| 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 |
Partial Payment | CL/CHC/PPI/21137 | CL/CHC/PPI/21137-01 |
IN-PATIENT | SOEUN TONIN | 238.00 |
| Account Code | Account Name | Debit | Credit |
|---|---|---|---|
111013 |
Claim Paid-Medical Exp. | 238.00 | 0.00 |
660020 |
Amount due from/(TO)Reinsuranc | 71.40 | 0.00 |
115513 |
Claim Rec.Cam.Re- Medical Exp | 0.00 | 71.40 |
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 | 238.00 |