pbp_a_hnumber	pbp_a_plan_identifier	segment_id	pbp_a_ben_cov	pbp_a_plan_type	orgtype	bid_id	version	pbp_vbid_group_id	pbp_b19b_package_type	pbp_b19b_tm_vbid	pbp_b19b_states_ehc_vbd	pbp_b19b_all_dis_yn	pbp_b19b_cmb_dis_yn	pbp_b19b_lis_vbid	pbp_b19b_enr_tar_vbid	pbp_b19b_enr_eng_vbid	pbp_b19b_states_ehc_ssbci	pbp_b19b_states_ssbci_other1	pbp_b19b_states_ssbci_other2	pbp_b19b_states_ssbci_other3	pbp_b19b_states_ssbci_other4	pbp_b19b_states_ssbci_other5	pbp_b19b_states_ehc_uf	pbp_b19b_states_uf_other1	pbp_b19b_states_uf_other2	pbp_b19b_states_uf_other3	pbp_b19b_states_uf_other4	pbp_b19b_states_uf_other5	pbp_b19b_states_uf_all_yn	pbp_b19b_states_uf_cmb_yn	pbp_b19b_mmp_yn	pbp_b19b_mmp_ehc	pbp_b19b_add_prereq_yn	pbp_b19b_add_prereq	pbp_b19b_add_nmc_bendesc_cats	pbp_b19b_add_apply_yn	pbp_b19b_add_exempt_yn	pbp_b19b_add_exempt_nmc_cats	pbp_b19b_reim_yn	pbp_b19b_reim_all_cats_yn	pbp_b19b_reim_nmc_bendesc_cats	pbp_b19b_agg_yn	pbp_b19b_agg_amt
H0028	007	0	1	01	01	H0028_007_0	7	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	1000
H0028	007	0	1	01	01	H0028_007_0	7	1	1	10				01111	1101	1101																	2		13d;		1	13d;	2			1	600
H0028	013	0	1	01	01	H0028_013_0	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H0028	014	0	1	01	01	H0028_014_0	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H0028	015	0	1	01	01	H0028_015_0	7	1	1	10				01111	7931	7931																	2		13d;		1	13d;	2			1	900.00
H0028	015	0	1	01	01	H0028_015_0	7	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	500.00
H0028	018	0	1	01	01	H0028_018_0	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	500.00
H0028	021	0	1	01	01	H0028_021_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H0028	023	0	1	01	01	H0028_023_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H0028	023	0	1	01	01	H0028_023_0	4	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H0028	025	1	1	01	01	H0028_025_1	5	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H0028	025	2	1	01	01	H0028_025_2	5	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H0028	027	0	1	01	01	H0028_027_0	4	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H0028	027	0	1	01	01	H0028_027_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H0028	028	0	1	01	01	H0028_028_0	5	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H0028	028	0	1	01	01	H0028_028_0	5	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H0028	031	0	1	01	01	H0028_031_0	5	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H0028	032	0	1	01	01	H0028_032_0	4	1	1	10				01111	7831	7831																	2		13d;		2		2			1	420.00
H0028	032	0	1	01	01	H0028_032_0	4	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H0028	033	0	1	01	01	H0028_033_0	6	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H0028	033	0	1	01	01	H0028_033_0	6	1	1	10				01111	4310	4310																	2		13d;		2		2			1	420.00
H0028	034	0	1	01	01	H0028_034_0	4	1	1	10				01111	838	838																	2		13d;		2		2			1	600.00
H0028	036	0	1	01	01	H0028_036_0	4	1	1	10				01111	5490	5490																	2		13d;		2		2			1	600.00
H0028	042	0	1	01	01	H0028_042_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H0028	043	1	1	01	01	H0028_043_1	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H0028	044	0	1	01	01	H0028_044_0	5	1	1	10				01111	1183	1183																	2		13d;		2		2			1	600.00
H0028	045	0	1	01	01	H0028_045_0	4	1	1	10				01111	1079	1079																	2		13d;		2		2			1	600.00
H0028	047	0	1	01	01	H0028_047_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H0028	050	0	1	01	01	H0028_050_0	5	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000
H0028	051	0	1	01	01	H0028_051_0	5	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000
H0028	052	0	1	01	01	H0028_052_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H0028	052	0	1	01	01	H0028_052_0	4	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H0028	053	1	1	01	01	H0028_053_1	6	1	3								00000101000010000000																1	001	13c;		2		2			2	
H0028	053	2	1	01	01	H0028_053_2	6	1	3								00000101000010000000																1	001	13c;		2		2			2	
H0028	053	3	1	01	01	H0028_053_3	6	1	3								00000101000010000000																1	001	13c;		2		2			2	
H0034	001	0	1	01	01	H0034_001_0	6	1	3								11111111111111111111	Arthritis	Hepatitis	Hyperlipidemia	Autism Spectrum Disorder	Osteoporosis											2		13i;		2		2			2	
H0034	002	0	1	01	01	H0034_002_0	6	1	3								11111111111111111111	Arthritis	Hepatitis	Hyperlipidemia	Autism Spectrum Disorder	Osteoporosis											2		13i;		2		2			2	
H0104	012	0	1	04	01	H0104_012_0	5	1	3								00000001000000001111	COPD	Rheumatoid Arthritis	Vascular Disease	Congestive Heart Failure												2		13c;	1	1	13c;	2			2	
H0104	014	0	1	04	01	H0104_014_0	5	1	3								00000001000000001111	COPD	Rheumatoid Arthritis	Vascular Disease	Congestive Heart Failure												2		13c;	1	1	13c;	2			2	
H0104	015	0	1	04	01	H0104_015_0	7	1	3								00000001000000001111	COPD	Rheumatoid Arthritis	Vascular Disease	Congestive Heart Failure												2		13c;	1	1	13c;	2			2	
H0111	003	0	1	04	01	H0111_003_0	4	1	3								01111111111111110000																1	001	13i;14c;	1	1	13i;14c;	2			2	
H0111	004	0	1	04	01	H0111_004_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			2	
H0111	005	0	1	04	01	H0111_005_0	5	1	3								01111111111111110000																1	001	13i;14c;	1	1	13i;14c;	2			2	
H0154	012	0	1	01	01	H0154_012_0	6	1	3								11111111111111111111	Hypertension	At risk for falls	Nutritional, Metabolic and Endocrine Disorders	Chronic and disabling physical conditions	Chronic pain											2		13i;		2		2			1	300.00
H0154	019	0	1	01	01	H0154_019_0	6	1	3								11111111111111111111	Hypertension	At risk for falls	Nutritional, Metabolic and Endocrine Disorders	Chronic and disabling physical conditions	Chronic pain											2		13i;		2		2			1	300.00
H0169	001	0	1	01	01	H0169_001_0	4	1	1	10				01111	17227	14643																	2		13d;		1	13d;	2			2	
H0169	002	0	1	01	01	H0169_002_0	4	1	1	10				01111	23360	19856																	2		13d;		1	13d;	2			2	
H0169	003	0	1	01	01	H0169_003_0	4	2	1	10				01111	9535	954																	2		13e;		1	13e;	2			2	
H0169	003	0	1	01	01	H0169_003_0	4	1	1	10				01111	9535	8105																	2		13d;		1	13d;	2			2	
H0169	004	0	1	02	01	H0169_004_0	4	2	1	10				01111	5283	528																	2		13e;	2	1	13e;	2			2	
H0169	004	0	1	02	01	H0169_004_0	4	1	1	10				01111	5283	4491																	2		13d;	2	1	13d;	2			2	
H0174	002	0	1	01	01	H0174_002_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	1		1	600.00
H0174	004	0	1	01	01	H0174_004_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	1200.00
H0174	006	0	1	01	01	H0174_006_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	2700.00
H0174	008	0	1	01	01	H0174_008_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	600.00
H0174	009	0	1	01	01	H0174_009_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	600.00
H0174	010	0	1	01	01	H0174_010_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	1		1	600.00
H0174	011	2	1	01	01	H0174_011_2	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	1		1	600.00
H0174	012	1	1	02	01	H0174_012_1	4	1	3								01111111111111110000																1	001	13i;	2	1	13i;	1	1		1	600.00
H0174	012	2	1	02	01	H0174_012_2	4	1	3								01111111111111110000																1	001	13i;	2	1	13i;	1	1		1	600.00
H0174	012	3	1	02	01	H0174_012_3	4	1	3								01111111111111110000																1	001	13i;	2	1	13i;	1	1		1	600.00
H0174	012	4	1	02	01	H0174_012_4	4	1	3								01111111111111110000																1	001	13i;	2	1	13i;	1	1		1	600.00
H0174	012	5	1	02	01	H0174_012_5	4	1	3								01111111111111110000																1	001	13i;	2	1	13i;	1	1		1	600.00
H0174	014	0	1	01	01	H0174_014_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	1		1	600.00
H0251	002	0	1	01	01	H0251_002_0	5	1	1	10				01111	74206	63075																	2		13d;		1	13d;	2			2	
H0251	004	0	1	01	01	H0251_004_0	5	1	1	10				01111	1123	955																	2		13d;		1	13d;	2			2	
H0271	005	0	1	04	01	H0271_005_0	4	1	1	10				01111	33579	28542																	2		13d;	1	1	13d;	2			2	
H0271	006	0	1	04	01	H0271_006_0	4	1	1	10				01111	9212	7830																	2		13d;	1	1	13d;	2			2	
H0271	013	0	1	04	01	H0271_013_0	5	1	1	10				01111	13527	11498																	2		13d;	1	1	13d;	2			2	
H0271	014	0	1	04	01	H0271_014_0	4	1	1	10				01111	48625	41331																	2		13d;	1	1	13d;	2			2	
H0271	016	0	1	04	01	H0271_016_0	5	1	1	10				01111	36768	31253																	2		13d;	1	1	13d;	2			2	
H0271	020	0	1	04	01	H0271_020_0	4	1	1	10				01111	2903	2468																	2		13d;	1	1	13d;	2			2	
H0271	023	0	1	04	01	H0271_023_0	4	1	1	10				01111	19744	16782																	2		13d;	1	1	13d;	2			2	
H0271	024	0	1	04	01	H0271_024_0	4	1	1	10				01111	874	743																	2		13d;	1	1	13d;	2			2	
H0271	028	0	1	04	01	H0271_028_0	4	1	1	10				01111	169	144																	2		13d;	1	1	13d;	2			2	
H0271	029	0	1	04	01	H0271_029_0	4	1	1	10				01111	23838	20262																	2		13d;	1	1	13d;	2			2	
H0271	030	0	1	04	01	H0271_030_0	4	1	1	10				01111	233	198																	2		13d;	1	1	13d;	2			2	
H0271	037	0	1	04	01	H0271_037_0	4	1	1	10				01111	189	161																	2		13d;	1	1	13d;	2			2	
H0271	038	0	1	04	01	H0271_038_0	4	1	1	10				01111	3728	3169																	2		13d;	1	1	13d;	2			2	
H0271	039	0	1	04	01	H0271_039_0	4	1	1	10				01111	447	380																	2		13d;	1	1	13d;	2			2	
H0271	042	0	1	04	01	H0271_042_0	5	1	1	10				01111	170	145																	2		13d;	1	1	13d;	2			2	
H0292	001	0	1	01	01	H0292_001_0	7	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000.00
H0321	002	0	1	01	01	H0321_002_0	4	1	1	10				01111	65513	55686																	2		13d;		1	13d;	2			2	
H0321	004	0	1	01	01	H0321_004_0	4	1	1	10				01111	5155	4382																	2		13d;		1	13d;	2			2	
H0351	038	0	1	01	01	H0351_038_0	7	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	600.00
H0351	055	0	1	01	01	H0351_055_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	2			1	600.00
H0351	057	0	1	01	01	H0351_057_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	600.00
H0354	027	0	1	01	01	H0354_027_0	5	1	3								00000001000000000000																1	001	13i;		2		2			2	
H0363	001	0	1	01	01	H0363_001_0	7	1	2														00000000011100	Behavioral health diagnosis	Documented chronic pain related to falls within the last year				2	2			2		14c;		2		2			2	
H0363	001	0	1	01	01	H0363_001_0	7	2	3								00000010000000001100	Behavioral Health Diagnosis	Documented chronic pain														2		13i;		2		2			2	
H0422	001	0	1	02	01	H0422_001_0	10	1	2														00010000000000										2		13c;	2	2		2			2	
H0422	003	0	1	02	01	H0422_003_0	10	1	2														00010000000000										2		13c;	2	2		2			2	
H0423	001	0	1	01	01	H0423_001_0	12	1	3								10011101001010011111	Alzheimer's Disease	Hyperlipidemia	Malnutrition/Undernutrition	Osteoporosis	Kidney Disease											1	001	13i;		1	13i;	2			1	64.00
H0432	009	0	1	01	01	H0432_009_0	4	1	1	10				01111	46941	39900																	2		13d;		1	13d;	2			2	
H0432	013	0	1	01	01	H0432_013_0	4	1	1	10				01111	3377	3201																	2		13d;		1	13d;	2			2	
H0439	012	0	1	01	01	H0439_012_0	5	1	3								00001001000000000000																2		13i;		2		2			2	
H0473	005	0	1	04	01	H0473_005_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H0482	001	0	1	01	01	H0482_001_0	6	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H0482	002	0	1	01	01	H0482_002_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	2700.00
H0482	003	0	1	01	01	H0482_003_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H0482	004	0	1	01	01	H0482_004_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	2700.00
H0482	005	0	1	01	01	H0482_005_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	2700.00
H0504	031	0	1	01	01	H0504_031_0	5	1	3								00011101000010010000																2		13i-O;		1	13i-O;	2			2	
H0504	037	0	1	01	01	H0504_037_0	5	1	3								00011101000010010000																2		13i-O;		1	13i-O;	2			2	
H0504	041	0	1	01	01	H0504_041_0	5	1	3								00011101000010010000																2		13i-O;		1	13i-O;	2			2	
H0504	046	0	1	01	01	H0504_046_0	5	1	3								00011101000010010000																2		13i-O;		1	13i-O;	2			2	
H0504	047	0	1	01	01	H0504_047_0	7	1	3								00011101000010010000																2		13i-O;		1	13i-O;	2			2	
H0504	048	0	1	01	01	H0504_048_0	7	1	3								00101001000000000000																2		13i;		1	13i;	2			2	
H0523	801	0	1	01	01	H0523_801_0	2	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H0523	805	0	1	01	01	H0523_805_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H0524	008	0	1	01	01	H0524_008_0	10	1	2														00000000001000	Advanced Care At Home (based on Health Status)									2		13c;14c;		2		2			2	
H0524	033	0	1	01	01	H0524_033_0	10	1	2														00000000001000	Advanced Care At Home (based on Health Status)									2		13c;14c;		2		2			2	
H0524	061	0	1	01	01	H0524_061_0	10	1	2														00000000001000	Advanced Care At Home (based on Health Status)									2		13c;14c;		2		2			2	
H0524	063	0	1	01	01	H0524_063_0	10	1	2														00000000001000	Advanced Care At Home (based on Health Status)									2		13c;14c;		2		2			2	
H0544	002	0	1	01	01	H0544_002_0	8	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	003	0	1	01	01	H0544_003_0	7	1	3								01111111111111111000	Plan approved chronic condition															2		13i;		2		2			2	
H0544	004	0	1	01	01	H0544_004_0	9	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	007	0	1	01	01	H0544_007_0	10	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	008	0	1	01	01	H0544_008_0	8	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	010	0	1	01	01	H0544_010_0	8	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	013	0	1	01	01	H0544_013_0	8	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	014	0	1	01	01	H0544_014_0	8	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	015	0	1	01	01	H0544_015_0	8	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	019	0	1	01	01	H0544_019_0	8	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	020	0	1	01	01	H0544_020_0	8	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	027	0	1	01	01	H0544_027_0	8	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	031	0	1	01	01	H0544_031_0	8	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	032	0	1	01	01	H0544_032_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	036	0	1	01	01	H0544_036_0	8	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	038	0	1	01	01	H0544_038_0	8	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	052	0	1	01	01	H0544_052_0	10	1	1	10				01111	1103	396																	2		13i;		2		2			2	
H0544	053	0	1	01	01	H0544_053_0	8	1	1	10				01111	816	293																	2		13i;		2		2			2	
H0544	055	0	1	01	01	H0544_055_0	6	1	1	10				01111	782	281																	2		13i;		2		2			2	
H0544	058	0	1	01	01	H0544_058_0	6	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	066	0	1	01	01	H0544_066_0	6	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	070	0	1	01	01	H0544_070_0	6	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	071	0	1	01	01	H0544_071_0	6	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	072	0	1	01	01	H0544_072_0	6	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	081	0	1	01	01	H0544_081_0	6	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	087	0	1	01	01	H0544_087_0	7	2	1	10				01111	1473	1473																	2		13i;		2		2			2	
H0544	087	0	1	01	01	H0544_087_0	7	1	1	10				01111	1473	529																	2		13i;		2		2			2	
H0544	088	0	1	01	01	H0544_088_0	6	2	1	10				01111	968	968																	2		13i;		2		2			2	
H0544	088	0	1	01	01	H0544_088_0	6	1	1	10				01111	968	348																	2		13i;		2		2			2	
H0544	090	0	1	01	01	H0544_090_0	6	1	1	10				01111	594	213																	2		13i;		2		2			2	
H0544	090	0	1	01	01	H0544_090_0	6	2	1	10				01111	594	594																	2		13i;		2		2			2	
H0544	094	0	1	01	01	H0544_094_0	8	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	095	0	1	01	01	H0544_095_0	6	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	099	0	1	01	01	H0544_099_0	8	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	101	0	1	01	01	H0544_101_0	8	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	102	0	1	01	01	H0544_102_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	106	0	1	01	01	H0544_106_0	8	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	110	0	1	01	01	H0544_110_0	6	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	117	1	1	01	01	H0544_117_1	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	117	2	1	01	01	H0544_117_2	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	118	1	1	01	01	H0544_118_1	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	118	2	1	01	01	H0544_118_2	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	119	1	1	01	01	H0544_119_1	8	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	119	2	1	01	01	H0544_119_2	8	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	120	1	1	01	01	H0544_120_1	8	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	120	2	1	01	01	H0544_120_2	8	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	121	1	1	01	01	H0544_121_1	10	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	121	2	1	01	01	H0544_121_2	8	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	125	0	1	01	01	H0544_125_0	6	2	1	10				01111	976	976																	2		13i;		2		2			2	
H0544	125	0	1	01	01	H0544_125_0	6	1	1	10				01111	976	350																	2		13i;		2		2			2	
H0544	126	0	1	01	01	H0544_126_0	6	1	3								01111111111111111000	Other plan approved chronic conditions															2		13i;		2		2			2	
H0544	128	0	1	01	01	H0544_128_0	10	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H0544	129	0	1	01	01	H0544_129_0	7	1	3								01111111111111111000	Plan approved chronic condition															2		13i;		2		2			2	
H0544	130	0	1	01	01	H0544_130_0	7	1	3								01111111111111111000	Plan approved chronic condition															2		13i;		2		2			2	
H0545	001	0	1	01	01	H0545_001_0	5	1	2														00110000001000	CVA with Hemiparesis					2	2			1	001	13c;14c;		2		2			2	
H0562	121	0	1	01	01	H0562_121_0	4	1	3								01111111111111110000																1	001	13i;13i-O;		1	13i;13i-O;	2			1	1200.00
H0562	122	0	1	01	01	H0562_122_0	4	1	3								01111111111111110000																1	001	13i;13i-O;		1	13i;13i-O;	2			1	1200.00
H0571	005	0	1	01	01	H0571_005_0	7	1	3								01111111111111110000																2		13i;		2		2			1	18.88
H0624	001	0	1	01	01	H0624_001_0	4	1	1	10				01111	29859	25380																	2		13d;		1	13d;	2			2	
H0628	001	0	1	02	01	H0628_001_0	3	1	3								00111111111110111100	Hyperlipidemia	Hypertension														1	001	10b;13b;14c;	1	1	10b;13b;14c;	2			2	
H0628	005	0	1	02	01	H0628_005_0	3	1	3								00111111111110111100	Hyperlipidemia	Hypertension														1	001	10b;13b;14c;	1	1	10b;13b;14c;	2			2	
H0628	012	0	1	01	01	H0628_012_0	3	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H0628	013	0	1	01	01	H0628_013_0	3	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H0628	017	0	1	02	01	H0628_017_0	4	1	3								00111111111110111100	Hyperlipidemia	Hypertension														1	001	10b;13b;14c;	1	1	10b;13b;14c;	2			2	
H0628	801	0	1	01	01	H0628_801_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H0628	802	0	1	01	01	H0628_802_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H0672	009	0	1	01	01	H0672_009_0	7	1	3								00001001000000000000																2		13i;		2		2			2	
H0712	005	0	1	01	01	H0712_005_0	6	1	3								01111111111111110000																1	001	13i;		1	13i;	1	1		1	600.00
H0712	029	0	1	01	01	H0712_029_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	1	1		1	600.00
H0798	001	0	1	01	01	H0798_001_0	7	1	3								00011111111010110000																2		13i;		2		2			2	
H0838	020	0	1	01	01	H0838_020_0	6	1	3								00001111000001001000	Kidney Disease															1	001	13i;		2		2			2	
H0838	024	0	1	01	01	H0838_024_0	5	1	3								00001111000001001000	Kidney Disease															1	001	13b;13i;		2		2			2	
H0838	029	0	1	01	01	H0838_029_0	5	1	3								00001111000001000000																1	001	13i;		2		2			2	
H0838	033	0	1	01	01	H0838_033_0	5	1	3								00001111000001000000																1	001	13i;		2		2			2	
H0838	039	1	1	01	01	H0838_039_1	5	1	3								00001100000000001000	Kidney Disease															1	001	13b;		2		2			2	
H0838	039	2	1	01	01	H0838_039_2	5	1	3								00001100000000001000	Kidney Disease															1	001	13b;		2		2			2	
H0838	040	1	1	01	01	H0838_040_1	5	1	3								00001111000001001000	Kidney Disease															1	001	13b;13i;		2		2			2	
H0838	040	2	1	01	01	H0838_040_2	5	1	3								00001111000001001000	Kidney Disease															1	001	13b;13i;		2		2			2	
H0838	042	0	1	01	01	H0838_042_0	5	1	3								00000000000000001000	Incontinence															1	001	13b;		2		2			2	
H0838	043	0	1	01	01	H0838_043_0	6	1	3								00000000000000001000	Incontinence															1	001	13b;		2		2			2	
H0838	047	0	1	01	01	H0838_047_0	6	1	3								00001100000000001000	Kidney Disease															1	001	13b;		2		2			2	
H0876	001	0	1	01	01	H0876_001_0	9	1	3								11111111111111111111	Chronic Kidney Disease (CKD)	Physical disabilities	Musculoskeletal conditions	Developmental disabilities	Vision & Hearing Disorders											2		13i;13i-O;		2		2			2	
H0885	001	0	1	04	01	H0885_001_0	6	1	3								00001101000000000000																1	001	13i;	1	1	13i;	2			2	
H0885	002	0	1	04	01	H0885_002_0	6	1	3								00001101000000000000																1	001	13i;	1	1	13i;	2			2	
H0907	001	0	1	01	01	H0907_001_0	7	1	1	10				01111	2852	2852																	2		13i;		2		2			2	
H0907	001	0	1	01	01	H0907_001_0	7	4	1	10				01111	2852	2852																	2		13i;		2		2			2	
H0907	001	0	1	01	01	H0907_001_0	7	2	1	10				01111	2852	2852																	2		13i-O;		2		2			2	
H0907	001	0	1	01	01	H0907_001_0	7	3	1	10				01111	2852	2852																	2		13i;		2		2			2	
H0907	001	0	1	01	01	H0907_001_0	7	5	1	10				01111	2852	970																	2		13i;		2		2			2	
H0908	001	0	1	01	01	H0908_001_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H0908	004	0	1	01	01	H0908_004_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H0913	013	0	1	01	01	H0913_013_0	7	1	3								01111111111111110000																1	001	13b;13d;13i;14c;		1	13b;13d;13i;14c;	1	2	13i;	1	2800.00
H0913	017	0	1	01	01	H0913_017_0	5	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	2			2	
H0969	005	0	1	04	01	H0969_005_0	6	1	3								01111111111111110000																1	001	13i;	1	1	13i;	1	2	13i;	1	1800.00
H0978	002	0	1	01	01	H0978_002_0	5	1	3								00011111010000100000																2		13i;		2		2			2	
H0978	003	0	1	01	01	H0978_003_0	5	1	3								00011111010000100000																2		13i;		2		2			2	
H0982	002	0	1	01	01	H0982_002_0	8	1	1	10				01111	1979	1979																	2		13d;14c;		2		2			2	
H0982	006	0	1	01	01	H0982_006_0	8	1	1	10				01111	1979	1979																	2		13d;14c;		2		2			2	
H0982	010	0	1	01	01	H0982_010_0	8	1	1	10				01111	1979	1979																	2		13d;14c;		2		2			2	
H0982	011	0	1	01	01	H0982_011_0	9	1	3								00000000000001000000																2		13i;14c;		2		2			2	
H0982	012	0	1	01	01	H0982_012_0	8	1	1	10				01111	1979	1979																	2		13d;14c;		2		2			2	
H0982	013	0	1	01	01	H0982_013_0	8	1	1	10				01111	1979	1979																	2		13d;14c;		2		2			2	
H1016	023	0	1	01	01	H1016_023_0	6	1	3								00000101000000001100	Coronary Artery Disease CAD	Chronic Obstructive Pulmonary Disease (COPD)														1	001	13b;13c;13i;		2		2			2	
H1016	024	0	1	01	01	H1016_024_0	6	1	3								00000101000000001100	Coronary Artery Disease CAD	Chronic Obstructive Pulmonary Disease (COPD)														1	001	13b;13c;13i;		2		2			2	
H1019	001	0	1	01	01	H1019_001_0	7	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H1019	006	0	1	01	01	H1019_006_0	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H1019	023	0	1	01	01	H1019_023_0	6	1	1	10				01111	33687	33687																	2		13d;		2		2			1	900.00
H1019	023	0	1	01	01	H1019_023_0	6	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000.00
H1019	026	0	1	01	01	H1019_026_0	6	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000.00
H1019	026	0	1	01	01	H1019_026_0	6	1	1	10				01111	37058	37058																	2		13d;		2		2			1	600.00
H1019	057	0	1	02	01	H1019_057_0	5	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	2		2			1	500.00
H1019	069	0	1	01	01	H1019_069_0	5	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H1019	073	0	1	01	01	H1019_073_0	6	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000.00
H1019	073	0	1	01	01	H1019_073_0	6	1	1	10				01111	5974	5974																	2		13d;		2		2			1	600.00
H1019	098	0	1	01	01	H1019_098_0	5	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H1019	102	0	1	01	01	H1019_102_0	5	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H1019	103	1	1	01	01	H1019_103_1	5	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H1019	103	2	1	01	01	H1019_103_2	5	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H1019	105	0	1	01	01	H1019_105_0	5	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H1019	106	0	1	01	01	H1019_106_0	5	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H1019	107	0	1	01	01	H1019_107_0	5	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H1019	108	0	1	01	01	H1019_108_0	5	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H1019	109	0	1	01	01	H1019_109_0	5	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H1019	114	0	1	01	01	H1019_114_0	5	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H1019	115	0	1	01	01	H1019_115_0	5	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H1019	116	0	1	01	01	H1019_116_0	5	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H1019	117	0	1	01	01	H1019_117_0	5	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H1019	118	0	1	01	01	H1019_118_0	5	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H1032	124	0	1	01	01	H1032_124_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H1032	170	0	1	01	01	H1032_170_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H1032	175	0	1	01	01	H1032_175_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H1032	176	0	1	01	01	H1032_176_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H1032	202	0	1	01	01	H1032_202_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	2			2	
H1032	206	0	1	01	01	H1032_206_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	2			2	
H1032	214	0	1	01	01	H1032_214_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	2			2	
H1032	217	0	1	01	01	H1032_217_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	2			2	
H1035	022	0	1	01	01	H1035_022_0	5	1	3								00000101000000001100	Coronary Artery Disease (CAD)	Chronic Obtructive Pulmonary Disease (COPD)														1	001	10b;13b;13i;14c;		1	10b;13b;13i;14c;	2			2	
H1035	023	0	1	01	01	H1035_023_0	5	1	3								00000101000000001100	Coronary Artery Disease (CAD)	Chronic Obtructive Pulmonary Disease (COPD)														1	001	10b;13b;13i;14c;		1	10b;13b;13i;14c;	2			2	
H1035	024	0	1	01	01	H1035_024_0	5	1	3								00000101000000001100	Coronary Artery Disease (CAD)	Chronic Obtructive Pulmonary Disease (COPD)														1	001	10b;13b;13i;14c;		1	10b;13b;13i;14c;	2			2	
H1035	025	0	1	01	01	H1035_025_0	5	1	3								00000101000000001100	Coronary Artery Disease (CAD)	Chronic Obtructive Pulmonary Disease (COPD)														1	001	10b;13b;13i;14c;		1	10b;13b;13i;14c;	2			2	
H1035	026	0	1	01	01	H1035_026_0	6	1	3								00000101000000001100	Coronary Artery Disease (CAD)	Chronic Obtructive Pulmonary Disease (COPD)														1	001	10b;13b;13i;14c;		1	10b;13b;13i;14c;	2			2	
H1035	027	0	1	01	01	H1035_027_0	6	1	3								00001101000010000000																1	001	13i;		1	13i;	2			2	
H1035	028	0	1	01	01	H1035_028_0	10	1	3								00001101000010000000																1	001	13i;		1	13i;	2			2	
H1035	029	0	1	01	01	H1035_029_0	6	1	3								00001101000010000000																1	001	13i;		1	13i;	2			2	
H1035	030	0	1	01	01	H1035_030_0	6	1	3								00001101000010000000																1	001	13i;		1	13i;	2			2	
H1035	031	0	1	01	01	H1035_031_0	6	1	3								00001101000010000000																1	001	13i;		1	13i;	2			2	
H1035	032	0	1	01	01	H1035_032_0	6	1	3								00001101000010000000																1	001	13i;		1	13i;	2			2	
H1035	033	0	1	01	01	H1035_033_0	5	1	3								00000101000000001100	Coronary Artery Disease (CAD)	Chronic Obtructive Pulmonary Disease (COPD)														1	001	10b;13b;13i;14c;		1	10b;13b;13i;14c;	2			2	
H1035	034	0	1	01	01	H1035_034_0	5	1	3								00000101000000001100	Coronary Artery Disease (CAD)	Chronic Obtructive Pulmonary Disease (COPD)														1	001	10b;13b;13i;14c;		1	10b;13b;13i;14c;	2			2	
H1035	043	0	1	01	01	H1035_043_0	5	1	3								00000101000000001100	Coronary Artery Disease (CAD)	Chronic Obtructive Pulmonary Disease (COPD)														1	001	13i;		1	13i;	2			2	
H1035	045	0	1	01	01	H1035_045_0	5	1	3								00000101000000001100	Coronary Artery Disease (CAD)	Chronic Obtructive Pulmonary Disease (COPD)														1	001	10b;13b;13i;14c;		1	10b;13b;13i;14c;	2			2	
H1035	048	0	1	01	01	H1035_048_0	6	1	3								00000101000000001100	Coronary Artery Disease (CAD)	Chronic Obtructive Pulmonary Disease (COPD)														1	001	10b;13b;13i;14c;		1	10b;13b;13i;14c;	2			2	
H1036	054	0	1	01	01	H1036_054_0	9	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H1036	054	0	1	01	01	H1036_054_0	9	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H1036	062	0	1	01	01	H1036_062_0	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H1036	062	0	1	01	01	H1036_062_0	6	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H1036	065	0	1	01	01	H1036_065_0	6	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H1036	065	0	1	01	01	H1036_065_0	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H1036	077	0	1	01	01	H1036_077_0	6	3	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H1036	077	0	1	01	01	H1036_077_0	6	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000.00
H1036	077	0	1	01	01	H1036_077_0	6	1	1	10				01111	15293	15293																	2		13d;		2		2			1	900.00
H1036	102	0	1	01	01	H1036_102_0	7	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000.00
H1036	102	0	1	01	01	H1036_102_0	7	1	1	10				01111	20842	20842																	2		13d;		2		2			1	900.00
H1036	103	0	1	01	01	H1036_103_0	6	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000.00
H1036	103	0	1	01	01	H1036_103_0	6	3	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H1036	103	0	1	01	01	H1036_103_0	6	1	1	10				01111	14746	14746																	2		13d;		2		2			1	900.00
H1036	104	0	1	01	01	H1036_104_0	6	3	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H1036	104	0	1	01	01	H1036_104_0	6	1	1	10				01111	9293	9293																	2		13d;		2		2			1	900.00
H1036	104	0	1	01	01	H1036_104_0	6	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000.00
H1036	121	0	1	01	01	H1036_121_0	6	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H1036	137	0	1	01	01	H1036_137_0	5	1	3								00000101000010001000	Depression															1	001	13c;		2		2			2	
H1036	156	0	1	01	01	H1036_156_0	8	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H1036	167	0	1	01	01	H1036_167_0	4	1	1	10				01111	8277	8277																	2		13d;		1	13d;	2			1	900.00
H1036	167	0	1	01	01	H1036_167_0	4	2	3								01111111111111111000	Depression															1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	500.00
H1036	168	0	1	01	01	H1036_168_0	4	2	3								00000101000010001000	Depression															1	001	13c;		1	13c;	2			2	
H1036	168	0	1	01	01	H1036_168_0	4	1	1	10				01111	5654	5654																	2		13d;		1	13d;	2			1	900.00
H1036	175	0	1	01	01	H1036_175_0	8	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000.00
H1036	199	0	1	01	01	H1036_199_0	6	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H1036	209	0	1	01	01	H1036_209_0	6	1	1	10				01111	7042	7042																	2		13d;		2		2			1	420.00
H1036	209	0	1	01	01	H1036_209_0	6	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000.00
H1036	210	0	1	01	01	H1036_210_0	6	1	1	10				01111	1949	1949																	2		13d;		2		2			1	600
H1036	210	0	1	01	01	H1036_210_0	6	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000
H1036	213	0	1	01	01	H1036_213_0	6	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000.00
H1036	213	0	1	01	01	H1036_213_0	6	1	1	10				01111	9877	9877																	2		13d;		2		2			1	900.00
H1036	214	0	1	01	01	H1036_214_0	6	1	1	10				01111	1242	1242																	2		13d;		2		2			1	420.00
H1036	214	0	1	01	01	H1036_214_0	6	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H1036	222	0	1	01	01	H1036_222_0	4	1	1	10				01111	9575	9575																	2		13d;		1	13d;	2			1	900.00
H1036	226	0	1	01	01	H1036_226_0	5	1	1	10				01111	1118	1118																	2		13d;		2		2			1	600.00
H1036	230	0	1	01	01	H1036_230_0	7	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H1036	231	0	1	01	01	H1036_231_0	6	1	1	10				01111	2771	2771																	2		13d;		2		2			1	900.00
H1036	231	0	1	01	01	H1036_231_0	6	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000.00
H1036	233	0	1	01	01	H1036_233_0	5	1	3								00000101000010001000	Depression															1	001	13c;		2		2			2	
H1036	234	0	1	01	01	H1036_234_0	7	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13f;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000.00
H1036	235	0	1	01	01	H1036_235_0	8	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	1000
H1036	235	0	1	01	01	H1036_235_0	8	1	1	10				01111	1036	1036																	2		13d;		1	13d;	2			1	600
H1036	236	0	1	01	01	H1036_236_0	7	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000.00
H1036	237	1	1	01	01	H1036_237_1	6	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H1036	237	2	1	01	01	H1036_237_2	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H1036	243	0	1	01	01	H1036_243_0	6	1	1	10				01111	4146	4146																	2		13d;		1	13d;	2			1	600
H1036	243	0	1	01	01	H1036_243_0	6	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	1000
H1036	245	0	1	01	01	H1036_245_0	6	1	1	10				01111	1817	1817																	1	001	13d;		2		2			1	300
H1036	245	0	1	01	01	H1036_245_0	6	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000
H1036	261	0	1	01	01	H1036_261_0	6	1	1	10				01111	222	222																	2		13d;		2		2			1	420.00
H1036	261	0	1	01	01	H1036_261_0	6	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000.00
H1036	262	0	1	01	01	H1036_262_0	4	1	1	10				01111	507	507																	2		13d;		2		2			1	300.00
H1036	276	0	1	01	01	H1036_276_0	4	2	3								00000101000010001000	Depression															1	001	13c;		1	13c;	2			2	
H1036	276	0	1	01	01	H1036_276_0	4	1	1	10				01111	1140	1140																	2		13d;		1	13d;	2			1	900.00
H1036	279	0	1	01	01	H1036_279_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H1036	280	0	1	01	01	H1036_280_0	5	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H1036	280	0	1	01	01	H1036_280_0	5	1	1	10				01111	69	69																	2		13d;		2		2			1	900.00
H1036	283	0	1	01	01	H1036_283_0	7	1	1	10				01111	31	31																	2		13d;		2		2			1	900.00
H1036	283	0	1	01	01	H1036_283_0	7	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000.00
H1036	284	0	1	01	01	H1036_284_0	6	1	1	10				01111	1008	1008																	2		13d;		2		2			1	420.00
H1036	284	0	1	01	01	H1036_284_0	6	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H1036	285	0	1	01	01	H1036_285_0	6	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000.00
H1036	285	0	1	01	01	H1036_285_0	6	1	1	10				01111	745	745																	2		13d;		2		2			1	600.00
H1036	291	0	1	01	01	H1036_291_0	5	1	3								00000101000010001000	Depression															1	001	13c;		2		2			2	
H1036	296	0	1	01	01	H1036_296_0	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H1045	012	0	1	01	01	H1045_012_0	3	1	1	10				01111	9572	8136																	2		13d;		1	13d;	2			2	
H1045	038	0	1	01	01	H1045_038_0	4	1	1	10				01111	915	778																	2		13d;		1	13d;	2			2	
H1045	039	0	1	01	01	H1045_039_0	4	1	1	10				01111	35096	29832																	2		13d;		1	13d;	2			2	
H1045	053	0	1	01	01	H1045_053_0	4	1	1	10				01111	7150	6078																	2		13d;		1	13d;	2			2	
H1109	801	0	1	01	01	H1109_801_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H1109	802	0	1	01	01	H1109_802_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H1112	006	0	1	01	01	H1112_006_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	2			1	600.00
H1112	033	0	1	01	01	H1112_033_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H1112	043	0	1	01	01	H1112_043_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	1		1	600.00
H1170	002	0	1	01	01	H1170_002_0	7	1	3								01111111111111110000																2		13i;		2		2			2	
H1170	008	0	1	01	01	H1170_008_0	9	1	3								01111111111111110000																2		13i;		2		2			2	
H1170	009	0	1	01	01	H1170_009_0	7	1	3								01111111111111110000																2		13i;		2		2			2	
H1170	010	0	1	01	01	H1170_010_0	7	1	3								01111111111111110000																2		13i;		2		2			2	
H1170	011	0	1	01	01	H1170_011_0	9	1	3								01111111111111110000																2		13i;		2		2			2	
H1170	012	0	1	01	01	H1170_012_0	7	1	3								01111111111111110000																2		13i;		2		2			2	
H1205	001	0	1	01	01	H1205_001_0	8	1	3								00000000000000001000	any chronic condition listed in Chapter 16b															2		13i;		2		2			1	0.00
H1205	002	0	1	01	01	H1205_002_0	8	1	3								00000000000000001000	any chronic condition listed in Chapter 16b															2		13i;		2		2			1	0.00
H1205	005	0	1	01	01	H1205_005_0	8	1	3								00000000000000001000	any chronic condition listed in Chapter 16b															2		13i;		2		2			1	0.00
H1205	006	0	1	01	01	H1205_006_0	8	1	3								00000000000000001000	any chronic condition listed in Chapter 16b															2		13i;		2		2			1	0.00
H1215	001	0	1	01	01	H1215_001_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	2			1	600.00
H1278	001	0	1	04	01	H1278_001_0	3	1	2														00000000010000										2		14c;	1	2		2			2	
H1278	007	0	1	04	01	H1278_007_0	3	1	2														00000000010000										2		14c;	1	2		2			2	
H1278	020	0	1	04	01	H1278_020_0	3	1	2														00000000010000										2		14c;	1	2		2			2	
H1290	001	0	1	01	01	H1290_001_0	11	1	3								01111111111111110000																2		13i-O;		2		1	1		1	240.00
H1290	002	0	1	01	01	H1290_002_0	10	1	3								01111111111111110000																2		13i-O;		2		1	1		1	240.00
H1290	003	0	1	01	01	H1290_003_0	10	1	3								01111111111111110000																2		13i-O;		2		1	1		1	240.00
H1290	005	0	1	01	01	H1290_005_0	10	1	3								01111111111111110000																2		13i-O;		2		1	1		1	240.00
H1290	019	0	1	01	01	H1290_019_0	13	1	3								01111111111111111000	Other Eligible Chronic Conditions															2		13i;13i-O;		2		1	1		1	1140.00
H1290	020	0	1	01	01	H1290_020_0	13	1	3								01111111111111111000	Other Eligible Chronic Conditions															2		13i;13i-O;		2		1	1		1	1140.00
H1290	021	0	1	01	01	H1290_021_0	13	1	3								01111111111111111000	Other Eligible Chronic Conditions															2		13i;13i-O;		2		1	1		1	1140.00
H1290	022	0	1	01	01	H1290_022_0	13	1	3								01111111111111111000	Other Eligible Chronic Conditions															2		13i;13i-O;		2		1	1		1	840.00
H1290	023	0	1	01	01	H1290_023_0	13	1	3								01111111111111111000	Other Eligible Chronic Conditions															2		13i;13i-O;		2		1	1		1	840.00
H1290	024	0	1	01	01	H1290_024_0	13	1	3								01111111111111111000	Other Eligible Chronic Conditions															2		13i;13i-O;		2		1	1		1	960.00
H1290	025	0	1	01	01	H1290_025_0	10	1	3								01111111111111110000																2		13i-O;		2		1	1		1	240.00
H1290	026	0	1	01	01	H1290_026_0	10	1	3								01111111111111110000																2		13i-O;		2		1	1		1	240.00
H1290	027	0	1	01	01	H1290_027_0	10	1	3								01111111111111110000																2		13i-O;		2		1	1		1	240.00
H1290	028	0	1	01	01	H1290_028_0	11	1	3								01111111111111110000																2		13i-O;		2		1	1		1	240.00
H1290	029	0	1	01	01	H1290_029_0	10	1	3								01111111111111110000																2		13i-O;		2		1	1		1	240.00
H1290	030	0	1	01	01	H1290_030_0	10	1	3								01111111111111110000																2		13i-O;		2		1	1		1	240.00
H1290	033	0	1	01	01	H1290_033_0	13	1	3								01111111111111111000	Other Eligible Chronic Conditions															2		13i;13i-O;		2		1	1		1	840.00
H1290	034	0	1	01	01	H1290_034_0	13	1	3								01111111111111111000	Other Eligible Chronic Conditions															2		13i;13i-O;		2		1	1		1	840.00
H1290	036	1	1	01	01	H1290_036_1	11	1	3								01111111111111110000																2		13i-O;		2		1	1		1	240.00
H1290	036	2	1	01	01	H1290_036_2	11	1	3								01111111111111110000																2		13i-O;		2		1	1		1	240.00
H1290	037	1	1	01	01	H1290_037_1	10	1	3								01111111111111110000																2		13i-O;		2		1	1		1	240.00
H1290	037	2	1	01	01	H1290_037_2	11	1	3								01111111111111110000																2		13i-O;		2		1	1		1	240.00
H1290	037	3	1	01	01	H1290_037_3	11	1	3								01111111111111110000																2		13i-O;		2		1	1		1	240.00
H1290	038	1	1	01	01	H1290_038_1	9	1	3								01111111111111110000																2		13i-O;		2		1	1		1	240.00
H1290	038	2	1	01	01	H1290_038_2	9	1	3								01111111111111110000																2		13i-O;		2		1	1		1	240.00
H1304	001	0	1	04	01	H1304_001_0	4	1	2														01000000000000										2		7f;	1	2		2			2	
H1304	001	0	1	04	01	H1304_001_0	4	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H1304	001	0	1	04	01	H1304_001_0	4	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H1304	004	0	1	04	01	H1304_004_0	7	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H1304	004	0	1	04	01	H1304_004_0	7	1	2														01000000000000										2		7f;	1	2		2			2	
H1304	004	0	1	04	01	H1304_004_0	7	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H1304	011	1	1	04	01	H1304_011_1	8	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H1304	011	1	1	04	01	H1304_011_1	8	1	2														01000000000000										2		7f;	1	2		2			2	
H1304	011	1	1	04	01	H1304_011_1	8	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H1304	011	2	1	04	01	H1304_011_2	8	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H1304	011	2	1	04	01	H1304_011_2	8	1	2														01000000000000										2		7f;	1	2		2			2	
H1304	011	2	1	04	01	H1304_011_2	8	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H1304	012	1	1	04	01	H1304_012_1	7	1	2														01000000000000										2		7f;	1	2		2			2	
H1304	012	1	1	04	01	H1304_012_1	7	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H1304	012	1	1	04	01	H1304_012_1	7	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H1304	012	2	1	04	01	H1304_012_2	7	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H1304	012	2	1	04	01	H1304_012_2	7	1	2														01000000000000										2		7f;	1	2		2			2	
H1304	012	2	1	04	01	H1304_012_2	7	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H1304	803	0	1	04	01	H1304_803_0	4	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H1304	803	0	1	04	01	H1304_803_0	4	1	2														01000000000000										2		7f;	1	2		2			2	
H1304	803	0	1	04	01	H1304_803_0	4	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H1304	804	0	1	04	01	H1304_804_0	4	1	2														01000000000000										2		7f;	1	2		2			2	
H1304	804	0	1	04	01	H1304_804_0	4	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H1304	804	0	1	04	01	H1304_804_0	4	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H1304	805	0	1	04	01	H1304_805_0	4	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H1304	805	0	1	04	01	H1304_805_0	4	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H1304	805	0	1	04	01	H1304_805_0	4	1	2														01000000000000										2		7f;	1	2		2			2	
H1304	806	0	1	04	01	H1304_806_0	4	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H1304	806	0	1	04	01	H1304_806_0	4	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H1304	806	0	1	04	01	H1304_806_0	4	1	2														01000000000000										2		7f;	1	2		2			2	
H1352	003	0	1	01	01	H1352_003_0	10	1	3								01111111111111110000																1	011	13i;		2		2			2	
H1353	002	0	1	01	01	H1353_002_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H1353	004	0	1	01	01	H1353_004_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1800.00
H1353	005	0	1	01	01	H1353_005_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	2			2	
H1353	006	0	1	01	01	H1353_006_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	2			2	
H1353	007	0	1	01	01	H1353_007_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	2			1	600.00
H1360	001	0	1	01	01	H1360_001_0	4	1	1	10				01111	7712	771																	2		13e;		1	13e;	2			2	
H1360	001	0	1	01	01	H1360_001_0	4	2	1	10				01111	7712	6555																	2		13d;		1	13d;	2			2	
H1365	001	0	1	04	01	H1365_001_0	6	1	2														00000000001100	Opiate Use DIsorder	Chronic Pain Syndrome				2	2			2		13a;14c;	1	2		1	1		1	200.00
H1365	001	0	1	04	01	H1365_001_0	6	2	3								00000100010000000000																2		13i;	1	2		2			2	
H1365	001	0	1	04	01	H1365_001_0	6	3	2														00000000001100	History of Falls	Hip Fracture				2	2			2		14c;	1	2		1	1		1	250.00
H1365	004	1	1	04	01	H1365_004_1	5	1	2														00000000001100	Opiate Use DIsorder	Chronic Pain Syndrome				2	2			2		13a;14c;	1	2		1	1		1	200.00
H1365	004	1	1	04	01	H1365_004_1	5	2	3								00000100010000000000																2		13i;	1	2		2			2	
H1365	004	1	1	04	01	H1365_004_1	5	3	2														00000000001100	History of Falls	Hip Fracture				2	2			2		14c;	1	2		1	1		1	250.00
H1365	004	2	1	04	01	H1365_004_2	5	2	3								00000100010000000000																2		13i;	1	2		2			2	
H1365	004	2	1	04	01	H1365_004_2	5	1	2														00000000001100	Opiate Use DIsorder	Chronic Pain Syndrome				2	2			2		13a;14c;	1	2		1	1		1	200.00
H1365	004	2	1	04	01	H1365_004_2	5	3	2														00000000001100	History of Falls	Hip Fracture				2	2			2		14c;	1	2		1	1		1	250.00
H1375	001	0	1	01	01	H1375_001_0	4	1	1	10				01111	1195	1016																	2		13d;		1	13d;	2			2	
H1375	002	0	1	01	01	H1375_002_0	4	1	1	10				01111	1763	1499																	2		13d;		1	13d;	2			2	
H1395	003	0	1	04	01	H1395_003_0	5	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			2	
H1416	009	0	1	02	01	H1416_009_0	4	1	3								01111111111111110000																1	001	13i;	2	1	13i;	2			2	
H1416	023	0	1	01	01	H1416_023_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	2			2	
H1416	034	0	1	01	01	H1416_034_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	2			2	
H1416	035	0	1	01	01	H1416_035_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	2			1	600.00
H1416	036	0	1	01	01	H1416_036_0	4	1	3								01111111111111110000																1	001	13b;13d;13i;14c;		1	13b;13d;13i;14c;	2			1	400.00
H1416	044	0	1	01	01	H1416_044_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H1416	048	0	1	01	01	H1416_048_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	2			2	
H1416	068	0	1	01	01	H1416_068_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	2			2	
H1423	001	0	1	01	01	H1423_001_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H1423	002	0	1	01	01	H1423_002_0	6	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H1423	003	0	1	01	01	H1423_003_0	6	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H1423	004	0	1	01	01	H1423_004_0	6	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H1423	005	0	1	01	01	H1423_005_0	6	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H1436	007	0	1	01	01	H1436_007_0	4	1	3								01111111111111110000																1	001	13b;13d;13i;14c;		1	13b;13d;13i;14c;	2			1	400.00
H1468	017	0	1	01	01	H1468_017_0	7	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000.00
H1468	019	0	1	01	01	H1468_019_0	8	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000.00
H1468	020	0	1	01	01	H1468_020_0	5	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000.00
H1607	015	0	1	04	01	H1607_015_0	8	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;	1	2		2			2	
H1608	027	0	1	04	01	H1608_027_0	3	1	1	01	0001000000				9901	4950																	1	001	13b;13c;13d;	1	1	13b;13c;13d;	2			2	
H1608	029	0	1	04	01	H1608_029_0	3	1	3								00001100000000000000																1	001	14c;	1	1	14c;	2			2	
H1608	801	0	1	04	01	H1608_801_0	2	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H1608	802	0	1	04	01	H1608_802_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H1609	016	0	1	01	01	H1609_016_0	4	1	3								01111111111111111100	Hyperlipidemia	Hypertension														2		13i;		1	13i;	2			2	
H1609	017	0	1	01	01	H1609_017_0	5	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H1609	018	0	1	01	01	H1609_018_0	3	1	3								01111111111111111100	Hyperlipidemia	Hypertension														2		13i;		1	13i;	2			2	
H1609	019	0	1	01	01	H1609_019_0	4	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H1609	023	0	1	01	01	H1609_023_0	4	1	1	10				01111	137895	137895																	2		14c;		1	14c;	2			2	
H1609	039	0	1	01	01	H1609_039_0	4	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H1609	040	0	1	01	01	H1609_040_0	4	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H1609	043	0	1	01	01	H1609_043_0	4	1	1	10				01111	137895	137895																	2		13i;13i-O;14c;		1	13i;13i-O;14c;	2			2	
H1609	044	0	1	01	01	H1609_044_0	4	1	1	10				01111	137895	137895																	2		13i;13i-O;14c;		1	13i;13i-O;14c;	2			2	
H1609	045	0	1	01	01	H1609_045_0	4	1	1	10				01111	137895	137895																	2		13i;13i-O;14c;		1	13i;13i-O;14c;	2			2	
H1609	046	0	1	01	01	H1609_046_0	4	1	1	10				01111	137895	137895																	2		13i;13i-O;14c;		1	13i;13i-O;14c;	2			2	
H1609	047	0	1	01	01	H1609_047_0	4	1	1	10				01111	137895	137895																	2		13i;13i-O;14c;		1	13i;13i-O;14c;	2			2	
H1609	048	0	1	01	01	H1609_048_0	6	1	1	10				01111	137895	137895																	2		13i;13i-O;14c;		1	13i;13i-O;14c;	2			2	
H1609	049	0	1	01	01	H1609_049_0	4	1	1	10				01111	137895	137895																	2		13i;13i-O;14c;		1	13i;13i-O;14c;	2			2	
H1609	054	0	1	01	01	H1609_054_0	4	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H1609	055	0	1	01	01	H1609_055_0	4	1	1	10				01111	137895	137895																	2		13i;13i-O;14c;		1	13i;13i-O;14c;	2			2	
H1609	056	0	1	01	01	H1609_056_0	4	1	1	10				01111	137895	137895																	2		13i;13i-O;14c;		1	13i;13i-O;14c;	2			2	
H1609	057	0	1	01	01	H1609_057_0	4	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H1609	801	0	1	01	01	H1609_801_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H1609	807	0	1	01	01	H1609_807_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H1610	001	0	1	01	01	H1610_001_0	2	1	3								01111111111111111100	Hyperlipidemia	Hypertension														2		13i;		1	13i;	2			2	
H1610	002	0	1	01	01	H1610_002_0	2	1	3								01111111111111111100	Hyperlipidemia	Hypertension														2		13i;		1	13i;	2			2	
H1644	001	0	1	01	01	H1644_001_0	4	1	2														00000000011100	Behavioral health diagnosis	Documented chronic pain related to falls within the last year				2	2			2		14c;		2		2			2	
H1644	001	0	1	01	01	H1644_001_0	4	2	3								00000010000000001100	Behavioral health diagnosis	Documented chronic pain														2		13i;		2		2			2	
H1664	005	0	1	01	01	H1664_005_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	2			1	600.00
H1664	007	0	1	01	01	H1664_007_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	2			1	600.00
H1692	005	0	1	01	01	H1692_005_0	4	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H1692	801	0	1	01	01	H1692_801_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H1692	802	0	1	01	01	H1692_802_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H1732	001	0	1	01	01	H1732_001_0	6	2	1	10				01111	126	126																	2		13i-O;		2		2			2	
H1732	001	0	1	01	01	H1732_001_0	6	1	1	10				01111	126	126																	2		13i;		2		2			2	
H1732	003	0	1	01	01	H1732_003_0	7	3	1	10				01111	8125	8125																	2		13i-O;		2		2			2	
H1732	003	0	1	01	01	H1732_003_0	7	5	1	10				01111	8125	8125																	2		13i;		2		2			2	
H1732	003	0	1	01	01	H1732_003_0	7	4	1	10				01111	8125	8125																	2		13i;		2		2			2	
H1732	003	0	1	01	01	H1732_003_0	7	2	1	10				01111	8125	8125																	2		13i;		2		2			2	
H1732	003	0	1	01	01	H1732_003_0	7	1	1	10				01111	8125	8125																	2		13i;		2		2			2	
H1732	004	0	1	01	01	H1732_004_0	6	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H1732	007	0	1	01	01	H1732_007_0	8	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H1774	001	0	1	04	01	H1774_001_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			2	
H1774	002	0	1	04	01	H1774_002_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	1	2	13i;	1	1200.00
H1799	001	0	1	01	01	H1799_001_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	960.00
H1799	002	0	1	01	01	H1799_002_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	960.00
H1822	002	0	1	01	01	H1822_002_0	5	1	3								00011111010000100000																2		13i;		2		2			2	
H1822	003	0	1	01	01	H1822_003_0	5	1	3								00011111010000100000																2		13i;		2		2			2	
H1848	003	0	1	04	01	H1848_003_0	5	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			1	600.00
H1889	002	1	1	04	01	H1889_002_1	4	1	1	10				01111	109321	92923																	2		13d;	1	1	13d;	2			2	
H1889	002	2	1	04	01	H1889_002_2	4	1	1	10				01111	33367	28362																	2		13d;	1	1	13d;	2			2	
H1894	001	0	1	01	01	H1894_001_0	9	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H1894	002	0	1	01	01	H1894_002_0	6	1	1	10				01111	2036	731																	2		13i;		2		2			2	
H1894	002	0	1	01	01	H1894_002_0	6	2	1	10				01111	2036	2036																	2		13i;		2		2			2	
H1894	008	0	1	01	01	H1894_008_0	9	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H1947	001	0	1	01	01	H1947_001_0	7	1	1	10				01111	3364	1208																	2		13i;		2		2			2	
H1947	001	0	1	01	01	H1947_001_0	7	2	1	10				01111	3364	3364																	2		13i;		2		2			2	
H1947	001	0	1	01	01	H1947_001_0	7	5	1	10				01111	3364	3364																	2		13i-O;		2		2			2	
H1947	001	0	1	01	01	H1947_001_0	7	4	1	10				01111	3364	3364																	2		13i;		2		2			2	
H1947	001	0	1	01	01	H1947_001_0	7	3	1	10				01111	3364	3364																	2		13i;		2		2			2	
H1951	032	0	1	01	01	H1951_032_0	4	1	1	10				01111	8590	8590																	2		13d;		1	13d;	2			1	1200.00
H1951	033	0	1	01	01	H1951_033_0	5	1	1	10				01111	15204	15204																	2		13d;		1	13d;	2			1	1200.00
H1951	034	0	1	01	01	H1951_034_0	4	1	1	10				01111	3551	3551																	2		13d;		1	13d;	2			1	900.00
H1951	038	0	1	01	01	H1951_038_0	4	1	3								00000101000000000000																1	001	13c;		1	13c;	2			2	
H1951	039	0	1	01	01	H1951_039_0	4	1	3								00000101000000000000																1	001	13c;		1	13c;	2			2	
H1951	041	0	1	01	01	H1951_041_0	4	1	1	10				01111	25201	25201																	2		13d;		1	13d;	2			1	900.00
H1951	044	0	1	01	01	H1951_044_0	6	1	3								01111111111111110000																2		13i;		2		2			1	600.00
H1951	056	0	1	01	01	H1951_056_0	4	1	1	10				01111	138	138																	2		13d;		2		2			1	600.00
H1961	003	0	1	01	01	H1961_003_0	4	2	2														00000000010000										2		14c;		1	14c;	2			2	
H1961	003	0	1	01	01	H1961_003_0	4	1	1	10				01111	17918	15230																	2		13d;		1	13d;	2			2	
H1961	014	1	1	01	01	H1961_014_1	3	1	2														00000000010000										2		14c;		1	14c;	2			2	
H1961	014	2	1	01	01	H1961_014_2	4	1	2														00000000010000										2		14c;		1	14c;	2			2	
H1961	014	3	1	01	01	H1961_014_3	3	1	2														00000000010000										2		14c;		1	14c;	2			2	
H1961	014	4	1	01	01	H1961_014_4	4	1	2														00000000010000										2		14c;		1	14c;	2			2	
H1961	017	0	1	01	01	H1961_017_0	3	1	2														00000000010000										2		14c;		1	14c;	2			2	
H1961	019	0	1	01	01	H1961_019_0	4	1	1	10				01111	11791	10022																	2		13d;		1	13d;	2			2	
H1961	019	0	1	01	01	H1961_019_0	4	2	2														00000000010000										2		14c;		1	14c;	2			2	
H1969	002	0	1	01	01	H1969_002_0	7	1	2														01000000000000										2		7f;		2		2			2	
H1969	002	0	1	01	01	H1969_002_0	7	2	2														00000000001000	Pre-diabetes									2		14c;		2		2			2	
H1969	002	0	1	01	01	H1969_002_0	7	3	3								01111111111111110000																1	001	13i;13i-O;		2		2			2	
H1969	004	0	1	01	01	H1969_004_0	7	3	3								01111111111111110000																1	001	13i;13i-O;		2		2			2	
H1969	004	0	1	01	01	H1969_004_0	7	1	2														01000000000000										2		7f;		2		2			2	
H1969	004	0	1	01	01	H1969_004_0	7	2	2														00000000001000	Pre-diabetes									2		14c;		2		2			2	
H1969	006	0	1	01	01	H1969_006_0	4	3	3								01111111111111110000																1	001	13i;13i-O;		2		2			2	
H1969	006	0	1	01	01	H1969_006_0	4	2	2														00000000001000	Pre-diabetes									2		14c;		2		2			2	
H1969	006	0	1	01	01	H1969_006_0	4	1	2														01000000000000										2		7f;		2		2			2	
H1969	007	3	1	01	01	H1969_007_3	8	2	2														00000000001000	Pre-diabetes									2		14c;		2		2			2	
H1969	007	3	1	01	01	H1969_007_3	8	3	3								01111111111111110000																1	001	13i;13i-O;		2		2			2	
H1969	007	3	1	01	01	H1969_007_3	8	1	2														01000000000000										2		7f;		2		2			2	
H1969	007	4	1	01	01	H1969_007_4	8	3	3								01111111111111110000																1	001	13i;13i-O;		2		2			2	
H1969	007	4	1	01	01	H1969_007_4	8	2	2														00000000001000	Pre-diabetes									2		14c;		2		2			2	
H1969	007	4	1	01	01	H1969_007_4	8	1	2														01000000000000										2		7f;		2		2			2	
H1969	008	1	1	01	01	H1969_008_1	8	2	2														00000000001000	Pre-diabetes									2		14c;		2		2			2	
H1969	008	1	1	01	01	H1969_008_1	8	3	3								01111111111111110000																1	001	13i;13i-O;		2		2			2	
H1969	008	1	1	01	01	H1969_008_1	8	1	2														01000000000000										2		7f;		2		2			2	
H1969	008	2	1	01	01	H1969_008_2	8	2	2														00000000001000	Pre-diabetes									2		14c;		2		2			2	
H1969	008	2	1	01	01	H1969_008_2	8	3	3								01111111111111110000																1	001	13i;13i-O;		2		2			2	
H1969	008	2	1	01	01	H1969_008_2	8	1	2														01000000000000										2		7f;		2		2			2	
H1993	001	0	1	01	01	H1993_001_0	9	1	3								00000000000000001000	Chronic Conditions TBD															2		13i;		2		2			1	300.00
H1993	002	0	1	01	01	H1993_002_0	8	1	3								00000000000000001000	Chronic Conditions TBD															2		13i;		2		2			1	300.00
H1993	003	0	1	01	01	H1993_003_0	9	1	3								00000000000000001000	Chronic Conditions TBD															2		13i;		2		2			1	300.00
H1993	004	0	1	01	01	H1993_004_0	8	1	3								00000000000000001000	Chronic Conditions TBD															2		13i;		2		2			1	300.00
H1997	002	0	1	01	01	H1997_002_0	7	1	2														01000000000000										2		7f;		2		2			2	
H1997	002	0	1	01	01	H1997_002_0	7	2	2														00000000001000	Pre-diabetes									2		14c;		2		2			2	
H1997	002	0	1	01	01	H1997_002_0	7	3	3								01111111111111110000																1	001	13i;13i-O;		2		2			2	
H1997	008	0	1	01	01	H1997_008_0	4	2	2														00000000001000	Pre-diabetes									2		14c;		2		2			2	
H1997	008	0	1	01	01	H1997_008_0	4	1	2														01000000000000										2		7f;		2		2			2	
H1997	008	0	1	01	01	H1997_008_0	4	3	3								01111111111111110000																1	001	13i;13i-O;		2		2			2	
H1997	009	0	1	01	01	H1997_009_0	7	3	3								01111111111111110000																1	001	13i;13i-O;		2		2			2	
H1997	009	0	1	01	01	H1997_009_0	7	1	2														01000000000000										2		7f;		2		2			2	
H1997	009	0	1	01	01	H1997_009_0	7	2	2														00000000001000	Pre-diabetes									2		14c;		2		2			2	
H1997	010	0	1	01	01	H1997_010_0	8	3	3								01111111111111110000																1	001	13i;13i-O;		2		2			2	
H1997	010	0	1	01	01	H1997_010_0	8	1	2														01000000000000										2		7f;		2		2			2	
H1997	010	0	1	01	01	H1997_010_0	8	2	2														00000000001000	Pre-diabetes									2		14c;		2		2			2	
H1997	011	0	1	01	01	H1997_011_0	8	1	2														01000000000000										2		7f;		2		2			2	
H1997	011	0	1	01	01	H1997_011_0	8	2	2														00000000001000	Pre-diabetes									2		14c;		2		2			2	
H1997	011	0	1	01	01	H1997_011_0	8	3	3								01111111111111110000																1	001	13i;13i-O;		2		2			2	
H2056	801	0	1	01	01	H2056_801_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H2056	802	0	1	01	01	H2056_802_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H2117	001	0	1	04	01	H2117_001_0	5	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			1	600.00
H2117	002	0	1	04	01	H2117_002_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	1	2	13i;	1	1200.00
H2134	001	0	1	01	01	H2134_001_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	900.00
H2134	002	0	1	01	01	H2134_002_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	2			2	
H2134	003	0	1	01	01	H2134_003_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	600.00
H2134	004	0	1	01	01	H2134_004_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	600.00
H2134	005	0	1	01	01	H2134_005_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	2			2	
H2134	006	0	1	01	01	H2134_006_0	3	1	3								01111111111111110000																1	001	13i;		1	13i;	2			2	
H2162	002	0	1	01	01	H2162_002_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	2400.00
H2168	002	0	1	01	01	H2168_002_0	4	1	3								01111111111111111100	Medical conditions related to long-term care needs	Medical conditions related to frailty														1	001	13i;		1	13i;	2			2	
H2174	001	0	1	01	01	H2174_001_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	2			1	600.00
H2224	001	0	1	01	01	H2224_001_0	6	1	3								00000010000001001000	Nursing Home Certifiable															1	001	13i;		2		2			1	400.00
H2224	003	0	1	01	01	H2224_003_0	6	1	3								00000010000001001000	Nursing Home Certifiable															1	001	13i;		2		2			1	400.00
H2225	001	0	1	01	01	H2225_001_0	11	1	3								11111111111111111111	Chronic Kidney Disease (CKD)	Physical disabilities	Musculoskeletal conditions	Developmental disabilities	Vision & Hearing Disorders											2		13i;13i-O;		2		2			2	
H2226	001	0	1	01	01	H2226_001_0	3	1	1	10				01111	13501	11476																	2		13d;		1	13d;	2			2	
H2226	003	0	1	01	01	H2226_003_0	3	1	1	10				01111	9191	7812																	2		13d;		1	13d;	2			2	
H2228	041	0	1	04	01	H2228_041_0	6	1	1	10				01111	20061	17052																	2		13d;	1	1	13d;	2			2	
H2228	043	0	1	04	01	H2228_043_0	4	1	1	10				01111	15434	13119																	2		13d;	1	1	13d;	2			2	
H2228	045	0	1	04	01	H2228_045_0	4	1	1	10				01111	14717	12509																	2		13d;	1	1	13d;	2			2	
H2235	001	0	1	01	01	H2235_001_0	10	1	3								00000001000000000000																2		7f;13b;14c;16a;		2		2			2	
H2235	003	0	1	01	01	H2235_003_0	10	1	3								00000001000000000000																2		7f;13b;14c;16a;		2		2			2	
H2237	001	0	1	01	01	H2237_001_0	13	1	1	10				01111	9639	7808																	2		13d;		1	13d;	2			1	600.00
H2237	001	0	1	01	01	H2237_001_0	13	2	3								00010101000000001000	Chronic Obstructive Pulmonary Disease															1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	500.00
H2237	007	0	1	01	01	H2237_007_0	12	1	1	10				01111	857	694																	2		13d;		1	13d;	2			1	600.00
H2247	001	0	1	01	01	H2247_001_0	4	1	1	10				01111	16598	14108																	2		13d;		1	13d;	2			2	
H2256	001	1	1	01	01	H2256_001_1	6	1	2														00110000001100	Pneumonia	Cellulitis				2	2			2		13d;14c;		2		2			2	
H2256	001	2	1	01	01	H2256_001_2	6	1	2														00110000001100	Pneumonia	Cellulitis				2	2			2		13d;14c;		2		2			2	
H2256	001	6	1	01	01	H2256_001_6	6	1	2														00110000001100	Pneumonia	Cellulitis				2	2			2		13d;14c;		2		2			2	
H2256	015	1	1	01	01	H2256_015_1	7	1	2														00110000001100	Pneumonia	Cellulitis				2	2			2		13d;14c;		2		2			2	
H2256	015	2	1	01	01	H2256_015_2	7	1	2														00110000001100	Pneumonia	Cellulitis				2	2			2		13d;14c;		2		2			2	
H2256	015	6	1	01	01	H2256_015_6	7	1	2														00110000001100	Pneumonia	Cellulitis				2	2			2		13d;14c;		2		2			2	
H2256	016	1	1	01	01	H2256_016_1	7	1	2														00110000001100	Pneumonia	Cellulitis				2	2			2		13d;14c;		2		2			2	
H2256	016	2	1	01	01	H2256_016_2	6	1	2														00110000001100	Pneumonia	Cellulitis				2	2			2		13d;14c;		2		2			2	
H2256	018	1	1	01	01	H2256_018_1	6	1	2														00110000001100	Pneumonia	Cellulitis				2	2			2		13d;14c;		2		2			2	
H2256	018	7	1	01	01	H2256_018_7	6	1	2														00110000001100	Pneumonia	Cellulitis				2	2			2		13d;14c;		2		2			2	
H2256	018	8	1	01	01	H2256_018_8	6	1	2														00110000001100	Pneumonia	Cellulitis				2	2			2		13d;14c;		2		2			2	
H2256	019	1	1	01	01	H2256_019_1	5	1	2														00110000001100	Pneumonia	Cellulitis				2	2			2		13d;14c;		2		2			2	
H2256	019	7	1	01	01	H2256_019_7	5	1	2														00110000001100	Pneumonia	Cellulitis				2	2			2		13d;14c;		2		2			2	
H2256	026	1	1	01	01	H2256_026_1	6	1	2														00110000001100	Pneumonia	Cellulitis				2	2			2		13d;14c;		2		2			2	
H2256	026	2	1	01	01	H2256_026_2	6	1	2														00110000001100	Pneumonia	Cellulitis				2	2			2		13d;14c;		2		2			2	
H2256	026	3	1	01	01	H2256_026_3	6	1	2														00110000001100	Pneumonia	Cellulitis				2	2			2		13d;14c;		2		2			2	
H2256	028	0	1	01	01	H2256_028_0	6	1	2														00110000001100	Pneumonia	Cellulitis				2	2			2		13d;14c;		2		2			2	
H2256	033	0	1	01	01	H2256_033_0	8	1	2														00110000001100	Pneumonia	Cellulitis				2	2			2		13d;14c;		2		2			2	
H2256	034	0	1	01	01	H2256_034_0	6	1	2														00110000001100	Pneumonia	Cellulitis				2	2			2		13d;14c;		2		2			2	
H2256	036	0	1	01	01	H2256_036_0	6	1	2														00110000001100	Pneumonia	Cellulitis				2	2			2		13d;14c;		2		2			2	
H2256	039	0	1	01	01	H2256_039_0	6	1	2														00110000001100	Pneumonia	Cellulitis				2	2			2		13d;14c;		2		2			2	
H2256	040	0	1	01	01	H2256_040_0	5	1	2														00110000001100	Pneumonia	Cellulitis				2	2			2		13d;14c;		2		2			2	
H2256	041	0	1	01	01	H2256_041_0	5	1	2														00110000001100	Pneumonia	Cellulitis				2	2			2		13d;14c;		2		2			2	
H2256	042	0	1	01	01	H2256_042_0	5	1	2														00110000001100	Pneumonia	Cellulitis				2	2			2		13d;14c;		2		2			2	
H2256	046	0	1	01	01	H2256_046_0	7	1	2														00110000001100	Pneumonia	Cellulitis				2	2			2		13d;14c;		2		2			2	
H2288	003	0	1	01	01	H2288_003_0	5	1	3								00001111000001001000	Kidney Disease															1	001	13b;13i;		2		2			2	
H2288	009	0	1	01	01	H2288_009_0	6	1	3								00001100000000001000	Kidney Disease															1	001	13b;		2		2			2	
H2288	010	0	1	01	01	H2288_010_0	5	1	3								00001111000001001000	Kidney Disease															1	001	13b;13i;		2		2			2	
H2354	025	0	1	01	01	H2354_025_0	9	1	3								00000100000011000000																2		13i;		1	13i;	2			1	500.00
H2392	002	0	1	01	01	H2392_002_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	2			2	
H2392	003	0	1	01	01	H2392_003_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	2			2	
H2416	001	0	1	01	01	H2416_001_0	7	1	3								00000001000000000000																1	001	13i;		2		2			2	
H2422	002	0	1	01	01	H2422_002_0	7	1	3								11111111111111111111	Chronic Kidney Disease	Spinal Cord Injury or Paralysis	Morbid Obesity	Chronic liver disease or cirrhosis	Neuromuscular Disorders											1	001	13i;14c;		2		2			2	
H2425	001	0	1	01	01	H2425_001_0	7	1	3								00011111110110010000																2		13b;13d;13i;		1	13b;13d;13i;	2			2	
H2456	002	0	1	01	01	H2456_002_0	6	4	2														00000000011111	Multiple Sclerosis (MS)	Amyotrophic Lateral Sclerosis (ALS)	Parkinsons	Cognitive Impairment		2	2			2		14c;		1	14c;	2			2	
H2456	002	0	1	01	01	H2456_002_0	6	2	2														00000000001000	Nursing Home Certifiable									2		14c;		1	14c;	2			2	
H2456	002	0	1	01	01	H2456_002_0	6	1	2														00000000001000	History/Risk of Falls									2		14c;		1	14c;	2			2	
H2456	002	0	1	01	01	H2456_002_0	6	3	3								01000001000000001000	Congestive Heart Failure															2		10b;13i;13i-O;		1	10b;13i-O;	2			2	
H2458	002	0	1	01	01	H2458_002_0	8	1	3								00001101000000000000																2		13i;		2		2			2	
H2459	021	1	1	02	01	H2459_021_1	5	1	2														00010000001000	Post Hospitalization					1				2		13c;	2	1	13c;	2			2	
H2459	031	0	1	01	01	H2459_031_0	8	1	3								00000000000000001100	COPD	Congestive heart failure														2		13b;		2		2			2	
H2459	032	0	1	01	01	H2459_032_0	8	1	3								00000000000000001100	COPD	Congestive heart failure														2		13b;		2		2			2	
H2463	001	0	1	01	01	H2463_001_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H2486	003	0	1	01	01	H2486_003_0	8	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H2486	005	0	1	01	01	H2486_005_0	5	1	3								00000001000000001110	Obesity	Chronic Kidney Disease (CKD)	Depression													1	001	13i;		2		2			2	
H2486	006	0	1	01	01	H2486_006_0	7	1	3								00000100000010000000																1	001	10b;13i;		2		2			2	
H2486	006	0	1	01	01	H2486_006_0	7	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H2486	007	0	1	01	01	H2486_007_0	8	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000.00
H2486	008	0	1	01	01	H2486_008_0	7	1	3								00000001000000001110	Obesity	Chronic Kidney Disease (CKD)	Depression													1	001	13i;		2		2			2	
H2491	006	0	1	01	01	H2491_006_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	1	1		1	600.00
H2491	007	0	1	01	01	H2491_007_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	2			1	600.00
H2491	010	0	1	01	01	H2491_010_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H2491	011	0	1	01	01	H2491_011_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H2491	012	0	1	01	01	H2491_012_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1800.00
H2563	004	0	1	01	01	H2563_004_0	10	1	3								01111111111111110000																2		13i;		2		2			2	
H2563	005	1	1	01	01	H2563_005_1	11	1	1	01	1000000000				431	108																	2		13d;		1	13d;	2			2	
H2563	005	2	1	01	01	H2563_005_2	11	1	1	01	1000000000				98	24																	2		13d;		1	13d;	2			2	
H2563	008	0	1	01	01	H2563_008_0	11	1	3								01111111111111110000																2		13i;		2		2			2	
H2563	009	0	1	01	01	H2563_009_0	11	1	3								01111111111111110000																2		13i;		2		2			2	
H2563	014	0	1	01	01	H2563_014_0	7	1	3								01111111111111110000																2		13i;		2		2			2	
H2563	015	0	1	01	01	H2563_015_0	11	1	3								01111111111111110000																2		13i;		2		2			2	
H2563	016	0	1	01	01	H2563_016_0	11	1	3								01111111111111110000																2		13i;		2		2			2	
H2563	017	1	1	01	01	H2563_017_1	11	1	1	01	1000000000				62	15																	2		13d;		1	13d;	2			2	
H2563	017	1	1	01	01	H2563_017_1	11	2	3								01111111111111110000																2		13i;		2		2			2	
H2563	017	2	1	01	01	H2563_017_2	11	2	3								01111111111111110000																2		13i;		2		2			2	
H2563	017	2	1	01	01	H2563_017_2	11	1	1	01	1000000000				9	3																	2		13d;		1	13d;	2			2	
H2582	002	0	1	01	01	H2582_002_0	4	1	1	10				01111	2440	2074																	2		13d;		1	13d;	2			2	
H2593	001	0	1	01	01	H2593_001_0	7	1	3								01111111111111111000	Plan Approved Chronis Conditions															2		13i;		2		2			2	
H2593	005	0	1	01	01	H2593_005_0	6	1	3								01111111111111110000																2		13i;		2		2			2	
H2593	006	0	1	01	01	H2593_006_0	6	1	3								01111111111111110000																2		13i;		2		2			2	
H2593	013	0	1	01	01	H2593_013_0	6	1	3								01111111111111110000																2		13i;		2		2			2	
H2593	018	0	1	01	01	H2593_018_0	6	1	3								01111111111111110000																2		13i;		2		2			2	
H2593	025	0	1	01	01	H2593_025_0	9	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H2593	031	0	1	02	01	H2593_031_0	9	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;	2	2		2			2	
H2593	032	0	1	01	01	H2593_032_0	8	1	1	10				01111	7527	2702																	2		13i;		2		2			2	
H2593	032	0	1	01	01	H2593_032_0	8	2	1	10				01111	7527	7527																	2		13i;		2		2			2	
H2593	040	0	1	01	01	H2593_040_0	6	1	3								01111111111111110000																2		13i;		2		2			2	
H2593	041	0	1	01	01	H2593_041_0	8	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H2593	043	0	1	01	01	H2593_043_0	10	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H2610	005	0	1	01	01	H2610_005_0	5	1	3								00000001000000000000																2		13b;		2		2			1	50.00
H2610	006	0	1	01	01	H2610_006_0	6	1	3								00000001000000000000																2		13b;		2		2			1	50.00
H2663	002	0	1	01	01	H2663_002_0	4	1	3								01111111111111111100	Hyperlipidemia	Hypertension														2		13i;		1	13i;	2			2	
H2663	805	0	1	01	01	H2663_805_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H2663	810	0	1	01	01	H2663_810_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H2678	001	0	1	01	01	H2678_001_0	5	1	3								01111111111111110000																2		13i;		2		2			2	
H2678	002	0	1	01	01	H2678_002_0	4	1	3								00000000000100000000																2		13i;		2		2			2	
H2678	003	0	1	01	01	H2678_003_0	4	1	3								00000000000000001000	Frailty															2		13i;		2		2			2	
H2678	004	0	1	01	01	H2678_004_0	4	1	3								00000000000000001000	Frailty															2		13i;		2		2			2	
H2697	001	0	1	01	01	H2697_001_0	8	1	3								01111111111111110000																2		13i-O;		2		1	1		1	240.00
H2697	002	0	1	01	01	H2697_002_0	9	1	3								01111111111111110000																2		13i-O;		2		1	1		1	240.00
H2775	112	0	1	04	01	H2775_112_0	5	1	3								01111111111111110000																1	001	13i;	1	1	13i;	1	1		1	600.00
H2775	114	0	1	04	01	H2775_114_0	6	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			1	600.00
H2775	115	0	1	04	01	H2775_115_0	6	1	3								01111111111111110000																1	001	13i;	1	1	13i;	1	1		1	600.00
H2802	001	0	1	02	01	H2802_001_0	3	1	2														00000000010000										2		14c;	2	2		2			2	
H2802	044	0	1	01	01	H2802_044_0	4	1	1	10				01111	11091	9427																	2		13d;		1	13d;	2			2	
H2802	053	0	1	01	01	H2802_053_0	4	1	1	10				01111	2706	2300																	2		13d;		1	13d;	2			2	
H2802	053	0	1	01	01	H2802_053_0	4	2	1	10				01111	2706	271																	2		13e;		1	13e;	2			2	
H2853	001	0	1	01	01	H2853_001_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H2853	002	0	1	01	01	H2853_002_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	2700.00
H2879	001	0	1	01	01	H2879_001_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	1020.00
H2879	002	0	1	01	01	H2879_002_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	960.00
H2879	003	0	1	01	01	H2879_003_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	960.00
H2915	002	0	1	01	01	H2915_002_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	2			2	
H2915	007	0	1	01	01	H2915_007_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1500.00
H2926	001	0	1	01	01	H2926_001_0	10	1	3								00000001000000000000																1	001	13i;		2		2			2	
H2960	022	0	1	01	01	H2960_022_0	5	1	3								00000101000010000000																2		13i;		2		2			2	
H2962	035	0	1	01	01	H2962_035_0	10	1	3								11111111111111111111	Hypertension	Chronic kidney disease (any stage)	Hypercholesterolemia	Tobacco Abuse	Depression											2		13i;		2		2			1	25.00
H2962	036	0	1	01	01	H2962_036_0	10	1	3								11111111111111111111	Hypertension	Chronic kidney disease (any stage)	Hypercholesterolemia	Tobacco Abuse	Depression											2		13i;		2		2			1	25.00
H2962	037	0	1	01	01	H2962_037_0	10	1	3								11111111111111111111	Hypertension	Chronic kidney disease (any stage)	Hypercholesterolemia	Tobacco Abuse	Depression											2		13i;		2		2			1	25.00
H2962	038	0	1	01	01	H2962_038_0	10	1	3								11111111111111111111	Hypertension	Chronic kidney disease (any stage)	Hypercholesterolemia	Tobacco Abuse	Depression											2		13i;		2		2			1	25.00
H2962	039	0	1	01	01	H2962_039_0	10	1	3								11111111111111111111	Hypertension	Chronic kidney disease (any stage)	Hypercholesterolemia	Tobacco Abuse	Depression											2		13i;		2		2			1	25.00
H2962	040	0	1	01	01	H2962_040_0	10	1	3								11111111111111111111	Hypertension	Chronic kidney disease (any stage)	Hypercholesterolemia	Tobacco Abuse	Depression											2		13i;		2		2			1	25.00
H2962	041	0	1	01	01	H2962_041_0	10	1	3								11111111111111111111	Hypertension	Chronic kidney disease (any stage)	Hypercholesterolemia	Tobacco Abuse	Depression											2		13i;		2		2			1	25.00
H2962	042	0	1	01	01	H2962_042_0	10	1	3								11111111111111111111	Hypertension	Chronic kidney disease (any stage)	Hypercholesterolemia	Tobacco Abuse	Depression											2		13i;		2		2			1	25.00
H2962	043	0	1	01	01	H2962_043_0	10	1	3								11111111111111111111	Hypertension	Chronic kidney disease (any stage)	Hypercholesterolemia	Tobacco Abuse	Depression											2		13i;		2		2			1	25.00
H2962	044	0	1	01	01	H2962_044_0	10	1	3								11111111111111111111	Hypertension	Chronic kidney disease (any stage)	Hypercholesterolemia	Tobacco Abuse	Depression											2		13i;		2		2			1	25.00
H3015	001	0	1	01	01	H3015_001_0	6	1	3								01111111111111111111	Diasbled Members	Members with Obesity	Members with Joint and Spine Conditions	Members with Endocrine Disorder												2		13i;		2		2			1	0.00
H3047	001	0	1	04	01	H3047_001_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			1	600.00
H3113	005	0	1	01	01	H3113_005_0	3	1	1	10				01111	33255	28267																	2		13d;		1	13d;	2			2	
H3113	009	0	1	01	01	H3113_009_0	4	1	1	10				01111	30965	26320																	2		13d;		1	13d;	2			2	
H3113	010	0	1	01	01	H3113_010_0	5	1	1	10				01111	8830	7506																	2		13d;		1	13d;	2			2	
H3113	011	0	1	01	01	H3113_011_0	5	1	1	10				01111	5691	4837																	2		13d;		1	13d;	2			2	
H3113	013	0	1	01	01	H3113_013_0	4	1	1	10				01111	185	157																	2		13d;		1	13d;	2			2	
H3113	014	0	1	01	01	H3113_014_0	4	1	1	10				01111	1382	1175																	2		13d;		1	13d;	2			2	
H3132	001	0	1	01	01	H3132_001_0	4	1	2														00000000001000	AIDS-Related Neuropathy									2		14c;		2		2			2	
H3146	001	0	1	02	01	H3146_001_0	3	1	2														00000100001000	Hyperlipidemia					2	2			2		10b;13b;	1	1	10b;13b;	2			2	
H3146	002	0	1	01	01	H3146_002_0	4	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H3146	003	0	1	01	01	H3146_003_0	4	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H3146	004	0	1	02	01	H3146_004_0	3	1	2														00000100001000	Hyperlipidemia					2	2			2		10b;13b;	1	1	10b;13b;	2			2	
H3146	005	0	1	01	01	H3146_005_0	3	1	2														00000100001000	Hyperlipidemia					2	2			2		10b;13b;		1	10b;13b;	2			2	
H3146	006	0	1	01	01	H3146_006_0	3	1	2														00000100001000	Hyperlipidemia					2	2			2		10b;13b;		1	10b;13b;	2			2	
H3146	007	0	1	02	01	H3146_007_0	3	1	2														00000100001000	Hyperlipidemia					2	2			2		10b;13b;	1	1	10b;13b;	2			2	
H3146	008	0	1	01	01	H3146_008_0	4	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H3146	009	0	1	01	01	H3146_009_0	4	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H3146	010	0	1	01	01	H3146_010_0	3	1	2														00000100001000	Hyperlipidemia					2	2			2		10b;13b;		1	10b;13b;	2			2	
H3146	011	0	1	01	01	H3146_011_0	3	1	2														00000100001000	Hyperlipidemia					2	2			2		10b;13b;		1	10b;13b;	2			2	
H3146	012	0	1	01	01	H3146_012_0	3	1	2														00000100001000	Hyperlipidemia					2	2			2		10b;13b;		1	10b;13b;	2			2	
H3146	013	0	1	01	01	H3146_013_0	3	1	2														00000100001000	Hyperlipidemia					2	2			2		10b;13b;		1	10b;13b;	2			2	
H3146	014	0	1	02	01	H3146_014_0	4	1	2														00000100001000	Hyperlipidemia					2	2			2		10b;13b;	1	1	10b;13b;	2			2	
H3146	801	0	1	01	01	H3146_801_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H3146	802	0	1	01	01	H3146_802_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H3152	801	0	1	01	01	H3152_801_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H3152	804	0	1	01	01	H3152_804_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H3186	001	0	1	04	01	H3186_001_0	12	1	3								00000101010000000000																2		13c;	1	2		2			2	
H3186	002	0	1	04	01	H3186_002_0	12	1	3								00000101010000000000																2		13c;	1	2		2			2	
H3192	001	0	1	02	01	H3192_001_0	6	1	3								01111111111111111100	Hyperlipidemia	Hypertension														2		13i;	1	1	13i;	2			2	
H3192	002	0	1	02	01	H3192_002_0	6	1	3								01111111111111111100	Hyperlipidemia	Hypertension														2		13i;	1	1	13i;	2			2	
H3192	003	0	1	02	01	H3192_003_0	6	1	3								01111111111111111100	Hyperlipidemia	Hypertension														2		13i;	1	1	13i;	2			2	
H3192	004	0	1	02	01	H3192_004_0	6	1	3								01111111111111111100	Hyperlipidemia	Hypertension														2		13i;	1	1	13i;	2			2	
H3192	005	0	1	02	01	H3192_005_0	6	1	3								01111111111111111100	Hyperlipidemia	Hypertension														2		13i;	1	1	13i;	2			2	
H3192	006	0	1	02	01	H3192_006_0	5	1	3								01111111111111111100	Hyperlipidemia	Hypertension														2		13i;	1	1	13i;	2			2	
H3192	007	0	1	01	01	H3192_007_0	5	1	1	10				01111	137895	137895																	2		13i;13i-O;14c;		1	13i;13i-O;14c;	2			2	
H3192	008	0	1	01	01	H3192_008_0	5	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H3192	009	0	1	01	01	H3192_009_0	6	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H3192	801	0	1	01	01	H3192_801_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H3192	802	0	1	01	01	H3192_802_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H3219	801	0	1	04	01	H3219_801_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H3219	802	0	1	04	01	H3219_802_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H3239	001	0	1	01	01	H3239_001_0	5	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H3239	002	0	1	01	01	H3239_002_0	5	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H3239	003	0	1	01	01	H3239_003_0	5	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H3239	005	0	1	01	01	H3239_005_0	5	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H3239	006	0	1	01	01	H3239_006_0	5	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H3239	007	0	1	01	01	H3239_007_0	5	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H3239	008	0	1	01	01	H3239_008_0	6	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H3240	013	0	1	01	01	H3240_013_0	6	3	1	10				01111	14424	14424																	2		13i;		2		2			2	
H3240	013	0	1	01	01	H3240_013_0	6	2	1	10				01111	14424	14424																	2		13i;		2		2			2	
H3240	013	0	1	01	01	H3240_013_0	6	1	1	10				01111	14424	14424																	2		13i;		2		2			2	
H3240	017	0	1	02	01	H3240_017_0	9	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;	2	2		2			2	
H3240	024	0	1	02	01	H3240_024_0	6	1	1	10				01111	767	767																	2		13i;	2	2		2			2	
H3240	024	0	1	02	01	H3240_024_0	6	4	1	10				01111	767	767																	2		13i;	2	2		2			2	
H3240	024	0	1	02	01	H3240_024_0	6	2	1	10				01111	767	767																	2		13i;	2	2		2			2	
H3240	024	0	1	02	01	H3240_024_0	6	3	1	10				01111	767	767																	2		13i;	2	2		2			2	
H3256	001	0	1	04	01	H3256_001_0	4	1	1	10				01111	36263	30824																	2		13d;	1	1	13d;	2			2	
H3256	002	0	1	04	01	H3256_002_0	4	1	1	10				01111	1697	1442																	2		13d;	1	1	13d;	2			2	
H3259	001	0	1	01	01	H3259_001_0	5	1	3								01111111111111111111	Disabled Members	Members with Obesity	Members with Joint and Spine Conditions	Members with Endocrine Disorders												2		13i;		2		2			1	0.00
H3259	002	0	1	01	01	H3259_002_0	6	1	3								01111111111111111111	Disabled Members	Members with Obesity	Members with Joint and Spine Conditions	Members with Endocrine Disorders												2		13i;		2		2			1	0.00
H3276	001	0	1	01	01	H3276_001_0	5	1	1	10				01111	3598	3598																	2		13b;		2		2			1	50.00
H3288	047	0	1	04	01	H3288_047_0	2	1	2														00000100001000	Hyperlipidemia					2	2			2		10b;13b;	1	1	10b;13b;	1	1		2	
H3288	801	0	1	04	01	H3288_801_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H3288	802	0	1	04	01	H3288_802_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H3291	002	0	1	01	01	H3291_002_0	8	1	3								10001011010011011111	Alzheimer's Dieases or related dementia	Intellectual disabilities and related conditions	Hypertention	Obesity	Malnutrition including failure to thrive											2		13i;		2		2			2	
H3293	004	0	1	01	01	H3293_004_0	8	1	1	10				01111	2780	1095																	1	100	13d;		2		2			2	
H3305	007	0	1	02	01	H3305_007_0	5	2	2														00001000000000										2		14c;	2	1	14c;	2			1	250.00
H3305	007	0	1	02	01	H3305_007_0	5	1	2														00000100000000										2		13b;	2	1	13b;	2			2	
H3305	015	0	1	02	01	H3305_015_0	8	1	2														00000100000000										2		13b;	2	1	13b;	2			2	
H3305	015	0	1	02	01	H3305_015_0	8	2	2														00001000000000										2		14c;	2	1	14c;	2			1	250.00
H3305	020	0	1	02	01	H3305_020_0	5	1	2														00000100000000										2		13b;	2	1	13b;	2			2	
H3305	020	0	1	02	01	H3305_020_0	5	2	2														00001000000000										2		14c;	2	1	14c;	2			1	250.00
H3305	021	0	1	02	01	H3305_021_0	7	2	2														00001000000000										2		14c;	2	1	14c;	2			1	250.00
H3305	021	0	1	02	01	H3305_021_0	7	1	2														00000100000000										2		13b;	2	1	13b;	2			2	
H3305	022	0	1	02	01	H3305_022_0	6	1	2														00000100000000										2		13b;	2	1	13b;	2			2	
H3305	022	0	1	02	01	H3305_022_0	6	2	2														00001000000000										2		14c;	2	1	14c;	2			1	250.00
H3305	030	0	1	02	01	H3305_030_0	7	1	2														00000100000000										2		13b;	2	1	13b;	2			2	
H3305	030	0	1	02	01	H3305_030_0	7	2	2														00001000000000										2		14c;	2	1	14c;	2			1	250.00
H3305	032	0	1	02	01	H3305_032_0	6	1	2														00000100000000										2		13b;	2	1	13b;	2			2	
H3305	032	0	1	02	01	H3305_032_0	6	2	2														00001000000000										2		14c;	2	1	14c;	2			1	250.00
H3312	069	0	1	01	01	H3312_069_0	3	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H3312	070	0	1	01	01	H3312_070_0	4	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H3312	801	0	1	01	01	H3312_801_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H3312	804	0	1	01	01	H3312_804_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H3330	042	1	1	01	01	H3330_042_1	5	1	1	10				01111	17980	17980																	2		13b;		2		2			1	120.00
H3330	042	2	1	01	01	H3330_042_2	5	1	1	10				01111	1489	1489																	2		13b;		2		2			1	50.00
H3330	042	3	1	01	01	H3330_042_3	5	1	1	10				01111	4932	4932																	2		13b;		2		2			1	100.00
H3347	002	0	1	01	01	H3347_002_0	5	1	3								11111111111111111111	Ophthalmic Conditions	Arthritis	Obesity	RSD (Reflex Sympathetic Dystrophy)	Other Conditions											2		13i;		2		2			2	
H3347	007	0	1	01	01	H3347_007_0	5	1	3								11111111111111111111	Ophthalmic Conditions	Arthritis	Obesity	RSD  (Reflex Sympathetic Dystrophy)	Other Conditions											2		13i;		2		2			2	
H3347	009	0	1	01	01	H3347_009_0	5	1	3								11111111111111111111	Ophthalmic Conditions	Arthritis	Obesity	RSD  (Reflex Sympathetic Dystrophy)	Other Conditions											2		13i;		2		2			2	
H3359	021	0	1	01	01	H3359_021_0	8	1	1	10				01110	166400	157805																	2		13d;13e;		1	13d;13e;	1	2	13b;13d;13e;	1	158.00
H3359	034	0	1	01	01	H3359_034_0	6	1	3								11111111111111111111	Alzheimer's Disease, ALS, arthritis (including rheumatoid arthritis)	heart disease, eating disorder, Hepatitis B, Hepatitis C, hypertension	COPD, cystic fibrosis, obesity, oral health, osteoporosis	Parkinson's Disease, reflex sympathetic dystrophy (RSD) syndrome	Emphysema and chronic conditions related to tobacco use											2		13i;		1	13i;	1	2	13i-O;	2	
H3359	038	0	1	01	01	H3359_038_0	7	1	1	10				01110	3500	3319																	2		13d;13e;		1	13d;13e;	1	2	13b;13d;13e;	1	270.00
H3387	014	1	1	01	01	H3387_014_1	4	1	1	10				01111	37649	32002																	2		13d;		1	13d;	2			2	
H3387	014	2	1	01	01	H3387_014_2	4	1	1	10				01111	79974	67978																	2		13d;		1	13d;	2			2	
H3387	015	1	1	01	01	H3387_015_1	4	1	1	10				01111	5251	4463																	2		13d;		1	13d;	2			2	
H3387	015	2	1	01	01	H3387_015_2	4	1	1	10				01111	7405	6294																	2		13d;		1	13d;	2			2	
H3388	001	0	1	01	01	H3388_001_0	5	1	3								01111111111111110000																1	011	14c;		2		2			2	
H3388	002	0	1	01	01	H3388_002_0	8	1	3								01111111111111110000																1	011	14c;		2		2			2	
H3388	004	0	1	01	01	H3388_004_0	9	1	3								01111111111111110000																1	011	14c;		2		2			2	
H3388	013	0	1	01	01	H3388_013_0	6	1	3								01111111111111110000																1	011	14c;		2		2			2	
H3388	014	0	1	01	01	H3388_014_0	6	1	3								01111111111111110000																1	011	14c;		2		2			2	
H3407	001	0	1	01	01	H3407_001_0	7	1	3								00000011000000001000	80+ Yr Adults in the community with 3 or more chronic conditions															2		13i;		1	13i;	2			2	
H3443	001	0	1	01	01	H3443_001_0	6	1	3								01111111111111110000																2		13i;13i-O;		2		2			2	
H3443	002	0	1	01	01	H3443_002_0	6	1	3								01111111111111110000																2		13i;13i-O;		2		2			2	
H3443	003	0	1	01	01	H3443_003_0	6	1	3								01111111111111110000																2		13i;13i-O;		2		2			2	
H3447	011	0	1	01	01	H3447_011_0	6	4	1	10				01111	17489	17489																	2		13i;		2		2			2	
H3447	011	0	1	01	01	H3447_011_0	6	2	1	10				01111	17489	17489																	2		13i;		2		2			2	
H3447	011	0	1	01	01	H3447_011_0	6	1	1	10				01111	17489	17489																	2		13i;		2		2			2	
H3447	011	0	1	01	01	H3447_011_0	6	5	1	10				01111	17489	17489																	2		13i;		2		2			2	
H3447	011	0	1	01	01	H3447_011_0	6	3	1	10				01111	17489	17489																	2		13i-O;		2		2			2	
H3447	013	0	1	01	01	H3447_013_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H3447	018	0	1	01	01	H3447_018_0	7	5	1	10				01111	15693	5336																	2		13i;		2		2			2	
H3447	018	0	1	01	01	H3447_018_0	7	3	1	10				01111	15693	15693																	2		13i;		2		2			2	
H3447	018	0	1	01	01	H3447_018_0	7	2	1	10				01111	15693	15693																	2		13i-O;		2		2			2	
H3447	018	0	1	01	01	H3447_018_0	7	1	1	10				01111	15693	15693																	2		13i;		2		2			2	
H3447	018	0	1	01	01	H3447_018_0	7	4	1	10				01111	15693	15693																	2		13i;		2		2			2	
H3447	020	0	1	01	01	H3447_020_0	10	5	1	10				01111	41105	13976																	2		13i;		2		2			2	
H3447	020	0	1	01	01	H3447_020_0	10	3	1	10				01111	41105	41105																	2		13i;		2		2			2	
H3447	020	0	1	01	01	H3447_020_0	10	2	1	10				01111	41105	41105																	2		13i-O;		2		2			2	
H3447	020	0	1	01	01	H3447_020_0	10	4	1	10				01111	41105	41105																	2		13i;		2		2			2	
H3447	020	0	1	01	01	H3447_020_0	10	1	1	10				01111	41105	41105																	2		13i;		2		2			2	
H3447	022	0	1	01	01	H3447_022_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H3447	024	0	1	01	01	H3447_024_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H3447	025	0	1	01	01	H3447_025_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H3447	027	0	1	01	01	H3447_027_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H3447	028	0	1	01	01	H3447_028_0	6	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H3447	030	0	1	01	01	H3447_030_0	7	4	1	10				01111	4137	4137																	2		13i;		2		2			2	
H3447	030	0	1	01	01	H3447_030_0	7	3	1	10				01111	4137	4137																	2		13i-O;		2		2			2	
H3447	030	0	1	01	01	H3447_030_0	7	2	1	10				01111	4137	4137																	2		13i;		2		2			2	
H3447	030	0	1	01	01	H3447_030_0	7	1	1	10				01111	4137	4137																	2		13i;		2		2			2	
H3447	030	0	1	01	01	H3447_030_0	7	5	1	10				01111	4137	4137																	2		13i;		2		2			2	
H3447	033	0	1	01	01	H3447_033_0	11	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H3447	035	1	1	01	01	H3447_035_1	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H3447	035	2	1	01	01	H3447_035_2	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H3447	036	1	1	01	01	H3447_036_1	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H3447	036	2	1	01	01	H3447_036_2	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H3447	037	0	1	01	01	H3447_037_0	6	1	3								01111111111111111000	Plan approved Chronic Conditions															2		13i;13i-O;		2		2			2	
H3447	038	1	1	01	01	H3447_038_1	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H3447	038	2	1	01	01	H3447_038_2	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H3447	039	0	1	01	01	H3447_039_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H3499	005	0	1	01	01	H3499_005_0	3	1	3								01111111111111110000																1	001	13i;		1	13i;	2			1	600.00
H3499	008	0	1	01	01	H3499_008_0	3	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H3533	001	0	1	01	01	H3533_001_0	4	1	3								00000001000000000000																1	001	13c;		2		2			2	
H3533	002	0	1	01	01	H3533_002_0	4	1	1	10				01111	10095	10095																	2		13d;		1	13d;	2			1	600.00
H3533	006	0	1	01	01	H3533_006_0	5	1	3								00000001000000000000																1	001	13c;		2		2			2	
H3533	010	0	1	01	01	H3533_010_0	5	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		1	13d;	2			2	
H3533	013	0	1	01	01	H3533_013_0	4	1	3								00000001000000000000																1	001	13c;		2		2			2	
H3533	027	0	1	01	01	H3533_027_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		1	13d;	2			2	
H3533	032	1	1	01	01	H3533_032_1	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		1	13d;	2			2	
H3533	032	2	1	01	01	H3533_032_2	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		1	13d;	2			2	
H3533	033	0	1	01	01	H3533_033_0	4	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H3533	033	0	1	01	01	H3533_033_0	4	1	3								00000101000010001000	Depression															1	001	13c;		2		2			2	
H3533	034	1	1	01	01	H3533_034_1	4	1	1	10				01111	4871	4871																	2		13d;		1	13d;	2			1	600.00
H3533	034	2	1	01	01	H3533_034_2	4	1	1	10				01111	3370	3370																	2		13d;		1	13d;	2			1	900.00
H3536	006	0	1	01	01	H3536_006_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H3554	002	0	1	04	01	H3554_002_0	4	1	3								00010001000000011100	Coronary artery disease	Sjgrens Syndrome														2		16a;16b;	1	2		2			2	
H3554	003	0	1	04	01	H3554_003_0	4	1	3								00010001000000011100	Coronary artery disease	Sjgrens Syndrome														2		16a;16b;	1	2		2			2	
H3554	004	0	1	04	01	H3554_004_0	4	1	3								00010001000000011100	Coronary artery disease	Sjgrens Syndrome														2		16a;16b;	1	2		2			2	
H3554	007	0	1	04	01	H3554_007_0	4	1	3								00010001000000011100	Coronary artery disease	Sjgrens Syndrome														2		16a;16b;	1	2		2			2	
H3554	008	0	1	04	01	H3554_008_0	4	1	3								00010001000000011100	Coronary artery disease	Sjgrens Syndrome														2		16a;16b;	1	2		2			2	
H3557	001	0	1	04	01	H3557_001_0	8	1	3								00001001000000000000																2		16b;	1	2		2			2	
H3561	001	0	1	01	01	H3561_001_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	1	1		1	600.00
H3561	002	0	1	01	01	H3561_002_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	1		1	600.00
H3597	011	0	1	02	01	H3597_011_0	5	1	1	10				01111	137895	137895																	2		13i;14c;	1	1	13i;14c;	2			2	
H3597	801	0	1	01	01	H3597_801_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H3597	802	0	1	01	01	H3597_802_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H3632	001	0	1	04	01	H3632_001_0	5	1	3								00011111111010110000																2		13i;	1	2		2			2	
H3653	004	0	1	01	01	H3653_004_0	6	1	2														00110000001110	Pneumonia	Urinary Tract Infection (UTI)	Cellulitis			2	2			2		13d;		2		2			2	
H3655	033	0	1	01	01	H3655_033_0	7	2	1	10				01111	44069	44069																	2		13i;		2		2			2	
H3655	033	0	1	01	01	H3655_033_0	7	1	1	10				01111	44069	14983																	2		13i;		2		2			2	
H3655	033	0	1	01	01	H3655_033_0	7	3	1	10				01111	44069	44069																	2		13i;		2		2			2	
H3655	033	0	1	01	01	H3655_033_0	7	5	1	10				01111	44069	44069																	2		13i-O;		2		2			2	
H3655	033	0	1	01	01	H3655_033_0	7	4	1	10				01111	44069	44069																	2		13i;		2		2			2	
H3655	034	0	1	01	01	H3655_034_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H3655	038	0	1	01	01	H3655_038_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H3655	041	0	1	01	01	H3655_041_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H3655	042	0	1	01	01	H3655_042_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H3655	044	0	1	01	01	H3655_044_0	7	4	1	10				01111	2354	2354																	2		13i;		2		2			2	
H3655	044	0	1	01	01	H3655_044_0	7	2	1	10				01111	2354	2354																	2		13i;		2		2			2	
H3655	044	0	1	01	01	H3655_044_0	7	1	1	10				01111	2354	800																	2		13i;		2		2			2	
H3655	044	0	1	01	01	H3655_044_0	7	3	1	10				01111	2354	2354																	2		13i;		2		2			2	
H3655	045	1	1	01	01	H3655_045_1	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H3655	045	2	1	01	01	H3655_045_2	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H3655	045	3	1	01	01	H3655_045_3	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H3655	045	4	1	01	01	H3655_045_4	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H3660	028	0	1	02	01	H3660_028_0	5	2	2														00000000001000	High A1C (over 8) Levels									2		13c;	2	2		2			2	
H3660	028	0	1	02	01	H3660_028_0	5	1	2														00000000001111	Hip Replacement	Knee Replacement	Femur Fracture	Falls or History of Falls		2	2			2		14c;	2	2		2			2	
H3660	029	0	1	02	01	H3660_029_0	7	1	2														00000000001111	Hip Replacement	Knee Replacement	Femur Fracture	Falls or History of Falls		2	2			2		14c;	2	2		2			2	
H3660	029	0	1	02	01	H3660_029_0	7	2	2														00000000001000	High A1C (over 8) Levels									2		13c;	2	2		2			2	
H3660	044	0	1	01	01	H3660_044_0	8	1	2														00000000001111	Hip Replacement	Knee Replacement	Femur Fracture	Falls or History of Falls		2	2			2		14c;		2		2			2	
H3660	044	0	1	01	01	H3660_044_0	8	2	2														00000000001000	High A1C (over 8) Levels									2		13c;		2		2			2	
H3660	050	0	1	01	01	H3660_050_0	5	2	2														00000000001000	High A1C (over 8) Levels									2		13c;		2		2			2	
H3660	050	0	1	01	01	H3660_050_0	5	1	2														00000000001111	Hip Replacement	Knee Replacement	Femur Fracture	Falls or History of Falls		2	2			2		14c;		2		2			2	
H3660	052	1	1	01	01	H3660_052_1	3	2	2														00000000001000	High A1C (over 8) Level									2		13c;		2		2			2	
H3660	052	1	1	01	01	H3660_052_1	3	1	2														00000000001111	Hip Replacement	Knee Replacement	Femur Fracture	Falls or History of Falls		2	2			2		14c;		2		2			2	
H3660	052	2	1	01	01	H3660_052_2	3	1	2														00000000001111	Hip Replacement	Knee Replacement	Femur Fracture	Falls or History of Falls		2	2			2		14c;		2		2			2	
H3660	052	2	1	01	01	H3660_052_2	3	2	2														00000000001000	High A1C (over 8) Level									2		13c;		2		2			2	
H3660	053	1	1	01	01	H3660_053_1	5	2	2														00000000001000	High A1C (over 8) Level									2		13c;		2		2			2	
H3660	053	1	1	01	01	H3660_053_1	5	1	2														00000000001111	Hip Replacement	Knee Replacement	Femur Fracture	Falls or History of Falls		2	2			2		14c;		2		2			2	
H3660	053	2	1	01	01	H3660_053_2	5	2	2														00000000001000	High A1C (over 8) Level									2		13c;		2		2			2	
H3660	053	2	1	01	01	H3660_053_2	5	1	2														00000000001111	Hip Replacement	Knee Replacement	Femur Fracture	Falls or History of Falls		2	2			2		14c;		2		2			2	
H3660	801	0	1	01	01	H3660_801_0	5	1	2														00000000001111	Hip Replacement	Knee Replacement	Femur Fracture	Falls or History of Falls		2	2			2		14c;		2		2			2	
H3660	801	0	1	01	01	H3660_801_0	5	2	2														00000000001000	High A1C (over 8) Levels									2		13c;		2		2			2	
H3660	805	0	1	02	01	H3660_805_0	5	1	2														00000000001111	Hip Replacement	Knee Replacement	Femur Fracture	Falls or History of Falls		2	2			2		14c;	2	2		2			2	
H3660	805	0	1	02	01	H3660_805_0	5	2	2														00000000001000	High A1C (over 8) Levels									2		13c;	2	2		2			2	
H3706	024	0	1	01	01	H3706_024_0	8	1	3								00001101000000000000																2		13i;		2		2			2	
H3706	025	0	1	01	01	H3706_025_0	9	1	3								00001101000000000000																2		13i;		2		2			2	
H3748	801	0	1	01	01	H3748_801_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H3748	802	0	1	01	01	H3748_802_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H3794	002	0	1	01	01	H3794_002_0	5	1	1	10				01111	30223	25690																	2		13d;		1	13d;	2			2	
H3800	001	0	1	01	01	H3800_001_0	18	1	3								01111111111111110000																2		13i;14c;		2		2			2	
H3800	002	0	1	01	01	H3800_002_0	20	1	3								01111111111111110000																2		13i;14c;		2		2			2	
H3815	001	0	1	01	01	H3815_001_0	4	1	3								01111111111111110000																2		13i;13i-O;		2		2			2	
H3815	006	0	1	01	01	H3815_006_0	3	1	3								01111111111111110000																2		13i-O;		2		2			2	
H3815	007	0	1	01	01	H3815_007_0	3	1	3								01111111111111100000																2		13i-O;		2		2			2	
H3815	008	0	1	01	01	H3815_008_0	3	1	3								01111111111111110000																2		13i;13i-O;		2		2			2	
H3815	009	0	1	01	01	H3815_009_0	4	1	3								01111111111111110000																2		13i;		2		2			2	
H3815	010	0	1	01	01	H3815_010_0	3	1	3								01111111111111110000																2		13i;13i-O;		2		2			2	
H3815	011	0	1	01	01	H3815_011_0	3	1	3								01111111111111110000																2		13i;13i-O;		2		2			2	
H3815	015	0	1	01	01	H3815_015_0	3	1	3								01111111111111110000																2		13i;13i-O;		2		2			2	
H3815	016	0	1	01	01	H3815_016_0	4	1	3								01111111111111110000																2		13i;13i-O;		2		2			2	
H3815	018	0	1	01	01	H3815_018_0	3	1	3								01111111111111110000																2		13i;13i-O;		2		2			2	
H3815	025	0	1	01	01	H3815_025_0	3	1	3								01111111111111110000																2		13i;13i-O;		2		2			2	
H3815	026	0	1	01	01	H3815_026_0	5	1	3								01111111111111110000																2		13i;13i-O;		2		2			2	
H3815	027	0	1	01	01	H3815_027_0	5	1	3								01111111111111110000																2		13i;13i-O;		2		2			2	
H3815	028	0	1	01	01	H3815_028_0	3	1	3								01111111111111110000																2		13i-O;		2		2			2	
H3815	029	0	1	01	01	H3815_029_0	3	1	3								01111111111111110000																2		13i-O;		2		2			2	
H3815	030	0	1	01	01	H3815_030_0	4	1	3								01111111111111110000																2		13i;13i-O;		2		2			2	
H3815	031	0	1	01	01	H3815_031_0	3	1	3								01111111111111110000																2		13i-O;		2		2			2	
H3815	033	0	1	01	01	H3815_033_0	5	1	3								01111111111111110000																2		13i;13i-O;		2		2			2	
H3815	034	0	1	01	01	H3815_034_0	3	1	3								01111111111111110000																2		13i;		2		2			2	
H3817	008	1	1	04	01	H3817_008_1	7	1	2														01000000000000										2		7f;	1	2		2			2	
H3817	008	1	1	04	01	H3817_008_1	7	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H3817	008	1	1	04	01	H3817_008_1	7	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H3817	008	2	1	04	01	H3817_008_2	7	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H3817	008	2	1	04	01	H3817_008_2	7	1	2														01000000000000										2		7f;	1	2		2			2	
H3817	008	2	1	04	01	H3817_008_2	7	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H3817	009	1	1	04	01	H3817_009_1	7	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H3817	009	1	1	04	01	H3817_009_1	7	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H3817	009	1	1	04	01	H3817_009_1	7	1	2														01000000000000										2		7f;	1	2		2			2	
H3817	009	2	1	04	01	H3817_009_2	7	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H3817	009	2	1	04	01	H3817_009_2	7	1	2														01000000000000										2		7f;	1	2		2			2	
H3817	009	2	1	04	01	H3817_009_2	7	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H3817	010	0	1	04	01	H3817_010_0	4	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H3817	010	0	1	04	01	H3817_010_0	4	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H3817	010	0	1	04	01	H3817_010_0	4	1	2														01000000000000										2		7f;	1	2		2			2	
H3817	011	1	1	04	01	H3817_011_1	7	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H3817	011	1	1	04	01	H3817_011_1	7	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H3817	011	1	1	04	01	H3817_011_1	7	1	2														01000000000000										2		7f;	1	2		2			2	
H3817	011	2	1	04	01	H3817_011_2	7	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H3817	011	2	1	04	01	H3817_011_2	7	1	2														01000000000000										2		7f;	1	2		2			2	
H3817	011	2	1	04	01	H3817_011_2	7	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H3817	801	0	1	04	01	H3817_801_0	4	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H3817	801	0	1	04	01	H3817_801_0	4	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H3817	801	0	1	04	01	H3817_801_0	4	1	2														01000000000000										2		7f;	1	2		2			2	
H3817	802	0	1	04	01	H3817_802_0	4	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H3817	802	0	1	04	01	H3817_802_0	4	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H3817	802	0	1	04	01	H3817_802_0	4	1	2														01000000000000										2		7f;	1	2		2			2	
H3817	803	0	1	04	01	H3817_803_0	4	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H3817	803	0	1	04	01	H3817_803_0	4	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H3817	803	0	1	04	01	H3817_803_0	4	1	2														01000000000000										2		7f;	1	2		2			2	
H3817	804	0	1	04	01	H3817_804_0	4	1	2														01000000000000										2		7f;	1	2		2			2	
H3817	804	0	1	04	01	H3817_804_0	4	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H3817	804	0	1	04	01	H3817_804_0	4	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H3832	011	0	1	04	01	H3832_011_0	11	2	2														00000000001110	Oral Cancer	Sjorgens	Head and Neck Cancer			2	2			2		16a;16b;	1	2		2			2	
H3832	011	0	1	04	01	H3832_011_0	11	1	2														01001010001000	Pregnancy					2	2			2		16a;16b;	1	2		2			2	
H3864	043	0	1	01	01	H3864_043_0	7	1	3								00001101000010000000																2		13i;		2		2			2	
H3907	002	0	1	01	01	H3907_002_0	6	1	2														01110000000000						1				2		13c;		1	13c;	2			2	
H3907	006	0	1	01	01	H3907_006_0	6	1	2														01110000000000						1				2		13c;		1	13c;	2			2	
H3907	029	0	1	01	01	H3907_029_0	7	1	2														01110000000000						1				2		13c;		1	13c;	2			2	
H3907	037	0	1	01	01	H3907_037_0	7	1	2														01110000000000						1				2		13c;		1	13c;	2			2	
H3907	045	0	1	01	01	H3907_045_0	7	1	2														01110000000000						1				2		13c;		1	13c;	2			2	
H3907	046	0	1	01	01	H3907_046_0	7	1	2														01110000000000						1				2		13c;		1	13c;	2			2	
H3907	049	0	1	01	01	H3907_049_0	7	1	2														01110000000000						1				2		13c;		1	13c;	2			2	
H3907	050	0	1	01	01	H3907_050_0	7	1	2														01110000000000						1				2		13c;		1	13c;	2			2	
H3907	051	0	1	01	01	H3907_051_0	7	1	2														01110000000000						1				2		13c;		1	13c;	2			2	
H3907	052	0	1	01	01	H3907_052_0	7	1	2														01110000000000						1				2		13c;		1	13c;	2			2	
H3907	053	0	1	01	01	H3907_053_0	5	1	2														01110000000000						1				2		13c;		1	13c;	2			2	
H3907	054	0	1	01	01	H3907_054_0	6	1	2														01110000000000						1				2		13c;		1	13c;	2			2	
H3907	055	0	1	01	01	H3907_055_0	6	1	2														01110000000000						1				2		13c;		1	13c;	2			2	
H3907	056	0	1	01	01	H3907_056_0	6	1	2														01110000000000						1				2		13c;		1	13c;	2			2	
H3909	001	0	1	04	01	H3909_001_0	3	1	3								00000001000000001000	Depression															2		13i;	1	2		2			2	
H3909	007	0	1	04	01	H3909_007_0	2	1	3								00000001000000001000	Depression															2		13i;	1	2		2			2	
H3909	009	0	1	04	01	H3909_009_0	2	1	3								00000001000000001000	Depression															2		13i;	1	2		2			2	
H3909	014	0	1	04	01	H3909_014_0	2	1	3								00000001000000001000	Depression															2		13i;	1	2		2			2	
H3909	015	0	1	04	01	H3909_015_0	3	1	3								00000001000000001000	Depression															2		13i;	1	2		2			2	
H3909	017	0	1	04	01	H3909_017_0	3	1	3								00000001000000001000	Depression															2		13i;	1	2		2			2	
H3916	001	0	1	04	01	H3916_001_0	6	1	3								00011110010010010000																2		14c;	1	2		2			2	
H3916	005	0	1	04	01	H3916_005_0	6	1	3								00001101000010000000																2		13d;	1	2		2			2	
H3916	012	0	1	04	01	H3916_012_0	5	1	3								00000001000000000000																2		13d;	1	2		2			2	
H3916	015	0	1	04	01	H3916_015_0	6	1	3								00001101000010000000																2		13d;	1	2		2			2	
H3916	022	0	1	04	01	H3916_022_0	6	1	3								00011110010010010000																2		14c;	1	2		2			2	
H3923	013	0	1	04	01	H3923_013_0	5	1	3								00001101000010000000																2		13i;	1	1	13i;	2			1	240.00
H3923	017	0	1	04	01	H3923_017_0	4	1	3								00001101000010000000																2		13i;	1	1	13i;	2			1	240.00
H3923	028	0	1	04	01	H3923_028_0	7	1	3								00001101000010000000																2		13i;	1	2		2			1	240.00
H3924	059	21	1	04	01	H3924_059_21	5	1	3								01111111111111110000																1	001	13c;13i;14c;	1	2		2			1	1000.00
H3924	059	22	1	04	01	H3924_059_22	5	1	3								01111111111111110000																1	001	13c;13i;14c;	1	2		2			1	1000.00
H3924	062	21	1	04	01	H3924_062_21	5	1	3								01111111111111110000																1	001	13c;13i;14c;	1	2		2			1	1000.00
H3924	062	22	1	04	01	H3924_062_22	5	1	3								01111111111111110000																1	001	13c;13i;14c;	1	2		2			1	1000.00
H3924	062	23	1	04	01	H3924_062_23	5	1	3								01111111111111110000																1	001	13c;13i;14c;	1	2		2			1	1000.00
H3924	065	0	1	04	01	H3924_065_0	5	1	3								01111111111111110000																1	001	13c;13i;14c;	1	2		2			1	1000.00
H3924	066	0	1	04	01	H3924_066_0	5	1	3								01111111111111110000																1	001	13c;13i;14c;	1	2		2			1	1000.00
H3928	801	0	1	01	01	H3928_801_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H3928	803	0	1	01	01	H3928_803_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H3931	004	0	1	01	01	H3931_004_0	2	1	1	01	0001000000				9901	4950																	1	001	10b;13b;13c;13d;13i;		1	10b;13b;13c;13d;13i;	2			2	
H3931	064	0	1	02	01	H3931_064_0	2	1	3								00001100000000000000																1	001	14c;	1	1	14c;	2			2	
H3931	801	0	1	01	01	H3931_801_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H3931	804	0	1	01	01	H3931_804_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H3949	024	0	1	01	01	H3949_024_0	4	1	3								00000001000000000000																1	001	13i;		2		2			2	
H3952	008	0	1	01	01	H3952_008_0	2	1	3								00010001000000001100	Depression	Congestive Heart Failure														2		13i;		2		2			2	
H3952	008	0	1	01	01	H3952_008_0	2	2	2														01010000000000						1				2		10b;		2		2			2	
H3952	020	0	1	01	01	H3952_020_0	4	1	3								00010001000000001100	Depression	Congestive Heart Failure														2		13i;		2		2			2	
H3952	020	0	1	01	01	H3952_020_0	4	2	2														01010000000000						1				2		10b;		2		2			2	
H3952	044	0	1	01	01	H3952_044_0	4	1	3								00010001000000001100	Depression	Congestive Heart Failure														2		13i;		2		2			2	
H3952	044	0	1	01	01	H3952_044_0	4	2	2														01010000000000						1				2		10b;		2		2			2	
H3952	045	0	1	01	01	H3952_045_0	3	2	2														01010000000000						1				2		10b;		2		2			2	
H3952	045	0	1	01	01	H3952_045_0	3	1	3								00010001000000001100	Depression	Congestive Heart Failure														2		13i;		2		2			2	
H3952	048	0	1	01	01	H3952_048_0	1	1	3								00010001000000001100	Depression	Congestive Heart Failure														2		13i;		2		2			2	
H3952	048	0	1	01	01	H3952_048_0	1	2	2														01010000000000						1				2		10b;		2		2			2	
H3952	049	0	1	01	01	H3952_049_0	2	1	3								00010001000000001100	Depression	Congestive Heart Failure														2		13i;		2		2			2	
H3952	049	0	1	01	01	H3952_049_0	2	2	2														01010000000000						1				2		10b;		2		2			2	
H3952	050	0	1	01	01	H3952_050_0	3	1	3								00010001000000001100	Depression	Congestive Heart Failure														2		13i;		2		2			2	
H3952	050	0	1	01	01	H3952_050_0	3	2	2														01010000000000						1				2		10b;		2		2			2	
H3952	051	0	1	01	01	H3952_051_0	2	2	2														01010000000000						1				2		10b;		2		2			2	
H3952	051	0	1	01	01	H3952_051_0	2	1	3								00010001000000001100	Depression	Congestive Heart Failure														2		13i;		2		2			2	
H3952	053	0	1	02	01	H3952_053_0	3	1	3								00010001000000001100	Depression	Congestive Heart Failure														2		13i;	2	2		2			2	
H3952	053	0	1	02	01	H3952_053_0	3	2	2														01000000000000										2		13b;	2	2		2			2	
H3952	054	0	1	02	01	H3952_054_0	2	1	3								00010001000000001100	Depression	Congestive Heart Failure														2		13i;	2	2		2			2	
H3952	054	0	1	02	01	H3952_054_0	2	2	2														01000000000000										2		13b;	2	2		2			2	
H3952	055	0	1	01	01	H3952_055_0	2	1	3								00010001000000001100	Depression	Congestive Heart Failure														2		13i;		2		2			2	
H3952	055	0	1	01	01	H3952_055_0	2	2	2														01010000000000						1				2		10b;		2		2			2	
H3952	056	0	1	01	01	H3952_056_0	3	1	3								00010001000000001100	Depression	Congestive Heart Failure														2		13i;		2		2			2	
H3952	056	0	1	01	01	H3952_056_0	3	2	2														01010000000000						1				2		10b;		2		2			2	
H3954	097	0	1	01	01	H3954_097_0	7	1	3								01111111111111110000																1	001	13c;13i;14c;		2		2			1	3000.00
H3954	156	21	1	01	01	H3954_156_21	5	1	3								01111111111111110000																1	001	13c;13i;14c;		2		2			1	1000.00
H3954	156	22	1	01	01	H3954_156_22	5	1	3								01111111111111110000																1	001	13c;13i;14c;		2		2			1	1000.00
H3954	156	23	1	01	01	H3954_156_23	5	1	3								01111111111111110000																1	001	13c;13i;14c;		2		2			1	1000.00
H3954	157	21	1	01	01	H3954_157_21	5	1	3								01111111111111110000																1	001	13c;13i;14c;		2		2			1	1000.00
H3954	157	22	1	01	01	H3954_157_22	5	1	3								01111111111111110000																1	001	13c;13i;14c;		2		2			1	1000.00
H3954	157	23	1	01	01	H3954_157_23	5	1	3								01111111111111110000																1	001	13c;13i;14c;		2		2			1	1000.00
H3954	158	13	1	01	01	H3954_158_13	5	1	3								01111111111111110000																1	001	13c;13i;14c;		2		2			1	1000.00
H3954	158	14	1	01	01	H3954_158_14	5	1	3								01111111111111110000																1	001	13c;13i;14c;		2		2			1	1000.00
H3954	160	0	1	01	01	H3954_160_0	5	1	3								01111111111111110000																1	001	13c;13i;14c;		2		2			1	1000.00
H3954	161	0	1	01	01	H3954_161_0	5	1	3								01111111111111110000																1	001	13c;13i;14c;		2		2			1	1000.00
H3957	031	0	1	02	01	H3957_031_0	7	1	1	01	0110000000	2	2		4900	4900																	1	010	10b;16b;	2	2		2			2	
H3957	042	1	1	01	01	H3957_042_1	6	1	3								00000001000000000000																2		13d;		2		2			2	
H3957	042	2	1	01	01	H3957_042_2	6	1	3								00000001000000000000																2		13d;		2		2			2	
H3957	042	4	1	01	01	H3957_042_4	6	1	3								00000001000000000000																2		13d;		2		2			2	
H3957	042	5	1	01	01	H3957_042_5	6	1	3								00000001000000000000																2		13d;		2		2			2	
H3957	043	1	1	02	01	H3957_043_1	5	1	3								00001101000010000000																2		13d;	2	2		2			2	
H3957	043	2	1	02	01	H3957_043_2	5	1	3								00001101000010000000																2		13d;	2	2		2			2	
H3957	044	1	1	02	01	H3957_044_1	6	1	3								00001101000010000000																2		13d;	2	2		2			2	
H3957	045	1	1	02	01	H3957_045_1	6	1	3								00011111010010010000																2		13d;14c;	2	2		2			2	
H3957	045	2	1	02	01	H3957_045_2	6	1	3								00001101000010000000																2		13d;	2	2		2			2	
H3957	046	1	1	02	01	H3957_046_1	6	1	3								00011111010010010000																2		13d;14c;	2	2		2			2	
H3957	046	2	1	02	01	H3957_046_2	6	1	3								00001101000010000000																2		13d;	2	2		2			2	
H3959	001	0	1	01	01	H3959_001_0	3	1	1	01	0001000000				9901	4950																	1	001	10b;13b;13c;13d;		1	10b;13b;13c;13d;	2			2	
H3959	002	0	1	01	01	H3959_002_0	3	1	1	01	0001000000				9901	4950																	1	001	10b;13b;13c;13d;		1	10b;13b;13c;13d;	2			2	
H3959	010	0	1	01	01	H3959_010_0	3	1	2														00000100001000	Hyperlipidemia					2	2			2		10b;13b;		1	10b;13b;	2			2	
H3959	010	0	1	01	01	H3959_010_0	3	2	3								00001100000000000000																1	001	14c;		1	14c;	2			2	
H3959	011	0	1	01	01	H3959_011_0	3	1	3								00001100000000000000																1	001	14c;		1	14c;	2			2	
H3959	032	0	1	02	01	H3959_032_0	2	1	3								01111111111111111100	hyperlipidemia	hypertension														1	001	13i;14c;	1	1	13i;14c;	2			2	
H3959	032	0	1	02	01	H3959_032_0	2	2	2														00000100001000	Hyperlipidemia					2	2			2		10b;13b;	1	1	10b;13b;	2			2	
H3959	035	0	1	01	01	H3959_035_0	3	1	1	10				01111	137895	137895																	2		13i;13i-O;14c;		1	13i;13i-O;14c;	2			2	
H3959	035	0	1	01	01	H3959_035_0	3	2	3								00001100000000000000																1	001	14c;		1	14c;	2			2	
H3959	036	0	1	01	01	H3959_036_0	3	1	1	10				01111	137895	137895																	2		13i;13i-O;14c;		1	13i;13i-O;14c;	2			2	
H3959	037	0	1	02	01	H3959_037_0	3	1	3								00001100000000000000																1	001	14c;	1	1	14c;	2			2	
H3959	039	0	1	02	01	H3959_039_0	2	1	1	01	0001000000				9901	4950																	1	001	10b;13b;13c;13d;13i;	1	1	10b;13b;13c;13d;13i;	2			2	
H3959	041	0	1	01	01	H3959_041_0	2	1	3								01111111111111111100	Hyperlipidemia	Hypertension														2		13i;		1	13i;	2			2	
H3959	046	0	1	01	01	H3959_046_0	3	1	2														00000100001000	Hyperlipidemia					2	2			2		10b;13b;		1	10b;13b;	2			2	
H3959	046	0	1	01	01	H3959_046_0	3	2	3								00111111111110111100	Hyperlipidemia	Hypertension														1	001	10b;13b;14c;		1	10b;13b;14c;	2			2	
H3959	047	0	1	01	01	H3959_047_0	3	2	3								00111111111110111100	Hyperlipidemia	Hypertension														1	001	10b;13b;14c;		1	10b;13b;14c;	2			2	
H3959	047	0	1	01	01	H3959_047_0	3	1	2														00000100001000	Hyperlipidemia					2	2			2		10b;13b;		1	10b;13b;	2			2	
H3959	049	0	1	01	01	H3959_049_0	3	2	3								00111111111110111100	Hyperlipidemia	Hypertension														1	001	10b;13b;14c;		1	10b;13b;14c;	2			2	
H3959	049	0	1	01	01	H3959_049_0	3	1	2														00000100001000	Hyperlipidemia					2	2			2		10b;13b;		1	10b;13b;	2			2	
H3959	051	0	1	01	01	H3959_051_0	3	1	3								01111111111111111100	Hyperlipidemia	Hypertension														2		13i;		1	13i;	2			2	
H3959	052	0	1	01	01	H3959_052_0	2	1	3								00001100000000000000																1	001	14c;		1	14c;	2			2	
H3959	053	0	1	01	01	H3959_053_0	3	1	3								01111111111111111100	Hyperlipidemia	Hypertension														2		13i;		1	13i;	2			2	
H3959	063	0	1	01	01	H3959_063_0	5	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H3959	803	0	1	01	01	H3959_803_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H3959	804	0	1	01	01	H3959_804_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H3962	001	0	1	01	01	H3962_001_0	4	1	3								00001101000010000000																2		13i;		2		2			1	240.00
H3962	004	0	1	01	01	H3962_004_0	4	1	3								00001101000010000000																2		13i;		2		2			1	240.00
H3962	007	0	1	01	01	H3962_007_0	4	1	3								00001101000010000000																2		13i;		2		2			1	240.00
H3975	002	0	1	04	01	H3975_002_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			2	
H4003	009	0	1	01	01	H4003_009_0	9	2	1	01	0100000000				185	92																	2		13d;		2		2			2	
H4003	009	0	1	01	01	H4003_009_0	9	1	3								01111111111111110000																2		13b;13i;13i-O;14c;		2		2			1	50.00
H4003	017	0	1	01	01	H4003_017_0	9	2	3								01111111111111110000																2		13b;13i;13i-O;14c;		2		2			1	90.00
H4003	017	0	1	01	01	H4003_017_0	9	1	1	01	0100000000				1569	784																	2		13d;		2		2			2	
H4003	019	0	1	02	01	H4003_019_0	9	1	3								01111111111111110000																2		13i-O;	2	2		2			2	
H4003	034	0	1	02	01	H4003_034_0	9	1	3								01111111111111110000																2		13b;13i;13i-O;14c;	2	2		2			1	20.00
H4003	044	0	1	02	01	H4003_044_0	10	1	3								01111111111111110000																2		13i-O;	2	2		2			2	
H4003	047	0	1	01	01	H4003_047_0	11	2	3								01111111111111110000																2		13i-O;		2		2			2	
H4003	047	0	1	01	01	H4003_047_0	11	1	1	01	0100000000				476	238																	2		13d;		2		2			2	
H4003	049	0	1	01	01	H4003_049_0	10	1	1	01	0100000000				81	40																	2		13d;		2		2			2	
H4003	049	0	1	01	01	H4003_049_0	10	2	3								01111111111111110000																2		13i;13i-O;		2		2			2	
H4003	051	0	1	02	01	H4003_051_0	12	1	3								01111111111111110000																2		13b;13i;13i-O;14c;	2	2		2			1	60.00
H4003	052	0	1	01	01	H4003_052_0	8	2	1	01	0100000000				28	14																	2		13d;		2		2			2	
H4003	052	0	1	01	01	H4003_052_0	8	1	3								01111111111111110000																2		13b;13i;13i-O;14c;		2		2			1	110.00
H4004	048	0	1	01	01	H4004_048_0	11	1	1	01	0100000000				152	76																	2		13d;		2		2			2	
H4004	048	0	1	01	01	H4004_048_0	11	2	3								01111111111111110000																2		13b;13i;13i-O;14c;		2		2			1	50.00
H4004	056	0	1	02	01	H4004_056_0	11	1	3								01111111111111110000																2		13b;13i;13i-O;14c;	2	2		2			1	35.00
H4004	061	0	1	01	01	H4004_061_0	11	1	1	01	0100000000				486	243																	2		13d;		2		2			2	
H4004	061	0	1	01	01	H4004_061_0	11	2	3								01111111111111110000																2		13b;13i;13i-O;14c;		2		2			1	75.00
H4004	062	0	1	01	01	H4004_062_0	10	1	1	01	0100000000				23	11																	2		13d;		2		2			2	
H4004	062	0	1	01	01	H4004_062_0	10	2	3								01111111111111110000																2		13b;13i;13i-O;14c;		2		2			1	225.00
H4004	063	0	1	02	01	H4004_063_0	9	1	3								01111111111111110000																2		13b;13i;13i-O;14c;	2	2		2			1	100.00
H4004	064	0	1	02	01	H4004_064_0	9	1	3								01111111111111110000																2		13b;13i;13i-O;14c;	2	2		2			1	200.00
H4004	065	0	1	02	01	H4004_065_0	8	1	3								01111111111111110000																2		13b;13i;13i-O;14c;	2	2		2			1	60.00
H4005	001	0	1	04	01	H4005_001_0	7	1	3								01111111111111110000																2		13i;14c;	1	2		2			2	
H4007	012	0	1	01	01	H4007_012_0	7	2	2														10010000011111	Malignant Neoplasm	Leukemia	Chronic Kidney Disease (CKD) & End State Renal Disease (ESRD)	Hepatitis	Pressure Ulcer	2	2			2		13b;		2		2			1	1200.00
H4007	012	0	1	01	01	H4007_012_0	7	1	3								01111111111111110000																1	001	13i;		2		2			2	
H4007	016	0	1	01	01	H4007_016_0	7	1	2														10010000011111	Malignant Neoplasm	Leukemia	Chronic Kidney Disease (CKD) & End State Renal Disease (ESRD)	Hepatitis	Pressure Ulcer	2	2			2		13b;		2		2			1	2400.00
H4007	018	0	1	01	01	H4007_018_0	7	1	3								01111111111111110000																1	001	13i;		2		2			2	
H4007	021	0	1	01	01	H4007_021_0	6	1	3								01111111111111110000																1	001	13i;		2		2			2	
H4036	020	0	1	04	01	H4036_020_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;	1	2		2			2	
H4036	023	0	1	04	01	H4036_023_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;	1	2		2			2	
H4054	001	0	1	01	01	H4054_001_0	17	1	3								01111111111111110000																2		13i;14c;		2		2			2	
H4054	002	0	1	01	01	H4054_002_0	18	1	3								01111111111111110000																2		13i;14c;		2		2			2	
H4073	001	0	1	01	01	H4073_001_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H4073	002	0	1	01	01	H4073_002_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H4093	001	0	1	01	01	H4093_001_0	19	1	3								01111111111111110000																2		13i;14c;		2		2			2	
H4093	004	0	1	01	01	H4093_004_0	19	1	3								01111111111111110000																2		13i;14c;		2		2			2	
H4094	001	0	1	02	01	H4094_001_0	4	1	1	10				01111	1681	1429																	2		13d;	1	1	13d;	2			2	
H4141	003	0	1	01	01	H4141_003_0	4	1	1	10				01111	28750	28750																	2		13d;		1	13d;	2			1	900.00
H4141	003	0	1	01	01	H4141_003_0	4	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		1	13d;	2			2	
H4141	015	0	1	01	01	H4141_015_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H4141	017	3	1	01	01	H4141_017_3	3	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H4141	017	4	1	01	01	H4141_017_4	3	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H4152	005	0	1	01	01	H4152_005_0	10	1	3								00001001000000000000																2		16b;		2		2			2	
H4152	007	0	1	02	01	H4152_007_0	10	1	3								00001001000000000000																2		16b;	2	2		2			2	
H4152	013	0	1	01	01	H4152_013_0	10	1	3								00001001000000000000																2		16b;		2		2			2	
H4152	018	0	1	02	01	H4152_018_0	9	1	3								00001001000000000000																2		16b;	2	2		2			2	
H4152	020	0	1	02	01	H4152_020_0	11	1	3								00001001000000000000																2		16b;	2	2		2			2	
H4152	021	0	1	01	01	H4152_021_0	7	1	3								01111111111111111111	Nutritional Conditions (ex. Obesity, Nutrit. defic., Failure to Thrive)	Chronic Kidney Disease Stage 4 and above	Gout	Arthropathy												1	001	13i;16b;		2		2			2	
H4213	016	1	1	09	04	H4213_016_1	3	1	3								00010001000000011100	Coronary artery disease	Sjgrens Syndrome														2		16a;16b;		2		2			2	
H4213	016	3	1	09	04	H4213_016_3	3	1	3								00010001000000011100	Coronary artery disease	Sjgrens Syndrome														2		16a;16b;		2		2			2	
H4213	016	4	1	09	04	H4213_016_4	3	1	3								00010001000000011100	Coronary artery disease	Sjgrens Syndrome														2		16a;16b;		2		2			2	
H4213	017	1	1	09	04	H4213_017_1	5	1	3								00010001000000011100	Coronary artery disease	Sjgrens Syndrome														2		16a;16b;		2		2			2	
H4213	017	5	1	09	04	H4213_017_5	5	1	3								00010001000000011100	Coronary artery disease	Sjgrens Syndrome														2		16a;16b;		2		2			2	
H4213	017	6	1	09	04	H4213_017_6	5	1	3								00010001000000011100	Coronary artery disease	Sjgrens Syndrome														2		16a;16b;		2		2			2	
H4232	002	0	1	01	01	H4232_002_0	2	1	3								01111111111111110000																1	001	13i;		1	13i;	2			2	
H4279	001	0	1	01	01	H4279_001_0	7	1	3								00000001000000000000																2		13i;		2		2			2	
H4286	002	0	1	01	01	H4286_002_0	9	1	3								00000101000010000000																1	001	13c;		2		2			2	
H4304	001	0	1	04	01	H4304_001_0	7	1	3								00000000000000001000	Fall Risk or Diagnosis of Fall Risk															2		14c;	1	2		2			2	
H4343	001	0	1	01	01	H4343_001_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H4343	002	0	1	01	01	H4343_002_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H4343	003	0	1	01	01	H4343_003_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	2700.00
H4343	004	0	1	01	01	H4343_004_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	2700.00
H4343	005	0	1	01	01	H4343_005_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	2700.00
H4343	006	0	1	01	01	H4343_006_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	2700.00
H4346	001	0	1	01	01	H4346_001_0	7	1	3								01111111111111111000	Plan approved Chronic Conditions															2		13i;		2		2			2	
H4346	005	0	1	01	01	H4346_005_0	6	1	3								01111111111111111000	Plan approved Chronic Conditions															2		13i;		2		2			2	
H4346	006	0	1	01	01	H4346_006_0	6	1	3								01111111111111111000	Plan approved Chronic Conditions															2		13i;		2		2			2	
H4346	008	0	1	01	01	H4346_008_0	6	1	3								01111111111111111000	Plan approved Chronic Conditions															2		13i;		2		2			2	
H4346	017	0	1	01	01	H4346_017_0	9	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H4346	022	0	1	01	01	H4346_022_0	9	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H4407	004	0	1	01	01	H4407_004_0	5	1	3								00001001000000000000																2		13i;		2		2			2	
H4461	022	0	1	01	01	H4461_022_0	9	1	1	10				01111	18468	18468																	2		13d;		1	13d;	2			1	420.00
H4461	022	0	1	01	01	H4461_022_0	9	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	500.00
H4461	038	0	1	01	01	H4461_038_0	6	1	1	10				01111	2366	2366																	2		13d;		1	13d;	2			1	900.00
H4461	038	0	1	01	01	H4461_038_0	6	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	500.00
H4490	002	0	1	01	01	H4490_002_0	2	1	3								01111111111111110000																1	001	13i;		1	13i;	2			2	
H4490	003	0	1	01	01	H4490_003_0	2	1	3								01111111111111110000																1	001	13i;		1	13i;	2			2	
H4513	027	0	1	01	01	H4513_027_0	5	1	3								00001001000000000000																2		13i;		2		2			2	
H4513	029	0	1	01	01	H4513_029_0	6	1	3								00001001000000000000																2		13i;		2		2			2	
H4513	039	0	1	01	01	H4513_039_0	5	1	3								00001001000000000000																2		13i;		2		2			2	
H4513	055	0	1	01	01	H4513_055_0	4	1	3								00001001000000000000																2		13i;		2		2			2	
H4513	056	1	1	01	01	H4513_056_1	4	1	3								00001001000000000000																2		13i;		2		2			2	
H4513	060	1	1	01	01	H4513_060_1	4	1	3								00001001000000000000																2		13i;		2		2			2	
H4513	060	2	1	01	01	H4513_060_2	4	1	3								00001001000000000000																2		13i;		2		2			2	
H4513	060	3	1	01	01	H4513_060_3	4	1	3								00001001000000000000																2		13i;		2		2			2	
H4513	063	0	1	01	01	H4513_063_0	4	1	3								00001001000000000000																2		13i;		2		2			2	
H4514	013	1	1	01	01	H4514_013_1	5	1	1	10				01111	35022	29769																	2		13d;		1	13d;	2			2	
H4514	013	2	1	01	01	H4514_013_2	5	1	1	10				01111	6516	5539																	2		13d;		1	13d;	2			2	
H4514	013	3	1	01	01	H4514_013_3	5	1	1	10				01111	4159	3535																	2		13d;		1	13d;	2			2	
H4514	016	0	1	01	01	H4514_016_0	4	1	1	10				01111	2598	2208																	2		13d;		1	13d;	2			2	
H4523	801	0	1	01	01	H4523_801_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H4523	802	0	1	01	01	H4523_802_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H4527	003	0	1	01	01	H4527_003_0	4	1	1	10				01111	2241	1905																	2		13d;		1	13d;	2			2	
H4527	004	0	1	01	01	H4527_004_0	4	1	1	10				01111	380	323																	2		13d;		1	13d;	2			2	
H4527	006	0	1	01	01	H4527_006_0	4	1	1	10				01111	808	687																	2		13d;		1	13d;	2			2	
H4527	015	0	1	01	01	H4527_015_0	4	1	1	10				01111	11694	9940																	2		13d;		1	13d;	2			2	
H4590	020	0	1	01	01	H4590_020_0	4	1	1	10				01111	31120	26452																	2		13d;		1	13d;	2			2	
H4590	022	0	1	01	01	H4590_022_0	4	1	1	10				01111	20011	17009																	2		13d;		1	13d;	2			2	
H4590	033	0	1	01	01	H4590_033_0	4	1	1	10				01111	8457	7188																	2		13d;		1	13d;	2			2	
H4605	001	0	1	04	01	H4605_001_0	4	1	2														01000000000000										2		7f;	1	2		2			2	
H4605	001	0	1	04	01	H4605_001_0	4	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H4605	001	0	1	04	01	H4605_001_0	4	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H4605	002	0	1	04	01	H4605_002_0	7	1	2														01000000000000										2		7f;	1	2		2			2	
H4605	002	0	1	04	01	H4605_002_0	7	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H4605	002	0	1	04	01	H4605_002_0	7	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H4605	004	0	1	04	01	H4605_004_0	7	1	2														01000000000000										2		7f;	1	2		2			2	
H4605	004	0	1	04	01	H4605_004_0	7	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H4605	004	0	1	04	01	H4605_004_0	7	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H4605	007	0	1	04	01	H4605_007_0	7	1	2														01000000000000										2		7f;	1	2		2			2	
H4605	007	0	1	04	01	H4605_007_0	7	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H4605	007	0	1	04	01	H4605_007_0	7	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H4605	008	0	1	04	01	H4605_008_0	7	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H4605	008	0	1	04	01	H4605_008_0	7	1	2														01000000000000										2		7f;	1	2		2			2	
H4605	008	0	1	04	01	H4605_008_0	7	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H4605	009	0	1	04	01	H4605_009_0	7	1	2														01000000000000										2		7f;	1	2		2			2	
H4605	009	0	1	04	01	H4605_009_0	7	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H4605	009	0	1	04	01	H4605_009_0	7	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H4605	801	0	1	04	01	H4605_801_0	4	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H4605	801	0	1	04	01	H4605_801_0	4	1	2														01000000000000										2		7f;	1	2		2			2	
H4605	801	0	1	04	01	H4605_801_0	4	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H4605	802	0	1	04	01	H4605_802_0	4	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H4605	802	0	1	04	01	H4605_802_0	4	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H4605	802	0	1	04	01	H4605_802_0	4	1	2														01000000000000										2		7f;	1	2		2			2	
H4605	803	0	1	04	01	H4605_803_0	4	1	2														01000000000000										2		7f;	1	2		2			2	
H4605	803	0	1	04	01	H4605_803_0	4	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H4605	803	0	1	04	01	H4605_803_0	4	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H4605	804	0	1	04	01	H4605_804_0	4	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H4605	804	0	1	04	01	H4605_804_0	4	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H4605	804	0	1	04	01	H4605_804_0	4	1	2														01000000000000										2		7f;	1	2		2			2	
H4623	002	0	1	01	01	H4623_002_0	7	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H4624	001	0	1	01	01	H4624_001_0	8	1	3								01111111111111110000																2		13i;		2		2			2	
H4624	002	0	1	02	01	H4624_002_0	8	1	3								01111111111111110000																2		13i;	2	2		2			2	
H4624	003	0	1	01	01	H4624_003_0	8	1	3								01111111111111110000																2		13i;		2		2			2	
H4624	006	0	1	01	01	H4624_006_0	8	1	3								01111111111111110000																2		13i;		2		2			2	
H4624	007	0	1	02	01	H4624_007_0	8	1	3								01111111111111110000																2		13i;	2	2		2			2	
H4624	010	0	1	01	01	H4624_010_0	8	1	3								01111111111111110000																2		13i;		2		2			2	
H4624	011	0	1	01	01	H4624_011_0	8	1	3								01111111111111110000																2		13i;		2		2			2	
H4624	012	0	1	01	01	H4624_012_0	8	1	3								01111111111111110000																2		13i;		2		2			2	
H4624	015	0	1	02	01	H4624_015_0	8	1	3								01111111111111110000																2		13i;	2	2		2			2	
H4624	016	0	1	02	01	H4624_016_0	9	1	3								01111111111111110000																1	001	13i;	2	2		2			2	
H4624	017	0	1	02	01	H4624_017_0	8	1	3								01111111111111110000																2		13i;	2	2		2			2	
H4624	018	0	1	02	01	H4624_018_0	9	1	3								01111111111111110000																2		13i;	2	2		2			2	
H4624	019	0	1	01	01	H4624_019_0	8	1	3								01111111111111110000																2		13i;		2		2			2	
H4675	001	0	1	01	01	H4675_001_0	6	1	3								00001101000000000000																1	001	13i;		1	13i;	2			2	
H4676	002	0	1	01	01	H4676_002_0	7	1	3								11111111111111111111	Morbid obesity	Malnutrition	Chronic skin ulcers, includes pressure	Limb Amputations	Major infections											2		13i;		2		1	2	13i;	1	420.00
H4699	003	0	1	04	01	H4699_003_0	6	1	3								01111111111111110000																1	001	13i;	1	1	13i;	1	2	13i;	1	1200.00
H4699	004	0	1	04	01	H4699_004_0	6	1	3								01111111111111110000																1	001	13i;	1	1	13i;	1	2	13i;	1	600.00
H4699	005	0	1	04	01	H4699_005_0	6	1	3								01111111111111110000																1	001	13i;	1	1	13i;	1	2	13i;	1	1500.00
H4709	027	0	1	01	01	H4709_027_0	5	1	3								00001100000000001000	Kidney Disease															1	001	13b;		2		2			2	
H4709	031	0	1	01	01	H4709_031_0	5	1	3								00001111000001001000	Kidney Disease															1	001	13b;13i;		2		2			2	
H4709	033	0	1	01	01	H4709_033_0	5	1	3								00001100000000001000	Kidney Disease															1	001	13b;		2		2			2	
H4709	037	0	1	01	01	H4709_037_0	5	1	3								00001100000000001000	Kidney Disease															1	001	13b;		2		2			2	
H4709	039	0	1	01	01	H4709_039_0	5	1	3								00001111000001001000	Kidney Disease															1	001	13b;13i;		2		2			2	
H4709	040	0	1	02	01	H4709_040_0	6	1	3								00001111000001000000																1	001	13i;	2	2		2			2	
H4711	011	0	1	01	01	H4711_011_0	5	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H4711	012	0	1	01	01	H4711_012_0	3	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H4711	013	0	1	01	01	H4711_013_0	6	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H4711	801	0	1	01	01	H4711_801_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H4711	802	0	1	01	01	H4711_802_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H4835	801	0	1	01	01	H4835_801_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H4835	802	0	1	01	01	H4835_802_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H4847	004	0	1	01	01	H4847_004_0	4	1	3								01111111111111110000																1	001	13b;13d;13i;14c;		1	13b;13d;13i;14c;	2			1	400.00
H4853	002	0	1	01	01	H4853_002_0	6	1	3								00001111000001001000	Kidney Disease															1	001	13i;		2		2			2	
H4853	016	0	1	01	01	H4853_016_0	6	1	3								00001100000000001000	Kidney Disease															1	001	13b;		2		2			2	
H4853	017	0	1	01	01	H4853_017_0	7	1	3								00001111000001001000	Kidney Disease															1	001	13b;13i;		2		2			2	
H4853	018	0	1	01	01	H4853_018_0	6	1	3								00001111000001001000	Kidney Disease															1	001	13i;		2		2			2	
H4853	020	0	1	01	01	H4853_020_0	6	1	3								00001111000001001000	Kidney Disease															1	001	13b;13i;		2		2			2	
H4868	004	0	1	01	01	H4868_004_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	2			1	600.00
H4868	014	0	1	01	01	H4868_014_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	2			1	600.00
H4875	022	1	1	04	01	H4875_022_1	9	1	3								01111111111111110000																2		13i;	1	1	13i;	2			1	10.00
H4875	022	2	1	04	01	H4875_022_2	9	1	3								01111111111111110000																2		13i;	1	1	13i;	2			1	10.00
H4875	022	5	1	04	01	H4875_022_5	9	1	3								01111111111111110000																2		13i;	1	1	13i;	2			1	10.00
H4909	016	0	1	04	01	H4909_016_0	8	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;	1	2		2			2	
H4909	018	0	1	04	01	H4909_018_0	6	2	1	10				01111	2042	2042																	2		13i;	1	2		2			2	
H4909	018	0	1	04	01	H4909_018_0	6	1	1	10				01111	2042	2042																	2		13i;	1	2		2			2	
H4909	022	0	1	04	01	H4909_022_0	12	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;	1	2		2			2	
H4909	024	0	1	04	01	H4909_024_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;	1	2		2			2	
H4909	025	0	1	04	01	H4909_025_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;	1	2		2			2	
H4909	026	0	1	04	01	H4909_026_0	6	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;	1	1	13i;	2			2	
H4931	001	0	1	01	01	H4931_001_0	11	3	3								01111111111111111000	MSK															2		13i;		2		2			1	75.00
H4931	001	0	1	01	01	H4931_001_0	11	2	1	01	1000000000				40	20																	2		13d;13i;		2		2			1	2300.00
H4931	001	0	1	01	01	H4931_001_0	11	1	1	01	0100000000				250	210																	1	101	13d;		2		2			2	
H4931	006	0	1	01	01	H4931_006_0	13	1	1	01	0100000000				250	210																	1	101	13d;		2		2			2	
H4931	006	0	1	01	01	H4931_006_0	13	3	3								01111111111111111000	MSK															2		13i;		2		2			1	75.00
H4931	006	0	1	01	01	H4931_006_0	13	2	1	01	1000000000				80	40																	2		13d;13i;		2		2			1	2300.00
H4931	007	0	1	01	01	H4931_007_0	12	1	1	01	0100000000				250	210																	1	101	13d;		2		2			2	
H4931	007	0	1	01	01	H4931_007_0	12	3	3								01111111111111111000	MSK															2		13i;		2		2			1	75.00
H4931	007	0	1	01	01	H4931_007_0	12	2	1	01	1000000000				40	20																	2		13d;13i;		2		2			1	2300.00
H4931	008	0	1	01	01	H4931_008_0	12	3	3								01111111111111111000	MSK															2		13i;		2		2			1	75.00
H4931	008	0	1	01	01	H4931_008_0	12	1	1	01	0100000000				460	410																	1	101	13d;		2		2			2	
H4931	008	0	1	01	01	H4931_008_0	12	2	1	01	1000000000				85	45																	2		13d;13i;		2		2			1	2300.00
H4931	013	0	1	01	01	H4931_013_0	12	2	1	01	1000000000				270	225																	2		13d;		2		2			2	
H4931	013	0	1	01	01	H4931_013_0	12	1	1	01	0100000000				110	90																	1	101	13d;		2		2			2	
H4931	013	0	1	01	01	H4931_013_0	12	3	3								01111111111111111000	MSK															2		13i;		2		2			1	75.00
H4931	013	0	1	01	01	H4931_013_0	12	4	1	01	0000000001				270	225																	2		13i;		2		2			2	
H4931	014	0	1	01	01	H4931_014_0	12	2	1	01	1000000000				30	10																	2		13d;		2		2			2	
H4931	014	0	1	01	01	H4931_014_0	12	3	3								01111111111111111000	MSK															2		13i;		2		2			1	75.00
H4931	014	0	1	01	01	H4931_014_0	12	4	1	01	0000000001				600	505																	2		13i;		2		2			2	
H4931	014	0	1	01	01	H4931_014_0	12	1	1	01	0100000000				220	200																	1	101	13d;		2		2			2	
H4931	015	0	1	01	01	H4931_015_0	12	2	1	01	1000000000				30	10																	2		13d;		2		2			2	
H4931	015	0	1	01	01	H4931_015_0	12	3	3								01111111111111111000	MSK															2		13i;		2		2			1	75.00
H4931	015	0	1	01	01	H4931_015_0	12	4	1	01	0000000001				700	590																	2		13i;		2		2			2	
H4931	015	0	1	01	01	H4931_015_0	12	1	1	01	0100000000				275	240																	1	101	13d;		2		2			2	
H4931	016	0	1	01	01	H4931_016_0	12	3	3								01111111111111111000	MSK															2		13i;		2		2			1	75.00
H4931	016	0	1	01	01	H4931_016_0	12	4	1	01	0000000001				430	355																	2		13i;		2		2			2	
H4931	016	0	1	01	01	H4931_016_0	12	1	1	01	0100000000				180	140																	1	101	13d;		2		2			2	
H4931	016	0	1	01	01	H4931_016_0	12	2	1	01	1000000000				30	10																	2		13d;		2		2			2	
H4937	001	0	1	04	01	H4937_001_0	7	1	3								00011101000010010000																2		13i-O;	1	1	13i-O;	2			2	
H4982	008	0	1	01	01	H4982_008_0	3	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H4982	009	0	1	01	01	H4982_009_0	3	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H4982	801	0	1	01	01	H4982_801_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H4982	802	0	1	01	01	H4982_802_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5008	002	0	1	01	01	H5008_002_0	4	1	1	10				01111	55269	46979																	2		13d;		1	13d;	2			2	
H5008	010	0	1	01	01	H5008_010_0	4	1	1	10				01111	20250	17213																	2		13d;		1	13d;	2			2	
H5008	011	0	1	01	01	H5008_011_0	4	1	1	10				01111	25720	21862																	2		13d;		1	13d;	2			2	
H5008	015	0	1	01	01	H5008_015_0	4	1	1	10				01111	170	145																	2		13d;		1	13d;	2			2	
H5009	001	0	1	04	01	H5009_001_0	4	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H5009	001	0	1	04	01	H5009_001_0	4	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H5009	001	0	1	04	01	H5009_001_0	4	1	2														01000000000000										2		7f;	1	2		2			2	
H5009	002	0	1	04	01	H5009_002_0	7	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H5009	002	0	1	04	01	H5009_002_0	7	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H5009	002	0	1	04	01	H5009_002_0	7	1	2														01000000000000										2		7f;	1	2		2			2	
H5009	008	0	1	04	01	H5009_008_0	8	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H5009	008	0	1	04	01	H5009_008_0	8	1	2														01000000000000										2		7f;	1	2		2			2	
H5009	008	0	1	04	01	H5009_008_0	8	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H5009	009	0	1	04	01	H5009_009_0	8	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H5009	009	0	1	04	01	H5009_009_0	8	1	2														01000000000000										2		7f;	1	2		2			2	
H5009	009	0	1	04	01	H5009_009_0	8	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H5009	801	0	1	04	01	H5009_801_0	4	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H5009	801	0	1	04	01	H5009_801_0	4	1	2														01000000000000										2		7f;	1	2		2			2	
H5009	801	0	1	04	01	H5009_801_0	4	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H5009	802	0	1	04	01	H5009_802_0	4	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H5009	802	0	1	04	01	H5009_802_0	4	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H5009	802	0	1	04	01	H5009_802_0	4	1	2														01000000000000										2		7f;	1	2		2			2	
H5009	803	0	1	04	01	H5009_803_0	4	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H5009	803	0	1	04	01	H5009_803_0	4	1	2														01000000000000										2		7f;	1	2		2			2	
H5009	803	0	1	04	01	H5009_803_0	4	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H5009	804	0	1	04	01	H5009_804_0	4	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H5009	804	0	1	04	01	H5009_804_0	4	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H5009	804	0	1	04	01	H5009_804_0	4	1	2														01000000000000										2		7f;	1	2		2			2	
H5010	001	0	1	04	01	H5010_001_0	4	1	2														01000000000000										2		7f;	1	2		2			2	
H5010	001	0	1	04	01	H5010_001_0	4	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H5010	001	0	1	04	01	H5010_001_0	4	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H5010	002	0	1	04	01	H5010_002_0	7	1	2														01000000000000										2		7f;	1	2		2			2	
H5010	002	0	1	04	01	H5010_002_0	7	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H5010	002	0	1	04	01	H5010_002_0	7	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H5010	007	0	1	04	01	H5010_007_0	8	2	2														00000000001000	Pre-diabetes									2		14c;	1	2		2			2	
H5010	007	0	1	04	01	H5010_007_0	8	3	3								01111111111111110000																1	001	13i;13i-O;	1	2		2			2	
H5010	007	0	1	04	01	H5010_007_0	8	1	2														01000000000000										2		7f;	1	2		2			2	
H5015	001	0	1	01	01	H5015_001_0	13	1	3								01111111111111110000																2		13i;14c;		2		2			2	
H5042	009	0	1	04	01	H5042_009_0	8	1	3								01111111111111110000																1	011	14c;	1	2		2			2	
H5042	011	0	1	04	01	H5042_011_0	7	1	3								01111111111111110000																1	011	14c;	1	2		2			2	
H5042	012	0	1	04	01	H5042_012_0	6	1	3								01111111111111110000																1	011	14c;	1	2		2			2	
H5087	001	0	1	01	01	H5087_001_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	1		1	600.00
H5087	002	0	1	01	01	H5087_002_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	2			1	600.00
H5087	027	0	1	01	01	H5087_027_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	2			1	600.00
H5141	001	0	1	04	01	H5141_001_0	17	1	3								11111111111111111111	Prediabetes	Hypertension	Hypercholesterolemia	Depression	Obesity/Overweight											2		13i;	1	2		2			1	0.00
H5141	004	0	1	04	01	H5141_004_0	16	1	3								11111111111111111111	Prediabetes	Hypertension	Hypercholesterolemia	Depression	Obesity/Overweight											2		13i;	1	2		2			1	0.00
H5141	007	0	1	04	01	H5141_007_0	13	1	3								11111111111111111111	Prediabetes	Hypertension	Hypercholesterolemia	Depression	Obesity/Overweight											2		13i;	1	2		2			1	0.00
H5141	025	0	1	04	01	H5141_025_0	15	1	3								11111111111111111111	Prediabetes	Hypertension	Hypercholesterolemia	Depression	Obesity/Overweight											2		13i;	1	2		2			1	0.00
H5141	026	0	1	04	01	H5141_026_0	15	1	3								11111111111111111111	Prediabetes	Hypertension	Hypercholesterolemia	Depression	Obesity/Overweight											2		13i;	1	2		2			1	0.00
H5141	033	0	1	04	01	H5141_033_0	15	1	3								11111111111111111111	Prediabetes	Hypertension	Hypercholesterolemia	Depression	Obesity/Overweight											2		13i;	1	2		2			1	0.00
H5141	034	0	1	04	01	H5141_034_0	15	1	3								11111111111111111111	Prediabetes	Hypertension	Hypercholesterolemia	Depression	Obesity/Overweight											2		13i;	1	2		2			1	0.00
H5141	035	0	1	04	01	H5141_035_0	15	1	3								11111111111111111111	Prediabetes	Hypertension	Hypercholesterolemia	Depression	Obesity/Overweight											2		13i;	1	2		2			1	0.00
H5141	036	0	1	04	01	H5141_036_0	15	1	3								11111111111111111111	Prediabetes	Hypertension	Hypercholesterolemia	Depression	Obesity/Overweight											2		13i;	1	2		2			1	0.00
H5141	037	0	1	04	01	H5141_037_0	15	1	3								11111111111111111111	Prediabetes	Hypertension	Hypercholesterolemia	Depression	Obesity/Overweight											2		13i;	1	2		2			1	0.00
H5141	038	0	1	04	01	H5141_038_0	15	1	3								11111111111111111111	Prediabetes	Hypertension	Hypercholesterolemia	Depression	Obesity/Overweight											2		13i;	1	2		2			1	0.00
H5141	039	0	1	04	01	H5141_039_0	14	1	3								11111111111111111111	Prediabetes	Hypertension	Hypercholesterolemia	Depression	Obesity/Overweight											2		13i;	1	2		2			1	0.00
H5141	040	0	1	04	01	H5141_040_0	15	1	3								11111111111111111111	Prediabetes	Hypertension	Hypercholesterolemia	Depression	Obesity/Overweight											2		13i;	1	2		2			1	0.00
H5141	045	0	1	04	01	H5141_045_0	14	1	3								11111111111111111111	Prediabetes	Hypertension	Hypercholesterolemia	Depression	Obesity/Overweight											2		13i;	1	2		2			1	0.00
H5141	046	0	1	04	01	H5141_046_0	15	1	3								11111111111111111111	Prediabetes	Hypertension	Hypercholesterolemia	Depression	Obesity/Overweight											2		13i;	1	2		2			1	0.00
H5141	047	0	1	04	01	H5141_047_0	14	1	3								11111111111111111111	Prediabetes	Hypertension	Hypercholesterolemia	Depression	Obesity/Overweight											2		13i;	1	2		2			1	0.00
H5141	048	0	1	04	01	H5141_048_0	15	1	3								11111111111111111111	Prediabetes	Hypertension	Hypercholesterolemia	Depression	Obesity/Overweight											2		13i;	1	2		2			1	0.00
H5141	049	0	1	04	01	H5141_049_0	14	1	3								11111111111111111111	Prediabetes	Hypertension	Hypercholesterolemia	Depression	Obesity/Overweight											2		13i;	1	2		2			1	0.00
H5141	050	0	1	04	01	H5141_050_0	15	1	3								11111111111111111111	Prediabetes	Hypertension	Hypercholesterolemia	Depression	Obesity/Overweight											2		13i;	1	2		2			1	0.00
H5141	051	0	1	04	01	H5141_051_0	14	1	3								11111111111111111111	Prediabetes	Hypertension	Hypercholesterolemia	Depression	Obesity/Overweight											2		13i;	1	2		2			1	0.00
H5141	052	0	1	04	01	H5141_052_0	15	1	3								11111111111111111111	Prediabetes	Hypertension	Hypercholesterolemia	Depression	Obesity/Overweight											2		13i;	1	2		2			1	0.00
H5141	053	0	1	04	01	H5141_053_0	14	1	3								11111111111111111111	Prediabetes	Hypertension	Hypercholesterolemia	Depression	Obesity/Overweight											2		13i;	1	2		2			1	0.00
H5141	054	0	1	04	01	H5141_054_0	14	1	3								11111111111111111111	Prediabetes	Hypertension	Hypercholesterolemia	Depression	Obesity/Overweight											2		13i;	1	2		2			1	0.00
H5199	016	0	1	04	01	H5199_016_0	6	1	3								01111111111111110000																1	001	13i;	1	1	13i;	1	2	13i;	1	1200.00
H5211	001	0	1	02	01	H5211_001_0	8	1	2														00010000000000										2		13c;	2	1	13c;	2			2	
H5211	002	0	1	02	01	H5211_002_0	9	1	2														00010000000000										2		13c;	2	1	13c;	2			2	
H5211	003	0	1	02	01	H5211_003_0	8	1	2														00010000000000										2		13c;	2	1	13c;	2			2	
H5211	004	0	1	02	01	H5211_004_0	8	1	2														00010000000000										2		13c;	2	1	13c;	2			2	
H5211	010	0	1	01	01	H5211_010_0	8	1	2														00010000000000										2		13c;		2		2			2	
H5211	012	0	1	02	01	H5211_012_0	9	1	2														00010000000000										2		13c;	2	1	13c;	2			2	
H5211	013	0	1	02	01	H5211_013_0	8	1	2														00010000000000										2		13c;	2	1	13c;	2			2	
H5215	001	0	1	04	01	H5215_001_0	7	1	3								00010000010000000000																1	001	10b;13a;14c;	1	2		1	2	13a;	2	
H5215	002	0	1	04	01	H5215_002_0	9	1	3								00010000010000000000																1	001	10b;13a;14c;	1	2		1	2	13a;	2	
H5215	005	0	1	04	01	H5215_005_0	7	1	3								00010000010000000000																1	001	10b;13a;14c;	1	2		1	2	13a;	2	
H5215	006	0	1	04	01	H5215_006_0	7	1	3								00010000010000000000																1	001	10b;13a;14c;	1	2		1	2	13a;	2	
H5215	007	0	1	04	01	H5215_007_0	8	1	3								00010000010000000000																1	001	10b;13a;14c;	1	2		1	2	13a;	2	
H5215	008	0	1	04	01	H5215_008_0	9	1	3								00010000010000000000																1	001	10b;13a;14c;	1	2		1	2	13a;	2	
H5215	009	0	1	04	01	H5215_009_0	10	1	3								00010000010000000000																1	001	10b;13a;14c;	1	2		1	2	13a;	2	
H5215	010	0	1	04	01	H5215_010_0	7	1	3								00010000010000000000																1	001	10b;13a;14c;	1	2		1	2	13a;	2	
H5215	011	0	1	04	01	H5215_011_0	7	1	3								00010000010000000000																1	001	10b;13a;14c;	1	2		1	2	13a;	2	
H5215	012	0	1	04	01	H5215_012_0	9	1	3								00010000010000000000																1	001	10b;13a;14c;	1	2		1	2	13a;	2	
H5216	014	0	1	04	01	H5216_014_0	4	1	3								00000101000010000000																1	001	13c;	1	2		2			2	
H5216	017	0	1	04	01	H5216_017_0	4	1	3								00000101000010001000	Depression															1	001	13c;	1	2		2			2	
H5216	027	0	1	04	01	H5216_027_0	4	1	3								00000101000010001000	Depression															1	001	13c;	1	2		2			2	
H5216	029	0	1	04	01	H5216_029_0	5	1	3								00000101000010001000	Depression															1	001	13c;	1	2		2			2	
H5216	034	0	1	04	01	H5216_034_0	4	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
H5216	034	0	1	04	01	H5216_034_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
H5216	036	0	1	04	01	H5216_036_0	5	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
H5216	037	0	1	04	01	H5216_037_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
H5216	042	0	1	04	01	H5216_042_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	043	1	1	04	01	H5216_043_1	5	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	043	2	1	04	01	H5216_043_2	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
H5216	047	0	1	04	01	H5216_047_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	048	0	1	04	01	H5216_048_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	065	0	1	04	01	H5216_065_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
H5216	068	0	1	04	01	H5216_068_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	073	0	1	04	01	H5216_073_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
H5216	077	0	1	04	01	H5216_077_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	078	1	1	04	01	H5216_078_1	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
H5216	128	0	1	04	01	H5216_128_0	2	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	129	0	1	04	01	H5216_129_0	3	1	3								00000101000010001000	Depression															1	001	13c;	1	2		2			2	
H5216	137	0	1	04	01	H5216_137_0	5	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
H5216	137	0	1	04	01	H5216_137_0	5	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
H5216	141	0	1	04	01	H5216_141_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
H5216	143	0	1	04	01	H5216_143_0	5	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	144	0	1	04	01	H5216_144_0	4	1	3								00000101000010001000	Depression															1	001	13c;	1	2		2			2	
H5216	144	0	1	04	01	H5216_144_0	4	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	149	0	1	04	01	H5216_149_0	7	1	3								00000101000010001000	Depression															1	001	13c;	1	2		2			2	
H5216	152	0	1	04	01	H5216_152_0	5	1	3								00000101000010001000	Depression															1	001	13c;	1	2		2			2	
H5216	152	0	1	04	01	H5216_152_0	5	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	154	0	1	04	01	H5216_154_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
H5216	154	0	1	04	01	H5216_154_0	4	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
H5216	157	0	1	04	01	H5216_157_0	2	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	157	0	1	04	01	H5216_157_0	2	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	164	0	1	04	01	H5216_164_0	7	1	1	10				01111	2424	2424																	2		13d;	1	1	13d;	2			1	600.00
H5216	164	0	1	04	01	H5216_164_0	7	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	500.00
H5216	165	0	1	04	01	H5216_165_0	7	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	500.00
H5216	166	0	1	04	01	H5216_166_0	7	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	500.00
H5216	195	0	1	04	01	H5216_195_0	5	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
H5216	197	0	1	04	01	H5216_197_0	5	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
H5216	197	0	1	04	01	H5216_197_0	5	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
H5216	203	1	1	04	01	H5216_203_1	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	205	0	1	04	01	H5216_205_0	7	1	1	10				01111	28916	28916																	2		13d;	1	1	13d;	2			1	600.00
H5216	205	0	1	04	01	H5216_205_0	7	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	500.00
H5216	205	0	1	04	01	H5216_205_0	7	3	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
H5216	206	0	1	04	01	H5216_206_0	4	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	206	0	1	04	01	H5216_206_0	4	1	1	10				01111	18526	18526																	2		13d;	1	2		2			1	300.00
H5216	211	0	1	04	01	H5216_211_0	5	1	3								00000101000010001000	Depression															1	001	13c;	1	1	13c;	2			2	
H5216	213	0	1	04	01	H5216_213_0	2	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	213	0	1	04	01	H5216_213_0	2	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	216	0	1	04	01	H5216_216_0	2	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
H5216	217	0	1	04	01	H5216_217_0	3	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
H5216	217	0	1	04	01	H5216_217_0	3	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
H5216	219	0	1	04	01	H5216_219_0	7	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	1000.00
H5216	219	0	1	04	01	H5216_219_0	7	1	1	10				01111	1894	1894																	2		13d;	1	1	13d;	2			1	600.00
H5216	220	0	1	04	01	H5216_220_0	7	1	1	10				01111	10200	10200																	2		13d;	1	1	13d;	2			1	420.00
H5216	220	0	1	04	01	H5216_220_0	7	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	1000.00
H5216	223	0	1	04	01	H5216_223_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	224	0	1	04	01	H5216_224_0	5	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	224	0	1	04	01	H5216_224_0	5	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	227	0	1	04	01	H5216_227_0	6	1	1	10				01111	3566	3566																	2		13d;	1	1	13d;	2			1	600.00
H5216	227	0	1	04	01	H5216_227_0	6	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	1000.00
H5216	228	0	1	04	01	H5216_228_0	8	1	1	10				01111	5002	5002																	2		13d;	1	1	13d;	2			1	600.00
H5216	228	0	1	04	01	H5216_228_0	8	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	500.00
H5216	231	0	1	04	01	H5216_231_0	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	500.00
H5216	237	1	1	04	01	H5216_237_1	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
H5216	239	0	1	04	01	H5216_239_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	240	0	1	04	01	H5216_240_0	5	1	1	10				01111	38	38																	2		13d;	1	1	13d;	2			1	300.00
H5216	240	0	1	04	01	H5216_240_0	5	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	500.00
H5216	240	0	1	04	01	H5216_240_0	5	3	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
H5216	242	0	1	04	01	H5216_242_0	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	1000.00
H5216	242	0	1	04	01	H5216_242_0	6	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
H5216	243	0	1	04	01	H5216_243_0	6	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
H5216	243	0	1	04	01	H5216_243_0	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;	2			1	1000.00
H5216	244	0	1	04	01	H5216_244_0	5	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	244	0	1	04	01	H5216_244_0	5	1	3								01111111111111110000																2		13i;	1	2		2			1	600.00
H5216	246	0	1	04	01	H5216_246_0	5	1	3								01111111111111110000																2		13i;	1	2		2			1	600.00
H5216	246	0	1	04	01	H5216_246_0	5	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	247	0	1	04	01	H5216_247_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	248	1	1	04	01	H5216_248_1	4	1	3								00000101000010001000	Depression															1	001	13c;	1	2		2			2	
H5216	248	1	1	04	01	H5216_248_1	4	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	248	2	1	04	01	H5216_248_2	4	1	3								00000101000010001000	Depression															1	001	13c;	1	2		2			2	
H5216	257	0	1	04	01	H5216_257_0	5	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	2		2			1	500.00
H5216	261	0	1	04	01	H5216_261_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	262	0	1	04	01	H5216_262_0	5	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	500.00
H5216	265	0	1	04	01	H5216_265_0	3	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	265	0	1	04	01	H5216_265_0	3	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	266	0	1	04	01	H5216_266_0	5	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	266	0	1	04	01	H5216_266_0	5	1	3								00000101000010001000	Depression															1	001	13c;	1	2		2			2	
H5216	267	0	1	04	01	H5216_267_0	4	1	1	10				01111	158	158																	2		13d;	1	2		2			1	900.00
H5216	267	0	1	04	01	H5216_267_0	4	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	268	0	1	04	01	H5216_268_0	7	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	500.00
H5216	268	0	1	04	01	H5216_268_0	7	1	1	10				01111	1933	1933																	2		13d;	1	1	13d;	2			1	600.00
H5216	277	0	1	04	01	H5216_277_0	6	3	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
H5216	277	0	1	04	01	H5216_277_0	6	1	1	10				01111	4873	4873																	2		13d;	1	1	13d;	2			1	600.00
H5216	277	0	1	04	01	H5216_277_0	6	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	500.00
H5216	279	0	1	04	01	H5216_279_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
H5216	280	1	1	04	01	H5216_280_1	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	280	2	1	04	01	H5216_280_2	5	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	281	0	1	04	01	H5216_281_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	282	1	1	04	01	H5216_282_1	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	282	2	1	04	01	H5216_282_2	6	1	3								01001111000011001000	Chronic Kidney Disease															1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	2		2			1	500.00
H5216	286	0	1	04	01	H5216_286_0	3	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	286	0	1	04	01	H5216_286_0	3	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	2		2			1	500.00
H5216	286	0	1	04	01	H5216_286_0	3	3	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	290	0	1	04	01	H5216_290_0	5	1	1	10				01111	331	331																	2		13d;	1	1	13d;	2			1	600.00
H5216	291	0	1	04	01	H5216_291_0	5	1	1	10				01111	891	891																	2		13d;	1	1	13d;	2			1	600.00
H5216	292	0	1	04	01	H5216_292_0	4	1	1	10				01111	569	569																	2		13d;	1	1	13d;	2			1	900.00
H5216	293	0	1	04	01	H5216_293_0	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	500.00
H5216	294	0	1	04	01	H5216_294_0	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	500.00
H5216	295	0	1	04	01	H5216_295_0	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	500.00
H5216	296	0	1	04	01	H5216_296_0	9	1	1	10				01111	394	394																	2		13d;	1	1	13d;	2			1	420.00
H5216	296	0	1	04	01	H5216_296_0	9	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	500.00
H5216	298	0	1	04	01	H5216_298_0	4	1	1	10				01111	127	127																	2		13d;	1	2		2			1	600.00
H5216	301	4	1	04	01	H5216_301_4	3	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5216	302	0	1	04	01	H5216_302_0	4	1	1	10				01111	351	351																	2		13d;	1	1	13d;	2			1	420
H5216	302	0	1	04	01	H5216_302_0	4	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
H5253	024	0	1	01	01	H5253_024_0	5	1	1	10				01111	12690	10787																	2		13d;		1	13d;	2			2	
H5253	041	0	1	02	01	H5253_041_0	5	1	1	10				01111	46044	39137																	2		13d;	2	1	13d;	2			2	
H5253	059	0	1	01	01	H5253_059_0	4	1	1	10				01111	34100	28985																	2		13d;		1	13d;	2			2	
H5253	107	1	1	02	01	H5253_107_1	3	1	2														00000000010000										2		14c;	2	2		2			2	
H5253	108	3	1	02	01	H5253_108_3	3	1	2														00000000010000										2		14c;	2	2		2			2	
H5262	001	0	1	01	01	H5262_001_0	4	1	2														10110000001111	Pneumonia	UTI	Cellulitis	Asthma	Deep Vein Thrombosis/Pulmonary Embolism	2	2			1	001	13d;		2		2			2	
H5262	003	0	1	01	01	H5262_003_0	4	1	2														10110000001111	Pneumonia	UTI	Cellulitis	Asthma	Deep Vein Thrombosis/Pulmonary Embolism	2	2			1	001	13d;		2		2			2	
H5262	004	0	1	01	01	H5262_004_0	3	1	2														10110000001111	Pneumonia	UTI	Cellulitis	Asthma	Deep Vein Thrombosis/Pulmonary Embolism	2	2			1	001	13d;		2		2			2	
H5262	005	0	1	01	01	H5262_005_0	3	1	2														10110000001111	Pneumonia	UTI	Cellulitis	Asthma	Deep Vein Thrombosis/Pulmonary Embolism	2	2			1	001	13d;		2		2			2	
H5262	021	0	1	01	01	H5262_021_0	4	1	2														10110000001111	Pneumonia	UTI	Cellulitis	Asthma	Deep Vein Thrombosis/Pulmonary Embolism	2	2			1	001	13d;		2		2			2	
H5294	010	0	1	01	01	H5294_010_0	5	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	1500.00
H5294	011	0	1	01	01	H5294_011_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	1		1	600.00
H5294	013	0	1	01	01	H5294_013_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	600.00
H5294	015	0	1	01	01	H5294_015_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	1200.00
H5294	016	0	1	01	01	H5294_016_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	600.00
H5294	017	0	1	01	01	H5294_017_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	1		1	600.00
H5294	018	0	1	01	01	H5294_018_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	1		1	600.00
H5296	001	0	1	01	01	H5296_001_0	5	1	3								01111111111111110000																2		13i-O;		2		2			2	
H5296	003	0	1	02	01	H5296_003_0	5	1	3								01111111111111110000																2		13i-O;	2	2		2			2	
H5296	004	0	1	01	01	H5296_004_0	5	1	3								01111111111111110000																2		13i;		2		2			2	
H5302	012	0	1	01	01	H5302_012_0	5	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H5302	013	0	1	01	01	H5302_013_0	5	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H5302	014	0	1	01	01	H5302_014_0	5	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H5302	809	0	1	01	01	H5302_809_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5302	810	0	1	01	01	H5302_810_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5322	025	0	1	01	01	H5322_025_0	4	1	1	10				01111	33160	28186																	2		13d;		1	13d;	2			2	
H5322	026	0	1	01	01	H5322_026_0	4	1	1	10				01111	4623	3930																	2		13d;		1	13d;	2			2	
H5322	028	0	1	02	01	H5322_028_0	4	1	1	10				01111	9262	7873																	2		13d;	1	1	13d;	2			2	
H5322	029	0	1	02	01	H5322_029_0	4	2	1	10				01111	3875	388																	2		13e;	2	1	13e;	2			2	
H5322	029	0	1	02	01	H5322_029_0	4	1	1	10				01111	3875	3294																	2		13d;	2	1	13d;	2			2	
H5322	030	0	1	02	01	H5322_030_0	4	1	1	10				01111	6888	5855																	2		13d;	2	1	13d;	2			2	
H5322	031	0	1	01	01	H5322_031_0	4	1	1	10				01111	17696	15042																	2		13d;		1	13d;	2			2	
H5325	001	0	1	01	01	H5325_001_0	4	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H5325	002	0	1	01	01	H5325_002_0	5	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H5325	003	0	1	01	01	H5325_003_0	5	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H5325	004	0	1	01	01	H5325_004_0	5	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H5325	005	0	1	01	01	H5325_005_0	5	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H5325	006	0	1	01	01	H5325_006_0	5	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H5325	007	0	1	01	01	H5325_007_0	5	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H5325	008	0	1	01	01	H5325_008_0	5	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H5325	009	0	1	01	01	H5325_009_0	6	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H5374	001	0	1	01	01	H5374_001_0	7	2	3								00000010000000001100	Behavioral Health Diagnosis	Documented chronic pain														2		13i;		2		2			2	
H5374	001	0	1	01	01	H5374_001_0	7	1	2														00000000011100	Behavioral health diagnosis	Documented chronic pain related to falls within the last year				2	2			2		14c;		2		2			2	
H5398	001	0	1	01	01	H5398_001_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H5398	002	0	1	01	01	H5398_002_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	2700.00
H5410	013	0	1	01	01	H5410_013_0	4	1	3								00001001000000000000																2		13i;		2		2			2	
H5410	025	0	1	01	01	H5410_025_0	5	1	3								00001001000000000000																2		13i;		2		2			2	
H5410	031	0	1	01	01	H5410_031_0	6	1	3								00001001000000000000																2		13i;		2		2			2	
H5410	032	0	1	01	01	H5410_032_0	6	1	3								00001001000000000000																2		13i;		2		2			2	
H5420	006	0	1	01	01	H5420_006_0	3	1	1	10				01111	10835	9210																	2		13d;		1	13d;	2			2	
H5420	013	0	1	01	01	H5420_013_0	4	1	1	10				01111	2027	1723																	2		13d;		1	13d;	2			2	
H5422	007	0	1	01	01	H5422_007_0	6	1	1	10				01111	5815	5815																	2		13i;		2		2			2	
H5422	007	0	1	01	01	H5422_007_0	6	2	1	10				01111	5815	5815																	2		13i;		2		2			2	
H5422	007	0	1	01	01	H5422_007_0	6	3	1	10				01111	5815	5815																	2		13i;		2		2			2	
H5422	011	0	1	01	01	H5422_011_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H5422	013	0	1	01	01	H5422_013_0	6	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H5422	014	0	1	01	01	H5422_014_0	5	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H5422	015	0	1	01	01	H5422_015_0	9	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H5422	016	0	1	01	01	H5422_016_0	7	2	1	10				01111	22	22																	2		13i;		2		2			2	
H5422	016	0	1	01	01	H5422_016_0	7	5	1	10				01111	22	22																	2		13i;		2		2			2	
H5422	016	0	1	01	01	H5422_016_0	7	4	1	10				01111	22	22																	2		13i;		2		2			2	
H5422	016	0	1	01	01	H5422_016_0	7	3	1	10				01111	22	22																	2		13i-O;		2		2			2	
H5422	016	0	1	01	01	H5422_016_0	7	1	1	10				01111	22	22																	2		13i;		2		2			2	
H5422	017	0	1	01	01	H5422_017_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H5425	010	0	1	01	01	H5425_010_0	5	1	3								00011111010000100000																2		13i;		2		2			2	
H5425	028	0	1	01	01	H5425_028_0	5	1	3								00011111010000100000																2		13i;		2		2			2	
H5425	030	0	1	01	01	H5425_030_0	5	1	3								00011111010000100000																2		13i;		2		2			2	
H5425	033	0	1	01	01	H5425_033_0	5	1	3								00011111010000100000																2		13i;		2		2			2	
H5425	034	0	1	01	01	H5425_034_0	5	1	3								00011111010000100000																2		13i;		2		2			2	
H5425	040	0	1	01	01	H5425_040_0	5	1	3								00011111010000100000																2		13i;		2		2			2	
H5425	045	0	1	01	01	H5425_045_0	5	1	3								00011111010000100000																2		13i;		2		2			2	
H5425	055	0	1	01	01	H5425_055_0	5	1	3								00011111010000100000																2		13i;		2		2			2	
H5425	070	0	1	01	01	H5425_070_0	5	1	3								00011111010000100000																2		13i;		2		2			2	
H5425	071	0	1	01	01	H5425_071_0	5	1	3								00011111010000100000																2		13i;		2		2			2	
H5425	072	0	1	01	01	H5425_072_0	6	1	3								00011111010000100000																2		13i;		2		2			2	
H5425	076	0	1	01	01	H5425_076_0	5	1	3								00011111010000100000																2		13i;		2		2			2	
H5425	077	0	1	01	01	H5425_077_0	5	1	3								00011111010000100000																2		13i;		2		2			2	
H5425	079	0	1	01	01	H5425_079_0	5	1	3								00011111010000100000																2		13i;		2		2			2	
H5425	080	0	1	01	01	H5425_080_0	5	1	3								00011111010000100000																2		13i;		2		2			2	
H5425	086	0	1	01	01	H5425_086_0	5	1	3								00011111010000100000																2		13i;		2		2			2	
H5425	087	0	1	01	01	H5425_087_0	5	1	3								00011111010000100000																2		13i;		2		2			2	
H5427	070	0	1	01	01	H5427_070_0	8	1	3								00001101000000000000																2		13i;		2		2			2	
H5427	072	0	1	01	01	H5427_072_0	7	1	3								00001101000000000000																2		13i;		2		2			2	
H5427	077	0	1	01	01	H5427_077_0	7	1	3								00000000000010000000																2		13i;		2		2			2	
H5427	099	0	1	01	01	H5427_099_0	7	1	3								00001101000000000000																2		13i;		2		2			2	
H5427	108	0	1	01	01	H5427_108_0	7	1	3								00001101000000000000																2		13i;		2		2			2	
H5431	001	0	1	01	01	H5431_001_0	7	1	3								01111111111111111000	All other chronic conditions approved by plan															2		13c;13i-O;		2		2			2	
H5431	006	0	1	01	01	H5431_006_0	7	1	3								01111111111111111000	All other chronic conditions approved by plan															2		13c;13i-O;		2		2			2	
H5431	012	0	1	01	01	H5431_012_0	7	1	3								01111111111111111000	All other chronic conditions approved by plan															2		13c;13i-O;		2		2			2	
H5431	013	0	1	01	01	H5431_013_0	7	1	3								01111111111111111000	All other chronic conditions approved by plan															2		13c;13i-O;		2		2			2	
H5431	015	0	1	01	01	H5431_015_0	9	2	1	10				01111	41165	41165																	2		13i;		2		2			2	
H5431	015	0	1	01	01	H5431_015_0	9	1	3								01111111111111111000	All other chronic conditions approved by plan															2		13c;13i-O;		2		2			2	
H5431	016	0	1	01	01	H5431_016_0	7	2	1	10				01111	396	396																	2		13i;		2		2			2	
H5431	016	0	1	01	01	H5431_016_0	7	1	3								01111111111111111000	All other chronic conditions approved by plan															2		13c;13i-O;		2		2			2	
H5431	017	0	1	01	01	H5431_017_0	7	1	3								01111111111111111000	All other chronic conditions approved by plan															2		13i-O;		2		2			2	
H5431	018	0	1	01	01	H5431_018_0	7	1	3								01111111111111111000	All other chronic conditions approved by plan															2		13i-O;		2		2			2	
H5431	019	0	1	01	01	H5431_019_0	11	2	1	10				01111	1135	1135																	2		13i;		2		2			2	
H5431	019	0	1	01	01	H5431_019_0	11	1	3								01111111111111111000	All other chronic conditions approved by plan															2		13c;13i-O;		2		2			2	
H5439	010	0	1	04	01	H5439_010_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			2	
H5439	011	0	1	04	01	H5439_011_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			2	
H5439	015	0	1	04	01	H5439_015_0	3	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			2	
H5439	017	0	1	04	01	H5439_017_0	3	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			2	
H5439	018	0	1	04	01	H5439_018_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			2	
H5439	019	0	1	04	01	H5439_019_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			2	
H5475	001	0	1	02	01	H5475_001_0	4	1	3								01111111111111110000																1	001	13i;	2	1	13i;	1	2	13i;	1	1800.00
H5475	026	0	1	02	01	H5475_026_0	4	1	3								01111111111111110000																1	001	13i;	2	1	13i;	2			2	
H5475	033	0	1	01	01	H5475_033_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	2			2	
H5521	016	0	1	04	01	H5521_016_0	7	1	3								01111111111111111100	Hyperlipidemia	Hypertension														2		13i;	1	1	13i;	2			2	
H5521	086	0	1	04	01	H5521_086_0	7	1	3								01111111111111111100	Hyperlipidemia	Hypertension														2		13i;	1	1	13i;	2			2	
H5521	314	0	1	04	01	H5521_314_0	5	1	3								01111111111111111100	Hyperlipidemia	Hypertension														2		13i;	1	1	13i;	2			2	
H5521	801	0	1	04	01	H5521_801_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5521	802	0	1	04	01	H5521_802_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5521	805	0	2	04	01	H5521_805_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5521	806	0	2	04	01	H5521_806_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5521	809	0	1	04	01	H5521_809_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5521	810	0	1	04	01	H5521_810_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5521	812	0	1	04	01	H5521_812_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5521	814	0	2	04	01	H5521_814_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5521	815	0	2	04	01	H5521_815_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5521	816	0	2	04	01	H5521_816_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5521	817	0	1	04	01	H5521_817_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5521	818	0	2	04	01	H5521_818_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5521	819	0	1	04	01	H5521_819_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5521	820	0	1	04	01	H5521_820_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5521	821	0	1	04	01	H5521_821_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5521	822	0	1	04	01	H5521_822_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5521	823	0	2	04	01	H5521_823_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5521	824	0	2	04	01	H5521_824_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5521	825	0	1	04	01	H5521_825_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5521	826	0	1	04	01	H5521_826_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5521	827	0	2	04	01	H5521_827_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5521	828	0	2	04	01	H5521_828_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5522	001	0	1	04	01	H5522_001_0	3	1	1	01	0001000000				9901	4950																	1	001	10b;13b;13c;13d;13i;	1	1	10b;13b;13c;13d;13i;	2			2	
H5522	002	0	1	04	01	H5522_002_0	3	2	1	01	0001000000				9901	4950																	1	001	13b;13c;13d;13i;	1	1	13b;13c;13d;13i;	2			2	
H5522	002	0	1	04	01	H5522_002_0	3	1	2														00000100001000	Hyperlipidemia					2	2			2		10b;13b;	1	1	10b;13b;	2			2	
H5522	005	0	1	04	01	H5522_005_0	2	1	1	01	0001000000				9901	4950																	1	001	10b;13b;13c;13d;13i;	1	1	10b;13b;13c;13d;13i;	2			2	
H5522	013	0	1	04	01	H5522_013_0	3	1	3								00001100000000000000																1	001	14c;	1	1	14c;	2			2	
H5522	018	0	1	04	01	H5522_018_0	3	2	3								01111111111111111100	Hyperlipidemia	Hypertension														2		13i;	1	1	13i;	2			2	
H5522	018	0	1	04	01	H5522_018_0	3	1	2														00000100001000	Hyperlipidemia					2	2			2		10b;13b;	1	1	10b;13b;	2			2	
H5522	802	0	1	04	01	H5522_802_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5522	803	0	1	04	01	H5522_803_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5525	026	0	1	04	01	H5525_026_0	5	1	3								00000101000010001000	Depression															1	001	13c;	1	1	13c;	2			2	
H5525	034	0	1	04	01	H5525_034_0	4	1	3								00000101000010001000	Depression															1	001	13c;	1	2		2			2	
H5525	035	0	1	04	01	H5525_035_0	5	1	3								00000101000010001000	Depression															1	001	13c;	1	2		2			2	
H5525	036	0	1	04	01	H5525_036_0	6	1	1	10				01111	13046	13046																	2		13d;	1	1	13d;	2			1	900.00
H5525	036	0	1	04	01	H5525_036_0	6	2	3								00000101000010001000	Depression															1	001	13c;	1	1	13c;	2			2	
H5525	045	0	1	04	01	H5525_045_0	7	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	1000.00
H5525	045	0	1	04	01	H5525_045_0	7	1	1	10				01111	8486	8486																	2		13d;	1	1	13d;	2			1	420.00
H5525	046	0	1	04	01	H5525_046_0	4	1	1	10				01111	6998	6998																	2		13d;	1	1	13d;	2			1	600.00
H5525	048	0	1	04	01	H5525_048_0	4	1	1	10				01111	4721	4721																	2		13d;	1	1	13d;	2			1	600.00
H5525	049	0	1	04	01	H5525_049_0	5	1	3								00000101000010001000	Depression															1	001	13c;	1	2		2			2	
H5525	050	0	1	04	01	H5525_050_0	3	1	3								00000101000010001000	Depression															1	001	13c;	1	2		2			2	
H5533	003	0	1	04	01	H5533_003_0	8	1	2														01110000000000						1				2		13c;	1	1	13c;	2			2	
H5533	005	0	1	04	01	H5533_005_0	8	1	2														01110000000000						1				2		13c;	1	1	13c;	2			2	
H5533	007	0	1	04	01	H5533_007_0	7	1	2														01110000000000						1				2		13c;	1	1	13c;	2			2	
H5533	008	0	1	04	01	H5533_008_0	8	1	2														01110000000000						1				2		13c;	1	1	13c;	2			2	
H5533	009	0	1	04	01	H5533_009_0	6	1	2														01110000000000						1				2		13c;	1	1	13c;	2			2	
H5533	010	0	1	04	01	H5533_010_0	7	1	2														01110000000000						1				2		13c;	1	1	13c;	2			2	
H5533	011	0	1	04	01	H5533_011_0	6	1	2														01110000000000						1				2		13c;	1	1	13c;	2			2	
H5549	003	0	1	01	01	H5549_003_0	10	1	3								01111111111111110000																2		13i;		2		2			1	50.00
H5549	011	0	1	01	01	H5549_011_0	8	1	3								01111111111111110000																2		13i;		2		2			1	50.00
H5577	002	0	1	01	01	H5577_002_0	3	1	3								11111111111111111111	Crohn's disease or Ulcerative colitis	Anemia	Chronic obstructive pulmonary disease (COPD)	Severe mental retardation	Moderate to Severe Autism											2		13i;		2		2			2	
H5577	005	0	1	01	01	H5577_005_0	4	1	3								11111111111111111111	Crohn's disease or Ulcerative colitis	Anemia	Chronic obstructive pulmonary disease (COPD)	Severe mental retardation	Moderate to Severe Autism											2		13i;		2		2			2	
H5577	008	0	1	02	01	H5577_008_0	4	1	3								11111111111111111111	Crohn's disease or Ulcerative colitis	Anemia	Chronic obstructive pulmonary disease (COPD)	Severe mental retardation	Moderate to Severe Autism											2		13i;	2	2		2			2	
H5577	014	0	1	01	01	H5577_014_0	3	1	3								11111111111111111111	Crohn's disease or Ulcerative colitis	Anemia	Chronic obstructive pulmonary disease (COPD)	Severe mental retardation	Moderate to Severe Autism											2		13i;		2		2			2	
H5577	016	0	1	01	01	H5577_016_0	2	1	3								11111111111111111111	Crohn's disease or Ulcerative colitis	Anemia	Chronic obstructive pulmonary disease (COPD)	Severe mental retardation	Moderate to Severe Autism											2		13i;		2		2			2	
H5577	017	0	1	01	01	H5577_017_0	3	1	3								11111111111111111111	Crohn's disease or Ulcerative colitis	Anemia	Chronic obstructive pulmonary disease (COPD)	Severe mental retardation	Moderate to Severe Autism											2		13i;		2		2			2	
H5577	029	0	1	01	01	H5577_029_0	3	1	3								11111111111111111111	Crohn's disease or Ulcerative colitis	Anemia	Chronic obstructive pulmonary disease (COPD)	Severe mental retardation	Moderate to Severe Autism											2		13i;		2		2			2	
H5577	031	0	1	01	01	H5577_031_0	4	1	3								11111111111111111111	Crohn's disease or Ulcerative colitis	Anemia	Chronic obstructive pulmonary disease (COPD)	Severe mental retardation	Moderate to Severe Autism											2		13i;		2		2			2	
H5577	036	0	1	01	01	H5577_036_0	3	1	3								11111111111111111111	Crohn's disease or Ulcerative colitis	Anemia	Chronic obstructive pulmonary disease (COPD)	Severe mental retardation	Moderate to Severe Autism											2		13i;		2		2			2	
H5577	036	0	1	01	01	H5577_036_0	3	2	1	10				10000	5162	2581																	1	100	13d;		2		2			1	500.00
H5577	037	0	1	01	01	H5577_037_0	3	1	3								11111111111111111111	Crohn's disease or Ulcerative colitis	Anemia	Chronic obstructive pulmonary disease (COPD)	Severe mental retardation	Moderate to Severe Autism											2		13i;		2		2			2	
H5577	038	0	1	01	01	H5577_038_0	4	1	3								11111111111111111111	Crohn's disease or Ulcerative colitis	Anemia	Chronic obstructive pulmonary disease (COPD)	Severe mental retardation	Moderate to Severe Autism											2		13i;		2		2			2	
H5577	039	0	1	01	01	H5577_039_0	4	1	3								11111111111111111111	Crohn's disease or Ulcerative colitis	Anemia	Chronic obstructive pulmonary disease (COPD)	Severe mental retardation	Moderate to Severe Autism											2		13i;		2		2			2	
H5577	041	0	1	01	01	H5577_041_0	3	1	3								11111111111111111111	Crohn's disease or Ulcerative colitis	Anemia	Chronic obstructive pulmonary disease (COPD)	Severe mental retardation	Moderate to Severe Autism											2		13i;		2		2			2	
H5577	042	0	1	01	01	H5577_042_0	4	1	3								11111111111111111111	Crohn's disease or Ulcerative colitis	Anemia	Chronic obstructive pulmonary disease (COPD)	Severe mental retardation	Moderate to Severe Autism											2		13i;		2		2			2	
H5577	043	0	1	01	01	H5577_043_0	4	1	3								11111111111111111111	Crohn's disease or Ulcerative colitis	Anemia	Chronic obstructive pulmonary disease (COPD)	Severe mental retardation	Moderate to Severe Autism											2		13i;		2		2			2	
H5577	044	0	1	01	01	H5577_044_0	4	1	3								11111111111111111111	Crohn's disease or Ulcerative colitis	Anemia	Chronic obstructive pulmonary disease (COPD)	Severe mental retardation	Moderate to Severe Autism											2		13i;		2		2			2	
H5577	045	0	1	01	01	H5577_045_0	4	1	3								11111111111111111111	Crohn's disease or Ulcerative colitis	Anemia	Chronic obstructive pulmonary disease (COPD)	Severe mental retardation	Moderate to Severe Autism											2		13i;		2		2			2	
H5587	002	0	1	01	01	H5587_002_0	5	1	3								10010101010010001111	High Blood Pressure	Digestive Disorders	Eating Disorders	Obesity	SDOH											2		13i;14c;		1	13i;14c;	2			2	
H5590	007	0	1	01	01	H5590_007_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	2			1	600.00
H5590	008	0	1	01	01	H5590_008_0	4	1	3								01111111111111110000																1	001	13b;13d;13i;14c;		1	13b;13d;13i;14c;	1	2	13i;	1	800.00
H5590	009	0	1	01	01	H5590_009_0	4	1	3								01111111111111110000																1	001	13b;13d;13i;14c;		1	13b;13d;13i;14c;	1	2	13i;	1	800.00
H5591	003	0	1	01	01	H5591_003_0	4	2	3								00000100010000000000																2		13i;		2		2			2	
H5591	003	0	1	01	01	H5591_003_0	4	3	2														00000000001100	History of Falls	Hip Fracture				2	2			2		14c;		2		1	1		1	250.00
H5591	003	0	1	01	01	H5591_003_0	4	1	2														00000000001100	Opiate Use Disorder	Chronic Pain Syndrome				2	2			2		13a;14c;		2		1	1		1	200.00
H5591	005	0	1	02	01	H5591_005_0	5	3	2														00000000001100	History of Falls	Hip Fracture				2	2			2		14c;	1	2		1	1		1	250.00
H5591	005	0	1	02	01	H5591_005_0	5	2	3								00000100010000000000																2		13i;	2	2		2			2	
H5591	005	0	1	02	01	H5591_005_0	5	1	2														00000000001100	Opiate Use DIsorder	Chronic Pain Syndrome				2	2			2		13a;14c;	1	2		1	1		1	200.00
H5591	006	1	1	02	01	H5591_006_1	5	1	2														00000000001100	Opiate Use DIsorder	Chronic Pain Syndrome				2	2			2		13a;14c;	1	2		1	1		1	200.00
H5591	006	1	1	02	01	H5591_006_1	5	3	2														00000000001100	History of Falls	Hip Fracture				2	2			2		14c;	1	2		1	1		1	250.00
H5591	006	1	1	02	01	H5591_006_1	5	2	3								00000100010000000000																2		13i;	2	2		2			2	
H5591	006	2	1	02	01	H5591_006_2	5	2	3								00000100010000000000																2		13i;	2	2		2			2	
H5591	006	2	1	02	01	H5591_006_2	5	1	2														00000000001100	Opiate Use DIsorder	Chronic Pain Syndrome				2	2			2		13a;14c;	1	2		1	1		1	200.00
H5591	006	2	1	02	01	H5591_006_2	5	3	2														00000000001100	History of Falls	Hip Fracture				2	2			2		14c;	1	2		1	1		1	250.00
H5591	006	4	1	02	01	H5591_006_4	5	3	2														00000000001100	History of Falls	Hip Fracture				2	2			2		14c;	1	2		1	1		1	250.00
H5591	006	4	1	02	01	H5591_006_4	5	1	2														00000000001100	Opiate Use DIsorder	Chronic Pain Syndrome				2	2			2		13a;14c;	1	2		1	1		1	200.00
H5591	006	4	1	02	01	H5591_006_4	5	2	3								00000100010000000000																2		13i;	2	2		2			2	
H5591	006	5	1	02	01	H5591_006_5	6	3	2														00000000001100	History of Falls	Hip Fracture				2	2			2		14c;	1	2		1	1		1	250.00
H5591	006	5	1	02	01	H5591_006_5	6	2	3								00000100010000000000																2		13i;	2	2		2			2	
H5591	006	5	1	02	01	H5591_006_5	6	1	2														00000000001100	Opiate Use DIsorder	Chronic Pain Syndrome				2	2			2		13a;14c;	1	2		1	1		1	200.00
H5591	007	0	1	01	01	H5591_007_0	5	1	2														00000000001100	Opiate Use Disorder	Chronic Pain Syndrome				2	2			2		13a;14c;		2		1	1		1	200.00
H5591	007	0	1	01	01	H5591_007_0	5	2	3								00000100010000000000																2		13i;		2		2			2	
H5591	007	0	1	01	01	H5591_007_0	5	3	2														00000000001100	History of Falls	Hip Fracture				2	2			2		14c;		2		1	1		1	250.00
H5591	009	0	1	01	01	H5591_009_0	5	1	2														00000000001100	Opiate Use DIsorder	Chronic Pain Syndrome				2	2			2		13a;14c;		2		1	1		1	200.00
H5591	009	0	1	01	01	H5591_009_0	5	2	3								00000100010000000000																2		13i;		2		2			2	
H5591	009	0	1	01	01	H5591_009_0	5	3	2														00000000001100	History of Falls	Hip Fracture				2	2			2		14c;		2		1	1		1	250.00
H5591	013	0	1	01	01	H5591_013_0	6	1	2														00000000001100	Opiate Use DIsorder	Chronic Pain Syndrome				2	2			2		13a;14c;		2		1	1		1	200.00
H5591	013	0	1	01	01	H5591_013_0	6	2	3								00000100010000000000																2		13i;		2		2			2	
H5591	013	0	1	01	01	H5591_013_0	6	3	2														00000000001100	History of Falls	Hip Fracture				2	2			2		14c;		2		1	1		1	250.00
H5591	015	1	1	02	01	H5591_015_1	5	1	2														00000000001100	Opiate Use DIsorder	Chronic Pain Syndrome				2	2			2		13a;14c;	1	2		1	1		1	200.00
H5591	015	1	1	02	01	H5591_015_1	5	2	3								00000100010000000000																2		13i;	2	2		2			2	
H5591	015	1	1	02	01	H5591_015_1	5	3	2														00000000001100	History of Falls	Hip Fracture				2	2			2		14c;	1	2		1	1		1	250.00
H5591	015	2	1	02	01	H5591_015_2	5	1	2														00000000001100	Opiate Use DIsorder	Chronic Pain Syndrome				2	2			2		13a;14c;	1	2		1	1		1	200.00
H5591	015	2	1	02	01	H5591_015_2	5	3	2														00000000001100	History of Falls	Hip Fracture				2	2			2		14c;	1	2		1	1		1	250.00
H5591	015	2	1	02	01	H5591_015_2	5	2	3								00000100010000000000																2		13i;	2	2		2			2	
H5593	001	0	1	01	01	H5593_001_0	4	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H5593	801	0	1	01	01	H5593_801_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5593	802	0	1	01	01	H5593_802_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5594	028	0	1	01	01	H5594_028_0	7	1	3								00001101000000000000																2		13i;		2		2			2	
H5594	029	0	1	01	01	H5594_029_0	7	1	3								00000000000010000000																2		13i;		2		2			2	
H5599	003	0	1	01	01	H5599_003_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	600.00
H5599	008	0	1	01	01	H5599_008_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	600.00
H5608	001	0	1	01	01	H5608_001_0	7	1	3								00001000000000000000																1	001	13b;		1	13b;	2			1	140.00
H5608	002	0	1	01	01	H5608_002_0	9	1	3								00001000000000000000																1	001	13b;		1	13b;	2			1	140.00
H5619	001	0	1	01	01	H5619_001_0	4	1	3								00000001000000000000																1	001	13c;		2		2			2	
H5619	003	0	1	01	01	H5619_003_0	4	1	1	10				01111	6175	6175																	2		13d;		1	13d;	2			1	900.00
H5619	038	0	1	01	01	H5619_038_0	4	1	1	10				01111	12790	12790																	2		13d;		1	13d;	2			1	420.00
H5619	041	0	1	01	01	H5619_041_0	6	1	3								00000101000010001000	Depression															1	001	13c;		2		2			2	
H5619	046	0	1	01	01	H5619_046_0	7	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H5619	046	0	1	01	01	H5619_046_0	7	1	3								00000101000010001000	Depression															1	001	13c;		2		2			2	
H5619	047	0	1	01	01	H5619_047_0	7	1	3								00000101000010001000	Depression															1	001	13c;		2		2			2	
H5619	054	0	1	01	01	H5619_054_0	5	1	1	10				01111	21890	21890																	2		13d;		1	13d;	2			1	600.00
H5619	057	0	1	01	01	H5619_057_0	7	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H5619	057	0	1	01	01	H5619_057_0	7	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H5619	059	0	1	01	01	H5619_059_0	6	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H5619	059	0	1	01	01	H5619_059_0	6	1	3								00000100000010000000																1	001	10b;13i;		1	10b;13i;	2			2	
H5619	061	0	1	01	01	H5619_061_0	7	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H5619	061	0	1	01	01	H5619_061_0	7	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H5619	063	0	1	01	01	H5619_063_0	6	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H5619	063	0	1	01	01	H5619_063_0	6	1	3								00000100000010000000																1	001	10b;13i;		1	10b;13i;	2			2	
H5619	066	0	1	01	01	H5619_066_0	6	1	3								00000001000000000000																1	001	13c;		1	13c;	2			2	
H5619	071	0	1	01	01	H5619_071_0	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H5619	073	0	1	01	01	H5619_073_0	7	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H5619	075	0	1	01	01	H5619_075_0	7	1	1	10				01111	6199	6199																	2		13d;		1	13d;	2			1	420.00
H5619	075	0	1	01	01	H5619_075_0	7	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	1000.00
H5619	076	0	1	01	01	H5619_076_0	7	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	1000.00
H5619	076	0	1	01	01	H5619_076_0	7	1	1	10				01111	857	857																	2		13d;		1	13d;	2			1	420.00
H5619	082	0	1	01	01	H5619_082_0	4	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		1	13d;	2			2	
H5619	082	0	1	01	01	H5619_082_0	4	1	1	10				01111	27654	27654																	2		13d;		1	13d;	2			1	900.00
H5619	087	0	1	01	01	H5619_087_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H5619	093	0	1	01	01	H5619_093_0	5	1	1	10				01111	15880	15880																	2		13d;		1	13d;	2			1	420.00
H5619	097	0	1	01	01	H5619_097_0	8	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H5619	097	0	1	01	01	H5619_097_0	8	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H5619	100	0	1	01	01	H5619_100_0	8	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H5619	100	0	1	01	01	H5619_100_0	8	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H5619	111	0	1	01	01	H5619_111_0	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H5619	113	0	1	01	01	H5619_113_0	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H5619	123	0	1	01	01	H5619_123_0	6	1	1	10				01111	13672	13672																	2		13d;		1	13d;	2			1	600.00
H5619	123	0	1	01	01	H5619_123_0	6	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	500.00
H5619	126	0	1	01	01	H5619_126_0	7	1	1	10				01111	2037	2037																	2		13d;		1	13d;	2			1	420.00
H5619	126	0	1	01	01	H5619_126_0	7	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	1000.00
H5619	134	0	1	01	01	H5619_134_0	7	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	1000.00
H5619	134	0	1	01	01	H5619_134_0	7	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		1	13d;	2			2	
H5619	136	1	1	01	01	H5619_136_1	6	1	1	10				01111	1549	1549																	2		13d;		1	13d;	2			1	900.00
H5619	136	1	1	01	01	H5619_136_1	6	2	3								00011101000010001110	Chronic Kidney Disease	Respiratory Failure	Depression													1	001	13i;		1	13i;	2			2	
H5619	136	2	1	01	01	H5619_136_2	5	3	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		1	13d;	2			2	
H5619	136	2	1	01	01	H5619_136_2	5	2	3								00000100000010000000																1	001	10b;13i;14c;		1	10b;13i;14c;	2			2	
H5619	136	2	1	01	01	H5619_136_2	5	1	1	10				01111	1322	1322																	2		13d;		1	13d;	2			1	900
H5619	136	3	1	01	01	H5619_136_3	6	1	1	10				01111	627	627																	2		13d;		1	13d;	2			1	900.00
H5619	136	3	1	01	01	H5619_136_3	6	2	3								00011101000010001110	Chronic Kidney Disease	Respiratory Failure	Depression													1	001	14c;		1	14c;	2			2	
H5619	136	4	1	01	01	H5619_136_4	7	1	1	10				01111	8142	8142																	2		13d;		1	13d;	2			1	900.00
H5619	136	4	1	01	01	H5619_136_4	7	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	1000.00
H5619	136	4	1	01	01	H5619_136_4	7	3	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		1	13d;	2			2	
H5619	137	0	1	01	01	H5619_137_0	4	1	3								00000001000000000000																1	001	13c;		2		2			2	
H5619	139	1	1	01	01	H5619_139_1	6	1	3								00000101000010001000	Depression															1	001	13c;		2		2			2	
H5619	139	1	1	01	01	H5619_139_1	6	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H5619	139	2	1	01	01	H5619_139_2	6	1	3								00000101000010001000	Depression															1	001	13c;		2		2			2	
H5619	139	2	1	01	01	H5619_139_2	6	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H5619	140	1	1	01	01	H5619_140_1	7	1	3								00000101000010001000	Depression															1	001	13c;		2		2			2	
H5619	140	2	1	01	01	H5619_140_2	7	1	3								00000101000010001000	Depression															1	001	13c;		2		2			2	
H5619	141	0	1	01	01	H5619_141_0	5	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000
H5619	144	1	1	01	01	H5619_144_1	6	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H5619	144	1	1	01	01	H5619_144_1	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H5619	144	2	1	01	01	H5619_144_2	6	1	3								01001111000011001000	Chronic Kidney Disease															1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H5628	001	0	1	01	01	H5628_001_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	1080.00
H5628	007	0	1	01	01	H5628_007_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	960.00
H5628	008	0	1	01	01	H5628_008_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	1080.00
H5628	009	0	1	01	01	H5628_009_0	6	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	960.00
H5628	010	0	1	01	01	H5628_010_0	6	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	960.00
H5628	011	0	1	01	01	H5628_011_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	1080.00
H5628	012	0	1	01	01	H5628_012_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	1080.00
H5644	002	0	1	01	01	H5644_002_0	8	1	3								00010000010000000000																1	001	10b;13a;14c;		2		1	2	13a;	2	
H5649	001	0	1	01	01	H5649_001_0	6	1	3								00001111000010010000																2		13b;13i;		1	13b;13i;	2			2	
H5649	002	0	1	01	01	H5649_002_0	6	1	3								00001111000010010000																2		13b;13i;		1	13b;13i;	2			2	
H5649	004	0	1	01	01	H5649_004_0	6	1	3								00001111000010010000																2		13b;13i;		1	13b;13i;	2			2	
H5649	006	0	1	01	01	H5649_006_0	6	1	3								00001111000010010000																2		13b;13i;		1	13b;13i;	2			2	
H5649	008	0	1	01	01	H5649_008_0	6	1	3								00001111000010010000																2		13b;13i;		1	13b;13i;	2			2	
H5649	009	0	1	01	01	H5649_009_0	6	1	3								00001111000010010000																2		13b;13i;		1	13b;13i;	2			2	
H5649	018	0	1	01	01	H5649_018_0	6	1	3								00001111000010010000																2		13b;13i;		1	13b;13i;	2			2	
H5649	019	0	1	01	01	H5649_019_0	6	1	3								00001111000010010000																2		13b;13i;		1	13b;13i;	2			2	
H5774	003	0	1	01	01	H5774_003_0	7	1	3								01111111111111110000																2		13i;14c;		2		2			2	
H5774	005	0	1	01	01	H5774_005_0	8	1	3								01111111111111110000																2		13i;14c;		2		2			2	
H5774	022	0	1	01	01	H5774_022_0	8	1	3								01111111111111110000																2		13i;14c;		2		2			2	
H5774	022	0	1	01	01	H5774_022_0	8	2	2														10110000001111	Oncology Patients with Active Chemo by Infusion or systemic radiothera	Acute Stroke	Hip, knee or open heart surgery	COPD patients with supplemental oxygen dependency	Bedridden patients	2	2			2		14c;		2		2			2	
H5774	022	0	1	01	01	H5774_022_0	8	3	2														00000000001000	Bedridden patients with specific essential services requirements									2		14c;		2		2			2	
H5774	024	0	1	01	01	H5774_024_0	10	2	1	10				10000	23226	23226																	2		10b;		2		2			2	
H5774	024	0	1	01	01	H5774_024_0	10	3	2														00000000001000	Bedridden patients with specific essential services requirements									2		14c;		2		2			2	
H5774	024	0	1	01	01	H5774_024_0	10	1	2														10110000001111	Oncology Patients with Active Chemo by Infusion or systemic radiotherapy	Acute Stroke	Hip, knee or open heart surgery	COPD patients with supplemental oxigen dependency	Bedridden patients	2	2			2		14c;		2		2			2	
H5774	025	0	1	01	01	H5774_025_0	8	3	2														00000000001000	Bedridden patients with specific essential services requirements									2		14c;		2		2			2	
H5774	025	0	1	01	01	H5774_025_0	8	2	3								01111111111111110000																2		13i;14c;		2		2			2	
H5774	025	0	1	01	01	H5774_025_0	8	1	2														10110000001111	Oncology Patients with Active Chemo by Infusion or systemic radiotherapy	Acute Stroke	Hip, knee or open heart surgery	COPD patients with supplemental oxygen dependency	Bedridden patients	2	2			2		14c;		2		2			2	
H5774	026	0	1	01	01	H5774_026_0	7	1	2														10110000001111	Oncology Patients with Active Chemo by Infusion or systemic radiotherapy	Acute Stroke	Hip, knee or open heart  Surgery	COPD patients with supplemental oxygen dependency	Bedridden patients	2	2			2		14c;		2		2			2	
H5774	026	0	1	01	01	H5774_026_0	7	2	2														00000000001000	Bedridden patients with specific essential services requirements									2		14c;		2		2			2	
H5774	028	0	1	01	01	H5774_028_0	9	2	2														00000000001000	Bedridden patients with specific essential services requirements									2		14c;		2		2			2	
H5774	028	0	1	01	01	H5774_028_0	9	1	2														10110000001111	Oncology Patients with Active Chemo by Infusion or systemic radiotherapy	Acute Stroke	Hip, knee or open heart surgery	COPD patients with supplemental oxygen dependency	Bedridden patients	2	2			2		14c;		2		2			2	
H5774	031	0	1	02	01	H5774_031_0	8	1	2														10110000001111	Oncology Patients with Active Chemo by Infusion or systemic radiotherapy	Acute Stroke	Hip, knee or open heart surgery	COPD patients with supplemental oxygen dependency	Bedridden patients	2	2			2		14c;	2	2		2			2	
H5774	035	0	1	01	01	H5774_035_0	8	2	3								01111111111111110000																2		13i;14c;		2		2			2	
H5774	035	0	1	01	01	H5774_035_0	8	3	2														00000000001000	Bedridden patients with specific essential services requirements									2		14c;		2		2			2	
H5774	035	0	1	01	01	H5774_035_0	8	1	2														10110000001111	Oncology Patients with Active Chemo by Infusion or systemic radiotherapy	Acute Stroke	Hip, knee or open heart  Surgery	COPD patients with supplemental oxygen dependency	Bedridden patients	2	2			2		14c;		2		2			2	
H5779	006	0	1	01	01	H5779_006_0	5	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	2			1	600.00
H5779	007	0	1	01	01	H5779_007_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	2			2	
H5793	017	0	1	02	01	H5793_017_0	4	1	1	10				01111	137895	137895																	2		13i;14c;	1	1	13i;14c;	2			2	
H5793	801	0	1	01	01	H5793_801_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5793	802	0	1	01	01	H5793_802_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H5810	001	0	1	01	01	H5810_001_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	1020.00
H5810	013	0	1	01	01	H5810_013_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	1020.00
H5810	014	0	1	01	01	H5810_014_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	960.00
H5823	006	0	1	01	01	H5823_006_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	1620.00
H5823	010	0	1	01	01	H5823_010_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	1080.00
H5823	011	0	1	01	01	H5823_011_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	960.00
H5826	006	0	1	01	01	H5826_006_0	4	3	2														10000000001111	Hypertension	Prehypertension	Congestive Heart Failure (CHF)	Morbid obesity	Obesity with co-occurring disorders	2	2			1	001	13b;		2		2			2	
H5826	006	0	1	01	01	H5826_006_0	4	1	2														01000000000000										2		7f;		2		2			2	
H5826	006	0	1	01	01	H5826_006_0	4	2	2														00111000011100	Frailty or osteoporosis	History of acute MI or angina or Parkinson's or fall risk or seizures				2	2			1	001	14c;		2		2			2	
H5826	008	0	1	01	01	H5826_008_0	5	3	2														10000000001111	Hypertension	Prehypertension	Congestive Heart Failure (CHF)	Morbid obesity	Obesity with co-occurring disorders	2	2			1	001	13b;		2		2			2	
H5826	008	0	1	01	01	H5826_008_0	5	1	2														01000000000000										2		7f;		2		2			2	
H5826	008	0	1	01	01	H5826_008_0	5	2	2														00111000011100	Frailty or osteoporosis	History of acute MI or angina or Parkinson's or fall risk or seizures				2	2			1	001	14c;		2		2			2	
H5826	009	0	1	01	01	H5826_009_0	5	1	2														01000000000000										2		7f;		2		2			2	
H5826	009	0	1	01	01	H5826_009_0	5	2	2														00111000011100	Frailty or osteoporosis	History of acute MI or angina or Parkinson's or fall risk or seizures				2	2			1	001	14c;		2		2			2	
H5826	009	0	1	01	01	H5826_009_0	5	3	2														10000000001111	Hypertension	Prehypertension	Congestive Heart Failure (CHF)	Morbid obesity	Obesity with co-occurring disorders	2	2			1	001	13b;		2		2			2	
H5826	010	0	1	01	01	H5826_010_0	7	2	2														00111000011100	Frailty or osteoporosis	History of acute MI or angina or Parkinson's or fall risk or seizures				2	2			1	001	14c;		2		2			2	
H5826	010	0	1	01	01	H5826_010_0	7	1	2														10000000001111	Hypertension	Prehypertension	Congestive Heart Failure (CHF)	Morbid obesity	Obesity with co-occurring disorders	2	2			1	001	13b;		2		2			2	
H5826	010	0	1	01	01	H5826_010_0	7	3	2														01000000000000										2		7f;		2		2			2	
H5826	014	0	1	01	01	H5826_014_0	5	3	2														10000000001111	Hypertension	Prehypertension	Congestive Heart Failure (CHF)	Morbid obesity	Obesity with co-occurring disorders	2	2			1	001	13b;		2		2			2	
H5826	014	0	1	01	01	H5826_014_0	5	2	2														00111000011100	Frailty or osteoporosis	History of acute MI or angina or Parkinson's or fall risk or seizures				2	2			1	001	14c;		2		2			2	
H5826	014	0	1	01	01	H5826_014_0	5	1	2														01000000000000										2		7f;		2		2			2	
H5826	016	0	1	01	01	H5826_016_0	5	3	2														10000000001111	Hypertension	Prehypertension	Congestive Heart Failure (CHF)	Morbid obesity	Obesity with co-occurring disorders	2	2			1	001	13b;		2		2			2	
H5826	016	0	1	01	01	H5826_016_0	5	1	2														01000000000000										2		7f;		2		2			2	
H5826	016	0	1	01	01	H5826_016_0	5	2	2														00111000011100	Frailty or osteoporosis	History of acute MI or angina or Parkinsons or fall risk or seizures				2	2			1	001	14c;		2		2			2	
H5828	001	0	1	01	01	H5828_001_0	5	1	1	10				01111	210	210																	2		13i;		2		2			2	
H5828	001	0	1	01	01	H5828_001_0	5	2	1	10				01111	210	210																	2		13i;		2		2			2	
H5828	002	0	1	01	01	H5828_002_0	7	5	1	10				01111	11526	11526																	2		13i-O;		2		2			2	
H5828	002	0	1	01	01	H5828_002_0	7	2	1	10				01111	11526	11526																	2		13i;		2		2			2	
H5828	002	0	1	01	01	H5828_002_0	7	3	1	10				01111	11526	11526																	2		13i;		2		2			2	
H5828	002	0	1	01	01	H5828_002_0	7	1	1	10				01111	11526	3919																	2		13i;		2		2			2	
H5828	002	0	1	01	01	H5828_002_0	7	4	1	10				01111	11526	11526																	2		13i;		2		2			2	
H5828	005	0	1	02	01	H5828_005_0	9	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;	2	2		2			2	
H5828	006	0	1	02	01	H5828_006_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;	2	2		2			2	
H5828	008	0	1	01	01	H5828_008_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H5843	001	0	1	01	01	H5843_001_0	12	2	1	01	1000000000				20	10																	2		13d;13i;		2		2			1	2300.00
H5843	001	0	1	01	01	H5843_001_0	12	1	1	01	0100000000				25	10																	1	101	13d;		2		2			2	
H5843	002	0	1	01	01	H5843_002_0	12	1	1	01	0100000000				25	10																	1	101	13d;		2		2			2	
H5843	002	0	1	01	01	H5843_002_0	12	2	1	01	1000000000				20	10																	2		13d;13i;		2		2			1	2300.00
H5843	004	0	1	01	01	H5843_004_0	12	2	1	01	1000000000				20	5																	2		13d;13i;		2		2			1	2300.00
H5843	004	0	1	01	01	H5843_004_0	12	1	1	01	0100000000				20	5																	1	101	13d;		2		2			2	
H5843	005	0	1	01	01	H5843_005_0	12	1	1	01	0100000000				30	25																	1	101	13d;		2		2			2	
H5843	005	0	1	01	01	H5843_005_0	12	2	1	01	1000000000				20	10																	2		13d;13i;		2		2			1	2300.00
H5852	001	0	1	01	01	H5852_001_0	4	1	2														00000000001000	AIDS-Related Neuropathy									2		14c;		2		2			2	
H5854	012	0	1	02	01	H5854_012_0	12	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;	2	2		2			2	
H5854	013	0	1	01	01	H5854_013_0	6	3	1	10				01111	10066	10066																	2		13i-O;		2		2			2	
H5854	013	0	1	01	01	H5854_013_0	6	4	1	10				01111	10066	10066																	2		13i;		2		2			2	
H5854	013	0	1	01	01	H5854_013_0	6	5	1	10				01111	10066	10066																	2		13i;		2		2			2	
H5854	013	0	1	01	01	H5854_013_0	6	1	1	10				01111	10066	10066																	2		13i;		2		2			2	
H5854	013	0	1	01	01	H5854_013_0	6	2	1	10				01111	10066	10066																	2		13i;		2		2			2	
H5854	015	0	1	01	01	H5854_015_0	6	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H5859	001	0	1	02	01	H5859_001_0	6	2	2														00000100000000										2		13b;	2	2		2			2	
H5859	001	0	1	02	01	H5859_001_0	6	1	1	10				01110	13756	7703																	2		13i;	2	2		2			1	0.00
H5883	001	1	1	02	01	H5883_001_1	5	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	2	2		2			1	100.00
H5883	001	2	1	02	01	H5883_001_2	6	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	2	2		2			1	100.00
H5883	001	3	1	02	01	H5883_001_3	5	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	2	2		2			1	100.00
H5883	001	4	1	02	01	H5883_001_4	6	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	2	2		2			1	100.00
H5883	001	5	1	02	01	H5883_001_5	5	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	2	2		2			1	100.00
H5883	002	1	1	02	01	H5883_002_1	8	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	2	2		2			1	100.00
H5883	002	2	1	02	01	H5883_002_2	8	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	2	2		2			1	100.00
H5883	002	3	1	02	01	H5883_002_3	8	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	2	2		2			1	100.00
H5883	002	4	1	02	01	H5883_002_4	8	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	2	2		2			1	100.00
H5883	002	7	1	02	01	H5883_002_7	8	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	2	2		2			1	100.00
H5883	003	1	1	02	01	H5883_003_1	8	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	2	2		2			1	100.00
H5883	003	2	1	02	01	H5883_003_2	8	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	2	2		2			1	100.00
H5883	003	3	1	02	01	H5883_003_3	8	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	2	2		2			1	100.00
H5883	003	4	1	02	01	H5883_003_4	8	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	2	2		2			1	100.00
H5883	003	5	1	02	01	H5883_003_5	8	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	2	2		2			1	100.00
H5883	007	0	1	01	01	H5883_007_0	8	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;		2		2			1	100.00
H5883	012	1	1	02	01	H5883_012_1	8	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	2	2		2			1	400.00
H5883	012	2	1	02	01	H5883_012_2	8	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	2	2		2			1	400.00
H5883	014	1	1	02	01	H5883_014_1	8	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	2	2		2			1	300.00
H5883	014	2	1	02	01	H5883_014_2	8	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	2	2		2			1	300.00
H5883	014	4	1	02	01	H5883_014_4	8	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	2	2		2			1	100.00
H5883	014	5	1	02	01	H5883_014_5	8	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	2	2		2			1	300.00
H5926	001	0	1	01	01	H5926_001_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	960.00
H5926	005	0	1	01	01	H5926_005_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	960.00
H5926	006	0	1	01	01	H5926_006_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	960.00
H5928	054	0	1	01	01	H5928_054_0	8	1	3								00000000000000001100	Independence and Safe Mobility with AAA	Groceries														2		13i;13i-O;		1	13i;13i-O;	2			2	
H5932	001	0	1	01	01	H5932_001_0	8	1	3								00000001010000001000	Chronic Obstructive Pulmonary Disease															1	001	13i;		1	13i;	2			2	
H5932	012	0	1	01	01	H5932_012_0	8	1	3								00000001010000001000	Chronic Obstructive Pulmonary Disease															1	001	13i;		1	13i;	2			2	
H5943	001	0	1	02	01	H5943_001_0	5	1	3								00000000010000001000	Peritoneal Dialysis Catheter or Peritoneal Dialysis Prescription															2		13i;13i-O;	2	2		2			2	
H5945	001	0	1	01	01	H5945_001_0	10	1	3								00000000010000000000																1	001	13c;		2		2			1	250.00
H5945	002	0	1	01	01	H5945_002_0	10	1	3								00000000010000000000																1	001	13c;		2		2			1	250.00
H5945	008	0	1	01	01	H5945_008_0	10	1	3								00000000010000000000																1	001	13c;		2		2			1	250.00
H5945	009	0	1	01	01	H5945_009_0	9	1	3								00000101010000000000																1	001	13c;13i;		2		2			1	250.00
H5965	001	0	1	04	01	H5965_001_0	5	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			2	
H5965	002	0	1	04	01	H5965_002_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			2	
H5965	003	0	1	04	01	H5965_003_0	3	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			2	
H5965	004	0	1	04	01	H5965_004_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	1	2	13i;	1	1500.00
H5970	016	0	1	04	01	H5970_016_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5970	020	0	1	04	01	H5970_020_0	5	1	1	10				01111	1662	1662																	2		13d;	1	1	13d;	2			1	600.00
H5970	024	1	1	04	01	H5970_024_1	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5970	024	2	1	04	01	H5970_024_2	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H5970	026	0	1	04	01	H5970_026_0	5	1	1	10				01111	491	491																	2		13d;	1	1	13d;	2			1	900.00
H5991	008	0	1	01	01	H5991_008_0	8	1	3								01111111111111110000																2		13i;		1	13i;	2			2	
H5991	010	0	1	01	01	H5991_010_0	7	1	1	10				01111	1617	1617																	2		13b;		2		2			1	147.00
H5992	007	0	1	01	01	H5992_007_0	6	1	3								00000010000001001000	Nursing Home Certifiable															1	001	13i;		2		2			1	600.00
H5992	008	0	1	01	01	H5992_008_0	5	1	3								00000010000001001000	Nursing Home Certifiable															1	001	13i;		2		2			1	600.00
H6062	005	0	1	01	01	H6062_005_0	7	1	3								00001101000000000000																2		13i;		2		2			2	
H6062	006	0	1	01	01	H6062_006_0	8	1	3								00001101000000000000																2		13i;		2		2			2	
H6154	001	0	1	02	01	H6154_001_0	5	1	3								00011111111010110000																1	001	13i;14c;	2	2		2			2	
H6154	002	0	1	02	01	H6154_002_0	8	1	3								00011111111010110000																2		13i;	2	2		2			2	
H6158	001	0	1	01	01	H6158_001_0	5	1	3								00010001000000011100	Coronary artery disease	Sjgrens Syndrome														2		16a;16b;		2		2			2	
H6158	002	0	1	01	01	H6158_002_0	5	1	3								00010001000000011100	Coronary artery disease	Sjgrens Syndrome														2		16a;16b;		2		2			2	
H6237	006	0	1	01	01	H6237_006_0	4	1	2														01000000000000										2		7f;		2		2			2	
H6237	006	0	1	01	01	H6237_006_0	4	2	2														00000000001000	Pre-diabetes									2		14c;		2		2			2	
H6237	006	0	1	01	01	H6237_006_0	4	3	3								01111111111111110000																1	001	13i;13i-O;		2		2			2	
H6237	007	1	1	01	01	H6237_007_1	7	2	2														00000000001000	Pre-diabetes									2		14c;		2		2			2	
H6237	007	1	1	01	01	H6237_007_1	7	3	3								01111111111111110000																1	001	13i;13i-O;		2		2			2	
H6237	007	1	1	01	01	H6237_007_1	7	1	2														01000000000000										2		7f;		2		2			2	
H6237	007	2	1	01	01	H6237_007_2	8	1	2														01000000000000										2		7f;		2		2			2	
H6237	007	2	1	01	01	H6237_007_2	8	2	2														00000000001000	Pre-diabetes									2		14c;		2		2			2	
H6237	007	2	1	01	01	H6237_007_2	8	3	3								01111111111111110000																1	001	13i;13i-O;		2		2			2	
H6237	007	3	1	01	01	H6237_007_3	8	3	3								01111111111111110000																1	001	13i;13i-O;		2		2			2	
H6237	007	3	1	01	01	H6237_007_3	8	1	2														01000000000000										2		7f;		2		2			2	
H6237	007	3	1	01	01	H6237_007_3	8	2	2														00000000001000	Pre-diabetes									2		14c;		2		2			2	
H6237	008	1	1	01	01	H6237_008_1	7	1	2														01000000000000										2		7f;		2		2			2	
H6237	008	1	1	01	01	H6237_008_1	7	3	3								01111111111111110000																1	001	13i;13i-O;		2		2			2	
H6237	008	1	1	01	01	H6237_008_1	7	2	2														00000000001000	Pre-diabetes									2		14c;		2		2			2	
H6237	008	2	1	01	01	H6237_008_2	8	3	3								01111111111111110000																1	001	13i;13i-O;		2		2			2	
H6237	008	2	1	01	01	H6237_008_2	8	2	2														00000000001000	Pre-diabetes									2		14c;		2		2			2	
H6237	008	2	1	01	01	H6237_008_2	8	1	2														01000000000000										2		7f;		2		2			2	
H6237	008	3	1	01	01	H6237_008_3	7	3	3								01111111111111110000																1	001	13i;13i-O;		2		2			2	
H6237	008	3	1	01	01	H6237_008_3	7	1	2														01000000000000										2		7f;		2		2			2	
H6237	008	3	1	01	01	H6237_008_3	7	2	2														00000000001000	Pre-diabetes									2		14c;		2		2			2	
H6316	001	0	1	01	01	H6316_001_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H6316	002	0	1	01	01	H6316_002_0	8	5	1	10				01111	24	24																	2		13i;		2		2			2	
H6316	002	0	1	01	01	H6316_002_0	8	4	1	10				01111	24	24																	2		13i;		2		2			2	
H6316	002	0	1	01	01	H6316_002_0	8	3	1	10				01111	24	8																	2		13i;		2		2			2	
H6316	002	0	1	01	01	H6316_002_0	8	1	1	10				01111	24	24																	2		13i;		2		2			2	
H6316	002	0	1	01	01	H6316_002_0	8	2	1	10				01111	24	24																	2		13i-O;		2		2			2	
H6351	003	0	1	01	01	H6351_003_0	10	1	3								00000101010000001000	COPD															2		14c;		2		2			2	
H6351	004	0	1	01	01	H6351_004_0	9	1	3								00000101010000001000	COPD															2		13c;14c;		2		2			2	
H6351	005	0	1	01	01	H6351_005_0	9	1	3								00000101010000001000	COPD															2		14c;		2		2			2	
H6396	001	0	1	01	01	H6396_001_0	4	1	2														01000100000000						2	2			1	001	10b;		2		2			2	
H6396	004	0	1	01	01	H6396_004_0	5	1	2														01000100000000						2	2			1	001	10b;		2		2			2	
H6396	011	0	1	01	01	H6396_011_0	4	1	2														01000100000000						2	2			1	001	10b;		2		2			2	
H6396	012	0	1	01	01	H6396_012_0	5	1	2														01000100000000						2	2			1	001	10b;		2		2			2	
H6396	013	0	1	01	01	H6396_013_0	5	1	2														01000100000000						2	2			1	001	10b;		2		2			2	
H6399	001	0	1	01	01	H6399_001_0	3	1	3								01111111111111111100	Hyperlipidemia	Hypertension														2		13i;		2		2			2	
H6446	011	0	1	01	01	H6446_011_0	4	1	3								01111111111111110000																1	001	13b;13d;13i;14c;		1	13b;13d;13i;14c;	2			1	200.00
H6446	012	0	1	01	01	H6446_012_0	4	1	3								01111111111111110000																1	001	13b;13d;13i;14c;		1	13b;13d;13i;14c;	2			1	200.00
H6446	013	0	1	01	01	H6446_013_0	4	1	3								01111111111111110000																1	001	13b;13d;13i;14c;		1	13b;13d;13i;14c;	2			1	200.00
H6446	014	0	1	01	01	H6446_014_0	4	1	3								01111111111111110000																1	001	13b;13d;13i;14c;		1	13b;13d;13i;14c;	1	2	13i;	1	800.00
H6446	015	0	1	01	01	H6446_015_0	4	1	3								01111111111111110000																1	001	13b;13d;13i;14c;		1	13b;13d;13i;14c;	1	2	13i;	1	800.00
H6446	016	0	1	01	01	H6446_016_0	4	1	3								01111111111111110000																1	001	13b;13d;13i;14c;		1	13b;13d;13i;14c;	1	2	13i;	1	800.00
H6446	017	0	1	01	01	H6446_017_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	2			2	
H6446	018	0	1	01	01	H6446_018_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	2			2	
H6550	004	0	1	01	01	H6550_004_0	3	1	3								01111111111111110000																1	001	13i;		1	13i;	2			2	
H6550	009	0	1	01	01	H6550_009_0	3	1	3								01111111111111110000																1	001	13i;		1	13i;	2			1	600.00
H6594	003	0	1	04	01	H6594_003_0	7	1	3								01111111111111110000																1	001	13i;	1	1	13i;	1	2	13i;	1	1200.00
H6594	004	0	1	04	01	H6594_004_0	6	1	3								01111111111111110000																1	001	13i;	1	1	13i;	1	1		1	600.00
H6595	002	1	1	01	01	H6595_002_1	4	1	1	10				01111	11990	10192																	2		13d;		1	13d;	2			2	
H6595	002	2	1	01	01	H6595_002_2	4	1	1	10				01111	1654	1406																	2		13d;		1	13d;	2			2	
H6622	004	0	1	01	01	H6622_004_0	4	1	3								00000101000010001000	Depression															1	001	13c;		2		2			2	
H6622	004	0	1	01	01	H6622_004_0	4	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H6622	005	0	1	01	01	H6622_005_0	4	1	3								00000101000010001000	Depression															1	001	13c;		2		2			2	
H6622	008	0	1	01	01	H6622_008_0	7	1	1	10				01111	3712	3712																	2		13d;		1	13d;	2			1	600.00
H6622	008	0	1	01	01	H6622_008_0	7	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	1000.00
H6622	010	0	1	01	01	H6622_010_0	5	1	3								00000101000010001000	Depression															1	001	13c;		2		2			2	
H6622	015	0	1	01	01	H6622_015_0	4	1	1	10				01111	15708	15708																	2		13d;		1	13d;	2			1	600.00
H6622	018	0	1	01	01	H6622_018_0	4	1	1	10				01111	1137	1137																	2		13d;		1	13d;	2			1	600.00
H6622	023	0	1	01	01	H6622_023_0	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H6622	025	0	1	02	01	H6622_025_0	5	1	3								00000101000010001000	Depression															1	001	13c;	1	2		2			2	
H6622	026	0	1	02	01	H6622_026_0	4	1	3								00000101000010001000	Depression															1	001	13c;	1	2		2			2	
H6622	027	0	1	01	01	H6622_027_0	4	2	3								00000101000010001000	Depression															1	001	13c;		1	13c;	2			2	
H6622	027	0	1	01	01	H6622_027_0	4	1	1	10				01111	2821	2821																	2		13d;		1	13d;	2			1	900.00
H6622	033	0	1	01	01	H6622_033_0	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H6622	035	0	1	01	01	H6622_035_0	7	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H6622	036	0	1	01	01	H6622_036_0	7	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H6622	037	0	1	01	01	H6622_037_0	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H6622	048	0	1	01	01	H6622_048_0	4	1	1	10				01111	5365	5365																	2		13d;		1	13d;	2			1	900.00
H6622	049	0	1	01	01	H6622_049_0	4	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	500.00
H6622	051	0	1	01	01	H6622_051_0	4	1	1	10				01111	2115	2115																	2		13d;		1	13d;	2			1	900.00
H6622	057	0	1	01	01	H6622_057_0	5	1	3								00000101000010001000	Depression															1	001	13c;		2		2			2	
H6622	060	0	1	01	01	H6622_060_0	6	1	3								00000101000010001000	Depression															1	001	13c;		2		2			2	
H6622	061	0	1	01	01	H6622_061_0	6	1	3								00000101000010001000	Depression															1	001	13c;		2		2			2	
H6622	063	0	1	01	01	H6622_063_0	4	1	3								00000001000000000000																1	001	13c;		2		2			2	
H6622	064	0	1	01	01	H6622_064_0	9	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	1000.00
H6622	071	0	1	01	01	H6622_071_0	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000.00
H6622	074	1	1	01	01	H6622_074_1	4	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H6622	074	1	1	01	01	H6622_074_1	4	1	3								00000101000010001000	Depression															1	001	13c;		2		2			2	
H6622	074	2	1	01	01	H6622_074_2	4	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H6622	074	2	1	01	01	H6622_074_2	4	1	3								00000101000010001000	Depression															1	001	13c;		2		2			2	
H6622	076	0	1	01	01	H6622_076_0	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000.00
H6622	077	0	1	01	01	H6622_077_0	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	1000.00
H6622	078	1	1	01	01	H6622_078_1	8	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	1000.00
H6622	078	1	1	01	01	H6622_078_1	8	1	1	10				01111	4034	4034																	2		13d;		1	13d;	2			1	420.00
H6622	078	2	1	01	01	H6622_078_2	7	1	1	10				01111	4879	4879																	2		13d;		1	13d;	2			1	420.00
H6622	078	2	1	01	01	H6622_078_2	7	2	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			1	1000.00
H6622	079	0	1	01	01	H6622_079_0	4	1	1	10				01111	1018	1018																	2		13d;		1	13d;	2			1	600.00
H6678	001	0	1	01	01	H6678_001_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H6678	002	0	1	01	01	H6678_002_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	2700.00
H6678	003	0	1	01	01	H6678_003_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H6678	004	0	1	01	01	H6678_004_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	2700.00
H6776	001	0	1	01	01	H6776_001_0	9	1	3								01111111111111111111	Osteoarthritis	Hypertension	Endocrine Disorders	Gastrointestinal Disorders												2		13i;		2		2			2	
H6776	002	0	1	01	01	H6776_002_0	7	1	3								01111111111111111111	Osteoarthritis	Hypertension	Endocrine Disorders	Gastrointestinal Disorders												2		13i;		2		2			2	
H6815	037	0	1	01	01	H6815_037_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	2			2	
H6815	038	0	1	01	01	H6815_038_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	2			2	
H6830	001	0	1	04	01	H6830_001_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			2	
H6830	002	0	1	04	01	H6830_002_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	1	2	13i;	1	1200.00
H6874	001	0	1	04	01	H6874_001_0	10	1	2														00010000000000										2		13c;	1	2		2			2	
H6874	002	0	1	04	01	H6874_002_0	8	1	2														00010000000000										2		13c;	1	2		2			2	
H6874	003	0	1	04	01	H6874_003_0	4	1	2														00010000000000										2		13c;	1	2		2			2	
H6975	002	0	1	01	01	H6975_002_0	5	1	3								01111111111111110000																1	001	13i;13i-O;		1	13i;13i-O;	2			1	1320.00
H6975	004	0	1	01	01	H6975_004_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	2			1	600.00
H6988	004	0	1	01	01	H6988_004_0	13	1	3								01111111111111110000																1	001	13i;		2		2			1	70.00
H7093	002	0	1	04	01	H7093_002_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;	1	2		2			2	
H7149	006	0	1	01	01	H7149_006_0	4	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H7149	801	0	1	01	01	H7149_801_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H7149	802	0	1	01	01	H7149_802_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H7151	001	0	1	01	01	H7151_001_0	12	1	3								01111111111111110000																2		13i-O;		2		1	1		1	240.00
H7151	002	0	1	01	01	H7151_002_0	14	1	3								01111111111111111000	Other Eligible Chronic Conditions															2		13i;13i-O;		2		1	1		1	660.00
H7175	006	0	1	04	01	H7175_006_0	6	1	3								01111111111111110000																1	001	13i;14c;	1	1	13i;14c;	2			2	
H7175	007	0	1	04	01	H7175_007_0	6	1	3								01111111111111110000																1	001	13i;14c;	1	1	13i;14c;	2			2	
H7220	002	0	1	01	01	H7220_002_0	4	1	2														00010000001110	Pneumonia	Kidney and Urinary Tract Infection	Cellulitis and Soft Tissue Infection			2	2			1	011	13d;		2		2			2	
H7220	004	0	1	02	01	H7220_004_0	7	1	2														00010000001110	Pneumonia	Kidney and Urinary Tract Infection	Cellulitis and Soft Tissue Infection			2	2			1	011	13d;	2	2		2			2	
H7220	009	1	1	01	01	H7220_009_1	6	1	2														00010000001110	Pneumonia	Kidney and Urinary Tract Infection	Cellulitis and Soft Tissue Infection			2	2			1	011	13d;		2		2			2	
H7220	009	2	1	01	01	H7220_009_2	6	1	2														00010000001110	Pneumonia	Kidney and Urinary Tract Infection	Cellulitis and Soft Tissue Infection			2	2			1	011	13d;		2		2			2	
H7220	009	3	1	01	01	H7220_009_3	6	1	2														00010000001110	Pneumonia	Kidney and Urinary Tract Infection	Cellulitis and Soft Tissue Infection			2	2			1	011	13d;		2		2			2	
H7220	010	0	1	01	01	H7220_010_0	7	1	2														00010000001110	Pneumonia	Kidney and Urinary Tract Infection	Cellulitis and Soft Tissue Infection			2	2			1	011	13d;		2		2			2	
H7220	011	0	1	02	01	H7220_011_0	8	1	2														00010000001110	Pneumonia	Kidney and Urinary Tract Infection	Cellulitis and Soft Tissue Infection			2	2			1	011	13d;	2	2		2			2	
H7273	001	0	1	04	01	H7273_001_0	12	1	1	01	0100000000				20	5																	1	101	13d;	1	2		2			2	
H7273	001	0	1	04	01	H7273_001_0	12	2	1	01	1000000000				10	5																	2		13d;13i;	1	2		2			1	2300.00
H7273	002	0	1	04	01	H7273_002_0	12	2	1	01	1000000000				20	5																	2		13d;13i;	1	2		2			1	2300.00
H7273	002	0	1	04	01	H7273_002_0	12	1	1	01	0100000000				20	5																	1	101	13d;	1	2		2			2	
H7273	004	0	1	04	01	H7273_004_0	12	1	1	01	0100000000				630	520																	1	101	13d;	1	2		2			2	
H7273	004	0	1	04	01	H7273_004_0	12	2	1	01	1000000000				10	5																	2		13d;13i;	1	2		2			1	2300.00
H7273	005	0	1	04	01	H7273_005_0	12	1	1	01	0100000000				630	520																	1	101	13d;	1	2		2			2	
H7273	005	0	1	04	01	H7273_005_0	12	2	1	01	1000000000				40	20																	2		13d;13i;	1	2		2			1	2300.00
H7284	003	0	1	04	01	H7284_003_0	6	1	1	10				01111	821	821																	2		13d;	1	2		2			1	420.00
H7284	007	0	1	04	01	H7284_007_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H7284	008	0	1	04	01	H7284_008_0	5	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
H7301	002	0	1	04	01	H7301_002_0	4	1	3								01111111111111111100	Hyperlipidemia	Hypertension														2		13i;	1	1	13i;	2			2	
H7301	002	0	1	04	01	H7301_002_0	4	2	2														00000100001000	Hyperlipidemia					2	2			2		10b;13b;	1	1	10b;13b;	2			2	
H7301	006	0	1	04	01	H7301_006_0	4	2	2														00000100001000	Hyperlipidemia					2	2			2		10b;13b;	1	1	10b;13b;	2			2	
H7301	006	0	1	04	01	H7301_006_0	4	1	3								01111111111111111100	Hyperlipidemia	Hypertension														2		13i;	1	1	13i;	2			2	
H7301	801	0	1	04	01	H7301_801_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H7301	803	0	1	04	01	H7301_803_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H7323	002	0	1	04	01	H7323_002_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	1	1		1	600.00
H7323	005	0	1	04	01	H7323_005_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	1	1		1	600.00
H7326	002	0	1	04	01	H7326_002_0	5	1	3								01111111111111110000																1	001	13i;14c;	1	1	13i;14c;	2			2	
H7330	001	0	1	01	01	H7330_001_0	8	1	3								01111111111111110000																2		13i;		2		2			2	
H7330	002	0	1	02	01	H7330_002_0	8	1	3								01111111111111110000																2		13i;	2	2		2			2	
H7330	003	0	1	01	01	H7330_003_0	8	1	3								01111111111111110000																2		13i;		2		2			2	
H7330	004	0	1	02	01	H7330_004_0	9	1	3								01111111111111110000																2		13i;	2	2		2			2	
H7399	001	0	1	01	01	H7399_001_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H7399	002	0	1	01	01	H7399_002_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	2700.00
H7404	001	0	1	04	01	H7404_001_0	6	1	2														00000000010000										2		14c;	1	2		2			2	
H7404	002	0	1	04	01	H7404_002_0	3	1	2														00000000010000										2		14c;	1	2		2			2	
H7404	014	0	1	04	01	H7404_014_0	3	1	2														00000000010000										2		14c;	1	2		2			2	
H7464	001	0	1	01	01	H7464_001_0	4	1	1	10				01111	11222	9539																	2		13d;		1	13d;	2			2	
H7464	005	0	1	01	01	H7464_005_0	4	1	1	10				01111	567	482																	2		13d;		1	13d;	2			2	
H7464	006	0	1	01	01	H7464_006_0	4	1	1	10				01111	205	174																	2		13d;		1	13d;	2			2	
H7464	007	0	1	01	01	H7464_007_0	4	1	1	10				01111	5906	5020																	2		13d;		1	13d;	2			2	
H7464	008	1	1	02	01	H7464_008_1	4	1	1	10				01111	1388	1180																	2		13d;	2	1	13d;	2			2	
H7464	008	2	1	02	01	H7464_008_2	4	1	1	10				01111	3800	3230																	2		13d;	2	1	13d;	2			2	
H7512	001	0	1	04	01	H7512_001_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			2	
H7512	002	0	1	04	01	H7512_002_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	1	2	13i;	1	1200.00
H7512	003	0	1	04	01	H7512_003_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			2	
H7512	004	0	1	04	01	H7512_004_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	1	2	13i;	1	1200.00
H7518	003	0	1	04	01	H7518_003_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			1	600.00
H7556	001	0	1	04	01	H7556_001_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			2	
H7556	002	0	1	04	01	H7556_002_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	1	2	13i;	1	1200.00
H7556	003	0	1	04	01	H7556_003_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			2	
H7556	004	0	1	04	01	H7556_004_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	1	2	13i;	1	1200.00
H7557	001	0	1	01	01	H7557_001_0	7	1	2														00000000011100	Behavioral health diagnosis	Documented chronic pain related to falls within the last year				2	2			2		14c;		2		2			2	
H7557	001	0	1	01	01	H7557_001_0	7	2	3								00000010000000001100	Behavioral Health Diagnosis	Documented chronic pain														2		13i;		2		2			2	
H7559	001	0	1	01	01	H7559_001_0	5	1	3								01111111111111110000																2		13i;		2		2			2	
H7607	002	1	1	01	01	H7607_002_1	13	1	3								00001111110111110000																1	001	13c;13i;14c;		2		1	2	13c;	2	
H7607	002	2	1	01	01	H7607_002_2	13	1	3								00001111110111110000																1	001	13c;13i;14c;		2		1	2	13c;	2	
H7607	002	3	1	01	01	H7607_002_3	13	1	3								00001111110111110000																1	001	13c;13i;14c;		2		1	2	13c;	2	
H7607	003	1	1	01	01	H7607_003_1	13	1	3								00001111110111110000																1	001	13c;13i;14c;		2		1	2	13c;	2	
H7607	003	2	1	01	01	H7607_003_2	13	1	3								00001111110111110000																1	001	13c;13i;14c;		2		1	2	13c;	2	
H7607	003	3	1	01	01	H7607_003_3	13	1	3								00001111110111110000																1	001	13c;13i;14c;		2		1	2	13c;	2	
H7607	007	1	1	01	01	H7607_007_1	13	1	3								00001111110111110000																1	001	13c;13i;14c;		2		1	2	13c;	2	
H7607	007	2	1	01	01	H7607_007_2	13	1	3								00001111110111110000																1	001	13c;13i;14c;		2		1	2	13c;	2	
H7607	007	3	1	01	01	H7607_007_3	13	1	3								00001111110111110000																1	001	13c;13i;14c;		2		1	2	13c;	2	
H7607	008	1	1	01	01	H7607_008_1	13	1	3								00001111110111110000																1	001	13c;13i;14c;		2		1	2	13c;	2	
H7607	008	2	1	01	01	H7607_008_2	13	1	3								00001111110111110000																1	001	13c;13i;14c;		2		1	2	13c;	2	
H7607	008	3	1	01	01	H7607_008_3	13	1	3								00001111110111110000																1	001	13c;13i;14c;		2		1	2	13c;	2	
H7621	001	0	1	01	01	H7621_001_0	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H7678	001	0	1	01	01	H7678_001_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	960.00
H7678	003	0	1	01	01	H7678_003_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	960.00
H7678	004	0	1	01	01	H7678_004_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	960.00
H7680	001	0	1	01	01	H7680_001_0	11	1	3								00000000010000000000																1	001	13c;		2		2			1	250.00
H7680	002	0	1	01	01	H7680_002_0	12	1	3								00000000010000000000																1	001	13c;		2		2			1	250.00
H7680	007	0	1	01	01	H7680_007_0	11	1	3								00000101010000000000																1	001	13c;13i;		2		2			1	250.00
H7728	009	0	1	04	01	H7728_009_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;	1	2		2			2	
H7728	011	0	1	04	01	H7728_011_0	7	1	1	10				01111	573	573																	2		13i;	1	2		2			2	
H7728	011	0	1	04	01	H7728_011_0	7	2	1	10				01111	573	573																	2		13i;	1	2		2			2	
H7728	012	0	1	04	01	H7728_012_0	6	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;	1	2		2			2	
H7853	011	0	1	01	01	H7853_011_0	6	1	3								00001111000001001000	Kidney Disease															1	001	13b;13i;		2		2			2	
H7853	012	0	1	01	01	H7853_012_0	6	1	3								00001100000000001000	Kidney Disease															1	001	13b;		2		2			2	
H7853	013	0	1	01	01	H7853_013_0	7	1	3								00001111000001001000	Kidney Disease															1	001	13b;13i;		2		2			2	
H7853	015	0	1	01	01	H7853_015_0	6	1	3								00001111000001001000	Kidney Disease															1	001	13b;13i;		2		2			2	
H7925	001	0	1	01	01	H7925_001_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H7925	002	0	1	01	01	H7925_002_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	2700.00
H7925	003	0	1	01	01	H7925_003_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	2700.00
H7993	001	0	1	01	01	H7993_001_0	8	1	3								01111111111111110000																2		13i-O;		2		1	1		1	240.00
H7993	002	0	1	01	01	H7993_002_0	9	1	3								01111111111111110000																2		13i-O;		2		1	1		1	240.00
H7993	003	0	1	01	01	H7993_003_0	8	1	3								01111111111111110000																2		13i-O;		2		1	1		1	240.00
H7993	004	0	1	01	01	H7993_004_0	10	1	3								01111111111111111000	Other Eligible Chronic Conditions															2		13i;13i-O;		2		1	1		1	540.00
H7993	005	0	1	01	01	H7993_005_0	11	1	3								01111111111111111000	Other Eligible Chronic Conditions															2		13i;13i-O;		2		1	1		1	1140.00
H8010	002	0	1	01	01	H8010_002_0	13	1	3								11111111111111111111	Prediabetes	Hypertension	Hypercholesterolemia	Depression	Obesity/Overweight											2		13i;		2		2			1	0.00
H8010	003	0	1	01	01	H8010_003_0	12	1	3								11111111111111111111	Prediabetes	Hypertension	Hypercholesterolemia	Depression	Obesity/Overweight											2		13i;		2		2			1	0.00
H8010	005	0	1	01	01	H8010_005_0	13	1	3								11111111111111111111	Prediabetes	Hypertension	Hypercholesterolemia	Depression	Obesity/Overweight											2		13i;		2		2			1	0.00
H8010	008	0	1	01	01	H8010_008_0	13	1	3								11111111111111111111	Prediabetes	Hypertension	Hypercholesterolemia	Depression	Obesity/Overweight											2		13i;		2		2			1	0.00
H8067	001	0	1	01	01	H8067_001_0	18	1	3								01111111111111110000																2		13i;14c;		2		2			2	
H8067	003	0	1	01	01	H8067_003_0	18	1	3								01111111111111110000																2		13i;14c;		2		2			2	
H8087	003	0	1	04	01	H8087_003_0	4	1	1	10				01111	16935	16935																	2		13d;	1	1	13d;	2			1	600.00
H8093	002	0	1	01	01	H8093_002_0	2	1	3								01111111111111110000																1	001	13i;		1	13i;	2			2	
H8121	001	0	1	04	01	H8121_001_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			2	
H8121	002	0	1	04	01	H8121_002_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	1	2	13i;	1	1200.00
H8125	002	0	1	01	01	H8125_002_0	4	1	1	10				01111	17471	14850																	2		13d;		1	13d;	2			2	
H8130	001	0	1	01	01	H8130_001_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	1080.00
H8130	008	0	1	01	01	H8130_008_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	2760.00
H8130	009	0	1	01	01	H8130_009_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	1080.00
H8130	010	0	1	01	01	H8130_010_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	960.00
H8145	004	0	1	09	04	H8145_004_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		1	13d;	2			2	
H8145	042	0	1	09	04	H8145_042_0	3	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		1	13d;	2			2	
H8145	061	0	1	09	04	H8145_061_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H8145	069	0	1	09	04	H8145_069_0	4	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H8145	069	0	1	09	04	H8145_069_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H8145	084	0	1	09	04	H8145_084_0	3	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H8145	122	0	1	09	04	H8145_122_0	5	1	3								01111111111111111000	Depression															1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		2		2			1	500.00
H8145	123	0	1	09	04	H8145_123_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H8145	126	0	1	09	04	H8145_126_0	2	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;		2		2			2	
H8173	001	0	1	01	01	H8173_001_0	8	1	3								01111111111111110000																2		13i-O;		2		1	1		1	240.00
H8173	002	0	1	01	01	H8173_002_0	11	1	3								01111111111111111000	Other Eligible Chronic Conditions															2		13i;13i-O;		2		1	1		1	540.00
H8173	004	0	1	01	01	H8173_004_0	10	1	3								01111111111111111000	Other Eligible Chronic Conditions															2		13i;13i-O;		2		1	1		1	840.00
H8173	005	0	1	01	01	H8173_005_0	7	1	3								01111111111111110000																2		13i-O;		2		1	1		1	240.00
H8173	006	0	1	01	01	H8173_006_0	10	1	3								01111111111111111000	Other Eligible Chronic Conditions															2		13i;13i-O;		2		1	1		1	840.00
H8173	007	0	1	01	01	H8173_007_0	8	1	3								01111111111111110000																2		13i-O;		2		1	1		1	240.00
H8173	008	0	1	01	01	H8173_008_0	10	1	3								01111111111111111000	Other Eligible Chronic Conditions															2		13i;13i-O;		2		1	1		1	660.00
H8173	010	0	1	01	01	H8173_010_0	10	1	3								01111111111111111000	Other Eligible Chronic Conditions															2		13i;13i-O;		2		1	1		1	840.00
H8176	001	0	1	01	01	H8176_001_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	1020.00
H8176	003	0	1	01	01	H8176_003_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	960.00
H8189	001	0	1	01	01	H8189_001_0	6	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	2700.00
H8225	001	0	1	01	01	H8225_001_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H8225	002	0	1	01	01	H8225_002_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H8225	003	0	1	01	01	H8225_003_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	2700.00
H8225	004	0	1	01	01	H8225_004_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	2700.00
H8225	005	0	1	01	01	H8225_005_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	2700.00
H8225	006	0	1	01	01	H8225_006_0	4	1	3								01111111111111110000																1	001	13i;14c;		1	13i;14c;	1	2	13i;	1	2700.00
H8225	007	0	1	02	01	H8225_007_0	4	1	3								01111111111111110000																1	001	13i;	2	1	13i;	1	2	13i;	1	1200.00
H8225	008	0	1	02	01	H8225_008_0	4	1	3								01111111111111110000																1	001	13i;	2	1	13i;	1	2	13i;	1	1200.00
H8298	001	0	1	01	01	H8298_001_0	7	1	3								01111111111111110000																2		13i;		1	13i;	2			2	
H8332	001	0	1	01	01	H8332_001_0	2	1	2														00000100001000	Hyperlipidemia					2	2			2		10b;13b;		1	10b;13b;	2			2	
H8332	002	0	1	01	01	H8332_002_0	2	1	2														00000100001000	Hyperlipidemia					2	2			2		10b;13b;		1	10b;13b;	2			2	
H8332	003	0	1	01	01	H8332_003_0	2	1	2														00000100001000	Hyperlipidemia					2	2			2		10b;13b;		1	10b;13b;	2			2	
H8332	004	0	1	01	01	H8332_004_0	3	1	2														00000100001000	Hyperlipidemia					2	2			2		10b;13b;		1	10b;13b;	2			2	
H8332	801	0	1	01	01	H8332_801_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H8332	802	0	1	01	01	H8332_802_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H8385	001	0	1	04	01	H8385_001_0	12	1	3								00000101010000000000																2		13c;	1	2		2			2	
H8385	002	0	1	04	01	H8385_002_0	12	1	3								00000101010000000000																2		13c;	1	2		2			2	
H8385	003	0	1	04	01	H8385_003_0	12	1	3								00000101010000000000																2		13c;	1	2		2			2	
H8385	004	0	1	04	01	H8385_004_0	12	1	3								00000101010000000000																2		13c;	1	2		2			2	
H8432	028	0	1	01	01	H8432_028_0	6	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H8432	034	0	1	01	01	H8432_034_0	6	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H8432	035	0	1	01	01	H8432_035_0	6	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H8432	038	1	1	01	01	H8432_038_1	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H8432	038	2	1	01	01	H8432_038_2	6	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H8457	001	0	1	01	01	H8457_001_0	3	1	3								00000010000000001100	Behavioral health diagnosis	Documented chronic pain related to falls within the last year														2		13i;		2		2			2	
H8597	001	0	1	01	01	H8597_001_0	3	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H8597	002	0	1	01	01	H8597_002_0	3	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H8597	003	0	1	01	01	H8597_003_0	4	1	1	10				01111	137895	137895																	2		13i;14c;		1	13i;14c;	2			2	
H8649	801	0	1	01	01	H8649_801_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H8649	803	0	1	01	01	H8649_803_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;		1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H8764	001	0	1	01	01	H8764_001_0	7	1	3								00010101010011100000																1	001	10b;13i;		2		2			2	
H8764	002	0	1	02	01	H8764_002_0	7	1	3								00010101010011100000																1	001	10b;13i;	2	2		2			2	
H8764	003	0	1	01	01	H8764_003_0	7	1	3								00010101010011100000																1	001	10b;13i;		2		2			2	
H8768	017	1	1	04	01	H8768_017_1	3	1	2														00000000010000										2		14c;	1	2		2			2	
H8783	001	0	1	04	01	H8783_001_0	8	1	2														00010000000000										2		13c;	1	2		2			2	
H8783	002	0	1	04	01	H8783_002_0	9	1	2														00010000000000										2		13c;	1	2		2			2	
H8783	003	0	1	04	01	H8783_003_0	9	1	2														00010000000000										2		13c;	1	2		2			2	
H8845	001	0	1	01	01	H8845_001_0	7	1	3								00000000000001000000																1	001	13d;13i-O;		2		2			1	600.00
H8849	001	0	1	01	01	H8849_001_0	8	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H8849	006	0	1	01	01	H8849_006_0	9	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H8849	008	2	1	01	01	H8849_008_2	9	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H8849	008	4	1	01	01	H8849_008_4	9	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H8849	009	0	1	01	01	H8849_009_0	9	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H8849	010	1	1	01	01	H8849_010_1	6	2	1	10				01111	13309	13309																	2		13i;		2		2			2	
H8849	010	1	1	01	01	H8849_010_1	6	1	1	10				01111	13309	4778																	2		13i;		2		2			2	
H8849	010	2	1	01	01	H8849_010_2	7	1	1	10				01111	4980	1788																	2		13i;		2		2			2	
H8849	010	2	1	01	01	H8849_010_2	7	2	1	10				01111	4980	4980																	2		13i;		2		2			2	
H8849	010	3	1	01	01	H8849_010_3	7	2	1	10				01111	4540	4540																	2		13i;		2		2			2	
H8849	010	3	1	01	01	H8849_010_3	7	1	1	10				01111	4540	1630																	2		13i;		2		2			2	
H8849	010	4	1	01	01	H8849_010_4	9	1	1	10				01111	2280	818																	2		13i;		2		2			2	
H8849	010	4	1	01	01	H8849_010_4	9	2	1	10				01111	2280	2280																	2		13i;		2		2			2	
H8849	010	5	1	01	01	H8849_010_5	7	2	1	10				01111	1977	1977																	2		13i;		2		2			2	
H8849	010	5	1	01	01	H8849_010_5	7	1	1	10				01111	1977	710																	2		13i;		2		2			2	
H8849	010	6	1	01	01	H8849_010_6	7	1	1	10				01111	1405	504																	2		13i;		2		2			2	
H8849	010	6	1	01	01	H8849_010_6	7	2	1	10				01111	1405	1405																	2		13i;		2		2			2	
H8849	011	1	1	01	01	H8849_011_1	6	2	1	10				01111	603	603																	2		13i;		2		2			2	
H8849	011	1	1	01	01	H8849_011_1	6	1	1	10				01111	603	217																	2		13i;		2		2			2	
H8849	011	2	1	01	01	H8849_011_2	7	1	1	10				01111	544	195																	2		13i;		2		2			2	
H8849	011	2	1	01	01	H8849_011_2	7	2	1	10				01111	544	544																	2		13i;		2		2			2	
H8849	011	3	1	01	01	H8849_011_3	9	2	1	10				01111	271	271																	2		13i;		2		2			2	
H8849	011	3	1	01	01	H8849_011_3	9	1	1	10				01111	271	97																	2		13i;		2		2			2	
H8849	011	4	1	01	01	H8849_011_4	9	2	1	10				01111	102	102																	2		13i;		2		2			2	
H8849	011	4	1	01	01	H8849_011_4	9	1	1	10				01111	102	37																	2		13i;		2		2			2	
H8849	011	5	1	01	01	H8849_011_5	7	2	1	10				01111	114	114																	2		13i;		2		2			2	
H8849	011	5	1	01	01	H8849_011_5	7	1	1	10				01111	114	41																	2		13i;		2		2			2	
H8849	011	6	1	01	01	H8849_011_6	7	2	1	10				01111	137	137																	2		13i;		2		2			2	
H8849	011	6	1	01	01	H8849_011_6	7	1	1	10				01111	137	49																	2		13i;		2		2			2	
H8849	012	0	1	01	01	H8849_012_0	10	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H8849	013	0	1	01	01	H8849_013_0	8	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H8854	002	0	1	01	01	H8854_002_0	7	1	2														01110000001000	ESRD					2	2			2		13c;14c;		2		2			2	
H8889	001	0	1	04	01	H8889_001_0	4	1	3								00011111111010111000	At-risk Osteoporosis															1	001	10b;13c;13d;13i;14c;	1	2		2			2	
H8889	002	0	1	04	01	H8889_002_0	4	1	3								00011111111010110000																2		13i;	1	2		2			2	
H8889	003	0	1	04	01	H8889_003_0	4	1	3								00011111111010111000	At-risk Osteoporosis															1	001	10b;13c;13d;13i;14c;	1	2		2			2	
H8889	004	0	1	04	01	H8889_004_0	5	1	3								00011111111010110000																2		13i;	1	2		2			2	
H8889	005	0	1	04	01	H8889_005_0	4	1	3								00011111111010111000	At-risk of Osteoporosis															1	001	10b;13c;13d;13i;14c;	1	2		2			2	
H8889	008	0	1	04	01	H8889_008_0	3	1	3								00011111111010110000																2		13i;	1	2		2			2	
H8889	009	0	1	04	01	H8889_009_0	2	1	3								00011111111010110000																2		13i;	1	2		2			2	
H8908	005	0	1	01	01	H8908_005_0	4	1	1	10				01111	10185	10185																	2		13d;		1	13d;	2			1	600.00
H9003	001	0	1	01	01	H9003_001_0	8	1	2														00000000001000	Acute Care At Home (based on Health Status)									2		13c;14c;		2		2			2	
H9003	006	0	1	01	01	H9003_006_0	8	1	2														00000000001000	Acute Care At Home (based on Health Status)									2		13c;14c;		2		2			2	
H9003	009	0	1	01	01	H9003_009_0	8	1	2														00000000001000	Acute Care At Home (based on Health Status)									2		13c;14c;		2		2			2	
H9065	001	0	1	01	01	H9065_001_0	7	4	1	10				01111	8722	2983																	2		13i-O;		2		2			2	
H9065	001	0	1	01	01	H9065_001_0	7	3	1	10				01111	8722	2983																	2		13i;		2		2			2	
H9065	001	0	1	01	01	H9065_001_0	7	2	1	10				01111	8722	2983																	2		13i;		2		2			2	
H9065	001	0	1	01	01	H9065_001_0	7	1	1	10				01111	8722	2983																	2		13i;		2		2			2	
H9065	001	0	1	01	01	H9065_001_0	7	5	1	10				01111	8722	2983																	2		13i;		2		2			2	
H9065	002	0	1	02	01	H9065_002_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;	2	2		2			2	
H9065	003	0	1	02	01	H9065_003_0	6	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;	2	2		2			2	
H9065	004	0	1	02	01	H9065_004_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;	2	2		2			2	
H9065	008	0	1	01	01	H9065_008_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H9066	001	0	1	01	01	H9066_001_0	6	1	3								01111111111111110000																2		13i;		2		2			2	
H9066	003	0	1	01	01	H9066_003_0	5	1	3								01111111111111110000																2		13i;		2		2			2	
H9070	003	0	1	04	01	H9070_003_0	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	2		2			1	500.00
H9070	004	0	1	04	01	H9070_004_0	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	2		2			1	500.00
H9070	006	1	1	04	01	H9070_006_1	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	2		2			1	1000.00
H9070	006	3	1	04	01	H9070_006_3	6	1	3								01111111111111110000																1	001	7b;7f;10b;13a;13b;13c;13e;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	2		2			1	500.00
H9078	007	0	1	01	01	H9078_007_0	7	1	3								00001101000000000000																2		13i;		2		2			2	
H9078	008	0	1	01	01	H9078_008_0	8	1	3								00001101000000000000																2		13i;		2		2			2	
H9078	009	0	1	01	01	H9078_009_0	7	1	3								00001101000000000000																2		13i;		2		2			2	
H9078	010	0	1	01	01	H9078_010_0	8	1	3								00001101000000000000																2		13i;		2		2			2	
H9082	009	0	1	01	01	H9082_009_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	1080.00
H9082	010	0	1	01	01	H9082_010_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	960.00
H9147	001	0	1	01	01	H9147_001_0	5	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H9191	001	0	1	01	01	H9191_001_0	18	1	3								01111111111111110000																2		13i;14c;		2		2			2	
H9207	004	0	1	01	01	H9207_004_0	8	1	3								01111111111111111100	Hypertension	Alzheimers														2		13i;		2		2			1	300.00
H9335	003	0	1	01	01	H9335_003_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	2			1	600.00
H9335	006	0	1	01	01	H9335_006_0	4	1	3								01111111111111110000																1	001	13i;		1	13i;	2			1	600.00
H9357	001	0	1	04	01	H9357_001_0	3	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			2	
H9357	002	0	1	04	01	H9357_002_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	1	2	13i;	1	1200.00
H9357	003	0	1	04	01	H9357_003_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			2	
H9357	004	0	1	04	01	H9357_004_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	1	2	13i;	1	1200.00
H9364	002	0	1	01	01	H9364_002_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	1	1		1	1200.00
H9364	003	0	1	01	01	H9364_003_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H9408	005	0	1	04	01	H9408_005_0	4	1	3								00001101000010001000	All chronic conditions															2		13i;	1	2		2			2	
H9408	006	1	1	04	01	H9408_006_1	4	1	3								00001101000010001000	All chronic conditions															2		13i;	1	2		2			2	
H9408	006	2	1	04	01	H9408_006_2	4	1	3								00001101000010001000	All chronic conditions															2		13i;	1	2		2			2	
H9414	002	0	1	04	01	H9414_002_0	13	1	3								11111111111111111111	Chronic Kidney Disease (CKD)	Physical disabilities	Musculoskeletal conditions	Developmental disabilities	Vision & Hearing Disorders											2		13i;13i-O;	1	2		2			2	
H9431	801	0	1	04	01	H9431_801_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H9431	802	0	1	04	01	H9431_802_0	1	1	3								01111111111111111000	at plan sponsor discretion															1	001	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	1	1	7b;7f;10b;13a;13b;13c;13i;13i-O;14c;16a;16b;17a;17b;18a;18b;	2			2	
H9455	001	0	1	01	01	H9455_001_0	7	1	3								01111111111111110000																2		10b;13i;14c;		1	10b;13i;14c;	2			2	
H9525	003	0	1	01	01	H9525_003_0	7	2	1	10				01111	9279	9279																	2		13i-O;		2		2			2	
H9525	003	0	1	01	01	H9525_003_0	7	3	1	10				01111	9279	9279																	2		13i;		2		2			2	
H9525	003	0	1	01	01	H9525_003_0	7	5	1	10				01111	9279	3155																	2		13i;		2		2			2	
H9525	003	0	1	01	01	H9525_003_0	7	1	1	10				01111	9279	9279																	2		13i;		2		2			2	
H9525	003	0	1	01	01	H9525_003_0	7	4	1	10				01111	9279	9279																	2		13i;		2		2			2	
H9525	004	0	1	01	01	H9525_004_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H9525	006	0	1	01	01	H9525_006_0	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H9525	007	0	1	01	01	H9525_007_0	9	5	1	10				01111	24856	24856																	2		13i-O;		2		2			2	
H9525	007	0	1	01	01	H9525_007_0	9	4	1	10				01111	24856	24856																	2		13i;		2		2			2	
H9525	007	0	1	01	01	H9525_007_0	9	3	1	10				01111	24856	24856																	2		13i;		2		2			2	
H9525	007	0	1	01	01	H9525_007_0	9	1	1	10				01111	24856	8451																	2		13i;		2		2			2	
H9525	007	0	1	01	01	H9525_007_0	9	2	1	10				01111	24856	24856																	2		13i;		2		2			2	
H9525	010	0	1	01	01	H9525_010_0	7	3	1	10				01111	1266	1266																	2		13i;		2		2			2	
H9525	010	0	1	01	01	H9525_010_0	7	1	1	10				01111	1266	431																	2		13i;		2		2			2	
H9525	010	0	1	01	01	H9525_010_0	7	4	1	10				01111	1266	1266																	2		13i;		2		2			2	
H9525	010	0	1	01	01	H9525_010_0	7	2	1	10				01111	1266	1266																	2		13i;		2		2			2	
H9525	011	0	1	01	01	H9525_011_0	9	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;		2		2			2	
H9525	012	0	1	01	01	H9525_012_0	7	2	1	10				01111	176	176																	2		13i;		2		2			2	
H9525	012	0	1	01	01	H9525_012_0	7	1	1	10				01111	176	60																	2		13i;		2		2			2	
H9525	013	1	1	01	01	H9525_013_1	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H9525	013	2	1	01	01	H9525_013_2	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H9525	013	3	1	01	01	H9525_013_3	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H9525	013	4	1	01	01	H9525_013_4	7	1	3								01111111111111111000	Plan approved chronic conditions															2		13i;13i-O;		2		2			2	
H9572	001	1	1	04	01	H9572_001_1	7	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	1	2		2			1	100.00
H9572	001	2	1	04	01	H9572_001_2	7	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	1	2		2			1	100.00
H9572	001	3	1	04	01	H9572_001_3	7	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	1	2		2			1	100.00
H9572	001	4	1	04	01	H9572_001_4	7	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	1	2		2			1	100.00
H9572	001	6	1	04	01	H9572_001_6	7	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	1	2		2			1	100.00
H9572	002	1	1	04	01	H9572_002_1	7	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	1	2		2			1	100.00
H9572	002	2	1	04	01	H9572_002_2	7	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	1	2		2			1	100.00
H9572	002	3	1	04	01	H9572_002_3	7	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	1	2		2			1	100.00
H9572	002	4	1	04	01	H9572_002_4	7	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	1	2		2			1	100.00
H9572	002	6	1	04	01	H9572_002_6	7	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	1	2		2			1	100.00
H9572	003	1	1	04	01	H9572_003_1	7	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	1	2		2			1	100.00
H9572	003	2	1	04	01	H9572_003_2	7	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	1	2		2			1	100.00
H9572	003	3	1	04	01	H9572_003_3	7	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	1	2		2			1	100.00
H9572	003	4	1	04	01	H9572_003_4	7	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	1	2		2			1	100.00
H9572	003	6	1	04	01	H9572_003_6	7	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	1	2		2			1	100.00
H9572	004	1	1	04	01	H9572_004_1	8	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	1	2		2			1	200.00
H9572	004	2	1	04	01	H9572_004_2	8	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	1	2		2			1	200.00
H9572	004	3	1	04	01	H9572_004_3	8	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	1	2		2			1	200.00
H9572	004	4	1	04	01	H9572_004_4	8	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	1	2		2			1	200.00
H9572	004	6	1	04	01	H9572_004_6	8	1	3								00001101000010011110	Hypertension	Rheumatoid arthritis	Prior exposure to or at risk for exposure to COVID													2		13i;	1	2		2			1	200.00
H9585	001	0	1	01	01	H9585_001_0	8	1	3								01111111111111110000																2		13i;		1	13i;	2			2	
H9590	001	0	1	01	01	H9590_001_0	4	2	3								00000010000000001100	Behavioral health diagnosis	Documented chronic pain														2		13i;		2		2			2	
H9590	001	0	1	01	01	H9590_001_0	4	1	2														00000000011100	Behavioral health diagnosis	Documented chronic pain related to falls within the last year				2	2			2		14c;		2		2			2	
H9615	007	0	1	04	01	H9615_007_0	6	2	2														00001000000000										2		14c;	1	1	14c;	2			1	250.00
H9615	007	0	1	04	01	H9615_007_0	6	1	2														00000100000000										2		13b;	1	1	13b;	2			2	
H9615	008	0	1	04	01	H9615_008_0	6	2	2														00001000000000										2		14c;	1	1	14c;	2			1	250.00
H9615	008	0	1	04	01	H9615_008_0	6	1	2														00000100000000										2		13b;	1	1	13b;	2			2	
H9615	009	0	1	04	01	H9615_009_0	6	1	2														00000100000000										2		13b;	1	1	13b;	2			2	
H9615	009	0	1	04	01	H9615_009_0	6	2	2														00001000000000										2		14c;	1	1	14c;	2			1	250.00
H9615	010	0	1	04	01	H9615_010_0	6	2	2														00001000000000										2		14c;	1	1	14c;	2			1	250.00
H9615	010	0	1	04	01	H9615_010_0	6	1	2														00000100000000										2		13b;	1	1	13b;	2			2	
H9615	012	0	1	04	01	H9615_012_0	7	2	2														00001000000000										2		14c;	1	1	14c;	2			1	250.00
H9615	012	0	1	04	01	H9615_012_0	7	1	2														00000100000000										2		13b;	1	1	13b;	2			2	
H9615	014	0	1	04	01	H9615_014_0	6	2	2														00001000000000										2		14c;	1	1	14c;	2			1	250.00
H9615	014	0	1	04	01	H9615_014_0	6	1	2														00000100000000										2		13b;	1	1	13b;	2			2	
H9615	015	0	1	04	01	H9615_015_0	7	1	2														00000100000000										2		13b;	1	1	13b;	2			2	
H9615	015	0	1	04	01	H9615_015_0	7	2	2														00001000000000										2		14c;	1	1	14c;	2			1	250.00
H9615	016	0	1	04	01	H9615_016_0	7	1	2														00000100000000										2		13b;	1	1	13b;	2			2	
H9615	016	0	1	04	01	H9615_016_0	7	2	2														00001000000000										2		14c;	1	1	14c;	2			1	250.00
H9615	017	0	1	04	01	H9615_017_0	6	1	2														00000100000000										2		13b;	1	1	13b;	2			2	
H9615	017	0	1	04	01	H9615_017_0	6	2	2														00001000000000										2		14c;	1	1	14c;	2			1	250.00
H9630	010	0	1	01	01	H9630_010_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	1	1		1	600.00
H9630	011	0	1	01	01	H9630_011_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	1	1		1	600.00
H9686	001	0	1	01	01	H9686_001_0	5	1	3								01111111111111110000																2		13i;		2		2			2	
H9686	003	0	1	01	01	H9686_003_0	7	1	3								01111111111111110000																2		13i;13i-O;		2		2			2	
H9686	004	0	1	01	01	H9686_004_0	6	1	3								01111111111111110000																2		13i;13i-O;		2		2			2	
H9686	005	0	1	01	01	H9686_005_0	5	1	3								01111111111111110000																2		13i;		2		2			2	
H9699	004	1	1	01	01	H9699_004_1	5	1	3								00010001000000011100	Coronary artery disease	Sjgrens Syndrome														2		16a;16b;		2		2			2	
H9699	004	2	1	01	01	H9699_004_2	5	1	3								00010001000000011100	Coronary artery disease	Sjgrens Syndrome														2		16a;16b;		2		2			2	
H9699	004	3	1	01	01	H9699_004_3	5	1	3								00010001000000011100	Coronary artery disease	Sjgrens Syndrome														2		16a;16b;		2		2			2	
H9699	006	0	1	01	01	H9699_006_0	5	1	3								00010001000000011100	Coronary artery disease	Sjgrens Syndrome														2		16a;16b;		2		2			2	
H9725	003	0	1	01	01	H9725_003_0	5	1	3								00001001000000000000																2		13i;		2		2			2	
H9730	003	0	1	01	01	H9730_003_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H9730	004	0	1	01	01	H9730_004_0	6	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	2400.00
H9730	010	0	1	01	01	H9730_010_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H9761	003	0	1	04	01	H9761_003_0	6	1	3								01111111111111110000																1	001	13i;	1	1	13i;	1	2	13i;	1	600.00
H9834	001	0	1	01	01	H9834_001_0	4	1	2														10110000001111	Pneumonia	UTI	Cellulitis	Asthma	Deep Vein Thrombosis/Pulmonary Embolism	2	2			1	001	13d;		2		2			2	
H9834	003	0	1	01	01	H9834_003_0	4	1	2														10110000001111	Pneumonia	UTI	Cellulitis	Asthma	Deep Vein Thrombosis/Pulmonary Embolism	2	2			1	001	13d;		2		2			2	
H9834	004	0	1	01	01	H9834_004_0	3	1	2														10110000001111	Pneumonia	UTI	Cellulitis	Asthma	Deep Vein Thrombosis/Pulmonary Embolism	2	2			1	001	13d;		2		2			2	
H9834	005	0	1	01	01	H9834_005_0	3	1	2														10110000001111	Pneumonia	UTI	Cellulitis	Asthma	Deep Vein Thrombosis/Pulmonary Embolism	2	2			1	001	13d;		2		2			2	
H9834	006	0	1	01	01	H9834_006_0	4	1	2														10110000001111	Pneumonia	UTI	Cellulitis	Asthma	Deep Vein Thrombosis/Pulmonary Embolism	2	2			1	001	13d;		2		2			2	
H9861	003	0	1	01	01	H9861_003_0	11	1	3								01111111111111111100	Hypertension	Alzheimer's														2		13i;		2		2			1	600.00
H9876	002	0	1	04	01	H9876_002_0	10	1	3								11111111111111111111	Chronic Kidney Disease (CKD)	Physical disabilities	Musculoskeletal conditions	Developmental disabilities	Vision & Hearing Disorders											2		13i;13i-O;	1	2		2			2	
H9877	001	0	1	01	01	H9877_001_0	10	1	3								01111111111111110000																2		13i;		2		2			2	
H9900	002	0	1	01	01	H9900_002_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1200.00
H9900	003	0	1	01	01	H9900_003_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	1	2	13i;	1	1800.00
H9900	004	0	1	01	01	H9900_004_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	1	1		1	600.00
H9900	005	0	1	01	01	H9900_005_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	1	1		1	600.00
H9900	006	0	1	01	01	H9900_006_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	1	1		1	600.00
H9900	007	0	1	01	01	H9900_007_0	5	1	3								01111111111111110000																1	001	13i;		1	13i;	1	1		1	600.00
H9942	001	0	1	04	01	H9942_001_0	5	2	3								00000010000000001100	Behavioral health diagnosis	Documented chronic pain														2		13i;	1	2		2			2	
H9942	001	0	1	04	01	H9942_001_0	5	1	2														00000000011100	Behavioral health diagnosis	Documented chronic pain related to falls within the last year				2	2			2		14c;	1	2		2			2	
H9952	001	0	1	01	01	H9952_001_0	7	1	3								00001101000000000000																2		13i;		2		2			2	
H9955	001	0	1	01	01	H9955_001_0	7	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	1020.00
H9955	002	0	1	01	01	H9955_002_0	5	1	3								01111111111111110000																1	001	13d;13e;13i;13i-O;		2		2			1	960.00
H9976	001	0	1	04	01	H9976_001_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	1	2	13i;	1	600.00
H9976	002	0	1	04	01	H9976_002_0	5	1	3								01111111111111110000																1	001	13i;	1	1	13i;	1	2	13i;	1	600.00
H9976	003	0	1	04	01	H9976_003_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			2	
H9976	004	0	1	04	01	H9976_004_0	4	1	3								01111111111111110000																1	001	13i;	1	1	13i;	2			2	
H9986	001	0	1	01	01	H9986_001_0	6	1	3								00000000000000001000	Frailty															2		13i;		2		1	2	13i;	1	250.00
H9986	002	0	1	01	01	H9986_002_0	6	1	3								00000000000000001000	Frailty															2		13c;13i;		2		1	2	13i;	1	250.00
R0802	001	0	1	31	11	R0802_001_0	7	2	3								00000100010000000000																2		13i;	1	2		2			2	
R0802	001	0	1	31	11	R0802_001_0	7	1	2														00000000001100	Opioid Use Disorder	Chronic Pain Syndrome				2	2			2		13a;14c;	1	2		1	1		1	200.00
R0802	001	0	1	31	11	R0802_001_0	7	3	2														00000000001100	History of Falls	Hip Fracture				2	2			2		14c;	1	2		1	1		1	250.00
R1390	001	0	1	31	11	R1390_001_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
R1390	002	0	1	31	11	R1390_002_0	3	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
R1390	003	0	1	31	11	R1390_003_0	3	1	3								00000101000010001000	Depression															1	001	13c;	1	2		2			2	
R1390	003	0	1	31	11	R1390_003_0	3	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
R1548	001	0	1	31	11	R1548_001_0	4	1	1	10				01111	73977	62880																	2		13d;	1	1	13d;	2			2	
R3392	001	0	1	31	11	R3392_001_0	6	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
R3392	001	0	1	31	11	R3392_001_0	6	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
R3392	002	0	1	31	11	R3392_002_0	4	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
R3392	002	0	1	31	11	R3392_002_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
R4182	001	0	1	31	11	R4182_001_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
R4182	003	0	1	31	11	R4182_003_0	3	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
R4182	004	0	1	31	11	R4182_004_0	3	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
R5826	005	0	1	31	11	R5826_005_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
R5826	018	0	1	31	11	R5826_018_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
R5826	074	0	1	31	11	R5826_074_0	3	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
R6801	011	0	1	31	11	R6801_011_0	4	1	1	10				01111	34786	29568																	2		13d;	1	1	13d;	2			2	
R7220	001	0	1	31	11	R7220_001_0	4	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
R7220	001	0	1	31	11	R7220_001_0	4	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	1	13d;	2			2	
R7220	002	0	1	31	11	R7220_002_0	3	2	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
R7220	002	0	1	31	11	R7220_002_0	3	1	2														01111111111111	UTI	Cellulitis	Nutritional & Metabolic Disorders	Respiratory Diseases		2	2			1	010	13d;	1	2		2			2	
