08677400500

[email protected]

cimas.co.zw

fb.com/cimasmedicalaid

East Block, Borrowdale Office Park

Together we make a difference P.O. Box 1243, Harare, Zimbabwe

0853534 2024/08/05
502044 SANTE 24 HR MEDICAL CENTRE Ref: 38649486
SHOP 5 ST JOHNS WAY
SOUTHERTON
HARARE

Claims Remittance Advice

Provider Date of payment run

113576 / 0853534 05/08/2024

See the end section of the statement for a detailed explanation of statement contents and reasons
Claims
Provider: 502044 SANTE 24 HR MEDICAL CENTRE (113576 / 0853534)
Treatment Invoice Claim Code Code Description Qty Claimed Accepted Shortfall Previously Pay To Pay To Tax Reason
Date Number Number Amount Amount Amount Paid You Member Amount

Treatment Details: Member : MR WILLIAM DZINGIRAI (11579669) Patient : MS PATIENCE DZUDA

30/07/2024 0932-10212- 6497755 02291 1 38.00 38.00 0.00 0.00 38.00 0.00 0.00
59965-98A
Treatment Details: Member : MS HAPPINESS ZHOU (11721096) Patient : MR RYAN RUNZINDI
22/07/2024 0932-10204- 6446054 02291 1 38.00 38.00 0.00 0.00 38.00 0.00 0.00
33790-08A
Treatment Details: Member : MR SYLVESTER CHIROMBO (12091540) Patient : MS ROSEMARY CHIROMBO
22/07/2024 0932-10204- 6448366 02291 1 38.00 38.00 0.00 0.00 38.00 0.00 0.00
43450-468
22/07/2024 0932-10204- 6448366 02558 1 27.00 0.00 0.00 0.00 0.00 0.00 0.00 6019
43450-468
22/07/2024 0932-10204- 6448366 02568 3 3.00 0.00 0.00 0.00 0.00 0.00 0.00 6019
43450-468
22/07/2024 0932-10204- 6448366 90082 1 5.00 5.00 0.00 0.00 5.00 0.00 0.00
43450-468
Sub Totals 73.00 43.00 0.00 0.00 43.00 0.00 0.00

CIMAS MEDICAL AID SOCIETY Page 1 of 3

Bulawayo Gweru Mutare Masvingo
Medical Centre, Cnr J. 23 Sixth Street Cimas House 39 Robert Mugabe,
Tongogara St/ 8th Ave P.O Box 1402 98 Second Street ZB Building
P.O. Box 5 +263 (0254) 222 6178 +263 (20) 677 03 +263 (039) 264 131/2
+263 (029) 648 76
Treatment Details: Member : MR EDSON BOSHA (13809275) Patient : MISS NOKUTENDA BOSHA
22/07/2024 0932-10204- 6444349 02291 1 38.00 38.00 0.00 0.00 38.00 0.00 0.00
25538-C4A
22/07/2024 0932-10204- 6444349 02558 3 52.00 0.00 0.00 0.00 0.00 0.00 0.00 6019
25538-C4A
22/07/2024 0932-10204- 6444349 02568 6 6.00 0.00 0.00 0.00 0.00 0.00 0.00 6019
25538-C4A
Sub Totals 96.00 38.00 0.00 0.00 38.00 0.00 0.00
Treatment Details: Member : MS MERCY NHERUDZO (14070202) Patient : MS MERCY NHERUDZO
22/07/2024 0932-10204- 6445919 02292 1 38.00 34.98 3.02 0.00 34.98 0.00 0.00 6
32973-A43
22/07/2024 0932-10204- 6445919 02558 3 52.00 0.00 0.00 0.00 0.00 0.00 0.00 6019
32973-A43
22/07/2024 0932-10204- 6445919 02568 6 6.00 0.00 0.00 0.00 0.00 0.00 0.00 6019
32973-A43
Sub Totals 96.00 34.98 3.02 0.00 34.98 0.00 0.00
25/07/2024 0932-10207- 6467769 02292 1 38.00 34.98 3.02 0.00 34.98 0.00 0.00 6
37170-D9B
Sub Totals 134.00 69.96 6.04 0.00 69.96 0.00 0.00
Treatment Details: Member : MS LUCY MWAVHERA (14203453) Patient : MS LUCY MWAVHERA
25/07/2024 0932-10207- 6466042 02291 1 38.00 38.00 0.00 0.00 38.00 0.00 0.00
26335-FAB
Treatment Details: Member : MR BERNARD KUPETA (14416544) Patient : MR BERNARD KUPETA
19/07/2024 0931-10201- 6432921 02291 1 38.00 38.00 0.00 0.00 38.00 0.00 0.00
29801-349
Treatment Details: Member : MS TINA UDINGE (14891824) Patient : MS TINA UDINGE
25/07/2024 0932-10207- 6468492 02026 1 300.00 113.42 186.58 0.00 113.42 0.00 0.00 6
41638-602
25/07/2024 0932-10207- 6468492 02551 10 100.00 0.00 0.00 0.00 0.00 0.00 0.00 6019
41638-602
25/07/2024 0932-10207- 6468492 02561 20 20.00 0.00 0.00 0.00 0.00 0.00 0.00 6019
41638-602
25/07/2024 0932-10207- 6468492 02102 1 100.00 100.00 0.00 0.00 100.00 0.00 0.00
41638-602
25/07/2024 0932-10207- 6468492 02552 5 50.00 0.00 0.00 0.00 0.00 0.00 0.00 6019
41638-602
25/07/2024 0932-10207- 6468492 02562 30 30.00 0.00 0.00 0.00 0.00 0.00 0.00 6019
41638-602
25/07/2024 0932-10207- 6468492 02121 1 50.00 14.84 35.16 0.00 14.84 0.00 0.00 6
41638-602
Sub Totals 650.00 228.26 221.74 0.00 228.26 0.00 0.00
Treatment Details: Member : MRS CHARITY ZHOU (15058125) Patient : MR SIKANYISO ZHOU
20/07/2024 0932-10202- 6440942 02291 1 38.00 38.00 0.00 0.00 38.00 0.00 0.00
43797-3D7
Treatment Details: Member : MR BLESSWARD JENYA (15950614) Patient : MR TINOTENDA JENYA
30/07/2024 0932-10212- 6492775 02291 1 38.00 38.00 0.00 0.00 38.00 0.00 0.00
31288-EAF
Treatment Details: Member : MRS KUDA MUDARIKWA (16045637) Patient : MRS KUDA MUDARIKWA
19/07/2024 0931-10201- 6432836 02291 1 38.00 38.00 0.00 0.00 38.00 0.00 0.00
29466-169
19/07/2024 0931-10201- 6432836 02558 3 30.00 0.00 0.00 0.00 0.00 0.00 0.00 6019
29466-169
19/07/2024 0931-10201- 6432836 02568 6 6.00 0.00 0.00 0.00 0.00 0.00 0.00 6019
29466-169
Sub Totals 74.00 38.00 0.00 0.00 38.00 0.00 0.00

Statement Totals 1,255.00 645.22 227.78 0.00 645.22 0.00 0.00

CIMAS MEDICAL AID SOCIETY Page 2 of 3

Bulawayo Gweru Mutare Masvingo
Medical Centre, Cnr J. 23 Sixth Street Cimas House 39 Robert Mugabe,
Tongogara St/ 8th Ave P.O Box 1402 98 Second Street ZB Building
P.O. Box 5 +263 (0254) 222 6178 +263 (20) 677 03 +263 (039) 264 131/2
+263 (029) 648 76
Provider Balances
Opening Balance 0.00
Claims Processed 645.22
Payment (Ref. 1205744) of 645.22 paid into account ****1012 on 07/08/2024 -645.22
Closing Balance 0.00

Reasons explained
Reason Description
6019 No breakdown of drugs and sundries
6 Amount claimed exceeds tariff amount

Statement columns explained

Column Explanation
Treatment Date Indicates the start date of treatment
Invoice Number Your invoice number
Claim Number Claim reference number
Code Treatment codes (e.g. tariff, nappi) submitted on this claim (including modifier). In the case of where invoice lines are accepted in full then 'Accepted in full' will appear in this column and the amounts will be summed up as a summary line
Qty The total quantity submitted. In the case of a summary line this will be left blank
Claimed Amount The amount submitted
Accepted Amount The amount the system accepted
Shortfall Amount The Amount Shortfall
Previously Paid Indicates the portion of the accepted amount that was paid to you prior to this statement period.
Pay To You The portion of the accepted amount that will be paid to you during the current statement period
Pay To Member The portion of the accepted amount that will be paid to a member during the current statement period
Reasons A list of reason codes explaining the current balance of the claim (as indicated above)

CIMAS MEDICAL AID SOCIETY Page 3 of 3

Bulawayo Gweru Mutare Masvingo
Medical Centre, Cnr J. 23 Sixth Street Cimas House 39 Robert Mugabe,
Tongogara St/ 8th Ave P.O Box 1402 98 Second Street ZB Building
P.O. Box 5 +263 (0254) 222 6178 +263 (20) 677 03 +263 (039) 264 131/2
+263 (029) 648 76