1095-B MONTHLY COVERAGE REVIEW
Provider / reporting year / person key / statement relationship:
Source snapshot / operative events / superseded event references:
Date convention: start meaning / end meaning / conversion / reviewer.
EVENT TABLE
Event ID | effective start | effective end | entry date | status | source | approval
MONTH TABLE
Month | operative interval reference | at least one confirmed covered day | reported indicator | unresolved question
Jan:
Feb:
Mar:
Apr:
May:
Jun:
Jul:
Aug:
Sep:
Oct:
Nov:
Dec:
FICTIONAL MC-024
Initial Jan 10-Mar 31 and Jul 15-Dec 31: 3 + 6 = 9 months.
Later approved Apr 1-May 31: 3 + 2 + 6 = 11; June remains unmarked.
Changed cells: April and May. Preserve initial and updated versions.
Already filed or furnished? / correction referral / owner:
All-year indicator check / person count / person-month total / reviewer: