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H0028	039	0	1	01	01	H0028_039_0	5	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H0028	046	0	1	01	01	H0028_046_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H0351	038	0	1	01	01	H0351_038_0	6	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;				2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H0351	053	0	1	01	01	H0351_053_0	7	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;				2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H0351	054	0	1	01	01	H0351_054_0	7	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;				2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H0351	057	0	1	01	01	H0351_057_0	5	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;				2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H0351	063	0	1	01	01	H0351_063_0	7	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;				2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H0351	064	0	1	01	01	H0351_064_0	6	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;				2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H0351	065	0	1	01	01	H0351_065_0	6	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;				2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H0351	066	0	1	02	01	H0351_066_0	8	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H0351	067	0	1	02	01	H0351_067_0	8	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H0351	068	0	1	02	01	H0351_068_0	8	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H0351	069	0	1	02	01	H0351_069_0	7	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H0351	070	0	1	02	01	H0351_070_0	8	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H0473	003	0	1	04	01	H0473_003_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H0523	805	0	1	01	01	H0523_805_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H0523	805	0	1	01	01	H0523_805_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H0524	008	0	1	01	01	H0524_008_0	5	1	2	Advanced Care At Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	11	10a1;11a;11b2;4a;7c;7d;7g;7i;	1	13e;		2				1	11	11a;11b2;	13e;																																																																							0	0			0	0																																																																			0	0																																																																																																															2																																																																																																																																													1	01	4a;7c;7d;7g;7i;10a1;										0.00	0.00													0.00	0.00	0.00	0.00							0.00	0.00					0.00	0.00																											0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H0524	032	0	1	01	01	H0524_032_0	5	1	2	Advanced Care At Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	11	4a;7c;7d;7g;7i;8b1;8b3;10a1;11a;11b2;	1	13e;		2				1	11	11a;11b2;	13e;																																																																							0	0			0	0																																																																			0	0																																																																																																															2																																																																																																																																													1	01	4a;7c;7d;7g;7i;8b1;8b3;10a1;										0.00	0.00													0.00	0.00	0.00	0.00							0.00	0.00					0.00	0.00									0.00	0.00			0.00	0.00													0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H0524	033	0	1	01	01	H0524_033_0	5	1	2	Advanced Care At Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	11	7c;7d;7g;7i;10a1;11a;11b2;4a;	1	13e;		2				1	11	11a;11b2;	13e;																																																																							0	0			0	0																																																																			0	0																																																																																																															2																																																																																																																																													1	01	4a;7c;7d;7g;7i;10a1;										0.00	0.00													0.00	0.00	0.00	0.00							0.00	0.00					0.00	0.00																											0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H0524	039	0	1	01	01	H0524_039_0	5	1	2	Advanced Care At Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	11	4a;11b2;11a;7c;7d;7g;7i;10a1;	1	13e;		2				1	11	11a;11b2;	13e;																																																																							0	0			0	0																																																																			0	0																																																																																																															2																																																																																																																																													1	01	4a;7c;7d;7g;7i;10a1;										0.00	0.00													0.00	0.00	0.00	0.00							0.00	0.00					0.00	0.00																											0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H0524	059	0	1	01	01	H0524_059_0	5	1	2	Advanced Care At Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	11	4a;7c;7d;7g;7i;8b1;8b3;10a1;11a;11b2;	1	13e;		2				1	11	11a;11b2;	13e;																																																																							0	0			0	0																																																																			0	0																																																																																																															2																																																																																																																																													1	01	4a;7c;7d;7g;7i;8b1;8b3;10a1;										0.00	0.00													0.00	0.00	0.00	0.00							0.00	0.00					0.00	0.00									0.00	0.00			0.00	0.00													0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H0524	060	0	1	01	01	H0524_060_0	5	1	2	Advanced Care At Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	11	4a;7c;7d;7g;7i;8b1;8b3;10a1;11a;11b2;	1	13e;		2				1	11	11a;11b2;	13e;																																																																							0	0			0	0																																																																			0	0																																																																																																															2																																																																																																																																													1	01	4a;7c;7d;7g;7i;8b1;8b3;10a1;										0.00	0.00													0.00	0.00	0.00	0.00							0.00	0.00					0.00	0.00									0.00	0.00			0.00	0.00													0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H0524	061	0	1	01	01	H0524_061_0	5	1	2	Advanced Care At Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	11	7d;7g;10a1;11a;11b2;4a;7c;7i;8b1;8b3;	1	13e;		2				1	11	11a;11b2;	13e;																																																																							0	0			0	0																																																																			0	0																																																																																																															2																																																																																																																																													1	01	4a;7c;7d;7g;7i;8b1;8b3;10a1;										0.00	0.00													0.00	0.00	0.00	0.00							0.00	0.00					0.00	0.00									0.00	0.00			0.00	0.00													0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H0524	062	0	1	01	01	H0524_062_0	5	1	2	Advanced Care At Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	11	4a;7c;7d;7g;7i;8b1;8b3;10a1;11a;11b2;	1	13e;		2				1	11	11a;11b2;	13e;																																																																							0	0			0	0																																																																			0	0																																																																																																															2																																																																																																																																													1	01	4a;7c;7d;7g;7i;8b1;8b3;10a1;										0.00	0.00													0.00	0.00	0.00	0.00							0.00	0.00					0.00	0.00									0.00	0.00			0.00	0.00													0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H0524	063	0	1	01	01	H0524_063_0	5	1	2	Advanced Care At Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	11	7d;7g;8b1;10a1;11a;11b2;4a;7c;7i;8b3;	1	13e;		2				1	11	11a;11b2;	13e;																																																																							0	0			0	0																																																																			0	0																																																																																																															2																																																																																																																																													1	01	4a;7c;7d;7g;7i;8b1;8b3;10a1;										0.00	0.00													0.00	0.00	0.00	0.00							0.00	0.00					0.00	0.00									0.00	0.00			0.00	0.00													0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H0628	001	0	1	02	01	H0628_001_0	4	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1	7f_2;	2	1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;	2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;																									10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																			10.00	10.00																																																																																																																																																																																																																																																																2			
H0628	005	0	1	02	01	H0628_005_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1	7f_2;	2	1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;	2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;																									10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																			10.00	10.00																																																																																																																																																																																																																																																																2			
H0628	017	0	1	02	01	H0628_017_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1	7f_2;	2	1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;	2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;																									10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																			10.00	10.00																																																																																																																																																																																																																																																																2			
H0628	801	0	1	01	01	H0628_801_0	2	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H0628	801	0	1	01	01	H0628_801_0	2	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H0630	013	0	1	01	01	H0630_013_0	5	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	11	11b2;11a;4a;4b;7c;7i;9b;10a1;8b1;		13d;		2				1	11	11a;11b2;	13d;																																																																							0	0			0	0																																																																	0	0																																																																																																																	2																																																																																																																																													1	01	4a;4b;7c;7i;8b1;9b;10a1;										0.00	0.00	0.00	0.00											0.00	0.00															0.00	0.00									0.00	0.00									0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H0630	014	0	1	01	01	H0630_014_0	5	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	11	4a;8b1;9b;10a1;11a;11b2;4b;		13d;		2				1	11	10a1;11a;11b2;	13d;																																																																			0	0			0	0			0	0																																																																	0	0																																																																																																																	2																																																																																																																																													1	01	4a;4b;8b1;9b;										0.00	0.00	0.00	0.00																																					0.00	0.00									0.00	0.00																																																																																																																																																																																																																																																																																																																																						2			
H0630	015	0	1	02	01	H0630_015_0	5	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	11	4a;4b;11a;11b2;7c;7i;8b1;9b;10a1;		13d;	2	2				1	11	11a;11b2;	13d;																																																																							0	0			0	0																																																																	0	0																																																																																																																	2																																																																																																																																													1	01	4a;4b;7c;7i;8b1;9b;10a1;										0.00	0.00	0.00	0.00											0.00	0.00															0.00	0.00									0.00	0.00									0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H0630	016	0	1	02	01	H0630_016_0	6	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	11	4a;4b;7c;7i;8b1;11a;11b2;9b;10a1;		13d;	2	2				1	11	11a;11b2;	13d;																																																																							0	0			0	0																																																																	0	0																																																																																																																	2																																																																																																																																													1	01	4a;4b;7c;7i;8b1;9b;10a1;										0.00	0.00	0.00	0.00											0.00	0.00															0.00	0.00									0.00	0.00									0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H0630	025	0	1	02	01	H0630_025_0	5	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	11	4a;4b;7c;7i;8b1;9b;10a1;11a;11b2;		13d;	2	2				1	11	11a;11b2;	13d;																																																																							0	0			0	0																																																																	0	0																																																																																																																	2																																																																																																																																													1	01	4a;4b;7c;7i;8b1;9b;10a1;										0.00	0.00	0.00	0.00											0.00	0.00															0.00	0.00									0.00	0.00									0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H0630	027	0	1	01	01	H0630_027_0	5	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	01	4a;8b1;9b;10a1;11a;11b2;7a;8a2;7g;7i;8b3;7c;4b;9a2;				2				1	01	7a;7c;7g;7i;8a2;8b1;8b3;9a2;9b;10a1;11a;11b2;																				0	0			0	0									0	0					0	0							0	0	0	0			0	0			0	0	0	0							0	0			0	0			0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;4b;										0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																																																																																						2			
H0783	004	0	1	01	01	H0783_004_0	2	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H0908	001	0	1	02	01	H0908_001_0	9	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H0908	003	0	1	02	01	H0908_003_0	10	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H0908	004	0	1	02	01	H0908_004_0	10	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H0908	006	0	1	02	01	H0908_006_0	9	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H0908	007	0	1	02	01	H0908_007_0	8	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H0908	008	0	1	02	01	H0908_008_0	14	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H1019	001	0	1	02	01	H1019_001_0	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1019	006	0	1	01	01	H1019_006_0	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1019	103	1	1	01	01	H1019_103_1	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1019	103	2	1	01	01	H1019_103_2	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1019	113	0	1	01	01	H1019_113_0	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1019	124	0	1	02	01	H1019_124_0	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1019	130	0	1	02	01	H1019_130_0	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1019	147	2	1	01	01	H1019_147_2	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1019	151	2	1	01	01	H1019_151_2	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	054	0	1	01	01	H1036_054_0	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	062	0	1	01	01	H1036_062_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	065	0	1	01	01	H1036_065_0	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	077	0	1	01	01	H1036_077_0	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	102	0	1	01	01	H1036_102_0	5	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	209	0	1	01	01	H1036_209_0	5	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	210	0	1	01	01	H1036_210_0	5	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	213	0	1	01	01	H1036_213_0	5	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	214	0	1	01	01	H1036_214_0	5	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	230	0	1	01	01	H1036_230_0	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	285	0	1	01	01	H1036_285_0	5	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	301	0	1	01	01	H1036_301_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	302	0	1	01	01	H1036_302_0	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	304	0	1	01	01	H1036_304_0	5	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	314	0	1	01	01	H1036_314_0	5	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	315	0	1	01	01	H1036_315_0	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	316	0	1	01	01	H1036_316_0	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	336	0	1	01	01	H1036_336_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	337	0	1	01	01	H1036_337_0	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	338	0	1	01	01	H1036_338_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	339	0	1	01	01	H1036_339_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	340	0	1	01	01	H1036_340_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1036	341	0	1	01	01	H1036_341_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H1099	001	0	1	02	01	H1099_001_0	7	2	2	COPD Spirometry Test																00100000000000									2			2	01	8a1;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8a1;																																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H1099	001	0	1	02	01	H1099_001_0	7	1	2	Diabetic Retinopathy Screening																01000000000000									2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H1099	006	0	1	01	01	H1099_006_0	7	1	2	Diabetic Retinopathy Screening																01000000000000									2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H1099	006	0	1	01	01	H1099_006_0	7	2	2	COPD Spirometry Test																00100000000000									2			2	01	8a1;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8a1;																																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H1099	009	0	1	01	01	H1099_009_0	5	1	2	Diabetic Retinopathy Screening																01000000000000									2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H1099	009	0	1	01	01	H1099_009_0	5	2	2	COPD Spirometry Test																00100000000000									2			2	01	8a1;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8a1;																																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H1099	014	0	1	01	01	H1099_014_0	8	1	2	Diabetic Retinopathy Screening																01000000000000									2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H1099	014	0	1	01	01	H1099_014_0	8	2	2	COPD Spirometry Test																00100000000000									2			2	01	8a1;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8a1;																																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H1099	016	0	1	01	01	H1099_016_0	7	2	2	COPD Spirometry Test																00100000000000									2			2	01	8a1;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8a1;																																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H1099	016	0	1	01	01	H1099_016_0	7	1	2	Diabetic Retinopathy Screening																01000000000000									2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H1099	023	0	1	01	01	H1099_023_0	6	2	2	COPD Spirometry Test																00100000000000									2			2	01	8a1;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8a1;																																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H1099	023	0	1	01	01	H1099_023_0	6	1	2	Diabetic Retinopathy Screening																01000000000000									2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H1099	024	0	1	01	01	H1099_024_0	6	2	2	COPD Spirometry Test																00100000000000									2			2	01	8a1;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8a1;																																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H1099	024	0	1	01	01	H1099_024_0	6	1	2	Diabetic Retinopathy Screening																01000000000000									2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H1099	025	0	1	02	01	H1099_025_0	6	1	2	Diabetic Retinopathy Screening																01000000000000									2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H1099	025	0	1	02	01	H1099_025_0	6	2	2	COPD Spirometry Test																00100000000000									2			2	01	8a1;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8a1;																																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H1099	026	0	1	01	01	H1099_026_0	7	1	2	Diabetic Retinopathy Screening																01000000000000									2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H1099	026	0	1	01	01	H1099_026_0	7	2	2	COPD Spirometry Test																00100000000000									2			2	01	8a1;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8a1;																																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H1099	027	0	1	02	01	H1099_027_0	6	1	2	Diabetic Retinopathy Screening																01000000000000									2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H1099	027	0	1	02	01	H1099_027_0	6	2	2	COPD Spirometry Test																00100000000000									2			2	01	8a1;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8a1;																																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H1099	028	0	1	01	01	H1099_028_0	5	2	2	COPD Spirometry Test																00100000000000									2			2	01	8a1;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8a1;																																														0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H1099	028	0	1	01	01	H1099_028_0	5	1	2	Diabetic Retinopathy Screening																01000000000000									2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H1109	801	0	1	01	01	H1109_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H1109	801	0	1	01	01	H1109_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H1109	802	0	1	01	01	H1109_802_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H1109	802	0	1	01	01	H1109_802_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H1170	002	0	1	01	01	H1170_002_0	6	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	01	7c;7g;7i;8a1;8b1;8b3;9a2;10a1;11a;11b2;4a;				2				1	01	11a;11b2;																																																																								0	0			0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;7c;7g;7i;8a1;8b1;8b3;9a2;10a1;										0.00	0.00													0.00	0.00									0.00	0.00					0.00	0.00					0.00	0.00			0.00	0.00			0.00	0.00			0.00	0.00									0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H1170	008	0	1	01	01	H1170_008_0	6	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	01	4a;7c;7i;10a1;8b1;8a1;9a2;11b2;11a;8b3;				2				1	01	11a;11b2;																																																																								0	0			0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;7c;7i;8a1;8b1;8b3;9a2;10a1;										0.00	0.00													0.00	0.00															0.00	0.00					0.00	0.00			0.00	0.00			0.00	0.00			0.00	0.00									0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H1170	009	0	1	01	01	H1170_009_0	6	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	01	7c;7g;7i;8a1;8b1;8b3;9a2;10a1;11a;11b2;4a;				2				1	01	11a;11b2;																																																																								0	0			0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;7c;7g;7i;8a1;8b1;8b3;9a2;10a1;										0.00	0.00													0.00	0.00									0.00	0.00					0.00	0.00					0.00	0.00			0.00	0.00			0.00	0.00			0.00	0.00									0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H1170	011	0	1	01	01	H1170_011_0	6	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	01	4a;10a1;7c;7i;8a1;8b1;8b3;9a2;11a;11b2;				2				1	01	11a;11b2;																																																																								0	0			0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;7c;7i;8a1;8b1;8b3;9a2;10a1;										0.00	0.00													0.00	0.00															0.00	0.00					0.00	0.00			0.00	0.00			0.00	0.00			0.00	0.00									0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H1170	012	0	1	01	01	H1170_012_0	6	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	01	7c;7g;7i;8a1;8b1;8b3;9a2;10a1;11a;11b2;4a;				2				1	01	11a;11b2;																																																																								0	0			0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;7c;7g;7i;8a1;8b1;8b3;9a2;10a1;										0.00	0.00													0.00	0.00									0.00	0.00					0.00	0.00					0.00	0.00			0.00	0.00			0.00	0.00			0.00	0.00									0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H1170	013	0	1	02	01	H1170_013_0	6	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	01	7c;7g;7i;8a1;8b1;8b3;9a2;10a1;11a;11b2;4a;			2	2				1	01	11a;11b2;																																																																								0	0			0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;7c;7g;7i;8a1;8b1;8b3;9a2;10a1;										0.00	0.00													0.00	0.00									0.00	0.00					0.00	0.00					0.00	0.00			0.00	0.00			0.00	0.00			0.00	0.00									0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H1170	014	0	1	01	01	H1170_014_0	5	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	01	7c;7g;7i;8b1;8a1;8b3;9a2;10a1;11a;11b2;4a;				2				1	01	11a;11b2;																																																																								0	0			0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;7c;7g;7i;8a1;8b1;8b3;9a2;10a1;										0.00	0.00													0.00	0.00									0.00	0.00					0.00	0.00					0.00	0.00			0.00	0.00			0.00	0.00			0.00	0.00									0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H1170	015	0	1	01	01	H1170_015_0	6	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	01	10a1;4a;7c;7g;7i;8a1;8a2;8b1;8b3;9a2;11a;11b2;				2				1	01	7c;7g;7i;8a1;8a2;8b1;8b3;9a2;10a1;11a;11b2;																								0	0									0	0					0	0					0	0	0	0	0	0			0	0			0	0									0	0			0	0			0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;										0.00	0.00																																																																																																																																																																																																																																																																																																																																																																																								2			
H1170	016	0	1	01	01	H1170_016_0	6	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	01	7c;7g;7i;8a1;8b1;8b3;9a2;10a1;11a;11b2;4a;				2				1	01	11a;11b2;																																																																								0	0			0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;7c;7g;7i;8a1;8b1;8b3;9a2;10a1;										0.00	0.00													0.00	0.00									0.00	0.00					0.00	0.00					0.00	0.00			0.00	0.00			0.00	0.00			0.00	0.00									0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H1170	017	0	1	01	01	H1170_017_0	5	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	01	7c;7g;7i;8b1;8a1;8b3;9a2;10a1;11a;11b2;4a;				2				1	01	11a;11b2;																																																																								0	0			0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;7c;7g;7i;8a1;8b1;8b3;9a2;10a1;										0.00	0.00													0.00	0.00									0.00	0.00					0.00	0.00					0.00	0.00			0.00	0.00			0.00	0.00			0.00	0.00									0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H1206	801	0	1	01	01	H1206_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H1206	801	0	1	01	01	H1206_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H1230	003	0	1	01	01	H1230_003_0	3	2	2	2																01000000000000									2			2	01	8a2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8a2;																																																0.00	0.00																																																																																																																																																																																																																																																																																																																																																		2			
H1230	003	0	1	01	01	H1230_003_0	3	3	2	3																00110100000000						2	2		2			2	01	8a2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8a2;																																																0.00	0.00																																																																																																																																																																																																																																																																																																																																																		2			
H1230	003	0	1	01	01	H1230_003_0	3	1	2	1																00000000001100	Liver Disease	Certain bleeding disorders				2	2		2			2	01	8a2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8a2;																																																0.00	0.00																																																																																																																																																																																																																																																																																																																																																		2			
H1248	004	0	1	04	01	H1248_004_0	13	1	2	Diabetic eye exams																01000000000000									2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H1248	007	0	1	04	01	H1248_007_0	12	1	2	Diabetic eye exams																01000000000000									2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H1248	014	0	1	04	01	H1248_014_0	12	1	2	Diabetic eye exams																01000000000000									2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H1608	027	0	1	04	01	H1608_027_0	2	1	2	Healthy Heart (CHF)																00000000001000	Chronic heart failure								1	001		2	01	7d;7j;	2		1	1	01	7d;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7j;																																										0.00	0.00																																																																																																																																																																																																																					2																																																				2																											1	030;018;012;008;					0.00	0.00			0.00	0.00											0.00	0.00																	0.00	0.00											2			
H1608	801	0	1	04	01	H1608_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H1608	801	0	1	04	01	H1608_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H1609	068	0	1	02	01	H1609_068_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		2	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H1609	801	0	1	01	01	H1609_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H1609	801	0	1	01	01	H1609_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H1609	807	0	1	01	01	H1609_807_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H1609	807	0	1	01	01	H1609_807_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H1692	801	0	1	01	01	H1692_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H1692	801	0	1	01	01	H1692_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H2056	801	0	1	01	01	H2056_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H2056	801	0	1	01	01	H2056_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H2056	802	0	1	01	01	H2056_802_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H2056	802	0	1	01	01	H2056_802_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H2172	001	0	1	02	01	H2172_001_0	5	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			2	01	4a;7g;8b1;9a2;11b2;			2	2				1	01	11b2;																																																																												0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;7g;8b1;9a2;										0.00	0.00																							0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																								2			
H2172	002	0	1	02	01	H2172_002_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			2	01	4a;7g;8b1;9a2;11b2;			2	2				1	01	11b2;																																																																												0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;7g;8b1;9a2;										0.00	0.00																							0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																								2			
H2172	005	0	1	01	01	H2172_005_0	3	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			2	01	4a;7g;8b1;9a2;11b2;				2				1	01	11b2;																																																																												0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;7g;8b1;9a2;										0.00	0.00																							0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																								2			
H2172	008	0	1	02	01	H2172_008_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	01	4a;7g;8b1;9a2;11b2;			2	2				1	01	11b2;																																																																												0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;7g;8b1;9a2;										0.00	0.00																							0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																								2			
H2172	009	0	1	02	01	H2172_009_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			2	01	4a;7g;8b1;9a2;11b2;			2	2				1	01	11b2;																																																																												0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;7g;8b1;9a2;										0.00	0.00																							0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																								2			
H2172	010	0	1	02	01	H2172_010_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			2	01	4a;7g;8b1;9a2;11b2;			2	2				1	01	11b2;																																																																												0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;7g;8b1;9a2;										0.00	0.00																							0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																								2			
H2172	013	0	1	02	01	H2172_013_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			2	01	4a;7g;8b1;9a2;11b2;			2	2				1	01	11b2;																																																																												0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;7g;8b1;9a2;										0.00	0.00																							0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																								2			
H2172	014	0	1	02	01	H2172_014_0	5	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			2	01	4a;7g;8b1;9a2;11b2;			2	2				1	01	11b2;																																																																												0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;7g;8b1;9a2;										0.00	0.00																							0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																								2			
H2172	016	0	1	01	01	H2172_016_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			2	01	4a;7g;8b1;9a2;11b2;8a1;8a2;8b3;				2				1	01	7g;8a1;8a2;8b1;8b3;9a2;11b2;																																		0	0											0	0	0	0	0	0			0	0			0	0																	0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;										0.00	0.00																																																																																																																																																																																																																																																																																																																																																																																								2			
H2172	017	0	1	01	01	H2172_017_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			2	01	4a;7g;8b1;9a2;11b2;8a2;8a1;8b3;				2				1	01	7g;8a1;8a2;8b1;8b3;9a2;11b2;																																		0	0											0	0	0	0	0	0			0	0			0	0																	0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;										0.00	0.00																																																																																																																																																																																																																																																																																																																																																																																								2			
H2172	018	0	1	01	01	H2172_018_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			2	01	4a;7g;8b1;9a2;11b2;				2				1	01	11b2;																																																																												0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;7g;8b1;9a2;										0.00	0.00																							0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																								2			
H2172	019	0	1	01	01	H2172_019_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			2	01	4a;7g;8b1;9a2;11b2;				2				1	01	11b2;																																																																												0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;7g;8b1;9a2;										0.00	0.00																							0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																								2			
H2172	020	0	1	02	01	H2172_020_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			2	01	4a;7g;8b1;11b2;9a2;			2	2				1	01	11b2;																																																																												0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;7g;8b1;9a2;										0.00	0.00																							0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																								2			
H2172	021	0	1	02	01	H2172_021_0	5	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	01	4a;7g;8b1;9a2;11b2;			2	2				1	01	11b2;																																																																												0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;7g;8b1;9a2;										0.00	0.00																							0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																								2			
H2172	022	0	1	02	01	H2172_022_0	5	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	01	4a;7g;8b1;9a2;11b2;			2	2				1	01	11b2;																																																																												0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;7g;8b1;9a2;										0.00	0.00																							0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																								2			
H2172	023	0	1	02	01	H2172_023_0	5	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			2	01	4a;7g;8b1;9a2;11b2;			2	2				1	01	11b2;																																																																												0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;7g;8b1;9a2;										0.00	0.00																							0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																								2			
H2172	024	0	1	02	01	H2172_024_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			2	01	4a;7g;8b1;9a2;11b2;			2	2				1	01	11b2;																																																																												0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;7g;8b1;9a2;										0.00	0.00																							0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																								2			
H2172	025	0	1	01	01	H2172_025_0	5	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			2	01	4a;7g;8b1;9a2;11b2;				2				1	01	11b2;																																																																												0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;7g;8b1;9a2;										0.00	0.00																							0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																								2			
H2172	026	0	1	01	01	H2172_026_0	5	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			2	01	4a;7g;8b1;9a2;11b2;				2				1	01	11b2;																																																																												0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;7g;8b1;9a2;										0.00	0.00																							0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																								2			
H2172	027	0	1	02	01	H2172_027_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			2	01	4a;7g;8b1;9a2;11b2;			2	2				1	01	11b2;																																																																												0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;7g;8b1;9a2;										0.00	0.00																							0.00	0.00															0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																																								2			
H2293	001	0	1	04	01	H2293_001_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H2293	019	0	1	04	01	H2293_019_0	3	1	2	Cancer Care																00000000001000	Cancer								1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H2293	019	0	1	04	01	H2293_019_0	3	2	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H2293	023	0	1	04	01	H2293_023_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H2293	026	0	1	04	01	H2293_026_0	3	2	2	Chronic Care																11000000001111	Autoimmune, chronic lung or neurologic disorders	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic and disabling mental health conditions	Chronic alcohol and other drug dep, or End-stage liver disease	Chronic musculoskeletal or metabolic conditions	2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H2293	026	0	1	04	01	H2293_026_0	3	1	2	Cancer Care																00000000001000	Cancer								1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H2293	026	0	1	04	01	H2293_026_0	3	3	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H2293	029	0	1	04	01	H2293_029_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H2610	005	0	1	01	01	H2610_005_0	9	1	2	Diabetic Eye Exam																01000000000000									2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H2610	006	0	1	01	01	H2610_006_0	9	1	2	Diabetic Eye Exam																01000000000000									2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H2610	015	0	1	01	01	H2610_015_0	8	1	2	Diabetic Eye Exam																01000000000000									2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H2610	016	0	1	01	01	H2610_016_0	7	1	2	Diabetic Eye Exam																01000000000000									2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H2610	021	0	1	01	01	H2610_021_0	8	1	2	Diabetic Eye Exam																01000000000000									2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H2610	027	0	1	01	01	H2610_027_0	7	1	2	Diabetic Eye Exam																01000000000000									2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H2663	067	0	1	01	01	H2663_067_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1			1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H2663	805	0	1	01	01	H2663_805_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H2663	805	0	1	01	01	H2663_805_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H2775	106	0	1	04	01	H2775_106_0	9	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H2775	109	0	1	04	01	H2775_109_0	9	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H2775	111	0	1	04	01	H2775_111_0	9	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H2775	112	0	1	04	01	H2775_112_0	8	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H2775	113	0	1	04	01	H2775_113_0	8	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H2775	115	0	1	04	01	H2775_115_0	8	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H2775	116	0	1	04	01	H2775_116_0	8	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H2816	013	0	1	09	04	H2816_013_0	8	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;				2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H2816	019	0	1	09	04	H2816_019_0	8	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;				2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H2816	037	0	1	09	04	H2816_037_0	8	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;				2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H2816	038	0	1	09	04	H2816_038_0	7	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;				2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H2816	040	0	1	09	04	H2816_040_0	8	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;				2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H2875	001	0	1	02	01	H2875_001_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H2875	002	0	1	02	01	H2875_002_0	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H2875	006	0	1	02	01	H2875_006_0	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H3146	021	0	1	01	01	H3146_021_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1			1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H3146	801	0	1	01	01	H3146_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H3146	801	0	1	01	01	H3146_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H3152	048	0	1	01	01	H3152_048_0	4	2	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;				1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H3152	048	0	1	01	01	H3152_048_0	4	3	2	Cancer Care																00000000001000	Cancer								1	010		2	01	7a;7j;				1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H3152	048	0	1	01	01	H3152_048_0	4	1	2	Chronic Care																11000000001111	Autoimmune, chronic lung or neurologic disorders	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic and disabling mental health conditions	Chronic alcohol and other drug dep, or End-stage liver disease	Chronic musculoskeletal or metabolic conditions	2	2		1	010		2	01	7a;7j;				1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H3152	080	0	1	02	01	H3152_080_0	3	3	2	Cancer Care																00000000001000	Cancer								1	010		2	01	7a;7j;			2	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H3152	080	0	1	02	01	H3152_080_0	3	1	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;			2	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H3152	080	0	1	02	01	H3152_080_0	3	2	2	Chronic Care																11000000001111	Autoimmune, chronic lung or neurologic disorders	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic and disabling mental health conditions	Chronic alcohol and other drug dep, End-stage liver disease	Chronic musculoskeletal or metabolic conditions	2	2		1	010		2	01	7a;7j;			2	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H3152	082	0	1	01	01	H3152_082_0	3	3	2	Cancer Care																00000000001000	Cancer								1	010		2	01	7a;7j;				1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H3152	082	0	1	01	01	H3152_082_0	3	2	2	Chronic Care																11000000001111	Autoimmune, chronic lung or neurologic disorders	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic and disabling mental health conditions	Chronic alcohol and other drug dep, or End-stage liver disease	Chronic musculoskeletal or metabolic conditions	2	2		1	010		2	01	7a;7j;				1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H3152	082	0	1	01	01	H3152_082_0	3	1	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;				1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H3152	801	0	1	01	01	H3152_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H3152	801	0	1	01	01	H3152_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H3152	804	0	1	01	01	H3152_804_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H3152	804	0	1	01	01	H3152_804_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H3192	020	0	1	02	01	H3192_020_0	2	1	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;			2	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H3192	021	0	1	02	01	H3192_021_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		2	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H3192	801	0	1	01	01	H3192_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H3192	801	0	1	01	01	H3192_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H3219	801	0	1	04	01	H3219_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H3219	801	0	1	04	01	H3219_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H3239	017	0	1	01	01	H3239_017_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1			1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H3239	020	0	1	01	01	H3239_020_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1			1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H3239	022	0	1	01	01	H3239_022_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1			1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H3288	046	0	1	04	01	H3288_046_0	3	1	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H3288	046	0	1	04	01	H3288_046_0	3	2	2	Cancer Care																00000000001000	Cancer								1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H3288	801	0	1	04	01	H3288_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H3288	801	0	1	04	01	H3288_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H3305	007	0	1	02	01	H3305_007_0	8	1	2	Package 1																01000000000000									2			2	01	7f;17a;			2	1	01	7f;17a;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7f;17a;																																0.00	0.00																																																																							0.00	0.00																																																																																																																																																																																																																																																																																										2			
H3305	015	0	1	02	01	H3305_015_0	17	1	2	Package 1																01000000000000									2			2	01	7f;17a;			2	1	01	7f;17a;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7f;17a;																																0.00	0.00																																																																							0.00	0.00																																																																																																																																																																																																																																																																																										2			
H3305	020	0	1	02	01	H3305_020_0	8	1	2	Package 1																01000000000000									2			2	01	7f;17a;			2	1	01	7f;17a;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7f;17a;																																0.00	0.00																																																																							0.00	0.00																																																																																																																																																																																																																																																																																										2			
H3305	022	0	1	02	01	H3305_022_0	16	1	2	Package 1																01000000000000									2			2	01	7f;17a;			2	1	01	7f;17a;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7f;17a;																																0.00	0.00																																																																							0.00	0.00																																																																																																																																																																																																																																																																																										2			
H3312	002	0	1	01	01	H3312_002_0	3	3	2	Cancer Care																00000000001000	Cancer								1	010		2	01	7a;7j;				1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H3312	002	0	1	01	01	H3312_002_0	3	2	2	Chronic Care																11000000001111	Autoimmune, chronic lung or neurologic disorders	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic and disabling mental health conditions	Chronic alcohol and other drug dep, or End-stage liver disease	Chronic musculoskeletal or metabolic conditions	2	2		1	010		2	01	7a;7j;				1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H3312	002	0	1	01	01	H3312_002_0	3	1	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;				1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H3312	048	0	1	01	01	H3312_048_0	3	2	2	Chronic Care																11000000001111	Autoimmune, chronic lung or neurologic disorders	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic and disabling mental health conditions	Chronic alcohol and other drug dep, or End-stage liver disease	Chronic musculoskeletal or metabolic conditions	2	2		1	010		2	01	7a;7j;				1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H3312	048	0	1	01	01	H3312_048_0	3	3	2	Cancer Care																00000000001000	Cancer								1	010		2	01	7a;7j;				1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H3312	048	0	1	01	01	H3312_048_0	3	1	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;				1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H3312	062	0	1	01	01	H3312_062_0	3	3	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;				1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H3312	062	0	1	01	01	H3312_062_0	3	1	2	Cancer Care																00000000001000	Cancer								1	010		2	01	7a;7j;				1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H3312	062	0	1	01	01	H3312_062_0	3	2	2	Chronic Care																11000000001111	Autoimmune, chronic lung or neurologic disorders	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic and disabling mental health conditions	Chronic alcohol and other drug dep, or End-stage liver disease	Chronic musculoskeletal or metabolic conditions	2	2		1	010		2	01	7a;7j;				1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H3312	065	0	1	02	01	H3312_065_0	3	2	2	Chronic Care																11000000001111	Autoimmune, chronic lung or neurologic disorders	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic and disabling mental health conditions	Chronic alcohol and other drug dep, or End-stage liver disease	Chronic musculoskeletal or metabolic conditions	2	2		1	010		2	01	7a;7j;			2	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H3312	065	0	1	02	01	H3312_065_0	3	1	2	Cancer Care																00000000001000	Cancer								1	010		2	01	7a;7j;			2	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H3312	065	0	1	02	01	H3312_065_0	3	3	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;			2	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H3312	074	0	1	01	01	H3312_074_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1			1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H3312	801	0	1	01	01	H3312_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H3312	801	0	1	01	01	H3312_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H3312	804	0	1	01	01	H3312_804_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H3312	804	0	1	01	01	H3312_804_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H3347	002	0	1	02	01	H3347_002_0	8	1	2	Package 1																01000000000000									2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H3347	009	0	1	02	01	H3347_009_0	9	1	2	Package 1																01000000000000									2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H3347	016	0	1	02	01	H3347_016_0	8	1	2	Package 1																01000000000000									2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H3597	801	0	1	01	01	H3597_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H3597	801	0	1	01	01	H3597_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H3597	802	0	1	01	01	H3597_802_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H3597	802	0	1	01	01	H3597_802_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H3748	801	0	1	01	01	H3748_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H3748	801	0	1	01	01	H3748_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H3832	007	0	1	04	01	H3832_007_0	5	1	2	House Calls																11111111111111	Cancers	Vascular Disease	Chronic Kidney Disease	Nutrition-related disorders including obesity	Hematological Disorders	2	2		1	010		2	01	8b1;			2	2				1	01	8b1;																																																		0	0																																																																																																																																																																																																													2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H3832	008	0	1	04	01	H3832_008_0	7	1	2	House Calls																11111111111111	Cancers	Vascular Disease	Chronic Kidney Disease	Nutrition-related disorders including obesity	Hematological Disorders	2	2		1	010		2	01	8b1;			2	2				1	01	8b1;																																																		0	0																																																																																																																																																																																																													2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H3832	009	0	1	04	01	H3832_009_0	5	1	2	House Calls																11111111111111	Cancers	Vascular Disease	Chronic Kidney Disease	Nutrition-related disorders including obesity	Hematological Disorders	2	2		1	010		2	01	8b1;			2	2				1	01	8b1;																																																		0	0																																																																																																																																																																																																													2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H3832	010	0	1	04	01	H3832_010_0	5	1	2	House Calls																11111111111111	Cancers	Vascular Disease	Chronic Kidney Disease	Nutrition-related disorders including obesity	Hematological Disorders	2	2		1	010		2	01	8b1;			2	2				1	01	8b1;																																																		0	0																																																																																																																																																																																																													2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H3907	002	0	1	01	01	H3907_002_0	13	1	3	SSBCI - Mental Health/LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;				1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H3907	037	0	1	01	01	H3907_037_0	16	1	3	SSBCI- Mental Health/LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;				1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H3907	057	1	1	01	01	H3907_057_1	18	1	3	SSBCI - Mental Health/LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;				1	01	7e1;7e2;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H3907	057	2	1	01	01	H3907_057_2	17	1	3	SSBCI - Mental Health/LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;				1	01	7e1;7e2;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H3907	057	3	1	01	01	H3907_057_3	17	1	3	SSBCI - Mental Health/LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;				1	01	7e1;7e2;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H3907	057	4	1	01	01	H3907_057_4	15	1	3	SSBCI - Mental Health/LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;				1	01	7e1;7e2;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H3907	057	5	1	01	01	H3907_057_5	16	1	3	SSBCI - Mental Health/LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;				1	01	7e1;7e2;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H3907	057	6	1	01	01	H3907_057_6	16	1	3	SSBCI - Mental Health/LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;				1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H3907	057	7	1	01	01	H3907_057_7	16	1	3	SSBCI - Mental Health/LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;				1	01	7e1;7e2;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H3907	058	1	1	01	01	H3907_058_1	16	1	3	SSBCI-Mental Health LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;				1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H3907	058	2	1	01	01	H3907_058_2	17	1	3	SSBCI-Mental Health LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;				1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H3907	058	3	1	01	01	H3907_058_3	17	1	3	SSBCI-Mental Health LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;				1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H3907	059	1	1	01	01	H3907_059_1	18	1	3	SSBCI- Mental Health LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;				1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H3907	059	2	1	01	01	H3907_059_2	18	1	3	SSBCI- Mental Health LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;				1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H3907	059	3	1	01	01	H3907_059_3	18	1	3	SSBCI- Mental Health/LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;				1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H3907	059	4	1	01	01	H3907_059_4	18	1	3	SSBCI - Mental Health/LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;				1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H3907	059	5	1	01	01	H3907_059_5	18	1	3	SSBCI- Mental Health LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;				1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H3909	001	0	1	04	01	H3909_001_0	6	1	2	Package # 1 Therapeutic Radiology																00000000001000	Breast Cancer								2			2	01	8b2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8b2;																																																				0.00	0.00																																																																																																																																																																																																																																																																																																																																														2			
H3909	001	0	1	04	01	H3909_001_0	6	2	2	Package 2 - Dementia Support																00000000010000									1	001		2	01	7d;7j;7i;7e1;7g;7h1;	2		2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7g;7h1;7i;7j;																												0.00	0.00					0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00																																																																																																																																																																																																																					2																																																				2																											1	019;																							0.00	0.00																											2			
H3909	007	0	1	04	01	H3909_007_0	6	1	2	Package # 1 Therapeutic Radiology																00000000001000	Breast Cancer								2			2	01	8b2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8b2;																																																				0.00	0.00																																																																																																																																																																																																																																																																																																																																														2			
H3909	007	0	1	04	01	H3909_007_0	6	2	2	Package 2 - Dementia Support																00000000010000									1	001		2	01	7d;7j;7i;7e1;7g;7h1;	2		2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7g;7h1;7i;7j;																												0.00	0.00					0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00																																																																																																																																																																																																																					2																																																				2																											1	019;																							0.00	0.00																											2			
H3909	009	0	1	04	01	H3909_009_0	6	1	2	Package # 1 Therapeutic Radiology																00000000001000	Breast Cancer								2			2	01	8b2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8b2;																																																				0.00	0.00																																																																																																																																																																																																																																																																																																																																														2			
H3909	009	0	1	04	01	H3909_009_0	6	2	2	Package 2 - Dementia Support																00000000010000									1	001		2	01	7d;7j;7i;7e1;7g;7h1;	2		2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7g;7h1;7i;7j;																												0.00	0.00					0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00																																																																																																																																																																																																																					2																																																				2																											1	019;																							0.00	0.00																											2			
H3909	018	0	1	04	01	H3909_018_0	6	2	2	Dementia Support																00000000010000									1	001		2	01	7d;7j;7i;7e1;7g;7h1;	2		2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7g;7h1;7i;7j;																												0.00	0.00					0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00																																																																																																																																																																																																																					2																																																				2																											1	019;																							0.00	0.00																											2			
H3909	018	0	1	04	01	H3909_018_0	6	1	2	Therapeutic Radiology																00000000001000	Breast Cancer								2			2	01	8b2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8b2;																																																				0.00	0.00																																																																																																																																																																																																																																																																																																																																														2			
H3909	020	0	1	04	01	H3909_020_0	6	2	2	Package 2 - Dementia Support																00000000010000									1	001		2	01	7d;7i;7j;7e1;7h1;7g;	2		2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7g;7h1;7i;7j;																												0.00	0.00					0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00																																																																																																																																																																																																																					2																																																				2																											1	019;																							0.00	0.00																											2			
H3909	020	0	1	04	01	H3909_020_0	6	1	2	Package 1 - Therapeutic Radiology																00000000001000	Breast Cancer								2			2	01	8b2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8b2;																																																				0.00	0.00																																																																																																																																																																																																																																																																																																																																														2			
H3916	001	0	1	04	01	H3916_001_0	6	1	3	Healing at Home - DME										000111100010010010000000000															2			2	01	11a;11b1;11b2;11c1;11c2;			1	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	11a;11b1;11b2;11c1;11c2;																																																																								0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																		1	1000.00	00100	
H3916	022	0	1	04	01	H3916_022_0	6	1	3	Healing at Home - DME										000111100010010010000000000															2			2	01	11a;11b1;11b2;11c1;11c2;			1	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	11a;11b1;11b2;11c1;11c2;																																																																								0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																		1	1000.00	00100	
H3928	001	0	1	01	01	H3928_001_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1			1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H3928	801	0	1	01	01	H3928_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H3928	801	0	1	01	01	H3928_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H3928	803	0	1	01	01	H3928_803_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H3928	803	0	1	01	01	H3928_803_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H3931	100	0	1	02	01	H3931_100_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		2	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H3931	143	0	1	02	01	H3931_143_0	2	1	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;			2	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H3931	801	0	1	01	01	H3931_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H3931	801	0	1	01	01	H3931_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H3931	804	0	1	01	01	H3931_804_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H3931	804	0	1	01	01	H3931_804_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H3952	008	0	1	01	01	H3952_008_0	6	1	2	Package #1 - Vital Care																01010000000000						1			2			2	11	7d;7f;	2	7f_2;		2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	11	7f;	7f_2;																															5.00	5.00																																																																																																	5.00	5.00																																																																																																																													2																																																				2																											1	012;008;					10.00	10.00			10.00	10.00																																									2			
H3952	008	0	1	01	01	H3952_008_0	6	2	2	Package #2 - Therapeutic Radiology																00000000001000	Breast Cancer								2			2	01	8b2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8b2;																																																				0.00	0.00																																																																																																																																																																																																																																																																																																																																														2			
H3952	008	0	1	01	01	H3952_008_0	6	3	2	Package  #3 - Dementia Support																00000000010000									1	001		2	01	7d;7j;7i;7e1;7g;7h1;	2			2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7g;7h1;7i;7j;																												0.00	0.00					0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00																																																																																																																																																																																																																					2																																																				2																											1	019;																							0.00	0.00																											2			
H3952	020	0	1	01	01	H3952_020_0	6	3	2	Package  #3 - Dementia Support																00000000010000									1	001		2	01	7d;7j;7i;7e1;7g;7h1;	2			2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7g;7h1;7i;7j;																												0.00	0.00					0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00																																																																																																																																																																																																																					2																																																				2																											1	019;																							0.00	0.00																											2			
H3952	020	0	1	01	01	H3952_020_0	6	1	2	Package #1 - Vital Care																01010000000000						1			2			2	11	7d;7f;	2	7f_2;		2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	11	7f;	7f_2;																															5.00	5.00																																																																																																	5.00	5.00																																																																																																																													2																																																				2																											1	008;012;					10.00	10.00			10.00	10.00																																									2			
H3952	020	0	1	01	01	H3952_020_0	6	2	2	Package #2 - Therapeutic Radiology																00000000001000	Breast Cancer								2			2	01	8b2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8b2;																																																				0.00	0.00																																																																																																																																																																																																																																																																																																																																														2			
H3952	045	0	1	01	01	H3952_045_0	6	1	2	Package #1 - Vital Care																01010000000000						1			2			2	11	7d;7f;	2	7f_2;		2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	11	7f;	7f_2;																															5.00	5.00																																																																																																	5.00	5.00																																																																																																																													2																																																				2																											1	008;012;					10.00	10.00			10.00	10.00																																									2			
H3952	045	0	1	01	01	H3952_045_0	6	2	2	Package #2 - Therapeutic Radiology																00000000001000	Breast Cancer								2			2	01	8b2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8b2;																																																				0.00	0.00																																																																																																																																																																																																																																																																																																																																														2			
H3952	045	0	1	01	01	H3952_045_0	6	3	2	Package  #3 - Dementia Support																00000000010000									1	001		2	01	7d;7j;7i;7e1;7g;7h1;	2			2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7g;7h1;7i;7j;																												0.00	0.00					0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00																																																																																																																																																																																																																					2																																																				2																											1	019;																							0.00	0.00																											2			
H3952	048	0	1	01	01	H3952_048_0	5	1	2	Package 1 - Vital Care																01010000000000						1			2			2	11	7d;7f;	2	7f_2;		2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	11	7f;	7f_2;																															5.00	5.00																																																																																																	5.00	5.00																																																																																																																													2																																																				2																											1	008;012;					10.00	10.00			10.00	10.00																																									2			
H3952	048	0	1	01	01	H3952_048_0	5	2	2	Package 2 - Therapeutic Radiology																00000000001000	Breast Cancer								2			2	01	8b2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8b2;																																																				0.00	0.00																																																																																																																																																																																																																																																																																																																																														2			
H3952	048	0	1	01	01	H3952_048_0	5	3	2	Package 3 - Dementia Support																00000000010000									1	001		2	01	7d;7j;7i;7e1;7g;7h1;	2			2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7g;7h1;7i;7j;																												0.00	0.00					0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00																																																																																																																																																																																																																					2																																																				2																											1	019;																							0.00	0.00																											2			
H3952	049	0	1	01	01	H3952_049_0	6	1	2	Package 1 - Vital Care																01010000000000						1			2			2	11	7d;7f;	2	7f_2;		2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	11	7f;	7f_2;																															5.00	5.00																																																																																																	5.00	5.00																																																																																																																													2																																																				2																											1	008;012;					10.00	10.00			10.00	10.00																																									2			
H3952	049	0	1	01	01	H3952_049_0	6	3	2	Package 3 - Dementia Support																00000000010000									1	001		2	01	7d;7j;7i;7e1;7g;7h1;	2			2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7g;7h1;7i;7j;																												0.00	0.00					0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00																																																																																																																																																																																																																					2																																																				2																											1	019;																							0.00	0.00																											2			
H3952	049	0	1	01	01	H3952_049_0	6	2	2	Package 2 - Therapeutic Radiology																00000000001000	Breast Cancer								2			2	01	8b2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8b2;																																																				0.00	0.00																																																																																																																																																																																																																																																																																																																																														2			
H3952	050	0	1	01	01	H3952_050_0	6	3	2	Package 3 - Dementia Support																00000000010000									1	001		2	01	7d;7j;7i;7e1;7g;7h1;	2			2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7g;7h1;7i;7j;																												0.00	0.00					0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00																																																																																																																																																																																																																					2																																																				2																											1	019;																							0.00	0.00																											2			
H3952	050	0	1	01	01	H3952_050_0	6	1	2	Package 1 - Vital Care																01010000000000						1			2			2	11	7d;7f;	2	7f_2;		2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	11	7f;	7f_2;																															5.00	5.00																																																																																																	5.00	5.00																																																																																																																													2																																																				2																											1	012;008;					10.00	10.00			10.00	10.00																																									2			
H3952	050	0	1	01	01	H3952_050_0	6	2	2	Package 2 - Therapeutic Radiology																00000000001000	Breast Cancer								2			2	01	8b2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8b2;																																																				0.00	0.00																																																																																																																																																																																																																																																																																																																																														2			
H3952	051	0	1	01	01	H3952_051_0	6	1	2	Package 1 - Vital Care																01010000000000						1			2			2	11	7d;7f;	2	7f_2;		2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	11	7f;	7f_2;																															5.00	5.00																																																																																																	5.00	5.00																																																																																																																													2																																																				2																											1	008;012;					10.00	10.00			10.00	10.00																																									2			
H3952	051	0	1	01	01	H3952_051_0	6	3	2	Package 3 - Dementia Support																00000000010000									1	001		2	01	7d;7j;7i;7e1;7g;7h1;	2			2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7g;7h1;7i;7j;																												0.00	0.00					0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00																																																																																																																																																																																																																					2																																																				2																											1	019;																							0.00	0.00																											2			
H3952	051	0	1	01	01	H3952_051_0	6	2	2	Package 2 - Therapeutic Radiology																00000000001000	Breast Cancer								2			2	01	8b2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8b2;																																																				0.00	0.00																																																																																																																																																																																																																																																																																																																																														2			
H3952	053	0	1	02	01	H3952_053_0	6	1	2	Package 1 - Vital Care Plus																01000000000000									2			2	11	7d;7f;	2	7f_2;	2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	11	7f;	7f_2;																															5.00	5.00																																																																																																	5.00	5.00																																																																																																																													2																																																				2																											1	012;030;008;					10.00	10.00			10.00	10.00																													10.00	10.00											2			
H3952	053	0	1	02	01	H3952_053_0	6	2	2	Package 2 - Therapeutic Radiology																00000000001000	Breast Cancer								2			2	01	8b2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8b2;																																																				0.00	0.00																																																																																																																																																																																																																																																																																																																																														2			
H3952	053	0	1	02	01	H3952_053_0	6	3	2	Package 3 - Dementia Support																00000000010000									1	001		2	01	7d;7j;7c;7i;7e1;7g;7h1;	2		2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7c;7e1;7g;7h1;7i;7j;																								0.00	0.00			0.00	0.00					0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00																																																																																																																																																																																																																					2																																																				2																											1	019;																							0.00	0.00																											2			
H3952	054	0	1	02	01	H3952_054_0	6	2	2	Package 2 - Therapeutic Radiology																00000000001000	Breast Cancer								2			2	01	8b2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8b2;																																																				0.00	0.00																																																																																																																																																																																																																																																																																																																																														2			
H3952	054	0	1	02	01	H3952_054_0	6	3	2	Package 3 - Dementia Support																00000000010000									1	001		2	01	7d;7j;7c;7i;7e1;7g;7h1;	2		2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7c;7e1;7g;7h1;7i;7j;																								0.00	0.00			0.00	0.00					0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00																																																																																																																																																																																																																					2																																																				2																											1	019;																							0.00	0.00																											2			
H3952	054	0	1	02	01	H3952_054_0	6	1	2	Package 1 - Vital Care Plus																01000000000000									2			2	11	7d;7f;	2	7f_2;	2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	11	7f;	7f_2;																															5.00	5.00																																																																																																	5.00	5.00																																																																																																																													2																																																				2																											1	008;012;030;					10.00	10.00			10.00	10.00																													10.00	10.00											2			
H3952	055	0	1	01	01	H3952_055_0	7	1	2	Package 1 - Vital Care																01010000000000						1			2			2	11	7d;7f;	2	7f_2;		2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	11	7f;	7f_2;																															5.00	5.00																																																																																																	5.00	5.00																																																																																																																													2																																																				2																											1	012;008;					10.00	10.00			10.00	10.00																																									2			
H3952	055	0	1	01	01	H3952_055_0	7	3	2	Package 3 - Dementia Support																00000000010000									1	001		2	01	7d;7j;7i;7e1;7g;7h1;	2			2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7g;7h1;7i;7j;																												0.00	0.00					0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00																																																																																																																																																																																																																					2																																																				2																											1	019;																							0.00	0.00																											2			
H3952	055	0	1	01	01	H3952_055_0	7	2	2	Package 2 - Therapeutic Radiology																00000000001000	Breast Cancer								2			2	01	8b2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8b2;																																																				0.00	0.00																																																																																																																																																																																																																																																																																																																																														2			
H3952	059	0	1	01	01	H3952_059_0	6	3	2	Package 3 - Dementia Support																00000000010000									1	001		2	01	7d;7j;7e1;7i;7g;7h1;	2			2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7g;7h1;7i;7j;																												0.00	0.00					0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00																																																																																																																																																																																																																					2																																																				2																											1	019;																							0.00	0.00																											2			
H3952	059	0	1	01	01	H3952_059_0	6	2	2	Package 2 - Therapeutic Radiology																00000000001000	Breast Cancer								2			2	01	8b2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8b2;																																																				0.00	0.00																																																																																																																																																																																																																																																																																																																																														2			
H3952	059	0	1	01	01	H3952_059_0	6	1	2	Package 1 - Vital Care																01010000000000						1			2			2	11	7d;7f;	2	7f_2;		2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	11	7f;	7f_2;																															5.00	5.00																																																																																																	5.00	5.00																																																																																																																													2																																																				2																											1	012;008;					10.00	10.00			10.00	10.00																																									2			
H3952	060	0	1	02	01	H3952_060_0	6	2	2	Package 2 - Therapeutic Radiology																00000000001000	Breast Cancer								2			2	01	8b2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	8b2;																																																				0.00	0.00																																																																																																																																																																																																																																																																																																																																														2			
H3952	060	0	1	02	01	H3952_060_0	6	1	2	Package 1 - Vital Care																01010000000000						1			2			2	11	7d;7f;	2	7f_2;	2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	11	7f;	7f_2;																															5.00	5.00																																																																																																	5.00	5.00																																																																																																																													2																																																				2																											1	008;012;					10.00	10.00			10.00	10.00																																									2			
H3952	060	0	1	02	01	H3952_060_0	6	3	2	Package 3 - Dementia Support																00000000010000									1	001		2	01	7d;7j;7i;7g;7e1;7h1;	2		2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7g;7h1;7i;7j;																												0.00	0.00					0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00																																																																																																																																																																																																																					2																																																				2																											1	019;																							0.00	0.00																											2			
H3954	157	21	1	01	01	H3954_157_21	3	1	2	COPD																00100000000000									2			2	01	7d;8a1;8b1;11a;	2			2				1	01	11a;																																																																								0	0																																																																																																																																																																																							2																																																																																																																																													1	01	8a1;8b1;																																														0.00	0.00			0.00	0.00																																																																																																																																																																																																													2																																																				2																											1	030;008;035;					0.00	0.00																																	0.00	0.00							0.00	0.00			2			
H3954	158	14	1	01	01	H3954_158_14	3	1	2	COPD																00100000000000									2			2	01	7d;8a1;8b1;11a;	2			2				1	01	11a;																																																																								0	0																																																																																																																																																																																							2																																																																																																																																													1	01	8a1;8b1;																																														0.00	0.00			0.00	0.00																																																																																																																																																																																																													2																																																				2																											1	030;008;035;					0.00	0.00																																	0.00	0.00							0.00	0.00			2			
H3957	031	0	1	02	01	H3957_031_0	6	1	3	Flex Benefits/Healing at Home										000111110010010010000000000															2			2	01	7d;8a1;11c1;11a;11b1;11b2;11c2;	1		2	2				1	01	11c1;																																																																														0	5																																																																																																																																																																																	2																																																																																																																																													1	01	7d;8a1;11a;11b1;11b2;11c1;11c2;																										10.00	10.00																			0.00	0.00																									0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																		1	1000.00	00100	
H3957	045	1	1	02	01	H3957_045_1	8	1	3	Healing at Home- DME										000111100010010010000000000															2			2	01	11a;11b1;11b2;11c1;11c2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	11a;11b1;11b2;11c1;11c2;																																																																								0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																		1	1000.00	00100	
H3957	046	1	1	02	01	H3957_046_1	7	1	3	Healing at Home - DME										000111100010010010000000000															2			2	01	11a;11b1;11b2;11c1;11c2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	11a;11b1;11b2;11c1;11c2;																																																																								0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																		1	1000.00	00100	
H3957	047	1	1	01	01	H3957_047_1	6	1	3	Healing at Home										000111100010010010000000000															2			2	01	11a;11b1;11b2;11c1;11c2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	11a;11b1;11b2;11c1;11c2;																																																																								0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																		1	1000.00	00100	
H3957	048	0	1	01	01	H3957_048_0	6	1	3	Healing at Home- DME										000111100010010010000000000															2			2	01	11a;11b1;11b2;11c1;11c2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	11a;11b1;11b2;11c1;11c2;																																																																								0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																		1	1000.00	00100	
H3957	050	1	1	01	01	H3957_050_1	7	1	3	Healing at Home- DME										000111100010010010000000000															2			2	01	11a;11b1;11b2;11c1;11c2;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	11a;11b1;11b2;11c1;11c2;																																																																								0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00																																																																																																																																																																																																																																																																																																																		1	1000.00	00100	
H3959	033	0	1	02	01	H3959_033_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1	7f_2;	2	1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;	2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;																									10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																			10.00	10.00																																																																																																																																																																																																																																																																2			
H3959	804	0	1	01	01	H3959_804_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H3959	804	0	1	01	01	H3959_804_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H4003	009	0	1	01	01	H4003_009_0	5	1	3	DEBIT CARD										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic back pain											2			2	11	1a;1b;4a;7b;7c;7e1;7e2;7g;7h1;7h2;7i;7k;8a2;8b1;9a1;9a2;9c1;9c2;12;15-2;15-3;15-1-I;		1a1;7b1;		2				1	01	7k;8a2;12;15-2;15-3;																																												0	0			0	0																																	0	0															0	0	0	0																																																																																																																																																											2																																																																																																																																													1	11	4a;7b;7c;7e1;7e2;7g;7h1;7h2;7i;8b1;9a1;9a2;9c1;9c2;15-3;15-1-I;	7b1;									0.00	0.00											0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00									0.00	0.00					0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00																															0.00	0.00			0.00	0.00																									0.00	0.00																																																																																																																																																																																																																																																																				1	65.00	00010	
H4003	019	0	1	02	01	H4003_019_0	6	1	3	DEBIT CARD										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain											2			2	11	1a;1b;4a;7k;8a2;8b1;9a1;9a2;12;15-1-I;15-2;15-3;		1a1;	2	2				1	01	7k;8a2;12;15-2;15-3;																																												0	0			0	0																																	0	0															0	0	0	0																																																																																																																																																											2																																																																																																																																													1	01	4a;8b1;9a1;9a2;15-3;15-1-I;										0.00	0.00																																							0.00	0.00					0.00	0.00	0.00	0.00																																					0.00	0.00			0.00	0.00																																																																																																																																																																																																																																																																																														1	45.00	00010	
H4003	034	0	1	02	01	H4003_034_0	5	1	3	DEBIT CARD										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic back pain											2			2	11	1a;1b;4a;7k;8a2;8b1;9a1;9a2;11b1;11b2;12;15-1-I;15-2;15-3;		13a;1a1;	2	2				1	01	7k;8a2;11b1;11b2;12;15-2;15-3;																																												0	0			0	0																									0	0	0	0					0	0															0	0	0	0																																																																																																																																																											2																																																																																																																																													1	11	4a;8b1;9a1;9a2;15-1-I;	13a;									0.00	0.00																																							0.00	0.00					0.00	0.00	0.00	0.00																																					0.00	0.00																																							0.00	0.00																																																																																																																																																																																																																																																										1	20.00	00010	
H4003	055	0	1	02	01	H4003_055_0	6	1	3	DEBIT CARD										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic back pain											2			2	11	1a;1b;3-1;3-2;3-3;3-4;4a;7b;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;7k;8a2;9a1;9a2;9c1;9c2;11a;11b2;12;15-1-I;15-2;15-3;8b1;16a;11b1;	1	7b1;7f_2;13a;1a1;	2	2				1	01	7k;8a2;11a;11b1;11b2;12;15-2;15-3;16a;																																												0	0			0	0																							0	0	0	0	0	0					0	0															0	0	0	0	0	0																																																																																																																																																									2																																																																																																																																													1	11	3-1;3-2;3-3;3-4;4a;7b;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;8b1;9a1;9a2;9c1;9c2;15-3;15-1-I;	7b1;7f_2;13a;	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00											0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00									0.00	0.00					0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00																															0.00	0.00			0.00	0.00																									0.00	0.00			0.00	0.00					0.00	0.00																																																																																																																																																																																																																																																										1	10.00	00010	
H4004	056	0	1	02	01	H4004_056_0	7	1	3	DEBIT CARD										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain											2			2	11	1a;1b;3-1;3-2;3-3;3-4;7b;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;7k;8a2;8b1;9a1;9a2;9c1;9c2;11a;12;15-1-I;15-2;15-3;4a;	1	7b1;7f_2;1a1;	2	2				1	01	7k;8a2;11a;12;15-2;15-3;																																												0	0			0	0																							0	0									0	0															0	0	0	0																																																																																																																																																											2																																																																																																																																													1	11	3-1;3-2;3-3;3-4;4a;7b;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;8b1;9a1;9a2;9c1;9c2;15-3;15-1-I;	7b1;7f_2;	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00											0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00									0.00	0.00					0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00																															0.00	0.00			0.00	0.00																									0.00	0.00			0.00	0.00																																																																																																																																																																																																																																																																1	75.00	00010	
H4004	065	0	1	02	01	H4004_065_0	5	1	3	DEBIT CARD										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain											2			2	11	1a;1b;3-1;3-2;3-3;3-4;4a;7c;7e1;7e2;7i;7k;8a2;8b1;9a1;9a2;11b1;11b2;12;15-1-I;15-2;15-3;7g;		13a;1a1;	2	2				1	01	7k;8a2;11b1;11b2;12;15-2;15-3;																																												0	0			0	0																									0	0	0	0					0	0															0	0	0	0																																																																																																																																																											2																																																																																																																																													1	11	3-1;3-2;3-3;3-4;4a;7c;7e1;7e2;7g;7i;8b1;9a1;9a2;15-3;15-1-I;	13a;	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00													0.00	0.00			0.00	0.00	0.00	0.00			0.00	0.00					0.00	0.00									0.00	0.00					0.00	0.00	0.00	0.00																																					0.00	0.00			0.00	0.00																																			0.00	0.00																																																																																																																																																																																																																																																										1	50.00	00010	
H4004	066	0	1	02	01	H4004_066_0	6	1	3	DEBIT CARD										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain											2			2	11	1a;1b;3-1;3-2;3-3;3-4;4a;7b;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7k;8a2;8b1;9a1;9a2;9c1;9c2;11a;11b1;11b2;12;15-1-I;15-2;15-3;7i;9b;	1	13a;7b1;7f_2;1a1;	2	2				1	01	7k;8a2;11a;11b1;11b2;12;15-2;15-3;																																												0	0			0	0																							0	0	0	0	0	0					0	0															0	0	0	0																																																																																																																																																											2																																																																																																																																													1	11	3-1;3-2;3-3;3-4;4a;7b;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;8b1;9a1;9a2;9b;9c1;9c2;15-3;15-1-I;	7b1;7f_2;13a;	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00											0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00									0.00	0.00					0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00																															0.00	0.00			0.00	0.00																									0.00	0.00			0.00	0.00					0.00	0.00																																																																																																																																																																																																																																																										1	15.00	00010	
H4004	068	0	1	01	01	H4004_068_0	5	1	3	DEBIT CARD										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic back pain											2			2	11	11a;11b1;11b2;16a;		16c1;16c4;16c6;16c7;16c10;		2				1	11	11a;11b1;11b2;16a;	16c1;16c4;16c6;16c7;16c10;																																																																							0	0	0	0	0	0																									0	0																																																																																																									0	0					0	0			0	0	0	0					0	0																													2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					1	120.00	00010	
H4004	069	0	1	01	01	H4004_069_0	5	1	3	DEBIT CARD										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic back pain											2			2	01	11a;11b1;11b2;16a;				2				1	01	11a;11b1;11b2;16a;																																																																								0	0	0	0	0	0																									0	0																																																																																																																																																									2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					1	220.00	00010	
H4004	070	0	1	02	01	H4004_070_0	5	1	3	DEBIT CARD										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic back pain											2			2	11	1a;1b;3-1;3-2;3-3;3-4;4a;7b;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;7k;8a2;9a1;9a2;9c1;9c2;11a;11b1;11b2;12;15-1-I;15-2;15-3;8b1;16a;	1	7b1;7f_2;13a;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;1a1;	2	2				1	11	7k;8a2;11a;11b1;11b2;12;15-2;15-3;16a;	16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;																																											0	0			0	0																							0	0	0	0	0	0					0	0															0	0	0	0	0	0																																																																																																									0	0	0	0	0	0	0	0			0	0	0	0	0	0			0	0																													2																																																																																																																																													1	11	3-1;3-2;3-3;3-4;4a;7b;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;8b1;9a1;9a2;9c1;9c2;15-3;15-1-I;	7b1;7f_2;13a;	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00											0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00									0.00	0.00					0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00																															0.00	0.00			0.00	0.00																									0.00	0.00			0.00	0.00					0.00	0.00																																																																																																																																																																																																																																																										1	100.00	00010	
H4004	071	0	1	02	01	H4004_071_0	5	1	3	DEBIT CARD										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain											2			2	11	1a;1b;3-1;3-2;3-3;3-4;4a;7b;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;7k;8a2;8b1;9a1;9a2;9c1;9c2;11a;11b1;11b2;12;15-1-I;15-2;15-3;16a;	1	7b1;7f_2;13a;1a1;	2	2				1	01	7k;8a2;11a;11b1;11b2;12;15-2;15-3;16a;																																												0	0			0	0																							0	0	0	0	0	0					0	0															0	0	0	0	0	0																																																																																																																																																									2																																																																																																																																													1	11	3-1;3-2;3-3;3-4;4a;7b;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;8b1;9a1;9a2;9c1;9c2;15-3;15-1-I;	7b1;7f_2;13a;	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00											0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00									0.00	0.00					0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00																															0.00	0.00			0.00	0.00																									0.00	0.00			0.00	0.00					0.00	0.00																																																																																																																																																																																																																																																										1	190.00	00010	
H4004	072	1	1	01	01	H4004_072_1	5	1	3	DEBIT CARD										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain											2			2	01	11a;11b1;11b2;				2				1	01	11a;11b1;11b2;																																																																								0	0	0	0	0	0																																																																																																																																																																																			2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					1	130.00	00010	
H4004	072	2	1	01	01	H4004_072_2	5	1	3	DEBIT CARD										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain											2			2	01	11a;11b1;11b2;				2				1	01	11a;11b1;11b2;																																																																								0	0	0	0	0	0																																																																																																																																																																																			2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					1	95.00	00010	
H4004	072	3	1	01	01	H4004_072_3	5	1	3	DEBIT CARD										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain											2			2	01	11a;11b1;11b2;				2				1	01	11a;11b1;11b2;																																																																								0	0	0	0	0	0																																																																																																																																																																																			2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					1	75.00	00010	
H4004	073	1	1	02	01	H4004_073_1	6	1	3	DEBIT CARD										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain											2			2	11	1a;1b;3-1;3-2;3-3;3-4;4a;7b;7c;7d;7e1;7e2;7g;7h1;7h2;7i;7k;8a2;8b1;9a1;9c1;9c2;11b1;11b2;12;15-1-I;15-2;15-3;9a2;	1	13a;7b1;1a1;	2	2				1	01	7k;8a2;11b1;11b2;12;15-2;15-3;																																												0	0			0	0																									0	0	0	0					0	0															0	0	0	0																																																																																																																																																											2																																																																																																																																													1	11	3-1;3-2;3-3;3-4;4a;7b;7c;7d;7e1;7e2;7g;7h1;7h2;7i;8b1;9a1;9a2;9c1;9c2;15-3;15-1-I;	7b1;13a;	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00											0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00									0.00	0.00					0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00																															0.00	0.00			0.00	0.00																									0.00	0.00									0.00	0.00																																																																																																																																																																																																																																																										1	85.00	00010	
H4004	073	2	1	02	01	H4004_073_2	6	1	3	DEBIT CARD										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain											2			2	11	1a;1b;3-1;3-2;3-3;3-4;4a;7b;7c;7d;7e1;7e2;7g;7h1;7h2;7i;7k;8a2;8b1;9a1;9c1;9c2;11b1;11b2;12;15-1-I;15-2;15-3;9a2;	1	13a;7b1;1a1;	2	2				1	01	7k;8a2;11b1;11b2;12;15-2;15-3;																																												0	0			0	0																									0	0	0	0					0	0															0	0	0	0																																																																																																																																																											2																																																																																																																																													1	11	3-1;3-2;3-3;3-4;4a;7b;7c;7d;7e1;7e2;7g;7h1;7h2;7i;8b1;9a1;9a2;9c1;9c2;15-3;15-1-I;	7b1;13a;	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00											0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00									0.00	0.00					0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00																															0.00	0.00			0.00	0.00																									0.00	0.00									0.00	0.00																																																																																																																																																																																																																																																										1	70.00	00010	
H4004	073	3	1	02	01	H4004_073_3	6	1	3	DEBIT CARD										011111111111111111111111111	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain											2			2	11	1a;1b;3-1;3-2;3-3;3-4;4a;7b;7c;7d;7e1;7e2;7g;7h1;7h2;7i;7k;8a2;8b1;9a1;9c1;9c2;11b1;11b2;12;15-1-I;15-2;15-3;9a2;	1	13a;7b1;1a1;	2	2				1	01	7k;8a2;11b1;11b2;12;15-2;15-3;																																												0	0			0	0																									0	0	0	0					0	0															0	0	0	0																																																																																																																																																											2																																																																																																																																													1	11	3-1;3-2;3-3;3-4;4a;7b;7c;7d;7e1;7e2;7g;7h1;7h2;7i;8b1;9a1;9a2;9c1;9c2;15-3;15-1-I;	7b1;13a;	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00											0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00									0.00	0.00					0.00	0.00	0.00	0.00			0.00	0.00	0.00	0.00																															0.00	0.00			0.00	0.00																									0.00	0.00									0.00	0.00																																																																																																																																																																																																																																																										1	45.00	00010	
H4158	001	0	1	01	01	H4158_001_0	8	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;				2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H4329	001	0	1	01	01	H4329_001_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H4461	022	0	1	01	01	H4461_022_0	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H4461	038	0	1	01	01	H4461_038_0	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H4461	052	0	1	01	01	H4461_052_0	2	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H4461	066	0	1	01	01	H4461_066_0	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H4523	020	0	1	01	01	H4523_020_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1			1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H4523	021	0	1	01	01	H4523_021_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1			1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H4523	024	0	1	01	01	H4523_024_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1			1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H4523	027	0	1	01	01	H4523_027_0	3	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1			1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H4523	801	0	1	01	01	H4523_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H4523	801	0	1	01	01	H4523_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H4523	802	0	1	01	01	H4523_802_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H4523	802	0	1	01	01	H4523_802_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H4624	023	0	1	01	01	H4624_023_0	8	1	2	Specialist Services																00000000001000	Chronic Kidney Disease (CKD)Level 5 CKD (ESRD)								2			2	01	7d;	2			2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																					2																																																				2																											1	004;018;008;012;023;030;	0.00	0.00			0.00	0.00			0.00	0.00											0.00	0.00									0.00	0.00							0.00	0.00											2			
H4624	023	0	1	01	01	H4624_023_0	8	2	2	Dialysis																00000000001000	Chronic Kidney Disease (CKD)Level 5 CKD (ESRD)								2			2	01	12;				2				1	01	12;																																																																																		0	0																																																																																																																																																																													2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H4624	023	0	1	01	01	H4624_023_0	8	3	3	Foods & Produce, Util, OTC, RICS and AC										000000000010000000000000000															1	100	HRA Completion	2	01	1a;1b;2;4a;4b;5a;5b;7b;7c;7d;7i;7j;7k;8b1;8b2;9a1;9b;10a1;10a2;	1			2				1	01	8b2;10a2;																																																				0	20																	0	20																																																																																																																																																																																									2																																																																																																																																													1	01	4a;4b;7b;7c;7d;7i;7j;7k;8b1;9a1;9b;10a1;5a;5b;										0.00	125.00	0.00	15.00	0.00	70.00	0.00	0.00					0.00	15.00	0.00	20.00	0.00	25.00													0.00	20.00	0.00	30.00	0.00	25.00					0.00	100.00					0.00	115.00			0.00	50.00							0.00	225.00																																																																																																																																																																																																																																																																																																																														1	137.00	00011	
H4624	025	0	1	01	01	H4624_025_0	9	3	3	Foods & Produce, Utilities, OTC and RICS										000000000010000000000000000															1	100	HRA Completion	2	01	1a;1b;2;4a;4b;5a;5b;7b;7c;7d;7i;7j;7k;8b1;8b2;9a1;9b;10a1;10a2;	1			2				1	01	8b2;10a2;																																																				0	20																	0	20																																																																																																																																																																																									2																																																																																																																																													1	01	4a;4b;7b;7c;7d;7i;7j;7k;8b1;9a1;9b;10a1;5a;5b;										0.00	130.00	0.00	30.00	0.00	95.00	0.00	0.00					0.00	15.00	0.00	25.00	0.00	25.00													0.00	25.00	0.00	30.00	0.00	25.00					0.00	100.00					0.00	135.00			0.00	50.00							0.00	225.00																																																																																																																																																																																																																																																																																																																														1	141.00	00011	
H4624	025	0	1	01	01	H4624_025_0	9	2	2	Dialysis																00000000001000	Chronic Kidney Disease (CKD)Level 5 CKD (ESRD)								2			2	01	12;				2				1	01	12;																																																																																		0	0																																																																																																																																																																													2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H4624	025	0	1	01	01	H4624_025_0	9	1	2	Specialist Services																00000000001000	Chronic Kidney Disease (CKD)Level 5 CKD (ESRD)								2			2	01	7d;	2			2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																					2																																																				2																											1	004;023;018;008;030;012;	0.00	0.00			0.00	0.00			0.00	0.00											0.00	0.00									0.00	0.00							0.00	0.00											2			
H4624	029	0	1	01	01	H4624_029_0	8	1	2	Specialist Services																00000000001000	Chronic Kidney Disease (CKD)Level 5 CKD (ESRD)								2			2	01	7d;	2			2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																					2																																																				2																											1	023;018;004;030;008;012;	0.00	0.00			0.00	0.00			0.00	0.00											0.00	0.00									0.00	0.00							0.00	0.00											2			
H4624	029	0	1	01	01	H4624_029_0	8	2	2	Dialysis																00000000001000	Chronic Kidney Disease (CKD)Level 5 CKD (ESRD)								2			2	01	12;				2				1	01	12;																																																																																		0	0																																																																																																																																																																													2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H4624	029	0	1	01	01	H4624_029_0	8	3	3	Foods & Produce, Utilities, OTC and RICS										000000000010000000000000000															1	100	HRA Completion	2	01	1a;1b;2;4a;4b;5a;5b;7b;7c;7d;7i;7j;7k;8b1;8b2;9a1;9b;10a1;10a2;	1			2				1	01	8b2;10a2;																																																				0	20																	0	20																																																																																																																																																																																									2																																																																																																																																													1	01	4a;4b;7b;7c;7d;7i;7j;7k;8b1;9a1;9b;10a1;5a;5b;										0.00	130.00	0.00	30.00	0.00	95.00	0.00	0.00					0.00	15.00	0.00	25.00	0.00	25.00													0.00	25.00	0.00	30.00	0.00	25.00					0.00	100.00					0.00	150.00			0.00	50.00							0.00	225.00																																																																																																																																																																																																																																																																																																																														1	130.00	00011	
H4624	036	0	1	01	01	H4624_036_0	8	1	2	Specialist Services																00000000001000	Chronic Kidney Disease (CKD)Level 5 CKD (ESRD)								2			2	01	7d;	2			2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																					2																																																				2																											1	018;023;008;030;012;004;	0.00	0.00			0.00	0.00			0.00	0.00											0.00	0.00									0.00	0.00							0.00	0.00											2			
H4624	036	0	1	01	01	H4624_036_0	8	3	3	Foods & Produce, Utilities, OTC and RICS										000000000010000000000000000															1	100	HRA Completion	2	01	1a;1b;2;4a;4b;5a;5b;7b;7c;7d;7i;7j;7k;8b1;8b2;9a1;9b;10a1;10a2;	1			2				1	01	8b2;10a2;																																																				0	20																	0	20																																																																																																																																																																																									2																																																																																																																																													1	01	4a;4b;7b;7c;7d;7i;7j;7k;8b1;9a1;9b;10a1;5a;5b;										0.00	130.00	0.00	30.00	0.00	95.00	0.00	0.00					0.00	15.00	0.00	25.00	0.00	25.00													0.00	25.00	0.00	30.00	0.00	25.00					0.00	100.00					0.00	130.00			0.00	50.00							0.00	225.00																																																																																																																																																																																																																																																																																																																														1	136.00	00011	
H4624	036	0	1	01	01	H4624_036_0	8	2	2	Dialysis																00000000001000	Chronic Kidney Disease (CKD)Level 5 CKD (ESRD)								2			2	01	12;				2				1	01	12;																																																																																		0	0																																																																																																																																																																													2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H4624	042	0	1	01	01	H4624_042_0	8	2	2	Dialysis																00000000001000	Chronic Kidney Disease (CKD)Level 5 CKD (ESRD)								2			2	01	12;				2				1	01	12;																																																																																		0	0																																																																																																																																																																													2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H4624	042	0	1	01	01	H4624_042_0	8	3	3	Foods & Produce, Utilities, OTC and RICS										000000000010000000000000000															1	100	HRA Completion	2	01	1a;1b;2;4a;4b;5a;5b;7b;7c;7d;7i;7j;7k;8b1;8b2;9a1;9b;10a1;10a2;9c1;9c2;	1			2				1	01	8b2;10a2;																																																				0	20																	0	20																																																																																																																																																																																									2																																																																																																																																													1	01	4a;4b;7b;7c;7d;7i;7j;7k;8b1;9a1;9b;9c1;9c2;10a1;5a;5b;										0.00	130.00	0.00	30.00	0.00	95.00	0.00	0.00					0.00	15.00	0.00	25.00	0.00	25.00													0.00	25.00	0.00	30.00	0.00	25.00					0.00	100.00					0.00	140.00			0.00	65.00	0.00	30.00	0.00	30.00			0.00	225.00																																																																																																																																																																																																																																																																																																																														1	130.00	00011	
H4624	042	0	1	01	01	H4624_042_0	8	1	2	Specialist Services																00000000001000	Chronic Kidney Disease (CKD)Level 5 CKD (ESRD)								2			2	01	7d;	2			2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																					2																																																				2																											1	012;008;004;023;030;018;	0.00	0.00			0.00	0.00			0.00	0.00											0.00	0.00									0.00	0.00							0.00	0.00											2			
H4711	801	0	1	01	01	H4711_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H4711	801	0	1	01	01	H4711_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H4835	801	0	1	01	01	H4835_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H4835	801	0	1	01	01	H4835_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H4868	003	0	1	02	01	H4868_003_0	8	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H4868	004	0	1	01	01	H4868_004_0	7	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;				2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H4868	014	0	1	01	01	H4868_014_0	7	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;				2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H4868	016	0	1	02	01	H4868_016_0	9	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H4868	019	0	1	02	01	H4868_019_0	9	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H4939	001	0	1	02	01	H4939_001_0	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H4982	801	0	1	01	01	H4982_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H4982	801	0	1	01	01	H4982_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H5050	004	0	1	01	01	H5050_004_0	4	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	01	7c;7g;7i;8b1;9a2;9b;10a1;11a;11b2;4a;4b;				2				1	01	11a;11b2;																																																																								0	0			0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;4b;7c;7g;7i;8b1;9a2;9b;10a1;										0.00	0.00	0.00	0.00											0.00	0.00									0.00	0.00					0.00	0.00									0.00	0.00							0.00	0.00	0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H5050	009	0	1	01	01	H5050_009_0	4	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	01	7c;7g;7i;8b1;9a2;9b;10a1;11a;11b2;4a;4b;				2				1	01	11a;11b2;																																																																								0	0			0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;4b;7c;7g;7i;8b1;9a2;9b;10a1;										0.00	0.00	0.00	0.00											0.00	0.00									0.00	0.00					0.00	0.00									0.00	0.00							0.00	0.00	0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H5050	022	0	1	01	01	H5050_022_0	4	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	01	7c;7g;7i;8a1;9a2;10a1;11a;11b2;4a;4b;8b1;9b;				2				1	01	11a;11b2;																																																																								0	0			0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;4b;7c;7g;7i;8a1;8b1;9a2;9b;10a1;										0.00	0.00	0.00	0.00											0.00	0.00									0.00	0.00					0.00	0.00					0.00	0.00			0.00	0.00							0.00	0.00	0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H5050	024	0	1	01	01	H5050_024_0	4	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	01	7c;7g;7i;8b1;9a2;9b;10a1;11a;11b2;4a;4b;				2				1	01	11a;11b2;																																																																								0	0			0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;4b;7c;7g;7i;8b1;9a2;9b;10a1;										0.00	0.00	0.00	0.00											0.00	0.00									0.00	0.00					0.00	0.00									0.00	0.00							0.00	0.00	0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H5050	025	0	1	01	01	H5050_025_0	4	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	01	7c;7g;7i;8b1;9a2;9b;10a1;11a;11b2;4a;4b;				2				1	01	11a;11b2;																																																																								0	0			0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;4b;7c;7g;7i;8b1;9a2;9b;10a1;										0.00	0.00	0.00	0.00											0.00	0.00									0.00	0.00					0.00	0.00									0.00	0.00							0.00	0.00	0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H5050	026	0	1	01	01	H5050_026_0	4	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	01	7c;7g;7i;8b1;9a2;9b;10a1;11a;11b2;4a;4b;				2				1	01	11a;11b2;																																																																								0	0			0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;4b;7c;7g;7i;8b1;9a2;9b;10a1;										0.00	0.00	0.00	0.00											0.00	0.00									0.00	0.00					0.00	0.00									0.00	0.00							0.00	0.00	0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H5050	027	0	1	01	01	H5050_027_0	4	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	01	7c;7g;7i;8b1;9a2;9b;10a1;11a;11b2;4a;4b;				2				1	01	11a;11b2;																																																																								0	0			0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;4b;7c;7g;7i;8b1;9a2;9b;10a1;										0.00	0.00	0.00	0.00											0.00	0.00									0.00	0.00					0.00	0.00									0.00	0.00							0.00	0.00	0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H5050	028	0	1	01	01	H5050_028_0	4	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	01	7c;7g;7i;8a1;9a2;10a1;11a;11b2;4a;4b;8b1;9b;				2				1	01	11a;11b2;																																																																								0	0			0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;4b;7c;7g;7i;8a1;8b1;9a2;9b;10a1;										0.00	0.00	0.00	0.00											0.00	0.00									0.00	0.00					0.00	0.00					0.00	0.00			0.00	0.00							0.00	0.00	0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H5050	029	0	1	01	01	H5050_029_0	4	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	01	7c;7g;7i;8a1;9a2;10a1;11a;11b2;4a;4b;8b1;9b;				2				1	01	11a;11b2;																																																																								0	0			0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;4b;7c;7g;7i;8a1;8b1;9a2;9b;10a1;										0.00	0.00	0.00	0.00											0.00	0.00									0.00	0.00					0.00	0.00					0.00	0.00			0.00	0.00							0.00	0.00	0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H5050	030	0	1	01	01	H5050_030_0	4	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	01	7c;7g;7i;8a1;9a2;10a1;11a;11b2;4a;4b;8b1;9b;				2				1	01	11a;11b2;																																																																								0	0			0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;4b;7c;7g;7i;8a1;8b1;9a2;9b;10a1;										0.00	0.00	0.00	0.00											0.00	0.00									0.00	0.00					0.00	0.00					0.00	0.00			0.00	0.00							0.00	0.00	0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H5050	031	0	1	01	01	H5050_031_0	4	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	01	7c;7g;7i;8a1;9a2;10a1;11a;11b2;4a;4b;8b1;9b;				2				1	01	11a;11b2;																																																																								0	0			0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;4b;7c;7g;7i;8a1;8b1;9a2;9b;10a1;										0.00	0.00	0.00	0.00											0.00	0.00									0.00	0.00					0.00	0.00					0.00	0.00			0.00	0.00							0.00	0.00	0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H5050	032	0	1	01	01	H5050_032_0	4	1	2	Advanced Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	01	7c;7g;7i;8a1;9a2;9b;10a1;11a;11b2;4a;4b;8b1;				2				1	01	11a;11b2;																																																																								0	0			0	0																																																																																																																																																																																			2																																																																																																																																													1	01	4a;4b;7c;7g;7i;8a1;8b1;9a2;9b;10a1;										0.00	0.00	0.00	0.00											0.00	0.00									0.00	0.00					0.00	0.00					0.00	0.00			0.00	0.00							0.00	0.00	0.00	0.00							0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H5178	002	0	1	01	01	H5178_002_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5211	001	0	1	02	01	H5211_001_0	9	2	2	Hospital at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			2	01	1a;			2	2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5211	001	0	1	02	01	H5211_001_0	9	1	3	Chronic Condition Home Health										000011110000001000000000000															1	001		2	01	7h1;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7h1;																																				0.00	0.00																																																																																																																																																																																																																																																																																																																																																														2			
H5211	002	0	1	02	01	H5211_002_0	10	2	3	Chronic Condition Home Health										000011110000001000000000000															1	001		2	01	7h1;8a2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7h1;8a2;																																				0.00	0.00											0.00	0.00																																																																																																																																																																																																																																																																																																																																																		2			
H5211	002	0	1	02	01	H5211_002_0	10	1	2	Hospital at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			2	01	1a;			2	2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5211	003	0	1	02	01	H5211_003_0	9	1	2	Hospital at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			2	01	1a;			2	2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5211	003	0	1	02	01	H5211_003_0	9	2	3	Chronic Condition Home Health										000011110000001000000000000															1	001		2	01	7h1;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7h1;																																				0.00	0.00																																																																																																																																																																																																																																																																																																																																																														2			
H5211	004	0	1	02	01	H5211_004_0	11	2	3	Chronic Condition Home Health										000011110000001000000000000															1	001		2	01	7h1;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7h1;																																				0.00	0.00																																																																																																																																																																																																																																																																																																																																																														2			
H5211	004	0	1	02	01	H5211_004_0	11	1	2	Hospital at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			2	01	1a;			2	2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5211	012	0	1	02	01	H5211_012_0	11	2	3	Chronic Condition Home Health										000011110000001000000000000															1	001		2	01	7h1;8a2;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7h1;8a2;																																				0.00	0.00											0.00	0.00																																																																																																																																																																																																																																																																																																																																																		2			
H5211	012	0	1	02	01	H5211_012_0	11	1	2	Hospital at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status.								2			2	01	1a;			2	2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																								2			
H5216	242	0	1	04	01	H5216_242_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	243	0	1	04	01	H5216_243_0	2	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	257	0	1	04	01	H5216_257_0	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	277	0	1	04	01	H5216_277_0	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	352	0	1	04	01	H5216_352_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	353	0	1	04	01	H5216_353_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	362	0	1	04	01	H5216_362_0	2	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	369	0	1	04	01	H5216_369_0	2	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	400	0	1	04	01	H5216_400_0	5	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	401	0	1	04	01	H5216_401_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	402	0	1	04	01	H5216_402_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	413	0	1	04	01	H5216_413_0	2	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	416	0	1	04	01	H5216_416_0	2	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	432	0	1	04	01	H5216_432_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	444	0	1	04	01	H5216_444_0	2	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	446	0	1	04	01	H5216_446_0	2	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	447	0	1	04	01	H5216_447_0	2	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5216	453	0	1	04	01	H5216_453_0	2	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5262	001	0	1	01	01	H5262_001_0	4	1	2	Package 1 Diabetes																01000000000000									2			2	01	11a;				2				1	01	11a;																																																																								0	10																																																																																																																																																																																							2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H5262	003	0	1	01	01	H5262_003_0	4	1	2	Package 1 Diabetes																01000000000000									2			2	01	11a;				2				1	01	11a;																																																																								10	10																																																																																																																																																																																							2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H5262	004	0	1	01	01	H5262_004_0	3	1	2	Package 1 Diabetes																01000000000000									2			2	01	11a;				2				1	01	11a;																																																																								10	10																																																																																																																																																																																							2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H5262	005	0	1	01	01	H5262_005_0	3	1	2	Package 1 Diabetes																01000000000000									2			2	01	11a;				2				1	01	11a;																																																																								10	10																																																																																																																																																																																							2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H5262	007	0	1	01	01	H5262_007_0	4	1	2	Package 1 Diabetes																01000000000000									2			2	01	11a;				2				1	01	11a;																																																																								10	10																																																																																																																																																																																							2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H5262	008	0	1	01	01	H5262_008_0	4	1	2	Package 1 Diabetes																01000000000000									2			2	01	11a;				2				1	01	11a;																																																																								10	10																																																																																																																																																																																							2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H5262	009	0	1	01	01	H5262_009_0	3	1	2	Package 1 Diabetes																01000000000000									2			2	01	11a;				2				1	01	11a;																																																																								10	10																																																																																																																																																																																							2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H5262	010	0	1	01	01	H5262_010_0	3	1	2	Package 1 Diabetes																01000000000000									2			2	01	11a;				2				1	01	11a;																																																																								10	10																																																																																																																																																																																							2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H5262	021	0	1	01	01	H5262_021_0	4	1	2	Package 1 Diabetes																01000000000000									2			2	01	11a;				2				1	01	11a;																																																																								10	10																																																																																																																																																																																							2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H5262	023	0	1	01	01	H5262_023_0	4	1	2	Package 1 Diabetes																01000000000000									2			2	01	11a;				2				1	01	11a;																																																																								10	10																																																																																																																																																																																							2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H5262	032	0	1	01	01	H5262_032_0	4	1	2	Package 1 Diabetes																01000000000000									2			2	01	11a;				2				1	01	11a;																																																																								10	10																																																																																																																																																																																							2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H5262	033	0	1	01	01	H5262_033_0	4	1	2	Package 1 Diabetes																01000000000000									2			2	01	11a;				2				1	01	11a;																																																																								10	10																																																																																																																																																																																							2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H5302	022	0	1	01	01	H5302_022_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1	7f_2;		1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;	2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;																									10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																			10.00	10.00																																																																																																																																																																																																																																																																2			
H5302	809	0	1	01	01	H5302_809_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H5302	809	0	1	01	01	H5302_809_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H5521	037	0	1	04	01	H5521_037_0	3	1	2	Chronic Care																11000000001111	Autoimmune, chronic lung or neurologic disorders	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic and disabling mental health conditions	Chronic alcohol and other drug dep, or End-stage liver disease	Chronic musculoskeletal or metabolic conditions	2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	037	0	1	04	01	H5521_037_0	3	2	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	037	0	1	04	01	H5521_037_0	3	3	2	Cancer Care																00000000001000	Cancer								1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	077	0	1	04	01	H5521_077_0	3	3	2	Chronic Care																11000000001111	Autoimmune, chronic lung or neurologic disorders	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic and disabling mental health conditions	Chronic alcohol and other drug dep, or End-stage liver disease	Chronic musculoskeletal or metabolic conditions	2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	077	0	1	04	01	H5521_077_0	3	2	2	Cancer Care																00000000001000	Cancer								1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	077	0	1	04	01	H5521_077_0	3	1	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	119	0	1	04	01	H5521_119_0	3	1	2	Cancer Care																00000000001000	Cancer								1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	119	0	1	04	01	H5521_119_0	3	2	2	Chronic Care																11000000001111	Autoimmune, chronic lung or neurologic disorders	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic and disabling mental health conditions	Chronic alcohol and other drug dep, or End-stage liver disease	Chronic musculoskeletal or metabolic conditions	2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	119	0	1	04	01	H5521_119_0	3	3	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	120	0	1	04	01	H5521_120_0	3	1	2	Cancer Care																00000000001000	Cancer								1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	120	0	1	04	01	H5521_120_0	3	2	2	Chronic Care																11000000001111	Autoimmune, chronic lung or neurologic disorders	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic and disabling mental health conditions	Chronic alcohol and other drug dep, or End-stage liver disease	Chronic musculoskeletal or metabolic conditions	2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	120	0	1	04	01	H5521_120_0	3	3	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	157	0	1	04	01	H5521_157_0	2	1	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	157	0	1	04	01	H5521_157_0	2	2	2	Cancer Care																00000000001000	Cancer								1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	211	0	1	04	01	H5521_211_0	2	1	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	215	0	1	04	01	H5521_215_0	3	1	2	Cancer Care																00000000001000	Cancer								1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	215	0	1	04	01	H5521_215_0	3	2	2	Chronic Care																11000000001111	Autoimmune, chronic lung or neurologic disorders	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic and disabling mental health conditions	Chronic alcohol and other drug dep, or End-stage liver disease	Chronic musculoskeletal or metabolic conditions	2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	215	0	1	04	01	H5521_215_0	3	3	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	219	0	1	04	01	H5521_219_0	2	1	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	223	0	1	04	01	H5521_223_0	2	1	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	277	0	1	04	01	H5521_277_0	3	1	2	Chronic Care																11000000001111	Autoimmune, chronic lung or neurologic disorders	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic and disabling mental health conditions	Chronic alcohol and other drug dep, or End-stage liver disease	Chronic musculoskeletal or metabolic conditions	2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	277	0	1	04	01	H5521_277_0	3	2	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	277	0	1	04	01	H5521_277_0	3	3	2	Cancer Care																00000000001000	Cancer								1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	285	0	1	04	01	H5521_285_0	2	1	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	302	0	1	04	01	H5521_302_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H5521	326	0	1	04	01	H5521_326_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H5521	364	0	1	04	01	H5521_364_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H5521	365	0	1	04	01	H5521_365_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1	7f_2;	1	1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;	2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;																									10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																			10.00	10.00																																																																																																																																																																																																																																																																2			
H5521	392	0	1	04	01	H5521_392_0	3	1	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	392	0	1	04	01	H5521_392_0	3	2	2	Chronic Care																11000000001111	Autoimmune, chronic lung or neurologic disorders	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic and disabling mental health conditions	Chronic alcohol and other drug dep, or End-stage liver disease	Chronic musculoskeletal or metabolic conditions	2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	392	0	1	04	01	H5521_392_0	3	3	2	Cancer Care																00000000001000	Cancer								1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	399	0	1	04	01	H5521_399_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H5521	400	0	1	04	01	H5521_400_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H5521	443	0	1	04	01	H5521_443_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H5521	484	0	1	04	01	H5521_484_0	2	1	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	496	0	1	04	01	H5521_496_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H5521	500	0	1	04	01	H5521_500_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H5521	502	0	1	04	01	H5521_502_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H5521	536	0	1	04	01	H5521_536_0	3	2	2	Chronic Care																11000000001111	Autoimmune, chronic lung or neurologic disorders	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic and disabling mental health conditions	Chronic alcohol and other drug dep, or End-stage liver disease	Chronic musculoskeletal or metabolic conditions	2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	536	0	1	04	01	H5521_536_0	3	1	2	Cancer Care																00000000001000	Cancer								1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	536	0	1	04	01	H5521_536_0	3	3	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	598	0	1	04	01	H5521_598_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H5521	609	0	1	04	01	H5521_609_0	2	1	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	609	0	1	04	01	H5521_609_0	2	2	2	Cancer Care																00000000001000	Cancer								1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H5521	649	0	1	04	01	H5521_649_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1		1	1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;																										10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																																																																																																																																																																																																																																																																																				2			
H5521	801	0	1	04	01	H5521_801_0	2	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5521	801	0	1	04	01	H5521_801_0	2	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5521	805	0	2	04	01	H5521_805_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5521	805	0	2	04	01	H5521_805_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	013	0	1	04	01	H5522_013_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1	7f_2;	1	1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;	2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;																									10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																			10.00	10.00																																																																																																																																																																																																																																																																2			
H5522	802	0	1	04	01	H5522_802_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	802	0	1	04	01	H5522_802_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	803	0	1	04	01	H5522_803_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	803	0	1	04	01	H5522_803_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	808	0	2	04	01	H5522_808_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	808	0	2	04	01	H5522_808_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	809	0	2	04	01	H5522_809_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	809	0	2	04	01	H5522_809_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	810	0	1	04	01	H5522_810_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	810	0	1	04	01	H5522_810_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	811	0	1	04	01	H5522_811_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	811	0	1	04	01	H5522_811_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	813	0	2	04	01	H5522_813_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	813	0	2	04	01	H5522_813_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	814	0	2	04	01	H5522_814_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	814	0	2	04	01	H5522_814_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	815	0	1	04	01	H5522_815_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	815	0	1	04	01	H5522_815_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	816	0	1	04	01	H5522_816_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	816	0	1	04	01	H5522_816_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	817	0	2	04	01	H5522_817_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	817	0	2	04	01	H5522_817_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	818	0	2	04	01	H5522_818_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	818	0	2	04	01	H5522_818_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	819	0	1	04	01	H5522_819_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	819	0	1	04	01	H5522_819_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	820	0	1	04	01	H5522_820_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	820	0	1	04	01	H5522_820_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	821	0	1	04	01	H5522_821_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	821	0	1	04	01	H5522_821_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	822	0	2	04	01	H5522_822_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	822	0	2	04	01	H5522_822_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	823	0	1	04	01	H5522_823_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	823	0	1	04	01	H5522_823_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	824	0	2	04	01	H5522_824_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	824	0	2	04	01	H5522_824_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	825	0	2	04	01	H5522_825_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	825	0	2	04	01	H5522_825_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	827	0	2	04	01	H5522_827_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	827	0	2	04	01	H5522_827_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	828	0	1	04	01	H5522_828_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	828	0	1	04	01	H5522_828_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	832	0	1	04	01	H5522_832_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	832	0	1	04	01	H5522_832_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	836	0	1	04	01	H5522_836_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	836	0	1	04	01	H5522_836_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	837	0	1	04	01	H5522_837_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	837	0	1	04	01	H5522_837_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	838	0	2	04	01	H5522_838_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5522	838	0	2	04	01	H5522_838_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H5525	036	0	1	04	01	H5525_036_0	4	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5533	003	0	1	04	01	H5533_003_0	15	1	3	SSBCI- Mental Health/LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;			2	1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H5533	005	0	1	04	01	H5533_005_0	15	1	3	SSBCI-Mental Health/LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;			2	1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H5533	008	0	1	04	01	H5533_008_0	16	1	3	SSBCI - Mental Health/LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;			2	1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H5533	011	0	1	04	01	H5533_011_0	17	1	3	SSBCI-Mental Health/LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;			2	1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H5533	013	0	1	04	01	H5533_013_0	18	1	3	SSBCI- Mental Health/LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;			2	1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H5533	015	1	1	04	01	H5533_015_1	17	1	3	SSBCI - Mental Health/LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;			2	1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H5533	015	2	1	04	01	H5533_015_2	17	1	3	SSBCI - Mental Health/LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H5533	015	3	1	04	01	H5533_015_3	17	1	3	SSBCI - Mental Health/LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H5533	015	4	1	04	01	H5533_015_4	15	1	3	SSBCI - Mental Health/LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;			2	1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H5533	015	6	1	04	01	H5533_015_6	16	1	3	SSBCI - Mental Health/LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;			2	1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H5533	017	1	1	04	01	H5533_017_1	15	1	3	SSBCI-Mental Health LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;			1	1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H5533	017	2	1	04	01	H5533_017_2	15	1	3	SSBCI-Mental Health LIS										000000000000001000000000000															2			2	01	7e1;7e2;7j;			1	1	01	7e1;7e2;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7e1;7e2;7j;																												15.00	15.00	15.00	15.00											0.00	15.00																																																																																																																																																																																																																																																																																																																																																								2			
H5590	008	0	1	01	01	H5590_008_0	8	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;				2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H5590	010	0	1	01	01	H5590_010_0	8	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;				2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H5593	801	0	1	01	01	H5593_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H5593	801	0	1	01	01	H5593_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H5599	002	0	1	02	01	H5599_002_0	9	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H5599	003	0	1	01	01	H5599_003_0	9	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;				2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H5599	004	0	1	02	01	H5599_004_0	9	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H5599	010	0	1	02	01	H5599_010_0	8	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H5599	013	1	1	01	01	H5599_013_1	8	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;				2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H5599	013	2	1	01	01	H5599_013_2	8	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;				2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H5619	173	0	1	01	01	H5619_173_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H5793	019	0	1	02	01	H5793_019_0	2	1	3	SSBCI Pkg										011111111111111111111111111	Anemia	Chronic Pain	Chronic Hyperlipidemia	Chronic Hypertension											1	010		2	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	1	7f_2;	2	1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;	2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	11	7d;7e1;7e2;7f;7h1;7h2;7j;8a1;	7f_2;																									10.00	10.00	0.00	0.00	0.00	0.00	10.00	10.00			0.00	0.00	0.00	0.00			0.00	10.00			0.00	0.00																																																																																			10.00	10.00																																																																																																																																																																																																																																																																2			
H5793	801	0	1	01	01	H5793_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H5793	801	0	1	01	01	H5793_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H5793	802	0	1	01	01	H5793_802_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H5793	802	0	1	01	01	H5793_802_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H5938	001	0	1	01	01	H5938_001_0	8	1	2	Medicare covered diabetic eye exams																01000000000000									2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H5938	006	0	1	01	01	H5938_006_0	8	1	2	Medicare covered diabetic eye exams																01000000000000									2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H5938	008	0	1	01	01	H5938_008_0	8	1	2	Medicare covered diabetic eye exams																01000000000000									2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										1	30.00	00100	
H5938	009	0	1	01	01	H5938_009_0	8	1	2	Medicare covered diabetic eye exams																01000000000000									2			2	01	17a;				2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H5938	802	0	1	01	01	H5938_802_0	6	1	2	Medicare covered diabetic eye exams																01000000000000									2			2	01	17a;				2				1	01	17a;																																																																																																								0	0																																																																																																																																																							2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H5938	803	0	1	01	01	H5938_803_0	6	1	2	Medicare covered diabetic eye exams																01000000000000									2			2	01	17a;				2				1	01	17a;																																																																																																								0	0																																																																																																																																																							2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H5938	804	0	1	01	01	H5938_804_0	6	1	2	Medicare covered diabetic eye exams																01000000000000									2			2	01	17a;				2				1	01	17a;																																																																																																								0	0																																																																																																																																																							2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H5938	805	0	1	01	01	H5938_805_0	6	1	2	Medicare covered diabetic eye exams																01000000000000									2			2	01	17a;				2				1	01	17a;																																																																																																								0	0																																																																																																																																																							2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H5959	009	0	1	04	01	H5959_009_0	4	1	2	MSK																00000000101110	history of joint & muscle pain	urinary incontinance	osteoarthritis			2	2		1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7i;																																								0.00	0.00																																																																																																																																																																																																																																																																																																																																																										2			
H5959	010	1	1	04	01	H5959_010_1	3	1	2	MSK																00000000101110	history of Joint & muscle pain	Urinary incontinence	Osteoarthritis			2	2		1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7i;																																								0.00	0.00																																																																																																																																																																																																																																																																																																																																																										2			
H5959	010	2	1	04	01	H5959_010_2	3	1	2	MSK																00000000101110	history of joint & muscle pain	urinary incontinance	osteoarthritis			2	2		1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7i;																																								0.00	0.00																																																																																																																																																																																																																																																																																																																																																										2			
H5959	011	0	1	04	01	H5959_011_0	5	1	2	MSK																00000000101110	history of joint & muscle pain	urinary inconrinance	osteoarthritis			2	2		1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7i;																																								0.00	0.00																																																																																																																																																																																																																																																																																																																																																										2			
H5959	012	0	1	04	01	H5959_012_0	4	1	2	MSK																00000000101110	history of joint & muscle pain	urinary incontinence	osteoarthritis			2	2		1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7i;																																								0.00	0.00																																																																																																																																																																																																																																																																																																																																																										2			
H5959	013	1	1	04	01	H5959_013_1	3	1	2	MSK																00000000101110	history of joint & muscle pain	urinary incontinence	osteoarthritis			2	2		1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7i;																																								0.00	0.00																																																																																																																																																																																																																																																																																																																																																										2			
H5959	013	2	1	04	01	H5959_013_2	3	1	2	MSK																00000000101110	history of joint & muscle pain	urinary incontinence	osteoarthritis			2	2		1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7i;																																								0.00	0.00																																																																																																																																																																																																																																																																																																																																																										2			
H5959	014	1	1	04	01	H5959_014_1	3	1	2	MSK																00000000101110	history of joint & muscle pain	urinary incontinence	osteoarthritis			2	2		1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7i;																																								0.00	0.00																																																																																																																																																																																																																																																																																																																																																										2			
H5959	014	2	1	04	01	H5959_014_2	3	1	2	MSK																00000000101110	history of joint & muscle pain	urinary incontinance	osteoarthritis			2	2		1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7i;																																								0.00	0.00																																																																																																																																																																																																																																																																																																																																																										2			
H5959	015	0	1	04	01	H5959_015_0	3	1	2	MSK																00000000101110	history of joint & muscle pain	urinary incontinence	osteoarthritis			2	2		1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7i;																																								0.00	0.00																																																																																																																																																																																																																																																																																																																																																										2			
H5959	016	0	1	04	01	H5959_016_0	3	1	2	MSK																00000000101110	history of joint & muscle pain	urinary incontinence	osteoarthritis			2	2		1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7i;																																								0.00	0.00																																																																																																																																																																																																																																																																																																																																																										2			
H5959	018	0	1	04	01	H5959_018_0	3	1	2	MSK																00000000101110	history of joint & muscle pain	urinary incontinence	osteoarthritis			2	2		1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7i;																																								0.00	0.00																																																																																																																																																																																																																																																																																																																																																										2			
H5959	801	0	1	04	01	H5959_801_0	1	1	2	MSK																00000000101110	history of joint & muscle pain	urinary incontinence	osteoarthritis			2	2		1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7i;																																								0.00	0.00																																																																																																																																																																																																																																																																																																																																																										2			
H5959	807	0	1	04	01	H5959_807_0	1	1	2	MSK																00000000101110	history of Joint & muscle pain	urinary incontinence	osteoarthritis			2	2		1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7i;																																								0.00	0.00																																																																																																																																																																																																																																																																																																																																																										2			
H5959	808	0	1	04	01	H5959_808_0	1	1	2	MSK																00000000101110	history of joint & muscle pain	urinary incontinance	osteoarthritis			2	2		1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7i;																																								0.00	0.00																																																																																																																																																																																																																																																																																																																																																										2			
H5959	809	0	1	04	01	H5959_809_0	1	1	2	MSK																00000000101110	history of joint & muscle pain	urinary incontinence	osteoarthritis			2	2		1	010		2	01	7i;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7i;																																								0.00	0.00																																																																																																																																																																																																																																																																																																																																																										2			
H6200	001	0	1	04	01	H6200_001_0	9	1	2	Diabetic Eye Exams																01000000000000									2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H6200	004	0	1	04	01	H6200_004_0	8	1	2	Diabetic Eye Exam																01000000000000									2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H6200	006	0	1	04	01	H6200_006_0	8	1	2	Diabetic Eye Exam																01000000000000									2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H6200	009	0	1	04	01	H6200_009_0	7	1	2	Diabetic Eye Exams																01000000000000									2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H6200	010	0	1	04	01	H6200_010_0	7	1	2	Diabetic Eye Exams																01000000000000									2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H6453	013	1	1	02	01	H6453_013_1	12	1	2	Diabetic eye exams																01000000000000									2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H6453	013	2	1	02	01	H6453_013_2	12	1	2	Diabetic eye exams																01000000000000									2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H6453	013	3	1	02	01	H6453_013_3	12	1	2	Diabetic eye exams																01000000000000									2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H6453	013	4	1	02	01	H6453_013_4	12	1	2	Diabetic eye exams																01000000000000									2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H6453	013	5	1	02	01	H6453_013_5	12	1	2	Diabetic eye exams																01000000000000									2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H6453	017	1	1	02	01	H6453_017_1	12	1	2	Diabetic eye exams																01000000000000									2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H6453	017	2	1	02	01	H6453_017_2	12	1	2	Diabetic eye exams																01000000000000									2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H6453	018	1	1	02	01	H6453_018_1	12	1	2	Diabetic eye exams																01000000000000									2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H6453	018	2	1	02	01	H6453_018_2	12	1	2	Diabetic eye exams																01000000000000									2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H6453	020	1	1	02	01	H6453_020_1	12	1	2	Diabetes eye exams																01000000000000									2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H6453	020	2	1	02	01	H6453_020_2	12	1	2	Diabetes eye exams																01000000000000									2			2	01	17a;			2	2				2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	17a;																																																																																																								0.00	0.00																																																																																																																																																																																																																																																																																										2			
H6622	033	0	1	01	01	H6622_033_0	2	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H6622	057	0	1	02	01	H6622_057_0	5	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H7149	801	0	1	01	01	H7149_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H7149	801	0	1	01	01	H7149_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H7301	033	0	1	04	01	H7301_033_0	2	2	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H7301	033	0	1	04	01	H7301_033_0	2	1	2	Cancer Care																00000000001000	Cancer								1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
H7301	803	0	1	04	01	H7301_803_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H7301	803	0	1	04	01	H7301_803_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H7617	053	0	1	04	01	H7617_053_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H7617	063	0	1	04	01	H7617_063_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H7617	095	0	1	04	01	H7617_095_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1					1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									1	1000.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H8332	801	0	1	01	01	H8332_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H8332	801	0	1	01	01	H8332_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H8481	001	0	1	04	01	H8481_001_0	6	1	2	House Calls																11111111111111	Cancers	Vascular Disease	Chronic Kidney Disease	Nutrition-related disorders including obesity	Hematological Disorders	2	2		1	010		2	01	7g;8b1;8a2;			2	2				1	01	8a2;8b1;																																																0	0	0	0																																																																																																																																																																																																													2																																																																																																																																													1	01	7g;																																		0.00	0.00																																																																																																																																																																																																																																																																																																																																																																2			
H8649	801	0	1	01	01	H8649_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H8649	801	0	1	01	01	H8649_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H8649	803	0	1	01	01	H8649_803_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H8649	803	0	1	01	01	H8649_803_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														2			
H8908	007	0	1	01	01	H8908_007_0	3	1	3	Chronic Condition Care Assistance										011111110011111111000000000															1	001		1																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																														1	500.00	10000	Purchases must be coordinated by a care manager on the member's behalf.
H9003	001	0	1	02	01	H9003_001_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	11	4a;7c;7g;7i;8a1;8b1;10a1;11a;11b2;		13e;	2	2				1	11	11a;11b2;	13e;																																																																							0	0			0	0																																																																			0	0																																																																																																															2																																																																																																																																													1	01	4a;7c;7g;7i;8a1;8b1;10a1;										0.00	0.00													0.00	0.00									0.00	0.00					0.00	0.00					0.00	0.00			0.00	0.00																	0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H9003	006	0	1	02	01	H9003_006_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	11	4a;7c;7g;7i;8a1;8b1;10a1;11a;11b2;		13e;	2	2				1	11	11a;11b2;	13e;																																																																							0	0			0	0																																																																			0	0																																																																																																															2																																																																																																																																													1	01	4a;7c;7g;7i;8a1;8b1;10a1;										0.00	0.00													0.00	0.00									0.00	0.00					0.00	0.00					0.00	0.00			0.00	0.00																	0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H9003	009	0	1	02	01	H9003_009_0	4	1	2	Acute Care at Home																00000000001000	Meets clinical criteria, hospital care in home based on health status								2			2	11	7c;7g;7i;8a1;8b1;10a1;11a;11b2;4a;		13e;	2	2				1	11	11a;11b2;	13e;																																																																							0	0			0	0																																																																			0	0																																																																																																															2																																																																																																																																													1	01	4a;7c;7g;7i;8a1;8b1;10a1;										0.00	0.00													0.00	0.00									0.00	0.00					0.00	0.00					0.00	0.00			0.00	0.00																	0.00	0.00																																																																																																																																																																																																																																																																																																																														2			
H9364	001	0	1	02	01	H9364_001_0	8	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H9364	002	0	1	02	01	H9364_002_0	8	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H9364	003	0	1	02	01	H9364_003_0	8	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H9364	004	0	1	02	01	H9364_004_0	8	1	2	Conversio																00100000001000	Chronic Bronchitis					2	2		1	101	Member has one or more COPD related ER visits or hospitalizations,  requires maintenance medication for the condition including LABA, LAMA, LABA-LAMA, LABA-ICS, LABA-LAMA-ICS,  and participates in a chronic respiratory management program	2	01	11a;11b2;15-3;			2	2				1	01	11a;11b2;15-3;																																																																								0	20			0	20																							0	20																																																																																																																																																											2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H9431	801	0	1	04	01	H9431_801_0	1	1	3	Package 1										011111111111111111111111000	Other CMS defined chronic conditions														1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H9431	801	0	1	04	01	H9431_801_0	1	2	2	Package 2																01111111111000	Other CMS defined chronic conditions					2	2		1	011		1					2																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																																									2			
H9615	021	0	1	04	01	H9615_021_0	16	1	2	Package 1																01000000000000									2			2	01	7f;17a;			2	1	01	7f;17a;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7f;17a;																																0.00	0.00																																																																							0.00	0.00																																																																																																																																																																																																																																																																																										2			
H9615	022	0	1	04	01	H9615_022_0	16	1	2	Package 1																01000000000000									2			2	01	7f;17a;			2	1	01	7f;17a;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7f;17a;																																0.00	0.00																																																																							0.00	0.00																																																																																																																																																																																																																																																																																										2			
H9615	023	0	1	04	01	H9615_023_0	16	1	2	Package 1																01000000000000									2			2	01	7f;17a;			2	1	01	7f;17a;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7f;17a;																																0.00	0.00																																																																							0.00	0.00																																																																																																																																																																																																																																																																																										2			
H9615	024	0	1	04	01	H9615_024_0	16	1	2	Package 1																01000000000000									2			2	01	7f;17a;			2	1	01	7f;17a;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7f;17a;																																0.00	0.00																																																																							0.00	0.00																																																																																																																																																																																																																																																																																										2			
H9834	001	0	1	01	01	H9834_001_0	5	1	2	Package 1 Diabetes																01000000000000									2			2	01	11a;				2				1	01	11a;																																																																								10	10																																																																																																																																																																																							2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H9834	003	0	1	01	01	H9834_003_0	4	1	2	Package 1 Diabetes																01000000000000									2			2	01	11a;				2				1	01	11a;																																																																								10	10																																																																																																																																																																																							2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H9834	004	0	1	01	01	H9834_004_0	3	1	2	Package 1 Diabetes																01000000000000									2			2	01	11a;				2				1	01	11a;																																																																								10	10																																																																																																																																																																																							2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H9834	006	0	1	01	01	H9834_006_0	4	1	2	Package 1 Diabetes																01000000000000									2			2	01	11a;				2				1	01	11a;																																																																								10	10																																																																																																																																																																																							2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
H9834	007	0	1	01	01	H9834_007_0	4	1	2	Package 1 Diabetes																01000000000000									2			2	01	11a;				2				1	01	11a;																																																																								10	10																																																																																																																																																																																							2																																																																																																																																													2																																																																																																																																																																																																																																																																																																																																																																																																					2			
R6694	006	0	1	31	11	R6694_006_0	3	1	2	Kidney Care																00000000001100	Advanced chronic kidney disease	End Stage Renal Disease (ESRD)				2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
R6694	006	0	1	31	11	R6694_006_0	3	3	2	Chronic Care																11000000001111	Autoimmune, chronic lung or neurologic disorders	Cancer, chronic heart failure, cardiovascular disorders or stroke	Chronic and disabling mental health conditions	Chronic alcohol and other drug dep, or End-stage liver disease	Chronic musculoskeletal or metabolic conditions	2	2		1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
R6694	006	0	1	31	11	R6694_006_0	3	2	2	Cancer Care																00000000001000	Cancer								1	010		2	01	7a;7j;			1	1	01	7a;7j;		2																																																																																																																																																																																																																																																																		2																																																																																																																																													1	01	7a;7j;																				0.00	0.00																					0.00	0.00																																																																																																																																																																																																																																																																																																																																																								2			
