Exhibit 41b - Cal Yrs 2023 and 2024 City of Miami CIGNA Medical - TC19 Disruption Report Serv and Pymts made.xlsx

XLSX spreadsheet 5 MB Posted

Attached to
RFP No. 2130386 - Employee Health Benefits Plan
Solicitation number
RFP No. 2130386
Issued by
Florida

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Exhibit 05c - Cal Yr 2025 City of Miami CIGNA Dental HMO Certificate Riders and Coverage for 7 States ETALLD25A Plan 3202272 HC-ETRDR.pdf PDF
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CITY_OF__TC19

_
CITY OF MIAMI
Account Numbers: ('3202272')
TC 19 REPORT
DATE : Service Date Between 01/01/2023 and 12/31/2024 and Paid Date Between 01/01/2023 and 12/31/2024
_
_Cigna - Disruption Analysis Results
EXHIBIT 41bOpen Access Plus
CLIENT_ACCT_NUMPROVIDER_TAX_IDCPF_IDPROV_NPIPROV_NMADDR_LN_1ADDR_LN_2CITY_NMST_CDPOSTL_CDNT_IDPART_INDICATORPRODT_TY_CDPROV_SPEC_CDPROVIDER_SPECIALTYPROVIDER_TYPECLAIM_PAID_NETWORK_INDBRANCH_NUMBERBEN_PLAN_NUMCLAIMANTSCLAIMSVISIT_COUNTSVC_UNIT_CNTELIGIBLE_BILLED_CHARGESCategorySpec_TypeOpen Access Plus_MatchOpen Access Plus_Match_TypeCollaborative Accountable Care
32022725906244240635019MOUNT SINAI MEDICAL CENTER4300 ALTON RDMIAMI BEACHFL33140FL851PARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNRETG1NPOS23288$122,056.61YESCPFN
32022725917139472944001JACKSON WEST MEDICAL CENTER2801 NW 79TH AVEDORALFL33122OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNRETG1OAPAE222521$48,664.71YESCPFN
32022725926160173438105UMHC1475 NW 12TH AVEMIAMIFL33136OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKE1211OAPAE2332897$92,642.99YESCPFN
32022726502329930854028HOMESTEAD HOSPITAL975 BAPTIST WAYHOMESTEADFL33033FL851PARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNAGENNPOS222646$50,181.00YESCPFN
32022727411525970919800MEMORIAL HERMANN HEALTH SYSTEM1635 NORTH LOOP WHOUSTONTX77008OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS OUT-OF-NETWORKRMEPDPOAPNX1110$0.00YESCPFN
32022725909103422730538BAPTIST HOSPITAL OF MIAMI8900 N KENDALL DRMIAMIFL33176OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNASEAOAPAE111519$146,126.00YESCPFN
32022725917139470634725JACKSON MEMORIAL HOSPITAL15055 NW 27TH AVEOPA LOCKAFL33054OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKE1211OAPAE111460$151,879.98YESCPFN
32022725906244240635019MOUNT SINAI MEDICAL CENTER4300 ALTON RDMIAMI BEACHFL33140FL851PARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNAGENNPOS6962131$540,940.00YESCPFN
32022721607432092982729UNIV OF ROCHESTER STRONG MEMORIAL HOSPITAL601 ELMWOOD AVE 684ROCHESTERNY14642OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNAGENOAPAE1112$96,456.60YESCPFN
32022725909103422730538BAPTIST HOSPITAL OF MIAMI8900 N KENDALL DRMIAMIFL33176OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKRMEPDPOAPNX4451524$37,409.43YESCPFN
32022726216941809462715HCA FLORIDA JFK NORTH HOSPITAL2201 45TH STWEST PALM BEACHFL33407FL851PARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNRETG1NPOS133511$421,028.00YESCPFN
32022725917139470941850JACKSON NORTH MEDICAL CENTER160 NW 170TH STNORTH MIAMI BEACHFL33169OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS OUT-OF-NETWORKRMEPDPOAPNX1110$0.00YESCPFN
32022725908725940637539SOUTH MIAMI HOSPITAL INC6200 SW 73RD STSOUTH MIAMIFL33143OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNRETE1OAPAE122544$117,431.00YESCPFN
320227259345293996352451437131919FL AHCA1945 SE PORT ST LUCIE BLVDFORT PIERCEFL34952FL851NONPARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNAGENNPOS1111$396.00Non-ParNon-ParYESNPIN
320227226401986825656991770743908VIERA HOSPITAL8745 N WICKHAM RDMELBOURNEFL32940OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKRMEPDPOAPNX11148$5,331.72YESCPFN
32022725917139477207912JACKSON MEMORIAL HOSPITAL1611 NW 12TH AVEMIAMIFL33136OA001NONPAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS OUT-OF-NETWORKNASEAOAPAE1110$0.00Non-ParNon-ParYESTIN+NAME+ADDRESS+STATEN
32022725917262734477823ORLANDO HEALTH INC1414 KUHL AVEORLANDOFL32806OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNAGENOAPAE1111479$127,032.24YESCPFN
32022725960149730635670MEMORIAL HOSPITAL PEMBROKE7800 SHERIDAN STPEMBROKE PINESFL33024OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNAGENOAPAE4441295$144,439.00YESCPFN
32022725960149733021946MEMORIAL HOSPITAL WEST703 N FLAMINGO RDPEMBROKE PINESFL33028OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKRMEPDPOAPNX222235$19,845.11YESCPFN
32022725224384528174876WEST KENDALL BAPTIST HSP9555 SW 162ND AVEMIAMIFL33196OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNAGENOAPAE2332836$476,558.00YESCPFN
32022728120705613626440DETOX CENTER2700 BROADWAYWEST PALM BEACHFL33407OA001NONPAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS OUT-OF-NETWORKNAGENOAPAE1212121$82,200.00Non-ParNon-ParNon-ParNo Disruption from incumbentN
32022725960012170632331HALIFAX MEDICAL CENTER1041 DUNLAWTON AVEPORT ORANGEFL32127FL851NONPARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS OUT-OF-NETWORKRMEPDPNPOS211110$76,831.00Non-ParNon-ParYESCPFN
320227265013419708516551093759276PORTABLE MEDICAL DIAGNOSTIC INC3540 FOREST HILL BLVD 112WEST PALM BEACHFL33406FL851NONPARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS OUT-OF-NETWORKNRETG1NPOS1114$530.00Non-ParNon-ParNon-ParNo Disruption from incumbentN
320227259345293996352451104577873FL AHCA1945 SE PORT ST LUCIE BLVDFORT PIERCEFL34952FL851NONPARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNASEANPOS1110$0.00Non-ParNon-ParYESTIN+STATEN
32022725917139472944001JACKSON WEST MEDICAL CENTER2801 NW 79TH AVEDORALFL33122FL851PARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNAGENNPOS2321$22,917.55YESCPFN
32022725919435020633192SHANDS AT THE UNIVERSITY OF FLORIDA720 SW 2ND AVE 126GAINESVILLEFL32601FL851PARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNAGENNPOS1117$45,730.91YESCPFN
32022725924475540631806BETHESDA HOSPITAL INC3800 S CONGRESS AVEBOYNTON BEACHFL33426OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS OUT-OF-NETWORKRMEPDPOAPNX1220$0.00YESCPFN
32022725224384528174876WEST KENDALL BAPTIST HSP9555 SW 162ND AVEMIAMIFL33196OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNRETG1OAPAE222579$30,248.18YESCPFN
32022725924475540631806BETHESDA HOSPITAL INC3800 S CONGRESS AVEBOYNTON BEACHFL33426OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNAGENOAPAE111107$50,581.00YESCPFN
32022725960149730633318MEMORIAL REGIONAL HOSPITAL3501 JOHNSON STHOLLYWOODFL33021OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNASEAOAPAE2221393$266,303.97YESCPFN
32022724711305082940297FT LAUDERDALE HEALTH & REHABILITATION CENTER2000 E COMMERCIAL BLVDFORT LAUDERDALEFL33308FL851PARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS OUT-OF-NETWORKNRETG1NPOS11210$4,566.73YESCPFN
320227285227662718212841336750801ASURE WOUND SOLUTIONS LLC20801 BISCAYNE BLVD 403444MIAMIFL33180OA001NONPAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS OUT-OF-NETWORKRMEPDPOAPNX1110$0.00Non-ParNon-ParNon-ParNo Disruption from incumbentN
32022725960149733021946MEMORIAL HOSPITAL WEST703 N FLAMINGO RDPEMBROKE PINESFL33028FL851PARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKE1211NPOS253100$1,606,224.01YESCPFN
32022725421293327262473VITAL MD9750 NW 33RD STPOMPANO BEACHFL33065OA001NONPAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS OUT-OF-NETWORKNAGENOAPAE2221$0.00Non-ParNon-ParYESTIN+STATEN
32022725906244240635019MOUNT SINAI MEDICAL CENTER4300 ALTON RDMIAMI BEACHFL33140OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS OUT-OF-NETWORKRMEPDPOAPNX2220$0.00YESCPFN
320227280056491956332551255321584INTEGRATED REG LAB PATH SERVICES LLC1108 E NEWPORT CENTER DRDEERFIELD BEACHFL33442FL851NONPARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNAGENNPOS1111$192.00Non-ParNon-ParYESHospital-BasedN
32022725623044270858648MIAMI VAMC1201 NW 16TH STMIAMIFL33125FL851NONPARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNASEANPOS1211$13,429.30Non-ParNon-ParYESCPFN
32022725917139470941850JACKSON NORTH MEDICAL CENTER160 NW 170TH STNORTH MIAMI BEACHFL33169FL851PARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNASEANPOS22239$129,074.60YESCPFN
32022725918259376649074HOSPICE OF PALM BEACH COUNTY5300 EAST AVEWEST PALM BEACHFL33407FL851PARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNRETG1NPOS1259$1,359.90InvalidHome HealthExcludedInvalid - Home HealthN
320227265098644125458191235127499AETNA BETTER HEALTH FLORIDAPO BOX 842528DALLASTX75284FL851NONPARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNAGENNPOS1110$0.00Non-ParNon-ParYESNPIN
32022725960149735718056MEMORIAL HOSPITAL MIRAMAR3162 MOMENTUM PLCHICAGOIL60689FL851PARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKE1211NPOS1117$49,661.00YESCPFN
32022724529051894705786EMCOMPASS HEALTH REHABILITATION831 S STATE ROAD 434ALTAMONTE SPRINGSFL32714FL851PARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNRETG1NPOS1116$12,911.08YESCPFN
32022725919435020633192SHANDS AT THE UNIVERSITY OF FLORIDA720 SW 2ND AVE 126GAINESVILLEFL32601OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKRMEPDPOAPNX111105$18,858.11YESCPFN
32022725907255536610713ADVENTHEALTH SEBRING4200 SUN N LAKE BLVDSEBRINGFL33872NONPARCOMPOTHERFACILITY INPATIENTCLAIMS PAID AS OUT-OF-NETWORKRMEPDPOOA211288$6,966.09Non-ParNon-ParYESCPFN
320227259286848779485421033185889ATLAS DIAGNOSTICS4023 N ARMENIA AVE 101TAMPAFL33607PARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNPOS1117$706.10YESCPFN
32022728715774108802472AVENTURA REGENTS OPCO LLC18905 NE 25TH AVEMIAMIFL33180OA001NONPAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS OUT-OF-NETWORKRMEPDPOAPNX14649$5,940.97Non-ParNon-ParNon-ParNo Disruption from incumbentN
32022725212457460564774RIVERSIDE REGIONAL MEDICAL CENTER500 J CLYDE MORRIS BLVDNEWPORT NEWSVA23601MD802PARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKRMEPDPNPOS21117$104,370.29YESCPFN
32022725408538980569331SENTARA NORTHERN VIRGINIA MEDICAL CENTER2300 OPITZ BLVDWOODBRIDGEVA22191FL851NONPARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS OUT-OF-NETWORKRMEPDPNPOS21117$61,972.98Non-ParNon-ParYESCPFN
32022725910066630631743BOCA RATON REGIONAL HOSPITAL800 MEADOWS RDBOCA RATONFL33486OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKRMEPDPOAPNX11172$5,043.25YESCPFN
32022725405482000564732MARY IMMACULATE HOSPITAL LLC2 BERNADINE DRNEWPORT NEWSVA23602OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS OUT-OF-NETWORKRMEPDPOAPNX1110$0.00YESCPFN
32022725960149733021946MEMORIAL HOSPITAL WEST703 N FLAMINGO RDPEMBROKE PINESFL33028FL851PARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKRMEPDPNPOS211112$271,152.00YESCPFN
32022725909103422730538BAPTIST HOSPITAL OF MIAMI8900 N KENDALL DRMIAMIFL33176OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKE1211OAPAE222200$105,115.00YESCPFN
32022725926160173438105UMHC1475 NW 12TH AVEMIAMIFL33136OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNAGENOAPAE7776025$883,714.00YESCPFN
32022726213723890768306HCA FLORIDA MERCY HOSPITAL3663 S MIAMI AVEMIAMIFL33133OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNASEAOAPAE333760$344,723.45YESCPFN
32022725908725940637539SOUTH MIAMI HOSPITAL INC6200 SW 73RD STSOUTH MIAMIFL33143FL851PARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKE1211NPOS222172$80,544.00YESCPFN
320227259100666306317431609856285BOCA RATON REGIONAL HOSPITAL800 MEADOWS RDBOCA RATONFL33486OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS OUT-OF-NETWORKRMEPDPOAPNX1110$0.00YESCPFN
32022725917139470634725JACKSON MEMORIAL HOSPITAL15055 NW 27TH AVEOPA LOCKAFL33054FL851PARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNAGENNPOS91110122$568,475.38YESCPFN
32022725917139470634725JACKSON MEMORIAL HOSPITAL15055 NW 27TH AVEOPA LOCKAFL33054OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS OUT-OF-NETWORKNRSEA1OAPAE1110$0.00YESCPFN
32022726502600784831131HCA FLORIDA KENDALL HOSPITAL11750 BIRD RDMIAMIFL33175OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNASEAOAPAE1215329$0.00YESCPFN
32022725960120650632667BROWARD HEALTH MEDICAL CENTER1600 S ANDREWS AVEFORT LAUDERDALEFL33316FL851PARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNAGENNPOS2225$10,530.56YESCPFN
32022725960149730633318MEMORIAL REGIONAL HOSPITAL3501 JOHNSON STHOLLYWOODFL33021OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKE1211OAPAE4666795$1,372,170.85YESCPFN
32022725908725940637539SOUTH MIAMI HOSPITAL INC6200 SW 73RD STSOUTH MIAMIFL33143OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNAGENOAPAE777900$260,117.00YESCPFN
320227259235958267307451356385736BAPTIST EKG ASSOCIATES8900 N KENDALL DRMIAMIFL33176FL851NONPARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKRMEPDPNPOS21111$110.50Non-ParNon-ParYESNPIN
32022725926160173438105UMHC1475 NW 12TH AVEMIAMIFL33136FL851PARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNRSEA1NPOS1115$163,480.00YESCPFN
32022727523790070774459HCA FLORIDA ADVENTURA HOSPITAL20900 BISCAYNE BLVDMIAMIFL33180OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKRMEPDPOAPNX111364$17,638.49YESCPFN
32022725908725940637539SOUTH MIAMI HOSPITAL INC6200 SW 73RD STSOUTH MIAMIFL33143OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNASEAOAPAE111154$35,452.00YESCPFN
32022725960120650632709BROWARD HEALTH IMPERIAL POINT6401 N FEDERAL HWYFORT LAUDERDALEFL33308FL851PARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNAGENNPOS1112$27,719.40YESCPFN
32022725820329040618702KENNESTONE HOSPITAL4550 COBB PARKWAY NORTH NW 109ACWORTHGA30101FL851NONPARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNAGENNPOS1111$11,380.40Non-ParNon-ParYESCPFN
320227265013419708516551093759276PORTABLE MEDICAL DIAGNOSTIC INC3540 FOREST HILL BLVD 112WEST PALM BEACHFL33406FL851NONPARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNAMCNPOS1113$470.00Non-ParNon-ParNon-ParNo Disruption from incumbentN
32022725906244240635019MOUNT SINAI MEDICAL CENTER4300 ALTON RDMIAMI BEACHFL33140FL851PARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKRMEPDPNPOS21118$89,322.04YESCPFN
32022726109478370631974HCA FL BRANDON HOSPITAL119 OAKFIELD DRBRANDONFL33511FL851PARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKE1211NPOS111325$43,907.64YESCPFN
32022725906384990634935NICKLAUS CHILDRENS HOSPITAL3915 BISCAYNE BLVDMIAMIFL33137OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNAGENOAPAE5551128$285,503.89YESCPFN
32022722029718761912442WEST GABLES REHABILITATION HOSPITAL2525 SW 75TH AVEMIAMIFL33155OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKRMEPDPOAPNX1111694$57,481.62YESCPFN
32022722752538180839412EMCOMPASS HEALTH REHABILITATION HOSPITAL20601 OLD CUTLER RDCUTLER BAYFL33189FL851PARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKRMEPDPNPOS211116$47,759.06YESCPFN
32022726211137400636510HCA FLORIDA ST LUCIE HOSPITAL1800 SE TIFFANY AVEPORT SAINT LUCIEFL34952FL851PARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKRMEPDPNPOS21112$192,589.66YESCPFN
32022725917139477289076JACKSON SOUTH MEDICAL CENTER9333 SW 152ND STPALMETTO BAYFL33157OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNASEAOAPAE122735$34,541.35YESCPFN
32022725908725940637539SOUTH MIAMI HOSPITAL INC6200 SW 73RD STSOUTH MIAMIFL33143OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNAMCOAPAE2221190$260,984.00YESCPFN
320227265098644125458191407295686AETNA BETTER HEALTH FLORIDAPO BOX 842528DALLASTX75284FL851NONPARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNAGENNPOS1220$0.00Non-ParNon-ParYESNPIN
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32022725909103422730538BAPTIST HOSPITAL OF MIAMI8900 N KENDALL DRMIAMIFL33176OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS OUT-OF-NETWORKRMEPDPOAPNX4440$0.00YESCPFN
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32022726507299210637518LARKIN COMMUNITY HOSPITAL7031 SW 62ND AVESOUTH MIAMIFL33143OA001NONPAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS OUT-OF-NETWORKNAMCOAPAE1110$0.00Non-ParNon-ParYESNAME+STATEN
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32022728626698490633255HIALEAH HOSPITAL651 E 25TH STHIALEAHFL33013OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNAMCOAPAE111128$102,793.04YESCPFN
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32022728512426901894737MALLARD LAKE RANCH DETOX CENTER LLC18407 HOPFE RDHOCKLEYTX77447OA001NONPAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS OUT-OF-NETWORKNAGENOAPAE1202020$112,400.00Non-ParNon-ParNon-ParNo Disruption from incumbentN
32022725926160173438105UMHC1475 NW 12TH AVEMIAMIFL33136OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS OUT-OF-NETWORKRMEPDPOAPNX1110$0.00YESCPFN
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32022725960149730633318MEMORIAL REGIONAL HOSPITAL3501 JOHNSON STHOLLYWOODFL33021OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNAGENOAPAE6661467$234,408.00YESCPFN
32022725926160173438105UMHC1475 NW 12TH AVEMIAMIFL33136FL851PARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNAGENNPOS114024153$4,539,336.00YESCPFN
320227259235958267307451356304455BAPTIST EKG ASSOCIATES8900 N KENDALL DRMIAMIFL33176FL851NONPARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS OUT-OF-NETWORKRMEPDPNPOS21122$221.00Non-ParNon-ParYESNPIN
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32022727523790070774459HCA FLORIDA ADVENTURA HOSPITAL20900 BISCAYNE BLVDMIAMIFL33180FL851PARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNRETG1NPOS11170$54,815.30YESCPFN
32022725960149730635670MEMORIAL HOSPITAL PEMBROKE7800 SHERIDAN STPEMBROKE PINESFL33024OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS OUT-OF-NETWORKRMEPDPOAPNX1110$0.00YESCPFN
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320227295326898002616711700865094MOBILEX USA13773 ICOT BLVDCLEARWATERFL33760OA001PAROAP1OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKRMEPDPOAPNX2222$19.10Hospital Based ProvidersRadiologyYESHospital-BasedN
320227265098644125458191750582508AETNA BETTER HEALTH FLORIDAPO BOX 842528DALLASTX75284FL851NONPARDPP4OTHERFACILITY INPATIENTCLAIMS PAID AS IN-NETWORKNAGENNPOS1220$0.00Non-ParNon-ParYESNPIN

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