Page 339 - Ebook health insurance IC27

Sashi Publications

been used during the antenatal care stage itself. In such an event only Rs. 400 will be
settled.

5. Data entry of the audited claim
On completion of the auditing stage, the results are entered into the system for data
creation in respect to that claim. Upon entry of the claim into the database, an identification
unit is provided. Usually the practice is to give a number. This identification ensures
easy retrieval and tracking of the audited claim.

6. Approval of the claim
All claims that complete the above mentioned stage are ready for approval. The auditor,
a supervisor, or a manager usually approves the claim.

7. Settlement of the claim
In this stage, the approved claim would be settled. The settlement along with a report for
the claim that is submitted and processed would be sent to the insured person or his
agent. This report details the date of the service, provider, amount billed and paid and an
explanation for the handling of the claim.

8. Filing of the settled claim
This is the end stage of the processing of a claim. All claims that complete all of the
above mentioned stages would be filed. The process is usually done as filing of physical
claims document or the "paperless" filing process such as scanning the document,
microfilms etc.

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