Get Axa Direct Billing Form

Completing the Axa Direct Billing Form online is a straightforward process that ensures prompt and accurate processing of your claim. This guide will take you through each section of the form, offering clear instructions to make the experience seamless.

Follow the steps to effectively fill out the Axa Direct Billing Form

1. Press the ‘Get Form’ button to access the Axa Direct Billing Form and open it in your editing tool.
2. In Section A, provide the administrative details. Enter your policy or membership numbers, the patient’s date of birth, gender, name, NRIC No./FIN/Passport number, plan, email address, and phone number.
3. Move to Section B, the medical section. Fill in the date of treatment, admitting hospital, symptoms presented, provisional diagnosis, necessary investigations, the date the patient first experienced symptoms, the date the patient first consulted a doctor, and the final diagnosis.
4. In Section C, treatment advised, include the treatment plan alongside the estimated hospital costs, fees for surgeon and anaesthetist, room per night charges, total room costs, daily visit estimate, and surgery estimates.
5. Proceed to Section D, detailing any further planned treatment.
6. In Section E, provide information on any other insurer's details. Indicate if the treatment was accident-related and if it is covered by another insurance policy, including the name of the insurance company involved.
7. Complete the patient’s declaration by confirming your identity and the accuracy of provided information. Sign and date it. If applicable, the medical practitioner must fill out their declaration, providing their name, signature, date, and contact number.
8. Once all sections are completed, review the information for accuracy. Save your changes, download, print, or share the form as needed.

Begin filling out your Axa Direct Billing Form online for efficient claims processing.