Contractor

Contractor		DMERC C		MEDICARE				RUN DATE		11/12/99
Program		DMEEC230		EDIT				RUN TIME		22:08:08
Reprot ID				REPORT				PAGE NO.		1
Originating DMERC								RUN TYPE		PROD


Supplier		HICN	CCN	BENE NAME		PAT ACCT NBR	TOTAL SUBMITTED	SERV DATE	BILL SLIP	STATUS
				ALLEN MARGARET		00133	6442.56	19991109		A
*YOUR SUPPLIER NUMBER, PATIENT MEDICARE NUMBER AND THE CLAIM CONTROL NUMBER APPEAR IN THESE COLUMNS*				ALLEN MARGARET		00133	270.91	19991109		A
				ALLEN MARGARET		00133	347.68	19991109		A
				BARNEY IRA		00132	3019.07	19991108		A
				BARNEY IRA		00132	329.28	19991108		A
				BARNEY IRA		00132	587.24	19991108		A
				HENINGBURG DANIEL		00115	928.83	19991109		A
				LOWERY WINONA		00134	5841.13	19991109		A
				LOWERY WINONA		00134	753.48	19991109		A
				LOWERY WINONA		00134	347.68	19991109		A
				PAIGE WILLIE		00109	5441.70	19991004		A
				PAIGE WILLIE		00137	1002.40	19991109		A
				SAUNDERS EVELYN		00135	5943.45	19991110		A
				SAUNDERS EVELYN		00135	475.26	19991110		A
				TAYLOR ROBERT		00136	5575.48	19991110		A
				TAYLOR ROBERT		00136	495.66	19991110		A
				TAYLOR ROBERT		00136	406.05	19991110		A
	ASSIGNED					17
	NONASSIGNED					0
	TOTAL NUMBER OF CLAIMS RECEIVED					17

	ASSIGNED					50
	NONASSIGNED					0
	TOTAL NUMBER OF LINES RECEIVED					50

	ASSIGNED					41207.86
	NONASSIGNED					00
	TOTAL DOLLAR VALUE OF CLAIMS RECEIVED					41207.86


STATUSES	A=ACCEPTED		R=REJECTED		TX= TRANSFERRED TO DMERC X		RX=REJECTED FOR NSF ERRORS AND SENT TO WRONG REGION


THIS REPORT IS FAXED TO YOU EVERY MORNING (KNOWN AS THE "EDIT REPORT") AND SHOWS CLAIMS THAT WERE SUBMITTED THE PREVIOUS DAY. THE REPORT SHOWS THE NUMBER OF ASSIGNED AND NON-ASSIGNED CLAIMS TRANSMITTED, THE DOLLAR AMOUNT OF EACH CLAIM, AND THE NUMBER OF CLAIMS REJECTED (IF ANY).