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HMO / Medical Insurance Reimbursement Checklist


In Patient Clients
Requirements
  1. Duly-accomplished Notification of Claim form (NOC).
  2. Original official receipt(s) of all payments made.
  3. Admitting medical history (includes details history of present illness; family, personal and past medical history.
  4. Discharge summary reports (includes patient’s course in wards, diagnosis test requested and medications given).
  5. Statement of Account (summarized and itemized).
    Supporting charge slips of in cases where hospital has no itemized statement of account.
    Copy of results of laboratory, x-ray, and other diagnostic exams and therapeutic services.

 

If Surgical Procedure Was Done
Copy of Operative Report (includes detailed description of surgical procedure done) or Histopathology Report (includes information on the nature, extent and stage of illness which may not be seen in other documents submitted).

 

For Injury As A Result of An Accident
  1. Basic Requirements for In-Patient Claims.
  2. Copy of Police Report.

 

In The Event of Death of the Insured
  1. Copy of Registered Death Certificate .
    and if applicable:
  2. Basic Requirements for In-Patient claims.
  3. Copy of Police Report.
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