Common use of Numeric Clause in Contracts

Numeric. Medicare crossovers are amounts that are billed to Medicaid for those Medicaid clients who are also eligible for Medicare. AHCA CONTRACT NO. FA309, AMENDMENT NO. 003, PAGE 8 OF 12 AHCA Form 2100-0002(Rev. OCT 02) AMERIGROUP FLORIDA, INC. MEDICAID HMO CONTRACT FEBRUARY 2003 ---------------------------------------------------------------------------------------------------------------------------- FIELD START FIELD NAME DESCRIPTION UNIT OF MEASUREMENT LENGTH COL. END COL. TEXT/NUMERIC ---------------------------------------------------------------------------------------------------------------------------- ESCORT Escort Services 15 Minute Unit 4 95 98 Numeric ---------------------------------------------------------------------------------------------------------------------------- FAMT_I Family Training Services (Individual) 15 Minute Unit 2 99 100 Numeric ---------------------------------------------------------------------------------------------------------------------------- FAMT_G Family Training Services (Group) 15 Minute Unit 2 101 102 Numeric ---------------------------------------------------------------------------------------------------------------------------- FINARRS Financial Assessment/Risk Reduction Services 15 Minute Unit 4 103 106 Numeric ---------------------------------------------------------------------------------------------------------------------------- FINM_RRS Financial Maintenance/Risk Reduction Services 15 Minute Unit 4 107 110 Numeric ---------------------------------------------------------------------------------------------------------------------------- HDMEAL Home Delivered Meals Meal 2 111 112 Numeric ---------------------------------------------------------------------------------------------------------------------------- HOMESRVS Homemaker Services 15 Minute Unit 4 113 116 Numeric ---------------------------------------------------------------------------------------------------------------------------- MH_CM Mental Health Case Management 15 Minute Unit 4 117 120 Numeric ---------------------------------------------------------------------------------------------------------------------------- SNF Nursing Facility Services- Long-term Days 2 121 122 Numeric ---------------------------------------------------------------------------------------------------------------------------- NUTR_RRS Nutritional Assessment/Risk Reduction Services 15 Minute Unit 4 123 126 Numeric ---------------------------------------------------------------------------------------------------------------------------- OT Occupational Therapy 15 Minute Unit 4 127 130 Numeric ---------------------------------------------------------------------------------------------------------------------------- PCS Personal Care Services 15 Minute Unit 4 131 134 Numeric ---------------------------------------------------------------------------------------------------------------------------- PERS_I Personal Emergency Response System Installation Job 2 135 136 Numeric ---------------------------------------------------------------------------------------------------------------------------- PERS_M Personal Emergency Response System- Maintenance Day 2 137 138 Numeric ---------------------------------------------------------------------------------------------------------------------------- PEST_I Pest Control - Initial Visit Job 2 139 140 Numeric ---------------------------------------------------------------------------------------------------------------------------- PEST_M Pest Control - Maintenance Month 1 141 141 Numeric ---------------------------------------------------------------------------------------------------------------------------- PT Physical Therapy 15 Minute Unit 4 142 145 Numeric ---------------------------------------------------------------------------------------------------------------------------- RISKREDU Physical Risk Assessment and Reduction 15 Minute Unit 4 146 149 Numeric ---------------------------------------------------------------------------------------------------------------------------- PRIVNURS Private Duty Nursing Services 15 Minute Unit 4 150 153 Numeric ---------------------------------------------------------------------------------------------------------------------------- PT_R Registered Physical Therapist Visit 2 154 155 Numeric ---------------------------------------------------------------------------------------------------------------------------- RSPTH Respiratory Therapy 15 Minute Unit 4 156 159 Numeric ---------------------------------------------------------------------------------------------------------------------------- RESP_HM Respite Care- In Home 15 Minute Unit 4 160 163 Numeric ---------------------------------------------------------------------------------------------------------------------------- RESP_FAC Respite Care- Facility-Based Days 2 164 165 Numeric ---------------------------------------------------------------------------------------------------------------------------- NURSE Skilled Nursing Visit 4 166 169 Numeric ---------------------------------------------------------------------------------------------------------------------------- SPTH Speech Therapy 15 Minute Unit 4 170 173 Numeric ---------------------------------------------------------------------------------------------------------------------------- TRANSPOR Transportation Services (not included in Escort or Adult Day Health services) Trips 3 174 176 Numeric ---------------------------------------------------------------------------------------------------------------------------- OTH_UNIT Other LTC Service not listed (unit) Unit/ Visit 6 177 182 Numeric ---------------------------------------------------------------------------------------------------------------------------- DESCR_1 Description of other LTC service 35 183 217 Text ---------------------------------------------------------------------------------------------------------------------------- OTH_$$ Other LTC service not listed (amount) Amount Paid 6 218 223 Numeric ---------------------------------------------------------------------------------------------------------------------------- DESCR_2 Description of other LTC service 35 224 258 Text ---------------------------------------------------------------------------------------------------------------------------- AHCA CONTRACT NO. FA309, AMENDMENT NO. 003, PAGE 9 OF 12 AHCA Form 2100-0002 (Rev. OCT 02) AMERIGROUP FLORIDA, INC. MEDICAID HMO CONTRACT FEBRUARY 2003 FILE 2: ACUTE CARE SERVICES

Numeric. ESCORT Escort Services 15 Minute Unit 4 95 98 Numeric -------------------------------------------------------------------------------------------------------------- FAMT_I Family Training Services (Individual) 15 Minute Unit 2 99 100 Numeric -------------------------------------------------------------------------------------------------------------- FAMT_G Family Training Services (Group) 15 Minute Unit 2 101 102 Numeric -------------------------------------------------------------------------------------------------------------- FINARRS Financial Assessment /Risk Reduction Services 15 Minute Unit 4 [ILLEGIBLE] 106 -------------------------------------------------------------------------------------------------------------- ---------- * Medicare crossovers are amounts that are billed to Medicaid for those Medicaid clients who are also eligible for Medicare. AHCA CONTRACT NO. FA309, AMENDMENT NO. 003, PAGE 8 EXHIBIT B (Page 2 of 3) -------------------------------------------------------------------------------------------------------------- UNIT OF 12 AHCA Form 2100-0002(Rev. OCT 02) AMERIGROUP FLORIDA, INC. MEDICAID HMO CONTRACT FEBRUARY 2003 ---------------------------------------------------------------------------------------------------------------------------- FIELD START FIELD NAME DESCRIPTION UNIT OF MEASUREMENT LENGTH START COL. END COL. TEXT/NUMERIC ---------------------------------------------------------------------------------------------------------------------------- ESCORT Escort Services 15 Minute Unit 4 95 98 Numeric ---------------------------------------------------------------------------------------------------------------------------- FAMT_I Family Training Services (Individual) 15 Minute Unit 2 99 100 Numeric ---------------------------------------------------------------------------------------------------------------------------- FAMT_G Family Training Services (Group) 15 Minute Unit 2 101 102 Numeric ---------------------------------------------------------------------------------------------------------------------------- FINARRS Financial Assessment/Risk Reduction Services 15 Minute Unit 4 103 106 Numeric ---------------------------------------------------------------------------------------------------------------------------- FINM_RRS -------------------------------------------------------------------------------------------------------------- FINM RRS Financial Maintenance/Risk Reduction Services 15 Minute Unit 4 107 110 Numeric ---------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------- HDMEAL Home Delivered Meals Meal Meal 2 111 112 Numeric ---------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------- HOMESRVS Homemaker Services 15 Minute Unit 4 113 116 Numeric ---------------------------------------------------------------------------------------------------------------------------- MH_CM Mental Health Case Management -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 117 120 Numeric ---------------------------------------------------------------------------------------------------------------------------- SNF Nursing Facility Services- Long-term -------------------------------------------------------------------------------------------------------------- Days 2 121 122 Numeric ---------------------------------------------------------------------------------------------------------------------------- NUTR_RRS Nutritional Assessment/Risk Reduction Services -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 123 126 Numeric ---------------------------------------------------------------------------------------------------------------------------- OT Occupational Therapy -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 127 130 Numeric ---------------------------------------------------------------------------------------------------------------------------- PCS Personal Care Services -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 131 134 Numeric ---------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------- PERS_I Personal Emergency Response System Installation Job 2 135 136 Numeric ---------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------- PERS_M Personal Emergency Response System- System - Maintenance Day 2 137 138 Numeric ---------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------- PEST_I Pest Control - Initial Visit Job 2 139 140 Numeric ---------------------------------------------------------------------------------------------------------------------------- PEST_M Pest Control - Maintenance -------------------------------------------------------------------------------------------------------------- Month 1 141 141 Numeric ---------------------------------------------------------------------------------------------------------------------------- PT Physical Therapy -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 142 145 Numeric ---------------------------------------------------------------------------------------------------------------------------- RISKREDU Physical Risk Assessment and Reduction -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 146 149 Numeric ---------------------------------------------------------------------------------------------------------------------------- PRIVNURS Private Duty Nursing Services -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 150 153 Numeric ---------------------------------------------------------------------------------------------------------------------------- PT_R Registered Physical Therapist -------------------------------------------------------------------------------------------------------------- Visit 2 154 155 Numeric ---------------------------------------------------------------------------------------------------------------------------- RSPTH Respiratory Therapy -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 156 159 Numeric ---------------------------------------------------------------------------------------------------------------------------- RESP_HM Respite Care- In Home -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 160 163 Numeric ---------------------------------------------------------------------------------------------------------------------------- RESP_FAC Respite Care- Facility-Based -------------------------------------------------------------------------------------------------------------- Days 2 164 165 Numeric ---------------------------------------------------------------------------------------------------------------------------- NURSE Skilled Nursing -------------------------------------------------------------------------------------------------------------- Visit 4 166 169 Numeric ---------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------- SPTH Speech Therapy 15 Minute Unit 4 170 173 Numeric ---------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------- TRANSPOR Transportation Services (not included in Escort or Adult Day Health services) Trips 3 174 176 Numeric ---------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------- OTH_UNIT Other LTC Service not listed (unit) Unit/ Unit/Visit 6 177 182 Numeric ---------------------------------------------------------------------------------------------------------------------------- DESCR_1 Description of other LTC service -------------------------------------------------------------------------------------------------------------- 35 183 217 Text ---------------------------------------------------------------------------------------------------------------------------- OTH_$$ Other LTC service not listed (amount) -------------------------------------------------------------------------------------------------------------- Amount Paid 6 218 223 Numeric ---------------------------------------------------------------------------------------------------------------------------- DESCR_2 Description of other LTC service -------------------------------------------------------------------------------------------------------------- 35 224 258 Text ---------------------------------------------------------------------------------------------------------------------------- AHCA CONTRACT NO. FA309, AMENDMENT NO. 003, PAGE 9 OF 12 AHCA Form 2100-0002 (Rev. OCT 02) AMERIGROUP FLORIDA, INC. MEDICAID HMO CONTRACT FEBRUARY 2003 -------------------------------------------------------------------------------------------------------------- EXHIBIT B FILE 2: ACUTE CARE SERVICES

Numeric. RX_$$ Pharmaceuticals Amount Paid 6 95 100 Numeric ------------------------------------------------------------------------------------------------------------------------------------ PA Physical Assistant Visit 2 101 102 Numeric ------------------------------------------------------------------------------------------------------------------------------------ PA_$$ Physical Assistant Costs Amount Paid 6 103 108 Numeric ------------------------------------------------------------------------------------------------------------------------------------ MD Physician Services Visit 2 109 110 Numeric ------------------------------------------------------------------------------------------------------------------------------------ MD_$$ Physician Services Costs Amount Paid 6 111 116 Numeric ------------------------------------------------------------------------------------------------------------------------------------ OUTPT Outpatient Hospital Services Encounter 3 117 119 Numeric ------------------------------------------------------------------------------------------------------------------------------------ OUTPT_$$ Outpatient Hospital Services Costs Amount Paid 6 120 125 Numeric ------------------------------------------------------------------------------------------------------------------------------------ PODIATRY Podiatry Visit 2 126 127 Numeric ------------------------------------------------------------------------------------------------------------------------------------ PODIAT$$ Podiatry Costs Amount Paid 6 128 133 Numeric ------------------------------------------------------------------------------------------------------------------------------------ RURAL Rural Health Services Visit 2 134 135 Numeric ------------------------------------------------------------------------------------------------------------------------------------ RURAL$$ Rural Health Services Costs Amount Paid 6 136 141 Numeric ------------------------------------------------------------------------------------------------------------------------------------ SNFREHAS Skilled nursing facility Amount Paid 6 142 147 Numeric services - rehabilitation** ------------------------------------------------------------------------------------------------------------------------------------ EYE_$$ Visual Services including eyeglasses Amount Paid 6 148 153 Numeric ------------------------------------------------------------------------------------------------------------------------------------ OTH UNIT Other Acute Service not listed (unit) Unit/Visit 6 154 159 Numeric ------------------------------------------------------------------------------------------------------------------------------------ DESCR_1 Description of other Acute service 35 160 194 Text ------------------------------------------------------------------------------------------------------------------------------------ OTH_$$ Other Acute service not listed (amount) Amount Paid 6 195 200 Numeric ------------------------------------------------------------------------------------------------------------------------------------ DESCR_2 Description of other Acute service 35 201 235 Text ------------------------------------------------------------------------------------------------------------------------------------ **Medicare crossovers are amounts that are billed to Medicaid for those Medicaid clients who are also eligible for Medicare. Crossovers AHCA CONTRACT NO. FA309, AMENDMENT NO. 003, PAGE 8 OF 12 AHCA Form 2100-0002(Rev. OCT 02) AMERIGROUP FLORIDA, INC. MEDICAID HMO CONTRACT FEBRUARY 2003 ---------------------------------------------------------------------------------------------------------------------------- FIELD START FIELD NAME DESCRIPTION UNIT OF MEASUREMENT LENGTH COL. END COL. TEXT/NUMERIC ---------------------------------------------------------------------------------------------------------------------------- ESCORT Escort Services 15 Minute Unit 4 95 98 Numeric ---------------------------------------------------------------------------------------------------------------------------- FAMT_I Family Training Services (Individual) 15 Minute Unit 2 99 100 Numeric ---------------------------------------------------------------------------------------------------------------------------- FAMT_G Family Training Services (Group) 15 Minute Unit 2 101 102 Numeric ---------------------------------------------------------------------------------------------------------------------------- FINARRS Financial Assessment/Risk Reduction Services 15 Minute Unit 4 103 106 Numeric ---------------------------------------------------------------------------------------------------------------------------- FINM_RRS Financial Maintenance/Risk Reduction Services 15 Minute Unit 4 107 110 Numeric ---------------------------------------------------------------------------------------------------------------------------- HDMEAL Home Delivered Meals Meal 2 111 112 Numeric ---------------------------------------------------------------------------------------------------------------------------- HOMESRVS Homemaker Services 15 Minute Unit 4 113 116 Numeric ---------------------------------------------------------------------------------------------------------------------------- MH_CM Mental Health Case Management 15 Minute Unit 4 117 120 Numeric ---------------------------------------------------------------------------------------------------------------------------- SNF Nursing Facility Services- Long-term Days 2 121 122 Numeric ---------------------------------------------------------------------------------------------------------------------------- NUTR_RRS Nutritional Assessment/Risk Reduction Services 15 Minute Unit 4 123 126 Numeric ---------------------------------------------------------------------------------------------------------------------------- OT Occupational Therapy 15 Minute Unit 4 127 130 Numeric ---------------------------------------------------------------------------------------------------------------------------- PCS Personal Care Services 15 Minute Unit 4 131 134 Numeric ---------------------------------------------------------------------------------------------------------------------------- PERS_I Personal Emergency Response System Installation Job 2 135 136 Numeric ---------------------------------------------------------------------------------------------------------------------------- PERS_M Personal Emergency Response System- Maintenance Day 2 137 138 Numeric ---------------------------------------------------------------------------------------------------------------------------- PEST_I Pest Control - Initial Visit Job 2 139 140 Numeric ---------------------------------------------------------------------------------------------------------------------------- PEST_M Pest Control - Maintenance Month 1 141 141 Numeric ---------------------------------------------------------------------------------------------------------------------------- PT Physical Therapy 15 Minute Unit 4 142 145 Numeric ---------------------------------------------------------------------------------------------------------------------------- RISKREDU Physical Risk Assessment and Reduction 15 Minute Unit 4 146 149 Numeric ---------------------------------------------------------------------------------------------------------------------------- PRIVNURS Private Duty Nursing Services 15 Minute Unit 4 150 153 Numeric ---------------------------------------------------------------------------------------------------------------------------- PT_R Registered Physical Therapist Visit 2 154 155 Numeric ---------------------------------------------------------------------------------------------------------------------------- RSPTH Respiratory Therapy 15 Minute Unit 4 156 159 Numeric ---------------------------------------------------------------------------------------------------------------------------- RESP_HM Respite Care- In Home 15 Minute Unit 4 160 163 Numeric ---------------------------------------------------------------------------------------------------------------------------- RESP_FAC Respite Care- Facility-Based Days 2 164 165 Numeric ---------------------------------------------------------------------------------------------------------------------------- NURSE Skilled Nursing Visit 4 166 169 Numeric ---------------------------------------------------------------------------------------------------------------------------- SPTH Speech Therapy 15 Minute Unit 4 170 173 Numeric ---------------------------------------------------------------------------------------------------------------------------- TRANSPOR Transportation Services (not included in Escort or Adult Day Health services) Trips 3 174 176 Numeric ---------------------------------------------------------------------------------------------------------------------------- OTH_UNIT Other LTC Service not listed (unit) Unit/ Visit 6 177 182 Numeric ---------------------------------------------------------------------------------------------------------------------------- DESCR_1 Description of other LTC service 35 183 217 Text ---------------------------------------------------------------------------------------------------------------------------- OTH_$$ Other LTC service not listed (amount) Amount Paid 6 218 223 Numeric ---------------------------------------------------------------------------------------------------------------------------- DESCR_2 Description of other LTC service 35 224 258 Text ---------------------------------------------------------------------------------------------------------------------------- AHCA CONTRACT NO. FA309, AMENDMENT NO. 003, PAGE 9 10 OF 12 AHCA Form 2100-0002 (Rev. OCT 02) AMERIGROUP FLORIDA, INC. MEDICAID HMO CONTRACT FEBRUARY 2003 FILE 2: ACUTE CARE SERVICES2003

Numeric. Medicare crossovers are amounts that are billed to Medicaid for those Medicaid clients who are also eligible for Medicare. AHCA CONTRACT NO. FA309, AMENDMENT NO. 003, PAGE 8 OF 12 AHCA Form 2100-0002(Rev. OCT 02) AMERIGROUP FLORIDA, INC. MEDICAID HMO CONTRACT FEBRUARY 2003 ---------------------------------------------------------------------------------------------------------------------------- FIELD START FIELD NAME DESCRIPTION UNIT OF MEASUREMENT LENGTH COL. END COL. TEXT/NUMERIC ---------------------------------------------------------------------------------------------------------------------------- ESCORT Escort Services 15 Minute Unit 4 X_$$ Pharmaceuticals Amount Paid 6 95 98 Numeric ---------------------------------------------------------------------------------------------------------------------------- FAMT_I Family Training Services (Individual) 15 Minute Unit 2 99 100 Numeric ---------------------------------------------------------------------------------------------------------------------------- FAMT_G Family Training Services (Group) 15 Minute Unit ------------------------------------------------------------------------------------------------------------- PA Physical Assistant Visit 2 101 102 Numeric ---------------------------------------------------------------------------------------------------------------------------- FINARRS Financial Assessment/Risk Reduction Services 15 Minute Unit 4 ------------------------------------------------------------------------------------------------------------- PA_$$ Physical Assistant Costs Amount Paid 6 103 106 Numeric ---------------------------------------------------------------------------------------------------------------------------- FINM_RRS Financial Maintenance/Risk Reduction ------------------------------------------------------------------------------------------------------------- MD Physician Services 15 Minute Unit 4 107 Visit 2 109 110 Numeric ---------------------------------------------------------------------------------------------------------------------------- HDMEAL Home Delivered Meals Meal 2 ------------------------------------------------------------------------------------------------------------- Physician Services Costs Amount Paid 6 111 112 Numeric ---------------------------------------------------------------------------------------------------------------------------- HOMESRVS Homemaker Services 15 Minute Unit 4 113 116 Numeric ---------------------------------------------------------------------------------------------------------------------------- MH_CM Mental ------------------------------------------------------------------------------------------------------------- Encounter 3 117 119 Numeric ------------------------------------------------------------------------------------------------------------- OUTPT_$$ Amount Paid 6 120 125 Numeric ------------------------------------------------------------------------------------------------------------- Visit 2 126 127 Numeric ------------------------------------------------------------------------------------------------------------- PODIAT$$ Amount Paid 6 128 133 Numeric ------------------------------------------------------------------------------------------------------------- Rural Health Case Management 15 Minute Unit 4 117 120 Services Visit 2 134 135 Numeric ---------------------------------------------------------------------------------------------------------------------------- SNF Nursing Facility Services- Long-term Days 2 121 122 Numeric ---------------------------------------------------------------------------------------------------------------------------- NUTR_RRS Nutritional Assessment/Risk Reduction ------------------------------------------------------------------------------------------------------------- Rural Health Services 15 Minute Unit 4 123 126 Numeric ---------------------------------------------------------------------------------------------------------------------------- OT Occupational Therapy 15 Minute Unit 4 127 130 Numeric ---------------------------------------------------------------------------------------------------------------------------- PCS Personal Care Services 15 Minute Unit 4 131 134 Numeric ---------------------------------------------------------------------------------------------------------------------------- PERS_I Personal Emergency Response System Installation Job 2 135 Costs Amount Paid 6 136 Numeric ---------------------------------------------------------------------------------------------------------------------------- PERS_M Personal Emergency Response System- Maintenance Day 2 137 138 Numeric ---------------------------------------------------------------------------------------------------------------------------- PEST_I Pest Control - Initial Visit Job 2 139 140 Numeric ---------------------------------------------------------------------------------------------------------------------------- PEST_M Pest Control - Maintenance Month 1 141 141 Numeric ---------------------------------------------------------------------------------------------------------------------------- PT Physical Therapy 15 Minute Unit 4 ------------------------------------------------------------------------------------------------------------- SNFREHAS Skilled nursing facility services - rehabilitation ** Amount Paid 6 142 145 147 Numeric ---------------------------------------------------------------------------------------------------------------------------- RISKREDU Physical Risk Assessment and Reduction 15 Minute Unit 4 146 149 Numeric ---------------------------------------------------------------------------------------------------------------------------- PRIVNURS Private Duty Nursing ------------------------------------------------------------------------------------------------------------- EYE_$$ Visual Services 15 Minute Unit 4 150 including eyeglasses Amount Paid 6 148 153 Numeric ---------------------------------------------------------------------------------------------------------------------------- PT_R Registered Physical Therapist Visit 2 154 155 Numeric ---------------------------------------------------------------------------------------------------------------------------- RSPTH Respiratory Therapy 15 Minute Unit 4 156 159 Numeric ---------------------------------------------------------------------------------------------------------------------------- RESP_HM Respite Care- In Home 15 Minute Unit 4 160 163 Numeric ---------------------------------------------------------------------------------------------------------------------------- RESP_FAC Respite Care- Facility-Based Days 2 164 165 Numeric ---------------------------------------------------------------------------------------------------------------------------- NURSE Skilled Nursing Visit 4 166 169 Numeric ---------------------------------------------------------------------------------------------------------------------------- SPTH Speech Therapy 15 Minute Unit 4 170 173 Numeric ---------------------------------------------------------------------------------------------------------------------------- TRANSPOR Transportation Services (not included in Escort or Adult Day Health services) Trips 3 174 176 Numeric ---------------------------------------------------------------------------------------------------------------------------- OTH_UNIT ------------------------------------------------------------------------------------------------------------- Other LTC Acute Service not listed (unit) Unit/ Unit/Visit 6 177 182 154 159 Numeric ---------------------------------------------------------------------------------------------------------------------------- DESCR_1 ------------------------------------------------------------------------------------------------------------- DESCR 1 Description of other LTC Acute service 35 183 217 160 194 Text ---------------------------------------------------------------------------------------------------------------------------- OTH_$$ ------------------------------------------------------------------------------------------------------------- OTH_$ Other LTC service Acute Service not listed (amount) Amount Paid 6 218 223 195 200 Numeric ---------------------------------------------------------------------------------------------------------------------------- DESCR_2 ------------------------------------------------------------------------------------------------------------- Description of other LTC Acute service 35 224 258 201 235 Text ---------------------------------------------------------------------------------------------------------------------------- AHCA CONTRACT NO. FA309, AMENDMENT NO. 003, PAGE 9 ------------------------------------------------------------------------------------------------------------- **Medicare Crossovers EXHIBIT C (Page 1 of 1) (Plan Name) REPORT OF 12 AHCA Form 2100-0002 GRIEVANCES (Rev. OCT 02Reporting Quarter) AMERIGROUP FLORIDA, INC. Were any new grievances filed during this reporting quarter? YES [ ] NO [ ] ------------------------------------------------------------------------------------------------------------------------------- ENROLLEE'S ENROLLEE'S ENROLLEE'S ENROLLEE'S GRIEVANCE GRIEVANCE EXPEDITED DISPOSITION DISPOSITION RESOLVED? LAST NAME FIRST NAME MEDICAID HMO CONTRACT FEBRUARY 2003 FILE 2: ACUTE CARE SERVICESSOCIAL TYPE * DATE REQUEST? TYPE ** DATE (Y OR N) ID # SECURITY # (Y OR N) -------------------------------------------------------------------------------------------------------------------------------