Body of Report

60.4 - Body of Report (Rev.12894; 10-17-24; Effective:11-01-24; Implementation:11-01-24) A3-3897.4 Section A: Bills Processed by State of Provider - The intermediary reports in this section the claims workload for each State for which you service one or more providers. Break out by State the number of initial bills (including demand and no-pay bills) reported as processed on line 12 of Form D (see §20.4) over the 3 months of the reporting quarter. NOTE: Categorize the information reported by the State of the individual provider, not the home office, if it is part of a chain organization. Line 1 - All - For each column 1 through 6, the system will sum the number of claims reported on the individual State lines completed below. The numbers so calculated by the system must equal the sum of the numbers reported on line 12 of Form D for the 3 months of the reporting quarter. State Lines - In the column just left of column (1), the intermediary reports the two-digit postal abbreviation of each State (or FO for foreign claims) which includes at least one provider for which you processed claims during the quarter. It reports opposite each listed State the number of initial bills processed during the reporting quarter for providers located in the State. It reports the data in total in column 1, and by type of bill in columns 2 through 6.