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Date(s) of Service Member Name Type Submitted Charges Claim Submission

10/26/2010 KAVYA MEDICAL $11.92 AUTO


10/5/2010 APARNA PHARMACY $5.00 AUTO
9/24/2010 HANMANTH MEDICAL $8.54 AUTO
09/05/10to09/24/10 KAVYA MEDICAL $48.09 PAPER
09/04/10to09/05/10 KAVYA MEDICAL $208.40 AUTO
08/26/10to09/04/10 APARNA MEDICAL $640.28 PAPER
06/10/10to08/19/10 APARNA MEDICAL $587.88 PAPER
04/16/10to09/24/10 HANMANTH MEDICAL $575.99 PAPER
4/14/2010 CHAITRA MEDICAL $107.26 PAPER
02/18/10to06/02/10 APARNA MEDICAL $262.21 PAPER
02/18/10to08/29/10 APARNA MEDICAL $355.51 PAPER
2/18/2010 APARNA MEDICAL $312.00 AUTO
2/18/2010 APARNA MEDICAL $42.37 AUTO
2/18/2010 APARNA MEDICAL $130.60 AUTO
2/2/2010 APARNA PHARMACY $9.31 AUTO
2/1/2010 APARNA MEDICAL $59.59 AUTO
1/22/2010 APARNA MEDICAL $6.46 AUTO
1/22/2010 APARNA MEDICAL $19.37 AUTO
1/22/2010 APARNA MEDICAL $121.83 AUTO
1/22/2010 APARNA MEDICAL $38.40 AUTO
1/22/2010 APARNA MEDICAL $70.40 AUTO
1/22/2010 APARNA MEDICAL $187.12 AUTO
1/15/2010 CHAITRA MEDICAL $110.66 AUTO
1/15/2010 CHAITRA MEDICAL $22.26 AUTO
1/15/2010 CHAITRA MEDICAL $58.08 AUTO
1/12/2010 APARNA PHARMACY $14.97 AUTO
1/7/2010 APARNA MEDICAL $59.59 AUTO
1/7/2010 APARNA MEDICAL $15.00 AUTO
Amount Waiting Payment
Paid Amount
$0.00 $11.92
$0.00 $5.00
$0.00 $8.54
$48.09 $0.00
$0.00 $208.40
$640.28 $0.00
$587.88 $0.00
$575.99 $0.00
$107.26 $0.00
$262.21 $0.00
$355.51 $0.00
$0.00 $178.79
$0.00 $24.37
$0.00 $130.60
$0.00 $9.31
$0.00 $59.59
$0.00 $6.46
$0.00 $19.37
$0.00 $121.83
$0.00 $0.00
$0.00 $0.00
$0.00 $169.12
$0.00 $110.66
$0.00 $22.26
$0.00 $58.08
$0.00 $14.97
$0.00 $59.59
$0.00 $15.00

-4000
$2,577.22 $1,233.86 ###
-188.92