“Expert Medical Billing Software” - Cortex Med...“Expert Medical Billing Software” CORTEX...
Transcript of “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
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
0228361 03/13/2008 -256.00Cash discount. GS 1027887GS 0231639
0228360 03/13/2008 -87.00Cash discount. GS 1027887GS 0231640
0228359 03/13/2008 -118.00Cash discount. GS 1027887GS 0257239
0228358 03/13/2008 -88.00Cash discount. GS 1027887GS 0257240
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
» REPORT IS FOUND IN THE DAILY PROCESS MODULE
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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
» REPORT IS FOUND IN THE DAILY PROCESS MODULE
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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
Payment Total 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
Payment Total 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
Payment Total 15.00 0.00 15.00
0334102 0004 1041064 WRAY, GALEN 0.00
04/15/2009 0000000 PRIVATE PAY 0402673 20.00 0.00 20.00
Payment Total 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
Payment Total 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
Payment Total 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
Payment Total 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
Payment Total 3.00 0.00 3.00
0334107 0004 1041064 WRAY, GALEN 0.00
04/15/2009 0000000 PRIVATE PAY 0402681 1.00 0.00 1.00
Payment Total 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
» REPORT IS FOUND IN THE DAILY PROCESS MODULE
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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
Cash Receipt Amount: 30.00 Total Payments for Cash Receipt: 30.00 30.00 0.00
CH 04026700334101 PRIVATE PAY0000000THAUT, BEULAH1042116
04/15/2009 5.00 5.00 0.00
CH 04026710334101 PRIVATE PAY0000000THAUT, BEULAH1042116
04/15/2009 5.00 5.00 0.00
CH 04026720334101 PRIVATE PAY0000000THAUT, BEULAH1042116
04/15/2009 5.00 5.00 0.00
Cash Receipt Amount: 15.00 Total Payments for Cash Receipt: 15.00 15.00 0.00
CH 04026730334102 PRIVATE PAY0000000WRAY, GALEN1041064
04/15/2009 20.00 20.00 0.00
Cash Receipt Amount: 20.00 Total Payments for Cash Receipt: 20.00 20.00 0.00
CH 04026740334103 BVMG/ONE HEALTHPLAN0000134PFISTER, EDWIN0007126
04/15/2009 50.00 50.00 0.00
Cash Receipt Amount: 50.00 Total Payments for Cash Receipt: 50.00 50.00 0.00
CH 04026750334104 PRIVATE PAY0000000RICHERT, JANET0007892
04/15/2009 5.00 5.00 0.00
Cash Receipt Amount: 5.00 Total Payments for Cash Receipt: 5.00 5.00 0.00
CH 04026760334105 PRIVATE PAY0000000EGGER, SHARON0186408
04/15/2009 2.50 2.50 0.00
Cash Receipt Amount: 5.00 Total Payments for Cash Receipt: 2.50 2.50 0.00
CH 04026780334106 PRIVATE PAY0000000THAUT, BEULAH1042116
04/15/2009 1.00 1.00 0.00
CH 04026790334106 PRIVATE PAY0000000THAUT, BEULAH1042116
04/15/2009 1.00 1.00 0.00
CH 04026800334106 PRIVATE PAY0000000THAUT, BEULAH1042116
04/15/2009 1.00 1.00 0.00
Cash Receipt Amount: 3.00 Total Payments for Cash Receipt: 3.00 3.00 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
» REPORT IS FOUND IN THE DAILY PROCESS MODULE
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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
Printed:04/23/2009Page 1 of 11
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
Payment 040269304/21/2009 PRIVATE PAY -10.00
Payment 040276505/03/2009 PRIVATE PAY 10.00
Service 036323704/13/2009 LEVEL 3 TISSUE EXAM 40 0.00 0.00
Service 036323804/14/2009 LEVEL 4 TISSUE EXAM 40 160.00 0.00
04/23/2009 0311902 -160.00Change payorService Adjustment
Service 036326104/13/2009 LEVEL 4 TISSUE EXAM 27 160.00 47.00
06/18/2009 0312003 -1.00Misc. adjustmentService Adjustment
04/01/2009 0312004 40.00Posting errorService Adjustment
Payment 040276605/03/2009 PRIVATE PAY -100.00
Payment 040278005/04/2009 PRIVATE PAY 0.00
Payment 040281005/07/2009 BLUE CROSS - WYOMING -30.00
Payment 040281105/07/2009 BLUE CROSS - WYOMING -10.00
Payment 040281305/07/2009 BLUE CROSS - WYOMING -10.00
Payment 040282006/18/2009 GREAT WEST -2.00
Service 036326304/14/2009 LEVEL 4 TISSUE EXAM 27 160.00 37.00
04/01/2009 0312006 20.00Posting errorService Adjustment
Payment 040276705/03/2009 PRIVATE PAY -100.00
Payment 040281205/07/2009 BLUE CROSS - WYOMING -20.00
Payment 040281405/07/2009 BLUE CROSS - WYOMING -10.00
Payment 040281505/07/2009 BLUE CROSS - WYOMING -10.00
Payment 040281605/07/2009 BLUE CROSS - WYOMING -10.00
05/22/2009 0311988Payment Adjustment Posting error 10.00
Payment 040281905/30/2009 PRIVATE PAY -1.00
Payment 040282106/18/2009 GREAT WEST -2.00
Service 036338107/01/2009 LEVEL 4 TISSUE EXAM 40 160.00 0.00
07/01/2009 0312055 -160.00Change payorService Adjustment
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
Printed:08/14/2009Page 1 of 1
MB120.rpt
GenTesting
» DISPLAYS ALL SERVICE, PAYMENT AND
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
Description INSBalanceStatusAmountNumberDate
Service 000813908/08/2005 LEVEL 4 TISSUE EXAM 40 140.00 0.00
09/06/2005 0004389 -140.00Change payorService Adjustment
Service 001504508/08/2005 LEVEL 4 TISSUE EXAM 40 140.00 0.00
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
» DISPLAYS ALL SERVICE, PAYMENT AND
ADJUSTMENT HISTORY FOR AN ACCOUNT PLUS ALL
PATIENT NOTES AND ANY SERVICE, PAYMENT OR
ADJUSTMENT COMMENTS
» 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 and Comments
Account Details for Patient Number : 0069077
Including Notes and CommentsSmithson, Jane
2107 Elliott Ave
Seattle, WA 98121
Billing
Description INSBalanceStatusAmountNumberDate
Service 036323604/13/2009 LEVEL 4 TISSUE EXAM 40 160.00 0.00
New Service Number 0363261Comment
04/22/2009 0311894 -160.00Change payorService Adjustment
Payment 040266504/15/2009 PRIVATE PAY -50.00
Payment 040266604/15/2009 PRIVATE PAY 50.00
Payment 040269304/21/2009 PRIVATE PAY -10.00
Payment 040276505/03/2009 PRIVATE PAY 10.00
Service 036323704/13/2009 LEVEL 3 TISSUE EXAM 40 0.00 0.00
Service 036323804/14/2009 LEVEL 4 TISSUE EXAM 40 160.00 0.00
New Service Number 0363263Comment
04/23/2009 0311902 -160.00Change payorService Adjustment
Comment Changed payor information
Service 036326104/13/2009 LEVEL 4 TISSUE EXAM 27 160.00 47.00
Old Service Number 0363236Comment
06/18/2009 0312003 -1.00Misc. adjustmentService Adjustment
04/01/2009 0312004 40.00Posting errorService Adjustment
Payment 040276605/03/2009 PRIVATE PAY -100.00
Payment 040278005/04/2009 PRIVATE PAY 0.00
Applied to dedComment
Payment 040281005/07/2009 BLUE CROSS - WYOMING -30.00
Payment 040281105/07/2009 BLUE CROSS - WYOMING -10.00
Payment 040281305/07/2009 BLUE CROSS - WYOMING -10.00
Payment 040282006/18/2009 GREAT WEST -2.00
Service 036326303/14/2009 LEVEL 4 TISSUE EXAM 27 160.00 37.00
Old Service Number 0363238Comment
04/01/2009 0312006 20.00Posting errorService Adjustment
Payment 040276705/03/2009 PRIVATE PAY -100.00
Payment 040281205/07/2009 BLUE CROSS - WYOMING -20.00
Payment 040281405/07/2009 BLUE CROSS - WYOMING -10.00
Payment 040281505/07/2009 BLUE CROSS - WYOMING -10.00
Payment 040281605/07/2009 BLUE CROSS - WYOMING -10.00
05/22/2009 0311988Payment Adjustment Posting error 10.00
Payment 040281905/30/2009 PRIVATE PAY -1.00
Payment 040282106/18/2009 GREAT WEST -2.00
Service 036338107/01/2009 LEVEL 4 TISSUE EXAM 40 160.00 0.00
New Service Number 0363382Comment
07/01/2009 0312055 -160.00Change payorService Adjustment
Comment Change Payor
Service 036338207/01/2009 LEVEL 4 TISSUE EXAM 23 160.00 X 160.00
Old Service Number 0363381Comment
Printed:08/27/2009Page 1 of 2MB129.rpt
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
» REPORT IS FOUND IN THE DAILY PROCESS MODULE
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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
Page 1 of 3 Printed:4/23/2009
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
12/22/2008 0303061 -29.22Medicare write-offService Adjustment
BVMG/ONE HEALTHPLAN
04/21/2009 0311888 -90.00Change payorService Adjustment
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
12/22/2008 0303062 -53.76Medicare write-offService Adjustment
BVMG/ONE HEALTHPLAN
04/21/2009 0311890 -160.00Change payorService Adjustment
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
Subscriber Nbr0011546, FRED M.
0000221 CIGNA
P.O. BOX 60007Address
18415A850BDX
Group #
Policy #
13929W
Seattle, WA 98121
Subscriber Nbr0011546, FRED M.
Printed:05/16/2009Page 1 of 1
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
» REPORT IS FOUND IN THE DAILY PROCESS MODULE
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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
Printed:08/14/2009Page 1 of 2
MB114.rpt
GenTesting
» DISPLAYS SERVICES AT A SERVICE STATUS CODE 99
» DISPLAYS SERVICE NUMBER, FROM DATE, PATIENT
NUMBER AND NAME, BILLING DESCRIPTION, UNITS,
UNIT AMOUNT AND SERVICE AMOUNT
» USE TO FIND SERVICES NEEDING TO BE RELEASED
FOR BILLING
» REPORT IS FOUND IN THE DAILY PROCESS MODULE
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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
0363399 07/01/2009 0069219 Test, Alecia Marie LEVEL 4 TISSUE EXAM 1 0.00 0.00
0363400 07/01/2009 0069219 Test, Alecia Marie LEVEL 3 TISSUE EXAM 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
0363468 06/23/2009 0069219 Test, Alecia Marie LEVEL 3 TISSUE EXAM 1 0.00 0.00
0363469 06/23/2009 0069219 Test, Alecia Marie STAINS FOR ORGANISM 1 0.00 0.00
0363470 06/23/2009 0069219 Test, Alecia Marie LEVEL 3 TISSUE EXAM 1 0.00 0.00
0363471 07/01/2009 0069219 Test, Alecia Marie LEVEL 4 TISSUE EXAM 1 0.00 0.00
0363472 07/01/2009 0069219 Test, Alecia Marie LEVEL 3 TISSUE EXAM 1 0.00 0.00
Total Service Amount:$2,401.00
Printed:8/31/2009Page 1 of 1
MB104.rpt
GenTesting
» DISPLAYS SERVICES NOT YET BILLED
» DISPLAYS SERVICE NUMBER, FROM DATE, PATIENT
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
» REPORT IS FOUND IN THE DAILY PROCESS MODULE
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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 View19-Jun-2009 8:49SEATTLE\adigleria
NumberPatient View10-Jun-2009 16:41SEATTLE\adigleria
NumberPatient View10-Jun-2009 16:37SEATTLE\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
» 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
» GROUPS DATA BY ACTION TYPE (INSERT, UPDATE,
DELETE, VIEW) THEN SCREEN NAME
» USEFUL TO DETERMINE WHO MADE A CHANGE AND
WHEN
» REPORT IS FOUND IN THE CHANGE TRACKING
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 View06-Jul-2010 16:39SEATTLE\athomas
NumberPatient View06-Jul-2010 16:29SEATTLE\athomas
NumberPatient View06-Jul-2010 16:27SEATTLE\athomas
NumberPatient View06-Jul-2010 16:27SEATTLE\athomas
NumberPatient View06-Jul-2010 16:25SEATTLE\athomas
NumberPatient View06-Jul-2010 16:22SEATTLE\athomas
NumberPatient View06-Jul-2010 16:21SEATTLE\athomas
NumberPatient View16-Mar-2010 14:09SEATTLE\athomas
NumberPatient View16-Mar-2010 9:37SEATTLE\athomas
NumberPatient View16-Mar-2010 9:26SEATTLE\athomas
NumberPatient View16-Mar-2010 9:10SEATTLE\athomas
NumberPatient View16-Mar-2010 9:09SEATTLE\athomas
Page: 4 Printed: 1/14/2011
MB432.rpt
SP1Tst
» PROVIDES AN AUDIT TRAIL OF UPDATES, INSERTS
AND DELETES DONE TO A SERVICE
» 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 AND
WHEN
» REPORT IS FOUND IN THE CHANGE TRACKING
MODULE
Ch
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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
ICDCode2Service Insert27-Oct-2009 11:28SEATTLE\athomas SLXSR0700
ICDCode3Service Insert27-Oct-2009 11:28SEATTLE\athomas SLXSR0700
ICDCode4Service 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
Modifier2Service Insert27-Oct-2009 11:28SEATTLE\athomas SLXSR0700
Modifier3Service 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
Page: 1 Printed: 1/14/2011
MB426.rpt
SP1Tst
» PROVIDES AN AUDIT TRAIL OF UPDATES, INSERTS
AND DELETES DONE TO A SERVICE
» 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
» GROUPS DATA BY ACTION TYPE (INSERT, UPDATE,
DELETE) THEN SCREEN NAME
» USEFUL TO DETERMINE WHO MADE A CHANGE AND
WHEN
» REPORT IS FOUND IN THE CHANGE TRACKING
MODULE
Ch
an
ge
Tra
ckin
g R
ep
ort
s Change Tracking by Service and Action
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
UserText2Service Insert27-Oct-2009 11:28SEATTLE\athomas
UserText3Service Insert27-Oct-2009 11:28SEATTLE\athomas
UserText4Service 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
Page: 2 Printed: 1/14/2011
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
» REPORT IS FOUND IN THE CHANGE TRACKING
MODULE AFTER ARCHIVING IS INSTALLED
Ch
an
ge
Tra
ckin
g R
ep
ort
s Change Tracking Archive by Service Number
Medical Billing Change Tracking Archive Report Service Number: 1215089
Old Value New ValueModified_DateModified_By Table Column Action
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
UserText3Service Insert13-Aug-2008 9:38Master
UserText4Service 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
ICDCode2Service Insert 285.113-Aug-2008 9:38Master
ICDCode3Service Insert 263.913-Aug-2008 9:38Master
ICDCode4Service Insert 560.113-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
» REPORT IS FOUND IN THE CHANGE TRACKING
MODULE AFTER ARCHIVING IS INSTALLED
Ch
an
ge
Tra
ckin
g R
ep
ort
s Change Tracking Archive by Patient Number
Medical Billing Change Tracking Archive by PatientTest, Alecia Marie Patient ID: 0069219
Old Value New ValueModified_DateModified_By Table Column Action
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
NumberPatient View26-Aug-2009 10:59SEATTLE\athomas
PolicyNumberPatientPayor Insert 89089026-Aug-2009 10:59SEATTLE\athomas
GroupNumberPatientPayor Insert 89089026-Aug-2009 10:59SEATTLE\athomas
NumberPatient View26-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 View26-Aug-2009 10:57SEATTLE\athomas
NumberPatient View19-Aug-2009 14:34SEATTLE\athomas
NumberPatient View19-Aug-2009 14:26SEATTLE\athomas
NumberPatient View12-Aug-2009 15:34SEATTLE\athomas
NumberPatient View05-Aug-2009 15:29SEATTLE\athomas
NumberPatient View02-Jul-2009 16:53CORTEXSQL\Administrator
NumberPatient View02-Jul-2009 16:50CORTEXSQL\Administrator
NumberPatient View02-Jul-2009 16:49CORTEXSQL\Administrator
NumberPatient View02-Jul-2009 16:48CORTEXSQL\Administrator
NumberPatient View02-Jul-2009 16:44CORTEXSQL\Administrator
NumberPatient View02-Jul-2009 16:35CORTEXSQL\Administrator
NumberPatient View02-Jul-2009 16:06CORTEXSQL\Administrator
NumberPatient View02-Jul-2009 16:03CORTEXSQL\Administrator
NumberPatient View02-Jul-2009 16:02CORTEXSQL\Administrator
NumberPatient View02-Jul-2009 16:02CORTEXSQL\Administrator
NumberPatient View02-Jul-2009 16:00CORTEXSQL\Administrator
NumberPatient View02-Jul-2009 16:00CORTEXSQL\Administrator
Page: 1 Printed: 8/31/2009
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
Cla
im R
ep
ort
s
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
1$160.00 $160.00LEVEL 4 TISSUE EXAM0363263 4/14/2009
Balance
Payments/Adjustments
Total Claim Charges
320.00
0.00
320.00
Primary Payor: 0000018 BLUE CROSS - WYOMING Supplemental Payor:
0286839 04/15/2009 04/16/2009 Claim Billed to Payor: PrimaryPrinted ReprintedClaim
Service Number UnitsUnit Amount Total AmountBillingDescriptionFrom Date
1$160.00 $160.00LEVEL 4 TISSUE EXAM0363238 4/14/2009
Balance
Payments/Adjustments
Total Claim Charges
160.00
0.00
160.00
Primary Payor: 0000018 BLUE CROSS - WYOMING Supplemental Payor:
0286828 04/14/2009 04/14/2009 Claim Billed to Payor: PrimaryPrinted ReprintedClaim
Service Number UnitsUnit Amount Total AmountBillingDescriptionFrom Date
1$160.00 $160.00LEVEL 4 TISSUE EXAM0363238 4/14/2009
Balance
Payments/Adjustments
Total Claim Charges
160.00
0.00
160.00
Printed:05/16/2009Page 1 of 1
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
ims
Re
po
rts
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 BOROWIAK, MARY0000845 55.0003632990000010
AARP HEALTH CARE OPTIONS LYDA, AILEEN0000846 55.0003858780000010
AARP HEALTH CARE OPTIONS SCHWARTMAN, JAKOB0000847 140.0003907690000010
AARP HEALTH CARE OPTIONS KEBER, SHARON0000848 55.0010003260000010
AARP HEALTH CARE OPTIONS MASTERS, MAUREEN0002341 55.0000621970000010
AARP HEALTH CARE OPTIONS MINCH, BARBARA0002342 55.0001972030000010
AARP HEALTH CARE OPTIONS LOEFFLER, MICHELLE0002343 55.0002231430000010
AARP HEALTH CARE OPTIONS SHOWEN, REBECCA0002344 55.0002826160000010
AARP HEALTH CARE OPTIONS BOROWIAK, MARY0002345 55.0003632990000010
AARP HEALTH CARE OPTIONS LYDA, AILEEN0002346 55.0003858780000010
AARP HEALTH CARE OPTIONS SCHWARTMAN, JAKOB0002347 140.0003907690000010
AARP HEALTH CARE OPTIONS KEBER, SHARON0002348 55.0010003260000010
AARP HEALTH CARE OPTIONS MASTERS, MAUREEN0003277 55.0000621970000010
AARP HEALTH CARE OPTIONS MINCH, BARBARA0003278 55.0001972030000010
AARP HEALTH CARE OPTIONS LOEFFLER, MICHELLE0003279 55.0002231430000010
AARP HEALTH CARE OPTIONS SHOWEN, REBECCA0003280 55.0002826160000010
AARP HEALTH CARE OPTIONS BOROWIAK, MARY0003281 55.0003632990000010
AARP HEALTH CARE OPTIONS LYDA, AILEEN0003282 55.0003858780000010
AARP HEALTH CARE OPTIONS SCHWARTMAN, JAKOB0003283 140.0003907690000010
AARP HEALTH CARE OPTIONS KEBER, SHARON0003284 55.0010003260000010
AARP HEALTH CARE OPTIONS MASTERS, MAUREEN0004212 55.0000621970000010
AARP HEALTH CARE OPTIONS MINCH, BARBARA0004213 55.0001972030000010
AARP HEALTH CARE OPTIONS LOEFFLER, MICHELLE0004214 55.0002231430000010
AARP HEALTH CARE OPTIONS SHOWEN, REBECCA0004215 55.0002826160000010
AARP HEALTH CARE OPTIONS BOROWIAK, MARY0004216 55.0003632990000010
AARP HEALTH CARE OPTIONS LYDA, AILEEN0004217 55.0003858780000010
AARP HEALTH CARE OPTIONS SCHWARTMAN, JAKOB0004218 140.0003907690000010
AARP HEALTH CARE OPTIONS KEBER, SHARON0004219 55.0010003260000010
AARP HEALTH CARE OPTIONS SNAPP, ORCELIA0006106 55.0000876080000010
AARP HEALTH CARE OPTIONS FRANS, EVELYN0006107 55.0010008490000010
AARP HEALTH CARE OPTIONS SNAPP, ORCELIA0006270 55.0000876080000010
AARP HEALTH CARE OPTIONS FRANS, EVELYN0006271 55.0010008490000010
AARP HEALTH CARE OPTIONS SNAPP, ORCELIA0006437 55.0000876080000010
AARP HEALTH CARE OPTIONS FRANS, EVELYN0006438 55.0010008490000010
AARP HEALTH CARE OPTIONS SNAPP, ORCELIA0007332 55.0000876080000010
AARP HEALTH CARE OPTIONS FRANS, EVELYN0007333 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
ims
Re
po
rts
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
Cla
im R
ep
ort
s
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
Pa
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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
Date Printed: 04/14/2009Statement Number: 0131591 Statement Amount: $160.00
Service Number Service AmountService Date
0363236 $160.004/13/2009
Date Printed: 06/24/2009Statement Number: 0133642 Statement Amount: $84.00
Service Number Service AmountService Date
0363261 $160.004/13/2009
0363263 $160.004/14/2009
Printed:08/27/2009Page 1 of 1
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
» REPORT IS FOUND IN THE PATIENT STATEMENT
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
Printed:04/23/2009Page 1 of 6MB111.rpt
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
» REPORT IS FOUND IN THE PATIENT STATEMENT
BILLING MODULE
Pa
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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
» REPORT IS FOUND IN THE PATIENT STATEMENT
BILLING MODULE
Pa
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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
» REPORT IS FOUND IN THE PATIENT STATEMENT
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
Printed: 04/30/2009Page 1 of 2
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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Co
lle
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ns
an
d A
gin
g
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
Printed:05/16/2009Page 1 of 43
MB101.rpt
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» 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
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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
Printed:04/16/2009Page 3 of 3
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
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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
LEVEL 5 TISSUE EXAMBAY AREA SCHOOL/CNA
Blue Cross denied
01/08/2009 0.000396900Payment
$315.0012/21/2008 88309 465.000356409PETERSEN, AMY
LEVEL 6 TISSUE EXAMBAY AREA SCHOOL/CNA
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
» DISPLAYS ALL SERVICE, PAYMENT AND
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
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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
573.00 0.00Service 07/25/2005 0000014 CLIENT SERVICE 40
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
2,272.00 0.00Service 09/21/2005 0000032 CLIENT SERVICE 40
Payment 11/17/2005 0026812 2,272.00
1,824.00 0.00Service 10/24/2005 0000049 CLIENT SERVICE 40
Payment 01/24/2006 0046357 1,824.00
1,896.00 0.00Service 11/21/2005 0000071 CLIENT SERVICE 40
Payment 01/24/2006 0046358 1,896.00
792.00 0.00Service 09/02/2005 0000090 CLIENT SERVICE 40
Payment 02/16/2006 0053175 792.00
48.00 0.00Service 01/24/2006 0000100 CLIENT SERVICE 40
Payment 02/16/2006 0053176 48.00
1,888.00 0.00Service 01/20/2006 0000104 CLIENT SERVICE 40
Payment 03/09/2006 0059202 1,888.00
56.00 0.00Service 02/21/2006 0000113 CLIENT SERVICE 40
Payment 03/09/2006 0059203 0.00
Payment 04/20/2006 0072355 56.00
64.00 0.00Service 02/22/2006 0000114 CLIENT SERVICE 40
Payment 03/09/2006 0059204 0.00
Payment 04/20/2006 0072356 64.00
88.00 0.00Service 02/23/2006 0000118 CLIENT SERVICE 40
Payment 03/09/2006 0059205 0.00
Payment 04/20/2006 0072357 88.00
1,128.00 0.00Service 02/27/2006 0000123 CLIENT SERVICE 40
Payment 04/20/2006 0072358 1,128.00
Printed:05/16/2009Page 1 of 4
MB313.rpt
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» 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
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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
Printed:08/14/2009Page 1 of 1
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
» FOUND IN THE CLIENT STATEMENT BILLING
MODULE
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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
Printed: 04/20/2009Page 1 of 1
MB303.rpt
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» 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
» FOUND IN THE CLIENT STATEMENT BILLING
MODULE
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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
011209DBatch Number:
01/12/20090330342 BAY VALLEY
MEDICAL GRP
(BVMG)
0005001 5.00 0.00 5.000030 0398048 5.00
Batch Number: 011209D Totals: $0.00$5.00 $5.00$5.00
011509DBatch Number:
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
012609DBatch Number:
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
Batch Number: 012609D Totals: $0.00$45.00 $45.00$45.00
Grand Totals: $0.00$1,221.00 $1,221.00$1,221.00
Printed:05/16/2009Page 1 of 1
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
» FOUND IN THE CLIENT STATEMENT BILLING
MODULE
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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
Tender Number: 060402
01/12/2009 060402CH0330342 BAY VALLEY MEDICAL GRP
(BVMG)
0005001 0398048 0.00 5.00 5.00
Totals for Tender Number: 060402 0.00 5.00 5.00
Tender Number: 060451
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
Totals for Tender Number: 060451 0.00 45.00 45.00
Tender Number: 259498
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
Printed:05/16/2009Page 1 of 1
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
» FOUND IN THE CLIENT STATEMENT BILLING
MODULE
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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
MB308.rptPage 1 of 8
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
» FOUND IN THE CLIENT STATEMENT BILLING
MODULE
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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
Sample IDNumber Price DOBDOS Patient Name Code Location NameDescription
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
Sample IDNumber Price DOBDOS Patient Name Code Location NameDescription
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
Sample IDNumber Price DOBDOS Patient Name Code Location NameDescription
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
Sample IDNumber Price DOBDOS Patient Name Code Location NameDescription
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
Printed:4/15/2009Page 1 of 10
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
» FOUND IN THE CLIENT STATEMENT BILLING
MODULE
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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
Printed:04/16/2009Page 1 of 1MB314.rpt
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
» FOUND IN THE CLIENT STATEMENT BILLING
MODULE
Cli
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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
98121WASeattleC/O DEL NORTE
ADMINISTRATION
BAY VALLEY MEDICAL
GRP (BVMG)
01/06/20090000526 0005001-25.00
98121WASeattleC/O DEL NORTE
ADMINISTRATION
BAYCARE MEDICAL
GRP (BCMG) SDC
01/05/20090000527 0005002-20.00
98121WASeattleC/O DEL NORTE
ADMINISTRATION
BERKELEY FAM
PRACTICE (BERK)
12/26/20080000528 0005003-55.00
98121WASeattleC/O DEL NORTE
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
Printed:08/14/2009Page 1 of 1
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
MODULE, ‘PRINT CLIENT STATEMENTS’ SCREEN
Cli
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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
Date of Service: 1/14/2009
SUTTON, BRANDY $160.008830505/27/1957S09-000768 LEVEL 4 TISSUE EXAM 1
Date of Service: 1/22/2009
CLARK, ELIZABETH $55.008817510/29/1959L09-001972 PAP SMEAR/FOCALPT 1
Date of Service: 1/27/2009
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
ASIAN HEALTH SERVICES/CHCN
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
Seattle ServicesP.O. Box 1068 * * Seattle, WA 98121
(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
ASIAN HEALTH SERVICES/CHCN
Page 3 of 3
Seattle ServicesP.O. Box 1068 * * Seattle, WA 98121
(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
Cli
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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
4$1,976.00 00000515000051204/20/20090000091 CLIENTSTATEMENT 0004
9$1,616.00 00000511000050304/15/20090000090 CLIENTSTATEMENT 0004
2$155.00 00000502000050112/31/20080000089 CLIENTSTATEMENT 0024
9$2,291.00 00000500000049212/31/20080000088 CLIENTSTATEMENT 0024
1$0.00 00000492000049211/26/20080000087 CLIENTSTATEMENT 0024
9$2,482.00 00000491000048311/26/20080000086 CLIENTSTATEMENT 0024
2$15.00 00000482000048110/31/20080000085 CLIENTSTATEMENT 0024
8$2,789.00 00000480000047310/31/20080000084 CLIENTSTATEMENT 0024
1$0.00 00000473000047309/30/20080000083 CLIENTSTATEMENT 0024
9$2,238.00 00000472000046409/30/20080000082 CLIENTSTATEMENT 0024
1$445.00 00000463000046308/29/20080000081 CLIENTSTATEMENT 0024
7$501.00 00000462000045608/29/20080000080 CLIENTSTATEMENT 0024
1$0.00 00000456000045607/31/20080000079 CLIENTSTATEMENT 0024
12$2,113.00 00000455000044407/31/20080000078 CLIENTSTATEMENT 0024
3$230.00 00000443000044106/30/20080000077 CLIENTSTATEMENT 0024
11$2,290.00 00000440000043006/30/20080000076 CLIENTSTATEMENT 0024
1$220.00 00000429000042905/30/20080000075 CLIENTSTATEMENT 0024
12$2,252.00 00000428000041705/30/20080000074 CLIENTSTATEMENT 0024
5$401.40 00000416000041204/30/20080000073 CLIENTSTATEMENT 0024
9$2,980.00 00000411000040304/30/20080000072 CLIENTSTATEMENT 0024
4$500.00 00000402000039903/31/20080000071 CLIENTSTATEMENT 0000
9$4,411.00 00000398000039003/31/20080000070 CLIENTSTATEMENT 0000
1$0.00 00000390000039002/29/20080000069 CLIENTSTATEMENT 0024
12$2,126.00 00000389000037802/29/20080000068 CLIENTSTATEMENT 0024
3$75.00 00000377000037501/31/20080000067 CLIENTSTATEMENT 0024
9$1,774.00 00000374000036601/31/20080000066 CLIENTSTATEMENT 0024
1$0.00 00000366000036612/31/20070000065 CLIENTSTATEMENT 0029
12$1,684.00 00000365000035412/31/20070000064 CLIENTSTATEMENT 0029
1$5.00 00000353000035311/30/20070000063 CLIENTSTATEMENT 0024
11$1,265.00 00000352000034211/30/20070000062 CLIENTSTATEMENT 0024
1$10.00 00000341000034110/31/20070000061 CLIENTSTATEMENT 0024
11$2,866.00 00000340000033010/31/20070000060 CLIENTSTATEMENT 0024
1$0.00 00000330000033009/29/20070000059 CLIENTSTATEMENT 0024
1$0.00 00000330000033009/29/20070000058 CLIENTSTATEMENT 0024
1$0.00 00000330000033009/29/20070000057 CLIENTSTATEMENT 0024
Printed:05/16/2009Page 1 of 3MB311.rpt
GenTesting
PAYOR COLLECTIONS
AND
AGING REPORTS
» DISPLAYS OUTSTANDING PAYOR ACCOUNTS AGED
BY 30, 60, 90 AND 120 DAYS
» DISPLAYS THE PAYOR ACCOUNT NUMBER AND
NAME, 30/60/90/120 AMOUNTS AND TOTAL
AMOUNT DUE
» CAN BE USED TO DETERMINE COLLECTION POLICY
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
» USE FOR COLLECTIONS AND REBILLING
» FOUND IN THE COLLECTIONS AND AGING MODULE
Pa
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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
Service# Over 120 Over 90 Over 60Over 30Current.DescriptionCodeDate
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
Service# Over 120 Over 90 Over 60Over 30Current.DescriptionCodeDate
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
Service# Over 120 Over 90 Over 60Over 30Current.DescriptionCodeDate
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
Service# Over 120 Over 90 Over 60Over 30Current.DescriptionCodeDate
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
Service# Over 120 Over 90 Over 60Over 30Current.DescriptionCodeDate
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
Service# Over 120 Over 90 Over 60Over 30Current.DescriptionCodeDate
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
Service# Over 120 Over 90 Over 60Over 30Current.DescriptionCodeDate
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
» USE FOR COLLECTIONS AND REBILLING
» FOUND IN THE COLLECTIONS AND AGING MODULE
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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)
Printed:05/16/2009Page 1 of 1MB216.rpt
GenTesting
» DISPLAYS PATIENT, SERVICE AND AGING
INFORMATION BY PAYOR TYPE
» USE FOR COLLECTIONS AND REBILLING
» FOUND IN THE COLLECTIONS AND AGING MODULE
Pa
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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
Service# Over 120 Amt.
Over 90 Amt.
Over 60 Amt.Over 30 Amt.Current Amt.DescriptionCodeDate
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 0.00 160.00LEVEL 4 TISSUE EXAM01/20/2009 160.000362325 883050286105
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
Service# Over 120 Amt.
Over 90 Amt.
Over 60 Amt.Over 30 Amt.Current Amt.DescriptionCodeDate
0005349 EVANS, DOUGLAS J.
Insurance Bal.
42 CHICORY DR Seattle, WA 98121 116-10-5925
Claim
(008) 034-3035 Subscriber:
0.00 0.00 0.00 0.00 20.32LEVEL 4 TISSUE EXAM01/13/2009 20.320360154 883050286141
Patient Total $20.32 $0.00 $0.00 $0.00 $0.00 $20.32
Service# Over 120 Amt.
Over 90 Amt.
Over 60 Amt.Over 30 Amt.Current Amt.DescriptionCodeDate
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:
0.00 0.00 0.00 254.98 0.00LEVEL 4 TISSUE EXAM12/11/2008 254.980353743 883050278741
Patient Total $0.00 $254.98 $0.00 $0.00 $0.00 $254.98
Service# Over 120 Amt.
Over 90 Amt.
Over 60 Amt.Over 30 Amt.Current Amt.DescriptionCodeDate
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:
0.00 0.00 0.00 0.00 160.00LEVEL 4 TISSUE EXAM01/05/2009 160.000358828 883050283382
0.00 0.00 0.00 0.00 315.00LEVEL 5 TISSUE EXAM01/05/2009 315.000358829 883070283382
Patient Total $475.00 $0.00 $0.00 $0.00 $0.00 $475.00
Service# Over 120 Amt.
Over 90 Amt.
Over 60 Amt.Over 30 Amt.Current Amt.DescriptionCodeDate
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 0.00 21.25 0.00LEVEL 4 TISSUE EXAM12/19/2008 21.250355793 883050280506
0.00 0.00 21.25 0.00 0.00LEVEL 4 TISSUE EXAM11/25/2008 21.250350304 883050275822
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
0.00 0.00 21.25 0.00 0.00LEVEL 4 TISSUE EXAM11/25/2008 21.250350369 883050275822
Patient Total $0.00 $21.25 $246.77 $0.00 $0.00 $268.02
Printed:05/16/2009
MB211.rptPage 326 of 765
GenTesting
» DISPLAYS OUTSTANDING PAYOR ACCOUNTS AGED
BY 30, 60, 90 AND 120 DAYS
» DISPLAYS THE PAYOR ACCOUNT NUMBER AND
NAME, 30/60/90/120 AMOUNTS AND TOTAL
AMOUNT DUE
» CAN BE USED TO DETERMINE COLLECTION POLICY
ON OVERDUE ACCOUNTS
» FOUND IN THE COLLECTIONS AND AGING MODULE
Pa
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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
MB210.rptPage 1 of 1
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
na
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me
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Re
po
rts
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
» REPORT IS FOUND IN THE ANALYSIS AND AR
MANAGEMENT MODULE
Ma
na
ge
me
nt
Re
po
rts
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
Page 97 of 99 Printed:05/16/2009
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
» REPORT IS FOUND IN THE CORTEX RCM+
ADMINISTRATION MODULE
Ma
na
ge
me
nt
Re
po
rts
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
» REPORT IS FOUND IN THE ANALYSIS AND AR
MANAGEMENT MODULE
Ma
na
ge
me
nt
Re
po
rts
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
» REPORT IS FOUND IN THE ANALYSIS AND AR
MANAGEMENT MODULE
Ma
na
ge
me
nt
Re
po
rts
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
Printed:05/16/2009Page 1 of 2MB414.rpt
» 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
» REPORT IS FOUND IN THE ANALYSIS AND AR
MANAGEMENT MODULE
Ma
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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
Printed:05/16/2009Page 1 of 2MB406.rpt
» DISPLAYS COMPLETED CASES WITH
SERVICES/PROCEDURES NOT YET BILLED
» DISPLAYS ACCESSION NUMBER, PATIENT NAME,
COMPLETED DATE, SEX, BIRTH DATE AND
PROCEDURES FROM THE CASE
» USED BY CUSTOMERS WHO ALSO USE OUR
PATHOLOGY SYSTEM, THE GOLD STANDARD ®
» REPORT IS FOUND IN THE INTERFACES MODULE
Ma
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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
» USED BY CUSTOMERS WHO ALSO USE OUR
PATHOLOGY SYSTEM, THE GOLD STANDARD ®
» REPORT IS FOUND IN THE INTERFACES MODULE
Ma
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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
Page 1 of 1 Printed:4/30/2009
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
» REPORT IS FOUND IN THE ANALYSIS AND AR
MANAGEMENT MODULE
Ma
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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 25.11BVMG/ONE HEALTHPLAN 0000134 -94.89 120.00 21%
1 23.46BVMG/ONE HEALTHPLAN 0000134 -96.54 120.00 20%
1 21.25BVMG/ONE HEALTHPLAN 0000134 -98.75 120.00 18%
1 16.63BVMG/ONE HEALTHPLAN 0000134 -103.37 120.00 14%
1 13.19BVMG/ONE HEALTHPLAN 0000134 -106.81 120.00 11%
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 -%
1 84.94BVMG/ONE HEALTHPLAN 0000134 0.00 -%
2 61.98BVMG/ONE HEALTHPLAN 0000134 0.00 -%
2 61.98BVMG/ONE HEALTHPLAN 0000134 0.00 -%
1 25.46BVMG/ONE HEALTHPLAN 0000134 0.00 -%
1 25.46BVMG/ONE HEALTHPLAN 0000134 0.00 -%
1 25.46BVMG/ONE HEALTHPLAN 0000134 0.00 -%
1 17.94BVMG/ONE HEALTHPLAN 0000134 0.00 -%
Secondary Payors Average Payment 49.48 (Total C/Total A)
88305 59 LEVEL 4 TISSUE EXAM
Primary Payors
2 169.98BVMG/ONE HEALTHPLAN 0000134 -70.02 240.00 71%
1 84.99BVMG/ONE HEALTHPLAN 0000134 -35.01 120.00 71%
1 84.99BVMG/ONE HEALTHPLAN 0000134 -35.01 120.00 71%
1 84.99BVMG/ONE HEALTHPLAN 0000134 -35.01 120.00 71%
1 84.99BVMG/ONE HEALTHPLAN 0000134 -35.01 120.00 71%
1 84.99BVMG/ONE HEALTHPLAN 0000134 -35.01 120.00 71%
1 84.99BVMG/ONE HEALTHPLAN 0000134 -35.01 120.00 71%
1 84.99BVMG/ONE HEALTHPLAN 0000134 -35.01 120.00 71%
1 84.99BVMG/ONE HEALTHPLAN 0000134 -35.01 120.00 71%
1 84.99BVMG/ONE HEALTHPLAN 0000134 -35.01 120.00 71%
1 80.74BVMG/ONE HEALTHPLAN 0000134 -39.26 120.00 67%
Primary Payors Average Payment 84.64 (Total C/Total A)
88305 ZS LEVEL 4 TISSUE EXAM
Primary Payors
1 60.25MEDI-CAL MED 136B -59.75 120.00 50%
Primary Payors Average Payment 60.25 (Total C/Total A)
88307 LEVEL 5 TISSUE EXAM
Primary Payors
Page 24 of 34 Printed:5/16/2009
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
» REPORT IS FOUND IN THE ANALYSIS AND AR
MANAGEMENT MODULE
Ma
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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
Page 1 of 1 Printed:5/16/2009
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
» REPORT IS FOUND IN THE CORTEX RCM+
ADMINISTRATION MODULE
Ma
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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
Page 1 of 1 Printed: 01/24/2011
MB132.rpt
SP1Tst
» SUMMARIZES BEGINNING AND ENDING A/R
BALANCE FOR EACH DAY
» USE TO AUDIT AGAINST SERVICE, PAYMENT AND
ADJUSTMENT BATCH REPORTS
» REPORT IS FOUND IN THE ANALYSIS AND AR
MANAGEMENT MODULE
Ma
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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
Printed:05/16/2009Page 1 of 1
MB400.rpt
» DISPLAYS REVENUE FOR CLIENT PAYMENTS BASED
ON PROVIDER
» REPORT IS FOUND IN THE CLIENT STATEMENT
BILLING MODULE
Ma
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Daily Client Revenue by Provider
Ma
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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
» REPORT IS FOUND IN THE ANALYSIS AND AR
MANAGEMENT MODULE
Ma
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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
Printed:05/16/2009Page 1 of 1
GenTesting
MB601.rpt
» DISPLAYS REVENUE BY PRIMARY SCREENER BY DAY
» USE FOR PERFORMANCE EVALUATIONS
» REPORT IS FOUND IN THE ANALYSIS AND AR
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
Page 1 of 1 Printed:5/16/2009
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
» REPORT IS FOUND IN THE CORTEX RCM+
ADMINISTRATION MODULE
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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
» REPORT IS FOUND IN THE ANALYSIS AND AR
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
Printed:05/16/2009Page 1 of 1
M212.rpt
GenTesting
» DISPLAYS AGING INFORMATION BY FINANCIAL
CLASS
» PROVIDES QUICK SUMMARY OF AGING
» REPORT IS FOUND IN THE ANALYSIS AND AR
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
Page 1 of 1 Printed: 05/16/2009
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
PATHOLOGY SYSTEM, THE GOLD STANDARD ®
» REPORT IS FOUND IN THE ANALYSIS AND AR
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
Page 1 of 1 Printed:5/16/2009
MB418.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
PATHOLOGY SYSTEM, THE GOLD STANDARD ®
» REPORT IS FOUND IN THE ANALYSIS AND AR
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
Page 1 of 1 Printed:5/16/2009
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
» REPORT IS FOUND IN THE ANALYSIS AND AR
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
Service Item Code Billing Description Units Amount
87491 CHLAMYDIA TESTING 5 $365.00
87591 GONORRHEA TESTING 5 $365.00
88141 PHYS INTERP OF PAP 10 $350.00
88142 PAP SMEAR/LIQUID 9 $495.00
88174 PAP SMEAR/LIQU/AUTO 6 $330.00
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
Service Item Code Billing Description Units Amount
99000 MISC CHARGE 1 $15.00
99005 MISC CHG-INTEREST 1 $0.01
2 $15.01Total
BLUFORD, BRENDA
Service Item Code Billing Description Units Amount
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
88174 PAP SMEAR/LIQU/AUTO 18 $990.00
88175 PAP SMEAR/FOCALPT 323 $17,765.00
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
Service Item Code Billing Description Units Amount
88141 PHYS INTERP OF PAP 3 $105.00
88142 PAP SMEAR/LIQUID BS 2 $110.00
88174 PAP SMEAR/LIQU/AUTO 6 $330.00
88175 PAP SMEAR/FOCALPT 71 $3,905.00
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
Service Item Code Billing Description Units Amount
87491 CHLAMYDIA TESTING 8 $600.00
87591 GONORRHEA TESTING 8 $600.00
88141 PHYS INTERP OF PAP 8 $280.00
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
» USEFUL TO CUSTOMERS WHO ALSO USE OUR
PATHOLOGY SYSTEM, THE GOLD STANDARD ®
» REPORT IS FOUND IN THE CORTEX RCM+
ADMINISTRATION MODULE
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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
» REPORT IS FOUND IN THE CORTEX RCM+
ADMINISTRATION MODULE
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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
0000221Missing Related Payor:
0322378 MCCALL, CAROL 0000021 BAY AREA SCHOOL/CNA
0000048Missing Related Payor:
0354060 SLAUGHTER, LAURA 0000021 BAY AREA SCHOOL/CNA
0000134Missing Related Payor:
1016102 WESCH, DEAN 0000021 BAY AREA SCHOOL/CNA
0000536Missing Related Payor:
1030970 OSHEIM, HELEN 0000021 BAY AREA SCHOOL/CNA
0000536Missing Related Payor:
0380878 HUTFLESS, DANIELLE 0000023 CBSA - MINNETONKA
0000071Missing Related Payor:
0069072 NOVAK, LUCILLE 0000023 CBSA - MINNETONKA
0000163Missing Related Payor:
1002434 BRUCE, JENNIFER 0000066 BLUE CROSS PRUDENT BUYER
0000136Missing Related Payor:
0367703 KLOCH, KAREN 0000069 BLUE CROSS PRUDENT BUYER
0000536Missing Related Payor:
0080207 WERTH, NATALIE 0000102 BLUE CROSS/CA CARE MISSION IPA
0000134Missing Related Payor:
0258402 HEITMAN, LAVONNE 0000134 BVMG/ONE HEALTHPLAN
0000136Missing Related Payor:
0275860 GARCELON, HELEN 0000134 BVMG/ONE HEALTHPLAN
0000021Missing Related Payor:
0038720 MAY, SHARON 0000134 BVMG/ONE HEALTHPLAN
0000021Missing Related Payor:
0050686 KALLWEIT, LENORA 0000134 BVMG/ONE HEALTHPLAN
21BMissing Related Payor:
0097740 EGGERSS, KAY 0000134 BVMG/ONE HEALTHPLAN
0000021Missing Related Payor:
0431608 CARTER, STEVE 0000134 BVMG/ONE HEALTHPLAN
0000126Missing Related Payor:
0365799 HULL, MILDRED 0000134 BVMG/ONE HEALTHPLAN
0000021Missing Related Payor:
1040021 SMITH, MARY 0000134 BVMG/ONE HEALTHPLAN
0000025Missing Related Payor:
1029219 KOZISEK, RAMONA 0000135 BVMG/PACIFICARE
0000017Missing Related Payor:
0345651 EDWARDS, MARLEE 0000135 BVMG/PACIFICARE
0000063Missing Related Payor:
0398133 JOHNSON, TIFFANY 0000135 BVMG/PACIFICARE
0000063Missing Related Payor:
Page 1 of 2 Printed:05/16/2009
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
» REPORT IS FOUND IN THE ANALYSIS AND AR
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
Printed: 8/27/2009Page 1 of 3
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
» REPORT IS FOUND IN THE CORTEX RCM+
ADMINISTRATION MODULE
Ma
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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.
Entered By 04/15/2009Entered DateThomas, Alecia Type B
Insurance ChangeNote Field 1
Note Field 2 Patient called back and gave update on insurance information . We had the policy number incorrect
Entered By 04/16/2009Entered DateThomas, Alecia Type B
Insurance rebilledNote Field 1
Note Field 2 Insurance rebilled with corrected information
Printed:08/28/2009Page 1 of 4
MB127.rpt
GenTesting
Smithson, Jane2107 Elliott Ave
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 Date 2 User Text 1
User Text 2 User Text 3
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 Date 2 User Text 1
User Text 2 User Text 3
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
Payment 04/15/2009 PRIVATE PAY -50.00
Payment 04/15/2009 PRIVATE PAY 50.00
Payment 04/21/2009 PRIVATE PAY -10.00
Payment 05/03/2009 PRIVATE PAY 10.00
Printed:08/28/2009Page 2 of 4
MB127.rpt
GenTesting
Smithson, Jane2107 Elliott Ave
0069077
Seattle, WA 98121
INS #BalanceAmountDate Billing Description
Service 04/13/2009 LEVEL 3 TISSUE EXAM 0.00 0.00 0005012
KRONE, CARMELReferred By:
ICD1: ICD2: ICD3: ICD4:
Modifier 3: Modifier 2:Modifier 1:88304CPT:
PaidStatus:
INS #BalanceAmountDate Billing Description
Service 04/14/2009 LEVEL 4 TISSUE EXAM 160.00 0.00 0000018
KRONE, CARMELReferred By:
ICD1: ICD2: ICD3: ICD4:
Modifier 3: Modifier 2:Modifier 1:88305CPT:
PaidStatus:
04/23/2009 -160.00Change payorService Adjustment
INS #BalanceAmountDate Billing Description
Service 04/13/2009 LEVEL 4 TISSUE EXAM 160.00 47.00 0000018
KRONE, CARMELReferred By:
ICD1: ICD2: ICD3: ICD4:
Modifier 3: Modifier 2:Modifier 1:88305CPT:
Awaiting Patient PaymentStatus:
06/18/2009 -1.00Misc. adjustmentService Adjustment
04/01/2009 40.00Posting errorService Adjustment
Payment 05/03/2009 PRIVATE PAY -100.00
Payment 05/04/2009 PRIVATE PAY 0.00
Payment 05/07/2009 BLUE CROSS - WYOMING -30.00
Payment 05/07/2009 BLUE CROSS - WYOMING -10.00
Payment 05/07/2009 BLUE CROSS - WYOMING -10.00
Payment 06/18/2009 GREAT WEST -2.00
INS #BalanceAmountDate Billing Description
Service 03/14/2009 LEVEL 4 TISSUE EXAM 160.00 37.00 0000018
KRONE, CARMELReferred By:
ICD1: ICD2: ICD3: ICD4:
Modifier 3: Modifier 2:Modifier 1:88305CPT:
Awaiting Patient PaymentStatus:
04/01/2009 20.00Posting errorService Adjustment
Payment 05/03/2009 PRIVATE PAY -100.00
Payment 05/07/2009 BLUE CROSS - WYOMING -20.00
Payment 05/07/2009 BLUE CROSS - WYOMING -10.00
Payment 05/07/2009 BLUE CROSS - WYOMING -10.00
Payment 05/07/2009 BLUE CROSS - WYOMING -10.00
05/22/2009Payment Adjustment Posting error 10.00
Payment 05/30/2009 PRIVATE PAY -1.00
Payment 06/18/2009 GREAT WEST -2.00
INS #BalanceAmountDate Billing Description
Service 07/01/2009 LEVEL 4 TISSUE EXAM 160.00 0.00 0000018
KRONE, CARMELReferred By:
ICD1: ICD2: ICD3: ICD4:
Modifier 3: Modifier 2:Modifier 1:88305CPT:
PaidStatus:
07/01/2009 -160.00Change payorService Adjustment
Printed:08/28/2009Page 3 of 4
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
» REPORT IS FOUND IN THE CORTEX RCM+
ADMINISTRATION MODULE
Ma
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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
Page 1 of 1 Printed: 05/16/2009
mb130.rpt
» DISPLAYS PAYMENT COUNTS AND AMOUNTS SUB-
TOTALED BY YEAR, MONTH, DEPARTMENT AND
PAYOR TYPE
» REPORT IS FOUND IN THE ANALYSIS AND AR
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
6,724.74Commercial Insurance Company
17,044.21Blue Cross and Blue Shield
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
2,593.75Commercial Insurance Company
5,589.54Blue Cross and Blue Shield
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
1,876.15Commercial Insurance Company
3,470.20Blue Cross and Blue Shield
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
Page 1 of 2 Printed:05/16/2009
» DISPLAYS PAYMENTS RECEIVED BY LOCATION,
SERVICE ITEM AND PAYOR
» REPORT IS FOUND IN THE ANALYSIS AND AR
MANAGEMENT MODULE
Ma
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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
G 147.82BLUE CROSS/BLUE SHIELD
P2361 $147.82Oil Red O Stain
P2470 Surg Path Special Stain Group I
C 44.40MEDICARE
D 193.99MEDICAID
E 11.10OTHER FEDERAL PROGRAM
F 143.05COMMERCIAL INSURANCE COMPANY
G 390.66BLUE CROSS/BLUE SHIELD
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
G 276.85BLUE CROSS/BLUE SHIELD
I 120.00HMO
N 81.66MANAGED CARE
P2471 $486.71Special Stain Group II
P2472 Surg Path Immunohistochemistry
D 90.32MEDICAID
E 26.23OTHER FEDERAL PROGRAM
F 174.84COMMERCIAL INSURANCE COMPANY
G 229.89BLUE CROSS/BLUE SHIELD
P2472 $521.28Surg Path Immunohistochemistry
Page 1 of 66 Printed: 8/27/2009
MB215.rpt
» DISPLAYS PAYMENTS RECEIVED BY LOCATION AND
PAYOR. NOTE: USES THE PAYOR ON THE CASH
RECEIPT RECORD
» REPORT IS FOUND IN THE ANALYSIS AND AR
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
» REPORT IS FOUND IN THE ANALYSIS AND AR
MANAGEMENT MODULE
Ma
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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%
Page 1 of 1 Printed: 08/21/2009
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
» REPORT IS FOUND IN THE DAILY PROCESS MODULE
Ma
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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
0394746 Blue Cross denied 8759101/02/2009
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
0394694 Blue Cross denied 8830701/02/2009
0394695 Blue Cross denied 8830901/02/2009
0394686 Blue Cross denied 8833101/02/2009
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
0394814 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
Page 1 of 2 Printed:7/20/2010
MB610.rpt
» DISPLAYS REVENUE INFORMATION BY PAYOR.
NOTE: USES THE PAYOR ON THE SERVICE
» REPORT IS FOUND IN THE ANALYSIS AND AR
MANAGEMENT MODULE
Ma
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Payor Revenue Report
Payor Revenue Reportfor
Seattle Services
Payor Services
Service
Adjustments Payments
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
Service + Client Totals: 0.00 20.00 -5.00 15.00 0.00
-415.67 519.33 0.00BLUE CROSS #0000028 935.00 0.00
0.00Client Totals: 0.00 0.00 0.00 0.00
Service + Client Totals: 0.00 935.00 -415.67 519.33 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
Service + Client Totals: 0.00 260.00 -72.56 187.44 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
Service + Client Totals: 0.00 145.00 -18.00 127.00 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
Service + Client Totals: 0.00 215.00 -71.75 143.25 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
Service + Client Totals: 0.00 670.00 -236.20 433.80 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
» REPORT IS FOUND IN THE ANALYSIS AND AR
MANAGEMENT MODULE
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Payor Revenue Report Detail
Payor Revenue Report Detailfor
Seattle Services
Payor Services
Service
Adjustments Payments
Payment
Adjustments New AR
Client Service # 55.00 -23.71 31.29 0.00Service # 0283260
Client Service # 55.00 -23.71 31.29 0.00Service # 0287321
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
Service + Client Totals: 0.00 110.00 -47.42 62.58 0.00
Client Service # 55.00 -55.00 0.00 0.00Service # 0282734
Client Service # 95.00 -28.30 66.70 0.00Service # 0282952
Client Service # 160.00 -47.03 112.97 0.00Service # 0283920
Client Service # 35.00 -9.57 25.43 0.00Service # 0284383
Client Service # 55.00 -14.29 40.71 0.00Service # 0284384
Client Service # 320.00 -244.06 75.94 0.00Service # 0284847
Client Service # 800.00 -235.15 564.85 0.00Service # 0285584
Client Service # 55.00 -14.29 40.71 0.00Service # 0286545
Client Service # 55.00 -25.39 29.61 0.00Service # 0286985
Client Service # 55.00 -14.29 40.71 0.00Service # 0287459
Client Service # 55.00 -14.29 40.71 0.00Service # 0288080
Client Service # 55.00 -14.29 40.71 0.00Service # 0288779
Client Service # 75.00 -21.06 53.94 0.00Service # 0288780
Client Service # 75.00 -21.06 53.94 0.00Service # 0288781
Client Service # 55.00 -14.29 40.71 0.00Service # 0289610
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
» REPORT IS FOUND IN THE ANALYSIS AND AR
MANAGEMENT MODULE
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Payor Type Revenue Report
Payor Type Revenue Reportfor
Seattle Services
Payor Type Services
Service
Adjustments Payments
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
BLUE CROSS PRUDENT BUYER
#0000076
1,683.00 0.00-527.01 1,155.99 0.00
BLUE CROSS PRUDENT BUYER
#0000077
165.00 0.00-8.87 156.13 0.00
BLUE CROSS PRUDENT BUYER
#0000081
260.00 0.00-205.00 55.00 0.00
BLUE CROSS PRUDENT BUYER
#0000082
55.00 0.00-14.04 40.96 0.00
BLUE CROSS PRUDENT BUYER
#0000084
55.00 0.00-55.00 0.00 0.00
BLUE CROSS PRUDENT BUYER
#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
MB404.rptPage 1 of 6
» 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
» REPORT IS FOUND IN THE ANALYSIS AND AR
MANAGEMENT MODULE
Ma
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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
BY-SERVICE-ENTERED-DATE
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
88307 LEVEL 5 TISSUE EXAM 29 9,015.00 132 39,400.00
88309 LEVEL 6 TISSUE EXAM 3 1,395.00 10 4,475.00
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
Printed: 05/16/2009Page 4 of 14MB407.rpt
» DISPLAYS ORDERING PATTERNS BY REFERRING
CLINICIAN, LOCATION AND SERVICE ITEM CODE
» CAN BE RUN FOR ANY DATE RANGE
» REPORT IS FOUND IN THE ANALYSIS AND AR
MANAGEMENT MODULE
Ma
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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
88304 LEVEL 3 TISSUE EXAM 95.00 1
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
88305 LEVEL 4 TISSUE EXAM 140.00 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
88304 LEVEL 3 TISSUE EXAM 190.00 2
88305 LEVEL 4 TISSUE EXAM 2,400.00 15
88307 LEVEL 5 TISSUE EXAM 1,240.00 4
88311 DECALCIFICATION 348.00 12
Total : 4,213.00 34ABC Clinic #0000053
ABC Clinic #0000194
88300 LEVEL I GROSS EXAM 175.00 5
88304 LEVEL 3 TISSUE EXAM 190.00 2
88305 LEVEL 4 TISSUE EXAM 160.00 1
88311 DECALCIFICATION 29.00 1
Total : 554.00 9ABC Clinic #0000194
ABC Clinic #0000243
88300 LEVEL I GROSS EXAM 315.00 9
88304 LEVEL 3 TISSUE EXAM 285.00 3
88305 LEVEL 4 TISSUE EXAM 640.00 4
88307 LEVEL 5 TISSUE EXAM 315.00 1
88311 DECALCIFICATION 145.00 5
Total : 1,700.00 22ABC Clinic #0000243
Total : 6,467.00ABELE, EVELYN 65
GenTesting
Printed: 05/16/2009Page 3 of 387MB410.rpt
» 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
» REPORT IS FOUND IN THE ANALYSIS AND AR
MANAGEMENT MODULE
Ma
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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
87491 CHLAMYDIA TESTING 0 0.00 0 0.00
87591 GONORRHEA TESTING 0 0.00 0 0.00
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
87491 CHLAMYDIA TESTING 0 0.00 0 0.00
87591 GONORRHEA TESTING 0 0.00 0 0.00
88174 PAP SMEAR/LIQU/AUTO 0 0.00 0 0.00
ABC Clinic #0000026 Total : 0 $0.00 0 $0.00
ABC Clinic #0000069
87491 CHLAMYDIA TESTING 0 0.00 3 225.00
87591 GONORRHEA TESTING 0 0.00 3 225.00
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
88305 LEVEL 4 TISSUE EXAM 0 0.00 0 0.00
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
88305 LEVEL 4 TISSUE EXAM 0 0.00 0 0.00
ABC Clinic #0000216 Total : 0 $0.00 0 $0.00
ABC Clinic #0000218
87491 CHLAMYDIA TESTING 0 0.00 0 0.00
Page 9 of 451
GenTesting
Printed:08/31/2009
MB409.rpt
» DISPLAYS REVENUE RECEIVED BY WHERE THE
SERVICE WAS PERFORMED
» DISPLAYS TOTALS BY MONTH
» REPORT IS FOUND IN THE ANALYSIS AND AR
MANAGEMENT MODULE
Ma
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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
Printed: 5/16/2009Page 1 of 1
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
» REPORT IS FOUND IN THE ANALYSIS AND AR
MANAGEMENT MODULE
Ma
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Service Item Revenue Report
Service Item Revenue Reportfor
Seattle Services
Service
Department/
BY-SERVICE-ENTERED-DATE
YEAR-TO June 2007
BY-SERVICE-ENTERED-DATE
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
» REPORT IS FOUND IN THE ANALYSIS AND AR
MANAGEMENT MODULE
Ma
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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
10,835.00 197Commercial Insurance Company
29,315.00 533Blue Cross and Blue Shield
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
2,550.00 34Commercial Insurance Company
9,900.00 132Blue Cross and Blue Shield
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
2,089.00 13Commercial Insurance Company
3,264.00 22Blue Cross and Blue Shield
4,349.00 25Blue Cross
375.00 3VA Plan
551.00 3Other
SPEC CYTO (NON GYNS) TOTAL $31,766.00 198
GenTesting
Printed:05/16/2009Page 4 of 86MB603.rpt
» DISPLAYS TOTAL PAYMENTS RECEIVED BY CLIENT
» CAN BE RUN BY PAYMENT ENTERED DATES OR FOR
A SPECIFIC CLIENT
» REPORT IS FOUND IN THE ANALYSIS AND AR
MANAGEMENT MODULE
Ma
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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
Printed:08/28/2009Page 1 of 1
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
» REPORT IS FOUND IN THE ANALYSIS AND AR
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
Page 1 of 4 Printed:5/16/2009
MB411.rpt
» DISPLAYS ALL SERVICE ITEM AND CPT CODE CODES
FOR TOP 10 SERVICE ITEM 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 VOLUME
» REPORT IS FOUND IN THE ANALYSIS AND AR
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
» RUN THE REPORT FOR A RANGE OF DATES AND/OR
SPECIFIC SERVICE ITEM CODE
» REPORT IS FOUND IN THE ANALYSIS AND AR
MANAGEMENT MODULE
Ma
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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
Page 1 of 4 Printed:5/16/2009
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