F32.9,E11.9,,,,195,MS-DRG,21,6,Y,83036,Pathology/Lab,,,0320,21,Inpatient Hospital,2,68.36,34.36,0.0,0.0,50.0,0.0,50.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000011320,MBR00000440,Institutional-OP,2023-06-12,2023-06-12,2023-07-19,PLN8482,1475984649,1475984649,SNF,In-Network,F41.9,F41.9,,,,,,,0,,G0468,Medicine,,,0200,22,Outpatient Hospital,3,638.98,246.56,0.0,246.56,0.0,0.0,246.56,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011321,MBR00000440,Professional,2021-09-30,2021-09-30,2021-10-18,PLN8274,1244186984,1244186984,Family Medicine,Out-of-Network,C50.912,Z12.31,,,,,,,0,,86900,Pathology/Lab,,,,81,Independent Laboratory,1,39.42,17.43,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011322,MBR00000440,Institutional-OP,2021-07-18,2021-07-18,2021-08-18,PLN2894,1389336600,1389336600,Critical Access Hospital,In-Network,F41.9,E11.9,,,,,,,0,,99222,E&M,,,0320,22,Outpatient Hospital,3,522.99,326.75,326.75,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011323,MBR00000440,Institutional-OP,2022-02-07,2022-02-07,2022-03-03,PLN8749,1283743001,1283743001,Family Medicine,In-Network,I10,Z23,,,,,,,0,,83036,Pathology/Lab,,,0740,22,Outpatient Hospital,1,99.83,73.48,0.0,73.48,0.0,0.0,73.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000011324,MBR00000440,Professional,2021-01-25,2021-01-25,2021-03-06,PLN4736,1244186984,1244186984,Family Medicine,Out-of-Network,F41.9,Z00.01,,,,,,,0,,85610,Pathology/Lab,,,,22,Outpatient Hospital,3,27.82,18.87,0.0,18.87,15.0,0.0,33.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011325,MBR00000440,Professional,2022-08-27,2022-08-27,2022-09-18,PLN3984,1514306773,1514306773,Endocrinology,In-Network,J44.1,N40.0,,,,,,,0,,93225,Medicine,,,,22,Outpatient Hospital,2,362.29,189.22,0.0,189.22,0.0,0.0,189.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011326,MBR00000440,Institutional-OP,2022-05-17,2022-05-17,2022-06-19,PLN2137,1236418230,1236418230,DME Supplier,In-Network,J20.9,Z96.641,,,,,,,0,,99284,E&M,,,0730,22,Outpatient Hospital,1,809.67,590.73,31.12,484.61,75.0,0.0,559.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011327,MBR00000440,Institutional-OP,2022-07-05,2022-07-05,2022-08-03,PLN5175,1355166277,1355166277,Endocrinology,In-Network,N18.3,Z23,,,,,,,0,,47562,Surgery,,,0120,22,Outpatient Hospital,2,5548.46,2329.05,2304.05,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011328,MBR00000440,Professional,2023-12-21,2023-12-21,2024-01-06,PLN6311,1856686341,1856686341,Geriatrics,In-Network,M54.5,Z51.11,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,3,6053.48,4290.03,4290.03,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011329,MBR00000440,Institutional-IP,2022-12-19,2023-01-01,2023-01-19,PLN4071,1450553056,1450553056,Clinical Laboratory,In-Network,I10,I48.91,,,,690,MS-DRG,14,13,N,72148,Radiology,,,0900,21,Inpatient Hospital,3,1515.89,940.82,890.82,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000011330,MBR00000440,Professional,2022-04-02,2022-04-02,2022-05-11,PLN8253,1590915516,1590915516,Physical Therapy,Out-of-Network,E11.65,I10,,,,,,,0,,99232,E&M,,,,12,Home,2,201.68,162.59,0.0,162.59,50.0,0.0,212.59,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011331,MBR00000440,Institutional-IP,2023-05-08,2023-05-11,2023-05-15,PLN5822,1561134315,1561134315,DME Supplier,In-Network,Z00.00,J06.9,,,,470,MS-DRG,4,3,Y,99214,E&M,,,0510,21,Inpatient Hospital,1,167.31,119.68,0.0,119.68,25.0,0.0,144.68,0.0,Denied,PR-1,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000011332,MBR00000440,Professional,2022-02-09,2022-02-09,2022-03-18,PLN4188,1757138478,1757138478,Pediatrics,In-Network,E11.9,Z87.891,,,,,,,0,,33533,Surgery,,,,11,Office,1,15362.7,10033.27,9540.21,493.06,0.0,0.0,493.06,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000011333,MBR00000440,Professional,2023-04-10,2023-04-10,2023-04-27,PLN2484,1806688928,1806688928,Geriatrics,In-Network,R10.9,J06.9,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,2,131.48,58.99,0.0,58.99,0.0,0.0,58.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011334,MBR00000440,Professional,2023-10-19,2023-10-19,2023-12-01,PLN5997,1645194539,1645194539,SNF,In-Network,M54.5,E11.9,,,,,,,0,,74177,Radiology,,,,49,Independent Clinic,3,1828.9,763.53,763.53,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011335,MBR00000440,Professional,2023-09-22,2023-09-22,2023-10-14,PLN4339,1717912431,1717912431,Oncology,In-Network,J06.9,J45.20,,,,,,,0,,99204,E&M,,,,11,Office,2,251.01,85.06,75.74,0.0,0.0,9.32,9.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011336,MBR00000440,Professional,2022-07-23,2022-07-23,2022-08-27,PLN4152,1540044947,1540044947,Pulmonology,Out-of-Network,I10,F41.9,,,,,,,0,,72148,Radiology,,,,65,End-Stage Renal Disease,2,2099.41,968.16,943.16,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011337,MBR00000440,Institutional-OP,2022-05-30,2022-05-30,2022-06-21,PLN7893,1856686341,1856686341,Geriatrics,In-Network,E11.9,J06.9,,,,,,,0,,66984,Surgery,,,0301,22,Outpatient Hospital,1,2744.89,1305.55,942.53,338.02,25.0,0.0,363.02,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011338,MBR00000440,Institutional-OP,2022-03-12,2022-03-12,2022-03-31,PLN2220,1247341320,1247341320,Urology,Out-of-Network,J06.9,J06.9,,,,,,,0,,47562,Surgery,,,0761,22,Outpatient Hospital,3,3625.93,2727.05,2727.05,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011339,MBR00000440,Institutional-IP,2022-08-08,2022-08-09,2022-08-23,PLN9777,1660288235,1660288235,ASC,In-Network,Z23,N18.3,,,,603,MS-DRG,23,1,Y,99232,E&M,,,0301,21,Inpatient Hospital,2,172.76,58.4,0.0,58.4,35.0,0.0,93.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011340,MBR00000440,Institutional-OP,2023-10-23,2023-10-23,2023-10-31,PLN8753,1422747896,1422747896,Urology,In-Network,E11.9,K21.0,,,,,,,0,,27447,Surgery,,,0360,22,Outpatient Hospital,2,4262.06,1452.34,1434.38,0.0,0.0,17.96,17.96,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011341,MBR00000440,Institutional-OP,2023-08-16,2023-08-16,2023-09-04,PLN6831,1502838586,1502838586,ASC,In-Network,R10.9,F03.90,,,,,,,0,,99213,E&M,,,0730,22,Outpatient Hospital,1,290.75,157.24,0.0,157.24,0.0,0.0,157.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011342,MBR00000440,Professional,2022-10-27,2022-10-27,2022-11-28,PLN3434,1273488618,1273488618,General Acute Care Hospital,In-Network,J20.9,K21.0,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,2,115.68,68.19,0.0,68.19,0.0,0.0,68.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011343,MBR00000440,Professional,2021-11-06,2021-11-06,2021-11-26,PLN4712,1696843572,1696843572,Critical Access Hospital,Out-of-Network,Z00.00,R10.9,,,,,,,0,,99222,E&M,,,,50,Federally Qualified Health Center,3,508.59,239.36,152.18,0.0,50.0,37.18,87.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011344,MBR00000440,Institutional-IP,2022-02-17,2022-02-25,2022-03-13,PLN4207,1915531927,1915531927,Critical Access Hospital,In-Network,R10.9,J20.9,,,,194,MS-DRG,19,8,Y,33533,Surgery,,,0120,21,Inpatient Hospital,1,13602.11,4189.17,3313.23,110.38,0.0,765.56,875.94,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000011345,MBR00000441,Institutional-OP,2021-09-27,2021-09-27,2021-10-19,PLN3768,1372918899,1372918899,Family Medicine,In-Network,F10.20,F41.9,,,,,,,0,,99204,E&M,,,0200,22,Outpatient Hospital,2,284.18,157.15,107.15,0.0,50.0,0.0,50.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011346,MBR00000441,Institutional-OP,2021-07-24,2021-07-24,2021-08-27,PLN1473,1609138981,1609138981,Critical Access Hospital,In-Network,Z12.31,Z79.4,,,,,,,0,,76700,Radiology,,,0301,22,Outpatient Hospital,2,569.63,402.55,20.57,381.79,0.0,0.19,381.98,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011347,MBR00000441,Professional,2021-01-10,2021-01-10,2021-02-22,PLN6088,1463205530,1463205530,Nephrology,In-Network,E11.9,E11.9,,,,,,,0,,99222,E&M,,,,11,Office,2,561.33,346.85,331.85,0.0,15.0,0.0,15.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011348,MBR00000441,Professional,2023-04-28,2023-04-28,2023-05-13,PLN6393,1453283987,1453283987,Critical Access Hospital,In-Network,I10,J44.1,,,,,,,0,,58661,Surgery,,,,20,Urgent Care,3,3123.19,1012.33,885.09,0.0,0.0,127.24,127.24,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011349,MBR00000441,Institutional-OP,2023-03-20,2023-03-20,2023-04-06,PLN6640,1124394415,1124394415,Pediatrics,In-Network,G43.909,E78.5,,,,,,,0,,93306,Radiology,,,0301,22,Outpatient Hospital,3,2732.68,858.48,691.59,0.0,35.0,131.89,166.89,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011350,MBR00000441,Institutional-OP,2021-07-16,2021-07-16,2021-08-03,PLN7422,1689639685,1689639685,SNF,In-Network,I25.10,I10,,,,,,,0,,G0468,Medicine,,,0320,22,Outpatient Hospital,2,710.12,581.49,339.3,242.19,0.0,0.0,242.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011351,MBR00000441,Professional,2023-01-23,2023-01-23,2023-02-16,PLN3365,1283743001,1283743001,Family Medicine,In-Network,C50.912,Z23,,,,,,,0,,23472,Surgery,,,,11,Office,2,2900.99,2396.57,2295.21,0.0,35.0,66.36,101.36,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011352,MBR00000441,Professional,2021-07-01,2021-07-01,2021-07-10,PLN2401,1687650653,1687650653,Internal Medicine,In-Network,F32.9,J44.1,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,1,304.72,93.37,83.66,0.0,0.0,9.71,9.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011353,MBR00000441,Institutional-OP,2021-10-31,2021-10-31,2021-12-14,PLN1667,1702692193,1702692193,Physical Therapy,In-Network,Z23,R10.9,,,,,,,0,,93000,Radiology,,,0360,22,Outpatient Hospital,3,106.21,70.65,45.65,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011354,MBR00000441,Professional,2021-10-11,2021-10-11,2021-11-13,PLN2056,1847081578,1847081578,Urology,Out-of-Network,E11.9,N39.0,,,,,,,0,,27130,Surgery,,,,11,Office,1,3969.06,2339.06,2304.06,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011355,MBR00000441,Institutional-OP,2021-05-23,2021-05-23,2021-06-30,PLN1153,1872272835,1872272835,Internal Medicine,In-Network,K21.0,E78.5,,,,,,,0,,99213,E&M,,,0450,22,Outpatient Hospital,3,178.22,124.92,124.92,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011356,MBR00000441,Institutional-OP,2023-03-10,2023-03-10,2023-03-27,PLN5174,1790497490,1790497490,OB/GYN,In-Network,M54.5,Z96.641,,,,,,,0,,77067,Radiology,,,0320,22,Outpatient Hospital,1,632.99,268.22,243.41,24.81,0.0,0.0,24.81,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000011357,MBR00000441,Professional,2021-02-16,2021-02-16,2021-03-23,PLN5989,1717912431,1717912431,Oncology,In-Network,E78.5,E11.9,,,,,,,0,,99204,E&M,,,,20,Urgent Care,3,489.91,185.48,133.95,0.0,50.0,1.53,51.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011358,MBR00000441,Professional,2022-03-20,2022-03-20,2022-04-11,PLN9104,1915531927,1915531927,Critical Access Hospital,In-Network,E11.9,Z12.31,,,,,,,0,,47562,Surgery,,,,23,Emergency Room,1,6104.13,4456.19,3668.65,0.0,35.0,752.54,787.54,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011359,MBR00000441,Institutional-OP,2022-06-19,2022-06-19,2022-07-27,PLN6409,1556140803,1556140803,Cardiology,In-Network,Z79.4,J06.9,,,,,,,0,,66984,Surgery,,,0730,22,Outpatient Hospital,1,1840.12,1023.73,0.0,306.72,35.0,20.94,362.66,0.0,Denied,CO-4,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011360,MBR00000441,Professional,2022-09-24,2022-09-24,2022-11-01,PLN2016,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,N18.3,Z12.31,,,,,,,0,,99232,E&M,,,,20,Urgent Care,1,369.09,159.29,0.0,159.29,15.0,0.0,174.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011361,MBR00000441,Professional,2021-07-31,2021-07-31,2021-08-23,PLN9072,1453936007,1453936007,ASC,In-Network,E11.9,E78.5,,,,,,,0,,93000,Radiology,,,,22,Outpatient Hospital,2,136.7,71.5,47.91,19.29,0.0,4.3,23.59,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011362,MBR00000441,Professional,2022-06-01,2022-06-01,2022-06-27,PLN7061,1395983630,1395983630,Nephrology,In-Network,E78.5,E11.9,,,,,,,0,,84443,Pathology/Lab,,,,20,Urgent Care,1,77.51,30.24,0.0,30.24,50.0,0.0,80.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011363,MBR00000441,Institutional-IP,2023-05-19,2023-05-25,2023-06-22,PLN3171,1434029575,1434029575,Endocrinology,In-Network,Z87.891,I10,,,,291,MS-DRG,12,6,Y,45378,Surgery,,,0200,21,Inpatient Hospital,2,1246.12,1016.41,955.91,60.5,0.0,0.0,60.5,0.0,Paid,,,1,,0,1,1,0,0,1,Duplicate,0,1,0,0,0
CLM0000011364,MBR00000441,Professional,2022-02-14,2022-02-14,2022-03-12,PLN5481,1198133277,1198133277,SNF,In-Network,G43.909,I10,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,1,7024.28,4236.42,0.0,15.71,50.0,0.0,65.71,0.0,Denied,CO-15,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011365,MBR00000441,Institutional-OP,2023-11-07,2023-11-07,2023-12-14,PLN9390,1980712759,1980712759,Outpatient Clinic,Out-of-Network,E78.5,E11.9,,,,,,,0,,23472,Surgery,,,0510,22,Outpatient Hospital,3,5498.12,3113.45,0.0,0.0,50.0,0.0,50.0,0.0,Denied,PR-1,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011366,MBR00000441,Professional,2022-04-16,2022-04-16,2022-05-28,PLN6672,1193493783,1193493783,Critical Access Hospital,Out-of-Network,K21.0,N39.0,,,,,,,0,,78452,Radiology,,,,11,Office,1,4406.77,3010.3,2723.5,0.0,0.0,286.8,286.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011367,MBR00000441,Professional,2023-05-01,2023-05-01,2023-05-20,PLN5229,1872613201,1872613201,Internal Medicine,In-Network,N18.3,Z00.00,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,2,44.91,14.66,14.06,0.0,0.0,0.6,0.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011368,MBR00000441,Professional,2021-05-05,2021-05-05,2021-06-15,PLN8448,1109850785,1109850785,ASC,Out-of-Network,Z12.31,N18.3,,,,,,,0,,99213,E&M,,,,20,Urgent Care,2,293.22,109.93,109.93,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011369,MBR00000441,Professional,2023-07-22,2023-07-22,2023-08-05,PLN5291,1139906830,1139906830,Endocrinology,Out-of-Network,I25.10,Z87.891,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,2,492.43,396.8,0.0,396.8,50.0,0.0,446.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011370,MBR00000441,Institutional-OP,2022-06-10,2022-06-10,2022-06-23,PLN6911,1727809972,1727809972,Home Health,In-Network,Z00.00,Z87.891,,,,,,,0,,85610,Pathology/Lab,,,0450,22,Outpatient Hospital,1,27.68,15.38,15.38,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011371,MBR00000441,Professional,2023-12-21,2023-12-21,2024-01-03,PLN7551,1569105090,1569105090,Geriatrics,In-Network,M81.0,F32.9,,,,,,,0,,58661,Surgery,,,,81,Independent Laboratory,3,4124.43,3456.93,3083.58,338.35,35.0,0.0,373.35,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011372,MBR00000441,Institutional-OP,2023-02-07,2023-02-07,2023-03-23,PLN7421,1817234602,1817234602,Clinical Laboratory,In-Network,E66.9,F41.9,,,,,,,0,,45378,Surgery,,,0636,22,Outpatient Hospital,1,1406.37,810.75,548.92,164.0,50.0,47.83,261.83,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000011373,MBR00000441,Professional,2023-03-23,2023-03-23,2023-04-10,PLN6831,1390307371,1390307371,DME Supplier,In-Network,Z00.00,I25.10,,,,,,,0,,78452,Radiology,,,,23,Emergency Room,2,2932.3,1593.55,0.0,0.0,0.0,42.42,42.42,0.0,Denied,CO-18,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011374,MBR00000441,Professional,2021-06-12,2021-06-12,2021-07-02,PLN2691,1500949740,1500949740,Pediatrics,In-Network,J06.9,Z23,,,,,,,0,,93225,Medicine,,,,11,Office,3,778.1,322.48,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-29,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000011375,MBR00000441,Professional,2022-09-14,2022-09-14,2022-10-11,PLN6424,1236418230,1236418230,DME Supplier,In-Network,I48.91,I10,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,2,65.96,37.7,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011376,MBR00000441,Institutional-OP,2023-03-20,2023-03-20,2023-04-21,PLN8411,1809014947,1809014947,Urology,In-Network,K21.0,F32.9,,,,,,,0,,66984,Surgery,,,0510,22,Outpatient Hospital,1,3457.7,1744.11,1669.11,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011377,MBR00000441,Institutional-IP,2023-06-06,2023-06-10,2023-06-28,PLN7868,1856686341,1856686341,Geriatrics,In-Network,M54.5,F03.90,,,,603,MS-DRG,16,4,Y,99233,E&M,,,0320,21,Inpatient Hospital,2,511.76,192.99,192.99,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000011378,MBR00000441,Institutional-OP,2022-02-17,2022-02-17,2022-03-02,PLN1970,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,E11.9,F41.9,,,,,,,0,,27447,Surgery,,,0450,22,Outpatient Hospital,2,3085.36,989.31,958.88,0.0,25.0,5.43,30.43,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011379,MBR00000441,Professional,2022-09-10,2022-09-10,2022-10-03,PLN9803,1124394415,1124394415,Pediatrics,In-Network,Z23,Z23,,,,,,,0,,27130,Surgery,,,,11,Office,2,4139.53,2941.18,2891.18,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011380,MBR00000441,Institutional-OP,2021-07-09,2021-07-09,2021-07-18,PLN2142,1860435061,1860435061,DME Supplier,In-Network,I10,E11.9,,,,,,,0,,99284,E&M,,,0636,22,Outpatient Hospital,1,829.36,268.04,268.04,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011381,MBR00000441,Institutional-OP,2022-04-19,2022-04-19,2022-05-16,PLN5460,1644128543,1644128543,Gastroenterology,In-Network,J45.20,Z12.31,,,,,,,0,,43239,Surgery,,,0730,22,Outpatient Hospital,2,1555.11,508.56,211.92,237.6,35.0,24.04,296.64,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011382,MBR00000441,Institutional-OP,2022-06-06,2022-06-06,2022-06-17,PLN6304,1556140803,1556140803,Cardiology,In-Network,M17.11,R51,,,,,,,0,,99406,Medicine,,,0900,22,Outpatient Hospital,3,63.5,40.03,40.03,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011383,MBR00000441,Professional,2021-02-05,2021-02-05,2021-03-20,PLN9430,1872613201,1872613201,Internal Medicine,In-Network,N39.0,J06.9,,,,,,,0,,27447,Surgery,,,,12,Home,1,2864.11,1529.6,1454.6,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011384,MBR00000441,Professional,2023-10-01,2023-10-01,2023-10-30,PLN6686,1872272835,1872272835,Internal Medicine,In-Network,N20.0,Z96.641,,,,,,,0,,90460,Medicine,,,,81,Independent Laboratory,1,30.23,22.6,0.0,22.6,0.0,0.0,22.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011385,MBR00000441,Institutional-IP,2022-12-06,2022-12-11,2022-12-25,PLN2650,1915531927,1915531927,Critical Access Hospital,In-Network,M54.5,B97.89,,,,871,MS-DRG,3,5,Y,99233,E&M,,,0270,21,Inpatient Hospital,3,496.8,310.68,234.82,0.0,35.0,40.86,75.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011386,MBR00000441,Professional,2021-07-20,2021-07-20,2021-08-24,PLN1498,1422747896,1422747896,Urology,In-Network,I63.9,E78.5,,,,,,,0,,71046,Radiology,,,,21,Inpatient Hospital,2,169.22,61.0,0.0,61.0,50.0,0.0,111.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011387,MBR00000441,Institutional-OP,2023-09-10,2023-09-10,2023-10-10,PLN8683,1366426662,1366426662,Urology,In-Network,K57.30,E78.5,,,,,,,0,,99214,E&M,,,0320,22,Outpatient Hospital,2,379.62,227.2,0.0,227.2,25.0,0.0,252.2,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011388,MBR00000441,Professional,2023-01-28,2023-01-28,2023-02-13,PLN9180,1266606767,1266606767,ASC,In-Network,I10,Z23,,,,,,,0,,83036,Pathology/Lab,,,,81,Independent Laboratory,3,80.42,58.94,0.0,58.94,0.0,0.0,58.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000011389,MBR00000441,Institutional-IP,2023-01-30,2023-02-04,2023-02-13,PLN9505,1840431511,1840431511,Geriatrics,Out-of-Network,J45.20,J44.1,,,,871,MS-DRG,20,5,Y,99283,E&M,,,0301,21,Inpatient Hospital,2,297.43,200.72,0.0,200.72,15.0,0.0,215.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011390,MBR00000441,Professional,2023-10-19,2023-10-19,2023-11-06,PLN3439,1563980627,1563980627,Critical Access Hospital,In-Network,J18.9,E11.9,,,,,,,0,,90837,Medicine,,,,11,Office,3,230.32,151.46,142.65,0.0,0.0,8.81,8.81,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011391,MBR00000441,Professional,2022-03-19,2022-03-19,2022-04-13,PLN3958,1337791138,1337791138,Internal Medicine,Out-of-Network,J06.9,J06.9,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,1,494.19,405.17,334.19,0.0,0.0,70.98,70.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011392,MBR00000441,Professional,2022-01-24,2022-01-24,2022-02-26,PLN4545,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,E78.5,Z23,,,,,,,0,,70553,Radiology,,,,23,Emergency Room,1,1624.59,1036.4,806.65,154.75,75.0,0.0,229.75,0.0,Pended,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011393,MBR00000441,Institutional-OP,2022-11-07,2022-11-07,2022-11-14,PLN2018,1236418230,1236418230,DME Supplier,In-Network,Z12.31,M54.5,,,,,,,0,,84443,Pathology/Lab,,,0360,22,Outpatient Hospital,1,161.17,71.53,0.0,71.53,0.0,0.0,71.53,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011394,MBR00000441,Professional,2023-08-31,2023-08-31,2023-09-27,PLN4430,1193493783,1193493783,Critical Access Hospital,Out-of-Network,Z79.4,Z12.31,,,,,,,0,,58661,Surgery,,,,21,Inpatient Hospital,2,2407.75,748.86,307.05,441.81,0.0,0.0,441.81,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011395,MBR00000442,Institutional-IP,2023-06-10,2023-06-17,2023-07-20,PLN5457,1968299309,1968299309,Internal Medicine,In-Network,Z23,N39.0,,,,603,MS-DRG,17,7,Y,G0444,Medicine,,,0761,21,Inpatient Hospital,1,98.6,53.34,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000011396,MBR00000442,Professional,2023-05-12,2023-05-12,2023-06-17,PLN5233,1545347862,1545347862,SNF,In-Network,J06.9,Z12.31,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,2,285.68,157.32,99.7,0.0,50.0,7.62,57.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011397,MBR00000442,Professional,2023-04-17,2023-04-17,2023-05-28,PLN4112,1528335731,1528335731,Critical Access Hospital,In-Network,F32.9,I48.91,,,,,,,0,,99204,E&M,,,,11,Office,2,418.42,141.27,141.27,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011398,MBR00000442,Professional,2021-02-08,2021-02-08,2021-02-15,PLN7618,1410468316,1410468316,SNF,In-Network,F32.9,E78.5,,,,,,,0,,74177,Radiology,,,,22,Outpatient Hospital,3,1703.18,1165.41,1040.69,0.0,25.0,99.72,124.72,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011399,MBR00000442,Professional,2022-06-22,2022-06-22,2022-07-25,PLN9056,1103747954,1103747954,Urology,In-Network,E11.9,I50.9,,,,,,,0,,58661,Surgery,,,,11,Office,2,2273.9,1160.87,472.66,441.24,15.0,27.83,484.07,204.14,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011400,MBR00000442,Professional,2022-01-25,2022-01-25,2022-02-05,PLN3298,1313212303,1313212303,Family Medicine,In-Network,Z00.00,I10,,,,,,,0,,78452,Radiology,,,,11,Office,3,3828.24,2081.96,1636.25,410.71,35.0,0.0,445.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011401,MBR00000442,Professional,2022-02-01,2022-02-01,2022-03-17,PLN7708,1518055405,1518055405,Urology,In-Network,Z87.891,J20.9,,,,,,,0,,77067,Radiology,,,,22,Outpatient Hospital,2,681.28,225.85,150.85,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000011402,MBR00000442,Institutional-OP,2023-07-27,2023-07-27,2023-09-01,PLN3643,1606140917,1606140917,ASC,In-Network,E78.5,I10,,,,,,,0,,83036,Pathology/Lab,,,0761,22,Outpatient Hospital,1,94.36,35.36,0.0,35.36,0.0,0.0,35.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000011403,MBR00000442,Institutional-OP,2022-03-11,2022-03-11,2022-04-10,PLN5274,1691062876,1691062876,SNF,In-Network,E11.65,I25.10,,,,,,,0,,45380,Surgery,,,0370,22,Outpatient Hospital,1,2202.4,1271.28,930.22,291.06,50.0,0.0,341.06,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000011404,MBR00000442,Institutional-OP,2023-07-06,2023-07-06,2023-07-28,PLN8525,1268679390,1268679390,Critical Access Hospital,In-Network,M54.5,E78.5,,,,,,,0,,99221,E&M,,,0636,22,Outpatient Hospital,1,215.04,85.09,45.7,0.0,35.0,4.39,39.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011405,MBR00000442,Professional,2023-09-22,2023-09-22,2023-10-04,PLN4219,1564502315,1564502315,ASC,In-Network,M54.5,K21.0,,,,,,,0,,99213,E&M,,,,22,Outpatient Hospital,3,162.4,129.38,129.38,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011406,MBR00000442,Professional,2022-05-14,2022-05-14,2022-05-24,PLN6404,1486164553,1486164553,DME Supplier,In-Network,R05,Z12.31,,,,,,,0,,99283,E&M,,,,11,Office,2,222.02,108.46,3.75,104.71,0.0,0.0,104.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011407,MBR00000442,Professional,2021-07-05,2021-07-05,2021-08-08,PLN2727,1795618275,1795618275,Pulmonology,In-Network,E11.9,R05,,,,,,,0,,90837,Medicine,,,,11,Office,3,507.07,366.96,338.1,0.0,0.0,0.0,0.0,28.86,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011408,MBR00000443,Professional,2023-02-04,2023-02-04,2023-02-28,PLN3758,1845057593,1845057593,Orthopedic Surgery,In-Network,M54.5,F41.9,,,,,,,0,,93225,Medicine,,,,23,Emergency Room,3,670.86,443.96,409.63,0.0,0.0,34.33,34.33,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011409,MBR00000443,Institutional-OP,2023-08-03,2023-08-03,2023-08-11,PLN1206,1193493783,1193493783,Critical Access Hospital,Out-of-Network,J06.9,M17.11,,,,,,,0,,33533,Surgery,,,0301,22,Outpatient Hospital,1,18260.94,6801.54,6641.11,160.43,0.0,0.0,160.43,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000011410,MBR00000443,Professional,2022-03-21,2022-03-21,2022-04-27,PLN1887,1245650222,1245650222,Gastroenterology,In-Network,I10,E11.9,,,,,,,0,,76700,Radiology,,,,11,Office,3,693.28,424.99,424.99,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011411,MBR00000443,Professional,2021-08-02,2021-08-02,2021-09-05,PLN5556,1247341320,1247341320,Urology,Out-of-Network,E11.9,E11.65,,,,,,,0,,99222,E&M,,,,31,Skilled Nursing Facility,2,534.19,336.14,0.0,336.14,0.0,0.0,336.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011412,MBR00000443,Institutional-OP,2022-07-25,2022-07-25,2022-09-04,PLN6709,1531398223,1531398223,OB/GYN,In-Network,B97.89,R10.9,,,,,,,0,,85610,Pathology/Lab,,,0510,22,Outpatient Hospital,2,30.28,23.22,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011413,MBR00000443,Professional,2023-12-11,2023-12-11,2023-12-29,PLN3950,1124394415,1124394415,Pediatrics,In-Network,Z12.31,Z00.01,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,1,1953.31,1133.08,1133.08,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011414,MBR00000443,Professional,2022-07-21,2022-07-21,2022-08-24,PLN7193,1778483301,1778483301,Home Health,In-Network,Z87.891,M81.0,,,,,,,0,,45378,Surgery,,,,11,Office,2,1373.3,628.9,523.58,0.0,75.0,30.32,105.32,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000011415,MBR00000443,Institutional-OP,2022-05-06,2022-05-06,2022-06-10,PLN7016,1872613201,1872613201,Internal Medicine,In-Network,I10,E78.5,,,,,,,0,,99284,E&M,,,0270,22,Outpatient Hospital,3,915.37,543.59,464.58,54.01,25.0,0.0,79.01,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011416,MBR00000443,Professional,2022-04-27,2022-04-27,2022-05-29,PLN4487,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,I10,I10,,,,,,,0,,45380,Surgery,,,,65,End-Stage Renal Disease,1,2258.1,1716.01,1716.01,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000011417,MBR00000443,Institutional-OP,2023-03-15,2023-03-15,2023-04-01,PLN4440,1283743001,1283743001,Family Medicine,In-Network,I50.9,E11.9,,,,,,,0,,99222,E&M,,,0740,22,Outpatient Hospital,1,532.36,203.79,0.0,203.79,0.0,0.0,203.79,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000011418,MBR00000443,Professional,2022-01-09,2022-01-09,2022-02-15,PLN8296,1239316214,1239316214,Internal Medicine,In-Network,J44.1,N40.0,,,,,,,0,,99214,E&M,,,,11,Office,2,407.54,204.56,126.62,42.94,35.0,0.0,77.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011419,MBR00000443,Institutional-OP,2023-03-10,2023-03-10,2023-04-22,PLN6946,1514306773,1514306773,Endocrinology,In-Network,J06.9,Z23,,,,,,,0,,45378,Surgery,,,0761,22,Outpatient Hospital,3,1989.67,1178.13,1178.13,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000011420,MBR00000443,Institutional-OP,2023-12-17,2023-12-17,2023-12-24,PLN2499,1236418230,1236418230,DME Supplier,In-Network,E11.9,Z23,,,,,,,0,,99222,E&M,,,0120,22,Outpatient Hospital,2,353.74,213.65,163.65,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011421,MBR00000443,Professional,2023-04-26,2023-04-26,2023-05-31,PLN2954,1728018911,1728018911,Nephrology,In-Network,E78.5,Z23,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,2,331.55,274.27,274.27,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011422,MBR00000443,Institutional-OP,2023-10-14,2023-10-14,2023-11-13,PLN6440,1148984206,1148984206,Psychiatry,In-Network,I63.9,J06.9,,,,,,,0,,27447,Surgery,,,0200,22,Outpatient Hospital,1,2262.96,1862.8,1862.8,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011423,MBR00000443,Professional,2023-05-15,2023-05-15,2023-06-18,PLN9231,1585582070,1585582070,Outpatient Clinic,In-Network,E11.65,N39.0,,,,,,,0,,27447,Surgery,,,,11,Office,1,3787.48,1952.91,1785.46,0.0,0.0,167.45,167.45,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011424,MBR00000443,Institutional-OP,2023-07-13,2023-07-13,2023-08-18,PLN5137,1268679390,1268679390,Critical Access Hospital,In-Network,Z96.641,G43.909,,,,,,,0,,99203,E&M,,,0900,22,Outpatient Hospital,1,170.89,127.1,77.1,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011425,MBR00000443,Institutional-IP,2021-02-12,2021-02-23,2021-03-11,PLN3088,1337791138,1337791138,Internal Medicine,Out-of-Network,Z23,M54.5,,,,603,MS-DRG,17,11,Y,97530,Medicine,,,0270,21,Inpatient Hospital,2,115.81,38.79,0.0,38.79,0.0,0.0,38.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011426,MBR00000443,Professional,2022-01-22,2022-01-22,2022-02-17,PLN3875,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,F41.9,M54.5,,,,,,,0,,90837,Medicine,,,,22,Outpatient Hospital,1,395.39,238.12,223.12,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011427,MBR00000443,Professional,2021-10-27,2021-10-27,2021-12-01,PLN3850,1366426662,1366426662,Urology,In-Network,K21.0,E66.9,,,,,,,0,,99214,E&M,,,,20,Urgent Care,2,372.74,149.61,60.66,0.0,75.0,13.95,88.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011428,MBR00000443,Professional,2023-08-04,2023-08-04,2023-09-08,PLN5206,1609138981,1609138981,Critical Access Hospital,In-Network,I63.9,E11.9,,,,,,,0,,45378,Surgery,,,,11,Office,2,2123.83,676.14,676.14,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000011429,MBR00000443,Institutional-IP,2021-09-09,2021-09-10,2021-10-22,PLN1416,1691062876,1691062876,SNF,In-Network,N18.3,N18.3,,,,292,MS-DRG,22,1,Y,70553,Radiology,,,0200,21,Inpatient Hospital,3,2609.43,2100.18,1996.99,88.19,15.0,0.0,103.19,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011430,MBR00000443,Institutional-IP,2023-11-26,2023-12-05,2023-12-08,PLN9366,1205377316,1205377316,Orthopedic Surgery,In-Network,Z00.00,J20.9,,,,872,MS-DRG,18,9,Y,99284,E&M,,,0450,21,Inpatient Hospital,1,445.28,370.15,0.0,370.15,0.0,0.0,370.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011431,MBR00000443,Professional,2023-02-04,2023-02-04,2023-03-05,PLN3717,1500949740,1500949740,Pediatrics,In-Network,E78.5,F41.9,,,,,,,0,,93306,Radiology,,,,11,Office,1,3086.93,2567.65,2186.88,188.61,0.0,192.16,380.77,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011432,MBR00000443,Institutional-OP,2021-05-16,2021-05-16,2021-06-19,PLN6952,1242201429,1242201429,General Acute Care Hospital,In-Network,G20,R05,,,,,,,0,,58661,Surgery,,,0120,22,Outpatient Hospital,3,4838.27,3745.21,3745.21,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,1,0,0,1,Phantom,0,0,0,0,0
CLM0000011433,MBR00000443,Institutional-OP,2023-01-19,2023-01-19,2023-02-14,PLN1101,1910255109,1910255109,DME Supplier,In-Network,Z79.4,Z00.00,,,,,,,0,,99214,E&M,,,0730,22,Outpatient Hospital,3,420.2,165.7,140.7,0.0,25.0,0.0,25.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011434,MBR00000443,Professional,2022-01-11,2022-01-11,2022-02-11,PLN7335,1780163051,1780163051,SNF,In-Network,Z00.01,M81.0,,,,,,,0,,99214,E&M,,,,49,Independent Clinic,1,461.31,169.3,42.37,123.88,0.0,3.05,126.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011435,MBR00000443,Institutional-IP,2021-11-22,2021-11-26,2021-12-02,PLN8379,1757138478,1757138478,Pediatrics,In-Network,J18.9,E78.5,,,,641,MS-DRG,6,4,N,99222,E&M,,,0761,21,Inpatient Hospital,1,309.86,104.79,104.79,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011436,MBR00000443,Professional,2023-12-25,2023-12-25,2024-01-06,PLN2663,1500949740,1500949740,Pediatrics,In-Network,I10,E66.9,,,,,,,0,,80061,Pathology/Lab,,,,23,Emergency Room,3,115.11,65.65,0.0,65.65,25.0,0.0,90.65,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011437,MBR00000443,Institutional-OP,2023-05-19,2023-05-19,2023-07-01,PLN5326,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,E11.9,E78.5,,,,,,,0,,66984,Surgery,,,0730,22,Outpatient Hospital,2,1582.91,1308.17,911.47,396.7,0.0,0.0,396.7,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011438,MBR00000443,Institutional-OP,2023-04-16,2023-04-16,2023-05-02,PLN8788,1745114564,1745114564,Endocrinology,In-Network,J06.9,I10,,,,,,,0,,99222,E&M,,,0360,22,Outpatient Hospital,1,328.05,260.04,0.0,260.04,35.0,0.0,295.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011439,MBR00000443,Institutional-OP,2021-12-08,2021-12-08,2022-01-09,PLN8336,1118885473,1118885473,ASC,In-Network,I10,J20.9,,,,,,,0,,78452,Radiology,,,0360,22,Outpatient Hospital,3,2928.43,2020.57,1872.89,0.0,0.0,147.68,147.68,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011440,MBR00000443,Institutional-OP,2022-12-27,2022-12-27,2023-02-08,PLN4934,1247341320,1247341320,Urology,Out-of-Network,G43.909,I11.9,,,,,,,0,,66984,Surgery,,,0761,22,Outpatient Hospital,3,3335.83,2580.43,2089.74,490.69,0.0,0.0,490.69,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011441,MBR00000443,Professional,2022-01-11,2022-01-11,2022-02-10,PLN1554,1550154147,1550154147,Outpatient Clinic,In-Network,J06.9,I10,,,,,,,0,,43239,Surgery,,,,23,Emergency Room,1,823.57,670.52,512.25,156.69,0.0,1.58,158.27,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011442,MBR00000443,Professional,2022-10-23,2022-10-23,2022-11-05,PLN1251,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,I10,N17.9,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,3,263.07,192.4,192.4,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000011443,MBR00000443,Professional,2022-03-13,2022-03-13,2022-04-19,PLN1537,1245650222,1245650222,Gastroenterology,In-Network,E11.9,N18.3,,,,,,,0,,74177,Radiology,,,,20,Urgent Care,3,1641.65,1345.02,1345.02,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011444,MBR00000443,Professional,2022-10-30,2022-10-30,2022-12-05,PLN8773,1845057593,1845057593,Orthopedic Surgery,In-Network,R10.9,E66.9,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,1,175.19,143.63,96.72,0.0,35.0,11.91,46.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011445,MBR00000443,Institutional-IP,2023-03-27,2023-03-31,2023-04-14,PLN1697,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,C50.912,E66.9,,,,690,MS-DRG,20,4,Y,27130,Surgery,,,0120,21,Inpatient Hospital,2,5977.07,3105.37,3042.61,62.76,0.0,0.0,62.76,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011446,MBR00000443,Professional,2021-12-12,2021-12-12,2022-01-07,PLN8532,1865904917,1865904917,Outpatient Clinic,In-Network,J06.9,I10,,,,,,,0,,99233,E&M,,,,11,Office,1,287.86,93.19,0.0,93.19,0.0,0.0,93.19,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011447,MBR00000443,Institutional-OP,2021-01-13,2021-01-13,2021-02-20,PLN8546,1450553056,1450553056,Clinical Laboratory,In-Network,I48.91,E78.5,,,,,,,0,,99204,E&M,,,0900,22,Outpatient Hospital,3,329.94,141.87,0.0,141.87,0.0,0.0,141.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011448,MBR00000443,Institutional-IP,2021-04-17,2021-04-22,2021-05-16,PLN1214,1696843572,1696843572,Critical Access Hospital,Out-of-Network,R07.9,J20.9,,,,194,MS-DRG,9,5,Y,47562,Surgery,,,0510,21,Inpatient Hospital,2,3439.09,2844.8,0.0,0.0,0.0,395.07,395.07,0.0,Denied,CO-97,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011449,MBR00000443,Professional,2023-09-20,2023-09-20,2023-10-20,PLN9986,1749494482,1749494482,Pediatrics,In-Network,C50.912,E66.9,,,,,,,0,,G0444,Medicine,,,,21,Inpatient Hospital,2,82.98,36.43,19.07,0.0,15.0,2.36,17.36,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000011450,MBR00000443,Institutional-OP,2023-11-17,2023-11-17,2023-12-05,PLN7906,1845900543,1845900543,ASC,In-Network,M54.5,Z23,,,,,,,0,,78452,Radiology,,,0200,22,Outpatient Hospital,1,7194.1,2945.83,2521.18,0.0,35.0,389.65,424.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011451,MBR00000443,Professional,2023-01-28,2023-01-28,2023-02-14,PLN4022,1689639685,1689639685,SNF,In-Network,I10,Z12.11,,,,,,,0,,93225,Medicine,,,,21,Inpatient Hospital,2,545.82,357.43,357.43,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011452,MBR00000443,Professional,2021-04-28,2021-04-28,2021-05-27,PLN9212,1561134315,1561134315,DME Supplier,In-Network,Z79.4,Z00.00,,,,,,,0,,33533,Surgery,,,,11,Office,2,12732.49,4435.04,4322.6,97.44,15.0,0.0,112.44,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000011453,MBR00000444,Professional,2022-10-05,2022-10-05,2022-11-10,PLN2161,1749327647,1749327647,Geriatrics,In-Network,Z12.31,J20.9,,,,,,,0,,93225,Medicine,,,,11,Office,2,800.19,626.18,576.18,0.0,50.0,0.0,50.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011454,MBR00000444,Professional,2022-04-19,2022-04-19,2022-05-03,PLN7517,1514306773,1514306773,Endocrinology,In-Network,Z23,K21.0,,,,,,,0,,80053,Pathology/Lab,,,,21,Inpatient Hospital,3,103.37,48.19,48.19,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011455,MBR00000444,Professional,2021-09-17,2021-09-17,2021-09-28,PLN7410,1528335731,1528335731,Critical Access Hospital,In-Network,Z12.31,J20.9,,,,,,,0,,90837,Medicine,,,,23,Emergency Room,2,420.06,326.34,291.34,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011456,MBR00000444,Professional,2022-02-20,2022-02-20,2022-04-05,PLN5006,1585582070,1585582070,Outpatient Clinic,In-Network,E11.9,Z12.31,,,,,,,0,,99222,E&M,,,,20,Urgent Care,3,600.77,338.76,0.0,338.76,50.0,0.0,388.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011457,MBR00000444,Professional,2023-05-11,2023-05-11,2023-05-29,PLN1681,1463205530,1463205530,Nephrology,In-Network,Z23,E78.5,,,,,,,0,,90460,Medicine,,,,11,Office,3,64.67,36.72,0.0,36.72,35.0,0.0,71.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011458,MBR00000444,Professional,2023-12-28,2023-12-28,2024-01-05,PLN2219,1856686341,1856686341,Geriatrics,In-Network,M54.5,I10,,,,,,,0,,70450,Radiology,,,,23,Emergency Room,3,1256.93,746.94,361.43,385.51,0.0,0.0,385.51,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011459,MBR00000444,Professional,2023-08-14,2023-08-14,2023-09-09,PLN4004,1899127912,1899127912,Neurology,In-Network,I10,N39.0,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,1,92.58,50.47,50.47,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011460,MBR00000444,Institutional-OP,2021-08-12,2021-08-12,2021-09-01,PLN1572,1585582070,1585582070,Outpatient Clinic,In-Network,N18.3,M54.5,,,,,,,0,,99222,E&M,,,0636,22,Outpatient Hospital,1,344.13,104.33,0.0,104.33,0.0,0.0,104.33,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011461,MBR00000444,Professional,2022-07-04,2022-07-04,2022-08-07,PLN7711,1575695214,1575695214,SNF,In-Network,Z12.11,E66.9,,,,,,,0,,99214,E&M,,,,11,Office,3,374.67,283.13,0.0,4.99,50.0,0.0,54.99,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011462,MBR00000444,Professional,2022-08-02,2022-08-02,2022-09-12,PLN1451,1422747896,1422747896,Urology,In-Network,I10,Z12.31,,,,,,,0,,97530,Medicine,,,,11,Office,2,199.28,132.21,20.1,97.11,15.0,0.0,112.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011463,MBR00000445,Professional,2021-11-17,2021-11-17,2021-12-14,PLN5549,1108115157,1108115157,General Acute Care Hospital,In-Network,Z87.891,E78.5,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,2,59.95,25.84,25.84,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011464,MBR00000445,Professional,2022-04-22,2022-04-22,2022-05-13,PLN7476,1283743001,1283743001,Family Medicine,In-Network,I10,Z51.11,,,,,,,0,,90460,Medicine,,,,20,Urgent Care,1,56.68,31.29,16.29,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011465,MBR00000445,Professional,2022-02-21,2022-02-21,2022-03-10,PLN8335,1840431511,1840431511,Geriatrics,Out-of-Network,K21.0,K21.0,,,,,,,0,,99221,E&M,,,,11,Office,2,198.7,147.61,147.61,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011466,MBR00000445,Professional,2021-03-18,2021-03-18,2021-04-21,PLN8801,1717912431,1717912431,Oncology,In-Network,I10,I10,,,,,,,0,,27447,Surgery,,,,11,Office,3,2556.35,2152.08,2137.08,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011467,MBR00000445,Institutional-OP,2022-04-01,2022-04-01,2022-04-23,PLN9655,1500037969,1500037969,Pulmonology,In-Network,K57.30,F10.20,,,,,,,0,,58661,Surgery,,,0360,22,Outpatient Hospital,1,2828.04,1426.79,1221.74,170.05,35.0,0.0,205.05,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011468,MBR00000445,Institutional-OP,2022-02-03,2022-02-03,2022-02-28,PLN9361,1198133277,1198133277,SNF,In-Network,Z00.00,J06.9,,,,,,,0,,99203,E&M,,,0360,22,Outpatient Hospital,2,352.38,230.26,230.26,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011469,MBR00000445,Institutional-OP,2021-12-01,2021-12-01,2021-12-20,PLN5939,1745114564,1745114564,Endocrinology,In-Network,E11.9,F32.9,,,,,,,0,,99204,E&M,,,0301,22,Outpatient Hospital,3,426.99,294.6,52.63,241.97,0.0,0.0,241.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011470,MBR00000445,Institutional-OP,2022-11-04,2022-11-04,2022-11-15,PLN7275,1139906830,1139906830,Endocrinology,Out-of-Network,K21.0,I25.10,,,,,,,0,,99284,E&M,,,0730,22,Outpatient Hospital,1,876.39,314.57,255.69,0.0,0.0,58.88,58.88,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011471,MBR00000445,Professional,2023-02-19,2023-02-19,2023-03-15,PLN9744,1767011137,1767011137,DME Supplier,In-Network,M17.11,I10,,,,,,,0,,47562,Surgery,,,,11,Office,1,3940.06,1795.11,1712.72,0.0,0.0,82.39,82.39,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011472,MBR00000445,Professional,2021-02-21,2021-02-21,2021-03-18,PLN8872,1991459367,1991459367,Neurology,Out-of-Network,E78.5,K21.0,,,,,,,0,,45378,Surgery,,,,21,Inpatient Hospital,2,1511.35,1218.51,1203.51,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000011473,MBR00000445,Professional,2022-01-10,2022-01-10,2022-02-17,PLN4376,1865904917,1865904917,Outpatient Clinic,In-Network,E11.9,M17.11,,,,,,,0,,99203,E&M,,,,21,Inpatient Hospital,1,315.98,172.16,0.0,172.16,35.0,0.0,207.16,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011474,MBR00000445,Institutional-IP,2021-02-03,2021-02-04,2021-02-16,PLN2896,1561134315,1561134315,DME Supplier,In-Network,N18.3,J44.1,,,,196,MS-DRG,5,1,Y,27130,Surgery,,,0120,21,Inpatient Hospital,1,6379.31,2838.39,2560.99,242.4,35.0,0.0,277.4,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011475,MBR00000445,Institutional-IP,2023-06-19,2023-06-21,2023-07-17,PLN1485,1500949740,1500949740,Pediatrics,In-Network,J45.20,M17.11,,,,682,MS-DRG,23,2,Y,23472,Surgery,,,0900,21,Inpatient Hospital,1,3632.74,2231.63,2216.63,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011476,MBR00000445,Professional,2023-10-13,2023-10-13,2023-10-27,PLN2905,1946680931,1946680931,Critical Access Hospital,Out-of-Network,J44.1,E11.9,,,,,,,0,,33533,Surgery,,,,11,Office,3,15268.43,6575.05,6575.05,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000011477,MBR00000445,Institutional-OP,2022-05-23,2022-05-23,2022-06-25,PLN4347,1540044947,1540044947,Pulmonology,Out-of-Network,I10,E11.9,,,,,,,0,,93306,Radiology,,,0320,22,Outpatient Hospital,2,1570.45,1161.61,1146.61,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011478,MBR00000445,Professional,2023-11-01,2023-11-01,2023-11-13,PLN8410,1702692193,1702692193,Physical Therapy,In-Network,R07.9,E11.9,,,,,,,0,,99222,E&M,,,,11,Office,3,362.3,292.97,292.97,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011479,MBR00000445,Institutional-OP,2022-11-20,2022-11-20,2022-12-14,PLN2721,1749494482,1749494482,Pediatrics,In-Network,Z87.891,E11.9,,,,,,,0,,93225,Medicine,,,0900,22,Outpatient Hospital,2,425.95,281.04,256.04,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011480,MBR00000446,Institutional-OP,2023-08-10,2023-08-10,2023-09-04,PLN7059,1366576336,1366576336,Geriatrics,In-Network,I25.10,M54.5,,,,,,,0,,99222,E&M,,,0740,22,Outpatient Hospital,1,641.93,424.47,0.0,236.48,75.0,0.0,311.48,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011481,MBR00000446,Professional,2023-11-05,2023-11-05,2023-12-10,PLN7298,1486164553,1486164553,DME Supplier,In-Network,I10,E11.9,,,,,,,0,,43239,Surgery,,,,21,Inpatient Hospital,2,2231.67,1079.05,897.87,176.63,0.0,4.55,181.18,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011482,MBR00000446,Professional,2022-10-05,2022-10-05,2022-11-10,PLN1796,1891849440,1891849440,Oncology,In-Network,Z23,I11.9,,,,,,,0,,97110,Medicine,,,,49,Independent Clinic,1,247.73,143.88,0.0,143.88,25.0,0.0,168.88,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011483,MBR00000446,Professional,2022-05-04,2022-05-04,2022-05-17,PLN2286,1948810580,1948810580,DME Supplier,In-Network,F41.9,Z12.31,,,,,,,0,,86900,Pathology/Lab,,,,22,Outpatient Hospital,1,50.14,37.64,22.3,0.0,15.0,0.34,15.34,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000011484,MBR00000446,Professional,2023-03-24,2023-03-24,2023-04-15,PLN1516,1780163051,1780163051,SNF,In-Network,I25.10,K92.1,,,,,,,0,,80061,Pathology/Lab,,,,22,Outpatient Hospital,2,62.66,37.88,0.0,37.88,0.0,0.0,37.88,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011485,MBR00000446,Institutional-OP,2021-07-06,2021-07-06,2021-08-17,PLN8514,1749494482,1749494482,Pediatrics,In-Network,J06.9,J06.9,,,,,,,0,,86900,Pathology/Lab,,,0730,22,Outpatient Hospital,1,28.04,9.95,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011486,MBR00000446,Institutional-OP,2021-11-21,2021-11-21,2021-12-08,PLN6981,1224179551,1224179551,Physical Therapy,In-Network,K21.0,N18.3,,,,,,,0,,93225,Medicine,,,0200,22,Outpatient Hospital,1,396.26,236.48,221.48,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011487,MBR00000446,Professional,2022-08-26,2022-08-26,2022-09-29,PLN6195,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,I10,Z23,,,,,,,0,,99203,E&M,,,,11,Office,1,162.95,56.66,0.0,56.66,25.0,0.0,81.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011488,MBR00000446,Professional,2021-08-09,2021-08-09,2021-08-19,PLN7101,1186826716,1186826716,Physical Therapy,In-Network,E66.9,R05,,,,,,,0,,90837,Medicine,,,,11,Office,3,385.86,190.1,165.1,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011489,MBR00000446,Institutional-OP,2022-06-28,2022-06-28,2022-07-30,PLN6041,1125190055,1125190055,Nephrology,In-Network,I10,Z12.31,,,,,,,0,,93225,Medicine,,,0900,22,Outpatient Hospital,1,433.66,356.36,41.41,314.95,0.0,0.0,314.95,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000011490,MBR00000446,Institutional-IP,2023-07-27,2023-07-31,2023-08-17,PLN3675,1463205530,1463205530,Nephrology,In-Network,Z00.01,E11.9,,,,603,MS-DRG,2,4,Y,99283,E&M,,,0360,21,Inpatient Hospital,3,608.65,330.66,255.66,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011491,MBR00000446,Institutional-OP,2023-05-07,2023-05-07,2023-06-03,PLN7926,1564502315,1564502315,ASC,In-Network,E11.65,Z12.11,,,,,,,0,,99221,E&M,,,0900,22,Outpatient Hospital,2,272.13,216.81,201.81,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011492,MBR00000446,Professional,2023-09-03,2023-09-03,2023-09-13,PLN1165,1542828721,1542828721,Orthopedic Surgery,In-Network,C50.912,J06.9,,,,,,,0,,78452,Radiology,,,,21,Inpatient Hospital,1,2667.45,1493.31,0.0,0.0,25.0,0.0,25.0,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011493,MBR00000446,Professional,2023-07-31,2023-07-31,2023-09-10,PLN9772,1980712759,1980712759,Outpatient Clinic,Out-of-Network,J06.9,E11.9,,,,,,,0,,G0468,Medicine,,,,11,Office,2,702.16,362.99,290.97,0.0,0.0,72.02,72.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011494,MBR00000446,Professional,2021-12-30,2021-12-30,2022-01-07,PLN9158,1609526529,1609526529,Psychiatry,In-Network,Z23,Z23,,,,,,,0,,47562,Surgery,,,,11,Office,1,6170.29,3742.38,3742.38,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011495,MBR00000446,Professional,2023-02-20,2023-02-20,2023-03-10,PLN3706,1749494482,1749494482,Pediatrics,In-Network,E66.9,I10,,,,,,,0,,23472,Surgery,,,,21,Inpatient Hospital,3,3436.33,2202.71,1894.33,0.0,0.0,308.38,308.38,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011496,MBR00000446,Professional,2022-02-12,2022-02-12,2022-03-24,PLN9588,1609138981,1609138981,Critical Access Hospital,In-Network,E66.9,J06.9,,,,,,,0,,99213,E&M,,,,11,Office,3,287.56,199.22,83.88,109.46,0.0,5.88,115.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011497,MBR00000446,Professional,2023-11-30,2023-11-30,2023-12-28,PLN1200,1872613201,1872613201,Internal Medicine,In-Network,I25.10,Z23,,,,,,,0,,81001,Pathology/Lab,,,,49,Independent Clinic,1,30.12,13.62,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011498,MBR00000446,Professional,2021-07-13,2021-07-13,2021-08-15,PLN3465,1395983630,1395983630,Nephrology,In-Network,M54.5,Z23,,,,,,,0,,58661,Surgery,,,,11,Office,2,2459.25,893.42,818.42,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011499,MBR00000446,Institutional-OP,2021-10-22,2021-10-22,2021-10-30,PLN9969,1563980627,1563980627,Critical Access Hospital,In-Network,J20.9,Z12.31,,,,,,,0,,99283,E&M,,,0301,22,Outpatient Hospital,3,347.38,195.13,0.0,195.13,25.0,0.0,220.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011500,MBR00000446,Professional,2023-10-29,2023-10-29,2023-11-26,PLN6526,1556140803,1556140803,Cardiology,In-Network,Z87.891,I25.10,,,,,,,0,,97530,Medicine,,,,11,Office,3,248.41,161.95,145.2,0.0,15.0,1.75,16.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011501,MBR00000446,Institutional-OP,2021-09-19,2021-09-19,2021-10-02,PLN1436,1284035364,1284035364,Pediatrics,In-Network,Z79.4,G43.909,,,,,,,0,,99232,E&M,,,0301,22,Outpatient Hospital,3,218.14,83.8,0.0,83.8,25.0,0.0,108.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011502,MBR00000446,Professional,2022-11-10,2022-11-10,2022-12-08,PLN2687,1631954542,1631954542,Oncology,In-Network,E78.5,Z87.891,,,,,,,0,,27130,Surgery,,,,21,Inpatient Hospital,1,3158.91,1002.19,1002.19,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011503,MBR00000446,Institutional-IP,2021-11-15,2021-11-16,2021-12-16,PLN8996,1865904917,1865904917,Outpatient Clinic,In-Network,Z79.4,I10,,,,682,MS-DRG,3,1,Y,84443,Pathology/Lab,,,0730,21,Inpatient Hospital,2,89.59,64.3,49.3,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011504,MBR00000446,Professional,2021-11-08,2021-11-08,2021-12-06,PLN5751,1273488618,1273488618,General Acute Care Hospital,In-Network,K21.0,K21.0,,,,,,,0,,76700,Radiology,,,,11,Office,2,526.06,281.16,260.36,0.0,15.0,5.8,20.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011505,MBR00000446,Institutional-OP,2023-01-05,2023-01-05,2023-01-29,PLN5955,1124394415,1124394415,Pediatrics,In-Network,E66.9,K57.30,,,,,,,0,,99233,E&M,,,0360,22,Outpatient Hospital,2,213.89,143.88,0.0,143.88,35.0,0.0,178.88,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011506,MBR00000446,Professional,2023-05-21,2023-05-21,2023-06-06,PLN4187,1390307371,1390307371,DME Supplier,In-Network,M81.0,E11.40,,,,,,,0,,97110,Medicine,,,,11,Office,3,294.49,89.79,0.0,89.79,0.0,0.0,89.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011507,MBR00000446,Professional,2021-09-12,2021-09-12,2021-10-10,PLN1454,1284035364,1284035364,Pediatrics,In-Network,E78.5,K57.30,,,,,,,0,,99203,E&M,,,,12,Home,3,230.28,174.47,0.0,174.47,35.0,0.0,209.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011508,MBR00000446,Institutional-OP,2023-12-13,2023-12-13,2023-12-21,PLN8069,1542828721,1542828721,Orthopedic Surgery,In-Network,C50.912,I10,,,,,,,0,,82043,Pathology/Lab,,,0636,22,Outpatient Hospital,3,62.47,49.99,23.45,0.0,25.0,1.54,26.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011509,MBR00000447,Professional,2021-04-07,2021-04-07,2021-04-15,PLN7228,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,N18.3,Z00.01,,,,,,,0,,45380,Surgery,,,,11,Office,2,2601.16,946.7,850.86,0.0,0.0,95.84,95.84,0.0,Paid,,,1,,0,0,1,0,0,1,Upcoding,0,1,0,0,0
CLM0000011510,MBR00000447,Institutional-OP,2021-04-20,2021-04-20,2021-05-04,PLN5012,1563980627,1563980627,Critical Access Hospital,In-Network,K21.0,J06.9,,,,,,,0,,99214,E&M,,,0301,22,Outpatient Hospital,1,314.92,120.1,120.1,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011511,MBR00000447,Institutional-OP,2023-12-07,2023-12-07,2023-12-24,PLN1070,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,E11.9,Z00.00,,,,,,,0,,99214,E&M,,,0510,22,Outpatient Hospital,3,429.42,257.4,0.0,257.4,0.0,0.0,257.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011512,MBR00000447,Professional,2021-03-02,2021-03-02,2021-03-29,PLN1449,1569105090,1569105090,Geriatrics,In-Network,I48.91,M54.5,,,,,,,0,,99213,E&M,,,,22,Outpatient Hospital,1,248.76,97.07,97.07,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011513,MBR00000447,Professional,2021-12-11,2021-12-11,2022-01-02,PLN9825,1511044648,1511044648,Endocrinology,In-Network,I10,Z23,,,,,,,0,,99214,E&M,,,,11,Office,2,442.98,196.65,97.84,0.0,75.0,23.81,98.81,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011514,MBR00000447,Institutional-OP,2021-05-13,2021-05-13,2021-05-24,PLN4647,1689639685,1689639685,SNF,In-Network,I10,M17.11,,,,,,,0,,93225,Medicine,,,0636,22,Outpatient Hospital,2,735.26,549.79,298.21,201.58,50.0,0.0,251.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011515,MBR00000447,Institutional-OP,2021-09-01,2021-09-01,2021-09-12,PLN8869,1817234602,1817234602,Clinical Laboratory,In-Network,J06.9,E11.40,,,,,,,0,,99203,E&M,,,0370,22,Outpatient Hospital,2,155.58,110.85,110.85,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011516,MBR00000447,Professional,2021-03-23,2021-03-23,2021-05-02,PLN2414,1872272835,1872272835,Internal Medicine,In-Network,N40.0,E11.65,,,,,,,0,,70553,Radiology,,,,23,Emergency Room,3,2186.03,1801.41,1801.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011517,MBR00000447,Institutional-OP,2022-01-28,2022-01-28,2022-03-12,PLN5894,1355166277,1355166277,Endocrinology,In-Network,E78.5,M17.11,,,,,,,0,,99283,E&M,,,0270,22,Outpatient Hospital,1,386.59,305.41,112.5,117.91,75.0,0.0,192.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011518,MBR00000447,Institutional-OP,2021-11-20,2021-11-20,2022-01-01,PLN4153,1390307371,1390307371,DME Supplier,In-Network,N18.3,I10,,,,,,,0,,99214,E&M,,,0730,22,Outpatient Hospital,3,442.52,206.25,119.32,36.93,50.0,0.0,86.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011519,MBR00000447,Institutional-IP,2021-06-23,2021-06-25,2021-07-12,PLN5267,1531398223,1531398223,OB/GYN,In-Network,R07.9,E11.65,,,,194,MS-DRG,24,2,Y,27447,Surgery,,,0120,21,Inpatient Hospital,1,5875.55,4947.33,4872.33,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000011520,MBR00000447,Institutional-OP,2023-02-26,2023-02-26,2023-04-05,PLN5389,1103747954,1103747954,Urology,In-Network,Z87.891,E11.9,,,,,,,0,,99406,Medicine,,,0450,22,Outpatient Hospital,1,63.09,33.91,33.91,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011521,MBR00000447,Professional,2021-02-09,2021-02-09,2021-03-01,PLN2497,1205377316,1205377316,Orthopedic Surgery,In-Network,E66.9,Z23,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,2,223.03,134.41,98.68,29.03,0.0,6.7,35.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011522,MBR00000447,Professional,2022-06-04,2022-06-04,2022-07-17,PLN7683,1450094833,1450094833,Outpatient Clinic,In-Network,I10,E78.5,,,,,,,0,,76700,Radiology,,,,22,Outpatient Hospital,1,816.06,407.7,372.7,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011523,MBR00000447,Institutional-OP,2021-12-01,2021-12-01,2021-12-30,PLN7096,1193493783,1193493783,Critical Access Hospital,Out-of-Network,Z12.31,K57.30,,,,,,,0,,45380,Surgery,,,0450,22,Outpatient Hospital,3,2122.73,1312.25,1237.25,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000011524,MBR00000447,Institutional-OP,2022-12-14,2022-12-14,2023-01-25,PLN5696,1939033455,1939033455,Pulmonology,In-Network,E11.9,E11.9,,,,,,,0,,99221,E&M,,,0301,22,Outpatient Hospital,1,250.41,144.23,119.23,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000011525,MBR00000447,Professional,2022-01-05,2022-01-05,2022-02-05,PLN2591,1840431511,1840431511,Geriatrics,Out-of-Network,Z96.641,K57.30,,,,,,,0,,71046,Radiology,,,,11,Office,2,128.95,59.7,0.0,59.7,25.0,0.0,84.7,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011526,MBR00000447,Institutional-IP,2022-06-02,2022-06-04,2022-07-02,PLN6444,1778483301,1778483301,Home Health,In-Network,I50.9,F32.9,,,,196,MS-DRG,1,2,N,45380,Surgery,,,0301,21,Inpatient Hospital,1,2934.46,1721.32,1721.32,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000011527,MBR00000447,Professional,2023-06-08,2023-06-08,2023-06-26,PLN6983,1691062876,1691062876,SNF,In-Network,M54.5,Z12.31,,,,,,,0,,97530,Medicine,,,,11,Office,1,244.83,169.15,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011528,MBR00000447,Professional,2021-06-08,2021-06-08,2021-07-12,PLN2043,1717912431,1717912431,Oncology,In-Network,R07.9,M17.11,,,,,,,0,,G0444,Medicine,,,,20,Urgent Care,1,93.72,54.32,49.08,0.0,0.0,5.24,5.24,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000011529,MBR00000447,Professional,2022-04-23,2022-04-23,2022-05-23,PLN3579,1410468316,1410468316,SNF,In-Network,K21.0,M17.11,,,,,,,0,,72148,Radiology,,,,20,Urgent Care,1,1282.92,973.44,569.84,403.6,0.0,0.0,403.6,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011530,MBR00000447,Professional,2022-09-08,2022-09-08,2022-10-22,PLN3152,1948810580,1948810580,DME Supplier,In-Network,M81.0,Z12.11,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,3,699.28,548.16,510.49,22.67,15.0,0.0,37.67,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000011531,MBR00000447,Professional,2023-03-18,2023-03-18,2023-03-30,PLN6672,1114982472,1114982472,Orthopedic Surgery,In-Network,Z12.31,J06.9,,,,,,,0,,23472,Surgery,,,,65,End-Stage Renal Disease,1,4961.95,2616.82,2201.09,400.73,15.0,0.0,415.73,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011532,MBR00000447,Professional,2022-08-11,2022-08-11,2022-09-14,PLN8652,1266606767,1266606767,ASC,In-Network,E66.9,Z12.31,,,,,,,0,,90686,Medicine,,,,11,Office,1,123.84,88.74,16.79,71.95,0.0,0.0,71.95,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000011533,MBR00000447,Institutional-OP,2023-03-17,2023-03-17,2023-04-21,PLN6142,1355166277,1355166277,Endocrinology,In-Network,F41.9,E78.5,,,,,,,0,,93000,Radiology,,,0120,22,Outpatient Hospital,2,175.35,141.23,0.0,141.23,25.0,0.0,166.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011534,MBR00000447,Institutional-OP,2023-05-22,2023-05-22,2023-07-05,PLN2641,1118885473,1118885473,ASC,In-Network,Z12.31,Z23,,,,,,,0,,99284,E&M,,,0120,22,Outpatient Hospital,1,393.71,282.41,282.41,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011535,MBR00000447,Professional,2023-05-14,2023-05-14,2023-06-16,PLN2624,1757138478,1757138478,Pediatrics,In-Network,Z00.00,N39.0,,,,,,,0,,99204,E&M,,,,23,Emergency Room,3,452.71,253.34,206.83,0.0,35.0,11.51,46.51,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011536,MBR00000447,Professional,2022-11-05,2022-11-05,2022-11-22,PLN6798,1514306773,1514306773,Endocrinology,In-Network,J20.9,J20.9,,,,,,,0,,99203,E&M,,,,81,Independent Laboratory,2,259.5,178.72,0.0,178.72,0.0,0.0,178.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011537,MBR00000447,Institutional-OP,2023-10-03,2023-10-03,2023-11-15,PLN6087,1817234602,1817234602,Clinical Laboratory,In-Network,I25.10,J06.9,,,,,,,0,,74177,Radiology,,,0301,22,Outpatient Hospital,1,1871.91,993.79,870.11,0.0,50.0,73.68,123.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011538,MBR00000447,Professional,2021-01-25,2021-01-25,2021-02-03,PLN7388,1609138981,1609138981,Critical Access Hospital,In-Network,I10,Z00.01,,,,,,,0,,99284,E&M,,,,11,Office,1,564.05,269.98,269.98,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011539,MBR00000447,Professional,2022-07-01,2022-07-01,2022-07-14,PLN6436,1809014947,1809014947,Urology,In-Network,Z23,I10,,,,,,,0,,99204,E&M,,,,11,Office,1,218.45,140.85,122.12,0.0,0.0,18.73,18.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011540,MBR00000447,Professional,2023-05-29,2023-05-29,2023-06-26,PLN3613,1645194539,1645194539,SNF,In-Network,M54.5,E11.9,,,,,,,0,,27447,Surgery,,,,21,Inpatient Hospital,3,3414.03,1141.27,727.73,388.54,25.0,0.0,413.54,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011541,MBR00000447,Institutional-OP,2021-04-24,2021-04-24,2021-05-30,PLN2539,1550154147,1550154147,Outpatient Clinic,In-Network,Z00.00,M54.5,,,,,,,0,,70553,Radiology,,,0761,22,Outpatient Hospital,3,4290.93,1680.06,1544.24,0.0,35.0,100.82,135.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011542,MBR00000447,Professional,2023-06-15,2023-06-15,2023-07-17,PLN9265,1235381502,1235381502,Cardiology,In-Network,I11.9,N39.0,,,,,,,0,,86900,Pathology/Lab,,,,22,Outpatient Hospital,1,49.33,30.04,0.0,30.04,0.0,0.0,30.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011543,MBR00000447,Institutional-OP,2021-02-12,2021-02-12,2021-03-13,PLN4771,1749327647,1749327647,Geriatrics,In-Network,E66.9,N39.0,,,,,,,0,,23472,Surgery,,,0636,22,Outpatient Hospital,1,6735.95,3532.26,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-97,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011544,MBR00000447,Institutional-OP,2023-05-12,2023-05-12,2023-06-23,PLN9292,1691062876,1691062876,SNF,In-Network,E11.9,Z87.891,,,,,,,0,,82043,Pathology/Lab,,,0740,22,Outpatient Hospital,2,47.85,19.18,4.18,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011545,MBR00000447,Institutional-OP,2021-07-24,2021-07-24,2021-08-28,PLN9352,1139906830,1139906830,Endocrinology,Out-of-Network,E66.9,Z12.31,,,,,,,0,,99213,E&M,,,0270,22,Outpatient Hospital,3,305.89,249.64,224.64,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011546,MBR00000447,Institutional-OP,2023-01-01,2023-01-01,2023-01-28,PLN9630,1168246159,1168246159,Internal Medicine,In-Network,N18.3,B97.89,,,,,,,0,,58661,Surgery,,,0200,22,Outpatient Hospital,3,3798.81,3222.83,2891.83,281.0,50.0,0.0,331.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011547,MBR00000447,Institutional-OP,2023-06-27,2023-06-27,2023-07-11,PLN8940,1168881145,1168881145,Orthopedic Surgery,In-Network,I10,Z12.31,,,,,,,0,,45378,Surgery,,,0636,22,Outpatient Hospital,3,2428.73,1248.36,1062.38,135.98,50.0,0.0,185.98,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000011548,MBR00000447,Institutional-OP,2023-06-11,2023-06-11,2023-06-29,PLN6509,1689639685,1689639685,SNF,In-Network,Z79.4,J44.1,,,,,,,0,,G0444,Medicine,,,0450,22,Outpatient Hospital,2,68.31,47.06,3.31,43.43,0.0,0.32,43.75,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000011549,MBR00000447,Professional,2022-09-21,2022-09-21,2022-10-21,PLN3605,1531398223,1531398223,OB/GYN,In-Network,Z12.31,F32.9,,,,,,,0,,86900,Pathology/Lab,,,,22,Outpatient Hospital,2,49.84,37.25,0.0,37.25,25.0,0.0,62.25,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011550,MBR00000447,Institutional-OP,2023-09-22,2023-09-22,2023-09-30,PLN6948,1946680931,1946680931,Critical Access Hospital,Out-of-Network,E78.5,E11.9,,,,,,,0,,77067,Radiology,,,0370,22,Outpatient Hospital,2,409.52,179.91,179.91,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000011551,MBR00000447,Professional,2021-06-03,2021-06-03,2021-07-15,PLN3942,1148984206,1148984206,Psychiatry,In-Network,N40.0,M54.5,,,,,,,0,,G0439,Medicine,,,,11,Office,1,376.05,160.31,93.49,0.0,50.0,16.82,66.82,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000011552,MBR00000447,Professional,2021-09-16,2021-09-16,2021-10-09,PLN1461,1800011727,1800011727,Clinical Laboratory,Out-of-Network,Z96.641,F41.9,,,,,,,0,,99284,E&M,,,,50,Federally Qualified Health Center,2,409.71,269.98,192.38,42.6,35.0,0.0,77.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011553,MBR00000447,Professional,2021-05-26,2021-05-26,2021-07-07,PLN5712,1752470395,1752470395,Home Health,In-Network,Z23,Z00.00,,,,,,,0,,85025,Pathology/Lab,,,,22,Outpatient Hospital,2,46.53,23.29,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011554,MBR00000447,Institutional-OP,2023-02-27,2023-02-27,2023-03-09,PLN8625,1896447406,1896447406,Nephrology,Out-of-Network,N18.3,M54.5,,,,,,,0,,90460,Medicine,,,0301,22,Outpatient Hospital,2,47.02,21.92,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011555,MBR00000447,Professional,2023-09-04,2023-09-04,2023-10-14,PLN2209,1168246159,1168246159,Internal Medicine,In-Network,E66.9,E78.5,,,,,,,0,,97530,Medicine,,,,11,Office,2,191.42,137.54,0.0,137.54,0.0,0.0,137.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011556,MBR00000447,Institutional-IP,2023-10-16,2023-10-25,2023-11-29,PLN1380,1266606767,1266606767,ASC,In-Network,F03.90,F41.9,,,,603,MS-DRG,6,9,Y,58661,Surgery,,,0200,21,Inpatient Hospital,1,4417.17,3414.26,2782.08,334.98,0.0,297.2,632.18,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011557,MBR00000447,Institutional-IP,2022-07-24,2022-07-28,2022-08-18,PLN9867,1727809972,1727809972,Home Health,In-Network,Z00.00,F41.9,,,,871,MS-DRG,3,4,Y,71046,Radiology,,,0636,21,Inpatient Hospital,2,218.33,73.62,0.0,73.62,15.0,0.0,88.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011558,MBR00000447,Institutional-IP,2021-05-25,2021-05-30,2021-06-10,PLN8805,1168881145,1168881145,Orthopedic Surgery,In-Network,Z12.31,I11.9,,,,690,MS-DRG,11,5,Y,99283,E&M,,,0900,21,Inpatient Hospital,2,282.03,144.51,69.51,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011559,MBR00000448,Professional,2021-07-08,2021-07-08,2021-07-22,PLN1939,1139906830,1139906830,Endocrinology,Out-of-Network,I10,N17.9,,,,,,,0,,78452,Radiology,,,,21,Inpatient Hospital,2,7139.54,5463.97,5112.97,351.0,0.0,0.0,351.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011560,MBR00000448,Institutional-IP,2022-11-17,2022-11-21,2022-12-02,PLN7171,1337791138,1337791138,Internal Medicine,Out-of-Network,Z00.00,G43.909,,,,194,MS-DRG,10,4,Y,58661,Surgery,,,0761,21,Inpatient Hospital,2,2636.71,1854.2,1819.2,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011561,MBR00000448,Institutional-IP,2023-09-09,2023-09-16,2023-09-23,PLN9247,1845057593,1845057593,Orthopedic Surgery,In-Network,K57.30,E11.40,,,,690,MS-DRG,5,7,Y,99283,E&M,,,0450,21,Inpatient Hospital,1,314.42,257.24,257.24,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011562,MBR00000448,Institutional-OP,2023-12-18,2023-12-18,2024-01-02,PLN6645,1389336600,1389336600,Critical Access Hospital,In-Network,Z12.31,J06.9,,,,,,,0,,G0439,Medicine,,,0510,22,Outpatient Hospital,2,645.39,392.49,65.62,309.01,15.0,2.86,326.87,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000011563,MBR00000448,Institutional-OP,2023-03-01,2023-03-01,2023-04-14,PLN2420,1964402759,1964402759,Outpatient Clinic,In-Network,R07.9,Z23,,,,,,,0,,99406,Medicine,,,0120,22,Outpatient Hospital,3,75.51,54.81,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011564,MBR00000448,Professional,2023-08-23,2023-08-23,2023-09-02,PLN6389,1624202402,1624202402,Orthopedic Surgery,In-Network,Z23,F41.9,,,,,,,0,,99406,Medicine,,,,23,Emergency Room,1,49.39,21.26,0.0,21.26,0.0,0.0,21.26,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011565,MBR00000448,Professional,2022-06-08,2022-06-08,2022-07-08,PLN6838,1168246159,1168246159,Internal Medicine,In-Network,Z12.31,M17.11,,,,,,,0,,99213,E&M,,,,12,Home,2,201.72,76.46,26.46,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011566,MBR00000448,Institutional-IP,2021-08-03,2021-08-11,2021-09-06,PLN8917,1372918899,1372918899,Family Medicine,In-Network,M54.5,Z87.891,,,,603,MS-DRG,5,8,Y,99203,E&M,,,0740,21,Inpatient Hospital,1,207.18,72.91,16.19,56.72,0.0,0.0,56.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011567,MBR00000448,Professional,2022-05-25,2022-05-25,2022-06-15,PLN9212,1717546253,1717546253,Family Medicine,In-Network,E11.65,K21.0,,,,,,,0,,85025,Pathology/Lab,,,,81,Independent Laboratory,2,60.07,47.09,47.09,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011568,MBR00000448,Institutional-OP,2021-04-19,2021-04-19,2021-04-30,PLN7554,1624802371,1624802371,ASC,Out-of-Network,I10,I10,,,,,,,0,,99214,E&M,,,0200,22,Outpatient Hospital,2,320.06,215.93,154.12,0.0,50.0,11.81,61.81,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011569,MBR00000448,Institutional-OP,2023-01-07,2023-01-07,2023-02-18,PLN3175,1728018911,1728018911,Nephrology,In-Network,Z00.01,E11.9,,,,,,,0,,76700,Radiology,,,0730,22,Outpatient Hospital,2,1084.51,566.37,362.8,203.57,0.0,0.0,203.57,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011570,MBR00000448,Professional,2021-12-27,2021-12-27,2022-02-04,PLN5488,1450094833,1450094833,Outpatient Clinic,In-Network,I10,Z23,,,,,,,0,,27447,Surgery,,,,12,Home,2,3256.29,2314.97,1865.87,449.1,0.0,0.0,449.1,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011571,MBR00000448,Institutional-OP,2022-01-06,2022-01-06,2022-01-21,PLN8366,1899127912,1899127912,Neurology,In-Network,R05,E78.5,,,,,,,0,,78452,Radiology,,,0730,22,Outpatient Hospital,3,3281.99,2541.25,2541.25,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011572,MBR00000448,Professional,2021-01-04,2021-01-04,2021-01-11,PLN2506,1622771872,1622771872,Pediatrics,In-Network,Z00.00,M54.5,,,,,,,0,,66984,Surgery,,,,11,Office,3,2541.98,1749.04,1164.14,416.11,0.0,168.79,584.9,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011573,MBR00000448,Institutional-OP,2023-12-31,2023-12-31,2024-01-28,PLN8245,1213165847,1213165847,Critical Access Hospital,In-Network,I50.9,K21.0,,,,,,,0,,99232,E&M,,,0360,22,Outpatient Hospital,2,301.1,96.07,21.07,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011574,MBR00000448,Professional,2022-04-13,2022-04-13,2022-05-04,PLN8273,1235381502,1235381502,Cardiology,In-Network,F41.9,K21.0,,,,,,,0,,99283,E&M,,,,11,Office,1,281.33,128.14,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011575,MBR00000448,Institutional-OP,2023-05-10,2023-05-10,2023-05-30,PLN1030,1812060197,1812060197,Oncology,Out-of-Network,C50.912,Z23,,,,,,,0,,90460,Medicine,,,0360,22,Outpatient Hospital,2,52.47,18.07,0.0,18.07,15.0,0.0,33.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011576,MBR00000448,Professional,2022-07-23,2022-07-23,2022-08-29,PLN1927,1968299309,1968299309,Internal Medicine,In-Network,K21.0,J18.9,,,,,,,0,,27447,Surgery,,,,20,Urgent Care,2,6114.28,4295.68,4016.54,264.14,15.0,0.0,279.14,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011577,MBR00000448,Professional,2022-12-03,2022-12-03,2023-01-09,PLN4639,1757138478,1757138478,Pediatrics,In-Network,I10,M54.5,,,,,,,0,,33533,Surgery,,,,81,Independent Laboratory,1,16285.44,13025.95,12896.32,114.63,15.0,0.0,129.63,0.0,Pended,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000011578,MBR00000448,Professional,2022-05-28,2022-05-28,2022-06-26,PLN5930,1364429278,1364429278,OB/GYN,In-Network,Z00.00,Z00.00,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,3,288.7,162.11,162.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011579,MBR00000448,Institutional-OP,2023-01-23,2023-01-23,2023-03-04,PLN9019,1974006077,1974006077,Orthopedic Surgery,In-Network,E78.5,K21.0,,,,,,,0,,45380,Surgery,,,0301,22,Outpatient Hospital,2,2015.24,1250.19,1107.92,0.0,25.0,117.27,142.27,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000011580,MBR00000448,Institutional-OP,2021-08-07,2021-08-07,2021-09-19,PLN1085,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,J20.9,Z79.4,,,,,,,0,,99284,E&M,,,0450,22,Outpatient Hospital,1,590.72,418.97,253.83,165.14,0.0,0.0,165.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011581,MBR00000449,Institutional-OP,2023-12-27,2023-12-27,2024-01-23,PLN5479,1475984649,1475984649,SNF,In-Network,K92.1,M17.11,,,,,,,0,,45380,Surgery,,,0636,22,Outpatient Hospital,3,2089.38,629.74,526.93,0.0,35.0,67.81,102.81,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000011582,MBR00000449,Institutional-IP,2022-04-14,2022-04-20,2022-04-27,PLN4537,1450094833,1450094833,Outpatient Clinic,In-Network,E11.9,I10,,,,195,MS-DRG,4,6,Y,93000,Radiology,,,0301,21,Inpatient Hospital,3,98.65,49.75,49.75,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011583,MBR00000449,Professional,2021-01-12,2021-01-12,2021-02-18,PLN6888,1727809972,1727809972,Home Health,In-Network,Z23,E78.5,,,,,,,0,,99233,E&M,,,,50,Federally Qualified Health Center,2,460.38,169.18,140.13,0.0,0.0,29.05,29.05,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011584,MBR00000449,Institutional-OP,2023-11-10,2023-11-10,2023-12-01,PLN6900,1845057593,1845057593,Orthopedic Surgery,In-Network,J06.9,M81.0,,,,,,,0,,85610,Pathology/Lab,,,0740,22,Outpatient Hospital,3,36.44,21.48,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011585,MBR00000450,Professional,2021-01-25,2021-01-25,2021-03-09,PLN8444,1990090423,1990090423,Orthopedic Surgery,In-Network,E11.65,Z12.31,,,,,,,0,,99233,E&M,,,,11,Office,2,505.23,185.17,185.17,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011586,MBR00000450,Institutional-IP,2022-06-02,2022-06-06,2022-06-22,PLN9444,1689639685,1689639685,SNF,In-Network,I10,B97.89,,,,194,MS-DRG,20,4,Y,71046,Radiology,,,0900,21,Inpatient Hospital,3,135.83,110.57,85.57,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011587,MBR00000450,Professional,2023-05-10,2023-05-10,2023-06-05,PLN1027,1245650222,1245650222,Gastroenterology,In-Network,F32.9,Z00.00,,,,,,,0,,99283,E&M,,,,12,Home,2,647.41,377.99,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011588,MBR00000450,Institutional-OP,2022-02-10,2022-02-10,2022-03-17,PLN5586,1687650653,1687650653,Internal Medicine,In-Network,I25.10,I10,,,,,,,0,,23472,Surgery,,,0200,22,Outpatient Hospital,3,3560.31,2814.81,2404.21,335.6,75.0,0.0,410.6,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011589,MBR00000450,Professional,2021-08-18,2021-08-18,2021-09-02,PLN5936,1935547131,1935547131,Pulmonology,In-Network,F32.9,N18.3,,,,,,,0,,99283,E&M,,,,49,Independent Clinic,1,622.05,374.49,311.39,38.1,25.0,0.0,63.1,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011590,MBR00000450,Professional,2021-09-21,2021-09-21,2021-10-25,PLN8886,1186826716,1186826716,Physical Therapy,In-Network,N39.0,F41.9,,,,,,,0,,72148,Radiology,,,,12,Home,2,1786.17,1342.17,661.79,494.65,25.0,160.73,680.38,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011591,MBR00000450,Professional,2023-01-21,2023-01-21,2023-02-06,PLN8359,1563980627,1563980627,Critical Access Hospital,In-Network,E78.5,I25.10,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,2,95.68,36.41,0.0,36.41,15.0,0.0,51.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011592,MBR00000450,Institutional-IP,2022-09-21,2022-09-25,2022-11-01,PLN4797,1334916761,1334916761,ASC,In-Network,N20.0,E78.5,,,,291,MS-DRG,6,4,Y,76700,Radiology,,,0740,21,Inpatient Hospital,2,1343.12,606.35,571.35,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011593,MBR00000450,Professional,2022-07-06,2022-07-06,2022-08-08,PLN2727,1284035364,1284035364,Pediatrics,In-Network,E78.5,E66.9,,,,,,,0,,97110,Medicine,,,,22,Outpatient Hospital,2,106.55,34.24,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011594,MBR00000450,Institutional-OP,2022-07-18,2022-07-18,2022-08-01,PLN2131,1795618275,1795618275,Pulmonology,In-Network,E66.9,Z12.11,,,,,,,0,,99284,E&M,,,0450,22,Outpatient Hospital,3,471.27,399.86,324.86,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011595,MBR00000450,Institutional-OP,2021-12-15,2021-12-15,2022-01-18,PLN5241,1410468316,1410468316,SNF,In-Network,N39.0,C50.912,,,,,,,0,,27447,Surgery,,,0636,22,Outpatient Hospital,2,2502.06,804.61,489.21,266.64,0.0,48.76,315.4,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011596,MBR00000450,Institutional-OP,2023-10-21,2023-10-21,2023-11-04,PLN1364,1817234602,1817234602,Clinical Laboratory,In-Network,N18.3,I25.10,,,,,,,0,,66984,Surgery,,,0900,22,Outpatient Hospital,2,3607.53,1092.28,1007.57,0.0,15.0,69.71,84.71,0.0,Paid,,,0,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000011597,MBR00000450,Professional,2021-09-11,2021-09-11,2021-10-13,PLN7206,1717546253,1717546253,Family Medicine,In-Network,E66.9,M54.5,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,2,2763.98,1593.18,1578.18,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011598,MBR00000450,Institutional-IP,2023-07-07,2023-07-15,2023-08-12,PLN6679,1550154147,1550154147,Outpatient Clinic,In-Network,E11.40,J44.1,,,,195,MS-DRG,4,8,N,45378,Surgery,,,0360,21,Inpatient Hospital,1,1725.53,1390.74,1296.44,94.3,0.0,0.0,94.3,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000011599,MBR00000450,Professional,2023-05-01,2023-05-01,2023-06-01,PLN2543,1713934949,1713934949,Neurology,In-Network,I10,Z79.4,,,,,,,0,,77067,Radiology,,,,65,End-Stage Renal Disease,2,523.72,348.15,127.26,220.89,0.0,0.0,220.89,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000011600,MBR00000450,Institutional-OP,2021-01-08,2021-01-08,2021-01-21,PLN6445,1239316214,1239316214,Internal Medicine,In-Network,I25.10,Z79.4,,,,,,,0,,99214,E&M,,,0761,22,Outpatient Hospital,2,431.74,165.56,0.0,165.56,50.0,0.0,215.56,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011601,MBR00000450,Professional,2021-07-07,2021-07-07,2021-08-20,PLN9572,1745114564,1745114564,Endocrinology,In-Network,I10,Z00.00,,,,,,,0,,99213,E&M,,,,20,Urgent Care,2,118.9,62.94,0.0,62.94,0.0,0.0,62.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011602,MBR00000450,Professional,2022-08-28,2022-08-28,2022-09-10,PLN5006,1994661817,1994661817,SNF,Out-of-Network,Z00.00,G43.909,,,,,,,0,,99283,E&M,,,,11,Office,2,401.59,207.4,136.08,71.32,0.0,0.0,71.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011603,MBR00000450,Professional,2021-06-23,2021-06-23,2021-07-06,PLN7001,1645194539,1645194539,SNF,In-Network,Z96.641,E11.9,,,,,,,0,,99222,E&M,,,,11,Office,2,419.2,330.99,0.0,174.85,0.0,0.0,174.85,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011604,MBR00000450,Professional,2023-07-23,2023-07-23,2023-08-10,PLN3848,1865904917,1865904917,Outpatient Clinic,In-Network,J45.20,N39.0,,,,,,,0,,93306,Radiology,,,,22,Outpatient Hospital,1,1321.16,691.3,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011605,MBR00000450,Institutional-OP,2022-04-29,2022-04-29,2022-05-10,PLN5153,1244186984,1244186984,Family Medicine,Out-of-Network,G43.909,J18.9,,,,,,,0,,27130,Surgery,,,0360,22,Outpatient Hospital,3,5053.16,2162.24,0.0,0.0,50.0,334.23,384.23,0.0,Denied,CO-97,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011606,MBR00000450,Professional,2023-07-06,2023-07-06,2023-07-16,PLN9227,1806688928,1806688928,Geriatrics,In-Network,E78.5,Z12.11,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,1,322.43,146.95,87.68,34.27,25.0,0.0,59.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011607,MBR00000450,Institutional-IP,2021-05-11,2021-05-14,2021-05-19,PLN5698,1453283987,1453283987,Critical Access Hospital,In-Network,N40.0,Z00.00,,,,872,MS-DRG,21,3,Y,G0444,Medicine,,,0761,21,Inpatient Hospital,3,82.29,63.04,56.48,0.0,0.0,6.56,6.56,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000011608,MBR00000450,Professional,2021-01-27,2021-01-27,2021-02-22,PLN6742,1124394415,1124394415,Pediatrics,In-Network,N20.0,J06.9,,,,,,,0,,70553,Radiology,,,,50,Federally Qualified Health Center,2,4110.05,2475.65,2213.74,0.0,75.0,186.91,261.91,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011609,MBR00000450,Professional,2022-12-04,2022-12-04,2022-12-29,PLN8446,1872272835,1872272835,Internal Medicine,In-Network,R07.9,Z12.31,,,,,,,0,,99284,E&M,,,,11,Office,2,524.91,177.1,0.0,177.1,0.0,0.0,177.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011610,MBR00000450,Institutional-OP,2023-05-29,2023-05-29,2023-06-17,PLN2140,1660288235,1660288235,ASC,In-Network,G20,I48.91,,,,,,,0,,99284,E&M,,,0510,22,Outpatient Hospital,3,882.17,622.65,622.65,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011611,MBR00000450,Institutional-OP,2023-12-23,2023-12-23,2024-02-01,PLN6485,1242201429,1242201429,General Acute Care Hospital,In-Network,F32.9,I10,,,,,,,0,,99284,E&M,,,0360,22,Outpatient Hospital,3,920.36,741.29,706.29,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011612,MBR00000450,Institutional-OP,2023-05-13,2023-05-13,2023-06-12,PLN9398,1609526529,1609526529,Psychiatry,In-Network,E11.9,I10,,,,,,,0,,45378,Surgery,,,0761,22,Outpatient Hospital,2,1388.01,1109.73,1109.73,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000011613,MBR00000450,Professional,2023-03-30,2023-03-30,2023-04-21,PLN8483,1689639685,1689639685,SNF,In-Network,I10,Z12.31,,,,,,,0,,99232,E&M,,,,11,Office,2,373.92,171.11,156.11,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011614,MBR00000451,Institutional-OP,2021-03-05,2021-03-05,2021-03-26,PLN7491,1968299309,1968299309,Internal Medicine,In-Network,Z12.31,Z87.891,,,,,,,0,,58661,Surgery,,,0370,22,Outpatient Hospital,3,3455.65,1587.21,1587.21,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011615,MBR00000451,Institutional-IP,2022-10-23,2022-10-25,2022-12-03,PLN9930,1689639685,1689639685,SNF,In-Network,J06.9,Z12.31,,,,690,MS-DRG,18,2,W,G0444,Medicine,,,0120,21,Inpatient Hospital,2,80.58,47.66,47.66,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000011616,MBR00000451,Institutional-IP,2023-02-21,2023-02-25,2023-03-30,PLN7121,1125190055,1125190055,Nephrology,In-Network,Z00.00,E78.5,,,,194,MS-DRG,1,4,Y,90460,Medicine,,,0320,21,Inpatient Hospital,1,76.47,34.2,0.0,34.2,0.0,0.0,34.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011617,MBR00000451,Professional,2022-03-09,2022-03-09,2022-04-02,PLN2131,1569105090,1569105090,Geriatrics,In-Network,M17.11,I10,,,,,,,0,,58661,Surgery,,,,49,Independent Clinic,1,2376.16,1633.42,1396.92,0.0,25.0,211.5,236.5,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011618,MBR00000451,Professional,2023-12-31,2023-12-31,2024-01-09,PLN7014,1948810580,1948810580,DME Supplier,In-Network,E66.9,J44.1,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,1,70.84,51.71,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011619,MBR00000451,Professional,2023-12-18,2023-12-18,2023-12-30,PLN4104,1438368327,1438368327,Home Health,In-Network,M81.0,I10,,,,,,,0,,99222,E&M,,,,11,Office,1,485.36,368.43,0.0,368.43,0.0,0.0,368.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011620,MBR00000451,Institutional-OP,2023-07-27,2023-07-27,2023-08-10,PLN2588,1236418230,1236418230,DME Supplier,In-Network,Z12.31,E11.9,,,,,,,0,,83036,Pathology/Lab,,,0120,22,Outpatient Hospital,1,109.79,74.72,0.0,74.72,50.0,0.0,124.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000011621,MBR00000451,Institutional-OP,2023-08-22,2023-08-22,2023-09-26,PLN9325,1453936007,1453936007,ASC,In-Network,E11.9,Z51.11,,,,,,,0,,90837,Medicine,,,0301,22,Outpatient Hospital,3,475.15,364.15,0.0,57.84,0.0,0.0,57.84,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011622,MBR00000451,Institutional-IP,2022-09-14,2022-09-18,2022-10-13,PLN3320,1266606767,1266606767,ASC,In-Network,I11.9,Z00.00,,,,292,MS-DRG,2,4,Y,87491,Pathology/Lab,,,0900,21,Inpatient Hospital,1,105.5,79.52,54.52,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011623,MBR00000452,Professional,2023-06-18,2023-06-18,2023-06-28,PLN6345,1334916761,1334916761,ASC,In-Network,J45.20,Z00.00,,,,,,,0,,74177,Radiology,,,,21,Inpatient Hospital,2,1769.18,692.89,677.89,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011624,MBR00000452,Institutional-OP,2021-03-20,2021-03-20,2021-04-12,PLN7634,1410468316,1410468316,SNF,In-Network,I11.9,I50.9,,,,,,,0,,81001,Pathology/Lab,,,0730,22,Outpatient Hospital,2,46.6,35.34,0.0,35.34,75.0,0.0,110.34,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011625,MBR00000452,Professional,2021-09-09,2021-09-09,2021-10-12,PLN5314,1817234602,1817234602,Clinical Laboratory,In-Network,R51,E11.9,,,,,,,0,,99222,E&M,,,,11,Office,3,244.66,126.06,0.0,126.06,50.0,0.0,176.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011626,MBR00000452,Institutional-OP,2022-12-29,2022-12-29,2023-01-28,PLN8657,1691062876,1691062876,SNF,In-Network,I10,E11.9,,,,,,,0,,47562,Surgery,,,0740,22,Outpatient Hospital,1,2900.38,1104.32,1029.32,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011627,MBR00000452,Professional,2021-05-16,2021-05-16,2021-06-23,PLN3585,1453283987,1453283987,Critical Access Hospital,In-Network,Z79.4,Z00.00,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,3,51.2,35.83,35.83,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011628,MBR00000452,Institutional-OP,2023-06-10,2023-06-10,2023-07-07,PLN9183,1283743001,1283743001,Family Medicine,In-Network,E11.9,F32.9,,,,,,,0,,45378,Surgery,,,0740,22,Outpatient Hospital,1,1701.56,1139.51,1139.51,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000011629,MBR00000452,Professional,2021-07-14,2021-07-14,2021-08-07,PLN1810,1717546253,1717546253,Family Medicine,In-Network,E11.9,M54.5,,,,,,,0,,99214,E&M,,,,11,Office,1,372.55,280.48,245.48,0.0,35.0,0.0,35.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011630,MBR00000452,Professional,2022-01-18,2022-01-18,2022-01-28,PLN7963,1390307371,1390307371,DME Supplier,In-Network,F41.9,E66.9,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,2,76.16,26.83,26.83,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000011631,MBR00000452,Professional,2021-10-11,2021-10-11,2021-10-31,PLN5182,1245650222,1245650222,Gastroenterology,In-Network,M81.0,Z12.31,,,,,,,0,,78452,Radiology,,,,12,Home,2,6853.1,5512.43,5334.13,178.3,0.0,0.0,178.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011632,MBR00000452,Professional,2022-08-16,2022-08-16,2022-09-27,PLN1598,1845900543,1845900543,ASC,In-Network,E78.5,J45.20,,,,,,,0,,23472,Surgery,,,,81,Independent Laboratory,2,6469.13,2794.15,2759.15,0.0,35.0,0.0,35.0,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011633,MBR00000452,Professional,2021-03-31,2021-03-31,2021-05-07,PLN3564,1511044648,1511044648,Endocrinology,In-Network,E11.9,Z12.31,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,2,2726.64,945.73,0.0,0.0,0.0,147.34,147.34,0.0,Denied,CO-27,,1,,0,0,1,0,0,1,Duplicate,0,0,0,0,0
CLM0000011634,MBR00000452,Professional,2023-06-09,2023-06-09,2023-06-30,PLN4104,1366286000,1366286000,SNF,In-Network,R05,E11.9,,,,,,,0,,99221,E&M,,,,11,Office,1,185.38,108.1,108.1,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000011635,MBR00000452,Professional,2023-08-31,2023-08-31,2023-10-13,PLN6423,1148984206,1148984206,Psychiatry,In-Network,Z23,I10,,,,,,,0,,G0444,Medicine,,,,21,Inpatient Hospital,2,65.17,34.55,0.0,0.0,0.0,2.38,2.38,0.0,Denied,CO-15,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000011636,MBR00000452,Institutional-OP,2023-03-30,2023-03-30,2023-04-20,PLN3891,1227362142,1227362142,DME Supplier,In-Network,I48.91,I48.91,,,,,,,0,,99203,E&M,,,0761,22,Outpatient Hospital,2,156.52,71.21,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011637,MBR00000452,Professional,2021-07-22,2021-07-22,2021-08-11,PLN9392,1872272835,1872272835,Internal Medicine,In-Network,C50.912,Z23,,,,,,,0,,72148,Radiology,,,,11,Office,3,2726.05,2165.91,2046.55,0.0,0.0,119.36,119.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011638,MBR00000452,Professional,2021-11-15,2021-11-15,2021-12-08,PLN8918,1713934949,1713934949,Neurology,In-Network,Z12.31,Z00.00,,,,,,,0,,99213,E&M,,,,23,Emergency Room,1,267.9,84.9,0.0,84.9,0.0,0.0,84.9,0.0,Denied,CO-11,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011639,MBR00000452,Institutional-IP,2021-09-06,2021-09-07,2021-10-15,PLN5155,1205377316,1205377316,Orthopedic Surgery,In-Network,E78.5,N39.0,,,,682,MS-DRG,19,1,Y,99284,E&M,,,0301,21,Inpatient Hospital,1,843.07,641.15,0.0,358.34,0.0,47.18,405.52,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011640,MBR00000452,Institutional-OP,2022-10-22,2022-10-22,2022-11-10,PLN3510,1872613201,1872613201,Internal Medicine,In-Network,I10,E11.9,,,,,,,0,,27447,Surgery,,,0730,22,Outpatient Hospital,2,2336.06,826.88,455.2,322.52,0.0,49.16,371.68,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011641,MBR00000452,Professional,2023-08-31,2023-08-31,2023-10-09,PLN3411,1809014947,1809014947,Urology,In-Network,E11.65,N18.3,,,,,,,0,,82043,Pathology/Lab,,,,23,Emergency Room,1,28.54,21.44,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011642,MBR00000452,Institutional-OP,2023-08-21,2023-08-21,2023-09-17,PLN1645,1561134315,1561134315,DME Supplier,In-Network,J18.9,E78.5,,,,,,,0,,99203,E&M,,,0301,22,Outpatient Hospital,1,250.17,109.62,84.62,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011643,MBR00000452,Institutional-OP,2023-11-16,2023-11-16,2023-12-08,PLN2700,1236418230,1236418230,DME Supplier,In-Network,Z23,Z12.31,,,,,,,0,,99232,E&M,,,0370,22,Outpatient Hospital,3,325.31,137.64,98.53,0.0,35.0,4.11,39.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011644,MBR00000452,Professional,2023-01-26,2023-01-26,2023-02-05,PLN4870,1609526529,1609526529,Psychiatry,In-Network,M17.11,R05,,,,,,,0,,27447,Surgery,,,,11,Office,1,4467.9,2248.48,2221.33,27.15,0.0,0.0,27.15,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011645,MBR00000452,Professional,2021-08-31,2021-08-31,2021-10-14,PLN9743,1749327647,1749327647,Geriatrics,In-Network,E78.5,E11.9,,,,,,,0,,58661,Surgery,,,,81,Independent Laboratory,1,1851.24,1042.54,959.7,0.0,0.0,82.84,82.84,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011646,MBR00000452,Professional,2022-03-12,2022-03-12,2022-03-23,PLN4368,1193493783,1193493783,Critical Access Hospital,Out-of-Network,J20.9,Z00.00,,,,,,,0,,72148,Radiology,,,,11,Office,3,1858.62,751.59,701.59,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011647,MBR00000452,Institutional-OP,2021-11-19,2021-11-19,2021-12-18,PLN7150,1752470395,1752470395,Home Health,In-Network,M17.11,I25.10,,,,,,,0,,66984,Surgery,,,0730,22,Outpatient Hospital,1,2409.05,1945.64,1776.93,0.0,15.0,153.71,168.71,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011648,MBR00000452,Professional,2021-03-11,2021-03-11,2021-04-11,PLN6020,1219817751,1219817751,OB/GYN,In-Network,E66.9,E66.9,,,,,,,0,,47562,Surgery,,,,11,Office,3,5870.88,2734.29,2296.45,362.84,75.0,0.0,437.84,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011649,MBR00000452,Professional,2023-05-27,2023-05-27,2023-07-09,PLN7615,1575695214,1575695214,SNF,In-Network,F41.9,F41.9,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,1,440.19,178.43,103.43,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011650,MBR00000452,Institutional-OP,2022-09-25,2022-09-25,2022-10-09,PLN7578,1486164553,1486164553,DME Supplier,In-Network,Z87.891,K92.1,,,,,,,0,,27130,Surgery,,,0740,22,Outpatient Hospital,2,5084.36,3817.39,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011651,MBR00000452,Institutional-OP,2023-11-29,2023-11-29,2024-01-06,PLN4497,1511044648,1511044648,Endocrinology,In-Network,Z23,Z12.31,,,,,,,0,,99222,E&M,,,0510,22,Outpatient Hospital,2,529.14,242.02,198.26,0.0,0.0,43.76,43.76,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011652,MBR00000452,Professional,2023-07-11,2023-07-11,2023-07-22,PLN6294,1606140917,1606140917,ASC,In-Network,F41.9,Z23,,,,,,,0,,99203,E&M,,,,11,Office,2,292.16,233.52,0.0,0.0,0.0,42.15,42.15,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011653,MBR00000452,Professional,2022-12-13,2022-12-13,2023-01-02,PLN6296,1780163051,1780163051,SNF,In-Network,Z12.31,J44.1,,,,,,,0,,90686,Medicine,,,,20,Urgent Care,1,100.83,76.65,36.25,0.0,35.0,5.4,40.4,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000011654,MBR00000452,Institutional-IP,2021-02-17,2021-02-18,2021-03-20,PLN2463,1247341320,1247341320,Urology,Out-of-Network,F41.9,I48.91,,,,871,MS-DRG,20,1,Y,99204,E&M,,,0636,21,Inpatient Hospital,2,593.06,288.38,263.38,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011655,MBR00000452,Institutional-OP,2022-04-30,2022-04-30,2022-05-09,PLN8246,1502838586,1502838586,ASC,In-Network,M54.5,Z12.31,,,,,,,0,,76700,Radiology,,,0360,22,Outpatient Hospital,1,587.78,446.6,446.6,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000011656,MBR00000452,Professional,2022-06-05,2022-06-05,2022-07-05,PLN1959,1713934949,1713934949,Neurology,In-Network,R51,N18.3,,,,,,,0,,66984,Surgery,,,,23,Emergency Room,1,3345.47,1836.42,1425.07,411.35,0.0,0.0,411.35,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011657,MBR00000452,Professional,2023-01-09,2023-01-09,2023-01-30,PLN4049,1410468316,1410468316,SNF,In-Network,E11.9,C50.912,,,,,,,0,,45378,Surgery,,,,12,Home,1,1694.21,714.85,714.85,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000011658,MBR00000452,Institutional-OP,2022-09-13,2022-09-13,2022-10-16,PLN4836,1213165847,1213165847,Critical Access Hospital,In-Network,J45.20,I10,,,,,,,0,,93306,Radiology,,,0370,22,Outpatient Hospital,2,2320.86,966.65,891.65,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011659,MBR00000452,Institutional-OP,2023-05-05,2023-05-05,2023-05-16,PLN4461,1910255109,1910255109,DME Supplier,In-Network,E11.9,I10,,,,,,,0,,58661,Surgery,,,0370,22,Outpatient Hospital,2,3955.72,1903.12,1610.03,0.0,0.0,293.09,293.09,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011660,MBR00000452,Professional,2021-01-25,2021-01-25,2021-02-28,PLN8034,1135158374,1135158374,Pulmonology,In-Network,I25.10,F32.9,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,1,3199.18,2488.39,1998.63,489.76,0.0,0.0,489.76,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011661,MBR00000452,Institutional-OP,2021-05-04,2021-05-04,2021-05-26,PLN5908,1700633438,1700633438,DME Supplier,In-Network,J06.9,E78.5,,,,,,,0,,43239,Surgery,,,0270,22,Outpatient Hospital,2,1433.24,994.18,0.0,0.0,0.0,0.0,0.0,0.0,Denied,PR-1,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011662,MBR00000452,Institutional-IP,2023-11-10,2023-11-13,2023-11-17,PLN7255,1806688928,1806688928,Geriatrics,In-Network,R05,E78.5,,,,690,MS-DRG,13,3,Y,99222,E&M,,,0200,21,Inpatient Hospital,2,580.45,382.97,382.97,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011663,MBR00000452,Institutional-OP,2022-04-22,2022-04-22,2022-05-27,PLN7957,1899127912,1899127912,Neurology,In-Network,F41.9,F03.90,,,,,,,0,,43239,Surgery,,,0301,22,Outpatient Hospital,3,1591.87,889.75,839.26,15.49,35.0,0.0,50.49,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011664,MBR00000452,Professional,2023-06-20,2023-06-20,2023-07-06,PLN9779,1757138478,1757138478,Pediatrics,In-Network,E11.9,Z12.31,,,,,,,0,,58661,Surgery,,,,11,Office,2,4838.94,3565.66,3310.7,229.96,25.0,0.0,254.96,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011665,MBR00000452,Professional,2023-07-28,2023-07-28,2023-09-02,PLN5260,1530904931,1530904931,Internal Medicine,In-Network,I10,I50.9,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,3,295.5,145.87,95.87,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011666,MBR00000452,Institutional-IP,2021-05-13,2021-05-15,2021-06-11,PLN8930,1245650222,1245650222,Gastroenterology,In-Network,J18.9,E66.9,,,,682,MS-DRG,5,2,Y,99222,E&M,,,0636,21,Inpatient Hospital,2,471.62,185.57,144.63,0.0,25.0,15.94,40.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011667,MBR00000452,Professional,2023-02-12,2023-02-12,2023-02-23,PLN9134,1266606767,1266606767,ASC,In-Network,K57.30,M54.5,,,,,,,0,,77067,Radiology,,,,49,Independent Clinic,1,782.52,267.0,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-29,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000011668,MBR00000452,Professional,2021-07-10,2021-07-10,2021-07-19,PLN4916,1571574052,1571574052,Critical Access Hospital,In-Network,C50.912,G43.909,,,,,,,0,,90686,Medicine,,,,11,Office,3,110.96,86.88,19.88,29.66,35.0,2.34,67.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000011669,MBR00000453,Institutional-IP,2021-06-18,2021-06-21,2021-07-18,PLN5106,1366426662,1366426662,Urology,In-Network,F32.9,I25.10,,,,196,MS-DRG,13,3,Y,G0468,Medicine,,,0270,21,Inpatient Hospital,3,474.72,144.49,123.87,0.0,0.0,20.62,20.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011670,MBR00000453,Institutional-IP,2021-09-25,2021-10-01,2021-10-16,PLN9750,1284035364,1284035364,Pediatrics,In-Network,R51,E11.9,,,,872,MS-DRG,3,6,Y,72148,Radiology,,,0200,21,Inpatient Hospital,1,1520.15,1278.92,1276.6,0.0,0.0,2.32,2.32,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011671,MBR00000453,Professional,2023-04-07,2023-04-07,2023-04-23,PLN4244,1114982472,1114982472,Orthopedic Surgery,In-Network,F32.9,F32.9,,,,,,,0,,23472,Surgery,,,,11,Office,2,7153.18,6078.87,5601.36,0.0,0.0,477.51,477.51,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011672,MBR00000453,Professional,2021-04-13,2021-04-13,2021-04-29,PLN1560,1450094833,1450094833,Outpatient Clinic,In-Network,E11.9,Z12.31,,,,,,,0,,83036,Pathology/Lab,,,,21,Inpatient Hospital,1,77.58,33.86,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000011673,MBR00000453,Institutional-OP,2023-01-01,2023-01-01,2023-02-09,PLN6299,1780163051,1780163051,SNF,In-Network,E11.9,F10.20,,,,,,,0,,99406,Medicine,,,0510,22,Outpatient Hospital,1,70.38,54.27,0.0,54.27,25.0,0.0,79.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011674,MBR00000453,Institutional-IP,2022-02-22,2022-03-02,2022-03-17,PLN9427,1799205295,1799205295,General Acute Care Hospital,In-Network,J44.1,Z12.31,,,,871,MS-DRG,16,8,Y,47562,Surgery,,,0761,21,Inpatient Hospital,1,2928.1,1591.56,1591.56,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011675,MBR00000453,Professional,2021-10-17,2021-10-17,2021-10-29,PLN8455,1860435061,1860435061,DME Supplier,In-Network,E66.9,Z23,,,,,,,0,,45378,Surgery,,,,11,Office,3,920.61,735.54,735.54,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000011676,MBR00000453,Professional,2021-09-20,2021-09-20,2021-10-25,PLN6559,1644128543,1644128543,Gastroenterology,In-Network,G43.909,E78.5,,,,,,,0,,99283,E&M,,,,49,Independent Clinic,3,364.85,186.05,153.96,0.0,25.0,7.09,32.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011677,MBR00000453,Professional,2022-01-12,2022-01-12,2022-02-04,PLN3254,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,I10,F32.9,,,,,,,0,,45378,Surgery,,,,11,Office,3,1443.53,843.37,778.57,0.0,0.0,64.8,64.8,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000011678,MBR00000453,Institutional-OP,2022-01-18,2022-01-18,2022-02-03,PLN8386,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,F41.9,N39.0,,,,,,,0,,99233,E&M,,,0510,22,Outpatient Hospital,3,414.7,293.71,253.59,0.0,0.0,40.12,40.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011679,MBR00000453,Institutional-OP,2021-12-11,2021-12-11,2021-12-20,PLN7938,1994661817,1994661817,SNF,Out-of-Network,Z12.31,N18.3,,,,,,,0,,33533,Surgery,,,0301,22,Outpatient Hospital,1,23058.0,14796.89,14721.89,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000011680,MBR00000453,Institutional-IP,2022-07-22,2022-07-28,2022-08-05,PLN9687,1531398223,1531398223,OB/GYN,In-Network,R07.9,R07.9,,,,470,MS-DRG,21,6,Y,72148,Radiology,,,0730,21,Inpatient Hospital,2,1221.43,507.07,435.36,0.0,0.0,71.71,71.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011681,MBR00000453,Institutional-IP,2023-12-24,2023-12-25,2024-01-30,PLN8030,1434029575,1434029575,Endocrinology,In-Network,Z12.31,F41.9,,,,291,MS-DRG,12,1,Y,99213,E&M,,,0360,21,Inpatient Hospital,3,256.86,132.96,0.0,132.96,0.0,0.0,132.96,0.0,Adjusted,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000011682,MBR00000453,Professional,2022-05-10,2022-05-10,2022-06-08,PLN6119,1939033455,1939033455,Pulmonology,In-Network,R07.9,K21.0,,,,,,,0,,99283,E&M,,,,11,Office,3,426.02,240.38,225.38,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000011683,MBR00000453,Professional,2021-07-21,2021-07-21,2021-08-02,PLN5682,1727809972,1727809972,Home Health,In-Network,J06.9,Z12.31,,,,,,,0,,72148,Radiology,,,,11,Office,3,1455.57,1023.79,1023.79,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011684,MBR00000453,Professional,2022-11-01,2022-11-01,2022-12-07,PLN6891,1564502315,1564502315,ASC,In-Network,I25.10,E66.9,,,,,,,0,,99221,E&M,,,,11,Office,3,371.6,119.39,0.0,0.0,0.0,15.22,15.22,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011685,MBR00000453,Professional,2023-06-28,2023-06-28,2023-08-08,PLN3855,1727809972,1727809972,Home Health,In-Network,Z87.891,J06.9,,,,,,,0,,G0444,Medicine,,,,81,Independent Laboratory,3,100.84,84.28,0.0,84.28,0.0,0.0,84.28,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000011686,MBR00000453,Professional,2022-10-19,2022-10-19,2022-11-05,PLN4744,1795618275,1795618275,Pulmonology,In-Network,E66.9,I25.10,,,,,,,0,,97110,Medicine,,,,11,Office,3,192.17,102.54,0.0,102.54,35.0,0.0,137.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011687,MBR00000453,Professional,2022-08-05,2022-08-05,2022-08-17,PLN7531,1268679390,1268679390,Critical Access Hospital,In-Network,Z87.891,E11.40,,,,,,,0,,90686,Medicine,,,,20,Urgent Care,3,123.67,64.62,58.11,0.0,0.0,6.51,6.51,0.0,Paid,,,0,,0,1,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000011688,MBR00000453,Institutional-OP,2023-01-03,2023-01-03,2023-01-31,PLN1848,1453283987,1453283987,Critical Access Hospital,In-Network,F32.9,N40.0,,,,,,,0,,99204,E&M,,,0360,22,Outpatient Hospital,2,594.93,463.2,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011689,MBR00000453,Institutional-IP,2023-08-23,2023-08-29,2023-10-04,PLN3564,1118885473,1118885473,ASC,In-Network,E11.9,E78.5,,,,194,MS-DRG,11,6,Y,99284,E&M,,,0270,21,Inpatient Hospital,2,904.76,513.73,280.49,233.24,0.0,0.0,233.24,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000011690,MBR00000453,Institutional-OP,2021-03-25,2021-03-25,2021-04-22,PLN3193,1193493783,1193493783,Critical Access Hospital,Out-of-Network,E11.9,E78.5,,,,,,,0,,99284,E&M,,,0360,22,Outpatient Hospital,3,580.88,363.59,232.15,76.11,35.0,20.33,131.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011691,MBR00000453,Institutional-IP,2023-12-12,2023-12-18,2024-01-01,PLN1087,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,M17.11,I10,,,,871,MS-DRG,5,6,N,G0439,Medicine,,,0730,21,Inpatient Hospital,3,224.38,155.29,141.34,0.0,0.0,13.95,13.95,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000011692,MBR00000453,Institutional-OP,2023-09-06,2023-09-06,2023-09-19,PLN4092,1511044648,1511044648,Endocrinology,In-Network,E78.5,J44.1,,,,,,,0,,G0468,Medicine,,,0320,22,Outpatient Hospital,1,454.67,210.74,210.74,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011693,MBR00000453,Professional,2023-11-19,2023-11-19,2023-12-30,PLN1037,1186826716,1186826716,Physical Therapy,In-Network,E11.65,N39.0,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,1,413.18,346.76,311.76,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011694,MBR00000453,Professional,2022-06-30,2022-06-30,2022-07-12,PLN5565,1422747896,1422747896,Urology,In-Network,I48.91,I25.10,,,,,,,0,,99221,E&M,,,,31,Skilled Nursing Facility,3,423.49,319.04,319.04,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011695,MBR00000453,Institutional-IP,2023-07-25,2023-08-03,2023-08-12,PLN8160,1935547131,1935547131,Pulmonology,In-Network,E11.9,E11.9,,,,196,MS-DRG,8,9,Y,58661,Surgery,,,0900,21,Inpatient Hospital,3,4400.93,3264.5,2774.15,490.35,0.0,0.0,490.35,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011696,MBR00000453,Professional,2021-03-31,2021-03-31,2021-04-30,PLN6650,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,Z00.00,Z87.891,,,,,,,0,,99283,E&M,,,,49,Independent Clinic,1,581.01,202.94,94.56,50.8,35.0,22.58,108.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011697,MBR00000453,Professional,2022-03-29,2022-03-29,2022-04-10,PLN3780,1915531927,1915531927,Critical Access Hospital,In-Network,F32.9,Z23,,,,,,,0,,99213,E&M,,,,11,Office,1,137.34,76.98,76.98,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011698,MBR00000453,Institutional-IP,2023-08-22,2023-08-24,2023-09-05,PLN6909,1236418230,1236418230,DME Supplier,In-Network,J06.9,E78.5,,,,871,MS-DRG,6,2,Y,99214,E&M,,,0301,21,Inpatient Hospital,3,382.48,218.47,0.0,218.47,75.0,0.0,293.47,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000011699,MBR00000453,Professional,2021-10-25,2021-10-25,2021-11-06,PLN7415,1486164553,1486164553,DME Supplier,In-Network,Z12.31,I10,,,,,,,0,,72148,Radiology,,,,23,Emergency Room,1,2362.82,797.68,536.76,260.92,0.0,0.0,260.92,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011700,MBR00000453,Professional,2023-04-17,2023-04-17,2023-05-25,PLN8303,1389336600,1389336600,Critical Access Hospital,In-Network,E78.5,Z87.891,,,,,,,0,,76700,Radiology,,,,11,Office,3,1193.08,830.36,0.0,101.07,25.0,49.89,175.96,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011701,MBR00000453,Institutional-OP,2021-12-16,2021-12-16,2022-01-29,PLN3883,1453283987,1453283987,Critical Access Hospital,In-Network,M54.5,I10,,,,,,,0,,66984,Surgery,,,0450,22,Outpatient Hospital,3,1856.02,917.92,870.43,0.0,0.0,47.49,47.49,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011702,MBR00000453,Institutional-IP,2022-10-08,2022-10-10,2022-11-01,PLN3664,1968299309,1968299309,Internal Medicine,In-Network,E11.9,I25.10,,,,603,MS-DRG,19,2,Y,99214,E&M,,,0301,21,Inpatient Hospital,1,418.45,216.13,141.13,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000011703,MBR00000453,Professional,2022-12-17,2022-12-17,2023-01-14,PLN7677,1968299309,1968299309,Internal Medicine,In-Network,J06.9,E66.9,,,,,,,0,,66984,Surgery,,,,21,Inpatient Hospital,1,1931.34,1253.84,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-97,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011704,MBR00000453,Professional,2023-08-20,2023-08-20,2023-08-28,PLN4478,1313212303,1313212303,Family Medicine,In-Network,Z00.00,I25.10,,,,,,,0,,93306,Radiology,,,,20,Urgent Care,2,1533.86,984.79,544.01,440.78,0.0,0.0,440.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011705,MBR00000453,Institutional-OP,2022-01-10,2022-01-10,2022-01-26,PLN3797,1453283987,1453283987,Critical Access Hospital,In-Network,Z12.11,N18.3,,,,,,,0,,23472,Surgery,,,0301,22,Outpatient Hospital,3,7611.84,5817.06,0.0,463.44,0.0,0.0,463.44,0.0,Denied,CO-97,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011706,MBR00000453,Institutional-OP,2023-05-13,2023-05-13,2023-05-22,PLN7823,1696843572,1696843572,Critical Access Hospital,Out-of-Network,E11.65,E87.6,,,,,,,0,,99222,E&M,,,0320,22,Outpatient Hospital,1,597.22,471.3,320.06,0.0,75.0,76.24,151.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011707,MBR00000453,Professional,2022-04-22,2022-04-22,2022-05-05,PLN7069,1219817751,1219817751,OB/GYN,In-Network,I10,J45.20,,,,,,,0,,G0444,Medicine,,,,81,Independent Laboratory,1,67.41,38.89,23.89,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000011708,MBR00000453,Professional,2022-03-07,2022-03-07,2022-04-17,PLN8652,1691062876,1691062876,SNF,In-Network,J20.9,I10,,,,,,,0,,99221,E&M,,,,11,Office,3,293.99,217.02,0.0,0.0,0.0,37.59,37.59,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011709,MBR00000453,Institutional-IP,2021-03-29,2021-04-04,2021-04-24,PLN7237,1561134315,1561134315,DME Supplier,In-Network,K21.0,F41.9,,,,872,MS-DRG,16,6,W,85025,Pathology/Lab,,,0301,21,Inpatient Hospital,3,41.66,26.92,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011710,MBR00000453,Professional,2021-03-25,2021-03-25,2021-04-27,PLN4134,1767011137,1767011137,DME Supplier,In-Network,N39.0,M54.5,,,,,,,0,,71046,Radiology,,,,11,Office,2,300.79,123.71,0.0,123.71,0.0,0.0,123.71,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011711,MBR00000453,Professional,2023-04-25,2023-04-25,2023-06-08,PLN3102,1691062876,1691062876,SNF,In-Network,N18.3,Z12.31,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,1,2215.23,685.64,0.0,228.8,35.0,0.0,263.8,0.0,Denied,CO-18,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000011712,MBR00000454,Professional,2021-04-25,2021-04-25,2021-05-02,PLN4184,1622771872,1622771872,Pediatrics,In-Network,F03.90,M54.5,,,,,,,0,,99203,E&M,,,,49,Independent Clinic,3,259.09,92.74,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011713,MBR00000454,Professional,2021-05-03,2021-05-03,2021-05-20,PLN9468,1528335731,1528335731,Critical Access Hospital,In-Network,K57.30,G43.909,,,,,,,0,,76700,Radiology,,,,20,Urgent Care,3,1041.04,491.51,128.36,363.15,0.0,0.0,363.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011714,MBR00000454,Institutional-IP,2021-07-22,2021-07-23,2021-08-07,PLN8226,1780163051,1780163051,SNF,In-Network,Z00.00,S72.001A,,,,641,MS-DRG,11,1,Y,23472,Surgery,,,0200,21,Inpatient Hospital,3,4154.98,2199.91,2184.91,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000011715,MBR00000454,Professional,2022-01-05,2022-01-05,2022-01-23,PLN9557,1860435061,1860435061,DME Supplier,In-Network,F32.9,E66.9,,,,,,,0,,99221,E&M,,,,49,Independent Clinic,1,307.62,201.82,10.58,191.24,0.0,0.0,191.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011716,MBR00000454,Institutional-IP,2021-06-28,2021-07-01,2021-08-06,PLN6432,1520687146,1520687146,ASC,In-Network,E78.5,Z00.00,,,,292,MS-DRG,4,3,Y,84443,Pathology/Lab,,,0200,21,Inpatient Hospital,2,89.05,49.92,14.92,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011717,MBR00000454,Professional,2022-10-09,2022-10-09,2022-10-29,PLN5313,1800011727,1800011727,Clinical Laboratory,Out-of-Network,Z00.00,M54.5,,,,,,,0,,71046,Radiology,,,,23,Emergency Room,3,300.47,241.91,206.91,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011718,MBR00000454,Professional,2023-06-20,2023-06-20,2023-07-07,PLN7444,1631954542,1631954542,Oncology,In-Network,R05,B97.89,,,,,,,0,,86900,Pathology/Lab,,,,65,End-Stage Renal Disease,2,28.35,10.7,0.0,10.7,75.0,0.0,85.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011719,MBR00000454,Institutional-OP,2022-08-05,2022-08-05,2022-08-16,PLN2589,1609138981,1609138981,Critical Access Hospital,In-Network,J45.20,N39.0,,,,,,,0,,99203,E&M,,,0270,22,Outpatient Hospital,3,303.81,105.83,0.0,105.83,0.0,0.0,105.83,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011720,MBR00000454,Professional,2022-12-30,2022-12-30,2023-01-12,PLN4675,1550154147,1550154147,Outpatient Clinic,In-Network,Z87.891,E11.40,,,,,,,0,,47562,Surgery,,,,23,Emergency Room,3,4988.62,4066.97,4066.97,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011721,MBR00000454,Professional,2023-09-05,2023-09-05,2023-10-07,PLN8791,1475984649,1475984649,SNF,In-Network,E11.9,J06.9,,,,,,,0,,23472,Surgery,,,,49,Independent Clinic,3,4098.8,1622.55,1622.55,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011722,MBR00000454,Professional,2023-09-07,2023-09-07,2023-10-14,PLN6412,1691062876,1691062876,SNF,In-Network,Z12.31,E78.5,,,,,,,0,,99221,E&M,,,,11,Office,2,444.75,323.46,298.46,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011723,MBR00000454,Institutional-OP,2022-12-23,2022-12-23,2023-02-04,PLN2863,1757138478,1757138478,Pediatrics,In-Network,Z23,E78.5,,,,,,,0,,90460,Medicine,,,0636,22,Outpatient Hospital,2,60.41,32.57,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011724,MBR00000454,Institutional-IP,2021-03-16,2021-03-22,2021-03-26,PLN8605,1561134315,1561134315,DME Supplier,In-Network,N18.3,S72.001A,,,,683,MS-DRG,22,6,Y,27447,Surgery,,,0360,21,Inpatient Hospital,1,4612.41,1997.92,1972.92,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011725,MBR00000454,Professional,2023-05-15,2023-05-15,2023-05-22,PLN3025,1500037969,1500037969,Pulmonology,In-Network,Z23,Z23,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,3,4094.19,1744.04,1434.71,309.33,0.0,0.0,309.33,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011726,MBR00000454,Professional,2023-04-10,2023-04-10,2023-04-20,PLN4002,1575695214,1575695214,SNF,In-Network,J18.9,E78.5,,,,,,,0,,23472,Surgery,,,,81,Independent Laboratory,2,6547.7,5170.55,4644.1,491.45,35.0,0.0,526.45,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011727,MBR00000454,Institutional-IP,2021-11-29,2021-12-01,2021-12-15,PLN2916,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,E11.40,Z79.4,,,,195,MS-DRG,22,2,Y,99406,Medicine,,,0320,21,Inpatient Hospital,1,36.22,22.19,0.0,22.19,15.0,0.0,37.19,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011728,MBR00000455,Institutional-OP,2021-06-27,2021-06-27,2021-08-10,PLN8765,1193493783,1193493783,Critical Access Hospital,Out-of-Network,E11.9,J06.9,,,,,,,0,,27130,Surgery,,,0370,22,Outpatient Hospital,3,5027.67,3640.47,3164.22,461.25,15.0,0.0,476.25,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011729,MBR00000455,Professional,2021-05-25,2021-05-25,2021-06-18,PLN8884,1528335731,1528335731,Critical Access Hospital,In-Network,J45.20,E78.5,,,,,,,0,,90460,Medicine,,,,49,Independent Clinic,2,67.98,40.76,40.76,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011730,MBR00000455,Professional,2021-10-30,2021-10-30,2021-11-26,PLN6924,1571574052,1571574052,Critical Access Hospital,In-Network,F32.9,E87.6,,,,,,,0,,97530,Medicine,,,,11,Office,3,124.81,43.09,8.09,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011731,MBR00000455,Institutional-IP,2023-03-25,2023-03-31,2023-04-22,PLN9498,1974006077,1974006077,Orthopedic Surgery,In-Network,E78.5,J06.9,,,,195,MS-DRG,20,6,Y,23472,Surgery,,,0730,21,Inpatient Hospital,3,5322.51,2607.98,2607.98,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011732,MBR00000455,Professional,2023-11-02,2023-11-02,2023-12-16,PLN6806,1757138478,1757138478,Pediatrics,In-Network,I10,N39.0,,,,,,,0,,76700,Radiology,,,,20,Urgent Care,1,1320.85,786.33,761.33,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011733,MBR00000455,Institutional-IP,2021-06-18,2021-06-19,2021-07-28,PLN8559,1114982472,1114982472,Orthopedic Surgery,In-Network,Z12.31,Z12.31,,,,603,MS-DRG,11,1,Y,71046,Radiology,,,0270,21,Inpatient Hospital,3,275.66,158.72,0.0,158.72,0.0,0.0,158.72,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011734,MBR00000455,Professional,2022-03-31,2022-03-31,2022-05-03,PLN4644,1561134315,1561134315,DME Supplier,In-Network,J18.9,Z00.01,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,1,256.8,187.86,151.65,0.0,0.0,36.21,36.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011735,MBR00000456,Institutional-IP,2023-07-03,2023-07-10,2023-07-30,PLN8910,1438368327,1438368327,Home Health,In-Network,M17.11,K21.0,,,,292,MS-DRG,17,7,Y,90837,Medicine,,,0370,21,Inpatient Hospital,3,261.55,185.34,0.0,133.24,75.0,0.0,208.24,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000011736,MBR00000456,Institutional-OP,2021-04-05,2021-04-05,2021-04-27,PLN3603,1840431511,1840431511,Geriatrics,Out-of-Network,C50.912,Z12.11,,,,,,,0,,70450,Radiology,,,0450,22,Outpatient Hospital,3,700.86,460.11,108.5,328.25,0.0,23.36,351.61,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011737,MBR00000456,Institutional-OP,2023-10-30,2023-10-30,2023-11-24,PLN8417,1809014947,1809014947,Urology,In-Network,E11.9,F10.20,,,,,,,0,,85610,Pathology/Lab,,,0900,22,Outpatient Hospital,2,67.88,54.34,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011738,MBR00000456,Institutional-IP,2021-01-20,2021-01-31,2021-03-05,PLN9317,1542828721,1542828721,Orthopedic Surgery,In-Network,J18.9,C50.912,,,,603,MS-DRG,18,11,Y,76700,Radiology,,,0270,21,Inpatient Hospital,2,1444.28,1210.74,1102.49,90.81,15.0,2.44,108.25,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011739,MBR00000456,Professional,2021-11-06,2021-11-06,2021-11-27,PLN7966,1749494482,1749494482,Pediatrics,In-Network,J44.1,I10,,,,,,,0,,99232,E&M,,,,23,Emergency Room,2,290.98,95.54,95.54,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011740,MBR00000456,Institutional-OP,2021-02-05,2021-02-05,2021-03-15,PLN3993,1540044947,1540044947,Pulmonology,Out-of-Network,E78.5,F41.9,,,,,,,0,,93306,Radiology,,,0320,22,Outpatient Hospital,2,3129.83,2564.44,2334.74,100.13,35.0,94.57,229.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011741,MBR00000456,Institutional-OP,2023-04-14,2023-04-14,2023-05-22,PLN5113,1389336600,1389336600,Critical Access Hospital,In-Network,I10,Z00.00,,,,,,,0,,90460,Medicine,,,0320,22,Outpatient Hospital,2,51.35,25.7,25.7,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011742,MBR00000456,Professional,2022-04-13,2022-04-13,2022-05-03,PLN4543,1511044648,1511044648,Endocrinology,In-Network,K21.0,J20.9,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,3,59.34,42.96,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000011743,MBR00000456,Professional,2022-04-24,2022-04-24,2022-05-20,PLN2903,1475984649,1475984649,SNF,In-Network,R05,Z00.01,,,,,,,0,,43239,Surgery,,,,11,Office,3,839.56,556.29,279.1,277.19,0.0,0.0,277.19,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011744,MBR00000456,Professional,2022-08-22,2022-08-22,2022-09-12,PLN5249,1295371663,1295371663,Critical Access Hospital,In-Network,M81.0,M54.5,,,,,,,0,,45380,Surgery,,,,11,Office,1,2519.76,1248.02,980.24,107.3,25.0,135.48,267.78,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000011745,MBR00000457,Institutional-IP,2021-11-24,2021-12-03,2021-12-27,PLN9174,1198133277,1198133277,SNF,In-Network,N20.0,J06.9,,,,196,MS-DRG,17,9,Y,72148,Radiology,,,0900,21,Inpatient Hospital,3,1994.26,1514.46,1514.46,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011746,MBR00000457,Professional,2023-04-09,2023-04-09,2023-04-17,PLN9305,1800011727,1800011727,Clinical Laboratory,Out-of-Network,I10,Z23,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,3,6152.92,2140.76,0.0,412.06,25.0,0.0,437.06,0.0,Denied,CO-15,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011747,MBR00000457,Professional,2022-04-18,2022-04-18,2022-04-30,PLN6141,1284035364,1284035364,Pediatrics,In-Network,K21.0,J20.9,,,,,,,0,,27447,Surgery,,,,11,Office,2,2968.35,1268.76,1114.0,0.0,0.0,154.76,154.76,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011748,MBR00000457,Institutional-IP,2023-05-22,2023-05-23,2023-06-20,PLN2066,1545347862,1545347862,SNF,In-Network,J06.9,R05,,,,194,MS-DRG,20,1,Y,47562,Surgery,,,0320,21,Inpatient Hospital,3,6117.25,4470.49,4148.76,296.73,25.0,0.0,321.73,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011749,MBR00000457,Institutional-OP,2022-12-10,2022-12-10,2022-12-18,PLN9392,1531398223,1531398223,OB/GYN,In-Network,J06.9,I25.10,,,,,,,0,,97530,Medicine,,,0730,22,Outpatient Hospital,3,271.65,158.77,0.0,158.77,0.0,0.0,158.77,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011750,MBR00000457,Professional,2023-01-10,2023-01-10,2023-01-31,PLN2061,1749494482,1749494482,Pediatrics,In-Network,J06.9,N40.0,,,,,,,0,,76700,Radiology,,,,22,Outpatient Hospital,2,1419.02,504.15,504.15,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011751,MBR00000457,Professional,2023-12-18,2023-12-18,2024-01-17,PLN9614,1366576336,1366576336,Geriatrics,In-Network,K21.0,M54.5,,,,,,,0,,99284,E&M,,,,49,Independent Clinic,2,821.01,535.51,409.93,100.58,25.0,0.0,125.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011752,MBR00000457,Institutional-OP,2022-07-09,2022-07-09,2022-08-08,PLN7809,1716521444,1716521444,Oncology,In-Network,Z79.4,M54.5,,,,,,,0,,99222,E&M,,,0360,22,Outpatient Hospital,1,403.61,211.31,0.0,95.2,0.0,20.31,115.51,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011753,MBR00000457,Institutional-OP,2021-11-25,2021-11-25,2021-12-11,PLN7002,1530904931,1530904931,Internal Medicine,In-Network,N39.0,E11.9,,,,,,,0,,99221,E&M,,,0636,22,Outpatient Hospital,2,391.82,131.99,46.56,43.86,35.0,6.57,85.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011754,MBR00000457,Professional,2023-03-09,2023-03-09,2023-04-12,PLN5292,1860435061,1860435061,DME Supplier,In-Network,G43.909,Z12.31,,,,,,,0,,97530,Medicine,,,,11,Office,3,241.26,78.94,78.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011755,MBR00000457,Professional,2023-02-13,2023-02-13,2023-03-02,PLN4882,1645194539,1645194539,SNF,In-Network,J06.9,E66.9,,,,,,,0,,99283,E&M,,,,11,Office,2,615.26,221.08,221.08,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011756,MBR00000457,Professional,2022-06-14,2022-06-14,2022-07-15,PLN7118,1561134315,1561134315,DME Supplier,In-Network,F32.9,E11.65,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,2,4170.09,2047.73,2019.26,0.0,0.0,28.47,28.47,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011757,MBR00000457,Professional,2022-01-02,2022-01-02,2022-02-07,PLN4151,1530904931,1530904931,Internal Medicine,In-Network,I10,I10,,,,,,,0,,70450,Radiology,,,,22,Outpatient Hospital,1,1172.43,730.27,680.27,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011758,MBR00000457,Professional,2023-10-16,2023-10-16,2023-11-18,PLN5267,1948810580,1948810580,DME Supplier,In-Network,Z00.00,N39.0,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,1,60.18,41.04,41.04,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011759,MBR00000457,Institutional-IP,2021-10-03,2021-10-14,2021-10-13,PLN1795,1109850785,1109850785,ASC,Out-of-Network,E78.5,J44.1,,,,194,MS-DRG,13,11,Y,47562,Surgery,,,0270,21,Inpatient Hospital,3,4581.15,3031.34,0.0,93.32,15.0,0.0,108.32,0.0,Denied,CO-4,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011760,MBR00000457,Institutional-OP,2021-03-28,2021-03-28,2021-04-26,PLN7665,1453936007,1453936007,ASC,In-Network,I11.9,F03.90,,,,,,,0,,99284,E&M,,,0730,22,Outpatient Hospital,2,477.09,171.79,0.0,171.79,15.0,0.0,186.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011761,MBR00000457,Institutional-IP,2022-11-23,2022-11-27,2022-12-24,PLN9823,1660288235,1660288235,ASC,In-Network,R51,I10,,,,872,MS-DRG,5,4,Y,99232,E&M,,,0320,21,Inpatient Hospital,3,146.39,108.21,83.21,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011762,MBR00000457,Institutional-OP,2021-03-31,2021-03-31,2021-05-01,PLN9901,1337791138,1337791138,Internal Medicine,Out-of-Network,Z96.641,I10,,,,,,,0,,99222,E&M,,,0270,22,Outpatient Hospital,1,391.86,289.93,285.19,0.0,0.0,4.74,4.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011763,MBR00000457,Institutional-OP,2023-04-14,2023-04-14,2023-05-02,PLN8513,1997536841,1997536841,Family Medicine,Out-of-Network,M54.5,E11.9,,,,,,,0,,99233,E&M,,,0301,22,Outpatient Hospital,3,553.89,267.33,252.33,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011764,MBR00000457,Professional,2023-07-12,2023-07-12,2023-08-11,PLN1897,1213165847,1213165847,Critical Access Hospital,In-Network,J18.9,E11.9,,,,,,,0,,70450,Radiology,,,,22,Outpatient Hospital,2,1622.48,1168.24,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-29,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000011765,MBR00000457,Professional,2023-02-25,2023-02-25,2023-03-18,PLN4606,1997536841,1997536841,Family Medicine,Out-of-Network,R10.9,I10,,,,,,,0,,99222,E&M,,,,11,Office,1,455.03,185.94,185.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011766,MBR00000457,Institutional-OP,2021-09-16,2021-09-16,2021-10-09,PLN6654,1809014947,1809014947,Urology,In-Network,Z12.31,E87.6,,,,,,,0,,72148,Radiology,,,0730,22,Outpatient Hospital,3,1133.51,436.86,205.81,231.05,0.0,0.0,231.05,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011767,MBR00000457,Institutional-OP,2023-10-30,2023-10-30,2023-11-16,PLN1664,1749494482,1749494482,Pediatrics,In-Network,E78.5,J45.20,,,,,,,0,,97530,Medicine,,,0320,22,Outpatient Hospital,3,240.38,138.2,89.14,24.06,25.0,0.0,49.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011768,MBR00000457,Professional,2021-04-07,2021-04-07,2021-05-12,PLN3937,1108115157,1108115157,General Acute Care Hospital,In-Network,M54.5,K21.0,,,,,,,0,,43239,Surgery,,,,11,Office,2,2078.32,734.14,699.14,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011769,MBR00000457,Professional,2021-04-28,2021-04-28,2021-06-11,PLN3908,1564502315,1564502315,ASC,In-Network,E66.9,N40.0,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,1,146.83,90.12,0.0,90.12,15.0,0.0,105.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011770,MBR00000457,Institutional-IP,2021-11-29,2021-12-01,2021-12-08,PLN1516,1590915516,1590915516,Physical Therapy,Out-of-Network,J20.9,F32.9,,,,682,MS-DRG,13,2,Y,27130,Surgery,,,0730,21,Inpatient Hospital,3,4495.62,2679.1,2654.1,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000011771,MBR00000457,Professional,2022-08-16,2022-08-16,2022-08-29,PLN3801,1114982472,1114982472,Orthopedic Surgery,In-Network,J45.20,J44.1,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,3,6449.53,2371.85,2346.85,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011772,MBR00000457,Institutional-OP,2023-02-17,2023-02-17,2023-02-24,PLN7371,1242201429,1242201429,General Acute Care Hospital,In-Network,Z12.31,S72.001A,,,,,,,0,,99283,E&M,,,0730,22,Outpatient Hospital,3,405.89,271.98,0.0,261.43,50.0,0.0,311.43,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011773,MBR00000457,Professional,2021-11-15,2021-11-15,2021-11-25,PLN6888,1514306773,1514306773,Endocrinology,In-Network,Z23,N17.9,,,,,,,0,,93306,Radiology,,,,11,Office,1,2864.43,1649.5,1318.46,20.26,0.0,310.78,331.04,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011774,MBR00000457,Institutional-IP,2023-09-30,2023-10-09,2023-10-19,PLN7446,1450094833,1450094833,Outpatient Clinic,In-Network,N39.0,J06.9,,,,292,MS-DRG,16,9,U,83036,Pathology/Lab,,,0320,21,Inpatient Hospital,3,56.65,19.63,16.39,0.0,0.0,3.24,3.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000011775,MBR00000457,Professional,2023-06-14,2023-06-14,2023-07-03,PLN1642,1502838586,1502838586,ASC,In-Network,E11.9,M81.0,,,,,,,0,,99283,E&M,,,,11,Office,3,438.42,275.98,250.8,0.0,0.0,25.18,25.18,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011776,MBR00000457,Professional,2021-09-10,2021-09-10,2021-09-29,PLN5226,1757138478,1757138478,Pediatrics,In-Network,I11.9,Z00.00,,,,,,,0,,70553,Radiology,,,,11,Office,2,2503.25,1338.1,778.71,362.43,75.0,121.96,559.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011777,MBR00000457,Institutional-OP,2021-03-09,2021-03-09,2021-03-20,PLN7160,1168881145,1168881145,Orthopedic Surgery,In-Network,G43.909,I10,,,,,,,0,,43239,Surgery,,,0900,22,Outpatient Hospital,1,1111.82,693.12,0.0,315.79,35.0,0.0,350.79,0.0,Denied,CO-29,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011778,MBR00000457,Professional,2023-02-08,2023-02-08,2023-03-24,PLN6777,1540044947,1540044947,Pulmonology,Out-of-Network,N18.3,Z23,,,,,,,0,,90837,Medicine,,,,21,Inpatient Hospital,1,462.39,294.08,0.0,294.08,0.0,0.0,294.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011779,MBR00000457,Professional,2021-07-12,2021-07-12,2021-07-25,PLN1678,1948810580,1948810580,DME Supplier,In-Network,I10,F41.9,,,,,,,0,,99233,E&M,,,,11,Office,2,577.29,300.09,110.41,189.68,0.0,0.0,189.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011780,MBR00000457,Professional,2021-11-05,2021-11-05,2021-12-03,PLN5497,1757138478,1757138478,Pediatrics,In-Network,Z79.4,E11.9,,,,,,,0,,27130,Surgery,,,,23,Emergency Room,1,5024.77,1860.33,1190.47,493.62,0.0,176.24,669.86,0.0,Adjusted,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011781,MBR00000457,Professional,2023-04-26,2023-04-26,2023-05-19,PLN8114,1563980627,1563980627,Critical Access Hospital,In-Network,I11.9,I63.9,,,,,,,0,,47562,Surgery,,,,12,Home,2,3930.3,2540.07,2540.07,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011782,MBR00000457,Professional,2021-07-27,2021-07-27,2021-08-05,PLN3479,1915531927,1915531927,Critical Access Hospital,In-Network,M81.0,N39.0,,,,,,,0,,43239,Surgery,,,,50,Federally Qualified Health Center,2,2024.87,1709.95,1515.1,194.85,0.0,0.0,194.85,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011783,MBR00000457,Professional,2022-01-24,2022-01-24,2022-02-06,PLN5971,1168881145,1168881145,Orthopedic Surgery,In-Network,J20.9,E78.5,,,,,,,0,,45380,Surgery,,,,11,Office,2,2190.55,1239.91,900.43,324.48,15.0,0.0,339.48,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000011784,MBR00000457,Professional,2023-10-13,2023-10-13,2023-11-08,PLN8985,1624802371,1624802371,ASC,Out-of-Network,M17.11,Z79.4,,,,,,,0,,99204,E&M,,,,23,Emergency Room,1,400.92,294.68,0.0,294.68,25.0,0.0,319.68,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011785,MBR00000457,Institutional-IP,2023-01-17,2023-01-30,2023-02-22,PLN6615,1139906830,1139906830,Endocrinology,Out-of-Network,N39.0,Z87.891,,,,603,MS-DRG,14,13,Y,66984,Surgery,,,0301,21,Inpatient Hospital,3,1646.98,1326.1,1326.1,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000011786,MBR00000457,Institutional-OP,2022-11-10,2022-11-10,2022-12-01,PLN6744,1915531927,1915531927,Critical Access Hospital,In-Network,Z00.00,N40.0,,,,,,,0,,99203,E&M,,,0120,22,Outpatient Hospital,2,255.95,166.62,141.62,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011787,MBR00000457,Professional,2023-12-30,2023-12-30,2024-02-05,PLN2471,1514306773,1514306773,Endocrinology,In-Network,I63.9,J06.9,,,,,,,0,,99222,E&M,,,,20,Urgent Care,1,587.66,241.66,191.66,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011788,MBR00000457,Institutional-OP,2023-04-24,2023-04-24,2023-05-25,PLN8134,1717912431,1717912431,Oncology,In-Network,E11.9,Z23,,,,,,,0,,99406,Medicine,,,0120,22,Outpatient Hospital,1,64.69,43.16,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011789,MBR00000457,Institutional-OP,2022-05-19,2022-05-19,2022-05-30,PLN4959,1186826716,1186826716,Physical Therapy,In-Network,Z23,Z23,,,,,,,0,,47562,Surgery,,,0120,22,Outpatient Hospital,2,3052.2,1442.68,1201.05,226.63,15.0,0.0,241.63,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011790,MBR00000457,Institutional-IP,2022-12-29,2023-01-03,2023-02-04,PLN1956,1103747954,1103747954,Urology,In-Network,R07.9,Z79.4,,,,195,MS-DRG,5,5,Y,84443,Pathology/Lab,,,0360,21,Inpatient Hospital,2,69.72,27.96,12.96,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011791,MBR00000457,Institutional-OP,2022-08-07,2022-08-07,2022-09-20,PLN2029,1410468316,1410468316,SNF,In-Network,J18.9,M54.5,,,,,,,0,,43239,Surgery,,,0301,22,Outpatient Hospital,3,1912.37,1263.77,1263.77,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011792,MBR00000457,Professional,2022-02-03,2022-02-03,2022-02-24,PLN3295,1114982472,1114982472,Orthopedic Surgery,In-Network,N39.0,I10,,,,,,,0,,90686,Medicine,,,,21,Inpatient Hospital,3,108.99,74.71,60.22,0.0,0.0,14.49,14.49,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000011793,MBR00000458,Professional,2023-12-04,2023-12-04,2023-12-17,PLN5319,1542828721,1542828721,Orthopedic Surgery,In-Network,E11.9,F32.9,,,,,,,0,,82043,Pathology/Lab,,,,31,Skilled Nursing Facility,3,41.86,33.64,0.0,33.64,0.0,0.0,33.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011794,MBR00000458,Institutional-OP,2022-10-12,2022-10-12,2022-11-19,PLN9938,1728018911,1728018911,Nephrology,In-Network,E66.9,E11.9,,,,,,,0,,97110,Medicine,,,0360,22,Outpatient Hospital,1,178.1,122.74,122.74,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011795,MBR00000458,Institutional-OP,2023-03-29,2023-03-29,2023-04-30,PLN5087,1366426662,1366426662,Urology,In-Network,N39.0,J20.9,,,,,,,0,,83036,Pathology/Lab,,,0301,22,Outpatient Hospital,2,68.63,40.2,40.2,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000011796,MBR00000458,Professional,2022-03-25,2022-03-25,2022-04-30,PLN2131,1193493783,1193493783,Critical Access Hospital,Out-of-Network,N39.0,F32.9,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,3,141.72,92.41,67.41,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011797,MBR00000458,Professional,2021-08-04,2021-08-04,2021-08-30,PLN3507,1716521444,1716521444,Oncology,In-Network,I10,E11.9,,,,,,,0,,71046,Radiology,,,,22,Outpatient Hospital,2,121.56,101.84,99.65,0.0,0.0,2.19,2.19,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011798,MBR00000458,Professional,2021-05-15,2021-05-15,2021-06-25,PLN4392,1980712759,1980712759,Outpatient Clinic,Out-of-Network,E78.5,R51,,,,,,,0,,84443,Pathology/Lab,,,,22,Outpatient Hospital,3,115.9,73.42,23.42,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011799,MBR00000458,Professional,2023-05-31,2023-05-31,2023-07-03,PLN5193,1631954542,1631954542,Oncology,In-Network,J06.9,E78.5,,,,,,,0,,43239,Surgery,,,,11,Office,3,2065.5,1129.97,947.48,0.0,50.0,132.49,182.49,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011800,MBR00000458,Institutional-OP,2022-07-25,2022-07-25,2022-09-03,PLN9590,1700633438,1700633438,DME Supplier,In-Network,Z23,N39.0,,,,,,,0,,99233,E&M,,,0636,22,Outpatient Hospital,1,569.37,362.95,356.18,0.0,0.0,6.77,6.77,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011801,MBR00000458,Professional,2022-07-19,2022-07-19,2022-08-18,PLN7485,1974006077,1974006077,Orthopedic Surgery,In-Network,F41.9,Z87.891,,,,,,,0,,23472,Surgery,,,,11,Office,3,3177.11,2227.69,2227.69,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011802,MBR00000458,Institutional-IP,2021-05-13,2021-05-22,2021-06-08,PLN8178,1518055405,1518055405,Urology,In-Network,E66.9,J44.1,,,,682,MS-DRG,19,9,Y,86900,Pathology/Lab,,,0320,21,Inpatient Hospital,1,28.81,22.48,0.0,22.48,0.0,0.0,22.48,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000011803,MBR00000458,Institutional-OP,2023-05-13,2023-05-13,2023-05-29,PLN7447,1422747896,1422747896,Urology,In-Network,Z23,Z00.00,,,,,,,0,,99283,E&M,,,0301,22,Outpatient Hospital,1,402.49,164.75,0.0,164.75,35.0,0.0,199.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011804,MBR00000458,Professional,2021-10-16,2021-10-16,2021-10-28,PLN5646,1752470395,1752470395,Home Health,In-Network,E11.9,F41.9,,,,,,,0,,97530,Medicine,,,,11,Office,3,136.03,49.47,14.47,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011805,MBR00000458,Institutional-IP,2022-10-18,2022-10-23,2022-10-30,PLN1873,1575695214,1575695214,SNF,In-Network,N17.9,R05,,,,291,MS-DRG,8,5,Y,33533,Surgery,,,0730,21,Inpatient Hospital,1,22361.44,12514.74,12120.19,394.55,0.0,0.0,394.55,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000011806,MBR00000458,Professional,2022-01-19,2022-01-19,2022-02-10,PLN4237,1563980627,1563980627,Critical Access Hospital,In-Network,I48.91,K57.30,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,2,106.41,76.02,23.63,0.0,50.0,2.39,52.39,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000011807,MBR00000458,Professional,2021-09-06,2021-09-06,2021-09-27,PLN2039,1422747896,1422747896,Urology,In-Network,J20.9,I10,,,,,,,0,,45380,Surgery,,,,11,Office,3,2499.33,877.72,510.71,283.24,75.0,8.77,367.01,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000011808,MBR00000458,Professional,2021-06-28,2021-06-28,2021-08-11,PLN7266,1550154147,1550154147,Outpatient Clinic,In-Network,M17.11,Z23,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,3,73.58,58.58,0.0,58.58,15.0,0.0,73.58,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000011809,MBR00000458,Professional,2023-06-11,2023-06-11,2023-07-11,PLN1897,1545347862,1545347862,SNF,In-Network,Z12.31,Z23,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,3,140.58,115.95,98.35,0.0,15.0,2.6,17.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011810,MBR00000458,Institutional-IP,2021-04-15,2021-04-27,2021-05-06,PLN7920,1860435061,1860435061,DME Supplier,In-Network,I50.9,R07.9,,,,872,MS-DRG,23,12,W,85610,Pathology/Lab,,,0360,21,Inpatient Hospital,2,66.07,55.83,0.0,55.83,35.0,0.0,90.83,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011811,MBR00000458,Professional,2021-01-03,2021-01-03,2021-02-09,PLN7395,1696843572,1696843572,Critical Access Hospital,Out-of-Network,K57.30,I11.9,,,,,,,0,,G0468,Medicine,,,,22,Outpatient Hospital,1,564.15,366.27,366.27,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011812,MBR00000458,Institutional-OP,2021-12-02,2021-12-02,2021-12-29,PLN6333,1795618275,1795618275,Pulmonology,In-Network,F41.9,E78.5,,,,,,,0,,80061,Pathology/Lab,,,0120,22,Outpatient Hospital,1,111.02,78.25,63.35,0.0,0.0,14.9,14.9,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011813,MBR00000458,Institutional-IP,2023-08-31,2023-09-03,2023-10-01,PLN5227,1205377316,1205377316,Orthopedic Surgery,In-Network,E66.9,G43.909,,,,683,MS-DRG,4,3,Y,27447,Surgery,,,0360,21,Inpatient Hospital,1,3298.15,1654.83,1646.25,0.0,0.0,8.58,8.58,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011814,MBR00000458,Institutional-OP,2023-02-08,2023-02-08,2023-02-24,PLN8247,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,J20.9,I10,,,,,,,0,,45378,Surgery,,,0900,22,Outpatient Hospital,3,1224.92,984.24,0.0,0.0,50.0,0.0,50.0,0.0,Denied,CO-27,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000011815,MBR00000458,Institutional-OP,2023-06-16,2023-06-16,2023-07-10,PLN7188,1395983630,1395983630,Nephrology,In-Network,Z00.00,K21.0,,,,,,,0,,72148,Radiology,,,0761,22,Outpatient Hospital,1,2261.74,816.74,781.74,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011816,MBR00000458,Institutional-OP,2021-08-13,2021-08-13,2021-09-15,PLN3801,1450094833,1450094833,Outpatient Clinic,In-Network,Z00.00,Z00.00,,,,,,,0,,99232,E&M,,,0636,22,Outpatient Hospital,2,211.63,102.54,67.54,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011817,MBR00000458,Professional,2023-11-29,2023-11-29,2023-12-12,PLN3439,1453936007,1453936007,ASC,In-Network,I10,Z12.31,,,,,,,0,,27447,Surgery,,,,21,Inpatient Hospital,3,5737.09,4700.57,4519.46,181.11,0.0,0.0,181.11,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011818,MBR00000458,Professional,2021-05-09,2021-05-09,2021-06-22,PLN7482,1624802371,1624802371,ASC,Out-of-Network,Z12.11,M54.5,,,,,,,0,,99222,E&M,,,,21,Inpatient Hospital,3,664.77,390.01,0.0,309.66,50.0,0.0,359.66,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011819,MBR00000458,Institutional-OP,2021-02-08,2021-02-08,2021-03-23,PLN7180,1366426662,1366426662,Urology,In-Network,Z00.01,Z51.11,,,,,,,0,,45378,Surgery,,,0761,22,Outpatient Hospital,1,2366.0,1642.68,1492.44,0.0,0.0,150.24,150.24,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000011820,MBR00000458,Institutional-OP,2022-06-07,2022-06-07,2022-06-21,PLN7176,1511044648,1511044648,Endocrinology,In-Network,Z00.00,Z00.00,,,,,,,0,,81001,Pathology/Lab,,,0301,22,Outpatient Hospital,3,51.89,30.41,0.0,0.0,75.0,0.0,75.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011821,MBR00000458,Institutional-IP,2022-04-25,2022-04-26,2022-05-20,PLN9385,1757138478,1757138478,Pediatrics,In-Network,M54.5,J06.9,,,,641,MS-DRG,7,1,U,99203,E&M,,,0120,21,Inpatient Hospital,2,377.02,114.01,0.0,114.01,0.0,0.0,114.01,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011822,MBR00000458,Professional,2021-11-15,2021-11-15,2021-12-14,PLN2579,1475984649,1475984649,SNF,In-Network,B97.89,J44.1,,,,,,,0,,G0439,Medicine,,,,22,Outpatient Hospital,2,595.86,260.94,185.94,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000011823,MBR00000458,Professional,2021-07-05,2021-07-05,2021-07-20,PLN3516,1806688928,1806688928,Geriatrics,In-Network,N39.0,Z23,,,,,,,0,,99221,E&M,,,,11,Office,3,381.79,158.9,0.0,158.9,50.0,0.0,208.9,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000011824,MBR00000459,Professional,2021-12-18,2021-12-18,2022-01-09,PLN6232,1118885473,1118885473,ASC,In-Network,Z79.4,Z00.00,,,,,,,0,,99214,E&M,,,,11,Office,2,335.22,134.0,108.78,0.0,0.0,25.22,25.22,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011825,MBR00000459,Professional,2022-02-14,2022-02-14,2022-03-02,PLN7841,1132188260,1132188260,Family Medicine,In-Network,E11.9,N39.0,,,,,,,0,,G0439,Medicine,,,,22,Outpatient Hospital,2,614.5,333.57,318.57,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000011826,MBR00000459,Institutional-OP,2022-10-21,2022-10-21,2022-11-21,PLN4163,1968299309,1968299309,Internal Medicine,In-Network,Z12.31,I10,,,,,,,0,,G0444,Medicine,,,0740,22,Outpatient Hospital,3,54.53,39.41,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000011827,MBR00000459,Professional,2022-01-29,2022-01-29,2022-02-17,PLN9761,1865904917,1865904917,Outpatient Clinic,In-Network,J06.9,Z23,,,,,,,0,,99214,E&M,,,,11,Office,2,316.14,177.51,14.76,137.75,25.0,0.0,162.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011828,MBR00000459,Professional,2021-09-25,2021-09-25,2021-10-21,PLN5965,1236418230,1236418230,DME Supplier,In-Network,G43.909,R05,,,,,,,0,,G0468,Medicine,,,,22,Outpatient Hospital,1,382.8,289.67,289.67,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011829,MBR00000459,Professional,2022-10-17,2022-10-17,2022-11-03,PLN1451,1728018911,1728018911,Nephrology,In-Network,R10.9,I25.10,,,,,,,0,,81001,Pathology/Lab,,,,22,Outpatient Hospital,2,38.27,17.46,0.0,17.46,0.0,0.0,17.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011830,MBR00000459,Institutional-OP,2022-09-30,2022-09-30,2022-10-21,PLN8680,1606140917,1606140917,ASC,In-Network,I48.91,I50.9,,,,,,,0,,45378,Surgery,,,0370,22,Outpatient Hospital,2,2212.13,1090.35,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-27,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000011831,MBR00000459,Professional,2022-04-24,2022-04-24,2022-06-01,PLN1237,1872613201,1872613201,Internal Medicine,In-Network,E78.5,I10,,,,,,,0,,97530,Medicine,,,,81,Independent Laboratory,3,197.49,148.64,148.64,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011832,MBR00000459,Professional,2021-05-01,2021-05-01,2021-06-13,PLN6863,1463205530,1463205530,Nephrology,In-Network,M54.5,J18.9,,,,,,,0,,27130,Surgery,,,,11,Office,1,2956.28,2072.55,1738.87,0.0,0.0,333.68,333.68,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011833,MBR00000459,Institutional-OP,2023-11-24,2023-11-24,2024-01-07,PLN4217,1997536841,1997536841,Family Medicine,Out-of-Network,I63.9,I10,,,,,,,0,,99283,E&M,,,0360,22,Outpatient Hospital,2,278.11,89.12,0.0,89.12,0.0,0.0,89.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011834,MBR00000459,Institutional-IP,2022-07-24,2022-08-01,2022-08-11,PLN5901,1757138478,1757138478,Pediatrics,In-Network,F32.9,E87.6,,,,871,MS-DRG,4,8,Y,99284,E&M,,,0450,21,Inpatient Hospital,1,429.29,246.03,0.0,0.0,0.0,48.6,48.6,0.0,Denied,CO-4,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000011835,MBR00000459,Professional,2021-11-01,2021-11-01,2021-12-12,PLN1940,1809014947,1809014947,Urology,In-Network,E78.5,G43.909,,,,,,,0,,27447,Surgery,,,,49,Independent Clinic,2,3531.74,1161.41,1161.41,0.0,0.0,0.0,0.0,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011836,MBR00000459,Professional,2023-03-06,2023-03-06,2023-03-25,PLN4445,1244186984,1244186984,Family Medicine,Out-of-Network,Z23,M17.11,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,1,3729.56,2707.27,2514.27,0.0,0.0,193.0,193.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011837,MBR00000459,Professional,2022-04-04,2022-04-04,2022-04-13,PLN3523,1108115157,1108115157,General Acute Care Hospital,In-Network,G43.909,E11.9,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,2,124.65,70.04,58.26,0.0,0.0,11.78,11.78,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000011838,MBR00000459,Institutional-IP,2021-06-29,2021-07-05,2021-07-21,PLN7120,1809014947,1809014947,Urology,In-Network,I10,E78.5,,,,683,MS-DRG,22,6,Y,99232,E&M,,,0270,21,Inpatient Hospital,3,210.66,137.95,122.95,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011839,MBR00000459,Professional,2023-02-07,2023-02-07,2023-02-19,PLN3243,1244186984,1244186984,Family Medicine,Out-of-Network,M54.5,Z00.00,,,,,,,0,,87491,Pathology/Lab,,,,49,Independent Clinic,1,161.8,83.72,48.53,0.0,25.0,10.19,35.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011840,MBR00000459,Institutional-IP,2021-04-12,2021-04-18,2021-05-14,PLN5986,1502838586,1502838586,ASC,In-Network,N40.0,J06.9,,,,196,MS-DRG,12,6,Y,70553,Radiology,,,0200,21,Inpatient Hospital,2,3331.54,1058.61,610.38,339.52,0.0,108.71,448.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011841,MBR00000459,Professional,2021-10-30,2021-10-30,2021-12-04,PLN4401,1366286000,1366286000,SNF,In-Network,M17.11,Z00.00,,,,,,,0,,72148,Radiology,,,,65,End-Stage Renal Disease,1,2842.92,1086.81,1071.81,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011842,MBR00000459,Institutional-IP,2022-12-27,2023-01-03,2023-01-04,PLN1878,1268679390,1268679390,Critical Access Hospital,In-Network,I10,Z00.00,,,,872,MS-DRG,8,7,Y,86900,Pathology/Lab,,,0510,21,Inpatient Hospital,1,43.97,18.76,0.0,18.76,25.0,0.0,43.76,0.0,Denied,CO-18,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000011843,MBR00000459,Institutional-OP,2023-03-04,2023-03-04,2023-04-03,PLN2336,1542828721,1542828721,Orthopedic Surgery,In-Network,J06.9,I10,,,,,,,0,,80053,Pathology/Lab,,,0270,22,Outpatient Hospital,3,113.68,36.91,18.42,0.0,15.0,3.49,18.49,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011844,MBR00000459,Institutional-OP,2023-12-22,2023-12-22,2024-01-10,PLN3413,1434029575,1434029575,Endocrinology,In-Network,M54.5,M17.11,,,,,,,0,,45380,Surgery,,,0360,22,Outpatient Hospital,3,2157.9,1026.67,801.99,0.0,75.0,149.68,224.68,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000011845,MBR00000459,Professional,2023-02-16,2023-02-16,2023-02-27,PLN8316,1569105090,1569105090,Geriatrics,In-Network,E11.9,E11.9,,,,,,,0,,70450,Radiology,,,,20,Urgent Care,3,1540.88,720.76,277.05,443.71,0.0,0.0,443.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011846,MBR00000459,Professional,2021-09-11,2021-09-11,2021-10-02,PLN6387,1948810580,1948810580,DME Supplier,In-Network,E11.9,R05,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,1,174.35,127.49,0.0,127.49,35.0,0.0,162.49,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011847,MBR00000459,Professional,2023-02-19,2023-02-19,2023-03-20,PLN3906,1531398223,1531398223,OB/GYN,In-Network,F32.9,N39.0,,,,,,,0,,80061,Pathology/Lab,,,,49,Independent Clinic,3,125.69,56.97,0.0,56.97,0.0,0.0,56.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011848,MBR00000459,Professional,2023-04-03,2023-04-03,2023-04-15,PLN4790,1283743001,1283743001,Family Medicine,In-Network,J06.9,E78.5,,,,,,,0,,84443,Pathology/Lab,,,,22,Outpatient Hospital,3,74.54,58.63,48.15,0.0,0.0,10.48,10.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011849,MBR00000459,Professional,2023-01-10,2023-01-10,2023-02-23,PLN2111,1148984206,1148984206,Psychiatry,In-Network,N18.3,E78.5,,,,,,,0,,97110,Medicine,,,,22,Outpatient Hospital,2,190.44,84.15,0.0,84.15,0.0,0.0,84.15,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011850,MBR00000459,Professional,2023-03-28,2023-03-28,2023-04-28,PLN5631,1528335731,1528335731,Critical Access Hospital,In-Network,J44.1,E78.5,,,,,,,0,,99283,E&M,,,,50,Federally Qualified Health Center,1,516.96,265.91,255.12,0.0,0.0,10.79,10.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011851,MBR00000459,Institutional-OP,2023-06-15,2023-06-15,2023-07-26,PLN8917,1997536841,1997536841,Family Medicine,Out-of-Network,Z00.01,E11.9,,,,,,,0,,99232,E&M,,,0636,22,Outpatient Hospital,3,265.04,109.3,109.3,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011852,MBR00000459,Institutional-OP,2022-09-15,2022-09-15,2022-10-03,PLN5517,1273488618,1273488618,General Acute Care Hospital,In-Network,I25.10,E78.5,,,,,,,0,,G0444,Medicine,,,0360,22,Outpatient Hospital,2,37.89,25.93,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000011853,MBR00000459,Institutional-OP,2023-12-26,2023-12-26,2024-01-27,PLN8356,1283743001,1283743001,Family Medicine,In-Network,E66.9,Z00.00,,,,,,,0,,33533,Surgery,,,0320,22,Outpatient Hospital,2,20759.42,8636.28,7451.19,0.0,35.0,1150.09,1185.09,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000011854,MBR00000459,Professional,2022-12-07,2022-12-07,2022-12-18,PLN8105,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,R07.9,E78.5,,,,,,,0,,76700,Radiology,,,,11,Office,2,1005.8,473.16,0.0,20.52,0.0,0.0,20.52,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011855,MBR00000459,Institutional-OP,2021-03-02,2021-03-02,2021-04-06,PLN4322,1845057593,1845057593,Orthopedic Surgery,In-Network,E78.5,M54.5,,,,,,,0,,G0444,Medicine,,,0200,22,Outpatient Hospital,3,70.56,50.69,0.0,50.69,0.0,0.0,50.69,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000011856,MBR00000459,Institutional-IP,2021-07-08,2021-07-16,2021-07-24,PLN9011,1372918899,1372918899,Family Medicine,In-Network,I10,Z00.00,,,,195,MS-DRG,3,8,Y,93000,Radiology,,,0370,21,Inpatient Hospital,3,75.22,46.05,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000011857,MBR00000459,Institutional-IP,2022-06-29,2022-07-03,2022-07-14,PLN3827,1514306773,1514306773,Endocrinology,In-Network,Z23,N18.3,,,,196,MS-DRG,3,4,Y,99221,E&M,,,0761,21,Inpatient Hospital,2,278.42,147.65,0.0,147.65,0.0,0.0,147.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011858,MBR00000459,Professional,2022-04-22,2022-04-22,2022-05-24,PLN4625,1422747896,1422747896,Urology,In-Network,M17.11,Z79.4,,,,,,,0,,99213,E&M,,,,31,Skilled Nursing Facility,3,117.54,95.95,0.0,95.95,35.0,0.0,130.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011859,MBR00000459,Institutional-OP,2023-06-10,2023-06-10,2023-06-28,PLN6355,1980712759,1980712759,Outpatient Clinic,Out-of-Network,J06.9,I10,,,,,,,0,,45378,Surgery,,,0761,22,Outpatient Hospital,3,1219.56,619.43,619.43,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000011860,MBR00000459,Professional,2023-01-07,2023-01-07,2023-02-19,PLN5409,1475984649,1475984649,SNF,In-Network,I10,F41.9,,,,,,,0,,93306,Radiology,,,,23,Emergency Room,1,2440.62,1633.68,1377.42,65.1,25.0,166.16,256.26,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011861,MBR00000459,Professional,2021-01-01,2021-01-01,2021-02-11,PLN4417,1700633438,1700633438,DME Supplier,In-Network,I10,R07.9,,,,,,,0,,97530,Medicine,,,,11,Office,2,161.12,113.63,87.13,26.5,0.0,0.0,26.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011862,MBR00000459,Professional,2022-05-14,2022-05-14,2022-05-25,PLN6947,1511044648,1511044648,Endocrinology,In-Network,J06.9,R05,,,,,,,0,,99283,E&M,,,,11,Office,1,261.72,208.94,11.53,197.41,0.0,0.0,197.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011863,MBR00000459,Professional,2022-08-20,2022-08-20,2022-09-16,PLN4288,1752470395,1752470395,Home Health,In-Network,I10,E11.9,,,,,,,0,,45380,Surgery,,,,11,Office,1,2131.79,1067.24,1067.24,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000011864,MBR00000459,Institutional-OP,2023-12-10,2023-12-10,2023-12-24,PLN5873,1542828721,1542828721,Orthopedic Surgery,In-Network,R07.9,E11.9,,,,,,,0,,83036,Pathology/Lab,,,0730,22,Outpatient Hospital,1,63.39,30.75,0.0,30.75,25.0,0.0,55.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000011865,MBR00000459,Institutional-IP,2022-12-24,2022-12-28,2023-01-22,PLN6872,1799205295,1799205295,General Acute Care Hospital,In-Network,Z00.00,E11.9,,,,196,MS-DRG,12,4,Y,G0439,Medicine,,,0370,21,Inpatient Hospital,2,363.69,123.03,104.86,0.0,0.0,18.17,18.17,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000011866,MBR00000460,Institutional-OP,2021-07-17,2021-07-17,2021-08-04,PLN3416,1556140803,1556140803,Cardiology,In-Network,E11.9,I25.10,,,,,,,0,,90837,Medicine,,,0510,22,Outpatient Hospital,1,201.58,79.79,0.0,79.79,0.0,0.0,79.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011867,MBR00000460,Institutional-OP,2021-07-29,2021-07-29,2021-08-28,PLN3875,1700633438,1700633438,DME Supplier,In-Network,R51,E66.9,,,,,,,0,,85025,Pathology/Lab,,,0510,22,Outpatient Hospital,2,64.77,31.1,13.25,0.0,15.0,2.85,17.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011868,MBR00000460,Institutional-IP,2021-12-12,2021-12-17,2021-12-21,PLN9208,1624802371,1624802371,ASC,Out-of-Network,F10.20,E11.9,,,,641,MS-DRG,9,5,Y,99213,E&M,,,0360,21,Inpatient Hospital,1,261.07,123.19,123.19,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011869,MBR00000460,Institutional-OP,2022-03-15,2022-03-15,2022-04-19,PLN5498,1514306773,1514306773,Endocrinology,In-Network,R51,K21.0,,,,,,,0,,45380,Surgery,,,0370,22,Outpatient Hospital,1,1716.94,575.07,575.07,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000011870,MBR00000460,Institutional-OP,2021-04-29,2021-04-29,2021-05-22,PLN9116,1395983630,1395983630,Nephrology,In-Network,E87.6,Z87.891,,,,,,,0,,71046,Radiology,,,0370,22,Outpatient Hospital,3,213.82,76.52,70.35,0.0,0.0,6.17,6.17,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011871,MBR00000460,Professional,2023-05-15,2023-05-15,2023-06-13,PLN1633,1313212303,1313212303,Family Medicine,In-Network,E78.5,I10,,,,,,,0,,99222,E&M,,,,31,Skilled Nursing Facility,3,334.7,151.45,115.42,0.0,35.0,1.03,36.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011872,MBR00000460,Professional,2021-03-16,2021-03-16,2021-04-23,PLN6855,1856686341,1856686341,Geriatrics,In-Network,Z12.31,Z12.31,,,,,,,0,,27130,Surgery,,,,11,Office,1,5115.87,2393.36,1888.35,0.0,75.0,430.01,505.01,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011873,MBR00000460,Professional,2021-03-15,2021-03-15,2021-04-28,PLN1991,1224179551,1224179551,Physical Therapy,In-Network,E66.9,Z12.31,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,3,255.54,80.82,13.0,67.82,0.0,0.0,67.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011874,MBR00000460,Institutional-IP,2021-05-20,2021-05-27,2021-06-28,PLN6141,1364429278,1364429278,OB/GYN,In-Network,M54.5,E78.5,,,,195,MS-DRG,13,7,Y,99284,E&M,,,0120,21,Inpatient Hospital,1,815.07,512.39,391.29,39.38,25.0,56.72,121.1,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011875,MBR00000460,Institutional-OP,2021-05-28,2021-05-28,2021-07-09,PLN3276,1266606767,1266606767,ASC,In-Network,I10,E11.9,,,,,,,0,,85025,Pathology/Lab,,,0120,22,Outpatient Hospital,3,47.96,20.76,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011876,MBR00000460,Professional,2022-09-10,2022-09-10,2022-10-20,PLN5359,1545347862,1545347862,SNF,In-Network,I48.91,J06.9,,,,,,,0,,72148,Radiology,,,,11,Office,1,2126.39,1130.55,1130.55,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011877,MBR00000460,Institutional-OP,2023-06-15,2023-06-15,2023-06-22,PLN8478,1422747896,1422747896,Urology,In-Network,Z00.00,I11.9,,,,,,,0,,99221,E&M,,,0370,22,Outpatient Hospital,1,220.83,154.54,79.54,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011878,MBR00000460,Institutional-IP,2023-10-30,2023-11-02,2023-11-12,PLN6695,1645194539,1645194539,SNF,In-Network,E11.9,J06.9,,,,292,MS-DRG,15,3,Y,93225,Medicine,,,0636,21,Inpatient Hospital,1,366.16,156.87,0.0,156.87,0.0,0.0,156.87,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000011879,MBR00000460,Professional,2023-06-06,2023-06-06,2023-06-23,PLN5681,1728018911,1728018911,Nephrology,In-Network,K21.0,J06.9,,,,,,,0,,27447,Surgery,,,,21,Inpatient Hospital,1,5739.04,3861.78,0.0,0.0,25.0,304.19,329.19,0.0,Denied,CO-11,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011880,MBR00000460,Institutional-IP,2023-01-21,2023-02-03,2023-01-31,PLN2511,1125190055,1125190055,Nephrology,In-Network,E11.9,I50.9,,,,683,MS-DRG,16,13,W,70450,Radiology,,,0761,21,Inpatient Hospital,2,1473.46,1121.22,1086.22,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011881,MBR00000460,Institutional-OP,2022-10-09,2022-10-09,2022-10-21,PLN8523,1778483301,1778483301,Home Health,In-Network,Z12.31,R10.9,,,,,,,0,,93306,Radiology,,,0450,22,Outpatient Hospital,3,1261.49,1052.89,1030.38,22.51,0.0,0.0,22.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011882,MBR00000460,Professional,2021-12-05,2021-12-05,2021-12-17,PLN8272,1817234602,1817234602,Clinical Laboratory,In-Network,M17.11,K21.0,,,,,,,0,,99233,E&M,,,,11,Office,3,223.03,135.97,120.97,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011883,MBR00000460,Professional,2022-04-01,2022-04-01,2022-05-09,PLN1072,1514306773,1514306773,Endocrinology,In-Network,Z23,C50.912,,,,,,,0,,90837,Medicine,,,,11,Office,3,519.85,267.5,0.0,7.08,0.0,0.0,7.08,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011884,MBR00000460,Institutional-IP,2023-08-14,2023-08-15,2023-09-22,PLN5103,1700633438,1700633438,DME Supplier,In-Network,R07.9,E11.9,,,,194,MS-DRG,23,1,Y,72148,Radiology,,,0360,21,Inpatient Hospital,1,2431.0,1197.29,1095.0,52.29,50.0,0.0,102.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011885,MBR00000460,Professional,2021-04-26,2021-04-26,2021-06-03,PLN3810,1514306773,1514306773,Endocrinology,In-Network,Z12.31,I10,,,,,,,0,,99203,E&M,,,,21,Inpatient Hospital,3,159.76,79.5,29.5,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011886,MBR00000460,Professional,2023-06-23,2023-06-23,2023-07-29,PLN1684,1186826716,1186826716,Physical Therapy,In-Network,J06.9,J45.20,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,3,183.66,83.78,83.78,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011887,MBR00000460,Institutional-OP,2023-06-08,2023-06-08,2023-07-15,PLN8395,1872613201,1872613201,Internal Medicine,In-Network,Z96.641,Z12.11,,,,,,,0,,99406,Medicine,,,0320,22,Outpatient Hospital,3,69.47,41.63,16.63,0.0,25.0,0.0,25.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011888,MBR00000460,Professional,2021-03-04,2021-03-04,2021-03-31,PLN4519,1891849440,1891849440,Oncology,In-Network,Z12.31,J06.9,,,,,,,0,,G0439,Medicine,,,,11,Office,2,393.49,164.41,129.41,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000011889,MBR00000460,Professional,2021-09-22,2021-09-22,2021-10-24,PLN1054,1563980627,1563980627,Critical Access Hospital,In-Network,I63.9,M81.0,,,,,,,0,,85025,Pathology/Lab,,,,22,Outpatient Hospital,1,89.9,35.91,10.91,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011890,MBR00000460,Institutional-OP,2021-12-06,2021-12-06,2021-12-30,PLN7005,1624202402,1624202402,Orthopedic Surgery,In-Network,E66.9,Z23,,,,,,,0,,45378,Surgery,,,0636,22,Outpatient Hospital,2,2030.96,694.81,333.55,227.85,75.0,58.41,361.26,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000011891,MBR00000461,Institutional-IP,2023-09-27,2023-10-10,2023-11-05,PLN5482,1899127912,1899127912,Neurology,In-Network,I10,Z00.00,,,,872,MS-DRG,15,13,Y,74177,Radiology,,,0510,21,Inpatient Hospital,3,2836.63,1967.59,1700.35,267.24,0.0,0.0,267.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011892,MBR00000461,Professional,2022-04-26,2022-04-26,2022-05-08,PLN6730,1645194539,1645194539,SNF,In-Network,J20.9,G43.909,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,3,1637.94,993.43,993.43,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000011893,MBR00000461,Professional,2023-04-30,2023-04-30,2023-05-15,PLN4349,1244186984,1244186984,Family Medicine,Out-of-Network,I10,N39.0,,,,,,,0,,97110,Medicine,,,,22,Outpatient Hospital,1,157.87,102.56,102.56,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011894,MBR00000461,Professional,2022-10-20,2022-10-20,2022-10-31,PLN7903,1872613201,1872613201,Internal Medicine,In-Network,R51,Z00.00,,,,,,,0,,82043,Pathology/Lab,,,,22,Outpatient Hospital,1,59.88,45.35,0.0,45.35,0.0,0.0,45.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011895,MBR00000461,Professional,2021-03-30,2021-03-30,2021-04-10,PLN2101,1812060197,1812060197,Oncology,Out-of-Network,N20.0,E78.5,,,,,,,0,,99283,E&M,,,,49,Independent Clinic,1,601.74,423.01,101.66,316.44,0.0,4.91,321.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011896,MBR00000461,Institutional-OP,2023-01-01,2023-01-01,2023-02-05,PLN9312,1687650653,1687650653,Internal Medicine,In-Network,J06.9,I25.10,,,,,,,0,,23472,Surgery,,,0636,22,Outpatient Hospital,2,7046.12,3905.1,3905.1,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011897,MBR00000461,Professional,2022-11-27,2022-11-27,2022-12-16,PLN1611,1990090423,1990090423,Orthopedic Surgery,In-Network,Z12.11,M54.5,,,,,,,0,,87491,Pathology/Lab,,,,50,Federally Qualified Health Center,3,178.27,72.79,22.79,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011898,MBR00000461,Professional,2023-08-12,2023-08-12,2023-08-28,PLN8912,1974006077,1974006077,Orthopedic Surgery,In-Network,Z23,Z00.00,,,,,,,0,,97110,Medicine,,,,50,Federally Qualified Health Center,2,172.35,57.64,56.99,0.0,0.0,0.65,0.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011899,MBR00000461,Institutional-OP,2023-10-06,2023-10-06,2023-11-17,PLN4775,1450094833,1450094833,Outpatient Clinic,In-Network,I25.10,R10.9,,,,,,,0,,87491,Pathology/Lab,,,0120,22,Outpatient Hospital,1,113.03,66.13,0.0,0.0,0.0,9.21,9.21,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011900,MBR00000461,Institutional-OP,2022-10-06,2022-10-06,2022-11-18,PLN8270,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,E11.9,R51,,,,,,,0,,27130,Surgery,,,0740,22,Outpatient Hospital,2,5982.2,2358.62,2283.62,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011901,MBR00000461,Institutional-OP,2023-08-21,2023-08-21,2023-09-13,PLN9351,1244186984,1244186984,Family Medicine,Out-of-Network,Z00.00,K57.30,,,,,,,0,,81001,Pathology/Lab,,,0200,22,Outpatient Hospital,1,48.6,31.19,0.0,31.19,0.0,0.0,31.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011902,MBR00000461,Professional,2021-06-02,2021-06-02,2021-06-12,PLN5099,1366576336,1366576336,Geriatrics,In-Network,J06.9,G43.909,,,,,,,0,,85610,Pathology/Lab,,,,81,Independent Laboratory,1,60.31,31.79,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011903,MBR00000461,Professional,2022-11-03,2022-11-03,2022-12-01,PLN4032,1514306773,1514306773,Endocrinology,In-Network,E78.5,R05,,,,,,,0,,87491,Pathology/Lab,,,,20,Urgent Care,2,115.54,49.03,43.08,0.0,0.0,5.95,5.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011904,MBR00000461,Institutional-OP,2022-09-25,2022-09-25,2022-10-04,PLN6637,1645194539,1645194539,SNF,In-Network,I10,Z51.11,,,,,,,0,,G0444,Medicine,,,0200,22,Outpatient Hospital,1,73.16,46.91,30.62,0.0,15.0,1.29,16.29,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000011905,MBR00000461,Institutional-OP,2021-07-08,2021-07-08,2021-07-23,PLN1586,1103747954,1103747954,Urology,In-Network,F32.9,N39.0,,,,,,,0,,74177,Radiology,,,0636,22,Outpatient Hospital,1,2579.39,1768.53,1276.5,220.71,0.0,271.32,492.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011906,MBR00000461,Institutional-OP,2022-08-13,2022-08-13,2022-09-04,PLN3377,1245650222,1245650222,Gastroenterology,In-Network,R10.9,F32.9,,,,,,,0,,27130,Surgery,,,0900,22,Outpatient Hospital,3,6003.6,3088.48,2888.74,149.74,50.0,0.0,199.74,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011907,MBR00000461,Professional,2023-01-15,2023-01-15,2023-02-19,PLN3368,1273488618,1273488618,General Acute Care Hospital,In-Network,E66.9,N18.3,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,2,41.27,20.77,0.0,20.77,0.0,0.0,20.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011908,MBR00000461,Institutional-OP,2022-03-31,2022-03-31,2022-04-15,PLN7842,1239316214,1239316214,Internal Medicine,In-Network,E78.5,Z23,,,,,,,0,,G0439,Medicine,,,0270,22,Outpatient Hospital,2,560.62,270.26,254.91,0.0,15.0,0.35,15.35,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000011909,MBR00000461,Institutional-OP,2022-12-31,2022-12-31,2023-01-30,PLN3478,1168881145,1168881145,Orthopedic Surgery,In-Network,E78.5,I10,,,,,,,0,,70450,Radiology,,,0730,22,Outpatient Hospital,3,1128.35,410.47,395.47,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011910,MBR00000461,Professional,2023-03-27,2023-03-27,2023-04-28,PLN5887,1186826716,1186826716,Physical Therapy,In-Network,F03.90,R51,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,2,449.05,336.34,0.0,336.34,0.0,0.0,336.34,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011911,MBR00000461,Professional,2022-10-07,2022-10-07,2022-10-25,PLN6394,1542828721,1542828721,Orthopedic Surgery,In-Network,J20.9,F41.9,,,,,,,0,,99213,E&M,,,,11,Office,3,268.83,111.25,0.0,111.25,25.0,0.0,136.25,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000011912,MBR00000461,Professional,2022-03-12,2022-03-12,2022-03-19,PLN6451,1108115157,1108115157,General Acute Care Hospital,In-Network,E78.5,Z12.31,,,,,,,0,,83036,Pathology/Lab,,,,12,Home,3,113.49,49.07,0.0,49.07,75.0,0.0,124.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000011913,MBR00000461,Institutional-OP,2021-10-18,2021-10-18,2021-11-19,PLN3431,1355166277,1355166277,Endocrinology,In-Network,Z23,B97.89,,,,,,,0,,45380,Surgery,,,0740,22,Outpatient Hospital,2,1659.02,657.72,440.22,217.5,0.0,0.0,217.5,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000011914,MBR00000461,Professional,2022-12-25,2022-12-25,2023-02-05,PLN8049,1337791138,1337791138,Internal Medicine,Out-of-Network,R10.9,F10.20,,,,,,,0,,97110,Medicine,,,,23,Emergency Room,3,240.2,176.18,151.18,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011915,MBR00000461,Professional,2023-09-13,2023-09-13,2023-10-26,PLN6513,1899127912,1899127912,Neurology,In-Network,F41.9,K21.0,,,,,,,0,,99213,E&M,,,,49,Independent Clinic,2,161.53,89.36,0.0,89.36,25.0,0.0,114.36,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000011916,MBR00000462,Institutional-IP,2022-05-21,2022-05-22,2022-06-18,PLN4467,1790497490,1790497490,OB/GYN,In-Network,J06.9,J45.20,,,,641,MS-DRG,13,1,Y,81001,Pathology/Lab,,,0370,21,Inpatient Hospital,3,42.56,12.81,0.0,0.0,35.0,0.0,35.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011917,MBR00000462,Institutional-OP,2022-07-05,2022-07-05,2022-08-01,PLN1595,1872613201,1872613201,Internal Medicine,In-Network,R05,E66.9,,,,,,,0,,23472,Surgery,,,0510,22,Outpatient Hospital,3,5196.36,2200.89,2175.89,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011918,MBR00000462,Professional,2023-09-26,2023-09-26,2023-10-22,PLN2615,1891849440,1891849440,Oncology,In-Network,M17.11,Z12.31,,,,,,,0,,99214,E&M,,,,11,Office,1,467.69,208.1,197.61,0.0,0.0,10.49,10.49,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011919,MBR00000462,Institutional-OP,2021-11-22,2021-11-22,2021-12-29,PLN2420,1644128543,1644128543,Gastroenterology,In-Network,N17.9,E11.65,,,,,,,0,,27130,Surgery,,,0301,22,Outpatient Hospital,3,3804.78,1510.9,1460.9,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011920,MBR00000462,Professional,2023-06-04,2023-06-04,2023-06-27,PLN7113,1193493783,1193493783,Critical Access Hospital,Out-of-Network,Z23,I10,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,3,506.94,268.32,268.32,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011921,MBR00000463,Professional,2021-10-07,2021-10-07,2021-11-05,PLN7416,1213165847,1213165847,Critical Access Hospital,In-Network,E11.40,I48.91,,,,,,,0,,33533,Surgery,,,,11,Office,2,21859.84,17218.13,16941.71,276.42,0.0,0.0,276.42,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000011922,MBR00000463,Institutional-IP,2021-10-10,2021-10-12,2021-10-23,PLN4716,1224179551,1224179551,Physical Therapy,In-Network,I63.9,E11.9,,,,641,MS-DRG,21,2,Y,97530,Medicine,,,0900,21,Inpatient Hospital,3,119.44,36.3,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011923,MBR00000463,Institutional-IP,2021-11-04,2021-11-06,2021-11-25,PLN7775,1939033455,1939033455,Pulmonology,In-Network,J44.1,J06.9,,,,872,MS-DRG,13,2,Y,99406,Medicine,,,0320,21,Inpatient Hospital,2,42.17,16.25,0.0,16.25,15.0,0.0,31.25,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000011924,MBR00000463,Institutional-IP,2021-02-27,2021-03-05,2021-03-06,PLN7887,1148984206,1148984206,Psychiatry,In-Network,I11.9,E66.9,,,,690,MS-DRG,2,6,Y,74177,Radiology,,,0120,21,Inpatient Hospital,1,2821.09,1368.21,1177.55,190.66,0.0,0.0,190.66,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011925,MBR00000463,Institutional-IP,2022-05-20,2022-05-22,2022-06-23,PLN1580,1244186984,1244186984,Family Medicine,Out-of-Network,E78.5,I10,,,,683,MS-DRG,24,2,Y,90686,Medicine,,,0200,21,Inpatient Hospital,3,69.29,37.32,0.0,37.32,0.0,0.0,37.32,0.0,Paid,,,0,,0,1,0,0,1,0,None,0,0,0,0,0
CLM0000011926,MBR00000463,Institutional-OP,2022-01-23,2022-01-23,2022-02-22,PLN2885,1266606767,1266606767,ASC,In-Network,F32.9,B97.89,,,,,,,0,,97110,Medicine,,,0320,22,Outpatient Hospital,3,220.37,87.72,59.97,0.0,15.0,12.75,27.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011927,MBR00000463,Institutional-OP,2021-09-10,2021-09-10,2021-09-28,PLN5836,1355166277,1355166277,Endocrinology,In-Network,I25.10,I10,,,,,,,0,,99213,E&M,,,0636,22,Outpatient Hospital,2,238.45,136.78,101.78,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011928,MBR00000463,Institutional-OP,2023-04-09,2023-04-09,2023-05-06,PLN5930,1713934949,1713934949,Neurology,In-Network,I48.91,Z00.00,,,,,,,0,,99222,E&M,,,0120,22,Outpatient Hospital,2,505.06,258.55,238.75,0.0,0.0,19.8,19.8,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011929,MBR00000463,Institutional-OP,2022-07-21,2022-07-21,2022-08-14,PLN1892,1224179551,1224179551,Physical Therapy,In-Network,G43.909,Z00.00,,,,,,,0,,97110,Medicine,,,0730,22,Outpatient Hospital,1,191.29,154.23,119.23,0.0,35.0,0.0,35.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011930,MBR00000463,Professional,2021-08-03,2021-08-03,2021-08-14,PLN1164,1997536841,1997536841,Family Medicine,Out-of-Network,R07.9,F10.20,,,,,,,0,,78452,Radiology,,,,11,Office,2,6445.72,2016.17,1420.56,499.03,25.0,71.58,595.61,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011931,MBR00000463,Institutional-OP,2021-07-30,2021-07-30,2021-08-10,PLN3058,1644128543,1644128543,Gastroenterology,In-Network,F41.9,F41.9,,,,,,,0,,80053,Pathology/Lab,,,0636,22,Outpatient Hospital,2,63.35,50.88,25.88,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011932,MBR00000463,Professional,2023-06-06,2023-06-06,2023-06-13,PLN4721,1266606767,1266606767,ASC,In-Network,J20.9,F32.9,,,,,,,0,,70553,Radiology,,,,22,Outpatient Hospital,2,4045.81,2805.63,2790.63,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011933,MBR00000463,Institutional-IP,2021-10-24,2021-11-04,2021-11-05,PLN8603,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,E78.5,E66.9,,,,291,MS-DRG,3,11,Y,99214,E&M,,,0636,21,Inpatient Hospital,3,238.27,92.51,0.0,92.51,0.0,0.0,92.51,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000011934,MBR00000463,Professional,2022-03-09,2022-03-09,2022-03-18,PLN9395,1991459367,1991459367,Neurology,Out-of-Network,Z79.4,F32.9,,,,,,,0,,47562,Surgery,,,,12,Home,3,4789.15,2707.83,2539.41,168.42,0.0,0.0,168.42,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011935,MBR00000463,Professional,2021-05-12,2021-05-12,2021-05-30,PLN8302,1790497490,1790497490,OB/GYN,In-Network,E11.65,Z00.01,,,,,,,0,,23472,Surgery,,,,12,Home,3,3320.94,2624.86,2194.33,0.0,35.0,395.53,430.53,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011936,MBR00000463,Institutional-OP,2023-05-31,2023-05-31,2023-07-09,PLN6066,1334916761,1334916761,ASC,In-Network,Z00.01,Z00.00,,,,,,,0,,78452,Radiology,,,0320,22,Outpatient Hospital,1,2991.81,1278.44,1203.44,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011937,MBR00000463,Institutional-IP,2022-01-27,2022-02-06,2022-03-09,PLN3637,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,I11.9,I10,,,,195,MS-DRG,3,10,W,99213,E&M,,,0730,21,Inpatient Hospital,3,244.59,143.55,103.33,0.0,35.0,5.22,40.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011938,MBR00000463,Professional,2023-02-11,2023-02-11,2023-03-08,PLN1966,1790497490,1790497490,OB/GYN,In-Network,J20.9,Z79.4,,,,,,,0,,27130,Surgery,,,,11,Office,1,3062.28,2360.01,1894.77,465.24,0.0,0.0,465.24,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011939,MBR00000463,Professional,2022-03-21,2022-03-21,2022-04-09,PLN4780,1795618275,1795618275,Pulmonology,In-Network,Z00.00,R07.9,,,,,,,0,,99203,E&M,,,,11,Office,3,194.52,68.96,68.96,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011940,MBR00000463,Professional,2023-05-28,2023-05-28,2023-06-19,PLN2800,1795618275,1795618275,Pulmonology,In-Network,I25.10,Z87.891,,,,,,,0,,83036,Pathology/Lab,,,,22,Outpatient Hospital,3,56.11,36.68,0.0,36.68,75.0,0.0,111.68,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000011941,MBR00000463,Institutional-OP,2022-03-19,2022-03-19,2022-04-07,PLN3727,1500949740,1500949740,Pediatrics,In-Network,K21.0,Z23,,,,,,,0,,45380,Surgery,,,0301,22,Outpatient Hospital,2,2503.78,998.54,950.1,0.0,0.0,48.44,48.44,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000011942,MBR00000463,Professional,2023-09-08,2023-09-08,2023-10-14,PLN7105,1434029575,1434029575,Endocrinology,In-Network,Z12.31,E66.9,,,,,,,0,,84443,Pathology/Lab,,,,20,Urgent Care,2,157.27,51.97,0.0,51.97,0.0,0.0,51.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011943,MBR00000463,Institutional-IP,2023-03-05,2023-03-06,2023-04-18,PLN5289,1645194539,1645194539,SNF,In-Network,I10,E11.9,,,,470,MS-DRG,20,1,Y,83036,Pathology/Lab,,,0761,21,Inpatient Hospital,1,59.03,43.59,0.0,43.59,0.0,0.0,43.59,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000011944,MBR00000463,Institutional-OP,2022-06-11,2022-06-11,2022-07-19,PLN8527,1624802371,1624802371,ASC,Out-of-Network,F03.90,E78.5,,,,,,,0,,85025,Pathology/Lab,,,0301,22,Outpatient Hospital,3,79.48,51.51,36.51,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011945,MBR00000463,Institutional-IP,2022-06-14,2022-06-20,2022-07-06,PLN7217,1990090423,1990090423,Orthopedic Surgery,In-Network,E78.5,Z79.4,,,,195,MS-DRG,4,6,N,G0468,Medicine,,,0450,21,Inpatient Hospital,2,552.24,427.18,427.18,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000011946,MBR00000463,Professional,2022-11-11,2022-11-11,2022-12-07,PLN7466,1236418230,1236418230,DME Supplier,In-Network,R51,E78.5,,,,,,,0,,99213,E&M,,,,23,Emergency Room,1,162.89,136.14,26.9,109.24,0.0,0.0,109.24,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011947,MBR00000463,Institutional-OP,2023-01-29,2023-01-29,2023-02-11,PLN1990,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,J06.9,E66.9,,,,,,,0,,99283,E&M,,,0510,22,Outpatient Hospital,2,586.17,230.38,84.76,145.62,0.0,0.0,145.62,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011948,MBR00000463,Institutional-OP,2023-02-13,2023-02-13,2023-02-20,PLN7387,1542828721,1542828721,Orthopedic Surgery,In-Network,E11.40,N18.3,,,,,,,0,,99284,E&M,,,0740,22,Outpatient Hospital,3,626.98,274.63,259.63,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011949,MBR00000463,Professional,2021-02-06,2021-02-06,2021-03-19,PLN2021,1790497490,1790497490,OB/GYN,In-Network,M17.11,G20,,,,,,,0,,27447,Surgery,,,,11,Office,3,3595.73,1130.44,700.93,297.88,75.0,56.63,429.51,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011950,MBR00000463,Professional,2021-10-18,2021-10-18,2021-11-28,PLN5964,1702692193,1702692193,Physical Therapy,In-Network,J18.9,E11.9,,,,,,,0,,45378,Surgery,,,,49,Independent Clinic,1,1869.12,1172.7,908.5,249.2,15.0,0.0,264.2,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000011951,MBR00000463,Institutional-IP,2022-04-24,2022-05-03,2022-06-02,PLN7604,1660288235,1660288235,ASC,In-Network,I25.10,J44.1,,,,871,MS-DRG,4,9,N,97110,Medicine,,,0370,21,Inpatient Hospital,2,253.69,127.34,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011952,MBR00000463,Professional,2022-08-11,2022-08-11,2022-08-23,PLN3855,1700633438,1700633438,DME Supplier,In-Network,N39.0,K21.0,,,,,,,0,,90686,Medicine,,,,11,Office,1,66.14,24.27,0.0,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000011953,MBR00000463,Professional,2021-04-09,2021-04-09,2021-05-12,PLN1220,1518055405,1518055405,Urology,In-Network,E11.65,E78.5,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,2,3124.51,1376.86,1053.47,323.39,0.0,0.0,323.39,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011954,MBR00000463,Professional,2021-08-07,2021-08-07,2021-08-26,PLN2495,1991459367,1991459367,Neurology,Out-of-Network,E11.9,E78.5,,,,,,,0,,G0439,Medicine,,,,22,Outpatient Hospital,1,246.75,159.01,110.88,0.0,35.0,13.13,48.13,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000011955,MBR00000463,Professional,2022-05-22,2022-05-22,2022-06-05,PLN6770,1847081578,1847081578,Urology,Out-of-Network,F41.9,R07.9,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,2,265.39,121.32,0.0,121.32,35.0,0.0,156.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011956,MBR00000463,Institutional-OP,2022-05-05,2022-05-05,2022-06-09,PLN2997,1631954542,1631954542,Oncology,In-Network,Z00.01,E11.9,,,,,,,0,,99233,E&M,,,0636,22,Outpatient Hospital,3,574.98,292.42,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011957,MBR00000463,Institutional-OP,2022-11-05,2022-11-05,2022-12-06,PLN6119,1364429278,1364429278,OB/GYN,In-Network,Z96.641,Z12.31,,,,,,,0,,71046,Radiology,,,0510,22,Outpatient Hospital,2,267.53,89.69,0.0,89.69,75.0,0.0,164.69,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011958,MBR00000463,Institutional-OP,2021-03-18,2021-03-18,2021-04-22,PLN8573,1395983630,1395983630,Nephrology,In-Network,R10.9,F32.9,,,,,,,0,,47562,Surgery,,,0761,22,Outpatient Hospital,2,5197.78,2132.29,2117.29,0.0,15.0,0.0,15.0,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011959,MBR00000463,Professional,2023-05-23,2023-05-23,2023-07-05,PLN1221,1168246159,1168246159,Internal Medicine,In-Network,M81.0,E87.6,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,3,55.05,31.06,0.0,31.06,25.0,0.0,56.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011960,MBR00000463,Professional,2021-11-26,2021-11-26,2021-12-14,PLN1269,1660288235,1660288235,ASC,In-Network,Z79.4,E11.40,,,,,,,0,,G0444,Medicine,,,,11,Office,1,60.78,35.43,0.0,0.0,50.0,0.0,50.0,0.0,Pended,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000011961,MBR00000463,Professional,2022-08-26,2022-08-26,2022-09-18,PLN5592,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,R51,Z96.641,,,,,,,0,,78452,Radiology,,,,20,Urgent Care,2,3435.2,1484.21,1319.1,0.0,35.0,130.11,165.11,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011962,MBR00000463,Institutional-IP,2023-11-04,2023-11-05,2023-12-06,PLN8434,1242201429,1242201429,General Acute Care Hospital,In-Network,C50.912,I48.91,,,,641,MS-DRG,18,1,Y,G0439,Medicine,,,0510,21,Inpatient Hospital,1,242.21,184.81,0.0,162.12,0.0,0.0,162.12,0.0,Denied,CO-18,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000011963,MBR00000463,Institutional-IP,2022-02-20,2022-02-22,2022-03-25,PLN1077,1997536841,1997536841,Family Medicine,Out-of-Network,Z12.31,I10,,,,871,MS-DRG,3,2,Y,47562,Surgery,,,0900,21,Inpatient Hospital,1,4958.9,4123.33,4108.33,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000011964,MBR00000463,Institutional-OP,2021-12-10,2021-12-10,2022-01-17,PLN2547,1980712759,1980712759,Outpatient Clinic,Out-of-Network,J20.9,N18.3,,,,,,,0,,99204,E&M,,,0740,22,Outpatient Hospital,3,331.5,239.5,208.38,0.0,25.0,6.12,31.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011965,MBR00000463,Professional,2021-10-17,2021-10-17,2021-10-28,PLN7086,1239316214,1239316214,Internal Medicine,In-Network,Z00.00,K21.0,,,,,,,0,,47562,Surgery,,,,11,Office,2,5391.31,1623.28,1548.28,0.0,75.0,0.0,75.0,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011966,MBR00000463,Professional,2022-12-16,2022-12-16,2023-01-10,PLN7701,1939033455,1939033455,Pulmonology,In-Network,I10,F32.9,,,,,,,0,,G0439,Medicine,,,,11,Office,1,516.32,286.78,207.37,0.0,50.0,29.41,79.41,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000011967,MBR00000463,Institutional-IP,2023-11-15,2023-11-22,2023-11-23,PLN8064,1915531927,1915531927,Critical Access Hospital,In-Network,M17.11,E66.9,,,,195,MS-DRG,17,7,Y,76700,Radiology,,,0320,21,Inpatient Hospital,2,1425.42,563.28,483.38,0.0,75.0,4.9,79.9,0.0,Paid,,,1,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000011968,MBR00000463,Professional,2022-09-05,2022-09-05,2022-10-12,PLN8841,1334916761,1334916761,ASC,In-Network,R51,E11.40,,,,,,,0,,81001,Pathology/Lab,,,,21,Inpatient Hospital,2,29.66,20.39,0.0,20.39,0.0,0.0,20.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011969,MBR00000463,Professional,2021-08-06,2021-08-06,2021-08-28,PLN6570,1528335731,1528335731,Critical Access Hospital,In-Network,Z00.00,I11.9,,,,,,,0,,90460,Medicine,,,,22,Outpatient Hospital,2,74.63,26.17,0.0,26.17,0.0,0.0,26.17,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000011970,MBR00000463,Professional,2023-11-02,2023-11-02,2023-11-26,PLN1064,1727809972,1727809972,Home Health,In-Network,N40.0,Z00.00,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,1,42.16,15.99,15.99,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011971,MBR00000464,Professional,2021-02-16,2021-02-16,2021-03-07,PLN2568,1896447406,1896447406,Nephrology,Out-of-Network,E78.5,Z00.00,,,,,,,0,,76700,Radiology,,,,11,Office,3,1243.71,424.33,0.0,424.33,0.0,0.0,424.33,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011972,MBR00000464,Professional,2022-03-26,2022-03-26,2022-04-11,PLN3302,1872272835,1872272835,Internal Medicine,In-Network,E66.9,Z00.00,,,,,,,0,,83036,Pathology/Lab,,,,21,Inpatient Hospital,2,42.87,25.28,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000011973,MBR00000464,Professional,2021-05-18,2021-05-18,2021-06-05,PLN8814,1518055405,1518055405,Urology,In-Network,J44.1,Z23,,,,,,,0,,58661,Surgery,,,,11,Office,2,3975.11,1459.4,1227.92,231.16,0.0,0.32,231.48,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011974,MBR00000464,Institutional-OP,2021-02-06,2021-02-06,2021-02-23,PLN9299,1946680931,1946680931,Critical Access Hospital,Out-of-Network,I25.10,J18.9,,,,,,,0,,78452,Radiology,,,0120,22,Outpatient Hospital,2,4163.38,2818.0,2657.03,160.97,0.0,0.0,160.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011975,MBR00000464,Institutional-OP,2023-12-29,2023-12-29,2024-02-06,PLN1036,1891849440,1891849440,Oncology,In-Network,E78.5,J20.9,,,,,,,0,,97530,Medicine,,,0510,22,Outpatient Hospital,1,141.79,50.16,50.16,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011976,MBR00000464,Professional,2021-04-04,2021-04-04,2021-04-18,PLN5559,1453283987,1453283987,Critical Access Hospital,In-Network,J06.9,F41.9,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,1,4901.55,2508.82,2493.82,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011977,MBR00000464,Professional,2023-09-20,2023-09-20,2023-10-03,PLN8513,1103747954,1103747954,Urology,In-Network,F32.9,I50.9,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,3,153.84,119.54,0.0,119.54,0.0,0.0,119.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011978,MBR00000464,Institutional-OP,2022-08-20,2022-08-20,2022-09-01,PLN2791,1372918899,1372918899,Family Medicine,In-Network,M17.11,E11.9,,,,,,,0,,85610,Pathology/Lab,,,0370,22,Outpatient Hospital,1,61.61,29.31,0.0,29.31,0.0,0.0,29.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011979,MBR00000464,Institutional-OP,2021-12-17,2021-12-17,2021-12-25,PLN7701,1935547131,1935547131,Pulmonology,In-Network,M54.5,J45.20,,,,,,,0,,27447,Surgery,,,0370,22,Outpatient Hospital,2,3054.57,1815.82,1464.72,0.0,25.0,326.1,351.1,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011980,MBR00000464,Institutional-OP,2023-08-03,2023-08-03,2023-09-16,PLN2988,1563980627,1563980627,Critical Access Hospital,In-Network,F41.9,E11.9,,,,,,,0,,72148,Radiology,,,0510,22,Outpatient Hospital,2,2224.53,1348.07,1121.79,191.28,35.0,0.0,226.28,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011981,MBR00000464,Professional,2021-01-05,2021-01-05,2021-01-18,PLN3538,1964402759,1964402759,Outpatient Clinic,In-Network,I25.10,M54.5,,,,,,,0,,47562,Surgery,,,,49,Independent Clinic,3,4591.26,2875.44,2848.21,0.0,0.0,27.23,27.23,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011982,MBR00000464,Institutional-OP,2023-01-26,2023-01-26,2023-03-10,PLN1903,1236418230,1236418230,DME Supplier,In-Network,Z00.00,S72.001A,,,,,,,0,,47562,Surgery,,,0360,22,Outpatient Hospital,3,4546.26,2068.96,1654.72,370.71,25.0,18.53,414.24,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011983,MBR00000464,Institutional-OP,2023-04-21,2023-04-21,2023-06-02,PLN6920,1727809972,1727809972,Home Health,In-Network,E11.9,Z79.4,,,,,,,0,,71046,Radiology,,,0360,22,Outpatient Hospital,2,253.82,100.83,0.0,100.83,35.0,0.0,135.83,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011984,MBR00000464,Professional,2022-02-03,2022-02-03,2022-03-05,PLN7421,1219817751,1219817751,OB/GYN,In-Network,I10,I10,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,1,826.64,630.89,630.89,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011985,MBR00000464,Professional,2021-11-26,2021-11-26,2021-12-18,PLN2762,1645194539,1645194539,SNF,In-Network,I63.9,Z12.31,,,,,,,0,,70553,Radiology,,,,81,Independent Laboratory,2,3758.33,3102.11,2641.15,460.96,0.0,0.0,460.96,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000011986,MBR00000465,Institutional-OP,2021-01-11,2021-01-11,2021-01-28,PLN4677,1520687146,1520687146,ASC,In-Network,R05,K21.0,,,,,,,0,,99213,E&M,,,0740,22,Outpatient Hospital,1,179.37,144.36,0.0,144.36,0.0,0.0,144.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011987,MBR00000465,Institutional-OP,2021-01-25,2021-01-25,2021-02-15,PLN2953,1542828721,1542828721,Orthopedic Surgery,In-Network,I10,G43.909,,,,,,,0,,45380,Surgery,,,0370,22,Outpatient Hospital,3,1256.3,419.03,394.03,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000011988,MBR00000465,Professional,2021-02-18,2021-02-18,2021-02-28,PLN9812,1845057593,1845057593,Orthopedic Surgery,In-Network,G43.909,K57.30,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,2,201.53,83.77,48.77,0.0,35.0,0.0,35.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011989,MBR00000465,Institutional-IP,2022-05-15,2022-05-29,2022-06-27,PLN5505,1609138981,1609138981,Critical Access Hospital,In-Network,E78.5,Z00.00,,,,690,MS-DRG,7,14,Y,77067,Radiology,,,0360,21,Inpatient Hospital,2,515.6,344.19,45.48,223.71,75.0,0.0,298.71,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000011990,MBR00000465,Professional,2022-08-05,2022-08-05,2022-09-07,PLN3602,1561134315,1561134315,DME Supplier,In-Network,N39.0,F03.90,,,,,,,0,,33533,Surgery,,,,11,Office,2,22035.6,8660.63,8337.47,323.16,0.0,0.0,323.16,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000011991,MBR00000465,Institutional-OP,2022-04-10,2022-04-10,2022-05-16,PLN2155,1644128543,1644128543,Gastroenterology,In-Network,E78.5,J06.9,,,,,,,0,,27447,Surgery,,,0270,22,Outpatient Hospital,1,2448.43,1882.7,1807.7,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011992,MBR00000465,Professional,2023-02-09,2023-02-09,2023-03-08,PLN9284,1689639685,1689639685,SNF,In-Network,F41.9,M54.5,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,1,266.94,203.98,188.98,0.0,15.0,0.0,15.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011993,MBR00000465,Professional,2022-02-01,2022-02-01,2022-03-08,PLN4488,1687650653,1687650653,Internal Medicine,In-Network,G43.909,K21.0,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,1,3222.16,1298.38,1185.04,38.34,75.0,0.0,113.34,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000011994,MBR00000465,Professional,2023-05-16,2023-05-16,2023-06-25,PLN2175,1486164553,1486164553,DME Supplier,In-Network,Z23,G20,,,,,,,0,,99406,Medicine,,,,21,Inpatient Hospital,1,75.41,53.46,0.0,53.46,50.0,0.0,103.46,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011995,MBR00000465,Professional,2022-12-17,2022-12-17,2023-01-21,PLN6736,1244186984,1244186984,Family Medicine,Out-of-Network,Z00.00,E78.5,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,1,95.26,46.61,0.0,46.61,0.0,0.0,46.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011996,MBR00000465,Institutional-OP,2023-10-24,2023-10-24,2023-11-30,PLN4521,1702692193,1702692193,Physical Therapy,In-Network,F32.9,Z00.00,,,,,,,0,,99221,E&M,,,0200,22,Outpatient Hospital,2,251.28,176.2,0.0,176.2,0.0,0.0,176.2,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011997,MBR00000465,Institutional-OP,2023-03-06,2023-03-06,2023-04-02,PLN6126,1266606767,1266606767,ASC,In-Network,Z12.31,K21.0,,,,,,,0,,99204,E&M,,,0120,22,Outpatient Hospital,2,355.24,227.12,227.12,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000011998,MBR00000465,Professional,2021-05-21,2021-05-21,2021-06-11,PLN3006,1186826716,1186826716,Physical Therapy,In-Network,Z12.11,N39.0,,,,,,,0,,99221,E&M,,,,23,Emergency Room,2,353.92,146.35,146.35,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000011999,MBR00000465,Professional,2022-09-05,2022-09-05,2022-09-13,PLN8724,1366576336,1366576336,Geriatrics,In-Network,J06.9,I11.9,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,3,7007.39,4782.0,4782.0,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012000,MBR00000465,Professional,2022-12-21,2022-12-21,2023-01-10,PLN4049,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,Z00.00,N39.0,,,,,,,0,,80061,Pathology/Lab,,,,21,Inpatient Hospital,2,55.92,27.22,10.95,0.0,15.0,1.27,16.27,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012001,MBR00000465,Professional,2021-01-16,2021-01-16,2021-02-18,PLN5946,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,F41.9,J44.1,,,,,,,0,,78452,Radiology,,,,22,Outpatient Hospital,2,3541.53,2007.36,1621.14,322.97,35.0,28.25,386.22,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012002,MBR00000465,Professional,2021-02-18,2021-02-18,2021-03-12,PLN2773,1606140917,1606140917,ASC,In-Network,J06.9,I63.9,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,2,303.15,135.91,135.91,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012003,MBR00000465,Professional,2021-01-25,2021-01-25,2021-02-08,PLN6844,1295371663,1295371663,Critical Access Hospital,In-Network,M17.11,E11.9,,,,,,,0,,47562,Surgery,,,,49,Independent Clinic,1,5763.23,1788.36,1526.96,211.4,50.0,0.0,261.4,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012004,MBR00000465,Professional,2021-07-07,2021-07-07,2021-07-24,PLN2477,1563980627,1563980627,Critical Access Hospital,In-Network,Z87.891,Z00.00,,,,,,,0,,99284,E&M,,,,11,Office,3,901.07,472.09,472.09,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012005,MBR00000465,Institutional-OP,2023-08-24,2023-08-24,2023-09-11,PLN1088,1531398223,1531398223,OB/GYN,In-Network,G43.909,J18.9,,,,,,,0,,45378,Surgery,,,0370,22,Outpatient Hospital,1,1100.72,345.39,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-27,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000012006,MBR00000465,Institutional-OP,2021-09-20,2021-09-20,2021-10-11,PLN6166,1840431511,1840431511,Geriatrics,Out-of-Network,M54.5,M17.11,,,,,,,0,,43239,Surgery,,,0200,22,Outpatient Hospital,2,1958.48,798.57,224.49,499.08,75.0,0.0,574.08,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012007,MBR00000465,Professional,2021-07-24,2021-07-24,2021-08-19,PLN7762,1511044648,1511044648,Endocrinology,In-Network,Z51.11,E87.6,,,,,,,0,,99214,E&M,,,,22,Outpatient Hospital,3,247.17,197.27,179.97,0.0,0.0,17.3,17.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012008,MBR00000465,Institutional-OP,2022-05-04,2022-05-04,2022-06-17,PLN8665,1840431511,1840431511,Geriatrics,Out-of-Network,Z00.00,E11.9,,,,,,,0,,99284,E&M,,,0510,22,Outpatient Hospital,1,856.48,670.89,292.91,327.98,50.0,0.0,377.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012009,MBR00000465,Professional,2022-03-12,2022-03-12,2022-04-03,PLN3064,1563980627,1563980627,Critical Access Hospital,In-Network,F41.9,E78.5,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,3,672.89,389.82,362.09,0.0,0.0,27.73,27.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012010,MBR00000465,Institutional-IP,2023-12-24,2023-12-26,2024-02-04,PLN1114,1585582070,1585582070,Outpatient Clinic,In-Network,B97.89,Z00.00,,,,641,MS-DRG,19,2,Y,99203,E&M,,,0200,21,Inpatient Hospital,2,362.1,219.13,219.13,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012011,MBR00000465,Professional,2021-04-24,2021-04-24,2021-05-10,PLN8453,1273488618,1273488618,General Acute Care Hospital,In-Network,E78.5,Z87.891,,,,,,,0,,99213,E&M,,,,22,Outpatient Hospital,1,283.0,170.32,150.4,0.0,0.0,19.92,19.92,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012012,MBR00000465,Professional,2023-07-10,2023-07-10,2023-08-03,PLN6240,1872272835,1872272835,Internal Medicine,In-Network,E11.40,I10,,,,,,,0,,G0444,Medicine,,,,11,Office,1,55.25,41.09,0.0,41.09,35.0,0.0,76.09,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000012013,MBR00000465,Professional,2021-09-09,2021-09-09,2021-10-09,PLN5949,1700633438,1700633438,DME Supplier,In-Network,Z87.891,N39.0,,,,,,,0,,93306,Radiology,,,,11,Office,3,2446.29,1475.68,1450.68,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000012014,MBR00000466,Institutional-OP,2021-12-06,2021-12-06,2022-01-17,PLN5507,1186826716,1186826716,Physical Therapy,In-Network,E78.5,F32.9,,,,,,,0,,74177,Radiology,,,0370,22,Outpatient Hospital,1,2209.23,1348.74,1120.73,153.01,75.0,0.0,228.01,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012015,MBR00000466,Institutional-OP,2022-06-16,2022-06-16,2022-07-23,PLN6529,1450553056,1450553056,Clinical Laboratory,In-Network,M17.11,E78.5,,,,,,,0,,27447,Surgery,,,0761,22,Outpatient Hospital,3,3860.5,2326.82,2032.52,96.3,0.0,198.0,294.3,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012016,MBR00000466,Institutional-IP,2023-12-05,2023-12-07,2024-01-09,PLN2305,1689639685,1689639685,SNF,In-Network,B97.89,Z00.00,,,,682,MS-DRG,7,2,Y,99283,E&M,,,0301,21,Inpatient Hospital,2,239.33,135.82,110.82,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012017,MBR00000466,Institutional-OP,2021-09-15,2021-09-15,2021-09-24,PLN8366,1590915516,1590915516,Physical Therapy,Out-of-Network,K92.1,N18.3,,,,,,,0,,27130,Surgery,,,0740,22,Outpatient Hospital,2,5399.78,3272.53,3272.53,0.0,0.0,0.0,0.0,0.0,Pended,,,1,,0,0,1,0,0,1,Duplicate,0,0,0,0,0
CLM0000012018,MBR00000466,Institutional-OP,2022-01-12,2022-01-12,2022-02-18,PLN2789,1795618275,1795618275,Pulmonology,In-Network,I10,F32.9,,,,,,,0,,58661,Surgery,,,0360,22,Outpatient Hospital,1,2852.55,2312.11,2312.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000012019,MBR00000466,Institutional-OP,2022-12-23,2022-12-23,2023-01-23,PLN7827,1475984649,1475984649,SNF,In-Network,E66.9,E11.9,,,,,,,0,,99284,E&M,,,0301,22,Outpatient Hospital,1,451.83,211.17,192.2,3.97,15.0,0.0,18.97,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012020,MBR00000466,Professional,2023-01-04,2023-01-04,2023-01-18,PLN7719,1997536841,1997536841,Family Medicine,Out-of-Network,E11.9,K21.0,,,,,,,0,,80053,Pathology/Lab,,,,20,Urgent Care,2,59.28,48.39,0.0,48.39,75.0,0.0,123.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012021,MBR00000466,Professional,2022-02-07,2022-02-07,2022-02-17,PLN7359,1313212303,1313212303,Family Medicine,In-Network,Z12.31,I11.9,,,,,,,0,,99233,E&M,,,,12,Home,2,237.47,143.64,143.64,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012022,MBR00000466,Institutional-OP,2021-05-24,2021-05-24,2021-07-01,PLN5016,1514306773,1514306773,Endocrinology,In-Network,E78.5,R10.9,,,,,,,0,,85025,Pathology/Lab,,,0360,22,Outpatient Hospital,1,44.97,22.52,0.0,22.52,0.0,0.0,22.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012023,MBR00000466,Institutional-OP,2023-05-14,2023-05-14,2023-05-31,PLN2790,1948810580,1948810580,DME Supplier,In-Network,I25.10,K57.30,,,,,,,0,,99203,E&M,,,0200,22,Outpatient Hospital,1,147.93,54.2,50.78,0.0,0.0,3.42,3.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012024,MBR00000466,Institutional-IP,2023-09-13,2023-09-16,2023-10-27,PLN2364,1486164553,1486164553,DME Supplier,In-Network,Z23,N40.0,,,,603,MS-DRG,10,3,Y,43239,Surgery,,,0636,21,Inpatient Hospital,2,1027.0,859.63,707.6,0.0,15.0,137.03,152.03,0.0,Paid,,,1,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000012025,MBR00000466,Institutional-OP,2022-10-22,2022-10-22,2022-11-06,PLN2928,1631954542,1631954542,Oncology,In-Network,K92.1,M81.0,,,,,,,0,,93306,Radiology,,,0510,22,Outpatient Hospital,1,1806.29,985.78,960.78,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012026,MBR00000466,Institutional-IP,2023-08-14,2023-08-24,2023-09-20,PLN2402,1518055405,1518055405,Urology,In-Network,J06.9,Z87.891,,,,292,MS-DRG,13,10,Y,93306,Radiology,,,0730,21,Inpatient Hospital,1,1499.77,1097.5,1062.5,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012027,MBR00000466,Professional,2021-10-06,2021-10-06,2021-10-21,PLN2298,1569105090,1569105090,Geriatrics,In-Network,I10,E78.5,,,,,,,0,,99406,Medicine,,,,49,Independent Clinic,2,48.73,31.81,26.72,0.0,0.0,5.09,5.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012028,MBR00000466,Institutional-OP,2023-08-05,2023-08-05,2023-08-16,PLN1794,1132188260,1132188260,Family Medicine,In-Network,F32.9,I10,,,,,,,0,,47562,Surgery,,,0370,22,Outpatient Hospital,2,3803.87,1389.33,1354.33,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012029,MBR00000466,Institutional-OP,2023-06-05,2023-06-05,2023-06-19,PLN9916,1422747896,1422747896,Urology,In-Network,J44.1,N40.0,,,,,,,0,,47562,Surgery,,,0320,22,Outpatient Hospital,2,3640.17,1392.85,1206.12,151.73,35.0,0.0,186.73,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012030,MBR00000466,Professional,2023-09-16,2023-09-16,2023-10-05,PLN5787,1745114564,1745114564,Endocrinology,In-Network,Z23,N18.3,,,,,,,0,,80053,Pathology/Lab,,,,49,Independent Clinic,2,131.72,93.23,0.0,93.23,0.0,0.0,93.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012031,MBR00000466,Institutional-OP,2023-10-18,2023-10-18,2023-10-27,PLN8015,1752470395,1752470395,Home Health,In-Network,Z96.641,F10.20,,,,,,,0,,99284,E&M,,,0120,22,Outpatient Hospital,3,424.85,254.1,0.0,254.1,15.0,0.0,269.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012032,MBR00000466,Professional,2022-01-14,2022-01-14,2022-02-12,PLN6126,1795618275,1795618275,Pulmonology,In-Network,Z12.31,Z00.01,,,,,,,0,,27130,Surgery,,,,11,Office,1,4639.47,2194.29,2111.26,0.0,25.0,58.03,83.03,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012033,MBR00000466,Institutional-IP,2021-05-12,2021-05-14,2021-06-08,PLN6893,1295371663,1295371663,Critical Access Hospital,In-Network,I25.10,M54.5,,,,641,MS-DRG,23,2,Y,97530,Medicine,,,0510,21,Inpatient Hospital,1,159.12,66.94,60.83,0.0,0.0,6.11,6.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012034,MBR00000466,Professional,2023-04-01,2023-04-01,2023-04-26,PLN6388,1273488618,1273488618,General Acute Care Hospital,In-Network,E66.9,R05,,,,,,,0,,99222,E&M,,,,11,Office,3,530.52,423.02,29.84,358.18,35.0,0.0,393.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012035,MBR00000466,Professional,2023-01-04,2023-01-04,2023-01-13,PLN2315,1700633438,1700633438,DME Supplier,In-Network,F10.20,Z12.31,,,,,,,0,,45380,Surgery,,,,11,Office,1,1474.91,598.69,563.69,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000012036,MBR00000466,Institutional-IP,2022-12-11,2022-12-19,2023-01-12,PLN7214,1609138981,1609138981,Critical Access Hospital,In-Network,K21.0,E11.9,,,,871,MS-DRG,13,8,Y,99221,E&M,,,0301,21,Inpatient Hospital,1,305.52,247.32,217.66,0.0,0.0,29.66,29.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012037,MBR00000466,Professional,2022-11-22,2022-11-22,2023-01-01,PLN8166,1109850785,1109850785,ASC,Out-of-Network,Z00.00,F41.9,,,,,,,0,,G0444,Medicine,,,,23,Emergency Room,2,104.15,71.08,21.08,0.0,50.0,0.0,50.0,0.0,Adjusted,,,0,,1,1,0,0,0,0,None,0,0,0,0,1
CLM0000012038,MBR00000466,Professional,2021-02-14,2021-02-14,2021-03-15,PLN4823,1266606767,1266606767,ASC,In-Network,Z12.31,R10.9,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,1,114.19,52.68,0.0,52.68,0.0,0.0,52.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012039,MBR00000466,Professional,2023-01-04,2023-01-04,2023-01-16,PLN6993,1569105090,1569105090,Geriatrics,In-Network,F41.9,I11.9,,,,,,,0,,85610,Pathology/Lab,,,,49,Independent Clinic,1,32.88,20.52,0.0,20.52,25.0,0.0,45.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012040,MBR00000466,Institutional-IP,2022-06-15,2022-06-18,2022-07-21,PLN7311,1364429278,1364429278,OB/GYN,In-Network,B97.89,F32.9,,,,871,MS-DRG,15,3,Y,99232,E&M,,,0900,21,Inpatient Hospital,2,242.35,163.07,101.33,0.0,50.0,11.74,61.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012041,MBR00000466,Professional,2021-02-04,2021-02-04,2021-03-15,PLN6485,1463205530,1463205530,Nephrology,In-Network,Z12.31,I25.10,,,,,,,0,,45380,Surgery,,,,11,Office,3,2351.44,1162.21,836.38,250.83,75.0,0.0,325.83,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000012042,MBR00000466,Professional,2023-07-26,2023-07-26,2023-08-04,PLN8649,1518055405,1518055405,Urology,In-Network,S72.001A,E78.5,,,,,,,0,,99232,E&M,,,,11,Office,2,354.18,237.15,237.15,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012043,MBR00000466,Professional,2021-01-31,2021-01-31,2021-03-15,PLN2081,1727809972,1727809972,Home Health,In-Network,E66.9,K57.30,,,,,,,0,,90837,Medicine,,,,23,Emergency Room,3,290.24,159.99,109.99,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000012044,MBR00000466,Professional,2021-09-13,2021-09-13,2021-10-05,PLN2503,1974006077,1974006077,Orthopedic Surgery,In-Network,Z00.01,S72.001A,,,,,,,0,,97110,Medicine,,,,50,Federally Qualified Health Center,3,279.85,117.16,104.37,0.0,0.0,12.79,12.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012045,MBR00000467,Institutional-OP,2021-11-19,2021-11-19,2021-12-18,PLN3219,1845900543,1845900543,ASC,In-Network,I10,E11.9,,,,,,,0,,80053,Pathology/Lab,,,0450,22,Outpatient Hospital,3,65.37,51.55,0.0,51.55,75.0,0.0,126.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012046,MBR00000467,Institutional-OP,2023-05-08,2023-05-08,2023-06-04,PLN1626,1946680931,1946680931,Critical Access Hospital,Out-of-Network,I10,Z12.31,,,,,,,0,,74177,Radiology,,,0360,22,Outpatient Hospital,3,1354.58,553.8,528.8,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012047,MBR00000467,Institutional-IP,2021-03-29,2021-04-02,2021-05-02,PLN5988,1224179551,1224179551,Physical Therapy,In-Network,M54.5,Z12.31,,,,195,MS-DRG,8,4,N,99284,E&M,,,0510,21,Inpatient Hospital,1,611.2,433.31,0.0,422.47,25.0,0.0,447.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012048,MBR00000467,Professional,2022-02-25,2022-02-25,2022-04-10,PLN7986,1660288235,1660288235,ASC,In-Network,F32.9,R05,,,,,,,0,,99233,E&M,,,,11,Office,1,571.43,307.56,0.0,307.56,15.0,0.0,322.56,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012049,MBR00000467,Institutional-IP,2022-02-05,2022-02-08,2022-02-12,PLN4375,1372918899,1372918899,Family Medicine,In-Network,Z51.11,E11.65,,,,682,MS-DRG,13,3,Y,84443,Pathology/Lab,,,0510,21,Inpatient Hospital,2,166.22,82.16,47.16,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012050,MBR00000467,Professional,2022-03-31,2022-03-31,2022-04-11,PLN1737,1514306773,1514306773,Endocrinology,In-Network,R07.9,I10,,,,,,,0,,99204,E&M,,,,11,Office,2,509.58,182.55,147.63,34.92,0.0,0.0,34.92,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012051,MBR00000467,Institutional-OP,2023-08-14,2023-08-14,2023-09-22,PLN3470,1716521444,1716521444,Oncology,In-Network,J06.9,Z87.891,,,,,,,0,,99203,E&M,,,0200,22,Outpatient Hospital,2,221.39,139.27,100.14,0.0,35.0,4.13,39.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012052,MBR00000467,Professional,2021-12-23,2021-12-23,2022-01-17,PLN3132,1198133277,1198133277,SNF,In-Network,E66.9,E78.5,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,3,477.05,302.39,91.61,175.78,35.0,0.0,210.78,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012053,MBR00000467,Institutional-OP,2022-01-24,2022-01-24,2022-02-20,PLN4166,1139906830,1139906830,Endocrinology,Out-of-Network,E66.9,I25.10,,,,,,,0,,23472,Surgery,,,0510,22,Outpatient Hospital,3,3076.72,2305.51,1868.01,387.5,50.0,0.0,437.5,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012054,MBR00000467,Institutional-OP,2022-03-24,2022-03-24,2022-04-02,PLN1707,1800011727,1800011727,Clinical Laboratory,Out-of-Network,E78.5,I25.10,,,,,,,0,,66984,Surgery,,,0120,22,Outpatient Hospital,2,3080.61,2584.69,0.0,415.76,50.0,165.19,630.95,0.0,Denied,CO-97,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012055,MBR00000467,Institutional-OP,2022-03-07,2022-03-07,2022-03-19,PLN2323,1817234602,1817234602,Clinical Laboratory,In-Network,E78.5,M17.11,,,,,,,0,,99233,E&M,,,0900,22,Outpatient Hospital,2,468.85,142.15,117.15,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012056,MBR00000467,Institutional-OP,2023-11-11,2023-11-11,2023-11-29,PLN7599,1997536841,1997536841,Family Medicine,Out-of-Network,N17.9,Z23,,,,,,,0,,99222,E&M,,,0730,22,Outpatient Hospital,3,442.83,287.55,0.0,287.55,0.0,0.0,287.55,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012057,MBR00000467,Professional,2021-10-20,2021-10-20,2021-11-30,PLN5467,1475984649,1475984649,SNF,In-Network,E87.6,R51,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,2,139.93,56.4,0.0,56.4,35.0,0.0,91.4,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012058,MBR00000467,Professional,2021-05-05,2021-05-05,2021-05-15,PLN4710,1438368327,1438368327,Home Health,In-Network,Z12.11,E87.6,,,,,,,0,,G0444,Medicine,,,,11,Office,1,67.52,48.13,0.0,48.13,35.0,0.0,83.13,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000012059,MBR00000467,Professional,2022-04-07,2022-04-07,2022-05-18,PLN5444,1244186984,1244186984,Family Medicine,Out-of-Network,N18.3,Z00.00,,,,,,,0,,99203,E&M,,,,11,Office,3,345.05,238.05,238.05,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000012060,MBR00000467,Professional,2021-04-02,2021-04-02,2021-04-14,PLN8742,1561134315,1561134315,DME Supplier,In-Network,F41.9,G43.909,,,,,,,0,,93306,Radiology,,,,11,Office,3,3295.89,1085.24,1039.85,0.0,0.0,45.39,45.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012061,MBR00000467,Institutional-OP,2023-05-24,2023-05-24,2023-06-16,PLN9595,1518055405,1518055405,Urology,In-Network,E66.9,N39.0,,,,,,,0,,58661,Surgery,,,0900,22,Outpatient Hospital,1,4377.5,1409.15,1211.59,197.56,0.0,0.0,197.56,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012062,MBR00000467,Institutional-OP,2023-09-04,2023-09-04,2023-09-22,PLN2494,1284035364,1284035364,Pediatrics,In-Network,Z12.31,F32.9,,,,,,,0,,45378,Surgery,,,0450,22,Outpatient Hospital,3,1952.38,1626.47,1152.87,458.6,15.0,0.0,473.6,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000012063,MBR00000467,Institutional-OP,2023-06-29,2023-06-29,2023-07-12,PLN6543,1542828721,1542828721,Orthopedic Surgery,In-Network,I63.9,I10,,,,,,,0,,82043,Pathology/Lab,,,0120,22,Outpatient Hospital,2,46.41,14.19,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012064,MBR00000467,Institutional-OP,2023-06-01,2023-06-01,2023-06-20,PLN4808,1812060197,1812060197,Oncology,Out-of-Network,E11.9,N39.0,,,,,,,0,,87491,Pathology/Lab,,,0761,22,Outpatient Hospital,2,217.52,99.55,0.0,96.37,35.0,0.0,131.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012065,MBR00000467,Professional,2022-04-07,2022-04-07,2022-04-16,PLN9068,1564502315,1564502315,ASC,In-Network,F41.9,I50.9,,,,,,,0,,99283,E&M,,,,21,Inpatient Hospital,2,249.73,182.54,182.54,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012066,MBR00000467,Institutional-OP,2023-02-04,2023-02-04,2023-02-14,PLN1666,1366426662,1366426662,Urology,In-Network,G43.909,Z00.00,,,,,,,0,,90686,Medicine,,,0370,22,Outpatient Hospital,2,123.21,72.38,72.38,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000012067,MBR00000467,Institutional-OP,2022-03-11,2022-03-11,2022-04-06,PLN6766,1540044947,1540044947,Pulmonology,Out-of-Network,Z00.00,E78.5,,,,,,,0,,99232,E&M,,,0900,22,Outpatient Hospital,2,226.58,97.89,72.89,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012068,MBR00000467,Institutional-OP,2023-07-25,2023-07-25,2023-08-21,PLN7555,1124394415,1124394415,Pediatrics,In-Network,M54.5,N18.3,,,,,,,0,,27130,Surgery,,,0761,22,Outpatient Hospital,1,5655.71,4758.6,4733.6,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012069,MBR00000467,Professional,2021-08-02,2021-08-02,2021-09-03,PLN8230,1545347862,1545347862,SNF,In-Network,Z23,I10,,,,,,,0,,99221,E&M,,,,65,End-Stage Renal Disease,1,389.69,264.96,189.96,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012070,MBR00000467,Professional,2021-06-04,2021-06-04,2021-06-23,PLN2075,1575695214,1575695214,SNF,In-Network,Z12.31,N20.0,,,,,,,0,,78452,Radiology,,,,31,Skilled Nursing Facility,2,2533.7,1367.6,1367.6,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012071,MBR00000468,Professional,2023-12-05,2023-12-05,2024-01-12,PLN6763,1109850785,1109850785,ASC,Out-of-Network,I10,G43.909,,,,,,,0,,43239,Surgery,,,,50,Federally Qualified Health Center,1,2171.12,1689.9,1664.9,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012072,MBR00000468,Professional,2022-01-30,2022-01-30,2022-03-09,PLN9164,1847081578,1847081578,Urology,Out-of-Network,I10,M17.11,,,,,,,0,,99203,E&M,,,,11,Office,1,230.01,174.3,24.96,93.87,50.0,5.47,149.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012073,MBR00000468,Professional,2021-12-07,2021-12-07,2021-12-15,PLN2871,1795618275,1795618275,Pulmonology,In-Network,J18.9,E78.5,,,,,,,0,,23472,Surgery,,,,49,Independent Clinic,2,4571.22,2602.13,2527.13,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012074,MBR00000468,Professional,2023-01-02,2023-01-02,2023-01-12,PLN7134,1114982472,1114982472,Orthopedic Surgery,In-Network,E78.5,Z12.31,,,,,,,0,,99232,E&M,,,,23,Emergency Room,1,164.78,116.41,81.41,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000012075,MBR00000468,Professional,2022-01-11,2022-01-11,2022-01-18,PLN8230,1845900543,1845900543,ASC,In-Network,Z00.00,R05,,,,,,,0,,74177,Radiology,,,,50,Federally Qualified Health Center,1,2204.88,987.5,473.53,426.79,50.0,37.18,513.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012076,MBR00000468,Institutional-IP,2023-03-30,2023-04-09,2023-04-06,PLN9473,1757138478,1757138478,Pediatrics,In-Network,E11.9,Z12.31,,,,872,MS-DRG,4,10,Y,71046,Radiology,,,0370,21,Inpatient Hospital,2,206.02,75.68,75.68,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012077,MBR00000468,Professional,2022-04-16,2022-04-16,2022-05-09,PLN8881,1800011727,1800011727,Clinical Laboratory,Out-of-Network,E11.65,I48.91,,,,,,,0,,45378,Surgery,,,,12,Home,2,2529.63,1074.46,1059.46,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000012078,MBR00000468,Institutional-OP,2023-05-09,2023-05-09,2023-05-29,PLN7900,1500037969,1500037969,Pulmonology,In-Network,E11.9,I10,,,,,,,0,,85025,Pathology/Lab,,,0740,22,Outpatient Hospital,3,53.98,41.19,0.0,41.19,0.0,0.0,41.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012079,MBR00000468,Professional,2021-03-30,2021-03-30,2021-04-25,PLN6376,1313212303,1313212303,Family Medicine,In-Network,E78.5,E11.65,,,,,,,0,,99232,E&M,,,,21,Inpatient Hospital,3,138.16,56.9,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012080,MBR00000468,Professional,2023-03-08,2023-03-08,2023-04-12,PLN4015,1219817751,1219817751,OB/GYN,In-Network,K21.0,F41.9,,,,,,,0,,93000,Radiology,,,,21,Inpatient Hospital,3,127.35,40.53,5.53,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012081,MBR00000468,Professional,2021-12-26,2021-12-26,2022-01-22,PLN4762,1700633438,1700633438,DME Supplier,In-Network,Z12.11,E78.5,,,,,,,0,,77067,Radiology,,,,21,Inpatient Hospital,3,759.87,454.84,370.91,0.0,75.0,8.93,83.93,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000012082,MBR00000468,Institutional-IP,2022-04-09,2022-04-14,2022-05-01,PLN4507,1463205530,1463205530,Nephrology,In-Network,Z12.31,J45.20,,,,603,MS-DRG,12,5,Y,58661,Surgery,,,0320,21,Inpatient Hospital,2,2330.13,957.7,674.99,250.81,0.0,31.9,282.71,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012083,MBR00000468,Professional,2023-10-16,2023-10-16,2023-11-28,PLN9329,1752470395,1752470395,Home Health,In-Network,E11.9,J45.20,,,,,,,0,,80061,Pathology/Lab,,,,50,Federally Qualified Health Center,1,74.47,39.9,0.0,39.9,15.0,0.0,54.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012084,MBR00000468,Institutional-OP,2022-06-13,2022-06-13,2022-06-28,PLN5899,1542828721,1542828721,Orthopedic Surgery,In-Network,E11.9,Z00.00,,,,,,,0,,99222,E&M,,,0200,22,Outpatient Hospital,2,632.45,516.81,353.72,0.0,75.0,88.09,163.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012085,MBR00000468,Professional,2021-03-23,2021-03-23,2021-03-30,PLN1399,1644128543,1644128543,Gastroenterology,In-Network,N17.9,Z96.641,,,,,,,0,,85025,Pathology/Lab,,,,11,Office,2,44.93,31.95,0.0,31.95,35.0,0.0,66.95,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012086,MBR00000468,Professional,2022-05-17,2022-05-17,2022-06-18,PLN7281,1564502315,1564502315,ASC,In-Network,N39.0,Z00.00,,,,,,,0,,27130,Surgery,,,,21,Inpatient Hospital,3,7117.59,2585.46,2377.57,172.89,35.0,0.0,207.89,0.0,Paid,,,0,,0,0,1,0,0,1,Phantom,0,0,0,0,0
CLM0000012087,MBR00000468,Professional,2021-09-21,2021-09-21,2021-10-05,PLN3623,1691062876,1691062876,SNF,In-Network,J18.9,I25.10,,,,,,,0,,99283,E&M,,,,11,Office,3,477.87,376.86,138.92,187.94,50.0,0.0,237.94,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012088,MBR00000468,Professional,2022-06-04,2022-06-04,2022-06-17,PLN8988,1713934949,1713934949,Neurology,In-Network,E78.5,E66.9,,,,,,,0,,99232,E&M,,,,23,Emergency Room,1,328.87,103.47,92.17,0.0,0.0,11.3,11.3,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000012089,MBR00000468,Institutional-OP,2021-08-27,2021-08-27,2021-09-13,PLN4865,1313212303,1313212303,Family Medicine,In-Network,F41.9,J06.9,,,,,,,0,,99233,E&M,,,0510,22,Outpatient Hospital,2,554.83,278.27,253.27,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012090,MBR00000468,Institutional-IP,2022-12-06,2022-12-09,2022-12-20,PLN1925,1337791138,1337791138,Internal Medicine,Out-of-Network,I11.9,Z87.891,,,,603,MS-DRG,5,3,Y,72148,Radiology,,,0360,21,Inpatient Hospital,1,2693.93,1652.03,1349.09,0.0,0.0,302.94,302.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012091,MBR00000468,Professional,2021-09-15,2021-09-15,2021-10-24,PLN1906,1795618275,1795618275,Pulmonology,In-Network,I10,N18.3,,,,,,,0,,70553,Radiology,,,,21,Inpatient Hospital,1,2000.1,1315.55,0.0,185.74,0.0,0.0,185.74,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012092,MBR00000468,Institutional-OP,2022-05-25,2022-05-25,2022-06-03,PLN2425,1528335731,1528335731,Critical Access Hospital,In-Network,E78.5,E78.5,,,,,,,0,,99222,E&M,,,0370,22,Outpatient Hospital,2,280.5,227.19,227.19,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012093,MBR00000468,Institutional-OP,2023-11-12,2023-11-12,2023-12-08,PLN9161,1840431511,1840431511,Geriatrics,Out-of-Network,N20.0,S72.001A,,,,,,,0,,99213,E&M,,,0270,22,Outpatient Hospital,1,282.6,151.48,0.0,151.48,0.0,0.0,151.48,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012094,MBR00000468,Professional,2022-11-30,2022-11-30,2022-12-13,PLN9420,1545347862,1545347862,SNF,In-Network,E11.9,M17.11,,,,,,,0,,99233,E&M,,,,11,Office,1,357.56,191.62,158.36,0.0,0.0,33.26,33.26,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012095,MBR00000468,Institutional-OP,2023-02-15,2023-02-15,2023-03-09,PLN2042,1245650222,1245650222,Gastroenterology,In-Network,I10,Z79.4,,,,,,,0,,86900,Pathology/Lab,,,0360,22,Outpatient Hospital,3,42.59,27.91,2.91,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012096,MBR00000468,Professional,2023-04-26,2023-04-26,2023-05-06,PLN2000,1964402759,1964402759,Outpatient Clinic,In-Network,Z23,Z12.31,,,,,,,0,,G0439,Medicine,,,,22,Outpatient Hospital,2,517.97,160.95,160.95,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000012097,MBR00000468,Professional,2023-10-05,2023-10-05,2023-10-15,PLN1915,1872613201,1872613201,Internal Medicine,In-Network,E66.9,E11.9,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,3,385.6,258.64,156.5,102.14,0.0,0.0,102.14,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012098,MBR00000468,Institutional-OP,2023-08-29,2023-08-29,2023-09-19,PLN6188,1108115157,1108115157,General Acute Care Hospital,In-Network,J45.20,I25.10,,,,,,,0,,90686,Medicine,,,0120,22,Outpatient Hospital,3,143.53,72.93,63.74,0.0,0.0,9.19,9.19,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000012099,MBR00000468,Institutional-OP,2023-07-29,2023-07-29,2023-08-08,PLN3316,1564502315,1564502315,ASC,In-Network,N18.3,E66.9,,,,,,,0,,99203,E&M,,,0510,22,Outpatient Hospital,1,331.85,137.1,137.1,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012100,MBR00000468,Professional,2022-01-09,2022-01-09,2022-02-18,PLN5368,1696843572,1696843572,Critical Access Hospital,Out-of-Network,N20.0,I48.91,,,,,,,0,,27447,Surgery,,,,11,Office,1,6204.94,2652.98,2177.47,446.54,25.0,3.97,475.51,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012101,MBR00000468,Professional,2022-11-16,2022-11-16,2022-12-27,PLN1750,1186826716,1186826716,Physical Therapy,In-Network,I10,F41.9,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,1,47.51,17.11,15.36,0.0,0.0,1.75,1.75,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012102,MBR00000468,Institutional-IP,2023-06-15,2023-06-19,2023-07-29,PLN2242,1224179551,1224179551,Physical Therapy,In-Network,J44.1,E66.9,,,,291,MS-DRG,7,4,Y,45380,Surgery,,,0360,21,Inpatient Hospital,3,2289.51,1117.8,1068.11,49.69,0.0,0.0,49.69,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000012103,MBR00000468,Institutional-OP,2022-09-05,2022-09-05,2022-09-22,PLN6623,1713934949,1713934949,Neurology,In-Network,I25.10,N17.9,,,,,,,0,,99221,E&M,,,0450,22,Outpatient Hospital,1,177.07,117.08,117.08,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012104,MBR00000468,Professional,2021-05-20,2021-05-20,2021-06-17,PLN2072,1372918899,1372918899,Family Medicine,In-Network,I10,I25.10,,,,,,,0,,80053,Pathology/Lab,,,,12,Home,3,154.52,115.83,84.26,0.0,15.0,16.57,31.57,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012105,MBR00000468,Institutional-OP,2022-07-12,2022-07-12,2022-08-20,PLN2010,1872272835,1872272835,Internal Medicine,In-Network,N18.3,I10,,,,,,,0,,85025,Pathology/Lab,,,0270,22,Outpatient Hospital,2,60.84,27.82,12.82,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012106,MBR00000468,Professional,2021-08-25,2021-08-25,2021-09-09,PLN3312,1644128543,1644128543,Gastroenterology,In-Network,N39.0,N18.3,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,1,4636.79,2650.91,2650.91,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012107,MBR00000468,Institutional-OP,2023-01-26,2023-01-26,2023-03-06,PLN3524,1757138478,1757138478,Pediatrics,In-Network,N40.0,Z23,,,,,,,0,,99213,E&M,,,0301,22,Outpatient Hospital,1,264.01,163.9,113.9,0.0,50.0,0.0,50.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012108,MBR00000468,Institutional-OP,2023-07-31,2023-07-31,2023-08-31,PLN3252,1860435061,1860435061,DME Supplier,In-Network,E66.9,J06.9,,,,,,,0,,93225,Medicine,,,0636,22,Outpatient Hospital,3,871.74,507.54,71.4,434.6,0.0,1.54,436.14,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012109,MBR00000468,Professional,2023-02-08,2023-02-08,2023-02-23,PLN3108,1795618275,1795618275,Pulmonology,In-Network,E11.9,K57.30,,,,,,,0,,99213,E&M,,,,23,Emergency Room,1,133.21,106.8,0.0,106.8,0.0,0.0,106.8,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000012110,MBR00000468,Professional,2022-08-27,2022-08-27,2022-10-02,PLN6590,1817234602,1817234602,Clinical Laboratory,In-Network,I10,N20.0,,,,,,,0,,99203,E&M,,,,11,Office,1,290.66,186.2,186.2,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012111,MBR00000468,Professional,2022-10-19,2022-10-19,2022-10-26,PLN1968,1799205295,1799205295,General Acute Care Hospital,In-Network,R51,Z87.891,,,,,,,0,,66984,Surgery,,,,12,Home,3,3453.92,2810.78,2416.86,358.92,35.0,0.0,393.92,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012112,MBR00000468,Institutional-IP,2022-08-13,2022-08-14,2022-08-20,PLN2180,1990090423,1990090423,Orthopedic Surgery,In-Network,I50.9,Z23,,,,470,MS-DRG,20,1,Y,47562,Surgery,,,0510,21,Inpatient Hospital,2,5184.92,3696.63,2901.97,332.37,0.0,462.29,794.66,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012113,MBR00000468,Professional,2022-05-07,2022-05-07,2022-05-14,PLN2330,1624802371,1624802371,ASC,Out-of-Network,M54.5,Z23,,,,,,,0,,27130,Surgery,,,,11,Office,3,3334.01,1259.63,1259.63,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012114,MBR00000468,Institutional-OP,2021-09-06,2021-09-06,2021-09-20,PLN5582,1395983630,1395983630,Nephrology,In-Network,N39.0,Z00.00,,,,,,,0,,99204,E&M,,,0270,22,Outpatient Hospital,3,329.09,124.27,124.27,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012115,MBR00000468,Professional,2023-01-10,2023-01-10,2023-01-31,PLN1558,1997536841,1997536841,Family Medicine,Out-of-Network,E66.9,Z12.31,,,,,,,0,,45378,Surgery,,,,11,Office,1,1070.46,790.93,790.93,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000012116,MBR00000468,Professional,2022-01-18,2022-01-18,2022-02-05,PLN4572,1205377316,1205377316,Orthopedic Surgery,In-Network,I10,Z12.31,,,,,,,0,,97110,Medicine,,,,11,Office,1,169.79,133.58,0.0,133.58,0.0,0.0,133.58,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012117,MBR00000468,Professional,2021-06-21,2021-06-21,2021-06-30,PLN7342,1118885473,1118885473,ASC,In-Network,Z00.00,M17.11,,,,,,,0,,93225,Medicine,,,,50,Federally Qualified Health Center,3,726.42,514.92,489.92,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012118,MBR00000468,Professional,2023-05-27,2023-05-27,2023-06-12,PLN5619,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,N39.0,I10,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,2,463.98,203.78,203.78,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012119,MBR00000468,Professional,2022-08-27,2022-08-27,2022-09-15,PLN5366,1702692193,1702692193,Physical Therapy,In-Network,Z12.31,Z12.31,,,,,,,0,,80053,Pathology/Lab,,,,22,Outpatient Hospital,3,109.63,61.5,51.22,0.0,0.0,10.28,10.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012120,MBR00000468,Institutional-OP,2022-07-24,2022-07-24,2022-08-21,PLN2092,1198133277,1198133277,SNF,In-Network,Z12.11,N20.0,,,,,,,0,,71046,Radiology,,,0320,22,Outpatient Hospital,3,307.86,135.09,0.0,135.09,0.0,0.0,135.09,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012121,MBR00000469,Institutional-OP,2022-07-23,2022-07-23,2022-08-28,PLN6058,1564502315,1564502315,ASC,In-Network,E11.9,Z87.891,,,,,,,0,,99203,E&M,,,0120,22,Outpatient Hospital,1,164.69,72.68,58.29,0.0,0.0,14.39,14.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012122,MBR00000469,Professional,2021-03-27,2021-03-27,2021-04-29,PLN2724,1337791138,1337791138,Internal Medicine,Out-of-Network,I50.9,I25.10,,,,,,,0,,80053,Pathology/Lab,,,,21,Inpatient Hospital,3,108.7,83.49,0.0,83.49,75.0,0.0,158.49,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012123,MBR00000469,Institutional-OP,2022-08-09,2022-08-09,2022-08-16,PLN6301,1799205295,1799205295,General Acute Care Hospital,In-Network,Z87.891,N39.0,,,,,,,0,,99233,E&M,,,0730,22,Outpatient Hospital,3,246.94,204.38,0.0,204.38,0.0,0.0,204.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012124,MBR00000469,Professional,2022-08-19,2022-08-19,2022-09-30,PLN4327,1389336600,1389336600,Critical Access Hospital,In-Network,I10,Z12.11,,,,,,,0,,99232,E&M,,,,23,Emergency Room,3,170.99,82.76,0.0,82.76,35.0,0.0,117.76,0.0,Denied,CO-4,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000012125,MBR00000469,Institutional-OP,2022-07-14,2022-07-14,2022-08-02,PLN1227,1749327647,1749327647,Geriatrics,In-Network,Z00.00,N18.3,,,,,,,0,,99214,E&M,,,0510,22,Outpatient Hospital,3,359.45,141.66,0.0,141.66,35.0,0.0,176.66,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012126,MBR00000469,Professional,2021-01-08,2021-01-08,2021-01-22,PLN3641,1135158374,1135158374,Pulmonology,In-Network,E11.9,Z00.00,,,,,,,0,,85025,Pathology/Lab,,,,81,Independent Laboratory,2,37.61,13.42,13.42,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012127,MBR00000469,Professional,2023-04-02,2023-04-02,2023-04-19,PLN8994,1564502315,1564502315,ASC,In-Network,N39.0,I25.10,,,,,,,0,,80053,Pathology/Lab,,,,11,Office,3,80.26,37.54,0.0,37.54,35.0,0.0,72.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012128,MBR00000469,Institutional-OP,2022-11-04,2022-11-04,2022-11-16,PLN7476,1390307371,1390307371,DME Supplier,In-Network,I10,E78.5,,,,,,,0,,80053,Pathology/Lab,,,0900,22,Outpatient Hospital,1,151.05,97.61,0.0,97.61,15.0,0.0,112.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012129,MBR00000469,Professional,2023-04-10,2023-04-10,2023-05-12,PLN3088,1545347862,1545347862,SNF,In-Network,R10.9,J45.20,,,,,,,0,,43239,Surgery,,,,65,End-Stage Renal Disease,1,1874.19,917.43,902.43,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012130,MBR00000469,Institutional-OP,2022-07-06,2022-07-06,2022-08-05,PLN9128,1847081578,1847081578,Urology,Out-of-Network,I48.91,F41.9,,,,,,,0,,27447,Surgery,,,0301,22,Outpatient Hospital,1,5817.07,4768.43,4038.32,0.0,0.0,730.11,730.11,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012131,MBR00000469,Institutional-OP,2021-12-27,2021-12-27,2022-02-02,PLN5889,1845057593,1845057593,Orthopedic Surgery,In-Network,E11.9,I48.91,,,,,,,0,,93000,Radiology,,,0270,22,Outpatient Hospital,2,107.14,38.96,0.0,38.96,50.0,0.0,88.96,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012132,MBR00000469,Professional,2023-07-02,2023-07-02,2023-07-16,PLN3145,1366576336,1366576336,Geriatrics,In-Network,I10,E66.9,,,,,,,0,,99204,E&M,,,,49,Independent Clinic,2,562.06,307.66,0.0,307.66,25.0,0.0,332.66,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000012133,MBR00000469,Professional,2022-01-20,2022-01-20,2022-02-23,PLN1978,1891849440,1891849440,Oncology,In-Network,Z12.31,Z00.00,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,2,147.02,98.84,0.0,98.84,0.0,0.0,98.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012134,MBR00000469,Professional,2022-05-12,2022-05-12,2022-06-16,PLN9876,1434029575,1434029575,Endocrinology,In-Network,E66.9,Z12.11,,,,,,,0,,80053,Pathology/Lab,,,,23,Emergency Room,2,59.89,31.06,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-27,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000012135,MBR00000469,Institutional-IP,2021-01-19,2021-01-30,2021-02-02,PLN5173,1590915516,1590915516,Physical Therapy,Out-of-Network,N17.9,F32.9,,,,682,MS-DRG,22,11,N,99222,E&M,,,0900,21,Inpatient Hospital,3,499.91,345.41,0.0,315.05,15.0,1.81,331.86,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012136,MBR00000469,Professional,2021-06-28,2021-06-28,2021-07-16,PLN2290,1624202402,1624202402,Orthopedic Surgery,In-Network,F32.9,E66.9,,,,,,,0,,G0439,Medicine,,,,11,Office,1,235.94,129.4,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-4,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000012137,MBR00000469,Professional,2021-05-05,2021-05-05,2021-06-13,PLN2444,1727809972,1727809972,Home Health,In-Network,J20.9,J44.1,,,,,,,0,,27130,Surgery,,,,20,Urgent Care,2,4922.89,3566.26,3531.26,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012138,MBR00000469,Professional,2022-04-09,2022-04-09,2022-05-15,PLN6696,1991459367,1991459367,Neurology,Out-of-Network,E78.5,E78.5,,,,,,,0,,99283,E&M,,,,12,Home,1,257.4,116.16,0.0,116.16,25.0,0.0,141.16,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012139,MBR00000469,Professional,2021-10-15,2021-10-15,2021-10-22,PLN7693,1364429278,1364429278,OB/GYN,In-Network,M81.0,Z23,,,,,,,0,,99233,E&M,,,,11,Office,2,203.74,158.59,0.0,158.59,0.0,0.0,158.59,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012140,MBR00000469,Professional,2021-12-31,2021-12-31,2022-02-03,PLN8657,1337791138,1337791138,Internal Medicine,Out-of-Network,I63.9,I10,,,,,,,0,,97110,Medicine,,,,11,Office,2,275.76,109.55,0.0,109.55,35.0,0.0,144.55,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000012141,MBR00000469,Professional,2023-04-19,2023-04-19,2023-05-20,PLN6430,1205377316,1205377316,Orthopedic Surgery,In-Network,Z23,Z87.891,,,,,,,0,,74177,Radiology,,,,11,Office,2,2386.19,1026.9,1001.9,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012142,MBR00000469,Professional,2023-01-18,2023-01-18,2023-02-01,PLN9097,1915531927,1915531927,Critical Access Hospital,In-Network,R05,Z12.31,,,,,,,0,,93000,Radiology,,,,11,Office,2,96.23,41.87,6.87,0.0,35.0,0.0,35.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012143,MBR00000469,Institutional-OP,2023-05-24,2023-05-24,2023-06-11,PLN2729,1334916761,1334916761,ASC,In-Network,E11.9,E11.9,,,,,,,0,,99204,E&M,,,0900,22,Outpatient Hospital,3,495.31,169.13,158.26,10.87,0.0,0.0,10.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012144,MBR00000469,Institutional-IP,2023-06-13,2023-06-20,2023-06-22,PLN1274,1453936007,1453936007,ASC,In-Network,E11.9,F32.9,,,,292,MS-DRG,20,7,Y,84443,Pathology/Lab,,,0510,21,Inpatient Hospital,2,63.42,31.46,0.0,31.46,25.0,0.0,56.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012145,MBR00000469,Professional,2021-09-29,2021-09-29,2021-10-23,PLN1836,1514306773,1514306773,Endocrinology,In-Network,S72.001A,E11.9,,,,,,,0,,76700,Radiology,,,,11,Office,3,1436.95,1066.16,568.55,367.41,15.0,115.2,497.61,0.0,Adjusted,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012146,MBR00000469,Institutional-OP,2022-11-06,2022-11-06,2022-12-01,PLN7476,1528335731,1528335731,Critical Access Hospital,In-Network,F32.9,N39.0,,,,,,,0,,66984,Surgery,,,0270,22,Outpatient Hospital,2,2124.95,1451.51,1338.1,0.0,15.0,98.41,113.41,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012147,MBR00000470,Professional,2023-08-11,2023-08-11,2023-08-19,PLN9137,1968299309,1968299309,Internal Medicine,In-Network,Z00.00,M54.5,,,,,,,0,,71046,Radiology,,,,11,Office,3,265.86,219.54,0.0,219.54,0.0,0.0,219.54,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012148,MBR00000470,Professional,2021-11-30,2021-11-30,2021-12-18,PLN5059,1410468316,1410468316,SNF,In-Network,Z12.31,E11.9,,,,,,,0,,99203,E&M,,,,20,Urgent Care,1,237.21,130.45,0.0,114.56,75.0,0.0,189.56,38.12,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012149,MBR00000470,Professional,2022-02-16,2022-02-16,2022-03-19,PLN4139,1745114564,1745114564,Endocrinology,In-Network,Z23,Z87.891,,,,,,,0,,27447,Surgery,,,,49,Independent Clinic,3,4403.8,2553.55,2478.55,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012150,MBR00000470,Professional,2022-08-05,2022-08-05,2022-08-15,PLN5074,1438368327,1438368327,Home Health,In-Network,I10,E11.9,,,,,,,0,,99214,E&M,,,,11,Office,2,230.28,87.78,71.59,0.0,0.0,0.0,0.0,16.19,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012151,MBR00000470,Institutional-OP,2023-05-24,2023-05-24,2023-06-01,PLN5509,1236418230,1236418230,DME Supplier,In-Network,J45.20,I10,,,,,,,0,,99213,E&M,,,0120,22,Outpatient Hospital,1,314.5,134.16,0.0,134.16,0.0,0.0,134.16,30.89,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012152,MBR00000470,Professional,2021-06-11,2021-06-11,2021-06-28,PLN8446,1542828721,1542828721,Orthopedic Surgery,In-Network,E11.65,I10,,,,,,,0,,G0468,Medicine,,,,50,Federally Qualified Health Center,2,598.58,480.69,0.0,0.0,0.0,0.0,0.0,118.71,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012153,MBR00000470,Institutional-IP,2022-05-27,2022-05-30,2022-06-28,PLN7373,1245650222,1245650222,Gastroenterology,In-Network,E78.5,E11.9,,,,196,MS-DRG,15,3,Y,99203,E&M,,,0200,21,Inpatient Hospital,1,156.68,133.01,0.0,133.01,15.0,0.0,148.01,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012154,MBR00000470,Professional,2021-09-23,2021-09-23,2021-10-15,PLN2121,1790497490,1790497490,OB/GYN,In-Network,F10.20,Z00.00,,,,,,,0,,99221,E&M,,,,49,Independent Clinic,2,221.9,150.93,0.0,150.93,0.0,0.0,150.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012155,MBR00000470,Professional,2023-02-20,2023-02-20,2023-04-02,PLN5395,1860435061,1860435061,DME Supplier,In-Network,Z23,Z87.891,,,,,,,0,,99214,E&M,,,,11,Office,1,187.58,88.97,65.76,0.0,15.0,8.21,23.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012156,MBR00000470,Professional,2021-09-22,2021-09-22,2021-10-27,PLN4894,1727809972,1727809972,Home Health,In-Network,Z00.00,J20.9,,,,,,,0,,43239,Surgery,,,,11,Office,3,994.28,772.62,545.92,0.0,50.0,0.0,50.0,176.7,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012157,MBR00000470,Professional,2022-01-26,2022-01-26,2022-02-19,PLN7838,1935547131,1935547131,Pulmonology,In-Network,M54.5,Z00.00,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,3,152.7,101.85,67.78,0.0,25.0,9.07,34.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012158,MBR00000470,Professional,2022-01-15,2022-01-15,2022-02-08,PLN1089,1450553056,1450553056,Clinical Laboratory,In-Network,J06.9,F41.9,,,,,,,0,,71046,Radiology,,,,11,Office,2,327.06,142.13,94.47,0.0,25.0,22.66,47.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012159,MBR00000470,Professional,2021-03-19,2021-03-19,2021-04-11,PLN5253,1366286000,1366286000,SNF,In-Network,I10,E66.9,,,,,,,0,,45378,Surgery,,,,12,Home,3,2038.49,1141.41,971.06,0.0,0.0,170.35,170.35,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000012160,MBR00000470,Professional,2023-01-02,2023-01-02,2023-02-14,PLN3275,1915531927,1915531927,Critical Access Hospital,In-Network,J44.1,F41.9,,,,,,,0,,45380,Surgery,,,,81,Independent Laboratory,3,2221.12,1259.18,1034.15,0.0,25.0,16.03,41.03,184.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000012161,MBR00000470,Institutional-OP,2021-10-06,2021-10-06,2021-10-19,PLN3295,1717546253,1717546253,Family Medicine,In-Network,M54.5,J45.20,,,,,,,0,,99406,Medicine,,,0730,22,Outpatient Hospital,2,81.66,67.33,60.9,0.0,0.0,6.43,6.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012162,MBR00000470,Institutional-IP,2022-06-22,2022-06-23,2022-07-24,PLN4158,1990090423,1990090423,Orthopedic Surgery,In-Network,Z23,Z12.31,,,,195,MS-DRG,9,1,Y,99204,E&M,,,0761,21,Inpatient Hospital,1,477.55,143.85,68.85,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000012163,MBR00000470,Institutional-OP,2023-02-03,2023-02-03,2023-03-15,PLN6840,1224179551,1224179551,Physical Therapy,In-Network,N18.3,N18.3,,,,,,,0,,99204,E&M,,,0320,22,Outpatient Hospital,1,425.33,136.75,0.0,136.75,0.0,0.0,136.75,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012164,MBR00000470,Institutional-OP,2023-05-12,2023-05-12,2023-05-22,PLN2566,1366426662,1366426662,Urology,In-Network,E11.65,N39.0,,,,,,,0,,99283,E&M,,,0320,22,Outpatient Hospital,1,559.21,196.18,157.16,0.0,25.0,0.0,25.0,14.02,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012165,MBR00000470,Professional,2023-10-03,2023-10-03,2023-11-05,PLN1873,1283743001,1283743001,Family Medicine,In-Network,N20.0,I25.10,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,1,88.73,67.74,63.5,0.0,0.0,4.24,4.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000012166,MBR00000470,Institutional-OP,2021-05-19,2021-05-19,2021-06-01,PLN6972,1845900543,1845900543,ASC,In-Network,N17.9,F32.9,,,,,,,0,,66984,Surgery,,,0740,22,Outpatient Hospital,3,1605.97,620.1,605.1,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012167,MBR00000470,Institutional-OP,2022-11-19,2022-11-19,2022-12-24,PLN6307,1865904917,1865904917,Outpatient Clinic,In-Network,Z00.00,J20.9,,,,,,,0,,90837,Medicine,,,0270,22,Outpatient Hospital,2,229.06,96.19,0.0,96.19,0.0,0.0,96.19,26.74,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012168,MBR00000470,Professional,2021-12-26,2021-12-26,2022-01-14,PLN4410,1528335731,1528335731,Critical Access Hospital,In-Network,I10,R05,,,,,,,0,,99204,E&M,,,,11,Office,3,237.59,111.65,0.0,111.65,75.0,0.0,186.65,3.64,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012169,MBR00000470,Institutional-IP,2023-04-23,2023-04-30,2023-05-12,PLN2333,1899127912,1899127912,Neurology,In-Network,N39.0,M54.5,,,,603,MS-DRG,20,7,Y,23472,Surgery,,,0636,21,Inpatient Hospital,3,3637.58,1576.54,1361.92,214.62,0.0,0.0,214.62,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012170,MBR00000470,Professional,2022-03-02,2022-03-02,2022-03-23,PLN5754,1219817751,1219817751,OB/GYN,In-Network,F41.9,K21.0,,,,,,,0,,99233,E&M,,,,20,Urgent Care,1,213.83,170.81,155.81,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012171,MBR00000470,Professional,2021-01-16,2021-01-16,2021-02-23,PLN9219,1571574052,1571574052,Critical Access Hospital,In-Network,I63.9,E11.9,,,,,,,0,,90686,Medicine,,,,49,Independent Clinic,3,92.1,76.84,76.84,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000012172,MBR00000470,Professional,2023-07-27,2023-07-27,2023-08-14,PLN6027,1245650222,1245650222,Gastroenterology,In-Network,E66.9,J06.9,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,2,3649.03,1817.96,1792.96,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012173,MBR00000470,Professional,2023-04-13,2023-04-13,2023-05-19,PLN5295,1713934949,1713934949,Neurology,In-Network,N39.0,N39.0,,,,,,,0,,99233,E&M,,,,12,Home,2,433.18,265.49,0.0,265.49,15.0,0.0,280.49,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012174,MBR00000470,Professional,2021-12-28,2021-12-28,2022-01-19,PLN8936,1991459367,1991459367,Neurology,Out-of-Network,B97.89,Z87.891,,,,,,,0,,99204,E&M,,,,11,Office,1,583.02,269.24,0.0,1.7,0.0,0.0,1.7,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012175,MBR00000470,Institutional-IP,2023-07-04,2023-07-10,2023-08-13,PLN2079,1193493783,1193493783,Critical Access Hospital,Out-of-Network,M54.5,R07.9,,,,195,MS-DRG,19,6,Y,58661,Surgery,,,0270,21,Inpatient Hospital,3,2590.44,2141.13,1774.33,0.0,0.0,0.0,0.0,366.8,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012176,MBR00000470,Professional,2022-03-26,2022-03-26,2022-04-11,PLN9880,1563980627,1563980627,Critical Access Hospital,In-Network,K21.0,Z87.891,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,1,179.48,88.71,0.0,88.71,25.0,0.0,113.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012177,MBR00000470,Professional,2022-03-28,2022-03-28,2022-04-14,PLN2930,1964402759,1964402759,Outpatient Clinic,In-Network,G43.909,G43.909,,,,,,,0,,99283,E&M,,,,21,Inpatient Hospital,2,477.78,390.47,390.47,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012178,MBR00000470,Professional,2021-11-25,2021-11-25,2022-01-05,PLN3742,1569105090,1569105090,Geriatrics,In-Network,F32.9,E78.5,,,,,,,0,,99232,E&M,,,,20,Urgent Care,3,218.89,84.42,0.0,84.42,75.0,0.0,159.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012179,MBR00000471,Institutional-OP,2022-06-25,2022-06-25,2022-07-27,PLN9663,1227362142,1227362142,DME Supplier,In-Network,E11.9,E11.9,,,,,,,0,,27447,Surgery,,,0730,22,Outpatient Hospital,3,3617.09,1708.03,1658.03,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012180,MBR00000471,Institutional-OP,2023-12-25,2023-12-25,2024-01-31,PLN2114,1453283987,1453283987,Critical Access Hospital,In-Network,I10,Z87.891,,,,,,,0,,99232,E&M,,,0740,22,Outpatient Hospital,2,400.11,129.08,0.0,129.08,0.0,0.0,129.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012181,MBR00000471,Professional,2021-02-27,2021-02-27,2021-03-21,PLN7023,1752470395,1752470395,Home Health,In-Network,I10,M54.5,,,,,,,0,,33533,Surgery,,,,11,Office,3,17048.37,9519.86,9519.86,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000012182,MBR00000471,Institutional-OP,2022-10-12,2022-10-12,2022-10-31,PLN1336,1463205530,1463205530,Nephrology,In-Network,M54.5,I63.9,,,,,,,0,,58661,Surgery,,,0301,22,Outpatient Hospital,3,2742.76,856.33,801.5,0.0,0.0,54.83,54.83,0.0,Paid,,,1,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000012183,MBR00000471,Institutional-OP,2021-07-11,2021-07-11,2021-08-08,PLN2326,1749327647,1749327647,Geriatrics,In-Network,M17.11,G20,,,,,,,0,,99283,E&M,,,0320,22,Outpatient Hospital,2,309.32,119.43,0.0,119.43,50.0,0.0,169.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012184,MBR00000471,Institutional-OP,2021-05-16,2021-05-16,2021-06-20,PLN9553,1716521444,1716521444,Oncology,In-Network,Z23,Z12.31,,,,,,,0,,71046,Radiology,,,0200,22,Outpatient Hospital,3,280.06,141.91,0.0,141.91,0.0,0.0,141.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012185,MBR00000471,Institutional-OP,2021-03-03,2021-03-03,2021-03-10,PLN4181,1624802371,1624802371,ASC,Out-of-Network,G20,Z00.00,,,,,,,0,,45378,Surgery,,,0510,22,Outpatient Hospital,3,1930.13,1569.41,1544.41,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000012186,MBR00000471,Professional,2021-10-27,2021-10-27,2021-11-09,PLN4802,1749494482,1749494482,Pediatrics,In-Network,I25.10,F41.9,,,,,,,0,,72148,Radiology,,,,11,Office,1,1238.88,514.69,464.69,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012187,MBR00000471,Professional,2023-03-12,2023-03-12,2023-04-05,PLN4861,1366576336,1366576336,Geriatrics,In-Network,E78.5,E11.9,,,,,,,0,,70553,Radiology,,,,12,Home,3,4086.97,1380.09,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012188,MBR00000471,Institutional-OP,2023-03-18,2023-03-18,2023-04-21,PLN9648,1410468316,1410468316,SNF,In-Network,J06.9,E11.9,,,,,,,0,,84443,Pathology/Lab,,,0360,22,Outpatient Hospital,3,163.18,116.65,0.0,116.65,75.0,0.0,191.65,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012189,MBR00000471,Institutional-OP,2023-05-26,2023-05-26,2023-06-15,PLN7324,1609526529,1609526529,Psychiatry,In-Network,I10,E78.5,,,,,,,0,,70450,Radiology,,,0730,22,Outpatient Hospital,3,1216.39,813.86,658.73,0.0,75.0,80.13,155.13,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012190,MBR00000471,Professional,2021-06-09,2021-06-09,2021-07-11,PLN5786,1860435061,1860435061,DME Supplier,In-Network,N39.0,I48.91,,,,,,,0,,99222,E&M,,,,11,Office,2,291.92,236.14,204.54,0.0,25.0,6.6,31.6,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012191,MBR00000471,Institutional-IP,2021-04-29,2021-05-03,2021-05-21,PLN4184,1283743001,1283743001,Family Medicine,In-Network,M54.5,I10,,,,292,MS-DRG,23,4,Y,99406,Medicine,,,0510,21,Inpatient Hospital,3,81.41,62.37,0.0,62.37,50.0,0.0,112.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012192,MBR00000471,Institutional-IP,2023-12-12,2023-12-14,2024-01-04,PLN6392,1475984649,1475984649,SNF,In-Network,Z12.11,Z00.01,,,,690,MS-DRG,21,2,N,87491,Pathology/Lab,,,0740,21,Inpatient Hospital,1,218.88,177.01,135.94,0.0,25.0,16.07,41.07,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012193,MBR00000471,Professional,2023-10-07,2023-10-07,2023-11-13,PLN6525,1500037969,1500037969,Pulmonology,In-Network,J18.9,N18.3,,,,,,,0,,90686,Medicine,,,,49,Independent Clinic,1,139.7,99.16,24.16,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000012194,MBR00000471,Institutional-IP,2023-02-06,2023-02-09,2023-03-21,PLN6482,1790497490,1790497490,OB/GYN,In-Network,I10,C50.912,,,,194,MS-DRG,22,3,Y,99232,E&M,,,0636,21,Inpatient Hospital,1,245.49,191.52,70.82,111.78,0.0,8.92,120.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012195,MBR00000471,Professional,2023-07-09,2023-07-09,2023-08-07,PLN4579,1778483301,1778483301,Home Health,In-Network,J20.9,I10,,,,,,,0,,77067,Radiology,,,,12,Home,2,518.1,364.11,289.11,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000012196,MBR00000471,Professional,2023-05-31,2023-05-31,2023-06-07,PLN5028,1219817751,1219817751,OB/GYN,In-Network,I63.9,I10,,,,,,,0,,G0439,Medicine,,,,22,Outpatient Hospital,1,427.68,258.84,0.0,258.84,0.0,0.0,258.84,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000012197,MBR00000471,Professional,2022-09-24,2022-09-24,2022-10-16,PLN1098,1624202402,1624202402,Orthopedic Surgery,In-Network,R10.9,Z23,,,,,,,0,,90686,Medicine,,,,11,Office,1,109.27,37.15,37.15,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000012198,MBR00000471,Professional,2022-06-05,2022-06-05,2022-07-13,PLN4824,1891849440,1891849440,Oncology,In-Network,R10.9,Z96.641,,,,,,,0,,66984,Surgery,,,,11,Office,3,2436.24,1370.85,1370.85,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012199,MBR00000471,Professional,2023-12-08,2023-12-08,2023-12-17,PLN6696,1817234602,1817234602,Clinical Laboratory,In-Network,E66.9,E66.9,,,,,,,0,,90686,Medicine,,,,49,Independent Clinic,3,119.22,83.62,26.33,22.29,35.0,0.0,57.29,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000012200,MBR00000471,Professional,2023-01-11,2023-01-11,2023-02-23,PLN8334,1295371663,1295371663,Critical Access Hospital,In-Network,Z23,E11.9,,,,,,,0,,47562,Surgery,,,,21,Inpatient Hospital,2,4814.65,2643.61,2643.61,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012201,MBR00000472,Professional,2023-08-25,2023-08-25,2023-09-10,PLN2265,1450094833,1450094833,Outpatient Clinic,In-Network,J44.1,E78.5,,,,,,,0,,99203,E&M,,,,65,End-Stage Renal Disease,3,386.89,309.0,259.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012202,MBR00000472,Professional,2021-08-15,2021-08-15,2021-09-06,PLN4821,1410468316,1410468316,SNF,In-Network,Z87.891,F32.9,,,,,,,0,,99406,Medicine,,,,11,Office,2,45.82,37.12,0.0,37.12,0.0,0.0,37.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012203,MBR00000472,Professional,2021-09-01,2021-09-01,2021-10-13,PLN4078,1780163051,1780163051,SNF,In-Network,E66.9,J06.9,,,,,,,0,,47562,Surgery,,,,11,Office,1,4017.46,2042.23,1588.37,451.17,0.0,2.69,453.86,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012204,MBR00000472,Professional,2022-11-21,2022-11-21,2022-11-28,PLN9979,1840431511,1840431511,Geriatrics,Out-of-Network,N17.9,Z00.01,,,,,,,0,,99222,E&M,,,,23,Emergency Room,1,230.72,141.77,0.0,141.77,50.0,0.0,191.77,0.0,Paid,,,0,,1,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000012205,MBR00000472,Professional,2023-11-11,2023-11-11,2023-12-24,PLN8462,1103747954,1103747954,Urology,In-Network,N39.0,M17.11,,,,,,,0,,97530,Medicine,,,,22,Outpatient Hospital,3,277.68,126.73,91.73,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012206,MBR00000472,Institutional-OP,2022-11-11,2022-11-11,2022-11-20,PLN9045,1845057593,1845057593,Orthopedic Surgery,In-Network,J06.9,E78.5,,,,,,,0,,87491,Pathology/Lab,,,0301,22,Outpatient Hospital,3,215.63,131.86,124.67,0.0,0.0,7.19,7.19,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012207,MBR00000472,Institutional-IP,2022-05-01,2022-05-04,2022-05-16,PLN4192,1486164553,1486164553,DME Supplier,In-Network,N39.0,Z00.00,,,,195,MS-DRG,3,3,Y,47562,Surgery,,,0320,21,Inpatient Hospital,2,6176.98,2367.19,2213.49,153.7,0.0,0.0,153.7,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012208,MBR00000472,Professional,2021-01-28,2021-01-28,2021-02-21,PLN2458,1991459367,1991459367,Neurology,Out-of-Network,R51,Z12.31,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,3,99.94,67.33,0.0,67.33,0.0,0.0,67.33,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000012209,MBR00000472,Institutional-IP,2021-06-19,2021-06-26,2021-07-30,PLN4822,1268679390,1268679390,Critical Access Hospital,In-Network,N39.0,N39.0,,,,683,MS-DRG,20,7,N,99204,E&M,,,0636,21,Inpatient Hospital,1,421.0,357.58,46.49,300.54,0.0,10.55,311.09,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012210,MBR00000472,Professional,2021-09-10,2021-09-10,2021-09-22,PLN6953,1531398223,1531398223,OB/GYN,In-Network,I10,N40.0,,,,,,,0,,93000,Radiology,,,,22,Outpatient Hospital,1,161.4,76.42,0.0,76.42,15.0,0.0,91.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012211,MBR00000472,Professional,2021-08-08,2021-08-08,2021-09-01,PLN8506,1575695214,1575695214,SNF,In-Network,E78.5,N18.3,,,,,,,0,,99221,E&M,,,,11,Office,3,271.63,95.43,81.15,0.0,0.0,14.28,14.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012212,MBR00000472,Professional,2023-02-09,2023-02-09,2023-03-04,PLN4378,1450094833,1450094833,Outpatient Clinic,In-Network,N40.0,F10.20,,,,,,,0,,76700,Radiology,,,,21,Inpatient Hospital,2,816.93,251.2,0.0,229.66,0.0,0.0,229.66,0.0,Denied,CO-4,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012213,MBR00000472,Institutional-OP,2023-01-20,2023-01-20,2023-02-22,PLN5069,1624202402,1624202402,Orthopedic Surgery,In-Network,I11.9,I48.91,,,,,,,0,,43239,Surgery,,,0730,22,Outpatient Hospital,1,2193.65,1378.81,1343.81,0.0,35.0,0.0,35.0,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012214,MBR00000472,Institutional-IP,2022-02-20,2022-02-26,2022-03-13,PLN5729,1845057593,1845057593,Orthopedic Surgery,In-Network,E78.5,M81.0,,,,641,MS-DRG,14,6,Y,80061,Pathology/Lab,,,0900,21,Inpatient Hospital,2,65.23,47.97,0.0,47.97,35.0,0.0,82.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012215,MBR00000472,Institutional-OP,2023-12-18,2023-12-18,2024-01-07,PLN2500,1689639685,1689639685,SNF,In-Network,M81.0,N18.3,,,,,,,0,,93000,Radiology,,,0730,22,Outpatient Hospital,2,86.27,30.31,0.0,30.31,75.0,0.0,105.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012216,MBR00000472,Institutional-OP,2022-03-08,2022-03-08,2022-04-08,PLN3097,1631954542,1631954542,Oncology,In-Network,E11.9,G20,,,,,,,0,,80061,Pathology/Lab,,,0270,22,Outpatient Hospital,1,83.64,48.63,33.63,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012217,MBR00000473,Professional,2022-05-03,2022-05-03,2022-06-02,PLN4056,1334916761,1334916761,ASC,In-Network,M54.5,J06.9,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,3,24.43,15.48,15.48,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012218,MBR00000473,Institutional-OP,2022-07-31,2022-07-31,2022-08-23,PLN7331,1939033455,1939033455,Pulmonology,In-Network,Z23,I10,,,,,,,0,,86900,Pathology/Lab,,,0510,22,Outpatient Hospital,1,39.49,28.28,0.0,28.28,0.0,0.0,28.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012219,MBR00000473,Institutional-IP,2022-09-20,2022-09-21,2022-10-04,PLN7119,1691062876,1691062876,SNF,In-Network,M17.11,M81.0,,,,871,MS-DRG,1,1,Y,G0468,Medicine,,,0510,21,Inpatient Hospital,3,635.15,427.74,0.0,0.0,15.0,20.54,35.54,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012220,MBR00000473,Institutional-IP,2021-07-29,2021-08-04,2021-08-26,PLN5833,1295371663,1295371663,Critical Access Hospital,In-Network,R07.9,Z23,,,,683,MS-DRG,6,6,N,43239,Surgery,,,0636,21,Inpatient Hospital,2,1293.35,996.51,946.51,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012221,MBR00000473,Professional,2021-11-25,2021-11-25,2021-12-22,PLN8796,1752470395,1752470395,Home Health,In-Network,E66.9,E11.9,,,,,,,0,,85610,Pathology/Lab,,,,23,Emergency Room,3,42.25,33.28,32.08,0.0,0.0,1.2,1.2,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000012222,MBR00000473,Professional,2023-01-24,2023-01-24,2023-02-01,PLN3645,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,I25.10,J20.9,,,,,,,0,,99233,E&M,,,,11,Office,1,341.29,151.41,22.02,102.03,25.0,2.36,129.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012223,MBR00000473,Professional,2023-07-15,2023-07-15,2023-08-21,PLN8113,1991459367,1991459367,Neurology,Out-of-Network,N39.0,J20.9,,,,,,,0,,90686,Medicine,,,,11,Office,1,103.78,48.13,0.0,48.13,0.0,0.0,48.13,0.0,Adjusted,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000012224,MBR00000473,Professional,2022-04-09,2022-04-09,2022-04-27,PLN6640,1609138981,1609138981,Critical Access Hospital,In-Network,S72.001A,Z12.31,,,,,,,0,,90837,Medicine,,,,11,Office,1,514.17,172.6,0.0,172.6,50.0,0.0,222.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012225,MBR00000473,Professional,2021-05-07,2021-05-07,2021-06-19,PLN7810,1935547131,1935547131,Pulmonology,In-Network,R10.9,J44.1,,,,,,,0,,99233,E&M,,,,11,Office,3,283.19,236.9,211.9,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012226,MBR00000473,Professional,2023-07-22,2023-07-22,2023-07-29,PLN1365,1139906830,1139906830,Endocrinology,Out-of-Network,I48.91,E11.9,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,2,92.5,63.01,52.7,0.0,0.0,10.31,10.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000012227,MBR00000473,Professional,2022-09-30,2022-09-30,2022-11-02,PLN4916,1689639685,1689639685,SNF,In-Network,K21.0,I10,,,,,,,0,,93306,Radiology,,,,11,Office,2,2515.87,2087.83,1792.14,0.0,75.0,220.69,295.69,0.0,Adjusted,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012228,MBR00000473,Professional,2022-04-23,2022-04-23,2022-06-04,PLN8049,1702692193,1702692193,Physical Therapy,In-Network,M81.0,Z12.11,,,,,,,0,,27447,Surgery,,,,11,Office,1,4821.49,1492.62,1166.96,300.66,25.0,0.0,325.66,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012229,MBR00000474,Institutional-OP,2022-10-04,2022-10-04,2022-10-27,PLN6449,1700633438,1700633438,DME Supplier,In-Network,F41.9,Z23,,,,,,,0,,99233,E&M,,,0360,22,Outpatient Hospital,3,509.23,267.47,267.47,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012230,MBR00000474,Professional,2023-06-21,2023-06-21,2023-07-05,PLN1041,1727809972,1727809972,Home Health,In-Network,E78.5,E78.5,,,,,,,0,,72148,Radiology,,,,21,Inpatient Hospital,2,1618.99,1368.41,1368.41,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012231,MBR00000474,Institutional-OP,2021-01-02,2021-01-02,2021-01-15,PLN5788,1135158374,1135158374,Pulmonology,In-Network,Z12.11,I10,,,,,,,0,,66984,Surgery,,,0320,22,Outpatient Hospital,1,1605.31,985.39,628.64,356.75,0.0,0.0,356.75,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012232,MBR00000474,Professional,2022-01-30,2022-01-30,2022-02-12,PLN3109,1891849440,1891849440,Oncology,In-Network,N39.0,B97.89,,,,,,,0,,87491,Pathology/Lab,,,,22,Outpatient Hospital,2,170.73,119.0,0.0,28.86,0.0,0.0,28.86,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012233,MBR00000474,Professional,2023-10-27,2023-10-27,2023-12-09,PLN8868,1284035364,1284035364,Pediatrics,In-Network,J20.9,Z00.00,,,,,,,0,,66984,Surgery,,,,11,Office,1,3461.96,2760.14,2665.08,0.0,75.0,20.06,95.06,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012234,MBR00000474,Professional,2021-11-26,2021-11-26,2022-01-04,PLN3249,1434029575,1434029575,Endocrinology,In-Network,I10,Z00.00,,,,,,,0,,27130,Surgery,,,,11,Office,3,4700.75,2276.22,2276.22,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012235,MBR00000475,Professional,2023-12-03,2023-12-03,2023-12-13,PLN5639,1860435061,1860435061,DME Supplier,In-Network,F32.9,E78.5,,,,,,,0,,27130,Surgery,,,,11,Office,1,4917.25,2369.44,2307.17,0.0,25.0,37.27,62.27,0.0,Paid,,,0,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000012236,MBR00000475,Professional,2021-11-05,2021-11-05,2021-12-12,PLN8541,1124394415,1124394415,Pediatrics,In-Network,M54.5,I10,,,,,,,0,,99221,E&M,,,,11,Office,1,254.29,200.84,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012237,MBR00000475,Professional,2022-05-27,2022-05-27,2022-07-01,PLN4212,1433937353,1433937353,Nephrology,In-Network,Z23,I10,,,,,,,0,,43239,Surgery,,,,11,Office,2,2204.77,1474.93,1439.93,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000012238,MBR00000475,Institutional-OP,2021-03-18,2021-03-18,2021-04-27,PLN3092,1486164553,1486164553,DME Supplier,In-Network,Z12.11,Z23,,,,,,,0,,97110,Medicine,,,0270,22,Outpatient Hospital,1,198.91,103.08,0.0,103.08,0.0,0.0,103.08,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012239,MBR00000475,Professional,2023-03-06,2023-03-06,2023-04-13,PLN5717,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,R51,F41.9,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,2,638.89,219.38,0.0,219.38,0.0,0.0,219.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012240,MBR00000475,Professional,2021-09-20,2021-09-20,2021-10-21,PLN2411,1946680931,1946680931,Critical Access Hospital,Out-of-Network,E11.40,K57.30,,,,,,,0,,82043,Pathology/Lab,,,,11,Office,2,53.17,36.31,36.31,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012241,MBR00000475,Professional,2023-07-19,2023-07-19,2023-08-30,PLN3108,1132188260,1132188260,Family Medicine,In-Network,J06.9,E78.5,,,,,,,0,,47562,Surgery,,,,11,Office,1,6438.14,4652.53,4577.53,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012242,MBR00000475,Institutional-IP,2021-05-23,2021-05-27,2021-06-08,PLN5855,1139906830,1139906830,Endocrinology,Out-of-Network,K21.0,Z79.4,,,,871,MS-DRG,18,4,Y,99222,E&M,,,0761,21,Inpatient Hospital,1,430.14,145.24,0.0,145.24,0.0,0.0,145.24,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012243,MBR00000475,Institutional-OP,2021-05-08,2021-05-08,2021-05-18,PLN8633,1239316214,1239316214,Internal Medicine,In-Network,Z23,Z12.11,,,,,,,0,,93306,Radiology,,,0200,22,Outpatient Hospital,3,1175.92,642.29,587.93,0.0,50.0,4.36,54.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012244,MBR00000475,Professional,2022-05-29,2022-05-29,2022-07-12,PLN1514,1355166277,1355166277,Endocrinology,In-Network,E78.5,E66.9,,,,,,,0,,27130,Surgery,,,,23,Emergency Room,1,4239.99,1938.2,1524.35,0.0,35.0,378.85,413.85,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000012245,MBR00000475,Professional,2021-04-03,2021-04-03,2021-04-18,PLN8736,1840431511,1840431511,Geriatrics,Out-of-Network,E11.9,S72.001A,,,,,,,0,,G0468,Medicine,,,,21,Inpatient Hospital,1,431.19,298.64,263.64,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012246,MBR00000475,Institutional-OP,2021-12-27,2021-12-27,2022-02-02,PLN9205,1865904917,1865904917,Outpatient Clinic,In-Network,I25.10,M81.0,,,,,,,0,,27447,Surgery,,,0761,22,Outpatient Hospital,3,5598.91,4655.35,4655.35,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012247,MBR00000475,Institutional-OP,2023-01-25,2023-01-25,2023-03-03,PLN7517,1660288235,1660288235,ASC,In-Network,Z23,I10,,,,,,,0,,47562,Surgery,,,0761,22,Outpatient Hospital,1,5979.38,2505.95,2505.95,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012248,MBR00000476,Institutional-OP,2022-07-07,2022-07-07,2022-08-06,PLN2508,1590915516,1590915516,Physical Therapy,Out-of-Network,Z23,I10,,,,,,,0,,G0444,Medicine,,,0761,22,Outpatient Hospital,2,97.93,39.63,0.0,39.63,15.0,0.0,54.63,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000012249,MBR00000476,Institutional-OP,2022-09-05,2022-09-05,2022-10-14,PLN3903,1585582070,1585582070,Outpatient Clinic,In-Network,E78.5,Z23,,,,,,,0,,99233,E&M,,,0301,22,Outpatient Hospital,1,281.83,103.0,103.0,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012250,MBR00000476,Professional,2021-04-10,2021-04-10,2021-05-09,PLN1309,1865904917,1865904917,Outpatient Clinic,In-Network,Z00.00,M17.11,,,,,,,0,,G0468,Medicine,,,,12,Home,2,616.27,488.23,116.86,371.37,0.0,0.0,371.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012251,MBR00000476,Professional,2023-01-14,2023-01-14,2023-02-25,PLN1026,1295371663,1295371663,Critical Access Hospital,In-Network,Z96.641,E78.5,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,3,41.25,26.38,26.38,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012252,MBR00000476,Professional,2021-04-10,2021-04-10,2021-04-17,PLN3469,1502838586,1502838586,ASC,In-Network,E11.9,F32.9,,,,,,,0,,27447,Surgery,,,,11,Office,2,2616.76,1535.2,1163.35,296.85,75.0,0.0,371.85,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012253,MBR00000476,Institutional-IP,2022-09-19,2022-09-21,2022-09-26,PLN4257,1213165847,1213165847,Critical Access Hospital,In-Network,J44.1,E66.9,,,,690,MS-DRG,13,2,N,27447,Surgery,,,0301,21,Inpatient Hospital,3,4409.52,2640.95,2565.95,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012254,MBR00000476,Institutional-OP,2023-05-16,2023-05-16,2023-06-27,PLN3938,1450553056,1450553056,Clinical Laboratory,In-Network,Z12.31,Z00.00,,,,,,,0,,99214,E&M,,,0761,22,Outpatient Hospital,1,168.1,94.58,94.58,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012255,MBR00000476,Professional,2023-03-07,2023-03-07,2023-03-29,PLN7748,1575695214,1575695214,SNF,In-Network,M54.5,F03.90,,,,,,,0,,G0439,Medicine,,,,49,Independent Clinic,1,513.74,416.91,0.0,0.0,0.0,0.0,0.0,0.0,Denied,PR-1,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000012256,MBR00000476,Professional,2022-01-22,2022-01-22,2022-02-02,PLN3608,1660288235,1660288235,ASC,In-Network,Z00.00,J20.9,,,,,,,0,,72148,Radiology,,,,22,Outpatient Hospital,3,2559.43,1774.58,1724.58,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012257,MBR00000476,Institutional-OP,2021-06-19,2021-06-19,2021-07-04,PLN5837,1609526529,1609526529,Psychiatry,In-Network,J45.20,I25.10,,,,,,,0,,27447,Surgery,,,0301,22,Outpatient Hospital,2,5123.74,3543.74,3468.74,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,1,Unbundling,0,0,0,0,0
CLM0000012258,MBR00000476,Professional,2023-06-29,2023-06-29,2023-08-01,PLN8902,1556140803,1556140803,Cardiology,In-Network,F03.90,Z23,,,,,,,0,,93000,Radiology,,,,21,Inpatient Hospital,2,112.24,38.47,38.47,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012259,MBR00000476,Institutional-IP,2021-08-25,2021-08-26,2021-10-08,PLN9979,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,S72.001A,I10,,,,871,MS-DRG,2,1,Y,97110,Medicine,,,0730,21,Inpatient Hospital,3,184.63,155.88,80.88,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012260,MBR00000476,Institutional-OP,2022-06-27,2022-06-27,2022-07-25,PLN7644,1545347862,1545347862,SNF,In-Network,E11.9,J20.9,,,,,,,0,,99283,E&M,,,0320,22,Outpatient Hospital,1,518.28,297.8,0.0,297.8,75.0,0.0,372.8,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012261,MBR00000476,Professional,2021-09-17,2021-09-17,2021-10-20,PLN2679,1948810580,1948810580,DME Supplier,In-Network,J20.9,E66.9,,,,,,,0,,23472,Surgery,,,,22,Outpatient Hospital,1,3375.76,1047.47,1047.47,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012262,MBR00000476,Professional,2021-02-02,2021-02-02,2021-03-09,PLN2350,1366426662,1366426662,Urology,In-Network,F03.90,N40.0,,,,,,,0,,86900,Pathology/Lab,,,,22,Outpatient Hospital,3,29.67,21.86,0.0,0.0,0.0,0.86,0.86,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012263,MBR00000476,Professional,2022-04-02,2022-04-02,2022-04-10,PLN3527,1284035364,1284035364,Pediatrics,In-Network,M54.5,M81.0,,,,,,,0,,99406,Medicine,,,,23,Emergency Room,2,85.67,59.36,59.36,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000012264,MBR00000476,Professional,2022-08-26,2022-08-26,2022-10-09,PLN3363,1103747954,1103747954,Urology,In-Network,Z00.00,J06.9,,,,,,,0,,81001,Pathology/Lab,,,,22,Outpatient Hospital,2,28.06,19.11,0.0,19.11,75.0,0.0,94.11,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000012265,MBR00000477,Professional,2023-04-12,2023-04-12,2023-05-17,PLN2807,1193493783,1193493783,Critical Access Hospital,Out-of-Network,E78.5,J44.1,,,,,,,0,,78452,Radiology,,,,23,Emergency Room,1,5310.68,2736.25,2063.26,401.03,0.0,0.0,401.03,271.96,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000012266,MBR00000477,Institutional-OP,2023-03-06,2023-03-06,2023-04-01,PLN3624,1752470395,1752470395,Home Health,In-Network,K57.30,J20.9,,,,,,,0,,23472,Surgery,,,0510,22,Outpatient Hospital,3,3312.89,1939.76,1782.62,0.0,0.0,157.14,157.14,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012267,MBR00000477,Professional,2023-06-30,2023-06-30,2023-07-15,PLN5261,1809014947,1809014947,Urology,In-Network,I10,Z12.31,,,,,,,0,,99233,E&M,,,,20,Urgent Care,3,345.99,239.34,239.34,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012268,MBR00000477,Institutional-IP,2023-06-11,2023-06-26,2023-06-21,PLN1504,1716521444,1716521444,Oncology,In-Network,Z12.31,N39.0,,,,682,MS-DRG,15,15,Y,70450,Radiology,,,0636,21,Inpatient Hospital,3,1172.62,353.49,0.0,353.49,15.0,0.0,368.49,0.0,Paid,,,1,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000012269,MBR00000477,Professional,2022-03-16,2022-03-16,2022-04-11,PLN7009,1125190055,1125190055,Nephrology,In-Network,I25.10,Z00.00,,,,,,,0,,82043,Pathology/Lab,,,,22,Outpatient Hospital,2,69.56,32.3,0.0,32.3,0.0,0.0,32.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012270,MBR00000477,Institutional-OP,2022-01-09,2022-01-09,2022-02-03,PLN7203,1609138981,1609138981,Critical Access Hospital,In-Network,E11.9,I50.9,,,,,,,0,,47562,Surgery,,,0636,22,Outpatient Hospital,3,4073.11,3159.31,2739.05,0.0,0.0,420.26,420.26,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012271,MBR00000477,Professional,2022-10-22,2022-10-22,2022-11-08,PLN7589,1745114564,1745114564,Endocrinology,In-Network,M54.5,K57.30,,,,,,,0,,99406,Medicine,,,,20,Urgent Care,2,76.1,30.12,30.12,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012272,MBR00000477,Institutional-OP,2022-06-10,2022-06-10,2022-07-17,PLN3774,1434029575,1434029575,Endocrinology,In-Network,E78.5,K57.30,,,,,,,0,,99284,E&M,,,0510,22,Outpatient Hospital,1,438.32,216.76,187.55,0.0,0.0,29.21,29.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012273,MBR00000477,Professional,2021-11-20,2021-11-20,2021-11-27,PLN8440,1899127912,1899127912,Neurology,In-Network,G43.909,J06.9,,,,,,,0,,45380,Surgery,,,,12,Home,1,2187.49,757.25,538.48,0.0,35.0,0.0,35.0,183.77,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000012274,MBR00000477,Institutional-OP,2021-02-04,2021-02-04,2021-02-25,PLN1855,1364429278,1364429278,OB/GYN,In-Network,Z00.00,N18.3,,,,,,,0,,71046,Radiology,,,0270,22,Outpatient Hospital,3,219.28,97.59,0.0,97.59,0.0,0.0,97.59,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012275,MBR00000477,Professional,2022-06-05,2022-06-05,2022-07-18,PLN5340,1125190055,1125190055,Nephrology,In-Network,K21.0,J18.9,,,,,,,0,,G0468,Medicine,,,,11,Office,1,498.74,274.92,103.6,136.32,35.0,0.0,171.32,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012276,MBR00000477,Institutional-OP,2022-05-29,2022-05-29,2022-07-09,PLN5410,1806688928,1806688928,Geriatrics,In-Network,F41.9,J44.1,,,,,,,0,,99284,E&M,,,0360,22,Outpatient Hospital,3,850.83,667.14,0.0,217.82,0.0,46.77,264.59,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012277,MBR00000477,Professional,2023-10-28,2023-10-28,2023-11-23,PLN5200,1575695214,1575695214,SNF,In-Network,F32.9,Z00.00,,,,,,,0,,99232,E&M,,,,21,Inpatient Hospital,1,354.54,239.54,225.42,4.36,0.0,0.0,4.36,9.76,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012278,MBR00000477,Institutional-OP,2023-06-09,2023-06-09,2023-07-16,PLN1180,1334916761,1334916761,ASC,In-Network,Z87.891,F32.9,,,,,,,0,,23472,Surgery,,,0636,22,Outpatient Hospital,2,5982.85,3677.63,3203.68,473.95,0.0,0.0,473.95,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012279,MBR00000477,Professional,2021-10-22,2021-10-22,2021-11-08,PLN8254,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,J44.1,F32.9,,,,,,,0,,80061,Pathology/Lab,,,,81,Independent Laboratory,2,129.63,92.47,0.0,92.47,0.0,0.0,92.47,2.82,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012280,MBR00000477,Professional,2021-05-01,2021-05-01,2021-05-24,PLN8070,1450094833,1450094833,Outpatient Clinic,In-Network,M17.11,F10.20,,,,,,,0,,27447,Surgery,,,,11,Office,3,5072.03,3145.22,1716.79,70.98,0.0,471.34,542.32,886.11,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012281,MBR00000477,Institutional-IP,2023-05-13,2023-05-18,2023-06-04,PLN6866,1687650653,1687650653,Internal Medicine,In-Network,Z23,M81.0,,,,292,MS-DRG,13,5,Y,27130,Surgery,,,0761,21,Inpatient Hospital,3,7275.03,2534.22,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-15,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012282,MBR00000477,Professional,2022-06-18,2022-06-18,2022-07-05,PLN8521,1337791138,1337791138,Internal Medicine,Out-of-Network,S72.001A,K21.0,,,,,,,0,,99204,E&M,,,,12,Home,2,514.16,320.59,225.02,0.0,75.0,12.39,87.39,8.18,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012283,MBR00000477,Institutional-OP,2021-02-16,2021-02-16,2021-03-17,PLN8749,1624202402,1624202402,Orthopedic Surgery,In-Network,N18.3,I10,,,,,,,0,,90686,Medicine,,,0270,22,Outpatient Hospital,3,139.94,102.47,0.0,0.0,0.0,0.41,0.41,0.0,Denied,CO-27,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000012284,MBR00000478,Professional,2023-04-06,2023-04-06,2023-05-05,PLN2773,1334916761,1334916761,ASC,In-Network,F41.9,J20.9,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,3,252.19,186.06,0.0,186.06,0.0,0.0,186.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012285,MBR00000478,Institutional-OP,2022-01-14,2022-01-14,2022-02-07,PLN9599,1800011727,1800011727,Clinical Laboratory,Out-of-Network,F32.9,N17.9,,,,,,,0,,99214,E&M,,,0360,22,Outpatient Hospital,1,239.16,96.11,96.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012286,MBR00000478,Professional,2021-07-07,2021-07-07,2021-08-01,PLN4509,1840431511,1840431511,Geriatrics,Out-of-Network,E11.9,I10,,,,,,,0,,45380,Surgery,,,,11,Office,3,2735.18,1773.92,1723.92,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000012287,MBR00000478,Professional,2022-12-23,2022-12-23,2023-01-17,PLN4431,1135158374,1135158374,Pulmonology,In-Network,Z79.4,Z51.11,,,,,,,0,,99222,E&M,,,,11,Office,1,390.56,158.01,0.0,158.01,0.0,0.0,158.01,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012288,MBR00000478,Institutional-OP,2023-05-10,2023-05-10,2023-05-22,PLN9344,1295371663,1295371663,Critical Access Hospital,In-Network,Z23,Z12.31,,,,,,,0,,90837,Medicine,,,0120,22,Outpatient Hospital,2,290.18,101.83,101.83,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012289,MBR00000478,Institutional-IP,2023-04-30,2023-05-04,2023-05-24,PLN7082,1840431511,1840431511,Geriatrics,Out-of-Network,I25.10,Z12.11,,,,291,MS-DRG,5,4,Y,70450,Radiology,,,0450,21,Inpatient Hospital,1,1355.01,459.16,384.16,0.0,75.0,0.0,75.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012290,MBR00000478,Institutional-IP,2021-10-28,2021-11-07,2021-11-24,PLN3943,1531398223,1531398223,OB/GYN,In-Network,R10.9,Z12.11,,,,603,MS-DRG,12,10,Y,72148,Radiology,,,0270,21,Inpatient Hospital,3,1144.12,677.42,450.23,179.59,0.0,47.6,227.19,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012291,MBR00000478,Institutional-IP,2022-10-11,2022-10-18,2022-11-11,PLN1830,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,N39.0,E11.40,,,,682,MS-DRG,24,7,Y,99283,E&M,,,0301,21,Inpatient Hospital,2,540.54,182.39,84.37,8.6,75.0,14.42,98.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012292,MBR00000478,Institutional-IP,2022-05-26,2022-06-07,2022-06-28,PLN6342,1631954542,1631954542,Oncology,In-Network,Z00.00,J06.9,,,,194,MS-DRG,12,12,Y,43239,Surgery,,,0120,21,Inpatient Hospital,3,906.16,276.67,250.52,0.0,25.0,1.15,26.15,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012293,MBR00000478,Institutional-OP,2023-08-10,2023-08-10,2023-08-21,PLN9788,1168881145,1168881145,Orthopedic Surgery,In-Network,I11.9,S72.001A,,,,,,,0,,99204,E&M,,,0730,22,Outpatient Hospital,2,249.17,142.61,122.24,0.0,0.0,20.37,20.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012294,MBR00000478,Professional,2021-07-27,2021-07-27,2021-08-23,PLN3487,1224179551,1224179551,Physical Therapy,In-Network,J20.9,J06.9,,,,,,,0,,99204,E&M,,,,11,Office,1,260.29,203.04,178.04,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012295,MBR00000478,Professional,2023-06-18,2023-06-18,2023-06-29,PLN7854,1563980627,1563980627,Critical Access Hospital,In-Network,I10,Z12.31,,,,,,,0,,45380,Surgery,,,,11,Office,3,3050.85,2326.99,2252.85,74.14,0.0,0.0,74.14,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000012296,MBR00000478,Institutional-OP,2022-01-15,2022-01-15,2022-02-09,PLN8351,1809014947,1809014947,Urology,In-Network,F32.9,E78.5,,,,,,,0,,58661,Surgery,,,0450,22,Outpatient Hospital,2,1742.32,959.51,874.08,0.0,15.0,70.43,85.43,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012297,MBR00000478,Professional,2022-11-08,2022-11-08,2022-12-10,PLN8417,1500949740,1500949740,Pediatrics,In-Network,M54.5,M81.0,,,,,,,0,,70450,Radiology,,,,11,Office,1,750.78,267.9,0.0,267.9,0.0,0.0,267.9,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012298,MBR00000478,Institutional-OP,2022-07-04,2022-07-04,2022-07-18,PLN5695,1361302520,1361302520,Critical Access Hospital,In-Network,E78.5,Z00.00,,,,,,,0,,27447,Surgery,,,0301,22,Outpatient Hospital,2,3230.39,1914.75,1794.39,0.0,75.0,45.36,120.36,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012299,MBR00000478,Institutional-OP,2022-01-17,2022-01-17,2022-02-13,PLN1384,1366576336,1366576336,Geriatrics,In-Network,F41.9,E78.5,,,,,,,0,,90837,Medicine,,,0360,22,Outpatient Hospital,1,491.91,188.81,0.0,188.81,0.0,0.0,188.81,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012300,MBR00000478,Institutional-OP,2021-09-11,2021-09-11,2021-09-22,PLN4989,1450553056,1450553056,Clinical Laboratory,In-Network,E66.9,N18.3,,,,,,,0,,66984,Surgery,,,0740,22,Outpatient Hospital,3,2125.55,786.34,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-119,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012301,MBR00000478,Professional,2022-02-03,2022-02-03,2022-03-04,PLN9919,1540044947,1540044947,Pulmonology,Out-of-Network,E11.9,E66.9,,,,,,,0,,66984,Surgery,,,,11,Office,2,3529.32,1326.5,0.0,161.42,0.0,0.0,161.42,0.0,Denied,PR-1,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012302,MBR00000478,Institutional-OP,2022-10-28,2022-10-28,2022-11-24,PLN9208,1757138478,1757138478,Pediatrics,In-Network,K21.0,E11.9,,,,,,,0,,99203,E&M,,,0450,22,Outpatient Hospital,2,183.14,110.18,60.64,0.0,35.0,14.54,49.54,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012303,MBR00000478,Professional,2022-11-05,2022-11-05,2022-12-12,PLN8221,1800011727,1800011727,Clinical Laboratory,Out-of-Network,E11.65,I10,,,,,,,0,,93306,Radiology,,,,21,Inpatient Hospital,2,1552.93,651.91,651.91,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012304,MBR00000478,Professional,2022-11-14,2022-11-14,2022-12-10,PLN9121,1994661817,1994661817,SNF,Out-of-Network,E11.40,E11.9,,,,,,,0,,87491,Pathology/Lab,,,,50,Federally Qualified Health Center,1,98.91,52.59,0.0,52.59,35.0,0.0,87.59,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012305,MBR00000478,Institutional-OP,2022-12-20,2022-12-20,2023-01-04,PLN6205,1186826716,1186826716,Physical Therapy,In-Network,Z23,N18.3,,,,,,,0,,97110,Medicine,,,0301,22,Outpatient Hospital,3,134.99,78.22,57.29,0.0,15.0,5.93,20.93,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012306,MBR00000478,Institutional-OP,2021-02-26,2021-02-26,2021-03-29,PLN5441,1198133277,1198133277,SNF,In-Network,E11.9,N18.3,,,,,,,0,,99203,E&M,,,0370,22,Outpatient Hospital,3,372.14,310.03,275.03,0.0,35.0,0.0,35.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012307,MBR00000478,Professional,2022-03-09,2022-03-09,2022-04-19,PLN8910,1990090423,1990090423,Orthopedic Surgery,In-Network,R10.9,M54.5,,,,,,,0,,99283,E&M,,,,21,Inpatient Hospital,3,406.07,142.05,0.0,142.05,0.0,0.0,142.05,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012308,MBR00000478,Institutional-OP,2021-12-11,2021-12-11,2021-12-21,PLN1787,1518055405,1518055405,Urology,In-Network,Z00.01,F32.9,,,,,,,0,,G0439,Medicine,,,0320,22,Outpatient Hospital,1,485.15,240.47,240.47,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000012309,MBR00000478,Institutional-OP,2022-03-12,2022-03-12,2022-03-23,PLN6841,1502838586,1502838586,ASC,In-Network,I48.91,M54.5,,,,,,,0,,43239,Surgery,,,0320,22,Outpatient Hospital,3,1197.54,958.38,768.55,0.0,0.0,189.83,189.83,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012310,MBR00000478,Professional,2022-02-23,2022-02-23,2022-03-05,PLN5283,1295371663,1295371663,Critical Access Hospital,In-Network,M54.5,Z12.31,,,,,,,0,,93000,Radiology,,,,11,Office,1,89.47,46.38,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012311,MBR00000478,Professional,2021-07-13,2021-07-13,2021-08-17,PLN5808,1168881145,1168881145,Orthopedic Surgery,In-Network,I11.9,Z12.31,,,,,,,0,,93225,Medicine,,,,21,Inpatient Hospital,1,669.73,411.45,189.67,171.78,50.0,0.0,221.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012312,MBR00000478,Institutional-OP,2023-11-23,2023-11-23,2023-12-19,PLN3662,1372918899,1372918899,Family Medicine,In-Network,I25.10,F32.9,,,,,,,0,,99284,E&M,,,0360,22,Outpatient Hospital,3,355.1,264.89,208.23,56.66,0.0,0.0,56.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012313,MBR00000478,Professional,2021-01-01,2021-01-01,2021-01-18,PLN9220,1542828721,1542828721,Orthopedic Surgery,In-Network,E11.9,R51,,,,,,,0,,99233,E&M,,,,20,Urgent Care,2,548.23,387.21,387.21,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012314,MBR00000478,Professional,2022-10-15,2022-10-15,2022-11-08,PLN5774,1422747896,1422747896,Urology,In-Network,E66.9,E78.5,,,,,,,0,,80061,Pathology/Lab,,,,23,Emergency Room,1,90.26,60.73,0.0,60.73,0.0,0.0,60.73,0.0,Paid,,,0,,1,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000012315,MBR00000478,Professional,2022-05-21,2022-05-21,2022-05-29,PLN1698,1795618275,1795618275,Pulmonology,In-Network,F41.9,F32.9,,,,,,,0,,78452,Radiology,,,,11,Office,2,3908.51,1612.84,1367.22,220.62,25.0,0.0,245.62,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012316,MBR00000478,Institutional-OP,2023-02-10,2023-02-10,2023-03-14,PLN2534,1283743001,1283743001,Family Medicine,In-Network,Z12.31,F10.20,,,,,,,0,,66984,Surgery,,,0320,22,Outpatient Hospital,2,1283.01,853.34,803.34,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012317,MBR00000478,Institutional-OP,2023-06-29,2023-06-29,2023-08-01,PLN7193,1606140917,1606140917,ASC,In-Network,I48.91,N39.0,,,,,,,0,,90837,Medicine,,,0370,22,Outpatient Hospital,3,203.19,148.48,148.48,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012318,MBR00000479,Institutional-IP,2022-12-12,2022-12-18,2023-01-17,PLN6933,1242201429,1242201429,General Acute Care Hospital,In-Network,E66.9,Z00.00,,,,682,MS-DRG,6,6,Y,93306,Radiology,,,0370,21,Inpatient Hospital,2,1745.05,915.86,863.25,0.0,0.0,52.61,52.61,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012319,MBR00000479,Institutional-OP,2023-04-20,2023-04-20,2023-05-07,PLN1653,1438368327,1438368327,Home Health,In-Network,Z51.11,M54.5,,,,,,,0,,99204,E&M,,,0450,22,Outpatient Hospital,2,271.59,215.8,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012320,MBR00000479,Institutional-IP,2021-10-27,2021-11-01,2021-11-04,PLN8478,1518055405,1518055405,Urology,In-Network,I10,Z00.00,,,,195,MS-DRG,19,5,Y,99214,E&M,,,0730,21,Inpatient Hospital,3,314.23,192.03,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012321,MBR00000479,Institutional-IP,2023-12-25,2024-01-04,2024-02-02,PLN6558,1915531927,1915531927,Critical Access Hospital,In-Network,J06.9,R07.9,,,,872,MS-DRG,8,10,Y,90837,Medicine,,,0510,21,Inpatient Hospital,1,353.6,258.97,0.0,258.97,75.0,0.0,333.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012322,MBR00000479,Professional,2021-04-06,2021-04-06,2021-05-04,PLN5269,1891849440,1891849440,Oncology,In-Network,Z79.4,E11.40,,,,,,,0,,97530,Medicine,,,,11,Office,3,135.11,48.62,0.0,48.62,0.0,0.0,48.62,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012323,MBR00000479,Professional,2023-01-03,2023-01-03,2023-01-23,PLN7345,1239316214,1239316214,Internal Medicine,In-Network,N40.0,E11.9,,,,,,,0,,99213,E&M,,,,22,Outpatient Hospital,2,255.98,102.66,0.0,102.66,75.0,0.0,177.66,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000012324,MBR00000479,Professional,2021-06-10,2021-06-10,2021-06-20,PLN1914,1284035364,1284035364,Pediatrics,In-Network,N17.9,N39.0,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,2,549.42,425.67,425.67,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012325,MBR00000479,Professional,2021-09-14,2021-09-14,2021-10-06,PLN6154,1799205295,1799205295,General Acute Care Hospital,In-Network,N39.0,Z12.31,,,,,,,0,,99232,E&M,,,,31,Skilled Nursing Facility,2,308.11,100.26,100.26,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012326,MBR00000479,Professional,2023-06-23,2023-06-23,2023-07-05,PLN2313,1717546253,1717546253,Family Medicine,In-Network,Z23,E11.9,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,3,265.2,88.62,73.62,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012327,MBR00000479,Professional,2023-01-12,2023-01-12,2023-01-21,PLN6541,1840431511,1840431511,Geriatrics,Out-of-Network,E78.5,Z12.31,,,,,,,0,,99213,E&M,,,,11,Office,3,154.09,126.48,101.48,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012328,MBR00000479,Professional,2022-11-25,2022-11-25,2022-12-04,PLN7412,1997536841,1997536841,Family Medicine,Out-of-Network,Z23,Z00.00,,,,,,,0,,99406,Medicine,,,,20,Urgent Care,3,72.44,23.28,23.28,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012329,MBR00000479,Professional,2023-06-27,2023-06-27,2023-07-23,PLN9488,1168246159,1168246159,Internal Medicine,In-Network,K21.0,K21.0,,,,,,,0,,99232,E&M,,,,20,Urgent Care,2,372.63,233.52,0.0,233.52,50.0,0.0,283.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012330,MBR00000479,Professional,2021-11-01,2021-11-01,2021-11-25,PLN3475,1148984206,1148984206,Psychiatry,In-Network,F41.9,E78.5,,,,,,,0,,99203,E&M,,,,21,Inpatient Hospital,2,343.57,204.02,96.06,107.96,0.0,0.0,107.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012331,MBR00000479,Professional,2022-12-03,2022-12-03,2022-12-25,PLN3388,1313212303,1313212303,Family Medicine,In-Network,J20.9,G43.909,,,,,,,0,,90837,Medicine,,,,22,Outpatient Hospital,3,343.72,208.97,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012332,MBR00000479,Institutional-OP,2021-08-10,2021-08-10,2021-08-24,PLN4455,1109850785,1109850785,ASC,Out-of-Network,M17.11,I11.9,,,,,,,0,,99221,E&M,,,0730,22,Outpatient Hospital,3,303.73,198.67,178.28,0.0,15.0,5.39,20.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012333,MBR00000479,Institutional-OP,2022-06-12,2022-06-12,2022-07-12,PLN8003,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,E11.9,Z96.641,,,,,,,0,,99213,E&M,,,0761,22,Outpatient Hospital,1,305.69,104.81,104.81,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012334,MBR00000479,Institutional-IP,2022-03-20,2022-03-25,2022-04-07,PLN8852,1236418230,1236418230,DME Supplier,In-Network,Z96.641,Z00.00,,,,603,MS-DRG,7,5,Y,58661,Surgery,,,0740,21,Inpatient Hospital,1,2074.09,1559.42,1015.29,457.98,25.0,61.15,544.13,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012335,MBR00000479,Professional,2022-11-09,2022-11-09,2022-11-16,PLN1857,1205377316,1205377316,Orthopedic Surgery,In-Network,Z00.00,E78.5,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,3,329.25,210.89,118.23,0.0,75.0,17.66,92.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012336,MBR00000479,Institutional-IP,2021-03-13,2021-03-18,2021-04-15,PLN8898,1193493783,1193493783,Critical Access Hospital,Out-of-Network,E11.9,R10.9,,,,195,MS-DRG,11,5,Y,43239,Surgery,,,0636,21,Inpatient Hospital,2,962.71,662.38,643.93,0.0,0.0,18.45,18.45,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012337,MBR00000479,Institutional-OP,2021-01-29,2021-01-29,2021-02-12,PLN9190,1631954542,1631954542,Oncology,In-Network,I10,Z12.11,,,,,,,0,,66984,Surgery,,,0270,22,Outpatient Hospital,2,3068.66,2083.8,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-15,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012338,MBR00000479,Professional,2021-02-04,2021-02-04,2021-02-13,PLN2506,1198133277,1198133277,SNF,In-Network,E78.5,E11.65,,,,,,,0,,72148,Radiology,,,,49,Independent Clinic,2,2339.48,1306.59,0.0,0.0,0.0,0.0,0.0,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012339,MBR00000479,Professional,2021-10-18,2021-10-18,2021-11-02,PLN3208,1540044947,1540044947,Pulmonology,Out-of-Network,B97.89,E11.9,,,,,,,0,,99233,E&M,,,,11,Office,3,481.35,165.03,162.69,0.0,0.0,2.34,2.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012340,MBR00000479,Professional,2022-09-23,2022-09-23,2022-10-15,PLN5666,1575695214,1575695214,SNF,In-Network,E66.9,E78.5,,,,,,,0,,87491,Pathology/Lab,,,,23,Emergency Room,2,194.07,107.63,0.0,107.63,0.0,0.0,107.63,0.0,Adjusted,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000012341,MBR00000479,Professional,2021-06-22,2021-06-22,2021-07-05,PLN1633,1475984649,1475984649,SNF,In-Network,F41.9,Z23,,,,,,,0,,23472,Surgery,,,,11,Office,2,6623.35,4364.06,0.0,0.0,50.0,467.56,517.56,0.0,Denied,CO-18,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012342,MBR00000480,Professional,2023-12-22,2023-12-22,2024-01-16,PLN3904,1948810580,1948810580,DME Supplier,In-Network,E78.5,E11.9,,,,,,,0,,99406,Medicine,,,,11,Office,3,90.44,51.77,47.15,0.0,0.0,4.62,4.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012343,MBR00000480,Professional,2022-03-29,2022-03-29,2022-04-21,PLN4933,1124394415,1124394415,Pediatrics,In-Network,Z00.00,E11.9,,,,,,,0,,99406,Medicine,,,,11,Office,3,95.44,28.91,3.91,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012344,MBR00000480,Professional,2021-11-28,2021-11-28,2021-12-26,PLN1220,1500949740,1500949740,Pediatrics,In-Network,F41.9,G43.909,,,,,,,0,,99232,E&M,,,,21,Inpatient Hospital,1,158.86,129.96,111.2,0.0,15.0,3.76,18.76,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012345,MBR00000480,Professional,2023-09-05,2023-09-05,2023-10-06,PLN3095,1168881145,1168881145,Orthopedic Surgery,In-Network,E11.9,Z87.891,,,,,,,0,,80061,Pathology/Lab,,,,49,Independent Clinic,3,50.99,15.51,0.0,15.51,50.0,0.0,65.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012346,MBR00000480,Professional,2021-07-11,2021-07-11,2021-08-17,PLN4970,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,Z00.00,J20.9,,,,,,,0,,99222,E&M,,,,11,Office,2,441.89,183.15,0.0,183.15,35.0,0.0,218.15,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012347,MBR00000480,Institutional-OP,2021-07-25,2021-07-25,2021-08-15,PLN9533,1856686341,1856686341,Geriatrics,In-Network,E66.9,R10.9,,,,,,,0,,99213,E&M,,,0450,22,Outpatient Hospital,2,132.58,105.14,76.15,0.0,15.0,13.99,28.99,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012348,MBR00000480,Professional,2022-02-21,2022-02-21,2022-03-26,PLN1147,1247341320,1247341320,Urology,Out-of-Network,E11.65,N40.0,,,,,,,0,,99214,E&M,,,,21,Inpatient Hospital,3,219.58,76.96,61.96,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012349,MBR00000480,Institutional-OP,2021-03-19,2021-03-19,2021-04-02,PLN6938,1266606767,1266606767,ASC,In-Network,R10.9,E78.5,,,,,,,0,,90460,Medicine,,,0761,22,Outpatient Hospital,3,49.58,33.45,0.0,0.0,15.0,2.01,17.01,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012350,MBR00000480,Professional,2023-01-17,2023-01-17,2023-02-06,PLN6156,1915531927,1915531927,Critical Access Hospital,In-Network,F41.9,E66.9,,,,,,,0,,45378,Surgery,,,,21,Inpatient Hospital,1,2466.75,1518.18,839.99,491.44,0.0,186.75,678.19,0.0,Pended,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000012351,MBR00000480,Institutional-OP,2023-05-01,2023-05-01,2023-06-01,PLN2086,1219817751,1219817751,OB/GYN,In-Network,F32.9,E11.9,,,,,,,0,,58661,Surgery,,,0200,22,Outpatient Hospital,1,2650.35,891.11,866.11,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,1,0,0,1,Upcoding,0,0,0,0,0
CLM0000012352,MBR00000480,Institutional-OP,2022-01-23,2022-01-23,2022-02-14,PLN6656,1778483301,1778483301,Home Health,In-Network,J20.9,E78.5,,,,,,,0,,80061,Pathology/Lab,,,0320,22,Outpatient Hospital,3,130.4,76.86,0.0,76.86,75.0,0.0,151.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012353,MBR00000480,Institutional-IP,2023-08-09,2023-08-20,2023-09-04,PLN5479,1795618275,1795618275,Pulmonology,In-Network,N17.9,Z00.00,,,,292,MS-DRG,20,11,Y,90686,Medicine,,,0636,21,Inpatient Hospital,3,135.62,77.45,0.0,77.45,0.0,0.0,77.45,0.0,Denied,CO-4,,0,,0,1,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000012354,MBR00000480,Institutional-IP,2021-01-09,2021-01-10,2021-01-25,PLN2655,1450094833,1450094833,Outpatient Clinic,In-Network,E11.9,R07.9,,,,196,MS-DRG,13,1,Y,G0444,Medicine,,,0450,21,Inpatient Hospital,2,73.1,54.81,54.81,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000012355,MBR00000480,Institutional-IP,2022-08-05,2022-08-11,2022-08-20,PLN1230,1219817751,1219817751,OB/GYN,In-Network,Z12.31,Z23,,,,682,MS-DRG,3,6,Y,G0439,Medicine,,,0200,21,Inpatient Hospital,1,436.44,145.03,0.0,82.99,0.0,6.84,89.83,0.0,Denied,CO-97,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000012356,MBR00000480,Institutional-OP,2023-03-11,2023-03-11,2023-04-02,PLN4952,1609138981,1609138981,Critical Access Hospital,In-Network,K21.0,Z12.31,,,,,,,0,,99222,E&M,,,0360,22,Outpatient Hospital,2,577.63,283.84,0.0,236.43,50.0,0.0,286.43,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012357,MBR00000480,Professional,2022-02-17,2022-02-17,2022-03-24,PLN1199,1702692193,1702692193,Physical Therapy,In-Network,F32.9,I48.91,,,,,,,0,,45378,Surgery,,,,81,Independent Laboratory,2,973.48,701.19,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,1,1,0,0,1,Phantom,0,1,0,0,0
CLM0000012358,MBR00000480,Professional,2023-11-03,2023-11-03,2023-12-16,PLN1454,1609138981,1609138981,Critical Access Hospital,In-Network,I25.10,B97.89,,,,,,,0,,99204,E&M,,,,21,Inpatient Hospital,1,313.67,221.05,183.91,0.0,0.0,37.14,37.14,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012359,MBR00000480,Institutional-OP,2022-04-17,2022-04-17,2022-05-12,PLN3185,1366576336,1366576336,Geriatrics,In-Network,K57.30,E66.9,,,,,,,0,,70553,Radiology,,,0740,22,Outpatient Hospital,3,2475.02,1483.79,1483.79,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012360,MBR00000480,Professional,2023-10-03,2023-10-03,2023-11-16,PLN1410,1795618275,1795618275,Pulmonology,In-Network,R05,J06.9,,,,,,,0,,93225,Medicine,,,,49,Independent Clinic,1,410.98,328.21,328.21,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012361,MBR00000480,Professional,2022-12-23,2022-12-23,2023-01-13,PLN3063,1247341320,1247341320,Urology,Out-of-Network,M54.5,J45.20,,,,,,,0,,97110,Medicine,,,,11,Office,2,110.95,93.38,0.0,93.38,0.0,0.0,93.38,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012362,MBR00000480,Institutional-OP,2021-09-10,2021-09-10,2021-09-29,PLN4687,1502838586,1502838586,ASC,In-Network,G43.909,Z23,,,,,,,0,,72148,Radiology,,,0370,22,Outpatient Hospital,1,2551.94,1171.67,769.23,327.44,75.0,0.0,402.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012363,MBR00000481,Institutional-OP,2023-06-30,2023-06-30,2023-08-10,PLN7323,1994661817,1994661817,SNF,Out-of-Network,F41.9,E11.9,,,,,,,0,,84443,Pathology/Lab,,,0120,22,Outpatient Hospital,2,72.58,30.33,0.0,30.33,15.0,0.0,45.33,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012364,MBR00000481,Professional,2021-02-03,2021-02-03,2021-02-23,PLN5013,1780163051,1780163051,SNF,In-Network,J20.9,E11.9,,,,,,,0,,93225,Medicine,,,,11,Office,2,657.98,319.85,302.68,17.17,0.0,0.0,17.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012365,MBR00000481,Professional,2021-07-27,2021-07-27,2021-08-25,PLN8884,1872613201,1872613201,Internal Medicine,In-Network,E66.9,Z00.00,,,,,,,0,,33533,Surgery,,,,21,Inpatient Hospital,1,22309.52,18903.34,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-15,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000012366,MBR00000481,Professional,2023-05-04,2023-05-04,2023-06-09,PLN2543,1997536841,1997536841,Family Medicine,Out-of-Network,Z23,I25.10,,,,,,,0,,72148,Radiology,,,,21,Inpatient Hospital,3,2004.88,708.11,683.11,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012367,MBR00000481,Professional,2023-09-15,2023-09-15,2023-10-21,PLN9647,1422747896,1422747896,Urology,In-Network,Z12.31,I50.9,,,,,,,0,,90686,Medicine,,,,12,Home,3,123.32,74.2,14.98,6.68,50.0,2.54,59.22,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000012368,MBR00000481,Institutional-OP,2022-03-01,2022-03-01,2022-03-13,PLN9939,1266606767,1266606767,ASC,In-Network,M17.11,N18.3,,,,,,,0,,45380,Surgery,,,0301,22,Outpatient Hospital,1,1491.49,482.47,201.58,251.14,0.0,29.75,280.89,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000012369,MBR00000481,Professional,2022-12-21,2022-12-21,2023-01-06,PLN8617,1702692193,1702692193,Physical Therapy,In-Network,Z23,N39.0,,,,,,,0,,27447,Surgery,,,,31,Skilled Nursing Facility,2,6139.52,2218.88,2168.88,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012370,MBR00000481,Professional,2023-02-03,2023-02-03,2023-02-18,PLN7242,1361302520,1361302520,Critical Access Hospital,In-Network,Z23,J44.1,,,,,,,0,,80061,Pathology/Lab,,,,81,Independent Laboratory,2,56.75,34.93,0.0,0.0,50.0,0.0,50.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012371,MBR00000481,Institutional-OP,2023-03-20,2023-03-20,2023-04-04,PLN4169,1502838586,1502838586,ASC,In-Network,I10,I63.9,,,,,,,0,,90837,Medicine,,,0301,22,Outpatient Hospital,2,477.5,328.16,294.18,0.0,15.0,18.98,33.98,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012372,MBR00000481,Professional,2023-09-19,2023-09-19,2023-10-30,PLN4164,1502838586,1502838586,ASC,In-Network,Z00.01,Z23,,,,,,,0,,85610,Pathology/Lab,,,,11,Office,2,49.6,39.29,0.0,39.29,0.0,0.0,39.29,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012373,MBR00000481,Institutional-OP,2021-04-06,2021-04-06,2021-05-10,PLN2367,1799205295,1799205295,General Acute Care Hospital,In-Network,E66.9,F41.9,,,,,,,0,,58661,Surgery,,,0360,22,Outpatient Hospital,1,2226.33,1273.84,1271.32,0.0,0.0,2.52,2.52,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012374,MBR00000481,Professional,2021-07-30,2021-07-30,2021-08-06,PLN9188,1696843572,1696843572,Critical Access Hospital,Out-of-Network,I50.9,R05,,,,,,,0,,27447,Surgery,,,,49,Independent Clinic,2,5213.8,3364.47,3329.47,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012375,MBR00000481,Professional,2023-10-03,2023-10-03,2023-11-12,PLN6843,1545347862,1545347862,SNF,In-Network,N39.0,E11.9,,,,,,,0,,99221,E&M,,,,21,Inpatient Hospital,1,271.1,210.6,0.0,40.43,0.0,0.0,40.43,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012376,MBR00000481,Institutional-OP,2022-08-20,2022-08-20,2022-09-13,PLN1708,1727809972,1727809972,Home Health,In-Network,Z00.00,Z00.00,,,,,,,0,,45378,Surgery,,,0301,22,Outpatient Hospital,2,1223.48,436.34,436.34,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000012377,MBR00000481,Professional,2022-08-02,2022-08-02,2022-08-09,PLN7629,1366576336,1366576336,Geriatrics,In-Network,I11.9,J06.9,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,1,604.29,442.33,442.33,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012378,MBR00000481,Institutional-IP,2022-03-18,2022-03-24,2022-04-15,PLN5162,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,I10,K21.0,,,,641,MS-DRG,17,6,N,99221,E&M,,,0301,21,Inpatient Hospital,1,196.89,63.75,0.0,63.75,35.0,0.0,98.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012379,MBR00000481,Professional,2022-02-01,2022-02-01,2022-03-15,PLN5798,1103747954,1103747954,Urology,In-Network,Z87.891,Z12.31,,,,,,,0,,82043,Pathology/Lab,,,,23,Emergency Room,1,75.96,27.77,0.0,27.77,0.0,0.0,27.77,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000012380,MBR00000481,Institutional-OP,2021-09-26,2021-09-26,2021-10-18,PLN5984,1696843572,1696843572,Critical Access Hospital,Out-of-Network,N39.0,I10,,,,,,,0,,70450,Radiology,,,0730,22,Outpatient Hospital,2,1711.54,622.61,240.06,382.55,0.0,0.0,382.55,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012381,MBR00000481,Professional,2022-03-13,2022-03-13,2022-04-15,PLN9135,1463205530,1463205530,Nephrology,In-Network,Z23,E78.5,,,,,,,0,,99214,E&M,,,,11,Office,2,181.04,108.05,23.0,85.05,0.0,0.0,85.05,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000012382,MBR00000482,Institutional-OP,2021-03-22,2021-03-22,2021-04-30,PLN1649,1450553056,1450553056,Clinical Laboratory,In-Network,E78.5,M54.5,,,,,,,0,,99204,E&M,,,0636,22,Outpatient Hospital,3,398.04,314.51,0.0,0.0,0.0,17.67,17.67,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012383,MBR00000482,Institutional-OP,2021-11-17,2021-11-17,2021-12-15,PLN8106,1389336600,1389336600,Critical Access Hospital,In-Network,J20.9,R51,,,,,,,0,,47562,Surgery,,,0200,22,Outpatient Hospital,1,5197.87,1854.22,1779.22,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012384,MBR00000482,Professional,2023-12-24,2023-12-24,2024-01-20,PLN1909,1295371663,1295371663,Critical Access Hospital,In-Network,Z87.891,N39.0,,,,,,,0,,27130,Surgery,,,,31,Skilled Nursing Facility,3,6391.28,4251.6,4216.6,0.0,35.0,0.0,35.0,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012385,MBR00000482,Professional,2021-06-28,2021-06-28,2021-07-28,PLN6530,1193493783,1193493783,Critical Access Hospital,Out-of-Network,J18.9,K57.30,,,,,,,0,,93225,Medicine,,,,20,Urgent Care,2,878.89,670.79,670.79,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012386,MBR00000482,Institutional-OP,2023-03-13,2023-03-13,2023-04-07,PLN9442,1463205530,1463205530,Nephrology,In-Network,Z00.00,E78.5,,,,,,,0,,99214,E&M,,,0450,22,Outpatient Hospital,1,172.21,87.79,37.63,0.0,50.0,0.16,50.16,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012387,MBR00000482,Institutional-OP,2021-02-07,2021-02-07,2021-02-23,PLN5535,1561134315,1561134315,DME Supplier,In-Network,I63.9,I25.10,,,,,,,0,,99213,E&M,,,0636,22,Outpatient Hospital,3,273.64,94.79,0.0,94.79,0.0,0.0,94.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012388,MBR00000482,Professional,2023-03-15,2023-03-15,2023-04-01,PLN9469,1132188260,1132188260,Family Medicine,In-Network,E11.65,J20.9,,,,,,,0,,90837,Medicine,,,,11,Office,2,183.41,101.08,0.0,0.0,50.0,2.77,52.77,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012389,MBR00000482,Institutional-OP,2021-10-17,2021-10-17,2021-11-15,PLN3144,1542828721,1542828721,Orthopedic Surgery,In-Network,I48.91,I10,,,,,,,0,,43239,Surgery,,,0320,22,Outpatient Hospital,2,2119.24,773.13,430.01,305.37,35.0,2.75,343.12,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012390,MBR00000482,Institutional-OP,2023-02-09,2023-02-09,2023-03-10,PLN1825,1132188260,1132188260,Family Medicine,In-Network,J06.9,Z00.00,,,,,,,0,,99284,E&M,,,0900,22,Outpatient Hospital,1,830.46,464.1,464.1,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012391,MBR00000482,Institutional-OP,2022-06-28,2022-06-28,2022-07-27,PLN5357,1745114564,1745114564,Endocrinology,In-Network,G43.909,E11.9,,,,,,,0,,74177,Radiology,,,0360,22,Outpatient Hospital,2,1822.97,1364.49,1205.47,159.02,0.0,0.0,159.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012392,MBR00000482,Professional,2023-04-30,2023-04-30,2023-06-07,PLN8335,1991459367,1991459367,Neurology,Out-of-Network,N18.3,Z00.00,,,,,,,0,,G0468,Medicine,,,,65,End-Stage Renal Disease,3,692.77,549.56,377.54,148.3,0.0,23.72,172.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012393,MBR00000482,Professional,2023-01-01,2023-01-01,2023-02-02,PLN4401,1514306773,1514306773,Endocrinology,In-Network,J06.9,J18.9,,,,,,,0,,99406,Medicine,,,,23,Emergency Room,1,74.39,47.57,0.0,47.57,0.0,0.0,47.57,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000012394,MBR00000482,Institutional-OP,2022-09-04,2022-09-04,2022-10-09,PLN3630,1691062876,1691062876,SNF,In-Network,I10,K92.1,,,,,,,0,,33533,Surgery,,,0120,22,Outpatient Hospital,1,27185.18,13761.13,13574.55,111.58,75.0,0.0,186.58,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000012395,MBR00000482,Institutional-IP,2023-03-15,2023-03-20,2023-04-15,PLN1380,1475984649,1475984649,SNF,In-Network,I25.10,J06.9,,,,682,MS-DRG,20,5,Y,99233,E&M,,,0730,21,Inpatient Hospital,3,403.37,221.57,105.69,105.73,0.0,10.15,115.88,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012396,MBR00000483,Professional,2023-11-24,2023-11-24,2023-12-11,PLN2571,1139906830,1139906830,Endocrinology,Out-of-Network,C50.912,I10,,,,,,,0,,99203,E&M,,,,11,Office,2,141.85,64.38,61.35,0.0,0.0,3.03,3.03,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012397,MBR00000483,Institutional-IP,2022-10-15,2022-10-18,2022-11-17,PLN6255,1749494482,1749494482,Pediatrics,In-Network,J06.9,I10,,,,872,MS-DRG,3,3,U,45378,Surgery,,,0900,21,Inpatient Hospital,3,1758.55,555.23,0.0,346.89,0.0,0.0,346.89,0.0,Denied,CO-4,,0,,0,1,1,0,1,0,None,0,1,0,0,0
CLM0000012398,MBR00000483,Institutional-OP,2021-07-10,2021-07-10,2021-08-03,PLN6004,1355166277,1355166277,Endocrinology,In-Network,F03.90,F32.9,,,,,,,0,,97530,Medicine,,,0301,22,Outpatient Hospital,3,174.19,125.51,0.0,112.44,25.0,0.0,137.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012399,MBR00000483,Professional,2021-05-08,2021-05-08,2021-06-21,PLN2195,1366426662,1366426662,Urology,In-Network,F03.90,E78.5,,,,,,,0,,81001,Pathology/Lab,,,,22,Outpatient Hospital,2,24.8,11.47,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012400,MBR00000483,Institutional-IP,2022-08-23,2022-08-25,2022-10-05,PLN9398,1780163051,1780163051,SNF,In-Network,C50.912,B97.89,,,,872,MS-DRG,8,2,Y,99406,Medicine,,,0320,21,Inpatient Hospital,2,101.56,49.56,49.56,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012401,MBR00000483,Professional,2022-04-18,2022-04-18,2022-05-21,PLN9219,1991459367,1991459367,Neurology,Out-of-Network,I10,R05,,,,,,,0,,27447,Surgery,,,,23,Emergency Room,3,6193.06,3910.72,3128.76,0.0,75.0,706.96,781.96,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000012402,MBR00000483,Professional,2022-10-29,2022-10-29,2022-12-08,PLN6629,1502838586,1502838586,ASC,In-Network,F32.9,B97.89,,,,,,,0,,72148,Radiology,,,,50,Federally Qualified Health Center,3,1928.72,1238.96,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012403,MBR00000483,Professional,2023-01-01,2023-01-01,2023-02-04,PLN5657,1475984649,1475984649,SNF,In-Network,E11.40,K21.0,,,,,,,0,,33533,Surgery,,,,11,Office,3,16946.48,8198.88,7720.8,0.0,50.0,428.08,478.08,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000012404,MBR00000483,Professional,2021-07-24,2021-07-24,2021-08-03,PLN2304,1700633438,1700633438,DME Supplier,In-Network,E11.9,K92.1,,,,,,,0,,33533,Surgery,,,,11,Office,1,28319.01,11561.32,11073.19,488.13,0.0,0.0,488.13,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000012405,MBR00000483,Institutional-IP,2023-03-25,2023-04-02,2023-04-21,PLN3096,1702692193,1702692193,Physical Therapy,In-Network,Z00.00,F10.20,,,,872,MS-DRG,15,8,Y,87491,Pathology/Lab,,,0510,21,Inpatient Hospital,1,131.76,47.25,47.25,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012406,MBR00000483,Institutional-OP,2023-12-22,2023-12-22,2024-01-27,PLN2224,1563980627,1563980627,Critical Access Hospital,In-Network,F32.9,Z23,,,,,,,0,,99222,E&M,,,0270,22,Outpatient Hospital,2,660.48,524.64,407.77,67.53,35.0,14.34,116.87,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012407,MBR00000483,Professional,2021-12-22,2021-12-22,2022-01-26,PLN7310,1205377316,1205377316,Orthopedic Surgery,In-Network,E11.9,N18.3,,,,,,,0,,97110,Medicine,,,,11,Office,1,196.41,62.38,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012408,MBR00000483,Professional,2023-10-14,2023-10-14,2023-11-10,PLN3303,1716521444,1716521444,Oncology,In-Network,I50.9,F32.9,,,,,,,0,,70553,Radiology,,,,21,Inpatient Hospital,2,2750.8,2283.13,2150.46,104.0,0.0,28.67,132.67,0.0,Pended,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012409,MBR00000483,Institutional-OP,2023-10-14,2023-10-14,2023-11-24,PLN2996,1752470395,1752470395,Home Health,In-Network,R10.9,J20.9,,,,,,,0,,27447,Surgery,,,0510,22,Outpatient Hospital,3,5326.07,2361.9,2041.74,0.0,0.0,320.16,320.16,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012410,MBR00000483,Professional,2022-04-04,2022-04-04,2022-04-13,PLN9888,1946680931,1946680931,Critical Access Hospital,Out-of-Network,E78.5,E78.5,,,,,,,0,,43239,Surgery,,,,11,Office,3,2172.62,1056.47,835.9,220.57,0.0,0.0,220.57,0.0,Pended,,,1,,0,0,1,0,0,1,Duplicate,0,0,0,0,0
CLM0000012411,MBR00000483,Institutional-OP,2023-05-21,2023-05-21,2023-06-18,PLN2632,1125190055,1125190055,Nephrology,In-Network,M81.0,E11.9,,,,,,,0,,99406,Medicine,,,0360,22,Outpatient Hospital,2,91.92,52.54,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012412,MBR00000483,Institutional-IP,2023-10-18,2023-10-21,2023-11-24,PLN9742,1422747896,1422747896,Urology,In-Network,Z87.891,Z79.4,,,,292,MS-DRG,10,3,N,99213,E&M,,,0450,21,Inpatient Hospital,2,270.7,183.56,0.0,183.56,0.0,0.0,183.56,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012413,MBR00000483,Institutional-OP,2023-07-22,2023-07-22,2023-08-10,PLN7750,1946680931,1946680931,Critical Access Hospital,Out-of-Network,M17.11,I10,,,,,,,0,,93000,Radiology,,,0900,22,Outpatient Hospital,2,79.51,27.83,0.0,27.83,75.0,0.0,102.83,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012414,MBR00000483,Institutional-OP,2022-03-02,2022-03-02,2022-03-26,PLN8364,1389336600,1389336600,Critical Access Hospital,In-Network,Z00.00,E11.9,,,,,,,0,,33533,Surgery,,,0360,22,Outpatient Hospital,3,12727.57,9516.23,9310.46,170.77,35.0,0.0,205.77,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000012415,MBR00000483,Institutional-OP,2022-12-31,2022-12-31,2023-02-13,PLN5890,1227362142,1227362142,DME Supplier,In-Network,E11.65,E66.9,,,,,,,0,,93306,Radiology,,,0270,22,Outpatient Hospital,2,3021.2,2115.06,1392.04,472.88,25.0,225.14,723.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012416,MBR00000483,Institutional-IP,2022-10-11,2022-10-29,2022-11-19,PLN6086,1561134315,1561134315,DME Supplier,In-Network,I48.91,Z96.641,,,,872,MS-DRG,23,18,Y,47562,Surgery,,,0270,21,Inpatient Hospital,3,5054.42,2957.7,2922.7,0.0,35.0,0.0,35.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012417,MBR00000483,Professional,2022-03-30,2022-03-30,2022-05-02,PLN1066,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,Z12.31,R10.9,,,,,,,0,,43239,Surgery,,,,21,Inpatient Hospital,1,1806.95,1071.35,1021.35,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012418,MBR00000483,Institutional-OP,2022-12-02,2022-12-02,2023-01-08,PLN2223,1687650653,1687650653,Internal Medicine,In-Network,R05,Z00.01,,,,,,,0,,99204,E&M,,,0730,22,Outpatient Hospital,3,487.61,150.98,0.0,131.23,25.0,0.0,156.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012419,MBR00000483,Professional,2023-10-20,2023-10-20,2023-11-06,PLN6248,1691062876,1691062876,SNF,In-Network,F41.9,I10,,,,,,,0,,99204,E&M,,,,11,Office,1,246.46,135.67,0.0,135.67,0.0,0.0,135.67,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012420,MBR00000483,Institutional-IP,2021-01-29,2021-02-03,2021-02-28,PLN7169,1780163051,1780163051,SNF,In-Network,I48.91,N39.0,,,,871,MS-DRG,7,5,Y,97530,Medicine,,,0450,21,Inpatient Hospital,3,167.52,80.65,0.0,80.65,0.0,0.0,80.65,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000012421,MBR00000483,Professional,2023-09-15,2023-09-15,2023-10-04,PLN2392,1284035364,1284035364,Pediatrics,In-Network,G43.909,I10,,,,,,,0,,84443,Pathology/Lab,,,,22,Outpatient Hospital,1,152.03,78.62,71.62,0.0,0.0,7.0,7.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012422,MBR00000483,Institutional-OP,2022-02-08,2022-02-08,2022-02-18,PLN1791,1727809972,1727809972,Home Health,In-Network,M81.0,F41.9,,,,,,,0,,97530,Medicine,,,0370,22,Outpatient Hospital,3,308.68,255.47,255.47,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012423,MBR00000483,Institutional-OP,2023-06-27,2023-06-27,2023-07-16,PLN7888,1609526529,1609526529,Psychiatry,In-Network,Z00.00,I50.9,,,,,,,0,,76700,Radiology,,,0301,22,Outpatient Hospital,1,1422.76,1105.94,750.26,280.68,75.0,0.0,355.68,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012424,MBR00000484,Institutional-OP,2021-04-29,2021-04-29,2021-05-11,PLN1876,1236418230,1236418230,DME Supplier,In-Network,K21.0,I11.9,,,,,,,0,,27130,Surgery,,,0450,22,Outpatient Hospital,2,3156.13,1900.72,1825.72,0.0,75.0,0.0,75.0,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012425,MBR00000484,Professional,2023-09-03,2023-09-03,2023-09-27,PLN8851,1896447406,1896447406,Nephrology,Out-of-Network,Z23,I11.9,,,,,,,0,,G0468,Medicine,,,,81,Independent Laboratory,1,528.79,234.99,153.27,0.0,50.0,31.72,81.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012426,MBR00000484,Institutional-OP,2022-05-06,2022-05-06,2022-05-24,PLN1977,1502838586,1502838586,ASC,In-Network,M54.5,J20.9,,,,,,,0,,93225,Medicine,,,0360,22,Outpatient Hospital,2,414.09,188.52,163.52,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012427,MBR00000484,Institutional-OP,2023-10-01,2023-10-01,2023-10-14,PLN5617,1571574052,1571574052,Critical Access Hospital,In-Network,I10,M54.5,,,,,,,0,,99221,E&M,,,0730,22,Outpatient Hospital,2,331.96,231.42,231.42,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012428,MBR00000484,Professional,2022-04-14,2022-04-14,2022-04-26,PLN7204,1224179551,1224179551,Physical Therapy,In-Network,J20.9,M54.5,,,,,,,0,,43239,Surgery,,,,49,Independent Clinic,1,1674.07,1346.59,1042.29,259.73,0.0,44.57,304.3,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012429,MBR00000484,Professional,2023-03-29,2023-03-29,2023-05-12,PLN9595,1295371663,1295371663,Critical Access Hospital,In-Network,E11.65,N39.0,,,,,,,0,,58661,Surgery,,,,21,Inpatient Hospital,2,2307.71,808.14,328.72,454.42,25.0,0.0,479.42,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012430,MBR00000484,Professional,2022-10-15,2022-10-15,2022-11-13,PLN8025,1980712759,1980712759,Outpatient Clinic,Out-of-Network,E11.9,I10,,,,,,,0,,43239,Surgery,,,,31,Skilled Nursing Facility,2,2249.79,1798.06,1798.06,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012431,MBR00000484,Professional,2021-08-08,2021-08-08,2021-09-14,PLN6680,1622771872,1622771872,Pediatrics,In-Network,I10,M54.5,,,,,,,0,,74177,Radiology,,,,22,Outpatient Hospital,3,1465.76,865.25,415.21,450.04,0.0,0.0,450.04,0.0,Pended,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000012432,MBR00000484,Institutional-IP,2021-10-01,2021-10-05,2021-11-01,PLN5776,1812060197,1812060197,Oncology,Out-of-Network,Z00.01,I10,,,,196,MS-DRG,15,4,Y,G0439,Medicine,,,0900,21,Inpatient Hospital,2,593.75,184.62,0.0,123.46,75.0,0.0,198.46,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000012433,MBR00000484,Professional,2022-08-13,2022-08-13,2022-09-04,PLN1190,1463205530,1463205530,Nephrology,In-Network,E11.9,Z12.31,,,,,,,0,,93225,Medicine,,,,11,Office,1,981.4,328.96,299.64,0.0,0.0,29.32,29.32,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012434,MBR00000484,Professional,2022-06-18,2022-06-18,2022-07-25,PLN1005,1994661817,1994661817,SNF,Out-of-Network,J06.9,Z12.11,,,,,,,0,,99222,E&M,,,,50,Federally Qualified Health Center,3,653.61,473.92,431.69,27.23,15.0,0.0,42.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012435,MBR00000484,Institutional-IP,2022-11-06,2022-11-13,2022-11-29,PLN1908,1856686341,1856686341,Geriatrics,In-Network,E87.6,Z23,,,,871,MS-DRG,4,7,Y,80053,Pathology/Lab,,,0120,21,Inpatient Hospital,1,129.12,79.88,29.38,23.97,25.0,1.53,50.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012436,MBR00000484,Professional,2023-06-03,2023-06-03,2023-07-10,PLN8948,1550154147,1550154147,Outpatient Clinic,In-Network,E78.5,F41.9,,,,,,,0,,99214,E&M,,,,81,Independent Laboratory,1,400.58,189.88,134.12,0.0,35.0,20.76,55.76,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000012437,MBR00000484,Institutional-OP,2023-04-27,2023-04-27,2023-05-18,PLN4820,1103747954,1103747954,Urology,In-Network,J06.9,G43.909,,,,,,,0,,23472,Surgery,,,0510,22,Outpatient Hospital,3,4339.9,2911.3,2875.65,20.65,15.0,0.0,35.65,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012438,MBR00000484,Professional,2021-03-06,2021-03-06,2021-03-25,PLN8172,1450094833,1450094833,Outpatient Clinic,In-Network,Z12.31,F32.9,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,2,3769.64,2593.36,2193.78,0.0,0.0,399.58,399.58,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012439,MBR00000484,Professional,2022-06-27,2022-06-27,2022-08-05,PLN9077,1872272835,1872272835,Internal Medicine,In-Network,Z79.4,R05,,,,,,,0,,90460,Medicine,,,,11,Office,2,75.28,63.03,28.03,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012440,MBR00000485,Institutional-OP,2021-06-12,2021-06-12,2021-06-25,PLN5102,1139906830,1139906830,Endocrinology,Out-of-Network,I50.9,R05,,,,,,,0,,58661,Surgery,,,0900,22,Outpatient Hospital,1,1926.88,939.02,939.02,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012441,MBR00000485,Professional,2022-07-16,2022-07-16,2022-08-16,PLN5508,1899127912,1899127912,Neurology,In-Network,E11.9,Z23,,,,,,,0,,93306,Radiology,,,,22,Outpatient Hospital,2,2233.09,1532.02,1532.02,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012442,MBR00000485,Professional,2022-08-10,2022-08-10,2022-08-23,PLN1983,1974006077,1974006077,Orthopedic Surgery,In-Network,N18.3,E78.5,,,,,,,0,,72148,Radiology,,,,11,Office,1,1498.08,918.83,802.26,41.57,75.0,0.0,116.57,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012443,MBR00000486,Institutional-OP,2023-12-27,2023-12-27,2024-01-20,PLN3950,1453936007,1453936007,ASC,In-Network,Z12.31,E11.9,,,,,,,0,,23472,Surgery,,,0636,22,Outpatient Hospital,1,3515.45,2534.15,2384.43,74.72,75.0,0.0,149.72,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012444,MBR00000486,Professional,2022-03-02,2022-03-02,2022-04-13,PLN9121,1244186984,1244186984,Family Medicine,Out-of-Network,E11.9,R10.9,,,,,,,0,,77067,Radiology,,,,11,Office,1,468.52,386.08,0.0,386.08,15.0,0.0,401.08,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000012445,MBR00000486,Institutional-OP,2022-05-11,2022-05-11,2022-06-02,PLN8233,1631954542,1631954542,Oncology,In-Network,F10.20,Z12.31,,,,,,,0,,45378,Surgery,,,0740,22,Outpatient Hospital,1,2260.12,718.71,573.27,93.37,35.0,17.07,145.44,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000012446,MBR00000486,Institutional-OP,2022-07-15,2022-07-15,2022-08-26,PLN9781,1809014947,1809014947,Urology,In-Network,B97.89,F10.20,,,,,,,0,,43239,Surgery,,,0320,22,Outpatient Hospital,2,1797.18,959.91,959.91,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012447,MBR00000486,Professional,2021-05-23,2021-05-23,2021-06-30,PLN6738,1974006077,1974006077,Orthopedic Surgery,In-Network,I48.91,E66.9,,,,,,,0,,33533,Surgery,,,,49,Independent Clinic,1,19378.49,8000.09,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000012448,MBR00000486,Institutional-OP,2021-03-07,2021-03-07,2021-03-19,PLN7033,1361302520,1361302520,Critical Access Hospital,In-Network,E11.65,E87.6,,,,,,,0,,99214,E&M,,,0270,22,Outpatient Hospital,2,297.46,188.48,138.48,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012449,MBR00000486,Institutional-IP,2023-02-17,2023-02-20,2023-03-06,PLN7163,1752470395,1752470395,Home Health,In-Network,K21.0,K21.0,,,,291,MS-DRG,20,3,Y,99222,E&M,,,0636,21,Inpatient Hospital,1,370.63,273.59,273.59,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012450,MBR00000486,Institutional-OP,2021-11-26,2021-11-26,2021-12-30,PLN9929,1713934949,1713934949,Neurology,In-Network,Z12.31,F32.9,,,,,,,0,,47562,Surgery,,,0510,22,Outpatient Hospital,2,5600.75,4434.57,4434.57,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012451,MBR00000486,Institutional-IP,2022-02-01,2022-02-09,2022-02-18,PLN1376,1865904917,1865904917,Outpatient Clinic,In-Network,J20.9,N18.3,,,,682,MS-DRG,10,8,Y,G0468,Medicine,,,0636,21,Inpatient Hospital,3,329.41,242.31,0.0,242.31,0.0,0.0,242.31,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012452,MBR00000486,Institutional-OP,2023-12-23,2023-12-23,2024-02-01,PLN8865,1103747954,1103747954,Urology,In-Network,M17.11,I10,,,,,,,0,,66984,Surgery,,,0200,22,Outpatient Hospital,1,1810.02,1222.42,0.0,88.56,0.0,77.14,165.7,0.0,Denied,CO-4,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012453,MBR00000486,Professional,2021-09-30,2021-09-30,2021-10-26,PLN1421,1590915516,1590915516,Physical Therapy,Out-of-Network,C50.912,I10,,,,,,,0,,G0439,Medicine,,,,49,Independent Clinic,1,408.91,177.16,173.8,0.0,0.0,3.36,3.36,0.0,Adjusted,,,0,,0,1,0,0,0,0,None,0,0,0,1,0
CLM0000012454,MBR00000486,Institutional-IP,2023-09-18,2023-09-20,2023-10-11,PLN3196,1453283987,1453283987,Critical Access Hospital,In-Network,Z87.891,Z79.4,,,,292,MS-DRG,20,2,Y,99283,E&M,,,0120,21,Inpatient Hospital,3,295.11,208.18,203.51,0.0,0.0,4.67,4.67,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012455,MBR00000486,Institutional-OP,2022-11-20,2022-11-20,2022-12-07,PLN3820,1219817751,1219817751,OB/GYN,In-Network,J06.9,N39.0,,,,,,,0,,66984,Surgery,,,0200,22,Outpatient Hospital,3,2614.7,1301.18,1112.93,0.0,0.0,188.25,188.25,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012456,MBR00000486,Institutional-OP,2021-10-18,2021-10-18,2021-11-13,PLN2953,1366576336,1366576336,Geriatrics,In-Network,I25.10,R10.9,,,,,,,0,,99283,E&M,,,0360,22,Outpatient Hospital,3,351.65,193.82,193.82,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012457,MBR00000486,Professional,2023-11-12,2023-11-12,2023-12-16,PLN2929,1438368327,1438368327,Home Health,In-Network,F10.20,E11.9,,,,,,,0,,58661,Surgery,,,,81,Independent Laboratory,1,3898.51,2969.06,2687.18,121.84,0.0,160.04,281.88,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012458,MBR00000486,Professional,2022-11-13,2022-11-13,2022-11-22,PLN2834,1812060197,1812060197,Oncology,Out-of-Network,F32.9,Z23,,,,,,,0,,74177,Radiology,,,,23,Emergency Room,1,1003.88,616.51,414.52,186.99,15.0,0.0,201.99,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000012459,MBR00000486,Institutional-OP,2021-12-09,2021-12-09,2022-01-03,PLN5080,1749327647,1749327647,Geriatrics,In-Network,E78.5,F32.9,,,,,,,0,,45378,Surgery,,,0360,22,Outpatient Hospital,2,1790.43,1192.14,1167.14,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000012460,MBR00000486,Institutional-IP,2022-05-10,2022-05-13,2022-05-21,PLN2032,1561134315,1561134315,DME Supplier,In-Network,Z12.31,Z12.31,,,,291,MS-DRG,20,3,Y,99233,E&M,,,0360,21,Inpatient Hospital,1,571.88,454.36,379.36,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012461,MBR00000486,Professional,2022-02-12,2022-02-12,2022-02-21,PLN7003,1689639685,1689639685,SNF,In-Network,N39.0,J18.9,,,,,,,0,,99204,E&M,,,,11,Office,1,519.8,251.55,176.55,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012462,MBR00000486,Professional,2023-07-15,2023-07-15,2023-07-27,PLN2535,1266606767,1266606767,ASC,In-Network,Z87.891,I10,,,,,,,0,,27447,Surgery,,,,11,Office,2,2664.22,1100.47,694.68,405.79,0.0,0.0,405.79,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012463,MBR00000486,Institutional-OP,2022-05-25,2022-05-25,2022-07-01,PLN7241,1334916761,1334916761,ASC,In-Network,J06.9,J20.9,,,,,,,0,,84443,Pathology/Lab,,,0636,22,Outpatient Hospital,3,101.51,71.72,0.0,71.72,75.0,0.0,146.72,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012464,MBR00000486,Institutional-OP,2021-02-10,2021-02-10,2021-03-12,PLN4072,1702692193,1702692193,Physical Therapy,In-Network,N40.0,Z12.31,,,,,,,0,,33533,Surgery,,,0320,22,Outpatient Hospital,3,27159.71,16533.39,13291.46,93.81,0.0,3148.12,3241.93,0.0,Paid,,,0,,0,0,1,1,0,1,Upcoding,0,0,0,0,0
CLM0000012465,MBR00000486,Professional,2023-01-24,2023-01-24,2023-02-07,PLN4932,1244186984,1244186984,Family Medicine,Out-of-Network,J45.20,E78.5,,,,,,,0,,90460,Medicine,,,,11,Office,2,29.93,19.82,0.0,19.82,25.0,0.0,44.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012466,MBR00000486,Institutional-OP,2023-04-09,2023-04-09,2023-04-28,PLN9295,1749494482,1749494482,Pediatrics,In-Network,E11.9,J20.9,,,,,,,0,,99232,E&M,,,0370,22,Outpatient Hospital,1,324.9,271.35,250.99,0.0,0.0,20.36,20.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012467,MBR00000486,Professional,2022-03-10,2022-03-10,2022-03-23,PLN9164,1242201429,1242201429,General Acute Care Hospital,In-Network,N18.3,N39.0,,,,,,,0,,G0444,Medicine,,,,11,Office,1,41.2,33.83,0.0,0.0,50.0,0.0,50.0,0.0,Pended,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000012468,MBR00000486,Professional,2023-10-07,2023-10-07,2023-11-17,PLN9772,1609138981,1609138981,Critical Access Hospital,In-Network,J06.9,I11.9,,,,,,,0,,86900,Pathology/Lab,,,,11,Office,3,31.97,13.94,13.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012469,MBR00000486,Institutional-OP,2022-04-11,2022-04-11,2022-05-14,PLN2839,1235381502,1235381502,Cardiology,In-Network,E11.9,M17.11,,,,,,,0,,81001,Pathology/Lab,,,0301,22,Outpatient Hospital,3,62.32,34.92,19.92,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012470,MBR00000486,Professional,2021-10-17,2021-10-17,2021-10-28,PLN3875,1964402759,1964402759,Outpatient Clinic,In-Network,J20.9,N39.0,,,,,,,0,,71046,Radiology,,,,11,Office,3,307.45,164.97,0.0,0.0,0.0,27.87,27.87,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012471,MBR00000486,Professional,2023-02-07,2023-02-07,2023-03-02,PLN8773,1717546253,1717546253,Family Medicine,In-Network,M54.5,K21.0,,,,,,,0,,99214,E&M,,,,11,Office,1,284.42,216.91,141.91,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012472,MBR00000487,Professional,2021-05-20,2021-05-20,2021-07-03,PLN6311,1575695214,1575695214,SNF,In-Network,N18.3,I50.9,,,,,,,0,,80053,Pathology/Lab,,,,81,Independent Laboratory,3,123.91,53.45,0.0,53.45,0.0,0.0,53.45,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012473,MBR00000487,Professional,2023-12-15,2023-12-15,2024-01-04,PLN4137,1757138478,1757138478,Pediatrics,In-Network,K21.0,Z00.01,,,,,,,0,,99221,E&M,,,,11,Office,1,294.12,99.92,96.96,0.0,0.0,2.96,2.96,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012474,MBR00000487,Professional,2023-01-19,2023-01-19,2023-02-12,PLN6791,1520687146,1520687146,ASC,In-Network,E78.5,I10,,,,,,,0,,27447,Surgery,,,,23,Emergency Room,3,2333.0,1675.72,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000012475,MBR00000487,Institutional-OP,2021-12-13,2021-12-13,2021-12-27,PLN2470,1644128543,1644128543,Gastroenterology,In-Network,Z00.00,Z87.891,,,,,,,0,,99232,E&M,,,0761,22,Outpatient Hospital,3,359.65,295.3,28.58,266.72,0.0,0.0,266.72,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000012476,MBR00000487,Professional,2021-03-31,2021-03-31,2021-05-12,PLN7655,1964402759,1964402759,Outpatient Clinic,In-Network,R07.9,Z00.00,,,,,,,0,,58661,Surgery,,,,11,Office,1,4220.0,1518.69,0.0,44.91,15.0,0.0,59.91,0.0,Denied,CO-119,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012477,MBR00000487,Institutional-IP,2022-10-03,2022-10-13,2022-10-28,PLN8004,1840431511,1840431511,Geriatrics,Out-of-Network,Z12.11,Z00.00,,,,603,MS-DRG,12,10,Y,99214,E&M,,,0120,21,Inpatient Hospital,1,460.03,141.97,141.97,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012478,MBR00000487,Professional,2022-10-05,2022-10-05,2022-10-14,PLN4454,1550154147,1550154147,Outpatient Clinic,In-Network,Z23,Z87.891,,,,,,,0,,97110,Medicine,,,,22,Outpatient Hospital,1,118.19,87.07,82.66,0.0,0.0,4.41,4.41,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000012479,MBR00000487,Institutional-OP,2023-05-20,2023-05-20,2023-06-02,PLN2041,1609526529,1609526529,Psychiatry,In-Network,G20,N39.0,,,,,,,0,,93000,Radiology,,,0270,22,Outpatient Hospital,1,91.65,71.97,0.0,71.97,25.0,0.0,96.97,0.0,Denied,CO-29,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012480,MBR00000487,Institutional-IP,2021-11-07,2021-11-13,2021-11-19,PLN3747,1799205295,1799205295,General Acute Care Hospital,In-Network,R07.9,M81.0,,,,690,MS-DRG,15,6,Y,70553,Radiology,,,0510,21,Inpatient Hospital,1,2518.52,1393.88,1382.22,0.0,0.0,11.66,11.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012481,MBR00000487,Institutional-OP,2021-08-21,2021-08-21,2021-09-09,PLN3635,1227362142,1227362142,DME Supplier,In-Network,E11.9,M54.5,,,,,,,0,,86900,Pathology/Lab,,,0900,22,Outpatient Hospital,1,47.12,28.75,13.55,0.0,15.0,0.2,15.2,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012482,MBR00000487,Professional,2022-03-28,2022-03-28,2022-04-26,PLN6258,1727809972,1727809972,Home Health,In-Network,F41.9,I10,,,,,,,0,,27130,Surgery,,,,11,Office,2,7157.5,4118.83,3521.09,456.63,0.0,141.11,597.74,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012483,MBR00000487,Professional,2023-06-16,2023-06-16,2023-06-28,PLN3344,1284035364,1284035364,Pediatrics,In-Network,Z12.31,K21.0,,,,,,,0,,93306,Radiology,,,,22,Outpatient Hospital,3,2949.39,2028.02,1993.02,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012484,MBR00000487,Professional,2023-09-22,2023-09-22,2023-10-03,PLN2435,1609138981,1609138981,Critical Access Hospital,In-Network,E78.5,F32.9,,,,,,,0,,77067,Radiology,,,,21,Inpatient Hospital,2,805.98,545.63,545.63,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000012485,MBR00000487,Professional,2022-01-24,2022-01-24,2022-02-16,PLN8563,1284035364,1284035364,Pediatrics,In-Network,Z23,Z23,,,,,,,0,,70553,Radiology,,,,11,Office,2,4670.95,1549.89,1549.89,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012486,MBR00000487,Institutional-IP,2021-02-22,2021-03-05,2021-03-07,PLN8503,1896447406,1896447406,Nephrology,Out-of-Network,I10,F41.9,,,,194,MS-DRG,24,11,Y,93306,Radiology,,,0510,21,Inpatient Hospital,1,2758.39,1540.87,1515.87,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012487,MBR00000487,Institutional-OP,2021-05-02,2021-05-02,2021-05-25,PLN3886,1224179551,1224179551,Physical Therapy,In-Network,J20.9,N39.0,,,,,,,0,,99233,E&M,,,0320,22,Outpatient Hospital,3,389.6,169.61,144.61,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012488,MBR00000487,Professional,2022-08-20,2022-08-20,2022-09-25,PLN4628,1689639685,1689639685,SNF,In-Network,I10,E11.9,,,,,,,0,,27447,Surgery,,,,20,Urgent Care,1,3040.41,1462.3,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012489,MBR00000487,Institutional-OP,2021-01-28,2021-01-28,2021-02-23,PLN7390,1453283987,1453283987,Critical Access Hospital,In-Network,J06.9,I50.9,,,,,,,0,,70450,Radiology,,,0370,22,Outpatient Hospital,2,999.62,563.5,413.16,0.0,75.0,75.34,150.34,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012490,MBR00000487,Institutional-IP,2023-03-04,2023-03-18,2023-03-17,PLN4782,1227362142,1227362142,DME Supplier,In-Network,G20,N18.3,,,,641,MS-DRG,18,14,Y,99222,E&M,,,0370,21,Inpatient Hospital,3,498.15,238.93,205.1,0.0,0.0,33.83,33.83,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012491,MBR00000487,Professional,2021-02-06,2021-02-06,2021-03-12,PLN9207,1366286000,1366286000,SNF,In-Network,M17.11,Z12.31,,,,,,,0,,99214,E&M,,,,11,Office,3,453.73,174.14,111.74,0.0,35.0,27.4,62.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012492,MBR00000487,Institutional-OP,2022-04-09,2022-04-09,2022-04-16,PLN8266,1856686341,1856686341,Geriatrics,In-Network,F10.20,F32.9,,,,,,,0,,78452,Radiology,,,0120,22,Outpatient Hospital,1,4794.34,2322.43,0.0,412.12,50.0,0.0,462.12,0.0,Denied,CO-50,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012493,MBR00000488,Institutional-IP,2023-05-24,2023-05-30,2023-06-18,PLN6962,1205377316,1205377316,Orthopedic Surgery,In-Network,E11.9,E11.9,,,,872,MS-DRG,23,6,N,99204,E&M,,,0200,21,Inpatient Hospital,1,399.26,290.3,215.3,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012494,MBR00000488,Institutional-OP,2022-05-28,2022-05-28,2022-07-07,PLN5512,1590915516,1590915516,Physical Therapy,Out-of-Network,J20.9,K57.30,,,,,,,0,,45380,Surgery,,,0730,22,Outpatient Hospital,2,2147.09,1379.8,1110.05,0.0,0.0,269.75,269.75,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000012495,MBR00000488,Institutional-OP,2023-01-10,2023-01-10,2023-02-19,PLN3887,1313212303,1313212303,Family Medicine,In-Network,Z23,E78.5,,,,,,,0,,99214,E&M,,,0761,22,Outpatient Hospital,1,418.06,187.09,185.42,0.0,0.0,1.67,1.67,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012496,MBR00000488,Institutional-OP,2022-01-01,2022-01-01,2022-01-13,PLN4292,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,E78.5,I10,,,,,,,0,,99283,E&M,,,0200,22,Outpatient Hospital,3,499.02,380.01,312.26,0.0,25.0,42.75,67.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012497,MBR00000488,Professional,2023-05-19,2023-05-19,2023-05-26,PLN5259,1530904931,1530904931,Internal Medicine,In-Network,N18.3,K21.0,,,,,,,0,,80061,Pathology/Lab,,,,22,Outpatient Hospital,3,89.33,71.99,36.99,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012498,MBR00000488,Institutional-OP,2022-04-13,2022-04-13,2022-04-20,PLN9585,1361302520,1361302520,Critical Access Hospital,In-Network,M54.5,E11.9,,,,,,,0,,83036,Pathology/Lab,,,0370,22,Outpatient Hospital,1,91.02,40.37,4.94,0.0,35.0,0.43,35.43,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000012499,MBR00000488,Institutional-OP,2023-04-05,2023-04-05,2023-05-07,PLN1942,1114982472,1114982472,Orthopedic Surgery,In-Network,N39.0,Z12.11,,,,,,,0,,33533,Surgery,,,0301,22,Outpatient Hospital,2,13206.34,9518.95,9421.27,97.68,0.0,0.0,97.68,0.0,Adjusted,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000012500,MBR00000488,Professional,2023-11-09,2023-11-09,2023-12-17,PLN6324,1563980627,1563980627,Critical Access Hospital,In-Network,I25.10,Z00.00,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,3,2646.59,843.74,828.74,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012501,MBR00000488,Professional,2022-02-22,2022-02-22,2022-03-21,PLN1923,1148984206,1148984206,Psychiatry,In-Network,I10,I10,,,,,,,0,,33533,Surgery,,,,23,Emergency Room,2,16749.91,13803.38,12401.21,0.0,15.0,1387.17,1402.17,0.0,Adjusted,,,1,,1,0,0,1,0,0,None,0,0,0,0,0
CLM0000012502,MBR00000488,Institutional-OP,2021-09-12,2021-09-12,2021-09-29,PLN4208,1609526529,1609526529,Psychiatry,In-Network,Z00.00,J45.20,,,,,,,0,,99213,E&M,,,0120,22,Outpatient Hospital,1,327.8,110.17,0.0,109.63,0.0,0.0,109.63,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012503,MBR00000488,Professional,2023-10-19,2023-10-19,2023-11-19,PLN8200,1168881145,1168881145,Orthopedic Surgery,In-Network,Z12.31,B97.89,,,,,,,0,,58661,Surgery,,,,11,Office,1,3796.2,2985.86,2985.86,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012504,MBR00000488,Professional,2023-01-16,2023-01-16,2023-02-24,PLN3346,1799205295,1799205295,General Acute Care Hospital,In-Network,N17.9,Z12.31,,,,,,,0,,90837,Medicine,,,,21,Inpatient Hospital,2,208.82,124.48,124.48,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012505,MBR00000488,Institutional-OP,2023-08-20,2023-08-20,2023-09-13,PLN7003,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,N20.0,M54.5,,,,,,,0,,84443,Pathology/Lab,,,0450,22,Outpatient Hospital,1,124.87,60.03,0.0,60.03,35.0,0.0,95.03,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012506,MBR00000489,Institutional-OP,2022-02-19,2022-02-19,2022-03-17,PLN5890,1974006077,1974006077,Orthopedic Surgery,In-Network,I10,R10.9,,,,,,,0,,99213,E&M,,,0270,22,Outpatient Hospital,2,144.4,121.39,0.0,121.39,0.0,0.0,121.39,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012507,MBR00000489,Professional,2022-01-17,2022-01-17,2022-02-26,PLN4336,1745114564,1745114564,Endocrinology,In-Network,J06.9,E11.9,,,,,,,0,,27130,Surgery,,,,11,Office,3,5922.11,4295.97,3992.17,288.8,15.0,0.0,303.8,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012508,MBR00000489,Professional,2021-05-16,2021-05-16,2021-06-08,PLN1406,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,J06.9,G20,,,,,,,0,,99283,E&M,,,,20,Urgent Care,1,467.85,329.39,245.8,0.0,35.0,48.59,83.59,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012509,MBR00000489,Professional,2023-04-27,2023-04-27,2023-06-10,PLN7728,1395983630,1395983630,Nephrology,In-Network,I25.10,F32.9,,,,,,,0,,76700,Radiology,,,,12,Home,2,1158.99,785.88,710.88,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012510,MBR00000489,Professional,2023-07-14,2023-07-14,2023-07-25,PLN6876,1696843572,1696843572,Critical Access Hospital,Out-of-Network,Z23,F10.20,,,,,,,0,,66984,Surgery,,,,23,Emergency Room,3,3088.25,2041.57,2041.57,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000012511,MBR00000489,Professional,2023-06-17,2023-06-17,2023-07-13,PLN9835,1545347862,1545347862,SNF,In-Network,Z00.01,K21.0,,,,,,,0,,G0444,Medicine,,,,11,Office,1,64.35,41.65,0.0,41.65,35.0,0.0,76.65,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000012512,MBR00000489,Institutional-OP,2021-11-15,2021-11-15,2021-11-22,PLN1349,1125190055,1125190055,Nephrology,In-Network,I10,M81.0,,,,,,,0,,80053,Pathology/Lab,,,0120,22,Outpatient Hospital,1,80.0,59.77,44.77,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012513,MBR00000489,Institutional-OP,2022-06-19,2022-06-19,2022-07-26,PLN2647,1283743001,1283743001,Family Medicine,In-Network,F41.9,J06.9,,,,,,,0,,27130,Surgery,,,0510,22,Outpatient Hospital,2,2914.68,1225.54,0.0,227.02,25.0,0.0,252.02,0.0,Denied,PR-1,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012514,MBR00000489,Institutional-OP,2022-06-25,2022-06-25,2022-07-30,PLN6500,1135158374,1135158374,Pulmonology,In-Network,E11.9,N20.0,,,,,,,0,,27447,Surgery,,,0301,22,Outpatient Hospital,1,6029.55,2195.76,2060.85,109.91,25.0,0.0,134.91,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012515,MBR00000489,Institutional-OP,2021-05-12,2021-05-12,2021-06-12,PLN3525,1948810580,1948810580,DME Supplier,In-Network,E78.5,M54.5,,,,,,,0,,99233,E&M,,,0270,22,Outpatient Hospital,1,203.38,120.56,0.0,17.36,0.0,0.0,17.36,0.0,Denied,CO-119,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012516,MBR00000489,Institutional-OP,2021-01-01,2021-01-01,2021-02-08,PLN8902,1355166277,1355166277,Endocrinology,In-Network,E11.9,Z00.00,,,,,,,0,,23472,Surgery,,,0740,22,Outpatient Hospital,2,6378.14,5064.37,4475.51,0.0,75.0,513.86,588.86,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012517,MBR00000489,Professional,2022-01-01,2022-01-01,2022-01-27,PLN1848,1997536841,1997536841,Family Medicine,Out-of-Network,Z12.31,C50.912,,,,,,,0,,99406,Medicine,,,,20,Urgent Care,2,98.36,62.01,0.0,62.01,0.0,0.0,62.01,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012518,MBR00000489,Professional,2022-07-13,2022-07-13,2022-08-20,PLN8038,1453936007,1453936007,ASC,In-Network,R05,E11.9,,,,,,,0,,77067,Radiology,,,,20,Urgent Care,2,579.2,368.53,353.53,0.0,15.0,0.0,15.0,0.0,Adjusted,,,1,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000012519,MBR00000489,Professional,2023-12-19,2023-12-19,2024-01-03,PLN8364,1540044947,1540044947,Pulmonology,Out-of-Network,I25.10,Z12.31,,,,,,,0,,58661,Surgery,,,,50,Federally Qualified Health Center,3,1712.94,1244.47,1244.47,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012520,MBR00000489,Institutional-IP,2023-08-15,2023-08-17,2023-09-28,PLN2515,1713934949,1713934949,Neurology,In-Network,M17.11,M17.11,,,,690,MS-DRG,19,2,Y,58661,Surgery,,,0510,21,Inpatient Hospital,3,3863.41,2615.11,2383.96,0.0,15.0,216.15,231.15,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012521,MBR00000489,Institutional-OP,2023-02-23,2023-02-23,2023-03-21,PLN6078,1563980627,1563980627,Critical Access Hospital,In-Network,E78.5,I48.91,,,,,,,0,,70450,Radiology,,,0120,22,Outpatient Hospital,3,900.12,345.64,345.64,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012522,MBR00000489,Professional,2023-11-21,2023-11-21,2023-11-30,PLN1416,1135158374,1135158374,Pulmonology,In-Network,I10,J44.1,,,,,,,0,,97530,Medicine,,,,11,Office,2,169.33,71.97,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012523,MBR00000489,Professional,2023-04-29,2023-04-29,2023-05-17,PLN2644,1997536841,1997536841,Family Medicine,Out-of-Network,I11.9,E11.9,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,3,4450.45,2179.45,1922.15,0.0,75.0,182.3,257.3,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012524,MBR00000489,Professional,2022-07-31,2022-07-31,2022-08-09,PLN9100,1556140803,1556140803,Cardiology,In-Network,J06.9,E11.9,,,,,,,0,,93000,Radiology,,,,22,Outpatient Hospital,3,86.23,66.17,19.35,46.82,0.0,0.0,46.82,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012525,MBR00000489,Professional,2023-09-26,2023-09-26,2023-10-23,PLN1390,1939033455,1939033455,Pulmonology,In-Network,I50.9,Z23,,,,,,,0,,97110,Medicine,,,,21,Inpatient Hospital,3,168.1,114.05,114.05,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012526,MBR00000489,Institutional-OP,2023-10-05,2023-10-05,2023-11-17,PLN3491,1687650653,1687650653,Internal Medicine,In-Network,R05,G43.909,,,,,,,0,,70450,Radiology,,,0270,22,Outpatient Hospital,3,1417.84,977.83,977.83,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012527,MBR00000489,Professional,2021-08-11,2021-08-11,2021-09-06,PLN7383,1590915516,1590915516,Physical Therapy,Out-of-Network,J20.9,Z12.31,,,,,,,0,,71046,Radiology,,,,11,Office,2,265.39,118.46,0.0,0.0,0.0,6.85,6.85,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012528,MBR00000489,Professional,2021-11-06,2021-11-06,2021-11-27,PLN9741,1198133277,1198133277,SNF,In-Network,E78.5,G20,,,,,,,0,,G0468,Medicine,,,,11,Office,2,704.2,468.36,364.36,104.0,0.0,0.0,104.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012529,MBR00000489,Institutional-OP,2023-11-27,2023-11-27,2024-01-02,PLN7286,1186826716,1186826716,Physical Therapy,In-Network,E11.9,Z12.11,,,,,,,0,,45380,Surgery,,,0301,22,Outpatient Hospital,3,2425.78,1613.69,1565.62,0.0,25.0,23.07,48.07,0.0,Paid,,,0,,0,0,1,0,0,1,Upcoding,0,1,0,0,0
CLM0000012530,MBR00000489,Professional,2021-01-07,2021-01-07,2021-01-25,PLN3204,1224179551,1224179551,Physical Therapy,In-Network,Z00.00,N17.9,,,,,,,0,,99204,E&M,,,,11,Office,2,233.01,169.44,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012531,MBR00000489,Professional,2022-07-22,2022-07-22,2022-07-29,PLN1117,1689639685,1689639685,SNF,In-Network,Z12.31,E78.5,,,,,,,0,,27447,Surgery,,,,49,Independent Clinic,2,2617.3,2172.11,0.0,0.0,75.0,0.0,75.0,0.0,Denied,CO-29,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012532,MBR00000489,Institutional-OP,2022-02-24,2022-02-24,2022-03-07,PLN4481,1224179551,1224179551,Physical Therapy,In-Network,M17.11,N39.0,,,,,,,0,,99222,E&M,,,0510,22,Outpatient Hospital,1,573.63,449.99,0.0,112.49,0.0,0.0,112.49,0.0,Denied,CO-15,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000012533,MBR00000490,Professional,2023-03-27,2023-03-27,2023-04-03,PLN6751,1809014947,1809014947,Urology,In-Network,R07.9,F32.9,,,,,,,0,,90837,Medicine,,,,11,Office,1,369.32,244.84,244.84,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012534,MBR00000490,Institutional-IP,2023-11-16,2023-11-17,2023-12-14,PLN5419,1872272835,1872272835,Internal Medicine,In-Network,N40.0,I25.10,,,,291,MS-DRG,12,1,Y,86900,Pathology/Lab,,,0370,21,Inpatient Hospital,1,27.66,17.08,17.08,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012535,MBR00000490,Professional,2021-12-15,2021-12-15,2021-12-24,PLN7409,1910255109,1910255109,DME Supplier,In-Network,Z23,Z51.11,,,,,,,0,,84443,Pathology/Lab,,,,65,End-Stage Renal Disease,2,134.51,110.63,0.0,110.63,35.0,0.0,145.63,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012536,MBR00000490,Professional,2021-08-30,2021-08-30,2021-09-18,PLN5070,1242201429,1242201429,General Acute Care Hospital,In-Network,I10,F03.90,,,,,,,0,,58661,Surgery,,,,11,Office,3,2424.33,1234.61,744.21,318.08,0.0,172.32,490.4,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012537,MBR00000490,Professional,2021-12-27,2021-12-27,2022-01-14,PLN2183,1433937353,1433937353,Nephrology,In-Network,E11.9,Z23,,,,,,,0,,86900,Pathology/Lab,,,,12,Home,2,24.05,13.2,0.0,13.2,15.0,0.0,28.2,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012538,MBR00000490,Institutional-OP,2023-02-23,2023-02-23,2023-04-01,PLN3059,1606140917,1606140917,ASC,In-Network,Z51.11,I10,,,,,,,0,,93306,Radiology,,,0360,22,Outpatient Hospital,3,1732.5,743.3,698.33,29.97,15.0,0.0,44.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012539,MBR00000490,Professional,2022-01-29,2022-01-29,2022-03-02,PLN3478,1283743001,1283743001,Family Medicine,In-Network,E11.9,J20.9,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,2,314.18,223.64,0.0,223.64,0.0,0.0,223.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012540,MBR00000490,Institutional-OP,2022-12-05,2022-12-05,2023-01-14,PLN3339,1511044648,1511044648,Endocrinology,In-Network,N39.0,Z00.00,,,,,,,0,,99222,E&M,,,0360,22,Outpatient Hospital,1,425.39,255.07,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012541,MBR00000490,Professional,2022-01-17,2022-01-17,2022-02-11,PLN6700,1337791138,1337791138,Internal Medicine,Out-of-Network,J45.20,M17.11,,,,,,,0,,85025,Pathology/Lab,,,,21,Inpatient Hospital,1,95.28,51.28,47.86,0.0,0.0,3.42,3.42,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012542,MBR00000490,Institutional-OP,2023-03-22,2023-03-22,2023-04-03,PLN6303,1717912431,1717912431,Oncology,In-Network,J45.20,Z87.891,,,,,,,0,,G0468,Medicine,,,0370,22,Outpatient Hospital,3,521.63,222.26,197.45,9.81,15.0,0.0,24.81,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012543,MBR00000490,Institutional-OP,2021-03-10,2021-03-10,2021-04-12,PLN9126,1626436776,1626436776,General Acute Care Hospital,Out-of-Network,E11.9,M17.11,,,,,,,0,,72148,Radiology,,,0900,22,Outpatient Hospital,3,2929.71,1619.17,0.0,0.0,15.0,251.39,266.39,0.0,Denied,CO-50,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012544,MBR00000490,Professional,2022-01-11,2022-01-11,2022-02-01,PLN8163,1790497490,1790497490,OB/GYN,In-Network,Z12.11,E11.9,,,,,,,0,,99221,E&M,,,,31,Skilled Nursing Facility,3,300.0,191.66,191.66,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012545,MBR00000490,Institutional-IP,2021-12-05,2021-12-10,2022-01-12,PLN6641,1422747896,1422747896,Urology,In-Network,Z23,J18.9,,,,291,MS-DRG,9,5,Y,97110,Medicine,,,0370,21,Inpatient Hospital,3,222.64,152.55,0.0,152.55,15.0,0.0,167.55,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012546,MBR00000490,Institutional-OP,2022-10-17,2022-10-17,2022-10-31,PLN6229,1644128543,1644128543,Gastroenterology,In-Network,E66.9,Z23,,,,,,,0,,G0444,Medicine,,,0450,22,Outpatient Hospital,1,85.9,68.55,59.23,0.0,0.0,9.32,9.32,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000012547,MBR00000490,Institutional-IP,2022-12-10,2022-12-17,2023-01-06,PLN5472,1530904931,1530904931,Internal Medicine,In-Network,E11.9,E78.5,,,,682,MS-DRG,7,7,Y,81001,Pathology/Lab,,,0370,21,Inpatient Hospital,3,31.28,16.35,0.0,16.35,75.0,0.0,91.35,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012548,MBR00000490,Institutional-OP,2023-03-08,2023-03-08,2023-04-18,PLN4049,1545347862,1545347862,SNF,In-Network,Z00.00,G43.909,,,,,,,0,,80053,Pathology/Lab,,,0360,22,Outpatient Hospital,3,142.8,66.97,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,1,Unbundling,0,0,0,0,0
CLM0000012549,MBR00000490,Professional,2023-09-15,2023-09-15,2023-10-16,PLN5434,1530904931,1530904931,Internal Medicine,In-Network,M81.0,Z23,,,,,,,0,,99203,E&M,,,,11,Office,2,138.85,98.97,63.97,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012550,MBR00000490,Institutional-OP,2023-05-22,2023-05-22,2023-06-25,PLN1123,1268679390,1268679390,Critical Access Hospital,In-Network,E78.5,K57.30,,,,,,,0,,84443,Pathology/Lab,,,0761,22,Outpatient Hospital,3,147.87,77.64,0.0,77.64,25.0,0.0,102.64,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012551,MBR00000490,Institutional-IP,2021-02-15,2021-02-19,2021-03-27,PLN7808,1124394415,1124394415,Pediatrics,In-Network,N20.0,J06.9,,,,872,MS-DRG,2,4,Y,90686,Medicine,,,0730,21,Inpatient Hospital,2,106.07,67.75,67.75,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000012552,MBR00000490,Professional,2023-01-13,2023-01-13,2023-02-04,PLN1456,1856686341,1856686341,Geriatrics,In-Network,J06.9,G20,,,,,,,0,,93000,Radiology,,,,11,Office,3,165.73,109.84,0.0,109.84,0.0,0.0,109.84,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012553,MBR00000490,Professional,2021-01-19,2021-01-19,2021-02-20,PLN2581,1799205295,1799205295,General Acute Care Hospital,In-Network,M54.5,R10.9,,,,,,,0,,97110,Medicine,,,,21,Inpatient Hospital,1,288.75,92.29,8.43,68.86,15.0,0.0,83.86,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012554,MBR00000490,Professional,2022-03-29,2022-03-29,2022-05-01,PLN2712,1717546253,1717546253,Family Medicine,In-Network,J20.9,M54.5,,,,,,,0,,99203,E&M,,,,23,Emergency Room,1,330.78,236.02,236.02,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000012555,MBR00000491,Professional,2022-10-11,2022-10-11,2022-10-29,PLN1063,1283743001,1283743001,Family Medicine,In-Network,Z79.4,Z00.00,,,,,,,0,,99283,E&M,,,,11,Office,1,358.68,288.68,173.56,40.12,75.0,0.0,115.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012556,MBR00000491,Professional,2021-12-16,2021-12-16,2022-01-11,PLN6843,1817234602,1817234602,Clinical Laboratory,In-Network,Z00.00,E11.9,,,,,,,0,,97110,Medicine,,,,21,Inpatient Hospital,2,285.96,113.45,113.45,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012557,MBR00000491,Institutional-OP,2023-02-06,2023-02-06,2023-02-14,PLN2397,1366286000,1366286000,SNF,In-Network,J44.1,C50.912,,,,,,,0,,G0444,Medicine,,,0450,22,Outpatient Hospital,1,47.29,31.7,31.7,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000012558,MBR00000491,Professional,2023-05-22,2023-05-22,2023-06-11,PLN6717,1366426662,1366426662,Urology,In-Network,E11.9,Z12.31,,,,,,,0,,99222,E&M,,,,22,Outpatient Hospital,2,432.01,268.61,243.61,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012559,MBR00000491,Professional,2022-10-29,2022-10-29,2022-11-28,PLN1598,1561134315,1561134315,DME Supplier,In-Network,E11.9,I63.9,,,,,,,0,,90460,Medicine,,,,12,Home,2,28.42,12.33,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012560,MBR00000491,Institutional-OP,2022-07-29,2022-07-29,2022-08-19,PLN2102,1899127912,1899127912,Neurology,In-Network,Z12.31,I25.10,,,,,,,0,,99222,E&M,,,0320,22,Outpatient Hospital,3,449.23,172.24,1.0,171.24,0.0,0.0,171.24,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012561,MBR00000491,Institutional-OP,2023-12-02,2023-12-02,2023-12-13,PLN7820,1530904931,1530904931,Internal Medicine,In-Network,Z00.00,M81.0,,,,,,,0,,45380,Surgery,,,0360,22,Outpatient Hospital,2,2343.7,886.07,811.07,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000012562,MBR00000491,Institutional-OP,2022-12-16,2022-12-16,2023-01-12,PLN7970,1542828721,1542828721,Orthopedic Surgery,In-Network,Z23,N40.0,,,,,,,0,,99214,E&M,,,0510,22,Outpatient Hospital,2,398.85,120.9,0.0,120.9,35.0,0.0,155.9,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012563,MBR00000491,Professional,2021-09-08,2021-09-08,2021-09-22,PLN5667,1295371663,1295371663,Critical Access Hospital,In-Network,K21.0,N40.0,,,,,,,0,,99406,Medicine,,,,20,Urgent Care,1,49.38,25.32,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012564,MBR00000491,Institutional-OP,2022-12-20,2022-12-20,2023-01-06,PLN3594,1845057593,1845057593,Orthopedic Surgery,In-Network,E78.5,Z00.00,,,,,,,0,,G0468,Medicine,,,0510,22,Outpatient Hospital,2,750.68,405.65,0.0,0.0,50.0,60.92,110.92,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012565,MBR00000491,Professional,2022-06-11,2022-06-11,2022-06-30,PLN2136,1609138981,1609138981,Critical Access Hospital,In-Network,I10,I50.9,,,,,,,0,,99204,E&M,,,,49,Independent Clinic,2,329.15,192.47,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-97,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012566,MBR00000491,Professional,2021-01-27,2021-01-27,2021-02-21,PLN8217,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,F41.9,M17.11,,,,,,,0,,G0444,Medicine,,,,22,Outpatient Hospital,1,73.3,62.09,47.09,0.0,15.0,0.0,15.0,0.0,Adjusted,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000012567,MBR00000491,Institutional-OP,2023-09-30,2023-09-30,2023-10-24,PLN8596,1644128543,1644128543,Gastroenterology,In-Network,E66.9,I25.10,,,,,,,0,,99284,E&M,,,0900,22,Outpatient Hospital,3,884.4,339.56,0.0,339.56,0.0,0.0,339.56,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012568,MBR00000491,Professional,2023-05-22,2023-05-22,2023-06-07,PLN4911,1486164553,1486164553,DME Supplier,In-Network,E66.9,Z51.11,,,,,,,0,,97110,Medicine,,,,31,Skilled Nursing Facility,2,211.51,151.23,21.95,49.41,75.0,4.87,129.28,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012569,MBR00000491,Professional,2022-11-08,2022-11-08,2022-11-15,PLN7842,1242201429,1242201429,General Acute Care Hospital,In-Network,I25.10,N39.0,,,,,,,0,,93225,Medicine,,,,81,Independent Laboratory,2,536.18,441.28,0.0,441.28,35.0,0.0,476.28,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012570,MBR00000491,Institutional-IP,2023-01-07,2023-01-08,2023-02-04,PLN9523,1990090423,1990090423,Orthopedic Surgery,In-Network,N39.0,J20.9,,,,871,MS-DRG,10,1,N,80053,Pathology/Lab,,,0761,21,Inpatient Hospital,2,97.17,73.03,73.03,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012571,MBR00000491,Professional,2022-09-24,2022-09-24,2022-10-24,PLN8453,1245650222,1245650222,Gastroenterology,In-Network,M54.5,F32.9,,,,,,,0,,99204,E&M,,,,23,Emergency Room,1,303.09,147.58,147.58,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000012572,MBR00000491,Professional,2022-01-11,2022-01-11,2022-01-21,PLN2110,1624802371,1624802371,ASC,Out-of-Network,F41.9,J18.9,,,,,,,0,,99232,E&M,,,,11,Office,1,142.03,75.84,75.84,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012573,MBR00000491,Institutional-OP,2023-10-19,2023-10-19,2023-11-17,PLN4231,1590915516,1590915516,Physical Therapy,Out-of-Network,I48.91,R10.9,,,,,,,0,,66984,Surgery,,,0301,22,Outpatient Hospital,3,1849.87,1084.54,871.23,0.0,0.0,213.31,213.31,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012574,MBR00000491,Institutional-OP,2022-08-29,2022-08-29,2022-10-04,PLN5900,1840431511,1840431511,Geriatrics,Out-of-Network,E78.5,I25.10,,,,,,,0,,23472,Surgery,,,0510,22,Outpatient Hospital,3,6332.61,4654.48,4063.26,0.0,25.0,566.22,591.22,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012575,MBR00000491,Institutional-OP,2022-01-07,2022-01-07,2022-02-19,PLN2333,1273488618,1273488618,General Acute Care Hospital,In-Network,E66.9,J06.9,,,,,,,0,,45378,Surgery,,,0200,22,Outpatient Hospital,3,1000.43,405.18,0.0,405.18,35.0,0.0,440.18,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000012576,MBR00000491,Professional,2023-01-20,2023-01-20,2023-02-20,PLN8722,1717546253,1717546253,Family Medicine,In-Network,N18.3,F32.9,,,,,,,0,,77067,Radiology,,,,49,Independent Clinic,3,737.02,372.15,0.0,372.15,0.0,0.0,372.15,0.0,Paid,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000012577,MBR00000491,Institutional-IP,2021-06-22,2021-07-03,2021-07-21,PLN8055,1103747954,1103747954,Urology,In-Network,E78.5,B97.89,,,,291,MS-DRG,5,11,Y,99284,E&M,,,0200,21,Inpatient Hospital,3,720.63,392.52,315.12,0.0,0.0,77.4,77.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012578,MBR00000491,Institutional-OP,2021-12-16,2021-12-16,2021-12-29,PLN5061,1530904931,1530904931,Internal Medicine,In-Network,R51,I10,,,,,,,0,,93000,Radiology,,,0120,22,Outpatient Hospital,2,162.86,103.41,78.98,0.0,15.0,9.43,24.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012579,MBR00000491,Professional,2021-05-22,2021-05-22,2021-06-03,PLN8066,1563980627,1563980627,Critical Access Hospital,In-Network,K57.30,R05,,,,,,,0,,99232,E&M,,,,11,Office,2,234.98,160.81,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012580,MBR00000491,Professional,2021-04-04,2021-04-04,2021-05-01,PLN9563,1486164553,1486164553,DME Supplier,In-Network,E78.5,E66.9,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,2,470.9,260.54,192.03,68.51,0.0,0.0,68.51,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012581,MBR00000491,Professional,2023-06-19,2023-06-19,2023-07-27,PLN5303,1840431511,1840431511,Geriatrics,Out-of-Network,J18.9,M54.5,,,,,,,0,,93306,Radiology,,,,49,Independent Clinic,3,3040.38,2084.46,2069.46,0.0,15.0,0.0,15.0,0.0,Pended,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000012582,MBR00000491,Professional,2022-04-24,2022-04-24,2022-05-08,PLN9299,1845057593,1845057593,Orthopedic Surgery,In-Network,R51,E87.6,,,,,,,0,,70450,Radiology,,,,20,Urgent Care,3,1154.98,377.63,374.03,0.0,0.0,3.6,3.6,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012583,MBR00000491,Professional,2023-07-28,2023-07-28,2023-08-19,PLN7027,1728018911,1728018911,Nephrology,In-Network,I25.10,J18.9,,,,,,,0,,99233,E&M,,,,21,Inpatient Hospital,1,494.89,288.33,288.33,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012584,MBR00000491,Institutional-OP,2022-11-30,2022-11-30,2022-12-24,PLN3266,1856686341,1856686341,Geriatrics,In-Network,R10.9,B97.89,,,,,,,0,,43239,Surgery,,,0370,22,Outpatient Hospital,2,2038.06,1407.92,1332.92,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,1,Duplicate,0,0,0,0,0
CLM0000012585,MBR00000491,Institutional-IP,2021-09-14,2021-09-16,2021-10-05,PLN4725,1108115157,1108115157,General Acute Care Hospital,In-Network,Z12.31,F32.9,,,,871,MS-DRG,7,2,Y,81001,Pathology/Lab,,,0270,21,Inpatient Hospital,2,50.1,17.81,0.0,17.81,0.0,0.0,17.81,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012586,MBR00000491,Professional,2021-08-20,2021-08-20,2021-09-18,PLN4132,1847081578,1847081578,Urology,Out-of-Network,R10.9,E11.65,,,,,,,0,,70450,Radiology,,,,50,Federally Qualified Health Center,2,1332.01,913.72,808.38,0.0,0.0,105.34,105.34,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012587,MBR00000491,Institutional-IP,2022-05-16,2022-05-19,2022-05-29,PLN5826,1500949740,1500949740,Pediatrics,In-Network,M17.11,J06.9,,,,641,MS-DRG,23,3,Y,23472,Surgery,,,0360,21,Inpatient Hospital,1,3107.76,2153.09,1888.93,0.0,0.0,264.16,264.16,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012588,MBR00000491,Professional,2021-04-14,2021-04-14,2021-05-13,PLN2158,1994661817,1994661817,SNF,Out-of-Network,I10,M54.5,,,,,,,0,,33533,Surgery,,,,21,Inpatient Hospital,2,23568.61,16038.73,16038.73,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000012589,MBR00000491,Professional,2022-10-03,2022-10-03,2022-10-30,PLN4895,1946680931,1946680931,Critical Access Hospital,Out-of-Network,I10,I10,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,1,662.1,554.13,479.13,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012590,MBR00000491,Institutional-OP,2022-05-19,2022-05-19,2022-06-08,PLN4520,1438368327,1438368327,Home Health,In-Network,I50.9,J20.9,,,,,,,0,,58661,Surgery,,,0900,22,Outpatient Hospital,2,2505.15,1995.64,1960.64,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012591,MBR00000491,Professional,2021-06-02,2021-06-02,2021-06-25,PLN2999,1915531927,1915531927,Critical Access Hospital,In-Network,E11.9,Z00.00,,,,,,,0,,86900,Pathology/Lab,,,,50,Federally Qualified Health Center,2,43.2,33.29,18.29,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012592,MBR00000491,Institutional-OP,2022-07-29,2022-07-29,2022-08-08,PLN5342,1872613201,1872613201,Internal Medicine,In-Network,Z00.00,R07.9,,,,,,,0,,G0444,Medicine,,,0636,22,Outpatient Hospital,2,76.46,26.17,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000012593,MBR00000491,Professional,2023-07-19,2023-07-19,2023-08-09,PLN6276,1872613201,1872613201,Internal Medicine,In-Network,E11.9,J06.9,,,,,,,0,,99203,E&M,,,,11,Office,3,231.43,191.99,191.99,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012594,MBR00000491,Professional,2023-09-23,2023-09-23,2023-10-07,PLN7309,1622771872,1622771872,Pediatrics,In-Network,I10,N18.3,,,,,,,0,,87491,Pathology/Lab,,,,21,Inpatient Hospital,2,132.47,103.97,0.0,103.97,75.0,0.0,178.97,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012595,MBR00000491,Institutional-OP,2022-04-04,2022-04-04,2022-05-07,PLN7677,1410468316,1410468316,SNF,In-Network,I10,I11.9,,,,,,,0,,99284,E&M,,,0360,22,Outpatient Hospital,1,844.9,520.16,455.04,15.25,0.0,49.87,65.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012596,MBR00000491,Professional,2021-03-22,2021-03-22,2021-04-22,PLN4065,1939033455,1939033455,Pulmonology,In-Network,N39.0,E78.5,,,,,,,0,,84443,Pathology/Lab,,,,23,Emergency Room,2,99.93,73.1,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000012597,MBR00000492,Professional,2023-08-04,2023-08-04,2023-09-15,PLN3647,1337791138,1337791138,Internal Medicine,Out-of-Network,N39.0,Z12.31,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,1,215.84,158.09,108.76,0.0,35.0,14.33,49.33,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000012598,MBR00000492,Institutional-OP,2022-08-27,2022-08-27,2022-10-09,PLN6419,1273488618,1273488618,General Acute Care Hospital,In-Network,E78.5,M54.5,,,,,,,0,,90686,Medicine,,,0900,22,Outpatient Hospital,2,112.03,82.96,57.96,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000012599,MBR00000492,Institutional-IP,2023-04-13,2023-04-15,2023-05-09,PLN9966,1840431511,1840431511,Geriatrics,Out-of-Network,J18.9,E11.40,,,,690,MS-DRG,12,2,Y,99232,E&M,,,0761,21,Inpatient Hospital,3,160.46,109.24,109.24,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012600,MBR00000492,Institutional-OP,2021-02-19,2021-02-19,2021-03-21,PLN9801,1696843572,1696843572,Critical Access Hospital,Out-of-Network,Z00.00,Z12.11,,,,,,,0,,99203,E&M,,,0900,22,Outpatient Hospital,1,402.18,257.79,0.0,257.79,50.0,0.0,307.79,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012601,MBR00000492,Institutional-OP,2021-11-19,2021-11-19,2021-12-04,PLN2537,1622771872,1622771872,Pediatrics,In-Network,K57.30,M17.11,,,,,,,0,,23472,Surgery,,,0761,22,Outpatient Hospital,1,4456.38,2718.28,2106.35,256.13,25.0,330.8,611.93,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012602,MBR00000492,Professional,2021-11-09,2021-11-09,2021-11-28,PLN8360,1990090423,1990090423,Orthopedic Surgery,In-Network,N20.0,M17.11,,,,,,,0,,99213,E&M,,,,20,Urgent Care,2,228.1,161.73,86.73,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012603,MBR00000492,Professional,2023-02-24,2023-02-24,2023-03-31,PLN5490,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,B97.89,F41.9,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,1,1715.21,1299.19,1299.19,0.0,0.0,0.0,0.0,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000012604,MBR00000492,Institutional-IP,2023-01-16,2023-01-19,2023-02-09,PLN6597,1609138981,1609138981,Critical Access Hospital,In-Network,E11.9,F32.9,,,,871,MS-DRG,6,3,Y,99283,E&M,,,0636,21,Inpatient Hospital,1,431.02,248.12,230.6,0.0,0.0,17.52,17.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012605,MBR00000492,Professional,2023-03-23,2023-03-23,2023-04-14,PLN2679,1284035364,1284035364,Pediatrics,In-Network,E87.6,N39.0,,,,,,,0,,81001,Pathology/Lab,,,,11,Office,2,54.68,30.47,0.0,30.47,50.0,0.0,80.47,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012606,MBR00000492,Professional,2022-03-11,2022-03-11,2022-03-23,PLN1858,1118885473,1118885473,ASC,In-Network,J18.9,M54.5,,,,,,,0,,74177,Radiology,,,,12,Home,1,2659.9,2091.15,1811.58,0.0,75.0,204.57,279.57,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012607,MBR00000492,Professional,2021-12-07,2021-12-07,2021-12-22,PLN7779,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,F41.9,E66.9,,,,,,,0,,47562,Surgery,,,,22,Outpatient Hospital,2,4330.35,2003.65,1930.35,73.3,0.0,0.0,73.3,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012608,MBR00000492,Institutional-OP,2021-07-27,2021-07-27,2021-09-06,PLN8950,1486164553,1486164553,DME Supplier,In-Network,N20.0,R05,,,,,,,0,,80061,Pathology/Lab,,,0450,22,Outpatient Hospital,1,118.5,37.26,37.26,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012609,MBR00000492,Institutional-OP,2021-10-05,2021-10-05,2021-11-14,PLN2534,1433937353,1433937353,Nephrology,In-Network,E11.9,G20,,,,,,,0,,58661,Surgery,,,0730,22,Outpatient Hospital,3,3340.75,1188.19,1156.3,0.0,0.0,31.89,31.89,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012610,MBR00000492,Professional,2021-06-29,2021-06-29,2021-08-09,PLN8974,1193493783,1193493783,Critical Access Hospital,Out-of-Network,I25.10,Z23,,,,,,,0,,76700,Radiology,,,,22,Outpatient Hospital,1,993.78,549.58,534.58,0.0,15.0,0.0,15.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012611,MBR00000492,Professional,2023-06-21,2023-06-21,2023-07-10,PLN7350,1227362142,1227362142,DME Supplier,In-Network,E11.9,E11.9,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,3,1500.47,537.55,289.3,223.25,25.0,0.0,248.25,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000012612,MBR00000492,Institutional-OP,2023-01-12,2023-01-12,2023-02-02,PLN4819,1518055405,1518055405,Urology,In-Network,E11.9,I11.9,,,,,,,0,,47562,Surgery,,,0270,22,Outpatient Hospital,2,4801.08,4069.18,4054.18,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012613,MBR00000492,Professional,2023-01-13,2023-01-13,2023-02-17,PLN7777,1148984206,1148984206,Psychiatry,In-Network,E66.9,I10,,,,,,,0,,99283,E&M,,,,11,Office,3,595.87,437.12,261.27,140.85,35.0,0.0,175.85,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000012614,MBR00000492,Professional,2023-08-29,2023-08-29,2023-09-23,PLN9363,1974006077,1974006077,Orthopedic Surgery,In-Network,J44.1,M54.5,,,,,,,0,,45378,Surgery,,,,12,Home,2,934.91,427.28,392.28,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000012615,MBR00000492,Professional,2023-03-21,2023-03-21,2023-04-16,PLN7193,1193493783,1193493783,Critical Access Hospital,Out-of-Network,Z87.891,Z00.00,,,,,,,0,,58661,Surgery,,,,20,Urgent Care,2,1903.13,921.27,846.27,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012616,MBR00000492,Professional,2021-12-18,2021-12-18,2022-01-15,PLN2868,1778483301,1778483301,Home Health,In-Network,J06.9,E11.9,,,,,,,0,,43239,Surgery,,,,11,Office,1,899.44,473.23,0.0,473.23,0.0,0.0,473.23,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012617,MBR00000492,Professional,2021-12-09,2021-12-09,2022-01-12,PLN9668,1799205295,1799205295,General Acute Care Hospital,In-Network,R51,E78.5,,,,,,,0,,G0444,Medicine,,,,11,Office,1,104.72,35.97,35.97,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000012618,MBR00000492,Professional,2021-05-20,2021-05-20,2021-06-15,PLN3561,1569105090,1569105090,Geriatrics,In-Network,E78.5,Z12.31,,,,,,,0,,99204,E&M,,,,11,Office,3,288.6,122.88,0.0,122.88,0.0,0.0,122.88,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012619,MBR00000492,Professional,2023-03-02,2023-03-02,2023-04-07,PLN7998,1389336600,1389336600,Critical Access Hospital,In-Network,J06.9,J20.9,,,,,,,0,,45380,Surgery,,,,23,Emergency Room,1,3059.49,921.15,665.32,205.83,50.0,0.0,255.83,0.0,Paid,,,1,,1,0,0,0,0,0,None,0,1,0,0,0
CLM0000012620,MBR00000492,Institutional-OP,2023-08-16,2023-08-16,2023-09-27,PLN3649,1780163051,1780163051,SNF,In-Network,I10,E78.5,,,,,,,0,,70450,Radiology,,,0900,22,Outpatient Hospital,1,1760.49,1214.78,1189.78,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012621,MBR00000492,Professional,2023-02-22,2023-02-22,2023-03-22,PLN7698,1749494482,1749494482,Pediatrics,In-Network,E11.9,E78.5,,,,,,,0,,99284,E&M,,,,20,Urgent Care,3,836.31,273.48,0.0,273.48,0.0,0.0,273.48,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012622,MBR00000492,Institutional-OP,2022-05-31,2022-05-31,2022-07-09,PLN1165,1545347862,1545347862,SNF,In-Network,Z79.4,C50.912,,,,,,,0,,27447,Surgery,,,0636,22,Outpatient Hospital,2,4062.64,1681.58,1656.58,0.0,25.0,0.0,25.0,0.0,Adjusted,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012623,MBR00000493,Institutional-IP,2021-12-31,2022-01-15,2022-01-22,PLN7943,1817234602,1817234602,Clinical Laboratory,In-Network,J06.9,M54.5,,,,195,MS-DRG,7,15,Y,87491,Pathology/Lab,,,0740,21,Inpatient Hospital,1,197.31,144.68,110.66,34.02,0.0,0.0,34.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012624,MBR00000493,Professional,2022-04-25,2022-04-25,2022-05-19,PLN2712,1313212303,1313212303,Family Medicine,In-Network,J06.9,Z12.31,,,,,,,0,,97530,Medicine,,,,31,Skilled Nursing Facility,3,147.62,81.85,0.0,81.85,0.0,0.0,81.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012625,MBR00000493,Institutional-OP,2021-10-24,2021-10-24,2021-11-30,PLN7653,1780163051,1780163051,SNF,In-Network,M54.5,M17.11,,,,,,,0,,66984,Surgery,,,0730,22,Outpatient Hospital,3,2149.09,1315.36,1223.9,91.46,0.0,0.0,91.46,0.0,Paid,,,1,,0,0,1,0,0,1,Duplicate,0,0,0,0,0
CLM0000012626,MBR00000493,Professional,2021-07-01,2021-07-01,2021-07-13,PLN9542,1974006077,1974006077,Orthopedic Surgery,In-Network,J06.9,G43.909,,,,,,,0,,80061,Pathology/Lab,,,,23,Emergency Room,3,78.72,53.71,53.71,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000012627,MBR00000493,Professional,2022-04-18,2022-04-18,2022-04-27,PLN9700,1806688928,1806688928,Geriatrics,In-Network,F32.9,F32.9,,,,,,,0,,80053,Pathology/Lab,,,,22,Outpatient Hospital,3,79.36,67.43,0.0,67.43,0.0,0.0,67.43,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012628,MBR00000493,Institutional-IP,2021-09-17,2021-09-19,2021-09-25,PLN2371,1224179551,1224179551,Physical Therapy,In-Network,E11.40,Z00.00,,,,872,MS-DRG,1,2,Y,27130,Surgery,,,0900,21,Inpatient Hospital,1,4863.08,2147.64,1762.61,385.03,0.0,0.0,385.03,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012629,MBR00000493,Professional,2023-03-21,2023-03-21,2023-04-27,PLN6872,1624802371,1624802371,ASC,Out-of-Network,B97.89,B97.89,,,,,,,0,,27447,Surgery,,,,11,Office,2,3841.4,2070.26,1545.72,475.71,0.0,48.83,524.54,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012630,MBR00000493,Professional,2023-09-20,2023-09-20,2023-10-10,PLN6989,1139906830,1139906830,Endocrinology,Out-of-Network,R10.9,Z23,,,,,,,0,,93225,Medicine,,,,21,Inpatient Hospital,2,811.67,521.79,446.88,0.0,50.0,24.91,74.91,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012631,MBR00000493,Institutional-OP,2021-07-31,2021-07-31,2021-09-07,PLN3651,1500949740,1500949740,Pediatrics,In-Network,N18.3,Z23,,,,,,,0,,72148,Radiology,,,0270,22,Outpatient Hospital,2,2881.6,1802.81,0.0,0.0,35.0,232.32,267.32,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012632,MBR00000493,Institutional-OP,2021-01-07,2021-01-07,2021-02-06,PLN3511,1450553056,1450553056,Clinical Laboratory,In-Network,N20.0,I10,,,,,,,0,,99214,E&M,,,0740,22,Outpatient Hospital,3,324.63,99.12,0.0,99.12,35.0,0.0,134.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012633,MBR00000493,Professional,2023-08-16,2023-08-16,2023-09-01,PLN5936,1224179551,1224179551,Physical Therapy,In-Network,M54.5,J44.1,,,,,,,0,,97110,Medicine,,,,22,Outpatient Hospital,1,133.42,40.1,40.1,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,1,Phantom,0,0,0,0,0
CLM0000012634,MBR00000493,Professional,2021-11-18,2021-11-18,2021-12-11,PLN4869,1806688928,1806688928,Geriatrics,In-Network,E11.9,I25.10,,,,,,,0,,58661,Surgery,,,,50,Federally Qualified Health Center,3,2306.73,1536.25,1536.25,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012635,MBR00000493,Institutional-IP,2021-10-07,2021-10-17,2021-10-29,PLN2867,1337791138,1337791138,Internal Medicine,Out-of-Network,R05,K57.30,,,,683,MS-DRG,20,10,Y,84443,Pathology/Lab,,,0450,21,Inpatient Hospital,1,161.64,57.22,26.34,0.0,25.0,5.88,30.88,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000012636,MBR00000493,Professional,2023-07-26,2023-07-26,2023-09-05,PLN9709,1168881145,1168881145,Orthopedic Surgery,In-Network,E66.9,J44.1,,,,,,,0,,27130,Surgery,,,,11,Office,3,2578.86,1686.08,1412.01,0.0,0.0,274.07,274.07,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012637,MBR00000493,Professional,2023-07-09,2023-07-09,2023-07-28,PLN2932,1450094833,1450094833,Outpatient Clinic,In-Network,M54.5,E11.9,,,,,,,0,,33533,Surgery,,,,21,Inpatient Hospital,2,12285.88,8227.6,7881.92,320.68,25.0,0.0,345.68,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000012638,MBR00000493,Institutional-IP,2022-09-28,2022-10-07,2022-10-28,PLN1542,1366576336,1366576336,Geriatrics,In-Network,E11.9,Z79.4,,,,682,MS-DRG,12,9,Y,23472,Surgery,,,0450,21,Inpatient Hospital,1,5724.06,4488.18,4488.18,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012639,MBR00000493,Professional,2021-06-20,2021-06-20,2021-07-14,PLN2032,1991459367,1991459367,Neurology,Out-of-Network,M54.5,Z23,,,,,,,0,,99204,E&M,,,,20,Urgent Care,3,535.77,300.46,250.46,0.0,50.0,0.0,50.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012640,MBR00000493,Professional,2023-02-12,2023-02-12,2023-03-05,PLN2546,1244186984,1244186984,Family Medicine,Out-of-Network,E78.5,Z96.641,,,,,,,0,,27130,Surgery,,,,21,Inpatient Hospital,1,5965.53,4487.15,4412.15,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012641,MBR00000493,Institutional-IP,2023-03-21,2023-03-29,2023-04-13,PLN4901,1168246159,1168246159,Internal Medicine,In-Network,E66.9,I10,,,,470,MS-DRG,10,8,Y,99284,E&M,,,0120,21,Inpatient Hospital,3,417.37,214.93,183.98,0.0,15.0,15.95,30.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012642,MBR00000493,Institutional-IP,2022-05-01,2022-05-05,2022-05-26,PLN6623,1696843572,1696843572,Critical Access Hospital,Out-of-Network,M54.5,E78.5,,,,195,MS-DRG,23,4,Y,78452,Radiology,,,0636,21,Inpatient Hospital,3,7008.83,5659.37,5387.2,170.48,0.0,101.69,272.17,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012643,MBR00000493,Professional,2022-09-07,2022-09-07,2022-10-02,PLN1198,1609138981,1609138981,Critical Access Hospital,In-Network,F41.9,E11.40,,,,,,,0,,93225,Medicine,,,,11,Office,1,706.1,246.81,213.76,0.0,25.0,8.05,33.05,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012644,MBR00000493,Institutional-OP,2022-08-11,2022-08-11,2022-08-20,PLN4545,1453283987,1453283987,Critical Access Hospital,In-Network,I10,N40.0,,,,,,,0,,84443,Pathology/Lab,,,0360,22,Outpatient Hospital,2,133.2,78.03,0.0,0.0,0.0,5.99,5.99,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012645,MBR00000493,Institutional-OP,2022-12-26,2022-12-26,2023-01-12,PLN7657,1266606767,1266606767,ASC,In-Network,I50.9,J06.9,,,,,,,0,,97530,Medicine,,,0900,22,Outpatient Hospital,3,261.85,207.29,0.0,207.29,0.0,0.0,207.29,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012646,MBR00000493,Institutional-IP,2022-07-19,2022-07-24,2022-08-28,PLN4985,1689639685,1689639685,SNF,In-Network,J44.1,J18.9,,,,641,MS-DRG,18,5,Y,43239,Surgery,,,0200,21,Inpatient Hospital,3,1619.13,937.18,902.18,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012647,MBR00000493,Professional,2023-12-03,2023-12-03,2024-01-08,PLN2172,1757138478,1757138478,Pediatrics,In-Network,I10,Z00.00,,,,,,,0,,99283,E&M,,,,22,Outpatient Hospital,2,580.42,432.15,417.15,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012648,MBR00000493,Institutional-IP,2021-02-08,2021-02-13,2021-02-28,PLN7721,1660288235,1660288235,ASC,In-Network,Z23,Z00.00,,,,871,MS-DRG,21,5,Y,99221,E&M,,,0636,21,Inpatient Hospital,3,238.46,131.8,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012649,MBR00000493,Institutional-IP,2021-02-27,2021-03-07,2021-03-17,PLN2200,1361302520,1361302520,Critical Access Hospital,In-Network,Z23,E78.5,,,,872,MS-DRG,5,8,N,45380,Surgery,,,0636,21,Inpatient Hospital,1,1269.28,663.25,239.77,408.48,15.0,0.0,423.48,0.0,Paid,,,1,,0,0,1,0,1,0,None,0,1,0,0,0
CLM0000012650,MBR00000493,Institutional-IP,2021-06-15,2021-06-28,2021-07-24,PLN6702,1806688928,1806688928,Geriatrics,In-Network,N18.3,Z12.11,,,,690,MS-DRG,7,13,Y,66984,Surgery,,,0370,21,Inpatient Hospital,1,1826.01,1147.62,1052.1,95.52,0.0,0.0,95.52,0.0,Paid,,,1,,0,0,1,0,1,0,None,0,0,0,0,0
CLM0000012651,MBR00000493,Institutional-IP,2021-06-13,2021-06-19,2021-06-21,PLN9156,1994661817,1994661817,SNF,Out-of-Network,Z00.00,J20.9,,,,291,MS-DRG,13,6,N,43239,Surgery,,,0320,21,Inpatient Hospital,1,1572.41,1256.38,1093.44,127.94,35.0,0.0,162.94,0.0,Adjusted,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012652,MBR00000493,Professional,2022-07-01,2022-07-01,2022-08-03,PLN7771,1624202402,1624202402,Orthopedic Surgery,In-Network,I25.10,Z12.31,,,,,,,0,,93225,Medicine,,,,11,Office,2,812.44,645.67,645.67,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012653,MBR00000493,Professional,2021-03-28,2021-03-28,2021-05-04,PLN3926,1767011137,1767011137,DME Supplier,In-Network,E11.9,J20.9,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,2,440.32,307.13,0.0,307.13,0.0,0.0,307.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012654,MBR00000493,Institutional-OP,2021-07-29,2021-07-29,2021-08-06,PLN8887,1108115157,1108115157,General Acute Care Hospital,In-Network,R05,R05,,,,,,,0,,99204,E&M,,,0120,22,Outpatient Hospital,3,274.21,162.74,87.74,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012655,MBR00000493,Professional,2022-07-24,2022-07-24,2022-08-19,PLN3214,1948810580,1948810580,DME Supplier,In-Network,E66.9,J20.9,,,,,,,0,,G0444,Medicine,,,,20,Urgent Care,3,69.43,39.68,0.0,39.68,0.0,0.0,39.68,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000012656,MBR00000493,Institutional-IP,2023-09-13,2023-09-25,2023-10-08,PLN2951,1687650653,1687650653,Internal Medicine,In-Network,J20.9,Z23,,,,871,MS-DRG,12,12,Y,72148,Radiology,,,0900,21,Inpatient Hospital,2,2717.41,1446.21,1325.57,120.64,0.0,0.0,120.64,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012657,MBR00000493,Institutional-OP,2023-05-30,2023-05-30,2023-07-07,PLN7438,1550154147,1550154147,Outpatient Clinic,In-Network,Z23,I11.9,,,,,,,0,,23472,Surgery,,,0900,22,Outpatient Hospital,2,6601.3,5382.43,5347.43,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012658,MBR00000493,Professional,2021-08-26,2021-08-26,2021-09-29,PLN1884,1780163051,1780163051,SNF,In-Network,E11.9,R10.9,,,,,,,0,,99204,E&M,,,,11,Office,3,461.47,330.89,0.0,330.89,0.0,0.0,330.89,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012659,MBR00000493,Institutional-OP,2021-03-02,2021-03-02,2021-03-24,PLN7483,1372918899,1372918899,Family Medicine,In-Network,Z12.31,F41.9,,,,,,,0,,45380,Surgery,,,0450,22,Outpatient Hospital,1,1362.69,608.37,608.37,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000012660,MBR00000493,Institutional-OP,2023-03-21,2023-03-21,2023-04-04,PLN6146,1997536841,1997536841,Family Medicine,Out-of-Network,M54.5,E66.9,,,,,,,0,,83036,Pathology/Lab,,,0636,22,Outpatient Hospital,1,87.08,69.49,44.49,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000012661,MBR00000493,Institutional-OP,2023-05-04,2023-05-04,2023-06-09,PLN7189,1193493783,1193493783,Critical Access Hospital,Out-of-Network,I10,Z23,,,,,,,0,,G0444,Medicine,,,0370,22,Outpatient Hospital,3,53.98,18.47,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000012662,MBR00000493,Institutional-OP,2023-10-15,2023-10-15,2023-11-03,PLN5987,1939033455,1939033455,Pulmonology,In-Network,J44.1,E11.9,,,,,,,0,,99284,E&M,,,0320,22,Outpatient Hospital,2,580.36,212.11,212.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012663,MBR00000493,Institutional-OP,2022-04-20,2022-04-20,2022-05-12,PLN7578,1235381502,1235381502,Cardiology,In-Network,G20,E78.5,,,,,,,0,,86900,Pathology/Lab,,,0450,22,Outpatient Hospital,3,28.08,18.42,0.0,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012664,MBR00000493,Professional,2021-03-05,2021-03-05,2021-04-14,PLN5969,1780163051,1780163051,SNF,In-Network,Z12.31,K57.30,,,,,,,0,,99203,E&M,,,,31,Skilled Nursing Facility,3,279.62,160.51,131.4,0.0,0.0,29.11,29.11,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012665,MBR00000493,Institutional-IP,2023-10-28,2023-11-03,2023-11-16,PLN9821,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,K57.30,C50.912,,,,682,MS-DRG,3,6,W,83036,Pathology/Lab,,,0270,21,Inpatient Hospital,3,82.57,39.59,36.61,0.0,0.0,2.98,2.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000012666,MBR00000493,Professional,2021-11-11,2021-11-11,2021-11-19,PLN8849,1366286000,1366286000,SNF,In-Network,E78.5,J45.20,,,,,,,0,,81001,Pathology/Lab,,,,23,Emergency Room,1,28.59,15.93,0.0,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000012667,MBR00000493,Institutional-OP,2022-02-24,2022-02-24,2022-03-22,PLN6515,1500949740,1500949740,Pediatrics,In-Network,Z00.00,Z79.4,,,,,,,0,,58661,Surgery,,,0636,22,Outpatient Hospital,1,1745.43,981.99,831.28,75.71,75.0,0.0,150.71,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012668,MBR00000493,Professional,2022-03-30,2022-03-30,2022-05-06,PLN8282,1502838586,1502838586,ASC,In-Network,Z12.31,Z79.4,,,,,,,0,,82043,Pathology/Lab,,,,20,Urgent Care,3,47.99,32.54,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,1,Upcoding,0,0,0,0,0
CLM0000012669,MBR00000493,Institutional-OP,2023-12-15,2023-12-15,2024-01-16,PLN9313,1236418230,1236418230,DME Supplier,In-Network,Z00.00,K92.1,,,,,,,0,,G0444,Medicine,,,0120,22,Outpatient Hospital,1,54.63,22.56,0.0,22.56,50.0,0.0,72.56,0.0,Denied,PR-1,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000012670,MBR00000493,Professional,2022-01-31,2022-01-31,2022-02-07,PLN5093,1475984649,1475984649,SNF,In-Network,I25.10,Z00.00,,,,,,,0,,93000,Radiology,,,,11,Office,2,108.02,75.49,0.0,75.49,75.0,0.0,150.49,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012671,MBR00000493,Professional,2022-09-02,2022-09-02,2022-09-29,PLN7015,1622771872,1622771872,Pediatrics,In-Network,E11.9,Z87.891,,,,,,,0,,70553,Radiology,,,,12,Home,1,4032.48,2552.79,2527.79,0.0,25.0,0.0,25.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012672,MBR00000493,Institutional-OP,2022-07-07,2022-07-07,2022-08-07,PLN2371,1847081578,1847081578,Urology,Out-of-Network,F41.9,Z12.31,,,,,,,0,,99203,E&M,,,0200,22,Outpatient Hospital,2,186.09,56.66,0.0,56.66,0.0,0.0,56.66,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012673,MBR00000494,Professional,2023-12-21,2023-12-21,2024-01-24,PLN5069,1148984206,1148984206,Psychiatry,In-Network,E11.65,F32.9,,,,,,,0,,99233,E&M,,,,21,Inpatient Hospital,1,263.69,152.68,99.57,0.0,35.0,18.11,53.11,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012674,MBR00000494,Professional,2023-11-09,2023-11-09,2023-12-08,PLN5779,1631954542,1631954542,Oncology,In-Network,E78.5,F41.9,,,,,,,0,,99222,E&M,,,,21,Inpatient Hospital,2,439.94,151.21,0.0,151.21,15.0,0.0,166.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012675,MBR00000494,Institutional-OP,2022-11-23,2022-11-23,2022-12-25,PLN5854,1168881145,1168881145,Orthopedic Surgery,In-Network,I10,N40.0,,,,,,,0,,99203,E&M,,,0200,22,Outpatient Hospital,2,335.97,191.85,191.85,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012676,MBR00000494,Professional,2021-04-26,2021-04-26,2021-05-30,PLN5865,1242201429,1242201429,General Acute Care Hospital,In-Network,E66.9,R10.9,,,,,,,0,,99203,E&M,,,,81,Independent Laboratory,3,289.86,134.12,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012677,MBR00000494,Professional,2022-01-15,2022-01-15,2022-02-14,PLN2195,1108115157,1108115157,General Acute Care Hospital,In-Network,E11.9,I10,,,,,,,0,,97110,Medicine,,,,23,Emergency Room,2,278.88,163.75,163.75,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000012678,MBR00000494,Professional,2022-12-31,2022-12-31,2023-02-04,PLN3954,1205377316,1205377316,Orthopedic Surgery,In-Network,E11.65,R10.9,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,1,379.9,196.27,9.56,186.16,0.0,0.55,186.71,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012679,MBR00000494,Institutional-OP,2023-05-30,2023-05-30,2023-06-16,PLN5375,1644128543,1644128543,Gastroenterology,In-Network,G43.909,Z87.891,,,,,,,0,,90686,Medicine,,,0320,22,Outpatient Hospital,2,92.03,48.61,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000012680,MBR00000494,Professional,2023-04-04,2023-04-04,2023-04-23,PLN8087,1561134315,1561134315,DME Supplier,In-Network,M81.0,N18.3,,,,,,,0,,90686,Medicine,,,,22,Outpatient Hospital,1,84.38,42.71,42.71,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000012681,MBR00000494,Professional,2022-06-18,2022-06-18,2022-06-30,PLN8471,1948810580,1948810580,DME Supplier,In-Network,E78.5,I50.9,,,,,,,0,,47562,Surgery,,,,20,Urgent Care,2,6144.44,4473.6,4032.85,126.43,50.0,264.32,440.75,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012682,MBR00000494,Institutional-OP,2023-01-05,2023-01-05,2023-02-08,PLN5317,1728018911,1728018911,Nephrology,In-Network,R51,E11.9,,,,,,,0,,99214,E&M,,,0270,22,Outpatient Hospital,2,468.41,240.85,0.0,240.85,0.0,0.0,240.85,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012683,MBR00000494,Institutional-OP,2021-12-05,2021-12-05,2022-01-03,PLN1967,1193493783,1193493783,Critical Access Hospital,Out-of-Network,I10,Z12.31,,,,,,,0,,85610,Pathology/Lab,,,0761,22,Outpatient Hospital,3,58.41,32.0,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012684,MBR00000494,Institutional-IP,2022-11-28,2022-11-30,2022-12-26,PLN3128,1795618275,1795618275,Pulmonology,In-Network,N39.0,E11.9,,,,690,MS-DRG,14,2,Y,90460,Medicine,,,0270,21,Inpatient Hospital,2,61.97,44.55,0.0,44.55,15.0,0.0,59.55,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012685,MBR00000495,Professional,2022-06-08,2022-06-08,2022-06-22,PLN4669,1700633438,1700633438,DME Supplier,In-Network,Z87.891,J06.9,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,1,253.61,166.39,131.39,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012686,MBR00000495,Institutional-OP,2023-01-19,2023-01-19,2023-02-12,PLN3515,1205377316,1205377316,Orthopedic Surgery,In-Network,F03.90,E78.5,,,,,,,0,,45380,Surgery,,,0320,22,Outpatient Hospital,3,2282.73,911.36,748.74,143.35,0.0,19.27,162.62,0.0,Pended,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000012687,MBR00000495,Institutional-OP,2023-08-13,2023-08-13,2023-08-26,PLN6387,1569105090,1569105090,Geriatrics,In-Network,K21.0,I10,,,,,,,0,,84443,Pathology/Lab,,,0510,22,Outpatient Hospital,3,140.89,103.91,88.91,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012688,MBR00000495,Institutional-OP,2023-06-17,2023-06-17,2023-07-08,PLN7037,1266606767,1266606767,ASC,In-Network,K21.0,N40.0,,,,,,,0,,99233,E&M,,,0360,22,Outpatient Hospital,1,575.46,379.5,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012689,MBR00000495,Institutional-IP,2023-03-13,2023-03-17,2023-03-23,PLN5099,1313212303,1313212303,Family Medicine,In-Network,Z12.11,N39.0,,,,683,MS-DRG,12,4,Y,27130,Surgery,,,0636,21,Inpatient Hospital,3,4274.61,2494.31,2419.31,0.0,75.0,0.0,75.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012690,MBR00000495,Institutional-OP,2023-04-21,2023-04-21,2023-06-03,PLN1585,1717546253,1717546253,Family Medicine,In-Network,E78.5,K21.0,,,,,,,0,,99283,E&M,,,0761,22,Outpatient Hospital,3,472.12,291.52,0.0,291.52,0.0,0.0,291.52,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012691,MBR00000495,Institutional-OP,2021-07-10,2021-07-10,2021-08-10,PLN9790,1550154147,1550154147,Outpatient Clinic,In-Network,N39.0,Z12.31,,,,,,,0,,84443,Pathology/Lab,,,0200,22,Outpatient Hospital,2,64.73,40.21,0.0,40.21,0.0,0.0,40.21,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012692,MBR00000495,Institutional-OP,2021-07-22,2021-07-22,2021-08-07,PLN1772,1224179551,1224179551,Physical Therapy,In-Network,M17.11,F32.9,,,,,,,0,,99233,E&M,,,0270,22,Outpatient Hospital,2,540.72,303.83,285.57,0.0,15.0,3.26,18.26,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012693,MBR00000495,Institutional-OP,2023-07-08,2023-07-08,2023-07-24,PLN3885,1355166277,1355166277,Endocrinology,In-Network,E11.9,I63.9,,,,,,,0,,76700,Radiology,,,0360,22,Outpatient Hospital,2,1450.7,569.61,397.73,171.88,0.0,0.0,171.88,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012694,MBR00000495,Professional,2022-08-16,2022-08-16,2022-09-07,PLN6366,1799205295,1799205295,General Acute Care Hospital,In-Network,M54.5,G20,,,,,,,0,,93000,Radiology,,,,12,Home,1,140.44,75.39,0.0,0.0,0.0,13.16,13.16,0.0,Denied,CO-27,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012695,MBR00000495,Institutional-OP,2022-04-18,2022-04-18,2022-05-28,PLN1150,1273488618,1273488618,General Acute Care Hospital,In-Network,G43.909,G43.909,,,,,,,0,,93225,Medicine,,,0120,22,Outpatient Hospital,3,604.34,237.9,237.9,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012696,MBR00000495,Professional,2022-12-30,2022-12-30,2023-01-13,PLN3509,1752470395,1752470395,Home Health,In-Network,M54.5,N18.3,,,,,,,0,,99283,E&M,,,,21,Inpatient Hospital,2,567.5,444.73,444.73,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012697,MBR00000495,Professional,2021-04-01,2021-04-01,2021-04-21,PLN6576,1847081578,1847081578,Urology,Out-of-Network,R05,R51,,,,,,,0,,45380,Surgery,,,,23,Emergency Room,1,1198.93,1009.65,939.47,19.54,15.0,35.64,70.18,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,1,0,0,0
CLM0000012698,MBR00000495,Professional,2021-06-30,2021-06-30,2021-08-05,PLN7935,1687650653,1687650653,Internal Medicine,In-Network,J20.9,I10,,,,,,,0,,99406,Medicine,,,,11,Office,3,77.45,58.17,0.0,58.17,75.0,0.0,133.17,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012699,MBR00000495,Professional,2021-06-11,2021-06-11,2021-07-03,PLN4870,1700633438,1700633438,DME Supplier,In-Network,G43.909,Z00.00,,,,,,,0,,58661,Surgery,,,,22,Outpatient Hospital,2,2826.23,2111.68,2111.68,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,1,Unbundling,0,0,0,0,0
CLM0000012700,MBR00000495,Professional,2022-09-12,2022-09-12,2022-10-06,PLN8591,1511044648,1511044648,Endocrinology,In-Network,I10,E11.65,,,,,,,0,,90460,Medicine,,,,23,Emergency Room,2,36.24,14.26,14.26,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000012701,MBR00000495,Professional,2021-03-14,2021-03-14,2021-04-16,PLN3375,1528335731,1528335731,Critical Access Hospital,In-Network,I11.9,J06.9,,,,,,,0,,99232,E&M,,,,81,Independent Laboratory,3,173.87,79.66,64.66,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012702,MBR00000495,Institutional-IP,2021-02-18,2021-02-23,2021-03-31,PLN3197,1227362142,1227362142,DME Supplier,In-Network,J45.20,I10,,,,871,MS-DRG,5,5,Y,27130,Surgery,,,0730,21,Inpatient Hospital,1,6139.66,3088.65,2642.73,420.92,25.0,0.0,445.92,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012703,MBR00000495,Institutional-OP,2023-01-11,2023-01-11,2023-01-29,PLN9418,1135158374,1135158374,Pulmonology,In-Network,M17.11,R10.9,,,,,,,0,,86900,Pathology/Lab,,,0360,22,Outpatient Hospital,3,43.71,25.82,25.82,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012704,MBR00000495,Professional,2023-03-16,2023-03-16,2023-04-15,PLN2015,1453283987,1453283987,Critical Access Hospital,In-Network,E11.9,Z00.00,,,,,,,0,,27447,Surgery,,,,22,Outpatient Hospital,2,5976.31,3882.22,3520.47,0.0,50.0,311.75,361.75,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012705,MBR00000495,Professional,2021-10-10,2021-10-10,2021-10-18,PLN8158,1103747954,1103747954,Urology,In-Network,N39.0,Z79.4,,,,,,,0,,99232,E&M,,,,21,Inpatient Hospital,1,286.35,125.51,0.0,125.51,35.0,0.0,160.51,0.0,Pended,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012706,MBR00000495,Professional,2023-01-27,2023-01-27,2023-03-02,PLN5887,1939033455,1939033455,Pulmonology,In-Network,Z12.31,E78.5,,,,,,,0,,99221,E&M,,,,21,Inpatient Hospital,3,191.64,116.3,0.0,116.3,0.0,0.0,116.3,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012707,MBR00000495,Institutional-OP,2021-04-16,2021-04-16,2021-04-29,PLN1675,1364429278,1364429278,OB/GYN,In-Network,Z12.31,M54.5,,,,,,,0,,80061,Pathology/Lab,,,0320,22,Outpatient Hospital,3,77.28,54.02,0.0,54.02,0.0,0.0,54.02,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012708,MBR00000495,Professional,2022-03-25,2022-03-25,2022-04-01,PLN2574,1422747896,1422747896,Urology,In-Network,Z23,E78.5,,,,,,,0,,99233,E&M,,,,22,Outpatient Hospital,3,326.75,137.54,64.04,38.5,35.0,0.0,73.5,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012709,MBR00000495,Professional,2022-02-05,2022-02-05,2022-02-20,PLN4976,1434029575,1434029575,Endocrinology,In-Network,E11.9,J06.9,,,,,,,0,,99204,E&M,,,,23,Emergency Room,3,383.53,305.47,290.47,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000012710,MBR00000495,Professional,2022-01-15,2022-01-15,2022-01-31,PLN3757,1361302520,1361302520,Critical Access Hospital,In-Network,Z12.11,I10,,,,,,,0,,33533,Surgery,,,,31,Skilled Nursing Facility,1,18521.59,10380.07,10316.13,63.94,0.0,0.0,63.94,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000012711,MBR00000495,Professional,2023-08-08,2023-08-08,2023-09-01,PLN6240,1660288235,1660288235,ASC,In-Network,J18.9,Z87.891,,,,,,,0,,97530,Medicine,,,,23,Emergency Room,1,127.15,94.57,0.0,94.57,25.0,0.0,119.57,0.0,Pended,,,0,,1,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000012712,MBR00000495,Institutional-OP,2021-03-27,2021-03-27,2021-04-24,PLN7405,1390307371,1390307371,DME Supplier,In-Network,Z87.891,F32.9,,,,,,,0,,70553,Radiology,,,0636,22,Outpatient Hospital,3,3121.56,1629.6,1629.6,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012713,MBR00000495,Institutional-OP,2022-11-20,2022-11-20,2022-12-09,PLN3202,1213165847,1213165847,Critical Access Hospital,In-Network,N40.0,M54.5,,,,,,,0,,27447,Surgery,,,0200,22,Outpatient Hospital,2,4902.93,2722.8,2190.26,457.54,75.0,0.0,532.54,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012714,MBR00000495,Professional,2021-10-27,2021-10-27,2021-11-30,PLN4845,1366286000,1366286000,SNF,In-Network,M54.5,N39.0,,,,,,,0,,G0444,Medicine,,,,11,Office,2,37.25,28.11,0.0,0.0,35.0,0.0,35.0,0.0,Denied,CO-15,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000012715,MBR00000495,Professional,2022-06-17,2022-06-17,2022-07-30,PLN1196,1896447406,1896447406,Nephrology,Out-of-Network,J45.20,F41.9,,,,,,,0,,99204,E&M,,,,11,Office,2,214.87,97.12,97.12,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012716,MBR00000495,Institutional-IP,2021-08-09,2021-08-11,2021-09-19,PLN5145,1168881145,1168881145,Orthopedic Surgery,In-Network,I25.10,E11.9,,,,683,MS-DRG,23,2,Y,99221,E&M,,,0450,21,Inpatient Hospital,2,340.51,127.73,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-11,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012717,MBR00000495,Institutional-OP,2023-03-14,2023-03-14,2023-04-26,PLN6903,1366286000,1366286000,SNF,In-Network,E11.9,I10,,,,,,,0,,45378,Surgery,,,0900,22,Outpatient Hospital,3,1892.31,1551.3,1536.3,0.0,15.0,0.0,15.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000012718,MBR00000495,Institutional-OP,2021-03-08,2021-03-08,2021-03-29,PLN4294,1450553056,1450553056,Clinical Laboratory,In-Network,M17.11,M81.0,,,,,,,0,,74177,Radiology,,,0740,22,Outpatient Hospital,3,2237.24,1361.42,0.0,0.0,15.0,0.0,15.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012719,MBR00000495,Institutional-OP,2021-03-25,2021-03-25,2021-04-13,PLN7381,1502838586,1502838586,ASC,In-Network,N39.0,Z87.891,,,,,,,0,,90460,Medicine,,,0761,22,Outpatient Hospital,1,61.3,29.72,0.0,29.72,0.0,0.0,29.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012720,MBR00000495,Institutional-OP,2021-12-27,2021-12-27,2022-02-02,PLN2477,1168881145,1168881145,Orthopedic Surgery,In-Network,N18.3,I10,,,,,,,0,,78452,Radiology,,,0301,22,Outpatient Hospital,3,6591.52,3797.31,2848.37,403.82,15.0,530.12,948.94,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012721,MBR00000495,Professional,2023-08-25,2023-08-25,2023-09-16,PLN9220,1390307371,1390307371,DME Supplier,In-Network,E11.9,I10,,,,,,,0,,70450,Radiology,,,,20,Urgent Care,1,1147.85,684.83,649.83,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012722,MBR00000495,Professional,2021-01-27,2021-01-27,2021-02-26,PLN9259,1990090423,1990090423,Orthopedic Surgery,In-Network,I25.10,N39.0,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,3,218.38,152.7,0.0,0.0,0.0,0.0,0.0,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012723,MBR00000495,Institutional-OP,2021-07-14,2021-07-14,2021-07-24,PLN1480,1696843572,1696843572,Critical Access Hospital,Out-of-Network,Z12.31,K21.0,,,,,,,0,,99283,E&M,,,0270,22,Outpatient Hospital,3,292.3,226.57,151.57,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012724,MBR00000496,Professional,2022-06-23,2022-06-23,2022-07-04,PLN1767,1511044648,1511044648,Endocrinology,In-Network,E66.9,I25.10,,,,,,,0,,90837,Medicine,,,,81,Independent Laboratory,3,180.89,85.9,85.9,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012725,MBR00000496,Professional,2021-01-24,2021-01-24,2021-03-07,PLN2044,1847081578,1847081578,Urology,Out-of-Network,N18.3,Z23,,,,,,,0,,70450,Radiology,,,,21,Inpatient Hospital,3,833.82,467.43,417.43,0.0,50.0,0.0,50.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012726,MBR00000496,Institutional-OP,2022-08-09,2022-08-09,2022-09-16,PLN8425,1242201429,1242201429,General Acute Care Hospital,In-Network,K21.0,I50.9,,,,,,,0,,66984,Surgery,,,0761,22,Outpatient Hospital,1,3013.9,1073.33,1058.33,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012727,MBR00000496,Institutional-IP,2022-02-01,2022-02-10,2022-03-02,PLN8816,1806688928,1806688928,Geriatrics,In-Network,J20.9,E11.9,,,,196,MS-DRG,22,9,Y,93000,Radiology,,,0636,21,Inpatient Hospital,2,179.58,132.61,132.61,0.0,0.0,0.0,0.0,0.0,Pended,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012728,MBR00000496,Professional,2022-12-08,2022-12-08,2023-01-03,PLN3740,1284035364,1284035364,Pediatrics,In-Network,N20.0,F32.9,,,,,,,0,,99283,E&M,,,,11,Office,3,265.01,135.57,126.49,0.0,0.0,9.08,9.08,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012729,MBR00000496,Professional,2021-03-05,2021-03-05,2021-03-12,PLN6222,1780163051,1780163051,SNF,In-Network,Z12.31,I10,,,,,,,0,,72148,Radiology,,,,11,Office,1,1890.95,847.9,550.77,136.79,75.0,85.34,297.13,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012730,MBR00000496,Professional,2021-07-13,2021-07-13,2021-07-25,PLN7739,1624802371,1624802371,ASC,Out-of-Network,F41.9,J06.9,,,,,,,0,,99283,E&M,,,,11,Office,3,465.61,318.56,318.27,0.0,0.0,0.29,0.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012731,MBR00000496,Professional,2021-07-02,2021-07-02,2021-07-27,PLN5111,1219817751,1219817751,OB/GYN,In-Network,M17.11,F32.9,,,,,,,0,,43239,Surgery,,,,23,Emergency Room,1,2109.78,1406.28,1406.28,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000012732,MBR00000496,Professional,2023-03-19,2023-03-19,2023-04-04,PLN7252,1840431511,1840431511,Geriatrics,Out-of-Network,I25.10,J20.9,,,,,,,0,,84443,Pathology/Lab,,,,11,Office,3,88.4,26.73,0.0,26.73,25.0,0.0,51.73,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012733,MBR00000496,Professional,2023-03-21,2023-03-21,2023-04-12,PLN7083,1935547131,1935547131,Pulmonology,In-Network,E11.65,I10,,,,,,,0,,99283,E&M,,,,21,Inpatient Hospital,1,501.04,376.21,277.12,0.0,75.0,24.09,99.09,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012734,MBR00000496,Institutional-OP,2021-05-08,2021-05-08,2021-05-19,PLN5898,1645194539,1645194539,SNF,In-Network,E11.40,J06.9,,,,,,,0,,58661,Surgery,,,0120,22,Outpatient Hospital,3,4369.8,2042.86,1851.01,166.85,25.0,0.0,191.85,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012735,MBR00000496,Professional,2022-03-20,2022-03-20,2022-03-27,PLN6838,1205377316,1205377316,Orthopedic Surgery,In-Network,F41.9,N39.0,,,,,,,0,,70450,Radiology,,,,11,Office,2,703.25,507.59,216.3,291.29,0.0,0.0,291.29,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012736,MBR00000496,Institutional-OP,2023-02-10,2023-02-10,2023-03-11,PLN6599,1806688928,1806688928,Geriatrics,In-Network,M81.0,M81.0,,,,,,,0,,76700,Radiology,,,0200,22,Outpatient Hospital,1,713.49,393.61,37.21,306.4,50.0,0.0,356.4,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012737,MBR00000496,Institutional-OP,2021-01-08,2021-01-08,2021-02-02,PLN6107,1872613201,1872613201,Internal Medicine,In-Network,F32.9,E11.9,,,,,,,0,,99221,E&M,,,0740,22,Outpatient Hospital,2,196.45,86.7,0.0,86.7,35.0,0.0,121.7,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012738,MBR00000496,Professional,2021-04-21,2021-04-21,2021-05-12,PLN7256,1372918899,1372918899,Family Medicine,In-Network,I50.9,Z79.4,,,,,,,0,,27447,Surgery,,,,50,Federally Qualified Health Center,1,5098.37,4120.54,3547.31,0.0,0.0,573.23,573.23,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012739,MBR00000496,Professional,2022-12-06,2022-12-06,2023-01-01,PLN2429,1511044648,1511044648,Endocrinology,In-Network,F32.9,Z12.11,,,,,,,0,,99213,E&M,,,,12,Home,3,177.3,88.39,13.39,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012740,MBR00000496,Institutional-OP,2022-09-11,2022-09-11,2022-10-23,PLN7046,1806688928,1806688928,Geriatrics,In-Network,E78.5,K21.0,,,,,,,0,,80061,Pathology/Lab,,,0450,22,Outpatient Hospital,1,51.64,42.25,37.64,0.0,0.0,4.61,4.61,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012741,MBR00000496,Professional,2023-02-14,2023-02-14,2023-03-29,PLN8177,1486164553,1486164553,DME Supplier,In-Network,Z12.11,I50.9,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,1,53.75,41.1,0.0,41.1,50.0,0.0,91.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012742,MBR00000496,Professional,2022-05-26,2022-05-26,2022-06-18,PLN6829,1997536841,1997536841,Family Medicine,Out-of-Network,M17.11,M81.0,,,,,,,0,,27447,Surgery,,,,12,Home,2,4996.83,2610.36,2401.71,0.0,50.0,158.65,208.65,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012743,MBR00000496,Professional,2023-09-15,2023-09-15,2023-09-29,PLN7196,1244186984,1244186984,Family Medicine,Out-of-Network,M17.11,F03.90,,,,,,,0,,90686,Medicine,,,,49,Independent Clinic,3,106.5,75.89,60.89,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000012744,MBR00000496,Institutional-OP,2021-05-18,2021-05-18,2021-06-08,PLN5553,1283743001,1283743001,Family Medicine,In-Network,F32.9,Z12.31,,,,,,,0,,99214,E&M,,,0270,22,Outpatient Hospital,2,265.32,182.77,107.77,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012745,MBR00000496,Institutional-OP,2021-06-19,2021-06-19,2021-07-08,PLN6652,1514306773,1514306773,Endocrinology,In-Network,Z12.31,Z23,,,,,,,0,,93306,Radiology,,,0301,22,Outpatient Hospital,2,3137.64,1205.54,955.79,249.75,0.0,0.0,249.75,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012746,MBR00000496,Institutional-IP,2022-11-27,2022-11-28,2022-12-06,PLN2359,1531398223,1531398223,OB/GYN,In-Network,J06.9,F32.9,,,,641,MS-DRG,24,1,Y,99222,E&M,,,0320,21,Inpatient Hospital,2,239.4,139.41,121.35,0.0,15.0,3.06,18.06,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012747,MBR00000496,Professional,2023-07-28,2023-07-28,2023-09-05,PLN4416,1872272835,1872272835,Internal Medicine,In-Network,Z00.00,J06.9,,,,,,,0,,45378,Surgery,,,,23,Emergency Room,3,1301.79,749.18,685.23,0.0,0.0,63.95,63.95,0.0,Adjusted,,,0,,1,1,0,0,0,0,None,0,1,0,0,0
CLM0000012748,MBR00000496,Institutional-IP,2021-01-26,2021-02-01,2021-02-22,PLN6654,1334916761,1334916761,ASC,In-Network,I50.9,E11.9,,,,871,MS-DRG,1,6,Y,99233,E&M,,,0730,21,Inpatient Hospital,2,406.42,166.32,0.0,166.32,0.0,0.0,166.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012749,MBR00000496,Institutional-IP,2023-02-16,2023-02-23,2023-03-30,PLN8183,1795618275,1795618275,Pulmonology,In-Network,M81.0,R07.9,,,,603,MS-DRG,11,7,N,99214,E&M,,,0301,21,Inpatient Hospital,3,456.96,347.52,250.11,0.0,50.0,47.41,97.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012750,MBR00000496,Institutional-IP,2023-12-01,2023-12-03,2023-12-25,PLN7304,1997536841,1997536841,Family Medicine,Out-of-Network,Z00.00,C50.912,,,,683,MS-DRG,17,2,Y,27447,Surgery,,,0900,21,Inpatient Hospital,1,5820.9,2775.44,2775.44,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012751,MBR00000496,Institutional-OP,2022-09-10,2022-09-10,2022-09-23,PLN3602,1433937353,1433937353,Nephrology,In-Network,F32.9,E11.9,,,,,,,0,,72148,Radiology,,,0636,22,Outpatient Hospital,3,2444.41,2042.25,1992.25,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012752,MBR00000496,Professional,2023-06-30,2023-06-30,2023-07-31,PLN9133,1968299309,1968299309,Internal Medicine,In-Network,R05,E11.9,,,,,,,0,,58661,Surgery,,,,49,Independent Clinic,2,3224.96,1654.16,1318.21,335.95,0.0,0.0,335.95,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012753,MBR00000496,Professional,2021-10-14,2021-10-14,2021-10-31,PLN1213,1530904931,1530904931,Internal Medicine,In-Network,I10,J44.1,,,,,,,0,,G0444,Medicine,,,,20,Urgent Care,1,66.08,21.79,0.0,21.79,50.0,0.0,71.79,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000012754,MBR00000496,Professional,2023-06-01,2023-06-01,2023-06-23,PLN5041,1528335731,1528335731,Critical Access Hospital,In-Network,J06.9,F41.9,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,3,212.38,132.63,107.63,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012755,MBR00000496,Institutional-IP,2022-05-17,2022-05-23,2022-06-05,PLN2410,1997536841,1997536841,Family Medicine,Out-of-Network,I10,Z23,,,,470,MS-DRG,14,6,Y,99221,E&M,,,0370,21,Inpatient Hospital,3,358.7,263.15,261.69,0.0,0.0,1.46,1.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012756,MBR00000496,Institutional-OP,2021-11-23,2021-11-23,2022-01-05,PLN6619,1609526529,1609526529,Psychiatry,In-Network,F32.9,E66.9,,,,,,,0,,99213,E&M,,,0450,22,Outpatient Hospital,2,200.36,127.66,0.0,127.66,0.0,0.0,127.66,0.0,Denied,PR-1,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012757,MBR00000496,Professional,2021-08-06,2021-08-06,2021-08-21,PLN4376,1337791138,1337791138,Internal Medicine,Out-of-Network,N39.0,R10.9,,,,,,,0,,93225,Medicine,,,,11,Office,1,917.9,305.2,74.43,230.77,0.0,0.0,230.77,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012758,MBR00000496,Professional,2023-07-23,2023-07-23,2023-08-31,PLN3754,1366426662,1366426662,Urology,In-Network,M54.5,M54.5,,,,,,,0,,66984,Surgery,,,,12,Home,2,3218.01,2380.34,2305.34,0.0,75.0,0.0,75.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012759,MBR00000496,Institutional-OP,2023-02-25,2023-02-25,2023-04-03,PLN8608,1239316214,1239316214,Internal Medicine,In-Network,E66.9,K21.0,,,,,,,0,,97110,Medicine,,,0510,22,Outpatient Hospital,2,294.59,208.51,0.0,0.0,25.0,24.55,49.55,0.0,Denied,CO-29,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012760,MBR00000496,Professional,2023-05-14,2023-05-14,2023-06-21,PLN9369,1799205295,1799205295,General Acute Care Hospital,In-Network,E78.5,J06.9,,,,,,,0,,99284,E&M,,,,20,Urgent Care,3,558.98,229.64,214.64,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012761,MBR00000497,Institutional-OP,2023-02-10,2023-02-10,2023-03-25,PLN9464,1569105090,1569105090,Geriatrics,In-Network,I10,Z00.01,,,,,,,0,,93225,Medicine,,,0636,22,Outpatient Hospital,3,480.72,342.99,0.0,35.05,0.0,0.0,35.05,0.0,Denied,CO-27,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012762,MBR00000497,Institutional-OP,2021-10-07,2021-10-07,2021-11-19,PLN6310,1609526529,1609526529,Psychiatry,In-Network,M81.0,E78.5,,,,,,,0,,77067,Radiology,,,0370,22,Outpatient Hospital,2,416.31,136.25,136.25,0.0,0.0,0.0,0.0,0.0,Adjusted,,,0,,0,1,0,0,0,0,None,1,0,0,0,0
CLM0000012763,MBR00000497,Institutional-OP,2021-07-29,2021-07-29,2021-08-11,PLN4919,1556140803,1556140803,Cardiology,In-Network,E11.9,E11.9,,,,,,,0,,27130,Surgery,,,0730,22,Outpatient Hospital,1,5621.63,3946.03,0.0,83.26,75.0,0.0,158.26,0.0,Denied,CO-18,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012764,MBR00000497,Professional,2022-12-11,2022-12-11,2023-01-15,PLN9590,1550154147,1550154147,Outpatient Clinic,In-Network,E11.65,E78.5,,,,,,,0,,99284,E&M,,,,21,Inpatient Hospital,3,440.13,221.46,0.0,221.46,35.0,0.0,256.46,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012765,MBR00000497,Institutional-IP,2021-10-04,2021-10-08,2021-10-15,PLN4878,1696843572,1696843572,Critical Access Hospital,Out-of-Network,E78.5,Z23,,,,194,MS-DRG,6,4,Y,27447,Surgery,,,0320,21,Inpatient Hospital,3,5221.22,3129.3,3023.02,106.28,0.0,0.0,106.28,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012766,MBR00000497,Professional,2022-12-11,2022-12-11,2023-01-02,PLN7326,1991459367,1991459367,Neurology,Out-of-Network,E11.9,F32.9,,,,,,,0,,70450,Radiology,,,,11,Office,2,1757.41,854.54,743.8,0.0,0.0,110.74,110.74,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012767,MBR00000497,Professional,2023-09-14,2023-09-14,2023-10-03,PLN5275,1502838586,1502838586,ASC,In-Network,Z12.31,Z12.31,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,3,334.7,191.04,110.26,25.59,50.0,5.19,80.78,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012768,MBR00000497,Professional,2023-04-01,2023-04-01,2023-05-09,PLN8084,1980712759,1980712759,Outpatient Clinic,Out-of-Network,E66.9,N18.3,,,,,,,0,,80061,Pathology/Lab,,,,31,Skilled Nursing Facility,2,122.19,86.01,71.01,0.0,15.0,0.0,15.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012769,MBR00000497,Professional,2022-06-01,2022-06-01,2022-06-14,PLN7916,1660288235,1660288235,ASC,In-Network,E11.9,I48.91,,,,,,,0,,G0444,Medicine,,,,22,Outpatient Hospital,3,51.82,16.38,0.0,16.38,50.0,0.0,66.38,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,1
CLM0000012770,MBR00000497,Institutional-OP,2023-09-23,2023-09-23,2023-10-27,PLN1431,1569105090,1569105090,Geriatrics,In-Network,N20.0,E11.9,,,,,,,0,,93000,Radiology,,,0200,22,Outpatient Hospital,2,135.79,107.95,0.0,107.95,35.0,0.0,142.95,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012771,MBR00000497,Institutional-IP,2022-08-27,2022-08-29,2022-09-07,PLN2916,1486164553,1486164553,DME Supplier,In-Network,F32.9,E11.9,,,,872,MS-DRG,11,2,Y,33533,Surgery,,,0730,21,Inpatient Hospital,2,15417.12,8539.64,8428.95,110.69,0.0,0.0,110.69,0.0,Paid,,,1,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000012772,MBR00000497,Professional,2022-05-30,2022-05-30,2022-06-17,PLN9559,1168881145,1168881145,Orthopedic Surgery,In-Network,E11.65,J06.9,,,,,,,0,,90460,Medicine,,,,11,Office,3,41.83,22.91,0.0,22.91,50.0,0.0,72.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012773,MBR00000497,Institutional-IP,2023-11-16,2023-11-21,2023-11-23,PLN9791,1395983630,1395983630,Nephrology,In-Network,J20.9,F32.9,,,,195,MS-DRG,7,5,Y,58661,Surgery,,,0320,21,Inpatient Hospital,1,4333.23,2295.06,2104.8,0.0,0.0,190.26,190.26,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012774,MBR00000497,Institutional-IP,2022-01-02,2022-01-09,2022-02-12,PLN6332,1590915516,1590915516,Physical Therapy,Out-of-Network,J45.20,Z12.31,,,,872,MS-DRG,8,7,Y,74177,Radiology,,,0761,21,Inpatient Hospital,2,1533.06,1278.83,1253.83,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,1,0,None,0,0,0,0,0
CLM0000012775,MBR00000497,Professional,2021-08-15,2021-08-15,2021-08-29,PLN7411,1193493783,1193493783,Critical Access Hospital,Out-of-Network,E11.9,N39.0,,,,,,,0,,27130,Surgery,,,,11,Office,1,6555.72,4672.29,4573.88,63.41,35.0,0.0,98.41,0.0,Pended,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012776,MBR00000497,Professional,2021-06-02,2021-06-02,2021-07-16,PLN1429,1168246159,1168246159,Internal Medicine,In-Network,M54.5,K21.0,,,,,,,0,,47562,Surgery,,,,11,Office,2,3670.54,2799.98,2799.98,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012777,MBR00000497,Professional,2022-11-18,2022-11-18,2022-12-22,PLN2563,1696843572,1696843572,Critical Access Hospital,Out-of-Network,N17.9,E11.40,,,,,,,0,,G0468,Medicine,,,,11,Office,2,372.45,176.02,141.02,0.0,35.0,0.0,35.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012778,MBR00000497,Institutional-OP,2022-07-13,2022-07-13,2022-08-19,PLN6815,1644128543,1644128543,Gastroenterology,In-Network,I10,Z12.11,,,,,,,0,,99204,E&M,,,0730,22,Outpatient Hospital,2,500.76,403.95,35.83,368.12,0.0,0.0,368.12,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012779,MBR00000497,Professional,2023-04-28,2023-04-28,2023-05-18,PLN4369,1453283987,1453283987,Critical Access Hospital,In-Network,J44.1,Z23,,,,,,,0,,71046,Radiology,,,,21,Inpatient Hospital,3,179.15,105.7,70.7,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012780,MBR00000497,Institutional-OP,2021-06-10,2021-06-10,2021-07-02,PLN6624,1486164553,1486164553,DME Supplier,In-Network,Z96.641,K21.0,,,,,,,0,,99222,E&M,,,0740,22,Outpatient Hospital,2,238.79,196.36,120.38,0.0,50.0,25.98,75.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012781,MBR00000497,Institutional-IP,2021-12-16,2021-12-21,2022-01-06,PLN7911,1840431511,1840431511,Geriatrics,Out-of-Network,J45.20,I50.9,,,,291,MS-DRG,24,5,Y,70553,Radiology,,,0900,21,Inpatient Hospital,2,2359.95,956.61,956.61,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012782,MBR00000497,Professional,2021-05-13,2021-05-13,2021-06-26,PLN6454,1609138981,1609138981,Critical Access Hospital,In-Network,M81.0,E66.9,,,,,,,0,,82043,Pathology/Lab,,,,21,Inpatient Hospital,3,67.51,54.53,29.53,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012783,MBR00000497,Professional,2021-12-05,2021-12-05,2022-01-16,PLN1338,1624802371,1624802371,ASC,Out-of-Network,Z12.31,Z12.31,,,,,,,0,,43239,Surgery,,,,11,Office,1,1706.39,596.0,581.0,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012784,MBR00000497,Professional,2023-11-18,2023-11-18,2023-12-10,PLN3742,1550154147,1550154147,Outpatient Clinic,In-Network,J20.9,I10,,,,,,,0,,66984,Surgery,,,,22,Outpatient Hospital,1,2231.3,1237.03,1002.25,0.0,0.0,234.78,234.78,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012785,MBR00000497,Professional,2023-09-10,2023-09-10,2023-10-10,PLN2051,1891283887,1891283887,General Acute Care Hospital,Out-of-Network,G43.909,Z23,,,,,,,0,,47562,Surgery,,,,11,Office,3,4573.33,1708.7,1708.7,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012786,MBR00000497,Professional,2022-06-28,2022-06-28,2022-07-20,PLN1256,1205377316,1205377316,Orthopedic Surgery,In-Network,Z23,E11.9,,,,,,,0,,45380,Surgery,,,,11,Office,2,1453.61,1066.76,1008.19,0.0,50.0,8.57,58.57,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000012787,MBR00000497,Institutional-OP,2021-04-19,2021-04-19,2021-05-07,PLN8180,1806688928,1806688928,Geriatrics,In-Network,M17.11,I48.91,,,,,,,0,,33533,Surgery,,,0370,22,Outpatient Hospital,2,15358.66,6542.84,6002.01,0.0,25.0,515.83,540.83,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000012788,MBR00000497,Professional,2023-12-26,2023-12-26,2024-01-28,PLN9036,1713934949,1713934949,Neurology,In-Network,R07.9,E66.9,,,,,,,0,,99204,E&M,,,,11,Office,1,237.01,120.6,2.69,92.91,25.0,0.0,117.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012789,MBR00000497,Professional,2021-06-22,2021-06-22,2021-07-29,PLN7070,1660288235,1660288235,ASC,In-Network,K21.0,F41.9,,,,,,,0,,70553,Radiology,,,,31,Skilled Nursing Facility,1,2487.16,1087.83,1087.83,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012790,MBR00000497,Professional,2021-04-21,2021-04-21,2021-05-27,PLN2884,1728018911,1728018911,Nephrology,In-Network,F41.9,F41.9,,,,,,,0,,85025,Pathology/Lab,,,,22,Outpatient Hospital,3,50.36,39.94,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-15,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012791,MBR00000498,Professional,2022-03-26,2022-03-26,2022-04-03,PLN7767,1355166277,1355166277,Endocrinology,In-Network,N40.0,F32.9,,,,,,,0,,82043,Pathology/Lab,,,,20,Urgent Care,3,48.5,36.1,0.0,36.1,0.0,0.0,36.1,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012792,MBR00000498,Institutional-OP,2023-10-28,2023-10-28,2023-11-07,PLN5044,1795618275,1795618275,Pulmonology,In-Network,Z23,Z00.00,,,,,,,0,,74177,Radiology,,,0120,22,Outpatient Hospital,2,2200.04,1342.07,1342.07,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012793,MBR00000498,Professional,2023-05-25,2023-05-25,2023-07-06,PLN1867,1812060197,1812060197,Oncology,Out-of-Network,K21.0,E78.5,,,,,,,0,,33533,Surgery,,,,22,Outpatient Hospital,3,21269.81,15336.29,15321.29,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,1,0,0,None,0,0,0,0,0
CLM0000012794,MBR00000498,Professional,2022-01-29,2022-01-29,2022-02-27,PLN8261,1757138478,1757138478,Pediatrics,In-Network,F32.9,Z12.31,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,2,2209.06,934.97,934.97,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000012795,MBR00000498,Institutional-OP,2022-05-14,2022-05-14,2022-06-09,PLN3691,1622771872,1622771872,Pediatrics,In-Network,N18.3,I10,,,,,,,0,,87491,Pathology/Lab,,,0370,22,Outpatient Hospital,3,136.29,84.69,0.0,84.69,0.0,0.0,84.69,0.0,Paid,,,0,,0,0,0,0,0,1,Identity_Theft,0,0,0,0,0
CLM0000012796,MBR00000498,Professional,2021-03-08,2021-03-08,2021-03-30,PLN2018,1561134315,1561134315,DME Supplier,In-Network,F41.9,M17.11,,,,,,,0,,99213,E&M,,,,11,Office,3,152.46,82.62,0.0,82.62,0.0,0.0,82.62,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012797,MBR00000498,Professional,2021-10-24,2021-10-24,2021-11-15,PLN3109,1717912431,1717912431,Oncology,In-Network,E78.5,N39.0,,,,,,,0,,27130,Surgery,,,,22,Outpatient Hospital,1,5861.78,3009.74,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-4,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012798,MBR00000498,Institutional-IP,2023-01-04,2023-01-07,2023-02-14,PLN5409,1545347862,1545347862,SNF,In-Network,Z00.00,E78.5,,,,194,MS-DRG,1,3,W,47562,Surgery,,,0740,21,Inpatient Hospital,3,2607.79,1491.42,0.0,444.93,75.0,6.38,526.31,0.0,Denied,CO-97,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012799,MBR00000498,Institutional-OP,2022-04-06,2022-04-06,2022-04-15,PLN2957,1713934949,1713934949,Neurology,In-Network,N18.3,N40.0,,,,,,,0,,70553,Radiology,,,0301,22,Outpatient Hospital,3,1929.78,758.79,758.79,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012800,MBR00000498,Institutional-IP,2023-12-08,2023-12-10,2024-01-04,PLN1951,1313212303,1313212303,Family Medicine,In-Network,E11.40,I25.10,,,,195,MS-DRG,23,2,N,82043,Pathology/Lab,,,0761,21,Inpatient Hospital,3,63.89,23.97,0.0,23.97,35.0,0.0,58.97,0.0,Paid,,,0,,0,0,0,0,0,1,Duplicate,0,0,0,0,0
CLM0000012801,MBR00000498,Professional,2022-05-03,2022-05-03,2022-06-13,PLN3241,1840431511,1840431511,Geriatrics,Out-of-Network,J06.9,E11.9,,,,,,,0,,99232,E&M,,,,20,Urgent Care,1,362.57,245.18,0.0,245.18,0.0,0.0,245.18,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012802,MBR00000498,Professional,2023-07-17,2023-07-17,2023-08-12,PLN7420,1186826716,1186826716,Physical Therapy,In-Network,J44.1,K21.0,,,,,,,0,,99232,E&M,,,,22,Outpatient Hospital,1,149.81,72.33,0.0,72.33,0.0,0.0,72.33,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012803,MBR00000498,Professional,2023-03-08,2023-03-08,2023-04-05,PLN6769,1980712759,1980712759,Outpatient Clinic,Out-of-Network,E11.65,Z23,,,,,,,0,,99203,E&M,,,,22,Outpatient Hospital,1,215.64,69.11,69.11,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012804,MBR00000498,Professional,2022-07-10,2022-07-10,2022-07-17,PLN8786,1520687146,1520687146,ASC,In-Network,N18.3,I10,,,,,,,0,,76700,Radiology,,,,31,Skilled Nursing Facility,1,884.56,554.13,554.13,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012805,MBR00000498,Institutional-OP,2023-08-10,2023-08-10,2023-09-12,PLN8180,1148984206,1148984206,Psychiatry,In-Network,R05,Z00.01,,,,,,,0,,72148,Radiology,,,0900,22,Outpatient Hospital,3,1773.12,902.82,0.0,449.14,0.0,0.0,449.14,0.0,Denied,PR-1,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012806,MBR00000498,Professional,2023-08-12,2023-08-12,2023-08-25,PLN6859,1948810580,1948810580,DME Supplier,In-Network,R10.9,E66.9,,,,,,,0,,99284,E&M,,,,11,Office,2,867.95,353.16,353.16,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012807,MBR00000498,Professional,2021-12-18,2021-12-18,2022-01-13,PLN7122,1991459367,1991459367,Neurology,Out-of-Network,I63.9,N39.0,,,,,,,0,,78452,Radiology,,,,22,Outpatient Hospital,2,3763.88,2991.31,2991.31,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012808,MBR00000498,Professional,2021-11-01,2021-11-01,2021-12-07,PLN5003,1585582070,1585582070,Outpatient Clinic,In-Network,E78.5,Z12.31,,,,,,,0,,87491,Pathology/Lab,,,,23,Emergency Room,3,260.47,176.58,141.58,0.0,35.0,0.0,35.0,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000012809,MBR00000498,Professional,2023-02-15,2023-02-15,2023-03-26,PLN4910,1935547131,1935547131,Pulmonology,In-Network,I10,E78.5,,,,,,,0,,99204,E&M,,,,22,Outpatient Hospital,2,324.77,270.07,259.75,0.0,0.0,10.32,10.32,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012810,MBR00000498,Professional,2021-01-30,2021-01-30,2021-03-13,PLN1256,1283743001,1283743001,Family Medicine,In-Network,E78.5,J20.9,,,,,,,0,,99204,E&M,,,,21,Inpatient Hospital,1,223.92,187.37,135.65,0.0,35.0,16.72,51.72,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012811,MBR00000498,Professional,2023-02-08,2023-02-08,2023-03-02,PLN5631,1273488618,1273488618,General Acute Care Hospital,In-Network,F32.9,J06.9,,,,,,,0,,99284,E&M,,,,22,Outpatient Hospital,3,524.12,167.54,152.54,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012812,MBR00000498,Institutional-OP,2022-04-22,2022-04-22,2022-05-23,PLN3612,1752470395,1752470395,Home Health,In-Network,Z00.00,I10,,,,,,,0,,74177,Radiology,,,0120,22,Outpatient Hospital,1,1899.39,1501.8,1221.07,280.73,0.0,0.0,280.73,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012813,MBR00000498,Professional,2023-04-20,2023-04-20,2023-05-13,PLN5899,1778483301,1778483301,Home Health,In-Network,E66.9,F32.9,,,,,,,0,,G0468,Medicine,,,,21,Inpatient Hospital,2,576.36,347.76,347.76,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012814,MBR00000498,Professional,2021-05-23,2021-05-23,2021-06-26,PLN3925,1168881145,1168881145,Orthopedic Surgery,In-Network,N17.9,K57.30,,,,,,,0,,99221,E&M,,,,22,Outpatient Hospital,2,348.06,166.85,0.0,163.04,50.0,0.0,213.04,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012815,MBR00000498,Institutional-IP,2022-09-22,2022-09-28,2022-10-19,PLN8524,1795618275,1795618275,Pulmonology,In-Network,J44.1,Z23,,,,641,MS-DRG,23,6,Y,G0468,Medicine,,,0360,21,Inpatient Hospital,1,399.25,334.22,334.22,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012816,MBR00000498,Professional,2022-08-11,2022-08-11,2022-09-12,PLN3507,1809014947,1809014947,Urology,In-Network,I25.10,I63.9,,,,,,,0,,66984,Surgery,,,,11,Office,3,3578.42,3034.0,2173.28,455.13,75.0,330.59,860.72,0.0,Paid,,,0,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012817,MBR00000499,Professional,2021-01-17,2021-01-17,2021-02-01,PLN6535,1689639685,1689639685,SNF,In-Network,M54.5,M54.5,,,,,,,0,,86900,Pathology/Lab,,,,12,Home,3,23.9,14.25,14.25,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012818,MBR00000499,Professional,2022-07-29,2022-07-29,2022-08-25,PLN9052,1872613201,1872613201,Internal Medicine,In-Network,E11.40,Z23,,,,,,,0,,83036,Pathology/Lab,,,,11,Office,2,89.7,43.61,0.0,43.61,0.0,0.0,43.61,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,1,0,0
CLM0000012819,MBR00000499,Institutional-OP,2022-12-20,2022-12-20,2023-01-01,PLN4898,1199138277,1199138277,Diagnostic Radiology,Out-of-Network,E78.5,F03.90,,,,,,,0,,72148,Radiology,,,0320,22,Outpatient Hospital,3,2217.98,1045.38,825.68,204.7,15.0,0.0,219.7,0.0,Paid,,,1,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012820,MBR00000499,Professional,2022-03-20,2022-03-20,2022-05-02,PLN8196,1227362142,1227362142,DME Supplier,In-Network,E11.9,Z12.31,,,,,,,0,,99284,E&M,,,,23,Emergency Room,1,520.67,310.7,266.39,19.31,25.0,0.0,44.31,0.0,Paid,,,0,,1,0,0,0,0,0,None,0,0,0,0,0
CLM0000012821,MBR00000499,Professional,2022-11-02,2022-11-02,2022-12-07,PLN6216,1716521444,1716521444,Oncology,In-Network,Z12.11,C50.912,,,,,,,0,,99283,E&M,,,,11,Office,3,546.81,338.61,288.61,0.0,50.0,0.0,50.0,0.0,Adjusted,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012822,MBR00000499,Institutional-IP,2021-12-24,2022-01-04,2022-01-26,PLN1951,1242201429,1242201429,General Acute Care Hospital,In-Network,E66.9,F41.9,,,,194,MS-DRG,16,11,Y,99214,E&M,,,0510,21,Inpatient Hospital,3,246.09,134.86,26.42,58.44,50.0,0.0,108.44,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012823,MBR00000499,Professional,2022-11-01,2022-11-01,2022-11-23,PLN9312,1334916761,1334916761,ASC,In-Network,J06.9,Z12.31,,,,,,,0,,33533,Surgery,,,,11,Office,3,14776.87,8867.76,8852.76,0.0,15.0,0.0,15.0,0.0,Paid,,,0,,0,0,1,1,0,1,Unbundling,0,0,0,0,0
CLM0000012824,MBR00000499,Institutional-OP,2021-09-24,2021-09-24,2021-10-11,PLN1274,1689639685,1689639685,SNF,In-Network,J20.9,M17.11,,,,,,,0,,86900,Pathology/Lab,,,0320,22,Outpatient Hospital,1,48.95,23.94,23.94,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012825,MBR00000499,Professional,2021-11-05,2021-11-05,2021-11-17,PLN6133,1125190055,1125190055,Nephrology,In-Network,I25.10,M54.5,,,,,,,0,,80053,Pathology/Lab,,,,21,Inpatient Hospital,1,113.68,86.98,0.0,86.98,75.0,0.0,161.98,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012826,MBR00000499,Professional,2021-03-19,2021-03-19,2021-04-22,PLN5212,1186826716,1186826716,Physical Therapy,In-Network,E87.6,N40.0,,,,,,,0,,45378,Surgery,,,,22,Outpatient Hospital,3,2176.22,1318.01,1189.27,0.0,35.0,93.74,128.74,0.0,Paid,,,1,,0,1,1,0,0,0,None,0,1,0,0,0
CLM0000012827,MBR00000499,Institutional-OP,2021-04-18,2021-04-18,2021-05-28,PLN7776,1500037969,1500037969,Pulmonology,In-Network,N39.0,F32.9,,,,,,,0,,99203,E&M,,,0900,22,Outpatient Hospital,2,271.54,136.18,111.18,0.0,25.0,0.0,25.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012828,MBR00000499,Institutional-IP,2021-05-28,2021-05-30,2021-06-19,PLN9116,1856686341,1856686341,Geriatrics,In-Network,E78.5,F10.20,,,,690,MS-DRG,16,2,Y,99233,E&M,,,0200,21,Inpatient Hospital,1,213.38,163.58,26.22,137.36,0.0,0.0,137.36,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012829,MBR00000499,Professional,2021-07-27,2021-07-27,2021-08-27,PLN8820,1355166277,1355166277,Endocrinology,In-Network,I25.10,Z00.00,,,,,,,0,,G0468,Medicine,,,,65,End-Stage Renal Disease,3,444.04,317.01,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-18,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012830,MBR00000500,Institutional-OP,2023-02-26,2023-02-26,2023-04-09,PLN4270,1800011727,1800011727,Clinical Laboratory,Out-of-Network,I11.9,F41.9,,,,,,,0,,82043,Pathology/Lab,,,0120,22,Outpatient Hospital,2,52.64,36.91,0.0,36.91,15.0,0.0,51.91,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012831,MBR00000500,Professional,2021-08-25,2021-08-25,2021-09-14,PLN5004,1463205530,1463205530,Nephrology,In-Network,Z00.00,F32.9,,,,,,,0,,90686,Medicine,,,,20,Urgent Care,1,139.13,47.56,0.0,0.0,50.0,0.0,50.0,0.0,Paid,,,0,,0,1,0,0,0,0,None,0,0,0,0,0
CLM0000012832,MBR00000500,Professional,2022-01-25,2022-01-25,2022-02-23,PLN2421,1716521444,1716521444,Oncology,In-Network,K21.0,Z51.11,,,,,,,0,,66984,Surgery,,,,11,Office,1,2246.06,1014.99,1014.99,0.0,0.0,0.0,0.0,0.0,Paid,,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012833,MBR00000500,Professional,2021-07-10,2021-07-10,2021-08-22,PLN8852,1429015908,1429015908,General Acute Care Hospital,Out-of-Network,Z12.31,Z51.11,,,,,,,0,,99214,E&M,,,,12,Home,1,170.95,93.03,91.7,0.0,0.0,1.33,1.33,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012834,MBR00000500,Professional,2022-04-10,2022-04-10,2022-05-05,PLN7704,1364429278,1364429278,OB/GYN,In-Network,E11.9,F41.9,,,,,,,0,,87491,Pathology/Lab,,,,31,Skilled Nursing Facility,3,248.85,90.04,77.36,0.0,0.0,0.0,0.0,12.68,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012835,MBR00000500,Professional,2021-09-25,2021-09-25,2021-10-21,PLN8701,1124394415,1124394415,Pediatrics,In-Network,G43.909,Z23,,,,,,,0,,90460,Medicine,,,,11,Office,1,70.44,22.23,0.0,22.23,75.0,0.0,97.23,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012836,MBR00000500,Institutional-OP,2021-12-27,2021-12-27,2022-01-09,PLN4361,1713934949,1713934949,Neurology,In-Network,Z87.891,E78.5,,,,,,,0,,43239,Surgery,,,0120,22,Outpatient Hospital,3,1661.68,737.46,0.0,0.0,0.0,0.0,0.0,0.0,Denied,CO-50,,1,,0,0,1,0,0,0,None,0,0,0,0,0
CLM0000012837,MBR00000500,Professional,2021-03-17,2021-03-17,2021-04-06,PLN6276,1702692193,1702692193,Physical Therapy,In-Network,E66.9,E11.65,,,,,,,0,,99233,E&M,,,,11,Office,1,420.25,231.72,199.5,0.0,0.0,0.0,0.0,32.22,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012838,MBR00000500,Institutional-OP,2022-07-07,2022-07-07,2022-08-10,PLN7585,1148984206,1148984206,Psychiatry,In-Network,N39.0,Z12.31,,,,,,,0,,70553,Radiology,,,0900,22,Outpatient Hospital,2,4612.47,2315.78,2315.78,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012839,MBR00000500,Professional,2021-10-22,2021-10-22,2021-11-07,PLN3462,1205377316,1205377316,Orthopedic Surgery,In-Network,M81.0,E11.40,,,,,,,0,,87491,Pathology/Lab,,,,22,Outpatient Hospital,2,115.92,89.66,33.7,0.0,50.0,0.0,50.0,5.96,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012840,MBR00000500,Professional,2022-12-15,2022-12-15,2023-01-19,PLN2321,1749327647,1749327647,Geriatrics,In-Network,F32.9,J44.1,,,,,,,0,,80061,Pathology/Lab,,,,11,Office,1,108.0,78.41,0.0,78.41,0.0,0.0,78.41,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012841,MBR00000500,Institutional-IP,2023-12-29,2024-01-03,2024-01-12,PLN4469,1114982472,1114982472,Orthopedic Surgery,In-Network,E11.9,E78.5,,,,291,MS-DRG,13,5,Y,85610,Pathology/Lab,,,0740,21,Inpatient Hospital,1,35.57,26.22,0.0,0.0,25.0,0.0,25.0,0.0,Denied,CO-4,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012842,MBR00000500,Professional,2022-06-16,2022-06-16,2022-07-30,PLN6971,1453936007,1453936007,ASC,In-Network,E78.5,I25.10,,,,,,,0,,93225,Medicine,,,,49,Independent Clinic,1,362.41,140.67,42.3,98.37,0.0,0.0,98.37,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012843,MBR00000500,Professional,2022-07-14,2022-07-14,2022-07-30,PLN8680,1609526529,1609526529,Psychiatry,In-Network,I10,K57.30,,,,,,,0,,45380,Surgery,,,,22,Outpatient Hospital,3,1336.82,1035.66,822.76,0.0,0.0,0.0,0.0,212.9,Paid,,,0,,0,0,1,0,0,0,None,0,1,0,0,0
CLM0000012844,MBR00000500,Professional,2023-06-29,2023-06-29,2023-07-27,PLN6366,1609526529,1609526529,Psychiatry,In-Network,N39.0,E78.5,,,,,,,0,,85025,Pathology/Lab,,,,49,Independent Clinic,2,41.7,34.95,0.0,0.0,50.0,0.0,50.0,6.07,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0
CLM0000012845,MBR00000500,Professional,2022-01-13,2022-01-13,2022-02-23,PLN9782,1590915516,1590915516,Physical Therapy,Out-of-Network,F32.9,E11.9,,,,,,,0,,87491,Pathology/Lab,,,,11,Office,2,91.99,48.61,48.61,0.0,0.0,0.0,0.0,0.0,Paid,,,0,,0,0,0,0,0,0,None,0,0,0,0,0