| Insured Name | Policy No | Payment Status | Claim No | Transaction No | In Payment Of | Payee Name | Summary Amount |
|---|---|---|---|---|---|---|---|
| WORLD VISION INTERNATIONAL | CHC/PPI/CR2-1027 |
Full Payment | CL/CHC/PPI/21058 | CL/CHC/PPI/21058-01 |
IN-PATIENT | BUN SOVANNA | 123.29 |
| Account Code | Account Name | Debit | Credit |
|---|---|---|---|
111013 |
Claim Paid-Medical Exp. | 123.29 | 0.00 |
660020 |
Amount due from/(TO)Reinsuranc | 36.99 | 0.00 |
115513 |
Claim Rec.Cam.Re- Medical Exp | 0.00 | 36.99 |
113413 |
Claim Rec.Out FAC-Medical | 0.00 | 0.00 |
114013 |
Claim Rec.Q.T Share-Medical | 0.00 | 0.00 |
660215 |
FTB-Claims Acc. | 0.00 | 123.29 |