Book1

Mediclaim Issues @ Jhagadia Site

Sr. # Employee Number Name of Employees Claim Number Issue in Details Attachments

1 7976396 Hiten Gohil 11078042 Amount towards ambulance charges are not reimbursed. NA

2 7976396 Hiten Gohil 11153511 NA

3 7926097 Snehal Patel Cliam is put on hold stating the endorsement for Mr. Snehal Patel's spouse is not received. NA

4 7556311 Shripad Rajpathak 11192622 NA

5 7830839 Tejas Patel 10964565 NA

6 7569596 Nikunj V Patel 11315212

amount of INR 400/- towards ambulance charges and 11,170/- towards surcharges are not reimbursed.

Mr. Shripad's mother was admitted in hospital on 17-May-2015 which was a cash less claim, the claim was not approved til 06-Jul-2015. Because the claim is not settled till date and payment is not made to the hospital where his mother hospitalized. The hospital will not give certificate until the claim is settled, Mr. Shripad require this certificate on urgent basis as he needs to submit the same to other insurance agency to claim disallowed amount by Liberty.

Out of INR 22,698/- claimed only INR 19887/- is settled, INR 2,811/- disallowed stating below reason.

Detail Itemized and cost wise breakup is asked for an amount of INR 1,740/- whereas employees has not enclosed the bill of the same amount in his claim file, employee has not submitted any bill for an amount of INR 1740/-.Claim file was dispatched from Jhagadia Site on 28-May-2015, Claim is still not settled staing below reasons.1] Employee did not intimate Libert / Mediassist at the time of hospitalization, As per LANXESS terms with Liberty employees need not take any intimation number. 2] Detail Itemized and cost wise breakup is being asked for an amount of INR 400/- whereas employees has not enclosed the bill of the same amount, the details of bills enclosed with the claim file is attached herewith for your reference which shows that employee has not submitted any bill for an amount of INR 400/-.

Sr.No Employee_Code Employee_Name Claiments_Name

1 7381260 Subhash Chandra Sharma Rekha Sharma

2 7381538 Jitendra Salve Jitendra Salve

3 7381228 Rajesh Yadav Arnav Yadav

4 7380728 N S Chouhan N S Chouhan5 7381929 Ajay Sirivastava Vedika Sirivastava

6 7921788 Gaurav Narain Yashi Saxena

7 8055456 Praveen Kumar Shikha Dhiman

8 7381538 Jitendra Salve Jitendra Salve

9 7381228 Rajesh Yadav Malti devi

10 7393870 Sanjay Gothwal Yohan Gothwal

Relation Claim_Type Claimed_Amount

Spouse Reimbursement 1248

Self Reimbursement 7166

Son Reimbursement 2469

Self Reimbursement 48619Daughter Reimbursement 14905

Daughter Reimbursement 4865

Spouse Reimbursement 8746

Self Reimbursement 7043

Mother in law Reimbursement 59266

Son Reimbursement 10045

Illness Hospital_Name

Other diseases of upper respiratory tract

Other Noninfective Gastroenteritis & colitis

Intracranial injury

Cholecystitis Urban Bank HospitalOther disorders of eyes & adnexa

Diaorrhoea & gastroenteritis of presumed infectious origin

Single spontaneous delivery Ravi Nursing Home

Dizziness and giddiness TAPTI HOSPITAL

Anal Fissure Bombay Hospital Indore

Neonatal jaundice from other and unspecified causes J K Nursing Home

INDUBHAI PAREKH MEMORIAL HOSPITAL

NIMAR HOSPITAL & RESEARCH CENTRE

INDUBHAI PAREKH MEMORIAL HOSPITAL

CHOITHRAM NETRALAYA

DR AMIT AGRAWAL NEW BORN & CHILD CARE

CENTRE

City_Name Comments/ Remark

Nagda pending since March 2015

Burhanpur

Nagda

DahodIndore Documents sent to TPA

Bareilly

Muzaffarnagar

Burhanpur Documents are sent to TPA

Indore

Ujjain

Status as on 28 July 2015

It’s a normal delivery case , however TPA is asking for indoor case papers which employee is not able to provide . Now empoyee is asking his documents back .

Claim was sent on 5th June 2015, till date we have not received any claim accknowldement information nor the claim is settled.

Claim was sent on 21st May 2015 along with mother(saraswati gothwal's claim) TPA is saying they received only mother's claim which is not possible as

both the claims were sent together. Earlier MS. Rashmita was handling while followig up with her she said baby/s name is not added thats why the claim is not registered. Employee was following up regulary

but now HR is handling

Sr no. Claim no. Emp code Emp Name Relation MAID

1 11078042 17-Aprr-15 7976396 Self

2 11153511 7-May-15 7976396 Self

3 13-Jul-157926097

Self

4 11192622 24-Jun-15 Mother

5 10964565 17-Mar-15 Spouse

6 11315212 17-Jun-15 7569596 Mother

Received on

Beneficiary Name

Hiten Ratilal Gohil

5017213630 Hiten Ratilal GohilHiten

Ratilal Gohil

5017213630 Hiten Ratilal Gohil

11407468 Snehal Kumar Patel

5019255794 Snehal Kumar Patel

7556311 Shripad Rajpathak

5018817279 Vijaya J Rajpathak

7830839 Tejas Kumar Patel

5017213318 Suchita T Patel

Nikunjkumar V Patel

5018817366 Nirmalaben Patel

Claim Type claim status

Reimbursement 28166 19871 24-Apr-15 Settled

Reimbursement 29919 13665 5-Jun-15 Settled

Reimbursement 3950 IR

Cashless 10-Jul-15 Settled

Reimbursement 25-Mar-15 Settled

Reimbursement 9692 6290 22-Jul-15 Settled

Claim Amount

Approved Amount

Settlement Date

268328 209963

22698 19887

REmarks

Pre auth request recived on 17th may and approved on 19th may and approved on 6th july and claime is settled on 8th july payment is made to the hospital.

1) Provide original discharge card.2) provide report done in support of diagnosis|(IR letter sent on 15th july to archana,hardik and lanxess's id.)

Pre auth request recived on 17th may and approved on 19th may and approved on 6th july and claime is settled on 8th july payment is made to the hospital.

Sr no. Claim no. Emp code Emp Name Relation MAID

111393987

8-Jul-15 Spouse

211260459

2-Jun-15 Self

311348672

26-Jun-15 Son5017211732

4 27-May-15 Self

5 12-Jun-15 Daughter 5017211860

6 11217699 22-May-15 7921788 Daughter

711016055

2-Apr-158055456

Spouse

8 11260403 2-Jun-15 Self

9 26-Jun-15 5017211732

10 7393870

Received on

7381260 Subhash Chandra Sharma

5017211741

7381538 Jitendra Salve 5017211778

7381228 Rajesh Yadav

11237050 7380728 N S Chouhan 5017211632

11298360 7381929 Ajay Sirivastava

Gaurav Narain 5017213534

Praveen Kumar

5017213849

Jitendra Salve 5017211778

11348672 Rajesh Yadav Son

Beneficiary Name Claim Type claim status






Reimbursement 4865 Closed

Reimbursement 8746 closed


Reimbursement

Claim Amount

Approved Amount

Settlement Date

Rekha Sharma

Jitendra Salve

Arnav Yadav

N S Chouhan

Vedika Sirivastava

Yashi Saxena

Shikha Dhiman

Jitendra Salve

Arnav Yadav

REmarks

No claim found

Claim documents recieved on but no endorsement hence, claim not recived in system.

provide indoor case papers with detail line of treatment from treating consultant with exact time of admission & discharge (IR LETTER SENT 2/7/15,2/6/15,6/6/15,15/6/15,25/6/15/25/7/15.1) Kindly provide reason for delay submission.2) Provide origina lpre-printed bill & receipt of rs- 100/- with consultating note of rs- 100/- on dated 28/03/2015.3) provide prescription for medicine taken on dated 12/04/2015 of rs- 828/- (IR LETTER SENT ON 30/6/15.)

provide original well numbered pre-printed paid receipt of rs- 38378/- ( submitted duplicate copies) IR letter sent 02-6/15, 13/6/15,23/6/15,25/7/15,13/7/15.

provide indoor case papers with detail line of treatment from treating consultant with exact time of admission & discharge

1)provide indoor case papers with detail line of treatment from treating consultant.2)Provide exact diagnosis from treating consultant.3)Provide original pre-printed well numbered hospital bill with paid receipt of rs- 6500/-

1) Kindly provide reason for delay submission (IR letter sent 3/7/15, 5/6/15, 16/6/15, 25/7/15, 25/6/15.)