Get Outpatient Claim Form ??? - Axa-contento-118412.eu

Filling out the OUTPATIENT CLAIM FORM can be a straightforward process with the right guidance. This guide will assist you in understanding each section and ensure that all necessary information is included to facilitate your claim submission.

Follow the steps to complete your outpatient claim form efficiently.

1. Click ‘Get Form’ button to access the outpatient claim form and open it in your chosen editor.
2. In the 'Insured Details' section, fill in the mandatory fields. Include your name, the name of the patient, the policy number, occupation, mobile number, and email address.
3. Proceed to 'Claim Information' where you will detail the nature of your claims and provide a breakdown of charges. Input the date of treatment and select the type of treatment received, such as general practitioner or specialist.
4. List additional treatment types, if applicable, such as physiotherapy or prescriptions. Ensure to attach required documents like referral letters or prescriptions as indicated.
5. In the 'Request for Document Return' section, indicate if you are making any other insurance claims related to this outpatient visit, and check the box if you want a certified true copy of the original receipts returned.
6. Complete the 'Declaration and Authorisation' section by confirming that all statements provided are true to the best of your knowledge. Sign the form, ensuring that the signature belongs to the patient or the insured, especially if the patient is under 18.
7. Review the checklist of documents required for submission, making sure you have submitted all necessary paperwork to support your claim.
8. Finally, submit the completed form along with all documentation to the Claims Department at the provided mailing address within 60 days of the treatment date.

Start your claim process today by filling out the OUTPATIENT CLAIM FORM online.