Health Payment Systems (HPS) Billing Information
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1 Valley Grinding Service and Supply (800) (866) Utschig, Inc. (800) (866) W909 Weyco Inc (800) (866) Rukert Mielke (800) Waterstone Bank/ Waterstone W753 Mortgage (800) Heresite Protective H889 Coating (800) City of Manitowoc/Man itowoc Public M614 Utilities (800) N787 W865 North Shore Bank (800) Watry Industries, LLC (800) P754 Purity Dialysis (800) Claims EOB Claims Status Lubbock TX (888) Little Chute 4/1/2008 Yes Lubbock TX (888) Greenville 4/1/2008 Yes Lubbock TX (888) Milwaukee 7/1/2008 Yes - ER only Lubbock TX (888) Waukesha 8/1/2008 Yes - TMJ only Lubbock TX (888) Milwaukee, Waukesha, Oak Creek 10/1/2008 Yes Lubbock TX (888) Manitowoc 10/1/2008 Yes Lubbock TX (888) Manitowoc 10/1/2008 No Lubbock TX (888) Milwaukee Brookfield Pewaukee Green Bay Sturgeon Bay Appleton 10/1/2008 Yes Lubbock TX (888) Sheboygan 11/1/2008 Yes Lubbock TX (888) Delafield 11/1/2008 Yes P814 PyraMax Bank (800) Lubbock TX (888) Greenfield, Milwaukee, Franklin, West Allis, Waukesha, Mukwonago 12/1/2008 Yes WOW Logistics Company (800) M905 Midland Plastics (800) Lubbock TX (888) Grafton, Menasha, Marshfield, Wisconsin Rapids, Chippewa Falls, Ashwaubenon, Little Chute, Oshkosh, Mosinee, Schofield 1/1/2009 Yes Lubbock TX (888) Green Bay, New Berlin 1/1/2009 Yes
2 A587 W808 Apple Steel Rule Die (800) Wisconsin & Southern Railroad (800) G757 Glenroy, Inc. (800) Oostburg Concrete O893 Products, Inc. (800) B777-1 V878 Bentley World Packaging (800) Van Horn Automotive (800) F789 City of Franklin (800) S885 M899 P886 Shepherds Baptist Ministry (800) Marine Credit Union (800) Plyco Corporation (800) P917 Primex Inc. (800) Johnson Brass & Machine J906 Foundry, Inc. (800) B918 H862 M790 City of Burlington (800) Household Utilities (800) Milwaukee Stove & Furnace (800) V523 VL Tool (800) Claims EOB Claims Status Lubbock TX (888) Milwaukee 1/1/2009 Yes Lubbock TX (888) Milwaukee, Janesville, Horicon, Madison 1/1/2009 Yes Lubbock TX (888) Menomonee Falls 1/1/2009 Yes Lubbock TX (888) Oostburg 1/1/2009 Yes Lubbock TX (888) Milwaukee 1/1/2009 Yes Lubbock TX (888) Fond du Lac, Sheboygan, Plymouth 1/1/2009 Yes Lubbock TX (888) Franklin 1/1/2009 Yes Lubbock TX (888) Union Grove 1/1/2009 Yes Lubbock TX (888) Fond du lac, LaCrosse 1/1/2009 Yes Lubbock TX (888) Elkhart Lake 1/1/2009 Yes - ER only Lubbock TX (888) Lake Geneva 1/1/2009 No Lubbock TX (888) Saukville 1/1/2009 Yes - ER only Lubbock TX (888) Burlington 1/1/2009 Yes Lubbock TX (888) Kiel 1/1/2009 No Lubbock TX (888) Milwaukee, Madison, Green Bay 1/1/2009 No Lubbock TX (888) Waukesha 1/1/2009 Yes
3 C904 Cost of Wisconsin (800) E892 Essco (800) Norka (800) O907 Orion Energy (800) U791 C908 M770 Universal s (800) Cher-Make Sausage Company (800) McAdams Graphics (800) K740 KSM Industries (800) M824 A792 G780 B765 C794 K924 M742 Midwest Dialysis & Midwest Nephrology (800) American State Equipment (800) Great Midwest Bank (800) Bader Rutter & Associates (800) Craft Cast Holdings (800) Kitchen Fresh Foods (800) Manitowoc Tool & Machining (800) A926 Air Cargo (800) Claims EOB Claims Status Lubbock TX (888) Jackson 1/1/2009 yes Lubbock TX (888) Green Bay 1/1/2009 Yes Lubbock TX (888) Appleton 1/1/2009 Yes Manitowoc, Plymouth, Lubbock TX (888) Sheboygan 3/1/2009 Yes Lubbock TX (888) Whitewater 3/1/2009 Yes Lubbock TX (888) Manitowoc 4/1/2009 Yes - ER only Lubbock TX (888) Oak Creek 4/1/2009 Yes Lubbock TX (888) Germantown 4/1/2009 Yes Lubbock TX (888) locations in SE Wisconsin 4/1/2009 Yes Milwaukee, Little Lubbock TX (888) Chute, Wausau 4/1/2009 No Brookfield, Madison, Lubbock TX (888) Chilton, Appleton 5/1/2009 Yes Lubbock TX (888) Brookfield 5/1/2009 Lubbock TX (888) Jackson 5/1/2009 Yes Lubbock TX (888) Yes - ER MRI Only Green Bay, Madison, Milwaukee 5/1/2009 Unsure Lubbock TX (888) Manitowoc 6/1/2009 Yes Lubbock TX (888) Hartford, Milwaukee 6/1/2009 Unsure
4 Claims EOB Claims Status Date Co-Pays D866 Diversatek,Adap tive Engineering Labs, Medovations, Sunlight Plastics (800) K867 Krier Foods (800) T910 Times Printing (800) W852 C927 S868 Washington County (800) Clintonville Lumber/Torberg s Lumber (800) Shawano School District (800) K896 Karl's Transport (800) Q828 Quadra (800) W852 M929 C925 Washington County (800) Metropolitan Associates (800) Country Springs Hotel (800) B912 Brotoloc (800) W931 WOW Distributing (800) T871 Timber Creek (800) Lubbock TX (888) Germantown, Milwaukee 6/1/2009 Yes Lubbock TX (888) Brown Deer 6/1/2009 No Lubbock TX (888) Random Lake 6/1/2009 8/31/2009 Unsure Lubbock TX (888) West Bend 6/1/2009 Yes Clintonville, Shawano, Lubbock TX (888) Waupaca 7/1/2009 Yes Lubbock TX (888) Shawano 7/1/2009 ER Only Lubbock TX (888) Antigo 7/1/2009 Yes Lubbock TX (888) Sturtevant 7/1/2009 ER Only Lubbock TX (888) West Bend 7/1/2009 Yes Lubbock TX (888) Milwaukee 8/1/2009 ER & Chiro Lubbock TX (888) Milwaukee 8/1/2009 Unsure Lubbock TX (888) Ellsworth, Eau Claire, Kenosha, Whitewater, West Allis, Hortonville 9/1/2009 Yes Lubbock TX (888) Sussex 9/1/2009 Yes Lubbock TX (888) Milwaukee 8/1/2009 Yes
5 A932 Acro Automation (800) M833 Mariott Construction (800) M833-1 Mariott Drywall (800) I873 W262 Iola Living Assistance (800) Walworth County (800) K752 Klein Dickert (800) W931-1 Beer Capitol (800) Experimental Aircraft E916 Association (800) SVA Certified Public S935 Accountants (800) Commercial Communications C854 Inc. (800) C854-1 Coakley Tech (800) F809 FABCO (800) K936 S939 Kaysun Corporation (800) SMC Metal Fabricators (800) H858 H.O. Bostrom (800) V937 VanVreede's (800) Claims EOB Claims Status Lubbock TX (888) Milwaukee 10/1/2009 Unsure Lubbock TX (888) Waukesha 9/1/2009 Yes Lubbock TX (888) Waukesha 9/1/2009 Yes Lubbock TX (888) Iola 11/1/2009 No Lubbock TX (888) Elkhorn 11/1/2009 Unsure Green Bay, Marinette, Lubbock TX (888) Oshkosh, Milwaukee 1/1/2010 Yes Lubbock TX (888) Wauwatosa 12/1/2009 Unsure Lubbock TX (888) Oshkosh 1/1/2010 ER Only Lubbock TX (888) Brookfield, Neenah 1/1/2010 Unsure Racine, Green Bay, Lubbock TX (888) Milwaukee 1/1/2010 Yes Lubbock TX (888) Racine, Green Bay, Milwaukee 1/1/2010 Yes Lubbock TX (888) Madison 1/1/2010 Yes Lubbock TX (888) Manitowoc 1/1/2010 Yes Lubbock TX (888) Oshkosh 1/1/2010 No Lubbock TX (888) Waukesha 1/1/2010 Yes Lubbock TX (888) Green Bay, Appleton 1/1/2010 Yes
6 C938 S855 The Coleman, inc. (800) Scan-Pac Mfg, Inc. (800) H903 Holt Dental (800) N837 B940 W883 R853 N.E.W. Industries, Inc. (800) BANNER Welder, Inc. (800) Willman Industries, Inc. (800) Rice Healthcare Facilities (800) Hillcrest Lumber (800) Conservent Benefit Plan K Weyco Inc (888) (800) CYP (920) (866) C91 Jim Pankow Inc (866) Y62 Services Plus C28 Kadant Grantek, Inc C78 Shallbetter Claims EOB Claims Status Lubbock TX (888) Elkhorn 1/1/2010 Unsure Lubbock TX (888) Menomonee Falls 1/1/2010 No Lubbock TX (888) Waukesha 1/1/2010 Yes Lubbock TX (888) Sturgeon Bay 1/1/2010 Yes Lubbock TX (888) Germantown 1/1/2010 No Lubbock TX (888) Cedar Grove 1/1/2010 Yes Lubbock TX (888) Appleton, Little Chute, Shawano, Stevens Point, WI Rapis, Marshfield, Two Rivers, Chilton, Plymouth,New Holstein, Ellsworth, Williams Bay 2/1/2010 Yes Lubbock TX (888) Brillion, DePere 2/1/2010 No Lubbock TX (888) Milwaukee 1/1/2008 6/30/2008 Yes - ER only Lubbock TX (888) Appleton 5/1/2008 No Lubbock TX (888) Plymouth 10/1/2008 5/1/2009 Yes Lubbock TX (888) Green Bay 12/1/2008 Yes Lubbock TX (888) Green Bay 12/1/2008 Yes Lubbock TX (888) Oshkosh 1/1/2009 No
7 C87 C57 Magnum Products, LLC City of Lake Geneva C90 Bay Towel C55 Milwaukee Plating Y33 Schenk Y47 Miller St. Nazianz Y50 Steel Craft C58 TTI Trucking Y15 C88 The Boldt Company Unlimited Services of Wisconsin, Inc Y37 Fox World Travel Fabio Perini North America, Y17 Inc Y56 Y20 Y68 Door County Co- Op Castle Sales Company North American Hydro Holdings Y62 Boston, Inc Claims EOB Claims Status Lubbock TX (888) Berlin 2/1/ /31/09 Yes Lubbock TX (888) Lake Geneva 3/1/2009 Yes Lubbock TX (888) Green Bay 5/1/2009 Yes Lubbock TX (888) Milwaukee 6/1/2009 Yes Lubbock TX (888) Appleton 7/1/2009 Yes Lubbock TX (888) St. Nazianz 9/1/2009 No Lubbock TX (888) Hartford 9/1/2009 Yes Lubbock TX (888) Eden 10/1/2009 Yes Appleton, Waukesha, Lubbock TX (888) Madison 1/1/2010 No Lubbock TX (888) Oconto 1/1/2010 Yes Green Bay, Oshkosh, Lubbock TX (888) Appleton 1/1/2010 Yes Lubbock TX (888) Green Bay 1/1/2010 Yes Green Bay, Sturgeon Lubbock TX (888) Bay 1/1/2010 Yes Lubbock TX (888) Green Bay 1/1/2010 Yes Lubbock TX (888) Neshkoro 1/1/2010 Yes Stevens Point, Green Bay, Plover, Appleton, Oshkosh, Wausau, Lubbock TX (888) Rhinelander, DePere 1/1/2010 No
8 Y30 C81 Y38 Valley Added Distributors, LLC Utica Energy, LLC ACE Manufacturing, Inc Y28 ST Paper, LLC Y64 Lakeshore Display Mfg, Inc Claims EOB Claims Status Shawano, Neenah, Lubbock TX (888) DePere 1/1/2010 Yes Lubbock TX (888) Oshkosh 1/1/2010 Yes Lubbock TX (888) Green Bay 1/1/2010 Yes Lubbock TX (888) oconto Falls 1/1/2010 Unsure Lubbock TX (888) Sheboygan 1/1/2010 Unsure Benefit Consultants, Inc. M Benefit Consultants, Inc. M-055 Sadoff & Rudoy Industries Proteus Packaging Lubbock TX (888) Fond Du Lac 11/1/2009 Yes - ER only Lubbock TX (888) Franklin 11/1/2009 Unsure Benefit Consultants, Inc. M Transpak Corp SCE NEM NLA JGS Sheboygan County Nemschoff Chairs Northern Labs, Inc Jagemann Stamping RCS RCS Empowers KIE Kieffer & Company STK Stecker Machine Lubbock TX (888) Franklin 11/1/2009 Unsure Lubbock TX (888) Sheboygan, Plymouth, Sheboygan Falls 11/1/2008 Yes - ER only Lubbock TX (888) Sheboygan 1/1/ /31/2009 Yes Lubbock TX (888) Manitowoc 1/1/2009 Yes Lubbock TX (888) Manitowoc 7/1/2009 No Lubbock TX (888) Sheboygan 8/1/2009 No Lubbock TX (888) Sheboygan 9/1/2009 Yes Lubbock TX (888) Manitowoc 10/1/2009 Yes
9 PLU/PLY RAP SAR City of Plymouth/Plymo uth Public Utililites Red Arrow Products Sartori Food Corporation OSH City of Oshkosh KSL Kahler Slater, Inc Claims EOB Claims Status Date Co-Pays Lubbock TX (888) Plymouth 10/1/2009 No Lubbock TX (888) Manitowoc 1/1/2010 Unsure Lubbock TX (888) Plymouth 1/1/2010 No Lubbock TX (888) Oshkosh 1/1/2010 Yes Lubbock TX (888) Milwaukee 1/1/2010 Yes
Health Payment Systems (HPS) Billing Information
Payer ARM 7277 Carpenter Brothers 800-392-1770 888-289-0700 20270 ARM 7267 Industrial Towel And Uniform 800-392-1770 888-289-0700 20270 ARM 7162 & 7163 Shady Lane, Inc 800-392-1770 888-289-0700 20270 A932
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P.O. Box P.O. Box P.O. Box P.O. Box P.O. Box P.O. Box
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Circuit 01 0110 Franklin - Risen Savior 359 $14,000.00 $483.00 $1,166.67 $6,316.30 $14,000.00 ($7,683.70) 45.1% 17.59 0115 Greendale - Our Shepherd 516 $15,000.00 $0 $1,250.00 $0.00 $15,000.00 ($15,000.00)
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