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["User Instructions"]
[]
["Step One"]
[]
["Click the Profile Information tab and provide the requested information."]
[]
["Step Two"]
[]
["*Enter the required information on the Input tab."]
["*After entering the patient information and diagnosis clusters, click \"Add Next CCC Record\" to add the record to the Records tab.  This must be done"]
["  after each CCC record entry has been completed."]
["*Click \"New Batch\" when you need to start a new batch."]
["*If you need to delete all the records on the Records tab before creating a file, click the \"Clear Records Tab.\""]
["*To clear out the information on the Profile Information tab, click \"Clear All CCC Records.\""]
["*Before clicking the “Create File” button, ensure that all CCC records have been added to the Records tab."]
["*The “Create File” button will build the file and clear the Profile Information and Input tabs."]
[]
[]
[]
["©\nThis material is the Confidential, Proprietary and Trade Secret product of BlueCross BlueShield of South Carolina and its subsidiaries. Any unauthorized use, reproduction or transfer of these materials is strictly prohibited. Copyright 2018 BlueCross BlueShield of South Carolina. ALL RIGHTS RESERVED.\n"]

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["Profile Information"]
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["Submitter Number"]
[]
["Prod/Test"]
[]
["Diagnosis File Type"]
[]
["Output File Path"]
[]
["File ID"]

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["Risk Adjustment Record Submission"]
[]
["Contract ID"]
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["Patient Info"]
["Patient Control #",null,null,"Optional"]
["Medicare ID",""]
["Date of Birth",null,null,"Optional"]
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["Diagnosis Cluster Information"]
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[2,"Provider Type"]
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[4,"Provider Type"]
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[null,"Delete Ind"]
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[null,"Risk Assessment Code"]
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[5,"Provider Type"]
[null,"From Date"]
[null,"Thru Date"]
[null,"Delete Ind"]
[null,"Diagnosis Code"]
[null,"Risk Assessment Code"]
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[6,"Provider Type"]
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[null,"Delete Ind"]
[null,"Diagnosis Code"]
[null,"Risk Assessment Code"]
[]
[7,"Provider Type"]
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[null,"Thru Date"]
[null,"Delete Ind"]
[null,"Diagnosis Code"]
[null,"Risk Assessment Code"]
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[8,"Provider Type"]
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[null,"Thru Date"]
[null,"Delete Ind"]
[null,"Diagnosis Code"]
[null,"Risk Assessment Code"]
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[9,"Provider Type"]
[null,"From Date"]
[null,"Thru Date"]
[null,"Delete Ind"]
[null,"Diagnosis Code"]
[null,"Risk Assessment Code"]
[]
[10,"Provider Type"]
[null,"From Date"]
[null,"Thru Date"]
[null,"Delete Ind"]
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[null,"Click this button to add CCC records.  You must click this button to move the CCC record to the Records tab before adding a new batch or creating a file."]
[]
[]
[null,"Click here to create a new batch."]
[]
[]
[null,"Click here to create a file."]
[]
[]
[null,"Click here in the event you want to remove CCC record entries from this tab only."]
[]
[]
[]
[]
["Clicking this button will clear ALL records on the Records tab.  Do not select this unless"]
["you want to delete all records created so far."]

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["01 - Hospital Inpatient Principal","02 - Hospital Inpatient Other","10 - Hospital Outpatient","20 - Physician"]
[]
[]
[null,"D"]
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["A - Clinical setting","B - Non-clinical, wellness requirements met","C - Non-clinical, wellness requirements not met"]
[]
["PROD"]
["TEST"]
[]
["ICD9"]
["ICD10"]