“expert medical billing software” - cortex med...“expert medical billing software” cortex...

CORTEX REVENUE CYCLE MANAGEMENT +

SAMPLE REPORTS BOOK

“Expert Medical Billing Software”

CORTEX RCM+ REPORTS

DAILY BILLING REPORTS

ADJUSTMENT REPORT

BANK DEPOSIT SLIP

CASH RECEIPTS BATCH REPORT

CASH RECEIPTS WITH PAYMENTS

CREDIT BALANCE SERVICE REPORT

PATIENT ACCOUNTS ON HOLD

PATIENT LEDGER

PATIENT LEDGER WITH NOTES

PATIENT LEDGER WITH NOTES AND COMMENTS

PENDING TRANSACTION LOG

REFUND REQUEST

SERVICES BATCH REPORT

SERVICES ON HOLD

UNBILLED SERVICES

CHANGE TRACKING REPORTS

CHANGE TRACKING BY PATIENT NUMBER

CHANGE TRACKING BY PATIENT AND ACTION TYPE

CHANGE TRACKING BY SERVICE NUMBER

CHANGE TRACKING BY SERVICE AND ACTION TYPE

CHANGE TRACKING ARCHIVE BY SERVICE NUMBER

CHANGE TRACKING ARCHIVE BY PATIENT NUMBER

CLAIM REPORTS

HCFA1500

PATIENT CLAIMS

DETAILED CLAIMS LIST

CLAIM RUN LIST

CLAIM RUN LIST - EXPANDED

PATIENT STATEMENT REPORTS

PATIENT STATEMENTS

PATIENT STATEMENTS LIST

PATIENT STATEMENT RUN LIST

DETAILED PATIENT STATEMENT LIST

CONTRACT PAYMENT PATIENT ACCOUNTS

CONTRACT PATIENTS WITH NO PAYMENTS IN 30

DAYS

PATIENT COLLECTIONS AND AGING REPORTS

PATIENT AGING REPORT

PRE-COLLECTION REPORT

PRE-COLLECTION LETTER

COLLECTION REPORT DETAIL

CLIENT BILLING REPORTS

CLIENT ACCOUNT DETAILS

CLIENT ADJUSTMENT REPORT

CLIENT ACCOUNT AGING REPORT

CLIENT CASH RECEIPT BATCH REPORT

CLIENT CASH RECEIPT WITH PAYMENTS

CLIENT DEPOSIT SLIP

CLIENT PROOF LIST

CLIENT SERVICES BATCH REPORT

CLIENT SERVICES WITH A CREDIT BALANCE

CLIENT STATEMENT

CLIENT STATEMENT RUN LIST

https://cortexmed1commicrosoftonlinecom-1.sharepoint.microsoftonline.com/Shared%20Documents/Sales%20and%20Marketing/Reports%20Books/MB/Supporting%20Docs/All%20Word%20Docs.docx#_Toc283631070















































PAYOR COLLECTIONS AND AGING REPORTS

PAYOR AGING SUMMARY REPORT

PAYOR AGING REPORT DETAIL

PAYOR AGING SUMMARY TOP 20

PAYOR TYPE AGING DETAIL REPORT

PAYOR TYPE AGING SUMMARY REPORT

MANAGEMENT REPORTS

ADJUSTMENTS BY PAYOR TYPE/DEPARTMENT

ACCOUNTS RECEIVABLE RECONCILIATION BY

MONTH

AVERAGE DAYS CASE COMPLETED TO BILLED

AVERAGE MONTHLY REVENUE DAYS IN A/R

AVERAGE MONTHLY REVENUE

CLINICIAN REVENUE REPORT

COMPLETED CASES WITHOUT BILLED DATES

COMPLETED CASES WITHOUT SERVICES

CONTRACTED VS. PAID COMPARISON REPORT BY

SERVICE ITEM CODE

CONTRACTED VS. PAID COMPARISON REPORT

CORTEX SYSTEM MANAGEMENT REPORT

DAILY ACCOUNTS RECEIVABLE BALANCE REPORT

DAILY CLIENT REVENUE BY PROVIDER

DAILY PAYMENTS BY PROVIDER

DAILY REVENUE BY SCREENER/PATHOLOGIST

DUPLICATE PATIENT BY SERVICE ENTERED DATE

FINANCIAL CLASS PERCENTAGE BILLING

FINANCIAL CLASS AGING REPORT SUMMARY

GYN/NONGYN CYTOLOGY DAILY REVENUE BY

SCREENER/PATHOLOGIST

HISTOLOGY DAILY REVENUE BY

SCREENER/PATHOLOGIST

LOCATION/CLINICIAN UTILIZATION REPORT

MISSING CASE NUMBERS

MISSING RELATED PATIENT PAYOR

MONTHLY SERVICES BY FINANCIAL CLASS

PATIENT LEDGER - ALL INFORMATION

PATIENT NAME WITHOUT A COMMA

PAYMENTS BY DEPARTMENT/PAYOR TYPE

PAYMENTS BY LOCATION/SERVICE ITEM/ PAYOR

TYPE

PAYMENTS BY LOCATION AND PAYOR

PAYMENTS RECEIVED BY MODIFIER/CPT

PAYMENTS WITH ZERO AMOUNTS

PAYOR REVENUE REPORT

PAYOR REVENUE REPORT DETAIL

PAYOR TYPE REVENUE REPORT

PERFORMING CLINICIAN UTILIZATION YEAR TO DATE

REFERRING CLINICIAN UTILIZATION REPORT

REFERRING CLINICIAN UTILIZATION YEAR TO DATE

REVENUE BY WHERE PERFORMED

SERVICE ITEM REVENUE REPORT

SERVICE TOTALS BY DEPARTMENT

TOTAL CLIENT PAYMENTS

VOLUME SUMMARY BY SERVICE ITEM CODE BY

MONTH

VOLUME SUMMARY BY SERVICE ITEM CODE TOP 10

BY MONTH

VOLUME SUMMARY OF SERVICE ITEM CODE BY

WHERE PERFORMED

REFERENCE FILE REPORTS

REFERENCE FILE REPORTS BY REPORT NUMBER

REFERENCE FILE REPORTS BY REPORT NAME


























































DAILY BILLING REPORTS

» DISPLAYS SERVICE AND PAYMENT ADJUSTMENTS

POSTED

» DISPLAYS ADJUSTMENT NUMBER, ENTERED DATE,

ENTERED BY, AMOUNT, ADJUSTMENT REASON,

SERVICE NUMBER AND PATIENT NUMBER

» GROUPS AND TOTALS BY PAYOR THEN

ADJUSTMENT TYPE

» USED IN AUDITING ADJUSTMENTS AND DAILY

BALANCING

» REPORT IS FOUND IN THE DAILY PROCESS MODULE

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Adjustment Report

Adjustment Report

NumberEntered

Date / By AmountAdjustment ReasonService

Number

Patient

Number

Adjustment.EnteredDate BETWEEN '01/01/2008' AND '05/01/2008'

BAY AREA SCHOOL/CNA #0000021

050 Posting error

0223485 02/22/2008 -5.25Posted incorrect amount. GS 0999995GS 0280305

0224574 02/27/2008 -55.00PT DID NOT HAVE SERVICES - REF PHY OFFICE

ERROR

1034257MAS 0280955

050 -60.25Posting error

051 Collection Turnover

0214386 01/15/2008 119.321002411DH 0223713

0214387 01/15/2008 122.311002411DH 0223714

0211843 01/03/2008 75.000396367GS 0231216

0219701 02/06/2008 31.450338905SHK 0240727

0226653 03/06/2008 41.680174845GS 0243809

0226652 03/06/2008 41.680174845GS 0243810

0226651 03/06/2008 23.670174845GS 0244374

0226650 03/06/2008 31.450174845GS 0244375

0228375 03/13/2008 -4.73Account sent to BCCB due to returned check. SK 0411186SHK 0264526

0228374 03/13/2008 -6.29Account sent to BCCB for returned check. SK 0411186SHK 0264527

0226668 03/07/2008 101.62add back pt paid on bulk ck 0021473DH 0249160

0232087 03/31/2008 75.00MCAL PD 03307650210517

0232086 03/31/2008 75.00MCAL PD 03307650210518

0226214 03/04/2008 118.00pt paid, rev c/t 10297650246150

0211844 01/03/2008 75.00Ref dr. will pay for charge. GS 0396367GS 0231215

0211806 01/03/2008 101.70rev collection to, pt pd 10272850224932

0223037 02/20/2008 10.31Reverse collections. GS 0068028GS 0234463

051 1,032.17Collection Turnover

053 Courtesy discount

0211847 01/03/2008 -20.000396367MAS 0231215

0211845 01/03/2008 -20.000396367MAS 0231216

0226042 03/03/2008 -5.001030700GS 0253558

0226043 03/03/2008 -15.001030700GS 0253559

0213642 01/14/2008 -55.000253025MAS 0268373

0213014 01/08/2008 -31.20Cash Discount. GS 0416080GS 0228275

0213013 01/08/2008 -64.00Cash discount. gS 0416080GS 0228276

0213012 01/08/2008 -5.80Cash discount. GS 0416080GS 0228277

0213011 01/08/2008 -20.00Cash discount. gS 0416080GS 0228278





0229727 03/19/2008 -64.00cash discount. GS 0429911GS 0282587

0214135 01/14/2008 -10.16Dr. wife discount. gS 0021380GS 0265455

0238192 04/21/2008 -101.62Employees spouse. Gs 1035676GS 0292126

0213627 01/11/2008 -5.38small balance write off 1027507GS 0227238

053 -966.16Courtesy discount

054 Refund to Patient

0231435 03/26/2008 -514.620390338SHK 0232110

0216030 01/23/2008 9.43dup pmt, refund to pt 01763520266604

0217753 01/31/2008 6.29dup pmt, refund to pt. 03204620263712

0224200 02/26/2008 15.72ins pd 01620090268366

0231436 03/26/2008 471.83Pt and BC paid. 0390338SHK 0232110

0224343 02/26/2008 11.33pt over pd 03707090273422

0224338 02/26/2008 30.95pt over pd 03707090273423

0236655 04/15/2008 239.68pt pd twice, refund to pt 01681410282091

0238365 04/22/2008 16.68Refund patient overpaid 1034667DH 0284333

0230141 03/21/2008 11.33Refund pt 0394837LKL 0285001

0230140 03/21/2008 30.95Refund pt 0394837LKL 0285002

Page 30 of 605 Printed:01/14/2011

MB107.rpt

GenTesting

» DISPLAYS PAYMENT INFORMATION FOR A GIVEN

DEPOSIT NUMBER

» DISPLAYS TENDER NUMBER, AMOUNT, PAYOR,

PATIENT NAME AND NUMBER

» TOTALS ALL PAYMENTS AT THE BOTTOM

» CAN BE ATTACHED TO THE BANK’S DEPOSIT SLIP

AND CAN BE CUSTOMIZED TO INCLUDE BANK

INFORMATION


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Bank Deposit Slip

Bank Deposit Slip

Deposit No.: 0000673

Description: 041406dh

Date: 04/14/2006

Type AmountTender No. Payor Patient Number / NameAdjustmentReceipt No.

Patient Account Deposits

WHIPPLE, CHRISTINA0054233PRIVATE PAY 17.001413281854MO0064048

WHITE, RAMONA0062438PRIVATE PAY 9.304445CH0064050

KREBS, DALENE0394493BAY AREA SCHOOL/CNA 0.004VZTPPCH0064053

MCGUIRE, GLORIA1006177BAY AREA SCHOOL/CNA 0.004YX8BNCH0064085

MCCURDY, MERILEE1006159BAY AREA SCHOOL/CNA 0.004YWPQRCH0064086

Total Patient Account Deposits 3,837.62

Payments & Adjustments:

0000673 Net Deposit :

$3,837.62

$3,837.62

0.00

Printed:08/27/2009

MB108.rptPage 3 of 3

» DISPLAYS ALL PAYMENTS ENTERED FOR A BATCH

OR RANGE OF CASH RECEIPT DATES

» DISPLAYS CASH RECEIPT NUMBER, ENTERED DATE,

TENDER TYPE, PAYOR NAME AND NUMBER, PATIENT

NAME AND NUMBER, WRITE OFF AMOUNT, PAYMENT

NUMBER, AMOUNT, TOTAL PAYMENT ADJUSTMENT

AND DEPOSIT NUMBER NET AMOUNT

» SUBTOTALS BY BATCH NUMBER

» CAN BE USED TO ENSURE ALL PAYMENTS ARE

ENTERED


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Cash Receipts Batch Report

Payment

Cash Receipt Batch Report

Net Amt.Number AmountAmount

Total Pmt

Adjmt.'s

PaymentCash

Rec.#

Entered

By ID/Date

Patient Number/Name

Payor Number/Name

Write Off Deposit #

0Batch Number:

0334097 0004 0069077 Thomas, Alecia 0.00

04/15/2009 0000000 PRIVATE PAY 0402665 50.00 0.00 50.00

Payment Total 50.00 0.00 50.00

Totals for Batch 0 50.00 0.00 0.00 50.00

041509JBatch Number:

0334098 0004 0069077 Thomas, Alecia 0.00

04/15/2009 0000000 PRIVATE PAY 0402666 -50.00 0.00 -50.00

Payment Total -50.00 0.00 -50.00

0334099 0004 0186408 EGGER, SHARON 0.00

04/15/2009 0000000 PRIVATE PAY 0402667 25.00 0.00 25.00


0334100 0004 0006065 HEESE, KAREN -15.00

04/15/2009 0000135 BVMG/PACIFICARE 0402669 30.00 0.00 30.00


0334101 0004 1042116 THAUT, BEULAH 0.00

04/15/2009 0000000 PRIVATE PAY 0402672 5.00 0.00 5.00

0402670 5.00 0.00 5.00

0402671 5.00 0.00 5.00


0334102 0004 1041064 WRAY, GALEN 0.00

04/15/2009 0000000 PRIVATE PAY 0402673 20.00 0.00 20.00


0334103 0004 0007126 PFISTER, EDWIN -54.98

04/15/2009 0000134 BVMG/ONE HEALTHPLAN 0402674 50.00 0.00 50.00


0334104 0004 0007892 RICHERT, JANET 0.00

04/15/2009 0000000 PRIVATE PAY 0402675 5.00 0.00 5.00


Totals for Batch 041509J 95.00 0.00-69.98 95.00

041509RBatch Number:

0334105 0004 0186408 EGGER, SHARON 0.00

04/15/2009 0000000 PRIVATE PAY 0402676 2.50 0.00 2.50


0334106 0004 1042116 THAUT, BEULAH 0.00

04/15/2009 0000000 PRIVATE PAY 0402678 1.00 0.00 1.00

0402679 1.00 0.00 1.00

0402680 1.00 0.00 1.00


0334107 0004 1041064 WRAY, GALEN 0.00

04/15/2009 0000000 PRIVATE PAY 0402681 1.00 0.00 1.00


Totals for Batch 041509R 6.50 0.00 0.00 6.50

Page 1 of 2 Printed: 04/23/2009

MB110.rpt

GenTesting

» DISPLAYS ALL PAYMENTS ENTERED

» DISPLAYS CASH RECEIPT NUMBER, ENTERED DATE,

TENDER TYPE, PAYOR NAME AND NUMBER, PATIENT

NAME AND NUMBER, PAYMENT NUMBER, AMOUNT,

TOTAL PAYMENT ADJUSTMENT AND ADJUSTED

PAYMENT AMOUNT

» SUBTOTALS BY TENDER

» CAN BE USED TO ENSURE ALL PAYMENTS ARE

ENTERED


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Cash Receipts with Payments

Cash Receipt with Payments

Entered

Date

Tender

Type

Payment

Amount

Payment

Number

Payor # /

Patient#

Payor Name /

Patient Name

Adjusted

Payment

Amount

Number Total

Payment

Adjustment

(CashReceipt.EnteredDate BETWEEN '04/15/2009' AND '04/15/2009' )

Tender Number: 234

CH 04026670334099 PRIVATE PAY0000000EGGER, SHARON0186408

04/15/2009 25.00 25.00 0.00

Cash Receipt Amount: 50.00 Total Payments for Cash Receipt: 25.00 25.00 0.00

CH 04026690334100 BVMG/PACIFICARE0000135HEESE, KAREN0006065

04/15/2009 30.00 30.00 0.00


CH 04026700334101 PRIVATE PAY0000000THAUT, BEULAH1042116

04/15/2009 5.00 5.00 0.00


04/15/2009 5.00 5.00 0.00


04/15/2009 5.00 5.00 0.00


CH 04026730334102 PRIVATE PAY0000000WRAY, GALEN1041064

04/15/2009 20.00 20.00 0.00


CH 04026740334103 BVMG/ONE HEALTHPLAN0000134PFISTER, EDWIN0007126

04/15/2009 50.00 50.00 0.00


CH 04026750334104 PRIVATE PAY0000000RICHERT, JANET0007892

04/15/2009 5.00 5.00 0.00


CH 04026760334105 PRIVATE PAY0000000EGGER, SHARON0186408

04/15/2009 2.50 2.50 0.00



04/15/2009 1.00 1.00 0.00


04/15/2009 1.00 1.00 0.00


04/15/2009 1.00 1.00 0.00


Printed:4/23/2009Page 1 of 2

MB109.rpt

GenTesting

» DISPLAYS SERVICES WITH A CREDIT BALANCE

» DISPLAYS SERVICE NUMBER, FROM DATE, PATIENT

NUMBER, NAME AND ADDRESS, BALANCE AMOUNT

AND USER SERVICE STATUS CODE

» USE TO LOCATE CREDIT BALANCES AND ISSUE

REFUNDS TO PATIENTS, INSURANCE OR A THIRD

PARTY


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Credit Balance Service Report

Credit Balance Service{Service.ServiceStatusCode} = 50

Patient Name/

Address

User Service

Status

Patient

Number

From

Date

Service

Number

Balance

Amount

CAMPBELL, ANNA 0227054

6056 MINERS RANCH RD Seattle WA 98121 08/26/20080327229 -60.05

-$60.05CASE, JEAN 1024802

1515 HWY 99W 6 Seattle WA 98121 06/20/20080311891 -55.00

-$55.00CLARK, JERRY 0279807

9339 PETERSON ESTATES DR Seattle WA 98121 12/02/20050043040 -10.00

-$10.00D'ACCIO, MAGINA 1019467

5851 JAMES DR C Seattle WA 98121 07/10/20080315199 -85.00

-$85.00DAILY, ALVIN 0210834

12157 CENTERVILLE RD Seattle WA 98121 12/18/20080355459 -21.25

-$21.25EIKMEIER, SHELLY 0370805

PO BOX 363 Seattle WA 98121 12/18/20080355496 -11.50

-$11.50FAILLA, MICHEAL 1038647

7875 COUNTY RD 40 Seattle WA 98121 08/26/20080327215 -0.01

-$0.01FARIS, NICOLE 0098840

539 COUNTRY SIDE LN Seattle WA 98121 12/17/20080356710 -23.67

12/17/20080356711 -24.05

-$47.72FJARE, JOY 0215608

853 KERN ST Seattle WA 98121 07/18/20080318926 -25.16

-$25.16FORCH (BARCLAY), KRISTINA 1039324

1253 W 5TH AVE 107 Seattle WA 98121 08/05/20080322447 -9.48

-$9.48HANTEN, TOBI 0000136

Seattle WA 98121 09/29/20080334571 -39.85

-$39.85HASENKAMP-GIBBS, HOPE 0366674

719 YOLO ST Seattle WA 98121 07/15/20080317434 -9.48

-$9.48HINDMAN, TONI 0410945

P.O. BOX 4184 Seattle WA 98121 06/03/20080307662 -55.00

-$55.00HOESCHE, WILLIAM 0011546

714 W. SYCAMORE ST Seattle WA 98121 11/25/20080350367 -77.84

11/25/20080350369 -138.75

12/19/20080355793 -138.75

-$355.34HURLEY, MARY 1003298

1259 STORYBOOK LN Seattle WA 98121 09/02/20080329540 -191.56

-$191.56ISRAEL, DEBORAH 0312455

1622 HARVEST GLEN DR Seattle WA 98121 12/18/20070266211 -160.00

-$160.00

Page 1 of 2 Printed:04/23/2009

MB106.rpt

GenTesting

» DISPLAYS PATIENT ACCOUNT NUMBER AND NAME

AND THE TYPE OF HOLD ON THE ACCOUNT

» USE TO DETERMINE IF ACCOUNTS ON HOLD

SHOULD BE RELEASED OR WRITTEN OFF

» REPORT IS FOUND IN THE PATIENT STATEMENT

BILLING MODULE

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Patient Accounts on Hold

Number Name Billing on Hold

Patient Accounts on Hold {Patient.BillingStatusCode} <> "N"

0000136 HANTEN, TOBI All Billing

0007599 NEIL, LORETTA Statements

0010401 ROWE, MARTA Claims

0011539 BRUNER, DEBRA Statements

0021380 ANDERSON, BILLY Statements

0023018 FICHTER, SAMANTHA Statements

0023106 LYBARGER, SHARON Statements

0032187 PETERSON, MARY Statements

0044889 WELLENSIEK, ERNA Statements

0048922 WICHERT, BARBARA Statements

0052163 BRUNER, ARNOLD Statements

0053186 BALKUS, SHERI Statements

0056624 MCKIERNAN, ELLIE Statements

0057165 KAMINSKI, AMI Statements

0060426 MOSER, CYNTHIA Statements

0061195 BAUMANN, THOMAS Statements

0068501 FARRALL, RACHELLE Statements

0072408 COLE, SHAWN Statements

0078969 MILLER, JAMES Statements

0082712 NICHOLS, LYNN Statements

0085699 ZWEERINK, SYLIVIA Statements

0093520 KINZIE, CANDACE Statements

0096782 ARNOLD, DERIK Statements

0099677 EARL, RAMONA Statements

0099749 MISFELDT, MARY Statements

0099909 SHULENBERG, EDNA Statements

0102548 MOORE, WILMA Statements

0106808 EWERT, BERNETTE Statements

0107362 DINAPOLI, NIKKOLAS Statements

0108212 CASTNER, EMALIE Statements

0111163 MAGUIRE, MICHAELA Statements

0111561 ELLIS, CLAIRE Statements

0112712 JAKSHA, JAMES Statements

0115541 SIMMONDS, ELIZABETH Statements

0117617 LEUTENEGGER, MARY Statements

0123356 JOHNSON, EVELYN Statements

0132324 SMITH, KARENINA Statements

0140681 WIESE, TAMI Statements

0147633 SMALLEY, JENNIFER Statements

0149552 DONAHUE, CYNTHIA Statements

0150815 GOMEZ, TRAUDE Statements


MB103.rpt

GenTesting

» DISPLAYS ALL SERVICE, PAYMENT AND

ADJUSTMENT HISTORY FOR A PATIENT ACCOUNT

» DISPLAYS ENTERED DATE, NUMBER AND

DESCRIPTION FOR EACH PAYMENT AND/OR

ADJUSTMENT

» GROUPED BY SERVICE NUMBER

» USEFUL WHEN A PATIENT REQUESTS AN ITEMIZED

STATEMENT OF THEIR ACCOUNT

» REPORT IS RUN BY CLICKING ON THE ‘PATIENT

LEDGER’ BUTTON ON THE PATIENT ACCOUNT DETAIL

SCREEN

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Patient Ledger

Account Details for Patient Number : 0069077

Thompson, Alecia

2107 Elliott Ave

Seattle, WA 98121

Billing

Description INSBalanceStatusAmountNumberDate

Service 036323604/13/2009 LEVEL 4 TISSUE EXAM 40 160.00 0.00

04/22/2009 0311894 -160.00Change payorService Adjustment

Payment 040266504/15/2009 PRIVATE PAY -50.00

Payment 040266604/15/2009 PRIVATE PAY 50.00







06/18/2009 0312003 -1.00Misc. adjustmentService Adjustment

04/01/2009 0312004 40.00Posting errorService Adjustment



Payment 040281005/07/2009 BLUE CROSS - WYOMING -30.00



Payment 040282006/18/2009 GREAT WEST -2.00








05/22/2009 0311988Payment Adjustment Posting error 10.00





Service 036338207/01/2009 LEVEL 4 TISSUE EXAM 3 160.00 X 160.00

CURRENT DUE OVER 30 DAYS OVER 60 DAYS OVER 90 DAYS PATIENT BALANCE

INSURANCE BALANCE

160.00 84.00 0.00 0.00 84.00 160.00


MB120.rpt

GenTesting


ADJUSTMENT HISTORY FOR AN ACCOUNT PLUS ALL

PATIENT NOTES

» USEFUL FOR REVIEWING ACCOUNT ACTIVITY

» REPORT IS FOUND IN THE CORTEX RCM+

ADMINISTRATION MODULE OR IT CAN BE ATTACHED

TO EITHER OF THE TWO CUSTOM REPORT BUTTONS

ON THE PATIENT ACCOUNT DETAIL SCREEN

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Patient Ledger with Notes

Account Details for Patient Number : 0101313 Including Notes

SPEIDEL, JARED

505 S. CULVER AVENUE

Seattle, WA 98121

Billing





10/17/2005 0014892 -33.94Medicare write-offService Adjustment

Payment 001741610/17/2005 BVMG/ONE HEALTHPLAN -84.85

Payment 002009510/26/2005 CBSA - MINNETONKA -21.21

CURRENT DUE OVER 30 DAYS OVER 60 DAYS OVER 90 DAYS PATIENT BALANCE

INSURANCE BALANCE

0.00 0.00 0.00 0.00 0.00 0.00

Patient Notes:

Entered ByTypeEntered

09/06/2005 BRUCKNER, LELANDUndefined

Note Field 1:

Note Field 2: SPOUSE CALLED TO CK ACCT SHE WILL CALL BS FEELS SHOULD BE COVERED.RH

08/24/2005 EASTIN, JOHNUndefined

BS DENIALNote Field 1:

Note Field 2: BS DENIED CLAIM THIS SERVICE IS NOT COVERED UNDER THE INSURED PLAN. GS

Printed:08/27/2009Page 2 of 27MB128.rpt

GenTesting


ADJUSTMENT HISTORY FOR AN ACCOUNT PLUS ALL

PATIENT NOTES AND ANY SERVICE, PAYMENT OR

ADJUSTMENT COMMENTS

» USEFUL FOR REVIEWING ACCOUNT ACTIVITY


ADMINISTRATION MODULE OR IT CAN BE ATTACHED

TO EITHER OF THE TWO CUSTOM REPORT BUTTONS

ON THE PATIENT ACCOUNT DETAIL SCREEN

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Patient Ledger with Notes and Comments

Account Details for Patient Number : 0069077

Including Notes and CommentsSmithson, Jane

2107 Elliott Ave

Seattle, WA 98121

Billing



New Service Number 0363261Comment










Comment Changed payor information


Old Service Number 0363236Comment

06/18/2009 0312003 -1.00Misc. adjustmentService Adjustment




Applied to dedComment













05/22/2009 0311988Payment Adjustment Posting error 10.00






Comment Change Payor

Service 036338207/01/2009 LEVEL 4 TISSUE EXAM 23 160.00 X 160.00



GenTesting

» PENDING TRANSACTION LOG PROGRAM REVIEWS

ALL SERVICES NOT YET BILLED AND GENERATES A

REPORT THAT LISTS ITEMS THAT MAY CAUSE A

CLAIM TO REJECT

» RUN THE PROGRAM AND REVIEW THE REPORT

BEFORE GENERATING CLAIMS TO CATCH ERRORS

» COMPLETE LIST OF DATA CHECKS PERFORMED IS

LISTED AT THE END OF THE REPORT


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Pending Transaction Log

Pending Transaction LogPatient

Number &

Name Error Message Current Value

0069077 Thompson, Alecia

Missing Policy Number

Service 0363261 is missing ICD Code 1

service 0363261 NPI number missing for Provider: 0000001 0000001

service 0363261 NPI number missing for Clinician: 0000002 0000002

0241771 ALLAN, REBECCA

Payor and Related Patient Payor are both marked as Secondary


MB125.rpt

GenTesting

» DISPLAYS SERVICES WITH A CREDIT BALANCE

» DISPLAYS SERVICE, PAYMENT AND ADJUSTMENT

INFORMATION

» INCLUDES A SECTION WHERE YOU CAN INDICATE

TO WHOM THE REFUND SHOULD BE ISSUED

» USED TO DETERMINE IF A REFUND IS DUE

» REPORT IS RUN BY CLICKING ON THE ‘REFUND

REQUEST’ BUTTON ON THE PATIENT ACCOUNT

DETAIL SCREEN

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Refund Request

Refund Request

HOESCHE, WILLIAM

714 W. SYCAMORE ST 0011546Patient Number:

Seattle, WA 98121

Billing

Description INSBalanceStatusAmountNumberDate Batch

Service 035036711/25/2008 CYTO SMEARS 50 90.00 -77.84120208G


BVMG/ONE HEALTHPLAN


BVMG/ONE HEALTHPLAN

Payment 039134912/22/2008 BVMG/ONE HEALTHPLAN -48.62122208M

Service 035036911/25/2008 LEVEL 4 TISSUE EXAM 50 160.00 -138.75120208G


BVMG/ONE HEALTHPLAN


BVMG/ONE HEALTHPLAN

Payment 039135112/22/2008 BVMG/ONE HEALTHPLAN -84.99122208M

CURRENT DUE OVER 30 DAYS OVER 60 DAYS OVER 90 DAYS PATIENT BALANCE INSURANCE BALANCE

-216.59 0.00 0.00 0.00 -216.59 0.00

Please refund patient $_______________. Please refund insurance $_________________.

Reason: Patient overpayment Insurance overpayment

Other_________________________________________________________________________

Explanation:____________________________________________________________________

______________________________________________________________________________

Requested by:________________________ Check number:_____________Date:__________

Payor Number / Name

Circle payor to be refunded

0000021 BAY AREA SCHOOL/CNA

PO BOX 60007Address

18415A750PDX

Group #

Policy #

65460M

Seattle, WA 98121

Subscriber Nbr0011546, FRED M.

0000134 BVMG/ONE HEALTHPLAN

PO BOX 1051Address

A544950925

Group #

Policy #

NONE

Seattle, WA 98121


0000221 CIGNA

P.O. BOX 60007Address

18415A850BDX

Group #

Policy #

13929W

Seattle, WA 98121



MB435.rpt

GenTesting

» DISPLAYS ALL SERVICES IN A GIVEN BATCH NUMBER

» DISPLAYS BATCH NUMBER, SERVICE NUMBER,

PATIENT NUMBER AND NAME, BIRTH DATE, FROM

DATE, SERVICE ITEM CODE, SERVICE AMOUNT, ICD

CODE, MODIFIER, UNITS, PAYOR NUMBER, SERVICE

TOTAL, PERFORMING CLINICIAN NUMBER

» SUBTOTALS BY BATCH NUMBER

» CAN BE USED TO ENSURE ALL SERVICES ARE

ENTERED AND NO FEES, PAYORS, BIRTHDATES OR

ICD CODES ARE MISSING FROM SERVICES


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Services Batch Report

Services Batch Report

(Service.BatchNumber BETWEEN '062909A' AND '062909A' )

Batch

Number

Service

Number

Patient

Number

Name Service

ItemCode

Svc. &

Client

Amount

UnitsICD

Code

Payor

Number

Svc. &

Client

Total

From

date/

(DOS)

Mod Perf.

By ID

Birthdate

062909A

NO ICD 145.00062909A 0363362 1030001 MORT, DONALD MARK 1 0000025883126/29/2009 000000211/22/1973 145.00

NO ICD 160.00062909A 0363366 1030002 HOFSTETTLER, JULI 1 0000134883056/29/2009 00000025/7/1941 160.00

NO ICD 145.00062909A 0363369 1030002 HOFSTETTLER, JULI 1 0000134883126/29/2009 00000025/7/1941 145.00

NO ICD 160.00062909A 0363371 0294069 SMITH, "JACK" 1 ZZZ883056/29/2009 00000029/16/1961 160.00

NO ICD NO PAYOR 145.00062909A 0363372 0294069 SMITH, "JACK" 1883126/29/2009 00000039/16/1961 145.00

NO ICD 180.00062909A 0363373 0166226 JONES, A.ELLEN 1 0000025883606/29/2009 00000026/3/1941 180.00

NO ICD 145.00062909A 0363375 0166227 LEAMY, SHIRLEY 1 0000225883126/29/2009 00000039/5/1916 145.00

7$1,080.00062909A 1,080.00

7$1,080.00Grand Total:

Checks Performed:

1) If Patient Sex is blank or 'Other' or 'Unknown', the patient name is underlined.

2) If Amount is 0 (or the ServiceItemCode is missing) then amount is underlined.

3) If Payor is missing, then Payor Number is underlined.

4) If Birthdate is missing, the Birthdate is underlined.

Pathology Specific Checks:

1) If ICD1 code is missing or not 'Complete', then ICD code is underlined.

2) If Service Item Code is 88331 then the Performing Pathologist is underlined so that it can be changed if needed to the Pathologist who

read the Frozen Section.

3) If Service Item Code is 88141 and Payor Type Code is Medicare ("C") the Service Item Code is underlined so the Service Item Code can

be changed. (See notes in manual.)

1,080.00


MB114.rpt

GenTesting

» DISPLAYS SERVICES AT A SERVICE STATUS CODE 99


NUMBER AND NAME, BILLING DESCRIPTION, UNITS,

UNIT AMOUNT AND SERVICE AMOUNT

» USE TO FIND SERVICES NEEDING TO BE RELEASED

FOR BILLING


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Services on Hold

Services on Hold

Number From

Date

Patient

Number

Name BillingDescription Units Unit

Amount

Service

Amount

{Service.ServiceStatusCode} = 99.00

0237872 08/29/2007 0999994 KNEE, JULIE Mcal withheld refunds due per eob 1 1.00 1.00

0357897 12/31/2008 0168946 WIEBELHAUS, CHARLOTTE PAP SMEAR/FOCALPT 1 55.00 55.00

0363397 06/23/2009 0069219 Test, Alecia Marie LEVEL 3 TISSUE EXAM 1 0.00 0.00

0363398 06/23/2009 0069219 Test, Alecia Marie STAINS FOR ORGANISM 1 0.00 0.00



0363405 01/20/2009 1044252 PETERS, JANEL PAP SMEAR/FOCALPT 1 55.00 55.00

0363408 01/22/2009 0254456 HANNA, KREYL PAP SMEAR/FOCALPT 1 55.00 55.00

0363416 01/22/2009 0020042 CLARK, ELIZABETH PAP SMEAR/FOCALPT 1 55.00 55.00

0363417 01/22/2009 1019164 LINDER, PAULINE PAP SMEAR/FOCALPT 1 55.00 55.00

0363418 01/21/2009 0384522 YENNY, FNU PAP SMEAR/FOCALPT 1 55.00 55.00

0363423 01/22/2009 0012501 MATYA, ANGELA PAP SMEAR/FOCALPT 1 55.00 55.00

0363424 01/23/2009 0275230 TURGEON, KALI PAP SMEAR/FOCALPT 1 55.00 55.00

0363425 01/22/2009 0060513 PITTMAN, BARBARA PAP SMEAR/FOCALPT 1 55.00 55.00

0363426 01/23/2009 0194655 ALLEN, JANE PAP SMEAR/FOCALPT 1 55.00 55.00

0363429 01/22/2009 0355943 JONES, JACKIE PAP SMEAR/FOCALPT 1 55.00 55.00

0363430 01/23/2009 0342885 ADKINS, TERRI PAP SMEAR/LIQUID 1 55.00 55.00

0363433 01/23/2009 0113886 GAY, LIDDELL PAP SMEAR/FOCALPT 1 55.00 55.00

0363434 01/22/2009 0020105 BAXTER, HEATHER PAP SMEAR/FOCALPT 1 55.00 55.00

0363435 01/22/2009 1017571 JABER, DIANE PAP SMEAR/FOCALPT 1 55.00 55.00

0363438 01/23/2009 1044373 JONES, LINDA PAP SMEAR/FOCALPT 1 55.00 55.00

0363444 01/23/2009 1044386 CIZEK, HOPE PAP SMEAR/FOCALPT 1 55.00 55.00

0363449 01/24/2009 0158290 GORDON, BEVERLY PAP SMEAR/FOCALPT 1 55.00 55.00

0363457 01/23/2009 1044413 HOGE, SHARI CHLAMYDIA TESTING 1 75.00 75.00

0363458 01/23/2009 1044413 HOGE, SHARI GONORRHEA TESTING 1 75.00 75.00

0363459 01/23/2009 0368944 MCCAULEY, SHARON CHLAMYDIA TESTING 1 75.00 75.00

0363460 01/23/2009 0368944 MCCAULEY, SHARON GONORRHEA TESTING 1 75.00 75.00

0363461 01/26/2009 0356578 HILZER, KAREN CHLAMYDIA TESTING 1 75.00 75.00

0363462 01/26/2009 0356578 HILZER, KAREN GONORRHEA TESTING 1 75.00 75.00

0363464 01/27/2009 1044433 SMITH, JACKY LEVEL 4 TISSUE EXAM 6 160.00 960.00

0363466 04/16/2009 1044459 WARREN, Emily LEVEL 3 TISSUE EXAM 1 0.00 0.00

0363467 04/16/2009 1044459 WARREN, Emily LEVEL 4 TISSUE EXAM 1 0.00 0.00


0363469 06/23/2009 0069219 Test, Alecia Marie STAINS FOR ORGANISM 1 0.00 0.00




Total Service Amount:$2,401.00


MB104.rpt

GenTesting

» DISPLAYS SERVICES NOT YET BILLED


NUMBER AND NAME, REFERRING AND PERFORMING

CLINICIAN, BILLING DESCRIPTION, UNITS, UNIT

AMOUNT, ICD CODE, ADMISSION NUMBER, PAYOR

AND INDICATES IF THE SERVICE IS ON HOLD

» DATA IS GROUPED BY SERVICE STATUS CODE

» MATRIX AT THE END OF THE REPORT DISPLAYS

TOTAL NUMBER OF SERVICES AT EACH SERVICE

STATUS CODE

» USE TO CONFIRM ALL SERVICES HAVE BILLED AS

EXPECTED


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Unbilled Services

Service

Number

From

Date

Patient

Number

Patient Name

Referred by Name

BillingDescription

Performed by Name

Units

ICD Code

Admission PayorAmount Hold

Unbilled Services Report{Service.ServiceStatusCode} < 23

Send Statement to Patient0363487 7/11/2009 0069269

MATTY,, MARIE E

ThinPrep IMAGING SYSTEM 1

V72.31

PC-09-0084100000000$55.00 N

0363521 7/11/2009 0069282

MATTY,, MARIE E

ThinPrep IMAGING SYSTEM 1

V72.31

PC-09-0084100000000$55.00 N

0363564 7/11/2009 0069293 TestDRIPPS, NANCY J

OH,, SANGIK

ANTRUM BIOPSY 5

211.4

GI-09-001577 0000000$160.00 N

Send Statement to Patient

Total Patient Accounts: 30

Total Unbilled Services: 83

Total Unbilled Service Amounts: $9,866.00

Report Totals

Grand Total Unbilled Services:432

Grand Total Unbilled Service Amounts:$31,039.00

Grand Total Patient Accounts:124

Other Send Claim

to Primary

Payor

Send Claim

to

Secondary

Payor

Send

Statement

to Client

Send

Statement

to Patient

Total

(A) Pri. Claim Form Name: 1 1

(A) Pri. Claim Form Name: ANSI837 15 15

(A) Pri. Claim Form Name: ANSI837MEDICAL 15 15

(A) Pri. Claim Form Name: ANSI837MEDICAR 3 3

(A) Pri. Claim Form Name: ELECTRONIC 1 1

(A) Pri. Claim Form Name: HCFA1500 32 32

(A) Pri. Claim Form Name: HCFA1500P 4 4

(A) Pri. Claim Form Name: MEDIMEDI 6 6

(B) Sec. Claim Form Name: HCFA1500 24 24

(B) Sec. Claim Form Name: MEDIMEDI 1 1

(C) Client Stmt. Name: CLIENTSTATEMENT 3 3

(D) Statement Name: ELECTRONIC 63 63

(D) Statement Name: STATEMENT 20 20

(E) Not Waiting to Be Billed - No Associated Fo 244 244

Total 244 77 25 3 83 432

Printed: 11/17/2009 Page 24 of 24

MB105.rpt

GenTesting

CHANGE TRACKING REPORTS

» PROVIDES AN AUDIT TRAIL OF UPDATES, INSERTS,

DELETES AND VIEWS PERFORMED ON A PATIENT’S

DEMOGRAPHIC INFORMATION

» DISPLAYS THE SCREEN THE ACTION HAPPENED IN,

WHO MADE THE CHANGE, MODIFIED DATE, TABLE,

COLUMN, THE ACTION THAT TOOK PLACE AND THE

OLD AND NEW FIELD VALUES

» USEFUL TO DETERMINE WHO MADE A CHANGE OR

VIEWED THE ACCOUNT AND WHEN

» REPORT IS FOUND IN THE CHANGE TRACKING

MODULE

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Change Tracking by Patient Number

Medical Billing Change Tracking by Patient

Washington, Irving Patient ID: 0000002

Old Value New ValueModified DateModified By Table Column Action

SLXPT0100

NumberPatient View19-Jun-2009 8:49SEATTLE\adigleria




NumberPatient View28-Apr-2009 12:14SEATTLE\adigleria

0024LastUpdatedByPatient Update 000825-Apr-2009 0:52SEATTLE\adigleria

Oct 27 2008 12:00AMLastUpdatedDatePatient Update Apr 25 2009 12:00AM25-Apr-2009 0:52SEATTLE\adigleria

HOFSTETTLER, JULINamePatient Update Washington, Irving25-Apr-2009 0:52SEATTLE\adigleria

NumberPatient View25-Apr-2009 0:52SEATTLE\adigleria

SLXPT0200AuthorizationNumberPatientPayor Insert27-May-2010 14:04seattle\jrandall

CommentPatientPayor Insert27-May-2010 14:04seattle\jrandall

GroupNumberPatientPayor Insert27-May-2010 14:04seattle\jrandall

PolicyNumberPatientPayor Insert27-May-2010 14:04seattle\jrandall

RelatedPayorNumberPatientPayor Insert27-May-2010 14:04seattle\jrandall

SignatureSourceCodePatientPayor Insert P27-May-2010 14:04seattle\jrandall

SubscriberBirthdatePatientPayor Insert Jan 1 1900 12:00AM27-May-2010 14:04seattle\jrandall

SubscriberNamePatientPayor Insert Washington, Irving27-May-2010 14:04seattle\jrandall

SubscriberSexPatientPayor Insert F27-May-2010 14:04seattle\jrandall

SubscriberSocSecNoPatientPayor Insert27-May-2010 14:04seattle\jrandall

PatientNumberPatientPayor Insert 000000227-May-2010 14:04seattle\jrandall

PayorNumberPatientPayor Insert 000000027-May-2010 14:04seattle\jrandall

Page: 2 Printed: 1/14/2011

MB427.rpt

SP1Tst

» PROVIDES AN AUDIT TRAIL OF UPDATES, INSERTS,

DELETES AND VIEWS PERFORMED ON A PATIENT’S

DEMOGRAPHIC INFORMATION





» GROUPS DATA BY ACTION TYPE (INSERT, UPDATE,

DELETE, VIEW) THEN SCREEN NAME

» USEFUL TO DETERMINE WHO MADE A CHANGE AND

WHEN


MODULE

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Change Tracking by Patient and Action

Type

Medical Billing Change Tracking by Patient and Action Type

Test, Alecia Marie Patient ID: 0069219

Old Value New ValueModified_DateModified_By Table Column Action

Insert

SLXPT0200AuthorizationNumberPatientPayor Insert27-Oct-2009 11:23SEATTLE\athomas

CommentPatientPayor Insert27-Oct-2009 11:23SEATTLE\athomas

GroupNumberPatientPayor Insert27-Oct-2009 11:23SEATTLE\athomas

PatientNumberPatientPayor Insert 006921927-Oct-2009 11:23SEATTLE\athomas

PayorNumberPatientPayor Insert TEST27-Oct-2009 11:23SEATTLE\athomas

PolicyNumberPatientPayor Insert27-Oct-2009 11:23SEATTLE\athomas

RelatedPayorNumberPatientPayor Insert27-Oct-2009 11:23SEATTLE\athomas

SignatureSourceCodePatientPayor Insert P27-Oct-2009 11:23SEATTLE\athomas

SubscriberBirthdatePatientPayor Insert Jul 24 1961 12:00AM27-Oct-2009 11:23SEATTLE\athomas

SubscriberNamePatientPayor Insert Test, Alecia Marie27-Oct-2009 11:23SEATTLE\athomas

SubscriberSexPatientPayor Insert F27-Oct-2009 11:23SEATTLE\athomas

SubscriberSocSecNoPatientPayor Insert27-Oct-2009 11:23SEATTLE\athomas

Update

SLXPT0200RelatedPayorNumberPatientPayor Update 000079727-Oct-2009 11:23SEATTLE\athomas

SLXSW0100SignatureSourceCodePatientPayor Update P23-Sep-2009 14:26SEATTLE\athomas

SignatureSourceCodePatientPayor Update P23-Sep-2009 14:26SEATTLE\athomas

SignatureSourceCodePatientPayor Update P23-Sep-2009 14:26SEATTLE\athomas

View

Anatomic Pathology SystemNumberPatient View09-Aug-2010 14:31SEATTLE\athomas

NumberPatient View27-Jul-2010 14:07SEATTLE\athomas








NumberPatient View16-Mar-2010 14:09SEATTLE\athomas






MB432.rpt

SP1Tst

» PROVIDES AN AUDIT TRAIL OF UPDATES, INSERTS

AND DELETES DONE TO A SERVICE






WHEN


MODULE

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Medical Billing Change Tracking by Service Service Number: 0363892

Old Value New ValueModified DateModified By Table Column ActionApplication

PerformedByIDService Update 000000227-Oct-2009 11:28SEATTLE\athomas SLXSR0500

3ServiceStatusCodeService Update 127-Oct-2009 11:28SEATTLE\athomas SLXSR0500

AdmissionNumberService Insert27-Oct-2009 11:28SEATTLE\athomas SLXSR0700

AmountService Insert 5027-Oct-2009 11:28SEATTLE\athomas SLXSR0700

BatchNumberService Insert 102709A27-Oct-2009 11:28SEATTLE\athomas SLXSR0700

CaseNumberService Insert27-Oct-2009 11:28SEATTLE\athomas SLXSR0700

ClaimNumberService Insert27-Oct-2009 11:28SEATTLE\athomas SLXSR0700

ClientAmountService Insert 027-Oct-2009 11:28SEATTLE\athomas SLXSR0700

ClientServiceNumberService Insert27-Oct-2009 11:28SEATTLE\athomas SLXSR0700

CommentService Insert27-Oct-2009 11:28SEATTLE\athomas SLXSR0700

EncounterNumberService Insert27-Oct-2009 11:28SEATTLE\athomas SLXSR0700

EnteredByIDService Insert 000627-Oct-2009 11:28SEATTLE\athomas SLXSR0700

EnteredDateService Insert Oct 27 2009 12:00AM27-Oct-2009 11:28SEATTLE\athomas SLXSR0700

FromDateService Insert Oct 27 2009 12:00AM27-Oct-2009 11:28SEATTLE\athomas SLXSR0700

ICDAdditionalDescService Insert27-Oct-2009 11:28SEATTLE\athomas SLXSR0700

ICDCode1Service Insert27-Oct-2009 11:28SEATTLE\athomas SLXSR0700




LastUpdatedByService Insert 000627-Oct-2009 11:28SEATTLE\athomas SLXSR0700

LastUpdatedDateService Insert Oct 27 2009 12:00AM27-Oct-2009 11:28SEATTLE\athomas SLXSR0700

LocationNumberService Insert27-Oct-2009 11:28SEATTLE\athomas SLXSR0700

Modifier1Service Insert27-Oct-2009 11:28SEATTLE\athomas SLXSR0700



NoteIDService Insert 027-Oct-2009 11:28SEATTLE\athomas SLXSR0700

NumberService Insert 036389227-Oct-2009 11:28SEATTLE\athomas SLXSR0700

PatientNumberService Insert 006921927-Oct-2009 11:28SEATTLE\athomas SLXSR0700

PayorNumberService Insert TEST27-Oct-2009 11:28SEATTLE\athomas SLXSR0700

PerformedByIDService Insert27-Oct-2009 11:28SEATTLE\athomas SLXSR0700

PostedService Insert27-Oct-2009 11:28SEATTLE\athomas SLXSR0700

PostedPeriodService Insert 20090927-Oct-2009 11:28SEATTLE\athomas SLXSR0700

ProviderNumberService Insert 000000227-Oct-2009 11:28SEATTLE\athomas SLXSR0700

ReferredByIDService Insert27-Oct-2009 11:28SEATTLE\athomas SLXSR0700

ServiceItemCodeService Insert 8005327-Oct-2009 11:28SEATTLE\athomas SLXSR0700

ServiceStatusCodeService Insert 327-Oct-2009 11:28SEATTLE\athomas SLXSR0700

StatementNumberService Insert27-Oct-2009 11:28SEATTLE\athomas SLXSR0700

TransToSvcNumService Insert27-Oct-2009 11:28SEATTLE\athomas SLXSR0700

UnitsService Insert 127-Oct-2009 11:28SEATTLE\athomas SLXSR0700


MB426.rpt

SP1Tst

» PROVIDES AN AUDIT TRAIL OF UPDATES, INSERTS

AND DELETES DONE TO A SERVICE





» GROUPS DATA BY ACTION TYPE (INSERT, UPDATE,

DELETE) THEN SCREEN NAME


WHEN


MODULE

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Type

Medical Billing Change Tracking by Service and Action Type Service Number: 0363892

Old Value New ValueModified DateModified By Table Column Action

Insert

SLXSR0700UserDate1Service Insert Jan 1 1900 12:00AM27-Oct-2009 11:28SEATTLE\athomas

UserDate2Service Insert Jan 1 1900 12:00AM27-Oct-2009 11:28SEATTLE\athomas

UserFloat1Service Insert 027-Oct-2009 11:28SEATTLE\athomas

UserFloat2Service Insert 027-Oct-2009 11:28SEATTLE\athomas

UserSvcStatusCodeService Insert27-Oct-2009 11:28SEATTLE\athomas

UserText1Service Insert27-Oct-2009 11:28SEATTLE\athomas




WherePerformedService Insert27-Oct-2009 11:28SEATTLE\athomas

Update

SLADJ020023ServiceStatusCodeService Update 324-Jun-2010 11:58SEATTLE\athomas

3ServiceStatusCodeService Update 2324-Jun-2010 11:54SEATTLE\athomas

SLXSR0500PerformedByIDService Update 000000227-Oct-2009 11:28SEATTLE\athomas

3ServiceStatusCodeService Update 127-Oct-2009 11:28SEATTLE\athomas

SLXSR1400LocationNumberService Update 000025027-Oct-2009 11:29SEATTLE\athomas

ReferredByIDService Update 000000527-Oct-2009 11:29SEATTLE\athomas

1ServiceStatusCodeService Update 327-Oct-2009 11:29SEATTLE\athomas


MB431.rpt

SP1Tst

» AUDITING DATA CAN BECOME EXTENSIVE,

THEREFORE, CORTEX CREATED A PROCESS TO

ARCHIVE OLDER AUDITING DATA TO PROMOTE A

MORE EFFICIENT AUDITING SYSTEM

» THIS REPORT DISPLAYS THE ARCHIVED DATA FOR A

SERVICE


MODULE AFTER ARCHIVING IS INSTALLED

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Medical Billing Change Tracking Archive Report Service Number: 1215089


Solomon IVVB6AdmissionNumberService Insert E081700106313-Aug-2008 9:38Master

AmountService Insert 013-Aug-2008 9:38Master

PostedPeriodService Insert 20080813-Aug-2008 9:38Master

ProviderNumberService Insert 000000213-Aug-2008 9:38Master

ReferredByIDService Insert 000094913-Aug-2008 9:38Master

ServiceItemCodeService Insert 8410013-Aug-2008 9:38Master

ServiceStatusCodeService Insert 9913-Aug-2008 9:38Master

StatementNumberService Insert 13-Aug-2008 9:38Master

TransToSvcNumService Insert 13-Aug-2008 9:38Master

UnitsService Insert -113-Aug-2008 9:38Master

UserDate1Service Insert Jan 1 1900 12:00AM13-Aug-2008 9:38Master

UserDate2Service Insert Jan 1 1900 12:00AM13-Aug-2008 9:38Master

UserFloat1Service Insert 013-Aug-2008 9:38Master

UserFloat2Service Insert 013-Aug-2008 9:38Master

UserSvcStatusCodeService Insert13-Aug-2008 9:38Master

UserText1Service Insert DRBILLE3_0713.dat13-Aug-2008 9:38Master

UserText2Service Insert13-Aug-2008 9:38Master



WherePerformedService Insert 000000413-Aug-2008 9:38Master

BatchNumberService Insert test0213-Aug-2008 9:38Master

CaseNumberService Insert 13-Aug-2008 9:38Master

ClaimNumberService Insert 13-Aug-2008 9:38Master

ClientAmountService Insert 013-Aug-2008 9:38Master

ClientServiceNumberService Insert 13-Aug-2008 9:38Master

CommentService Insert13-Aug-2008 9:38Master

EncounterNumberService Insert 13-Aug-2008 9:38Master

EnteredByIDService Insert 000113-Aug-2008 9:38Master

EnteredDateService Insert Aug 13 2008 12:00AM13-Aug-2008 9:38Master

FromDateService Insert Jun 24 2008 12:00AM13-Aug-2008 9:38Master

ICDAdditionalDescService Insert13-Aug-2008 9:38Master

ICDCode1Service Insert 562.1113-Aug-2008 9:38Master




LastUpdatedByService Insert 13-Aug-2008 9:38Master

LastUpdatedDateService Insert Jan 1 1900 12:00AM13-Aug-2008 9:38Master

LocationNumberService Insert 000000213-Aug-2008 9:38Master

Page: 2Printed: 8/27/2009

MB428.rpt

VPC2008SP1

» AUDITING DATA CAN BECOME EXTENSIVE,

THEREFORE, CORTEX CREATED A PROCESS TO

ARCHIVE OLDER AUDITING DATA TO PROMOTE A

MORE EFFICIENT AUDITING SYSTEM

» THIS REPORT DISPLAYS THE ARCHIVED DATA FOR A

PATIENT ACCOUNT


MODULE AFTER ARCHIVING IS INSTALLED

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Medical Billing Change Tracking Archive by PatientTest, Alecia Marie Patient ID: 0069219


Anatomic Pathology SystemNumberPatient View26-Aug-2009 11:01SEATTLE\athomas

PolicyNumberPatientPayor Insert test26-Aug-2009 11:00SEATTLE\athomas

NumberPatient View26-Aug-2009 11:00SEATTLE\athomas

SubscriberNamePatientPayor Insert Test, Alecia Marie26-Aug-2009 11:00SEATTLE\athomas

SubscriberSexPatientPayor Insert F26-Aug-2009 11:00SEATTLE\athomas

PatientNumberPatientPayor Insert 006921926-Aug-2009 11:00SEATTLE\athomas

PayorNumberPatientPayor Insert 000200026-Aug-2009 11:00SEATTLE\athomas


PolicyNumberPatientPayor Insert 89089026-Aug-2009 10:59SEATTLE\athomas

GroupNumberPatientPayor Insert 89089026-Aug-2009 10:59SEATTLE\athomas


PatientNumberPatientPayor Insert 006921926-Aug-2009 10:58SEATTLE\athomas

PayorNumberPatientPayor Insert 000002826-Aug-2009 10:58SEATTLE\athomas

SubscriberSexPatientPayor Insert F26-Aug-2009 10:58SEATTLE\athomas

SubscriberNamePatientPayor Insert Test, Alecia Marie26-Aug-2009 10:58SEATTLE\athomas






NumberPatient View02-Jul-2009 16:53CORTEXSQL\Administrator













MB429.rpt

GenTesting

CLAIM REPORTS

» CUSTOMIZED FOR EACH CUSTOMER PER THEIR

SPECIFICATIONS

» SYSTEM ALLOWS FOR UP TO 16 DIFFERENT

FORMATS

C

laim

Re

po

rts

HCFA1500

» DISPLAYS ALL CLAIMS FOR A PATIENT

» DATA DISPLAYED INCLUDES CLAIM NUMBER, DATE

PRINTED, LAST REPRINTED DATE, PAYOR THE CLAIM

WAS BILLED TO AND PRIMARY AND SECONDARY

INSURANCE NAMES AND NUMBERS. ALSO DISPLAYED

IS INFORMATION ABOUT THE SERVICE(S) ON THE

CLAIM SUCH AS DATE OF SERVICE, SERVICE

DESCRIPTION, AMOUNT OF SERVICE AND ANY

PAYMENTS AND ADJUSTMENTS THAT WERE SHOWN

ON THE CLAIM.

» RUN THE REPORT FROM THE PATIENT ACCOUNT BY

CLICKING ON THE ‘CLAIMS 3’ BUTTON

Patient Claims

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Patient ClaimsPatient.Number = '0069077'

Patient Name / Address Number

Thompson, Alecia 0069077

23242 28th Ave South 1 Des Moines WA 98198

Primary Payor: 0000018 BLUE CROSS - WYOMING Supplemental Payor:

0286844 04/27/2009 04/27/2009 Claim Billed to Payor: PrimaryPrinted ReprintedClaim

Service Number UnitsUnit Amount Total AmountBillingDescriptionFrom Date

1$160.00 $160.00LEVEL 4 TISSUE EXAM0363261 4/13/2009


Balance

Payments/Adjustments

Total Claim Charges

320.00

0.00

320.00





Balance


Total Claim Charges

160.00

0.00

160.00





Balance


Total Claim Charges

160.00

0.00

160.00


MB121.rpt

GenTesting

» LISTS THE DETAILS FOR EACH CLAIM IN A GIVEN

CLAIM RUN

» DISPLAYS THE CLAIM NUMBER, PAYOR NUMBER

AND NAME, PATIENT NUMBER AND NAME AND BILLED

AMOUNT

» USEFUL FOR VIEWING DETAILS REGARDING A

SPECIFIC CLAIM RUN

» REPORT IS FOUND IN THE OUTPATIENT INSURANCE

BILLING MODULE

Cla

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Detailed Claims List

Detailed Claims List

Payor Number \ Name Patient Number \ Name

Claim

Number

Billed

Amount

AARP HEALTH CARE OPTIONS MEYERS, CANDICE0000031 55.0000467580000010

AARP HEALTH CARE OPTIONS KOELMEL, MISCHELLE0000032 55.0003955380000010

AARP HEALTH CARE OPTIONS FRANCK, PATRICIA0000033 90.0010001380000010

AARP HEALTH CARE OPTIONS LOERA, ANN0000034 55.0010001410000010

AARP HEALTH CARE OPTIONS BRENDLE, JANICE0000361 55.0004113950000010

AARP HEALTH CARE OPTIONS BOROWIAK, MARY0000510 55.0003632990000010

AARP HEALTH CARE OPTIONS LYDA, AILEEN0000511 55.0003858780000010

AARP HEALTH CARE OPTIONS SCHWARTMAN, JAKOB0000512 140.0003907690000010

AARP HEALTH CARE OPTIONS KEBER, SHARON0000513 55.0010003260000010

AARP HEALTH CARE OPTIONS MASTERS, MAUREEN0000842 55.0000621970000010

AARP HEALTH CARE OPTIONS MINCH, BARBARA0000843 55.0001972030000010

AARP HEALTH CARE OPTIONS LOEFFLER, MICHELLE0000844 55.0002231430000010








AARP HEALTH CARE OPTIONS SHOWEN, REBECCA0002344 55.0002826160000010





















AARP HEALTH CARE OPTIONS SNAPP, ORCELIA0006106 55.0000876080000010

AARP HEALTH CARE OPTIONS FRANS, EVELYN0006107 55.0010008490000010







AARP HEALTH CARE OPTIONS WING, SONYA0007761 55.0001120980000010

AARP HEALTH CARE OPTIONS SCHMIT, KAREN0007762 55.0003851470000010

AARP HEALTH CARE OPTIONS WILFINGS, BETTY0007763 55.0004014180000010

AARP HEALTH CARE OPTIONS WING, SONYA0007997 55.0001120980000010

AARP HEALTH CARE OPTIONS SCHMIT, KAREN0007998 55.0003851470000010

AARP HEALTH CARE OPTIONS WILFINGS, BETTY0007999 55.0004014180000010

AARP HEALTH CARE OPTIONS RAHLFS, RENAE0008668 55.0000364790000010

AARP HEALTH CARE OPTIONS COPPLE, CAROL0008669 55.0004052470000010

AARP HEALTH CARE OPTIONS HARDER, CARRIE0008670 55.0004106980000010

AARP HEALTH CARE OPTIONS HAUGHT, BRENDA0008671 55.0004176060000010

AARP HEALTH CARE OPTIONS IVERS, VIRGINIA0008672 55.0010010830000010

Page 1 of 4654 Printed: 5/16/2009

MB217.rpt

GenTesting

» LISTS THE SUMMARY FOR EACH CLAIM RUN

» DISPLAYS THE RUN NUMBER, RUN DATE, RUN

MINUTES, STARTING AND ENDING CLAIM NUMBERS,

BILLED AMOUNT, TOTAL CLAIMS CREATED, CLAIM

FORM NAME AND WHO RAN THE CLAIMS

» USEFUL FOR RE-RUNNING CLAIMS IF PRINTER JAMS

OR CONFIRMING ALL CLAIM FORMS BILLED ON A

PARTICULAR DAY

» REPORT IS FOUND IN THE OUTPATIENT INSURANCE

BILLING MODULE

Cla

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Claim Run List

Claim Run List

Run

Number

Run

Date

Starting

Number

Ending

Number

Error

Count

Billed

Amount

Total

Claims

Form

Name

Run

By

Run

Minutes

Apr-2009

0008224 04/28/2009 0286845 $160.00 0 1 00060286845 HCFA1500 0

0008223 04/27/2009 0286844 $320.00 0 1 00040286844 HCFA1500 0

0008222 04/27/2009 0000000 $0.00 0 0 00040286844 ANSI837 0

0008221 04/24/2009 9999999 $1,975.00 0 1 00049999999 ANSI837 0

0008220 04/24/2009 9999999 $6,100.00 0 1 00049999999 HCFA1500 0

0008219 04/24/2009 0000000 $0.00 0 0 00049999999 HCFA1500 0

0008218 04/24/2009 0000000 $0.00 0 0 00049999999 HCFA1500 0

0008217 04/24/2009 9999999 $3,265.00 0 1 00049999999 HCFA1500 1

0008216 04/16/2009 0286843 $627.00 0 4 00040286840 ANSI837 0

0008215 04/15/2009 0286839 $160.00 0 1 00040286839 HCFA1500 0

0008214 04/14/2009 0286838 $2,853.00 0 10 00060286829 HCFA1500 0

0008213 04/14/2009 0286828 $160.00 0 1 00060286828 HCFA1500 1

Total Apr-2009 $15,620.00 21

Jan-2009

0008212 01/28/2009 0286827 $11,394.00 0 37 02850286791 ANSI837MEDICARE 0

0008211 01/28/2009 0286790 $1,145.00 0 14 02850286777 ANSI837MEDICAREP 0

0008210 01/28/2009 0286776 $16,325.00 0 109 02850286668 ANSI837MEDICAL 0

0008209 01/28/2009 0286667 $17,092.00 0 142 02850286526 ANSI837 0

0008208 01/28/2009 0000000 $0.00 0 0 02850286526 HCFA1500 0

0008207 01/28/2009 0000000 $0.00 0 0 02850286526 MEDIMEDI 0

0008206 01/28/2009 0286525 $6,560.00 0 29 02850286497 HCFA1500 0

0008205 01/27/2009 0286496 $1,995.00 0 2 00250286495 HCFA1500 0

0008204 01/27/2009 0286494 $55.00 0 1 02850286494 MEDIMEDI 0

0008203 01/27/2009 0286493 $1,440.00 0 1 02850286493 MEDIMEDI 0

0008202 01/27/2009 0286492 $160.00 0 1 00290286492 HCFA1500 0

0008201 01/27/2009 0286491 $360.00 0 1 02850286491 MEDIMEDI 0

0008200 01/27/2009 0286490 $305.00 0 1 00290286490 ANSI837MEDICARE 0

0008199 01/27/2009 0286489 $1,970.00 0 5 00290286485 ANSI837MEDICARE 0

0008198 01/27/2009 0000000 $0.00 0 0 00290286485 ANSIMEDICARE 0

0008197 01/27/2009 0286484 $320.00 0 1 02850286484 MEDIMEDI 0

0008196 01/27/2009 0286483 $15,913.00 0 99 02850286385 ANSI837 0

0008195 01/27/2009 0286384 $13,121.00 0 37 02850286348 ANSI837MEDICARE 0

0008194 01/27/2009 0286347 $535.00 0 8 02850286340 ANSI837MEDICAREP 0

0008193 01/27/2009 0286339 $6,719.00 0 50 02850286290 ANSI837MEDICAL 0

0008192 01/27/2009 0286289 $15,913.00 0 99 02850286191 ANSI837 1

0008191 01/27/2009 0000000 $0.00 0 0 02850286191 MEDIMEDI 0

0008190 01/27/2009 0286190 $1,990.00 0 16 02850286175 HCFA1500 0

0008189 01/26/2009 0286174 $360.00 0 1 02850286174 MEDIMEDI 0

0008188 01/26/2009 0286173 $58.00 0 1 02850286173 HCFA1500 0

0008187 01/26/2009 0000000 $0.00 0 0 02850286173 MEDIMEDI 0

0008186 01/26/2009 0286172 $640.00 0 4 00250286169 MEDIMEDI 0

0008185 01/26/2009 0286168 $7,943.00 0 28 00250286141 HCFA1500 0

0008184 01/26/2009 0286140 $14,188.00 0 36 00250286105 ANSI837MEDICARE 0

0008183 01/26/2009 0286104 $1,360.00 0 20 00250286085 ANSI837MEDICAREP 0

0008182 01/26/2009 0286084 $24,497.00 0 131 00250285954 ANSI837 0

0008181 01/26/2009 0285953 $11,609.00 0 84 00250285870 ANSI837MEDICAL 0

0008180 01/26/2009 0000000 $0.00 0 0 00250285870 MEDIMEDI 0

0008179 01/26/2009 0285869 $2,960.00 0 21 00250285849 HCFA1500 1

0008178 01/23/2009 0285848 $55.00 0 1 00250285848 HCFA1500 0

0008177 01/23/2009 0285847 $375.00 0 2 00250285846 HCFA1500 0

0008176 01/23/2009 0285845 $270.00 0 1 00250285845 HCFA1500 0

0008175 01/23/2009 0285844 $55.00 0 1 00250285844 HCFA1500 0

Printed:05/16/2009

MB202.rpt

Page 1 of 158

GenTesting

» DISPLAYS THE OPTIONS CHOSEN TO GENERATE THE

CLAIM RUN SUCH AS THE CLAIM FORM NAME, RUN

TYPE, PROVIDER NUMBER (IF ENTERED) AND WHICH

OPTIONS WERE CHOSEN FOR ANSI837 CLAIMS (SUCH

AS SUPPRESS NON-NPI INFORMATION)

» INFORMATION FROM THE CLAIM RUN LIST REPORT

IS ALSO DISPLAYED

» USEFUL FOR TROUBLESHOOTING CLAIM FILE

REJECTIONS

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Claim Run List - Expanded

Claim Run List - Expanded

Run

Number

Run

Date

Starting

Number

Ending

Number

Error

Count

Billed

Amount

Total

Claims

Form

Name

Run

By

Run

Minutes

Apr-2009

0008224 04/28/2009 0286845 $160.00 0 1 00060286845 HCFA1500 0

Options: HCFA1500, Patient: 0069118, Include Allowed Amts0008223 04/27/2009 0286844 $320.00 0 1 00040286844 HCFA1500 0

Options: HCFA1500, Patient: 0069077, Include Allowed Amts0008222 04/27/2009 0000000 $0.00 0 0 00040286844 ANSI837 0

Options: ANSI837, Patient: 0069077, Include Allowed Amts0008221 04/24/2009 9999999 $1,975.00 0 1 00049999999 ANSI837 0

Options: ANSI837, Payor: 0000073, Delinquent Days: 30, Include Allowed Amts0008220 04/24/2009 9999999 $6,100.00 0 1 00049999999 HCFA1500 0

Options: HCFA1500, Payor: 0000186, Delinquent Days: 30, Include Allowed Amts0008219 04/24/2009 0000000 $0.00 0 0 00049999999 HCFA1500 0

Options: HCFA1500, Payor: 0000857, Delinquent Days: 1, Include Allowed Amts0008218 04/24/2009 0000000 $0.00 0 0 00049999999 HCFA1500 0

Options: HCFA1500, Payor: 0000857, Delinquent Days: 0, Include Allowed Amts0008217 04/24/2009 9999999 $3,265.00 0 1 00049999999 HCFA1500 1

Options: HCFA1500, Payor: 0000857, Delinquent Days: 30, Include Allowed Amts0008216 04/16/2009 0286843 $627.00 0 4 00040286840 ANSI837 0

Options: ANSI837, Unbilled, Suppress Non-NPI, Include Allowed Amts, Suppress Rendering Provider0008215 04/15/2009 0286839 $160.00 0 1 00040286839 HCFA1500 0

Options: HCFA1500, Unbilled, Include Allowed Amts0008214 04/14/2009 0286838 $2,853.00 0 10 00060286829 HCFA1500 0

Options: HCFA1500, Unbilled, Include Allowed Amts0008213 04/14/2009 0286828 $160.00 0 1 00060286828 HCFA1500 1

Options: HCFA1500, Provider: 0000001, Patient: 0069077, Include Allowed Amts

Total Apr-2009 $15,620.00 21

Jan-2009

0008212 01/28/2009 0286827 $11,394.00 0 37 02850286791 ANSI837MEDICARE 0

Options: ANSI837MEDICARE, Provider: 0000001, Unbilled, Suppress Non-NPI, Include Allowed Amts0008211 01/28/2009 0286790 $1,145.00 0 14 02850286777 ANSI837MEDICAREP 0

Options: ANSI837MEDICAREP, Provider: 0000001, Unbilled, Suppress Non-NPI, Include Allowed Amts0008210 01/28/2009 0286776 $16,325.00 0 109 02850286668 ANSI837MEDICAL 0

Options: ANSI837MEDICAL, Provider: 0000001, Unbilled, Suppress Non-NPI, Include Allowed Amts0008209 01/28/2009 0286667 $17,092.00 0 142 02850286526 ANSI837 0

Options: ANSI837, Provider: 0000001, Unbilled, Include Allowed Amts0008208 01/28/2009 0000000 $0.00 0 0 02850286526 HCFA1500 0

Options: HCFA1500, Provider: 0000001, Unbilled, Include Allowed Amts0008207 01/28/2009 0000000 $0.00 0 0 02850286526 MEDIMEDI 0

Options: MEDIMEDI, Provider: 0000001, Unbilled, Include Allowed Amts0008206 01/28/2009 0286525 $6,560.00 0 29 02850286497 HCFA1500 0

Options: HCFA1500, Provider: 0000001, Unbilled, Include Allowed Amts0008205 01/27/2009 0286496 $1,995.00 0 2 00250286495 HCFA1500 0

Options: HCFA1500, Provider: 0000001, Patient: 0424601, Include Allowed Amts0008204 01/27/2009 0286494 $55.00 0 1 02850286494 MEDIMEDI 0

Options: MEDIMEDI, Provider: 0000001, Patient: 1019922, Include Allowed Amts0008203 01/27/2009 0286493 $1,440.00 0 1 02850286493 MEDIMEDI 0

Options: MEDIMEDI, Provider: 0000001, Patient: 0263698, Include Allowed Amts0008202 01/27/2009 0286492 $160.00 0 1 00290286492 HCFA1500 0

Options: HCFA1500, Provider: 0000001, Patient: 0339040, Include Allowed Amts0008201 01/27/2009 0286491 $360.00 0 1 02850286491 MEDIMEDI 0

Options: MEDIMEDI, Provider: 0000001, Patient: 1033267, Include Allowed Amts0008200 01/27/2009 0286490 $305.00 0 1 00290286490 ANSI837MEDICARE 0

Options: ANSI837MEDICARE, Provider: 0000001, Unbilled, Suppress Non-NPI, Include Allowed Amts0008199 01/27/2009 0286489 $1,970.00 0 5 00290286485 ANSI837MEDICARE 0

Printed:05/16/2009

MB201.rpt

Page 1 of 173

GenTesting

PATIENT STATEMENT REPORTS

» PAPER STATEMENTS ARE CUSTOMIZED FOR EACH

CUSTOMER PER THEIR SPECIFICATIONS

» SYSTEM ALLOWS FOR UP TO 16 DIFFERENT

FORMATS

» CAN PRODUCE AN ELECTRONIC FILE TO SEND TO A

CLEARINGHOUSE

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Patient Statements

Seattle Services

P.O. Box 1068

Tax ID: 94-6325427

Seattle, WA 98121

(206)555-1212

7/2/2009

AMOUNT DUE UPON RECEIPT

$85.00

Bookkeeping:Address Service Requested

3413 ROAD V

ANGEL HUFFMAN

Seattle, WA 98121

0004879

PATIENT NUMBER

0133643

STATEMENT NUMBER

8/1/2009

STATEMENT DUE DATE

07/02/2009

STATEMENT DATE

01/10/2009 88304 $95.00DR. LESLEY RUNDEPerformed by:LEVEL 3 TISSUE EXAM

540.9

Service Adj -$10.00Misc. adjustment06/23/2009

$85.00----------------------------------------------------------------------------------------------------------------------------------------- Total due this item:

85.00

Current Balance

$0.00

Prior Balance

$0.00

1-30 Days

$0.00 $0.00 $0.00 $0.00

Over 30 Over 60 Over 90 Over 120

Fold and Tear Here

PAYMENT INFORMATION

Return this section in the enclosed envelope with

check or money order payable to:

PATIENT NAME

$85.00

PATIENT NUMBER

0004879

07/02/2009STATEMENT DATE

0133643

Seattle Services

P.O. Box 1068

AMOUNT PAID: $Seattle, WA 98121

ANGEL HUFFMAN

BALANCE DUE UPON RECEIPT

STATEMENT NUMBER

Page 2 of 2

» DISPLAYS STATEMENT DETAILS FOR A SINGLE

PATIENT

» DISPLAYS STATEMENT NUMBER, PRINTED DATE,

AND STATEMENT AMOUNT, SERVICE DATE, SERVICE

NUMBER AND SERVICE AMOUNT

» USEFUL WHEN YOU WANT TO VERIFY WHAT WAS

SHOWN ON A STATEMENT WITHOUT HAVING TO

REPRINT THE STATEMENT

» REPORT IS RUN BY CLICKING ON THE ‘STATEMENTS’

BUTTON ON THE PATIENT ACCOUNT DETAIL SCREEN

Pa

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Patient Statements List

Patient StatementsStatement Details for Patient: 0069077

Smithson, Jane

2107 Elliott AveSeattle, WA 98121

Date Printed: 12/30/2008Statement Number: 0129507 Statement Amount: $160.00

Service Number Service AmountService Date

0363236 $160.004/13/2009



0363236 $160.004/13/2009



0363261 $160.004/13/2009

0363263 $160.004/14/2009


MB122.rpt

GenTesting

» DISPLAYS THE DATE AND STATEMENT FORM NAME

USED FOR EACH STATEMENT RUN

» DISPLAYS STATEMENT RUN NUMBER, RUN DATE,

STARTING AND ENDING STATEMENT NUMBERS,

BILLED AMOUNT, TOTAL STATEMENTS, STATEMENT

FORM USED, WHO RAN THE STATEMENTS AND RUN

MINUTES

» USEFUL FOR DETERMINING THE DOLLARS BILLED

AND AUDITING AGAINST THE ACTUAL NUMBER OF

STATEMENTS CREATED


BILLING MODULE

Pa

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Patient Statement Run List

Patient Statement Run List

Run

Number

Run

Minutes

Billed

Amount

Error

Count

Ending

Number

Starting

Number

Run

Date

Total

Statements Form Run By

Apr-20090000206 04/14/2009 0131490 13 0 $173,914.45 ELECTRONIC 0006 2,0840133573

0000205 04/14/2009 0131490 0 0 $0.00 STATEMENT 0006 00000000

0000204 04/14/2009 0131490 0 0 $0.00 ELECTRONIC 0006 00000000

0000203 04/14/2009 0129406 7 0 $173,914.45 ELECTRONIC 0006 2,0840131489

0000202 04/14/2009 0129406 0 0 $0.00 STATEMENT 0006 00000000

$347,828.90 4,168Total Apr-2009

Jan-20090000201 01/23/2009 0128848 10 0 $53,157.02 ELECTRONIC 0029 5580129405

0000200 01/16/2009 0127923 9 0 $68,830.73 ELECTRONIC 0029 9250128847

0000199 01/09/2009 0127570 9 0 $27,469.09 ELECTRONIC 0029 3530127922

0000198 01/02/2009 0126769 11 0 $58,833.92 ELECTRONIC 0029 8010127569

$208,290.76 2,637Total Jan-2009

Dec-20080000197 12/26/2008 0126245 6 0 $48,245.52 ELECTRONIC 0029 5240126768

0000196 12/19/2008 0125407 11 0 $69,265.48 ELECTRONIC 0029 8380126244

0000195 12/15/2008 0125096 0 0 $23,560.58 ELECTRONIC 0029 3110125406

0000194 12/12/2008 0124881 3 0 $17,388.01 ELECTRONIC 0029 2150125095

0000193 12/05/2008 0123921 10 0 $80,674.87 ELECTRONIC 0024 9600124880

$239,134.46 2,848Total Dec-2008

Nov-20080000192 11/26/2008 0123542 11 0 $30,650.25 ELECTRONIC 0029 3790123920

0000191 11/21/2008 0122766 10 0 $57,569.29 ELECTRONIC 0029 7760123541

0000190 11/14/2008 0122084 9 0 $55,176.21 ELECTRONIC 0029 6820122765

0000189 11/07/2008 0121255 11 0 $63,210.79 ELECTRONIC 0029 8290122083

0000188 11/01/2008 0121031 6 0 $26,725.69 ELECTRONIC 0029 2240121254

$233,332.23 2,890Total Nov-2008

Oct-20080000187 10/31/2008 0120692 1 0 $24,771.36 ELECTRONIC 0029 3390121030

0000186 10/24/2008 0119841 10 0 $65,276.40 ELECTRONIC 0029 8510120691

0000185 10/17/2008 0119149 10 0 $57,770.50 ELECTRONIC 0029 6920119840

0000184 10/10/2008 0118304 11 0 $75,123.41 ELECTRONIC 0029 8450119148

0000183 10/03/2008 0117817 9 0 $42,664.19 ELECTRONIC 0029 4870118303

$265,605.86 3,214Total Oct-2008

Sep-20080000182 09/26/2008 0117010 15 0 $67,311.49 ELECTRONIC 0029 8070117816

0000181 09/19/2008 0116298 10 0 $58,398.29 ELECTRONIC 0029 7120117009

0000180 09/12/2008 0115282 11 0 $92,923.83 ELECTRONIC 0029 1,0160116297

0000179 09/05/2008 0114974 9 0 $20,659.57 ELECTRONIC 0029 3080115281

$239,293.18 2,843Total Sep-2008

Aug-20080000178 08/29/2008 0114146 6 0 $66,768.64 ELECTRONIC 0029 8280114973

0000177 08/22/2008 0113420 9 0 $52,537.44 ELECTRONIC 0029 7260114145

0000176 08/15/2008 0112671 10 0 $69,653.18 ELECTRONIC 0029 7490113419

0000175 08/11/2008 0112004 10 0 $62,263.11 ELECTRONIC 0029 6670112670

0000174 08/01/2008 0111250 11 0 $64,038.51 ELECTRONIC 0029 7540112003

$315,260.88 3,724Total Aug-2008

Jul-20080000173 07/25/2008 0110563 7 0 $52,179.65 ELECTRONIC 0024 6870111249

0000172 07/25/2008 0110563 0 0 $0.00 STATEMENT 0024 00000000

0000171 07/18/2008 0109764 9 0 $68,380.94 ELECTRONIC 0029 7990110562


GenTesting

» DISPLAYS ALL PATIENTS WHO HAVE RECEIVED A

STATEMENT

» DISPLAYS STATEMENT NUMBER, PRINTED DATE,

PATIENT NAME AND ACCOUNT NUMBER AND THE

AMOUNT OF THE STATEMENT

» USEFUL IF STATEMENTS DID NOT PRINT

COMPLETELY OR THE ELECTRONIC BATCH WAS NOT

FULLY PROCESSED; USE THE REPORT TO FIND

STATEMENTS THAT DID NOT PRINT AND REPRINT

THEM

» CAN BE RUN BY MANY DIFFERENT CRITERIA

INCLUDING FOR A SPECIFIC STATEMENT PRINTED

DATE OR STATEMENT NUMBER RANGE AND CAN ALSO

BE SORTED IN SEVERAL WAYS INCLUDING

ALPHABETICALLY OR BY STATEMENT NUMBER


BILLING MODULE

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Detailed Patient Statement List

Detailed Patient Statement ListStatement

Number

Billed

AmountPatient Number \ Name

Printed

Date

0038080 586.00LINDAHL, PAULINE0000002 07/14/2005

0047305 140.00BRENDLE, LISA0000003 07/14/2005

0061580 55.00TVRDY, GAIL0000004 07/14/2005

0071566 519.00RODRIGUEZ, JOEL0000005 07/14/2005

0108694 55.00KANTAS, DIANE0000006 07/14/2005

0129354 55.00MCALLISTER, PATTY0000007 07/14/2005

0270648 140.00ARMES, REBECCA0000008 07/14/2005

0282065 55.00CHOMA, RENAE0000009 07/14/2005

0335259 55.00STIBOLT, CARA0000010 07/14/2005

0362805 55.00SULLIVAN, TAMMY0000011 07/14/2005

0368092 55.00GRAY, EDNA0000012 07/14/2005

0371244 140.00CALDER, MARJORIE0000013 07/14/2005

0371790 79.00MANDARICH, CONNIE0000014 07/14/2005

0373629 55.00EBLEN, CATHRYN0000015 07/14/2005

0381688 55.00SLEDGE, DIANE0000016 07/14/2005

0387251 55.00TRACY, JONI0000017 07/14/2005

0388267 55.00MILLER, AGNES0000018 07/14/2005

0389722 55.00BAUMER, STACY0000019 07/14/2005

0396834 55.00BROPHY, BARBARA0000020 07/14/2005

0403196 55.00WOODARD, KAREN0000021 07/14/2005

0405818 120.00HARRAH, CAROLYN0000022 07/14/2005

0409682 420.00VARGAS-CASTRO, GABRIEL0000023 07/14/2005

0410542 55.00BISSEN, MARGARET0000024 07/14/2005

0410785 90.00BUTCHER, DOROTHY0000025 07/14/2005

0417224 55.00OLSON, LYNN0000026 07/14/2005

0418476 55.00BOOTEN, ORMA0000027 07/14/2005

0422853 90.00CORNELSEN, JOANN0000028 07/14/2005

0431174 356.00CASTORAL, PATRICIA0000029 07/14/2005

1000000 79.00MOSS, LAURA0000030 07/14/2005

1000001 230.00MORT, DONALD0000031 07/14/2005

1000050 79.00EISERMAN, NEDRA0000032 07/14/2005

1000068 58.00HARMON, GENE0000033 07/14/2005

1000074 55.00DAVIS, DAWN0000034 07/14/2005

1000077 370.00LIBE, TINA0000035 07/14/2005

1000098 171.00SIMMS, IRVIN0000036 07/14/2005

1000143 140.00MERCADES, WILLIAMS0000037 07/14/2005

1000144 79.00BOMBERGER, MICHAEL0000038 07/14/2005

1000157 55.00MCDANIEL, SHARON0000039 07/14/2005

1000189 55.00SEENIVASAKAN, RADHIKA0000040 07/14/2005

1000192 55.00MCGINNIS, DIANA0000041 07/14/2005

1000211 31.00JOHNSEN, ALVIN0000042 07/14/2005

1000217 79.00LARUE, HUBERT0000043 07/14/2005

1000239 216.00STOUT, CATHERINE0000044 07/14/2005

1000243 216.00GRANT, TERRY0000045 07/14/2005

1000245 216.00SHANDERA, TERESA0000046 07/14/2005

1000265 79.00FALLET, MARCEL0000047 07/14/2005

0011539 55.00BRUNER, DEBRA0000048 08/01/2005

0027431 140.00LIESKE, VICTORINE0000049 08/01/2005

0031429 140.00GALLAGHER, KRISTINE0000050 08/01/2005

0044467 55.00LUNA, BARBARA0000051 08/01/2005

1017046 58.00LARSEN, MARGARET0000052 08/01/2005

0157335 90.00SCOTT, RITA0000053 08/01/2005

0163947 90.00FOGLEMAN, JANET0000054 08/01/2005

0170994 90.00TEWS, JOSEPHINE0000055 08/01/2005

0179946 90.00TAYLOR, JOSEPHINE0000056 08/01/2005

0182331 55.00WILSON, CATHY0000057 08/01/2005

0223215 55.00FRAZIER, ARZETTA0000058 08/01/2005

0225199 28.00RAGLAND, ELIZABETH0000059 08/01/2005

0247819 55.00QUINN, MIMI0000060 08/01/2005

0255011 230.00BRADLEY, JUDY0000061 08/01/2005

» DISPLAYS INFORMATION FOR ALL PATIENTS ON A

CONTRACT PAYMENT SCHEDULE

» DISPLAYS PATIENT NUMBER AND NAME,

CONTRACT PAYMENT AMOUNT, CONTRACT PAYMENT

DAYS, LAST PAYMENT DATE, LAST PAYMENT

AMOUNT AND BALANCE

» USEFUL FOR ENSURING PATIENTS ARE PAYING ON

TIME


BILLING MODULE

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Contract Payment Patient Accounts

Contract Payment Patient Accounts

Name Contract

Payment

Amount

Contract

Payment

Days

Balance

Amount

Number Last

Payment

Date

Last

Payment

Amount

{Patient.CreditStatusCode} = 10.00

0064991 PRICE, TERRY 133.00 30 $0.001/14/2009 532.07

0074527 KUBIK, LAVERNE 20.00 30 $0.001/20/2009 80.00

0077094 HAYWARD, EMILY 20.00 30 $120.0012/8/2008 120.50

0079177 FAZI, MARYANN 25.00 30 $0.001/5/2009 75.00

0089362 REINGROVER, AMANDA 10.00 30 $40.001/27/2009 10.00

0105661 KNUTH, WANDA 40.00 30 $190.361/8/2009 32.14

0108804 YOUNG, MADELINE 40.00 30 $200.001/2/2009 40.00

0109991 HOWARD, MARTHA 20.00 30 $130.0012/2/2008 20.00

0124132 JUAREZ, MARIA 25.00 30 $51.6212/2/2008 50.00

0141925 JEMIOLA, MELODY 50.00 30 $51.6212/19/2008 50.00

0214873 REIMER, GERTRUDE 42.00 30 $0.0012/24/2008 44.00

0223344 SKILLETT, NINA 50.00 30 $275.001/5/2009 75.00

0234099 ADAIR, JANICE 50.00 30 $164.911/8/2009 50.00

0234112 LEE, MELISSA 40.00 30 $750.871/6/2009 40.00

0238794 GROTE, RACHEL 110.00 30 $110.311/23/2009 110.00

0239871 MAGNUSON, MARY 30.00 30 $0.001/27/2009 120.00

0243019 HEMMINGER, ANNA 50.00 30 $0.001/9/2009 9.43

0250728 PHIPPS, LITA 97.50 30 $0.0012/29/2008 26.00

0258971 GENOWAYS, JOYCE 20.00 30 $31.9712/29/2008 30.00

0280647 DAVISON, BETTY 40.00 30 $187.151/12/2009 20.00

0287141 BLOCK, PEARL 75.00 30 $420.001/22/2009 10.00

0301071 SCOTT, JUDITH 100.00 30 $925.201/27/2009 50.00

0302393 MAPLE, DEBBIE 25.00 30 $28.541/26/2009 25.54

0305661 KNUTH, WANDA 40.00 30 $0.001/23/2009 40.00

0314893 WILLET, LARRY 50.00 30 $383.661/7/2009 50.00

0331264 SIEMS, JOYCE 30.00 30 $0.001/26/2009 30.00

0337777 CRABB, MILLIE 100.00 30 $205.0012/19/2005 29.61

0340397 MEYER, SHELLY 50.00 30 $180.151/26/2009 50.00

0340737 CASTILLO, YVETTE 20.00 30 $0.0012/30/2008 20.00

0353148 STROUGH, ALEXANDER 100.00 30 $509.691/21/2009 100.00

0353408 GRAFF, FAUNEIL 100.00 30 $261.2911/19/2008 100.00

0365178 OCONNOR, KATHLEEN 111.00 30 $347.701/7/2009 50.00

0365334 CHAMPOUX, AMY 50.00 30 $298.411/7/2009 50.00

0365889 PLESKAC, GEORGE 50.00 30 $333.811/27/2009 25.00

0392080 HOLLINGS, TIFFANY 100.00 30 $104.851/19/2009 100.00

0398317 HELD, LAVONNE 5.00 30 $30.0012/10/2008 10.00

0399012 JACOBY, EMMA 50.00 30 $0.001/6/2009 125.00

Printed: 04/30/2009Page 1 of 2

MB102.rpt

GenTesting

» DISPLAYS INFORMATION FOR ALL PATIENTS ON A

CONTRACT PAYMENT SCHEDULE WHO HAVE NOT

MADE A PAYMENT IN 30 DAYS

» DISPLAYS PATIENT NUMBER AND NAME,

CONTRACT PAYMENT AMOUNT, CONTRACT PAYMENT

DAYS, LAST PAYMENT DATE, LAST PAYMENT

AMOUNT AND BALANCE

» USE TO LOCATE PATIENTS WHO HAVEN’T MADE A

PAYMENT IN 30 DAYS


BILLING MODULE

Pa

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s Contract Patients with No Payments in 30 Days

Name

Contract

Payment

AmountNumber

Contract Payment Patients

With No Payment in the Last 30 Days

Contract

Payment

Days

Last

Payment

Date

Last

Payment

Amount

Balance

Amount

0077094 HAYWARD, EMILY 20.00 30 $120.0012/8/2008 120.50

0089362 REINGROVER, AMANDA 10.00 30 $40.001/27/2009 10.00

0105661 KNUTH, WANDA 40.00 30 $190.361/8/2009 32.14

0108804 YOUNG, MADELINE 40.00 30 $200.001/2/2009 40.00

0109991 HOWARD, MARTHA 20.00 30 $130.0012/2/2008 20.00

0124132 JUAREZ, MARIA 25.00 30 $51.6212/2/2008 50.00

0141925 JEMIOLA, MELODY 50.00 30 $51.6212/19/2008 50.00

0223344 SKILLETT, NINA 50.00 30 $275.001/5/2009 75.00

0234099 ADAIR, JANICE 50.00 30 $164.911/8/2009 50.00

0234112 LEE, MELISSA 40.00 30 $750.871/6/2009 40.00

0238794 GROTE, RACHEL 110.00 30 $110.311/23/2009 110.00

0258971 GENOWAYS, JOYCE 20.00 30 $31.9712/29/2008 30.00

0280647 DAVISON, BETTY 40.00 30 $187.151/12/2009 20.00

0287141 BLOCK, PEARL 75.00 30 $420.001/22/2009 10.00

0301071 SCOTT, JUDITH 100.00 30 $925.201/27/2009 50.00

0302393 MAPLE, DEBBIE 25.00 30 $28.541/26/2009 25.54

0314893 WILLET, LARRY 50.00 30 $383.661/7/2009 50.00

0337777 CRABB, MILLIE 100.00 30 $205.0012/19/2005 29.61

0340397 MEYER, SHELLY 50.00 30 $180.151/26/2009 50.00

0353148 STROUGH, ALEXANDER 100.00 30 $509.691/21/2009 100.00

0353408 GRAFF, FAUNEIL 100.00 30 $261.2911/19/2008 100.00

0365178 OCONNOR, KATHLEEN 111.00 30 $347.701/7/2009 50.00

0365334 CHAMPOUX, AMY 50.00 30 $298.411/7/2009 50.00

0365889 PLESKAC, GEORGE 50.00 30 $333.811/27/2009 25.00

0392080 HOLLINGS, TIFFANY 100.00 30 $104.851/19/2009 100.00

0398317 HELD, LAVONNE 5.00 30 $30.0012/10/2008 10.00

1014860 BOWMAN, CARRIE 120.00 30 $492.961/9/2009 120.00

1019247 REIGHTER, OPAL 20.00 30 $26.291/28/2009 20.00

1022276 PARKS, MARGENE 40.00 30 $8.001/12/2009 40.80

1027887 GWARTNEY, LLOYD 500.00 30 $396.0010/2/2008 100.00

1028296 LOWE, JULEE 25.00 30 $98.1110/24/2008 0.00

1031039 FARRAND, JOAN 42.59 30 $45.0012/30/2008 40.18

1036837 DENSON, RICK 34.00 30 $65.631/6/2009 34.00

1037014 METZLER, ROBERT 117.00 30 $200.3011/5/2008 120.00

1037360 PLETTNER, DEBORAH 37.50 30 $15.0012/30/2008 15.00

1038662 RHODES, SADIE 55.00 30 $148.231/20/2009 55.00

1038921 YEARIAN, BARBARA 60.00 30 $240.0012/15/2008 20.16


MB124.rpt

GenTesting

PATIENT COLLECTIONS

AND

AGING REPORTS

» DISPLAYS AGING INFORMATION FOR PATIENT

ACCOUNTS

» DISPLAYS PATIENT NUMBER AND NAME, CURRENT

AMOUNT DUE, AMOUNTS OVER 30/60/90/120,

PATIENT BALANCE AND INSURANCE BALANCE

» USE FOR COLLECTIONS AND REBILLING

» REPORT CAN BE RUN BY MANY DIFFERENT

SELECTION CRITERIA; CRITERIA WILL DISPLAY IN

HEADER IF USED

» REPORT IS FOUND IN THE COLLECTIONS AND

AGING MODULE

Pa

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Patient Aging Report

Patient Aging Report

{Aging.PayorTypeCode} = "A"

Current

Amount

Amount

Over 30

Amount

Over 60

Amount

Over 90

Amount

Over 120

Patient

Balance

Insurance

Balance

Number Name

9.540409158 ABBEY, DONNA F 0.00 0.00 0.00 0.00 9.54 0.00

0.000223122 ABERNATHY, JUDI A. 0.00 0.00 0.00 35.00 35.00 0.00

0.000186408 ABILDGAARD, GLENDA 562.54 0.00 0.00 0.00 562.54 0.00

0.000300923 ABOLD, ROBERT W. 0.00 0.00 315.00 0.00 315.00 0.00

0.000361086 ACEVEDO, SILVIA 0.00 31.45 0.00 0.00 31.45 0.00

64.330427224 ACKER, KAREN M. 0.00 0.00 0.00 0.00 64.33 0.00

0.000396581 ACOSTA, ELIZABETH A 0.00 0.00 214.41 0.00 214.41 0.00

0.001042116 ADAIR, LYNETTE 0.00 205.00 0.00 0.00 205.00 0.00

0.000128404 ADAMS, CATHERINE E 0.00 0.00 0.00 5.42 5.42 0.00

0.001041064 AGUILAR, LEON 0.00 0.00 320.00 0.00 320.00 0.00

0.000371893 AGUIRRE, JUANITA 0.00 0.00 0.00 55.94 55.94 0.00

0.001039414 AGUIRRE, ROBIN 0.00 0.00 0.00 93.00 93.00 0.00

55.000379552 AHLERS-DAILEY, MELISSA J 0.00 0.00 0.00 0.00 55.00 0.00

0.001043867 AHRENS, JOHN M 37.80 0.00 0.00 0.00 37.80 0.00

55.000270375 AKERS, LESLIE A 0.00 0.00 0.00 0.00 55.00 0.00

0.001005172 AKIN, PATRICIA 0.00 0.00 0.00 8.88 8.88 0.00

0.001036794 ALCANTAR, GUADALUPE R 0.00 0.00 0.00 21.25 21.25 0.00

96.001018513 ALCANTAR, JENI N 0.00 0.00 0.00 0.00 96.00 0.00

0.001017364 ALCANTAR, JESUS 0.00 0.00 0.00 58.77 58.77 0.00

95.001043575 ALDERSON, PAUL R 0.00 0.00 0.00 0.00 95.00 0.00

55.000417867 ALDERSON, RUTH S. 0.00 0.00 0.00 0.00 55.00 0.00

0.001011096 ALDRICH, TERRI 0.00 0.00 0.00 31.45 31.45 0.00

0.000426535 ALFARO, JUANA E 0.00 6.29 0.00 0.00 6.29 0.00

6.290410806 ALFARO, STAR 0.00 0.00 0.00 0.00 6.29 0.00

0.000253103 ALLARD, BEN D. 189.00 0.00 0.00 0.00 189.00 0.00

0.001040584 ALLEE, RONALD L 0.00 0.00 0.00 9.47 9.47 0.00

89.650421415 ALLEN, BRENDA 0.00 0.00 0.00 0.00 89.65 0.00

0.000302940 ALLEN, JENNIFER 10.00 0.00 0.00 0.00 10.00 0.00

0.000245280 ALLEN, JENNY L 83.36 0.00 0.00 0.00 83.36 0.00

0.001043667 ALLEN, JOANNA R 3.14 0.00 0.00 0.00 3.14 0.00

0.000214262 ALLEN, LEORA J. 0.00 0.00 215.00 0.00 215.00 0.00

0.001036719 ALLISON, SARA M 138.48 0.00 0.00 0.00 138.48 0.00

0.000356776 ALVAREZ, JANET 0.00 0.00 186.48 0.00 186.48 0.00

10.620194313 ALVIDREZ, JEANIE 0.00 0.00 0.00 0.00 10.62 0.00

20.960288254 ALVISTUR, ANNEMARIE 0.00 0.00 0.00 0.00 20.96 0.00

16.680400648 ALVORD, PHYLLIS 0.00 0.00 0.00 0.00 16.68 0.00

0.001042819 AMARO, CALLY 0.00 9.44 0.00 0.00 9.44 0.00

55.001003924 AMARO, GREGORIA 0.00 0.00 0.00 0.00 55.00 0.00

0.001040480 AMBRIZ, MARTHA SELENA 0.00 205.00 0.00 0.00 205.00 0.00

0.001017659 AMBRUSTER, LANA R 0.00 0.00 0.00 9.44 9.44 0.00

0.001032159 ANASTASI, ELIZABETH M 0.00 0.00 31.45 0.00 31.45 0.00

0.000255064 ANDERSEN, FRANKLIN K 98.11 0.00 0.00 0.00 98.11 0.00

0.000244377 ANDERSEN, VICTORIA K 0.00 0.00 38.48 0.00 38.48 0.00

0.001039776 ANDERSON, CHERIE 0.00 0.00 0.00 71.13 71.13 0.00

0.000416826 ANDERSON, ELEANOR A 0.00 0.00 32.14 0.00 32.14 0.00

0.000193586 ANDERSON, HANNAH L 18.90 30.49 0.00 0.00 49.39 0.00

0.000279807 ANDERSON, HOLLI T 0.00 0.00 25.00 0.00 25.00 0.00

0.001034363 ANDERSON, KATELYN M 0.00 0.00 0.00 50.00 50.00 0.00

0.001038499 ANDERSON, KEITH 0.00 0.00 0.00 160.00 160.00 0.00

55.001043353 ANDERSON, LORENA 0.00 0.00 0.00 0.00 55.00 0.00

0.001043910 ANDERSON, PAUL JASON 160.00 0.00 0.00 0.00 160.00 0.00

42.501013154 ANDERSON, PAULINE D 0.00 0.00 0.00 0.00 42.50 0.00

55.001003664 ANDES, DIANE R. 0.00 0.00 0.00 0.00 55.00 0.00

6.431036571 ANDES, TIFFANY D 0.00 0.00 0.00 0.00 6.43 0.00


MB101.rpt

GenTesting

» DISPLAYS PATIENT NUMBER AND NAME, ACCOUNT

BALANCE, LAST PAYMENT AMOUNT, DATE AND

NUMBER AND PAYOR WHO MADE THE LAST PAYMENT

» USE THE REPORT TO CONFIRM APPROPRIATE

PATIENTS WILL BE SENT TO COLLECTIONS

» REMOVE PATIENTS FROM COLLECTIONS BY

CHANGING CREDIT STATUS CODE TO ‘NONE’ ON

PATIENT DEMOGRAPHICS SCREEN

» REPORT IS PRODUCED BY RUNNING ‘GENERATE

PRE-COLLECTION RECORDS’ IN THE COLLECTIONS

AND AGING MODULE

Pa

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Pre-Collection Report

Pre-Collection Report

Name

Patient

Number

Account

Balance

Last

Payment

Amount

Last

Payment

Date

Last

Payment

Number

Last Payment

Payor Name

SHELTON, HOWARD1041461 $255.00 $0.00

SILVER, EARL1041459 $480.00 $0.00

SLAUGHTER, LAURA1044060 $305.00 $0.00 01/27/2009 0402405 CBSA - MINNETONKA

SOHL, ALLEN0357544 $812.92 $0.00 01/26/2009 0402118 BAY AREA SCHOOL/CNA

SOTO, MARIA0019947 $248.07 $46.26 10/21/2008 0370690 CBSA - MINNETONKA

STANOSHECK, MARY0397874 $361.84 $540.29 11/20/2008 0381774 CIGNA

STAPELTON, ROMONA0391647 $210.50 $0.00 11/24/2008 0382406 BAY AREA SCHOOL/CNA

STINSON, MARGARET0396581 $214.41 $20.00 01/05/2009 0395154 PRIVATE PAY

STORY, JAMES1042618 $1,120.00 $0.00 12/18/2008 0390670 BVMG/ONE HEALTHPLAN

SUING, ZACH1039639 $285.00 $10.00 01/05/2009 0395077 PRIVATE PAY

SWEENEY, PATRICK1042082 $350.00 $25.00 01/26/2009 0401391 PRIVATE PAY

TEMME, JOE1040941 $462.80 $100.00 01/14/2009 0398695 PRIVATE PAY

TEMPLE, LAURIE0325281 $254.98 $0.00 12/15/2008 0389896 BLUE CROSS PPO

THOENE, DUANE0288610 $812.92 $0.00 01/28/2009 0402616 BAY AREA SCHOOL/CNA

TRAMP, DALE0378127 $535.00 $208.91 11/17/2008 0380036 CORPORATE BENEFITS

TROIA, MARIE0357177 $205.00 $0.00

TULL, KATHY0079108 $287.49 $66.39 01/26/2009 0402034 BLUE CROSS PRUD BUYER

TURNER, NANCY0393382 $290.00 $0.00

WEBB, CHARLENE1015317 $1,116.06 $0.00 08/15/2008 0348271 BAY AREA SCHOOL/CNA

WELLENSIEK, CARMEN1041193 $1,973.41 $81.30 01/02/2009 0394793 BAY AREA SCHOOL/CNA

WIESE, CAROLYN1024087 $217.73 $97.22 01/26/2009 0402090 AARP HEALTH CARE OPTIONS

WILKINSON, SUSAN0349487 $315.00 $0.00 12/29/2008 0393275 BVMG/PRUCARE

WILMOT, LOUISE0417890 $565.00 $0.00 12/19/2008 0390786 L & H ADMINISTRATORS

WINKER, DONNA0272275 $205.00 $0.00

WOJTALEWICZ, LILLIAN0389908 $233.13 $0.00 12/09/2008 0388056 CBSA - MINNETONKA

WOLESENSKY, CAMILLE1029448 $406.99 $0.00 11/25/2008 0383522 CBSA - MINNETONKA

ZASTERA, MARVIN1043132 $238.87 $349.79 12/29/2008 0393454 CHRISTIAN BROTHERS EMP BENEFIT

ZOLINSKY, CECILE1043103 $240.00 $0.00

GRAND TOTAL: $56,107.30 $6,351.08


MB117.rpt

GenTesting

» CUSTOMIZED FOR EACH CUSTOMER PER THEIR

SPECIFICATIONS

» CAN BE SENT ELECTRONICALLY TO A

CLEARINGHOUSE

» USE THE REPORT TO SEND NOTICE OF PRE-

COLLECTIONS STATUS TO PATIENTS

» REPORT IS FOUND IN THE COLLECTIONS AND

AGING MODULE

Pa

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Pre-Collection Letter

04/16/2009

Seattle Services

P.O. Box 1068

Phone:

Seattle, WA 98121

(206) 555-1212

1272 ORCHARD WAY

ABELE, EVELYN

FINAL NOTICE

Account Number:

Amount Past Due:

0020213

$236.79

98121

Repeated requests for payment have been ignored. Unless full payment is received within (15) days we may assign this

account to our collection agency. Please call our office if you have questions regarding this matter.

Seattle, WA

Primary Payor

Group NumberPolicy NumberName/AddressNumber

0000023 CBSA - MINNETONKA

PO BOX 272550

18529110JCEX MF0181

Seattle, WA 98121

Relationship:Subscriber Name: Nbr0020213, KRISANNE SELF

Activity

Date

Activity

Description Amount Balance

Account

Balance

10/16/2008 88305 160.00LEVEL 4 TISSUE EXAM

10/27/2008 Service Adjustment -61.89

Blue Shield

10/27/2008 0.00Payment CBSA - MINNETONKA

Blue Shield

12/31/2008 -50.00Payment PRIVATE PAY

Patient

$48.11

10/16/2008 88360 360.00TUMOR IMMUNO/ER-PR

10/27/2008 Service Adjustment -121.32

Blue Shield

10/27/2008 0.00Payment CBSA - MINNETONKA

Blue Shield

12/31/2008 -50.00Payment PRIVATE PAY

Patient

$188.68

$236.79

» DISPLAYS PATIENTS THAT WILL BE SENT TO

COLLECTIONS UNLESS THEIR CREDIT STATUS CODE IS

SET TO ‘NONE’ ON THE PATIENT DEMOGRAPHICS

SCREEN

» DISPLAYS PATIENT ACCOUNT, SERVICE AND

PATIENT PAYOR DETAILS

» USE THE REPORT TO CONFIRM APPROPRIATE

PATIENTS WILL BE SENT TO COLLECTIONS

» REPORT IS PRODUCED BY RUNNING ‘GENERATE

COLLECTION RECORDS’ IN THE COLLECTIONS AND

AGING MODULE

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Collection Report Detail

Collection Report Detail

Provider: 0000001 Seattle Services

PhoneBirthdateSocial Security #Name/AddressPatient #

590-56-5055 (917)227-803507/12/19541043500 AL-MUGOTIA, HUSSAN

9000 SKYWAY

Seattle WA 98121

81976A622XDX 503300BAY AREA SCHOOL/CNA0000021

Primary Payor Group NumberPolicy Number

PO BOX 60007

98121Subscriber Name: Nbr1043500, RONALD Relationship: SELFSeattle WA

Account Activity

Date Description Number Amount

Service

Balance

Payor

Balance

Account

BalanceReferring Physician

12/21/2008 88304 95.000356407PETERSEN, AMY

LEVEL 3 TISSUE EXAMBAY AREA SCHOOL/CNA

Blue Cross denied

01/08/2009 0.000396899Payment

$95.0012/21/2008 88307 315.000356408PETERSEN, AMY


Blue Cross denied

01/08/2009 0.000396900Payment

$315.0012/21/2008 88309 465.000356409PETERSEN, AMY


Blue Cross denied

01/08/2009 0.000396901Payment

$465.00$875.00

$875.00

998-52-6465 (473)877-803510/22/19540111327 ANDERSON, CYNTHIA

1800 HEYNEN RD

Seattle WA 98121

88181220JCEX C30114CBSA - MINNETONKA0000023

Primary Payor Group NumberPolicy Number

PO BOX 272550

98121Subscriber Name: Nbr0111327, LINDA C. Relationship: SELFSeattle WA

Account Activity

Date Description Number Amount

Service

Balance

Payor

Balance

Account

BalanceReferring Physician

11/03/2008 88305 160.000344665GOOS, SONDRA

LEVEL 4 TISSUE EXAM11/14/2008 Service Adjustment -61.89

Blue Shield

0293636

CBSA - MINNETONKA

Blue Shield

11/14/2008 0.000379457Payment

$98.1111/10/2008 88307 630.000347175KOESTER, BARBARA

LEVEL 5 TISSUE EXAM11/25/2008 Service Adjustment -321.12

Blue Shield

0296795

CBSA - MINNETONKA

Blue Shield

11/25/2008 0.000383509Payment

$308.8811/10/2008 88342 300.000347176KOESTER, BARBARA

IMMUNOHISTOCHEMISTR11/25/2008 Service Adjustment -108.28

Blue Shield

0296796

CBSA - MINNETONKA

Blue Shield

11/25/2008 0.000383510Payment

$191.7211/10/2008 88360 360.000347177KOESTER, BARBARA

TUMOR IMMUNO/ER-PR

Printed: 08/17/2009Page 1 of 23MB115.rpt

GenTesting

CLIENT BILLING REPORTS


ADJUSTMENT HISTORY POSTED ON A CLIENT

ACCOUNT

» CAN BE USED TO SEND ITEMIZED ACCOUNT DETAIL

TO A CLIENT

» RUN THE REPORT BY CLICKING ON THE ‘LEDGER’

BUTTON ON THE ‘CLIENT ACCOUNT DETAIL’ SCREEN

IN THE CLIENT STATEMENT BILLING MODULE

Cli

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Client Account Details

Account Details for Client Number : 0005000

ASIAN HEALTH SERVICES/CHCNSTUDENT HEALTH CTR LAB #777

ACTIVITY DATE NUMBER DESCRIPTION AMOUNT BALANCESTATUS

BILLING

Seattle WA 98121

122.00 0.00Service 07/07/2005 0000009 CLIENT SERVICE 40

Payment 10/17/2005 0016788 122.00


Payment 10/17/2005 0016789 573.00

2,536.00 0.00Service 08/23/2005 0000025 CLIENT SERVICE 40

Payment 10/17/2005 0016790 2,536.00


Payment 11/17/2005 0026812 2,272.00


Payment 01/24/2006 0046357 1,824.00


Payment 01/24/2006 0046358 1,896.00


Payment 02/16/2006 0053175 792.00


Payment 02/16/2006 0053176 48.00


Payment 03/09/2006 0059202 1,888.00


Payment 03/09/2006 0059203 0.00

Payment 04/20/2006 0072355 56.00


Payment 03/09/2006 0059204 0.00

Payment 04/20/2006 0072356 64.00


Payment 03/09/2006 0059205 0.00

Payment 04/20/2006 0072357 88.00


Payment 04/20/2006 0072358 1,128.00


MB313.rpt

GenTesting

» DISPLAYS ADJUSTMENTS APPLIED TO CLIENT

ACCOUNTS

» DISPLAYS THE ADJUSTMENT NUMBER, ENTERED

DATE, REASON TEXT, SERVICE NUMBER, PAYMENT

NUMBER AND AMOUNT

» DATA IS GROUPED AND SUBTOTALED BY

ADJUSTMENT TYPE

» CAN BE USED FOR AUDITING

» FOUND IN THE CLIENT STATEMENT BILLING

MODULE

Cli

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Client Adjustment Report

Client Adjustment Report

Number

Entered

Date AmountReasonText

Service

Number

Payment

Number

Service Adjustments

Change payor0710000164 04/11/2008 -5.00Bill CDP for patient Maria Tapia (2/27/08 DOS) 0000426

0000177 07/09/2008 -5.00HERMELINDA MONZON; BILLING INSURANCE 0000462

0000178 07/09/2008 -10.00Patients Regusci & Paul - billing insurance 0000463

0000175 06/03/2008 -5.00Billing CDP for patient Martha Raya (May Statement) 0000451

071 Change payor -25.00

Courtesy discount0530000172 04/25/2008 -80.000000420

0000133 02/25/2008 0.000000406

053 Courtesy discount -80.00

Misc. adjustment0660000176 06/16/2008 0.000000415

0000162 03/24/2008 0.000000415

066 Misc. adjustment 0.00

Other write-off0670000173 05/05/2008 -65.630000419

0000174 05/19/2008 -14.290000392

0000187 10/30/2008 -56.410000466

0000188 10/30/2008 -69.840000455

067 Other write-off -206.17

Posting error0500000136 03/03/2008 -75.000000420

0000137 03/03/2008 -75.00To correct 0000420

0000138 03/03/2008 -75.00to correct 0000420

0000139 03/03/2008 -75.000000420

0000152 03/03/2008 75.00To reverse 0000420

0000154 03/03/2008 75.00to correct 0000420

0000156 03/03/2008 75.00to correct 0000420

0000158 03/03/2008 75.00to correct 0000420

0000160 03/03/2008 0.00to change service status code 0000420

050 Posting error 0.00

Service Adjustment Total -311.17

-311.17GRAND TOTAL:

Total

050 Posting error 0.00

053 Courtesy discount -80.00

066 Misc. adjustment 0.00

067 Other write-off -206.17

071 Change payor -25.00

Total -311.17


MB307.rpt

GenTesting

»DISPLAYS OUTSTANDING CLIENT ACCOUNTS AGED

BY 30, 60, 90 AND 120 DAYS

» DISPLAYS THE CLIENT ACCOUNT NUMBER AND

NAME, 30/60/90/120 AMOUNTS AND TOTAL

AMOUNT DUE

» CAN BE USED TO DETERMINE COLLECTION POLICY

ON OVERDUE ACCOUNTS


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Client Account Aging Report

Client Account Aging Report

Number Name Current Over 30 Over 60 Over 90 Total DueOver 120

ASIAN HEALTH

SERVICES/CHCN 0.00 0.00 0.00 0.00 421.00 421.000005000

(142) 589-8035

BAY VALLEY MEDICAL

GRP (BVMG) 5.00 0.00 0.00 0.00 5.00 0.000005001

(024) 937-6035

BAYCARE MEDICAL GRP

(BCMG) SDC 10.00 0.00 0.00 0.00 5.00-5.000005002

(024) 937-6035

BERKELEY FAM

PRACTICE (BERK) 5.00 0.00 0.00 0.00 5.00 0.000005003

(024) 937-6035

CARE POINT MEDICAL

CENTER 5.00 0.00 0.00 5.00 10.00 0.000005007

(024) 937-6035

CENTERS FOR

ELDERS/OAK/SDC 0.00 0.00 0.00 10.00 10.00 0.000005009

(024) 937-6035

CHARLES QUEST, MD 10.00 0.00 0.00 0.00 10.00 0.000005010

(024) 937-6035

CINICA DE SALUD DEL

VALLE 95.00 0.00 0.00 1,050.00 1,145.00 0.000005012

(909) 767-8035

CLIN DE SALUD DE

GREENFIELD/SDC 5.00 0.00 0.00 0.00 5.00 0.000005014

(002) 267-4035

CLINICA DE

SALUD/SANBORN/SDC 10.00 0.00 0.00 0.00 10.00 0.000005018

(142) 589-8035

CLINICA DE

SALUDE/SOLEDAD/SDC 0.00 0.00 0.00 0.00 160.00 160.000005019

(533) 043-9035

145.00 0.00 0.00 1,065.00 1,786.00Totals:

Records printed: 11

576.00


MB303.rpt

GenTesting

» DISPLAYS PAYMENTS POSTED TO A CLIENT

ACCOUNT BY BATCH

» DISPLAYS THE CASH RECEIPT NUMBER AND

AMOUNT, ENTERED DATE, STAFF NUMBER, CLIENT

NUMBER AND NAME, PAYMENT NUMBER AND

AMOUNT, ADJUSTMENT AMOUNT AND ADJUSTMENT

PAYMENT AMOUNT

» RUN FOR ANY DATE RANGE OR BY BATCH NUMBER

» DATA GROUPED AND SUBTOTALED BY BATCH

NUMBER

» USE TO AUDIT DATA ENTRY


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Client Cash Receipt Batch Report

Entered

Date

Staff

Number

Payment

Amount

Client

Number Name

Adj. Paymt

Amount.

Adj.

Amount

Client Cash Receipt Batch Report

Cash Rec.

Number

Cash Rec.

Amount

Payment

Number

010909DBatch Number:

01/09/20090329482 CARE POINT

MEDICAL CENTER

0005007 5.00 0.00 5.000030 0397067 5.00

01/09/20090329484 BAY VALLEY

MEDICAL GRP

(BVMG)

0005001 15.00 0.00 15.000030 0397068 15.00

Batch Number: 010909D Totals: $0.00$20.00 $20.00$20.00


01/12/20090330342 BAY VALLEY

MEDICAL GRP

(BVMG)

0005001 5.00 0.00 5.000030 0398048 5.00



01/15/20090331053 ASIAN HEALTH

SERVICES/CHCN

0005000 920.00 0.00 920.000030 0399005 920.00

01/15/20090331057 CLINICA DE

SALUD/SANBORN/SD

C

0005018 231.00 0.00 231.000030 0399008 231.00

Batch Number: 011509D Totals: $0.00$1,151.00 $1,151.00$1,151.00


01/26/20090332909 BERKELEY FAM

PRACTICE (BERK)

0005003 5.00 0.00 5.000030 0401224 15.00

BERKELEY FAM

PRACTICE (BERK)

0005003 10.00 0.00 10.000401225

01/26/20090332910 BULLOCK, PETER/PC0005005 15.00 0.00 15.000030 0401226 25.00

BULLOCK, PETER/PC0005005 10.00 0.00 10.000401227

01/26/20090332911 BERKELEY PRIMARY

CARE/SDC

0005004 5.00 0.00 5.000030 0401228 5.00


Grand Totals: $0.00$1,221.00 $1,221.00$1,221.00


MB310.rpt

GenTesting

» DISPLAYS PAYMENTS POSTED TO A CLIENT

ACCOUNT BY TENDER NUMBER. THE REPORT LISTS

THE CASH RECEIPT NUMBER, ENTERED DATE,

TENDER NUMBER, CLIENT NAME AND NUMBER,

PAYMENT NUMBER AND AMOUNT, PAYMENT

ADJUSTMENT AMOUNT AND ADJUSTED PAYMENT

TOTAL AMOUNT

» RUN FOR ANY DATE RANGE OR BY CASH RECEIPT

NUMBER

» USED FOR RECONCILING YOUR RECEIPTS TO WHAT

WAS POSTED


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Client Cash Receipt with Payments

Client Cash Receipt with Payments

Tender

Type #

Payment

Amount

Payment

Number

Client

Number

Client Name Adj. Paymt.

Amount

Adj.

Amount

Cash Rec.

Number

Entered

Date

Tender Number: 060315

01/09/2009 060315CH0329482 CARE POINT MEDICAL

CENTER

0005007 0397067 0.00 5.00 5.00

01/09/2009 060315CH0329484 BAY VALLEY MEDICAL GRP

(BVMG)

0005001 0397068 0.00 15.00 15.00

Totals for Tender Number: 060315 0.00 20.00 20.00


01/12/2009 060402CH0330342 BAY VALLEY MEDICAL GRP

(BVMG)

0005001 0398048 0.00 5.00 5.00



01/26/2009 060451CH0332909 BERKELEY FAM PRACTICE

(BERK)

0005003 0401224 0.00 5.00 5.00

01/26/2009 060451CH0332909 BERKELEY FAM PRACTICE

(BERK)

0005003 0401225 0.00 10.00 10.00

01/26/2009 060451CH0332910 BULLOCK, PETER/PC0005005 0401226 0.00 15.00 15.00

01/26/2009 060451CH0332910 BULLOCK, PETER/PC0005005 0401227 0.00 10.00 10.00

01/26/2009 060451CH0332911 BERKELEY PRIMARY

CARE/SDC

0005004 0401228 0.00 5.00 5.00



01/15/2009 259498CH0331053 ASIAN HEALTH

SERVICES/CHCN

0005000 0399005 0.00 920.00 920.00

01/15/2009 259498CH0331057 CLINICA DE

SALUD/SANBORN/SDC

0005018 0399008 0.00 231.00 231.00

Totals for Tender Number: 259498 0.00 1,151.00 1,151.00

Grand Totals: $0.00$1,221.00 $1,221.00


MB309.rpt

GenTesting

» DISPLAYS PAYMENTS POSTED

» DISPLAYS THE DEPOSIT NUMBER, ENTERED DATE,

TENDER TYPE, AMOUNT, CASH RECEIPT NUMBER,

CLIENT NAME, TENDER NUMBER AND DESCRIPTION

» RUN BY DEPOSIT NUMBER OR DATE RANGE

» ELIMINATES HANDWRITEN BANK DEPOSIT SLIPS

AND REDUCES AUDITING TIME


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Client Deposit Slip

Client Bank Deposit Slip

Deposit No.:0000042

Description:081905RH

Date: 08/19/2005 Amount: 0.00

Type AmountTender No. Payor Patient Number / NameAdjustmentReceipt No.

Patient Account Deposits

TOUSSAINT, LATOYA0016207CELTIC LIFE INS - MADISON 112.43000500884CH0001405

HOFFER, JULIE1000201CBSA - MINNETONKA 117.17003934106CH0001406

HELLERICH, JEANETT0086633BLUE SHIELD OF CALIFORNIA 60.8715756190CH0001407

WESTMORELAND, DONNA0286876BLUE SHIELD OF CALIFORNIA 21.2315470010CH0001410

BUSS, JERALD1001062BLUE SHIELD OUT OF STATE 202.3715470010CH0001412

THOMPSON, DORIS0174899BLUE SHIELD OF CALIFORNIA 280.1415858020CH0001413

WASHINGTON, SUSIE0420989BLUE SHIELD OUT OF STATE 46.9515858020CH0001414

WILLIAMSEN, JANELLE0345294BLUE SHIELD OUT OF STATE 0.0015858020CH0001415

KRUMLAND, DOROTHY0237846BLUE SHIELD OUT OF STATE 33.3115858020CH0001416

VAN DE BOGART, BECKY0386165BLUE SHIELD OUT OF STATE 0.0015858020CH0001417

TRIMBLE, SAMANTHA0166160BLUE SHIELD OUT OF STATE 0.0015858020CH0001418

KALIVODA, MARY-JO0212538CBSA - MINNETONKA 37.01016190260CH0001421

TAFOYA, TRACY0279445CBSA - MINNETONKA 65.09016190260CH0001422

LUBEN, SHARON0421756CBSA - MINNETONKA 112.43016190260CH0001423

MARLOW, ANGELINA0172842CBSA - MINNETONKA 112.43016190260CH0001424

SHAFFER, LORETTA0252745CBSA - MINNETONKA 21.23016190260CH0001425

FAZI, MARYANN0329177CBSA - MINNETONKA 37.01016190260CH0001426

OTTERBERG, ELISABETH1001221CBSA - MINNETONKA 37.01016190260CH0001427

BROWN, TONY0383744CBSA - MINNETONKA 37.01016190260CH0001428

OROZCO, JANET0312484CBSA - MINNETONKA 37.01016190260CH0001429

KUWITZKY, BONNIE0364280CBSA - MINNETONKA 52.17016190260CH0001430

VORLAND, JON0336363CBSA - MINNETONKA 112.43016190260CH0001431

FISCHER, KATHERINE0378256CBSA - MINNETONKA 21.23016190260CH0001432

STRATMAN, LAURA0422368CBSA - MINNETONKA 112.43016190260CH0001433

DOHMEN, VERLENE0403740CBSA - MINNETONKA 423.70016190260CH0001434

MILLER, EUGENE0242376CBSA - MINNETONKA 112.43016190260CH0001435

LOPEZ, CYNTHIA0325262CBSA - MINNETONKA 37.01016190260CH0001436

LOPEZ, CYNTHIA0325262CBSA - MINNETONKA 23.86016190260CH0001437

ZIMMERMAN, GERALD1000076CBSA - MINNETONKA 112.43016190260CH0001438

BINA, RAPHAEL0241712CBSA - MINNETONKA 52.17016190260CH0001439

JONES, PHYLLIS0330413CBSA - MINNETONKA 198.84016190260CH0001441

LOGEMAN, HARRY0350673CBSA - MINNETONKA 112.43016190260CH0001442

RATHJE, BRENDA0353357CBSA - MINNETONKA 112.43016190260CH0001443

BARR, JAYCEE0311551CBSA - MINNETONKA 37.01016190260CH0001444

WALL, LILLIAN0250769CBSA - MINNETONKA 52.17016190260CH0001445

WILLIAMS, ROSCOE1000078CBSA - MINNETONKA 449.72016190260CH0001446

YOBLE, CAROLYN0176607CBSA - MINNETONKA 112.43016190260CH0001447

JOHNSTON, TOVEY0378681CBSA - MINNETONKA 37.01016190260CH0001448

FROSCHHEISER, WILMA0400634CBSA - MINNETONKA 37.01016190260CH0001449

KAUFMAN, FERN0177464CBSA - MINNETONKA 28.31016190260CH0001450

KAUFMAN, FERN0177464CBSA - MINNETONKA 23.86016190260CH0001451

HOPPNER, DELPHIA0398740CBSA - MINNETONKA 37.01016190260CH0001452

STOLLE, DONNA0336974CBSA - MINNETONKA 37.01016190260CH0001453

DUGAN, CLAIRE1001015CBSA - MINNETONKA 52.17016190260CH0001455

JOHNSON, REGINA0025769CBSA - MINNETONKA 21.23016190260CH0001456

KELLER, ESTHER0056881CBSA - MINNETONKA 112.43016190260CH0001457

GROVE, MAXINE1000057CBSA - MINNETONKA 112.43016190260CH0001458

GROVE, MAXINE1000057CBSA - MINNETONKA 311.27016190260CH0001459

DURAND, KATHY0345346CBSA - MINNETONKA 37.01016190260CH0001460

VERMEULEN, LINDA0134181CBSA - MINNETONKA 238.68016190260CH0001461

Printed:11/24/2009


GenTesting

» DISPLAYS LIST OF SERVICES NOT YET BILLED TO

THE CLIENT

» DISPLAYS DATE OF SERVICE, PATIENT NAME AND

NUMBER, SERVICE ITEM CODE, LOCATION, SAMPLE

ID, PRICE AND DATE OF BIRTH

» GROUPS AND TOTALS INFORMATION BY CLIENT

THEN CLINICIAN

» RUN THE REPORT BEFORE GENERATING CLIENT

STATEMENTS TO FIND MEDICARE AGE PATIENTS

THAT MAY NEED TO HAVE SERVICES SWITCHED TO

MEDICARE AS THE PAYOR


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Client Proof List

Client Proof Listing

ASIAN HEALTH SERVICES/CHCN 0005000

BRANDL, KIMBERLY 0000184

Sample IDNumber Price DOBDOS Patient Name Code Location NameDescription

1/6/2009 ROWE, DALE 88305 21.00 5/29/19921043742 ABC Clinic #0000261LEVEL 4 TISSUE EXAM S09-000166

Total: BRANDL, KIMBERLY 0000184 $21.00

GATHER, MILDRED 0000445


1/6/2009 COMBS, JEAN 88141 0.00 4/18/19981031018 ABC Clinic #0000261PHYS INTERP OF PAP C09-090016

1/6/2009 COMBS, JEAN 88164 10.00 4/18/19981031018 ABC Clinic #0000261SCREENING PAP SMEAR C09-090016

Total: GATHER, MILDRED 0000445 $10.00

NELSON, MILDRED 0000538


1/9/2009 CHAMBLISS, ELAINE 88148 10.00 9/26/19950410735 ABC Clinic #0000261SCREENING PAP SMEAR C09-090022

Total: NELSON, MILDRED 0000538 $10.00

OLSON, MIKAELA 0000093


1/6/2009 KULA, JULIE 88141 0.00 1/17/19950140029 ABC Clinic #0000261PHYS INTERP OF PAP C09-090013

1/6/2009 KULA, JULIE 88148 10.00 1/17/19950140029 ABC Clinic #0000261SCREENING PAP SMEAR C09-090013

1/21/2009 KELLY, MADDIE 88141 0.00 7/7/19960425669 ABC Clinic #0000261PHYS INTERP OF PAP C09-090069

1/21/2009 KELLY, MADDIE 88164 10.00 7/7/19960425669 ABC Clinic #0000261SCREENING PAP SMEAR C09-090069

Total: OLSON, MIKAELA 0000093 $20.00

PAUKUNE, DEBRA 0000209


1/14/2009 LAMBERT, VELMA 88148 10.00 11/18/19640132947 ABC Clinic #0000261SCREENING PAP SMEAR C09-090029

1/20/2009 JOHNSON, EVELYN 88141 0.00 10/18/19890333356 ABC Clinic #0000261PHYS INTERP OF PAP C09-090065

1/20/2009 JOHNSON, EVELYN 88164 10.00 10/18/19890333356 ABC Clinic #0000261SCREENING PAP SMEAR C09-090065

1/15/2009 NAVRKAL, ELAINE 88148 10.00 8/21/19960419792 ABC Clinic #0000261SCREENING PAP SMEAR C09-090045

1/20/2009 HARROW, LISA 88141 0.00 2/3/19960426544 ABC Clinic #0000261PHYS INTERP OF PAP C09-090066

1/20/2009 HARROW, LISA 88164 10.00 2/3/19960426544 ABC Clinic #0000261SCREENING PAP SMEAR C09-090066

1/20/2009 HURLEY, BARBARA 88141 0.00 7/7/19971003039 ABC Clinic #0000261PHYS INTERP OF PAP C09-090062

1/20/2009 HURLEY, BARBARA 88164 10.00 7/7/19971003039 ABC Clinic #0000261SCREENING PAP SMEAR C09-090062

1/14/2009 FLOTT, ETTA 88148 10.00 10/11/19971003632 ABC Clinic #0000261SCREENING PAP SMEAR C09-090044

1/14/2009 HAMMOND, IDA 88148 10.00 7/29/19961003808 ABC Clinic #0000261SCREENING PAP SMEAR C09-090031

1/20/2009 SCHNELL, DIANE 88148 10.00 1/15/19961005359 ABC Clinic #0000261SCREENING PAP SMEAR C09-090061

1/22/2009 DAHLBERG, JEAN 88148 10.00 7/12/19961012955 ABC Clinic #0000261SCREENING PAP SMEAR C09-090077

1/14/2009 OHEARN, TERRY 88148 10.00 12/18/19951016341 ABC Clinic #0000261SCREENING PAP SMEAR C09-090028

1/16/2009 JOHNSON, TIFFANY 88148 10.00 6/9/19951018133 ABC Clinic #0000261SCREENING PAP SMEAR C09-090051

1/22/2009 RATHMAN, SHARONANN 88148 10.00 4/12/19961025502 ABC Clinic #0000261SCREENING PAP SMEAR C09-090076

1/20/2009 CHRISTENSEN, SHIRLEY 88148 10.00 10/14/19981029589 ABC Clinic #0000261SCREENING PAP SMEAR C09-090063

1/22/2009 TENEYCK, EMILY 88148 10.00 1/10/19961033232 ABC Clinic #0000261SCREENING PAP SMEAR C09-090080

1/12/2009 SIMETICH, CHRISTINE 88148 10.00 8/13/19971043931 ABC Clinic #0000261SCREENING PAP SMEAR C09-090024

1/14/2009 MARSHALL, DOROTHY 88148 10.00 4/18/19971044030 ABC Clinic #0000261SCREENING PAP SMEAR C09-090033

1/20/2009 BOUSHA, ANNE 88148 10.00 12/14/19951044209 ABC Clinic #0000261SCREENING PAP SMEAR C09-090057

1/21/2009 LANTZ, SHAN 88148 10.00 2/14/19971044255 ABC Clinic #0000261SCREENING PAP SMEAR C09-090068

1/20/2009 CHRISTIANSEN, KELLI 88148 10.00 3/16/19941044256 ABC Clinic #0000261SCREENING PAP SMEAR C09-090071

1/22/2009 SINNER, SEASON 88148 10.00 12/6/19951044311 ABC Clinic #0000261SCREENING PAP SMEAR C09-090078

Total: PAUKUNE, DEBRA 0000209 $200.0


GenTestingMB316.rpt

» DISPLAYS INFORMATION ON SERVICES ENTERED ON

A CLIENT ACCOUNT

» DISPLAYS CLIENT NUMBER AND NAME, ENTERED BY

ID, SERVICE NUMBER, SERVICE ENTERED DATE,

SERVICE ITEM CODE, UNITS, AMOUNT, STATEMENT

NUMBER AND TOTAL DUE

» RUN BY BATCH NUMBER OR RANGE OF SERVICE

DATES


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Client Services Batch Report

Client Services Batch Report

Client

Number

Entered

By ID

Service

Number

Entered

Date

Service

Item Code Units Amount

Total

DueClient Name

Statement

Number

415Batch Number:

ASIAN HEALTH SERVICES/CHCN 0004 0000525 04/15/2009 90000 1 421.00 421.000005000 0000503

BAY VALLEY MEDICAL GRP (BVMG) 0004 0000526 04/15/2009 90000 1 5.00 5.000005001 0000504

BAYCARE MEDICAL GRP (BCMG) SDC 0004 0000527 04/15/2009 90000 1 10.00 10.000005002 0000505

BERKELEY FAM PRACTICE (BERK) 0004 0000528 04/15/2009 90000 1 5.00 5.000005003 0000506

CARE POINT MEDICAL CENTER 0004 0000529 04/15/2009 90000 1 5.00 5.000005007 0000507

CHARLES QUEST, MD 0004 0000530 04/15/2009 90000 1 10.00 10.000005010 0000508

CINICA DE SALUD DEL VALLE 0004 0000531 04/15/2009 90000 1 95.00 95.000005012 0000509

CLIN DE SALUD DE GREENFIELD/SDC 0004 0000532 04/15/2009 90000 1 5.00 5.000005014 0000510

CLINICA DE SALUD/SANBORN/SDC 0004 0000533 04/15/2009 90000 1 10.00 10.000005018 0000511

Totals for Batch Number:415 9 566.00 $566.00

Grand Totals: 9 $566.00 $566.00


GenTesting

»DISPLAYS CLIENT ACCOUNTS WITH A CREDIT

BALANCE

» DISPLAYS THE CLIENT SERVICE NUMBER, FROM

DATE, BALANCE AMOUNT, CLIENT NUMBER, NAME

AND ADDRESS

» CAN BE USED TO DETERMINE IF A REFUND IS

APPROPRIATE


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Client Services with a Credit Balance

Client Services with a Credit Balance Service

Number

From

Date

Client

Number

Client

Name

Balance

Amount

Client

Address

Client

City, State, Zip

98121WASeattleC/O DEL NORTE

ADMINISTRATION

BAYCARE MEDICAL

GRP (BCMG) SDC

01/13/20080000402 0005002-5.00


ADMINISTRATION

BAY VALLEY MEDICAL

GRP (BVMG)

01/06/20090000526 0005001-25.00


ADMINISTRATION

BAYCARE MEDICAL

GRP (BCMG) SDC

01/05/20090000527 0005002-20.00


ADMINISTRATION

BERKELEY FAM

PRACTICE (BERK)

12/26/20080000528 0005003-55.00


ADMINISTRATION

CARE POINT MEDICAL

CENTER

01/13/20090000529 0005007-27.00

98121WASeattle89 PUTNAM WAYCLIN DE SALUD DE

GREENFIELD/SDC

01/15/20090000532 0005014-17.00

Records Printed: 6


MB305.rpt

GenTesting

» CUSTOMIZED BY CORTEX FOR EACH CUSTOMER

» STATEMENTS CAN HAVE DIFFERENT FORMATS,

DETAILS SORTS AND SUBTOTALS PER CUSTOMER

SPECIFICATIONS

» CAN BE REPRINTED IF CLIENT REQUESTS ANOTHER

COPY

» PRINTED FROM THE CLIENT STATEMENT BILLING

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Client Statement

Seattle Services

Account Number: 0005000-0000603

Amount Due

Previous Balance

Current Charges

$338.00

$8,270.00

$0.00Payments

$608.00

STUDENT HEALTH CTR LAB #777

ASIAN HEALTH SERVICES/CHCN

Seattle, WA 98121

$338.00Balance Forward

Credits / Adjustments $0.00

31 - 60 Days

$273.00Over 120 Days

$0.0091 - 120 Days

$0.0061 -90 Days

$65.00

$0.001 - 30 Days

$270.00Current Amount

1/20/2011

PLEASE RETURN THIS PORTION WITH YOUR REMITTANCE PAYABLE TO:

Seattle Services

P.O. Box 1068

Seattle, WA 98121

Page 1 of 3

Seattle ServicesP.O. Box 1068 * * Seattle, WA 98121

(206) 555-1212

Accession # CPT

Client

AmountDOB Patient DescriptionUnits

Date of Service: 1/5/2009

WHITNEY, JUNE $55.008814801/02/1942C09-090007 SCREENING PAP SMEAR 1


SUTTON, BRANDY $160.008830505/27/1957S09-000768 LEVEL 4 TISSUE EXAM 1


CLARK, ELIZABETH $55.008817510/29/1959L09-001972 PAP SMEAR/FOCALPT 1


sKRONE, CARMEL $8,000.009500001/01/1910 MEDICAL DIR FEES 1

$338.00

Total Amount Due $608.00

$273.00Over 120 Days

$0.0091 - 120 Days

$0.0061 -90 Days

$65.0031 - 60 Days

$0.001 - 30 Days

$270.00Current Amount


Payments

Credits/Adjustments

$0.00

Account Number: 0005000-0000603

Amount Due

Previous Balance

Balance Forward

$338.00

$608.00

$8,270.00Current Service Charges

$0.00

Page 2 of 3


(206) 555-1212

Total

88148

SCREENING PAP $55.00

1

88175 PAP

SMEAR/FOCALPT $55.00

1

88305 LEVEL 4

TISSUE EXAM $160.00

1

95000 MEDICAL

DIR FEES Units$8,000.00

1

Total $8,270.00

4


Page 3 of 3


(206) 555-1212

» DISPLAYS THE SUMMARY FOR EACH CLIENT

STATEMENT RUN

» DISPLAYS THE RUN NUMBER, RUN DATE, STARTING

AND ENDING STATEMENT NUMBERS, BILLED

AMOUNT, STATEMENT COUNT, STATEMENT FORM

NAME USED AND STAFF NUMBER

» USEFUL FOR DETERMINING DOLLARS BILLED AND

AUDITING THE ACTUAL NUMBER OF STATEMENTS

PRINTED

» RUN THE REPORT BY CLICKING ON THE ‘DISPLAY

STATEMENT RUNS’ BUTTON ON THE ‘PRINT CLIENT

STATEMENT’ SCREEN IN THE CLIENT STATEMENT

BILLING MODULE

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Client Statement Run List

Number

Client Statement Run ListStarting

Statement

Number

Ending

Statement

Number

Run

Date

Error

CountBilled

Amount

Statement

Count

Form

Name

Run

By

1$1,494.00 00000516000051605/01/20090000092 CLIENTSTATEMENT 0006



2$155.00 00000502000050112/31/20080000089 CLIENTSTATEMENT 0024


































GenTesting

PAYOR COLLECTIONS

AND

AGING REPORTS

» DISPLAYS OUTSTANDING PAYOR ACCOUNTS AGED

BY 30, 60, 90 AND 120 DAYS

» DISPLAYS THE PAYOR ACCOUNT NUMBER AND


AMOUNT DUE


ON OVERDUE ACCOUNTS

» FOUND IN THE COLLECTIONS AND AGING MODULE

Pa

yo

r C

oll

ect

ion

s a

nd

Ag

ing

Payor Aging Summary Report

Payor Aging Report Summary

Number

Current

Amount Total DueName

Amount

Over 30

Amount

Over 60

Amount

Over 90

Amount

Over 120

As Of: 7/14/2008

702.87 0.00 0.00 0.00 0.00 702.87

Incomplete Services 5,473.00 0.00 0.00 0.00 0.00 5,473.00

Services with Credit Balance -180,094.69 0.00 0.00 0.00 0.00 -180,094.69

Services On Hold 275,895.15 0.00 0.00 0.00 0.00 275,895.15

Client Services - Unbilled 15,512.85 0.00 0.00 0.00 0.00 15,512.85

Other/Unknown 886.93 0.00 0.00 0.00 0.00 886.93

Patient 59,166.60 0.00 0.00 0.00 530,632.14 589,798.740000000

A A R P 0.00 0.00 0.00 0.00 297.65 297.65D400010

AARP 0.00 0.00 0.00 0.00 48.65 48.650015976

AARP 10.85 0.00 0.00 0.00 0.00 10.85E700800

AARP HEALTHCARE OPTIONS 0.00 0.00 0.00 0.00 0.00 0.00E700269

AARP PRUDENTIAL 0.00 0.00 0.00 0.00 10.85 10.850720268

AARP/UNITED HEALTHCARE 36.11 0.00 0.00 0.00 5,457.26 5,493.370400010

ACCLAIM MEDICAL 0.00 0.00 0.00 0.00 2,095.00 2,095.000016216

ACCORDIA NATIONAL 0.00 0.00 0.00 0.00 931.00 931.000020805

ACEC 0.00 0.00 0.00 0.00 85.00 85.000013011

ACORDIA 0.00 0.00 0.00 0.00 221.00 221.000002439

ACORDIA 0.00 0.00 0.00 0.00 607.00 607.000013078

ACORDIA 0.00 0.00 0.00 0.00 315.00 315.000013079

ACORDIA NATIONAL 0.00 0.00 0.00 0.00 230.00 230.000002534

ACS Benefits Services 50.00 0.00 0.00 0.00 85.00 135.000015072

ACTIVE DUTY PERSONNEL 0.00 0.00 0.00 0.00 1,079.00 1,079.000000308

ACTIVE DUTY PERSONNEL 0.00 0.00 0.00 0.00 666.00 666.000003377

ADESA CORPORATION 0.00 0.00 0.00 0.00 225.00 225.000017210

ADMINISTRATIVE BENEFITS 0.00 0.00 0.00 0.00 116.00 116.000018787

Administrative Consulting Services 0.00 0.00 0.00 0.00 190.20 190.200900937

ADVANCED INSURANCE 0.00 0.00 0.00 0.00 16.87 16.870017334

ADVANTRA FREEDOM 0.00 0.00 0.00 0.00 1,813.69 1,813.690020852

ADVENTIST RISK MANAGEMENT 0.00 0.00 0.00 0.00 5.94 5.940019143

AETNA 0.00 0.00 0.00 0.00 3,752.05 3,752.050011765

AETNA 0.00 0.00 0.00 0.00 498.47 498.470013968

AETNA 0.00 0.00 0.00 0.00 4,178.58 4,178.580013969

Aetna 0.00 0.00 0.00 0.00 676.98 676.980014559

Aetna 0.00 0.00 0.00 0.00 18.75 18.750014615

Aetna 0.00 0.00 0.00 0.00 79.22 79.220014664

Aetna 0.00 0.00 0.00 0.00 9,442.56 9,442.560014733

Aetna 0.00 0.00 0.00 0.00 12,118.57 12,118.570014734

Aetna 0.00 0.00 0.00 0.00 85.00 85.000014738

Aetna 0.00 0.00 0.00 0.00 354.54 354.540015370

Aetna 0.00 0.00 0.00 0.00 1,958.08 1,958.080015427

Aetna 0.00 0.00 0.00 0.00 160.00 160.000015452

AETNA 0.00 0.00 0.00 0.00 1,630.66 1,630.660016371

AETNA 0.00 0.00 0.00 0.00 13.00 13.000017031

AETNA 0.00 0.00 0.00 0.00 1,331.11 1,331.110017122

AETNA 0.00 0.00 0.00 0.00 10.60 10.600017123

AETNA 0.00 0.00 0.00 0.00 8.03 8.030017427

AETNA 0.00 0.00 0.00 0.00 3,077.45 3,077.450018336

Aetna 1364 0.00 0.00 0.00 0.00 148.77 148.770014717

AETNA AKRON 0.00 0.00 0.00 0.00 6.86 6.86E900612

AETNA ALLENTOWN 0.00 0.00 0.00 0.00 8.03 8.030020445

AETNA COLUMBUS 0.00 0.00 0.00 0.00 74.98 74.980014326

AETNA CORRECTED CLAIM 0.00 0.00 0.00 0.00 699.91 699.910015670

Printed:03/17/2009

MB203.rpt

Page 1 of 19

Alpha2009

» DISPLAYS PATIENT, SERVICE AND AGING

INFORMATION BY PAYOR NUMBER



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Payor Aging Report Detail

Payor Aging Report Detail

PAYOR:

Patient

Number

MEDICARE (P) - PALMETTO

Name Address

0000135

As of: 1/27/2009

SSN: Policy # Group #

Service# Over 120 Over 90 Over 60Over 30Current.DescriptionCodeDate

0016076 BONDS, NAOMA J.

Ins. Bal. Pat. Bal

996-26-48558-B SAN GABRIEL DR #B Seattle, WA 98121 A996264855 NONE

Claim

(974) 124-3035 Nbr0016076, NAOMA J. 11/22/1934Subscriber:

0.00 0.00 0.00 55.00PAP

SMEAR/FOCALPT

01/19/2009 55.000362104 88175 0.00 0.000286085

$55.00 $0.00 $0.00 $0.00 $0.00 $55.00 $0.00 Patient Total


0018150 USSERY, LINDA L

Ins. Bal. Pat. Bal

242-66-57451276 HOWARD DR Seattle, WA 98121 A242665745 NONE

Claim

(175) 934-3035 Nbr0018150, LINDA L 7/25/1941Subscriber:

0.00 0.00 0.00 55.00PAP SMEAR/LIQUID01/08/2009 55.000359426 88142 0.00 0.000283686

$55.00 $0.00 $0.00 $0.00 $0.00 $55.00 $0.00 Patient Total


0021620 CRANSTON, DOROTHY L

Ins. Bal. Pat. Bal

404-88-42557 LOWER LAKE CT Seattle, WA 98121 A404884255 NONE

Claim

(505) 539-8035 Nbr0021620, DOROTHY L 1/18/1939Subscriber:

0.00 0.00 0.00 55.00PAP SMEAR/LIQUID01/15/2009 55.000362373 88142 0.00 0.000286086

$55.00 $0.00 $0.00 $0.00 $0.00 $55.00 $0.00 Patient Total


0021738 LISOWSKI, JUDITH I

Ins. Bal. Pat. Bal

895-24-59553 CAMBRIDGE CT Seattle, WA 98121 A895245955 NONE

Claim

(213) 159-8035 Nbr0021738, JUDITH I 8/16/1941Subscriber:

0.00 0.00 0.00 55.00PAP

SMEAR/FOCALPT

01/18/2009 55.000361890 88175 0.00 0.000285771

$55.00 $0.00 $0.00 $0.00 $0.00 $55.00 $0.00 Patient Total


0022579 NAIR, BASANT K

Ins. Bal. Pat. Bal

400-14-8355P.O. BOX 523 Seattle, WA 98121 A400148355 NONE

Claim

(165) 785-4035 Nbr0022579, BASANT K 4/14/1945Subscriber:

0.00 0.00 0.00 35.00PHYS INTERP/LIQ

PAP

01/19/2009 35.000362153 G0124 0.00 0.000286087

0.00 0.00 0.00 55.00PAP SMEAR/LIQUID01/19/2009 55.000362154 88142 0.00 0.000286087

$90.00 $0.00 $0.00 $0.00 $0.00 $90.00 $0.00 Patient Total


0023974 KRAEMER, ANGELA M

Ins. Bal. Pat. Bal

392-93-28453801 MICHIGAN AV Seattle, WA 98121 A392932845 NONE

Claim

(623) 342-8035 Nbr0023974, ANGELA M 7/22/1939Subscriber:

0.00 0.00 0.00 55.00PAP

SMEAR/FOCALPT

12/30/2008 55.000357863 88175 0.00 0.000283948

$55.00 $0.00 $0.00 $0.00 $0.00 $55.00 $0.00 Patient Total


0025460 MILOSEVICH, SILVIA M.

Ins. Bal. Pat. Bal

632-00-654510287 SNOE WAY Seattle, WA 98121 A632006545 NONE

Claim

(068) 834-3035 Nbr0025460, SILVIA M. 1/14/1943Subscriber:

0.00 0.00 0.00 55.00PAP

SMEAR/FOCALPT

01/13/2009 55.000360446 88175 0.00 0.000284676

$55.00 $0.00 $0.00 $0.00 $0.00 $55.00 $0.00 Patient Total


0027206 BRENTWOOD, MARY L

Ins. Bal. Pat. Bal

811-86-54651671 COOKS WY Seattle, WA 98121 A811865465 NONE

Claim

(013) 399-8619 Nbr0027206, MARY L 7/27/1942Subscriber:

0.00 0.00 0.00 55.00PAP

SMEAR/FOCALPT

10/17/2008 55.000357682 D175 0.00 0.000286777

$55.00 $0.00 $0.00 $0.00 $0.00 $55.00 $0.00 Patient Total

Printed:5/16/2009

MB204.rpt

Page 777 of 905

GenTesting

» DISPLAYS AGING INFORMATION FOR THE TOP 20

PAYORS



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Payor Aging Summary Top 20

Payor Aging Report Summary - Top 20 Payors

Number

Current

Amount Total DueName

Amount

over 30

Amount

over 60

Amount

over 90

Amount

over 120

As Of: 1/27/2009

44,006.91 38,833.74 32,244.12 27,646.25 51,308.67 194,039.690000000 PRIVATE PAY 1

145,630.64 5,516.09 9,120.75 4,829.25 10,026.85 175,123.580000134 MEDICARE - PALMETTO 2

85,268.66 5,170.00 4,784.62 4,782.53 14,146.48 114,152.290000136 MEDI-CAL MED 3

66,045.02 12,918.90 5,148.49 824.57 573.21 85,510.190000021 ANTHEM BLUE CROSS 4

34,976.30 350.55 1,147.03 1,020.12 1,922.33 39,416.330000023 BLUE SHIELD 5

17,485.00 2,660.00 945.00 355.00 3,442.36 24,887.36136F MEDI-CAL FPACT 6

10,608.87 2,892.78 1,680.83 1,216.58 947.08 17,346.140000025 BS BLUE CARD PROGRAM 7

10,250.03 395.57 110.00 120.06 0.00 10,875.660000135 MEDICARE (P) - PALMETTO 8

5,755.00 470.00 775.00 0.00 745.11 7,745.110000288 CMSP BC 9

1,025.00 692.00 865.00 1,564.00 3,092.00 7,238.00136B MEDI-CAL MED 10

6,585.00 315.00 0.00 55.00 64.93 7,019.93136P MEDI-CAL PRESUMP 11

5,580.67 989.69 112.29 84.99 0.00 6,767.640000117 UFCW 12

1,760.00 2,890.00 0.00 1,450.00 0.00 6,100.000000186 PAC TRUST HEALTHCARE PLAN 13

4,575.00 935.00 110.00 415.00 0.00 6,035.00136C MEDI-CAL CDP 14

3,436.00 1,275.00 21.25 0.00 493.00 5,225.250000035 CIGNA HEALTHCARE 15

4,983.00 179.17 0.00 0.00 0.00 5,162.170000010 AETNA 16

2,825.00 1,227.06 770.00 0.00 0.00 4,822.060000164 CCN-FRH 17

3,102.50 55.00 150.00 608.66 116.25 4,032.410000063 HEALTHNET COMM CLAIMS 18

3,600.00 95.00 0.00 0.00 0.00 3,695.000000045 DELTA HEALTH SYSTEMS 19

2,750.00 215.00 375.00 0.00 160.00 3,500.000000116 TRIBAL HEALTH PARTNERS 20

40,323.96 11,879.70 10,798.11 5,802.42 8,783.03 77,587.22OTHERS 21

Totals as of 1/27/2009 $500,572.56

$89,955.25

$69,157.49

$50,774.43

$95,821.30

$806,281.03

0000000

0000134

0000136

0000021

0000023

136F

0000025

00001350000288

136B136P

00001170000186136C000003500000100000164000006300000450000116

Others0000000 24.1%0000134 21.7%0000136 14.2%0000021 10.6%0000023 4.9%136F 3.1%0000025 2.2%0000135 1.3%0000288 1.0%136B 0.9%136P 0.9%0000117 0.8%0000186 0.8%136C 0.7%0000035 0.6%0000010 0.6%0000164 0.6%0000063 0.5%0000045 0.5%0000116 0.4%Others 9.6%

Total: 100.0%

Sum of Total Due / Year

(Note: % represents % of Top 20)


GenTesting

» DISPLAYS PATIENT, SERVICE AND AGING

INFORMATION BY PAYOR TYPE



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Payor Type Aging Detail Report

Payor Type Aging Report Detail

PAYOR TYPE:

Patient

Number Name Address

MEDICARE

As Of: 1/27/2009

SSN: Policy # Group #

MEDICARE - PALMETTO0000134

Service# Over 120 Amt.

Over 90 Amt.

Over 60 Amt.Over 30 Amt.Current Amt.DescriptionCodeDate

0003272 STOKES, RAMONA R.

Insurance Bal.

378 PAPST AVE Seattle, WA 98121

Claim

NONE B863504075

(851) 356-8035 06/07/1933Nbr0003272, RAMONA R.Subscriber:

0.00 0.00 0.00 0.00 35.00LEVEL I GROSS EXAM01/20/2009 35.000361949 883000285787

0.00 0.00 0.00 0.00 95.00LEVEL 3 TISSUE EXAM01/20/2009 95.000361950 883040285787

Patient Total $130.00 $0.00 $0.00 $0.00 $0.00 $130.00


Over 90 Amt.


0005287 ANDERSON, ROBERT

STANLEY

Insurance Bal.

PO BOX 24 Seattle, WA 98121 886-92-4845

Claim

NONE A886924845

(205) 177-8035 04/10/1928Nbr0005287, ROBERT STANLEYSubscriber:


0.00 0.00 0.00 0.00 145.00STAINS FOR ORGANISM01/20/2009 145.000362326 883120286105

Patient Total $305.00 $0.00 $0.00 $0.00 $0.00 $305.00


Over 90 Amt.


0005349 EVANS, DOUGLAS J.

Insurance Bal.

42 CHICORY DR Seattle, WA 98121 116-10-5925

Claim

(008) 034-3035 Subscriber:


Patient Total $20.32 $0.00 $0.00 $0.00 $0.00 $20.32


Over 90 Amt.


0007126 BROCKMAN, RAYMOND

Insurance Bal.

P O BOX 1582 Seattle, WA 98121 466-50-4455

Claim

NONE A466504455

(381) 119-8035 10/03/1929Nbr0007126, RAYMONDSubscriber:


Patient Total $0.00 $254.98 $0.00 $0.00 $0.00 $254.98


Over 90 Amt.


0011277 SALGADO, RUTH M.

Insurance Bal.

7640 CUTLER AVENUE Seattle, WA 98121 880-12-6255

Claim

NONE A880126255

(817) 256-8035 01/31/1942Nbr0011277, RUTH M.Subscriber:



Patient Total $475.00 $0.00 $0.00 $0.00 $0.00 $475.00


Over 90 Amt.


0011546 ROBERTS, FRED M.

Insurance Bal.

714 W. SYCAMORE ST Seattle, WA 98121 544-95-0925

Claim

NONE A544950925

(480) 343-9035 03/23/1920Nbr0011546, FRED M.Subscriber:



0.00 0.00 19.11 0.00 0.00STAINS FOR ORGANISM11/25/2008 19.110350305 883120275822

0.00 0.00 12.16 0.00 0.00CYTO SMEARS11/25/2008 12.160350367 881040275822

0.00 0.00 173.00 0.00 0.00CYTOPATH/CELL

ENHAN

11/25/2008 173.000350368 881120280231


Patient Total $0.00 $21.25 $246.77 $0.00 $0.00 $268.02

Printed:05/16/2009


GenTesting

» DISPLAYS OUTSTANDING PAYOR ACCOUNTS AGED

BY 30, 60, 90 AND 120 DAYS

» DISPLAYS THE PAYOR ACCOUNT NUMBER AND


AMOUNT DUE


ON OVERDUE ACCOUNTS


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Payor Type Aging Summary Report

Payor Type Aging Summary

PAYOR TYPE CODE Current Amt Over 30 Days Over 60 Days Over 90 Days Over 120 Days Total Due

As Of: 1/27/2009

Services on Hold -544.62 0.00 0.00 0.00 0.00 -544.62

PATIENT 44,006.91 38,833.74 32,244.12 27,646.25 51,308.67 194,039.69A

WORKER'S

COMPENSATION

660.00 170.00 0.00 0.00 62.41 892.41B

MEDICARE 156,911.29 6,040.00 9,492.22 5,123.86 10,773.70 188,341.07C

MEDICAID 120,748.66 11,157.91 7,726.75 7,438.47 22,936.33 170,008.12D

COMMERCIAL

INSURANCE

COMPANY

44,885.33 14,361.26 10,409.52 5,375.62 6,066.91 81,098.64F

BLUE CROSS/BLUE

SHIELD

47,870.66 3,265.29 2,958.11 2,236.70 3,008.74 59,339.50G

CHAMPUS 2,895.00 0.00 55.00 0.00 10.36 2,960.36H

BLUE CROSS 66,255.48 13,302.56 5,272.07 987.80 573.21 86,391.12P

VA PLAN 1,050.00 282.19 0.00 333.00 160.00 1,825.19V

OTHER 15,833.85 2,542.30 999.70 1,632.73 920.97 21,929.55Z

Totals $500,572.56 $89,955.25 $69,157.49 $50,774.43 $95,821.30 $806,281.03

Printed:05/16/2009


GenTesting

MANAGEMENT REPORTS

» DISPLAYS ADJUSTMENT COUNTS AND AMOUNTS

SUB-TOTALED BY YEAR, MONTH PAYOR TYPE AND

DEPARTMENT

» REPORT QUERIES INFORMATION BASED ON

ADJUSTMENT ENTERED DATE

» REPORT IS FOUND IN THE ANALYSIS AND AR

MANAGEMENT MODULE

Ma

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Adjustments by Payor Type/Department

Amount

Adjustments by Payor Type / Department

Year Month AdjustmentTypePayor Type Dept.

2008

December

-194.57Worker's Compensation Service Total

Worker's Compensation Payment Total 0.00

Worker's Compensation Total -194.57

Medicare

1 SURGICALS-88,645.24060 Medicare write-offS

-88,645.241 SURGICALS Service Total

0.001 SURGICALS Payment Total

1 SURGICALS Total -88,645.24

11 LIQUID/F. POINT-4,523.53060 Medicare write-offS

-4,523.5311 LIQUID/F. POINT Service Total

0.0011 LIQUID/F. POINT Payment Total

11 LIQUID/F. POINT Total -4,523.53

12 GC/CT-588.44060 Medicare write-offS

-588.4412 GC/CT Service Total

0.0012 GC/CT Payment Total

12 GC/CT Total -588.44

2 SPEC CYTO (NON GYNS)-8,496.42060 Medicare write-offS

-8,496.422 SPEC CYTO (NON GYNS) Service Total

0.002 SPEC CYTO (NON GYNS) Payment Total

2 SPEC CYTO (NON GYNS) Total -8,496.42

3 HEM-PATH-775.45060 Medicare write-offS

-775.453 HEM-PATH Service Total

0.003 HEM-PATH Payment Total

3 HEM-PATH Total -775.45

5 CONV PAPS/F. POINT-962.03060 Medicare write-offS

-962.035 CONV PAPS/F. POINT Service Total

0.005 CONV PAPS/F. POINT Payment Total

5 CONV PAPS/F. POINT Total -962.03

6 LIQUID PAPS ONLY-882.39060 Medicare write-offS

-882.396 LIQUID PAPS ONLY Service Total

0.006 LIQUID PAPS ONLY Payment Total

6 LIQUID PAPS ONLY Total -882.39

-104,873.50Medicare Service Total

Medicare Payment Total 0.00

Medicare Total -104,873.50

Medicaid

1 SURGICALS-73,297.23056 Medi-Cal write-offS

-73,297.231 SURGICALS Service Total

0.001 SURGICALS Payment Total

GenTesting

MB604.rpt

Page 16 of 363 Printed:05/16/2009

» DISPLAYS TOTAL GENERAL SERVICES AMOUNT,

TOTAL CLIENT SERVICES AMOUNT AND BALANCES

THEM WITH THE AMOUNT IN DAILY A/R

» IF FIGURES DO NOT MATCH A MESSAGE SHOWING

THE DISCREPANCY AMOUNT IS DISPLAYED IN RED

» DISPLAYS TOTAL BY MONTH WITH EACH MONTH ON

A NEW PAGE

» USE DAILY TO ENSURE YOU ARE IN BALANCE


MANAGEMENT MODULE

Ma

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Accounts Receivable Reconciliation

by Month

Accounts Receivable Reconciliation by Month

Dec-2008

$884,914.32Beginning Balance *

Gross Services 902,822.56

Less: Contractual Adjustments

Less: Other Adjustments

Less: Bad Debt

-389,066.19

-15,245.19

-18,077.57

599,042.80Gross Payments

Net Services $480,433.61

-422,388.95Gross Service Adjustments *

*

0.00Gross Payment Adjustments *

Net Payments $599,042.80

Gross Client Services 2,251.00

-5.00Gross Client Adjustments *

2,282.00Gross Client Payments

Net Client Services $2,246.00

*

0.00Gross Client Payment Adjustments *

$766,269.13

$905,073.56

Ending Balance

Net Client Payments $2,282.00

Total Services *

*

Gross Collection Percent 66%

124%Net Collection Percent

Gross Payments / Gross Services

(Net Payments - Bad Debt) / Net Services - Bad Debt

Bad Debt Ratio Bad Debt / Net Services - Bad Debt 3.28%

A/R Days (Ending Balance / Total Net Payments) * Number of days in Month 40

NOTE: Figures followed by an asterisk can be balanced with MB400 Daily AR Balances.

MB401.rpt


GenTesting

» DISPLAYS THE NUMBER OF DAYS THAT HAVE

PASSED SINCE THE CASE WAS COMPLETED AND THE

DATE THE SERVICES WERE BILLED

» DISPLAYS CASE COMPLETED DATE, MINIMUM DAYS,

MAXIMUM DAYS, AVERAGE DAYS AND CASE COUNT

» USED BY CUSTOMERS WHO ALSO USE OUR

PATHOLOGY SYSTEM, THE GOLD STANDARD ®

» USE TO DETERMINE THE EFFICIENCY OF THE

BILLING DEPARTMENT AND STAFFING NEEDS OR

IDENTIFY POSSIBLE WORKFLOW ISSUES


ADMINISTRATION MODULE

Ma

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Average Days Case Completed to Billed

Average Days Case Completed to Billed

Case

Completed

Minimum

Days

Maximum

Days

Average

Days

Case Count

Days between case completed and service entered

04/01/2008 2 86 8.31 28

04/02/2008 1 85 6.06 24

04/03/2008 4 120 7.87 23

04/04/2008 0 4 3.74 22

04/05/2008 4 4 4.00 1

04/07/2008 2 116 7.43 28

04/08/2008 2 148 11.54 24

04/09/2008 2 2 2.00 23

04/10/2008 4 4 4.00 25

04/11/2008 4 42 5.03 26

04/14/2008 2 2 2.00 32

04/15/2008 2 55 3.55 29

04/16/2008 2 63 4.10 20

04/17/2008 4 76 6.80 28

04/18/2008 4 105 6.85 27

04/21/2008 2 42 2.91 30

04/22/2008 0 3 2.03 28

04/23/2008 2 117 12.33 20

04/24/2008 4 4 4.00 26

04/25/2008 4 4 4.00 24

04/28/2008 0 95 3.69 38

04/29/2008 2 79 6.78 27

04/30/2008 2 2 2.00 27

Grand Total: 0 5.28 148

This report calculates the number of days between the case completed date and the billing entered date.

580

GenTestingMB430.rptPage 1 of 1 Printed:5/19/2009

» DISPLAYS REVENUE DAYS IN ACCOUNT RECEIVABLE

BY MONTH

» DISPLAYS SERVICES TOTAL, A/R BALANCE AND 3

MONTH AVERAGE FOR EACH MONTH

» TOTALS BY YEAR


MANAGEMENT MODULE

Ma

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Average Monthly Revenue Days in A/R

ServicesA/R

Balance

Average Monthly Revenue Days in A/R

3 Month

Average

2008

915,135.56 854,451.79 29.60Jan

909,662.05 893,658.19 30.00Feb

963,604.88 856,236.33 27.94Mar

1,007,847.55 877,278.82 26.93Apr

941,844.73 838,597.44 26.15May

931,357.56 807,787.43 25.40Jun

943,167.20 869,749.29 27.94Jul

955,731.76 851,144.76 27.67Aug

921,250.36 917,674.41 29.93Sep

1,040,196.54 906,238.95 28.15Oct

879,485.22 884,914.32 28.66Nov

905,073.56 766,269.13 24.60Dec

2008 Total: $11,314,356.97

0

4

8

12

16

20

24

28

32

Jan

Feb Mar Apr

May Ju

nJu

lAug Sep O

ctNov

Dec

Month

A/R

Da

ys

Days in Accounts Receivable

Page 1 of 1

GenTesting

Printed: 5/16/2009

MB415.rpt

» DISPLAYS REVENUE STATISTIC TOTALS BY MONTH

» DISPLAYS BEGINNING BALANCE, SERVICE TOTALS,

PAYMENT TOTALS, ADJUSTMENT TOTALS,

COLLECTION %, CLIENT ADJUSTMENT TOTALS,

CLIENT PAYMENT TOTALS, ENDING BALANCE AND 3

MONTH AVERAGE FOR EACH A/R DATE


MANAGEMENT MODULE

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Average Monthly Revenue

A/R Date

Beginning

Balance Services AdjustmentsPayments

Ending

Balance

Average Monthly Revenue

Collection %

Client

AdjustmentsClient

Payments

3 Month

Average

57.65% 716,499.07 447,139.05 -328,484.79 915,135.56 0.00 1,559.001/31/2008 854,451.79 29.60

56.57% 854,451.79 491,368.09 -377,256.14 909,662.05 -10.00 1,834.002/29/2008 893,658.19 30.00

59.11% 893,658.19 590,993.07 -408,774.71 963,604.88 0.00 1,661.003/31/2008 856,236.33 27.94

57.95% 856,236.33 569,206.76 -413,013.70 1,007,847.55 -85.00 4,499.604/30/2008 877,278.82 26.93

56.98% 877,278.82 557,154.77 -420,650.94 941,844.73 -79.92 2,670.485/31/2008 838,597.44 26.15

57.80% 838,597.44 555,312.97 -405,362.90 931,357.56 -5.00 1,997.006/30/2008 807,787.43 25.40

56.67% 807,787.43 498,322.12 -381,028.22 943,167.20 -15.00 1,840.007/31/2008 869,749.29 27.94

58.79% 869,749.29 571,845.82 -400,827.47 955,731.76 0.00 1,663.008/31/2008 851,144.76 27.67

53.99% 851,144.76 461,339.67 -393,184.08 921,250.36 0.00 491.009/30/2008 917,674.41 29.93

56.06% 917,674.41 589,012.91 -461,671.09 1,040,196.54 -126.25 2,051.7510/31/2008 906,238.95 28.15

57.45% 906,238.95 515,953.04 -382,146.39 879,485.22 0.00 2,779.0011/30/2008 884,914.32 28.66

58.65% 884,914.32 599,042.80 -422,388.95 905,073.56 -5.00 2,282.0012/31/2008 766,269.13 24.60

GenTesting


» DISPLAYS REVENUE BY PERFORMING CLINICIAN

» DISPLAYS CLINICIAN NUMBER, NAME, SERVICE

TOTAL, SERVICE ADJUSTMENT TOTAL, PAYMENT

TOTAL, PAYMENT ADJUSTMENT TOTAL AND NEW A/R

» USEFUL FOR PERFORMANCE REVIEWS AND

DETERMINING BONUS OR PROFIT SHARING


MANAGEMENT MODULE

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Clinician Revenue Report

Clinician Revenue Reportfor

Seattle Services

Clinician Services

Service

Adjustments Payments

Payment

Adjustments New AR

(service.entereddate between '3/1/2008' and '3/31/2008')

222,255.09 -98,368.23 123,552.86 -9.44 343.440009903 ADAMS, DONNA

137,365.00 -62,113.31 75,239.50 0.00 12.190009905 AKERT, BEN

48,146.00 -22,547.31 25,448.69 0.00 150.000009907 FICHTL, IRENE

100,788.76 -43,418.35 57,186.75 0.00 183.660009902 FOREE, JEAN

215,125.00 -87,333.90 127,508.17 0.00 282.930009904 RUNDE, LESLEY

82,523.00 -29,951.13 52,512.84 0.00 59.030009906 STEINBACH, MICHELLE

154,006.00 -68,222.53 85,355.04 0.00 428.430009908 WOJTALEWICZ, LILLIAN

Totals: $960,208.85 -$411,954.76 $546,803.85 -$9.44 $1,459.68

GenTesting


» DISPLAYS COMPLETED CASES WITH

SERVICES/PROCEDURES NOT YET BILLED

» DISPLAYS ACCESSION NUMBER, PATIENT NAME,

COMPLETED DATE, SEX, BIRTH DATE AND

PROCEDURES FROM THE CASE



» REPORT IS FOUND IN THE INTERFACES MODULE

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Completed Cases without Billed Dates

Completed Cases Without Billed Dates

Completed Sex BirthdateAccession Number Patient Name Procedure

C09-090072 10/21/1991FWASCHER, LUCILLE 1/27/09 88148PI

GC09-002232 02/28/1990FHOGE, SHARI 1/27/09 8759187491

GC09-002252 06/09/1993FMCCAULEY, SHARON 1/27/09 8759187491

GC09-002262 10/12/1990FHILZER, KAREN 1/27/09 8759187491

L09-001822 10/05/1936FPETERS, JANEL 1/27/09 88175

L09-001882 05/23/1970FHANNA, KREYL 1/27/09 88175

L09-001932 02/20/1968FSLOMA, CLEO 1/27/09 88175PI

L09-001962 05/04/1972FBIX, MELODY 1/27/09 88175PI

L09-001972 10/29/1959FCLARK, ELIZABETH 1/27/09 88175

L09-001982 01/30/1972FLINDER, PAULINE 1/27/09 88175

L09-001992 01/24/1996FYENNY, FNU 1/27/09 88175

L09-002032 06/26/1950FMATYA, ANGELA 1/27/09 88175

L09-002042 05/27/1983FTURGEON, KALI 1/27/09 88175

L09-002092 10/29/1965FGAY, LIDDELL 1/27/09 88175

S09-001062 09/21/1983FELSASSER, VICKEY 1/27/09 8830988360PQ

S09-001132 06/27/1935FGRZYWA, VIRGINIA 1/27/09 883058836088342

S09-001252 07/20/1998FWELLIVER, WANDA 1/27/09 88307

S09-001262 07/27/1960FKNOTT, BETTY 1/27/09 88304

S09-001302 03/07/1994FMARKEY, MARGARET 1/27/09 88305

S09-001312 04/07/1969FHENNINGER, PAULETTE 1/27/09 8830588342

S09-001322 01/31/1949MCUMMINGS, JEREMIAH 1/27/09 88305

S09-001352 02/05/1951FBUETTGENBACH, MARJORIE 1/27/09 88305

Page: 1

MB502.rpt

Printed: 4/30/2009

3 GenTesting

» DISPLAYS COMPLETED CASES WITHOUT

SERVICES/PROCEDURES

» DISPLAYS CASE COMPLETED DATE AND ACCESSION

NUMBER



» REPORT IS FOUND IN THE INTERFACES MODULE

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Completed Cases without Services

Completed Cases without Services

Case

Completed Date Accession Number

Cases Completed in The Gold Standard where there is no MB Service record with the same case number

1/27/2009 S09-001352GC09-002252N09-050112L09-001932L09-001962S09-001062S09-001262L09-001882C09-090072L09-001972L09-001822S09-001252L09-001992L09-002092S09-001322GC09-002262L09-001982L09-002032S09-001312L09-002042S09-001302S09-001132GC09-002232


GenTestingMB501.rpt

» DISPLAYS AMOUNT BILLED AND AMOUNT ALLOWED

BY THE PAYOR PER SERVICE ITEM CODE

» DISPLAYS THE DIFFERENCE BETWEEN ALLOWED

AND PAID AMOUNTS AND IDENTIFIES PATIENT AND

SERVICE INFORMATION FOR EASY FOLLOW UP

» CAN BE LIMITED TO A SPECIFIC SERVICE ITEM,

PAYOR AND/OR DATE RANGE

» USEFUL FOR DETERMINING IF THE CORRECT

REIMBURSEMENT WAS RECEIVED


MANAGEMENT MODULE

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Contracted vs. Paid Comparison Report by

Service Item Code

Contracted vs. Paid Comparison Report By Service Item Code(cashreceipt.entereddate between '3/1/2008' and '3/31/2008') AND (payor.pripaysched = 'rg')

{Payment.Amount} <> 0.00 and {Payor.TypeCode} <> "Patient"

A C-B C/BCB

%

Paid

Difference

between

Contracted

vs. Paid

Total

Payments

and Adj.

Units Contracted

Amount

Total

88305 LEVEL 4 TISSUE EXAM

Primary Payors

1 25.91BVMG/ONE HEALTHPLAN 0000134 -94.09 120.00 22%






1 -21.25BVMG/ONE HEALTHPLAN 0000134 -141.25 120.00 (18%)

Primary Payors Average Payment 79.66 (Total C/Total A)

Secondary Payors

4 339.97BVMG/ONE HEALTHPLAN 0000134 0.00 -%








Secondary Payors Average Payment 49.48 (Total C/Total A)

88305 59 LEVEL 4 TISSUE EXAM

Primary Payors













88305 ZS LEVEL 4 TISSUE EXAM

Primary Payors

1 60.25MEDI-CAL MED 136B -59.75 120.00 50%


88307 LEVEL 5 TISSUE EXAM

Primary Payors


MB607.rpt

GenTesting

» DISPLAYS AMOUNT BILLED AND AMOUNT ALLOWED

INFORMATION BY PAYOR THEN SERVICE ITEM CODE

» DISPLAYS UNITS, SERVICE AMOUNT, SERVICE

TOTAL, CONTRACTED AMOUNT, TOTAL PAYMENTS,

DIFFERENCE BETWEEN CONTRACTED AND PAID

AMOUNTS AND THE PERCENTAGE PAID

» CAN BE LIMITED TO A SPECIFIC SERVICE ITEM,

PAYOR AND/OR DATE RANGE

» USEFUL FOR DETERMINING IF THE CORRECT

REIMBURSEMENT WAS RECEIVED


MANAGEMENT MODULE

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Contracted vs. Paid Comparison Report

Contracted vs. Paid Comparison Report(cashreceipt.entereddate between '3/1/2008' and '3/31/2008') AND (service.serviceitemcode = '88342') AND (cashreceipt.payornumber =

'0000134')

{Payment.Amount} <> 0.00 and {Payor.TypeCode} <> "Patient"

A C-B C/B C/ACB

Service

Number

Patient

Number

Average

Payment

%

Paid

Difference

between

Contracted

vs. Paid

Total

Payments

and Adj.

Allowed

Amount

Units Service

Amount

Contracted

Amount

Service

Total

Contracted

Amount

Total

Date of

Service

Primary Payor BVMG/ONE HEALTHPLAN 0000134

88342 IMMUNOHISTOCHEMISTRY

0282760 02/27/20080195980 7 555.24 694.05 92.00 145.00 1,015.00 -88.76 644.00 86%

0281753 02/25/20080386015 6 475.92 594.90 92.00 145.00 870.00 -76.08 552.00 86%

0278197 02/08/20080005260 5 396.60 495.75 92.00 145.00 725.00 -63.40 460.00 86%

0281048 02/21/20081034278 5 396.60 495.75 92.00 145.00 725.00 -63.40 460.00 86%

0278969 02/13/20080098417 4 317.28 396.60 92.00 145.00 580.00 -50.72 368.00 86%

0279091 02/12/20080231553 4 317.28 396.60 92.00 145.00 580.00 -50.72 368.00 86%

0278736 02/12/20081033964 3 237.96 297.45 92.00 145.00 435.00 -38.04 276.00 86%

0279450 02/14/20080024213 3 237.96 297.45 92.00 145.00 435.00 -38.04 276.00 86%

0281013 02/21/20080366544 3 237.96 297.45 92.00 145.00 435.00 -38.04 276.00 86%

0282690 02/26/20081034094 3 237.96 297.45 92.00 145.00 435.00 -38.04 276.00 86%

0284599 03/04/20080045115 3 237.96 297.45 92.00 150.00 450.00 -38.04 276.00 86%

0277864 02/08/20081032609 2 158.64 198.30 92.00 145.00 290.00 -25.36 184.00 86%

0279085 02/12/20080018150 2 158.64 198.30 92.00 145.00 290.00 -25.36 184.00 86%

0281934 02/21/20081013995 2 158.64 198.30 92.00 145.00 290.00 -25.36 184.00 86%

0284289 03/04/20081034643 2 158.64 198.30 92.00 150.00 300.00 -25.36 184.00 86%

0284595 03/04/20081016212 2 158.64 198.30 92.00 150.00 300.00 -25.36 184.00 86%

0284751 03/06/20081034746 2 158.64 198.30 92.00 150.00 300.00 -25.36 184.00 86%

0278662 02/14/20070256140 2 150.85 188.56 92.00 125.00 250.00 -33.15 184.00 82%

0277434 02/07/20081033831 1 79.32 99.15 92.00 145.00 145.00 -12.68 92.00 86%

0277674 02/07/20080110941 1 79.32 99.15 92.00 145.00 145.00 -12.68 92.00 86%

0278669 02/11/20080164799 1 79.32 99.15 92.00 145.00 145.00 -12.68 92.00 86%

0278734 02/12/20080049476 1 79.32 99.15 92.00 145.00 145.00 -12.68 92.00 86%

0279258 02/14/20081033287 1 79.32 99.15 92.00 145.00 145.00 -12.68 92.00 86%

0279823 02/15/20080277854 1 79.32 99.15 92.00 145.00 145.00 -12.68 92.00 86%

0280086 02/18/20080136383 1 79.32 99.15 92.00 145.00 145.00 -12.68 92.00 86%

0281985 02/25/20080340827 1 79.32 99.15 92.00 145.00 145.00 -12.68 92.00 86%

0282423 02/25/20080047089 1 79.32 99.15 92.00 145.00 145.00 -12.68 92.00 86%

0285490 03/10/20081033287 1 79.32 99.15 92.00 150.00 150.00 -12.68 92.00 86%

0278662 02/14/20070256140 2 -15.09 37.71 92.00 125.00 250.00 -199.09 184.00 (8%)

Total 83% 76.80 10,410.00 6,624.00 72 5,529.52 6,968.47

88342 59 IMMUNOHISTOCHEMISTRY

0277609 02/07/20080018262 10 793.20 991.50 92.00 145.00 1,450.00 -126.80 920.00 86%

0285486 03/08/20081009824 7 555.24 694.05 92.00 150.00 1,050.00 -88.76 644.00 86%

0280966 02/21/20080097772 6 475.92 594.90 92.00 145.00 870.00 -76.08 552.00 86%

0278915 02/13/20080135599 5 396.60 495.75 92.00 145.00 725.00 -63.40 460.00 86%

0281947 02/25/20081005921 5 396.60 495.75 92.00 145.00 725.00 -63.40 460.00 86%

0282462 02/26/20080389113 4 317.28 396.60 92.00 145.00 580.00 -50.72 368.00 86%

0273799 01/22/20080037453 3 237.96 297.45 92.00 145.00 435.00 -38.04 276.00 86%

0282896 02/28/20081030720 3 237.96 297.45 92.00 145.00 435.00 -38.04 276.00 86%

0284703 03/06/20080360439 3 237.96 297.45 92.00 150.00 450.00 -38.04 276.00 86%

0281855 02/26/20080350844 2 158.64 198.30 92.00 145.00 290.00 -25.36 184.00 86%

0285484 03/10/20081034816 2 158.64 198.30 92.00 150.00 300.00 -25.36 184.00 86%

0281032 02/21/20081034277 1 79.32 99.15 92.00 145.00 145.00 -12.68 92.00 86%

0282321 02/27/20081034452 1 79.32 99.15 92.00 145.00 145.00 -12.68 92.00 86%

0285022 03/06/20080249315 1 79.32 99.15 92.00 150.00 150.00 -12.68 92.00 86%

0273799 01/22/20080037453 3 -237.96-195.46 92.00 145.00 435.00 -513.96 276.00 (86%)

Total 77% 70.82 8,185.00 5,152.00 56 3,966.00 5,059.49


MB606.rpt

GenTesting

» DISPLAYS STATISTICS FOR SYSTEM CRITICAL

TABLES

» DISPLAYS THE CURRENT SEQUENCE NUMBER,

HIGHEST NUMBER, TOTAL RECORDS AND PERCENT

FULL FOR EACH SYSTEM CRITICAL TABLE

» WARNING MESSAGES WILL APPEAR NEXT TO EACH

TABLE WHEN APPROPRIATE

» USE ON A MONTHLY BASIS TO PREVENT SYSTEM

ISSUES DUE TO LIMITED SPACE



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Cortex System Management Report

Cortex System Management Report

Table Percent Full

Highest

Number Warning Messages

Record

Count

Current

Sequence #

0Cases 0%N/A

Patient 0% 381,182 574413 009999999

Service 0% 1,121,184 1357166 001357165

Adjustment 7% 645,026 676501 000676500

Payment 0% 960,646 1041061 001041060

Claims 0% 876,625 876627 000876626

Patient Statements 0% 539,843 539845 000539844


MB132.rpt

SP1Tst

» SUMMARIZES BEGINNING AND ENDING A/R

BALANCE FOR EACH DAY

» USE TO AUDIT AGAINST SERVICE, PAYMENT AND

ADJUSTMENT BATCH REPORTS


MANAGEMENT MODULE

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Daily Accounts Receivable Balance Report

AR Balance Report

ARDate

Beginning

Balance

Service

Amount

Service

Adjustment

AmountPayment

Amount

Payment

Adjustment

Amount

Ending

Balance

Client Service

Adjustment

Amount

Client

Payment

Amount

Client Payment

Adjustment

Amount

01/27/2009 $790,881.80 $45,594.91 -$10,789.76 $18,265.92 $807,421.03$0.00 $0.00 $0.00$0.00

01/26/2009 $829,480.02 $54,434.00 -$44,651.13 $48,336.09 $790,881.80$0.00 $45.00 $0.00$0.00

01/25/2009 $829,480.02 $0.00 $0.00 $0.00 $829,480.02$0.00 $0.00 $0.00$0.00

01/24/2009 $829,480.02 $0.00 $0.00 $0.00 $829,480.02$0.00 $0.00 $0.00$0.00

01/23/2009 $799,669.80 $40,449.00 -$3,928.52 $6,710.26 $829,480.02$0.00 $0.00 $0.00$0.00

01/22/2009 $782,781.64 $35,249.00 -$6,391.12 $11,969.72 $799,669.80$0.00 $0.00 $0.00$0.00

01/21/2009 $751,258.20 $49,387.00 -$7,977.66 $9,885.90 $782,781.64$0.00 $0.00 $0.00$0.00

01/20/2009 $752,596.89 $44,365.00 -$18,744.00 $26,959.69 $751,258.20$0.00 $0.00 $0.00$0.00

01/19/2009 $740,380.51 $57,346.00 -$19,640.48 $25,489.14 $752,596.89$0.00 $0.00 $0.00$0.00

01/18/2009 $740,380.51 $0.00 $0.00 $0.00 $740,380.51$0.00 $0.00 $0.00$0.00

01/17/2009 $740,380.51 $0.00 $0.00 $0.00 $740,380.51$0.00 $0.00 $0.00$0.00

01/16/2009 $715,546.39 $39,745.00 -$8,716.03 $6,194.85 $740,380.51$0.00 $0.00 $0.00$0.00

01/15/2009 $705,205.91 $42,791.00 -$12,609.45 $18,690.07 $715,546.39$0.00 $1,151.00 $0.00$0.00

01/14/2009 $673,125.87 $53,881.00 -$7,895.22 $13,905.74 $705,205.91$0.00 $0.00 $0.00$0.00

01/13/2009 $632,680.28 $44,160.00 -$1,518.75 $2,195.66 $673,125.87$0.00 $0.00 $0.00$0.00

01/12/2009 $676,312.09 $73,904.32 -$45,144.92 $72,376.21 $632,680.28$0.00 $15.00 $0.00$0.00

01/11/2009 $676,312.09 $0.00 $0.00 $0.00 $676,312.09$0.00 $0.00 $0.00$0.00

01/10/2009 $676,312.09 $0.00 $0.00 $0.00 $676,312.09$0.00 $0.00 $0.00$0.00

01/09/2009 $678,955.99 $33,107.00 -$13,042.50 $22,688.40 $676,312.09$0.00 $20.00 $0.00$0.00

01/08/2009 $668,140.95 $35,461.95 -$8,902.16 $15,744.75 $678,955.99$0.00 $0.00 $0.00$0.00

01/07/2009 $659,391.71 $25,508.00 -$4,764.81 $11,988.95 $668,140.95-$5.00 $0.00 $0.00$0.00

01/06/2009 $639,449.62 $32,823.60 -$3,762.52 $9,118.99 $659,391.71$0.00 $0.00 $0.00$0.00

01/05/2009 $770,022.98 $3,195.00 -$62,024.09 $71,744.27 $639,449.62$0.00 $0.00 $0.00$0.00

01/04/2009 $770,022.98 $0.00 $0.00 $0.00 $770,022.98$0.00 $0.00 $0.00$0.00

01/03/2009 $770,022.98 $0.00 $0.00 $0.00 $770,022.98$0.00 $0.00 $0.00$0.00

01/02/2009 $766,269.13 $66,678.00 -$41,182.81 $21,741.34 $770,022.98$0.00 $0.00 $0.00$0.00

01/01/2009 $766,269.13 $0.00 $0.00 $0.00 $766,269.13$0.00 $0.00 $0.00$0.00

Grand Totals: $778,079.78 -$321,685.93 $414,005.95 $0.00 -$5.00 $1,231.00 $0.00

GenTesting


MB400.rpt

» DISPLAYS REVENUE FOR CLIENT PAYMENTS BASED

ON PROVIDER

» REPORT IS FOUND IN THE CLIENT STATEMENT

BILLING MODULE

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Daily Client Revenue by Provider

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Daily Client Revenue by Provider

(clientpayment.entereddate > '1/1/2007')

Provider Entered Date Amount

Cortex Medical Management 0000002

09/01/2010 0.00

10/29/2010 25.00

Total for : Cortex Medical Management 0000002 $25.00

Seattle Services 0000001

01/02/2007 45.00

01/04/2007 0.00

01/11/2007 750.00

01/15/2007 1,050.00

01/18/2007 1,905.00

01/31/2007 0.00

02/01/2007 10.00

02/05/2007 185.00

02/14/2007 1,100.00

02/16/2007 723.00

02/23/2007 100.00

02/26/2007 15.00

02/28/2007 80.00

03/15/2007 2,453.00

03/16/2007 1,100.00

03/26/2007 146.07

04/25/2007 1,961.00

05/03/2007 1,000.00

05/08/2007 75.00

05/15/2007 200.00

05/21/2007 130.00

05/23/2007 1,304.00

05/24/2007 567.00

06/01/2007 0.00

06/06/2007 10.00

06/14/2007 2,071.00

06/18/2007 25.00

06/20/2007 25.00

06/21/2007 1,000.00

07/02/2007 15.00

07/09/2007 134.93

07/11/2007 951.00

07/16/2007 1,215.00

07/30/2007 10.00

08/01/2007 0.00

08/02/2007 950.00

08/13/2007 45.00

08/30/2007 85.00

09/17/2007 1,100.00

Page 1 of 3

SP1Tst

Printed:1/24/2011MB602.rpt

» DISPLAYS PAYMENT INFORMATION BY PROVIDER


MANAGEMENT MODULE

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Daily Payments by Provider

Daily Payments by Provider

Organization Name Organization Number

0000002Cortex Medical Management

EnteredDate Amount

0.0303/13/2008

Total for : Cortex Medical Management 0000002 $0.03

0000001Seattle Services

EnteredDate Amount

41,517.2103/03/2008

12,468.6703/04/2008

31,597.4303/05/2008

14,055.7903/06/2008

16,046.2303/07/2008

45,690.2103/10/2008

16,754.5503/11/2008

37,706.9003/12/2008

42,099.6203/13/2008

12,938.6503/14/2008

34,772.0603/17/2008

40,779.9903/18/2008

12,337.5703/19/2008

24,993.8203/20/2008

14,535.9203/21/2008

43,917.7003/24/2008

30,928.2603/25/2008

8,565.7503/26/2008

14,549.0803/27/2008

9,210.8703/28/2008

85,526.7603/31/2008

Total for : Seattle Services 0000001 $590,993.04

Grand Total : $ 590,993.07

Total

Cortex Medical Management 0000002 $0.03

Seattle Services 0000001 $590,993.04

Total $590,993.07


GenTesting

MB601.rpt

» DISPLAYS REVENUE BY PRIMARY SCREENER BY DAY

» USE FOR PERFORMANCE EVALUATIONS


MANAGEMENT MODULE

Daily Revenue by Screener/Pathologist

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Daily Revenue by Screener / Pathologist

Note: Based on Service MB Entered Date

3/1/2008 3/3/2008 3/4/2008 3/5/2008 Total Service Units

Total Service Amount

ADAMS,

DONNA

1

160.00

14

2,190.00

139

16,152.00

113

18,445.00

267.00

$36,947.00

AKERT, BEN 7

530.00

55

7,751.00

31

4,767.00

278

19,339.00

371.00

$32,387.00

FICHTL, IRENE 0

0.00

75

8,202.00

5

375.00

0

0.00

80.00

$8,577.00

FOREE, JEAN 0

0.00

0

0.00

0

0.00

2

30.00

2.00

$30.00

RUNDE,

LESLEY

0

0.00

351

31,549.00

16

2,575.00

24

3,935.00

391.00

$38,059.00

STEINBACH,

MICHELLE

1

295.00

21

3,052.00

73

6,427.00

32

1,458.00

127.00

$11,232.00

WOJTALEWICZ

, LILLIAN

3

455.00

1

55.00

0

0.00

26

3,965.00

30.00

$4,475.00

Total 12

$1,440.00

517

$52,799.00

264

$30,296.00

475

$47,172.00

1,268

$131,707.00

GenTesting


MB421.rpt

» DISPLAYS DUPLICATE PATIENT INFORMATION

BASED ON SERVICE ENTERED DATE

» REPORT LOOKS FOR MATCHES ON SOCIAL SECURITY

NUMBER, MEDICAL RECORD NUMBER AND PATIENT

FIRST NAME + DATE OF BIRTH

» PATIENT NAMES WITHOUT A COMMA ARE IGNORED,

THEREFORE, RUNNING ‘PATIENT NAME WITHOUT A

COMMA’ SHOULD BE RUN AND RECORDS FIXED PRIOR

TO RUNNING THIS REPORT

» USE TO IDENTIFY DUPLICATE PATIENTS SO

ACCOUNTS CAN BE MERGED



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Duplicate Patient by Service Entered Date

Patient Number

Duplicate Patient by Service Entered Date

Patient Birthdate Medical Record Number Social Security NumberService Entered

0004673 01/15/2009 KILLHAM, GERALD 07/14/1958

1005935 MERRITT, GERALD 07/14/1958 494-84-7175

0005012 10/13/2006 MURPHY, ANN 02/17/1960 954-04-5544

0360141 LOERA, ANN 02/17/1960 656-66-7465

0006679 09/21/2007 BIGA, JOHN 02/05/1958 056-68-6065

0140522 LOOTENS, JOHN 02/05/1958

0008569 09/11/2007 TAYLOR, BARRY 10/27/1962 1234 760-78-8755

0228569 TAYLOR, BARRY 123405/25/1981

0010211 02/27/2006 NELSON, BARBARA 05/13/1944 881-66-7525

0391189 DUNBAR, BARBARA 05/13/1944 008-52-4375

0010896 09/27/2006 DIXON, LOIS 01/30/1967

0424241 BUCKINGHAM, LOIS 01/30/1967 645132 695-28-5172

0011461 08/24/2006 MONAHAN-HARDIN, KELLY 12/13/1966 111-33-1665

0379954 WOLTERMAN, KELLY 12/13/1966

0011600 08/02/2007 WARREN, CHRISTINE 06/11/1954 532-54-4413

1017336 NYGREN, CHRISTINE 06/11/1954

0012569 07/10/2007 CAMPBELL, LINDA 04/02/1965

0018408 FIELDS, LINDA 04/02/1965

0014378 05/23/2007 MILLER, MARY 10/20/1972 855-94-6344

0212019 MORGAN, MARY 10/20/1972

0015675 03/17/2006 COSTER, PATRICIA 03/04/1949 485-42-5375

1015626 YOUNG, PATRICIA 03/04/1949 413-84-6965

0016247 02/05/2007 DENG, MARY 07/17/1961

0258366 MCMANUS, MARY 07/17/1961

0016795 03/19/2008 THEILER, JOYCE 03/19/1937

0042346 HANSEN, JOYCE 03/19/1937

0017265 12/19/2005 SWEETWOOD, NANCY 12/27/1956

0326757 WILKE, NANCY 12/27/1956

0017860 06/05/2006 RIXSTINE, BARBARA 04/19/1952 258-32-6634

Page: 1 Printed:5/16/2009 NOTE: It is recommended to run MB130.rpt 'PATIENT NAME WITHOUT COMMA' on the Administration menu and fix patient names prior to running this report.

MB131.rpt

GenTesting

» DISPLAYS UNITS AND DOLLARS BY FINANCIAL CLASS

BASED ON SERVICES

» COMPUTES PERCENTAGE OF UNITS AND DOLLARS

» CAN BE RUN FOR ANY DATE RANGE


MANAGEMENT MODULE

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Financial Class Percentage Billing

Financial Class Percentage Billing

BilledAmountFinancial Class Units % %

$19,720,000.87 51 186,047 55 No Associated Financial Class

$2,144.00 0 22 0 Medicare

$420,749.00 2 6,741 1 Medicaid

$1,040,819.25 3 11,238 3 Patient

$14,355,130.87 44 157,551 40 REGULAR

$35,538,843.99 361,599Total


M212.rpt

GenTesting

» DISPLAYS AGING INFORMATION BY FINANCIAL

CLASS

» PROVIDES QUICK SUMMARY OF AGING


MANAGEMENT MODULE

Financial Class Aging Report Summary

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Financial Class Aging Report Summary

Financial Class

Current

Amount Total> 120 Days

As Of: 1/27/2009

% of

Total

% of

Total

% of

Total

% of

Total

% of

Total > 90 Days> 60 Days> 30 Days

267,769.18 22,612.01 23,772.70 13,756.03 31,273.67 359,183.59 25.14% 34.37% 27.09% 32.64% 44.55%NO FINANCIAL CLASS

DESCRIPTION

29,670.00 4,602.00 1,920.00 2,389.00 6,599.29 45,180.29Medicaid 5.12% 2.78% 4.71% 6.89% 5.60%

44,006.91 38,833.74 32,244.12 27,646.25 51,308.67 194,039.69Patient 43.17% 46.62% 54.45% 53.55% 24.07%

159,126.47 23,907.50 11,220.67 6,983.15 6,639.67 207,877.46REGULAR 26.58% 16.22% 13.75% 6.93% 25.78%

$89,955.25Total $500,572.56 $69,157.49 $50,774.43 $95,821.30 $806,281.03

44.5%Medicaid 5.6%Patient 24.1%REGULAR 25.8%

Total: 100.0%

Percentage of Total Due / Financial Class

GenTesting


Mb413.rpt

» DISPLAYS TOTAL SERVICE UNITS AND TOTAL

SERVICE AMOUNTS FOR EACH PRIMARY SCREENER

» CAN BE USED FOR PERFORMANCE EVALUATIONS

» USEFUL TO CUSTOMERS WHO ALSO USE OUR



MANAGEMENT MODULE

Gyn/NonGyn Cytology Daily Revenue by

Screener/Pathologist

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Gyn/NonGyn Cytology Daily Revenue

by Screener / PathologistNote:Based on Service MB Entered Date, Primary Screeners Only

3/3/2008 3/4/2008 3/5/2008 Total

BIRKETT, JACK 5

275.00

2

110.00

2

110.00

9

$495.00

BRANSTROM,

THEODORE

5

275.00

4

220.00

3

165.00

12

$660.00

COLEMAN, JOSEPH 0

0.00

2

333.00

0

0.00

2

$333.00

DONOVAN, PATTY 2

290.00

0

0.00

8

360.00

10

$650.00

HAAR, TIM 10

750.00

0

0.00

10

750.00

20

$1,500.00

MILOS, NIKOLA 7

385.00

0

0.00

5

275.00

12

$660.00

ROHANI, RAMIN 0

0.00

0

0.00

5

275.00

5

$275.00

SVEHLA, DONALD 0

0.00

0

0.00

1

205.00

1

$205.00

Total 29

1,975.00

8

663.00

34

2,140.00

71

$4,778.00

GenTesting


MB418.rpt

» DISPLAYS TOTAL SERVICE UNITS AND TOTAL

SERVICE AMOUNTS FOR EACH PRIMARY SCREENER

» CAN BE USED FOR PERFORMANCE EVALUATIONS




MANAGEMENT MODULE

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Histology Daily Revenue by

Screener/Pathologist

Histology Daily Revenue by Screener / Pathologist

Note:Based on Service MB Entered Date, Primary Screeners Only

3/3/2008 3/4/2008 3/5/2008 Total

BLOYD, DAVID 2

189.00

0

0.00

0

0.00

2

$189.00

CHICK, GEORGE 4

710.00

0

0.00

0

0.00

4

$710.00

COLEMAN, JOSEPH 6

910.00

2

320.00

0

0.00

8

$1,230.00

DONOVAN, PATTY 0

0.00

3

480.00

0

0.00

3

$480.00

Jrandall 0

0.00

11

1,900.00

5

870.00

16

$2,770.00

Total 12

1,809.00

16

2,700.00

5

870.00

33

$5,379.00

GenTesting


MB420.rpt

» DISPLAYS ORDERING PATTERNS OF REFERRING

CLINICIANS BASED ON LOCATION

» CAN BE USED TO DETERMINE THE NUMBER OF

SERVICES BEING SENT FROM A SPECIFIC LOCATION

» RUN THE REPORT FOR A DATE RANGE AND/OR

LOCATION


MANAGEMENT MODULE

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Location/Clinician Utilization Report

Location/Clinician Utilization Report

ABC Clinic #0000001

LINDSEY, MARGARET

Service Item Code Billing Description Units Amount

88141 PHYS INTERP OF PAP 2 $70.00

88174 PAP SMEAR/LIQU/AUTO 2 $110.00

88175 PAP SMEAR/FOCALPT 7 $385.00

13 $715.00Total

NELSON, KAYLENE


87491 CHLAMYDIA TESTING 5 $365.00

87591 GONORRHEA TESTING 5 $365.00


88142 PAP SMEAR/LIQUID 9 $495.00


88175 PAP SMEAR/FOCALPT 155 $8,525.00

G0124 PHYS INTERP/LIQ PAP 2 $70.00

192 $10,500.00Total

2,121ABC Clinic #0000001Total $121,170.45

ABC Clinic #0000002


99000 MISC CHARGE 1 $15.00

99005 MISC CHG-INTEREST 1 $0.01

2 $15.01Total

BLUFORD, BRENDA


87491 CHLAMYDIA TESTING 21 $1,515.00

87591 GONORRHEA TESTING 21 $1,515.00

88141 PHYS INTERP OF PAP 53 $1,855.00

88142 PAP SMEAR/LIQUID BS 28 $1,540.00

88148 SCREENING PAP SMEAR 28 $1,540.00

88164 SCREENING PAP SMEAR 3 $165.00



88304 LEVEL 3 TISSUE EXAM 2 $190.00

88305 LEVEL 4 TISSUE EXAM 7 $1,100.00

D142 PAP SMEAR/LIQUID 2 $110.00

G0141 PHYSICIAN INTERP 1 $35.00

507 $28,320.00Total

BUCKINGHAM, CHANNON



88142 PAP SMEAR/LIQUID BS 2 $110.00



88304 LEVEL 3 TISSUE EXAM 9 $711.00

88305 LEVEL 4 TISSUE EXAM 97 $13,580.00

88312 STAINS FOR ORGANISM 1 $90.00

88342 IMMUNOHISTOCHEMISTR 3 $375.00

192 $19,206.00Total

BURNS, SARA


87491 CHLAMYDIA TESTING 8 $600.00

87591 GONORRHEA TESTING 8 $600.00


Printed:05/16/2009Page:2MB126.rpt

GenTesting

» DISPLAYS LIST OF CASES FOR A RANGE OF DATES

» A ‘*’ NEXT TO A CASE NUMBER MEANS THE NEXT

CASE HAS NOT BEEN BILLED OR THE CASE NUMBER

WAS NOT ENTERED CORRECTLY

» USE TO ENSURE ALL CASES ARE BILLED





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Missing Case Numbers

Missing Case NumbersFrom Date Case Number

A05-000001001/12/2006

A05-000001101/05/2006 *A05-710/13/2005

A05-811/09/2005

A05-911/14/2005

A06-000000308/29/2006

A06-000000410/02/2006 *A06-00000205/17/2006 *A06-00000510/31/2006 *A06-102/28/2006 *A06-612/28/2006

A06-712/28/2006

A07-000000303/31/2007 *A07-000000505/17/2007

A07-000000605/18/2007 *A07-000000809/25/2007 *A07-00000101/13/2007

A07-00000202/28/2007 *A07-00000405/21/2007 *A07-00000708/31/2007

A08-00000102/29/2008 *A08-00000403/05/2008 *A08-00000606/28/2008 *A08-00000809/26/2008

A08-00000911/26/2008

A08-00001012/08/2008 *A08-201/18/2008

A08-303/08/2008

A08-403/07/2008

C05-09000107/01/2005

C05-09000206/30/2005

C05-09000306/30/2005

C05-09000406/30/2005

C05-09000506/30/2005

C05-09000606/29/2005

C05-09000706/29/2005

C05-09000806/30/2005

C05-09000907/01/2005

C05-09001006/29/2005

C05-09001106/28/2005

C05-09001207/01/2005

C05-09001306/28/2005

C05-09001406/29/2005

C05-09001506/30/2005

C05-09001606/30/2005

C05-09001707/01/2005

C05-09001807/05/2005

C05-09001906/30/2005

C05-09002007/05/2005

C05-09002106/29/2005

C05-09002206/29/2005

C05-09002306/30/2005

C05-09002406/28/2005

C05-09002507/01/2005

C05-09002607/05/2005

C05-09002707/01/2005

C05-09002807/05/2005

C05-09002907/05/2005

C05-09003007/05/2005

C05-09003106/30/2005

C05-09003206/30/2005

C05-09003307/06/2005

C05-09003407/05/2005

Page 1 of 3737

MB436.rpt

Printed:05/18/2009

GenTesting

» DISPLAYS LIST OF PATIENT ACCOUNTS WITH

RELATED PATIENT PAYOR RECORDS AND A PATIENT

PAYOR REFERENCE FILE IS MISSING

» USE TO FIND PROBLEM ACCOUNTS AND CORRECT

BEFORE BILLING CLAIMS



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Missing Related Patient Payor

Patient Number Name Payor Number Payor Name

Missing Related Patient Payor

0251952 BARNES, DENISE 0000021 BAY AREA SCHOOL/CNA

0000136Missing Related Payor:

0287428 MILBOURN-BAKER, PATTI 0000021 BAY AREA SCHOOL/CNA


0322378 MCCALL, CAROL 0000021 BAY AREA SCHOOL/CNA


0354060 SLAUGHTER, LAURA 0000021 BAY AREA SCHOOL/CNA


1016102 WESCH, DEAN 0000021 BAY AREA SCHOOL/CNA


1030970 OSHEIM, HELEN 0000021 BAY AREA SCHOOL/CNA


0380878 HUTFLESS, DANIELLE 0000023 CBSA - MINNETONKA


0069072 NOVAK, LUCILLE 0000023 CBSA - MINNETONKA


1002434 BRUCE, JENNIFER 0000066 BLUE CROSS PRUDENT BUYER


0367703 KLOCH, KAREN 0000069 BLUE CROSS PRUDENT BUYER


0080207 WERTH, NATALIE 0000102 BLUE CROSS/CA CARE MISSION IPA


0258402 HEITMAN, LAVONNE 0000134 BVMG/ONE HEALTHPLAN


0275860 GARCELON, HELEN 0000134 BVMG/ONE HEALTHPLAN


0038720 MAY, SHARON 0000134 BVMG/ONE HEALTHPLAN


0050686 KALLWEIT, LENORA 0000134 BVMG/ONE HEALTHPLAN

21BMissing Related Payor:

0097740 EGGERSS, KAY 0000134 BVMG/ONE HEALTHPLAN


0431608 CARTER, STEVE 0000134 BVMG/ONE HEALTHPLAN


0365799 HULL, MILDRED 0000134 BVMG/ONE HEALTHPLAN


1040021 SMITH, MARY 0000134 BVMG/ONE HEALTHPLAN


1029219 KOZISEK, RAMONA 0000135 BVMG/PACIFICARE


0345651 EDWARDS, MARLEE 0000135 BVMG/PACIFICARE


0398133 JOHNSON, TIFFANY 0000135 BVMG/PACIFICARE



MB437.rpt

GenTesting

» DISPLAYS MONTHLY SERVICE TOTALS BY

FINANCIAL CLASS

» SHOWS EACH MONTH FOR COMPARISON PURPOSES

» RUN REPORT BY SERVICE DATE, FINANCIAL CLASS

OR OTHER CRITERIA


MANAGEMENT MODULE

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Monthly Services by Financial Class

Monthly Services by Financial Class

1/2007 2/2007 3/2007 4/2007 5/2007 Total Services

Monthly

Services by

Financial Class

Medicaid 750.00 1,160.00 1,336.00 1,265.00 0.00 4,511.00

Medicare 0.00 31.00 31.00 0.00 0.00 62.00

Other 26,859.00 40,144.83 48,191.03 39,587.38 66.00 154,848.24

Patient 15,752.00 25,804.00 24,782.00 23,988.00 895.00 91,221.00

REGULAR 629,314.00 722,235.35 900,310.00 848,376.32 38,725.00 3,138,960.67

Total 672,675.00 789,375.18 974,650.03 913,216.70 39,686.00 3,389,602.91

Total 672,675.00 789,375.18 974,650.03 913,216.70 39,686.00 3,389,602.91


MB416.rpt

GenTesting

» DISPLAYS ALL INFORMATION REGARDING A

PATIENT

» DISPLAYS DEMOGRAPHIC, PATIENT PAYOR, PATIENT

ACCOUNT NOTE AND SERVICE INFORMATION

» USEFUL WHEN A COMPLETE ACCOUNT REVIEW IS

NECESSARY

» RUN REPORT FOR ONE PATIENT NUMBER



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Patient Ledger - All Information

Smithson, Jane2107 Elliott Ave

0069077

Seattle, WA 98121

Patient Data:

Address Line 1 2107 Elliott Ave Address Line 2

RichterAlias Name Billing Status Code No Hold

Birthdate 01/01/1985 SeattleCity

Contract Payment Amt 0.00 0Contract Payment Days

Credit Status Code Employment StatusNone

Expired Date Expired Text

Expired Time

Last Updated By Last Updated Date 08/27/2009Jrandall

Marital Status 55544546879Medical Record No

Phone Description 1 Phone Description 2

Phone No 1 Phone No 2(206)812-6981

WRace FSex

Social Security No WAState999-12-3456

Student Status User Date 1

User Date 2 User Text 1

User Text 2 User Text 3

User Text 4 98121Zip Code

Most recent patient statement printed on : 12/30/2008

Most recent insurance claim printed on: 04/14/2009

Patient Notes:

Entered By 04/14/2009Entered DateThomas, Alecia Type B

Patient CalledNote Field 1

Note Field 2 Patient called to ask what these charges were for.


Insurance ChangeNote Field 1

Note Field 2 Patient called back and gave update on insurance information . We had the policy number incorrect


Insurance rebilledNote Field 1

Note Field 2 Insurance rebilled with corrected information


MB127.rpt

GenTesting


0069077

Seattle, WA 98121

Patient Insurance:

0000018BLUE CROSS - WYOMINGPrimary

Accept Assignment Y Authorization Number

Comment

Date Coverage Begins Date Coverage Ends

Employer Name ZZZ234Group Number

MPInsurance Type YMedical Rec Release

NMedigap

0069077Patient Number

6598755ZZZPolicy Number 0000050Related Payor Number

Signature Source Code 2107 Elliott AveSubscriber Address 1Signature generated by provider

Subscriber Address 2 01/01/1985Subscriber Birthdate

SeattleSubscriber City Thomas, AleciaSubscriber Name

Subscriber Phone Subscriber Relation Self()-

FSubscriber Sex Subscriber SSN 999-12-3456

WASubscriber State 98121Subscriber Zip Code

User Date 1Type Code Blue Cross and Blue Shield



User Text 4

0000050GREAT WESTSecondary

Accept Assignment Y Authorization Number

Comment

Date Coverage Begins Date Coverage Ends

Cortex MMS, IncEmployer Name CortexGroup Number

C1Insurance Type YMedical Rec Release

NMedigap

0069077Patient Number

987654X1P2Policy Number Related Payor Number

Signature Source Code 2107 Elliott AveSubscriber Address 1Signature generated by provider

Subscriber Address 2 01/01/1985Subscriber Birthdate

SeattleSubscriber City Thomas, AleciaSubscriber Name

Subscriber Phone Subscriber Relation Self()-

FSubscriber Sex Subscriber SSN 999-12-3456

WASubscriber State 98121Subscriber Zip Code

User Date 1Type Code Commercial Insurance Company



User Text 4

INS #BalanceAmountDate Billing Description

Service 04/13/2009 LEVEL 4 TISSUE EXAM 160.00 0.00 0000001

KRONE, CARMELReferred By:

ICD1: ICD2: ICD3: ICD4:

Modifier 3: Modifier 2:Modifier 1:88305CPT:

PaidStatus:

04/22/2009 -160.00Change payorService Adjustment






MB127.rpt

GenTesting


0069077

Seattle, WA 98121






PaidStatus:






PaidStatus:







Awaiting Patient PaymentStatus:

06/18/2009 -1.00Misc. adjustmentService Adjustment

04/01/2009 40.00Posting errorService Adjustment












Awaiting Patient PaymentStatus:

04/01/2009 20.00Posting errorService Adjustment






05/22/2009Payment Adjustment Posting error 10.00








PaidStatus:



MB127.rpt

GenTesting

» DISPLAYS INFORMATION ON PATIENTS WHERE A

COMMA IS MISSING FROM THEIR NAME

» DISPLAYS PATIENT NUMBER, NAME, BIRTH DATE,

SOCIAL SECURITY NUMBER AND MEDICAL RECORD

NUMBER

» AFTER THE ACCOUNTS ARE FIXED USE THE

DUPLICATE PATIENT REPORT TO FIND AND MERGE

DUPLICATE PATIENTS



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Patient Name without a Comma

Patient Name Without Comma

Number Name Birthdate Social Security Number MedicalRecordNo0305662 COLEMAN ROBERT 01/07/1938 167-70-2002

0345556 NIELSON JODY 10/15/1946 720-47-2945

0175297 OVERS & UNDERS 01/07/1934 748-90-2925

1035297 OVERS & UNDERS 12/08/1982

0355297 OVERS & UNDERS 07/05/1989 957-25-4575

0365297 OVERS & UNDERS 06/28/1971

0325297 OVERS & UNDERS 01/17/1989

0135297 OVERS & UNDERS 08/04/1919

0245297 OVERS & UNDERS 08/16/1973 923-45-4745

0105297 OVERS & UNDERS 02/03/1966

0375297 OVERS & UNDERS 08/06/1943 287-60-4165

1015297 OVERS & UNDERS 05/16/1973 303-72-8755

0395297 OVERS & UNDERS 09/03/1992

1025297 OVERS & UNDERS 06/19/1971

0405297 OVERS & UNDERS 07/25/1991 044-79-0706

0235297 OVERS & UNDERS 07/06/1933

0345297 OVERS & UNDERS 05/12/1965 379-58-0175

0264905 POOL JAYMI 08/19/1966 477-73-1755


mb130.rpt

» DISPLAYS PAYMENT COUNTS AND AMOUNTS SUB-

TOTALED BY YEAR, MONTH, DEPARTMENT AND

PAYOR TYPE


MANAGEMENT MODULE

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Payments by Department/Payor Type

AmountPayorTypeDept.

Payments by Department / Payor Type

2008

March

1 SURGICALS

51,213.63Patient

458.91Worker's Compensation

141,636.71Medicare

31,953.44Medicaid

42,213.36Commercial Insurance Company

53,664.80Blue Cross and Blue Shield

3,607.76CHAMPUS

46,184.92Blue Cross

345.71VA Plan

8,176.85Other

379,456.091 SURGICALS Total

10 LIQUID/F. POINT/ARCHIVED

61.24Patient

28.81Blue Cross and Blue Shield

90.0510 LIQUID/F. POINT/ARCHIVED Total

11 LIQUID/F. POINT

13,761.58Patient

7,585.75Medicare

11,241.62Medicaid



590.93CHAMPUS

14,408.07Blue Cross

30.23VA Plan

1,567.00Other

72,954.1311 LIQUID/F. POINT Total

12 GC/CT

4,703.26Patient

1,078.88Medicare

33,525.22Medicaid



478.60CHAMPUS

2,434.93Blue Cross

80.11VA Plan

282.98Other

50,767.2712 GC/CT Total

16 MEDICAL DIRECTOR FEES

38,800.00Other

38,800.0016 MEDICAL DIRECTOR FEES Total

2 SPEC CYTO (NON GYNS)

3,016.04Patient

9,039.14Medicare

1,113.83Medicaid



2,554.24Blue Cross

0.00VA Plan

309.09Other

21,378.692 SPEC CYTO (NON GYNS) Total

3 HEM-PATH

313.98Patient

1,319.47Medicare

GenTesting

MB604.rpt


» DISPLAYS PAYMENTS RECEIVED BY LOCATION,

SERVICE ITEM AND PAYOR


MANAGEMENT MODULE

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Payments by Location/Service Item/

Payor Type

Payments by Location / Service Item / Payor Type

Location

Service

Item

Payor

Type / Name

Total

Payments

0000002 ABC Clinic #0000002

P0472 Surg Path Immunohistochemistry

D 0.00MEDICAID

Z 189.42OTHER

P0472 $189.42Surg Path Immunohistochemistry

P1710 Cell Block Cytology

C 185.22MEDICARE

D 27.28MEDICAID

E 7.72OTHER FEDERAL PROGRAM

F 7.72COMMERCIAL INSURANCE COMPANY

G 129.99BLUE CROSS/BLUE SHIELD

L 43.38SELF ADMINISTERED GROUP

N 210.00MANAGED CARE

Z 168.00OTHER

P1710 $779.31Cell Block Cytology

P2361 Oil Red O Stain

D 0.00MEDICAID


P2361 $147.82Oil Red O Stain

P2470 Surg Path Special Stain Group I

C 44.40MEDICARE

D 193.99MEDICAID




I 220.00HMO

K 0.00CENTRAL CERTIFICATION

N 214.50MANAGED CARE

Z 80.65OTHER

P2470 $1,298.35Surg Path Special Stain Group I

P2471 Special Stain Group II

D 8.20MEDICAID


I 120.00HMO

N 81.66MANAGED CARE

P2471 $486.71Special Stain Group II

P2472 Surg Path Immunohistochemistry

D 90.32MEDICAID




P2472 $521.28Surg Path Immunohistochemistry


MB215.rpt

» DISPLAYS PAYMENTS RECEIVED BY LOCATION AND

PAYOR. NOTE: USES THE PAYOR ON THE CASH

RECEIPT RECORD


MANAGEMENT MODULE

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Payments by Location and Payor

Payments by Location and Payor AmountLocation Payor Nam

ABC Clinic #0000009CBSA - MINNETONKA 112.43

Total:ABC Clinic #0000009 112.43

ABC Clinic #0000011PRIVATE PAY 1,522.35

ALAMEDA PODS/PACIFICARE HMO 48.57

BAY AREA SCHOOL/CNA 676.71

CBSA - MINNETONKA 390.61

CHRISTIAN BROTHERS EMP BENEFIT 328.94

GEHA - INDEPENDENCE 43.07

BLUE CROSS PBP 12.38

BLUE CROSS PRUDENT BUYER 197.38

BLUE CROSS PRUDENT BUYER PLAN 0.00

BLUE SHIELD 232.19

BLUE SHIELD 163.60

BLUE SHIELD OUT OF STATE 112.97

BVMG/ONE HEALTHPLAN 1,187.12

BVMG/PRUCARE 114.00

BX/BS OF MISSOURI 27.34

CIGNA/PPO 149.99

ECMG/BLUE SHIELD HMO 60.36

Total:ABC Clinic #0000011 5,267.58

ABC Clinic #0000012ALAMEDA PODS/PACIFICARE HMO 12.38

BVMG/ONE HEALTHPLAN 49.53

Total:ABC Clinic #0000012 61.91

Grand Total: 5,441.92

Printed:05/16/2009Page:1

MB213.rpt

GenTesting

» DISPLAYS PAYMENTS RECEIVED BASED ON THE

FIRST MODIFIER ON THE SERVICE

» DISPLAYS MODIFIER, CPT CODE, ADJUSTED

PAYMENT (PAYMENT TOTAL MINUS PAYMENT

ADJUSTMENTS), UNIT VALUE AND TOTAL PAYMENTS

RECEIVED


MANAGEMENT MODULE

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Payments Received by Modifier/CPT

Adjusted

PaymentCPT Code

Unit

Value Professional TechnicalModifier

Payments Received By Modifier 1 / CPT(service.entereddate between '1/1/2008' and '2/28/2008')

All Other Modifiers

662.1310021 0.00% 0.00 662.13

0.003260F 0.00% 0.00 0.00

4,730.3285097 0.00% 0.00 4,730.32

42,863.9187491 0.00% 0.00 42,863.91

42,885.7287591 0.00% 0.00 42,885.72

1,564.7588104 0.00% 0.00 1,564.75

15,618.0288112 0.00% 0.00 15,618.02

14,014.3488141 0.00% 0.00 14,014.34

16,825.9288142 0.00% 0.00 16,825.92

2,875.4288148 0.00% 0.00 2,875.42

2,469.6988164 0.00% 0.00 2,469.69

2,777.3388172 0.00% 0.00 2,777.33

12,895.6488173 0.00% 0.00 12,895.64

28.8188174 0.00% 0.00 28.81

139,165.8488175 0.00% 0.00 139,165.84

4,897.1488300 0.00% 0.00 4,897.14

919.2588302 0.00% 0.00 919.25

21,131.9888304 0.00% 0.00 21,131.98

410,584.0788305 0.00% 0.00 410,584.07

81,641.3488307 0.00% 0.00 81,641.34

10,656.7188309 0.00% 0.00 10,656.71

1,685.1188311 0.00% 0.00 1,685.11

43,784.1388312 0.00% 0.00 43,784.13

10,470.3088313 0.00% 0.00 10,470.30

243.2788321 0.00% 0.00 243.27

210.0088323 0.00% 0.00 210.00

160.3288329 0.00% 0.00 160.32

8,322.0688331 0.00% 0.00 8,322.06

111.3688332 0.00% 0.00 111.36

40,556.0688342 0.00% 0.00 40,556.06

10,692.3688360 0.00% 0.00 10,692.36

71,375.0095000 0.00% 0.00 71,375.00

6,276.7299000 0.00% 0.00 6,276.72

196.5299001 0.00% 0.00 196.52

27.6499005 0.00% 0.00 27.64

All Other Modifiers 1,023,319.18 0.00 1,023,319.18

26

2,297.3688141

115.5688305

2,412.9226 2,412.92

TC

10.4388148

4.6888164

28.3988305

TC 43.50 43.50

Report Totals $1,025,775.60 $2,412.92 $1,023,362.68

Report is grouped by Service.Modifier1 for 'TC' & '26', 'All Other Modifiers' are grouped together. Second group is ServiceItem.CPTCode

.00% 1.00%


MB615.rpt3 GenTesting

» DISPLAYS PAYMENTS POSTED WITH A ZERO

AMOUNT

» DISPLAYS WHO POSTED THE PAYMENT, PATIENT

NAME AND NUMBER, CASH RECEIPT NUMBER AND

BATCH NUMBER

» THE PARAMETERS FOR WHICH THE REPORT WAS

RUN DISPLAYS IN THE HEADER OF THE REPORT

» DATA IS GROUPED BY PAYOR, THEN BATCH THEN

TENDER

» USEFUL FOR FOLLOWING UP ON ZERO AMOUNT

PAYMENTS TO SEE IF FOLLOW UP IS NEEDED


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Payments with Zero Amounts

Payments With Zero Amounts

(payment.entereddate > '1/1/2009') AND (payment.entereddate < '1/3/2009')

{Payment.Amount} = 0.00 and

{Service.TransToSvcNum} = ""

Payment

Batch Tender Entered /

Patient

Number / Name EOB Reason

Service

Item

Payor

Number

AARP HEALTH CARE OPTIONS #0000010

010209A 056401150

0394819 1027100 PETTENGILL,

BURDENA

Aetna 8830501/02/2009

0394816 0189454 RAPAICH, CINDY Aetna 8830501/02/2009

BAY AREA SCHOOL/CNA #0000021

010209A 0000523769

0394834 0367534 KOLBET, LEONA deductible 8817501/02/2009

0000524066

0394707 1009885 YATES, BOBETTE Blue Cross denied 8817501/02/2009

0000524213

0394851 1000712 MORENO, CLAUDIA Blue Cross denied 8749101/02/2009

0394852 Blue Cross denied 8759101/02/2009

0080881020

0394750 0113326 PAGE, KIMBERLY Blue Cross 8817501/02/2009

0394751 0223510 WURDEMAN, ANNETTE Blue Cross 8817501/02/2009

0394745 1029741 LAWSON, JESSICA Blue cross denied 8749101/02/2009


0080922108

0394700 0361666 DAGOSTA, TERESA Blue Cross 8814201/02/2009

0394703 1031958 ALVARADO, DORA Blue Cross 8814801/02/2009

0394693 1042764 KING, JAMES Not a covered expense 3260F01/02/2009




0394701 0419053 MEDLEY, THERESA Blue Cross 8830401/02/2009

0394704 0426644 CHUDOMELKA,

DONALD

Blue Cross 8830501/02/2009

0394696 0350630 HUETSON, INEZ Blue Cross 8749101/02/2009

0394697 Blue Cross 8759101/02/2009

0394685 1043377 FRANSEN, ALFRED Blue Cross 8830701/02/2009

0394698 0355663 ALBRO, MARGARET Blue Cross 8749101/02/2009

0394699 Blue Cross 8759101/02/2009

0080937332

0394813 0229713 BENZEL, MARJORIE Blue Cross denied 8830501/02/2009


0394801 0278822 FISHER, CHRISTINE Blue Cross denied 8817501/02/2009

0394802 0350630 HUETSON, INEZ Blue Cross 8817501/02/2009

0394803 1024211 PARSONAGE, JANET Blue Cross 8830401/02/2009

0394799 1010821 SPURGEON, ROMA Blue Cross 8814101/02/2009

0394800 Blue Cross 8814201/02/2009

0394807 0201819 HOLM, BARBARA Blue Cross 8749101/02/2009

0394808 Blue Cross 8759101/02/2009

0080951926

0394739 1032911 WALKER, JAMES Blue Cross 8830501/02/2009

0394738 0202680 BONEBRIGHT, RACHEL Blue Cross 8817501/02/2009

0394735 0355663 ALBRO, MARGARET Blue Cross 8817501/02/2009

0080981256

0394787 0395454 DENNIS, MARLENIA Blue Cross denied 8817501/02/2009

0394780 0412029 MALCHOW, MILDRED Blue Cross 8830401/02/2009

200804554

0394876 0127520 REED, PAUL Blue Cross 8830501/02/2009

200804561

0394874 1043400 CLAUSEN, FRANCES Blue Cross denied 8830401/02/2009

V9SP1Testing


MB610.rpt

» DISPLAYS REVENUE INFORMATION BY PAYOR.

NOTE: USES THE PAYOR ON THE SERVICE


MANAGEMENT MODULE

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Payor Revenue Report

Payor Revenue Reportfor

Seattle Services

Payor Services

Service


Payment

Adjustments New AR

-2,471.18 3,873.82 0.00AARP HEALTH CARE OPTIONS #0000010 6,345.00 0.00

0.00Client Totals: 0.00 0.00 0.00 0.00

Service + Client Totals: 0.00 6,345.00 -2,471.18 3,873.82 0.00

-160.00 0.00 0.00ALAMEDA PODS/PACIFICARE HMO #0000007 160.00 0.00

0.00Client Totals: 0.00 0.00 0.00 0.00

Service + Client Totals: 0.00 160.00 -160.00 0.00 0.00

0.00 0.00 0.00ASIAN HEALTH SERVICES/CHCN #0005000 0.00 0.00

0.00Client Totals: 0.00 840.00 0.00 840.00

Service + Client Totals: 0.00 840.00 0.00 840.00 0.00

-67,304.05 93,293.70 -9.44BAY AREA SCHOOL/CNA #0000021 160,772.29 183.98

0.00Client Totals: 0.00 0.00 0.00 0.00

Service + Client Totals: 183.98 160,772.29 -67,304.05 93,293.70 -9.44

0.00 0.00 0.00BAYCARE MEDICAL GRP (BCMG) SDC

#0005002

0.00 0.00

0.00Client Totals: 0.00 15.00 0.00 15.00

Service + Client Totals: 0.00 15.00 0.00 15.00 0.00

0.00 0.00 0.00BERKELEY FAM PRACTICE (BERK) #0005003 0.00 0.00

0.00Client Totals: -5.00 15.00 0.00 20.00


-415.67 519.33 0.00BLUE CROSS #0000028 935.00 0.00

0.00Client Totals: 0.00 0.00 0.00 0.00


-72.56 187.44 0.00BLUE CROSS #0000031 260.00 0.00

0.00Client Totals: 0.00 0.00 0.00 0.00


-18.00 127.00 0.00BLUE CROSS PBP #0000056 145.00 0.00

0.00Client Totals: 0.00 0.00 0.00 0.00


-513.30 926.70 0.00BLUE CROSS PPO #0000059 1,440.00 0.00

0.00Client Totals: 0.00 0.00 0.00 0.00

Service + Client Totals: 0.00 1,440.00 -513.30 926.70 0.00

-836.19 1,563.81 0.00BLUE CROSS PRUD BUYER #0000062 2,400.00 0.00

0.00Client Totals: 0.00 0.00 0.00 0.00

Service + Client Totals: 0.00 2,400.00 -836.19 1,563.81 0.00

-1,148.99 2,202.01 0.00BLUE CROSS PRUD BUYER #0000063 3,351.00 0.00

0.00Client Totals: 0.00 0.00 0.00 0.00

Service + Client Totals: 0.00 3,351.00 -1,148.99 2,202.01 0.00

-71.75 143.25 0.00BLUE CROSS PRUDENT BUYER #0000065 215.00 0.00

0.00Client Totals: 0.00 0.00 0.00 0.00


-236.20 433.80 0.00BLUE CROSS PRUDENT BUYER #0000068 670.00 0.00

0.00Client Totals: 0.00 0.00 0.00 0.00


-616.99 816.36 0.00BLUE CROSS PRUDENT BUYER #0000071 1,545.00 111.65

0.00Client Totals: 0.00 0.00 0.00 0.00

Service + Client Totals: 111.65 1,545.00 -616.99 816.36 0.00

Printed:05/16/2009

GenTesting

Page:1MB403.rpt

» DISPLAYS A DETAILED LIST OF REVENUE BY PAYOR

» RUN FOR A SPECIFIC PAYOR WITH A DATE RANGE

» USEFUL TO DETERMINE A SPECIFIC PAYOR’S

REVENUE


MANAGEMENT MODULE

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Payor Revenue Report Detail

Payor Revenue Report Detailfor

Seattle Services

Payor Services

Service


Payment

Adjustments New AR

Client Service # 55.00 -23.71 31.29 0.00Service # 0283260


Client Service # 0.00 0.00 0.00 0.00

-47.42 62.58 0.00BLUE SHIELD FEDERAL EMPLOYEES

#0000121

110.00 0.00

0.00Client Totals: 0.00 0.00 0.00 0.00

















Client Service # 0.00 0.00 0.00 0.00

-772.36 1,227.64 0.00BLUE SHIELD OF CALIFORNIA #0000123 2,000.00 0.00

0.00Client Totals: 0.00 0.00 0.00 0.00

Service + Client Totals: 0.00 2,000.00 -772.36 1,227.64 0.00

Printed:05/16/2009

GenTesting

Page:42MB433.rpt

» DISPLAYS REVENUE INFORMATION BY PAYOR TYPE


MANAGEMENT MODULE

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Payor Type Revenue Report

Payor Type Revenue Reportfor

Seattle Services

Payor Type Services

Service


Payment

Adjustments New AR

A PATIENT

PRIVATE PAY #0000000 26,278.00 0.00-17,125.44 9,152.56 0.00

PRIVATE PAY SOC #0000001 3,460.00 0.00-3,315.00 145.00 0.00

29,738.00A -20,440.44 9,297.56 0.00 0.00PATIENT Service Totals:

B WORKER'S COMPENSATION

BX/BS OF NORTH CAROLINA #0000142 160.00 0.00-160.00 0.00 0.00

CIGNA #0000152 70.00 0.00-10.15 59.85 0.00

FOUNDATION FOR MEDICARE CARE

PPO #0000388

95.00 0.00-34.44 60.56 0.00

PMG/SJ HEALTHNET #0000600 95.00 0.00-34.44 60.56 0.00

UNICARE #0000791 35.00 0.00-13.52 21.48 0.00

455.00B -252.55 202.45 0.00 0.00WORKER'S COMPENSATION

Service Totals:

C MEDICARE

BVMG/ONE HEALTHPLAN #0000134 240,719.00 0.00-88,967.68 151,751.32 0.00

BVMG/PACIFICARE #0000135 18,640.00 5.03-6,799.89 11,835.08 0.00

BX/BS OF MISSISSIPPI #0000138 2,055.00 0.00-796.13 1,258.87 0.00

CIGNA IND #0000238 260.00 0.00-87.90 172.10 0.00

261,674.00C -96,651.60 165,017.37 0.00 5.03MEDICARE Service Totals:

D MEDICAID

BVMG/PRUCARE #0000136 189,928.00 300.00-108,535.70 81,092.30 0.00

CIGNA/PPO #0000288 22,640.00 0.00-13,073.51 9,566.49 0.00

MEDI-CAL MED #136B 11,082.00 360.00-8,401.89 2,320.11 0.00

223,650.00D -130,011.10 92,978.90 0.00 660.00MEDICAID Service Totals:

F COMMERCIAL INSURANCE COMPANY

AARP HEALTH CARE OPTIONS

#0000010

6,345.00 0.00-2,471.18 3,873.82 0.00

ALAMEDA PODS/PACIFICARE HMO

#0000007

160.00 0.00-160.00 0.00 0.00

BLUE CROSS PBP #0000056 145.00 0.00-18.00 127.00 0.00

BLUE CROSS PPO #0000059 1,440.00 0.00-513.30 926.70 0.00

BLUE CROSS PRUD BUYER #0000062 2,400.00 0.00-836.19 1,563.81 0.00

BLUE CROSS PRUD BUYER #0000063 3,351.00 0.00-1,148.99 2,202.01 0.00

BLUE CROSS PRUDENT BUYER

#0000065

215.00 0.00-71.75 143.25 0.00


#0000076

1,683.00 0.00-527.01 1,155.99 0.00


#0000077

165.00 0.00-8.87 156.13 0.00


#0000081

260.00 0.00-205.00 55.00 0.00


#0000082

55.00 0.00-14.04 40.96 0.00


#0000084

55.00 0.00-55.00 0.00 0.00


#0000090

1,665.00 0.00-464.26 1,200.74 0.00

BLUE CROSS/CA CARE MISSION IPA

#0000102

850.00 0.00-172.46 677.54 0.00

BLUE SHIELD #0000110 150.00 0.00-150.00 0.00 0.00

BLUE SHIELD #0000117 5,445.00 0.00-2,436.61 3,008.39 0.00

Printed:05/16/2009

GenTesting


» DISPLAYS PERFORMING PHYSICIAN REVENUE

STATISTICS FOR A MONTH AND YEAR-TO-DATE

MONTH FOR WHICH REPORT WAS RUN

» BREAKS DOWN DATA BY SERVICE ITEM CODE


MANAGEMENT MODULE

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Performing Clinician Utilization Year to Date

Performing Clinician Utilization YTDfor

Seattle Services

Clinician/Service Item

Code

BY-SERVICE-ENTERED-DATE

YEAR-TO March 2008


Number

Performed

Services

Billed Amount

Number

Performed

Services

Billed Amount

March 2008

AKERT, BEN 000990588300 LEVEL I GROSS EXAM 18 630.00 71 2,485.00

88302 LEVEL 2 TISSUE EXAM 2 150.00 9 675.00

88304 LEVEL 3 TISSUE EXAM 50 4,750.00 132 12,540.00

88305 LEVEL 4 TISSUE EXAM 343 54,602.00 1,283 203,596.00



88311 DECALCIFICATION 10 290.00 36 1,044.00

88312 STAINS FOR ORGANISM 46 6,560.00 197 26,945.00

88313 SPECIAL STAINS MISC 13 1,390.00 74 7,490.00

88321 SLIDE CONSULTATION 0 0.00 0 0.00

88323 SLIDE CONSULT RECUT 0 0.00 0 0.00

88329 OR CONSULTATION 0 0.00 1 76.00

88331 FROZEN SECTION 12 1,620.00 36 4,860.00

88332 FROZEN SECTION 4 252.00 6 378.00

88333 TOUCH/SQUASH PREP, 0 0.00 0 0.00

88342 IMMUNOHISTOCHEMISTR 46 6,795.00 180 26,225.00

88360 TUMOR IMMUNO/ER-PR 14 2,488.00 54 9,368.00

99001 HANDLING/CONVEYANCE 1 25.00 3 75.00

D142 PAP SMEAR/LIQUID 0 0.00 6 330.00

D164 PAP SMEAR 0 0.00 0 0.00

D175 PAP SMEAR/FOCALPT 0 0.00 1 55.00

G0124 PHYS INTERP/LIQ PAP 3 105.00 12 420.00

G0141 PHYSICIAN INTERP 0 0.00 0 0.00

P3001 PHYS INTERP OF PAP 0 0.00 0 0.00

$526,049.00 5,115$137,497.00 1,282AKERT, BENTotals for:

BLACKMAN, BETHENE 000990110021 FINE NEEDLE ASP BX 0 0.00 0 0.00

85097 BM ASP-INTERP ONLY 0 0.00 0 0.00

87491 CHLAMYDIA TESTING 0 0.00 0 0.00

87591 GONORRHEA TESTING 0 0.00 0 0.00

88020 GROSS MICRO TRUNK 0 0.00 0 0.00

88104 CYTO SMEARS 0 0.00 0 0.00

88112 CYTOPATH/CELL ENHAN 0 0.00 0 0.00

88141 PHYS INTERP OF PAP 0 0.00 0 0.00

GenTesting


» DISPLAYS ORDERING PATTERNS BY REFERRING

CLINICIAN, LOCATION AND SERVICE ITEM CODE

» CAN BE RUN FOR ANY DATE RANGE


MANAGEMENT MODULE

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Referring Clinician Utilization Report

Referring Clinician Utilization Reportfor

Seattle Services

Clinician/ Location/ ServiceNumber

Performed

Services

Billed

0000213 ABELE, EVELYNABC Clinic #0000053

88112 CYTOPATH/CELL ENHAN 473.00 3

88305 LEVEL 4 TISSUE EXAM 760.00 5

Total : 1,233.00 8ABC Clinic #0000053

ABC Clinic #0000075

88173 FNA FINAL REPORT 990.00 6


88305 LEVEL 4 TISSUE EXAM 59,500.00 399

88312 STAINS FOR ORGANISM 580.00 4

88342 IMMUNOHISTOCHEMISTR 8,545.00 62

88360 TUMOR IMMUNO/ER-PR 28,984.00 185

99001 HANDLING/CONVEYANCE 100.00 4

Total : 98,794.00 661ABC Clinic #0000075

ABC Clinic #0000076

88173 FNA FINAL REPORT 145.00 1


88360 TUMOR IMMUNO/ER-PR 172.00 1

Total : 457.00 3ABC Clinic #0000076

Total : 100,484.00ABELE, EVELYN 672

0010213 ABELE, EVELYNABC Clinic #0000053

88300 LEVEL I GROSS EXAM 35.00 1




88311 DECALCIFICATION 348.00 12

Total : 4,213.00 34ABC Clinic #0000053

ABC Clinic #0000194





Total : 554.00 9ABC Clinic #0000194

ABC Clinic #0000243






Total : 1,700.00 22ABC Clinic #0000243

Total : 6,467.00ABELE, EVELYN 65

GenTesting


» DISPLAYS REFERRING PHYSICIAN REVENUE

STATISTICS FOR A MONTH AND YEAR-TO-DATE

MONTH FOR WHICH REPORT WAS RUN

» BREAKS DOWN DATA BY SERVICE ITEM CODE


MANAGEMENT MODULE

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Referring Clinician Utilization Year to Date

Referring Clinician Utilization YTDfor

Seattle Services

Clinician/ Location/ Service

BY-SERVICE-ENTERED-DATE BY-SERVICE-ENTERED-DATE

Services

Billed Amount

Number

Performed

Services

Billed Amount

Number

Performed

March 2008 YEAR-TO March 2008

ALM, VICKI 0000185

ABC Clinic #0000386 Total : 0 $0.00 0 $0.00

$1,255.00Total :ALM, VICKI 6 $370.00 21

ALM, VICKI 0010185

ABC Clinic #0000366



88175 PAP SMEAR/FOCALPT 0 0.00 0 0.00

ABC Clinic #0000366 Total : 0 $0.00 0 $0.00

$0.00Total :ALM, VICKI 0 $0.00 0

AMICK, QUINSONYA 0000094

ABC Clinic #0000026



88174 PAP SMEAR/LIQU/AUTO 0 0.00 0 0.00

ABC Clinic #0000026 Total : 0 $0.00 0 $0.00

ABC Clinic #0000069



88104 CYTO SMEARS 0 0.00 0 0.00

88141 PHYS INTERP OF PAP 1 35.00 6 210.00

88142 PAP SMEAR/LIQUID 0 0.00 2 110.00

88174 PAP SMEAR/LIQU/AUTO 0 0.00 0 0.00

88175 PAP SMEAR/FOCALPT 8 440.00 27 1,485.00


88312 STAINS FOR ORGANISM 0 0.00 0 0.00

ABC Clinic #0000069 Total : 9 $475.00 41 $2,255.00

ABC Clinic #0000216

88175 PAP SMEAR/FOCALPT 0 0.00 0 0.00


ABC Clinic #0000216 Total : 0 $0.00 0 $0.00

ABC Clinic #0000218


Page 9 of 451

GenTesting

Printed:08/31/2009

MB409.rpt

» DISPLAYS REVENUE RECEIVED BY WHERE THE

SERVICE WAS PERFORMED

» DISPLAYS TOTALS BY MONTH


MANAGEMENT MODULE

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Revenue by Where Performed

Revenue By Where PerformedNote: Filter based on Service.EnteredDate

1/2008 2/2008 3/2008 4/2008 5/2008 6/2008 Total Services

0.01 5.27 0.00 0.00 0.00 0.00 $5.28

Cortex Medical M 914,975.55 907,740.78 963,459.88 1,007,847.55 941,754.17 931,357.56 $5,667,135.49

Seattle Services 160.00 1,916.00 145.00 0.00 90.56 0.00 $2,311.56

Total $915,135.56 $909,662.05 $963,604.88 $1,007,847.55 $941,844.73 $931,357.56 $5,669,452.33


GenTesting

MB419.rpt

» DISPLAYS SERVICE ITEM STATISTICS FOR A MONTH

AND YEAR-TO-DATE MONTH FOR WHICH REPORT

WAS RUN

» DISPLAYS INFORMATION BY DEPARTMENT AND

SERVICE ITEM CODE


MANAGEMENT MODULE

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Service Item Revenue Report

Service Item Revenue Reportfor

Seattle Services

Service

Department/


YEAR-TO June 2007


Number

Performed

Services

Billed Amount

Number

Performed

Services Billed

Amount

June 2007

0 0.00 0 0.00

0LEESH LEVEL 4 TISSUE EXAM 0.00 0 0.00

0 $0.00 0 $0.00

SURGICALS Test

03250F PQRI QUALITY CODE 0.00 0 0.00

03260F Reporting pT,pN with Histology

Grad

0.00 0 0.00

14188300 LEVEL I GROSS EXAM 4,935.00 772 25,908.00

2588302 RIGHT FALLOPIAN TUBE

SEGMENT

1,875.00 117 8,180.00

22388304 LEVEL 3 TISSUE EXAM 21,153.00 1,338 118,592.00

2,12088305 LEVEL 4 TISSUE EXAM 337,568.00 13,103 1,981,599.00

23088307 RIGHT BREAST TISSUE 67,160.00 1,472 390,258.00

2788309 UTERUS WITH CERVIX 11,810.00 125 51,850.00

4188311 DECALCIFICATION 1,189.00 225 6,525.00

25188312 STAINS FOR ORGANISM 33,885.00 1,584 189,405.00

7788313 Special stains - Group II 7,700.00 534 51,520.00

688321 SLIDE CONSULTATION 1,140.00 12 1,874.00

088323 SLIDE CONSULT RECUT 0.00 2 360.00

088329 OR CONSULTATION 0.00 3 228.00

4688331 H-E, FROZEN SECTION 6,210.00 229 30,915.00

288332 FROZEN SECTION ADDT 126.00 3 189.00

088333 TOUCH/SQUASH PREP, 0.00 8 1,060.00

15088342 PSA 21,750.00 942 129,075.00

5088360 TUMOR IMMUNO/ER-PR 8,600.00 272 43,824.00

0CLSV1 Client Service 1 0.00 0 0.00

0CLSV2 Client Service 2 0.00 0 0.00

SURGICALS Test 3,389 $525,101.00 20,741 $3,031,362.00

LIQUID/F. POINT/ARCHIVED

10388174 PAP SMEAR/LIQU/AUTO 5,615.00 712 38,930.00

LIQUID/F. POINT/ARCHIVED 103 $5,615.00 712 $38,930.00

LIQUID/F. POINT

2,12088175 PAP SMEAR/FOCALPT 116,400.00 14,222 778,913.00

4D175 PAP SMEAR 220.00 32 1,760.00

LIQUID/F. POINT 2,124 $116,620.00 14,254 $780,673.00

GC/CT

50087491 CHLAMYDIA TESTING 37,265.00 3,368 248,330.00

49987591 STD Test Panel 37,190.00 3,368 248,330.00

0STD STD Test Panel 0.00 0 0.00

SP1Tst

Printed:01/14/2011Page:3MB405.rpt

» DISPLAYS SERVICE COUNTS AND AMOUNTS SUB-

TOTALED BY YEAR, MONTH, DEPARTMENT AND

PAYOR TYPE


MANAGEMENT MODULE

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Service Totals by Department

Service Totals by Department

Year Month PayorType Units AmountDept.

2008 December

1 SURGICALS

15,624.00 102Patient

834.00 10Worker's Compensation

196,378.00 1,258Medicare

86,296.00 526Medicaid

52,500.00 332Commercial Insurance Company

86,608.00 552Blue Cross and Blue Shield

1,430.00 8CHAMPUS

109,020.00 700Blue Cross

160.00 1VA Plan

11,371.00 86Other

SURGICALS TOTAL $560,221.00 3,575

10 LIQUID/F. POINT/ARCHIVED

55.00 1Blue Cross

LIQUID/F. POINT/ARCHIVED TOTAL $55.00 1

11 LIQUID/F. POINT

3,520.00 64Patient

10,835.00 197Medicare

34,430.00 626Medicaid



550.00 10CHAMPUS

28,875.00 525Blue Cross

165.00 3VA Plan

2,405.00 51Other

LIQUID/F. POINT TOTAL $120,930.00 2,206

12 GC/CT

2,700.00 36Patient

1,950.00 26Medicare

45,750.00 610Medicaid



300.00 4CHAMPUS

5,550.00 74Blue Cross

1,050.00 18Other

GC/CT TOTAL $69,750.00 934

16 MEDICAL DIRECTOR FEES

48,000.00 8Other

MEDICAL DIRECTOR FEES TOTAL $48,000.00 8

2 SPEC CYTO (NON GYNS)

1,211.00 7Patient

17,317.00 108Medicare

2,610.00 17Medicaid



4,349.00 25Blue Cross

375.00 3VA Plan

551.00 3Other

SPEC CYTO (NON GYNS) TOTAL $31,766.00 198

GenTesting


» DISPLAYS TOTAL PAYMENTS RECEIVED BY CLIENT

» CAN BE RUN BY PAYMENT ENTERED DATES OR FOR

A SPECIFIC CLIENT


MANAGEMENT MODULE

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Total Client Payments

Total Client Payments by ClientPayment AmountClient Name

$45,257.00ASIAN HEALTH SERVICES/CHCN

$615.00BAY VALLEY MEDICAL GRP (BVMG)

$440.00BAYCARE MEDICAL GRP (BCMG) SDC

$1,070.00BERKELEY FAM PRACTICE (BERK)

$150.00BERKELEY PRIMARY CARE/SDC

$335.00BULLOCK, PETER/PC

$275.00CALIFORNIA STATE UNIV.

$282.00CARE POINT MEDICAL CENTER

$5.00CENTER FOR ELDER INDEP/OAK/SDC

$325.00CENTERS FOR ELDERS/OAK/SDC

$220.00CHARLES QUEST, MD

$15.00CHINATOWN MEDICAL LAB/PC

$6,400.00CINICA DE SALUD DEL VALLE

$24,950.00CL

$22.00CLIN DE SALUD DE GREENFIELD/SDC

$59.00CLINICA ALTA VISTA/OAK/SDC

$16,664.00CLINICA DE SALUD/SANBORN/SDC

$1,468.51CLINICA DE SALUDE/SOLEDAD/SDC

$65.00CLINICA UNIVERSAL

$220.00CONNIE TAN, MD

$200.00CRAIG KLOOSTER, DPM/ PC

Grand Total: $99,037.51


MB214.rpt

GenTesting

» DISPLAYS ALL SERVICE ITEM AND CPT CODE CODES

» DISPLAYS TOTALS FOR EACH

» RUN THE REPORT FOR A RANGE OF DATES AND/OR

SPECIFIC SERVICE ITEM CODE

» USEFUL TO QUICKLY SEE WHICH SERVICES HAVE

THE HIGHEST AND LOWEST VOLUME


MANAGEMENT MODULE

Ma

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Volume Summary by Service Item Code

by Month

Volume Summary of Service Item Codes by MonthDisplayed by ServiceItem.CPTCode, Service.ServiceItemCode, Sum of Service.Units for Service.EnteredDate (Monthly)

Jan-2008 Total

10021 10021 3 3

Total 3 3

3260F 3260F 21 21

Total 21 21

85097 85097 23 23

Total 23 23

87491 87491 570 570

Total 570 570

87591 87591 570 570

Total 570 570

88020 88020 1 1

Total 1 1

88104 88104 19 19

Total 19 19

88112 88112 85 85

Total 85 85

88141 88141 518 518

G0124 25 25

G0141 1 1

Total 544 544

88142 88142 363 363

D142 4 4

Total 367 367

88148 88148 117 117

Total 117 117

88164 88164 150 150

D164 1 1

Total 151 151

88172 88172 32 32

Total 32 32

GenTesting


MB411.rpt

» DISPLAYS ALL SERVICE ITEM AND CPT CODE CODES

FOR TOP 10 SERVICE ITEM CODES

» DISPLAYS TOTALS FOR EACH



» USEFUL TO QUICKLY SEE WHICH SERVICES HAVE

THE HIGHEST VOLUME


MANAGEMENT MODULE

Ma

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Volume Summary by Service Item Code

Top 10 by Month

Volume Summary of Service Item Code

Top 10 by MonthDisplayed by ServiceItem.CPTCode, Service.ServiceItemCode, Sum of Service.Units for Service.FromDate (Monthly)

Jan-2008 Total

Volume

Summary of

Service Item

Code

88305 88305 2,274 2,274

Total 2,274 2,274

88175 88175 2,080 2,080

D175 1 1

Total 2,081 2,081

87591 87591 570 570

Total 570 570

87491 87491 570 570

Total 570 570

88141 88141 518 518

G0124 25 25

G0141 1 1

Total 544 544

88142 88142 363 363

D142 4 4

Total 367 367

88312 88312 303 303

Total 303 303

88307 88307 283 283

Total 283 283

88342 88342 266 266

GenTesting

Printed : 5/16/2009Page 1 of 3MB412.rpt

» DISPLAYS SERVICE ITEM CODE STATISTICS SUB-

TOTALED BY CPT CODE, SERVICE ITEM CODE AND

MONTH/YEAR

» GROUPS TOTALS BY WHERE PERFORMED




MANAGEMENT MODULE

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Volume Summary of Service Item Code

by Where Performed

Volume Summary of Service Item Codes by Where PerformedPlease Note: Totals are based on Service *Entered* date

3/2008 Total

Cortex Medical

Management10021 10021 2 2

Total 2 2

3260F 3260F 24 24

Total 24 24

85097 85097 24 24

Total 24 24

87491 87491 664 664

Total 664 664

87591 87591 661 661

Total 661 661

88020 88020 1 1

Total 1 1

88029 88029 1 1

Total 1 1

88104 88104 16 16

Total 16 16

88112 88112 100 100

Total 100 100

88141 88141 537 537

G0124 26 26

Total 563 563

88142 88142 348 348

D142 4 4

Total 352 352

88148 88148 152 152

Total 152 152

88164 88164 67 67

Total 67 67

88172 88172 43 43

Total 43 43

88173 88173 66 66


GenTesting

MB417.rpt

REFERENCE FILE REPORTS

Reference File Reports by Report Number

Report Name Number Adjustment Type Code List MB001 Clinician List MB002 Clinician Location List MB003 CPT Code List MB004 Department Code List MB005 Fee Schedule List MB006 ICD Code List MB007 Payor List MB008 Place of Service Code List MB009 Service Entry Message List MB010 Service Item Code List MB011 Service Item Schedule Code List MB012 Patient Payor MB013 Type of Service Code List MB014 Patient List MB015 Provider List MB016 Specialty Code List MB017 Deposit List MB018 Service Modifier Code List MB019 Financial Classes MB020 Financial Classes Panel MB021 Payor Provider List MB023 Clearing House Report MB024 Payment Schedule MB025 Claim Filing Indicator MB026 Taxonomy Codes MB027 Remark Codes MB028 Staff Report MB029 Fee Schedule By Payor MB031 Zip Code List MB032 User Service Status Code MB035 Adjustment Reason Codes MB036 Adjustment Type Group Codes MB037 Claim Adjustment Reason Codes MB040 Claim Adjustment Group Code List MB041

Reference File Reports by Report Name

Report Name Number Adjustment Reason Codes MB036 Adjustment Type Code List MB001 Adjustment Type Group Codes MB037 Claim Adjustment Group Code List MB041 Claim Adjustment Reason Codes MB040 Claim Filing Indicator MB026 Clearing House Report MB024 Clinician List MB002 Clinician Location List MB003 CPT Code List MB004 Department Code List MB005 Deposit List MB018 Fee Schedule By Payor MB031 Fee Schedule List MB006 Financial Classes MB020 Financial Classes Panel MB021 ICD Code List MB007 Patient List MB015 Patient Payor MB013 Payment Schedule MB025 Payor List MB008 Payor Provider List MB023 Place of Service Code List MB009 Provider List MB016 Remark Codes MB028 Service Entry Message List MB010 Service Item Code List MB011 Service Item Schedule Code List MB012 Service Modifier Code List MB019 Specialty Code List MB017 Staff Report MB029 Taxonomy Codes MB027 Type of Service Code List MB014 User Service Status Code MB035 Zip Code List MB032