Format Specified. The ▇▇▇▇ is expected to be in two formats. i. The summary ▇▇▇▇ ( ANNEXURE II) Schedule-IV A and ii. The detailed breakup of the bills. ( ANNEXURE II_A Schedule-IV B ) 3. Explanation and Guidelines - Summary ▇▇▇▇ ▇. The summary form ii. The ▇▇▇▇ shall be generated on the letter head of the provider and in A4 size to aid scanning. iii. The summary ▇▇▇▇ shall not have any additional items (only 9) iv. The provider has to mention the service tax number in case they charge service tax to the insurance company. v. The payer mentioned in the ▇▇▇▇ has to be necessarily the insurance company and not the TPA. vi. In case of package charged for any procedure/treatment, the provider is expected to mention the amount in serial no 9 only. Items beyond the package are to be mentioned in serial numbers 1 to 8. vii. The patient/attendant signature is mandatory on the summary ▇▇▇▇ viii. The additional guidelines to fill the summary format is provided in ( ANNEXURE II_B )
Appears in 2 contracts
Sources: Memorandum of Understanding (Mou), Memorandum of Understanding (Mou)