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    Auto Credit Payment Notice: Philippine Health Insurance Corporation

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    mahayag municipal hospital
    This notice provides payment details from PhilHealth to Mahayag Municipal Hospital for one patient claim covering the period of April 10 to 13, 2021. PhilHealth will deposit a total of 7,350 pesos into the hospital's bank account as an auto credit payment for this claim.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Auto Credit Payment Notice: Philippine Health Insurance Corporation

    Uploaded by

    mahayag municipal hospital
    37 views1 page
    This notice provides payment details from PhilHealth to Mahayag Municipal Hospital for one patient claim covering the period of April 10 to 13, 2021. PhilHealth will deposit a total of 7,350 pesos into the hospital's bank account as an auto credit payment for this claim.

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    06-21-06-25-2021

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    This notice provides payment details from PhilHealth to Mahayag Municipal Hospital for one patient claim covering the period of April 10 to 13, 2021. PhilHealth will deposit a total of 7,350 pesos into the hospital's bank account as an auto credit payment for this claim.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    37 views1 page

    Auto Credit Payment Notice: Philippine Health Insurance Corporation

    Uploaded by

    mahayag municipal hospital
    This notice provides payment details from PhilHealth to Mahayag Municipal Hospital for one patient claim covering the period of April 10 to 13, 2021. PhilHealth will deposit a total of 7,350 pesos into the hospital's bank account as an auto credit payment for this claim.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Republic of the Philippines

    PHILIPPINE HEALTH INSURANCE CORPORATION

    www.philhealth.gov.ph

    AUTO CREDIT PAYMENT NOTICE


    PERIOD COVERED: 06/21/2021 to 06/25/2021
    HCI NAME: MAHAYAG MUNICIPAL HOSPITAL
    ADDRESS: SAN VICENTE, MAHAYAG, ZAMBOANGA DEL SUR
    ACCREDITATION NO: H09014295

    Bank Account Name: MAHAYAG MUNICIPAL GOVERNMENT - MUNICIPAL HOSPITAL PHILHEALTH - HCI
    Bank Account No.: 2842107884
    Caserate 1 Caserate 2 Others Total
    PABN No. Series No. Member PIN Patient Name Confinement Period
    Code Gross Code Gross Code Gross Gross WTax HCI PF
    P14-2106-04776 2105071400602 P142022854789 BULAWIN, JOHN MARK L 04/10/2021 to 04/13/2021 J18.92 10,500.00 NONE 0.00 NONE 0.00 10,500.00 0.00 7,350.00 3,150.00
    Health Care Professional/s: ABBAS , NURHAINA A. Credited

    GRAND TOTAL 10,500.00 0.00 7,350.00 3,150.00


    Total no. of claims: 1

    Note:
    * - Deducted from IRM/IFM
    ** - Deducted from DCPM
    *** - Deducted from Payment Recovery Breakdown :
    IRM/IFM Deduction (06/30/2021) 0.00
    DCPM Deduction (06/30/2021) 0.00
    Payment Recovery Deduction (06/30/2021) 0.00
    Auto Credit Payment (06/30/2021) 7,350.00
    Grand Total 7,350.00

    IN COMPLIANCE TO THE NATIONAL INTERNAL REVENUE CODE CHAPTER 11 SECTION 237, OFFICIAL RECEIPT (O.R.) OF THIS REIMBURSEMENT SHOULD BE ISSUED NOTE: THIS IS A SYSTEM GENERATED REPORT, SIGNATURE IS NO LONGER REQUIRED
    Page 1 of 1 / Date Generated: 12/13/2022 02:47:58 PM
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