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					                                                                                  Attachment A-1
                                                                    Northwest Portland Area Indian Health Board
                                                       Estimated FY 2007 Medicare Fee-for-Service Inpatient Hospital Case Rates

                                                                                                         Calculation of Inpatient Hospital Conversion Factor by Facility
Medicare Provider ID                                                                       380089              380037                500050               380007             380009
                                                                                       Legacy Meridian       Providence          S W Washington      Legacy Emanuel        Ohsu Hospital
                                                                                        Park Hospital     Newberg Medical         Medical Center         Hospital           And Clinics
                                                                                                                Center


Operating Amount
   (a) Regional Wage Index                                                                      1.1210               1.1210               1.1210               1.1210              1.1210
   (b) NAOSA, Labor                                                             x             3,397.52             3,397.52             3,397.52             3,397.52            3,397.52
   (c) Adjusted Labor Amount (a)x(b)                                                          3,808.62             3,808.62             3,808.62             3,808.62            3,808.62

   (d) NAOSA, Non-Labor                                                                       1,476.97             1,476.97             1,476.97             1,476.97            1,476.97
   (e) COLA                                                                     x               1.0000               1.0000               1.0000               1.0000              1.0000
    (f) Adjusted NonLabor Amount (d)x(e)                                                      1,476.97             1,476.97             1,476.97             1,476.97            1,476.97

   (g) Total Adjusted Operating Amount (c)+(f)                                                5,285.59             5,285.59             5,285.59             5,285.59            5,285.59

   (h) DSH %                                                                                       -                0.0430                0.1274               0.2434              0.2562
    (i) IME %                                                                                      -                   -                  0.0297               0.0650              0.2903

    (j) Disproportionate Share Amount (g)x(h)                                                     -                 227.28                673.38             1,286.51            1,354.17
   (k) Indirect Medical Education Amount (g)x(i)                                                  -                    -                  157.04               343.78            1,534.66

    (l) Subtotal Operating (g)+(j)+(k)                                                        5,285.59             5,512.87             6,116.02             6,915.88            8,174.41

Capital Amount
   (o) GAF                                                                                     1.0814               1.0814                1.0814               1.0814              1.0814
   (p) National Capital Standard Federal Rate                                   x              427.03               427.03                427.03               427.03              427.03
   (q) Large Urban Area Adj.                                                    x                 1.03                 1.03                  1.03                 1.03                1.03
    (r) COLA                                                                    x              1.0000               1.0000                1.0000               1.0000              1.0000
   (s) Adjusted Capital Amount (o)x(p)x(q)x(r)                                                 475.64               475.64                475.64               475.64              475.64

    (t) DSH %                                                                                  0.0212                   -                 0.0595               0.0901              0.0935
   (u) IME %                                                                                      -                     -                 0.0202               0.0587              0.2517

    (v) Disproportionate Share Amount (s)x(t)                                                   10.08                   -                  28.30                42.86               44.47
   (w) Indirect Medical Education Amount (s)x(u)                                                  -                     -                   9.60                27.92              119.70

   (x) Subtotal Capital (q)+(t)+(u)                                                            485.73               475.64                513.54               546.42              639.81

Total Amount (l)+(x)                                                                          5,771.32             5,988.51             6,629.56             7,462.30            8,814.23

Pass Through Amount (per diem)²                                                                   9.66                 8.11                33.48                75.23              290.94

                                                                                                                 Case Rates for Specific DRGs by Hospital
                                                                                                            Providence
                                                                              DRG      Legacy Meridian    Newberg Medical     S W Washington     Legacy Emanuel            Ohsu Hospital
DRG DRG Description                                                           Weight    Park Hospital         Center           Medical Center        Hospital               And Clinics

  1    Craniotomy Age >17 W Cc                                                3.4651          $19,998              $20,751              $22,972              $25,858              $30,542
  88   Chronic Obstructive Pulmonary Disease                                  0.8878           $5,124               $5,317               $5,886               $6,625               $7,825
  89   Simple Pneumonia & Pleurisy Age >17 W Cc                               1.0376           $5,988               $6,214               $6,879               $7,743               $9,146
 106   Coronary Bypass W Ptca                                                 6.7383          $38,889              $40,352              $44,672              $50,283              $59,393
 143   Chest Pain                                                             0.5637           $3,253               $3,376               $3,737               $4,206               $4,969


Notes:
    1) Outlier payments are not shown and are assumed to be zero.
    2) The Pass Through Amount is not used in the DRG Case Rate calculation. Pass Through payments are equal to the LOS times the Pass Through per
       diem.




    pai 7/19/2011 1:37 AM
                                                                                            Milliman
    D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [IPPS]                                                                                                 Page 1 of 28
                                                                 Attachment A-2
                                                  Northwest Portland Area Indian Health Board
                                       Outlier Calculation - Ohsu Hospital And Clinics (Provider ID 380009)
                                                                                                 Non-Transfer          Line
                  Input Data
                  DRG                                                                                          7
                        DRG Relative Weight                                                               2.6609              a
                  Operating
                        Standardized Amounts
                              Labor-related                                                              3,397.52          b
                              Nonlabor-related                                                           1,476.97          c
                        CBSA Wage Index                                                                    1.1210          d
                        COLA                                                                               1.0000         d1
                        IME Operating Adjustment Factor                                                    0.2903          e
                        DSH Operating Adjustment Factor                                                    0.2562          f
                        Labor Related Portion                                                               0.697          g
                        Nonlabor Related Portion                                                            0.303          h

                  Capital
                        Federal Capital Rate                                                              427.03           j
                        Add-on                                                                             1.030           k
                        COLA                                                                               1.000          k1
                        MSA Geographic Adjustment Factor                                                  1.0814           l
                        IME Capital Adjustment Factor                                                     0.2517          m
                        DSH Capital Adjustment Factor                                                     0.0935           n




                  Step 1: Federal Rates
                  Federal Rate for Operating Costs
                    a x [(b x d)+(c x d1)] x (1+e+f) =                                                $21,751.30              i
                  Federal Rate for Capital Costs
                            a * j * k * k1 * l * (1+m+n)=                                               $1,702.48             o

                  Step 2: Determine Costs:
                        Billed Charges                                                                  $200,000              p
                        Operating Cost to Charge Ratio                                                    0.3970              q
                  Operating Costs = (Billed Charges x Operating Cost to Charge Ratio)
                        (p * q) =                                                                        $79,400              r
                  Capital Cost to Charge Ratio                                                            0.0300              s
                  Capital Costs = (Billed Charges x Capital Cost to Charge Ratio)
                        (p * s) =                                                                         $6,000              t

                  Step 3: Determine Outlier Threshold                                                FY2007
                         Fixed Loss Threshold                                                           $24,485               u
                         Operating CCR to Total CCR                                                      0.9297               v
                        ( Operating Threshold =
                  Operating Outlier CCR )/ (Operating CCR + Capital CCR) (q/(q+s))=
                  {[Fixed Loss Threshold x ((Labor
                  related portion x MSA Wage
                  Index) + Nonlabor related portion x
                           (u * ((g*d)+(h*d1))*v)+i =                                                 $46,435.95          w
                         Threshold Adjustment Factor - for Transfers                                       1.000          w1
                         Adjusted Operating Outlier Threshold    (w x w1)                             $46,435.95          w2

                        Capital CCR to Total CCR
                        [Capital CCR ) (Operating CCR + Capital CCR)] (s/(q+s))=                          0.0703              x
                  Capital Outlier Threshold = (Fixed
                  Loss Threshold x Geographic
                  Adjustment Factor x Add-On x
                           (u * l * k * k1 * x ) + o =                                                  $3,618.57          y
                        Adjusted Capital Outlier Threshold    (y x w1)                                  $3,618.57         y1

                  Step 4: Determine Outlier Payment:
                        Marginal Cost Factor                                                                    0.80          z
                        Outlier Payment = (Costs - Outlier Threshold) x Marginal Cost Factor
                  Operating                                  (r - w2) *z                              $26,371.24          aa
                  Capital                                    (t - y1) *z                               $1,905.14          bb
                  Total                                      aa+bb                                    $28,276.38

pai 7/19/2011 1:37 AM
                                                                           Milliman
D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [IPPS2]                                                          Page 2 of 28
                                                   Attachment B
                                    Northwest Portland Area Indian Health Board
                                Estimated 2007 Long-Term Care Hospital Case Rates


                                                                                       LTCH Payment Rate by Facility
Medicare Provider ID                                                                    262010             262013
                                                                                        Kindred
                                                                                      Hospital - St.   Select Specialty
                                                                                         Louis             Hospital
Payment Rate Effective 7/1/2006 to 6/30/2007
Labor Cost Calculation
  (a) Unadjusted 2007 Federal Rate                                                       $38,086.04            $38,086.04
 (b) National Labor Share %                                                     x           75.665%               75.665%
  (c) Adjusted Labor Amount (a)x(b)                                                      $28,817.80            $28,817.80

 (d)   Provider Wage Index (Full Wage Index for St. Louis, MO)                               0.8954                0.8954
 (e)   Adjusted Labor Cost (c)x(d)                                                       $25,803.46            $25,803.46

Non-Labor Cost Calculation
 (a) Unadjusted 2007 Federal Rate                                                        $38,086.04            $38,086.04
 (f) National Non-Labor Share % 1-(b)                                           x           24.335%               24.335%
 (g) Non-Labor Cost (a)x(f)                                                               $9,268.24             $9,268.24

Total Payment Rate (e)+(g)                                                               $35,071.70            $35,071.70



                                                                                    Case Rates for Specific DRGs by Hospital
                                                                           FY2007        Kindred
                                                                            DRG       Hospital - St.        Select Specialty
DRG DRG Description                                                        Weight         Louis                 Hospital

   1   Craniotomy Age >17 W Cc                                             1.6835           $59,043               $59,043
  88   Chronic Obstructive Pulmonary Disease                               0.6411           $22,484               $22,484
  89   Simple Pneumonia & Pleurisy Age >17 W Cc                            0.6802           $23,856               $23,856
 106   Coronary Bypass W Ptca                                              1.1625           $40,771               $40,771
 143   Chest Pain                                                          0.4175           $14,642               $14,642




  pai 7/19/2011 1:37 AM
                                                                 Milliman
  D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [LTC]                                                    Page 3 of 28
                                                                Attachment C-1
                                                  Northwest Portland Area Indian Health Board
                                                        Estimated 2007 IRF Case Rates


                                                                                                      Rehab Payment Rate by Facility
Medicare Provider ID                                                                                 260077                  263025

                                                                                                 ST ANTHONYS                SSM
                                                                                                   MEDICAL             REHABILITATION
                                                                                                    CENTER               INSTITUTE
Payment Rate Effective 10/1/2006 to 9/30/2007
Labor Cost Calculation
  (a) Unadjusted 2007 Federal Rate                                                                    $12,981.00               $12,981.00
  (b) National Labor Share %                                                                 x           75.612%                  75.612%
  (c) Adjusted Labor Amount (a)x(b)                                                                    $9,815.19                $9,815.19

 (d)    Provider Wage Index (Full Wage Index for St. Louis, MO)                              x            0.8954                   0.8954
 (e)    Adjusted Labor Cost (c)x(d)                                                                    $8,788.52                $8,788.52

Non-Labor Cost Calculation
 (a) Unadjusted 2007 Federal Rate                                                                     $12,981.00               $12,981.00
 (f) National Non-Labor Share % 1-(b)                                                        x           24.388%                  24.388%
 (g) Non-Labor Cost (a)x(f)                                                                            $3,165.81                $3,165.81

Wage- and Rural- Adjusted Payment
 (h) Wage-Adjusted Federal Payment (e) + (g)                                                          $11,954.33               $11,954.33
 (i) Rural Adjustment Factor (1.213 if Rural)                                                x            1.0000                   1.0000
 (j) Wage- and Rural- Adjusted Federal Payment (h)x(i)                                                $11,954.33               $11,954.33

LIP (DSH) Adjustment Calculation
  (k) LIP (DSH) Adjustment                                                                                0.0306                   0.0743
  (l) LIP (DSH) Adjustment Amount (j)x(k)                                                                $365.96                  $887.94

Teaching Status Adjustment Calculation
 (m) Teaching Status Adjustment                                                                              -                           -
 (n) Teaching Status Adjustment Amount (j)x(m)                                                             $0.00                       $0.00

 (o)    Final FY 2007 Adjusted Federal Case Rate (j)+(l)+(n)                                          $12,320.29               $12,842.27



                                                                                                  Case Rates for Specific CMGs by Hospital
                                                                                  FY2007 CMG     ST ANTHONYS                    SSM
                                                                                   Weight (No      MEDICAL                REHABILITATION
CMG CMG Description (M=motor, C=cognitive, A=age)                                 Comorbidity)      CENTER                  INSTITUTE

 0101   Stroke                       M>51.05                                            0.6347            $7,820                   $8,151
 0302   Non-traumatic brain injury M>35.05 and M<41.05                                  1.0147           $12,501                  $13,031
 0703   Fracture of lower extremity M>28.15 and M<34.15                                 1.0722           $13,210                  $13,769
 1603   Pain syndrome               M<26.75                                             1.1762           $14,491                  $15,105
 1901   Guillian Barre               M>35.95                                            0.9350           $11,519                  $12,008




   pai 7/19/2011 1:37 AM
                                                                       Milliman
   D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [Rehab]                                                  Page 4 of 28
                                                                       Attachment C-2
                                                         Northwest Portland Area Indian Health Board
                                                             Estimated 2007 IRF Outlier Payments

                                                                                     260077                 263025
                                                                                                             SSM
                                                                                ST ANTHONYS             REHABILITATION
                                                                               MEDICAL CENTER             INSTITUTE            Line

 Unadjusted 2007 Federal Rate                                                            $12,981.00            $12,981.00      (a)
 National Labor Share %                                                                     75.612%               75.612%      (b)
 Adjusted Labor Amount (a)x(b)                                                            $9,815.19             $9,815.19      (c)

 Provider Wage Index (Full Wage Index for St. Louis, MO)                                     0.8954                0.8954      (d)
 Adjusted Labor Cost (c)x(d)                                                              $8,788.52             $8,788.52      (e)


 Unadjusted 2007 Federal Rate                                                            $12,981.00            $12,981.00      (a)
 National Non-Labor Share % 1-(b)                                                           24.388%               24.388%      (f)
 Non-Labor Cost (a)x(f)                                                                   $3,165.81             $3,165.81      (g)


 Wage-Adjusted Federal Payment (e) + (g)                                                 $11,954.33            $11,954.33      (h)
 Rural Adjustment Factor                                                                     1.0000                1.0000      (i)
 Wage- and Rural- Adjusted Federal Payment (h)x(i)                                       $11,954.33            $11,954.33      (j)


 LIP (DSH) Adjustment                                                                          0.0306                 0.0743   (k)
 LIP (DSH) Adjustment Amount (j)x(k)                                                          $365.96                $887.94   (l)


 Teaching Status Adjustment                                                                       -                      -     (m)
 Teaching Status Adjustment Amount (j)x(m)                                                      $0.00                  $0.00   (n)

 Final FY 2007 Adjusted Federal Case Rate (j)+(l)+(n)                                    $12,320.29            $12,842.27      (o)

                                                                                     260077                 263025

 FY 2007 CMG Weight for CMG 0302, Tier 1                                                       1.4875                 1.4875   (p)
 Final FY 2007 Adjusted Payment Amount
     For CMG 0302, Tier 1 (o)x(p)                                                        $18,326.43            $19,102.87      (q)


                                                                                     260077                 263025


 Billed Amount                                                                           $60,000.00            $60,000.00      (s)
 Cost to Charge Ratio (CCR)                                                                  0.5390                0.4610      (t)
 CCR Adjusted Billed Amount (s)x(t)                                                      $32,340.00            $27,660.00      (u)

 Fixed Loss Threshold Amount                                                              $5,534.00             $5,534.00      (v)

 Wage, Rural-, and LIP- Adjusted Threshold Amount
    For CMG 0302, Tier 1 [(v)x(b)x(d)+(v)x(f)]*(i)*[(1+(k)+(m)]                           $5,252.33             $5,474.86      (w)

 Final Outlier Threshold Amount (q)+(w)                                                  $23,578.76            $24,577.73      (y)

 Outlier Payment Amount ((u)-(y))*.8                                                      $7,008.99             $2,465.82      (z)




pai 7/19/2011 1:37 AM
                                                                            Milliman
D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [Rehab2]                                                            Page 5 of 28
                                                      Attachment D-1
                                            IPPS Psychiatric Prospective Payment
                                            Calculation Steps (Effective 7/1/2006)

        Base Per Diem Calculation
   A       Federal Per Diem Base Rate                   $595.09
   B        -Labor Portion                              $450.27
   C        -Wage Index                                  0.8982 Akron, OH
   D        -Non-Labor Portion                          $144.82
   E        -COLA                                           1.00
   F    Wage Adjusted Per Diem                          $549.25 B x C +D x E
   G     Rural Adjustment Factor                            1.00
   H     Teaching Adjustment Factor                         1.00
    I   Facility Specific Per Diem                     $549.25 F x G x H

        PPS Adjustment Factor
          Day X Adjustment                                  1.31   Day 1, w/ER
          DRG Primary Diagnosis Factor                      0.99   426
          Age Adjustment                                    1.10   65-69
          Comorbidity factor                                1.12   Chronic Obstructed Pulmonary Disease
          Comorbidity factor                                1.06   Tracheostomy
          Comorbidity factor                                1.05   Uncontrolled Diabetes Mellitus with or without complications
          Comorbidity factor
          Comorbidity factor
        PPS Adjustment Factor                               1.78 Product of factors above

        Electroconvulsive Therapy Calculation
   A    Base Rate                                       $256.20
   B        -Labor Portion                              $193.85
   C        -Wage Index                                  0.8982 Akron, OH
   D        -Non-Labor Portion                           $62.35
   E        -COLA                                           1.00
   F    Wage Adjusted Per Diem                          $236.47 B x C +D x E
   G    Days of ECT                                            1
   H    ECT Payment                                    $236.47 F x G

     Day X Calculation
   A   Facility Specific Per Diem                       $549.25from above
   B     -PPS Adjustment Factor                            1.78from above
   C Adjusted Per Diem                                  $976.75AxB
   D ECT Payment                                        $236.47from above
   E Total PPS Allowable                             $1,213.22 C + D




pai 7/19/2011 1:37 AM
                                                                Milliman
D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [Psy1]                                                  Page 6 of 28
                                                                                 Attachment D-2
                                                                       IPPS Psychiatric Prospective Payment
                                                                      Rate and Adjustment Factors (Effective (7/1/2006)


Per Diem Rate:                                                                              Variable Per Diem Adjustments:
Federal Per Diem Base Rate                                                     #######      Adjustment Factor
Labor Share (0.75665)                                                          #######      Day 1 -- Facility Without a 24/7 Full-service Emergency Department\                  1.19
Non-Labor Share (0.24335)                                                      #######      Day 1 -- Facility With a 24/7 Full-service Emergency Department                      1.31
                                                                                            Day 2                                                                                1.12
Facility Adjustments:                                                                       Day 3                                                                                1.08
Rural Adjustment Factor                                                         1.170       Day 4                                                                                1.05
Urban Adjustment Factor                                                         1.000       Day 5                                                                                1.04
Teaching Adjustment:                                                                        Day 6                                                                                1.02
   Teaching Adjustment component                                                0.515       Day 7                                                                                1.01
   Residents to Beds Ratio (if a teaching facility)                               -         Day 8                                                                                1.01
Teaching Adjustment Factor                                                      1.000       Day 9                                                                                1.00
                                                                                            Day 10                                                                               1.00
Wage Area (See Attachment A)                                                                Day 11                                                                               0.99
                                                                                            Day 12                                                                               0.99
Cost of Living Adjustments (COLAs):                                                         Day 13                                                                               0.99
Alaska                                                                         1.2500       Day 14                                                                               0.99
Hawaii County:                                                                              Day 15                                                                               0.98
 Honolulu                                                                      1.2500       Day 16                                                                               0.97
 Hawaii                                                                        1.1650       Day 17                                                                               0.97
 Kauai                                                                         1.2325       Day 18                                                                               0.96
 Maui                                                                          1.2375       Day 19                                                                               0.95
 Kalawao                                                                       1.2375       Day 20                                                                               0.95
Rest of the U.S.                                                               1.0000       Day 21                                                                               0.95
                                                                                            Day 22+                                                                              0.92
Patient Adjustments:
ECT – Per Treatment (Electroconvulsive Therapy) Base Amount                    #######      Age Adjustments:
Wage Index share (0.75665)                                                     #######      Age (in years)
COLA share (.24335)                                                             $62.35      Under 45                                                                             1.00
                                                                                            45 and under 50                                                                      1.01
Comorbidity Adjustments:                                                                    50 and under 55                                                                      1.02
None                                                                              1.00      55 and under 60                                                                      1.04
Artificial Openings-Digestive and Urinary                                         1.08      60 and under 65                                                                      1.07
Cardiac Conditions                                                                1.11      65 and under 70                                                                      1.10
Chronic Obstructed Pulmonary Disease                                              1.12      70 and under 75                                                                      1.13
Coagulation Factor Deficits                                                       1.13      75 and under 80                                                                      1.15
Developmental Disabilities                                                        1.04      80 and over                                                                          1.17
Drug and/or Alcohol Induced Mental Disorders                                      1.03
Eating and Conduct Disorders                                                      1.12      DRG Adjustments:
Gangrene                                                                          1.10      Principal Diagnosis
Infectious Diseases                                                               1.07      DRG DRG Definition Adjustment Factor
Oncology Treatment                                                                1.07      DRG 424 Procedure with principal diagnosis of mental illness                         1.22
Poisoning                                                                         1.11      DRG 425 Acute adjustment reaction                                                    1.05
Renal Failure, Acute                                                              1.11      DRG 426 Depressive neurosis                                                          0.99
Renal Failure, Chronic                                                            1.11      DRG 427 Neurosis, except depressive                                                  1.02
Severe Musculoskeletal and Connective Tissue Diseases                             1.09      DRG 428 Disorders of personality                                                     1.02
Severe Protein Calorie Malnutrition                                               1.13      DRG 429 Organic disturbances                                                         1.03
Tracheostomy                                                                      1.06      DRG 430 Psychosis                                                                    1.00
Uncontrolled Diabetes Mellitus with or without complications                      1.05      DRG 431 Childhood disorders                                                          0.99
                                                                                            DRG 432 Other mental disorders                                                       0.92
                                                                                            DRG 433 Alcohol/Drug use Leave against Medical Advice (LAMA)                         0.97
                                                                                            DRG 521 Alcohol/Drug use with comorbid conditions                                    1.02
                                                                                            DRG 522 Alcohol/Drug use without comorbid conditions                                 0.98
                                                                                            DRG 523 Alcohol/Drug use without rehabilitation                                      0.88
                                                                                            DRG 12 Degenerative nervous system disorders                                         1.05
                                                                                            DRG 23 Non-traumatic stupor & coma                                                   1.07




     pai 7/19/2011 1:37 AM
                                                                                         Milliman
     D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [Psy2]                                                                                      Page 7 of 28
                                 Attachment E
                                 Northwest Portland Area Indian Health Board
                                 Skilled Nursing PPS
                                 Table of RUG Scores, Descriptions and Payment Amounts
                                 FY 2007 Urban Rates
                                 Source: July 1, 2006 Federal Register, CMS Transmittals, other CMS Studies


                                 RUG                                                                                                                 Nursing     Therapy Non-case Mix   Non-case Mix      Total
                                 Category       Description                                            ADL* Index   End Splits                     Component   Component Therapy Comp     Component        Rate
                                 RUX            Rehabilitation -- Ultra High plus Extensive Services   16-18                                         $269.88     $240.73                     $72.49    $583.10
                                 RUL            Rehabilitation -- Ultra High plus Extensive Services   7-15                                          $198.86     $240.73                     $72.49    $512.08
                                 RVX            Rehabilitation -- Very High plus Extensive Services    16-18                                         $218.74     $150.86                     $72.49    $442.09
                                 RVL            Rehabilitation -- Very High plus Extensive Services    7-15                                          $188.91     $150.86                     $72.49    $412.26
                                 RHX            Rehabilitation -- High plus Extensive Services         13-18                                         $201.70     $100.57                     $72.49    $374.76
                                 RHL            Rehabilitation -- High plus Extensive Services         7-12                                          $194.59     $100.57                     $72.49    $367.65
                                 RMX            Rehabilitation -- Medium plus Extensive Services       15-18                                         $274.14      $82.38                     $72.49    $429.01
                                 RML            Rehabilitation -- Medium plus Extensive Services       7-14                                          $238.63      $82.38                     $72.49    $393.50
                                 RLX            Rehabilitation -- Low plus Extensive Services          7-18                                          $186.07      $46.01                     $72.49    $304.57
                                 RUC            Rehabilitation -- Ultra High                           16-18                                         $181.81     $240.73                     $72.49    $495.03
                                 RUB            Rehabilitation -- Ultra High                           9-15                                          $140.62     $240.73                     $72.49    $453.84
                                 RUA            Rehabilitation -- Ultra High                           4-8                                           $119.31     $240.73                     $72.49    $432.53
                                 RVC            Rehabilitation -- Very High                            16-18                                         $174.71     $150.86                     $72.49    $398.06
                                 RVB            Rehabilitation -- Very High                            9-15                                          $154.82     $150.86                     $72.49    $378.17
                                 RVA            Rehabilitation -- Very High                            4-8                                           $116.47     $150.86                     $72.49    $339.82
                                 RHC            Rehabilitation -- High                                 13-18                                         $173.29     $100.57                     $72.49    $346.35
                                 RHB            Rehabilitation -- High                                 8-12                                          $157.66     $100.57                     $72.49    $330.72
                                 RHA            Rehabilitation -- High                                 4-7                                           $133.52     $100.57                     $72.49    $306.58
                                 RMC            Rehabilitation -- Medium                               15-18                                         $163.35      $82.38                     $72.49    $318.22
                                 RMB            Rehabilitation -- Medium                               8-14                                          $154.82      $82.38                     $72.49    $309.69
                                 RMA            Rehabilitation -- Medium                               4-7                                           $147.72      $82.38                     $72.49    $302.59
                                 RLB            Rehabilitation -- Low                                  14-18                                         $161.93      $46.01                     $72.49    $280.43
                                 RLA            Rehabilitation -- Low                                  4-13                                          $120.73      $46.01                     $72.49    $239.23
                                 SE3            Extensive Services                                     7-18         Varies with Services Count       $264.19                   $14.09        $72.49    $350.77
                                 SE2            Extensive Services                                     7-18         Varies with Services Count       $211.64                   $14.09        $72.49    $298.22
                                 SE1            Extensive Services                                     7-18         Varies with Services Count       $178.97                   $14.09        $72.49    $265.55
                                 SSC            Special Care                                           17-18                                         $174.71                   $14.09        $72.49    $261.29
                                 SSB            Special Care                                           15-16                                         $160.51                   $14.09        $72.49    $247.09
                                 SSA            Special Care                                           7-14                                          $156.24                   $14.09        $72.49    $242.82
                                 CC2            Clinically Complex                                     17-18        Signs of Depression              $173.29                   $14.09        $72.49    $259.87
                                 CC1            Clinically Complex                                     17-18        No Signs of Depression           $150.56                   $14.09        $72.49    $237.14
                                 CB2            Clinically Complex                                     15-16        Signs of Depression              $139.20                   $14.09        $72.49    $225.78
                                 CB1            Clinically Complex                                     15-16        No Signs of Depression           $129.26                   $14.09        $72.49    $215.84
                                 CA2            Clinically Complex                                     7-14         Signs of Depression              $127.84                   $14.09        $72.49    $214.42
                                 CA1            Clinically Complex                                     7-14         No Signs of Depression           $113.63                   $14.09        $72.49    $200.21
                                 IB2            Impaired Cognition                                     6-10         Nursing Rehabilitation           $105.11                   $14.09        $72.49    $191.69
                                 IB1            Impaired Cognition                                     6-10         Not Receiving Rehabilitation     $102.27                   $14.09        $72.49    $188.85
                                 IA2            Impaired Cognition                                     4-5          Nursing Rehabilitation            $86.64                   $14.09        $72.49    $173.22
                                 IA1            Impaired Cognition                                     4-5          Not Receiving Rehabilitation      $79.54                   $14.09        $72.49    $166.12
                                 BB2            Behavioral Only                                        6-10         Nursing Rehabilitation           $103.69                   $14.09        $72.49    $190.27
                                 BB1            Behavioral Only                                        6-10         Not Receiving Rehabilitation      $98.01                   $14.09        $72.49    $184.59
                                 BA2            Behavioral Only                                        4-5          Nursing Rehabilitation            $85.22                   $14.09        $72.49    $171.80
                                 BA1            Behavioral Only                                        4-5          Not Receiving Rehabilitation      $73.86                   $14.09        $72.49    $160.44
                                 PE2            Physical Function Reduced                              16-18        Nursing Rehabilitation           $120.73                   $14.09        $72.49    $207.31
                                 PE1            Physical Function Reduced                              16-18        Not Receiving Rehabilitation     $116.47                   $14.09        $72.49    $203.05
                                 PD2            Physical Function Reduced                              11-15        Nursing Rehabilitation           $110.79                   $14.09        $72.49    $197.37
                                 PD1            Physical Function Reduced                              11-15        Not Receiving Rehabilitation     $107.95                   $14.09        $72.49    $194.53
                                 PC2            Physical Function Reduced                              9-10         Nursing Rehabilitation           $100.85                   $14.09        $72.49    $187.43
                                 PC1            Physical Function Reduced                              9-10         Not Receiving Rehabilitation      $98.01                   $14.09        $72.49    $184.59
                                 PB2            Physical Function Reduced                              6-8          Nursing Rehabilitation            $78.12                   $14.09        $72.49    $164.70
                                 PB1            Physical Function Reduced                              6-8          Not Receiving Rehabilitation      $76.70                   $14.09        $72.49    $163.28
                                 PA2            Physical Function Reduced                              4-5          Nursing Rehabilitation            $75.28                   $14.09        $72.49    $161.86
                                 PA1            Physical Function Reduced                              4-5          Not Receiving Rehabilitation      $71.02                   $14.09        $72.49    $157.60
                                                * ADL = Activities of Daily Living


pai 7/19/2011 1:37 AM
                                                                                                                                 Milliman
D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [SNF]                                                                                                                                            Page 8 of 28
                             Attachment F-1
               Northwest Portland Area Indian Health Board
      ADDENDUM B.--PAYMENT STATUS BY HCPCS CODE AND RELATED
                 INFORMATION CALENDAR YEAR 2007
                                                                                                 61.468            2007 CF
                                                                                               National             Minimum
HCPCS/                                                                    Relative            Unadjusted            Unadjusted
CPT                  Short Descriptor               CI      SI     APC    Weight Payment Rate Copayment             Copayment
25150     Partial removal of ulna                           T      0050    25.1296 $1,544.67                           $308.93
25151     Partial removal of radius                         T      0050    25.1296 $1,544.67                           $308.93
25170     Extensive forearm surgery                 CH      T      0051    41.0893 $2,525.68                           $505.14
25210     Removal of wrist bone                             T      0054    25.8758 $1,590.53                           $318.11
25215     Removal of wrist bones                            T      0054    25.8758 $1,590.53                           $318.11
25230     Partial removal of radius                         T      0050    25.1296 $1,544.67                           $308.93
25240     Partial removal of ulna                           T      0050    25.1296 $1,544.67                           $308.93
25246     Injection for wrist x-ray                         N
25248     Remove forearm foreign body                       T      0049    20.8706   $1,282.87                         $256.57
25250     Removal of wrist prosthesis                       T      0050    25.1296   $1,544.67                         $308.93
25251     Removal of wrist prosthesis                       T      0050    25.1296   $1,544.67                         $308.93
25259     Manipulate wrist w/anesthes                       T      0043     1.6857     $103.62                          $20.72
25260     Repair forearm tendon/muscle                      T      0050    25.1296   $1,544.67                         $308.93
25263     Repair forearm tendon/muscle                      T      0050    25.1296   $1,544.67                         $308.93
25265     Repair forearm tendon/muscle                      T      0050    25.1296   $1,544.67                         $308.93
25270     Repair forearm tendon/muscle                      T      0050    25.1296   $1,544.67                         $308.93
25272     Repair forearm tendon/muscle                      T      0050    25.1296   $1,544.67                         $308.93
25274     Repair forearm tendon/muscle                      T      0050    25.1296   $1,544.67                         $308.93
25275     Repair forearm tendon sheath                      T      0050    25.1296   $1,544.67                         $308.93
25280     Revise wrist/forearm tendon                       T      0050    25.1296   $1,544.67                         $308.93
25290     Incise wrist/forearm tendon                       T      0050    25.1296   $1,544.67                         $308.93
25295     Release wrist/forearm tendon                      T      0049    20.8706   $1,282.87                         $256.57
25300     Fusion of tendons at wrist                        T      0050    25.1296   $1,544.67                         $308.93
25301     Fusion of tendons at wrist                        T      0050    25.1296   $1,544.67                         $308.93
25310     Transplant forearm tendon                         T      0051    41.0893   $2,525.68                         $505.14
25312     Transplant forearm tendon                         T      0051    41.0893   $2,525.68                         $505.14
25315     Revise palsy hand tendon(s)                       T      0051    41.0893   $2,525.68                         $505.14
25316     Revise palsy hand tendon(s)               CH      T      0052    66.5800   $4,092.54                         $818.51
25320     Repair/revise wrist joint                         T      0051    41.0893   $2,525.68                         $505.14
25332     Revise wrist joint                                T      0047    33.4505   $2,056.14            537.03       $411.23
25335     Realignment of hand                               T      0051    41.0893   $2,525.68                         $505.14
25337     Reconstruct ulna/radioulnar                       T      0051    41.0893   $2,525.68                         $505.14
25350     Revision of radius                        CH      T      0052    66.5800   $4,092.54                         $818.51
25355     Revision of radius                                T      0051    41.0893   $2,525.68                         $505.14
25360     Revision of ulna                                  T      0050    25.1296   $1,544.67                         $308.93
25365     Revise radius & ulna                              T      0050    25.1296   $1,544.67                         $308.93
25370     Revise radius or ulna                             T      0051    41.0893   $2,525.68                         $505.14
25375     Revise radius & ulna                              T      0051    41.0893   $2,525.68                         $505.14
25390     Shorten radius or ulna                            T      0050    25.1296   $1,544.67                         $308.93
25391     Lengthen radius or ulna                           T      0051    41.0893   $2,525.68                         $505.14
25392     Shorten radius & ulna                             T      0050    25.1296   $1,544.67                         $308.93
25393     Lengthen radius & ulna                            T      0051    41.0893   $2,525.68                         $505.14
25394     Repair carpal bone, shorten                       T      0053    16.1540     $992.95        $253.49          $198.59




pai 7/19/2011 1:37 AM
                                                              Milliman
D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [ADDB]                                              Page 9 of 28
                                                             Attachment F-2
                                               Northwest Portland Area Indian Health Board
                                                           Sample OPPS Claims


                                                Service Rev                                                            Adjusted
             ClaimID               LineNum       Units Code HCPCS                    Type      Status   Billed Allowed Allowed
        0000000035                       1           20  272                  Supply                        335      0         0
        0000000035                       2            1  312 88305            Lab                X           93     75       75
        0000000035                       3            1  324 71020            Imaging            X          265     20       20
        0000000035                       4            1  360 11623            Surgery            T          484    669      669
        0000000035                       5            1  360 12042            Surgery            T          484     81       40
        0000000035                       6            1  370                  Anesthesia                    343      0         0
        0000000035                       7            3  636 J3010            Drug               N           37      0         0
        0000000035                       8            1  710                  Recovery                      341      0         0
        0000000036                       1            1  300 36415            Blood Draw         A            7      3         3
        0000000036                       2            1  301 82565            Lab                A           35      7         7
        0000000036                       3            1  301 84520            Lab                A           35      5         5
        0000000036                       4            1  324 71020            Imaging            X          275     20       20
        0000000036                       5            1  352 74150            Imaging            S       1,551     214      214
        0000000036                       6            1  480 93307            Cardio             S          480    133      133
        0000000036                       7            1  480 93320            Cardio             S          199     61       61
        0000000036                       8            1  480 93325            Cardio             S          200     32       32
        0000000118                       1            1  250                  Drug                           17      0         0
        0000000118                       2            2  250 J0690            Drug                           44      0         0
        0000000118                       3            1  271                  Supply                         26      0         0
        0000000118                       4            6  272                  Supply                        222      0         0
        0000000118                       5            1  320 73550            Imaging            X          172     19       19
        0000000118                       6            1  450 12004            Surgery            T          173     88       88
        0000000118                       7            1  450 99284            Emergency Room     V          341    210      210
        0000000118                       8            1  636 90718            Drug               N           33      0         0
        0000000119                       1            1  250                  Drug                            6      0         0
        0000000119                       2            1  272                  Supply                         40      0         0
        0000000119                       3            1  450 99281            Emergency Room     V           41     50       50




pai 7/19/2011 1:37 AM
                                                                          Milliman
D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [OPPS]                                                      Page 10 of 28
                                                                                                                        Attachment F-3
                                                                                                          Northwest Portland Area Indian Health Board
                                                                                Addendum D1.--Payment Status Indicators for the Hospital Outpatient Prospective Payment System
 Indicator                                                         Item/code/service                                                                                                                OPPS Payment Status
A             Services furnished to a hospital outpatient that are paid under a fee schedule or payment system other than OPPS, e.g.:    Not paid under OPPS. Paid by fiscal intermediaries under a fee schedule
              ● Ambulance Services                                                                                                       or payment system other than OPPS.
              ● Clinical Diagnostic Laboratory Services
              ● Non-Implantable Prosthetic and Orthotic Devices
              ● EPO for ESRD Patients
              ● Physical, Occupational, and Speech Therapy
              ● Routine Dialysis Services for ESRD Patients Provided in a Certified Dialysis Unit of a Hospital
              ● Diagnostic Mammography
              ● Screening Mammography
B             Codes that are not recognized by OPPS when submitted on an outpatient hospital Part B bill type (12x                       Not paid under OPPS.
              and 13x).                                                                                                                  ● May be paid by intermediaries when submitted on a different bill type, e.g., 75x (CORF), but not paid under OPPS.
                                                                                                                                         ● An alternate code that is recognized by OPPS when submitted on an outpatient hospital Part B bill type (12x, 13x) may be available.

C             Inpatient Procedures                                                                                                       Not paid under OPPS. Admit patient. Bill as inpatient.
D             Discontinued Codes                                                                                                         Not paid under OPPS.
E             Items, Codes, and Services:                                                                                                Not paid under OPPS.
              ● That are not covered by Medicare based on Statutory Exclusion.
              ● That are not covered by Medicare for reasons other than Statutory Exclusion.
              ● That are not recognized by Medicare but for which an alternate code for the same item or service may be available.
              ● For which separate payment is not provided by Medicare.
F             Corneal Tissue Acquisition; Certain CRNA Services and Hepatitis B Vaccines                                                 Not paid under OPPS. Paid at reasonable cost.
G             Pass-Through Drugs and Biologicals                                                                                         Paid under OPPS; Separate APC payment includes Pass-Through amount.
H             (1) Pass-through Device Categories;                                                                                        Paid under OPPS; (1) Separate cost-based Pass-Through payment; No Coins.
              (2) Radiopharmaceutical Agents                                                                                             (2) Separate cost-based non-pass-through payment.
K             Non-Pass-Through Drugs, Biologicals, Brachytherapy and Radiopharmaceuticals Agents                                         Paid under OPPS; Separate APC payment.
L             Influenza Vaccine; Pneumococcal Pneumonia Vaccine                                                                          Not paid under OPPS. Paid at reasonable cost; Not subject to deductible or coinsurance.
M             Items and Services Not Billable to the Fiscal Intermediary                                                                 Not paid under OPPS.
N             Items and Services packaged into APC Rates                                                                                 Paid under OPPS; Payment is packaged into payment for other services, including outliers, therefore, there is no separate APC payment.
P             Partial Hospitalization                                                                                                    Paid under OPPS; Per diem APC payment.
Q             Packaged Services Subject to Separate Payment Under the OPPS Payment Criteria                                              Paid under OPPS;
                                                                                                                                         (1) Separate APC payment based on OPPS payment criteria.
                                                                                                                                         (2) If criteria are not met, payment is packaged into payment for other services, including outliers. Therefore, there is no separate APC payment.
S             Significant Service, Separately Payable                                                                                    Paid under OPPS; Separate APC payment.
T             Significant Procedure, Multiple Reduction Applies                                                                          Paid under OPPS; Separate APC payment.
V             Clinic or Emergency Department Visit                                                                                       Paid under OPPS; Separate APC payment.
Y             Non-Implantable Durable Medical Equipment                                                                                  Not paid under OPPS. All institutional providers other than Home Health Agencies bill to DMERC.
X             Ancillary Services                                                                                                         Paid under OPPS; Separate APC payment.




ADDENDUM D2.--COMMENT INDICATORS
            Descriptor
Comment Indicator
NF          New code, final APC assignment; Comments were accepted on a proposed APC assignment in the Proposed Rule; APC assignment is no longer open to comment.
NI          New code, interim APC assignment; Comments will be accepted on the interim APC assignment for the new code.
CH          Active HCPCS code in current year and next calendar year, status indicator and/or APC assignment has changed; or active HCPCS code that is discontinued at the end of the current calendar year.




     zaw 7/19/2011 1:37 AM
     D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [ADD_D]                                                           Milliman                                                                                                                        Page 11 of 28
                                            Attachment F-4
                              Northwest Portland Area Indian Health Board
                                   2007 Outlier Calculation for OPPS


      A    Cost                                                 $2,484 (Includes allocated Costs from packaged line items)
      B    APC Allowed                                            $235
      C    APC Multiplier                                         1.75
      D    Multiplier Threshold [B x C]                           $411
      E    Cost over Threshold [A - D]                          $2,072
      F    Fixed Dollar Threshold                               $1,825
      G    Marginal Payment Percent                                 0.5
      H    Outlier Payment if(E > F, [E x G]                    $1,036


           Cost Allocation Example
           APC's on the Bill
                APC                                     APC Allowed         Percent
           0612                High Level ER                 $226.39            47.1%
           0283                CT Scan                       $234.98            48.9%
           0099                EKG                            $19.20             4.0%
                                                             $480.57           100.0%


           Actual Bill
              Rev Code                                      Billed         Allocated     CCR          Cost
                       250         Pharmacy                 $2,986.50           $0.00      0.314        $0.00
                       270         Med Supplies             $3,957.80           $0.00      0.314        $0.00
                       350         CT Scan                  $4,514.00       $7,909.49      0.314    $2,483.58
                       450         ER                       $2,597.00       $5,868.37      0.314    $1,842.67
                       730         EKG                        $237.00         $514.44      0.314      $161.53
                                                           $14,292.30      $14,292.30




pai 7/19/2011 1:37 AM
                                                               Milliman
D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [OPPS2]                                              Page 12 of 28
                                     Milliman Hospital Evaluation and Comparison System - Medicare OPPS 2005 2007.0 Update
                                     Sample OPPS Claims



                                                                              Service Rev           Status                    Adjusted
                                           ClaimID              LineNum        Units Code HCPCS    Lookup    Billed Allowed   Allowed
                                     0000000001                        1             1 250                        22      0           0
                                     0000000001                        2             1 250 J0170                   9      0           0
                                     0000000001                        3             1 250 J1200                  14      0           0
                                     0000000001                        4             1 250 J2930                  21      0           0
                                     0000000001                        5             1 258                        46      0           0
                                     0000000001                        6             1 260 90780                 141      0           0
                                     0000000001                        7             1 271                        17      0           0
                                     0000000001                        8             1 272                        43      0           0
                                     0000000001                        9             1 300 36415     A             7      3           3
                                     0000000001                       10             1 450 99283     V           198    130        130
                                     0000000002                        1             1 250 J1200                  14      0           0
                                     0000000002                        2             1 250 J2930                  19      0           0
                                     0000000002                        3             1 271                        27      0           0
                                     0000000002                        4             1 272                        45      0           0
                                     0000000002                        5             1 450 90784     S            74     19          19
                                     0000000002                        6             1 450 99284     V           355    210        210
                                     0000000003                        1             1 921 93880     S           302    233        233
                                     0000000004                        1             1 250 J2175                  13      0           0
                                     0000000004                        2             1 255                       402      0           0
                                     0000000004                        3             1 258                        46      0           0
                                     0000000004                        4             1 260 90780                 141      0           0
                                     0000000004                        5             1 270                        61      0           0
                                     0000000004                        6             1 271                        26      0           0
                                     0000000004                        7             1 272                        43      0           0
                                     0000000004                        8             1 300 36415     A             7      3           3
                                     0000000004                        9             1 301 80053     A           142     14          14
                                     0000000004                       10             1 301 82150     A            73      9           9
                                     0000000004                       11             1 301 83690     A            44      9           9
                                     0000000004                       12             1 302 86677     A           102     19          19
                                     0000000004                       13             1 305 85025     A            86     11          11
                                     0000000004                       14             1 307 81001     A            34      4           4
                                     0000000004                       15             1 352 72193     S        1,491     271        271
                                     0000000004                       16             1 352 74160     S        1,491     315        315


pai 7/19/2011 1:37 AM
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D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [OPPS (2)]                                                               Page 13 of 28
                                                                              Service Rev           Status                  Adjusted
                                           ClaimID              LineNum        Units Code HCPCS    Lookup    Billed Allowed Allowed
                                     0000000004                       17             1 450 90784      S           71     19        19
                                     0000000004                       18             1 450 99284      V          341    210      210
                                     0000000004                       19             4 636 J2405      K           94      4        15
                                     0000000005                        1             1 740 95810      S       2,325     651      651
                                     0000000006                        1             1 921 93971      S          273    153      153
                                     0000000007                        1             1 255                       402      0         0
                                     0000000007                        2             1 258                        46      0         0
                                     0000000007                        3             1 260 90780                 141      0         0
                                     0000000007                        4             2 270                       164      0         0
                                     0000000007                        5             1 271                        26      0         0
                                     0000000007                        6             1 272                        43      0         0
                                     0000000007                        7             1 300 36415     A             7      3         3
                                     0000000007                        8             1 301 80053     A           142     14        14
                                     0000000007                        9             1 301 82150     A            73      9         9
                                     0000000007                       10             1 301 83690     A            44      9         9
                                     0000000007                       11             1 305 85025     A            86     11        11
                                     0000000007                       12             1 307 81001     A            34      4         4
                                     0000000007                       13             1 324 71010     X           200     14        14
                                     0000000007                       14             1 352 72193     S        1,491     271      271
                                     0000000007                       15             1 352 74160     S        1,491     315      315
                                     0000000007                       16             1 450 99284     V           341    210      210
                                     0000000008                        1             1 250                        19      0         0
                                     0000000008                        2             3 270                    1,195       0         0
                                     0000000008                        3             1 272                        35      0         0
                                     0000000008                        4             1 312 88305     X            93     75        75
                                     0000000008                        5             1 360 19103     T        1,053     396      396
                                     0000000008                        6             1 360 19295     S           290     83        83
                                     0000000008                        7             1 401 76095     A           303    113      113
                                     0000000009                        1             3 250                        31      0         0
                                     0000000009                        2             1 250 J2175                  13      0         0
                                     0000000009                        3             1 255                       171      0         0
                                     0000000009                        4             2 258                        91      0         0
                                     0000000009                        5             2 270                        57      0         0
                                     0000000009                        6             1 270                        52      0         0
                                     0000000009                        7             1 271                        45      0         0
                                     0000000009                        8             1 271                        45      0         0
                                     0000000009                        9             5 272                        83      0         0


pai 7/19/2011 1:37 AM
                                                                                     Milliman
D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [OPPS (2)]                                                             Page 14 of 28
                                                                              Service Rev           Status                    Adjusted
                                           ClaimID              LineNum        Units Code HCPCS    Lookup    Billed   Allowed Allowed
                                     0000000009                       10             1 300 36415      A           7         3         3
                                     0000000009                       11             1 301 80053      A         142        14        14
                                     0000000009                       12             4 301 82948      A          43         4        17
                                     0000000009                       13             1 301 82948      A          11         4         4
                                     0000000009                       14             1 305 85025      A          86        11        11
                                     0000000009                       15             1 307 81001      A          34         4         4
                                     0000000009                       16             1 320 76005                363         0         0
                                     0000000009                       17             1 360 64483     T        2,274       574      287
                                     0000000009                       18             1 360 64484     T        1,000       757      757
                                     0000000009                       19             4 636 J3301     N           31         0         0
                                     0000000009                       20           17  637 A9270                141         0         0
                                     0000000009                       21             1 637 A9270                 50         0         0
                                     0000000009                       22             1 730 93005     S          125        11        11
                                     0000000009                       23           11  762 99217                286         0         0
                                     0000000009                       24             9 762 99218                234         0         0
                                     0000000010                        1             1 343 C1775                571         0         0
                                     0000000010                        2             1 404 78815     S        2,814       950      950
                                     0000000011                        1             1 271                       26         0         0
                                     0000000011                        2             1 272                       43         0         0
                                     0000000011                        3             1 300 36415     A            7         3         3
                                     0000000011                        4             1 301 80053     A          142        14        14
                                     0000000011                        5             1 301 82550     A           34         9         9
                                     0000000011                        6             1 301 82553     A           48        14        14
                                     0000000011                        7             1 301 83880     A           79        47        47
                                     0000000011                        8             1 301 84484     A           40        13        13
                                     0000000011                        9             1 305 85025     A           86        11        11
                                     0000000011                       10             1 305 85610     A           49         5         5
                                     0000000011                       11             1 305 85730     A           58         8         8
                                     0000000011                       12             1 306 87449     A           38        16        16
                                     0000000011                       13             1 324 71020     X          265        20        20
                                     0000000011                       14             1 450 99284     V          341       210      210
                                     0000000011                       15             1 730 93005     S          125        11        11
                                     0000000012                        1             1 921 93923     S          455       178      178
                                     0000000013                        1             1 320 73130     X          265        23        23
                                     0000000014                        1             1 250                       17         0         0
                                     0000000014                        2             1 271                       17         0         0
                                     0000000014                        3             2 272                      100         0         0


pai 7/19/2011 1:37 AM
                                                                                     Milliman
D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [OPPS (2)]                                                               Page 15 of 28
                                                                              Service Rev           Status                  Adjusted
                                           ClaimID              LineNum        Units Code HCPCS    Lookup    Billed Allowed Allowed
                                     0000000014                        4             1 274 L2112                 712      0         0
                                     0000000014                        5             1 450 12011     T           173     79        79
                                     0000000014                        6             1 450 90471     S            35     26         0
                                     0000000014                        7             1 450 90782     S            76     26        26
                                     0000000014                        8             1 450 99283     V           198    130      130
                                     0000000014                        9             1 636 90718     N            33      0         0
                                     0000000015                        1             1 402 76775     S           513     81        81
                                     0000000016                        1             1 312 88305     X            93     75        75
                                     0000000016                        2             1 312 88331     X            87     34        34
                                     0000000017                        1             2 250 J2310                  17      0         0
                                     0000000017                        2             1 271                        26      0         0
                                     0000000017                        3             2 272                        77      0         0
                                     0000000017                        4             1 300 36415     A             7      3         3
                                     0000000017                        5             1 301 80053     A           142     14        14
                                     0000000017                        6             1 301 82055     A            79     15        15
                                     0000000017                        7             1 301 82550     A            34      9         9
                                     0000000017                        8             1 301 82553     A            48     14        14
                                     0000000017                        9             1 301 83880     A            79     47        47
                                     0000000017                       10             1 301 84443     A            79     23        23
                                     0000000017                       11             1 301 84484     A            40     13        13
                                     0000000017                       12             1 305 85025     A            86     11        11
                                     0000000017                       13             1 307 80100     A           111     19        19
                                     0000000017                       14             1 307 81001     A            34      4         4
                                     0000000017                       15             1 320 73564     X           387     30        30
                                     0000000017                       16             1 324 71010     X           200     14        14
                                     0000000017                       17             1 351 70450     S        1,144     175      175
                                     0000000017                       18             1 450 51702     X            35     44         0
                                     0000000017                       19             1 450 90784     S            35     19        19
                                     0000000017                       20             1 450 99284     V           341    210      210
                                     0000000017                       21             1 730 93005     S           125     11        11
                                     0000000018                        1             1 740 95816     S           381    191      191
                                     0000000019                        1             1 610 73721     S        1,885     502      502
                                     0000000020                        1             2 271                        30      0         0
                                     0000000020                        2             1 272                        45      0         0
                                     0000000020                        3             1 300 36415     A             7      3         3
                                     0000000020                        4             1 301 80053     A           148     14        14
                                     0000000020                        5             1 301 82550     A            35      9         9


pai 7/19/2011 1:37 AM
                                                                                     Milliman
D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [OPPS (2)]                                                             Page 16 of 28
                                                                              Service Rev           Status                  Adjusted
                                           ClaimID              LineNum        Units Code HCPCS    Lookup    Billed Allowed Allowed
                                     0000000020                        6             1 301 82553      A           50     14        14
                                     0000000020                        7             1 301 83880      A           82     47        47
                                     0000000020                        8             1 301 84484      A           42     13        13
                                     0000000020                        9             1 305 85025      A           90     11        11
                                     0000000020                       10             1 305 85610      A           51      5         5
                                     0000000020                       11             1 305 85730      A           60      8         8
                                     0000000020                       12             2 306 87040      A          214     14        28
                                     0000000020                       13             1 307 81001      A           35      4         4
                                     0000000020                       14             1 324 71010      X          208     14        14
                                     0000000020                       15             1 410 94640      S           62     14        14
                                     0000000020                       16             1 410 94664      S           64     17        17
                                     0000000020                       17             1 450 99284      V          355    210      210
                                     0000000020                       18             1 730 93005      S          130     11        11
                                     0000000021                        1             1 740 95810      S       2,235     651      651
                                     0000000022                        1             1 740 95811      S       2,275     726      726
                                     0000000023                        1             1 320 72050      X          397     37        37
                                     0000000024                        1             1 250                       137      0         0
                                     0000000024                        2             1 270                        52      0         0
                                     0000000024                        3             1 341 78223     S        1,193     301      301
                                     0000000024                        4             1 636 A9513                  97      0         0
                                     0000000025                        1             1 611 70551     S        1,912     526      526
                                     0000000025                        2             1 921 93880     S           314    233      233
                                     0000000026                        1             5 250                        59      0         0
                                     0000000026                        2           10  250 J1100                  39      0         0
                                     0000000026                        3             6 250 J2250                  36      0         0
                                     0000000026                        4             1 258                        46      0         0
                                     0000000026                        5             8 271                       939      0         0
                                     0000000026                        6           17  272                       246      0         0
                                     0000000026                        7             1 301 82565     A            34      7         7
                                     0000000026                        8             1 301 84132     A            34      6         6
                                     0000000026                        9             1 312 88305     X            93     75        75
                                     0000000026                       10             2 312 88305     X           187     75      151
                                     0000000026                       11             1 312 88331     X            87     34        34
                                     0000000026                       12             2 312 88331     X           173     34        68
                                     0000000026                       13             1 360 14040     T           500    820      410
                                     0000000026                       14             1 360 14040     T           500    820      410
                                     0000000026                       15             1 360 14060     T           408    875      875


pai 7/19/2011 1:37 AM
                                                                                     Milliman
D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [OPPS (2)]                                                             Page 17 of 28
                                                                              Service Rev           Status                  Adjusted
                                           ClaimID              LineNum        Units Code HCPCS    Lookup    Billed Allowed Allowed
                                     0000000026                       16             1 370                       555      0         0
                                     0000000026                       17             1 710                       576      0         0
                                     0000000026                       18             1 730 93005     S           125     11        11
                                     0000000027                        1             1 255                       221      0         0
                                     0000000027                        2             1 272                        43      0         0
                                     0000000027                        3             1 300 36415     A             7      3         3
                                     0000000027                        4             1 301 82565     A            34      7         7
                                     0000000027                        5             1 301 84520     A            34      5         5
                                     0000000027                        6             1 320 74415     S        1,111     116      116
                                     0000000028                        1             1 320 74230     S           521     66        66
                                     0000000028                        2             1 440 92611     A           242     73        73
                                     0000000029                        1             1 250 J1580                  15      0         0
                                     0000000029                        2             1 250 J2175                  14      0         0
                                     0000000029                        3             2 250 J2250                  12      0         0
                                     0000000029                        4             2 250 J3370                  40      0         0
                                     0000000029                        5             2 258                        50      0         0
                                     0000000029                        6             2 270                       111      0         0
                                     0000000029                        7             4 271                       792      0         0
                                     0000000029                        8             4 272                       129      0         0
                                     0000000029                        9             1 300 36415     A             7      3         3
                                     0000000029                       10             1 305 85610     A            49      5         5
                                     0000000029                       11             1 305 85730     A            58      8         8
                                     0000000029                       12             1 312 88305     X            93     75        75
                                     0000000029                       13             1 312 88312     X            71     88        88
                                     0000000029                       14             1 360 43239     T           450    506      506
                                     0000000029                       15             1 710                       341      0         0
                                     0000000030                        1             1 250                         6      0         0
                                     0000000030                        2             1 750 91010     X        1,321     119      119
                                     0000000031                        1             1 312 88305     X            93     75        75
                                     0000000031                        2             1 312 88312     X            71     88        88
                                     0000000032                        1             1 341 78264     S        1,014     255      255
                                     0000000032                        2             1 636 A9520                  82      0         0
                                     0000000033                        1             1 312 88305     X            93     75        75
                                     0000000034                        1             1 300 36415     A             7      3         3
                                     0000000034                        2             1 301 82565     A            34      7         7
                                     0000000034                        3             1 301 84132     A            34      6         6
                                     0000000034                        4             1 305 85014     A            35      3         3


pai 7/19/2011 1:37 AM
                                                                                     Milliman
D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [OPPS (2)]                                                             Page 18 of 28
                                                                              Service Rev           Status                  Adjusted
                                           ClaimID              LineNum        Units Code HCPCS    Lookup    Billed Allowed Allowed
                                     0000000034                        5             1 730 93005      S          125     11        11
                                     0000000035                        1             4 250                        71      0         0
                                     0000000035                        2             2 250 J0690                  16      0         0
                                     0000000035                        3             2 250 J2250                  17      0         0
                                     0000000035                        4             8 271                    1,080       0         0
                                     0000000035                        5           20  272                       335      0         0
                                     0000000035                        6             1 312 88305     X            93     75        75
                                     0000000035                        7             1 324 71020     X           265     20        20
                                     0000000035                        8             1 360 11623     T           484    669      669
                                     0000000035                        9             1 360 12042     T           484     81        40
                                     0000000035                       10             1 370                       343      0         0
                                     0000000035                       11             3 636 J3010     N            37      0         0
                                     0000000035                       12             1 710                       341      0         0
                                     0000000036                        1             1 300 36415     A             7      3         3
                                     0000000036                        2             1 301 82565     A            35      7         7
                                     0000000036                        3             1 301 84520     A            35      5         5
                                     0000000036                        4             1 324 71020     X           275     20        20
                                     0000000036                        5             1 352 74150     S        1,551     214      214
                                     0000000036                        6             1 480 93307     S           480    133      133
                                     0000000036                        7             1 480 93320     S           199     61        61
                                     0000000036                        8             1 480 93325     S           200     32        32
                                     0000000037                        1             1 250                         6      0         0
                                     0000000037                        2             1 250 J2175                  14      0         0
                                     0000000037                        3             2 250 J2250                  12      0         0
                                     0000000037                        4             1 270                        53      0         0
                                     0000000037                        5             1 270                        58      0         0
                                     0000000037                        6             1 271                       145      0         0
                                     0000000037                        7             1 272                       718      0         0
                                     0000000037                        8             2 272                        79      0         0
                                     0000000037                        9             1 301 82948                  11      0         0
                                     0000000037                       10             1 360 43235                 450      0         0
                                     0000000037                       11             1 637 A9270                   6      0         0
                                     0000000037                       12             1 710                       341      0         0
                                     0000000038                        1             1 402 76775     S           451     81        81
                                     0000000039                        1             5 250                        59      0         0
                                     0000000039                        2             2 250 J2250                  13      0         0
                                     0000000039                        3             4 258                       157      0         0


pai 7/19/2011 1:37 AM
                                                                                     Milliman
D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [OPPS (2)]                                                             Page 19 of 28
                                                                              Service Rev           Status                  Adjusted
                                           ClaimID              LineNum        Units Code HCPCS    Lookup    Billed Allowed Allowed
                                     0000000039                        4             8 271                    1,126       0         0
                                     0000000039                        5           12  272                       273      0         0
                                     0000000039                        6             1 301 84132     A            35      6         6
                                     0000000039                        7             1 312 88305     X           108     75        75
                                     0000000039                        8             1 312 88331     X            90     34        34
                                     0000000039                        9             1 360 14000     T           782    811      811
                                     0000000039                       10             1 370                       297      0         0
                                     0000000039                       11             3 636 J3010     N            38      0         0
                                     0000000039                       12             2 637 A9270                   6      0         0
                                     0000000039                       13             1 710                       355      0         0
                                     0000000039                       14             1 730 93005     S           130     11        11
                                     0000000040                        1             1 250 J2270                  14      0         0
                                     0000000040                        2             1 250 J2550                  14      0         0
                                     0000000040                        3             1 271                        26      0         0
                                     0000000040                        4             1 300 36415     A             7      3         3
                                     0000000040                        5             1 301 80048     A            83     11        11
                                     0000000040                        6             1 305 85025     A            86     11        11
                                     0000000040                        7             1 307 81001     A            34      4         4
                                     0000000040                        8             1 320 72110     X           402     40        40
                                     0000000040                        9             1 352 72192     S        1,292     215      215
                                     0000000040                       10             1 352 74150     S        1,491     214      214
                                     0000000040                       11             1 450 90782     S            76     26        26
                                     0000000040                       12             1 450 99284     V           341    210      210
                                     0000000041                        1             1 271                        26      0         0
                                     0000000041                        2             1 272                        43      0         0
                                     0000000041                        3             1 300 36415     A             7      3         3
                                     0000000041                        4             1 301 80053     A           142     14        14
                                     0000000041                        5             2 301 82948     A            22      4         9
                                     0000000041                        6             1 305 85025     A            86     11        11
                                     0000000041                        7             1 307 81001     A            34      4         4
                                     0000000041                        8             1 450 99284     V           341    210      210
                                     0000000041                        9             1 730 93005     S           125     11        11
                                     0000000042                        1             1 255                       169      0         0
                                     0000000042                        2             2 270                       101      0         0
                                     0000000042                        3             1 300 36415     A             7      3         3
                                     0000000042                        4             1 301 82565     A            34      7         7
                                     0000000042                        5             1 301 84520     A            34      5         5


pai 7/19/2011 1:37 AM
                                                                                     Milliman
D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [OPPS (2)]                                                             Page 20 of 28
                                                                              Service Rev           Status                  Adjusted
                                           ClaimID              LineNum        Units Code HCPCS    Lookup    Billed Allowed Allowed
                                     0000000042                        6             1 352 71260      S       1,239     286      286
                                     0000000043                        1             1 250 J2175                  14      0         0
                                     0000000043                        2             6 250 J2250                  36      0         0
                                     0000000043                        3             2 270                       111      0         0
                                     0000000043                        4             1 271                       145      0         0
                                     0000000043                        5             3 272                       571      0         0
                                     0000000043                        6             1 360 45378     T           585    481      481
                                     0000000043                        7             1 710                       341      0         0
                                     0000000044                        1             1 255                        83      0         0
                                     0000000044                        2             1 341 78306     S        1,395     214      214
                                     0000000045                        1             1 270                       103      0         0
                                     0000000045                        2             1 352 72192     S        1,292     215      215
                                     0000000045                        3             1 352 74150     S        1,491     214      214
                                     0000000046                        1             1 271                        27      0         0
                                     0000000046                        2             1 271                         9      0         0
                                     0000000046                        3             1 272                        45      0         0
                                     0000000046                        4             1 300 36415     A             7      3         3
                                     0000000046                        5             1 301 80048     A            87     11        11
                                     0000000046                        6             1 301 82550     A            35      9         9
                                     0000000046                        7             1 301 82553     A            50     14        14
                                     0000000046                        8             1 301 84484     A            42     13        13
                                     0000000046                        9             1 305 85025     A            90     11        11
                                     0000000046                       10             1 306 87088     A            95     10         0
                                     0000000046                       11             1 307 81001     A            35      4         4
                                     0000000046                       12             1 320 72050     X           397     37        37
                                     0000000046                       13             1 320 73030     X           251     20        20
                                     0000000046                       14             1 351 70450     S        1,190     175      175
                                     0000000046                       15             1 352 72125     S        1,707     230      230
                                     0000000046                       16             1 450 90782     S            79     26        26
                                     0000000046                       17             1 450 99281     V            96     50        50
                                     0000000046                       18             1 450 99284     V           355    210      210
                                     0000000046                       19             1 636 90718     N            34      0         0
                                     0000000046                       20             2 637 A9270                   5      0         0
                                     0000000046                       21             1 730 93005     S           130     11        11
                                     0000000047                        1           14  250                       142      0         0
                                     0000000047                        2             2 250 J0690                  16      0         0
                                     0000000047                        3           10  250 J1840                 156      0         0


pai 7/19/2011 1:37 AM
                                                                                     Milliman
D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [OPPS (2)]                                                             Page 21 of 28
                                                                              Service Rev           Status                  Adjusted
                                           ClaimID              LineNum        Units Code HCPCS    Lookup    Billed Allowed Allowed
                                     0000000047                        4             2 250 J2250                  17      0         0
                                     0000000047                        5             1 258                        58      0         0
                                     0000000047                        6             1 270                    1,302       0         0
                                     0000000047                        7             7 271                       681      0         0
                                     0000000047                        8           29  272                       498      0         0
                                     0000000047                        9             1 300 36415     A             7      3         3
                                     0000000047                       10             1 301 84132     A            34      6         6
                                     0000000047                       11             1 305 85014     A            35      3         3
                                     0000000047                       12             1 360 10180     T        1,410     995      995
                                     0000000047                       13             1 370                       536      0         0
                                     0000000047                       14             1 636 J3010     N            12      0         0
                                     0000000047                       15             1 637 A9270                   3      0         0
                                     0000000047                       16             1 710                       846      0         0
                                     0000000048                        1             1 255                       188      0         0
                                     0000000048                        2             1 610 70549     S        2,603     869      869
                                     0000000049                        1             1 250 J2175                  14      0         0
                                     0000000049                        2             6 250 J2250                  35      0         0
                                     0000000049                        3             2 270                       111      0         0
                                     0000000049                        4             2 271                       421      0         0
                                     0000000049                        5             3 272                    1,062       0         0
                                     0000000049                        6             1 360 43248     T           300    505      505
                                     0000000049                        7             1 360 45378     T           348    481      241
                                     0000000049                        8             1 710                       341      0         0
                                     0000000050                        1             1 301 82948     A            11      4         0
                                     0000000050                        2             1 343 C1775                 594      0         0
                                     0000000050                        3             1 404 78815     S        2,926     950      950
                                     0000000051                        1             1 250                         9      0         0
                                     0000000051                        2             1 740 95811     S        2,275     726      726
                                     0000000052                        1             3 250                        50      0         0
                                     0000000052                        2             2 250 J0690                  44      0         0
                                     0000000052                        3             2 250 J2250                  12      0         0
                                     0000000052                        4             7 271                    1,081       0         0
                                     0000000052                        5           24  272                       378      0         0
                                     0000000052                        6             1 300 36415     A             7      3         3
                                     0000000052                        7             1 301 80048     A            83     11        11
                                     0000000052                        8             1 305 85014     A            35      3         3
                                     0000000052                        9             1 305 85610     A            49      5         0


pai 7/19/2011 1:37 AM
                                                                                     Milliman
D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [OPPS (2)]                                                             Page 22 of 28
                                                                              Service Rev           Status                   Adjusted
                                           ClaimID              LineNum        Units Code HCPCS    Lookup    Billed Allowed Allowed
                                     0000000052                       10             1 305 85730      A           58       8         0
                                     0000000052                       11             1 312 88305      X           93      75        75
                                     0000000052                       12             1 360 11643      T          803     540      540
                                     0000000052                       13             1 360 12052      T          803     123        61
                                     0000000052                       14             1 370                       456       0         0
                                     0000000052                       15             1 710                       341       0         0
                                     0000000052                       16             1 730 93005     S           125      11        11
                                     0000000053                        1             1 300 36415     A             7       3         3
                                     0000000053                        2             1 301 82565     A            34       7         7
                                     0000000053                        3             1 301 84132     A            34       6         6
                                     0000000053                        4             1 730 93005     S           125      11        11
                                     0000000054                        1             5 250                        72       0         0
                                     0000000054                        2             2 250 J2250                  17       0         0
                                     0000000054                        3             8 271                    1,006        0         0
                                     0000000054                        4           31  272                       412       0         0
                                     0000000054                        5             1 360 15823     T        2,640    1,028    1,028
                                     0000000054                        6             1 370                       840       0         0
                                     0000000054                        7             1 636 J3010     N            12       0         0
                                     0000000054                        8             1 637 A9270                   7       0         0
                                     0000000054                        9             1 710                       341       0         0
                                     0000000055                        1             1 250                         6       0         0
                                     0000000055                        2             1 271                        17       0         0
                                     0000000055                        3             1 272                        40       0         0
                                     0000000055                        4             1 450 90471     S            35      26        26
                                     0000000055                        5             1 450 99283     V           198     130      130
                                     0000000055                        6             1 636 90718     N            33       0         0
                                     0000000055                        7             1 637 A9270                   3       0         0
                                     0000000056                        1             1 351 70450     S        1,144      175      175
                                     0000000056                        2             1 921 93880     S           302     233      233
                                     0000000057                        1             1 250                         6       0         0
                                     0000000057                        2             1 271                        17       0         0
                                     0000000057                        3             1 300 36415     A             7       3         3
                                     0000000057                        4             1 301 82435     A            14       6         6
                                     0000000057                        5             1 301 82947     A            14       5         0




pai 7/19/2011 1:37 AM
                                                                                     Milliman
D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [OPPS (2)]                                                              Page 23 of 28
   Milliman Hospital Evaluation and Comparison System - Medicare OPPS 2005 2007.0 Update
   Sample Outpatient Data
   Dates of Service: From January 1, 2005 to December 31, 2005


                                                                                   Rev                                                                        Milliman Max    Max Milliman RevCod                                                                                          RVU              Service Case Milliman                   RVU              Case
    Sequence                                                             Service   Cod                                    Patient                  Repriced     Unit   Units Units Adjusted e Bundle Milliman Milliman     NCP   Status HCG    Service Milliman Milliman Exclusion Edit    Unit    Service Inclusion Looku  Case   Case    Case     Case      Case Inclusion
     Number            ClaimID              LineNum Service Date          Units     e    HCPC Modifier   Billed Allowed    Pay      COB    Paid    Allowed     Count Lookup Flag Units      Lookup HCPC Modifier Bundled Lookup Lookup Line   Category Billed Allowed      Flag    Code Lookup     RVUs      Flag      p   Counter HCPC Category   Lookup    RVUs    Flag
              1   0000000001                       1    1/1/2005               1   250                        22      0         0      0       0          0          0      1    0        0        1                   1 -              P46   ER             22        0         0      1    -        -            1     0       0 99283 ER            -        -          1
              2   0000000001                       2    1/1/2005               1   250   J0170                 9      0         0      0       0          0          0      1    0        0        1                   1 -              P46   ER              9        0         0      1    -        -            1     0       0 99283 ER            -        -          1
              3   0000000001                       3    1/1/2005               1   250   J1200                14      0         0      0       0          0          0      1    0        0        1                   1 -              P46   ER             14        0         0      1    -        -            1     0       0 99283 ER            -        -          1
              4   0000000001                       4    1/1/2005               1   250   J2930                21      0         0      0       0          0          0      1    0        0        1                   1 -              P46   ER             21        0         0      1    -        -            1     0       0 99283 ER            -        -          1
              5   0000000001                       5    1/1/2005               1   258                        46      0         0      0       0          0          0      1    0        0        1                   1 -              P46   ER             46        0         0      1    -        -            1     0       0 99283 ER            -        -          1
              6   0000000001                       6    1/1/2005               1   260   90780               141     96         0      0      96         96          1      1    0        1        1                   1 -              P46   ER            141       96         0      0    -        -            1     0       0 99283 ER            -        -          1
              7   0000000001                       7    1/1/2005               1   271                        17      0         0      0       0          0          0      1    0        0        1                   1 -              P84   ER             17        0         0      1    -        -            1     0       0 99283 ER            -        -          1
              8   0000000001                       8    1/1/2005               1   272                        43      0         0      0       0          0          0      1    0        0        1                   1 -              P84   ER             43        0         0      1    -        -            1     0       0 99283 ER            -        -          1
              9   0000000001                       9    1/1/2005               1   300   36415                 7      3         0      0       3          3          1      2    0        1        0 36415             0 -         A    P49   OTHER           7        3         0      0  0.079    0.079          1     0       0 99283 ER          0.079      -          1
             10   0000000001                      10    1/1/2005               1   450   99283               198    117         0      0     117        117          1      2    0        1        0 99283             0 -         V    P61   ER            198      117         0      0  3.430    3.430          1     1       1 99283 ER          3.430    3.430        1
             12   0000000002                       1    1/1/2005               1   250   J1200                14      0         0      0       0          0          0      1    0        0        1                   1 -              P46   ER             14        0         0      1    -        -            1     0       0 99284 ER            -        -          1
             13   0000000002                       2    1/1/2005               1   250   J2930                19      0         0      0       0          0          0      1    0        0        1                   1 -              P46   ER             19        0         0      1    -        -            1     0       0 99284 ER            -        -          1
             14   0000000002                       3    1/1/2005               1   271                        27      0         0      0       0          0          0      1    0        0        1                   1 -              P84   ER             27        0         0      1    -        -            1     0       0 99284 ER            -        -          1
             15   0000000002                       4    1/1/2005               1   272                        45      0         0      0       0          0          0      1    0        0        1                   1 -              P84   ER             45        0         0      1    -        -            1     0       0 99284 ER            -        -          1
             16   0000000002                       5    1/1/2005               1   450   90784                74     43         0      0      43         43          1      7    0        1        0 90774             0 -         S    P46   OTHER          74       43         0      4  0.494    0.494          1     0       0 99284 ER          0.494      -          1
             17   0000000002                       6    1/1/2005               1   450   99284               355    201         0      0     201        201          1      2    0        1        0 99284             0 -         V    P61   ER            355      201         0      0  5.541    5.541          1     1       1 99284 ER          5.541    5.541        1
             19   0000000003                       1    1/1/2005               1   921   93880               302    119         0      0     119        119          1      1    0        1        0 93880             0 -         S    P49   OTHER         302      119         0      0  6.160    6.160          1     0       0       OTHER       6.160    6.160        1
             21   0000000004                       1    1/1/2005               1   250   J2175                13      0         0      0       0          0          0      1    0        0        1                   1 -              P46   RAD            13        0         0      1    -        -            1     0       0 74160 RAD           -        -          1
             22   0000000004                       2    1/1/2005               1   255                       402      0         0      0       0          0          0      1    0        0        1                   1 -              P66   RAD           402        0         0      1    -        -            1     0       0 74160 RAD           -        -          1
             23   0000000004                       3    1/1/2005               1   258                        46      0         0      0       0          0          0      1    0        0        1                   1 -              P46   RAD            46        0         0      1    -        -            1     0       0 74160 RAD           -        -          1
             24   0000000004                       4    1/1/2005               1   260   90780               141     96         0      0      96         96          1      1    0        1        1                   1 -              P46   RAD           141       96         0      0    -        -            1     0       0 74160 RAD           -        -          1
             25   0000000004                       5    1/1/2005               1   270                        61      0         0      0       0          0          0      1    0        0        1                   1 -              P84   RAD            61        0         0      1    -        -            1     0       0 74160 RAD           -        -          1
             26   0000000004                       6    1/1/2005               1   271                        26      0         0      0       0          0          0      1    0        0        1                   1 -              P84   RAD            26        0         0      1    -        -            1     0       0 74160 RAD           -        -          1
             27   0000000004                       7    1/1/2005               1   272                        43      0         0      0       0          0          0      1    0        0        1                   1 -              P84   RAD            43        0         0      1    -        -            1     0       0 74160 RAD           -        -          1
             28   0000000004                       8    1/1/2005               1   300   36415                 7      3         0      0       3          3          1      2    0        1        0 36415             0 -         A    P49   OTHER           7        3         0      0  0.079    0.079          1     0       0 74160 RAD         0.079      -          1
             29   0000000004                       9    1/1/2005               1   301   80053               142     15         0      0      15         15          1      1    0        1        0 80053             0 -         A    P67   LAB           142       15         0      0  0.381    0.381          1     0       0 74160 RAD         0.381      -          1
             30   0000000004                      10    1/1/2005               1   301   82150                73      9         0      0       9          9          1      1    0        1        0 82150             0 -         A    P67   LAB            73        9         0      0  0.238    0.238          1     0       0 74160 RAD         0.238      -          1
             31   0000000004                      11    1/1/2005               1   301   83690                44     10         0      0      10         10          1      1    0        1        0 83690             0 -         A    P67   LAB            44       10         0      0  0.246    0.246          1     0       0 74160 RAD         0.246      -          1
             32   0000000004                      12    1/1/2005               1   302   86677               102     20         0      0      20         20          1      3    0        1        0 86677             0 -         A    P67   LAB           102       20         0      0  0.499    0.499          1     0       0 74160 RAD         0.499      -          1
             33   0000000004                      13    1/1/2005               1   305   85025                86     11         0      0      11         11          1      1    0        1        0 85025             0 -         A    P67   LAB            86       11         0      0  0.279    0.279          1     0       0 74160 RAD         0.279      -          1
             34   0000000004                      14    1/1/2005               1   307   81001                34      4         0      0       4          4          1      1    0        1        0 81001             0 -         A    P67   LAB            34        4         0      0  0.116    0.116          1     0       0 74160 RAD         0.116      -          1
             35   0000000004                      15    1/1/2005               1   352   72193            1,491     232         0      0     232        232          1      1    0        1        0 72193             0 -         S    P66   RAD         1,491      232         0      0  7.140    7.140          1     0       0 74160 RAD         7.140      -          1
             36   0000000004                      16    1/1/2005               1   352   74160            1,491     232         0      0     232        232          1      1    0        1        0 74160             0 -         S    P66   RAD         1,491      232         0      0  8.320    8.320          1     0       1 74160 RAD         8.320    8.320        1
             37   0000000004                      17    1/1/2005               1   450   90784                71     43         0      0      43         43          1      7    0        1        0 90774             0 -         S    P46   OTHER          71       43         0      4  0.494    0.494          1     0       0 74160 RAD         0.494      -          1
             38   0000000004                      18    1/1/2005               1   450   99284               341    201         0      0     201        201          1      2    0        1        0 99284             0 -         V    P61   ER            341      201         0      0  5.541    5.541          1     1       0 74160 RAD         5.541      -          1
             39   0000000004                      19    1/1/2005               4   636   J2405                94     22         0      0      22         22          4     36    0        4        0 J2405             0 -         K    P46   OTHER          94       22         0      0  0.098    0.392          1     0       0 74160 RAD         0.098      -          1
             41   0000000005                       1    1/1/2005               1   740   95810            2,325     569         0      0     569        569          1      1    0        1        0 95810             0 -         S    P49   OTHER       2,325      569         0      0 17.170   17.170          1     0       0       OTHER      17.170   17.170        1
             43   0000000006                       1    1/1/2005               1   921   93971               273    119         0      0     119        119          1      1    0        1        0 93971             0 -         S    P49   OTHER         273      119         0      0  4.040    4.040          1     0       0       OTHER       4.040    4.040        1
             45   0000000007                       1    1/1/2005               1   255                       402      0         0      0       0          0          0      1    0        0        1                   1 -              P66   RAD           402        0         0      1    -        -            1     0       0 74160 RAD           -        -          1
             46   0000000007                       2    1/1/2005               1   258                        46      0         0      0       0          0          0      1    0        0        1                   1 -              P46   RAD            46        0         0      1    -        -            1     0       0 74160 RAD           -        -          1
             47   0000000007                       3    1/1/2005               1   260   90780               141     96         0      0      96         96          1      1    0        1        1                   1 -              P46   RAD           141       96         0      0    -        -            1     0       0 74160 RAD           -        -          1
             48   0000000007                       4    1/1/2005               2   270                       164      0         0      0       0          0          0      1    0        0        1                   1 -              P84   RAD           164        0         0      1    -        -            1     0       0 74160 RAD           -        -          1
             49   0000000007                       5    1/1/2005               1   271                        26      0         0      0       0          0          0      1    0        0        1                   1 -              P84   RAD            26        0         0      1    -        -            1     0       0 74160 RAD           -        -          1
             50   0000000007                       6    1/1/2005               1   272                        43      0         0      0       0          0          0      1    0        0        1                   1 -              P84   RAD            43        0         0      1    -        -            1     0       0 74160 RAD           -        -          1
             51   0000000007                       7    1/1/2005               1   300   36415                 7      3         0      0       3          3          1      2    0        1        0 36415             0 -         A    P49   OTHER           7        3         0      0  0.079    0.079          1     0       0 74160 RAD         0.079      -          1
             52   0000000007                       8    1/1/2005               1   301   80053               142     15         0      0      15         15          1      1    0        1        0 80053             0 -         A    P67   LAB           142       15         0      0  0.381    0.381          1     0       0 74160 RAD         0.381      -          1
             53   0000000007                       9    1/1/2005               1   301   82150                73      9         0      0       9          9          1      1    0        1        0 82150             0 -         A    P67   LAB            73        9         0      0  0.238    0.238          1     0       0 74160 RAD         0.238      -          1
             54   0000000007                      10    1/1/2005               1   301   83690                44     10         0      0      10         10          1      1    0        1        0 83690             0 -         A    P67   LAB            44       10         0      0  0.246    0.246          1     0       0 74160 RAD         0.246      -          1
             55   0000000007                      11    1/1/2005               1   305   85025                86     11         0      0      11         11          1      1    0        1        0 85025             0 -         A    P67   LAB            86       11         0      0  0.279    0.279          1     0       0 74160 RAD         0.279      -          1
             56   0000000007                      12    1/1/2005               1   307   81001                34      4         0      0       4          4          1      1    0        1        0 81001             0 -         A    P67   LAB            34        4         0      0  0.116    0.116          1     0       0 74160 RAD         0.116      -          1
             57   0000000007                      13    1/1/2005               1   324   71010               200     38         0      0      38         38          1      2    0        1        0 71010             0 -         X    P66   RAD           200       38         0      0  0.370    0.370          1     0       0 74160 RAD         0.370      -          1
             58   0000000007                      14    1/1/2005               1   352   72193            1,491     232         0      0     232        232          1      1    0        1        0 72193             0 -         S    P66   RAD         1,491      232         0      0  7.140    7.140          1     0       0 74160 RAD         7.140      -          1
             59   0000000007                      15    1/1/2005               1   352   74160            1,491     232         0      0     232        232          1      1    0        1        0 74160             0 -         S    P66   RAD         1,491      232         0      0  8.320    8.320          1     0       1 74160 RAD         8.320    8.320        1
             60   0000000007                      16    1/1/2005               1   450   99284               341    201         0      0     201        201          1      2    0        1        0 99284             0 -         V    P61   ER            341      201         0      0  5.541    5.541          1     1       0 74160 RAD         5.541      -          1
             62   0000000008                       1    1/1/2005               1   250                        19      0         0      0       0          0          0      1    0        0        1                   1 -              P46   SURG           19        0         0      1    -        -            1     0       0 19103 SURG          -        -          1
             63   0000000008                       2    1/1/2005               3   270                    1,195       0         0      0       0          0          0      1    0        0        1                   1 -              P84   SURG        1,195        0         0      1    -        -            1     0       0 19103 SURG          -        -          1
             64   0000000008                       3    1/1/2005               1   272                        35      0         0      0       0          0          0      1    0        0        1                   1 -              P84   SURG           35        0         0      1    -        -            1     0       0 19103 SURG          -        -          1
             65   0000000008                       4    1/1/2005               1   312   88305                93     21         0      0      21         21          1      7    0        1        0 88305             0 -         X    P67   LAB            93       21         0      0  1.990    1.990          1     0       0 19103 SURG        1.990      -          1
             66   0000000008                       5    1/1/2005               1   360   19103            1,053     327         0      0     327        327          1      2    0        1        0 19103             0 -         T    P11   SURG        1,053      327         0      0 10.443   10.443          1     1       1 19103 SURG       10.443   10.443        1
             67   0000000008                       6    1/1/2005               1   360   19295               290     90         0      0      90         90          1      2    0        1        0 19295             0 -         S    P11   SURG          290       90         0      0  2.200    2.200          1     1       0 19103 SURG        2.200      -          1
             68   0000000008                       7    1/1/2005               1   401   76095               303     94         0      0      94         94          1      2    0        1        0 G0204             0 -         A    P66   RAD           303       94         0      4  2.970    2.970          1     0       0 19103 SURG        2.970      -          1
             70   0000000009                       1    1/1/2005               3   250                        31      0         0      0       0          0          0      1    0        0        1                   1 -              P46   SURG           31        0         0      1    -        -            1     0       0 64484 SURG          -        -          1
             71   0000000009                       2    1/1/2005               1   250   J2175                13      0         0      0       0          0          0      1    0        0        1                   1 -              P46   SURG           13        0         0      1    -        -            1     0       0 64484 SURG          -        -          1
             72   0000000009                       3    1/1/2005               1   255                       171      0         0      0       0          0          0      1    0        0        1                   1 -              P66   RAD           171        0         0      1    -        -            1     0       0 64484 SURG          -        -          1
             73   0000000009                       4    1/1/2005               2   258                        91      0         0      0       0          0          0      1    0        0        1                   1 -              P46   SURG           91        0         0      1    -        -            1     0       0 64484 SURG          -        -          1
             74   0000000009                       5    1/1/2005               2   270                        57      0         0      0       0          0          0      1    0        0        1                   1 -              P84   SURG           57        0         0      1    -        -            1     0       0 64484 SURG          -        -          1
             75   0000000009                       6    1/2/2005               1   270                        52      0         0      0       0          0          0      1    0        0        1                   1 -              P84   OTHER          52        0         0      1    -        -            0     0       0       OTHER         -        -          0
             76   0000000009                       7    1/1/2005               1   271                        45      0         0      0       0          0          0      1    0        0        1                   1 -              P84   SURG           45        0         0      1    -        -            1     0       0 64484 SURG          -        -          1
             77   0000000009                       8    1/2/2005               1   271                        45      0         0      0       0          0          0      1    0        0        1                   1 -              P84   OTHER          45        0         0      1    -        -            0     0       0       OTHER         -        -          0
             78   0000000009                       9    1/1/2005               5   272                        83      0         0      0       0          0          0      1    0        0        1                   1 -              P84   SURG           83        0         0      1    -        -            1     0       0 64484 SURG          -        -          1
             79   0000000009                      10    1/1/2005               1   300   36415                 7      3         0      0       3          3          1      2    0        1        0 36415             0 -         A    P49   OTHER           7        3         0      0  0.079    0.079          1     0       0 64484 SURG        0.079      -          1
             80   0000000009                      11    1/1/2005               1   301   80053               142     15         0      0      15         15          1      1    0        1        0 80053             0 -         A    P67   LAB           142       15         0      0  0.381    0.381          1     0       0 64484 SURG        0.381      -          1
             81   0000000009                      12    1/1/2005               4   301   82948                43     18         0      0      18         18          4      6    0        4        0 82948             0 -         A    P67   LAB            43       18         0      0  0.113    0.452          1     0       0 64484 SURG        0.113      -          1
             82   0000000009                      13    1/2/2005               1   301   82948                11      4         0      0       4          4          1      6    0        1        0 82948             0 -         A    P67   LAB            11        4         0      0  0.113    0.113          1     0       0       LAB         0.113    0.113        1
             83   0000000009                      14    1/1/2005               1   305   85025                86     11         0      0      11         11          1      1    0        1        0 85025             0 -         A    P67   LAB            86       11         0      0  0.279    0.279          1     0       0 64484 SURG        0.279      -          1
             84   0000000009                      15    1/1/2005               1   307   81001                34      4         0      0       4          4          1      1    0        1        0 81001             0 -         A    P67   LAB            34        4         0      0  0.116    0.116          1     0       0 64484 SURG        0.116      -          1
             85   0000000009                      16    1/1/2005               1   320   76005               363      0         0      0       0          0          0      1    0        0        0 76005             0 -              P66   RAD           363        0         0      1    -        -            0     0       0 64484 SURG          -        -          1
             86   0000000009                      17    1/1/2005               1   360   64483            2,274     285         0      0     285        285          1      2    0        1        0 64483             0 -         T    P11   SURG        2,274      285         0      0 15.159    7.580          1     1       0 64484 SURG       15.159      -          1
             87   0000000009                      18    1/1/2005               1   360   64484            1,000     143         0      0     143        143          1      3    0        1        0 64484             0 -         T    P11   SURG        1,000      143         0      0 19.976   19.976          1     1       1 64484 SURG       19.976   19.976        1
             88   0000000009                      19    1/1/2005               4   636   J3301                31      0         0      0       0          0          0      0    0        0        0 J3301             1 B         N    P46   SURG           31        0         0      1    -        -            1     0       0 64484 SURG          -        -          1
             89   0000000009                      20    1/1/2005              17   637   A9270               141      0         0      0       0          0          0      1    0        0        1                   1 -              P46   SURG          141        0         0      1    -        -            1     0       0 64484 SURG          -        -          1
             90   0000000009                      21    1/2/2005               1   637   A9270                50      0         0      0       0          0          0      1    0        0        1                   1 -              P46   OTHER          50        0         0      1    -        -            0     0       0       OTHER         -        -          0
             91   0000000009                      22    1/1/2005               1   730   93005               125     19         0      0      19         19          1      2    0        1        0 93005             0 -         S    P64   OTHER         125       19         0      0  0.290    0.290          1     0       0 64484 SURG        0.290      -          1
             92   0000000009                      23    1/2/2005              11   762   99217               286      0         0      0       0          0          0      1    0        0        1                   1 -              P99   OTHER         286        0         0      1    -        -            0     0       0       OTHER         -        -          0
             93   0000000009                      24    1/1/2005               9   762   99218               234      0         0      0       0          0          0      1    0        0        1                   1 -              P99   SURG          234        0         0      1    -        -            1     0       0 64484 SURG          -        -          1
             95   0000000010                       1    1/1/2005               1   343   C1775               571    221         0      0     221        221          1      1    0        1        1                   1 -              P66   RAD           571      221         0      0    -        -            1     0       0       RAD           -        -          1
             96   0000000010                       2    1/1/2005               1   404   78815            2,814   1,074         0      0   1,074      1,074          1      1    0        1        0 78815             0 -         S    P66   RAD         2,814    1,074         0      0 25.068   25.068          1     0       0       RAD        25.068   25.068        1
             98   0000000011                       1    1/1/2005               1   271                        26      0         0      0       0          0          0      1    0        0        1                   1 -              P84   ER             26        0         0      1    -        -            1     0       0 99284 ER            -        -          1
             99   0000000011                       2    1/1/2005               1   272                        43      0         0      0       0          0          0      1    0        0        1                   1 -              P84   ER             43        0         0      1    -        -            1     0       0 99284 ER            -        -          1
            100   0000000011                       3    1/1/2005               1   300   36415                 7      3         0      0       3          3          1      2    0        1        0 36415             0 -         A    P49   OTHER           7        3         0      0  0.079    0.079          1     0       0 99284 ER          0.079      -          1
            101   0000000011                       4    1/1/2005               1   301   80053               142     15         0      0      15         15          1      1    0        1        0 80053             0 -         A    P67   LAB           142       15         0      0  0.381    0.381          1     0       0 99284 ER          0.381      -          1




pai 7/19/2011 1:37 AM
                                                                                                                                                                                              Milliman
D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [OP Sample]                                                                                                                                                                                                                                                                                         Page 24 of 28
                                                                                   Rev                                                                        Milliman Max    Max Milliman RevCod                                                                                          RVU              Service Case Milliman                   RVU              Case
    Sequence                                                             Service   Cod                                    Patient                  Repriced     Unit   Units Units Adjusted e Bundle Milliman Milliman     NCP   Status HCG    Service Milliman Milliman Exclusion Edit    Unit    Service Inclusion Looku  Case   Case    Case     Case      Case Inclusion
     Number            ClaimID              LineNum Service Date          Units     e    HCPC Modifier   Billed Allowed    Pay      COB    Paid    Allowed     Count Lookup Flag Units      Lookup HCPC Modifier Bundled Lookup Lookup Line   Category Billed Allowed      Flag    Code Lookup     RVUs      Flag      p   Counter HCPC Category   Lookup    RVUs    Flag
          102     0000000011                       5    1/1/2005               1   301   82550                34      9         0      0       9          9          1      3    0        1        0 82550             0 -         A    P67   LAB            34        9         0      0  0.240    0.240          1     0       0 99284 ER          0.240      -          1
          103     0000000011                       6    1/1/2005               1   301   82553                48     16         0      0      16         16          1      3    0        1        0 82553             0 -         A    P67   LAB            48       16         0      0  0.367    0.367          1     0       0 99284 ER          0.367      -          1
          104     0000000011                       7    1/1/2005               1   301   83880                79     47         0      0      47         47          1      1    0        1        0 83880             0 -         A    P67   LAB            79       47         0      0  1.235    1.235          1     0       0 99284 ER          1.235      -          1
          105     0000000011                       8    1/1/2005               1   301   84484                40     14         0      0      14         14          1      3    0        1        0 84484             0 -         A    P67   LAB            40       14         0      0  0.343    0.343          1     0       0 99284 ER          0.343      -          1
          106     0000000011                       9    1/1/2005               1   305   85025                86     11         0      0      11         11          1      1    0        1        0 85025             0 -         A    P67   LAB            86       11         0      0  0.279    0.279          1     0       0 99284 ER          0.279      -          1
          107     0000000011                      10    1/1/2005               1   305   85610                49      5         0      0       5          5          1      2    0        1        0 85610             0 -         A    P67   LAB            49        5         0      0  0.144    0.144          1     0       0 99284 ER          0.144      -          1
          108     0000000011                      11    1/1/2005               1   305   85730                58      8         0      0       8          8          1      2    0        1        0 85730             0 -         A    P67   LAB            58        8         0      0  0.220    0.220          1     0       0 99284 ER          0.220      -          1
          109     0000000011                      12    1/1/2005               1   306   87449                38     15         0      0      15         15          1      3    0        1        0 87449             0 -         A    P67   LAB            38       15         0      0  0.426    0.426          1     0       0 99284 ER          0.426      -          1
          110     0000000011                      13    1/1/2005               1   324   71020               265     38         0      0      38         38          1      1    0        1        0 71020             0 -         X    P66   RAD           265       38         0      0  0.520    0.520          1     0       0 99284 ER          0.520      -          1
          111     0000000011                      14    1/1/2005               1   450   99284               341    201         0      0     201        201          1      2    0        1        0 99284             0 -         V    P61   ER            341      201         0      0  5.541    5.541          1     1       1 99284 ER          5.541    5.541        1
          112     0000000011                      15    1/1/2005               1   730   93005               125     19         0      0      19         19          1      2    0        1        0 93005             0 -         S    P64   OTHER         125       19         0      0  0.290    0.290          1     0       0 99284 ER          0.290      -          1
          114     0000000012                       1    1/1/2005               1   921   93923               455     83         0      0      83         83          1      1    0        1        0 93923             0 -         S    P49   OTHER         455       83         0      0  4.690    4.690          1     0       0       OTHER       4.690    4.690        1
          116     0000000013                       1    1/1/2005               1   320   73130               265     38         0      0      38         38          1      2    0        1        0 73130             0 -         X    P66   RAD           265       38         0      0  0.600    0.600          1     0       0       RAD         0.600    0.600        1
          118     0000000014                       1    1/1/2005               1   250                        17      0         0      0       0          0          0      1    0        0        1                   1 -              P46   ER             17        0         0      1    -        -            1     0       0 99283 ER            -        -          1
          119     0000000014                       2    1/1/2005               1   271                        17      0         0      0       0          0          0      1    0        0        1                   1 -              P84   ER             17        0         0      1    -        -            1     0       0 99283 ER            -        -          1
          120     0000000014                       3    1/1/2005               2   272                       100      0         0      0       0          0          0      1    0        0        1                   1 -              P84   ER            100        0         0      1    -        -            1     0       0 99283 ER            -        -          1
          121     0000000014                       4    1/1/2005               1   274   L2112               712    448         0      0     448        448          1      1    0        1        1                   1 -              P84   ER            712      448         0      0    -        -            1     0       0 99283 ER            -        -          1
          122     0000000014                       5    1/1/2005               1   450   12011               173     87         0      0      87         87          1      2    0        1        0 12011             0 -         T    P11   SURG          173       87         0      0  2.094    2.094          1     1       0 99283 ER          2.094      -          1
          123     0000000014                       6    1/1/2005               1   450   90471                35      0         0      0       0          0          0      1    0        0        0 90471             0 -         S    P51   OTHER          35        0         0      1  0.678      -            0     0       0 99283 ER          0.678      -          1
          124     0000000014                       7    1/1/2005               1   450   90782                76     19         0      0      19         19          1      3    0        1        0 90772             0 -         S    P46   OTHER          76       19         0      4  0.678    0.678          1     0       0 99283 ER          0.678      -          1
          125     0000000014                       8    1/1/2005               1   450   99283               198    117         0      0     117        117          1      2    0        1        0 99283             0 -         V    P61   ER            198      117         0      0  3.430    3.430          1     1       1 99283 ER          3.430    3.430        1
          126     0000000014                       9    1/1/2005               1   636   90718                33      0         0      0       0          0          0      0    0        0        0 90718             1 B         N    P51   ER             33        0         0      1    -        -            1     0       0 99283 ER            -        -          1
          128     0000000015                       1    1/1/2005               1   402   76775               513     80         0      0      80         80          1      2    0        1        0 76775             0 -         S    P66   RAD           513       80         0      0  2.140    2.140          1     0       0       RAD         2.140    2.140        1
          130     0000000016                       1    1/1/2005               1   312   88305                93     21         0      0      21         21          1      7    0        1        0 88305             0 -         X    P67   LAB            93       21         0      0  1.990    1.990          1     0       0       LAB         1.990    1.990        1
          131     0000000016                       2    1/1/2005               1   312   88331                87     21         0      0      21         21          1      7    0        1        0 88331             0 -         X    P67   LAB            87       21         0      0  0.900    0.900          1     0       0       LAB         0.900    0.900        1
          133     0000000017                       1    1/1/2005               2   250   J2310                17      0         0      0       0          0          0      1    0        0        1                   1 -              P46   ER             17        0         0      1    -        -            1     0       0 99284 ER            -        -          1
          134     0000000017                       2    1/1/2005               1   271                        26      0         0      0       0          0          0      1    0        0        1                   1 -              P84   ER             26        0         0      1    -        -            1     0       0 99284 ER            -        -          1
          135     0000000017                       3    1/1/2005               2   272                        77      0         0      0       0          0          0      1    0        0        1                   1 -              P84   ER             77        0         0      1    -        -            1     0       0 99284 ER            -        -          1
          136     0000000017                       4    1/1/2005               1   300   36415                 7      3         0      0       3          3          1      2    0        1        0 36415             0 -         A    P49   OTHER           7        3         0      0  0.079    0.079          1     0       0 99284 ER          0.079      -          1
          137     0000000017                       5    1/1/2005               1   301   80053               142     15         0      0      15         15          1      1    0        1        0 80053             0 -         A    P67   LAB           142       15         0      0  0.381    0.381          1     0       0 99284 ER          0.381      -          1
          138     0000000017                       6    1/1/2005               1   301   82055                79     15         0      0      15         15          1      2    0        1        0 82055             0 -         A    P67   LAB            79       15         0      0  0.392    0.392          1     0       0 99284 ER          0.392      -          1
          139     0000000017                       7    1/1/2005               1   301   82550                34      9         0      0       9          9          1      3    0        1        0 82550             0 -         A    P67   LAB            34        9         0      0  0.240    0.240          1     0       0 99284 ER          0.240      -          1
          140     0000000017                       8    1/1/2005               1   301   82553                48     16         0      0      16         16          1      3    0        1        0 82553             0 -         A    P67   LAB            48       16         0      0  0.367    0.367          1     0       0 99284 ER          0.367      -          1
          141     0000000017                       9    1/1/2005               1   301   83880                79     47         0      0      47         47          1      1    0        1        0 83880             0 -         A    P67   LAB            79       47         0      0  1.235    1.235          1     0       0 99284 ER          1.235      -          1
          142     0000000017                      10    1/1/2005               1   301   84443                79     23         0      0      23         23          1      1    0        1        0 84443             0 -         A    P67   LAB            79       23         0      0  0.618    0.618          1     0       0 99284 ER          0.618      -          1
          143     0000000017                      11    1/1/2005               1   301   84484                40     14         0      0      14         14          1      3    0        1        0 84484             0 -         A    P67   LAB            40       14         0      0  0.343    0.343          1     0       0 99284 ER          0.343      -          1
          144     0000000017                      12    1/1/2005               1   305   85025                86     11         0      0      11         11          1      1    0        1        0 85025             0 -         A    P67   LAB            86       11         0      0  0.279    0.279          1     0       0 99284 ER          0.279      -          1
          145     0000000017                      13    1/1/2005               1   307   80100               111     20         0      0      20         20          1      6    0        1        0 80100             0 -         A    P67   LAB           111       20         0      0  0.508    0.508          1     0       0 99284 ER          0.508      -          1
          146     0000000017                      14    1/1/2005               1   307   81001                34      4         0      0       4          4          1      1    0        1        0 81001             0 -         A    P67   LAB            34        4         0      0  0.116    0.116          1     0       0 99284 ER          0.116      -          1
          147     0000000017                      15    1/1/2005               1   320   73564               387     38         0      0      38         38          1      2    0        1        0 73564             0 -         X    P66   RAD           387       38         0      0  0.800    0.800          1     0       0 99284 ER          0.800      -          1
          148     0000000017                      16    1/1/2005               1   324   71010               200     38         0      0      38         38          1      2    0        1        0 71010             0 -         X    P66   RAD           200       38         0      0  0.370    0.370          1     0       0 99284 ER          0.370      -          1
          149     0000000017                      17    1/1/2005               1   351   70450            1,144     166         0      0     166        166          1      1    0        1        0 70450             0 -         S    P66   RAD         1,144      166         0      0  4.630    4.630          1     0       0 99284 ER          4.630      -          1
          150     0000000017                      18    1/1/2005               1   450   51702                35      0         0      0       0          0          0      1    0        0        0 51702             0 -         X    P11   SURG           35        0         0      1  1.161      -            0     1       0 99284 ER          1.161      -          1
          151     0000000017                      19    1/1/2005               1   450   90784                35     43         0      0      43         43          1      7    0        1        0 90774             0 -         S    P46   OTHER          35       43         0      4  0.494    0.494          1     0       0 99284 ER          0.494      -          1
          152     0000000017                      20    1/1/2005               1   450   99284               341    201         0      0     201        201          1      2    0        1        0 99284             0 -         V    P61   ER            341      201         0      0  5.541    5.541          1     1       1 99284 ER          5.541    5.541        1
          153     0000000017                      21    1/1/2005               1   730   93005               125     19         0      0      19         19          1      2    0        1        0 93005             0 -         S    P64   OTHER         125       19         0      0  0.290    0.290          1     0       0 99284 ER          0.290      -          1
          155     0000000018                       1    1/1/2005               1   740   95816               381    112         0      0     112        112          1      1    0        1        0 95816             0 -         S    P49   OTHER         381      112         0      0  5.050    5.050          1     0       0       OTHER       5.050    5.050        1
          157     0000000019                       1    1/1/2005               1   610   73721            1,885     309         0      0     309        309          1      2    0        1        0 73721             0 -         S    P66   RAD         1,885      309         0      0 13.250   13.250          1     0       0       RAD        13.250   13.250        1
          159     0000000020                       1    1/1/2005               2   271                        30      0         0      0       0          0          0      1    0        0        1                   1 -              P84   ER             30        0         0      1    -        -            1     0       0 99284 ER            -        -          1
          160     0000000020                       2    1/1/2005               1   272                        45      0         0      0       0          0          0      1    0        0        1                   1 -              P84   ER             45        0         0      1    -        -            1     0       0 99284 ER            -        -          1
          161     0000000020                       3    1/1/2005               1   300   36415                 7      3         0      0       3          3          1      2    0        1        0 36415             0 -         A    P49   OTHER           7        3         0      0  0.079    0.079          1     0       0 99284 ER          0.079      -          1
          162     0000000020                       4    1/1/2005               1   301   80053               148     15         0      0      15         15          1      1    0        1        0 80053             0 -         A    P67   LAB           148       15         0      0  0.381    0.381          1     0       0 99284 ER          0.381      -          1
          163     0000000020                       5    1/1/2005               1   301   82550                35      9         0      0       9          9          1      3    0        1        0 82550             0 -         A    P67   LAB            35        9         0      0  0.240    0.240          1     0       0 99284 ER          0.240      -          1
          164     0000000020                       6    1/1/2005               1   301   82553                50     16         0      0      16         16          1      3    0        1        0 82553             0 -         A    P67   LAB            50       16         0      0  0.367    0.367          1     0       0 99284 ER          0.367      -          1
          165     0000000020                       7    1/1/2005               1   301   83880                82     47         0      0      47         47          1      1    0        1        0 83880             0 -         A    P67   LAB            82       47         0      0  1.235    1.235          1     0       0 99284 ER          1.235      -          1
          166     0000000020                       8    1/1/2005               1   301   84484                42     14         0      0      14         14          1      3    0        1        0 84484             0 -         A    P67   LAB            42       14         0      0  0.343    0.343          1     0       0 99284 ER          0.343      -          1
          167     0000000020                       9    1/1/2005               1   305   85025                90     11         0      0      11         11          1      1    0        1        0 85025             0 -         A    P67   LAB            90       11         0      0  0.279    0.279          1     0       0 99284 ER          0.279      -          1
          168     0000000020                      10    1/1/2005               1   305   85610                51      5         0      0       5          5          1      2    0        1        0 85610             0 -         A    P67   LAB            51        5         0      0  0.144    0.144          1     0       0 99284 ER          0.144      -          1
          169     0000000020                      11    1/1/2005               1   305   85730                60      8         0      0       8          8          1      2    0        1        0 85730             0 -         A    P67   LAB            60        8         0      0  0.220    0.220          1     0       0 99284 ER          0.220      -          1
          170     0000000020                      12    1/1/2005               2   306   87040               214     29         0      0      29         29          2      4    0        2        0 87040             0 -         A    P67   LAB           214       29         0      0  0.367    0.734          1     0       0 99284 ER          0.367      -          1
          171     0000000020                      13    1/1/2005               1   307   81001                35      4         0      0       4          4          1      1    0        1        0 81001             0 -         A    P67   LAB            35        4         0      0  0.116    0.116          1     0       0 99284 ER          0.116      -          1
          172     0000000020                      14    1/1/2005               1   324   71010               208     38         0      0      38         38          1      2    0        1        0 71010             0 -         X    P66   RAD           208       38         0      0  0.370    0.370          1     0       0 99284 ER          0.370      -          1
          173     0000000020                      15    1/1/2005               1   410   94640                62     16         0      0      16         16          1      6    0        1        0 94640             0 -         S    P49   OTHER          62       16         0      0  0.380    0.380          1     0       0 99284 ER          0.380      -          1
          174     0000000020                      16    1/1/2005               1   410   94664                64     16         0      0      16         16          1      4    0        1        0 94664             0 -         S    P49   OTHER          64       16         0      0  0.440    0.440          1     0       0 99284 ER          0.440      -          1
          175     0000000020                      17    1/1/2005               1   450   99284               355    201         0      0     201        201          1      2    0        1        0 99284             0 -         V    P61   ER            355      201         0      0  5.541    5.541          1     1       1 99284 ER          5.541    5.541        1
          176     0000000020                      18    1/1/2005               1   730   93005               130     19         0      0      19         19          1      2    0        1        0 93005             0 -         S    P64   OTHER         130       19         0      0  0.290    0.290          1     0       0 99284 ER          0.290      -          1
          178     0000000021                       1    1/1/2005               1   740   95810            2,235     241         0      0     241        241          1      1    0        1        0 95810             0 -         S    P49   OTHER       2,235      241         0      0 17.170   17.170          1     0       0       OTHER      17.170   17.170        1
          180     0000000022                       1    1/1/2005               1   740   95811            2,275     241         0      0     241        241          1      1    0        1        0 95811             0 -         S    P49   OTHER       2,275      241         0      0 19.150   19.150          1     0       0       OTHER      19.150   19.150        1
          182     0000000023                       1    1/1/2005               1   320   72050               397     65         0      0      65         65          1      1    0        1        0 72050             0 -         X    P66   RAD           397       65         0      0  0.980    0.980          1     0       0       RAD         0.980    0.980        1
          184     0000000024                       1    1/1/2005               1   250                       137      0         0      0       0          0          1      1    0        1        1                   1 -              P46   OTHER         137       21         0      2    -        -            1     0       0       OTHER         -        -          1
          185     0000000024                       2    1/1/2005               1   270                        52      0         0      0       0          0          1      1    0        1        1                   1 -              P84   OTHER          52        8         0      2    -        -            1     0       0       OTHER         -        -          1
          186     0000000024                       3    1/1/2005               1   341   78223            1,193     225         0      0     225        225          1      2    0        1        0 78223             0 -         S    P66   RAD         1,193      181         0      2  7.940    7.940          1     0       0       RAD         7.940    7.940        1
          187     0000000024                       4    1/1/2005               1   636   A9513                97      0         0      0       0          0          1      1    0        1        0 A9513             0 -              P46   OTHER          97       15         0      2    -        -            0     0       0       OTHER         -        -          0
          189     0000000025                       1    1/1/2005               1   611   70551            1,912     309         0      0     309        309          1      1    0        1        0 70551             0 -         S    P66   RAD         1,912      309         0      0 13.890   13.890          1     0       0       RAD        13.890   13.890        1
          190     0000000025                       2    1/1/2005               1   921   93880               314    119         0      0     119        119          1      1    0        1        0 93880             0 -         S    P49   OTHER         314      119         0      0  6.160    6.160          1     0       0       OTHER       6.160    6.160        1
          192     0000000026                       1    1/1/2005               5   250                        59      0         0      0       0          0          0      1    0        0        1                   1 -              P46   SURG           59        0         0      1    -        -            1     0       0 14060 SURG          -        -          1
          193     0000000026                       2    1/1/2005              10   250   J1100                39      0         0      0       0          0          0      1    0        0        1                   1 -              P46   SURG           39        0         0      1    -        -            1     0       0 14060 SURG          -        -          1
          194     0000000026                       3    1/1/2005               6   250   J2250                36      0         0      0       0          0          0      1    0        0        1                   1 -              P46   SURG           36        0         0      1    -        -            1     0       0 14060 SURG          -        -          1
          195     0000000026                       4    1/1/2005               1   258                        46      0         0      0       0          0          0      1    0        0        1                   1 -              P46   SURG           46        0         0      1    -        -            1     0       0 14060 SURG          -        -          1
          196     0000000026                       5    1/1/2005               8   271                       939      0         0      0       0          0          0      1    0        0        1                   1 -              P84   SURG          939        0         0      1    -        -            1     0       0 14060 SURG          -        -          1
          197     0000000026                       6    1/1/2005              17   272                       246      0         0      0       0          0          0      1    0        0        1                   1 -              P84   SURG          246        0         0      1    -        -            1     0       0 14060 SURG          -        -          1
          198     0000000026                       7    1/1/2005               1   301   82565                34      2         0      0       2          2          1      1    0        1        0 82565             0 -         A    P67   LAB            34        2         0      0  0.188    0.188          1     0       0 14060 SURG        0.188      -          1
          199     0000000026                       8    1/1/2005               1   301   84132                34      2         0      0       2          2          1      2    0        1        0 84132             0 -         A    P67   LAB            34        2         0      0  0.169    0.169          1     0       0 14060 SURG        0.169      -          1
          200     0000000026                       9    1/1/2005               1   312   88305                93     21         0      0      21         21          1      7    0        1        0 88305             0 -         X    P67   LAB            93       21         0      0  1.990    1.990          1     0       0 14060 SURG        1.990      -          1
          201     0000000026                      10    1/1/2005               2   312   88305               187     42         0      0      42         42          2      7    0        2        0 88305             0 -         X    P67   LAB           187       42         0      0  1.990    3.980          1     0       0 14060 SURG        1.990      -          1
          202     0000000026                      11    1/1/2005               1   312   88331                87     21         0      0      21         21          1      7    0        1        0 88331             0 -         X    P67   LAB            87       21         0      0  0.900    0.900          1     0       0 14060 SURG        0.900      -          1
          203     0000000026                      12    1/1/2005               2   312   88331               173     42         0      0      42         42          2      7    0        2        0 88331             0 -         X    P67   LAB           173       42         0      0  0.900    1.800          1     0       0 14060 SURG        0.900      -          1
          204     0000000026                      13    1/1/2005               1   360   14040               500    824         0      0     824        824          1      2    0        1        0 14040             0 -         T    P11   SURG          500      824         0      0 21.650   10.825          1     1       0 14060 SURG       21.650      -          1
          205     0000000026                      14    1/1/2005               1   360   14040               500    412         0      0     412        412          1      2    0        1        0 14040             0 -         T    P11   SURG          500      412         0      0 21.650   10.825          1     1       0 14060 SURG       21.650      -          1
          206     0000000026                      15    1/1/2005               1   360   14060               408    412         0      0     412        412          1      2    0        1        0 14060             0 -         T    P11   SURG          408      412         0      0 23.094   23.094          1     1       1 14060 SURG       23.094   23.094        1
          207     0000000026                      16    1/1/2005               1   370                       555      0         0      0       0          0          0      1    0        0        1                   1 -              P13   SURG          555        0         0      1    -        -            1     0       0 14060 SURG          -        -          1
          208     0000000026                      17    1/1/2005               1   710                       576      0         0      0       0          0          0      1    0        0        1                   1 -              P99   SURG          576        0         0      1    -        -            1     0       0 14060 SURG          -        -          1
          209     0000000026                      18    1/1/2005               1   730   93005               125     19         0      0      19         19          1      2    0        1        0 93005             0 -         S    P64   OTHER         125       19         0      0  0.290    0.290          1     0       0 14060 SURG        0.290      -          1
          211     0000000027                       1    1/1/2005               1   255                       221      0         0      0       0          0          0      1    0        0        1                   1 -              P66   RAD           221        0         0      1    -        -            1     0       0       RAD           -        -          1
          212     0000000027                       2    1/1/2005               1   272                        43      0         0      0       0          0          0      1    0        0        1                   1 -              P84   OTHER          43        0         0      1    -        -            1     0       0       OTHER         -        -          1




pai 7/19/2011 1:37 AM
                                                                                                                                                                                              Milliman
D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [OP Sample]                                                                                                                                                                                                                                                                                         Page 25 of 28
                                                                                   Rev                                                                        Milliman Max    Max Milliman RevCod                                                                                          RVU              Service Case Milliman                   RVU              Case
    Sequence                                                             Service   Cod                                    Patient                  Repriced     Unit   Units Units Adjusted e Bundle Milliman Milliman     NCP   Status HCG    Service Milliman Milliman Exclusion Edit    Unit    Service Inclusion Looku  Case   Case    Case     Case      Case Inclusion
     Number            ClaimID              LineNum Service Date          Units     e    HCPC Modifier   Billed Allowed    Pay      COB    Paid    Allowed     Count Lookup Flag Units      Lookup HCPC Modifier Bundled Lookup Lookup Line   Category Billed Allowed      Flag    Code Lookup     RVUs      Flag      p   Counter HCPC Category   Lookup    RVUs    Flag
          213     0000000027                       3    1/1/2005               1   300   36415                 7      3         0      0       3          3          1      2    0        1        0 36415             0 -         A    P49   OTHER           7        3         0      0  0.079    0.079          1     0       0       OTHER       0.079    0.079        1
          214     0000000027                       4    1/1/2005               1   301   82565                34      3         0      0       3          3          1      1    0        1        0 82565             0 -         A    P67   LAB            34        3         0      0  0.188    0.188          1     0       0       LAB         0.188    0.188        1
          215     0000000027                       5    1/1/2005               1   301   84520                34      2         0      0       2          2          1      2    0        1        0 84520             0 -         A    P67   LAB            34        2         0      0  0.145    0.145          1     0       0       LAB         0.145    0.145        1
          216     0000000027                       6    1/1/2005               1   320   74415            1,111     140         0      0     140        140          1      1    0        1        0 74415             0 -         S    P66   RAD         1,111      140         0      0  3.070    3.070          1     0       0       RAD         3.070    3.070        1
          218     0000000028                       1    1/1/2005               1   320   74230               521     77         0      0      77         77          1      1    0        1        0 74230             0 -         S    P66   RAD           521       77         0      0  1.730    1.730          1     0       0       RAD         1.730    1.730        1
          219     0000000028                       2    1/1/2005               1   440   92611               242    114         0      0     114        114          1      2    0        1        0 92611             0 -         A    P49   OTHER         242      114         0      0  1.930    1.930          1     0       0       OTHER       1.930    1.930        1
          221     0000000029                       1    1/1/2005               1   250   J1580                15      0         0      0       0          0          0      1    0        0        1                   1 -              P46   SURG           15        0         0      1    -        -            1     0       0 43239 SURG          -        -          1
          222     0000000029                       2    1/1/2005               1   250   J2175                14      0         0      0       0          0          0      1    0        0        1                   1 -              P46   SURG           14        0         0      1    -        -            1     0       0 43239 SURG          -        -          1
          223     0000000029                       3    1/1/2005               2   250   J2250                12      0         0      0       0          0          0      1    0        0        1                   1 -              P46   SURG           12        0         0      1    -        -            1     0       0 43239 SURG          -        -          1
          224     0000000029                       4    1/1/2005               2   250   J3370                40      0         0      0       0          0          0      1    0        0        1                   1 -              P46   SURG           40        0         0      1    -        -            1     0       0 43239 SURG          -        -          1
          225     0000000029                       5    1/1/2005               2   258                        50      0         0      0       0          0          0      1    0        0        1                   1 -              P46   SURG           50        0         0      1    -        -            1     0       0 43239 SURG          -        -          1
          226     0000000029                       6    1/1/2005               2   270                       111      0         0      0       0          0          0      1    0        0        1                   1 -              P84   SURG          111        0         0      1    -        -            1     0       0 43239 SURG          -        -          1
          227     0000000029                       7    1/1/2005               4   271                       792      0         0      0       0          0          0      1    0        0        1                   1 -              P84   SURG          792        0         0      1    -        -            1     0       0 43239 SURG          -        -          1
          228     0000000029                       8    1/1/2005               4   272                       129      0         0      0       0          0          0      1    0        0        1                   1 -              P84   SURG          129        0         0      1    -        -            1     0       0 43239 SURG          -        -          1
          229     0000000029                       9    1/1/2005               1   300   36415                 7      3         0      0       3          3          1      2    0        1        0 36415             0 -         A    P49   OTHER           7        3         0      0  0.079    0.079          1     0       0 43239 SURG        0.079      -          1
          230     0000000029                      10    1/1/2005               1   305   85610                49      5         0      0       5          5          1      2    0        1        0 85610             0 -         A    P67   LAB            49        5         0      0  0.144    0.144          1     0       0 43239 SURG        0.144      -          1
          231     0000000029                      11    1/1/2005               1   305   85730                58      8         0      0       8          8          1      2    0        1        0 85730             0 -         A    P67   LAB            58        8         0      0  0.220    0.220          1     0       0 43239 SURG        0.220      -          1
          232     0000000029                      12    1/1/2005               1   312   88305                93     21         0      0      21         21          1      7    0        1        0 88305             0 -         X    P67   LAB            93       21         0      0  1.990    1.990          1     0       0 43239 SURG        1.990      -          1
          233     0000000029                      13    1/1/2005               1   312   88312                71     10         0      0      10         10          1      4    0        1        0 88312             0 -         X    P67   LAB            71       10         0      0  2.320    2.320          1     0       0 43239 SURG        2.320      -          1
          234     0000000029                      14    1/1/2005               1   360   43239               450    395         0      0     395        395          1      2    0        1        0 43239             0 -         T    P11   SURG          450      395         0      0 13.343   13.343          1     1       1 43239 SURG       13.343   13.343        1
          235     0000000029                      15    1/1/2005               1   710                       341      0         0      0       0          0          0      1    0        0        1                   1 -              P99   SURG          341        0         0      1    -        -            1     0       0 43239 SURG          -        -          1
          237     0000000030                       1    1/1/2005               1   250                         6      0         0      0       0          0          1      1    0        1        1                   1 -              P46   OTHER           6        1         0      2    -        -            1     0       0       OTHER         -        -          1
          238     0000000030                       2    1/1/2005               1   750   91010            1,321     178         0      0     178        178          1      2    0        1        0 91010             0 -         X    P49   OTHER       1,321      177         0      2  3.150    3.150          1     0       0       OTHER       3.150    3.150        1
          240     0000000031                       1    1/1/2005               1   312   88305                93     21         0      0      21         21          1      7    0        1        0 88305             0 -         X    P67   LAB            93       21         0      0  1.990    1.990          1     0       0       LAB         1.990    1.990        1
          241     0000000031                       2    1/1/2005               1   312   88312                71     10         0      0      10         10          1      4    0        1        0 88312             0 -         X    P67   LAB            71       10         0      0  2.320    2.320          1     0       0       LAB         2.320    2.320        1
          243     0000000032                       1    1/1/2005               1   341   78264            1,014     195         0      0     195        195          1      2    0        1        0 78264             0 -         S    P66   RAD         1,014      180         0      2  6.730    6.730          1     0       0       RAD         6.730    6.730        1
          244     0000000032                       2    1/1/2005               1   636   A9520                82      0         0      0       0          0          1      1    0        1        0 A9520             0 -              P46   OTHER          82       15         0      2    -        -            0     0       0       OTHER         -        -          0
          246     0000000033                       1    1/1/2005               1   312   88305                93     21         0      0      21         21          1      7    0        1        0 88305             0 -         X    P67   LAB            93       21         0      0  1.990    1.990          1     0       0       LAB         1.990    1.990        1
          248     0000000034                       1    1/1/2005               1   300   36415                 7      3         0      0       3          3          1      2    0        1        0 36415             0 -         A    P49   OTHER           7        3         0      0  0.079    0.079          1     0       0       OTHER       0.079    0.079        1
          249     0000000034                       2    1/1/2005               1   301   82565                34      2         0      0       2          2          1      1    0        1        0 82565             0 -         A    P67   LAB            34        2         0      0  0.188    0.188          1     0       0       LAB         0.188    0.188        1
          250     0000000034                       3    1/1/2005               1   301   84132                34      2         0      0       2          2          1      2    0        1        0 84132             0 -         A    P67   LAB            34        2         0      0  0.169    0.169          1     0       0       LAB         0.169    0.169        1
          251     0000000034                       4    1/1/2005               1   305   85014                35      3         0      0       3          3          1      3    0        1        0 85014             0 -         A    P67   LAB            35        3         0      0  0.087    0.087          1     0       0       LAB         0.087    0.087        1
          252     0000000034                       5    1/1/2005               1   730   93005               125     19         0      0      19         19          1      2    0        1        0 93005             0 -         S    P64   OTHER         125       19         0      0  0.290    0.290          1     0       0       OTHER       0.290    0.290        1
          254     0000000035                       1    1/1/2005               4   250                        71      0         0      0       0          0          0      1    0        0        1                   1 -              P46   SURG           71        0         0      1    -        -            1     0       0 11623 SURG          -        -          1
          255     0000000035                       2    1/1/2005               2   250   J0690                16      0         0      0       0          0          0      1    0        0        1                   1 -              P46   SURG           16        0         0      1    -        -            1     0       0 11623 SURG          -        -          1
          256     0000000035                       3    1/1/2005               2   250   J2250                17      0         0      0       0          0          0      1    0        0        1                   1 -              P46   SURG           17        0         0      1    -        -            1     0       0 11623 SURG          -        -          1
          257     0000000035                       4    1/1/2005               8   271                    1,080       0         0      0       0          0          0      1    0        0        1                   1 -              P84   SURG        1,080        0         0      1    -        -            1     0       0 11623 SURG          -        -          1
          258     0000000035                       5    1/1/2005              20   272                       335      0         0      0       0          0          0      1    0        0        1                   1 -              P84   SURG          335        0         0      1    -        -            1     0       0 11623 SURG          -        -          1
          259     0000000035                       6    1/1/2005               1   312   88305                93     21         0      0      21         21          1      7    0        1        0 88305             0 -         X    P67   LAB            93       21         0      0  1.990    1.990          1     0       0 11623 SURG        1.990      -          1
          260     0000000035                       7    1/1/2005               1   324   71020               265     38         0      0      38         38          1      1    0        1        0 71020             0 -         X    P66   RAD           265       38         0      0  0.520    0.520          1     0       0 11623 SURG        0.520      -          1
          261     0000000035                       8    1/1/2005               1   360   11623               484    729         0      0     729        729          1      2    0        1        0 11623             0 -         T    P11   SURG          484      729         0      0 17.664   17.664          1     1       1 11623 SURG       17.664   17.664        1
          262     0000000035                       9    1/1/2005               1   360   12042               484     43         0      0      43         43          1      2    0        1        0 12042             0 -         T    P11   SURG          484       43         0      0  2.131    1.066          1     1       0 11623 SURG        2.131      -          1
          263     0000000035                      10    1/1/2005               1   370                       343      0         0      0       0          0          0      1    0        0        1                   1 -              P13   SURG          343        0         0      1    -        -            1     0       0 11623 SURG          -        -          1
          264     0000000035                      11    1/1/2005               3   636   J3010                37      0         0      0       0          0          0      0    0        0        0 J3010             1 B         N    P46   SURG           37        0         0      1    -        -            1     0       0 11623 SURG          -        -          1
          265     0000000035                      12    1/1/2005               1   710                       341      0         0      0       0          0          0      1    0        0        1                   1 -              P99   SURG          341        0         0      1    -        -            1     0       0 11623 SURG          -        -          1
          267     0000000036                       1    1/1/2005               1   300   36415                 7      3         0      0       3          3          1      2    0        1        0 36415             0 -         A    P49   OTHER           7        3         0      0  0.079    0.079          1     0       0       OTHER       0.079    0.079        1
          268     0000000036                       2    1/1/2005               1   301   82565                35      3         0      0       3          3          1      1    0        1        0 82565             0 -         A    P67   LAB            35        3         0      0  0.188    0.188          1     0       0       LAB         0.188    0.188        1
          269     0000000036                       3    1/1/2005               1   301   84520                35      2         0      0       2          2          1      2    0        1        0 84520             0 -         A    P67   LAB            35        2         0      0  0.145    0.145          1     0       0       LAB         0.145    0.145        1
          270     0000000036                       4    1/1/2005               1   324   71020               275     38         0      0      38         38          1      1    0        1        0 71020             0 -         X    P66   RAD           275       38         0      0  0.520    0.520          1     0       0       RAD         0.520    0.520        1
          271     0000000036                       5    1/1/2005               1   352   74150            1,551     166         0      0     166        166          1      1    0        1        0 74150             0 -         S    P66   RAD         1,551      166         0      0  5.660    5.660          1     0       0       RAD         5.660    5.660        1
          272     0000000036                       6    1/1/2005               1   480   93307               480    159         0      0     159        159          1      1    0        1        0 93307             0 -         S    P64   OTHER         480      159         0      0  3.510    3.510          1     0       0       OTHER       3.510    3.510        1
          273     0000000036                       7    1/1/2005               1   480   93320               199     84         0      0      84         84          1      1    0        1        0 93320             0 -         S    P64   OTHER         199       84         0      0  1.610    1.610          1     0       0       OTHER       1.610    1.610        1
          274     0000000036                       8    1/1/2005               1   480   93325               200     74         0      0      74         74          1      1    0        1        0 93325             0 -         S    P64   OTHER         200       74         0      0  0.840    0.840          1     0       0       OTHER       0.840    0.840        1
          276     0000000037                       1    1/2/2005               1   250                         6      0         0      0       0          0          1      1    0        1        1                   1 -              P46   OTHER           6        0         2      2    -        -            0     0       0       OTHER         -        -          0
          277     0000000037                       2    1/2/2005               1   250   J2175                14      0         0      0       0          0          1      1    0        1        1                   1 -              P46   OTHER          14        0         2      2    -        -            0     0       0       OTHER         -        -          0
          278     0000000037                       3    1/2/2005               2   250   J2250                12      0         0      0       0          0          2      1    0        2        1                   1 -              P46   OTHER          12        0         2      2    -        -            0     0       0       OTHER         -        -          0
          279     0000000037                       4    1/1/2005               1   270                        53      0         0      0       0          0          1      1    0        1        1                   1 -              P84   OTHER          53        0         2      2    -        -            0     0       0       OTHER         -        -          0
          280     0000000037                       5    1/2/2005               1   270                        58      0         0      0       0          0          1      1    0        1        1                   1 -              P84   OTHER          58        0         2      2    -        -            0     0       0       OTHER         -        -          0
          281     0000000037                       6    1/2/2005               1   271                       145      0         0      0       0          0          1      1    0        1        1                   1 -              P84   OTHER         145        0         2      2    -        -            0     0       0       OTHER         -        -          0
          282     0000000037                       7    1/1/2005               1   272                       718      0         0      0       0          0          1      1    0        1        1                   1 -              P84   OTHER         718        2         2      2    -        -            0     0       0       OTHER         -        -          0
          283     0000000037                       8    1/2/2005               2   272                        79      0         0      0       0          0          2      1    0        2        1                   1 -              P84   OTHER          79        0         2      2    -        -            0     0       0       OTHER         -        -          0
          284     0000000037                       9    1/2/2005               1   301   82948                11      4         0      0       4          4          1      1    0        1        0                   0 -              P67   LAB            11        0         2      2    -        -            0     0       0       LAB           -        -          0
          285     0000000037                      10    1/1/2005               1   360   43235               450      0         0      0       0          0          1      1    0        1        0                   0 -              P14   SURG          450        1         2      2    -        -            0     0       0       SURG          -        -          0
          286     0000000037                      11    1/2/2005               1   637   A9270                 6      0         0      0       0          0          1      1    0        1        1                   1 -              P46   OTHER           6        0         2      2    -        -            0     0       0       OTHER         -        -          0
          287     0000000037                      12    1/2/2005               1   710                       341      0         0      0       0          0          1      1    0        1        1                   1 -              P99   OTHER         341        1         2      2    -        -            0     0       0       OTHER         -        -          0
          289     0000000038                       1    1/1/2005               1   402   76775               451     80         0      0      80         80          1      2    0        1        0 76775             0 -         S    P66   RAD           451       80         0      0  2.140    2.140          1     0       0       RAD         2.140    2.140        1
          291     0000000039                       1    1/1/2005               5   250                        59      0         0      0       0          0          0      1    0        0        1                   1 -              P46   SURG           59        0         0      1    -        -            1     0       0 14000 SURG          -        -          1
          292     0000000039                       2    1/1/2005               2   250   J2250                13      0         0      0       0          0          0      1    0        0        1                   1 -              P46   SURG           13        0         0      1    -        -            1     0       0 14000 SURG          -        -          1
          293     0000000039                       3    1/1/2005               4   258                       157      0         0      0       0          0          0      1    0        0        1                   1 -              P46   SURG          157        0         0      1    -        -            1     0       0 14000 SURG          -        -          1
          294     0000000039                       4    1/1/2005               8   271                    1,126       0         0      0       0          0          0      1    0        0        1                   1 -              P84   SURG        1,126        0         0      1    -        -            1     0       0 14000 SURG          -        -          1
          295     0000000039                       5    1/1/2005              12   272                       273      0         0      0       0          0          0      1    0        0        1                   1 -              P84   SURG          273        0         0      1    -        -            1     0       0 14000 SURG          -        -          1
          296     0000000039                       6    1/1/2005               1   301   84132                35      6         0      0       6          6          1      2    0        1        0 84132             0 -         A    P67   LAB            35        6         0      0  0.169    0.169          1     0       0 14000 SURG        0.169      -          1
          297     0000000039                       7    1/1/2005               1   312   88305               108     21         0      0      21         21          1      7    0        1        0 88305             0 -         X    P67   LAB           108       21         0      0  1.990    1.990          1     0       0 14000 SURG        1.990      -          1
          298     0000000039                       8    1/1/2005               1   312   88331                90     21         0      0      21         21          1      7    0        1        0 88331             0 -         X    P67   LAB            90       21         0      0  0.900    0.900          1     0       0 14000 SURG        0.900      -          1
          299     0000000039                       9    1/1/2005               1   360   14000               782    824         0      0     824        824          1      3    0        1        0 14000             0 -         T    P11   SURG          782      824         0      0 21.393   21.393          1     1       1 14000 SURG       21.393   21.393        1
          300     0000000039                      10    1/1/2005               1   370                       297      0         0      0       0          0          0      1    0        0        1                   1 -              P13   SURG          297        0         0      1    -        -            1     0       0 14000 SURG          -        -          1
          301     0000000039                      11    1/1/2005               3   636   J3010                38      0         0      0       0          0          0      0    0        0        0 J3010             1 B         N    P46   SURG           38        0         0      1    -        -            1     0       0 14000 SURG          -        -          1
          302     0000000039                      12    1/1/2005               2   637   A9270                 6      0         0      0       0          0          0      1    0        0        1                   1 -              P46   SURG            6        0         0      1    -        -            1     0       0 14000 SURG          -        -          1
          303     0000000039                      13    1/1/2005               1   710                       355      0         0      0       0          0          0      1    0        0        1                   1 -              P99   SURG          355        0         0      1    -        -            1     0       0 14000 SURG          -        -          1
          304     0000000039                      14    1/1/2005               1   730   93005               130     19         0      0      19         19          1      2    0        1        0 93005             0 -         S    P64   OTHER         130       19         0      0  0.290    0.290          1     0       0 14000 SURG        0.290      -          1
          306     0000000040                       1    1/1/2005               1   250   J2270                14      0         0      0       0          0          0      1    0        0        1                   1 -              P46   RAD            14        0         0      1    -        -            1     0       0 72192 RAD           -        -          1
          307     0000000040                       2    1/1/2005               1   250   J2550                14      0         0      0       0          0          0      1    0        0        1                   1 -              P46   RAD            14        0         0      1    -        -            1     0       0 72192 RAD           -        -          1
          308     0000000040                       3    1/1/2005               1   271                        26      0         0      0       0          0          0      1    0        0        1                   1 -              P84   RAD            26        0         0      1    -        -            1     0       0 72192 RAD           -        -          1
          309     0000000040                       4    1/1/2005               1   300   36415                 7      3         0      0       3          3          1      2    0        1        0 36415             0 -         A    P49   OTHER           7        3         0      0  0.079    0.079          1     0       0 72192 RAD         0.079      -          1
          310     0000000040                       5    1/1/2005               1   301   80048                83     12         0      0      12         12          1      1    0        1        0 80048             0 -         A    P67   LAB            83       12         0      0  0.302    0.302          1     0       0 72192 RAD         0.302      -          1
          311     0000000040                       6    1/1/2005               1   305   85025                86     11         0      0      11         11          1      1    0        1        0 85025             0 -         A    P67   LAB            86       11         0      0  0.279    0.279          1     0       0 72192 RAD         0.279      -          1
          312     0000000040                       7    1/1/2005               1   307   81001                34      4         0      0       4          4          1      1    0        1        0 81001             0 -         A    P67   LAB            34        4         0      0  0.116    0.116          1     0       0 72192 RAD         0.116      -          1
          313     0000000040                       8    1/1/2005               1   320   72110               402     65         0      0      65         65          1      1    0        1        0 72110             0 -         X    P66   RAD           402       65         0      0  1.050    1.050          1     0       0 72192 RAD         1.050      -          1
          314     0000000040                       9    1/1/2005               1   352   72192            1,292     166         0      0     166        166          1      1    0        1        0 72192             0 -         S    P66   RAD         1,292      166         0      0  5.670    5.670          1     0       1 72192 RAD         5.670    5.670        1
          315     0000000040                      10    1/1/2005               1   352   74150            1,491     166         0      0     166        166          1      1    0        1        0 74150             0 -         S    P66   RAD         1,491      166         0      0  5.660    5.660          1     0       0 72192 RAD         5.660      -          1
          316     0000000040                      11    1/1/2005               1   450   90782                76     19         0      0      19         19          1      3    0        1        0 90772             0 -         S    P46   OTHER          76       19         0      4  0.678    0.678          1     0       0 72192 RAD         0.678      -          1
          317     0000000040                      12    1/1/2005               1   450   99284               341    201         0      0     201        201          1      2    0        1        0 99284             0 -         V    P61   ER            341      201         0      0  5.541    5.541          1     1       0 72192 RAD         5.541      -          1
          319     0000000041                       1    1/1/2005               1   271                        26      0         0      0       0          0          0      1    0        0        1                   1 -              P84   ER             26        0         0      1    -        -            1     0       0 99284 ER            -        -          1
          320     0000000041                       2    1/1/2005               1   272                        43      0         0      0       0          0          0      1    0        0        1                   1 -              P84   ER             43        0         0      1    -        -            1     0       0 99284 ER            -        -          1
          321     0000000041                       3    1/1/2005               1   300   36415                 7      3         0      0       3          3          1      2    0        1        0 36415             0 -         A    P49   OTHER           7        3         0      0  0.079    0.079          1     0       0 99284 ER          0.079      -          1




pai 7/19/2011 1:37 AM
                                                                                                                                                                                              Milliman
D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [OP Sample]                                                                                                                                                                                                                                                                                         Page 26 of 28
                                                                                   Rev                                                                       Milliman Max    Max Milliman RevCod                                                                                          RVU              Service Case Milliman                   RVU              Case
    Sequence                                                             Service   Cod                                    Patient                 Repriced     Unit   Units Units Adjusted e Bundle Milliman Milliman     NCP   Status HCG    Service Milliman Milliman Exclusion Edit    Unit    Service Inclusion Looku  Case   Case    Case     Case      Case Inclusion
     Number            ClaimID              LineNum Service Date          Units     e    HCPC Modifier   Billed Allowed    Pay      COB    Paid   Allowed     Count Lookup Flag Units      Lookup HCPC Modifier Bundled Lookup Lookup Line   Category Billed Allowed      Flag    Code Lookup     RVUs      Flag      p   Counter HCPC Category   Lookup    RVUs    Flag
          322     0000000041                       4    1/1/2005               1   301   80053               142     15         0      0       15       15          1      1    0        1        0 80053             0 -         A    P67   LAB           142       15         0      0  0.381    0.381          1     0       0 99284 ER          0.381      -          1
          323     0000000041                       5    1/1/2005               2   301   82948                22      9         0      0        9        9          2      6    0        2        0 82948             0 -         A    P67   LAB            22        9         0      0  0.113    0.226          1     0       0 99284 ER          0.113      -          1
          324     0000000041                       6    1/1/2005               1   305   85025                86     11         0      0       11       11          1      1    0        1        0 85025             0 -         A    P67   LAB            86       11         0      0  0.279    0.279          1     0       0 99284 ER          0.279      -          1
          325     0000000041                       7    1/1/2005               1   307   81001                34      4         0      0        4        4          1      1    0        1        0 81001             0 -         A    P67   LAB            34        4         0      0  0.116    0.116          1     0       0 99284 ER          0.116      -          1
          326     0000000041                       8    1/1/2005               1   450   99284               341    201         0      0     201       201          1      2    0        1        0 99284             0 -         V    P61   ER            341      201         0      0  5.541    5.541          1     1       1 99284 ER          5.541    5.541        1
          327     0000000041                       9    1/1/2005               1   730   93005               125     19         0      0       19       19          1      2    0        1        0 93005             0 -         S    P64   OTHER         125       19         0      0  0.290    0.290          1     0       0 99284 ER          0.290      -          1
          329     0000000042                       1    1/1/2005               1   255                       169      0         0      0        0        0          0      1    0        0        1                   1 -              P66   RAD           169        0         0      1    -        -            1     0       0       RAD           -        -          1
          330     0000000042                       2    1/1/2005               2   270                       101      0         0      0        0        0          0      1    0        0        1                   1 -              P84   OTHER         101        0         0      1    -        -            1     0       0       OTHER         -        -          1
          331     0000000042                       3    1/1/2005               1   300   36415                 7      3         0      0        3        3          1      2    0        1        0 36415             0 -         A    P49   OTHER           7        3         0      0  0.079    0.079          1     0       0       OTHER       0.079    0.079        1
          332     0000000042                       4    1/1/2005               1   301   82565                34      3         0      0        3        3          1      1    0        1        0 82565             0 -         A    P67   LAB            34        3         0      0  0.188    0.188          1     0       0       LAB         0.188    0.188        1
          333     0000000042                       5    1/1/2005               1   301   84520                34      2         0      0        2        2          1      2    0        1        0 84520             0 -         A    P67   LAB            34        2         0      0  0.145    0.145          1     0       0       LAB         0.145    0.145        1
          334     0000000042                       6    1/1/2005               1   352   71260            1,239     232         0      0     232       232          1      1    0        1        0 71260             0 -         S    P66   RAD         1,239      232         0      0  7.560    7.560          1     0       0       RAD         7.560    7.560        1
          336     0000000043                       1    1/1/2005               1   250   J2175                14      0         0      0        0        0          1      1    0        1        1                   1 -              P46   SURG           14        3         0      2    -        -            1     0       0 45378 SURG          -        -          1
          337     0000000043                       2    1/1/2005               6   250   J2250                36      0         0      0        0        0          6      1    0        6        1                   1 -              P46   SURG           36        8         0      2    -        -            1     0       0 45378 SURG          -        -          1
          338     0000000043                       3    1/1/2005               2   270                       111      0         0      0        0        0          2      1    0        2        1                   1 -              P84   SURG          111       26         0      2    -        -            1     0       0 45378 SURG          -        -          1
          339     0000000043                       4    1/1/2005               1   271                       145      0         0      0        0        0          1      1    0        1        1                   1 -              P84   SURG          145       34         0      2    -        -            1     0       0 45378 SURG          -        -          1
          340     0000000043                       5    1/1/2005               3   272                       571      0         0      0        0        0          3      1    0        3        1                   1 -              P84   SURG          571      133         0      2    -        -            1     0       0 45378 SURG          -        -          1
          341     0000000043                       6    1/1/2005               1   360   45378               585    421         0      0     421       421          1      1    0        1        0 45378             0 -         T    P11   SURG          585      137         0      2 12.702   12.702          1     1       1 45378 SURG       12.702   12.702        1
          342     0000000043                       7    1/1/2005               1   710                       341      0         0      0        0        0          1      1    0        1        1                   1 -              P99   SURG          341       80         0      2    -        -            1     0       0 45378 SURG          -        -          1
          344     0000000044                       1    1/1/2005               1   255                        83      0         0      0        0        0          1      1    0        1        1                   1 -              P66   RAD            83       12         0      2    -        -            1     0       0       RAD           -        -          1
          345     0000000044                       2    1/1/2005               1   341   78306            1,395     206         0      0     206       206          1      1    0        1        0 78306             0 -         S    P66   RAD         1,395      194         0      2  5.660    5.660          1     0       0       RAD         5.660    5.660        1
          347     0000000045                       1    1/1/2005               1   270                       103      0         0      0        0        0          0      1    0        0        1                   1 -              P84   OTHER         103        0         0      1    -        -            1     0       0       OTHER         -        -          1
          348     0000000045                       2    1/1/2005               1   352   72192            1,292     166         0      0     166       166          1      1    0        1        0 72192             0 -         S    P66   RAD         1,292      166         0      0  5.670    5.670          1     0       0       RAD         5.670    5.670        1
          349     0000000045                       3    1/1/2005               1   352   74150            1,491     166         0      0     166       166          1      1    0        1        0 74150             0 -         S    P66   RAD         1,491      166         0      0  5.660    5.660          1     0       0       RAD         5.660    5.660        1
          351     0000000046                       1    1/1/2005               1   271                        27      0         0      0        0        0          0      1    0        0        1                   1 -              P84   ER             27        0         0      1    -        -            1     0       0 99284 ER            -        -          1
          352     0000000046                       2    1/2/2005               1   271                         9      0         0      0        0        0          0      1    0        0        1                   1 -              P84   RAD             9        0         0      1    -        -            1     0       0 72125 RAD           -        -          1
          353     0000000046                       3    1/1/2005               1   272                        45      0         0      0        0        0          0      1    0        0        1                   1 -              P84   ER             45        0         0      1    -        -            1     0       0 99284 ER            -        -          1
          354     0000000046                       4    1/1/2005               1   300   36415                 7      3         0      0        3        3          1      2    0        1        0 36415             0 -         A    P49   OTHER           7        3         0      0  0.079    0.079          1     0       0 99284 ER          0.079      -          1
          355     0000000046                       5    1/1/2005               1   301   80048                87     12         0      0       12       12          1      1    0        1        0 80048             0 -         A    P67   LAB            87       12         0      0  0.302    0.302          1     0       0 99284 ER          0.302      -          1
          356     0000000046                       6    1/1/2005               1   301   82550                35      9         0      0        9        9          1      3    0        1        0 82550             0 -         A    P67   LAB            35        9         0      0  0.240    0.240          1     0       0 99284 ER          0.240      -          1
          357     0000000046                       7    1/1/2005               1   301   82553                50     16         0      0       16       16          1      3    0        1        0 82553             0 -         A    P67   LAB            50       16         0      0  0.367    0.367          1     0       0 99284 ER          0.367      -          1
          358     0000000046                       8    1/2/2005               1   301   84484                42     14         0      0       14       14          1      3    0        1        0 84484             0 -         A    P67   LAB            42       14         0      0  0.343    0.343          1     0       0 72125 RAD         0.343      -          1
          359     0000000046                       9    1/1/2005               1   305   85025                90     11         0      0       11       11          1      1    0        1        0 85025             0 -         A    P67   LAB            90       11         0      0  0.279    0.279          1     0       0 99284 ER          0.279      -          1
          360     0000000046                      10    1/1/2005               1   306   87088                95      0         0      0        0        0          0      2    0        0        0 87088             0 -         A    P67   LAB            95        0         0      1  0.275      -            0     0       0 99284 ER          0.275      -          1
          361     0000000046                      11    1/1/2005               1   307   81001                35      4         0      0        4        4          1      1    0        1        0 81001             0 -         A    P67   LAB            35        4         0      0  0.116    0.116          1     0       0 99284 ER          0.116      -          1
          362     0000000046                      12    1/2/2005               1   320   72050               397     65         0      0       65       65          1      1    0        1        0 72050             0 -         X    P66   RAD           397       65         0      0  0.980    0.980          1     0       0 72125 RAD         0.980      -          1
          363     0000000046                      13    1/2/2005               1   320   73030               251     38         0      0       38       38          1      2    0        1        0 73030             0 -         X    P66   RAD           251       38         0      0  0.530    0.530          1     0       0 72125 RAD         0.530      -          1
          364     0000000046                      14    1/1/2005               1   351   70450            1,190     166         0      0     166       166          1      1    0        1        0 70450             0 -         S    P66   RAD         1,190      166         0      0  4.630    4.630          1     0       0 99284 ER          4.630      -          1
          365     0000000046                      15    1/2/2005               1   352   72125            1,707     166         0      0     166       166          1      1    0        1        0 72125             0 -         S    P66   RAD         1,707      166         0      0  6.060    6.060          1     0       1 72125 RAD         6.060    6.060        1
          366     0000000046                      16    1/1/2005               1   450   90782                79     19         0      0       19       19          1      3    0        1        0 90772             0 -         S    P46   OTHER          79       19         0      4  0.678    0.678          1     0       0 99284 ER          0.678      -          1
          367     0000000046                      17    1/2/2005               1   450   99281                96     66         0      0       66       66          1      1    0        1        0 99281             0 -         V    P61   ER             96       66         0      0  1.320    1.320          1     1       0 72125 RAD         1.320      -          1
          368     0000000046                      18    1/1/2005               1   450   99284               355    201         0      0     201       201          1      2    0        1        0 99284             0 -         V    P61   ER            355      201         0      0  5.541    5.541          1     1       1 99284 ER          5.541    5.541        1
          369     0000000046                      19    1/2/2005               1   636   90718                34      0         0      0        0        0          0      0    0        0        0 90718             1 B         N    P51   RAD            34        0         0      1    -        -            1     0       0 72125 RAD           -        -          1
          370     0000000046                      20    1/1/2005               2   637   A9270                 5      0         0      0        0        0          0      1    0        0        1                   1 -              P46   ER              5        0         0      1    -        -            1     0       0 99284 ER            -        -          1
          371     0000000046                      21    1/1/2005               1   730   93005               130     19         0      0       19       19          1      2    0        1        0 93005             0 -         S    P64   OTHER         130       19         0      0  0.290    0.290          1     0       0 99284 ER          0.290      -          1
          373     0000000047                       1    1/1/2005              14   250                       142      0         0      0        0        0          0      1    0        0        1                   1 -              P46   SURG          142        0         0      1    -        -            1     0       0 10180 SURG          -        -          1
          374     0000000047                       2    1/1/2005               2   250   J0690                16      0         0      0        0        0          0      1    0        0        1                   1 -              P46   SURG           16        0         0      1    -        -            1     0       0 10180 SURG          -        -          1
          375     0000000047                       3    1/1/2005              10   250   J1840               156      0         0      0        0        0          0      1    0        0        1                   1 -              P46   SURG          156        0         0      1    -        -            1     0       0 10180 SURG          -        -          1
          376     0000000047                       4    1/1/2005               2   250   J2250                17      0         0      0        0        0          0      1    0        0        1                   1 -              P46   SURG           17        0         0      1    -        -            1     0       0 10180 SURG          -        -          1
          377     0000000047                       5    1/1/2005               1   258                        58      0         0      0        0        0          0      1    0        0        1                   1 -              P46   SURG           58        0         0      1    -        -            1     0       0 10180 SURG          -        -          1
          378     0000000047                       6    1/1/2005               1   270                    1,302       0         0      0        0        0          0      1    0        0        1                   1 -              P84   SURG        1,302        0         0      1    -        -            1     0       0 10180 SURG          -        -          1
          379     0000000047                       7    1/1/2005               7   271                       681      0         0      0        0        0          0      1    0        0        1                   1 -              P84   SURG          681        0         0      1    -        -            1     0       0 10180 SURG          -        -          1
          380     0000000047                       8    1/1/2005              29   272                       498      0         0      0        0        0          0      1    0        0        1                   1 -              P84   SURG          498        0         0      1    -        -            1     0       0 10180 SURG          -        -          1
          381     0000000047                       9    1/1/2005               1   300   36415                 7      3         0      0        3        3          1      2    0        1        0 36415             0 -         A    P49   OTHER           7        3         0      0  0.079    0.079          1     0       0 10180 SURG        0.079      -          1
          382     0000000047                      10    1/1/2005               1   301   84132                34      6         0      0        6        6          1      2    0        1        0 84132             0 -         A    P67   LAB            34        6         0      0  0.169    0.169          1     0       0 10180 SURG        0.169      -          1
          383     0000000047                      11    1/1/2005               1   305   85014                35      3         0      0        3        3          1      3    0        1        0 85014             0 -         A    P67   LAB            35        3         0      0  0.087    0.087          1     0       0 10180 SURG        0.087      -          1
          384     0000000047                      12    1/1/2005               1   360   10180            1,410     609         0      0     609       609          1      1    0        1        0 10180             0 -         T    P11   SURG        1,410      609         0      0 26.264   26.264          1     1       1 10180 SURG       26.264   26.264        1
          385     0000000047                      13    1/1/2005               1   370                       536      0         0      0        0        0          0      1    0        0        1                   1 -              P13   SURG          536        0         0      1    -        -            1     0       0 10180 SURG          -        -          1
          386     0000000047                      14    1/1/2005               1   636   J3010                12      0         0      0        0        0          0      0    0        0        0 J3010             1 B         N    P46   SURG           12        0         0      1    -        -            1     0       0 10180 SURG          -        -          1
          387     0000000047                      15    1/1/2005               1   637   A9270                 3      0         0      0        0        0          0      1    0        0        1                   1 -              P46   SURG            3        0         0      1    -        -            1     0       0 10180 SURG          -        -          1
          388     0000000047                      16    1/1/2005               1   710                       846      0         0      0        0        0          0      1    0        0        1                   1 -              P99   SURG          846        0         0      1    -        -            1     0       0 10180 SURG          -        -          1
          390     0000000048                       1    1/1/2005               1   255                       188      0         0      0        0        0          1      1    0        1        1                   1 -              P66   RAD           188       30         0      2    -        -            1     0       0       RAD           -        -          1
          391     0000000048                       2    1/1/2005               1   610   70549            2,603     449         0      0     449       449          1      1    0        1        0 70549             0 -         S    P66   RAD         2,603      419         0      2 22.930   22.930          1     0       0       RAD        22.930   22.930        1
          393     0000000049                       1    1/1/2005               1   250   J2175                14      0         0      0        0        0          0      1    0        0        1                   1 -              P46   SURG           14        0         0      1    -        -            1     0       0 43248 SURG          -        -          1
          394     0000000049                       2    1/1/2005               6   250   J2250                35      0         0      0        0        0          0      1    0        0        1                   1 -              P46   SURG           35        0         0      1    -        -            1     0       0 43248 SURG          -        -          1
          395     0000000049                       3    1/1/2005               2   270                       111      0         0      0        0        0          0      1    0        0        1                   1 -              P84   SURG          111        0         0      1    -        -            1     0       0 43248 SURG          -        -          1
          396     0000000049                       4    1/1/2005               2   271                       421      0         0      0        0        0          0      1    0        0        1                   1 -              P84   SURG          421        0         0      1    -        -            1     0       0 43248 SURG          -        -          1
          397     0000000049                       5    1/1/2005               3   272                    1,062       0         0      0        0        0          0      1    0        0        1                   1 -              P84   SURG        1,062        0         0      1    -        -            1     0       0 43248 SURG          -        -          1
          398     0000000049                       6    1/1/2005               1   360   43248               300    198         0      0     198       198          1      2    0        1        0 43248             0 -         T    P11   SURG          300      198         0      0 13.340   13.340          1     1       1 43248 SURG       13.340   13.340        1
          399     0000000049                       7    1/1/2005               1   360   45378               348    421         0      0     421       421          1      1    0        1        0 45378             0 -         T    P11   SURG          348      421         0      0 12.702    6.351          1     1       0 43248 SURG       12.702      -          1
          400     0000000049                       8    1/1/2005               1   710                       341      0         0      0        0        0          0      1    0        0        1                   1 -              P99   SURG          341        0         0      1    -        -            1     0       0 43248 SURG          -        -          1
          402     0000000050                       1    1/1/2005               1   301   82948                11      0         0      0        0        0          0      6    0        0        0 82948             0 -         A    P67   LAB            11        0         0      1  0.113      -            0     0       0       LAB         0.113      -          0
          403     0000000050                       2    1/1/2005               1   343   C1775               594    221         0      0     221       221          1      1    0        1        1                   1 -              P66   RAD           594      221         0      0    -        -            1     0       0       RAD           -        -          1
          404     0000000050                       3    1/1/2005               1   404   78815            2,926   1,074         0      0   1,074     1,074          1      1    0        1        0 78815             0 -         S    P66   RAD         2,926    1,074         0      0 25.068   25.068          1     0       0       RAD        25.068   25.068        1
          406     0000000051                       1    1/1/2005               1   250                         9      0         0      0        0        0          1      1    0        1        1                   1 -              P46   OTHER           9        2         0      2    -        -            1     0       0       OTHER         -        -          1
          407     0000000051                       2    1/1/2005               1   740   95811            2,275     569         0      0     569       569          1      1    0        1        0 95811             0 -         S    P49   OTHER       2,275      566         0      2 19.150   19.150          1     0       0       OTHER      19.150   19.150        1
          409     0000000052                       1    1/1/2005               3   250                        50      0         0      0        0        0          0      1    0        0        1                   1 -              P46   SURG           50        0         0      1    -        -            1     0       0 11643 SURG          -        -          1
          410     0000000052                       2    1/1/2005               2   250   J0690                44      0         0      0        0        0          0      1    0        0        1                   1 -              P46   SURG           44        0         0      1    -        -            1     0       0 11643 SURG          -        -          1
          411     0000000052                       3    1/1/2005               2   250   J2250                12      0         0      0        0        0          0      1    0        0        1                   1 -              P46   SURG           12        0         0      1    -        -            1     0       0 11643 SURG          -        -          1
          412     0000000052                       4    1/1/2005               7   271                    1,081       0         0      0        0        0          0      1    0        0        1                   1 -              P84   SURG        1,081        0         0      1    -        -            1     0       0 11643 SURG          -        -          1
          413     0000000052                       5    1/1/2005              24   272                       378      0         0      0        0        0          0      1    0        0        1                   1 -              P84   SURG          378        0         0      1    -        -            1     0       0 11643 SURG          -        -          1
          414     0000000052                       6    1/1/2005               1   300   36415                 7      3         0      0        3        3          1      2    0        1        0 36415             0 -         A    P49   OTHER           7        3         0      0  0.079    0.079          1     0       0 11643 SURG        0.079      -          1
          415     0000000052                       7    1/1/2005               1   301   80048                83     12         0      0       12       12          1      1    0        1        0 80048             0 -         A    P67   LAB            83       12         0      0  0.302    0.302          1     0       0 11643 SURG        0.302      -          1
          416     0000000052                       8    1/1/2005               1   305   85014                35      3         0      0        3        3          1      3    0        1        0 85014             0 -         A    P67   LAB            35        3         0      0  0.087    0.087          1     0       0 11643 SURG        0.087      -          1
          417     0000000052                       9    1/1/2005               1   305   85610                49      0         0      0        0        0          0      2    0        0        0 85610             0 -         A    P67   LAB            49        0         0      1  0.144      -            0     0       0 11643 SURG        0.144      -          1
          418     0000000052                      10    1/1/2005               1   305   85730                58      0         0      0        0        0          0      2    0        0        0 85730             0 -         A    P67   LAB            58        0         0      1  0.220      -            0     0       0 11643 SURG        0.220      -          1
          419     0000000052                      11    1/1/2005               1   312   88305                93     21         0      0       21       21          1      7    0        1        0 88305             0 -         X    P67   LAB            93       21         0      0  1.990    1.990          1     0       0 11643 SURG        1.990      -          1
          420     0000000052                      12    1/1/2005               1   360   11643               803    373         0      0     373       373          1      2    0        1        0 11643             0 -         T    P11   SURG          803      373         0      0 14.241   14.241          1     1       1 11643 SURG       14.241   14.241        1
          421     0000000052                      13    1/1/2005               1   360   12052               803     43         0      0       43       43          1      2    0        1        0 12052             0 -         T    P11   SURG          803       43         0      0  3.240    1.620          1     1       0 11643 SURG        3.240      -          1
          422     0000000052                      14    1/1/2005               1   370                       456      0         0      0        0        0          0      1    0        0        1                   1 -              P13   SURG          456        0         0      1    -        -            1     0       0 11643 SURG          -        -          1
          423     0000000052                      15    1/1/2005               1   710                       341      0         0      0        0        0          0      1    0        0        1                   1 -              P99   SURG          341        0         0      1    -        -            1     0       0 11643 SURG          -        -          1
          424     0000000052                      16    1/1/2005               1   730   93005               125     19         0      0       19       19          1      2    0        1        0 93005             0 -         S    P64   OTHER         125       19         0      0  0.290    0.290          1     0       0 11643 SURG        0.290      -          1
          426     0000000053                       1    1/1/2005               1   300   36415                 7      3         0      0        3        3          1      2    0        1        0 36415             0 -         A    P49   OTHER           7        3         0      0  0.079    0.079          1     0       0       OTHER       0.079    0.079        1
          427     0000000053                       2    1/1/2005               1   301   82565                34      2         0      0        2        2          1      1    0        1        0 82565             0 -         A    P67   LAB            34        2         0      0  0.188    0.188          1     0       0       LAB         0.188    0.188        1
          428     0000000053                       3    1/1/2005               1   301   84132                34      2         0      0        2        2          1      2    0        1        0 84132             0 -         A    P67   LAB            34        2         0      0  0.169    0.169          1     0       0       LAB         0.169    0.169        1




pai 7/19/2011 1:37 AM
                                                                                                                                                                                             Milliman
D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [OP Sample]                                                                                                                                                                                                                                                                                        Page 27 of 28
                                                                                   Rev                                                                       Milliman Max    Max Milliman RevCod                                                                                          RVU              Service Case Milliman                   RVU              Case
    Sequence                                                             Service   Cod                                    Patient                 Repriced     Unit   Units Units Adjusted e Bundle Milliman Milliman     NCP   Status HCG    Service Milliman Milliman Exclusion Edit    Unit    Service Inclusion Looku  Case   Case    Case     Case      Case Inclusion
     Number            ClaimID              LineNum Service Date          Units     e    HCPC Modifier   Billed Allowed    Pay      COB    Paid   Allowed     Count Lookup Flag Units      Lookup HCPC Modifier Bundled Lookup Lookup Line   Category Billed Allowed      Flag    Code Lookup     RVUs      Flag      p   Counter HCPC Category   Lookup    RVUs    Flag
          429     0000000053                      4     1/1/2005               1   730   93005               125     19         0      0       19       19          1      2    0        1        0 93005             0 -         S    P64   OTHER         125       19         0      0  0.290    0.290          1     0       0       OTHER       0.290    0.290        1
          431     0000000054                      1     1/1/2005               5   250                        72      0         0      0        0        0          5      1    0        5        1                   1 -              P46   SURG           72       17         0      2    -        -            1     0       0 15823 SURG          -        -          1
          432     0000000054                      2     1/1/2005               2   250   J2250                17      0         0      0        0        0          2      1    0        2        1                   1 -              P46   SURG           17        4         0      2    -        -            1     0       0 15823 SURG          -        -          1
          433     0000000054                      3     1/1/2005               8   271                    1,006       0         0      0        0        0          8      1    0        8        1                   1 -              P84   SURG        1,006      233         0      2    -        -            1     0       0 15823 SURG          -        -          1
          434     0000000054                      4     1/1/2005              31   272                       412      0         0      0        0        0         31      1    0       31        1                   1 -              P84   SURG          412       95         0      2    -        -            1     0       0 15823 SURG          -        -          1
          435     0000000054                      5     1/1/2005               1   360   15823            2,640   1,236         0      0   1,236     1,236          1      2    0        1        0 15823             0 -         T    P11   SURG        2,640      610         0      2 27.124   27.124          1     1       1 15823 SURG       27.124   27.124        1
          436     0000000054                      6     1/1/2005               1   370                       840      0         0      0        0        0          1      1    0        1        1                   1 -              P13   SURG          840      194         0      2    -        -            1     0       0 15823 SURG          -        -          1
          437     0000000054                      7     1/1/2005               1   636   J3010                12      0         0      0        0        0          1      0    0        1        0 J3010             1 B         N    P46   SURG           12        3         0      2    -        -            1     0       0 15823 SURG          -        -          1
          438     0000000054                      8     1/1/2005               1   637   A9270                 7      0         0      0        0        0          1      1    0        1        1                   1 -              P46   SURG            7        2         0      2    -        -            1     0       0 15823 SURG          -        -          1
          439     0000000054                      9     1/1/2005               1   710                       341      0         0      0        0        0          1      1    0        1        1                   1 -              P99   SURG          341       79         0      2    -        -            1     0       0 15823 SURG          -        -          1
          441     0000000055                      1     1/1/2005               1   250                         6      0         0      0        0        0          1      1    0        1        1                   1 -              P46   ER              6        2         0      2    -        -            1     0       0 99283 ER            -        -          1
          442     0000000055                      2     1/1/2005               1   271                        17      0         0      0        0        0          1      1    0        1        1                   1 -              P84   ER             17        6         0      2    -        -            1     0       0 99283 ER            -        -          1
          443     0000000055                      3     1/1/2005               1   272                        40      0         0      0        0        0          1      1    0        1        1                   1 -              P84   ER             40       14         0      2    -        -            1     0       0 99283 ER            -        -          1
          444     0000000055                      4     1/1/2005               1   450   90471                35      0         0      0        0        0          1      1    0        1        0 90471             0 -         S    P51   OTHER          35       12         0      2  0.678    0.678          1     0       0 99283 ER          0.678      -          1
          445     0000000055                      5     1/1/2005               1   450   99283               198    117         0      0     117       117          1      2    0        1        0 99283             0 -         V    P61   ER            198       70         0      2  3.430    3.430          1     1       1 99283 ER          3.430    3.430        1
          446     0000000055                      6     1/1/2005               1   636   90718                33      0         0      0        0        0          1      0    0        1        0 90718             1 B         N    P51   ER             33       12         0      2    -        -            1     0       0 99283 ER            -        -          1
          447     0000000055                      7     1/1/2005               1   637   A9270                 3      0         0      0        0        0          1      1    0        1        1                   1 -              P46   ER              3        1         0      2    -        -            1     0       0 99283 ER            -        -          1
          449     0000000056                      1     1/1/2005               1   351   70450            1,144     166         0      0     166       166          1      1    0        1        0 70450             0 -         S    P66   RAD         1,144      166         0      0  4.630    4.630          1     0       0       RAD         4.630    4.630        1
          450     0000000056                      2     1/1/2005               1   921   93880               302    119         0      0     119       119          1      1    0        1        0 93880             0 -         S    P49   OTHER         302      119         0      0  6.160    6.160          1     0       0       OTHER       6.160    6.160        1
          452     0000000057                      1     1/1/2005               1   250                         6      0         0      0        0        0          0      1    0        0        1                   1 -              P46   ER              6        0         0      1    -        -            1     0       0 99283 ER            -        -          1
          453     0000000057                      2     1/1/2005               1   271                        17      0         0      0        0        0          0      1    0        0        1                   1 -              P84   ER             17        0         0      1    -        -            1     0       0 99283 ER            -        -          1
          454     0000000057                      3     1/1/2005               1   300   36415                 7      3         0      0        3        3          1      2    0        1        0 36415             0 -         A    P49   OTHER           7        3         0      0  0.079    0.079          1     0       0 99283 ER          0.079      -          1
          455     0000000057                      4     1/1/2005               1   301   82435                14      2         0      0        2        2          1      2    0        1        0 82435             0 -         A    P67   LAB            14        2         0      0  0.164    0.164          1     0       0 99283 ER          0.164      -          1
          456     0000000057                      5     1/1/2005               1   301   82947                14      0         0      0        0        0          0      3    0        0        0 82947             0 -         A    P67   LAB            14        0         0      1  0.144      -            0     0       0 99283 ER          0.144      -          1




pai 7/19/2011 1:37 AM
                                                                                                                                                                                             Milliman
D:\Docstoc\Working\pdf\3cc48611-dce7-4e38-a2c6-aad31c8c9cf0.xls\ [OP Sample]                                                                                                                                                                                                                                                                                        Page 28 of 28

				
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