Exhibit 3

110.3 – Exhibit 3 (Rev. 45, 05-28-04) Medicare Program - Intermediary Part A and Part B Appeals Report - Form CMS-2591, Screen 3 INTERMEDIARY APPEALS REPORT INTERMEDIARY ID REPORTING PERIOD A. INTERMEDIARY APPEAL REQUESTS REVIEWS PART B APPEALS Reviews Hearings (1) HEARINGS (2) PROCESSING TIMES PROCESSING TIMES 25. AVERAGE 35. AVERAGE 26. NO. 1-30 DAYS 36. NO. 1-60 DAYS 27. NO. 31-45 DAYS 37. NO. 61-90 DAYS 28. NO. 46-60 DAYS 38. NO. 91-120 DAYS 29. NO. OVER 60 DAYS 39. NO. OVER 120 DAYS PENDING TIMES PENDING TIMES 30. CLOSING PENDING 40. AVERAGE 31. NO. 1-30 DAYS 41. NO. 1-60 DAYS 32. NO. 31-45 DAYS 42. NO. 61-90 DAYS 33. NO. 46-60 DAYS 43. NO. 91-120 DAYS 34. NO. OVER 60 DAYS 44. NO. OVER 120 DAYS B. PART B OTR All All HEARING RESULTS With No Subsequent (1) Telephone Hearings (2) In-Person Hearings (3) Number In 120 Days (4) 45. REVERSALS 46. AFFIRMATIONS 47. TOTAL DECISIONS 48. NBR IN 120 DAYS 49. NO PREV. OTR HELD 50. PREV. OTR COUNTED 51. PREV. OTR NOT CNTD Form CMS-2591 Screen 3