Exhibit 4 - Status of Accounts Receivable - SMI - (Rev. 5, 08-30-

400.4 - Exhibit 4 - Status of Accounts Receivable - SMI - (Rev. 5, 08-30- 02) This exhibit is the same as Exhibit 3, with the following exceptions: • Section B, items 5d through 5g and Section D, items 5d and 5e refer to the POR for the HI report and refer to the POR/PSOR for the SMI report. • Only intermediaries enter POR data on both the HI report and the SMI report. • Only carriers enter the PSOR data on the SMI report. • Form CMS-H751A is the CMS Form Number for the HI (Part A) report. • Form CMS-H751B is the CMS Form Number for the SMI (Part B) report.