| Insured Name | Policy No. | Payment Status | Claim No. | Transaction No. | In Payment Of | Payee Name | Summary Amount |
|---|---|---|---|---|---|---|---|
| ROOM TO READ CAMBODIA | CHC/PPI/C-1050 |
Full Payment | CL/CHC/PPI/21014 | CL/CHC/PPI/21014-01 |
OUT-PATIENT | CHHAM SREYNICH | 13.75 |
| Account Code | Account Name | Debit (USD) | Credit (USD) |
|---|---|---|---|
111013 |
Claim Paid-Medical Exp. | 13.75 | 0.00 |
660020 |
Amount due from/(TO)Reinsuranc | 4.13 | 0.00 |
115513 |
Claim Rec.Cam.Re- Medical Exp | 0.00 | 4.13 |
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 | 13.75 |