(sy Het the Httypnas ¥ Philippine Health insurance Corporation ANS SLUG Il, ALIEKNAIE KOAD, LEGASPI CY Tol. No May 31, 2018 ERLINDA €. VITAL VITAL LYING-IN CLINIC P1 BAGONG SILANG | 4604 LABO, CAMARINES NORTE Nane of Patient MARIBEL E CARINAN Name of Menber MARIBEL E CARINAN Henber No/PIN 102018165276 Confinerent. Period 03/29/2018 to 03/31/2018 Claim No. 1804081000024 Sirf Madam : The processing of NHIP claims for the above-mentioned patient is witheld pending the compliance of the following requirement(s): orenoocuenrscounen [Ge 4. You are requested to comply with the above within 60 days from receipt hereof. Failure to do $0 shall invalidate the processing of claims. Very truly yours, ORLANDO D. INIGO JR. Regional Vice President - PRO V CC: MARIBEL E CARINAN CANAPAWAN, LABO, CAMARINES NORTE (For the Member: Please submit compliance to the hospital.) {THis ISA COMPUTER GENERATED FORM (NATURE OF HE MANAGER! AVP I NOT REQUIREDValidation Report VALIDATION REPORT [eClaims] bhup/172.21.27.16ficlaims.d1VS! ‘osr2272018 16:56:19, Sn 18081000024 ow roanisieso% ected CARINAN, MARIBEL ESPERAS Aimitet; GBASTOISORATAMRecsned:— 4pSNO18 co-ctin Ducted: Q9OUROI8 ROAM Ref 10s ‘fe HOURS 440 MINUTES wating diese eAfiann Ag0 CARE NORTE A Eat ~ Moores osor2s8983/0 Patent a CARINAN. MARIBEL ESPERAS Dupesion: —evED Health Care Institution: 2839 15(MCP-PRIVATE)-VITAL LYING-IN CLINIC Aas (asimvenecls 7 PI RAGONG SILANG 14608 LABO, CAMARINES NORTE Sex: FEMALE fo1/0u2018 - 12/31/2018) Claim Case: Te ae ravage cin ype: ALL-CASE,RATE OWS tacking ge Bows zoso1sisio0001 rave Eee Tac Rae (CR4652 - ROUTINE OBSTETRIC CARE INCLUDING “4 PRENAJ DELIVERY AND NEWBORN SERVICES. Meal 0.00 GENO HOMPITAL FACILITIES (MATERNITY Chas patencen ist CLAD — TT Trani To0 sto Pfeil aN NAME wimicowy | coray | _pERCODES ‘comarageY Vs ERLINDA BLAGR x a5 Vatiation Cote DEECOE DESCRIPTION EEVECT CATEGORY REMARKS CB COPE ert. oF OPERATION NOT WITHIN THE CONFINEMENT oe estes see Ba crete betvem amir an Sache es Po syste Mentor Cuegory: 2XDIGENT-NHTS-PR | Based on Computer calculation excep for eode 990 Doe ga aERY VALIDATED 01D pre yee prevail Cte ? 1) Petont cornet FO precctel Ch 49 4) pew 2 Loft 5 102018165276 “hy doe proses Por) * tere pooma! Dr 5722/2018 4:56 PM.