Medicare denial codes, reason, action and Medical billing appeal, what is claim number.#What #is #claim

Medicare denial codes, reason, action and Medical billing appeal

Medicare denial codes, reason, remark and adjustment codes.Medicare, UHC, BCBS, Medicaid denial codes and insurance appeal. Sample appeal letter for denial claim. CO, PR and OA denial reason codes codes.


What is claim number

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What is claim number

What is claim number

Wednesday, October 11, 2017

Wheelchair CPT code list

Procedure Code Description Rate



Friday, September 8, 2017

Getting Authorization for inpatient hospital visit


Reconsiderations The attending physician/dentist or the hospital may request reconsideration of the adverse determination of the ACRC regarding the need for admission, readmission, transfer, or continued stay. This reconsideration right applies regardless of the current hospitalization status of the beneficiary. Reconsiderations must be requested within three business days of the adverse determination. (Refer to the Directory Appendix for ACRC contact information.) If requested by the ACRC, the provider must provide written documentation. The provider is notified of the reconsideration decision within one business day of receipt of the request or the date of receipt of written documentation. If the initial adverse determination is overturned, the adverse determination is considered null and void. If the initial adverse determination is upheld or is modified in such a manner that some portion of the hospital care is not authorized, the hospital is liable for the cost of care provided from the date of the initial determination, unless this determination is overturned in the Medicaid appeals

If the ACRC does not authorize the admission or the continued stay for an admission and the beneficiary remains in the hospital for one or more days after Medicaid payment is not authorized, the hospital is at risk of Medicaid nonpayment for those days. The provider may request post-discharge review by the ACRC, regardless of whether reconsideration was requested on the case, in writing within 30 calendar days of the discharge from the hospital. A copy of the medical record must accompany the post-discharge review request.

case is in the reconsideration, post-discharge review, or formal appeals process. Submission of such a claim does not imply acceptance of the ACRC determination.


** Medicaid beneficiaries enrolled in a Medicaid Health Plan (MHP). (Authorization must be obtained through the MHP.)

AMSOIL Synthetic Anti-Wear Hydraulic Oil – ISO 46, iso claim search.#Iso #claim #search

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    All trademarked names and images are the property of their respective owners and may be registered marks in some countries. No affiliation or endorsement claim, express or implied, is made by their use. All products advertised here are AMSOIL-engineered for use in the applications shown.

    Australian Doctor Medical Negligence Solicitor Injury Compensation Claims, injury claims.#Injury #claims

    Australian Doctor – Medical Negligence Solicitor Compensation Claims

    Our solicitors specialise in medical negligence compensation claims against negligent doctors. If you have been injured as a result of negligent medical treatment, you should seek legal advice as soon as possible. Time limits apply to compensation claims, and it is important that you seek legal advice as soon as you become aware that you may have been injured or suffered some other harm or loss as a result of a doctor’s actions or omissions. Compensation may also be available to family members who have lost a loved one as a result of medical negligence.

    For obligation-free legal advice and No Win No Fee representation, call our helpline, complete the contact form or send an email.

    SOLICITORS HELPLINE 1800 339 353

    Doctor Duty of Care

    Doctors have a duty to exercise reasonable care, skill and judgement in examining, diagnosing, treating and providing information to their patients. A breach in duty of care may result in damages being awarded to the patient. Despite the fact that the execution of a consent form specifies acknowledgement of the stated risks and complications in conjunction with a given treatment or operation, it doesn’t relieve a doctor from their responsibility of meeting the standard of care in association with such treatment or operations.

    Our medical negligence lawyers have handled hundreds of compensation cases against doctors and hospitals. They can provide accurate advice on whether you should take legal action against a doctor such as a :

    • General Practitioner – GP
    • Anaesthetist
    • Cardiovascular and thoracic surgeon
    • Dermatologist
    • Emergency Medicine Physician
    • Gastroenterologist
    • Family Physician – GP
    • General Surgeon
    • Gynaecologist
    • Internal Medicine Physician
    • Neurologist
    • Neurosurgeon
    • Obstetrician
    • Oncologist
    • Ophthalmologist
    • Ophthalmic Surgeon
    • Oral Surgeon
    • Orthopaedic Surgeon
    • Pathologist
    • Paediatrician
    • Plastic Surgeon
    • Psychiatrist
    • Radiologist
    • Urologist

    SOLICITORS HELPLINE 1800 339 353


    For a patient to succeed with a medical negligence claim it is not enough to show that there was a breach in duty of care, or that the results of the treatment were poor. They must be able to prove, on the balance of probabilities, that the doctor’s poor performance caused the unsatisfactory result. This is known as “causation”, and proving this link between the actions of the doctor and the harm a patient experiences can be one of the most difficult areas of a medical negligence claim. If a patient can prove “breach in duty of care” and “causation of damage”, the final hurdle is to assess the value of the claim or damages award.

    SOLICITORS HELPLINE 1800 339 353

    Damages Award

    Compensation is usually awarded as a lump sum, once-and-for-all payment intended to cover past, present and future expenses. The lump sum award is calculated based on loss and harm suffered and needs arising, as a result of the negligence.

    A patient may be awarded compensation for :

    • Loss of income
    • Loss of earning capacity
    • Medical expenses
    • Allied health care expenses
    • Equipment aides
    • Pharmaceuticals
    • Attendant care
    • Domestic assistance
    • Pain and suffering

    Because of the complexities involved in bringing a medical negligence case, you should seek the assistance of an experienced medical negligence lawyer who will provide a thorough assessment of liability, causation, and quantum (the value of the claim).

    SOLICITORS HELPLINE 1800 339 353

    Medical Negligence Case Examples

    Our accredited Personal Injury Specialists (medical negligence law), have extensive knowledge and experience in handling claims involving :

    • Errors in diagnosis
    • Improper procedure performance
    • Failure to supervise or monitor
    • Medication errors
    • Failure or delay by GP in referral or consultation
    • Equipment malfunction
    • Lack of informed consent
    • Failure to perform
    • Delay in performance of a procedure
    • Failure to recognise a complication of treatment
    • Failure to instruct or communicate with the patient
    • Premature discharge of a patient
    • Unnecessary treatment
    • Sexual misconduct

    SOLICITORS HELPLINE 1800 339 353

    Misdiagnosed Conditions

    One of the biggest areas of medical negligence is the misdiagnosis of medical conditions. Some of the most commonly misdiagnosed medical conditions are :

    • Heart Attack / Myocardial Infarction
    • Coronary Artherosclerosis
    • Aortic Aneurysm
    • Breast Cancer
    • Lung Cancer
    • Colon Cancer
    • Cancer of the Rectum
    • Prostate Cancer
    • Appendicitis
    • Pneumonia
    • Meningitis
    • Pulmonary Embolism
    • Diabetes
    • Bone Fracture
    • Back Disorders
    • Endocarditis

    SOLICITORS HELPLINE 1800 339 353

    Death Claims

    Relatives of a person who has died as a result of medical negligence may be able to make a claim for “Compensation to Relatives” for their loss of a reasonable expectation of future pecuniary benefits. Compensation may also be available for mental or nervous shock; a psychiatric illness such as major depression, anxiety disorder or adjustment disorder sustained by the deceased’s family.

    Where a patient has died as a result of medical negligence, we may recommend that a report be made to the Coroner’s Court. Sometimes a report should also be made to the appropriate regulatory body such as the :

    • Health Care Complaints Commission of New South Wales
    • Health Services Commissioner of Victoria
    • Health Quality and Complaints Commission, Queensland
    • Health and Community Services Complaints Commissioner, South Australia
    • The ACT Health Services Commissioner
    • The Health and Community Services Complaints Commission, Northern Territory
    • Health Complaints Commissioner, Tasmania
    • Office of Health Review, Western Australia
    • Medical Board of Australia

    SOLICITORS HELPLINE 1800 339 353

    Statute of Limitations

    With any personal injury claim, the plaintiff has a limited time after the occurrence of the alleged negligence in which to commence legal proceedings. Many States follow the “discovery rule” for medical negligence claims. Under the discovery rule, the statute of limitation begins to run from the time the plaintiff knew or should have known of the alleged negligence, with the time limit being 3 years in many jurisdictions. Special rules may also apply to children claiming medical negligence.

    It is important that you seek legal advice as soon as possible to avoid losing your right to sue, as failing to bring legal action within the legal time limit, may mean your claim becomes “statute-barred”.

    Call our legal team today to find out what time limit applies to your case.

    SOLICITORS HELPLINE 1800 339 353

    Doctor Negligence Solicitor

    Our legal team will assess whether your case appears to have merit, and if so, they will recommend that an investigation be conducted. An investigation of a medical negligence case usually involves the taking of a statement from the patient, review of medical and hospital records, and commissioning an independent report from a medical expert. You may have to contribute to the cost of disbursements (obtaining copies of your medical records and a medico-legal report), however you will not be asked to pay your solicitor’s professional fees. Your solicitor will not be paid their professional fees unless they are successful in obtaining compensation for you.

    If you would like further information on how a No Win No Fee agreement operates, please contact our legal team today.

    This website is not intended for viewing by residents of Queensland, Australia. There are laws which prohibit advertising of personal injury legal services

    in Queensland. If you were injured in Queensland or if you are a resident of Queensland, we are unable to refer you to a solicitor. This referral service

    is not available for any Queensland accident claims or claims connected with Queensland. This website operates by way of referral to specialist solicitors

    who may pay a commission to the operator upon receiving client contact information.

    Why is the South China Sea contentious? BBC News, what is claim number.#What #is #claim

    Why is the South China Sea contentious?

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    Rival countries have wrangled over territory in the South China Sea for centuries, but tension has steadily increased in recent years.

    China, Vietnam, the Philippines, Taiwan, Malaysia and Brunei all have competing claims.

    China has backed its expansive claims with island-building and naval patrols. The US says it does not take sides in territorial disputes, but has sent military ships and planes near disputed islands, calling them “freedom of navigation” operations to ensure access to key shipping and air routes.

    Both sides have accused each other of “militarising” the South China Sea.

    There are fears that the area is becoming a flashpoint, with potentially serious global consequences.

    What is the argument about?

    It is a dispute over territory and sovereignty over ocean areas, and the Paracels and the Spratlys – two island chains claimed in whole or in part by a number of countries.

    Alongside the fully fledged islands, there are dozens of rocky outcrops, atolls, sandbanks and reefs, such as the Scarborough Shoal.

    Why are they worth arguing over?

    Although largely uninhabited, the Paracels and the Spratlys may have reserves of natural resources around them. There has been little detailed exploration of the area, so estimates are largely extrapolated from the mineral wealth of neighbouring areas.

    The sea is also a major shipping route and home to fishing grounds that supply the livelihoods of people across the region.

    Who claims what?

    China claims by far the largest portion of territory – an area defined by the “nine-dash line” which stretches hundreds of miles south and east from its most southerly province of Hainan.

    Beijing says its right to the area goes back centuries to when the Paracel and Spratly island chains were regarded as integral parts of the Chinese nation, and in 1947 it issued a map detailing its claims. It showed the two island groups falling entirely within its territory. Those claims are mirrored by Taiwan.

    However, critics say China has not clarified its claims sufficiently – and that the nine-dash line that appears on Chinese maps encompassing almost the entirety of the South China Sea includes no coordinates.

    It is also not clear whether China claims only land territory within the nine-dash line, or all the territorial waters within the line as well.

    Vietnam hotly disputes China’s historical account, saying China had never claimed sovereignty over the islands before the 1940s. Vietnam says it has actively ruled over both the Paracels and the Spratlys since the 17th Century – and has the documents to prove it.

    The other major claimant in the area is the Philippines, which invokes its geographical proximity to the Spratly Islands as the main basis of its claim for part of the grouping.

    Both the Philippines and China lay claim to the Scarborough Shoal (known as Huangyan Island in China) – a little more than 100 miles (160km) from the Philippines and 500 miles from China.

    Malaysia and Brunei also lay claim to territory in the South China Sea that they say falls within their economic exclusion zones, as defined by UNCLOS – the United Nations Convention on the Law of the Sea.

    Brunei does not claim any of the disputed islands, but Malaysia claims a small number of islands in the Spratlys.

    Recent flashpoints

    The most serious trouble in recent decades has flared between Vietnam and China, and there have also been stand-offs between the Philippines and China. Some of the incidents include:

    • In 1974 the Chinese seized the Paracels from Vietnam, killing more than 70 Vietnamese troops.
    • In 1988 the two sides clashed in the Spratlys, with Vietnam again coming off worse, losing about 60 sailors.
    • In early 2012, China and the Philippines engaged in a lengthy maritime stand-off, accusing each other of intrusions in the Scarborough Shoal.
    • Unverified claims that the Chinese navy sabotaged two Vietnamese exploration operations in late 2012 led to large anti-China protests on Vietnam’s streets.
    • In January 2013, Manila said it was taking China to a UN tribunal under the auspices of the UN Convention on the Laws of the Sea, to challenge its claims.
    • In May 2014, the introduction by China of a drilling rig into waters near the Paracel Islands led to multiple collisions between Vietnamese and Chinese ships.

    Have they tried to reach a resolution?

    China prefers bilateral negotiations with the other parties. But many of its neighbours argue that China’s relative size and clout give it an unfair advantage.

    Some countries have argued that China should negotiate with Asean (the Association of South East Asian Nations), a 10-member regional grouping that consists of Thailand, Indonesia, Malaysia, the Philippines, Singapore, Brunei, Laos, Vietnam, Myanmar and Cambodia.

    However, China is opposed to this, while Asean is also divided over how to resolve the dispute.

    The Philippines has sought international arbitration instead. In 2013, it announced it would take China to an arbitration tribunal under the auspices of the UN Convention on the Laws of the Sea, to challenge its claims.

    In July 2016, the tribunal backed the Philippines’ case, saying China had violated the Philippines’ sovereign rights.

    China had boycotted the proceedings, and called the ruling “ill-founded”. It says it will not be bound by it.

    Synonyms and Antonyms of Words at, dictionary of thesaurus.#Dictionary #of #thesaurus

    Thesaurus Synonyms

    • 12 NOV
    • 11 NOV
    • 10 NOV
    • 09 NOV
    • 08 NOV

    1 : characterized by a pleasing rhythm; harmoniously ordered or proportioned.

    2 : of or relating to eurhythmics.

    E : We must have had some such normal notions to fall back upon as our eyes swept that limitless, tempest-sca. More examples

    Grammar Tips

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    If you re traveling around the U.S., make sure you know these commonly misused.


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    What does it mean to glo up? Who the heck is Salt Bae? We help you decode these.

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    We declare these Southern phrases to be hot.

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    Say What You Will About Millennials.

    Hangry, glamping, lumbersexual: We are lucky to have these words.

    The UK Road Accident Claims Expert, EasiGo, accident at work claim.#Accident #at #work #claim

    Easi Go

    Accident Management Company

    Accident Claims Expert

    Call Us FREE : (0800) 044 3747 0330 022 6781

    EasiGo Accident Management Offers

    • UK wide assistance-whatever your insurance cover
    • Quality courtesy car delivered to your home
    • Courtesy car supplied even if your car is a write off
    • Help with Parked car claims
    • Full Vehicle Recovery and Repair
    • Main Dealer Repairs
    • Specialist Injury Claim Solictors
    • NO insurance excess and NCB protected
    • Help with uninsured driver claims

    If you had a non fault accident, we can help you! Whether you drive a car, a taxi, a van or a motorbike, we will handle your claim; supplying you with a replacement vehicle, dealing with the other driver’s insurers, and getting you full compensation for your injuries and other losses. Even if you only have Third Party cover, we will still lend you a courtesy car, and deal with all aspects of your car accident claim.

    We file your car accident claim directly with the other insurers, so we save you paying any Policy Excess! We recover all uninsured losses, including lost earnings. Even if you were uninsured, we will recover repair costs, if there is an injury claim involved.We file your car accident claim directly with the other party’s insurers, so we protect your No Claims Bonus and save you paying any insurance policy excess! We will recover all uninsured losses, including loss of earnings, and even if you are uninsured we will recover your repair costs, or car value, if there is an injury claim involved.

    Accident at work claim

    Accident at work claim


    If your car is not roadworthy, we will deliver a quality replacement to your home. If your car is still roadworthy, we will arrange a replacement to use, when yours goes in for repairs. The courtesy car will be collected when yours is returned.

    Accident at work claim


    If your car is not safe to use, or not driveable, we will arrange to collect it from your home, or from a storage yard, if the police have moved it there. It will be taken to a secure compound, where it can be properly examined by a qualified accident engineer.

    Accident at work claim

    Paper Work

    We will track down the other driver’s insurers, using the registration number, and file your claim directly. If needed, we will contact witnesses. We make our own enquires, rather than requiring an admission of liability from the other insurers. We arrange vehicle inspections and valuations, as well as repairs.

    Accident at work claim

    Injuries Claims

    Our associated solicitors are specialists in road accident claims will file your claim against the other insurer. They will also organise any medical treatment (physiotherapy etc) that you may need to help your recovery.

    Accident at work claim

    Accident Law

    The solicitors don t just deal with your injury claim; they will also take legal action to recover any other losses, will also take the other insurers to court, if liability for the accident is in dispute. If they are handling your injury claim, the agreement is they handle all aspects of your claim.

    Why use us Instead of your own insurer?

    EasiGo offers:

    • A similar, or better,replacement vechicle to your own-even if you are only Third Party Insured!
    • Pay no policy excess- we claim directly off the other insurers, so you don’t pay your insurance excess.
    • Main dealer, or your own repairer- safeguard the value of your car.
    • We get forecourt values for your vehicle-even if you have Motor Trade cover
    • We file your claim directly with the other insurers, we handle all the paper work & claim admin.
    • Cash on lieu of repair option, if we handle your injury claim.
    • Our associate solicitors will not only pursue your injury claim, but deal with all other aspects of your car claim.

    Your insurer :

    EasiGo Accident Management offers a total service!

    We ONLY handle road accident claims from repairing your car and lending you a free one, to getting you compensation for your injuries. We will deliver a replacement vehicle to your home or place of work, and will also organize for your damaged car to be taken to an approved repairer. A damage report will be prepared, assessing whether it is repairable and also giving a replacement value if it is too badly damaged. Even if it is a write off, we will lend you a car until you have been paid out, plus a week to find a new car- most insurers will not supply you with a courtesy car, if yours is written off! Easigo will contact the other party’s insurers, collect police reports and witness statements. Because we deal directly with the other party’s insurers, there will be no effect on your no claims bonus, nor will you have to pay any insurance policy excess.

    Tips to Write Effective Claim Letter – Samples & Examples, claim letter sample.#Claim #letter #sample

    Claim Letter

    The letter of announcement will be referred to the upcoming customers, client contacts, existing customers to make them aware of some offers and schemes that can help them to make big savings.

    This would entitle the purpose of offering exciting offers in a money-spinning sense. These letters are written to the customers so that they can make good profits.

    Table of Contents

    Claim Letter Writing Tips:

    • Write briefly about the offers and the schemes; write what benefit the reader is going to get from the schemes.
    • Write the period in which the offer is valid. This will help the customer to avail the offer.
    • Use positive tone. Ask for a positive reply. Use attractive language so that it can grab the attention of the readers towards the offers and discounts.
    • Write that the reader is very valued customer and hence you are writing this letter.

    Claim Letter Template

    Subject – sample credit letter

    I am ___________ (name) writing this letter to you to declare the schemes and offers on behalf of our company that is ____________ (name of the company) .On this Diwali we have declared festive season offers. If you place an order between 01.11.2013 to 15.11.2013 then you can avail these offers. We will also regular products prices in this time period. So if you want to gain huge profits then you can place big orders in this period of time. You can also buy larger quantities. These offers for all our important customers and you are one of them. Hence you are requested to be benefited by these offers.

    Download Template (Doc and PDF)

    Claim Letter Sample, Email and Example/Format


    Subject – sample credit letter

    We feel very good to announce various schemes and offers for our honoured customers like you. We have arranged special festive season cent per cent discount concessions for all the orders for new and old range of products. Kindly not that this is not stock clearance offers but we will present you with fresh stock. The offers are Diwali special and hence they are for limited period of 01.11.2013 to 1511.2013. We suggest you to place your order between these periods so that you can avail such offer and make profit. Moreover, for a limited period, we are reducing the prices for all items in our catalog. Hence you are requested to take advantage of the same. You can order for larger quantities or heavy consignments so that you can make good profits. Waiting for a huge response from your side. Hope to see you soon in regard to this.

    Email Format

    A Claim Letter is a tool informing a company of the partial or full damage done and requesting a decent reimbursement against it. It however may either be written by the claimant informing about the loss or the company giving the reimbursement informing the claimant of the reimbursement that is on its way may also write it.

    ________________ (Name and address of insurance company)

    Subject: Sum Assured against death of my father

    Dear Sir or Madam

    I, ________ (name) had taken a life insurance policy from your company against policy number ____________ on _________ (date) for my father, ____________ (name of father). The nominee of the policy is my mother, ___________ (name of mother).

    With deep regret this is to inform you that my father passed away on _________ (date) due to a massive heart attack. I have attached a copy of the doctor’s report as well as the death certificate for your reference.

    Even though nothing can repair our loss but since my mother was dependent on him and she was the nominee of the policy, I would like to file this claim with you. May I request you to please release the money due to my mother against my father’s life insurance policy at the earliest. As per our records the sum due to her is Rs.___________?

    We look forward to a quick resolution to our claim.

    Award Nomination letter, Sample – Format, claim letter sample.#Claim #letter #sample

    Award Nomination letter, Sample & Format

    by Nishanth CR Published January 8, 2016 Updated October 12, 2017


    An Award nomination letter is written for an individual who has performed excellently in some task that warrants a public acknowledgment. An award nomination letter is similar to a recommendation letter where the favored candidate is suggested to the authorities for consideration in getting a reward or award. The Award Nomination letter is written by a competent authority to nominate a potential candidate who meets all the criteria for an award. The letter is a recommendation letter that highlights the competencies and weaknesses of the awardee.

    The Award Nomination letter should be written formally. The nominator must ensure that the candidate that he/she is backing meets the relevant criteria and can portray the skills and achievement required to be awarded the particular honor. Only relevant information should be mentioned in the letter with regards to the award nomination. The letter must be written clearly so that it highlights the strengths and weaknesses of the candidate. The letter must be written with an appropriate measure of respect to the awards committee.

    Award Nomination letter Sample

    The following is a Sample Award Nomination Letter.

    Green Meadows High School,

    The United States of America.

    Mr. Joseph McCallum,

    Green Meadows High School,

    The United States of America.

    Subject: Best Sportsman Award Nomination – Randy Lockett

    Dear Principal McCallum,

    Please allow me to put forward the name of Randy Lockett, a Grade 12 football captain at Green Meadows High School, for the school’s prestigious award of Best Sportsman of the year for this year, YYYY.

    Mr. Randy is an exceptional student and is in the top 5% of his academic cohort. He takes immense initiatives and ensures that he completes them with perfection. The activeness that he shows both in academics and extra-curricular is truly a great deal of commitment and an expression of his leadership skills. I can attest without a doubt that he will one day be a great leader of this country. I have that much confidence in the working of Mr. Randy.

    Mr. Randy Lockett has been involved in 3 football competitions this year and led the team to a championship in all three competitions: the inter-school league, the district league, and the national league football competitions. Mr. Lockett, a responsible and talented football captain, has greatly motivated his team to excel in the games they entered. Mr. Lockett is also a Duke of Edinburgh Award recipient and is an avid reader and volunteer. He was responsible for organizing the cleanliness drive of 2007 in his neighborhood.

    I would like to nominate Mr. Randy Lockett, for the coveted Green Meadows Best Sportsman award for this year, for his excellent performance in this year’s competitions. He has certainly raised the football standard with his exceptional showmanship.

    Sample Letter for Requesting Copies of Claim-Related Documents, United Policyholders, claim letter sample.#Claim #letter #sample

    claim letter sample

    NOTE: This letter is a sample that must be customized to fit the facts of your individual situation and claim. All bracketed and underlined portions must be completed or revised before sending.

    (Name of adjuster or highest-ranking ins. co. employee you can identify)

    (Name of Insurance Co.)

    Re: Claim Number _____________

    Date of Loss: _____________

    Name of Insured: _______________________

    Address of Insured Property: _________________________________________


    As part of your investigation of our claim, your adjuster and people associated with or hired by your company may have inspected our property, taken notes and written or obtained reports and estimates on the damage. We need to see those reports and estimates so we can be informed and continue cooperating with you on our claim. Thank you in advance for your return cooperation.

    Please provide complete copies of our claim file and/or all claim-related documents. For purposes of this request, “claim-related documents” means all documents that relate to the evaluation of damages, including, but not limited to, repair and replacement estimates and bids, appraisals, scopes of loss, drawings, plans, reports, third-party findings on the amount of loss, covered damages, and cost of repairs, and all other valuation, measurement, and loss adjustment calculations of the amount of loss, covered damage, and cost of repairs.

    [NOTE: If you live in California, your insurance company is legally required to comply with this request by Cal. Ins. Code section 2071 – Requirements in Case Loss Occurs]

    Please send these documents to the mailing address listed below within fifteen (15) calendar days of the date of this letter. Thank you in advance for your prompt handling of this request. I look forward to receiving the above-requested documents and working with [INSURANCE COMPANY] to reach a full, fair and timely settlement.

    Vipul MedCorp Insurance TPA Private Limited, vipul medcorp claim form.#Vipul #medcorp #claim #form

    vipul medcorp claim form

    We at Vipul MedCorp Insurance TPA are a group of professionals dedicated to our mission of providing excellent services to our clients (Corporate as well as Retail). For deliverance of services the SLA (Service Level Agreements) are in place, which would be signed with various Insurance companies and the corporate groups. These broadly define the Turn around Time (TAT) for the deliverance of the following services:

    1. ID Cards Printing and Dispatch
      • Vipul MedCorp Insurance TPA TAT for the Delivery of cards is within seven (7) days of the receipt of the complete data of insured members and the details of the policy from the insurance company
    2. Cashless Authorization / Rejection
      • Cashless authorization requests are to be scrutinized and the decision of acceptance or rejection is to be conveyed to the service provider within 24 hrs. of the receipt of the Pre Hospitalization Authorization Form.
      • In case where a query has been raised the query has to be satisfied by the concerned party and the authorization will be given within 24 hrs. of the receipt of the reply.
    3. Claims Settlement / Reimbursement
      • Turn-Around-Time (TAT) for the settlement of all claims is 15 days
    4. Customer Grievance Redressal
      • TAT for response is max. 2 working days, for any queries or grievance raised by the client.
    5. Call Center Responses
      • Vipul MedCorp Insurance TPA operates a 24 * 7 / 365 days Call center to provide instant accessibility to the clients for all information required for medical services facilitation and claims status.
    6. MIS Reports
      • Weekly/ Monthly MIS are prepared for the following:
        1. Claims Paid /Outstanding
        2. Premium Collection
        3. ID Cards Processed Dispatched
        4. Special reports annually for disease wise analysis, total age wise claim incidences etc.
    7. Adequate Coverage of Network Hospitals
      • Providing a comprehensive coverage of network hospitals at all locations of client operations.

    Vipul MedCorp Insurance TPA has service level agreement for all the above-defined parameters and the same can be incorporated in the client agreement.

    Cashless Facilitation Procedure

    • Receipt & Record of Data & Member Enrollment (Issuance of Photo ID Card)
    • Pre-Admission Authorisation after checking Doctor Prescription, Admission Form, Hospital Information
    • Claim form is submitted with Original bills along with Doctor Prescription, Diagnostic Reports & Discharge summary

    When Cash Less Facility is not accorded or Insured goes to a Non Network Hospital then following documents are required :

    • Claim Forms
    • Original bills with Diagnostic reports
    • Doctor’s First prescription
    • Discharge summary/certificate
    • Original Bills are verified & scrutinised against Standard Discounted Tariff
    • Cost Containment by Medical procedure audit & Bill scrutiny
    • 2nd Medical opinion taken for complicated cases
    • Repricing done on case to case basis.

    Cash Less medical services lead to: :

    • Bill Scrutiny before release of payment
    • Discounted Rates
    • Eliminates Reimbursement Frauds

    All the above leads to Cost Containment and lowering of Claims/Premium Ratio