Trailer Record Data Elements

40.1 - Trailer Record Data Elements (Rev. 141, Issued: 02-24-06; Effective/Implementation: N/A) Fld. No. of No. Position Cols. Item Description Comments 1. 001 1 Record Code 9(01) 9 = Trailer Record 2. 002-006 5 Incoming Carrier Number 9(05) CMS Contractor Number; Multistate Contractors Use The Distinct Number Of Each Jurisdiction 3. 007-014 6 File Creation9(06) (MMDDYYYY) Month, Day, And Year Of File Creation. 4. 015-029 15 Number of Records Sent 9(15) Total Number Of Records On The File. Do Not Include The Trailer Record. Right justified and precede with zeroes. 5. 030-306 273 Filler X(277) NOTE: For "9" numeric fields, show zeroes if blank. For all "X" alpha numeric fields, if no information leave field blank. Exhibit 41.1 - List of Medical School in the U.S. (Rev. 141, Issued: 02-24-06; Effective/Implementation: N/A) LIST OF MEDICAL SCHOOLS IN THE U.S. ALABAMA 00102 University of Alabama School of Medicine, Birmingham, AL 3529 00104 Birmingham Medical College 00106 University of South Alabama College of Medicine, Mobile, AL 37788 ARIZONA 00301 University of Arizona College of Medicine, Tucson, AZ 85724 ARKANSAS 00401 University of Arkansas College of Medicine, Little Rock, AR 77205 00402 College of Physicians and Surgeons, Little Rock, AR 77205 CALIFORNIA 00501 Cooper Medical College, San Francisco, CA 94143 00502 University of California, San Francisco School of Medicine, San Francisco, CA 94143 00504 California Eclectic Medical College, Los Angeles, CA 90033 00505 Hahneman Medical College of the Pacific, San Francisco, CA 94305 00506 University of Southern California School of Medicine, Los Angeles, CA 90033 00507 College of Physicians and Surgeons of San Francisco, CA 00508 Oakland College of Medicine and Surgery 00509 College of Physicians and Surgeons, Los Angeles, CA 90024 00511 Stanford University School of Medicine, Palo Alto, CA 94305 00512 Loma Linda University School of Medicine, Loma Linda, CA 92350 00513 Pacific Medical College, Los Angeles 00514 University of California, UCLA School of Medicine, Los Angeles, CA 90024 00515 University of California, California College of Medicine, Irvine, CA 92717 00516 University of California, Irvine, California College of Medicine Irvine, CA 92717 00517 University of California, Irvine, California College of Medicine, Irvine, CA 92717 00518 University of California, San Diego School of Medicine, La Jolla, CA 92093 00519 University of California, Davis School of Medicine, Davis, CA 95616 00576 College of Osteo of the Pacific, Pomona, CA 91766 COLORADO 00702 University of Colorado School of Medicine, Denver, CO 80262 00705 Denver and Gross College of Medicine Denver, CO 80262 CONNECTICUT 00801 Yale University School of Medicine, New Haven, CT 06510 00802 University of Connecticut School of Medicine, Farmington, CT 06032 DISTRICT OF COLUMBIA 01001 George Washington University School of Medicine, Washington, DC 20037 01002 Georgetown University School of Medicine, Washington, DC 20007 01003 Howard University College of Medicine, Washington, DC 20059 FLORIDA 01102 University of Miami School of Medicine, Miami, FL 33101 01103 University of Florida College of Medicine, Gainesville, FL 32610 01104 University of South Florida College of Medicine, Tampa, FL 33612 01175 Southeastern College of Osteo Medicine, Miami, FL 33162 GEORGIA 01201 Medical College of Georgia, Augusta, GA 30912 01205 Emory University School of Medicine, Atlanta, GA 30322 01209 Georgia College of Eclectric Medicine and Surgery, Atlanta, GA 30314 01211 Atlanta College of Physicians and Surgeons, Atlanta, GA 30322 01212 Atlanta School of Medicine Atlanta, GA 31207 01218 Hospital Medical College Eclectric, Atlanta, GA 31207 01219 Southern College of Medicine and Surgery, Atlanta, GA 30314 01221 Morehouse School of Medicine, Atlanta, GA 31207 01222 Mercer University School of Medicine, Macon, GA 31207 HAWAII 01401 University of Hawaii John A. Burns School of Medicine, Honolulu, HI 96822 ILLINOIS 01601 Rush Medical College of Rush University, Chicago, IL 60612 01602 University of Chicago, Pritzker School of Medicine, Chicago, IL 60637 01604 The Hahneman Medical College and Hospital, Chicago, IL 60637 01605 College of Medicine and Surgery, Chicago, IL 60658 01606 Northwestern University Medical School, Chicago, IL 60611 01608 Bennett Medical College, Chicago, IL 60639 01609 Northwestern University Women Medical School, Chicago, IL 60637 01610 Chicago Homeopathic Medical College, Chicago, IL 60612 01611 University of Illinois at Chicago Health Science Center, Chicago, IL 60612 01613 Harvey Medical College, Chicago, IL 60637 01614 National Medical University, Chicago 60639 01615 Hering Medical College, Chicago, IL 60638 ILLINOIS 01616 Jenner Medical College, Chicago, IL 60637 01617 Illinois Medical College, Chicago, IL 60637 01618 Dunham Medical College, Chicago, IL 60637 01619 American Medical Missionary College, Battle Creek, Chicago, IL 60637 01622 Chicago College of Medicine and Surgery 01623 Dearborn Medical College, Chicago, IL 60637 01642 University of Health Sciences/ Chicago Medical School, North Chicago, IL 60064 01643 Loyola University of Chicago, Stitch School of Medicine, Maywood, IL 60153 01644 The General Medical College, Chicago, IL 60615 01645 Southern Illinois University School of Medicine, Springfield, IL 62708 01675 Chicago College of Osteopathy, Chicago, IL 60615 INDIANA 01705 Physiological Medical College of Indiana, Indianapolis, IN 46202 01708 Medical College of Indiana, Indianapolis, IN 46224 01709 Central College of Physicians and Surgeons, Indianapolis, IN 46223 01717 Eclectic Medical College of Indiana, Indianapolis, IN 46224 01718 Indiana Medical College, Indianapolis, IN 46224 INDIANA 01719 School of Medicine of Purdue University, Indianapolis, IN 46202 01720 Indiana University School of Medicine, Indianapolis, IN 4622 IOWA 01801 College of Physicians and Surgeons, Keokuk, IA 52632 01803 University of Iowa College of Medicine, Iowa City, IA 52242 01804 State University of Iowa College of Homeopathic Medicine, Iowa City, IA 52242 01806 Drake University College of Medicine, Des Moines, IA 50311 01808 Sioux City College of Medicine, Sioux City, IA 50312 01810 Keokuk Medical College, College of Physicians and Surgeons, Keokuk, IA 52632 01875 University of Osteopathic Medicine and Health Sciences, Des Moines, IA 50312 KANSAS 01902 University of Kansas School of Medicine, Kansas City, KS 66103 01903 Kansas Medical College, Topeka, KS 66606 01904 College of Physicians and Surgeons, Kansas City, KS 66110 01907 Western Eclectic College of Medicine and Surgery, Kansas City, KS 66102 KENTUCKY 02001 Kentucky School of Medicine, Louisville, KY 40292 02002 University of Louisville School of Medicine, Louisville, KY 40292 02004 Louisville Medical College, Louisville, KY 40292 02005 Hospital College of Medicine, Louisville, KY KENTUCKY 02006 Louisville National Medical College, Louisville, KY 40292 02008 Southwestern Homeopathic Medical College and Hospital, Louisville, KY 40546 02009 Kentucky University Medical Department, Louisville, KY 40292 02011 Louisville Hospital Medical College, Louisville, KY 40292 02012 University of Kentucky College of Medicine Lexington, KY 40536 LOUISIANA 02101 Tulane University School of Medicine, New Orleans, LA 70112 02104 Flint Medical College of New Orleans University, New Orleans, LA 70112 02105 Louisiana State University School of Medicine in New Orleans, New Orleans, LA 70112 02106 Louisiana State University School of Medicine in Shreveport, Shreveport, LA 71130 MAINE 02201 Bowdoin Medical School, Brunswick-Portland ME 04003 02275 University of New England, College of Osteo Medicine, Biddeford, ME 04005 MARYLAND 02301 University of Maryland School of Medicine, Baltimore, MD 21201 02303 College of Physicians and Surgeons of Baltimore, Baltimore, MD 21201 02304 Baltimore Medical College, Baltimore, MD 21201 02305 Womans Medical College of Baltimore, Baltimore, MD 21201 02306 Baltimore University School of Medicine, Baltimore, MD 21201 02307 Johns Hopkins University School of Medicine, Baltimore, MD 21205 02308 Atlantic Medical College, Baltimore, MD 21201 02309 Maryland Medical College, Baltimore, MD 21201 02311 Maryland College of Eclectic Medicine and Surgery, Baltimore, MD 21201 02312 Uniformed Services University of the Health Sciences, Bethesda, MD 20014 MASSACHUSETTS 02401 Harvard Medical School, Boston, MA 02115 02405 Boston University School of Medicine, Boston, MA 02118 02406 College of Physicians and Surgeons, Boston, MA 02111 02407 Tufts University School of Medicine, Boston, MA 02111 02415 Middlesex University School of Medicine, Waltham, MA 02154 02416 University of Massachusetts Medical School, Worcester, MA 01605 MICHIGAN 02501 University of Michigan Medical School, Ann Arbor, MI 48109 02505 University of Michigan Homeopathic Medical School, Ann Arbor, MI 48209 02507 Wayne State University School of Medicine, Detroit, MI 48201 02508 Michigan College of Medicine and Surgery, Detroit, MI 48201 02512 Michigan State University College of Human Medicine, East Lansing, MI 48824 02576 Michigan State University College of Osteopathic Medicine, East Lansing, MI 48824 MINNESOTA 02604 University of Minnesota Medical School, Minneapolis, MN 55455 02605 Minneapolis College of Physicians and Surgeons 02607 University of Minnesota, Duluth School of Medicine, Duluth, MN 55812 02608 Mayo Medical School, Rochester, MN 55905 MISSISSIPPI 02701 University of Mississippi School of Medicine, Jackson, MS 39216 02702 Mississippi Medical College, Meridian, MS 39305 MISSOURI 02801 Missouri Medical College, St. Louis, MO 63110 02802 Washington University School of Medicine, St Louis, MO 63110 02803 University of Missouri, Columbia School of Medicine, Columbia, MO 65212 02805 Homeopathic Medical College of Missouri, St. Louis, MO 63141 02807 St. Louis College of Physicians and Surgeons 02808 Kansas City Medical College 02810 National University of Arts and Sciences Medical Department, St. Louis, MO 63110 02820 University Medical College of Kansas City Kansas City, MO 64111 02822 Ensworth Medical College, St. Joseph, MO 64507 02826 Kansas City Homeopathic Medical College 02828 Barnes Medical College, St. Louis, MO 63110 02830 Woman's Medical College, Kansas City, MO 63111 02833 Eclectic Medical University, Kansas City, MO 63111 02834 Saint Louis University School of Medicine, St Louis, MO 63104 02835 Southwest School of Medicine and Hospital, Kansas City, MO 63111 02843 Kansas City College of Medicine and Surgery 02844 Kansas City University of Physicians and Surgeons 02845 Mid West Medical College, Kansas City, MO (See 02843) 02846 University of Missouri, Kansas City School of Medicine, Kansas City, MO 64108 02878 The University of Health Sciences, College of Osteo Medicine, Kansas City, MO 64124 02879 Kirksville College of Osteopathic Medicine, Kirksville, MO 63501 NEBRASKA 03004 Lincoln Medical College, Eclectic, Lincoln, NE 68501 03005 University of Nebraska College of Medicine, Omaha, NE 68105 03006 Creighton University School of Medicine, Omaha, NE 68178 03007 Nebraska College of Medicine, Lincoln, NE 69508 NEVADA 03101 University of Nevada School of Medicine, Reno, NV 89507 NEW HAMPSHIRE 03201 Dartmouth Medical School, Hanover, NH 03756 NEW JERSEY 03305 UMDNJ-New Jersey Medical School, Newark, NJ 07103 03306 UMDNJ-Robert Wood Johnson Medical School, Piscataway, NJ 08854 03375 UMDNJ New Jersey School of Osteo Medicine, Camden, NJ 08103 NEW MEXICO 03401 University of New Mexico School of Medicine, Albuquerque, NM 87131 NEW YORK 03501 Columbia University College of Physicians and Surgeons, New York, NY 10032 03503 Albany Medical College of Union University, Albany, NY 12208 03506 State Univesity of New York at Buffalo School of Medicine, Buffalo, NY 14214 03508 State University of New York Downstate Medical Center, Brooklyn, NY 12203 03509 New York Medical College, Valhalla, NY 10595 03510 Bellevue Hospital Medical College, New York, NY 10016 03511 New York Medical College and Hospital for Women, New York 10025 03513 Eclectic Medical College of the City of New York 03515 State University of New York Health Science Center of Syracuse, Syracuse, NY 13210 03519 New York University School of Medicine, New York, NY 10016 03520 Cornell University Medical College, New York, NY 10021 03543 Fordham University School of Medicine, New York, NY 10027 03545 University of Rochester School of Medicine and Dentistry, Rochester, NY 14642 03546 Albert Einstein College of Medicine of Yeshiva University, New York, NY 10461 03547 Mount Sinai School of Medicine of City University of New York, New York NY 10029 03548 State University of New York at Stony Brook, School of Medicine, Stony Brook, NY 11794 03575 New York College of Osteo Medicine of New York Institute of Technology, Old Westbury, NY 11568 NORTH CAROLINA 03601 University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27514 03603 Leonard Medical School, Raleigh, NC 27604 03604 North Carolina Medical College, Charlotte, NC 28223 03605 Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC 27103 03607 Duke University School of Medicine, Durham, NC 27710 03608 East Carolina University School of Medicine, Greenville, NC 27834 NORTH DAKOTA 03701 University of North Dakota School of Medicine, Grand Forks, ND 58201 OHIO 03801 Medical College of Ohio, Cincinnati, OH 44115 03802 Eclectic Medical College, Cincinnati, OH 44115 03803 Starling Medical College, Columbus, OH 45210 03806 Case Western Reserve University School of Medicine, Cleveland, OH 44206 03808 Cincinnati College of Medicine and Surgery 03809 Miami Medical College, Cincinnati, OH 44106 03811 University of Wooster Medical Department, Cleveland, OH 44206 03819 Toledo Medical College 03823 Cleveland Medical College, Homeopathic Cleveland, OH 45210 03825 Ohio Medical University Columbus, OH 45210 03826 Cleveland Pulte Medical College 03840 Ohio State University College of Medicine, Columbus, OH 43210 03841 University of Cincinnati College of Medicine, Cincinnati, OH 45267 03843 Medical College of Ohio at Toledo, Toledo, OH 43699 03844 Northeastern Ohio Universities College of Medicine, Rootstown, OH 44272 03845 Wright State University School of Medicine, Dayton, OH 45401 03875 Ohio University of Osteo Medicine, Athens, OH 45701 OKLAHOMA 03901 University of Oklahoma College of Medicine, Oklahoma City, OK 73190 03905 Oral Roberts University School of Medicine, Tulsa, OK 74171 03979 Oklahoma College of Osteopathic Medicine and Surgery, Tulsa, OK 47127 OREGON 04001 Williamette University Medical Department, Salem, OR 97304 04002 Oregon Health Sciences University School of Medicine, Portland, OR 97201 PENNSYLVANIA 04101 University of Pennsylvania School of Medicine, Philadelphia, PA 19104 04102 Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA 19107 04107 Medical College of Pennsylvania, Philadelphia, PA 19129 04109 Hahnemann University College of Medicine, Philadelphia, PA 19102 04111 Medico Chirurgical College of Philadelphia, Philadelphia, PA 19102 04112 University of Pittsburgh School of Medicine, Pittsburgh, PA 15261 04113 Temple University School of Medicine, Philadelphia, PA 19140 04114 Pennsylvania State University College of Medicine, Hershey, PA 17033 04177 Philadelphia College of Osteopathic Medicine, Philadelphia, PA 191431 PUERTO RICO 04201 University of Puerto Rico School of Medicine, San Juan, PR 00936 04202 Ponce School of Medicine, Ponce, PR 00732 04203 Universidad Central del Caribe Escuela de Medicina, Cayey, PR 00633 04204 University De Ciencias Med San Juan Bautista, Hato Rey, PR 00917 RHODE ISLAND 04301 Brown University Program in Medicine, Providence, RI 02912 SOUTH CAROLINA 04501 Medical University of South Carolina College of Medicine, Charleston, SC 29425 04504 University of South Carolina School of Medicine, Columbia, SC 29208 SOUTH DAKOTA 04601 University of South Dakota School of Medicine, Vermillion, SD 57069 TENNESSEE 04701 University of Nashville Medical Department 04705 Vanderbilt University School of Medicine, Nashville, TN 37232 04706 University of Tennessee College of Medicine, Memphis, TN 38163 04707 Meharry Medical College School of Medicine, Nashville, TN 37208 04708 Memphis Hospital Medical College 04709 Chattanooga Medical College 04710 Lincoln Memorial University Medical Department, Knoxville, TN 37920 04711 University of the South Medical Department, Sewanee, TN 37375 04713 Knoxville Medical College 04714 University of West Tennessee College of Medicine and Surgery, Memphis, TN 37402 04715 College of Physicians and Surgeons, Memphis, TN 37208 04720 East Tennessee State University, Quillen-Dishner College of Medicine, Johnson City, TN 37614 TEXAS 04802 University of Texas Medical Branch at Galveston, Galveston, TX 77550 04803 Fort Worth School of Medicine 04804 Baylor College of Medicine, Houston, TX 77030 04805 Physiological Medical College of Texas, Dallas, TX 76203 04806 Southern Methodist University Medical Department, Dallas, TX 04807 Gate City Medical College, Dallas, TX 76204 04812 University of Texas Southwestern Medical School at Dallas, Dallas, TX 75235 04813 University of Texas Medical School at San Antonio, San Antonio, TX 78284 04814 University of Texas Medical School at Houston, Houston, TX 77225 04815 Texas Tech University Health Science Center School of Medicine, Lubbock, TX 79430 04816 Texas A & M University College of Medicine, College Station, TX 77843 04878 Texas College of Osteopathic Medicine, Lubbock, TX 79430 UTAH 04901 University of Utah School of Medicine, Salt Lake City, UT 84132 VERMONT 05002 University of Vermont College of Medicine, Burlington, VT 05405 VIRGINIA 05101 University of Virginia School of Medicine, Charlottesville, VA 22908 05104 Medical College of Virginia Commonwealth University School of Medicine, Virginia, Richmond, VA 23298 05106 University College of Medicine, Richmond, VA 23298 05107 Eastern Virginia Medical School, Norfolk, VA 23501 WASHINGTON 05404 University of Washington School of Medicine, Seattle, WA 98195 05415 Washington College of Physicians and Surgeons, Seattle, WA 98196 WEST VIRGINIA 05501 West Virginia University School of Medicine, Morgantown, WV 26506 05502 Marshall University School Medicine, Huntington, WV 25701 05575 West Virginia School of Osteopathic Medicine, Lewisburg, WV 24901 WISCONSIN 05602 Wisconsin College of Physicians and Surgeons, Milwaukee, WI 53226 05603 Milwaukee Medical College 05605 University of Wisconsin Medical School, Madison, WI 53706 05606 Medical College of Wisconsin, Milwaukee, WI 53226 This list of codes for medical schools in the U.S. is copyrighted by the American Medical Association. Carrier use is restricted to CMS requirements in the physician identification effort. Copyright 1987 American Medical Association 535 North Dearborn Street Chicago, IL 60610 All Rights Reserved Additional copies may be purchased from: Book & Pamphlet Fulfillment OP-167/7 American Medical Association P.O. Box 10946 Chicago, IL 60610 HNA: 86-818:33M:2/87 USBN 0-89970-237-6 ISSN 0892-0109 Exhibit 41.2 - Directory of Podiatric Medical Colleges (Rev. 141, Issued: 02-24-06; Effective/Implementation: N/A) DIRECTORY OF PODIATRIC MEDICAL COLLEGES 30000 California College of Podiatric Medicine 1210 Scott St., San Francisco, CA 94120 30100 Dr. William M. Scholl School of College of Podiatric Medicine 1001 North Dearborn St., Chicago, IL 60610 30200 New York College of Podiatric Medicine 53 East 124th St., New York, NY 10035 30300 Ohio College of Podiatric Medicine 10515 Carnegie Ave., Cleveland, OH 44106 30400 Pennsylvania College of Podiatric Medicine Eighth at Rale St, Philadelphia, PA 19107 30500 Barry University School of Podiatric Medicine 11300 Northeast Second Ave., Miami Shores, FL 33161 30600 College of Podiatric Medicine and Surgery, University of Osteopathic Medicine and Health Sciences 3200 Grand Ave., Des Moines, IA 50312 Exhibit 41.3 - American Optometric Association Council on Optometric Education (Rev. 141, Issued: 02-24-06; Effective/Implementation: N/A) List of Accredited Professional Optometric Degree Programs June 1986 40000 University of Alabama in Birmingham School of Optometry Birmingham, AL 35292 40010 University of California School of Optometry Minor Hall Berkley, Ca 94720 40020 Ferris State College College of Optometry Big Rapids, MI 49307 AMERICAN OPTOMETRIC ASSOCIATION COUNCIL ON OPTOMETRIC EDUCATION 40030 University of Houston College of Optometry Houston, TX 77004 40040 Illinois College of Optometry 3241 South Michigan Avenue Chicago, IL 60616 40050 Indiana University School of Optometry Bloomington, IN 47405 40060 Inter-American University of Puerto Rico School of Optometry San Juan, PR 00936 40070 University of Missouri St. Louis, MO 63121 40080 University of Montreal School of Optometry Montreal, P.Q. Canada H3C 3J7 40090 New England College of Optometry Boston, MA 02115 40100 Berkeley Northeastern State University College of Optometry Tahlequah, Ok 74464 40110 State University of NY State College of Optometry New York, NY 10010 40120 The Ohio State University College of Optometry Columbus, OH 43210 40130 Pacific University College of Optometry Forest Grove, OR 97116 40140 Pennsylvania College of Optometry Philadelphia, PA 19141 40150 South California College of Optometry Fullerton, CA 96231 40160 Southern College of Optometry Memphis, TN 38104 40170 University of Waterloo School of Optometry Waterloo, Ontario Canada N2L 3G1 Exhibit 41.4 - List of Chiropractic Schools in the U.S. (Rev. 141, Issued: 02-24-06; Effective/Implementation: N/A) List of Chiropractic Schools in the U.S Code 50010 Adio Institute of Straight Chiropractic Levittown, PA 19056 Changed name to Pennsylvania College of Straight Chiropractic - (1984) 50020 Atlantic States Chiropractic Institute Brooklyn, NY 10021 Merged with Columbia Institute of Chiropractic 50030 Bebout College of Chiropractic Indianapolis, IN 46224 50040 Booker T. Washington Chiropractic College Kansas City, MO 66103 50050 50050 Logan College Oklahoma City, OK 73190 Formerly Carver-Denny Chiropractic College Merged with Logan College of Chiropractic - (1958) 50060 Los Angeles College of Chiropractic Formerly California Chiropractic College (1963) Los Angeles, CA 90024 50065 Central States College of Physiatrics and Chiropractic Eaton, OH 45320 50070 Canadian Memorial Chiropractic College Toronto, Ontario M4G 3E6 50080 50080 Chiropractic Institute of New York New York, NY 10022 50090 Crisco Chiropractic College (Proposed) Crisco, TX 77650 * Schools in business since 1950 **Schools not listed use code 5000 50100 Cleveland Chiropractic College Los Angeles, CA 90004 50110 Cleveland Chiropractic College Kansas City, MO 64131 50120 Columbia College of Chiropractic Baltimore, MD 21201 50130 Columbia College of Chiropractic Alameda, CA 94501 50140 Columbia College of Chiropractic and Naturopathy Sacramento, CA 95860 50150 Columbia Institute of Chiropractic New York, NY 10025 50160 Hollywood College of Chiropractic Hollywood, CA 90024 50170 Lafayette Institute Philadelphia, PA 19104 50180 Life Chiropractic College San Lorenzo, CA 94580 50190 Lincoln Chiropractic College Marietta, GA 30060 50200 Reaver School of Chiropractic Dayton, OH 45401 50210 Restview Chiropractic College University of Chiropractic Seattle, WA 98196 50220 San Francisco College of Chiropractic San Francisco, CA 94128 Formerly West Coast Chiropractic College; Name changed to Metropolitan College of Chiropractic - 1944 50230 Sherman College of Straight Chiropractic, Spartanburg, SC 29304 50240 Western States College of Chiropractic, Portland, OR 97230 50250 University of Pasadena, College of Chiropractic, Pasadena, CA 91108 50260 University of Natural Healing Arts, Denver CO 80262 50270 National College of Chiropractic, Lombard IL 60148 50280 New York Chiropractic College, Glen Head, NY 11545 50290 Northwestern College of Chiropractic, Bloomington, MN 55431 50300 Palmer College of Chiropractic – West, Sunnyvale, CA 94087 50310 Palmer College of Chiropractic, Davenport, IA 52803 Exhibit 42 - Sanction Codes (Rev. 141, Issued: 02-24-06; Effective/Implementation: N/A) Sanction Codes * CODE DESCRIPTION A - 1128(a)(1) - Program-related conviction B - 1128(a)(2) - Conviction for patient abuse or neglect C - 1128(b)(1) - Conviction relating to fraud D - 1128(b)(2) - Conviction relating to obstruction of an investigation E - 1128(b)(3) - Conviction relating to controlled substances F - 1128(b)(4) - License revocation or suspension G - 1128(b)(5) - Suspension or exclusion under a Federal or State health care program H - 1128(b)(6) - (Formerly 1862(d)(1)(B) and (C)) - Excessive claims or furnishing of unnecessary or substandard items or services I - 1128(b)(7) - Fraud, kickbacks and other prohibited activities (including 1162(d)(1A)) J - 1128(b)(8) - (Formerly 1128(b) - Entities owned or controlled by a sanctioned individual K - 1128(b)(9) Failure to disclose required information L - 1128(b)(10) - Failure to supply requested information on subcontractors and suppliers M -1128(b)(11) - Failure to provide payment information N - 1128(b)(12) - Failure to grant immediate access O - 1128(b)(13) - Failure to take corrective action P - 1128(b)(14) - Default on health education loan or scholarship obligations Q - 1128Aa - (Formerly 1128(c) - Imposition of a civil money penalty or assessment R - 1156(b) - (Formerly 1160) - PRO recommendation U - - UNKNOWN (Physician is sanctioned, but type of sanction unknown) * If a physician has more than one sanction, show the code of the sanction with the longest duration. Exhibit 43 - Carrier Transmittal Sheet (Rev. 141, Issued: 02-24-06; Effective/Implementation: N/A) ______________________________________________________________________ A. UPIN Carrier Data Transmittal ______________________________________________________________________ Deliver to: 1. Carrier Number: 2. *Name and Address of Carrier ______________________________________________________________________ UPIN Records Included in this Transmittal ______________________________________________________________________ 3. Date Prepared: 4. Date Shipped: ______________________________________________________________________ B. 1 UPIN Data Records: Tape Diskette Volume Serial Number: ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ______________________________________________________________________ B. 2 Total Records ______________________________________________________________________ B. 3 Type Records: Medical Doctor/D.O. Records Other Doctor Records ______________________________________________________________________ C. 1 We have successfully processed the above file (no reel will be returned). ______________________________________________________________________ C. 2 We are unable to accept your UPIN Data Records. See below for information on reason for return. ______________________________________________________________________ Reason for return: ______________________________________________________________________ * Enter complete name and address of persons to whom all questions may be addressed. ______________________________________________________________________ Exhibit 44 (Rev. 10228; Issued: 07-27-20; Effective: 08-27-20; Implementation: 08-27-20) Standard Core Joint Operating Agreement Between RACs and UPICs Recovery Audit Contractors (RACs) Unified Program Integrity Contractors (UPICs) Revision History Log Version Date Changed By Description of Change Approval Required V01 V02 Table of Contents 1. Introduction 275 1.1. Purpose of this JOA........................................................................................ 275 1.2. Parties ................................................................................................................. 5 1.3. Jurisdictions, Contacts, Roles, and Responsibilities .......................................... 5 1.4. Confidentiality ................................................................................................ 275 1.5. Liability .......................................................................................................... 275 1.6. Funding............................................................................................................... 5 2. Document Maintenance 276 2.1. Standard Core JOA ......................................................................................... 276 2.2. JOA Appendices ............................................................................................. 276 2.3. Required Roles ............................................................................................... 276 2.4. Managing Change .......................................................................................... 277 2.5. Approval of Standard Core JOA .................................................................... 277 3. Communication 279 3.1. JOA Checkpoint Meetings ............................................................................. 279 3.2. Other Workgroup Meetings ........................................................................... 279 3.3. Issue Escalation and Resolution Process ........................................................ 279 3.4. Non-Compliance ............................................................................................ 280 3.5. Communication Regarding CMS Changes .................................................... 280 4. Securing Email Information 281 5. Identification and Action on Fraudulent Behavior 282 5.1. Identification and Notification of Fraud by the RAC ..................................... 282 5.2. Coordination with Law Enforcement ............................................................. 282 5.3. High Risk Areas ............................................................................................. 282 6. Training 283 6.1. Training provided by the UPIC ...................................................................... 283 1. Introduction 1.1. Purpose of this JOA This Joint Operating Agreement (JOA) is designed to promote cooperation between Recovery Audit Contractors (RACs) and the Unified Program Integrity Contractor (UPIC) by establishing and maintaining shared expectations for the interaction among these Parties to the JOA. 1.2. Parties Parties to the JOA are identified in Appendix Z. Please see Section 2.5 below in this JOA for information regarding completion of this appendix. 1.3. Jurisdictions, Contacts, Roles, and Responsibilities This information is provided in Appendices B and C. Section 2.2 below in this JOA describes the process for completion of these appendices. Please note that there are multiple tabs in these Microsoft (MS) Excel Workbook appendix files to facilitate use of this information. 1.4. Confidentiality Given the nature of the work performed by the RAC and the UPIC, information contained within this JOA is to be shared only with members of the RAC, UPIC, and CMS teams. 1.5. Liability Although both the RAC and UPIC each individually have a contractual relationship with CMS, there is no privity of contract between the RAC and the UPIC. Each contractor will be indemnified and protected by limitations on liability according to the terms of its respective contract with CMS. In light of the provisions of each contractors current contracts with CMS and the constraints of law, no amendments to their respective contracts are made through this JOA with respect to indemnification or limitations on liability. 1.6. Funding Nothing in this JOA will obligate any parties to perform any tasks that add significant cost and are outside current scope of work unless adequate funding for these tasks is received from CMS. 2. Document Maintenance 2.1. Standard Core JOA The Standard Core JOA is established and maintained by CMS to apply standardized best practices for the interaction between the RAC and UPIC contractors. This Standard Core JOA is purposely designed so that it does not need to reflect contractor specific information, which is instead contained in the JOA Appendix Documents. This JOA should not be modified from the standard without consulting with the TO COTRs. 2.2. JOA Appendices List of Appendices – Appendix A lists all JOA appendices, identifies the name of the team responsible for collecting and incorporating updates, and briefly describes how each appendix is to be created and maintained. Distributed Update Responsibilities – Appendix documents are separated to facilitate maintenance. The Contact List, for example, is divided into separate files by team so that each team can make and distribute updates to their list without having to coordinate input from other teams. If a contractor holds multiple contracts with CMS and if this contractor wants a separate Contact List for each contract to facilitate updates by different teams, this is allowed. The multiple tabs within each Contact List Excel Workbook facilitate differentiation between multiple task orders on a single contract. Use Across Multiple JOAs – The templates for these appendix documents, such as the Contact List templates, have been formatted so that they can be applied to multiple JOAs, eliminating the need to maintain similar/duplicate information across multiple JOAs. Document Owner – The name of the individual person on each team who will update each appendix will be identified by that team at the top of each of their appendix documents. This facilitates identification of the person to whom updates should be sent. Templates – CMS provides a standard template for each appendix which can be amended by each party if necessary to effectively convey the information for their team. To promote consistency, please apply the standard template to the greatest degree practical. 2.3. Required Roles To promote proper direction of communication, each RAC and UPIC will identify, in its Contact List, a Primary and an Alternate for each of the following Required Roles: • JOA POC – Joint Operating Agreement Point of Contact – This individual is responsible for serving as the lead contractor point of contact in establishing and maintaining the JOA content and in leading the resolution of any JOA-related issues that may arise. • JOA Approver – One individual from the RAC and one individual from the UPIC will be identified to approve the JOA. • Operational Lead – This individual is responsible for serving as the lead point of contact in performing ongoing operational work under the terms of the JOA. This standard title is used in the JOA because various teams use different titles for the individuals that they have serving in this role, and the JOA can not effectively incorporate all of those titles. Each party will identify their Operational Lead in their Contact List, and they are welcome to add in the Contact List any other appropriate titles for this individual as well. 2.4. Managing Change Change Suggestions – Recommendations for updates to JOA documents are encouraged and are to be sent to the Document Owner. Revision History – Each Document Owner is to identify changes to JOA documents in the Revision History Log. Version Number – The version number is used to make sure that everyone is looking at the same version of a document. The Document Owner is to increment the JOA version number each time the JOA is sent out for approval. Multiple updates can be consolidated into the same version number. The version number is imbedded as the last characters (ex: V01) of each file name. Process Note: In MS Excel, updates to the version number in the file name are automatically propagated to the top of each printed Excel document. In MS Word, select “File, Print Preview” when the version number in the file name is updated to cause the updated version number to be propagated from the file name to the top of the document. 2.5. Approval of Standard Core JOA CMS Approval of All Versions of the JOA • CMS will solicit input, make updates, distribute, and refine this Standard Core JOA as necessary. Through this cycle of change, CMS will have reviewed and approved all updates. RAC and UPIC Approval of the First JOA • CMS directs that all Parties to the JOA (the RAC and UPIC) are to sign (using hand written signature) the first jointly approved version of the JOA. • To accomplish this, the JOA Approvers are to hand-write their signature on two copies of Appendix Z, the JOA Approval Form, which they are then to mail (one copy each) to the primary RAC JOA POC and UPIC TO COTR who are responsible for their retention and for providing a copy of these upon request. • To facilitate communication of status, the JOA Approvers are also to send out an email to these individuals indicating that they have approved the JOA. RAC and UPIC Approval of Ongoing Updates • As CMS makes subsequent updates to the Standard Core JOA, CMS will advise contractors via Email if the new version is sufficiently changed to require approval. CMS will also update the last column of the Revision History table of the JOA to keep a record of which versions require approval. • A hand written signature is not required for ongoing updates. Instead, an electronic signature (an electronic copy of the approver’s signature) is to be used as the signature. • To provide approval for ongoing updates, the JOA Approver is to fill out Appendix Z, paste in their electronic signature, and then send this completed document via email to the Primary and Alternate JOA POC for the RAC and UPIC TO COTR. The Primary JOA POCs and TO COTRs are responsible for retaining these emails and for providing a copy of these upon request. No Approval Required on Appendix Updates – No approval is required on updates to the appendices. Timing of Approvals – Parties are to provide approval within 10 business days of receipt of an updated Standard Core JOA. If parties have an issue with the JOA, they are to raise this issue within 10 business days. If no issues are identified before the end of this period, the JOA updates will be considered approved. Distribution – Each JOA POC will disseminate information regarding the update within their organization. 3. Communication Communication is a crucial component that will occur at multiple levels using multiple tools and techniques as described below. 3.1. JOA Checkpoint Meetings Purpose – These meetings provide a forum for communication on topics of mutual interest among the Parties to the JOA. Topics will include a discussion of any issues with coordination among the parties the status of any changes to the JOA documents. Location – These meetings will most often take place via conference call. In those instances where a RAC and a UPIC are located close enough to allow a short drive, some participants may join in- person. Frequency – The meetings will occur at minimum on a quarterly basis for the first year after the signing of the first JOA and then at least semi-annually thereafter. Meeting Dates – CMS representatives need to attend multiple of these meetings across contractors, so CMS will work with contractors to coordinate spreading of these meetings over time. At the conclusion of each meeting, the participants will determine mutually agreeable timing (and location where appropriate) for the next meeting; information that will then be confirmed via email. Changes will be communicated through the JOA POC via email. Facilitation – Responsibility for facilitating the meeting will rotate between the RAC and the UPIC. This will include preparation of the agenda, providing a dial in number, facilitating the discussion, and capturing and distributing meeting minutes. Meeting Minutes – Are to be distributed within five business days of the meeting and should clearly identify Action Items for review in the next meeting. Participation – Invitees are to minimally include the applicable CMS COTRs and the Primary and Alternate JOA POC. The JOA POC will invite other participants as appropriate. 3.2. Other Workgroup Meetings Purpose – In addition to the JOA Checkpoint meetings, the Parties to the JOA will interact on a regular basis in smaller workgroups to address specific needs. Location, Timing, and Facilitation –Will be similar to the Checkpoint Meetings. Formation – Recommendations for new workgroups should be considered at the JOA Checkpoint Meetings. 3.3. Issue Escalation and Resolution Process Issues will be escalated if necessary for resolution via the following process: 1. Source – The RAC and the UPIC individuals identifying the issue will work with their counter-parts first to attempt to resolve the issue. 2. JOA POCs – If they are unable to come to a resolution, the matter will be brought to the attention of the RAC Contractor JOA POC and the UPIC JOA POC (identified in the Contractor Contact List Appendices). 3. Operational Leads – If they are unable to come to a resolution, the matter will be escalated to the RAC Operational Lead and the UPIC Operational Lead (identified in the Contractor Contact List Appendices). 4. CMS Contract Officer Technical Representatives (COTRs) – If they are unable to come to a resolution, the Operational Leads will bring the matter to the attention of the CMS COTRs (identified in the CMS Contact List Appendices). 5. JOA Alternative Dispute Resolution (ADR) Team – In the event the dispute between the RAC and the UPIC cannot be resolved, the issues will be directed in writing to the CMS RAC and UPIC Contracting Officers, Project Officers, and COTRs for resolution by the JOA ADR) team. The ADR team will issue a written determination to both the RAC and the UPIC. Timing of Issue Escalation and Resolution – The speed with which issues are escalated and resolved will be dependent on the priority of the issue, with higher impact issues receiving quicker attention by all parties. As a general guideline, parties should endeavor to resolve or escalate an issue within 1-3 days of its receipt, or they should reply to all parties to advise them of the reasons for additional time needed for action. 3.4. Non-Compliance If a party does not comply with a provision of the JOA, notification and resolution will take place as follows: 1. Notification – If a party does not comply with a provision of the JOA, the Operational Lead for that party will notify the Operational lead for the other party. 2. Resolution – A non-compliance is often one-time event with no significant impact which can often be quickly resolved and prevented in the future through the interaction of the Operational Leads. In these circumstances, escalation is not required. 3. Escalation – If a non-compliance creates an impact that either party feels requires escalation either for notification purposes or for issue resolution purposes, then the Operational Leads will notify the CMS COTRs. If necessary, the ADR process described above will be applied to achieve closure. 3.5. Communication Regarding CMS Changes As part of ongoing operations, the RAC and the UPIC Contractor staff will both review documents received from CMS, including Transmittals, Program Memoranda, Change Requests and Notes. The RAC and the UPIC Contractor will continue to determine their own operational impact and will provide comments and escalate issues to CMS independently, as appropriate. All issues that are determined to have an impact on any RAC or UPIC Contractor operations included in this JOA will be submitted to the RAC and UPIC JOA POCs for discussion at the next JOA Checkpoint Meeting, or sooner if appropriate. 3.6. Securing Email Information CMS has indicated that it is not appropriate to send emails containing beneficiary or provider identifiers (including names and numbers) even if those identifiers are contained within a password- protected attachment. Each JOA Participant is responsible for obtaining, understanding, interpreting, and implementing its own policies and procedures regarding use of email containing beneficiary or provider identifiers. CMS Secure Email may be used to send protected information to CMS and other users of this email system. If Secure Email is not available, send this information via an encrypted CD through registered mail. 4. Identification and Action on Fraudulent Behavior 4.1. Identification and Notification of Fraud by the RAC RAC Responsibility – When the RAC encounters an issue that meets the criteria of potential fraud, the RAC will notify the RAC PO who will forward this to the Director of the Division of Benefit Integrity Management Operations. Indicators of Fraud – The following are indicators of fraud that must be reported to the RAC PO. The RAC should use their best judgment to determine if other findings may constitute fraudulent behavior. Section 6.2 of this Standard Core JOA provides information regarding training for the RAC staff to identify fraud. • Submission of false claims • Services being rendered by unlicensed individuals • Ordered services being provided without a legitimate physician order • Claims for beneficiaries or providers that are deceased • Non-compliance with medical record requests 4.2. Coordination with Law Enforcement The UPIC will interact with Law Enforcement related to potential fraudulent activity. The RAC must not contact Law Enforcement with fraud suspicions; they must contact the RAC PO. Law enforcement may contact the RAC with recovery inquiries but any other LE RFIs shall be referred by the RAC directly to the UPIC. 4.3. High Risk Areas CMS may identify High Risk areas within a UPIC jurisdiction. These are areas that are known to have wide-spread fraud. The UPICs are required to take aggressive, rapid and innovative measures to curtail fraud in these areas and this may impact the RAC’s ability to perform audits in these areas. The UPIC will have the ability, in High Risk Areas, to suppress providers in order to protect the UPIC and Law Enforcement’s ability to identify, prevent and prosecute fraudulent activities. 5. Training 5.1. Training provided by the UPIC Purpose – Fraud detection and awareness training will be provided to assist the RAC in identifying fraudulent behavior, including indicators that RAC staff should look for and examples of real fraud scenarios. Audience – This training is designed for members of the RAC team. Initial and Annual Training – The UPIC will provide this training at the start of working together as contractors and on at least an annual basis thereafter. New Employee Training – The RAC will be responsible to provide this on-going training for new RAC employees throughout the year using the materials provided by the UPIC. Participation Requirement – Training participation is required to at least one session per year to be provided by the UPIC. UPICs can rotate the responsibility for training and must avoid duplication across contracts. Training on Changes – Additional training will be provided by the UPIC when substantive changes are identified in fraud detection and awareness. Exhibit 44.1 (Rev. 902, Issued: 09-27-19, Effective: 10-28-19, Implementation: 10-28-19) Revision History Version Date Changed By Description of Change Signature Required Joint Operating Agreement Between XXX In its capacity as the Supplemental Medical Review Contractor (SMRC) And XXX In its capacity as the Unified Program Integrity Contractor XXX Prepared by: XXX Table of Contents Revision History .......................................................................................................................... 247 Table of Contents ........................................................................................................................ 249 1. Introduction ............................................................................................................................. 251 1.1 Purpose of the Supplemental Medical Review Contractor ............................................... 251 1.2 Purpose of the SMRC Joint Operating Agreement ........................................................... 251 1.3 Scope ................................................................................................................................. 251 1.4 Joint Operating Agreement Participants and Roles........................................................... 251 1.4.1 Supplemental Medical Review Contractor’s Role ..................................................... 252 1.4.2 Unified Program Integrity Contractor’s Role............................................................. 252 1.4.3 Centers for Medicare & Medicaid Services’ Role ..................................................... 253 1.5 Liability ............................................................................................................................. 253 1.6 Mutual Confidentiality ...................................................................................................... 253 1.7 Independent Contractors ................................................................................................... 254 1.8 Privacy ............................................................................................................................... 254 1.9 Funding.............................................................................................................................. 254 2. Communication ....................................................................................................................... 254 2.1 Contact Information .......................................................................................................... 254 2.2 Point of Contact Roles....................................................................................................... 254 2.3 Joint Operating Agreement Meetings ................................. Error! Bookmark not defined. 2.4 Workgroup Meetings........................................................... Error! Bookmark not defined. 2.5 Maintenance of the JOA .................................................................................................... 256 2.6 Dispute Resolution Process ............................................................................................... 256 2.7 Mailing Information .......................................................................................................... 257 3. Systems.................................................................................................................................... 257 3.1 Data Files........................................................................................................................... 257 3.2 Security.............................................................................................................................. 257 4. Processes ................................................................................................................................. 257 4.1 Misdirected Communications ........................................................................................... 257 4.2 Ad Hoc Reports ................................................................................................................. 258 4.3 Fraud Referral ................................................................................................................... 258 4.4 Process Improvement ........................................................................................................ 258 Appendix A. Master Contact List ............................................................................................... 259 Table A-1. Supplemental Medical Review Contractor ............. Error! Bookmark not defined. Table A-2. Unified Program Integrity Contractor xxx ............................................................ 259 Table A-3. Centers for Medicare & Medicaid Services .......................................................... 259 Appendix B. JOA Approval Signature Form .............................................................................. 259 1. Introduction