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					Run Date and Time                                                                                                                 Stop Loss Claimant Diagnosis Summary For MISSION
10/04/2010 21:24                                                                                                                     Paid 10/2009 thru 09/2010 Total Paid > 022500




         Group Name      Identifier   Dep   Eff Dt    Ben Dt Cov End      DOB Age Sex     Status   Unprocessed Claims Chg      Open Mail Claims Chg    Copay RX Chg Total Chg Copay RX Paid Total Paid    Lifetime Max     Diag 1           Diag 1 Desc        Diag 2            Diag 2 Desc      Diag 3
         MISSION       8802            s    10/1/09   10/1/09            6/29/51 59 f   Active                          0.00                      0.00     11,451.96   67,503.96   10,064.96  29,609.29        48,010.70   25000    DM2/NOS UNCOMP NSU         4139     ANGINA PECTORIS NEC&NOS   41401
         MISSION       2030            e    10/1/09   10/1/09            3/27/50 60 f   Active                          0.00                      0.00         367.79  70,046.90      295.06  47,042.43        58,562.94   V103     HX BREAST CA               45340    DVT LEG NOS               V4571
         MISSION       1464            e    10/1/09   10/1/09  5/23/10   8/27/57 53 m   Inactive                        0.00                      0.00       2,066.23 130,440.63    1,842.85  53,456.00        80,501.30   34590    EPILEPSY NOS W/O INTRACT   47819    OTHER DISEASES OF NASAL   53081
         MISSION       6208            e    10/1/09   10/1/09 10/21/09   6/10/60 50 m   Inactive                      267.78                      0.00         161.83 110,047.88      111.83  64,375.40       501,904.96   43491    CEREB ART OCCL W INFARCT   51881    AC RESPIRATORY FAILURE    78001
         MISSION       4532            1    10/1/09   10/1/09            1/29/02  8 f   Active                          0.00                      0.00     35,059.55   38,487.55   34,706.52  36,058.71        21,750.24   7586     GONADAL DYSGENESIS         38200    ACUTE SOM NOS             37202
         MISSION       9135            e    10/1/09   10/1/09             1/4/51 59 m   Active                          0.00                      0.00         377.60 306,564.43      274.14 162,703.97       165,157.92   1890     KIDNEY CA NEC              5990     URINARY TRACT INF NOS     72886
         MISSION       7460            e    10/1/09   10/1/09            7/25/58 52 f   Active                     15,552.00                    225.00       3,433.81 102,692.87    3,160.24  23,216.24        30,637.80   7260     ADHESIVE CAPS-SHOULDER     8406     SUPRASPINATUS SPRAIN      7262
         MISSION       6763            e    10/1/09   10/1/09  8/31/10   8/31/76 34 m   Inactive                        0.00                      0.00         735.91 112,836.91      573.52  30,292.21        29,718.69   4019     HYPERTENSION NOS           57400    GB CAL W ACUTE CHOL       32723
         MISSION       9167            3    10/1/09   1/11/10            1/11/10  0 f   Active                          0.00                      0.00         190.60  79,443.52      113.07  56,150.32        56,037.25   6822     TRUNK CELLULITIS           99859    POSTOP INFECTION NEC      V4589
         MISSION       1413            1    10/1/09   10/1/09            5/16/94 16 m   Active                          0.00                      0.00          93.61  55,229.86       46.94  28,793.92        48,637.40   920      CONTUSION HEAD X EYE       8470     NECK SPRAIN               8505
         MISSION       7746            e    10/1/09   10/1/09            10/7/75 34 m   Active                     81,662.30                 18,157.00     46,337.47 350,392.69    45,542.32 142,161.41       172,428.76   1911     FRONTAL LOBE CA            V580     RADIOTHERAPY ENCOUNTER    V5869




710163ed-e02e-4bb4-afcc-18ba8563dc7b.xlsx                                                                                                            Page 1 of 2
Run Date and Time                                                         Stop Loss Claimant Diagnosis Summary For MISSION
10/04/2010 21:24                                                             Paid 10/2009 thru 09/2010 Total Paid > 022500




                                                     Diag 3 Desc       Diag 4             Diag 4 Desc       Diag 5            Diag 5 Desc         Plan#
                                            COR AS-NATIVE VESSEL       4019     HYPERTENSION NOS            53510    ATROPH GASTRITIS S HEMOR   LTBrj0SQ
                                            ACQ ABSENCE OF BREAST      V1582    HX TOBACCO USE              41401    COR AS-NATIVE VESSEL       LTBrjdSQ
                                            ESOPHAGEAL REFLUX          2704     SULPHUR AA METAB DISTURB    2724     HYPERLIPIDEMIA NEC & NOS   LTBrjcSQ
                                            COMA                       5070     FOOD/VOMIT PNEUMONITIS      4280     CHF NOS                    LTBrjdSQ
                                            AC FOLLIC CONJUNCTIVITIS   37835    ACCOMMODATIVE ESOTROPIA     11282    CANDIDAL OTITIS EXTERNA    LTBrjdSQ
                                            NECROTIZING FASCIITIS      5849     ACUTE RENAL FAILURE NOS     78552    SEPTIC SHOCK               LTBrjcSQ
                                            SHOULD REGION DISORD NEC   71941    JOINT PAIN-SHOULDER         25000    DM2/NOS UNCOMP NSU         LTBrjdSQ
                                            OBSTRUCTIVE SLEEP APNEA    5180     PULMONARY COLLAPSE          27800    OBESITY NOS                LTBrjcSQ
                                            POSTSURGICAL STATES NEC    55321    INCISIONAL HERNIA           7505     CONG PYLORIC STENOSIS      LTBrjdSQ
                                            CONCUSSION W COMA NOS      E8282    RIDDEN ANIMAL ACC-RIDER     E8490    HOME ACCIDENTS             LTBrjdSQ
                                            LONG-TERM USE MEDS NEC     1918     BRAIN CA NEC                41519    PULMON EMBOL/INFARCT NEC   LTBrjdSQ




710163ed-e02e-4bb4-afcc-18ba8563dc7b.xlsx                                                    Page 2 of 2

				
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