{"CLAIM_TPA_CREDENTIAL":"<CREDENTIAL><USER_ID><\/USER_ID><PASSWORD>/Yg==<\/PASSWORD

><\/CREDENTIAL>","CLAIM_UPLOAD_STRING":"<CLAIM
CLAIMNUMBER=\"TP01397000019900147551\" CLAIMEVENT=\"INTIMATED\" CLAIMSTATUS=\"O\"
EVENTEFFECTIVEDATE=\"10/09/2019 12:39:00\" INTIMATIONDATE=\"10/09/2019 12:39:00\"
POLICYNUMBER=\"97000034180400000047\" LOSSDATE=\"10/09/2019 12:39:00\"
PRODUCTCODE=\"TF\" PRIMARYCAUSE=\"TOPUPILLNS \" SECONDARYCAUSE=\"ILLNESS\"
PINCODE=\"713103\" RESERVETYPE=\"MEDICAL\" RESERVEAMOUNT=\"500\"
PAYMENTAMOUNT=\"0\" PAYMENTPURPOSE=\"CPTAI\" CHEQUENO=\"\" CHEQUEDATE=\"\"
CHEQUEBANKNAME=\"\" CHEQUEBRANCHNAME=\"\" EMPLOYEENO=\"8867\" SERIALNO=\"4\"
MEMBERCODE=\"\" REJECTIONREASON=\"Closed - No Claim-not pursued by
insured\"><PAYMENTDETAIL PARTYCODE=\"\" TDSVENDORTYPE=\"\" PANNO=\"\"
SECTIONCODE=\"\" PAYMENTMETHOD=\"\" BANKACCOUNTTYPE=\"\" BANKACCOUNTNO=\"\"
MICRCODE=\"\" IFSCCODE=\"\" BRANCHNAME=\"\" BANKNMAE=\"\" PAYMENTTYPE=\"\"
PARTYNAME=\"\" MOBILENO=\"\" EMAILID=\"\" /><INSUREDITEMATTRIBUTE><A P=\"Whether
the claim falls under the exclusion 4.1\" V=\"N\" /><A P=\"Whether the claim falls
under the exclusion 4.2\" V=\"N\" /><A P=\"Whether the claim falls under the
exclusion 4.3\" V=\"N\" /><A P=\"Name of the disease\" V=\"NA\" /><A P=\"Other
Details(if any)-Nature of Loss\" V=\"NA\" /><A P=\"TPA Claim Number\"
V=\"TP01397000019900147551\" /><A P=\"Claim\" V=\"FRESH\" /><A P=\"Reason for
Reopen\" V=\"NA\" /><A P=\"TPA Remarks\" V=\"NA\" /><A P=\"Date of Symptoms first
appeared\" V=\"01/06/2016\" /><A P=\"Date of Admission\" V=\"01/06/2016\" /><A
P=\"Date of discharge\" V=\"01/06/2016\" /><A P=\"Procedure Codes Level 1\"
V=\"16\" /><A P=\"Procedure Codes Level 2\" V=\"99\" /><A P=\"Procedure Codes Level
3\" V=\"99.1\" /><A P=\"Procedure Description Level 1\" V=\"MISCELLANEOUS
DIAGNOSTIC AND THERAPEUTIC PROCEDURES\" /><A P=\"Procedure Description Level 2\"
V=\"OTHER NONOPERATIVE PROCEDURES\" /><A P=\"Procedure Description Level 3\"
V=\"INJECTION OR INFUSION OF THERAPEUTIC OR PROPHYLACTIC SUBSTANCE\" /><A
P=\"Details of Pre Existing Disease Declared Level 1\" V=\"NA\" /><A P=\"Details of
Pre Existing Disease Declared Level 2\" V=\"NA\" /><A P=\"Details of Pre Existing
Disease Declared Level 3\" V=\"NA\" /><A P=\"Medical History Level 1\" V=\"NA\"
/><A P=\"Medical History Level 2\" V=\"NA\" /><A P=\"Medical History Level 3\"
V=\"NA\" /><A P=\"Diagnosis\" V=\"ABCD\" /><A P=\"Diagnosis Code Level 2\"
V=\"I47\" /><A P=\"Diagnosis Code Level 3\" V=\"I47\" /><A P=\"Amount Claimed\"
V=\"5000\" /><A P=\"Name of Body Parts for Procedure Codes Level 1\" V=\"30\" /><A
P=\"Whether Hospital is networked\" V=\"Y\" /><A P=\"Nature of Treatment For
Mediclaim\" V=\"ALLO\" /><A P=\"Claim Type for Mediclaim\" V=\"CASHLESS\" /><A
P=\"Age as per Discharge card\" V=\"30\" /><A P=\"Name of Illness/Operation\"
V=\"OTHER\" /><A P=\"Surgery Type\" V=\"NONSUR\" /><A P=\"Total Room Tariff
(inclusive of nursing/treatment charges) for Minor Surgery\" V=\"0\" /><A P=\"Minor
surgery/Day care room rent per day for Minor Surgery\" V=\"0\" /><A P=\"Operation
Theatre Charges for Minor Surgery\" V=\"0\" /><A P=\"Anesthesia for Minor Surgery\"
V=\"0\" /><A P=\"Anesthetist Fees for Minor Surgery\" V=\"0\" /><A P=\"Surgeon fees
for Minor Surgery\" V=\"0\" /><A P=\"Total Room Tariff for intermediary surgery\"
V=\"0\" /><A P=\"Operation Theatre Charges for intermediary surgery\" V=\"0\" /><A
P=\"Anesthetist Fees for intermediary surgery\" V=\"0\" /><A P=\"Surgeon fees for
intermediary surgery\" V=\"0\" /><A P=\"Total Room Tariff for Major surgery\"
V=\"0\" /><A P=\"Operation Theatre Charges for Major Surgery\" V=\"0\" /><A
P=\"Anesthetist Fees for Major Surgery\" V=\"0\" /><A P=\"Surgeon fees for Major
surgery\" V=\"0\" /><A P=\"Total Room Tariff for Supra Major surgery\" V=\"0\" /><A
P=\"Operation Theatre Charges for Supra Major surgery\" V=\"0\" /><A
P=\"Anesthetist Fees for Supra Major surgery\" V=\"0\" /><A P=\"Surgeon fees for
Supra Major surgery\" V=\"0\" /><A P=\"ICU Total Room Tariff for Supra Major
surgery\" V=\"0\" /><A P=\"Description of Non-Surgical Type\" V=\"NA\" /><A
P=\"Investigation or Diagnostic\" V=\"100\" /><A P=\"Medicine Charge\" V=\"100\"
/><A P=\"Consultation Charges\" V=\"100\" /><A P=\"Ambulance charges\" V=\"100\"
/><A P=\"Transportation Expenses\" V=\"0\" /><A P=\"Meals\" V=\"0\" /><A P=\"Other
Non Hospital Expenses\" V=\"100\" /><A P=\"Miscellaneous Expenses\" V=\"100\" /><A
P=\"Surgery Charge\" V=\"100\" /><A P=\"Pre Hospitalization Charges\" V=\"100\"
/><A P=\"Post Hospitalization Charges\" V=\"100\" /><A P=\"Number of days admitted
in hospital\" V=\"1\" /><A P=\"Room Tariff per Day\" V=\"100\" /><A P=\"Number of
days Stayed in Room\" V=\"1\" /><A P=\"Total Room Tariff\" V=\"100\" /><A P=\"ICU
Room Tariff per Day\" V=\"0\" /><A P=\"Number of days Stayed in ICU\" V=\"0\" /><A
P=\"ICU Total Room Tariff\" V=\"0\" /><A P=\"ICCU Room Tariff per Day\" V=\"0\"
/><A P=\"Number of days Stayed in ICCU\" V=\"0\" /><A P=\"ICCU Total Room Tariff\"
V=\"0\" /><A P=\"Total Charges\" V=\"900\" /><A P=\"Co-Payment(Excess)\" V=\"0\"
/><A P=\"Co-payment\" V=\"0\" /><A P=\"Compulsory Excess\" V=\"0\" /><A
P=\"Voluntary Excess\" V=\"0\" /><A P=\"Amount After Deduction of Excess\"
V=\"900\" /><A P=\"Amount Admissible\" V=\"900\" /><A P=\"Deduction if any (change
in zone)\" V=\"0\" /><A P=\"Amount After Deduction of Zone\" V=\"900\" /><A
P=\"Difference in Age Band\" V=\"0\" /><A P=\"Deduction if any (Age Mismatch)\"
V=\"0\" /><A P=\"Amount After Deduction of Age\" V=\"900\" /><A P=\"Premium For Age
Mismatch\" V=\"0\" /><A P=\"Total Penalty Premium For Age Mismatch\" V=\"0\" /><A
P=\"Previous Claim Amount For Non-Allopathy\" V=\"0\" /><A P=\"Total Payable
Amount\" V=\"900\" /><A P=\"Reduction Amount\" V=\"4100\" /><A P=\"Reason for
Reduction\" V=\"014\" /><A P=\"Service tax for Cashless Claim\" V=\"0\" /><A
P=\"TDS for Cashless Claim\" V=\"0\" /><A P=\"Net Claim Amount Payable\"
V=\"900\" /><A P=\"PAN No. of Policyholder\" V=\"FBQPS1677R\" /><A P=\"PAN No. of
Member\" V=\"FBQPS1677R\" /><A P=\"Name of the hospital for reimbursement payment\"
V=\"DSS\" /><A P=\"Rohini Registration no. of the hospital for reimbursement
payment \" V=\"1256\" /><A P=\"Validity date of ROHINI registration number\"
V=\"24/01/2019\" /><A P=\"NABH certificate number\" V=\"900\" /><A P=\"Validity
date of NABH certificate \" V=\"24/01/2019\" /><A P=\"Category of NABH
accreditation\" V=\"PREACCPL\" /><A P=\"Address of the hospital for reimbursement
payment\" V=\"ASDSAD\" /><A P=\"Pin code of the hospital for reimbursement
payment\" V=\"713103\" /><A P=\"GSTIN of the hospital\" V=\"\" /><A P=\"Hospital
Discount(Amount)\" V=\"90\" /><A P=\"Hospital Discount(Percentage)\" V=\"90\"
/></INSUREDITEMATTRIBUTE></CLAIM>"}