Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 8 views

    Mediassist Check List - E40e6d8ea4f - 1716976129506

    Uploaded by

    hasaj75201

    Copyright:

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

    Mediassist Check List - E40e6d8ea4f - 1716976129506

    Uploaded by

    hasaj75201
    8 views2 pages

    Original Title

    Mediassist Check List_e40e6d8ea4f_1716976129506

    Copyright

    © © All Rights Reserved

    Available Formats

    DOC, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Copyright:

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

    Mediassist Check List - E40e6d8ea4f - 1716976129506

    Uploaded by

    hasaj75201

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    You are on page 1of 2

    Dear Sir / Madam,

    We need your kind corporation to arrange to send all the original documents
    couriered to the below mentioned address in order to get the claim registered
    and get it processed as per the policy terms and condition.

    Please fill the attached claim form and arrange documents as per the checklist
    for claim processing and retain a scan copy of all the documents for your
    reference and kindly follow the below guidelines.

    Postal Address for courier:

    To,
    Medi Assist Insurance TPA Pvt Ltd
    58/1A, Singhasandra Village, Hosur Main Road, Begur Hobli, Bangalore
    South Taluk, Karnataka - 560 068.

     On top of the envelope : mention employee’s name, emp ID, contact no


    and Corporate name and write “Claim documents”.
     Documents should be neatly stapled to avoid missing of documents,
    company name, mobile number and email address should be captured
    clearly in the claim form.
     During this process TPA may raise shortfall mail to your official email ids,
    on receipt additional documents need to be submitted for further
    processing of the claim.
     Policy Number, TPA ID, Certificate Number and Details of Insurance
    history please can leave blank in the claim form Part A.

    Check list : The following are the documents that you would have to submit in
    original & retain copy of the same.

    1. Original duly completed and signed claim form. Claim form attached in this
    mail.
    2. Original hospital final bill.
    3.Pre-Numbered Cash paid receipt / Printed paid Receipts for payments made to
    the hospital(cash paid &/ advance receipts)
    4.Complete break-up of the hospital bill with description, unit price, quantity of
    service rendered or item purchased.
    5. Original Detailed Discharge Summary / Treatment summary with diagnosis,
    treatment, ICP, investigations, presenting complaints, history, advice at discharge
    etc.
    6. All original Investigation reports with prescriptions
    7.All medicine bills with relevant prescriptions
    8.Operation Theatre Notes in the event of a surgery performed
    9. Sticker or invoice for the Implant user, if any, during the surgery. IOL sticker in
    case of cataract.
    10. Medical Practitioner’s letter with obstetric history and gravida status in case
    of maternity claim.
    11. For RTA / Road Accident Claims , these Documents are Mandatory:

    1. MEDICO LEGAL CERTIFICATE ( MLC ) COPY.


    2. FIRST INFORMATION REPORT ( FIR) COPY -If Police case done.
    3. DETAILS OF ACCIDENT AND INTOXICATION DETAILS OF THE PATIENT. -
    from Treating Doctor .
    12. Copy of your ID card.
    13. Photo id and address proof , PAN card copy , if the claim value is more than 1
    Lakh.
    14. Copy of Company Employee ID card.
    15. Documents for National Electronic Fund Transfer (NEFT) Example: cancelled
    cheque or bank statement with account holder name, account number, IFSC
    code, account type, bank name and address. (Mandatory document for all
    claims)

    You might also like