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CMS Pub. 100-06, ch. 5, § 510.4

Reconciliation of Claim Payments from the Detailed Claims Data File/Report to the Month-to-Date Analysis of

activein force · 2026-08-25 – presentas-observed

Payment (MCS Report #2002 or HBDR2002) - This attachment is an illustration of the electronic spreadsheet (Exhibit

1) that will be used to input the dollar value of the specific line items from the detailed claims data file on a cycle basis.

(Rev. 21, 08-01-03)

Section 510.4: Reconciliation of Claim Payments from the Detailed Claims Data File/Report to the Month-to-Date Analysis of Payment (HBDR2002)

Col. A Col. B Col. C Col. D Col. E Col. F Col. G

DETAILED DAILY DIFFERENCE DETAILED DAILY DIFFERENCE

CLAIM PAYMENTS CLAIM PAYMENTS CLAIM PAYMENTS ADJUSTMENTS ADJUSTMENTS ADJUSTMENTS

LINE DATE Report Title ## HBDR2002 (B-C) Report Title ## HBDR2002 (E-F)

38 12/1/2002 0.00 0.00 0.00 0.00 0.00 0.00

39 12/2/2002 0.00 0.00 0.00 350,782.36 (350,782.36)

40 12/3/2002 0.00 0.00 0.00 386,166.12 (386,166.12)

41 12/4/2002 0.00 0.00 0.00 504,327.28 (504,327.28)

42 12/5/2002 0.00 0.00 0.00 309,629.56 (309,629.56)

43 12/6/2002 0.00 0.00 0.00 451,525.15 (451,525.15)

44 12/7/2002 0.00 0.00 0.00 0.00 0.00

45 12/8/2002 0.00 0.00 0.00 0.00 0.00

46 12/9/2002 0.00 0.00 0.00 360,978.06 (360,978.06)

47 12/10/2002 0.00 0.00 0.00 363,366.69 (363,366.69)

48 12/11/2002 0.00 0.00 0.00 361,998.44 (361,998.44)

49 12/12/2002 0.00 0.00 0.00 352,961.21 (352,961.21)

50 12/13/2002 0.00 0.00 0.00 372,426.91 (372,426.91)

51 12/14/2002 0.00 0.00 0.00 0.00 0.00

52 12/15/2002 0.00 0.00 0.00 0.00 0.00

53 12/16/2002 0.00 0.00 0.00 299,624.59 (299,624.59)

54 12/17/2002 0.00 0.00 0.00 695,311.73 (695,311.73)

55 12/18/2002 0.00 0.00 0.00 448,313.96 (448,313.96)

56 12/19/2002 0.00 0.00 0.00 378,403.93 (378,403.93)

57 12/20/2002 0.00 0.00 0.00 391,304.93 (391,304.93)

58 12/21/2002 0.00 0.00 0.00 0.00 0.00

59 12/22/2002 0.00 0.00 0.00 0.00 0.00

60 12/23/2002 0.00 0.00 0.00 338,378.43 (338,378.43)

61 12/24/2002 0.00 0.00 0.00 0.00 0.00

62 12/25/2002 0.00 0.00 0.00 0.00 0.00

63 12/26/2002 0.00 0.00 0.00 416,537.31 (416,537.31)

64 12/27/2002 0.00 0.00 0.00 347,191.72 (347,191.72)

65 12/28/2002 0.00 0.00 0.00 0.00 0.00

66 12/29/2002 0.00 0.00 0.00 0.00 0.00

67 12/30/2002 0.00 0.00 0.00 286,326.18 (286,326.18)

68 12/31/2002 0.00 0.00 0.00 0.00 0.00

70 Totals 15,810,912.00 15,597,653.42 (1,845.22) 0.00 215,103.80 (7,415,554.56)

History

(Rev. 21, 08-01-03)

Provenance

Source: cms.gov
Retrieved: 2026-08-25
Edition: iom-2026-08-25
Content hash: f1ccce6f0ee47c6344fd0c2a7fdadc931c3c8d67a11adb74652a48e18225ac18

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