HomeMy WebLinkAbout20070917 - VI-09
VI-9
MARK J. HOLMES, CHIEF
115 West 5th Street
Hastings, Minnesota 55033-1815
HASTINGS FIRE DEPARTMENT
Business Office (651) 480-6150
Fax (651) 480-6170
TO: Mayor Hicks and City Council Members
FROM: Penne Schuldt, Business Office Manage~ ~
DATE: September 11, 2007
SUBJECT: Request for Cancellation of Ambulance Invoices
Attached is a list of ambulance invoices, being submitted for cancellation and the
reason for each request. The auditors like to have all older or uncollectible
accounts taken off the books, even though we may, at a later date, collect a few.
Although the requested cancellations may seem to be high, this request for
cancellation of ambulance invoices includes call dates for the years 2000 through
2007 and our uncollectibles are approximately ~Al of the amount billed, which is
significantly less than the industry standard. The last request for cancellation
was in July 2005.
The reasons for cancellation range from balances due after insurance or Medicare
have paid, bankruptcy filing, patient is deceased, patient has no assets or none
that can be attached, or the balance is too small for our collection agency to
pursue.
Although we are requesting the above-mentioned cancellations, it does not
impede our ability to accept payment on any account should a party come
forward to pay a cancelled account. On occasion, a cancelled bill does get paid
when an estate is settled or when a debtor needs to settle in order to purchase a
house, vehicle, etc. All delinquent accounts are submitted to the Credit Bureau
and are maintained in their files.
If you have any questions, please feel free to contact me.
Requested Action: Approve cancellation of ambulance invoices as submitted with
this memo.
Attachment
cc: Mark J. Holmes, Fire Chief
Charlene Stark, Finance Director
FIRE SUPPRESSION
FIRE EDUCATION
FIRE PREVENTION
AMBULANCE SERVICE
Credit Detail
Total Page: 1 of 10
Page: 1 of 10
Date: 09/11/2007
Time: 14:49:51
History ID : 1100023
Call No Patient # Call Date Current Payor Code Description # Rec. Date Recpt. # Amount
20000138 3716 01/26/2000 PRIVATE (SELF F WBAN Write Off-Bankruptc' 06/07/2006 435.85
----
Total Credits For This Call 435.85
20000140 3716 01/26/2000 PRIVATE (SELF F WBAN Write Off-Bankruptc: 06/07/2006 577.54
--
Total Credits For This Call 577.54
20001078 4226 08/04/2000 PRIVATE (SELF F WBAN Write Off-Bankruptc' 03/28/2006 903.80
Total Credits For This Call 903.80
20001214 2672 09/01/2000 PRIVATE (SELF F WDEe Write Off-Deceased 01/18/2007 803.88
Total Credits For This Call 803.88
20010129 2672 01/2412001 PRIVATE (SELF F WDEe Write Off-Deceased 01/18/2007 803.88
--
Total Credits For This Call 803.88
20010910 2672 07/09/2001 PRIVATE (SELF F WDEe Write Off-Deceased 01118/2007 626.86
---
Total Credits For This Call 626.86
20011078 2091 08/08/2001 PRIVATE (SELF F WONA Write off - no assets 02/17/2006 650.20
--
Total Credits For This Call 650.20
20011513 2672 11/12/2001 PRIVATE (SELF F WDEe Write Off-Deceased 01/18/2007 517.24
Total Credits For This Call 517.24
20020253 5641 02/15/2002 PRIVATE (SELF F WBAN Write Off-Bankruptc' 01/26/2006 468.52
--
Total Credits For This Call 468.52
20020350 2091 03/06/2002 PRIVATE (SELF F WONA Write off - no assets 02/1712006 516.20
---
Total Credits For This Call 516.20
20020355 2091 03/08/2002 PRIVATE (SELF F WONA Write off - no assets 02/17/2006 792.00
----
Total Credits For This Call 792.00
20020929 5996 07/06/2002 PRIVATE (SELF F WSML Write Off-Small Bala 09/14/2006 0.33
Total Credits For This Call 0.33
20021678 6387 12/01/2002 Insurance - Primar WMGT Write Off-Per Mana~ 02/23/2007 385.61
--
Total Credits For This Call 385.61
20030329 6663 03/05/2003 Insurance - Primar WDEe Write Off-Deceased 10/07/2005 821.95
Total Credits For This Call 821.95
20030345 6673 03/08/2003 Insurance - Primar WBAN Write Off-Bankruptc: 08/0312005 568.81
Total Credits For This Call 568.81
20030392 2672 0311712003 PRIVATE (SELF F WDEe Write Off-Deceased 01/18/2007 461.60
Total Credits For This Call 461.60
20030546 67n 04118/2003 Insurance - Primar WBAN Write Off-Bankruptc' 04105/2006 160.78
--
Total Credits For This Call 160.78
20030624 6830 05/0412003 Insurance - Primar WBAN Write Off-Bankruptc' 01/26/2006 769.58
--
Total Credits For This Call 769.58
Credit Detail
Total Page: 2 of 10
Page: 2 of 10
Date: 09/11/2007
Time: 14:49:51
History 10 : 1100023
Call No Patient # Call Date Current Payor Code Description # Ree. Date Reept. # Amount
20030699 6883 05/18/2003 Insurance - Primar WBAN Write Off-Bankruptc: 08/03/2006 622.64
WBAN Write Off-Bankruptc: 08/03/2006 -622.64
WBAN Write Off-Bankruptc: 08/31/2006 607.01
WBAN Write Off-Bankruptc' 08/31/2006 -607.01
WBAN Write Off-Bankruptc' 11/30/2006 562.15
--
Total Credits For This Call 562.15
20030776 6939 06/02/2003 Insurance - Primar WBAN Write Off-Bankruptc' 03/06/2007 899.90
Total Credits For This Call 899.90
20030976, 7085 07/11/2003 Insurance - P.rimar WBAN Write Off-Bankruptc' 01/26/2006 157.33
Total Credits For This Call 157.33
20030977 7087 07/11/2003 Insurance - Primar WBAN Write Off-Bankruptc' 01/26/2006 646.35
--
Total Credits For'This Call 646.35
20030979 7087 07/11/2003 Insurance - Primar WBAN Write Off-Bankruptc' 01/26/2006 868.64
---
Total Credits For This Call 868.64
20031010 2672 07/19/2003 Insurance - Primar WDEC Write Off-Deceased 01/18/2007 794.14
--
Total Credits For This Call 794.14
20031031 7126 07/23/2003 PRIVATE (SELF F WDEC Write Off-Deceased 09/23/2005 650.20
Total Credits For This Call 650.20
20031095 7162 08/04/2003 Insurance - Primar WBAN Write Off-BankruptC' 01/26/2006 571.24
Total Credits For This Call 571.24
20031320 7298 09/15/2003 Insurance - Primar WDEC Write Off-Deceased 10/0512005 468.52
--
Total Credits For This Call 468.52
20031516 4979 10/25/2003 Insurance - Primar WBAN Write Off-Bankruptc: 01/26/2006 402.78
WBAN Write Off-Bankruptc: 01/26/2006 -402.78
WBAN Write Off-Bankruptc: 05103/2006 386.55
WBAN Write Off-Bankruptc: 05103/2006 -386.55
WBAN Write Off-Bankruptc: 02/13/2007 378.58
Total Credits For This Call 378.58
20040053 7616 01/10/2004 Insurance - Primar WSML Write Off-Small BaJa 03/14/2006 0.25
--
Total Credits For This Call 0.25
20040073 7627 01/14/2004 PRIVATE (SELF F MED WO, bal. after Med., 12/2212005 99.40
--
Total Credits For This Call 99.40
20040185 7627 02/02/2004 PRIVATE (SELF F MED WO, bal. after Med., 12/2212005 47.32
Total Credits For This Call 47.32
20040626 5261 04/28/2004 PRIVATE (SELF F WBAN Write Off-Bankruptc: 01/26/2006 686.26
Total Credits For This Call 686.26
20041446 5261 10/0312004 PRIVATE (SELF F WBAN Write Off-Bankruptc: 01/26/2006 480.62
WBAN Write Off-Bankruptc: 01/26/2006 -480.62
Credit Detail
Total Page: 3 of 10
Page: 3 of 10
Date: 09/11/2007
Time: 14:49:51
History 10: 1100023
CaUNo Patient # Call Date Current Payor Code Description # Rec. Date Recpt. # Amount
Total Credits For This Call 0.00
20041475 6126 10/10/2004 Insurance - Primar WMGT Write Off-Per Mana~ 08/03/2005 -21.13
--
Total Credits For This Call -21.13
20041548 6562 10/25/2004 Medicare Assigne< MED WO, bat after Med., 08/02/2005 60.70
Total Credits For This Call 60.70
20041582 6562 10/31/2004 Medicare Assignee: MED WO, bal. after Med., 08/02/2005 49.76
--
Total Credits For This Call 49.76
20041688- 7296 11/19/2004 MA Minnesota WDEC Write Off-Deceased 03/09/2006 751.13
---
Total Credits For This Call 751.13
20041698 7296 11/21/2004 MA Minnesota WDEC Write Off-Deceased 03109/2006 807.84
Total Credits For This Call 807.84
20041700 8534 11/21/2004 Insurance - Primar WMGT Write Off-Per Mana~ 07/11/2005 352. 14
Total Credits For This Call 352.14
20041883 6991 12/29/2004 PRIVATE (SELF F WDEC Write Off-Deceased 08/02/2005 71.41
--
Total Credits For This Call 71.41
20050076 8238 01/1012005 Medicare Assignee: WDEC Write Off-Deceased 11/17/2005 144.26
Total Credits For This Call 144.26
20050104 8694 01/14/2005 Insurance - Primar WMGT Write Off-Per Mana~ 08/03/2005 182.08
--
Total Credits For This Call 182.08
20050117 8238 01/16/2005 Medicare Assignee: WDEC Write Off-Deceased 11/17/2005 67.96
Total Credits For This Call 67.96
20050138 8238 01/20/2005 Medicare Assignee: WDEC Write Off-Deceased 11/17/2005 56.26
Total Credits For This Call 56.26
20050185 8738 01/26/2005 Medicare Assignee: WDEC Write Off-Deceased 0811712005 110.04
--
Total Credits For This Call 110.04
20050190 8742 01127/2005 Insurance - Primar WDEC Write Off-Deceased 08/04/2005 843.54
Total Credits For This Call 843.54
20050194 8743 01/28/2005 HP Medicaid WDEC Write Off-Deceased 07/20/2005 541.84
Total Credits For This Call 541.84
20050209 8231 01/29/2Q05 UHC Medica MA WONA Write off - no assets 08/0512005 506.60
WONA Write off - no assets 08/05/2005 -506.60
Total Credits For This Call 0.00
20050211 8750 01/30/2005 PRIVATE (SELF F WDEC Write Off-Deceased 07/12/2005 91.65
Total Credits For This Call 91.65
20050281 8798 02/12/2005 Insurance - Primar WBAN Write Off-Bankruptc: 01/26/2006 807.84
Total Credits For This Call 807.84
Credit Detail
Total Page: 4 of 10
Page: 4 of 10
Date: 09/11/2007
Time: 14:49:51
History 10 : 1100023
Call No Patient # Call Date Current Payor Code Description # Rec. Date Recpt. # Amount
20050387 6880 03/0112005 PRIVATE (SELF F WDEC Write Off-Deceased 11/1712006 65.35
--
Total Credits For This Call 65.35
20050562 8948 04101/2005 Insurance - Primar WBAN Write Off-Bankruptc: 01/26/2006 408.61
----
Total Credits For This Call 408.61
20050583 3985 04/05/2005 Medicare Assigne< MED WO, bal. after Med., 08/10/2005 56.26
--~-
Total Credits For This Call 56.26
20050605 3985 04/09/2005 Medicare Assignee MED WO, bal. after Med., 08/10/2005 56.26
--
Total Credits For This Call 56.26
20050620 8980 04112/2005 Medicare Assigne< WDEC Write Off-Deceased 08/23/2005 41.97
-----
Total Credits For This Call 41.97
20050684 3985 0412512005 Medicare Assignee MED WO, bal. after Med., 08/10/2005 55.13
Total Credits For This Call 55.13
20050685 3985 0412512005 Medicare Assigne< MED WO, bal. after Med., 08/10/2005 36.29
Total Credits For This Call 36.29
20050701 9029 04128/2005 MA Minnesota WSML Write Off-Small Bala 09/14/2006 -0.01
Total Credits For This Call -0.01
20050731 4690 05/0512005 MA Minnesota MED WO, bat after Me<I., 05/10/2006 66.83
--
Total Credits For This Call 66.83
20050763 9065 05111/2005 Insurance - Primar WDEC Write Off-Deceased 07/12/2005 649.54
---
Total Credits For This Call 649.54
20050764 9065 05/11/2005 Insurance - Primar WDEC Write Off-Deceased 07/12/2005 612.00
---
Total Credits For This Call 612.00
20050794 9082 05116/2005 MA Wisconsin WMGT Write Off-Per Mana{ 03/28/2006 824.80
Total Credits For This Call 824.80
20050873 4200 . 06/01/2005 PRIVATE (SELF F WDEC Write Off-Deceased 08/2512005 155.00
Total Credits For This Call 155.00
20050895 9126 06/05/2005 MA Minnesota WMGT Write Off-Per Mana{ 0810312005 -3.10
Total Credits For This Call -3.10
20050927 7126 06/11/2005 UHC Medica MA WDEC Write Off-Deceased 10/04/2005 56.41
Total Credits For This Call 56.41
20050928 6497 06/12/2005 Insurance - Primar WMGT Write Off-Per Mana{ 08/11/2005 -0.31
--
Total Credits For This Call -0.31
20050954 9159 06/16/2005 MA Minnesota WMGT Write Off-Per Mana{ 01/04/2007 642.40
Total Credits For This Call 642.40
20051018 8089 06/24/2005 Medicare Assigne< WONA Write off - no assets 11/30/2005 55.13
Total Credits For This Call 55.13
Credit Detail
Total Page: 5 of 10
Page: 5 of 10
Dale: 09/11/2007
Time: 14:49:51
History ID: 1100023
Call No Patient # Call Date Current Payor Code Description # Rec. Date Recpt. # Amount
20051021 8672 06125/2005 Medicare Assigne< WDEC Write Off-Deceased 03/31/2006 55.13
--
Total Credits For This Call 55.13
20051029 8089 06/26/2005 Medicare Assigne< WONA Write off - no assets 11/30/2005 56.26
Total Credits For This Call 56.26
20051050 9212 06/30/2005 Medicare Assigne< MED WO, bat after Med., 01/20/2006 deathcer 154.83
--
Total Credits For This Call 154.83
20051073 9226 07/0412005 Insurance - Primar WBAN Write Off-Bankruptc' 03/03/2006 643.62
Total Credits For This Call 643.62
20051131 2110 07115/2005 MA Minnesota WMGT Write Off-Per Mana~ 08/16/2005 -3.87
WMGT Write Off-Per Mana~ 08/16/2005 3.87
WMGT Write Off-Per Mana~ 11/21/2005 -4.16
Total Credits For This Call -4.16
20051139 9212 07115/2005 Medicare Assignee MED WO, bat after Med., 01/20/2006 67.96
MED WO, bat after Med., 01/20/2006 -67.96
MED WO, bat after Med., 01/20/2006 deathcer 67.96
Total Credits For This Call 67.96
20051142 9255 07/15/2005 Insurance - Primar WSML Write Off-Small Bala 09/14/2006 0.64
--
Total Credits For This Call 0.64
20051157 4436 07/18/2005 Insurance - Primar WONA Write off - no assets 09/23/2005 663.20
Total Credits For This Call 663.20
20051257 5395 08/07/2005 Insurance - Primar WBAN Write Off-BankruptC' 08/29/2006 658.20
--
Total Credits For This Call 658.20
20051369 9374 08/26/2005 Insurance - Primar WDEC Write Off-Deceased 11/23/2005 835.99
Total Credits For This Call 835.99
20051370 9374 08/26/2005 Insurance - Primar WDEC Write Off-Deceased 11/23/2005 917.59
Total Credits For This Call 917.59
20051385 288 08/30/2005 Insurance - Primar WMGT Write Off-Per Mana~ 12/12/2005 45.84
-.-
Total Credits For This Call 45.84
20051421 9397 09/06/2005 Insurance - Primar WMGT Write Off-Per Mana~ 12/07/2006 7.38
Total Credits For This Call 7.38
20051489 8089 09/1712005 ,Medicare Assigne< WONA Write off - no assets 11/30/2005 55.13
Total Credits For This Call 55.13
20051495 4436 09/18/2005 Insurance - Primar WONA Write off - no assets 09/23/2005 547.54
--
Total Credits For This Call 547.54
20051498 9440 09/18/2005 Insurance - Primar WBAN Write Off-Bankruptc: 01/10/2007 493.27
Total Credits For This Call 493.27
20051548 9465 09/30/2005 Insurance - Primar WDEC Write Off-Deceased 04/12/2006 686.26
Credit Detail
Total Page: 6 of 10
Page: 6 of 10
Date: 09/11/2007
Time: 14:49:51
History 10: 1100023
Call No Patient # Call Date Current Payor Code Description # Rec. Date Recpt. # Amount
Total Credits For This Call 686.26
20051610 9500 10/11/2005 MA Minnesota WMGT Write Off-Per Mana~ 04/04/2007 602.20
--
Total Credits For This Call 602.20
20051633 9279 . 10/14/2005 Insurance - Primar WONA Write off - no assets 06/0812007 187.00
---
Total Credits For This Call 187.00
20051663 6548 10/19/2005 Insurance - Primar WMGT Write Off-Per Mana~ 01/20/2006 12.81
Total Credits For This Call 12.81
20051697, 3257 10/24/2005 Insurance - Primar WMGT Write Off-Per Mana~ 08127/2007 682.79
Total Credits For This Call 682.79
20051699 3257 10/24/2005 Insurance - Primar WMGT Write Off-Per Mana~ 08/27/2007 798.05
---
Total Credits For This Call 798.05
20051717 9556 10/27/2005 Insurance - Primar WBAN Write Off-Bankruptc' 04/11/2007 236.32
Total Credits For This Call 236.32
20051723 9559 10/27/2005 Insurance - Primar WMGT Write Off-Per Mana~ 04/24/2006 266.56
Total Credits For This Call 266.56
20051754 3257 11/0112005 Insurance - Primar WMGT Write Off-Per Mana~ 08127/2007 557.33
Total Credits For This Call 557.33
20051762 6880 11/0212005 Medicare Assigne< WDEC Write Off-Deceased 11/17/2006 75.91
Total Credits For This Call 75.91
20051764 6880 11/0212005 Medicare Assigne< WDEC Write Off-Deceased 11/17/2006 72.53
--
Total Credits For This Call 72.53
20051766 9224 11/0312005 UHC Medica MA WSML Write Off-Small Bala 01/19/2006 -0.20
--
Total Credits For This Call -0.20
20051779 9224 11/05/2005 UHC Medica MA WSML Write Off-Small Bala 01119/2006 -0.21
--
Total Credits For This Call -0.21
20051782 9589 1110612005 Insurance - Primar WMGT Write Off-Per Mana~ 04/24/2006 7.20
--
Total Credits For This Call 7.20
20051801 9614 11/0812005 Insurance - Primar WONA Write off - no assets 06/29/2006 732.16
Total Credits For This Call 732. 16
20051814 9603 11/1212005 Insurance - Primar WBAN Write Off-Bankruptc: 06/29/2007 455.62
Total Credits For This Call 455.62
20051866 4867 11/19/2005 Medicare Assigne< WSML Write Off-Small Bala 01/30/2006 0.19
Total Credits For This Call 0.19
20051934 8717 11/30/2005 MA Minnesota WMGT Write Off-Per Mana~ 04/04/2007 471.20
--
Total Credits For This Call 471.20
20051969 9709 1210512005 Insurance - Primar WDEC Write Off-Deceased 07/07/2006 663.20
Credit Detail
Total Page: 7 of 10
Page: 7 of 10
Date: 09/11/2007
Time: 14:49:51
History 10: 1100023
Call No Patient # Call Date Current Payor Code Description # Rec. Date Recpt. # Amount
--
Total Credits For This Call 663.20
20051970 9709 12105/2005 Insurance - Primar WDEC Write Off-Deceased 07/07/2006 798.05
--
Total Credits For This Call 798.05
20052009 9731 1211212005 Medicare Assigne< WSML Write Off-Small Bala 02117/2006 -0.02
Total Credits For This Call -0.02
20052070 4892 12120/2005 Insurance - Primar WSML Write Off-Small Bala 01/26/2006 -0.01
Total Credits For This Call -0.01
20052107- 8204 1212812005 Insurance - Primar WMGT Write Off-Per Mana~ 04107/2006 12.24
--
Total Credits For This Call 12.24
20052123 9796 12130/2005 Insurance - Primar WMGT Write Off-Per Mana~ 05115/2006 232.12
WMGT Write Off-Per Mana~ 05115/2006 -232.12
---
Total Credits For This Call 0.00
20060004 9808 01/0212006 Insurance - Primar WDEC Write Off-Deceased 0312812006 741.34
---
Total Credits For This Call 741.34
20060088 9164 01116/2006 MA Minnesota WSML Write Off-Small Bala 10109/2006 -4.30
Total Credits For This Call -4.30
20060095 9858 01/1712006 Insurance - Primar WSML Write Off-Small Bala 04/03/2006 -0.20
----
Total Credits For This Call -0.20
20060110 9869 01/2012006 Medicaid HMO - U WDEC Write Off-Deceased 01/0812007 619.80
Total Credits For This Call 619.80
20060174 9911 0210212006 Medicare Assignee WMGT Write Off-Per Mana~ 12129/2006 75.59
WMGT Write Off-Per Mana~ 0310812007 11.19
Total Credits For This Call 86.78
20060215 9932 02109/2006 Insurance - Primar WMGT Write Off-Per Mana~ 03120/2006 201.74
Total Credits For This Call 201.74
20060251 9957 02114/2006 Medicare Assignee WSML Write Off-Small Bala 0212112007 -0.29
--
Total Credits For This Call -0.29
20060346 10015 02126/2006 Insurance - Primar WMGT Write Off-Per Mana~ 05131/2007 800.40
Total Credits For This Call 800.40
20060365 10025 0212812006 Insurance - Primar WSML Write Off-Small Bala 0611212006 -0.01
Total Credits For This Call -0.01
20060372 10030 03101/2006 Insurance - Primar WMGT Write Offcper Mana~ 05/1212006 167.00
WMGT Write Off-Per Mana~ 05/1212006 -167.00
WMGT Write Off-Per Mana~ 05/1212006 183.70
Total Credits For This Call 183.70
20060383 10037 03/0212006 Insurance - Primar WMGT Write Off-Per Mana~ 06106/2006 694.65
Credit Detail
Total Page: 8 of 10
Page: 8 of 10
Date: 09/11/2007
Time: 14:49:51
History 10 : 1100023
Call No Patient # Call Date Current Payor Code Description # Ree. Date Recpt. # Amount
--
Total Credits For This Call 694.65
20060414 7204 03/06/2006 MA Minnesota WSML Write Off-Small Bala 10/24/2006 -3.10
Total Credits For This Call -3.10
20060494 8204 0311712006 Insurance - Primar WMGT Write Off-Per Mana~ 08/11/2006 3.21
--
Total Credits For This Call 3.21
20060512 10118 03/19/2006 Insurance - Primar WSML Write Off-Small Bala 12127/2006 0.01
Total Credits For This Call 0.01
2006060& 10170 04/0312006 Insurance - Primar WDEC Write Off-Deceased 12106/2006 635.66
Total Credits For This Call 635.66
20060682 8020 04/15/2006 Insurance - Primar WDEC Write Off-Deceased 06/06/2006 225.42
Total Credits For This Call 225.42
20060701 10227 04/19/2006 MA Minnesota WSML Write Off-Small Baja 10/09/2006 -0.79
Total Credits For This Call -0.79
20060732 10243 04121/2006 PRIVATE (SELF F WSML Write Off-Small Bala 06/27/2006 -0.58
Total Credits For This Call -0.58
20060772 2596 04/29/2006 Insurance - Primar WSML Write Off-Small Bala 10/17/2006 -0.20
Total Credits For This Call -0.20
20060788 10274 05/0212006 Insurance - Primar WONA Write off - no assets 10/20/2006 165.20
Total Credits For This Call 165.20
20060810 10283 05/06/2006 Insurance - Primar WSML Write Off-Small Bala 06/1212006 -0.01
Total Credits For This Call -0.01
20060843 7669 05/10/2006 Medicaid HMO - U WSML Write Off-Small Bala 10/04/2006 -0.93
Total Credits For This Call -0.93
20060909 9709 OS/23/2006 Insurance - Primar WDEC Write Off-Deceased 08111/2006 225.42
--
Total Credits For This Call 225.42
20060948 10345 OS/29/2006 Insurance - Primar WSML Write Off-Small Bala 07/1212006 -0.01
Total Credits For This Call -0.01
20060955 10353 05/31/2006 Insurance - Primar WSML Write Off-Small Bala 0810312006 -0.02
Total Credits For This Call -0.02
20060985 10364 06/0412006 Insurance - Primar WSML Write Off-Small Bala 09/11/2006 -9.17
Total Credits For This Call -9.17
20060996 10373 06/06/2006 Insurance ~ Primar WMGT Write Off-Per Mana~ 09/25/2006 12.81
Total Credits For This Call 12.81
20061007 10385 06/0812006 Insurance - Primar WSML Write Off-Small Baja 07/25/2006 -0.01
Total Credits For This Call -0.01
20061028 6747 06/11/2006 MA Minnesota WSML Write Off-Small Bala 01/04/2007 8.00
Credit Detail
Total Page: 9 of 10
Page: 9 of 10
Date: 09/11/2007
Time: 14:49:51
History ID : 1100023
Call No Patient # Call Date Current Payor Code Description # Rec. Date Recpt. # Amount
--
Total Credits For This Call 8.00
20061030 6747 06/11/2006 MA Minnesota WMGT Write Off-Per Mana{ 01/04/2007 134.94
-
Total Credits For This Call 134.94
20061040 10170 06/12/2006 Insurance - Primar WDEC Write Off-Deceased 10/04/2006 682.79
Total Credits For This Call 682.79
20061113 10441 06/24/2006 Medicare Assignee WMGT Write Off-Per Mana{ 07/28/2006 -3.10
Total Credits For This Call -3.10
20061208- 10492 07/12/2006 Insurance - Primar WMGT Write Off-Per Mana{ 02/27/2007 258.36
--
Total Credits For This Call 258.36
20061225 10501 07/15/2006 Medicare Assignee WDEC Write Off-Deceased 02/09/2007 75.42
Total Credits For This Call 75.42
20061267 10530 07/20/2006 Insurance - Primar WSML Write Off-Small Bala 08/30/2006 -0.01
--
Total Credits For This Call -0.01
20061278 5395 07/22/2006 Insurance - Primar WBAN Write Off-Bankruptc: 08/29/2006 603.43
--
Total Credits For This Call 603.43
20061282 5395 07/2212006 Insurance - Primar WBAN Write Off-Bankruptc' 08/29/2006 645.46
Total Credits For This Call 645.46
20061426 10625 08/16/2006 Medicare Assignee WSML Write Off-Small Bala 01/10/2007 -0.04
--
Total Credits For This Call -0.04
20061483 10648 08/28/2006 Insurance - Primar WSML Write Off-Small Bala 09/18/2006 -0.01
--
Total Credits For This Call -0.01
20061628 10738 09/23/2006 Insurance - Primar WSML Write Off-Small Bala 10/31/2006 -0.01
Total Credits For This Call -0.01
20061704 10783 10/06/2006 Insurance - Primar WSML Write Off-Small Bala 10/31/2006 -0.Q1
--"
Total Credits For This Call -0.01
20061712 10795 10/07/2006 Medicare Assignee WBAN Write Off-Bankruptc: 03128/2007 75.42
Total Credits For This Call 75.42
20061716 10795 10/08/2006 Medicare Assignee WBAN Write Off-Bankruptc: 03128/2007 128.52
Total Credits For This Call 128.52
20061775 10830 10/20/2006 Insurance - Prirnar WSML Write Off-Small Bala 01/16/2007 -0.05
Total Credits For This Call -0.05
20061847 10863 11/02/2006 Insurance- Primar WSML Write Off-Small Bala 02/0512007 0.90
Total Credits For This Call 0.90
20061958 2760 11/18/2006 Medicare Assignee WSML Write Off-Small Bala 02/13/2007 -0.40
Total Credits For This Call -0.40
20062120 11012 12/15/2006 Insurance - Primar WSML Write Off-Small Bala 01/19/2007 -0.01
Call No
20062120
20062176
A07-0079
A07-0190
A07-0455
A07-1104
Totals For All
Number of Calls
Patient #
11014
8621
11129
11198
11363
11734
161
Credit Detail
Call Date Current Payor Code
12/15/2006 Insurance - Primar WSML
Description #
Write Off-Small Bala
Total Page: 10 of 10
Page: 10 of 10
Date: 09/11/2007
Time: 14:49:51
History 10: 1100023
Rec. Date Recpt. # Amount
01/18/2007
-0.01
12/23/2006 MA Minnesota
Total Credits For This Call
WSML Write Off-Small Bala 01/31/2007
-0.02
-0.79
Total Credits For This Call
01/14/2007 Insurance - Primar WSML Write Off-Small Bala 04/17/2007
-0.79
0.19
Total Credits For This Call
01/29/2007 Medicare Assignee WSML
WSML
Write Off-Small Bala
Write Off-Small Bala
04/06/2007
04/06/2007
0.19
-0.01
0.01
Total Credits For This Call
03110/2007 Insurance - Primar WSML Write Off-Small Bala 04/11/2007
0.00
-0.77
Total Credits For This Call
07/01/2007 Insurance - Primar WSML Write Off-Small Bala 0810812007
-0.77
-0.72
Total Credits For This Call
Number Of Credits
180
-0.72
Total Credits
45490.41