Get Claim Intimation Form

Filling out the Claim Intimation Form online is an essential step for users seeking to initiate a claim under the Mediclaim policy for retired employees. This guide provides clear, easy-to-follow instructions for completing the form accurately and efficiently.

Follow the steps to fill out the Claim Intimation Form online.

1. Press the ‘Get Form’ button to access the Claim Intimation Form and open it for completion.
2. Enter the patient’s name in the designated field. Ensure that the name matches the official documents.
3. Provide the patient's MIN number and MDID number in the respective fields. These identifiers are crucial for processing the claim.
4. Input the patient's age in the appropriate field and select their sex from the options provided.
5. Fill in the contact number of the patient to ensure that the insurance company can easily reach them.
6. Specify the diagnosis during the visit to the hospital, which will be crucial for treatment justification.
7. Provide the probable date of discharge, ensuring accuracy to avoid delays in the claims process.
8. Enter the date and time of admission to the hospital to establish a timeline for the claim.
9. Detail the line of treatment that the patient received, which may aid in validating the claim.
10. Write the name and address of the hospital where the treatment took place, along with its contact number.
11. Input the name of the treating doctor, their address, and contact number to facilitate communication if needed.
12. Include the mobile number of the patient or their representative for quicker contact.
13. Document the name and contact information of the family physician, if applicable, for additional context.
14. Estimate the expenses expected to be incurred. This can help in processing the claim efficiently.
15. Make sure to provide any other relevant information that could assist in the claim evaluation.
16. Indicate if any additional documents are attached to support the claim.
17. Select who is submitting the intimation by checking the appropriate box for the insured, patient, or relative.
18. Carefully read the authorization statement and ensure it is filled out correctly to allow necessary information retrieval.
19. Check that all mandatory fields marked with an asterisk (*) are completed before proceeding.
20. At the end of the process, users can save changes, download a copy, print, or share the completed form for submission.

Start filling out your Claim Intimation Form online today to ensure a smooth claims process.