Aging by BL - Summarized

User : AMORALES01

Total 1-30 days 31-60 days 61-90 Days 91-120 Days 121-150 Days 151 +

BL Code Business Line Count Balance Count Balance Count Balance Count Balance Count Balance Count Balance Count Balance

Billing Office/Provider : CENTRO PSIQUIATRICO GLOMARISH

Provider : LOPEZ MARQUEZ, JOSE

0001123
FHC OF PR 3 256.05 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 3 256.05
455
HUMGOL APS HEALTHCARE
39 2,838.18 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 39 2,838.18
D PUERTO RICO, INC.
INTERNATIONAL
IMC 25 1,106.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 25 1,106.00
MEDICAL CARD
MEDICARE Y
MMM MUCHO MAS 2 245.41 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 2 245.41
HEALTHCARE
Sub Total By Provider : 69 4,445.64 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 69 4,445.64

Sub Total By Office : 69 4,445.64 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 69 4,445.64

8/15/2019 10:15:10 AM Page 1 of 4

Aging by BL - Summarized
User : AMORALES01

Total 1-30 days 31-60 days 61-90 Days 91-120 Days 121-150 Days 151 +

BL Code Business Line Count Balance Count Balance Count Balance Count Balance Count Balance Count Balance Count Balance

Billing Office/Provider : INAYA PSICHIATRIC MEDICAL GROUP PSC

Provider : LOPEZ MARQUEZ, JOSE

0001123
FHC OF PR 81 5,058.04 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 81 5,058.04
455
APS HEALTHCARE
APS 1734 85,036.61 116 6,039.25 112 5,704.22 119 6,222.95 64 1,230.41 93 3,437.22 1230 62,402.56
PUERTO RICO, INC.
CONSTEL CONSTELLATION
1 80.35 0 0.00 0 0.00 0 0.00 1 80.35 0 0.00 0 0.00
LATION HEALTH LLC
HUMGOL APS HEALTHCARE
61 3,954.49 1 45.00 1 50.00 0 0.00 0 0.00 1 56.06 58 3,803.43
D PUERTO RICO, INC.
INTERNATIONAL
IMC 8 207.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 8 207.00
MEDICAL CARD
MEDICAL CARD
MCS 2 208.14 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 2 208.14
SYSTEM, INC.
MCSCLAS
MCS CLASSICARE 7 509.13 0 0.00 1 78.04 1 78.04 0 0.00 0 0.00 5 353.05
S
MEDICAR MEDICARE PART B
1 65.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 1 65.00
E PR
TRIPLE S
SSSADV MEDICARE 54 2,665.96 0 0.00 0 0.00 1 40.00 2 95.00 0 0.00 51 2,530.96
ADVANTAGE
SSSREGU
TRIPLE-S, INC. 1 40.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 1 40.00
LAR
Sub Total By Provider : 1950 97,824.72 117 6,084.25 114 5,832.26 121 6,340.99 67 1,405.76 94 3,493.28 1437 74,668.18

Sub Total By Office : 1950 97,824.72 117 6,084.25 114 5,832.26 121 6,340.99 67 1,405.76 94 3,493.28 1437 74,668.18

8/15/2019 10:15:10 AM Page 2 of 4

Aging by BL - Summarized
User : AMORALES01

Total 1-30 days 31-60 days 61-90 Days 91-120 Days 121-150 Days 151 +

BL Code Business Line Count Balance Count Balance Count Balance Count Balance Count Balance Count Balance Count Balance

Billing Office/Provider : LOPEZ MARQUEZ, JOSE

Provider : LOPEZ MARQUEZ, JOSE

0001123
FHC OF PR 15 901.58 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 15 901.58
455
APS HEALTHCARE
APS 47 1,749.26 1 12.00 0 0.00 0 0.00 0 0.00 7 205.00 39 1,532.26
PUERTO RICO, INC.
CONSTEL CONSTELLATION
132 9,353.10 0 0.00 0 0.00 1 75.00 1 52.75 1 75.00 129 9,150.35
LATION HEALTH LLC
HUMANA HUMANA PR 1 131.26 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 1 131.26
HUMGOL APS HEALTHCARE
17 1,081.32 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 17 1,081.32
D PUERTO RICO, INC.
INTERNATIONAL
IMC 32 1,220.63 0 0.00 0 0.00 0 0.00 0 0.00 1 12.00 31 1,208.63
MEDICAL CARD
MEDICAL CARD
MCS 45 1,424.54 19 655.00 0 0.00 1 30.27 0 0.00 1 35.00 24 704.27
SYSTEM, INC.
MCSCLAS
MCS CLASSICARE 470 31,021.24 82 5,692.37 2 134.48 4 196.65 26 1,327.53 1 69.89 355 23,600.32
S
MEDICAR MEDICARE PART B
121 6,461.56 0 0.00 0 0.00 2 76.46 0 0.00 1 23.00 118 6,362.10
E PR
MEDICARE Y
MMM MUCHO MAS 169 9,818.55 27 1,968.25 1 1.00 5 370.00 0 0.00 4 258.25 132 7,221.05
HEALTHCARE
PREFERRED
PMC 6 399.88 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 6 399.88
MEDICARE CHOICE
PMC GOVERNMENT
PMCREF 2 114.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 2 114.00
HEALTH PLAN GHP
TRIPLE S
SSSADV MEDICARE 17 1,092.37 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 17 1,092.37
ADVANTAGE
SSSREGU
TRIPLE-S, INC. 649 22,618.48 43 1,545.81 20 665.27 6 135.54 1 26.00 2 44.00 577 20,201.86
LAR
Sub Total By Provider : 1723 87,387.77 172 9,873.43 23 800.75 19 883.92 28 1,406.28 18 722.14 1463 73,701.25

Provider : MEDICAL GROUP, INAYA PSCHYATRIC

APS HEALTHCARE
APS 1 56.06 0 0.00 1 56.06 0 0.00 0 0.00 0 0.00 0 0.00
PUERTO RICO, INC.
Sub Total By Provider : 1 56.06 0 0.00 1 56.06 0 0.00 0 0.00 0 0.00 0 0.00

Sub Total By Office : 1724 87,443.83 172 9,873.43 24 856.81 19 883.92 28 1,406.28 18 722.14 1463 73,701.25

8/15/2019 10:15:10 AM Page 3 of 4

Aging by BL - Summarized
User : AMORALES01

Total 1-30 days 31-60 days 61-90 Days 91-120 Days 121-150 Days 151 +

BL Code Business Line Count Balance Count Balance Count Balance Count Balance Count Balance Count Balance Count Balance

Billing Office/Provider : PSICHIATRIC MEDICAL GROUP PSC, INAYA

Provider : LOPEZ MARQUEZ, JOSE

APS HEALTHCARE
APS 2 146.29 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 2 146.29
PUERTO RICO, INC.
Sub Total By Provider : 2 146.29 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 2 146.29

Provider : PSICHIATRIC MEDICAL GROUP PSC, INAYA

APS HEALTHCARE
APS 1 52.95 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 1 52.95
PUERTO RICO, INC.
Sub Total By Provider : 1 52.95 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 1 52.95

Sub Total By Office : 3 199.24 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 3 199.24

Grand Total : 3746 189,913.43 289 15,957.68 138 6,689.07 140 7,224.91 95 2,812.04 112 4,215.42 2972 153,014.31

8/15/2019 10:15:10 AM Page 4 of 4