Covering letter To Date - 14" Aug 2020. The Claim manager, Accenture service Pvt Itd, Plant 3, Godrej & Boyce Complex, LBS Rd, Pirojshanagar. Vikhroli West, Mumbai, Maharashtra 400079 | Sub ; Submission of Mediclaim billing for Reimbursement Respected sir/madam, 1am attaching following document for Mediclaim bill submission. List of documents. 1. Discharge summary 2. Hospital bill summary with break up. 3. Claim Form A. 4. Claim Form B. 5. Electronie clearing service form. 6. Declaration of Electronic submission of claim document. 7. Medical shop bills (amounting to Rs. 16,156/- along with medical shop attested) 8 Doctor's prescriptions 9. Blood, Scan and Uterine reports and 10. Vidal claim intimation ID # CLM-A1243-652639. Kindly de the needful in processing my claims. Let me know if you have any question. Thanking you and assuring you our best services Selvaraj 9962503124 EMP: 11508975 Accenture India Pvt Itd. Chennai flist of “Original Invoices” amounting to Rs. 16,156/- along with medical shop attested. Bill no Date ‘Amount co1024291 | 03.08.2020 | 3614 c01021235 | 22.05.2020 | 2277 c01018079 | 26.02.2020 | 1635 c01014829 | 25.12.2019 1232 €01021260 | 23.05.2020 803 €01020183 | 16.04.2020 78a €01022692 | 26.06.2020 77 01024325 | 04.08.2020 720 01024376 | 05.08.2020 679 c01024398 | 06.08.2020 677 001022202 | 13.06.2020 632 01024525 | 08.08.2020 630 €01023222 | 09.07.2020 608 €01023590 | 18.07.2020 375 €01015274 | 02.01.2020 325 €01017986 | 25.02.2020 130 c01024051 | 28.07.2020 128 €01024487 | 07.08.2020 107 / 001024426 | 06.08.2020 86 €01024289 | 03.08.2020 4a Total 16156 ‘The Vidal health insurance TPA claim intimation ID # CLM-A1243-652639. von. Hea tout ec @ commer @ came m= cease @ vox quem (A suner eOUCIEARS = ceric REED) © eens 9 camenmay= “ ASHWINI MATERNITY HOS Nw.90, Vastuthavur Main Baad, VV Nayar Puducherry Phy 04ns . 207400N, 227098 Conwubting . Gonsulernge No-90,Vazhuthavur Nain Road,V.V.P.NagarPuducherry-6050( ) PHONE Nos0415-2274380,2274688 DL NO 20/100594 & 2171005979 | j GST NO © S4AEEPC1OB00120 Oo CASH Bill » CoLozaze9 Dates 05/00/20/06840 Ft Nomex KAVITHA { Dr. DR.CHITRA BANU MD,DNBE MN Oo Qty Particulars Gsl% Hatch — Exp aman 1 soDAC 25 GST 12% UNNOZ7N7 OB/21 As 4 DISPOVAN 1Onl SYRINGE GBT 12% 1001 O/ 9.00 © ) Raser8.04 COST 22.2 T.Ttems: 2 Qty: 2 Smant “ELA OE. — Rounded OFF to Ro. as ee 4 We o& HEED ae