Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
123456789A MARTIN L F 19150709 200401-200401 73.38 653.71 -73.38 389.01 191.32 580.33
123456789A COHEN R M 19171019 200401-200401 73.38 811.54 -73.38 479.27 258.89 738.16
123456789D RUBIN J F 19121124 200401-200401 73.38 857.74 -73.38 509.52 274.84 784.36
123456789A TROUTMA J M 19110502 200401-200401 73.38 980.15 -73.38 577.46 329.31 906.77
123456789A ROUND P F 19170127 200401-200401 73.38 569.89 -73.38 339.14 157.37 496.51
123456789A AZMAN F F 19180203 200401-200401 73.38 734.82 -73.38 436.59 224.85 661.44
123456789D PRATT F F 19080919 200401-200401 73.38 746.11 -73.38 443.95 228.78 672.73
123456789A LOMBARD F F 19160926 200401-200401 73.38 834.62 -73.38 496.76 264.48 761.24
123456789D BALTIMO M F 19080301 200401-200401 73.38 837.34 -73.38 498.26 265.70 763.96
123456789D HOWARD J F 19070402 200401-200401 73.38 580.51 -73.38 345.61 161.52 507.13
123456789A COLUMBU F M 19180904 200401-200401 73.38 1,004.55 -73.38 593.51 337.66 931.17
123456789C2 CARROLL K M 19580202 200401-200401 73.38 333.27 -73.38 182.23 77.66 259.89
PBP ID: 027 TOTALS: 39 $ 26,783.70 $ -2,861.82 $ 23,921.88
AGED REDUCTION: $ -2,568.30
DIB REDUCTION: $ -293.52
0 CONTRACT: H3333 TOTALS: 77 $ 54,385.95 $ -4,049.32 $ 50,336.63
AGED REDUCTION: $ -3,755.80
DIB REDUCTION: $ -293.52
December 28, 2012 J-5 BIPA 606 Payment Reduction Report