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1 c Claim form duly signed 2 c Original pre authorization request 3 c Copy of pre - authorization approval letter 4 c Copy of photo ID card of patient verified by hospital 5 c Hospital discharge summary 6 c Operation theatre notes 7 c Hospital main bill 8 c Hospital break up bill SECTION D - CLAIM DOCUMENTS SUBMITTED - CHECK LIST
Raksha Health Insurance TPA Pvt. Ltd. ISO 9001:2008 & 27001:2013 Certified Company. 0129-3501420. Faridabad ,Haryana. crcm@rakshatpa.com. We do not sell any health policy/ preventive health packages /related products as per IRDAI regulations, please beware of the agents/websites/emails circulated with our brand name. Raksha.
Raksha Health Insurance TPA Pvt. Ltd. ISO 9001:2008 & 27001:2013 Certified Company . 0129-3501420. Faridabad ,Haryana. ... Claim Form(Hospital) Cashless Request Form;
Raksha Health Insurance TPA Pvt. Ltd. ISO 9001:2015 & 27001:2013 Certified Company
3. We agree that TPA / Insurance Company will not be Liable to make the payment in the event of any discrepancy between the facts in this form and discharge summary or other documents. 8. We confirm that no recoveries would be made from the deposit amount collected from the lnsured except for costs towards non-admissible
Claim Form under Niramaya All Claims for settlement under Niramaya has to be submitted to Oriental Insurance in the prescribed Claim Form alongwith relevant vouchers/ bills, etc. within 30 days of treatment or discharge from hospital. Mailing Address : RAKSHA TPA – Plot No:42, Victora Building, First Floor, Sector 20A, Near ICAI
6. Original Claim Form B duly Signed 7. PPN Declaration letter form duly signed 8. Pre-Auth Form Part –C & D in Original. The Hospital is requested to submit the claim within 7 days from the date of discharge or else it will be deemed as this Authorization Letter has not been used & company holds no responsibility for payments
