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Reimbursement Claim Require Documents

The document outlines the required documents for hospitalization reimbursement claims, including claim forms, identification proofs, discharge summaries, and hospital bills. Specific requirements for maternity, cataract, cancer, chronic kidney disease, and accident claims are also detailed. Each claim type has additional documentation needs, such as scan reports and medical certificates.

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jawahar007
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9 views2 pages

Reimbursement Claim Require Documents

The document outlines the required documents for hospitalization reimbursement claims, including claim forms, identification proofs, discharge summaries, and hospital bills. Specific requirements for maternity, cataract, cancer, chronic kidney disease, and accident claims are also detailed. Each claim type has additional documentation needs, such as scan reports and medical certificates.

Uploaded by

jawahar007
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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REQUIRED DOCUMENT FOR HOSPITALIZATION RIMBURSEMENT CLAIMS

1. Claim form Part A should be filled by employee with basic details.


2. Claim form Part B should be filled by hospital with all required details
3. Govt Id Proof copy of Patient
4. Employee ID card copy (Provided by Employer)
5. Employee’s bank cheque leaf with account holder name printed (or) Detailed bank account E-
Statement
6. Detailed discharge summary (for hospitalization claim) or Detailed Day care summary (Day care
treatment) with hospital seal and sign
7. Hospital final bill with detailed breakup (Hospital seal and sign is mandatory)
8. Advance and Final Payment cash paid receipt with Hospital seal and sign
9. All original pharmacy bills & Doctor prescriptions with Hospital seal and sign
10. All original lab reports with hospital seal and sign
11. Complete set of indoor case papers

For Maternity Claim:-

1. USG Scan report (Anti Natal scan report) prior to the delivery
2. Gravida Status certified by the treating Dr (GPLA Status)

For Cataract Claim:-

1. A-Scan report or B-Scan Report prior to the surgery


2. Implant sticker with IOL invoice (If bulk purchase please get the separate letter from Hospital with
seal and sign)

For Cancer Claim-

1. Copy of Radio therapy charts for regular radio therapy claims with Hospital seal and sign
2. Copy of Chemo therapy charts for regular radio therapy claims with Hospital seal and sign

For CKD Claim:- (Chronic Kidney Dialysis)

1. Copy of Dialysis charts for regular dialysis claims with Hospital seal and sign
2. Recently done serum creatinine report for regular dialysis claims

For Accident and Fracture Claim:-

1. Original stent stickers and Stent invoice for those cases where implant involved.
2. Medico legal certificate (MLC) or Accident register copy or FIR copy
3. Pre and post-surgery X-ray reports with films

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