Transition History

TPA Name: TPA Claim NO Hospital: Date Of Intimation Claim Status Agency Name Pending Under Which Bucket Investigation Site Ageing Assign By Status Assign Date
{{TPA_NAME}} {{TPA_CLAIM_NUMBER}} {{HOSPITAL}} {{DATE_OF_INTIMATION}} {{CLAIM_STATUS}} {{Agency_Name}} {{Pending_under_which_Bucket}} {{Investigation_Site}} {{Ageing}} {{Assign_By}} {{Status}} {{Assign_Date}}
Document

Attachments


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Attachments


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<% for(let a of report){ %> <% if(a.hospital ){ %>
Investigation Finding (Hospital Verification)
Hospital Registration Number OT
ICU/ICCU/ PICU/CCU Visit To Hospital
Hospital Visit Date How Far From Member Address (Approx Km)
Any Relative Near Hospital Where Insured Stayed Comments
IP Register Entry (Entry Found) If No – Reason
If Yes
<%= a.hospital.ManagementCase%>
If Not Matching – Observations
ICPs Collected If No – Reason
If Yes, Any PED/Non-Disclosure Findings
Any Other Discrepancy Noted If Yes
TPR/BP/VITAL Charts If Yes – Observations
If No – Reason
In Case Of Medical Management
Active Line Of Treatment
In Case Of Surgical Management
Operative Notes If Provided - Findings
If Not Provided - Reason
Anaesthesia Notes If Provided - Findings
If Not Provided - Reason
Any PED History
Any Implants Used If Yes – Invoice / Sticker Number
Invoice Verified Reason / Findings
MLC Details
MLC Copy Received If Yes - Date Of MLC
If No
Is MLC Verification Done If Yes-Observations
If No – Reason
FIR Details
FIR Copy Received If Yes - Date Of FIR
Is FIR Verification Done If Yes-Observations
If No – Reason
Any alcohol /Drug Intoxication Found As Per Documents If Yes – Details
If No – Reason
MRD Records checked If Yes-Observations
If No – Reason
Bill Book collected If Yes-Observations
If No – Reason
Tariff Details Card Collected If Yes-Observations
If No – Reason
Hospital Authority Statement If Yes-Observations
If No – Reason If Yes – Any findings
Treating Doctor Visit
Name of doctor Qualification
Registration Number Tariff Details Card Collected
If No – Reason If Yes – Any PED findings
Any discrepancy noted If Yes-Observations
Lab Verification Details
Lab Name Lab Location
Inhouse If No, then Distance from hospital / Resident
Lab Register Entry Verified If Yes
If Not matching – Observations
Bill Records
Findings
Purchase invoices Collected If No – Reason
If YES, Verified Findings
Past Records Checked Findings
Chemist Statement Collected If No – Reason
If Yes – Findings If Yes – Any PED findings
Overall Chemist Verification Summary
X-Ray/Sonography/MRI/CT Scan/Blood Bank Visit/Physiotherapy Centres Verification
Visit Done If No – Reason
If Yes – Visit Date Reports Verified
Findings Past Records Details
Any Other Observations/Findings If Yes – Any PED Findings
Over All Hospital Virification Findings
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Home Visit
Visit done If No - Reason
If Yes - Visit Date Appointment Taken
If No - Reason If Yes - Name of insured with whom appointment was taken
Mobile no Member Address
Name of Patient Date of Birth of Patient
Gender Statement Collected
If No - Reason If Yes - Finding
Any discrepancies
If Yes - Finding Any PED / Non-Disclosure findings
Insured Habits
Past documents collected If No - Reason
If Yes – please specify
KYC Documents collected If No - Reason
If Yes
If No - Reason
Vicinity verification
Visit done If No - Reason
If Yes – please specify If Yes - Visit Date
Visit to Family Physician
Name of Family Physician Location
Contact number Distance from Insured Home
Visit to Family Physician if No - Reason
If Yes - Registration Number Qualification
Statement Collected Any PED / Non-Disclosure findings
In Cases of First Consultant / Referral doctor
Name of Family Physician Location
Contact number Distance from Insured Home
Visit to Family Physician if No - Reason
If Yes - Registration Number Qualification
Statement Collected Any PED / Non-Disclosure findings
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Office / School / Collage Visit
Visit done If No - Reason
If Yes - Visit Date If Yes - Visit To
Attandence Record Collected If Yes Check Whether Patient Was Present In Office / School / Collage During Hospitalization Period
If Patient Is Employee - Then Check Employment Status If Patient Is Student In Collage / Schiool Then Check Enrolment Status Name Of Person With Whom Information Was Collected
Mobile Of Person With Whom Information Was Collected Address of Office / School / Collage
Statement Collected If No Than Reason / Yes Then Finding
Any Other Observation If YES – Findings
Any PED / Non-Disclosure findings
Any other Investigation findings
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