Αποτελέσματα Αναζήτησης
GUIDANCE FOR FILLING CLAIM FORM - PART B (To be filled in by the hospital) DATA ELEMENT. DESCRIPTION. FORMAT. SECTION A - DETAILS OF HOSPITAL. a) Name of the hospital: Enter the name of hospital.
HEALTH INSURANCE TPA OF INDIA LTD. CLAIM FORM - PART B TO BE FILLED IN BY THE HOSPITAL The issue of this Form is not to be taken as an admission of liability Please include the original preauthorization form in lieu of PART A DETAILS OF HOSPITAL DETAILS THE PATIENT ADMITTED.
CLAIM FORM B. (To be filled in BLOCK letters) CLAIM FOR PART - B TO BE FILLED IN BY THE HOSPITAL. The issue of this Form is not to be taken as an admission of liability Please include the original pre-authorization request form in lieu of PART - A. Name of Hospital:
GUIDANCE FOR FILLING CLAIM FORM - PART B (To be filled in by the hospital) DATA ELEMENT DESCRIPTION FORMAT SECTION A - DETAILS OF HOSPITAL a) Name of the hospital: Enter the name of hospital Name of the hospital in full b) Hospital ID Enter ID number of hospital As allocated by the TPA
Claim Form - Part B. To Be Filled In By Ł e Hospital. The issue of this Form is not to be taken as an admission of liability. Please include the original preauthorization request form in lieu of PART A (To be filled in block letters) DETAILS OF HOSPITAL. Name of the hospital: Hospital ID:
Address. Enter the full postal address. Include Street, City and Pin Code. b) Phone No. Enter the phone number of hospital. Include STD code with telephone number. c) Registration No. with State Code. Enter the registration number of the doctor along with the state code.
CLAIM FORM – PART A: DULY COMPLETED BY THE INSURED ON THE PRESCRIBED FORMAT - ORIGINAL. B. CLAIM FORM – PART B: DULY COMPLETED AND SIGNED BY THE HOSPITAL AUTHORITIES - ORIGINAL. C. ADMISSION NOTES – CERTIFIED COPY.
