Recons Partly Overturned %
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- Shannon Armstrong
- 8 years ago
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1 1 TABLE 1 Annual Report of Medicare ideration Results: National Summary of Final Decisions and Value of Contested Claims for Cases During, by Service Appealed Service Partly Total $ $ $ $ $ W/drawn Practitioner Services $19,795,986 $1,847,522 $7,243,727 $ $524,631 OPD Mental Health $245,426 $22,004 $135,407 $79,552 $8,463 Hospice Care $44,517 $4,174 $23,650 $16,694 $0 Non-Medicare Benefit $3,245,650 $304,221 $2,249,162 $617,860 $74,407 Emergency Room $1,101,991 $173,927 $470,652 $440,066 $17,347 Inpatient Hospital $48,448,663 $7,387,304 $ $ $1,184,462 Clinic (Lab, X-ray) $8,062,559 $857,477 $2,595,176 $4,413,391 $196,515 Nursing Home Care $39,896,533 $7,562,804 $ $6,999,117 $735,925 Therapies $1,225,827 $137,713 $715,755 $345,170 $27,188 Ambulance $3,363,878 $214,571 $1,484,682 $1,587,948 $76,677 Home Health Care $1,795,976 $264,015 $644,062 $847,539 $40,359 DME/Medical Supplies $5,285,485 $498,039 $3,371,463 $1,274,597 $141,386 TOTAL All Services $132,512,491 $ $ $ $3,027,359 Dollar figures are estimates based on records received during with cost data. Mean values by service category are applied to all records with that service. Partial overturn decisions have the dollar value apportioned to the appropriate category, equally divided between $ and $.
2 2 TABLE 2 Annual Report of Medicare ideration Results: National Summary of Final Decisions and Value of Contested Claims for Cases During, by Region Region Total $ $ $ $ $ W/drawn 01: Boston $4,826,984 $642,950 $3,404,152 $672,683 $107,199 02: New York $10,143,806 $1,671,620 $4,600,445 $3,653,127 $218,614 03: Philadelphia $14,002,316 $2,077,564 $7,017,149 $4,543,104 $364,499 04: Atlanta $25,689,892 $3,336,291 $4,897,657 $ $577,502 05: Chicago $6,209,070 $2,109,579 $3,660,694 $354,237 $84,560 06: Dallas $2,076,185 $275,587 $1,064,387 $710,354 $25,856 07: Kansas City $11,422,424 $1,518,177 $4,465,975 $5,233,714 $204,559 08: Denver $6,698,514 $988,171 $2,458,720 $3,014,879 $236,744 09: San Francisco $43,454,350 $5,237,912 $ $ $750,394 10: Seattle $7,988,950 $1,415,919 $5,174,496 $941,102 $457,433 TOTAL All Regions $132,512,491 $ $ $ $3,027,359 Dollar figures are estimates based on records received during with cost data. Mean values by service category are applied to all records with that service. Partial overturn decisions have the dollar value apportioned to the appropriate category, equally divided between $ and $.
3 3 TABLE 3 Annual Report of Medicare ideration Results: National Summary of Final Decisions and Value of Contested Claims for Cases During, by Region and Service Appealed Service Region=01: Boston Total $ $ $ TOTAL All Services $4,826,984 $642,950 $3,404,152 Practitioner Services $600,992 $56,564 $436,957 OPD Mental Health $8,463 $1,693 $6,770 Non-Medicare Benefit $160,116 $11,302 $131,860 Emergency Room $25,564 $913 $21,912 Inpatient Hospital $1,028,612 $103,900 $685,741 Clinic (Lab, X-ray) $228,357 $30,478 $83,246 Nursing Home Care $2,364,355 $407,107 $1,753,694 Therapies $42,555 $4,728 $34,281 Ambulance $181,798 $14,222 $130,474 Home Health Care $43,722 $6,727 $23,543 DME/Medical Supplies $142,449 $5,315 $95,675 Appealed Service Region=02: New York Total $ $ $ TOTAL All Services $10,143,806 $1,671,620 $4,600,445 Practitioner Services $1,244,408 $120,199 $366,252 OPD Mental Health $32,159 $3,385 $15,233 Non-Medicare Benefit $261,837 $57,453 $157,291 Emergency Room $29,216 $1,826 $15,521 Inpatient Hospital $3,096,226 $394,821 $987,052 Clinic (Lab, X-ray) $833,368 $154,209 $267,023 Dollar figures are estimates based on records received during with cost data. Mean values by service category are applied to all records with that service. Partial overturn decisions have the dollar value apportioned to the appropriate category, equally divided between $ and $.
4 4 TABLE 3 Annual Report of Medicare ideration Results: National Summary of Final Decisions and Value of Contested Claims for Cases During, by Region and Service Appealed Service Total $ $ $ Nursing Home Care $3,820,547 $759,412 $2,387,842 Therapies $74,472 $11,821 $43,737 Ambulance $129,856 $9,275 $36,483 Home Health Care $181,616 $67,265 $47,086 DME/Medical Supplies $440,103 $91,954 $276,925 Appealed Service Region=03: Philadelphia Total $ $ $ TOTAL All Services $14,002,316 $2,077,564 $7,017,149 Practitioner Services $1,165,218 $128,683 $513,318 OPD Mental Health $20,311 $3,385 $11,848 Non-Medicare Benefit $464,337 $25,901 $385,692 Emergency Room $83,996 $15,065 $48,846 Inpatient Hospital $6,649,613 $950,687 $2,540,360 Clinic (Lab, X-ray) $567,709 $80,971 $161,943 Nursing Home Care $3,773,573 $751,583 $2,552,251 Therapies $257,696 $28,961 $154,263 Ambulance $315,364 $17,932 $203,440 Home Health Care $137,893 $20,180 $57,175 DME/Medical Supplies $566,606 $54,216 $388,013 Dollar figures are estimates based on records received during with cost data. Mean values by service category are applied to all records with that service. Partial overturn decisions have the dollar value apportioned to the appropriate category, equally divided between $ and $.
5 5 TABLE 3 Annual Report of Medicare ideration Results: National Summary of Final Decisions and Value of Contested Claims for Cases During, by Region and Service Appealed Service Region=04: Atlanta Total $ $ $ TOTAL All Services $25,689,892 $3,336,291 $4,897,657 Practitioner Services $5,311,360 $198,681 $659,678 OPD Mental Health $23,696 $1,693 $5,078 Non-Medicare Benefit $323,058 $22,134 $152,110 Emergency Room $59,345 $1,826 $7,304 Inpatient Hospital $12,478,414 $2,171,514 $2,296,194 Clinic (Lab, X-ray) $2,400,026 $105,991 $351,634 Nursing Home Care $3,444,756 $657,635 $1,033,427 Therapies $193,863 $19,504 $65,606 Ambulance $586,205 $87,189 $100,793 Home Health Care $443,949 $40,359 $70,628 DME/Medical Supplies $425,220 $29,765 $155,205 Appealed Service Region=05: Chicago Total $ $ $ TOTAL All Services $6,209,070 $2,109,579 $3,660,694 Practitioner Services $578,367 $147,066 $364,838 OPD Mental Health $13,541 $0 $10,156 Hospice Care $2,782 $1,391 $1,391 Non-Medicare Benefit $147,872 $10,831 $119,145 Emergency Room $6,391 $0 $4,565 Inpatient Hospital $1,080,562 $342,871 $623,401 Dollar figures are estimates based on records received during with cost data. Mean values by service category are applied to all records with that service. Partial overturn decisions have the dollar value apportioned to the appropriate category, equally divided between $ and $.
6 6 TABLE 3 Annual Report of Medicare ideration Results: National Summary of Final Decisions and Value of Contested Claims for Cases During, by Region and Service Appealed Service Total $ $ $ Clinic (Lab, X-ray) $206,522 $41,395 $145,112 Nursing Home Care $3,789,231 $1,510,995 $2,105,998 Therapies $42,555 $4,728 $34,281 Ambulance $54,416 $6,184 $43,285 Home Health Care $16,816 $0 $13,453 DME/Medical Supplies $270,015 $44,117 $195,070 Appealed Service Region=06: Dallas Total $ $ $ TOTAL All Services $2,076,184 $275,587 $1,064,387 Practitioner Services $452,512 $60,806 $264,437 OPD Mental Health $1,693 $0 $1,693 Non-Medicare Benefit $78,174 $6,593 $54,628 Emergency Room $9,130 $913 $5,478 Inpatient Hospital $696,131 $25,975 $254,555 Clinic (Lab, X-ray) $130,100 $8,188 $40,031 Nursing Home Care $407,107 $156,580 $234,870 Therapies $22,460 $2,364 $13,003 Ambulance $48,232 $0 $23,498 Home Health Care $40,359 $6,727 $20,180 DME/Medical Supplies $190,286 $7,441 $152,016 Dollar figures are estimates based on records received during with cost data. Mean values by service category are applied to all records with that service. Partial overturn decisions have the dollar value apportioned to the appropriate category, equally divided between $ and $.
7 7 TABLE 3 Annual Report of Medicare ideration Results: National Summary of Final Decisions and Value of Contested Claims for Cases During, by Region and Service Appealed Service Region=07: Kansas City Total $ $ $ TOTAL All Services $11,422,424 $1,518,177 $4,465,975 Practitioner Services $2,894,663 $306,860 $1,066,231 OPD Mental Health $42,315 $0 $20,311 Hospice Care $12,521 $2,782 $6,956 Non-Medicare Benefit $487,883 $53,215 $341,424 Emergency Room $179,861 $18,260 $50,215 Inpatient Hospital $4,020,938 $644,181 $1,288,362 Clinic (Lab, X-ray) $1,506,612 $160,578 $602,736 Nursing Home Care $1,252,638 $211,383 $618,490 Therapies $119,391 $11,821 $69,743 Ambulance $191,692 $8,657 $43,285 Home Health Care $114,351 $20,180 $30,269 DME/Medical Supplies $599,560 $80,260 $327,951 Appealed Service Region=08: Denver Total $ $ $ TOTAL All Services $6,698,514 $988,171 $2,458,720 Practitioner Services $924,821 $82,018 $288,476 OPD Mental Health $3,385 $0 $1,693 Hospice Care $5,565 $0 $2,782 Non-Medicare Benefit $172,360 $18,837 $113,023 Emergency Room $79,431 $22,369 $44,281 Dollar figures are estimates based on records received during with cost data. Mean values by service category are applied to all records with that service. Partial overturn decisions have the dollar value apportioned to the appropriate category, equally divided between $ and $.
8 8 TABLE 3 Annual Report of Medicare ideration Results: National Summary of Final Decisions and Value of Contested Claims for Cases During, by Region and Service Appealed Service Total $ $ $ Inpatient Hospital $2,763,745 $477,941 $851,982 Clinic (Lab, X-ray) $302,960 $39,121 $87,340 Nursing Home Care $1,456,192 $281,844 $798,557 Therapies $61,469 $7,093 $23,642 Ambulance $521,896 $11,130 $59,363 Home Health Care $114,351 $20,180 $50,449 DME/Medical Supplies $292,339 $27,639 $137,133 Appealed Service Region=09: San Francisco Total $ $ $ TOTAL All Services $43,454,350 $5,237,912 $ Practitioner Services $5,762,457 $613,719 $2,787,191 OPD Mental Health $77,859 $8,463 $47,393 Hospice Care $23,650 $0 $12,521 Non-Medicare Benefit $822,244 $79,116 $525,558 Emergency Room $606,232 $110,017 $258,836 Inpatient Hospital $15,481,130 $2,088,394 $6,815,853 Clinic (Lab, X-ray) $1,554,831 $182,868 $662,327 Nursing Home Care $15,031,661 $1,894,616 $ Therapies $321,528 $32,507 $219,278 Ambulance $1,167,464 $36,483 $736,467 Home Health Care $652,471 $68,947 $307,737 DME/Medical Supplies $1,952,823 $122,782 $1,325,092 Dollar figures are estimates based on records received during with cost data. Mean values by service category are applied to all records with that service. Partial overturn decisions have the dollar value apportioned to the appropriate category, equally divided between $ and $.
9 9 TABLE 3 Annual Report of Medicare ideration Results: National Summary of Final Decisions and Value of Contested Claims for Cases During, by Region and Service Appealed Service Region=10: Seattle Total $ $ $ TOTAL All Services $7,988,950 $1,415,919 $5,174,496 Practitioner Services $861,187 $132,925 $496,349 OPD Mental Health $22,004 $3,385 $15,233 Non-Medicare Benefit $327,767 $18,837 $268,430 Emergency Room $22,825 $2,739 $13,695 Inpatient Hospital $1,153,292 $187,020 $571,451 Clinic (Lab, X-ray) $332,073 $53,678 $193,785 Nursing Home Care $4,556,472 $931,650 $3,108,109 Therapies $89,839 $14,185 $57,922 Ambulance $166,957 $23,498 $107,595 Home Health Care $50,449 $13,453 $23,543 DME/Medical Supplies $406,085 $34,549 $318,383 Dollar figures are estimates based on records received during with cost data. Mean values by service category are applied to all records with that service. Partial overturn decisions have the dollar value apportioned to the appropriate category, equally divided between $ and $.
10 10 TABLE 4 Annual Report of Medicare ideration Results: National Summary of Final Decisions and Value of Contested Claims for Cases During, by Appeal Priority and Service Appealed Service of All Cases Priority=Standard Service Denial Total $ Practitioner Services $3,072,839 OPD Mental Health $52,470 Hospice Care $1,391 Non-Medicare Benefit $818,476 Inpatient Hospital $249,360 Clinic (Lab, X-ray) $1,004,408 Nursing Home Care $328,818 Therapies $465,743 Ambulance $100,174 Home Health Care $440,586 DME/Medical Supplies $2,920,198 Priority $9,454,465 Appealed Service of All Cases Priority=Standard Claim Denial Total $ Practitioner Services $16,024,581 OPD Mental Health $186,185 Hospice Care $43,126 Non-Medicare Benefit $2,311,324 Emergency Room $1,101,991 Inpatient Hospital $42,651,032 Clinic (Lab, X-ray) $6,666,031 Nursing Home Care $19,353,263 Therapies $657,242 Ambulance $3,238,970
11 11 TABLE 4 Annual Report of Medicare ideration Results: National Summary of Final Decisions and Value of Contested Claims for Cases During, by Appeal Priority and Service Appealed Service of All Cases Total $ Home Health Care $1,133,415 DME/Medical Supplies $2,153,739 Priority $95,520,901 Appealed Service of All Cases Priority=Expedited Appeal Total $ Practitioner Services $698,565 OPD Mental Health $6,770 Non-Medicare Benefit $115,849 Inpatient Hospital $5,548,271 Clinic (Lab, X-ray) $392,119 Nursing Home Care $20,214,452 Therapies $102,842 Ambulance $24,734 Home Health Care $221,975 DME/Medical Supplies $211,547 Priority $27,537, $132,512,491
12 12 TABLE 5 - Annual Report of Medicare ideration Activity: iderations During, and Distribution of Final Region=01: BOSTON H0318: AETNA HEALTH INC H0322: AETNA LIFE INSURANCE COMPANY H0346: PACE VERMONT, INC H0523: AETNA HEALTH OF CALIFORNIA,INC. 27, H0768: AETNA LIFE INSURANCE COMPANY H0901: AETNA HEALTH INC H0902: AETNA LIFE INSURANCE COMPANY H1109: AETNA HEALTH INC.(GEORGIA) 1, H1110: AETNA LIFE INSURANCE COMPANY H1419: AETNA HEALTH OF ILLINOIS, INC. 1, H1420: AETNA LIFE INSURANCE COMPANY H2047: AETNA LIFE INSURANCE COMPANY H2112: AETNA HEALTH INC. (MARYLAND) 4, H2206: HARVARD PILGRIM HEALTH CARE H2218: HARBOR HEALTH SERVICES H2219: FALLON COMMUNITY HEALTH PLAN H2220: UPHAMS CORNER HEALTH COMMITTEE, INC H2221: ELDER SRVC PLN/CAMBRIDGE HEALTH ALLIANCE H2222: ELDER SERVICE PLAN OF THE NORTH SHORE H2223: ELDER SVC PLN/E BOSTON HEALTH CENTER H2224: SENIOR WHOLE HEALTH, LLC 4, H2225: COMMONWEALTH CARE ALLIANCE, INC. 1, H2229: TUFTS ASSOCIATED HMO, INC. 3, H2230: BLUE CROSS AND BLUE SHIELD OF MA HMO BLUE, INC rate of reconsiderations per members, and is calculated as the sum of appeals received during divided by the mid-year enrollment, times.
13 13 TABLE 5 - Annual Report of Medicare ideration Activity: iderations During, and Distribution of Final H2256: TUFTS ASSOCIATED HMO, INC. 72, H2258: PILGRIM HEALTH CARE, INC H2261: BLUE CROSS AND BLUE SHIELD OF MA HMO BLUE, INC. 32, H2411: FALLON COMMUNITY HEALTH PLAN H3011: BLUE CROSS AND BLUE SHIELD OF MASS. HMO BLUE, INC H3051: MATTHEW THORNTON HEALTH PLAN H3057: TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION, H3152: AETNA HEALTH, INC. 33, H3312: AETNA HEALTH INC. 13, H3597: AETNA HEALTH H3623: AETNA HEALTH, INC. 1, H3624: AETNA LIFE INSURANCE COMPANY H3931: AETNA HEALTH INC 40, H4105: PACE ORGANIZATION OF RHODE ISLAND H4152: BLUE CROSS AND BLUE SHIELD OF RHODE ISLAND 40, H4362: AETNA LIFE INSURANCE COMPANY H4523: AETNA HEALTH INC. 3, H4524: AETNA LIFE INSURANCE COMPANY 1, H4781: AETNA LIFE INSURANCE COMPANY H4910: AETNA HEALTH INC H4911: AETNA LIFE INSURANCE COMPANY H5414: AETNA HEALTH INC. 1, H5437: AETNA LIFE INSURANCE COMPANY H5510: AETNA LIFE INSURANCE COMPANY 3, rate of reconsiderations per members, and is calculated as the sum of appeals received during divided by the mid-year enrollment, times.
14 14 TABLE 5 - Annual Report of Medicare ideration Activity: iderations During, and Distribution of Final H5512: AETNA LIFE INSURANCE COMPANY 8, H5521: AETNA LIFE INSURANCE COMPANY 10, H5527: UNITED HEALTHCARE INS. COMPA H5531: AETNA LIFE INSURANCE COMPANY H5591: MARTINS POINT GENERATIONS, LLC 1, H5736: AETNA LIFE INSURANCE COMPANY 196, H5793: AETNA HEALTH INC H5813: AETNA HEALTH, INC H5832: AETNA HEALTH INC H5838: COMMONWEALTH CARE ALLIANCE H5949: SENIOR WHOLE HEALTH, LLC H5950: AETNA HEALTH INC H5992: SENIOR WHOLE HEALTH, LLC H7226: HARVARD PILGRIM HEALTH CARE INC. 25, H7908: AETNA HEALTH H9001: FALLON COMMUNITY HEALTH PLAN 30, H9418: UNITED HEALTHCARE INSURANCE R5595: AETNA LIFE INSURANCE COMPANY 1, Region=02: NEW YORK E6036: ASOCIACION DE MAESTROS DE PUERTO RICO 1, H0423: METROPLUS HEALTH PLAN, INC H1777: CATHOLIC SPECIAL NEEDS PLAN, LLC H2291: PROSALUD HMO, CORP rate of reconsiderations per members, and is calculated as the sum of appeals received during divided by the mid-year enrollment, times.
15 15 TABLE 5 - Annual Report of Medicare ideration Activity: iderations During, and Distribution of Final H3109: HORIZON HEALTHCARE OF NJ,INC H3154: HORIZON HEALTHCARE OF NEW JERSEY, INC. 53, H3214: FIRST MEDICAL HEALTH PLAN (OF FLORIDA) H3240: AMERIGROUP NEW JERSEY, INC H3304: EXCELLUS HEALTH PLAN, INC H3305: ROCHESTER AREA HMO/ DBA PREFERRED CARE 68, H3314: HIP OF GREATER NEW YORK 1, H3321: INDEPENDENT LIVING SRVCS OF CENTRAL NY H3322: SENIOR CARE CONNECTION, INC H3327: TOUCHSTONE HEALTH HMO, INC. 6, H3328: NEW YORK STATE CATHOLIC HLTH PLAN INC 2, H3329: COMPREHENSIVE CARE MANAGEMENT CORP. 1, H3330: HIP OF GREATER NEW YORK 127, H3331: INDEPENDENT LIVING FOR SENIORS, INC H3335: EXCELLUS HEALTH PLAN, INC. 21, H3336: NEIGHBORHOOD HEALTH PROVIDERS LLC 2, H3337: LIBERTY HEALTH ADVANTAGE, INC. 1, H3338: NATIONAL HEALTH PLAN NETWORK INC H3344: INDEPENDENT HEALTH BENEFITS CORP 2, H3346: ROCHESTER AREA HEALTH MAINTENANCE ORG H3347: ELDERPLAN, INC H3351: EXCELLUS HEALTH PLAN, INC. 47, H3356: EXCELLUS HEALTH PLAN, INC. 4, H3359: MANAGED HEALTH, INC. 73, H3362: INDEPENDENT HEALTH ASSOCIATION, INC. 45, H3366: TOUCHSTONE HEALTH HMO, INC. 4, rate of reconsiderations per members, and is calculated as the sum of appeals received during divided by the mid-year enrollment, times.
16 16 TABLE 5 - Annual Report of Medicare ideration Activity: iderations During, and Distribution of Final H3384: HEALTHNOW NEW YORK INC 35, H3388: CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC. 19, H3528: CONNECTICARE, INC. 2, H4003: MMM HEALTHCARE, INC. 121, H4004: PREFERRED MEDICARE CHOICE, INC. 48, H4005: TRIPLE-S, INC. 25, H4006: MCS ADVANTAGE INC. 38, H4009: SDM HEALTHCARE MANAGEMENT, INC. 5, H4011: FIRST MEDICAL HEALTH PLAN, INC. 9, H4012: TRIPLE-S, INC. 31, H4729: GROUP HEALTH, INC H5042: CDPHP UNIVERSAL BENEFITS, INC H5526: HEALTHNOW NEW YORK INC. 14, H5528: GROUP HEALTH INCORPORATED 13, H5549: VNS CHOICE 1, H5577: MCS ADVANTAGE INC. 31, H5711: QMEDCARE OF NEW JERSEY, INC H5732: AUXILIO PLATINO, INC. 1, H5746: AMERIGROUP NEW MEXICO, INC H5760: COOPERATIVA DE SEGUROS DE VIDA DE PUERTO RICO 5, H5774: AMERICAN HEALTH, INC. 21, H5817: AMERIGROUP TEXAS, INC. 4, H5821: MAPFRE LIFE INSURANCE COMPANY 14, H5887: FIRST MEDICAL HEALTH PLAN, INC. 1, H5896: AMERIGROUP MARYLAND, INC rate of reconsiderations per members, and is calculated as the sum of appeals received during divided by the mid-year enrollment, times.
17 17 TABLE 5 - Annual Report of Medicare ideration Activity: iderations During, and Distribution of Final H5989: COMPREHENSIVE CARE MANAGEMENT CORP H5991: AFFINITY HEALTH PLAN, INC. 1, H6181: AMERIGROUP NEW YORK, LLC H6331: BORO MEDICAL CENTER 2, H6334: NY HOTEL TRADES COUNCIL and HOTEL ASSN OF NYC 3, H6497: MENNONITE GENERAL HOSPITAL, INC H6504: CONNECTICARE INSURANCE COMPANY, INC H6806: ROCHESTER AREA HEALTH MAINTENANCE ORGANIZATION 17, H6864: GUILDNET, INC H7015: HEALTHFIRST HEALTH PLAN OF NEW JERSEY, INC. 1, H7200: AMERIGROUP TENNESSEE, INC H8606: PREFERRED HEALTH INC H8991: AMERIGROUP FLORIDA, INC H9101: ELDERPLAN, INC. - SHMO 16, H9519: INDEPENDENT HEALTH BENEFITS CORPORATION H9859: MVP HEALTH PLAN, INC, 4, : UNITED MINE WORKERS OF AMERICA HEALTH & RETIREMENT Region=03: PHILADELPHIA 38, H0097: QCC INSURANCE COMPANY H0245: UNISON HEALTH PLAN OF TENNESSEE, INC H1254: UPMC HEALTH BENEFITS, INC. 8, rate of reconsiderations per members, and is calculated as the sum of appeals received during divided by the mid-year enrollment, times.
18 18 TABLE 5 - Annual Report of Medicare ideration Activity: iderations During, and Distribution of Final H1643: HM HEALTH INSURANCE COMPANY H2102: M.D. - IPA, INC H2108: BRAVO HEALTH MID- ATLANTIC INC. 10, H2109: JOHNS HOPKINS HEALTH SYSTEM, INC H2110: AETNA HEALTH INC H2386: APPALACHIAN AENCY FOR SENIOR CITIZENS, INC H2699: LIFE AT HOME, LLC H2941: SENTARA LIFE CARE CORPORATION, INC H3112: AMERIHEALTH HMO_INC 4, H3156: AMERIHEALTH HMO_INC 1, H3672: HOMETOWN HEALTH PLAN 8, H3907: UNIVERSITY OF PITTSBURGH MEDICAL CENTER 64, H3908: TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA H3909: INDEPENDENCE BLUE CROSS 18, H3916: HIGHMARK, INC. 61, H3917: PITTSBURGH CARE PARTNERSHIP, INC H3918: LIVING INDEPENDENCE FOR THE ELDERLY H3919: ST AGNES MEDICAL CENTER H3920: UNISON HEALTH PLAN OF PENNSYLVANIA, INC. 14, H3923: CAPITAL ADVANTAGE INSURANCE COMPANY 7, H3924: GEISINGER INDEMNITY INSURANCE COMPANY H3925: PENNSYLVANIA PACE, INC H3949: BRAVO HEALTH PENNSYLVANIA INC. 15, H3952: KEYSTONE HEALTH PLAN EAST, INC. 127, H3954: GEISINGER HEALTH PLAN 34, H3957: KEYSTONE HEALTH PLAN WEST, INC. 176, rate of reconsiderations per members, and is calculated as the sum of appeals received during divided by the mid-year enrollment, times.
19 19 TABLE 5 - Annual Report of Medicare ideration Activity: iderations During, and Distribution of Final H3962: KEYSTONE HEALTH PLAN CENTRAL,INC. 18, H3964: SENIOR PARTNERS BY BRAVO HEALTH 23, H3972: ELDER HEALTH PENNSYLVANIA, I H4528: BRAVO HEALTH TEXAS, INC. 8, H4906: C AND O EMPLOYEES' HOSPITAL ASSOCIATION 2, H4908: OPTIMA HEALTH INSURANCE COMPANY 2, H4950: PRUDENTIAL HEALTH CARE PLAN H5037: MOUNTAIN EMPIRE OLDER CITIZENS, INCX H5102: HEALTH PLAN OF THE UPPER OHI H5106: HIGHMARK HEALTH INSURANCE COMPANY 6, H5151: HEALTH PLAN OF THE UPPER OHIO VALLEY 9, H5189: UNISON HEALTH PLAN OF TENNESSEE, INC H5533: UPMC HEALTH NETWORK 1, H5539: MARYLAND CARE - MEDICARE, INC H5665: CARE IMPROVEMENT PLUS OF MARYLAND, INC. 3, H5812: GEISINGER INDEMNITY INSURANCE COMPANY 1, H5932: GATEWAY HEALTH PLAN, INC. 23, H5998: UNISON HEALTH PLAN OF TENNESSEE, INC. 2, H6421: BRAVO HEALTH MID- ATLANTIC INC H6621: THP INSURANCE COMPANY H7406: BRAVO HEALTH INSURANCE COMPANY, INC H8031: GATEWAY HEALTH PLAN OF OHIO, INC H8604: THP INSURANCE COMPANY H8655: RIVERSIDE RETIREMENT SERVICES, INC H9793: HIGHMARK, INC. 19, H9882: VIRGINIA PREMIER HEALTH PLAN, INC rate of reconsiderations per members, and is calculated as the sum of appeals received during divided by the mid-year enrollment, times.
20 20 TABLE 5 - Annual Report of Medicare ideration Activity: iderations During, and Distribution of Final R3444: CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO. R6801: CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY R9896: CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO 11, , , Region=04: ATLANTA H0104: BLUE CROSS AND BLUE SHIELD OF ALABAMA 39, H0117: WELLCARE OF OHIO, INC. 1, H0154: VIVA HEALTH, INC. 26, H0712: WELLCARE OF CONNECTICUT, INC. 3, H0913: WELLCARE HEALTH PLANS OF NEW JERSEY, INC. 1, H0967: WELLCARE HEALTH INSURANCE OF ILLINOIS, INC H0979: AMERICA'S 1ST CHOICE INSURANCE COMPANY OF NC, INC H1016: AVMED, INC 18, H1026: HEALTH OPTIONS, INC 24, H1032: WELL CARE OF FLORIDA, INC. 76, , H1035: FLORIDA HEALTH CARE PLAN, INC. 15, H1037: CHOICE CARE HEALTH PLAN 3, H1043: FLORIDA PACE CENTERS, INC H1045: PREFERRED CARE PARTNERS INC. 22, H1054: PRUDENTIAL INSURANCE CO H1073: PRUDENTIAL HLTH CARE PLAN, I rate of reconsiderations per members, and is calculated as the sum of appeals received during divided by the mid-year enrollment, times.
21 21 TABLE 5 - Annual Report of Medicare ideration Activity: iderations During, and Distribution of Final H1087: CIGNA HEALTHCARE OF FLORIDA, H1099: HEALTH FIRST HEALTH PLANS, INC. 22, H1112: WELLCARE OF GEORGIA, INC. 4, H1216: HARMONY HEALTH PLAN OF ILLINOIS, INC. 1, H1264: WELLCARE OF TEXAS, INC. 3, H1340: WELLCARE HEALTH INSURANCE OF ARIZONA, INC. 57, H1416: HARMONY HEALTH PLAN OF ILLINOIS, INC. 11, H1657: HARMONY HEALTH PLANS OF ILLINOIS, INC. 1, H1807: UNIVERSITY HEALTH CARE, INC. 9, H1851: ADVANTAGE CARE, INC H1903: WELLCARE OF LOUISIANA, INC. 4, H3292: WELLCARE HEALTH INSURANCE OF ARIZONA, INC H3361: WELLCARE_OF NEW YORK, INC. 25, , H3404: PARTNERS NATIONAL HEALTH PLANS OF NC INC 2, H3449: PARTNERS NATIONAL HEALTH PLANS OF NC, INC. 39, H3518: BLUE CROSS BLUE SHIELD OF FLORIDA, INC. 1, H3942: ELDERHAUS INC H4203: PALMETTO HEALTH ALLIANCE H4204: INSTIL HEALTH INSURANCE COMPANY 7, H4205: BLUE CROSS AND BLUE SHIELD OF SOUTH CAROLINA 2, H4206: INSTIL HEALTH INSURANCE COMPANY H4207: BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA H4209: BLUE CROSS AND BLUE SHIELD OF SOUTH CAROLINA H4402: ALEXIAN BROTHERS COMMUNITY SERVICES H4577: WELLCARE HEALTH INSURANCE OF ILLINOIS, INC. 37, rate of reconsiderations per members, and is calculated as the sum of appeals received during divided by the mid-year enrollment, times.
22 22 TABLE 5 - Annual Report of Medicare ideration Activity: iderations During, and Distribution of Final H5402: QUALITY HEALTH PLANS, INC. 8, H5404: UNIVERSAL HEALTH CARE, INC. 18, H5407: CITRUS HEALTH CARE, INC. 22, H5420: MEDICA HEALTHCARE PLANS, INC. 12, H5427: FREEDOM HEALTH PLAN, INC. 19, H5429: UNIVERSAL HEALTH CARE, INC. 1, H5431: HEALTHSUN HEALTH PLANS, INC. 2, H5434: BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC. 7, H5436: AVMED, INC H5594: OPTIMUM HEALTHCARE, INC. 3, H5696: PHYSICIANS UNITED PLAN, INC. 10, H5729: MD MEDICARE CHOICE 15, H5820: UNIVERSAL HEALTH CARE INSURANCE COMPANY 32, H5884: BLUECROSS BLUESHIELD OF TENNESSEE 17, H5934: HOPE HOSPICE AND COMMUNITY SERVICES, INC H5938: CAPITAL HEALTH PLAN 8, H6499: WELLCARE HEALTH INSURANCE OF NEW YORK, INC. 4, H6934: UAHC HEALTH PLAN OF TENNESSEE, INC H7917: BLUE CROSS BLUE SHIELD OF TENNESSEE H9720: AMERICA'S 1ST CHOICE HEALTH PLANS, INC R5553: INSTIL HEALTH INSURANCE COMPANY 1, rate of reconsiderations per members, and is calculated as the sum of appeals received during divided by the mid-year enrollment, times.
23 23 TABLE 5 - Annual Report of Medicare ideration Activity: iderations During, and Distribution of Final Region=05: CHICAGO H0087: HEALTH ALLIANCE MEDICAL PLANS H0141: COMMUNITY CHOICE MICHIGAN H0540: UNICARE LIFE AND HEALTH INS. COMPANY 152, H0564: BLUE CROSS OF CALIFORNIA 19, H0974: HMO MINNESOTA D/B/A BLUE PLUS H1417: HEALTH ALLIANCE MEDICAL PLANS 2, H1463: HEALTH ALLIANCE MEDICAL PLANS 6, H1472: UNITED HEALTHCARE PLAN OF TH H1511: ANTHEM INSURANCE COMPANIES, INC H1517: ANTHEM INSURANCE COMPANIES, INC H1553: THE M PLAN, INC. 6, H1555: ARNETT HMO 4, H1558: WELBORN HEALTH PLAN 2, H1607: ANTHEM INSURANCE COMPANIES, INC. 2, H1689: ANTHEM INSURANCE COMPANIES, INC. 32, H1849: ANTHEM HEALTH PLANS OF KENTUCKY, INC. 7, H2237: INDEPENDENT CARE HEALTH PLAN, INC. 2, H2312: HEALTH ALLIANCE PLAN OF MICHIGAN 22, H2318: HENRY FORD HEALTH SYSTEM H2319: BLUE CROSS BLUE SHIELD OF MICHIGAN 251, H2320: PRIORITY HEALTH 8, H2322: ALLIANCE HEALTH AND LIFE INSURANCE, CO 1, H2323: FIDELIS SECURECARE OF MICHIGAN 1, H2354: HEALTHPLUS OF MICHIGAN 3, H2407: UCARE MINNESOTA rate of reconsiderations per members, and is calculated as the sum of appeals received during divided by the mid-year enrollment, times.
24 24 TABLE 5 - Annual Report of Medicare ideration Activity: iderations During, and Distribution of Final H2409: MEDICA INSURANCE COMPANY H2410: MEDICA HEALTH PLANS 2, H2416: PRIMEWEST HEALTH SYSTEM 2, H2417: ITASCA MEDICAL CARE H2419: SOUTH COUNTRY HEALTH ALLIANCE 1, H2422: GROUP HEALTH 2, H2424: FIRST PLAN OF MINNESOTA H2425: BLUE PLUS 10, H2450: MEDICA INSURANCE COMPANY 48, H2456: UCARE MINNESOTA 7, H2457: METROPOLITAN HEALTH PLAN H2458: MEDICA HEALTH PLANS 8, H2459: UCARE MINNESOTA 43, H2461: BLUE CROSS BLUE SHIELD OF MINNESOTA H2462: HEALTHPARTNERS 34, H2613: HEALTHY ALLIANCE LIFE INSURANCE COMPANY 4, H2926: PRIMEWEST HEALTH SYSTEM H2997: ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICES, INC H3044: NHP OF INDIANA, LLC H3342: EMPIRE HEALTHCHOICE ASSURANCE, INC. 3, H3370: EMPIRE HEALTHCHOICE HMO, INC. 70, H3613: CONCORDIA CARE H3614: TRIHEALTH SENIORLINK H3620: MCKINLEY LIFE INSURANCE COMPANY H3653: PARAMOUNT CARE, INC 14, H3655: COMMUNITY INSURANCE COMPANY 79, rate of reconsiderations per members, and is calculated as the sum of appeals received during divided by the mid-year enrollment, times.
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