pbp_a_hnumber	pbp_a_plan_identifier	segment_id	pbp_a_ben_cov	pbp_a_plan_type	orgtype	bid_id	version	pbp_vbid_group_id	pbp_b19b_package_type	pbp_b19b_package_name	pbp_b19b_states_ehc_ssbci	pbp_b19b_states_ssbci_other1	pbp_b19b_states_ssbci_other2	pbp_b19b_states_ssbci_other3	pbp_b19b_states_ssbci_other4	pbp_b19b_states_ssbci_other5	pbp_b19b_states_ssbci_other6	pbp_b19b_states_ssbci_other7	pbp_b19b_states_ssbci_other8	pbp_b19b_states_ssbci_other9	pbp_b19b_states_ssbci_other10	pbp_b19b_eligible_ssbci	pbp_b19b_utilize_ssbci	pbp_b19b_states_ehc_uf	pbp_b19b_states_uf_other1	pbp_b19b_states_uf_other2	pbp_b19b_states_uf_other3	pbp_b19b_states_uf_other4	pbp_b19b_states_uf_other5	pbp_b19b_states_uf_other6	pbp_b19b_states_uf_other7	pbp_b19b_states_uf_other8	pbp_b19b_states_uf_other9	pbp_b19b_states_uf_other10	pbp_b19b_states_uf_all_yn	pbp_b19b_states_uf_cmb_yn	pbp_b19b_states_uf_cmb_d	pbp_b19b_add_prereq_yn	pbp_b19b_add_prereq	pbp_b19b_add_prereq_d	pbp_b19b_add_nmc_bendesc_cats	pbp_b19b_add_apply_yn	pbp_b19b_add_exempt_yn	pbp_b19b_add_exempt_nmc_cats	pbp_b19b_agg_yn	pbp_b19b_agg_amt	pbp_b19b_agg_period	pbp_b19b_agg_period_d	pbp_b19b_agg_mode	pbp_b19b_agg_mode_desc	pbp_b19b_agg_nmc_bendesc_cats
H0028	007	0	1	01	01	H0028_007_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									830	830															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	007	0	1	01	01	H0028_007_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H0028	007	0	1	01	01	H0028_007_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H0028	014	0	1	01	01	H0028_014_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	015	0	1	02	01	H0028_015_0	6	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									6429	6429															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	015	0	1	02	01	H0028_015_0	6	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H0028	015	0	1	02	01	H0028_015_0	6	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H0028	016	0	1	02	01	H0028_016_0	7	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H0028	017	0	1	01	01	H0028_017_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	019	0	1	01	01	H0028_019_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	019	0	1	01	01	H0028_019_0	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H0028	021	0	1	01	01	H0028_021_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	024	0	1	01	01	H0028_024_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	028	0	1	01	01	H0028_028_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	029	0	1	01	01	H0028_029_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	029	0	1	01	01	H0028_029_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H0028	030	0	1	01	01	H0028_030_0	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H0028	030	0	1	01	01	H0028_030_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	032	0	1	01	01	H0028_032_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H0028	032	0	1	01	01	H0028_032_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									3403	3403															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	032	0	1	01	01	H0028_032_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H0028	035	0	1	01	01	H0028_035_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H0028	035	0	1	01	01	H0028_035_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	036	0	1	01	01	H0028_036_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H0028	036	0	1	01	01	H0028_036_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H0028	036	0	1	01	01	H0028_036_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									1850	1850															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	037	0	1	01	01	H0028_037_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	037	0	1	01	01	H0028_037_0	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H0028	039	0	1	01	01	H0028_039_0	5	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	039	0	1	01	01	H0028_039_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									7403	7403															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	039	0	1	01	01	H0028_039_0	5	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H0028	041	0	1	01	01	H0028_041_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	041	0	1	01	01	H0028_041_0	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H0028	042	0	1	01	01	H0028_042_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	042	0	1	01	01	H0028_042_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H0028	043	1	1	01	01	H0028_043_1	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	043	2	1	01	01	H0028_043_2	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	046	0	1	01	01	H0028_046_0	5	1	3	Chronic Condition Care Assistance	01111111001111111100000000000000											288	4															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H0028	046	0	1	01	01	H0028_046_0	5	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H0028	046	0	1	01	01	H0028_046_0	5	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	051	0	1	01	01	H0028_051_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									4671	4671															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	051	0	1	01	01	H0028_051_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	053	1	1	01	01	H0028_053_1	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H0028	053	3	1	01	01	H0028_053_3	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H0028	054	1	1	02	01	H0028_054_1	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H0028	054	2	1	02	01	H0028_054_2	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H0028	055	0	1	02	01	H0028_055_0	7	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H0028	055	0	1	02	01	H0028_055_0	7	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									1863	1863															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	056	0	1	02	01	H0028_056_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									1057	1057															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	056	0	1	02	01	H0028_056_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H0028	059	0	1	01	01	H0028_059_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	059	0	1	01	01	H0028_059_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H0028	060	0	1	01	01	H0028_060_0	6	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									4104	4104															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	060	0	1	01	01	H0028_060_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	062	0	1	01	01	H0028_062_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	063	0	1	01	01	H0028_063_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	065	0	1	01	01	H0028_065_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H0028	066	0	1	02	01	H0028_066_0	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H0028	067	0	1	02	01	H0028_067_0	5	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H0028	067	0	1	02	01	H0028_067_0	5	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H0028	067	0	1	02	01	H0028_067_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2064	2064															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	070	0	1	01	01	H0028_070_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	070	0	1	01	01	H0028_070_0	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H0028	072	0	1	01	01	H0028_072_0	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H0028	072	0	1	01	01	H0028_072_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	074	1	1	01	01	H0028_074_1	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	074	2	1	01	01	H0028_074_2	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	076	0	1	01	01	H0028_076_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H0028	076	0	1	01	01	H0028_076_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H0028	076	0	1	01	01	H0028_076_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									1601	1601															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	077	0	1	01	01	H0028_077_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H0028	077	0	1	01	01	H0028_077_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H0028	077	0	1	01	01	H0028_077_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									4401	4401															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	078	0	1	01	01	H0028_078_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H0028	078	0	1	01	01	H0028_078_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2791	2791															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	078	0	1	01	01	H0028_078_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	079	0	1	01	01	H0028_079_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H0028	079	0	1	01	01	H0028_079_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2127	2127															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	079	0	1	01	01	H0028_079_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	080	0	1	01	01	H0028_080_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2547	2547															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0028	080	0	1	01	01	H0028_080_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H0028	080	0	1	01	01	H0028_080_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H0028	081	1	1	01	01	H0028_081_1	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	081	2	1	01	01	H0028_081_2	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0028	082	0	1	01	01	H0028_082_0	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0029	007	0	1	01	01	H0029_007_0	5	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										909	802															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H0034	001	0	1	01	01	H0034_001_0	6	1	3	SSBCI - Food and Utilities	01111111011111111000100110000000	Chronic Hyperlipidemia	Autism Spectrum Disorder									436	276															2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0034	002	0	1	01	01	H0034_002_0	6	1	3	SSBCI - Food and Utilities	01111111011111111000100110000000	Chronic Hyperlipidemia	Autism Spectrum Disorder									1775	1383															2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0062	011	0	1	01	01	H0062_011_0	7	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										2486	2303															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H0062	012	0	1	01	01	H0062_012_0	7	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										6954	6606															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H0062	013	0	1	01	01	H0062_013_0	5	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										384	364															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H0074	004	0	1	04	01	H0074_004_0	5	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										211	200															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H0111	004	0	1	04	01	H0111_004_0	5	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										1033	977															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H0154	012	0	1	01	01	H0154_012_0	5	1	3	Healthy Food and Produce	01111111111111111111111110000000	Chronic Musculoskeletal Disorders	Chronic Malnutrition/Under Nutrition									11845	7936															2			13i1;		2		1	0.00	7		01010		13i1;
H0154	019	0	1	01	01	H0154_019_0	5	1	3	Healthy Food and Produce	01111111111111111111111110000000	Chronic Musculoskeletal Disorders	Chronic Malnutrition/Under Nutrition									815	628															2			13i1;		2		1	0.00	7		01010		13i1;
H0169	001	0	1	02	01	H0169_001_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								17387	14779															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0169	002	0	1	02	01	H0169_002_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								6530	5550															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0169	004	0	1	02	01	H0169_004_0	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								7882	6699															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0169	010	0	1	02	01	H0169_010_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								2548	2166															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0169	014	1	1	02	01	H0169_014_1	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								13408	11397															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0169	014	2	1	02	01	H0169_014_2	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								26151	22228															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0169	014	3	1	02	01	H0169_014_3	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								7110	6043															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0169	015	1	1	02	01	H0169_015_1	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								3444	2927															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0169	015	2	1	02	01	H0169_015_2	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								2528	2149															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0169	015	3	1	02	01	H0169_015_3	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1020	867															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0169	016	0	1	02	01	H0169_016_0	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								3483	2961															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0174	004	0	1	01	01	H0174_004_0	5	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										5260	4986															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H0174	022	0	1	01	01	H0174_022_0	6	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										303	288															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H0174	023	0	1	01	01	H0174_023_0	5	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										437	414															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H0174	024	0	1	01	01	H0174_024_0	5	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										119	113															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H0174	025	0	1	01	01	H0174_025_0	5	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										210	199															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H0174	026	0	1	01	01	H0174_026_0	5	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										325	308															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H0174	027	1	1	01	01	H0174_027_1	6	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										1400	1297															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H0174	027	2	1	01	01	H0174_027_2	6	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										3073	2847															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H0251	004	0	1	02	01	H0251_004_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								2441	2075															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0251	009	1	1	02	01	H0251_009_1	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								7859	6680															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0251	009	2	1	02	01	H0251_009_2	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								7300	6205															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0251	009	3	1	02	01	H0251_009_3	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								13689	11636															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0251	010	1	1	02	01	H0251_010_1	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								3687	3134															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0251	010	2	1	02	01	H0251_010_2	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1759	1495															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0251	010	3	1	02	01	H0251_010_3	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								5878	4996															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0292	001	0	1	01	01	H0292_001_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0292	001	0	1	01	01	H0292_001_0	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H0292	002	0	1	01	01	H0292_002_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H0292	002	0	1	01	01	H0292_002_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0292	003	0	1	01	01	H0292_003_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H0292	004	0	1	02	01	H0292_004_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H0292	004	0	1	02	01	H0292_004_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H0294	002	0	1	04	01	H0294_002_0	6	1	3	SSBCI Package 1	00001101000000000000000000000000											4717	4009															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
H0294	027	0	1	04	01	H0294_027_0	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1755	1492															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0294	048	0	1	04	01	H0294_048_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											2584	2197															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
H0294	050	0	1	04	01	H0294_050_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								7198	6118															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0294	051	0	1	04	01	H0294_051_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								668	568															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0294	052	1	1	04	01	H0294_052_1	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								6443	5476															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0294	052	2	1	04	01	H0294_052_2	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								3502	2976															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0321	002	0	1	02	01	H0321_002_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								58541	49760															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0321	004	0	1	02	01	H0321_004_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								6119	5202															2			13i1;13i4;13i10;	2	1	13i1;13i4;13i10;	1	0.00	7		01010		13i1;13i10;
H0332	004	0	1	02	01	H0332_004_0	12	1	3	SSBCI Transportation	00010100001100000000000000000000											3000	500															2			10b1;	2	2		2						
H0351	066	0	1	02	01	H0351_066_0	5	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										180	161															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H0351	068	0	1	02	01	H0351_068_0	5	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										215	193															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H0354	027	0	1	01	01	H0354_027_0	5	1	3	Food and Produce	00001101000000000000000000000000											2280	1710															2			13i1;		2		2						
H0363	001	0	1	01	01	H0363_001_0	6	1	3	SSBCI	01111111111111111111111000000000											440	293															2			10b1;13i4;13i6;13i-O1;13i-O2;14c17;		2		1	500.00	5		01100		13i6;13i-O1;13i-O2;
H0413	003	0	1	04	01	H0413_003_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											54	49															2			13i1;13i10;	1	1	13i1;13i10;	1	280.00	7		00010		13i1;13i10;
H0421	001	0	1	04	01	H0421_001_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1495	1270															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0423	001	0	1	01	01	H0423_001_0	8	1	3	Package 1	01111111111111111111111000000000											13010	13010															2			13i1;13i10;13i-O1;		1	13i1;13i10;13i-O1;	1	0.00	5		00011		13i1;13i10;13i-O1;
H0423	007	0	1	01	01	H0423_007_0	8	1	3	Package 1	01111111111111111111111000000000											786	786															2			13i1;13i10;13i-O1;		1	13i1;13i10;13i-O1;	1	0.00	5		00011		13i1;13i10;13i-O1;
H0432	009	0	1	02	01	H0432_009_0	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								9075	7713															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0432	017	0	1	02	01	H0432_017_0	6	1	3	SSBCI Package 1	00001101000000000000000000000000											3228	2744															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H0439	002	0	1	01	01	H0439_002_0	7	1	3	Food and Produce	00001101000001001000000000000000											561	421															2			13i1;		2		2						
H0439	012	0	1	01	01	H0439_012_0	6	1	3	Food and Produce	00001101000001001000000000000000											356	267															2			13i1;		2		2						
H0439	022	0	1	01	01	H0439_022_0	6	1	3	Food and Produce	00001101000001001000000000000000											5	4															2			13i1;		2		2						
H0439	023	0	1	01	01	H0439_023_0	6	1	3	Food and Produce	00001101000001001000000000000000											38	28															2			13i1;		2		2						
H0473	003	0	1	04	01	H0473_003_0	5	1	3	Chronic Condition Care Assistance	01111111001111111100000000000000											710	9															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	2		1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H0473	003	0	1	04	01	H0473_003_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H0473	004	0	1	04	01	H0473_004_0	4	1	2	Non-Emergency Medical Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;	1	2		2						
H0473	004	0	1	04	01	H0473_004_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H0473	005	0	1	04	01	H0473_005_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H0523	074	0	1	01	01	H0523_074_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							151	114															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	45.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0523	094	0	1	01	01	H0523_094_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											303	272															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0523	095	0	1	01	01	H0523_095_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											253	227															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0523	096	0	1	01	01	H0523_096_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											402	360															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0523	097	0	1	01	01	H0523_097_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											204	183															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0523	098	0	1	01	01	H0523_098_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											254	228															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0523	801	0	1	01	01	H0523_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H0523	801	0	1	01	01	H0523_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H0523	805	0	1	01	01	H0523_805_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H0523	805	0	1	01	01	H0523_805_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H0523	808	0	1	01	01	H0523_808_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H0523	808	0	1	01	01	H0523_808_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H0524	008	0	1	01	01	H0524_008_0	6	1	2	Advanced Care At Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13f;		2		2						
H0524	032	0	1	01	01	H0524_032_0	6	1	2	Advanced Care At Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13f;		2		2						
H0524	033	0	1	01	01	H0524_033_0	6	1	2	Advanced Care At Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13f;		2		2						
H0524	039	0	1	01	01	H0524_039_0	6	1	2	Advanced Care At Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13f;		2		2						
H0524	059	0	1	01	01	H0524_059_0	6	1	2	Advanced Care At Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13f;		2		2						
H0524	060	0	1	01	01	H0524_060_0	6	1	2	Advanced Care At Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13f;		2		2						
H0524	061	0	1	01	01	H0524_061_0	7	1	2	Advanced Care At Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13f;		2		2						
H0524	062	0	1	01	01	H0524_062_0	6	1	2	Advanced Care At Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13f;		2		2						
H0524	063	0	1	01	01	H0524_063_0	6	1	2	Advanced Care At Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13f;		2		2						
H0543	214	0	1	02	01	H0543_214_0	6	1	3	SSBCI Package 1	00001101000000000000000000000000											2000	1700															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H0543	217	0	1	02	01	H0543_217_0	6	1	3	SSBCI Package 1	00001101000000000000000000000000											3912	3325															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H0543	218	0	1	02	01	H0543_218_0	6	1	3	SSBCI Package 1	00001101000000000000000000000000											1198	1018															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H0543	219	0	1	02	01	H0543_219_0	6	1	3	SSBCI Package 1	00001101000000000000000000000000											3052	2594															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H0543	226	0	1	02	01	H0543_226_0	6	1	3	SSBCI Package 1	00001101000000000000000000000000											544	462															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H0543	239	0	1	01	01	H0543_239_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											318	271															2			13i1;		1	13i1;	1	0.00	7		01010		13i1;
H0543	240	0	1	01	01	H0543_240_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											187	159															2			13i1;		1	13i1;	1	0.00	7		01010		13i1;
H0543	241	0	1	01	01	H0543_241_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											583	496															2			13i1;		1	13i1;	1	0.00	7		01010		13i1;
H0543	242	0	1	01	01	H0543_242_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											102	87															2			13i1;		1	13i1;	1	0.00	7		01010		13i1;
H0543	246	0	1	01	01	H0543_246_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											1157	984															2			13i1;		1	13i1;	1	0.00	7		01010		13i1;
H0543	249	0	1	02	01	H0543_249_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											1079	917															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H0544	004	0	1	02	01	H0544_004_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							2592	896															2			13i10;	2	2		2						
H0544	010	0	1	02	01	H0544_010_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							796	356															2			13i10;	2	2		2						
H0544	014	0	1	02	01	H0544_014_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							252	84															2			13i10;	2	2		2						
H0544	015	0	1	02	01	H0544_015_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							24	9															2			13i1;13i10;	2	2		2						
H0544	019	0	1	02	01	H0544_019_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							111	46															2			13i10;	2	2		2						
H0544	020	0	1	02	01	H0544_020_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							9	4															2			13i1;13i10;	2	2		2						
H0571	005	0	1	01	01	H0571_005_0	7	1	3	OTC and Food/Produce	01111111111111111111111100000000	Chronic Hypertension										3437	2750															1	001		13b;13i1;		2		1	45.00	7		00011		13b;13i1;
H0609	037	0	1	02	01	H0609_037_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											8804	7483															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H0609	042	0	1	02	01	H0609_042_0	5	1	3	SSBCI Package 1	00001101000000000000000000000000											5915	5028															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H0609	043	0	1	02	01	H0609_043_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											2597	2207															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H0609	047	0	1	02	01	H0609_047_0	5	1	3	SSBCI Package 1	00001101000000000000000000000000											4298	3653															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H0609	049	0	1	02	01	H0609_049_0	5	1	3	SSBCI Package 1	00001101000000000000000000000000											1843	1567															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H0609	052	0	1	02	01	H0609_052_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1644	1397															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0609	058	0	1	02	01	H0609_058_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											25064	21304															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H0609	062	0	1	02	01	H0609_062_0	6	1	3	SSBCI Package 1	00001101000000000000000000000000											51920	44132															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H0609	072	0	1	02	01	H0609_072_0	6	1	3	SSBCI Package 1	00001101000000000000000000000000											3607	3066															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H0609	091	0	1	02	01	H0609_091_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											2211	1879															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H0624	001	0	1	02	01	H0624_001_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								11639	9893															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0624	007	0	1	02	01	H0624_007_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								2443	2076															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0624	008	1	1	02	01	H0624_008_1	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								3356	2853															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0624	008	2	1	02	01	H0624_008_2	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								13021	11068															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0628	001	0	1	02	01	H0628_001_0	3	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	2	1	14c21;	2						
H0628	001	0	1	02	01	H0628_001_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							13547	9535															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	55.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	003	0	1	02	01	H0628_003_0	3	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	2	1	14c21;	2						
H0628	005	0	1	02	01	H0628_005_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							27052	19179															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	005	0	1	02	01	H0628_005_0	3	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	2	1	14c21;	2						
H0628	012	0	1	01	01	H0628_012_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							3038	3012															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	017	0	1	02	01	H0628_017_0	3	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	2	1	14c21;	2						
H0628	017	0	1	02	01	H0628_017_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							23108	16265															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	55.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	018	0	1	01	01	H0628_018_0	4	1	3	SSBCI Pkg	01000110001001110000000000000000											322	95															1	001		13i6;		1	13i6;	2						
H0628	021	0	1	02	01	H0628_021_0	3	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	2	1	14c21;	2						
H0628	031	0	1	01	01	H0628_031_0	3	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H0628	031	0	1	01	01	H0628_031_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											6331	6306															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	032	0	1	01	01	H0628_032_0	3	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H0628	032	0	1	01	01	H0628_032_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											4012	3978															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	033	0	1	01	01	H0628_033_0	3	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H0628	033	0	1	01	01	H0628_033_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											5203	5159															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	034	0	1	01	01	H0628_034_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											2476	2442															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	034	0	1	01	01	H0628_034_0	3	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H0628	036	0	1	01	01	H0628_036_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											3707	3344															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	036	0	1	01	01	H0628_036_0	3	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H0628	037	0	1	01	01	H0628_037_0	3	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H0628	037	0	1	01	01	H0628_037_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											3167	2857															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	038	0	1	01	01	H0628_038_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											5935	5354															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	038	0	1	01	01	H0628_038_0	3	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H0628	039	0	1	01	01	H0628_039_0	3	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H0628	039	0	1	01	01	H0628_039_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											3006	2712															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	040	0	1	01	01	H0628_040_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							8982	8727															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	042	0	1	01	01	H0628_042_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											232	211															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	043	0	1	01	01	H0628_043_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											311	283															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	044	0	1	01	01	H0628_044_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											312	284															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	045	0	1	02	01	H0628_045_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							2013	1530															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	75.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H0628	045	0	1	02	01	H0628_045_0	3	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	2	1	14c21;	2						
H0628	801	0	1	01	01	H0628_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H0628	801	0	1	01	01	H0628_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H0629	001	0	1	01	01	H0629_001_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							5748	5329															2			13i1;13i10;		2		2						
H0629	002	0	1	01	01	H0629_002_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							9233	8560															2			13i1;13i10;		2		2						
H0629	003	0	1	01	01	H0629_003_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							10555	9786															2			13i1;13i10;		2		2						
H0629	004	0	1	01	01	H0629_004_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							5114	4742															2			13i1;13i10;		2		2						
H0630	013	0	1	02	01	H0630_013_0	9	1	2	Advanced Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13e;	2	2		2						
H0630	014	0	1	01	01	H0630_014_0	9	1	2	Advanced Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13e;		2		2						
H0630	015	0	1	02	01	H0630_015_0	8	1	2	Advanced Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13e;	2	2		2						
H0630	016	0	1	02	01	H0630_016_0	8	1	2	Advanced Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13e;	2	2		2						
H0630	025	0	1	02	01	H0630_025_0	8	1	2	Advanced Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13e;	2	2		2						
H0630	027	0	1	01	01	H0630_027_0	8	1	2	Advanced Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13e;		2		2						
H0710	030	0	1	04	01	H0710_030_0	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1499	1274															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
H0710	037	0	1	04	01	H0710_037_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1361	1157															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
H0710	057	0	1	04	01	H0710_057_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								293	249															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
H0712	005	0	1	02	01	H0712_005_0	6	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										2792	2322															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H0712	029	0	1	01	01	H0712_029_0	6	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										1469	1241															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H0738	001	0	1	01	01	H0738_001_0	6	1	3	Package 1	00001111110001101000000100000000	Connective Tissue Disease										566	374															2			13i1;13i3;13i10;		1	13i1;13i3;13i10;	1	0.00	7		01011		13i1;13i3;13i10;
H0738	002	0	1	01	01	H0738_002_0	9	1	3	Package 1	00001111110001101000000100000000	Connective Tissue Disease										48	32															2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		01011		13i1;13i10;
H0755	047	0	1	02	01	H0755_047_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											2732	2322															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H0764	001	0	1	04	01	H0764_001_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1190	1011															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H0777	001	0	1	01	01	H0777_001_0	6	1	3	SSBCI Package 1	00001101001001010000100000000000											1470	1325															2			13i1;13i4;13i-O1;		2		1	0.00	5		01011		13i1;13i-O1;
H0907	003	0	1	02	01	H0907_003_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							3140	2797															2			13i1;13i10;	2	2		2						
H0913	013	0	1	01	01	H0913_013_0	7	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										8773	8334															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H0963	001	0	1	01	01	H0963_001_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									17366	17366															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H0963	001	0	1	01	01	H0963_001_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H0976	001	0	1	01	01	H0976_001_0	11	1	3	Food-Utilities, Non-med Transport and Home Mod	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						24809	13644															2			13i1;13i3;13i4;13i5;13i10;		1	13i1;13i3;13i4;13i5;13i10;	1	0.00	7		00111		13i1;13i3;13i5;13i10;
H0976	002	0	1	01	01	H0976_002_0	10	1	3	Food-Utilities, Non-med Transport and Home Mod	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						3239	1781															2			13i1;13i3;13i4;13i5;13i10;		1	13i1;13i3;13i4;13i5;13i10;	1	0.00	7		00111		13i1;13i3;13i5;13i10;
H0978	002	0	1	01	01	H0978_002_0	11	1	3	Food and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						2308	1269															2			13i1;13i4;		2		2						
H0978	010	0	1	01	01	H0978_010_0	11	1	3	Food, Utilities and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						544	299															2			13i1;13i4;13i10;		1	13i1;13i4;13i10;	1	0.00	7		00111		13i1;13i10;
H0978	012	0	1	01	01	H0978_012_0	10	1	3	Food and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						545	299															2			13i1;13i4;		2		2						
H0982	002	0	1	01	01	H0982_002_0	16	1	3	Healthy Living Allowance	01111111111111111111111100000000	Chronic hypertension										10940	10151															2			13i1;13i3;13i4;13i10;13i-O1;		2		1	260.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	007	0	1	01	01	H0982_007_0	14	1	3	Healthy Living Allowance	01111111111111111111111100000000	Chronic hypertension										399	276															2			13i1;13i3;13i4;13i10;13i-O1;		2		1	30.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	008	0	1	01	01	H0982_008_0	14	1	3	Healthy Living Allowance	01111111111111111111111100000000	Chronic hypertension										41	28															2			13i1;13i3;13i4;13i10;13i-O1;		2		1	25.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	009	0	1	01	01	H0982_009_0	15	1	3	Healthy Living Allowance	01111111111111111111111100000000	Chronic hypertension										41	28															2			13i1;13i3;13i4;13i10;13i-O1;		2		1	45.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	010	0	1	01	01	H0982_010_0	14	1	3	Healthy Living Allowance	01111111111111111111111100000000	Chronic hypertension										283	263															2			13i1;13i3;13i4;13i10;13i-O1;		2		1	230.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	012	0	1	01	01	H0982_012_0	14	1	3	Healthy Living Allowance	01111111111111111111111100000000	Chronic hypertension										1655	1535															2			13i1;13i3;13i4;13i10;13i-O1;		2		1	250.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	013	0	1	01	01	H0982_013_0	14	1	3	Healthy Living Allowance	01111111111111111111111100000000	Chronic hypertension										163	151															2			13i1;13i3;13i4;13i10;13i-O1;		2		1	240.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	016	0	1	01	01	H0982_016_0	14	1	3	Healthy Living Allowance	01111111111111111111111100000000	Chronic hypertension										1603	1110															2			13i1;13i3;13i4;13i10;13i-O1;		2		1	100.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	017	0	1	01	01	H0982_017_0	14	1	3	Healthy Living Allowance	01111111111111111111111100000000	Chronic hypertension										394	273															2			13i1;13i3;13i4;13i10;13i-O1;		2		1	100.	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	022	0	1	01	01	H0982_022_0	15	1	3	Healthy Living Allowance	01111111111111111111111100000000	Chronic hypertension										647	448															2			13i1;13i3;13i4;13i10;13i-O1;		2		1	50.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	024	0	1	01	01	H0982_024_0	14	1	3	Healthy Living Allowance	01111111111111111111111100000000	Chronic hypertension										98	68															2			13i1;13i3;13i4;13i10;13i-O1;		2		1	30.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	025	0	1	01	01	H0982_025_0	14	1	3	Healthy Living Allowance	01111111111111111111111100000000	Chronic hypertension										790	733															2			13i1;13i3;13i4;13i10;13i-O1;		2		1	230.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	026	0	1	01	01	H0982_026_0	14	1	3	Healthy Living Allowance	01111111111111111111111100000000	Chronic hypertension										236	163															2			13i1;13i3;13i4;13i10;13i-O1;		2		1	100.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	027	0	1	01	01	H0982_027_0	15	1	3	Healthy Living Allowance	01111111111111111111111100000000	Chronic hypertension										1452	1347															2			13i1;13i3;13i4;13i10;13i-O1;		2		1	200.	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	028	0	1	01	01	H0982_028_0	14	1	3	Healthy Living Allowance	01111111111111111111111100000000	Chronic hypertension										6008	5626															2			13i1;13i3;13i4;13i10;13i-O1;		2		1	75.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	030	0	1	01	01	H0982_030_0	14	1	3	Healthy Living Allowance	01111111111111111111111100000000	Chronic hypertension										1389	1300															2			13i1;13i3;13i4;13i10;13i-O1;		2		1	50.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	031	0	1	01	01	H0982_031_0	14	1	3	Healthy Living Allowance	01111111111111111111111100000000	Chronic hypertension										409	383															2			13i1;13i3;13i4;13i10;13i-O1;		2		1	90.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	033	0	1	01	01	H0982_033_0	14	1	3	Healthy Living Allowance	01111111111111111111111100000000	Chronic hypertension										827	774															2			13i1;13i3;13i4;13i10;13i-O1;		2		1	90.00	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H0982	034	0	1	01	01	H0982_034_0	14	1	3	Healthy Living Allowance	01111111111111111111111100000000	Chronic hypertension										117	109															2			13i1;13i3;13i4;13i10;13i-O1;		2		1	150.	7		00011		13i1;13i3;13i4;13i10;13i-O1;
H1019	001	0	1	02	01	H1019_001_0	6	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H1019	001	0	1	02	01	H1019_001_0	6	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									8229	6756															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	2		1	500.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1019	001	0	1	02	01	H1019_001_0	6	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H1019	006	0	1	01	01	H1019_006_0	6	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1019	006	0	1	01	01	H1019_006_0	6	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1019	006	0	1	01	01	H1019_006_0	6	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									5142	4221															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1019	023	0	1	01	01	H1019_023_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									10015	10015															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1019	023	0	1	01	01	H1019_023_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1019	043	0	1	02	01	H1019_043_0	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H1019	043	0	1	02	01	H1019_043_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H1019	057	0	1	02	01	H1019_057_0	5	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H1019	057	0	1	02	01	H1019_057_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									5222	4288															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1019	057	0	1	02	01	H1019_057_0	5	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H1019	065	0	1	01	01	H1019_065_0	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1019	065	0	1	01	01	H1019_065_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1019	073	0	1	01	01	H1019_073_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									3245	3245															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1019	073	0	1	01	01	H1019_073_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1019	094	0	1	01	01	H1019_094_0	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1019	094	0	1	01	01	H1019_094_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1019	103	1	1	02	01	H1019_103_1	6	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H1019	103	1	1	02	01	H1019_103_1	6	1	3	Chronic Condition Care Assistance	01111111001111111100000000000000											2068	27															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1019	103	1	1	02	01	H1019_103_1	6	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H1019	103	2	1	02	01	H1019_103_2	6	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H1019	103	2	1	02	01	H1019_103_2	6	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H1019	103	2	1	02	01	H1019_103_2	6	1	3	Chronic Condition Care Assistance	01111111001111111100000000000000											1454	19															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1019	104	1	1	01	01	H1019_104_1	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1019	104	1	1	01	01	H1019_104_1	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1019	104	2	1	01	01	H1019_104_2	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1019	104	2	1	01	01	H1019_104_2	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1019	109	0	1	01	01	H1019_109_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									987	987															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1019	109	0	1	01	01	H1019_109_0	5	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1019	109	0	1	01	01	H1019_109_0	5	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1019	113	0	1	01	01	H1019_113_0	5	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1019	113	0	1	01	01	H1019_113_0	5	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2798	2297															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1019	113	0	1	01	01	H1019_113_0	5	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1019	118	0	1	01	01	H1019_118_0	6	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1019	118	0	1	01	01	H1019_118_0	6	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									319	319															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1019	118	0	1	01	01	H1019_118_0	6	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1019	121	0	1	01	01	H1019_121_0	5	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1019	121	0	1	01	01	H1019_121_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									1099	1099															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1019	121	0	1	01	01	H1019_121_0	5	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1019	123	0	1	01	01	H1019_123_0	5	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1019	123	0	1	01	01	H1019_123_0	5	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1019	123	0	1	01	01	H1019_123_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									145	145															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1019	124	0	1	02	01	H1019_124_0	6	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H1019	124	0	1	02	01	H1019_124_0	6	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									154	154															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	2		1	500.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1019	124	0	1	02	01	H1019_124_0	6	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H1019	130	0	1	02	01	H1019_130_0	7	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									673	673															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	2		1	500.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1019	130	0	1	02	01	H1019_130_0	7	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H1019	130	0	1	02	01	H1019_130_0	7	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H1019	132	0	1	01	01	H1019_132_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1019	132	0	1	01	01	H1019_132_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1019	134	0	1	01	01	H1019_134_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1019	134	0	1	01	01	H1019_134_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1019	135	0	1	02	01	H1019_135_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H1019	135	0	1	02	01	H1019_135_0	6	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H1019	136	0	1	01	01	H1019_136_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1019	136	0	1	01	01	H1019_136_0	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1019	138	0	1	01	01	H1019_138_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1019	138	0	1	01	01	H1019_138_0	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1019	139	0	1	01	01	H1019_139_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1019	139	0	1	01	01	H1019_139_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1019	144	0	1	01	01	H1019_144_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1019	144	0	1	01	01	H1019_144_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1019	144	0	1	01	01	H1019_144_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									323	266															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1019	146	0	1	01	01	H1019_146_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									17919	17919															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1019	146	0	1	01	01	H1019_146_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1019	147	1	1	01	01	H1019_147_1	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1019	147	1	1	01	01	H1019_147_1	6	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1019	147	2	1	01	01	H1019_147_2	5	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1019	147	2	1	01	01	H1019_147_2	5	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1019	147	2	1	01	01	H1019_147_2	5	1	3	Chronic Condition Care Assistance	01111111001111111100000000000000											3893	51															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1019	148	0	1	01	01	H1019_148_0	5	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1019	148	0	1	01	01	H1019_148_0	5	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1019	148	0	1	01	01	H1019_148_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									338	278															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1019	149	0	1	01	01	H1019_149_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1019	149	0	1	01	01	H1019_149_0	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1019	150	0	1	01	01	H1019_150_0	5	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1019	150	0	1	01	01	H1019_150_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									17498	17498															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1019	150	0	1	01	01	H1019_150_0	5	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1019	151	1	1	01	01	H1019_151_1	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1019	151	1	1	01	01	H1019_151_1	6	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1019	151	2	1	01	01	H1019_151_2	5	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1019	151	2	1	01	01	H1019_151_2	5	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									876	876															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1019	151	2	1	01	01	H1019_151_2	5	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1019	153	0	1	01	01	H1019_153_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H1019	153	0	1	01	01	H1019_153_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									355	355															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1019	154	0	1	01	01	H1019_154_0	5	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1019	154	0	1	01	01	H1019_154_0	5	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1019	154	0	1	01	01	H1019_154_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2312	2312															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1019	155	0	1	02	01	H1019_155_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H1019	156	0	1	01	01	H1019_156_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									131	131															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1019	156	0	1	01	01	H1019_156_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1032	202	0	1	02	01	H1032_202_0	10	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										2711	2564															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H1032	246	0	1	01	01	H1032_246_0	8	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										11083	10279															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H1032	247	0	1	01	01	H1032_247_0	8	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										1184	1109															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H1032	248	0	1	02	01	H1032_248_0	10	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										5785	5453															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H1032	249	0	1	02	01	H1032_249_0	9	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										596	558															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H1032	250	0	1	01	01	H1032_250_0	8	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										2499	2340															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H1035	055	0	1	01	01	H1035_055_0	10	1	3	Package 1	00001101000000000000000000000000											481	457															2			13i1;		1	13i1;	1	0.00	7		00011		13i1;
H1035	056	0	1	01	01	H1035_056_0	10	1	3	Package 1	00001101000000000000000000000000											1528	1452															2			13i1;		1	13i1;	1	0.00	7		00011		13i1;
H1035	057	0	1	01	01	H1035_057_0	9	1	3	Package 1	00001101000000000000000000000000											745	708															2			13i1;		1	13i1;	1	0.00	7		00011		13i1;
H1036	025	0	1	01	01	H1036_025_0	6	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	025	0	1	01	01	H1036_025_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	044	0	1	01	01	H1036_044_0	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	044	0	1	01	01	H1036_044_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	054	0	1	01	01	H1036_054_0	6	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	054	0	1	01	01	H1036_054_0	6	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	054	0	1	01	01	H1036_054_0	6	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									33630	27610															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1036	062	0	1	01	01	H1036_062_0	5	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	062	0	1	01	01	H1036_062_0	5	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	062	0	1	01	01	H1036_062_0	5	1	3	Chronic Condition Care Assistance	01111111001111111100000000000000											21076	274															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1036	065	0	1	01	01	H1036_065_0	5	1	3	Chronic Condition Care Assistance	01111111001111111100000000000000											47565	618															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1036	065	0	1	01	01	H1036_065_0	5	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	065	0	1	01	01	H1036_065_0	5	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	068	0	1	01	01	H1036_068_0	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	068	0	1	01	01	H1036_068_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	074	0	1	01	01	H1036_074_0	6	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	074	0	1	01	01	H1036_074_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	077	0	1	01	01	H1036_077_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	077	0	1	01	01	H1036_077_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									4113	4113															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	102	0	1	01	01	H1036_102_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	102	0	1	01	01	H1036_102_0	4	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									4159	4159															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	1000.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1036	119	0	1	01	01	H1036_119_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	119	0	1	01	01	H1036_119_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	121	0	1	01	01	H1036_121_0	6	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	121	0	1	01	01	H1036_121_0	6	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									16269	16269															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	121	0	1	01	01	H1036_121_0	6	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	137	0	1	02	01	H1036_137_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H1036	143	0	1	01	01	H1036_143_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	146	0	1	01	01	H1036_146_0	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	146	0	1	01	01	H1036_146_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	151	0	1	01	01	H1036_151_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	153	0	1	01	01	H1036_153_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	157	0	1	01	01	H1036_157_0	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	157	0	1	01	01	H1036_157_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	167	0	1	01	01	H1036_167_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									5863	5863															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	167	0	1	01	01	H1036_167_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H1036	209	0	1	01	01	H1036_209_0	4	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									1075	1075															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	1000.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1036	209	0	1	01	01	H1036_209_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	210	0	1	01	01	H1036_210_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	210	0	1	01	01	H1036_210_0	4	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									902	902															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	1000.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1036	213	0	1	01	01	H1036_213_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	213	0	1	01	01	H1036_213_0	4	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2402	2402															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	1000.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1036	214	0	1	01	01	H1036_214_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	214	0	1	01	01	H1036_214_0	4	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									286	286															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1036	217	0	1	01	01	H1036_217_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	217	0	1	01	01	H1036_217_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									7409	6083															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	222	0	1	01	01	H1036_222_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H1036	222	0	1	01	01	H1036_222_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H1036	222	0	1	01	01	H1036_222_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									5603	5603															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	226	0	1	01	01	H1036_226_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									1661	1661															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	226	0	1	01	01	H1036_226_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	229	0	1	01	01	H1036_229_0	6	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	229	0	1	01	01	H1036_229_0	6	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2152	1767															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	229	0	1	01	01	H1036_229_0	6	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	230	0	1	01	01	H1036_230_0	6	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2208	1813															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1036	230	0	1	01	01	H1036_230_0	6	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	230	0	1	01	01	H1036_230_0	6	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	233	0	1	02	01	H1036_233_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H1036	234	0	1	01	01	H1036_234_0	5	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	234	0	1	01	01	H1036_234_0	5	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	234	0	1	01	01	H1036_234_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									3293	3293															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	236	0	1	01	01	H1036_236_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	236	0	1	01	01	H1036_236_0	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	265	1	1	01	01	H1036_265_1	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	265	1	1	01	01	H1036_265_1	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	265	2	1	01	01	H1036_265_2	6	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	265	2	1	01	01	H1036_265_2	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	266	0	1	01	01	H1036_266_0	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	266	0	1	01	01	H1036_266_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	269	0	1	01	01	H1036_269_0	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	269	0	1	01	01	H1036_269_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	270	0	1	01	01	H1036_270_0	6	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	270	0	1	01	01	H1036_270_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	271	0	1	01	01	H1036_271_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	278	0	1	01	01	H1036_278_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	279	0	1	01	01	H1036_279_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	279	0	1	01	01	H1036_279_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	280	0	1	01	01	H1036_280_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									743	743															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	280	0	1	01	01	H1036_280_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	285	0	1	01	01	H1036_285_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	285	0	1	01	01	H1036_285_0	4	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									408	408															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	1000.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1036	286	0	1	01	01	H1036_286_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	290	0	1	01	01	H1036_290_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	290	0	1	01	01	H1036_290_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	292	0	1	01	01	H1036_292_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	292	0	1	01	01	H1036_292_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									1900	1900															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	297	0	1	01	01	H1036_297_0	7	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2881	2881															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	297	0	1	01	01	H1036_297_0	7	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	297	0	1	01	01	H1036_297_0	7	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	298	0	1	01	01	H1036_298_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									544	544															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	298	0	1	01	01	H1036_298_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	299	0	1	01	01	H1036_299_0	6	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									35307	35307															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	299	0	1	01	01	H1036_299_0	6	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	299	0	1	01	01	H1036_299_0	6	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	300	0	1	01	01	H1036_300_0	6	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	300	0	1	01	01	H1036_300_0	6	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	300	0	1	01	01	H1036_300_0	6	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									10133	10133															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	301	0	1	01	01	H1036_301_0	6	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2397	2397															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1036	301	0	1	01	01	H1036_301_0	6	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	301	0	1	01	01	H1036_301_0	6	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	302	0	1	01	01	H1036_302_0	6	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	302	0	1	01	01	H1036_302_0	6	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	302	0	1	01	01	H1036_302_0	6	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									4991	4991															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1036	304	0	1	01	01	H1036_304_0	4	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									35076	35076															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	1000.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1036	304	0	1	01	01	H1036_304_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	305	0	1	01	01	H1036_305_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	305	0	1	01	01	H1036_305_0	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	306	0	1	01	01	H1036_306_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	307	0	1	01	01	H1036_307_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									5464	5464															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	307	0	1	01	01	H1036_307_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	308	0	1	01	01	H1036_308_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									10321	10321															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	308	0	1	01	01	H1036_308_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	310	0	1	01	01	H1036_310_0	6	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									1855	1855															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	310	0	1	01	01	H1036_310_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	311	0	1	01	01	H1036_311_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	311	0	1	01	01	H1036_311_0	6	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									5306	5306															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	312	0	1	01	01	H1036_312_0	6	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	312	0	1	01	01	H1036_312_0	6	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									11421	11421															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	312	0	1	01	01	H1036_312_0	6	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	313	0	1	01	01	H1036_313_0	6	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	313	0	1	01	01	H1036_313_0	6	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	313	0	1	01	01	H1036_313_0	6	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2032	2032															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	314	0	1	01	01	H1036_314_0	4	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									55648	55648															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	1000.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1036	314	0	1	01	01	H1036_314_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	315	0	1	01	01	H1036_315_0	6	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	315	0	1	01	01	H1036_315_0	6	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									692	692															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1036	315	0	1	01	01	H1036_315_0	6	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	316	0	1	01	01	H1036_316_0	6	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									960	960															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1036	316	0	1	01	01	H1036_316_0	6	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	316	0	1	01	01	H1036_316_0	6	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	317	0	1	01	01	H1036_317_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H1036	317	0	1	01	01	H1036_317_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									877	877															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	318	0	1	02	01	H1036_318_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H1036	319	0	1	01	01	H1036_319_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H1036	321	0	1	01	01	H1036_321_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	322	0	1	01	01	H1036_322_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H1036	323	0	1	01	01	H1036_323_0	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H1036	325	0	1	01	01	H1036_325_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H1036	325	0	1	01	01	H1036_325_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H1036	325	0	1	01	01	H1036_325_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									7250	7250															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	327	0	1	01	01	H1036_327_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	328	0	1	01	01	H1036_328_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									9780	9780															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	328	0	1	01	01	H1036_328_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H1036	328	0	1	01	01	H1036_328_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H1036	329	0	1	01	01	H1036_329_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2188	2188															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	329	0	1	01	01	H1036_329_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	329	0	1	01	01	H1036_329_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	330	0	1	01	01	H1036_330_0	4	1	2	Non-Emergency Medical Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;		2		2						
H1036	331	0	1	01	01	H1036_331_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H1036	331	0	1	01	01	H1036_331_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									38131	38131															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	332	0	1	01	01	H1036_332_0	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	333	0	1	01	01	H1036_333_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	333	0	1	01	01	H1036_333_0	5	1	2	Non-Emergency Medical Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;		2		2						
H1036	334	0	1	01	01	H1036_334_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H1036	335	1	1	02	01	H1036_335_1	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H1036	335	2	1	02	01	H1036_335_2	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H1036	335	2	1	02	01	H1036_335_2	5	1	2	Non-Emergency Medical Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;	1	2		2						
H1036	336	0	1	01	01	H1036_336_0	6	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									4014	4014															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1036	336	0	1	01	01	H1036_336_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	337	0	1	01	01	H1036_337_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	337	0	1	01	01	H1036_337_0	4	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									617	617															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1036	338	0	1	01	01	H1036_338_0	6	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	338	0	1	01	01	H1036_338_0	6	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1036	338	0	1	01	01	H1036_338_0	6	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									7172	7172															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1036	339	0	1	01	01	H1036_339_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									36433	36433															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	339	0	1	01	01	H1036_339_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H1036	340	0	1	01	01	H1036_340_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H1036	340	0	1	01	01	H1036_340_0	4	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									24449	24449															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		1	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	1000.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1036	341	0	1	01	01	H1036_341_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H1036	341	0	1	01	01	H1036_341_0	4	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									1114	1114															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		1	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	1000.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H1036	342	0	1	01	01	H1036_342_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	342	0	1	01	01	H1036_342_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									132	132															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1036	343	0	1	02	01	H1036_343_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H1036	344	0	1	01	01	H1036_344_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1036	344	0	1	01	01	H1036_344_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1045	012	0	1	01	01	H1045_012_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								13972	11876															2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1045	018	0	1	01	01	H1045_018_0	6	1	3	SSBCI Package 1	00001101000000000000000000000000											8884	7552															2			13i1;		1	13i1;	1	0.00	7		01010		13i1;
H1045	038	0	1	01	01	H1045_038_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1073	912															2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1045	039	0	1	02	01	H1045_039_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								71821	61048															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1045	048	1	1	02	01	H1045_048_1	6	1	3	SSBCI Package 1	00001101000000000000000000000000											8679	7377															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H1045	048	2	1	02	01	H1045_048_2	5	1	3	SSBCI Package 1	00001101000000000000000000000000											6690	5687															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H1045	048	3	1	02	01	H1045_048_3	5	1	3	SSBCI Package 1	00001101000000000000000000000000											5833	4958															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H1045	061	0	1	01	01	H1045_061_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								5547	4715															2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1045	063	0	1	02	01	H1045_063_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								32931	27991															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1045	065	0	1	02	01	H1045_065_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								2313	1966															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1045	073	0	1	02	01	H1045_073_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								52532	44652															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1109	801	0	1	01	01	H1109_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H1109	801	0	1	01	01	H1109_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H1109	802	0	1	01	01	H1109_802_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H1109	802	0	1	01	01	H1109_802_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H1109	805	0	1	01	01	H1109_805_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H1109	805	0	1	01	01	H1109_805_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H1112	006	0	1	02	01	H1112_006_0	6	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										2554	2371															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H1112	033	0	1	02	01	H1112_033_0	6	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										4013	3744															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H1112	046	0	1	02	01	H1112_046_0	6	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										1540	1434															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H1112	047	0	1	02	01	H1112_047_0	6	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										299	279															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H1112	048	0	1	02	01	H1112_048_0	6	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										91	85															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H1170	002	0	1	01	01	H1170_002_0	6	2	3	Healthy Food Card	01111111111111111111111000000000											5468	4115															2			13i1;		2		2						
H1170	002	0	1	01	01	H1170_002_0	6	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13f;		2		2						
H1170	008	0	1	01	01	H1170_008_0	6	2	3	Healthy Food Card	01111111111111111111111000000000											884	782															2			13i1;		2		2						
H1170	008	0	1	01	01	H1170_008_0	6	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13f;		2		2						
H1170	009	0	1	01	01	H1170_009_0	6	2	3	Healthy Food Card	01111111111111111111111000000000											20347	15313															2			13i1;		2		2						
H1170	009	0	1	01	01	H1170_009_0	6	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13f;		2		2						
H1170	011	0	1	01	01	H1170_011_0	6	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13f;		2		2						
H1170	011	0	1	01	01	H1170_011_0	6	2	3	Healthy Food Card	01111111111111111111111000000000											74	65															2			13i1;		2		2						
H1170	012	0	1	01	01	H1170_012_0	6	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13f;		2		2						
H1170	012	0	1	01	01	H1170_012_0	6	2	3	Healthy Food Card	01111111111111111111111000000000											1163	875															2			13i1;		2		2						
H1170	013	0	1	02	01	H1170_013_0	6	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13f;	2	2		2						
H1170	013	0	1	02	01	H1170_013_0	6	2	3	Healthy Food Card	01111111111111111111111000000000											1699	1279															2			13i1;	2	2		2						
H1170	014	0	1	01	01	H1170_014_0	6	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13f;		2		2						
H1170	014	0	1	01	01	H1170_014_0	6	2	3	Healthy Food Card	01111111111111111111111000000000											141	106															2			13i1;		2		2						
H1170	015	0	1	01	01	H1170_015_0	6	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13f;		2		2						
H1170	015	0	1	01	01	H1170_015_0	6	2	3	Healthy Food Card	01111111111111111111111000000000											623	551															2			13i1;		2		2						
H1170	016	0	1	01	01	H1170_016_0	6	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13f;		2		2						
H1170	017	0	1	01	01	H1170_017_0	5	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13f;		2		2						
H1206	004	0	1	01	01	H1206_004_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											1393	1267															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1206	010	0	1	01	01	H1206_010_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							460	350															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	80.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1206	801	0	1	01	01	H1206_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H1206	801	0	1	01	01	H1206_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H1212	001	0	1	01	01	H1212_001_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							671	603															2			13i1;13i10;		2		2						
H1212	002	0	1	01	01	H1212_002_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							88	79															2			13i1;13i10;		2		2						
H1215	001	0	1	02	01	H1215_001_0	6	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										428	386															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H1224	001	0	1	01	01	H1224_001_0	12	1	3	Package 1	01111111111111111111111000000000											24775	22050															1	001		13i1;13i4;13i10;		1	13i1;13i4;13i10;	1	0.00	7		01010		13i1;13i4;13i10;
H1225	003	0	1	01	01	H1225_003_0	8	1	3	Healthy Foods	01111111111111111111111000000000											398	390															2			13i1;		2		2						
H1225	006	0	1	01	01	H1225_006_0	9	1	3	Healthy Food	01111111111111111111111000000000											228	223															2			13i1;		2		2						
H1280	001	0	1	01	01	H1280_001_0	8	1	3	Grocery OTC	00011001001000100000000000000000											630	580															1	001		13b;13i1;		2		1	75.00	5		01011		13b;13i1;
H1290	019	0	1	01	01	H1290_019_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								133	119															2			13i1;13i10;		1	13i1;13i10;	1	163.00	7		00010		13i1;13i10;
H1290	020	0	1	01	01	H1290_020_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								103	92															2			13i1;13i10;		1	13i1;13i10;	1	156.00	7		00010		13i1;13i10;
H1290	021	0	1	01	01	H1290_021_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								99	89															2			13i1;13i10;		1	13i1;13i10;	1	156.00	7		00010		13i1;13i10;
H1290	022	0	1	01	01	H1290_022_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								124	112															2			13i1;13i10;		1	13i1;13i10;	1	156.00	7		00010		13i1;13i10;
H1290	023	0	1	01	01	H1290_023_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								112	100															2			13i1;13i10;		1	13i1;13i10;	1	156.00	7		00010		13i1;13i10;
H1290	024	0	1	01	01	H1290_024_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								300	269															2			13i1;13i10;		1	13i1;13i10;	1	151.00	7		00010		13i1;13i10;
H1290	033	0	1	01	01	H1290_033_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								70	63															2			13i1;13i10;		1	13i1;13i10;	1	152.00	7		00010		13i1;13i10;
H1290	034	0	1	01	01	H1290_034_0	4	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								93	83															2			13i1;13i10;		1	13i1;13i10;	1	162.00	7		00010		13i1;13i10;
H1290	037	1	1	01	01	H1290_037_1	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								5	4															2			13i1;13i10;		1	13i1;13i10;	1	20.00	7		00010		13i1;13i10;
H1290	037	2	1	01	01	H1290_037_2	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								6	6															2			13i1;13i10;		1	13i1;13i10;	1	20.00	7		00010		13i1;13i10;
H1290	039	0	1	01	01	H1290_039_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								141	127															2			13i1;13i10;		1	13i1;13i10;	1	155.00	7		00010		13i1;13i10;
H1290	041	0	1	01	01	H1290_041_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								20	18															2			13i1;13i10;		1	13i1;13i10;	1	157.00	7		00010		13i1;13i10;
H1290	042	0	1	01	01	H1290_042_0	7	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								110	99															2			13i1;13i10;		1	13i1;13i10;	1	272.00	7		00010		13i1;13i10;
H1290	043	0	1	01	01	H1290_043_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								16	14															2			13i1;13i10;		1	13i1;13i10;	1	144.00	7		00010		13i1;13i10;
H1290	044	2	1	01	01	H1290_044_2	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								25	23															2			13i1;13i10;		1	13i1;13i10;	1	20.00	7		00010		13i1;13i10;
H1290	044	3	1	01	01	H1290_044_3	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								5	5															2			13i1;13i10;		1	13i1;13i10;	1	25.00	7		00010		13i1;13i10;
H1290	052	0	1	01	01	H1290_052_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								7650	6869															2			13i1;13i10;		1	13i1;13i10;	1	303.00	7		00010		13i1;13i10;
H1290	053	0	1	01	01	H1290_053_0	7	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								1053	946															2			13i1;13i10;		1	13i1;13i10;	1	324.00	7		00010		13i1;13i10;
H1290	054	0	1	01	01	H1290_054_0	7	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								747	671															2			13i1;13i10;		1	13i1;13i10;	1	328.00	7		00010		13i1;13i10;
H1290	055	0	1	01	01	H1290_055_0	7	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								662	595															2			13i1;13i10;		1	13i1;13i10;	1	329.00	7		00010		13i1;13i10;
H1290	067	0	1	01	01	H1290_067_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											111	100															2			13i1;13i10;		1	13i1;13i10;	1	240.00	7		00010		13i1;13i10;
H1290	068	0	1	01	01	H1290_068_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											118	106															2			13i1;13i10;		1	13i1;13i10;	1	240.00	7		00010		13i1;13i10;
H1290	069	0	1	01	01	H1290_069_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											149	134															2			13i1;13i10;		1	13i1;13i10;	1	240.00	7		00010		13i1;13i10;
H1290	070	0	1	01	01	H1290_070_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											91	82															2			13i1;13i10;		1	13i1;13i10;	1	240.00	7		00010		13i1;13i10;
H1290	071	0	1	01	01	H1290_071_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											183	164															2			13i1;13i10;		1	13i1;13i10;	1	240.00	7		00010		13i1;13i10;
H1290	072	0	1	01	01	H1290_072_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											87	79															2			13i1;13i10;		1	13i1;13i10;	1	240.00	7		00010		13i1;13i10;
H1290	073	0	1	01	01	H1290_073_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											144	129															2			13i1;13i10;		1	13i1;13i10;	1	240.00	7		00010		13i1;13i10;
H1290	074	0	1	01	01	H1290_074_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											167	150															2			13i1;13i10;		1	13i1;13i10;	1	240.00	7		00010		13i1;13i10;
H1290	077	0	1	01	01	H1290_077_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								912	819															2			13i1;13i10;		1	13i1;13i10;	1	456.00	7		00010		13i1;13i10;
H1290	078	0	1	01	01	H1290_078_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								2297	2063															2			13i1;13i10;		1	13i1;13i10;	1	455.00	7		00010		13i1;13i10;
H1290	079	0	1	01	01	H1290_079_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								825	741															2			13i1;13i10;		1	13i1;13i10;	1	456.00	7		00010		13i1;13i10;
H1290	080	0	1	01	01	H1290_080_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								2639	2370															2			13i1;13i10;		1	13i1;13i10;	1	456.00	7		00010		13i1;13i10;
H1290	081	0	1	01	01	H1290_081_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								1348	1211															2			13i1;13i10;		1	13i1;13i10;	1	456.00	7		00010		13i1;13i10;
H1290	082	0	1	01	01	H1290_082_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								2497	2242															2			13i1;13i10;		1	13i1;13i10;	1	455.00	7		00010		13i1;13i10;
H1290	083	0	1	01	01	H1290_083_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								611	548															2			13i1;13i10;		1	13i1;13i10;	1	456.00	7		00010		13i1;13i10;
H1290	084	0	1	01	01	H1290_084_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											371	333															2			13i1;13i10;		1	13i1;13i10;	1	492.00	7		00010		13i1;13i10;
H1290	085	0	1	01	01	H1290_085_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											1597	1434															2			13i1;13i10;		1	13i1;13i10;	1	490.00	7		00010		13i1;13i10;
H1290	086	0	1	01	01	H1290_086_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											768	690															2			13i1;13i10;		1	13i1;13i10;	1	493.00	7		00010		13i1;13i10;
H1290	087	0	1	01	01	H1290_087_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											3332	2992															2			13i1;13i10;		1	13i1;13i10;	1	490.00	7		00010		13i1;13i10;
H1290	088	0	1	01	01	H1290_088_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											1838	1651															2			13i1;13i10;		1	13i1;13i10;	1	490.00	7		00010		13i1;13i10;
H1290	089	0	1	01	01	H1290_089_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											3028	2719															2			13i1;13i10;		1	13i1;13i10;	1	490.00	7		00010		13i1;13i10;
H1290	090	0	1	01	01	H1290_090_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											468	420															2			13i1;13i10;		1	13i1;13i10;	1	490.00	7		00010		13i1;13i10;
H1290	091	0	1	01	01	H1290_091_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											435	391															2			13i1;13i10;		1	13i1;13i10;	1	489.00	7		00010		13i1;13i10;
H1290	096	0	1	01	01	H1290_096_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								106	96															2			13i1;13i10;		1	13i1;13i10;	1	456.00	7		00010		13i1;13i10;
H1290	098	0	1	01	01	H1290_098_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								476	428															2			13i1;13i10;		1	13i1;13i10;	1	456.00	7		00010		13i1;13i10;
H1290	100	0	1	01	01	H1290_100_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								144	130															2			13i1;13i10;		1	13i1;13i10;	1	456.00	7		00010		13i1;13i10;
H1290	101	0	1	01	01	H1290_101_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								144	129															2			13i1;13i10;		1	13i1;13i10;	1	456.00	7		00010		13i1;13i10;
H1290	103	0	1	01	01	H1290_103_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								128	115															2			13i1;13i10;		1	13i1;13i10;	1	456.00	7		00010		13i1;13i10;
H1290	104	0	1	01	01	H1290_104_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								42	38															2			13i1;13i10;		1	13i1;13i10;	1	369.00	7		00010		13i1;13i10;
H1304	803	0	1	04	01	H1304_803_0	3	1	2	Routine Podiatry														0100000000000000000														2			7f_2;	1	1	7f_2;	2						
H1304	804	0	1	04	01	H1304_804_0	3	1	2	Routine Podiatry														0100000000000000000														2			7f_2;	1	1	7f_2;	2						
H1360	001	0	1	02	01	H1360_001_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1458	1239															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1360	002	0	1	02	01	H1360_002_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								36	31															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1360	003	0	1	02	01	H1360_003_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								121	103															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1365	006	0	1	04	01	H1365_006_0	6	1	3	Meals	00000100001000000000000000000000											171	3															2			13i2;	1	2		2						
H1365	006	0	1	04	01	H1365_006_0	6	2	2	Bathroom Safety														0000000000110000000	History of Falls	Hip Fracture									2	2		2			14c8;	1	2		1	200.00	3		00001		14c8;
H1365	007	0	1	04	01	H1365_007_0	5	2	2	Home and Bathroom Safety														0000000000110000000	History of Falls	Hip Fracture									2	2		2			14c8;	1	2		1	200.00	3		00001		14c8;
H1365	007	0	1	04	01	H1365_007_0	5	1	3	Meals	00000100001000000000000000000000											35	1															2			13i2;	1	2		2						
H1372	001	0	1	01	01	H1372_001_0	5	1	3	Food and Grocery, Hygiene	01111111111111111111111000000000											757	681															2			13i1;13i-O1;		1	13i1;13i-O1;	1	0.00	5		00010		13i1;13i-O1;
H1372	002	0	1	01	01	H1372_002_0	5	1	3	Hygiene	01111111111111111111111111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								279	98															2			13i-O1;		2		1	0.00	5		00010		13i-O1;
H1372	003	0	1	01	01	H1372_003_0	5	1	3	Food and Produce, Hygiene	00001101000000000000000000000000											22	20															2			13i1;13i-O1;		1	13i1;13i-O1;	1	0.00	7		00010		13i1;13i-O1;
H1390	003	0	1	04	01	H1390_003_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											139	125															2			13i1;13i10;	1	1	13i1;13i10;	1	353.00	7		00010		13i1;13i10;
H1390	004	0	1	04	01	H1390_004_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											371	333															2			13i1;13i10;	1	1	13i1;13i10;	1	142.00	7		00010		13i1;13i10;
H1396	001	0	1	01	01	H1396_001_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									34702	34702															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1396	001	0	1	01	01	H1396_001_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H1416	044	0	1	02	01	H1416_044_0	6	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										2480	2356															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H1416	081	0	1	02	01	H1416_081_0	6	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										1197	1135															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H1416	087	1	1	02	01	H1416_087_1	6	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										792	753															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H1416	087	2	1	02	01	H1416_087_2	6	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										1700	1615															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H1416	087	3	1	02	01	H1416_087_3	6	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										242	230															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H1423	001	0	1	02	01	H1423_001_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							509	253															2			13i1;13i10;	2	2		2						
H1423	002	0	1	02	01	H1423_002_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							1192	545															2			13i1;13i10;	2	2		2						
H1423	004	0	1	02	01	H1423_004_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							509	140															2			13i1;13i10;	2	2		2						
H1423	009	0	1	02	01	H1423_009_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							324	110															2			13i1;13i10;	2	2		2						
H1468	007	0	1	01	01	H1468_007_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1468	013	0	1	01	01	H1468_013_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1468	017	0	1	01	01	H1468_017_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1468	017	0	1	01	01	H1468_017_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1468	017	0	1	01	01	H1468_017_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									11955	11955															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1468	021	0	1	01	01	H1468_021_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1526	001	0	1	02	01	H1526_001_0	7	1	3	Chronic Illness Package	00001101000000000000000000000000											1779	1423															1	011		13b;13i1;13i10;	2	1	13b;13i1;13i10;	1	75.00	5		01010		13b;13i10;
H1526	002	0	1	02	01	H1526_002_0	8	1	3	Chronic Illness Package	00001101000000000000000000000000											84	67															1	011		13b;13i1;13i10;	2	1	13b;13i1;13i10;	1	100.00	5		01010		13b;13i10;
H1526	003	0	1	02	01	H1526_003_0	6	1	3	CKD Package	00000000001000000000000000000000											315	252															1	011		13b;13d;13i1;13i10;	2	1	13b;13d;13i1;13i10;	1	100.00	5		01010		13b;13i10;
H1526	003	0	1	02	01	H1526_003_0	6	2	2	ESRD Support Package														0000000000100000000	End Stage Renal Disease													1	011		10b1;14c21;	2	2		2						
H1526	004	0	1	02	01	H1526_004_0	6	1	3	CKD Package	00000000001000000000000000000000											33	26															1	011		13b;13d;13i1;13i10;	2	1	13b;13d;13i1;13i10;	1	100.00	5		01010		13b;13i10;
H1526	004	0	1	02	01	H1526_004_0	6	2	2	ESRD Support Package														0000000000100000000	End Stage Renal Disease													1	011		10b1;14c21;	2	2		2						
H1526	009	0	1	02	01	H1526_009_0	6	2	2	ESRD Support Package														0000000000100000000	End Stage Renal Disease													1	011		10b1;14c21;	2	2		2						
H1526	009	0	1	02	01	H1526_009_0	6	1	3	CKD Package	00000000001000000000000000000000											39	31															1	011		13b;13d;13i1;13i10;	2	1	13b;13i1;13i10;	1	100.00	5		01010		13b;13i10;
H1526	010	0	1	02	01	H1526_010_0	5	4	2	ESRD Vision														0000000000100000000	End-Stage Renal Disease													1	011		17a1;17b1;17b2;17b3;17b4;	2	2		1	300.00	3		00100		17a1;17b1;17b2;17b3;17b4;
H1526	010	0	1	02	01	H1526_010_0	5	2	2	ESRD Support Package														0000000000100000000	End Stage Renal Disease													1	011		10b1;14c21;	2	2		2						
H1526	010	0	1	02	01	H1526_010_0	5	5	2	ESRD Hearing														0000000000100000000	End-Stage Renal Disease													1	011		18a1;18a2;18b1;	2	2		2						
H1526	010	0	1	02	01	H1526_010_0	5	3	2	ESRD Dental														0000000000100000000	End-Stage Renal Disease													1	011		16b1;16b2;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c8;16c10;	2	2		1	3000.00	3		00100		16b1;16b2;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c8;16c10;
H1526	010	0	1	02	01	H1526_010_0	5	1	3	CKD Package	00000000001000000000000000000000											10	8															1	011		13b;13d;13i1;13i10;	2	1	13b;13d;13i1;13i10;	1	100.00	5		01010		13b;13i10;
H1526	011	0	1	02	01	H1526_011_0	5	2	2	ESRD Support Package														0000000000100000000	End Stage Renal Disease													1	011		10b1;14c21;	2	2		2						
H1526	011	0	1	02	01	H1526_011_0	5	4	2	ESRD Vision														0000000000100000000	End-Stage Renal Disease													1	011		17a1;17b1;17b2;17b3;17b4;	2	2		1	300.00	3		00100		17a1;17b1;17b2;17b3;17b4;
H1526	011	0	1	02	01	H1526_011_0	5	3	2	ESRD Dental														0000000000100000000	End-Stage Renal Disease													1	011		16b1;16b2;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c8;16c10;	2	2		1	3000.00	3		00100		16b1;16b2;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c8;16c10;
H1526	011	0	1	02	01	H1526_011_0	5	1	3	CKD Package	00000000001000000000000000000000											10	8															1	011		13b;13d;13i1;13i10;	2	1	13b;13d;13i1;13i10;	1	100.00	5		01010		13b;13i10;
H1526	011	0	1	02	01	H1526_011_0	5	5	2	ESRD Hearing														0000000000100000000	End-Stage Renal Disease													1	011		18a1;18a2;18b1;	2	2		2						
H1526	012	0	1	02	01	H1526_012_0	5	1	3	Chronic Illness Package	00001101000000000000000000000000											55	44															1	011		13b;13i1;13i10;	2	1	13b;13i1;13i10;	1	100.00	5		01010		13b;13i10;
H1526	013	0	1	02	01	H1526_013_0	5	1	3	Chronic Illness Package	00001101000000000000000000000000											53	42															1	011		13b;13i1;13i10;	2	1	13b;13i1;13i10;	1	100.00	5		01010		13b;13i10;
H1587	001	0	1	01	01	H1587_001_0	9	1	3	Health Choices Produce and Food Plus Utility	01111111000111111000000000000000											260	208															1	001		13i1;13i10;		2		1	370.00	7		00010		13i1;13i10;
H1608	021	0	1	04	01	H1608_021_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							2687	1905															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1608	027	0	1	04	01	H1608_027_0	5	1	3	SSBCI Pkg	00000100000000000000000000000000											377	325															1	001		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	75.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1608	027	0	1	04	01	H1608_027_0	5	3	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	1	1	14c21;	2						
H1608	027	0	1	04	01	H1608_027_0	5	2	2	Healthy Heart (CHF)														0000000000100000000	Chronic heart failure													1	001		13b;13c;14c8;	1	1	13b;13c;14c8;	2						
H1608	029	0	1	04	01	H1608_029_0	4	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	1	1	14c21;	2						
H1608	062	0	1	04	01	H1608_062_0	5	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							161	156															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1608	121	0	1	04	01	H1608_121_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							126	124															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1608	801	0	1	04	01	H1608_801_0	2	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H1608	801	0	1	04	01	H1608_801_0	2	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H1609	018	0	1	01	01	H1609_018_0	4	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	020	0	1	01	01	H1609_020_0	4	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	021	0	1	01	01	H1609_021_0	4	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	025	0	1	01	01	H1609_025_0	4	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	027	0	1	01	01	H1609_027_0	4	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	028	0	1	02	01	H1609_028_0	4	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	2	1	14c21;	2						
H1609	041	0	1	01	01	H1609_041_0	4	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	043	0	1	01	01	H1609_043_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	043	0	1	01	01	H1609_043_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1853	1846															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	044	0	1	01	01	H1609_044_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							760	756															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	044	0	1	01	01	H1609_044_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	045	0	1	01	01	H1609_045_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	045	0	1	01	01	H1609_045_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1052	1040															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	046	0	1	01	01	H1609_046_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							662	651															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	046	0	1	01	01	H1609_046_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	047	0	1	01	01	H1609_047_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							639	631															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	047	0	1	01	01	H1609_047_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	048	0	1	01	01	H1609_048_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	048	0	1	01	01	H1609_048_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							422	422															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	055	0	1	01	01	H1609_055_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	055	0	1	01	01	H1609_055_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							180	178															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	056	0	1	01	01	H1609_056_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							794	785															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	056	0	1	01	01	H1609_056_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	059	0	1	01	01	H1609_059_0	4	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	062	0	1	01	01	H1609_062_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	062	0	1	01	01	H1609_062_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							335	329															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	063	0	1	01	01	H1609_063_0	4	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	064	0	1	01	01	H1609_064_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							149	147															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	064	0	1	01	01	H1609_064_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	068	0	1	02	01	H1609_068_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							5887	4474															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	75.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	073	0	1	01	01	H1609_073_0	5	3	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	073	0	1	01	01	H1609_073_0	5	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							5288	5288															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	073	0	1	01	01	H1609_073_0	5	2	2	In-Home Support-Personal Care Services														0000000000100000000	Individuals with significant functional challenges from neuro, musculoskeletal & sensory impairments													1	001		14c21;		1	14c21;	2						
H1609	074	0	1	01	01	H1609_074_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							698	698															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	074	0	1	01	01	H1609_074_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	075	0	1	01	01	H1609_075_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	075	0	1	01	01	H1609_075_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							448	448															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	077	0	1	01	01	H1609_077_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	077	0	1	01	01	H1609_077_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							108	108															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	078	0	1	01	01	H1609_078_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	078	0	1	01	01	H1609_078_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							795	795															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	079	0	1	01	01	H1609_079_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	079	0	1	01	01	H1609_079_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							96	96															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	080	0	1	01	01	H1609_080_0	4	1	3	SSBCI Pkg	00001101000000000000000000000000											1148	1097															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	080	0	1	01	01	H1609_080_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	081	0	1	01	01	H1609_081_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	081	0	1	01	01	H1609_081_0	4	1	3	SSBCI Pkg	00001101000000000000000000000000											369	365															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	082	0	1	01	01	H1609_082_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	082	0	1	01	01	H1609_082_0	4	1	3	SSBCI Pkg	00001101000000000000000000000000											677	646															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	084	0	1	01	01	H1609_084_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	084	0	1	01	01	H1609_084_0	4	1	3	SSBCI Pkg	00001101000000000000000000000000											914	876															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	085	0	1	01	01	H1609_085_0	4	1	3	SSBCI Pkg	00001101000000000000000000000000											476	446															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	085	0	1	01	01	H1609_085_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	086	0	1	01	01	H1609_086_0	4	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	087	0	1	01	01	H1609_087_0	4	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	088	0	1	01	01	H1609_088_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	088	0	1	01	01	H1609_088_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1386	1386															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	089	0	1	01	01	H1609_089_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	089	0	1	01	01	H1609_089_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							717	717															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	090	0	1	01	01	H1609_090_0	5	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1477	1477															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	090	0	1	01	01	H1609_090_0	5	2	2	In-Home Support-Personal Care Services														0000000000100000000	Individuals with significant functional challenges from neuro, musculoskeletal & sensory impairments													1	001		14c21;		1	14c21;	2						
H1609	090	0	1	01	01	H1609_090_0	5	3	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	092	0	1	01	01	H1609_092_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							464	464															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	092	0	1	01	01	H1609_092_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	093	0	1	01	01	H1609_093_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							3000	2112															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	55.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	093	0	1	01	01	H1609_093_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	094	0	1	01	01	H1609_094_0	4	1	3	SSBCI Pkg	00001101000000000000000000000000											727	693															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	094	0	1	01	01	H1609_094_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	098	0	1	01	01	H1609_098_0	4	1	3	SSBCI Pkg	00001101000000000000000000000000											715	683															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	098	0	1	01	01	H1609_098_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	099	0	1	01	01	H1609_099_0	4	1	3	SSBCI Pkg	00001101000000000000000000000000											724	710															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	099	0	1	01	01	H1609_099_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	100	0	1	01	01	H1609_100_0	4	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	101	0	1	01	01	H1609_101_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	101	0	1	01	01	H1609_101_0	4	1	3	SSBCI Pkg	00001101000000000000000000000000											129	120															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	102	0	1	01	01	H1609_102_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	102	0	1	01	01	H1609_102_0	4	1	3	SSBCI Pkg	00001101000000000000000000000000											166	155															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	103	0	1	01	01	H1609_103_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							4829	4715															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	103	0	1	01	01	H1609_103_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	104	0	1	01	01	H1609_104_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	104	0	1	01	01	H1609_104_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1305	1294															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	105	0	1	01	01	H1609_105_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1609	105	0	1	01	01	H1609_105_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1681	1656															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1609	801	0	1	01	01	H1609_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H1609	801	0	1	01	01	H1609_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H1609	807	0	1	01	01	H1609_807_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H1609	807	0	1	01	01	H1609_807_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H1609	810	0	1	01	01	H1609_810_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H1609	810	0	1	01	01	H1609_810_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H1610	001	0	1	01	01	H1610_001_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							10675	10675															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1644	001	0	1	01	01	H1644_001_0	6	1	3	SSBCI	01111111111111111111111000000000											871	580															2			13i6;13i-O1;13i-O2;14c17;		2		1	500.00	5		01100		13i6;13i-O1;13i-O2;
H1664	005	0	1	02	01	H1664_005_0	6	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										192	182															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H1671	001	0	1	01	01	H1671_001_0	11	1	3	SSBCI Package 1	01111111011111111000000000000000											400	250															1	001		13i1;13i4;		1	13i1;13i4;	2						
H1692	002	0	1	01	01	H1692_002_0	3	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H1692	005	0	1	01	01	H1692_005_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							5183	5132															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1692	005	0	1	01	01	H1692_005_0	3	2	2	In-Home Support-Personal Care Services														0000000000100000000	Individuals with significant functional challenges from neuro, musculoskeletal & sensory impairments													1	001		14c21;		1	14c21;	2						
H1692	006	0	1	01	01	H1692_006_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1154	818															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1692	010	0	1	01	01	H1692_010_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							4756	4648															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1692	011	0	1	01	01	H1692_011_0	3	2	2	In-Home Support-Personal Care Services														0000000000100000000	Individuals with significant functional challenges from neuro, musculoskeletal & sensory impairments													1	001		14c21;		1	14c21;	2						
H1692	011	0	1	01	01	H1692_011_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							494	490															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H1692	801	0	1	01	01	H1692_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H1692	801	0	1	01	01	H1692_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H1799	003	1	1	01	01	H1799_003_1	6	1	3	SSBCI	01111111111111111111111000000000											664	598															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H1799	003	2	1	01	01	H1799_003_2	5	1	3	SSBCI	01111111111111111111111000000000											335	302															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H1799	003	3	1	01	01	H1799_003_3	6	1	3	SSBCI	01111111111111111111111000000000											290	261															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H1822	002	0	1	01	01	H1822_002_0	10	1	3	Food, Non-medical Transportation, and Utilities	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						3673	2020															2			13i1;13i4;13i10;		2		1	0.00	7		00111		13i1;13i10;
H1822	005	0	1	02	01	H1822_005_0	10	1	3	Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						1097	603															2			13i4;	2	2		2						
H1822	008	0	1	02	01	H1822_008_0	10	1	3	Food and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						44	24															2			13i1;13i4;	2	2		2						
H1822	009	0	1	01	01	H1822_009_0	9	1	3	Food and Non-medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						3757	2066															2			13i1;13i4;		2		2						
H1822	010	0	1	01	01	H1822_010_0	9	1	3	Food and Non-medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						791	435															2			13i1;13i4;		2		2						
H1822	011	0	1	02	01	H1822_011_0	10	1	3	OTC-Food-Utilities-Transport-Meals	00000000001000000100000000000000											39	21															2			10b1;13b;13c;13i1;13i10;	2	1	10b1;13b;13c;13i1;13i10;	1	86.00	7		01010		13b;13i1;13i10;
H1823	001	0	1	04	01	H1823_001_0	11	1	3	SSBCI	01111111111111111111111000000000											550	110															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	5		00011		13i1;13i10;
H1823	002	0	1	04	01	H1823_002_0	11	1	3	SSBCI	01111111111111111111111000000000											573	116															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00110		13i1;13i10;
H1823	003	0	1	04	01	H1823_003_0	11	1	3	SSBCI	01111111111111111111111000000000											123	80															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	5		00011		13i1;13i10;
H1862	003	0	1	02	01	H1862_003_0	6	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										1253	1163															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H1862	004	0	1	02	01	H1862_004_0	6	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										162	148															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H1862	006	0	1	02	01	H1862_006_0	7	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										586	536															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H1889	002	1	1	04	01	H1889_002_1	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								20378	17321															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1889	002	2	1	04	01	H1889_002_2	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								5228	4444															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1889	005	0	1	04	01	H1889_005_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								12155	10332															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1889	007	0	1	04	01	H1889_007_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								3568	3032															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1889	008	0	1	04	01	H1889_008_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1142	970															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1889	009	0	1	04	01	H1889_009_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								10721	9113															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1889	010	0	1	04	01	H1889_010_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1230	1046															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1889	012	0	1	04	01	H1889_012_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								2104	1789															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1889	019	0	1	04	01	H1889_019_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											11536	9805															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
H1889	020	0	1	04	01	H1889_020_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											17223	14640															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
H1889	025	0	1	04	01	H1889_025_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											13708	11652															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
H1889	026	0	1	04	01	H1889_026_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								13887	11804															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1889	028	0	1	04	01	H1889_028_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											14165	12040															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
H1889	030	0	1	04	01	H1889_030_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								285	242															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1889	031	0	1	04	01	H1889_031_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1725	1466															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1889	034	0	1	04	01	H1889_034_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								2461	2092															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1889	035	0	1	04	01	H1889_035_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								2696	2292															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1889	043	0	1	04	01	H1889_043_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								127	108															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1889	044	1	1	04	01	H1889_044_1	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								7286	6193															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1889	044	2	1	04	01	H1889_044_2	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								5332	4532															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1889	045	1	1	04	01	H1889_045_1	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								5759	4895															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1889	045	2	1	04	01	H1889_045_2	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								6335	5385															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1914	008	0	1	04	01	H1914_008_0	5	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										201	186															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H1947	003	0	1	01	01	H1947_003_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							119	107															2			13i1;13i10;		2		2						
H1947	004	0	1	01	01	H1947_004_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							3118	2853															2			13i1;13i10;		2		2						
H1951	013	0	1	01	01	H1951_013_0	6	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1951	013	0	1	01	01	H1951_013_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1951	024	0	1	01	01	H1951_024_0	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1951	028	0	1	01	01	H1951_028_0	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1951	032	0	1	01	01	H1951_032_0	5	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									6227	6227															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1951	032	0	1	01	01	H1951_032_0	5	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H1951	032	0	1	01	01	H1951_032_0	5	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H1951	038	0	1	01	01	H1951_038_0	7	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1951	039	0	1	01	01	H1951_039_0	7	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1951	041	0	1	01	01	H1951_041_0	5	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H1951	041	0	1	01	01	H1951_041_0	5	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									4458	4458															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1951	041	0	1	01	01	H1951_041_0	5	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H1951	044	0	1	01	01	H1951_044_0	6	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1951	044	0	1	01	01	H1951_044_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1951	047	1	1	01	01	H1951_047_1	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1951	047	2	1	01	01	H1951_047_2	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1951	048	1	1	01	01	H1951_048_1	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1951	048	2	1	01	01	H1951_048_2	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1951	049	1	1	01	01	H1951_049_1	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1951	049	2	1	01	01	H1951_049_2	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1951	049	3	1	01	01	H1951_049_3	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1951	051	0	1	01	01	H1951_051_0	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1951	052	0	1	01	01	H1951_052_0	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1951	053	0	1	01	01	H1951_053_0	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1951	056	0	1	01	01	H1951_056_0	5	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1951	056	0	1	01	01	H1951_056_0	5	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1951	056	0	1	01	01	H1951_056_0	5	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									14795	14795															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1951	057	0	1	01	01	H1951_057_0	5	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									8821	8821															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1951	057	0	1	01	01	H1951_057_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H1951	059	0	1	01	01	H1951_059_0	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1951	060	0	1	01	01	H1951_060_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H1951	060	0	1	01	01	H1951_060_0	6	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H1951	061	0	1	01	01	H1951_061_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H1951	061	0	1	01	01	H1951_061_0	6	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									38293	38293															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H1951	062	0	1	01	01	H1951_062_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H1951	062	0	1	01	01	H1951_062_0	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H1961	014	1	1	02	01	H1961_014_1	7	1	2	MAUF Package 1														0000000001000000000														2			14c22;	2	1	14c22;	2						
H1961	014	2	1	02	01	H1961_014_2	7	1	2	MAUF Package 1														0000000001000000000														2			14c22;	2	1	14c22;	2						
H1961	014	3	1	02	01	H1961_014_3	5	1	2	MAUF Package 1														0000000001000000000														2			14c22;	2	1	14c22;	2						
H1961	017	0	1	02	01	H1961_017_0	6	1	2	MAUF Package 1														0000000001000000000														2			14c22;	2	1	14c22;	2						
H1961	020	0	1	02	01	H1961_020_0	6	1	2	MAUF Package 1														0000000001000000000														2			14c22;	2	1	14c22;	2						
H1961	022	0	1	02	01	H1961_022_0	7	1	3	SSBCI Package 1	00001101000000000000000000000000											11359	9655															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H1961	022	0	1	02	01	H1961_022_0	7	2	2	MAUF Package 1														0000000001000000000														2			14c22;	2	1	14c22;	2						
H1961	023	0	1	02	01	H1961_023_0	7	2	2	MAUF Package 1														0000000001000000000														2			14c22;	2	1	14c22;	2						
H1961	023	0	1	02	01	H1961_023_0	7	1	3	SSBCI Package 1	00001101000000000000000000000000											8504	7228															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H1961	026	0	1	02	01	H1961_026_0	4	1	2	MAUF Package 1														0000000001000000000														2			14c22;	2	1	14c22;	2						
H1961	028	0	1	02	01	H1961_028_0	5	1	2	MAUF Package 1														0000000001000000000														2			14c22;	2	1	14c22;	2						
H1961	029	1	1	02	01	H1961_029_1	5	1	3	SSBCI Package 1	00001101000000000000000000000000											126	107															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H1961	029	1	1	02	01	H1961_029_1	5	2	2	MAUF Package 1														0000000001000000000														2			14c22;	2	1	14c22;	2						
H1961	029	2	1	02	01	H1961_029_2	5	2	2	MAUF Package 1														0000000001000000000														2			14c22;	2	1	14c22;	2						
H1961	029	2	1	02	01	H1961_029_2	5	1	3	SSBCI Package 1	00001101000000000000000000000000											126	107															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H1961	030	1	1	02	01	H1961_030_1	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								7750	6588															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1961	030	1	1	02	01	H1961_030_1	5	2	2	MAUF Package 1														0000000001000000000														2			14c22;	2	1	14c22;	2						
H1961	030	2	1	02	01	H1961_030_2	5	2	2	MAUF Package 1														0000000001000000000														2			14c22;	2	1	14c22;	2						
H1961	030	2	1	02	01	H1961_030_2	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								10981	9334															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1961	031	1	1	02	01	H1961_031_1	5	2	2	MAUF Package 1														0000000001000000000														2			14c22;	2	1	14c22;	2						
H1961	031	1	1	02	01	H1961_031_1	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								8208	6977															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1961	031	2	1	02	01	H1961_031_2	5	2	2	MAUF Package 1														0000000001000000000														2			14c22;	2	1	14c22;	2						
H1961	031	2	1	02	01	H1961_031_2	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								10079	8567															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1961	032	1	1	02	01	H1961_032_1	5	2	2	MAUF Package 1														0000000001000000000														2			14c22;	2	1	14c22;	2						
H1961	032	1	1	02	01	H1961_032_1	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								7541	6409															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1961	032	2	1	02	01	H1961_032_2	5	2	2	MAUF Package 1														0000000001000000000														2			14c22;	2	1	14c22;	2						
H1961	032	2	1	02	01	H1961_032_2	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								11126	9457															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H1961	033	1	1	02	01	H1961_033_1	6	2	2	MAUF Package 1														0000000001000000000														2			14c22;	2	1	14c22;	2						
H1961	033	1	1	02	01	H1961_033_1	6	1	3	SSBCI Package 1	00001101000000000000000000000000											2682	2279															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H1961	033	2	1	02	01	H1961_033_2	6	1	3	SSBCI Package 1	00001101000000000000000000000000											1473	1252															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H1961	033	2	1	02	01	H1961_033_2	6	2	2	MAUF Package 1														0000000001000000000														2			14c22;	2	1	14c22;	2						
H1969	805	0	1	01	01	H1969_805_0	3	1	2	Routine Podiatry														0100000000000000000														2			7f_2;		1	7f_2;	2						
H1993	007	0	1	01	01	H1993_007_0	7	1	3	SSBCI - Food	00001101000000000000000000000000											9240	9240															2			13i1;		1	13i1;	1	0.00	7		00011		13i1;
H1993	008	0	1	01	01	H1993_008_0	7	1	3	SSBCI - Food	00001101000000000000000000000000											10718	10718															2			13i1;		1	13i1;	1	0.00	7		00011		13i1;
H1993	013	0	1	01	01	H1993_013_0	8	1	3	SSBCI - Food	00001101000000000000000000000000											442	442															2			13i1;		1	13i1;	1	0.00	7		00011		13i1;
H1993	019	0	1	01	01	H1993_019_0	7	1	3	SSBCI - Food	00000000001000000000000000000000											363	363															2			13i1;		1	13i1;	1	0.00	7		00011		13i1;
H1993	020	0	1	01	01	H1993_020_0	7	1	3	SSBCI - Food	00000000000001000000000000000000											363	363															2			13i1;		1	13i1;	1	0.00	7		00010		13i1;
H1994	015	0	1	01	01	H1994_015_0	8	1	3	Food & Produce Benefit	01111111111111111000000111100000	Chronic Hypertension	Chronic Malnutrition	Chronic Musculoskeletal disorders	Chronic Hyperlipidemia							1400	1100															2			13i1;		2		1	300.00	5		01011		13i1;
H1997	014	0	1	01	01	H1997_014_0	6	1	2	Routine Podiatry														0100000000000000000														2			7f_2;		2		2						
H2001	030	0	1	04	01	H2001_030_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								5292	4498															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	031	0	1	04	01	H2001_031_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								7673	6522															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	032	0	1	04	01	H2001_032_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								25536	21705															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	034	0	1	04	01	H2001_034_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								17294	14700															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	035	0	1	04	01	H2001_035_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								4158	3534															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	036	0	1	04	01	H2001_036_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											2189	1861															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
H2001	037	0	1	04	01	H2001_037_0	6	1	3	SSBCI Package 1	00001101000000000000000000000000											7861	6682															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
H2001	038	0	1	04	01	H2001_038_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											40171	34146															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
H2001	039	0	1	04	01	H2001_039_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								309	262															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	040	0	1	04	01	H2001_040_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								3034	2578															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	041	0	1	04	01	H2001_041_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								887	754															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	042	0	1	04	01	H2001_042_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											563	478															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
H2001	043	0	1	04	01	H2001_043_0	6	1	3	SSBCI Package 1	00001101000000000000000000000000											1083	920															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
H2001	044	0	1	04	01	H2001_044_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											938	797															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
H2001	045	0	1	04	01	H2001_045_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											12446	10579															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
H2001	046	0	1	04	01	H2001_046_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1248	1060															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	047	0	1	04	01	H2001_047_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								3335	2835															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	048	0	1	04	01	H2001_048_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1198	1018															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	050	0	1	04	01	H2001_050_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											2101	1786															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
H2001	051	0	1	04	01	H2001_051_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								2877	2445															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	052	0	1	04	01	H2001_052_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1605	1364															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	053	0	1	04	01	H2001_053_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								2047	1740															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	054	0	1	04	01	H2001_054_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								438	372															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	055	0	1	04	01	H2001_055_0	5	1	3	SSBCI Package 1	00001101000000000000000000000000											19281	16389															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
H2001	056	0	1	04	01	H2001_056_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								2594	2205															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	059	0	1	04	01	H2001_059_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								853	725															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	060	0	1	04	01	H2001_060_0	6	1	3	SSBCI Package 1	00001101000000000000000000000000											27843	23666															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
H2001	061	0	1	04	01	H2001_061_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1258	1069															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	062	0	1	04	01	H2001_062_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								29787	25319															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	063	1	1	04	01	H2001_063_1	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								6509	5533															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	063	2	1	04	01	H2001_063_2	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								2864	2434															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	065	0	1	04	01	H2001_065_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								17687	15034															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	066	0	1	04	01	H2001_066_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								8258	7019															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	068	1	1	04	01	H2001_068_1	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								4532	3852															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	068	2	1	04	01	H2001_068_2	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								3022	2569															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	069	1	1	04	01	H2001_069_1	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								4757	4043															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	069	2	1	04	01	H2001_069_2	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								4494	3820															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	070	0	1	04	01	H2001_070_0	5	1	3	SSBCI Package 1	00001101000000000000000000000000											1413	1201															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
H2001	075	0	1	04	01	H2001_075_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								17643	14997															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	076	0	1	04	01	H2001_076_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											15413	13101															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
H2001	077	0	1	04	01	H2001_077_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								2384	2026															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	078	0	1	04	01	H2001_078_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								5586	4748															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	079	0	1	04	01	H2001_079_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								8639	7343															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	080	0	1	04	01	H2001_080_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1463	1244															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	081	0	1	04	01	H2001_081_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								20382	17324															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	082	0	1	04	01	H2001_082_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								7394	6285															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	085	0	1	04	01	H2001_085_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1902	1616															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	133	0	1	04	01	H2001_133_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											1805	1534															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
H2001	134	0	1	04	01	H2001_134_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											1869	1588															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
H2001	135	0	1	04	01	H2001_135_0	6	1	3	SSBCI Package 1	00001101000000000000000000000000											439	373															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
H2001	141	0	1	04	01	H2001_141_0	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								4165	3540															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	142	0	1	04	01	H2001_142_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								123	104															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	143	0	1	04	01	H2001_143_0	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								811	689															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2001	144	0	1	04	01	H2001_144_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								123	104															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2041	007	0	1	01	01	H2041_007_0	4	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								1440	1293															2			13i1;13i10;		1	13i1;13i10;	1	292.00	7		00010		13i1;13i10;
H2041	008	0	1	01	01	H2041_008_0	4	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								1419	1274															2			13i1;13i10;		1	13i1;13i10;	1	118.00	7		00010		13i1;13i10;
H2041	011	0	1	01	01	H2041_011_0	4	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								2955	2654															2			13i1;13i10;		1	13i1;13i10;	1	317.00	7		00010		13i1;13i10;
H2041	012	0	1	01	01	H2041_012_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											25	23															2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H2041	013	0	1	01	01	H2041_013_0	3	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											324	291															2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H2041	014	0	1	01	01	H2041_014_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											1437	1290															2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H2041	015	0	1	01	01	H2041_015_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											302	271															2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H2041	016	0	1	01	01	H2041_016_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											1609	1445															2			13i1;13i10;		1	13i1;13i10;	1	369.00	7		00010		13i1;13i10;
H2041	027	0	1	01	01	H2041_027_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;		1	13i1;13i10;	1	167.00	7		00010		13i1;13i10;
H2056	801	0	1	01	01	H2056_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H2056	801	0	1	01	01	H2056_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H2056	802	0	1	01	01	H2056_802_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H2056	802	0	1	01	01	H2056_802_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H2056	804	0	1	01	01	H2056_804_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H2056	804	0	1	01	01	H2056_804_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H2108	029	0	1	01	01	H2108_029_0	6	1	3	Food and Produce	00001101000000000000000000000000											231	173															2			13i1;		2		2						
H2108	030	0	1	01	01	H2108_030_0	6	1	3	Food and Produce	00001101000000000000000000000000											1588	1191															2			13i1;		2		2						
H2108	041	0	1	01	01	H2108_041_0	6	1	3	Food and Produce	00001101000001001000000000000000											660	495															2			13i1;		2		2						
H2126	001	0	1	01	01	H2126_001_0	3	1	3	SSBCI - Food and Produce	01111111111111111111111000000000											18	17															2			13i1;		1	13i1;	2						
H2168	001	0	1	01	01	H2168_001_0	5	1	3	Package 1	01111111111111111111111100000000	Osteoporosis										2759	2345															1	001		13i1;13i3;13i4;13i5;13i10;		1	13i1;13i3;13i4;13i5;13i10;	1	0.00	7		00010		13i1;13i3;13i4;13i5;13i10;
H2168	002	0	1	01	01	H2168_002_0	5	1	3	Package 1	01111111111111111111111100000000	Osteoporosis										9466	8993															1	001		13i1;13i3;13i4;13i5;13i10;		1	13i1;13i3;13i4;13i5;13i10;	1	0.00	7		00010		13i1;13i3;13i4;13i5;13i10;
H2168	004	0	1	01	01	H2168_004_0	5	1	3	Package 1	01111111111111111111111100000000	Osteoporosis										414	352															1	001		13i1;13i3;13i4;13i5;13i10;		1	13i1;13i3;13i4;13i5;13i10;	1	0.00	7		00010		13i1;13i3;13i4;13i5;13i10;
H2172	001	0	1	02	01	H2172_001_0	6	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13f;	2	2		2						
H2172	002	0	1	02	01	H2172_002_0	7	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13f;	2	2		2						
H2172	005	0	1	01	01	H2172_005_0	5	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13f;		2		2						
H2172	008	0	1	02	01	H2172_008_0	6	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13f;	2	2		2						
H2172	009	0	1	02	01	H2172_009_0	6	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13f;	2	2		2						
H2172	010	0	1	02	01	H2172_010_0	6	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13f;	2	2		2						
H2172	013	0	1	02	01	H2172_013_0	6	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13f;	2	2		2						
H2172	014	0	1	02	01	H2172_014_0	5	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13f;	2	2		2						
H2172	016	0	1	01	01	H2172_016_0	7	2	3	Healthy Food Card	01111111111111111111111000000000											2748	2501															2			13i1;		2		2						
H2172	016	0	1	01	01	H2172_016_0	7	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13f;		2		2						
H2172	017	0	1	01	01	H2172_017_0	6	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13f;		2		2						
H2172	017	0	1	01	01	H2172_017_0	6	2	3	Healthy Food Card	01111111111111111111111000000000											1665	1515															2			13i1;		2		2						
H2172	018	0	1	01	01	H2172_018_0	6	2	3	Healthy Food Card	01111111111111111111111000000000											855	778															2			13i1;		2		2						
H2172	018	0	1	01	01	H2172_018_0	6	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13f;		2		2						
H2172	019	0	1	01	01	H2172_019_0	6	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13f;		2		2						
H2172	019	0	1	01	01	H2172_019_0	6	2	3	Healthy Food Card	01111111111111111111111000000000											855	778															2			13i1;		2		2						
H2172	020	0	1	02	01	H2172_020_0	6	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13f;	2	2		2						
H2172	021	0	1	02	01	H2172_021_0	6	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13f;	2	2		2						
H2172	022	0	1	02	01	H2172_022_0	6	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13f;	2	2		2						
H2172	023	0	1	02	01	H2172_023_0	6	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13f;	2	2		2						
H2172	024	0	1	02	01	H2172_024_0	6	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13f;	2	2		2						
H2172	025	0	1	01	01	H2172_025_0	6	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13f;		2		2						
H2172	026	0	1	01	01	H2172_026_0	6	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13f;		2		2						
H2172	027	0	1	02	01	H2172_027_0	6	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status.													2			13f;	2	2		2						
H2174	001	0	1	01	01	H2174_001_0	5	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										3200	2353															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H2185	001	0	1	01	01	H2185_001_0	7	1	3	Flex and Transportation Benefit	01111111111111111111111111000000	Osteoporosis	Chronic Hypertension	Chronic Hyperlipidemia								738	221															2			13i1;13i4;13i10;13i-O2;		1	13i1;13i4;13i10;13i-O2;	1	0.00	5		01010		13i10;13i-O2;
H2185	003	0	1	02	01	H2185_003_0	8	1	3	Flex Benefit	01111111111111111111111111000000	osteoporosis	chronic hypertension	chronic hyperlipidemia								44	13															2			13i4;13i6;13i10;13i-O2;	2	1	13i4;13i6;13i10;13i-O2;	1	0.00	5		01010		13i6;13i10;13i-O2;
H2224	001	0	1	01	01	H2224_001_0	7	1	3	SSBCI	01111111111111111111111000000000											2346	2111															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i10;
H2224	003	0	1	01	01	H2224_003_0	7	1	3	SSBCI	01111111111111111111111000000000											7337	6603															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i10;
H2225	001	0	1	01	01	H2225_001_0	5	1	3	Food + Utilities + Non-Medical Transportation	01111111111111111111111000000000											18512	15876															2			10b1;13i1;13i10;		1	10b1;13i1;13i10;	1	0.00	5		01010		13i1;13i10;
H2226	001	0	1	01	01	H2226_001_0	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								11561	9827															2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2226	003	0	1	01	01	H2226_003_0	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								7684	6532															2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2237	007	0	1	01	01	H2237_007_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H2247	001	0	1	02	01	H2247_001_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								573	487															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2247	003	0	1	02	01	H2247_003_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1839	1563															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2247	004	0	1	01	01	H2247_004_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								16560	14076															2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2247	006	1	1	01	01	H2247_006_1	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								9284	7891															2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2247	006	2	1	01	01	H2247_006_2	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								14328	12179															2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2272	001	0	1	02	01	H2272_001_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								875	743															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2272	003	0	1	02	01	H2272_003_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								8836	7511															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2293	001	0	1	04	01	H2293_001_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							7576	6571															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	125.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2293	002	0	1	04	01	H2293_002_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							15318	14864															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2293	004	0	1	04	01	H2293_004_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							4375	4152															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2293	009	0	1	04	01	H2293_009_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							2022	1786															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	150.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2293	021	0	1	04	01	H2293_021_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							5219	5059															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2293	023	0	1	04	01	H2293_023_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1379	1119															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	90.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2293	029	0	1	04	01	H2293_029_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							6612	4688															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2293	031	0	1	04	01	H2293_031_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							16985	12042															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2293	033	0	1	04	01	H2293_033_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1428	1237															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	90.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2320	033	1	1	02	01	H2320_033_1	3	1	3	OTC Plus	01111111111111111111111111000000	Chronic Hypertension	Osteoporosis	Chronic Low Back Pain								1570	471															2			13i1;	2	1	13i1;	1	0.00	5		01011		13i1;
H2320	033	2	1	02	01	H2320_033_2	3	1	3	OTC Plus	01111111111111111111111111000000	Chronic Hypertension	Osteoporosis	Chronic Low Back Pain								139	42															2			13i1;	2	1	13i1;	1	0.00	5		01011		13i1;
H2320	033	5	1	02	01	H2320_033_5	3	1	3	OTC Plus	01111111111111111111111111000000	Chronic Hypertension	Osteoporosis	Chronic Low Back Pain								828	248															2			13i1;	2	1	13i1;	1	0.00	5		01011		13i1;
H2320	034	3	1	02	01	H2320_034_3	6	1	3	OTC Plus	01111111111111111111111111000000	Chronic Hypertension	Osteoporosis	Chronic low back pain								32066	9620															2			13i1;	2	1	13i1;	1	0.00	5		01011		13i1;
H2320	034	4	1	02	01	H2320_034_4	6	1	3	OTC Plus	01111111111111111111111111000000	Chronic Hypertension	Osteoporosis	Chronic low back pain								13249	3975															2			13i1;	2	1	13i1;	1	0.00	5		01011		13i1;
H2322	020	0	1	04	01	H2322_020_0	7	1	3	Flex Card	01111111011111111000000000000000											615	615															2			13i1;13i3;13i4;13i9;13i10;	1	1	13i1;13i3;13i4;13i9;13i10;	1	0.00	7		01010		13i1;13i3;13i4;13i9;13i10;
H2354	025	0	1	01	01	H2354_025_0	7	1	3	Flex Card	01111111011111111000000000000000											1710	1710															2			13i1;13i3;13i4;13i9;13i10;		2		1	0.00	7		01010		13i1;13i3;13i4;13i9;13i10;
H2354	030	0	1	01	01	H2354_030_0	7	1	3	Food and Produce	01111111011111111000000000000000											2055	2055															2			13i1;		1	13i1;	2						
H2385	001	0	1	04	01	H2385_001_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								7679	6527															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2385	002	0	1	04	01	H2385_002_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								10788	9170															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2385	003	0	1	04	01	H2385_003_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								14602	12412															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2385	004	0	1	04	01	H2385_004_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								9302	7906															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2392	003	0	1	01	01	H2392_003_0	5	1	3	Healthy Food	01111111011111111111111000000000											210	175															1	001		13i1;		1	13i1;	2						
H2400	001	0	1	01	01	H2400_001_0	3	1	3	SSBCI Package	01111111111111111111111000000000											1216	486															2			13i1;13i6;13i-O1;		2		2						
H2400	002	0	1	01	01	H2400_002_0	3	1	3	SSBCI Package	01111111111111111111111000000000											102	41															2			13i1;13i6;13i-O1;		2		2						
H2406	050	0	1	04	01	H2406_050_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1943	1651															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2406	053	0	1	04	01	H2406_053_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								7023	5970															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2406	099	0	1	04	01	H2406_099_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								5589	4750															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2406	142	0	1	04	01	H2406_142_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								121	103															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
H2406	144	0	1	04	01	H2406_144_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								119	101															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
H2416	001	0	1	01	01	H2416_001_0	9	1	3	MSHO SSBCI	01111111111111111111111000000000											4580	3660															2			13i1;13i6;		1	13i1;13i6;	2						
H2417	001	0	1	01	01	H2417_001_0	6	1	3	Healthy Foods	01111111111111111111111000000000											375	300															2			13i1;		1	13i1;	2						
H2419	001	0	1	01	01	H2419_001_0	7	1	3	SeniorCare Complete Healthy Foods	01111111011111111000000000000000											250	200															2			13i1;		1	13i1;	1	50.00	5		00011		13i1;
H2422	002	0	1	01	01	H2422_002_0	7	1	3	MSHO SSBCI Benefits	01111111111111111001000100000000	Chronic Liver disease or cirrhosis										5340	3738															1	001		13i1;13i6;13i10;14c22;		2		2						
H2425	001	0	1	01	01	H2425_001_0	7	1	3	SSBCI	01111111011011111001000110000000	chronic pain syndrom	chronic liver disease									10000	7400															2			13i1;13i4;13i6;13i10;		1	13i1;13i4;13i6;13i10;	1	250.00	5		01010		13i1;13i10;
H2441	001	0	1	04	01	H2441_001_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							915	443															2			13i1;	1	2		2						
H2445	001	0	1	02	01	H2445_001_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								6129	5209															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2445	002	0	1	02	01	H2445_002_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								7818	6645															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2445	003	0	1	02	01	H2445_003_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								22697	19292															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2445	004	0	1	02	01	H2445_004_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								5484	4662															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2458	002	0	1	01	01	H2458_002_0	3	1	3	Flex Part C	00001001000000100000000000000000											17405	13875															2			13i1;13i10;		2		1	0.00	7		00010		13i1;13i10;
H2463	001	0	1	01	01	H2463_001_0	7	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H2486	003	0	1	01	01	H2486_003_0	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H2486	005	0	1	01	01	H2486_005_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H2491	025	0	1	02	01	H2491_025_0	5	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										541	513															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H2491	035	0	1	02	01	H2491_035_0	5	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										1827	1736															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H2491	036	0	1	02	01	H2491_036_0	5	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										1015	964															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H2491	037	0	1	02	01	H2491_037_0	5	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										741	703															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H2491	038	0	1	02	01	H2491_038_0	5	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										369	351															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H2509	001	0	1	02	01	H2509_001_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								4152	3530															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2509	002	0	1	02	01	H2509_002_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								13218	11236															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2509	003	0	1	02	01	H2509_003_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								9780	8313															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2526	003	0	1	04	01	H2526_003_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								3203	2876															2			13i1;13i10;	1	1	13i1;13i10;	1	38.00	7		00010		13i1;13i10;
H2561	001	0	1	01	01	H2561_001_0	9	3	2	OHTH 3														0110101000111000000	Pregnancy	End Stage Renal Disease (ESRD)	Metabolic Syndrome								2	2		2			16c3;		2		2						
H2561	001	0	1	01	01	H2561_001_0	9	4	2	OHTH 4														0000000000111000000	Oral Cancer	Sjorgens	Head and Neck Cancer								2	2		2			16c3;		2		2						
H2561	001	0	1	01	01	H2561_001_0	9	1	2	OHTH 1														0110101000111000000	Pregnancy	End Stage Renal Disease (ESRD)	Metabolic Syndrome								2	2		2			16b4;16c3;		2		2						
H2561	001	0	1	01	01	H2561_001_0	9	2	2	OHTH 2														0000000000111000000	Oral Cancer	Sjorgens	Head and Neck Cancer								2	2		2			16b1;16b4;16b5;16c3;		2		2						
H2563	020	0	1	01	01	H2563_020_0	6	1	3	Food Produce/General Supports Living/Transport	01111111111111111111111000000000											1016	965															2			13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i10;
H2564	001	0	1	01	01	H2564_001_0	7	1	3	Package 1	00001111110001101000000100000000	Connective Tissue Disease										41	27															2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		01011		13i1;13i10;
H2593	031	0	1	02	01	H2593_031_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							9	6															2			13i1;	2	2		2						
H2593	040	0	1	02	01	H2593_040_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							8	6															2			13i1;13i2;13i10;	2	2		2						
H2593	043	0	1	02	01	H2593_043_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							141	73															2			13i1;13i10;	2	2		2						
H2628	001	0	1	01	01	H2628_001_0	9	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							11421	10550															2			13i1;13i10;13i-O1;		2		2						
H2628	005	0	1	01	01	H2628_005_0	6	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							5598	5171															2			13i1;13i10;		2		2						
H2628	006	0	1	01	01	H2628_006_0	6	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							14318	13226															2			13i1;13i10;		2		2						
H2628	007	0	1	01	01	H2628_007_0	9	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							26648	24616															2			13i1;13i10;13i-O1;		2		2						
H2630	001	0	1	01	01	H2630_001_0	9	1	3	SSBCI	01111111111101111111011100000000	Chronic Hypertension										90	76															2			13i1;		2		2						
H2630	002	0	1	01	01	H2630_002_0	9	1	3	SSBCI	01111111111101111111011100000000	Chronic Hypertension										325	276															2			13i1;		2		2						
H2663	034	0	1	01	01	H2663_034_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1034	733															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	039	0	1	01	01	H2663_039_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1469	1041															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	35.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	052	0	1	01	01	H2663_052_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							3177	2765															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	110.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	057	0	1	02	01	H2663_057_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							2199	1942															2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	150.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	064	0	1	01	01	H2663_064_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1511	1316															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	110.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	067	0	1	01	01	H2663_067_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							487	370															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	75.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	097	0	1	01	01	H2663_097_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							2013	1999															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	098	0	1	01	01	H2663_098_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											2531	2314															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	100	0	1	01	01	H2663_100_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											612	562															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	102	0	1	01	01	H2663_102_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											2049	1873															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	104	0	1	01	01	H2663_104_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											357	322															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	107	0	1	01	01	H2663_107_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											464	424															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	108	0	1	01	01	H2663_108_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											464	424															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	109	0	1	01	01	H2663_109_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							646	641															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	110	0	1	01	01	H2663_110_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							954	954															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	111	0	1	01	01	H2663_111_0	4	1	3	SSBCI Pkg	01000110001001110000000000000000											93	27															1	001		13i6;		1	13i6;	2						
H2663	112	0	1	01	01	H2663_112_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							4168	4168															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	113	0	1	01	01	H2663_113_0	4	1	3	SSBCI Pkg	01000110001001110000000000000000											229	67															1	001		13i6;		1	13i6;	2						
H2663	114	0	1	01	01	H2663_114_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							3622	3622															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	116	0	1	01	01	H2663_116_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							507	359															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	117	0	1	01	01	H2663_117_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							60	59															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H2663	805	0	1	01	01	H2663_805_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H2663	805	0	1	01	01	H2663_805_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H2694	002	0	1	04	01	H2694_002_0	10	1	3	Grocery and OTC	00011001001000100000000000000000											1260	1134															1	001		13b;13i1;	1	2		1	50.00	5		01011		13b;13i1;
H2697	007	0	1	01	01	H2697_007_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								235	211															2			13i1;13i10;		1	13i1;13i10;	1	25.00	7		00010		13i1;13i10;
H2697	016	0	1	01	01	H2697_016_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											2921	2623															2			13i1;13i10;		1	13i1;13i10;	1	370.00	7		00010		13i1;13i10;
H2697	017	0	1	01	01	H2697_017_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											1475	1325															2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H2697	018	0	1	01	01	H2697_018_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											241	216															2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H2697	020	0	1	01	01	H2697_020_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											266	239															2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H2736	002	0	1	02	01	H2736_002_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											2162	1838															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H2752	008	0	1	01	01	H2752_008_0	6	1	3	Food and Produce	00001101000001001000000000000000											70	52															2			13i1;		2		2						
H2752	009	0	1	01	01	H2752_009_0	6	1	3	Food and Produce	00001101000001001000000000000000											173	130															2			13i1;		2		2						
H2775	112	0	1	04	01	H2775_112_0	5	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										5826	4842															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H2802	044	0	1	02	01	H2802_044_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								13098	11134															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2802	053	0	1	02	01	H2802_053_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								6922	5884															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2802	064	0	1	02	01	H2802_064_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								15113	12846															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2802	067	0	1	02	01	H2802_067_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											3770	3205															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H2802	068	0	1	02	01	H2802_068_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											7581	6444															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H2802	070	0	1	02	01	H2802_070_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											3737	3177															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H2802	082	0	1	02	01	H2802_082_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1277	1085															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2802	088	0	1	02	01	H2802_088_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											17330	14730															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H2802	090	0	1	02	01	H2802_090_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1166	991															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2802	094	0	1	02	01	H2802_094_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								5335	4535															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H2819	001	0	1	01	01	H2819_001_0	7	1	3	Food and Produce	01111111111111111111111000000000											13001	13001															2			13i1;		2		1	0.00	5		00010		13i1;
H2836	006	0	1	04	01	H2836_006_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							367	178															2			13i1;13i10;	1	2		2						
H2845	003	0	1	04	01	H2845_003_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								987	887															2			13i1;13i10;	1	1	13i1;13i10;	1	270.00	7		00010		13i1;13i10;
H2845	008	0	1	04	01	H2845_008_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											476	428															2			13i1;13i10;	1	1	13i1;13i10;	1	296.00	7		00010		13i1;13i10;
H2845	009	0	1	04	01	H2845_009_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											155	139															2			13i1;13i10;	1	1	13i1;13i10;	1	193.00	7		00010		13i1;13i10;
H2845	010	0	1	04	01	H2845_010_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											344	309															2			13i1;13i10;	1	1	13i1;13i10;	1	193.00	7		00010		13i1;13i10;
H2851	001	0	1	01	01	H2851_001_0	9	1	3	Healthy Food and Produce	01111111111111111111111000000000											750	375															2			13i1;		1	13i1;	1	0.00	5		00011		13i1;
H2875	001	0	1	02	01	H2875_001_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H2875	001	0	1	02	01	H2875_001_0	4	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									3708	3708															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	1000.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H2875	002	0	1	02	01	H2875_002_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H2875	002	0	1	02	01	H2875_002_0	4	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									4078	4078															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	1000.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H2875	003	0	1	01	01	H2875_003_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									318	318															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H2875	003	0	1	01	01	H2875_003_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H2875	004	0	1	01	01	H2875_004_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									555	555															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H2875	004	0	1	01	01	H2875_004_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H2875	004	0	1	01	01	H2875_004_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H2875	005	0	1	01	01	H2875_005_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									411	411															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H2875	005	0	1	01	01	H2875_005_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H2875	005	0	1	01	01	H2875_005_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H2875	006	0	1	02	01	H2875_006_0	4	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									7321	7321															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	2		1	1000.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H2875	006	0	1	02	01	H2875_006_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H2915	002	0	1	02	01	H2915_002_0	5	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										8613	7398															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H2915	018	0	1	02	01	H2915_018_0	5	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										161	138															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H2923	001	0	1	01	01	H2923_001_0	7	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								796	715															2			13i1;13i10;		1	13i1;13i10;	1	30.00	7		00010		13i1;13i10;
H2923	009	0	1	01	01	H2923_009_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											939	843															2			13i1;13i10;		1	13i1;13i10;	1	289.00	7		00010		13i1;13i10;
H2923	013	0	1	01	01	H2923_013_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;		1	13i1;13i10;	1	40.00	7		00010		13i1;13i10;
H2923	014	0	1	01	01	H2923_014_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;		1	13i1;13i10;	1	142.00	7		00010		13i1;13i10;
H2923	026	1	1	01	01	H2923_026_1	7	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								418	375															2			13i1;13i10;		1	13i1;13i10;	1	30.00	7		00010		13i1;13i10;
H2923	026	2	1	01	01	H2923_026_2	7	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								1521	1366															2			13i1;13i10;		1	13i1;13i10;	1	30.00	7		00010		13i1;13i10;
H2926	001	0	1	01	01	H2926_001_0	9	1	3	SNBC SSBCI	01111111111111111111111000000000											1300	1040															2			13i1;		1	13i1;	2						
H2962	021	0	1	01	01	H2962_021_0	9	1	3	SSBCI Package 1	00001101000000000000000000000000											10204	9233															2			13i1;13i10;		1	13i1;13i10;	1	125.00	7		00010		13i1;13i10;
H2962	023	0	1	01	01	H2962_023_0	8	1	3	SSBCI Package 1	00000000000001000000000000000000											2508	2269															2			13i1;13i10;		2		1	125.00	7		00010		13i1;13i10;
H2962	026	0	1	01	01	H2962_026_0	7	1	3	SSBCI Package 1	00001101000000000000000000000000											1229	1112															2			13i1;13i10;		2		1	125.00	7		00010		13i1;13i10;
H2962	029	0	1	01	01	H2962_029_0	8	1	3	SSBCI Package 1	00001101000000000000000000000000											3955	3579															2			13i1;13i10;		2		1	125.00	7		00010		13i1;13i10;
H2962	033	0	1	01	01	H2962_033_0	7	1	3	SSBCI Package 1	00001101000000000000000000000000											1183	1071															2			13i1;13i10;		2		1	125.00	7		00010		13i1;13i10;
H2962	035	0	1	01	01	H2962_035_0	7	1	3	SSBCI Package 1	01111111111111111111111000000000											259	228															2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H2962	036	0	1	01	01	H2962_036_0	7	1	3	SSBCI Package 1	01111111111111111111111000000000											1583	1453															2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H2962	050	0	1	01	01	H2962_050_0	8	1	3	SSBCI Package 1	00001101000000000000000000000000											762	690															2			13i1;13i10;		1	13i1;13i10;	1	125.00	7		00010		13i1;13i10;
H2962	051	0	1	01	01	H2962_051_0	8	1	3	SSBCI Package 1	00001101000000000000000000000000											213	193															2			13i1;13i10;		1	13i1;13i10;	1	125.00	7		00010		13i1;13i10;
H2962	052	0	1	01	01	H2962_052_0	8	1	3	SSBCI Package 1	00001101000000000000000000000000											56	51															2			13i1;13i10;		1	13i1;13i10;	1	125.00	7		00010		13i1;13i10;
H2962	053	0	1	01	01	H2962_053_0	6	1	3	SSBCI Package 1	00000000000001000000000000000000											1987	1799															2			13i1;13i10;		2		1	125.00	7		00010		13i1;13i10;
H3038	004	1	1	01	01	H3038_004_1	7	1	3	SSBCI	01111111111111111111111000000000											11197	10078															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H3038	004	2	1	01	01	H3038_004_2	7	1	3	SSBCI	01111111111111111111111000000000											6670	6003															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H3038	004	3	1	01	01	H3038_004_3	6	1	3	SSBCI	01111111111111111111111000000000											11000	7130															1	001		13i1;		2		2						
H3038	004	4	1	01	01	H3038_004_4	6	1	3	SSBCI	01111111111111111111111000000000											666	329															1	001		13i1;		2		2						
H3041	001	0	1	01	01	H3041_001_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								683	613															2			13i1;13i10;		1	13i1;13i10;	1	45.00	7		00010		13i1;13i10;
H3048	002	0	1	01	01	H3048_002_0	6	1	3	Healthy Foods & Social Supports	01111111001111111000000000000000											200	94															1	001		13i1;13i6;		2		1	0.00	7		00010		13i1;13i6;
H3080	001	0	1	01	01	H3080_001_0	4	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								394	354															2			13i1;13i10;		1	13i1;13i10;	1	48.00	7		00010		13i1;13i10;
H3080	003	0	1	01	01	H3080_003_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								4001	3593															2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H3080	004	0	1	01	01	H3080_004_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								2225	1998															2			13i1;13i10;		1	13i1;13i10;	1	177.00	7		00010		13i1;13i10;
H3080	006	0	1	01	01	H3080_006_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								1100	988															2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H3080	007	0	1	01	01	H3080_007_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								773	694															2			13i1;13i10;		1	13i1;13i10;	1	165.00	7		00010		13i1;13i10;
H3093	002	0	1	01	01	H3093_002_0	6	1	3	SSBCI	01111111111111111111111000000000											13622	12260															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H3113	005	0	1	01	01	H3113_005_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								33935	28845															2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3113	009	0	1	02	01	H3113_009_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								5729	4870															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3113	010	0	1	02	01	H3113_010_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								2056	1747															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3113	014	0	1	02	01	H3113_014_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								395	336															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3113	016	0	1	02	01	H3113_016_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								20475	17404															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3127	001	0	1	01	01	H3127_001_0	6	1	3	SSBCI Package 1 Grocery	01111111111111111111111000000000											3913	3717															2			13i1;		1	13i1;	1	0.00	7		00010		13i1;
H3146	002	0	1	01	01	H3146_002_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							4706	4706															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3146	006	0	1	01	01	H3146_006_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							9788	8645															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	150.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3146	011	0	1	01	01	H3146_011_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							6079	5550															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	235.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3146	012	0	1	01	01	H3146_012_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1805	1569															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	100.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3146	016	0	1	01	01	H3146_016_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1699	1664															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3146	022	0	1	01	01	H3146_022_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							3919	3919															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3146	023	0	1	01	01	H3146_023_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							2263	2247															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3146	036	0	1	01	01	H3146_036_0	4	1	3	SSBCI Pkg	00001101000000000000000000000000											999	996															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3146	037	0	1	01	01	H3146_037_0	4	1	3	SSBCI Pkg	00001101000000000000000000000000											462	433															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3146	038	0	1	01	01	H3146_038_0	4	1	3	SSBCI Pkg	00001101000000000000000000000000											796	763															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3146	044	0	1	01	01	H3146_044_0	4	1	3	SSBCI Pkg	00001101000000000000000000000000											295	276															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3146	053	0	1	01	01	H3146_053_0	4	1	3	SSBCI Pkg	00001101000000000000000000000000											526	492															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3146	801	0	1	01	01	H3146_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3146	801	0	1	01	01	H3146_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3152	022	0	1	02	01	H3152_022_0	3	2	2	ESRD Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;	2	1	10b1;	2						
H3152	022	0	1	02	01	H3152_022_0	3	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	2	1	14c21;	2						
H3152	045	0	1	01	01	H3152_045_0	2	2	2	ESRD Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;		1	10b1;	2						
H3152	045	0	1	01	01	H3152_045_0	2	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H3152	048	0	1	01	01	H3152_048_0	3	2	2	ESRD Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;		1	10b1;	2						
H3152	048	0	1	01	01	H3152_048_0	3	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H3152	080	0	1	02	01	H3152_080_0	3	2	2	ESRD Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;	2	1	10b1;	2						
H3152	080	0	1	02	01	H3152_080_0	3	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	2	1	14c21;	2						
H3152	082	0	1	01	01	H3152_082_0	3	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H3152	082	0	1	01	01	H3152_082_0	3	2	2	ESRD Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;		1	10b1;	2						
H3152	098	0	1	01	01	H3152_098_0	3	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H3152	098	0	1	01	01	H3152_098_0	3	2	2	ESRD Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;		1	10b1;	2						
H3152	801	0	1	01	01	H3152_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3152	801	0	1	01	01	H3152_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3152	804	0	1	01	01	H3152_804_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3152	804	0	1	01	01	H3152_804_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3152	807	0	1	01	01	H3152_807_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3152	807	0	1	01	01	H3152_807_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3192	007	0	1	01	01	H3192_007_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							11448	11347															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3192	028	0	1	01	01	H3192_028_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											336	313															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3192	029	0	1	01	01	H3192_029_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											377	351															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3192	033	0	1	01	01	H3192_033_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											2873	2576															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3192	036	0	1	01	01	H3192_036_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											409	323															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3192	037	0	1	01	01	H3192_037_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											192	152															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3192	801	0	1	01	01	H3192_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3192	801	0	1	01	01	H3192_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3204	013	4	1	01	01	H3204_013_4	5	1	3	Food and Produce Benefit	00000101000000000000000110000000	Chronic Hypertension	Chronic Hyperlipidemia									3400	2700															1	100	Completion of Annual Wellness Visit (AWV) within a 12-month period (rolling year).	13i1;		2		2						
H3204	013	6	1	01	01	H3204_013_6	5	1	3	Food and Produce Benefit	00000101000000000000000110000000	Chronic Hypertension	Chronic Hyperlipidemia									800	600															1	100	Completion of Annual Wellness Visit (AWV) within a 12-month period (rolling year).	13i1;		2		2						
H3219	015	0	1	04	01	H3219_015_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											1687	1557															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3219	016	0	1	04	01	H3219_016_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											1614	1490															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3219	801	0	1	04	01	H3219_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3219	801	0	1	04	01	H3219_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3239	001	0	1	01	01	H3239_001_0	5	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1016	993															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	002	0	1	01	01	H3239_002_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							14439	14055															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	005	0	1	01	01	H3239_005_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							5898	5764															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	010	0	1	01	01	H3239_010_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1818	1695															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	012	0	1	01	01	H3239_012_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							2265	2168															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	015	0	1	01	01	H3239_015_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							298	289															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	017	0	1	01	01	H3239_017_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							375	264															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	55.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	020	0	1	01	01	H3239_020_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							6194	5339															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	110.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	022	0	1	01	01	H3239_022_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							4970	3498															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	55.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	023	0	1	01	01	H3239_023_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							553	534															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	026	0	1	01	01	H3239_026_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							2083	2048															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	027	0	1	01	01	H3239_027_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							6421	6421															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	028	0	1	01	01	H3239_028_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							4458	4440															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	030	0	1	01	01	H3239_030_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											120	111															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3239	031	0	1	01	01	H3239_031_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							863	700															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	90.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3240	013	0	1	01	01	H3240_013_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							11036	10029															2			13i1;13i2;13i10;		2		2						
H3240	017	0	1	02	01	H3240_017_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							29	10															2			13i1;	2	2		2						
H3256	004	1	1	04	01	H3256_004_1	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								3019	2566															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3256	004	2	1	04	01	H3256_004_2	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								6480	5508															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3256	005	1	1	04	01	H3256_005_1	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								4888	4155															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3256	005	2	1	04	01	H3256_005_2	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								17667	15017															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3256	006	1	1	04	01	H3256_006_1	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								3467	2947															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3256	006	2	1	04	01	H3256_006_2	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								11568	9832															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3256	006	3	1	04	01	H3256_006_3	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								361	307															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3259	001	0	1	01	01	H3259_001_0	9	1	3	Healthy Food	01111111111111111111111000000000											19422	17479															2			13i1;		1	13i1;	1	0.00	7		01011		13i1;
H3259	002	0	1	01	01	H3259_002_0	8	1	3	Healthy Food	01111111111111111111111000000000											2500	2300															2			13i1;		1	13i1;	1	0.00	7		01011		13i1;
H3259	003	0	1	01	01	H3259_003_0	9	1	3	Healthy Food	01111111111111111111111000000000											6700	6400															2			13i1;		1	13i1;	1	0.00	7		01011		13i1;
H3274	001	0	1	01	01	H3274_001_0	8	1	3	Flex and Transportation Benefit	01111111111111111111111111000000	osteoporosis	chronic hypertension	chronic hyperlipidemia								146	37															2			13i1;13i4;13i10;13i-O2;		1	13i1;13i4;13i10;13i-O2;	1	0.00	5		01010		13i10;13i-O2;
H3274	002	0	1	01	01	H3274_002_0	8	1	3	OTC and Transportation	01111111111111111111111111000000	osteoporosis	chronic hypertension	chronic hyperlipidemia								521	156															2			13i4;13i10;13i-O2;		1	13i4;13i10;13i-O2;	1	0.00	5		01010		13i10;13i-O2;
H3274	005	0	1	01	01	H3274_005_0	7	1	3	OTC and Transportation Benefit	01111111111111111111111111000000	osteoporosis	chronic hypertension	chronic hyperlipidemia								142	50															2			13i4;13i10;13i-O2;		1	13i4;13i10;13i-O2;	1	0.00	5		01010		13i10;13i-O2;
H3288	001	0	1	04	01	H3288_001_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							567	402															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3288	002	0	1	04	01	H3288_002_0	5	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1039	737															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3288	003	0	1	04	01	H3288_003_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1644	1166															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3288	004	0	1	04	01	H3288_004_0	5	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							387	275															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3288	017	0	1	04	01	H3288_017_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							170	121															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3288	018	0	1	04	01	H3288_018_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1759	1247															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3288	019	0	1	04	01	H3288_019_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							261	181															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	15.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3288	034	0	1	04	01	H3288_034_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							677	604															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	180.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3288	048	0	1	04	01	H3288_048_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							718	498															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	15.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3288	053	0	1	04	01	H3288_053_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							913	895															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3288	801	0	1	04	01	H3288_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3288	801	0	1	04	01	H3288_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3291	002	0	1	01	01	H3291_002_0	6	1	3	Meal, Flex Card, and Transportation	01111111111111111111111111000000	Chronic Hyperlipidemia	Chronic Hypertension	Osteoporosis								1289	1117															2			13c;13i1;13i4;13i10;13i-O1;		2		1	0.00	7		00010		13c;13i1;13i4;13i10;13i-O1;
H3291	003	0	1	01	01	H3291_003_0	4	1	3	Food and Produce, Hygiene	01111111111111111111111111000000	Chronic Hypertension	Chronic Hyperlipidemia	Chronic malnutrition including failure to thrive								85	74															2			13i1;13i-O1;		1	13i1;13i-O1;	1	0.00	5		00010		13i1;
H3305	007	0	1	02	01	H3305_007_0	6	1	2	Package 1														0000010000000000000														2			13b;	2	1	13b;	2						
H3305	007	0	1	02	01	H3305_007_0	6	2	2	Package 2														0000100000000000000														2			14c8;	2	1	14c8;	1	250.00	3		01000		14c8;
H3305	007	0	1	02	01	H3305_007_0	6	3	2	Package 3														0000000010110000000	Osteoarthritis	Undergone a joint replacement									2	1	Enrollee must have a diagnosis for Rheumatoid Arthritis or Osteoarthritis, along with having undergone a joint replacement.	2			14c8;	2	1	14c8;	2						
H3305	015	0	1	02	01	H3305_015_0	7	2	2	Package 2														0000100000000000000														2			14c8;	2	1	14c8;	1	250.00	3		01000		14c8;
H3305	015	0	1	02	01	H3305_015_0	7	1	2	Package 1														0000010000000000000														2			13b;	2	1	13b;	2						
H3305	015	0	1	02	01	H3305_015_0	7	3	2	Package 3														0000000010110000000	Osteoarthritis	Undergone a joint replacement									2	1	Enrollee must have a diagnosis for Rheumatoid Arthritis or Osteoarthritis, along with having undergone a joint replacement.	2			14c8;	2	1	14c8;	2						
H3305	020	0	1	02	01	H3305_020_0	6	3	2	Package 3														0000000010110000000	Osteoarthritis	Undergone a joint replacement									2	1	Enrollee must have a diagnosis for Rheumatoid Arthritis or Osteoarthritis, along with having undergone a joint replacement.	2			14c8;	2	1	14c8;	2						
H3305	020	0	1	02	01	H3305_020_0	6	1	2	Package 1														0000010000000000000														2			13b;	2	1	13b;	2						
H3305	020	0	1	02	01	H3305_020_0	6	2	2	Package 2														0000100000000000000														2			14c8;	2	1	14c8;	1	250.00	3		01000		14c8;
H3305	022	0	1	02	01	H3305_022_0	8	1	2	Package 1														0000010000000000000														2			13b;	2	1	13b;	2						
H3305	022	0	1	02	01	H3305_022_0	8	2	2	Package 2														0000100000000000000														2			14c8;	2	1	14c8;	1	250.00	3		01000		14c8;
H3305	022	0	1	02	01	H3305_022_0	8	3	2	Package 3														0000000010110000000	Osteoarthritis	Undergone a joint replacement									2	1	Enrollee must have a diagnosis for Rheumatoid Arthritis or Osteoarthritis, along with having undergone a joint replacement.	2			14c8;	2	1	14c8;	2						
H3305	033	0	1	01	01	H3305_033_0	6	2	3	SSBCI Package 1	00011111000001100000000000000000											2277	2050															2			13i1;13i10;		1	13i1;13i10;	1	50.00	7		01011		13i1;13i10;
H3305	033	0	1	01	01	H3305_033_0	6	1	2	UF Package 1														0000000010110000000	Osteoarthritis	Undergone a joint replacement									2	1	Enrollee must have a diagnosis for Rheumatoid Arthritis or Osteoarthritis, along with having undergone a joint replacement.	2			14c8;		1	14c8;	2						
H3305	034	0	1	01	01	H3305_034_0	7	1	2	UF Package 1														0000000010110000000	Osteoarthritis	Undergone a joint replacement									2	1	Enrollee must have a diagnosis for Rheumatoid Arthritis or Osteoarthritis, along with having undergone a joint replacement.	2			14c8;		1	14c8;	2						
H3305	034	0	1	01	01	H3305_034_0	7	2	3	SSBCI package 1	00011111000001100000000000000000											1908	1717															2			13i1;13i10;		1	13i1;13i10;	1	100.00	7		01011		13i1;13i10;
H3305	038	0	1	02	01	H3305_038_0	8	1	2	Package 1														0000010000000000000														2			13b;	2	1	13b;	2						
H3305	039	0	1	02	01	H3305_039_0	8	1	2	Package 1														0000010000000000000														2			13b;	2	1	13b;	2						
H3312	069	0	1	01	01	H3312_069_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							41907	41331															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3312	070	0	1	01	01	H3312_070_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							17662	17297															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3312	073	0	1	01	01	H3312_073_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							49	48															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3312	074	0	1	01	01	H3312_074_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							7493	5198															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	45.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3312	091	0	1	01	01	H3312_091_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											5209	4485															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3312	105	0	1	01	01	H3312_105_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											194	174															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3312	111	0	1	01	01	H3312_111_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											523	473															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3312	112	0	1	01	01	H3312_112_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											398	359															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3312	801	0	1	01	01	H3312_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3312	801	0	1	01	01	H3312_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3312	804	0	1	01	01	H3312_804_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3312	804	0	1	01	01	H3312_804_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3312	807	0	1	01	01	H3312_807_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3312	807	0	1	01	01	H3312_807_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3347	002	0	1	02	01	H3347_002_0	8	1	3	Package 1	01111111111111111111111110000000	Osteoporosis	RSD (Reflex Sympathetic Dystrophy)									7384	6482															2			13i1;13i3;13i5;13i10;13i-O1;	2	2		1	0.00	7		00011		13i1;13i3;13i5;13i10;13i-O1;
H3347	003	0	1	02	01	H3347_003_0	8	1	3	1	01111111111111111111111110000000	Osteoporosis	RSD (Reflex Sympathetic Dystrophy)									1203	222															2			13i1;13i3;13i5;13i6;13i10;13i-O1;	2	2		1	0.00	7		00011		13i1;13i3;13i5;13i6;13i10;13i-O1;
H3347	007	0	1	02	01	H3347_007_0	10	1	3	Package 1	01111111111111111111111110000000	Osteoporosis	RSD (Reflex Sympathetic Dystrophy)									11467	10722															2			13i1;13i3;13i4;13i5;13i10;13i-O1;	2	2		1	0.00	7		00011		13i1;13i3;13i4;13i5;13i10;13i-O1;
H3347	018	0	1	02	01	H3347_018_0	10	1	3	1	01111111111111111111111110000000	Osteoporosis	RSD (Reflex Sympathetic Dystrophy)									541	83															2			13i1;13i3;13i5;13i10;13i-O1;	2	2		1	0.00	7		00011		13i1;13i3;13i5;13i10;13i-O1;
H3359	021	0	1	01	01	H3359_021_0	10	1	3	OTC Plus	11111111111111111111111111110000	Chronic hypertension	Osteoporosis	Hypothyroidism	Prediabetes	Chronic Hyperlipidemia	Hyperthyroidism					80274	72247															2			13i1;13i5;13i10;13i-O1;		1	13i1;13i5;13i10;13i-O1;	1	0.00	7		00011		13i1;13i5;13i10;13i-O1;
H3359	034	0	1	01	01	H3359_034_0	10	1	3	SSBCI	11111111111111111111111111110000	Chronic Hypertension	Osteoporosis	Hypothyroidism	Prediabetes	Chronic Hyperlipidemia	Hyperthyroidism					46660	45726															2			13i1;13i10;13i-O1;		1	13i1;13i10;13i-O1;	1	0.00	7		00011		13i1;13i10;13i-O1;
H3359	038	0	1	01	01	H3359_038_0	10	1	3	OTC Plus	11111111111111111111111111110000	Chronic Hypertension	Osteoporosis	Hypothyroidism	Prediabetes	Chronic Hyperlipidemia	Hyperthyroidism					658	593															2			13i1;13i5;13i10;13i-O1;		1	13i1;13i5;13i10;13i-O1;	1	0.00	7		00011		13i1;13i5;13i10;13i-O1;
H3379	053	0	1	02	01	H3379_053_0	6	1	3	SSBCI Package 1	00001101000000000000000000000000											4493	3819															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H3379	054	0	1	02	01	H3379_054_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											7844	6667															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H3379	056	0	1	02	01	H3379_056_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											3886	3303															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H3379	061	0	1	02	01	H3379_061_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											754	641															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H3387	013	0	1	02	01	H3387_013_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								74	63															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3387	014	1	1	02	01	H3387_014_1	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								29498	25073															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3387	014	2	1	02	01	H3387_014_2	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								19024	16171															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3387	014	3	1	02	01	H3387_014_3	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								42407	36046															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3387	014	4	1	02	01	H3387_014_4	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								17125	14556															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3387	014	5	1	02	01	H3387_014_5	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								5941	5049															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3387	014	6	1	02	01	H3387_014_6	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								3252	2765															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3387	015	1	1	02	01	H3387_015_1	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								3438	2923															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3387	015	2	1	02	01	H3387_015_2	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1913	1626															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3387	017	0	1	02	01	H3387_017_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								4769	4054															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3407	001	0	1	01	01	H3407_001_0	8	1	3	SSBCI Package 1	01111111111111111111111000000000											1216	1155															2			13b;13i1;13i10;		1	13b;13i1;13i10;	1	75.00	7		00010		13b;13i1;13i10;
H3407	004	0	1	01	01	H3407_004_0	8	1	3	SSBCI Package 1	01111111111111111111111000000000											1216	1155															2			13b;13i1;13i10;		1	13b;13i1;13i10;	1	90.00	7		00010		13b;13i1;13i10;
H3419	001	0	1	01	01	H3419_001_0	7	1	3	Transportation and Flex	01111111111111111111111111000000	chronic hyperlipidemia	chronic hypertension	osteoporosis								104	26															2			13i4;13i10;13i-O2;		2		1	0.00	5		01010		13i10;13i-O2;
H3419	003	0	1	02	01	H3419_003_0	10	1	3	Flex Benefits and Transportation	01111111111111111111111111000000	osteoporosis	chronic hypertension	chronic hyperlipidemia								125	75															2			13i1;13i4;13i10;13i-O2;	2	1	13i1;13i4;13i10;13i-O2;	1	0.00	5		01010		13i1;13i10;13i-O2;
H3419	004	0	1	02	01	H3419_004_0	8	1	3	Flex Benefits and Transportation	01111111111111111111111111000000	osteoporosis	chronic hypertension	chronic hyperlipidemia								41	19															2			13i1;13i4;13i10;13i-O2;	2	1	13i1;13i4;13i10;13i-O2;	1	0.00	5		01010		13i1;13i10;13i-O2;
H3419	005	0	1	01	01	H3419_005_0	9	1	3	Flex Benefits	01111111111111111111111111000000	chronic hypertension	chronic hyperlipidemia	osteoporosis								210	52															2			13i4;13i10;13i-O2;14c22;		1	13i4;13i10;13i-O2;14c22;	1	0.00	5		01010		13i10;13i-O2;14c22;
H3419	006	0	1	01	01	H3419_006_0	8	1	3	Flex Benefits	01111111111111111111111111000000	osteoporosis	chronic hypertension	chronic hyperlipidemia								88	31															2			13i1;13i10;13i-O2;14c22;		1	13i1;13i10;13i-O2;14c22;	1	100.00	7		01011		13i1;13i10;14c22;
H3419	007	0	1	01	01	H3419_007_0	9	1	3	Flex Benefits	01111111111111111111111111000000	osteoporosis	chronic hypertension	chronic hyperlipidemia								84	38															2			13i1;13i10;13i-O2;14c22;		1	13i1;13i10;13i-O2;14c22;	1	0.00	7		01010		13i1;13i10;13i-O2;14c22;
H3443	001	0	1	01	01	H3443_001_0	9	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									1542	1117															2			13i1;13i3;13i5;13i10;13i-O1;14c8;		2		1	30.00	7		00010		13i1;13i10;14c8;
H3443	002	0	1	01	01	H3443_002_0	10	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									2365	1582															2			13i1;13i3;13i5;13i10;13i-O1;14c8;		2		1	30.00	7		00010		13i1;13i10;14c8;
H3443	003	0	1	01	01	H3443_003_0	9	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									2837	2286															2			13i1;13i3;13i5;13i10;13i-O1;14c8;		2		1	30.00	7		00010		13i1;13i10;14c8;
H3443	005	0	1	01	01	H3443_005_0	9	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									1087	4															2			13i3;13i10;13i-O1;		2		2						
H3443	006	0	1	01	01	H3443_006_0	9	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									809	772															2			13i1;13i3;13i5;13i10;13i-O1;14c8;		2		1	0.00	7		00010		13i1;13i10;14c8;
H3443	007	0	1	01	01	H3443_007_0	10	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									536	450															2			13i1;13i3;13i5;13i10;13i-O1;14c8;		2		1	0.00	7		00010		13i1;13i10;14c8;
H3443	008	0	1	01	01	H3443_008_0	9	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									175	117															2			13i1;13i3;13i5;13i10;13i-O1;14c8;		2		1	51.00	7		00010		13i1;13i10;14c8;
H3447	018	0	1	01	01	H3447_018_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							2966	2761															2			13i1;13i10;		2		2						
H3447	033	0	1	02	01	H3447_033_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							673	394															2			13i1;13i10;	2	2		2						
H3447	053	0	1	01	01	H3447_053_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							2458	2287															2			13i1;13i10;		2		2						
H3447	056	0	1	02	01	H3447_056_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							1237	1079															2			13i1;	2	2		2						
H3467	001	0	1	02	01	H3467_001_0	5	1	3	Hygiene	01111111111111111111111111000000	Osteoporosis	Chronic Hypertension	Chronic Hyperlipidemia								2875	1438															2			13i-O1;	2	1	13i-O1;	1	0.00	5		01000		13i-O1;
H3467	002	0	1	02	01	H3467_002_0	5	1	3	Food, Produce, Utilities, Transportation, Hygiene	00000000001000000000000000000000											60	52															2			13i1;13i4;13i10;13i-O1;	2	1	13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		13i1;13i4;13i10;13i-O1;
H3467	005	0	1	02	01	H3467_005_0	5	1	3	Food, Produce, Transportation, Hygiene	00000001000000000000000000000000											299	259															2			13i1;13i4;13i-O1;	2	1	13i1;13i4;13i-O1;	1	0.00	7		00010		13i1;13i4;13i-O1;
H3515	003	0	1	01	01	H3515_003_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											230	206															2			13i1;13i10;		1	13i1;13i10;	1	142.00	7		00010		13i1;13i10;
H3515	005	0	1	01	01	H3515_005_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;		1	13i1;13i10;	1	268.00	7		00010		13i1;13i10;
H3515	008	0	1	01	01	H3515_008_0	3	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;		1	13i1;13i10;	1	142.00	7		00010		13i1;13i10;
H3515	010	0	1	01	01	H3515_010_0	3	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;		1	13i1;13i10;	1	253.00	7		00010		13i1;13i10;
H3515	013	0	1	01	01	H3515_013_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;		1	13i1;13i10;	1	142.00	7		00010		13i1;13i10;
H3515	015	0	1	01	01	H3515_015_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;		1	13i1;13i10;	1	253.00	7		00010		13i1;13i10;
H3533	033	0	1	01	01	H3533_033_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H3533	035	0	1	01	01	H3533_035_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H3533	036	1	1	01	01	H3533_036_1	5	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H3533	036	1	1	01	01	H3533_036_1	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									5870	5870															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H3533	036	1	1	01	01	H3533_036_1	5	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H3533	036	2	1	01	01	H3533_036_2	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									4564	4564															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H3533	036	2	1	01	01	H3533_036_2	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H3533	037	0	1	01	01	H3533_037_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H3551	003	0	1	02	01	H3551_003_0	7	1	3	Essentials wallet	00011001001000100000000000000000											500	400															1	001		13i1;13i4;13i10;14c8;	2	2		1	200.00	5		01011		13i1;13i4;13i10;14c8;
H3551	004	0	1	01	01	H3551_004_0	8	1	3	Grocery and OTC	00011001001000100000000000000000											650	600															1	001		13b;13i1;		2		1	115.00	5		01011		13b;13i1;
H3551	005	0	1	01	01	H3551_005_0	11	1	3	Grocery and OTC	00011001001000100000000000000000											250	200															1	001		13b;13i1;		2		1	65.00	5		01011		13b;13i1;
H3561	007	0	1	01	01	H3561_007_0	5	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										2896	2387															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H3561	009	0	1	01	01	H3561_009_0	5	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										7064	6087															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H3561	010	1	1	01	01	H3561_010_1	5	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										23076	18139															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H3561	010	2	1	01	01	H3561_010_2	5	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										9316	7659															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H3597	011	0	1	02	01	H3597_011_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							6917	6788															2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3597	012	0	1	02	01	H3597_012_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							2188	1950															2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3597	801	0	1	01	01	H3597_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3597	801	0	1	01	01	H3597_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3597	802	0	1	01	01	H3597_802_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3597	802	0	1	01	01	H3597_802_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3597	804	0	1	01	01	H3597_804_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3597	804	0	1	01	01	H3597_804_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3642	001	0	1	04	01	H3642_001_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H3660	028	0	1	02	01	H3660_028_0	10	1	2	A1C Meals														0000000000100000000	High A1C (over 8) Levels													2			13c;	2	2		2						
H3660	029	0	1	02	01	H3660_029_0	10	1	2	Home Safety Devices														0000000000111100000	History of Hip Replacement	History of Knee Replacement	History of Femur Fracture	Falls or History of Falls							2	2		2			14c8;	2	2		1	225.00	3		01000		14c8;
H3660	029	0	1	02	01	H3660_029_0	10	2	2	A1C Meals														0000000000100000000	High A1C (over 8) Levels													2			13c;	2	2		2						
H3660	044	0	1	01	01	H3660_044_0	10	1	2	Home Safety Devices														0000000000111100000	History of Hip Replacement	History of Hip Knee Replacement	History of Hip Femur Fracture	Falls or History of Falls							2	2		2			14c8;		2		1	175.00	3		01000		14c8;
H3660	044	0	1	01	01	H3660_044_0	10	2	2	A1C Meals														0000000000100000000	High A1C (over 8) Levels													2			13c;		2		2						
H3660	050	0	1	01	01	H3660_050_0	10	1	2	Home Safety Devices														0000000000111100000	History of Hip Replacement	History of Knee Replacement	History of Femur Fracture	Falls or History of Falls							2	2		2			14c8;		2		1	150.00	3		01000		14c8;
H3660	058	0	1	01	01	H3660_058_0	8	2	2	A1C Meals														0000000000100000000	High A1C (over 8) Levels													2			13c;		2		2						
H3660	058	0	1	01	01	H3660_058_0	8	1	2	Home Safety Devices														0000000000111100000	History of Hip Replacement	History of Knee Replacement	History of Femur Fracture	Falls or History of Falls							2	2		2			14c8;		2		1	150.00	3		01000		14c8;
H3660	801	0	1	01	01	H3660_801_0	2	2	2	A1C Meals														0000000000100000000	High A1C (over 8)													2			13c;		2		2						
H3660	801	0	1	01	01	H3660_801_0	2	1	2	Home Safety Devices														0000000000111100000	History of Hip Replacement	History of Knee Replacement	History of Femur Fracture	Falls or History of Falls							2	2		2			14c8;		2		1	175.00	3		01000		14c8;
H3660	805	0	1	02	01	H3660_805_0	2	1	2	Home Safety Devices														0000000000111100000	History of Hip Replacement	History of Knee Replacement	History of Femur Fracture	Falls or History of Falls							2	2		2			14c8;	2	2		2						
H3660	805	0	1	02	01	H3660_805_0	2	2	2	A1C Meals														0000000000100000000	High A1C (over 9)													2			13c;	2	2		2						
H3672	019	0	1	01	01	H3672_019_0	7	1	3	SSBCI Benefits	01111111111111111111111000000000											2279	1975															2			13i1;13i4;13i10;		2		1	0.00	7		00011		13i1;13i10;
H3706	024	0	1	01	01	H3706_024_0	5	1	3	Smart Wallet Benefit	00001101000000000000000000000000											1632	1632															2			13b;13i1;13i4;13i10;		2		1	0.00	7		00010		13b;13i1;13i4;13i10;
H3706	025	0	1	01	01	H3706_025_0	5	1	3	Smart Wallet Benefit	00001101000000000000000000000000											7188	7188															2			13b;13i1;13i4;13i10;		2		1	0.00	7		00010		13b;13i1;13i4;13i10;
H3706	028	0	1	01	01	H3706_028_0	5	1	3	Smart Wallet Benefit	11111111111111111111111111100000	Chronic anemia	Chronic hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer						1575	1575															2			13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H3706	029	0	1	01	01	H3706_029_0	5	1	3	Smart Wallet Benefit	11111111111111111111111111100000	Chronic Anemia,	Chronic hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer						482	482															2			13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H3748	020	0	1	01	01	H3748_020_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											670	601															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3748	801	0	1	01	01	H3748_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3748	801	0	1	01	01	H3748_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3755	006	0	1	01	01	H3755_006_0	6	1	3	Meal Benefit	00001001000000000000000000000000											54	11															1	001		13c;		1	13c;	2						
H3767	001	0	1	01	01	H3767_001_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H3767	002	0	1	01	01	H3767_002_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H3767	002	0	1	01	01	H3767_002_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H3794	002	0	1	02	01	H3794_002_0	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								643	547															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3794	004	0	1	02	01	H3794_004_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								2747	2335															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3794	010	0	1	02	01	H3794_010_0	6	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								18	15															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3794	011	1	1	02	01	H3794_011_1	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								32559	27675															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3794	011	2	1	02	01	H3794_011_2	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								3927	3338															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3794	011	3	1	02	01	H3794_011_3	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1292	1098															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3800	001	0	1	01	01	H3800_001_0	7	1	3	Essential Clothing Items	01111111111111111111111000000000											1087	906															2			13i10;		2		2						
H3805	040	0	1	02	01	H3805_040_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											5773	4907															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H3805	049	0	1	02	01	H3805_049_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											126	107															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H3805	050	0	1	02	01	H3805_050_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											126	107															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H3805	051	0	1	02	01	H3805_051_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											126	107															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H3815	001	0	1	01	01	H3815_001_0	12	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									9114	50															2			13i3;13i5;13i10;13i-O1;		2		2						
H3815	008	0	1	01	01	H3815_008_0	13	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									13659	9636															2			13i1;13i3;13i10;13i-O1;		2		2						
H3815	010	0	1	01	01	H3815_010_0	11	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									7478	5927															2			13i1;13i3;13i5;13i10;13i-O1;14c8;		2		1	25.00	7		00010		13i1;13i10;14c8;
H3815	011	0	1	01	01	H3815_011_0	11	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									10831	8514															2			13i1;13i3;13i10;13i-O1;14c8;		2		1	10.00	7		00010		13i1;13i10;14c8;
H3815	013	0	1	01	01	H3815_013_0	12	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									1	1															2			13i3;13i-O1;		2		2						
H3815	016	0	1	02	01	H3815_016_0	11	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									8412	6302															2			13i1;13i3;13i10;13i-O1;	2	2		2						
H3815	019	0	1	01	01	H3815_019_0	10	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									9249	27															2			13i3;13i10;13i-O1;		2		2						
H3815	020	0	1	01	01	H3815_020_0	10	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									4056	4															2			13i3;13i-O1;		2		2						
H3815	021	0	1	01	01	H3815_021_0	8	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									2323	1															2			13i3;13i10;13i-O1;		2		2						
H3815	023	0	1	01	01	H3815_023_0	11	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									5707	13															2			13i3;13i-O1;		2		2						
H3815	028	0	1	01	01	H3815_028_0	11	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									7240	15															2			13i3;13i-O1;		2		2						
H3815	030	0	1	01	01	H3815_030_0	10	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									4526	3440															2			13i1;13i3;13i5;13i10;13i-O1;14c8;		2		1	162.00	7		00010		13i1;13i10;14c8;
H3815	031	0	1	01	01	H3815_031_0	11	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									3198	2322															2			13i1;13i10;13i-O1;14c8;		2		1	30.00	7		00010		13i1;13i10;14c8;
H3815	033	0	1	01	01	H3815_033_0	9	1	3	Package 1	00000000001000000000000000000000											122	107															2			13i1;13i3;13i10;13i-O1;14c8;		2		1	0.00	7		00010		13i1;13i10;14c8;
H3815	035	0	1	01	01	H3815_035_0	11	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									11895	7848															2			13i1;13i3;13i10;13i-O1;14c8;		2		1	10.00	7		00010		13i1;13i10;14c8;
H3815	038	0	1	01	01	H3815_038_0	11	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									1052	6															2			13i3;13i10;13i-O1;		2		2						
H3815	039	0	1	01	01	H3815_039_0	10	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									32161	28974															2			13i1;13i3;13i5;13i10;13i-O1;14c8;		2		1	0.00	7		00010		13i1;13i10;14c8;
H3815	040	0	1	01	01	H3815_040_0	11	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									2618	12															2			13i3;13i10;13i-O1;		2		2						
H3815	041	0	1	01	01	H3815_041_0	11	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									1518	1395															2			13i1;13i3;13i5;13i10;13i-O1;14c8;		2		1	0.00	7		00010		13i1;13i10;14c8;
H3815	042	0	1	01	01	H3815_042_0	10	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									1380	1187															2			13i1;13i3;13i5;13i10;13i-O1;14c8;		2		1	0.00	7		00010		13i1;13i10;14c8;
H3815	044	0	1	01	01	H3815_044_0	12	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									6212	5735															2			13i1;13i3;13i5;13i10;13i-O1;14c8;		2		1	0.00	7		00010		13i1;13i10;14c8;
H3815	045	0	1	01	01	H3815_045_0	9	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									1612	1508															2			13i1;13i3;13i5;13i10;13i-O1;14c8;		2		1	0.00	7		00010		13i1;13i10;14c8;
H3815	046	0	1	01	01	H3815_046_0	10	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									717	323															2			13i1;13i3;13i10;13i-O1;14c8;		2		1	20.00	7		00010		13i1;13i10;14c8;
H3815	047	0	1	01	01	H3815_047_0	11	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									13545	28															2			13i3;13i-O1;		2		2						
H3815	048	0	1	01	01	H3815_048_0	11	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									4750	2580															2			13i1;13i3;13i5;13i10;13i-O1;14c8;		2		1	35.00	7		00010		13i1;13i10;14c8;
H3815	050	0	1	01	01	H3815_050_0	10	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									15052	10085															2			13i1;13i3;13i10;13i-O1;14c8;		2		1	40.00	7		00010		13i1;13i10;14c8;
H3815	051	0	1	01	01	H3815_051_0	10	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									12480	10483															2			13i1;13i3;13i10;13i-O1;14c8;		2		1	40.00	7		00010		13i1;13i10;14c8;
H3815	053	0	1	01	01	H3815_053_0	10	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									72	1															2			13i3;13i-O1;		2		2						
H3815	054	0	1	01	01	H3815_054_0	10	1	3	Package 1	01101111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									1596	1341															2			13i1;13i3;13i5;13i10;13i-O1;14c8;		2		1	50.00	7		00010		13i1;13i10;14c8;
H3815	055	0	1	01	01	H3815_055_0	11	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									1395	14															2			13i3;13i-O1;		2		2						
H3815	056	0	1	01	01	H3815_056_0	10	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									1	1															2			13i3;13i-O1;		2		2						
H3815	057	0	1	01	01	H3815_057_0	10	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									444	329															2			13i3;13i-O1;		2		2						
H3815	059	0	1	01	01	H3815_059_0	11	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									151	2															2			13i3;13i-O1;		2		2						
H3815	060	0	1	01	01	H3815_060_0	11	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									5394	3614															2			13i1;13i3;13i10;13i-O1;14c8;		2		1	0.00	7		00010		13i1;13i10;14c8;
H3815	061	0	1	01	01	H3815_061_0	10	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									76	1															2			13i3;13i-O1;		2		2						
H3817	008	1	1	04	01	H3817_008_1	7	1	2	Routine Podiatry														0100000000000000000														2			7f_2;	1	2		2						
H3817	008	2	1	04	01	H3817_008_2	7	1	2	Routine Podiatry														0100000000000000000														2			7f_2;	1	2		2						
H3817	008	4	1	04	01	H3817_008_4	8	1	2	Routine Podiatry														0100000000000000000														2			7f_2;	1	2		2						
H3817	009	1	1	04	01	H3817_009_1	7	1	2	Routine Podiatry														0100000000000000000														2			7f_2;	1	2		2						
H3817	009	2	1	04	01	H3817_009_2	7	1	2	Routine Podiatry														0100000000000000000														2			7f_2;	1	2		2						
H3817	010	0	1	04	01	H3817_010_0	5	1	2	Routine Podiatry														0100000000000000000														2			7f_2;	1	2		2						
H3817	011	1	1	04	01	H3817_011_1	10	1	2	Routine Podiatry														0100000000000000000														2			7f_2;	1	2		2						
H3817	011	2	1	04	01	H3817_011_2	10	1	2	Routine Podiatry														0100000000000000000														2			7f_2;	1	2		2						
H3817	011	3	1	04	01	H3817_011_3	10	1	2	Routine Podiatry														0100000000000000000														2			7f_2;	1	2		2						
H3817	801	0	1	04	01	H3817_801_0	3	1	2	Routine Podiatry														0100000000000000000														2			7f_2;	1	1	7f_2;	2						
H3817	802	0	1	04	01	H3817_802_0	3	1	2	Routine Podiatry														0100000000000000000														2			7f_2;	1	1	7f_2;	2						
H3822	017	0	1	02	01	H3822_017_0	8	1	3	SSBCI Grocery/Dietitian Benefit	00001101000000001000000000000000											700	140															1	001		13i1;14c2;	2	2		2						
H3822	018	0	1	02	01	H3822_018_0	7	1	3	SSBCI Grocery/Dietitian Benefit	00001101000000001000000000000000											399	199															1	001		13i1;14c2;	2	2		2						
H3832	007	0	1	04	01	H3832_007_0	8	1	2	OHTH 1														0110101000111000000	Pregnancy	End Stage Renal Disease (ESRD)	Metabolic Syndrome								2	2		2			16b4;16c3;	1	2		2						
H3832	007	0	1	04	01	H3832_007_0	8	2	2	OHTH 2														0000000000111000000	Oral Cancer	Sjorgens	Head and Neck Cancer								2	2		2			16b1;16b4;16b5;16c3;	1	2		2						
H3832	007	0	1	04	01	H3832_007_0	8	3	2	OHTH 3														0110101000111000000	Pregnancy	End Stage Renal Disease (ESRD)	Metabolic Syndrome								2	2		2			16c3;	1	2		2						
H3832	007	0	1	04	01	H3832_007_0	8	4	2	OHTH 4														0000000000111000000	Oral Cancer	Sjorgens	Head and Neck Cancer								2	2		2			16c3;	1	2		2						
H3832	009	0	1	04	01	H3832_009_0	8	3	2	OHTH 3														0110101000111000000	Pregnancy	End Stage Renal Disease (ESRD)	Metabolic Syndrome								2	2		2			16c3;	1	2		2						
H3832	009	0	1	04	01	H3832_009_0	8	4	2	OHTH 4														0000000000111000000	Oral Cancer	Sjorgens	Head and Neck Cancer								2	2		2			16c3;	1	2		2						
H3832	009	0	1	04	01	H3832_009_0	8	1	2	OHTH 1														0110101000111000000	Pregnancy	End Stage Renal Disease (ESRD)	Metabolic Syndrome								2	2		2			16b4;16c3;	1	2		2						
H3832	009	0	1	04	01	H3832_009_0	8	2	2	OHTH 2														0000000000111000000	Oral Cancer	Sjorgens	Head and Neck Cancer								2	2		2			16b1;16b4;16b5;16c3;	1	2		2						
H3832	014	0	1	04	01	H3832_014_0	8	3	2	OHTH 3														0110101000111000000	Pregnancy	End Stage Renal Disease (ESRD)	Metabolic Syndrome								2	2		2			16c3;	1	2		2						
H3832	014	0	1	04	01	H3832_014_0	8	2	2	OHTH 2														0000000000111000000	Oral Cancer	Sjorgens	Head and Neck Cancer								2	2		2			16b1;16b4;16b5;16c3;	1	2		2						
H3832	014	0	1	04	01	H3832_014_0	8	4	2	OHTH 4														0000000000111000000	Oral Cancer	Sjorgens	Head and Neck Cancer								2	2		2			16c3;	1	2		2						
H3832	014	0	1	04	01	H3832_014_0	8	1	2	OHTH 1														0110101000111000000	Pregnancy	End Stage Renal Disease (ESRD)	Metabolic Syndrome								2	2		2			16b4;16c3;	1	2		2						
H3832	015	0	1	04	01	H3832_015_0	9	3	2	OHTH 3														0110101000111000000	Pregnancy	End Stage Renal Disease (ESRD)	Metabolic Syndrome								2	2		2			16c3;	1	2		2						
H3832	015	0	1	04	01	H3832_015_0	9	4	2	OHTH 4														0000000000111000000	Oral Cancer	Sjorgens	Head and Neck Cancer								2	2		2			16c3;	1	2		2						
H3832	015	0	1	04	01	H3832_015_0	9	2	2	OHTH 2														0000000000111000000	Oral Cancer	Sjorgens	Head and Neck Cancer								2	2		2			16b1;16b4;16b5;16c3;	1	2		2						
H3832	015	0	1	04	01	H3832_015_0	9	1	2	OHTH 1														0110101000111000000	Pregnancy	End Stage Renal Disease (ESRD)	Metabolic Syndrome								2	2		2			16b4;16c3;	1	2		2						
H3868	001	0	1	02	01	H3868_001_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								53284	45292															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3868	003	1	1	02	01	H3868_003_1	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								5239	4453															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3868	003	2	1	02	01	H3868_003_2	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								13582	11545															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3868	003	3	1	02	01	H3868_003_3	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								20172	17146															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3868	004	1	1	02	01	H3868_004_1	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								36340	30889															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3868	004	2	1	02	01	H3868_004_2	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								11796	10027															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3868	005	0	1	02	01	H3868_005_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								2751	2338															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3868	007	0	1	02	01	H3868_007_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								3278	2786															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H3879	001	0	1	02	01	H3879_001_0	10	1	3	Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						239	131															2			13i4;	2	2		2						
H3879	002	0	1	02	01	H3879_002_0	11	1	3	Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						5	2															2			13i4;	2	2		2						
H3907	002	0	1	01	01	H3907_002_0	9	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes														0111000000000000000											1			2			13c;		1	13c;	2						
H3907	006	0	1	01	01	H3907_006_0	8	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes														0111000000000000000											1			2			13c;		1	13c;	2						
H3907	037	0	1	01	01	H3907_037_0	8	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes														0111000000000000000											1			2			13c;		1	13c;	2						
H3907	057	1	1	01	01	H3907_057_1	8	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes														0111000000000000000											1			2			13c;		1	13c;	2						
H3907	057	2	1	01	01	H3907_057_2	7	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes														0111000000000000000											1			2			13c;		1	13c;	2						
H3907	057	3	1	01	01	H3907_057_3	8	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes														0111000000000000000											1			2			13c;		1	13c;	2						
H3907	057	4	1	01	01	H3907_057_4	8	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes														0111000000000000000											1			2			13c;		1	13c;	2						
H3907	057	8	1	01	01	H3907_057_8	7	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes														0111000000000000000											1			2			13c;		1	13c;	2						
H3907	058	1	1	01	01	H3907_058_1	7	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes														0111000000000000000											1			2			13c;		1	13c;	2						
H3907	058	2	1	01	01	H3907_058_2	7	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes														0111000000000000000											1			2			13c;		1	13c;	2						
H3907	058	3	1	01	01	H3907_058_3	7	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes														0111000000000000000											1			2			13c;		1	13c;	2						
H3907	059	1	1	01	01	H3907_059_1	9	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes														0111000000000000000											1			2			13c;		1	13c;	2						
H3907	059	2	1	01	01	H3907_059_2	8	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes														0111000000000000000											1			2			13c;		1	13c;	2						
H3907	059	3	1	01	01	H3907_059_3	9	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes														0111000000000000000											1			2			13c;		1	13c;	2						
H3907	061	0	1	01	01	H3907_061_0	7	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes														0111000000000000000											1			2			13c;		1	13c;	2						
H3907	062	0	1	01	01	H3907_062_0	7	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes														0111000000000000000											1			2			13c;		1	13c;	2						
H3907	063	0	1	01	01	H3907_063_0	7	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes														0111000000000000000											1			2			13c;		1	13c;	2						
H3907	064	0	1	01	01	H3907_064_0	7	1	2	MA Uniformity Flexibility - CHF/COPD/Diabetes														0111000000000000000											1			2			13c;		1	13c;	2						
H3916	001	0	1	04	01	H3916_001_0	9	1	3	Healing at Home - In Home Support	00011110001001001000000000000000											198	1															2			14c21;	1	2		2						
H3916	022	0	1	04	01	H3916_022_0	8	1	3	Healing at Home - In Home Support	00011110001001001000000000000000											387	2															2			14c21;	1	2		2						
H3928	001	0	1	01	01	H3928_001_0	5	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							945	766															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	90.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3928	801	0	1	01	01	H3928_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3928	801	0	1	01	01	H3928_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3928	803	0	1	01	01	H3928_803_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3928	803	0	1	01	01	H3928_803_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3928	805	0	1	01	01	H3928_805_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3928	805	0	1	01	01	H3928_805_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3931	095	0	1	02	01	H3931_095_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1093	975															2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	180.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3931	099	0	1	02	01	H3931_099_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							9664	8850															2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	270.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3931	100	0	1	02	01	H3931_100_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							3071	2334															2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	45.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3931	157	0	1	01	01	H3931_157_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							219	156															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3931	160	0	1	01	01	H3931_160_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							190	135															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3931	175	0	1	01	01	H3931_175_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							642	625															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3931	191	0	1	01	01	H3931_191_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											319	292															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3931	196	0	1	01	01	H3931_196_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							824	814															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3931	801	0	1	01	01	H3931_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3931	801	0	1	01	01	H3931_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3931	804	0	1	01	01	H3931_804_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3931	804	0	1	01	01	H3931_804_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3931	808	0	1	01	01	H3931_808_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3931	808	0	1	01	01	H3931_808_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3949	009	0	1	01	01	H3949_009_0	6	1	3	Food and Produce	00001101000001001000000000000000											2476	1857															2			13i1;		2		2						
H3949	024	0	1	01	01	H3949_024_0	6	1	3	Food and Produce	00001101000000000000000000000000											1694	1271															2			13i1;		2		2						
H3952	008	0	1	01	01	H3952_008_0	6	2	2	Package # 2 - Transportation														0101000000000000000											1			2			10b1;		2		2						
H3952	008	0	1	01	01	H3952_008_0	6	1	3	Package #1 - Food	00010101000000100000000000000000											31	8															1	001		13i1;13i2;		2		2						
H3952	008	0	1	01	01	H3952_008_0	6	3	2	Package #3 - PERS														1000100001111111000	Multiple Sclerosis and Transverse Myelitis	Fibromyalgia, Chronic Pain and Fatigue	Mobility Impairments	Osteoporosis with or without Pathological Fracture	Cerebral Palsy	Muscular Dystrophy	Parkinson's Disease and Secondary Parkinsonism				2	2		2			14c11;		2		2						
H3952	020	0	1	01	01	H3952_020_0	7	2	2	Package # 2 - Transportation														0101000000000000000											1			2			10b1;		2		2						
H3952	020	0	1	01	01	H3952_020_0	7	3	2	Package #3 - PERS														1000100001111111000	Multiple Sclerosis and Transverse Myelitis	Fibromyalgia, Chronic Pain and Fatigue	Mobility Impairments	Osteoporosis with or without Pathological Fracture	Cerebral Palsy	Muscular Dystrophy	Parkinson's Disease and Secondary Parkinsonism				2	2		2			14c11;		2		2						
H3952	020	0	1	01	01	H3952_020_0	7	1	3	Package #1 - Food	00010101000000100000000000000000											226	52															1	001		13i1;13i2;		2		2						
H3952	045	0	1	01	01	H3952_045_0	7	2	2	Package # 2 - Transportation														0101000000000000000											1			2			10b1;		2		2						
H3952	045	0	1	01	01	H3952_045_0	7	3	2	Package #3 - PERS														1000100001111111000	Multiple Sclerosis and Transverse Myelitis	Fibromyalgia, Chronic Pain and Fatigue	Mobility Impairments	Osteoporosis with or without Pathological Fracture	Cerebral Palsy	Muscular Dystrophy	Parkinson's Disease and Secondary Parkinsonism				2	2		2			14c11;		2		2						
H3952	045	0	1	01	01	H3952_045_0	7	1	3	Package #1 - Food	00010101000000100000000000000000											134	32															1	001		13i1;13i2;		2		2						
H3952	048	0	1	01	01	H3952_048_0	6	3	2	Package 3 - PERS														1000100001111111000	Multiple Sclerosis and Transverse Myelitis	Fibromyalgia, Chronic Pain and Fatigue	Mobility Impairments	Osteoporosis with or without Pathological Fracture	Cerebral Palsy	Muscular Dystrophy	Parkinson's Disease and Secondary Parkinsonism				2	2		2			14c11;		2		2						
H3952	048	0	1	01	01	H3952_048_0	6	1	3	Package 1 - Food	00010101000000100000000000000000											64	21															1	001		13i1;13i2;		2		2						
H3952	048	0	1	01	01	H3952_048_0	6	2	2	Package 2 - Transportation														0101000000000000000											1			2			10b1;		2		2						
H3952	049	0	1	01	01	H3952_049_0	7	1	3	Package 1 - Food	00010101000000100000000000000000											773	252															1	001		13i1;13i2;		2		2						
H3952	049	0	1	01	01	H3952_049_0	7	3	2	Package 3 - PERS														1000100001111111000	Multiple Sclerosis and Transverse Myelitis	Fibromyalgia, Chronic Pain and Fatigue	Mobility Impairments	Osteoporosis with or without Pathological Fracture	Cerebral Palsy	Muscular Dystrophy	Parkinson's Disease and Secondary Parkinsonism				2	2		2			14c11;		2		2						
H3952	049	0	1	01	01	H3952_049_0	7	2	2	Package 2 - Transportation														0101000000000000000											1			2			10b1;		2		2						
H3952	050	0	1	01	01	H3952_050_0	6	1	3	Package 1 - Food	00010101000000100000000000000000											48	18															1	001		13i1;13i2;		2		2						
H3952	050	0	1	01	01	H3952_050_0	6	3	2	Package 3 - PERS														1000100001111111000	Multiple Sclerosis and Transverse Myelitis	Fibromyalgia, Chronic Pain and Fatigue	Mobility Impairments	Osteoporosis with or without Pathological Fracture	Cerebral Palsy	Muscular Dystrophy	Parkinson's Disease and Secondary Parkinsonism				2	2		2			14c11;		2		2						
H3952	050	0	1	01	01	H3952_050_0	6	2	2	Package 2 - Transportation														0101000000000000000											1			2			10b1;		2		2						
H3952	051	0	1	01	01	H3952_051_0	7	1	3	Package 1 - Food	00010101000000100000000000000000											5711	183															1	001		13i1;13i2;		2		2						
H3952	051	0	1	01	01	H3952_051_0	7	2	2	Package 2 - Transportation														0101000000000000000											1			2			10b1;		2		2						
H3952	051	0	1	01	01	H3952_051_0	7	3	2	Package 3 - PERS														1000100001111111000	Multiple Sclerosis and Transverse Myelitis	Fibromyalgia, Chronic Pain and Fatigue	Mobility Impairments	Osteoporosis with or without Pathological Fracture	Cerebral Palsy	Muscular Dystrophy	Parkinson's Disease and Secondary Parkinsonism				2	2		2			14c11;		2		2						
H3952	053	0	1	02	01	H3952_053_0	7	2	2	Package 2 - Transportation														0101000000000000000											1			2			10b1;	2	2		2						
H3952	053	0	1	02	01	H3952_053_0	7	1	3	Package 1 - Food	00010101000000100000000000000000											811	361															1	001		13i1;13i2;	2	2		2						
H3952	053	0	1	02	01	H3952_053_0	7	3	2	Package 3 - PERS														1000100001111111000	Multiple Sclerosis and Transverse Myelitis	Fibromyalgia, Chronic Pain and Fatigue	Mobility Impairments	Osteoporosis With or Without Pathological Fracture	Cerebral Palsy	Muscular Dystrophy	Parkinson's Disease and Secondary Parkinsonism				2	2		2			14c11;	2	2		2						
H3952	054	0	1	02	01	H3952_054_0	7	2	2	Package 2 - Transportation														0101000000000000000											1			2			10b1;	2	2		2						
H3952	054	0	1	02	01	H3952_054_0	7	3	2	Package 3 - PERS														1000100001111111000	Multiple Sclerosis and Transverse Myelitis	Fibromyalgia, Chronic Pain and Fatigue	Mobility Impairments	Osteoporosis With or Without Pathological Fracture	Cerebral Palsy	Muscular Dystrophy	Parkinson's Disease and Secondary Parkinsonism				2	2		2			14c11;	2	2		2						
H3952	054	0	1	02	01	H3952_054_0	7	1	3	Package 1 - Food	00010101000000100000000000000000											358	155															1	001		13i1;13i2;	2	2		2						
H3952	060	0	1	02	01	H3952_060_0	7	2	2	Package 2 - PERS														1000100001111111000	Multiple Sclerosis and Transverse Myelitis	Fibromyalgia, Chronic Pain and Fatigue	Mobility Impairments	Osteoporosis With or Without Pathological Fracture	Cerebral Palsy	Muscular Dystrophy	Parkinson's Disease and Secondary Parkinsonism				2	2		2			14c11;	2	2		2						
H3952	060	0	1	02	01	H3952_060_0	7	1	3	Package 1 - Food	00010101000000000000000000000000											93	11															1	001		13i2;	2	2		2						
H3952	062	0	1	01	01	H3952_062_0	7	1	3	Package 1 - Food	00010101000000000000000000000000											159	13															1	001		13i2;		2		2						
H3952	062	0	1	01	01	H3952_062_0	7	2	2	Package 2 - PERS														1000100001111111000	Multiple Sclerosis and Transverse Myelitis	Muscular Dystrophy	Cerebral Palsy	Parkinsons Disease and Secondary Parkinsonism	Fibromyalgia Chronic Pain and Fatigue	Mobility Impairments	Osteoporosis With or Without Pathological Fracture				2	2		2			14c11;		2		2						
H3954	097	0	1	01	01	H3954_097_0	5	1	3	Healthy Foods and Utilities	01111111111111111111111000000000											8100	8100															2			13i1;13i10;		2		1	0.00	7		00010		13i1;13i10;
H3957	031	0	1	02	01	H3957_031_0	9	1	3	Healing at Home- In Home Support	00011110001001001000000000000000											1488	1															2			14c21;	2	2		2						
H3957	045	1	1	02	01	H3957_045_1	8	1	3	Healing at Home- In Home Support	00011110001001001000000000000000											513	1															2			14c21;	2	2		2						
H3957	046	1	1	02	01	H3957_046_1	8	1	3	Healing at Home - In Home Support	00011110001001001000000000000000											696	1															2			14c21;	2	2		2						
H3957	047	1	1	01	01	H3957_047_1	9	1	3	Healing at Home	00011110001001001000000000000000											1734	1															2			14c21;		2		2						
H3957	048	0	1	01	01	H3957_048_0	11	1	3	Healing at Home- In Home Support	00011110001001001000000000000000											988	1															2			14c21;		2		2						
H3957	050	1	1	01	01	H3957_050_1	8	1	3	Healing at Home- In Home Support	00011110001001001000000000000000											728	1															2			14c21;		2		2						
H3959	001	0	1	02	01	H3959_001_0	3	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	2	1	14c21;	2						
H3959	002	0	1	02	01	H3959_002_0	3	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	2	1	14c21;	2						
H3959	010	0	1	02	01	H3959_010_0	3	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	2	1	14c21;	2						
H3959	010	0	1	02	01	H3959_010_0	3	3	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							5743	4950															2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	75.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	010	0	1	02	01	H3959_010_0	3	1	2	Hypertension & Hyperlipidemia														0000010000100000000	Hyperlipidemia										2	2		2			10b1;13b;	2	1	10b1;13b;	2						
H3959	011	0	1	02	01	H3959_011_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							21835	18821															2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	75.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	011	0	1	02	01	H3959_011_0	3	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	2	1	14c21;	2						
H3959	011	0	1	02	01	H3959_011_0	3	3	2	Hypertension & Hyperlipidemia														0000010000100000000	Hyperlipidemia										2	2		2			10b1;13b;	2	1	10b1;13b;	2						
H3959	032	0	1	02	01	H3959_032_0	3	2	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							19639	16929															2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	75.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	032	0	1	02	01	H3959_032_0	3	3	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	2	1	14c21;	2						
H3959	032	0	1	02	01	H3959_032_0	3	1	2	Hypertension & Hyperlipidemia														0000010000100000000	Hyperlipidemia										2	2		2			10b1;13b;	2	1	10b1;13b;	2						
H3959	033	0	1	02	01	H3959_033_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1612	1390															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	105.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	035	0	1	01	01	H3959_035_0	3	3	2	In-Home Support-Personal Care Services														0000000000100000000	Individuals with significant functional challenges from neuro, musculoskeletal & sensory impairments													1	001		14c21;		1	14c21;	2						
H3959	035	0	1	01	01	H3959_035_0	3	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H3959	035	0	1	01	01	H3959_035_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							22862	22839															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	036	0	1	01	01	H3959_036_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							28244	28244															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	036	0	1	01	01	H3959_036_0	3	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H3959	036	0	1	01	01	H3959_036_0	3	3	2	In-Home Support-Personal Care Services														0000000000100000000	Individuals with significant functional challenges from neuro, musculoskeletal & sensory impairments													1	001		14c21;		1	14c21;	2						
H3959	037	0	1	02	01	H3959_037_0	3	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	2	1	14c21;	2						
H3959	041	0	1	02	01	H3959_041_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							11353	10076															2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	175.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	052	0	1	02	01	H3959_052_0	3	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	2	1	14c21;	2						
H3959	053	0	1	02	01	H3959_053_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1386	976															2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	25.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	056	0	1	01	01	H3959_056_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							676	479															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	066	0	1	01	01	H3959_066_0	4	1	3	SSBCI Pkg	01000110001001110000000000000000											1431	421															1	001		13i6;		1	13i6;	2						
H3959	074	0	1	01	01	H3959_074_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											4305	3973															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	075	0	1	01	01	H3959_075_0	3	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H3959	075	0	1	01	01	H3959_075_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											1900	1749															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	076	0	1	01	01	H3959_076_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											1876	1707															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	076	0	1	01	01	H3959_076_0	3	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H3959	083	0	1	01	01	H3959_083_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											714	684															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	084	0	1	01	01	H3959_084_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											1269	1093															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	085	0	1	01	01	H3959_085_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											2033	1867															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	088	0	1	01	01	H3959_088_0	3	3	2	In-Home Support-Personal Care Services														0000000000100000000	Individuals with significant functional challenges from neuro, musculoskeletal & sensory impairments													1	001		14c21;		1	14c21;	2						
H3959	088	0	1	01	01	H3959_088_0	3	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H3959	088	0	1	01	01	H3959_088_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1874	1874															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	089	0	1	01	01	H3959_089_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							7449	7449															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	089	0	1	01	01	H3959_089_0	3	3	2	In-Home Support-Personal Care Services														0000000000100000000	Individuals with significant functional challenges from neuro, musculoskeletal & sensory impairments													1	001		14c21;		1	14c21;	2						
H3959	089	0	1	01	01	H3959_089_0	3	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H3959	090	0	1	01	01	H3959_090_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							5096	5096															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	090	0	1	01	01	H3959_090_0	3	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H3959	090	0	1	01	01	H3959_090_0	3	3	2	In-Home Support-Personal Care Services														0000000000100000000	Individuals with significant functional challenges from neuro, musculoskeletal & sensory impairments													1	001		14c21;		1	14c21;	2						
H3959	091	0	1	01	01	H3959_091_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							2494	2494															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	091	0	1	01	01	H3959_091_0	3	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H3959	091	0	1	01	01	H3959_091_0	3	3	2	In-Home Support-Personal Care Services														0000000000100000000	Individuals with significant functional challenges from neuro, musculoskeletal & sensory impairments													1	001		14c21;		1	14c21;	2						
H3959	092	0	1	01	01	H3959_092_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							4605	4605															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	092	0	1	01	01	H3959_092_0	3	3	2	In-Home Support-Personal Care Services														0000000000100000000	Individuals with significant functional challenges from neuro, musculoskeletal & sensory impairments													1	001		14c21;		1	14c21;	2						
H3959	092	0	1	01	01	H3959_092_0	3	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;		1	14c21;	2						
H3959	097	0	1	01	01	H3959_097_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											143	121															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	098	0	1	01	01	H3959_098_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											144	131															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H3959	804	0	1	01	01	H3959_804_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H3959	804	0	1	01	01	H3959_804_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H4003	009	0	1	01	01	H4003_009_0	4	1	3	SSBCI Coverage	01111111111111111111111111100000	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic back pain							3806	2720															2			13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;		2		1	55.00	7		00010		13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4003	017	0	1	01	01	H4003_017_0	5	1	3	SSBCI Coverage	01111111111111111111111111100000	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain							30152	29226															2			13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;		2		1	85.00	7		00010		13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4003	034	0	1	02	01	H4003_034_0	4	1	3	SSBCI Coverage	01111111111111111111111111100000	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic back pain							11602	9382															2			13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;	2	2		1	85.00	7		00010		13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4003	055	0	1	02	01	H4003_055_0	4	1	3	SSBCI Coverage	01111111111111111111111111100000	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain							4220	308															2			13i3;13i4;13i5;13i10;	2	2		2						
H4003	058	0	1	01	01	H4003_058_0	4	1	3	SSBCI Coverage	01111111111111111111111111100000	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic back pain							2917	2788															2			13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;		2		1	145.00	7		00010		13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4003	059	1	1	02	01	H4003_059_1	4	1	3	SSBCI Coverage	01111111111111111111111111100000	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain							4292	3697															2			13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;	2	2		1	160.00	7		00010		13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4003	059	2	1	02	01	H4003_059_2	4	1	3	SSBCI Coverage	01111111111111111111111111100000	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain							5769	4969															2			13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;	2	2		1	100.00	7		00010		13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4003	059	3	1	02	01	H4003_059_3	4	1	3	SSBCI Coverage	01111111111111111111111111100000	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain							11945	10287															2			13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;	2	2		1	25.00	7		00010		13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	048	0	1	01	01	H4004_048_0	4	1	3	SSBCI Coverage	01111111111111111111111111100000	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic back pain							4554	4307															2			13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;		2		1	85.00	7		00010		13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	056	0	1	02	01	H4004_056_0	4	1	3	SSBCI Coverage	01111111111111111111111111100000	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain							2540	2397															2			13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;	2	2		1	70.00	7		00010		13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	065	0	1	02	01	H4004_065_0	4	1	3	SSBCI Coverage	01111111111111111111111111100000	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain							12947	12547															2			13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;	2	2		1	42.00	7		00010		13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	066	0	1	02	01	H4004_066_0	4	1	3	SSBCI Coverage	01111111111111111111111111100000	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic back pain							1542	1254															2			13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;	2	2		1	5.00	7		00010		13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	068	0	1	01	01	H4004_068_0	4	1	3	SSBCI Coverage	01111111111111111111111111100000	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic back pain							6946	6640															2			13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;		2		1	120.00	7		00010		13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	070	0	1	02	01	H4004_070_0	4	1	3	SSBCI Coverage	01111111111111111111111111100000	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic back pain							3474	3389															2			13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;	2	2		1	92.00	7		00010		13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	071	0	1	02	01	H4004_071_0	4	1	3	SSBCI Coverage	01111111111111111111111111100000	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain							1294	1264															2			13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;	2	2		1	132.00	7		00010		13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	072	1	1	01	01	H4004_072_1	4	1	3	SSBCI Coverage	01111111111111111111111111100000	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain							4928	4721															2			13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;		2		1	210.00	7		00010		13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	072	2	1	01	01	H4004_072_2	4	1	3	SSBCI Coverage	01111111111111111111111111100000	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain							15921	15251															2			13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;		2		1	95.00	7		00010		13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	072	3	1	01	01	H4004_072_3	4	1	3	SSBCI Coverage	01111111111111111111111111100000	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain							11117	10649															2			13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;		2		1	100.00	7		00010		13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	073	1	1	02	01	H4004_073_1	4	1	3	SSBCI Coverage	01111111111111111111111111100000	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain							1689	1652															2			13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;	2	2		1	77.00	7		00010		13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	073	2	1	02	01	H4004_073_2	4	1	3	SSBCI Coverage	01111111111111111111111111100000	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain							7133	6976															2			13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;	2	2		1	63.00	7		00010		13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	073	3	1	02	01	H4004_073_3	4	1	3	SSBCI Coverage	01111111111111111111111111100000	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain							3325	3252															2			13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;	2	2		1	72.00	7		00010		13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	075	0	1	02	01	H4004_075_0	4	1	3	SSBCI Coverage	01111111111111111111111111100000	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain							548	506															2			13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;	2	2		1	75.00	7		00010		13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	076	1	1	01	01	H4004_076_1	4	1	3	SSBCI Coverage	01111111111111111111111111100000	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain							1559	1378															2			13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;		2		1	185.00	7		00010		13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	076	2	1	01	01	H4004_076_2	4	1	3	SSBCI Coverage	01111111111111111111111111100000	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain							2958	2614															2			13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;		2		1	155.00	7		00010		13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4004	076	3	1	01	01	H4004_076_3	4	1	3	SSBCI Coverage	01111111111111111111111111100000	Chronic Hypertension	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%	Osteoporosis	Chronic Back Pain							7830	6919															2			13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;		2		1	175.00	7		00010		13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;13i-O1;13i-O3;14c4;14c8;16b1;16b2;16b3;16c1;16c2;16c3;16c4;16c6;16c7;16c8;16c10;17b1;17b2;17b5;18a2;18b1;
H4032	001	0	1	02	01	H4032_001_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								6129	5210															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H4032	002	0	1	02	01	H4032_002_0	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								2468	2098															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H4032	003	0	1	02	01	H4032_003_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								3272	2781															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H4054	001	0	1	01	01	H4054_001_0	7	1	3	Digital Communications and Essential Clothing	01111111111111111111111000000000											2407	2006															2			13i10;		2		1	150.00	5		00010		13i10;
H4057	001	0	1	01	01	H4057_001_0	4	1	3	Grocery Debit Card and Online Benefit	00001111100101011000000000000000											1600	960															2			13i1;		1	13i1;	1	101.00	5		01010		13i1;
H4073	003	0	1	02	01	H4073_003_0	5	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										202	188															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H4073	004	0	1	02	01	H4073_004_0	5	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										712	660															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H4086	001	0	1	04	01	H4086_001_0	10	1	3	SSBCI	01111111111111111111111000000000											208	42															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	5		00011		13i1;13i10;
H4086	002	0	1	04	01	H4086_002_0	10	1	3	SSBCI	01111111111111111111111000000000											498	100															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		00011		13i1;13i10;
H4091	001	0	1	04	01	H4091_001_0	4	1	3	SSBCI Package	01111111111111111111111000000000											2805	2618															2			13i1;13i6;13i10;13i-O1;	1	2		1	0.00	7		00010		13i1;13i6;13i10;13i-O1;
H4091	002	0	1	04	01	H4091_002_0	4	1	3	Food, Produce, Rent & Utilities, Hygiene, Clothing	01111111111111111111111000000000											1036	967															2			13i1;13i6;13i10;13i-O1;	1	2		1	0.00	7		00010		13i1;13i6;13i10;13i-O1;
H4091	003	0	1	04	01	H4091_003_0	4	1	3	SSBCI Package	00001111000001101000000100000000	Chronic malnutrition including failure to thrive										26	24															2			13i1;13i6;13i10;13i-O1;	1	2		1	0.00	7		00010		13i1;13i6;13i10;13i-O1;
H4093	001	0	1	01	01	H4093_001_0	7	1	3	Essential Clothing Items	01111111111111111111111000000000											705	587															2			13i10;		2		2						
H4093	009	0	1	01	01	H4093_009_0	4	1	3	Food and Produce and Essential Clothing	01111111111111111111111000000000											45	38															2			13i1;13i10;		2		2						
H4093	010	0	1	01	01	H4093_010_0	4	1	3	Food and Produce and Essential Clothing	01111111111111111111111000000000											5	5															2			13i1;13i10;		2		2						
H4127	001	0	1	01	01	H4127_001_0	9	1	3	OTC Benefit	01111111111111111111111111000000	osteoporosis	chronic hypertension	chronic hyperlipidemia								442	111															2			13i10;13i-O2;		1	13i10;13i-O2;	1	0.00	5		01010		13i10;13i-O2;
H4127	002	0	1	01	01	H4127_002_0	9	1	3	OTC Benefit	01111111111111111111111111000000	osteoporosis	chronic hypertension	chronic hyperlipidemia								47	14															2			13i10;13i-O2;		1	13i10;13i-O2;	1	0.00	5		01010		13i10;13i-O2;
H4140	013	0	1	01	01	H4140_013_0	8	1	3	SSBCI Package	01111111110111111011111111000000	Chronic Hypertension	Osteoporosis	Chronic Back Pain								5539	5484															2			13b;13i1;13i2;13i4;13i10;13i-O1;13i-O2;14c4;		1	13b;13i1;13i2;13i4;13i10;13i-O1;13i-O2;14c4;	1	422.00	7		01010		13b;13i1;13i2;13i4;13i10;13i-O1;13i-O2;14c4;
H4140	017	0	1	01	01	H4140_017_0	8	1	3	SSBCI Package	01111111110111111011111111000000	Chronic Hypertension	Osteoporosis	Chronic Back Pain								100	99															2			13b;13i1;13i2;13i4;13i10;13i-O1;13i-O2;14c4;		1	13b;13i1;13i2;13i4;13i10;13i-O1;13i-O2;14c4;	1	313.00	7		01010		13b;13i1;13i2;13i4;13i10;13i-O1;13i-O2;14c4;
H4140	020	0	1	01	01	H4140_020_0	8	1	3	SSBCI Package	01111111110111111011111111000000	Chronic Hypertension	Osteoporosis	Chronic Back Pain								8853	8764															2			13b;13i1;13i2;13i4;13i10;13i-O1;13i-O2;14c4;		1	13b;13i1;13i2;13i4;13i10;13i-O1;13i-O2;14c4;	1	300.00	7		01010		13b;13i1;13i2;13i4;13i10;13i-O1;13i-O2;14c4;
H4140	021	0	1	01	01	H4140_021_0	8	1	3	SSBCI Package	01111111110111111011111111000000	Chronic Hypertension	Osteoporosis	Chronic Back Pain								236	234															2			13b;13i1;13i2;13i4;13i10;13i-O1;13i-O2;14c4;		1	13b;13i1;13i2;13i4;13i10;13i-O1;13i-O2;14c4;	1	209.00	7		01010		13b;13i1;13i2;13i4;13i10;13i-O1;13i-O2;14c4;
H4140	023	0	1	01	01	H4140_023_0	9	1	3	SSBCI Package	01111111110111111011111111000000	Chronic Hypertension	Osteoporosis	Chronic Back Pain								5768	5595															2			13b;13i1;13i2;13i4;13i10;13i-O1;13i-O2;		2		1	143.00	7		01010		13b;13i1;13i2;13i4;13i10;13i-O1;13i-O2;
H4140	024	0	1	01	01	H4140_024_0	8	1	3	SSBCI Package	00001101000000000000000000000000											1637	1621															2			13b;13i1;13i2;13i4;13i10;13i-O1;13i-O2;		1	13b;13i1;13i2;13i4;13i10;13i-O1;13i-O2;	1	188.00	7		01010		13b;13i1;13i2;13i4;13i10;13i-O1;13i-O2;
H4140	025	0	1	01	01	H4140_025_0	9	1	3	SSBCI Package	01111111110111111011111111000000	Chronic Hypertension	Osteoporosis	Chronic Back Pain								471	466															2			13i1;13i2;13i4;13i10;13i-O1;13i-O2;		2		1	53.00	7		00010		13i1;13i2;13i4;13i10;13i-O1;13i-O2;
H4141	003	0	1	01	01	H4141_003_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									12158	12158															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4141	003	0	1	01	01	H4141_003_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H4141	015	0	1	01	01	H4141_015_0	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4141	017	3	1	01	01	H4141_017_3	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4141	017	5	1	01	01	H4141_017_5	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4141	022	0	1	01	01	H4141_022_0	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H4141	023	0	1	01	01	H4141_023_0	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H4141	024	0	1	01	01	H4141_024_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									17654	17654															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4141	024	0	1	01	01	H4141_024_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H4152	021	0	1	01	01	H4152_021_0	7	1	3	Food/Produce/Utility	01111111111111111111111000000000											3871	3553															2			13i1;13i10;		2		1	0.00	7		01010		13i1;13i10;
H4152	022	0	1	02	01	H4152_022_0	6	1	3	OTC/Food & Produce	01111111111111111111111000000000											2127	1761															2			13b;13i1;	2	2		1	41.67	7		01010		13b;13i1;
H4158	001	0	1	01	01	H4158_001_0	8	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										3338	3171															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H4158	002	0	1	01	01	H4158_002_0	5	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										402	382															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H4158	003	0	1	01	01	H4158_003_0	5	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										203	193															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H4158	004	0	1	01	01	H4158_004_0	8	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										7359	6991															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H4161	004	0	1	02	01	H4161_004_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							1320	465															2			13i1;13i10;	2	2		2						
H4161	014	0	1	02	01	H4161_014_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							1570	1012															2			13i1;13i10;	2	2		2						
H4161	015	0	1	02	01	H4161_015_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							712	489															2			13i1;13i10;	2	2		2						
H4161	016	0	1	02	01	H4161_016_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							282	182															2			13i1;13i10;	2	2		2						
H4161	017	0	1	02	01	H4161_017_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							141	115															2			13i1;13i2;13i10;	2	2		2						
H4172	001	0	1	01	01	H4172_001_0	7	1	3	Beauty and Barber Shop, Hygiene, Clothing	01111111111111111111111111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								1395	930															2			13i10;13i-O1;13i-O2;		1	13i10;13i-O1;13i-O2;	1	0.00	5		01000		13i10;13i-O1;13i-O2;
H4172	003	0	1	01	01	H4172_003_0	8	1	3	Food and Barbershop, Hygiene, Clothing	01111111111111111111111111000000	Osteoporosis	Chronic Hypertension	Chronic Hyperlipidemia								191	178															2			13i1;13i10;13i-O1;13i-O2;		1	13i1;13i10;13i-O1;13i-O2;	1	0.00	5		00010		13i1;13i10;13i-O1;13i-O2;
H4193	001	0	1	01	01	H4193_001_0	6	1	3	Healthy Benefits+	01111111111111111111111000000000											3492	2716															2			13i1;13i10;13i-O1;		1	13i1;13i10;13i-O1;	1	0.00	7		01010		13i1;13i10;13i-O1;
H4227	001	0	1	01	01	H4227_001_0	6	1	3	Package 1	00001111110001101000000100000000	Connective Tissue Disease										10210	6739															2			13i1;13i3;13i4;13i10;		1	13i1;13i3;13i4;13i10;	1	0.00	7		01011		13i1;13i3;13i4;13i10;
H4227	002	0	1	01	01	H4227_002_0	6	1	3	Package 1	00001111110001101000000100000000	Connective Tissue Disease										6212	4100															2			13i1;13i3;13i4;13i10;		1	13i1;13i3;13i4;13i10;	1	0.00	7		01011		13i1;13i3;13i4;13i10;
H4279	007	1	1	01	01	H4279_007_1	9	1	3	Healthy Food/Non-Medical Transportation/Utilities	01111111111111111111110000000000											22751	22004															2			13i1;13i4;13i10;		2		2						
H4279	007	2	1	01	01	H4279_007_2	9	1	3	Healthy Food/Non-Medical Transportation/Utilities	01111111111111111111110000000000											7776	4988															2			13i1;13i4;13i10;		2		2						
H4279	007	3	1	01	01	H4279_007_3	9	1	3	Healthy Food/Non-Medical Transportation/Utilities	01111111111111111111110000000000											3993	3890															2			13i1;13i4;13i10;		2		2						
H4279	007	4	1	01	01	H4279_007_4	9	1	3	Healthy Food/Non-Medical Transportation/Utilities	01111111111111111111110000000000											1131	1098															2			13i1;13i4;13i10;		2		2						
H4286	001	0	1	01	01	H4286_001_0	10	1	3	Flex Card	01111111111111111111111111100000	Prediabetes	Chronic Hypertension	Chronic Hypercholesterolemia	Osteoporosis							12206	12084															1	001		13i1;13i2;13i3;13i4;13i10;13i-O1;14c4;14c11;14c17;		2		1	0.00	7		00010		13i1;13i2;13i3;13i4;13i10;13i-O1;14c4;14c11;14c17;
H4286	002	0	1	01	01	H4286_002_0	10	1	3	Flex Card	01111111111111111111111111100000	Prediabetes	Chronic Hypertension	Chronic Hypercholesterolemia	Osteoporosis							9129	9037															1	001		13i1;13i2;13i3;13i4;13i10;13i-O1;14c4;14c11;14c17;		2		1	0.00	7		00010		13i1;13i2;13i3;13i4;13i10;13i-O1;14c4;14c11;14c17;
H4286	005	0	1	01	01	H4286_005_0	10	1	3	Flex Card	01111111111111111111111111100000	Prediabetes	Chronic Hypertension	Chronic Hypercholesterolemia	Osteoporosis							9669	9572															1	001		13i1;13i2;13i3;13i4;13i10;13i-O1;14c4;14c11;14c17;		2		1	0.00	7		00010		13i1;13i2;13i3;13i4;13i10;13i-O1;14c4;14c11;14c17;
H4329	001	0	1	01	01	H4329_001_0	4	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									50096	50096															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		1	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H4329	001	0	1	01	01	H4329_001_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H4346	005	0	1	02	01	H4346_005_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							158	93															2			13i1;13i10;	2	2		2						
H4346	006	0	1	02	01	H4346_006_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							984	648															2			13i1;13i10;	2	2		2						
H4346	014	0	1	01	01	H4346_014_0	6	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							1156	876															2			13i1;13i10;		2		2						
H4346	025	0	1	01	01	H4346_025_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							173	124															2			13i1;13i10;		2		2						
H4346	030	0	1	02	01	H4346_030_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							18	16															2			13i1;13i10;	2	2		2						
H4346	031	0	1	01	01	H4346_031_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							152	136															2			13i1;13i10;		2		2						
H4346	037	0	1	02	01	H4346_037_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							399	348															2			13i1;	2	2		2						
H4348	003	0	1	04	01	H4348_003_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											216	194															2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H4348	004	0	1	04	01	H4348_004_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											334	300															2			13i1;13i10;	1	1	13i1;13i10;	1	334.00	7		00010		13i1;13i10;
H4348	007	0	1	04	01	H4348_007_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											175	157															2			13i1;13i10;	1	1	13i1;13i10;	1	175.00	7		00010		13i1;13i10;
H4367	001	0	1	01	01	H4367_001_0	5	1	3	SSBCI	01111111111111111111111000000000											429	386															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H4367	002	0	1	01	01	H4367_002_0	5	1	3	SSBCI	01111111111111111111111000000000											422	380															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H4407	004	0	1	01	01	H4407_004_0	5	1	3	Food and Produce	00001101000001001000000000000000											533	400															2			13i1;		2		2						
H4407	029	0	1	01	01	H4407_029_0	5	1	3	Food and Produce	00001101000001001000000000000000											379	284															2			13i1;		2		2						
H4407	034	0	1	01	01	H4407_034_0	5	1	3	Food and Produce	00001101000000000000000000000000											1219	914															2			13i1;		2		2						
H4439	001	0	1	01	01	H4439_001_0	6	1	3	Essential Clothing Items	01111111111111111111111000000000											14	11															2			13i10;		2		2						
H4439	004	0	1	01	01	H4439_004_0	3	1	3	Food and Produce and Essential Clothing	01111111111111111111111000000000											55	46															2			13i1;13i10;		2		2						
H4439	005	0	1	01	01	H4439_005_0	3	1	3	Food and Produce and Digital, Essential Clothing	01111111111111111111111000000000											44	37															2			13i1;13i10;		2		1	300.00	5		00010		13i1;13i10;
H4444	001	0	1	01	01	H4444_001_0	7	1	3	Food and Produce and Essential Clothing	01111111111111111111111000000000											4352	3631															2			13i1;13i10;		2		2						
H4444	003	0	1	01	01	H4444_003_0	7	1	3	Food and Produce and Essential Clothing	01111111111111111111111000000000											59	50															2			13i1;13i10;		2		2						
H4444	004	0	1	01	01	H4444_004_0	4	1	3	Food and Produce and Essential Clothing	01111111111111111111111000000000											162	135															2			13i1;13i10;		2		2						
H4461	004	0	1	01	01	H4461_004_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	022	0	1	01	01	H4461_022_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H4461	022	0	1	01	01	H4461_022_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H4461	022	0	1	01	01	H4461_022_0	4	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									1833	1833															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		1	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H4461	025	0	1	01	01	H4461_025_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	038	0	1	01	01	H4461_038_0	4	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									3666	3666															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		1	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H4461	038	0	1	01	01	H4461_038_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H4461	039	0	1	01	01	H4461_039_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H4461	042	0	1	01	01	H4461_042_0	6	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H4461	042	0	1	01	01	H4461_042_0	6	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									8447	8447															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	042	0	1	01	01	H4461_042_0	6	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H4461	043	1	1	01	01	H4461_043_1	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	043	2	1	01	01	H4461_043_2	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H4461	044	0	1	02	01	H4461_044_0	5	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H4461	044	0	1	02	01	H4461_044_0	5	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H4461	044	0	1	02	01	H4461_044_0	5	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									11045	11045															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	045	0	1	01	01	H4461_045_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H4461	046	0	1	01	01	H4461_046_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	047	0	1	02	01	H4461_047_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H4461	048	0	1	02	01	H4461_048_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H4461	049	0	1	01	01	H4461_049_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	049	0	1	01	01	H4461_049_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H4461	050	0	1	01	01	H4461_050_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H4461	050	0	1	01	01	H4461_050_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	051	0	1	01	01	H4461_051_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	052	0	1	01	01	H4461_052_0	4	1	3	Chronic Condition Care Assistance	01111111001111111100000000000000											975	13															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H4461	052	0	1	01	01	H4461_052_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H4461	052	0	1	01	01	H4461_052_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	053	0	1	01	01	H4461_053_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H4461	053	0	1	01	01	H4461_053_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	054	0	1	01	01	H4461_054_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	054	0	1	01	01	H4461_054_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H4461	055	0	1	01	01	H4461_055_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	055	0	1	01	01	H4461_055_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H4461	056	0	1	01	01	H4461_056_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	057	0	1	01	01	H4461_057_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H4461	057	0	1	01	01	H4461_057_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	058	0	1	01	01	H4461_058_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H4461	058	0	1	01	01	H4461_058_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	059	0	1	01	01	H4461_059_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	060	0	1	01	01	H4461_060_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H4461	060	0	1	01	01	H4461_060_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	061	0	1	01	01	H4461_061_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	061	0	1	01	01	H4461_061_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H4461	062	0	1	01	01	H4461_062_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	063	0	1	01	01	H4461_063_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									6050	6050															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	063	0	1	01	01	H4461_063_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	063	0	1	01	01	H4461_063_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H4461	064	0	1	01	01	H4461_064_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	064	0	1	01	01	H4461_064_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H4461	065	0	1	01	01	H4461_065_0	5	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	065	0	1	01	01	H4461_065_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									1182	1182															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	065	0	1	01	01	H4461_065_0	5	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H4461	066	0	1	01	01	H4461_066_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									18454	18454															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	066	0	1	01	01	H4461_066_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	066	0	1	01	01	H4461_066_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H4461	067	0	1	01	01	H4461_067_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	067	0	1	01	01	H4461_067_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									17970	17970															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	068	0	1	01	01	H4461_068_0	5	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	068	0	1	01	01	H4461_068_0	5	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H4461	068	0	1	01	01	H4461_068_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									6341	6341															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	069	0	1	01	01	H4461_069_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H4461	069	0	1	01	01	H4461_069_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									5539	5539															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	069	0	1	01	01	H4461_069_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H4461	070	0	1	01	01	H4461_070_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									5009	5009															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	070	0	1	01	01	H4461_070_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H4461	070	0	1	01	01	H4461_070_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H4461	071	0	1	01	01	H4461_071_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H4461	071	0	1	01	01	H4461_071_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H4461	071	0	1	01	01	H4461_071_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									8506	8506															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	072	0	1	01	01	H4461_072_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									5240	5240															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	072	0	1	01	01	H4461_072_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H4461	072	0	1	01	01	H4461_072_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H4461	073	0	1	01	01	H4461_073_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	074	0	1	01	01	H4461_074_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									7711	7711															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	074	0	1	01	01	H4461_074_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H4461	074	0	1	01	01	H4461_074_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	075	0	1	01	01	H4461_075_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	076	0	1	01	01	H4461_076_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	076	0	1	01	01	H4461_076_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H4461	076	0	1	01	01	H4461_076_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									13412	13412															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	077	0	1	01	01	H4461_077_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	077	0	1	01	01	H4461_077_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H4461	077	0	1	01	01	H4461_077_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									4716	4716															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	078	0	1	01	01	H4461_078_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	079	0	1	01	01	H4461_079_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	080	1	1	01	01	H4461_080_1	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	080	2	1	01	01	H4461_080_2	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H4461	080	2	1	01	01	H4461_080_2	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	081	1	1	01	01	H4461_081_1	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	081	2	1	01	01	H4461_081_2	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	082	0	1	01	01	H4461_082_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	082	0	1	01	01	H4461_082_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									199	199															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	083	1	1	01	01	H4461_083_1	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	083	2	1	01	01	H4461_083_2	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	084	0	1	01	01	H4461_084_0	4	1	3	Chronic Condition Care Assistance	01111111001111111100000000000000											474	6															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H4461	084	0	1	01	01	H4461_084_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H4461	085	0	1	01	01	H4461_085_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									4570	4570															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4461	085	0	1	01	01	H4461_085_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H4461	085	0	1	01	01	H4461_085_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H4471	005	0	1	01	01	H4471_005_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							1256	1006															2			13i1;13i10;		2		2						
H4471	010	1	1	01	01	H4471_010_1	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							32453	27354															2			13i1;13i10;		2		2						
H4471	010	2	1	01	01	H4471_010_2	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							38135	32008															2			13i1;13i10;		2		2						
H4471	011	0	1	01	01	H4471_011_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							896	806															2			13i1;13i10;		2		2						
H4473	003	0	1	04	01	H4473_003_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											127	114															2			13i1;13i10;	1	1	13i1;13i10;	1	196.00	7		00010		13i1;13i10;
H4473	004	0	1	04	01	H4473_004_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								217	195															2			13i1;13i10;	1	1	13i1;13i10;	1	208.00	7		00010		13i1;13i10;
H4473	007	0	1	04	01	H4473_007_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											88	79															2			13i1;13i10;	1	1	13i1;13i10;	1	242.00	7		00010		13i1;13i10;
H4490	003	0	1	01	01	H4490_003_0	5	1	3	Healthy Food	01111111111111111111111000000000											222	150															1	001		13i1;		1	13i1;	2						
H4499	001	0	1	01	01	H4499_001_0	6	1	3	Food Produce/General Supports Living/Transport	01111111111111111111111000000000											9292	8827															2			13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i10;
H4513	027	0	1	01	01	H4513_027_0	8	1	3	Food and Produce	00001101000001001000000000000000											219	164															2			13i1;		2		2						
H4513	034	0	1	01	01	H4513_034_0	9	1	3	Food and Produce	00001101000001001000000000000000											267	200															2			13i1;		2		2						
H4513	039	0	1	01	01	H4513_039_0	9	1	3	Food and Produce	00001101000001001000000000000000											257	193															2			13i1;		2		2						
H4513	060	1	1	01	01	H4513_060_1	8	1	3	Food and Produce	00001101000001001000000000000000											2283	1712															2			13i1;		2		2						
H4513	060	2	1	01	01	H4513_060_2	8	1	3	Food and Produce	00001101000001001000000000000000											4177	3133															2			13i1;		2		2						
H4513	060	3	1	01	01	H4513_060_3	8	1	3	Food and Produce	00001101000001001000000000000000											1176	882															2			13i1;		2		2						
H4513	060	4	1	01	01	H4513_060_4	8	1	3	Food and Produce	00001101000001001000000000000000											631	473															2			13i1;		2		2						
H4513	060	5	1	01	01	H4513_060_5	8	1	3	Food and Produce	00001101000001001000000000000000											685	514															2			13i1;		2		2						
H4513	075	0	1	01	01	H4513_075_0	8	1	3	Food and Produce	00001101000001001000000000000000											39	30															2			13i1;		2		2						
H4513	079	0	1	01	01	H4513_079_0	8	1	3	Food and Produce	00001101000001001000000000000000											43	32															2			13i1;		2		2						
H4513	080	0	1	01	01	H4513_080_0	8	1	3	Food and Produce	00001101000001001000000000000000											82	62															2			13i1;		2		2						
H4513	081	0	1	01	01	H4513_081_0	8	1	3	Food and Produce	00001101000001001000000000000000											219	164															2			13i1;		2		2						
H4513	094	0	1	01	01	H4513_094_0	8	1	3	Food and Produce	00001101000000000000000000000000											1113	834															2			13i1;		2		2						
H4513	097	0	1	01	01	H4513_097_0	8	1	3	Food and Produce	00001101000000000000000000000000											616	462															2			13i1;		2		2						
H4513	098	0	1	01	01	H4513_098_0	9	1	3	Food and Produce	00001101000000000000000000000000											1139	854															2			13i1;		2		2						
H4513	104	0	1	01	01	H4513_104_0	9	1	3	Food and Produce	00001101000001001000000000000000											526	395															2			13i1;		2		2						
H4513	105	0	1	01	01	H4513_105_0	11	1	3	Food and Produce	00001101000001001000000000000000											1645	1233															2			13i1;		2		2						
H4513	109	1	1	01	01	H4513_109_1	8	1	3	Food and Produce	00001101000001001000000000000000											1724	1293															2			13i1;		2		2						
H4513	109	2	1	01	01	H4513_109_2	8	1	3	Food and Produce	00001101000001001000000000000000											69	52															2			13i1;		2		2						
H4513	110	1	1	01	01	H4513_110_1	8	1	3	Food and Produce	00001101000001001000000000000000											1991	1493															2			13i1;		2		2						
H4513	110	2	1	01	01	H4513_110_2	8	1	3	Food and Produce	00001101000001001000000000000000											184	138															2			13i1;		2		2						
H4514	015	0	1	02	01	H4514_015_0	5	1	3	SSBCI Package 1	00001101000000000000000000000000											8529	7250															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H4514	023	0	1	02	01	H4514_023_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1517	1289															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H4523	020	0	1	01	01	H4523_020_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1688	1197															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	021	0	1	01	01	H4523_021_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							2890	2196															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	80.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	024	0	1	01	01	H4523_024_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							7649	5423															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	027	0	1	01	01	H4523_027_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							836	635															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	75.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	028	0	1	01	01	H4523_028_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							493	483															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	029	0	1	01	01	H4523_029_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							979	966															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	030	0	1	01	01	H4523_030_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							679	669															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	034	0	1	01	01	H4523_034_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1796	1780															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	037	0	1	01	01	H4523_037_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											1688	1558															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	038	0	1	01	01	H4523_038_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											372	335															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	039	0	1	01	01	H4523_039_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											1855	1712															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	041	0	1	01	01	H4523_041_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							432	421															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	043	0	1	01	01	H4523_043_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1586	1536															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	044	0	1	01	01	H4523_044_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1121	1088															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	047	0	1	01	01	H4523_047_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											174	160															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	048	0	1	01	01	H4523_048_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											379	355															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	049	0	1	01	01	H4523_049_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											379	353															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	050	0	1	01	01	H4523_050_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											379	353															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	051	0	1	01	01	H4523_051_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											380	362															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4523	801	0	1	01	01	H4523_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H4523	801	0	1	01	01	H4523_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H4523	802	0	1	01	01	H4523_802_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H4523	802	0	1	01	01	H4523_802_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H4523	805	0	1	01	01	H4523_805_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H4523	805	0	1	01	01	H4523_805_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H4527	003	0	1	02	01	H4527_003_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								340	289															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H4527	039	0	1	02	01	H4527_039_0	6	1	3	SSBCI Package 1	00001101000000000000000000000000											5611	4769															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H4527	040	0	1	02	01	H4527_040_0	5	1	3	SSBCI Package 1	00001101000000000000000000000000											5287	4494															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H4527	041	0	1	02	01	H4527_041_0	6	1	3	SSBCI Package 1	00001101000000000000000000000000											10186	8658															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H4527	042	0	1	02	01	H4527_042_0	5	1	3	SSBCI Package 1	00001101000000000000000000000000											10691	9087															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H4527	057	0	1	02	01	H4527_057_0	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								4103	3488															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H4527	060	1	1	02	01	H4527_060_1	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								2213	1881															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H4527	060	2	1	02	01	H4527_060_2	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								3197	2717															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H4527	061	0	1	02	01	H4527_061_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											126	107															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H4604	017	0	1	02	01	H4604_017_0	5	1	3	SSBCI Package 1	00001101000000000000000000000000											14184	12056															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H4604	024	0	1	02	01	H4604_024_0	5	1	3	SSBCI Package 1	00001101000000000000000000000000											1141	970															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H4604	025	0	1	02	01	H4604_025_0	5	1	3	SSBCI Package 1	00001101000000000000000000000000											1067	907															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H4604	026	0	1	02	01	H4604_026_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								4961	4216															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H4604	037	0	1	02	01	H4604_037_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											400	340															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H4605	002	0	1	04	01	H4605_002_0	8	1	2	Routine Podiatry														0100000000000000000														2			7f_2;	1	2		2						
H4605	004	0	1	04	01	H4605_004_0	8	1	2	Routine Podiatry														0100000000000000000														2			7f_2;	1	2		2						
H4605	801	0	1	04	01	H4605_801_0	3	1	2	Routine Podiatry														0100000000000000000														2			7f_2;	1	1	7f_2;	2						
H4605	802	0	1	04	01	H4605_802_0	3	1	2	Routine Podiatry														0100000000000000000														2			7f_2;	1	1	7f_2;	2						
H4623	001	0	1	02	01	H4623_001_0	7	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H4623	002	0	1	02	01	H4623_002_0	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H4624	001	0	1	01	01	H4624_001_0	5	1	2	Transportation														0000000000100000000	Chronic Kidney Disease - Stage 5													2			10b1;		2		2						
H4624	003	0	1	01	01	H4624_003_0	4	1	2	Transportation														0000000000100000000	Chronic Kidney Disease - Stage 5													2			10b1;		2		2						
H4624	006	0	1	01	01	H4624_006_0	4	1	2	Transportation														0000000000100000000	Chronic Kidney Disease - Stage 5													2			10b1;		2		2						
H4624	010	0	1	01	01	H4624_010_0	6	1	3	Foods & Produce and Utilities	00111111001011001000000000000000											3820	2680															2			13i1;13i10;		2		1	110.00	7		01011		13i1;13i10;
H4624	010	0	1	01	01	H4624_010_0	6	2	2	Transportation														0000000000100000000	Chronic Kidney Disease - Stage 5													2			10b1;		2		2						
H4624	011	0	1	01	01	H4624_011_0	5	2	2	Transportation														0000000000100000000	Chronic Kidney Disease - Stage 5													2			10b1;		2		2						
H4624	011	0	1	01	01	H4624_011_0	5	1	3	Foods & Produce and Utilities	00111111001011001000000000000000											1619	1135															2			13i1;13i10;		2		1	95.00	7		01011		13i1;13i10;
H4624	012	0	1	01	01	H4624_012_0	5	1	3	Foods & Produce and Utilities	00111111001011001000000000000000											1573	1103															2			13i1;13i10;		2		1	70.00	7		01011		13i1;13i10;
H4624	012	0	1	01	01	H4624_012_0	5	2	2	Transportation														0000000000100000000	Chronic Kidney Disease - Stage 5													2			10b1;		2		2						
H4624	022	0	1	01	01	H4624_022_0	4	1	2	Transportation														0000000000100000000	Chronic Kidney Disease - Stage 5													2			10b1;		2		2						
H4624	023	0	1	01	01	H4624_023_0	6	1	3	Food & Produce and Utilities	00111111001011001000000000000000											210	147															2			13i1;13i10;		2		1	100.00	7		01011		13i1;13i10;
H4624	023	0	1	01	01	H4624_023_0	6	2	2	Transportation														0000000000100000000	Chronic Kidney Disease - Stage 5													2			10b1;		2		2						
H4624	025	0	1	01	01	H4624_025_0	6	2	2	Transportation														0000000000100000000	Chronic Kidney Disease - Stage 5													2			10b1;		2		2						
H4624	025	0	1	01	01	H4624_025_0	6	1	3	Food & Produce and Utilities	00111111001011001000000000000000											162	114															2			13i1;13i10;		2		1	110.00	7		01011		13i1;13i10;
H4624	026	0	1	01	01	H4624_026_0	8	1	2	Transportation														0000000000100000000	Chronic Kidney Disease - Stage 5													2			10b1;		2		2						
H4624	027	0	1	01	01	H4624_027_0	5	2	2	Transportation														0000000000100000000	Chronic Kidney Disease - Stage 5													2			10b1;		2		2						
H4624	027	0	1	01	01	H4624_027_0	5	1	3	Foods & Produce and Utilities	00111111001011001000000000000000											745	522															2			13i1;13i10;		1	13i1;13i10;	1	135.00	7		01011		13i1;13i10;
H4624	028	0	1	01	01	H4624_028_0	5	1	3	Foods & Produce and Utilities	00111111001011001000000000000000											2185	1533															2			13i1;13i10;		2		1	120.00	7		01011		13i1;13i10;
H4624	028	0	1	01	01	H4624_028_0	5	2	2	Transportation														0000000000100000000	Chronic Kidney Disease - Stage 5													2			10b1;		2		2						
H4624	029	0	1	01	01	H4624_029_0	6	2	2	Transportation														0000000000100000000	Chronic Kidney Disease - Stage 5													2			10b1;		2		2						
H4624	029	0	1	01	01	H4624_029_0	6	1	3	Food & Produce and Utilities	00111111001011001000000000000000											349	245															2			13i1;13i10;		2		1	80.00	7		01011		13i1;13i10;
H4624	031	0	1	01	01	H4624_031_0	5	2	2	Transportation														0000000000100000000	Chronic kidney disease - Stage 5													2			10b1;		2		2						
H4624	031	0	1	01	01	H4624_031_0	5	1	3	Foods & Produce and Utilities	00111111001011001000000000000000											787	552															2			13i1;13i10;		2		1	125.00	7		01011		13i1;13i10;
H4624	032	0	1	01	01	H4624_032_0	5	2	2	Transportation														0000000000100000000	Chronic kidney disease - Stage 5													2			10b1;		2		2						
H4624	032	0	1	01	01	H4624_032_0	5	1	3	Foods & Produce and Utilities	00111111001011001000000000000000											1912	1341															2			13i1;13i10;		2		1	115.00	7		01011		13i1;13i10;
H4624	033	0	1	01	01	H4624_033_0	5	2	2	Transportation														0000000000100000000	Chronic kidney disease - Stage 5													2			10b1;		2		2						
H4624	033	0	1	01	01	H4624_033_0	5	1	3	Foods & Produce and Utilities	00111111001011001000000000000000											546	383															2			13i1;13i10;		2		1	130.00	7		01011		13i1;13i10;
H4624	034	0	1	01	01	H4624_034_0	5	1	3	Foods & Produce and Utilities	00111111001011001000000000000000											651	457															2			13i1;13i10;		2		1	110.00	7		01011		13i1;13i10;
H4624	034	0	1	01	01	H4624_034_0	5	2	2	Transportation														0000000000100000000	Chronic Kidney Disease - Stage 5													2			10b1;		2		2						
H4624	036	0	1	01	01	H4624_036_0	6	2	2	Transportation														0000000000100000000	Chronic Kidney Disease - Stage 5													2			10b1;		2		2						
H4624	036	0	1	01	01	H4624_036_0	6	1	3	Food & Produce and Utilities	00111111001011001000000000000000											36	25															2			13i1;13i10;		2		1	95.00	7		01011		13i1;13i10;
H4624	037	0	1	01	01	H4624_037_0	6	1	2	Transportation														0000000000100000000	Chronic Kidney Disease - Stage 5													2			10b1;		2		2						
H4624	038	0	1	01	01	H4624_038_0	6	1	2	Transportation														0000000000100000000	Chronic Kidney Disease - Stage 5													2			10b1;		2		2						
H4624	039	0	1	01	01	H4624_039_0	5	2	2	Transportation														0000000000100000000	Chronic kidney disease - Stage 5													2			10b1;		2		2						
H4624	039	0	1	01	01	H4624_039_0	5	1	3	Foods & Produce and Utilities	00111111001011001000000000000000											612	429															2			13i1;13i10;		2		1	125.00	7		01011		13i1;13i10;
H4624	040	0	1	01	01	H4624_040_0	5	1	3	Foods & Produce and Utilities	00111111001011001000000000000000											672	472															2			13i1;13i10;		2		1	115.00	7		01011		13i1;13i10;
H4624	040	0	1	01	01	H4624_040_0	5	2	2	Transportation														0000000000100000000	Chronic Kidney Disease - Stage 5													2			10b1;		2		2						
H4624	042	0	1	01	01	H4624_042_0	6	2	2	Transportation														0000000000100000000	Chronic Kidney Disease - Stage 5													2			10b1;		2		2						
H4624	042	0	1	01	01	H4624_042_0	6	1	3	Food & Produce and Utilities	00111111001011001000000000000000											66	46															2			13i1;13i10;		2		1	90.00	7		01011		13i1;13i10;
H4624	043	0	1	01	01	H4624_043_0	4	1	2	Transportation														0000000000100000000	Chronic Kidney Disease - Stage 5													2			10b1;		2		2						
H4624	044	0	1	01	01	H4624_044_0	4	1	2	Transportation														0000000000100000000	Chronic Kidney Disease - Stage 5													2			10b1;		2		2						
H4624	045	0	1	01	01	H4624_045_0	5	1	3	Foods & Produce and Utilities	00111111001011001000000000000000											2297	1611															2			13i1;13i10;		2		1	165.00	7		01011		13i1;13i10;
H4624	045	0	1	01	01	H4624_045_0	5	2	2	Transportation														0000000000100000000	Chronic kidney disease - Stage 5													2			10b1;		2		2						
H4624	046	0	1	01	01	H4624_046_0	3	1	2	Transportation														0000000000100000000	Chronic Kidney Disease - Stage 5													2			10b1;		2		2						
H4624	047	0	1	01	01	H4624_047_0	4	1	3	Foods & Produce and Utilities	00111111001011001000000000000000											840	589															2			13i1;13i10;		2		1	180.00	7		01011		13i1;13i10;
H4624	047	0	1	01	01	H4624_047_0	4	2	2	Transportation														0000000000100000000	Chronic kidney disease - Stage 5													2			10b1;		2		2						
H4624	048	0	1	01	01	H4624_048_0	4	1	3	Foods & Produce and Utilities	00111111001011001000000000000000											167	117															2			13i1;13i10;		2		1	180.00	7		01011		13i1;13i10;
H4624	048	0	1	01	01	H4624_048_0	4	2	2	Transportation														0000000000100000000	Chronic kidney disease - Stage 5													2			10b1;		2		2						
H4624	049	0	1	01	01	H4624_049_0	5	1	3	Foods & Produce and Utilities	00111111001011001000000000000000											179	125															2			13i1;13i10;		2		1	180.00	7		01011		13i1;13i10;
H4624	049	0	1	01	01	H4624_049_0	5	2	2	Transportation														0000000000100000000	Chronic kidney disease - Stage 5													2			10b1;		2		2						
H4647	002	0	1	01	01	H4647_002_0	5	1	3	Food, Meals and Home Mod	00000101001000000000000000000000											1708	854															2			13i1;13i2;13i9;14c10;		2		2						
H4661	003	0	1	02	01	H4661_003_0	6	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										1368	1266															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H4661	005	0	1	02	01	H4661_005_0	5	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										1192	1099															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H4676	002	0	1	01	01	H4676_002_0	4	1	3	Healthy Foods and Utilities	01111111111111111111111100000000	Chronic sleep disorders										333	300															2			13i1;13i10;		2		2						
H4694	002	0	1	01	01	H4694_002_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							8476	6884															2			13i1;13i10;		2		2						
H4694	003	0	1	01	01	H4694_003_0	6	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							8898	7227															2			13i1;13i10;		2		2						
H4694	004	0	1	01	01	H4694_004_0	6	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							13551	11006															2			13i1;13i10;		2		2						
H4711	011	0	1	01	01	H4711_011_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1329	1298															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4711	014	0	1	01	01	H4711_014_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1159	1144															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4711	801	0	1	01	01	H4711_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H4711	801	0	1	01	01	H4711_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H4739	001	0	1	01	01	H4739_001_0	6	1	3	Package 1	00001111110001101000000100000000	Connective Tissue Disease										3324	2193															2			13i1;13i3;13i10;		1	13i1;13i3;13i10;	1	0.00	7		01011		13i1;13i3;13i10;
H4808	001	0	1	04	01	H4808_001_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								531	477															2			13i1;13i10;	1	1	13i1;13i10;	1	54.00	7		00010		13i1;13i10;
H4835	801	0	1	01	01	H4835_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H4835	801	0	1	01	01	H4835_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H4869	001	0	1	02	01	H4869_001_0	7	1	3	Chronic Illness Package	00001101000000000000000000000000											3591	2873															1	011		13b;13i1;13i10;	2	1	13b;13i1;13i10;	1	100.00	5		01010		13b;13i10;
H4869	003	0	1	02	01	H4869_003_0	6	1	3	CKD Package	00000000001000000000000000000000											1143	914															1	011		13b;13d;13i1;13i10;	2	1	13b;13d;13i1;13i10;	1	100.00	5		01010		13b;13i10;
H4869	003	0	1	02	01	H4869_003_0	6	2	2	ESRD Support Package														0000000000100000000	End Stage Renal Disease													1	011		10b1;14c21;	2	2		2						
H4869	011	0	1	02	01	H4869_011_0	7	1	3	Chronic Illness Package + Transportation	00001101000000000000000000000000											355	284															1	011		13b;13i1;13i4;13i10;	2	1	13b;13i1;13i4;13i10;	1	100.00	5		01010		13b;13i10;
H4869	013	0	1	02	01	H4869_013_0	6	1	3	CKD Package + Transportation	00000000001000000000000000000000											79	63															1	011		13b;13d;13i1;13i4;13i10;	2	1	13b;13d;13i1;13i4;13i10;	1	100.00	5		01010		13b;13i10;
H4869	013	0	1	02	01	H4869_013_0	6	2	2	ESRD Support Package														0000000000100000000	End Stage Renal Disease													1	011		10b1;14c21;	2	2		2						
H4869	014	0	1	02	01	H4869_014_0	5	1	3	CKD Package	00000000001000000000000000000000											56	45															1	011		13b;13d;13i1;13i10;	2	1	13b;13d;13i1;13i10;	1	100.00	5		01010		13b;13i10;
H4869	014	0	1	02	01	H4869_014_0	5	2	2	ESRD Support Package														0000000000100000000	End Stage Renal Disease													1	011		10b1;14c21;	2	2		2						
H4869	015	0	1	02	01	H4869_015_0	5	4	2	ESRD Vision														0000000000100000000	End-Stage Renal Disease													1	011		17a1;17b1;17b2;17b3;17b4;	2	2		2						
H4869	015	0	1	02	01	H4869_015_0	5	3	2	ESRD Support Package														0000000000100000000	End Stage Renal Disease													1	011		10b1;14c21;	2	2		2						
H4869	015	0	1	02	01	H4869_015_0	5	2	2	ESRD Dental														0000000000100000000	End Stage Renal Disease (CKD Stage 5)													1	011		16b1;16b2;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c8;16c10;	2	2		1	3000.00	3		00100		16b1;16b2;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c8;16c10;
H4869	015	0	1	02	01	H4869_015_0	5	1	3	CKD Package	00000000001000000000000000000000											35	28															1	011		13b;13d;13i1;13i10;	2	1	13b;13d;13i1;13i10;	1	100.00	5		01010		13b;13i10;
H4869	015	0	1	02	01	H4869_015_0	5	5	2	ESRD Hearing														0000000000100000000	End-Stage Renal Disease													1	011		18a1;18a2;18b1;	2	2		2						
H4909	030	0	1	04	01	H4909_030_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							52	35															2			13i1;	1	2		2						
H4931	007	0	1	01	01	H4931_007_0	5	1	3	Flex Card	01111111111111111111111000000000											3900	3900															2			13i1;13i10;		2		1	0.00	5		00010		13i1;13i10;
H4931	015	0	1	01	01	H4931_015_0	5	1	3	Flex Card	01111111111111111111111000000000											1600	1600															2			13i1;13i10;		2		1	0.00	5		00010		13i1;13i10;
H4939	001	0	1	02	01	H4939_001_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H4939	001	0	1	02	01	H4939_001_0	5	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									12979	12979															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	1000.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H4939	002	0	1	02	01	H4939_002_0	5	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H4939	002	0	1	02	01	H4939_002_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									16688	16688															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4939	002	0	1	02	01	H4939_002_0	5	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H4939	003	0	1	02	01	H4939_003_0	5	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H4939	003	0	1	02	01	H4939_003_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									9030	9030															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H4939	003	0	1	02	01	H4939_003_0	5	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H4939	004	0	1	02	01	H4939_004_0	5	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									11953	11953															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H4939	004	0	1	02	01	H4939_004_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H4961	001	0	1	04	01	H4961_001_0	11	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									2344	5															2			13i3;13i10;13i-O1;	1	2		2						
H4961	006	0	1	04	01	H4961_006_0	10	1	3	Package 1	00000000001000000000000000000000											83	27															2			13i1;13i3;13i10;13i-O1;14c8;	1	2		1	150.00	7		00010		13i1;13i10;14c8;
H4982	022	0	1	01	01	H4982_022_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							544	386															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H4982	801	0	1	01	01	H4982_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H4982	801	0	1	01	01	H4982_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5008	002	0	1	02	01	H5008_002_0	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								6701	5695															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H5008	010	0	1	02	01	H5008_010_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								2025	1721															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H5008	011	0	1	02	01	H5008_011_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								2604	2214															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H5008	015	0	1	02	01	H5008_015_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								3680	3128															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H5008	016	0	1	02	01	H5008_016_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								3517	2989															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H5008	017	0	1	02	01	H5008_017_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								176	150															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H5008	018	0	1	02	01	H5008_018_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								3676	3125															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H5008	019	0	1	02	01	H5008_019_0	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								8071	6860															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H5008	020	0	1	02	01	H5008_020_0	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1797	1528															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H5009	002	0	1	04	01	H5009_002_0	9	1	2	Routine Podiatry														0100000000000000000														2			7f_2;	1	2		2						
H5009	801	0	1	04	01	H5009_801_0	3	1	2	Routine Podiatry														0100000000000000000														2			7f_2;	1	1	7f_2;	2						
H5009	802	0	1	04	01	H5009_802_0	3	1	2	Routine Podiatry														0100000000000000000														2			7f_2;	1	1	7f_2;	2						
H5015	001	0	1	01	01	H5015_001_0	6	1	3	Non-Primarily Health Related Benefits	01111111001111111001100000000000											2500	1500															2			13i4;13i6;		2		2						
H5015	002	0	1	01	01	H5015_002_0	5	1	3	Non-Primarily Health Related Benefits	01111111001111111010100000000000											50	25															2			13i4;13i6;		2		2						
H5050	004	0	1	01	01	H5050_004_0	8	1	2	Advanced Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13d;		2		2						
H5050	009	0	1	01	01	H5050_009_0	8	1	2	Advanced Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13d;		2		2						
H5050	024	0	1	01	01	H5050_024_0	8	1	2	Advanced Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13d;		2		2						
H5050	025	0	1	01	01	H5050_025_0	8	1	2	Advanced Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13d;		2		2						
H5050	026	0	1	01	01	H5050_026_0	8	1	2	Advanced Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13d;		2		2						
H5050	027	0	1	01	01	H5050_027_0	8	1	2	Advanced Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13d;		2		2						
H5050	028	0	1	01	01	H5050_028_0	8	1	2	Advanced Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13d;		2		2						
H5050	029	0	1	01	01	H5050_029_0	8	1	2	Advanced Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13d;		2		2						
H5050	030	0	1	01	01	H5050_030_0	8	1	2	Advanced Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13d;		2		2						
H5050	031	0	1	01	01	H5050_031_0	8	1	2	Advanced Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13d;		2		2						
H5050	032	0	1	01	01	H5050_032_0	8	1	2	Advanced Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13d;		2		2						
H5163	001	0	1	01	01	H5163_001_0	9	1	3	SSBCI	01111111111101111111011100000000	Chronic Hypertension										670	569															2			13i1;13i10;		2		2						
H5163	002	0	1	01	01	H5163_002_0	8	1	3	SSBCI	01111111111101111111011100000000	Chronic Hypertension										3639	3093															2			13i1;13i10;		2		2						
H5163	003	0	1	01	01	H5163_003_0	8	1	3	SSBCI	01111111111101111111011100000000	Chronic Hypertension										110	93															2			13i1;		2		2						
H5163	004	0	1	01	01	H5163_004_0	8	1	3	SSBCI	01111111111101111111011100000000	Chronic Hypertension										375	318															2			13i1;		2		2						
H5177	010	0	1	04	01	H5177_010_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;	1	1	13i1;13i10;	1	142.00	7		00010		13i1;13i10;
H5177	012	0	1	04	01	H5177_012_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;	1	1	13i1;13i10;	1	142.00	7		00010		13i1;13i10;
H5177	013	0	1	04	01	H5177_013_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;	1	1	13i1;13i10;	1	270.00	7		00010		13i1;13i10;
H5177	014	0	1	04	01	H5177_014_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;	1	1	13i1;13i10;	1	261.00	7		00010		13i1;13i10;
H5178	002	0	1	01	01	H5178_002_0	4	1	3	Chronic Condition Care Assistance	01111111001111111100000000000000											496	6															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H5178	002	0	1	01	01	H5178_002_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H5178	002	0	1	01	01	H5178_002_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5178	003	0	1	01	01	H5178_003_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5178	004	0	1	01	01	H5178_004_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5209	005	1	1	01	01	H5209_005_1	6	1	3	SSBCI	01111111111111111111111000000000											693	624															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H5209	005	2	1	01	01	H5209_005_2	6	1	3	SSBCI	01111111111111111111111000000000											171	154															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H5209	006	1	1	01	01	H5209_006_1	6	1	3	SSBCI	01111111111111111111111000000000											1460	1314															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H5209	006	2	1	01	01	H5209_006_2	6	1	3	SSBCI	01111111111111111111111000000000											459	413															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H5216	001	0	1	04	01	H5216_001_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	001	0	1	04	01	H5216_001_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	006	0	1	04	01	H5216_006_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	006	0	1	04	01	H5216_006_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	011	0	1	04	01	H5216_011_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	011	0	1	04	01	H5216_011_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	013	0	1	04	01	H5216_013_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	013	0	1	04	01	H5216_013_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	014	0	1	04	01	H5216_014_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	014	0	1	04	01	H5216_014_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	017	0	1	04	01	H5216_017_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	017	0	1	04	01	H5216_017_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	019	0	1	04	01	H5216_019_0	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	019	0	1	04	01	H5216_019_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	023	0	1	04	01	H5216_023_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	023	0	1	04	01	H5216_023_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	027	0	1	04	01	H5216_027_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	027	0	1	04	01	H5216_027_0	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	032	0	1	04	01	H5216_032_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	032	0	1	04	01	H5216_032_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	034	0	1	04	01	H5216_034_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	034	0	1	04	01	H5216_034_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	037	0	1	04	01	H5216_037_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	037	0	1	04	01	H5216_037_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	039	0	1	04	01	H5216_039_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	039	0	1	04	01	H5216_039_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	042	0	1	04	01	H5216_042_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	042	0	1	04	01	H5216_042_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	043	1	1	04	01	H5216_043_1	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	043	1	1	04	01	H5216_043_1	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	043	5	1	04	01	H5216_043_5	7	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	043	5	1	04	01	H5216_043_5	7	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	043	6	1	04	01	H5216_043_6	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	043	6	1	04	01	H5216_043_6	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	048	0	1	04	01	H5216_048_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	048	0	1	04	01	H5216_048_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	053	0	1	04	01	H5216_053_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	053	0	1	04	01	H5216_053_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	059	0	1	04	01	H5216_059_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	059	0	1	04	01	H5216_059_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H5216	059	0	1	04	01	H5216_059_0	4	2	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	062	0	1	04	01	H5216_062_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	062	0	1	04	01	H5216_062_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	064	0	1	04	01	H5216_064_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	064	0	1	04	01	H5216_064_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	068	0	1	04	01	H5216_068_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	068	0	1	04	01	H5216_068_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	070	0	1	04	01	H5216_070_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	070	0	1	04	01	H5216_070_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	072	0	1	04	01	H5216_072_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	072	0	1	04	01	H5216_072_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	074	0	1	04	01	H5216_074_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	074	0	1	04	01	H5216_074_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	078	1	1	04	01	H5216_078_1	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	078	1	1	04	01	H5216_078_1	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	078	2	1	04	01	H5216_078_2	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	078	2	1	04	01	H5216_078_2	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	078	6	1	04	01	H5216_078_6	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	078	6	1	04	01	H5216_078_6	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	081	0	1	04	01	H5216_081_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	081	0	1	04	01	H5216_081_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	083	0	1	04	01	H5216_083_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	083	0	1	04	01	H5216_083_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	089	0	1	04	01	H5216_089_0	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	089	0	1	04	01	H5216_089_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	097	0	1	04	01	H5216_097_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	097	0	1	04	01	H5216_097_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	100	0	1	04	01	H5216_100_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	100	0	1	04	01	H5216_100_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	106	0	1	04	01	H5216_106_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	106	0	1	04	01	H5216_106_0	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	116	0	1	04	01	H5216_116_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	116	0	1	04	01	H5216_116_0	4	2	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	116	0	1	04	01	H5216_116_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H5216	120	0	1	04	01	H5216_120_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	120	0	1	04	01	H5216_120_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	124	0	1	04	01	H5216_124_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	124	0	1	04	01	H5216_124_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	132	0	1	04	01	H5216_132_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	132	0	1	04	01	H5216_132_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	136	0	1	04	01	H5216_136_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	136	0	1	04	01	H5216_136_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	138	0	1	04	01	H5216_138_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	138	0	1	04	01	H5216_138_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	141	0	1	04	01	H5216_141_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	141	0	1	04	01	H5216_141_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	144	0	1	04	01	H5216_144_0	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	144	0	1	04	01	H5216_144_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	152	0	1	04	01	H5216_152_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	152	0	1	04	01	H5216_152_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	154	0	1	04	01	H5216_154_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	154	0	1	04	01	H5216_154_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	157	0	1	04	01	H5216_157_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	157	0	1	04	01	H5216_157_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	160	0	1	04	01	H5216_160_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2088	1715															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	160	0	1	04	01	H5216_160_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5216	160	0	1	04	01	H5216_160_0	4	3	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	160	0	1	04	01	H5216_160_0	4	4	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	161	0	1	04	01	H5216_161_0	4	3	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	161	0	1	04	01	H5216_161_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									938	770															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	161	0	1	04	01	H5216_161_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5216	161	0	1	04	01	H5216_161_0	4	4	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	164	0	1	04	01	H5216_164_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									1477	1477															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	164	0	1	04	01	H5216_164_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5216	164	0	1	04	01	H5216_164_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	168	0	1	04	01	H5216_168_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	168	0	1	04	01	H5216_168_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	173	0	1	04	01	H5216_173_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	173	0	1	04	01	H5216_173_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	174	0	1	04	01	H5216_174_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	174	0	1	04	01	H5216_174_0	4	2	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	174	0	1	04	01	H5216_174_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H5216	175	0	1	04	01	H5216_175_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	175	0	1	04	01	H5216_175_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	179	0	1	04	01	H5216_179_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5216	179	0	1	04	01	H5216_179_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									3367	2764															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	179	0	1	04	01	H5216_179_0	4	4	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	179	0	1	04	01	H5216_179_0	4	3	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	180	0	1	04	01	H5216_180_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5216	180	0	1	04	01	H5216_180_0	4	3	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	180	0	1	04	01	H5216_180_0	4	4	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	180	0	1	04	01	H5216_180_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									5512	4526															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	188	0	1	04	01	H5216_188_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	188	0	1	04	01	H5216_188_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	190	0	1	04	01	H5216_190_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	190	0	1	04	01	H5216_190_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	192	0	1	04	01	H5216_192_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	192	0	1	04	01	H5216_192_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	194	0	1	04	01	H5216_194_0	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	194	0	1	04	01	H5216_194_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	200	0	1	04	01	H5216_200_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	200	0	1	04	01	H5216_200_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	201	0	1	04	01	H5216_201_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H5216	201	0	1	04	01	H5216_201_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	201	0	1	04	01	H5216_201_0	4	2	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	203	1	1	04	01	H5216_203_1	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	203	1	1	04	01	H5216_203_1	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	203	2	1	04	01	H5216_203_2	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	203	2	1	04	01	H5216_203_2	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	205	0	1	04	01	H5216_205_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									10432	10432															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	205	0	1	04	01	H5216_205_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	206	0	1	04	01	H5216_206_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									5261	5261															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	206	0	1	04	01	H5216_206_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	207	0	1	04	01	H5216_207_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	207	0	1	04	01	H5216_207_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	211	0	1	04	01	H5216_211_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	211	0	1	04	01	H5216_211_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	216	0	1	04	01	H5216_216_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	216	0	1	04	01	H5216_216_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	217	0	1	04	01	H5216_217_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	217	0	1	04	01	H5216_217_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	218	0	1	04	01	H5216_218_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	218	0	1	04	01	H5216_218_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	219	0	1	04	01	H5216_219_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	219	0	1	04	01	H5216_219_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5216	219	0	1	04	01	H5216_219_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									560	560															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	220	0	1	04	01	H5216_220_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5216	220	0	1	04	01	H5216_220_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									4061	4061															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	220	0	1	04	01	H5216_220_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	221	0	1	04	01	H5216_221_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H5216	221	0	1	04	01	H5216_221_0	4	2	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	221	0	1	04	01	H5216_221_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	223	0	1	04	01	H5216_223_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	223	0	1	04	01	H5216_223_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	224	0	1	04	01	H5216_224_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	224	0	1	04	01	H5216_224_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	225	0	1	04	01	H5216_225_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	225	0	1	04	01	H5216_225_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	226	0	1	04	01	H5216_226_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	226	0	1	04	01	H5216_226_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	227	0	1	04	01	H5216_227_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	227	0	1	04	01	H5216_227_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									736	736															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	228	0	1	04	01	H5216_228_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	228	0	1	04	01	H5216_228_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									1193	1193															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	228	0	1	04	01	H5216_228_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5216	229	0	1	04	01	H5216_229_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	229	0	1	04	01	H5216_229_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	231	0	1	04	01	H5216_231_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	231	0	1	04	01	H5216_231_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	234	0	1	04	01	H5216_234_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	234	0	1	04	01	H5216_234_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	235	0	1	04	01	H5216_235_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	235	0	1	04	01	H5216_235_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	236	0	1	04	01	H5216_236_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	236	0	1	04	01	H5216_236_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	242	0	1	04	01	H5216_242_0	5	1	3	Chronic Care Assistance and Music Therapy	01111111001111111100000000000000											347	206															1	001		10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i10;14c15;17b2;17b3;17b4;18b1;18c;
H5216	243	0	1	04	01	H5216_243_0	4	1	3	Chronic Care Assistance and Music Therapy	01111111001111111100000000000000											771	457															1	001		10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i10;14c15;17b2;17b3;17b4;18b1;18c;
H5216	244	0	1	04	01	H5216_244_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2972	2972															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	244	0	1	04	01	H5216_244_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	246	0	1	04	01	H5216_246_0	6	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									18734	18734															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	246	0	1	04	01	H5216_246_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	249	0	1	04	01	H5216_249_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	249	0	1	04	01	H5216_249_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H5216	249	0	1	04	01	H5216_249_0	4	2	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	251	0	1	04	01	H5216_251_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	251	0	1	04	01	H5216_251_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	252	0	1	04	01	H5216_252_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	252	0	1	04	01	H5216_252_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	253	0	1	04	01	H5216_253_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	253	0	1	04	01	H5216_253_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	256	0	1	04	01	H5216_256_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	256	0	1	04	01	H5216_256_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	257	0	1	04	01	H5216_257_0	4	2	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	257	0	1	04	01	H5216_257_0	4	1	3	Chronic Condition Care Assistance	01111111001111111100000000000000											3512	46															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H5216	257	0	1	04	01	H5216_257_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	261	0	1	04	01	H5216_261_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	261	0	1	04	01	H5216_261_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	263	0	1	04	01	H5216_263_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	263	0	1	04	01	H5216_263_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	264	0	1	04	01	H5216_264_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	264	0	1	04	01	H5216_264_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	265	0	1	04	01	H5216_265_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	265	0	1	04	01	H5216_265_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	266	0	1	04	01	H5216_266_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	266	0	1	04	01	H5216_266_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	267	0	1	04	01	H5216_267_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	267	0	1	04	01	H5216_267_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5216	267	0	1	04	01	H5216_267_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									3895	3895															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	268	0	1	04	01	H5216_268_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5216	268	0	1	04	01	H5216_268_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	268	0	1	04	01	H5216_268_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									1701	1701															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	269	0	1	04	01	H5216_269_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	269	0	1	04	01	H5216_269_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	271	0	1	04	01	H5216_271_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	271	0	1	04	01	H5216_271_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	277	0	1	04	01	H5216_277_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	277	0	1	04	01	H5216_277_0	4	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									7165	7165															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H5216	278	1	1	04	01	H5216_278_1	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	278	1	1	04	01	H5216_278_1	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	278	3	1	04	01	H5216_278_3	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	278	3	1	04	01	H5216_278_3	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	280	1	1	04	01	H5216_280_1	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	280	1	1	04	01	H5216_280_1	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	280	2	1	04	01	H5216_280_2	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	280	2	1	04	01	H5216_280_2	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	281	0	1	04	01	H5216_281_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	281	0	1	04	01	H5216_281_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	283	0	1	04	01	H5216_283_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	283	0	1	04	01	H5216_283_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	284	0	1	04	01	H5216_284_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	284	0	1	04	01	H5216_284_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	285	0	1	04	01	H5216_285_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	285	0	1	04	01	H5216_285_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	286	0	1	04	01	H5216_286_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	286	0	1	04	01	H5216_286_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	288	0	1	04	01	H5216_288_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	288	0	1	04	01	H5216_288_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	289	0	1	04	01	H5216_289_0	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	289	0	1	04	01	H5216_289_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	291	0	1	04	01	H5216_291_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	291	0	1	04	01	H5216_291_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2275	2275															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	292	0	1	04	01	H5216_292_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5216	292	0	1	04	01	H5216_292_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	292	0	1	04	01	H5216_292_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2918	2918															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	296	0	1	04	01	H5216_296_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									896	896															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	296	0	1	04	01	H5216_296_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5216	296	0	1	04	01	H5216_296_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	298	0	1	04	01	H5216_298_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	298	0	1	04	01	H5216_298_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H5216	298	0	1	04	01	H5216_298_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									4198	4198															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	300	0	1	04	01	H5216_300_0	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	300	0	1	04	01	H5216_300_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	302	0	1	04	01	H5216_302_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5216	302	0	1	04	01	H5216_302_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	302	0	1	04	01	H5216_302_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2704	2704															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	306	0	1	04	01	H5216_306_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	306	0	1	04	01	H5216_306_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	308	0	1	04	01	H5216_308_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	308	0	1	04	01	H5216_308_0	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	310	0	1	04	01	H5216_310_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	310	0	1	04	01	H5216_310_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	311	0	1	04	01	H5216_311_0	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	311	0	1	04	01	H5216_311_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	313	0	1	04	01	H5216_313_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	313	0	1	04	01	H5216_313_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	314	0	1	04	01	H5216_314_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	314	0	1	04	01	H5216_314_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	316	1	1	04	01	H5216_316_1	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	316	1	1	04	01	H5216_316_1	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	316	3	1	04	01	H5216_316_3	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	316	3	1	04	01	H5216_316_3	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	317	0	1	04	01	H5216_317_0	6	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	317	0	1	04	01	H5216_317_0	6	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5216	317	0	1	04	01	H5216_317_0	6	2	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	318	1	1	04	01	H5216_318_1	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	318	1	1	04	01	H5216_318_1	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	318	2	1	04	01	H5216_318_2	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	318	2	1	04	01	H5216_318_2	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	318	3	1	04	01	H5216_318_3	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	318	3	1	04	01	H5216_318_3	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	319	0	1	04	01	H5216_319_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	319	0	1	04	01	H5216_319_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	322	0	1	04	01	H5216_322_0	7	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	322	0	1	04	01	H5216_322_0	7	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	325	0	1	04	01	H5216_325_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	325	0	1	04	01	H5216_325_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	326	0	1	04	01	H5216_326_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	326	0	1	04	01	H5216_326_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	327	0	1	04	01	H5216_327_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	327	0	1	04	01	H5216_327_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	328	0	1	04	01	H5216_328_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	328	0	1	04	01	H5216_328_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	330	0	1	04	01	H5216_330_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	330	0	1	04	01	H5216_330_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									1580	1580															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	331	0	1	04	01	H5216_331_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									6456	6456															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	331	0	1	04	01	H5216_331_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5216	331	0	1	04	01	H5216_331_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	332	0	1	04	01	H5216_332_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	332	0	1	04	01	H5216_332_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									759	759															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	334	0	1	04	01	H5216_334_0	6	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5216	334	0	1	04	01	H5216_334_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	337	1	1	04	01	H5216_337_1	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	337	1	1	04	01	H5216_337_1	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	337	2	1	04	01	H5216_337_2	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	337	2	1	04	01	H5216_337_2	4	2	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	337	2	1	04	01	H5216_337_2	4	1	3	Chronic Condition Care Assistance	01111111001111111100000000000000											5562	72															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	2		1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H5216	337	3	1	04	01	H5216_337_3	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	337	3	1	04	01	H5216_337_3	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	339	0	1	04	01	H5216_339_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	339	0	1	04	01	H5216_339_0	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	340	0	1	04	01	H5216_340_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	340	0	1	04	01	H5216_340_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	343	0	1	04	01	H5216_343_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	343	0	1	04	01	H5216_343_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	345	0	1	04	01	H5216_345_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	345	0	1	04	01	H5216_345_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	347	0	1	04	01	H5216_347_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	347	0	1	04	01	H5216_347_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	348	0	1	04	01	H5216_348_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	348	0	1	04	01	H5216_348_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	350	0	1	04	01	H5216_350_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	350	0	1	04	01	H5216_350_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	351	0	1	04	01	H5216_351_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	351	0	1	04	01	H5216_351_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	352	0	1	04	01	H5216_352_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	352	0	1	04	01	H5216_352_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	355	0	1	04	01	H5216_355_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	355	0	1	04	01	H5216_355_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	358	0	1	04	01	H5216_358_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	358	0	1	04	01	H5216_358_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	361	0	1	04	01	H5216_361_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H5216	361	0	1	04	01	H5216_361_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2919	2919															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	361	0	1	04	01	H5216_361_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	362	0	1	04	01	H5216_362_0	4	1	3	Chronic Care Assistance and Music Therapy	01111111001111111100000000000000											209	124															1	001		10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i10;14c15;17b2;17b3;17b4;18b1;18c;
H5216	363	0	1	04	01	H5216_363_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	363	0	1	04	01	H5216_363_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	366	0	1	04	01	H5216_366_0	6	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H5216	366	0	1	04	01	H5216_366_0	6	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	366	0	1	04	01	H5216_366_0	6	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									5553	5553															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	367	0	1	04	01	H5216_367_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	367	0	1	04	01	H5216_367_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									8468	8468															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	367	0	1	04	01	H5216_367_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5216	368	0	1	04	01	H5216_368_0	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	368	0	1	04	01	H5216_368_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	369	0	1	04	01	H5216_369_0	4	1	3	Chronic Care Assistance and Music Therapy	01111111001111111100000000000000											792	470															1	001		10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i10;14c15;17b2;17b3;17b4;18b1;18c;
H5216	370	0	1	04	01	H5216_370_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									4620	4620															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	370	0	1	04	01	H5216_370_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5216	370	0	1	04	01	H5216_370_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	371	0	1	04	01	H5216_371_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	371	0	1	04	01	H5216_371_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	372	0	1	04	01	H5216_372_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	372	0	1	04	01	H5216_372_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									5065	5065															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	375	0	1	04	01	H5216_375_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	375	0	1	04	01	H5216_375_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									13129	13129															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	375	0	1	04	01	H5216_375_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H5216	376	0	1	04	01	H5216_376_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	376	0	1	04	01	H5216_376_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	379	0	1	04	01	H5216_379_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	379	0	1	04	01	H5216_379_0	4	2	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	379	0	1	04	01	H5216_379_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H5216	381	0	1	04	01	H5216_381_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H5216	381	0	1	04	01	H5216_381_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	381	0	1	04	01	H5216_381_0	4	2	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	382	0	1	04	01	H5216_382_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5216	382	0	1	04	01	H5216_382_0	4	2	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	382	0	1	04	01	H5216_382_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	383	0	1	04	01	H5216_383_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	383	0	1	04	01	H5216_383_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	384	0	1	04	01	H5216_384_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H5216	384	0	1	04	01	H5216_384_0	4	2	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	384	0	1	04	01	H5216_384_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	385	0	1	04	01	H5216_385_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									5831	5831															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	385	0	1	04	01	H5216_385_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H5216	385	0	1	04	01	H5216_385_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	387	1	1	04	01	H5216_387_1	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	387	1	1	04	01	H5216_387_1	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	387	2	1	04	01	H5216_387_2	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	387	2	1	04	01	H5216_387_2	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	388	0	1	04	01	H5216_388_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									12787	12787															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	388	0	1	04	01	H5216_388_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	390	0	1	04	01	H5216_390_0	4	2	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	390	0	1	04	01	H5216_390_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H5216	390	0	1	04	01	H5216_390_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	394	0	1	04	01	H5216_394_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	394	0	1	04	01	H5216_394_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									8728	8728															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	399	0	1	04	01	H5216_399_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	399	0	1	04	01	H5216_399_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	401	0	1	04	01	H5216_401_0	5	1	3	Chronic Care Assistance and Music Therapy	01111111001111111100000000000000											955	566															1	001		10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i10;14c15;17b2;17b3;17b4;18b1;18c;
H5216	403	0	1	04	01	H5216_403_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	403	0	1	04	01	H5216_403_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	404	0	1	04	01	H5216_404_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	404	0	1	04	01	H5216_404_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	405	0	1	04	01	H5216_405_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	405	0	1	04	01	H5216_405_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	406	0	1	04	01	H5216_406_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	406	0	1	04	01	H5216_406_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	407	0	1	04	01	H5216_407_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	407	0	1	04	01	H5216_407_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	408	0	1	04	01	H5216_408_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	408	0	1	04	01	H5216_408_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	409	0	1	04	01	H5216_409_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	409	0	1	04	01	H5216_409_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	410	0	1	04	01	H5216_410_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	410	0	1	04	01	H5216_410_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	416	0	1	04	01	H5216_416_0	4	1	3	Chronic Care Assistance and Music Therapy	01111111001111111100000000000000											447	265															1	001		10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i10;14c15;17b2;17b3;17b4;18b1;18c;
H5216	417	0	1	04	01	H5216_417_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	417	0	1	04	01	H5216_417_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	420	0	1	04	01	H5216_420_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5216	420	0	1	04	01	H5216_420_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									11205	11205															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	420	0	1	04	01	H5216_420_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	421	0	1	04	01	H5216_421_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	421	0	1	04	01	H5216_421_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	423	0	1	04	01	H5216_423_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	423	0	1	04	01	H5216_423_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	425	0	1	04	01	H5216_425_0	5	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	425	0	1	04	01	H5216_425_0	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H5216	425	0	1	04	01	H5216_425_0	5	2	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	427	1	1	04	01	H5216_427_1	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	427	1	1	04	01	H5216_427_1	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	427	2	1	04	01	H5216_427_2	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	427	2	1	04	01	H5216_427_2	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	427	3	1	04	01	H5216_427_3	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	427	3	1	04	01	H5216_427_3	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	427	4	1	04	01	H5216_427_4	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	427	4	1	04	01	H5216_427_4	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	427	5	1	04	01	H5216_427_5	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	427	5	1	04	01	H5216_427_5	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	428	1	1	04	01	H5216_428_1	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	428	1	1	04	01	H5216_428_1	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	428	2	1	04	01	H5216_428_2	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	428	2	1	04	01	H5216_428_2	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	428	3	1	04	01	H5216_428_3	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	428	3	1	04	01	H5216_428_3	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	428	5	1	04	01	H5216_428_5	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	428	5	1	04	01	H5216_428_5	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	430	0	1	04	01	H5216_430_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	430	0	1	04	01	H5216_430_0	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	431	0	1	04	01	H5216_431_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	431	0	1	04	01	H5216_431_0	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	432	0	1	04	01	H5216_432_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	432	0	1	04	01	H5216_432_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	433	0	1	04	01	H5216_433_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	433	0	1	04	01	H5216_433_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	435	1	1	04	01	H5216_435_1	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	435	1	1	04	01	H5216_435_1	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	435	2	1	04	01	H5216_435_2	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	435	2	1	04	01	H5216_435_2	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	435	3	1	04	01	H5216_435_3	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	435	3	1	04	01	H5216_435_3	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	436	1	1	04	01	H5216_436_1	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	436	1	1	04	01	H5216_436_1	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	436	2	1	04	01	H5216_436_2	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	436	2	1	04	01	H5216_436_2	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	436	3	1	04	01	H5216_436_3	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	436	3	1	04	01	H5216_436_3	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	441	0	1	04	01	H5216_441_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	441	0	1	04	01	H5216_441_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	442	0	1	04	01	H5216_442_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	442	0	1	04	01	H5216_442_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	443	0	1	04	01	H5216_443_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	443	0	1	04	01	H5216_443_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2037	2037															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	443	0	1	04	01	H5216_443_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5216	446	0	1	04	01	H5216_446_0	4	1	3	Chronic Care Assistance and Music Therapy	01111111001111111100000000000000											1766	1047															1	001		10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i10;14c15;17b2;17b3;17b4;18b1;18c;
H5216	455	0	1	04	01	H5216_455_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	455	0	1	04	01	H5216_455_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	457	1	1	04	01	H5216_457_1	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	457	1	1	04	01	H5216_457_1	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	457	2	1	04	01	H5216_457_2	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	457	2	1	04	01	H5216_457_2	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	461	0	1	04	01	H5216_461_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	461	0	1	04	01	H5216_461_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	463	0	1	04	01	H5216_463_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	463	0	1	04	01	H5216_463_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	464	0	1	04	01	H5216_464_0	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	464	0	1	04	01	H5216_464_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	465	0	1	04	01	H5216_465_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	465	0	1	04	01	H5216_465_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	466	0	1	04	01	H5216_466_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	466	0	1	04	01	H5216_466_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	471	0	1	04	01	H5216_471_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	471	0	1	04	01	H5216_471_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	472	0	1	04	01	H5216_472_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	472	0	1	04	01	H5216_472_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	473	0	1	04	01	H5216_473_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H5216	473	0	1	04	01	H5216_473_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5216	474	0	1	04	01	H5216_474_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	474	0	1	04	01	H5216_474_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	475	0	1	04	01	H5216_475_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	475	0	1	04	01	H5216_475_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	476	0	1	04	01	H5216_476_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	476	0	1	04	01	H5216_476_0	4	2	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	476	0	1	04	01	H5216_476_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5216	477	0	1	04	01	H5216_477_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	477	0	1	04	01	H5216_477_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5216	477	0	1	04	01	H5216_477_0	4	2	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	478	0	1	04	01	H5216_478_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5216	478	0	1	04	01	H5216_478_0	4	2	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	478	0	1	04	01	H5216_478_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	479	0	1	04	01	H5216_479_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	479	0	1	04	01	H5216_479_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									112	112															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	480	0	1	04	01	H5216_480_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	480	0	1	04	01	H5216_480_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2282	2282															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5216	481	1	1	04	01	H5216_481_1	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5216	481	1	1	04	01	H5216_481_1	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	481	2	1	04	01	H5216_481_2	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5216	481	2	1	04	01	H5216_481_2	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H5253	064	0	1	02	01	H5253_064_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								942	800															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	116	0	1	02	01	H5253_116_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								4639	3943															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H5253	155	0	1	02	01	H5253_155_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											2216	1883															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	161	0	1	02	01	H5253_161_0	6	1	3	SSBCI Package 1	00001101000000000000000000000000											602	511															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	166	0	1	02	01	H5253_166_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											1657	1409															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	168	0	1	02	01	H5253_168_0	5	1	3	SSBCI Package 1	00001101000000000000000000000000											6217	5285															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	175	0	1	02	01	H5253_175_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											2062	1752															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	176	0	1	02	01	H5253_176_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											2578	2191															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	179	0	1	02	01	H5253_179_0	5	1	3	SSBCI Package 1	00001101000000000000000000000000											2167	1842															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	182	0	1	02	01	H5253_182_0	6	1	3	SSBCI Package 1	00001101000000000000000000000000											4915	4177															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	183	0	1	02	01	H5253_183_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											13691	11637															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	186	0	1	02	01	H5253_186_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											3334	2834															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	188	0	1	02	01	H5253_188_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											6089	5176															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	189	0	1	02	01	H5253_189_0	6	1	3	SSBCI Package 1	00001101000000000000000000000000											18788	15970															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	190	0	1	02	01	H5253_190_0	5	1	3	SSBCI Package 1	00001101000000000000000000000000											33624	28580															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	192	0	1	02	01	H5253_192_0	6	1	3	SSBCI Package 1	00001101000000000000000000000000											8107	6891															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	193	1	1	02	01	H5253_193_1	4	1	3	SSBCI Package 1	00001101000000000000000000000000											6637	5641															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	193	2	1	02	01	H5253_193_2	4	1	3	SSBCI Package 1	00001101000000000000000000000000											16202	13772															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	194	1	1	02	01	H5253_194_1	4	1	3	SSBCI Package 1	00001101000000000000000000000000											5124	4355															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	194	2	1	02	01	H5253_194_2	4	1	3	SSBCI Package 1	00001101000000000000000000000000											7644	6497															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	195	0	1	02	01	H5253_195_0	6	1	3	SSBCI Package 1	00001101000000000000000000000000											1420	1207															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	196	0	1	02	01	H5253_196_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											4237	3601															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	197	0	1	02	01	H5253_197_0	6	1	3	SSBCI Package 1	00001101000000000000000000000000											4202	3572															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	200	0	1	02	01	H5253_200_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											4438	3773															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	202	0	1	02	01	H5253_202_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											6240	5304															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	214	0	1	02	01	H5253_214_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											126	107															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	216	1	1	02	01	H5253_216_1	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								53374	47068															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H5253	216	2	1	02	01	H5253_216_2	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								13321	11323															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H5253	217	1	1	02	01	H5253_217_1	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								30401	25841															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H5253	217	2	1	02	01	H5253_217_2	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								10976	9329															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H5253	222	0	1	02	01	H5253_222_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								117	100															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	234	1	1	02	01	H5253_234_1	4	1	3	SSBCI Package 1	00001101000000000000000000000000											126	107															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	234	2	1	02	01	H5253_234_2	4	1	3	SSBCI Package 1	00001101000000000000000000000000											126	107															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	239	0	1	01	01	H5253_239_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											126	107															2			13i1;		1	13i1;	1	0.00	7		01010		13i1;
H5253	240	0	1	02	01	H5253_240_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											126	107															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	243	1	1	02	01	H5253_243_1	4	1	3	SSBCI Package 1	00001101000000000000000000000000											508	432															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	243	2	1	02	01	H5253_243_2	6	1	3	SSBCI Package 1	00001101000000000000000000000000											1736	1476															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	253	0	1	02	01	H5253_253_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								117	100															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	262	0	1	02	01	H5253_262_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											4678	3976															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5253	264	0	1	02	01	H5253_264_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											2807	2386															2			13i1;	2	1	13i1;	1	0.00	7		01010		13i1;
H5262	001	0	1	01	01	H5262_001_0	6	1	3	Package 1	00000101100000000000000100000000	Chronic Hypertension										1516	160															1	001		13b;13i1;13i2;		2		2						
H5262	003	0	1	01	01	H5262_003_0	6	1	3	Package 1	00000101100000000000000100000000	Chronic Hypertension										3131	330															1	001		13b;13i1;13i2;		2		2						
H5262	004	0	1	01	01	H5262_004_0	4	1	3	Package 1	00000101100000000000000100000000	Chronic Hypertension										468	49															1	001		13b;13i1;13i2;		2		2						
H5262	005	0	1	01	01	H5262_005_0	4	1	3	Package 1	00000101100000000000000100000000	Chronic Hypertension										171	18															1	001		13b;13i1;13i2;		2		2						
H5262	007	0	1	01	01	H5262_007_0	6	2	2	Hospital at Home														0000000000100000000	Same disease states as CMS waiver													2			13d;		2		2						
H5262	007	0	1	01	01	H5262_007_0	6	1	3	Package 1	00000101100000000000000100000000	Chronic Hypertension										1603	169															1	001		13b;13i1;13i2;		2		2						
H5262	008	0	1	01	01	H5262_008_0	6	1	3	Package 1	00000101100000000000000100000000	Chronic Hypertension										469	49															1	001		13b;13i1;13i2;		2		2						
H5262	008	0	1	01	01	H5262_008_0	6	2	2	Hospital at Home														0000000000100000000	Same disease states as CMS waiver													2			13d;		2		2						
H5262	009	0	1	01	01	H5262_009_0	4	1	3	Package 1	00000101100000000000000100000000	Chronic Hypertension										290	31															1	001		13b;13i1;13i2;		2		2						
H5262	009	0	1	01	01	H5262_009_0	4	2	2	Hospital at Home														0000000000100000000	Same disease states as CMS waiver													2			13d;		2		2						
H5262	010	0	1	01	01	H5262_010_0	4	2	2	Hospital at Home														0000000000100000000	Same disease states as CMS waiver													2			13d;		2		2						
H5262	010	0	1	01	01	H5262_010_0	4	1	3	Package 1	00000101100000000000000100000000	Chronic Hypertension										194	20															1	001		13b;13i1;13i2;		2		2						
H5262	021	0	1	01	01	H5262_021_0	6	1	3	Package 1	00000101100000000000000100000000	Chronic Hypertension										599	63															1	001		13b;13i1;13i2;		2		2						
H5262	023	0	1	01	01	H5262_023_0	6	1	3	Package 1	00000101100000000000000100000000	Chronic Hypertension										1037	109															1	001		13b;13i1;13i2;		2		2						
H5262	023	0	1	01	01	H5262_023_0	6	2	2	Hospital at Home														0000000000100000000	Same disease states as CMS waiver													2			13d;		2		2						
H5262	029	0	1	01	01	H5262_029_0	6	1	3	Package 1	01000101100001100000100100000000	Chronic Hypertension										92	85															1	001		13b;13i1;13i2;13i10;		2		1	60.00	5		00010		13i1;13i10;
H5262	030	0	1	01	01	H5262_030_0	6	2	2	Hospital at Home														0000000000100000000	Same disease states as CMS waiver													2			13d;		2		2						
H5262	030	0	1	01	01	H5262_030_0	6	1	3	Package 1	01000101100001100000100100000000	Chronic Hypertension										115	106															1	001		13b;13i1;13i2;13i10;		2		1	75.00	5		00010		13i1;13i10;
H5262	032	0	1	01	01	H5262_032_0	6	1	3	Package 1	00000101100000000000000100000000	Chronic Hypertension										238	25															1	001		13b;13i1;13i2;		2		2						
H5262	033	0	1	01	01	H5262_033_0	6	1	3	Package 1	00000101100000000000000100000000	Chronic Hypertension										443	47															1	001		13b;13i1;13i2;		2		2						
H5262	033	0	1	01	01	H5262_033_0	6	2	2	Hospital at Home														0000000000100000000	Same disease states as CMS waiver													2			13d;		2		2						
H5272	001	0	1	01	01	H5272_001_0	7	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										5920	5469															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H5294	010	0	1	01	01	H5294_010_0	6	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										280	265															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H5294	021	0	1	01	01	H5294_021_0	6	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										3606	3426															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H5294	022	0	1	01	01	H5294_022_0	6	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										572	542															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H5294	023	0	1	01	01	H5294_023_0	6	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										590	559															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H5294	024	0	1	01	01	H5294_024_0	6	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										183	173															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H5294	025	0	1	01	01	H5294_025_0	6	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										405	384															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H5296	004	0	1	02	01	H5296_004_0	9	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									721	548															2			13i1;13i3;13i10;13i-O1;14c8;	2	2		1	0.00	7		00010		13i1;13i10;14c8;
H5296	006	0	1	01	01	H5296_006_0	9	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									3925	25															2			13i3;13i10;13i-O1;		2		2						
H5296	007	0	1	01	01	H5296_007_0	9	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									11901	9095															2			13i1;13i3;13i5;13i10;13i-O1;		2		2						
H5296	008	0	1	01	01	H5296_008_0	11	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									2004	7															2			13i3;13i10;13i-O1;		2		2						
H5296	009	0	1	02	01	H5296_009_0	9	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									392	329															2			13i1;13i3;13i10;13i-O1;14c8;	2	2		1	0.00	7		00010		13i1;13i10;14c8;
H5296	010	0	1	01	01	H5296_010_0	11	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									1189	12															2			13i3;13i10;13i-O1;		2		2						
H5296	011	0	1	01	01	H5296_011_0	10	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									2715	2281															2			13i1;13i3;13i5;13i10;13i-O1;14c8;		2		1	60.00	7		00010		13i1;13i10;14c8;
H5296	012	0	1	01	01	H5296_012_0	9	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									13	1															2			13i3;13i-O1;		2		2						
H5296	013	0	1	01	01	H5296_013_0	8	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									13	1															2			13i3;13i-O1;		2		2						
H5299	001	0	1	01	01	H5299_001_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								883	793															2			13i1;13i10;		1	13i1;13i10;	1	33.00	7		00010		13i1;13i10;
H5299	006	0	1	01	01	H5299_006_0	4	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								829	745															2			13i1;13i10;		1	13i1;13i10;	1	346.00	7		00010		13i1;13i10;
H5299	009	0	1	01	01	H5299_009_0	4	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								1464	1315															2			13i1;13i10;		1	13i1;13i10;	1	185.00	7		00010		13i1;13i10;
H5299	013	0	1	01	01	H5299_013_0	4	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								5483	4924															2			13i1;13i10;		1	13i1;13i10;	1	427.00	7		00010		13i1;13i10;
H5299	014	0	1	01	01	H5299_014_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											86	77															2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H5299	015	0	1	01	01	H5299_015_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											2183	1961															2			13i1;13i10;		1	13i1;13i10;	1	453.00	7		00010		13i1;13i10;
H5299	016	0	1	01	01	H5299_016_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											1419	1274															2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H5299	017	0	1	01	01	H5299_017_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											938	842															2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H5299	018	0	1	01	01	H5299_018_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											181	163															2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H5302	012	0	1	01	01	H5302_012_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							24817	24181															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5302	020	0	1	01	01	H5302_020_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							2161	2086															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5302	022	0	1	01	01	H5302_022_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							14654	10389															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5302	024	0	1	01	01	H5302_024_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							10299	10248															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5302	026	0	1	01	01	H5302_026_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											6894	6211															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5302	028	0	1	01	01	H5302_028_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1201	851															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5302	809	0	1	01	01	H5302_809_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5302	809	0	1	01	01	H5302_809_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5322	025	0	1	02	01	H5322_025_0	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								7091	6028															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H5322	033	0	1	02	01	H5322_033_0	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								3984	3386															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H5322	038	0	1	02	01	H5322_038_0	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1259	1070															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H5322	046	0	1	02	01	H5322_046_0	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								5752	4889															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H5322	049	1	1	02	01	H5322_049_1	7	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								9561	8127															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H5322	049	2	1	02	01	H5322_049_2	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								20307	17261															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H5322	049	3	1	02	01	H5322_049_3	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								453	385															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H5322	050	1	1	02	01	H5322_050_1	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								10273	8732															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H5322	050	2	1	02	01	H5322_050_2	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								27701	23546															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H5322	050	3	1	02	01	H5322_050_3	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1591	1352															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H5322	052	1	1	02	01	H5322_052_1	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								7321	6223															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H5322	052	2	1	02	01	H5322_052_2	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								4241	3605															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H5322	052	3	1	02	01	H5322_052_3	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								8631	7336															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H5325	003	0	1	01	01	H5325_003_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1089	1072															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5325	004	0	1	01	01	H5325_004_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							930	923															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5325	005	0	1	01	01	H5325_005_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							2686	2665															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5325	006	0	1	01	01	H5325_006_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1894	1879															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5325	007	0	1	01	01	H5325_007_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							2091	2048															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5325	012	0	1	01	01	H5325_012_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							720	714															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5325	013	0	1	01	01	H5325_013_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							887	886															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5325	014	0	1	01	01	H5325_014_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							422	422															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5325	015	0	1	01	01	H5325_015_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							257	257															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5334	013	0	1	04	01	H5334_013_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;	1	1	13i1;13i10;	1	288.00	7		00010		13i1;13i10;
H5334	014	0	1	04	01	H5334_014_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;	1	1	13i1;13i10;	1	288.00	7		00010		13i1;13i10;
H5334	015	0	1	04	01	H5334_015_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;	1	1	13i1;13i10;	1	288.00	7		00010		13i1;13i10;
H5334	016	0	1	04	01	H5334_016_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;	1	1	13i1;13i10;	1	137.00	7		00010		13i1;13i10;
H5334	017	0	1	04	01	H5334_017_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;	1	1	13i1;13i10;	1	137.00	7		00010		13i1;13i10;
H5334	019	0	1	04	01	H5334_019_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											252	227															2			13i1;13i10;	1	1	13i1;13i10;	1	137.00	7		00010		13i1;13i10;
H5334	020	0	1	04	01	H5334_020_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											121	109															2			13i1;13i10;	1	1	13i1;13i10;	1	137.00	7		00010		13i1;13i10;
H5374	001	0	1	01	01	H5374_001_0	6	1	3	SSBCI	01111111111111111111111000000000											1117	744															2			10b1;13i4;13i6;13i-O1;13i-O2;14c4;14c17;		2		1	500.00	5		01100		13i6;13i-O1;13i-O2;
H5377	002	0	1	02	01	H5377_002_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5377	003	0	1	01	01	H5377_003_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H5377	003	0	1	01	01	H5377_003_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H5377	003	0	1	01	01	H5377_003_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2833	2833															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5397	003	0	1	01	01	H5397_003_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											262	235															2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H5410	013	0	1	01	01	H5410_013_0	5	1	3	Food and Produce	00001101000001001000000000000000											196	147															2			13i1;		2		2						
H5410	025	0	1	01	01	H5410_025_0	5	1	3	Food and Produce	00001101000001001000000000000000											50	38															2			13i1;		2		2						
H5410	031	0	1	01	01	H5410_031_0	5	1	3	Food and Produce	00001101000001001000000000000000											43	33															2			13i1;		2		2						
H5410	032	0	1	01	01	H5410_032_0	5	1	3	Food and Produce	00001101000001001000000000000000											64	48															2			13i1;		2		2						
H5410	042	0	1	01	01	H5410_042_0	5	1	3	Food and Produce	00001101000001001000000000000000											110	83															2			13i1;		2		2						
H5410	045	0	1	01	01	H5410_045_0	5	1	3	Food and Produce	00001101000001001000000000000000											45	33															2			13i1;		2		2						
H5410	046	0	1	01	01	H5410_046_0	5	1	3	Food and Produce	00001101000001001000000000000000											203	152															2			13i1;		2		2						
H5422	015	0	1	02	01	H5422_015_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							83	62															2			13i1;13i10;	2	2		2						
H5422	018	0	1	01	01	H5422_018_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							1100	1004															2			13i1;13i10;		2		2						
H5422	019	0	1	01	01	H5422_019_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							929	845															2			13i1;13i10;		2		2						
H5425	034	0	1	01	01	H5425_034_0	11	1	3	Food and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						26139	14376															2			13i1;13i4;		2		2						
H5425	070	0	1	01	01	H5425_070_0	10	1	3	Food and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						3204	1762															2			13i1;13i4;		2		2						
H5425	076	0	1	01	01	H5425_076_0	10	1	3	Food and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						2271	1249															2			13i1;13i4;		2		2						
H5425	086	0	1	01	01	H5425_086_0	10	1	3	Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						1563	859															2			13i4;		2		2						
H5425	087	0	1	01	01	H5425_087_0	10	1	3	Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						1252	688															2			13i4;		2		2						
H5425	091	0	1	02	01	H5425_091_0	10	1	3	Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						555	305															2			13i4;	2	2		2						
H5425	097	0	1	01	01	H5425_097_0	10	1	3	Food, Utilities and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						8557	4706															2			13i1;13i4;13i10;		1	13i1;13i4;13i10;	1	0.00	7		00111		13i1;13i10;
H5425	098	0	1	01	01	H5425_098_0	10	1	3	Food, Utilities and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						6886	3787															2			13i1;13i4;13i10;		1	13i1;13i4;13i10;	1	0.00	7		00111		13i1;13i10;
H5425	102	0	1	01	01	H5425_102_0	10	1	3	Food and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						1170	643															2			13i1;13i4;		2		2						
H5425	104	0	1	01	01	H5425_104_0	10	1	3	Food and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						10797	5938															2			13i1;13i4;		2		2						
H5425	105	0	1	01	01	H5425_105_0	10	1	3	Food and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						2084	1146															2			13i1;13i4;		2		2						
H5425	106	0	1	01	01	H5425_106_0	10	1	3	Food and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						475	261															2			13i1;13i4;		2		2						
H5425	118	0	1	01	01	H5425_118_0	10	1	3	Food	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						2112	1161															2			13i1;		2		2						
H5425	123	0	1	01	01	H5425_123_0	10	1	3	Food	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						12111	6661															2			13i1;		2		2						
H5425	129	0	1	01	01	H5425_129_0	10	1	3	Food and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						1354	744															2			13i1;13i4;		2		2						
H5425	131	0	1	01	01	H5425_131_0	10	1	3	Food and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						56	30															2			13i1;13i4;		1	13i1;13i4;	2						
H5425	132	0	1	02	01	H5425_132_0	11	1	3	Food and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						20	11															2			13i1;13i4;	2	2		2						
H5425	136	0	1	01	01	H5425_136_0	10	1	3	Groceries	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						243	133															2			13i1;		2		2						
H5425	137	0	1	01	01	H5425_137_0	10	1	3	Food and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						1115	613															2			13i1;13i4;		2		2						
H5425	138	0	1	01	01	H5425_138_0	10	1	3	Food and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						1092	600															2			13i1;13i4;		2		2						
H5425	139	0	1	01	01	H5425_139_0	10	1	3	Groceries	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						1018	559															2			13i1;		2		2						
H5425	140	0	1	01	01	H5425_140_0	10	1	3	Food and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						354	194															2			13i1;13i4;		2		2						
H5425	141	0	1	01	01	H5425_141_0	10	1	3	Food and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						3980	2189															2			13i1;13i4;		2		2						
H5425	142	0	1	01	01	H5425_142_0	10	1	3	Food and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						2299	1264															2			13i1;13i4;		2		2						
H5425	143	0	1	01	01	H5425_143_0	10	1	3	Food and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						2186	1202															2			13i1;13i4;		2		2						
H5425	144	0	1	01	01	H5425_144_0	10	1	3	Food and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						1234	678															2			13i1;13i4;		2		2						
H5425	145	0	1	01	01	H5425_145_0	10	1	3	Groceries	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						1634	898															2			13i1;		2		2						
H5425	146	0	1	01	01	H5425_146_0	10	1	3	Food and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						372	204															2			13i1;13i4;		2		2						
H5425	149	0	1	01	01	H5425_149_0	10	1	3	Legal Reimbursement and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						5	2															2			13i4;13i8;		2		2						
H5425	150	0	1	01	01	H5425_150_0	10	1	3	Food and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						276	151															2			13i1;13i4;		2		2						
H5425	151	0	1	01	01	H5425_151_0	10	1	3	Food and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						573	315															2			13i1;13i4;		2		2						
H5425	155	0	1	01	01	H5425_155_0	10	1	3	Food	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						2416	1328															2			13i1;		2		2						
H5425	156	0	1	01	01	H5425_156_0	10	1	3	Food, Non-medical Transport	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						1132	622															2			13i1;13i4;		2		2						
H5425	158	0	1	01	01	H5425_158_0	10	1	3	Legal Reimbursement and Non-Medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						49	26															2			13i4;13i8;		2		2						
H5427	070	0	1	01	01	H5427_070_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							4175	3729															2			13i1;13i10;		2		2						
H5427	072	0	1	01	01	H5427_072_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							35935	33598															2			13i1;13i10;		2		2						
H5427	077	0	1	01	01	H5427_077_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							6716	6281															2			13i1;13i10;		2		2						
H5427	078	0	1	01	01	H5427_078_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							7587	7224															2			13i1;13i10;		2		2						
H5427	087	0	1	01	01	H5427_087_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							53	50															2			13i1;13i10;		2		2						
H5427	099	0	1	01	01	H5427_099_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							4531	4268															2			13i1;13i10;		2		2						
H5427	108	0	1	01	01	H5427_108_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							2673	2558															2			13i1;13i10;		2		2						
H5431	019	0	1	01	01	H5431_019_0	5	1	3	Meals and Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							10764	10545															2			13i1;13i2;13i10;		2		2						
H5431	021	0	1	01	01	H5431_021_0	5	1	3	Meals and Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							18593	17244															2			13i1;13i2;13i10;		2		2						
H5431	022	0	1	01	01	H5431_022_0	5	1	3	Meals and Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							715	592															2			13i1;13i2;13i10;		2		2						
H5431	026	0	1	01	01	H5431_026_0	5	1	3	Meals and Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							23758	22975															2			13i1;13i2;13i10;		2		2						
H5433	001	0	1	01	01	H5433_001_0	6	1	3	SSBCI - Food and Produce Card; Transportation	01111111111111111111111110000000	Chronic hypertension	Chronic hyperlipidemia									14500	11600															2			13i1;13i4;		2		1	0.00	5		00010		13i1;
H5447	002	0	1	01	01	H5447_002_0	5	1	3	SSBCI Flex Card	01001101101000101001010000000000											2012	1810															2			13i1;13i10;		1	13i1;13i10;	1	0.00	5		00010		13i1;13i10;
H5447	003	0	1	01	01	H5447_003_0	6	1	3	SSBCI Flex Card	01001101101000101001010000000000											144	130															2			13i1;13i10;		1	13i1;13i10;	1	0.00	5		00010		13i1;13i10;
H5453	001	0	1	04	01	H5453_001_0	7	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								4209	3780															2			13i1;13i10;	1	1	13i1;13i10;	1	92.00	7		00010		13i1;13i10;
H5453	004	0	1	04	01	H5453_004_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								666	598															2			13i1;13i10;	1	1	13i1;13i10;	1	56.00	7		00010		13i1;13i10;
H5453	010	0	1	04	01	H5453_010_0	7	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								231	208															2			13i1;13i10;	1	1	13i1;13i10;	1	52.00	7		00010		13i1;13i10;
H5453	015	0	1	04	01	H5453_015_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											2074	1862															2			13i1;13i10;	1	1	13i1;13i10;	1	150.00	7		00010		13i1;13i10;
H5453	016	0	1	04	01	H5453_016_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											6415	5760															2			13i1;13i10;	1	1	13i1;13i10;	1	318.00	7		00010		13i1;13i10;
H5453	017	0	1	04	01	H5453_017_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											657	590															2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H5453	018	0	1	04	01	H5453_018_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											2037	1830															2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H5471	118	0	1	01	01	H5471_118_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							2082	1919															2			13i1;13i10;		2		2						
H5471	125	0	1	01	01	H5471_125_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							3149	3001															2			13i1;13i10;		2		2						
H5471	135	0	1	01	01	H5471_135_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							3437	3220															2			13i1;13i10;		2		2						
H5472	001	0	1	02	01	H5472_001_0	11	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									969	11															2			13i1;13i3;13i10;13i-O1;14c8;	2	2		1	30.00	7		00010		13i1;13i10;14c8;
H5472	002	0	1	02	01	H5472_002_0	11	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									1236	1106															2			13i1;13i3;13i10;13i-O1;14c8;	2	2		1	40.00	7		00010		13i1;13i10;14c8;
H5472	003	0	1	02	01	H5472_003_0	11	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									109	9															2			13i3;13i10;13i-O1;	2	2		2						
H5472	004	0	1	02	01	H5472_004_0	12	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									987	946															2			13i1;13i3;13i5;13i10;13i-O1;14c8;	2	2		1	0.00	7		00010		13i1;13i10;14c8;
H5472	007	0	1	02	01	H5472_007_0	10	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									1719	1306															2			13i1;13i3;13i5;13i10;13i-O1;14c8;	2	2		1	100.00	7		00010		13i1;13i10;14c8;
H5472	009	0	1	02	01	H5472_009_0	10	1	3	Package 1	01111111111111111111111000000000											1017	773															2			13i1;13i3;13i5;13i10;13i-O1;14c8;	2	2		1	0.00	7		00010		13i1;13i10;14c8;
H5472	010	0	1	02	01	H5472_010_0	12	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									3098	31															2			13i3;13i10;13i-O1;	2	2		2						
H5472	011	0	1	02	01	H5472_011_0	10	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									192	129															2			13i1;13i3;13i10;13i-O1;14c8;	2	2		1	30.00	7		00010		13i1;13i10;14c8;
H5472	012	0	1	02	01	H5472_012_0	8	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									166	2															2			13i3;13i-O1;	2	2		2						
H5472	013	0	1	02	01	H5472_013_0	11	1	3	Package 1	00000000100000000000000000000000											192	129															2			13i1;13i3;13i-O1;13i-O2;	2	2		2						
H5475	001	0	1	02	01	H5475_001_0	5	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										172	164															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H5496	005	0	1	01	01	H5496_005_0	7	1	3	Grocery Card	01111111111111111111111000000000											800	600															2			13i1;		1	13i1;	2						
H5496	012	0	1	01	01	H5496_012_0	9	1	3	Grocery Card	01111111111111111111111000000000											800	600															2			13i1;		1	13i1;	2						
H5496	017	0	1	01	01	H5496_017_0	9	1	3	SSBCI Combined Flex	01111111111111111111111000000000											17000	17000															2			13i1;13i3;13i10;		1	13i1;13i3;13i10;	1	0.00	5		00011		13i1;13i3;13i10;
H5521	037	0	1	04	01	H5521_037_0	3	1	2	ESRD Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;	1	1	10b1;	2						
H5521	087	0	1	04	01	H5521_087_0	3	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	1	1	14c21;	2						
H5521	088	0	1	04	01	H5521_088_0	3	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	1	1	14c21;	2						
H5521	089	0	1	04	01	H5521_089_0	3	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	1	1	14c21;	2						
H5521	116	0	1	04	01	H5521_116_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1842	1494															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	123	0	1	04	01	H5521_123_0	3	1	2	ESRD Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;	1	1	10b1;	2						
H5521	124	0	1	04	01	H5521_124_0	3	1	2	ESRD Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;	1	1	10b1;	2						
H5521	171	0	1	04	01	H5521_171_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							2335	1933															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	70.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	218	0	1	04	01	H5521_218_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							9333	6617															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	227	0	1	04	01	H5521_227_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1203	976															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	229	0	1	04	01	H5521_229_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							572	510															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	180.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	233	0	1	04	01	H5521_233_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							2706	1918															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	235	0	1	04	01	H5521_235_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							848	763															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	210.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	275	0	1	04	01	H5521_275_0	3	1	2	ESRD Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;	1	1	10b1;	2						
H5521	277	0	1	04	01	H5521_277_0	3	1	2	ESRD Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;	1	1	10b1;	2						
H5521	302	0	1	04	01	H5521_302_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							408	290															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	324	0	1	04	01	H5521_324_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							762	683															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	195.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	326	0	1	04	01	H5521_326_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1205	1069															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	195.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	364	0	1	04	01	H5521_364_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							2872	2183															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	75.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	365	0	1	04	01	H5521_365_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1321	937															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	392	0	1	04	01	H5521_392_0	3	1	2	ESRD Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;	1	1	10b1;	2						
H5521	398	0	1	04	01	H5521_398_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							705	690															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	399	0	1	04	01	H5521_399_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							883	626															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	400	0	1	04	01	H5521_400_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							606	461															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	75.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	414	0	1	04	01	H5521_414_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							261	185															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	443	0	1	04	01	H5521_443_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1674	1272															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	80.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	461	0	1	04	01	H5521_461_0	4	1	3	SSBCI Pkg	01000110001001110000000000000000											2025	595															1	001		13i6;	1	1	13i6;	2						
H5521	464	0	1	04	01	H5521_464_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1186	1156															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	465	0	1	04	01	H5521_465_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1617	1521															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	467	0	1	04	01	H5521_467_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							606	532															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	135.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	470	0	1	04	01	H5521_470_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							2206	1952															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	160.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	487	0	1	04	01	H5521_487_0	2	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	1	1	14c21;	2						
H5521	490	0	1	04	01	H5521_490_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							3182	2418															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	50.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	496	0	1	04	01	H5521_496_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							217	154															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	504	0	1	04	01	H5521_504_0	2	1	2	ESRD Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;	1	1	10b1;	2						
H5521	510	0	1	04	01	H5521_510_0	3	1	2	ESRD Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;	1	1	10b1;	2						
H5521	512	0	1	04	01	H5521_512_0	3	1	2	ESRD Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;	1	1	10b1;	2						
H5521	553	0	1	04	01	H5521_553_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							2992	2121															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	645	0	1	04	01	H5521_645_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1310	929															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	646	0	1	04	01	H5521_646_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							288	255															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	150.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	649	0	1	04	01	H5521_649_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							677	480															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	722	0	1	04	01	H5521_722_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1335	946															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	726	0	1	04	01	H5521_726_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							167	118															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	727	0	1	04	01	H5521_727_0	3	2	2	Healthy Heart (CHF)														0000000000100000000	Chronic heart failure													1	001		13b;13c;14c8;	1	1	13b;13c;14c8;	2						
H5521	727	0	1	04	01	H5521_727_0	3	1	3	SSBCI Pkg	00000100000000000000000000000000											27	23															1	001		10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	75.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	727	0	1	04	01	H5521_727_0	3	3	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	1	1	14c21;	2						
H5521	758	0	1	04	01	H5521_758_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							238	234															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5521	801	0	1	04	01	H5521_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5521	801	0	1	04	01	H5521_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5521	805	0	2	04	01	H5521_805_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5521	805	0	2	04	01	H5521_805_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	001	0	1	04	01	H5522_001_0	4	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	1	1	14c21;	2						
H5522	001	0	1	04	01	H5522_001_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							9353	8062															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	75.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5522	002	0	1	04	01	H5522_002_0	3	1	2	Hypertension & Hyperlipidemia														0000010000100000000	Hyperlipidemia										2	2		2			10b1;13b;	1	1	10b1;13b;	2						
H5522	004	0	1	04	01	H5522_004_0	3	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	1	1	14c21;	2						
H5522	005	0	1	04	01	H5522_005_0	3	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	1	1	14c21;	2						
H5522	005	0	1	04	01	H5522_005_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							15337	13220															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	75.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5522	013	0	1	04	01	H5522_013_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							7579	6533															2			10b2;13b;13i1;13i4;13i10;13i-O1;	1	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	75.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5522	013	0	1	04	01	H5522_013_0	3	2	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	1	1	14c21;	2						
H5522	017	0	1	04	01	H5522_017_0	3	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	1	1	14c21;	2						
H5522	022	0	1	04	01	H5522_022_0	3	1	2	Recovery at Home Program														1001000000111100000	Fractures	Neurologic Disorders	Musculoskeletal (MSK)	Pneumonia	Urologic Conditions						2	2		1	001		14c21;	1	1	14c21;	2						
H5522	802	0	1	04	01	H5522_802_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										3853	3468															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	802	0	1	04	01	H5522_802_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	803	0	1	04	01	H5522_803_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	803	0	1	04	01	H5522_803_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	808	0	2	04	01	H5522_808_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	808	0	2	04	01	H5522_808_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	809	0	2	04	01	H5522_809_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	809	0	2	04	01	H5522_809_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	810	0	1	04	01	H5522_810_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	810	0	1	04	01	H5522_810_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	811	0	1	04	01	H5522_811_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	811	0	1	04	01	H5522_811_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	813	0	2	04	01	H5522_813_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	813	0	2	04	01	H5522_813_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	814	0	2	04	01	H5522_814_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	814	0	2	04	01	H5522_814_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	815	0	1	04	01	H5522_815_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	815	0	1	04	01	H5522_815_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	816	0	1	04	01	H5522_816_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	816	0	1	04	01	H5522_816_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	817	0	2	04	01	H5522_817_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	817	0	2	04	01	H5522_817_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	818	0	2	04	01	H5522_818_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	818	0	2	04	01	H5522_818_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	819	0	1	04	01	H5522_819_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	819	0	1	04	01	H5522_819_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	828	0	1	04	01	H5522_828_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	828	0	1	04	01	H5522_828_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	832	0	1	04	01	H5522_832_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	832	0	1	04	01	H5522_832_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	837	0	1	04	01	H5522_837_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	837	0	1	04	01	H5522_837_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	838	0	2	04	01	H5522_838_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	838	0	2	04	01	H5522_838_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	839	0	1	04	01	H5522_839_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	839	0	1	04	01	H5522_839_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	840	0	1	04	01	H5522_840_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5522	840	0	1	04	01	H5522_840_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5525	004	0	1	04	01	H5525_004_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5525	005	0	1	04	01	H5525_005_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5525	006	0	1	04	01	H5525_006_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5525	008	0	1	04	01	H5525_008_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5525	030	0	1	04	01	H5525_030_0	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5525	031	0	1	04	01	H5525_031_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5525	034	0	1	04	01	H5525_034_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5525	035	0	1	04	01	H5525_035_0	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5525	036	0	1	04	01	H5525_036_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5525	036	0	1	04	01	H5525_036_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									3141	3141															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5525	042	0	1	04	01	H5525_042_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5525	045	0	1	04	01	H5525_045_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5525	049	0	1	04	01	H5525_049_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5525	051	1	1	04	01	H5525_051_1	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5525	051	2	1	04	01	H5525_051_2	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5525	054	0	1	04	01	H5525_054_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5525	056	0	1	04	01	H5525_056_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5525	057	0	1	04	01	H5525_057_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5525	059	0	1	04	01	H5525_059_0	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5525	059	0	1	04	01	H5525_059_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5525	065	0	1	04	01	H5525_065_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5525	070	0	1	04	01	H5525_070_0	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5525	072	0	1	04	01	H5525_072_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2624	2624															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5525	072	0	1	04	01	H5525_072_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5525	074	0	1	04	01	H5525_074_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5525	075	0	1	04	01	H5525_075_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5525	078	0	1	04	01	H5525_078_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5525	079	0	1	04	01	H5525_079_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5525	080	0	1	04	01	H5525_080_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5525	084	0	1	04	01	H5525_084_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5525	085	1	1	04	01	H5525_085_1	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5525	085	2	1	04	01	H5525_085_2	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5525	086	1	1	04	01	H5525_086_1	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5525	086	1	1	04	01	H5525_086_1	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H5525	086	2	1	04	01	H5525_086_2	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H5525	086	2	1	04	01	H5525_086_2	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5525	087	0	1	04	01	H5525_087_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5549	003	0	1	01	01	H5549_003_0	10	1	3	Combined Food & Produce and FLEX Card	01111111111111111111111000000000											20000	19500															2			13i1;13i10;		2		1	0.00	7		01011		13i1;13i10;
H5549	011	0	1	01	01	H5549_011_0	10	1	3	Combined Food & Produce and FLEX Card	01111111111111111111111000000000											59500	58500															2			13i1;13i10;		2		1	0.00	7		01011		13i1;13i10;
H5577	002	0	1	01	01	H5577_002_0	9	1	3	Package 1	11111111111111111111111111100000	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer						67634	67634															2			13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;13i-O4;14c4;14c17;		2		1	0.00	7		00010		13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;14c4;14c17;
H5577	005	0	1	01	01	H5577_005_0	10	1	3	Package 1	11111111111111111111111111100000	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer						23858	23858															2			13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;13i-O4;14c4;14c17;		2		1	0.00	7		00010		13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;14c4;14c17;
H5577	008	0	1	02	01	H5577_008_0	8	1	3	Package 1	11111111111111111111111111100000	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer						19669	19669															2			13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;13i-O4;14c4;14c17;	2	2		1	0.00	7		00010		13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;14c4;14c17;
H5577	016	0	1	01	01	H5577_016_0	5	1	3	Package 1	11111111111111111111111111100000	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer						4000	4000															2			13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;13i-O4;14c4;14c17;		2		1	0.00	7		00010		13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;14c4;14c17;
H5577	017	0	1	01	01	H5577_017_0	7	1	3	Package 1	11111111111111111111111111100000	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer						24071	24071															2			13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;13i-O4;14c4;14c17;		2		1	0.00	7		00010		13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;14c4;14c17;
H5577	038	0	1	01	01	H5577_038_0	8	1	3	Package 1	11111111111111111111111111100000	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer						18997	18997															2			13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;13i-O4;14c4;14c17;		2		1	0.00	7		00010		13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;14c4;14c17;
H5577	042	0	1	01	01	H5577_042_0	7	1	3	Package 1	11111111111111111111111111100000	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer						34360	34360															2			13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;13i-O4;14c4;14c17;		2		1	0.00	7		00010		13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;14c4;14c17;
H5577	043	0	1	01	01	H5577_043_0	8	1	3	Package 1	11111111111111111111111111100000	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer						1715	1715															2			13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;13i-O4;14c4;14c17;		2		1	0.00	7		00010		13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;14c4;14c17;
H5577	044	0	1	01	01	H5577_044_0	7	1	3	Package 1	11111111111111111111111111100000	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer						2479	2479															2			13i3;13i4;13i10;13i-O4;		2		2						
H5577	046	0	1	01	01	H5577_046_0	7	1	3	Package 1	11111111111111111111111111100000	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer						30309	30309															2			13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;13i-O4;14c4;14c17;		2		1	0.00	7		00010		13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;14c4;14c17;
H5577	052	0	1	01	01	H5577_052_0	7	1	3	Package 1	11111111111111111111111111100000	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer						7000	7000															2			13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;13i-O4;14c4;14c17;		2		1	0.00	7		00010		13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;14c4;14c17;
H5577	054	1	1	01	01	H5577_054_1	9	1	3	Package 1	11111111111111111111111111100000	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer						24890	24890															2			13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;13i-O4;14c4;14c17;		2		1	0.00	7		00010		13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;14c4;14c17;
H5577	054	2	1	01	01	H5577_054_2	8	1	3	Package 1	11111111111111111111111111100000	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer						8081	8081															2			13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;13i-O4;14c4;14c17;		2		1	0.00	7		00010		13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;14c4;14c17;
H5577	054	3	1	01	01	H5577_054_3	8	1	3	Package 1	11111111111111111111111111100000	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer						6696	6696															2			13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;13i-O4;14c4;14c17;		2		1	0.00	7		00010		13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;14c4;14c17;
H5577	056	1	1	01	01	H5577_056_1	10	1	3	Package 1	11111111111111111111111111100000	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer						18580	18580															2			13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;13i-O4;14c4;14c17;		2		1	0.00	7		00010		13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;14c4;14c17;
H5577	056	2	1	01	01	H5577_056_2	8	1	3	Package 1	11111111111111111111111111100000	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer						4862	4862															2			13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;13i-O4;14c4;14c17;		2		1	0.00	7		00010		13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;14c4;14c17;
H5577	056	4	1	01	01	H5577_056_4	9	1	3	Package 1	11111111111111111111111111100000	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer						2016	2016															2			13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;13i-O4;14c4;14c17;		2		1	0.00	7		00010		13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;14c4;14c17;
H5577	059	0	1	01	01	H5577_059_0	8	1	3	Package 1	11111111111111111111111111100000	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer						579	579															2			13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;13i-O4;14c4;14c17;		2		1	0.00	7		00010		13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;14c4;14c17;
H5577	060	0	1	01	01	H5577_060_0	7	1	3	Package 1	11111111111111111111111111100000	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer						15516	15516															2			13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;13i-O4;14c4;14c17;		2		1	0.00	7		00010		13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;14c4;14c17;
H5577	062	0	1	01	01	H5577_062_0	7	1	3	Package 1	11111111111111111111111111100000	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer						3516	3516															2			13i1;13i3;13i4;13i10;13i-O1;		2		2						
H5577	063	0	1	01	01	H5577_063_0	8	1	3	Package 1	11111111111111111111111111100000	Chronic Anemia	Chronic Hypertension	Cerebrovascular disease	Chronic malnutrition	Non-pressure chronic ulcer						10060	10060															2			13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;13i-O4;14c4;14c17;		2		1	0.00	7		00010		13i1;13i3;13i4;13i5;13i6;13i8;13i10;13i-O2;13i-O3;14c4;14c17;
H5580	001	0	1	01	01	H5580_001_0	5	1	3	OTC + Food & Produce card	00001111011010000000000000000000											3150	2730															2			13i1;		1	13i1;	1	0.00	7		00010		13i1;
H5580	004	0	1	01	01	H5580_004_0	5	1	3	OTC + Food & Produce card	00001111011010000000000000000000											1300	1125															2			13b;13i1;		1	13b;13i1;	1	45.00	7		00010		13b;13i1;
H5580	005	0	1	01	01	H5580_005_0	5	1	3	OTC + Food & Produce card	00001111011010000000000000000000											430	375															2			13i1;		1	13i1;	1	0.00	7		00010		13i1;
H5587	002	0	1	01	01	H5587_002_0	8	1	3	Healthy Food and Produce	01001101110001100000011000000000											7600	7600															2			13i1;		1	13i1;	1	225.00	5		00010		13i1;
H5590	012	1	1	01	01	H5590_012_1	5	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										6075	5368															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H5590	012	2	1	01	01	H5590_012_2	5	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										15441	13644															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H5591	003	0	1	01	01	H5591_003_0	5	1	3	Meals	00000100001000000000000000000000											618	12															2			13i2;		2		2						
H5591	017	0	1	01	01	H5591_017_0	6	2	2	Bathroom Safety														0000000000110000000	History of Falls	Hip Fracture									2	2		2			14c8;		2		1	200.00	3		00001		14c8;
H5591	017	0	1	01	01	H5591_017_0	6	1	3	Meals	00000100001000000000000000000000											335	6															2			13i2;		2		2						
H5591	018	0	1	01	01	H5591_018_0	6	2	2	Bathroom Safety														0000000000110000000	History of Falls	Hip Fracture									2	2		2			14c8;		2		1	200.00	3		00001		14c8;
H5591	018	0	1	01	01	H5591_018_0	6	1	3	Meals	00000100001000000000000000000000											347	7															2			13i2;		2		2						
H5591	019	0	1	01	01	H5591_019_0	6	2	2	Bathroom Safety														0000000000110000000	History of Falls	Hip Fracture									2	2		2			14c8;		2		1	200.00	3		00001		14c8;
H5591	019	0	1	01	01	H5591_019_0	6	1	3	Meals	00000100001000000000000000000000											798	15															2			13i2;		2		2						
H5591	020	0	1	01	01	H5591_020_0	5	2	2	Bathroom Safety														0000000000110000000	History of Falls	Hip Fracture									2	2		2			14c8;		2		1	200.00	3		00001		14c8;
H5591	020	0	1	01	01	H5591_020_0	5	1	3	Meals	00000100001000000000000000000000											84	2															2			13i2;		2		2						
H5591	021	0	1	01	01	H5591_021_0	6	2	2	Bathroom Safety														0000000000110000000	History of Falls	Hip Fracture									2	2		2			14c8;		2		1	200.00	3		00001		14c8;
H5591	021	0	1	01	01	H5591_021_0	6	1	3	Meals	00000100001000000000000000000000											1715	33															2			13i2;		2		2						
H5591	022	0	1	01	01	H5591_022_0	6	2	2	Bathroom Safety														0000000000110000000	History of Falls	Hip Fracture									2	2		2			14c8;		2		1	200.00	3		00001		14c8;
H5591	022	0	1	01	01	H5591_022_0	6	1	3	Meals	00000100001000000000000000000000											1007	19															2			13i2;		2		2						
H5593	001	0	1	01	01	H5593_001_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							3234	3186															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5593	003	0	1	01	01	H5593_003_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											627	570															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5593	004	0	1	01	01	H5593_004_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											353	324															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5593	005	0	1	01	01	H5593_005_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							963	961															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5593	009	0	1	01	01	H5593_009_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											473	468															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5593	801	0	1	01	01	H5593_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5593	801	0	1	01	01	H5593_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5594	016	0	1	01	01	H5594_016_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							3289	3104															2			13i1;13i10;		2		2						
H5594	017	0	1	01	01	H5594_017_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							15	15															2			13i1;13i10;		2		2						
H5594	028	0	1	01	01	H5594_028_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							32873	31032															2			13i1;13i10;		2		2						
H5594	029	0	1	01	01	H5594_029_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							6575	6200															2			13i1;13i10;		2		2						
H5594	036	0	1	01	01	H5594_036_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							223	200															2			13i1;13i10;		2		2						
H5599	003	0	1	01	01	H5599_003_0	6	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										4841	4599															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H5599	014	0	1	01	01	H5599_014_0	5	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										18007	16184															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H5599	015	0	1	01	01	H5599_015_0	5	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										29968	27721															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H5599	016	0	1	01	01	H5599_016_0	6	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										2037	1863															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H5599	017	0	1	01	01	H5599_017_0	5	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										2481	2270															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H5608	001	0	1	01	01	H5608_001_0	7	1	3	SSBCI Grocery Card, BP Monitor, and Phone Benefit	01111111111111111111111100000000	Chronic hypertension										2431	2431															1	001		13b;13i1;13i10;		1	13b;13i1;13i10;	1	0.00	7		00010		13b;13i1;13i10;
H5608	002	0	1	01	01	H5608_002_0	7	1	3	SSBCI Blood Pressure Monitors	01111111111111111111111000000000											1450	1450															2			13b;		1	13b;	2						
H5619	001	0	1	01	01	H5619_001_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	003	0	1	01	01	H5619_003_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H5619	003	0	1	01	01	H5619_003_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									3803	3803															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	012	0	1	01	01	H5619_012_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	015	0	1	01	01	H5619_015_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	016	0	1	01	01	H5619_016_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	021	0	1	01	01	H5619_021_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	021	0	1	01	01	H5619_021_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H5619	026	0	1	01	01	H5619_026_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	038	0	1	01	01	H5619_038_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H5619	038	0	1	01	01	H5619_038_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									3620	3620															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	046	0	1	01	01	H5619_046_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	047	0	1	01	01	H5619_047_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	051	0	1	02	01	H5619_051_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5619	055	0	1	01	01	H5619_055_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	055	0	1	01	01	H5619_055_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									6084	6084															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	057	0	1	01	01	H5619_057_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	061	0	1	01	01	H5619_061_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	066	0	1	01	01	H5619_066_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H5619	069	0	1	02	01	H5619_069_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5619	075	0	1	01	01	H5619_075_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									13351	13351															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	075	0	1	01	01	H5619_075_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H5619	075	0	1	01	01	H5619_075_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	089	0	1	01	01	H5619_089_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	090	0	1	01	01	H5619_090_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	091	0	1	01	01	H5619_091_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	093	0	1	01	01	H5619_093_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H5619	093	0	1	01	01	H5619_093_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									6120	6120															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	093	0	1	01	01	H5619_093_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	095	0	1	01	01	H5619_095_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	111	0	1	02	01	H5619_111_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5619	113	0	1	02	01	H5619_113_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H5619	113	0	1	02	01	H5619_113_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5619	116	0	1	01	01	H5619_116_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	119	0	1	01	01	H5619_119_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	121	0	1	01	01	H5619_121_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	122	0	1	01	01	H5619_122_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	123	0	1	02	01	H5619_123_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									6898	6898															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	123	0	1	02	01	H5619_123_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5619	123	0	1	02	01	H5619_123_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5619	126	0	1	02	01	H5619_126_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5619	126	0	1	02	01	H5619_126_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2012	2012															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	133	0	1	01	01	H5619_133_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H5619	135	0	1	01	01	H5619_135_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H5619	137	0	1	01	01	H5619_137_0	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	143	0	1	01	01	H5619_143_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H5619	145	0	1	01	01	H5619_145_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2087	2087															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	145	0	1	01	01	H5619_145_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	146	0	1	01	01	H5619_146_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	147	0	1	01	01	H5619_147_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	150	0	1	01	01	H5619_150_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	151	0	1	01	01	H5619_151_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	152	0	1	01	01	H5619_152_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H5619	157	0	1	01	01	H5619_157_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H5619	159	0	1	01	01	H5619_159_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	161	0	1	01	01	H5619_161_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	161	0	1	01	01	H5619_161_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									19584	19584															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	162	0	1	02	01	H5619_162_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									1124	1124															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	162	0	1	02	01	H5619_162_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5619	162	0	1	02	01	H5619_162_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5619	163	0	1	01	01	H5619_163_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H5619	163	0	1	01	01	H5619_163_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									13397	13397															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	163	0	1	01	01	H5619_163_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H5619	165	0	1	01	01	H5619_165_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	165	0	1	01	01	H5619_165_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2875	2875															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	165	0	1	01	01	H5619_165_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H5619	166	0	1	01	01	H5619_166_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H5619	166	0	1	01	01	H5619_166_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									15217	15217															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	166	0	1	01	01	H5619_166_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H5619	167	0	1	01	01	H5619_167_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2648	2648															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	167	0	1	01	01	H5619_167_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H5619	167	0	1	01	01	H5619_167_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H5619	169	0	1	01	01	H5619_169_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H5619	171	0	1	01	01	H5619_171_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H5619	174	0	1	01	01	H5619_174_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H5619	177	0	1	01	01	H5619_177_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H5619	178	0	1	01	01	H5619_178_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	179	0	1	02	01	H5619_179_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5619	179	0	1	02	01	H5619_179_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									3457	3457															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	179	0	1	02	01	H5619_179_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H5619	180	0	1	01	01	H5619_180_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H5619	180	0	1	01	01	H5619_180_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H5619	181	0	1	01	01	H5619_181_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	181	0	1	01	01	H5619_181_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									305	305															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	182	0	1	01	01	H5619_182_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H5619	182	0	1	01	01	H5619_182_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									1349	1349															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	183	0	1	01	01	H5619_183_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	184	0	1	01	01	H5619_184_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	185	0	1	01	01	H5619_185_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	186	0	1	01	01	H5619_186_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	188	1	1	01	01	H5619_188_1	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	188	1	1	01	01	H5619_188_1	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H5619	188	2	1	01	01	H5619_188_2	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H5619	188	2	1	01	01	H5619_188_2	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	189	1	1	02	01	H5619_189_1	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H5619	189	1	1	02	01	H5619_189_1	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5619	189	2	1	02	01	H5619_189_2	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5619	189	2	1	02	01	H5619_189_2	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H5619	190	0	1	01	01	H5619_190_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H5619	190	0	1	01	01	H5619_190_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H5619	190	0	1	01	01	H5619_190_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									11789	11789															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H5619	191	1	1	01	01	H5619_191_1	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	191	2	1	01	01	H5619_191_2	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5619	191	3	1	01	01	H5619_191_3	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H5628	001	0	1	01	01	H5628_001_0	6	1	3	SSBCI	01111111111111111111111000000000											2843	2029															1	001		13i1;		2		2						
H5628	013	1	1	01	01	H5628_013_1	6	2	2	MA Uniformity Flexibility														0100000000000000000														1	001		13c;		2		2						
H5628	013	1	1	01	01	H5628_013_1	6	1	3	SSBCI	01111111111111111111111000000000											3038	2735															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H5628	013	2	1	01	01	H5628_013_2	6	2	2	MA Uniformity Flexibility														0100000000000000000														1	001		13c;		2		2						
H5628	013	2	1	01	01	H5628_013_2	6	1	3	SSBCI	01111111111111111111111000000000											4939	4445															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H5703	001	0	1	01	01	H5703_001_0	7	1	3	AbilityCare Healthy Foods	01111111011111111000000000000000											140	110															2			13i1;		1	13i1;	1	130.00	5		00011		13i1;
H5718	004	0	1	04	01	H5718_004_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											1576	1415															2			13i1;13i10;	1	1	13i1;13i10;	1	262.00	7		00010		13i1;13i10;
H5718	005	0	1	04	01	H5718_005_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											264	237															2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H5718	006	0	1	04	01	H5718_006_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											1321	1186															2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H5767	002	0	1	01	01	H5767_002_0	10	1	3	Enhanced Care	00001101000000000000000000000000											200	178															1	001		13i1;		1	13i1;	1	0.00	5		00010		13i1;
H5767	003	0	1	01	01	H5767_003_0	10	1	3	Enhanced Care	00001101000000000000000000000000											200	184															1	001		13i1;		1	13i1;	1	0.00	5		00010		13i1;
H5774	022	0	1	01	01	H5774_022_0	10	1	3	1	01111111011111111000000000000000											3160	3160															2			13b;13i1;13i3;13i4;13i10;		2		1	25.00	7		00010		13b;13i1;13i3;13i4;13i10;
H5774	035	0	1	01	01	H5774_035_0	12	1	3	Package 1	01111111011111111000000000000000											1077	1077															2			13b;13i1;13i3;13i4;13i10;		2		1	115.00	7		00010		13b;13i1;13i3;13i4;13i10;
H5774	041	1	1	01	01	H5774_041_1	12	1	2	Package 1														0000000000111100000	Oncology patients undergoing active chemo by infusion or systemic radiotherapy.	Post-inpatient stay for acute stroke with the transition of care to patients home.	Patients discharged from thoracic, abdominal, musculoskeletal, and peripheral vascular surgeries.	Bedridden patients with essential services requirements.							2	2		2			14c21;		2		2						
H5774	041	1	1	01	01	H5774_041_1	12	2	3	Package 2	01111111011111111000000000000000											4416	4416															2			13b;13i1;13i3;13i4;13i10;		2		1	270.00	7		00010		13b;13i1;13i3;13i4;13i10;
H5774	041	2	1	01	01	H5774_041_2	11	1	2	Package 1														0000000000111100000	Oncology patients undergoing active chemo by infusion or systemic radiotherapy.	Post-inpatient stay for acute stroke with the transition of care to patients home.	Patients discharged from thoracic, abdominal, musculoskeletal, and peripheral vascular surgeries.	Bedridden patients with essential services requirements.							2	2		2			14c21;		2		2						
H5774	041	2	1	01	01	H5774_041_2	11	2	3	Package 2	01111111011111111000000000000000											413	413															2			13b;13i1;13i3;13i4;13i10;		2		1	135.00	7		00010		13b;13i1;13i3;13i4;13i10;
H5774	041	3	1	01	01	H5774_041_3	11	2	3	Package 2	01111111011111111000000000000000											531	531															2			13b;13i1;13i3;13i4;13i10;		2		1	215.00	7		00010		13b;13i1;13i3;13i4;13i10;
H5774	041	3	1	01	01	H5774_041_3	11	1	2	Package 1														0000000000111100000	Oncology patients undergoing active chemo by infusion or systemic radiotherapy.	Post-inpatient stay for acute stroke with the transition of care to patients home.	Patients discharged from thoracic, abdominal, musculoskeletal, and peripheral vascular surgeries.	Bedridden patients with essential services requirements.							2	2		2			14c21;		2		2						
H5774	043	1	1	01	01	H5774_043_1	11	2	3	Package #2	01111111011111111000000000000000											29651	29651															2			13b;13i1;13i3;13i4;13i10;		2		1	80.00	7		00010		13b;13i1;13i3;13i4;13i10;
H5774	043	1	1	01	01	H5774_043_1	11	1	2	Package #1														0000000000111100000	Oncology patients undergoing active chemo by infusion or systemic radiotherapy	Post-inpatient stay for acute stroke with the transition of care to patients home	Patients discharged from thoracic, abdominal, musculoskeletal, and peripheral vascular surgeries.	Bedridden patients with essential services requirements.							2	2		2			14c21;		2		2						
H5774	043	2	1	01	01	H5774_043_2	11	2	3	Package #2	01111111011111111000000000000000											4227	4227															2			13b;13i1;13i3;13i4;13i10;		2		1	60.00	7		00010		13b;13i1;13i3;13i4;13i10;
H5774	043	2	1	01	01	H5774_043_2	11	1	2	Package #1														0000000000111100000	Oncology patients undergoing active chemo by infusion or systemic radiotherapy	Post-inpatient stay for acute stroke with the transition of care to patients home	Patients discharged from thoracic, abdominal, musculoskeletal, and peripheral vascular surgeries.	Bedridden patients with essential services requirements.							2	2		2			14c21;		2		2						
H5774	043	3	1	01	01	H5774_043_3	11	1	2	Package #1														0000000000111100000	Oncology patients undergoing active chemo by infusion or systemic radiotherapy	Post-inpatient stay for acute stroke with the transition of care to patients home	Patients discharged from thoracic, abdominal, musculoskeletal, and peripheral vascular surgeries.	Bedridden patients with essential services requirements.							2	2		2			14c21;		2		2						
H5774	043	3	1	01	01	H5774_043_3	11	2	3	Package #2	01111111011111111000000000000000											6297	6297															2			13b;13i1;13i3;13i4;13i10;		2		1	85.00	7		00010		13b;13i1;13i3;13i4;13i10;
H5774	046	0	1	01	01	H5774_046_0	9	1	3	1	01111111011111111000000000000000											1986	1986															2			13b;13i1;13i3;13i4;13i10;13i-O1;		2		1	75.00	7		00010		13b;13i1;13i3;13i4;13i10;
H5774	046	0	1	01	01	H5774_046_0	9	2	2	2														0000000000100000000	Bedridden patients													2			14c21;		2		2						
H5774	047	1	1	01	01	H5774_047_1	12	1	3	1	01111111011111111000000000000000											17864	17864															2			13b;13i1;13i3;13i4;13i10;		2		1	60.00	7		00010		13b;13i1;13i3;13i4;13i10;
H5774	047	2	1	01	01	H5774_047_2	11	1	3	1	01111111011111111000000000000000											7865	7865															2			13b;13i1;13i3;13i4;13i10;		2		1	50.00	7		00010		13b;13i1;13i3;13i4;13i10;
H5774	047	3	1	01	01	H5774_047_3	11	1	3	1	01111111011111111000000000000000											5016	5016															2			13b;13i1;13i3;13i4;13i10;		2		1	75.00	7		00010		13b;13i1;13i3;13i4;13i10;
H5774	049	0	1	01	01	H5774_049_0	12	2	3	Package #2	01111111011111111000000000000000											2055	2055															2			13b;13i1;13i3;13i4;13i10;		2		1	100.00	7		00010		13b;13i1;13i3;13i4;13i10;
H5774	049	0	1	01	01	H5774_049_0	12	1	2	Package #1														0000000000111100000	Oncology patients undergoing active chemo by infusion or systemic radiotherapy	Post-inpatient stay for acute stroke with the transition of care to patients home	Patients discharged from thoracic, abdominal, musculoskeletal, and peripheral vascular surgeries.	Bedridden patients with essential services requirements.							2	2		2			14c21;		2		2						
H5793	017	0	1	02	01	H5793_017_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							7633	7453															2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5793	019	0	1	02	01	H5793_019_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							1884	1336															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	60.00	5		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5793	020	0	1	02	01	H5793_020_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							14298	12742															2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H5793	801	0	1	01	01	H5793_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5793	801	0	1	01	01	H5793_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5793	802	0	1	01	01	H5793_802_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5793	802	0	1	01	01	H5793_802_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5793	805	0	1	01	01	H5793_805_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5793	805	0	1	01	01	H5793_805_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H5823	013	1	1	01	01	H5823_013_1	6	1	3	SSBCI	01111111111111111111111000000000											2944	2650															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H5823	013	2	1	01	01	H5823_013_2	6	1	3	SSBCI	01111111111111111111111000000000											4101	3691															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H5826	014	0	1	01	01	H5826_014_0	6	2	2	Personal Emergency Response System (PERS)														1011101001111100000	Frailty	Osteoporosis	Parkinson's	Fall Risk or seizures	History of acute MI or angina						2	2		1	001		14c11;		2		2						
H5826	014	0	1	01	01	H5826_014_0	6	4	3	Grocery Benefit	01111111011111111000000000000000											4162	2977															2			13i1;		2		2						
H5826	014	0	1	01	01	H5826_014_0	6	3	2	Blood Pressure Monitor														0000010000110000000	Pre-hypertension	Refractory, high-risk high blood pressure									2	2		1	001		13b;		2		2						
H5826	014	0	1	01	01	H5826_014_0	6	1	2	Diabetic Podiatry														0100000000000000000														2			7f_2;		2		2						
H5826	014	0	1	01	01	H5826_014_0	6	5	2	Personal Weight Scale														0001000000110000000	Morbid Obesity	Obesity with co-occurring disorders									2	2		1	001		13b;		2		2						
H5826	017	0	1	01	01	H5826_017_0	6	3	2	Blood Pressure Monitor														0000010000110000000	Prehypertension	Refractory hypertension									2	2		1	001		13b;		2		2						
H5826	017	0	1	01	01	H5826_017_0	6	2	2	Personal Emergency Response System (PERS)														1011101001111100000	Frailty	Osteoporosis	Parkinson's	Fall Risk or seizures	History of acute MI or angina						2	2		1	001		14c11;		2		2						
H5826	017	0	1	01	01	H5826_017_0	6	4	2	Personal Weight Scale														0001000000110000000	Morbid Obesity	Obesity with co-occurring disorders									2	2		1	001		13b;		2		2						
H5826	017	0	1	01	01	H5826_017_0	6	1	2	Diabetic Podiatry														0100000000000000000														2			7f_2;		2		2						
H5828	001	0	1	01	01	H5828_001_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							808	712															2			13i1;13i10;		2		2						
H5828	002	0	1	01	01	H5828_002_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							1821	1605															2			13i1;13i10;		2		2						
H5828	018	0	1	01	01	H5828_018_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							8889	7835															2			13i1;13i10;		2		2						
H5852	001	0	1	01	01	H5852_001_0	8	1	3	SSBCI	00011101001011000000100000000000											610	600															2			10b1;13c;13i1;13i3;13i5;13i10;14c11;14c18;		2		2						
H5854	012	0	1	02	01	H5854_012_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							11	2															2			13i1;	2	2		2						
H5854	013	0	1	01	01	H5854_013_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							4346	4021															2			13i1;13i10;		2		2						
H5854	020	0	1	01	01	H5854_020_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							20414	18886															2			13i1;13i10;		2		2						
H5859	001	0	1	01	01	H5859_001_0	6	2	3	SSBCI Benefits	01111111111111111111111000000000											9244	7078															2			13i1;		1	13i1;	2						
H5859	001	0	1	01	01	H5859_001_0	6	1	2	Blood Pressure Monitors														0000010000000000000														2			13b;		1	13b;	2						
H5883	002	1	1	02	01	H5883_002_1	9	1	3	Package 1	01111111011111110000100110000000	Chronic Hypertension	Pre-diabetes									1746	1065															2			13i1;	2	2		1	0.00	5		00010		13i1;
H5883	002	2	1	02	01	H5883_002_2	8	1	3	Package 1	01111111011111110000100110000000	Chronic Hypertension	Pre-diabetes									1127	687															2			13i1;	2	2		1	0.00	5		00010		13i1;
H5883	002	3	1	02	01	H5883_002_3	8	1	3	Package 1	01111111011111110000100110000000	Chronic Hypertension	Pre-diabetes									746	455															2			13i1;	2	2		1	0.00	5		00010		13i1;
H5883	002	4	1	02	01	H5883_002_4	8	1	3	Package 1	01111111011111110000100110000000	Chronic Hypertension	Pre-diabetes									1880	1147															2			13i1;	2	2		1	0.00	5		00010		13i1;
H5883	002	7	1	02	01	H5883_002_7	8	1	3	Package 1	01111111011111110000100110000000	Chronic Hypertension	Pre-diabetes									3040	1854															2			13i1;	2	2		1	0.00	5		00010		13i1;
H5883	003	1	1	02	01	H5883_003_1	9	1	3	Package 1	01111111011111110000100110000000	Chronic Hypertension	Pre-diabetes									155	94															2			13i1;	2	2		1	0.00	5		00010		13i1;
H5883	003	2	1	02	01	H5883_003_2	8	1	3	Package 1	01111111011111110000100110000000	Chronic Hypertension	Pre-diabetes									74	45															2			13i1;	2	2		1	0.00	5		00010		13i1;
H5883	003	3	1	02	01	H5883_003_3	8	1	3	Package 1	01111111011111110000100110000000	Chronic Hypertension	Pre-diabetes									39	24															2			13i1;	2	2		1	0.00	5		00010		13i1;
H5883	003	4	1	02	01	H5883_003_4	8	1	3	Package 1	01111111011111110000100110000000	Chronic Hypertension	Pre-diabetes									164	100															2			13i1;	2	2		1	0.00	5		00010		13i1;
H5883	003	5	1	02	01	H5883_003_5	8	1	3	Package 1	01111111011111110000100110000000	Chronic Hypertension	Pre-diabetes									409	250															2			13i1;	2	2		1	0.00	5		00010		13i1;
H5883	007	0	1	01	01	H5883_007_0	10	1	3	Package 1	01111111011111110000100110000000	Chronic Hypertension	Pre-diabetes									1619	987															2			13i1;		2		1	0.00	5		00010		13i1;
H5883	017	0	1	02	01	H5883_017_0	7	1	3	Package 1	01111111011111110000100110000000	Chronic Hypertension	Pre-diabetes									1287	1223															2			13i1;	2	2		1	0.00	5		00010		13i1;
H5926	001	0	1	01	01	H5926_001_0	5	1	3	SSBCI	01111111111111111111111000000000											4469	4022															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H5926	008	0	1	01	01	H5926_008_0	8	1	3	SSBCI	01111111111111111111111000000000											6582	5924															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H5926	009	0	1	01	01	H5926_009_0	8	1	3	SSBCI	01111111111111111111111000000000											43	38															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H5932	001	0	1	01	01	H5932_001_0	10	2	2	ESRD Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;		1	10b1;	2						
H5932	001	0	1	01	01	H5932_001_0	10	1	3	Healthy Benefits	01111111111111111111111000000000											29070	27327															2			13i1;13i4;13i5;13i10;13i-O1;		1	13i1;13i4;13i5;13i10;13i-O1;	1	200.00	7		01010		13i1;13i4;13i5;13i10;13i-O1;
H5932	009	0	1	01	01	H5932_009_0	10	1	3	Healthy Benefits	01111111111111111111111000000000											3850	3620															2			13i1;13i10;		1	13i1;13i10;	1	12.00	7		01010		13i1;13i10;
H5932	012	0	1	01	01	H5932_012_0	10	1	3	Healthy Benefits	01111111111111111111111000000000											3225	3032															2			13i1;13i4;13i5;13i10;13i-O1;		1	13i1;13i4;13i5;13i10;13i-O1;	1	193.00	7		01010		13i1;13i4;13i5;13i10;13i-O1;
H5932	012	0	1	01	01	H5932_012_0	10	2	2	ESRD Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;		1	10b1;	2						
H5932	013	0	1	01	01	H5932_013_0	9	1	3	Healthy Benefits	01111111111111111111111000000000											216	203															2			13i1;13i10;		1	13i1;13i10;	1	15.00	7		01010		13i1;13i10;
H5938	001	0	1	01	01	H5938_001_0	6	1	3	Food and Produce	00000001000000000000000000000000											2778	705															1	001		13i1;		2		1	0.00	3		00010		13i1;
H5938	006	0	1	01	01	H5938_006_0	6	1	3	Food and Produce	00000001000000000000000000000000											1629	468															1	001		13i1;		2		1	0.00	3		00010		13i1;
H5938	008	0	1	01	01	H5938_008_0	6	1	3	Food and Produce	00000001000000000000000000000000											1302	276															1	001		13i1;		2		1	0.00	3		00010		13i1;
H5943	003	0	1	02	01	H5943_003_0	11	1	3	OTC-Food-Utilities-Transport-Meals	00000000001000000100000000000000											433	238															2			10b1;13b;13c;13i1;13i10;	2	1	10b1;13b;13c;13i1;13i10;	1	66.00	7		01010		13b;13i1;13i10;
H5943	005	0	1	02	01	H5943_005_0	10	1	3	OTC-Food-Utilities-Transport-Meals	00000000001000000100000000000000											20	11															2			10b1;13b;13c;13i1;13i10;	2	1	10b1;13b;13c;13i1;13i10;	1	25.00	7		01010		13b;13i1;13i10;
H5945	002	0	1	01	01	H5945_002_0	7	1	3	SSBCI - Food / OTC	01111111000111111000000000000000											5615	2695															2			13i1;		1	13i1;	1	0.00	5		00010		13i1;
H5945	013	0	1	01	01	H5945_013_0	7	1	3	SSBCI - Food Card/OTC/Utilities	01111111100111111000000100000000	Chronic Hypertension										745	313															2			13i1;13i10;		1	13i1;13i10;	1	0.00	5		00010		13i1;13i10;
H5945	014	0	1	01	01	H5945_014_0	7	1	3	SSBCI - Food Card/OTC/Utilities	01111111100111111000000100000000	Chronic Hypertension										914	457															2			13i1;13i10;		1	13i1;13i10;	1	0.00	5		00010		13i1;13i10;
H5945	016	0	1	01	01	H5945_016_0	7	1	3	SSBCI - Food Card/OTC	01111111100011111000000100000000	Chronic Hypertension										1907	1163															2			13i1;		1	13i1;	1	0.00	5		00010		13i1;
H5945	017	0	1	01	01	H5945_017_0	6	1	3	SSBCI - Food Card/OTC/Utilities/Transportation	01111111100111110000000100000000	Chronic Hypertension										536	257															1	001		13i1;13i4;13i10;		1	13i1;13i4;13i10;	2						
H5945	018	0	1	01	01	H5945_018_0	6	1	3	SSBCI - Food Card/OTC/Utilities/Transportation	01111111100011111000000100000000	Chronic Hypertension										651	378															1	001		13i1;13i4;13i10;		1	13i1;13i4;13i10;	2						
H5969	002	0	1	01	01	H5969_002_0	3	1	3	SSBCI	01111111001111111000000000000000											1580	1260															1	001		13i1;13i10;		1	13i1;13i10;	1	0.00	7		01011		13i1;13i10;
H5970	016	0	1	04	01	H5970_016_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5970	016	0	1	04	01	H5970_016_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H5970	028	0	1	04	01	H5970_028_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H5970	029	0	1	04	01	H5970_029_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H5992	007	0	1	01	01	H5992_007_0	7	1	3	SSBCI	01111111111111111111111000000000											1184	1066															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H5992	010	0	1	01	01	H5992_010_0	5	1	3	SSBCI	01111111111111111111111000000000											306	162															1	001		13i1;13i10;		2		2						
H6170	001	0	1	02	01	H6170_001_0	8	1	3	ESRD Care	00000000001000000000000000000000											306	225															1	001		10b1;13b;13e;13i1;13i10;	1	2		1	90.00	7		00010		13b;13i1;13i10;
H6170	002	0	1	02	01	H6170_002_0	8	1	3	ESRD Care	00000000001000000000000000000000											827	620															1	001		10b1;13b;13e;13i1;13i10;	1	2		1	160.00	7		00010		13b;13i1;13i10;
H6170	007	0	1	01	01	H6170_007_0	10	1	3	Healthy Choices	01111111111111111111111000000000											4275	3205															2			13i1;13i10;		2		1	0.00	5		00010		13i1;13i10;
H6170	008	0	1	01	01	H6170_008_0	9	1	3	Healthy Choices	00001101000000000000000000000000											4155	3115															1	001		13b;13i1;13i10;		2		1	93.33	7		00010		13b;13i1;13i10;
H6170	009	0	1	01	01	H6170_009_0	8	1	3	Healthy Choices	00001101000000000000000000000000											6233	4674															1	001		13b;13i1;13i10;		2		1	194.00	7		00010		13b;13i1;13i10;
H6170	010	0	1	01	01	H6170_010_0	8	1	3	Healthy Choices	00000000000000100000000000000000											641	480															1	001		13b;13i1;13i10;		2		1	160.00	7		00010		13b;13i1;13i10;
H6170	015	0	1	01	01	H6170_015_0	8	1	3	Healthy Choices	00001101000000000000000000000000											256	158															1	001		13b;14c13;14c22;		1	13b;14c13;14c22;	1	83.33	7		00010		13b;14c13;14c22;
H6170	016	0	1	01	01	H6170_016_0	9	1	3	Healthy Choices	00001101000000000000000000000000											342	164															1	001		13b;14c13;14c22;		1	13b;14c13;14c22;	1	156.00	7		00010		13b;14c13;14c22;
H6170	017	0	1	01	01	H6170_017_0	10	1	3	Healthy Choices	00001101000000000000000000000000											256	160															1	001		13i6;		1	13i6;	2						
H6170	018	0	1	01	01	H6170_018_0	10	1	3	Healthy Choices	01111111111111111111111000000000											45	30															2			13i1;13i10;14c17;		2		2						
H6224	001	0	1	01	01	H6224_001_0	10	1	3	Healthy Benefits	01111111111111111111111000000000											485	456															2			13i1;13i4;13i5;13i10;13i-O1;		1	13i1;13i4;13i5;13i10;13i-O1;	1	135.00	7		01010		13i1;13i4;13i5;13i10;13i-O1;
H6237	009	0	1	01	01	H6237_009_0	10	1	2	Routine Podiatry														0100000000000000000														2			7f_2;		1	7f_2;	2						
H6303	001	0	1	02	01	H6303_001_0	3	1	3	SSBCI Pkg	00001101000000000000000000000000											143	113															2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H6303	004	0	1	02	01	H6303_004_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							174	170															2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H6303	005	0	1	02	01	H6303_005_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							174	158															2			10b2;13b;13i1;13i4;13i10;13i-O1;	2	1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H6316	007	1	1	01	01	H6316_007_1	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							2085	1969															2			13i1;13i10;		2		2						
H6316	007	2	1	01	01	H6316_007_2	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							774	731															2			13i1;13i10;		2		2						
H6322	002	0	1	01	01	H6322_002_0	7	1	3	Healthy Groceries	01111111111111111111111000000000											150	124															2			13i1;		1	13i1;	1	50.00	7		00010		13i1;
H6341	001	0	1	01	01	H6341_001_0	6	1	3	Package 1	00001111110001101000000100000000	Connective Tissue Disease										1613	1097															2			13i1;13i3;13i10;		1	13i1;13i3;13i10;	1	0.00	5		01011		13i1;13i3;13i10;
H6341	002	0	1	01	01	H6341_002_0	5	1	3	Package 1	00001111110001101000000100000000	Connective Tissue Disease										383	261															2			13i1;13i3;13i10;		1	13i1;13i3;13i10;	1	0.00	5		01011		13i1;13i3;13i10;
H6345	001	0	1	01	01	H6345_001_0	4	1	3	Food and Produce, Hygiene	01111111111111111111111111000000	Chronic Hyperlipidemia	Chronic Hypertension	Osteoporosis								432	389															2			13i1;13i-O1;		2		1	0.00	7		00010		13i1;13i-O1;
H6345	002	0	1	01	01	H6345_002_0	5	1	3	Hygiene	01111111111111111111111111000000	Chronic Hyperlipidemia	Chronic Hypertension	Osteoporosis								573	191															2			13i-O1;		2		1	0.00	7		01000		13i-O1;
H6345	003	0	1	01	01	H6345_003_0	4	1	3	Food and Produce, Hygiene	01111111111111111111111111000000	Chronic Hypertension	Chronic Hyperlipidemia	Chronic malnutrition including failure to thrive								5	4															2			13i1;13i-O1;		1	13i1;13i-O1;	1	0.00	5		00010		13i1;13i-O1;
H6351	004	0	1	01	01	H6351_004_0	4	1	3	SSBCI Food and Produce	00001101000001000000000000000000											2256	2256															2			13i1;		2		1	0.00	7		00010		13i1;
H6368	001	0	1	01	01	H6368_001_0	6	1	3	EHP 001 SSBCI Grocery	01001101100001000000010000000000											603	543															2			13i1;		2		1	0.00	5		00011		13i1;
H6368	002	0	1	01	01	H6368_002_0	6	1	3	EHP 002 SSBCI Grocery	01001101100001000000010000000000											456	410															2			13i1;		2		1	0.00	5		00011		13i1;
H6378	001	0	1	01	01	H6378_001_0	7	1	3	Package 1	00001111110001101000000100000000	Connective Tissue Disease										81	53															2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		01011		13i1;13i10;
H6378	002	0	1	01	01	H6378_002_0	7	1	3	Package 1	00001111110001101000000100000000	Connective Tissue Disease										70	46															2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		01011		13i1;13i10;
H6396	017	0	1	01	01	H6396_017_0	6	1	3	Healthy Benefits+	01111111111111111111111000000000											31564	27070															2			13i1;13i10;13i-O1;13i-O4;		1	13i1;13i10;13i-O1;13i-O4;	1	0.00	7		01010		13i1;13i10;13i-O1;13i-O4;
H6399	001	0	1	01	01	H6399_001_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							7051	7051															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H6407	002	0	1	01	01	H6407_002_0	9	1	2	Package 1 - PERS														1000100001111111000	Multiple Sclerosis and Transverse Myelitis	Fibromyalgia, Chronic Pain and Fatigue	Mobility Impairments	Osteoporosis With or Without Pathological Fracture	Cerebral Palsy	Muscular Dystrophy	Parkinson's Disease and Secondary Parkinsonism				2	2		2			14c11;		2		2						
H6453	019	0	1	02	01	H6453_019_0	9	1	3	Healthy Foods and Utilities	01111111111111111111111000000000											2021	1629															1	001		13i1;13i10;	2	1	13i1;13i10;	1	100.00	7		00011		13i1;13i10;
H6453	019	0	1	02	01	H6453_019_0	9	2	2	Transportation														0000000000100000000	Chronic Kidney Disease/ESRD													1	001		10b1;	2	1	10b1;	2						
H6474	001	0	1	02	01	H6474_001_0	8	1	3	ESRD Care	00000000001000000000000000000000											61	45															1	001		10b1;13b;13e;13i1;13i10;	1	2		1	90.00	7		00010		13b;13i1;13i10;
H6474	002	0	1	02	01	H6474_002_0	8	1	3	ESRD Care	00000000001000000000000000000000											164	123															1	001		10b1;13b;13e;13i1;13i10;	1	2		1	165.00	7		00010		13b;13i1;13i10;
H6474	007	0	1	01	01	H6474_007_0	8	1	3	Healthy Choices	01111111111111111111111000000000											417	312															2			13i1;13i10;		2		1	0.00	5		00010		13i1;13i10;
H6474	008	0	1	01	01	H6474_008_0	8	1	3	Healthy Choices	00001101000000000000000000000000											366	274															1	001		13b;13i1;13i10;		2		1	93.33	7		00010		13b;13i1;13i10;
H6474	009	0	1	01	01	H6474_009_0	8	1	3	Healthy Choices	00001101000000000000000000000000											548	411															1	001		13b;13i1;13i10;		2		1	163.33	7		00010		13b;13i1;13i10;
H6474	010	0	1	01	01	H6474_010_0	8	1	3	Healthy Choices	00000000000000100000000000000000											144	108															1	001		13b;13i1;13i10;		2		1	160.00	7		00010		13b;13i1;13i10;
H6515	001	0	1	01	01	H6515_001_0	6	1	3	SSBCI	01111111111111111111111000000000											1701	1531															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H6515	002	0	1	01	01	H6515_002_0	6	1	3	SSBCI	01111111111111111111111000000000											3534	3180															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H6515	003	0	1	01	01	H6515_003_0	6	1	3	SSBCI	01111111111111111111111000000000											1148	1033															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H6515	004	0	1	01	01	H6515_004_0	6	1	3	SSBCI	01111111111111111111111000000000											1476	1329															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H6515	005	0	1	01	01	H6515_005_0	6	1	3	SSBCI	01111111111111111111111000000000											2155	1939															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H6550	004	0	1	02	01	H6550_004_0	6	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										1079	1024															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H6550	009	0	1	02	01	H6550_009_0	5	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										301	280															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H6566	001	0	1	04	01	H6566_001_0	8	1	3	Flex Benefits	01111111111111111111111111000000	osteoporosis	chronic hypertension	chronic hyperlipidemia								1997	499															2			13i1;13i10;13i-O2;	1	1	13i1;13i10;13i-O2;	1	0.00	5		01100		13i10;13i-O2;
H6585	001	0	1	01	01	H6585_001_0	5	1	3	SSBCI	01111111111111111111111000000000											332	298															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H6585	002	0	1	01	01	H6585_002_0	5	1	3	SSBCI	01111111111111111111111000000000											96	86															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H6586	002	0	1	04	01	H6586_002_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								784	704															2			13i1;13i10;	1	1	13i1;13i10;	1	55.00	7		00010		13i1;13i10;
H6586	003	0	1	04	01	H6586_003_0	7	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								37	34															2			13i1;13i10;	1	1	13i1;13i10;	1	41.00	7		00010		13i1;13i10;
H6595	003	0	1	02	01	H6595_003_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								3386	2878															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H6595	006	1	1	02	01	H6595_006_1	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								10071	8561															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H6595	006	2	1	02	01	H6595_006_2	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								3630	3086															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H6595	007	1	1	02	01	H6595_007_1	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								7740	6579															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H6595	007	2	1	02	01	H6595_007_2	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								4237	3602															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H6622	001	0	1	01	01	H6622_001_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H6622	004	0	1	01	01	H6622_004_0	4	1	2	Non-Emergency Medical Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;		2		2						
H6622	004	0	1	01	01	H6622_004_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H6622	007	0	1	01	01	H6622_007_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H6622	008	0	1	01	01	H6622_008_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H6622	008	0	1	01	01	H6622_008_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H6622	008	0	1	01	01	H6622_008_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2242	2242															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H6622	013	0	1	02	01	H6622_013_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H6622	013	0	1	02	01	H6622_013_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H6622	014	0	1	02	01	H6622_014_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H6622	014	0	1	02	01	H6622_014_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H6622	017	0	1	01	01	H6622_017_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H6622	017	0	1	01	01	H6622_017_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									5403	5403															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H6622	018	0	1	01	01	H6622_018_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H6622	018	0	1	01	01	H6622_018_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H6622	018	0	1	01	01	H6622_018_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									1241	1241															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H6622	021	1	1	02	01	H6622_021_1	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H6622	021	1	1	02	01	H6622_021_1	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H6622	021	2	1	02	01	H6622_021_2	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H6622	021	2	1	02	01	H6622_021_2	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H6622	022	0	1	02	01	H6622_022_0	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H6622	022	0	1	02	01	H6622_022_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H6622	023	0	1	02	01	H6622_023_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H6622	023	0	1	02	01	H6622_023_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H6622	025	0	1	02	01	H6622_025_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H6622	026	0	1	02	01	H6622_026_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H6622	027	0	1	02	01	H6622_027_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									965	965															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H6622	027	0	1	02	01	H6622_027_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H6622	028	0	1	01	01	H6622_028_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H6622	029	0	1	01	01	H6622_029_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H6622	029	0	1	01	01	H6622_029_0	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H6622	032	0	1	01	01	H6622_032_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H6622	033	0	1	01	01	H6622_033_0	4	1	3	Chronic Condition Care Assistance	01111111001111111100000000000000											2307	30															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		2		1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H6622	033	0	1	01	01	H6622_033_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H6622	033	0	1	01	01	H6622_033_0	4	2	2	Non-Emergency Medical Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;		2		2						
H6622	035	0	1	01	01	H6622_035_0	5	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H6622	035	0	1	01	01	H6622_035_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H6622	036	0	1	01	01	H6622_036_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H6622	036	0	1	01	01	H6622_036_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H6622	037	0	1	01	01	H6622_037_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H6622	047	0	1	01	01	H6622_047_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H6622	048	0	1	01	01	H6622_048_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H6622	048	0	1	01	01	H6622_048_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									413	413															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H6622	048	0	1	01	01	H6622_048_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H6622	054	0	1	01	01	H6622_054_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H6622	054	0	1	01	01	H6622_054_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H6622	055	0	1	01	01	H6622_055_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H6622	056	0	1	01	01	H6622_056_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H6622	056	0	1	01	01	H6622_056_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H6622	057	0	1	02	01	H6622_057_0	5	1	3	Chronic Condition Care Assistance	01111111001111111100000000000000											270	4															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H6622	057	0	1	02	01	H6622_057_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H6622	060	0	1	02	01	H6622_060_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H6622	061	0	1	02	01	H6622_061_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H6622	071	0	1	01	01	H6622_071_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H6622	075	0	1	01	01	H6622_075_0	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H6622	078	1	1	01	01	H6622_078_1	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H6622	078	1	1	01	01	H6622_078_1	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H6622	078	1	1	01	01	H6622_078_1	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									948	948															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H6622	078	2	1	01	01	H6622_078_2	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H6622	078	2	1	01	01	H6622_078_2	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									6899	6899															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H6622	078	2	1	01	01	H6622_078_2	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H6622	079	0	1	01	01	H6622_079_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H6622	079	0	1	01	01	H6622_079_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H6622	079	0	1	01	01	H6622_079_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									7064	7064															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H6622	081	0	1	01	01	H6622_081_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H6622	082	0	1	01	01	H6622_082_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H6622	083	0	1	01	01	H6622_083_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H6622	084	0	1	01	01	H6622_084_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H6622	084	0	1	01	01	H6622_084_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									5247	5247															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H6622	085	0	1	01	01	H6622_085_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H6622	090	0	1	01	01	H6622_090_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H6622	091	0	1	01	01	H6622_091_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H6622	094	0	1	01	01	H6622_094_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H6622	097	0	1	01	01	H6622_097_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H6622	098	0	1	01	01	H6622_098_0	6	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H6622	098	0	1	01	01	H6622_098_0	6	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									1620	1620															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H6622	098	0	1	01	01	H6622_098_0	6	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H6622	099	1	1	01	01	H6622_099_1	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H6622	099	2	1	01	01	H6622_099_2	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H6622	100	1	1	01	01	H6622_100_1	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H6622	100	2	1	01	01	H6622_100_2	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H6622	101	0	1	01	01	H6622_101_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H6622	101	0	1	01	01	H6622_101_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H6622	101	0	1	01	01	H6622_101_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2371	2371															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H6622	103	0	1	01	01	H6622_103_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		2		2						
H6622	103	0	1	01	01	H6622_103_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									682	682															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H6622	103	0	1	01	01	H6622_103_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		2		2						
H6622	104	0	1	01	01	H6622_104_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H6622	104	0	1	01	01	H6622_104_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									786	786															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H6622	104	0	1	01	01	H6622_104_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H6622	105	0	1	01	01	H6622_105_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									1149	1149															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H6622	105	0	1	01	01	H6622_105_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H6622	105	0	1	01	01	H6622_105_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H6697	001	0	1	01	01	H6697_001_0	9	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									6131	300															2			13i1;13i3;13i10;13i-O1;14c8;		2		1	0.00	7		00010		13i1;13i10;14c8;
H6697	002	0	1	01	01	H6697_002_0	12	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									530	445															2			13i1;13i3;13i5;13i10;13i-O1;14c8;		2		1	0.00	7		00010		13i1;13i10;14c8;
H6697	003	0	1	01	01	H6697_003_0	11	1	3	Package 1	00000000100000000000000000000000											13659	9636															2			13i1;13i3;13i-O1;13i-O2;		2		2						
H6697	004	0	1	01	01	H6697_004_0	10	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									300	100															2			13i1;13i3;13i10;13i-O1;14c8;		2		1	0.00	7		00010		13i1;13i10;14c8;
H6697	005	0	1	01	01	H6697_005_0	10	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									100	10															2			13i3;13i-O1;		2		2						
H6765	002	0	1	01	01	H6765_002_0	5	1	3	Healthy Food	01111111111111111111111000000000											40	32															1	001		13i1;		1	13i1;	2						
H6776	001	0	1	01	01	H6776_001_0	4	1	3	SSBCI OTC Benefit	01111111011111111001110110000000	Chronic Hypertension	Chronic Endocrine Disorders									28	28															2			13i1;		1	13i1;	2						
H6776	002	0	1	01	01	H6776_002_0	3	1	3	SSBCI OTC Benefit	01111111011111111001110110000000	Chronic Hypertension	Chronic Endocrine Disorder									876	876															2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H6824	002	0	1	04	01	H6824_002_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								16596	14106															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H6824	003	0	1	04	01	H6824_003_0	5	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								2405	2044															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H6832	001	0	1	01	01	H6832_001_0	7	1	3	Flex Benefit	01111111111111111111111111000000	osteoporosis	chronic hypertension	chronic hyperlipidemia								1318	329															2			13i1;13i4;13i6;13i10;13i-O2;		1	13i1;13i4;13i6;13i10;13i-O2;	1	0.00	5		01010		13i6;13i10;13i-O2;
H6832	004	0	1	02	01	H6832_004_0	7	1	3	Flex and Transportation Benefit	01111111111111111111111111000000	osteoporosis	chronic hypertension	chronic hyperlipidemia								61	18															2			13i1;13i4;13i6;13i10;13i-O2;	2	1	13i1;13i4;13i6;13i10;13i-O2;	1	0.00	5		01010		13i6;13i10;13i-O2;
H6852	005	0	1	01	01	H6852_005_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								347	312															2			13i1;13i10;		1	13i1;13i10;	1	285.00	7		00010		13i1;13i10;
H6852	007	0	1	01	01	H6852_007_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								771	692															2			13i1;13i10;		1	13i1;13i10;	1	285.00	7		00010		13i1;13i10;
H6852	016	0	1	01	01	H6852_016_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											405	364															2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H6852	017	0	1	01	01	H6852_017_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											140	126															2			13i1;13i10;		1	13i1;13i10;	1	185.00	7		00010		13i1;13i10;
H6852	018	0	1	01	01	H6852_018_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											83	74															2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H6852	019	0	1	01	01	H6852_019_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											106	95															2			13i1;13i10;		1	13i1;13i10;	1	185.00	7		00010		13i1;13i10;
H6852	020	0	1	01	01	H6852_020_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											135	121															2			13i1;13i10;		1	13i1;13i10;	1	185.00	7		00010		13i1;13i10;
H6852	021	0	1	01	01	H6852_021_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											617	554															2			13i1;13i10;		1	13i1;13i10;	1	391.00	7		00010		13i1;13i10;
H6852	022	0	1	01	01	H6852_022_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											397	356															2			13i1;13i10;		1	13i1;13i10;	1	391.00	7		00010		13i1;13i10;
H6852	025	0	1	01	01	H6852_025_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								1284	1153															2			13i1;13i10;		1	13i1;13i10;	1	335.00	7		00010		13i1;13i10;
H6852	026	0	1	01	01	H6852_026_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								1594	1432															2			13i1;13i10;		1	13i1;13i10;	1	335.00	7		00010		13i1;13i10;
H6876	003	0	1	04	01	H6876_003_0	7	1	3	Food & Produce and Utilities	00111111001011001000000000000000											1123	788															2			13i1;13i10;	1	2		1	95.00	7		01011		13i1;13i10;
H6876	005	0	1	04	01	H6876_005_0	7	1	3	Food & Produce and Utilities	00111111001011001000000000000000											1184	831															2			13i1;13i10;	1	2		1	95.00	7		01011		13i1;13i10;
H6876	007	0	1	04	01	H6876_007_0	5	1	3	Food & Produce and Utilities	00111111001011001000000000000000											73	51															2			13i1;13i10;	1	2		1	110.00	7		01011		13i1;13i10;
H6959	001	0	1	01	01	H6959_001_0	6	1	3	Beauty and Barber Shop, Hygiene, Clothing	01111111111111111111111111000000	Chronic Hyperlipidemia	Chronic Hypertension	Osteoporosis								523	349															2			13i10;13i-O1;13i-O2;		1	13i10;13i-O1;13i-O2;	1	0.00	5		01000		13i10;13i-O1;13i-O2;
H6959	002	0	1	01	01	H6959_002_0	7	1	3	Food, Produce, House Cleaning, Hygiene, Clothing	00001101000000000000000000000000											65	56															2			13i1;13i10;13i-O1;		1	13i1;13i10;13i-O1;	1	0.00	5		00010		13i1;13i10;13i-O1;
H6971	001	0	1	01	01	H6971_001_0	7	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										18598	17668															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H6988	004	0	1	01	01	H6988_004_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							5326	5075															2			13i1;13i10;		2		2						
H6994	001	0	1	01	01	H6994_001_0	7	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								12	11															2			13i1;13i10;		1	13i1;13i10;	1	19.00	7		00010		13i1;13i10;
H6994	003	0	1	01	01	H6994_003_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											43	38															2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H6994	004	0	1	01	01	H6994_004_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											218	196															2			13i1;13i10;		1	13i1;13i10;	1	416.00	7		00010		13i1;13i10;
H6994	010	0	1	01	01	H6994_010_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											460	413															2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H6994	011	0	1	01	01	H6994_011_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								16	15															2			13i1;13i10;		1	13i1;13i10;	1	19.00	7		00010		13i1;13i10;
H6994	013	0	1	01	01	H6994_013_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											32	29															2			13i1;13i10;		1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H7020	012	0	1	01	01	H7020_012_0	6	1	3	Food and Produce	00001101000000000000000000000000											428	321															2			13i1;		2		2						
H7028	001	0	1	04	01	H7028_001_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								1311	1177															2			13i1;13i10;	1	1	13i1;13i10;	1	51.00	7		00010		13i1;13i10;
H7028	004	0	1	04	01	H7028_004_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											509	457															2			13i1;13i10;	1	1	13i1;13i10;	1	33.00	7		00010		13i1;13i10;
H7028	005	0	1	04	01	H7028_005_0	2	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											2078	1866															2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H7028	006	0	1	04	01	H7028_006_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											1664	1494															2			13i1;13i10;	1	1	13i1;13i10;	1	349.00	7		00010		13i1;13i10;
H7028	007	0	1	04	01	H7028_007_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								65	59															2			13i1;13i10;	1	1	13i1;13i10;	1	9.00	7		00010		13i1;13i10;
H7028	011	0	1	04	01	H7028_011_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								257	231															2			13i1;13i10;	1	1	13i1;13i10;	1	275.00	7		00010		13i1;13i10;
H7028	012	0	1	04	01	H7028_012_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								128	115															2			13i1;13i10;	1	1	13i1;13i10;	1	275.00	7		00010		13i1;13i10;
H7028	013	0	1	04	01	H7028_013_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											187	168															2			13i1;13i10;	1	1	13i1;13i10;	1	192.00	7		00010		13i1;13i10;
H7028	014	0	1	04	01	H7028_014_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;	1	1	13i1;13i10;	1	192.00	7		00010		13i1;13i10;
H7028	015	0	1	04	01	H7028_015_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;	1	1	13i1;13i10;	1	292.00	7		00010		13i1;13i10;
H7028	016	0	1	04	01	H7028_016_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;	1	1	13i1;13i10;	1	292.00	7		00010		13i1;13i10;
H7028	026	0	1	04	01	H7028_026_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								45	40															2			13i1;13i10;	1	1	13i1;13i10;	1	9.00	7		00010		13i1;13i10;
H7028	027	0	1	04	01	H7028_027_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;	1	1	13i1;13i10;	1	192.00	7		00010		13i1;13i10;
H7028	028	0	1	04	01	H7028_028_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;	1	1	13i1;13i10;	1	192.00	7		00010		13i1;13i10;
H7028	029	0	1	04	01	H7028_029_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;	1	1	13i1;13i10;	1	192.00	7		00010		13i1;13i10;
H7028	030	0	1	04	01	H7028_030_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;	1	1	13i1;13i10;	1	192.00	7		00010		13i1;13i10;
H7028	031	0	1	04	01	H7028_031_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											134	121															2			13i1;13i10;	1	1	13i1;13i10;	1	432.00	7		00010		13i1;13i10;
H7028	037	0	1	04	01	H7028_037_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;	1	1	13i1;13i10;	1	192.00	7		00010		13i1;13i10;
H7074	001	0	1	04	01	H7074_001_0	9	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									756	7															2			13i3;13i10;13i-O1;	1	2		2						
H7123	001	0	1	01	01	H7123_001_0	9	1	3	Healthy Food/Non-Medical Transportation/Utilities	01111111111111111111110000000000											1213	734															2			13i1;13i4;13i10;		2		2						
H7147	001	0	1	01	01	H7147_001_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								474	425															2			13i1;13i10;		1	13i1;13i10;	1	65.00	7		00010		13i1;13i10;
H7147	003	0	1	01	01	H7147_003_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								1779	1597															2			13i1;13i10;		1	13i1;13i10;	1	252.00	7		00010		13i1;13i10;
H7147	004	0	1	01	01	H7147_004_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								1231	1106															2			13i1;13i10;		1	13i1;13i10;	1	69.00	7		00010		13i1;13i10;
H7147	007	0	1	01	01	H7147_007_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								381	342															2			13i1;13i10;		1	13i1;13i10;	1	100.00	7		00010		13i1;13i10;
H7147	009	0	1	01	01	H7147_009_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											256	230															2			13i1;13i10;		1	13i1;13i10;	1	185.00	7		00010		13i1;13i10;
H7147	010	0	1	01	01	H7147_010_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											207	186															2			13i1;13i10;		1	13i1;13i10;	1	185.00	7		00010		13i1;13i10;
H7147	011	0	1	01	01	H7147_011_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											7	6															2			13i1;13i10;		1	13i1;13i10;	1	185.00	7		00010		13i1;13i10;
H7147	012	0	1	01	01	H7147_012_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								1021	917															2			13i1;13i10;		1	13i1;13i10;	1	306.00	7		00010		13i1;13i10;
H7147	013	0	1	01	01	H7147_013_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											474	426															2			13i1;13i10;		1	13i1;13i10;	1	353.00	7		00010		13i1;13i10;
H7149	006	0	1	01	01	H7149_006_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							570	559															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H7149	801	0	1	01	01	H7149_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H7149	801	0	1	01	01	H7149_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H7151	001	0	1	01	01	H7151_001_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								1131	1016															2			13i1;13i10;		1	13i1;13i10;	1	39.00	7		00010		13i1;13i10;
H7151	005	0	1	01	01	H7151_005_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											298	267															2			13i1;13i10;		1	13i1;13i10;	1	150.00	7		00010		13i1;13i10;
H7151	006	0	1	01	01	H7151_006_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											865	776															2			13i1;13i10;		1	13i1;13i10;	1	336.00	7		00010		13i1;13i10;
H7191	003	0	1	04	01	H7191_003_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;	1	1	13i1;13i10;	1	142.00	7		00010		13i1;13i10;
H7191	004	0	1	04	01	H7191_004_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;	1	1	13i1;13i10;	1	40.00	7		00010		13i1;13i10;
H7239	001	0	1	01	01	H7239_001_0	7	1	3	SSBCI - Food Card/OTC	01111110100011111000000100000000	Chronic Hypertension										965	695															2			13i1;		1	13i1;	1	0.00	5		00010		13i1;
H7239	002	0	1	01	01	H7239_002_0	6	1	3	SSBCI - Food Card/OTC/Utilities/Transportation	01111111100011111000000100000000	Chronic Hypertension										349	231															1	001		13i1;13i4;13i10;		1	13i1;13i4;13i10;	2						
H7239	003	0	1	01	01	H7239_003_0	7	1	3	SSBCI - Food Card/OTC/Utilities	01111111100011111000000100000000	Chronic Hypertension										124	89															2			13i1;13i10;		1	13i1;13i10;	2						
H7239	005	0	1	01	01	H7239_005_0	6	1	3	SSBCI - Food Card/OTC	01111111100111111000000100000000	Chronic Hypertension										739	532															2			13i1;		1	13i1;	1	0.00	5		00010		13i1;
H7284	008	0	1	04	01	H7284_008_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7284	009	0	1	04	01	H7284_009_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7284	010	0	1	04	01	H7284_010_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7284	010	0	1	04	01	H7284_010_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									1278	1278															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7284	011	0	1	04	01	H7284_011_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7284	012	0	1	04	01	H7284_012_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7284	013	0	1	04	01	H7284_013_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									1149	1149															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7284	013	0	1	04	01	H7284_013_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7301	803	0	1	04	01	H7301_803_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H7301	803	0	1	04	01	H7301_803_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H7318	001	0	1	01	01	H7318_001_0	5	1	3	SSBCI	01111111111111111111111000000000											789	710															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H7355	001	0	1	04	01	H7355_001_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								829	745															2			13i1;13i10;	1	1	13i1;13i10;	1	44.00	7		00010		13i1;13i10;
H7355	003	0	1	04	01	H7355_003_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								1884	1692															2			13i1;13i10;	1	1	13i1;13i10;	1	250.00	7		00010		13i1;13i10;
H7355	004	0	1	04	01	H7355_004_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								651	584															2			13i1;13i10;	1	1	13i1;13i10;	1	115.00	7		00010		13i1;13i10;
H7355	006	0	1	04	01	H7355_006_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											211	190															2			13i1;13i10;	1	1	13i1;13i10;	1	34.00	7		00010		13i1;13i10;
H7355	007	0	1	04	01	H7355_007_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											827	743															2			13i1;13i10;	1	1	13i1;13i10;	1	190.00	7		00010		13i1;13i10;
H7355	009	0	1	04	01	H7355_009_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								822	738															2			13i1;13i10;	1	1	13i1;13i10;	1	301.00	7		00010		13i1;13i10;
H7355	010	0	1	04	01	H7355_010_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											1159	1041															2			13i1;13i10;	1	1	13i1;13i10;	1	326.00	7		00010		13i1;13i10;
H7379	003	0	1	04	01	H7379_003_0	10	1	3	Healthcare Prepaid Card	01111111111111111111111100000000	Chronically underweight										2000	1500															2			13i1;13i10;	1	2		1	75.00	7		00011		13i1;13i10;
H7397	003	0	1	04	01	H7397_003_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								916	822															2			13i1;13i10;	1	1	13i1;13i10;	1	205.00	7		00010		13i1;13i10;
H7397	004	0	1	04	01	H7397_004_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								243	219															2			13i1;13i10;	1	1	13i1;13i10;	1	91.00	7		00010		13i1;13i10;
H7397	006	0	1	04	01	H7397_006_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											194	175															2			13i1;13i10;	1	1	13i1;13i10;	1	34.00	7		00010		13i1;13i10;
H7397	007	0	1	04	01	H7397_007_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											524	470															2			13i1;13i10;	1	1	13i1;13i10;	1	188.00	7		00010		13i1;13i10;
H7397	009	0	1	04	01	H7397_009_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								664	597															2			13i1;13i10;	1	1	13i1;13i10;	1	260.00	7		00010		13i1;13i10;
H7397	010	0	1	04	01	H7397_010_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											627	563															2			13i1;13i10;	1	1	13i1;13i10;	1	299.00	7		00010		13i1;13i10;
H7435	001	0	1	01	01	H7435_001_0	8	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										5981	5682															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H7435	002	0	1	01	01	H7435_002_0	5	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										1157	1100															2			13i1;13i2;13i3;13i4;13i6;13i10;		1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H7440	001	0	1	02	01	H7440_001_0	10	1	3	SSBCI	01111111111111111111111000000000											156	31															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	5		00010		13i1;13i10;
H7464	008	1	1	01	01	H7464_008_1	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								5472	4651															2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H7464	008	2	1	01	01	H7464_008_2	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								5858	4980															2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H7464	010	0	1	01	01	H7464_010_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								1252	1064															2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H7464	012	0	1	01	01	H7464_012_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								2462	2093															2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
H7471	013	0	1	04	01	H7471_013_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											1379	1238															2			13i1;13i10;	1	1	13i1;13i10;	1	423.00	7		00010		13i1;13i10;
H7471	014	0	1	04	01	H7471_014_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											367	330															2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H7471	015	0	1	04	01	H7471_015_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											92	82															2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H7471	016	0	1	04	01	H7471_016_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											268	241															2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H7471	017	0	1	04	01	H7471_017_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											102	92															2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H7518	003	0	1	04	01	H7518_003_0	5	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										149	141															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H7524	001	0	1	01	01	H7524_001_0	6	1	3	Healthy Food	01111111111111111111111000000000											390	293															2			13i1;		1	13i1;	2						
H7524	002	0	1	01	01	H7524_002_0	6	1	3	Healthy Food	01111111111111111111111000000000											11	8															2			13i1;		1	13i1;	2						
H7524	003	0	1	01	01	H7524_003_0	6	1	3	Healthy Food	01111111111111111111111000000000											4487	3365															2			13i1;		1	13i1;	2						
H7524	004	0	1	01	01	H7524_004_0	7	1	3	Healthy Food	01111111111111111111111000000000											129	97															2			13i1;		1	13i1;	2						
H7557	001	0	1	01	01	H7557_001_0	6	1	3	SSBCI	01111111111111111111111000000000											1428	952															2			10b1;13i4;13i6;13i-O1;13i-O2;14c17;		2		1	500.00	5		01100		13i6;13i-O1;13i-O2;
H7598	003	0	1	01	01	H7598_003_0	6	1	3	Food / Grocery Card	01111111111111111111111000000000											491	442															2			13i1;		2		2						
H7605	004	0	1	01	01	H7605_004_0	7	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								271	243															2			13i1;13i10;		1	13i1;13i10;	1	60.00	7		00010		13i1;13i10;
H7605	016	0	1	01	01	H7605_016_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											403	362															2			13i1;13i10;		1	13i1;13i10;	1	180.00	7		00010		13i1;13i10;
H7607	014	0	1	01	01	H7607_014_0	7	1	3	Package 1	01111111011111111111100000000000											8124	8124															2			13i1;13i2;13i6;14c6;14c10;14c21;14c22;		2		2						
H7607	015	0	1	01	01	H7607_015_0	7	1	3	Package 1	01111111011111111111000000000000											1664	1664															2			13i1;		2		2						
H7607	016	0	1	01	01	H7607_016_0	7	1	3	Package 1	01111111011111111111000000000000											19120	19120															2			13i1;13i2;13i6;14c6;14c10;14c21;14c22;		2		2						
H7607	017	0	1	01	01	H7607_017_0	7	1	3	Package 1	01111111011111111111000000000000											1581	1581															2			13i1;13i2;13i5;13i6;14c6;14c10;14c21;14c22;		2		2						
H7607	018	0	1	01	01	H7607_018_0	7	1	3	Package 1	01111111011111111111000000000000											2631	2631															2			13i1;13i2;13i6;14c6;14c10;14c21;14c22;		2		2						
H7607	019	0	1	01	01	H7607_019_0	7	1	3	Package 1	01111111011111111111000000000000											1008	1008															2			13i1;13i2;13i6;14c6;14c10;14c21;14c22;		2		2						
H7617	004	0	1	04	01	H7617_004_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	004	0	1	04	01	H7617_004_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	006	0	1	04	01	H7617_006_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	006	0	1	04	01	H7617_006_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2554	2554															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	006	0	1	04	01	H7617_006_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H7617	007	0	1	04	01	H7617_007_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	007	0	1	04	01	H7617_007_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	008	0	1	04	01	H7617_008_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	008	0	1	04	01	H7617_008_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	010	0	1	04	01	H7617_010_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	010	0	1	04	01	H7617_010_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	011	0	1	04	01	H7617_011_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	011	0	1	04	01	H7617_011_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	012	0	1	04	01	H7617_012_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	012	0	1	04	01	H7617_012_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	013	0	1	04	01	H7617_013_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	013	0	1	04	01	H7617_013_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	014	0	1	04	01	H7617_014_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	014	0	1	04	01	H7617_014_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	015	0	1	04	01	H7617_015_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	015	0	1	04	01	H7617_015_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	016	0	1	04	01	H7617_016_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	016	0	1	04	01	H7617_016_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	017	0	1	04	01	H7617_017_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	017	0	1	04	01	H7617_017_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	018	0	1	04	01	H7617_018_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	018	0	1	04	01	H7617_018_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	020	0	1	04	01	H7617_020_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	020	0	1	04	01	H7617_020_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	021	0	1	04	01	H7617_021_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	021	0	1	04	01	H7617_021_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	022	0	1	04	01	H7617_022_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	022	0	1	04	01	H7617_022_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	023	0	1	04	01	H7617_023_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	023	0	1	04	01	H7617_023_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	024	0	1	04	01	H7617_024_0	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	024	0	1	04	01	H7617_024_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	025	0	1	04	01	H7617_025_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	025	0	1	04	01	H7617_025_0	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	026	0	1	04	01	H7617_026_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	026	0	1	04	01	H7617_026_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	027	0	1	04	01	H7617_027_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	027	0	1	04	01	H7617_027_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	028	0	1	04	01	H7617_028_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	028	0	1	04	01	H7617_028_0	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	029	0	1	04	01	H7617_029_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	029	0	1	04	01	H7617_029_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	030	0	1	04	01	H7617_030_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	030	0	1	04	01	H7617_030_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	031	0	1	04	01	H7617_031_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	031	0	1	04	01	H7617_031_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	032	0	1	04	01	H7617_032_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	032	0	1	04	01	H7617_032_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	033	0	1	04	01	H7617_033_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									262	262															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	033	0	1	04	01	H7617_033_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	035	0	1	04	01	H7617_035_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	035	0	1	04	01	H7617_035_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	036	0	1	04	01	H7617_036_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	036	0	1	04	01	H7617_036_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2552	2552															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	036	0	1	04	01	H7617_036_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H7617	037	0	1	04	01	H7617_037_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									159	159															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	037	0	1	04	01	H7617_037_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H7617	037	0	1	04	01	H7617_037_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	038	0	1	04	01	H7617_038_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H7617	038	0	1	04	01	H7617_038_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	038	0	1	04	01	H7617_038_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									4450	4450															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	039	0	1	04	01	H7617_039_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H7617	039	0	1	04	01	H7617_039_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									864	864															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	039	0	1	04	01	H7617_039_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	041	0	1	04	01	H7617_041_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	041	0	1	04	01	H7617_041_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	042	0	1	04	01	H7617_042_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	042	0	1	04	01	H7617_042_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	043	0	1	04	01	H7617_043_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	043	0	1	04	01	H7617_043_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	044	0	1	04	01	H7617_044_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	044	0	1	04	01	H7617_044_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	045	0	1	04	01	H7617_045_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	045	0	1	04	01	H7617_045_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	046	0	1	04	01	H7617_046_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	046	0	1	04	01	H7617_046_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	048	0	1	04	01	H7617_048_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									2034	2034															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	048	0	1	04	01	H7617_048_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	049	0	1	04	01	H7617_049_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	049	0	1	04	01	H7617_049_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	050	0	1	04	01	H7617_050_0	6	2	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	050	0	1	04	01	H7617_050_0	6	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	050	0	1	04	01	H7617_050_0	6	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H7617	051	0	1	04	01	H7617_051_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	051	0	1	04	01	H7617_051_0	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	052	0	1	04	01	H7617_052_0	4	2	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	052	0	1	04	01	H7617_052_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H7617	052	0	1	04	01	H7617_052_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	053	0	1	04	01	H7617_053_0	4	2	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	053	0	1	04	01	H7617_053_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	053	0	1	04	01	H7617_053_0	4	1	3	Chronic Condition Care Assistance	01111111001111111100000000000000											10743	140															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	2		1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H7617	054	0	1	04	01	H7617_054_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	054	0	1	04	01	H7617_054_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	056	0	1	04	01	H7617_056_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	056	0	1	04	01	H7617_056_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	057	0	1	04	01	H7617_057_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	057	0	1	04	01	H7617_057_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	058	0	1	04	01	H7617_058_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	058	0	1	04	01	H7617_058_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	059	0	1	04	01	H7617_059_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	059	0	1	04	01	H7617_059_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	061	0	1	04	01	H7617_061_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	061	0	1	04	01	H7617_061_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	062	0	1	04	01	H7617_062_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	062	0	1	04	01	H7617_062_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	063	0	1	04	01	H7617_063_0	4	1	3	Chronic Condition Care Assistance	01111111001111111100000000000000											495	6															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	2		1	1000.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H7617	063	0	1	04	01	H7617_063_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H7617	063	0	1	04	01	H7617_063_0	4	3	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	063	0	1	04	01	H7617_063_0	4	4	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	064	0	1	04	01	H7617_064_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	064	0	1	04	01	H7617_064_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	065	0	1	04	01	H7617_065_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	065	0	1	04	01	H7617_065_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	066	0	1	04	01	H7617_066_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	066	0	1	04	01	H7617_066_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	067	0	1	04	01	H7617_067_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									7887	7887															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	067	0	1	04	01	H7617_067_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	067	0	1	04	01	H7617_067_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H7617	068	0	1	04	01	H7617_068_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	068	0	1	04	01	H7617_068_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	069	0	1	04	01	H7617_069_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	069	0	1	04	01	H7617_069_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	070	0	1	04	01	H7617_070_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	070	0	1	04	01	H7617_070_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	073	0	1	04	01	H7617_073_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	073	0	1	04	01	H7617_073_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	074	0	1	04	01	H7617_074_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									8162	8162															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	074	0	1	04	01	H7617_074_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	074	0	1	04	01	H7617_074_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H7617	075	0	1	04	01	H7617_075_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H7617	075	0	1	04	01	H7617_075_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									8544	8544															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	075	0	1	04	01	H7617_075_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	076	0	1	04	01	H7617_076_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									18901	18901															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	076	0	1	04	01	H7617_076_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H7617	076	0	1	04	01	H7617_076_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	077	0	1	04	01	H7617_077_0	5	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	077	0	1	04	01	H7617_077_0	5	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H7617	077	0	1	04	01	H7617_077_0	5	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									6558	6558															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	078	0	1	04	01	H7617_078_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	078	0	1	04	01	H7617_078_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									9454	9454															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	079	0	1	04	01	H7617_079_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	079	0	1	04	01	H7617_079_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	080	0	1	04	01	H7617_080_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	080	0	1	04	01	H7617_080_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	081	0	1	04	01	H7617_081_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H7617	081	0	1	04	01	H7617_081_0	4	3	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	081	0	1	04	01	H7617_081_0	4	4	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	081	0	1	04	01	H7617_081_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									3014	2474															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	082	0	1	04	01	H7617_082_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H7617	082	0	1	04	01	H7617_082_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	082	0	1	04	01	H7617_082_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									3513	3513															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	083	0	1	04	01	H7617_083_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									4125	4125															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	083	0	1	04	01	H7617_083_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	083	0	1	04	01	H7617_083_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H7617	084	0	1	04	01	H7617_084_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	084	0	1	04	01	H7617_084_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H7617	084	0	1	04	01	H7617_084_0	4	1	3	Healthy Options Allowance and Cell Phone Benefit	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									6210	6210															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	085	0	1	04	01	H7617_085_0	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	085	0	1	04	01	H7617_085_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	086	0	1	04	01	H7617_086_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	086	0	1	04	01	H7617_086_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	087	0	1	04	01	H7617_087_0	4	3	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	087	0	1	04	01	H7617_087_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									4938	4054															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	087	0	1	04	01	H7617_087_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H7617	087	0	1	04	01	H7617_087_0	4	4	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	088	0	1	04	01	H7617_088_0	4	3	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	088	0	1	04	01	H7617_088_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									10345	8493															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	088	0	1	04	01	H7617_088_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H7617	088	0	1	04	01	H7617_088_0	4	4	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	089	0	1	04	01	H7617_089_0	4	3	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	089	0	1	04	01	H7617_089_0	4	4	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	089	0	1	04	01	H7617_089_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									10921	8966															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	089	0	1	04	01	H7617_089_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
H7617	090	0	1	04	01	H7617_090_0	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	090	0	1	04	01	H7617_090_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	091	0	1	04	01	H7617_091_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	091	0	1	04	01	H7617_091_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	092	0	1	04	01	H7617_092_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	092	0	1	04	01	H7617_092_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	093	0	1	04	01	H7617_093_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	093	0	1	04	01	H7617_093_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	094	0	1	04	01	H7617_094_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	094	0	1	04	01	H7617_094_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	095	0	1	04	01	H7617_095_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	095	0	1	04	01	H7617_095_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	096	0	1	04	01	H7617_096_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	096	0	1	04	01	H7617_096_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	098	0	1	04	01	H7617_098_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	098	0	1	04	01	H7617_098_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	100	0	1	04	01	H7617_100_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	100	0	1	04	01	H7617_100_0	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	101	0	1	04	01	H7617_101_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	101	0	1	04	01	H7617_101_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	107	0	1	04	01	H7617_107_0	5	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	107	0	1	04	01	H7617_107_0	5	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	108	0	1	04	01	H7617_108_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	108	0	1	04	01	H7617_108_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	110	0	1	04	01	H7617_110_0	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	110	0	1	04	01	H7617_110_0	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	114	0	1	04	01	H7617_114_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	114	0	1	04	01	H7617_114_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	115	0	1	04	01	H7617_115_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									143	143															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	115	0	1	04	01	H7617_115_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	116	0	1	04	01	H7617_116_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H7617	116	0	1	04	01	H7617_116_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	116	0	1	04	01	H7617_116_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									172	172															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	117	0	1	04	01	H7617_117_0	4	1	3	Chronic Care Assistance and Music Therapy	01111111001111111100000000000000											282	167															1	001		10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i10;14c15;17b2;17b3;17b4;18b1;18c;
H7617	118	0	1	04	01	H7617_118_0	4	1	3	Chronic Care Assistance and Music Therapy	01111111001111111100000000000000											136	80															1	001		10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i10;14c15;17b2;17b3;17b4;18b1;18c;
H7617	119	0	1	04	01	H7617_119_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	119	0	1	04	01	H7617_119_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	120	0	1	04	01	H7617_120_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	120	0	1	04	01	H7617_120_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	121	0	1	04	01	H7617_121_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	121	0	1	04	01	H7617_121_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									1802	1802															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	122	0	1	04	01	H7617_122_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	122	0	1	04	01	H7617_122_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	123	0	1	04	01	H7617_123_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	123	0	1	04	01	H7617_123_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	124	0	1	04	01	H7617_124_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	124	0	1	04	01	H7617_124_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	125	0	1	04	01	H7617_125_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	2		2						
H7617	125	0	1	04	01	H7617_125_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	126	0	1	04	01	H7617_126_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	126	0	1	04	01	H7617_126_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	127	0	1	04	01	H7617_127_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	127	0	1	04	01	H7617_127_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	128	0	1	04	01	H7617_128_0	4	1	3	Chronic Care Assistance and Music Therapy	01111111001111111100000000000000											361	214															1	001		10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i10;14c15;17b2;17b3;17b4;18b1;18c;
H7617	129	0	1	04	01	H7617_129_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H7617	129	0	1	04	01	H7617_129_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									383	383															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	2		1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	130	0	1	04	01	H7617_130_0	4	1	3	Chronic Care Assistance and Music Therapy	01111111001111111100000000000000											155	92															1	001		10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i10;14c15;17b2;17b3;17b4;18b1;18c;
H7617	131	0	1	04	01	H7617_131_0	4	1	3	Chronic Care Assistance and Music Therapy	01111111001111111100000000000000											273	162															1	001		10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i10;14c15;17b2;17b3;17b4;18b1;18c;
H7617	132	0	1	04	01	H7617_132_0	4	1	2	Non-Emergency Medical Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;	1	2		2						
H7617	133	0	1	04	01	H7617_133_0	4	1	2	Non-Emergency Medical Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;	1	2		2						
H7617	134	0	1	04	01	H7617_134_0	4	2	2	Non-Emergency Medical Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;	1	1	10b1;	2						
H7617	134	0	1	04	01	H7617_134_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									135	135															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	135	0	1	04	01	H7617_135_0	4	2	2	Non-Emergency Medical Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;	1	1	10b1;	2						
H7617	135	0	1	04	01	H7617_135_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									135	135															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	136	0	1	04	01	H7617_136_0	4	1	2	Non-Emergency Medical Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;	1	2		2						
H7617	137	0	1	04	01	H7617_137_0	4	2	2	Non-Emergency Medical Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;	1	1	10b1;	2						
H7617	137	0	1	04	01	H7617_137_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									138	138															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H7617	138	0	1	04	01	H7617_138_0	4	1	3	Chronic Care Assistance and Music Therapy	01111111001111111100000000000000											370	219															1	001		10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i10;14c15;17b2;17b3;17b4;18b1;18c;
H7617	139	0	1	04	01	H7617_139_0	4	1	3	Chronic Care Assistance and Music Therapy	01111111001111111100000000000000											134	79															1	001		10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i10;14c15;17b2;17b3;17b4;18b1;18c;
H7617	140	0	1	04	01	H7617_140_0	4	1	3	Chronic Care Assistance and Music Therapy	01111111001111111100000000000000											225	134															1	001		10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i10;14c15;17b2;17b3;17b4;18b1;18c;
H7617	142	0	1	04	01	H7617_142_0	4	1	3	Chronic Condition Care Assistance	01111111001111111100000000000000											149	2															1	001		10b1;13b;13i4;13i6;13i10;14c11;14c15;17b2;17b3;17b4;18b1;18c;	1	2		1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i10;14c11;14c15;17b2;17b3;17b4;18b1;18c;
H7617	142	0	1	04	01	H7617_142_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H7617	143	0	1	04	01	H7617_143_0	4	1	3	Chronic Care Assistance and Music Therapy	01111111001111111100000000000000											471	279															1	001		10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	1	10b1;13b;13i4;13i6;13i10;14c15;14c17;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10000	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i4;13i6;13i10;14c15;17b2;17b3;17b4;18b1;18c;
H7617	144	1	1	04	01	H7617_144_1	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	144	1	1	04	01	H7617_144_1	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	144	2	1	04	01	H7617_144_2	6	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	144	2	1	04	01	H7617_144_2	6	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7617	145	0	1	04	01	H7617_145_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H7617	145	0	1	04	01	H7617_145_0	4	1	2	Nutritional Benefit														0001000000000000000														2			13c;14c2;	1	1	13c;14c2;	2						
H7635	001	0	1	01	01	H7635_001_0	5	1	3	SSBCI - Food and Produce/In-Home Support Services	01111111111111111111111000000000											10844	10302															2			13i1;14c21;		1	13i1;14c21;	2						
H7678	006	1	1	01	01	H7678_006_1	5	1	3	SSBCI	01111111111111111111111000000000											431	388															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H7678	006	2	1	01	01	H7678_006_2	6	1	3	SSBCI	01111111111111111111111000000000											1181	1063															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H7680	002	0	1	01	01	H7680_002_0	7	1	3	SSBCI - Food / OTC	01111111100011111000000100000000	Chronic Hypertension										2695	1725															2			13i1;		1	13i1;	1	0.00	5		00010		13i1;
H7680	007	0	1	01	01	H7680_007_0	7	1	3	SSBCI -Food Card/OTC/Utilities/Transportation	01111111100111111000000100000000	Chronic Hypertension										6224	5104															1	001		13i1;13i4;13i10;		1	13i1;13i4;13i10;	2						
H7680	009	0	1	01	01	H7680_009_0	7	1	3	SSBCI - Food Card/OTC/Utilities	01111111100111111000000100000000	Chronic Hypertension										3952	3438															2			13i1;13i10;		1	13i1;13i10;	1	0.00	5		00010		13i1;13i10;
H7680	015	0	1	01	01	H7680_015_0	7	1	3	SSBCI -Food Card/OTC	01111111100011111000000100000000	Chronic Hypertension										462	245															2			13i1;		1	13i1;	1	0.00	5		00010		13i1;
H7680	016	0	1	01	01	H7680_016_0	7	1	3	SSBCI - Food Card/OTC	01111111100111111000000100000000	Chronic Hypertension										2090	1839															2			13i1;		1	13i1;	1	0.00	5		00010		13i1;
H7680	017	0	1	01	01	H7680_017_0	6	1	3	SSBCI - Food Card/OTC/Utilities	01111111100111111000000100000000	Chronic Hypertension										275	228															2			13i1;13i10;		1	13i1;13i10;	1	0.00	5		00010		13i1;13i10;
H7680	018	0	1	01	01	H7680_018_0	7	1	3	SSBCI - Food Card/OTC/Utilities	01111111100111111000000100000000	Chronic Hypertension										211	169															2			13i1;13i10;		1	13i10;	1	0.00	7		00010		13i10;
H7680	020	0	1	01	01	H7680_020_0	5	1	3	SSBCI - Food Card/OTC	01111111100111111000000100000000	Chronic Hypertension										426	273															2			13i1;		1	13i1;	1	0.00	5		00010		13i1;
H7680	021	0	1	01	01	H7680_021_0	7	1	3	SSBCI -Food Card/OTC/Utilities	01111111100111111000000100000000	Chronic Hypertension										120	104															1	001		13i1;13i10;		1	13i1;13i10;	2						
H7710	001	0	1	01	01	H7710_001_0	12	1	3	Healthy Benefits	01111111111111111111111000000000											3624	3407															2			13i1;13i4;13i5;13i10;13i-O1;		1	13i1;13i4;13i5;13i10;13i-O1;	1	179.00	7		01010		13i1;13i4;13i5;13i10;13i-O1;
H7710	002	0	1	01	01	H7710_002_0	12	1	3	Healthy Benefits	01111111111111111111111000000000											1062	998															2			13i1;13i10;		1	13i1;13i10;	1	147.00	5		01010		13i1;13i10;
H7766	004	0	1	04	01	H7766_004_0	4	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								392	352															2			13i1;13i10;	1	1	13i1;13i10;	1	192.00	7		00010		13i1;13i10;
H7766	012	0	1	04	01	H7766_012_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											67	60															2			13i1;13i10;	1	1	13i1;13i10;	1	192.00	7		00010		13i1;13i10;
H7766	013	0	1	04	01	H7766_013_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											72	64															2			13i1;13i10;	1	1	13i1;13i10;	1	192.00	7		00010		13i1;13i10;
H7766	014	0	1	04	01	H7766_014_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											284	255															2			13i1;13i10;	1	1	13i1;13i10;	1	344.00	7		00010		13i1;13i10;
H7766	015	0	1	04	01	H7766_015_0	4	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								451	405															2			13i1;13i10;	1	1	13i1;13i10;	1	318.00	7		00010		13i1;13i10;
H7766	018	0	1	04	01	H7766_018_0	3	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;	1	1	13i1;13i10;	1	167.00	7		00010		13i1;13i10;
H7766	022	0	1	04	01	H7766_022_0	4	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								128	115															2			13i1;13i10;	1	1	13i1;13i10;	1	305.00	7		00010		13i1;13i10;
H7766	023	0	1	04	01	H7766_023_0	4	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								128	115															2			13i1;13i10;	1	1	13i1;13i10;	1	135.00	7		00010		13i1;13i10;
H7766	024	0	1	04	01	H7766_024_0	3	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;	1	1	13i1;13i10;	1	323.00	7		00010		13i1;13i10;
H7766	025	0	1	04	01	H7766_025_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								228	205															2			13i1;13i10;	1	1	13i1;13i10;	1	220.00	7		00010		13i1;13i10;
H7766	026	0	1	04	01	H7766_026_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								128	115															2			13i1;13i10;	1	1	13i1;13i10;	1	220.00	7		00010		13i1;13i10;
H7917	044	0	1	04	01	H7917_044_0	7	1	3	OTC + Health Food	00001101000000000000000000000000											2871	2728															2			13i1;	1	2		1	0.00	7		01010		13i1;
H7917	045	0	1	04	01	H7917_045_0	6	1	3	OTC + Health Food	00001101000000000000000000000000											1704	1619															2			13i1;	1	2		1	0.00	7		00010		13i1;
H7917	046	0	1	04	01	H7917_046_0	4	1	3	OTC + Health Food	00001101000000000000000000000000											948	901															2			13i1;	1	2		1	0.00	7		00010		13i1;
H7993	003	0	1	01	01	H7993_003_0	7	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								349	313															2			13i1;13i10;		1	13i1;13i10;	1	37.00	7		00010		13i1;13i10;
H7993	004	0	1	01	01	H7993_004_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								265	238															2			13i1;13i10;		1	13i1;13i10;	1	56.00	7		00010		13i1;13i10;
H7993	007	0	1	01	01	H7993_007_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								159	143															2			13i1;13i10;		1	13i1;13i10;	1	75.00	7		00010		13i1;13i10;
H7993	010	0	1	01	01	H7993_010_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								1366	1227															2			13i1;13i10;		1	13i1;13i10;	1	235.00	7		00010		13i1;13i10;
H7993	012	0	1	01	01	H7993_012_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								1536	1379															2			13i1;13i10;		1	13i1;13i10;	1	195.00	7		00010		13i1;13i10;
H7993	014	0	1	01	01	H7993_014_0	7	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								217	195															2			13i1;13i10;		1	13i1;13i10;	1	77.00	7		00010		13i1;13i10;
H7993	015	0	1	01	01	H7993_015_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								236	212															2			13i1;13i10;		1	13i1;13i10;	1	159.00	7		00010		13i1;13i10;
H7993	017	0	1	01	01	H7993_017_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								686	616															2			13i1;13i10;		1	13i1;13i10;	1	213.00	7		00010		13i1;13i10;
H7993	019	0	1	01	01	H7993_019_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								2885	2591															2			13i1;13i10;		1	13i1;13i10;	1	19.00	7		00010		13i1;13i10;
H7993	023	0	1	01	01	H7993_023_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											89	80															2			13i1;13i10;		1	13i1;13i10;	1	90.00	7		00010		13i1;13i10;
H7993	024	0	1	01	01	H7993_024_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											89	80															2			13i1;13i10;		1	13i1;13i10;	1	285.00	7		00010		13i1;13i10;
H7993	027	0	1	01	01	H7993_027_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											4	4															2			13i1;13i10;		1	13i1;13i10;	1	24.00	7		00010		13i1;13i10;
H7993	028	0	1	01	01	H7993_028_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											106	95															2			13i1;13i10;		1	13i1;13i10;	1	175.00	7		00010		13i1;13i10;
H7993	029	0	1	01	01	H7993_029_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											1064	955															2			13i1;13i10;		1	13i1;13i10;	1	410.00	7		00010		13i1;13i10;
H7993	030	0	1	01	01	H7993_030_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											1123	1009															2			13i1;13i10;		1	13i1;13i10;	1	150.00	7		00010		13i1;13i10;
H7993	031	0	1	01	01	H7993_031_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											1587	1425															2			13i1;13i10;		1	13i1;13i10;	1	385.00	7		00010		13i1;13i10;
H7993	033	0	1	01	01	H7993_033_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											1393	1251															2			13i1;13i10;		1	13i1;13i10;	1	385.00	7		00010		13i1;13i10;
H7993	036	0	1	01	01	H7993_036_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											79	71															2			13i1;13i10;		1	13i1;13i10;	1	293.00	7		00010		13i1;13i10;
H7993	037	0	1	01	01	H7993_037_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								199	179															2			13i1;13i10;		1	13i1;13i10;	1	236.00	7		00010		13i1;13i10;
H7993	038	0	1	01	01	H7993_038_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								551	494															2			13i1;13i10;		1	13i1;13i10;	1	360.00	7		00010		13i1;13i10;
H7993	040	0	1	01	01	H7993_040_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								1690	1518															2			13i1;13i10;		1	13i1;13i10;	1	335.00	7		00010		13i1;13i10;
H7993	041	0	1	01	01	H7993_041_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								934	838															2			13i1;13i10;		1	13i1;13i10;	1	335.00	7		00010		13i1;13i10;
H7993	046	0	1	01	01	H7993_046_0	6	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											615	552															2			13i1;13i10;		1	13i1;13i10;	1	65.00	7		00010		13i1;13i10;
H7993	069	0	1	01	01	H7993_069_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;		1	13i1;13i10;	1	137.00	7		00010		13i1;13i10;
H7993	070	0	1	01	01	H7993_070_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;		1	13i1;13i10;	1	240.00	7		00010		13i1;13i10;
H7993	071	0	1	01	01	H7993_071_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								128	115															2			13i1;13i10;		1	13i1;13i10;	1	220.00	7		00010		13i1;13i10;
H7993	072	0	1	01	01	H7993_072_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								128	115															2			13i1;13i10;		1	13i1;13i10;	1	220.00	7		00010		13i1;13i10;
H7993	075	0	1	01	01	H7993_075_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;		1	13i1;13i10;	1	142.00	7		00010		13i1;13i10;
H7993	092	0	1	01	01	H7993_092_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											277	249															2			13i1;13i10;		1	13i1;13i10;	1	192.00	7		00010		13i1;13i10;
H7993	093	0	1	01	01	H7993_093_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;		1	13i1;13i10;	1	344.00	7		00010		13i1;13i10;
H7993	094	0	1	01	01	H7993_094_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								45	40															2			13i1;13i10;		1	13i1;13i10;	1	41.00	7		00010		13i1;13i10;
H7993	096	0	1	01	01	H7993_096_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;		1	13i1;13i10;	1	152.00	7		00010		13i1;13i10;
H7993	097	0	1	01	01	H7993_097_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;		1	13i1;13i10;	1	253.00	7		00010		13i1;13i10;
H7993	100	0	1	01	01	H7993_100_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;		1	13i1;13i10;	1	192.00	7		00010		13i1;13i10;
H7993	101	0	1	01	01	H7993_101_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;		1	13i1;13i10;	1	344.00	7		00010		13i1;13i10;
H7993	117	0	1	01	01	H7993_117_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;		1	13i1;13i10;	1	253.00	7		00010		13i1;13i10;
H7993	118	0	1	01	01	H7993_118_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								128	115															2			13i1;13i10;		1	13i1;13i10;	1	235.00	7		00010		13i1;13i10;
H7993	119	0	1	01	01	H7993_119_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								128	115															2			13i1;13i10;		1	13i1;13i10;	1	235.00	7		00010		13i1;13i10;
H8051	001	0	1	01	01	H8051_001_0	8	1	3	SSBCI Package 1	01111111111111111111111000000000											1600	1440															2			13i1;13i4;13i10;		1	13i1;13i4;13i10;	1	0.00	7		00010		13i1;13i10;
H8093	002	0	1	01	01	H8093_002_0	8	1	3	Healthy Food and Utility Services	01111111111111111111111000000000											110	100															1	001		13i1;13i10;		1	13i1;13i10;	1	110.00	7		00010		13i1;13i10;
H8142	001	0	1	02	01	H8142_001_0	10	1	3	CHF - Supplemental	00000100000000000000000000000000											2205	2205															1	011		10b1;14c2;	2	1	10b1;14c2;	2						
H8142	002	0	1	02	01	H8142_002_0	10	1	3	CHF - Supplemental	00000100000000000000000000000000											983	983															1	011		10b1;14c2;	2	1	10b1;14c2;	2						
H8142	003	0	1	02	01	H8142_003_0	10	1	3	CHF - Supplemental	00000100000000000000000000000000											1313	1313															1	011		10b1;14c2;	2	1	10b1;14c2;	2						
H8142	007	0	1	02	01	H8142_007_0	12	1	3	CHF - Supplemental	00000100000000000000000000000000											881	881															1	011		10b1;14c2;	2	1	10b1;14c2;	2						
H8145	004	0	1	09	04	H8145_004_0	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H8145	006	0	1	09	04	H8145_006_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H8145	042	0	1	09	04	H8145_042_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H8145	052	0	1	09	04	H8145_052_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H8145	069	0	1	09	04	H8145_069_0	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H8145	091	0	1	09	04	H8145_091_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
H8145	126	0	1	09	04	H8145_126_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H8173	014	0	1	01	01	H8173_014_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											736	661															2			13i1;13i10;		1	13i1;13i10;	1	141.00	7		00010		13i1;13i10;
H8173	020	0	1	01	01	H8173_020_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								140	126															2			13i1;13i10;		1	13i1;13i10;	1	70.00	7		00010		13i1;13i10;
H8173	022	0	1	01	01	H8173_022_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											693	623															2			13i1;13i10;		1	13i1;13i10;	1	220.00	7		00010		13i1;13i10;
H8173	023	0	1	01	01	H8173_023_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											23	20															2			13i1;13i10;		1	13i1;13i10;	1	34.00	7		00010		13i1;13i10;
H8173	025	0	1	01	01	H8173_025_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											328	294															2			13i1;13i10;		1	13i1;13i10;	1	230.00	7		00010		13i1;13i10;
H8173	027	0	1	01	01	H8173_027_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											495	444															2			13i1;13i10;		1	13i1;13i10;	1	220.00	7		00010		13i1;13i10;
H8176	004	1	1	01	01	H8176_004_1	6	1	3	SSBCI	01111111111111111111111000000000											1622	1459															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H8176	004	2	1	01	01	H8176_004_2	6	1	3	SSBCI	01111111111111111111111000000000											676	608															1	001		13i1;13i4;13i10;		2		1	0.00	7		01010		13i1;13i4;13i10;
H8189	001	0	1	02	01	H8189_001_0	5	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										6573	6244															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H8189	007	0	1	02	01	H8189_007_0	5	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										311	296															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H8212	001	0	1	01	01	H8212_001_0	7	1	3	Package 1	00001111110001101000000100000000	Connective Tissue Disease										102	67															2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		01011		13i1;13i10;
H8298	001	0	1	01	01	H8298_001_0	10	1	3	Package 1	01111111111111111111111111000000	Prediabetes	Chronic Hypertension	Chronic Anemia								26350	24450															1	011		13i1;13i10;		1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H8298	002	0	1	01	01	H8298_002_0	7	1	3	SSBCI Package 1	00001101000000000000000000000000											1340	1240															2			13i1;13i10;		1	13i1;13i10;	1	0.00	7		00010		13i1;13i10;
H8320	011	0	1	04	01	H8320_011_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											91	82															2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H8320	012	0	1	04	01	H8320_012_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											400	359															2			13i1;13i10;	1	1	13i1;13i10;	1	300.00	7		00010		13i1;13i10;
H8320	013	0	1	04	01	H8320_013_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											100	90															2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H8320	014	0	1	04	01	H8320_014_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											108	97															2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H8332	009	0	1	01	01	H8332_009_0	4	1	3	SSBCI Pkg	00001101000000000000000000000000											574	537															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H8332	010	0	1	01	01	H8332_010_0	4	1	3	SSBCI Pkg	00001101000000000000000000000000											916	833															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H8332	801	0	1	01	01	H8332_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H8332	801	0	1	01	01	H8332_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H8379	001	0	1	01	01	H8379_001_0	3	1	3	SSBCI Flex	01111111111111111111111111000000	Chronic Hypertension	Osteoporosis	Chronic Low Back Pain								6316	1895															2			13i1;13i2;13i3;13i10;13i-O1;		1	13i1;13i2;13i3;13i10;13i-O1;	1	0.00	7		01101		13i1;13i2;13i3;13i10;13i-O1;
H8379	003	1	1	01	01	H8379_003_1	4	1	3	SSBCI Flex	01111111111111111111111111000000	chronic hypertension	Osteoporosis	Chronic low back pain								434	130															2			13i1;13i2;13i3;13i10;13i-O1;		1	13i1;13i2;13i3;13i10;13i-O1;	1	0.00	7		01011		13i1;13i2;13i3;13i10;13i-O1;
H8379	003	2	1	01	01	H8379_003_2	4	1	3	SSBCI Flex	01111111111111111111111111000000	chronic hypertension	Osteoporosis	Chronic low back pain								295	89															2			13i1;13i2;13i3;13i10;13i-O1;		1	13i1;13i2;13i3;13i10;13i-O1;	1	0.00	7		01011		13i1;13i2;13i3;13i10;13i-O1;
H8379	003	3	1	01	01	H8379_003_3	4	1	3	SSBCI Flex	01111111111111111111111111000000	chronic hypertension	Osteoporosis	Chronic low back pain								36	11															2			13i1;13i2;13i3;13i10;13i-O1;		1	13i1;13i2;13i3;13i10;13i-O1;	1	0.00	7		01011		13i1;13i2;13i3;13i10;13i-O1;
H8379	003	4	1	01	01	H8379_003_4	4	1	3	SSBCI Flex	01111111111111111111111111000000	chronic hypertension	Osteoporosis	Chronic low back pain								440	132															2			13i1;13i2;13i3;13i10;13i-O1;		1	13i1;13i2;13i3;13i10;13i-O1;	1	0.00	7		01011		13i1;13i2;13i3;13i10;13i-O1;
H8432	042	0	1	01	01	H8432_042_0	6	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							16694	14565															2			13i1;13i10;		2		2						
H8432	043	0	1	01	01	H8432_043_0	6	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							57	51															2			13i1;13i10;		2		2						
H8457	001	0	1	01	01	H8457_001_0	7	1	3	SSBCI	01111111111111111111111000000000											676	450															2			13i6;13i-O1;13i-O2;14c17;		2		1	500.00	5		01100		13i6;13i-O1;13i-O2;
H8481	001	0	1	04	01	H8481_001_0	8	4	2	OHTH 3														0110101000111000000	Pregnancy	End Stage Renal Disease	Metabolic Syndrome								2	2		2			16c3;	1	2		2						
H8481	001	0	1	04	01	H8481_001_0	8	3	2	OHTH 2														0000000000111000000	Oral Cancer	Sjorgens	Head and Neck Cancer								2	2		2			16b1;16b4;16b5;16c3;	1	2		2						
H8481	001	0	1	04	01	H8481_001_0	8	2	2	OHTH 1														0110101000111000000	Pregnancy	End Stage Renal Disease	Metabolic Syndrome								2	2		2			16b4;16c3;	1	2		2						
H8481	001	0	1	04	01	H8481_001_0	8	1	3	Food and Utilities	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									5786	4565															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01011		13i1;13i10;
H8481	001	0	1	04	01	H8481_001_0	8	5	2	OHTH 4														0000000000111000000	Oral Cancer	Sjorgens	Head and Neck Cancer								2	2		2			16c3;	1	2		2						
H8492	002	0	1	01	01	H8492_002_0	5	1	3	Healthy Food	01111111111111111111111000000000											172	140															1	001		13i1;		1	13i1;	2						
H8597	001	0	1	01	01	H8597_001_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							2241	2204															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H8597	002	0	1	01	01	H8597_002_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							614	599															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H8597	003	0	1	01	01	H8597_003_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							785	759															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H8597	004	0	1	01	01	H8597_004_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							7477	7285															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H8597	005	0	1	01	01	H8597_005_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							603	577															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H8597	006	0	1	01	01	H8597_006_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							886	833															1	010		10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	30.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H8604	014	2	1	04	01	H8604_014_2	7	1	3	SSBCI Food & Utilities	01111111111111111111111000000000											690	651															2			13i1;13i10;	1	2		1	0.00	5		00011		13i1;13i10;
H8649	010	0	1	01	01	H8649_010_0	3	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							823	812															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H8649	801	0	1	01	01	H8649_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H8649	801	0	1	01	01	H8649_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H8649	803	0	1	01	01	H8649_803_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H8649	803	0	1	01	01	H8649_803_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H8649	805	0	1	01	01	H8649_805_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H8649	805	0	1	01	01	H8649_805_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;		1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H8794	001	0	1	01	01	H8794_001_0	5	1	3	Healthy Food Card	01111111111111111111111000000000											8103	7373															2			13i1;		2		2						
H8794	006	0	1	01	01	H8794_006_0	5	1	3	Healthy Food Card	01111111111111111111111000000000											14246	12964															2			13i1;		2		2						
H8794	007	0	1	01	01	H8794_007_0	5	1	3	Healthy Food Card	01111111111111111111111000000000											2684	2442															2			13i1;		2		2						
H8794	009	0	1	01	01	H8794_009_0	7	1	3	Healthy Food Card	01111111111111111111111000000000											37263	33909															2			13i1;		2		2						
H8794	010	0	1	01	01	H8794_010_0	5	1	3	Healthy Food Card	01111111111111111111111000000000											5728	5212															2			13i1;		2		2						
H8794	011	0	1	01	01	H8794_011_0	6	1	3	Healthy Food Card	01111111111111111111111000000000											1126	1025															2			13i1;		2		2						
H8794	016	0	1	01	01	H8794_016_0	5	1	2	Advanced Care At Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13f;		2		2						
H8794	017	0	1	01	01	H8794_017_0	5	1	2	Advanced Care At Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13f;		2		2						
H8794	019	0	1	01	01	H8794_019_0	5	1	2	Advanced Care At Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13f;		2		2						
H8794	023	0	1	01	01	H8794_023_0	5	1	2	Advanced Care At Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13f;		2		2						
H8797	001	0	1	01	01	H8797_001_0	10	1	3	Combined Flex Benefits	01111111111111111111111111000000	osteoporosis	chronic hypertension	chronic hyperlipidemia								621	155															2			13i1;13i4;13i10;13i-O2;		1	13i1;13i4;13i10;13i-O2;	1	0.00	5		01010		13i10;13i-O2;
H8797	003	0	1	02	01	H8797_003_0	8	1	3	Combined Flex Benefits	01111111111111111111111111000000	osteoporosis	chronic hypertension	chronic hyperlipidemia								835	501															2			13i1;13i4;13i10;13i-O2;	2	1	13i1;13i4;13i10;13i-O2;	1	0.00	5		01010		13i1;13i10;13i-O2;
H8797	004	0	1	02	01	H8797_004_0	9	1	3	Flex Benefits	01111111111111111111111111000000	osteoporosis	chronic hypertension	chronic hyperlipidemia								248	112															2			13i1;13i4;13i10;13i-O2;	2	1	13i1;13i4;13i10;13i-O2;	1	0.00	5		01010		13i1;13i10;13i-O2;
H8832	001	0	1	04	01	H8832_001_0	9	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									4233	9															2			13i3;13i10;13i-O1;	1	2		2						
H8832	002	0	1	04	01	H8832_002_0	9	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									954	2															2			13i3;13i10;13i-O1;	1	2		2						
H8832	004	0	1	04	01	H8832_004_0	8	1	3	Package 1	00000000001000000000000000000000											377	287															2			13i1;13i3;13i10;13i-O1;14c8;	1	2		1	200.00	7		00010		13i1;13i10;14c8;
H8832	005	0	1	04	01	H8832_005_0	7	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									4233	9															2			13i3;13i-O1;	1	2		2						
H8845	001	0	1	01	01	H8845_001_0	7	1	3	SSBCI	01111111111111111111111000000000											322	290															1	001		13i1;13i4;13i10;		2		1	0.00	7		00010		13i1;13i4;13i10;
H8849	001	0	1	02	01	H8849_001_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							845	742															2			13i1;13i2;	2	2		2						
H8849	003	0	1	02	01	H8849_003_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							5394	4744															2			13i1;	2	2		2						
H8849	005	0	1	02	01	H8849_005_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							169	148															2			13i1;	2	2		2						
H8849	015	0	1	01	01	H8849_015_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							1004	741															2			13i1;13i2;13i10;		2		2						
H8849	016	0	1	01	01	H8849_016_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							102	80															2			13i1;13i10;		2		2						
H8849	017	0	1	01	01	H8849_017_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							445	329															2			13i1;13i2;13i10;		2		2						
H8849	018	1	1	01	01	H8849_018_1	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							1613	1475															2			13i1;13i10;		2		2						
H8849	018	2	1	01	01	H8849_018_2	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							568	415															2			13i1;13i10;		2		2						
H8849	018	3	1	01	01	H8849_018_3	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							1319	1134															2			13i1;13i10;		2		2						
H8849	018	4	1	01	01	H8849_018_4	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							63	59															2			13i1;13i10;		2		2						
H8849	019	1	1	01	01	H8849_019_1	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							1106	1012															2			13i1;13i10;		2		2						
H8849	019	2	1	01	01	H8849_019_2	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							968	708															2			13i1;13i10;		2		2						
H8849	019	3	1	01	01	H8849_019_3	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							1593	1369															2			13i1;13i10;		2		2						
H8849	019	4	1	01	01	H8849_019_4	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							552	517															2			13i1;13i10;		2		2						
H8849	020	1	1	01	01	H8849_020_1	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							28	26															2			13i1;13i10;		2		2						
H8849	020	2	1	01	01	H8849_020_2	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							33	24															2			13i1;13i10;		2		2						
H8849	020	3	1	01	01	H8849_020_3	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							22	19															2			13i1;13i10;		2		2						
H8849	020	4	1	01	01	H8849_020_4	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							5	5															2			13i1;13i10;		2		2						
H8849	021	0	1	01	01	H8849_021_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							2562	2328															2			13i1;13i10;		2		2						
H8849	022	0	1	01	01	H8849_022_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							5593	5084															2			13i1;13i10;		2		2						
H8849	023	0	1	01	01	H8849_023_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							364	285															2			13i1;13i10;		2		2						
H8849	024	1	1	01	01	H8849_024_1	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							8534	7757															2			13i1;13i10;		2		2						
H8849	024	2	1	01	01	H8849_024_2	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							856	671															2			13i1;13i10;		2		2						
H8849	025	0	1	01	01	H8849_025_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							549	499															2			13i1;13i10;		2		2						
H8849	026	0	1	01	01	H8849_026_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							2620	2390															2			13i1;13i10;		2		2						
H8849	027	0	1	01	01	H8849_027_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							508	435															2			13i1;13i10;		2		2						
H8849	028	0	1	01	01	H8849_028_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							4695	4283															2			13i1;13i10;		2		2						
H8849	029	0	1	01	01	H8849_029_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							1709	1490															2			13i1;13i10;		2		2						
H8849	030	0	1	01	01	H8849_030_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							323	294															2			13i1;13i10;		2		2						
H8849	031	0	1	01	01	H8849_031_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							347	303															2			13i1;13i10;		2		2						
H8854	002	0	1	01	01	H8854_002_0	10	2	2	PERS														0111101010100000000	ESRD										2	2		2			14c11;		1	14c11;	2						
H8854	002	0	1	01	01	H8854_002_0	10	1	3	Flex Benefit	01111111111111111111111100000000	Chronically Underweight										9000	8500															2			13i1;13i10;		2		1	0.00	7		00011		13i1;13i10;
H8879	001	0	1	02	01	H8879_001_0	10	1	3	SSBCI	01111111111111111111111000000000											258	52															2			13i1;13i10;	2	1	13i1;13i10;	1	0.00	5		00010		13i1;13i10;
H8889	002	0	1	04	01	H8889_002_0	4	1	3	SSBCI	00011111011101011000000000000000											396	127															1	001		10b1;13c;13i4;14c8;14c20;	1	2		2						
H8889	009	0	1	04	01	H8889_009_0	2	1	3	SSBCI	00011111011101011000000000000000											274	88															1	001		13c;14c8;	1	2		2						
H8889	012	0	1	04	01	H8889_012_0	3	1	3	SSBCI	00011111011101011000000000000000											411	131															1	001		13c;14c8;	1	2		2						
H8889	013	0	1	04	01	H8889_013_0	3	1	3	SSBCI	00011111011101011000000000000000											87	28															1	001		13c;14c8;	1	2		2						
H8889	014	0	1	04	01	H8889_014_0	3	1	3	SSBCI	00011111011101011000000000000000											241	77															1	001		13c;14c8;	1	2		2						
H8889	016	0	1	04	01	H8889_016_0	3	1	3	Flex Part C	00001001000000100000000000000000											543	377															2			13i1;13i10;	1	2		1	100.00	7		00010		13i1;13i10;
H8889	019	1	1	04	01	H8889_019_1	3	1	3	SSBCI	00011111011101011000000000000000											391	125															1	001		10b1;13c;13i4;14c8;14c20;	1	2		2						
H8889	019	2	1	04	01	H8889_019_2	3	1	3	SSBCI	00011111011101011000000000000000											338	108															1	001		10b1;13c;13i4;14c8;14c20;	1	2		2						
H8889	020	1	1	04	01	H8889_020_1	3	1	3	SSBCI	00011111011101011000000000000000											794	254															1	001		10b1;13c;13i4;14c8;14c20;	1	2		2						
H8889	020	2	1	04	01	H8889_020_2	3	1	3	SSBCI	00011111011101011000000000000000											583	186															1	001		10b1;13c;13i4;14c8;14c20;	1	2		2						
H8889	021	1	1	04	01	H8889_021_1	3	1	3	SSBCI	00011111011101011000000000000000											141	45															1	001		10b1;13c;13i4;14c8;14c20;	1	2		2						
H8889	021	2	1	04	01	H8889_021_2	3	1	3	SSBCI	00011111011101011000000000000000											100	32															1	001		10b1;13c;13i4;14c8;14c20;	1	2		2						
H8889	022	0	1	04	01	H8889_022_0	5	1	3	SSBCI	00011111011101011000000000000000											191	61															1	001		10b1;13c;13i4;14c8;14c20;	1	2		2						
H8889	023	0	1	04	01	H8889_023_0	5	1	3	SSBCI	00011111011101011000000000000000											776	248															1	001		10b1;13c;13i4;14c8;	1	2		2						
H8889	024	0	1	04	01	H8889_024_0	3	1	3	SSBCI	00011111011101011000000000000000											293	93															1	001		10b1;13c;13i4;14c8;	1	2		2						
H8889	025	0	1	04	01	H8889_025_0	8	1	3	SSBCI	00011111011101011000000000000000											26	8															1	001		13c;14c8;	1	2		2						
H8889	026	0	1	04	01	H8889_026_0	3	1	3	SSBCI	00011111011101011000000000000000											109	35															1	001		13c;14c8;	1	2		2						
H8889	027	1	1	04	01	H8889_027_1	6	1	3	SSBCI	00011111011101011000000000000000											181	58															1	001		13c;14c8;	1	2		2						
H8889	027	2	1	04	01	H8889_027_2	5	1	3	SSBCI	00011111011101011000000000000000											196	63															1	001		13c;14c8;	1	2		2						
H8889	028	1	1	04	01	H8889_028_1	5	1	3	SSBCI	00011111011101011000000000000000											209	67															1	001		13c;14c8;	1	2		2						
H8889	028	2	1	04	01	H8889_028_2	5	1	3	SSBCI	00011111011101011000000000000000											383	122															1	001		13c;14c8;	1	2		2						
H8889	029	1	1	04	01	H8889_029_1	3	1	3	SSBCI	00011111011101011000000000000000											77	25															1	001		13c;14c8;	1	2		2						
H8889	029	2	1	04	01	H8889_029_2	3	1	3	SSBCI	00011111011101011000000000000000											63	20															1	001		13c;14c8;	1	2		2						
H8902	002	0	1	01	01	H8902_002_0	11	1	3	Food, Utilities, Non-medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						2206	1213															2			13i1;13i4;13i10;		2		1	0.00	7		00111		13i1;13i10;
H8902	012	0	1	01	01	H8902_012_0	9	1	3	Food and Non-medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						490	269															2			13i1;13i4;		2		2						
H8902	013	0	1	01	01	H8902_013_0	9	1	3	Food and Non-medical Transportation	11111111111111111111111111100000	Chronic Hypertension	Chronic disorders of bones, joints, and muscles	Chronic Genitourinary Disorders	Chronic Hyperlipidemia	Chronic Endocrine System Disorders						1392	765															2			13i1;13i4;		2		2						
H8908	004	0	1	02	01	H8908_004_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
H8908	004	0	1	02	01	H8908_004_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
H8908	005	0	1	01	01	H8908_005_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H8908	005	0	1	01	01	H8908_005_0	4	1	3	Healthy Options Allowance	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									9819	9819															2			13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;		1	13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;	1	0.00	3		00010		13i1;13i3;13i4;13i5;13i6;13i10;14c8;14c11;
H8908	007	0	1	01	01	H8908_007_0	4	2	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;		1	10b1;	2						
H8908	007	0	1	01	01	H8908_007_0	4	3	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;		1	13d;	2						
H8908	007	0	1	01	01	H8908_007_0	4	1	3	Chronic Care Assistance and Healthy Options	01111111011111111101100110000000	Chronic Hyperlipidemia	Chronic Hypertension									1198	1198															1	001		10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;		1	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;	1	500.00	3		10010	Purchases must be coordinated by a care manager on the member's behalf.	10b1;13b;13i1;13i2;13i3;13i4;13i5;13i6;13i10;14c8;14c10;14c11;14c15;14c19;14c21;17b2;17b3;17b4;18b1;18c;
H8917	001	0	1	04	01	H8917_001_0	7	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								657	590															2			13i1;13i10;	1	1	13i1;13i10;	1	42.00	7		00010		13i1;13i10;
H8917	005	0	1	04	01	H8917_005_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											92	83															2			13i1;13i10;	1	1	13i1;13i10;	1	153.00	7		00010		13i1;13i10;
H8917	006	0	1	04	01	H8917_006_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											260	233															2			13i1;13i10;	1	1	13i1;13i10;	1	230.00	7		00010		13i1;13i10;
H8928	001	0	1	01	01	H8928_001_0	7	1	3	Grocery and Transportation	01111111111111111111111000000000											5521	4755															2			13i1;13i4;		1	13i1;13i4;	1	0.00	5		01011		13i1;
H8928	002	0	1	01	01	H8928_002_0	8	1	3	Grocery and Transportation	01111111111111111111111000000000											2821	2430															2			13i1;13i4;		1	13i1;13i4;	1	0.00	5		01011		13i1;
H8947	006	0	1	04	01	H8947_006_0	7	1	3	OTC SSBCI	01111111111111111111111000000000											383	345															2			13b;13i1;13i10;14c8;	1	1	13b;13i1;13i10;14c8;	1	0.00	7		01010		13b;13i1;13i10;14c8;
H9003	001	0	1	02	01	H9003_001_0	7	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13f;	2	2		2						
H9003	006	0	1	02	01	H9003_006_0	7	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13f;	2	2		2						
H9003	009	0	1	02	01	H9003_009_0	7	1	2	Acute Care at Home														0000000000100000000	Meets clinical criteria, hospital care in home based on health status													2			13f;	2	2		2						
H9065	001	0	1	01	01	H9065_001_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							2750	2350															2			13i1;13i10;		2		2						
H9065	014	0	1	02	01	H9065_014_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							77	67															2			13i1;13i10;	2	2		2						
H9065	016	0	1	01	01	H9065_016_0	6	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							1472	1258															2			13i1;13i10;		2		2						
H9066	001	0	1	01	01	H9066_001_0	4	1	3	Package 1	01111111111111111111111000000000											237	220															2			13i1;13i6;13i10;		2		1	0.00	7		00011		13i1;13i6;13i10;
H9066	002	0	1	01	01	H9066_002_0	6	1	3	Package 1	01111111111111111111111000000000											233	171															2			13d;13i-O1;		2		2						
H9066	003	0	1	01	01	H9066_003_0	5	1	3	Package 1	01111111111111111111111000000000											237	220															2			13i1;13i6;13i10;		2		1	0.00	7		10000	Debit card for Food and Produce and Social Supports living.  And direct reimbursement for Social Needs Benefit. Social Needs Benefit reimbursement	13i1;13i6;13i10;
H9147	001	0	1	02	01	H9147_001_0	9	1	3	Non-Medical Transport & Wellness Support Allowance	11111111111111111111111111111111	Chronic hypertension	Pre-diabetes (fasting blood glucose 100-125 mg/dl or Hgb A1C 5.7-6.4%)	Myoneural disorders	Inflammatory and toxic neuropathy	Sleep apnea	Autism Spectrum Disorder	Osteoporosis	Chronic low back pain (cLBP)	Hypercholesterolemia	Chronic migraines	3000	3000															2			13i1;13i4;	2	1	13i1;13i4;	2						
H9191	001	0	1	01	01	H9191_001_0	6	1	3	Essential Clothing Items	01111111111111111111111000000000											1229	1024															2			13i10;		2		2						
H9191	006	0	1	01	01	H9191_006_0	3	1	3	Food and Produce and Essential Clothing	01111111111111111111111000000000											14	11															2			13i1;13i10;		2		2						
H9191	007	0	1	01	01	H9191_007_0	3	1	3	Food and Produce and Essential Clothing	01111111111111111111111000000000											14	11															2			13i1;13i10;		2		2						
H9207	004	0	1	01	01	H9207_004_0	11	1	3	SSBCI Supplemental Benefit Package - Flexcard	01111111111111111111100000000000											5644	5150															2			13i1;13i10;		2		1	0.00	7		00010		13i1;13i10;
H9207	016	0	1	01	01	H9207_016_0	12	1	3	SSBCI Supplemental Benefit Package - Flexcard	01111111111111111111100000000000											567	530															2			13i1;13i10;		2		1	0.00	7		00010		13i1;13i10;
H9207	017	0	1	01	01	H9207_017_0	11	1	3	SSBCI Supplemental Benefit Package - Flexcard	01111111111111111111100000000000											2208	2015															2			13i1;13i10;		2		1	0.00	7		00010		13i1;13i10;
H9231	015	0	1	04	01	H9231_015_0	4	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								78	70															2			13i1;13i10;	1	1	13i1;13i10;	1	9.00	7		00010		13i1;13i10;
H9231	018	0	1	04	01	H9231_018_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											293	263															2			13i1;13i10;	1	1	13i1;13i10;	1	170.00	7		00010		13i1;13i10;
H9231	020	0	1	04	01	H9231_020_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											735	660															2			13i1;13i10;	1	1	13i1;13i10;	1	355.00	7		00010		13i1;13i10;
H9306	004	0	1	01	01	H9306_004_0	3	1	3	Flex Card	01111111111111111111111000000000											1760	1075															2			13i1;13i3;13i10;		2		1	0.00	7		01010		13i1;13i3;13i10;
H9306	007	0	1	01	01	H9306_007_0	3	1	3	Flex Card	01111111111111111111111000000000											2210	1250															2			13i1;13i3;13i10;		2		1	0.00	7		01010		13i1;13i3;13i10;
H9314	001	0	1	01	01	H9314_001_0	4	2	2	Medication Adherence Support														0000000000111000000	Age-related cognitive or functional decline with polypharmacy	Chronic medical conditions requiring strict medication adherence	Neurological Disorders incl cognitive impairments,serious mental illness,developmental disabilities								2	2		1	001		13b;		1	13b;	2						
H9314	001	0	1	01	01	H9314_001_0	4	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							18978	18956															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H9364	002	0	1	02	01	H9364_002_0	5	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										2967	2783															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H9364	003	0	1	02	01	H9364_003_0	5	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										4383	4085															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H9431	801	0	1	04	01	H9431_801_0	1	2	2	Package 2														0111111111100000000	Other CMS defined chronic conditions										2	2		1	011		1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	1a1;1a2;1a3;1b1;1b2;2-1;3-1_2;3-2_2;3-3_2;3-4_2;4c1;4c2;4c3;7b1;7b2;7f_2;10b1;13a;13b;13c;13d;14b;14c1;14c2;14c3;14c4;14c5;14c6;14c7;14c8;14c9;14c10;14c11;14c12;14c13;14c14;14c15;14c16;14c17;14c18;14c19;14c20;14c21;14c22;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H9431	801	0	1	04	01	H9431_801_0	1	1	3	Package 1	01111111111111111111111100000000	Other CMS defined chronic conditions										1	1															1	011		7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	1	1	7b1;7b2;7f_2;10b1;13a;13b;13c;13i6;13i7;13i-O1;14c3;14c5;14c6;14c8;14c11;14c16;14c17;16b1;16b2;16b3;16b4;16b5;16b6;16c1;16c2;16c3;16c4;16c5;16c6;16c7;16c8;16c9;16c10;17a1;17a2;17b1;17b2;17b3;17b4;17b5;18a1;18a2;18b1;	2						
H9525	011	0	1	02	01	H9525_011_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							248	187															2			13i1;13i10;	2	2		2						
H9525	022	0	1	01	01	H9525_022_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							2782	2426															2			13i1;13i10;		2		2						
H9525	027	0	1	01	01	H9525_027_0	4	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							12975	11696															2			13i1;13i10;		2		2						
H9525	028	0	1	01	01	H9525_028_0	5	1	3	Non-Health Related Benefits	01111111111111111111111111100000	Chronic Hypertension	Osteoporosis	Chronic back pain	Pre-diabetes: Fasting blood glucose: 100-125 mg/dl or Hgb A1C:5.7-6.4%							683	616															2			13i1;13i10;		2		2						
H9572	001	1	1	04	01	H9572_001_1	10	1	3	Food and Produce	01111111011111110000100110000000	Chronic Hypertension	Pre-diabetes									679	414															2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	001	2	1	04	01	H9572_001_2	9	1	3	Food and Produce	01111111011111110000100110000000	Chronic Hypertension	Pre-diabetes									1874	1143															2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	001	3	1	04	01	H9572_001_3	9	1	3	Food and Produce	01111111011111110000100110000000	Chronic Hypertension	Pre-diabetes									2028	1237															2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	001	4	1	04	01	H9572_001_4	9	1	3	Food and Produce	01111111011111110000100110000000	Chronic Hypertension	Pre-diabetes									4369	2665															2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	001	6	1	04	01	H9572_001_6	9	1	3	Food and Produce	01111111011111110000100110000000	Chronic Hypertension	Pre-diabetes									12873	7853															2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	002	1	1	04	01	H9572_002_1	12	1	3	Package 1	01111111011111110000100110000000	Chronic Hypertension	Pre-Diabetes									2912	1776															2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	002	2	1	04	01	H9572_002_2	11	1	3	Package 1	01111111011111110000100110000000	Chronic Hypertension	Pre-Diabetes									2954	1802															2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	002	3	1	04	01	H9572_002_3	11	1	3	Package 1	01111111011111110000100110000000	Chronic Hypertension	Pre-Diabetes									3694	2253															2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	002	4	1	04	01	H9572_002_4	11	1	3	Package 1	01111111011111110000100110000000	Chronic Hypertension	Pre-Diabetes									6344	3870															2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	002	6	1	04	01	H9572_002_6	11	1	3	Package 1	01111111011111110000100110000000	Chronic Hypertension	Pre-Diabetes									9607	5860															2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	003	1	1	04	01	H9572_003_1	9	1	3	Package 1	01111111011111110000100110000000	Chronic Hypertension	Pre-diabetes									333	203															2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	003	2	1	04	01	H9572_003_2	8	1	3	Package 1	01111111011111110000100110000000	Chronic Hypertension	Pre-diabetes									730	445															2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	003	3	1	04	01	H9572_003_3	8	1	3	Package 1	01111111011111110000100110000000	Chronic Hypertension	Pre-diabetes									391	239															2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	003	4	1	04	01	H9572_003_4	8	1	3	Package 1	01111111011111110000100110000000	Chronic Hypertension	Pre-diabetes									1423	868															2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	003	6	1	04	01	H9572_003_6	8	1	3	Package 1	01111111011111110000100110000000	Chronic Hypertension	Pre-diabetes									2267	1383															2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	007	1	1	04	01	H9572_007_1	12	1	3	Package 1	01111111011111110000100110000000	Chronic Hypertension	Pre-diabetes									4931	3008															2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	007	2	1	04	01	H9572_007_2	12	1	3	Package 1	01111111011111110000100110000000	Chronic Hypertension	Pre-diabetes									6425	3919															2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	009	0	1	04	01	H9572_009_0	9	1	3	Food and Produce	01111111011111110000100110000000	Chronic Hypertension	Pre-diabetes									43977	26826															2			13i1;	1	2		1	0.00	5		00010		13i1;
H9572	010	0	1	04	01	H9572_010_0	9	1	3	Food and Produce	01111111011111110000100110000000	Chronic Hypertension	Pre-diabetes									4436	2706															2			13i1;	1	2		1	0.00	5		00010		13i1;
H9590	001	0	1	01	01	H9590_001_0	7	1	3	SSBCI	01111111111111111111111000000000											1073	715															2			13i6;13i-O1;13i-O2;14c17;		2		1	500.00	5		01100		13i6;13i-O1;13i-O2;
H9615	023	0	1	04	01	H9615_023_0	10	1	2	Package 1														0000010000000000000														2			13b;	1	1	13b;	2						
H9615	025	0	1	04	01	H9615_025_0	8	2	2	Package 2														0000100000000000000														2			14c8;	1	1	14c8;	1	250.00	3		01000		14c8;
H9615	025	0	1	04	01	H9615_025_0	8	3	2	Package 3														0000000010110000000	Osteoarthritis	Undergone a joint relacement									2	1	Enrollee must have a diagnosis for Rheumatoid Arthritis or Osteoarthritis along with having undergone a joint replacement.	2			14c8;	1	1	14c8;	2						
H9615	025	0	1	04	01	H9615_025_0	8	1	2	Package 1														0000010000000000000														2			13b;	1	1	13b;	2						
H9623	001	0	1	01	01	H9623_001_0	5	1	3	Non-medical Transportation and Food	01111111111111111111111000000000											600	400															2			13i1;13i4;		1	13i1;13i4;	2						
H9630	010	0	1	02	01	H9630_010_0	6	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										607	577															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H9630	011	0	1	02	01	H9630_011_0	5	1	3	SSBCI OTC DVH	01111111111111111111111100000000	Endometriosis										1797	1707															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H9686	004	0	1	01	01	H9686_004_0	10	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									377	287															2			13i1;13i3;13i5;13i10;13i-O1;14c8;		2		1	50.00	7		00010		13i1;13i10;14c8;
H9686	005	0	1	01	01	H9686_005_0	9	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									2709	2059															2			13i1;13i3;13i5;13i10;13i-O1;14c8;		2		1	0.00	7		00010		13i1;13i10;14c8;
H9686	006	0	1	01	01	H9686_006_0	10	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									287	241															2			13i1;13i3;13i5;13i10;13i-O1;14c8;		2		1	0.00	7		00010		13i1;13i10;14c8;
H9686	009	0	1	01	01	H9686_009_0	10	1	3	Package 1	01111111111111111111111110000000	Chronic Hypertension	Chronic Hyperlipidemia									645	432															2			13i1;13i3;13i5;13i10;13i-O1;14c8;		2		1	25.00	7		00010		13i1;13i10;14c8;
H9700	001	0	1	04	01	H9700_001_0	7	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								1527	1371															2			13i1;13i10;	1	1	13i1;13i10;	1	70.00	7		00010		13i1;13i10;
H9700	003	0	1	04	01	H9700_003_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								900	808															2			13i1;13i10;	1	1	13i1;13i10;	1	44.00	7		00010		13i1;13i10;
H9700	005	0	1	04	01	H9700_005_0	6	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								263	236															2			13i1;13i10;	1	1	13i1;13i10;	1	61.00	7		00010		13i1;13i10;
H9725	003	0	1	01	01	H9725_003_0	6	1	3	Food and Produce	00001101000001001000000000000000											214	161															2			13i1;		2		2						
H9725	013	0	1	01	01	H9725_013_0	6	1	3	Food and Produce	00001101000001001000000000000000											226	169															2			13i1;		2		2						
H9725	020	0	1	01	01	H9725_020_0	6	1	3	Food and Produce	00001101000000000000000000000000											428	321															2			13i1;		2		2						
H9730	003	0	1	02	01	H9730_003_0	5	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										2399	2279															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H9730	004	0	1	02	01	H9730_004_0	5	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										10614	9927															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H9730	011	0	1	02	01	H9730_011_0	5	1	3	SSBCI OTC	01111111111111111111111100000000	Endometriosis										1798	1708															2			13i1;13i2;13i3;13i4;13i6;13i10;	1	1	13i1;13i2;13i3;13i4;13i6;13i10;	1	0.00	7		00011		13i1;13i2;13i3;13i4;13i6;13i10;
H9771	001	0	1	01	01	H9771_001_0	5	1	3	SSBCI Pkg	01111111111111111111111111100000	Anemia	Chronic Hyperlipidemia	Chronic Hypertension	Chronic Pain							35437	35402															2			10b2;13b;13i1;13i4;13i10;13i-O1;		1	10b2;13b;13i1;13i4;13i10;13i-O1;	1	0.00	7		00010		10b2;13b;13i1;13i4;13i10;13i-O1;
H9802	004	0	1	04	01	H9802_004_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								142	127															2			13i1;13i10;	1	1	13i1;13i10;	1	147.00	7		00010		13i1;13i10;
H9802	006	0	1	04	01	H9802_006_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											173	155															2			13i1;13i10;	1	1	13i1;13i10;	1	321.00	7		00010		13i1;13i10;
H9802	008	0	1	04	01	H9802_008_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								515	463															2			13i1;13i10;	1	1	13i1;13i10;	1	243.00	7		00010		13i1;13i10;
H9802	009	0	1	04	01	H9802_009_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											139	125															2			13i1;13i10;	1	1	13i1;13i10;	1	200.00	7		00010		13i1;13i10;
H9826	003	0	1	01	01	H9826_003_0	6	1	3	Combined SSBCI Benefits	01111111111111111111111000000000											453	362															2			13i1;13i6;13i8;13i10;		1	13i1;13i6;13i8;13i10;	2						
H9826	004	0	1	01	01	H9826_004_0	6	1	3	Combined SSBCI Benefits	01111111111111111111111000000000											78	62															2			13i1;13i6;13i10;		1	13i1;13i6;13i10;	2						
H9826	005	0	1	01	01	H9826_005_0	6	1	3	Combined SSBCI Benefits	01111111111111111111111000000000											1969	1575															2			13i1;13i6;13i8;13i10;		1	13i1;13i6;13i8;13i10;	2						
H9826	006	0	1	01	01	H9826_006_0	6	1	3	Combined SSBCI Benefits	01111111111111111111111000000000											1545	1236															2			13i1;13i6;13i8;13i10;		1	13i1;13i6;13i8;13i10;	2						
H9826	007	0	1	01	01	H9826_007_0	6	1	3	Combined SSBCI Benefits	01111111111111111111111000000000											131	105															2			13i1;13i6;13i8;13i10;		1	13i1;13i6;13i8;13i10;	2						
H9834	001	0	1	01	01	H9834_001_0	6	1	3	Package 1	00000101100000000000000100000000	Chronic Hypertension										125	13															1	001		13b;13i1;13i2;		2		2						
H9834	003	0	1	01	01	H9834_003_0	6	1	3	Package 1	00000101100000000000000100000000	Chronic Hypertension										755	80															1	001		13b;13i1;13i2;		2		2						
H9834	004	0	1	01	01	H9834_004_0	4	1	3	Package 1	00000101100000000000000100000000	Chronic Hypertension										56	6															1	001		13b;13i1;13i2;		2		2						
H9834	006	0	1	01	01	H9834_006_0	6	1	3	Package 1	00000101100000000000000100000000	Chronic Hypertension										174	18															1	001		13b;13i1;13i2;		2		2						
H9834	007	0	1	01	01	H9834_007_0	6	1	3	Package 1	00000101100000000000000100000000	Chronic Hypertension										158	17															1	001		13b;13i1;13i2;		2		2						
H9862	003	0	1	04	01	H9862_003_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;	1	1	13i1;13i10;	1	193.00	7		00010		13i1;13i10;
H9862	004	0	1	04	01	H9862_004_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											226	203															2			13i1;13i10;	1	1	13i1;13i10;	1	77.00	7		00010		13i1;13i10;
H9862	012	0	1	04	01	H9862_012_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											117	105															2			13i1;13i10;	1	1	13i1;13i10;	1	193.00	7		00010		13i1;13i10;
H9862	013	0	1	04	01	H9862_013_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											226	203															2			13i1;13i10;	1	1	13i1;13i10;	1	77.00	7		00010		13i1;13i10;
H9888	001	0	1	04	01	H9888_001_0	4	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								381	342															2			13i1;13i10;	1	1	13i1;13i10;	1	29.00	7		00010		13i1;13i10;
H9888	008	0	1	04	01	H9888_008_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											312	280															2			13i1;13i10;	1	1	13i1;13i10;	1	34.00	7		00010		13i1;13i10;
H9888	009	0	1	04	01	H9888_009_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											1417	1272															2			13i1;13i10;	1	1	13i1;13i10;	1	149.00	7		00010		13i1;13i10;
H9888	010	0	1	04	01	H9888_010_0	5	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											156	140															2			13i1;13i10;	1	1	13i1;13i10;	1	34.00	7		00010		13i1;13i10;
H9888	011	0	1	04	01	H9888_011_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											419	376															2			13i1;13i10;	1	1	13i1;13i10;	1	164.00	7		00010		13i1;13i10;
H9888	012	0	1	04	01	H9888_012_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											2115	1899															2			13i1;13i10;	1	1	13i1;13i10;	1	270.00	7		00010		13i1;13i10;
H9888	013	0	1	04	01	H9888_013_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								1624	1458															2			13i1;13i10;	1	1	13i1;13i10;	1	245.00	7		00010		13i1;13i10;
H9888	014	0	1	04	01	H9888_014_0	5	1	3	Food, Utility, and Rent Card	01011111111001100001100111000000	Chronic Hypertension	Chronic Hyperlipidemia	Osteoporosis								355	319															2			13i1;13i10;	1	1	13i1;13i10;	1	230.00	7		00010		13i1;13i10;
H9888	015	0	1	04	01	H9888_015_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											527	474															2			13i1;13i10;	1	1	13i1;13i10;	1	255.00	7		00010		13i1;13i10;
H9909	001	0	1	01	01	H9909_001_0	5	1	3	Healthy Food	01111111111111111111111000000000											900	720															1	001		13i1;		1	13i1;	2						
H9917	006	0	1	01	01	H9917_006_0	8	1	3	Flex Benefits	01111111111111111111111111000000	osteoporosis	chronic hypertension	chronic hyperlipidemia								500	125															2			13i4;13i10;13i-O1;13i-O2;		1	13i4;13i10;13i-O1;13i-O2;	1	0.00	5		01010		13i10;13i-O2;
H9917	007	0	1	01	01	H9917_007_0	8	1	3	Flex Benefits	01111111111111111111111111000000	osteoporosis	chronic hypertension	chronic hyperlipidemia								155	47															2			13i4;13i10;13i-O1;13i-O2;		1	13i4;13i10;13i-O1;	1	0.00	5		01010		13i10;13i-O2;
H9942	001	0	1	04	01	H9942_001_0	7	1	3	SSBCI	01111111111111111111111000000000											1179	786															2			10b1;13i4;13i6;13i-O1;13i-O2;14c17;	1	2		1	500.00	5		01100		13i6;13i-O1;13i-O2;
H9942	002	0	1	04	01	H9942_002_0	7	1	3	SSBCI	01111111111111111111111000000000											200	133															2			10b1;13i4;13i6;13i-O1;13i-O2;14c17;	1	2		1	500.00	5		01100		13i6;13i-O1;13i-O2;
H9955	008	0	1	01	01	H9955_008_0	5	1	3	SSBCI	01111111111111111111111000000000											16181	14563															1	001		13i1;13i4;13i10;13i-O1;		2		1	0.00	7		00010		13i1;13i4;13i10;13i-O1;
H9955	009	0	1	01	01	H9955_009_0	6	1	3	SSBCI	01111111111111111111111000000000											7650	6885															1	001		13i1;13i4;13i10;13i-O1;		2		1	0.00	7		00010		13i1;13i4;13i10;13i-O1;
H9977	003	0	1	01	01	H9977_003_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											93	84															2			13i1;13i10;		1	13i1;13i10;	1	160.00	7		00010		13i1;13i10;
H9977	004	0	1	01	01	H9977_004_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											520	467															2			13i1;13i10;		1	13i1;13i10;	1	251.00	7		00010		13i1;13i10;
H9977	007	0	1	01	01	H9977_007_0	4	1	3	Food, Utility, and Rent Card	00001101000100000000000000000000											252	226															2			13i1;13i10;		1	13i1;13i10;	1	160.00	7		00010		13i1;13i10;
H9986	002	0	1	02	01	H9986_002_0	8	1	2	FC2 Specialist at-Home Program														0111111111000000000											2	2		2			13d;	2	2		2						
H9986	002	0	1	02	01	H9986_002_0	8	2	3	SSBCI Benefits	01111111111111111111111000000000											1343	1343															2			13i1;	2	2		2						
H9986	004	1	1	02	01	H9986_004_1	9	1	2	FC2 Specialist at-Home Program														0111111111000000000											2	2		2			13d;	2	2		2						
H9986	004	1	1	02	01	H9986_004_1	9	2	3	SSBCI Benefits	01111111111111111111111000000000											289	289															2			13i1;13i10;	2	2		2						
H9986	004	2	1	02	01	H9986_004_2	8	2	3	SSBCI Benefits	01111111111111111111111000000000											64	64															2			13i1;13i10;	2	2		2						
H9986	004	2	1	02	01	H9986_004_2	8	1	2	FC2 Specialist at-Home Program														0111111111000000000											2	2		2			13d;	2	2		2						
H9986	004	3	1	02	01	H9986_004_3	5	2	3	SSBCI Benefits	01111111111111111111111000000000											17	17															2			13i1;13i10;	2	2		2						
H9986	004	3	1	02	01	H9986_004_3	5	1	2	FC2 Specialist at-Home Program														0111111111000000000											2	2		2			13d;	2	2		2						
R0110	001	0	1	31	11	R0110_001_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	1	10b1;	2						
R0110	001	0	1	31	11	R0110_001_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
R0110	003	0	1	31	11	R0110_003_0	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
R0110	004	0	1	31	11	R0110_004_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
R0110	005	0	1	31	11	R0110_005_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
R0110	006	0	1	31	11	R0110_006_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
R0110	007	0	1	31	11	R0110_007_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
R0110	007	0	1	31	11	R0110_007_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
R0110	008	0	1	31	11	R0110_008_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
R0110	011	0	1	31	11	R0110_011_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
R0110	011	0	1	31	11	R0110_011_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
R0110	012	0	1	31	11	R0110_012_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
R0110	013	0	1	31	11	R0110_013_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
R0110	014	0	1	31	11	R0110_014_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
R0110	015	0	1	31	11	R0110_015_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
R0110	016	0	1	31	11	R0110_016_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
R0110	017	0	1	31	11	R0110_017_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
R0110	018	0	1	31	11	R0110_018_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
R0110	019	0	1	31	11	R0110_019_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
R0110	020	0	1	31	11	R0110_020_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
R0759	003	0	1	31	11	R0759_003_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								836	710															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
R1532	001	0	1	31	11	R1532_001_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
R1532	002	0	1	31	11	R1532_002_0	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
R2604	002	0	1	31	11	R2604_002_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											3068	2608															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
R4182	001	0	1	31	11	R4182_001_0	4	1	2	Non-Emergency Medical Transportation														0000000000111000000	End Stage Renal Disease (ESRD)	Chronic Kidney Disease (CKD)	Cancer								2	2		2			10b1;	1	2		2						
R4182	001	0	1	31	11	R4182_001_0	4	2	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
R4182	003	0	1	31	11	R4182_003_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
R4182	004	0	1	31	11	R4182_004_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
R5361	001	0	1	31	11	R5361_001_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
R5361	002	0	1	31	11	R5361_002_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
R5826	005	0	1	31	11	R5826_005_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
R5826	018	0	1	31	11	R5826_018_0	5	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
R5826	074	0	1	31	11	R5826_074_0	4	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	1	13d;	2						
R6694	006	0	1	31	11	R6694_006_0	3	1	2	ESRD Transportation														0000000000100000000	End Stage Renal Disease (ESRD)													2			10b1;	1	1	10b1;	2						
R6801	009	0	1	31	11	R6801_009_0	4	1	3	SSBCI Package 1	00001101000000000000000000000000											6546	5564															2			13i1;	1	1	13i1;	1	0.00	7		01010		13i1;
R6801	011	0	1	31	11	R6801_011_0	4	1	3	SSBCI Package 1	01111111111111111111100111000000	Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy	Chronic Hyperlipidemia	Chronic Hypertension								5772	4906															2			13i1;13i10;	1	1	13i1;13i10;	1	0.00	7		01010		13i1;13i10;
R7220	001	0	1	31	11	R7220_001_0	7	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
R7220	002	0	1	31	11	R7220_002_0	6	1	2	Virtual Cardiac Recovery Program														0001010000110000000	Pneumonia	Respiratory Illnesses									2	2		2			13d;	1	2		2						
