Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
J.7 Monthly Summary of Bills Report
Description
This report summarizes all Medicare fee-for-service activity, both Part A and Part B, for Beneficiaries enrolled in the contract.
Example
1 MONTHLY SUMMARY OF CLAIMS PAID BY CARRIERS FOR HMO ENROLLEES
0 HMO NO H123A HMO NAME ABC FOUNDATION, INC. HMO FY ENDING 12/2004 CURRENT MONTH 01/2009
0 TOTALS FOR THIS MONTH
0 CARRIER MEDICAL REIMB TOTAL
NUMBER CHARGES AMOUNT BILLS
NO ACTIVITY FOR THIS HMO FOR THIS PERIOD
FY TOTAL $198,903- $151,602- 4,266
1 MONTHLY SUMMARY OF BILLS PAID BY INTERMEDIARIES FOR HMO ENROLLEES
0 HMO NO H123B HMO NAME ABC FOUNDATION, INC. HMO FY ENDING 12/2005 CURRENT MONTH 01/2009
BILLS THROUGH 01/30/2009
0 ------------------ INPATIENT BILLS -------------- ------ OUTPATIENT BILLS -------- -------------- HHA BILLS ------------
NON
TOTAL COVERED REIMB COVERED TOTAL COVERED REIMB TOTAL TOTAL REIMB TOTAL TOTAL
CHARGES CHARGES AMOUNT DAYS BILLS CHARGES AMOUNT BILLS CHARGES AMOUNT VISITS BILLS
NO ACTIVITY FOR THIS HMO FOR THIS PERIOD
FY TOTAL $123,526,251 $113,627,247 42,572 $570,708- $245,326 9
$1,315,398 16,614 $3,309,867- 1,606 $229,640 617
1 MONTHLY SUMMARY OF CLAIMS PAID BY CARRIERS FOR HMO ENROLLEES
0 HMO NO H123C HMO NAME ABC FOUNDATION, INC. HMO FY ENDING 12/2005 CURRENT MONTH 01/2009
0 TOTALS FOR THIS MONTH
0 CARRIER MEDICAL REIMB TOTAL
NUMBER CHARGES AMOUNT BILLS
NO ACTIVITY FOR THIS HMO FOR THIS PERIOD
FY TOTAL $548,050- $428,202- 8,315
1 MONTHLY SUMMARY OF BILLS PAID BY INTERMEDIARIES FOR HMO ENROLLEES
0 HMO NO H123D HMO NAME ABC FOUNDATION, INC. HMO FY ENDING 12/2006 CURRENT MONTH 01/2009
BILLS THROUGH 01/30/2009
0 ------------------ INPATIENT BILLS -------------- ------ OUTPATIENT BILLS -------- -------------- HHA BILLS ------------
NON
TOTAL COVERED REIMB COVERED TOTAL COVERED REIMB TOTAL TOTAL REIMB TOTAL TOTAL
December 28, 2012 J-19 Monthly Summary of Bills Report