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    Dear Member,: (Please Quote This Reference Number in All Future Correspondence in Regard To This Claim)

    Uploaded by

    Zeeshan
    The insurance company has received a reimbursement claim for a patient named Nishi Fatima from Charak Hospital. To process the claim, the following documents must be submitted within 15 days: original claim form, bills, payment receipts, discharge summary, investigation reports, implant invoices, and identity proof of the patient and primary beneficiary. The letter provides important notes on availing cashless facilities and checking claim status online.

    Copyright:

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

    Dear Member,: (Please Quote This Reference Number in All Future Correspondence in Regard To This Claim)

    Uploaded by

    Zeeshan
    119 views2 pages
    The insurance company has received a reimbursement claim for a patient named Nishi Fatima from Charak Hospital. To process the claim, the following documents must be submitted within 15 days: original claim form, bills, payment receipts, discharge summary, investigation reports, implant invoices, and identity proof of the patient and primary beneficiary. The letter provides important notes on availing cashless facilities and checking claim status online.

    Original Description:

    Noor Ali

    Original Title

    279068

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    The insurance company has received a reimbursement claim for a patient named Nishi Fatima from Charak Hospital. To process the claim, the following documents must be submitted within 15 days: original claim form, bills, payment receipts, discharge summary, investigation reports, implant invoices, and identity proof of the patient and primary beneficiary. The letter provides important notes on availing cashless facilities and checking claim status online.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    119 views2 pages

    Dear Member,: (Please Quote This Reference Number in All Future Correspondence in Regard To This Claim)

    Uploaded by

    Zeeshan
    The insurance company has received a reimbursement claim for a patient named Nishi Fatima from Charak Hospital. To process the claim, the following documents must be submitted within 15 days: original claim form, bills, payment receipts, discharge summary, investigation reports, implant invoices, and identity proof of the patient and primary beneficiary. The letter provides important notes on availing cashless facilities and checking claim status online.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Dear Member,

    We acknowledge receipt of reimbursement claims intimation bearing ID 279068. The details of the intimation are as follows:

    (Please quote this reference number in all future correspondence in regard to this claim)

    Beneficiary Details

    Patient Name Nishi Fatima

    Insurance Company Tata AIG General Insurance Company LTD

    Policy Holder / Primary Beneficiary VARNADA INDUSTRIES PRIVATE LIMITED / Zeeshan Haider

    Corporate VARNADA INDUSTRIES PRIVATE LIMITED

    Hospital Name Charak Hospital And Research Centre

    Medi Assist ID 4024121246

    Policy No. 0260017247_00

    Relationship with Primary Beneficiary Spouse

    Employee ID 66

    Ailment details meternethy

    DOA 18-03-2019 00:00:00

    DOD 22-03-2019 00:00:00

    The following documents must be submitted in full within 15 days from date of discharge

    Original claim form in IRDAI format


    Original bill and cash paid receipts in IRDAI format, duly signed by insured
    Original discharge summary in IRDAI format, duly signed by the insured
    Break-up of the bill amount being claimed, including pharmacy, investigations, etc.
    All original investigation reports / x ray films etc
    Original sticker and invoice for all the implants & high value consumables
    Original OT notes for surgical cases
    Self-attested copy of photo id card of the patient is mandatory; any one of these documents will be accepted -? (a) Driving
    Licence (b) PAN Card (c)Voter ID Card (d) School/College Id card for students (e) Passport (f) ID card issued by present
    employer
    If the bill amount exceeds INR 1 lakh, it is mandatory to submit the address proof of the Primary Beneficiary; any of these
    documents will be accepted ? (a)Driving Licence (b) Passport (c) Voter ID Card (d) Aadhar Card?

    Click here for templates above check list.

    Here are some important notes:

    In case of admission at network hospital, consider availing cashless facility for your claim before discharge. Click here, to see
    your list of network hospitals.
    Claim adjudication will be as per policy terms and conditions.
    For admissions availing GIPSA packages, the reimbursement would be restricted to the package rate.

    QUICK LINKS:

    Track this claim on MediBuddy


    Learn more about common reasons for difference in claimed and approved amounts
    Read more about reducing cost of care. Plan your hospitalization with MediBuddy.
    Avail exclusive pricing on cashless hospitalization. Sign Up on?MediBuddy
    Get the MediBuddy app

    We assure you the best of our services, always

    Warm Regards,

    Medi Assist Insurance TPA Pvt. Ltd


    (Formerly known as Medi Assist India TPA Private Limited) CIN: U85199KA1999PTC025676. Regd Off: Tower "D", 4th floor, IBC Knowledge Park, 4/1,
    Bannerghatta Road, Bangalore - 560 029.
    Helpline:1800 425 9449 | Email: www.medibuddy.in/contactus
    If you are not satisfied with our settlement, you may approach the Grievance Cell of the Insurer at their Underwriting Office or Controlling Offices. If you are not
    satisfied with the resolution of the Grievance Cell, you may approach the jurisdictional Insurance Ombudsman, address of which is available on the website of
    the Insurer.

    App Connect

    THIS IS A COMPUTER GENERATED SETTLEMENT ADVICE AND SIGNATURE IS NOT REQUIRED.

    ? 2018 Medi Assist

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