Policy Number,Name Of The Insured,Name Of The Self Member,Relationship,Card Number/UHID,Member Reference No.,Co-Payment Type,Co-Payment Value,Category Of Claim,AL-Inward Number,AL-Inward Date,AL-Number,AL-Expected Date Of Admission,AL-Diagnosis,AL-Status,AL-Sanctioned Amount,AL-Sanction Date,AL-Request Date,AL-Copay Deduction,Claim-Hospital Name,Type Of Claim,Claim-Inward Number,Claim-Inward Date,Claim Number,Claim-Final Diagnosis,Claim-Documents Received Date,Claim-Date Of Admission,Claim-Date Of Discharge,Claim-Status,Claim-Date Of Approval,Claim-Amount Claimed,Claim-Sanctioned Amount,Claim-Disallowed Amount,Claim-Disallowed Reasons,Claim-Co-Payment Deduction,Payment Mode,Claim-Cheque Date,Claim-Cheque Number,Service Tax Rate,TDS Rate,Claim-Service Tax Amt,Claim-TDS Amt,Claim-Transferred Amt,Batch-Service Tax Amt,Batch-TDS Amt,Batch-Transferred Amt,Claim-Rejection/Query Reasons,Claim-Rejection/Query Details,Claim-Date Of Last Query Sent,Claim-Date Of Query Revert,IS_AUTO_ADJ,NT CODE,GROUP_ADMIN
4016/X/244055389/00/000,RAHUL SHUKLA,RAHUL SHUKLA,SELF,IL20032977900,1080,NA,0,CASHLESS,AL-003769728,03-May-22,1.10E+11,01-May-22,Oth symptoms and signs involving the dgstv sys and abdomen,APPROVED,306245,,03-May-22,,Medanta Super Speciality Hospital,FRESH CLAIM,CL-005579013,12-May-22,2.20E+11,Chronic pulmonary embolism,16-May-22,01-May-22,11-May-22,APPROVED AND PAID,25-May-22,278957,271545,7412,~~~~~~~~~~~~,,FT,19-May-22,CMS2590112574,10.3,10,0,27155,244390,0,27155,244390,,,,,,N13426/CORE/I,N
4016/X/244055389/00/000,NEELIMA SIRVAIYA,RISHAB SIRVAIIYA,MOTHER,IL20032977603,1091,NA,,REIMBURSEMENT,,,,,,,,,,,CHL CBCC Cancer Centre,FRESH CLAIM,CL-005574979,10-May-22,2.20E+11,"Acute lymphoblastic leukemia, in relapse",09-May-22,15-Mar-22,16-Mar-22,APPROVED AND PAID,25-May-22,21145,18722,2423,"~~Rs. 750/- deducted towards excess charges as these are not justified and incidental with the treatment taken. Please get clarification from Hospital/treating doctor for further consideration of this amount~Rs. 1038/- service charges not payable.~Rs. 180/- thermometer digital, Rs. 455/- gloves.~",,FT,20-May-22,CMS2593285405,0,0,0,0,18722,0,0,18722,,,,,,N15452/CORE/I,N
4016/X/244055389/00/000,MORESHWAR GOKHALE,MANDAR GOKHALE,FATHER,IL20032977004,1103,NA,,REIMBURSEMENT,,,,,,,,,,,Shushrusha Citizens Co-op. Hosp.Ltd.,ADDENDUM,CL-005634926,16-Jun-22,220202572732-1,Calculus of ureter,16-Jun-22,22-May-22,26-May-22,APPROVED AND PAID,21-Jun-22,168479,168479,0,,,FT,20-Jun-22,CMS2654882999,0,0,0,0,168479,0,0,168479,,,,,,,N
4016/X/244055389/00/000,ANSHU TIWARI,RAVI NANDAN MISHRA,WIFE,IL20032979901,1056,NA,0,CASHLESS,AL-003806230,31-May-22,1.10E+11,01-Jun-22,Ectopic pregnancy,APPROVED,80800,,31-May-22,,Eureka Hospital & Research Center Pvt Ltd,FRESH CLAIM,CL-005612889,02-Jun-22,2.20E+11,Ectopic pregnancy,13-Jun-22,01-Jun-22,02-Jun-22,APPROVED AND PAID,16-Jun-22,45900,39015,6885,,,FT,15-Jun-22,CMS2645938658,10.3,10,0,3902,35113,0,3902,35113,,,,,,N10844/CORE/I,N
4016/X/244055389/00/000,RAHUL SHUKLA,RAHUL SHUKLA,SELF,IL20032977900,1080,NA,0,CASHLESS,AL-003819030,10-Jun-22,1.10E+11,09-Jun-22,Chronic pulmonary embolism,APPROVED,74689,,10-Jun-22,,Medanta Super Speciality Hospital,FRESH CLAIM,CL-005628087,12-Jun-22,2.20E+11,"Chronic pulmonary embolism~Systemic lupus erythematosus, unspecified",16-Jun-22,09-Jun-22,11-Jun-22,APPROVED AND PAID,20-Jun-22,32165,29089,3076,~~~~~~~~~,,FT,20-Jun-22,CMS2653724988,10.3,10,0,2909,26180,0,2909,26180,,,,,,N13426/CORE/I,N
4016/X/244055389/00/000,MORESHWAR GOKHALE,MANDAR GOKHALE,FATHER,IL20032977004,1103,NA,,REIMBURSEMENT,,,,,,,,,,,Shushrusha Citizens Co-op. Hosp.Ltd.,FRESH CLAIM,CL-005615802,04-Jun-22,2.20E+11,Calculus of ureter,04-Jun-22,22-May-22,26-May-22,APPROVED AND PAID,16-Jun-22,305896,35000,270896,"Deducted as per room eligibility~Deducted as per room eligibility,Deducted as Sublimit exhausted~~Deducted as Proportionate deductions applicable,Deducted as Sublimit exhausted~Deducted as Proportionate deductions applicable~~Deducted as Proportionate deductions applicable~Deducted as Proportionate deductions applicable,Deducted as Sublimit exhausted~~Deducted as Sublimit exhausted~~bed bath wipes, nebulizer mask, under pad, ecg electrodes, gloves, olio oil, Infection control charges ,Deducted as Sublimit exhausted",,FT,16-Jun-22,CMS2645341761,0,0,0,0,35000,0,0,35000,,,,,,,N
4016/X/244055389/00/000,HANSABEN PATEL,SACHIN KUMAR PATEL,MOTHER,IL20032977103,1098,NA,,REIMBURSEMENT,,,,,,,,,,,Krishna Shalby Hospital,FRESH CLAIM,CL-005630930,14-Jun-22,2.20E+11,"Osteoarthritis of knee, unspecified",13-Jun-22,01-May-22,07-May-22,APPROVED AND PAID,21-Jun-22,431458,80000,351458,~~Deducted as Sublimit exhausted~~~~,,FT,20-Jun-22,CMS2653724490,0,0,0,0,80000,0,0,80000,,,,,,N3521/CORE/I,N
4016/X/244055389/00/000,RAHUL SHUKLA,RAHUL SHUKLA,SELF,IL20032977900,1080,NA,0,CASHLESS,AL-003769728,03-May-22,1.10E+11,01-May-22,Oth symptoms and signs involving the dgstv sys and abdomen,APPROVED,,,03-May-22,,Medanta Super Speciality Hospital,PREPOST,CL-005620047,07-Jun-22,220202549486-1,Chronic pulmonary embolism,07-Jun-22,01-May-22,11-May-22,APPROVED AND PAID,15-Jun-22,32810,32810,0,,,FT,14-Jun-22,CMS2642926699,0,0,0,0,32810,0,0,32810,,,,,,N13426/CORE/I,N
4016/X/244055389/00/000,NEELIMA SIRVAIYA,RISHAB SIRVAIIYA,MOTHER,IL20032977603,1091,NA,,REIMBURSEMENT,,,,,,,,,,,CHL CBCC Cancer Centre,FRESH CLAIM,CL-005618219,06-Jun-22,2.20E+11,"Acute lymphoblastic leukemia, in remission",31-May-22,12-Mar-22,15-May-22,APPROVED AND PAID,09-Jun-22,25981,24562,1419,~Rs.1000/-deducted towards excess charges against medicine… as these are not justified and incidental with the treatment taken. Please get clarification from Hospital/treating doctor for further consideration of this amount,,FT,09-Jun-22,CMS2634142363,0,0,0,0,24562,0,0,24562,,,,,,N15452/CORE/I,N
4016/X/244055389/00/000,MORESHWAR GOKHALE,MANDAR GOKHALE,FATHER,IL20032977004,1103,NA,,REIMBURSEMENT,,,,,,,,,,,Shushrusha Citizens Co-op. Hosp.Ltd.,ADDENDUM,CL-005642476,21-Jun-22,220202572732-2,Calculus of ureter,21-Jun-22,22-May-22,26-May-22,APPROVED AND PAID,27-Jun-22,100399,68169,32230,,,FT,24-Jun-22,CMS2660018531,0,0,0,0,68169,0,0,68169,,,,,,,N
4016/X/244055389/00/000,HANSABEN PATEL,SACHIN KUMAR PATEL,MOTHER,IL20032977103,1098,NA,,REIMBURSEMENT,,,,,,,,,,,Krishna Shalby Hospital,ADDENDUM,CL-005654046,28-Jun-22,220202582549-1,"Osteoarthritis of knee, unspecified",28-Jun-22,01-May-22,07-May-22,APPROVED AND PAID,30-Jul-22,351458,151458,200000,RS.200000/-Deducted as Already settled by other TPA,,FT,22-Jul-22,CMS2720903421,0,0,0,0,151458,0,0,151458,,,18-Jul-22,,,N3521/CORE/I,N
4016/X/244055389/00/000,PD SIRVAIYA,RISHAB SIRVAIIYA,FATHER,IL20032977604,1091,NA,,CASHLESS,AL-003887138,28-Jul-22,1.10E+11,28-Jul-22,Fracture Of Lower End Of Both Ulna And Radius,APPROVED,182465,,28-Jul-22,,Shalby Limited,FRESH CLAIM,CL-005710032,01-Aug-22,2.20E+11,Fracture Of Lower End Of Both Ulna And Radius,22-Aug-22,28-Jul-22,31-Jul-22,REJECTED,,124205,,,,,-,,,0,,0,,,,,,Documents Not Received," Claim documents not received within the stipulated time, hence claim is rejected.",27-Dec-22,,,N15517/CORE/I,N
4016/X/244055389/00/000,RAHUL SHUKLA,RAHUL SHUKLA,SELF,IL20032977900,1080,NA,0,CASHLESS,AL-003819030,10-Jun-22,1.10E+11,09-Jun-22,Chronic pulmonary embolism,APPROVED,,,10-Jun-22,,Medanta Super Speciality Hospital,PREPOST,CL-005661133,02-Jul-22,220202580617-1,"Chronic pulmonary embolism~Systemic lupus erythematosus, unspecified",02-Jul-22,09-Jun-22,11-Jun-22,APPROVED AND PAID,06-Jul-22,14865,14865,0,,,FT,06-Jul-22,CMS2688236461,0,0,0,0,14865,0,0,14865,,,,,,N13426/CORE/I,N
4016/X/244055389/00/000,VEDANSHI SHARMA,VARENDER SHARMA,DAUGHTER,IL20032975905,1081,NA,,REIMBURSEMENT,,,,,,,,,,,Tejankar Healthcare and Medical Research Institute Pvt Ltd,FRESH CLAIM,CL-005670065,08-Jul-22,2.20E+11,"Fever, unspecified",08-Jul-22,27-Jun-22,29-Jun-22,APPROVED AND PAID,19-Jul-22,14804,14019,785,&#8377….750. /- deducted towards excess charges against ………as these are not justified and incidental with the treatment taken. Please get clarification from Hospital/treating doctor for further consideration of this amount~~~Gloves charges not payable,,FT,19-Jul-22,CMS2713327653,0,0,0,0,14019,0,0,14019,,,11-Jul-22,11-Jul-22,,N22754/CORE/I,N
4016/X/244055389/00/000,NEELIMA SIRVAIYA,RISHAB SIRVAIIYA,MOTHER,IL20032977603,1091,NA,,REIMBURSEMENT,,,,,,,,,,,CHL CBCC Cancer Centre,FRESH CLAIM,CL-005679886,14-Jul-22,2.20E+11,"Acute Lymphoblastic Leukemia, In Relapse~Acute viral hepatitis, unspecified",14-Jul-22,16-Jun-22,17-Jun-22,APPROVED AND PAID,19-Jul-22,43599,39127,4472,~~~Deducted as per room eligibility~~Deducted as Proportionate deductions applicable,,FT,19-Jul-22,CMS2713327804,0,0,0,0,39127,0,0,39127,,,,,,N15452/CORE/I,N
4016/X/244055389/00/000,AKSHIT RATHORE,AKSHAY RATHORE,SON,IL20032974906,1088,NA,,REIMBURSEMENT,,,,,,,,,,,MEHRA NURSING HOME,FRESH CLAIM,CL-005679857,14-Jul-22,2.20E+11,Unspecified Acute Lower Respiratory Infection,14-Jul-22,10-Jun-22,14-Jun-22,APPROVED AND PAID,21-Jul-22,29420,29420,0,~~~~,,FT,21-Jul-22,CMS2717528992,0,0,0,0,29420,0,0,29420,,,,,,,N
4016/X/244055389/00/000,MADHU TILOTIYA,MOHIT TILOTIYA,MOTHER,IL20032977203,1017,NA,,CASHLESS,AL-003811439,04-Jun-22,1.10E+11,04-Jun-22,"Osteoarthritis of knee, unspecified",APPROVED,1172172,,04-Jun-22,,Shalby Limited,FRESH CLAIM,CL-005624643,10-Jun-22,2.20E+11,Bilateral primary osteoarthritis of knee,22-Jun-22,04-Jun-22,09-Jun-22,APPROVED AND PAID,27-Jun-22,410717,409572,1145,~~~~,,FT,27-Jun-22,CMS2664000329,10.3,3.25,0,13312,396260,0,13312,396260,,,,,,N15517/CORE/I,N
4016/X/244055389/00/000,MADHU TILOTIYA,MOHIT TILOTIYA,MOTHER,IL20032977203,1017,NA,,CASHLESS,AL-003811439,04-Jun-22,1.10E+11,04-Jun-22,"Osteoarthritis of knee, unspecified",APPROVED,,,04-Jun-22,,Shalby Limited,PREPOST,CL-005716588,04-Aug-22,220202578518-1,Bilateral primary osteoarthritis of knee,04-Aug-22,04-Jun-22,09-Jun-22,APPROVED AND PAID,09-Aug-22,45811,45711,100,Miscellaneous charges,,FT,09-Aug-22,CMS2760547630,0,0,0,0,45711,0,0,45711,,,,,,N15517/CORE/I,N
4016/X/244055389/00/000,ANJALI JOSHI,JITENDRA BHATT,WIFE,IL20032978301,1055,NA,,REIMBURSEMENT,,,,,,,,,,,St Stephens Hospital,FRESH CLAIM,CL-005798122,15-Sep-22,2.20E+11,"Matern Care For Oth Or Susp Poor Fetl Grth, Unsp Tri, Unsp",15-Sep-22,29-Jul-22,02-Aug-22,REJECTED,,48420,,,,,-,,,0,,0,,,,,,OTHERS,"Kindly note as the Maternity sub limit available under the policy has been exhausted,hence the claim request is rejected.",31-Oct-22,,,N0453/CORE/I,N
4016/X/244055389/00/000,NEELIMA SIRVAIYA,RISHAB SIRVAIIYA,MOTHER,IL20032977603,1091,NA,,REIMBURSEMENT,,,,,,,,,,,CHL CBCC Cancer Centre,ADDENDUM,CL-005693654,22-Jul-22,220202614890-2,"Acute Lymphoblastic Leukemia, In Relapse~Acute viral hepatitis, unspecified",22-Jul-22,16-Jun-22,17-Jun-22,APPROVED AND PAID,27-Jul-22,4264,4264,0,,,FT,27-Jul-22,CMS2728177175,0,0,0,0,4264,0,0,4264,,,,,,N15452/CORE/I,N
4016/X/244055389/00/000,ANSHU TIWARI,RAVI NANDAN MISHRA,WIFE,IL20032979901,1056,NA,0,CASHLESS,AL-003806230,31-May-22,1.10E+11,01-Jun-22,Ectopic pregnancy,APPROVED,,,31-May-22,,Eureka Hospital & Research Center Pvt Ltd,ADDENDUM,CL-005704976,29-Jul-22,220202570904-1,Ectopic pregnancy,29-Jul-22,01-Jun-22,02-Jun-22,APPROVED AND PAID,02-Aug-22,6885,6885,0,,,FT,02-Aug-22,CMS2743702046,0,10,0,689,6196,0,689,6196,,,,,,N10844/CORE/I,N
4016/X/244055389/00/000,SONIT JAISWAL MALVIYA,VIPIN MALVIYA,WIFE,IL20032974501,1038,NA,,CASHLESS,AL-003892170,31-Jul-22,1.10E+11,30-Jul-22,"Anemia, unspecified",APPROVED,84770,,31-Jul-22,,Convenient Hospitals Ltd,FRESH CLAIM,CL-005711503,02-Aug-22,2.20E+11,"Anemia, unspecified",04-Aug-22,30-Jul-22,01-Aug-22,APPROVED AND PAID,06-Aug-22,52781,46370,6411,~~~~Deducted as Proportionate deductions applicable~Deducted as per room eligibility~,,FT,05-Aug-22,CMS2753913694,10.3,10,0,4637,41733,0,4637,41733,,,,,,N1357/CORE/I,N
4016/X/244055389/00/000,ANJALI JOSHI,JITENDRA BHATT,WIFE,IL20032978301,1055,NA,,CASHLESS,AL-003876762,21-Jul-22,1.10E+11,20-Jul-22,Respiratory distress of newborn,APPROVED,23084,,21-Jul-22,,St Stephens Hospital,FRESH CLAIM,CL-005696458,24-Jul-22,2.20E+11,Respiratory distress of newborn,29-Jul-22,20-Jul-22,23-Jul-22,APPROVED AND PAID,02-Aug-22,16834,15484,1350,~~~~~,,FT,02-Aug-22,CMS2745316264,10.3,10,0,1549,13935,0,1549,13935,,,,,,N0453/CORE/I,N
4016/X/244055389/00/000,RAHUL SHUKLA,RAHUL SHUKLA,SELF,IL20032977900,1080,NA,0,CASHLESS,AL-003819030,10-Jun-22,1.10E+11,09-Jun-22,Chronic pulmonary embolism,APPROVED,,,10-Jun-22,,Medanta Super Speciality Hospital,PREPOST,CL-005710666,01-Aug-22,220202580617-3,"Chronic pulmonary embolism~Systemic lupus erythematosus, unspecified",01-Aug-22,09-Jun-22,11-Jun-22,APPROVED AND PAID,05-Aug-22,12631,10181,2450,2450-lens and Frame.~,,FT,05-Aug-22,CMS2750052083,0,0,0,0,10181,0,0,10181,,,,,,N13426/CORE/I,N
4016/X/244055389/00/000,AAGASTYA PATIDAR,GOURAV PATIDAR,SON,IL20032975506,1067,NA,,CASHLESS,AL-003902779,06-Aug-22,1.10E+11,06-Aug-22,"Urinary Tract Infection, Site Not Specified",APPROVED,40432,,06-Aug-22,,Motherhood Hospital Indore,FRESH CLAIM,CL-005722893,08-Aug-22,2.20E+11,"Urinary Tract Infection, Site Not Specified",12-Aug-22,06-Aug-22,08-Aug-22,APPROVED AND PAID,20-Aug-22,18232,15309,2923,~Deducted as per the MOU Discount~~~~,,FT,20-Aug-22,CMS2779158544,10.3,0.1,0,16,15293,0,16,15293,,,,,,N17272/CORE/I,N
4016/X/244055389/00/000,RAHUL SHUKLA,RAHUL SHUKLA,SELF,IL20032977900,1080,NA,0,CASHLESS,AL-003819030,10-Jun-22,1.10E+11,09-Jun-22,Chronic pulmonary embolism,APPROVED,,,10-Jun-22,,Medanta Super Speciality Hospital,PREPOST,CL-005796202,14-Sep-22,220202580617-5,"Chronic pulmonary embolism~Systemic lupus erythematosus, unspecified",14-Sep-22,09-Jun-22,11-Jun-22,APPROVED AND PAID,22-Sep-22,9562,7562,2000,details not provided,,FT,22-Sep-22,CMS2846380697,0,0,0,0,7562,0,0,7562,,,,,,N13426/CORE/I,N
4016/X/244055389/00/000,ANJALI JOSHI,JITENDRA BHATT,WIFE,IL20032978301,1055,NA,,CASHLESS,AL-003875995,20-Jul-22,1.10E+11,19-Jul-22,Single Pregnancy,APPROVED,209200.22,,20-Jul-22,,St Stephens Hospital,FRESH CLAIM,CL-005696358,24-Jul-22,2.20E+11,Single Pregnancy,26-Jul-22,19-Jul-22,23-Jul-22,APPROVED AND PAID,02-Aug-22,144706,100000,44706,~~~~~~~~~~~~,,FT,02-Aug-22,CMS2745317139,10.3,10,0,10000,90000,0,10000,90000,,,,,,N0453/CORE/I,N
4016/X/244055389/00/000,ANURAG SINGH THAKUR,ANURAG SINGH THAKUR,SELF,IL20032976100,1105,NA,,REIMBURSEMENT,,,,,,,,,,,Sri Aurobindo Institute of Medical Sciences,FRESH CLAIM,CL-005779789,06-Sep-22,2.20E+11,"Unsp fracture of upper end of unspecified tibia, sequela",06-Sep-22,21-Apr-22,29-Apr-22,APPROVED AND PAID,18-Oct-22,127926,102101,25825,"Deducted towards diaper, gloves, mask , carry bag are non payables.~~~~~ Rs.11344….. /- deducted towards excess charges against as these are not justified and incidental with the treatment taken. Please get clarification from Hospital/treating doctor for further consideration of this amount.",,FT,18-Oct-22,CMS2896093191,0,0,0,0,102101,0,0,102101,,,08-Sep-22,26-Sep-22,,,N
4016/X/244055389/00/000,RAHUL SHUKLA,RAHUL SHUKLA,SELF,IL20032977900,1080,NA,0,CASHLESS,AL-003819030,10-Jun-22,1.10E+11,09-Jun-22,Chronic pulmonary embolism,APPROVED,,,10-Jun-22,,Medanta Super Speciality Hospital,PREPOST,CL-005772790,02-Sep-22,220202580617-4,"Chronic pulmonary embolism~Systemic lupus erythematosus, unspecified",01-Sep-22,09-Jun-22,11-Jun-22,APPROVED AND PAID,08-Sep-22,2924,2896,28,no bills,,FT,07-Sep-22,CMS2816253654,0,0,0,0,2896,0,0,2896,,,,,,N13426/CORE/I,N
4016/X/244055389/00/000,MALIKA SHUKLA,RAHUL SHUKLA,WIFE,IL20032977901,1080,NA,,CASHLESS,AL-003978165,22-Sep-22,1.10E+11,21-Sep-22,Generalized abdominal pain,APPROVED,48401,,22-Sep-22,,Medanta Super Speciality Hospital,FRESH CLAIM,CL-005813157,23-Sep-22,2.20E+11,"Unspecified ovarian cyst, left side",28-Sep-22,21-Sep-22,22-Sep-22,APPROVED AND PAID,04-Oct-22,12663,12201,462,~~~~~~~,,FT,03-Oct-22,CMS2868559651,10.3,10,0,1221,10980,0,1221,10980,,,,,,N13426/CORE/I,N
4016/X/244055389/00/000,SUDIKSHA KUMARI,SANJEET KUMAR,DAUGHTER,IL20032976405,1108,NA,,REIMBURSEMENT,,,,,,,,,,,V-Care Hospital,FRESH CLAIM,CL-005850538,13-Oct-22,2.20E+11,"Fever, unspecified",12-Oct-22,30-Sep-22,01-Oct-22,APPROVED AND PAID,20-Oct-22,18614,17684,930,Deducted towards 3 way are non payable.~,,FT,20-Oct-22,CMS2900272980,0,0,0,0,17684,0,0,17684,,,,,,,N
4016/X/244055389/00/000,NEELIMA SIRVAIYA,RISHAB SIRVAIIYA,MOTHER,IL20032977603,1091,NA,,REIMBURSEMENT,,,,,,,,,,,CHL  CBCC Cancer Hospitals,FRESH CLAIM,CL-005848366,12-Oct-22,2.20E+11,"Acute Lymphoblastic Leukemia, In Relapse",11-Oct-22,12-Sep-22,13-Sep-22,APPROVED AND PAID,29-Oct-22,18992,18803,189,~~~ Rs.189….. /- deducted towards excess charges against as these are not justified and incidental with the treatment taken. Please get clarification from Hospital/treating doctor for further consideration of this amount.,,FT,25-Oct-22,CMS2910769701,0,0,0,0,18803,0,0,18803,,,,,,,N
4016/X/244055389/00/000,PD SIRVAIYA,RISHAB SIRVAIIYA,FATHER,IL20032977604,1091,NA,,REIMBURSEMENT,,,,,,,,,,,Shalby Limited,FRESH CLAIM,CL-005848377,12-Oct-22,2.20E+11,Pre-Post Claim,11-Oct-22,28-Jul-22,30-Jul-22,APPROVED AND PAID,22-Oct-22,874,874,0,,,FT,21-Oct-22,CMS2906261175,0,0,0,0,874,0,0,874,,,,,,N15517/CORE/I,N
4016/X/244055389/00/000,SONIT JAISWAL MALVIYA,VIPIN MALVIYA,WIFE,IL20032974501,1038,NA,,REIMBURSEMENT,,,,,,,,,,,PUSHP SHREE HOSPITAL,FRESH CLAIM,CL-005854575,15-Oct-22,2.20E+11,"Acute upper respiratory infection, unspecified~Fever, unspecified",14-Oct-22,26-Jul-22,28-Jul-22,APPROVED AND PAID,20-Oct-22,27818,27402,416,"~~~glass , gloves , mask ",,FT,20-Oct-22,CMS2900275398,0,0,0,0,27402,0,0,27402,,,,,,,N
4016/X/244055389/00/000,MALIKA SHUKLA,RAHUL SHUKLA,WIFE,IL20032977901,1080,NA,,CASHLESS,AL-003978165,22-Sep-22,1.10E+11,21-Sep-22,Generalized abdominal pain,APPROVED,,,22-Sep-22,,Medanta Super Speciality Hospital,PREPOST,CL-005869262,22-Oct-22,220202703174-2,"Unspecified ovarian cyst, left side",22-Oct-22,21-Sep-22,22-Sep-22,APPROVED AND PAID,30-Oct-22,4297,4297,0,,,FT,29-Oct-22,CMS2916262945,0,0,0,0,4297,0,0,4297,,,,,,N13426/CORE/I,N
4016/X/244055389/00/000,PUSHPA DUBEY,INDRESH KUMAR DUBEY,MOTHER,IL20032975303,1034,NA,,CASHLESS,AL-004016622,16-Oct-22,1.10E+11,17-Oct-22,Malignant Neoplasm Of Unsp Site Of Unspecified Female Breast,APPROVED,246380.75,,16-Oct-22,,Shalby Limited,FRESH CLAIM,CL-005863922,20-Oct-22,2.20E+11,Malignant Neoplasm Of Unsp Site Of Unspecified Female Breast,03-Dec-22,16-Oct-22,19-Oct-22,APPROVED AND PAID,16-Dec-22,175205,160981,14224,~ deducted as reasonable & customary charges (To be borne by insured)~~~~~~,,FT,16-Dec-22,CMS3009837131,10.3,3.25,0,5232,155749,0,5232,155749,,,,,,N15517/CORE/I,N
4016/X/244055389/00/000,NEELIMA SIRVAIYA,RISHAB SIRVAIIYA,MOTHER,IL20032977603,1091,NA,,REIMBURSEMENT,,,,,,,,,,,CHL CBCC Cancer Centre,PREPOST,CL-005727603,10-Aug-22,220202614890-3,"Acute Lymphoblastic Leukemia, In Relapse~Acute viral hepatitis, unspecified",10-Aug-22,16-Jun-22,17-Jun-22,APPROVED AND PAID,17-Aug-22,10516,7062,3454,,,FT,16-Aug-22,CMS2771331338,0,0,0,0,7062,0,0,7062,,,,,,N15452/CORE/I,N
4016/X/244055389/00/000,MALIKA SHUKLA,RAHUL SHUKLA,WIFE,IL20032977901,1080,NA,,CASHLESS,AL-003978165,22-Sep-22,1.10E+11,21-Sep-22,Generalized abdominal pain,APPROVED,,,22-Sep-22,,Medanta Super Speciality Hospital,PREPOST,CL-005833136,03-Oct-22,220202703174-1,"Unspecified ovarian cyst, left side",03-Oct-22,21-Sep-22,22-Sep-22,APPROVED AND PAID,11-Oct-22,3650,3650,0,,,FT,10-Oct-22,CMS2883241586,0,0,0,0,3650,0,0,3650,,,,,,N13426/CORE/I,N
4016/X/244055389/00/000,PD SIRVAIYA,RISHAB SIRVAIIYA,FATHER,IL20032977604,1091,NA,,REIMBURSEMENT,,,,,,,,,,,Shalby Limited,FRESH CLAIM,CL-005803152,17-Sep-22,2.20E+11,Pre-Post Claim,16-Sep-22,28-Jul-22,01-Aug-22,APPROVED AND PAID,24-Sep-22,8046,7822,224,~,,FT,23-Sep-22,CMS2850427544,0,0,0,0,7822,0,0,7822,,,,,,N15517/CORE/I,N
4016/X/244055389/00/000,SOMYA MALVIYA,VIPIN MALVIYA,SON,IL20032974506,1038,NA,,REIMBURSEMENT,,,,,,,,,,,Apple Hospital,FRESH CLAIM,CL-005929001,21-Nov-22,2.20E+11,Unspecified Acute Lower Respiratory Infection,21-Nov-22,15-Aug-22,21-Aug-22,APPROVED AND PAID,29-Nov-22,79999,78359,1640,"Deducted towards powder, diaper are non payables.~ Rs. 1193 /- deducted towards excess charges against as these are not justified and incidental with the treatment taken. Please get clarification from Hospital/treating doctor for further consideration of this amount.~~",,FT,28-Nov-22,CMS2969578794,0,0,0,0,78359,0,0,78359,,,,,,,N
4016/X/244055389/00/000,ALKA JOSHI,RASHI JOSHI,MOTHER,IL20032976903,1033,NA,,REIMBURSEMENT,,,,,,,,,,,Akash Hospital And Diagnostic Center,FRESH CLAIM,CL-005954533,04-Dec-22,2.20E+11,"Uterovaginal prolapse, unspecified",02-Dec-22,01-Nov-22,04-Nov-22,APPROVED AND PAID,16-Dec-22,151736,24625,127111,"Deducted as Sublimit exhausted~Deducted as Sublimit exhausted~Deducted as Sublimit exhausted~Deducted as Investigation reports not furnished,Deducted as Sublimit exhausted~gloves,under sheet,ecg electrodes are non payable,Deducted as Sublimit exhausted~Deducted as Bills not available,Rs. 375/-deducted towards excess charges as these are not justified and incidental with the treatment taken ",,FT,16-Dec-22,CMS3008821326,0,0,0,0,24625,0,0,24625,,,08-Dec-22,12-Dec-22,,,N
4016/X/244055389/00/000,SANVI GOUD,SANDEEP GOUD,DAUGHTER,IL20032978605,1085,NA,,REIMBURSEMENT,,,,,,,,,,,Bhandari Hospital & Research Centre,FRESH CLAIM,CL-005942480,28-Nov-22,2.20E+11,Hypersensitivity Pneumonitis Due To Unspecified Organic Dust,28-Nov-22,12-Nov-22,16-Nov-22,APPROVED AND PAID,07-Dec-22,39462,31586,7876,"Deducted as per room eligibility,Rs. 117/-deducted towards excess charges as these are not justified and incidental with the treatment taken.~carry bag,gloves,mask are non payable~Deducted as Proportionate deductions applicable,Deducted as Investigation reports not furnished~",,FT,07-Dec-22,CMS2989104989,0,0,0,0,31586,0,0,31586,,,,,,,N
4016/X/244055389/00/000,AAGASTYA PATIDAR,GOURAV PATIDAR,SON,IL20032975506,1067,NA,,CASHLESS,AL-004117641,18-Dec-22,1.10E+11,17-Dec-22,"Fever, unspecified",APPROVED,49523,,18-Dec-22,,Motherhood Hospital Indore,FRESH CLAIM,CL-005994004,24-Dec-22,2.20E+11,"Fever, unspecified",26-Dec-22,17-Dec-22,23-Dec-22,APPROVED AND PAID,06-Jan-23,41482,36683,4799,Others~~~~~,,FT,06-Jan-23,CMS3050388025,10.3,0.1,0,37,36646,0,37,36646,,,,,,N17272/CORE/I,N
4016/X/244055389/00/000,ALKA JOSHI,RASHI JOSHI,MOTHER,IL20032976903,1033,NA,,REIMBURSEMENT,,,,,,,,,,,Akash Hospital And Diagnostic Center,ADDENDUM,CL-006014025,03-Jan-23,220202800035-1,"Uterovaginal prolapse, unspecified",03-Jan-23,01-Nov-22,04-Nov-22,APPROVED AND PAID,07-Jan-23,122684,122684,0,,,FT,06-Jan-23,CMS3049592022,0,0,0,0,122684,0,0,122684,,,,,,,N
4016/X/244055389/00/000,PUSHPA DUBEY,INDRESH KUMAR DUBEY,MOTHER,IL20032975303,1034,NA,,CASHLESS,AL-004066288,15-Nov-22,1.10E+11,23-Nov-22,Unspecified Type Of Carcinoma In Situ Of Unspecified Breast,APPROVED,190803,,15-Nov-22,,Choithram Hospital & Research Centre,FRESH CLAIM,CL-005996574,25-Dec-22,2.20E+11,Unspecified Type Of Carcinoma In Situ Of Unspecified Breast,04-Jan-23,23-Nov-22,24-Dec-22,APPROVED AND PAID,16-Jan-23,126500,124603,1897,reasonable and customary charges,,FT,16-Jan-23,CMS3069506338,10.3,10,0,12461,112142,0,12461,112142,,,,,,N1358/CORE/I,N
4016/X/244055389/00/000,SOMYA MALVIYA,VIPIN MALVIYA,SON,IL20032974506,1038,NA,,REIMBURSEMENT,,,,,,,,,,,Aarogyam Hospital,FRESH CLAIM,CL-006055288,24-Jan-23,2.20E+11,Other gastritis without bleeding,24-Jan-23,28-Oct-22,31-Oct-22,APPROVED AND PAID,31-Jan-23,32841,31565,1276,Rs.976 deducted towards excess charges against as these are not justified and incidental with the treatment taken ~~~,,FT,31-Jan-23,CMS3093167362,0,0,0,0,31565,0,0,31565,,,,,,,N
4016/X/244055389/00/000,NEELIMA SIRVAIYA,RISHAB SIRVAIIYA,MOTHER,IL20032977603,1091,NA,,REIMBURSEMENT,,,,,,,,,,,CHL Hospitals 114,FRESH CLAIM,CL-005975826,15-Dec-22,2.20E+11,"Acute Lymphoblastic Leukemia, In Relapse~Pre-Post Claim",15-Dec-22,12-Sep-22,14-Sep-22,APPROVED AND PAID,24-Dec-22,13363,13163,200,~Rs.200 /-deducted towards excess charges as these are not justified and incidental with the treatment taken.~~,,FT,23-Dec-22,CMS3023705604,0,0,0,0,13163,0,0,13163,,,,,,N20521/CORE/I,N
4016/X/244055389/00/000,ANJALI JOSHI,JITENDRA BHATT,WIFE,IL20032978301,1055,NA,,,AL-003890533,30-Jul-22,1.10E+11,29-Jul-22,Failed Medical Induction Of Labor,REJECTED,,,30-Jul-22,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,N,N0453/CORE/I,N