Forest_Service_Detailed_Loss_Report(2).xlsx
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Attachment Forest Service Detailed Loss Report(2).xlsx
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| AIU Client Code | TPA Claim No | Claimant Name | TPA Check Number | Check Date | Date of Birth | State Code | Check Amount | Benfit Code | Date of Loss | Date Reported | Policy Desc | Effective Date | Termination Date | Diagnosis | Total Charges | Deductible Taken | Discount | Denied Amount | Denied Reason Code | Currency |
| GLB 9111697 | 20901849300 | 27974 | 20091117 | MD | 80.17 | DVM | 20090902 | 20091103 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 959.7 | 220.00 | 0.00 | 139.83 | 0.00 | 0.00 | 0.00 | ||
| GLB 9111697 | 20901849500 | 28513 | 20091211 | MD | 1037.00 | DVM | 20090910 | 20090918 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 728.71 | 127.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | ||
| GLB 9111697 | 20901849500 | 20091211 | MD | 0.00 | XRY | 20090910 | 20090918 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 728.71 | 70.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | |||
| GLB 9111697 | 20901849500 | 20091211 | MD | 0.00 | XRY | 20090910 | 20090918 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 728.71 | 150.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | |||
| GLB 9111697 | 20901849500 | 20091211 | MD | 0.00 | DME | 20090910 | 20090918 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 728.71 | 280.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | |||
| GLB 9111697 | 20901849500 | 20091211 | MD | 0.00 | DME | 20090910 | 20090918 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 728.71 | 280.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | |||
| GLB 9111697 | 20901849500 | 20091211 | MD | 0.00 | DME | 20090910 | 20090918 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 728.71 | 130.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | |||
| GLB 9111697 | 20901967200 | 27786 | 20091110 | MD | 74.00 | DVM | 20091001 | 20091013 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 728.71 | 74.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | ||
| GLB 9111697 | 20901992500 | 20100105 | MD | 0.00 | DRU | 20090902 | 20091013 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 729.5 | 5.00 | 0.00 | 0.00 | 5.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 20901992500 | 20100105 | MD | 0.00 | DRU | 20090911 | 20091013 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 729.5 | 194.99 | 0.00 | 0.00 | 194.99 | 31.00 | 0.00 | |||
| GLB 9111697 | 20901992500 | 20100105 | MD | 0.00 | DRU | 20090911 | 20091013 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 729.5 | 75.99 | 0.00 | 0.00 | 75.99 | 31.00 | 0.00 | |||
| GLB 9111697 | 20902219000 | 28197 | 20091124 | MD | 74.00 | DVM | 20091103 | 20091124 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 728.71 | 74.00 | 0.00 | 0.00 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 20902620500 | 30010 | 20100202 | MD | 74.00 | DVM | 20091117 | 20100112 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 728.71 | 74.00 | 0.00 | 0.00 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 20902650900 | 29718 | 20100122 | MD | 275.98 | DRU | 20090902 | 20100119 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 729.5 | 5.00 | 0.00 | 0.00 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 20902650900 | 20100122 | MD | 0.00 | DRU | 20090911 | 20100119 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 729.5 | 194.99 | 0.00 | 0.00 | 0.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 20902650900 | 20100122 | MD | 0.00 | DRU | 20090911 | 20100119 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 729.5 | 75.99 | 0.00 | 0.00 | 0.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 20902796000 | 32552 | 20100409 | NV | 176.78 | DVM | 20091106 | 20091209 | FOREST SERVICE INT'L PROGRAMS | 20081025 | 20091124 | 599.0 | 158.00 | 0.00 | 0.00 | 30.95 | 2.00 | 0.00 | ||
| GLB 9111697 | 20902796000 | 20100409 | NV | 0.00 | LAB | 20091106 | 20091209 | FOREST SERVICE INT'L PROGRAMS | 20081025 | 20091124 | 599.0 | 26.00 | 0.00 | 0.00 | 1.27 | 2.00 | 0.00 | |||
| GLB 9111697 | 20902796000 | 20100409 | NV | 0.00 | PRO | 20091106 | 20091209 | FOREST SERVICE INT'L PROGRAMS | 20081025 | 20091124 | 599.0 | 25.00 | 0.00 | 0.00 | 0.00 | 2.00 | 0.00 | |||
| GLB 9111697 | 21000477600 | 20100514 | WA | 0.00 | NCV | 20100327 | 20100414 | FOREST SERVICE INT'L PROGRAMS | 20100121 | 20100620 | V70.0 | 399.00 | 0.00 | 0.00 | 399.00 | 3.00 | 0.00 | |||
| GLB 9111697 | 21000477700 | 34361 | 20100602 | WA | 123.18 | DVM | 20100326 | 20100525 | FOREST SERVICE INT'L PROGRAMS | 20100121 | 20100620 | 724.2 | 234.00 | 0.00 | 110.82 | 0.00 | 3.00 | 0.00 | ||
| GLB 9111697 | 21000517000 | 20100622 | DC | 0.00 | XRP | 20100420 | 20100618 | FOREST SERVICE INT'L PROGRAMS | 20100409 | 20100509 | 719.47 | 29.00 | 0.00 | 0.00 | 29.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21000522000 | 20100618 | DC | 0.00 | ERA | 20100420 | 20100618 | FOREST SERVICE INT'L PROGRAMS | 20100409 | 20100509 | 845.00 | 713.00 | 0.00 | 0.00 | 713.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21000522100 | 20100622 | DC | 0.00 | ERP | 20100420 | 20100618 | FOREST SERVICE INT'L PROGRAMS | 20100409 | 20100509 | 845.00 | 85.00 | 0.00 | 0.00 | 85.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21000523300 | 33673 | 20100514 | DC | 172.58 | DVM | 20100427 | 20100504 | FOREST SERVICE INT'L PROGRAMS | 20100409 | 20100509 | 372.51 | 123.10 | 0.00 | 0.00 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 21000523300 | 20100514 | DC | 0.00 | PRO | 20100427 | 20100504 | FOREST SERVICE INT'L PROGRAMS | 20100409 | 20100509 | 372.51 | 49.48 | 0.00 | 0.00 | 0.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21000523301 | 33673 | 20100728 | DC | -172.58 | DVM | 20100427 | 20100504 | FOREST SERVICE INT'L PROGRAMS | 20100409 | 20100509 | 372.51 | 123.10 | 0.00 | 0.00 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 21000523301 | 20100728 | DC | 0.00 | PRO | 20100427 | 20100504 | FOREST SERVICE INT'L PROGRAMS | 20100409 | 20100509 | 372.51 | 49.48 | 0.00 | 0.00 | 0.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21000581700 | 20100622 | DC | 0.00 | XRP | 20100428 | 20100618 | FOREST SERVICE INT'L PROGRAMS | 20100409 | 20100509 | 789.00 | 57.00 | 0.00 | 0.00 | 57.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21000585000 | 20100713 | DC | 0.00 | DVM | 20100429 | 20100713 | FOREST SERVICE INT'L PROGRAMS | 20100409 | 20100509 | 375.15 | 123.10 | 0.00 | 0.00 | 123.10 | 31.00 | 0.00 | |||
| GLB 9111697 | 21000585100 | 34073 | 20100525 | DC | 49.00 | DVM | 20100429 | 20100507 | FOREST SERVICE INT'L PROGRAMS | 20100409 | 20100509 | 372.51 | 49.00 | 0.00 | 0.00 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 21000656900 | 36443 | 20100806 | DC | 889.80 | LAB | 20100428 | 20100804 | FOREST SERVICE INT'L PROGRAMS | 20100409 | 20100509 | 789.00 | 653.77 | 0.00 | 66.97 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 21000656900 | 20100806 | DC | 0.00 | OPH | 20100428 | 20100804 | FOREST SERVICE INT'L PROGRAMS | 20100409 | 20100509 | 789.00 | 303.00 | 0.00 | 0.00 | 0.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21000679700 | 20100806 | DC | 0.00 | LAB | 20100427 | 20100804 | FOREST SERVICE INT'L PROGRAMS | 20100409 | 20100509 | 787.01 | 387.50 | 0.00 | 0.00 | 387.50 | 31.00 | 0.00 | |||
| GLB 9111697 | 21000708800 | 36778 | 20100817 | WA | 2463.00 | OPH | 20100402 | 20100816 | FOREST SERVICE INT'L PROGRAMS | 20100121 | 20100620 | 616.2 | 3228.85 | 0.00 | 765.85 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 21000708900 | 36444 | 20100806 | WA | 480.00 | ANE | 20100402 | 20100727 | FOREST SERVICE INT'L PROGRAMS | 20100121 | 20100620 | 616.2 | 480.00 | 0.00 | 0.00 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 21000709000 | 20100604 | WA | 0.00 | ANE | 20100402 | 20100419 | FOREST SERVICE INT'L PROGRAMS | 20100121 | 20100620 | 616.2 | 480.00 | 0.00 | 0.00 | 480.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21000709100 | 36444 | 20100806 | WA | 348.00 | DVM | 20100312 | 20100724 | FOREST SERVICE INT'L PROGRAMS | 20100121 | 20100620 | 616.2 | 348.00 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21000709200 | 20100618 | WA | 0.00 | SUR | 20100402 | 20100617 | FOREST SERVICE INT'L PROGRAMS | 20100121 | 20100620 | 616.2 | 422.00 | 0.00 | 0.00 | 422.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21000831700 | 20100806 | WA | 0.00 | DVM | 20100607 | 20100804 | FOREST SERVICE INT'L PROGRAMS | 20100121 | 20100620 | 402.10 | 448.00 | 0.00 | 0.00 | 448.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21000915500 | 38208 | 20101015 | WA | 399.00 | LAB | 20100327 | 20100630 | FOREST SERVICE INT'L PROGRAMS | 20100121 | 20100620 | 789.04 | 399.00 | 0.00 | 0.00 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 21000950100 | 20100709 | WA | 0.00 | NCV | 20100621 | 20100702 | FOREST SERVICE INT'L PROGRAMS | 20100121 | 20100620 | V72.31 | 227.00 | 0.00 | 0.00 | 227.00 | 12.00 | 0.00 | |||
| GLB 9111697 | 21000970900 | 35735 | 20100713 | 39.31 | REV | 20100601 | 20100709 | FOREST SERVICE INT'L PROGRAMS | 20090520 | 000.0 | 39.31 | 0.00 | 0.00 | 0.00 | 12.00 | 0.00 | ||||
| GLB 9111697 | 21001005000 | 20100720 | WA | 0.00 | LAB | 20100621 | 20100712 | FOREST SERVICE INT'L PROGRAMS | 20100121 | 20100620 | V72.31 | 67.00 | 0.00 | 0.00 | 67.00 | 12.00 | 0.00 | |||
| GLB 9111697 | 21001026500 | 20100720 | WA | 0.00 | LAB | 20100621 | 20100715 | FOREST SERVICE INT'L PROGRAMS | 20100121 | 20100620 | V72.31 | 302.00 | 0.00 | 0.00 | 302.00 | 12.00 | 0.00 | |||
| GLB 9111697 | 21001090200 | 36193 | 20100728 | DC | 172.58 | DVM | 20100427 | 20100723 | FOREST SERVICE INT'L PROGRAMS | 20100409 | 20100509 | 372.51 | 123.10 | 0.00 | 0.00 | 0.00 | 12.00 | 0.00 | ||
| GLB 9111697 | 21001090200 | 20100728 | DC | 0.00 | DRU | 20100427 | 20100723 | FOREST SERVICE INT'L PROGRAMS | 20100409 | 20100509 | 372.51 | 49.48 | 0.00 | 0.00 | 0.00 | 12.00 | 0.00 | |||
| GLB 9111697 | 21001165100 | 36446 | 20100806 | WA | 422.00 | SUR | 20100402 | 20100728 | FOREST SERVICE INT'L PROGRAMS | 20100121 | 20100620 | 616.2 | 422.00 | 0.00 | 0.00 | 0.00 | 12.00 | 0.00 | ||
| GLB 9111697 | 21001371400 | 37517 | 20100914 | WA | 273.00 | ERP | 20100812 | 20100913 | FOREST SERVICE INT'L PROGRAMS | 20100121 | 20100620 | 616.2 | 273.00 | 0.00 | 0.00 | 0.00 | 12.00 | 0.00 | ||
| GLB 9111697 | 21001392400 | 37637 | 20100917 | MD | 58.07 | DVM | 20100813 | 20100913 | FOREST SERVICE INT'L PROGRAMS | 20091001 | 20110930 | 782.1 | 150.00 | 0.00 | 91.93 | 0.00 | 12.00 | 0.00 | ||
| GLB 9111697 | 21001412200 | 37795 | 20100924 | WA | 961.11 | ERI | 20100812 | 20100922 | FOREST SERVICE INT'L PROGRAMS | 20100121 | 20100620 | 616.2 | 1201.39 | 0.00 | 240.28 | 0.00 | 12.00 | 0.00 | ||
| GLB 9111697 | 21001469200 | 37881 | 20100928 | WA | 419.29 | DVM | 20100812 | 20100927 | FOREST SERVICE INT'L PROGRAMS | 20100121 | 20100620 | 616.2 | 348.00 | 0.00 | 92.00 | 0.00 | 12.00 | 0.00 | ||
| GLB 9111697 | 21001469200 | 20100928 | WA | 0.00 | SUR | 20100812 | 20100927 | FOREST SERVICE INT'L PROGRAMS | 20100121 | 20100620 | 616.2 | 309.00 | 0.00 | 145.71 | 0.00 | 12.00 | 0.00 | |||
| GLB 9111697 | 21001469300 | 37956 | 20101001 | WA | 115.77 | DVM | 20100826 | 20100928 | FOREST SERVICE INT'L PROGRAMS | 20100121 | 20100620 | 616.2 | 269.00 | 0.00 | 153.23 | 0.00 | 12.00 | 0.00 | ||
| GLB 9111697 | 21001516100 | 37722 | 20100924 | 12.06 | REV | 20100801 | 20100922 | FOREST SERVICE INT'L PROGRAMS | 20090520 | 000.0 | 12.06 | 0.00 | 0.00 | 0.00 | 12.00 | 0.00 | ||||
| GLB 9111697 | 21001539300 | 37882 | 20100928 | WA | 480.00 | ANE | 20100402 | 20100927 | FOREST SERVICE INT'L PROGRAMS | 20100121 | 20100620 | 616.2 | 480.00 | 0.00 | 0.00 | 0.00 | 12.00 | 0.00 | ||
| GLB 9111697 | 21001588600 | 38209 | 20101015 | WA | 255.73 | DVM | 20100607 | 20101013 | FOREST SERVICE INT'L PROGRAMS | 20100121 | 20100620 | 402.10 | 448.00 | 0.00 | 192.27 | 0.00 | 12.00 | 0.00 | ||
| GLB 9111697 | 21001635700 | 20101012 | OR | 0.00 | DEL | 20100806 | 20100928 | FOREST SERVICE INT'L PROGRAMS | 20100315 | 20101114 | V06.5 | 25.00 | 0.00 | 0.00 | 25.00 | 34.00 | 0.00 | |||
| GLB 9111697 | 21001635700 | 20101012 | OR | 0.00 | NCV | 20100806 | 20100928 | FOREST SERVICE INT'L PROGRAMS | 20100315 | 20101114 | V06.5 | 13.00 | 0.00 | 0.00 | 13.00 | 3.00 | 0.00 | |||
| GLB 9111697 | 21001786400 | 38451 | 20101026 | MD | 30.85 | LAB | 20101001 | 20101022 | FOREST SERVICE INT'L PROGRAMS | 20091013 | 599.70 | 30.85 | 0.00 | 0.00 | 0.00 | 3.00 | 0.00 | |||
| GLB 9111697 | 21001786600 | 20101026 | OR | 0.00 | INJ | 20100806 | 20101026 | FOREST SERVICE INT'L PROGRAMS | 20100315 | 20101114 | V06.5 | 25.00 | 0.00 | 0.00 | 25.00 | 3.00 | 0.00 | |||
| GLB 9111697 | 21001786600 | 20101026 | OR | 0.00 | INJ | 20100806 | 20101026 | FOREST SERVICE INT'L PROGRAMS | 20100315 | 20101114 | V06.5 | 13.00 | 0.00 | 0.00 | 13.00 | 3.00 | 0.00 | |||
| GLB 9111697 | 21001807600 | 39231 | 20101206 | MD | 1372.10 | MSP | 20101013 | 20101130 | FOREST SERVICE INT'L PROGRAMS | 20091013 | 599.72 | 22.00 | 0.00 | 4.40 | 0.00 | 3.00 | 0.00 | |||
| GLB 9111697 | 21001807600 | 20101206 | MD | 0.00 | CAT | 20101013 | 20101130 | FOREST SERVICE INT'L PROGRAMS | 20091013 | 599.72 | 868.00 | 0.00 | 269.50 | 0.00 | 3.00 | 0.00 | ||||
| GLB 9111697 | 21001807600 | 20101206 | MD | 0.00 | CAT | 20101013 | 20101130 | FOREST SERVICE INT'L PROGRAMS | 20091013 | 599.72 | 812.00 | 0.00 | 56.00 | 0.00 | 3.00 | 0.00 | ||||
| GLB 9111697 | 21001816200 | 38577 | 20101102 | MD | 200.00 | DVM | 20101001 | 20101027 | FOREST SERVICE INT'L PROGRAMS | 20091013 | 782.1 | 200.00 | 0.00 | 0.00 | 0.00 | 3.00 | 0.00 | |||
| GLB 9111697 | 21001816300 | 39647 | 20101221 | MD | 85.00 | DVM | 20101009 | 20101027 | FOREST SERVICE INT'L PROGRAMS | 20091013 | 599.70 | 85.00 | 0.00 | 0.00 | 0.00 | 3.00 | 0.00 | |||
| GLB 9111697 | 21002084300 | 39284 | 20101214 | 16.55 | REV | 20100901 | 20101209 | FOREST SERVICE INT'L PROGRAMS | 20090520 | 000.0 | 16.55 | 0.00 | 0.00 | 0.00 | 3.00 | 0.00 | ||||
| GLB 9111697 | 21002299300 | 40384 | 20110125 | MD | 85.00 | DVM | 20101214 | 20110106 | FOREST SERVICE INT'L PROGRAMS | 20091013 | 599.0 | 85.00 | 0.00 | 0.00 | 0.00 | 3.00 | 0.00 | |||
| GLB 9111697 | 21002301000 | 40384 | 20110125 | MD | 85.00 | DVM | 20101020 | 20110106 | FOREST SERVICE INT'L PROGRAMS | 20091013 | 599.70 | 85.00 | 0.00 | 0.00 | 0.00 | 3.00 | 0.00 | |||
| GLB 9111697 | 21002301600 | 40384 | 20110125 | MD | 85.00 | DVM | 20101006 | 20110106 | FOREST SERVICE INT'L PROGRAMS | 20091013 | 599.70 | 85.00 | 0.00 | 0.00 | 0.00 | 3.00 | 0.00 | |||
| GLB 9111697 | 21002528400 | 20110301 | MD | 0.00 | DVM | 20101006 | 20110222 | FOREST SERVICE INT'L PROGRAMS | 20091013 | 599.70 | 85.00 | 0.00 | 0.00 | 85.00 | 16.00 | 0.00 | ||||
| GLB 9111697 | 21002528500 | 20110301 | MD | 0.00 | DVM | 20101020 | 20110222 | FOREST SERVICE INT'L PROGRAMS | 20091013 | 599.70 | 85.00 | 0.00 | 0.00 | 85.00 | 16.00 | 0.00 | ||||
| GLB 9111697 | 21002548600 | 41397 | 20110308 | MD | 4.63 | LAB | 20101208 | 20110307 | FOREST SERVICE INT'L PROGRAMS | 20091013 | 599.70 | 30.85 | 0.00 | 26.22 | 0.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21100541900 | 42463 | 20110426 | 4.72 | REV | 20110301 | 20110425 | FOREST SERVICE INT'L PROGRAMS | 20090520 | 000.0 | 4.72 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | ||||
| $ 11,721.68 |
2009 Benefit Code
| Benefit Code and Description | Total Paid |
| ANE - ANESTHESIA | 960.00 |
| CAT - CAT SCAN | 1354.50 |
| DEL - DELETED OR INVALID CODE | 0.00 |
| DME - DURABLE MEDICAL EQUIPMENT | 690.00 |
| DRU - MEDICATIONS | 325.46 |
| DVM - PHYSICIAN VISIT | 2425.07 |
| ERA - EMERGENCY ROOM ACCIDENT | 0.00 |
| ERI - EMERGENCY ROOM ILLNESS | 961.11 |
| ERP - EMERGENCY ROOM PHYSICIAN | 273.00 |
| INJ - INJECTIONS | 0.00 |
| LAB - LABORATORY CHARGES | 1046.01 |
| MNI- M/N INPATIENT | 0.00 |
| MNO- M/N OUTPATIENT | 0.00 |
| MSP - MEDICAL SUPPLIES | 17.60 |
| NCV - NOT COVERED UNDER YOUR PLAN | 0.00 |
| OPH - OUT PATIENT HOSPITAL | 2766.00 |
| PRO - PROCEDURE | 25.00 |
| PRX- PRE-EXISTING CONDITION | 0.00 |
| REV - RE-PRICING FEE | 72.64 |
| SUR - SURGERY | 585.29 |
| XRP - X-RAY PROFESSIONAL COMPONENT | 0.00 |
| XRY - X-RAY | 220.00 |
| Report Totals: | |
| 11721.68 |
| AIU Client Code | TPA Claim No | Claimant Name | TPA Check Number | Check Date | Date of Birth | State Code | Check Amount | Benfit Code | Date of Loss | Date Reported | Policy Desc | Effective Date | Termination Date | Diagnosis | Total Charges | Deductible Taken | Discount | Denied Amount | Denied Reason Code | Currency |
| GLB 9111697 | 21001786300 | 38861 | 20101117 | MD | 78.66 | LAB | 20101001 | 20101115 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 794.5 | 15.77 | 0.00 | 10.83 | 0.00 | 0.00 | 0.00 | ||
| GLB 9111697 | 21001786300 | 20101117 | MD | 0.00 | LAB | 20101001 | 20101115 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 794.5 | 126.39 | 0.00 | 113.23 | 0.00 | 0.00 | 0.00 | |||
| GLB 9111697 | 21001786300 | 20101117 | MD | 0.00 | LAB | 20101001 | 20101115 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 794.5 | 120.42 | 0.00 | 95.91 | 0.00 | 0.00 | 0.00 | |||
| GLB 9111697 | 21001786300 | 20101117 | MD | 0.00 | LAB | 20101001 | 20101115 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 794.5 | 175.00 | 0.00 | 150.29 | 0.00 | 0.00 | 0.00 | |||
| GLB 9111697 | 21001786300 | 20101117 | MD | 0.00 | LAB | 20101001 | 20101115 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 794.5 | 51.82 | 0.00 | 40.48 | 0.00 | 0.00 | 0.00 | |||
| GLB 9111697 | 21001816400 | 38577 | 20101102 | MD | 285.00 | DVM | 20101001 | 20101027 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 794.5 | 200.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | ||
| GLB 9111697 | 21001816400 | 20101102 | MD | 0.00 | DVM | 20101006 | 20101027 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 794.5 | 85.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | |||
| GLB 9111697 | 21001999300 | 39648 | 20101221 | MD | 45.08 | DVM | 20101111 | 20101217 | FOREST SERVICE INT'L PROGRAMS | 20091001 | 20110930 | 382.9 | 127.00 | 0.00 | 81.92 | 0.00 | 0.00 | 0.00 | ||
| GLB 9111697 | 21002414100 | 20110927 | MD | 0.00 | ERA | 20101229 | 20110922 | FOREST SERVICE INT'L PROGRAMS | 20091001 | 20110930 | 922.1 | 147.65 | 0.00 | 0.00 | 147.65 | 31.00 | 0.00 | |||
| GLB 9111697 | 21002439300 | 20110927 | MD | 0.00 | ERA | 20101223 | 20110922 | FOREST SERVICE INT'L PROGRAMS | 20091001 | 20110930 | V71.4 | 442.87 | 0.00 | 0.00 | 442.87 | 31.00 | 0.00 | |||
| GLB 9111697 | 21002455000 | 20110927 | MD | 0.00 | ERP | 20101223 | 20110922 | FOREST SERVICE INT'L PROGRAMS | 20091001 | 20110930 | 786.51 | 306.00 | 0.00 | 0.00 | 306.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21002455100 | 20110927 | MD | 0.00 | ERP | 20101229 | 20110922 | FOREST SERVICE INT'L PROGRAMS | 20091001 | 20110930 | 959.01 | 306.00 | 0.00 | 0.00 | 306.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21002455300 | 20110927 | MD | 0.00 | XRP | 20101223 | 20110922 | FOREST SERVICE INT'L PROGRAMS | 20091001 | 20110930 | 922.1 | 31.00 | 0.00 | 0.00 | 31.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21002455300 | 20110927 | MD | 0.00 | XRP | 20101223 | 20110922 | FOREST SERVICE INT'L PROGRAMS | 20091001 | 20110930 | 922.1 | 31.00 | 0.00 | 0.00 | 31.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21002455300 | 20110927 | MD | 0.00 | XRP | 20101223 | 20110922 | FOREST SERVICE INT'L PROGRAMS | 20091001 | 20110930 | 922.1 | 27.00 | 0.00 | 0.00 | 27.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21002455400 | 20110927 | MD | 0.00 | CAT | 20101229 | 20110922 | FOREST SERVICE INT'L PROGRAMS | 20091001 | 20110930 | V71.4 | 123.00 | 0.00 | 0.00 | 123.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21002502300 | 20110927 | MD | 0.00 | AMB | 20101223 | 20110922 | FOREST SERVICE INT'L PROGRAMS | 20091001 | 20110930 | 959.8 | 500.00 | 0.00 | 0.00 | 500.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21002502300 | 20110927 | MD | 0.00 | AMB | 20101223 | 20110922 | FOREST SERVICE INT'L PROGRAMS | 20091001 | 20110930 | 959.8 | 20.00 | 0.00 | 0.00 | 20.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21100334200 | 20110510 | OR | 0.00 | DVM | 20110314 | 20110427 | FOREST SERVICE INT'L PROGRAMS | 20110313 | 20110412 | 112.9 | 174.00 | 0.00 | 0.00 | 174.00 | 17.00 | 0.00 | |||
| GLB 9111697 | 21100336800 | 42679 | 20110503 | MD | 181.12 | DVM | 20110311 | 20110427 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 924.11 | 305.00 | 0.00 | 192.73 | 0.00 | 17.00 | 0.00 | ||
| GLB 9111697 | 21100336800 | 20110503 | MD | 0.00 | XRY | 20110311 | 20110427 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 924.11 | 121.00 | 0.00 | 52.15 | 0.00 | 17.00 | 0.00 | |||
| GLB 9111697 | 21100513600 | 43087 | 20110517 | MD | 916.65 | ERI | 20110407 | 20110516 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 455.3 | 925.91 | 0.00 | 9.26 | 0.00 | 17.00 | 0.00 | ||
| GLB 9111697 | 21100580400 | 42907 | 20110510 | MD | 210.00 | ERP | 20110407 | 20110426 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 455.6 | 210.00 | 0.00 | 0.00 | 0.00 | 17.00 | 0.00 | ||
| GLB 9111697 | 21100593300 | 42908 | 20110510 | LA | 71.00 | DVM | 20110415 | 20110427 | FOREST SERVICE INT'L PROGRAMS | 20101015 | 20111014 | 692.9 | 71.00 | 0.00 | 0.00 | 0.00 | 17.00 | 0.00 | ||
| GLB 9111697 | 21100595900 | 42909 | 20110510 | MD | 181.00 | DVM | 20110415 | 20110427 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 578.9 | 181.00 | 0.00 | 0.00 | 0.00 | 17.00 | 0.00 | ||
| GLB 9111697 | 21100641900 | 43228 | 20110524 | MD | 842.00 | LAB | 20110425 | 20110516 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 041.86 | 233.00 | 0.00 | 0.00 | 0.00 | 17.00 | 0.00 | ||
| GLB 9111697 | 21100641900 | 20110524 | MD | 0.00 | LAB | 20110425 | 20110516 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 041.86 | 233.00 | 0.00 | 0.00 | 0.00 | 17.00 | 0.00 | |||
| GLB 9111697 | 21100641900 | 20110524 | MD | 0.00 | LAB | 20110425 | 20110516 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 041.86 | 161.00 | 0.00 | 0.00 | 0.00 | 17.00 | 0.00 | |||
| GLB 9111697 | 21100641900 | 20110524 | MD | 0.00 | LAB | 20110425 | 20110516 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 041.86 | 215.00 | 0.00 | 0.00 | 0.00 | 17.00 | 0.00 | |||
| GLB 9111697 | 21100642000 | 43229 | 20110524 | MD | 400.00 | ANE | 20110425 | 20110516 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 578.9 | 400.00 | 0.00 | 0.00 | 0.00 | 17.00 | 0.00 | ||
| GLB 9111697 | 21100660500 | 45062 | 20110809 | MD | 1188.06 | SUR | 20110425 | 20110809 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 578.9 | 686.10 | 0.00 | 0.00 | 0.00 | 17.00 | 0.00 | ||
| GLB 9111697 | 21100660500 | 20110809 | MD | 0.00 | SUR | 20110425 | 20110809 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 578.9 | 547.38 | 0.00 | 0.00 | 45.42 | 2.00 | 0.00 | |||
| GLB 9111697 | 21100660600 | 45349 | 20110824 | MD | 542.30 | CAT | 20110407 | 20110816 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 592.0 | 638.00 | 0.00 | 95.70 | 0.00 | 2.00 | 0.00 | ||
| GLB 9111697 | 21100660800 | 20110510 | MD | 0.00 | CAT | 20110407 | 20110503 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 592.0 | 638.00 | 0.00 | 0.00 | 638.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21100660900 | 45350 | 20110824 | MD | 907.50 | SUR | 20110425 | 20110816 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 578.9 | 1295.00 | 0.00 | 841.25 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21100660900 | 20110824 | MD | 0.00 | SUR | 20110425 | 20110816 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 578.9 | 1295.00 | 0.00 | 841.25 | 0.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21100725300 | 44879 | 20110802 | MD | 119.00 | DVM | 20110509 | 20110708 | FOREST SERVICE INT'L PROGRAMS | 20090518 | 20110902 | 041.86 | 119.00 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21100761600 | 45063 | 20110809 | WI | 176.00 | DVM | 20110510 | 20110714 | FOREST SERVICE INT'L PROGRAMS | 20110406 | 20111230 | 959.3 | 154.00 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21100761600 | 20110809 | WI | 0.00 | MSP | 20110510 | 20110714 | FOREST SERVICE INT'L PROGRAMS | 20110406 | 20111230 | 959.3 | 8.00 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21100761600 | 20110809 | WI | 0.00 | DME | 20110510 | 20110714 | FOREST SERVICE INT'L PROGRAMS | 20110406 | 20111230 | 959.3 | 14.00 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21100761800 | 45063 | 20110809 | WI | 274.00 | XRY | 20110510 | 20110717 | FOREST SERVICE INT'L PROGRAMS | 20110406 | 20111230 | 959.3 | 137.00 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21100761800 | 20110809 | WI | 0.00 | XRY | 20110510 | 20110717 | FOREST SERVICE INT'L PROGRAMS | 20110406 | 20111230 | 959.3 | 137.00 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21100772200 | 43143 | 20110524 | 44.08 | REV | 20110401 | 20110524 | FOREST SERVICE INT'L PROGRAMS | 20100901 | 000.0 | 44.08 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | ||||
| GLB 9111697 | 21100806400 | 43368 | 20110531 | OR | 174.00 | DVM | 20110314 | 20110314 | FOREST SERVICE INT'L PROGRAMS | 20110313 | 20110412 | 112.9 | 174.00 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21100853600 | 43496 | 20110607 | MD | 220.00 | DVM | 20110523 | 20110603 | FOREST SERVICE INT'L PROGRAMS | 20110401 | 20110715 | 564.00 | 220.00 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21100935200 | 44025 | 20110628 | WI | 133.00 | DVM | 20110603 | 20110615 | FOREST SERVICE INT'L PROGRAMS | 20081205 | 20120327 | 466.0 | 133.00 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21101022700 | 44338 | 20110712 | MD | 321.00 | DVM | 20110617 | 20110628 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 565.0 | 321.00 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21101042900 | 45499 | 20110830 | MD | 98.35 | DVM | 20110615 | 20110824 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 717.7 | 349.62 | 0.00 | 251.27 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21101065300 | 44716 | 20110726 | MD | 45.00 | DRU | 20110622 | 20110628 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 565.0 | 45.00 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21101155800 | 20110809 | WI | 0.00 | XRY | 20110510 | 20110714 | FOREST SERVICE INT'L PROGRAMS | 20110406 | 20111230 | 959.3 | 137.00 | 0.00 | 137.00 | 0.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21101155800 | 20110809 | WI | 0.00 | XRY | 20110510 | 20110714 | FOREST SERVICE INT'L PROGRAMS | 20110406 | 20111230 | 959.3 | 137.00 | 0.00 | 137.00 | 0.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21101156000 | 20110809 | WI | 0.00 | DVM | 20110510 | 20110714 | FOREST SERVICE INT'L PROGRAMS | 20110406 | 20111230 | 959.3 | 154.00 | 0.00 | 154.00 | 0.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21101156000 | 20110809 | WI | 0.00 | MSP | 20110510 | 20110714 | FOREST SERVICE INT'L PROGRAMS | 20110406 | 20111230 | 959.3 | 8.00 | 0.00 | 8.00 | 0.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21101156000 | 20110809 | WI | 0.00 | DME | 20110510 | 20110714 | FOREST SERVICE INT'L PROGRAMS | 20110406 | 20111230 | 959.3 | 14.00 | 0.00 | 14.00 | 0.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21101304200 | 46297 | 20111018 | 226.00 | DVM | 20110725 | 20110922 | FOREST SERVICE INT'L PROGRAMS | 20110501 | 20110930 | 922.1 | 226.00 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21101434100 | 45351 | 20110824 | WI | 274.00 | XRY | 20110510 | 20110823 | FOREST SERVICE INT'L PROGRAMS | 20110406 | 20111230 | 959.3 | 137.00 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21101434100 | 20110824 | WI | 0.00 | XRY | 20110510 | 20110823 | FOREST SERVICE INT'L PROGRAMS | 20110406 | 20111230 | 959.3 | 137.00 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21101434101 | RF000124 | 20130409 | WI | -274.00 | XRY | 20110510 | 20110823 | FOREST SERVICE INT'L PROGRAMS | 20110406 | 20111230 | 959.3 | -137.00 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21101434101 | 20130409 | WI | 0.00 | XRY | 20110510 | 20110823 | FOREST SERVICE INT'L PROGRAMS | 20110406 | 20111230 | 959.3 | -137.00 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21101480500 | 20110920 | MD | 0.00 | DVM | 20110615 | 20110913 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 717.7 | 349.62 | 0.00 | 0.00 | 349.62 | 16.00 | 0.00 | |||
| GLB 9111697 | 21101654800 | 45954 | 20110927 | 45.23 | REV | 20110801 | 20110831 | FOREST SERVICE INT'L PROGRAMS | 20100901 | 000.0 | 45.23 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | ||||
| GLB 9111697 | 21101750600 | 20111011 | CA | 0.00 | NCV | 20110914 | 20110928 | FOREST SERVICE INT'L PROGRAMS | 20110901 | 20120301 | V20.2 | 27.00 | 0.00 | 0.00 | 27.00 | 12.00 | 0.00 | |||
| GLB 9111697 | 21101750600 | 20111011 | CA | 0.00 | RIM | 20110914 | 20110928 | FOREST SERVICE INT'L PROGRAMS | 20110901 | 20120301 | V20.2 | 34.85 | 0.00 | 0.00 | 34.85 | 13.00 | 0.00 | |||
| GLB 9111697 | 21101750600 | 20111011 | CA | 0.00 | RIM | 20110914 | 20110928 | FOREST SERVICE INT'L PROGRAMS | 20110901 | 20120301 | V20.2 | 52.35 | 0.00 | 0.00 | 52.35 | 13.00 | 0.00 | |||
| GLB 9111697 | 21101750600 | 20111011 | CA | 0.00 | RIM | 20110914 | 20110928 | FOREST SERVICE INT'L PROGRAMS | 20110901 | 20120301 | V20.2 | 82.08 | 0.00 | 0.00 | 82.08 | 13.00 | 0.00 | |||
| GLB 9111697 | 21101750600 | 20111011 | CA | 0.00 | RIM | 20110914 | 20110928 | FOREST SERVICE INT'L PROGRAMS | 20110901 | 20120301 | V20.2 | 39.24 | 0.00 | 0.00 | 39.24 | 13.00 | 0.00 | |||
| GLB 9111697 | 21101750600 | 20111011 | CA | 0.00 | RIM | 20110914 | 20110928 | FOREST SERVICE INT'L PROGRAMS | 20110901 | 20120301 | V20.2 | 138.16 | 0.00 | 0.00 | 138.16 | 13.00 | 0.00 | |||
| GLB 9111697 | 21101750600 | 20111011 | CA | 0.00 | PRO | 20110914 | 20110928 | FOREST SERVICE INT'L PROGRAMS | 20110901 | 20120301 | V20.2 | 48.00 | 0.00 | 0.00 | 48.00 | 12.00 | 0.00 | |||
| GLB 9111697 | 21101750600 | 20111011 | CA | 0.00 | PRO | 20110914 | 20110928 | FOREST SERVICE INT'L PROGRAMS | 20110901 | 20120301 | V20.2 | 23.60 | 0.00 | 0.00 | 23.60 | 12.00 | 0.00 | |||
| GLB 9111697 | 21101750601 | 20111011 | CA | 0.00 | REN | 20110914 | 20110928 | FOREST SERVICE INT'L PROGRAMS | 20110901 | 20120301 | V20.2 | 193.00 | 0.00 | 0.00 | 193.00 | 12.00 | 0.00 | |||
| GLB 9111697 | 21101881800 | 48672 | 20120207 | WI | 362.95 | ERP | 20110920 | 20120123 | FOREST SERVICE INT'L PROGRAMS | 20110901 | 20120930 | 789.00 | 427.00 | 0.00 | 64.05 | 0.00 | 12.00 | 0.00 | ||
| GLB 9111697 | 21101881900 | 48673 | 20120207 | WI | 2197.86 | ERI | 20110920 | 20120123 | FOREST SERVICE INT'L PROGRAMS | 20110901 | 20120930 | 787.03 | 2585.70 | 0.00 | 387.84 | 0.00 | 12.00 | 0.00 | ||
| GLB 9111697 | 21101882300 | 48018 | 20120110 | CA | 159.78 | LAB | 20111004 | 20111019 | FOREST SERVICE INT'L PROGRAMS | 20110713 | 20111230 | 244.9 | 13.85 | 0.00 | 3.05 | 0.00 | 12.00 | 0.00 | ||
| GLB 9111697 | 21101882300 | 20120110 | CA | 0.00 | DVM | 20111004 | 20111019 | FOREST SERVICE INT'L PROGRAMS | 20110713 | 20111230 | 244.9 | 191.00 | 0.00 | 42.02 | 0.00 | 12.00 | 0.00 | |||
| GLB 9111697 | 21101934800 | 48019 | 20120110 | CA | 73.32 | DVM | 20111011 | 20111026 | FOREST SERVICE INT'L PROGRAMS | 20110713 | 20111230 | 244.9 | 94.00 | 0.00 | 20.68 | 0.00 | 12.00 | 0.00 | ||
| GLB 9111697 | 21102027000 | 47189 | 20111123 | MD | 140.26 | XRY | 20111027 | 20111116 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | V22.2 | 255.00 | 0.00 | 114.74 | 0.00 | 12.00 | 0.00 | ||
| GLB 9111697 | 21102118000 | 48020 | 20120110 | CA | 390.27 | LAB | 20111004 | 20111118 | FOREST SERVICE INT'L PROGRAMS | 20110713 | 20111230 | 244.9 | 500.35 | 0.00 | 110.08 | 0.00 | 12.00 | 0.00 | ||
| GLB 9111697 | 21102220200 | 47487 | 20111213 | MD | 395.06 | LAB | 20111027 | 20111208 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | V22.1 | 78.78 | 0.00 | 48.79 | 0.00 | 12.00 | 0.00 | ||
| GLB 9111697 | 21102220200 | 20111213 | MD | 0.00 | LAB | 20111027 | 20111208 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | V22.1 | 65.55 | 0.00 | 49.43 | 0.00 | 12.00 | 0.00 | |||
| GLB 9111697 | 21102220200 | 20111213 | MD | 0.00 | LAB | 20111027 | 20111208 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | V22.1 | 392.33 | 0.00 | 196.16 | 0.00 | 12.00 | 0.00 | |||
| GLB 9111697 | 21102220200 | 20111213 | MD | 0.00 | LAB | 20111027 | 20111208 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | V22.1 | 115.89 | 0.00 | 93.10 | 0.00 | 12.00 | 0.00 | |||
| GLB 9111697 | 21102220200 | 20111213 | MD | 0.00 | LAB | 20111027 | 20111208 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | V22.1 | 60.17 | 0.00 | 46.76 | 0.00 | 12.00 | 0.00 | |||
| GLB 9111697 | 21102220200 | 20111213 | MD | 0.00 | LAB | 20111027 | 20111208 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | V22.1 | 92.00 | 0.00 | 33.71 | 0.00 | 12.00 | 0.00 | |||
| GLB 9111697 | 21102220200 | 20111213 | MD | 0.00 | LAB | 20111027 | 20111208 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | V22.1 | 92.00 | 0.00 | 33.71 | 0.00 | 12.00 | 0.00 | |||
| GLB 9111697 | 21102227500 | 47976 | 20120110 | MD | 43.99 | LAB | 20111027 | 20111216 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | V22.1 | 103.91 | 0.00 | 59.92 | 0.00 | 12.00 | 0.00 | ||
| GLB 9111697 | 21102249500 | 20111213 | CA | 0.00 | LAB | 20111004 | 20111207 | FOREST SERVICE INT'L PROGRAMS | 20110713 | 20111230 | 244.9 | 500.35 | 0.00 | 0.00 | 500.35 | 16.00 | 0.00 | |||
| GLB 9111697 | 21102298200 | 20111221 | WI | 0.00 | ERP | 20110920 | 20111212 | FOREST SERVICE INT'L PROGRAMS | 20110901 | 20120930 | 789.00 | 427.00 | 0.00 | 0.00 | 427.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21102315200 | 48324 | 20120125 | MD | 118.91 | LAB | 20111103 | 20111221 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | V22.1 | 155.25 | 0.00 | 127.39 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21102315200 | 20120125 | MD | 0.00 | LAB | 20111103 | 20111221 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | V22.1 | 155.25 | 0.00 | 115.08 | 0.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21102315200 | 20120125 | MD | 0.00 | LAB | 20111103 | 20111221 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | V22.1 | 155.25 | 0.00 | 130.25 | 0.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21102315200 | 20120125 | MD | 0.00 | LAB | 20111103 | 20111221 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | V22.1 | 155.25 | 0.00 | 129.37 | 0.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21102315300 | 48324 | 20120125 | MD | 7.89 | LAB | 20111110 | 20111221 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | V22.1 | 36.98 | 0.00 | 29.09 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21102360300 | 47817 | 20111222 | 22.95 | NEG | 20111101 | 20111222 | FOREST SERVICE INT'L PROGRAMS | 20100901 | 000.0 | 22.95 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | ||||
| GLB 9111697 | 21102366900 | 48674 | 20120207 | MD | 92.35 | MAT | 20111212 | 20120123 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | 648.83 | 235.00 | 0.00 | 142.65 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21102367000 | 48674 | 20120207 | MD | 430.88 | MAT | 20111109 | 20120123 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | 655.13 | 315.00 | 0.00 | 124.12 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21102367000 | 20120207 | MD | 0.00 | MAT | 20111109 | 20120123 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | 655.13 | 240.00 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21102367100 | 48674 | 20120207 | MD | 216.92 | MAT | 20111206 | 20120123 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | 655.13 | 155.00 | 0.00 | 95.86 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21102367100 | 20120207 | MD | 0.00 | MAT | 20111206 | 20120123 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | 655.13 | 330.00 | 0.00 | 172.22 | 0.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21102445900 | 48789 | 20120214 | MD | 33.41 | LAB | 20111130 | 20120209 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | V22.1 | 18.14 | 0.00 | 12.63 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21102445900 | 20120214 | MD | 0.00 | LAB | 20111130 | 20120209 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | V22.1 | 72.32 | 0.00 | 50.93 | 0.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21102445900 | 20120214 | MD | 0.00 | LAB | 20111130 | 20120209 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | V22.1 | 20.49 | 0.00 | 13.98 | 0.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21102536400 | 48878 | 20120214 | MD | 216.92 | MAT | 20120109 | 20120209 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | 648.83 | 155.00 | 0.00 | 95.86 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21102536400 | 20120214 | MD | 0.00 | MAT | 20120109 | 20120209 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | 648.83 | 330.00 | 0.00 | 172.22 | 0.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21102565900 | 48325 | 20120125 | MD | 146.98 | DRU | 20111212 | 20111227 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | 648.83 | 130.99 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21102565900 | 20120125 | MD | 0.00 | DRU | 20111212 | 20111227 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | 648.83 | 15.99 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21102611100 | 48428 | 20120201 | 215.67 | REV | 20111201 | 20120131 | FOREST SERVICE INT'L PROGRAMS | 20100901 | 000.0 | 215.67 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | ||||
| GLB 9111697 | 21102748000 | 49971 | 20120327 | MD | 140.31 | XRY | 20120224 | 20120323 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | 655.73 | 260.00 | 0.00 | 119.69 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21102773000 | 50435 | 20120417 | MD | 222.04 | XRY | 20120315 | 20120405 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | 656.53 | 410.00 | 0.00 | 187.96 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21102785500 | 51029 | 20120516 | MD | 222.04 | XRY | 20120322 | 20120416 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | 656.63 | 410.00 | 0.00 | 187.96 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21102796100 | 51548 | 20120606 | MD | 140.31 | XRY | 20120329 | 20120523 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | 656.53 | 260.00 | 0.00 | 119.69 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21102847400 | 20120705 | MD | 0.00 | XRY | 20120329 | 20120703 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | 656.53 | 260.00 | 0.00 | 0.00 | 260.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21102847500 | 20120710 | MD | 0.00 | SUR | 20120409 | 20120608 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | 650 | 4470.00 | 0.00 | 0.00 | 4470.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21102859100 | 52529 | 20120710 | MD | 2987.00 | SUR | 20110708 | 20120706 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | 650 | 4470.00 | 0.00 | 1483.00 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21200097900 | 48730 | 20120214 | 167.74 | REV | 20120101 | 20120201 | FOREST SERVICE INT'L PROGRAMS | 20100901 | 000.0 | 167.74 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | ||||
| GLB 9111697 | 21200177500 | 49358 | 20120301 | MD | 146.98 | DRU | 20120117 | 20120131 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | 648.33 | 130.99 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21200177500 | 20120301 | MD | 0.00 | DRU | 20120117 | 20120131 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | 648.33 | 15.99 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21200226500 | 20120327 | MD | 0.00 | DVM | 20120214 | 20120229 | FOREST SERVICE INT'L PROGRAMS | 20101001 | 20120930 | 611.72 | 185.00 | 0.00 | 0.00 | 185.00 | 6.00 | 0.00 | |||
| GLB 9111697 | 21200257000 | 20120327 | MD | 0.00 | XRT | 20120222 | 20120306 | FOREST SERVICE INT'L PROGRAMS | 20101001 | 20120930 | 611.72 | 570.73 | 0.00 | 0.00 | 570.73 | 6.00 | 0.00 | |||
| GLB 9111697 | 21200337400 | 49882 | 20120327 | 58.75 | REV | 20120201 | 20120321 | FOREST SERVICE INT'L PROGRAMS | 20100901 | 000.0 | 58.75 | 0.00 | 0.00 | 0.00 | 6.00 | 0.00 | ||||
| GLB 9111697 | 21200365700 | 50436 | 20120417 | PA | 215.00 | DVM | 20120216 | 20120221 | FOREST SERVICE INT'L PROGRAMS | 20120206 | 20120805 | 787.01 | 100.00 | 0.00 | 0.00 | 0.00 | 6.00 | 0.00 | ||
| GLB 9111697 | 21200365700 | 20120417 | PA | 0.00 | URG | 20120220 | 20120221 | FOREST SERVICE INT'L PROGRAMS | 20120206 | 20120805 | 787.01 | 115.00 | 0.00 | 0.00 | 0.00 | 6.00 | 0.00 | |||
| GLB 9111697 | 21200367100 | 49972 | 20120327 | PA | 54.00 | LAB | 20120217 | 20120301 | FOREST SERVICE INT'L PROGRAMS | 20120206 | 20120805 | 780.60 | 54.00 | 0.00 | 0.00 | 0.00 | 6.00 | 0.00 | ||
| GLB 9111697 | 21200374100 | 20120327 | MD | 0.00 | DVM | 20120307 | 20120321 | FOREST SERVICE INT'L PROGRAMS | 20101001 | 20120930 | 611.72 | 91.00 | 0.00 | 0.00 | 91.00 | 6.00 | 0.00 | |||
| GLB 9111697 | 21200414800 | 50280 | 20120411 | MD | 75.68 | DVM | 20120307 | 20120409 | FOREST SERVICE INT'L PROGRAMS | 20101001 | 20120930 | 611.72 | 91.00 | 0.00 | 15.32 | 0.00 | 6.00 | 0.00 | ||
| GLB 9111697 | 21200414801 | RF000206 | 20121004 | MD | -75.68 | DVM | 20120307 | 20120409 | FOREST SERVICE INT'L PROGRAMS | 20101001 | 20120930 | 611.72 | -91.00 | 0.00 | -15.32 | 0.00 | 6.00 | 0.00 | ||
| GLB 9111697 | 21200414900 | 50281 | 20120411 | MD | 565.02 | XRT | 20120222 | 20120409 | FOREST SERVICE INT'L PROGRAMS | 20101001 | 20120930 | 611.72 | 570.73 | 0.00 | 5.71 | 0.00 | 6.00 | 0.00 | ||
| GLB 9111697 | 21200415000 | 50280 | 20120411 | MD | 153.48 | DVM | 20120214 | 20120409 | FOREST SERVICE INT'L PROGRAMS | 20101001 | 20120930 | 611.72 | 185.00 | 0.00 | 31.52 | 0.00 | 6.00 | 0.00 | ||
| GLB 9111697 | 21200415001 | RF000207 | 20121004 | MD | -153.48 | DVM | 20120214 | 20120409 | FOREST SERVICE INT'L PROGRAMS | 20101001 | 20120930 | 611.72 | -185.00 | 0.00 | -31.52 | 0.00 | 6.00 | 0.00 | ||
| GLB 9111697 | 21200517900 | 54343 | 20120925 | MD | 159.96 | LAB | 20120327 | 20120918 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 285.9 | 46.00 | 0.00 | 21.92 | 0.00 | 6.00 | 0.00 | ||
| GLB 9111697 | 21200517900 | 20120925 | MD | 0.00 | LAB | 20120327 | 20120918 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 285.9 | 37.00 | 0.00 | 21.52 | 0.00 | 6.00 | 0.00 | |||
| GLB 9111697 | 21200517900 | 20120925 | MD | 0.00 | LAB | 20120327 | 20120918 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 285.9 | 153.12 | 0.00 | 122.16 | 0.00 | 6.00 | 0.00 | |||
| GLB 9111697 | 21200517900 | 20120925 | MD | 0.00 | LAB | 20120327 | 20120918 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 285.9 | 46.88 | 0.00 | 39.14 | 0.00 | 6.00 | 0.00 | |||
| GLB 9111697 | 21200517900 | 20120925 | MD | 0.00 | LAB | 20120327 | 20120918 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 285.9 | 93.00 | 0.00 | 68.92 | 0.00 | 6.00 | 0.00 | |||
| GLB 9111697 | 21200517900 | 20120925 | MD | 0.00 | LAB | 20120327 | 20120918 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 285.9 | 78.00 | 0.00 | 57.36 | 0.00 | 6.00 | 0.00 | |||
| GLB 9111697 | 21200517900 | 20120925 | MD | 0.00 | LAB | 20120327 | 20120918 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 285.9 | 66.00 | 0.00 | 53.96 | 0.00 | 6.00 | 0.00 | |||
| GLB 9111697 | 21200517900 | 20120925 | MD | 0.00 | LAB | 20120327 | 20120918 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 285.9 | 94.00 | 0.00 | 69.06 | 0.00 | 6.00 | 0.00 | |||
| GLB 9111697 | 21200517901 | 54343 | 20120925 | MD | 73.10 | LAB | 20120327 | 20120918 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 285.9 | 232.00 | 0.00 | 170.08 | 0.00 | 6.00 | 0.00 | ||
| GLB 9111697 | 21200517901 | 20120925 | MD | 0.00 | LAB | 20120327 | 20120918 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 285.9 | 44.00 | 0.00 | 32.82 | 0.00 | 6.00 | 0.00 | |||
| GLB 9111697 | 21200546400 | 20120606 | MD | 0.00 | SUR | 20120329 | 20120604 | FOREST SERVICE INT'L PROGRAMS | 20101001 | 20120930 | 216.5 | 834.00 | 0.00 | 0.00 | 834.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21200546400 | 20120606 | MD | 0.00 | SUR | 20120329 | 20120604 | FOREST SERVICE INT'L PROGRAMS | 20101001 | 20120930 | 216.5 | 845.00 | 0.00 | 0.00 | 845.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21200566200 | 51335 | 20120522 | ID | 297.75 | ERI | 20120330 | 20120425 | FOREST SERVICE INT'L PROGRAMS | 20120304 | 20120501 | 787.91 | 297.75 | 0.00 | 0.00 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 21200566300 | 51335 | 20120522 | ID | 199.75 | ERP | 20120330 | 20120425 | FOREST SERVICE INT'L PROGRAMS | 20120304 | 20120501 | 787.91 | 199.75 | 0.00 | 0.00 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 21200612600 | 20120914 | MD | 0.00 | LAB | 20120327 | 20120425 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 285.9 | 46.00 | 0.00 | 0.00 | 46.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21200612600 | 20120914 | MD | 0.00 | LAB | 20120327 | 20120425 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 285.9 | 37.00 | 0.00 | 0.00 | 37.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21200612600 | 20120914 | MD | 0.00 | LAB | 20120327 | 20120425 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 285.9 | 153.12 | 0.00 | 0.00 | 153.12 | 16.00 | 0.00 | |||
| GLB 9111697 | 21200612600 | 20120914 | MD | 0.00 | LAB | 20120327 | 20120425 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 285.9 | 46.88 | 0.00 | 0.00 | 46.88 | 16.00 | 0.00 | |||
| GLB 9111697 | 21200612600 | 20120914 | MD | 0.00 | LAB | 20120327 | 20120425 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 285.9 | 93.00 | 0.00 | 0.00 | 93.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21200612600 | 20120914 | MD | 0.00 | LAB | 20120327 | 20120425 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 285.9 | 78.00 | 0.00 | 0.00 | 78.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21200612600 | 20120914 | MD | 0.00 | LAB | 20120327 | 20120425 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 285.9 | 66.00 | 0.00 | 0.00 | 66.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21200612600 | 20120914 | MD | 0.00 | LAB | 20120327 | 20120425 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 285.9 | 94.00 | 0.00 | 0.00 | 94.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21200612601 | 20120914 | MD | 0.00 | LAB | 20120327 | 20120425 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 285.9 | 232.00 | 0.00 | 0.00 | 232.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21200612601 | 20120914 | MD | 0.00 | LAB | 20120327 | 20120425 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 285.9 | 44.00 | 0.00 | 0.00 | 44.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21200620000 | 50595 | 20120501 | 23.94 | NEG | 20120301 | 20120430 | FOREST SERVICE INT'L PROGRAMS | 20100901 | 000.0 | 23.94 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | ||||
| GLB 9111697 | 21200692200 | 51912 | 20120614 | MD | 3457.35 | MAT | 20120409 | 20120523 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | 664.01 | 1142.00 | 0.00 | 11.42 | 0.00 | 16.00 | 0.00 | ||
| GLB 9111697 | 21200692200 | 20120614 | MD | 0.00 | MAT | 20120409 | 20120523 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | 664.01 | 2350.28 | 0.00 | 23.51 | 0.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21200820700 | 51405 | 20120529 | 75.18 | NEG | 20120401 | 20120501 | FOREST SERVICE INT'L PROGRAMS | 20100901 | 000.0 | 75.18 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | ||||
| GLB 9111697 | 21200824800 | 20120705 | MD | 0.00 | LAB | 20120208 | 20120703 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | V22.1 | 59.59 | 0.00 | 0.00 | 59.59 | 16.00 | 0.00 | |||
| GLB 9111697 | 21200824800 | 20120705 | MD | 0.00 | LAB | 20120208 | 20120703 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | V22.1 | 37.85 | 0.00 | 0.00 | 37.85 | 16.00 | 0.00 | |||
| GLB 9111697 | 21200840200 | 20120606 | MD | 0.00 | XRP | 20120222 | 20120604 | FOREST SERVICE INT'L PROGRAMS | 20101001 | 20120930 | 785.6 | 70.25 | 0.00 | 0.00 | 70.25 | 31.00 | 0.00 | |||
| GLB 9111697 | 21200840400 | 20120606 | MD | 0.00 | MAM | 20120222 | 20120604 | FOREST SERVICE INT'L PROGRAMS | 20101001 | 20120930 | 793.89 | 150.00 | 0.00 | 0.00 | 150.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21200884700 | 51518 | 20120606 | 8.93 | REV | 20120401 | 20120501 | FOREST SERVICE INT'L PROGRAMS | 20100901 | 000.0 | 8.93 | 0.00 | 0.00 | 0.00 | 31.00 | 0.00 | ||||
| GLB 9111697 | 21201019800 | 52048 | 20120621 | MD | 127.00 | DVM | 20120507 | 20120606 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 565.0 | 127.00 | 0.00 | 0.00 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 21201019900 | 52049 | 20120621 | MD | 19.69 | DRU | 20120301 | 20120606 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 780.4 | 19.69 | 0.00 | 0.00 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 21201083700 | 52313 | 20120702 | 46.75 | NEG | 20120501 | 20120601 | FOREST SERVICE INT'L PROGRAMS | 20100901 | 000.0 | 46.75 | 0.00 | 0.00 | 0.00 | 31.00 | 0.00 | ||||
| GLB 9111697 | 21201090100 | 52313 | 20120702 | 200.44 | REV | 20120501 | 20120601 | FOREST SERVICE INT'L PROGRAMS | 20100901 | 000.0 | 200.44 | 0.00 | 0.00 | 0.00 | 31.00 | 0.00 | ||||
| GLB 9111697 | 21201139000 | 52419 | 20120705 | MD | 19.99 | LAB | 20120208 | 20120703 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | V22.1 | 59.59 | 0.00 | 46.68 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 21201139000 | 20120705 | MD | 0.00 | LAB | 20120208 | 20120703 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | V22.1 | 37.85 | 0.00 | 30.77 | 0.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21201139100 | 52419 | 20120705 | MD | 44.32 | LAB | 20120315 | 20120703 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | V22.1 | 67.74 | 0.00 | 56.73 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 21201139100 | 20120705 | MD | 0.00 | LAB | 20120315 | 20120703 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | V22.1 | 40.12 | 0.00 | 6.81 | 0.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21201276100 | 52815 | 20120725 | MD | 838.58 | HRB | 20120409 | 20120717 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | V30.00 | 696.00 | 0.00 | 6.96 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 21201276100 | 20120725 | MD | 0.00 | ANC | 20120409 | 20120717 | FOREST SERVICE INT'L PROGRAMS | 20100102 | 20120331 | V30.00 | 151.05 | 0.00 | 1.51 | 0.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21201381600 | 54343 | 20120925 | MD | 61.92 | LAB | 20120717 | 20120918 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 272.4 | 232.00 | 0.00 | 170.08 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 21201539800 | 54149 | 20120914 | MD | 45.08 | DVM | 20120804 | 20120830 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 372.30 | 127.00 | 0.00 | 81.92 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 21201560200 | 53725 | 20120828 | 25.41 | REV | 20120701 | 20120801 | FOREST SERVICE INT'L PROGRAMS | 20100901 | 000.0 | 25.41 | 0.00 | 0.00 | 0.00 | 31.00 | 0.00 | ||||
| GLB 9111697 | 21201568700 | 53725 | 20120828 | 296.60 | NEG | 20120701 | 20120801 | FOREST SERVICE INT'L PROGRAMS | 20100901 | 000.0 | 296.60 | 0.00 | 0.00 | 0.00 | 31.00 | 0.00 | ||||
| GLB 9111697 | 21201705300 | 54344 | 20120925 | MD | 65.82 | DVM | 20120430 | 20120918 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | 477.9 | 200.00 | 0.00 | 134.18 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 21201705400 | 54794 | 20121016 | MD | 137.97 | DVM | 20120327 | 20120918 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | V70.0 | 194.00 | 0.00 | 110.43 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 21201705400 | 20121016 | MD | 0.00 | PRO | 20120327 | 20120918 | FOREST SERVICE INT'L PROGRAMS | 20110118 | 20120930 | V70.0 | 75.00 | 0.00 | 20.60 | 0.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21201719200 | 55005 | 20121025 | WV | 423.30 | ERP | 20120706 | 20121016 | FOREST SERVICE INT'L PROGRAMS | 20110920 | 20120919 | 919.4 | 498.00 | 0.00 | 74.70 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 21201719300 | 20130226 | WV | 0.00 | ERI | 20120706 | 20130222 | FOREST SERVICE INT'L PROGRAMS | 20110920 | 20120919 | 000.0 | 168.33 | 0.00 | 0.00 | 168.33 | 31.00 | 0.00 | |||
| GLB 9111697 | 21201971400 | 20121025 | WV | 0.00 | ERP | 20120706 | 20121011 | FOREST SERVICE INT'L PROGRAMS | 20110920 | 20120919 | 919.4 | 498.00 | 0.00 | 0.00 | 498.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21202102100 | 55029 | 20121101 | 185.68 | REV | 20120901 | 20121001 | FOREST SERVICE INT'L PROGRAMS | 20100901 | 000.0 | 185.68 | 0.00 | 0.00 | 0.00 | 16.00 | 0.00 | ||||
| $ 24,744.10 |
2010 Benefit Code
| Benefit Code and Description | Total Paid |
| AMB - AMBULANCE | 0.00 |
| ANC - HOSPITAL ANCILLARY CHARGES | 149.54 |
| ANE - ANESTHESIA | 400.00 |
| CAT - CAT SCAN | 542.30 |
| DME - DURABLE MEDICAL EQUIPMENT | 14.00 |
| DRU - MEDICATIONS | 358.65 |
| DVM - PHYSICIAN VISIT | 2609.47 |
| ERA - EMERGENCY ROOM ACCIDENT | 0.00 |
| ERI - EMERGENCY ROOM ILLNESS | 3412.26 |
| ERP - EMERGENCY ROOM PHYSICIAN | 1196.00 |
| HRB - HOSPITAL ROOM & BOARD CHARGES | 689.04 |
| LAB - LABORATORY CHARGES | 2334.28 |
| MAM - MAMMOGRAPHY | 0.00 |
| MAT - MATERNITY COVERAGE | 4414.42 |
| MNI- M/N INPATIENT | 0.00 |
| MNO- M/N OUTPATIENT | 0.00 |
| MSP - MEDICAL SUPPLIES | 8.00 |
| NCV - NOT COVERED UNDER YOUR PLAN | 0.00 |
| NEG - FEE NEGOTIATION-PHX | 465.42 |
| PRO - PROCEDURE | 54.40 |
| PRX- PRE-EXISTING CONDITION | 174.00 |
| REN - ROUTINE EXAMS | 0.00 |
| REV - RE-PRICING FEE | 951.93 |
| RIM - ROUTINE IMMUNIZATIONS | 0.00 |
| SUR - SURGERY | 5082.56 |
| URG - URGENT CARE ILLNESS | 115.00 |
| XRP - X-RAY PROFESSIONAL COMPONENT | 0.00 |
| XRT - X-RAY TECHNICAL COMPONENT | 565.02 |
| XRY - X-RAY | 1207.81 |
| Report Totals: | 24744.10 |
| AIU Client Code | TPA Claim No | Claimant Name | TPA Check Number | Check Date | Date of Birth | State Code | Check Amount | Benfit Code | Date of Loss | Date Reported | Policy Desc | Effective Date | Termination Date | Diagnosis | Total Charges | Deductible Taken | Discount | Denied Amount | Denied Reason Code | Currency |
| GLB 9111697 | 21200824200 | 51693 | 20120606 | DC | 908.00 | ERP | 20120427 | 20120604 | FOREST SERVICE INT'L PROGRAMS | 20120414 | 20120513 | 780.4 | 908.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | ||
| GLB 9111697 | 21200824900 | 20120705 | MD | 0.00 | LAB | 20120315 | 20120703 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | V22.1 | 67.74 | 0.00 | 0.00 | 67.74 | 16.00 | 0.00 | |||
| GLB 9111697 | 21200824900 | 20120705 | MD | 0.00 | LAB | 20120315 | 20120703 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | V22.1 | 40.12 | 0.00 | 0.00 | 40.12 | 16.00 | 0.00 | |||
| GLB 9111697 | 21200825200 | 20120628 | MD | 0.00 | MAT | 20120409 | 20120620 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | 664.01 | 1142.00 | 0.00 | 0.00 | 1142.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21200825200 | 20120628 | MD | 0.00 | MAT | 20120409 | 20120620 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | 664.01 | 2350.28 | 0.00 | 0.00 | 2350.28 | 16.00 | 0.00 | |||
| GLB 9111697 | 21200839100 | 20121016 | 0.00 | DVM | 20120505 | 20121015 | FOREST SERVICE INT'L PROGRAMS | 20120428 | 20120527 | 427.9 | 325.00 | 0.00 | 0.00 | 325.00 | 31.00 | 0.00 | ||||
| GLB 9111697 | 21200849000 | 20120725 | MD | 0.00 | HRB | 20120409 | 20120504 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | V30.00 | 696.00 | 0.00 | 0.00 | 696.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21200849000 | 20120725 | MD | 0.00 | ANC | 20120409 | 20120504 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | V30.00 | 151.05 | 0.00 | 0.00 | 151.05 | 16.00 | 0.00 | |||
| GLB 9111697 | 21200849100 | 20120911 | MD | 0.00 | NCV | 20120409 | 20120503 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | V30.00 | 170.00 | 0.00 | 0.00 | 170.00 | 12.00 | 0.00 | |||
| GLB 9111697 | 21200849100 | 20120911 | MD | 0.00 | NCV | 20120411 | 20120503 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | V30.00 | 150.00 | 0.00 | 0.00 | 150.00 | 12.00 | 0.00 | |||
| GLB 9111697 | 21201279700 | 54030 | 20120911 | MD | 18.33 | LAB | 20120706 | 20120907 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | 729.1 | 44.00 | 0.00 | 41.57 | 0.00 | 12.00 | 0.00 | ||
| GLB 9111697 | 21201279700 | 20120911 | MD | 0.00 | LAB | 20120706 | 20120907 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | 729.1 | 110.75 | 0.00 | 99.93 | 0.00 | 12.00 | 0.00 | |||
| GLB 9111697 | 21201279700 | 20120911 | MD | 0.00 | LAB | 20120706 | 20120907 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | 729.1 | 77.50 | 0.00 | 72.42 | 0.00 | 12.00 | 0.00 | |||
| GLB 9111697 | 21201279800 | 54030 | 20120911 | MD | 28.49 | LAB | 20120706 | 20120907 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | 729.1 | 46.00 | 0.00 | 40.26 | 0.00 | 12.00 | 0.00 | ||
| GLB 9111697 | 21201279800 | 20120911 | MD | 0.00 | LAB | 20120706 | 20120907 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | 729.1 | 51.88 | 0.00 | 45.70 | 0.00 | 12.00 | 0.00 | |||
| GLB 9111697 | 21201279800 | 20120911 | MD | 0.00 | LAB | 20120706 | 20120907 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | 729.1 | 132.91 | 0.00 | 117.89 | 15.02 | 81.00 | 0.00 | |||
| GLB 9111697 | 21201279800 | 20120911 | MD | 0.00 | LAB | 20120706 | 20120907 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | 729.1 | 61.21 | 0.00 | 48.62 | 0.00 | 81.00 | 0.00 | |||
| GLB 9111697 | 21201279800 | 20120911 | MD | 0.00 | LAB | 20120706 | 20120907 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | 729.1 | 44.00 | 0.00 | 40.02 | 0.00 | 81.00 | 0.00 | |||
| GLB 9111697 | 21201279800 | 20120911 | MD | 0.00 | LAB | 20120706 | 20120907 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | 729.1 | 40.75 | 0.00 | 33.91 | 6.84 | 81.00 | 0.00 | |||
| GLB 9111697 | 21201280000 | 54030 | 20120911 | MD | 53.21 | LAB | 20120706 | 20120907 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | 729.1 | 57.75 | 0.00 | 48.25 | 9.50 | 81.00 | 0.00 | ||
| GLB 9111697 | 21201280000 | 20120911 | MD | 0.00 | LAB | 20120706 | 20120907 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | 729.1 | 96.50 | 0.00 | 82.15 | 0.00 | 81.00 | 0.00 | |||
| GLB 9111697 | 21201280000 | 20120911 | MD | 0.00 | LAB | 20120706 | 20120907 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | 729.1 | 52.00 | 0.00 | 46.26 | 0.00 | 81.00 | 0.00 | |||
| GLB 9111697 | 21201280000 | 20120911 | MD | 0.00 | LAB | 20120706 | 20120907 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | 729.1 | 135.75 | 0.00 | 122.28 | 0.00 | 81.00 | 0.00 | |||
| GLB 9111697 | 21201280000 | 20120911 | MD | 0.00 | LAB | 20120706 | 20120907 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | 729.1 | 119.75 | 0.00 | 106.50 | 0.00 | 81.00 | 0.00 | |||
| GLB 9111697 | 21201280000 | 20120911 | MD | 0.00 | LAB | 20120706 | 20120907 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | 729.1 | 44.00 | 0.00 | 37.60 | 0.00 | 81.00 | 0.00 | |||
| GLB 9111697 | 21201306500 | 53639 | 20120821 | MD | 80.17 | DVM | 20120705 | 20120815 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | 724.3 | 150.00 | 0.00 | 69.83 | 0.00 | 81.00 | 0.00 | ||
| GLB 9111697 | 21201338400 | 20121004 | MD | 0.00 | DVM | 20120717 | 20121004 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | 272.2 | 100.00 | 0.00 | 0.00 | 100.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21201441300 | 54791 | 20121016 | MD | 153.98 | DRU | 20120614 | 20120725 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | 250.01 | 137.99 | 0.00 | 0.00 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 21201441300 | 20121016 | MD | 0.00 | DRU | 20120618 | 20120725 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | 250.01 | 15.99 | 0.00 | 0.00 | 0.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21201514400 | 54148 | 20120914 | DC | 1630.20 | ERI | 20120427 | 20120907 | FOREST SERVICE INT'L PROGRAMS | 20120414 | 20120513 | 780.79 | 2587.62 | 0.00 | 957.42 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 21201584000 | 55261 | 20121113 | MT | 160.00 | MNO | 20120723 | 20121107 | FOREST SERVICE INT'L PROGRAMS | 20120701 | 20130630 | 300.23 | 200.00 | 0.00 | 40.00 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 21201584100 | 55261 | 20121113 | MT | 304.00 | MNO | 20120724 | 20121107 | FOREST SERVICE INT'L PROGRAMS | 20120701 | 20130630 | 300.23 | 380.00 | 0.00 | 76.00 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 21201592400 | 54792 | 20121016 | MD | 1100.00 | MRI | 20120809 | 20121016 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | 722.0 | 1100.00 | 0.00 | 0.00 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 21201592500 | 20120920 | MD | 0.00 | MRI | 20120809 | 20120828 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | 722.10 | 1100.00 | 0.00 | 0.00 | 1100.00 | 16.00 | 0.00 | |||
| GLB 9111697 | 21201615300 | 20121106 | DC | 0.00 | DVM | 20120630 | 20121101 | FOREST SERVICE INT'L PROGRAMS | 20120622 | 20120721 | 681.00 | 125.00 | 0.00 | 0.00 | 125.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21201615300 | 20121106 | DC | 0.00 | DRU | 20120701 | 20121101 | FOREST SERVICE INT'L PROGRAMS | 20120622 | 20120721 | 681.00 | 42.09 | 0.00 | 0.00 | 42.09 | 31.00 | 0.00 | |||
| GLB 9111697 | 21201654400 | 55598 | 20121204 | 263.15 | ERA | 20120815 | 20121130 | FOREST SERVICE INT'L PROGRAMS | 20120719 | 20120925 | 989.5 | 277.00 | 0.00 | 13.85 | 0.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21201669100 | 54793 | 20121016 | MD | 45.08 | DVM | 20120815 | 20121016 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | 272.2 | 100.00 | 0.00 | 54.92 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 21201669900 | 55599 | 20121204 | 193.00 | ERP | 20120815 | 20121130 | FOREST SERVICE INT'L PROGRAMS | 20120719 | 20120925 | 989.5 | 193.00 | 0.00 | 0.00 | 0.00 | 31.00 | 0.00 | |||
| GLB 9111697 | 21201670000 | 55262 | 20121113 | CA | 285.00 | ERP | 20120821 | 20121107 | FOREST SERVICE INT'L PROGRAMS | 20120601 | 20121031 | 684 | 300.00 | 0.00 | 15.00 | 0.00 | 31.00 | 0.00 | ||
| GLB 9111697 | 21201765000 | 20121106 | MD | 0.00 | DVM | 20120825 | 20121105 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | V30.00 | 158.00 | 0.00 | 0.00 | 158.00 | 3.00 | 0.00 | |||
| GLB 9111697 | 21201841800 | 54498 | 20121002 | 25.80 | REV | 20120801 | 20120901 | FOREST SERVICE INT'L PROGRAMS | 20120301 | 000.0 | 25.80 | 0.00 | 0.00 | 0.00 | 3.00 | 0.00 | ||||
| GLB 9111697 | 21201865400 | 55778 | 20121211 | WI | 23.80 | LAB | 20120918 | 20121207 | FOREST SERVICE INT'L PROGRAMS | 20120625 | 20130625 | 626.4 | 28.00 | 0.00 | 4.20 | 0.00 | 3.00 | 0.00 | ||
| GLB 9111697 | 21201916900 | 55778 | 20121211 | WI | 191.25 | DVM | 20120918 | 20121207 | FOREST SERVICE INT'L PROGRAMS | 20120625 | 20130625 | 626.4 | 225.00 | 0.00 | 33.75 | 0.00 | 3.00 | 0.00 | ||
| GLB 9111697 | 21201923600 | 54792 | 20121016 | MD | 1100.00 | MRI | 20120809 | 20121016 | FOREST SERVICE INT'L PROGRAMS | 20120401 | 20120930 | 722.10 | 1100.00 | 0.00 | 0.00 | 0.00 | 3.00 | 0.00 | ||
| GLB 9111697 | 21201955600 | 55779 | 20121211 | WI | 475.31 | URG | 20120918 | 20121207 | FOREST SERVICE INT'L PROGRAMS | 20120625 | 20130625 | 626.4 | 128.00 | 0.00 | 19.20 | 0.00 | 3.00 | 0.00 | ||
| GLB 9111697 | 21201955600 | 20121211 | WI | 0.00 | LAB | 20120918 | 20121207 | FOREST SERVICE INT'L PROGRAMS | 20120625 | 20130625 | 626.4 | 431.20 | 0.00 | 64.69 | 0.00 | 3.00 | 0.00 | |||
| GLB 9111697 | 21202017300 | 55779 | 20121211 | WI | 860.46 | LAB | 20121001 | 20121207 | FOREST SERVICE INT'L PROGRAMS | 20120625 | 20130625 | 626.0 | 1012.30 | 0.00 | 151.84 | 0.00 | 3.00 | 0.00 | ||
| GLB 9111697 | 21202017400 | 55263 | 20121113 | MT | 36.00 | LAB | 20120921 | 20121105 | FOREST SERVICE INT'L PROGRAMS | 20120701 | 20130630 | 295.70 | 182.58 | 0.00 | 0.00 | 146.58 | 7.00 | 0.00 |
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