Claimid Patient Name Insurance CPT To Date Charges Balance

1000244104 Desai, Dahiben Self Pay 93000 11/29/2007 34.42 34.42

1000244104 Desai, Dahiben Self Pay 99213 11/29/2007 83.16 83.16
1000212352 Desai, Dahiben Self Pay 82948 7/24/2007 10 10
1000212352 Desai, Dahiben Self Pay 93000 7/24/2007 34.42 34.42
1000212352 Desai, Dahiben Self Pay 99213 7/24/2007 83.16 83.16
1000206338 Saffeels, Doreen UNICARE PO Box 795180 93018 5/31/2007 21.21 21.21
1000206338 Saffeels, Doreen UNICARE PO Box 795180 93016 5/31/2007 32.35 32.35
1000206338 Saffeels, Doreen UNICARE PO Box 795180 78480 5/31/2007 100.66 100.66
1000206338 Saffeels, Doreen UNICARE PO Box 795180 78478 5/31/2007 111.79 111.79
1000206338 Saffeels, Doreen UNICARE PO Box 795180 78465 5/31/2007 689.5 689.5
1000196589 Rappleye, Carol BCBS OF ARIZONA PO BO99233 5/9/2007 127.33 127.33
1000196589 Rappleye, Carol BCBS OF ARIZONA PO BO99254 5/8/2007 219.16 17.24
1000186466 Chavez, Francis SUMMERLIN LIFE & HEALT80061 3/19/2007 30 20
1000174394 Desai, Dahiben Self Pay 82948 2/8/2007 10 10
1000174394 Desai, Dahiben Self Pay 99212 2/8/2007 51.38 51.38
1000171709 Desai, Dahiben Self Pay 82948 1/29/2007 10 10
1000171709 Desai, Dahiben Self Pay 93000 1/29/2007 34.43 34.43
1000171709 Desai, Dahiben Self Pay 99213 1/29/2007 83.16 83.16
1000171593 Vance, Edna DESERT CANYON COMMUN 99213 1/29/2007 83.16 10
1000167419 Hammack, Donald DESERT CANYON COMMUN 93018 1/4/2007 19.96 19.96
1000167419 Hammack, Donald DESERT CANYON COMMUN 93016 1/4/2007 30.46 30.46
1000167419 Hammack, Donald DESERT CANYON COMMUN 78480 1/4/2007 95.4 95.4
1000167419 Hammack, Donald DESERT CANYON COMMUN 78478 1/4/2007 105.85 105.85
1000167419 Hammack, Donald DESERT CANYON COMMUN 78465 1/4/2007 653.84 653.84
1000164743 Kuehn, Joyce ARIZONA FOUNDATION PO93307 12/21/2006 272.69 9.32
1000164743 Kuehn, Joyce ARIZONA FOUNDATION PO93320 12/21/2006 119.74 119.74
1000164743 Kuehn, Joyce ARIZONA FOUNDATION PO93325 12/21/2006 163.17 120.94
1000163964 Stout, Yancy BCBS OF ARIZONA PO BO99203 11/30/2006 129.51 15
1000152226 Martin, Sandra MEDICARE PART B 99213 10/26/2006 75 10.51
1000150607 Desai, Dahiben Self Pay 82948 10/5/2006 10 10
1000150607 Desai, Dahiben Self Pay 99212 10/5/2006 55 55
1000343742 Jordan, Danny ARIZONA FOUNDATION PO92982 7/1/2009 860.87 85
1000332685 Mangrum, Olivia CIGNA HEALTH CARE PO 99214 4/14/2009 126.44 45
1000330790 Huber, Sally DESERT CANYON COMMUN 99213 4/10/2009 83.94 15
1000321298 Kinkle, Annie MEDICARE PART B 99211 2/9/2009 25.42 18.16
1000320644 Kite, Lynn AETNA P O BOX 981106 93018 2/5/2009 22.33 15.43
1000320644 Kite, Lynn AETNA P O BOX 981106 93016 2/5/2009 33.69 23.53
1000320644 Kite, Lynn AETNA P O BOX 981106 78480 2/5/2009 24.19 4.84
1000320644 Kite, Lynn AETNA P O BOX 981106 78478 2/5/2009 37.67 6.39
1000320644 Kite, Lynn AETNA P O BOX 981106 78465 2/5/2009 108.65 14.92
1000305295 Carey, Dean BCBS OF ARIZONA PO BO99238 10/24/2008 89.78 10.68
1000305295 Carey, Dean BCBS OF ARIZONA PO BO99232 10/23/2008 87.85 10.37
1000305295 Carey, Dean BCBS OF ARIZONA PO BO99232 10/22/2008 87.85 10.37
1000305295 Carey, Dean BCBS OF ARIZONA PO BO99232 10/21/2008 87.85 10.37
1000305295 Carey, Dean BCBS OF ARIZONA PO BO99232 10/20/2008 87.85 20.08
1000305295 Carey, Dean BCBS OF ARIZONA PO BO99223 10/20/2008 238.64 173.57
1000304002 Vance, Edna DESERT CANYON COMMUN 99213 10/30/2008 82.64 15
1000302645 Desai, Dahiben Self Pay 82948 10/20/2008 10 10
1000301869 Desai, Dahiben Self Pay 93000 10/16/2008 31.33 31.33
1000301869 Desai, Dahiben Self Pay 99211 10/16/2008 27.21 27.21
1000301280 Atherton, Dennis HUMANA CLAIMS PO BOX 99213 10/15/2008 82.64 10
1000300736 Register, Carla BCBS OF ARIZONA PO BO93325 10/10/2008 5.26 4.21
1000300736 Register, Carla BCBS OF ARIZONA PO BO93320 10/10/2008 26.93 21.55
1000300736 Register, Carla BCBS OF ARIZONA PO BO93307 10/10/2008 65.47 52.38
1000300736 Register, Carla BCBS OF ARIZONA PO BO99232 10/10/2008 87.85 69.16
1000300736 Register, Carla BCBS OF ARIZONA PO BO99254 10/9/2008 217.26 172.91
1000299454 Vance, Edna DESERT CANYON COMMUN 99213 10/1/2008 82.64 15
1000288914 Chavez, Francis ADMINISTRATIVE ENTERP99214 7/21/2008 124.25 20
1000287799 Desai, Dahiben KINGMAN REGIONAL MED93325 7/8/2008 5.26 5.26
1000287799 Desai, Dahiben KINGMAN REGIONAL MED93320 7/8/2008 26.93 26.93
1000287799 Desai, Dahiben KINGMAN REGIONAL MED93307 7/8/2008 65.47 65.47
1000286627 Desai, Dahiben Self Pay 99212 7/3/2008 51.42 51.42
1000286099 Desai, Dahiben Self Pay 99213 6/30/2008 82.64 82.64
1000284293 Vance, Edna DESERT CANYON COMMUN 99213 6/18/2008 82.64 15
1000280065 Martin, Sandra SECURE HORIZONS DIREC99213 5/20/2008 82.64 10
1000278681 Wells, Alexandra MEDICARE PART B 99214 4/23/2008 124.25 17.75
1000274549 Wells, Alexandra MEDICARE PART B 86580 4/23/2008 11.39 1.63
1000272906 Desai, Dahiben Self Pay 93000 4/16/2008 31.33 31.33
1000272906 Desai, Dahiben Self Pay 99213 4/16/2008 82.64 82.64
1000267991 Desai, Dahiben Self Pay 83036 3/31/2008 20 20
1000267991 Desai, Dahiben Self Pay 80061 3/31/2008 30 30
1000267991 Desai, Dahiben Self Pay 80053 3/31/2008 25 25
1000267991 Desai, Dahiben Self Pay 36415 3/31/2008 10 10
1000267302 Floyd, Joyce MEDICARE PART B 93018 3/17/2008 21.12 3.02
1000267302 Floyd, Joyce MEDICARE PART B 93016 3/17/2008 32.71 4.67
1000267302 Floyd, Joyce MEDICARE PART B 78480 3/17/2008 24.22 3.46
1000267302 Floyd, Joyce MEDICARE PART B 78478 3/17/2008 36.93 5.28
1000267302 Floyd, Joyce MEDICARE PART B 78465 3/17/2008 102.99 14.71
1000267300 Floyd, Joyce MEDICARE PART B 93325 3/16/2008 5.26 0.75
1000267300 Floyd, Joyce MEDICARE PART B 93320 3/16/2008 26.93 3.85
1000267300 Floyd, Joyce MEDICARE PART B 93307 3/16/2008 65.47 9.35
1000267300 Floyd, Joyce MEDICARE PART B 99233 3/17/2008 125.95 17.99
1000267300 Floyd, Joyce MEDICARE PART B 99233 3/16/2008 125.95 17.99
1000267300 Floyd, Joyce MEDICARE PART B 99254 3/15/2008 217.26 31.04
1000264425 Hatch, Kathryn BCBS OF ARIZONA PO BO93015 3/19/2008 143.03 35
1000258174 Atherton, Dennis BCBS OF ARIZONA PO BO93000 2/7/2008 31.33 20.07
1000256892 Kinkle, Annie MEDICARE PART B 99204 1/24/2008 191.7 70.39
1000255941 Olivito, Marsha MEDICARE PART B 99213 1/28/2008 82.64 11.81
1000253943 Lackovich, William BCBS OF ARIZONA PO BO99213 1/15/2008 82.64 20
1000251377 Olivito, Marsha MEDICARE PART B 99214 1/2/2008 124.25 26.38
1000251108 Vance, Edna DESERT CANYON COMMUN 99214 12/31/2007 126.08 35
1000398743 Riddle, William DESERT CANYON COMMUN 99213 5/24/2010 71 33
1000398123 Wilcox, Johathan BCBS OF ARIZONA PO BO99213 5/19/2010 71 56.8
1000392973 Smith, Ben MEDICARE PART B 99204 4/26/2010 162 162
1000392200 Wiggin, Nathan KINGMAN REGIONAL MED93510 12/30/2009 341 341
1000392200 Wiggin, Nathan KINGMAN REGIONAL MED93325 12/29/2009 6 6
1000392200 Wiggin, Nathan KINGMAN REGIONAL MED93320 12/29/2009 29 29
1000392200 Wiggin, Nathan KINGMAN REGIONAL MED93307 12/29/2009 69 69
1000392200 Wiggin, Nathan KINGMAN REGIONAL MED93018 12/29/2009 23 23
1000392200 Wiggin, Nathan KINGMAN REGIONAL MED93016 12/29/2009 34 34
1000387579 Sanfilippo, Candice KINGMAN REGIONAL MED93306 3/30/2010 76 76
1000386917 Wilcox, Johathan BCBS OF ARIZONA PO BO93000 3/29/2010 22 17.6
1000386917 Wilcox, Johathan BCBS OF ARIZONA PO BO99244 3/29/2010 235 10.8
1000385215 Lake, Phyllis HEALTH CHOICE 410 NOR99239 3/20/2010 107 107
1000385215 Lake, Phyllis HEALTH CHOICE 410 NOR99223 3/19/2010 204 204
1000385021 Cornett, Terry AMERIBEN IEC GROUP 99214 3/18/2010 106 30
1000381344 Baird, Ronald MEDICARE PART B 99222 2/27/2010 139 25.16
1000380065 Barber, Dana ADMINISTRATIVE ENTERP99202 1/16/2010 71.94 10
1000377327 Cafarelli, Ralph DESERT CANYON COMMUN 93306 2/8/2010 252.81 45.96
1000375462 Davis, Mcarthur CIGNA HEALTH CARE PO 93018 1/27/2010 17.05 16.6
1000375462 Davis, Mcarthur CIGNA HEALTH CARE PO 93016 1/27/2010 25.6 25.6
1000375462 Davis, Mcarthur CIGNA HEALTH CARE PO 78452 1/27/2010 85.02 42.51
1000373834 Cafarelli, Ralph DESERT CANYON COMMUN 99213 1/21/2010 70.15 33
1000373197 Lewis, Patricia AMERICAN NATIONAL LIF 93000 12/28/2009 28.19 5.64
1000373197 Lewis, Patricia AMERICAN NATIONAL LIF 99213 12/28/2009 83.94 16.79
1000372810 Michael, Jean DESERT CANYON COMMUN 93306 1/13/2010 252.81 47.78
1000370665 Nichols, Melba DESERT CANYON COMMUN 99213 12/23/2009 83.94 35
1000369212 Kaiser, Charles ADMINISTRATIVE ENTERP99211 12/12/2009 25.42 4.07
1000368498 Kaiser, Charles ADMINISTRATIVE ENTERP99212 12/5/2009 50.54 30
1000366913 Haynes, Edith KINGMAN REGIONAL MED93018 11/16/2009 22.33 22.33
1000366911 Haynes, Edith KINGMAN REGIONAL MED93016 11/16/2009 33.69 33.69
1000366911 Haynes, Edith KINGMAN REGIONAL MED78480 11/16/2009 24.19 24.19
1000366911 Haynes, Edith KINGMAN REGIONAL MED78478 11/16/2009 37.67 37.67
1000366911 Haynes, Edith KINGMAN REGIONAL MED78465 11/16/2009 108.65 108.65
1000366911 Haynes, Edith KINGMAN REGIONAL MED93306 11/16/2009 98.71 98.71
1000366911 Haynes, Edith KINGMAN REGIONAL MED99254 11/16/2009 228.06 228.06
1000366618 Allen, Linda AETNA PO BOX 14079 99211 8/27/2009 25.42 20
1000365711 Sanfilippo, Candice KINGMAN REGIONAL MED99234 11/9/2009 175.25 175.25
1000363354 Sanfilippo, Candice KINGMAN REGIONAL MED99213 10/27/2009 83.94 83.94
1000362314 Kaiser, Charles ADMINISTRATIVE ENTERP99213 10/20/2009 83.94 25
1000361761 Kaiser, Charles ADMINISTRATIVE ENTERP93306 10/19/2009 358.84 5
1000358301 Meehan, William SECURE HORIZONS DIREC99213 9/29/2009 83.94 30
1000357958 Meehan, William SECURE HORIZONS DIREC93016 9/21/2009 33.69 30
1000355271 Wilson, Jimmie MEDICARE PART B 93556 9/11/2009 62.97 9
1000355271 Wilson, Jimmie MEDICARE PART B 93555 9/11/2009 61.47 8.78
1000355271 Wilson, Jimmie MEDICARE PART B 93545 9/11/2009 224.53 32.08
1000355271 Wilson, Jimmie MEDICARE PART B 93543 9/11/2009 106.87 15.27
1000355271 Wilson, Jimmie MEDICARE PART B 93510 9/11/2009 340.76 34.87
1000121463 Beach, Elmer MEDICARE PART B 93307 4/13/2006 275 -29.54
1000121463 Beach, Elmer MEDICARE PART B 93320 4/13/2006 120 -22.86
1000121463 Beach, Elmer MEDICARE PART B 93325 4/13/2006 165 -6.7
1000375435 Lockard, John MEDICARE PART B 93306 1/25/2010 75.23 13.72
1000399966 Smith, Steven MEDICARE PART B 99213 6/1/2010 71 13.16
1000400141 Ferguson, Richard MEDICARE PART B 99213 6/1/2010 71 3.03
1000400098 Wilde, Elizabeth MEDICARE PART B 99213 6/2/2010 71 3.03
1000400097 Wilde, Wolfgang MEDICARE PART B 99214 6/2/2010 106 4.54
1000400096 Hamon, Joan MEDICARE PART B 99213 6/2/2010 71 3.03
1000399962 Owens, Ricky MEDICARE PART B 99213 6/1/2010 71 3.03
1000399837 Pewsey, Roger MEDICARE PART B 99214 6/1/2010 106 4.54
1000399825 Pratte, Darlyene MEDICARE PART B 99213 6/1/2010 71 3.03
1000376310 Pace, Lucille MEDICARE PART B 99213 2/4/2010 70.15 63.69
1000290590 Tharp, Jimmy MEDICARE PART B 94640 7/22/2008 18.67 2.67
1000290158 Tharp, Jimmy MEDICARE PART B 99213 7/31/2008 82.64 11.81
1000279153 Westphal, Earl MEDICARE PART B 93880 5/15/2008 40.65 5.81
1000279153 Westphal, Earl MEDICARE PART B 93880 5/15/2008 206.43 28.22
1000279150 Westphal, Earl MEDICARE PART B 93325 5/15/2008 5.26 0.75
1000279150 Westphal, Earl MEDICARE PART B 93320 5/15/2008 26.93 3.85
1000279150 Westphal, Earl MEDICARE PART B 93320 5/15/2008 89.16 12.74
1000279150 Westphal, Earl MEDICARE PART B 93307 5/15/2008 65.47 9.35
1000104492 Li, Jiro SIERRA SPECTRUM PO BO85610 5/5/2006 10 -5.49
1000339640 Smith, Calvin MEDICARE PART B 93925 6/9/2009 40.61 5.8
1000339640 Smith, Calvin MEDICARE PART B 93880 6/9/2009 42.58 6.08
1000339640 Smith, Calvin MEDICARE PART B 93306 6/9/2009 260.13 37.16
1000320792 Bowling, Charles MEDICARE PART B 75716 2/6/2009 93.21 -51.96
1000312489 Thompson, Craig MEDICARE PART B 94760 12/22/2008 3.59 0.96
1000234119 Bockoven, Robert DESERT CANYON COMMUN 99213 10/18/2007 83.16 20
1000198429 Brown, Virginia DESERT CANYON COMMUN 36415 5/9/2007 10 10
1000198429 Brown, Virginia DESERT CANYON COMMUN 85025 5/9/2007 15 15
1000198429 Brown, Virginia DESERT CANYON COMMUN 80053 5/9/2007 25 25
1000198429 Brown, Virginia DESERT CANYON COMMUN 80061 5/9/2007 30 30
1000320083 Van Dyck, Walter MEDICARE PART B 99239 2/9/2009 132.66 2.67
1000320083 Van Dyck, Walter MEDICARE PART B 99233 2/8/2009 131.99 4.32
1000320083 Van Dyck, Walter MEDICARE PART B 99233 2/7/2009 131.99 4.32
1000320083 Van Dyck, Walter MEDICARE PART B 99223 2/6/2009 248.93 7.37
1000318134 Blake, Billie MEDICARE PART B 99310 1/30/2009 163.53 95.53
1000399929 Kilgroe, Janeene MEDICARE PART B 99212 6/1/2010 42 7.84
1000399844 Sorensen, Eileen MEDICARE PART B 99214 6/1/2010 106 19.72
1000399967 Gridley, Zena MEDICARE PART B 99213 6/1/2010 71 3.03
1000399901 Lent, Dale MEDICARE PART B 99213 6/1/2010 71 3.03
1000260190 Ponder, Cleo GILSBAR INC PO BOX 294 93000 2/18/2008 31.33 25.06
1000260190 Ponder, Cleo GILSBAR INC PO BOX 294 99214 2/18/2008 124.25 30
1000215950 Ponder, Cleo GILSBAR INC PO BOX 294 93000 7/9/2007 34.42 28.89
1000215950 Ponder, Cleo GILSBAR INC PO BOX 294 99214 7/9/2007 126.08 30
1000206925 Ponder, Cleo GILSBAR INC PO BOX 294 80061 6/4/2007 30 11.02
1000206925 Ponder, Cleo GILSBAR INC PO BOX 294 80053 6/4/2007 25 14.18
1000158968 Keatley, Ina MEDICARE PART B 93010 12/4/2006 15 -9.1
1000158968 Keatley, Ina MEDICARE PART B 93005 12/4/2006 23.69 -17.73
1000158968 Keatley, Ina MEDICARE PART B 99213 12/4/2006 75 -52.55
1000158356 Keatley, Ina MEDICARE PART B 83721 11/30/2006 20 -13.33
1000158356 Keatley, Ina MEDICARE PART B 80061 11/30/2006 30 -14.3
1000158356 Keatley, Ina MEDICARE PART B 80053 11/30/2006 25 -11.91
1000158356 Keatley, Ina MEDICARE PART B 36415 11/30/2006 10 -3
1000139216 Keatley, Ina MEDICARE PART B 83721 9/11/2006 20 -20
1000139212 Keatley, Ina MEDICARE PART B 80061 9/11/2006 30 -30
1000139212 Keatley, Ina MEDICARE PART B 80053 9/11/2006 25 -25
1000139212 Keatley, Ina MEDICARE PART B 93010 9/11/2006 15 -15
1000139212 Keatley, Ina MEDICARE PART B 93005 9/11/2006 25 -25
1000139212 Keatley, Ina MEDICARE PART B 36415 9/11/2006 10 -10
1000139212 Keatley, Ina MEDICARE PART B 99213 9/11/2006 75 -75
1000133421 Keatley, Ina MEDICARE PART B 82948 8/16/2006 10 -10
1000133421 Keatley, Ina MEDICARE PART B 99213 8/16/2006 75 -75
1000295593 Powlis, Gladys MEDICARE PART B 93735 9/5/2008 28.5 0.46
1000399912 Bethel, Lois MEDICARE PART B 99213 6/1/2010 71 6.81
1000142249 Marcott, Edward MEDICARE PART B 36100 9/12/2006 780 -348.15
1000208858 Ruggles, Duane MEDICARE PART B 93010 7/10/2007 15 1.67
1000208858 Ruggles, Duane MEDICARE PART B 93005 7/10/2007 22.73 3.25
1000208858 Ruggles, Duane MEDICARE PART B 99213 7/10/2007 83.16 44.63
1000241709 Webb, William HEALTH NET PO BOX 142 99213 11/19/2007 83.16 35
1000201706 Webb, William HEALTH NET PO BOX 142 99213 6/5/2007 83.16 -12.52
1000142784 Slaughter, Aline MEDICARE PART B 99244 9/25/2006 235 34.61
1000399827 Cronan, William MEDICARE PART B 99214 6/1/2010 106 4.54
1000219425 Smelter, Ethel HUMANA GOLD CHOICE P99214 8/23/2007 126.08 15
1000167181 Jackson, Linda ADMINISTRATIVE ENTERP36215 1/5/2007 324.93 25.99
1000167181 Jackson, Linda ADMINISTRATIVE ENTERP75710 1/5/2007 660.18 52.81
1000167181 Jackson, Linda ADMINISTRATIVE ENTERP92980 1/5/2007 1,115.00 39.2
1000127969 Powell, William BCBS OF ARIZONA PO BO99213 7/24/2006 75 20
1000110634 Powell, William BCBS OF ARIZONA PO BO99213 3/16/2006 75 20
1000110633 Powell, William BCBS OF ARIZONA PO BO36415 3/17/2006 10 4.8
1000167761 Garza, Ramon MEDICARE PART B 99213 1/9/2007 83.16 59.4
1000163448 Garza, Ramon MEDICARE PART B 99213 12/20/2006 70.22 10.51
1000373879 Arnold, Margarete MEDICARE PART B 99204 1/21/2010 161.88 132.48
1000139567 Launer, Marilynn HUMANA GOLD CHOICE P99211 9/8/2006 30 15
1000388265 Allen, Paul AMERICHOICE APIPA PO 99291 1/9/2010 233 38.59
1000388265 Allen, Paul AMERICHOICE APIPA PO 99291 1/8/2010 233 38.59
1000388265 Allen, Paul AMERICHOICE APIPA PO 99291 1/7/2010 233 38.59
1000388265 Allen, Paul AMERICHOICE APIPA PO 99291 1/6/2010 233 38.59
1000388265 Allen, Paul AMERICHOICE APIPA PO 99291 1/5/2010 233 38.59
1000388265 Allen, Paul AMERICHOICE APIPA PO 99255 1/4/2010 278.06 36.5
1000186611 Curtindale, William MEDICARE PART B 99232 2/19/2007 89.12 12.73
1000186611 Curtindale, William MEDICARE PART B 99232 2/18/2007 89.12 12.73
1000186611 Curtindale, William MEDICARE PART B 99232 2/17/2007 89.12 12.73
1000186611 Curtindale, William MEDICARE PART B 99232 2/16/2007 89.12 12.73
1000186611 Curtindale, William MEDICARE PART B 99233 2/15/2007 127.33 18.19
1000186611 Curtindale, William MEDICARE PART B 99255 2/14/2007 273.31 39.04
1000307902 Stroud, Donald DESERT CANYON COMMUN 99214 11/25/2008 124.25 10
1000295081 Stroud, Donald DESERT CANYON COMMUN 99213 8/26/2008 82.64 3
1000260655 Stroud, Donald DESERT CANYON COMMUN 99214 2/21/2008 124.25 5
1000243921 Stroud, Donald DESERT CANYON COMMUN 99213 11/27/2007 83.16 35
1000161768 Stroud, Donald DESERT CANYON COMMUN 99214 12/13/2006 111 15
1000400115 Linson, Helen MEDICARE PART B 99212 6/2/2010 42 1.81
1000400095 Anderson, Lee MEDICARE PART B 99213 6/2/2010 71 3.03
1000399852 Wallace, Loechol MEDICARE PART B 93010 6/1/2010 15 0.42
1000399852 Wallace, Loechol MEDICARE PART B 93005 6/1/2010 12 0.49
1000399897 Mcdavid, Vanessa MEDICARE PART B 99213 6/1/2010 71 13.16
1000399892 Milham, Lorien MEDICARE PART B 99213 6/1/2010 71 13.16
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Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually budget
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually budget
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually budget
Set Status Manually
Set Status Manually
Set Status Manually budget
Set Status Manually budget
Set Status Manually budget
Set Status Manually budget
Set Status Manually budget
Set Status Manually budget
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually budget
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
Set Status Manually
AR Comments

billed pt - RV As per CM ID 117157 08/20/2009 Renee Fields We are both familiar on this case as we have worked it a few tim
billed pt - RV As per CM ID 117157 08/20/2009 Renee Fields We are both familiar on this case as we have worked it a few tim
billed pt - RV As per CM ID 117157 08/20/2009 Renee Fields We are both familiar on this case as we have worked it a few tim
billed pt - RV As per CM ID 117157 08/20/2009 Renee Fields We are both familiar on this case as we have worked it a few tim
billed pt - RV As per CM ID 117157 08/20/2009 Renee Fields We are both familiar on this case as we have worked it a few tim
BCBS- cpt 99233 dnd as the subscriber contract has a precertification authorization requirement for this service. File ref# mail
BCBS- cpt 99233 dnd as the subscriber contract has a precertification authorization requirement for this service. File ref# mail
$75 SUMMERLIN LIFE & HEALTH INS- cpt 83721 dnd as inclusive. file ref# mail 7-3-07_20070703173748 pg 13 rev 070507

Received copay payment $15 on 8/4/2008 and applied to this claim Id

As per calling mail dt 120509 Cld to the pt. Donald hammack ph#928 767 4230 tt his wife mary she sd they received a bill in th
As per calling mail dt 120509 Cld to the pt. Donald hammack ph#928 767 4230 tt his wife mary she sd they received a bill in th
As per calling mail dt 120509 Cld to the pt. Donald hammack ph#928 767 4230 tt his wife mary she sd they received a bill in th
As per calling mail dt 120509 Cld to the pt. Donald hammack ph#928 767 4230 tt his wife mary she sd they received a bill in th
As per calling mail dt 120509 Cld to the pt. Donald hammack ph#928 767 4230 tt his wife mary she sd they received a bill in th
555.60 ARIZONA FOUNDATION-cpt 93325/93320 $240.68 amounthas been appiled to the deductible mail 2-6-07_20070206
555.60 ARIZONA FOUNDATION-cpt 93325/93320 $240.68 amounthas been appiled to the deductible mail 2-6-07_20070206
555.60 ARIZONA FOUNDATION-cpt 93325/93320 $240.68 amounthas been appiled to the deductible mail 2-6-07_20070206
corrected claims for DOS 11/30/06 mailed to BCBS of Arizona on 3/19/07. sue Recd BCBS eob dt 032907 - EOB PaulKalanit
MCR,as claim denied as patient cannot be identified as our insured.Ref Elec img#,121406,pgno31_sudar122006 Patient nam

MMSI-CPT-93555, 93556-Identification adjustment. File ref; MAIL B 1 _20090814173816 pg-30 mn 081909 Received copay
CIGNA 80053/80438 This service is payable to the provider based upon the provider contract, Therefore the patient participan
As per mail dt 9/3/2009 pat copay is $15 so adjusted the balance-sri 090309
MCR-CPT-G0107-Contractural Obligations. Payment adjusted because this procedure code and modifier were invalid on the
Received copay payment $40 on 02/16/2009 and applied to this claim Id AETNA Deductibles applied $ 38.96 as per file ref M
Received copay payment $40 on 02/16/2009 and applied to this claim Id AETNA Deductibles applied $ 38.96 as per file ref M
Received copay payment $40 on 02/16/2009 and applied to this claim Id AETNA Deductibles applied $ 38.96 as per file ref M
Received copay payment $40 on 02/16/2009 and applied to this claim Id AETNA Deductibles applied $ 38.96 as per file ref M
Received copay payment $40 on 02/16/2009 and applied to this claim Id AETNA Deductibles applied $ 38.96 as per file ref M
as per cm cpt taken 114099 mur111208 BCBS-CPT-99223-Deductible amount $ 188.57 File ref; MAIL 11-24 B1_2008112511
as per cm cpt taken 114099 mur111208 BCBS-CPT-99223-Deductible amount $ 188.57 File ref; MAIL 11-24 B1_2008112511
as per cm cpt taken 114099 mur111208 BCBS-CPT-99223-Deductible amount $ 188.57 File ref; MAIL 11-24 B1_2008112511
as per cm cpt taken 114099 mur111208 BCBS-CPT-99223-Deductible amount $ 188.57 File ref; MAIL 11-24 B1_2008112511
as per cm cpt taken 114099 mur111208 BCBS-CPT-99223-Deductible amount $ 188.57 File ref; MAIL 11-24 B1_2008112511
as per cm cpt taken 114099 mur111208 BCBS-CPT-99223-Deductible amount $ 188.57 File ref; MAIL 11-24 B1_2008112511
As per chked in online claim inprocess - sar 111808 as per online claim status _ pymt $46.98 check # 10196849 dt 11/26/200

updated in cm-113972 mur102508. As per cm Renee Fields- There is no insurance. Dr. K will collect it on his own from the so
updated in cm-113972 mur102508. As per cm Renee Fields- There is no insurance. Dr. K will collect it on his own from the so
Received copay payment $10 on 10/15/2008 and applied to this claim Id
BCBS-Deductible amount $ 320.21 File ref; mail paymnts 10-22_20081023170449 pg-09 mn 102508
BCBS-Deductible amount $ 320.21 File ref; mail paymnts 10-22_20081023170449 pg-09 mn 102508
BCBS-Deductible amount $ 320.21 File ref; mail paymnts 10-22_20081023170449 pg-09 mn 102508
BCBS-Deductible amount $ 320.21 File ref; mail paymnts 10-22_20081023170449 pg-09 mn 102508
BCBS-Deductible amount $ 320.21 File ref; mail paymnts 10-22_20081023170449 pg-09 mn 102508
As per chked in online NIS claim refiled on 101508 sar As per chked in online status inprocess - sar 102008
claim refiled on 081908 moh

i have checked scan card.

Misc payment arrangements vadivel scan date stated $15 a month, status changed to set status manually - RV
adjusted claim 1000274547 for the CPT 99203 create new claim enter moh Claim#1000278681 sent to secondary on 06172
Claim#1000274549 sent to secondary on 06172008-Denise HEALTH CHOICE-CPT-Member not enrolled at DOS.File ref;MA

Sent Hardship application by dr office to patient ref EOB 8.19 MAIL DEPOSIT_20080819170954.pdf Pg 53
Sent Hardship application by dr office to patient ref EOB 8.19 MAIL DEPOSIT_20080819170954.pdf Pg 53
Sent Hardship application by dr office to patient ref EOB 8.19 MAIL DEPOSIT_20080819170954.pdf Pg 53
Sent Hardship application by dr office to patient ref EOB 8.19 MAIL DEPOSIT_20080819170954.pdf Pg 53
Sent Hardship application by dr office to patient ref EOB 8.19 MAIL DEPOSIT_20080819170954.pdf Pg 53
Sent Hardship application by dr office to patient ref EOB 8.19 MAIL DEPOSIT_20080819170954.pdf Pg 53
Sent Hardship application by dr office to patient ref EOB 8.19 MAIL DEPOSIT_20080819170954.pdf Pg 53
Sent Hardship application by dr office to patient ref EOB 8.19 MAIL DEPOSIT_20080819170954.pdf Pg 53
Sent Hardship application by dr office to patient ref EOB 8.19 MAIL DEPOSIT_20080819170954.pdf Pg 53
Sent Hardship application by dr office to patient ref EOB 8.19 MAIL DEPOSIT_20080819170954.pdf Pg 53
Sent Hardship application by dr office to patient ref EOB 8.19 MAIL DEPOSIT_20080819170954.pdf Pg 53

Received copay $25 for Dos 2/7/2008 and applied

As per CM Id 117414 ( 09/10/2009 Renee Fields: I spoke with her (yesterday) and Iam sending her a hardship application to s

BCBS-CPT-Onset date needed before claim can be processed.File ref;mail b6_20080219192315.pdf pg#13 arun022708 Pen
MCR-CPT-99214-CO-45-Charges exceed your contracted/ legislated fee arrangement. This change to be effective 6/1/07:Cha
NIS refiled - RV

MCR - Payment adjusted because New Patient qualifications were not met. Ref 081010-1 pg 4
audited cal 03292010 NIS. Claim refiled. Udaya042110.
Claim has to be filed to VA Once refund has made-sel 07262010
updated in cm 119658 Claim#1000380065 sent to primary on 06042010 by Paper - RG

Pt said he will pay bill in full on june 10th - Ref misc 20100528115913 - suresh 052910
Pt said he will pay bill in full on june 10th - Ref misc 20100528115913 - suresh 052910
Pt said he will pay bill in full on june 10th - Ref misc 20100528115913 - suresh 052910

Claim#1000373197 sent to primary on 01262010 by Paper - RG Claim#1000373197 sent to primary on 01262010 by Paper
Claim#1000373197 sent to primary on 01262010 by Paper - RG Claim#1000373197 sent to primary on 01262010 by Paper

Claim#1000369212 sent to primary on 12212009 by Paper - RG

Claim#1000368498 sent to primary on 12212009 by Paper - RG

AS PER SB MENTIONED AS SELF PAY, SO BILLED TO PATIENT MUR112509

Claim was denied as Member not enrolled at DOS file ref #MAIL B3_20091125163010 pg # 28. - CHA 113009
Claim#1000362314 sent to primary on 11132009 by Paper - RG
Claim#1000361761 sent to primary on 11132009 by Paper - RG

MCR-CPT-75756-Contractural Obligations. Payment adjusted because this service/procedure requires that a qualifying servic
MCR-CPT-75756-Contractural Obligations. Payment adjusted because this service/procedure requires that a qualifying servic
MCR-CPT-75756-Contractural Obligations. Payment adjusted because this service/procedure requires that a qualifying servic
MCR-CPT-75756-Contractural Obligations. Payment adjusted because this service/procedure requires that a qualifying servic
MCR-CPT-75756-Contractural Obligations. Payment adjusted because this service/procedure requires that a qualifying servic
claim NIS(7/17/2006)-Refiled on 090506-Moh MCR,cpt 93880,93925 as Duplicate claim/service.cpt 93971 as These are non
claim NIS(7/17/2006)-Refiled on 090506-Moh MCR,cpt 93880,93925 as Duplicate claim/service.cpt 93971 as These are non
claim NIS(7/17/2006)-Refiled on 090506-Moh MCR,cpt 93880,93925 as Duplicate claim/service.cpt 93971 as These are non
Claim#1000375435 sent to secondary on 03012010- RG United American Inc - Service dates were after coverage lapsed. Fi
245a22671 Claim#1000399966 sent to secondary on 07062010- RG
NIS. Claim refiled. Udaya062510. claim forwarded to Secondary insurance - 06/29/2010
Claim forwarded to Secondary insurance - 06/29/2010
claim forwarded to Secondary insurance - 06/29/2010
Claim forwarded to Secondary insurance - 06/29/2010
NIS. Claim refiled. Udaya062110. claim forwarded to Secondary insurance - 06/28/2010
NIS. Claim refiled. Udaya062110. claim forwarded to Secondary insurance - 06/28/2010 AARP - CPTs 80053,85025 Becaus
NIS. Claim refiled. Udaya062110. claim forwarded to Secondary insurance - 06/28/2010
Claim forwarded to Secondary insurance - 02/13/2010 AARP-$63.69 as applied as deductible, file ref;REF MAIL B1 3-11-10
MCR-Received denail medicare EOB#081908.pdf pg#11 as CPT - 99204 as Payment denied because only one visit or consu
 Claim#1000290158 sent to secondary on 09192008-Denise AARP-Oue records show that you did not have coverage at the
CLAIM INFORMATION FORWARDED TO: AETNA, INC. file ref 060308 Aetna - $35.30 co insurance DEPOSIT 7-1-08_2008
CLAIM INFORMATION FORWARDED TO: AETNA, INC. file ref 060308 Aetna - $35.30 co insurance DEPOSIT 7-1-08_2008
CLAIM INFORMATION FORWARDED TO: AETNA, INC. file ref 060308 Aetna - $69.48 co insurance DEPOSIT 7-1-08_2008
CLAIM INFORMATION FORWARDED TO: AETNA, INC. file ref 060308 Aetna - $69.48 co insurance DEPOSIT 7-1-08_2008
CLAIM INFORMATION FORWARDED TO: AETNA, INC. file ref 060308 Aetna - $69.48 co insurance DEPOSIT 7-1-08_2008
CLAIM INFORMATION FORWARDED TO: AETNA, INC. file ref 060308 Aetna - $69.48 co insurance DEPOSIT 7-1-08_2008
File ref 20060609113712_Pg 7 Chk# 162527393 $21.51 ded applied_Chi 061006 CPT 85610 dnd as Missing/incomplete/inva
Claim#1000339640 sent to secondary on 07272009- RG UHC-CPT-93306, 93880, 93925-Primary carrier paid in full. File ref
Claim#1000339640 sent to secondary on 07272009- RG UHC-CPT-93306, 93880, 93925-Primary carrier paid in full. File ref
Claim#1000339640 sent to secondary on 07272009- RG UHC-CPT-93306, 93880, 93925-Primary carrier paid in full. File ref
CPT 75716 refiled with 59 mod on 030609 moh MCR-CPT-75716Contractural Obligations. Payment adjusted because this se
CPT 94760 adjusted on 012209 moh Claim#1000312489 sent to secondary on 02172009-Denise
Claim#1000234119 sent to secondary on 02152008-Denise AETNA-CPT-These expenses require further review.No action,on
NIS refiled on 070307 moh claim refiled on 081607-GP. 80 Claim Refiled on 120707-mani claim refiled taken by arun on 06
NIS refiled on 070307 moh claim refiled on 081607-GP. 80 Claim Refiled on 120707-mani claim refiled taken by arun on 06
NIS refiled on 070307 moh claim refiled on 081607-GP. 80 Claim Refiled on 120707-mani claim refiled taken by arun on 06
NIS refiled on 070307 moh claim refiled on 081607-GP. 80 Claim Refiled on 120707-mani claim refiled taken by arun on 06
Claim#1000320083 sent to secondary on 04202009-Denise As per calling send to sec-sel 060609 Claim#1000320083 sent
Claim#1000320083 sent to secondary on 04202009-Denise As per calling send to sec-sel 060609 Claim#1000320083 sent
Claim#1000320083 sent to secondary on 04202009-Denise As per calling send to sec-sel 060609 Claim#1000320083 sent
Claim#1000320083 sent to secondary on 04202009-Denise As per calling send to sec-sel 060609 Claim#1000320083 sent
Claim#1000318134 sent to secondary on 03092009-Denise
NIS. Claim refiled. Udaya062110.
NIS. Claim refiled. Udaya062110. claim forwarded to Secondary insurance - 06/28/2 UHC - This plan determines benefits on
Claim forwarded to Secondary insurance - 06/29/2010
NIS. Claim refiled. Udaya062110. claim forwarded to Secondary insurance - 06/28/2010 UHC - CPT 99213 Duplicate claim/s
GILSBAR-CPT-93000-$25.06 Deductible applied.File ref;mail pymnts 3-17 b1_20080318100221.pdf pg#44 arun03108
GILSBAR-CPT-93000-$25.06 Deductible applied.File ref;mail pymnts 3-17 b1_20080318100221.pdf pg#44 arun03108
160.5 GILSBAR-CPT-93000 as $28.89 deductible applied.File ref;mail deposit 09102007_20070910183503.pdf pgno65 arun
160.5 GILSBAR-CPT-93000 as $28.89 deductible applied.File ref;mail deposit 09102007_20070910183503.pdf pgno65 arun
GILSBAR-CPT,36415 as $4.80 deductible applied.CPT-80053 as $14.18 deductible applied.File ref;MAIL_20070806212035.p
GILSBAR-CPT,36415 as $4.80 deductible applied.CPT-80053 as $14.18 deductible applied.File ref;MAIL_20070806212035.p
claim info forwarded to sec ref#122006 Refile the claim changed policy id,ssn #-122906\ clm retracted for incorrect pymt and
claim info forwarded to sec ref#122006 Refile the claim changed policy id,ssn #-122906\ clm retracted for incorrect pymt and
claim info forwarded to sec ref#122006 Refile the claim changed policy id,ssn #-122906\ clm retracted for incorrect pymt and
Refile the claim changed policy id,ssn #-122906 MCR,as claim retracted for incorrect payment and got deneid as claim/servic
Refile the claim changed policy id,ssn #-122906 MCR,as claim retracted for incorrect payment and got deneid as claim/servic
Refile the claim changed policy id,ssn #-122906 MCR,as claim retracted for incorrect payment and got deneid as claim/servic
Refile the claim changed policy id,ssn #-122906 MCR,as claim retracted for incorrect payment and got deneid as claim/servic
Refile the claim changed policy id,ssn #. 122906 MCR,as claim retracted for incorrect payment and got deneid as claim/servi
Refile the claim Changed policy id,SSN # .122906 180 MCR,as claim retracted for incorrect payment and got deneid as clai
Refile the claim Changed policy id,SSN # .122906 180 MCR,as claim retracted for incorrect payment and got deneid as clai
Refile the claim Changed policy id,SSN # .122906 180 MCR,as claim retracted for incorrect payment and got deneid as clai
Refile the claim Changed policy id,SSN # .122906 180 MCR,as claim retracted for incorrect payment and got deneid as clai
Refile the claim Changed policy id,SSN # .122906 180 MCR,as claim retracted for incorrect payment and got deneid as clai
Refile the claim Changed policy id,SSN # .122906 180 MCR,as claim retracted for incorrect payment and got deneid as clai
NIS refiled. $ub 083106 Refile the claim changed policy id & ssn No. 122906 MCR,as claim retracted for incorrect payment a
NIS refiled. $ub 083106 Refile the claim changed policy id & ssn No. 122906 MCR,as claim retracted for incorrect payment a
Claim#1000295593 sent to secondary on 09262008-Denise need to file secondary evercare per MAIL 11-14 B2_200811190
NIS. Claim refiled. Udaya062110. claim forwarded to Secondary insurance - 06/28/2010 WFIS - This amount disallowed by M
MCR,cpt 36140 as allowed amount has been reduced because a component of the basic procedure/test was paid.Ref Elec im
120.79 Claim#1000208858 sent to secondary on 11022007-Denise As per cm Id 117136 8/19/2009 Renee Fields Vadivel, c
120.79 Claim#1000208858 sent to secondary on 11022007-Denise As per cm Id 117136 8/19/2009 Renee Fields Vadivel, c
120.79 Claim#1000208858 sent to secondary on 11022007-Denise As per cm Id 117136 8/19/2009 Renee Fields Vadivel, c
filed to healthnet - RV mcr-dnd cpt 99213 Payment for charges adjusted. Charges are covered under a capitation agreement/
Claim#1000201706 sent to secondary on 08152007-Denise mcr-dnd for cpt 99213 : Payment for charges adjusted. Charges
MCR partially denied for the cpt 94760 as Payment is included in the allowance for another service -10/12/2006-101206-14. C
Claim forwarded to Secondary insurance - 06/28/2010
MCR-Received denail Medicare Eob img#080708 ref pg #79 as CPT as 99214 as Payment for charges adjusted. Charges are
AEI-92982/92984/92981 this service has been combined/or rebundeled with other service.mail 2_20070206184827 pg 20-mo
AEI-92982/92984/92981 this service has been combined/or rebundeled with other service.mail 2_20070206184827 pg 20-mo
AEI-92982/92984/92981 this service has been combined/or rebundeled with other service.mail 2_20070206184827 pg 20-mo

Received denial from Bcbs stating Invalid Modifiers .062406. Removed the mofifier UB and resubmitted the claim.062406.R

MCR,as deductible on amt $59.4.Ref Elec img#,012507,pgno36_sudar020907 claim info forwarded to sec ref#012507 CIGN
claim info forwarded to sec ref#010907 BCBS- $10.51 subcriber liability .Fileref_MAIL B7 1-22_20070123131205 Pg_25.Hari
claim forwarded to Secondary insurance - 02/24/2010 MCR - Payment adjusted because New Patient qualifications were no
sec. clm for dos 9/8/06 mailed to PHYSICIANS MUTUAL w/EOB-4/2/07mG PM,cpt 99211-the policy number was not in force
HEALTH CHOICE - Resubmit with correct eob. File ref: MAIL B FOUR_20100604163312, pg-9. Udaya060710. Need to send
HEALTH CHOICE - Resubmit with correct eob. File ref: MAIL B FOUR_20100604163312, pg-9. Udaya060710. Need to send
HEALTH CHOICE - Resubmit with correct eob. File ref: MAIL B FOUR_20100604163312, pg-9. Udaya060710. Need to send
HEALTH CHOICE - Resubmit with correct eob. File ref: MAIL B FOUR_20100604163312, pg-9. Udaya060710. Need to send
HEALTH CHOICE - Resubmit with correct eob. File ref: MAIL B FOUR_20100604163312, pg-9. Udaya060710. Need to send
HEALTH CHOICE - Resubmit with correct eob. File ref: MAIL B FOUR_20100604163312, pg-9. Udaya060710. Need to send
Claim#1000186611 sent to secondary on 07202007-Denise 757.12 we received sec ins medicare part D (Drug coverage). s
Claim#1000186611 sent to secondary on 07202007-Denise 757.12 we received sec ins medicare part D (Drug coverage). s
Claim#1000186611 sent to secondary on 07202007-Denise 757.12 we received sec ins medicare part D (Drug coverage). s
Claim#1000186611 sent to secondary on 07202007-Denise 757.12 we received sec ins medicare part D (Drug coverage). s
Claim#1000186611 sent to secondary on 07202007-Denise 757.12 we received sec ins medicare part D (Drug coverage). s
Claim#1000186611 sent to secondary on 07202007-Denise 757.12 we received sec ins medicare part D (Drug coverage). s
AS PER ONLINE NIS CLAIM REFILED ON 12152008 LAL As per online claim paid $58.19 check # 10206553 check 12/31/2
As per chk in online claim inprocess - sar 091708 As per cm Id 115506 03/04/2009 Renee Fields: spoke with patient - he has
Received other payment $15 on 12/10/2008 and applied to this claim Id As per cm Id 115506 03/04/2009 Renee Fields: spok
DESERT CANYON-refund request- reason-Service covered under global surgical payment - post operative visits amt-$30.34
As per cm Id 115506 03/04/2009 Renee Fields. spoke with patient - he has a previous payment arrangement with us that is st
NIS. Claim refiled. Udaya062510. claim forwarded to Secondary insurance - 06/29/2010
Claim forwarded to Secondary insurance - 06/29/2010
NIS. Claim refiled. Udaya062110. claim forwarded to Secondary insurance - 06/28/2010
NIS. Claim refiled. Udaya062110. claim forwarded to Secondary insurance - 06/28/2010
NIS. Claim refiled. Udaya062110.
NIS. Claim refiled. Udaya062110.
Calling Comments

cld unicare tt nancy.f sd clm processed on 071807 awl$721.42 pd$696.42 co-pay$25 its a single chk chk#500281256 clm#071
cld unicare tt nancy.f sd clm processed on 071807 awl$721.42 pd$696.42 co-pay$25 its a single chk chk#500281256 clm#071
cld unicare tt nancy.f sd clm processed on 071807 awl$721.42 pd$696.42 co-pay$25 its a single chk chk#500281256 clm#071
cld unicare tt nancy.f sd clm processed on 071807 awl$721.42 pd$696.42 co-pay$25 its a single chk chk#500281256 clm#071
cld unicare tt nancy.f sd clm processed on 071807 awl$721.42 pd$696.42 co-pay$25 its a single chk chk#500281256 clm#071
cld bcbs tt debra sd the clm for the cpt 99233 was dnd as they require pre auth. asked her to verify the auth#01a2tc9b whethe
cld bcbs tt debra sd the clm for the cpt 99233 was dnd as they require pre auth. asked her to verify the auth#01a2tc9b whethe
Cld summerlin tt linda sd clm is inprocess.it will get processed within 10days.michael 051107

cld desert canyon tt amearo sd clm was dnd reason is not activated on plan and aslo sd he cancalled is plan.-james 022807
cld desert canyon tt amearo sd clm was dnd reason is not activated on plan and aslo sd he cancalled is plan.-james 022807
cld desert canyon tt amearo sd clm was dnd reason is not activated on plan and aslo sd he cancalled is plan.-james 022807
cld desert canyon tt amearo sd clm was dnd reason is not activated on plan and aslo sd he cancalled is plan.-james 022807
cld desert canyon tt amearo sd clm was dnd reason is not activated on plan and aslo sd he cancalled is plan.-james 022807
cld az foundation tt pat sd clm send to zenith on 011707 ph#800-553-2801 clm#2070163192 ,cld tt vanida sd clm processed o
cld az foundation tt pat sd clm send to zenith on 011707 ph#800-553-2801 clm#2070163192 ,cld tt vanida sd clm processed o
cld az foundation tt pat sd clm send to zenith on 011707 ph#800-553-2801 clm#2070163192 ,cld tt vanida sd clm processed o
cld bcbs tt angilica sd clm send for reprocessing because dnd due to an error, told to call back ofter 30 days -john 012907 Cld
cld mcr avr sd clm under process -john 120406

cld az foundation tt tim sd clm in process clm# 2091951945 . john 07/23/09 cld az foundation tt tami sd clm processed and s
cld cigna avr sd processed on 05/02/09 pd$ 239.84 chk# 00547475114 clm# 4190912190523 try to call the customer care the
cld desertcanyon tt sheirly sd clm is currently under process clm#2009050499900247.kevin 050509 Received a voice msg
cld mcr avr sd the members dob is incorrect.-Gopi 02/23/09 cld mcr tt jennifer sd cpt G0107 is not valid for 2009 ,she sd that
cld aetna avr sd the member policy eff from 07/08/2005 to still active.-mark 02/17/09 cld aetna avr sd clm was processed on
cld aetna avr sd the member policy eff from 07/08/2005 to still active.-mark 02/17/09 cld aetna avr sd clm was processed on
cld aetna avr sd the member policy eff from 07/08/2005 to still active.-mark 02/17/09 cld aetna avr sd clm was processed on
cld aetna avr sd the member policy eff from 07/08/2005 to still active.-mark 02/17/09 cld aetna avr sd clm was processed on
cld aetna avr sd the member policy eff from 07/08/2005 to still active.-mark 02/17/09 cld aetna avr sd clm was processed on
cld bcbs avr sd the member policy eff from 01/01/2005 to still active.-mark 11/12/08 Cld to the pt. Dean carey ph#928 767 484
cld bcbs avr sd the member policy eff from 01/01/2005 to still active.-mark 11/12/08 Cld to the pt. Dean carey ph#928 767 484
cld bcbs avr sd the member policy eff from 01/01/2005 to still active.-mark 11/12/08 Cld to the pt. Dean carey ph#928 767 484
cld bcbs avr sd the member policy eff from 01/01/2005 to still active.-mark 11/12/08 Cld to the pt. Dean carey ph#928 767 484
cld bcbs avr sd the member policy eff from 01/01/2005 to still active.-mark 11/12/08 Cld to the pt. Dean carey ph#928 767 484
cld bcbs avr sd the member policy eff from 01/01/2005 to still active.-mark 11/12/08 Cld to the pt. Dean carey ph#928 767 484
 Cld to the pt. Dennis atherton ph#928 565 2655 he sd he received a bill in the amt of $70 and asked the reason for that. i verif
Cld to the pt. Carla register ph#928 753 4288 she sd she received a bill in the amt of $320.21 and asked the reason for that. i
Cld to the pt. Carla register ph#928 753 4288 she sd she received a bill in the amt of $320.21 and asked the reason for that. i
Cld to the pt. Carla register ph#928 753 4288 she sd she received a bill in the amt of $320.21 and asked the reason for that. i
Cld to the pt. Carla register ph#928 753 4288 she sd she received a bill in the amt of $320.21 and asked the reason for that. i
Cld to the pt. Carla register ph#928 753 4288 she sd she received a bill in the amt of $320.21 and asked the reason for that. i

Cld ae tt lisa sd clm is nis , this policy eff from 08/01/2007 to still active . payer id 53589 . i verify the mailing add. john 08/19/08

cld Desert canyon avr sd clm was processed and pd$47.67 chq#10148649 issued on 072308 clm#200807019990598.kevin 0
cld mcr tried with the policy#541402252A avr sd the member policy# is incorrect.-mark 02/13/09
Cld to the pt. Alexandra wells ph#928 767 3163/ 928 715 2142 tt her care taker gela she sd they received a bill in the amt of $
cld ever care tt esther sd she can not locate the pt with her policy# ssn# name and dob. john 10/03/08 Cld to the pt. Alexandr

Cld to the pt. Kathryn hatch ph#928 692 0335 she sd she received a bill in the amt of $35 for the dos 03/19/08 but she sd she
Cld to the pt. Dennis atherton ph#928 565 2655 he sd he received a bill in the amt of $70 and asked the reason for that. i verif
monthly billing until I get back the hardship form and can tell you otherwise - thank you so much, Renee) so change the status to budget pay

Cld bcbs tt alisha sd clm dnd as required pre existing information providers office . she sd they recvd the medical records so sh
Cld to the pt. Marsha olivito ph#928 699 6539 she sd she received a bill in the amt of $54.76 but she sd she previously made
Cld desert canyon tt jesse sd clm nis.member policy is effective from 050106 and still active. need to refile the clm again. verifi
Cld to the pt. William riddle ph#928 692 4784 he sd he received a bill in the amt of $33 which was for the copay balance for th
Cld to the pt. Jonathan wilcox ph#928 279 0528 he sd he received a bill in the amt of $74.40 dated 08/02/10 but he sd he alre

Cld health choice tt erica tried with the policy#A67990260 sd the member policy eff from 05/13/09 and the policy termd on 08/3
 Cld to the pt. Jonathan wilcox ph#928 279 0528 he sd he received a bill in the amt of $74.40 dated 08/02/10 but he sd he alre
Cld to the pt. Jonathan wilcox ph#928 279 0528 he sd he received a bill in the amt of $74.40 dated 08/02/10 but he sd he alre
cld ahccs avr sd no member found in this policy# and ssn#. john 07/01/10
cld ahccs avr sd no member found in this policy# and ssn#. john 07/01/10
cld ameriben tt cracy sd clm nis . john 04/20/10 cld ameriben tt ginger sd clm processed on 05/06/10 pd$ 72.40 pt ded$ 30 c
cld mcr avr sd the eff date of the policy is from 12/01/2007 and currently active. Member is not enrolled with an hmo. Mcr is pri
ckd ADMINISTRATIVE ENTERPRISES website policy eff from 01/01/1992 to still active . saravanan 05/18/10 Cld to the pt.

Cld cigna avr sd the member policy eff from 08/01/2009 to still active and it is a primary ins.-mark 02/05/10
Cld cigna avr sd the member policy eff from 08/01/2009 to still active and it is a primary ins.-mark 02/05/10
Cld cigna avr sd the member policy eff from 08/01/2009 to still active and it is a primary ins.-mark 02/05/10
Cld desert canyon avr sd clm processed on 02/12/10 pd$ 30.69 chk# 10349046 clm# 2010020299901677 . john 02/15/10 Cld
cld universal health care tt lagcia sd the member policy eff from 02/01/10 to still active and it is a primary, correct policy#PF179
cld universal health care tt lagcia sd the member policy eff from 02/01/10 to still active and it is a primary, correct policy#PF179
Cld desert canyon tt jackie sd the $47.48 was applied towards the members copay/ co ins. and it was not applied towards mem
cld desert canyon avr sd clm in process. john 01/13/10 Cld to the pt. Melba nichols ph#928 753 4540 she sd she received a b
chk in aei web site clm nis . john 01/20/10 Cld to the pt. Charles kaiser ph# 928 692 2533 he sd he received a bill in the amt o
chk in aei web site clm nis . john 01/20/10 Cld to the pt. Charles kaiser ph# 928 692 2533 he sd he received a bill in the amt o
Cld to the pt. Edith haynes ph#928 681 9094 she sd she received a bill in the amt of $553.30 which was for the inpatient stay
Cld to the pt. Edith haynes ph#928 681 9094 she sd she received a bill in the amt of $553.30 which was for the inpatient stay
Cld to the pt. Edith haynes ph#928 681 9094 she sd she received a bill in the amt of $553.30 which was for the inpatient stay
Cld to the pt. Edith haynes ph#928 681 9094 she sd she received a bill in the amt of $553.30 which was for the inpatient stay
Cld to the pt. Edith haynes ph#928 681 9094 she sd she received a bill in the amt of $553.30 which was for the inpatient stay
Cld to the pt. Edith haynes ph#928 681 9094 she sd she received a bill in the amt of $553.30 which was for the inpatient stay
Cld to the pt. Edith haynes ph#928 681 9094 she sd she received a bill in the amt of $553.30 which was for the inpatient stay
Cld aetna avr sd the member policy eff from 01/01/2008 to still active.-mark 11/23/09 cld aetna tt rose sd clm was processed
cld health choice tt sandra sd the member policy eff from 07/01/2008 and the policy termd on 08/31/09 and it is a primary ins f
chk health choice web site clm in process clm#930765748.kevin 111809
chk in aei website clm nis the policy eff from 01/01/92 to still active. john 11/19/09 Cld to the pt. Charles kaiser ph# 928 692 2
chk in aei website clm nis the policy eff from 01/01/92 to still active. john 11/19/09 Cld to the pt. Charles kaiser ph# 928 692 2

Cld to the pt. Jimmie wilson ph# 928 377 2110 he sd he received 2 statements one in december in the amt of $147.73 and he
Cld to the pt. Jimmie wilson ph# 928 377 2110 he sd he received 2 statements one in december in the amt of $147.73 and he
Cld to the pt. Jimmie wilson ph# 928 377 2110 he sd he received 2 statements one in december in the amt of $147.73 and he
Cld to the pt. Jimmie wilson ph# 928 377 2110 he sd he received 2 statements one in december in the amt of $147.73 and he
Cld to the pt. Jimmie wilson ph# 928 377 2110 he sd he received 2 statements one in december in the amt of $147.73 and he
3106-moh MISC MISC ALTERNATE DIAGNOSIS CODE_20070125152728-claim refiled with ICD 782.3-020107-Dee sec. clm for dos 4/13
3106-moh MISC MISC ALTERNATE DIAGNOSIS CODE_20070125152728-claim refiled with ICD 782.3-020107-Dee sec. clm for dos 4/13
3106-moh MISC MISC ALTERNATE DIAGNOSIS CODE_20070125152728-claim refiled with ICD 782.3-020107-Dee sec. clm for dos 4/13
cld mcr avr sd the eff date of the policy is from 08/01/1997 and currently active. Member is not enrolled with an hmo. Mcr is pri
cld mcr avr sd the eff date of the policy is from 05/01/1990 and currently active. Member is not enrolled with an hmo. Mcr is pri

Cld to the pt. Lucille pace ph#928 530 4984 she sd she received a bill in the amt of $63.69 which was for the dos 02/04/10 but
Cld to the pt. Jimmy tharp ph#928 565 3030 he sd he received a bill in the amt of $205.53 and he sd he sent a money order f
 cld mcr avr sd clm is currently under process.kevin 081308 Cld to the pt. Jimmy tharp ph#928 565 3030 he sd he received a b
Cld to the pt. Earl westphal ph#928 757 2537 tt his wife darlene she sd she received a bill in the amt of $110.72 but she sd sh
Cld to the pt. Earl westphal ph#928 757 2537 tt his wife darlene she sd she received a bill in the amt of $110.72 but she sd sh
Cld to the pt. Earl westphal ph#928 757 2537 tt his wife darlene she sd she received a bill in the amt of $110.72 but she sd sh
Cld to the pt. Earl westphal ph#928 757 2537 tt his wife darlene she sd she received a bill in the amt of $110.72 but she sd sh
Cld to the pt. Earl westphal ph#928 757 2537 tt his wife darlene she sd she received a bill in the amt of $110.72 but she sd sh
Cld to the pt. Earl westphal ph#928 757 2537 tt his wife darlene she sd she received a bill in the amt of $110.72 but she sd sh
cld mcr avr sd cld mcr avr sd processed amt$30 allowed$21.51 applied to deductable -laksh 071306 cld mcr tt helen sd both

cld mcr reopening dept tt monisha sd add 59 modi and send to reprocess . john 03/23/09 cld mcr avr sd reprocessed clm nis
cld mcr avr sd the eff date of the policy is from 06/01/2008 and currently active. Member is not enrolled with an hmo. Mcr is p
n maximum or not covered under plan provisions.File ref;mail pymnts 5-27 b7_20080528125346.pdf pg#11 arun052908
cld desert canyon tt chris sd clm not on file and the eff date of the policy isfrm 070106 and stil active.-james 062907 cld dese
cld desert canyon tt chris sd clm not on file and the eff date of the policy isfrm 070106 and stil active.-james 062907 cld dese
cld desert canyon tt chris sd clm not on file and the eff date of the policy isfrm 070106 and stil active.-james 062907 cld dese
cld desert canyon tt chris sd clm not on file and the eff date of the policy isfrm 070106 and stil active.-james 062907 cld dese
cld apipa tt barry sd clm nis and he sd evercare is secondary ins for this member. john 05/29/09
cld apipa tt barry sd clm nis and he sd evercare is secondary ins for this member. john 05/29/09
cld apipa tt barry sd clm nis and he sd evercare is secondary ins for this member. john 05/29/09
cld apipa tt barry sd clm nis and he sd evercare is secondary ins for this member. john 05/29/09

mount if the physician or provider accept. File ref:MAIL 7-8_20100708170256. PG-7, WL071510.

Cld gilsbar wents to fax back system left details. michael 03/19/08 cld desert canyon avr sd the member is not eligible for the
Cld gilsbar wents to fax back system left details. michael 03/19/08 cld desert canyon avr sd the member is not eligible for the
cld glisbar inc tt sandry sd clm processed on 083107 pd$67.82 copay$30 chq#3547 chqdt 083107 (its a single chq) clm#0723
cld glisbar inc tt sandry sd clm processed on 083107 pd$67.82 copay$30 chq#3547 chqdt 083107 (its a single chq) clm#0723
cld gilsbar avr sd clm will obtained through fax back system.-james 080307 Cld humana tt jermie tried with policy#602-562-1
cld gilsbar avr sd clm will obtained through fax back system.-james 080307 Cld humana tt jermie tried with policy#602-562-1
cld mcr tt ashley explained her that this clm was billed with incorrect policy#212-36-2797A for the pt. Ina keatley as this policy#
cld mcr tt ashley explained her that this clm was billed with incorrect policy#212-36-2797A for the pt. Ina keatley as this policy#
cld mcr tt ashley explained her that this clm was billed with incorrect policy#212-36-2797A for the pt. Ina keatley as this policy#
cld mcr tt ashley explained her that this clm was billed with incorrect policy#212-36-2797A for the pt. Ina keatley as this policy#
cld mcr tt ashley explained her that this clm was billed with incorrect policy#212-36-2797A for the pt. Ina keatley as this policy#
cld mcr tt ashley explained her that this clm was billed with incorrect policy#212-36-2797A for the pt. Ina keatley as this policy#
cld mcr tt ashley explained her that this clm was billed with incorrect policy#212-36-2797A for the pt. Ina keatley as this policy#
cld mcr avr sd clm currrently under process -john 092706 cld mcr tt ashley explained her that this clm was billed with incorre
cld mcr avr sd clm under processs -john 092606 cld mcr tt ashley explained her that this clm was billed with incorrect policy#
cld mcr avr sd clm under processs -john 092606 cld mcr tt ashley explained her that this clm was billed with incorrect policy#
cld mcr avr sd clm under processs -john 092606 cld mcr tt ashley explained her that this clm was billed with incorrect policy#
cld mcr avr sd clm under processs -john 092606 cld mcr tt ashley explained her that this clm was billed with incorrect policy#
cld mcr avr sd clm under processs -john 092606 cld mcr tt ashley explained her that this clm was billed with incorrect policy#
cld mcr avr sd clm under processs -john 092606 cld mcr tt ashley explained her that this clm was billed with incorrect policy#
cld mcr avr sd the clm nis.-david 082906 cld mcr tt ashley explained her that this clm was billed with incorrect policy#212-36-
cld mcr avr sd the clm nis.-david 082906 cld mcr tt ashley explained her that this clm was billed with incorrect policy#212-36-
cld ever care avr sd clm nis. john 03/06/09 cld ever care tt marya sd clm nis the policy eff from 09/01/08 to still active. john 0
 cld mcr avr sd clm under process -john 101206 cld mcr tt amie explained her that we submitted this clm with incorrect pt. nam
cld mcr avr sd clm is currently under process.-sam 072507 Cld royal neighbours avr sd office was closed. michael 09/05/08
cld mcr avr sd clm is currently under process.-sam 072507 Cld royal neighbours avr sd office was closed. michael 09/05/08
cld mcr avr sd clm is currently under process.-sam 072507 Cld royal neighbours avr sd office was closed. michael 09/05/08
cld mcr avr sd clm dnd on 112807 as member is enrolled in a hmo clm#1107330160330 . jack 113007 Cld to the pt. William w
Cld mcr avr sd member policy is effective from 10/01/03 and still active. member has met the deductible .member enrolled in h
cld mcr avr sd the clm is in process.-david 101006

cld humana gold choice tt candy sd clm currently inprocess clm#7239x01z2 . jack 090607 cld humana gold choice tt robert.h
cld administrative tt tonya sd clm for cpt#92982,92984,92981 dnd on 013007 because they are bundle with cpt#92980 clm#45
cld administrative tt tonya sd clm for cpt#92982,92984,92981 dnd on 013007 because they are bundle with cpt#92980 clm#45
cld administrative tt tonya sd clm for cpt#92982,92984,92981 dnd on 013007 because they are bundle with cpt#92980 clm#45

cld bcbs tt theresa sd the clm was not yet recvd in their system. also sd the provider Belal sharaf is a non participating provide
Cld to the pt. Ramon garza ph#928 718 2266 he sd he received a bill in the amt of $102.34 which was for the year 2006 & 20
Cld to the pt. Ramon garza ph#928 718 2266 he sd he received a bill in the amt of $102.34 which was for the year 2006 & 20
cld mcr avr sd the eff date of the policy is from 09/01/1990 and currently active. Member is not enrolled with an hmo. Mcr is pri
cld humana tt marida sd the clm is in process,received on 091406,clm#6257x142w.-david 092106 Cld to the pt. Marilynn laune

cld mcr avr sd clm currently under process .-james 041807 Cld mh tt anna sd she can not pull anything in this policy# ssn# a
cld mcr avr sd clm currently under process .-james 041807 Cld mh tt anna sd she can not pull anything in this policy# ssn# a
cld mcr avr sd clm currently under process .-james 041807 Cld mh tt anna sd she can not pull anything in this policy# ssn# a
cld mcr avr sd clm currently under process .-james 041807 Cld mh tt anna sd she can not pull anything in this policy# ssn# a
cld mcr avr sd clm currently under process .-james 041807 Cld mh tt anna sd she can not pull anything in this policy# ssn# a
cld mcr avr sd clm currently under process .-james 041807 Cld mh tt anna sd she can not pull anything in this policy# ssn# a
nd agrees to pay 25 thru mail on next wednesday and then 15 a month until paid - he is allowed to do that with us - if you will mark his accou
to do that with us - if you will mark his account just as a fyi - thank you so much for your help, Renee
ntil paid - he is allowed to do that with us - if you will mark his account just as a fyi - thank you so much for your help, Renee
Cld desert canyon tt brayn sd clm processed on 122607,pd$30.34 chk issued on 122607,chk#10067013. it is bulk amt of $284
as a fyi - thank you so much for your help, Renee
 der. again the chk was reissued on 06/02/08 but she sd this time it was sent to krmc mailing add. and returned back to them so i asked her
der. again the chk was reissued on 06/02/08 but she sd this time it was sent to krmc mailing add. and returned back to them so i asked her
der. again the chk was reissued on 06/02/08 but she sd this time it was sent to krmc mailing add. and returned back to them so i asked her
der. again the chk was reissued on 06/02/08 but she sd this time it was sent to krmc mailing add. and returned back to them so i asked her
der. again the chk was reissued on 06/02/08 but she sd this time it was sent to krmc mailing add. and returned back to them so i asked her
so sd if we need more details need to contact the home plan directly. cld bcbs homeplan tt gerald sd cpt 99233 require auth to process the
so sd if we need more details need to contact the home plan directly. cld bcbs homeplan tt gerald sd cpt 99233 require auth to process the

nd the coverage was active for the dos. 800 775 6490
nd the coverage was active for the dos. 800 775 6490
nd the coverage was active for the dos. 800 775 6490
nd the coverage was active for the dos. 800 775 6490
nd the coverage was active for the dos. 800 775 6490

he wants us to take an adjustment on the balance as the pt. was expired.-sam 01/09/09

y jordan ph#928 757 0662 tt his wife patty she sd they received a bill in the amt of $456.54 which was for the dos 07/01/09 but she sd they
3/80438 was dnd as duplicate,she sd she send the clm for reprocess and sd allow 30 days to get process ref#3647.kevin 072909 Received
eepak and for an pcp visit her copay should only be $15 and not $35 but we billed the clms under dr. Kalanithi and because of this they cha
d whether she can get any discounts on the bill. i asked her to contact the dr. office directly regarding this. then she sd she will contact them
at she received a bill in the amt of $65.11 which was for the dos 02/05/09 but she stated that she did not had any service with dr. Kalanithi o
at she received a bill in the amt of $65.11 which was for the dos 02/05/09 but she stated that she did not had any service with dr. Kalanithi o
at she received a bill in the amt of $65.11 which was for the dos 02/05/09 but she stated that she did not had any service with dr. Kalanithi o
at she received a bill in the amt of $65.11 which was for the dos 02/05/09 but she stated that she did not had any service with dr. Kalanithi o
at she received a bill in the amt of $65.11 which was for the dos 02/05/09 but she stated that she did not had any service with dr. Kalanithi o
Deepak so he want to know why he received a bill for dr. Deepak. so he wants us to check this with the dr. office and give him a call back
Deepak so he want to know why he received a bill for dr. Deepak. so he wants us to check this with the dr. office and give him a call back
Deepak so he want to know why he received a bill for dr. Deepak. so he wants us to check this with the dr. office and give him a call back
Deepak so he want to know why he received a bill for dr. Deepak. so he wants us to check this with the dr. office and give him a call back
Deepak so he want to know why he received a bill for dr. Deepak. so he wants us to check this with the dr. office and give him a call back
Deepak so he want to know why he received a bill for dr. Deepak. so he wants us to check this with the dr. office and give him a call back
0 but he sd his copay for an pcp visit should only be $10 and not $30 so he sd we need to verify this with the ins. company. cld humana tt l
h and she will finish it off within 3 months. changed the status as set status manually.-sam 12/09/08
h and she will finish it off within 3 months. changed the status as set status manually.-sam 12/09/08
h and she will finish it off within 3 months. changed the status as set status manually.-sam 12/09/08
h and she will finish it off within 3 months. changed the status as set status manually.-sam 12/09/08
h and she will finish it off within 3 months. changed the status as set status manually.-sam 12/09/08

08/20/08 Cld to the pt. Francis chavez ph#928 753 0736 extn:4116 tt his wife terri she sd she received a bill in the amt of $93.92 but she sd

have proof for that. so she sd we need to verify this with the dr. office and adjust the balance.-sam 02/06/09
ermal test but she sd the pt. did not had an TB intradermal test with dr. sharaf on that day and she also have proof for that. so she sd we ne

adjustment on her balance..-sam 08/07/08

0 but he sd his copay for an pcp visit should only be $10 and not $30 so he sd we need to verify this with the ins. company. cld humana tt l

ut it reached the voice mail box. left voice msg asking him to give us a call back with the chk details. left my ph# and extn. for him to call ba
unt but it will not be reflected on the statements which we send. but she sd the bill which we send is really confusing and she sd she will con

he copay will be adjusted but now he is receiving a bill for the copay for a follow up visit so he sd we need to verify this with the dr. office an
d he already paid it on 07/15/10 thro online using his bank of america account and it was cashed so he sd we need to verify this with the dr.
02/27/10 but he sd the clm was incorrectly billed to mcr and all his hospital stay clms should be billed only to Northern AZ VA and they will
arber Ph# 928 530 9770 Pt. Zip code: 86401 Type of card:Visa Card no:4465 4201 7210 8839 Expiration date:01/14 3 digits on the back of

10 with the chk#1573 for $78.96 and the chk was cashed on 04/15/10 so he sd we need to verify this with the dr. office and post the payme
f she paid the full amt of $72 thro cash so she sd we need to verify this with the dr. office and need to adjust the balance of $22.43 and nee
f she paid the full amt of $72 thro cash so she sd we need to verify this with the dr. office and need to adjust the balance of $22.43 and nee

sd she already made a payment in the amt of $35 on 02/12/2010 thro online banking using her bank of america account and also gave the c
s printed on the bills and his insurance company is not Administrative enterprises. so he sd the bill was incorrectly sent to him to his add. an
s printed on the bills and his insurance company is not Administrative enterprises. so he sd the bill was incorrectly sent to him to his add. an
verage thro ahcccs soon and once it got thro she sd she will call us and give the policy# so that we can bill these clms to ahcccs for payme
verage thro ahcccs soon and once it got thro she sd she will call us and give the policy# so that we can bill these clms to ahcccs for payme
verage thro ahcccs soon and once it got thro she sd she will call us and give the policy# so that we can bill these clms to ahcccs for payme
verage thro ahcccs soon and once it got thro she sd she will call us and give the policy# so that we can bill these clms to ahcccs for payme
verage thro ahcccs soon and once it got thro she sd she will call us and give the policy# so that we can bill these clms to ahcccs for payme
verage thro ahcccs soon and once it got thro she sd she will call us and give the policy# so that we can bill these clms to ahcccs for payme
verage thro ahcccs soon and once it got thro she sd she will call us and give the policy# so that we can bill these clms to ahcccs for payme

e coverage with health choice after the termination date. explained her that other clm for this pt. with the dos 10/27/09 is currently under pro

d that he dont know any of the dr. names printed on the bills and his insurance company is not Administrative enterprises. so he sd the bill w
d that he dont know any of the dr. names printed on the bills and his insurance company is not Administrative enterprises. so he sd the bill w

is paid then he he sd he already mailed a payment in the amt of $100 on 01/19/10 with the chk#1414 (he is not sure abt the chk# he sd he
is paid then he he sd he already mailed a payment in the amt of $100 on 01/19/10 with the chk#1414 (he is not sure abt the chk# he sd he
is paid then he he sd he already mailed a payment in the amt of $100 on 01/19/10 with the chk#1414 (he is not sure abt the chk# he sd he
is paid then he he sd he already mailed a payment in the amt of $100 on 01/19/10 with the chk#1414 (he is not sure abt the chk# he sd he
is paid then he he sd he already mailed a payment in the amt of $100 on 01/19/10 with the chk#1414 (he is not sure abt the chk# he sd he

the member with policy# (245a22671), ssn , name and dob. john 06/23/10

h the dr. office and post the payment on her account.-sam 05/11/10
policy is eff from 07/01/2006 to still active and the mailling address also correct.mady 08/15/07 Cld Desert Canyon tt livatha sd the clm is n
policy is eff from 07/01/2006 to still active and the mailling address also correct.mady 08/15/07 Cld Desert Canyon tt livatha sd the clm is n
policy is eff from 07/01/2006 to still active and the mailling address also correct.mady 08/15/07 Cld Desert Canyon tt livatha sd the clm is n
policy is eff from 07/01/2006 to still active and the mailling address also correct.mady 08/15/07 Cld Desert Canyon tt livatha sd the clm is n

2/2009 to still active.-mark 08/20/09

2/2009 to still active.-mark 08/20/09
nd ansi code 027, she sd not able to locate the member at all. michael 01/23/08 Pending Id : 112641 07/25/2008 Renee Fields: vadivel,
nd ansi code 027, she sd not able to locate the member at all. michael 01/23/08 Pending Id : 112641 07/25/2008 Renee Fields: vadivel,
562-164 and ssn#527562401. i explain to her that we recvd eob and ansi code 027, she sd not able to locate the member at all. michael 01
562-164 and ssn#527562401. i explain to her that we recvd eob and ansi code 027, she sd not able to locate the member at all. michael 01
recouped-sam 011207 cld mcr tt allen sd the cpt 36140 was not offsetted due to error. he sd he will do that immediately and it will take 5
unable to pull anything with the policy#, mcr#, name and dob.-mark 01/25/10
unable to pull anything with the policy#, mcr#, name and dob.-mark 01/25/10
unable to pull anything with the policy#, mcr#, name and dob.-mark 01/25/10
with the dr. office and adjust the balance.-sam 08/06/08
for specialist visit member have copay $35 clms mailing add is po box 14225, lexington, ky 40512, TFL is 120 days from the dos. michael

active. He is a member of Humana Ins. which is a risk type of Hmo.-selvam 06/19/08 cld to the pt. ethel smelter ph#928 753 1237 she sd
t her husband paul jackson he sd they received a bill in the amt of $168 and asked the reason for that. i verified her account and explained
t her husband paul jackson he sd they received a bill in the amt of $168 and asked the reason for that. i verified her account and explained
t her husband paul jackson he sd they received a bill in the amt of $168 and asked the reason for that. i verified her account and explained

ectronic submission.-sam 062606

ut he sd he dont have that info. as he paid it long time before.-sam 02/05/09
ut he sd he dont have that info. as he paid it long time before.-sam 02/05/09

ave the cashed date. she wants us to verify this with the dr. office and need to post the payment of $15 on her account.-sam 10/07/08

ason for that. i verified his account and explained him that it was all the copay balance left for the dos starting from 12/13/08 - 02/21/08 as h
ck to them so i asked her to reissue the chk to our correct payto add. also updated our correct payto add. with them. she sd she will reissue
ck to them so i asked her to reissue the chk to our correct payto add. also updated our correct payto add. with them. she sd she will reissue
ck to them so i asked her to reissue the chk to our correct payto add. also updated our correct payto add. with them. she sd she will reissue
ck to them so i asked her to reissue the chk to our correct payto add. also updated our correct payto add. with them. she sd she will reissue
ck to them so i asked her to reissue the chk to our correct payto add. also updated our correct payto add. with them. she sd she will reissue
quire auth to process the clm. he also sd that they have the auth for dos 10/08/07-10/09/07 alone and there is no auth found for the dos 05
quire auth to process the clm. he also sd that they have the auth for dos 10/08/07-10/09/07 alone and there is no auth found for the dos 05

07/01/09 but she sd they are hospital employees and the provider is an contracted provider so she sd they should not have a balance of $4
7.kevin 072909 Received a voice msg from the pt. Olivia mangrum ph#928 753 4744 she stated that she received a bill in the amt of $45 b
because of this they charged $35 so she sd we need to verify this and adjust the balance.-sam 09/02/09
e sd she will contact them directly.-sam 09/09/09
service with dr. Kalanithi on 02/05/09 she just saw the dr. for 2 seconds but she received a bill in the amt of $65.11 she also sd she already
service with dr. Kalanithi on 02/05/09 she just saw the dr. for 2 seconds but she received a bill in the amt of $65.11 she also sd she already
service with dr. Kalanithi on 02/05/09 she just saw the dr. for 2 seconds but she received a bill in the amt of $65.11 she also sd she already
service with dr. Kalanithi on 02/05/09 she just saw the dr. for 2 seconds but she received a bill in the amt of $65.11 she also sd she already
service with dr. Kalanithi on 02/05/09 she just saw the dr. for 2 seconds but she received a bill in the amt of $65.11 she also sd she already
and give him a call back with the details.-sam 01/05/09
and give him a call back with the details.-sam 01/05/09
and give him a call back with the details.-sam 01/05/09
and give him a call back with the details.-sam 01/05/09
and give him a call back with the details.-sam 01/05/09
and give him a call back with the details.-sam 01/05/09
company. cld humana tt lee explained him that the pt. cld us and stated that his copay should only be $10 for an pcp visit and not $30 then

amt of $93.92 but she sd she already made a payment in the amt of $73.92 with the chk#3702 on 09/19/08 and the chk was cashed in oct

f for that. so she sd we need to verify this with the dr. office and adjust the balance.-sam 02/06/09

company. cld humana tt lee explained him that the pt. cld us and stated that his copay should only be $10 for an pcp visit and not $30 then

nd extn. for him to call back. 122908

ng and she sd she will contact the dr. office directly to check on this.-sam 09/12/08

y this with the dr. office and adjust the $33 balance.-sam 08/09/10 Cld to the pt. William riddle ph#928 692 4784 he sd he received a bill in t
d to verify this with the dr. office and post the payment to his account.-sam 08/13/10
hern AZ VA and they will pay the clm in full. so he sd we need to refund the payment received from mcr and we need to bill the clm to North
14 3 digits on the back of the card: 281 Amt to be paid : $10 Dr. name: Dr. Kalanithi-sam 08/18/10

office and post the payment on his account.-Sam 05/10/10

alance of $22.43 and need to refund the credit balance to her.-sam 04/08/10
alance of $22.43 and need to refund the credit balance to her.-sam 04/08/10

count and also gave the confrimatin#9VH7G-MZ8F2 so she sd we need to verify this with the dr. office and post the payment of $35 on her
sent to him to his add. and so he sd we need to verify this with the dr. office and we need to send the bill to correct pt. also verified the dob
sent to him to his add. and so he sd we need to verify this with the dr. office and we need to send the bill to correct pt. also verified the dob
clms to ahcccs for payment and she just cld us to inform about this and wants us to make a note on this.-sam 02/24/10
clms to ahcccs for payment and she just cld us to inform about this and wants us to make a note on this.-sam 02/24/10
clms to ahcccs for payment and she just cld us to inform about this and wants us to make a note on this.-sam 02/24/10
clms to ahcccs for payment and she just cld us to inform about this and wants us to make a note on this.-sam 02/24/10
clms to ahcccs for payment and she just cld us to inform about this and wants us to make a note on this.-sam 02/24/10
clms to ahcccs for payment and she just cld us to inform about this and wants us to make a note on this.-sam 02/24/10
clms to ahcccs for payment and she just cld us to inform about this and wants us to make a note on this.-sam 02/24/10

7/09 is currently under process then she sd that clm will be rejected as no coverage for dos.-sam 11/23/09 cld ahcccs tt mary sd the mem

rprises. so he sd the bill was incorrectly sent to him to his add. and so he sd we need to verify this with the dr. office and we need to send t
rprises. so he sd the bill was incorrectly sent to him to his add. and so he sd we need to verify this with the dr. office and we need to send t

ure abt the chk# he sd he will call us on monday to give the correct chk#) but it was not posted on his account and he is receiving the same
ure abt the chk# he sd he will call us on monday to give the correct chk#) but it was not posted on his account and he is receiving the same
ure abt the chk# he sd he will call us on monday to give the correct chk#) but it was not posted on his account and he is receiving the same
ure abt the chk# he sd he will call us on monday to give the correct chk#) but it was not posted on his account and he is receiving the same
ure abt the chk# he sd he will call us on monday to give the correct chk#) but it was not posted on his account and he is receiving the same
on tt livatha sd the clm is nis, the member policy is eff from 07/01/2006 and still active and also verified mailling address,i explained her that
on tt livatha sd the clm is nis, the member policy is eff from 07/01/2006 and still active and also verified mailling address,i explained her that
on tt livatha sd the clm is nis, the member policy is eff from 07/01/2006 and still active and also verified mailling address,i explained her that
on tt livatha sd the clm is nis, the member policy is eff from 07/01/2006 and still active and also verified mailling address,i explained her that

08 Renee Fields: vadivel, Im in receipt of an application on this referenced patient, you may write off all of her 2006 guarantor balances that
08 Renee Fields: vadivel, Im in receipt of an application on this referenced patient, you may write off all of her 2006 guarantor balances that
member at all. michael 01/11/08 Pending Id : 112641 07/25/2008 Renee Fields: vadivel, Im in receipt of an application on this reference
member at all. michael 01/11/08 Pending Id : 112641 07/25/2008 Renee Fields: vadivel, Im in receipt of an application on this reference
mediately and it will take 5 buss. days. -sam 011907

ys from the dos. michael 120707 Regarding the refund issue in letter itself they clearly mentioned that if we are not refunding the pymt with

ph#928 753 1237 she sd she received a bill in the amt of $15 and asked the reason for that. i verified her account and explained her that it
er account and explained him that it was the co ins. balance left by their ins. Aei for the dos 01/05/07 then he sd he cannot pay that fully bu
er account and explained him that it was the co ins. balance left by their ins. Aei for the dos 01/05/07 then he sd he cannot pay that fully bu
er account and explained him that it was the co ins. balance left by their ins. Aei for the dos 01/05/07 then he sd he cannot pay that fully bu

ount.-sam 10/07/08

m 12/13/08 - 02/21/08 as his copay for a visit is $35 then she sd he cannot pay that fully and he can pay only $25 per month. so i sd him tha
em. she sd she will reissue the chk to the correct payto add. and it will take 30 days for us to receive the chk.-sam 091908 cld unicare tt ra
em. she sd she will reissue the chk to the correct payto add. and it will take 30 days for us to receive the chk.-sam 091908 cld unicare tt ra
em. she sd she will reissue the chk to the correct payto add. and it will take 30 days for us to receive the chk.-sam 091908 cld unicare tt ra
em. she sd she will reissue the chk to the correct payto add. and it will take 30 days for us to receive the chk.-sam 091908 cld unicare tt ra
em. she sd she will reissue the chk to the correct payto add. and it will take 30 days for us to receive the chk.-sam 091908 cld unicare tt ra
auth found for the dos 05/08/07 - 05/09/07. explained him that we previously got the info that authorization is not required for automation b
auth found for the dos 05/08/07 - 05/09/07. explained him that we previously got the info that authorization is not required for automation b

d not have a balance of $456.64 she sd their balance should only be $100 or less than that so she sd we need to verify with the dr. office an
d a bill in the amt of $45 but she already made the payment in the amt of $45 thro money order in the month of october 09 so she stated tha

1 she also sd she already paid her copay of $40 for this visit and so she sd she should not receive any other bills other than the $40 for the
1 she also sd she already paid her copay of $40 for this visit and so she sd she should not receive any other bills other than the $40 for the
1 she also sd she already paid her copay of $40 for this visit and so she sd she should not receive any other bills other than the $40 for the
1 she also sd she already paid her copay of $40 for this visit and so she sd she should not receive any other bills other than the $40 for the
1 she also sd she already paid her copay of $40 for this visit and so she sd she should not receive any other bills other than the $40 for the
pcp visit and not $30 then he sd he will send all the 3 clms back for review and it will take 30 days ref#435400572409. i cld the pt. again and

he chk was cashed in october but she dont know the exact cashed date. so she sd she should currently owe only $20 so she sd we need to

pcp visit and not $30 then he sd he will send all the 3 clms back for review and it will take 30 days ref#435400572409. i cld the pt. again and

e sd he received a bill in the amt of $33 which was for the copay balance for the dos 05/24/10 but during this visit he got the info. from dr. o
eed to bill the clm to Northern AZ va for payment.-sam 06/08/10

he payment of $35 on her account and now she should owe only $18.27.-sam 04/21/10
ct pt. also verified the dob and ssn# we have on file but he sd its not his ssn# and his dob.-sam 04/05/10 Cld to the pt. Charles kaiser ph#
ct pt. also verified the dob and ssn# we have on file but he sd its not his ssn# and his dob.-sam 04/05/10 Cld to the pt. Charles kaiser ph#

hcccs tt mary sd the member covered under health choice, the policy eff from 07/01/2008 and the policy termd on 08/31/09, no coverage fo

ce and we need to send the bill to correct pt. also verified the dob and ssn# we have on file but he sd its not his ssn# and his dob.-sam 04/0
ce and we need to send the bill to correct pt. also verified the dob and ssn# we have on file but he sd its not his ssn# and his dob.-sam 04/0

he is receiving the same bill again with the balance of $147.73 so he sd we need to check with the dr. office regarding this and we need to
he is receiving the same bill again with the balance of $147.73 so he sd we need to check with the dr. office regarding this and we need to
he is receiving the same bill again with the balance of $147.73 so he sd we need to check with the dr. office regarding this and we need to
he is receiving the same bill again with the balance of $147.73 so he sd we need to check with the dr. office regarding this and we need to
he is receiving the same bill again with the balance of $147.73 so he sd we need to check with the dr. office regarding this and we need to
dress,i explained her that the clm was refiled on 08/16/07 ,she sd that the clm nis for this DOS and charge amount.kevin 110907 Cld des
dress,i explained her that the clm was refiled on 08/16/07 ,she sd that the clm nis for this DOS and charge amount.kevin 110907 Cld des
dress,i explained her that the clm was refiled on 08/16/07 ,she sd that the clm nis for this DOS and charge amount.kevin 110907 Cld des
dress,i explained her that the clm was refiled on 08/16/07 ,she sd that the clm nis for this DOS and charge amount.kevin 110907 Cld des

6 guarantor balances that have been paid by gilsbar already. For 2007 and 2008 she is on a 20 a month payment arrangement if you need
6 guarantor balances that have been paid by gilsbar already. For 2007 and 2008 she is on a 20 a month payment arrangement if you need
plication on this referenced patient, you may write off all of her 2006 guarantor balances that have been paid by gilsbar already. For 2007 a
plication on this referenced patient, you may write off all of her 2006 guarantor balances that have been paid by gilsbar already. For 2007 a
ot refunding the pymt within January 6 2008 they pymt will be offset by them automatically.

t and explained her that it was the copay balance left by the ins. humana for the dos 08/23/07 but she sd she paid her copay during her visi
e cannot pay that fully but he will send a chk for some part of the amt today.-sam 09/30/08 Cld to the pt. Linda jackson ph#928 565 3684 tt
e cannot pay that fully but he will send a chk for some part of the amt today.-sam 09/30/08 Cld to the pt. Linda jackson ph#928 565 3684 tt
e cannot pay that fully but he will send a chk for some part of the amt today.-sam 09/30/08 Cld to the pt. Linda jackson ph#928 565 3684 tt

per month. so i sd him that he need to contact the dr. office regarding this. he sd he will do that.-sam 09/09/08
091908 cld unicare tt randi,requested EOB copy thru fax,i given our fax# ,we will receive it shortly.kevin 013009 Cld unicare tt lovesa sd
091908 cld unicare tt randi,requested EOB copy thru fax,i given our fax# ,we will receive it shortly.kevin 013009 Cld unicare tt lovesa sd
091908 cld unicare tt randi,requested EOB copy thru fax,i given our fax# ,we will receive it shortly.kevin 013009 Cld unicare tt lovesa sd
091908 cld unicare tt randi,requested EOB copy thru fax,i given our fax# ,we will receive it shortly.kevin 013009 Cld unicare tt lovesa sd
091908 cld unicare tt randi,requested EOB copy thru fax,i given our fax# ,we will receive it shortly.kevin 013009 Cld unicare tt lovesa sd
required for automation but he sd they require pre auth for automation he also we need to contact pre certification dept to check on this. Cl
required for automation but he sd they require pre auth for automation he also we need to contact pre certification dept to check on this. Cl

verify with the dr. office and need to send them a correct statement.-sam 10/05/09 Cld to the pt. Danny jordan ph# 928 263 1270 he sd he
ober 09 so she stated that we need to verify this with the dr. office and post the payment on her account. i cld her but it reached the voice m

other than the $40 for the dos 02/05/09 for which she did not had any service with dr. kalanithi. so she sd we need to verify this with dr. offic
other than the $40 for the dos 02/05/09 for which she did not had any service with dr. kalanithi. so she sd we need to verify this with dr. offic
other than the $40 for the dos 02/05/09 for which she did not had any service with dr. kalanithi. so she sd we need to verify this with dr. offic
other than the $40 for the dos 02/05/09 for which she did not had any service with dr. kalanithi. so she sd we need to verify this with dr. offic
other than the $40 for the dos 02/05/09 for which she did not had any service with dr. kalanithi. so she sd we need to verify this with dr. offic
409. i cld the pt. again and gave this info. the pt. asked us not to move the bill to the collection agency until we receive info. from humana.

$20 so she sd we need to verify this with the dr. office and post the payment on this pt. account.-sam 12/17/08 Received a voice msg from

409. i cld the pt. again and gave this info. the pt. asked us not to move the bill to the collection agency until we receive info. from humana.

he got the info. from dr. office that this is an follow up visit for the stint putin and so he need not want to pay any copays for this follow up vis
he pt. Charles kaiser ph# 928 692 2533 he sd he received a bill in the amt of $135.92 which was for the dos starting from 10/19/09 - 12/12/
he pt. Charles kaiser ph# 928 692 2533 he sd he received a bill in the amt of $135.92 which was for the dos starting from 10/19/09 - 12/12/

08/31/09, no coverage for dos.-mark 11/24/09

sn# and his dob.-sam 04/05/10 Cld to the pt. Charles kaiser ph# 928 692 2533 he sd he received a bill in the amt of $135.92 which was fo
sn# and his dob.-sam 04/05/10 Cld to the pt. Charles kaiser ph# 928 692 2533 he sd he received a bill in the amt of $135.92 which was fo

rding this and we need to post $100 on his account and we need to send a new bill with his current balance.-sam 02/05/10
rding this and we need to post $100 on his account and we need to send a new bill with his current balance.-sam 02/05/10
rding this and we need to post $100 on his account and we need to send a new bill with his current balance.-sam 02/05/10
rding this and we need to post $100 on his account and we need to send a new bill with his current balance.-sam 02/05/10
rding this and we need to post $100 on his account and we need to send a new bill with his current balance.-sam 02/05/10
t.kevin 110907 Cld desertcanyon avr sd clm processed on 06/15/07 pd$ 06.10 chq#10007450 clm#2007061199900565 . john 08/22/08
t.kevin 110907 Cld desertcanyon avr sd clm processed on 06/15/07 pd$ 06.10 chq#10007450 clm#2007061199900565 . john 08/22/08
t.kevin 110907 Cld desertcanyon avr sd clm processed on 06/15/07 pd$ 06.10 chq#10007450 clm#2007061199900565 . john 08/22/08
t.kevin 110907 Cld desertcanyon avr sd clm processed on 06/15/07 pd$ 06.10 chq#10007450 clm#2007061199900565 . john 08/22/08

arrangement if you need to indicate this somewhere. If there are any further questions please let me know.
arrangement if you need to indicate this somewhere. If there are any further questions please let me know.
lsbar already. For 2007 and 2008 she is on a 20 a month payment arrangement if you need to indicate this somewhere. If there are any fur
lsbar already. For 2007 and 2008 she is on a 20 a month payment arrangement if you need to indicate this somewhere. If there are any fur
 her copay during her visit itself and she also contacted the dr. office regarding this and they sd her that she do not owe anything so she wa
kson ph#928 565 3684 tt her husband paul jackson he sd he received a bill in the amt of $118 and he sd he will pay $50 this month and he
kson ph#928 565 3684 tt her husband paul jackson he sd he received a bill in the amt of $118 and he sd he will pay $50 this month and he
kson ph#928 565 3684 tt her husband paul jackson he sd he received a bill in the amt of $118 and he sd he will pay $50 this month and he
 Cld unicare tt lovesa sd that this clm was paid directly to the member on 07/18/07 in the amt of $696.42 and we need to get the payment
Cld unicare tt lovesa sd that this clm was paid directly to the member on 07/18/07 in the amt of $696.42 and we need to get the payment
Cld unicare tt lovesa sd that this clm was paid directly to the member on 07/18/07 in the amt of $696.42 and we need to get the payment
Cld unicare tt lovesa sd that this clm was paid directly to the member on 07/18/07 in the amt of $696.42 and we need to get the payment
Cld unicare tt lovesa sd that this clm was paid directly to the member on 07/18/07 in the amt of $696.42 and we need to get the payment
dept to check on this. Cld bcbs pre certification @ 866-776-4793 tt catherine asked her verify the auth #01a2tc9b is correct or not. she sd
dept to check on this. Cld bcbs pre certification @ 866-776-4793 tt catherine asked her verify the auth #01a2tc9b is correct or not. she sd

# 928 263 1270 he sd he received a bill in the amt of $85 which was for the dos 07/01/09 but he sd dr. Alkhatib accepts whatever the paym
but it reached the voice mail box.-sam 01/05/10

to verify this with dr. office and adjust the balance. i cld her back to the ph# several times but it reached the voice mail box. left voice msg a
to verify this with dr. office and adjust the balance. i cld her back to the ph# several times but it reached the voice mail box. left voice msg a
to verify this with dr. office and adjust the balance. i cld her back to the ph# several times but it reached the voice mail box. left voice msg a
to verify this with dr. office and adjust the balance. i cld her back to the ph# several times but it reached the voice mail box. left voice msg a
to verify this with dr. office and adjust the balance. i cld her back to the ph# several times but it reached the voice mail box. left voice msg a
 eive info. from humana.

Received a voice msg from the pt. Francis chavez ph#928 757 4810 his wife terri stated that they received a bill in the amt of $93.72 couple

eive info. from humana.

opays for this follow up visit and the copay will be adjusted but now he is receiving a bill for the copay for a follow up visit so he sd we need
ng from 10/19/09 - 12/12/09 but he sd he didnt have any services on any of these dos and he also stated that he dont know any of the dr. n
ng from 10/19/09 - 12/12/09 but he sd he didnt have any services on any of these dos and he also stated that he dont know any of the dr. n

of $135.92 which was for the dos starting from 10/19/09 - 12/12/09 but he sd he didnt have any services on any of these dos and he also s
of $135.92 which was for the dos starting from 10/19/09 - 12/12/09 but he sd he didnt have any services on any of these dos and he also s
99900565 . john 08/22/08 Cld desert canyon tt oliver sd they have not received a clm for $80 but he sd they received a clm only for $10 w
99900565 . john 08/22/08 Cld desert canyon tt oliver sd they have not received a clm for $80 but he sd they received a clm only for $10 w
99900565 . john 08/22/08 Cld desert canyon tt oliver sd they have not received a clm for $80 but he sd they received a clm only for $10 w
99900565 . john 08/22/08 Cld desert canyon tt oliver sd they have not received a clm for $80 but he sd they received a clm only for $10 w

where. If there are any further questions please let me know.

where. If there are any further questions please let me know.
ot owe anything so she wants us to verify this with the dr. office.-sam 09/05/08
ay $50 this month and he will pay the rest next month. he cld just to give this info.-sam 12/09/08
ay $50 this month and he will pay the rest next month. he cld just to give this info.-sam 12/09/08
ay $50 this month and he will pay the rest next month. he cld just to give this info.-sam 12/09/08
e need to get the payment from the member. i explained her that we previously cld on 09/19/08 and got the info. that the chk was sent to the
e need to get the payment from the member. i explained her that we previously cld on 09/19/08 and got the info. that the chk was sent to the
e need to get the payment from the member. i explained her that we previously cld on 09/19/08 and got the info. that the chk was sent to the
e need to get the payment from the member. i explained her that we previously cld on 09/19/08 and got the info. that the chk was sent to the
e need to get the payment from the member. i explained her that we previously cld on 09/19/08 and got the info. that the chk was sent to the
b is correct or not. she sd cannot chk this bcoz she dont have access to chk this.-michael 08/29/08 Cld to the pt. Carol rappleye ph#928 72
b is correct or not. she sd cannot chk this bcoz she dont have access to chk this.-michael 08/29/08 Cld to the pt. Carol rappleye ph#928 72

ccepts whatever the payment made by the insurance and a $15 copay as the payment in full and nothing should be billed to the patient so h

mail box. left voice msg asking her to give us a call back.-sam 11/03/09 Cld to the pt. Lynn kite ph#928 692 9660 she sd she received a b
mail box. left voice msg asking her to give us a call back.-sam 11/03/09 Cld to the pt. Lynn kite ph#928 692 9660 she sd she received a b
mail box. left voice msg asking her to give us a call back.-sam 11/03/09 Cld to the pt. Lynn kite ph#928 692 9660 she sd she received a b
mail box. left voice msg asking her to give us a call back.-sam 11/03/09 Cld to the pt. Lynn kite ph#928 692 9660 she sd she received a b
mail box. left voice msg asking her to give us a call back.-sam 11/03/09 Cld to the pt. Lynn kite ph#928 692 9660 she sd she received a b
the amt of $93.72 couple of months before and they sent 2 payments one in the amt of $73.92 with the chk#3702 dated 09/19/08 and anoth

up visit so he sd we need to verify this with the dr. office and adjust the $33 balance.-sam 08/09/10
dont know any of the dr. names printed on the bills and his insurance company is not Administrative enterprises. so he sd the bill was incorr
dont know any of the dr. names printed on the bills and his insurance company is not Administrative enterprises. so he sd the bill was incorr

of these dos and he also stated that he dont know any of the dr. names printed on the bills and his insurance company is not Administrative
of these dos and he also stated that he dont know any of the dr. names printed on the bills and his insurance company is not Administrative
eived a clm only for $10 which is for the cpt 36415 and that clm was procesed on 06/15/07 and pd $6.10 chk#10007450 bulk amt $5902.02
eived a clm only for $10 which is for the cpt 36415 and that clm was procesed on 06/15/07 and pd $6.10 chk#10007450 bulk amt $5902.02
eived a clm only for $10 which is for the cpt 36415 and that clm was procesed on 06/15/07 and pd $6.10 chk#10007450 bulk amt $5902.02
eived a clm only for $10 which is for the cpt 36415 and that clm was procesed on 06/15/07 and pd $6.10 chk#10007450 bulk amt $5902.02
at the chk was sent to the incorrect add. so they sd they will reissue the chk again to us but she sd it was already paid to the member and w
at the chk was sent to the incorrect add. so they sd they will reissue the chk again to us but she sd it was already paid to the member and w
at the chk was sent to the incorrect add. so they sd they will reissue the chk again to us but she sd it was already paid to the member and w
at the chk was sent to the incorrect add. so they sd they will reissue the chk again to us but she sd it was already paid to the member and w
at the chk was sent to the incorrect add. so they sd they will reissue the chk again to us but she sd it was already paid to the member and w
Carol rappleye ph#928 727 8801 she sd she received a bill in the amt of $1632.30 which was for the dos 05/08/07 - 05/09/07 & 10/08/07 b
Carol rappleye ph#928 727 8801 she sd she received a bill in the amt of $1632.30 which was for the dos 05/08/07 - 05/09/07 & 10/08/07 b

e billed to the patient so he sd the bill sent to him in the amt of $85 was incorrect. so he sd we need to verify this with the dr. office and adju

0 she sd she received a bill in the amt of $65.11 which was for the dos 02/05/09 but she sd the bill we sent is incorrect because on the dos
0 she sd she received a bill in the amt of $65.11 which was for the dos 02/05/09 but she sd the bill we sent is incorrect because on the dos
0 she sd she received a bill in the amt of $65.11 which was for the dos 02/05/09 but she sd the bill we sent is incorrect because on the dos
0 she sd she received a bill in the amt of $65.11 which was for the dos 02/05/09 but she sd the bill we sent is incorrect because on the dos
0 she sd she received a bill in the amt of $65.11 which was for the dos 02/05/09 but she sd the bill we sent is incorrect because on the dos
dated 09/19/08 and another payment in the amt of $20 with the chk#3800 dated 01/23/09 so she sd she paid everything and she should no
o he sd the bill was incorrectly sent to him to his add. and so he sd we need to verify this with the dr. office and we need to send the bill to c
o he sd the bill was incorrectly sent to him to his add. and so he sd we need to verify this with the dr. office and we need to send the bill to c

pany is not Administrative enterprises. so he sd the bill was incorrectly sent to him to his add. and so he sd we need to verify this with the d
pany is not Administrative enterprises. so he sd the bill was incorrectly sent to him to his add. and so he sd we need to verify this with the d
007450 bulk amt $5902.02 clm#2007061199900565. he sd we need to refile the clm again for the other 3 cpts with proof of timely filing.-sam
007450 bulk amt $5902.02 clm#2007061199900565. he sd we need to refile the clm again for the other 3 cpts with proof of timely filing.-sam
007450 bulk amt $5902.02 clm#2007061199900565. he sd we need to refile the clm again for the other 3 cpts with proof of timely filing.-sam
007450 bulk amt $5902.02 clm#2007061199900565. he sd we need to refile the clm again for the other 3 cpts with proof of timely filing.-sam
 paid to the member and we need to contact the member for the payment details and she cannot release anyother info. on this clm. clm#07
paid to the member and we need to contact the member for the payment details and she cannot release anyother info. on this clm. clm#07
paid to the member and we need to contact the member for the payment details and she cannot release anyother info. on this clm. clm#07
paid to the member and we need to contact the member for the payment details and she cannot release anyother info. on this clm. clm#07
paid to the member and we need to contact the member for the payment details and she cannot release anyother info. on this clm. clm#07
7 - 05/09/07 & 10/08/07 but she sd the cpt code 37215 billed on 10/08/07 was billed incorrectly to the ins. she sd on that day she had stint p
7 - 05/09/07 & 10/08/07 but she sd the cpt code 37215 billed on 10/08/07 was billed incorrectly to the ins. she sd on that day she had stint p

with the dr. office and adjust the balance.-sam 11/05/09

rrect because on the dos 02/05/09 she just saw the dr. for 5 mins and she did not had any service on that day she also sd she paid her cop
rrect because on the dos 02/05/09 she just saw the dr. for 5 mins and she did not had any service on that day she also sd she paid her cop
rrect because on the dos 02/05/09 she just saw the dr. for 5 mins and she did not had any service on that day she also sd she paid her cop
rrect because on the dos 02/05/09 she just saw the dr. for 5 mins and she did not had any service on that day she also sd she paid her cop
rrect because on the dos 02/05/09 she just saw the dr. for 5 mins and she did not had any service on that day she also sd she paid her cop
rything and she should not owe any balance. but again now they received a bill in the amt of $140 which she stated is incorrect. i verified h
e need to send the bill to correct pt. also verified the dob and ssn# we have on file but he sd its not his ssn# and his dob.-sam 04/05/10 Re
e need to send the bill to correct pt. also verified the dob and ssn# we have on file but he sd its not his ssn# and his dob.-sam 04/05/10 Re

ed to verify this with the dr. office and we need to send the bill to correct pt. also verified the dob and ssn# we have on file but he sd its not h
ed to verify this with the dr. office and we need to send the bill to correct pt. also verified the dob and ssn# we have on file but he sd its not h
h proof of timely filing.-sam 09/23/08 chk desert canyon website refiled clm nis, need to refile.-mark 11/11/08
h proof of timely filing.-sam 09/23/08 chk desert canyon website refiled clm nis, need to refile.-mark 11/11/08
h proof of timely filing.-sam 09/23/08 chk desert canyon website refiled clm nis, need to refile.-mark 11/11/08
h proof of timely filing.-sam 09/23/08 chk desert canyon website refiled clm nis, need to refile.-mark 11/11/08
r info. on this clm. clm#071920201100-sam 02/23/09 Cld to the pt. Doreen saffeels ph#928 757 9283 she sd she recieved a bill in the amt
r info. on this clm. clm#071920201100-sam 02/23/09 Cld to the pt. Doreen saffeels ph#928 757 9283 she sd she recieved a bill in the amt
r info. on this clm. clm#071920201100-sam 02/23/09 Cld to the pt. Doreen saffeels ph#928 757 9283 she sd she recieved a bill in the amt
r info. on this clm. clm#071920201100-sam 02/23/09 Cld to the pt. Doreen saffeels ph#928 757 9283 she sd she recieved a bill in the amt
r info. on this clm. clm#071920201100-sam 02/23/09 Cld to the pt. Doreen saffeels ph#928 757 9283 she sd she recieved a bill in the amt
on that day she had stint putting in her heart which is covered under her plan but the cpt code was billed incorrectly as experimental or inves
on that day she had stint putting in her heart which is covered under her plan but the cpt code was billed incorrectly as experimental or inves

also sd she paid her copay of $40 on the dos and she should not owe anything more than $40 but in the bill which she received it was stat
also sd she paid her copay of $40 on the dos and she should not owe anything more than $40 but in the bill which she received it was stat
also sd she paid her copay of $40 on the dos and she should not owe anything more than $40 but in the bill which she received it was stat
also sd she paid her copay of $40 on the dos and she should not owe anything more than $40 but in the bill which she received it was stat
also sd she paid her copay of $40 on the dos and she should not owe anything more than $40 but in the bill which she received it was stat
ed is incorrect. i verified her account and found that the $20 payment she made on 01/23/09 was not yet received from the dr. office and the
is dob.-sam 04/05/10 Received a call again from this pt. Charles kaiser ph#925 890 3517 he previously cld us and stated that the bill sent
is dob.-sam 04/05/10 Received a call again from this pt. Charles kaiser ph#925 890 3517 he previously cld us and stated that the bill sent

e on file but he sd its not his ssn# and his dob.-sam 04/05/10
e on file but he sd its not his ssn# and his dob.-sam 04/05/10
recieved a bill in the amt of $955.51 which was for the dos 05/31/07 so she asked the reason for the bill. i verified her account and explaine
recieved a bill in the amt of $955.51 which was for the dos 05/31/07 so she asked the reason for the bill. i verified her account and explaine
recieved a bill in the amt of $955.51 which was for the dos 05/31/07 so she asked the reason for the bill. i verified her account and explaine
recieved a bill in the amt of $955.51 which was for the dos 05/31/07 so she asked the reason for the bill. i verified her account and explaine
recieved a bill in the amt of $955.51 which was for the dos 05/31/07 so she asked the reason for the bill. i verified her account and explaine
y as experimental or investigational procedure she also sd the same thing had happened on 05/09/07 also. so she sd we need to check wit
y as experimental or investigational procedure she also sd the same thing had happened on 05/09/07 also. so she sd we need to check wit

h she received it was stated that she had Myocardial perfusion ima & Myocardial perfusion stu but she never had those services on that da
h she received it was stated that she had Myocardial perfusion ima & Myocardial perfusion stu but she never had those services on that da
h she received it was stated that she had Myocardial perfusion ima & Myocardial perfusion stu but she never had those services on that da
h she received it was stated that she had Myocardial perfusion ima & Myocardial perfusion stu but she never had those services on that da
h she received it was stated that she had Myocardial perfusion ima & Myocardial perfusion stu but she never had those services on that da
from the dr. office and the rest of the due is for the 2007 clms so i cld her to give this info. but the phone line reached the voice mail box. le
d stated that the bill sent to him was incorrect and the dob and insurance details we have does not belongs to him so he sd we need send t
d stated that the bill sent to him was incorrect and the dob and insurance details we have does not belongs to him so he sd we need send t
 her account and explained her that this clm was first paid by the ins. unicare on 07/18/07 later they took back the payment on 05/28/08 as
her account and explained her that this clm was first paid by the ins. unicare on 07/18/07 later they took back the payment on 05/28/08 as
her account and explained her that this clm was first paid by the ins. unicare on 07/18/07 later they took back the payment on 05/28/08 as
her account and explained her that this clm was first paid by the ins. unicare on 07/18/07 later they took back the payment on 05/28/08 as
her account and explained her that this clm was first paid by the ins. unicare on 07/18/07 later they took back the payment on 05/28/08 as
e sd we need to check with the dr. office for the correct cpt code and need to rebill the clms again to bcbs with the correct cpt code for paym
e sd we need to check with the dr. office for the correct cpt code and need to rebill the clms again to bcbs with the correct cpt code for paym

those services on that day so she sd we need to verify this with the dr. office and adjust the balance also stated that we need to post $40 o
those services on that day so she sd we need to verify this with the dr. office and adjust the balance also stated that we need to post $40 o
those services on that day so she sd we need to verify this with the dr. office and adjust the balance also stated that we need to post $40 o
those services on that day so she sd we need to verify this with the dr. office and adjust the balance also stated that we need to post $40 o
those services on that day so she sd we need to verify this with the dr. office and adjust the balance also stated that we need to post $40 o
hed the voice mail box. left voice msg asking her to give us a call back.-sam 02/09/09
m so he sd we need send the statement to the correct pt. add. but again he received the same bill dated 05/04/10 so he sd we need to chec
m so he sd we need send the statement to the correct pt. add. but again he received the same bill dated 05/04/10 so he sd we need to chec
payment on 05/28/08 as it was paid to he wrong provider so they sd they will reissue the chk again but till now we have not received the pa
payment on 05/28/08 as it was paid to he wrong provider so they sd they will reissue the chk again but till now we have not received the pa
payment on 05/28/08 as it was paid to he wrong provider so they sd they will reissue the chk again but till now we have not received the pa
payment on 05/28/08 as it was paid to he wrong provider so they sd they will reissue the chk again but till now we have not received the pa
payment on 05/28/08 as it was paid to he wrong provider so they sd they will reissue the chk again but till now we have not received the pa
correct cpt code for payment.-sam 12/15/08
correct cpt code for payment.-sam 12/15/08

hat we need to post $40 on this dos which she already paid. -sam 01/05/10
hat we need to post $40 on this dos which she already paid. -sam 01/05/10
hat we need to post $40 on this dos which she already paid. -sam 01/05/10
hat we need to post $40 on this dos which she already paid. -sam 01/05/10
hat we need to post $40 on this dos which she already paid. -sam 01/05/10
so he sd we need to check with the dr. office and need to send the bill to the correct pt. add. and he should not receive this bill again. pls d
so he sd we need to check with the dr. office and need to send the bill to the correct pt. add. and he should not receive this bill again. pls d
eceive this bill again. pls do the needful.-Sam 05/12/10
eceive this bill again. pls do the needful.-Sam 05/12/10