Financial Report

Claims, amounts, ITBIS, and insurance coverage from audited submissions

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Claims
1
2026-03-11 to 2026-03-18
Total Authorized
1,396.54
Voucher totals (pre-ITBIS)
Total Receipts
1,396.54
Fiscal receipt totals
Total Copay
418.96
Patient responsibility
Insurance Covers
977.58
Receipt - Copay
Total ITBIS
0.00
Tax collected

Claim Details (1)

# Document Insurance Auth # Date Verdict Authorized Receipt Copay ITBIS Insurance Covers Risk
2 maria ysa_2026030312001136.pdf... ARS YUNEN Y2614262495561 2026-03-13 approved 1,396.54 1,396.54 418.96 — 977.58 low 0.0% View
Excellent claim documentation. Financial amounts reconcile perfectly with no ITBIS discrepancies. Th
Totals (1 claims) 1,396.54 1,396.54 418.96 0.00 977.58