| 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 |
