MDINDIA HEALTHCARE SERVICES (TPA) PVT. LTD.

An ISO 9001:2000 Company

IRDA License No:005
Toll Free Customer Care No.: 1 800 233 11 66

Toll Free Cashless No.: 1 800 233 45 05

UAN Fax No.: 1 860 233 44 49

Download Forms

MDIndia do not charge from the hospital for the empanelment, in case of such a demand please contact our nearest branch or our Head office at Toll Free No : 1800 233 11 66

Download Claim Form

*Please select city and Click 'Download' button
to download claim form for Particular city.


Select City

Claim Intimation Format
Other Forms

Provider Empanelment Kit

Future Generali India Insurance Company Ltd. Forms

The New India Assurance Company Limited Forms

Saint Gobain Claim Form

ECS Form  

Standard Discharge Summary Format

Standard Bill Format

Pune PPN MOU

Documents Request Form


Request For Authorisation Letter
Request For Authorisation Letter
Check List

Discharge Voucher
Discharge Voucher

You could down load and fill the forms mentioned below for empanelment of your Hospitals / Nursing Homes with us.
Provider Empanelment Kit
Covering Letter
Agreement
Provider Information
Schedule Of Charges
Undertaking Declaration from Hospital
Future Generali India Insurance Company Ltd.
Claim Form
Request For Authorisation Letter
National Insurance Company Limited
New Mediclaim
The New India Assurance Company Limited
Family Floater
Group Mediclaim
Janata Mediclaim
Mediclaim 2007
New Mediclaim
Senior Citizen
Steel Authority of India Limited
SAIL - GuideBook
   
SBI General Insurance Company Limited
  Claim Form
   
Birla Sun Life Insurance
  Claim Form
  Preauthorization Request Form
  Reimbursement Claim - Claimant's Statement
  Reimbursement Claim - Hospital Treatment Certificate
   
L&T General Insurance Company Ltd
  Claim Form
HDFC ERGO General Insurance Co.
  Claim Form
   
Bharti Axa General Insurance Company Limited
  Claim Form
  Preauthorization Request Form
   
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