Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Sr. #
1
Employee Number
Name of Employees
Claim Number
Issue in Details
Attachments
7976396
Hiten Gohil
11078042
NA
11153511
amount of INR 400/- towards ambulance charges and 11,170/- towards surcharges are not
reimbursed.
NA
NA
7976396
Hiten Gohil
7926097
Snehal Patel
Cliam is put on hold stating the endorsement for Mr. Snehal Patel's spouse is not received.
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
NA
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.
7556311
Shripad Rajpathak
11192622
7830839
Tejas Patel
10964565
7569596
Nikunj V Patel
11315212
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
NA
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
7381260
Rekha Sharma
7381538
Jitendra Salve
Jitendra Salve
7381228
Rajesh Yadav
Arnav Yadav
4
5
7380728
7381929
N S Chouhan
Ajay Sirivastava
N S Chouhan
Vedika Sirivastava
7921788
Gaurav Narain
Yashi Saxena
8055456
Praveen Kumar
Shikha Dhiman
7381538
Jitendra Salve
Jitendra Salve
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
Daughter
Reimbursement
Reimbursement
48619
14905
Daughter
Reimbursement
4865
Spouse
Reimbursement
8746
Self
Reimbursement
7043
Mother in law
Reimbursement
59266
Son
Reimbursement
10045
Illness
Hospital_Name
INDUBHAI PAREKH
MEMORIAL HOSPITAL
NIMAR HOSPITAL &
Other Noninfective Gastroenteritis & colitis
RESEARCH CENTRE
INDUBHAI PAREKH
Intracranial injury
MEMORIAL HOSPITAL
Cholecystitis
Urban Bank Hospital
CHOITHRAM
Other disorders of eyes & adnexa
NETRALAYA
DR AMIT AGRAWAL NEW
Diaorrhoea & gastroenteritis of presumed infectious origin
BORN & CHILD CARE
CENTRE
Other diseases of upper respiratory tract
TAPTI HOSPITAL
Anal Fissure
J K Nursing Home
City_Name
Nagda
Comments/ Remark
pending since March 2015
Burhanpur
Nagda
Dahod
Indore
Bareilly
Muzaffarnagar
Burhanpur
Indore
Ujjain
Status as on
28 July 2015
Sr no.
Claim no.
11078042
11153511
Received
on
17-Aprr-15
7-May-15
11407468
3
Emp code
7976396
7976396
7926097
13-Jul-15
11192622
10964565
5
6
11315212
24-Jun-15
17-Mar-15
17-Jun-15
7556311
7830839
7569596
Emp Name
Hiten
Ratilal
Gohil
Hiten
Ratilal
Gohil
Snehal
Kumar
Patel
Relation
Self
Self
MAID
5017213630
5017213630
5019255794
Self
Shripad
Rajpathak Mother
Tejas
Kumar
Spouse
Patel
Nikunjkum
ar V Patel Mother
5018817279
5017213318
5018817366
Beneficiary
Name
Hiten
Ratilal
Gohil
Hiten
Ratilal
Gohil
Snehal
Kumar
Patel
Vijaya J
Rajpathak
Suchita T
Patel
Nirmalaben
Patel
Claim Type
Claim
Amount
Approved
Amount
Settlement
Date
claim status
Reimbursement
28166
19871
24-Apr-15
Settled
Reimbursement
29919
13665
5-Jun-15
Settled
Reimbursement
3950
Cashless
Reimbursement
Reimbursement
IR
268328
209963
22698
19887
9692
6290
10-Jul-15
Settled
25-Mar-15
Settled
22-Jul-15 Settled
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 m
Sr no.
Claim no.
Received
on
11393987
1
Emp code
7381260
8-Jul-15
11260459
2-Jun-15
11348672
3
4
5
6
7381228
Subhash
Chandra
Sharma
Spouse
Jitendra Salve
7380728
N S Chouhan
11298360
12-Jun-15
7381929
Ajay
Sirivastava
7921788
Gaurav Narain
8055456
Praveen
Kumar
22-May-15
2-Apr-15
11260403
9 11348672
Self
5017211778
5017211732
Son
27-May-15
11217699
MAID
5017211741
Rajesh Yadav
11237050
10
Relation
26-Jun-15
11016055
7381538
Emp Name
Jitendra Salve
2-Jun-15
Rajesh Yadav
26-Jun-15
7393870
Self
Daughter
Daughter
5017211632
5017211860
5017213534
5017213849
Spouse
Self
Son
5017211778
5017211732
Claim
Amount
Approved
Amount
Settlement
Date
claim status
Reimbursement
1248
1148
22-Jul-15
Settled
Reimbursement
7166
IR
Arnav Yadav
N S Chouhan
Vedika
Sirivastava
Yashi Saxena
Reimbursement
2469
IR
Reimbursement
48619
IR
Reimbursement
14905
Reimbursement
4865
Closed
Reimbursement
8746
closed
Reimbursement
7043
IR
12898
23-Jul-15 Settled
Shikha Dhiman
Jitendra Salve
Arnav Yadav
Reimbursement
REmarks
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.)
No claim found
Claim documents recieved on but no endorsement hence, claim not recived in system.