East west tpa claim form pdf 2025

1. Click ‘Get Form’ to open the east west tpa claim form PDF in the editor.
2. Begin by filling out the 'Policy Holder Information' section. Enter your name, card ID number, and relation to the patient. Ensure all details are accurate.
3. Next, complete the 'Patient Information' section. Provide the patient's name, address, contact details, and email address.
4. In the 'Hospital / Doctor’s Information' section, input the hospital's name, provider information number, and address. This is crucial for processing your claim.
5. Fill out the 'Claim Information' section with admission and discharge dates, patient status, and any relevant diagnosis codes.
6. Complete the 'Serviceline Information' by detailing claim type, disease code, amounts paid by the patient, and any remarks necessary for clarity.
7. Finally, authorize your claim by signing at the bottom of the form. Don’t forget to attach a signed cancelled cheque for fund transfer.

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