New Claim

CLM-2443

Pooja Menon · Policy PT-3318-4477

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TAT breachedQueryLast updated 2026-04-22 09:30
Lifecycle
63%

Patient information

Pooja Menon
PT-2443
Age / Gender
42 · Male
Contact
+91 98xxx 4421
Admission date
2026-03-26
Discharge date
2026-04-01

Insurance information

Insurer
ICICI Lombard
TPA
Paramount
Claim type
Cashless
Workflow type
Pre-Authorization
Policy number
PT-3318-4477
Sum insured
₹5,00,000

Hospital details

Hospital
Lilavati Hospital, Mumbai
Empanelment
Network · Tier-1
Treating doctor
Dr. R. Kulkarni
Department
Cardiology
Procedure
Angioplasty (PTCA)
Room category
Single AC

Claim financial details

Claim amount
₹2,01,700
Pre-auth approved
₹1,81,530
Approved amount
₹25,717(incl. ₹25,717 enh.)
Total deductions
₹24,900
Co-pay
₹0
Net payable
₹817
Completion
44%
Verified
4
Pending
3
Missing
1
Rejected
1
1 required document pending
Claim cannot be compiled until all required documents are verified.
Required documents
  • Insurance Card*
    Insurance_Card.pdf · 212 KB
    Verified
  • Aadhaar Card*
    Aadhaar_Front_Back.pdf · 320 KB
    Verified
  • Pre Authorization Form*
    Pre_Auth_Form.pdf · 98 KB
    Verified
  • Final Approval Letter*
    Final_Approval.pdf · 76 KB
    Pending review
  • Discharge Summary*
    Discharge_Summary.pdf · 412 KB
    Verified
  • Final Detailed Bill*
    Final_Itemised_Bill.pdf · 188 KB
    Pending review
  • Patient Receipt*
    No file uploaded
    Missing
  • Radiology Reports
    MRI_Report.pdf · 2.1 MB
    Pending review
  • Implant Stickers
    Implant_Sticker_Scan.jpg · 640 KB
    Rejected
Preview · Insurance CardVerified
File
Insurance_Card.pdf
Uploaded
2026-04-12
OCR extraction
98%

High confidence — fields auto-mapped to claim.

Compile claim file
Merge all verified documents into a single PDF for TPA submission.