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{"sheet":"SMMC Authorization Overview","index":0,"n_rows":27,"n_cols":7,"rows_kept":27,"hidden":true,"merged":[[0,0,0,12],[1,0,1,12],[3,1,3,3],[4,1,4,3],[5,1,5,3],[6,1,6,3],[7,1,7,3],[8,1,8,3]],"read":"bin_skipped_in_rows","flags":["formulas_cached_only","records_skipped"],"rows_in_doubt":{"n":0,"rows":[]},"rows_in_doubt_other":1}
["Service Authorization Performance Outcome Report (Test Draft 06062019)"]
["SMMC Authorization Overview"]
[]
["Plan Name:"]
["Plan Type:"]
["Plan 7-Digit Medicaid ID:"]
["Reporting Month/Year:"]
["Report Submission Date:"]
["Report Submitted By:"]
[]
["Service Type","Number of Requests Pending At Beginning of the Reporting Month","Number of Requests Received","Number of Requests Completed","Number of Requests Pending at End of the Reporting Month","Number of Requests Received in the Reporting Month that Required an Extension in Order to Receive Additional Information","Percentage of Requests that Required an Extension in Order to Receive Additional Information"]
["Behavioral Health Inpatient",{"$nulls":5},"0%"]
["Durable Medical Equipment and Supplies",{"$nulls":5},"0%"]
["Early Intervention Services",{"$nulls":5},"0%"]
["Home Health Services",{"$nulls":5},"0%"]
["Medical Foster Care Services",{"$nulls":5},"0%"]
["Nursing Facility Services",{"$nulls":5},"0%"]
["Occupational Therapy",{"$nulls":5},"0%"]
["Pharmacy Services",{"$nulls":5},"0%"]
["Physical Therapy",{"$nulls":5},"0%"]
["Private Duty Nursing",{"$nulls":5},"0%"]
["Speech-Language Pathology",{"$nulls":5},"0%"]
["Statewide Inpatient Psychiatric  Hospital",{"$nulls":5},"0%"]
["Targeted Case Management",{"$nulls":5},"0%"]
["Transportation Services",{"$nulls":5},"0%"]
["Visual Care Services",{"$nulls":5},"0%"]
["Total",null,0,0,0,0,"0%"]

{"sheet":"Instructions","index":1,"n_rows":175,"n_cols":16,"rows_kept":175,"merged":[[0,1,0,17],[2,1,2,17],[3,1,3,17],[4,1,4,17],[6,1,6,17],[7,1,7,17],[8,1,8,17],[10,1,10,17],[12,1,12,17],[14,1,14,19],[16,1,16,17],[18,1,18,19],[20,1,20,19],[22,1,22,19],[26,1,26,17],[28,1,28,17],[30,1,30,17],[32,1,32,17],[34,1,34,17],[36,1,36,17],[38,1,38,17],[40,1,40,17],[42,1,42,17],[44,1,44,17],[46,1,46,17],[48,1,48,17],[50,1,50,17],[52,1,52,17],[54,1,54,17],[58,1,58,17],[60,1,60,17],[62,1,62,17],[64,1,64,17],[66,1,66,17],[68,1,68,17],[70,1,70,17],[72,1,72,17],[74,1,74,17],[91,1,91,17],[93,1,93,17],[95,3,95,5],[98,1,98,17],[100,1,100,17],[106,1,106,17],[108,1,108,17],[110,1,110,17],[115,1,115,17],[117,1,117,17],[119,1,119,17],[121,1,121,17],[123,1,123,17],[125,1,125,17],[128,1,128,17],[130,1,130,17],[132,1,132,17],[134,1,134,17],[136,1,136,17],[138,1,138,17],[140,1,140,17],[142,1,142,17],[144,1,144,17],[146,1,146,20],[148,1,148,20],[150,1,150,20],[152,1,152,17],[154,1,154,17],[156,1,156,17],[158,1,158,17],[160,1,160,17],[162,1,162,17],[164,1,164,17],[166,1,166,17],[168,1,168,17],[170,1,170,17],[172,1,172,17],[174,1,174,17]],"flags":["formulas_cached_only"]}
[null,"Instructions for Completing the Service Authorization Performance Outcome Report"]
[]
[null,"This report is due monthly, within fifteen (15) calendar days after the end of the reporting month."]
[null,"Do not make any entries other than those specified below or edit formulas within the template."]
[null,"Health plans will complete each tab as applicable, indicating the plan type using the drop-down menu above the data table."]
[]
[null,"* Comprehensive LTC Plans and LTC Plus Plans only need to complete this report for service authorizations for Managed Medical Assistance Program services covered under Attachment II, Exhibit II-A of the SMMC contract."]
[null,"* MMA Plans do not need to report service authorization data for expanded benefits. Dental Plans must report service authorization data for expanded benefits."]
[null,"* Dental Plans must report services rendered by a dentist, registered dental hygienist, or orthodontist.  This includes services provided in an ambulatory surgical center, outpatient hospital settings, and anesthesiology services administered in conjunction with covered dental services."]
[]
[null,"Managed Care Plan Information"]
[]
[null,"Managed Care Plan Name: Enter the complete managed care plan name."]
[]
[null,"Benefit Type: Enter the managed care plan's benefit type. (\"IDD\", \"MMA\", \"Dental\")"]
[]
[null,"Managed Care Plan 7-Digit Medicaid ID: Enter the seven-digit managed care plan's Medicaid identification number."]
[]
[null,"Reporting Month/Year: Enter the date of the reporting month and year (e.g. January 2019, February 2019)."]
[]
[null,"Report Submission Date: Enter the date the managed care plan submitted the report (MM/DD/YYYY)."]
[]
[null,"Report Submitted By: Enter the first name and last name (ONLY) of the managed care plan's contact individual for this report. Exclude titles, \"Sr\", \"Jr\", \"2nd\", etc."]
[]
[null,"Authorization Outcome (Note tab for SMMC & Dental)"]
[]
[null,"Service Type: For service authorization of SMMC or Dental* services, the Service Types to be reported are listed on the SMMC or Dental Services tab. For definition of Service Types, see Medicaid coverage policy."]
[]
[null,"Total Requests Completed: Enter the total number of Service Authorization Requests that were completed during the reporting month."]
[]
[null,"Total Requested Services Fully Approved: Enter the total number of Requested Services that were fully approved during the reporting month."]
[]
[null,"Percentage of Requested Services Fully Approved: PLEASE DO NOT ALTER THE FORMULA. This column automatically calculates the percentage of Service Authorization Requests that were fully approved during the reporting month."]
[]
[null,"Total Requests Partially Approved: Enter the total number of Service Authorization Requests that were partially approved during the reporting month (this includes requests for continued authorization that were reduced)."]
[]
[null,"Percentage of Requests Partially Approved: PLEASE DO NOT ALTER THE FORMULA. This column automatically calculates the percentage of Service Authorization Requests that were partially approved during the reporting month (this includes requests for continued authorization that were reduced)."]
[]
[null,"Total Requests Denied: Enter the total number of Service Authorization Requests that were denied (in whole) during the reporting month."]
[]
[null,"Percentage of Requests Denied: PLEASE DO NOT ALTER THE FORMULA. This column automatically calculates the percentage of Service Authorization Requests that were denied (in whole) during the reporting month."]
[]
[null,"Total Requests Referred to a Physician (or Dentist) Reviewer or Medical Director: Enter the total number of Service Authorization Requests that were referred to a physician reviewer or medical director during the reporting month."]
[]
[null,"Percentage of Requests Referred to a Physician (or Dentist) Reviewer or Medical Director: PLEASE DO NOT ALTER THE FORMULA. This column automatically calculates the percentage of Service Authorization Requests that were referred to a physician reviewer or medical director during the reporting month."]
[]
[null,"Total Requests Required Peer-to-Peer Consultation: Enter the total number of Service Authorization Requests that required a peer-to-peer review during the reporting month."]
[]
[null,"Percentage of Requests Required Peer-to-Peer Consultation: PLEASE DO NOT ALTER THE FORMULA. This column automatically calculates the percentage of Service Authorization Requests that required a peer-to-peer review during the reporting month."]
[]
[null,"Total Requests Required an Extension in Order to Receive Additional Information: Enter the total number of Service Authorization Requests that required an extension in order to request/receive additional information during the reporting month."]
[]
[null,"Percentage of Requests Required an Extension in Order to Receive Additional Information: PLEASE DO NOT ALTER THE FORMULA. This column automatically calculates the percentage of Service Authorization Requests that required an extension in order to request/receive additional information during the reporting month."]
[]
[null,"*For the Dental tab \"Requested Service Type\" fields, include the applicable service type for services rendered by a dentist, registered dental hygienist, or orthodontist.  This includes services provided in an ambulatory surgical center, outpatient hospital settings, and anesthesiology services administered in conjunction with covered dental services.  "]
[]
[null,"Authorization Timeliness *"]
[]
[null,"The Managed Care Plan must report on all service authorization requests completed during the reporting month on the Authorization Timeliness worksheet."]
[]
[null,"Enrollee Last Name: Enter the last name of the enrollee with no initials and no special characters such as hyphens, parentheses, apostrophes, forward slashes, etc."]
[]
[null,"Enrollee First Name: Enter the first name of the enrollee with no initials and no special characters such as hyphens, parentheses, apostrophes, forward slashes, etc."]
[]
[null,"Enrollee Middle Initial: Enter the middle initial of the enrollee with no special characters such as hyphens, parentheses, apostrophes, forward slashes, etc."]
[]
[null,"Enrollee Medicaid ID: Enter the enrollee's 10-digit Medicaid ID number. All leading and trailing zeros are to be included."]
[]
[null,"Enrollee Date of Birth (DOB): Enter the date of birth of the enrollee MM/DD/YYYY."]
[]
[null,"Provider Name: Enter the full/complete business name of the provider originating the service authorization request."]
[]
[null,"Provider Medicaid ID: Enter the Medicaid ID number of the provider originating the service authorization request. If the requesting provider does not have a Medicaid ID number or if the requester is unknown, enter 999999999.  "]
[]
[null,"Requested Service Category (MMA): Enter the covered service category of the service that was requested for MMA, if applicable. Utilize the following categories listed below: "]
[null,null,"Allergy",{"$nulls":4},"Cardiovascular",{"$nulls":3},"Integumentary",{"$nulls":3},"Regional Perinatal Intensive Care Center"]
[null,null,"Ambulance Transportation",{"$nulls":4},"Child Health Services Targeted Case Management ",{"$nulls":3},"Laboratory",{"$nulls":3},"Reproductive"]
[null,null,"Ambulatory Surgical Center",{"$nulls":4},"Chiropractic",{"$nulls":3},"Medical Foster Care",{"$nulls":3},"Respiratory System"]
[null,null,"Anesthesia",{"$nulls":4},"Dialysis",{"$nulls":3},"Neurology",{"$nulls":3},"Respiratory Therapy"]
[null,null,"Assistive Care",{"$nulls":4},"Durable Medical Equipment and Supplies",{"$nulls":3},"Nursing Facility",{"$nulls":3},"Rural Health Clinic"]
[null,null,"Behavioral Health Assessment Services",{"$nulls":4},"Early Intervention",{"$nulls":3},"Occupational Therapy",{"$nulls":3},"Speech Language Pathology"]
[null,null,"Behavioral Health Community Support and Rehabilitative Services",{"$nulls":4},"Emergency & Non Emergency Transportation",{"$nulls":3},"Oral and Maxillofacial Surgery",{"$nulls":3},"Statewide Inpatient Psychiatric Hospital (SIPP)"]
[null,null,"Behavior Analysis Services",{"$nulls":4},"Evaluation and Management",{"$nulls":3},"Orthopedic",{"$nulls":3},"Therapeutic Behavioral On-Site Services for Recipient Under Age of 21 Years"]
[null,null,"Behavioral Health Inpatient",{"$nulls":4},"Gastrointestinal",{"$nulls":3},"Outpatient Hospital",{"$nulls":3},"Therapeutic Group Care Services"]
[null,null,"Behavioral Health Medical",{"$nulls":4},"Genitourinary",{"$nulls":3},"Pain Management",{"$nulls":3},"Transplant"]
[null,null,"Behavioral Health Outpatient Hospital Services",{"$nulls":4},"Hearing",{"$nulls":3},"Personal Care Services",{"$nulls":3},"Visual Aid"]
[null,null,"Behavioral Health Overlay Services",{"$nulls":4},"Home Health",{"$nulls":3},"Physical Therapy",{"$nulls":3},"Visual Care"]
[null,null,"Behavioral Health Specialized Therapeutic Services",{"$nulls":4},"Hospice",{"$nulls":3},"Podiatry"]
[null,null,"Behavioral Health Targeted Case Management",{"$nulls":4},"Inpatient Hospital",{"$nulls":3},"Private Duty Nursing"]
[null,null,"Behavioral Health Therapy Services",{"$nulls":8},"Radiology and Nuclear Medicine"]
[]
[null,"*  Do not enter 'prescribed drug' or diabetic supply services (pharmacy) on this tab. Please utilize the Pharmacy Timeliness tab for these two service categories"]
[]
[null,"Requested Service Category (Dental Services*): Enter the covered service category of the service that was requested for Dental, if applicable. Utilize the following categories listed below:"]
[{"$nulls":3},"Adjunctive General Services",{"$nulls":3},"Endodontic Services",{"$nulls":3},"Preventive Services",{"$nulls":3},"Oral and Maxillofacial Surgery"]
[{"$nulls":3},"Anesthesia Services",{"$nulls":3},"Orthodontic Services",{"$nulls":3},"Prosthodontic Services"]
[{"$nulls":3},"Diagnostic Services",{"$nulls":3},"Periodontal Services",{"$nulls":3},"Restorative Services"]
[]
[null,"*For the \"Dental Services Category,\" include the applicable category for services rendered by a dentist, registered dental hygienist, or orthodontist.  This is includes services provided in an ambulatory surgical center, outpatient hospital settings, and anesthesiology services administered in conjunction with covered dental services.  "]
[]
[null,"Authorization Service Type: Identify if the service request is a Standard Authorization, Extended Standard Authorization, Expedited Authorization, Extended Expedited Authorization. Utilize the following options listed below:"]
[{"$nulls":3},"Standard Authorization"]
[{"$nulls":3},"Extended Standard Authorization"]
[{"$nulls":3},"Expedited Authorization"]
[{"$nulls":3},"Extended Expedited Authorization"]
[]
[null,"Request Referred to a Physician (or Dentist) Reviewer or Medical Director? (Yes or No): Identify if the service authorization requests was referred to a physician reviewer or medical director during the reporting month."]
[]
[null,"Request Required Peer-to-Peer Consultation? (Yes or No): Identify if the service authorization request required a peer-to-peer review during the reporting month."]
[]
[null,"Requested Service Outcome: Enter the outcome of the requested service. List if the service was approved, partially approved, or denied. Utilize the following options listed below:"]
[{"$nulls":3},"Approved "]
[{"$nulls":3},"Partially Approved"]
[{"$nulls":3},"Denied"]
[]
[null,"Date Request was Received by Plan (MM/DD/YYYY): Enter the date the service authorization request was received by the Managed Care Plan."]
[]
[null,"Date Provider was Notified (MM/DD/YYYY): Enter the date the provider was notified of the service authorization decision."]
[]
[null,"Number of Days Between Request Date and Provider Notification Date: PLEASE DO NOT ALTER THE FORMULA. The number of days will auto-calculate."]
[]
[null,"Date Notice of Adverse Benefit Determination was Sent to Enrollee (MM/DD/YYYY): Enter the date the Notice of Adverse Benefit Determination was sent to the Enrollee."]
[]
[null,"Number of Days Between Request and Date Notice of Adverse Benefit Determination was Sent: PLEASE DO NOT ALTER THE FORMULA. The number of days will auto-calculate."]
[]
[null,"Comments: Enter comments to explain why the provider notification and/or NABD was not processed within the required contracted timeframe. Limit responses to 255 characters. If not applicable, leave blank."]
[]
[]
[null,"Pharmacy Services (Prescribed Drug and Diabetic Supply Services) - Authorization Timeliness"]
[]
[null,"The Managed Care Plan must report on all prior authorization requests for prescribed drugs and diabetic supply services completed during the reporting month on the Pharmacy Authorization Timeliness worksheet.  Dental Plans do not need to complete this worksheet."]
[]
[null,"Enrollee Last Name: Enter the last name of the enrollee with no initials and no special characters such as hyphens, parentheses, apostrophes, forward slashes, etc."]
[]
[null,"Enrollee First Name: Enter the first name of the enrollee with no initials and no special characters such as hyphens, parentheses, apostrophes, forward slashes, etc."]
[]
[null,"Enrollee Middle Initial: Enter the middle initial of the enrollee with no special characters such as hyphens, parentheses, apostrophes, forward slashes, etc."]
[]
[null,"Enrollee Medicaid ID: Enter the enrollee's 10-digit Medicaid ID number. All leading and trailing zeros are to be included."]
[]
[null,"Enrollee Date of Birth (DOB): Enter the date of birth of the enrollee MM/DD/YYYY."]
[]
[null,"Provider Name: Enter the full/complete name of the prescriber originating the prior authorization request."]
[]
[null,"Provider Medicaid ID: Enter the Medicaid ID number of the prescriber originating the prior authorization request. If the requesting provider does not have a Medicaid ID number or if the requester is unknown, enter 999999999.  "]
[]
[null,"Drug Label Name : Enter the label name of the drug product. The label name must include the drug name, the strength, and the dosage form."]
[]
[null,"Diabetic Supplies - Product Name: Enter the Diabetic Supply Product Name."]
[]
[null,"Diabetic Supplies - Manufacturer Name: Enter the Diabetic Supply Manufacturer's Name."]
[]
[null,"Request Referred to a Physician Reviewer or Medical Director? (Yes or No): Identify if the prior authorization request was referred to a physician reviewer or medical director during the reporting month."]
[]
[null,"Request Required Peer-to-Peer Consultation? (Yes or No): Identify if the prior authorization request required a peer-to-peer review during the reporting month."]
[]
[null,"Prior authorization Request Determination: Enter the prior authorization determination. Select from the drop-down list if the drug was approved or denied."]
[]
[null,"Prior authorization begin date (MM/DD/YYYY): Enter the date the prior authorization approval begins. If the prior authorization request was denied, enter N/A in the cell. "]
[]
[null,"Prior authorization end date (MM/DD/YYYY): Enter the date the prior authorization approval ends. If the prior authorization request was denied, enter N/A in the cell. "]
[]
[null,"Length of Authorization: Enter the number of days between the \"Prior Authorization Begin Date (numerator)\" and the \"Prior Authorization End Date (denominator).\""]
[]
[null,"Date the Request was Received by Plan: Enter the date (MM/DD/YYYY) the prior authorization request was received by the Managed Care Plan."]
[]
[null,"Date the Provider was Notified: Enter the date (MM/DD/YYYY) and time the provider was notified of the prior authorization determination."]
[]
[null,"Number of Days Between Request Date and Provider Notification Date: PLEASE DO NOT ALTER THE FORMULA. The number of days will auto-calculate."]
[]
[null,"Date Notice of Adverse Benefit Determination was Sent to Enrollee: Enter the date the Notice of Adverse Benefit Determination (NABD) was sent to the enrollee (MM/DD/YYYY)."]
[]
[null,"Number of Days Between Request and Date Notice of Adverse Benefit Determination was Sent: PLEASE DO NOT ALTER THE FORMULA. The number of days will auto-calculate. The cell will calculate the number of days between the \"Date Request was Received by Plan (numerator)\" and the \"Date Notice of Adverse Benefit Determination was Sent to Enrollee (denominator).\""]
[]
[null,"Comments: Enter comments to explain why the provider notification and/or NABD was not processed within the required contracted timeframe. Limit responses to 255 characters. If not applicable, leave blank."]

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["Service Authorization Performance Outcome Report"]
["SMMC Authorization Outcome"]
[]
["Managed Care Plan Name:"]
["Benefit Type:"]
["Managed Care Plan 7-Digit Medicaid ID:"]
["Reporting Month/Year:"]
["Report Submission Date:"]
["Report Submitted By:"]
[]
["Service Type","Total Requests Completed","Total Requested Services Fully Approved","Percentage of Requested Services Fully Approved","Total Requests Partially Approved","Percentage of  Requests Partially Approved","Total Requests Denied","Percentage of Requests Denied","Total Requests Referred to a Physician Reviewer or Medical Director","Percentage of Requests Referred to a Physician Reviewer or Medical Director","Total Requests Required Peer-to-Peer Consultation","Percentage of Requests Required Peer-to-Peer Consultation","Total Requests Required an Extension in Order to Receive Additional Information","Percentage of Requests Required an Extension in Order to Receive Additional Information","Plan 7-Digit Medicaid ID","Plan Reporting Month","Plan Reporting Year"]
["Allergy",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Ambulance Transportation",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Ambulatory Surgical Center",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Anesthesia",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Assistive Care",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Cardiovascular",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Child Health Services Targeted Case Management ",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Chiropractic",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Diabetic Supply Services - Pharmacy",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Dialysis",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Durable Medical Equipment and Supplies",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Early Intervention Services",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Early Intervention Services Targeted Case Management",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Emergency & Non Emergency Transportation",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Evaluation and Management",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Gastrointestinal",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Genitourinary",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Hearing",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Home Health Services",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Hospice",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Inpatient Hospital",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Integumentary",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Laboratory",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Medical Foster Care Services",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Neurology",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Nursing Facility Services",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Occupational Therapy",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Orthopedic",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Outpatient Hospital",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Pain Management",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Personal Care",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
["Physical Therapy",null,null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",null,"0%",{"v":0,"d":"0000000"},"00:00:00","00:00:00"]
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