Mediclaim Issues @ Jhagadia Site

Sr. #
1

Employee Number

Name of Employees

Claim Number

Issue in Details

Attachments

7976396

Hiten Gohil

11078042

Amount towards ambulance charges are not reimbursed.

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

Subhash Chandra Sharma

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

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

City_Name
Nagda

Comments/ Remark
pending since March 2015

Burhanpur
Nagda
Dahod
Indore

Documents sent to TPA

Bareilly

Muzaffarnagar
Burhanpur
Indore

Ujjain

Its 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 .
Documents are sent to TPA
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

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

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 m

tled on 8th july payment is made to the hospital.

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

Beneficiary Name Claim Type

Rekha Sharma
Jitendra Salve

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.