OTHER CLAIM RELATED FEE SUMMARY                                           
                     Other Claim Related Fee Description/Incurred Date/Product/Sub Group-8 Digit                     

INVOICE NUMBER:     240116583345                                           PAGE:               1 of 2            
BILL ACCOUNT NUMBER:CN02401002                                             PAID CLAIMS MONTH:  January 2024      
BILL ACCOUNT NAME:  Admiral Peary                                          CLAIMS PAID THRU:   01/12/2024        
CLIENT NUMBER:      0240                                                   BILL CYCLE:         2 of 4            
CLIENT NAME:        Admiral Peary                                          PREPARED DATE:      01/16/2024        

Other Claim Related Fee Description                                                                                Fee Amount                            
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
Pre Pay Coding Validation
  11/23
    Pre Pay Coding Validation
      014267-34                                                                                                         $3.15
      014267- Total                                                                                                     $3.15
    Pre Pay Coding Validation Total                                                                                     $3.15
  11/23 Total                                                                                                           $3.15
  01/24
    Pre Pay Coding Validation
      014267-05                                                                                                        $10.15
      014267- Total                                                                                                    $10.15
      017728-00                                                                                                         $6.83
      017728- Total                                                                                                     $6.83
    Pre Pay Coding Validation Total                                                                                    $16.98
  01/24 Total                                                                                                          $16.98
Pre Pay Coding Validation Total                                                                                        $20.13
                                                                                                                                                            
Prepay Claims Savings Fee
  08/23
    Prepay Claims Savings Fee
      017697-00                                                                                                        $91.57
      017697- Total                                                                                                    $91.57
    Prepay Claims Savings Fee Total                                                                                    $91.57
  08/23 Total                                                                                                          $91.57
  11/23
    Prepay Claims Savings Fee
      014267-34                                                                                                         $3.33

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Other Claim Related Fee Description                                                                                Fee Amount                            
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
      014267- Total                                                                                                     $3.33
      104272-02                                                                                                        $60.66
      104272- Total                                                                                                    $60.66
    Prepay Claims Savings Fee Total                                                                                    $63.99
  11/23 Total                                                                                                          $63.99
  12/23
    Prepay Claims Savings Fee
      014267-06                                                                                                      ($10.80)
      014267- Total                                                                                                  ($10.80)
      104272-02                                                                                                        $60.66
      104272- Total                                                                                                    $60.66
    Prepay Claims Savings Fee Total                                                                                    $49.86
  12/23 Total                                                                                                          $49.86
  01/24
    Prepay Claims Savings Fee
      014267-03                                                                                                        $53.09
      014267- Total                                                                                                    $53.09
    Prepay Claims Savings Fee Total                                                                                    $53.09
  01/24 Total                                                                                                          $53.09
Prepay Claims Savings Fee Total                                                                                       $258.51
                                                                                                                                                            
Other Claims Related Fee Summary Total                                                                                $278.64