Nothing Special   »   [go: up one dir, main page]
Scribd Logo
Upload

Welcome to Scribd!

  • 188 views

    GMC Claim Document Check List: Employee Number: Name of Insured: Officialmail Id: Name of Company: Mobile Number

    Uploaded by

    Satya Sundar
    This document provides a check list of documents required to submit an insurance claim, including a completed claim form, proof of identity, discharge summaries, bills, receipts, investigation reports, and additional documents depending on the type of claim such as MLC/FIR reports for accidents or dialysis charts for related claims. The checklist specifies the original or copy status required for each document and includes remarks or notes for certain documents.

    Copyright:

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

    GMC Claim Document Check List: Employee Number: Name of Insured: Officialmail Id: Name of Company: Mobile Number

    Uploaded by

    Satya Sundar
    188 views1 page
    This document provides a check list of documents required to submit an insurance claim, including a completed claim form, proof of identity, discharge summaries, bills, receipts, investigation reports, and additional documents depending on the type of claim such as MLC/FIR reports for accidents or dialysis charts for related claims. The checklist specifies the original or copy status required for each document and includes remarks or notes for certain documents.

    Original Description:

    Original Title

    Checklist - GMC

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document provides a check list of documents required to submit an insurance claim, including a completed claim form, proof of identity, discharge summaries, bills, receipts, investigation reports, and additional documents depending on the type of claim such as MLC/FIR reports for accidents or dialysis charts for related claims. The checklist specifies the original or copy status required for each document and includes remarks or notes for certain documents.

    Copyright:

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

    GMC Claim Document Check List: Employee Number: Name of Insured: Officialmail Id: Name of Company: Mobile Number

    Uploaded by

    Satya Sundar
    This document provides a check list of documents required to submit an insurance claim, including a completed claim form, proof of identity, discharge summaries, bills, receipts, investigation reports, and additional documents depending on the type of claim such as MLC/FIR reports for accidents or dialysis charts for related claims. The checklist specifies the original or copy status required for each document and includes remarks or notes for certain documents.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    GMC CLAIM DOCUMENT CHECK LIST

    Name of insured : EMPLOYEE NUMBER :


    OfficialMail ID : Mobile Number :
    Name of Company :

    S.NO PARTICULARS FORM IN WHICH THE DOCS ARE REQUIRED REMARK


    CLAIM FORM DULLY FILLED & SIGNED BY INSURED WITH CLAIMED AMOUNT.
    1 PART B OF CLAIM FORM & PPN DECALARATION FORM SHOULD BE SIGNED & STAMPED FROM ORIGINAL
    HOSPITAL.
    VALID PHOTO ID PROOF
    2 * Photo id of patient (copy of aadhar card). COPY
    * Copy of PAN card of employee & one id with address proof.
    NEFT DETAILS AS GIVEN IN CLAIM FORM ALONG WITH COPY OF CANCELLED CHEQUE
    3 ORIGINAL
    (*name printed cheque for NEFT verification)
    NATURE OF CLAIM DOCUMENTS - FRESH CLAIM / PRE-POST CLAIM / DEFICIENCY RETRIEVAL
    4 INDICATE THE NATURE OF CLAIM
    DOCUMENT
    DISCHARGE SUMMARY / DEATH SUMMARY ( IN CASE OF DEATH CLAIMS) / DAY CARE SUMMARY
    5 ORIGINAL
    IN CASE OF DAY CARE TREATMENTS
    a) Copy of the Legal heir certificate, if the claim is for the death of the principle insured. ORIGINAL
    b) Copy of Post Mortem Report & Death Certificate (In Accidental Death cases) ORIGINAL
    6 Original Final Hospital bill with breakup of each Item ORIGINAL
    7 Original Payment Receipt of Main Hospital bill ( both Deposit / Refund) ORIGINAL
    Original copy of Implant Invoice along with Payment Receipts & Implant Labels /
    8 ORIGINAL
    Stickers for Stents/Mesh/IOL
    CASH-MEMO OF MEDICINES WITH BATCH NUMBER & EXPIRY DATE OF MEDICINE
    9 ORIGINAL
    (with date wise doctor's prescription).
    Original bills, original Payment Receipts and investigation / Laboratory Reports (with date wise
    doctor's prescription).
    10 ORIGINAL
    LAB REPORTS SHOULD BE COUNTER SIGNED BY REGISTERED MEDICAL PRACTITIONER WITH A
    POST GRADUATE QUALIFICATION IN PATHOLOGY.
    a) X-RAY, USG, MRI AND ALL INVESTIGATION FIMS, IF ANY (with date wise doctor's prescription). ORIGINAL
    11 OPD CARDS and/or PRESCRIPTIONS ORIGINAL
    12 CONSULTATION RECEIPTS (with date wise doctor's prescription) ORIGINAL

    13 IN CASE OF PRE-PLANNED SURGERIES NEED PRIOR CONSULATION AND INVESGATION REPORTS. ORIGINAL

    14 ANY OTHER DOCUMENTS BEING SUBMITTED ( EXAMPLE: MLC AND FIR IN CASE OF ACCIDENT) ORIGINAL

    OTHER MANDATORY DOCUMENTS


    1 Original A-Scan Report along with IOL S;cker and Tax paid invoice in case of Cataract Claim ORIGINAL
    GRAVIDA STATUS for Maternity Claim : Original copy of Obstetric history (Gravida, Para, Living children,
    2 Abortions) from treating doctor.
    ORIGINAL

    FOR ACCIDENTAL CASES :


    * CIRCUMSTANCES OF INJURY- WHEN, WHERE AND HOW
    3 * INFUANCE OF ALCOHOL AT THE TIME OF INFURY NEED TO BE CERTIFIED THROUGH TREATING DOCTOR
    ORIGINAL
    * MLC/FIR COPY NEEDED AND IF NOT DONE CONFIRMATION THROUGH TREATING DOCTOR

    4 Original Dialysis flow chart for dialysis cases. ORIGINAL


    For coinsurance cases : In case of claims where the insured has submitted documents to another
    insurance co. /TPA.
    * Original copy of settlement letter from 1st insurer/TPA & an undertaking stating that all original
    5 documents are retained by them.
    ORIGINAL
    * Xerox copy of all claim documents submitted to 1st insurer/TPA for claim, attested by them.

    DATE AND TIME OF ADMISSION :


    DATE AND TIME OF DISCHARGE :
    DATE OF CLAIM SUBMISSION :
    SIGNATURE OF EMPLOYEE & DATE :

    You might also like