Date: 01/12/06  Time: 17:19:48                                     Page: 1

                   FastEMC Transmission Generation Report (837 format)
--------------------------------------------------------------------------------

PayerID:00630           Batch Total:    365.00 Batch Number: 1091
Provider:PMC173128
                            Total
1                         Charges                             Claims
             Medicare:     365.00         .00                     7
             Medicaid:        .00         .00                     0
          Blue Shield:        .00         .00                     0
              Champus:        .00         .00                     0
           Commercial:        .00         .00                     0
           Key Health:        .00         .00                     0
                       ---------   ----------                -------
                           365.00      365.00                     7
--------------------------------------------------------------------------------

Provider:PMC173128          Total:    365.00

                            Total
TOTAL:                    Charges                             Claims
           Medicare:     365.00         .00                     7
           Medicaid:        .00         .00                     0
        Blue Shield:        .00         .00                     0
            Champus:        .00         .00                     0
         Commercial:        .00         .00                     0
         Key Health:        .00         .00                     0
                     ---------   ----------                -------
                         365.00      365.00                     7
================================================================================


PayerID:40224           Batch Total:    740.00 Batch Number: 1092
Provider:PBS337223
                            Total
2                         Charges                             Claims
             Medicare:        .00         .00                     0
             Medicaid:        .00         .00                     0
          Blue Shield:     740.00         .00                     4
              Champus:        .00         .00                     0
           Commercial:        .00         .00                     0
           Key Health:        .00         .00                     0
                       ---------   ----------                -------
                           740.00      740.00                     4
--------------------------------------------------------------------------------



















Date: 01/12/06  Time: 17:19:48                                     Page: 2

                   FastEMC Transmission Generation Report (837 format)
--------------------------------------------------------------------------------

Provider:PBS337223          Total:    740.00

                            Total
TOTAL:                    Charges                             Claims
           Medicare:        .00         .00                     0
           Medicaid:        .00         .00                     0
        Blue Shield:     740.00         .00                     4
            Champus:        .00         .00                     0
         Commercial:        .00         .00                     0
         Key Health:        .00         .00                     0
                     ---------   ----------                -------
                         740.00      740.00                     4
================================================================================


PayerID:00660           Batch Total:    300.00 Batch Number: 1093
Provider:PMD1566801
                            Total
3                         Charges                             Claims
             Medicare:        .00         .00                     0
             Medicaid:     300.00         .00                     3
          Blue Shield:        .00         .00                     0
              Champus:        .00         .00                     0
           Commercial:        .00         .00                     0
           Key Health:        .00         .00                     0
                       ---------   ----------                -------
                           300.00      300.00                     3
--------------------------------------------------------------------------------

Provider:PMD1566801         Total:    300.00

                            Total
TOTAL:                    Charges                             Claims
           Medicare:        .00         .00                     0
           Medicaid:     300.00         .00                     3
        Blue Shield:        .00         .00                     0
            Champus:        .00         .00                     0
         Commercial:        .00         .00                     0
         Key Health:        .00         .00                     0
                     ---------   ----------                -------
                         300.00      300.00                     3
================================================================================



















Date: 01/12/06  Time: 17:19:49                                     Page: 3

                   FastEMC Transmission Generation Report (837 format)
--------------------------------------------------------------------------------
     Grand Totals       1405.00     1405.00                    14


   Use this to track the claims:                                DATE

      Received an upload acknowledgement:   YES   NO         _________________
        (Within a few hours)

      Claims have been accepted and are pending for payment  _________________
        (Within 48 hours this should be available)


      Check was received for this group of claims            _________________
        (14-21 days to process and receive check)
















































