|
SERIAL NUMBER
|
Procedure
|
1st Qtr
|
Per Qtr (for next 3 Qtrs)
|
Requirements while submitting for follow-up Preauth
|
Requirements while submitting for follow-up Claims
|
|
69
|
FP0069 : Stay in General Ward @ Rs.500day
|
3,200
|
1,600
|
Previous Discharge Summary
|
(Clinical Evaluation of Polytrauma-Mandatory)
|
|
70
|
FP0070 : Stay in Neuro ICU @ Rs.4000day
|
3,200
|
1,600
|
Previous Discharge Summary
|
(Clinical Evaluation, Including detailed Neuorological Evaluation-Mandatory)
|
|
71
|
FP0071 : Surgical Treatment (Up to)
|
3,200
|
1,600
|
Previous Discharge Summary
|
(Clinical Evaluation-Mandatory), Relevant Investigations
|
|
