RESTITUTION CHECK JANUARY 2022.PDF

Maricopa County — Formal (2022-02-09)

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09 09 21 10025697 KANSAS CITY, MO 4039 28771238

000727918710 4039 28771238 M2 ooo0s08s02cMCcTC
AHCCCS

HEALTH MANAGEMENT SYSTEMS

PO BOX 10530 GeeeeEESOL*EO
PHOENIX AZ 85064

REGIONAL DISBURSING OFFICER

Per Enclosed Mailing Notice

we OWA du BO000005 kets Fh Pees ee OLOUZS
NOTICE TO CHECK RECIPIENT TREASURY-FINANCIAL MANAGEMENT SERVICE TFS FORM 3090(Rev.)
VENDOR I.D.
VENDOR NAME: AHCCCS NUMBER:
AQUSC U.S. TREASURY REG-KANSAS CITY, MO

MY MEV ONE COLUMBUS CIRCLE, N.E. | FINANCIAL CENTER: ‘
AND BILLING) ROOM 5.300 CHECK NUMBER CHECK AMOUNT CHECK DATE
appress: | WASHINGTON, D.C. 20544 4039-28771238 | S*¥*¥***504%*89) 09-09-21
FEDERAL Resteayron EROM Baptisto, Edward AGENCY SCHEDULE NUMBER
oe es eee eo eee eee ERIE OOO090802CMCTC
THIS PAYMENT REPRESENTS A FEDERAL COURT DISBURSEMENT AGENCY TELEPHONE NUMBER
For Questions Regarding This Payment, Please Call .

U.S. District Court, District of Arizonagiemance Office [202-502-2384
602-322-7144

SEP 13 2021
=

PLEASE DIRECT ANY ENQUIRZES CONCERNING THIS PAYMENT TO THE AGENCY AT THE ADDRESS (OR PHONE NUMBER) INDICATED ABOVE

September 16, 2021

Cristi Cost

Maricopa Managed Care
010083

301 W. Jefferson, Suite 3200
Phoenix, AZ 85003

| Re: Total Plan Check

Recipient: Scott Bowen
AHCCCS ID#: A50715836
Date of Injury: 10/25/2003
Case File #: 101111

Dear Cristi Cost:

As you are aware, the Recovery Unit (RU) of Health Management Systems (HMS) is contracted with the
Arizona Health Care Cost Containment System Administration (AHCCCS) to perform first and
third-party liability recovery activities in connection with claims paid by AHCCCS, and its Health Plans
and Program Contractors.

Our office is in receipt of the enclosed check. We have verified that the check forwarded to our attention
is a total plan check and that AHCCCS has no fee-for-service nor reinsurance interest in this case.
Consequently, AHCCCS is not due any of the recovery amount.

If AHCCCS is named as a payor, we have endorsed the check so that your office may deposit the check.

Please contact our office toll free at 888 378 2836 if you have any questions or comment concerning this
matter.

Thank you.

Sincerely,

Gloria Delgado
Caseworker