TPA readiness

Ramesh Kulkarni, 52

High Risk

Laparoscopic Cholecystectomy

3 Critical2 Warning8 Passed

Medical Necessity

Length of stay 4d exceeds expected 3d
Extended stay needs a treating-doctor justification note or the extra days may be deducted. · At risk: ₹4,500
ICD-10 codes consistent across documents
K80.2 on notes and bill.

Documentation

Missing: Histopathology Report
Histopathology Report is mandatory for Star Health claim packets. · At risk: ₹1,12,400
Missing: Pre-Auth Extension Approval
Bill ₹1,12,400 exceeds approved pre-auth ₹85,000. Request enhancement before submission. · At risk: ₹27,400
Discharge Summary attached
discharge_summary.pdf
Final Hospital Bill attached
final_bill.pdf
Doctor / Admission Notes attached
admission_notes.pdf
Lab / Investigation Reports attached
lft_usg.pdf
Pre-Auth Approval Letter attached
preauth_approval.pdf

Rate & Capping

Room rent ₹4,500/day exceeds policy cap ₹4,000/day
Proportionate deduction likely on associated charges. Excess: ₹2,000. · At risk: ₹2,000

Signatures & Stamps

Missing: Hospital seal / stamp on final bill
Unsigned/unstamped documents are returned by TPAs as incomplete. · At risk: ₹5,620
Treating doctor signature on discharge summary
Verified
Patient / attendant signature on claim form
Verified