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    Claim Submission Check List PDF

    Uploaded by

    Reemy
    This checklist provides guidance for submitting an insurance claim. It lists important documents needed, including the original claim form, hospital bills, discharge summary, payment receipts, doctor registration details, prescriptions, investigation reports, and police reports for accidents. The checklist emphasizes arranging documents in the specified order and retaining copies for reference. It notes additional requirements may apply and contact information is provided for assistance.

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

    Claim Submission Check List PDF

    Uploaded by

    Reemy
    80 views1 page
    This checklist provides guidance for submitting an insurance claim. It lists important documents needed, including the original claim form, hospital bills, discharge summary, payment receipts, doctor registration details, prescriptions, investigation reports, and police reports for accidents. The checklist emphasizes arranging documents in the specified order and retaining copies for reference. It notes additional requirements may apply and contact information is provided for assistance.

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    Claim_submission_check_list.pdf

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    This checklist provides guidance for submitting an insurance claim. It lists important documents needed, including the original claim form, hospital bills, discharge summary, payment receipts, doctor registration details, prescriptions, investigation reports, and police reports for accidents. The checklist emphasizes arranging documents in the specified order and retaining copies for reference. It notes additional requirements may apply and contact information is provided for assistance.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    80 views1 page

    Claim Submission Check List PDF

    Uploaded by

    Reemy
    This checklist provides guidance for submitting an insurance claim. It lists important documents needed, including the original claim form, hospital bills, discharge summary, payment receipts, doctor registration details, prescriptions, investigation reports, and police reports for accidents. The checklist emphasizes arranging documents in the specified order and retaining copies for reference. It notes additional requirements may apply and contact information is provided for assistance.

    Copyright:

    © All Rights Reserved
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    CHECK LIST FOR SUBMISSION OF CLAIM

    Very IMP:

    Do not forget to attach this checklist with the Claim file.


    Arrange the documents in the same order as in the checklist, checking against the designated
    box when you do so. This way you can ensure that you have not missed any documents.

    Employee Name:- ________________________________Employee No:___________ Claim No. _______________


    Name of the company: ____________________________________________________________________________
    Contact Number:___________________ Mobile no. _____________________ E- Mail ID: _____________________
    Check list for Documents: Please put a X mark against the box
    Original Claim Form duly signed by you.
    [Fill the claim amt in Signed Claim Form ]
    Original Main Hospital bill with Bill Number & break up,
    (With detailed break up of various heads like Room Rent/OT charges/Nursing etc).
    Original Discharge summary
    (Gives the summary of diagnosis and treatment in hospital)
    Original Death summary
    (Only in case of death of Patient during Hospital stay).
    Original Hospital Payment Receipt with receipt number
    (With seal & signature of hospital) (if main bill does not carry a bill number).
    Original Payment Receipt with receipt number
    (For consultation/surgeon charges if charged outside the main hospital bill).
    Hospital registration number
    (Registration No. & Number of beds, on hospital letterhead with signature).
    Doctors registration number
    (On doctors letterhead with signature).
    Original Pharmacy and Investigation bills
    (Along with prescriptions & Lab reports).
    Original prescriptions
    (On doctors letterhead mentioning duration and dosage for medicines and advice for diagnostic tests).
    investigation reports in original/attested from hospital
    (Reports for all tests done along with images)
    Police FIR / Medico Legal Certificate (MLC)
    (Mandatory for All Road traffic accidents-Duly attested by Police with
    Points to remember
    Please retain copies of all the documents submitted to us for future reference.
    For any assistance with any of the above formats, please contact us at [email protected]
    or call at 1800 22 4646
    Please retain a POD copy of the courier for tracking your consignment in case of any delay etc.
    The above list of documents is indicative. In case of any other document requirement as specified by the
    insurance company our Document recovery Team will contact you on receipt of your claim documents by
    us.
    For Implants used in Cataract, Heart Valve surgeries, CABG, Abdominal Surgeries, Knee replacement
    surgeries, please submit the bill from the vendor for the prosthetic device used along with Sticker.
    Please enter your Bank Account details online for Electronic Fund Transfer of your medical claim
    directly into your bank account. Please ensure that you mention the correct account number for the
    fund transfer since the claim credit will be processed solely based on the account number provided
    by you. Kindly logon at "www.uhcpindia.com"

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