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UWI LAB - STAFF

C/o UWI Heath Centre


University of the West I
Mona, Kingston 6
CHEQUE DETAILS
GUARDIAN LIFE LIMITED - 001
Batch Id Date Claim No Member_ID Name Benefit Charged Copay Payable Fee Gct Total Reject Reason

Cheque Number: E1142451 1/20/14 12:00 AM


5971 20140115 0190168 5505-01_12-12884-000 LEVENE GRIFFITHS LAB 9,000.00 1,800.00 7,200.00 126.00 20.79 7,053.21 PAID

5971 20140115 0190169 5505-01_12-12884-000 LEVENE GRIFFITHS LAB 700.00 140.00 560.00 9.80 1.62 548.58 PAID

5971 20140115 0190173 5506-01-620059037-000 PRISCILLA ARCHER- LAB 11,000.00 3,200.00 7,800.00 136.50 22.52 7,640.98 PAID

5971 20140115 0190174 5506-01-620059037-000 PRISCILLA ARCHER- LAB 700.00 140.00 560.00 9.80 1.62 548.58 PAID

5971 20140115 0190187 5506-01-620042138-000 CHRISANN ANDERSON LAB 3,300.00 300.00 3,000.00 52.50 8.66 2,938.84 PAID

5971 20140115 0190188 5506-01-620042138-000 CHRISANN ANDERSON LAB 700.00 700.00 0.00 0.00 0.00 0.00 BENEFIT EXHAUSTED / CALL
MEDECUS FOR DETAILS
5971 20140116 0190261 5506-01-620044052-000 DELROY ALLEN LAB 11,500.00 3,360.00 8,140.00 142.45 23.50 7,974.05 PAID

5971 20140116 0190262 5506-01-620044052-000 DELROY ALLEN LAB 700.00 140.00 560.00 9.80 1.62 548.58 PAID

5971 20140116 0190265 5505-01_26-14290-000 ANTHONY PERRY LAB 9,500.00 1,900.00 7,600.00 133.00 21.95 7,445.05 PAID

5971 20140116 0190266 5505-01_26-14290-000 ANTHONY PERRY LAB 700.00 140.00 560.00 9.80 1.62 548.58 PAID

5971 20140116 0190281 5505-77-10782-000 CASFORD CAMPBELL LAB 700.00 140.00 560.00 9.80 1.62 548.58 PAID

5971 20140116 0190282 5505-77-10782-000 CASFORD CAMPBELL LAB 1,800.00 360.00 1,440.00 25.20 4.16 1,410.64 PAID

5971 20140116 0190285 5505-01_10-13647-000 GRETA EVERETT LAB 700.00 140.00 560.00 9.80 1.62 548.58 PAID

5971 20140116 0190286 5505-01_10-13647-000 GRETA EVERETT LAB 9,000.00 1,800.00 7,200.00 126.00 20.79 7,053.21 PAID

5971 20140116 0190294 5505-01_45-07085-000 CARMEN JAGGANARINE LAB 700.00 140.00 560.00 9.80 1.62 548.58 PAID

5971 20140116 0190295 5505-01_45-07085-000 CARMEN JAGGANARINE LAB 1,400.00 280.00 1,120.00 19.60 3.23 1,097.17 PAID

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5971 20140116 0190296 5505-01_19-13988-000 GARFIELD MYLES LAB 700.00 140.00 560.00 9.80 1.62 548.58 PAID

5971 20140116 0190297 5505-01_19-13988-000 GARFIELD MYLES LAB 1,800.00 360.00 1,440.00 25.20 4.16 1,410.64 PAID

5971 20140116 0190304 5506-01-620054343-000 SHINIZE DAVIS LAB 700.00 0.00 700.00 12.25 2.02 685.73 PAID

5971 20140116 0190305 5506-01-620054343-000 SHINIZE DAVIS LAB 4,400.00 2,020.00 2,380.00 41.65 6.87 2,331.48 PAID

5971 20140116 0190306 5506-01-620054343-000 SHINIZE DAVIS LAB 1,500.00 300.00 1,200.00 21.00 3.47 1,175.53 PAID

5971 20140116 0190312 5505-01_22-32984-000 JODY-KAY JACKSON LAB 700.00 140.00 560.00 9.80 1.62 548.58 PAID

5971 20140116 0190313 5505-01_22-32984-000 JODY-KAY JACKSON LAB 1,300.00 260.00 1,040.00 18.20 3.00 1,018.80 PAID

5971 20140116 0190314 5505-01_09-11791-000 MORNAN PINNOCK LAB 700.00 140.00 560.00 9.80 1.62 548.58 PAID

5971 20140116 0190315 5505-01_09-11791-000 MORNAN PINNOCK LAB 650.00 130.00 520.00 9.10 1.50 509.40 PAID

5971 20140116 0190316 5505-01_09-11791-000 MORNAN PINNOCK LAB 1,400.00 280.00 1,120.00 19.60 3.23 1,097.17 PAID

5971 20140116 0190317 5505-01_09-11791-000 MORNAN PINNOCK LAB 1,500.00 300.00 1,200.00 21.00 3.47 1,175.53 PAID

5971 20140116 0190318 5505-01_09-11791-000 MORNAN PINNOCK LAB 4,400.00 880.00 3,520.00 61.60 10.16 3,448.24 PAID

5971 20140117 0190358 5505-01_02-10794-000 ANGELA DAVIS LAB 11,000.00 2,200.00 8,800.00 154.00 25.41 8,620.59 PAID

5971 20140117 0190359 5505-01_02-10794-000 ANGELA DAVIS LAB 700.00 140.00 560.00 9.80 1.62 548.58 PAID

5971 20140117 0190361 5505-77-07795-000 GRETHEL THOMAS LAB 4,100.00 820.00 3,280.00 57.40 9.47 3,213.13 PAID

5971 20140117 0190362 5505-77-07795-000 GRETHEL THOMAS LAB 1,400.00 280.00 1,120.00 19.60 3.23 1,097.17 PAID

5971 20140117 0190363 5505-77-07795-000 GRETHEL THOMAS LAB 700.00 140.00 560.00 9.80 1.62 548.58 PAID

5971 20140117 0190364 5505-77-07795-000 GRETHEL THOMAS LAB 700.00 140.00 560.00 9.80 1.62 548.58 PAID

5971 20140117 0190394 5506-01-620040934-000 TASHANA WALTERS LAB 700.00 0.00 700.00 12.25 2.02 685.73 PAID

5971 20140117 0190395 5506-01-620040934-000 TASHANA WALTERS LAB 1,000.00 0.00 1,000.00 17.50 2.89 979.61 PAID

5971 20140117 0190396 5506-01-620040934-000 TASHANA WALTERS LAB 700.00 0.00 700.00 12.25 2.02 685.73 PAID

5971 20140117 0190402 5505-01_09-10011-003 MARLENE SMITH LAB 700.00 140.00 560.00 9.80 1.62 548.58 PAID

5971 20140117 0190403 5505-01_09-10011-003 MARLENE SMITH LAB 700.00 140.00 560.00 9.80 1.62 548.58 PAID

5971 20140117 0190404 5505-01_35-17613-000 CAMILLE MORRIS LAB 700.00 140.00 560.00 9.80 1.62 548.58 PAID

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5971 20140117 0190405 5505-01_35-17613-000 CAMILLE MORRIS LAB 4,400.00 880.00 3,520.00 61.60 10.16 3,448.24 PAID

5971 20140117 0190406 5505-01_35-17613-000 CAMILLE MORRIS LAB 1,500.00 300.00 1,200.00 21.00 3.47 1,175.53 PAID

5971 20140117 0190409 5505-01_12-09245-000 SWITHIN WILMOT LAB 700.00 140.00 560.00 9.80 1.62 548.58 PAID

5971 20140117 0190410 5505-01_12-09245-000 SWITHIN WILMOT LAB 1,400.00 280.00 1,120.00 19.60 3.23 1,097.17 PAID

Totals for Cheque number: E1142451 112,950.00 25,370.00 87,580.00 1,532.65 252.92 85,794.43

Totals for: UWI LAB - STAFF 112,950.00 25,370.00 87,580.00 1,532.65 252.92 85,794.43

Received By:

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