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    Inv. 6 April 15

    Uploaded by

    SJAIN12
    This document contains a list of 15 cashless intimation claims and 10 general intimation claims made to an insurance company. It provides details such as claim number, policy number, name and details of insured and hospital, diagnosis code, disease, date of request and admission. The high level information is that it involves various medical insurance claims covering diseases such as pancreas cancer, kidney stones, diabetes, influenza and accidents.

    Copyright:

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

    Inv. 6 April 15

    Uploaded by

    SJAIN12
    12 views24 pages
    This document contains a list of 15 cashless intimation claims and 10 general intimation claims made to an insurance company. It provides details such as claim number, policy number, name and details of insured and hospital, diagnosis code, disease, date of request and admission. The high level information is that it involves various medical insurance claims covering diseases such as pancreas cancer, kidney stones, diabetes, influenza and accidents.

    Original Description:

    MEDICLAIM 06APRIL2015

    Original Title

    inv. 6 April 15

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    © © All Rights Reserved

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    This document contains a list of 15 cashless intimation claims and 10 general intimation claims made to an insurance company. It provides details such as claim number, policy number, name and details of insured and hospital, diagnosis code, disease, date of request and admission. The high level information is that it involves various medical insurance claims covering diseases such as pancreas cancer, kidney stones, diabetes, influenza and accidents.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Download as xls, pdf, or txt
    12 views24 pages

    Inv. 6 April 15

    Uploaded by

    SJAIN12
    This document contains a list of 15 cashless intimation claims and 10 general intimation claims made to an insurance company. It provides details such as claim number, policy number, name and details of insured and hospital, diagnosis code, disease, date of request and admission. The high level information is that it involves various medical insurance claims covering diseases such as pancreas cancer, kidney stones, diabetes, influenza and accidents.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Download as xls, pdf, or txt
    of 24

    6-Apr-15

    CASHLESS INTIMATION
    Sr. No.

    Claim No.

    Policy
    NO

    INSURED MEMBER
    NAME
    NAME

    SEX

    AGE

    RELATIO
    SUM
    N
    INSURED

    VIHAN
    20150405 190101/4 NETWOR
    B006C2A 7/14/09/0 KS
    SHANTA
    1 062
    0000005 LIMITED RAINA

    FEMALE

    78 Mother

    20150404 19010128 MR.


    MRS.
    B006C2A 14P10231 RAKESH MANJU
    2 056
    3573
    TADIYA
    TADIYA

    Female

    46 Wife

    M/s
    VARDHM
    20150404 19010128 AN
    B006C2A 14P10454 FABRICS DEEPAK
    3 061
    0427
    BUDYHNI ARORA

    Male

    Mr.
    20150404 19010128 ARVIND VEENA
    B006C2A 14P10963 BARJATY BARJATY
    4 052
    6840
    A
    A
    Female

    20150404 19010328 SHRI


    MASTER
    B006C2A 14P10290 AVINASH YASH
    5 054
    9665
    VYAS
    VYAS
    Male

    29 Employee

    62 Wife

    9 SON-2

    50000

    225000

    125000

    HAREND
    20150406 19010328 ER
    B006C2A 14P10902 SINGH
    6 071
    7193
    SODHI

    HAREND
    ER
    SINGH
    SODHI
    Male

    44 Self

    300000

    MR.
    20150404 19010328 BHAGWA
    B006C2A 14P11060 NDAS
    7 057
    0191
    VALECHA

    MR.
    BHAGWA
    NDAS
    VALECHA Male

    57 Self

    300000

    20150404 190403/4 MR. JEET MR. JEET


    B006C2A 8/14/06/0 SINGH
    SINGH
    8 058
    0000205 RAJPAL RAJPAL Male

    55 Self

    200000

    20150404 190804/4
    B006C2A 8/14/41/0 M/s S R F
    9 059
    0000066 LIMITED PALAK

    10 Daughter

    Female

    20150405 190804/4
    KEDAR
    B006C2A 8/14/41/0 M/s S R F LAL
    10 065
    0000066 LIMITED SHARMA Male

    47 Employee

    100000

    20150406 191100/4 MR.


    MR.
    B006C2A 8/14/06/0 KULDEEP KULDEEP
    11 070
    0000160 B. SONI B. SONI Male

    46 Self

    250000

    20150404 191100/4 MR.


    SMT.
    B006C2A 8/14/06/0 KULDEEP SUSHMA
    12 051
    0000160 B. SONI SONI
    Female

    40 Wife

    20150405 19110328 BASANT


    B006C2A 14P10837 KUMAR
    13 063
    2059
    PATEL

    MRS.
    KAVITA
    PATEL

    Female

    36 WIFE

    GENRAL INTIMATION
    Sr. No.

    Claim No.

    Policy
    NO

    INSURED MEMBER
    NAME
    NAME

    20150404 19010128 MR.


    MRS.
    B006R2A 14P10231 RAKESH MANJU
    1 050
    3573
    TADIYA
    TADIYA

    SEX

    Female

    AGE

    RELATIO
    SUM
    N
    INSURED

    46 Wife

    100000

    SMT.
    20150406 19010128 ANNIE
    B006R2A 14P10435 MARY
    2 067
    3497
    JOHN

    MASTER
    JOEL. K.
    JOHN
    Male

    20 Son

    100000

    20150404 190300/4 SMT.


    B006R2A 8/14/41/0 SUNITA
    3 053
    0000672 JAIN

    MR.
    VIPIN
    JAIN

    Male

    47 Husband

    150000

    SHRI
    20150405 19040028 UMESH
    B006R2A 14P11041 KUMAR
    4 066
    1244
    JAIN

    SHRI
    UMESH
    KUMAR
    JAIN

    Male

    56 Self

    100000

    SHRI
    20150404 19040028 UMESH
    B006R2A 14P11041 KUMAR
    5 055
    1244
    JAIN

    SHRI
    UMESH
    KUMAR
    JAIN

    Male

    56 Self

    100000

    SHRI
    PRAKAS
    20150405 19040228 H
    B006R2A 14P10954 CHANDR
    6 064
    9050
    A SETHIA

    SHRI
    PRAKAS
    H
    CHANDR
    A SETHIA Male

    56 Self

    150000

    20150404 190403/4 MR. JEET MR. JEET


    B006R2A 8/14/06/0 SINGH
    SINGH
    7 048
    0000205 RAJPAL RAJPAL Male

    55 Self

    200000

    20150404 190403/4 MR. JEET MR. JEET


    B006R2A 8/14/06/0 SINGH
    SINGH
    8 049
    0000205 RAJPAL RAJPAL Male

    55 Self

    200000

    MR.
    MR.
    20150406 190900/4 GYAN
    GYAN
    B006R2A 8/14/97/0 SWAROO SWAROO
    9 069
    0000018 P NIGAM P NIGAM Male

    SHRI
    20150406 190900/4 MUKESH
    B006R2A 8/14/97/0 SINGH
    10 068
    0000133 PATEL

    SHRI
    MUKESH
    SINGH
    PATEL
    Male

    61 SELF

    100000

    53 SELF

    150000

    Period of Period of
    Insured
    insuranc insuranc
    address
    e - from
    e - to

    11/3/2015 10/3/2016

    BHAGAT
    SINGH
    MARG
    POST &
    DISTT.
    ASHOK
    NAGAR ,
    12/7/2014 11/7/2015 BHOPAL

    Insured
    contact
    no

    Hospital
    Name

    Hospital
    Address ICD code
    & Phone

    Cashless
    request
    Disease
    received Date

    BLOCKB,SUSHA
    NT
    LOK
    ,PHASEI, NEXT
    TO PARK
    PLAZA
    HOTEL,, ,
    GURGAO
    MAX
    N, Ph:
    HOSPITA 0124L
    6623000 C25

    Malignant
    neoplasm
    of
    pancreas

    5/4/2015

    16/1,
    SOUTH
    TUKOGA
    NJ, NEAR
    SAMAVS
    HARAN
    MANDIR,
    KANCHA
    N BAGH
    MAIN
    ROAD, ,
    INDORE,
    Ph: 0731SNG
    2525555,
    HOSPITA 58,42191
    0 L
    91
    K80

    Cholelithi
    asis

    4/4/2015

    DOUBLE
    PATHAK,
    HARDA
    BYPASS
    ROAD,
    HOSHAN
    GABAD, ,
    NARMAD HOSHAN
    A APNA
    GABAD,
    HOSPITA Ph: 07574
    0 L
    - 405060 N45

    Orchitis
    and
    epididymit
    is LT
    SIDE

    4/4/2015

    E-3/23,
    ARERA
    COLONY,
    BHOPAL,
    ,
    BHOPAL,
    NARMAD Ph: 0755139/98,
    99931769 A
    4040000,
    SAKET
    39
    TRAUMA 4040001,
    NAGAR , 09713600 CENTER 4040002,
    11/2/2015 10/2/2016 BHOPAL 000
    PVT.LTD 4040003 N20.1

    Calculus
    of ureter

    4/4/2015

    GEETANJ
    ALI
    COMPLE
    X, ,MAIN
    ROAD
    NO.
    2,NEAR
    MATA
    MANDIR,
    T.T.NAGA
    R, ,
    BHOPAL,
    E-8/24,
    Ph: 0755BHARAT
    230578/2
    NAGAR,
    37578/26
    SHAHPU 00000000
    71188/
    RA,
    00
    HAJELA 2671959/
    24/07/201 23/07/201 BHOPAL , 00000000 HOSPITA 2773392 4
    5
    BHOPAL 00
    L
    93
    E10

    Insulindependen
    t diabetes
    mellitus

    4/4/2015

    31/08/201 BUDHANI
    1/9/2014 5
    ,SEHORE

    226 -C
    -SECTOR
    ,INDRAP
    URI,RAIS
    EN
    ROAD,
    NEAR
    ESIC
    85
    08962435 R.K.
    HOSPITA
    DANISH 899
    HOSPITA L, ,
    KUNJ-1, 98260168 L &
    BHOPAL,
    KOLAR
    61
    RESEAR Ph: 0755 14/03/201 13/03/201 ROAD
    00000000 CH
    2750754,
    5
    6
    ,BHOPAL 00
    CENTRE 4260605
    127,A
    NEW
    SINDHI
    COLONY
    BEHIND
    RED
    ROSE
    SCHOOL
    BERSIA
    31/03/201 30/03/201 ROAD
    5
    6
    ,BHOPAL

    6
    MALIPUR
    A,
    PEERGA
    TE, ,
    CHIRAYU BHOPAL,
    00000000 HEALTH Ph:
    00
    &
    2531122,
    00000000 MEDICAR 2531133,
    00
    E(P) LTD 2531777 C00

    KASTUR
    BA MARG
    PUNJABI
    MOHALL
    A
    SHUJALP
    UR
    MANDI
    DIST.
    SHAJAPU
    R
    24/06/201 23/06/201 ,SHAHJA
    4
    5
    PUR
    9.8E+009

    MALANP
    27/04/201 26/04/201 UR
    4
    5
    ,BHIND

    RAJSHRE
    E
    HOSPITA
    L&
    RESEAR
    CH
    CENTRE
    PVT. LTD.

    SCH. NO.
    74-C,
    SECTORD, VIJAY
    NAGAR,
    INDORE,
    ,
    INDORE,
    Ph:
    98599076
    73
    I20.0

    LAXMI
    BAI
    COLONY,
    PADAV,
    GWALIO
    MAHESH R, Ph:
    WARI
    0751NURSING 4012551/
    0 HOME
    52
    N20.1

    6/4/2015

    CA
    BUCCAL
    MUCOSA

    4/4/2015

    Unstable
    angina

    4/4/2015

    Calculus
    of ureter
    RT.

    4/4/2015

    MALANP
    27/04/201 26/04/201 UR
    4
    5
    ,BHIND

    SURYA
    MANDIR
    BIMR
    ROAD,
    HOSPITA RESIDEN
    LS (RUN CY,
    BY BIRLA MORAR, ,
    NAGAR
    GWALIO
    JANA
    R, Ph:
    SEVA
    07510 TRUST) 2405702 F55

    Abuse of
    nondependen
    ceproducing
    substance
    s OPIOID

    5/4/2015

    F-4, SIRT
    COLLEG
    E
    CAMPUS
    AYODHY
    A BY
    PASS
    ROAD
    6/5/2015 ,BHOPAL

    E-3/23,
    ARERA
    COLONY,
    BHOPAL,
    ,
    BHOPAL,
    NARMAD Ph: 0755A
    4040000,
    TRAUMA 4040001,
    CENTER 4040002,
    0 PVT.LTD 4040003 J09

    Influenza
    due to
    certain
    identified
    influenza
    virus

    6/4/2015

    F-4, SIRT
    COLLEG
    E
    CAMPUS
    AYODHY
    A BY
    PASS
    ROAD
    6/5/2015 ,BHOPAL

    E-3/23,
    ARERA
    COLONY,
    BHOPAL,
    ,
    BHOPAL,
    NARMAD Ph: 0755A
    4040000,
    TRAUMA 4040001,
    CENTER 4040002,
    0 PVT.LTD 4040003 J22

    LOWER
    RESPIRA
    TORY
    TRACT
    INFECTI
    ON

    4/4/2015

    7/5/2014

    7/5/2014

    7/1/2015

    S/O MR.
    KANHAIY
    A LAL
    PATEL
    H.NO26/4,
    W.NO-02,
    PATEL
    MOHALL
    A
    DHANAS
    ARI ,
    POSTPUNOUR
    PIPARIYA
    , NA
    ,HOSHAN
    6/1/2016 GABAD

    Period of Period of
    Insured
    insuranc insuranc
    address
    e - from
    e - to

    BHAGAT
    SINGH
    MARG
    POST &
    DISTT.
    ASHOK
    NAGAR ,
    12/7/2014 11/7/2015 BHOPAL

    EKTA
    CHOWK,
    SANICKA
    SA, ,
    HOSHAN
    NEW
    GABAD,
    PANDEY Ph:
    HOSPITA 075740 L
    252536
    A01.0

    Insured
    contact
    no

    Hospital
    Name

    Hospital
    Remarks
    address

    16/1,
    SOUTH
    TUKOGA
    NJ, NEAR
    SAMAVS
    HARAN
    MANDIR,
    KANCHA
    SNG
    N BAGH
    HOSPITA MAIN
    L~
    ROAD
    0 INDORE ,INDORE

    Typhoid
    fever

    5/4/2015

    Date Of
    Disease Admissio
    n

    3/4/2015

    MIG-28
    SHIV
    KALP
    AYODHY
    A BY
    PASS
    PEOPLE
    HOSPITA
    L
    BHANPU
    15/09/201 14/09/201 R
    4
    5
    ,BHOPAL
    80, IMLI
    BAZAR
    MANJU
    SHREE
    TENT
    HOUSE
    20/05/201 19/05/201 INDORE ,
    4
    5
    INDORE

    PEOPLE
    S
    GENERA
    L
    HOSPITA
    L
    BHOPAL
    ~
    BHOPAL

    99261014
    90
    07312432
    043
    99261014
    90

    6
    MALVIYA
    NAGAR ,
    BHOPAL

    1/4/2015

    PRINCE
    ALY
    KHAN
    HOSPITA
    L
    ,

    MEDICAR
    E
    HOSPITA
    L&
    RESEAR
    CH
    CENTRE
    59/2,NAG
    (UNIT OF
    NATH KI
    LAHOTI
    GALI
    MEDICAR
    BHAGSIP
    E PVT
    26/02/201 25/02/201 URA
    LTD) ~
    5
    6
    ,UJJAIN
    9.4E+009 INDORE

    4/5, OLD
    PALASIA,
    RAVINDR
    A NAGAR
    ,INDORE

    CHLMEDICAL
    CENTER
    59/2,NAG
    (UNIT OF
    NATH KI
    APOLLO
    GALI
    HOSPITA
    BHAGSIP
    L,
    26/02/201 25/02/201 URA
    INFORE ~
    5
    6
    ,UJJAIN
    9.4E+009 UJJAIN

    NANAKH
    EDA,
    HARI
    PHATAK
    BYPASS
    (MAHAKA
    L
    ROAD)
    ,UJJAIN

    3/4/2015

    Disease;brain
    embrage
    estimate
    amount
    not
    conform

    5/4/2015

    3/4/2015

    43-B,
    DINDAYA
    L NAGAR,
    BEHIND
    MANOHA
    R
    GENERA
    L
    STORES,
    RATLAM
    DIST. :
    RATLAM,
    MADHYA
    PRADES
    24/02/201 23/02/201 H , NA
    5
    6
    ,RATLAM

    ADDRES
    SSAGOD
    ROAD
    RATLAM
    MADHYA
    PRADES
    H 230231
    DISEASE
    - PAIN IN
    HOLE
    BODY

    4/4/2015

    AB
    ROAD
    VISHESH NEAR
    HOSPITA GEETA
    L
    BHAWAN
    INDORE CHOURA
    ~
    HA
    INDORE ,INDORE

    contact no
    -0731423
    8111,
    Disease heart
    problem .

    4/4/2015

    RAJSHRI
    APOLLO
    HOSPITA
    L
    ,

    address scheme
    no. 74 c
    sector D
    vijay
    nagar
    indore
    contact no
    07312445
    566,
    2445544
    Disease heart
    problem .

    4/4/2015

    CHL
    APOLO
    JAIN
    98277694 DIWAKA
    29
    R
    98277694 HOSPITA
    29
    L
    ,

    KASTUR
    BA MARG
    PUNJABI
    MOHALL
    A
    SHUJALP
    UR
    MANDI
    DIST.
    SHAJAPU
    R
    24/06/201 23/06/201 ,SHAHJA
    4
    5
    PUR
    9.8E+009

    KASTUR
    BA MARG
    PUNJABI
    MOHALL
    A
    SHUJALP
    UR
    MANDI
    DIST.
    SHAJAPU
    R
    24/06/201 23/06/201 ,SHAHJA
    4
    5
    PUR
    9.8E+009

    8/4/2014

    ATUL
    VIHAR
    FLAT NO
    C2,FIRST
    FLOOR,
    WRIGHT
    TOWN
    ,JABALP
    7/4/2015 UR

    723
    PATEL
    MARG
    HATHITA
    L
    COLONY
    JABALPU
    R
    30/04/201 29/04/201 ,JABALP
    4
    5
    UR

    HOME
    SCIENCE
    COLLEG
    ASHISH E ROAD
    HOAPITA NRPIER
    L~
    TOWN
    JABALPU ,JABALP
    R
    UR

    5/4/2015

    SARVOD
    AY
    HOSPITA
    L&
    RESEAR
    CH
    CENTRE
    ~
    JABALPU
    R

    2/4/2015

    864
    NAPIER
    TOWN
    ,JABALP
    UR

    Cashless
    Date Of
    Expected
    request
    Approve
    Claim Approved
    Admissio
    discharg
    STATUS
    received Date
    Amount Amount
    n
    e date
    Time

    11:04:02

    3/4/2015

    5/4/2015

    120550

    50000 Approved

    13:30:50

    3/4/2015

    4/4/2015

    52400

    39425 Approved

    17:36:11

    3/4/2015

    4/4/2015

    15000

    8000 Approved

    11:24:23

    2/4/2015

    4/4/2015

    59500

    0 Query

    11:29:48

    3/4/2015

    4/4/2015

    25000

    10000 Approved

    10:53:04

    8/4/2015

    55000

    14:36:25

    3/4/2015

    4/4/2015

    35000

    16:01:21

    4/4/2015

    4/4/2015

    20000

    16:14:59

    4/4/2015

    4/4/2015

    8200

    0 Pending

    15000 Approved

    0 Query

    0 Rejected

    14:53:44

    5/4/2015

    5/4/2015

    51000

    0 Rejected

    10:43:10

    4/4/2015

    6/4/2015

    54000

    10000 Approved

    11:18:42

    3/4/2015

    4/4/2015

    76000

    10000 Approved

    11:35:27

    4/4/2015

    Expected
    Claim
    discharg
    Amount
    e date

    1000

    5/4/2015

    18000

    8000 Approved

    1000

    1000

    1000

    1000

    1000

    1000

    1000

    1000

    1000

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