Transaction Detail Previous Day 05 03 2021-02 58 23 PDF

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Download Transaction Detail Previous Day 05 03 2021-02 58 23 PDF

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Transaction Detail Report - PreviousDay Physicians Medical Center LLC - Q48069 Selected Criteria: Date: Accounts:

04/20/2021 00:00 to 04/20/2021 23:59 07023514917

Transaction Group:

ACH Credit, ACH Debit, Account Transfer Credit, Account Transfer Debit, CPS Device Credit, CPS Device Credit Adjustment, CPS Device Credit Reversal, CPS Device Debit, CPS Device Debit Adjustment, CPS Device Debit Reversal, Cash Letter Credit, Cash Recycle Debit Reversal, Cash Recycler Credit, Cash Recycler Credit Adjustment, Cash Recycler Credit Reversal, Cash Recycler Debit, Cash Recycler Debit Adjustment, Check, Deposit, Disbursing Credit, Disbursing Debit, Fee, International, Lockbox, Miscellaneous Credit, Miscellaneous Debit, Real Time Payment Credit, Real Time Payment Credit Adjustment, Real Time Payment Credits, Real Time Payment Debit, Real Time Payment Debit Adjustment, Real Time Payment Debits, Return, Wire Transfer Incoming, Wire Transfer Outgoing, Wire Transfer outgoing, ZBA Credit, ZBA Debit

Fifth Third Bank - 042000314 07023514917 - Checking - Physicians Medical Center - USD Date

Transaction Type

Bank Ref. #

Customer Ref. #

04/20/2021

Check

600478586510

21377

04/20/2021

Lockbox

599478405174

36033000668

$18,828.51

04/20/2021

Lockbox

599478405165

36033000667

$37,065.19

04/20/2021 Description:

Deposit 200501575712 99999042021 5-3 BANKCARD COMB. DEP. CHAIN 0U1675 COMB. DEP. PHYSICIANS MEDICAL CEN 042021

$350.00

04/20/2021 Description:

ACH Credit 200109833890 Colonial Penn Li HCCLAIMPMT 041001037809620 PHYSICIANS MEDICAL CEN TRN*1*3661417*1231628836~ 042021

04/20/2021 Description:

ACH Credit 200109250460 HHP LOU DISDATA-OPTIONAL HCCLAIMPMT 610208 PHYSICIANS MEDICAL CEN TRN*1*005920001305341*1611013183 0420

04/20/2021 Description:

ACH Credit 200109250296 HHP DISDATA-OPTIONAL HCCLAIMPMT 610208 PHYSICIANS MEDICAL CEN TRN*1*001270018598888*1611013183 042021

04/20/2021 Description:

ACH Credit 200109250226 HHP DISDATA-OPTIONAL HCCLAIMPMT 610208 PHYSICIANS MEDICAL CEN TRN*1*001270018594910*1611013183 042021

04/20/2021 Description:

ACH Credit 200109250180 HHP DISDATA-OPTIONAL HCCLAIMPMT 610208 PHYSICIANS MEDICAL CEN TRN*1*011810018596517*1611013183 042021

04/20/2021 Description:

ACH Credit 200109250118 HHP DISDATA-OPTIONAL HCCLAIMPMT 610208 PHYSICIANS MEDICAL CEN TRN*1*011810018595283*1611013183 042021

04/20/2021 Description:

ACH Credit 200109156329 MDwise Healthy I HCCLAIMPMT 205071967 PHYSICIANS MEDICAL CEN TRN*1*157407*1473192307*0000MDWS5 042021

04/20/2021 Description:

ACH Credit 200109156251 MDwise Hoosier H HCCLAIMPMT 205071967 PHYSICIANS MEDICAL CEN TRN*1*121755*1473192307*0000MDWS5 042021

04/20/2021

ACH Credit

Mon May 03 14:58:23 EDT 2021

Debit Amount $159,691.00

Credit Amount

$173.95

$10,590.09

$2,913.61

$14,121.63

$7,548.68

$2,823.02

$4,182.33

$3,436.46

$87.60

200109000296

Confidential

Page 1 of3

Deposit and credit products provided by Fifth Third Bank, National Association, Member FDIC. Equal Housing Lender. Fifth Third and Fifth Third Bank are registered service marks of Fifth Third Bancorp.

07023514917 - Checking - Physicians Medical Center - USD Date Description:

Transaction Type Bank Ref. # Customer Ref. # UnitedHealthcare HCCLAIMPMT 205071967 PHYSICIANS MEDICAL CEN TRN*1*1629089949*1411289245*000087726 0420

04/20/2021 Description:

ACH Credit 200108997575 UNITEDHEALTHCARE HCCLAIMPMT 205071967 PHYSICIANS MEDICAL CEN TRN*1*1TR81633620*1411289245*000087726 042

04/20/2021 Description:

ACH Credit 200108995327 AARP Supplementa HCCLAIMPMT 205071967 PHYSICIANS MEDICAL CEN TRN*1*1628963869*1362739571*000036273 0420

04/20/2021 Description:

ACH Credit 200108994298 UMR HCCLAIMPMT 205071967 PHYSICIANS MEDICAL CEN TRN*1*628817120*1391995276*0000UMR01 042021

$1,625.26

04/20/2021 Description:

ACH Credit 200108990590 Optum VA CCN Reg HCCLAIMPMT 205071967 PHYSICIANS MEDICAL CEN TRN*1*9000878299*1204581265*0000VACCN 0420

$35.78

04/20/2021 Description:

ACH Credit 200108985528 United HealthCar HCCLAIMPMT 205071967 PHYSICIANS MEDICAL CEN TRN*1*1SG09076297*1411289245*000087726 042

04/20/2021 Description:

ACH Credit 200106898134 ANTHEM BLUE IN5F EDI PAYMENT HCCLAIMPMT 3148461956 PHYSICIANS MEDICAL CEN TRN*1*3148461956*1350781558 0

04/20/2021 Description:

ACH Credit 200106895959 ANTHEM BLUE IN5C EDI PAYMENT HCCLAIMPMT 3148461957 PHYSICIANS MEDICAL CEN TRN*1*3148461957*1350781558 0

04/20/2021 Description:

ACH Credit 200104743227 CIGNA PROVIDER PAYMENT HCCLAIMPMT 202100592946658 PHYSICIANS MEDICAL CEN TRN*1*1123001MS2021041808005958

04/20/2021 Description:

ACH Credit 200104740745 CIGNA PROVIDER PAYMENT HCCLAIMPMT 202100592947323 PHYSICIANS MEDICAL CEN TRN*1*1123001MS2021041813007151

04/20/2021 Description:

ACH Credit 200104740413 CIGNA PROVIDER PAYMENT HCCLAIMPMT 202100593157482 PHYSICIANS MEDICAL CEN TRN*1*1123001MS2021041805002900

04/20/2021 Description:

ACH Credit 200104736494 WPS-TDEFIC CONTR HCCLAIMPMT 2220209870 PHYSICIANS MEDICAL CEN TRN*1*2220209870*1391268299*WPSTDEFIC 042

$1,606.60

04/20/2021 Description:

ACH Credit 200104019675 WellCare Health HCCLAIMPMT PHYSICIANS MEDICAL CEN TRN*1*1006091046*1366069295 042021

$2,613.23

04/20/2021 Description:

ACH Credit 200104011918 HUMANA AHP DISDATA-OPTIONAL HCCLAIMPMT 610208 PHYSICIANS MEDICAL CEN TRN*1*014740102957543*1611013183 0

$950.07

04/20/2021 Description:

ACH Credit 200104011882 HUMANA AHP DISDATA-OPTIONAL HCCLAIMPMT 610208 PHYSICIANS MEDICAL CEN TRN*1*014740102953719*1611013183 0

$3,293.14

04/20/2021 Description:

ACH Credit 200104011840 HUMANA AHP DISDATA-OPTIONAL HCCLAIMPMT 610208 PHYSICIANS MEDICAL CEN TRN*1*014740102949578*1611013183 0

04/20/2021

ACH Credit

Mon May 03 14:58:23 EDT 2021

Debit Amount

Credit Amount

$59,643.08

$199.98

$924.76

$330.63

$17,879.52

$117.02

$1,193.09

$117.02

$20,162.83

$5,863.37

200104005945 Confidential

Page 2 of3

Deposit and credit products provided by Fifth Third Bank, National Association, Member FDIC. Equal Housing Lender. Fifth Third and Fifth Third Bank are registered service marks of Fifth Third Bancorp.

07023514917 - Checking - Physicians Medical Center - USD Date Description:

Transaction Type Bank Ref. # Customer Ref. # HUMANA INS CO DISDATA-OPTIONAL HCCLAIMPMT 610208 PHYSICIANS MEDICAL CEN TRN*1*001290056565936*1391263473

04/20/2021 Description:

ACH Credit 200104005683 HUMANA INS CO DISDATA-OPTIONAL HCCLAIMPMT 610208 PHYSICIANS MEDICAL CEN TRN*1*001290056544472*1391263473

04/20/2021 Description:

ACH Credit 200104005431 HUMANA INS CO DISDATA-OPTIONAL HCCLAIMPMT 610208 PHYSICIANS MEDICAL CEN TRN*1*001290056519916*1391263473

04/20/2021 Description:

ACH Credit 200103986856 HUMANA FORDMOC DISDATA-OPTIONAL HCCLAIMPMT 610208 PHYSICIANS MEDICAL CEN TRN*1*017300100066211*139126347

$7,716.56

04/20/2021 Description:

ACH Credit 200103986732 HUMANA METROLOU DISDATA-OPTIONAL HCCLAIMPMT 610208 PHYSICIANS MEDICAL CEN TRN*1*014040100053146*13912634

$1,320.82

04/20/2021 Description:

ACH Credit 200103984493 HUMANA CEDAR LAK DISDATA-OPTIONAL HCCLAIMPMT 610208 PHYSICIANS MEDICAL CEN TRN*1*013980099920689*1391263

04/20/2021 Description:

ACH Credit 200103983966 HUMANA CITYJEFF DISDATA-OPTIONAL HCCLAIMPMT 610208 PHYSICIANS MEDICAL CEN TRN*1*017210099931444*13912634

04/20/2021 Description:

ACH Credit 200103983933 HUMANA HAASCAB DISDATA-OPTIONAL HCCLAIMPMT 610208 PHYSICIANS MEDICAL CEN TRN*1*015920099906480*162157904

04/20/2021 Description:

ACH Credit 200103978754 ARI ARI PAY PMC PMC REGIONAL HOSPITAL NTE*AR BILLING SERVICES 042021

04/20/2021 Description:

ACH Credit 200103919612 HUMANA HIC DISDATA-OPTIONAL HCCLAIMPMT 610208 PHYSICIANS MEDICAL CEN TRN*1*059830101840289*1391263473 0

04/20/2021 Description:

ACH Credit 200103106392 ANTHEM BCBS HCCLAIMPMT 730565869 22000000591309 TRN*1*730565869*1311440175 042021

04/20/2021 Description:

ACH Credit 200103106388 ANTHEM BCBS HCCLAIMPMT 730563107 22000000591309 TRN*1*730563107*1311440175 042021

04/20/2021 Description:

ACH Credit 200103061916 WISCONSIN PHYSIC 08101 HCCLAIMPMT 150172 PHYSICIANS MEDICAL CEN TRN*1*EFT2348746*1391268299*000008101~ 0

04/20/2021 Deposit Totals (in USD): No. of Transactions:

Mon May 03 14:58:23 EDT 2021

Debit Amount

Credit Amount

$6,370.98

$24,997.64

$1,237.48

$3,918.47

$838.09

$153,949.61

$2,730.43

$17,580.60

$6,534.23

$49,593.11

$4,040.00

082342378409 $159,691.00 1

Confidential

$499,504.47 41

Page 3 of3

Deposit and credit products provided by Fifth Third Bank, National Association, Member FDIC. Equal Housing Lender. Fifth Third and Fifth Third Bank are registered service marks of Fifth Third Bancorp....