Domiciliary treatment forms
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MANOHAR SHARMA
Dec 21, 2016, 5:49:24 AM12/21/16
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Till now I have not seen a circular of Central Bank of India on PROCEDURE TO BE FOLLOWED IN SUBMISSION OF CLAIM FOR DOMICILIARY TREATMENT .
BUT AFTER GETTING VARIOUS CLARIFICATIONS FROM MDINDIA TPA THE CLAIM ( PRESCRIPTION+BILLS+REPORTS-ALL IN ORIGINAL) CAN BE SUBMITTED IN FOLLOWING MANNER ,AT NEAREST BRANCH OF MDINDIA .
( TAKE ACKNOWLEDGEMENT ON PHOTO COPY OF CLAIM )
Bills for Domiciliary Treatment shall be submitted in a bunch for a particular month on or before the 10th of the succeeding month.
LIST :
(1) New DOMICILIARY CLAIM FORM filled and duly signed.
(2)Illness Certificate by Treating Doctor with duration.
Please note that "Illness Certificate will be required with DETAILED DURATION OF THE ILLNESS ."
----Prescriptions without any time limit shall remain valid till 90 days.
------Prescriptions with the time limit of more than 180 days shall require to be re validated after 180 days by the Treating doctor.
(3)Pharmacy prescriptions by Treating Doctor.
(4)Pharmacy bills Cash Memo.
(5)Investigation Prescriptions by Treating Doctor.
(6)Investigation Bills Cash Memo.
(7)Investigation Reports.
(8)Treating Doctor Consultancy Charges -Cash Receipts.
(9)Duly filled ECS FORM
(10)Original Cancelled cheque of a Policy holder bearing the IFSC Code and MICR Code.
(11)KYC Documents (Pan Card, Passport, Voter’s Identity Card, Driving License).(I think any one of these will suffice )
(12) In my opinion also please enclose copy of NEW E-CARD showing Option 2
BUT AFTER GETTING VARIOUS CLARIFICATIONS FROM MDINDIA TPA THE CLAIM ( PRESCRIPTION+BILLS+REPORTS-ALL IN ORIGINAL) CAN BE SUBMITTED IN FOLLOWING MANNER ,AT NEAREST BRANCH OF MDINDIA .
( TAKE ACKNOWLEDGEMENT ON PHOTO COPY OF CLAIM )
Bills for Domiciliary Treatment shall be submitted in a bunch for a particular month on or before the 10th of the succeeding month.
LIST :
(1) New DOMICILIARY CLAIM FORM filled and duly signed.
(2)Illness Certificate by Treating Doctor with duration.
Please note that "Illness Certificate will be required with DETAILED DURATION OF THE ILLNESS ."
----Prescriptions without any time limit shall remain valid till 90 days.
------Prescriptions with the time limit of more than 180 days shall require to be re validated after 180 days by the Treating doctor.
(3)Pharmacy prescriptions by Treating Doctor.
(4)Pharmacy bills Cash Memo.
(5)Investigation Prescriptions by Treating Doctor.
(6)Investigation Bills Cash Memo.
(7)Investigation Reports.
(8)Treating Doctor Consultancy Charges -Cash Receipts.
(9)Duly filled ECS FORM
(10)Original Cancelled cheque of a Policy holder bearing the IFSC Code and MICR Code.
(11)KYC Documents (Pan Card, Passport, Voter’s Identity Card, Driving License).(I think any one of these will suffice )
(12) In my opinion also please enclose copy of NEW E-CARD showing Option 2
With this message there are 3 attachments:
(1) NEW DOMICILIARY TREATMENT CLAIM FORM
(2)ECS FORM
(3) SPECIMEN WHICH YOUR DOCTOR MAY FOLLOW WHILE ISSUING CERTIFICATE
On Tue, Dec 20, 2016 at 8:34 PM, Sukumaran Ramaraj <sukuma...@gmail.com> wrote:
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