CSClaimScrub · TPA Pre-Audit
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Clearance slip
86
TPA readiness

Fatima Sheikh, 29

Needs Review

Dengue Fever – Medical Management

Claim ID
CLM-24102
Payer / TPA
Medi Assist
Policy
MA-88231907
Stay
2026-10-10 → 2026-10-14 (4d)
ICD (notes / bill)
A90 / R50.9
Pre-auth
₹45,000
Billed
₹38,900
Package
—
0 Critical2 Warning9 Passed
Medical Necessity
  • ICD-10 mismatch between admission notes and final bill
    Admission notes code A90, bill codes R50.9. TPAs raise a query when diagnosis drifts without a clinical note. · At risk: ₹5,835
  • Length of stay justified
    4 day(s) admitted.
Documentation
  • Missing: Lab / Investigation Reports
    Lab / Investigation Reports is mandatory for Medi Assist claim packets. · At risk: ₹3,890
  • Discharge Summary attached
    discharge_summary.pdf
  • Final Hospital Bill attached
    final_bill.pdf
  • Doctor / Admission Notes attached
    doctor_notes.pdf
  • Pre-Auth Approval Letter attached
    preauth.pdf
Rate & Capping
  • Room rent within policy cap
    ₹2,500/day ≤ ₹3,000/day
Signatures & Stamps
  • Treating doctor signature on discharge summary
    Verified
  • Hospital seal / stamp on final bill
    Verified
  • Patient / attendant signature on claim form
    Verified