| Insured Name |
Policy No |
Payment Status |
Claim No |
Transaction No |
In Payment Of |
Payee Name |
Summary Amount |
| INTERNATIONAL JUSTICE MISSION (IJM) |
CHC/PPI/CR1-1058 |
Full Payment
|
CL/CHC/PPI/21037 |
CL/CHC/PPI/21037-01 |
IN-PATIENT |
BUNCHHAT KHET |
9.12 |
| Payment Merge |
Paid Amount |
Payee Name |
Payment For |
Amount in Word |
Payment ID |
|
|
|
|
|
|
| Account Code |
Account Name |
Debit |
Credit |
111013 |
Claim Paid-Medical Exp. |
9.12 |
0.00 |
660020 |
Amount due from/(TO)Reinsuranc |
2.74 |
0.00 |
115513 |
Claim Rec.Cam.Re- Medical Exp |
0.00 |
2.74 |
113413 |
Claim Rec.Out FAC-Medical |
0.00 |
0.00 |
114013 |
Claim Rec.Q.T Share-Medical |
0.00 |
0.00 |
660216 |
ABA - Collection Acct |
0.00 |
9.12 |