To ascertain the authenticity and genuineness of referred suspicious claims basis the evidences collected thereby mitigating fraudulent activities and intent.

Areas explored while investigating a claim: Objective of health claim investigation:

  1. Insured statement
  2. Examination of family physician
  3. Examination of treating doctor / hospital
  4. Examination of relatives
  5. Insured’s residence
  6. Investigation at hospital Bill
  7. Vicinity check
  8. Neighbor check
  9. Chemist / hospital / doctor
  10. Hospital check
  11. Employer check
  12. Treating consultant
  13. Pathology
  14. Pharmacy.

Cashless Claims Investigations

Conducting spot checks as to Genuinity of the claims of the patients admitted in the hospital(s) under Cashless Scheme (On spot Verifications)

RSBY Claim Process

Checking the Genuinity of the claims lodged under Rastriya Swathya Bima Yojna amongst empanelled hospitals, we also assist the insurer in empanelling the hospitals.