|
|
|
A |
B |
C |
D |
E |
F |
G |
H |
|
|
|
|
|
Estimated |
|
|
Estimated |
|
Estimated |
|
|
|
|
Estimated |
Payable |
|
Recoverable |
Amount Eligible |
Estimated |
First Interim |
|
|
|
Submitted |
Percent |
Amount |
Two-Thirds |
Amount |
for Distribution |
Distribution |
Distribution |
Type |
POC # |
Provider Name |
POC Amount |
Allowable |
(Col A x B) |
of Col C |
To Date |
(Col D - E) |
at 35% |
w/ De Minimus |
Hospital |
APP0009839 |
ATLANTIC CITY MEDICAL CENTER |
$235,068.38 |
97.2% |
$228,529.49 |
$152,352.99 |
$0.00 |
$152,352.99 |
$53,323.55 |
$53,323.55 |
Hospital |
APP0009817 |
ATLANTIC CITY MEDICAL CENTER |
$0.00 |
0.0% |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
Hospital |
APP0010850 |
BARNERT HOSPITAL |
$1,089,618.65 |
58.6% |
$638,928.87 |
$425,952.58 |
$387,359.89 |
$38,592.69 |
$13,507.44 |
$13,507.44 |
Hospital |
APP0009489 |
BAYONNE HOSPITAL |
$214,759.06 |
56.2% |
$120,736.84 |
$80,491.23 |
$14,951.40 |
$65,539.83 |
$22,938.94 |
$22,938.94 |
Hospital |
APP0009809 |
BAYSHORE COMMUNITY HOSPITAL |
$1,788.73 |
39.4% |
$705.00 |
$470.00 |
$942.00 |
($472.00) |
$0.00 |
$0.00 |
Hospital |
APP0010812 |
BERGEN REGIONAL MEDICAL CENTER & BERGEN PINES COUN |
$21,713.60 |
35.7% |
$7,745.55 |
$5,163.70 |
$745.00 |
$4,418.70 |
$1,546.54 |
$1,546.54 |
Hospital |
APP0010839 |
BROCKTON HOSPITAL |
$279.01 |
100.0% |
$279.01 |
$186.01 |
$0.00 |
$186.01 |
$65.10 |
$0.00 |
Hospital |
APP0049315 |
CAPITAL HEALTH SYSTEM |
$15,179.61 |
92.7% |
$14,075.81 |
$9,383.87 |
$45.00 |
$9,338.87 |
$3,268.60 |
$3,268.60 |
Hospital |
APP0010799 |
CAPITAL HEALTH SYSTEM AT FULD |
$981.00 |
17.8% |
$175.00 |
$116.67 |
$45.00 |
$71.67 |
$25.08 |
$0.00 |
Hospital |
APP0010808 |
CHILDREN'S HOSPITAL OF PHILADELPHIA |
$324,381.97 |
41.3% |
$134,077.40 |
$89,384.93 |
$0.00 |
$89,384.93 |
$31,284.73 |
$31,284.73 |
Hospital |
APP0010860 |
CHILDREN'S SPECIALIZED HOSPITAL |
$113,976.16 |
60.8% |
$69,315.18 |
$46,210.12 |
$0.00 |
$46,210.12 |
$16,173.54 |
$16,173.54 |
Hospital |
APP0009818 |
CHILTON MEMORIAL HOSPITAL |
$18,379.00 |
31.7% |
$5,832.60 |
$3,888.40 |
$590.80 |
$3,297.60 |
$1,154.16 |
$1,154.16 |
Hospital |
APP0009486 |
CHRIST HOSPITAL |
$910,560.33 |
53.9% |
$491,184.43 |
$327,456.29 |
$62,424.22 |
$265,032.07 |
$92,761.22 |
$92,761.22 |
Hospital |
APP0010262 |
CLARA MAAS MEDICAL CENTER |
$110,009.23 |
59.2% |
$65,161.51 |
$43,441.01 |
$130.00 |
$43,311.01 |
$15,158.85 |
$15,158.85 |
Hospital |
APP0001220 |
COLUMBUS HOSPITAL |
$543,970.30 |
28.2% |
$153,644.49 |
$102,429.66 |
$21,272.81 |
$81,156.85 |
$28,404.90 |
$28,404.90 |
Hospital |
APP0049198 |
CT. CHILDREN'S MEDICAL CENTER |
$2,129.00 |
0.0% |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
Hospital |
APP0010775 |
EAST ORANGE GENERAL HOSPITAL |
$52,655.81 |
30.7% |
$16,139.59 |
$10,759.73 |
$3,790.00 |
$6,969.73 |
$2,439.41 |
$2,439.41 |
Hospital |
APP0002662 |
ELIZABETH GENERAL MEDICAL CENTER |
$585,932.85 |
64.7% |
$379,025.61 |
$252,683.74 |
$754.90 |
$251,928.84 |
$88,175.09 |
$88,175.09 |
Hospital |
APP0011052 |
ENGLEWOOD HOSPITAL AND MEDICAL CENTER |
$651,279.10 |
44.2% |
$287,554.12 |
$191,702.75 |
$15,031.13 |
$176,671.62 |
$61,835.07 |
$61,835.07 |
Hospital |
APP0010832 |
EPISCOPAL HOSPITAL |
$4,049.00 |
81.1% |
$3,282.00 |
$2,188.00 |
$0.00 |
$2,188.00 |
$765.80 |
$0.00 |
Hospital |
APP0010848 |
GENERAL HOSPITAL CENTER AT PASSAIC |
$531,388.94 |
78.3% |
$416,147.39 |
$277,431.59 |
$18,420.70 |
$259,010.89 |
$90,653.81 |
$90,653.81 |
Hospital |
APP0009484 |
GREENVILLE HOSPITAL |
$450,928.00 |
12.0% |
$53,905.60 |
$35,937.07 |
$3,249.60 |
$32,687.47 |
$11,440.61 |
$11,440.61 |
Hospital |
APP0009816 |
HACKENSACK MEDICAL CENTER |
$980,148.29 |
52.9% |
$518,533.64 |
$345,689.09 |
$28,220.88 |
$317,468.21 |
$111,113.87 |
$111,113.87 |
Hospital |
APP0010815 |
HOLY NAME HOSPITAL |
$663,568.16 |
32.5% |
$215,951.64 |
$143,967.76 |
$13,416.31 |
$130,551.45 |
$45,693.01 |
$45,693.01 |
Hospital |
APP0010261 |
HOSPITAL CENTER AT ORANGE |
$238,946.04 |
37.8% |
$90,297.05 |
$60,198.03 |
$10,946.85 |
$49,251.18 |
$17,237.91 |
$17,237.91 |
Hospital |
APP0010263 |
IRVINGTON GENERAL HOSPITAL |
$21,859.80 |
32.3% |
$7,055.52 |
$4,703.68 |
$135.68 |
$4,568.00 |
$1,598.80 |
$1,598.80 |
Hospital |
APP0010790 |
JACOBI MEDICAL CENTER NYC |
$38,220.00 |
41.3% |
$15,797.60 |
$10,531.73 |
$0.00 |
$10,531.73 |
$3,686.11 |
$3,686.11 |
Hospital |
APP0009483 |
JERSEY CITY MEDICAL CENTER |
$6,628,275.68 |
30.9% |
$2,045,642.37 |
$1,363,761.58 |
$992,419.29 |
$371,342.29 |
$129,969.80 |
$129,969.80 |
Hospital |
APP0009831 |
JERSEY SHORE MEDICAL CENTER |
$7,292.00 |
45.3% |
$3,300.00 |
$2,200.00 |
$0.00 |
$2,200.00 |
$770.00 |
$0.00 |
Hospital |
APP0010868 |
JOHN F. KENNEDY MEDICAL CENTER |
$224,607.79 |
71.6% |
$160,850.66 |
$107,233.77 |
$13,581.74 |
$93,652.03 |
$32,778.21 |
$32,778.21 |
Hospital |
APP0049505 |
JOHNS HOPKINS BAYVIEW MED CTR |
$285.15 |
179.1% |
$510.77 |
$340.51 |
$0.00 |
$340.51 |
$119.18 |
$0.00 |
Hospital |
APP0049504 |
JOHNS HOPKINS HOSPITAL |
$4,406.87 |
2.7% |
$117.86 |
$78.57 |
$0.00 |
$78.57 |
$27.50 |
$0.00 |
Hospital |
APP0009814 |
KIMBALL MEDICAL CENTER |
$2,844.25 |
77.3% |
$2,200.00 |
$1,466.67 |
$0.00 |
$1,466.67 |
$513.33 |
$0.00 |
Hospital |
APP0049450 |
LINCOLN HOSPITAL |
$5,532.31 |
33.5% |
$1,851.73 |
$1,234.49 |
$0.00 |
$1,234.49 |
$432.07 |
$0.00 |
Hospital |
APP0009485 |
MEADOWLANDS HOSPITAL |
$102,950.65 |
41.7% |
$42,897.68 |
$28,598.45 |
$101.00 |
$28,497.45 |
$9,974.11 |
$9,974.11 |
Hospital |
APP0010870 |
MEMORIAL MEDICAL CENTER |
$21,932.40 |
55.2% |
$12,101.28 |
$8,067.52 |
$90.00 |
$7,977.52 |
$2,792.13 |
$2,792.13 |
Hospital |
APP0009811 |
MEMORIAL SLOAN-KETTERING HOSP. |
$214,822.00 |
1.5% |
$3,302.30 |
$2,201.53 |
$0.00 |
$2,201.53 |
$770.54 |
$0.00 |
Hospital |
APP0009813 |
MONMOUTH HOSPITAL/MEDICAL CNTR |
$9,487.70 |
86.5% |
$8,202.95 |
$5,468.63 |
$0.00 |
$5,468.63 |
$1,914.02 |
$1,914.02 |
Hospital |
APP0009819 |
MORRISTOWN MEMORIAL HOSPITAL |
$423,096.25 |
87.8% |
$371,276.06 |
$247,517.37 |
$3,859.05 |
$243,658.32 |
$85,280.41 |
$85,280.41 |
Hospital |
APP0010777 |
MOUNTAINSIDE HOSPITAL |
$14,236.21 |
85.5% |
$12,167.33 |
$8,111.55 |
$38.40 |
$8,073.15 |
$2,825.60 |
$2,825.60 |
Hospital |
APP0010856 |
MUHLENBERG HOSPITAL |
$767,808.61 |
42.0% |
$322,480.60 |
$214,987.07 |
$87,644.73 |
$127,342.34 |
$44,569.82 |
$44,569.82 |
Hospital |
APP0010260 |
NEWARK BETH ISRAEL MEDICAL CENTER |
$144,689.16 |
78.6% |
$113,781.20 |
$75,854.13 |
$41,134.45 |
$34,719.68 |
$12,151.89 |
$12,151.89 |
Hospital |
APP0010820 |
NEWTON MEMORIAL HOSPITAL |
$12,926.00 |
88.6% |
$11,452.90 |
$7,635.27 |
$0.00 |
$7,635.27 |
$2,672.34 |
$2,672.34 |
Hospital |
APP0010859 |
OVERLOOK HOSPITAL |
$369,367.65 |
80.4% |
$297,094.80 |
$198,063.20 |
$22,382.01 |
$175,681.19 |
$61,488.42 |
$61,488.42 |
Hospital |
APP0009487 |
PALISADES MEDICAL CENTER |
$367,354.65 |
75.4% |
$277,117.06 |
$184,744.71 |
$36,727.97 |
$148,016.74 |
$51,805.86 |
$51,805.86 |
Hospital |
APP0010813 |
PASCACK VALLEY HOSPITAL |
$100,114.48 |
50.4% |
$50,489.98 |
$33,659.99 |
$268.20 |
$33,391.79 |
$11,687.13 |
$11,687.13 |
Hospital |
APP0010849 |
PASSAIC BETH ISRAEL HOSPITAL |
$506,608.06 |
32.4% |
$164,104.09 |
$109,402.73 |
$11,261.71 |
$98,141.02 |
$34,349.36 |
$34,349.36 |
Hospital |
APP0009894 |
POCONO HOSPITAL |
$130.00 |
0.0% |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
$0.00 |
Hospital |
APP0010835 |
PRESBYTERIAN ALLEN PAVILI |
$5,512.00 |
70.6% |
$3,892.90 |
$2,595.27 |
$0.00 |
$2,595.27 |
$908.34 |
$0.00 |
Hospital |
APP0009490 |
PRESBYTERIAN HOSPITAL |
$125,918.82 |
9.9% |
$12,491.10 |
$8,327.40 |
$0.00 |
$8,327.40 |
$2,914.59 |
$2,914.59 |
Hospital |
APP0010857 |
RAHWAY HOSPITAL |
$121,774.46 |
58.0% |
$70,683.60 |
$47,122.40 |
$4,408.46 |
$42,713.94 |
$14,949.88 |
$14,949.88 |
Hospital |
APP0010867 |
RARITAN BAY MEDICAL CENTER |
$3,266,412.74 |
48.7% |
$1,591,245.23 |
$1,060,830.15 |
$192,524.40 |
$868,305.75 |
$303,907.01 |
$303,907.01 |
Hospital |
APP0010866 |
ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL |
$1,901,207.79 |
37.9% |
$721,168.15 |
$480,778.77 |
$69,573.44 |
$411,205.33 |
$143,921.87 |
$143,921.87 |
Hospital |
APP0007683 |
RWJUH AT HAMILTON |
$50,347.44 |
22.6% |
$11,353.93 |
$7,569.29 |
$0.00 |
$7,569.29 |
$2,649.25 |
$2,649.25 |
Hospital |
APP0010792 |
SHORE MEMORIAL HOSPITAL |
$21,172.34 |
40.4% |
$8,553.80 |
$5,702.53 |
$0.00 |
$5,702.53 |
$1,995.89 |
$1,995.89 |
Hospital |
APP0009822 |
SOMERSET MEDICAL CENTER |
$41,884.45 |
63.9% |
$26,765.04 |
$17,843.36 |
$59.04 |
$17,784.32 |
$6,224.51 |
$6,224.51 |
Hospital |
APP0049472 |
SOUTH FULTON MEDICAL CENTER |
$3,770.45 |
100.0% |
$3,770.45 |
$2,513.63 |
$0.00 |
$2,513.63 |
$879.77 |
$0.00 |
Hospital |
APP0009837 |
ST. CLARES HOSPITAL |
$42,670.35 |
52.3% |
$22,300.00 |
$14,866.67 |
$0.00 |
$14,866.67 |
$5,203.33 |
$5,203.33 |
Hospital |
APP0010858 |
ST. ELIZABETH HOSPITAL |
$1,347,797.06 |
33.0% |
$444,128.29 |
$296,085.53 |
$32,371.00 |
$263,714.53 |
$92,300.09 |
$92,300.09 |
Hospital |
APP0009482 |
ST. FRANCIS HOSPITAL |
$265,644.99 |
65.3% |
$173,574.48 |
$115,716.32 |
$92,337.63 |
$23,378.69 |
$8,182.54 |
$8,182.54 |
Hospital |
APP0010258 |
ST. JAMES HOSPITAL |
$123,366.85 |
49.0% |
$60,443.88 |
$40,295.92 |
$9,591.30 |
$30,704.62 |
$10,746.62 |
$10,746.62 |
Hospital |
APP0010851 |
ST. JOSEPH'S HOSPITAL |
$15,091,000.01 |
30.5% |
$4,608,393.04 |
$3,072,262.03 |
$1,133,555.40 |
$1,938,706.63 |
$678,547.32 |
$678,547.32 |
Hospital |
APP0010788 |
ST. MARY'S HOSPITAL |
$325,253.88 |
86.1% |
$279,992.24 |
$186,661.49 |
$175.00 |
$186,486.49 |
$65,270.27 |
$65,270.27 |
Hospital |
APP0010853 |
ST. MARY'S HOSPITAL (HOSP/CLIN) |
$810,620.63 |
71.5% |
$579,239.59 |
$386,159.73 |
$19,713.22 |
$366,446.51 |
$128,256.28 |
$128,256.28 |
Hospital |
APP0010774 |
ST. MICHAEL'S HOSPITAL |
$528,424.51 |
27.5% |
$145,356.41 |
$96,904.27 |
$13,212.20 |
$83,692.07 |
$29,292.22 |
$29,292.22 |
Hospital |
APP0010869 |
ST. PETER'S MEDICAL CENTER |
$1,485,743.66 |
47.0% |
$697,656.21 |
$465,104.14 |
$89,545.90 |
$375,558.24 |
$131,445.38 |
$131,445.38 |
Hospital |
APP0010823 |
ST. VINCENT MEDICAL CENTER |
$563.00 |
11.0% |
$62.00 |
$41.33 |
$0.00 |
$41.33 |
$14.47 |
$0.00 |
Hospital |
APP0010784 |
TAMPA GENERAL HOSPITAL |
$554.00 |
22.6% |
$125.00 |
$83.33 |
$0.00 |
$83.33 |
$29.17 |
$0.00 |
Hospital |
APP0010816 |
THE VALLEY HOSPITAL |
$118,214.88 |
78.4% |
$92,665.72 |
$61,777.15 |
$0.00 |
$61,777.15 |
$21,622.00 |
$21,622.00 |
Hospital |
APP0010257 |
UMDNJ/UNIVERSITY HOSPITAL |
$1,033,019.08 |
88.9% |
$918,625.04 |
$612,416.69 |
$90,172.35 |
$522,244.34 |
$182,785.52 |
$182,785.52 |
Hospital |
APP0010264 |
UNION HOSPITAL |
$21,052.71 |
77.1% |
$16,225.46 |
$10,816.97 |
$0.00 |
$10,816.97 |
$3,785.94 |
$3,785.94 |
Hospital |
APP0049364 |
WAYNE GENERAL HOSPITAL |
$34,304.24 |
10.8% |
$3,698.14 |
$2,465.43 |
$0.00 |
$2,465.43 |
$862.90 |
$0.00 |
Hospital |
APP0010852 |
WAYNE GENERAL HOSPITAL |
$2,554,638.25 |
41.7% |
$1,064,304.08 |
$709,536.05 |
$81,021.37 |
$628,514.68 |
$219,980.14 |
$219,980.14 |
Hospital |
APP0009840 |
WEST HUDSON HOSPITAL |
$9,553.20 |
10.5% |
$1,004.66 |
$669.77 |
$0.00 |
$669.77 |
$234.42 |
$0.00 |
|
|
TOTALS |
$47,080,959.68 |
|
$19,392,741.00 |
$12,928,493.99 |
$3,620,241.43 |
$9,308,252.56 |
$3,258,053.58 |
$3,251,635.91 |