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Enter claim details and attach the packet. Files stay in your browser.

Claim details

Patient nameAgePayer / TPAPolicy / Card no.Procedure / diagnosisSurgical case?ICD-10 (admission notes)ICD-10 (final bill)Admit dateDischarge dateExpected LOS (days)Package rate ₹ (blank if none)Pre-auth approved ₹Final bill ₹Room rent ₹/dayPolicy room cap ₹/day

Claim documents

Discharge SummaryUpload
Final Hospital BillUpload
Doctor / Admission NotesUpload
Lab / Investigation ReportsUpload
Pre-Auth Approval LetterUpload
Histopathology ReportUpload
Pre-Auth Extension ApprovalUpload

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Signatures & stamps verified

Doctor signature on discharge summaryHospital stamp on billPatient signature on claim form