Exhibits - (Rev. 5, 08-30-02)

400 - Exhibits - (Rev. 5, 08-30-02) A1-1960, B1-4960 Exhibit 1 CMS-750A Contractor Financial Reports, Hospital Insurance (HI) Statement of Financial Position/Statement of Operations Exhibit 2 CMS-750B Contractor Financial Reports, Supplementary Medical Insurance (SMI) Statement of Financial Position/Statement of Operations Exhibit 3 CMS-751A Status of Accounts Receivable, Hospital Insurance (HI) Exhibit 4 CMS-751B Status of Accounts Receivable, Supplementary Medical Insurance (SMI) Exhibit 5 Form CMS-C751A Status of Non-MSP Currently Not Collectible (CNC) Accounts Receivable, Hospital Insurance (HI) Exhibit 6 Form CMS-C751B Status of Non-MSP Currently Not Collectible (CNC) Accounts Receivable, Supplementary Medical Insurance (SMI) Exhibit 7 Form CMS-M751A Status of Medicare Secondary Payer (MSP) Accounts Receivable, Hospital Insurance (HI) Exhibit 8 Form CMS-M751B Status of Medicare Secondary Payer (MSP) Accounts Receivable, Supplementary Medical Insurance (SMI) Exhibit 9 Form CMS-MC751A Status of MSP Currently Not Collectible (CNC) Accounts Receivable, Hospital Insurance (HI) Exhibit 10 Form CMS-MC751B Status of MSP Currently Not Collectible (CNC) Accounts Receivable, Supplementary Medical Insurance (SMI) Exhibit 11 Medicare Contractor Account Definitions, Data Element Definitions Exhibit 12 Accounts Payable, Protocol for Estimating Claims Exhibit 13 Periodic Interim (PIP) Payments Protocol for Estimating Payables/Receivables on the CMS-750A/B, Statement of Financial Position Exhibit 14 Protocol for Estimating Allowance for Uncollectible Accounts Exhibit 15 Protocol for Prorating Intermediary Time Account Balances Between the CMS 750A (HI) and the CMS 750B (SMI) Exhibit 16 Electronic Certification Exhibit 17 Transfer of Debt Between Reporting Entities Exhibit 18 Collection Reconciliation/Acknowledgement Form Exhibit 19 Procedures for Non-MSP Reclassification as Currently Not Collectible (CNC) Exhibit 20 Procedures for MSP Reclassification as Currently Not Collectible (CNC) Exhibit 21 CMS Policy for Recognizing Accounts Receivable