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Specific Claim Submission Log
Received
When the claim submission was received.
Policyholder
Policy holder name.
Effective
When the policy became effective.
Claimant
Who made the claim.
Status
Status of the claim.
Requested
Requested claim amount.
Initial
Whether or not this is an initial claim.
Primary Diagnosis
Patient primary diagnosis (code and description).
Assigned
When the claim was assigned.
Auditor Name
Who is auditing the claim.