Date: Jan 12, 2006                                                Your Practice Name                    (EZA2)
Time: 17:15:01                                          VSS MOS - FastEMC ANSI837
                                                       HCFA Download Edit Report				Page: 1
                                                 MOS Batch: 117       Date: 01/12/06

Record      Patient                          Date of       Ins.
Number      Account#        Patient Name      Birth        Type         Amount     Insured Name      HIC/SSN/Cert#
----------------------------------------------------------------------------------------------------------------------------
47       1-264          HELENA M ADELLS       10/04/1912 MEDICARE       124.40  HELENA ADELLS        234290293A
                     210    Payer Company Name Required                    MEDICARE
                     344    Second Ins Co Insured Date Of Birth Inva
                     ------------------------------------------------------------
48       1-325          HELENA M ADELLS       10/04/1912 Medicare       135.00  HELENA ADELLS        234290293A
                     344    Second Ins Co Insured Date Of Birth Inva
                     ------------------------------------------------------------
52       4-228          JOYCE AFISH           08/27/1943 Blue Shiel     185.00  GEORGE RACZ          A187320243
                     332    Second Insurance Policy Number Invalid         1211121121A
                     ------------------------------------------------------------
58       23-204         MICHAEL B BYRAN       02/13/1937 Blue Shiel    3125.00  MICHAEL BYRAN        126289364
                     534    Accident Date Required                         A
                     ------------------------------------------------------------
53       8-287          SUSAN CUDDLES         10/04/1061 Medicare        55.00  SUSAN CUDDLES        KSKDKSJFSDKFJSK
                     232    Insured Id Number Invalid                      KSKDKSJFSDKFJSK
                     ------------------------------------------------------------
61       31-65          MARGARET S DUMBBER    11/17/1930 Medicare        50.00  MARGARET S DUMBBER   A187220886          *
                     ------------------------------------------------------------
65       46-53          EDWARD HIGHLAND       03/02/1920 Blue Shiel      55.00  EDWARD HIGHLAND      169055975A          *
                     ------------------------------------------------------------
66       46-71          EDWARD HIGHLAND       03/02/1920 Medicare        55.00  EDWARD HIGHLAND      169055975A          *
                     ------------------------------------------------------------
68       50-134         MARIANNE JACKSON      11/28/1953 Medicare      1200.00  MARIANNE JACKSON     SRS186465895
                     232    Insured Id Number Invalid                      SRS186465895
                     ------------------------------------------------------------
46       3-308          PETER KING            12/04/1923 Medicaid       100.00  MARIE NIKOLICH       12443231            *
                     ------------------------------------------------------------
49       3-283          PETER KING            12/04/1923 Blue Shiel     410.00  MARGARET B RABBINI   189125135A          *
                     ------------------------------------------------------------
50       3-291          PETER KING            12/04/1923 Blue Shiel     115.00  MARGARET B RABBINI   189125135A          *
                     ------------------------------------------------------------
51       3-318          PETER KING            12/04/1923 Blue Shiel     160.00  MARGARET B RABBINI   189125135A          *
                     ------------------------------------------------------------
67       47-55          DOROTHY LANDING       03/18/1918 Medicare        55.00  DOROTHY LANDING      175303045A          *
                     ------------------------------------------------------------
57       22-95          PHYLLIS MANFIELD      03/05/1921 Medicare        56.67  PHYLLIS MANFIELD     175122465A
                     24d    Cpt / Procedure Code Invalid                    07/25/00 .83
                     24d    Cpt / Procedure Code Invalid                    03/24/03 .84
                     24e    Diagnosis Code Required                         07/25/00 .83
                     24e    Diagnosis Code Required                         03/24/03 .84
                     24l    Place Of Service Codes Invalid                 07/25/00
                     ------------------------------------------------------------
64       36-253         WANDA NEWMAN          02/14/1925 Medicare        50.00  WANDA NEWMAN         199148790D          *
                     ------------------------------------------------------------
55       13-280         ROSE PIAELLA          11/29/1926 Medicare        35.00  ROSE PIAELLA         197208015A          *
                     ------------------------------------------------------------
62       32-168         JAY V RAMSKY          03/03/1949 KING COUNT     135.00  KAREN A RAMSEY       169423553           *
                     ------------------------------------------------------------
63       32-208         JAY V RAMSKY          03/03/1949 KING COUNT      55.00  KAREN A RAMSEY       169423553           *
                     ------------------------------------------------------------
59       24-30          JOSEPH RANQUICK       01/05/1925 Medicaid        65.00  JOSEPH RANQUICK      5223423             *
                     ------------------------------------------------------------






Date: Jan 12, 2006                                                Your Practice Name                    Page:      2
Time: 17:15:03                                          VSS MOS - FastEMC ANSI837
                                                       HCFA Download Edit Report
                                                 MOS Batch: 117       Date: 01/12/06

Record      Patient                          Date of       Ins.
Number      Account#        Patient Name      Birth        Type         Amount     Insured Name      HIC/SSN/Cert#
----------------------------------------------------------------------------------------------------------------------------
60       24-198         JOSEPH RANQUICK       01/05/1925 Medicare        20.00  JOSEPH RANQUICK      255384416A          *
                     ------------------------------------------------------------
54       11-251         GEORGE STOMACH        06/16/1933 Medicare       100.00  GEORGE M STOMACH     169262674A          *
                     ------------------------------------------------------------
56       21-275         MARY VASE             02/03/1950 Medicaid       135.00  MARY VASE            192384609           *
                     ------------------------------------------------------------




















































