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  • Inv.7 Nov 14

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    SJAIN12
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    This document contains details of cashless insurance claims from multiple hospitals. It includes the claim number, policy number, name and details of the insured person, hospital name and address where treatment was received, diagnosis and ICD code, date cashless request was received, expected admission and discharge dates, cashless request status and approved claim amount. There are 5 cashless requests listed with details of injuries, diseases like hernia, angina and urethral stricture treated at hospitals in various cities across India.

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    inv.7 Nov 14

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    This document contains details of cashless insurance claims from multiple hospitals. It includes the claim number, policy number, name and details of the insured person, hospital name and address where treatment was received, diagnosis and ICD code, date cashless request was received, expected admission and discharge dates, cashless request status and approved claim amount. There are 5 cashless requests listed with details of injuries, diseases like hernia, angina and urethral stricture treated at hospitals in various cities across India.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xls, pdf, or txt
    21 views6 pages

    Inv.7 Nov 14

    Uploaded by

    SJAIN12
    This document contains details of cashless insurance claims from multiple hospitals. It includes the claim number, policy number, name and details of the insured person, hospital name and address where treatment was received, diagnosis and ICD code, date cashless request was received, expected admission and discharge dates, cashless request status and approved claim amount. There are 5 cashless requests listed with details of injuries, diseases like hernia, angina and urethral stricture treated at hospitals in various cities across India.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xls, pdf, or txt
    of 6

    7-Nov-14

    CASHLESS INTIMATION
    Sr. No.

    Claim No.

    Policy
    NO

    INSURED MEMBER
    NAME
    NAME

    SEX

    AGE

    RELATIO
    SUM
    N
    INSURED

    M/s
    BHASKA
    R
    20141106 190101/4 INDUSTR GOURI
    B006C2A 8/13/41/0 IES
    SHANKA
    1 7091
    0000491 LIMITED R GIRI
    Male

    29 Employee

    50000

    RAMESH
    20141106 190804/4
    WAR
    B006C2A 8/14/41/0 M/s S R F DAYAL
    2 7093
    0000066 LIMITED RAI
    Male

    43 Employee

    100000

    20141106 190900/4 SANJAY SANJAY


    B006C2A 8/14/06/0 CHOUDH CHOUDH
    3 7103
    0000426 ARY
    ARY
    Male

    56 Self

    150000

    GENRAL INTIMATION
    Sr. No.

    Claim No.

    Policy
    NO

    INSURED MEMBER
    NAME
    NAME

    SEX

    AGE

    RELATIO
    SUM
    N
    INSURED

    20141106 19010028
    B006R2A 14P10424 RAJEEV
    1 7085
    3442
    SAXENA

    RAJEEV
    SAXENA

    48 Self

    200000

    SH,
    20141106 190401/4 DHARME SMT,
    B006R2A 8/13/06/0 NDRA
    KALPNA
    2 7101
    0000770 CHAWDA CHAWDA Female

    27 Wife

    100000

    20141106 19040228
    B006R2A 14P10335 GOVIND
    3 7096
    0803
    BHATI

    Female

    26 Wife

    100000

    20141106 19040228 SH.


    B006R2A 14P10360 RAJESH SMT.
    4 7090
    6068
    JHAMAR CHAYA

    Female

    44 Wife

    100000

    20141106 191581/4 MR
    B006R2A 8/13/06/0 SAPAN
    5 7092
    0000533 NAYAK

    Male

    42 Self

    600000

    AARTI

    SAPAN
    KUMAR
    NAYAK

    Male

    Period of Period of
    insuranc insurance
    e - from
    - to

    Insured
    address

    Insured
    contact no

    Hospital
    Name

    Hospital
    Address ICD code
    & Phone

    Cashless
    request
    Disease
    received Date

    15-16, D
    SECTOR,
    INDUSTR
    IAL
    AREA,MA
    13/12/201
    NDIDEEP
    3
    12/12/2014 ,RAISEN

    B-46,
    INDIRA
    NAGAR,
    MANDIDE
    EP,
    RAISEN, ,
    SAI
    RAISEN,
    HOSPITA Ph:
    0 L
    233030
    K40

    Inguinal
    hernia

    6/11/2014

    MALANP
    27/04/201
    UR
    4
    26/04/2015 ,BHIND

    19-A
    VASANT
    VIHAR,
    VASANT
    VIHAR,
    GWALIO
    R, Ph:
    2336352,
    2336290,
    SAHARA 2336953,
    HOSPITA 2511003,
    0 L
    2511004 N35

    Urethral
    stricture

    6/11/2014

    417,
    CHOUDH
    ARY
    NIWAS,
    HANUMA
    NTAL
    ROAD,JA
    BALPUR ,
    JABALPU
    1/7/2014 30/06/2015 R

    Period of Period of
    insuranc insurance
    e - from
    - to

    Insured
    address

    JABALPU
    R
    HOSPITA
    L&
    RESEAR
    CH
    0 CENTRE

    Insured
    contact no

    Hospital
    Name

    RUSSEL
    CROSSIN
    G,NAPIE
    R
    TOWN, ,
    JABALPU
    R, Ph:
    4026000 I20

    Hospital
    Remarks
    address

    UNSTABL
    E
    ANGINA
    6/11/2014

    Date Of
    Disease Admissio
    n

    9/9/2014

    IG-4
    SHASTRI
    NAGAR
    INFRUNT
    OF UNIQ
    COLLEG
    E
    8/9/2015 ,BHOPAL

    BANSAL
    HOSPITA
    L~
    0 BHOPAL

    36,
    KAMLA
    NEGAR
    SANWER
    ROAD
    22/12/201
    UJJAIN
    3
    21/12/2014 ,UJJAIN
    9827250019

    PATIDAR
    HOSPITA
    L&
    RESEAR
    CH
    CENTRE
    ~ UJJAIN

    CSECTOR,
    SHAHPU
    RA
    ,BHOPAL

    6/11/2014

    12,
    KSHAPA
    NAK
    MARG,
    FREEGA
    NJ
    Disease:i
    ,UJJAIN njury

    5/11/2014

    WARD
    NO. 19RATNES
    HWAR
    ROAD
    12/8/2015 ,RATLAM

    RATLAM
    DISTRICT
    HOSPITA
    L~
    RATLAM ,
    0 RATLAM RATLAM

    6/11/2014

    29-NEEM
    CHOUK
    DIST.
    18/08/201
    RATLAM ,
    4
    17/08/2015 RATLAM

    RATLAM
    DISTRICT
    HOSPITA
    L~
    RATLAM ,
    0 RATLAM RATLAM

    5/11/2014

    13/08/201
    4

    7/12/2013

    PLOT303, ST02,
    SMRITI
    NAGAR
    BHILAI
    6/12/2014 ,DURG

    SHRI
    RAM
    SPARSH MARKET
    MULTISP SIRSA
    ECIALITY ROAD
    HOSPITA RAM
    DiseaseL~
    NAGAR , accident
    BHILAI
    BHILAI
    injuery

    6/11/2014

    Cashless
    Date Of
    Expected
    request
    Approve
    Claim Approved
    Admissio
    discharg
    STATUS
    received Date
    Amount Amount
    n
    e date
    Time

    12:34:11 8/11/2014 6/11/2014

    30700

    12500 Approved

    13:17:17 7/11/2014 6/11/2014

    44000

    20000 Approved

    15:54:14 5/11/2014 6/11/2014

    30000

    10000 Approved

    Expected
    Claim
    discharg
    Amount
    e date

    1000

    1000

    1000

    1000

    1000

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