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Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14

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Page 1: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 2: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14

Single Level Level H: AIDS Single Level Single Level

Provider

Number

Effective Date

Format

YYYYMMDD

Intermediate I

(IN1)

Skilled AIDS

(SKA)

Intermediate II

(IN2) Skilled (SKD)

MFAO

number

Audit

Number

000113600 20150101 234.79 0.00 234.79 234.79 84326-18 NH14-037C

000113600 20150901 232.90 0.00 232.90 232.90 84326-18 NH14-037C

000585000 20140701 220.60 0.00 220.60 220.60 84326-18 NH14-125C

003248200 20120101 204.22 351.83 204.22 204.22 84326-18 NH13-095C

003248200 20120701 212.36 361.57 212.36 212.36 84326-18 NH13-095C

003248200 20130101 216.14 366.95 216.14 216.14 84326-18 NH13-095C

003248200 20130701 227.68 0.00 227.68 227.68 84326-18 NH13-095C

003248200 20140101 224.82 0.00 224.82 224.82 84326-18 NH13-095C

003248200 20140701 233.72 0.00 233.72 233.72 84326-18 NH13-095C

003248200 20160901 246.16 0.00 246.16 246.16 84326-18 NH13-095C

003248200 20170901 235.73 0.00 235.73 235.73 84326-18 NH13-095C

003248600 20120101 216.07 363.68 216.07 216.07 84326-18 NH13-096C

003248600 20120701 223.59 372.80 223.59 223.59 84326-18 NH13-096C

003248600 20130101 226.32 377.13 226.32 226.32 84326-18 NH13-096C

003248600 20130701 232.22 0.00 232.22 232.22 84326-18 NH13-096C

003248600 20140101 226.30 0.00 226.30 226.30 84326-18 NH13-096C

003248600 20140701 242.03 0.00 242.03 242.03 84326-18 NH13-096C

003248600 20150101 247.45 0.00 247.45 247.45 84326-18 NH13-096C

003248600 20150901 246.32 0.00 246.32 246.32 84326-18 NH13-096C

003248600 20160901 250.05 0.00 250.05 250.05 84326-18 NH13-096C

003248600 20170901 238.58 0.00 238.58 238.58 84326-18 NH13-096C

003255300 20120101 208.00 355.61 208.00 208.00 84326-18 NH13-099C

003255300 20120701 214.18 363.39 214.18 214.18 84326-18 NH13-099C

021346200 20140701 243.55 0.00 243.55 243.55 84326-18 NH14-107C

021346200 20150101 247.32 0.00 247.32 247.32 84326-18 NH14-107C

021390000 20140701 246.57 0.00 246.57 246.57 84326-18 NH14-115W

021390000 20150101 249.57 0.00 249.57 249.57 84326-18 NH14-115W

021390000 20150901 249.40 0.00 249.40 249.40 84326-18 NH14-115W

021390000 20160901 244.89 0.00 244.89 244.89 84326-18 NH14-115W

022060400 20140701 221.89 0.00 221.89 221.89 84326-18 NH14-105C

022527400 20140701 218.69 0.00 218.69 218.69 84326-18 NH14-080C

022527400 20150101 222.14 0.00 222.14 222.14 84326-18 NH14-080C

022575400 20120101 230.60 378.21 230.60 230.60 84326-18 NH13--143L

026356700 20140101 210.17 0.00 210.17 210.17 84326-18 NH14-121W

026356700 20140701 216.11 0.00 216.11 216.11 84326-18 NH14-121W

026358300 20140101 196.45 0.00 196.45 196.45 84326-18 NH14-119W

032043900 20140701 225.70 0.00 225.70 225.70 84326-18 NH14-089C

032043900 20150101 227.72 0.00 227.72 227.72 84326-18 NH14-089C

032043900 20150901 226.66 0.00 226.66 226.66 84326-18 NH14-089C

032444200 20150101 219.18 0.00 219.18 219.18 84326-18 NH14-035C

032444200 20150901 217.06 0.00 217.06 217.06 84326-18 NH14-035C

032449300 20150101 217.29 0.00 217.29 217.29 84326-18 NH14-041C

032449300 20150901 215.90 0.00 215.90 215.90 84326-18 NH14-041C

Page 1 of 1

Page 3: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 4: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 5: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 6: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 7: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 8: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 9: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 10: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 11: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 12: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 13: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 14: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 15: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 16: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 17: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 18: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 19: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 20: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 21: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 22: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 23: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 24: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 25: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 26: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 27: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 28: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 29: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 30: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 31: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 32: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 33: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 34: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 35: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 36: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 37: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 38: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 39: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 40: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 41: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 42: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
Page 43: Single Level Level H: AIDS Single Level Single Level€¦ · 01.10.2018  · 022527400 20140701 218.69 0.00 218.69 218.69 84326-18 nh14-080c 022527400 20150101 222.14 0.00 222.14
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