CSClaimScrub · TPA Pre-Audit
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Clearance slip
100
TPA readiness

Lakshmi Devi, 61

Ready to Submit

Cataract (Phaco with IOL) – SE003A

Claim ID
CLM-24117
Payer / TPA
PMJAY / Ayushman Bharat
Policy
PMJAY-UP-7781203
Stay
2026-10-13 → 2026-10-14 (1d)
ICD (notes / bill)
H25.1 / H25.1
Pre-auth
₹15,000
Billed
₹15,000
Package
₹15,000
0 Critical0 Warning12 Passed
Medical Necessity
  • ICD-10 codes consistent across documents
    H25.1 on notes and bill.
  • Length of stay justified
    1 day(s) admitted.
Documentation
  • Discharge Summary attached
    discharge_summary.pdf
  • Final Hospital Bill attached
    final_bill.pdf
  • Doctor / Admission Notes attached
    op_notes.pdf
  • Lab / Investigation Reports attached
    biometry_report.pdf
  • Pre-Auth Approval Letter attached
    tms_preauth.pdf
Rate & Capping
  • Room rent within policy cap
    ₹0/day ≤ ₹0/day
  • Billed within package rate
    ₹15,000
Signatures & Stamps
  • Treating doctor signature on discharge summary
    Verified
  • Hospital seal / stamp on final bill
    Verified
  • Patient / attendant signature on claim form
    Verified