DECISION AND ORDER
I. INTRODUCTION
Various hospitals (Providers) requested hearings on decisions by the Medical Review Division (MRD) of the Texas Department of Insurance, Division of Workers’ Compensation (Division)[1] denying additional reimbursement to Providers under the Stop-Loss Exception for a hospital stay provided to an injured worker. Providers argued that reimbursement for the admission should be based on the Stop-Loss Exception to the per diem reimbursement methodology contained in the 1997 Acute Care Inpatient Hospital Fee Guideline (1997 ACIHFG).[2] By Order dated October 31, 2014, the Stop-Loss Exception cases involving the two Vista hospitals, Vista Medical Center Hospital/Surgical Specialty Hospital of America and Vista Hospital of Dallas (Vista), listed in Attachment A, were consolidated for hearing and decision under Consolidated SOAH Docket No. 454-12-1961.M4 (Lead Docket). The Lead Docket cases went to hearing in February 2016. Also set forth in Attachment A to this Order are pending non-Vista Stop‑Loss cases joined by Order dated April 14, 2014 for a common Decision and Order. By Order dated March 26, 2015, the Lead Docket was joined with the non-Vista Stop-Loss cases for a common Decision and Order (collectively, Joined Cases). The Administrative Law Judges (ALJs) find the Stop-Loss Exception should be followed in the cases set forth in Attachment 1 to this Decision and Order (Decision). For the cases set forth in Attachment 2, the ALJs find that no additional reimbursement is owed Provider. For the cases set forth in Attachment 3, the ALJs find the Stop-Loss Exception does not apply but that additional reimbursement is owed Provider. The cases set forth in Attachment 4 are rehabilitation and trauma cases to be reimbursed under a fair and reasonable standard. They are referred to Henry D. Card, the State Office of Administrative Hearings (SOAH) Economic Team Leader, for hearing.[3]
In each of the cases, Providers filed a request for dispute resolution with MRD. The MRD issued its Medical Fee Dispute Resolution Findings and Decision (MRD Decision) for each case. Providers timely requested a contested case hearing at SOAH in each of the cases. In certain of the cases, the responsible workers’ compensation insurers or self-insureds (Carrier) also filed a request for contested case hearing following issuance of the MRD Decision.
Adequate and timely notice of each hearing was provided as required. A number of SOAH ALJs presided over the hearings, presiding either individually or in various combinations. Both Providers and Carriers were represented by attorneys. The record for the cases on Attachments 1, 2, and 3 closed on June 5, 2019, following additional requests for status reports on continued/abated cases.
II. APPLICABLE LAW
Workers’ compensation insurance in Texas covers all medically necessary health care, which includes all reasonable medical aid, examinations, treatments, diagnoses, evaluations, and services reasonably required by the nature of the compensable injury and reasonably intended to cure or relieve the effects naturally resulting from a compensable injury. It includes procedures designed to promote recovery or to enhance the injured worker’s ability to return to or retain employment.[4] Title 5, subtitle A, chapters 401 through 419 of the Texas Labor Code constitute the Texas Workers’ Compensation Act (Act).
Act § 413.011 provides that the Division by rule shall establish medical policies and guidelines relating to fees charged or paid for medical services for employees who suffer compensable injuries, including guidelines relating to payment of fees for specific medical treatments or services. That section further provides that fee guidelines must befair and reasonableand designed to ensure the quality of medical care and to achieve effective medical cost control.[5]
Moreover, the guidelines may not provide for payment of a fee in excess of the fee charged for similar treatment of an injured individual of an equivalent standard of living and paid by that individual or by someone acting on that individual’s behalf.[6] In setting such guidelines, the increased security of payment afforded by the Act must be considered.[7]
The 1997 ACIHFG governed the reimbursement that workers’ compensation carriers paid hospitals for qualified inpatients with admissions dates commencing August 1, 1997,[8]and prior to March 1, 2008.[9] As previously noted, the 1997 ACIHFG generally reimbursed hospitals according to a per diem methodology.[10] The per diem rate was intended to cover all inpatient services provided to the injured worker. However, so long as the “bills do not reach the stop-loss threshold,” in addition to the standard per diem rate, a hospital could recover reimbursement in addition to the standard per diem.[11] Implantables (revenue codes 275, 276, and 278), and orthotics and prosthetics (revenue code 274) were to be reimbursed at the hospital’s cost plus 10%.[12] Pharmaceuticals administered during the admission charged at greater than $250 per dose were reimbursed at the hospital’s cost plus 10%.[13] The following services were to be reimbursed at “a fair and reasonable rate:” (1) Magnetic Resonance Imaging (MRI) (revenue codes 610-619);[14] (2) Computerized Axial Tomography (CAT scans) (revenue codes 350-352, and 359);[15] (3) Hyperbaric oxygen (revenue code 413);[16] (4) Blood (revenue codes 380-399);[17] and (5) Air ambulance (revenue code 545).[18]
Certain types of admissions were exempted from the per diem methodology based upon their ICD-9 Codes.[19] The following admissions were reimbursed at a fair and reasonable rate: (1) Trauma (ICD-9 codes 800.0-959.50); Burns (ICD-9 codes 940-949.9); and Human Immunodeficiency Virus (HIV) (ICD-9 codes 042-044.9).
The purpose of the Stop-Loss Methodology is “to ensure fair and reasonable compensation to the hospital for unusually costly services rendered during treatment to an injured worker.”[20] For the Stop-Loss Exception to apply, a hospital’s total post-audit charges must exceed $40,000, the minimum stop-loss threshold (Stop-Loss Threshold).[21] Hospitals were required to bill their usual and customary charges.[22] Thus, a hospital’s post-audit usual and customary charges for the admission, including items listed in Former Rule 134.401(c)(4), are used to calculate whether the Stop-Loss Threshold has been met for a workers’ compensation admission. According to Former Rule 134.401(c)(6)(A)(3), “[i]f audited charges exceed the Stop-Loss Threshold, reimbursement for the entire admission shall be paid using a Stop-Loss Reimbursement Factor (SLRF) of 75%.” Thus, when the Stop-Loss Methodology applies to a workers’ compensation hospitalization, all eligible items, including items listed in Former Rule 134.401(c)(4), are reimbursed at 75% of their post-audit charges.
The application of the Stop-Loss Exception and the meaning of Former Rule 134.401(c)(6)(A)(3), was the subject of intense and protracted litigation. The history of the legal debate is well-described in Vista Medical Center Hospital v. Texas Mutual Insurance Co., 416 S.W.3d 11, 18-20 (Tex. App.—Austin 2013, no pet.) (op. on reh’g). The interpretation of the Former Rule and the application of the Stop-Loss Exception were somewhat resolved in Texas Mutual Insurance Co. v. Vista Community Medical Center, LLP, 275 S.W.3d 538 (Tex. App.—Austin 2008, pet. denied) (Vista I). In Vista I, the Court held that in addition to showing that the charges from the admission met the Stop-Loss Threshold, the hospitals were also required to show that “the admission involved unusually costly and unusually extensive services to receive reimbursement under the Stop-Loss method.”[23]
The unresolved portion of the multi-prong Stop-Loss Exception is defining “unusually costly and unusually extensive.” “What is unusually costly and unusually extensive in any particular fee dispute remains a fact-intensive inquiry best left to the Division’s determination on a case-by-case basis.”[24] The court also stated that the two phrases are sufficiently definite to provide guidance to the Division and to the “ALJs who review and determine medical fee disputes on a case-by case basis.”[25]
III. DISCUSSION
The insurance carriers and hospitals have proffered various theories as to the interpretation of the phrase “unusually costly” services. Two proposals used comparisons with several variables: (1) measuring a hospital’s billed charges and its payments received by diagnosis and procedure against the relevant averages to determine whether the charges and/or payments fall under, at, or above, the statewide average; or (2) using hospital cost to charge ratio(s) calculated by the Centers for Medicare and Medicaid Services (CMS) for each hospital on an annual basis for the Medicare cost report and then comparing the cost, using either an average cost-to-charge ratio (single ratio methodology) or a traditional departmental cost-to-charge ratio methodology, of a specific admission against the hospital average admission, average workers’ compensation admission, etc. Four other proposals used bright-line comparisons: (1) determining whether the admission was assigned to a Medicare DRG[26] with a relative weight greater than 1.6 or some other number; (2) determining whether the admission was assigned to a DRG with a relative weight greater than the unweighted average of some Medicare case mix indices; (3) determining whether the principal procedure in the admission was performed in 9% or fewer of all workers’ compensation admissions in that year; or (4) determining whether the admission, had it been covered by Medicare, would have qualified for Medicare outlier payment using cost-to-charge ratios from the hospital’s Medicare cost report. Mindful of the emphasis that Vista I placed on a case‑by‑case decision on the application of the Stop-Loss Exception, the ALJs respectfully decline to adopt any of the bright-line tests proffered. Thus, there is no need to analyze any of the bright-line tests further.
With respect to whether the services provided by the hospital were “unusually extensive,” Vista I also makes clear the determination is a fact-intensive inquiry made on a case-by-case basis.[27] Carriers generally contend the correct comparison is between either identical or similar surgical procedures while Providers generally proposed a comparison to a mix of procedures.
Once the ALJs determined the post-audit billed charges for a qualifying admission met the Stop-Loss Threshold, the ALJs proceeded with the two-part analysis required under Vista I. For the unusually costly services determination, the ALJs concluded it was appropriate and helpful, as an initial cost analysis, to compare the hospital’s costs for the admission using the CMS[28] departmental cost-to-charge ratios methodology for the departments covered by the per diem reimbursement (Per Diem Services) against the per diem reimbursement for that admission. If the hospital’s costs for Per Diem Services are covered by the per diem reimbursement, then no further analysis is required. If the hospital’s costs for Per Diem Services are not covered by the per diem reimbursement, then a second analysis may be required.
The second analysis attempts to determine why the hospital’s costs for Per Diem Services were not covered by the per diem reimbursement. The second analysis examines the Per Diem Services provided to the injured worker during the admission and considers the injured worker’s prior medical history, condition and medical events at the time of admission through time of surgery, the surgery and medical events during surgery, and post-operative condition and post‑operative medical events until time of discharge. While the need and scope of consulting specialists is a factor in determining “unusually extensive,” the associated professional fees are not considered in determining “unusually costly” because the associated professional fees are not costs absorbed by the hospital. If the second analysis determined that the Per Diem Services provided to treat the injured worker were unusually extensive, then the ALJs applied the Stop-Loss Exception to all post-audit billed charges. If the second analysis determined that the Per Diem Services provided to treat the injured worker were not unusually extensive, the reimbursement deficiency may simply reflect that the per diem reimbursement was inadequate for reasons either outside the scope of the hearing or due to insufficient cost reimbursement evidence.
There are adjustments to Provider reimbursement even when the Stop-Loss Exception does not apply. As the ALJs examined the reimbursement disputes on a case-by-case basis, they attempted to address some deficiencies in implant reimbursement calculations and some calculation errors. For some Per Diem Services, additional reimbursement could not be determined because of insufficient evidence. In some cases, the Carrier sought a refund of some portion of the reimbursement paid to a Provider. In each of those cases, the ALJs agreed with the Division that the Carrier failed to comply with the applicable regulatory requirements. Moreover, in each of those cases the credible evidence in the record failed to prove that the payment made to the Provider violated the Act.
In support of these determinations, the ALJs make the following findings of fact and conclusions of law.
IV. FINDINGS OF FACT
- On various dates between 1997 through 2008, various hospitals (Providers) provided inpatient hospital services to injured workers in the cases listed on Attachments 1, 2, 3, and 4.
- The carriers or self-insureds (Carriers) specified on Attachment A were the responsible workers’ compensation insurers for the respective injured workers.
- Providers billed the respective Carriers for the services they provided to the injured worker in each case.
- The responsible Carrier reimbursed the Provider the amount specified in the column denominated “Carrier Payment” for the services provided to the injured worker in each case.
- Carriers were required to reimburse Providers under the Texas Department of Insurance, Division of Workers’ Compensation’s (Division) Acute Care Inpatient Hospital Fee Guideline (1997 ACIHFG).
- The 1997 ACIHFG generally reimbursed hospitals according to a per diem methodology (Fee Rule).
- Providers requested additional reimbursement in each case under the Stop‑Loss Exception to the Fee Rule. The Stop-Loss Exception, 28 Texas Administrative Code § 134.401(c)(2)(c), when it applies, provides for payment by the insurer in the amount of 75% of the hospital’s audited billed charges.
- Renaissance Hospitals is in a Chapter 7 bankruptcy proceeding. Pursuant to an August 2010 Bankruptcy Court Order, the automatic stay was lifted to allow the Chapter 7 Bankruptcy Trustee for Renaissance Hospitals to continue the claims adjudication process regarding workers’ compensation receivables on behalf of the debtor’s estate.
- All cases listed on Attachments 1, 2, and 3 involve billed charges greater than $40,000, one of the three requirements for application of the Stop-Loss Exception. In each case, the Division separately identified and analyzed the following additional issues to determine whether the admission qualified for the Stop-Loss Exception: (1) whether the admission involved unusually extensive hospital services, and (2) whether the admission involved unusually costly hospital services.
- Providers timely filed requests for medical fee dispute resolution with the Division.
- The Division issued a Medical Fee Dispute Resolution Findings and Decision (MRD Decision) in each case.
- In each case, the Division found that the admissions in dispute were not eligible for reimbursement under the Stop-Loss Exception and should be calculated pursuant to the Fee Rule –– 28 Texas Administrative Code § 134.401(c)(1), entitled “Standard Per Diem Amount,” and §134.401(c)(4), entitled “Additional Reimbursements.”
- In certain of the cases, the Division ordered Carriers to pay additional reimbursement to Providers.
- In certain of the cases, the Division determined the reimbursement owed Providers was less than the Carriers paid Providers.
- The Division almost never possessed all of the documentation needed to fully calculate the total reimbursement owed under the per diem methodology.
- Providers timely requested hearings before the State Office of Administrative Hearings (SOAH) to contest the MRD Decisions in these cases.
- By Order dated October 31, 2014, the Stop-Loss Exception cases involving the two Vista hospitals, Vista Medical Center Hospital/Surgical Specialty Hospital of America and Vista Hospital of Dallas (Vista), were consolidated for hearing and decision under Consolidated SOAH Docket No. 454-12-1961.M4 (Lead Docket).
- Non-Vista Stop-Loss cases were joined by Order dated April 14, 2014, for a common Decision and Order.
- By Order dated March 26, 2015, the Lead Docket was joined with the non-Vista Stop-Loss cases joined by previous order for a common Decision and Order.
- All parties were informed of the date, time, and location of the hearing; the matters to be considered; the legal authority under which the hearing would be held; and the statutory provisions applicable to the matters to be considered.
- The hearing on the merits in the Lead Docket was convened at SOAH in Austin, Texas, on February 23 and 24, 2016, before a five‑judge panel consisting of Administrative Law Judges Howard S. Seitzman, Gary W. Elkins, Michael J. O’Malley, Steven M. Rivas, and Pratibha J. Shenoy. All parties were represented by counsel. The non-Vista Stop-Loss cases were heard on various dates or were submitted by agreement for decision based upon written submissions, including the pre-filed evidence. All parties were represented by counsel. The record for the cases on Attachments 1, 2, and 3 closed on June 5, 2019.
- Providers proposed specific categorical approaches to determining what constituted unusually extensive and unusually costly hospital services.
- Cases received after a certain date and cases for which no responsible representative could be determined (Orphan Cases) were excluded from the hearing docket and remain pending at SOAH for further proceedings.
- Certain of the cases initially included in the Lead Docket and the non-Vista Stop-Loss docket involved types of admissions exempted from the per diem methodology based upon their ICD-9 Codes. The following admissions are reimbursed at a fair and reasonable rate: (1) Trauma (ICD-9 codes 800.0-959.50); Burns (ICD-9 codes 940-949.9); and Human Immunodeficiency Virus (HIV) (ICD-9 codes 042-044.9).
- For the cases set forth in Attachment 1, the preponderance of the credible evidence in the record shows the inpatient hospital stay qualifies for the Stop-Loss Exception to the per diem methodology and that additional reimbursement is owed to Provider by the respective Carrier.
- For the cases set forth in Attachment 2, the preponderance of the credible evidence in the record shows the inpatient hospital stay does not qualify for the Stop-Loss Exception to the per diem methodology and that no additional reimbursement is owed to Provider by the respective Carrier.
- For the cases set forth in Attachment 3, the preponderance of the credible evidence in the record shows the inpatient hospital stay does not qualify for the Stop-Loss Exception to the per diem methodology but that additional reimbursement is owed to Provider by the respective Carrier.
- For the cases set forth in Attachment 4, the preponderance of the credible evidence in the record shows the inpatient hospital admission is exempted from the per diem methodology based upon the ICD-9 Codes, either (1) Trauma (ICD-9 codes 800.0-959.50); (2) Burns (ICD-9 codes 940-949.9); or (3) Human Immunodeficiency Virus (HIV) (ICD-9 codes 042-044.9), and are to be reimbursed at a fair and reasonable rate.
- In each of the cases in which Carrier sought a refund of any of the reimbursement paid to Provider, the preponderance of the credible evidence in the record fails to show that Carrier complied with the applicable regulatory requirements for seeking and obtaining a refund.
- In each of the cases in which Carrier sought a refund of any of the reimbursement paid to Provider, the preponderance of the credible evidence in the record fails to prove that the payment made to Provider violated the Act.
V. CONCLUSIONS OF LAW
- SOAH has jurisdiction over this proceeding, including the authority to issue a decision and order. Tex. Lab. Code § 413.031; Tex. Gov’t Code ch. 2003.
- Adequate and timely notice of the hearing was provided as required. Tex. Gov’t Code §§ 2001.051, .052.
- The 1997 ACIHFG governed the reimbursement that workers’ compensation carriers paid hospitals for qualified inpatients with admissions dates commencing August 1, 1997, and prior to March 1, 2008.
- The 1997 ACIHFG, originally codified at 28 Texas Administrative Code § 134.401 (Former Rule), established a general reimbursement scheme for all inpatient services provided by an acute care hospital for medical and/or surgical admissions using a service‑related standard per diem amount. Independent reimbursement is allowed on a case-by-case basis if the particular case exceeds the Stop-Loss Threshold as described in paragraph (6) of Former Rule 134.401(c). This independent reimbursement mechanism, the Stop-Loss Method or Stop-Loss Methodology, is sometimes referred to as the Stop‑Loss Exception or the Stop-Loss Rule.
- The Stop-Loss Exception requires a hospital to demonstrate that the hospital services it provided were both “unusually extensive” and “unusually costly.” Texas Mutual Insurance Co. v. Vista Community Medical Center, LLP., 275 SW 3d 538 (Tex. App.—Austin 2008, pet. denied).
- Whether the hospital provided unusually extensive and unusually costly services is a fact‑intensive inquiry that is determined on a case‑by‑case basis. Texas Mutual Insurance Co. v. Vista Community Medical Center, LLP., 275 SW 3d 538 (Tex. App.—Austin 2008, pet. denied).
- For the cases set forth in Attachment 1, the preponderance of the credible evidence in the record shows the inpatient hospital stay qualifies for the Stop-Loss Exception to the per diem methodology and that additional reimbursement is owed to Provider by the respective Carrier.
- For the cases set forth in Attachment 2, the preponderance of the credible evidence in the record shows the inpatient hospital stay does not qualify for the Stop-Loss Exception to the per diem methodology and that no additional reimbursement is owed to Provider by the respective Carrier.
- For the cases set forth in Attachment 3, the preponderance of the credible evidence in the record shows the inpatient hospital stay does not qualify for the Stop-Loss Exception to the per diem methodology but that additional reimbursement is owed to Provider by the respective Carrier.
- For the cases set forth in Attachment 4, the preponderance of the credible evidence in the record shows the inpatient hospital admission is exempted from the per diem methodology based upon the ICD-9 Codes, and is to be reimbursed at a fair and reasonable rate.
- For the cases set forth in Attachment 4, additional proceedings will be needed to determine a fair and reasonable reimbursement amount.
- For the cases set forth in Attachments 1, 2, and 3, Carriers are not entitled to refunds for any of the reimbursement paid to Providers.
- In each of the cases in which Carrier sought a refund of any of the reimbursement paid to Provider, the preponderance of the credible evidence in the record fails to prove that the payment made to Provider violated the Act.
- For the cases listed on Attachments 1 and 3, Carriers should be ordered to make the additional reimbursement payments as set forth in the column denominated “Additional Reimbursement Owed to Provider.”
ORDER
IT IS ORDERED that the respective Carriers shall make payments to the respective Providers as set forth on Attachment 1 and 3 to this Decision and Order, together with all interest as required by law. IT IS FURTHER ORDERED that no additional reimbursement is owed to Providers by the respective Carriers for the cases set forth in Attachment 2 to this Decision and Order. IT IS FURTHER ORDERED thatCarriers receive no refunds for any reimbursement paid to Providers in the cases set forth in Attachments 1, 2, and 3 to this Decision and Order. IT IS FURTHER ORDERED that the cases set forth in Attachment 4 to this Decision and Order are SEVERED from these Joined and Consolidated dockets andassigned toAdministrative Law Judge HDC, SOAH Economic Team Leader, for further proceedings as to a fair and reasonable reimbursement amount. All relief not expressly granted herein is expressly DENIED.
Signed June 24, 2019.
ATTACHMENT A (03-25-2015) Stop-Loss
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-1389.M4 |
06-4838 |
Corpus Christi Medical Center |
Texas Mutual Insurance Co. |
|
454-13-1806.M4 |
07-2097 |
Clear Lake Regional Medical Center |
Texas Mutual Insurance Co. |
|
454-13-1807.M4 |
07-7244 |
Corpus Christi Medical Center |
Texas Mutual Insurance Co. |
|
454-13-1818.M4 |
06-2572 |
Rio Grande Regional Hospital |
Texas Mutual Insurance Co. |
|
454-13-1858.M4 |
07-5853 |
Texas Orthopedic Hospital |
Texas Mutual Insurance Co. |
|
454-13-1875.M4 |
07-2005 |
Rio Grande Regional Hospital |
Texas Mutual Insurance Co. |
|
454-13-2595.M4 |
07-5061 |
Texas Orthopedic Hospital |
Texas Mutual Insurance Co. |
|
454-13-3425.M4 |
08-1539 |
Corpus Christi Medical Center |
Texas Mutual Insurance Co. |
|
454-13-3436.M4 |
07-5962 |
Corpus Christi Medical Center |
Texas Mutual Insurance Co. |
|
454-13-3464.M4 |
06-7434 |
Corpus Christi Medical Center |
Texas Mutual Insurance Co. |
|
454-13-3466.M4 |
08-6413 |
Texas Orthopedic Hospital |
Texas Mutual Insurance Co. |
|
454-13-3467.M4 |
07-5070 |
Texas Orthopedic Hospital |
Texas Mutual Insurance Co. |
|
454-13-3472.M4 |
06-7049 |
Corpus Christi Medical Center |
Texas Mutual Insurance Co. |
ATTACHMENT A (03-25-2015) Stop-Loss
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-1788.M4 |
06-2835 |
Texas Orthopedic Hospital |
Indiana Lumbermens Mutual |
|
454-13-1850.M4 |
06-3621 |
Corpus Christi Medical Center |
Zurich American Insurance Co. |
|
454-13-1851.M4 |
06-6520 |
Texas Orthopedic Hospital |
Old Republic Insurance Co. |
|
454-13-1852.M4 |
05-6931 |
Texas Orthopedic Hospital |
Zurich American Insurance Co. |
|
454-13-1853.M4 |
08-7019 |
Corpus Christi Medical Center |
Facility Insurance Corp. |
|
454-13-1854.M4 |
08-3458 |
Texas Orthopedic Hospital |
American Zurich Insurance Co. |
|
454-13-1855.M4 |
08-2999 |
Texas Orthopedic Hospital |
TML Axia Services |
|
454-13-1856.M4 |
08-2041 |
Texas Orthopedic Hospital |
Texas Municipal League Intergovernmental Risk Pool |
|
454-13-1878.M4 |
09-0050 |
Corpus Christi Medical Center |
Bradford Holding Co., Inc. |
|
454-13-1879.M4 |
09-0049 |
Corpus Christi Medical Center |
Bradford Holding Co., Inc. |
|
454-13-2591.M4 |
08-4746 |
Kingwood Medical Center |
United States Fire Ins. Co. |
|
454-13-2606.M4 |
05-B502 |
Corpus Christi Medical Center |
American Home Assurance Co. |
|
454-13-3440.M4 |
08-7132 |
Texas Orthopedic Hospital |
East Tx Educational Ins. Assoc. |
|
454-13-3545.M4 |
07-5944 |
Texas Orthopedic Hospital |
Connecticut Indemnity Co. |
|
454-13-3547.M4 |
06-6830 |
Texas Orthopedic Hospital |
Gray Insurance Co. |
|
454-13-3548.M4 |
08-5240 |
Texas Orthopedic Hospital |
Texas Municipal League Intergovernmental Risk Pool |
|
454-13-3560.M4 |
07-3678 |
Texas Orthopedic Hospital |
Metropolitan Transit Authority |
|
454-13-4188.M4 |
06-4514 |
Texas Orthopedic Hospital |
Insurance Co. of the State of PA |
ATTACHMENT A (CONTINUED) (03-25-2015) Stop-Loss
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-4189.M4 |
07-0920 |
Texas Orthopedic Hospital |
New Hampshire Insurance Co. |
|
454-13-4190.M4 |
05-2742 |
Corpus Christi Medical Center |
Kiewit Corporation |
|
454-13-4195.M4 |
08-2226 |
Kingwood Medical Center |
Indemnity Insurance Co. of North America |
|
454-13-4329.M4 |
05-6894 |
Texas Orthopedic Hospital |
TPS Joint Self Insurance Funds |
|
454-13-4632.M4 |
07-5963 |
Spring Branch Medical Center |
Ace American Insurance Co. |
|
454-13-4633.M4 |
07-7231 |
Texas Orthopedic Hospital |
Fidelity & Guaranty Insurance Co. |
|
454-13-4700.M4 |
08-6310 |
Corpus Christi Medical Center |
Bradford Holding Co., Inc. |
ATTACHMENT A (03-25-2015) Stop-Loss
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-1804.M4 |
07-1386 |
Christus St. John Hospital |
Texas Mutual Insurance Co. |
|
454-13-3422.M4 |
09-0147 |
Christus St. John Hospital |
Texas Mutual Insurance Co. |
|
454-13-3471.M4 |
07-4384 |
Christus St. Elizabeth Hospital |
Texas Municipal League Intergovernmental Risk Pool |
|
454-13-3559.M4 |
08-2269 |
Christus St. Elizabeth Hospital |
East TX Educational Ins. Assoc. |
|
454-13-4196.M4 |
07-4526 |
Christus St. Elizabeth Hospital |
Insurance Co. of the State of PA |
|
454-13-4328.M4 |
06-2199 |
Christus St. Joseph Hospital |
Continental Western Insurance Co. |
|
454-13-4634.M4 |
07-6458 |
Christus St. Elizabeth Hospital |
Dolgencorp of Texas, Inc. |
ATTACHMENT A (03-25-2015) Stop-Loss
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-12-0785.M4 |
04-6842 |
Spring Branch Medical Center |
Texas Mutual Insurance Co. |
|
454-13-1265.M4 |
04-A430 |
Spring Branch Medical Center |
Texas Mutual Insurance Co. |
|
454-13-1805.M4 |
06-6439 |
Spring Branch Medical Center |
Texas Mutual Insurance Co. |
|
454-13-3424.M4 |
04-A432 |
Texas Orthopedic Hospital |
Texas Mutual Insurance Co. |
ATTACHMENT A (03-25-2015) Stop-Loss
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-0988.M4 |
09-8055 |
Sierra Medical Center |
Texas Mutual Insurance Co. |
|
454-13-2530.M4 |
08-7184 |
Encino Medical Center |
Texas Mutual Insurance Co. |
|
454-13-2957.M4 |
05-1635 |
RHD Memorial Medical Center |
Texas Mutual Insurance Co. |
|
454-13-2965.M4 |
09-2649 |
Sierra Medical Center |
Texas Mutual Insurance Co. |
|
454-13-2528.M4 |
08-5290 |
Houston Northwest Medical Center |
American Home Assurance Co. |
|
454-13-2527.M4 |
09-2100 |
Centennial Medical Center |
Insurance Co. of the State of PA |
|
454-13-2963.M4 |
09-2681 |
Providence Memorial Hospital |
Facility Insurance Corp. |
|
454-13-2967.M4 |
08-0921 |
RHD Memorial Medical Center |
Zurich American Insurance Co. |
|
454-13-5958.M4 |
08-4321 |
Centennial Medical Center |
Zurich American Insurance Co. |
ATTACHMENT A (03-25-2015) Stop-Loss
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-1270.M4 |
06-5742 |
Twelve Oaks Medical Center |
State Office of Risk Management |
|
454-13-1271.M4 |
05-6242 |
Twelve Oaks Medical Center |
State Office of Risk Management |
|
454-13-1272.M4 |
06-0183 |
Twelve Oaks Medical Center |
State Office of Risk Management |
|
454-13-1874.M4 |
06-5355 |
Corpus Christi Medical Center |
State Office of Risk Management |
|
454-13-2610.M4 |
08-0380 |
Texas Orthopedic Hospital |
State Office of Risk Management |
|
454-13-3468.M4 |
07-1690 |
Twelve Oaks Medical Center |
State Office of Risk Management |
|
454-13-3469.M4 |
08-7134 |
Texas Orthopedic Hospital |
State Office of Risk Management |
|
454-13-3470.M4 |
07-8012 |
Texas Orthopedic Hospital |
State Office of Risk Management |
|
454-13-3764.M4 |
06-7165 |
Twelve Oaks Medical Center |
State Office of Risk Management |
|
454-13-4701.M4 |
07-1731 |
Texas Orthopedic Hospital |
State Office of Risk Management |
ATTACHMENT A (03-25-2014) Stop-Loss
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-12-7500.M4 |
05-A362 |
Corpus Christi Medical Center |
Liberty Mutual Fire Ins. Co. |
|
454-12-7510.M4 |
06-4720 |
HCA Mainland Medical Center |
Liberty Mutual Ins. Co. |
|
454-12-7513.M4 |
05-0798 |
Liberty Mutual Ins. Co. (Josey) |
HCA Spring Branch Medical Center |
|
454-12-7515.M4 |
05-3904 |
Liberty Mutual Ins. Co. (Josey) |
HCA Spring Branch Medical Center |
|
454-13-1841.M4 |
08-6350 |
Bayshore Medical Center |
Texas Association of Counties RMP |
|
454-13-1842.M4 |
07-3139 |
Corpus Christi Medical Center |
Liberty Mutual Fire Ins. Co. |
|
454-13-1843.M4 |
07-3761 |
Twelve Oaks Medical Center |
Wausau Business Insurance Co. |
|
454-13-1845.M4 |
08-2554 |
Triumph Hospital San Angelo |
Lumbermens Mutual Casualty Co. |
|
454-13-2607.M4 |
09-1348 |
Triumph Hospital El Paso |
Liberty Insurance Corporation |
|
454-13-3551.M4 |
07-4555 |
Christus St. Elizabeth Hospital |
Liberty Insurance Corporation |
|
454-13-3552.M4 |
07-3599 |
Texas Orthopedic Hospital |
Liberty Mutual Ins. Co. |
|
454-13-4192.M4 |
09-3479 |
Christus St. Elizabeth Hospital |
Liberty Mutual Ins. Co. |
|
454-13-4193.M4 |
05-1926 |
Spring Branch Medical Center |
Liberty Mutual Ins. Co. |
|
454-13-4318.M4 |
07-0672 |
Twelve Oaks Medical Center |
Netherlands Insurance Co. |
|
454-13-4330.M4 |
06-6523 |
Christus St. Joseph Hospital |
Liberty Mutual Fire Ins. Co. |
|
454-13-4641.M4 |
06-7044 |
Texas Orthopedic Hospital |
Liberty Mutual Fire Ins. Co. |
|
454-13-4642.M4 |
08-2140 |
West Houston Medical Center |
Liberty Mutual Ins. Co. |
|
454-13-4643.M4 |
05-3214 |
Corpus Christi Medical Center |
Liberty Mutual Fire Ins. Co. |
|
454-13-4647.M4 |
06-7763 |
Austin Surgical Hospital |
Liberty Mutual Ins. Co. |
|
454-13-4695.M4 |
08-5593 |
Christus St. John Hospital |
Pacific Employers Insurance Co. |
ATTACHMENT A (03-25-2015) CONTINUED Stop-Loss
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-4698.M4 |
06-5764 |
Texas Orthopedic Hospital |
Liberty Insurance Corporation |
|
454-13-4706.M4 |
08-4751 |
Texas Orthopedic Hospital |
Liberty Insurance Corporation |
|
454-13-4762.M4 |
04-7903 |
Spring Branch Medical Center |
Liberty Mutual Fire Ins. Co. |
|
454-13-4763.M4 |
09-6007 |
Corpus Christi Medical Center |
Liberty Insurance Corporation |
ATTACHMENT A (03-25-2015) Stop-Loss
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-12-0520.M4 |
04-2761 |
HCA Spring Branch Medical Center |
TPCIGA for Reliance National |
|
454-12-7453.M4 |
06-3096 |
Twelve Oaks Medical Center |
Continental Cas. Co. |
|
454-12-7498.M4 |
05-B550 |
Transportation Insurance Co. |
HCA Conroe Regional Medical Center |
|
454-12-7499.M4 |
06-2756 |
Texas Orthopedic Hospital |
TASB Risk Management Fund |
|
454-12-7503.M4 |
06-0636 |
Twelve Oaks Medical Center |
Mid-Century Ins. Co. |
|
454-12-7504.M4 |
05-5765 |
Twelve Oaks Medical Center |
TPCIGA for Reliance National |
|
454-12-7508.M4 |
06-1375 |
Corpus Christi Medical Center |
West Texas Educational Insurance/Alice ISD |
|
454-12-7511.M4 |
05-1928 |
Mid-Century Ins. Co. |
HCA Spring Branch Medical Center |
|
454-12-7512.M4 |
04-1493 |
Truck Insurance Exchange |
HCA Spring Branch Medical Center |
|
454-12-7710.M4 |
05-5106 |
American Home Assurance Co. |
Texas Orthopedic Hospital |
|
454-12-7730.M4 |
04-B464 |
TPCIGA for Paula Ins. Co. |
Valley Regional Medical Center |
|
454-12-7744.M4 |
04-9796 |
TPCIGA for Petrosurance Casualty Co. |
Rio Grande Regional Hospital |
|
454-12-7746.M4 |
05-0303 |
TPCIGA for Colonial Casualty Insurance Co. |
HCA Spring Branch Medical Center |
|
454-13-1268.M4 |
05-9198 |
Spring Branch Medical Center |
Am. Cas. Co. of Reading, PA |
|
454-13-1274.M4 |
07-1249 |
Texas Orthopedic Hospital |
Transcontinental Insurance Co. |
|
454-13-1384.M4 |
05-A343 |
Spring Branch Medical Center |
Continental Cas. Co. |
|
454-13-1494.M4 |
07-5069 |
TPCIGA for Reliance National |
Twelve Oaks Medical Center |
ATTACHMENT A (03-25-2015) CONTINUED Stop-Loss
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-1759.M4 |
07-1104 |
TPCIGA for Home Insurance Co. |
Twelve Oaks Medical Center |
|
454-13-1764.M4 |
08-6253 |
Employers Assurance Co. |
Texas Orthopedic Hospital |
|
454-13-1789.M4 |
06-1935 |
Twelve Oaks Medical Center |
Truck Insurance Exchange |
|
454-13-1798.M4 |
06-1691 |
Twelve Oaks Medical Center |
TPCIGA for Home Indemnity Co. |
|
454-13-1813.M4 |
05-9361 |
Twelve Oaks Medical Center |
Am. Cas. Co. of Reading, PA |
|
454-13-1844.M4 |
07-4938 |
Corpus Christi Medical Center |
National American Insurance Co. |
|
454-13-1846.M4 |
07-5069 |
Twelve Oaks Medical Center |
TPCIGA for Reliance National |
|
454-13-1887.M4 |
08-2555 |
Texas Orthopedic Hospital |
TPCIGA for Paula Ins. Co. |
|
454-13-1888.M4 |
07-0578 |
Corpus Christi Medical Center |
Am. Cas. Co. of Reading, PA |
|
454-13-2526.M4 |
07-1395 |
Twelve Oaks Medical Center |
Am. Cas. Co. of Reading, PA |
|
454-13-2960.M4 |
05-4435 |
Twelve Oaks Medical Center |
TPCIGA for Colonial Casualty Insurance Co. |
|
454-13-2971.M4 |
07-3266 |
Twelve Oaks Medical Center |
Hartford Underwriters Insurance Co. |
|
454-13-3407.M4 |
07-0181 |
Twelve Oaks Medical Center |
TPCIGA for Casualty Reciprocal |
|
454-13-3435.M4 |
06-3826 |
Corpus Christi Medical Center |
TASB Risk Management Fund |
|
454-13-3439.M4 |
08-6253 |
Texas Orthopedic Hospital |
Employers Assurance Co. |
|
454-13-3460.M4 |
08-2040 |
Spring Branch Medical Center |
TASB Risk Management Fund |
|
454-13-3462.M4 |
07-0906 |
Twelve Oaks Medical Center |
TASB Risk Management Fund |
|
454-13-3554.M4 |
07-1852 |
Twelve Oaks Medical Center |
Aberdeen Ins. Co. |
|
454-13-3555.M4 |
07-2414 |
Rio Grande Regional Hospital |
Employers Assurance Co. |
ATTACHMENT A (03-25-2015) CONTINUED Stop-Loss
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-3556.M4 |
07-0973 |
Twelve Oaks Medical Center |
National Fire Insurance |
|
454-13-3558.M4 |
07-1104 |
Twelve Oaks Medical Center |
TPCIGA for Home Insurance Co. |
|
454-13-3766.M4 |
06-7477 |
Twelve Oaks Medical Center |
Am. Cas. Co. of Reading, PA |
|
454-13-3800.M4 |
08-0332 |
Texas Orthopedic Hospital |
Hartford Insurance Co. of the Midwest |
|
454-13-3805.M4 |
07-5509 |
Corpus Christi Medical Center |
National American Insurance Co. |
|
454-13-4194.M4 |
05-5106 |
Texas Orthopedic Hospital |
American Home Assurance Co. |
|
454-13-4637.M4 |
06-6838 |
Petroleum Casualty Co. |
Texas Orthopedic Hospital |
|
454-13-4697.M4 |
08-2284 |
Texas Orthopedic Hospital |
TPCIGA for Reliance National Insurance) |
|
454-13-5585.M4 |
06-6838 |
Texas Orthopedic Hospital |
Petroleum Casualty Co. |
|
454-13-1267.M4 |
05-A363 |
Spring Branch Medical Center |
TPCIGA for Am. Motorists Ins. Co. ABATED |
|
454-13-1273.M4 |
05-9933 |
Twelve Oaks Medical Center |
TPCIGA for American Manufacturers Mutual Ins. ABATED |
|
454-13-4316.M4 |
07-2924 |
Twelve Oaks Medical Center |
TPCIGA for American Manufacturers Mutual Ins. ABATED |
|
454-13-4692.M4 |
07-0288 |
Twelve Oaks Medical Center |
TPCIGA for Lumbermens Mutual Casualty Co. ABATED |
|
454-13-4708.M4 |
07-0752 |
Twelve Oaks Medical Center |
TPCIGA for Lumbermens Mutual Casualty Co. ABATED |
|
454-13-4709.M4 |
06-6598 |
Twelve Oaks Medical Center |
TPCIGA for Lumbermens Mutual Casualty Co. ABATED |
ATTACHMENT A (03-25-2015) Stop-Loss
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-4181.M4 |
07-6050 |
Valley Regional Medical Center |
West American Insurance Co. |
ATTACHMENT A (03-25-2015) Stop-Loss
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-3798.M4 |
05-4612 |
Renaissance Hospital |
Insurance Co. of the State of PA |
|
454-13-3803.M4 |
07-7937 |
Renaissance Hospital |
Assurance Co. of America |
|
454-13-3942.M4 |
08-4649 |
Renaissance Hospital |
Facility Insurance Corp. |
|
454-13-4019.M4 |
07-3229 |
Renaissance Hospital |
Zurich American Insurance Co. |
|
454-13-4029.M4 |
09-2859 |
Renaissance Hospital |
TPS Joint Self Insurance Funds |
|
454-13-4153.M4 |
08-0968 |
Renaissance Hospital |
Old Republic Insurance Co. |
|
454-13-4156.M4 |
08-1419 |
Renaissance Hospital |
Zurich American Insurance Co. |
|
454-13-5234.M4 |
08-1628 |
Renaissance Hospital |
American Zurich Insurance Co. |
|
454-13-5237.M4 |
07-0732 |
Renaissance Hospital |
American Zurich Insurance Co. |
|
454-13-5238.M4 |
09-0032 |
Renaissance Hospital |
Fire & Casualty Insurance Co.of Connecticut |
ATTACHMENT A (03-25-2015) Stop-Loss
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-2529.M4 |
07-6767 |
Houston Northwest Medical Center |
Liberty Insurance Corporation |
|
454-13-2596.M4 |
09-2165 |
Centennial Medical Center |
Liberty Mutual Fire Ins. Co. |
|
454-13-2597.M4 |
09-3854 |
Houston Northwest Medical Center |
Liberty Insurance Corporation |
|
454-13-2954.M4 |
09-0203 |
Providence Memorial Hospital |
Liberty Insurance Corporation |
|
454-13-2956.M4 |
09-2863 |
Providence Memorial Hospital |
Liberty Mutual Ins. Co. |
|
454-13-3950.M4 |
08-4685 |
Park Plaza Hospital |
Liberty Insurance Corporation |
|
454-13-4166.M4 |
07-4267 |
Trinity Medical Center |
Liberty Mutual Ins. Co. |
|
454-13-5957.M4 |
07-4250 |
Trinity Medical Center |
Liberty Mutual Fire Insurance Co. |
ATTACHMENT A (03-25-2015) Stop-Loss
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-1106.M4 |
07-4485 |
Park Plaza Hospital |
Hartford Underwriters Insurance Co. |
|
454-13-2600.M4 |
09-3868 |
Centennial Medical Center |
Hartford Casualty Insurance Co. |
|
454-13-2969.M4 |
06-6108 |
Sierra Medical Center |
Hartford Casualty Insurance Co. |
ATTACHMENT A Vista Consolidated Stop-Loss Cases
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-1548.M4 |
06-3132 |
Vista Medical Center Hospital |
North Forest ISD |
|
454-13-2183.M4 |
07-4277 |
Vista Medical Center Hospital |
Houston ISD |
|
454-13-4582.M4 |
04-6097 |
Vista Medical Center Hospital |
Harris Health System |
|
454-13-0083.M4 |
04-0292 |
Vista Medical Center Hospital |
Houston ISD |
ATTACHMENT A Vista Consolidated Stop-Loss Cases
Part 1 of 2
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-0141.M4 |
06-2077 |
Texas Mutual Insurance Co. |
Vista Hospital of Dallas |
|
454-13-0143.M4 |
06-2270 |
Texas Mutual Insurance Co. |
Vista Medical Center Hospital |
|
454-13-0417.M4 |
06-2270 |
Vista Medical Center Hospital |
Texas Mutual Insurance Co. |
|
454-13-0419.M4 |
06-2077 |
Vista Hospital of Dallas |
Texas Mutual Insurance Co. |
|
454-13-0420.M4 |
03-9053 |
Vista Medical Center Hospital |
Texas Mutual Insurance Co. |
|
454-13-0898.M4 |
05-A922 |
Vista Medical Center Hospital |
Texas Mutual Insurance Co. |
|
454-13-0899.M4 |
05-8001 |
Vista Hospital of Dallas |
Texas Mutual Insurance Co. |
|
454-13-0989.M4 |
08-1759 |
Vista Hospital of Dallas |
Texas Mutual Insurance Co. |
|
454-13-1538.M4 |
07-8171 |
Vista Hospital of Dallas |
Texas Mutual Insurance Co. |
|
454-13-1544.M4 |
06-5864 |
Vista Medical Center Hospital |
Texas Mutual Insurance Co. |
|
454-13-1547.M4 |
06-2300 |
Vista Hospital of Dallas |
Texas Mutual Insurance Co. |
|
454-13-1550.M4 |
07-2560 |
Vista Medical Center Hospital |
Texas Mutual Insurance Co. |
|
454-13-1605.M4 |
07-4568 |
Vista Hospital of Dallas |
Texas Mutual Insurance Co. |
|
454-13-2126.M4 |
07-0571 |
Vista Hospital of Dallas |
Texas Mutual Insurance Co. |
|
454-13-2127.M4 |
06-5194 |
Vista Hospital of Dallas |
Texas Mutual Insurance Co. |
|
454-13-2135.M4 |
07-7746 |
Vista Hospital of Dallas |
Texas Mutual Insurance Co. |
|
454-13-2188.M4 |
07-3964 |
Vista Medical Center Hospital |
Texas Mutual Insurance Co. |
|
454-13-2427.M4 |
07-7060 |
Vista Hospital of Dallas |
Texas Mutual Insurance Co. |
|
454-13-2430.M4 |
06-3550 |
Vista Hospital of Dallas |
Texas Mutual Insurance Co. |
|
454-13-2443.M4 |
07-1614 |
Vista Hospital of Dallas |
Texas Mutual Insurance Co. |
|
454-13-2445.M4 |
07-4045 |
Vista Hospital of Dallas |
Texas Mutual Insurance Co. |
|
454-13-2450.M4 |
07-7352 |
Vista Medical Center Hospital |
Texas Mutual Insurance Co. |
|
454-13-2538.M4 |
07-0709 |
Vista Medical Center Hospital |
Texas Mutual Insurance Co. |
|
454-13-2774.M4 |
08-0634 |
Surgery Specialty Hospital of America |
Texas Mutual Insurance Co. |
|
454-13-2776.M4 |
07-4976 |
Vista Medical Center Hospital |
Texas Mutual Insurance Co. |
|
454-13-3300.M4 |
08-4499 |
Vista Hospital of Dallas |
Texas Mutual Insurance Co. |
|
454-13-3303.M4 |
08-6241 |
Surgery Specialty Hospital of America SE Houston Campus |
Texas Mutual Insurance Co. |
|
454-13-3306.M4 |
07-5511 |
Vista Medical Center Hospital |
Texas Mutual Insurance Co. |
|
454-13-3307.M4 |
08-6160 |
Surgery Specialty Hospital of America SE Houston Campus |
Texas Mutual Insurance Co. |
|
454-13-3309.M4 |
06-7626 |
Vista Medical Center Hospital |
Texas Mutual Insurance Co. |
|
454-13-3312.M4 |
07-5191 |
Vista Hospital of Dallas |
Texas Mutual Insurance Co. |
|
454-13-3327.M4 |
06-7727 |
Vista Medical Center Hospital |
Texas Mutual Insurance Co. |
|
454-13-3334.M4 |
06-6823 |
Vista Medical Center Hospital |
Texas Mutual Insurance Co. |
|
454-13-3689.M4 |
06-5224 |
Vista Hospital of Dallas |
Texas Mutual Insurance Co. |
|
454-13-3691.M4 |
07-0727 |
Vista Medical Center Hospital |
Texas Mutual Insurance Co. |
ATTACHMENT A Vista Consolidated Stop-Loss Cases
Part 2 of 2
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-3694.M4 |
05-4551 |
Vista Hospital of Dallas |
Texas Mutual Insurance Co. |
|
454-13-4259.M4 |
07-5293 |
Vista Hospital of Dallas |
Texas Mutual Insurance Co. |
|
454-13-4381.M4 |
04-1080 |
Vista Medical Center Hospital |
Texas Mutual Insurance Co. |
|
454-13-4384.M4 |
07-3987 |
Vista Medical Center Hospital |
Texas Mutual Insurance Co. |
|
454-13-4386.M4 |
07-0576 |
Vista Hospital of Dallas |
Texas Mutual Insurance Co. |
|
454-13-4440.M4 |
07-4038 |
Vista Medical Center Hospital |
Texas Mutual Insurance Co. |
|
454-13-4444.M4 |
07-5512 |
Vista Medical Center Hospital |
Texas Mutual Insurance Co. |
|
454-13-4459.M4 |
08-4997 |
Vista Hospital of Dallas |
Texas Mutual Insurance Co. |
|
454-13-4461.M4 |
08-6154 |
Vista Hospital of Dallas |
Texas Mutual Insurance Co. |
|
454-13-4463.M4 |
09-3486 |
Vista Hospital of Dallas |
Texas Mutual Insurance Co. |
|
454-13-4568.M4 |
05-8002 |
Vista Hospital of Dallas |
Texas Mutual Insurance Co. |
|
454-13-4583.M4 |
03-9085 |
Vista Medical Center Hospital |
Texas Mutual Insurance Co. |
|
454-13-5035.M4 |
04-5349 |
Vista Medical Center Hospital |
Texas Mutual Insurance Co. |
|
454-13-5055.M4 |
06-2396 |
Vista Hospital of Dallas |
Texas Mutual Insurance Co. |
|
454-14-2857.M4 |
14-1734 |
Vista Medical Center Hospital |
Texas Mutual Insurance Co. |
|
454-14-2861.M4 |
14-1733 |
Vista Medical Center Hospital |
Texas Mutual Insurance Co. |
|
454-15-1335.M4 |
06-2223 |
Vista Medical Center Hospital |
Texas Mutual Insurance Co. |
|
454-15-1336.M4 |
05-6409 |
Vista Hospital of Dallas |
Texas Mutual Insurance Co. |
ATTACHMENT A Vista Consolidated Stop-Loss Cases
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-14-2085.M4 |
06-3910 |
Vista Medical Center Hospital |
Louisiana Pacific Corporation |
ATTACHMENT A Vista Consolidated Stop-Loss Cases
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-2140.M4 |
07-2209 |
Vista Hospital of Dallas |
American Home Assurance Co. |
|
454-13-3305.M4 |
07-5593 |
Vista Medical Center Hospital |
American Home Assurance Co. |
|
454-13-3321.M4 |
08-5502 |
Surgery Specialty Hospital of America SE Houston Campus |
American Home Assurance Co. |
|
454-13-3685.M4 |
09-5185 |
Vista Hospital of Dallas |
American Home Assurance Co. |
|
454-13-4278.M4 |
09-5344 |
Surgery Specialty Hospital of America |
American Home Assurance Co. |
ATTACHMENT A Vista Consolidated Stop-Loss Cases
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-1534.M4 |
07-3237 |
Vista Hospital of Dallas |
ABF Freight System, Inc. |
ATTACHMENT A Vista Consolidated Stop-Loss Cases
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-0604.M4 |
07-1490 |
Vista Medical Center Hospital |
Texas Department of Transportation |
|
454-13-2415.M4 |
06-6524 |
Vista Medical Center Hospital |
Texas Department of Transportation |
ATTACHMENT A Vista Consolidated Stop-Loss Cases
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-2187.M4 |
05-4763 |
Vista Medical Center Hospital |
State Office of Risk Management |
|
454-13-2456.M4 |
06-5284 |
Vista Hospital of Dallas |
State Office of Risk Management |
|
454-13-2465.M4 |
07-1518 |
Vista Hospital of Dallas |
State Office of Risk Management |
|
454-13-5181.M4 |
06-3938 |
Vista Medical Center Hospital |
State Office of Risk Management |
ATTACHMENT A Vista Consolidated Stop-Loss Cases
Part 1 of 3
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-12-7446.M4 |
06-1464 |
Vista Medical Center Hospital |
Twin City Fire Insurance Co. |
|
454-12-7449.M4 |
06-2240 |
Vista Medical Center Hospital |
Continental Cas. Co. |
|
454-12-7450.M4 |
06-2391 |
Vista Hospital of Dallas |
Valley Forge Insurance Co. |
|
454-12-7451.M4 |
06-2625 |
Vista Medical Center Hospital |
Continental Cas. Co. |
|
454-12-7452.M4 |
06-2973 |
Vista Hospital of Dallas |
Continental Cas. Co. |
|
454-12-7497.M4 |
06-0376 |
Vista Medical Center Hospital |
Benchmark Insurance Co. |
|
454-12-7501.M4 |
05-B626 |
Vista Medical Center Hospital |
Transportation Insurance Co. |
|
454-12-7502.M4 |
06-1568 |
Vista Medical Center Hospital |
Mid-Century Ins. Co. |
|
454-12-7505.M4 |
04-7872 |
Texas Hospital Insurance Exchange |
Vista Medical Center Hospital |
|
454-12-7514.M4 |
04-6524 |
Aberdeen Insur. Com |
Vista Medical Center Hospital |
|
454-12-7518.M4 |
05-2655 |
Twin City Fire Insurance Co. |
Vista Medical Center Hospital |
|
454-12-7709.M4 |
04-4839 |
Valley Forge Insurance Co. |
Vista Medical Center Hospital |
|
454-12-7711.M4 |
04-1629 |
Zenith Insurance Co. |
Vista Medical Center Hospital |
|
454-12-7713.M4 |
04-B490 |
Hartford Casualty Insurance Co. |
Vista Medical Center Hospital |
|
454-12-7716.M4 |
04-7849 |
Hartford Underwriters Insurance Co. |
Vista Medical Center Hospital |
|
454-12-7717.M4 |
03-A580 |
Twin City Fire Insurance Co. |
Vista Medical Center Hospital |
|
454-12-7728.M4 |
03-7954 |
TPCIGA for Reliance National Ins. |
Vista Medical Center Hospital |
|
454-12-7729.M4 |
03-8985 |
TPCIGA for Reliance National Ins. |
Vista Medical Center Hospital |
|
454-12-7731.M4 |
04-4031 |
TPCIGA for Reliance National Ins. |
Vista Medical Center Hospital |
|
454-12-7732.M4 |
04-3841 |
Mid-Century Ins. Co. |
Vista Medical Center Hospital |
|
454-12-7733.M4 |
05-6933 |
TPCIGA for United Pacific Ins. Co. |
Vista Medical Center Hospital |
|
454-12-7734.M4 |
04-6514 |
TPCIGA for Credit Genera Indem. |
Vista Medical Center Hospital |
|
454-12-7735.M4 |
04-7821 |
TPCIGA for Reliance National Ins. |
Vista Medical Center Hospital |
|
454-12-7736.M4 |
04-6054 |
TPCIGA for United Pacific Ins. Co. |
Vista Medical Center Hospital |
|
454-12-7738.M4 |
04-5607 |
TPCIGA for United Pacific Ins. Co. |
Vista Medical Center Hospital |
|
454-12-7740.M4 |
04-6048 |
Highland Insurance Co. |
Vista Medical Center Hospital |
|
454-12-7741.M4 |
04-5352 |
TPCIGA for Petrosurance Cas. Co. |
Vista Medical Center Hospital |
|
454-12-7742.M4 |
03-2228 |
TPCIGA for Petrosurance Cas. Co. |
Vista Medical Center Hospital |
|
454-12-7743.M4 |
03-1728 |
TPCIGA for United Pacific Ins. Co. |
Vista Medical Center Hospital |
|
454-12-7745.M4 |
05-1477 |
TPCIGA for Reliance National |
Vista Medical Center Hospital |
|
454-12-7747.M4 |
04-3359 |
TPCIGA for Reliance National |
Vista Medical Center Hospital |
|
454-12-7957.M4 |
04-3770 |
Valley Forge Insurance Co. |
Vista Medical Center Hospital |
|
454-12-7958.M4 |
03-3974 |
TPCIGA for Reliance National Ins. |
Vista Medical Center Hospital |
|
454-12-7959.M4 |
04-5383 |
Transcontinental Insurance Co. |
Vista Medical Center Hospital |
|
454-12-7960.M4 |
03-5820 |
Continental Cas. Co. |
Vista Medical Center Hospital |
|
454-12-7961.M4 |
04-2253 |
Am. Cas. Co. of Reading, PA |
Vista Medical Center Hospital |
|
454-12-7962.M4 |
04-6388 |
TPCIGA for Reliance National Ins. |
Vista Medical Center Hospital |
|
454-12-7963.M4 |
04-3351 |
TPCIGA for Legion Insurance Co. |
Vista Medical Center Hospital |
ATTACHMENT A Vista Consolidated Stop-Loss Cases
Part 2 of 3
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-12-7964.M4 |
05-3457 |
TPCIGA for Home Indemnity Co. |
Vista Medical Center Hospital |
|
454-12-7965.M4 |
03-8491 |
TPCIGA for Legion Insurance Co. |
Vista Medical Center Hospital |
|
454-13-0983.M4 |
07-7015 |
Vista Medical Center Hospital |
TPCIGA for Freestone Ins. fka Dallas Nat. Ins. Co. |
|
454-13-1118.M4 |
05-5193 |
Vista Hospital of Dallas |
Transportation Insurance Co. |
|
454-13-1119.M4 |
05-B619 |
Vista Hospital of Dallas |
TPCIGA for Legion Insurance Co. |
|
454-13-1120.M4 |
04-7834 |
Vista Medical Center Hospital |
Twin City Fire Insurance Co. |
|
454-13-1122.M4 |
06-2142 |
Vista Hospital of Dallas |
Hartford Underwriters Insurance Co. |
|
454-13-1124.M4 |
06-7709 |
Vista Hospital of Dallas |
Nat’l Fire Ins. Co. of Hartford |
|
454-13-1254.M4 |
07-4131 |
Vista Medical Center Hospital |
ACIG Insurance Co. |
|
454-13-1333.M4 |
06-5196 |
Vista Hospital of Dallas |
Am. Cas. Co. of Reading, PA |
|
454-13-1364.M4 |
08-6244 |
Surgery Specialty Hospital of America SE Houston Campus |
Twin City Fire Insurance Co. |
|
454-13-1367.M4 |
07-4009 |
Vista Medical Center Hospital |
TPCIGA for Petrosurance Cas. Co. |
|
454-13-2138.M4 |
07-1482 |
Vista Hospital of Dallas |
TPCIGA for Freestone Ins. fka Dallas Nat. Ins. Co. |
|
454-13-2420.M4 |
07-1594 |
Vista Hospital of Dallas |
TASB Risk Management Fund |
|
454-13-2438.M4 |
07-0120 |
Vista Hospital of Dallas |
Midwest Employers Casualty Co. |
|
454-13-2464.M4 |
06-0444 |
Vista Hospital of Dallas |
TPCIGA for Lumbermens Mutual Casualty Co. |
|
454-13-2517.M4 |
06-6002 |
Vista Hospital of Dallas |
National American Insurance Co. |
|
454-13-2520.M4 |
06-2351 |
Vista Hospital of Dallas |
Transportation Insurance Co. |
|
454-13-2540.M4 |
06-0627 |
Vista Medical Center Hospital |
TPCIGA for Freestone Insurance fka Dallas Nat. Ins. Co. |
|
454-13-2542.M4 |
03-3911 |
Vista Medical Center Hospital |
ACIG Insurance Co. |
|
454-13-2772.M4 |
07-3326 |
Vista Medical Center Hospital |
Aberdeen Insurance Co. |
|
454-13-3631.M4 |
09-3472 |
Vista Hospital of Dallas |
Fidelity & Guaranty Ins. Co. |
|
454-13-4367.M4 |
05-8699 |
Vista Hospital of Dallas |
TPCIGA for Lumbermens Mutual Casualty Co. |
|
454-13-4385.M4 |
07-5187 |
Vista Medical Center Hospital |
Highlands Casualty Co. |
|
454-13-4387.M4 |
07-1613 |
Vista Hospital of Dallas |
TPCIGA for Am. Motorists Ins. Co. |
|
454-13-4441.M4 |
07-4940 |
Vista Medical Center Hospital |
Truck Insurance Exchange |
|
454-13-4443.M4 |
07-5436 |
Vista Hospital of Dallas |
TASB Risk Management Fund |
|
454-13-4451.M4 |
07-8172 |
Vista Hospital of Dallas |
TASB Risk Management Fund |
|
454-13-4454.M4 |
08-0625 |
Vista Hospital of Dallas |
United State Fire Ins. Co. |
|
454-13-5037.M4 |
06-3888 |
Vista Medical Center Hospital |
TPCIGA for Reliance National Ins. |
|
454-13-5041.M4 |
08-6162 |
Vista Hospital of Dallas |
TPCIGA for Centennial Ins. Co. |
ATTACHMENT A Vista Consolidated Stop-Loss Cases
Part 3 of 3
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-5043.M4 |
06-3894 |
Vista Hospital of Dallas |
Continental Cas. Co. |
|
454-13-5052.M4 |
08-0113 |
Vista Hospital of Dallas |
National Fire Insurance |
|
454-13-5054.M4 |
03-7992 |
Vista Medical Center Hospital |
TPCIGA for Am. Motorists Ins. Co. |
|
454-13-5125.M4 |
05-2442 |
Vista Hospital of Dallas |
Am. Cas. Co. of Reading, PA |
|
454-13-5128.M4 |
05-A440 |
Vista Medical Center Hospital |
TPCIGA for American Manufacturers Mutual Ins. |
|
454-14-1844.M4 |
03-2847 |
Vista Medical Center Hospital |
Zenith Insurance Co. |
|
454-14-1846.M4 |
05-1993 |
Vista Medical Center Hospital |
Transcontinental Insurance Co. |
|
454-14-1851.M4 |
03-2265 |
Vista Medical Center Hospital |
TPCIGA for Reliance National |
|
454-14-1852.M4 |
03-2123 |
Vista Medical Center Hospital |
Hartford Casualty Ins. Co. |
|
454-14-1853.M4 |
03-6199 |
Vista Medical Center Hospital |
TPCIGA for Credit General Indemnity |
|
454-14-1854.M4 |
03-2230 |
Vista Medical Center Hospital |
Hartford Casualty Ins. Co. |
|
454-14-1855.M4 |
04-1001 |
Vista Medical Center Hospital |
Texas Builders Insurance Co. |
|
454-14-2077.M4 |
04-6031 |
Vista Medical Center Hospital |
TPCIGA for Fremont Indemnity Co. |
|
454-14-2078.M4 |
04-1024 |
Vista Medical Center Hospital |
TPCIGA for Petrosurance Cas. Co. |
|
454-14-2079.M4 |
04-6150 |
Vista Medical Center Hospital |
TPCIGA for Fremont Indemnity Co. |
|
454-14-2080.M4 |
04-4929 |
Vista Medical Center Hospital |
TPCIGA for Paula Ins. Co. |
|
454-14-2086.M4 |
07-1599 |
Vista Medical Center Hospital |
Mid-Century Ins. Co. |
|
454-14-2144.M4 |
04-6150 |
TPCIGA for Fremont Indemnity Co. |
Vista Medical Center Hospital |
|
454-14-2283.M4 |
03-2477 |
Vista Medical Center Hospital |
Mid-Century Ins. Co. |
|
454-15-1318.M4 |
08-6246 |
Surgery Specialty Hospitals of America |
TASB Risk Management Fund |
|
454-15-2438.M4 |
03-6225 |
Vista Medical Center Hospital |
Transcontinental Insurance Co. |
ATTACHMENT A Vista Consolidated Stop-Loss Cases
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-15-2434.M5 |
05-2400 |
Vista Medical Center Hospital |
Ace Insurance Co. of Texas |
|
454-15-2436.M5 |
05-2400 |
Ace Insurance Co. of Texas |
Vista Medical Center Hospital |
ATTACHMENT A Vista Consolidated Stop-Loss Cases
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-0416.M4 |
06-7050 |
Vista Medical Center Hospital |
Jacobs Engineering Group Inc. |
|
454-13-0530.M4 |
07-7030 |
Vista Medical Center Hospital |
Ace American Insurance Co. |
|
454-13-1361.M4 |
06-7656 |
Vista Hospital of Dallas |
Lockheed Martin Corp. |
|
454-13-1490.M4 |
07-7011 |
Vista Hospital of Dallas |
Insurance Co. of the State of PA |
|
454-13-1536.M4 |
07-0602 |
Vista Hospital of Dallas |
International Paper Co. |
|
454-13-1537.M4 |
07-3231 |
Vista Hospital of Dallas |
Ace American Insurance Co. |
|
454-13-2136.M4 |
08-1408 |
Vista Medical Center Hospital |
Ace American Insurance Co. |
|
454-13-2172.M4 |
07-2129 |
Vista Medical Center Hospital |
Lowes Home Center Inc. |
|
454-13-2173.M4 |
07-1020 |
Vista Medical Center Hospital |
Ace American Insurance Co. |
|
454-13-2177.M4 |
07-2600 |
Vista Medical Center Hospital |
Pacific Employers Insurance Co. |
|
454-13-2180.M4 |
04-6460 |
Vista Medical Center Hospital |
Pacific Employers Insurance Co. |
|
454-13-2414.M4 |
06-6271 |
Vista Medical Center Hospital |
Jacobs Engineering Group Inc. |
|
454-13-2446.M4 |
07-8177 |
Vista Hospital of Dallas |
American Zurich Insurance Co. |
|
454-13-2461.M4 |
06-1406 |
Vista Medical Center Hospital |
Illinois National Insurance Co. |
|
454-13-2466.M4 |
07-4012 |
Vista Hospital of Dallas |
Federal Insurance Co. |
|
454-13-3311.M4 |
07-7666 |
Vista Medical Center Hospital |
K Mart Corporation |
|
454-13-3324.M4 |
08-2806 |
Vista Hospital of Dallas |
Ace American Insurance Co. |
|
454-13-4584.M4 |
07-0668 |
Vista Medical Center Hospital |
Ace American Insurance Co. |
|
454-13-5039.M4 |
05-A692 |
Vista Hospital of Dallas |
Great Northern Insurance Co. |
|
454-13-5045.M4 |
06-6333 |
Vista Medical Center Hospital |
Insurance Co. of North America |
|
454-13-5177.M4 |
08-1498 |
Vista Hospital of Dallas |
Ace American Insurance Co. |
|
454-15-1313.M4 |
04-5632 |
Vista Medical Center Hospital |
Onebeacon Insurance Co. |
|
454-15-1334.M4 |
06-5881 |
Vista Medical Center Hospital |
Pacific Employers Insurance Co. |
|
454-15-2439.M4 |
04-3905 |
Vista Medical Center Hospital |
TPCIGA for Reliance National |
ATTACHMENT A Vista Consolidated Stop-Loss Cases
Part 1 of 3
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-0418.M4 |
06-2214 |
Vista Medical Center Hospital |
Liberty Mutual Fire Ins. Co. |
|
454-13-0423.M4 |
03-A371 |
Vista Medical Center Hospital |
Liberty Insurance Corporation |
|
454-13-0523.M4 |
06-5230 |
Vista Hospital of Dallas |
Liberty Insurance Corporation |
|
454-13-0603.M4 |
05-5455 |
Vista Hospital of Dallas |
Liberty Mutual Fire Ins. Co. |
|
454-13-0895.M4 |
08-6919 |
Vista Hospital of Dallas |
Liberty Insurance Corporation |
|
454-13-1461.M4 |
05-8119 |
Vista Medical Center Hospital |
Liberty Insurance Corporation |
|
454-13-1542.M4 |
07-0575 |
Vista Hospital of Dallas |
Liberty Insurance Corporation |
|
454-13-1549.M4 |
06-3108 |
Vista Hospital of Dallas |
Wausau Underwriters Ins. Co. |
|
454-13-2132.M4 |
07-0614 |
Vista Hospital of Dallas |
Liberty Mutual Fire Ins. Co. |
|
454-13-2139.M4 |
08-1644 |
Vista Hospital of Dallas |
Liberty Mutual Fire Ins. Co. |
|
454-13-2179.M4 |
06-6129 |
Vista Medical Center Hospital |
Liberty Mutual Fire Ins. Co. |
|
454-13-2182.M4 |
07-2672 |
Vista Hospital of Dallas |
American States Ins. Co. of Texas |
|
454-13-2186.M4 |
03-7974 |
Vista Medical Center Hospital |
Employers Insurance Co. of Wausau |
|
454-13-2189.M4 |
07-2647 |
Vista Hospital of Dallas |
Employers Insurance Co. of Wausau |
|
454-13-2192.M4 |
05-A559 |
Vista Hospital of Dallas |
Liberty Insurance Corporation |
|
454-13-2416.M4 |
08-1288 |
Vista Hospital of Dallas |
Liberty Insurance Corporation |
|
454-13-2417.M4 |
03-8976 |
Vista Medical Center Hospital |
Liberty Insurance Corporation |
|
454-13-2428.M4 |
09-6371 |
Surgery Specialty Hospital of America SE Houston Campus |
Liberty Insurance Corporation |
|
454-13-2435.M4 |
08-1645 |
Vista Hospital of Dallas |
Liberty Insurance Corporation |
|
454-13-2441.M4 |
06-5150 |
Vista Medical Center Hospital |
Service Lloyds Insurance Co. |
|
454-13-2468.M4 |
04-5545 |
Vista Medical Center Hospital |
Texas Association of Counties RMP |
|
454-13-2473.M4 |
04-0081 |
Vista Medical Center Hospital |
Liberty Mutual Fire Ins. Co. |
|
454-13-2475.M4 |
08-1415 |
Vista Hospital of Dallas |
LM Insurance Corporation |
|
454-13-2577.M4 |
06-6003 |
Vista Medical Center Hospital |
Texas Association of Counties RMP |
|
454-13-2871.M4 |
04-4847 |
Vista Medical Center Hospital |
Wausau Business Insurance Co. |
|
454-13-3320.M4 |
06-7710 |
Vista Hospital of Dallas |
Liberty Insurance Corporation |
|
454-13-3328.M4 |
06-7494 |
Vista Hospital of Dallas |
Liberty Mutual Fire Ins. Co. |
|
454-13-3331.M4 |
07-3126 |
Vista Medical Center Hospital |
Liberty Mutual Fire Ins. Co. |
|
454-13-3680.M4 |
06-6032 |
Vista Medical Center Hospital |
Liberty Mutual Ins. Co. |
|
454-13-3686.M4 |
07-6977 |
Vista Medical Center Hospital |
Liberty Insurance Corporation |
|
454-13-3690.M4 |
06-6820 |
Vista Medical Center Hospital |
Liberty Mutual Ins. Co. |
|
454-13-4263.M4 |
07-7414 |
Vista Hospital of Dallas |
Liberty Insurance Corporation |
|
454-13-4265.M4 |
08-1297 |
Vista Hospital of Dallas |
LM Insurance Corporation |
|
454-13-4275.M4 |
07-7007 |
Vista Hospital of Dallas |
Liberty Insurance Corporation |
|
454-13-4368.M4 |
05-A469 |
Vista Hospital of Dallas |
Liberty Insurance Corporation |
ATTACHMENT A Vista Consolidated Stop-Loss Cases
Part 2 of 3
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-4374.M4 |
05-A515 |
Vista Hospital of Dallas |
Liberty Insurance Corporation |
|
454-13-4375.M4 |
05-B128 |
Vista Hospital of Dallas |
Liberty Mutual Ins. Co. |
|
454-13-4462.M4 |
08-6245 |
Surgery Specialty Hospital of America |
Liberty Mutual Fire Ins. Co. |
|
454-13-5040.M4 |
06-5251 |
Vista Hospital of Dallas |
Liberty Mutual Fire Ins. Co. |
|
454-13-5126.M4 |
07-7344 |
Vista Medical Center Hospital |
Liberty Mutual Fire Ins. Co. |
|
454-13-5134.M4 |
09-7537 |
Vista Hospital of Dallas |
Liberty Mutual Fire Ins. Co. |
|
454-13-5164.M4 |
07-8178 |
Vista Hospital of Dallas |
LM Insurance Corporation |
|
454-13-5180.M4 |
08-3896 |
Vista Hospital of Dallas |
Liberty Insurance Corporation |
|
454-14-2285.M4 |
06-1982 |
Vista Medical Center Hospital |
Liberty Mutual Ins. Co. |
|
454-15-0048.M4 |
05-B552 |
Vista Hospital of Dallas |
Liberty Mutual Fire Ins. Co. |
|
454-15-0049.M4 |
04-0014 |
Vista Medical Center Hospital |
Employers Insurance Co. of Wausau |
|
454-15-0050.M4 |
05-B571 |
Vista Hospital of Dallas |
Liberty Mutual Fire Ins. Co. |
|
454-15-0051.M4 |
04-0486 |
Vista Medical Center Hospital |
Liberty Mutual Fire Ins. Co. |
|
454-15-0053.M4 |
03-2238 |
Vista Medical Center Hospital |
Liberty Mutual Ins. Co. |
|
454-15-0056.M4 |
03-6050 |
Vista Medical Center Hospital |
Liberty Insurance Corporation |
|
454-15-0057.M4 |
05-1115 |
Vista Hospital of Dallas |
Liberty Mutual Fire Ins. Co. |
|
454-15-0058.M4 |
03-1595 |
Vista Medical Center Hospital |
Liberty Insurance Corporation |
|
454-15-0059.M4 |
03-2194 |
Vista Medical Center Hospital |
Liberty Mutual Fire Ins. Co. |
|
454-15-0060.M4 |
03-2149 |
Vista Medical Center Hospital |
Wausau Underwriters Ins. Co. |
|
454-15-0061.M4 |
03-2229 |
Vista Medical Center Hospital |
LM Insurance Corporation |
|
454-15-0302.M4 |
03-1819 |
Vista Medical Center Hospital |
Liberty Mutual Fire Ins. Co. |
|
454-15-0303.M4 |
03-5571 |
Vista Medical Center Hospital |
Mid-Century Ins. Co. |
|
454-15-0304.M4 |
03-3045 |
Vista Medical Center Hospital |
Employers Ins. Co. of Wausau |
|
454-15-0305.M4 |
03-5855 |
Vista Medical Center Hospital |
Liberty Insurance Corporation |
|
454-15-0306.M4 |
03-5536 |
Vista Medical Center Hospital |
Employers Ins. Co. of Wausau |
|
454-15-0376.M4 |
04-7875 |
Vista Medical Center Hospital |
Liberty Insurance Corporation |
|
454-15-0378.M4 |
04-7893 |
Vista Medical Center Hospital |
Liberty Mutual Fire Ins. Co. |
|
454-15-0379.M4 |
04-8101 |
Vista Medical Center Hospital |
Liberty Mutual Fire Ins. Co. |
|
454-15-0381.M4 |
04-7825 |
Vista Medical Center Hospital |
Liberty Mutual Fire Ins. Co. |
|
454-15-0383.M4 |
04-7847 |
Vista Medical Center Hospital |
Liberty Mutual Fire Ins. Co. |
|
454-15-0384.M4 |
04-2251 |
Vista Medical Center Hospital |
Liberty Mutual Fire Ins. Co. |
|
454-15-0385.M4 |
04-5555 |
Vista Medical Center Hospital |
Employers Ins. Co. of Wausau |
|
454-15-0386.M4 |
04-3435 |
Vista Medical Center Hospital |
Employers Ins. Co. of Wausau |
|
454-15-0387.M4 |
04-6058 |
Vista Medical Center Hospital |
Liberty Mutual Fire Ins. Co. |
|
454-15-0388.M4 |
04-3571 |
Vista Medical Center Hospital |
Liberty Mutual Fire Ins. Co. |
ATTACHMENT A Vista Consolidated Stop-Loss Cases
Part 3 of 3
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-15-0389.M4 |
03-7251 |
Vista Medical Center Hospital |
Liberty Mutual Fire Ins. Co. |
|
454-15-0390.M4 |
04-0084 |
Vista Medical Center Hospital |
Liberty Mutual Ins. Co. |
|
454-15-0391.M4 |
03-9076 |
Vista Medical Center Hospital |
Liberty Mutual Ins. Co. |
|
454-15-0392.M4 |
04-1206 |
Vista Medical Center Hospital |
LM Insurance Co. |
|
454-15-0393.M4 |
03-9462 |
Vista Medical Center Hospital |
Liberty Insurance Corporation |
|
454-15-0559.M4 |
05-8455 |
Vista Hospital of Dallas |
Liberty Mutual Fire Ins. Co. |
|
454-15-0560.M4 |
05-B628 |
Vista Hospital of Dallas |
Liberty Mutual Fire Ins. Co. |
|
454-15-0562.M4 |
06-2263 |
Vista Hospital of Dallas |
Liberty Mutual Fire Ins. Co. |
|
454-15-0563.M4 |
05-2671 |
Vista Hospital of Dallas |
Liberty Insurance Corporation |
|
454-15-0564.M4 |
05-5333 |
Vista Medical Center Hospital |
Liberty Mutual Fire Ins. Co. |
|
454-15-0565.M4 |
05-2675 |
Vista Hospital of Dallas |
Employers Ins. Co. of Wausau |
|
454-15-0566.M4 |
05-6932 |
Vista Medical Center Hospital |
Liberty Mutual Fire Ins. Co. |
|
454-15-0568.M4 |
05-1648 |
Vista Medical Center Hospital |
Liberty Mutual Ins. Co. |
|
454-15-0569.M4 |
05-2051 |
Vista Medical Center Hospital |
Liberty Mutual Fire Ins. Co. |
|
454-15-0571.M4 |
05-2669 |
Vista Hospital of Dallas |
Liberty Mutual Fire Ins. Co. |
|
454-15-0572.M4 |
05-2050 |
Vista Medical Center Hospital |
Liberty Mutual Fire Ins. Co. |
|
454-15-0598.M4 |
04-7891 |
Vista Medical Center Hospital |
Liberty Mutual Fire Ins. Co. |
|
454-15-0602.M4 |
04-5369 |
Vista Medical Center Hospital |
Liberty Insurance Corporation |
|
454-15-0708.M4 |
04-0263 |
Vista Medical Center Hospital |
Employers Ins. Co. of Wausau |
|
454-15-0710.M4 |
06-2643 |
Vista Hospital of Dallas |
Liberty Insurance Corporation |
|
454-15-0712.M4 |
05-3533 |
Vista Hospital of Dallas |
Liberty Insurance Corporation |
|
454-15-0713.M4 |
04-A011 |
Vista Medical Center Hospital |
Liberty Insurance Corporation |
|
454-15-0715.M4 |
04-5685 |
Vista Medical Center Hospital |
Liberty Insurance Corporation |
|
454-15-0716.M4 |
04-6407 |
Vista Medical Center Hospital |
JC Penny Corporation Inc. |
|
454-15-0717.M4 |
04-5990 |
Vista Medical Center Hospital |
Liberty Mutual Fire Ins. Co. |
|
454-15-0718.M4 |
04-6331 |
Vista Medical Center Hospital |
LM Insurance Corporation |
|
454-16-0691.M4 |
03-9105 |
Vista Medical Center Hospital |
Liberty Mutual Fire Ins. Co. |
ATTACHMENT A Vista Consolidated Stop-Loss Cases
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-4254.M4 |
08-0133 |
Vista Hospital of Dallas |
University of Texas System |
ATTACHMENT A Vista Consolidated Stop-Loss Cases
Page 1 of 5
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-12-1961.M4 |
06-6001 |
Vista Medical Center Hospital |
Zurich American Insurance Co. |
|
454-12-2515.M4 |
06-5999 |
Vista Medical Center Hospital |
Insurance Co. of the State of PA |
|
454-12-4717.M4 |
06-6813 |
Vista Medical Center Hospital |
American Home Assurance Co. |
|
454-12-5113.M4 |
04-4886 |
Vista Medical Center Hospital |
Insurance Co. of the State of PA |
|
454-12-5429.M4 |
05-2357 |
Vista Hospital of Dallas |
Sentry Insurance Co. |
|
454-12-5431.M4 |
05-6406 |
Vista Hospital of Dallas |
Zurich American Insurance Co. |
|
454-12-5500.M4 |
05-6722 |
Vista Hospital of Dallas |
Insurance Co. of the State of PA |
|
454-12-5562.M4 |
06-0427 |
Vista Hospital of Dallas |
Dallas ISD |
|
454-12-5563.M4 |
05-B068 |
Vista Hospital of Dallas |
Amer. Guarantee & Liability Ins. |
|
454-12-5565.M4 |
06-2096 |
Vista Hospital of Dallas |
Albertsons Inc. |
|
454-12-5566.M4 |
05-9499 |
Vista Hospital of Dallas |
RCH Protect Cooperative |
|
454-12-5568.M4 |
05-1381 |
Vista Medical Center Hospital |
American Home Assurance Co. |
|
454-12-5569.M4 |
06-6231 |
Vista Medical Center Hospital |
Commerce & Industry Ins. Co. |
|
454-12-5858.M4 |
05-2250 |
Vista Medical Center Hospital |
Zurich American Insurance Co. |
|
454-12-5859.M4 |
04-6132 |
Vista Medical Center Hospital |
Illinois National Ins. Co. |
|
454-12-5860.M4 |
05-A450 |
Vista Medical Center Hospital |
American Zurich Insurance Co. |
|
454-12-5861.M4 |
06-2054 |
Vista Hospital of Dallas |
Zurich American Insurance Co. |
|
454-12-5864.M4 |
06-6082 |
Vista Medical Center Hospital |
Fidelity & Guaranty Ins. Co. |
|
454-12-5957.M4 |
06-6819 |
Vista Medical Center Hospital |
Commerce & Industry Ins. Co. |
|
454-12-5958.M4 |
06-7047 |
Vista Medical Center Hospital |
Commerce & Industry Ins. Co. |
|
454-12-6021.M4 |
08-0068 |
Vista Hospital of Dallas |
Zurich American Insurance Co. |
|
454-12-6121.M4 |
05-8105 |
Vista Medical Center Hospital |
Facility Insurance Corp. |
|
454-12-6572.M4 |
06-6235 |
Vista Medical Center Hospital |
TML Intergovernmental Risk Pool |
|
454-12-7032.M4 |
06-6080 |
Vista Medical Center Hospital |
Facility Insurance Corp. |
|
454-12-7146.M4 |
03-7989 |
Vista Medical Center Hospital |
American Zurich Insurance Co. |
|
454-12-7149.M4 |
06-7060 |
Vista Medical Center Hospital |
Fidelity & Guaranty Ins. Co. |
|
454-12-7150.M4 |
06-6795 |
Vista Medical Center Hospital |
Commerce & Industry Ins. Co. |
|
454-12-7312.M4 |
07-0731 |
Vista Medical Center Hospital |
Zurich American Insurance Co. |
|
454-12-7313.M4 |
07-2867 |
Vista Medical Center Hospital |
Zurich American Insurance Co. |
|
454-12-7314.M4 |
09-3488 |
Vista Hospital of Dallas |
Zurich American Insurance Co. |
|
454-12-7316.M4 |
07-0172 |
Vista Hospital of Dallas |
Zurich American Insurance Co. |
|
454-12-7320.M4 |
06-6826 |
Vista Medical Center Hospital |
Zurich American Insurance Co. |
|
454-12-7333.M4 |
07-4046 |
American Home Assurance Co. |
Vista Medical Center Hospital |
|
454-12-7495.M4 |
04-6315 |
Vista Medical Center Hospital |
American Insurance Co. |
|
454-12-7838.M4 |
06-1611 |
Facility Insurance Corp. |
Vista Medical Center Hospital |
|
454-13-0105.M4 |
07-4673 |
American Guarantee & Liability Ins. |
Vista Hospital of Dallas |
|
454-13-0106.M4 |
07-1021 |
Employers Mutual Casualty Co. |
Vista Hospital of Dallas |
ATTACHMENT A Vista Consolidated Stop-Loss Cases
Page 2 of 5
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-0107.M4 |
08-5035 |
American Guarantee & Liability Ins. |
Vista Hospital of Dallas |
|
454-13-0108.M4 |
07-4151 |
Zurich American Insurance Co. |
Vista Medical Center Hospital |
|
454-13-0140.M4 |
06-0659 |
Gray Insurance Co. |
Vista Medical Center Hospital |
|
454-13-0517.M4 |
09-6009 |
Surgery Specialty Hospital of Amer. |
Amer. Guarantee & Liability Ins. |
|
454-13-0518.M4 |
09-4686 |
Vista Hospital of Dallas |
Insurance Co. of the State of PA |
|
454-13-0519.M4 |
09-2399 |
Surgery Specialty Hospital of Amer. |
Zurich American Insurance Co. |
|
454-13-0520.M4 |
07-0060 |
Vista Hospital of Dallas |
Zurich American Insurance Co. |
|
454-13-0521.M4 |
07-0600 |
Vista Hospital of Dallas |
Dallas ISD |
|
454-13-0524.M4 |
06-6000 |
Vista Hospital of Dallas |
East TX Educational Ins. Assoc. |
|
454-13-0525.M4 |
06-6004 |
Vista Medical Center Hospital |
Commerce & Industry Ins. Co. |
|
454-13-0526.M4 |
07-0601 |
Vista Hospital of Dallas |
Amer. Guarantee & Liability Ins. |
|
454-13-0527.M4 |
07-1868 |
Vista Hospital of Dallas |
Amer. Guarantee & Liability Ins. |
|
454-13-0529.M4 |
07-4151 |
Vista Medical Center Hospital |
Zurich American Insurance Co. |
|
454-13-0531.M4 |
07-7038 |
Vista Hospital of Dallas |
Insurance Co. of the State of PA |
|
454-13-0532.M4 |
08-0199 |
Vista Hospital of Dallas |
Zurich American Insurance Co. |
|
454-13-0896.M4 |
08-4985 |
Vista Medical Center Hospital |
Commerce & Industry Ins. Co. |
|
454-13-1278.M4 |
09-6011 |
Surgery Specialty Hospital of American SE Houston Campus |
Ace American Insurance Co. |
|
454-13-1406.M4 |
07-3984 |
Vista Medical Center Hospital |
American Home Assurance Co. |
|
454-13-1407.M4 |
07-8133 |
Vista Medical Center Hospital |
Zurich American Insurance Co. |
|
454-13-1408.M4 |
07-4026 |
Vista Hospital of Dallas |
Zurich American Insurance Co. |
|
454-13-1409.M4 |
07-0726 |
Vista Hospital of Dallas |
Harbor Specialty Insurance Co. |
|
454-13-1410.M4 |
07-3130 |
Vista Medical Center Hospital |
Insurance Co. of the State of PA |
|
454-13-1411.M4 |
08-1472 |
Vista Hospital of Dallas |
Commerce & Industry Ins. Co. |
|
454-13-1412.M4 |
07-3222 |
Vista Medical Center Hospital |
Fidelity & Guaranty Insurance Co. |
|
454-13-1463.M4 |
07-4000 |
Vista Hospital of Dallas |
New Hampshire Insurance Co. |
|
454-13-1464.M4 |
08-1294 |
Vista Hospital of Dallas |
New Hampshire Insurance Co. |
|
454-13-1465.M4 |
07-3993 |
Vista Medical Center Hospital |
Insurance Co. of the State of PA |
|
454-13-1466.M4 |
08-2803 |
Vista Medical Center Hospital |
American Home Assurance Co. |
|
454-13-1467.M4 |
07-4010 |
Vista Hospital of Dallas |
Zurich American Insurance Co. |
|
454-13-1468.M4 |
08-2804 |
Vista Hospital of Dallas |
Sentry Insurance Co. |
|
454-13-1469.M4 |
07-3972 |
Vista Medical Center Hospital |
Insurance Co. of the State of PA |
|
454-13-1470.M4 |
08-5039 |
Vista Medical Center Hospital |
Insurance Co. of the State of PA |
|
454-13-1471.M4 |
08-1305 |
Vista Hospital of Dallas |
American Home Assurance Co. |
|
454-13-1472.M4 |
07-2077 |
Vista Medical Center Hospital |
Insurance Co. of the State of PA |
|
454-13-1486.M4 |
06-2925 |
Vista Hospital of Dallas |
American Home Assurance Co. |
|
454-13-1491.M4 |
09-6427 |
Vista Hospital of Dallas |
Zurich American Insurance Co. |
ATTACHMENT A Vista Consolidated Stop-Loss Cases
Page 3 of 5
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-1492.M4 |
07-7022 |
Vista Medical Center Hospital |
Sentry Insurance Co. |
|
454-13-1493.M4 |
07-7857 |
Vista Medical Center Hospital |
Bituminous Cas. Corporation |
|
454-13-1535.M4 |
07-7768 |
Vista Hospital of Dallas |
Federated Mutual Insurance Co. |
|
454-13-1540.M4 |
09-6031 |
Vista Hospital of Dallas |
American Home Assurance Co. |
|
454-13-1541.M4 |
08-1441 |
Vista Hospital of Dallas |
New Hampshire Insurance Co. |
|
454-13-1545.M4 |
08-2355 |
Vista Hospital of Dallas |
Insurance Co. of the State of PA |
|
454-13-2121.M4 |
03-9084 |
Vista Medical Center Hospital |
Continental Cas. Co. |
|
454-13-2125.M4 |
07-2680 |
Vista Hospital of Dallas |
Zurich American Insurance Co. |
|
454-13-2129.M4 |
07-1008 |
Vista Hospital of Dallas |
Hartford Underwriters Ins. Co. |
|
454-13-2130.M4 |
07-4044 |
Vista Hospital of Dallas |
East TX Educational Ins. Assoc. |
|
454-13-2131.M4 |
08-6248 |
Vista Hospital of Dallas |
American Home Assurance Co. |
|
454-13-2141.M4 |
07-4673 |
Vista Hospital of Dallas |
American Guarantee & Liability Ins. |
|
454-13-2176.M4 |
08-6247 |
Surgery Specialty Hospital of America SE Houston Campus |
Zurich American Insurance Co. |
|
454-13-2190.M4 |
03-8005 |
Vista Medical Center Hospital |
Lumbermens Mutual Casualty Co. |
|
454-13-2432.M4 |
08-6161 |
Vista Hospital of Dallas |
East TX Educational Ins. Assoc. |
|
454-13-2437.M4 |
08-2899 |
Vista Hospital of Dallas |
Zurich American Insurance Co. |
|
454-13-2452.M4 |
07-2180 |
Vista Medical Center Hospital |
Zurich American Insurance Co. |
|
454-13-2453.M4 |
08-1749 |
Vista Hospital of Dallas |
American Home Assurance Co. |
|
454-13-2455.M4 |
07-0728 |
Vista Hospital of Dallas |
American Home Assurance Co. |
|
454-13-2462.M4 |
08-1293 |
Vista Medical Center Hospital |
America First Lloyds Insurance |
|
454-13-2463.M4 |
05-B592 |
Vista Hospital of Dallas |
TML Intergovernmental Risk Pool |
|
454-13-2476.M4 |
06-6236 |
Vista Medical Center Hospital |
Commerce & Industry Ins. Co. |
|
454-13-2477.M4 |
06-5234 |
Vista Hospital of Dallas |
American Insurance Co. |
|
454-13-2514.M4 |
07-3199 |
Vista Hospital of Dallas |
Royal Ins. Co. of America |
|
454-13-2541.M4 |
05-B563 |
Vista Hospital of Dallas |
Zurich American Insurance Co. |
|
454-13-2723.M4 |
07-4046 |
Vista Medical Center Hospital |
American Home Assurance Co. |
|
454-13-2866.M4 |
07-1012 |
Vista Medical Center Hospital |
Commerce & Industry Ins. Co. |
|
454-13-2867.M4 |
07-0952 |
Vista Medical Center Hospital |
Amer. Guarantee & Liability Ins. |
|
454-13-2868.M4 |
07-0091 |
Vista Medical Center Hospital |
Amer. Guarantee & Liability Ins. |
|
454-13-2870.M4 |
06-2156 |
Vista Hospital of Dallas |
WC Solutions |
|
454-13-2872.M4 |
06-1611 |
Vista Medical Center Hospital |
Facility Insurance Corp. |
|
454-13-3168.M4 |
07-0110 |
Vista Hospital of Dallas |
Nationwide Mutual Fire Ins. Co. |
|
454-13-3187.M4 |
07-0110 |
Nationwide Mutual Fire Ins. Co. |
Vista Hospital of Dallas |
|
454-13-3317.M4 |
07-4294 |
Vista Hospital of Dallas |
TPCIGA for Reliance National |
|
454-13-3325.M4 |
07-2857 |
Vista Hospital of Dallas |
Liberty Mutual Fire Ins. Co. |
ATTACHMENT A Vista Consolidated Stop-Loss Cases
Page 4 of 5
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-3410.M4 |
08-5573 |
Surgery Specialty Hospital of America SE Houston Campus |
Old Glory Insurance Co. |
|
454-13-3687.M4 |
07-1591 |
Vista Medical Center Hospital |
Royal Ins. Co. of America |
|
454-13-3688.M4 |
08-4938 |
Vista Medical Center Hospital |
Houston General Insurance Co. |
|
454-13-3987.M4 |
08-4929 |
Vista Hospital of Dallas |
Facility Insurance Corp. |
|
454-13-4271.M4 |
05-7994 |
Vista Medical Center Hospital |
Beaumont ISD |
|
454-13-4377.M4 |
06-2094 |
Vista Hospital of Dallas |
Security Insurance Co. of Hartford |
|
454-13-4383.M4 |
04-7873 |
Vista Medical Center Hospital |
Target Corporation |
|
454-13-4437.M4 |
07-2705 |
Vista Medical Center Hospital |
American Zurich Insurance Co. |
|
454-13-4439.M4 |
07-4011 |
Vista Medical Center Hospital |
Houston General Insurance Co. |
|
454-13-4446.M4 |
07-7388 |
Vista Medical Center Hospital |
Houston General Insurance Co. |
|
454-13-4450.M4 |
07-8009 |
Vista Hospital of Dallas |
Federated Mutual Ins. Co. |
|
454-13-4455.M4 |
08-1389 |
Vista Hospital of Dallas |
Old Republic Insurance Co. |
|
454-13-4456.M4 |
08-1659 |
Vista Hospital of Dallas |
Hartford Underwriters Ins. Co. |
|
454-13-4458.M4 |
08-4982 |
Surgery Specialty Hospital of America |
Federated Mutual Ins. Co. |
|
454-13-4460.M4 |
08-5430 |
Surgery Specialty Hospital of America |
TML Intergovernmental Risk Pool |
|
454-13-4464.M4 |
09-5953 |
Vista Hospital of Dallas |
American Home Assurance Co. |
|
454-13-4466.M4 |
09-6308 |
Surgery Specialty Hospital of America |
Commerce & Industry Ins. Co. |
|
454-13-4577.M4 |
03-2855 |
Vista Medical Center Hospital |
Ace Insurance Co. of Texas |
|
454-13-4585.M4 |
08-6250 |
Surgery Specialty Hospital of America |
Amer. Guarantee & Liability Ins. |
|
454-13-5036.M4 |
06-5138 |
Vista Hospital of Dallas |
St. Paul Fire & Marine Ins. Co. |
|
454-13-5130.M4 |
09-4878 |
Surgery Specialty Hospital of America |
Indemnity Insurance Co. of North |
|
454-13-5168.M4 |
05-8432 |
Vista Hospital of Dallas |
Zurich American Insurance Co. |
|
454-13-5171.M4 |
04-3345 |
Vista Medical Center Hospital |
Insurance Co. of the State of PA |
|
454-13-6110.M4 |
06-5310 |
Vista Hospital of Dallas |
American Home Assurance Co. |
|
454-14-0080.M4 |
07-7741 |
VHD 0 SSIC |
Sentry Insurance Co. |
|
454-14-0081.M4 |
03-5858 |
Vista Medical Center Hospital |
Zurich American Insurance Co. |
|
454-14-0468.M4 |
07-8170 |
Vista Medical Center Hospital |
American Zurich Insurance Co. |
|
454-14-2363.M4 |
09-4874 |
Surgery Specialty Hospital of America |
Zurich American Insurance Co. |
|
454-14-2394.M4 |
07-6990 |
Vista Hospital of Dallas |
WC Solutions |
|
454-14-2858.M4 |
09-6270 |
Vista Hospital of Dallas |
American Home Assurance Co. |
|
454-15-1312.M4 |
07-4048 |
Vista Hospital of Dallas |
Albertson Inc. |
ATTACHMENT A Vista Consolidated Stop-Loss Cases
Page 5 of 5
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-15-1316.M4 |
07-4629 |
Vista Medical Center Hospital |
Commerce & Industry Ins. Co. |
|
454-15-1317.M4 |
07-8215 |
Vista Medical Center Hospital |
Zurich American Insurance Co. |
|
454-15-1319.M4 |
08-0064 |
Vista Hospital of Dallas |
Fidelity & Guaranty Insurance Co. |
|
454-15-1320.M4 |
08-0067 |
Vista Hospital of Dallas |
Insurance Co. of the State of PA |
|
454-15-1330.M4 |
07-3992 |
Vista Medical Center Hospital |
American Home Assurance Co. |
|
454-15-1331.M4 |
07-2666 |
Vista Hospital of Dallas |
American Guarantee & Liability Ins. |
|
454-15-1333.M4 |
07-0122 |
Vista Hospital of Dallas |
Dallas ISD |
ATTACHMENT A Vista Consolidated Stop-Loss Cases
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-3314.M4 |
08-2856 |
Vista Hospital of Dallas |
Dallas County |
ATTACHMENT A Vista Consolidated Stop-Loss Cases
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-0522.M4 |
06-5151 |
Vista Medical Center Hospital |
Bankers Standard Insurance Co. |
|
454-13-1543.M4 |
06-2213 |
Vista Hospital of Dallas |
Bankers Standard Insurance Co. |
ATTACHMENT A Vista Consolidated Stop-Loss Cases
|
SOAH DKT NO. |
MR NO. |
PETITIONER |
RESPONDENT |
|
454-13-1487.M4 |
05-4623 |
Vista Hospital of Dallas |
Insurance Co. of the State of PA |
|
454-13-2184.M4 |
07-8134 |
Vista Hospital of Dallas |
St. Paul Fire & Marine Ins. Co. |
|
454-13-2423.M4 |
07-2127 |
Vista Hospital of Dallas |
Travelers Indemnity Co. of Connecticut |
|
454-13-2424.M4 |
06-0415 |
Vista Hospital of Dallas |
Travelers Indemnity Co. of Connecticut |
|
454-13-2425.M4 |
04-5059 |
Vista Medical Center Hospital |
MetLife Insurance Co. of Conn. |
|
454-13-3679.M4 |
08-4935 |
Vista Hospital of Dallas |
Travelers Indemnity Co. of Connecticut |
|
454-13-4274.M4 |
07-4685 |
Vista Hospital of Dallas |
Travelers Indemnity Co. |
|
454-13-4364.M4 |
04-8156 |
Vista Medical Center Hospital |
Travelers Indemnity Co. of Connecticut |
|
454-13-4376.M4 |
05-B242 |
Vista Medical Center Hospital |
Travelers Casualty & Surety Co. |
|
454-13-4382.M4 |
04-1365 |
Vista Medical Center Hospital |
Travelers Indemnity Co. of Connecticut |
|
454-13-4445.M4 |
07-7047 |
Vista Hospital of Dallas |
St. Paul Fire & Marine Ins. Co. |
|
454-13-4447.M4 |
07-7417 |
Vista Hospital of Dallas |
St. Paul Fire & Marine Ins. Co. |
|
454-13-4448.M4 |
07-7667 |
Vista Hospital of Dallas |
Travelers Indemnity Co. of Connecticut |
|
454-13-4449.M4 |
07-7742 |
Vista Hospital of Dallas |
St. Paul Fire & Marine Ins. Co. |
|
454-13-5056.M4 |
03-3672 |
Vista Medical Center Hospital |
Travelers Indemnity Co. of America |
|
454-13-2860.M4 |
07-4122 |
Vista Hospital of Dallas |
Travelers Property Casualty Co. |
|
454-13-1314.M4 |
03-A346 |
Vista Medical Center Hospital |
Phoenix Insurance Co. |
ATTACHMENT 1
Page 1 of 1
CASE REIMBURSED UNDER STOP-LOSS EXCEPTION
|
NO. |
SOAH Dkt. No. |
MR No. |
Post Audit Billed Charges |
Total Owed |
Carrier Payment |
Additional Reimbursement Owed to Provider |
|---|---|---|---|---|---|---|
|
1 |
454-13-3309.M4 |
06-7626 |
$273,647.84 |
$205,235.88 |
$138,430.13 |
$66,805.75 |
|
2 |
454-12-7728.M4 |
03-7954 |
$173,888.29 |
$130,416.22 |
$74,551.05 |
$55,865.17 |
|
3 |
454-12-7958.M4 |
03-3974 |
$164,005.28 |
$123,003.96 |
$106,574.45 |
$16,429.51 |
|
4 |
454-13-5128.M4 |
05-A440 |
$392,539.86 |
$294,404.90 |
$88,519.32 |
$205,885.58 |
|
5 |
454-13-2180.M4 |
04-6460 |
$119,518.49 |
$89,638.87 |
$14,873.80 |
$74,765.07 |
|
6 |
454-13-0423.M4 |
03-A371 |
$197,188.79 |
$147,891.59 |
$109,435.04 |
$38,456.55 |
|
7 |
454-13-1549.M4 |
06-3108 |
$181,049.42 |
$135,787.07 |
$84,595.51 |
$51,191.56 |
|
8 |
454-13-2870.M4 |
06-2156 |
$129,654.00 |
$97,240.50 |
$12,298.00 |
$84,942.50 |
|
9 |
454-13-3168.M4 |
07-0110 |
$223,866.45 |
$167,899.84 |
$59,371.82 |
$108,528.02 |
|
10 |
454-13-3187.M4 |
07-0110 |
See 454-13-3168.M4 |
See 454-13-3168.M4 |
See 454-13-3168.M4 |
See 454-13-3168.M4 |
|
11 |
454-13-4320.M4 |
06-4328 |
$131,353.50 |
$98,515.13 |
$89,247.77 |
$9,267.36 |
|
12 |
454-13-1788.M4 |
06-2835 |
$69,368.17 |
$52,026.13 |
$16,907.05 |
$35,119.08 |
|
13 |
454-13-1853.M4 |
08-7019 |
$208,313.00 |
$156,234.75 |
$36,192.00 |
$120,042.75 |
|
14 |
454-13-4196.M4 |
07-4526 |
$179,863.10 |
$134,747.33 |
$0.00 |
$134,897.33 |
ATTACHMENT 2
Page 1 of 13
NO ADDITIONAL REIMBURSEMENT OWED TO PROVIDER
|
NO. |
SOAH Dkt. No. |
MR No. |
Carrier Payment |
Additional Reimbursement Owed to Provider |
|
1 |
454-13-0141.M4 |
06-2077 |
See 454-13-0419 |
$0.00 |
|
2 |
454-13-0143.M4 |
06-2270 |
See 454-13-0417 |
$0.00 |
|
3 |
454-13-0417.M4 |
06-2270 |
$21,901.52 |
$0.00 |
|
4 |
454-13-0419.M4 |
06-2077 |
$17,500.00 |
$0.00 |
|
5 |
454-13-0420.M4 |
03-9053 |
$24,580.88 |
$0.00 |
|
6 |
454-13-0898.M4 |
05-A922 |
$28,492.06 |
$0.00 |
|
7 |
454-13-0899.M4 |
05-8001 |
$12,902.50 |
$0.00 |
|
8 |
454-13-0989.M4 |
08-1759 |
$27,664.00 |
$0.00 |
|
9 |
454-13-1538.M4 |
07-8171 |
$21,128.50 |
$0.00 |
|
10 |
454-13-1547.M4 |
06-2300 |
$26,069.00 |
$0.00 |
|
11 |
454-13-1550.M4 |
07-2560 |
$18,923.00 |
$0.00 |
|
12 |
454-13-1605.M4 |
07-4568 |
$21,269.36 |
$0.00 |
|
13 |
454-13-2126.M4 |
07-0571 |
$19,645.00 |
$0.00 |
|
14 |
454-13-2127.M4 |
06-5194 |
$14,466.60 |
$0.00 |
|
15 |
454-13-2135.M4 |
07-7746 |
$28,291.00 |
$0.00 |
|
16 |
454-13-2188.M4 |
07-3964 |
$22,743.45 |
$0.00 |
|
17 |
454-13-2427.M4 |
07-7060 |
$22,810.46 |
$0.00 |
|
18 |
454-13-2430.M4 |
06-3550 |
$17,152.00 |
$0.00 |
|
19 |
454-13-2445.M4 |
07-4045 |
$13,321.25 |
$0.00 |
|
20 |
454-13-2450.M4 |
07-7352 |
$24,199.00 |
$0.00 |
|
21 |
454-13-2774.M4 |
08-6234 |
$7,718.00 |
$0.00 |
|
22 |
454-13-2776.M4 |
07-4976 |
$11,169.58 |
$0.00 |
|
23 |
454-13-3300.M4 |
08-4499 |
$19,594.00 |
$0.00 |
|
24 |
454-13-3306.M4 |
07-5511 |
$11,129.50 |
$0.00 |
|
25 |
454-13-3312.M4 |
07-5191 |
$20,220.30 |
$0.00 |
|
26 |
454-13-3327.M4 |
06-7727 |
$25,787.00 |
$0.00 |
|
27 |
454-13-3334.M4 |
06-6823 |
$6,563.00 |
$0.00 |
|
28 |
454-13-3691.M4 |
07-0727 |
$16,347.20 |
$0.00 |
|
29 |
454-13-3694.M4 |
05-4551 |
$28,773.20 |
$0.00 |
|
30 |
454-13-4259.M4 |
07-5293 |
$28,093.41 |
$0.00 |
|
31 |
454-13-4381.M4 |
04-1080 |
$29,862.88 |
$0.00 |
|
32 |
454-13-4386.M4 |
07-0576 |
$18,312.50 |
$0.00 |
|
33 |
454-13-4440.M4 |
07-4038 |
$23,321.75 |
$0.00 |
|
34 |
454-13-4459.M4 |
08-4997 |
$6,612.50 |
$0.00 |
|
35 |
454-13-4463.M4 |
09-3486 |
$16,276.00 |
$0.00 |
To assist counsel, a Bold entry denominates the start of cases for a particular Provider or Carrier attorney.
ATTACHMENT 2
Page 2 of 13
NO ADDITIONAL REIMBURSEMENT OWED TO PROVIDER
|
NO. |
SOAH Dkt. No. |
MR No. |
Carrier Payment |
Additional Reimbursement Owed to Provider |
|
36 |
454-13-4583.M4 |
03-9085 |
$3,354.00 |
$0.00 |
|
37 |
454-13-5055.M4 |
06-2396 |
$39,431.80 |
$0.00 |
|
38 |
454-14-2857.M4 |
14-1734 |
$15,197.00 |
$0.00 |
|
39 |
454-15-1335.M4 |
06-2223 |
$50,344.66 |
$0.00 |
|
40 |
454-15-1336.M4 |
05-6409 |
$19,756.50 |
$0.00 |
|
41 |
454-14-2085.M4 |
06-3910 |
$52,763.10 |
$0.00 |
|
42 |
454-13-2140.M4 |
07-2209 |
$12,930.75 |
$0.00 |
|
43 |
454-13-3685.M4 |
09-5185 |
$36,977.88 |
$0.00 |
|
44 |
454-13-4278.M4 |
09-6344 |
$6,656.00 |
$0.00 |
|
45 |
454-13-2415.M4 |
06-6524 |
$26,836.90 |
$0.00 |
|
46 |
454-13-2187.M4 |
05-4763 |
$11,398.50 |
$0.00 |
|
47 |
454-12-7449.M4 |
06-2240 |
$25,842.66 |
$0.00 |
|
48 |
454-12-7450.M4 |
06-2391 |
$19,990.20 |
$0.00 |
|
49 |
454-12-7451.M4 |
06-2625 |
$28,328.00 |
$0.00 |
|
50 |
454-12-7501.M4 |
05-B626 |
$17,898.90 |
$0.00 |
|
51 |
454-12-7505.M4 |
04-7872 |
$37,983.43 |
$0.00 |
|
52 |
454-12-7514.M4 |
04-6524 |
$11,517.55 |
$0.00 |
|
53 |
454-12-7709.M4 |
04-4839 |
$15,851.00 |
$0.00 |
|
54 |
454-12-7711.M4 |
04-1629 |
$10,200.40 |
$0.00 |
|
55 |
454-12-7713.M4 |
04-B490 |
$33,575.65 |
$0.00 |
|
56 |
454-12-7716.M4 |
04-7849 |
$22,913.84 |
$0.00 |
|
57 |
454-12-7717.M4 |
03-A580 |
$24,445.65 |
$0.00 |
|
58 |
454-12-7729.M4 |
03-8985 |
$48,344.49 |
$0.00 |
|
59 |
454-12-7731.M4 |
04-4031 |
$38,209.56 |
$0.00 |
|
60 |
454-12-7732.M4 |
04-3841 |
$76,918.84 |
$0.00 |
|
61 |
454-12-7733.M4 |
05-6933 |
$47,264.42 |
$0.00 |
|
62 |
454-12-7734.M4 |
04-6514 |
$55,782.22 |
$0.00 |
|
63 |
454-12-7736.M4 |
04-6054 |
$70,542.14 |
$0.00 |
|
64 |
454-12-7738.M4 |
04-5607 |
$58,941.20 |
$0.00 |
|
65 |
454-12-7740.M4 |
04-6048 |
$32,878.00 |
$0.00 |
|
66 |
454-12-7742.M4 |
03-2228 |
$31,989.73 |
$0.00 |
|
67 |
454-12-7743.M4 |
03-1728 |
$33,997.02 |
$0.00 |
|
68 |
454-12-7745.M4 |
05-1477 |
$17,198.11 |
$0.00 |
|
69 |
454-12-7747.M4 |
04-3359 |
$57,067.72 |
$0.00 |
|
70 |
454-12-7957.M4 |
04-3770 |
$94,958.90 |
$0.00 |
ATTACHMENT 2
Page 3 of 13
NO ADDITIONAL REIMBURSEMENT OWED TO PROVIDER
|
NO. |
SOAH Dkt. No. |
MR No. |
Carrier Payment |
Additional Reimbursement Owed to Provider |
|
71 |
454-12-7959.M4 |
04-5383 |
$20,447.50 |
$0.00 |
|
72 |
454-12-7960.M4 |
03-5820 |
$83,204.08 |
$0.00 |
|
73 |
454-12-7961.M4 |
04-2253 |
$24,812.00 |
$0.00 |
|
74 |
454-12-7962.M4 |
04-6388 |
$46,304.83 |
$0.00 |
|
75 |
454-12-7963.M4 |
04-3351 |
$41,817.41 |
$0.00 |
|
76 |
454-12-7964.M4 |
05-3457 |
$75,460.09 |
$0.00 |
|
77 |
454-12-7965.M4 |
03-8491 |
$37,689.50 |
$0.00 |
|
78 |
454-13-0983.M4 |
07-7015 |
$48,376.99 |
$0.00 |
|
79 |
454-13-1118.M4 |
05-5193 |
$17,780.20 |
$0.00 |
|
80 |
454-13-1120.M4 |
04-7834 |
$48,937.20 |
$0.00 |
|
81 |
454-13-1124.M4 |
06-7709 |
$1,118.00 |
$0.00 |
|
82 |
454-13-2138.M4 |
07-1482 |
$14,414.77 |
$0.00 |
|
83 |
454-13-2420.M4 |
07-1594 |
$43,623.62 |
$0.00 |
|
84 |
454-13-2438.M4 |
07-0120 |
$17,670.50 |
$0.00 |
|
85 |
454-13-2517.M4 |
06-6002 |
$39,548.14 |
$0.00 |
|
86 |
454-13-2520.M4 |
06-2351 |
$25,227.50 |
$0.00 |
|
87 |
454-13-2542.M4 |
03-3911 |
$10,843.50 |
$0.00 |
|
88 |
454-13-2772.M4 |
07-3326 |
$30,073.90 |
$0.00 |
|
89 |
454-13-3631.M4 |
09-3472 |
$36,742.21 |
$0.00 |
|
90 |
454-13-4385.M4 |
07-5187 |
$15,449.60 |
$0.00 |
|
91 |
454-13-4387.M4 |
07-1613 |
$20,219.50 |
$0.00 |
|
92 |
454-13-4451.M4 |
07-8172 |
$51,598.76 |
$0.00 |
|
93 |
454-13-4454.M4 |
08-0625 |
$68,833.31 |
$0.00 |
|
94 |
454-13-5037.M4 |
06-3888 |
$53,645.09 |
$0.00 |
|
95 |
454-13-5041.M4 |
08-6162 |
$2,236.00 |
$0.00 |
|
96 |
454-13-5043.M4 |
06-3894 |
$23,444.40 |
$0.00 |
|
97 |
454-13-5052.M4 |
08-0113 |
$28,133.00 |
$0.00 |
|
98 |
454-13-5054.M4 |
03-7992 |
$83,417.79 |
$0.00 |
|
99 |
454-14-1844.M5 |
03-2847 |
$24,668.40 |
$0.00 |
|
100 |
454-14-1846.M5 |
05-1993 |
$5,590.00 |
$0.00 |
|
101 |
454-14-1851.M4 |
03-2265 |
$11,500.50 |
$0.00 |
|
102 |
454-14-1852.M4 |
03-2123 |
$16,981.50 |
$0.00 |
|
103 |
454-14-1853.M4 |
03-6199 |
$34,981.32 |
$0.00 |
|
104 |
454-14-1854.M4 |
03-2230 |
$27,367.50 |
$0.00 |
|
105 |
454-14-2077.M4 |
04-6031 |
$37,768.46 |
$0.00 |
ATTACHMENT 2
Page 4 of 13
NO ADDITIONAL REIMBURSEMENT OWED TO PROVIDER
|
NO. |
SOAH Dkt. No. |
MR No. |
Carrier Payment |
Additional Reimbursement Owed to Provider |
|
106 |
454-14-2078.M4 |
04-1024 |
$58,247.52 |
$0.00 |
|
107 |
454-14-2079.M4 |
04-6150 |
$77,553.33 |
$0.00 |
|
108 |
454-14-2080.M4 |
04-4929 |
$45,833.53 |
$0.00 |
|
109 |
454-14-2144.M4 |
04-6150 |
See 454-14-2079.M4 |
See 454-14-2079.M4 |
|
110 |
454-14-2283.M4 |
03-2477 |
$102,931.37 |
$0.00 |
|
111 |
454-15-1318.M4 |
08-6246 |
$51,713.06 |
$0.00 |
|
112 |
454-15-2438.M4 |
03-6225 |
$65,606.14 |
$0.00 |
|
113 |
454-15-2434.M5 |
05-2400 |
$62,700.15 |
$0.00 |
|
114 |
454-15-2436.M5 |
05-2400 |
See 454-14.2434.M5 |
$0.00 |
|
115 |
454-13-0530.M4 |
07-7030 |
$52,229.38 |
$0.00 |
|
116 |
454-13-1361.M4 |
06-7656 |
$7,177.90 |
$0.00 |
|
117 |
454-13-1490.M4 |
07-7011 |
$21,999.00 |
$0.00 |
|
118 |
454-13-1536.M4 |
07-0602 |
$12,230.60 |
$0.00 |
|
119 |
454-13-1537.M4 |
07-3231 |
$21,468.40 |
$0.00 |
|
120 |
454-13-2172.M4 |
07-2129 |
$81,022.70 |
$0.00 |
|
121 |
454-13-2173.M4 |
07-1020 |
$11,883.00 |
$0.00 |
|
122 |
454-13-2177.M4 |
07-2600 |
$13,302.40 |
$0.00 |
|
123 |
454-13-3311.M4 |
07-7666 |
$16,938.00 |
$0.00 |
|
124 |
454-13-3324.M4 |
08-2806 |
$66,495.65 |
$0.00 |
|
125 |
454-13-5039.M4 |
05-A692 |
$47,229.58 |
$0.00 |
|
126 |
454-13-5177.M4 |
08-1498 |
$12,915.20 |
$0.00 |
|
127 |
454-15-1313.M4 |
04-5632 |
$44,896.80 |
$0.00 |
|
128 |
454-15-1334.M4 |
06-5881 |
$43,952.35 |
$0.00 |
|
129 |
454-15-2439.M4 |
04-3905 |
$20,705.07 |
$0.00 |
|
130 |
454-13-0418.M4 |
06-2214 |
$81,785.13 |
$0.00 |
|
131 |
454-13-0523.M4 |
06-5230 |
$9,763.10 |
$0.00 |
|
132 |
454-13-0603.M4 |
05-5455 |
$41,165.35 |
$0.00 |
|
133 |
454-13-0895.M4 |
08-6919 |
$23,459.50 |
$0.00 |
|
134 |
454-13-1461.M4 |
05-8119 |
$84,303.30 |
$0.00 |
|
135 |
454-13-2132.M4 |
07-0614 |
$10,198.50 |
$0.00 |
|
136 |
454-13-2139.M4 |
08-1644 |
$12,191.00 |
$0.00 |
|
137 |
454-13-2179.M4 |
06-6129 |
$66,765.25 |
$0.00 |
|
138 |
454-13-2182.M4 |
07-2672 |
$16,522.10 |
$0.00 |
|
139 |
454-13-2189.M4 |
07-2647 |
$32,244.00 |
$0.00 |
|
140 |
454-13-2192.M4 |
05-A559 |
$49,448.05 |
$0.00 |
ATTACHMENT 2
Page 5 of 13
NO ADDITIONAL REIMBURSEMENT OWED TO PROVIDER
|
NO. |
SOAH Dkt. No. |
MR No. |
Carrier Payment |
Additional Reimbursement Owed to Provider |
|
141 |
454-13-2416.M4 |
08-1288 |
$14,239.60 |
$0.00 |
|
142 |
454-13-2417.M4 |
03-8976 |
$37,461.53 |
$0.00 |
|
143 |
454-13-2441.M4 |
06-5150 |
$4,363.00 |
$0.00 |
|
144 |
454-13-2468.M4 |
04-5545 |
$60,689.55 |
$0.00 |
|
145 |
454-13-2473.M4 |
04-0081 |
$74,267.55 |
$0.00 |
|
146 |
454-13-2475.M4 |
08-1415 |
$16,983.00 |
$0.00 |
|
147 |
454-13-2577.M4 |
06-6003 |
$1,417.00 |
$0.00 |
|
148 |
454-13-2871.M4 |
04-4847 |
$67,295.48 |
$0.00 |
|
149 |
454-13-3320.M4 |
06-7710 |
$2,236.00 |
$0.00 |
|
150 |
454-13-3328.M4 |
06-7494 |
$18,382.20 |
$0.00 |
|
151 |
454-13-3331.M4 |
07-3126 |
$25,445.65 |
$0.00 |
|
152 |
454-13-3680.M4 |
06-6032 |
$4,784.00 |
$0.00 |
|
153 |
454-13-3690.M4 |
06-6820 |
$144,928.41 |
$0.00 |
|
154 |
454-13-4263.M4 |
07-7414 |
$18,967.40 |
$0.00 |
|
155 |
454-13-4275.M4 |
07-7007 |
$19,753.50 |
$0.00 |
|
156 |
454-13-4368.M4 |
05-A469 |
$37,390.17 |
$0.00 |
|
157 |
454-13-4374.M4 |
05-A515 |
$15,816.60 |
$0.00 |
|
158 |
454-13-4375.M4 |
05-B128 |
$4,583.00 |
$0.00 |
|
159 |
454-13-4462.M4 |
08-6245 |
$14,645.50 |
$0.00 |
|
160 |
454-13-5134.M4 |
09-7537 |
$242,088.49 |
$0.00 |
|
161 |
454-13-5164.M4 |
07-8178 |
$21,262.00 |
$0.00 |
|
162 |
454-13-5180.M4 |
08-3896 |
$10,045.32 |
$0.00 |
|
163 |
454-14-2285.M4 |
06-1982 |
$93,171.31 |
$0.00 |
|
164 |
454-15-0048.M4 |
05-B552 |
$11,564.00 |
$0.00 |
|
165 |
454-15-0049.M4 |
04-0014 |
$70,466.50 |
$0.00 |
|
166 |
454-15-0050.M4 |
05-B571 |
$47,787.03 |
$0.00 |
|
167 |
454-15-0051.M4 |
04-0486 |
$55,842.08 |
$0.00 |
|
168 |
454-15-0053.M4 |
03-2238 |
$69,112.49 |
$0.00 |
|
169 |
454-15-0056.M4 |
03-6050 |
$58,546.75 |
$0.00 |
|
170 |
454-15-0057.M4 |
05-1115 |
$35,448.21 |
$0.00 |
|
171 |
454-15-0059.M4 |
03-2194 |
$76,398.80 |
$0.00 |
|
172 |
454-15-0060.M4 |
03-2149 |
$82,754.17 |
$0.00 |
|
173 |
454-15-0061.M4 |
03-2229 |
$66,114.53 |
$0.00 |
|
174 |
454-15-0302.M4 |
03-1819 |
$63,111.51 |
$0.00 |
|
175 |
454-15-0303.M4 |
03-5571 |
$76,212.71 |
$0.00 |
|
176 |
454-15-0304.M4 |
03-3045 |
$51,536.24 |
$0.00 |
|
177 |
454-15-0305.M4 |
03-5855 |
$63,434.22 |
$0.00 |
ATTACHMENT 2
Page 6 of 13
NO ADDITIONAL REIMBURSEMENT OWED TO PROVIDER
|
NO. |
SOAH Dkt. No. |
MR No. |
Carrier Payment |
Additional Reimbursement Owed to Provider |
|
178 |
454-15-0306.M4 |
03-5536 |
$60,119.03 |
$0.00 |
|
179 |
454-15-0376.M4 |
04-7875 |
$67,974.90 |
$0.00 |
|
180 |
454-15-0378.M4 |
04-7893 |
$56,420.00 |
$0.00 |
|
181 |
454-15-0379.M4 |
04-8101 |
$67,545.64 |
$0.00 |
|
182 |
454-15-0381.M4 |
04-7825 |
$48,803.14 |
$0.00 |
|
183 |
454-15-0383.M4 |
04-7847 |
$82,787.20 |
$0.00 |
|
184 |
454-15-0384.M4 |
04-2251 |
$82,317.82 |
$0.00 |
|
185 |
454-15-0385.M4 |
04-5555 |
$60,830.59 |
$0.00 |
|
186 |
454-15-0386.M4 |
04-3435 |
$45,903.69 |
$0.00 |
|
187 |
454-15-0388.M4 |
04-3571 |
$68,506.45 |
$0.00 |
|
188 |
454-15-0389.M4 |
03-7251 |
$38,239.54 |
$0.00 |
|
189 |
454-15-0390.M4 |
04-0084 |
$65,186.06 |
$0.00 |
|
190 |
454-15-0391.M4 |
03-9076 |
$63,786.13 |
$0.00 |
|
191 |
454-15-0392.M4 |
04-1206 |
$97,876.74 |
$0.00 |
|
192 |
454-15-0393.M4 |
03-9462 |
$64,597.54 |
$0.00 |
|
193 |
454-15-0559.M4 |
05-8455 |
$22,835.70 |
$0.00 |
|
194 |
454-15-0560.M4 |
05-B628 |
$60,676.06 |
$0.00 |
|
195 |
454-15-0562.M4 |
06-2263 |
$76,350.99 |
$0.00 |
|
196 |
454-15-0563.M4 |
05-2671 |
$45,970.30 |
$0.00 |
|
197 |
454-15-0564.M4 |
05-5333 |
$26,069.48 |
$0.00 |
|
198 |
454-15-0566.M4 |
05-6932 |
$80,426.08 |
$0.00 |
|
199 |
454-15-0569.M4 |
05-2051 |
$75,077.40 |
$0.00 |
|
200 |
454-15-0571.M4 |
05-2669 |
$38,782.56 |
$0.00 |
|
201 |
454-15-0572.M4 |
05-2050 |
$67,003.09 |
$0.00 |
|
202 |
454-15-0598.M4 |
04-7891 |
$52,336.95 |
$0.00 |
|
203 |
454-15-0602.M4 |
04-5369 |
$111,690.85 |
$0.00 |
|
204 |
454-15-0708.M4 |
04-0263 |
$70,909.07 |
$0.00 |
|
205 |
454-15-0710.M4 |
06-2643 |
$16,288.50 |
$0.00 |
|
206 |
454-15-0712.M4 |
05-3533 |
$57,288.98 |
$0.00 |
|
207 |
454-15-0713.M4 |
04-A011 |
$19,643.29 |
$0.00 |
|
208 |
454-15-0715.M4 |
04-5685 |
$85,436.63 |
$0.00 |
|
209 |
454-15-0716.M4 |
04-6407 |
$57,615.46 |
$0.00 |
|
210 |
454-15-0718.M4 |
04-6331 |
$45,121.52 |
$0.00 |
|
211 |
454-12-2515.M4 |
06-5999 |
$11,588.00 |
$0.00 |
|
212 |
454-12-4717.M4 |
06-6813 |
$34,181.37 |
$0.00 |
|
213 |
454-12-5113.M4 |
04-4886 |
$52,702.34 |
$0.00 |
|
214 |
454-12-5429.M4 |
05-2357 |
$72,293.07 |
$0.00 |
ATTACHMENT 2
Page 7 of 13
NO ADDITIONAL REIMBURSEMENT OWED TO PROVIDER
|
NO. |
SOAH Dkt. No. |
MR No. |
Carrier Payment |
Additional Reimbursement Owed to Provider |
|
215 |
454-12-5431.M4 |
05-6406 |
$4,410.00 |
$0.00 |
|
216 |
454-12-5563.M4 |
05-B068 |
$26,676.60 |
$0.00 |
|
217 |
454-12-5566.M4 |
05-9499 |
$45,668.83 |
$0.00 |
|
218 |
454-12-5568.M4 |
05-1381 |
$32,490.25 |
$0.00 |
|
219 |
454-12-5858.M4 |
05-2250 |
$15,447.50 |
$0.00 |
|
220 |
454-12-5859.M4 |
04-6132 |
$14,100.00 |
$0.00 |
|
221 |
454-12-5860.M4 |
05-A450 |
$63,647.62 |
$0.00 |
|
222 |
454-12-5861.M4 |
06-2054 |
$42,750.50 |
$0.00 |
|
223 |
454-12-5957.M4 |
06-6819 |
$3,840.50 |
$0.00 |
|
224 |
454-12-6021.M4 |
08-0068 |
$18,098.60 |
$0.00 |
|
225 |
454-12-6121.M4 |
05-8105 |
$14,012.52 |
$0.00 |
|
226 |
454-12-6572.M4 |
06-6235 |
$9,565.55 |
$0.00 |
|
227 |
454-12-7146.M4 |
03-7989 |
$48,246.68 |
$0.00 |
|
228 |
454-12-7149.M4 |
06-7060 |
$27,047.58 |
$0.00 |
|
229 |
454-12-7150.M4 |
06-6795 |
$2,678.00 |
$0.00 |
|
230 |
454-12-7313.M4 |
07-2867 |
$7,846.00 |
$0.00 |
|
231 |
454-12-7316.M4 |
07-0172 |
$11,206.50 |
$0.00 |
|
232 |
454-12-7320.M4 |
06-6826 |
$9,205.45 |
$0.00 |
|
233 |
454-12-7495.M4 |
04-6315 |
$35,859.80 |
$0.00 |
|
234 |
454-13-0108.M4 |
07-4151 |
$10,209.50 |
$0.00 |
|
235 |
454-13-0517.M4 |
09-6009 |
$22,982.00 |
$0.00 |
|
236 |
454-13-0518.M4 |
09-4686 |
$47,769.82 |
$0.00 |
|
237 |
454-13-0520.M4 |
07-0060 |
$30,551.50 |
$0.00 |
|
238 |
454-13-0521.M4 |
07-0600 |
$18,446.00 |
$0.00 |
|
239 |
454-13-0524.M4 |
06-6000 |
$2,236.00 |
$0.00 |
|
240 |
454-13-0526.M4 |
07-0601 |
$19,554.50 |
$0.00 |
|
241 |
454-13-0527.M4 |
07-1868 |
$9,648.00 |
$0.00 |
|
242 |
454-13-0529.M4 |
07-4151 |
See 454-13-0108.M4 |
$0.00 |
|
243 |
454-13-0531.M4 |
07-7038 |
$26,654.60 |
$0.00 |
|
244 |
454-13-0532.M4 |
08-0199 |
$20,943.60 |
$0.00 |
|
245 |
454-13-0896.M4 |
08-4985 |
$9,428.90 |
$0.00 |
|
246 |
454-13-1278.M4 |
09-6011 |
$9,401.00 |
$0.00 |
|
247 |
454-13-1408.M4 |
07-4026 |
$7,674.00 |
$0.00 |
|
248 |
454-13-1409.M4 |
07-0726 |
$26,131.00 |
$0.00 |
|
249 |
454-13-1410.M4 |
07-3130 |
$14,531.50 |
$0.00 |
|
250 |
454-13-1411.M4 |
08-1472 |
$6,486.00 |
$0.00 |
|
251 |
454-13-1412.M4 |
07-3222 |
$56,387.52 |
$0.00 |
ATTACHMENT 2
Page 8 of 13
NO ADDITIONAL REIMBURSEMENT OWED TO PROVIDER
|
NO. |
SOAH Dkt. No. |
MR No. |
Carrier Payment |
Additional Reimbursement Owed to Provider |
|
252 |
454-13-1463.M4 |
07-4000 |
$13,255.80 |
$0.00 |
|
253 |
454-13-1464.M4 |
08-1294 |
$25,289.50 |
$0.00 |
|
254 |
454-13-1465.M4 |
07-3993 |
$42,779.70 |
$0.00 |
|
255 |
454-13-1466.M4 |
08-2803 |
$22,798.38 |
$0.00 |
|
256 |
454-13-1467.M4 |
07-4010 |
$36,766.50 |
$0.00 |
|
257 |
454-13-1468.M4 |
08-2804 |
$48,697.52 |
$0.00 |
|
258 |
454-13-1469.M4 |
07-3972 |
$9,131.50 |
$0.00 |
|
259 |
454-13-1470.M4 |
08-5039 |
$60,381.62 |
$0.00 |
|
260 |
454-13-1471.M4 |
08-1305 |
$2,236.00 |
$0.00 |
|
261 |
454-13-1472.M4 |
07-2077 |
$42,549.77 |
$0.00 |
|
262 |
454-13-1486.M4 |
06-2925 |
$41,488.40 |
$0.00 |
|
263 |
454-13-1492.M4 |
07-7022 |
$64,160.87 |
$0.00 |
|
264 |
454-13-1493.M4 |
07-7857 |
$65,949.39 |
$0.00 |
|
265 |
454-13-1540.M4 |
09-6031 |
$44,795.34 |
$0.00 |
|
266 |
454-13-1541.M4 |
08-1441 |
$8,106.70 |
$0.00 |
|
267 |
454-13-2121.M4 |
03-9084 |
$47,925.55 |
$0.00 |
|
268 |
454-13-2129.M4 |
07-1008 |
$26,822.00 |
$0.00 |
|
269 |
454-13-2130.M4 |
07-4044 |
$15,848.50 |
$0.00 |
|
270 |
454-13-2131.M4 |
08-6248 |
$24,032.30 |
$0.00 |
|
271 |
454-13-2176.M4 |
08-6247 |
$45,214.59 |
$0.00 |
|
272 |
454-13-2190.M4 |
03-8005 |
$32,735.40 |
$0.00 |
|
273 |
454-13-2432.M4 |
08-6161 |
$68,445.40 |
$0.00 |
|
274 |
454-13-2437.M4 |
08-2899 |
$62,642.74 |
$0.00 |
|
275 |
454-13-2452.M4 |
07-2180 |
$31,255.50 |
$0.00 |
|
276 |
454-13-2453.M4 |
08-1749 |
$18,567.00 |
$0.00 |
|
277 |
454-13-2455.M4 |
07-0728 |
$16,868.60 |
$0.00 |
|
278 |
454-13-2462.M4 |
08-1293 |
$21,434.50 |
$0.00 |
|
279 |
454-13-2463.M4 |
05-B592 |
$4,865.00 |
$0.00 |
|
280 |
454-13-2476.M4 |
06-6236 |
$3,840.50 |
$0.00 |
|
281 |
454-13-2477.M4 |
06-5234 |
$80,740.58 |
$0.00 |
|
282 |
454-13-2514.M4 |
07-3199 |
$40,813.00 |
$0.00 |
|
283 |
454-13-2866.M4 |
07-1012 |
$22,914.00 |
$0.00 |
|
284 |
454-13-2867.M4 |
07-0952 |
$26,997.00 |
$0.00 |
|
285 |
454-13-2868.M4 |
07-0091 |
$17,571.50 |
$0.00 |
|
286 |
454-13-3317.M4 |
07-3130 |
$16,962.80 |
$0.00 |
|
287 |
454-13-3325.M4 |
08-1472 |
$20,291.40 |
$0.00 |
|
288 |
454-13-3410.M4 |
07-3222 |
$22,434.03 |
$0.00 |
ATTACHMENT 2
Page 9 of 13
NO ADDITIONAL REIMBURSEMENT OWED TO PROVIDER
|
NO. |
SOAH Dkt. No. |
MR No. |
Carrier Payment |
Additional Reimbursement Owed to Provider |
|
289 |
454-13-3687.M4 |
07-1591 |
$16,204.70 |
$0.00 |
|
290 |
454-13-3688.M4 |
08-4938 |
$55,749.95 |
$0.00 |
|
291 |
454-13-4271.M4 |
05-7994 |
$93,473.16 |
$0.00 |
|
292 |
454-13-4383.M4 |
04-7873 |
$39,128.79 |
$0.00 |
|
293 |
454-13-4437.M4 |
07-2705 |
$18,688.20 |
$0.00 |
|
294 |
454-13-4439.M4 |
07-4011 |
$17,899.16 |
$0.00 |
|
295 |
454-13-4450.M4 |
07-8009 |
$28,749.25 |
$0.00 |
|
296 |
454-13-4455.M4 |
08-1389 |
$48,977.21 |
$0.00 |
|
297 |
454-13-4456.M4 |
08-1659 |
$25,842.00 |
$0.00 |
|
298 |
454-13-4458.M4 |
08-4982 |
$87,802.47 |
$0.00 |
|
299 |
454-13-4460.M4 |
08-5430 |
$106,688.01 |
$0.00 |
|
300 |
454-13-4466.M4 |
09-6308 |
$27,825.50 |
$0.00 |
|
301 |
454-13-4577.M4 |
03-2855 |
$37,247.94 |
$0.00 |
|
302 |
454-13-5036.M4 |
06-5138 |
$15,740.06 |
$0.00 |
|
303 |
454-13-5130.M4 |
09-4878 |
$6,420.00 |
$0.00 |
|
304 |
454-13-5168.M4 |
05-8432 |
$52,032.96 |
$0.00 |
|
305 |
454-13-6110.M4 |
06-5310 |
$158,119.33 |
$0.00 |
|
306 |
454-14-0080.M4 |
07-7741 |
$77,669.77 |
$0.00 |
|
307 |
454-14-0081.M4 |
03-5858 |
$39,488.45 |
$0.00 |
|
308 |
454-14-0468.M4 |
07-8170 |
$4,032.73 |
$0.00 |
|
309 |
454-14-2363.M4 |
09-4874 |
$6,178.00 |
$0.00 |
|
310 |
454-14-2394.M4 |
07-6990 |
$20,653.00 |
$0.00 |
|
311 |
454-14-2858.M4 |
09-6270 |
$99,690.54 |
$0.00 |
|
312 |
454-15-1312.M4 |
07-4048 |
$63,713.75 |
$0.00 |
|
313 |
454-15-1316.M4 |
07-4629 |
$7,790.10 |
$0.00 |
|
314 |
454-15-1317.M4 |
07-8215 |
$15,817.00 |
$0.00 |
|
315 |
454-15-1319.M4 |
08-0064 |
$72,187.27 |
$0.00 |
|
316 |
454-15-1320.M4 |
08-0067 |
$19,146.00 |
$0.00 |
|
317 |
454-15-1330.M4 |
07-3992 |
$8,720.50 |
$0.00 |
|
318 |
454-15-1331.M4 |
07-2666 |
$21,669.00 |
$0.00 |
|
319 |
454-13-3314.M4 |
08-2856 |
$73,051.49 |
$0.00 |
|
320 |
454-13-1543.M4 |
06-2213 |
$24,843.40 |
$0.00 |
|
321 |
454-13-1487.M4 |
05-4623 |
$10,416.20 |
$0.00 |
|
322 |
454-13-2184.M4 |
07-8134 |
$10,803.50 |
$0.00 |
|
323 |
454-13-2423.M4 |
07-2127 |
$8,161.00 |
$0.00 |
|
324 |
454-13-2424.M4 |
06-0415 |
$18,459.68 |
$0.00 |
|
325 |
454-13-3679.M4 |
08-4935 |
$15,100.50 |
$0.00 |
ATTACHMENT 2
Page 10 of 13
NO ADDITIONAL REIMBURSEMENT OWED TO PROVIDER
|
NO. |
SOAH Dkt. No. |
MR No. |
Carrier Payment |
Additional Reimbursement Owed to Provider |
|
326 |
454-13-4274.M4 |
07-4685 |
$18,720.55 |
$0.00 |
|
327 |
454-13-4376.M4 |
05-B242 |
$43,321.03 |
$0.00 |
|
328 |
454-13-4445.M4 |
07-7047 |
$25,093.00 |
$0.00 |
|
329 |
454-13-4447.M4 |
07-7417 |
$24,648.20 |
$0.00 |
|
330 |
454-13-4448.M4 |
07-7667 |
$28,285.00 |
$0.00 |
|
331 |
454-13-4449.M4 |
07-7742 |
$16,212.30 |
$0.00 |
|
332 |
454-13-5056.M4 |
03-3672 |
$89,142.76 |
$0.00 |
|
333 |
454-14-2860.M4 |
07-4122 |
$33,777.20 |
$0.00 |
|
334 |
454-15-1314.M4 |
03-A346 |
$70,802.57 |
$0.00 |
|
335 |
454-13-0988.M4 |
09-8055 |
$9,269.49 |
$0.00 |
|
336 |
454-13-2530.M4 |
08-7184 |
$3,365.95 |
$0.00 |
|
337 |
454-13-2965.M4 |
09-2649 |
$19,510.40 |
$0.00 |
|
338 |
454-13-2528.M4 |
08-5290 |
$28,248.61 |
$0.00 |
|
339 |
454-13-1106.M4 |
07-4485 |
$16,770.00 |
$0.00 |
|
340 |
454-13-2600.M4 |
09-3868 |
$12,645.96 |
$0.00 |
|
341 |
454-13-2969.M4 |
06-6108 |
$21,173.47 |
$0.00 |
|
342 |
454-13-2596.M4 |
09-2165 |
$10,705.10 |
$0.00 |
|
343 |
454-13-2597.M4 |
09-3854 |
$4,870.89 |
$0.00 |
|
344 |
454-13-2954.M4 |
09-0203 |
$91,706.70 |
$0.00 |
|
345 |
454-13-2956.M4 |
09-2863 |
$12,112.89 |
$0.00 |
|
346 |
454-13-4166.M4 |
07-4267 |
$46,647.30 |
$0.00 |
|
347 |
454-13-2963.M4 |
09-2681 |
$15,393.30 |
$0.00 |
|
348 |
454-13-5958.M4 |
08-4321 |
$8,622.60 |
$0.00 |
|
349 |
454-13-3798.M4 |
05-4612 |
$67,850.10 |
$0.00 |
|
350 |
454-13-3942.M4 |
08-4649 |
$23,275.00 |
$0.00 |
|
351 |
454-13-4019.M4 |
07-3229 |
$8,842.88 |
$0.00 |
|
352 |
454-13-4156.M4 |
08-1419 |
$4,243.70 |
$0.00 |
|
353 |
454-13-5234.M4 |
08-1628 |
$28,170.00 |
$0.00 |
|
354 |
454-13-5237.M4 |
07-0732 |
$10,271.50 |
$0.00 |
|
355 |
454-13-5238.M4 |
09-0032 |
$30,977.72 |
$0.00 |
|
356 |
454-12-0785.M4 |
04-6842 |
$22,275.38 |
$0.00 |
|
357 |
454-13-1265.M4 |
04-A430 |
$22,524.72 |
$0.00 |
|
358 |
454-13-1389.M4 |
06-4838 |
$26,489.12 |
$0.00 |
|
359 |
454-13-1804.M4 |
07-1386 |
$19,936.14 |
$0.00 |
|
360 |
454-13-1805.M4 |
06-6439 |
$10,308.53 |
$0.00 |
|
361 |
454-13-1818.M4 |
06-2572 |
$10,170.09 |
$0.00 |
|
362 |
454-13-1858.M4 |
07-5853 |
$11,616.78 |
$0.00 |
ATTACHMENT 2
Page 11 of 13
NO ADDITIONAL REIMBURSEMENT OWED TO PROVIDER
|
NO. |
SOAH Dkt. No. |
MR No. |
Carrier Payment |
Additional Reimbursement Owed to Provider |
|
363 |
454-13-1875.M4 |
07-2005 |
$6,382.89 |
$0.00 |
|
364 |
454-13-2595.M4 |
07-5061 |
$9,062.15 |
$0.00 |
|
365 |
454-13-3422.M4 |
09-0147 |
$27,561.67 |
$0.00 |
|
366 |
454-13-3424.M4 |
04-A432 |
$15,927.40 |
$0.00 |
|
367 |
454-13-3425.M4 |
08-1539 |
$15,157.04 |
$0.00 |
|
368 |
454-13-3436.M4 |
07-5962 |
$18,945.30 |
$0.00 |
|
369 |
454-13-3464.M4 |
06-7434 |
$20,828.71 |
$0.00 |
|
370 |
454-13-3466.M4 |
08-6413 |
$8,708.76 |
$0.00 |
|
371 |
454-13-3467.M4 |
07-5070 |
$15,733.76 |
$0.00 |
|
382 |
454-13-3472.M4 |
06-7049 |
$14,091.86 |
$0.00 |
|
383 |
454-13-2523.M4 |
08-6662 |
$7,387.76 |
$0.00 |
|
384 |
454-13-4191.M4 |
07-0560 |
$18,009.91 |
$0.00 |
|
385 |
454-13-1874.M4 |
06-5355 |
$26,825.00 |
$0.00 |
|
386 |
454-13-2610.M4 |
08-0380 |
$17,502.06 |
$0.00 |
|
387 |
454-13-3469.M4 |
08-7134 |
$32,770.79 |
$0.00 |
|
388 |
454-13-3470.M4 |
07-8012 |
$9,878.14 |
$0.00 |
|
389 |
454-13-4701.M4 |
07-1731 |
$7,813.26 |
$0.00 |
|
390 |
454-12-0520.M4 |
04-2761 |
$112,561.36 |
$0.00 |
|
391 |
454-12-7498.M4 |
05-B550 |
$30,559.96 |
$0.00 |
|
392 |
454-12-7499.M4 |
06-2756 |
$7,836.57 |
$0.00 |
|
393 |
454-12-7508.M4 |
06.1375 |
$17,149.74 |
$0.00 |
|
394 |
454-12-7511.M4 |
05-1928 |
$5,106.67 |
$0.00 |
|
395 |
454-12-7512.M4 |
04-1493 |
$15,584.59 |
$0.00 |
|
396 |
454-12-7730.M4 |
04-B464 |
$44,456.53 |
$0.00 |
|
397 |
454-12-7744.M4 |
04-9796 |
$9,166.84 |
$0.00 |
|
398 |
454-12-7746.M4 |
05-0303 |
$30,911.39 |
$0.00 |
|
399 |
454-13-1268.M4 |
05-9198 |
$8,287.19 |
$0.00 |
|
400 |
454-13-1274.M4 |
07-1249 |
$11,582.77 |
$0.00 |
|
401 |
454-13-1384.M4 |
05-A343 |
$7,818.00 |
$0.00 |
|
402 |
454-13-1764.M4 |
08-6253 |
$10,396.20 |
$0.00 |
|
403 |
454-13-1844.M4 |
07-4938 |
$5,590.00 |
$0.00 |
|
404 |
454-13-1887.M4 |
08-2555 |
$5,631.76 |
$0.00 |
|
405 |
454-13-1888.M4 |
07-0578 |
$6,708.00 |
$0.00 |
|
406 |
454-13-3435.M4 |
06-3826 |
$30,773.13 |
$0.00 |
|
407 |
454-13-3439.M4 |
08-6253 |
$10,396.20 |
$0.00 |
|
408 |
454-13-3460.M4 |
08-2040 |
$13,880.00 |
$0.00 |
|
409 |
454-13-3555.M4 |
07-2414 |
$24,761.50 |
$0.00 |
ATTACHMENT 2
Page 12 of 13
NO ADDITIONAL REIMBURSEMENT OWED TO PROVIDER
|
NO. |
SOAH Dkt. No. |
MR No. |
Carrier Payment |
Additional Reimbursement Owed to Provider |
|
410 |
454-13-3800.M4 |
08-0332 |
$16,034.41 |
$0.00 |
|
411 |
454-13-3805.M4 |
07-5509 |
$44,684.04 |
$0.00 |
|
412 |
454-13-4194.M4 |
05-5106 |
$11,647.32 |
$0.00 |
|
413 |
454-13-4637.M4 |
06-6838 |
$22,446.53 |
$0.00 |
|
414 |
454-13-4697.M4 |
08-2284 |
$10,737.89 |
$0.00 |
|
415 |
454-13-5585.M4 |
06-6838 |
See 454-13-4637.M4 |
See 454-13-4637.M4 |
|
416 |
454-13-4181.M4 |
07-6050 |
$39,299.96 |
$0.00 |
|
417 |
454-12-7500.M4 |
05-A362 |
$29,057.06 |
$0.00 |
|
418 |
454-12-7510.M4 |
06-4720 |
$6,700.05 |
$0.00 |
|
419 |
454-12-7513.M4 |
05-0798 |
$50,983.63 |
$0.00 |
|
420 |
454-12-7515.M4 |
05-3904 |
$36,542.42 |
$0.00 |
|
421 |
454-13-1842.M4 |
07-3139 |
$69,400.44 |
$0.00 |
|
422 |
454-13-1843.M4 |
07-3761 |
$64,131.32 |
$0.00 |
|
423 |
454-13-3551.M4 |
07-4555 |
$12,071.22 |
$0.00 |
|
424 |
454-13-3552.M4 |
07-3599 |
$9,333.75 |
$0.00 |
|
425 |
454-13-4193.M4 |
05-1926 |
$43,091.92 |
$0.00 |
|
426 |
454-13-4318.M4 |
07-0672 |
$57,363.70 |
$0.00 |
|
427 |
454-13-4330.M4 |
06-6523 |
$12,963.25 |
$0.00 |
|
428 |
454-13-4641.M4 |
06-7044 |
$23,630.32 |
$0.00 |
|
429 |
454-13-4643.M4 |
05-3214 |
$50,406.55 |
$0.00 |
|
430 |
454-13-4647.M4 |
06-7763 |
$8,784.78 |
$0.00 |
|
431 |
454-13-4695.M4 |
08-5593 |
$27,049.31 |
$0.00 |
|
432 |
454-13-4698.M4 |
06-5764 |
$11,446.21 |
$0.00 |
|
433 |
454-13-4706.M4 |
08-4751 |
$28,078.05 |
$0.00 |
|
434 |
454-13-4762.M4 |
04-7903 |
$47,297.26 |
$0.00 |
|
435 |
454-13-4763.M4 |
09-6007 |
$20,528.66 |
$0.00 |
|
436 |
454-13-1850.M4 |
06-3621 |
$13,773.19 |
$0.00 |
|
437 |
454-13-1851.M4 |
06-6520 |
$12,766.25 |
$0.00 |
|
438 |
454-13-1852.M4 |
05-6931 |
$9,523.55 |
$0.00 |
|
439 |
454-13-1854.M4 |
08-3458 |
$30,251.60 |
$0.00 |
|
440 |
454-13-1855.M4 |
08-2999 |
$15,636.20 |
$0.00 |
|
441 |
454-13-1856.M4 |
08-2041 |
$13,227.20 |
$0.00 |
|
442 |
454-13-1878.M4 |
09-0050 |
$36,655.63 |
$0.00 |
|
443 |
454-13-1879.M4 |
09-0049 |
$38,146.39 |
$0.00 |
|
444 |
454-13-2591.M4 |
08-4746 |
$11,693.06 |
$0.00 |
|
445 |
454-13-2606.M4 |
05-B502 |
$18,563.66 |
$0.00 |
|
446 |
454-13-3440.M4 |
08-7132 |
$7,461.00 |
$0.00 |
ATTACHMENT 2
Page 13 of 13
NO ADDITIONAL REIMBURSEMENT OWED TO PROVIDER
|
NO. |
SOAH Dkt. No. |
MR No. |
Carrier Payment |
Additional Reimbursement Owed to Provider |
|
447 |
454-13-3471.M4 |
07-4384 |
$3,343.26 |
$0.00 |
|
448 |
454-13-3545.M4 |
07-5944 |
$3,527.70 |
$0.00 |
|
449 |
454-13-3547.M4 |
06-6830 |
$6,009.23 |
$0.00 |
|
450 |
454-13-3548.M4 |
08-5240 |
$7,314.00 |
$0.00 |
|
451 |
454-13-3560.M4 |
07-3678 |
$16,223.30 |
$0.00 |
|
452 |
454-13-4188.M4 |
06-4514 |
$9,393.53 |
$0.00 |
|
453 |
454-13-4189.M4 |
07-0920 |
$23,137.57 |
$0.00 |
|
454 |
454-13-4190.M4 |
05-2742 |
$58,362.59 |
$0.00 |
|
455 |
454-13-4195.M4 |
08-2226 |
$18,552.71 |
$0.00 |
|
456 |
454-13-4328.M4 |
06-2199 |
$27,167.67 |
$0.00 |
|
457 |
454-13-4329.M4 |
05-6894 |
$25,500.17 |
$0.00 |
|
458 |
454-13-4632.M4 |
07-5963 |
$15,757.88 |
$0.00 |
|
459 |
454-13-4633.M4 |
07-7231 |
$11,233.75 |
$0.00 |
|
460 |
454-13-4634.M4 |
07-6458 |
$1,118.00 |
$0.00 |
|
461 |
454-13-4700.M4 |
08-6310 |
$17,245.05 |
$0.00 |
ATTACHMENT 3
Page 1 of 2
CASE REIMBURSED UNDER PER DIEM METHODOLOGY
ADDITIONAL REIMBURSEMENT OWED PROVIDER
|
NO. |
SOAH Dkt. No. |
MR No. |
Total Owed |
Carrier Payment |
Additional Reimbursement Owed to Provider |
|
1 |
454-13-2443.M4 |
07-1614 |
$29,641.80 |
$27,257.00 |
$2,384.80 |
|
2 |
454-13-3303.M4 |
08-6241 |
$9,786.07 |
$9,032.57 |
$753.50 |
|
3 |
454-13-3307.M4 |
08-6160 |
$11,827.67 |
$11,075.16 |
$752.51 |
|
4 |
454-13-4444.M4 |
07-5512 |
$10,570.20 |
$8,650.70 |
$1,919.50 |
|
5 |
454-13-5035.M4 |
04-5349 |
$43,355.10 |
$36,647.10 |
$6,708.00 |
|
6 |
454-14-2861.M4 |
14-1733 |
$19,748.80 |
$15,681.00 |
$4,067.80 |
|
7 |
454-13-0604.M4 |
07-1490 |
$21,169.00 |
$17,843.00 |
$3,326.00 |
|
8 |
454-12-7446.M4 |
06-1461 |
$16,415.46 |
$13,980.70 |
$2,434.76 |
|
9 |
454-12-7452.M4 |
06-2973 |
$2,236.00 |
$0.00 |
$2,236.00 |
|
10 |
454-12-7518.M4 |
05-2655 |
$8,325.20 |
$2,889.30 |
$5,435.90 |
|
11 |
454-13-1122.M4 |
06-2142 |
$37,754.30 |
$19,161.00 |
$18,593.30 |
|
12 |
454-13-1254.M4 |
07-4131 |
$23,396.20 |
$18,778.30 |
$4,617.90 |
|
13 |
454-13-4367.M4 |
05-8699 |
$22,941.70 |
$22,817.40 |
$124.30 |
|
14 |
454-13-4443.M4 |
07-5436 |
$19,148.50 |
$18,395.00 |
$753.50 |
|
15 |
454-13-2446.M4 |
07-8177 |
$17,477.60 |
$17,365.60 |
$112.00 |
|
16 |
454-13-2461.M4 |
06-1406 |
$37,370.05 |
$26,263.50 |
$11,106.55 |
|
17 |
454-13-2466.M4 |
07-4012 |
$15,221.50 |
$15,133.50 |
$88.00 |
|
18 |
454-13-1542.M4 |
07-0575 |
$36,123.00 |
$13,210.00 |
$22,913.00 |
|
19 |
454-13-5126.M4 |
07-7344 |
$29,924.50 |
$28,170.50 |
$1,754.00 |
|
20 |
454-12-1961.M4 |
06-6001 |
$26,954.50 |
$3,354.00 |
$23,600.50 |
|
21 |
454-12-5500.M4 |
05-6722 |
$12,026.00 |
$11,594.69 |
$431.31 |
|
22 |
454-12-5565.M4 |
06-2096 |
$35,761.50 |
$30,987.00 |
$4,774.50 |
|
23 |
454-12-5569.M4 |
06-6231 |
$14,475.70 |
$6,945.10 |
$7,530.60 |
|
24 |
454-12-7312.M4 |
07-0731 |
$28,026.50 |
$27,836.50 |
$190.00 |
|
25 |
454-12-7333.M4 |
07-4046 |
$10,176.50 |
$1,118.00 |
$9,058.50 |
|
26 |
454-12-7838.M4 |
06-1611 |
$44,762.45 |
$38,571.13 |
$6,191.32 |
|
27 |
454-13-0105.M4 |
07-4673 |
$20,297.00 |
$18,812.00 |
$1,485.00 |
|
28 |
454-13-0106.M4 |
07-1021 |
$18,638.40 |
$17,538.40 |
$1,100.00 |
|
29 |
454-13-0107.M4 |
08-5035 |
$9,633.97 |
$2,236.00 |
$7,397.97 |
|
30 |
454-13-0140.M4 |
06-0659 |
$48,900.89 |
$40,157.00 |
$8,743.89 |
|
31 |
454-13-0525.M4 |
06-6004 |
$23,930.58 |
$18,267.78 |
$5,662.80 |
|
32 |
454-13-1406.M4 |
07-3984 |
$5,859.00 |
$3,659.00 |
$2,200.00 |
|
33 |
454-13-1407.M4 |
07-8133 |
$10,545.00 |
$9,648.50 |
$896.50 |
|
34 |
454-13-1491.M4 |
09-6427 |
$26,634.00 |
$22,809.30 |
$3,824.70 |
|
35 |
454-13-2141.M4 |
07-4673 |
See 454-13-0105.M4 |
See 454-13-0105.M4 |
See 454-13-0105.M4 |
ATTACHMENT 3
Page 2 of 2
CASE REIMBURSED UNDER PER DIEM METHODOLOGY
ADDITIONAL REIMBURSEMENT OWED PROVIDER
|
NO. |
SOAH Dkt. No. |
MR No. |
Total Owed |
Carrier Payment |
Additional Reimbursement Owed to Provider |
|
36 |
454-13-2541.M4 |
05-B563 |
$24,607.10 |
$23,936.10 |
$671.00 |
|
37 |
454-13-2723.M4 |
07-4046 |
See 454-12-7333.M4 |
See 454-12-7333.M4 |
See 454-12-7333.M4 |
|
38 |
454-13-2872.M4 |
06-1611 |
See 454 12-7838.M4 |
See 454 12-7838.M4 |
See 454 12-7838.M4 |
|
39 |
454-13-4377.M4 |
06-2094 |
$25,986.50 |
$23,594.00 |
$2,392.50 |
|
40 |
454-13-4446.M4 |
07-7388 |
$38,083.00 |
$34,783.00 |
$3,300.00 |
|
41 |
454-15-1333.M4 |
07-0122 |
$27,577.90 |
$27,090.50 |
$487.40 |
|
42 |
454-13-0522.M4 |
06-5151 |
$26,242.98 |
$20,754.00 |
$5,488.98 |
|
43 |
454-13-4382.M4 |
04-1365 |
$32,164.80 |
$2,236.00 |
$29,928.80 |
|
44 |
454-13-2957.M4 |
05-1635 |
$12,350.50 |
$7,325.01 |
$5,025.49 |
|
45 |
454-13-2529.M4 |
07-6767 |
$9,814.25 |
$0.00 |
$9,814.25 |
|
46 |
454-13-5957.M4 |
07-4250 |
$12,603.53 |
$11,401.23 |
$1,202.30 |
|
47 |
454-13-2527.M4 |
09-2100 |
$36,110.50 |
$2,236.00 |
$33,874.50 |
|
48 |
454-13-2967.M4 |
08-0921 |
$14,064.84 |
$13,773.60 |
$291.24 |
|
49 |
454-13-3803.M4 |
07-7937 |
$20,718.61 |
$19,487.98 |
$1,230.63 |
|
50 |
454-13-4029.M4 |
09-2859 |
$14,949.41 |
$5,590.00 |
$9,359.41 |
|
51 |
454-13-4153.M4 |
08-0968 |
$60,548.47 |
$60,317.37 |
$231.10 |
|
52 |
454-13-1806.M4 |
07-2097 |
$22,738.82 |
$22,386.15 |
$352.67 |
|
53 |
454-13-1807.M4 |
07-7244 |
$20,212.02 |
$15,974.02 |
$4,238.00 |
|
54 |
454-12-7710.M4 |
05-5106 |
$11,982.72 |
$11,647.32 |
$335.40 |
|
55 |
454-13-3804.M4 |
08-1048 |
$6,708.00 |
$3,354.00 |
$3,354.00 |
|
56 |
454-13-4642.M4 |
08-2140 |
$10,850.43 |
$10,469.38 |
$381.05 |
|
57 |
454-13-3559.M4 |
08-2269 |
$12,969.40 |
$11,851.40 |
$1,118.00 |
ATTACHMENT 4
Page 1 of 1
CASES THAT ARE EXCLUDED FROM PER DIEM/STOP-LOSS EXCEPTION
|
NO. |
SOAH Dkt. No. |
MR No. |
Provider |
Carrier |
Type of Reimbursement |
|
1 |
454-12-0230.M4 |
07-2681 |
Corpus Christi Medical Center |
Texas Mutual Insurance Co. |
Trauma-Fair & Reasonable |
|
2 |
454-12-0231.M4 |
07-0774 |
Bayshore Medical Center Center |
Texas Mutual Insurance Co. |
Trauma-Fair & Reasonable |
|
3 |
454-12-5958.M4 |
06-7047 |
Vista Medical Center Hospital |
Commerce & Industry Insurance Co. |
Trauma-Fair & Reasonable |
|
4 |
454-13-1849.M4 |
09-3797 |
Christus St. Elizabeth Hospital |
Zurich American Insurance Co. |
Trauma-Fair & Reasonable |
|
5 |
454-13-2533.M4 |
06-7290 |
Bayshore Medical Center Center |
Texas Municipal League Intergovernmental Risk Pool |
Trauma-Fair & Reasonable |
|
6 |
454-13-3950.M4 |
08-4685 |
Park Plaza Hospital |
Liberty Insurance Corporation |
Rehab- Fair & Reasonable |
|
7 |
454-13-4314.M4 |
06-0819 |
Texas Orthopedic Hospital |
American Home Assurance Co. |
Trauma-Fair & Reasonable |
|
8 |
454-13-2607.M4 |
09-1348 |
Triumph Hospital El Paso |
Liberty Insurance Corporation |
Rehab- Fair & Reasonable |
|
9 |
454-13-4192.M4 |
09-3479 |
Christus St. Elizabeth Hospital |
Liberty Mutual Ins. Co. |
Trauma-Fair & Reasonable |
|
10 |
454-14-1564.M4 |
09-4193 |
Christus St. Elizabeth Hospital |
Zurich American Insurance Co. |
Trauma-Fair & Reasonable |
- Effective September 1, 2005, the legislature dissolved the Texas Workers’ Compensation Commission (Commission) and created the Division of Workers’ Compensation within the Texas Department of Insurance. Act of June 1, 2005, 79th Leg., R.S., ch. 265, § 8.001, 2005 Tex. Gen. Laws 469, 607. This Decision and Order refers to the Commission and its successor collectively as the Division.↑
- The 1997 ACIHFG, originally codified at 28 Texas Administrative Code § 134.401 (Former Rule), established a general reimbursement scheme for all inpatient services provided by an acute care hospital for medical and/or surgical admissions using a service-related standard per diem amount. On a case-by-case basis, independent reimbursement is allowed if the particular case exceeds the Stop-Loss Threshold as described in paragraph (6) of Former Rule 134.401(c). This independent reimbursement mechanism, the Stop-Loss Method or Stop-Loss Methodology, is sometimes referred to as the Stop-Loss Exception or the Stop-Loss Rule.↑
- A large number of cases were referred to the State Office of Administrative Hearings (SOAH) too late to be included in the consolidated and joined hearing dockets. Those cases remain pending at SOAH for hearing assignment by ALJ Card. Several cases in the hearing docket were abated or continued at the request of the parties and will be transferred to ALJ Card for additional proceedings.↑
- Tex. Lab. Code § 401.011(19) and (31). The Texas Workers’ Compensation Act is found at Texas Labor Code chapters 401‑419 (the Act).↑
- Act § 413.011(d).↑
- Id.↑
- Id.↑
- 22 TexReg 6305, 6306 (July 4, 1997).↑
- 28 Tex. Admin. Code § 134.404(a)(2). See 33 TexReg 5319 (July 4, 2008).↑
- The “Standard Per Diem Amount” was $870 for a medical admission, $1,118 for a surgical admission, and $1,560 for an Intensive Care Unit (ICU)/Cardiac Care Unit (CCU) stay. Former Rule 134.401(c)(1). When the injured worker’s admission was a medical admission but surgery was subsequently performed during the stay, the entire stay was considered a surgical admission. Former Rule 134.401(b)(2)(F). For each day the injured worker was in the ICU or CCU, the ICU/CCU per diem reimbursement rate was paid in lieu of the medical or surgical per diem rate. Former Rule 134.401(c)(2)(B).↑
- Former Rule 134.401(c)(4).↑
- Former Rule 134.401(c)(4)(A)(i-ii).↑
- Former Rule 134.401(c)(4)(C).↑
- Former Rule 134.401(c)(4)(B)(i).↑
- Former Rule 134.401(c)(4)(B)(ii).↑
- Former Rule 134.401(c)(4)(B)(iii).↑
- Former Rule 134.401(c)(4)(B)(iv).↑
- Former Rule 134.401(c)(4)(B)(v).↑
- Former Rule 134.401(c). ICD-9 is The International Statistical Classification of Diseases, ninth revision.↑
- Former Rule 134.401(c)(6).↑
- Former Rule 134.401(c)(6)(A)(i). The Former Rule defined “Stop-Loss Threshold (SLT)” as follows:
- Former Rule 134.401(b)(2)(A).↑
- Vista I at 551.↑
- Vista I at 554.↑
- Vista I at 554.↑
- A diagnosis-related group is a patient classification system that standardizes prospective payment to hospitals. In general, a DRG payment covers all charges associated with an inpatient stay from the time of admission to discharge.↑
- Vista I at 554.↑
- Centers for Medicare & Medicaid Services.↑
Threshold of total charges established by the Commission, beyond which reimbursement is calculated by multiplying the applicable Stop-Loss Reimbursement Factor by the total charges identifying that particular threshold.
Former Rule 134.401(b)(1)(H).↑