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4 changes: 2 additions & 2 deletions apps/bfd-pipeline-idr/test_samples2/SYNTHETIC_CLM.csv
Original file line number Diff line number Diff line change
@@ -1,6 +1,6 @@
CLM_DT_SGNTR_SK,CLM_UNIQ_ID,CLM_RLT_COND_SGNTR_SK,CLM_TYPE_CD,CLM_SRC_ID,CLM_FROM_DT,CLM_THRU_DT,CLM_CNTL_NUM,CLM_BLOOD_PT_FRNSH_QTY,CLM_NUM_SK,CLM_EFCTV_DT,CLM_IDR_LD_DT,CLM_OBSLT_DT,GEO_BENE_SK,BENE_SK,CLM_DISP_CD,CLM_QUERY_CD,CLM_ADJSTMT_TYPE_CD,CLM_BILL_FAC_TYPE_CD,CLM_BILL_CLSFCTN_CD,CLM_BILL_FREQ_CD,CLM_CNTRCTR_NUM,CLM_NCH_PRMRY_PYR_CD,CLM_FINL_ACTN_IND,CLM_LTST_CLM_IND,CLM_ATNDG_PRVDR_NPI_NUM,CLM_OPRTG_PRVDR_NPI_NUM,CLM_OTHR_PRVDR_NPI_NUM,CLM_RNDRG_PRVDR_NPI_NUM,CLM_BLG_PRVDR_OSCAR_NUM,CLM_MDCR_COINSRNC_AMT,CLM_SBMT_CHRG_AMT,CLM_PMT_AMT,CLM_MDCR_DDCTBL_AMT,CLM_NCVRD_CHRG_AMT,CLM_BLOOD_LBLTY_AMT,CLM_PD_DT,CLM_ALOWD_CHRG_AMT,CLM_BENE_PMT_AMT,CLM_RIC_CD,CLM_SRVC_PRVDR_GNRC_ID_NUM,PRVDR_RFRG_PRVDR_NPI_NUM,PRVDR_BLG_PRVDR_NPI_NUM,META_SRC_SK,CLM_BENE_PMT_COINSRNC_AMT,CLM_BLOOD_CHRG_AMT,CLM_TOT_CNTRCTL_AMT,CLM_COB_PTNT_RESP_AMT,CLM_PRVDR_OTAF_AMT,CLM_PRVDR_RMNG_DUE_AMT,CLM_BLOOD_NCVRD_CHRG_AMT,CLM_PRVDR_INTRST_PD_AMT
CLM_DT_SGNTR_SK,CLM_UNIQ_ID,CLM_RLT_COND_SGNTR_SK,CLM_TYPE_CD,CLM_SRC_ID,CLM_FROM_DT,CLM_THRU_DT,CLM_CNTL_NUM,CLM_BLOOD_PT_FRNSH_QTY,CLM_NUM_SK,CLM_EFCTV_DT,CLM_IDR_LD_DT,CLM_OBSLT_DT,GEO_BENE_SK,BENE_SK,CLM_DISP_CD,CLM_QUERY_CD,CLM_ADJSTMT_TYPE_CD,CLM_BILL_FAC_TYPE_CD,CLM_BILL_CLSFCTN_CD,CLM_BILL_FREQ_CD,CLM_CNTRCTR_NUM,CLM_NCH_PRMRY_PYR_CD,CLM_FINL_ACTN_IND,CLM_LTST_CLM_IND,PRVDR_ATNDG_PRVDR_NPI_NUM,PRVDR_OPRTG_PRVDR_NPI_NUM,PRVDR_OTHR_PRVDR_NPI_NUM,PRVDR_RNDRNG_PRVDR_NPI_NUM,CLM_BLG_PRVDR_OSCAR_NUM,CLM_MDCR_COINSRNC_AMT,CLM_SBMT_CHRG_AMT,CLM_PMT_AMT,CLM_MDCR_DDCTBL_AMT,CLM_NCVRD_CHRG_AMT,CLM_BLOOD_LBLTY_AMT,CLM_PD_DT,CLM_ALOWD_CHRG_AMT,CLM_BENE_PMT_AMT,CLM_RIC_CD,PRVDR_SRVC_PRVDR_NPI_NUM,PRVDR_RFRG_PRVDR_NPI_NUM,PRVDR_BLG_PRVDR_NPI_NUM,META_SRC_SK,CLM_BENE_PMT_COINSRNC_AMT,CLM_BLOOD_CHRG_AMT,CLM_TOT_CNTRCTL_AMT,CLM_COB_PTNT_RESP_AMT,CLM_PRVDR_OTAF_AMT,CLM_PRVDR_RMNG_DUE_AMT,CLM_BLOOD_NCVRD_CHRG_AMT,CLM_PRVDR_INTRST_PD_AMT
322823692140,1071939711294,673069517797,40,20000,2021-09-26,2021-10-03,67289832423923BIX,0,1,2025-05-30,2025-05-30,9999-12-31,86974,178083966,55,3,0,3,3,X,01211,L,Y,Y,1437702123,1942945159,1972944437,1558719914,001500,0.83,815173.1329847890098,625244.33,776.87,189928.8,8.66,9999-12-31,916765.7358968634376,225008.17,,,,1104867175,7,544.3189236473176,,243.4283926422387,360.5390326439280,312.97,854.41,,609.69
322823692141,1071939711295,,10,20000,2021-09-26,2021-10-03,67289832423923BIX,0,1,2025-05-30,2025-05-30,9999-12-31,86974,181968400,55,3,0,3,3,X,01211,L,Y,Y,1437702123,1942945159,1972944437,1558719914,001500,0.83,815173.13,625244.33,776.8698768765123,189928.8,8.6587654578765,9999-12-31,916765.73,225008.1723456788765,,,,1104867175,7,,6.9911829076291,207.0781097280107,151.2789573902381,96.6890386948091,,77.3,377.9276567879876
322823692142,1071939711296,616234798483,40,20000,2021-09-26,2021-10-03,67289832423923BIX,0,1,2025-05-30,2025-05-30,9999-12-31,86974,181968400,55,3,0,3,3,X,01211,L,Y,Y,1437702123,1942945159,1972944437,1558719914,001500,0.83,815173.13,625244.33,776.87,189928.8,8.66,9999-12-31,82490.85,450536.56,,,,1104867175,7,694.2593027489236,,8569.4,95.82,523.7798679801093,393.0490172830912,,180.88
322823692143,1071939711297,1699821257,1013,21000,2021-09-26,2021-10-03,67289832423923BIX,0,1,2025-05-30,2025-05-30,9999-12-31,86974,181968400,55,3,~,3,3,X,01211,L,N,Y,1437702123,1942945159,1972944437,1558719914,001500,0.83,815173.13,625244.33,776.87,189928.8,8.66,9999-12-31,82490.85,450536.56,,,,1104867175,1003
322823692144,1071939711298,111457034536,2013,21000,2021-09-26,2021-10-03,67289832423923BIX,0,1,2025-05-30,2025-05-30,9999-12-31,86974,181968400,55,3,~,3,3,X,01211,L,Y,Y,1437702123,1942945159,1972944437,1558719914,001500,0.83,815173.13,625244.33,776.87,189928.8,8.66,9999-12-31,82490.8499963378906,450536.56,,,,1104867175,1003,,,,,
322823692144,1071939711298,111457034536,2013,21000,2021-09-26,2021-10-03,67289832423923BIX,0,1,2025-05-30,2025-05-30,9999-12-31,86974,181968400,55,3,~,3,3,X,01211,L,Y,Y,1437702123,1942945159,1972944437,1558719914,001500,0.83,815173.13,625244.33,776.87,189928.8,8.66,9999-12-31,82490.8499963378906,450536.56,,,,1104867175,1003,,,,,
Original file line number Diff line number Diff line change
@@ -1,3 +1,3 @@
CLM_DT_SGNTR_SK,CLM_UNIQ_ID,CLM_TYPE_CD,CLM_SRC_ID,CLM_FROM_DT,CLM_THRU_DT,CLM_CNTL_NUM,CLM_BLOOD_PT_FRNSH_QTY,CLM_NUM_SK,CLM_EFCTV_DT,CLM_IDR_LD_DT,CLM_OBSLT_DT,GEO_BENE_SK,BENE_SK,CLM_DISP_CD,CLM_QUERY_CD,CLM_BILL_FAC_TYPE_CD,CLM_BILL_CLSFCTN_CD,CLM_BILL_FREQ_CD,CLM_CNTRCTR_NUM,CLM_NCH_PRMRY_PYR_CD,CLM_FINL_ACTN_IND,CLM_LTST_CLM_IND,CLM_ATNDG_PRVDR_NPI_NUM,CLM_OPRTG_PRVDR_NPI_NUM,CLM_OTHR_PRVDR_NPI_NUM,CLM_RNDRG_PRVDR_NPI_NUM,CLM_BLG_PRVDR_OSCAR_NUM,CLM_MDCR_COINSRNC_AMT,CLM_SBMT_CHRG_AMT,CLM_PMT_AMT,CLM_MDCR_DDCTBL_AMT,CLM_NCVRD_CHRG_AMT,CLM_BLOOD_LBLTY_AMT,CLM_PD_DT,CLM_ALOWD_CHRG_AMT,CLM_BENE_PMT_AMT,CLM_RIC_CD,CLM_SRVC_PRVDR_GNRC_ID_NUM,PRVDR_RFRG_PRVDR_NPI_NUM,PRVDR_BLG_PRVDR_NPI_NUM,META_SRC_SK
CLM_DT_SGNTR_SK,CLM_UNIQ_ID,CLM_TYPE_CD,CLM_SRC_ID,CLM_FROM_DT,CLM_THRU_DT,CLM_CNTL_NUM,CLM_BLOOD_PT_FRNSH_QTY,CLM_NUM_SK,CLM_EFCTV_DT,CLM_IDR_LD_DT,CLM_OBSLT_DT,GEO_BENE_SK,BENE_SK,CLM_DISP_CD,CLM_QUERY_CD,CLM_BILL_FAC_TYPE_CD,CLM_BILL_CLSFCTN_CD,CLM_BILL_FREQ_CD,CLM_CNTRCTR_NUM,CLM_NCH_PRMRY_PYR_CD,CLM_FINL_ACTN_IND,CLM_LTST_CLM_IND,PRVDR_ATNDG_PRVDR_NPI_NUM,PRVDR_OPRTG_PRVDR_NPI_NUM,PRVDR_OTHR_PRVDR_NPI_NUM,PRVDR_RNDRNG_PRVDR_NPI_NUM,CLM_BLG_PRVDR_OSCAR_NUM,CLM_MDCR_COINSRNC_AMT,CLM_SBMT_CHRG_AMT,CLM_PMT_AMT,CLM_MDCR_DDCTBL_AMT,CLM_NCVRD_CHRG_AMT,CLM_BLOOD_LBLTY_AMT,CLM_PD_DT,CLM_ALOWD_CHRG_AMT,CLM_BENE_PMT_AMT,CLM_RIC_CD,PRVDR_SRVC_PRVDR_NPI_NUM,PRVDR_RFRG_PRVDR_NPI_NUM,PRVDR_BLG_PRVDR_NPI_NUM,META_SRC_SK
322823692240,1071939712294,40,20000,2021-09-26,2021-10-03,67289832423923BIX,0,1,2025-05-30,2025-05-30,9999-12-31,86974,517782585,55,3,3,3,X,01211,L,Y,Y,617782585,1942945159,617782585,1558719914,001500,0.83,815173.13,625244.33,776.87,189928.8,8.66,9999-12-31,916765.73,225008.17,,,,1104867175,7
322823692241,1071939712295,10,20000,2021-09-26,2021-10-03,67289832423923BIX,0,1,2025-05-30,2025-05-30,9999-12-31,86974,517782585,55,3,3,3,X,01211,L,Y,Y,617782585,1942945159,617782585,1558719914,001500,0.83,815173.13,625244.33,776.87,189928.8,8.66,9999-12-31,916765.73,225008.17,,,,1104867175,7
322823692241,1071939712295,10,20000,2021-09-26,2021-10-03,67289832423923BIX,0,1,2025-05-30,2025-05-30,9999-12-31,86974,517782585,55,3,3,3,X,01211,L,Y,Y,617782585,1942945159,617782585,1558719914,001500,0.83,815173.13,625244.33,776.87,189928.8,8.66,9999-12-31,916765.73,225008.17,,,,1104867175,7
Original file line number Diff line number Diff line change
@@ -1,3 +1,3 @@
CLM_DT_SGNTR_SK,CLM_UNIQ_ID,CLM_TYPE_CD,CLM_SRC_ID,CLM_FROM_DT,CLM_THRU_DT,CLM_CNTL_NUM,CLM_BLOOD_PT_FRNSH_QTY,CLM_NUM_SK,CLM_EFCTV_DT,CLM_IDR_LD_DT,CLM_OBSLT_DT,GEO_BENE_SK,BENE_SK,CLM_DISP_CD,CLM_QUERY_CD,CLM_BILL_FAC_TYPE_CD,CLM_BILL_CLSFCTN_CD,CLM_BILL_FREQ_CD,CLM_CNTRCTR_NUM,CLM_NCH_PRMRY_PYR_CD,CLM_FINL_ACTN_IND,CLM_LTST_CLM_IND,CLM_ATNDG_PRVDR_NPI_NUM,CLM_OPRTG_PRVDR_NPI_NUM,CLM_OTHR_PRVDR_NPI_NUM,CLM_RNDRG_PRVDR_NPI_NUM,CLM_BLG_PRVDR_OSCAR_NUM,CLM_MDCR_COINSRNC_AMT,CLM_SBMT_CHRG_AMT,CLM_PMT_AMT,CLM_MDCR_DDCTBL_AMT,CLM_NCVRD_CHRG_AMT,CLM_BLOOD_LBLTY_AMT,CLM_PD_DT,CLM_ALOWD_CHRG_AMT,CLM_BENE_PMT_AMT,CLM_RIC_CD,CLM_SRVC_PRVDR_GNRC_ID_NUM,PRVDR_RFRG_PRVDR_NPI_NUM,PRVDR_BLG_PRVDR_NPI_NUM,CLM_ADJSTMT_TYPE_CD,CLM_ORIG_CNTL_NUM,CLM_SBMTR_CNTRCT_PBP_NUM,CLM_SBMTR_CNTRCT_NUM,CLM_SBMT_FRMT_CD,PRVDR_PRSCRBNG_PRVDR_NPI_NUM,META_SRC_SK
CLM_DT_SGNTR_SK,CLM_UNIQ_ID,CLM_TYPE_CD,CLM_SRC_ID,CLM_FROM_DT,CLM_THRU_DT,CLM_CNTL_NUM,CLM_BLOOD_PT_FRNSH_QTY,CLM_NUM_SK,CLM_EFCTV_DT,CLM_IDR_LD_DT,CLM_OBSLT_DT,GEO_BENE_SK,BENE_SK,CLM_DISP_CD,CLM_QUERY_CD,CLM_BILL_FAC_TYPE_CD,CLM_BILL_CLSFCTN_CD,CLM_BILL_FREQ_CD,CLM_CNTRCTR_NUM,CLM_NCH_PRMRY_PYR_CD,CLM_FINL_ACTN_IND,CLM_LTST_CLM_IND,PRVDR_ATNDG_PRVDR_NPI_NUM,PRVDR_OPRTG_PRVDR_NPI_NUM,PRVDR_OTHR_PRVDR_NPI_NUM,PRVDR_RNDRNG_PRVDR_NPI_NUM,CLM_BLG_PRVDR_OSCAR_NUM,CLM_MDCR_COINSRNC_AMT,CLM_SBMT_CHRG_AMT,CLM_PMT_AMT,CLM_MDCR_DDCTBL_AMT,CLM_NCVRD_CHRG_AMT,CLM_BLOOD_LBLTY_AMT,CLM_PD_DT,CLM_ALOWD_CHRG_AMT,CLM_BENE_PMT_AMT,CLM_RIC_CD,PRVDR_SRVC_PRVDR_NPI_NUM,PRVDR_RFRG_PRVDR_NPI_NUM,PRVDR_BLG_PRVDR_NPI_NUM,CLM_ADJSTMT_TYPE_CD,CLM_ORIG_CNTL_NUM,CLM_SBMTR_CNTRCT_PBP_NUM,CLM_SBMTR_CNTRCT_NUM,CLM_SBMT_FRMT_CD,PRVDR_PRSCRBNG_PRVDR_NPI_NUM,META_SRC_SK
626896033050,5213363418309,3,20000,2018-08-12,2018-08-21,50787281107100OQH,,1,2025-10-31,2022-09-22,9999-12-31,41582,280720433,59,3,7,5,I,01001,X,Y,Y,,,,,,,320262.8,241515.19,153.06,78747.61,22.73,2018-08-20,,,,1548226988,,,4,15564917518692RYL,007,Z0001,~,1730548868,1
271048844534,1409088853940,3,20000,2025-08-10,2025-08-12,31646182683546TDF,,1,2025-11-12,2025-11-12,2025-10-02,97992,587115515,54,2,3,5,D,12401,A,Y,N,,,,,,,99813.94,38656.27,1397.69,61157.67,6.96,2025-08-11,,,,1649041195,,,1,31646182683546TDF,001,Z0001,S,1437702123,1
271048844534,1409088853940,3,20000,2025-08-10,2025-08-12,31646182683546TDF,,1,2025-11-12,2025-11-12,2025-10-02,97992,587115515,54,2,3,5,D,12401,A,Y,N,,,,,,,99813.94,38656.27,1397.69,61157.67,6.96,2025-08-11,,,,1649041195,,,1,31646182683546TDF,001,Z0001,S,1437702123,1
Original file line number Diff line number Diff line change
@@ -1,4 +1,4 @@
CLM_DT_SGNTR_SK,CLM_UNIQ_ID,CLM_TYPE_CD,CLM_SRC_ID,CLM_FROM_DT,CLM_THRU_DT,CLM_CNTL_NUM,CLM_BLOOD_PT_FRNSH_QTY,CLM_NUM_SK,CLM_EFCTV_DT,CLM_IDR_LD_DT,CLM_OBSLT_DT,GEO_BENE_SK,BENE_SK,CLM_DISP_CD,CLM_QUERY_CD,CLM_ADJSTMT_TYPE_CD,CLM_BILL_FAC_TYPE_CD,CLM_BILL_CLSFCTN_CD,CLM_BILL_FREQ_CD,CLM_CNTRCTR_NUM,CLM_NCH_PRMRY_PYR_CD,CLM_FINL_ACTN_IND,CLM_LTST_CLM_IND,CLM_ATNDG_PRVDR_NPI_NUM,CLM_OPRTG_PRVDR_NPI_NUM,CLM_OTHR_PRVDR_NPI_NUM,CLM_RNDRG_PRVDR_NPI_NUM,CLM_BLG_PRVDR_OSCAR_NUM,CLM_MDCR_COINSRNC_AMT,CLM_SBMT_CHRG_AMT,CLM_PMT_AMT,CLM_MDCR_DDCTBL_AMT,CLM_NCVRD_CHRG_AMT,CLM_BLOOD_LBLTY_AMT,CLM_PD_DT,CLM_ALOWD_CHRG_AMT,CLM_BENE_PMT_AMT,CLM_RIC_CD,CLM_SRVC_PRVDR_GNRC_ID_NUM,PRVDR_RFRG_PRVDR_NPI_NUM,PRVDR_BLG_PRVDR_NPI_NUM,CLM_RFRG_PRVDR_PIN_NUM,CLM_BLG_PRVDR_ZIP5_CD,CLM_PRVDR_PMT_AMT,META_SRC_SK
CLM_DT_SGNTR_SK,CLM_UNIQ_ID,CLM_TYPE_CD,CLM_SRC_ID,CLM_FROM_DT,CLM_THRU_DT,CLM_CNTL_NUM,CLM_BLOOD_PT_FRNSH_QTY,CLM_NUM_SK,CLM_EFCTV_DT,CLM_IDR_LD_DT,CLM_OBSLT_DT,GEO_BENE_SK,BENE_SK,CLM_DISP_CD,CLM_QUERY_CD,CLM_ADJSTMT_TYPE_CD,CLM_BILL_FAC_TYPE_CD,CLM_BILL_CLSFCTN_CD,CLM_BILL_FREQ_CD,CLM_CNTRCTR_NUM,CLM_NCH_PRMRY_PYR_CD,CLM_FINL_ACTN_IND,CLM_LTST_CLM_IND,PRVDR_ATNDG_PRVDR_NPI_NUM,PRVDR_OPRTG_PRVDR_NPI_NUM,PRVDR_OTHR_PRVDR_NPI_NUM,PRVDR_RNDRNG_PRVDR_NPI_NUM,CLM_BLG_PRVDR_OSCAR_NUM,CLM_MDCR_COINSRNC_AMT,CLM_SBMT_CHRG_AMT,CLM_PMT_AMT,CLM_MDCR_DDCTBL_AMT,CLM_NCVRD_CHRG_AMT,CLM_BLOOD_LBLTY_AMT,CLM_PD_DT,CLM_ALOWD_CHRG_AMT,CLM_BENE_PMT_AMT,CLM_RIC_CD,PRVDR_SRVC_PRVDR_NPI_NUM,PRVDR_RFRG_PRVDR_NPI_NUM,PRVDR_BLG_PRVDR_NPI_NUM,CLM_RFRG_PRVDR_PIN_NUM,CLM_BLG_PRVDR_ZIP5_CD,CLM_PRVDR_PMT_AMT,META_SRC_SK
659052754348,3351266481401,2800,23000,2022-10-18,2022-10-25,28977596005798RIF,,1,2025-08-15,2023-06-04,9999-12-31,86974,178083966,~,1,~,1,4,1,04011,C,Y,Y,1942945159,1023051596,1003488552,1558719914,001502,16.72,84909.15,448471.81,924.67,53582.08,14.05,,30.3,12.23,M,,1720749690,1093792350,9181272391,79928,21.3145678998712,1002
659052754349,3351266481402,71,20000,2022-10-18,2022-10-25,28977596005798RIF,,1,2025-08-15,2023-06-04,9999-12-31,86975,178083966,~,1,~,1,4,1,04011,C,Y,Y,1942945159,1023051596,1003488552,1558719914,001502,16.72,84909.15,448471.81,924.67,53582.08,14.05,,30.3,12.23,M,,1720749690,1003488552,9181272391,79928,21.31,7
659052754350,3351266481403,2700,22000,2022-10-18,2022-10-25,28977596005798RIF,,1,2025-08-15,2023-06-04,9999-12-31,86975,181968400,~,1,~,~,~,~,04011,C,Y,Y,1942945159,1023051596,1003488552,1558719914,001502,16.72,84909.15,448471.81,924.67,53582.08,14.05,,30.3,12.23,M,,1720749690,1003488552,9181272391,79928,21.31,1001
Original file line number Diff line number Diff line change
@@ -1,4 +1,5 @@
GEO_BENE_SK,CLM_DT_SGNTR_SK,CLM_TYPE_CD,CLM_NUM_SK,CLM_FROM_DT,CLM_LINE_HCPCS_CD,HCPCS_1_MDFR_CD,HCPCS_2_MDFR_CD,CLM_LINE_SRVC_UNIT_QTY,CLM_LINE_REV_CTR_CD,CLM_LINE_BENE_PMT_AMT,CLM_LINE_BENE_PD_AMT,CLM_LINE_ALOWD_CHRG_AMT,CLM_LINE_SBMT_CHRG_AMT,CLM_LINE_CVRD_PD_AMT,CLM_LINE_BLOOD_DDCTBL_AMT,CLM_LINE_MDCR_DDCTBL_AMT,CLM_LINE_PRVDR_PMT_AMT,CLM_LINE_NCVRD_CHRG_AMT,CLM_UNIQ_ID,CLM_LINE_NUM,CLM_LINE_NDC_CD,CLM_LINE_NDC_QTY,CLM_LINE_NDC_QTY_QLFYR_CD,HCPCS_3_MDFR_CD,HCPCS_4_MDFR_CD,HCPCS_5_MDFR_CD,CLM_LINE_ANSTHSA_UNIT_CNT,CLM_LINE_DGNS_CD,CLM_LINE_MDCR_COINSRNC_AMT,CLM_LINE_FROM_DT,CLM_LINE_RX_NUM,CLM_LINE_THRU_DT,CLM_POS_CD,CLM_RNDRG_PRVDR_PRTCPTG_CD,CLM_RNDRG_PRVDR_TAX_NUM,CLM_RNDRG_PRVDR_TYPE_CD,CLM_RNDRG_PRVDR_NPI_NUM
GEO_BENE_SK,CLM_DT_SGNTR_SK,CLM_TYPE_CD,CLM_NUM_SK,CLM_FROM_DT,CLM_LINE_HCPCS_CD,HCPCS_1_MDFR_CD,HCPCS_2_MDFR_CD,CLM_LINE_SRVC_UNIT_QTY,CLM_LINE_REV_CTR_CD,CLM_LINE_BENE_PMT_AMT,CLM_LINE_BENE_PD_AMT,CLM_LINE_ALOWD_CHRG_AMT,CLM_LINE_SBMT_CHRG_AMT,CLM_LINE_CVRD_PD_AMT,CLM_LINE_BLOOD_DDCTBL_AMT,CLM_LINE_MDCR_DDCTBL_AMT,CLM_LINE_PRVDR_PMT_AMT,CLM_LINE_NCVRD_CHRG_AMT,CLM_UNIQ_ID,CLM_LINE_NUM,CLM_LINE_NDC_CD,CLM_LINE_NDC_QTY,CLM_LINE_NDC_QTY_QLFYR_CD,HCPCS_3_MDFR_CD,HCPCS_4_MDFR_CD,HCPCS_5_MDFR_CD,CLM_LINE_ANSTHSA_UNIT_CNT,CLM_LINE_DGNS_CD,CLM_LINE_MDCR_COINSRNC_AMT,CLM_LINE_FROM_DT,CLM_LINE_RX_NUM,CLM_LINE_THRU_DT,CLM_POS_CD,CLM_RNDRG_PRVDR_PRTCPTG_CD,CLM_RNDRG_PRVDR_TAX_NUM,CLM_RNDRG_PRVDR_TYPE_CD,PRVDR_RNDRNG_PRVDR_NPI_NUM
86974,659052754348,2800,1,2021-09-26,J2270,PC,23,4.75,0929,1.89,4.06,2.44,0.35,2.68,13.45,0.61,203.91,474.15,3351266481401,1,,,,,,,,W213,,2021-12-21,,2021-12-26,68,1,1928347912,5,1558719914
86975,659052754349,71,1,2021-09-26,J2270,PC,23,4.75,0929,1.89,4.06,2.44,0.35,2.68,13.45,0.61,203.91,474.15,3351266481402,1,,,,,,,,W213,,2021-12-21,,2021-12-26,68,1,1928347912,5,1558719914
86975,659052754350,2700,1,2021-09-26,J2270,PC,23,4.75,0929,1.89,4.06,2.44,0.35,2.68,13.45,0.61,203.91,474.15,3351266481403,1,,,,,,,,W213,,2021-12-21,,2021-12-26,68,1,1928347912,5,1558719914
86975,659052754350,2700,1,2021-09-26,J2270,PC,23,4.75,0929,1.89,4.06,2.44,0.35,2.68,13.45,0.61,203.91,474.15,3351266481403,1,,,,,,,,W213,,2021-12-21,,2021-12-26,68,1,1928347912,5,1558719914
86975,659052754350,2700,1,2021-09-26,J2270,PC,23,4.75,0929,1.89,4.06,2.44,0.35,2.68,13.45,0.61,203.91,474.15,3351266481403,2,,,,,,,,W213,,2021-12-21,,2021-12-26,68,1,1928347912,5,1558719914
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