Common use of Scrutiny of Claim Documents Clause in Contracts

Scrutiny of Claim Documents. a. We shall scrutinize the claim and accompanying documents. Any deficiency of documents, shall be intimated to You and the Network Provider, as the case may be within 5 days of their receipt. b. If the deficiency in the necessary claim documents is not met or are partially met in 10 working days of the first intimation, We shall remind You of the same and every 10 (ten) days thereafter. c. We will send a maximum of 3 (three) reminders. d. We may at our sole discretion decide to deduct the amount of claim for which deficiency is intimated to the insured person and settle the claim if we observe that such a claim is otherwise valid under the policy. e. In case a reimbursement claim is received when a Pre-Authorization letter has been issued, before approving such claim a check will be made with the provider whether the Pre- authorization has been utilized as well as whether the Policyholder has settled all the dues with the provider. Once such check and declaration is received from the Provider, the case will be processed.

Scrutiny of Claim Documents. a. We shall scrutinize the claim and accompanying documents. Any deficiency of documents, shall be intimated to You and the Network Provider, as the case may be within 5 days of their receipt. b. If the deficiency in the necessary claim documents is not met or are partially met in 10 working days of the first intimation, We shall remind You of the same and every 10 (ten) days thereafter. c. We will send a maximum of 3 (three) remindersreminders following which We will send a closure letter. d. We may at our sole discretion decide to deduct the amount of claim for which deficiency is intimated to the insured person and settle the claim if we observe that such a claim is otherwise valid under the policy. e. In case a reimbursement claim is received when a Pre-Authorization letter has been issued, before approving such claim a check will be made with the provider whether the Pre- authorization has been utilized as well as whether the Policyholder has settled all the dues with the provider. Once such check and declaration is received from the Provider, the case will be processed.

Scrutiny of Claim Documents. a. a) We shall scrutinize the claim and accompanying documents. Any deficiency of documents, documents shall be intimated to You Insured Person and the Network Provider, as the case may be be, within 5 days of their receipt. b. b) If the deficiency in the necessary claim documents is not met or are partially met in 10 working days of the first intimation, We shall remind You the Insured Person of the same and every 10 (ten) days thereafter. c. c) We will send a maximum of 3 (three) reminders. d. d) We may at our Our sole discretion decide to deduct the amount of claim for which deficiency is intimated to the insured person and Insured Person or settle the claim if we We observe that such a claim is otherwise valid under the policyPolicy. e. e) In case a reimbursement claim is received when a Prepre-Authorization authorisation letter has been issued, before approving such claim a claim, a check will be made with the provider Network Provider whether the Pre- authorization pre-authorisation has been utilized utilised as well as whether the Policyholder Insured Person has settled all the dues with the providerNetwork Provider. Once such check and declaration is received from the Network Provider, the case will be processed.