VAS Beneficiary Details OCT 2015-DEC 2015

Transcription

Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Diseases
Plan of
treatment
Package Code Sugery Code
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Cheque No. Cheque Date
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks :
567
567
100000
24000
12000
1200
10800
IDBI - 321
30-Oct-15
31500
120101
31500
3150
28350
IDBI - 321
30-Oct-15
H_2001089349
Male
42
Others SHIVAPURA
DAVANAGERE
DAVANGERE
Bangalore
2
H_21052149228
Female
38
Others KAVOOR
MANGALORE
DAKSHINA
KANNADA
Mysore
KMC HOSPITAL MANGALORE
CARCINOMA
OVARY
CANCER
Medical Oncology
Ovarian Cancer
Carboplatin/Paclit
axel/Cycle
512
512
3
H_20010150047
Male
52
Others CALONY
BIDAR
BIDAR
Gulbarga
M S Ramaiah
Hospital
BANGALORE
NORTH
CA LOWER
ESOPHAGUS
CANCER
Surgical Oncology
Esophagus
Oesophagectomy
with Three field
Lymphadenectomy
674
674
23-Jan-14
25-Mar-14
100000
100000
50000
5000
45000
IDBI - 321
30-Oct-15
4
H_20010154901
Female
68
Others MADAGONDAHALLI
DODDABALLAPU BANGALORE R
RURAL
Bangalore
M S Ramaiah
Hospital
BANGALORE
NORTH
CANCER
Surgical Oncology
Gastro Intestinal System
Gastrectomy - any
type
636
636
3-Feb-14
17-Mar-14
50000
50000
25000
2500
22500
IDBI - 321
30-Oct-15
5
H_20010160633
Female
60
BANGALORE RURAL
Bangalore
M S Ramaiah
Hospital
BANGALORE
NORTH
CANCER
Surgical Oncology
Gastrectomy - any
type
636
636
20-Feb-14
29-Mar-14
45000
45000
20000
2000
18000
IDBI - 321
30-Oct-15
6
H_20010163340
Male
48
CHITRADURGA
Bangalore
M S Ramaiah
Hospital
BANGALORE
NORTH
CANCER
Surgical Oncology
Gastrectomy - any
type
636
636
6-Mar-14
24-Apr-14
40000
50000
25000
2500
22500
IDBI - 321
30-Oct-15
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
7-Mar-14
10-May-14
80000
84000
37000
3700
33300
IDBI - 321
30-Oct-15
505
505
131000
63805
31902
3190
28712
IDBI - 321
30-Oct-15
Others TAGARANATTI
CHITRADURGA
CA STOMACH
PYLOPUS
GROWTH
CARCINOMA
STOMACH S/P
NACT
CA STOMACH
(SIGNET RING
CELL TUMOR)
CT3N1M0
CA ESOPHAGUS
UPPER 1/3
STAGE 2
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
CANCER
Medical Oncology
Breast
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
26-Mar-14
28-May-14
85000
73000
36500
3650
32850
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
25-Apr-14
26-Jun-14
93000
91000
43250
4325
38925
IDBI - 321
30-Oct-15
5-FluorouracilOxaliplatin Leucovorin
(FOLFOX)
(Paliation CT
only)/Week Max. 6
cycles
531
531
10-May-14
2-Jun-14
60000
22126
10000
1000
9000
IDBI - 321
30-Oct-15
563
563
25-Jun-14
2-Jul-14
10000
10915
5000
500
4500
IDBI - 321
30-Oct-15
7
H_20010164259
Male
38
Others SOLAHALLI
CHITTAPUR
GULBARGA
Gulbarga
M S Ramaiah
Hospital
8
H_21052161264
Female
38
Others HOSADURGA
HOSADURGA
CHITRADURGA
Bangalore
CA BREAST T3
N2 M0 III A
Bangalore
M S Ramaiah
Hospital
BANGALORE
NORTH
CARCINOMA
POST CRICOID
cT1 N2 M0
Bangalore
M S Ramaiah
Hospital
BANGALORE
NORTH
9
10
H_20010168800
H_20010176653
Female
Female
60
Others CHIKKAMALUR
MADHUGIRI
47
BANGALORE
Others BYATARAYANAPURA
NORTH
TUMKUR
BANGALORE URBAN
BANGALORE
NORTH
CANCER
Disease Sub Category
1
GADDADHANAGEHAL
DEVANAHALLI
LI
CA PYRIFORM
FOSSA
Disease Main
Category
M S Ramaiah
Hospital
SC
BANGALORE
NORTH
Final
Diagnosis
CA CERVIX II B
CANCER
CANCER
Paclitaxel/docetax
el/Cycle
11
H_21052178796
Male
73
Others BOLAR
MANGALORE
DAKSHINA
KANNADA
Mysore
CA COLON WITH
OMENTAL
CANCER
METASTASIS
Medical Oncology
Colorectal Cancer
12
H_20082187007
Female
37
Others HONNUDIKE
TUMKUR
TUMKUR
Bangalore
Kidwai
Memorial
Institute of
Oncology
Ca Supraglottis
T3N1Mo
Radiation Oncology
Cobalt 60 External Beam Palliative
Radiotherapy
Treatment
13
H_21052184903
Female
58
Others BALTHILA
BANTWAL
DAKSHINA
KANNADA
Mysore
CA BREAST WITH
CANCER
LN METASTASIS
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
3-Jun-14
27-Aug-14
45000
79678
15000
1500
13500
IDBI - 321
30-Oct-15
M S Ramaiah
Hospital
BANGALORE
NORTH
CARCINOMA
CERVIX STAGE II CANCER
B
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
26-May-14
19-Jul-14
93000
91000
45500
4550
40950
IDBI - 321
30-Oct-15
Mysore
ADINOCARCINO
MA OF LEFT
CANCER
OVARY STAGE
IIIc
Medical Oncology
Ovarian Cancer
Carboplatin/Paclit
axel/Cycle
512
512
27-May-14
7-Aug-14
71500
71500
29750
0
29750
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
CANCER
14
H_20010183913
Female
51
Others AJJAMPURA
TARIKERE
CHIKKAMANAGL
Mysore
UR
15
H_19505180168
Female
50
Others HALIYURU
KR NAGAR
MYSORE
Mysore
Bharath
Hospital
Institute of
Oncology
16
H_21052187957
Male
72
Others ARIYADKA
PUTTUR
DAKSHINA
KANNADA
Mysore
CA PROSTATE
POST OP 3
YEARS BACK
CANCER
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
14-Jun-14
20-Aug-14
22500
96450
7500
750
6750
IDBI - 321
30-Oct-15
17
H_19504195642
Male
68
Others Honnihal
BELGAUM
BELGAUM
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Ca Floor of
Mouth Stage IVA CANCER
cT4aN2bM0
Medical Oncology
Head & Neck
Carboplatin +
Paclitaxel/Cycle
Max. of 6 cycles
only
521
521
21-Jul-14
19-Aug-14
31500
21000
10500
1050
9450
IDBI - 321
30-Oct-15
18
H_20082191529
Male
61
Others ELIGEHALLI
MAGADI
RAMANAGAR
Bangalore
BANGALORE
SOUTH
Ca Esophagus T3
CANCER
N21 M0
Surgical Oncology
Palliative Surgeries
Jejunostomy
677
677
24-Jun-14
28-Jun-14
20000
21745
10000
1000
9000
IDBI - 321
30-Oct-15
19
H_20082192507
Male
41
Others KADURHALLI
KADUR
CHIKKAMANAGL
Mysore
UR
BANGALORE
SOUTH
Ca Oropharynx
T4 N3 M0
Radiation Oncology
Radiotherapy
Treatment
563
563
30-Jul-14
1-Aug-14
10000
10940
3000
300
2700
IDBI - 321
30-Oct-15
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
CANCER
Sl.No
20
Preauth No
H_19505188645
Gender
Male
Age
49
21
H_20010189774
Female
35
22
H_19505190193
Female
37
23
H_21052199132
Female
53
Caste
SC
Village
HADINARU
Taluk
HAMPAPURA
Others BANTENAHALLI
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Radiation Oncology
568
568
3-Jul-14
28-Jul-14
69000
51000
24500
0
24500
IDBI - 321
30-Oct-15
CARCINOMA
VAGINAL VAULT CANCER
STAGE III B
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
13-Jun-14
15-Sep-14
95000
93000
46500
4650
41850
IDBI - 321
30-Oct-15
CA CERVIX POST
CANCER
OP
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
(linear accelarator)
565
565
27-Jun-14
22-Aug-14
73500
73500
36750
0
36750
IDBI - 321
30-Oct-15
LEIOMYOSARCO
CANCER
MA
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
14-Jul-14
22-Sep-14
49500
112889
11250
1125
10125
IDBI - 321
30-Oct-15
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
21-Jul-14
9-Sep-14
75000
135255
36500
3650
32850
IDBI - 321
30-Oct-15
CANCER
Radiation Oncology
Cobalt 60 External Beam
Radical Treatment
Radiotherapy
562
562
7-Aug-14
14-Sep-14
32000
42330
13000
1300
11700
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
11-Aug-14
9-Oct-14
93000
91000
45500
4550
40950
IDBI - 321
30-Oct-15
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
2-Aug-14
29-Sep-14
85000
85000
42500
4250
38250
IDBI - 321
30-Oct-15
Mysore
Mysore
CHITRADURGA
Bangalore
M S Ramaiah
Hospital
BANGALORE
NORTH
KR NAGAR
MYSORE
Mysore
Bharath
Hospital
Institute of
Oncology
Mysore
BELUR
HASSAN
Mysore
MYSORE
Disease Main
Category
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
CA
OESOPHAGUS
T3N2M0 STAGE
III b
NANJANAGUD
Diseases
3D Conformational
Radio Therapy
Bharath
Hospital
Institute of
Oncology
CHITHRANAYAKANA
Others
CHALLAKERE
HALLI
ST
Patient District
CANCER
24
H_21052197602
Male
6
Others SOMVARPETE
SOMAVARPET
KODAGU
Mysore
BRAIN STEM
GLIOMA
25
H_20082197875
Male
42
Minorit
MASKI
y
LINGASUGUR
RAICHUR
Gulbarga
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca (Lt) Pyriform
Since cT3NoMo
SIDLAGATTA
CHIKKABALLAPU
Bangalore
R
M S Ramaiah
Hospital
BANGALORE
NORTH
CARCINOMA
CERVIX II B
BANGALORE
NORTH
ANAPLASTIC
OLIGODENDROG
CANCER
LIOMA STAGE III
(WHO)
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
CA LEFT BREAST
CANCER
T4 N1 M0
Medical Oncology
Breast
Adriamycin/Cyclop
hosphamide
(AC)/Cycle
501
501
30-Jul-14
3-Jan-15
56000
98167
28000
2800
25200
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Esophagus T3
CANCER
N1 M0
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
19-Aug-14
21-Aug-14
32000
32250
3000
300
2700
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Cervix III B
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
27-Aug-14
30-Sep-14
34500
37170
9750
975
8775
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
12-Sep-14
17-Oct-14
73500
77715
10000
1000
9000
IDBI - 321
30-Oct-15
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
30-Aug-14
31-Dec-14
45000
119457
22500
2250
20250
IDBI - 321
30-Oct-15
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
29-Oct-14
27-Nov-14
78000
100425
29750
2975
26775
IDBI - 321
30-Oct-15
Radical Treatment
with Photons
565
565
1-Sep-14
4-Nov-14
73500
73500
36750
0
36750
IDBI - 321
30-Oct-15
533
533
22-Sep-14
28-Jan-15
32000
78330
15750
1575
14175
IDBI - 321
30-Oct-15
550
550
4-Dec-14
17-Dec-14
70000
96485
34750
3475
31275
IDBI - 321
30-Oct-15
26
H_20010202127
Female
58
Others YARANAGENAHALLI
27
H_20010202139
Male
44
Others SINDAGI
BIJAPUR
BIJAPUR
Belgaum
M S Ramaiah
Hospital
28
H_21052199590
Female
40
Others BELLE
UDUPI
UDUPI
Mysore
29
H_20082199718
Female
56
Others RAMANA BLOCK
KUNIGAL
TUMKUR
Bangalore
30
H_20082203065
Female
45
Others ADESONNATTI
ANEKAL
BANGALORE URBAN
Bangalore
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
CANCER
CANCER
31
H_20082203402
Female
40
Others DODDABANAGERE
SIRA
TUMKUR
Bangalore
Kidwai
Memorial
Institute of
Oncology
32
H_21052206731
Female
52
Others PACHANADI
MANGALORE
DAKSHINA
KANNADA
Mysore
CA
ENDOMETRIUM CANCER
IIIA
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca Vault T3 N1
M0
CANCER
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Mysore
CA.CERVIX
STAGE:- IIIB.
CANCER
Radiation Oncology
Linear Accelerators
Medical Oncology
Lymphoma-Hodgkin
disease
Medical Oncology
Acute Lymphoblastic
Leukemia
DAVANGERE
BANGALORE
SOUTH
ca cervix III B
CANCER
33
H_20082202983
Female
67
Others HULIKATTE
DAVANAGERE
34
H_19505204669
Female
66
Others KEMPANAPURA
CHAMARAJANA CHAMARAJANA
Mysore
GAR
GAR
Bharath
Hospital
Institute of
Oncology
BANGALORE
SOUTH
Hodgkin
Lymphoma Stage CANCER
III
BANGALORE
SOUTH
ALL
35
H_20082211496
Female
12
Others KODAGANUR
DAVANAGERE
DAVANGERE
Bangalore
Kidwai
Memorial
Institute of
Oncology
36
H_20082209080
Female
10
Minorit
DEVIKERA
y
SURPUR
YADGIRI
Gulbarga
Kidwai
Memorial
Institute of
Oncology
CANCER
Doxorubicin Bleomycin Vinblastine
Dacarbazine
(DBVD)/Cycle
(Day1 & Day12)
Induction &
Consolidation/1st
phase - 1st ,2nd ,
3rd , 4th & 5th
months
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
30-Oct-15
M S Ramaiah
Hospital
BANGALORE
NORTH
CARCINOMA
LUNG WITH
BRAIN
METASTASIS
CANCER
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
26-Sep-14
13-Oct-14
20000
20000
10000
1000
9000
IDBI - 321
30-Oct-15
Mysore
GAR
GAR
Bharath
Hospital
Institute of
Oncology
Mysore
Ca. CERVIX
STAGE:- IIIB
CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
30-Sep-14
28-Nov-14
73500
73500
35750
0
35750
IDBI - 321
30-Oct-15
M S Ramaiah
Hospital
BANGALORE
NORTH
CA LEFT
GINGIVO
CANCER
BUCCAL SULCUS
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
18-Sep-14
25-Nov-14
85000
79000
39500
3950
35550
IDBI - 321
30-Oct-15
Mysore
Bharath
Hospital
Institute of
Oncology
Mysore
Ca. Bladder
Stage:PT2N0M0 IIa.
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
6-Oct-14
17-Nov-14
60000
58000
29000
0
29000
IDBI - 321
30-Oct-15
Mysore
Bharath
Hospital
Institute of
Oncology
Mysore
ACUTE
LYMPHOBLASTE CANCER
LEUKAMIA
Medical Oncology
Acute Lymphoblastic
Leukemia
Induction &
Consolidation/1st
phase - 1st ,2nd ,
3rd , 4th & 5th
months
550
550
29-Sep-14
31-Oct-14
70000
40000
9500
0
9500
IDBI - 321
30-Oct-15
BANGALORE
NORTH
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
10-Sep-14
22-Nov-14
103000
87500
43500
4350
39150
IDBI - 321
30-Oct-15
H_19505214696
Female
50
Others THORAVALLI
Mysore
40
H_20010213985
Female
25
Others BURAGAMODUGU
CHIKKABALLAPU CHIKKABALLAPU
Bangalore
R
R
41
H_19505212749
Male
54
Others RAMABAI NAGARA
MYSORE
Others
45
H_19505213834
Female
30
Others HULLENAHALLI
46
H_20010213146
Female
38
HALASURU GRAMA,
KADAHALLI
POST,SATHANURU
HOBHALI
Others BOMMANAHALLI
MYSORE
CHANNARAYAP
HASSAN
ATNA
SINDAGI
BIJAPUR
Belgaum
M S Ramaiah
Hospital
KANAKAPURA
RAMANAGAR
Bangalore
CHANNARAYAP
HASSAN
ATNA
KANAKAPURA
RAMANAGAR
CA CERVIX 2A
CANCER
Radiation Oncology
Krishnarajendra
MYSORE
Hospital
CA. BREAST
T3N1M0
CANCER
Medical Oncology
Breast
AC (AC then
T)/Cycle
503
503
27-Sep-14
12-May-15
47000
47000
32900
3290
29610
IDBI - 321
30-Oct-15
Mysore
Bharath
Hospital
Institute of
Oncology
Mysore
CA. RIGHT
BREAST STAGE:- CANCER
T2N2 IIIA
Medical Oncology
Breast
FEC (Epirubicin
based)/Cycle
504
504
7-Oct-14
20-Nov-14
40000
15000
7500
0
7500
IDBI - 321
30-Oct-15
Bangalore
M S Ramaiah
Hospital
BANGALORE
NORTH
CARCINOMA
CERVIX II A
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
19-Sep-14
20-Nov-14
93000
93000
46500
4650
41850
IDBI - 321
30-Oct-15
Mysore
CA. LEFT BREAST
WITH MULTIPLE
SKELETAL METS CANCER
STAGE:T4cN3M1 IV.
Medical Oncology
MULTIPLE MYELOMA
Zoledronic acid
along with
Adjuvant
Chemotherapy of
AS-I/Cycle
558
558
29-Sep-14
2-Dec-14
12000
12000
6000
0
6000
IDBI - 321
30-Oct-15
CA LUNG T3 N2
M1
CANCER
Medical Oncology
Non-small cell lung
cancer
Carboplatin +
Paclitaxel/Cycle
526
526
15-Sep-14
29-Sep-14
31500
27723
5250
525
4725
IDBI - 321
30-Oct-15
Mysore
CA. TONSIL
STAGE:T4N2aM0 IVA
CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
13-Oct-14
3-Dec-14
60000
60000
30000
0
30000
IDBI - 321
30-Oct-15
Mysore
ca. cervix stage:CANCER
IIIB
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
11-Oct-14
9-Dec-14
73500
71500
35750
0
35750
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Renal cell Ca
(Postop)
T3N1M0
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
17-Oct-14
13-Nov-14
50000
56920
16750
1675
15075
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Adenocarcinoma
dupdenum
CANCER
T3N1Mo
Surgical Oncology
Pancreas
Whipples - any
type
582
582
10-Oct-14
8-Nov-14
85000
86805
4750
475
4275
IDBI - 321
30-Oct-15
Mysore
CA. OVARY
STAGE:-IV
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
26-Nov-14
27-Nov-14
45000
15000
7500
0
7500
IDBI - 321
30-Oct-15
Colorectal Cancer
(FOLFOX)
(Paliation CT
only)/Week Max. 6
cycles
531
531
20-Oct-14
20-Nov-14
30000
30000
15000
0
15000
IDBI - 321
30-Oct-15
47
H_19505206486
Female
43
Others SEEGURU
HASSAN
HASSAN
Mysore
48
H_21052212386
Male
34
Others CHELAIRU
MANGALORE
DAKSHINA
KANNADA
Mysore
H_19505216235
Male
78
Others NANJANGUD ROAD
50
H_19505216013
Female
44
Others
51
H_20082215194
Female
2
52
H_20082213877
Male
66
53
H_19505216656
Female
54
54
H_19505217099
Male
25
T NARASIPUR
MYSORE
Mysore
MANDYA
MANDYA
Mysore
Others HEGADE BADAVANE ANEKAL
BANGALORE URBAN
Bangalore
Others CHANDLAPUR
SURPUR
YADGIRI
Gulbarga
SOMESHWARAPURA MYSORE
MYSORE
Mysore
ST
MALLANAYAKANA
KATTE
Others KADADARAVALLI
HASSAN
HASSAN
CANCER
3D Conformational
Radio Therapy
Bharath
Hospital
Institute of
Oncology
49
IDBI - 321
39
58
Net Amt
Paid
25200
CHIKKABALLAPU
Bangalore
R
Female
TDS
2800
BAGEPALLI
H_20968212764
Gross
Amount
approved by
28000
Others MARAVEPALLI
44
Hospital
claimed
Amount
56000
44
Others YALAGODA
Preauth
Approved
Amt
56000
Male
65
Date of
Discharge
23-Oct-14
H_20010214229
Female
Date of
Admission
8-Sep-14
38
H_20010213983
565
MYSORE
43
Plan of
treatment
565
NANJANAGUD
BASAVANA KATTE
Radical Treatment
with Photons
Others GEJJAGANAHALLI
SC
Disease Main
Category
Linear Accelerators
50
53
Diseases
Radiation Oncology
Male
Female
Final
Diagnosis
CA SUBGLOTTISOPERATED FOR
CANCER
CHEMORADIOTH
ERAPY
H_20025207540
H_19505213971
Hospital
District
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
37
42
Hospital Name
Mysore
Bharath
Hospital
Institute of
Oncology
Bharath
Hospital
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
Bharath
Hospital
Institute of
Oncology
Bharath
Hospital
Institute of
Oncology
Mysore
CA RECTUM
WITH LIVER
METASTATIC
CANCER
CANCER
CANCER
CANCER
Medical Oncology
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Hospital
District
M S Ramaiah
Hospital
BANGALORE
NORTH
Final
Diagnosis
CARCINOMA
RECTUM
Diseases
H_20010216553
Female
46
Others VIDAYANAGAR
JEVARGI
56
H_20010222369
Female
57
Others CHIKKABALLAPURA
Bangalore
R
R
M S Ramaiah
Hospital
BANGALORE
NORTH
57
H_19505222171
Female
36
Others MALKUNDI
NANJANAGUD
Mysore
Bharath
Hospital
Institute of
Oncology
Mysore
Gulbarga
M S Ramaiah
Hospital
BANGALORE
NORTH
CARCINOMA
OROPHARYNX T3 CANCER
N2c M0
Mysore
Bharath
Hospital
Institute of
Oncology
Mysore
CA LEFT PYRI
FORMA FOSSA
T2N0M0 IV A
Bangalore
M S Ramaiah
Hospital
BANGALORE
NORTH
CARCINOMA
RECTUM STAGE
III
59
60
H_20010221534
H_19505222038
H_20010221378
Male
Male
Female
52
58
36
Others JEERHALLI
Others KONANURU
Others ECHANUR
GULBARGA
PIRIYAPATNA
MYSORE
GULBARGA
MYSORE
Gulbarga
Hospital Name
55
58
GULBARGA
Patient
Division
CANCER
CARCINOMA
BUCCAL
CANCER
MUCOSA STAGE
III
CA
OESOPHAGUS 1CANCER
3 RD WITH
NODAL METS
STAGE III
CANCER
CANCER
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
2-Oct-14
17-Nov-14
73000
73000
36500
3650
32850
IDBI - 321
30-Oct-15
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
28-Oct-14
6-Dec-14
60000
60000
30000
3000
27000
IDBI - 321
30-Oct-15
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
4-Nov-14
16-Dec-14
60000
60000
29000
0
29000
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
17-Oct-14
23-Dec-14
75000
75000
37500
3750
33750
IDBI - 321
30-Oct-15
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
10-Nov-14
30-Dec-14
96000
94000
47000
0
47000
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
21-Oct-14
11-Dec-14
73000
73000
36500
3650
32850
IDBI - 321
30-Oct-15
Induction &
Consolidation/1st
phase - 1st ,2nd ,
3rd , 4th & 5th
months
550
550
21-Oct-14
26-Dec-14
70000
200506
14000
1400
12600
IDBI - 321
30-Oct-15
TIPTUR
TUMKUR
ALL- RELAPSE
CANCER
Medical Oncology
Acute Lymphoblastic
Leukemia
61
H_21052220813
Female
12
Others MUDIGERE
MUDIGERE
CHIKKAMANAGL
Mysore
UR
62
H_21052220599
Male
45
Others SHIVAYOGIPURA
BELUR
HASSAN
Mysore
CA RECTUM
STAGE IV
CANCER
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
23-Oct-14
13-Feb-15
22500
104601
18750
1875
16875
IDBI - 321
30-Oct-15
63
H_20010218984
Female
58
Others MOTHKAHALLI
BANGARPET
KOLAR
Bangalore
M S Ramaiah
Hospital
CARCINOMA
TONGUE STAGE
T3 N1 M0
CANCER
Surgical Oncology
Head & Neck
Hemiglossectomy
613
613
11-Oct-14
26-Dec-14
27500
27500
13750
1375
12375
IDBI - 321
30-Oct-15
64
H_21052219751
Male
13
Others LAKKIKOPPA
SHIGGAON
HAVERI
Belgaum
B CELL
LYMPHOBLASTIC CANCER
LYMPHOMA
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
16-Oct-14
1-Jun-15
22500
466108
22500
2250
20250
IDBI - 321
30-Oct-15
65
H_19569223482
Female
50
Others Ingalagundi
HARAPANAHALL
DAVANGERE
I
Bangalore
HCG NMR
CURIE CENTRE
OF ONCOLOGY
HUBLI
Medical Oncology
Breast
AC (AC then
T)/Cycle
503
503
12-Nov-14
30-Jun-15
121000
121000
121000
605
120395
IDBI - 321
30-Oct-15
66
H_19505223452
Female
52
Others DAVANI BEEDHI
HUNSUR
Mysore
Bharath
Hospital
Institute of
Oncology
Mysore
Surgical Oncology
Breast
Mastectomy - any
type
598
598
10-Nov-14
14-Nov-14
25000
25000
12025
0
12025
IDBI - 321
30-Oct-15
67
H_21052223915
Male
29
Others
68
H_19505224011
Male
69
SC
69
H_21052223252
Male
56
Minorit
KAROPADI
y
70
H_20082227789
Female
82
Others CHOWDADENAHALLI KOLAR
MYSORE
BANGALORE
NORTH
Carcinoma (L)
Breast T3N2M0
CANCER
Post op (MRM)
(stage-III)
CA RIGHT
BREAST
CANCER
CT3N1M0 STAGE
III
NARASIMHARAJAPU
NARASAPURA
RA
CHIKKAMANAGL
Mysore
UR
MUO(METASTAS
IS OF UNKNOWN
CANCER
ORIGIN). STAGE
IV
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
31-Oct-14
5-Dec-14
22500
54873
7500
750
6750
IDBI - 321
30-Oct-15
HANCHYA
MYSORE
MYSORE
Mysore
Bharath
Hospital
Institute of
Oncology
CA LARYNX
CT1AN2M0
CANCER
Surgical Oncology
Head & Neck
Laryngectomy any type
617
617
26-Nov-14
15-Dec-14
40000
40000
18000
0
18000
IDBI - 321
30-Oct-15
BANTWAL
DAKSHINA
KANNADA
Mysore
CA PANCREAS
STAGE IV
CANCER
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
3-Nov-14
12-Dec-14
36000
66849
3000
300
2700
IDBI - 321
30-Oct-15
KOLAR
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
CA BUCCAL
Mucosa
CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
8-Dec-14
1-Jan-15
62000
63435
18000
1800
16200
IDBI - 321
30-Oct-15
M S Ramaiah
Hospital
BANGALORE
NORTH
CARCINOMA
CERVIX-IIIB
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
17-Nov-14
31-Jan-15
95000
93000
46250
4625
41625
IDBI - 321
30-Oct-15
Bharath
Hospital
Institute of
Oncology
Mysore
CA CERVIX
STAGE III B
CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
4-Nov-14
5-Feb-15
73500
73500
34875
0
34875
IDBI - 321
30-Oct-15
71
H_20010229897
Female
40
Others CHIGATAGERE
CHIKKABALLAPU
GOWRIBIDANUR
Bangalore
R
72
H_19505230076
Female
50
Others GANDHI NAGARA
MYSORE
MYSORE
Mysore
Mysore
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
73
H_20082229138
Male
44
Others IRAGASANDRA
KOLAR
KOLAR
Bangalore
74
H_20082225184
Male
58
Others KOTE
KOLAR
KOLAR
Bangalore
Mysore
Mysore
75
H_21052228690
Female
28
Others MULUJR
MANGALORE
DAKSHINA
KANNADA
76
H_19505227843
Male
60
Others KEDAGA
KR NAGAR
MYSORE
77
H_19505228470
Male
58
GUNDLUPET
CHAMARAJANA
Mysore
GAR
ST
SOMANAPURA
Hospital Name
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
Hospital
District
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
BANGALORE
SOUTH
Ca left PFS
T2N0M0
CANCER
Medical Oncology
Cervical Cancer
Weekly
Cisplatin/Week
509
509
11-Feb-15
16-Apr-15
87000
89680
42500
4250
38250
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Analcanal
T3N1M0
CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
28-Nov-14
12-Jan-15
62000
65835
23000
2300
20700
IDBI - 321
30-Oct-15
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
10-Nov-14
26-Nov-14
87000
60299
9500
950
8550
IDBI - 321
30-Oct-15
CA
HYPOPHARYNX
T4b N0 M0
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Mysore
CA LEFT VOCAL
CORD IVA
T4AN2M0
CANCER
Medical Oncology
Head & Neck
Carboplatin +
Paclitaxel/Cycle
Max. of 6 cycles
only
521
521
26-Nov-14
16-Dec-14
21000
21000
10500
0
10500
IDBI - 321
30-Oct-15
Mysore
CA STOMACH
CANCER
CT3/4N2/3M1 IV
Surgical Oncology
Gastro
Jejunostomy
681
681
19-Nov-14
3-Dec-14
45000
45000
15300
0
15300
IDBI - 321
30-Oct-15
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
7-Nov-14
4-Dec-14
115000
61115
16500
1650
14850
IDBI - 321
30-Oct-15
Bharath
Hospital
Institute of
Oncology
Bharath
Hospital
Institute of
Oncology
Final
Diagnosis
78
H_19504227605
Male
30
Others Manur
BELGAUM
BELGAUM
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
79
H_19505225471
Male
55
Others RAMENAHALLI
HD KOTE
MYSORE
Mysore
Bharath
Hospital
Institute of
Oncology
Mysore
MUO OF NECK
NODE
M S Ramaiah
Hospital
BANGALORE
NORTH
CARCINOMA
BASE OF
TONGUE
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
CA OVARY
STAGE III
CANCER
Medical Oncology
Ovarian Cancer
Carboplatin/Paclit
axel/Cycle
512
512
9-Dec-14
23-Apr-15
63000
109038
31500
3150
28350
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Fallopian
CANCER
Medical Oncology
Ovarian Cancer
Carboplatin/Paclit
axel/Cycle
512
512
16-Dec-14
7-Jan-15
21000
21000
5000
500
4500
IDBI - 321
30-Oct-15
Mysore
CA RIGHT
BREAST II A
CANCER
Surgical Oncology
Breast
598
598
16-Dec-14
22-Dec-14
25000
25000
12500
0
12500
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Tongue
cT4aN2bM0
CANCER
Radiation Oncology
Radiotherapy
Treatment
563
563
19-Dec-14
23-Dec-14
22000
22755
4000
400
3600
IDBI - 321
30-Oct-15
MYSORE
IHD-NSTEMI CADCARDIOLOGY
DVD
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
2-Dec-14
7-Dec-14
90000
90000
44500
4450
40050
IDBI - 321
30-Oct-15
Mysore
CA OVARY
STAGE III
CANCER
Surgical Oncology
Gynaec
Surgery for Ca
Ovary - advance
stage
596
596
16-Dec-14
22-Dec-14
40000
40000
20000
0
20000
IDBI - 321
30-Oct-15
Mysore
CA OVARY
STAGE I/II
CANCER
Surgical Oncology
Gynaec
Surgery for Ca
Ovary - early stage
595
595
10-Dec-14
16-Dec-14
25000
25000
12500
0
12500
IDBI - 321
30-Oct-15
BANGALORE
NORTH
CA VOCAL CORD
CANCER
STG I
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
29-Nov-14
9-Dec-14
75000
37500
3750
33750
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Cervix
CANCER
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
6-Jan-15
20-Jan-15
43500
46570
3500
350
3150
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca BOT
CANCER
Radiation Oncology
Radiotherapy
Treatment
563
563
29-Dec-14
14-Jan-15
10000
17865
5000
500
4500
IDBI - 321
30-Oct-15
Medical Oncology
Acute Lymphoblastic
Leukemia
550
550
9-Dec-14
3-Jun-15
70000
49000
4900
44100
IDBI - 321
30-Oct-15
80
H_20010224464
Female
55
Others MANCHENAHALLI
CHIKKABALLAPU
GOWRIBIDANUR
Bangalore
R
81
H_21052234418
Female
40
Others BHADRAVATHI
SHIMOGA
82
H_20082232623
Female
47
Others
83
H_19505234240
Female
41
Others
84
H_20082231903
Female
58
Others SALGERERI
85
H_20733232610
Male
70
86
H_19505232576
Female
57
87
H_19505232294
Female
53
SHIMOGA
Bangalore
RAJGOPALANGARA(V BANGALORE
)
SOUTH
BANGALORE URBAN
Bangalore
KONTAIAHANAHUND
NANJANAGUD
I
MYSORE
Mysore
ARAKALAGUD
HASSAN
Mysore
Others Edallidoddi
KOLLEGAL
CHAMARAJANA
Mysore
GAR
Others KESTHURU
YELANDUR
CHAMARAJANA
Mysore
GAR
HD KOTE
MYSORE
Bangalore
Bangalore
SC
KOLAGALA
88
H_20010232085
Male
55
Others LAKKONDAHALLI
HOSAKOTE
BANGALORE RURAL
89
H_20082233206
Female
65
Others SHAVALI MAKAN
HARIHARA
DAVANGERE
90
H_20082234951
Male
65
Others H.BYADARAHALLY
CHANNAPATNA RAMANAGAR
91
H_21052234000
Male
13
Others BANTRA
PUTTUR
DAKSHINA
KANNADA
Mysore
Bangalore
Mysore
Kidwai
Memorial
Institute of
Oncology
Bharath
Hospital
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
SJICR MYSORE
Bharath
Hospital
Institute of
Oncology
Bharath
Hospital
Institute of
Oncology
M S Ramaiah
Hospital
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
Ca Rectum Stage
CANCER
IV T3N1M0
Radiation Oncology
3D Conformational
Radio Therapy
Medical Oncology
Head & Neck
Carboplatin +
Paclitaxel/Cycle
Max. of 6 cycles
only
521
521
21-Nov-14
2-Jan-15
31500
31500
15750
0
15750
IDBI - 321
30-Oct-15
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
2-Nov-14
29-Nov-14
85000
27000
13500
1350
12150
IDBI - 321
30-Oct-15
ALL
CANCER
CANCER
Mastectomy - any
type
Induction &
Consolidation/1st
phase - 1st ,2nd ,
3rd , 4th & 5th
months
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
92
H_20082241373
Female
3
Others BEERAPAGALI
BELLARY
BELLARY
Gulbarga
Kidwai
Memorial
Institute of
Oncology
93
H_21052241758
Female
61
Others SALAKODA
HONNAVAR
UTTARA
KANNADA
Belgaum
94
H_21052241896
Female
40
Others MATASAGARA
SAKLESHPURA
HASSAN
Others CHIKKABETTAHALLI
BANGALORE
NORTH
BANGALORE URBAN
95
96
97
H_20010240545
H_20082239606
H_20010240380
Female
Male
Female
39
32
Others AGASAVALLI
SHIKARIPURA
KANAKAPURA
SHIMOGA
5
Others MULAGALU
RAMANAGAR
UDUPI
UDUPI
Diseases
Disease Main
Category
All
CANCER
Medical Oncology
CA RECTUM
STAGE III
CANCER
Medical Oncology
Colorectal Cancer
Mysore
CA OVARY
STAGE IV
CANCER
Medical Oncology
unlisted regimen
Bangalore
M S Ramaiah
Hospital
BANGALORE
NORTH
CA LEFT BREAST
POST OP POST
CANCER
CHEMO
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca Glioma
BANGALORE
NORTH
VERMIUN &
RIGHT
CEREBELLAR
TUMOR ME
DULLO
BLASTOMA
GLCOMA
MANGALORE
T CELL RICH B
CELL
LYMPHOMA
CANCER
Medical Oncology
Lymphoma-NHL
M S Ramaiah
Hospital
Kidwai
Memorial
Institute of
Oncology
BANGALORE
NORTH
L5 - S1 PIVD
NEURO SURGERY
Neuro Surgery
Spinal
BANGALORE
SOUTH
Ca Cervix III B
CANCER
Medical Oncology
Cervical Cancer
M S Ramaiah
Hospital
BANGALORE
NORTH
L3-L4-5
SECONDARY
NEURO SURGERY
CANAL STENOSIS
Neuro Surgery
Mysore
CA RIGHT
BREAST
cT4N0M0
CANCER
BANGALORE
SOUTH
Ca Cervix III B
Bangalore
M S Ramaiah
Hospital
Mysore
MANGALORE
INSTITUTE OF
ONCOLOGY
98
H_20575239342
Female
34
99
H_20010239689
Male
31
Others THOLLAPALLI
BAGEPALLI
CHIKKABALLAPU
Bangalore
R
100 H_20082231952
Female
60
Others KAGGALIPURA
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
101 H_20010239336
Male
60
Others HOSAPETE ONI
HANAGAL
HAVERI
Belgaum
102 H_19505239345
Female
47
Others
103 H_20082234720
Female
30
104 H_20010238529
Female
105 H_20010238524
106 H_21052237291
Bharath
Hospital
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Final
Diagnosis
Acute Lymphoblastic
Leukemia
Minorit
KODAVOOR
y
GAYATHRI
BADAVANE
Hospital
District
Plan of
treatment
Induction &
Consolidation/1st
phase - 1st ,2nd ,
3rd , 4th & 5th
months
(FOLFOX)
(Paliation CT
only)/Week Max. 6
cycles
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
550
550
10-Jan-15
2-Mar-15
70000
70190
19750
1975
17775
IDBI - 321
30-Oct-15
531
531
3-Jan-15
27-Jan-15
20000
27842
10000
1000
9000
IDBI - 321
30-Oct-15
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
5-Jan-15
29-Apr-15
22500
115806
22500
2250
20250
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
22-Dec-14
6-Jan-15
50000
25000
2500
22500
IDBI - 321
30-Oct-15
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
24-Feb-15
7-Apr-15
85000
86255
40250
4025
36225
IDBI - 321
30-Oct-15
NEURO SURGERY
Neuro Surgery
Brain Tumour
Excision of Brain
Tumors Subtentorial
408
408
23-Dec-14
12-Jan-15
48000
48000
24000
2400
21600
IDBI - 321
30-Oct-15
534
534
29-Dec-14
14-Sep-15
24000
28500
2850
25650
IDBI - 321
30-Oct-15
433
433
27-Dec-14
1-Jan-15
25000
25000
12500
1250
11250
IDBI - 321
30-Oct-15
Weekly
Cisplatin/Week
509
509
26-Dec-14
7-Apr-15
60000
64885
26750
2675
24075
IDBI - 321
30-Oct-15
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
22-Dec-14
12-Jan-15
50000
50000
25000
2500
22500
IDBI - 321
30-Oct-15
Surgical Oncology
Breast
Mastectomy - any
type
598
598
30-Dec-14
1-Jan-15
25000
25000
12100
0
12100
IDBI - 321
30-Oct-15
CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
22-Jan-15
27-Feb-15
75500
77650
29000
2900
26100
IDBI - 321
30-Oct-15
Cyclophosphamide
- Doxorubicin
Vincristine Prednisone
(CHOP)/Cycle
(Day1 & Day12)
DiscectomyLumbar
CHANNARAYAP
HASSAN
ATNA
Mysore
Others BARAGUR
SIRA
TUMKUR
Bangalore
65
Others BHOVI PALYA
SIRA
TUMKUR
Bangalore
M S Ramaiah
Hospital
BANGALORE
NORTH
RENAL CELL
CARCINOMA
LEFT SIDE STGE:
T2N0M0
CANCER
Surgical Oncology
Genito Urinary System
Radical
Nephrectomy
584
584
15-Dec-14
10-Jan-15
40000
40000
14000
1400
12600
IDBI - 321
30-Oct-15
Female
60
Others DODDAGHATTA
ARASIKERE
HASSAN
Mysore
M S Ramaiah
Hospital
BANGALORE
NORTH
PAPILLARAY CA
THYROID STAGE: CANCER
T1N0M0
Surgical Oncology
Head & Neck
Thyroidectomy any type
615
615
11-Dec-14
31-Dec-14
20000
20000
6750
675
6075
IDBI - 321
30-Oct-15
Male
33
Others VITLA
BANTWAL
DAKSHINA
KANNADA
Mysore
GERM CELL
TUMOR STAGE
III
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
15-Dec-14
10-Apr-15
24000
46757
3750
375
3375
IDBI - 321
30-Oct-15
533
533
15-Dec-14
20-May-15
32000
85707
22400
2240
20160
IDBI - 321
30-Oct-15
447
447
10-Dec-14
10-Jan-15
80000
80000
40000
4000
36000
IDBI - 321
30-Oct-15
504
504
20-Dec-14
9-Apr-15
30000
70634
15000
1500
13500
IDBI - 321
30-Oct-15
107 H_21052237976
Male
35
Others IVARNADU
SULYA
DAKSHINA
KANNADA
Mysore
HODGKIN S
LYMPHOMA
STAGE IAx .
108 H_20010237635
Male
24
Minorit
GOGIPETA
y
SHAHPUR
YADGIRI
Gulbarga
M S Ramaiah
Hospital
109 H_21052237650
Female
39
Others BHAGYANAGARA
RAMADURGA
BELGAUM
Belgaum
BANGALORE
NORTH
CANCER
Medical Oncology
Lymphoma-Hodgkin
disease
KOCHS CERVICAL
& LUMBAR
NEURO SURGERY
SPINE
Neuro Surgery
Spinal
CA BREAST
STAGE II
Medical Oncology
Breast
CANCER
CANCER
Dacarbazine
(DBVD)/Cycle
(Day1 & Day12)
Corpectomy for
Spinal
Fixation(40000) +
cost of
implant(20000)
FEC (Epirubicin
based)/Cycle
Sl.No
Preauth No
110 H_20082234208
Gender
Age
Male
71
Caste
Village
Others YAMARE
Taluk
ANEKAL
Patient District
BANGALORE URBAN
Patient
Division
Bangalore
Hospital Name
Kidwai
Memorial
Institute of
Oncology
Hospital
District
BANGALORE
SOUTH
Final
Diagnosis
Ca TONSIL
T4BN2M0
Diseases
CANCER
111 H_21897236711
Male
24
Others HANAPURA
BADAMI
BAGLAKOT
Belgaum
GLOBAL
MULTISPECIALIT
MANGALORE
Y HOSPITAL
INDIA PVT LTD
CONTRACTED
RIGHT KIDNEY
WITH
MODERATE
HYDRONEPHROS RENAL
IS,LARGE
CALCULUS IN
RENAL PELVIS
20MM
112 H_22254245633
Male
65
Others RANGA PUR
RAICHUR
RAICHUR
Gulbarga
BIBI GENERAL
HOSPITAL AND HYDERABAD
CANCER CENTER
ca lung
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Medical Oncology
Cervical Cancer
Weekly
Cisplatin/Week
509
509
20-Jan-15
5-Feb-15
62000
63470
8750
875
7875
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side
907
907
17-Dec-14
24-Dec-14
27500
27500
12750
1275
11475
IDBI - 321
30-Oct-15
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
30-Jan-15
17-May-15
45000
45000
15000
1500
13500
IDBI - 321
30-Oct-15
Induction &
Consolidation/1st
phase - 1st ,2nd ,
3rd , 4th & 5th
months
550
550
16-Jan-15
6-Jul-15
70000
235051
63000
6300
56700
IDBI - 321
30-Oct-15
ALL
CANCER
Medical Oncology
Acute Lymphoblastic
Leukemia
BANGALORE
SOUTH
Ca Cervix III B
CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
16-Feb-15
22-Apr-15
80000
81315
28750
2875
25875
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Cervix III B
CANCER
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
27-Jan-15
27-Feb-15
34500
36400
10000
1000
9000
IDBI - 321
30-Oct-15
CA RT BREAST
STAGE IV
CANCER
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
16-Jan-15
3-Apr-15
22500
136152
11250
1125
10125
IDBI - 321
30-Oct-15
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Rectum post
op
CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
3-Feb-15
19-Aug-15
74000
86110
72680
7268
65412
IDBI-294
9-Oct-15
Belgaum
VYDEHI
HOSPITAL
BANGALORE
B-Cell All
CANCER
Medical Oncology
Acute Lymphoblastic
Leukemia
Induction &
Consolidation/1st
phase - 1st ,2nd ,
3rd , 4th & 5th
months
550
550
14-Jan-15
7-Sep-15
70000
70000
7000
63000
IDBI - 321
30-Oct-15
113 H_21052246851
Male
12
Others IGOOR
SAKLESHPURA
HASSAN
Mysore
114 H_20082246551
Female
39
Others MALAPANAHALLI
KORATAGERE
TUMKUR
Bangalore
115 H_20082245662
Female
58
Others KORLAPARTHI
CHINTAMANI
CHIKKABALLAPU
Bangalore
R
116 H_21052245647
Female
41
Minorit
KALIHITHLU
y
KUNDAPURA
UDUPI
Mysore
117 H_19567246437
Female
52
Others Gamanagatti
DHARWAD
DHARWAD
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
118 H_19574245061
Male
6
Others GADYALA
JAMAKHANDI
119 H_20082245331
Female
67
Others DB PURA NEAR
RURAL
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca Vault stage III CANCER
Medical Oncology
Cervical Cancer
Weekly
Cisplatin/Week
509
509
4-Feb-15
6-Mar-15
60000
87125
20000
2000
18000
IDBI - 321
30-Oct-15
120 H_19574245679
Female
15
Minorit
KRISHANANAGARA
y
HUBLI
DHARWAD
Belgaum
VYDEHI
HOSPITAL
BANGALORE
Ewing sarcoma
of right
hemipelvis
CANCER
Medical Oncology
Ewings sarcoma
Variable
Regimen/Month
545
545
9-Feb-15
20-Aug-15
36000
36000
36000
3600
32400
IDBI - 321
30-Oct-15
121 H_19505243552
Male
39
YELANDUR
CHAMARAJANA
Mysore
GAR
Bharath
Hospital
Institute of
Oncology
Mysore
CA
OESOPHAGUS
T3N1M0 III A
CANCER
Medical Oncology
Head & Neck
Carboplatin +
Paclitaxel/Cycle
Max. of 6 cycles
only
521
521
20-Jan-15
23-Jan-15
86000
5025
0
5025
IDBI - 321
30-Oct-15
122 H_21052245540
Male
54
Others KEMMINJE
PUTTUR
DAKSHINA
KANNADA
Mysore
CA STOMACH
STAGE III
CANCER
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
16-Jan-15
23-Jan-15
45000
19921
3750
375
3375
IDBI - 321
30-Oct-15
123 H_20082243491
Male
60
Others KURUPETE
KANAKAPURA
RAMANAGAR
Bangalore
Kidwai
Memorial
Institute of
Oncology
ca Oesophagus
T3N1Mo
CANCER
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
21-Jan-15
20-Feb-15
20000
22220
10000
1000
9000
IDBI - 321
30-Oct-15
124 H_21052244309
Female
47
Others KADEKAR
UDUPI
UDUPI
Mysore
CA LEFT BREAST
CANCER
STAGE T3 N1 M0
Medical Oncology
Breast
501
501
12-Jan-15
20-Jun-15
56000
110660
39200
3920
35280
IDBI - 321
30-Oct-15
125 H_20082242487
Female
53
Others CHILNAHALLI
ARASIKERE
HASSAN
Mysore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca Cervix III B
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
21-Jan-15
5-Mar-15
32500
38055
11000
1100
9900
IDBI - 321
30-Oct-15
BANGALORE
NORTH
GLIDBLASTOMA
MULTIFORME
(GRADE4) OF RT CANCER
TEMPORAL LOBE
POST OP
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
1-Jan-15
16-Jan-15
85000
85000
42500
4250
38250
IDBI - 321
30-Oct-15
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
5-Feb-15
11-Feb-15
65000
65000
32500
3250
29250
IDBI - 321
30-Oct-15
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
10-Feb-15
17-Apr-15
107000
22000
0
22000
IDBI - 321
30-Oct-15
SC
AMBALE
BAGLAKOT
CANCER
Disease Main
Category
BANGALORE
SOUTH
126 H_20010242317
Male
50
Others SHIVAPURA
JEVARGI
GULBARGA
Gulbarga
M S Ramaiah
Hospital
127 H_20076251397
Female
73
Others BANGALORE
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
Suguna Hospital BANGALORE
Bangalore
NORTH
CAD-SINGLE
VESSEL DISEASE
YELANDUR
CHAMARAJANA
Mysore
GAR
Bharath
Hospital
Institute of
Oncology
CA BOT
T4N2aM0
128 H_19505250185
Male
57
SC
HONNURU
Mysore
CANCER
CARDIOLOGY
CANCER
Adriamycin/Cyclop
hosphamide
(AC)/Cycle
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
129 H_19574250733
Male
16
Others CHAMANALLI
YADGIR
YADGIRI
Gulbarga
130 H_20082249399
Male
43
Minorit
SSPALYA
y
MAGADI
RAMANAGAR
Bangalore
131 H_19505243543
Female
47
Minorit
MANDI MOHALLA
y
MYSORE
MYSORE
Mysore
132 H_21052247616
Male
38
Others KATEEL
MANGALORE
DAKSHINA
KANNADA
Mysore
133 H_19505243492
Female
35
Others HASSAN
HASSAN
HASSAN
Mysore
134 H_22478249305
Male
32
Others B.SEEHALLI
T NARASIPUR
MYSORE
Mysore
135 H_20968248690
Female
46
#174,K.S.C.B. KALONI
Minorit
KALYANIGIRI
MYSORE
y
NAGARA WARD 65
MYSORE
Mysore
136 H_21052248651
Male
38
Others GAVATOOR
HOSANAGARA
SHIMOGA
Bangalore
137 H_20082245311
Female
40
Others BHADRAVATI
BHADRAVATHI
SHIMOGA
Bangalore
138 H_20082247313
Male
57
Others RT NAGARA
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
Hospital Name
VYDEHI
HOSPITAL
Hospital
District
SHIKARIPURA
SHIMOGA
Bangalore
145 H_19505259844
Male
49
GUNDLUPET
146 H_20082259053
Male
6
HUBLI
147 H_22472257852
Male
36
ST
KANIYANAPURA
Others MANTUR
ST
0
INDI
63000
IDBI - 321
30-Oct-15
Radical
Hysterectomy
594
594
16-Feb-15
1-Mar-15
40000
47900
14750
1475
13275
IDBI - 321
30-Oct-15
501
501
18-Feb-15
1-Sep-15
106000
103000
0
103000
IDBI - 321
30-Oct-15
550
550
22-Jan-15
4-Mar-15
70000
7000
700
6300
IDBI - 321
30-Oct-15
32175
0
32175
IDBI - 321
30-Oct-15
13750
1375
12375
IDBI - 321
30-Oct-15
47000
4700
42300
IDBI - 321
30-Oct-15
9-Feb-15
18-May-15
80000
LEFT VUJ
CALCULUS WITH RENAL
GRADE II HUN
Genito Urinary
Surgery
Urology
URSL - Single Side
909
909
29-Jan-15
4-Feb-15
27500
Krishnarajendra
MYSORE
Hospital
CA. (L) BREST
STAGE:
PY3N2M0
CANCER
Medical Oncology
Breast
AC (AC then
T)/Cycle
503
503
28-Jan-15
21-Aug-15
12000
CA STOMACH
STAGE IV .
CANCER
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
22-Jan-15
28-May-15
45000
112100
22500
2250
20250
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Cervix stage
III B
CANCER
Medical Oncology
Cervical Cancer
Weekly
Cisplatin/Week
509
509
3-Feb-15
25-Apr-15
32000
35775
22400
2240
20160
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca right PFS
cT4bN2bM0
CANCER
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
9-Jan-15
18-Feb-15
20000
23690
4750
475
4275
IDBI - 321
30-Oct-15
Induction &
Consolidation/1st
phase - 1st ,2nd ,
3rd , 4th & 5th
months
550
550
28-Jan-15
9-Jul-15
70000
70250
70000
7000
63000
IDBI - 321
30-Oct-15
SIOP/NWTS
regimen(Stages I III)/Month
538
538
29-Jan-15
8-Apr-15
42000
538
13750
1375
12375
IDBI - 321
30-Oct-15
550
550
11-Mar-15
9-Aug-15
70000
69500
6950
62550
IDBI - 321
30-Oct-15
502
502
3-Mar-15
19-Aug-15
3100
33600
3360
30240
IDBI - 321
30-Oct-15
501
501
11-Mar-15
1-Apr-15
3000
6000
2800
0
2800
IDBI - 321
30-Oct-15
501
501
4-Mar-15
4-Aug-15
3000
56000
56000
5600
50400
IDBI - 321
30-Oct-15
533
533
10-Mar-15
18-Aug-15
8000
48000
48000
0
48000
IDBI - 321
30-Oct-15
550
550
6-Mar-15
3-Aug-15
70000
81445
70000
7000
63000
IDBI - 321
30-Oct-15
612
612
3-Mar-15
10-Mar-15
25000
35000
17500
1750
15750
IDBI - 321
30-Oct-15
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
CANCER
BANGALORE
SOUTH
ALL
CANCER
Medical Oncology
Acute Lymphoblastic
Leukemia
Wilms Tumor
CANCER
Medical Oncology
Wilm's Tumor
Krishnarajendra
MYSORE
Hospital
Bharath
Hospital
Mysore
Institute of
Oncology
all
CANCER
Medical Oncology
Acute Lymphoblastic
Leukemia
ca. (L)breast
PT2N0M0
CANCER
Medical Oncology
Breast
CA LEFT BREAST
CANCER
T4N0M0 III B
Medical Oncology
Breast
MANGALORE
INSTITUTE OF
ONCOLOGY
MANGALORE
CA RIGHT
CANCER
BREAST T3N2M0
Medical Oncology
Breast
CHAMARAJANA
Mysore
GAR
Bharath
Hospital
Institute of
Oncology
Mysore
HODGKINS
LYMPHOMA
CANCER
Medical Oncology
Lymphoma-Hodgkin
disease
DHARWAD
Belgaum
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
ALL
CANCER
Medical Oncology
Acute Lymphoblastic
Leukemia
Belgaum
Shri
Siddheshwar
Cancer Hospital Solapur
and Research
Cent
Cancer -Tongue
CANCER
Surgical Oncology
Head & Neck
BIJAPUR
7000
565
Bangalore
Others 0
70000
565
BANGALORE
SOUTH
62
70000
Radical Treatment
with Photons
Kidwai
Memorial
Institute of
Oncology
Female
70000
Linear Accelerators
BANGALORE URBAN
144 H_20575259609
21-Aug-15
Radiation Oncology
BANGALORE
SOUTH
Mysore
7-Feb-15
CA RIGHT
BREAST T3N1M0 CANCER
III A
Bharath
Hospital
Mysore
Institute of
Oncology
SHREE
MAHADESHWA
MYSORE
RA NURSING
HOME
BANGALORE
SOUTH
KODAGU
550
Acute Lymphoblastic
Leukemia
Kidwai
Memorial
Institute of
Oncology
VIJAPET
550
Medical Oncology
Bangalore
Others GUDDEHOSURU
Induction &
Consolidation/1st
phase - 1st ,2nd ,
3rd , 4th & 5th
months
ALL
BANGALORE URBAN
72
Breast
BANGALORE
EAST
Male
Net Amt
Paid
Medical Oncology
Minorit
AYOTHINAGARA
y
143 H_19505259853
TDS
CA LEFT BREAST
CANCER
T2N2M0 III A
1
Mysore
Gross
Amount
approved by
Mysore
Male
CHANNARAYAP
HASSAN
ATNA
Hospital
claimed
Amount
Gynaec
140 H_20082247295
Others ULLAVALLI
Preauth
Approved
Amt
Surgical Oncology
Gulbarga
54
Date of
Discharge
ca endometrium
CANCER
III
GULBARGA
Female
Date of
Admission
BANGALORE
SOUTH
Kidwai
Memorial
Institute of
Oncology
Bharath
Hospital
Institute of
Oncology
JEVARGI
142 H_20968259632
Medical Oncology
Others HARANOOR
ELEKUNTE
Plan of
treatment
CANCER
18
SC
Acute leukemia
Female
5
Disease Main
Category
BANGALORE
139 H_20082247770
Female
Diseases
Acute Lymphoblastic
Leukemia
Kidwai
Memorial
Institute of
Oncology
141 H_20082260057
Final
Diagnosis
Adriamycin/Cyclop
hosphamide
(AC)/Cycle
Induction &
Consolidation/1st
phase - 1st ,2nd ,
3rd , 4th & 5th
months
Induction &
Consolidation/1st
phase - 1st ,2nd ,
3rd , 4th & 5th
months
5- Fluorouracil AC (FAC)/Cycle
Adriamycin/Cyclop
hosphamide
(AC)/Cycle
Adriamycin/Cyclop
hosphamide
(AC)/Cycle
Dacarbazine
(DBVD)/Cycle
(Day1 & Day12)
Induction &
Consolidation/1st
phase - 1st ,2nd ,
3rd , 4th & 5th
months
Neck Dissection any type
54447
27500
Sl.No
Preauth No
148 H_19505259599
Gender
Age
Caste
Male
34
SC
Village
HONGALLI
Taluk
Patient District
Patient
Division
Hospital Name
GUNDLUPET
CHAMARAJANA
Mysore
GAR
Bharath
Hospital
Institute of
Oncology
DAKSHINA
KANNADA
Mysore
MANGALORE
INSTITUTE OF
ONCOLOGY
Gulbarga
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Mysore
CA
OESOPHAGUS
cT3N0
MANGALORE
NON HODGKINS
LYMPHOMA
CANCER
STAGE III
Medical Oncology
Lymphoma-NHL
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Cervix IV B
CANCER
Medical Oncology
unlisted regimen
CANCER
Surgical Oncology
Esophagus
Plan of
treatment
Oesophagectomy
with Three field
Lymphadenectomy
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
100000
37500
0
37500
IDBI - 321
30-Oct-15
25200
2520
22680
IDBI - 321
30-Oct-15
674
674
11-Mar-15
24-Mar-15
90000
534
534
27-Feb-15
26-Jun-15
6000
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
7-Mar-15
10-Mar-15
7500
7500
0
0
0
IDBI-294
9-Oct-15
120000
50000
5000
45000
IDBI - 321
30-Oct-15
20000
2000
18000
IDBI - 321
30-Oct-15
Cyclophosphamide
- Doxorubicin
(CHOP)/Cycle
(Day1 & Day12)
149 H_20575258519
Female
63
Others MIJAR
MANGALORE
150 H_19567258848
Male
42
Others Pura
HUVINAHADAG
BELLARY
ALI
151 H_20025255454
Female
65
Others HARADANAHALLI
Mysore
GAR
GAR
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
CA RETRO
ARYTENOID, T3
N0
CANCER
Surgical Oncology
Head & Neck
Laryngectomy
with Voice
Prosthesis
618
618
2-Mar-15
20-May-15
60000
152 H_20575257003
Male
52
Others 0
THIRTHAHALLI
SHIMOGA
Bangalore
MANGALORE
INSTITUTE OF
ONCOLOGY
MANGALORE
CA
OESOPHAGUS
STAGE III
CANCER
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
24-Feb-15
15-Sep-15
7500
153 H_20082258031
Male
83
Others DAASANAPURA
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca Vallecula
cT3N2cMo
CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
3-Mar-15
31-Mar-15
50000
65750
23750
2375
21375
IDBI - 321
30-Oct-15
154 H_20270257197
Male
21
Others LAKSHMI SAGARA
CHITRADURGA
CHITRADURGA
Bangalore
SDS TRC RGICD
JAYANAGAR
POST
TUBERCULAR
EMPYEMA (RT)
CARDIOLOGY
Cardiothoracic Surgery Thoracic Surgery
Decortication
192
192
28-Jan-15
17-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
HODGKIN S
LYMPHOMA
533
533
18-Mar-15
29-Jul-15
8000
28033
27164
815
26349
IDBI - 321
30-Oct-15
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
ca nasopharynx
t4n1m0
CHAMARAJANA
Mysore
GAR
SJICR MYSORE
MYSORE
BANGALORE
SOUTH
155 H_19528256744
Male
20
Others NEERAMANVI
YELANDUR
156 H_20082254968
Male
23
Minorit
BEEDI COLONY
y
157 H_20733255818
Female
43
Others YALANDURU
MANVI
RAICHUR
Medical Oncology
Lymphoma-Hodgkin
disease
Dacarbazine
(DBVD)/Cycle
(Day1 & Day12)
CANCER
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
11-Mar-15
5-May-15
100000
111515
50000
5000
45000
IDBI - 321
30-Oct-15
RHD/Sev MS
CARDIOLOGY
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
20-Feb-15
21-Feb-15
20000
20000
9000
900
8100
IDBI - 321
30-Oct-15
Grade I SCC (Rt)
Buccal Mucosa
CANCER
Surgical Oncology
Head & Neck
Laser Surgery
622
622
26-Dec-14
2-Mar-15
10000
34135
12500
1250
11250
IDBI - 321
30-Oct-15
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
17-Feb-15
20-Apr-15
7500
15000
7500
750
6750
IDBI - 321
30-Oct-15
512
512
27-Jan-15
12-Aug-15
10500
63000
63000
6300
56700
IDBI - 321
30-Oct-15
CANCER
158 H_20082255795
Female
70
Others BETHAMANGALA
BANGARPET
KOLAR
Bangalore
Kidwai
Memorial
Institute of
Oncology
159 H_22254254851
Male
24
Others bidar
BIDAR
BIDAR
Gulbarga
BIBI GENERAL
CANCER CENTER
CA BUCCAL
MUCOSA
CANCER
Medical Oncology
unlisted regimen
Medical Oncology
Ovarian Cancer
160 H_21132254389
Female
52
Others MADAPURA
ARASIKERE
HASSAN
Mysore
Shree
Chamarajendra Hassan
Hospital/HIMS
c/o distension of
abdomen 1 year
back ,usg
abdomen pelivis
scan showed
serons papillamy CANCER
cystadeno
carcinoma of
oram hpe
showed,mod
diffuentialed,
161 H_19505254516
Female
70
Others MANCHALLI
VIJAPET
KODAGU
Mysore
Bharath
Hospital
Institute of
Oncology
CA LEFT
ALVEOLUS
cT4aN0/1M0
CANCER
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
23-Feb-15
5-Mar-15
60000
60000
30000
0
30000
IDBI - 321
30-Oct-15
162 H_21052254770
Male
68
Others BADEKOTTU
BELTHANGADI
DAKSHINA
KANNADA
Mysore
CA STOMACH
STAGE IV
CANCER
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
9-Feb-15
6-Apr-15
7500
51409
11250
1125
10125
IDBI - 321
30-Oct-15
163 H_21052253887
Female
34
Others BELUR
BELUR
HASSAN
Mysore
CA LEFT BREAST
CANCER
STAGE IV
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
9-Feb-15
23-Feb-15
7500
16474
3750
375
3375
IDBI - 321
30-Oct-15
164 H_19505252047
Male
58
Others GOPANAHALLI
MADDUR
MANDYA
Mysore
Bharath
Hospital
Institute of
Oncology
CA STOMACH
WITH NODEL
AND OMENTAL
METS IV
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
18-Feb-15
8-Apr-15
7500
5000
0
5000
IDBI - 321
30-Oct-15
Mysore
Mysore
CANCER
Carboplatin/Paclit
axel/Cycle
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
10-Feb-15
14-Apr-15
100000
90000
45000
4500
40500
IDBI - 321
30-Oct-15
165 H_22254252330
Male
51
Others nidgunda
CHINCHOLI
GULBARGA
Gulbarga
BIBI GENERAL
CANCER CENTER
166 H_22254251671
Male
62
Others bidar
BIDAR
BIDAR
Gulbarga
BIBI GENERAL
CANCER CENTER
ca left maxilla
CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
26-Jan-15
3-Mar-15
50000
60000
30000
3000
27000
IDBI - 321
30-Oct-15
167 H_20082252552
Male
55
Others MUNDURU
KR NAGAR
MYSORE
Mysore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca Glottis
T4N0Mx
CANCER
Surgical Oncology
Head & Neck
617
617
16-Feb-15
2-Mar-15
40000
47455
20000
2000
18000
IDBI - 321
30-Oct-15
168 H_20575251056
Female
47
Minorit
BARYA
y
BELTHANGADI
DAKSHINA
KANNADA
Mysore
MANGALORE
INSTITUTE OF
ONCOLOGY
MANGALORE
CA RIGHT
BREAST
T4BN2M0
CANCER
Medical Oncology
Breast
501
501
5-Feb-15
13-Jul-15
3000
56000
56000
5600
50400
IDBI - 321
30-Oct-15
169 H_20082267004
Male
37
Others BANNI KUPPE
RAMANAGAR
RAMANAGAR
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
ca breast txnxmo CANCER
Medical Oncology
Breast
FEC (Epirubicin
based)/Cycle
504
504
1-Apr-15
24-Aug-15
5000
48000
4800
43200
IDBI - 321
30-Oct-15
170 H_20815266669
Female
40
Others BIJAPUR
BIJAPUR
BIJAPUR
Belgaum
CHIRAYU
HOSPITAL
GULBARGA
Ca Breast T4N1
Medical Oncology
Breast
Adriamycin/Cyclop
hosphamide
(AC)/Cycle
501
501
6-Apr-15
29-Aug-15
3000
56000
5600
50400
IDBI - 321
30-Oct-15
171 H_20082265161
Male
45
Others MELEKOTE
RURAL
BANGALORE
SOUTH
ca (Lt) Pyriform
CANCER
Fossa (cT2N0M0
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
10-Apr-15
30-Jul-15
20000
18000
1800
16200
IDBI - 321
30-Oct-15
172 H_20082266513
Female
53
Others SHANKARPURA
CHIKKAMAGALU CHIKKAMANAGL
Mysore
R
UR
BANGALORE
SOUTH
Follicular
lymphoma stage CANCER
III B
Medical Oncology
Lymphoma-NHL
Cyclophosphamide
- Doxorubicin
Vincristine Prednis
534
534
16-Apr-15
18-Aug-15
6000
30000
3000
27000
IDBI - 321
30-Oct-15
173 H_21052261952
Male
62
Others KUMBALUR
HONNALI
CARCINOMA
OESOPHAGUS
STAGE III
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30
568
568
5-Mar-15
16-May-15
75000
53500
5350
48150
IDBI - 321
30-Oct-15
174 H_20968266191
Female
36
Krishnarajendra
MYSORE
Hospital
Ca. (R) BREAST,
T3N1M0
CANCER
Medical Oncology
Breast
Adriamycin/Cyclop
hosphamide
(AC)/Cycle
501
501
23-Mar-15
27-Aug-15
3000
56000
5600
50400
IDBI - 321
30-Oct-15
175 H_20082264986
Male
72
Others WARD 07
KADUR
CHIKKAMANAGL
Mysore
UR
Kidwai
Memorial
Institute of
Oncology
Ca right Tonsil
CT1N2bM0
CANCER
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
567
567
15-May-15
2-Jul-15
100000
104485
94000
9400
84600
IDBI - 321
30-Oct-15
176 H_21052266020
Male
54
Others HANTHOOR
MUDIGERE
CHIKKAMANAGL
Mysore
UR
CA ESOPHAGUS
STAGE III
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30
568
568
12-Mar-15
15-May-15
75000
87512
39500
3950
35550
IDBI - 321
30-Oct-15
PROSTATOMEGA
LY WITH
RENAL
BLADDER
OUTLET
OBSTRUCTION
Genito Urinary
Surgery
Urology
TURP
917
917
18-Mar-15
28-Mar-15
20000
34233
10000
1000
9000
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
CA CERVIX I B
CANCER
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
26-Mar-15
23-Apr-15
20000
44960
14750
1475
13275
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
all
CANCER
Medical Oncology
Acute Lymphoblastic
Leukemia
Induction &
Consolidation/1st
phase - 1st ,2nd ,
3rd
550
550
20-Mar-15
18-Aug-15
70000
70000
7000
63000
IDBI - 321
30-Oct-15
a case of ca
oropharynx
t3n1m
CANCER
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
567
567
19-Mar-15
13-Jun-15
100000
78329
53200
5320
47880
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
NHL Stage II
CANCER
Medical Oncology
Lymphoma-NHL
Cyclophosphamide
- Doxorubicin
Vincristine Prednis
534
534
24-Mar-15
28-Apr-15
6000
24245
17500
1750
15750
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Lung T4N3M1 CANCER
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
24-Mar-15
30-Mar-15
7500
56335
2750
275
2475
IDBI - 321
30-Oct-15
SC
KUMBESHWARA
COLONY
DAVANGERE
Bangalore
Bangalore
Mysore
GAR
GAR
CANCER
Adriamycin/Cyclop
hosphamide
(AC)/Cycle
142498
Male
82
Others GOVINAHALU
HARIHARA
178 H_20082265793
Female
66
Others HANDANAKERE
CHIKKANAYAKA
TUMKUR
NAHALLI
Bangalore
179 H_20082265628
Female
9
Others LAGGERE
BANGALORE
EAST
BANGALORE URBAN
Bangalore
180 H_22254265531
Male
54
BIDAR
BIDAR
Gulbarga
181 H_20082265156
Male
27
Minorit
VINYANAGAR
y
BANGALORE
EAST
BANGALORE URBAN
Bangalore
182 H_20082264329
Female
46
Others JAYANAGAR
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
183 H_20968264289
Male
28
Others K.R.NAGARA
KR NAGAR
MYSORE
Mysore
Krishnarajendra
MYSORE
Hospital
embryoscal cell
and testis
CANCER
Medical Oncology
Testicular Cancer
BleomycinEtoposideCisplatin
(BEP)/Cycle
517
517
17-Mar-15
17-Jul-15
8000
32000
32000
3200
28800
IDBI - 321
30-Oct-15
184 H_20082264126
Female
45
Others
RAMANAGAR
Bangalore
Kidwai
Memorial
Institute of
Oncology
ca stomach III
CANCER
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
4-Apr-15
28-Jul-15
7500
32525
30000
3000
27000
IDBI - 321
30-Oct-15
CHITTA
MANCHANAYAKANA
RAMANAGAR
HALLY
Bangalore
BANGALORE
SOUTH
CANCER
177 H_21052266060
SC
DAVANGERE
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
CA EPIGLOTTIS
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
BIBI GENERAL
CANCER CENTER
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Sl.No
Preauth No
Caste
185 H_20082259889
Male
62
Others GOWDANAPALYA
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
186 H_20082264102
Female
13
Others LINGAPURA
HONNALI
DAVANGERE
Bangalore
187 H_21052264342
Female
62
Others THENKULIPADI
MANGALORE
DAKSHINA
KANNADA
Mysore
188 H_20082264290
Female
60
Others AKKANAHALLI
CHANNARAYAP
HASSAN
ATNA
Mysore
189 H_20575264045
Female
27
Others MADE
MADIKERI
Mysore
190 H_20082261046
Female
67
Others MALLAPPANAHALLI
HOLENARSIPUR HASSAN
Mysore
191 H_20082262200
Male
3
Others BILIGERE
NANJANAGUD
MYSORE
Mysore
192 H_19567263750
Female
29
Others Kurtkoti
GADAG
GADAG
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
193 H_22254262836
Female
40
Others GARAKPALLY
CHINCHOLI
GULBARGA
Gulbarga
BIBI GENERAL
CANCER CENTER
194 H_20082263081
Female
10
Others KYALSANAHALLI
BANGALORE
EAST
BANGALORE URBAN
Bangalore
195 H_20082262209
Male
2
Others UDBOORKAVAL
HUNSUR
MYSORE
Mysore
196 H_20082262213
Female
2
Minorit BADAROZNOORBAG
GULBARGA
y
H
GULBARGA
Gulbarga
197 H_19562262789
Female
45
Beeranahalli
Taluk
Patient District
KODAGU
KADUR
CHIKKAMANAGL
Mysore
UR
BANGALORE URBAN
Bangalore
198 H_20082261006
Female
53
Others GOTTIGERE
BANGALORE
SOUTH
199 H_20082260803
Male
51
Others HEGGURU
T NARASIPUR
MYSORE
Mysore
200 H_20082261494
Male
48
Others BAVANINAGARA
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
201 H_20082261782
Male
36
Minorit
GALIPURA
y
Mysore
GAR
GAR
202 H_19505261071
Female
85
Others AGASARAHALLI
KR PET
MANDYA
Mysore
203 H_20082260426
Female
47
Others SABBANAKUPPE
SHRIRANGAPAT
MANDYA
NA
Mysore
204 H_20733269187
Male
42
Others BASAVAIYA KERI
MALAVALLI
MANDYA
Mysore
Hospital Name
Hospital
District
Age
SC
Village
Patient
Division
Gender
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
Bharath
Hospital
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
SJICR MYSORE
Diseases
Disease Main
Category
Plan of
treatment
BANGALORE
SOUTH
Ca tonsil
ct4n2bm0
CANCER
Medical Oncology
Cervical Cancer
Weekly
Cisplatin/Week
BANGALORE
SOUTH
all
CANCER
Medical Oncology
Acute Lymphoblastic
Leukemia
ALL
CANCER
Medical Oncology
Acute Lymphoblastic
Leukemia
BANGALORE
SOUTH
CA LUNG
T3N1M1
CANCER
Radiation Oncology
Radiotherapy
Treatment
MANGALORE
CA LEFT BREAST
CANCER
T2N2M0
Medical Oncology
Breast
BANGALORE
SOUTH
verrecous
carcinoma
T3N1M0
CANCER
Surgical Oncology
BANGALORE
SOUTH
All
CANCER
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
509
509
16-Mar-15
7-May-15
2000
15750
1575
14175
IDBI - 321
30-Oct-15
550
550
20-Mar-15
17-Aug-15
70000
69500
6950
62550
IDBI - 321
30-Oct-15
550
550
13-Mar-15
1-Apr-15
70000
8400
840
7560
IDBI - 321
30-Oct-15
563
563
19-Mar-15
20-Mar-15
10000
2000
200
1800
IDBI - 321
30-Oct-15
Adriamycin/Cyclop
hosphamide
(AC)/Cycle
501
501
16-Mar-15
19-Aug-15
3000
56000
56000
5600
50400
IDBI - 321
30-Oct-15
Head & Neck
Composite
Resection &
Reconstruction
611
611
30-Mar-15
14-May-15
60000
60675
41650
4165
37485
IDBI - 321
30-Oct-15
Medical Oncology
Acute Lymphoblastic
Leukemia
Induction &
Consolidation/1st
phase - 1st ,2nd ,
3rd
550
550
18-Mar-15
13-Aug-15
70000
70000
7000
63000
IDBI - 321
30-Oct-15
Ca Rt Breast Post
CANCER
op
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30
568
568
20-Jul-15
27-Aug-15
75000
103830
95000
9500
85500
IDBI-294
9-Oct-15
ca cervix III B
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30
568
568
12-Mar-15
5-May-15
75000
88500
61950
6195
55755
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
ALL
CANCER
Medical Oncology
Acute Lymphoblastic
Leukemia
550
550
24-Feb-15
20-Aug-15
70000
69500
6950
62550
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
All
CANCER
Medical Oncology
Acute Lymphoblastic
Leukemia
550
550
14-Mar-15
13-Aug-15
70000
70000
7000
63000
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
All
CANCER
Medical Oncology
Acute Lymphoblastic
Leukemia
550
550
14-Mar-15
21-Aug-15
70000
45000
4500
40500
IDBI - 321
30-Oct-15
SHIMOGA
Ca. Cervix STAGE
CANCER
IIIB
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30
568
568
19-Mar-15
20-Jun-15
75000
75000
7500
67500
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Ovary stage III CANCER
Medical Oncology
Ovarian Cancer
Carboplatin/Paclit
axel/Cycle
512
512
20-Mar-15
17-Aug-15
10500
52000
5200
46800
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
ca tongu
t4an2cm0
CANCER
Medical Oncology
Cervical Cancer
Weekly
Cisplatin/Week
509
509
18-Mar-15
20-Apr-15
2000
36305
3000
300
2700
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
CA (Rt) Buccal
Mucosa
cT4aN2cMx
CANCER
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
18-Mar-15
24-Mar-15
20000
36905
3750
375
3375
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Hodgkin
lymphoma stage CANCER
III
Medical Oncology
Lymphoma-Hodgkin
disease
533
533
18-Mar-15
27-May-15
8000
49575
14000
1400
12600
IDBI - 321
30-Oct-15
Mysore
CA,CERVIX
STAGE IV
CANCER
Radiation Oncology
Linear Accelerators
566
566
13-Mar-15
14-Mar-15
20000
4000
2000
0
2000
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Breast(r)
T3N1Mo
CANCER
Medical Oncology
Breast
FEC (Epirubicin
based)/Cycle
504
504
11-Mar-15
20-Jul-15
5000
49340
34675
3468
31207
IDBI - 321
30-Oct-15
MYSORE
ACS-Extensive
Anterior wall MI,
CARDIOLOGY
Cardiac Aresst,
CAD/SVD
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
31-Mar-15
31-Mar-15
65000
65000
32000
3200
28800
IDBI - 321
30-Oct-15
Kidwai
Memorial
Institute of
Oncology
MANGALORE
INSTITUTE OF
ONCOLOGY
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
Final
Diagnosis
Cardiology
Induction &
Consolidation/1st
phase - 1st ,2nd ,
3rd
Induction &
Consolidation/1st
phase - 1st ,2nd ,
3rd
Induction &
Consolidation/1st
phase - 1st ,2nd ,
3rd
Induction &
Consolidation/1st
phase - 1st ,2nd ,
3rd
Induction &
Consolidation/1st
phase - 1st ,2nd ,
3rd
Dacarbazine (D
Palliative
Treatment with
Photons (linear
accelarato
48040
77500
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
83357
37500
3750
33750
IDBI - 321
30-Oct-15
5250
0
5250
IDBI - 321
30-Oct-15
6250
625
5625
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
21-Mar-15
10-Jun-15
83000
CA
PYRIFORMFOSSA CANCER
T3N1M0 III
Medical Oncology
Head & Neck
Carboplatin +
Paclitaxel/Cycle
Max. of 6 cycles
only
521
521
7-Apr-15
9-Apr-15
107000
Genito Urinary
Surgery
Urology
URSL - Single Side
909
909
20-Mar-15
13-Apr-15
37500
501
501
31-Mar-15
15-Sep-15
56000
56000
5600
50400
IDBI - 321
30-Oct-15
15425
1543
13882
IDBI - 321
30-Oct-15
205 H_21052266933
Male
50
206 H_19505261800
Male
89
Others BOGANAHALLI
PIRIYAPATNA
MYSORE
Mysore
Bharath
Hospital
Institute of
Oncology
207 H_20790267174
Male
38
Others Bhayranahalli
NAGAMANGALA MANDYA
Mysore
Sri
Adichunchanagi
B G Nagara
ri Hospital and
Research Center
B/L Ureateric
calculai.
208 H_20575269220
Female
41
Others HILLUR
ANKOLA
UTTARA
KANNADA
Belgaum
MANGALORE
INSTITUTE OF
ONCOLOGY
MANGALORE
CA RIGHT
CANCER
BREAST T3N1M0
Medical Oncology
Breast
209 H_20082266527
Female
32
Others MALURU
MALUR
KOLAR
Bangalore
BANGALORE
SOUTH
ca breast (Rt)
Stage IV
CANCER
Medical Oncology
Breast
Tamoxifen
tabs/Month
507
507
1-Apr-15
14-Aug-15
18510
210 H_20082267559
Female
33
Others
GULBARGA
GULBARGA
Gulbarga
BANGALORE
SOUTH
CA OVARY stage
CANCER
III
Surgical Oncology
Gynaec
Surgery for Ca
Ovary - advance
stage
596
596
30-Mar-15
13-Apr-15
40000
45570
19750
1975
17775
IDBI - 321
30-Oct-15
POST BURN RAW
AREA OVER LT
MEDIAL ASPECT
BURNS
OF FOOT WITH
GANGRENE OF
TOES
Burns
Burns
upto-40% Mixed
Burns(with
grafting)
3
3
10-Apr-15
21-Apr-15
40000
40000
20000
2000
18000
IDBI - 321
30-Oct-15
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
31-Mar-15
20-Aug-15
45000
22500
2250
20250
IDBI - 321
30-Oct-15
501
501
31-Mar-15
13-May-15
9000
9000
6300
0
6300
IDBI - 321
30-Oct-15
550
550
30-Mar-15
30-Jul-15
70000
80700
70000
7000
63000
IDBI - 321
30-Oct-15
7500
750
4
746
IDBI - 321
30-Oct-15
28500
2850
25650
IDBI - 321
30-Oct-15
211 H_20025263957
Female
25
Others TIGER BLOCK
212 H_20613267850
Female
63
213 H_19505266486
Female
48
Others HULLENAHALLI
214 H_20082267783
Male
13
Others HANGARAHALLI
SC
Nilogi
GULBARGA
Gulbarga
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
ca breast
Relapsed IV
CANCER
Medical Oncology
unlisted regimen
CHANNARAYAP
HASSAN
ATNA
Mysore
Bharath
Hospital
Institute of
Oncology
Mysore
CA RIGHT
BREAST STAGE
T4bN1M0 IIIB
CANCER
Medical Oncology
Breast
HOLENARSIPUR HASSAN
Mysore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
all
CANCER
Medical Oncology
Acute Lymphoblastic
Leukemia
HUBLI
Carcinoma
Middle & Lower
1/3rd Esophagus
CANCER
+ Carcinoma
Pyriform Tossa
Lung Metastatis
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
1-Apr-15
2-Apr-15
45000
MANGALORE
CA LEFT BREAST
T3N2M1 WITH CANCER
LIVER METS
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
26-Mar-15
3-Aug-15
15000
Adriamycin/Cyclop
hosphamide
(AC)/Cycle
Induction &
Consolidation/1st
phase - 1st ,2nd ,
3rd , 4th & 5th
months
Others Kulagod
GOKAK
BELGAUM
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Ca Cervix IV A
CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
31-Mar-15
6-Aug-15
73500
73500
60500
6050
54450
IDBI - 321
30-Oct-15
Others AMBEDKAR HUTS
BANGALORE
EAST
BANGALORE URBAN
Bangalore
Kidwai
Memorial
Institute of
Oncology
ca esophagus
t3n2m0
CANCER
Medical Oncology
Cervical Cancer
Weekly
Cisplatin/Week
509
509
21-May-15
15-Jul-15
62000
72255
59500
5950
53550
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
25-Mar-15
6-Jun-15
75000
193547
51100
5110
45990
IDBI - 321
30-Oct-15
217 H_19504265383
Female
65
218 H_20082268541
Male
45
22
JEVARGI
MANGALORE
INSTITUTE OF
ONCOLOGY
Others
Male
Mysore
Bangalore
43
221 H_20698279301
MYSORE
CHITRADURGA
Female
60
MYSORE
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
CHALLAKERE
216 H_20575267608
Male
Adriamycin/Cyclop
hosphamide
(AC)/Cycle
37500
Belgaum
Minorit
Indra Nagar
y
220 H_21052267881
RENAL
UTTARA
KANNADA
62
57
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
Mysore
MUNDAGODA
Male
Female
CA RECTUM T3
CANCER
NO MO POST OP
HCG NMR
CURIE CENTRE
OF ONCOLOGY
215 H_19569267520
219 H_21052268691
Mysore
Hospital
District
NEETTANIGE
Others
MUDNUR
BASAVALINGA
NAGARA
PUTTUR
DAKSHINA
KANNADA
Hospital Name
VEERADIMMANA
HALLI
Others HALE NIDANEGILU
SC
SASIHITHLU
Others CHORANOOR
BANGALORE
SOUTH
HIREKERUR
HAVERI
Belgaum
CA CERVIX /
VAGINAL VAULT CANCER
STAGE 3
MANGALORE
DAKSHINA
KANNADA
Mysore
CA THYROID
STAGE IV
CANCER
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
23-Mar-15
21-Apr-15
20000
30928
6000
600
5400
IDBI - 321
30-Oct-15
SANDUR
BELLARY
Gulbarga
YENEPOYA
MEDICAL
COLLEGE
HOSPITAL
RIGHT RENAL
CELL
CARCINOMA T2
N0 M0
RENAL
Genito Urinary
Surgery
Urology
Lap. Nephrectomy
Radical (Lap
920
920
23-Apr-15
19-May-15
50000
50000
35000
3500
31500
IDBI - 321
30-Oct-15
MANGALORE
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
222 H_20127278466
Female
31
Others VALIKEHALLI
CHITRADURGA
CHITRADURGA
Bangalore
A J HOSPITAL
AND RESEARCH MANGALORE
CENTRE
CARCINOMA
RECTO SIGMOID CANCER
COLON STAGE 4
Medical Oncology
Colorectal Cancer
(FOLFOX)
(Paliation CT
only)/Week Max. 6
cycles
223 H_20082276884
Male
61
Others N.G.HALLI
HOLALKERE
CHITRADURGA
Bangalore
Kidwai
Memorial
Institute of
Oncology
Ca Thyroid
T3N1M0
Surgical Oncology
Head & Neck
Non Hodgkins
II
Medical Oncology
Lymphoma-NHL
Ca Cervix Stage
IV
CANCER
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
2-May-15
20-Aug-15
45000
45000
45000
4500
40500
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Cervix III B
CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
13-May-15
6-Jul-15
56000
72570
54000
5400
48600
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca right Breast
Stage III
CANCER
Medical Oncology
Breast
FEC (Epirubicin
based)/Cycle
504
504
2-May-15
25-Aug-15
48000
85735
48000
4800
43200
IDBI - 321
30-Oct-15
Medical Oncology
Colorectal Cancer
(FOLFOX) (Stage III
only)/Week
530
530
30-Apr-15
15-Aug-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
4-May-15
23-Jun-15
88500
88500
49049
196
48853
IDBI - 321
30-Oct-15
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
4-May-15
4-Jul-15
85500
85500
83500
8350
75150
IDBI - 321
30-Oct-15
525
525
29-Apr-15
2-May-15
21000
21000
18900
1890
17010
IDBI - 321
30-Oct-15
555
555
1-May-15
12-Aug-15
30000
46080
25000
2500
22500
IDBI - 321
30-Oct-15
534
534
1-May-15
31-Aug-15
36000
37200
36000
3600
32400
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
224 H_19504277727
Male
60
Others Melavanki
GOKAK
BELGAUM
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
225 H_19504278469
Female
50
Others Avaradi
GOKAK
BELGAUM
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
226 H_20082277552
Female
39
Others BADANAVALU
NANJANAGUD
MYSORE
Mysore
227 H_20082278641
Female
35
Others HARDAGERE
GUBBI
TUMKUR
Bangalore
228 H_20613278990
229 H_19491278651
Female
Female
35
63
Others Kuranalli
JEVARGI
GULBARGA
Gulbarga
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
CANCER
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
Ca .colon post op
CANCER
t2 N2 M0
BGS GLOBAL
HOSPITAL
BANGALORE
SOUTH
CARCINOMA
CERVIX POST
OPERATIVE
WITH BULKY
RESIDUAL
CENTRAL AND
BILATERAL
PARAMETRIUM
Radiation Oncology
3D Conformational
Radio Therapy
Others NARASIHALLI
CHIKKANAYAKA
TUMKUR
NAHALLI
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
SHIMOGA
Ca. Cervix STAGE
CANCER
IIIB
Bangalore
CANCER
230 H_19562278945
Female
60
Others HALASUMANE
Mysore
R
UR
231 H_20114278664
Male
44
Others HALHALLI
BIDAR
BIDAR
Gulbarga
KAMINENI
HOSPITALS
HYDERABAD
CA LUNG STAGE
CANCER
III
Medical Oncology
Non-small cell lung
cancer
232 H_20082276964
Male
43
Others CHINAKAVAJRA
MADHUGIRI
TUMKUR
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
CA OESOPHAUS
CANCER
T3N1M0
Medical Oncology
unlisted regimen
Mysore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Sri
Adichunchanagi
B G Nagara
ri Hospital and
Research Center
233 H_20082277760
Female
35
Others HERAGU
HASSAN
234 H_20790278358
Male
40
Others Thattahalli
NAGAMANGALA MANDYA
Mysore
235 H_20082278137
Male
38
Minorit
BHANUVALLI
y
HARIHARA
DAVANGERE
Bangalore
236 H_20082278277
Female
51
Others BYTRYANAPURA
BANGALORE
EAST
BANGALORE URBAN
Bangalore
237 H_20082278161
Female
36
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
238 H_20082277394
Male
8
SC
DASARAHALLI
Others GOLLARAHATTI
TURVEKERE
HASSAN
TUMKUR
Bangalore
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
Cyclophosphamide
- Doxorubicin
(CHOP)/Cycle
(Day1 & Day12)
Cisplatin/Etoposid
e (IIIB)/Cycle
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
Cyclophosphamide
- Doxorubicin
(CHOP)/Cycle
(Day1 & Day12)
531
531
20-Apr-15
24-Jul-15
60000
60000
61200
6120
55080
IDBI - 321
30-Oct-15
615
615
7-May-15
16-May-15
20000
22040
10000
1000
9000
IDBI - 321
30-Oct-15
534
534
6-May-15
6-May-15
36000
36000
75
8
67
IDBI - 321
30-Oct-15
DLBCL Stage III
CANCER
Medical Oncology
Lymphoma-NHL
Rt Ureteric
calculus.
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
24-Apr-15
11-May-15
25000
25000
17465
1747
15718
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Esophagus
T3N1Mo
CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
14-May-15
19-Jun-15
80000
80000
34650
3465
31185
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Rectum
CANCER
Surgical Oncology
Colostomy
679
679
26-Apr-15
30-Apr-15
20000
22020
9750
975
8775
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Cervix POST
EBRT
CANCER
Surgical Oncology
Gynaec
Radical
Hysterectomy
594
594
19-May-15
1-Jun-15
30000
32400
20650
2065
18585
IDBI - 321
30-Oct-15
Medical Oncology
Acute Lymphoblastic
Leukemia
Induction &
Consolidation/1st
phase - 1st ,2nd ,
3rd , 4th & 5th
months
550
550
28-Apr-15
31-Jul-15
70000
70000
45000
4500
40500
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
All
CANCER
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
MANGALORE
DAKSHINA
KANNADA
Mysore
Hospital Name
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
M S Ramaiah
Hospital
Hospital
District
Final
Diagnosis
MANGALORE
CARCINOMA
OVARY STAGE
IIIC
CANCER
Medical Oncology
Ovarian Cancer
BANGALORE
NORTH
B/L UREFIED
CALCULUS BPM
RENAL
Genito Urinary
Surgery
Urology
CARDIOLOGY
Cardiovascular Surgery Vascular
239 H_19522276927
Female
32
Minorit
PERMANNUR
y
240 H_20010277627
Male
60
Others ARALEPETE
TUMKUR
TUMKUR
Bangalore
241 H_20079277106
Male
58
Others WARD-24
SAGARA
SHIMOGA
Bangalore
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
ABDOMINAL
AORTIC
ANEURYSM
Belgaum
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
CARCINOMA
RECTUM
CT3N1M0
Diseases
Disease Main
Category
Plan of
treatment
Carboplatin/Paclit
axel/Cycle
URSL - Single Side
+ DJ Stent
Aorto Billiac /
Bifemoral bypass
with Synthetic
Graft
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
512
512
21-Apr-15
11-Sep-15
103000
103000
103000
10300
92700
IDBI - 321
30-Oct-15
909
909
23-Apr-15
2-May-15
47500
47500
23750
2375
21375
IDBI - 321
30-Oct-15
227
227
11-May-15
21-May-15
90000
90000
85500
8550
76950
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
17-Apr-15
8-Aug-15
139000
139000
139000
13900
125100
IDBI - 321
30-Oct-15
242 H_19522276908
Male
54
Others BHAVIKERI
ANKOLA
UTTARA
KANNADA
243 H_20127277597
Female
66
Others BELLIYARU
MANGALORE
DAKSHINA
KANNADA
Mysore
A J HOSPITAL
CENTRE
CONGENITAL
SCOLIOSIS,DERM NEURO SURGERY
AL SINUS
Neuro Surgery
Spinal
Spina Bifida
Surgery Major
437
437
15-Apr-15
9-May-15
30000
48212
15300
1530
13770
IDBI - 321
30-Oct-15
244 H_20698277510
Male
28
Others PULIYERI
VIJAPET
KODAGU
Mysore
YENEPOYA
MEDICAL
COLLEGE
HOSPITAL
CARCINOMA
STOMACHSTAGE 4
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
17-Apr-15
24-Aug-15
45000
22500
22500
2250
20250
IDBI - 321
30-Oct-15
a case of
CANCER
tonge(T4N1M0)
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
7-Apr-15
30-May-15
85000
85000
65550
6555
58995
IDBI - 321
30-Oct-15
MANGALORE
ADVANCED
HEPATOMA
STAGE IV
CANCER
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
23-Apr-15
27-Aug-15
22500
45000
45000
4500
40500
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
CA CERVIX III B
CANCER
Medical Oncology
Cervical Cancer
Weekly
Cisplatin/Week
509
509
29-Apr-15
30-Apr-15
34500
34500
1750
175
1575
IDBI - 321
30-Oct-15
MANGALORE
CARCINOMA
STOMACH WITH
CANCER
LIVER
SECONDARIES
STAGE IV
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
13-Apr-15
24-Aug-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
245 H_22254271306
Female
35
246 H_20575277274
Female
66
247 H_20082271324
Female
60
248 H_19522274920
Male
65
249 H_20968276528
Female
57
250 H_20082275936
Female
51
251 H_20733275076
Female
26
SC
KUNCHARAM
Others UJIRE
SC
KUVEMPUNAGARA
Others KODUVALLI
SC
KESTHURU
Others SRIRAMPURA
SC
BANNIMANTAP
MANGALORE
MANGALORE
CHINCHOLI
GULBARGA
Gulbarga
BIBI GENERAL
CANCER CENTER
BELTHANGADI
DAKSHINA
KANNADA
Mysore
MANGALORE
INSTITUTE OF
ONCOLOGY
ANEKAL
BANGALORE URBAN
Bangalore
Mysore
R
UR
Kidwai
Memorial
Institute of
Oncology
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
CANCER
CANCER
KR NAGAR
MYSORE
Mysore
Krishnarajendra
MYSORE
Hospital
ca. esophagus,
stage: txnomo
CANCER
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
22-Apr-15
6-Jun-15
22500
22500
11250
1125
10125
IDBI - 321
30-Oct-15
HOSADURGA
CHITRADURGA
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca cervix IIIB
CANCER
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
13-May-15
12-Jun-15
22500
42465
14000
1400
12600
IDBI - 321
30-Oct-15
MYSORE
MYSORE
Mysore
SJICR MYSORE
MYSORE
RHD-SUMS
CARDIOLOGY
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
17-Apr-15
24-Apr-15
20000
20000
9750
975
8775
IDBI - 321
30-Oct-15
Narayana
Hrudayalaya
Private Limited
Bangalore
MOD
MALALIGNED
OUTLET VSD L-R CARDIOLOGY
SHUNT RCC
PROLAPSE
Cardiothoracic Surgery Congenital (Simple)
VSD
152
152
20-Apr-15
6-Aug-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
ALL
CANCER
Medical Oncology
Acute Lymphoblastic
Leukemia
Maintenance/Mon
th
552
552
28-May-15
17-Aug-15
12000
24850
6000
600
5400
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Colon with
pertoration
peritonitis
T3N1Mo
CANCER
Surgical Oncology
Colectomy - any
type
637
637
13-Apr-15
20-Apr-15
40000
47745
10000
1000
9000
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Breast
T3N1M0
CANCER
Medical Oncology
Breast
FEC (Epirubicin
based)/Cycle
504
504
25-Apr-15
13-Aug-15
57000
58985
48000
4800
43200
IDBI - 321
30-Oct-15
Ca BOT T3NoMo CANCER
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
2-Jun-15
22-Jul-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
Ca. ( r) lung,
stage: t3n1m1
CANCER
Medical Oncology
Non-small cell lung
cancer
526
526
16-Apr-15
29-Jul-15
63000
63000
42000
4200
37800
IDBI - 321
30-Oct-15
RECURRENT
CARCINOMA
LARYNX
CANCER
Medical Oncology
Head & Neck
521
521
22-Apr-15
23-Apr-15
31500
10500
5250
0
5250
IDBI - 321
30-Oct-15
252 H_19528276046
Female
1
Others GANDHI NAGAR
GULBARGA
GULBARGA
Gulbarga
253 H_20082272202
Male
4
Others TALYA
HOLALKERE
CHITRADURGA
Bangalore
254 H_20082271110
Female
65
Others HUSUKURU
ANEKAL
BANGALORE URBAN
Bangalore
255 H_20082271960
Female
34
Others HOSAHALLI
KANAKAPURA
RAMANAGAR
Bangalore
256 H_20082272671
Male
38
Others SHIVAPURA
Mysore
GAR
GAR
257 H_20968274948
Male
55
Minorit
0
y
MYSORE
MYSORE
258 H_19505275432
Male
57
Minorit
KAGGALADAHALLI
y
GUNDLUPET
CHAMARAJANA
Mysore
GAR
Mysore
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Krishnarajendra
MYSORE
Hospital
Bharath
Hospital
Mysore
Institute of
Oncology
Carboplatin +
Paclitaxel/Cycle
Carboplatin +
Paclitaxel/Cycle
Max. of 6 cycles
only
Sl.No
Preauth No
259 H_20010274007
Gender
Male
Age
14
Caste
SC
Village
DODDA AGRAHARA
Taluk
SIRA
Patient District
TUMKUR
Patient
Division
Hospital Name
Hospital
District
BANGALORE
NORTH
Final
Diagnosis
Diseases
Bangalore
M S Ramaiah
Hospital
MANGALORE
CARCINOMA OVARY FIGO
STAGE II
CANCER
B.PAPILLARY
CYSTADENOCAR
CINOMA-OVARY.
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
7-Apr-15
3-Jun-15
37500
37500
26250
2625
23625
IDBI - 321
30-Oct-15
Surgical Oncology
Gynaec
Surgery for Ca
Ovary - advance
stage
596
596
27-Mar-15
24-Aug-15
103000
103000
103000
10300
92700
IDBI - 321
30-Oct-15
525
525
26-Mar-15
13-Aug-15
42000
42000
42000
4200
37800
IDBI - 321
30-Oct-15
B/L NEAL CHALIS RENAL
Genito Urinary
Surgery
260 H_20015270291
Female
40
Others HALAGERI
SIDDAPUR
UTTARA
KANNADA
Belgaum
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
261 H_20698274863
Male
44
Others HARIHAR
HARIHARA
DAVANGERE
Bangalore
YENEPOYA
MEDICAL
COLLEGE
HOSPITAL
MANGALORE
Small cell lung
carcinoma Stage CANCER
III
Medical Oncology
Non-small cell lung
cancer
262 H_21052274750
Female
67
Others KUNDAPURA
KUNDAPURA
UDUPI
Mysore
CA ORAL CAVITY
CANCER
STAGE IV A
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
13-Apr-15
30-Apr-15
20000
40729
5000
500
4500
IDBI - 321
30-Oct-15
263 H_20575275132
Female
41
Others GANGOLLI
KUNDAPURA
UDUPI
Mysore
MANGALORE
INSTITUTE OF
ONCOLOGY
MANGALORE
CA LEFT BREAST
WITH LUNG
CANCER
METS STAGE IV
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
17-Apr-15
4-Aug-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
264 H_20082271329
Female
38
Others HAROKOPPA
Bangalore
BANGALORE
SOUTH
ca (Lt) Breast
T3N1Mo
CANCER
Medical Oncology
Breast
FEC (Epirubicin
based)/Cycle
504
504
24-Apr-15
7-Aug-15
48000
48000
48000
4800
43200
IDBI - 321
30-Oct-15
265 H_20082271962
Female
54
MALAVALLI
Mysore
BANGALORE
SOUTH
Ca right Breast
T2N1M0
CANCER
Medical Oncology
Breast
FEC (Epirubicin
based)/Cycle
504
504
24-Apr-15
7-Aug-15
48000
48000
47500
4750
42750
IDBI - 321
30-Oct-15
Mysore
METASTATIC
SQUAMOUS CELL
CARCINOMA(foo
CANCER
t)PRIMARY TO
RIGHT INGUINAL
NODES STAGE IV
Medical Oncology
Head & Neck
Carboplatin +
Paclitaxel/Cycle
Max. of 6 cycles
only
521
521
20-Apr-15
1-Jun-15
31500
31500
15750
0
15750
IDBI - 321
30-Oct-15
SC
KYATHANAHALLI
Male
76
Others
267 H_20025274606
Male
88
Others SHANIVARSANTE
268 H_20082274112
Female
8
Others HUNDI
269 H_19504273867
Male
17
Others Ullagaddi Khanapur
270 H_19491273814
Female
55
271 H_20082273432
Female
48
SC
272 H_19562272933
Female
63
SC
273 H_20790273524
274 H_19505272067
Male
Male
40
46
MYSORE
Mysore
Bharath
Hospital
Institute of
Oncology
SOMAVARPET
KODAGU
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
IHD, MILD LV
DYSFUNCTION,
CARDIOLOGY
S/P CAG- TVD OF
RCA AND LAD
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
22-Apr-15
7-May-15
90000
90000
61362
6136
55226
IDBI - 321
30-Oct-15
T NARASIPUR
MYSORE
Mysore
Kidwai
Memorial
Institute of
Oncology
epithelooid
CANCER
sarcoma stage III
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
17-Apr-15
24-May-15
45000
49080
10500
1050
9450
IDBI - 321
30-Oct-15
Medical Oncology
Lymphoma-Hodgkin
disease
Dacarbazine
(DBVD)/Cycle
(Day1 & Day12)
533
533
20-Apr-15
10-Aug-15
32000
32000
31500
3150
28350
IDBI - 321
30-Oct-15
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
21-Apr-15
23-Jun-15
83000
12000
7483
30
7453
IDBI - 321
30-Oct-15
KADEMANUGANAHA
HUNSUR
LLI
266 H_19505273664
Others MARANAGERE
MANDYA
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
HUKKERI
BELGAUM
BANGALORE
SOUTH
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Hodgkins
III
Bangalore
BGS GLOBAL
HOSPITAL
BANGALORE
SOUTH
Recurrent
Carcinoma of
CANCER
Right breast post
MRM T3N0M0
Radiation Oncology
3D Conformational
Radio Therapy
Medical Oncology
Head & Neck
Carboplatin +
Paclitaxel/Cycle
Max. of 6 cycles
only
521
521
20-Apr-15
11-May-15
63000
64355
14350
1435
12915
IDBI - 321
30-Oct-15
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
11-May-15
17-Jul-15
28000
28000
1350
135
1215
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
10-Apr-15
9-May-15
25000
25000
12500
1250
11250
IDBI - 321
30-Oct-15
Colorectal Cancer
(FOLFOX)
(Paliation CT
only)/Week Max. 6
cycles
531
531
2-May-15
4-May-15
60000
10000
5000
0
5000
IDBI - 321
30-Oct-15
TIPTUR
TUMKUR
KAIWARA
CHINTAMANI
CHIKKABALLAPU
Bangalore
R
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
ca buccal
mucossa
Kalenahalli
SHIKARIPURA
SHIMOGA
Bangalore
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
SHIMOGA
Ca.Cervix STAGE
CANCER
IVB
Radiation Oncology
Mysore
Sri
Adichunchanagi
B G Nagara
ri Hospital and
Research Center
Lft Renal
Calculai.
Genito Urinary
Surgery
Mysore
Bharath
Hospital
Institute of
Oncology
CA RECTO
SIGMOID COLON
CANCER
T4N2M0 STAGE
III C
Others Chandanahalli
Minorit N.R.MOHALLA,
y
MYSORE
Cisplatin/Etoposid
e (IIIB)/Cycle
NAGAMANGALA MANDYA
MYSORE
MYSORE
Mysore
CANCER
RENAL
Medical Oncology
Sl.No
Preauth No
Gender
Age
Caste
275 H_19505270229
Male
55
Others
276 H_20575273093
Female
45
Others SIRIGERE
Taluk
MALLARAJANAHUND
NANJANAGUD
I
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
MYSORE
Mysore
Bharath
Hospital
Institute of
Oncology
Mysore
CA RIGHT LUNG
SQUAMOUS CELL CANCER
CARCINOMA
Medical Oncology
Non-small cell lung
cancer
Carboplatin +
Paclitaxel/Cycle
CHITRADURGA
Bangalore
MANGALORE
INSTITUTE OF
ONCOLOGY
MANGALORE
CA OVARY
STAGE IIIC
Medical Oncology
Ovarian Cancer
Carboplatin/Paclit
axel/Cycle
case of ca buccal
CANCER
mucose t4n1m0
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Medical Oncology
Non-small cell lung
cancer
CANCER
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
526
526
17-Apr-15
16-Jul-15
107000
75000
67500
0
67500
IDBI - 321
30-Oct-15
512
512
11-Apr-15
4-Aug-15
63000
63000
63000
6300
56700
IDBI - 321
30-Oct-15
567
567
7-Apr-15
13-Jun-15
96000
96000
67200
6720
60480
IDBI - 321
30-Oct-15
525
525
17-Apr-15
29-May-15
28000
28000
10500
1050
9450
IDBI - 321
30-Oct-15
534
534
13-Apr-15
6-Aug-15
36000
36000
36000
0
36000
IDBI - 321
30-Oct-15
239
239
11-Apr-15
12-Apr-15
67000
67000
33500
3350
30150
IDBI - 321
30-Oct-15
BHALKI
BIDAR
Gulbarga
BIBI GENERAL
CANCER CENTER
MADDUR
MANDYA
Mysore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca Lung
Bangalore
SRI SHANKARA
CANCER
HOSPITAL AND
RESEARCH
CENTRE
BANGALORE
SOUTH
diffuse large b
cell lymphoma
left gluteal
region stage 2
IHD-ACS-IWMI
WITH RV MI AND CARDIOLOGY
CHB
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
Carcinoma
Esophagus with
(L) SCL stage IV
CANCER
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
6-May-15
21-Aug-15
45000
45000
45000
225
44775
IDBI - 321
30-Oct-15
Male
24
278 H_20082272823
Male
38
Others SHETTIHALLI
65
Minorit Gudenarayana shetty
KANAKAPURA
y
Road
Female
0
CHITRADURGA
277 H_22254272343
279 H_22163273307
SC
Village
RAMANAGAR
CANCER
CANCER
Medical Oncology
Lymphoma-NHL
Cisplatin/Etoposid
e (IIIB)/Cycle
Cyclophosphamide
- Doxorubicin
(CHOP)/Cycle
(Day1 & Day12)
280 H_20086272856
Female
55
Others KGF
BANGARPET
KOLAR
Bangalore
R L JALAPPA
NARAYANA
KOLAR
HRUDAYALAYA
HEART CENTRE
281 H_19569272432
Female
39
Others Benachi
DHARWAD
DHARWAD
Belgaum
HCG NMR
CURIE CENTRE
OF ONCOLOGY
282 H_20613272753
Male
60
Others Yalparatti
RAIBAGH
BELGAUM
Belgaum
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
ca lung III
CANCER
Medical Oncology
Non-small cell lung
cancer
Carboplatin +
Paclitaxel/Cycle
526
526
15-Apr-15
6-Aug-15
31500
93116
52500
5250
47250
IDBI - 321
30-Oct-15
283 H_21052271430
Female
57
Others PERDOOR
UDUPI
UDUPI
Mysore
CA BREST T1 N0
CANCER
M0
Medical Oncology
Breast
502
502
1-Apr-15
29-Jul-15
18600
18600
17670
1767
15903
IDBI - 321
30-Oct-15
284 H_20127272132
Female
41
Others HERANGADI
HONNAVAR
UTTARA
KANNADA
Belgaum
A J HOSPITAL
CENTRE
CARCINOMA
CANCER
OVARY STAGE IC
Medical Oncology
Ovarian Cancer
512
512
3-Apr-15
10-Aug-15
63000
63000
63416
6342
57074
IDBI - 321
30-Oct-15
285 H_19528271641
Male
8
Others BAGALUR
SINDAGI
BIJAPUR
Belgaum
Narayana
Hrudayalaya
Private Limited
MYXOMATUS
PROLAPSING AV
CARDIOLOGY
VALVES SEV MR
SEV TR SEV PAH
Cardiothoracic Surgery Valve Replacement
Mitral Valve
Replacement
145
145
7-Apr-15
12-Sep-15
120000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
286 H_21132271238
Female
65
Others
DODDAMANDIGANA
HASSAN
HALLI
HASSAN
Mysore
Shree
Hospital/HIMS
ca left breast
post MRM t4 n1 CANCER
mo
Medical Oncology
Breast
502
502
31-Mar-15
12-Aug-15
18600
18600
18600
1860
16740
IDBI - 321
30-Oct-15
287 H_20082269574
Female
41
Others KODIGEHALLI
Bangalore
Kidwai
Memorial
Institute of
Oncology
CA BREAST (lf)
T4N1Mo
Medical Oncology
Breast
FEC (Epirubicin
based)/Cycle
504
504
13-Apr-15
27-Jul-15
48000
48000
48000
4800
43200
IDBI - 321
30-Oct-15
Mysore
Krishnarajendra
MYSORE
Hospital
Ca.Colon
T3N1M0
Medical Oncology
Colorectal Cancer
(FOLFOX) (Stage III
only)/Week
530
530
7-Apr-15
22-Aug-15
60000
120000
119000
11900
107100
IDBI - 321
30-Oct-15
Bangalore
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
SHIMOGA
Ca.Nasopharynx
CANCER
cT2N1M0
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
20-Apr-15
8-Sep-15
102000
102000
87000
8700
78300
IDBI - 321
30-Oct-15
Mysore
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
MANGALORE
PVD-LONG
SEGMENT
OCCLUSSION OF
PROXIMAL 2/3 CARDIOLOGY
OF B/L
SFA.OCCLUSSION
OF LEFT DPA.
Aorto Billiac /
Bifemoral bypass
with Synthetic
Graft
227
227
31-Mar-15
20-Apr-15
90000
90000
70000
7000
63000
IDBI - 321
30-Oct-15
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
CA CERVIX IIB
Radiation Oncology
ii. HDR per
application
571
571
8-Apr-15
5-May-15
13500
23200
6500
650
5850
IDBI - 321
30-Oct-15
288 H_20968271243
289 H_19562268430
Male
Female
18
58
290 H_20015270908
Male
60
291 H_20082269315
Female
48
Others nidudi
Others SHETTIHALLI
Others SHAMBURU
SC
SADALI
RURAL
HASSAN
SHIMOGA
HASSAN
SHIMOGA
BANTWAL
DAKSHINA
KANNADA
SIDLAGATTA
CHIKKABALLAPU
Bangalore
R
HUBLI
Bangalore
BANGALORE
SOUTH
CANCER
CANCER
CANCER
BrachytherapyIntracavitary-ii
Carboplatin/Paclit
axel/Cycle
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
LT PELVIC
URINOMA WITH
LEAK FROM
NEONATAL
DISTAL URETER
WITH LT HUN
Paediatric Surgeries
Ureteric
Genito Urinary Surgeries Reimplantations
Unilateral
292 H_20025270211
Male
41
Others VAJAMANGALA
MYSORE
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
293 H_20082269070
Female
58
Others BALLALSAMUDRA
HOSADURGA
CHITRADURGA
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
CA ESOPHAGUS
t3n1m0
CANCER
Radiation Oncology
Linear Accelerators
294 H_20082268967
Male
67
Others VENKATAPURA
SIDLAGATTA
CHIKKABALLAPU
Bangalore
R
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca Esophagus
T4N1M0
CANCER
Surgical Oncology
295 H_20082269569
Female
82
Others A K COLONY
BANGALORE
EAST
BANGALORE URBAN
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca Anal Canal
T3N1Mo
CANCER
Gulbarga
VYDEHI
HOSPITAL
BANGALORE
Carcinoma lung
advanced right
side with
skeletal/liver
metastasis
CANCER
296 H_19574269189
Male
44
Others MALGATTI
SURPUR
YADGIRI
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
315
315
7-Apr-15
21-Apr-15
32500
32500
22750
2275
20475
IDBI - 321
30-Oct-15
Radical Treatment
with Photons
565
565
7-May-15
15-Jun-15
71000
86465
46900
4690
42210
IDBI - 321
30-Oct-15
Esophagus
Oesophagectomy
with Two field
Lymphadenectomy
673
673
18-Mar-15
23-Apr-15
75000
76860
37250
3725
33525
IDBI - 321
30-Oct-15
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
13-May-15
15-Jun-15
72500
75365
30150
3015
27135
IDBI - 321
30-Oct-15
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
31-Mar-15
11-Jun-15
22500
22500
15000
1500
13500
IDBI - 321
30-Oct-15
Burns
Burns
upto 30% (with
grafting)
1
1
4-Apr-15
19-May-15
40000
40000
20000
2000
18000
IDBI - 321
30-Oct-15
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
17-May-15
27-Aug-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
297 H_20025269560
Male
42
Others KURUBARA BEEDI
HOLENARSIPUR HASSAN
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
ELECTRICAL
BURNS OF RT
UPPER LIMB
AND RT LEG
WITH
BURNS
COMPARTMENT
SYNDROME OF
RT FOREARM
AND HAND
298 H_20815284878
Female
65
Others RUMMANGUD
GULBARGA
GULBARGA
Gulbarga
CHIRAYU
HOSPITAL
Metastatic Ca
Breast
299 H_20079284828
Male
29
Others CHIKKAMENAHALLI
HASSAN
HASSAN
Mysore
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
LEFT DISTAL SFA
CARDIOLOGY
OCCLUSION
Femoro Distal
Bypass with Vein
Graft
229
229
25-May-15
30-May-15
50000
50000
47500
4750
42750
IDBI - 321
30-Oct-15
BANGALORE
NORTH
ARNOLD CHARI
MALFORMATION
NEURO SURGERY
+ ATLANTO
AXIAL
DISSLOCATION
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
30-Apr-15
17-Jun-15
50000
50000
45000
4500
40500
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Esophagus
T3N1M0
Surgical Oncology
Jejunostomy
677
677
20-May-15
27-May-15
20000
20000
14000
1400
12600
IDBI - 321
30-Oct-15
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
29-May-15
16-Jul-15
98000
148732
98000
9800
88200
IDBI - 321
30-Oct-15
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
18-May-15
29-Aug-15
95000
99765
91000
9100
81900
IDBI - 321
30-Oct-15
322
322
13-May-15
28-May-15
22000
22000
11000
1100
9900
IDBI - 321
30-Oct-15
GULBARGA
CANCER
300 H_20010280592
Female
18
Others HOSAHALLI
KUDLIGI
BELLARY
Gulbarga
M S Ramaiah
Hospital
301 H_20082282051
Female
69
Others MANVI
MANVI
RAICHUR
Gulbarga
Kidwai
Memorial
Institute of
Oncology
Belgaum
Kolhapur Cancer
Karveer
Centre
BAGLAKOT
Belgaum
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
ca vault IIIB
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Hypospadias
NEONATAL
Genito Urinary Surgeries Hypospadias
302 H_20435284377
Male
53
Others KOGANOLLI
CHIKKODI
CANCER
303 H_20613283970
Female
41
Others Rabakavi
304 H_20010284263
Male
16
Others KADARAMANDALAGI BYADAGI
HAVERI
Belgaum
M S Ramaiah
Hospital
305 H_20025284169
Male
72
Others ASHOKAPURAM
MYSORE
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
RECURRENT CA
CANCER
LARYNX Yc T3 N0
Surgical Oncology
Head & Neck
Laryngectomy
with Voice
Prosthesis
618
618
15-May-15
23-May-15
60000
60000
28000
2800
25200
IDBI - 321
30-Oct-15
306 H_20127283680
Male
41
Others BALLUR
BHATKALA
UTTARA
KANNADA
Belgaum
A J HOSPITAL
CENTRE
CARCINOMA OF
BASE TONGUE
CANCER
T2 N2a MO
STAGE IV A
Medical Oncology
Cervical Cancer
Weekly
Cisplatin/Week
509
509
7-May-15
13-Jul-15
87000
87000
84303
8430
75873
IDBI - 321
30-Oct-15
307 H_20082283775
Female
54
Others UTTARAHALLI
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
Kidwai
Memorial
Institute of
Oncology
Ca Cervix IIB
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
3-Jun-15
15-Jul-15
62000
62000
61500
6150
55350
IDBI - 321
30-Oct-15
308 H_19504283036
Male
52
BELGAUM
BELGAUM
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Ca Tongue Stage
CANCER
IV A T4N0M0
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
18-May-15
29-Jun-15
45000
45000
21375
2138
19237
IDBI - 321
30-Oct-15
309 H_20017282478
Male
65
ATHANI
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
S/P AVR 2004
CARDIOLOGY
WITH SEVERE AS
Aortic Valve
Replacement
146
146
5-May-15
25-May-15
120000
130000
130000
13000
117000
IDBI - 321
30-Oct-15
SC
Kotabagi
Minorit
SATTI
y
JAMAKHANDI
BELGAUM
CA
OROPHARYNX
T3N1M0
CANCER
BANGALORE
NORTH
BANGALORE
SOUTH
CANCER
Sl.No
Preauth No
Gender
Age
Caste
310 H_21701283084
Female
13
Others malkapur
311 H_19577283604
Female
40
Minorit
BANGALORE
BANGALORE SOUTH
y
SOUTH
312 H_20082282072
Female
25
Others
313 H_20164282941
Female
47
SC
314 H_19505282723
315 H_19504281521
Male
Female
56
45
Village
Taluk
BIDAR
Patient District
Patient
Division
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
145
9-May-15
18-May-15
120000
241834
85680
8568
77112
IDBI - 321
30-Oct-15
BANGALORE URBAN
Bangalore
SJICR
BANGALORE
SOUTH
RHD MODERATE MS
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
26-May-15
28-May-15
20000
20000
19000
0
19000
IDBI - 321
30-Oct-15
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Anplastic
oligoastrocytom CANCER
a (lt) stage III
Medical Oncology
Head & Neck
Brain - GBM, High
grade Astrocytoma
only - Cap
Temozolamide(10
0mg/day), during
RT only/Cycle
523
523
8-Jun-15
15-Jul-15
100000
100000
96000
9600
86400
IDBI - 321
30-Oct-15
KOLAR
CARCINOMA
OVARY 3C
Medical Oncology
Ovarian Cancer
512
512
13-May-15
15-Jun-15
42000
10500
9975
998
8977
IDBI - 321
30-Oct-15
Mysore
CA ETHMOID
SINUS T3N0M0
III
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
25-May-15
10-Jul-15
94000
94000
93600
0
93600
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
18-May-15
21-Jul-15
94500
94500
94500
9450
85050
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
6-May-15
26-Jun-15
75000
80349
52500
5250
47250
IDBI - 321
30-Oct-15
SAH WITH ACOM
NEURO SURGERY
Aneurysm
Neuro Surgery
Brain
Aneurysm
Clipping
422
422
8-May-15
9-Jun-15
100000
167213
100000
10000
90000
IDBI - 321
30-Oct-15
CA CERVIX
STAGE III B
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
12-May-15
17-Jun-15
73500
58000
40285
0
40285
IDBI - 321
30-Oct-15
Cardiothoracic Surgery Congenital (Complex)
Root Replacement
(Aortic Aneurysm/
Aortic Dissection)
/ Bental Procedure
169
169
13-May-15
17-May-15
125000
125000
86100
8610
77490
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
Coarctation
dilatation
106
106
12-May-15
23-May-15
20000
20000
20400
612
19788
IDBI - 321
30-Oct-15
CANCER
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
23-Apr-15
29-May-15
60000
60000
30000
3000
27000
IDBI - 321
30-Oct-15
MYSORE
Mysore
Bharath
Hospital
Institute of
Oncology
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Ca Cervix Stage
III B
CA CERVIX
STAGE IIIA
RAMADURGA
BELGAUM
Belgaum
49
Others YELAVADIKAVOOR
BHATKALA
317 H_20021282773
Female
75
Minorit
GULBARGA
y
GULBARGA
GULBARGA
Gulbarga
318 H_19505282900
Female
69
Others ATHAHALLI
T NARASIPUR
MYSORE
Mysore
HD KOTE
Date of
Admission
145
R L JALAPPA
HOSPITAL AND
RESEARCH
CENTRE
Others MADAPURA
Mitral Valve
Replacement
CHIKKABALLAPU
Bangalore
R
Others Batakurki
Plan of
treatment
MALAPALLI
MYSORE
rhd,severe
mr,severe tr with CARDIOLOGY
severe pah
CHITRADURGA
Others DATTAGALLI
Disease Main
Category
Paradise, S.D.
Road
BANJEGANDANAHAL
HOLALKERE
LI
CHINTAMANI
Diseases
SUNSHINE
HEART
INSTITUTE
Female
34
Final
Diagnosis
Gulbarga
316 H_21052282765
Female
Hospital
District
BIDAR
UTTARA
KANNADA
319 H_20025282745
Hospital Name
MYSORE
BASAVESHWAR
TEACHING AND
GULBARGA
GENERAL
HOSPITAL
Bharath
Hospital
Mysore
Institute of
Oncology
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
Bangalore
BANGALORE
NORTH
CARDIOLOGY
CANCER
CANCER
CANCER
CANCER
CANCER
SEVERE AORTIC
REGURGITATION
, ASCENDIND+
CARDIOLOGY
AORTIC ARCH
ANEURYSM
SEV COARCTATION
OF AORTA
BICUSPID
AORTIC VALVE
CARCINOMA
LEFT BUCCAL
MUCOSIA
CT4AN0M0
Carboplatin/Paclit
axel/Cycle
Others GANDHINAGAR
HOSPET
BELLARY
Gulbarga
Narayana
Hrudayalaya
Private Limited
39
Others BYADAGERE
GUBBI
TUMKUR
Bangalore
M S Ramaiah
Hospital
Male
46
Others NANJANGUD
NANJANAGUD
MYSORE
Mysore
Krishnarajendra
MYSORE
Hospital
MUO NECK,
CANCER
STAGE: TxN3M0
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
7-May-15
21-Jul-15
45000
45000
30000
3000
27000
IDBI - 321
30-Oct-15
323 H_19504280634
Female
52
Others Kurani
BELGAUM
BELGAUM
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Ca Cervix Stage
IIIB
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
12-May-15
19-Aug-15
73500
73500
73500
7350
66150
IDBI - 321
30-Oct-15
324 H_20025281234
Female
31
Others SHANTHI NAGAR
MYSORE
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
? CA HEAD OF
PANCREAS T3 NX CANCER
MX
Surgical Oncology
Pancreas
Whipples - any
type
582
582
7-May-15
21-May-15
75000
75000
70300
7030
63270
IDBI - 321
30-Oct-15
325 H_21052279215
Male
45
Others MALADI
BELTHANGADI
DAKSHINA
KANNADA
Mysore
CA
OROPHARYNX
STAGE 4
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
27-Apr-15
27-Jul-15
62000
106325
54000
5400
48600
IDBI - 321
30-Oct-15
326 H_22254278320
Female
60
Others BENAKNALLI
BIDAR
BIDAR
Gulbarga
BIBI GENERAL
CANCER CENTER
ca breast post op
CANCER
Stage T2N1M0
Medical Oncology
Breast
AC (AC then
T)/Cycle
503
503
7-May-15
31-Jul-15
12000
12000
12000
1200
10800
IDBI - 321
30-Oct-15
Mysore
Bharath
Hospital
Institute of
Oncology
CA OVARY III
Medical Oncology
Ovarian Cancer
512
512
7-May-15
9-May-15
63000
10500
5250
0
5250
IDBI - 321
30-Oct-15
320 H_19528282806
Female
9 Months
321 H_20010282284
Female
322 H_20968281913
327 H_19505280888
Female
78
Others DASANAKOPPALU
MYSORE
MYSORE
Mysore
CANCER
CANCER
CANCER
Carboplatin/Paclit
axel/Cycle
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
328 H_20790278606
Male
30
Others Thyluru
MADDUR
MANDYA
Mysore
329 H_20082279890
Male
53
Others JP NAGARA
BANGALORE
EAST
BANGALORE URBAN
Bangalore
330 H_21194269557
Male
51
Others Harokoppa
Bangalore
331 H_19505278676
Female
61
Minorit
MYSORE
y
MYSORE
Mysore
MYSORE
Hospital Name
Hospital
District
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Lft forgotten and
encrusted stent
with calculai in RENAL
lft ureter and
bladder.
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
24-Apr-15
19-May-15
32500
32500
22750
2275
20475
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca BOT
T4aN2bMo
CANCER
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
11-May-15
24-Jul-15
20000
31295
19000
1900
17100
IDBI - 321
30-Oct-15
Mandya
cancer of antrum
tongue 2/3rd
CANCER
stage of the
tongue
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
7-Apr-15
7-Jul-15
20000
20000
14000
1400
12600
IDBI - 321
30-Oct-15
Mysore
CARCINOMA OF
STOMACH
CANCER
pT2N1 II A
Medical Oncology
Gastric Cancer
5-FU -Leucovorin
(McDonald
Regimen)/Cycle
528
528
5-May-15
7-Sep-15
86000
86000
86000
0
86000
IDBI - 321
30-Oct-15
10
10
4-May-15
16-May-15
30000
31790
27000
2700
24300
IDBI - 321
30-Oct-15
Sri
Adichunchanagi
B G Nagara
ri Hospital and
Research Center
Kidwai
Memorial
Institute of
Oncology
Mandya
Institute of
Medical
Sciences
Mandya
Bharath
Hospital
Institute of
Oncology
Final
Diagnosis
Post burn
contracture
posterior thigh & BURNS
leg with knee
contracture
Burns
Burns
Post Burn
Contracture
surgeries for
Functional
Improvement(Pack
age including
splints, pressure
garments and
physiotherapy),
Moderate
332 H_20021279351
Male
2
Others Nippani
GULBARGA
GULBARGA
Gulbarga
BASAVESHWAR
TEACHING AND
GULBARGA
GENERAL
HOSPITAL
333 H_19567279755
Female
66
Others Kerur
CHIKKODI
BELGAUM
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Alveolus post
CANCER
op
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
5-May-15
18-Sep-15
45000
53650
45000
4500
40500
IDBI-294
9-Oct-15
334 H_19504278391
Male
65
Others benchinmaradi
GOKAK
BELGAUM
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Ca Lung Stage IV CANCER
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
4-May-15
4-May-15
45000
17316
1175
118
1057
IDBI - 321
30-Oct-15
Burns
Burns
Post Burn
Contracture
surgeries for
Functional
Improvement(Pack
age including
splints, pressure
garments and
physiotherapy),
Moderate
10
10
25-May-15
7-Jul-15
30000
30000
28500
2850
25650
IDBI - 321
30-Oct-15
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
2-Jun-15
13-Aug-15
122000
122000
114000
11400
102600
IDBI - 321
30-Oct-15
Laser Surgery
622
622
8-Jun-15
25-Jun-15
35000
82960
31050
3105
27945
IDBI - 321
30-Oct-15
562
562
9-Jun-15
17-Jul-15
45500
45500
38500
3850
34650
IDBI - 321
30-Oct-15
202
202
16-Apr-15
25-Aug-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
335 H_20010292505
Male
41
Others BADDEPALLI
YADGIR
YADGIRI
Gulbarga
M S Ramaiah
Hospital
Mysore
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
BANGALORE
NORTH
POST BURN
SCAR
CONTRACTIVE
NECK
MANGALORE
CARCINOMA
HYPOPHARYNYX
CANCER
T4N2c STAGE
IVA
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
BANGALORE
SOUTH
Ca Buccal Sulcus
CANCER
T3N1Mo
Surgical Oncology
Head & Neck
BANGALORE
SOUTH
ca cervix IIIB
Radiation Oncology
Radical Treatment
Radiotherapy
BURNS
336 H_19522292608
Female
30
Others KALIYA
BELTHANGADI
DAKSHINA
KANNADA
337 H_20082289263
Female
43
Others KESARAMADU
TUMKUR
TUMKUR
Bangalore
338 H_20082291782
Female
29
Others THYARANAHALLI
BANGARPET
KOLAR
Bangalore
339 H_20270289442
Female
42
Others ATTIVATTA
HOSAKOTE
BANGALORE RURAL
Bangalore
SDS TRC RGICD
JAYANAGAR
(Rt) Intermediate
Bronchus CARDIOLOGY
Bronchial
Carariod
340 H_20082291744
Female
63
Minorit
BANGALORE
DODDASHETTYHALLI
y
EAST
BANGALORE URBAN
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca Oesophagus
T3N1Mo
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
16-Jun-15
7-Aug-15
32000
32000
29500
2950
26550
IDBI - 321
30-Oct-15
HUBLI
DHARWAD
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Ca Larynx
stage III
T3,N1,M0
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
15-Jun-15
31-Jul-15
75000
75000
75000
7500
67500
IDBI-294
9-Oct-15
KR PET
MANDYA
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
IHD-NSTEMI
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
1-Jun-15
4-Jun-15
65000
65000
58500
5850
52650
IDBI - 321
30-Oct-15
341 H_19567291672
Male
72
Mkukundan
Others
Kunniraman
342 H_20025291625
Male
45
Others GOVINDANAHALLI
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
CANCER
CANCER
Thoracotomy,
Thoraco
Abdominal
Approach
Sl.No
Preauth No
Gender
Age
Caste
KUSTAGI
KOPPAL
Gulbarga
VYDEHI
HOSPITAL
BANGALORE
SC
SHAHABAD
CHITTAPUR
GULBARGA
Gulbarga
VYDEHI
HOSPITAL
BANGALORE
SC
KARYA
NANJANAGUD
MYSORE
Mysore
50
SC
345 H_19574291750
Female
45
346 H_20968291946
Male
37
63
Others MATALLI
Others KOPPAL;A
ALAND
GULBARGA
BANTWAL
DAKSHINA
KANNADA
Gulbarga
Krishnarajendra
MYSORE
Hospital
Kidwai
BANGALORE
Memorial
SOUTH
Institute of
Oncology
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
Carcinoma cervix
CANCER
III B
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
26-May-15
24-Aug-15
73500
73500
69000
6900
62100
IDBI - 321
30-Oct-15
Carcinoma cervix
CANCER
III B
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
5-Jun-15
14-Aug-15
73500
73500
63500
6350
57150
IDBI - 321
30-Oct-15
VESICAL
CALCULUS
Genito Urinary
Surgery
Urology
Cystolithotripsy
906
906
3-Jun-15
13-Jun-15
12500
12500
8750
875
7875
IDBI - 321
30-Oct-15
Medical Oncology
Testicular Cancer
BleomycinEtoposideCisplatin
(BEP)/Cycle
517
517
8-Jun-15
1-Jul-15
48000
49005
11200
1120
10080
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
25-May-15
31-Jul-15
89000
89000
75000
7500
67500
IDBI - 321
30-Oct-15
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
17-Jun-15
4-Aug-15
98000
98000
98000
9800
88200
IDBI - 321
30-Oct-15
IHD-ACS=IWMI
WITH FIRST
DEGREE AV
BLOCK
CARDIOLOGY
RENAL
Metastatic
mixed germ cell CANCER
tumor stage III
Mysore
CA TONGUE
STAGE III
CA
PYRIFORMFOSSA CANCER
T3N2M0
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
CANCER
239
239
2-Jun-15
6-Jun-15
67000
67000
46900
4690
42210
IDBI - 321
30-Oct-15
CHIKKODI
BELGAUM
Belgaum
Others SOWLANGA
HONNALI
DAVANGERE
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
ca stomach
t4n0m0
CANCER
Surgical Oncology
Miscellaneous
Internal Staplers
690
690
28-May-15
8-Jun-15
50000
54270
17550
1755
15795
IDBI - 321
30-Oct-15
71
Others KAVRADI
KUNDAPURA
UDUPI
Mysore
KASTURBA
HOSPITAL
UDUPI
ACUTE IWMI
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
1-Jun-15
11-Jun-15
90000
90000
91290
9129
82161
IDBI - 321
30-Oct-15
Female
62
Minorit
BALEPETE
y
YELANDUR
CHAMARAJANA
Mysore
GAR
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
CA
OESOPHAGUS
CANCER
LOWER 1/3 T3N1
Surgical Oncology
Esophagus
Oesophagectomy
with Two field
Lymphadenectomy
673
673
5-Jun-15
23-Jun-15
95000
95000
85500
8550
76950
IDBI - 321
30-Oct-15
Female
63
BANGALORE
EAST
BANGALORE URBAN
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca cervix IIIB
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
8-Jun-15
24-Jun-15
45500
46385
21600
2160
19440
IDBI - 321
30-Oct-15
Bangalore
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
SHIMOGA
Ca. Cervix STAGE
CANCER
IIIB
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
5-Jun-15
31-Jul-15
85500
85500
83500
8350
75150
IDBI - 321
30-Oct-15
Bangalore
THE RADIANT
INSTITUTE
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
3-Jun-15
8-Jul-15
94500
94500
74500
7450
67050
IDBI - 321
30-Oct-15
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Ca Cervix Stage
IIB
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
8-Jun-15
11-Aug-15
94500
94500
94500
9450
85050
IDBI - 321
30-Oct-15
Kidwai
Memorial
Institute of
Oncology
Ca Cervix III B
CANCER
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
15-Jun-15
20-Jul-15
43500
43500
26125
2613
23512
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
19-Jun-15
24-Aug-15
86500
86500
86500
0
86500
IDBI - 321
30-Oct-15
Male
43
350 H_20082290743
Female
43
351 H_19564291483
Male
352 H_20025291279
353 H_20082289495
355 H_23069291200
Others DODDAMALE
Final
Diagnosis
Kolhapur Cancer
Karveer
Centre
349 H_20435291450
354 H_19562287024
Hospital
District
AMBEDKAR NAGAR
Female
Male
Hospital Name
Bangalore
344 H_19574291755
348 H_21052291296
Patient
Division
KOLAR
75
21
Patient District
KOLAR
Male
Male
Taluk
R L JALAPPA
NARAYANA
KOLAR
HRUDAYALAYA
HEART CENTRE
343 H_20086292272
347 H_20082289763
Village
Female
Female
51
62
ST
BORGAON
SC
AMBEDKAR NAGARA
ST
AMRUTHA
KAMMACHI
Others GANGONDANA
HOSANAGARA
SHIMOGA
DEVANAHALLI
BANGALORE RURAL
356 H_19504291097
Female
50
Others Mugali
BELGAUM
BELGAUM
357 H_20082287436
Female
50
Others CHEEMNAHALLI
CHINTAMANI
CHIKKABALLAPU
Bangalore
R
Mysore
358 H_19505289984
Female
41
Others NERALEKERE
SHRIRANGAPAT
MANDYA
NA
359 H_19505291000
Female
59
Others UMMATTUR
HUNSUR
MYSORE
Mysore
360 H_20082285938
Male
60
Others KAMANAHALLI
KR PET
MANDYA
Mysore
Bharath
Hospital
Institute of
Oncology
Bharath
Hospital
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
MYSORE
BANGALORE
SOUTH
CA CERVIX IB
CANCER
CANCER
Mysore
CA CERVIX III A
CANCER
Mysore
CA
CANCER
OESOPHAGUS IV
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 cycles)
555
555
5-Jun-15
17-Aug-15
20000
20000
20000
0
20000
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca upper
esophagus
T3N1M0
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
9-Jun-15
30-Jul-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
CANCER
Sl.No
Preauth No
361 H_21194288797
362 H_20613290766
Gender
Female
Male
Age
48
69
363 H_19562284587
Female
37
364 H_20164289743
Female
15
Caste
Village
Others Chamanahalli
Others BUDIHAL
SC
SAVEMARADIHALLI
Others MELERI
Taluk
MADDUR
Patient District
MANDYA
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Mysore
Mandya
Institute of
Medical
Sciences
Mandya
Belgaum
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
k/c/o ca
pancreas with
liver mets IV
MUDDEBIHAL
BIJAPUR
TARIKERE
CHIKKAMANAGL
Mysore
UR
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
MULABAGILU
KOLAR
R L JALAPPA
HOSPITAL AND
RESEARCH
CENTRE
Bangalore
Mandya
Diseases
Ca Breast Lt Post
CANCER
op and post Ct
Disease Main
Category
Radiation Oncology
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Adjuvant Therapy
Radiotherapy
564
564
6-Jun-15
9-Sep-15
15000
15000
15000
1500
13500
IDBI - 321
30-Oct-15
531
531
3-Jun-15
19-Aug-15
45000
80978
45000
4500
40500
IDBI - 321
30-Oct-15
Medical Oncology
Colorectal Cancer
(FOLFOX)
(Paliation CT
only)/Week Max. 6
cycles
SHIMOGA
Ca. Cervix STAGE
CANCER
IB
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
6-Jun-15
26-Aug-15
85500
85500
81000
8100
72900
IDBI - 321
30-Oct-15
KOLAR
SOFT TISSUE
CARSOMA RIGHT CANCER
THIGH
Surgical Oncology
Bone / soft tissue
tumors
Limb salvage
surgery for Bone
Tumors with
Prosthesis
654
654
29-May-15
26-Jun-15
75000
75000
10500
1050
9450
IDBI - 321
30-Oct-15
BURNS
Burns
Burns
upto 30% (with
grafting)
1
1
6-Jun-15
4-Jul-15
40000
40000
28000
2800
25200
IDBI - 321
30-Oct-15
upto 30% (with
grafting)
1
1
2-Jun-15
15-Jun-15
40000
40000
36000
3600
32400
IDBI - 321
30-Oct-15
562
562
2-Jun-15
9-Jul-15
34500
34500
25500
2550
22950
IDBI - 321
30-Oct-15
CANCER
365 H_20025290779
Male
33
Others NADAPPANAHALLI
HUNSUR
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
20-25%
ACCIDENTAL
ELECTRICAL
BURNS OVER
FACE,RT UPPER
LIMB,RT KNEE
AND LT KNEE
366 H_20025290777
Male
34
Others NAGANAHALLI
MYSORE
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
ELECTRICAL
BURNS 30-35%
BURNS
Burns
Burns
367 H_20082290190
Female
53
SC
AMBEDKARNAGARA
BANGALORE
EAST
BANGALORE URBAN
Bangalore
Kidwai
Memorial
Institute of
Oncology
Ca Cervix II B
CANCER
Radiation Oncology
Radical Treatment
Radiotherapy
368 H_19504290420
Female
45
SC
Murgod
BELGAUM
BELGAUM
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
ca breast stage
IV (T4N0M0)
CANCER
Medical Oncology
Breast
502
502
13-Jun-15
25-Jul-15
9300
9300
8835
884
7951
IDBI - 321
30-Oct-15
369 H_22933289687
Male
39
HASSAN
HASSAN
Mysore
Janapriya
Hospital
L2-L4 Intra
medullary
tumor.
NEURO SURGERY
Neuro Surgery
Spinal
Spinal Intra
Medullary
Tumours
436
436
31-May-15
10-Jun-15
50000
50000
25000
2500
22500
IDBI - 321
30-Oct-15
Cancer cervix
stage IIB
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
11-Jun-15
28-Aug-15
94500
94500
94500
9450
85050
IDBI - 321
30-Oct-15
501
501
20-May-15
18-Aug-15
12000
12000
12000
1200
10800
IDBI - 321
30-Oct-15
11
11
26-May-15
10-Jun-15
40000
40000
28000
2800
25200
IDBI - 321
30-Oct-15
Others Nidudi
BANGALORE
SOUTH
HASSAN
370 H_19504290452
Female
63
Others Appachiwadi
CHIKKODI
BELGAUM
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
371 H_22254290496
Female
53
Others hudgi
HUMNABAD
BIDAR
Gulbarga
BIBI GENERAL
CANCER CENTER
a case of ca
breast
CANCER
Medical Oncology
Breast
372 H_20790289801
Male
25
Others Marasinganahalli
SHRIRANGAPAT
MANDYA
NA
Mysore
Sri
Adichunchanagi
B G Nagara
ri Hospital and
Research Center
Post burn
contracture of
wrist , scar over
chest.
BURNS
Burns
Burns
373 H_20698289886
Male
63
Others HAREKALA
MANGALORE
Mysore
YENEPOYA
MEDICAL
COLLEGE
HOSPITAL
MANGALORE
CARCINOMA
CANCER
LUNG - STAGE 4
Medical Oncology
Non-small cell lung
cancer
Carboplatin +
Paclitaxel/Cycle
526
526
18-May-15
31-Aug-15
45000
37500
37500
3750
33750
IDBI - 321
30-Oct-15
Mysore
Bharath
Hospital
Institute of
Oncology
Mysore
CA CERVIX
STAGE III B
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
22-Jun-15
20-Aug-15
88500
88500
86050
0
86050
IDBI - 321
30-Oct-15
Mysore
Bharath
Hospital
Institute of
Oncology
Mysore
CA
OESOPHAGUS
T2N3M0
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
9-Jun-15
22-Jun-15
80000
49000
42300
0
42300
IDBI - 321
30-Oct-15
374 H_19505289833
375 H_19505288804
Female
Male
64
59
Others MANDYA
Others BELAVATHA
MANDYA
MYSORE
DAKSHINA
KANNADA
MANDYA
MYSORE
CANCER
CANCER
Adriamycin/Cyclop
hosphamide
(AC)/Cycle
Post Burn
Contracture
surgeries for
Functional
Improvement(Pack
age including
splints, pressure
garments and
physiotherapy),
Severe
Sl.No
Preauth No
Gender
Age
Patient
Division
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
12-Jun-15
5-Aug-15
87000
87000
81700
8170
73530
IDBI - 321
30-Oct-15
Ca Buccal
Mucosa Stage IV CANCER
A T4N1M0
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
11-Jun-15
3-Jul-15
22500
18280
8932
893
8039
IDBI - 321
30-Oct-15
53
Others BANNURU
T NARASIPUR
MYSORE
Mysore
SJICR MYSORE
MYSORE
IHD-AWMI CADCARDIOLOGY
SVD
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
27-May-15
30-May-15
65000
65000
32250
3225
29025
IDBI - 321
30-Oct-15
42
Others SANIKERE
CHALLAKERE
CHITRADURGA
Bangalore
Chitradurga
Government
Hospital
CHITRADURGA
Right PUJ
Obstruction
RENAL
Genito Urinary
Surgery
Urology
Pyeloplasty Single Side
905
905
25-May-15
31-May-15
35000
50000
12500
1250
11250
IDBI - 321
30-Oct-15
Belgaum
SRI LAXMI
SURGICAL
TRAUMA
ORTHO AND
MULTISPECILIT
RANEBENNUR
Rt Renal
Calculus.
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
31-May-15
6-Jun-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Belgaum
A J HOSPITAL
CENTRE
METASTATIC
CHOLANGIOCAR
CANCER
CINOMA-STAGE
IV
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
30-May-15
8-Aug-15
45000
45000
45900
4590
41310
IDBI - 321
30-Oct-15
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Mets Spine
TxN1M1
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
5-Jun-15
16-Jun-15
35000
76320
12350
1235
11115
IDBI - 321
30-Oct-15
HIRIYUR
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca Cervix IIIB
CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
15-Jun-15
15-Aug-15
73500
86250
65550
6555
58995
IDBI - 321
30-Oct-15
BANGALORE
Carcinoma
Oropharynx
T3N2Mo
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
29-May-15
30-Jul-15
85000
85000
77000
7700
69300
IDBI - 321
30-Oct-15
Urology
URSL - Single Side
+ DJ Stent
909
909
1-Jun-15
6-Jun-15
25000
25000
23750
2375
21375
IDBI - 321
30-Oct-15
907
907
19-May-15
3-Jun-15
25000
25000
20700
2070
18630
IDBI - 321
30-Oct-15
Male
39
35
382 H_20082289745
Male
63
383 H_20082289242
Female
61
SC
Tadasnur
Others Bidanala
Others HEDIYALA
Others ANGRAHALLI
SC
OLD YALANADU
HUBLI
RANEBENNUR
DHARWAD
HAVERI
CHITRADURGA
SINDNUR
RAICHUR
Gulbarga
KANTHEGOWDANAK
HUNSUR
OPPALU
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
RT UPPER
URETERIC
RENAL
CALCULUS WITH
HUN
Genito Urinary
Surgery
BANGALORE URBAN
Bangalore
M S Ramaiah
Hospital
BANGALORE
NORTH
LEFT RRENAL
CALCONIMA
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
BANGALORE
SOUTH
Ca Rt Breast
PT2N3M0(IIIC)
CANCER
Medical Oncology
Breast
FEC (Epirubicin
based)/Cycle
504
504
30-May-15
11-Jul-15
48000
48000
13775
1378
12397
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
ALL
CANCER
Medical Oncology
Acute Lymphoblastic
Leukemia
Reinduction/2nd
Phase
551
551
2-Jun-15
25-Aug-15
50000
51300
50000
5000
45000
IDBI - 321
30-Oct-15
MANGALORE
NON HODGKINS
LYMPHOMA
CANCER
STAGE III
Medical Oncology
534
534
27-May-15
21-Sep-15
18000
36000
34200
3420
30780
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
1-Jun-15
23-Jun-15
37500
37500
17500
1750
15750
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
5-Jun-15
6-Aug-15
91000
91000
59000
5900
53100
IDBI - 321
30-Oct-15
Female
56
Others DHADESUGUR
385 H_20025289321
Male
25
Others
386 H_20010288805
Male
49
Minorit
KORAMANGALA
y
387 H_20082284999
Female
45
Others VISHWANATHAPURA DEVANAHALLI
BANGALORE RURAL
Bangalore
388 H_20082288803
Male
20
Others TAJPUR
BIJAPUR
Belgaum
56
67
60
CANCER
VYDEHI
HOSPITAL
384 H_19574288694
Male
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
379 H_22867286461
391 H_19504287972
Disease Main
Category
Belgaum
Male
Male
ca hypophrynx
stage IV
(T3N2bM0)
Diseases
BELGAUM
378 H_20733288907
390 H_20025288982
Final
Diagnosis
BELGAUM
50
Male
Hospital
District
Others Vantamori
Female
389 H_20575289291
Hospital Name
Belgaum
377 H_19504288729
Female
Patient District
BELGAUM
55
381 H_20127289744
Taluk
BELGAUM
Male
Female
Village
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
376 H_19504289997
380 H_20215289444
Caste
Others BAILADKA
Others THIRUMALAPURA
Others Donawadi
BANGALORE
SOUTH
BIJAPUR
KARKALA
UDUPI
PANDAVAPURA MANDYA
CHIKKODI
BELGAUM
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
CANCER
Mysore
MANGALORE
INSTITUTE OF
ONCOLOGY
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
B/L RENAL
CALCULI
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Ca Rectum Stage
CANCER
II T3N0M0
RENAL
Lymphoma-NHL
Cyclophosphamide
- Doxorubicin
(CHOP)/Cycle
(Day1 & Day12)
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Belgaum
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
SQUAMOUS CELL
CARCINOMA OF
OESOPHAGIAL
CANCER
JUNCTION
STAGE IV
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
21-May-15
22-Jul-15
30000
30000
15000
1500
13500
IDBI - 321
30-Oct-15
392 H_19522288772
Female
52
Others MAJALI
KARWAR
UTTARA
KANNADA
393 H_19504287540
Female
49
Others dadibavi
RAMADURGA
BELGAUM
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Ca Endometrium
Stage II A
CANCER
pT2NxM0
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
28-May-15
11-Aug-15
63500
63500
63500
6350
57150
IDBI - 321
30-Oct-15
394 H_19504286982
Male
65
Minorit
Kallolli
y
GOKAK
BELGAUM
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Hepato Cellular
Carcinoma
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
28-May-15
9-Jul-15
22500
29421
17350
1735
15615
IDBI - 321
30-Oct-15
BELGAUM
BELGAUM
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Ca Cervix Stage
IIB
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
6-Jun-15
25-Jul-15
94500
198269
87690
8769
78921
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Cervix II B
CANCER
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
12-Jun-15
23-Jul-15
45500
45500
20500
2050
18450
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca PFS T3N1M0
CANCER
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
10-Jun-15
29-Jul-15
32000
32000
27500
2750
24750
IDBI - 321
30-Oct-15
CANCER
Surgical Oncology
Esophagus
Oesophagectomy
with Two field
Lymphadenectomy
673
673
15-May-15
30-Jul-15
85000
85000
75000
7500
67500
IDBI - 321
30-Oct-15
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
22-Jun-15
7-Aug-15
32000
36540
24700
2470
22230
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
28-May-15
6-Jul-15
87000
87000
71000
7100
63900
IDBI - 321
30-Oct-15
Surgical Oncology
Breast
Mastectomy - any
type
598
598
4-May-15
11-May-15
25000
25000
12500
1250
11250
IDBI - 321
30-Oct-15
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
17-Jun-15
20-Aug-15
96000
96000
95550
0
95550
IDBI - 321
30-Oct-15
MANGALORE
CANCER
395 H_19504286998
Female
62
Minorit
Aahok Nagar
y
396 H_20082286554
Female
38
Others THAGGAHALLI
MALAVALLI
MANDYA
Mysore
397 H_20082287454
Male
47
Minorit
D J HALLI
y
BANGALORE
EAST
BANGALORE URBAN
Bangalore
398 H_20082287956
Female
54
Others SIDDAPPANAPALYA
TUMKUR
TUMKUR
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca Oesophagus
T3N1Mo
399 H_20082287952
Male
39
CHITTAPURA
LINGASUGUR
RAICHUR
Gulbarga
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca Floor of
CANCER
mouth T3N1M0
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
SHIMOGA
Ca. Oesophagus
CANCER
STAGE II
Mysore
Krishnarajendra
MYSORE
Hospital
SC
400 H_19562286227
Male
56
SC
DUMGERE
Mysore
R
UR
401 H_20968280980
Female
65
ST
KALYANAGIRI
MYSORE
MYSORE
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
carcinoma of left
CANCER
breast
CA BASE OF
TONGUE,
VALLECULLA
AND
CANCER
PYRIFORMFOSSA
/OROPHARYNX
T3N1M0
402 H_19505288378
Male
60
Others ANIVALU
PIRIYAPATNA
MYSORE
Mysore
Bharath
Hospital
Institute of
Oncology
403 H_19504286953
Male
68
Others Lokapur
MUDHOLA
BAGLAKOT
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Ca Oesophagus
G E Junction with CANCER
liver mets
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
6-Jun-15
9-Jun-15
30000
6374
2695
270
2425
IDBI - 321
30-Oct-15
SIRSI
UTTARA
KANNADA
Belgaum
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
MANGALORE
POORLY
DIFFERENTIATED
SCC OF RIGHT
CANCER
LUNG WITH
METASTASIS
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
12-May-15
12-Sep-15
45000
45000
45000
4500
40500
IDBI - 321
30-Oct-15
ALAND
GULBARGA
Gulbarga
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Acute
Promyelocytic
Leukemia
Medical Oncology
Acute Myeloid Leukemia
Induction/1st
Phase
547
547
25-May-15
22-Jul-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Ca Tongue Stage
CANCER
III T4N2bM0
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
4-Jun-15
23-Jul-15
87000
87000
84700
8470
76230
IDBI - 321
30-Oct-15
CA (L)FRONTOTEMPORAL SOL
GRADE III
CANCER
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
4-Jun-15
17-Jul-15
90000
90000
81000
8100
72900
IDBI - 321
30-Oct-15
Carcinoma cervix
CANCER
IV A
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
16-May-15
31-Jul-15
73500
73500
71500
7150
64350
IDBI - 321
30-Oct-15
SEVERE AS
Aortic Valve
Replacement
146
146
4-Jun-15
18-Jun-15
120000
120000
84000
8400
75600
IDBI - 321
30-Oct-15
404 H_20015287980
Male
56
Minorit
HEGDEKATTA
y
405 H_20082286605
Female
26
Minorit
ANSARIMOHAL
y
406 H_19504286990
Female
66
407 H_20435285817
Male
40
408 H_19574286687
Female
36
409 H_20079287853
Male
54
Others Belgaum
Others NANDIKURALI
SC
NARASAPUR
Minorit KODICAMP 5TH
y
CROSS
BELGAUM
BELGAUM
Mysore
RAIBAGH
BELGAUM
Belgaum
Kolhapur Cancer
Karveer
Centre
RAMADURGA
BELGAUM
Belgaum
VYDEHI
HOSPITAL
TARIKERE
CHIKKAMANAGL
Mysore
UR
BANGALORE
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
CANCER
CARDIOLOGY
Sl.No
Preauth No
410 H_19576287820
Gender
Age
Male
27
Caste
Village
Others Ukkund
Taluk
Patient District
Patient
Division
Belgaum
Hospital Name
SDM Narayana
Hrudayalaya
Hospital
District
Dharwad
Final
Diagnosis
Diseases
RHD Severe MS
with MUO of
CARDIOLOGY
1.0cm Mild MR.
Disease Main
Category
RANEBENNUR
HAVERI
Mysore
NHL STAGE IA
CANCER
Medical Oncology
Lymphoma-NHL
Plan of
treatment
Mitral Valve
Replacement
Cyclophosphamide
- Doxorubicin
(CHOP)/Cycle
(Day1 & Day12)
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
145
145
14-May-15
25-May-15
120000
120000
108000
10800
97200
IDBI - 321
30-Oct-15
534
534
16-May-15
11-Sep-15
36000
77732
36000
3600
32400
IDBI - 321
30-Oct-15
526
526
25-May-15
5-Sep-15
63000
63000
63000
6300
56700
IDBI - 321
30-Oct-15
411 H_21052286970
Female
57
Others KILENJAR
MANGALORE
DAKSHINA
KANNADA
412 H_19562285347
Male
30
Minorit
HUTHA COLONY
y
BHADRAVATHI
SHIMOGA
Bangalore
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
SHIMOGA
Ca. Lung
CANCER
Medical Oncology
Non-small cell lung
cancer
413 H_20082285264
Female
48
Minorit
MILLARAPETE
y
BELLARY
BELLARY
Gulbarga
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca Cervix IIB
CANCER
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
28-May-15
14-Jul-15
34500
39255
26500
2650
23850
IDBI - 321
30-Oct-15
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
MANGALORE
CARCINOMA
TONGUE STAGE
CT3N0
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
16-May-15
31-Jul-15
87000
87000
87000
8700
78300
IDBI - 321
30-Oct-15
Mysore
CA STOMACH
AND LOWER
OESOPHAGUS
T4bN2M0 III C
CANCER
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
26-May-15
22-Jun-15
30000
15000
7200
0
7200
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Cervix III B
CANCER
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
26-May-15
2-Jul-15
34500
35265
30000
3000
27000
IDBI - 321
30-Oct-15
Surgical Oncology
677
677
14-May-15
1-Aug-15
82000
82000
59160
5916
53244
IDBI - 321
30-Oct-15
534
534
27-May-15
10-Aug-15
36000
37155
24000
2400
21600
IDBI - 321
30-Oct-15
562
562
29-May-15
2-Jul-15
34500
37765
28500
2850
25650
IDBI - 321
30-Oct-15
414 H_19522287475
Male
50
Others NAVALA GATTI
415 H_19505287429
Male
66
ST
416 H_20082284500
Female
54
ST
417 H_20127287265
Male
78
BYLAHONGALA
BELGAUM
Belgaum
RAMENAHALLI
HUNSUR
MYSORE
Mysore
DODDA AGRAHARA
SIRA
TUMKUR
Bangalore
MANGALORE
DAKSHINA
KANNADA
Mysore
A J HOSPITAL
CENTRE
CARCINOMA OF
N2c Mx
BANGALORE
SOUTH
FOLLICULAR
DENTRITIC
SARCOMA
STAGE IV
CANCER
Medical Oncology
Lymphoma-NHL
Others ADYAPADI
Bharath
Hospital
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
Carboplatin +
Paclitaxel/Cycle
Jejunostomy
Cyclophosphamide
- Doxorubicin
(CHOP)/Cycle
(Day1 & Day12)
418 H_20082286597
Female
20
Others VASANATHNAGARA
KR PET
MANDYA
Mysore
Kidwai
Memorial
Institute of
Oncology
419 H_20082286550
Female
52
Others GUDEHOSAHALLI
KR PET
MANDYA
Mysore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca Cervix II B
CANCER
Radiation Oncology
Radical Treatment
Radiotherapy
420 H_20010285434
Male
46
Others SOMALARA
MADHUGIRI
TUMKUR
Bangalore
M S Ramaiah
Hospital
BANGALORE
NORTH
CARCINOMA
ASCENDING
COLON STAGE:IV
CANCER
Surgical Oncology
Colectomy - any
type
637
637
7-May-15
1-Jun-15
40000
40000
20000
2000
18000
IDBI - 321
30-Oct-15
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
5-Jun-15
21-Jul-15
102000
102000
98000
9800
88200
IDBI - 321
30-Oct-15
Ca Pyriform
Fossa Stage II
T1N3M0
CANCER
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
BANGALORE
SOUTH
Ca Buccal
Mucosa
T4BN12M0
CANCER
Medical Oncology
Head & Neck
Carboplatin +
Paclitaxel/Cycle
Max. of 6 cycles
only
521
521
26-May-15
21-Jul-15
31500
31500
18000
1800
16200
IDBI - 321
30-Oct-15
CHITRADURGA
BPH with AUK
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
21-May-15
26-May-15
20000
24200
10000
1000
9000
IDBI - 321
30-Oct-15
Mysore
CA CERVIX
STAGE II B
CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
26-May-15
5-Jun-15
73500
14000
6000
0
6000
IDBI - 321
30-Oct-15
421 H_19504287053
Male
65
Others At:Hukeri
HUKKERI
BELGAUM
Belgaum
422 H_20082286366
Male
43
Others KONKUNTE
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
423 H_22867278998
Male
65
Others SHRAVANAGERE
HIRIYUR
CHITRADURGA
Bangalore
424 H_19505286319
Female
40
PIRIYAPATNA
MYSORE
Mysore
425 H_20790286163
Male
40
Others Bindiganavile
NAGAMANGALA MANDYA
Mysore
Sri
Adichunchanagi
B G Nagara
ri Hospital and
Research Center
Vesical calculus. RENAL
Genito Urinary
Surgery
Urology
Cystolithotripsy
906
906
18-May-15
22-May-15
12500
12500
8750
875
7875
IDBI - 321
30-Oct-15
426 H_19504285355
Female
45
Others Kasba Jambagi
MUDHOLA
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Ca Cervix Stage
IIB
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
25-May-15
27-Jul-15
73500
73500
71511
7151
64360
IDBI - 321
30-Oct-15
57
Minorit
SUNDARANAGARA
y
Mysore
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
CARCINOMA
CERVIX STAGE
IIIB
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
9-May-15
11-Aug-15
88500
88500
86500
8650
77850
IDBI - 321
30-Oct-15
427 H_19522286594
Female
ST
ASWALU
SOMAVARPET
BAGLAKOT
KODAGU
Kidwai
Memorial
Institute of
Oncology
Chitradurga
Government
Hospital
Bharath
Hospital
Institute of
Oncology
MANGALORE
CANCER
CANCER
Sl.No
Preauth No
428 H_19504285440
Gender
Age
Male
60
Caste
Village
Others Neelgund
Taluk
Patient District
MUDHOLA
BAGLAKOT
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Ca Tongue Stage
CANCER
IV A T4N1M0
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Ca Cervix Stage
IV A
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
25-May-15
21-Jul-15
22500
22500
19380
1938
17442
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
28-May-15
10-Aug-15
75500
75500
67500
6750
60750
IDBI - 321
30-Oct-15
556
556
11-May-15
6-Jul-15
18000
46460
6000
600
5400
IDBI - 321
30-Oct-15
429 H_19504285366
Female
53
Others Mangalwad
HALIYAL
UTTARA
KANNADA
430 H_21052286549
Male
28
Others TATTEKERE
HASSAN
HASSAN
Mysore
PROGRESSIVE
GLIOBLASTOMA CANCER
MULTIFORME
Medical Oncology
Palliative and
For Terminally ill cancer
Supportive
patient
Therapy/Cycle
431 H_20782286201
Female
62
BIJAPUR
BIJAPUR
Belgaum
HEALTHCARE
GLOBAL
ENTERPRISES
LTD
Bangalore
Carcinoma of
post cricoid
stage T3N0M0
CANCER
Medical Oncology
Cervical Cancer
Weekly
Cisplatin/Week
509
509
26-May-15
15-Jul-15
102000
100000
99500
498
99002
IDBI - 321
30-Oct-15
432 H_19505286220
Male
54
KOLLEGAL
CHAMARAJANA
Mysore
GAR
Bharath
Hospital
Institute of
Oncology
Mysore
CA LUNG RIGHT
(METASTATIVE)N
CANCER
EUEOENDOCRIN
E CARCINOMA IV
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
22-May-15
9-Sep-15
45000
45000
42000
0
42000
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Tongue
T3N1M0
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
22-Jun-15
27-Jul-15
87000
87785
76950
7695
69255
IDBI - 321
30-Oct-15
CANCER
Medical Oncology
Ovarian Cancer
512
512
22-May-15
23-May-15
31500
10500
5950
0
5950
IDBI - 321
30-Oct-15
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
15-Jun-15
28-Jul-15
80000
107815
76000
7600
68400
IDBI - 321
30-Oct-15
SC
Bijapur
Others UTHAMBALLI
CANCER
433 H_20082286166
Female
64
Others BETHAMANGALA
BANGARPET
KOLAR
Bangalore
Kidwai
Memorial
Institute of
Oncology
434 H_19505277438
Female
71
Others K G KOPPALU
MYSORE
MYSORE
Mysore
Bharath
Hospital
Institute of
Oncology
Mysore
CA OVARY III
HUNSUR
MYSORE
Mysore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
CRANIOPHARYN
CANCER
GIOMA STAGE III
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Carboplatin/Paclit
axel/Cycle
435 H_20082284242
Male
41
Minorit
HUNSUR
y
436 H_20127286434
Female
35
Others HUKKALI
SIDDAPUR
UTTARA
KANNADA
Belgaum
A J HOSPITAL
CENTRE
CARCINOMA OF
CANCER
GE T3 NO MO
Surgical Oncology
Jejunostomy
677
677
13-May-15
8-Aug-15
103000
103000
92820
9282
83538
IDBI - 321
30-Oct-15
437 H_20613286437
Male
32
Others Kudachi
RAIBAGH
BELGAUM
Belgaum
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
ca
esophaguswith
liver mets IV
CANCER
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
16-May-15
8-Sep-15
45000
76719
45000
4500
40500
IDBI - 321
30-Oct-15
IDDALANAGENAHALL
Others
CHITRADURGA
I
CHITRADURGA
Bangalore
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
MANGALORE
OSTEOSARCOMA
OF RIGHT TIBIA
WITH LUNG
CANCER
METASTASIS
STAGE IV
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
14-May-15
20-Aug-15
45000
37500
37500
3750
33750
IDBI - 321
30-Oct-15
GULBARGA
GULBARGA
Gulbarga
CHIRAYU
HOSPITAL
GULBARGA
Metastatic Ca of
CANCER
stomach
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
20-May-15
1-Jul-15
45000
24558
15750
1575
14175
IDBI - 321
30-Oct-15
MYSORE
MYSORE
Mysore
SJICR MYSORE
MYSORE
IHD- ACS IWMI
Cardiology
Cardiology
Medical
treatment of
Acute MI with
Thrombolysis
128
128
16-May-15
20-May-15
10000
10000
7000
700
6300
IDBI - 321
30-Oct-15
Bangalore
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
SHIMOGA
Ca. Vallecula
T3N3M0
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
21-May-15
16-Sep-15
96000
108000
108000
10800
97200
IDBI - 321
30-Oct-15
SHIMOGA
Ca. Rt Tonsil
T3N2bM0
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
22-May-15
7-Sep-15
87000
87000
87000
8700
78300
IDBI - 321
30-Oct-15
Mysore
RECURRENCE OF
CANCER
CA OVARY
Medical Oncology
Ovarian Cancer
512
512
20-May-15
11-Jun-15
63000
21000
14700
0
14700
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
568
568
21-May-15
25-Jul-15
75500
71000
66975
6698
60277
IDBI - 321
30-Oct-15
438 H_20015286259
Male
20
439 H_20815286197
Female
47
440 H_20733285816
Female
75
441 H_19562276384
Female
SC
BELUR (J)
Others KUVEMPU NAGAR
43
Others SHANKARAGATTA
BHADRAVATHI
TUMKUR
Bangalore
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
MANDYA
Mysore
Bharath
Hospital
Institute of
Oncology
Mysore
THE RADIANT
INSTITUTE
442 H_19562282888
Male
49
CHIKKAMARPANAHA
Others
TIPTUR
LLI
443 H_19505285748
Female
51
Others GOPALAPURA
444 H_23069284836
Female
30
SC
HAGINAVALU
MANDYA
NANJANAGUD
SHIMOGA
MYSORE
MYSORE
CA CERVIX IIIB
CARDIOLOGY
CANCER
CANCER
CANCER
Carboplatin/Paclit
axel/Cycle
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
Sl.No
Preauth No
445 H_21052285570
446 H_19562283136
Gender
Age
Male
28
Female
50
447 H_19562282980
Male
56
448 H_20082284473
Female
59
449 H_20082284250
Male
50
Caste
Village
Taluk
Others CHIRADONI VILLAGE CHANNAGIRI
ST
DIDAGUR
Others MARUTHI NAGAR
SC
MUDNOOR
Others JAKKANAHALLI
HONNALI
Patient District
DAVANGERE
DAVANGERE
Patient
Division
Bangalore
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
Ca. Cervix STAGE
CANCER
IIIA
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
BHADRAVATHI
SHIMOGA
Bangalore
SURPUR
YADGIRI
Gulbarga
ARASIKERE
HASSAN
Mysore
Others HALEBUDANURU
MANDYA
MANDYA
Mysore
451 H_21701297886
Female
44
Minorit
ali faizpur
y
BIDAR
BIDAR
Gulbarga
452 H_20082296473
Female
42
Others VALAGERE
KR PET
MANDYA
Mysore
453 H_19574296487
Male
39
Minorit
NARASARAJ PET
y
DAVANAGERE
DAVANGERE
Bangalore
455 H_20127298804
Male
36
Others SIDDAPPANAKERI
Others
RAJA RAJESHWARI
NAGARA
456 H_19528298108
Female
58
Others JUTAMARADI
457 H_20082295364
Female
30
Others
HONNALI
MADIKERI
DEVADURGA
DODDADEVANAHALL
HOSAKOTE
I
DAVANGERE
Diseases
CA TESTIS STAGE
CANCER
3C
44
31
Final
Diagnosis
Female
Male
Hospital
District
Bangalore
450 H_19505284605
454 H_21052299038
Hospital Name
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
Bharath
Hospital
Institute of
Oncology
SUNSHINE
HEART
INSTITUTE
Kidwai
Memorial
Institute of
Oncology
VYDEHI
HOSPITAL
SHIMOGA
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
15-May-15
31-Jul-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
22-May-15
16-Jul-15
75000
77500
69750
6975
62775
IDBI - 321
30-Oct-15
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
21-May-15
10-Aug-15
86000
95000
81000
8100
72900
IDBI - 321
30-Oct-15
SHIMOGA
Ca. Oesophagus CANCER
Radiation Oncology
3D Conformational
Radio Therapy
BANGALORE
SOUTH
ca esophagus
T3N1M0
CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
15-Jun-15
6-Aug-15
62000
64760
53200
5320
47880
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
ca pysiform
T2N2bM0
CANCER
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
25-May-15
16-Jul-15
32000
32000
30000
3000
27000
IDBI - 321
30-Oct-15
Mysore
CA.CERVIX
STAGE III A
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
25-May-15
11-Aug-15
86500
86500
86500
0
86500
IDBI - 321
30-Oct-15
Paradise, S.D.
Road
cad_ svd
CARDIOLOGY
ptca+stent to rca
Cardiology
Cardiology
PTCA - 2 stent
(non-medicated)
104
104
17-Jun-15
23-Jun-15
70000
105051
49980
4998
44982
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
CA THYROD
T3N1M0
CANCER
Surgical Oncology
Head & Neck
612
612
26-Jun-15
2-Jul-15
35000
38135
24500
2450
22050
IDBI - 321
30-Oct-15
BANGALORE
Metastasis
carcinoma of GE CANCER
junction Stage IV
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
29-May-15
15-Jul-15
22500
22500
22500
2250
20250
IDBI - 321
30-Oct-15
Medical Oncology
Acute Lymphoblastic
Leukemia
Induction &
Consolidation/1st
phase - 1st ,2nd ,
3rd , 4th & 5th
months
550
550
16-Jun-15
22-Jul-15
70000
70000
30000
3000
27000
IDBI - 321
30-Oct-15
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
18-Jun-15
25-Jun-15
65000
122326
62985
6299
56686
IDBI - 321
30-Oct-15
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
29-Jun-15
7-Aug-15
92000
92000
91800
2754
89046
IDBI - 321
30-Oct-15
Bangalore
Mysore
A J HOSPITAL
CENTRE
RAICHUR
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
CA LARNX
CT3NOMO
CANCER
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
BANGALORE RURAL
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
ca cervix II B
CANCER
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
29-Jun-15
31-Jul-15
36500
36500
27500
2750
24750
IDBI - 321
30-Oct-15
KOLAR
STRICTURE
URETHRA
RENAL
Genito Urinary
Surgery
Urology
Urethroplasty for
Stricture Diseasessingle stage(Twice
a year can be
considered)
912
912
24-Jun-15
17-Jul-15
30000
30000
28500
2850
25650
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Breast
T3N1M0
CANCER
Medical Oncology
Breast
FEC (Epirubicin
based)/Cycle
504
504
24-Jun-15
5-Aug-15
15000
15000
12000
1200
10800
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
16-Jun-15
27-Jun-15
25000
25000
12500
1250
11250
IDBI - 321
30-Oct-15
KODAGU
T CELL ALL
CANCER
ACUTE MI
CANCER
CARDIOLOGY
Cardiology
458 H_20164297088
Male
66
Others KARADIGANAHALLI
MULABAGILU
KOLAR
Bangalore
R L JALAPPA
HOSPITAL AND
RESEARCH
CENTRE
459 H_20082289765
Female
40
Others DODDAGUNI
GUBBI
TUMKUR
Bangalore
Kidwai
Memorial
Institute of
Oncology
Mysore
GLOBAL
MULTISPECIALIT
MANGALORE
Y HOSPITAL
INDIA PVT LTD
LEFT RENAL
CALCULI
RENAL
Genito Urinary
Surgery
Bangalore
M S Ramaiah
Hospital
BANGALORE
NORTH
CA RECTUM
CANCER
Surgical Oncology
Colectomy - any
type
637
637
15-Jun-15
10-Jul-15
40000
40000
28000
2800
25200
IDBI - 321
30-Oct-15
MYSORE
IHD-EVOLVED
IWMI CADSIGNIFICCANT
RCA+LAD
DISEASE
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
22-Jun-15
27-Jun-15
90000
90000
63000
6300
56700
IDBI - 321
30-Oct-15
460 H_21897298733
Female
61
Others 0
MANGALORE
DAKSHINA
KANNADA
461 H_20010298605
Male
27
Others HONNENAHALLY
SIRA
TUMKUR
462 H_20733298687
Female
41
SC
HOSAHOLALU
MANDYA
MANDYA
Mysore
SJICR MYSORE
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
10-Jun-15
20-Aug-15
102000
102000
102000
10200
91800
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
24-Jun-15
26-Jun-15
25000
25000
17500
1750
15750
IDBI - 321
30-Oct-15
463 H_20698297078
Female
48
Others HALLADKERE
HARIHARA
DAVANGERE
Bangalore
YENEPOYA
MEDICAL
COLLEGE
HOSPITAL
464 H_22478298199
Female
24
Others NEELANA HALLY
MANDYA
MANDYA
Mysore
SHREE
MAHADESHWA
MYSORE
RA NURSING
HOME
LEFT RENAL
CALCULUS
465 H_19528298542
Male
33
Minorit
HOKRANA
y
BIDAR
BIDAR
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
CARCINOMA OF
HEAD AND NECK CANCER
STAGE IV
Medical Oncology
Head & Neck
Carboplatin +
Paclitaxel/Cycle
Max. of 6 cycles
only
521
521
25-Jun-15
7-Aug-15
63000
31500
30524
916
29608
IDBI - 321
30-Oct-15
466 H_19564298406
Male
64
Others PADU
UDUPI
UDUPI
Mysore
KASTURBA
HOSPITAL
UDUPI
CHRONIC STABLE
CARDIOLOGY
ANGINA
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
19-Jun-15
24-Jun-15
90000
90000
91290
9129
82161
IDBI - 321
30-Oct-15
467 H_22447297291
Male
25
SHAHPUR
YADGIRI
Gulbarga
UNITED
HOSPITAL
GULBARGA
Fracture left
ZMC
POLYTRAUMA
Polytrauma
Plastic Surgery
Facial bone
fractures (FacioMaxillary Injuries)
807
807
16-Jun-15
23-Jun-15
35000
35000
31500
3150
28350
IDBI - 321
30-Oct-15
468 H_20082297046
Female
38
VIJAPET
KODAGU
Mysore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca esophagus
T3N1M0
CANCER
Medical Oncology
Cervical Cancer
Weekly
Cisplatin/week
509
509
23-Jun-15
7-Aug-15
32000
32000
32000
3200
28800
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
CANCER
Medical Oncology
Acute Lymphoblastic
Leukemia
Induction &
Consolidation/1st
phase - 1st ,2nd ,
3rd , 4th & 5th
months
550
550
22-Jun-15
25-Jul-15
70000
70000
13300
1330
11970
IDBI - 321
30-Oct-15
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
25-Jun-15
7-Aug-15
22500
22500
22500
2250
20250
IDBI - 321
30-Oct-15
CANCER
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
22-Jun-15
31-Jul-15
88000
88000
80037
320
79717
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
Peripheral
Angioplasty
withstent (nonmedicated)
109
109
1-Jun-15
22-Jun-15
55000
55000
52250
5225
47025
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
19-Jun-15
22-Jun-15
20000
20000
12950
1295
11655
IDBI - 321
30-Oct-15
469 H_20082297650
Female
40
470 H_20435298276
Female
36
471 H_19491296795
Female
65
SC
0
Others VIRAJPET
Others BELURU
SC
MANGUR
Others JANNAWARA
MANGALORE
CA
N0 M0
RENAL
JEVARGI
GULBARGA
Gulbarga
Kidwai
Memorial
Institute of
Oncology
CHIKKODI
BELGAUM
Belgaum
Kolhapur Cancer
Karveer
Centre
CA VAGINAL
VAULT STAGE IV CANCER
A
Mysore
BGS GLOBAL
HOSPITAL
CARCINOMA
RECTUM
T3N1M0
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
ARASIKERE
HASSAN
BANGALORE
SOUTH
all
ACUTE
MESCENTRIC
ISCHEMIA
SUPERIOR
MESCENTRIC
ARTERY
OCCLUSION
RHD-SEVERE
MITRAL
STENOSIS
472 H_20017298231
Male
70
Others MASUTI
BASAVANABAGE
BIJAPUR
WADI
473 H_20733297960
Female
36
Others CHANNIPURA MOLE
Mysore
GAR
GAR
SJICR MYSORE
474 H_20613298059
Male
23
Others TAVANASHI
ATHANI
BELGAUM
Belgaum
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
c/o malignant
melenoma -thigh
CANCER
region with mets
IV
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
22-Jun-15
26-Aug-15
30000
25725
22500
2250
20250
IDBI - 321
30-Oct-15
475 H_19564297647
Male
45
Others MARAVANTHE
KUNDAPURA
UDUPI
Mysore
KASTURBA
HOSPITAL
ACUTE AWMI
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
16-Jun-15
29-Jun-15
90000
90000
91290
9129
82161
IDBI - 321
30-Oct-15
476 H_20079298039
Female
48
Others CHIKKAKABBAR
HIREKERUR
HAVERI
Belgaum
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
RHD,SEVER MS
AF.
CARDIOLOGY
Mitral Valve
Replacement
145
145
19-Jun-15
17-Jul-15
120000
120000
114000
11400
102600
IDBI - 321
30-Oct-15
477 H_20082297859
Female
38
Others MADAPURA
GUBBI
TUMKUR
Bangalore
Kidwai
Memorial
Institute of
Oncology
Ca breast
cT3N0M0
CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
22-Jun-15
29-Jun-15
25000
26030
19800
1980
17820
IDBI - 321
30-Oct-15
BELGAUM
Belgaum
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
ca lung post CT
T2 N2 M0
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
23-Jun-15
26-Aug-15
103000
100615
75000
7500
67500
IDBI - 321
30-Oct-15
CARCINOMA
OVARY.STAGE
CANCER
IIIC (ADVANCED
STAGE)
Medical Oncology
Ovarian Cancer
512
512
16-Jun-15
12-Aug-15
31500
31500
31500
3150
28350
IDBI - 321
30-Oct-15
ca marginal zone
T3N2a Mx stage
CANCER
IV (pyrifoma
sinus)
Medical Oncology
Cervical Cancer
509
509
30-Jun-15
13-Aug-15
62000
62000
62000
6200
55800
IDBI - 321
30-Oct-15
RAIBAGH
MYSORE
UDUPI
BANGALORE
SOUTH
478 H_20613297623
Female
63
Others Suttati
479 H_20015297850
Female
41
Others NAGARABASTHIKERI HONNAVAR
UTTARA
KANNADA
Belgaum
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
480 H_20254296040
Female
45
Others Bailkur
BIJAPUR
Belgaum
Shakuntala
Memorial
Hubli
Hospital and
Research Centre
MUDDEBIHAL
MANGALORE
CANCER
Carboplatin/Paclit
axel/Cycle
Weekly
Cisplatin/Week
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
22-Jun-15
17-Aug-15
85000
85000
84500
8450
76050
IDBI - 321
30-Oct-15
CANCER
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
26-Jun-15
30-Jul-15
32000
32000
28800
2880
25920
IDBI - 321
30-Oct-15
MYSORE
CA POST
CRICOID
CANCER
T2N1MO STAGE
II
BANGALORE
SOUTH
Ca Esophagus
T3N1Mo
481 H_23069296808
Male
52
Others DODDRAYANAPETE
Mysore
GAR
GAR
482 H_20082294259
Male
74
Others ARABHIKOTHANUR
KOLAR
KOLAR
Bangalore
Kidwai
Memorial
Institute of
Oncology
483 H_20968296026
Male
49
SC
T NARASIPUR
MYSORE
Mysore
Krishnarajendra
MYSORE
Hospital
CA. BASE
TONGUE
T3N3M0
CANCER
Medical Oncology
Head & Neck
Carboplatin +
Paclitaxel/Cycle
Max. of 6 cycles
only
521
521
16-Jun-15
7-Aug-15
51500
51500
41000
4100
36900
IDBI - 321
30-Oct-15
484 H_20733296615
Male
65
Others
MYSORE
Mysore
SJICR MYSORE
IHD-EVOLVED
TMIT+VE ON
GOING CHEST
PAIN
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
16-Jun-15
19-Jun-15
90000
90000
85500
8550
76950
IDBI - 321
30-Oct-15
239
239
16-Jun-15
22-Jun-15
65000
65000
61750
6175
55575
IDBI - 321
30-Oct-15
120
120
19-Jun-15
22-Jun-15
80000
80000
55650
5565
50085
IDBI - 321
30-Oct-15
562
562
22-Jun-15
28-Jul-15
32000
32000
25650
2565
23085
IDBI - 321
30-Oct-15
239
239
15-Jun-15
19-Jun-15
55000
55000
38500
3850
34650
IDBI - 321
30-Oct-15
SOMANATHAPURA
CHAMARAJAMOHALL
MYSORE
A
THE RADIANT
INSTITUTE
Hospital
District
MYSORE
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
ASD Device
Closure
485 H_21057297325
Male
70
Others NARIMOGARU
PUTTUR
DAKSHINA
KANNADA
Mysore
KMC HOSPITAL Mangalore
NEW
IHD, ACUTE
ANTERIOR WALL CARDIOLOGY
MI
486 H_20733297596
Male
32
Others UPPARAKOPPALU
MANDYA
MANDYA
Mysore
SJICR MYSORE
MYSORE
CHD/SS/OS/ASD CARDIOLOGY
Cardiology
Device Closure
Gulbarga
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca Vagina III B
Radiation Oncology
Radical Treatment
Radiotherapy
487 H_20082296617
488 H_20733296303
Male
Female
40
54
Others GINAL
ST
#234, Suyaz Form
Road
SHAHPUR
YADGIRI
MYSORE
MYSORE
MYSORE
IHD-ACS-ACUTE
AWMI
Belgaum
MANGALORE
INSTITUTE OF
ONCOLOGY
MANGALORE
CA UTERINE
CERVIX STAGE
IIB (L)
Mysore
SJICR MYSORE
CANCER
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
18-Jun-15
1-Sep-15
92500
92500
92500
9250
83250
IDBI - 321
30-Oct-15
CANCER
Medical Oncology
Cervical Cancer
Weekly
Cisplatin/week
509
509
23-Jun-15
27-Jul-15
45500
45500
21850
2185
19665
IDBI - 321
30-Oct-15
CARDIOLOGY
489 H_20575297424
Female
55
Others TALGERI
BHATKALA
UTTARA
KANNADA
490 H_20082294830
Male
56
Others WADNAHALLI
YADGIR
YADGIRI
Gulbarga
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca Cervix III A
491 H_19562292445
Male
53
Others GOWRAPURA
BHADRAVATHI
SHIMOGA
Bangalore
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
SHIMOGA
Ca.BOT
T3N2bM1 STAGE CANCER
IVB
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
29-Jun-15
31-Aug-15
32000
32000
32000
3200
28800
IDBI - 321
30-Oct-15
492 H_20082296191
Male
48
Others WARD 04
RAMANAGAR
RAMANAGAR
Bangalore
ca gall bladder
T3N1M0
CANCER
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 cycles)
555
555
20-Jun-15
1-Aug-15
22500
23270
21375
2138
19237
IDBI - 321
30-Oct-15
493 H_20968296419
Male
67
Others BEGURU
GUNDLUPET
CHAMARAJANA
Mysore
GAR
BPH WITH AUR
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
17-Jun-15
4-Aug-15
20000
20000
19000
1900
17100
IDBI - 321
30-Oct-15
MANDYA
Mysore
THE RADIANT
INSTITUTE
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
22-Jun-15
24-Jul-15
88500
88500
74500
7450
67050
IDBI - 321
30-Oct-15
521
521
26-Jun-15
8-Aug-15
31500
40500
31500
3150
28350
IDBI - 321
30-Oct-15
612
612
17-Jul-15
21-Jul-15
35000
35000
33250
3325
29925
IDBI - 321
30-Oct-15
494 H_23069296873
Female
68
KURIKEMPANADODD
Others
MADDUR
I
495 H_20435297365
Male
39
Others BUDIHAL
CHIKKODI
BELGAUM
Belgaum
496 H_20435297339
Male
40
Others RAMPUR
CHIKKODI
BELGAUM
55
Others NIRUVAGALAPPA
CHIKKANAYAKA
TUMKUR
NAHALLI
45
BANGALORE
Others ULLALU UPANAGARA
NORTH
497 H_20082296496
498 H_19491296101
Female
Female
BANGALORE URBAN
Kidwai
BANGALORE
Memorial
SOUTH
Institute of
Oncology
Krishnarajendra
MYSORE
Hospital
CA CERVIX IIIB
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Kolhapur Cancer
Karveer
Centre
CA BUCCAL
MUCOSA
T4N1M0
CANCER
Medical Oncology
Head & Neck
Belgaum
Kolhapur Cancer
Karveer
Centre
CA TONGUE
T2N0M0
CANCER
Surgical Oncology
Head & Neck
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
ca breast
pt2n1m0
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
23-Jul-15
1-Sep-15
65000
75665
62000
6200
55800
IDBI - 321
30-Oct-15
Bangalore
BGS GLOBAL
HOSPITAL
BANGALORE
SOUTH
CARCINOMA
B
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
19-Jun-15
22-Jul-15
75000
75000
64575
258
64317
IDBI - 321
30-Oct-15
MYSORE
CANCER
Carboplatin +
Paclitaxel/Cycle
Max. of 6 cycles
only
Sl.No
Preauth No
499 H_22879297109
Gender
Male
Age
66
Caste
Village
Others Kognoli
Taluk
CHIKKODI
Patient District
BELGAUM
Patient
Division
Hospital Name
Belgaum
SIDDHAGIRI
HOSPITAL AND
RESEARCH
CENTRE
Hospital
District
Final
Diagnosis
KOLHAPUR
D12
osteoporotic
compression
fracture
MANGALORE
CARCINOMA
GASTRO
OESOPHAGEAL
JUNCTION
STAGE T3N2M0
Diseases
86000
114000
114000
11400
102600
IDBI - 321
30-Oct-15
NEURO SURGERY
Neuro Surgery
Brain Tumour
Excision of Brain
Tumor
Supratentorial &
others
407
407
16-Jun-15
2-Jul-15
45000
55740
31500
3150
28350
IDBI - 321
30-Oct-15
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
16-Jun-15
4-Aug-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
19-Jun-15
23-Jul-15
88500
88500
74500
7450
67050
IDBI - 321
30-Oct-15
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
14-Jun-15
18-Jun-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
531
531
19-Jun-15
13-Jul-15
30000
20000
9000
0
9000
IDBI - 321
30-Oct-15
Minorit
STATION BAZAR
y
GULBARGA
GULBARGA
Gulbarga
BASAVESHWAR
TEACHING AND
GULBARGA
GENERAL
HOSPITAL
PNET TUMOR
69
Minorit
NEHARU ROAD
y
MUDIGERE
CHIKKAMANAGL
Mysore
UR
MANGALORE
INSTITUTE OF
ONCOLOGY
MANGALORE
RETROPERITONI
AL SARCOMA
CANCER
STAGE III
MYSORE
THE RADIANT
INSTITUTE
MYSORE
CA CERVIX
STAGE IIB
46
Others Murundi
ARASIKERE
HASSAN
Mysore
SJICR MYSORE
Mysore
Bharath
Hospital
Institute of
Oncology
505 H_19505296475
Male
46
Others UNDAVADI
MYSORE
MYSORE
506 H_20082296382
Female
19
Others NAGARALU
KADUR
CHIKKAMANAGL
Mysore
UR
507 H_20082295221
Female
32
Minorit
KARATAGI
y
GANGAVATHI
KOPPAL
Gulbarga
508 H_20082296425
Female
40
Minorit
WARD 56
y
MYSORE
MYSORE
Mysore
509 H_20613296028
Male
45
Others Bhanahatti
510 H_20968295657
Female
46
Others
511 H_20435295726
Female
1
JAMAKHANDI
SHANABOGANAHALL
HUNSUR
I
Others AKKOL
CHIKKODI
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
30-Oct-15
Mysore
CA COLON WITH
CANCER
LIVER METS IV
Medical Oncology
Colorectal Cancer
(FOLFOX)
(Paliation CT
only)/week(max 6
cycles)
BANGALORE
SOUTH
AML
CANCER
Medical Oncology
Induction/1st
Phase
547
547
17-Jun-15
7-Aug-15
50000
58575
47500
4750
42750
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
ca thyroid
T3N1M0
CANCER
Nuclear Medicine
Thyroid
Radioiodine
Treatment > 100
Millicuries
575
575
25-Jul-15
28-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
CA BREAST
T3N0M0
CANCER
Medical Oncology
Breast
FEC (Epirubicin
based)/Cycle
504
504
17-Jun-15
29-Jul-15
15000
15000
15000
1500
13500
IDBI - 321
30-Oct-15
568
568
16-Jun-15
20-Aug-15
87000
111816
85000
8500
76500
IDBI - 321
30-Oct-15
k/c/o ca
tonsil+uvula T3
N1 M0
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
CARCIMOMA
RIGHT BREAST
STAGE IIB
CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
16-Jun-15
22-Jun-15
25000
25000
17500
1750
15750
IDBI - 321
30-Oct-15
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
6-Jul-15
14-Aug-15
70000
106000
65000
6500
58500
IDBI - 321
30-Oct-15
Head & Neck
Brain - GBM, High
grade Astrocytoma
only - Cap
Temozolamide(10
0mg/day), during
RT only/Cycle
523
523
11-Jun-15
10-Aug-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
Medical Oncology
IHD - IWMI, TVD CARDIOLOGY
Cardiothoracic Surgery CABG
CABG
132
132
17-Jun-15
23-Jun-15
95000
115000
94000
0
94000
IDBI - 321
30-Oct-15
IHD - AWMI,
DM, HTN, TVD
CARDIOLOGY
CABG with IABP
133
133
9-Jun-15
27-Jun-15
115000
115000
115000
0
115000
IDBI - 321
30-Oct-15
CA Thoroid
txn1m0
CANCER
Surgical Oncology
615
615
8-Jun-15
26-Jun-15
20000
24770
18000
1800
16200
IDBI - 321
30-Oct-15
57
Others THAVRAGATTE
KANAKAPURA
RAMANAGAR
Bangalore
SJICR
SHETTAHALLI
IDBI - 321
RIFRONTAL
GLIOBLSATOMA
MULTIFORMAE CANCER
GRADE IV POST
OP
Male
SC
40500
CA VAGINA III B
513 H_19577296160
27
4500
Belgaum
BELGAUM
Mysore
Female
45000
Kolhapur Cancer
Karveer
Centre
DAKSHINA
KANNADA
515 H_20082294835
60000
Krishnarajendra
MYSORE
Hospital
MANGALORE
BANGARPET
60000
Mysore
Minorit
THALAPADY
y
ZAMALINGAPURA
26-Jun-15
MYSORE
24
SC
Cardiology
16-Jun-15
Belgaum
Male
55
IHD-ACS-AWMI,
CARDIOLOGY
CAD-SVD
447
BAGLAKOT
512 H_20575294799
Male
CANCER
447
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
MANGALORE
INSTITUTE OF
ONCOLOGY
514 H_19577296189
MYSORE
26-Aug-15
2
Male
Net Amt
Paid
11-Jun-15
Female
504 H_20733296295
TDS
567
501 H_20021297008
Mysore
Gross
Amount
approved by
567
Bangalore
NANJANAGUD
Hospital
claimed
Amount
Radiation Oncology
CHITRADURGA
HARADANAHALLI
Preauth
Approved
Amt
CANCER
CHITRADURGA
SC
Date of
Discharge
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
Others MANDAKKI BHATTI
45
Date of
Admission
Intensity Modulated
Radiotherpy(IMRT)
61
Female
Spinal
Female
503 H_23069296664
Plan of
treatment
Neuro Surgery
NEURO SURGERY
500 H_19522296143
Female
Corpectomy for
Spinal
Fixation(40000) +
cost of
implant(20000)
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
502 H_20575296431
Disease Main
Category
KOLAR
SHRIRANGAPAT
MANDYA
NA
Bangalore
SJICR
Mysore
Kidwai
Memorial
Institute of
Oncology
MANGALORE
BANGALORE
SOUTH
BANGALORE
SOUTH
BANGALORE
SOUTH
CANCER
Head & Neck
Sl.No
Preauth No
516 H_20733295360
517 H_19491293779
Gender
Age
Male
65
Male
31
Caste
Village
Others KALLAKOPPALU
Others K.R.NAGARA
518 H_20782295957
Female
34
ST
519 H_20698295953
Male
48
Others
520 H_21194295298
Female
51
Others KALELE
521 H_20015295775
Male
60
522 H_22478295492
Female
47
523 H_20613295696
524 H_19522294736
Male
Female
NAYAKANAHATTI
HASSAN
KR NAGAR
CHALLAKERE
MATAN MARKET 3RD
ARASIKERE
CROSS
Others CHAPPARA MANE
SC
Taluk
GERUDADA VI.
NANJANAGUD
25
ST
KANUVANAHALLI
Mysore
SJICR MYSORE
MYSORE
IHD-ACS NSTEMI
ON GOING
CARDIOLOGY
CHESTPAIN CADDVD
Mysore
BGS GLOBAL
HOSPITAL
BANGALORE
SOUTH
RECURRENT
ASTROCYTOMA
GRADE II
CHITRADURGA
Bangalore
HEALTHCARE
GLOBAL
ENTERPRISES
LTD
HASSAN
Mysore
MYSORE
Mysore
HASSAN
MYSORE
YENEPOYA
MEDICAL
COLLEGE
HOSPITAL
Mandya
Institute of
Medical
Sciences
Mandya
76950
IDBI - 321
30-Oct-15
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
19-Jun-15
17-Jul-15
60000
60000
54000
216
53784
IDBI - 321
30-Oct-15
Bangalore
CARCINOMA OF
CERVIX STAGE
CANCER
IB2
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
23-Jun-15
6-Aug-15
88500
88500
68500
343
68157
IDBI - 321
30-Oct-15
MANGALORE
CA.
HYPOPHARYNX CANCER
T2 N3 M0 STAGE 3
Medical Oncology
Cervical Cancer
Weekly
Cisplatin/Week
509
509
8-Jun-15
3-Aug-15
87000
87000
85000
8500
76500
IDBI - 321
30-Oct-15
Mandya
Ca Breast
Surgical Oncology
Breast
Mastectomy - any
type
598
598
8-Jun-15
27-Jul-15
25000
25000
23750
2375
21375
IDBI - 321
30-Oct-15
MANGALORE
MULTI LEVEL
OPLL CAUSING
CORD
COMPRESSION
NEURO SURGERY
AND
MYELOMALACIA
AT C3-4 AND C56 LEVELS.
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
12-Jun-15
25-Jun-15
75000
50000
36000
3600
32400
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
16-Jun-15
17-Jun-15
25000
25000
17500
1750
15750
IDBI - 321
30-Oct-15
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
17-Jun-15
19-Aug-15
102000
102000
100000
10000
90000
IDBI - 321
30-Oct-15
512
512
1-Jun-15
13-Aug-15
63000
31500
31500
3150
28350
IDBI - 321
30-Oct-15
907
907
17-Jun-15
27-Jun-15
25000
25000
17500
1750
15750
IDBI - 321
30-Oct-15
CANCER
CANCER
MYSORE
Mysore
SHREE
MAHADESHWA
MYSORE
RA NURSING
HOME
LEFT URETERIC
CALCULUS
Belgaum
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
k/c/o ca soft
palate+tonsil T2 CANCER
N2 M0
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Mysore
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
MANGALORE
PRIMARY
PERITONEAL
CANCER
CARCINOMATOS
IS STAGE IIIc
Medical Oncology
Ovarian Cancer
BANGALORE RURAL
Bangalore
M S Ramaiah
Hospital
BANGALORE
NORTH
RIGHT PUJ
CALCULES AND
LEFT UPPER
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
BANGALORE RURAL
Bangalore
SJICR
BANGALORE
SOUTH
CHD - OS ASD
CARDIOLOGY
Cardiology
Device Closure
ASD Device
Closure
120
120
23-Jun-15
26-Jun-15
80000
80000
80000
0
80000
IDBI - 321
30-Oct-15
Gulbarga
HEALTHCARE
GLOBAL
ENTERPRISES
LTD
Bangalore
CARCINOMA OF
CERVIX STAGE
CANCER
IIB
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
15-Jun-15
7-Aug-15
88500
88500
88000
440
87560
IDBI - 321
30-Oct-15
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
ca bresat III
Medical Oncology
Breast
FEC (Epirubicin
based)/Cycle
504
504
26-Jun-15
13-Aug-15
15000
19075
15000
1500
13500
IDBI - 321
30-Oct-15
SHIMOGA
Ca. PFS
cT3N2cM0
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
18-Jun-15
19-Aug-15
87000
87000
87000
8700
78300
IDBI - 321
30-Oct-15
Medical Oncology
Breast
FEC (Epirubicin
based)/Cycle
504
504
16-Jun-15
30-Jul-15
15000
15000
15000
1500
13500
IDBI - 321
30-Oct-15
Surgical Oncology
Jejunostomy
677
677
10-Jun-15
31-Jul-15
62500
47500
45125
4513
40612
IDBI - 321
30-Oct-15
ATHANI
BELGAUM
BANTWAL
DAKSHINA
KANNADA
NELEMANGALA
CHIKKABALLAPU
Bangalore
R
Others SIRABADIGE
Mysore
R
UR
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
RAMADURGA
BELGAUM
Belgaum
Kolhapur Cancer
Karveer
Centre
HONNAVAR
UTTARA
KANNADA
Belgaum
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
Others KADEGERE
Net Amt
Paid
8550
CHINTAMANI
56
TDS
85500
Others HIMSANDRA
Male
Gross
Amount
approved by
90000
53
531 H_20015295407
Hospital
claimed
Amount
90000
Female
KALKOL
Preauth
Approved
Amt
16-Jun-15
528 H_20082292563
SC
Date of
Discharge
12-Jun-15
YADGIRI
40
Date of
Admission
241
SHAHPUR
Female
241
Others DONARAHALLI
530 H_20435295458
Plan of
treatment
PTCA - Two stent
(Drug Eluting
Stents , elective)
39
45
Cardiology
Female
Male
Disease Main
Category
Cardiology
527 H_20782295608
529 H_19562284627
Diseases
KR NAGAR
GADDADHANAGERE
Others
DEVANAHALLI
HALLI
Female
Final
Diagnosis
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
55
526 H_19577295596
Hospital
District
Belgaum
Minorit
B.MOODA
y
31
Hospital Name
UTTARA
KANNADA
Others Ugar Kurd
Female
Patient
Division
SIDDAPUR
40
525 H_20010295539
Patient District
MANGALORE
RENAL
CANCER
CANCER
CA BREAST
CANCER
T3N1M0
MODERATELY
DIFFERENTIATED
CANCER
SCC OF
OESOPHAGUS.
STAGE IV.
Carboplatin/Paclit
axel/Cycle
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Gastro
StudyFollowed by
Thoracotomy &
Repairs for
Oesophageal
Injury for
Corrosive
Injuries/FB
205
205
30-May-15
14-Jul-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
532 H_21223293428
Male
4
Others ARAKERE
SHRIRANGAPAT
MANDYA
NA
Mysore
INDIRA GANDHI
BANGALORE
INSTITUTE OF
SOUTH
CHILD HEALTH
caustic
esophageal
injury
533 H_21701293854
Male
66
Others sirnoor
GULBARGA
GULBARGA
Gulbarga
SUNSHINE
HEART
INSTITUTE
cad triple vessel
CARDIOLOGY
disease
CABG
132
132
5-Jun-15
22-Jun-15
95000
163457
67830
6783
61047
IDBI - 321
30-Oct-15
534 H_20086293522
Male
43
Others SULIKUNTE
BANGARPET
KOLAR
Bangalore
R L JALAPPA
NARAYANA
KOLAR
HRUDAYALAYA
HEART CENTRE
IHD-ACS-IWMI
(LATE
CARDIOLOGY
PRESENTATION)
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
5-Jun-15
14-Jun-15
90000
90000
85500
8550
76950
IDBI - 321
30-Oct-15
Mysore
Janapriya
Hospital
right uretric
calculas right
renal calculas uti RENAL
acute kidney
injury
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
11-Jun-15
15-Jun-15
25000
0
22500
2250
20250
IDBI - 321
30-Oct-15
Post Burn
Contracture
surgeries for
Functional
Improvement(Pack
age including
splints, pressure
garments and
physiotherapy),
Severe
11
11
10-Jun-15
1-Jul-15
40000
40000
38000
3800
34200
IDBI - 321
30-Oct-15
532
532
15-Jun-15
22-Aug-15
80000
88740
60000
6000
54000
IDBI - 321
30-Oct-15
907
907
20-Jun-15
25-Jun-15
25000
25000
23750
2375
21375
IDBI - 321
30-Oct-15
241
241
7-Jun-15
12-Jun-15
90000
90000
85500
8550
76950
IDBI - 321
30-Oct-15
512
512
17-Jun-15
31-Jul-15
31500
33700
5700
570
5130
IDBI - 321
30-Oct-15
550
550
13-Jun-15
17-Aug-15
70000
79495
25000
2500
22500
IDBI - 321
30-Oct-15
509
509
10-Jun-15
22-Jul-15
30000
30000
28000
2800
25200
IDBI - 321
30-Oct-15
535 H_22933294967
536 H_20790295089
537 H_20613294837
Male
Male
Female
30
40
20
SC
Bantenahalli
Others Ajjanapalya
Others Banahatti
BELUR
HASSAN
NAGAMANGALA MANDYA
JAMAKHANDI
BAGLAKOT
Paradise, S.D.
Road
HASSAN
CARDIOLOGY
Mysore
Sri
Adichunchanagi
B G Nagara
ri Hospital and
Research Center
Post burn
contracture of
neck with
discharging
sinuses.
BURNS
Burns
Burns
Belgaum
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
k/c/o
osteosarcoma lower third of
femur non
metastasic
CANCER
Medical Oncology
Osteosarcoma Bone
Tumors
RT RENAL
CALCULUS WITH RENAL
DJ STENT IN SITE
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
PTCA - Two stent
(Drug Eluting
Stents , elective)
538 H_20025294087
Female
59
Others KOPPEGALA
MYSORE
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
539 H_20733293916
Female
61
Others K.R.NAGAR
KR NAGAR
MYSORE
Mysore
SJICR MYSORE
MYSORE
IHD-IWMI RVMI
CARDIOLOGY
CAD-DVD
Cardiology
Cardiology
540 H_20082294331
Female
43
Others HIRIYOOR
T NARASIPUR
MYSORE
Mysore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
ca ovary III c
Medical Oncology
Ovarian Cancer
BANGALORE
SOUTH
541 H_20082294633
Male
14
Others KADRAMANAGARA
Bangalore
Kidwai
Memorial
Institute of
Oncology
542 H_20968293907
Female
51
Others MUDDANAHALLI
ARAKALAGUD
HASSAN
Mysore
543 H_22447293290
Male
18
Others CHANNUR
SHAHPUR
YADGIRI
HONNAVAR
UTTARA
KANNADA
544 H_20575294660
Female
40
SC
0
545 H_20332294637
Male
47
Others KOTHAMALLI
546 H_19528294629
Female
50
Others MEDHIKERENAHALLI JAGALURU
547 H_19491294394
Male
58
Others CHIKKAPETE
SOMAVARPET
TUMKUR
CANCER
Cisplatin/Adriamyc
in+ifosmide
(IAP)/Week
Carboplatin/Paclit
axel/Cycle
Induction &
Consolidation/1st
phase - 1st ,2nd ,
3rd , 4th & 5th
months
Weekly
Cisplatin/Week
ALL
CANCER
Medical Oncology
Acute Lymphoblastic
Leukemia
Krishnarajendra
MYSORE
Hospital
CA.CERVIX IIIB
CANCER
Medical Oncology
Cervical Cancer
Gulbarga
UNITED
HOSPITAL
GULBARGA
Fracture maxilla POLYTRAUMA
Polytrauma
Plastic Surgery
Facial bone
807
807
6-Jun-15
12-Jun-15
35000
35000
24500
2450
22050
IDBI - 321
30-Oct-15
Belgaum
MANGALORE
INSTITUTE OF
ONCOLOGY
MANGALORE
CA UTERINE
CERVIX STAGE
IIIB
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
10-Jun-15
27-Aug-15
94500
90500
90500
9050
81450
IDBI - 321
30-Oct-15
KODAGU
Mysore
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
b/l renal calculi
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
9-Jun-15
15-Jun-15
37500
35000
24500
2450
22050
IDBI - 321
30-Oct-15
DAVANGERE
Bangalore
Narayana
Hrudayalaya
Private Limited
Bangalore
CARCINOMA OF
CANCER
CERVIX
Medical Oncology
Cervical Cancer
Weekly
Cisplatin/Week
509
509
16-Jun-15
16-Jul-15
12000
12000
10200
306
9894
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
ischaemic heart
disease Unstable
angina coronary
CARDIOLOGY
angiography 2
vessel disease
DM
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
9-Jun-15
12-Jun-15
90000
90000
86000
344
85656
IDBI - 321
30-Oct-15
TUMKUR
Bangalore
BGS GLOBAL
HOSPITAL
Sl.No
Preauth No
548 H_20082294454
Gender
Male
Age
43
Caste
Village
Minorit
J C ROAD
y
Taluk
TUMKUR
Patient District
TUMKUR
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca Breast
T1NoMo
CANCER
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
18-Jun-15
23-Jul-15
86000
104650
45000
4500
40500
IDBI - 321
30-Oct-15
549 H_21194294342
Male
20
Others UPPARADHODDI
MADDUR
MANDYA
Mysore
Mandya
Institute of
Medical
Sciences
Mandya
Mandya
astrogyan
sceloma or left
index fenxs
CANCER
Surgical Oncology
Soft Tissue and Bone
Tumors
Amputation for
bone / soft tissue
tumours (Major /
Minor)
688
688
8-Jun-15
28-Jul-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
550 H_20968293866
Female
11
Others TALAGAVADI
MALAVALLI
MANDYA
Mysore
Krishnarajendra
MYSORE
Hospital
RT. NON
FUNCTIONING
KIDNEY
RENAL
Genito Urinary
Surgery
Urology
Lap. Nephrectomy
Simple (Lap
919
919
10-Jun-15
1-Jul-15
45000
45000
31500
3150
28350
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
BGS GLOBAL
HOSPITAL
BANGALORE
SOUTH
EWINGS
SARCOMA LEFT
THIGH
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
28-Jul-15
10-Sep-15
75000
75000
74500
298
74202
IDBI - 321
30-Oct-15
Mysore
Bharath
Hospital
Institute of
Oncology
Mysore
CA LEFT
PYRIFORM
CANCER
FOSSA STAGE III
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
3-Jul-15
17-Aug-15
94000
94000
92000
0
92000
IDBI - 321
30-Oct-15
Mysore
THE RADIANT
INSTITUTE
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
11-Jun-15
14-Jul-15
94500
94500
67050
6705
60345
IDBI - 321
30-Oct-15
FEC (Epirubicin
based)/Cycle
504
504
15-Jun-15
27-Jul-15
15000
15000
12000
1200
10800
IDBI - 321
30-Oct-15
512
512
12-Jun-15
4-Jul-15
31500
31500
12250
1225
11025
IDBI - 321
30-Oct-15
551 H_19491290151
552 H_19505294370
Female
Male
3
66
SC
SC
G.V PALYA
HANUMANTHAPURA HUNSUR
MYSORE
MYSORE
CA CERVIX IIA
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
BANGALORE
SOUTH
ca breast (rt)
T3N1M0
CANCER
Medical Oncology
Breast
BANGALORE
SOUTH
Ca Ovary
Advanced
CANCER
Medical Oncology
Ovarian Cancer
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
?GIST-SIGMOID
COLOIN
CANCER
Surgical Oncology
Resection with
reconstruction
634
634
4-Jun-15
17-Jun-15
45000
45000
40500
4050
36450
IDBI - 321
30-Oct-15
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca Cervix Stage
IV
CANCER
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 cycles)
555
555
11-Jun-15
23-Jul-15
22500
22500
22500
2250
20250
IDBI - 321
30-Oct-15
Bangalore
STAGHORN
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
14-Jun-15
17-Jun-15
25000
25500
17493
1749
15744
IDBI - 321
30-Oct-15
Ca Cervix stage
III B -IV A
CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
11-Jun-15
24-Jul-15
60000
68000
58000
5800
52200
IDBI-294
9-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
15-Jun-15
22-Jul-15
88500
88500
31000
3100
27900
IDBI - 321
30-Oct-15
Carboplatin +
Paclitaxel/Cycle
Max. of 6 cycles
only
521
521
2-Jun-15
13-Jun-15
63000
63000
7350
735
6615
IDBI - 321
30-Oct-15
553 H_23069292798
Female
39
Others GAYANAHALLI
KR NAGAR
MYSORE
554 H_20082292564
Female
30
Minorit
GOLLAHALLI
y
CHINTAMANI
CHIKKABALLAPU
Bangalore
R
555 H_20082291907
Female
42
Others ARASANA HALI
HOSAKOTE
BANGALORE RURAL
556 H_20025294037
Female
58
Others MULLURU
Mysore
GAR
GAR
557 H_20082291747
Female
54
Others CHENNASHETTIHALLI GUBBI
558 H_21919293509
Male
53
Others THUNGANI
BANGALORE
SOUTH
559 H_19567292893
Female
45
Minorit
Ramankoppa
y
KUNDAGOL
TUMKUR
CANCER
Bangalore
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
BANGALORE URBAN
Bangalore
NU Hospitals
Pvt Ltd
DHARWAD
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
CA CERVIX III B
MANGALORE
CARCINOMA
BASE OF
CANCER
TONGUE- T4 N2a
Mx
Medical Oncology
Head & Neck
Mandya
Cancer of Lt
Breast (Post op) CANCER
(post CT)
Radiation Oncology
Adjuvant Therapy
Radiotherapy
564
564
10-Jun-15
25-Aug-15
15000
15000
15000
1500
13500
IDBI - 321
30-Oct-15
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
8-Jun-15
5-Aug-15
58000
58000
58000
5800
52200
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
9-Jun-15
20-Jul-15
75000
75000
69000
6900
62100
IDBI - 321
30-Oct-15
560 H_20082293352
Female
36
Others HOSAKERE
GULBARGA
GULBARGA
Gulbarga
561 H_20698293819
Male
66
Others MANJANADY
MANGALORE
DAKSHINA
KANNADA
Mysore
562 H_21194288796
Female
50
Others Mayannanakoppalu
MANDYA
MANDYA
Mysore
563 H_20077293802
Female
56
Others KAMPLI
HOSPET
BELLARY
Gulbarga
viswabharathi bellary road
Cancer hospital kurnool
Ca esophagus
U/3rd,
C?T2N1Mx
Belgaum
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
ca rectum T2 N1
CANCER
M0
564 H_20613293628
Female
80
Others Krishna Kittur
ATHANI
BELGAUM
YENEPOYA
MEDICAL
COLLEGE
HOSPITAL
Mandya
Institute of
Medical
Sciences
Mandya
Carboplatin/Paclit
axel/Cycle
CANCER
CANCER
Sl.No
Preauth No
565 H_21268293817
Gender
Age
Female
25
566 H_19504293039
Male
28
567 H_22478293592
Female
40
568 H_20082292910
Female
51
569 H_20025293001
Male
38
Caste
Village
Taluk
Others KHANDERAYANPALLI SEDAM
Others Gajapati
SC
BANAVE
Others HOSURU
Others ODEYARAPALYA
Patient District
GULBARGA
Patient
Division
Hospital
District
Gulbarga
PANACEA
MERIDIAN
HOSPITAL
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
BELGAUM
BELGAUM
Belgaum
T NARASIPUR
MYSORE
Mysore
YELANDUR
CHAMARAJANA
Mysore
GAR
KOLLEGAL
Hospital Name
HYDERABAD
SHREE
MAHADESHWA
MYSORE
RA NURSING
HOME
Kidwai
BANGALORE
Memorial
SOUTH
Institute of
Oncology
Final
Diagnosis
Diseases
L5-S1 EXTREDED
NEURO SURGERY
DISC L4-L5 PIVD
Disease Main
Category
Neuro Surgery
Spinal
Plan of
treatment
DiscectomyLumbar
Cyclophosphamide
- Doxorubicin
(CHOP)/Cycle
(Day1 & Day12)
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
433
433
8-Jun-15
13-Jun-15
25000
25000
17500
1750
15750
IDBI - 321
30-Oct-15
534
534
12-Jun-15
20-Aug-15
24000
24000
21726
2173
19553
IDBI - 321
30-Oct-15
Non Hodgkins
II AX
Medical Oncology
Lymphoma-NHL
Right renal
calculus
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
11-Jun-15
12-Jun-15
25000
25000
17500
1750
15750
IDBI - 321
30-Oct-15
CA CERVIX III B
CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
19-Jun-15
5-Aug-15
66500
66500
59375
5938
53437
IDBI - 321
30-Oct-15
239
239
5-Jun-15
8-Jun-15
65000
65000
45500
4550
40950
IDBI - 321
30-Oct-15
CHAMARAJANA
Mysore
GAR
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
ACS-ANTERIOR
WALL MI
CARDIOLOGY
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
SCC Rt BM
T4aN1M0
CANCER
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
1-Jun-15
22-Jun-15
60000
60865
57000
5700
51300
IDBI - 321
30-Oct-15
570 H_20082292909
Female
55
Others SHIVANASAMUDRA
MAGADI
RAMANAGAR
Bangalore
Kidwai
Memorial
Institute of
Oncology
571 H_20025293547
Female
63
Others HALAVARA
T NARASIPUR
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
CA POST
CRICOID T3N0
CANCER
Surgical Oncology
Head & Neck
Laryngopharyngo
Oesophagectomy
619
619
15-Jun-15
6-Jul-15
70000
70000
66500
6650
59850
IDBI - 321
30-Oct-15
572 H_20435293624
Female
50
Others NIPPANI
CHIKKODI
BELGAUM
Belgaum
Kolhapur Cancer
Karveer
Centre
CA BREAST WITH
LIVER & LUNG
CANCER
METS(STAGE IV)
Medical Oncology
Breast
502
502
22-Jun-15
4-Aug-15
9300
9300
9300
930
8370
IDBI - 321
30-Oct-15
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Ca Tongue
T4N0M0
CANCER
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
19-Jun-15
13-Aug-15
102000
102000
95200
9520
85680
IDBI - 321
30-Oct-15
Bangalore
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
VVF
RENAL
Genito Urinary
Surgery
Urology
VVF Repair
904
904
29-Jun-15
29-Jul-15
30000
30000
28500
2850
25650
IDBI - 321
30-Oct-15
573 H_19504293058
Male
60
Others Honaga
574 H_20332288878
Female
30
Others MUNIYAPANADODDI CHANNAPATNA RAMANAGAR
575 H_21052291614
Male
45
Others MUDURU
BANTWAL
DAKSHINA
KANNADA
Mysore
CA
SUPRAGLOTTIS
STAGE IV A
CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
26-May-15
5-Aug-15
64000
64000
62000
6200
55800
IDBI - 321
30-Oct-15
576 H_21052293082
Female
27
Others BELEKE
BHATKALA
UTTARA
KANNADA
Belgaum
CA
NASOPHARYNX
STAGE T4N2M0
CANCER
Medical Oncology
Head & Neck
Carboplatin +
Paclitaxel/Cycle
Max. of 6 cycles
only
521
521
3-Jun-15
14-Aug-15
30000
82250
30000
3000
27000
IDBI - 321
30-Oct-15
577 H_20010292572
Male
74
Others KARAHATTI
T NARASIPUR
MYSORE
Mysore
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
3-Jun-15
12-Jun-15
20000
20000
14000
1400
12600
IDBI - 321
30-Oct-15
578 H_20082290945
Female
40
Others THADIGOL
SREENIVASAPUR KOLAR
579 H_20010292046
Male
50
Others
580 H_20308293106
Male
54
Others (V)JAMBAGI.
581 H_20613293128
Male
25
BELGAUM
BASAVESHWARANAG
JEVARGI
AR
Others katharaki
AURAD
BILAGI
BELGAUM
BANGALORE
SOUTH
Bangalore
M S Ramaiah
Hospital
Kidwai
Memorial
Institute of
Oncology
BANGALORE
NORTH
BPL
BANGALORE
SOUTH
Ca GBS T4N1Mo CANCER
Surgical Oncology
Head & Neck
612
612
5-Jun-15
29-Jun-15
37500
39450
23750
2375
21375
IDBI - 321
30-Oct-15
GULBARGA
Gulbarga
M S Ramaiah
Hospital
BANGALORE
NORTH
CERVICAL CANAL
NEURO SURGERY
STENOSIS - L3-7
Neuro Surgery
Spinal
LaminectomyCervical
431
431
1-Jun-15
29-Jun-15
25000
25000
22500
2250
20250
IDBI - 321
30-Oct-15
BIDAR
Gulbarga
MEDWIN
HOSPITALS
HYDERABAD
METASTATIC
UNKNOWN
ORIGIN
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
4-Jun-15
17-Jul-15
60000
60000
53200
5320
47880
IDBI - 321
30-Oct-15
Belgaum
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
Ca .buccal
mucosa T3 N2
M0
CANCER
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
8-Jun-15
7-Jul-15
88000
88000
44000
4400
39600
IDBI - 321
30-Oct-15
KOLAR
(RT) RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
13-Jun-15
4-Jul-15
25000
25000
23750
2375
21375
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
ca breast (p.o)
CANCER
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
12-Jun-15
7-Jul-15
20000
21550
11550
1155
10395
IDBI - 321
30-Oct-15
BAGLAKOT
582 H_20164293016
Male
54
Others BUDIKOTE(V)
BANGARPET
KOLAR
Bangalore
R L JALAPPA
HOSPITAL AND
RESEARCH
CENTRE
583 H_20082291351
Female
58
Minorit
THAMARASAHALLI
y
HOSAKOTE
BANGALORE RURAL
Bangalore
Kidwai
Memorial
Institute of
Oncology
CANCER
Sl.No
Preauth No
Caste
Village
Taluk
Patient District
Patient
Division
Gender
Age
Hospital Name
584 H_20082292163
Female
69
Others C S PURA
GUBBI
TUMKUR
Bangalore
585 H_20082292575
Female
37
Others HADALGI
ALAND
GULBARGA
Gulbarga
586 H_22933291838
Female
48
Others Kallesomanahally
CHANNARAYAP
HASSAN
ATNA
Mysore
587 H_20082292583
Female
63
Others TUMBAGI
MUDDEBIHAL
BIJAPUR
Belgaum
588 H_19504291766
Male
52
Others Arlwad
HALIYAL
UTTARA
KANNADA
Belgaum
589 H_20968292829
Male
48
Others KALASURU
HD KOTE
MYSORE
Mysore
590 H_20237312189
Male
38
ST
0
HANAGAL
HAVERI
Belgaum
591 H_20010311314
Male
69
ST
VADDAHALLI
CHINTAMANI
CHIKKABALLAPU
Bangalore
R
M S Ramaiah
Hospital
592 H_23124311751
Male
66
Others YAGAPURA
BIJAPUR
BIJAPUR
Belgaum
593 H_20575311684
Female
66
Others 0
UDUPI
UDUPI
594 H_20308311663
Female
17
Others (NARAYANPUR).
595 H_22558310841
Male
39
Others Chittanahalli
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
Janapriya
Hospital
Kidwai
Memorial
Institute of
Oncology
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
BANGALORE
SOUTH
ca anal canal
t3n1m0
CANCER
Radiation Oncology
Radiotherapy
Treatment
563
563
12-Jun-15
17-Jun-15
10000
10000
7000
700
6300
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
CA OVARY
CANCER
Medical Oncology
Ovarian Cancer
512
512
8-Jun-15
2-Jul-15
31500
31500
18900
1890
17010
IDBI - 321
30-Oct-15
HASSAN
L4-L5 IVDP
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
6-Jun-15
15-Jun-15
25000
0
17500
1750
15750
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Utters sarcoma
stage II
CANCER
Surgical Oncology
Gynaec
Radical
Hysterectomy
594
594
10-Jun-15
16-Jun-15
30000
33955
18900
1890
17010
IDBI - 321
30-Oct-15
Ca Rt Buccal
Mucosa Stage IV CANCER
A T4N1M0
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
9-Jun-15
30-Jun-15
22500
22500
14250
1425
12825
IDBI - 321
30-Oct-15
BPH WITH AUR
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
5-Jun-15
16-Jun-15
20000
20000
14000
1400
12600
IDBI - 321
30-Oct-15
Rt Ureteric
Calculus
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
30-Jul-15
2-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
BANGALORE
NORTH
CA RIGHT
BUCCAL
MUCOSA
CANCER
Surgical Oncology
Head & Neck
620
620
16-Jul-15
27-Aug-15
35000
35000
35000
3500
31500
IDBI - 321
30-Oct-15
SPARSH SUPER
SPECIALITY
HOSPITAL
BANGALORE
NORTH
IHD-RECENT
IWMI + AWMI
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
24-Jul-15
30-Jul-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
Mysore
MANGALORE
INSTITUTE OF
ONCOLOGY
MANGALORE
CA GASTRO
OESOPHAGEAL
JUNCTION
T2N0M0
CANCER
Surgical Oncology
Esophagus
Oesophagectomy
with Three field
Lymphadenectomy
674
674
20-Jul-15
18-Aug-15
100000
100000
100000
10000
90000
IDBI - 321
30-Oct-15
BASAVAKALYAN
BIDAR
A
Gulbarga
MEDWIN
HOSPITALS
HYDERABAD
CARDIOLOGY
Mitral Valve
Replacement
145
145
21-Jul-15
31-Jul-15
120000
120000
108000
10800
97200
IDBI - 321
30-Oct-15
HOLENARSIPUR HASSAN
Mysore
Vaatsalya
Hospital
HASSAN
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
28-Jul-15
30-Jul-15
25000
25000
22500
2250
20250
IDBI - 321
30-Oct-15
BANGALORE
NORTH
RIGHT RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
21-Jul-15
1-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Tumours
Adrenalectomy
663
663
17-Jul-15
17-Aug-15
45000
45000
42750
4275
38475
IDBI - 321
30-Oct-15
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Krishnarajendra
MYSORE
Hospital
TSS-Shripad
Hegde Kadave
SIRSI
Institute of
Medical Scie
CRHD SEVERE
MS SEVERE MR
WITH MOD TR
AND MOD PAH
left ureteric
stone
Carboplatin/Paclit
axel/Cycle
Hemimandibulect
omy
BELLARY
BELLARY
Gulbarga
M S Ramaiah
Hospital
Others 0
HONNALI
DAVANGERE
Bangalore
WENLOCK
DISTRICT
HOSPITAL
MANGALORE
LEFT
ADRENOCORTIC CANCER
AL CALCULUS
Surgical Oncology
63
Others K G F
BANGARPET
KOLAR
Bangalore
SJICR
BANGALORE
SOUTH
IHD - AWMI, SVD CARDIOLOGY
CABG
132
132
24-Jul-15
8-Aug-15
95000
95000
95000
0
95000
IDBI - 321
30-Oct-15
Male
21
Others KAVASPURA
SHIKARIPURA
SHIMOGA
Bangalore
WENLOCK
DISTRICT
HOSPITAL
MANGALORE
LEFT MID
URETERIC
RENAL
CALCULUS WITH
PROXIMAL HUN
Genito Urinary
Surgery
URSL - Single Side
+ DJ Stent
909
909
31-Jul-15
13-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
600 H_19593310885
Female
44
Others Sulakod
BASAVANABAGE
BIJAPUR
WADI
Belgaum
TRINITY
HOSPITAL AND
HEART
FOUNDATION
BANGALORE
SOUTH
Rheumatic Heart
Disease - Severe CARDIOLOGY
MR
Mitral Valve
Replacement
145
145
23-Jul-15
3-Aug-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
601 H_20733307790
Male
51
Others JABAGERE
HUNSUR
MYSORE
Mysore
SJICR MYSORE
MYSORE
TVD
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
22-Jul-15
29-Jul-15
90000
90000
58050
5805
52245
IDBI - 321
30-Oct-15
602 H_20733310779
Male
68
Others TORESHETTAHALLI
MADDUR
MANDYA
Mysore
SJICR MYSORE
MYSORE
IHD-IWMI CADDVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
24-Jul-15
28-Jul-15
90000
90000
80550
8055
72495
IDBI - 321
30-Oct-15
603 H_20733311644
Male
49
KR PET
MANDYA
Mysore
SJICR MYSORE
MYSORE
IHD-ACS ACUTE
IWMI
CARDIOLOGY
Cardiology
Cardiology
Medical
treatment of
Acute MI with
Thrombolysis
128
128
23-Jul-15
28-Jul-15
10000
10000
9025
903
8122
IDBI - 321
30-Oct-15
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Cervix II B
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
2-Aug-15
10-Sep-15
81000
90980
81000
8100
72900
IDBI-294
9-Oct-15
Bangalore
Bapuji Child
Health Institute
Davanaere
and Research
Centre
INTESTINAL
OBSTRACTION
NEONATAL
Gastro Intestinal Tract
Intestinal Atresias
& Obstructions
303
303
27-Jul-15
4-Aug-15
40000
40000
39954
3995
35959
IDBI - 321
30-Oct-15
596 H_20010310671
Female
33
597 H_21044311827
Male
30
598 H_19577311977
Male
599 H_21044311837
604 H_19567311943
605 H_23099311933
Female
Female
63
15 Days
SC
SC
KAGGAL
NARGANALLI
Others Yallapur oni
Others AYYANAHALLI
DHARWAD
JAGALURU
DHARWAD
DAVANGERE
Urology
Sl.No
Preauth No
Village
Taluk
Hospital Name
Hospital
District
Final
Diagnosis
Age
Caste
606 H_22867307897
Male
67
SC
DODDASIDDAVVANA
CHITRADURGA
HALLI
CHITRADURGA
Bangalore
Chitradurga
Government
Hospital
607 H_19567311562
Female
48
SC
Hirenandihalli
BELGAUM
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
MYSORE
SINGLE VESSEL
DISEASE.
CARDIOLOGY
BYLAHONGALA
Patient District
Patient
Division
Gender
CHITRADURGA
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
BPH
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
11-Aug-15
17-Aug-15
20000
24200
20000
2000
18000
IDBI - 321
30-Oct-15
Cystosarcoma
Phylloides Lt
Breast
CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
29-Jul-15
10-Aug-15
25000
25000
22250
2225
20025
IDBI-294
9-Oct-15
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
23-Jul-15
28-Jul-15
65000
65000
62985
6299
56686
IDBI - 321
30-Oct-15
608 H_19542311199
Male
52
Others HITTUVALLI
T NARASIPUR
MYSORE
Mysore
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
609 H_23124311702
Male
60
Others HANJAGI
INDI
BIJAPUR
Belgaum
SPARSH SUPER
SPECIALITY
HOSPITAL
BANGALORE
NORTH
IHD RECENT
IWMI, SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting Stent
, elective)
240
240
24-Jul-15
29-Jul-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
610 H_20733310344
Male
48
ST
VATAL
T NARASIPUR
MYSORE
Mysore
SJICR MYSORE
MYSORE
IHD-ACS ACUTE
IWMI CAD-DVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
21-Jul-15
29-Jul-15
90000
90000
80550
8055
72495
IDBI - 321
30-Oct-15
611 H_20733310334
Male
60
ST
KALKUNI
HUNSUR
MYSORE
Mysore
SJICR MYSORE
MYSORE
IHD-ACS ACUTE
IWMI CAD-DVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
20-Jul-15
29-Jul-15
90000
90000
85025
8503
76522
IDBI - 321
30-Oct-15
612 H_21044310963
Male
87
Others BELENAHALLI
TARIKERE
CHIKKAMANAGL
Mysore
UR
MANGALORE
BEP WITH AUR
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
15-Jul-15
6-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
613 H_19522310986
Female
63
Others BADAGULIPADY
MANGALORE
DAKSHINA
KANNADA
Mysore
MANGALORE
CARCINOMA
TRANSVERSE
CANCER
COLON STAGE II
Surgical Oncology
Colectomy - any
type
637
637
24-Jul-15
10-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
614 H_22330310273
Male
25
Others
KOLAR
Bangalore
VICTORIA
HOSPITAL
BANGALORE
SOUTH
60% Thermal
Burns (2nd
degree)
BURNS
Burns
Burns
Up to-60% Mixed
Burns (with
Surgeries)
7
7
2-Jul-15
22-Jul-15
100000
100000
75000
7500
67500
IDBI - 321
30-Oct-15
615 H_20025311085
Male
26
Others BHUGATHAGALLI
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
RHD ,
CARDIOLOGY
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
28-Jul-15
3-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
54
Minorit
Bannimantap
y
Mysore
NARAYANA
HRUDAYALAYA
SURGICAL
MYSORE
HOSPITAL PVT
LTD
1.RIGHTt DJ
STENTING WITH
RENAL
MULTIPLE
URETRIC STONES
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
3-Aug-15
7-Aug-15
25000
25000
10000
0
10000
IDBI - 321
30-Oct-15
MANGALORE
CARCINOMA
HYPOPHARYNX
T2N0 STAGE II
CANCER
Surgical Oncology
Tracheostomy
675
675
9-Jul-15
12-Sep-15
105000
97000
97000
9700
87300
IDBI - 321
30-Oct-15
Mandya
c/o lump in Right
CANCER
breat T3 N2 Mo
Surgical Oncology
Breast
Mastectomy - any
type
598
598
22-Jul-15
20-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
21-Jul-15
4-Aug-15
25000
38918
25000
2500
22500
IDBI - 321
30-Oct-15
LT RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
25-Jul-15
14-Aug-15
25000
42957
25000
2500
22500
IDBI - 321
30-Oct-15
616 H_20200309846
Male
EREGAMUTTINAHALL
MULABAGILU
I
MYSORE
MYSORE
MYSORE
617 H_19522311583
Male
65
Others NELLI KOPPA
SORABA
SHIMOGA
Bangalore
618 H_21194311591
Female
86
Others UMMADAHALLI
MANDYA
MANDYA
Mysore
619 H_19571309711
Female
32
620 H_19571308552
Female
8
621 H_19571310515
Male
32
622 H_21919311730
Male
41
623 H_21701311694
Male
17
SC
KUMASI
GULBARGA
GULBARGA
WENLOCK
DISTRICT
HOSPITAL
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
Mandya
Institute of
Medical
Sciences
Mandya
CHINCHOLI
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
Others ANDOLA
JEVARGI
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
23-Jul-15
30-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Others jaraganahalli
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
NU Hospitals
Pvt Ltd
Bangalore
pus obstruction
RENAL
Genito Urinary
Surgery
Urology
Open
Pyelolithotomy Single Side
901
901
28-Jul-15
31-Jul-15
35000
35000
35190
3519
31671
IDBI - 321
30-Oct-15
Gulbarga
SUNSHINE
HEART
INSTITUTE
Paradise, S.D.
Road
RHD PLAIL
MITRAL
VALVE/SEVERE
AS DILATED LA
NORMAL LV
FUNCTION
CARDIOLOGY
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
24-Jul-15
6-Aug-15
20000
20000
20400
2040
18360
IDBI - 321
30-Oct-15
SC
KAMAKNOOR
Others ganjgera
CHINCHOLI
GULBARGA
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
624 H_21701311678
Male
30
Others soldapka
BASAVAKALYAN
BIDAR
A
625 H_19576311630
Female
35
Others Laxmwshwar
SIRAHATTI
626 H_19571309694
Male
43
Others UJALAM
BASAVAKALYAN
BIDAR
A
627 H_20127311392
Male
75
Minorit
CHANDRAPURA
y
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Gulbarga
Paradise, S.D.
Road
CRHD,SEVERE
MS,TRIVIAL MR
DILATED LA,PA
GOOD BV
FUNCATION
CARDIOLOGY
Cardiology
Belgaum
SDM Narayana
Hrudayalaya
Dharwad
RHD-Severe
Mitral stenosis,
CARDIOLOGY
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT RENAL
CALCULUS + RT
RENAL
LOWER
URETERIC STONE
TDS
Net Amt
Paid
Balloon Mitral
Valvotomy
105
105
24-Jul-15
6-Aug-15
20000
20000
20400
2040
18360
IDBI - 321
30-Oct-15
Mitral Valve
Replacement
145
145
24-Jul-15
10-Aug-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
21-Jul-15
1-Aug-15
37500
37500
37500
3750
33750
IDBI - 321
30-Oct-15
239
239
22-Jul-15
27-Jul-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
Cardiology
SAKLESHPURA
HASSAN
Mysore
DOUBLE VESSEL
CARDIOLOGY
DISEASE.
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
29-Jul-15
31-Jul-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
ALAND
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT PUJ
OBSTRUCTION
RENAL
Genito Urinary
Surgery
Urology
905
905
21-Jul-15
8-Aug-15
37500
52743
37500
3750
33750
IDBI - 321
30-Oct-15
COMPLETE
HEART BLOCK
CARDIOLOGY
Cardiology
113
113
25-Jul-15
29-Jul-15
77000
77000
77000
7700
69300
IDBI - 321
30-Oct-15
CHD-PDA
CARDIOLOGY
119
119
31-Jul-15
6-Aug-15
60000
60000
60000
0
60000
IDBI - 321
30-Oct-15
145
145
23-Jul-15
18-Aug-15
120000
120000
100000
0
100000
IDBI - 321
30-Oct-15
Others BUCHAHALLI
HUNSUR
MYSORE
Mysore
Cauvery
Hospital
631 H_19577311510
Female
4
Minorit
P PURA 8TH CROSS
y
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
SJICR
632 H_19577311215
Female
14
Others GULAGATTA
MALAVALLI
MANDYA
Mysore
SJICR
BHATKALA
UTTARA
KANNADA
Belgaum
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
Bangalore
SUKSHEMA
HOSPITAL
PVTLTD
Inferior STEMI
CARDIOLOGY
CANCER
Others DAVANAGERE
Gross
Amount
approved by
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
66
64
Hospital
claimed
Amount
Cardiology
Male
Male
Preauth
Approved
Amt
Cardiology
630 H_19581311627
634 H_20619310802
Date of
Discharge
CARDIOLOGY
15
Others BEDRAMANE
Date of
Admission
IWMI
Male
32
CHIKKAMANAGL
Mysore
UR
MUDIGERE
629 H_19571309705
Male
Plan of
treatment
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
51
MADIYAL
A J HOSPITAL
CENTRE
Male
SC
Disease Main
Category
SUNSHINE
HEART
INSTITUTE
628 H_19542310997
633 H_20015311587
Others KODRAHALLI
GADAG
Patient
Division
DAVANAGERE
DAVANGERE
MYSORE
MYSORE
BANGALORE
SOUTH
BANGALORE
SOUTH
RHD-SEVERE,MR CARDIOLOGY
Temporary
Pacemaker Implantation Pacemaker
implantation
PDA Device
Cardiology
Device Closure
Closure
Mitral Valve
Replacement
MANGALORE
SOFT TISSUE
GIANT CELL
TUMOR OF LEFT CANCER
TIBIA AND
FIBULA.STAGE II.
Surgical Oncology
DAVANGERE
STRICTURE
URETHRA
Genito Urinary
Surgery
RENAL
Tumors
Wide excision +
Reconstruction for
soft tissue and
bone tumors
687
687
25-Jul-15
3-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Urology
Urethroplasty for
a year can be
considered)
912
912
28-Jul-15
1-Aug-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
23-Jul-15
27-Jul-15
92500
92500
92500
0
92500
IDBI - 321
30-Oct-15
Radiation Oncology
BrachytherapyInterstitial-ii
ii. HDR - one
application and
multiple dose
fractions
573
573
2-Aug-15
4-Aug-15
20000
20000
18762
75
18687
IDBI - 321
30-Oct-15
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
23-Jul-15
29-Jul-15
90000
90000
91290
9129
82161
IDBI - 321
30-Oct-15
635 H_20200310855
Male
34
Others chandra layout
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
NARAYANA
HRUDAYALAYA
SURGICAL
MYSORE
HOSPITAL PVT
LTD
636 H_19491304974
Female
45
Others HEMMARAGALA
NANJANAGUD
MYSORE
Mysore
BGS GLOBAL
HOSPITAL
BANGALORE
SOUTH
Carcinoma
Cervix stage II B
637 H_19564311248
Male
67
Others GOPADI
KUNDAPURA
UDUPI
Mysore
KASTURBA
HOSPITAL
UDUPI
CHRONIC STABLE
CARDIOLOGY
ANGINA
Cardiology
638 H_19577311025
Female
28
Others HHULIKALLU
MAGADI
RAMANAGAR
Bangalore
SJICR
BANGALORE
SOUTH
RHD - SEVERE
MR, SEVERE AR, CARDIOLOGY
MODERATE TR
Double Valve
Replacement
149
149
24-Jul-15
11-Aug-15
150000
150000
150000
0
150000
IDBI - 321
30-Oct-15
Mysore
NARAYANA
HRUDAYALAYA
SURGICAL
MYSORE
HOSPITAL PVT
LTD
CAD-Acute
IW/PW
CARDIOLOGY
STEMI/CHB/Card
iogenic shock
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
21-Jul-15
27-Jul-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
Right Renal
calculi
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
10-Aug-15
2-Sep-15
25000
46395
25000
2500
22500
IDBI - 321
30-Oct-15
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
23-Jul-15
29-Jul-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
176
176
21-Jul-15
31-Jul-15
20000
20000
19380
1938
17442
IDBI - 321
30-Oct-15
639 H_20200310098
Male
54
640 H_20031311464
Female
70
641 H_19549311228
Male
57
642 H_21701310668
Female
23
Others karigowda street
SC
Nagavi
Others SHRIRAMNAGAR
SC
mailor nagar
HUNSUR
MYSORE
SINDAGI
BIJAPUR
Belgaum
BLDE University
Shri BM Patil
Bijapur
Medical College
Hosp
DAVANAGERE
DAVANGERE
Bangalore
Sagar Hospitals
BANGALORE
SOUTH
IHD- RECENT
CARDIOLOGY
AWMI, CAG-DVD
Cardiology
RAICHUR
RAICHUR
Gulbarga
SUNSHINE
HEART
INSTITUTE
Paradise, S.D.
Road
PDA WITH L->R
SHUNT
Cardiothoracic Surgery Closed Heart Procedures PDA Closure
RENAL
CARDIOLOGY
Sl.No
Preauth No
Gender
Age
Caste
Village
643 H_21701311136
Female
28
SC
644 H_20015311356
Female
76
Others KELAGINAIDAGUNJI
645 H_20127311397
Male
33
Minorit
SOMESHWARA
y
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
YADGIRI
Gulbarga
SUNSHINE
HEART
INSTITUTE
Paradise, S.D.
Road
CRHD
MODERATE TO
SEVERE MS,NO
MR
HONNAVAR
UTTARA
KANNADA
Belgaum
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
MANGALORE
MANGALORE
DAKSHINA
KANNADA
Mysore
A J HOSPITAL
CENTRE
MANGALORE
MANGALORE
kamal nagar yadlapur
YADGIR
tanda
646 H_20015311415
Female
57
Others BASAL
YELLAPUR
UTTARA
KANNADA
Belgaum
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
647 H_20322311012
Female
40
Others HABBUWADA
KARWAR
UTTARA
KANNADA
Belgaum
INDIANA
HOSPITAL AND
HEART
INSTITUTE LTD
648 H_20661310352
Female
29
SIRAGUPPA
BELLARY
Gulbarga
Vijayanagara
Institute of
BELLARY
Medical Science
649 H_20082310058
Female
55
Others MADAPUR
RAMANAGAR
RAMANAGAR
Bangalore
650 H_20015311345
Male
38
Others SUGAVI
SIRSI
UTTARA
KANNADA
Belgaum
651 H_19581311306
Male
41
Others BYADARAHALLI
HUNSUR
MYSORE
Mysore
Cauvery
Hospital
Belgaum
VENKATESH
HOSPITAL
Belgaum
Narayana
Hrudayalaya
Private Limited
652 H_22458311309
653 H_19528311056
Female
Male
38
1 Months
ST
KUDUDURAHAL
Others Mahalingpur
Others KUSUGAL
MUDHOLA
HUBLI
BAGLAKOT
DHARWAD
654 H_19564310706
Female
72
Others KURUVALLI
THIRTHAHALLI
655 H_20079311238
Male
40
Minorit
NEHARU NAGER
y
Mysore
R
UR
656 H_19577311175
Female
13
657 H_19577311037
Female
28
658 H_19577311128
Male
23
659 H_19528309422
Male
55
660 H_20270310774
661 H_19510309914
Male
Male
28
52
SC
YARAB NAGAR
Others MAJARAHOSAHALLI
SC
UPANAGARA
Others DHANURA
Others YALACHAVALLI
Others TAKKALAKI
Final
Diagnosis
SHIMOGA
BANGALORE
SOUTH
DODDABALLAPU
R
BANGALORE URBAN
BANGALORE RURAL
BANGALORE
NORTH
BANGALORE URBAN
BASAVAKALYAN
BIDAR
A
KANAKAPURA
KUSTAGI
RAMANAGAR
KOPPAL
Bangalore
Bangalore
Kidwai
Memorial
Institute of
Oncology
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
KASTURBA
HOSPITAL
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Mitral Valve
Replacement
145
145
22-Jul-15
5-Aug-15
120000
120000
122400
12240
110160
IDBI - 321
30-Oct-15
RHD- SEVERE MS CARDIOLOGY
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
23-Jul-15
30-Jul-15
20000
20000
18000
1800
16200
IDBI - 321
30-Oct-15
left hemiparesis NEURO SURGERY
Neuro Surgery
Brain Tumour
Excision of Brain
Tumor
SupratentorialBasal
404
404
20-Jul-15
24-Aug-15
60000
74838
61200
6120
55080
IDBI - 321
30-Oct-15
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
22-Jul-15
14-Aug-15
60000
60000
47500
4750
42750
IDBI - 321
30-Oct-15
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
25-Jul-15
27-Jul-15
20000
20000
18000
1800
16200
IDBI - 321
30-Oct-15
CARDIOLOGY
WELL
DIFFERENTIATED
SCC OF LEFT
CANCER
BUCCAL
MUCOSA.T4N2M
0.
RHD SEVER MS
MILD TO
CARDIOLOGY
MODERATION
PAH NORMAL LV
FUNCTION
ca cx 3b
CANCER
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
21-Jul-15
10-Sep-15
32000
32000
30000
3000
27000
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
CA BREAST
T3N1Mo
CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
18-Jul-15
29-Jul-15
25000
25000
22000
2200
19800
IDBI - 321
30-Oct-15
MANGALORE
BILATERAL
EXTRADURAL
HEMATOMA
NEURO SURGERY
Neuro Surgery
Brain
Craniotomy and
Evacuation of
Haematoma Extradural
402
402
24-Jul-15
1-Aug-15
45000
45000
45000
4500
40500
IDBI - 321
30-Oct-15
MYSORE
SINGLE VESSEL
CORONARY
CARDIOLOGY
ARTERY DISEASE
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
23-Jul-15
27-Jul-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
MAHALINGPUR
right renal
calculus
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
25-Jul-15
29-Jul-15
25000
25000
23275
2328
20947
IDBI - 321
30-Oct-15
Bangalore
SUPRACARDIAC
TAPVC
CARDIOLOGY
RESTRICTIVE
SECUNDUM ASD
R-L SHUNT
TAPVC
160
160
23-Jul-15
13-Aug-15
95000
95000
96900
2907
93993
IDBI - 321
30-Oct-15
ACUTE INFERIOR
CARDIOLOGY
WALL MI
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
22-Jul-15
27-Jul-15
65000
65000
65790
6579
59211
IDBI - 321
30-Oct-15
LMCA +DVD.
CARDIOLOGY
CABG
132
132
29-Jul-15
13-Aug-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
EP study
125
125
30-Jul-15
4-Aug-15
30000
30000
30000
0
30000
IDBI - 321
30-Oct-15
145
145
23-Jul-15
14-Aug-15
120000
120000
120000
0
120000
IDBI - 321
30-Oct-15
UDUPI
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
SJICR
Diseases
BANGALORE
SOUTH
BANGALORE
SOUTH
WPW
SYNDROME
RHD - SEVERE
MR
RENAL
Cardiology
Cardiology
CARDIOLOGY
Mitral Valve
Replacement
AWMI, SVD
CARDIOLOGY
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
4-Aug-15
7-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
Bangalore
CAD-TVD
CARDIOLOGY
CABG
132
132
25-Jul-15
3-Aug-15
95000
95000
96900
2907
93993
IDBI - 321
30-Oct-15
JAYANAGAR
(Lt) UN
RESERVED
LOCULATED
TUBERCULAR
CARDIOLOGY
EMPYEMA WITH
PLEURA
THIKKNESS
Decortication
192
192
15-Jul-15
11-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
RIGHT RENAL
CALCULUS
Genito Urinary
Surgery
ESWL (Extra
carporial shockwave lithotripsy) Single Side + DJ
Stent
908
908
7-Aug-15
7-Aug-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
Bangalore
SJICR
Bangalore
SJICR
BANGALORE
SOUTH
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
SDS TRC RGICD
Gulbarga
M/s Kerudi
Hospital And
Bagalkot
Research Centre
Bagalkot
RENAL
Cardiology
Urology
Sl.No
Preauth No
662 H_20015309341
663 H_19571308489
664 H_20025311094
665 H_20010310002
666 H_20332310707
Gender
Male
Male
Male
Male
Female
Age
71
35
30
5
26
Caste
Village
Others MADAMAKKI
Taluk
KUNDAPURA
Patient District
UDUPI
Hospital Name
Hospital
District
Final
Diagnosis
RENAL
Genito Urinary
Surgery
RENAL
Genito Urinary
Surgery
RENAL
Genito Urinary
Surgery
rt renal calculus RENAL
Genito Urinary
Surgery
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
BILATERAL
RENAL
CALCULUS.
HUMNABAD
Others GANGAVDI
Mysore
GAR
GAR
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
RT RENAL
CALCULUS
BANGALORE NELEMANGALA
RURAL
M S Ramaiah
Hospital
LEFT RENAL +
LEFT VERTICAL
CALCULI
BASAVANAHALLI
Others MUDUGERE
Bangalore
BANGALORE
NORTH
Disease Main
Category
Surgical Oncology
Mysore
MANGALORE
Diseases
WELL
DIFFERENTIATED
SCC OF RIGHT
CANCER
BUCCAL
MUCOSA.T3N2M
0.
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
Others MEENKERA
SC
BIDAR
Patient
Division
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Head & Neck
612
612
16-Jul-15
3-Sep-15
47500
47500
47500
4750
42750
IDBI - 321
30-Oct-15
Urology
ESWL (Extra
Stent
908
908
17-Jul-15
31-Jul-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
Urology
ESWL (Extra
Stent
908
908
27-Jul-15
27-Jul-15
10000
10000
9500
950
8550
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
14-Jul-15
29-Jul-15
25000
25000
15600
1560
14040
IDBI - 321
30-Oct-15
Urology
ESWL (Extra
Stent
908
908
3-Aug-15
4-Aug-15
10000
10000
9600
960
8640
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
17-Jul-15
31-Jul-15
25001
25001
20000
2000
18000
IDBI - 321
30-Oct-15
CHIKKABALLAPU
GOWRIBIDANUR
Bangalore
R
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
rt puj calculus
RENAL
Genito Urinary
Surgery
L4-L5 and L5-S1
Disc Prolapse
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
23-Jul-15
28-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
3-Aug-15
11-Sep-15
75000
75000
76500
2295
74205
IDBI - 321
30-Oct-15
2
2
15-Jul-15
28-Jul-15
35000
36520
31500
3150
28350
IDBI - 321
30-Oct-15
667 H_20332305915
Male
55
Others GOLLAHALLI
KORATAGERE
TUMKUR
Bangalore
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
668 H_22226310544
Male
30
Others BHUTRAMATTI
BELGAUM
BELGAUM
Belgaum
Viajya Ortho
and Trauma
Centre
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
Narayana
Hrudayalaya
Private Limited
Bangalore
CA LUNG
SINDAGI
BIJAPUR
Belgaum
DR MUNIR
BANGI
HOSPITAL
BIJAPUR
Scar Mark
BURNS
ABOUT 8 TO 10/-
Burns
Burns
upto-40% with
Scalds(
Conservative/
without grafting)
CHIKKODI
BELGAUM
Belgaum
Kolhapur Cancer
Karveer
Centre
CA LEFT BREAST
CANCER
T2N1M0
Surgical Oncology
Breast
Mastectomy - any
type
598
598
26-Jul-15
29-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
M S Ramaiah
Hospital
CA LEFT BREAST
PT2N3M0 STAGE CANCER
IIIC
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
7-Jul-15
30-Jul-15
65000
65000
58500
5850
52650
IDBI - 321
30-Oct-15
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
22-Jul-15
4-Sep-15
85000
85000
80750
8075
72675
IDBI - 321
30-Oct-15
669 H_19528308160
Male
58
Minorit
SONNAPPA BLOCK
y
670 H_22054308786
Male
3
Others Kalakeri
671 H_20435310346
Female
65
672 H_20010310608
Female
SC
MAMADAPUR
56
Others MADAVARA
SHIKARIPURA
SHIMOGA
Bangalore
MANGALORE
INSTITUTE OF
ONCOLOGY
BELGAUM
BANGALORE
NORTH
673 H_20575310257
Male
40
Minorit
SHIRALAKOPPA
y
674 H_20025310325
Male
51
Others HIRIGE
HD KOTE
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
675 H_19583310013
Female
70
Minorit
BASAVANAKOPPA
y
SAVANUR
HAVERI
Belgaum
676 H_20332304795
Male
37
Others YADIYUR
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
677 H_20733310164
Female
30
Others CHIKKA MOLE
678 H_23099310486
Male
6 Months
Others NAVILEHAL
CA RECTUM
CANCER
Radiation Oncology
AORTOILIAC
OCCLUSIVE
DISEASE
CARDIOLOGY
Aorto Billiac /
Bifemoral bypass
with Synthetic
Graft
227
227
27-Jul-15
2-Aug-15
90000
90000
85500
8550
76950
IDBI - 321
30-Oct-15
S.S. INSTITUTE
OF MEDICAL
NH-4,Bypass PB
Upto 30% burns BURNS
SCIENCES &
Road Davanagere
RESEARCH CENT
Burns
Burns
upto 30% (with
grafting)
1
1
20-Jul-15
9-Aug-15
40000
40000
28508
2851
25657
IDBI - 321
30-Oct-15
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
lt lower ureteric
RENAL
calculus
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
30-Jul-15
3-Aug-15
30000
30000
25000
2500
22500
IDBI - 321
30-Oct-15
Mysore
GAR
GAR
SJICR MYSORE
RHD/SEVERAL
MS
CARDIOLOGY
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
24-Jul-15
27-Jul-15
20000
20000
18525
1853
16672
IDBI - 321
30-Oct-15
CHANNAGIRI
Bapuji Child
Health Institute
Davanaere
and Research
Centre
ARM Status
Colostomy
NEONATAL
Anorectal
Malformations
Stage 3
307
307
22-Jul-15
1-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
DAVANGERE
Bangalore
MANGALORE
CANCER
MYSORE
Sl.No
Preauth No
679 H_19571308078
680 H_21718310547
Gender
Age
Male
76
Male
39
Caste
Village
Minorit
MARPALLI
y
Taluk
CHINCHOLI
Patient District
GULBARGA
HASSAN
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
PATIL NURSING
HOME
GULBARGA
GULBARGA
BENIGN
ENLARGEMENT
OF PROSTATE
Mysore
SSM Hospital
Right Renal
Calculi and Left
VUJ Calculi
Gulbarga
Others NARIHALLI
HASSAN
HASSAN
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
Diseases
Disease Main
Category
RENAL
Genito Urinary
Surgery
RENAL
Genito Urinary
Surgery
RT KIDNEY
STONE + BENIGN
RENAL
ENLARGEMENT
OF PROSTATE.
Genito Urinary
Surgery
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Urology
TURP
917
917
16-Jul-15
30-Jul-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
25-Jul-15
4-Aug-15
37500
39322
35625
3563
32062
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
23-Jul-15
1-Aug-15
35000
35000
35000
3500
31500
IDBI - 321
30-Oct-15
681 H_19571304655
Male
62
Others GUNDUR WADI
BASAVAKALYAN
BIDAR
A
682 H_19528310898
Female
16
Others KOLLUR
SHAHPUR
YADGIRI
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
TETROLOGY OF
FALLOT
CARDIOLOGY
ICR for TOF
154
154
3-Aug-15
12-Aug-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
683 H_19515310529
Male
32
Others 0
RANEBENNUR
HAVERI
Belgaum
CITY CENTRAL
HOSPITAL
PRIVATE
LIMITED
DAVANGERE
Left Uretreric
Calculi
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
27-Jul-15
29-Jul-15
25000
26375
25000
2500
22500
IDBI - 321
30-Oct-15
684 H_19528308861
Female
34
Others BOMMANAHALLI
NELEMANGALA
BANGALORE RURAL
Bangalore
Narayana
Hrudayalaya
Private Limited
Bangalore
CARCINOMAQ
OF CERVIX
STAGE II
CANCER
Medical Oncology
Cervical Cancer
Weekly
Cisplatin/Week
509
509
27-Jul-15
7-Sep-15
12000
10000
10200
306
9894
IDBI - 321
30-Oct-15
685 H_20017310859
Female
1
Others TADAVALAGA
INDI
BIJAPUR
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
CHD TOF WITH
VSD WITH
SEVERE PS
CARDIOLOGY
ICR for TOF
154
154
21-Jul-15
11-Aug-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
Others HONGANURU
Mysore
GAR
GAR
Cauvery
Hospital
RT RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
29-Jul-15
1-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
NANJANAGUD
MYSORE
Mysore
CSI Holdsworth
Memorial
Mysore
Hospital
CARCINOMA OF
RIGHT BREAST - CANCER
STAGE T3N0M0
Surgical Oncology
Breast
Mastectomy - any
type
598
598
25-Jul-15
31-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
MYSORE
Mysore
Cauvery
Hospital
RT RENAL
RENAL
CALCULUS
CA R
RETROMOLAR
CANCER
PRIGON STAGE
T1N0M0
LEVOCARDIA
TGA LARGE
UPPER
MUSCULAR VSD CARDIOLOGY
BD SHUNT
ADDITIONAL
MULTIPLE VSDs
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
28-Jul-15
30-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Surgical Oncology
Head & Neck
612
612
20-Jul-15
17-Aug-15
37500
37500
37500
3750
33750
IDBI - 321
30-Oct-15
Arterial Switch
Operation
163
163
26-Jul-15
1-Aug-15
95000
95000
96900
2907
93993
IDBI - 321
30-Oct-15
ARM STAGE -2
NEONATAL
Anorectal
Malformations
Stage 2
306
306
21-Jul-15
14-Aug-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
SEVERE AS
CARDIOLOGY
Aortic Valve
Replacement
146
146
11-Jun-15
14-Aug-15
120000
120000
120000
0
120000
IDBI - 321
30-Oct-15
114
114
21-Jul-15
2-Aug-15
75000
75000
75000
0
75000
IDBI - 321
30-Oct-15
ICR for TOF
154
154
21-Jul-15
11-Aug-15
80000
80000
80000
0
80000
IDBI - 321
30-Oct-15
Radiation Oncology
Stereotactic Radio
Surgery(SRS) /
Stereotactic Radio
Therapy(SRT)
Radical Treatment
& Post Operative
RT(SRS/SRT) Upto
30 fractions in 6
weeks
569
569
28-Jul-15
29-Jul-15
75000
75000
70775
283
70492
IDBI - 321
30-Oct-15
686 H_19581310856
Male
61
687 H_22971307621
Female
31
688 H_19581310850
Male
18
Others HEBSURU
KR NAGAR
689 H_21052310211
Female
79
Others HARAPANAHALLI
HARAPANAHALL
DAVANGERE
I
Bangalore
690 H_19528309672
Female
5 Months
Others DEVARAHALLI
SIRA
TUMKUR
Bangalore
Narayana
Hrudayalaya
Private Limited
691 H_20017310759
Male
GOKAK
BELGAUM
Belgaum
692 H_19577310722
Female
TUMKUR
TUMKUR
Bangalore
BANGALORE URBAN
Bangalore
MYSORE
ST
THAGADURU
11 Months Others WADERAHATTI
33
SC
BATAWADI
693 H_19577310719
Female
60
Others UDAYAPURA
BANGALORE
SOUTH
694 H_19577310575
Female
4 Months
Minorit KALYANAGIRI
y
NAGARA
MYSORE
MYSORE
MYSORE
Bangalore
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
BANGALORE
SJICR
SOUTH
SJICR
BANGALORE
SOUTH
SICK SINUS
SYNDROME
Mysore
SJICR
BANGALORE
SOUTH
CHD - PFA. VSD,
CARDIOLOGY
SEVERE PAH
BANGALORE
SOUTH
recurrence of
functonal
pituitary
adenoma
CARDIOLOGY
Cardiology
Permanent
pacemaker
Pacemaker Implantation implantation (only
VVI) including
Pacemaker value
695 H_19491298759
Female
35
Others CHAPPARADALLI
HIREKERUR
HAVERI
Belgaum
BGS GLOBAL
HOSPITAL
696 H_22458310692
Male
29
Others Dhavaleshwar
MUDHOLA
BAGLAKOT
Belgaum
VENKATESH
HOSPITAL
MAHALINGPUR
right distal
RENAL
ureteric calculus
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
25-Jul-15
28-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
TARIKERE
CHIKKAMANAGL
Mysore
UR
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
MANGALORE
PAPILLARY
CARCINOMA
CANCER
THYROID STAGE
II
Surgical Oncology
Head & Neck
612
612
18-Jul-15
4-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
697 H_19522309221
Male
47
Others TARIKERE
CANCER
Sl.No
Preauth No
698 H_19505309573
Gender
Female
Age
43
Caste
Village
Others BELAGOLA
Taluk
Patient District
SHRIRANGAPAT
MANDYA
NA
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
10-Aug-15
12-Sep-15
78000
74000
74000
0
74000
IDBI - 321
30-Oct-15
907
907
31-Jul-15
7-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Mysore
Bharath
Hospital
Institute of
Oncology
RT LARGE PELVIC
CALCULUS WITH
LT LOWER
RENAL
URETERIC
CALCULUS
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
CA RECTUM
LOCALLY
ADVANCED
CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
29-Jul-15
5-Sep-15
75000
75000
55000
0
55000
IDBI - 321
30-Oct-15
CARDIOLOGY
AP Window
156
156
27-Jul-15
26-Aug-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
NEONATAL
Thorax
Thoracic
Duplication
324
324
25-Jul-15
1-Aug-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
Mysore
699 H_20025310207
Female
23
Others GOPALAPURA
SOMAVARPET
KODAGU
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
700 H_19505309555
Female
32
Others NANDITHAPURA
HD KOTE
MYSORE
Mysore
Bharath
Hospital
Institute of
Oncology
Others DEVASANDRA
BANGALORE
EAST
BANGALORE URBAN
Bangalore
Narayana
Hrudayalaya
Private Limited
Bangalore
HUbli
Mysore
CA
OESOPHAGUS
MIDDLE 1/3 rd
T3N1M0
Diseases
TOG-TYPE I AP
WINDOW
FUNCTIONAL
PULMONARY
ATRESIA
THORACIC
DUPLICATION
CANCER
Radiation Oncology
701 H_19528310587
Male
2 Months
702 H_22193308791
Female
3
Others 0
SINDNUR
RAICHUR
Gulbarga
Tatwadarsha
Hospital
703 H_20079310569
Female
1
Others VADDINA KOPPA
SHIMOGA
SHIMOGA
Bangalore
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
MODERATE SIZE
PDA WITH L -> R CARDIOLOGY
SHUNT.
Cardiology
Device Closure
PDA Device
Closure
119
119
26-Jul-15
30-Jul-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
704 H_19571309688
Male
61
Others WALLAPUR
BIDAR
BIDAR
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
21-Jul-15
27-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
705 H_20733310193
Female
12
Others GANJAM
SHRIRANGAPAT
MANDYA
NA
Mysore
SJICR MYSORE
CHB-PDA
Cardiology
Device Closure
PDA Device
Closure
119
119
24-Jul-15
27-Jul-15
60000
60000
56525
5653
50872
IDBI - 321
30-Oct-15
706 H_20254310153
Female
46
Others Vasan
HANAGAL
HAVERI
Belgaum
Shakuntala
Memorial
Hubli
Hospital and
Research Centre
ca right breast
CANCER
T4 b N2 stage III
Surgical Oncology
Breast
Mastectomy - any
type
598
598
27-Jul-15
3-Aug-15
25000
25000
23750
2375
21375
IDBI - 321
30-Oct-15
707 H_22867309900
Male
45
Others
CHITRADURGA
Bangalore
Chitradurga
Government
Hospital
Right Ureteric
Calculus
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
20-Jul-15
24-Jul-15
25000
25000
23750
2375
21375
IDBI - 321
30-Oct-15
Burns
Post Burn
Contracture
surgeries for
Functional
Improvement(Pack
age including
splints, pressure
garments and
physiotherapy),
Severe
11
11
25-Aug-15
30-Aug-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
CABG with IABP
133
133
2-Aug-15
13-Aug-15
115000
115000
117300
11730
105570
IDBI - 321
30-Oct-15
435
435
17-Jul-15
14-Aug-15
30000
39691
29070
2907
26163
IDBI - 321
30-Oct-15
566
566
6-Jul-15
20-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
708 H_20215310460
Male
42
MURUGARAJENDRA
CHITRADURGA
NAGARA
Others Dharawad
Belgaum
MYSORE
CHITRADURGA
CARDIOLOGY
RENAL
SRI LAXMI
SURGICAL
TRAUMA
ORTHO AND
MULTISPECILIT
RANEBENNUR
Mentosternal
Contracture post BURNS
burn.
Burns
MYSORE
TRIPPLE VESSEL
DISEASE.
CARDIOLOGY
NEURO SURGERY
Neuro Surgery
Spinal
DHARWAD
DHARWAD
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
709 H_19542310451
Male
67
Others HOREYALA
GUNDLUPET
CHAMARAJANA
Mysore
GAR
710 H_20127310467
Male
68
Others HEROOR
KUNDAPURA
UDUPI
Mysore
A J HOSPITAL
CENTRE
C4/5 PIVD
711 H_20010308544
Male
66
Others ANAJAGI
JEVARGI
GULBARGA
Gulbarga
M S Ramaiah
Hospital
BANGALORE
NORTH
CA CARCINOMA
X CT4N0M0
CANCER
STAGE IVA
Radiation Oncology
Linear Accelerators
712 H_20733309720
Female
58
Others DEPAPURA
GUNDLUPET
CHAMARAJANA
Mysore
GAR
SJICR MYSORE
MYSORE
IHD-IWMI CADSVD
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
18-Jul-15
26-Jul-15
90000
65000
61275
6128
55147
IDBI - 321
30-Oct-15
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
21-Jul-15
24-Jul-15
65000
65000
57150
5715
51435
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
25-Jul-15
4-Aug-15
25000
39322
23750
2375
21375
IDBI - 321
30-Oct-15
713 H_20733309716
714 H_21718309137
Male
Male
40
65
Others DASARAGUPPE
ST
B.HOSAHALLI
SHRIRANGAPAT
MANDYA
NA
BELUR
HASSAN
Mysore
Mysore
SJICR MYSORE
SSM Hospital
MYSORE
HASSAN
CARDIOLOGY
IHD-ACS ACUTE
CARDIOLOGY
AWMI CAD-SVD
Cardiology
Right PUJ Calculi RENAL
Genito Urinary
Surgery
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
Palliative
Treatment with
Photons (linear
accelarator)
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
715 H_20086310396
Male
55
Others MULBAGAL
MULABAGILU
KOLAR
Bangalore
R L JALAPPA
NARAYANA
KOLAR
HRUDAYALAYA
HEART CENTRE
716 H_20086310217
Male
57
Others KGF
BANGARPET
KOLAR
Bangalore
R L JALAPPA
NARAYANA
KOLAR
HRUDAYALAYA
HEART CENTRE
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
IHD-ACSEVOLVED
AWMI,LYSED
CARDIOLOGY
THE
STREPTOKINAN,
HTN/DM
CABG with IABP
133
133
28-Jul-15
10-Aug-15
115000
115000
90250
9025
81225
IDBI - 321
30-Oct-15
IHD-ACSAWMI,LYSED
THE
STREPTOKINAN
CABG
132
132
28-Jul-15
12-Aug-15
95000
95000
90250
9025
81225
IDBI - 321
30-Oct-15
Post Burn
Contracture
surgeries for
Functional
Improvement(Pack
age including
splints, pressure
garments and
physiotherapy),
Mild
9
9
26-Jul-15
29-Jul-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
CARDIOLOGY
Right Ring and
Little finger
Flexion
contracture.
BURNS
Burns
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
TRICUSPID
ATRESIA NRGV
VSD & ASD
CARDIOLOGY
Cardiothoracic Surgery Closed Heart Procedures Glenn Shunt
181
181
22-Jul-15
5-Aug-15
50000
50000
50000
1500
48500
IDBI - 321
30-Oct-15
Mysore
GAR
GAR
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
B/L URETERIC
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
27-Jul-15
7-Aug-15
37500
37500
37500
3750
33750
IDBI - 321
30-Oct-15
MUDHOLA
Belgaum
VENKATESH
HOSPITAL
right distal
RENAL
ureteric calculus
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
25-Jul-15
28-Jul-15
25000
25000
23275
2328
20947
IDBI - 321
30-Oct-15
RIGHT
CEREBELLOR
CYSTIC
LAEMANG
BLESTEMA
NEURO SURGERY
Neuro Surgery
Brain Tumour
Excision of Brain
Tumors Subtentorial
408
408
27-Jul-15
3-Aug-15
48000
48000
48000
4800
43200
IDBI - 321
30-Oct-15
ca.retro molar
trigone III
CANCER
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
23-Jul-15
3-Aug-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
CHD - ASD,
PAPVC
CARDIOLOGY
TAPVC
160
160
15-Jul-15
3-Aug-15
95000
95000
80000
0
80000
IDBI - 321
30-Oct-15
IHD RECENT
AWMI CAD SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
21-Jul-15
30-Jul-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
rt vuj calculi
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
6-Aug-15
10-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
CHD - OS ASD,
SEVERE TR
CARDIOLOGY
ASD
151
151
18-Jul-15
8-Aug-15
100000
80000
80000
0
80000
IDBI - 321
30-Oct-15
RT UPPER MID
LOWER
URETERIC
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
1-Aug-15
7-Aug-15
37500
37500
37500
3750
33750
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Device Closure
PDA Device
Closure
119
119
24-Jul-15
27-Jul-15
60000
60000
56525
5653
50872
IDBI - 321
30-Oct-15
Radiation Oncology
Radiotherapy
Treatment
563
563
23-Jul-15
10-Aug-15
10000
15055
9500
950
8550
IDBI - 321
30-Oct-15
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
22-Jul-15
7-Sep-15
75000
81250
75000
7500
67500
IDBI-294
9-Oct-15
717 H_22226310262
Female
5
Others MOHARE
BYLAHONGALA
BELGAUM
718 H_20112310337
Male
2
Others KADALABALU
HAGARIBOMMA
BELLARY
NAHALLI
719 H_20025310329
Male
39
Others NAGAVALLI
720 H_22458310331
Female
27
Others Mahalingpur
BAGLAKOT
Belgaum
Viajya Ortho
and Trauma
Centre
Gulbarga
BELGAUM
MAHALINGPUR
721 H_19549310139
Male
33
Others 0
INDI
BIJAPUR
Belgaum
BANGALORE
Sagar Hospitals
SOUTH
722 H_20613310083
Male
58
Others Vaddarahatti
GOKAK
BELGAUM
Belgaum
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
723 H_19577310206
Female
14
Minorit
BANGALORE
y
HOSAKOTE
BANGALORE RURAL
Bangalore
SJICR
724 H_20017310269
Male
71
Minorit
BELAGAVI
y
BELGAUM
BELGAUM
Belgaum
725 H_20332308659
Female
21
Others NEGONDAMAHALLI
KORATAGERE
TUMKUR
Bangalore
726 H_19577310140
Female
35
Others KODUR
MALUR
KOLAR
Bangalore
BANGALORE
SOUTH
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
BANGALORE
SJICR
SOUTH
Burns
727 H_20025310216
Female
61
Others HARATALE
NANJANAGUD
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
728 H_20733310166
Female
7
Others KIRANAHALLI
PIRIYAPATNA
MYSORE
Mysore
SJICR MYSORE
MYSORE
CHD/SS/PDA
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
ca tongu t3n1m0 CANCER
Ca Oesophagus
Mid& Lower
third stage III
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Left cerebellar
abscess, neck
abscess
NEURO SURGERY
Neuro Surgery
Brain
Excision of Brain
Abcess
421
421
20-Jul-15
30-Jul-15
50000
50000
47500
4750
42750
IDBI - 321
30-Oct-15
Spinal
DiscectomyLumbar
433
433
26-Jul-15
31-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
729 H_20082308649
Male
45
730 H_19567309857
Male
55
731 H_22879309864
Male
1
732 H_20079305052
Male
42
Others CHATNAHALLI
Others Gudageri
SC
SADALAGA
Others VARAKODU
HONNALI
DAVANGERE
KUNDAGOL
DHARWAD
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
BELGAUM
BELGAUM
Belgaum
SIDDHAGIRI
HOSPITAL AND
RESEARCH
CENTRE
HOSANAGARA
SHIMOGA
Bangalore
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
L4-5 PIVD.
NEURO SURGERY
Neuro Surgery
Severe AS
CARDIOLOGY
Aortic Valve
Replacement
146
146
27-Jul-15
5-Aug-15
120000
120000
120000
0
120000
IDBI - 321
30-Oct-15
CADMULTIVESSEL
DISEASE.
CARDIOLOGY
CABG with IABP
133
133
17-Jul-15
1-Aug-15
115000
115000
96390
9639
86751
IDBI - 321
30-Oct-15
KOLHAPUR
733 H_20200310113
Male
70
Others bannimantap
MYSORE
MYSORE
Mysore
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
734 H_19564309610
Male
61
Others GANGOLLI
KUNDAPURA
UDUPI
Mysore
KASTURBA
HOSPITAL
UDUPI
Sl.No
Preauth No
Gender
Age
735 H_23099309882
Female
8 Months
736 H_19576310061
Female
737 H_20082308280
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Others SANDURU
BELLARY
BELLARY
Gulbarga
Bapuji Child
Health Institute
Davanaere
and Research
Centre
RECTOVERITIBUL
NEONATAL
AL FISTULA
39
Others Basapur
HUKKERI
BELGAUM
Belgaum
SDM Narayana
Hrudayalaya
Dharwad
RHD with severe
MS with Mod
CARDIOLOGY
MR/TR with IE
Male
10
Others WARD 09
BELLARY
BELLARY
Gulbarga
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
NHL
Medical Oncology
738 H_21044308663
Male
6
Others gowrammahalli
JAGALURU
DAVANGERE
Bangalore
WENLOCK
DISTRICT
HOSPITAL
MANGALORE
avulsion of
malleolus TALUS POLYTRAUMA
FRACTURE
Polytrauma
739 H_19587308978
Female
3
Others PUTANI VILLAGE
MADIKERI
KODAGU
Mysore
Apollo BGS
Hospital
MYSORE
CHD-SUBAORTIC
VSD -LEFT TO
CARDIOLOGY
RIGHT SHUNT
740 H_20332309379
Male
66
Others HULUGONAHALLI
KORATAGERE
TUMKUR
Bangalore
BANGALORE
EAST
VESICAL
CALCULUS+BPH
741 H_20203309638
Male
44
Minorit
Aanand Nagar
y
HUBLI
DHARWAD
Belgaum
HUBLI
742 H_20968309222
Female
35
MYSORE
MYSORE
Mysore
743 H_19564309305
Female
50
Others KALUR
HOSANAGARA
SHIMOGA
Bangalore
KASTURBA
HOSPITAL
58
PANCHASHEEL
Others
NAGAR GBL
744 H_19571308622
Male
745 H_19571302594
Male
28
746 H_19571307271
Male
20
747 H_19586307642
Male
55
SC
HULLAHALLI
GULBARGA
GULBARGA
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Anorectal
Malformations
Stage 3
307
307
21-Jul-15
28-Jul-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
Mitral Valve
Replacement
145
145
23-Jul-15
5-Aug-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
Childhood B Cell
Lymphomas
Variable
Regimen/Cycle
540
540
22-Jul-15
31-Jul-15
12000
12000
8500
850
7650
IDBI - 321
30-Oct-15
Plastic Surgery
Flap cover Surgery
for wound in
compound
fracture
804
804
25-May-15
31-Jul-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
VSD
152
152
26-Jul-15
1-Aug-15
80000
80000
81600
8160
73440
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
Cystolithotripsy
906
906
1-Aug-15
6-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
Double Vessel
Disease
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
24-Jul-15
27-Jul-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
MYSORE
CA. CERVIX
STAGE - IIB
CANCER
Medical Oncology
Cervical Cancer
Weekly
Cisplatin/Week
509
509
21-Jul-15
1-Sep-15
32000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
UDUPI
SEVERE MITRAL
RAGURGITATION
CARDIOLOGY
WITH MITRAL
STENOSIS.
Mitral Valve
Replacement
145
145
17-Jul-15
28-Aug-15
120000
120000
122400
12240
110160
IDBI - 321
30-Oct-15
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT RENAL
CALCULUS.
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
17-Jul-15
30-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
RT UPPER
URETERIC
CALCULUS + LT
RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
21-Jul-15
4-Aug-15
37500
41746
25000
2500
22500
IDBI - 321
30-Oct-15
INSTITUTE OF
NEPHROUROLO
GY
KARNATAKA
INSTITUTE OF
MEDICAL
SCINCES
Krishnarajendra
Hospital
CANCER
SHAHPUR
YADGIRI
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
Others INGALAGI
CHITTAPUR
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT LOWER
URETRIC &
RENAL
UPPER URETERIC
STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
14-Jul-15
24-Jul-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
Others 0
HAGARIBOMMA
BELLARY
NAHALLI
Gulbarga
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
BANGALORE
IHD-DVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
13-Jul-15
28-Jul-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
Bangalore
MITRAL VALVE
PROLAPSE
MITRAL
REGUGITATION
SEV TRMODERATE
CARDIOLOGY
Mitral Valve
Replacement
145
145
26-Jul-15
10-Aug-15
120000
120000
102000
3060
98940
IDBI - 321
30-Oct-15
SC
DIGGI BASE WARD
NO6 SHAHPUR
748 H_19528309771
Male
28
Others DIKSANGA
AFJALPUR
GULBARGA
Gulbarga
Narayana
Hrudayalaya
Private Limited
749 H_22879309905
Male
31
Others KAKAMARI
BELGAUM
BELGAUM
Belgaum
SIDDHAGIRI
HOSPITAL AND
RESEARCH
CENTRE
KOLHAPUR
Leff restibelar
schwannoma
NEURO SURGERY
Neuro Surgery
Brain Tumour
Excision of Brain
Tumor
Supratentorial-C P
Angle
406
406
21-Jul-15
28-Jul-15
60000
60000
57000
5700
51300
IDBI - 321
30-Oct-15
750 H_20164309700
Male
75
KOLAR
KOLAR
Bangalore
R L JALAPPA
HOSPITAL AND
RESEARCH
CENTRE
KOLAR
BPH WITH BOO
ON CATHETER
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
23-Jul-15
1-Aug-15
20000
20000
18000
1800
16200
IDBI - 321
30-Oct-15
751 H_21701309715
Male
55
Minorit
noor khan taleem
y
BIDAR
BIDAR
Gulbarga
SUNSHINE
HEART
INSTITUTE
Paradise, S.D.
Road
CAD-TVD
CARDIOLOGY
CABG
132
132
15-Jul-15
29-Jul-15
95000
95000
92055
9206
82849
IDBI - 321
30-Oct-15
752 H_19528309764
Male
40
Others ALIMATI
BASAVANABAGE
BIJAPUR
WADI
Belgaum
Narayana
Hrudayalaya
Private Limited
Bangalore
RHD SEVERE MS CARDIOLOGY
Mitral Valve
Replacement
145
145
23-Jul-15
29-Jul-15
120000
120000
122400
3672
118728
IDBI - 321
30-Oct-15
753 H_19577309630
Female
50
Others AMMASANDRA
TURVEKERE
Bangalore
SJICR
BANGALORE
SOUTH
ACS- USA, DVD
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
22-Jul-15
25-Jul-15
90000
90000
90000
0
90000
IDBI - 321
30-Oct-15
ST
BALAGERE
TUMKUR
CARDIOLOGY
Cardiology
Sl.No
Preauth No
Gender
Age
754 H_22439309692
Male
41
Minorit
TATWANGI
y
755 H_20733306385
Female
44
Others
756 H_19577309389
Male
36
Others BELAGERA
757 H_19577309679
Male
53
Others
758 H_20059309805
Male
30
Others somanahalli
759 H_20613307290
760 H_20613309757
761 H_21868309761
762 H_20067309118
763 H_20237309664
764 H_20015309657
765 H_19567309216
766 H_21057309405
Male
Female
Female
Male
Female
Male
Female
Female
50
38
40
50
23
56
55
65
Caste
Village
RAGHAVENDRA
COLONY
Taluk
Minorit
varad galli Sindagi
y
Others Ikanahalli
Minorit
KUDEL HOUSE
y
Others Mainal
Others ANKOLA
Others Ramankoppa
Others MUDAR
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
HALIYAL
UTTARA
KANNADA
Belgaum
BHS lakeview
Hospital
BELGAUM
RT LOWER
URETERIC
CALCULI + LT
RENAL CALCULI
MYSORE
MYSORE
Mysore
SJICR MYSORE
MYSORE
YADGIR
YADGIRI
Gulbarga
SJICR
TUMKUR
Bangalore
BOMMARASANAHAL
GUBBI
LI
Others Galataga
Patient District
KADUR
CHIKKODI
SINDAGI
KR PET
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
21-Jul-15
25-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
SVD
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
8-Jul-15
17-Jul-15
65000
65000
45150
4515
40635
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
RHD - SEVEREMS CARDIOLOGY
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
18-Aug-15
21-Aug-15
20000
20000
20000
0
20000
IDBI - 321
30-Oct-15
SJICR
BANGALORE
SOUTH
IHD- NSTEMI,
DM, SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
9-Aug-15
12-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
CHIKKAMANAGL
Mysore
UR
KUMAR
HOSPITAL
TIPTUR
left uretric
calculus
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
22-Jul-15
25-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
BELGAUM
Belgaum
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
23-Jul-15
29-Aug-15
92000
90366
80000
8000
72000
IDBI - 321
30-Oct-15
Belgaum
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
21-Jul-15
29-Aug-15
82000
94443
82000
8200
73800
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
26-Jul-15
1-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Cardiology
PTCA - one stent
(non-medicated,
emergency,
inclusive of
angiogram) at the
same admission.
103
103
18-Jul-15
23-Jul-15
55000
161902
52250
5225
47025
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
25-Jul-15
30-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
16-Jul-15
4-Sep-15
87000
75000
75000
7500
67500
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
23-Jul-15
1-Sep-15
81000
89830
79720
7972
71748
IDBI-294
9-Oct-15
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
17-Jul-15
24-Jul-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
20-Jul-15
1-Sep-15
83000
83000
73150
7315
65835
IDBI - 321
30-Oct-15
BIJAPUR
MANDYA
BANTWAL
DAKSHINA
KANNADA
HALIYAL
UTTARA
KANNADA
ANKOLA
UTTARA
KANNADA
KUNDAGOL
Diseases
DHARWAD
KARKALA
UDUPI
2nd primary ca
post cricoid
CANCER
Stage T2 N1M0.
ca rectum T3 N0
CANCER
M0
Left Mild HN
with Renal
Calculus Mid
CHANNARAYAPA
Pole Calyx
TNA
10x2mm &
Pelvic Calculus
17x9mm
Mysore
NAGESH
HOSPITAL
Mysore
YENEPOYA
SPECIALTY
HOSPITAL
Belgaum
TSS-Shripad
Hegde Kadave
Institute of
Medical Scie
Belgaum
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
MANGALORE
RENAL
INTEROSEPTAL
MI
RENAL
CARDIOLOGY
SIRSI
Rt Renal calculus RENAL
MANGALORE
MODERATELY
DIFFERENCIATED
SCC OF RIGHT
CANCER
PYRIFORM SINUS
T2N2M0
Ca cervix Post op
CANCER
stage II A
Radiation Oncology
Genito Urinary
Surgery
Cardiology
Mysore
NEW
IHD, ANTERIOR
WALL MI
Belgaum
MANGALORE
INSTITUTE OF
ONCOLOGY
CA
OESHOPHAGUS
M/3 T3N0M0 II
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
CARDIOLOGY
767 H_20575309255
Female
53
Others BELAMBARA
ANKOLA
UTTARA
KANNADA
768 H_20332309372
Male
53
Others THONDAGERE
TUMKUR
TUMKUR
Bangalore
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
rt upper uretric
calculus
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
25-Jul-15
29-Jul-15
25000
25000
23750
2375
21375
IDBI - 321
30-Oct-15
769 H_19520308784
Female
23
Others MALAGITTI
KUSTAGI
KOPPAL
Gulbarga
SNMC HSK
HSopital
VESICLE
CALCULUS 5X6
CM
RENAL
Genito Urinary
Surgery
Urology
Open
Cystolithotomy
903
903
13-Jul-15
5-Aug-15
15000
15000
15000
1500
13500
IDBI - 321
30-Oct-15
770 H_20332308662
Female
40
Others GOLLAHALLI
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
ca bladder
RENAL
Genito Urinary
Surgery
Urology
TURBT
916
916
25-Jul-15
29-Jul-15
30000
30000
4850
485
4365
IDBI - 321
30-Oct-15
MANGALORE
BAGALKOTE
Sl.No
Preauth No
Gender
Age
771 H_20613309508
Female
37
772 H_20107308814
Male
42
Caste
Village
Others Kudachi
SC
NAGUR
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
RAIBAGH
BELGAUM
Belgaum
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
AURAD
BIDAR
Gulbarga
CARE Hospital A
unit of Quality
Nampally
Care India
Limite
CAD SINGLE
VESSEL DISEASE
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
STRICTURE
URETHRA
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
SUNSHINE
Paradise, S.D.
HEART
Road
INSTITUTE
B/L RENAL
CALCULUS
+RT.URETERIC
CALCULUS
CHD-LARGE OS
ASD WITH L->R
SHUNT
Diseases
Disease Main
Category
Plan of
treatment
Net Amt
Paid
8-Sep-15
86500
101687
86500
8650
77850
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
17-Jul-15
25-Jul-15
65000
142923
65000
6500
58500
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
Urethroplasty for
a year can be
considered)
912
912
15-Jul-15
28-Jul-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
9-Jul-15
25-Jul-15
25000
25000
24950
2495
22455
IDBI - 321
30-Oct-15
CARDIOLOGY
ASD
151
151
15-Jul-15
27-Jul-15
80000
165690
77520
7752
69768
IDBI - 321
30-Oct-15
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
18-Jul-15
25-Jul-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
22-Jul-15
28-Aug-15
76000
127500
76000
7600
68400
IDBI - 321
30-Oct-15
114
114
16-Jul-15
7-Aug-15
75000
75000
75000
7500
67500
IDBI - 321
30-Oct-15
URSL - Single Side
+ DJ Stent
909
909
25-Jul-15
1-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Belgaum
774 H_20017309501
Male
31
Others 0
KHANAPUR
BELGAUM
Belgaum
775 H_21701308262
Female
10
Others sidrampur sirigeri
SIRAGUPPA
BELLARY
Gulbarga
776 H_20061309483
Male
57
Others
BIDAR
Gulbarga
NARAYANA
HRUDAYALAYA HYDERABAD
HOSPITALS
CAD-DOUBLE
CARDIOLOGY
VESSEL DISEASE.
Belgaum
Kolhapur Cancer
Karveer
Centre
CA PANCREAS
(JUNCTION OF
HEAD &
BODY)T3N0M0
HYDERABAD
COMPLETE
HEART BOLCK
CARDIOLOGY
Cardiology
Permanent
pacemaker
VVI) including
Pacemaker value
Urology
BELGAUM
TDS
22-Jul-15
BAGLAKOT
BELGAUM
Gross
Amount
approved by
568
MUDHOLA
Others SULEBHAVI
Hospital
claimed
Amount
568
CANCER
Others 0
71
Preauth
Approved
Amt
Radiation Oncology
CA Cervix III B
72
Female
Date of
Discharge
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
Male
777 H_20435307905
Date of
Admission
3D Conformational
Radio Therapy
773 H_20017309505
(V) EKLAR (T,Q)
AURAD
AURAD (DIST) BIDAR.
CANCER
778 H_21736309318
Male
52
Others HANCHINAL CAMP
SINDNUR
RAICHUR
Gulbarga
NANO
HOSPITALS
PRIVATE
LIMITED
779 H_21718309404
Male
21
Others MADABALU
ALUR
HASSAN
Mysore
SSM Hospital
HASSAN
Left VUJ Calculi
RENAL
Genito Urinary
Surgery
780 H_19576309458
Male
52
Others Herakal
SIRAGUPPA
BELLARY
Gulbarga
SDM Narayana
Hrudayalaya
Dharwad
CAD-Significant
LAD and LCX
disease
CARDIOLOGY
CABG
132
132
20-Jul-15
7-Aug-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
781 H_20025309324
Male
55
Others KIRAGASURU
Mysore
GAR
GAR
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
L4 L5,L5S1 PIVD
WITH CANAL
STENOSIS
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
27-Jul-15
3-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
CHIKKAMANAGL
Mysore
UR
MANGALORE
INSTITUTE OF
ONCOLOGY
MANGALORE
CA
HYPOPHARNYX
T3N1M0
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
20-Jul-15
5-Sep-15
87000
83000
83000
8300
74700
IDBI - 321
30-Oct-15
UDUPI
MANGALORE
INSTITUTE OF
ONCOLOGY
MANGALORE
CA
OESOPHAGUS
M+L/3 T3N0M0
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
20-Jul-15
5-Sep-15
87000
85000
85000
8500
76500
IDBI - 321
30-Oct-15
UDUPI
ACUTE
MI
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
18-Jul-15
22-Jul-15
65000
65000
65790
6579
59211
IDBI - 321
30-Oct-15
Cardiology
Balloon
Pulmonary
Valvotomy
/Pulmonary Artery
and Branch
Vessels(LPA/RPA)
Stenosis for
Balloon Dilatation
107
107
23-Jul-15
26-Jul-15
20000
20000
20000
0
20000
IDBI - 321
30-Oct-15
Mitral Valve
Replacement
145
145
16-Jul-15
7-Aug-15
140000
140000
100000
0
100000
IDBI - 321
30-Oct-15
Cardiology
EP study
125
125
23-Jul-15
29-Jul-15
30000
30000
30000
0
30000
IDBI - 321
30-Oct-15
782 H_20575309233
783 H_20575309249
784 H_19564309110
Male
Male
Male
51
55
48
Others KIRUGUNDA
Others HALLIHOLE
Others HEROOR
785 H_19577309236
Male
786 H_19577309211
Male
18
Others RAJAPURA
787 H_19577309224
Female
52
Others JYOTHI PALYA
MUDIGERE
KUNDAPURA
UDUPI
UDUPI
Mysore
Mysore
KASTURBA
HOSPITAL
Mysore
SJICR
BANGALORE
SOUTH
MOLAKALMURU CHITRADURGA
Bangalore
SJICR
BANGALORE
SOUTH
MAGADI
Bangalore
SJICR
BANGALORE
SOUTH
11 Months Others AMBALAGEERAHALLI NAGAMANGALA MANDYA
RAMANAGAR
CANCER
CANCER
CHD - SEVERE PS CARDIOLOGY
RHD - MOD MS,
CARDIOLOGY
MOD MR,
SEVERE TR
MAHIM FIBRE
CARDIOLOGY
TACHYCARDIA
Cardiology
Cardiology
Cardiology
Sl.No
Preauth No
788 H_21223309298
Gender
Age
Caste
Village
Male
1
Others
MARANAGERE
KOPPA
Taluk
Patient District
MADDUR
MANDYA
UTTARA
KANNADA
789 H_20015309260
Female
47
Others HANDYANEMATA
SIDDAPUR
790 H_19577309215
Female
37
Others HIRISAVE
CHANNARAYAP
HASSAN
ATNA
791 H_19522308824
792 H_19581309223
Male
Female
69
51
Others SULYA
Others HASSAN
SULYA
ARAKALAGUD
DAKSHINA
KANNADA
HASSAN
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Mysore
INDIRA GANDHI
BANGALORE
INSTITUTE OF
SOUTH
CHILD HEALTH
anorectal
malformation
Belgaum
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
Mysore
SJICR
Mysore
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Anorectal
Malformations
Stage 3
307
307
20-Jul-15
31-Jul-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
MANGALORE
MODERATELY
DIFFERENTIATED
CANCER
SCC OF
OESOPHAGUS.T3
N1M0.
Surgical Oncology
Esophagus
Oesophagectomy
with Two field
Lymphadenectomy
673
673
13-Jul-15
13-Aug-15
85000
85000
85000
8500
76500
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
PSVT - AVNRT
Cardiology
Cardiology
EP study
125
125
27-Jul-15
29-Jul-15
30000
30000
30000
0
30000
IDBI - 321
30-Oct-15
MANGALORE
CARCINOMA
HYPOPHARYNX
T3N1
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
14-Jul-15
4-Sep-15
102000
102000
102000
10200
91800
IDBI - 321
30-Oct-15
MYSORE
DOUBLE VESSEL
CORONARY
CARDIOLOGY
ARTERY DISEASE
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
19-Jul-15
24-Jul-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
14-Jul-15
3-Aug-15
25000
40455
25000
2500
22500
IDBI - 321
30-Oct-15
NEONATAL
CARDIOLOGY
CANCER
Mysore
Cauvery
Hospital
RT RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Right Renal mass RENAL
Genito Urinary
Surgery
Urology
Lap. Nephrectomy
Radical (Lap
920
920
22-Jul-15
11-Aug-15
50000
50000
35000
3500
31500
IDBI - 321
30-Oct-15
793 H_19571307228
Female
7
Others SALADAPUR
SHAHPUR
YADGIRI
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
794 H_19574307519
Male
47
Minorit
MILATH NAGAR
y
KOLAR
KOLAR
Bangalore
VYDEHI
HOSPITAL
795 H_19571308509
Male
40
Others BIRAL
JEVARGI
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
17-Jul-15
22-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
796 H_19505309163
Male
47
Minorit
THERANIMANTI
y
HD KOTE
MYSORE
Mysore
Bharath
Hospital
Institute of
Oncology
CA TONGUE
T4N1M0 IV A
CANCER
Medical Oncology
Head & Neck
Carboplatin +
Paclitaxel/Cycle(max of 6 cycles
only)
521
521
23-Jul-15
3-Sep-15
31500
31500
31500
0
31500
IDBI - 321
30-Oct-15
797 H_19567307770
Female
37
Others Hirur
SAVADATTI
BELGAUM
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Lt Breast Post
CANCER
op
Surgical Oncology
Breast
Mastectomy - any
type
598
598
22-Jul-15
31-Jul-15
25000
25000
25000
2500
22500
IDBI-294
9-Oct-15
798 H_22054309154
Female
40
Others Kumatagi
BIJAPUR
BIJAPUR
Belgaum
DR MUNIR
BANGI
HOSPITAL
Urinary Bladdar
Calculi
RENAL
Genito Urinary
Surgery
Urology
Open
Cystolithotomy
903
903
16-Jul-15
22-Jul-15
15000
15000
13500
1350
12150
IDBI - 321
30-Oct-15
799 H_19571303358
Female
14
Others ULLISUGUR
SHAHPUR
YADGIRI
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT PUJ
OBSTRUCTION.
RENAL
Genito Urinary
Surgery
Urology
905
905
20-Jul-15
3-Aug-15
35000
48066
35000
3500
31500
IDBI - 321
30-Oct-15
CARDIOLOGY
Femoro Distal
Bypass with Vein
Graft
229
229
26-Jul-15
10-Aug-15
50000
50000
51000
5100
45900
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
23-Jul-15
29-Jul-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
908
908
20-Jul-15
24-Jul-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
BANGALORE
Mysore
BIJAPUR
800 H_19542308970
Male
52
Others HALEBEEDU
HUNSUR
MYSORE
Mysore
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
MYSORE
PVD-RT
POPLITEAL
ARTERY
THROMBOSIS.
801 H_20025308463
Male
65
Others DEBURU
NANJANAGUD
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
UNSTABLE
ANGINA , HTN
BANGALORE URBAN
Bangalore
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
rt upper ureteric
RENAL
calculus
Genito Urinary
Surgery
Urology
ESWL (Extra
Stent
MANDYA
Mysore
SJICR MYSORE
MYSORE
TVD
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
26-Jul-15
31-Jul-15
90000
90000
58050
5805
52245
IDBI - 321
30-Oct-15
Decortication
192
192
9-Jul-15
29-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
802 H_20332304767
Female
38
Others GUNDUR
BANGALORE
NORTH
803 H_20733308688
Male
77
Others KYATHANAHALLI
MALAVALLI
804 H_20270309070
Male
45
Others SULTHANPURA
RAICHUR
RAICHUR
Gulbarga
SDS TRC RGICD
JAYANAGAR
POST
TRAUMATIC
EMPYEMA WITH CARDIOLOGY
MULTIPLE RIBS
(L) SIDE
805 H_20733306792
Male
51
Others SAGARE
HD KOTE
MYSORE
Mysore
SJICR MYSORE
MYSORE
IHD-ACS ACUTE
CARDIOLOGY
AWMI CAD-SVD
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
13-Jul-15
21-Jul-15
90000
90000
84075
8408
75667
IDBI - 321
30-Oct-15
66
KORETHIMMANAHAL
Others
SIRA
LI
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
ca vaginal grade I CANCER
Surgical Oncology
Gynaec
Radical
Hysterectomy
594
594
20-Jul-15
27-Jul-15
55000
55000
37000
3700
33300
IDBI - 321
30-Oct-15
806 H_20082306336
Female
TUMKUR
Sl.No
Preauth No
807 H_20082308903
Gender
Age
Male
55
Caste
Village
Taluk
Others GANGE GALLI
GULBARGA
Patient District
GULBARGA
Patient
Division
Hospital Name
Gulbarga
Kidwai
Memorial
Institute of
Oncology
Hospital
District
Final
Diagnosis
BANGALORE
SOUTH
Ca Penis Grade
III
Diseases
Disease Main
Category
CANCER
Surgical Oncology
MANGALORE
STRICTURE
URETHRA
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Total Penectomy
590
590
25-Jul-15
4-Aug-15
25000
27825
20900
2090
18810
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
Urethroplasty for
a year can be
considered)
912
912
26-Jun-15
7-Aug-15
30000
30000
9500
950
8550
IDBI - 321
30-Oct-15
808 H_21044308464
Male
50
Others UBBUR
THIRTHAHALLI
SHIMOGA
Bangalore
WENLOCK
DISTRICT
HOSPITAL
809 H_20082308889
Female
39
Others SEETHPPANAHALLI
KOLAR
KOLAR
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
SCC Grade I
CANCER
Surgical Oncology
Head & Neck
Laser Surgery
622
622
27-Jul-15
3-Aug-15
35000
35000
32000
3200
28800
IDBI - 321
30-Oct-15
810 H_20733308840
Male
64
NANJANAGUD
MYSORE
Mysore
SJICR MYSORE
MYSORE
IHD-ACS-Acute
AWMI
CARDIOLOGY
Cardiology
Cardiology
Medical
treatment of
Acute MI with
Thrombolysis
128
128
15-Jul-15
21-Jul-15
10000
10000
9025
903
8122
IDBI - 321
30-Oct-15
811 H_20733308717
Male
41
Others NAGARANAHALLI
HASSAN
HASSAN
Mysore
SJICR MYSORE
MYSORE
Ihd-EV-AWMI
CAD-SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
14-Jul-15
23-Jul-15
65000
65000
58050
5805
52245
IDBI - 321
30-Oct-15
812 H_20017307918
Female
45
Others 0
MUDHOLA
BAGLAKOT
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
IHD-USA CAD
SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
10-Jul-15
23-Jul-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
TARIKERE
CHIKKAMANAGL
Mysore
UR
SUKSHEMA
HOSPITAL
PVTLTD
DAVANGERE
RIGHT RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
ESWL (Extra
Stent
908
908
21-Jul-15
23-Jul-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
Mitral Valve
Replacement
145
145
31-Jul-15
18-Aug-15
120000
120000
122400
3672
118728
IDBI - 321
30-Oct-15
813 H_20619307387
Male
36
ST
Kembalu
Others CHIKKATTURU
814 H_19528308998
Female
24
Others BANAHATTI
JAMAKHANDI
BAGLAKOT
Belgaum
Narayana
Hrudayalaya
Private Limited
Bangalore
RHD-MILD
MITRAL STENO
SIS SEV MITRAL
REGURGITATION CARDIOLOGY
MILD AR MILD
TO MODERATE
TR
815 H_20015308984
Male
50
Others AJJIBALA
SIRSI
UTTARA
KANNADA
Belgaum
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
MANGALORE
L1
COMPRESSION
NEURO SURGERY
FRACTURE WITH
RETROPULSION.
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
17-Jul-15
1-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
816 H_19571308981
Male
25
Others KAVADIMETHA
SURPUR
YADGIRI
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
13-Jul-15
22-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
817 H_20237308956
Male
45
Others Kantraji
SIRSI
UTTARA
KANNADA
Belgaum
TSS-Shripad
Hegde Kadave
Institute of
Medical Scie
Left Ureteric
calculus
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
21-Jul-15
22-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
MYSORE
DOUBLE VESSEL
CARDIOLOGY
DISEASE.
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
17-Jul-15
21-Jul-15
65000
65000
62985
6299
56686
IDBI - 321
30-Oct-15
DAVANGERE
BEP
Genito Urinary
Surgery
Urology
TURP
917
917
17-Jul-15
21-Jul-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
SIRSI
RENAL
818 H_19542308953
Female
53
Others KAGGERE
KR NAGAR
MYSORE
Mysore
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
819 H_20619307385
Male
60
Others HAGANAWADI
HARIHARA
DAVANGERE
Bangalore
SUKSHEMA
HOSPITAL
PVTLTD
820 H_19567308939
Male
60
Others Balaghanur
GADAG
GADAG
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Oropharynx
CANCER
IV A cT3 N2b M0
Medical Oncology
Head & Neck
Carboplatin +
Paclitaxel/Cycle
Max. of 6 cycles
only
521
521
22-Jul-15
10-Sep-15
31500
37730
31500
3150
28350
IDBI-294
9-Oct-15
821 H_19567302248
Male
32
Others Bhairwadgi
BASAVANABAGE
BIJAPUR
WADI
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Lt. Buccal
Mucosa
T4:N2b:M0
CANCER
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
23-Jul-15
4-Sep-15
60000
77490
60000
6000
54000
IDBI-294
9-Oct-15
822 H_20733307287
Female
44
Others HUNSURU
HUNSUR
MYSORE
Mysore
SJICR MYSORE
MYSORE
IHD-ACS AWMI
CAD-SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
13-Jul-15
20-Jul-15
90000
90000
80550
8055
72495
IDBI - 321
30-Oct-15
823 H_19505308910
Female
75
Minorit
MYSORE
y
MYSORE
MYSORE
Mysore
Bharath
Hospital
Institute of
Oncology
Mysore
CA LEFT BREAST
CANCER
cT2N0
Surgical Oncology
Breast
Mastectomy - any
type
598
598
26-Jul-15
29-Jul-15
25000
25000
25000
0
25000
IDBI - 321
30-Oct-15
RENAL
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
824 H_20015308284
Female
20
Others SASIHIYLU
MANGALORE
DAKSHINA
KANNADA
Mysore
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
MANGALORE
LEFT CP ANGLE
SHWANNOMA RESEDUAL
TUMOR NOT
NEURO SURGERY
RESPONDING TO
RT AND
INCREASING IN
SIZE.
825 H_20733307801
Male
52
Others NERALE
NANJANAGUD
MYSORE
Mysore
SJICR MYSORE
MYSORE
IHD-EVOLVED
IWMI CAD-TVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
15-Jul-15
20-Jul-15
90000
90000
57150
5715
51435
IDBI - 321
30-Oct-15
826 H_19581308593
Male
51
Others HASSAN
HASSAN
HASSAN
Mysore
Cauvery
Hospital
MYSORE
DOUBLE VESSEL
CORONARY
CARDIOLOGY
ARTERY DISEASE
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
16-Jul-15
20-Jul-15
55000
55000
52250
5225
47025
IDBI - 321
30-Oct-15
Bangalore
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
MANGALORE
CARCINOMA
POST CRICOID
CANCER
STAGE cT3N0M0
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
13-Jul-15
4-Sep-15
112000
98000
98000
9800
88200
IDBI - 321
30-Oct-15
827 H_19522308372
Male
46
828 H_20026308798
Female
17
829 H_20118308535
Female
35
Others KESHAVA NAGARA
ST
0
Others Honnamanhalli
HARIHARA
DAVANGERE
SIDLAGATTA
CHIKKABALLAPU
Bangalore
R
VIMS Speciality
Bangalore
Hospital
HASSAN
HASSAN
Mysore
Mangala
Hospital
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Ca Upper lip
stage II
(pt2N0M0)
Brain Tumour
Excision of Brain
Tumor
Supratentorial-C P
Angle
406
406
6-Jul-15
13-Aug-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
CARDIOLOGY
ASD
151
151
17-Jul-15
27-Jul-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
16-Jul-15
20-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
CANCER
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
22-Jul-15
1-Sep-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
830 H_19504308700
Male
55
Others Tarihal
BELGAUM
831 H_23124307309
Male
54
Others KARACHARAHATTI
CHIKKANAYAKA
TUMKUR
NAHALLI
Bangalore
SPARSH SUPER
SPECIALITY
HOSPITAL
BANGALORE
NORTH
CAD DVD
WITHM LV
DYSFUNCTION
CARDIOLOGY
CABG with IABP
133
133
9-Jul-15
24-Jul-15
115000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
832 H_23124307281
Male
51
Others BANHATTI
JAMAKHANDI
Belgaum
SPARSH SUPER
SPECIALITY
HOSPITAL
BANGALORE
NORTH
IHD
EXCERTIONAL
ANGINA
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting Stent
, elective)
240
240
11-Jul-15
22-Jul-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
833 H_20733308696
Male
47
Others CHIKKAYARAHALLI
PANDAVAPURA MANDYA
Mysore
SJICR MYSORE
MYSORE
IHD-ACS ACUTE
IWMI/PWMI
CARDIOLOGY
Cardiology
Cardiology
Medical
treatment of
Acute MI with
Thrombolysis
128
128
13-Jul-15
20-Jul-15
10000
10000
8550
855
7695
IDBI - 321
30-Oct-15
834 H_19515306850
Male
52
HAGARIBOMMA
BELLARY
NAHALLI
Gulbarga
CITY CENTRAL
HOSPITAL
PRIVATE
LIMITED
DAVANGERE
Vesical Calcilis
RENAL
Genito Urinary
Surgery
Urology
Cystolithotripsy
906
906
20-Jul-15
23-Jul-15
12500
21882
10000
1000
9000
IDBI - 321
30-Oct-15
835 H_19571305104
Male
31
MANVI
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT LOWER
RENAL
URETRIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
6-Jul-15
24-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Mysore
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
MANGALORE
ATHEROSCLEROT
IC TRIPLE VESSEL
CARDIOLOGY
CORONARY
ARTERY DISEASE.
CABG
132
132
15-Jul-15
29-Jul-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
IHD.ACUTE
ANTERIOR WALL
MI,CARDIOGENI CARDIOLOGY
C SHOCK,TRIPPLE
VESSEL DISEASE
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
13-Jul-15
22-Jul-15
90000
129212
91800
9180
82620
IDBI - 321
30-Oct-15
836 H_19522308589
Male
51
SC
0
Others HARIJAN WADA
Minorit
PUDU
y
BELGAUM
K R Puram
CHD, O S ASD
(1.5CM) WITH
L>R SHUNT
Lt uper ureteric
stone.
Neuro Surgery
BAGLAKOT
RAICHUR
BANTWAL
DAKSHINA
KANNADA
Belgaum
A J HOSPITAL
CENTRE
837 H_20127308128
Male
42
Others SARALAGI
HONNAVAR
UTTARA
KANNADA
838 H_19571307218
Male
63
Others KALLUR
HUMNABAD
BIDAR
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
BENIGN
ENLARGEMENT
OF PROSTATE
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
14-Jul-15
24-Jul-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
839 H_19571304643
Female
59
Others
CHITTAPUR
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT UPPER
RENAL
URETRIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
17-Jul-15
28-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
840 H_20017308601
Male
55
Others BALLIGERI
ATHANI
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
IHD USA CAD
SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - 2 stent
(non-medicated)
104
104
15-Jul-15
21-Jul-15
70000
70000
70000
7000
63000
IDBI - 321
30-Oct-15
841 H_20733308326
Male
69
Others UDBURU
MYSORE
MYSORE
Mysore
SJICR MYSORE
IHD-ACS ACUTE
IWMI
CARDIOLOGY
Cardiology
Cardiology
Medical
treatment of
Acute MI with
Thrombolysis
128
128
14-Jul-15
19-Jul-15
10000
10000
8550
855
7695
IDBI - 321
30-Oct-15
MAHANGAR
THANDA
MYSORE
Sl.No
Preauth No
Gender
Age
Caste
842 H_20082308002
Female
63
ST
843 H_20082304157
Female
34
Others
844 H_20015308446
Female
56
845 H_20531308332
Male
10 Days
846 H_20082306002
Female
58
847 H_19564306891
Male
Village
MITTAHALLI
Taluk
MULABAGILU
MARIKYATHANAHAL
MYSORE
LI
Patient District
Patient
Division
KOLAR
Bangalore
MYSORE
Mysore
Hospital Name
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
Belgaum
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
BANGALORE
SOUTH
Ca (Rt) Alveolus
T4N1Mo
CANCER
Surgical Oncology
Head & Neck
612
612
9-Jul-15
3-Aug-15
47500
51585
42275
4228
38047
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca cervix
T3N1M0
CANCER
Radiation Oncology
ii. HDR per
application
571
571
4-Aug-15
6-Aug-15
4500
4500
1500
150
1350
IDBI - 321
30-Oct-15
MANGALORE
RECENT
IWMI,CADCARDIOLOGY
TVD,MILD LV
DYSFUNCTION EF
45%.
CABG
132
132
16-Jul-15
29-Jul-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
Others CHIPAGI
SIRSI
UTTARA
KANNADA
Others SRINIVAS COLONY
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
RAJARAJESWARI
MEDICALCOLLE
BANGALORE
GE AND
HOSPITAL
Exompholos
minor with acute
NEONATAL
intestinalobstruc
tion
Intestinal Atresias
& Obstructions
303
303
7-Jul-15
14-Aug-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
Others ISLAMPURA
NELEMANGALA
BANGALORE RURAL
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
ca colon t3n1m0 CANCER
Surgical Oncology
Colectomy - any
type
637
637
27-Jul-15
12-Aug-15
40000
48450
36500
3650
32850
IDBI - 321
30-Oct-15
Mysore
KASTURBA
HOSPITAL
UDUPI
MALIGNANT
SOFT TISSUE
SARCOMA WITH NEURO SURGERY
INTRACRARID
EXTERSION
Neuro Surgery
Brain Tumour
Excision of Brain
Tumor
Supratentorial &
others
407
407
7-Jul-15
23-Jul-15
45000
45000
45390
4539
40851
IDBI - 321
30-Oct-15
AWMI WITH
POST
INFRACTION
ANGINA WITH
CAD-DVD.
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
22-Jul-15
24-Jul-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
MYSORE
IHD-ACS ACUTE
AWMI
CARDIOLOGY
Cardiology
Cardiology
128
128
10-Jul-15
18-Jul-15
10000
10000
9025
903
8122
IDBI - 321
30-Oct-15
MYSORE
LEFT PUJ
OBSTRUCTION
RENAL
Genito Urinary
Surgery
Urology
905
905
17-Jul-15
29-Jul-15
35000
35000
33250
3325
29925
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
ca Lung T4NoMo CANCER
Radiation Oncology
Radiotherapy
Treatment
563
563
17-Jul-15
20-Jul-15
10000
10000
2250
225
2025
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
CA THYROID
T3N1Mo
CANCER
Nuclear Medicine
Thyroid
Radioiodine
Treatment < 100
Millicuries
574
574
1-Aug-15
4-Aug-15
15000
15000
11400
1140
10260
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
ca Ovary
CANCER
Surgical Oncology
Gynaec
Surgery for Ca
Ovary - early stage
595
595
28-Jul-15
3-Aug-15
25000
25000
14000
1400
12600
IDBI - 321
30-Oct-15
HONAVAR
RT URETERIC
CALCULLY
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
22-Jul-15
23-Jul-15
25000
25000
22500
2250
20250
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
18-Jul-15
25-Jul-15
37500
37500
35625
3563
32062
IDBI - 321
30-Oct-15
62
Others ULTHUR
KUNDAPURA
UDUPI
THIRTHAHALLI
SHIMOGA
Bangalore
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
SJICR MYSORE
848 H_20079308532
Male
64
Minorit
BETTAMAKKI
y
849 H_20733308247
Male
61
Others BANDIHOLE
KR PET
MANDYA
Mysore
850 H_20968308455
Male
17
Others BG MOLE
MALAVALLI
MANDYA
Mysore
851 H_20082308499
Male
33
Others BABUS PALLY
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
852 H_20082308000
Female
29
ARASIKERE
HASSAN
Mysore
853 H_20082308014
Female
43
Minorit
BANGALORE
CHINNAPPA LAYOUT
y
NORTH
BANGALORE URBAN
Bangalore
854 H_20139308466
Male
43
Others CHANDAVAR
UTTARA
KANNADA
Belgaum
SC
MALLADEVIHALLI
HONNAVAR
Krishnarajendra
Hospital
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
SRIDEVIMULTIS
PECIALITY
HOSPITAL
Medical
treatment of
Acute MI with
Thrombolysis
HASSAN
HASSAN
Mysore
SSM Hospital
HASSAN
Right Renal
Calculi with Right RENAL
Ureteric calculi
Others ARAVE
HUNSUR
MYSORE
Mysore
SJICR MYSORE
MYSORE
IHD-ACS ACUTE
IWMI CAD-SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
15-Jul-15
20-Jul-15
90000
90000
85025
8503
76522
IDBI - 321
30-Oct-15
58
Others NANDINI LAYOUT
BANGALORE
EAST
BANGALORE URBAN
Bangalore
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
b/l renal clculai
RENAL
Genito Urinary
Surgery
Urology
Open
901
901
29-Jul-15
20-Aug-15
25000
25000
20000
2000
18000
IDBI - 321
30-Oct-15
Male
58
Others BYRAPURA
T NARASIPUR
MYSORE
Mysore
SJICR MYSORE
SVD
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
13-Jul-15
22-Jul-15
65000
65000
61275
6128
55147
IDBI - 321
30-Oct-15
859 H_21897308436
Female
27
Others 0
SOMAVARPET
KODAGU
Mysore
LEFT RENAL
PELVIS
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
14-Jul-15
23-Jul-15
25000
25000
22500
2250
20250
IDBI - 321
30-Oct-15
860 H_22867308403
Male
28
HIRIYUR
CHITRADURGA
Bangalore
Left Ureteric
Calculus
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
7-Jul-15
23-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
861 H_20025307785
Male
57
Others HIREHALLI KOPPALU ARAKALAGUD
HASSAN
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
VESICAL
CALCULUS WITH
RENAL
LT RENAL
CALCULUS
Genito Urinary
Surgery
Urology
Cystolithotripsy
906
906
23-Jul-15
28-Jul-15
17500
17500
15000
1500
13500
IDBI - 321
30-Oct-15
862 H_19571307251
Male
33
Others MADIYAL THAND
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT UPPER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
14-Jul-15
19-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
855 H_21718308375
Male
50
Others
856 H_20733308256
Male
36
857 H_20332305911
Female
858 H_20733306766
ST
CHIKKA
BAGANAHALLI
HEMADALA
GULBARGA
MYSORE
GLOBAL
MULTISPECIALIT
MANGALORE
Y HOSPITAL
INDIA PVT LTD
Chitradurga
CHITRADURGA
Government
Hospital
Sl.No
Preauth No
863 H_20079308347
Gender
Age
Male
65
Caste
Village
Others GOPALA
Taluk
SHIMOGA
Patient District
SHIMOGA
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Net Amt
Paid
132
20-Jul-15
30-Jul-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
CA RT
HEMILARYNX
WITH NECK
METASTASIS T3
N1
CANCER
Surgical Oncology
Head & Neck
Laryngectomy
with Voice
Prosthesis
618
618
22-Jul-15
5-Aug-15
60000
60000
38000
3800
34200
IDBI - 321
30-Oct-15
Ca (Rt) Breast
T3N1Mo
CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
22-Jul-15
25-Jul-15
25000
27700
19350
1935
17415
IDBI - 321
30-Oct-15
Mitral Valve
Replacement
145
145
20-Jul-15
9-Aug-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
620
620
23-Jul-15
8-Aug-15
47500
47500
47500
4750
42750
IDBI - 321
30-Oct-15
Tricuspid Valve
Repair
142
142
21-Jul-15
11-Aug-15
80000
80000
80000
0
80000
IDBI - 321
30-Oct-15
568
568
15-Jul-15
10-Sep-15
83000
83000
78850
7885
70965
IDBI - 321
30-Oct-15
Mysore
865 H_20082307148
Female
38
Minorit
VINAYAKANAGARA
y
BANGALORE
EAST
BANGALORE URBAN
Bangalore
Kidwai
Memorial
Institute of
Oncology
866 H_20079308232
Male
45
SHIKARIPURA
SHIMOGA
Bangalore
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
MVP,SEVERE MR CARDIOLOGY
867 H_20082306025
Male
47
868 H_19577308185
Male
9 Months
BANGALORE
SOUTH
Others KODIHALLI
HAGARIBOMMA
BELLARY
NAHALLI
Gulbarga
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Scc of lt GBS
t4an1m0
CANCER
Surgical Oncology
Others HALLIKHED (K)
HUMNABAD
Gulbarga
SJICR
BANGALORE
SOUTH
SEVERE TR
CARDIOLOGY
Cardiothoracic Surgery Valve Repair
MANGALORE
CA
OESOPHAGUS
T3N0M0 STAGE
III
Head & Neck
Hemimandibulect
omy
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
CANCER
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
22-Jul-15
7-Sep-15
96000
105250
96000
9600
86400
IDBI-294
9-Oct-15
right lower
uteric stone
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
10-Jul-15
11-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
2
2
13-Jul-15
1-Sep-15
35000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
CHIKKAMANAGL
Mysore
UR
MANGALORE
INSTITUTE OF
ONCOLOGY
KALAGATAGI
DHARWAD
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Larynx
(Supraglottis)
stage II cT2 N0
M0
SHRUNGERI
TDS
132
MANDYA
Others MENASE
Gross
Amount
approved by
CABG
MALAVALLI
65
Hospital
claimed
Amount
Others RAMADUR
Female
Preauth
Approved
Amt
CARDIOLOGY
55
869 H_20575307955
Date of
Discharge
CAD-DVD.
Male
BIDAR
Date of
Admission
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
864 H_20025308169
DEVARAJ HARSA
NAGAR
Bangalore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
SC
Plan of
treatment
CANCER
870 H_19567308210
Male
55
Minorit
Lingankoppa
y
871 H_20118307873
Female
36
Others Chikkabasavanahalli
HASSAN
HASSAN
Mysore
Mangala
Hospital
872 H_21132308193
Female
5
Others ANEKERE
CHANNARAYAP
HASSAN
ATNA
Mysore
Shree
Hospital/HIMS
scalds upto
40%burn
BURNS
Burns
Burns
upto-40% with
Scalds(
Conservative/
without grafting)
873 H_19567307323
Male
49
Others Singapur plot
HANAGAL
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Tongue Post
op Rec Stage II
T2 N0 M0
CANCER
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
20-Jul-15
27-Aug-15
60000
60000
59000
5900
53100
IDBI-294
9-Oct-15
239
239
13-Jul-15
17-Jul-15
65000
65000
65790
6579
59211
IDBI - 321
30-Oct-15
HAVERI
K R Puram
874 H_19564307688
Male
47
Others GABADI MALUR
THIRTHAHALLI
SHIMOGA
Bangalore
KASTURBA
HOSPITAL
UDUPI
ACS NSTEMI,SVD CARDIOLOGY
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
875 H_20733307795
Male
62
Others RAMANUJA ROAD
MYSORE
MYSORE
Mysore
SJICR MYSORE
MYSORE
IHD-ACS ACUTE
IWMI / PWMI
CARDIOLOGY
Cardiology
Cardiology
Medical
treatment of
Acute MI with
Thrombolysis
128
128
12-Jul-15
18-Jul-15
10000
10000
8550
855
7695
IDBI - 321
30-Oct-15
876 H_20025307800
Male
38
Others MALALI
HOLENARSIPUR HASSAN
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
IHD - RECENT
IWMI , S/P CAG- CARDIOLOGY
DVD
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
12-Jul-15
16-Jul-15
90000
90000
85500
8550
76950
IDBI - 321
30-Oct-15
Bangalore
SPARSH SUPER
SPECIALITY
HOSPITAL
BANGALORE
NORTH
IHD, ACUTE
INFERIOR IWMI
CARDIOLOGY
Cardiology
Cardiology
PTCA - one Drug
Eluting stent (
emergency,
inclusive of
angiogram) at the
same admission.
239
239
11-Jul-15
15-Jul-15
65000
65000
61750
6175
55575
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
CA COLON
T3N1M0
CANCER
Surgical Oncology
Colectomy - any
type
637
637
10-Jul-15
28-Jul-15
40000
40000
34675
3468
31207
IDBI - 321
30-Oct-15
877 H_23124307425
Male
52
Others KAMAKSHIPALYA
BANGALORE
EAST
BANGALORE URBAN
878 H_20082307618
Female
62
Minorit
TANGLI
y
KADUR
CHIKKAMANAGL
Mysore
UR
Kidwai
Memorial
Institute of
Oncology
879 H_20079307757
Male
68
Minorit
TIPPU NAGARA
y
SHIMOGA
SHIMOGA
Bangalore
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
RIGHT SFA
OCCLUSION
CARDIOLOGY
Femoro Distal
Bypass with Vein
Graft
229
229
29-Jul-15
7-Aug-15
50000
60000
50000
5000
45000
IDBI - 321
30-Oct-15
880 H_21044306884
Male
54
Others KOLURU
SAGARA
SHIMOGA
Bangalore
WENLOCK
DISTRICT
HOSPITAL
MANGALORE
SUBMENTAL
STENOSIS
STRICTURE
URETHRA
RENAL
Genito Urinary
Surgery
Urology
Urethroplasty for
Stricture DiseasesFirst Stage
913
913
7-Jun-15
20-Jul-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
881 H_20082307646
Female
40
Others HUNISANEHALLI
RAMANAGAR
RAMANAGAR
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
MALIGNENT
mELANOMA (LT) CANCER
Foot T2NoMo
Surgical Oncology
Tumors
Wide excision for soft tissue and
bone tumors
686
686
9-Jul-15
23-Jul-15
30000
30000
25650
2565
23085
IDBI - 321
30-Oct-15
Sl.No
Preauth No
882 H_19574307018
Gender
Female
Age
35
Caste
SC
Village
JOGIMATTI ROAD
Taluk
CHITRADURGA
Patient District
CHITRADURGA
Patient
Division
Bangalore
BLDE University
Shri BM Patil
Bijapur
Medical College
Hosp
Female
55
Others Tadvalga
INDI
BIJAPUR
Belgaum
884 H_20017307950
Male
10
Others NALLANATTI
GOKAK
BELGAUM
Belgaum
885 H_20322307944
Female
63
Others NADUGODU
MANGALORE
DAKSHINA
KANNADA
Mysore
886 H_20782306715
Female
43
HOLALKERE
CHITRADURGA
Bangalore
887 H_19567307907
Female
45
Others Holenarasipura
HEREKANDAVADI
Others HIREMALLANAKERE
Others KADUVALLI
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
8-Sep-15
75000
75000
75000
7500
67500
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
29-Jul-15
12-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
CHD MODERATE
CARDIOLOGY
VSD
VSD
152
152
6-Jul-15
31-Jul-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
ANEURYSMAL
SUBARACHNOID NEURO SURGERY
HEMORRHAGE
Neuro Surgery
Brain
Aneurysm
Clipping
422
422
15-Jul-15
29-Jul-15
100000
100000
100000
10000
90000
IDBI - 321
30-Oct-15
CARCINOMA OF
CERVIX STAGE
CANCER
IIIB
Radiation Oncology
ii. HDR - one
application and
multiple dose
fractions
573
573
17-Jul-15
22-Jul-15
20000
20000
19500
98
19402
IDBI - 321
30-Oct-15
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
22-Jul-15
11-Sep-15
60000
78090
60000
6000
54000
IDBI-294
9-Oct-15
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
11-Jul-15
3-Sep-15
87000
87000
87000
8700
78300
IDBI - 321
30-Oct-15
Femoropopliteal
by pass procedure
with graft (inclu.
Graft)
212
212
20-Jul-15
27-Jul-15
45000
45000
45000
4500
40500
IDBI - 321
30-Oct-15
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
9-Jul-15
31-Aug-15
87000
85000
85000
8500
76500
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
20-Jul-15
23-Jul-15
37500
37500
37500
3750
33750
IDBI - 321
30-Oct-15
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
18-Jul-15
25-Jul-15
37500
37500
37500
3750
33750
IDBI - 321
30-Oct-15
541
541
15-Jul-15
8-Sep-15
30000
30000
20000
2000
18000
IDBI-294
9-Oct-15
MANDYA
MANDYA
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
LT SFA
OCCLUSION
CARDIOLOGY
PUTTUR
DAKSHINA
KANNADA
Mysore
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
MANGALORE
CLEAR CELL
CARCINOMA OF
CANCER
TONGUE
T3N2M0
Radiation Oncology
Gulbarga
SUKSHEMA
HOSPITAL
PVTLTD
DAVANGERE
RIGHT
STAGHORN
CALCULUS WITH
RENAL
LEFT UPPER
URETERIC
CALCULUS
Genito Urinary
Surgery
HASSAN
Right Renal
Calculi, and Left RENAL
VUJ calculi
Genito Urinary
Surgery
Urology
HUVINAHADAG
BELLARY
ALI
Preauth
Approved
Amt
21-Jul-15
Radiation Oncology
Others MARALAKERE
Date of
Discharge
569
CANCER
MANGALORE
Date of
Admission
569
Bangalore
66
55
RENAL
Genito Urinary
Surgery
Radical Treatment
& Post Operative
RT(SRS/SRT) Upto
30 fractions in 6
weeks
DAVANGERE
Male
Female
Radiation Oncology
Plan of
treatment
Stereotactic Radio
Surgery(SRS) /
Stereotactic Radio
Therapy(SRT)
CA RIGHT
BUCCAL
MOCOSA T3 N1
M0
889 H_20025307867
891 H_20619306801
CANCER
YENEPOYA
MEDICAL
COLLEGE
HOSPITAL
42
Others NIDPALLI
Left Renal
Calculus
Disease Main
Category
Ca Buccal
mucosa Lt T3 N0 CANCER
M0
Male
50
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
INDIANA
HOSPITAL AND
MANGALORE
HEART
INSTITUTE LTD
HEALTHCARE
GLOBAL
Bangalore
ENTERPRISES
LTD
Anaplastic
meningioma
Diseases
Karnataka
Cancer Therapy
Hubli
and Research
Institute
888 H_20698307127
Male
BANGALORE
Final
Diagnosis
Mysore
HOLENARSIPUR HASSAN
YALLAMMANANAGA
Others
DAVANAGERE
RA
890 H_20015307908
Hospital
District
VYDEHI
HOSPITAL
883 H_20031306995
SC
Hospital Name
MUDIGERE
CHIKKAMANAGL
Mysore
UR
SSM Hospital
HIRIYUR
CHITRADURGA
Bangalore
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca
Neuroblastoma(
CANCER
Abdomen)stage
II
Medical Oncology
Neuroblastoma ( Stages Variable
I-III )
Regimen/Cycle
892 H_21718307766
Female
53
893 H_19567305386
Female
4
894 H_20010306741
Male
74
Others VIDYARANYANAGAR
BANGALORE
EAST
BANGALORE URBAN
Bangalore
M S Ramaiah
Hospital
BANGALORE
NORTH
PAPILLARY CA
THYRAOID
T4aN1M0
CANCER
Surgical Oncology
Head & Neck
615
615
19-Jun-15
28-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
895 H_20082307154
Female
42
Others KARLE
HASSAN
HASSAN
Mysore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca thyroid
T1N0M0
CANCER
Surgical Oncology
Head & Neck
615
615
8-Jul-15
22-Jul-15
20000
21155
15300
1530
13770
IDBI - 321
30-Oct-15
896 H_20112307635
Male
64
DAVANAGERE
DAVANGERE
Bangalore
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
IHD ACCUTE
IWMI (LYSED
WITH STK )
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
14-Jul-15
20-Jul-15
90000
90000
90000
2700
87300
IDBI - 321
30-Oct-15
SC
ST
Hiriyur
YARAGUNTI
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
897 H_20082307158
Male
49
Others C S PURA
GUBBI
TUMKUR
898 H_20082306180
Male
58
Others H N PURA
CHANNARAYAP
HASSAN
ATNA
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca cervix IIA
CANCER
Surgical Oncology
Gynaec-Ca.Cervix
Radical
Hysterectomy
+Bilateral Pelvic
Lymph Node
Dissection (BPLND)
+ Bilateral Salpingo
Ophorectomy
(BSO) / Ovarian
transposition
Mysore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
CA(r) BREAST
T1NoMo
CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
21-Jul-15
29-Jul-15
25000
25000
20900
2090
18810
IDBI - 321
30-Oct-15
Bangalore
RAJARAJESWARI
MEDICALCOLLE
BANGALORE
GE AND
HOSPITAL
Neuro Surgery
Spinal
Anterior Cervical
Discectomy Single
level
428
428
9-Jul-15
29-Jul-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
Cervical canal
stenosis C5/C6
PIVD & posterior NEURO SURGERY
cord
decompression
648
648
20-Jul-15
27-Jul-15
45000
45000
42000
4200
37800
IDBI - 321
30-Oct-15
899 H_20531307639
Male
47
Others VAJARA HALLI
RURAL
900 H_19583306430
Female
70
Others G KADIHALLI
HAGARIBOMMA
BELLARY
NAHALLI
Gulbarga
S.S. INSTITUTE
OF MEDICAL
NH-4,Bypass PB Carcinoma of left
CANCER
SCIENCES &
Road Davanagere breast stage 2nd
RESEARCH CENT
Surgical Oncology
Breast
Mastectomy - any
type
598
598
9-Jul-15
29-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
901 H_20082306331
Female
44
CHALLAKERE
Bangalore
Kidwai
Memorial
Institute of
Oncology
Surgical Oncology
Head & Neck
612
612
23-Jul-15
10-Aug-15
37500
37500
34075
3408
30667
IDBI - 321
30-Oct-15
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Ca Oesophagus
CANCER
stage II(T2N0M0)
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
17-Jul-15
27-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Glottis
t3n1mx
CANCER
Surgical Oncology
Head & Neck
617
617
17-Jul-15
25-Jul-15
52500
52500
47025
4703
42322
IDBI - 321
30-Oct-15
BANGALORE
NORTH
CA STOMACH
CT2N0M0
CANCER
Surgical Oncology
Gastrectomy - any
type
636
636
22-Jun-15
22-Jul-15
50000
40000
28000
2800
25200
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
23-Jul-15
30-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
ST
YALAGATTA
CHITRADURGA
902 H_19504306253
Male
85
Others Surapur
BELGAUM
BELGAUM
Belgaum
903 H_20082306009
Male
44
Others BIJAVARA
MADHUGIRI
TUMKUR
Bangalore
904 H_20010304797
Male
50
MANVI
RAICHUR
Gulbarga
ST
NEERAMANVI
Kidwai
Memorial
Institute of
Oncology
M S Ramaiah
Hospital
BANGALORE
SOUTH
ca Buccal
CANCER
mucosa t3n1m0
905 H_20025306769
Male
19
Others YALIYUR
MANDYA
MANDYA
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
906 H_20025307355
Male
37
Others KELLUR
PIRIYAPATNA
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
LT PUJ
OBSTRUCTION
Ca Floor of
mouth T2:N1:M0 CANCER
II
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
15-Jul-15
18-Aug-15
60000
60000
60000
6000
54000
IDBI-294
9-Oct-15
LEFT RENAL
PELVIC
CALCULUS
RENAL
Genito Urinary
Surgery
RENAL
Genito Urinary
Surgery
Urology
905
905
21-Jul-15
1-Aug-15
35000
35000
33250
3325
29925
IDBI - 321
30-Oct-15
DHARWAD
DHARWAD
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
RONA
GADAG
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Larynx Lt
Glottic
CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
20-Jul-15
4-Sep-15
50000
51755
50000
5000
45000
IDBI-294
9-Oct-15
Others CHINCHOLI
AFJALPUR
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
BENIGN
ENLARGEMENT
OF PROSTATE
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
27-Jul-15
3-Aug-15
20000
22629
20000
2000
18000
IDBI - 321
30-Oct-15
Others Gopanakoppa
HUBLI
DHARWAD
Belgaum
Shakuntala
Memorial
Hubli
Hospital and
Research Centre
CA tongue
T2N0Mx stage II
CANCER
post CTRT
recidual lesion
Surgical Oncology
Head & Neck
Wide excision
621
621
23-Jul-15
28-Jul-15
20000
20000
19000
1900
17100
IDBI - 321
30-Oct-15
KONKANIDODDI
RAMANAGAR
RAMANAGAR
Bangalore
BGS GLOBAL
HOSPITAL
BANGALORE
SOUTH
RIGHT URETRIC
CALCULUS
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
17-Jul-15
18-Jul-15
25000
25000
23750
95
23655
IDBI - 321
30-Oct-15
WEWARS COLONY
GOTTIGERE
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
SJICR
BANGALORE
SOUTH
ACS,IWMI+PWM
CARDIOLOGY
I,HTN,DVD
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
9-Jul-15
18-Jul-15
90000
90000
90000
0
90000
IDBI - 321
30-Oct-15
BIJAPUR
Belgaum
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
ca .tongue T3 N2
CANCER
M0
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
15-Jul-15
26-Aug-15
92000
97931
80000
8000
72000
IDBI - 321
30-Oct-15
YADGIRI
Gulbarga
SJICR
IHD,AWMI,DM,T
CARDIOLOGY
VD
CABG
132
132
13-Jul-15
29-Jul-15
95000
95000
95000
0
95000
IDBI - 321
30-Oct-15
907 H_19567307280
Male
65
Others Amminabhavi
908 H_19567307541
Male
23
909 H_19571305113
Male
41
910 H_20254307202
Female
47
911 H_19491306915
Male
25
SC
912 H_19577307433
Male
65
Others
BIJAPUR
SHAHPUR
ST
Naregal
913 H_20613307304
Male
42
PWD Office rani
Others
bagicha Bijapur
914 H_19577307255
Female
56
Others IBRAHIMPUR
BANGALORE
SOUTH
RENAL
Sl.No
Preauth No
Caste
Village
Taluk
Patient District
Patient
Division
Gender
Age
915 H_19491303117
Male
28
Others GUNJALLI
SINDNUR
RAICHUR
Gulbarga
916 H_21897307398
Female
35
Others 0
MANGALORE
DAKSHINA
KANNADA
Mysore
917 H_19586307168
Female
33
Others
918 H_19562297144
Female
72
SC
919 H_19571304665
Male
66
920 H_20733307291
Male
921 H_19528307260
HAREGONDANAHALL HAGARIBOMMA
BELLARY
I
NAHALLI
Gulbarga
KUNDURU
Hospital Name
BGS GLOBAL
HOSPITAL
Hospital
District
BANGALORE
SOUTH
GLOBAL
MULTISPECIALIT
MANGALORE
Y HOSPITAL
INDIA PVT LTD
SAPTHAGIRI
SUPER
BANGALORE
SPECIALITY
HOSPITAL
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
rheumatoid
heart disease
Myxomatous
AML SEV MR
CARDIOLOGY
Mitral Valve
Repair
141
141
25-Jul-15
3-Aug-15
80000
80000
72000
288
71712
IDBI - 321
30-Oct-15
(L)LOWER
URETERIC
CALCULUS
RENAL
Genito Urinary
Surgery
URSL - Single Side
+ DJ Stent
909
909
11-Jul-15
16-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Urology
RHD SEVERE MR CARDIOLOGY
Mitral Valve
Replacement
145
145
13-Jul-15
1-Aug-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
A Known case of
Ca. Cervix Stage CANCER
IV B
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
21-Jul-15
3-Sep-15
54000
54000
19000
1900
17100
IDBI - 321
30-Oct-15
HONNALI
DAVANGERE
Bangalore
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
LAXMI NAGAR
Minorit
STATION AREA
y
YADGIR
YADGIR
YADGIRI
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
BENIGN
ENLARGEMENT
OF PROSTATE
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
7-Jul-15
17-Jul-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
49
Minorit
MANDI MOHALLA
y
MYSORE
MYSORE
Mysore
SJICR MYSORE
MYSORE
IHD-IWMI CADSVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
13-Jul-15
17-Jul-15
90000
90000
64500
6450
58050
IDBI - 321
30-Oct-15
Male
59
Others SINGANODI
RAICHUR
RAICHUR
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
CAD-DVD,RHD
AORTIC VALVE
CARDIOLOGY
DISEASE MOD AS
CABG + Valve
Replacement +
IABP
134
134
16-Jul-15
1-Aug-15
130000
130000
122400
3672
118728
IDBI - 321
30-Oct-15
922 H_20086304510
Male
51
BANGARPET
KOLAR
Bangalore
R L JALAPPA
NARAYANA
KOLAR
HRUDAYALAYA
HEART CENTRE
IHD -ACS- IWMI
WITH CHB
CARDIOLOGY
Cardiology
Temporary
implantation
113
113
5-Jul-15
15-Jul-15
57000
57000
51300
5130
46170
IDBI - 321
30-Oct-15
923 H_19505306362
Male
57
Others BUDAMBALLI
Mysore
GAR
GAR
Mysore
CA POST
CRICOID cT2N0
III
CANCER
Medical Oncology
Head & Neck
Carboplatin +
only)
521
521
16-Jul-15
10-Aug-15
21000
21000
21000
0
21000
IDBI - 321
30-Oct-15
924 H_20082302666
Male
61
Others BANNAHALLI
MADDUR
MANDYA
Mysore
BANGALORE
SOUTH
ca tongue
t3n1m0
CANCER
Surgical Oncology
Tracheostomy
675
675
4-Jun-15
6-Jun-15
3000
7805
2100
210
1890
IDBI - 321
30-Oct-15
925 H_22971306171
Female
27
Others BEERANAHALLI
KR NAGAR
MYSORE
Mysore
CSI Holdsworth
Memorial
Mysore
Hospital
RETRO
CEREBELLAR
ARACHNOID
CYST
NEURO SURGERY
Neuro Surgery
Brain Tumour
Excision of Brain
Tumors Subtentorial
408
408
22-Jul-15
3-Aug-15
48000
48000
48000
4800
43200
IDBI - 321
30-Oct-15
Bangalore
NU Hospitals
Pvt Ltd
bilateral+(L)
URETERIC
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
19-Jul-15
23-Jul-15
25000
25000
20196
2020
18176
IDBI - 321
30-Oct-15
CANCER
Surgical Oncology
Esophagus
Oesophagectomy
with Three field
Lymphadenectomy
674
674
18-Jul-15
14-Aug-15
110000
110000
110000
11000
99000
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
ESWL (Extra
Stent
908
908
27-Jul-15
1-Aug-15
10000
10000
9500
950
8550
IDBI - 321
30-Oct-15
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
12-Jul-15
16-Jul-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
SC
KGF
Bharath
Hospital
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
SHIMOGA
926 H_21919306897
Male
20
Others bharth nagar
DEVANAHALLI
BANGALORE RURAL
927 H_20025306735
Male
57
Others TAGADOODU
NANJANAGUD
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
CA
OESOPHAGUS
T2N0
Others KEMPANAPALY
Mysore
GAR
GAR
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
LT RENAL
CALCULUS
ihd anterior
lateral stemi
CARDIOLOGY
single vessel cad
Cardiology
928 H_20025306952
Male
49
Bangalore
929 H_20200307071
Male
45
Minorit
KOLEGAL
y
KOLLEGAL
CHAMARAJANA
Mysore
GAR
NARAYANA
HRUDAYALAYA
SURGICAL
MYSORE
HOSPITAL PVT
LTD
930 H_20086306907
Female
8
Others BYRANADODDI
MALUR
KOLAR
Bangalore
R L JALAPPA
NARAYANA
KOLAR
HRUDAYALAYA
HEART CENTRE
CHD-7MM PM
VSD WITH L-R
SHUNT
CARDIOLOGY
VSD
152
152
13-Jul-15
22-Jul-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
931 H_20025306970
Female
57
Others MADAPURA
NANJANAGUD
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
RHD, MS
CARDIOLOGY
Mitral Valve
Replacement
145
145
17-Jul-15
29-Jul-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
932 H_20082306169
Female
66
Minorit
BANGALORE
SHAMANNA NAGARA
y
NORTH
BANGALORE URBAN
Bangalore
Kidwai
Memorial
Institute of
Oncology
ca cervix IV
CANCER
Radiation Oncology
ii. HDR per
application
571
571
22-Jul-15
24-Jul-15
13500
13500
0
0
0
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Sl.No
Preauth No
933 H_20790307014
934 H_20619305308
Gender
Female
Male
Age
25
30
Caste
Village
Others Nattekere
Others SHIVANI
935 H_21044306997
Male
52
936 H_20010305039
Male
30
937 H_20025306983
Male
48
Others NIDAGHATTA
938 H_19577306868
Male
65
Others
939 H_20198306826
Female
45
940 H_19577306880
Female
55
941 H_19577306877
Female
35
942 H_19581306909
Male
24
943 H_22254306371
Female
56
944 H_20575306864
Male
50
Others MUNDUVALLI
ST
SC
RACHANAHALLI
KONDA REDDY
PALYA
SIRASGI
Others T NARASIPURA
Others KEMBHAVI
SC
CHAMARAJANAGAR
Others 0
Others SIDDAPURA
Taluk
Patient District
Others SAI NAGAR BDR
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
URSL - Single Side
+ DJ Stent
909
909
14-Jul-15
17-Jul-15
37500
37500
37500
3750
33750
IDBI - 321
30-Oct-15
THIRTHAHALLI
SHIMOGA
WENLOCK
DISTRICT
HOSPITAL
MANGALORE
RIGHT URETERIC
CALCULUS WITH
BILATERAL
RENAL
RENAL
CALCULUS
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
7-Jul-15
3-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
SIDLAGATTA
CHIKKABALLAPU
Bangalore
R
M S Ramaiah
Hospital
BANGALORE
NORTH
RIGHT PVJ
OBSTRUCTURE
RENAL
Genito Urinary
Surgery
Urology
905
905
2-Jul-15
22-Jul-15
35000
35000
35000
3500
31500
IDBI - 321
30-Oct-15
MANDYA
MANDYA
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
RT HUN
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
21-Jul-15
27-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
BAGEPALLI
CHIKKABALLAPU
Bangalore
R
SJICR
BANGALORE
SOUTH
IHD - ANGINA,
DM, HTN, DVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
9-Jul-15
17-Jul-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
SINDAGI
BIJAPUR
Belgaum
YASHODHARA
SUPER
SPECIALITY
HOSPITAL PVT
LTD
SOLAPUR
CORONARY
ARTERY DISEASE, CARDIOLOGY
SVD
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
11-Jul-15
18-Jul-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
T NARASIPUR
MYSORE
Mysore
SJICR
BANGALORE
SOUTH
IHD - ANGINA,
TVD
CARDIOLOGY
CABG
132
132
13-Jul-15
31-Jul-15
95000
95000
95000
0
95000
IDBI - 321
30-Oct-15
SJICR
BANGALORE
SOUTH
RHD - S/P MVR,
PROSTHETIC
VALVE
THROMBOSIS,
SECERE TR,
SEVERE PAH
CARDIOLOGY
Mitral Valve
Replacement
145
145
13-Jul-15
20-Jul-15
140000
140000
20000
0
20000
IDBI - 321
30-Oct-15
Mysore
GAR
GAR
Cauvery
Hospital
MYSORE
LEFT RENAL
CALCULUS.
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
15-Jul-15
17-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
BHALKI
Gulbarga
BIBI GENERAL
CANCER CENTER
a case of ca
breast right
T2N1Mx
CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
7-Jul-15
17-Jul-15
25000
25000
22500
2250
20250
IDBI - 321
30-Oct-15
Mysore
MANGALORE
INSTITUTE OF
ONCOLOGY
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
13-Jul-15
30-Aug-15
79000
79000
79000
7900
71100
IDBI - 321
30-Oct-15
Bangalore
R L JALAPPA
HOSPITAL AND
RESEARCH
CENTRE
Belgaum
SURPUR
KUNDAPURA
YADGIRI
BIDAR
UDUPI
HUBLI
54
Preauth
Approved
Amt
Urology
Old hubli
Female
Date of
Discharge
Genito Urinary
Surgery
SC
949 H_19571304672
Date of
Admission
DAVANGERE
TARIKERE
28
ST
RIGHT MID
URETERIC
CALCULUS WITH RENAL
LEFT RENAL
CALCULI
Female
44
Plan of
treatment
SUKSHEMA
HOSPITAL
PVTLTD
946 H_20254306629
Female
CHIKKAMANAGL
Mysore
UR
SHENGA NAGAR
948 H_20531306835
Disease Main
Category
Burns
ST
CHOLA NAYAKANA
HALLI
Diseases
Burns
49
49
Final
Diagnosis
PBC- Release
BURNS
wrist and fingers.
Male
Male
Hospital
District
Sri
Adichunchanagi
B G Nagara
ri Hospital and
Research Center
CHANNARAYAP
HASSAN
ATNA
945 H_20164301996
947 H_20079304984
Hospital Name
Post Burn
Contracture
surgeries for
Functional
Improvement(Pack
age including
splints, pressure
garments and
physiotherapy),
Severe
RURAL
Minorit
HULIYAR
y
Patient
Division
DHARWAD
CHIKKANAYAKA
TUMKUR
NAHALLI
Mysore
Bangalore
Mysore
Gulbarga
11
11
9-Jul-15
24-Jul-15
40000
40000
36000
3600
32400
IDBI - 321
30-Oct-15
MANGALORE
CA RECTUM L/3
CANCER
T3N1M0 III
Radiation Oncology
KOLAR
(L) REANL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
ESWL (Extra
Stent
908
908
15-Jul-15
19-Jul-15
10000
10000
9500
950
8550
IDBI - 321
30-Oct-15
Shakuntala
Memorial
Hubli
Hospital and
Research Centre
Chorio
Carcinoma Low
Risk
CANCER
Medical Oncology
Weekly
Gestational Trophoblast
Methotrexate/We
Ds.-Lowrisk
ek
514
514
16-Jul-15
31-Jul-15
3600
3600
1800
180
1620
IDBI - 321
30-Oct-15
Bangalore
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
CERVICAL
SPONDYLOPATH NEURO SURGERY
Y.
Neuro Surgery
Spinal
Corpectomy for
Spinal
Fixation(40000) +
cost of
implant(20000)
447
447
23-Jul-15
1-Aug-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
Lt Renal calculus RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
13-Jul-15
24-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
RT LOWER
RENAL
URETRIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
7-Jul-15
16-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
RAJARAJESWARI
MEDICALCOLLE
BANGALORE
GE AND
HOSPITAL
BIDAR
BIDAR
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
Sl.No
Preauth No
Village
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
404
14-Jul-15
20-Jul-15
60000
60000
57000
5700
51300
IDBI - 321
30-Oct-15
435
435
11-Jul-15
20-Jul-15
50000
138706
50000
5000
45000
IDBI - 321
30-Oct-15
Medical
treatment of
Acute MI with
Thrombolysis
128
128
8-Jul-15
15-Jul-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
Linear Accelerators
Radical Treatment
with Photons
565
565
16-Jul-15
25-Aug-15
60000
60000
60000
0
60000
IDBI - 321
30-Oct-15
Spinal
Anterior Cervical
Discectomy Single
level
428
428
30-Jun-15
24-Jul-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
648
648
13-Jul-15
16-Jul-15
55000
55515
52000
5200
46800
IDBI - 321
30-Oct-15
7
ST
M C HALLI
TARIKERE
CHIKKAMANAGL
Mysore
UR
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
RIGHT
PARASAGITTAL
LESION
NEURO SURGERY
Neuro Surgery
Brain Tumour
Excision of Brain
Tumor
SupratentorialBasal
404
951 H_20107306585
Female
42
ST
BAGDAL
BIDAR
BIDAR
Gulbarga
CARE Hospital A
unit of Quality
Nampally
Care India
Limite
L4-L5 PIVD WITH
THECAL SAC
NEURO SURGERY
COMPRESSION.
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
952 H_21225305928
Female
58
Others RAJOLA
BASAVAKALYAN
BIDAR
A
Gulbarga
Prime Hospitals HYDERABAD
CAD,AWMI.
Cardiology
Cardiology
953 H_19505305112
Female
77
Others
HASSAN
Mysore
Bharath
Hospital
Institute of
Oncology
Mysore
CA
OESOPHAGUS
CANCER
MIDDLE 1/3rd III
Radiation Oncology
954 H_20010305031
Male
58
Others NEERALAGI
BIJAPUR
Belgaum
M S Ramaiah
Hospital
BANGALORE
NORTH
C5 - C6 ACDF
Neuro Surgery
955 H_20082304546
Female
79
956 H_20733306153
Male
68
Others
957 H_20059306669
Male
38
Others 0
958 H_19577306466
Male
60
Minorit
GANDHINAGARA
y
Female
25
SC
NEURO SURGERY
BANGALORE
SOUTH
CA
ENDOMETRIUM CANCER
STAGE III
Surgical Oncology
Gynaec-Ca.Cervix
Radical
Hysterectomy
+Bilateral Pelvic
Lymph Node
Dissection (BPLND)
Ophorectomy
(BSO) / Ovarian
transposition
TUMKUR
Bangalore
Kidwai
Memorial
Institute of
Oncology
MYSORE
Mysore
SJICR MYSORE
MYSORE
IHD-ACS
EVOLVED IWMI
CAD-SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
13-Jul-15
17-Jul-15
90000
90000
58050
5805
52245
IDBI - 321
30-Oct-15
CHIKKANAYAKA
TUMKUR
NAHALLI
Bangalore
KUMAR
HOSPITAL
TIPTUR
right renal
calculus
RENAL
Genito Urinary
Surgery
Urology
Open
901
901
17-Jul-15
20-Jul-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
HARIHARA
Bangalore
SJICR
BANGALORE
SOUTH
IHD - EA, DM,
SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
23-Jul-15
26-Jul-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
Bangalore
R L JALAPPA
HOSPITAL AND
RESEARCH
CENTRE
KOLAR
B/L RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
13-Jul-15
20-Jul-15
30000
30000
28500
2850
25650
IDBI - 321
30-Oct-15
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
10-Jul-15
16-Jul-15
65000
65000
65790
6579
59211
IDBI - 321
30-Oct-15
TUMKUR
MENASIKYATHANAH
T NARASIPUR
ALLI
DANAVAHALLI
CARDIOLOGY
Plan of
treatment
Male
MALLASANDRA
Others
PALYA
Diseases
Disease Main
Category
950 H_20079306500
SINDAGI
Hospital Name
Final
Diagnosis
Caste
KACHANAYAKANAHA
HASSAN
LLI
Patient District
Hospital
District
Age
959 H_20164306479
Taluk
Patient
Division
Gender
KOLAR
DAVANGERE
KOLAR
960 H_19564306524
Male
68
Others HOSADU
KUNDAPURA
UDUPI
Mysore
KASTURBA
HOSPITAL
UDUPI
A/C IWMI
961 H_20575306455
Female
47
Others CHINNAKATTE
HONNALI
DAVANGERE
Bangalore
MANGALORE
INSTITUTE OF
ONCOLOGY
MANGALORE
HEPATOCELLULA
R CARCINOMA CANCER
STAGE IV
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
11-Jul-15
4-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
962 H_19574306234
Female
49
Minorit
KADLIPETI
y
MUNDARGI
GADAG
Belgaum
VYDEHI
HOSPITAL
BANGALORE
Carcinoma
esophagus Stage CANCER
III
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
20-Jul-15
4-Sep-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
Mysore
NARAYANA
HRUDAYALAYA
SURGICAL
MYSORE
HOSPITAL PVT
LTD
RHD+SEVER
CALCIFIC
MS+SEVERE
AS+SEVERE
MR+SEVERE
PTR+CHF
CARDIOLOGY
Tricuspid Valve
Repair
142
142
6-Jul-15
28-Jul-15
150000
150000
150000
0
150000
IDBI - 321
30-Oct-15
SEVERE MR
CARDIOLOGY
Mitral Valve
Repair
141
141
29-Jun-15
13-Jul-15
100000
100000
100000
10000
90000
IDBI - 321
30-Oct-15
CHD, PDA L->R
SHUNT
CARDIOLOGY
Cardiology
PDA Device
Closure
119
119
8-Jul-15
16-Jul-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
963 H_20200305963
Male
47
Others KALAGATTA
HUNSUR
MYSORE
964 H_19586302417
Female
13
Others SONAGANAHALLI
SIDLAGATTA
CHIKKABALLAPU
Bangalore
R
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
965 H_20242306476
Male
9
Minorit
BAMMIGATTI
y
KALAGATAGI
DHARWAD
MEDIHOPE
HOSPITALS AND
BANGALORE
RESEARCH
CENTRE PVT LTD
Belgaum
BANGALORE
CARDIOLOGY
Device Closure
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
966 H_20017304698
Male
32
Others KANNDAL
RAIBAGH
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
25-30% 3RD TO
4TH DEGREE
DEEP ALLEGED
ACCIDENTAL
ELECTRICAL
BURNS WITH RT
UL
BURNS
COMPARTMENT
SYNDROME
WITH GANGREN
OF HAND + LEFT
ELBOW DEFECT
WITH UL NERVE
INJURY
967 H_19505305940
Female
60
Others NATANAHALLI
KR PET
MANDYA
Mysore
Bharath
Hospital
Institute of
Oncology
Mysore
CA OVARY
STAGE III
CANCER
Medical Oncology
Ovarian Cancer
Gulbarga
DR RAGHOJI
KIDNEY
HOSPITAL AND
RESEARCH
CENTER PV
SOLAPUR
Rt UVJ Calculus
RENAL
Genito Urinary
Surgery
Urology
Burns
upto-60% with
Scalds
(Conservative)
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
6
6
6-Jul-15
15-Jul-15
75000
75000
71250
7125
64125
IDBI - 321
30-Oct-15
512
512
16-Jul-15
27-Aug-15
31500
31500
31500
0
31500
IDBI - 321
30-Oct-15
909
909
9-Jul-15
14-Jul-15
25000
25000
23750
2375
21375
IDBI - 321
30-Oct-15
512
512
16-Jul-15
27-Aug-15
31500
31500
31500
0
31500
IDBI - 321
30-Oct-15
241
241
7-Jul-15
13-Jul-15
90000
90000
91290
9129
82161
IDBI - 321
30-Oct-15
322
322
11-Jul-15
31-Jul-15
22000
22000
22000
2200
19800
IDBI - 321
30-Oct-15
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
20-Jun-15
21-Aug-15
107000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
Carboplatin/Paclit
axel/Cycle
URSL - Single Side
+ DJ Stent
968 H_21254306384
Male
37
Others 0
HUMNABAD
969 H_19505305749
Female
50
Others KADALAGERE
PANDAVAPURA MANDYA
Mysore
Bharath
Hospital
Institute of
Oncology
Mysore
CA OVARY III
CANCER
Medical Oncology
Ovarian Cancer
970 H_19564305949
Male
52
Others YARAGANAL
HONNALI
DAVANGERE
Bangalore
KASTURBA
HOSPITAL
UDUPI
ACS-NSTEMI
CARDIOLOGY
Cardiology
Cardiology
971 H_20015306338
Male
2
Others SUBRAMANYAM
SULYA
DAKSHINA
KANNADA
Mysore
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
MANGALORE
HYPOSPADIAS
NEONATAL
Mysore
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
MANGALORE
WELL
DIFFERENTIATED
SCC OF
CANCER
HYPOPHARYNX.T
3N2M0
Radiation Oncology
3D Conformational
Radio Therapy
MANGALORE
SMALL
PERIMEMBRANO
US VSD WITH
CARDIOLOGY
LEFT TO RIGHT
SHUNT MILD
AR/TR/PAH
VSD
152
152
13-Jul-15
20-Jul-15
80000
108630
80000
8000
72000
IDBI - 321
30-Oct-15
972 H_20015300885
Female
49
Others MIYARU
KARKALA
BIDAR
Burns
Plan of
treatment
UDUPI
Carboplatin/Paclit
axel/Cycle
PTCA - Two stent
(Drug Eluting
Stents , elective)
973 H_20322306070
Male
14
Others MUTNAL
GOKAK
BELGAUM
Belgaum
INDIANA
HOSPITAL AND
HEART
INSTITUTE LTD
974 H_20082305493
Male
66
Others RR NAGARA
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca larynx
T4aN1M0
CANCER
Surgical Oncology
Head & Neck
617
617
15-Jul-15
6-Aug-15
40000
42840
36500
3650
32850
IDBI - 321
30-Oct-15
975 H_20733305961
Male
68
Others MANENAHALLI
KR NAGAR
MYSORE
Mysore
SJICR MYSORE
MYSORE
IHD-UNSTABLE
ANGINA CADDVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
10-Jul-15
15-Jul-15
90000
90000
79650
7965
71685
IDBI - 321
30-Oct-15
976 H_20082303968
Male
58
Others
RAMANAGAR
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
scc of buccal
CANCER
mucosa T2N0M0
Surgical Oncology
Head & Neck
Wide excision
621
621
6-Jul-15
16-Jul-15
50001
78748
29400
2940
26460
IDBI - 321
30-Oct-15
Bangalore
M S Ramaiah
Hospital
BANGALORE
NORTH
LEFT RENAL
CALCULUS
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
7-Jul-15
20-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Mitral Valve
Replacement
145
145
4-Jul-15
20-Jul-15
120000
229292
110160
11016
99144
IDBI - 321
30-Oct-15
977 H_20010305913
Male
68
SC
DODDAGOWDANAPA
MAGADI
LYA
JANGANAHALLI
MALUR
KOLAR
RENAL
978 H_21701306054
Female
52
Others kotaga
CHINCHOLI
GULBARGA
Gulbarga
SUNSHINE
HEART
INSTITUTE
Paradise, S.D.
Road
CRHD SERVER
MR WITH
MODERTATE MS
MILD TR WITH
CARDIOLOGY
MILD PAH
NORAMAL LV&
RV FUNCTION
979 H_19528306301
Male
55
Others CHILLARGI
BIDAR
BIDAR
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
CAD-SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
12-Jul-15
14-Jul-15
55000
55000
56100
1683
54417
IDBI - 321
30-Oct-15
Bangalore
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
MANGALORE
CARCINOMA
OESOPHAGUS
STAGE II
CANCER
Surgical Oncology
Jejunostomy
677
677
30-Jun-15
28-Aug-15
104000
132000
132000
13200
118800
IDBI - 321
30-Oct-15
980 H_19522303520
Male
76
Others HOLEKOPPA
THIRTHAHALLI
SHIMOGA
Sl.No
Preauth No
981 H_19562290332
Gender
Female
Age
Taluk
KODAGU
Mysore
KHANAPUR
BELGAUM
Belgaum
BELGAUM
BELGAUM
Belgaum
Others PARWAD
Others KADOLI
Female
7 Months
984 H_20017306245
Male
58
68
986 H_20613306132
Male
58
987 H_19583305927
Female
54
Others Beeravalli
SC
Nandral
Others HAMMIGI
BHADRAVATHI
DHARWAD
SHIMOGA
DHARWAD
Hospital
District
Final
Diagnosis
Diseases
SHIMOGA
Ca.Oesophagus
cT3N0M0 STAGE CANCER
III
MANGALORE
CARCINOMA
LEFT LUNG
STAGE T4N0
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
CANCER
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
22-Jul-15
8-Sep-15
95000
95000
75000
7500
67500
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
6-Jul-15
27-Aug-15
87000
87000
87000
8700
78300
IDBI - 321
30-Oct-15
CHD MODERATE
PDA WITH ASD CARDIOLOGY
WITH PAH
176
176
7-Jul-15
28-Jul-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
RHD SEVERE AS
Aortic Valve
Replacement
146
146
8-Jul-15
22-Jul-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
17-Jul-15
8-Sep-15
85000
85000
79000
7900
71100
IDBI - 321
30-Oct-15
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
10-Jul-15
24-Aug-15
92000
122791
90000
9000
81000
IDBI - 321
30-Oct-15
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Ca oesophagus
stageII
CT2N0M0)
Ca Tongue T3
N0M0
CARDIOLOGY
CANCER
INDI
BIJAPUR
Belgaum
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
MUNDARGI
GADAG
Belgaum
S.S. INSTITUTE
OF MEDICAL
NH-4,Bypass PB
SCIENCES &
Road Davanagere
RESEARCH CENT
Carcinoma of left
check with
CANCER
mandibular
infiltration
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
7-Jul-15
22-Aug-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
MYSORE
Mysore
Bharath
Hospital
Institute of
Oncology
Mysore
CARCINOMA
GASTROESOPHA
GEAL JUNCTION CANCER
LOCALLY
ADVANCED
Medical Oncology
Oesophageal Cancer
Cisplatin5FU/cycle
527
527
16-Jul-15
3-Sep-15
15000
15000
15000
0
15000
IDBI - 321
30-Oct-15
Paradise, S.D.
Road
CAD DOUBLE
VESSEL DISAESS
CARDIOLOGY
CABG
132
132
6-Jul-15
20-Jul-15
95000
158157
92055
9206
82849
IDBI - 321
30-Oct-15
SINGAMARANAHALL
HUNSUR
Y
CANCER
988 H_19505305725
Male
57
989 H_21701305277
Female
55
Others kallahangaraga
GULBARGA
GULBARGA
Gulbarga
SUNSHINE
HEART
INSTITUTE
990 H_20127302643
Male
44
Others M L HALLI
SAGARA
SHIMOGA
Bangalore
A J HOSPITAL
CENTRE
ca pancreas
CANCER
Surgical Oncology
Pancreas
Whipples - any
type
582
582
25-Jun-15
11-Aug-15
75000
75000
45900
4590
41310
IDBI - 321
30-Oct-15
991 H_19528305256
Male
50
Others DUNNAPPA
HOSAKOTE
BANGALORE RURAL
Bangalore
Narayana
Hrudayalaya
Private Limited
Bangalore
CARCINOMA OF
PYRIFORM SINUS CANCER
STAGE III
Medical Oncology
Head & Neck
Cisplatin + 5
FU/Cycle Max. of 6
cycles only
522
522
14-Jul-15
4-Aug-15
15000
10000
9690
291
9399
IDBI - 321
30-Oct-15
992 H_22458304583
Male
31
MUDHOLA
BAGLAKOT
Belgaum
VENKATESH
HOSPITAL
MAHALINGPUR
cystolithotripsy
Genito Urinary
Surgery
Urology
Cystolithotripsy
906
906
11-Jul-15
13-Jul-15
12500
12500
11250
1125
10125
IDBI - 321
30-Oct-15
993 H_19576306017
Male
45
Others Gondi
HANAGAL
HAVERI
Belgaum
SDM Narayana
Hrudayalaya
Dharwad
IHD-Significant
CARDIOLOGY
LAD&D1 stenosis
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
8-Jul-15
13-Jul-15
90000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
994 H_19574305482
Female
35
Others CHIKKAJANTHAKAL
KOPPAL
KOPPAL
Gulbarga
VYDEHI
HOSPITAL
BANGALORE
Relapsed
Carcinoma Right CANCER
Breast
Medical Oncology
Breast
505
505
10-Jul-15
29-Aug-15
33000
33000
15000
1500
13500
IDBI - 321
30-Oct-15
995 H_23069305449
Male
44
MYSORE
MYSORE
Mysore
THE RADIANT
INSTITUTE
MYSORE
CA-CARCINOMA
HYPO PAHRYNX CANCER
STAGE III
Medical Oncology
Head & Neck
521
521
14-Jul-15
16-Jul-15
31500
31500
10000
1000
9000
IDBI - 321
30-Oct-15
996 H_19504305800
Female
30
HUKKERI
BELGAUM
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
ca Synchronous
Malignancy
CANCER
(Carvix & Ovary)
Medical Oncology
Ovarian Cancer
512
512
20-Jul-15
7-Sep-15
31500
26520
26520
2652
23868
IDBI - 321
30-Oct-15
CANCER
Medical Oncology
516
516
15-Jul-15
31-Aug-15
18000
18000
18000
1800
16200
IDBI - 321
30-Oct-15
CANCER
Medical Oncology
521
521
8-Jul-15
3-Sep-15
31500
31500
29925
2993
26932
IDBI - 321
30-Oct-15
997 H_19574305690
Female
25
998 H_20575305036
Male
57
SC
Hospital Name
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
SOMAVARPET
983 H_20017306209
Patient
Division
Bangalore
Minorit
DODDAHANAKODU
y
53
Patient District
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
Others MANGOTE
Male
Male
Village
47
982 H_19522306097
985 H_19504305554
Caste
SC
ST
Mugalkod
HEBBALAGUPPE
Others Ingali
ST
HASAHALA
Others BALAKORA
LINGASUGUR
RAICHUR
Gulbarga
VYDEHI
HOSPITAL
BANGALORE
Gestational
trophoblastic
disease
HONNAVAR
UTTARA
KANNADA
Belgaum
MANGALORE
INSTITUTE OF
ONCOLOGY
MANGALORE
CA TONGUE
T4N2M0
RENAL
Paclitaxel/docetax
el/Cycle
Carboplatin +
Paclitaxel/Cycle
Max. of 6 cycles
only
Carboplatin/Paclit
axel/Cycle
EtoposideMethotrexateGestational Trophoblast Actinomycin /
Ds.-Highrisk
Cyclophosphamide
-Vincristine (EMACO)/Cycle
Carboplatin +
Paclitaxel/Cycle
Head & Neck
Max. of 6 cycles
only
Sl.No
Preauth No
Gender
Age
999 H_19574305753
Female
36
1000 H_20082305541
Female
58
1001 H_20435305172
Female
63
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
16-Jul-15
9-Sep-15
100000
100000
98000
9800
88200
IDBI - 321
30-Oct-15
ca cervix t3n1m0 CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
15-Jul-15
21-Jul-15
25000
25000
19800
1980
17820
IDBI - 321
30-Oct-15
Medical Oncology
Breast
FEC (Epirubicin
based)/Cycle
504
504
15-Jul-15
8-Aug-15
15000
22000
14250
1425
12825
IDBI - 321
30-Oct-15
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
14-Jul-15
1-Sep-15
85000
83982
74550
7455
67095
IDBI - 321
30-Oct-15
BANGALORE
Carcinoma
Nasopharyngeal CANCER
T3N3aMo
BANGALORE
SOUTH
GUBBI
TUMKUR
Bangalore
VYDEHI
HOSPITAL
Others WARD 9
KANAKAPURA
RAMANAGAR
Bangalore
Kidwai
Memorial
Institute of
Oncology
Others BEDKIHAL
CHIKKODI
BELGAUM
Belgaum
Kolhapur Cancer
Karveer
Centre
CA RIGHT
CANCER
BREAST T4N1M0
Myxoid
liposarcoma left CANCER
Thigh stage II
Radiation Oncology
CABG with IABP
133
133
9-Jun-15
21-Jul-15
115000
115000
115000
11500
103500
IDBI - 321
30-Oct-15
SC
M, N, KOTE
1002 H_19504305638
Female
24
Others Shindi kurbet
GOKAK
BELGAUM
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
1003 H_20242305826
Male
69
Others VADDARA ONI
KOPPAL
KOPPAL
Gulbarga
MEDIHOPE
HOSPITALS AND
BANGALORE
RESEARCH
CENTRE PVT LTD
IHD, TVD WITH
LV
DYSFUNCTION
1004 H_20575305047
Male
67
Others ALDUR
Mysore
R
UR
MANGALORE
INSTITUTE OF
ONCOLOGY
PAPPILARY
CARCINOMA OF
CANCER
THYROID
T3N1LM1
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
8-Jul-15
22-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
1005 H_20025305533
Male
72
Others RAMASAMUDRA
Mysore
GAR
GAR
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
CA LT PYRIFORM
CANCER
FOSSA
Surgical Oncology
Head & Neck
Laryngectomy
with Voice
Prosthesis
618
618
14-Jul-15
8-Aug-15
60000
60000
52500
5250
47250
IDBI - 321
30-Oct-15
1006 H_20021305339
Female
22
Others KANCHANAL
CHINCHOLI
GULBARGA
Gulbarga
BASAVESHWAR
TEACHING AND
GULBARGA
GENERAL
HOSPITAL
L4-5 PIVD WITH
NEURO SURGERY
CANAL STENOSIS
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
14-Jul-15
21-Jul-15
25000
25872
22500
2250
20250
IDBI - 321
30-Oct-15
1007 H_20061305464
Female
79
Others
(V) GADGI (T,Q)
BIDAR (DIST) BIDAR.
BIDAR
BIDAR
Gulbarga
NARAYANA
HOSPITALS
CAD-SINGLE
CARDIOLOGY
VESSEL DISEASE.
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
7-Jul-15
13-Jul-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
1008 H_19574304488
Female
21
SC
J P NAGARA
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
VYDEHI
HOSPITAL
Bilateral ureteric
calculi with
RENAL
Hydronephrosis
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
22-Jul-15
10-Aug-15
37500
37500
37500
3750
33750
IDBI - 321
30-Oct-15
Surgical Oncology
Gynaec-Ca.Cervix
Radical
Hysterectomy
+Bilateral Pelvic
Lymph Node
Dissection (BPLND)
Ophorectomy
(BSO) / Ovarian
transposition
648
648
11-Jul-15
22-Jul-15
45000
45000
40000
4000
36000
IDBI - 321
30-Oct-15
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
9-Jul-15
11-Jul-15
90000
90000
89500
8950
80550
IDBI - 321
30-Oct-15
Cardiology
Permanent
pacemaker
VVI) including
Pacemaker value
114
114
10-Jul-15
15-Jul-15
75000
75000
67050
6705
60345
IDBI - 321
30-Oct-15
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
13-Jul-15
28-Aug-15
80000
80000
80000
320
79680
IDBI - 321
30-Oct-15
RAICHUR
Gulbarga
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Ca Carvix stage
IB
MYSORE
MYSORE
Mysore
SJICR MYSORE
IHD EA CAD-DVD CARDIOLOGY
Female
63
Others Amadihal
1010 H_20733305629
Male
43
Others
58
Rayanahundi,
Others
Mysore(Tq & D),
PIRIYAPATNA
MYSORE
Others RAMASANDRA
BANGALORE
SOUTH
1011 H_20733305627
Male
26
MYSORE
CANCER
Mysore
SJICR MYSORE
MYSORE
CHB
BANGALORE URBAN
Bangalore
BGS GLOBAL
HOSPITAL
BANGALORE
SOUTH
Carcinoma
Rectum mid
1/3rd
ALAND
GULBARGA
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
MODERATE SUB
AORTIC VSD L-R CARDIOLOGY
SHUNT
VSD
152
152
17-Jul-15
27-Jul-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
ca bladder
Genito Urinary
Surgery
Urology
TURBT
916
916
13-Jul-15
27-Jul-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
26-Jun-15
13-Aug-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
1012 H_19491304922
Female
1013 H_19528305647
Male
1014 H_20332304576
Male
73
Others S R PALYA
PAVAGADA
TUMKUR
Bangalore
1015 H_19522304905
Male
60
Others KOLAMBE
MANGALORE
DAKSHINA
KANNADA
Mysore
11 Months Others DANNURTANDA
BANGALORE
LINGASUGUR
1009 H_19504305537
#1862, K R Mohalla,
Mysore
MANGALORE
CARDIOLOGY
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
FATHER
MULLER
MANGALORE
MEDICAL
COLLEGE
HOSPITAL
CARDIOLOGY
CANCER
RENAL
CARCINOMA (L)
BUCCAL
CANCER
MUCOSA STAGE
III
Sl.No
Preauth No
1016 H_20332304771
Gender
Age
Caste
Male
21
SC
Village
K M HATTI
Taluk
HOSADURGA
CHITRADURGA
Patient
Division
Bangalore
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
lt non
functioning of
kidney+puj
abstruction
LARGE
POSTERIOR MID
MUSCULAR VSD
BD SHUNT
CARDIOLOGY
PROLAPSING AV
VALVES SEV
MR/SEV TR
RENAL
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Simple
Nephrectomy Single side
918
918
17-Jul-15
1-Aug-15
37500
37500
35000
3500
31500
IDBI - 321
30-Oct-15
VSD
152
152
13-Jul-15
19-Aug-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
MANDYA
MANDYA
Mysore
Narayana
Hrudayalaya
Private Limited
CHIKKODI
BELGAUM
Belgaum
Kolhapur Cancer
Karveer
Centre
CA LEFT BREAST
CANCER
T3N1M0
Surgical Oncology
Breast
Mastectomy - any
type
598
598
10-Jul-15
13-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Others BENEKPALLI
GULBARGA
GULBARGA
Gulbarga
CHIRAYU
HOSPITAL
GULBARGA
Non small cell Ca
CANCER
of Lung stage 4
Medical Oncology
Non-small cell lung
cancer
Carboplatin +
Paclitaxel/Cycle
526
526
10-Jul-15
31-Jul-15
31500
31500
21000
2100
18900
IDBI - 321
30-Oct-15
Others MAGADI
MAGADI
RAMANAGAR
Bangalore
BANGALORE
EAST
lt ureteric
calculus
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
13-Jul-15
17-Jul-15
25000
25000
22500
2250
20250
IDBI - 321
30-Oct-15
MALUR
KOLAR
Bangalore
BANGALORE
CARCINOMA OF
RIGHT BREAST C CANCER
T4N1MO
Surgical Oncology
Breast
Mastectomy - any
type
598
598
4-Jul-15
20-Jul-15
22500
25000
22500
2250
20250
IDBI - 321
30-Oct-15
KHANAPUR
BELGAUM
Belgaum
Belgaum
IHD IWMI CAD
SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - 2 stent
(non-medicated)
104
104
26-Jun-15
20-Jul-15
70000
70000
70000
7000
63000
IDBI - 321
30-Oct-15
CHALLAKERE
CHITRADURGA
Bangalore
CHITRADURGA
B/L uereteric
calculus
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
6-Jul-15
10-Jul-15
37500
50000
35625
3563
32062
IDBI - 321
30-Oct-15
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
ACS
ANTEROLATERAL CARDIOLOGY
WALL MI
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
6-Jul-15
9-Jul-15
90000
90000
81000
8100
72900
IDBI - 321
30-Oct-15
Ca Oesophagus
mid&lower
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
8-Jul-15
26-Aug-15
105000
105000
100000
10000
90000
IDBI-294
9-Oct-15
RENAL
Genito Urinary
Surgery
Urology
905
905
4-Jul-15
4-Aug-15
35000
35000
33250
3325
29925
IDBI - 321
30-Oct-15
1017 H_19528305540
Female
1
1018 H_20435305222
Female
40
1019 H_20815305065
Male
56
1020 H_20332304779
Female
30
1021 H_19586305477
Female
31
1022 H_20017303613
Male
49
Others SINGNIKOP
1023 H_22867304875
Male
25
Others
KAMMATH
MARIKUNTE
1024 H_20025305097
Male
65
Others
ADAKANAHALLIHUN
NANJANAGUD
DE
Others BEVUKALLU
SC
ST
NIPPANI
KADHADENAHALLI
INSTITUTE OF
NEPHROUROLO
GY
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
KLES Dr
Prabhakar Kore
Hospital and
MRC
Chitradurga
Government
Hospital
Bangalore
RENAL
HIREKERUR
HAVERI
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
RAJAGOPALA NAGAR
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
Krishnarajendra
MYSORE
Hospital
LEFT PUJ
OBSTRUCTION
pakhalwada
BIDAR
BIDAR
Gulbarga
SUNSHINE
HEART
INSTITUTE
Paradise, S.D.
Road
cad single vessel
CARDIOLOGY
disease
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
3-Jul-15
11-Jul-15
55000
55000
50490
5049
45441
IDBI - 321
30-Oct-15
SREENIVASAPUR KOLAR
Bangalore
SJICR
BANGALORE
SOUTH
IHD - S/P PTCA,
EA, TVD
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
13-Jul-15
16-Jul-15
90000
90000
90000
0
90000
IDBI - 321
30-Oct-15
Others KAVALAGA
GULBARGA
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
BILATERAL
RENAL STONE +
RENAL
LT
PYONEPHROSIS.
Genito Urinary
Surgery
Urology
Nephrostomy
(PCN) - Single Side
910
910
29-Jun-15
19-Jul-15
12500
12500
12500
1250
11250
IDBI - 321
30-Oct-15
41
Others THOPLU
KUNDAPURA
UDUPI
Mysore
KASTURBA
HOSPITAL
UDUPI
CARCINOMA
TONGUE
CT2N1M0
Surgical Oncology
Head & Neck
612
612
30-Jun-15
27-Jul-15
25000
25000
24990
2499
22491
IDBI - 321
30-Oct-15
Male
75
Others KALAVARA
KUNDAPURA
UDUPI
Mysore
KASTURBA
HOSPITAL
UDUPI
ACUTE INFERIOR
-POSTERIOR
CARDIOLOGY
WALL MI
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
7-Jul-15
10-Jul-15
90000
90000
91290
9129
82161
IDBI - 321
30-Oct-15
Female
27
Minorit
GUDDAHALLI
y
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca (Rt) Breast
T2N1Mo
CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
11-Jul-15
15-Jul-15
25000
25000
20425
2043
18382
IDBI - 321
30-Oct-15
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT PU-J STONE
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
6-Jul-15
24-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Mysore
Krishnarajendra
MYSORE
Hospital
CA CERVIX
STAGE IIIB
CANCER
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
7-Jul-15
15-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
Kolhapur Cancer
Karveer
Centre
CA NON
HODGKN'S
LYMPHOMA(MO
CANCER
DIFIED
ANNANBOR
STAGE II A)
534
534
13-Jul-15
25-Aug-15
18000
26000
18000
1800
16200
IDBI - 321
30-Oct-15
1025 H_19567305452
Female
66
1026 H_20968303853
Female
24
SC
1027 H_21701304304
Male
44
ST
1028 H_19577305192
Male
58
Minorit
ADDAGAL
y
1029 H_19571301785
Female
21
1030 H_19564304764
Female
1031 H_19564305091
1032 H_20082303774
1033 H_19571304204
Female
21
1034 H_20968304558
Female
67
1035 H_20435304511
Patient District
Female
35
Others Chodeshwari nagar
Others MOGANATAGA
SC
ST
JEVARGI
GULBARGA
CHIKKAANKANAHALL SHRIRANGAPAT
MANDYA
I
NA
UGAR
ATHANI
BELGAUM
Belgaum
CARDIOLOGY
CANCER
Medical Oncology
Lymphoma-NHL
Cyclophosphamide
- Doxorubicin
(CHOP)/Cycle
(Day1 & Day12)
Sl.No
Preauth No
Caste
Village
Taluk
Patient District
Patient
Division
Gender
Age
1036 H_20082302971
Male
56
Minorit
BAPUJINAGARA
y
GUDIBANDE
CHIKKABALLAPU
Bangalore
R
1037 H_20082304980
Female
28
Others SUNKASLE
KOPPA
CHIKKAMANAGL
Mysore
UR
Mysore
Hospital Name
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
BANGALORE
SOUTH
scc of Lt toung
CANCER
Surgical Oncology
Head & Neck
612
612
20-Jul-15
27-Jul-15
35000
35000
32000
3200
28800
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Stomach
T2NoMo
CANCER
Surgical Oncology
Gastrectomy - any
type
636
636
6-Jul-15
21-Jul-15
60000
60000
33300
3330
29970
IDBI - 321
30-Oct-15
MANGALORE
CARCINOMA LIP
T4aN2c STAGE
CANCER
IVA
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
22-Jun-15
29-Aug-15
102000
100000
100000
10000
90000
IDBI - 321
30-Oct-15
HYDERABAD
CORONARY
CARDIOLOGY
ARTERY DISEASE
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
2-Jul-15
11-Jul-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Stomach
T3N1Mo
CANCER
Surgical Oncology
Gastrectomy - any
type
636
636
3-Jul-15
20-Jul-15
40000
40000
34200
3420
30780
IDBI - 321
30-Oct-15
UDUPI
P/S CABG
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
3-Jul-15
10-Jul-15
90000
90000
91290
9129
82161
IDBI - 321
30-Oct-15
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
8-Jul-15
10-Jul-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
1038 H_19522303963
Female
65
Others KOMPADAVU
MANGALORE
DAKSHINA
KANNADA
1039 H_21736303621
Male
29
Others MALIABAD
RAICHUR
RAICHUR
Gulbarga
1040 H_20082304537
Male
69
Others NARASAPURA
TUMKUR
TUMKUR
Bangalore
1041 H_19564304322
Male
60
Others NADA
KUNDAPURA
UDUPI
Mysore
KASTURBA
HOSPITAL
1042 H_20025303979
Male
56
Others SUBHASHNAGAR
MYSORE
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
IHD - S/P CAG DOUBLE VESSEL CARDIOLOGY
DISEASE , DM
Cardiology
1043 H_19587304967
Male
69
Others
KINAHAHALLI
VILLAGE
YELANDUR
CHAMARAJANA
Mysore
GAR
Apollo BGS
Hospital
MYSORE
CAD- LEFT MAIN
CARDIOLOGY
+ TVD
CABG
132
132
13-Jul-15
19-Jul-15
95000
95000
96900
9690
87210
IDBI - 321
30-Oct-15
SANNA
HARAKANAHAL
THANDA
HARAPANAHALL
DAVANGERE
I
DAVANGERE
RIGHT PELVI
CALCULUS WITH
RIGHT LOWER
RENAL
URETERIC
CALCULUS
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
13-Jul-15
16-Jul-15
37500
37500
37500
3750
33750
IDBI - 321
30-Oct-15
POST
ELECTRICAL
BURN
GANGRENE OF
RT HAND AND
BURNS
DISTAL FORARM
AND WITH BURN
WOUND OVER
TRUNCK AND
LOWER LIMBS
Burns
Burns
upto-40% Mixed
Burns(with
grafting)
3
3
5-Jul-15
28-Jul-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
CA OVARY
STAGE III
CANCER
Surgical Oncology
Gynaec
Surgery for Ca
Ovary - advance
stage
596
596
15-Jul-15
27-Jul-15
40000
40000
35150
3515
31635
IDBI - 321
30-Oct-15
BANGALORE
EAST
lt puj
RENAL
Genito Urinary
Surgery
Urology
905
905
22-Jul-15
3-Aug-15
35000
35000
35000
3500
31500
IDBI - 321
30-Oct-15
BANGALORE
ACHD Large
subaortic VSD
10mm
Predominant
Left->Right
CARDIOLOGY
Shunt,Gr 40mm
Hg Severe
valvular PS
Gr:76/44mm Hg
ICR for TOF
154
154
8-Jul-15
22-Jul-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
RT LOWER
RENAL
URETRIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
3-Jul-15
9-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
11-Jul-15
20-Jul-15
25000
25000
23750
2375
21375
IDBI - 321
30-Oct-15
1044 H_20619304470
Female
54
SC
Bangalore
1045 H_20025304398
Male
15
Others CHOWDENAHALLI
KR PET
MANDYA
Mysore
1046 H_20082304552
Female
54
Others DODDAGUNI
GUBBI
TUMKUR
Bangalore
1047 H_20332300629
Female
45
KANAKAPURA
RAMANAGAR
Bangalore
SC
NAGENDRA
YALAVALLI
1048 H_19574303704
Male
11
Others HATTI
KOPPAL
1049 H_19571303452
Male
18
Others HIRAPUR GULBARGA GULBARGA
NANO
HOSPITALS
PRIVATE
LIMITED
Kidwai
Memorial
Institute of
Oncology
SUKSHEMA
HOSPITAL
PVTLTD
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
Kidwai
Memorial
Institute of
Oncology
INSTITUTE OF
NEPHROUROLO
GY
KOPPAL
Gulbarga
VYDEHI
HOSPITAL
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
1050 H_21718304433
Male
35
SC
CHIKAKASHADE
BELUR
HASSAN
Mysore
SSM Hospital
HASSAN
Left Renal Calculi RENAL
Genito Urinary
Surgery
1051 H_21718304430
Male
30
SC
GANDHI NAGAR
HOLENARSIPUR HASSAN
Mysore
SSM Hospital
HASSAN
Left VUJ Calculi
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
11-Jul-15
14-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Belgaum
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
MUO Neck
TxN3Mo
CANCER
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
8-Jul-15
4-Aug-15
60000
64235
33250
3325
29925
IDBI - 321
30-Oct-15
1052 H_20082301927
Male
65
Others HIREMANNURU
RONA
GADAG
Sl.No
Preauth No
1053 H_20082303305
Female
30
ST
G G HALLI
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
Kidwai
Memorial
Institute of
Oncology
1054 H_20079304653
Female
32
SC
HANUMA SAGARA
KUSTAGI
KOPPAL
Gulbarga
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
SEVERE MITRAL
RESTENOSIS,SEV CARDIOLOGY
ERE PAH.
BELTHANGADI
DAKSHINA
KANNADA
Mysore
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
MANGALORE
WELL
DIFFERENCIATED
SCC OF BUCCAL CANCER
MUCOSA
PT4N0M0
MADIKERI
KODAGU
Mysore
WENLOCK
DISTRICT
HOSPITAL
MANGALORE
VESICOSTOMY
CLOSURE
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
1056 H_21044304351
Male
1057 H_19504304544
Male
63
Others MACCHINA
11 Months Others HERAVANADU
60
Others A/P:Gokak,
GOKAK
Patient District
BELGAUM
1058 H_20017304163
Female
17
Others MALADDINI
GOKAK
BELGAUM
Belgaum
1059 H_22478304130
Male
37
Others CHORNA HALLY
MYSORE
MYSORE
Mysore
1060 H_19504303567
1061 H_22163304469
1062 H_19542304405
Male
Female
Male
63
38
66
Others Venkatapur
GOKAK
BELGAUM
Others Lakshmipura
BANGALORE
SOUTH
BANGALORE URBAN
Others GUDDENAHALLI
HASSAN
HASSAN
Hospital Name
Final
Diagnosis
Caste
Male
Taluk
Hospital
District
Age
1055 H_20015304490
Village
Patient
Division
Gender
BANGALORE
SOUTH
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
SHREE
MAHADESHWA
MYSORE
RA NURSING
HOME
Ca thyroid
T3N1M0
Diseases
CANCER
NEONATAL
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
615
615
9-Jul-15
16-Jul-15
45000
46310
16500
1650
14850
IDBI - 321
30-Oct-15
Mitral Valve
Replacement
145
145
1-Jul-15
29-Jul-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
6-Jul-15
28-Aug-15
87000
85000
85000
8500
76500
IDBI - 321
30-Oct-15
Genito Urinary Surgeries
Urinary Diversion Undiversion
320
320
4-Jul-15
16-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
10-Jul-15
22-Aug-15
112000
112000
98000
9800
88200
IDBI - 321
30-Oct-15
Surgical Oncology
Head & Neck
MUO ctxn2m0
CANCER
Radiation Oncology
RHD SEVERE
MITRAL
STENOSIS
CARDIOLOGY
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
30-Jun-15
10-Jul-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
B/L RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
4-Jul-15
9-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
20-Jul-15
29-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
Medical Oncology
Cervical Cancer
Weekly
Cisplatin/Week
509
509
10-Jul-15
2-Sep-15
95000
167904
93000
0
93000
IDBI - 321
30-Oct-15
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
4-Jul-15
7-Jul-15
65000
65000
59670
5967
53703
IDBI - 321
30-Oct-15
907
907
14-Jul-15
23-Jul-15
25000
25000
23750
2375
21375
IDBI - 321
30-Oct-15
Belgaum
NHL Stage II
Bangalore
SRI SHANKARA
CANCER
HOSPITAL AND
RESEARCH
CENTRE
ca cervix stage Ii CANCER
Mysore
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
LT PELVIC
CALCULUS
MYSORE
Intensity Modulated
Radiotherpy(IMRT)
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
BANGALORE
SOUTH
Disease Main
Category
SINGLE VESSEL
DISEASE.
CANCER
CARDIOLOGY
Cardiology
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
a case of ca
CANCER
breast L advance
Medical Oncology
Breast
502
502
29-Jun-15
31-Aug-15
18600
3100
3100
310
2790
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Cervix III B
CANCER
Medical Oncology
Cervical Cancer
Weekly
Cisplatin/week
509
509
14-Jul-15
21-Jul-15
12000
12000
950
95
855
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca (Lt) Pyriform
Fossa T3N2Mo
CANCER
Surgical Oncology
Head & Neck
612
612
9-Jul-15
16-Jul-15
40000
40330
36500
3650
32850
IDBI - 321
30-Oct-15
1063 H_20025304381
Male
29
Others HEBBALU
KR NAGAR
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
1064 H_22254301982
Female
58
Others 0
HUMNABAD
BIDAR
Gulbarga
BIBI GENERAL
CANCER CENTER
1065 H_20082303784
Female
34
Others NELLURU
MULABAGILU
KOLAR
Bangalore
1066 H_20082303751
Female
51
Others VIJAYANAGARA
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
1067 H_19574303923
Female
60
TUMKUR
Bangalore
VYDEHI
HOSPITAL
BANGALORE
Carcinoma cervix
CANCER
II B
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
26-Jun-15
4-Sep-15
73500
73500
69000
6900
62100
IDBI - 321
30-Oct-15
1068 H_22933303646
Male
41
Others Ajjenahalli
BELUR
HASSAN
Mysore
Janapriya
Hospital
HASSAN
left lower
ureteric calculas
RENAL
and right renal
calculas
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
8-Jul-15
13-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
1069 H_20082303001
Female
36
Others MANNE
NELEMANGALA
BANGALORE RURAL
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Verrucous
carcinoma
T2N1M0
Surgical Oncology
Head & Neck
612
612
6-Jul-15
27-Jul-15
37500
37500
35625
3563
32062
IDBI - 321
30-Oct-15
Belgaum
Shakuntala
Memorial
Hubli
Hospital and
Research Centre
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
20-Jul-15
24-Jul-15
50000
50000
47500
4750
42750
IDBI - 321
30-Oct-15
1070 H_20254303000
Female
60
SC
RANGANATHAPURA SIRA
Others Gopanakoppa
HUBLI
DHARWAD
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
CANCER
L1-L2,L4-L5 PIVD
with cauda
NEURO SURGERY
equina nerve
roots
compression
Sl.No
Preauth No
Gender
Age
Caste
1071 H_20082302956
Male
62
Others
1072 H_20254302993
Female
35
Others Bijaguppi
1073 H_19564301518
Male
77
1074 H_20015304221
Male
66
1075 H_19505304215
Female
61
1076 H_21044304200
Female
55
Village
ANKEGOWDNADODD
MADDUR
I
Others MATTARU
Others MUDAHADU
SC
Taluk
DODDARAYAPETE
Others HONNALLI
RAMADURGA
UDUPI
UDUPI
Patient District
Patient
Division
Hospital
District
MANDYA
Mysore
Kidwai
Memorial
Institute of
Oncology
BELGAUM
Belgaum
Shakuntala
Memorial
Hubli
Hospital and
Research Centre
UDUPI
UDUPI
Mysore
KASTURBA
HOSPITAL
Mysore
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
Mysore
GAR
GAR
HONNALI
Hospital Name
DAVANGERE
Bangalore
Bharath
Hospital
Institute of
Oncology
WENLOCK
DISTRICT
HOSPITAL
BANGALORE
SOUTH
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
ca prostate with
bone mets
CANCER
T4N1M1
Surgical Oncology
Bilateral
Orchidectomy
588
588
10-Jul-15
16-Jul-15
10000
10000
6300
630
5670
IDBI - 321
30-Oct-15
D11 TDEM
Neuro Surgery
Spinal
Spinal Cord
Tumours
426
426
8-Jul-15
13-Jul-15
35000
35000
33250
3325
29925
IDBI - 321
30-Oct-15
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
29-Jun-15
29-Jun-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
NEURO SURGERY
UDUPI
INFERIOR WALL
MI
MANGALORE
WELL
DIFFERENTIATED
SCC OF UPPER
CANCER
OESOPHAGUS.T4
N1M0.
Surgical Oncology
Jejunostomy
677
677
27-Jun-15
25-Aug-15
107000
105000
105000
10500
94500
IDBI - 321
30-Oct-15
Mysore
CA CERVIX
STAGE III B
CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
9-Jul-15
10-Jul-15
73500
6000
3150
0
3150
IDBI - 321
30-Oct-15
MANGALORE
CARCINOMA
RECTUM
(T4,N1,MO)
CANCER
Surgical Oncology
Ca. Gastro Intestinal
Tract
Closure of
Ileostomy/
Colostomy
628
628
19-Jun-15
17-Jul-15
20000
20000
18000
1800
16200
IDBI - 321
30-Oct-15
MYSORE
IHD-ACS
EVOLVED IWMI
CARDIOLOGY
ONGOING CHEST
PAIN CAD-SVD
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
3-Jul-15
7-Jul-15
65000
65000
58050
5805
52245
IDBI - 321
30-Oct-15
CARDIOLOGY
1077 H_20733303550
Male
68
Minorit
MULLUSOGE
y
SOMAVARPET
KODAGU
Mysore
SJICR MYSORE
1078 H_20127303643
Male
46
Others HADINABALA
HONNAVAR
UTTARA
KANNADA
Belgaum
A J HOSPITAL
CENTRE
CAD- DVD AWMI CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
1-Jul-15
7-Jul-15
90000
133415
91800
9180
82620
IDBI - 321
30-Oct-15
1079 H_20661303350
Female
64
Others KURUGODU
BELLARY
BELLARY
Gulbarga
Vijayanagara
Institute of
BELLARY
Medical Science
CARCINOMA OF
LOWER 1/3 rd
CANCER
ESOPHAGUS
Surgical Oncology
Esophagus
Oesophagectomy
with Two field
Lymphadenectomy
673
673
20-Jun-15
18-Jul-15
75000
75000
20000
2000
18000
IDBI - 321
30-Oct-15
1080 H_20082303167
Female
38
Others A NAGATHIHALLI
NAGAMANGALA MANDYA
Mysore
BANGALORE
SOUTH
Ca stomach
T3N1M0
CANCER
Surgical Oncology
Gastrectomy - any
type
636
636
26-Jun-15
16-Jul-15
40000
40000
34675
3468
31207
IDBI - 321
30-Oct-15
1081 H_20082302525
Female
47
Others TUMBINAKERE
KUNIGAL
Bangalore
BANGALORE
SOUTH
Ca Ovary Stage
III
CANCER
Surgical Oncology
Gynaec
Surgery for Ca
Ovary - early stage
595
595
8-Jul-15
20-Jul-15
25000
25000
22000
2200
19800
IDBI - 321
30-Oct-15
MYSORE
RT RENAL
CALCULUS.
RENAL
Genito Urinary
Surgery
Urology
ESWL (Extra
Stent
908
908
22-Jul-15
24-Jul-15
10000
10000
9690
969
8721
IDBI - 321
30-Oct-15
Bangalore
CARCINOMA OF
LEFT BREAST
CANCER
STAGE III
PT3N0M0
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
8-Jul-15
12-Aug-15
65000
65000
64500
323
64177
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
905
905
29-Jun-15
14-Jul-15
37500
37500
37500
3750
33750
IDBI - 321
30-Oct-15
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
10-Jul-15
27-Aug-15
88500
88500
88000
440
87560
IDBI - 321
30-Oct-15
1082 H_19542303703
Female
42
Others SHRIRANGAPATNA
Minorit MOHANAKUMARAN BANGALORE
y
AGARA
EAST
1083 H_20782304077
Female
31
1084 H_19571301621
Male
20
SC
BANDALLI
MANDYA
YADGIR
TUMKUR
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
Mysore
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
BANGALORE URBAN
Bangalore
HEALTHCARE
GLOBAL
ENTERPRISES
LTD
YADGIRI
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT PUJ
OBSTRUCTION
Bangalore
CARCINOMA OF
CERVIX STAGE
CANCER
IIB
Radiation Oncology
3D Conformational
Radio Therapy
BANGALORE
SOUTH
ca Sigmoid
T3N1Mo
Surgical Oncology
Colectomy - any
type
637
637
8-Jul-15
18-Jul-15
40000
40000
32850
3285
29565
IDBI - 321
30-Oct-15
MANGALORE
CA EPIGLOTTIS
T3N1M0
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
2-Jul-15
22-Aug-15
87000
87000
87000
8700
78300
IDBI - 321
30-Oct-15
MANDYA
1085 H_20782303969
Female
66
Others SOG COLONY
DAVANAGERE
DAVANGERE
Bangalore
HEALTHCARE
GLOBAL
ENTERPRISES
LTD
1086 H_20082303300
Female
74
Others SATYAVARA
HOSAKOTE
BANGALORE RURAL
Bangalore
Kidwai
Memorial
Institute of
Oncology
Bangalore
MANGALORE
INSTITUTE OF
ONCOLOGY
1087 H_20575302926
Male
66
Others KAGADA
BHADRAVATHI
SHIMOGA
RENAL
CANCER
CANCER
Sl.No
Preauth No
Gender
Age
Caste
1088 H_20112304002
Male
44
ST
1089 H_21914302901
Male
32
1090 H_20082302715
Male
1091 H_20968303834
Village
BETHUR
Taluk
Patient District
Patient
Division
DAVANAGERE
DAVANGERE
Bangalore
Others KEDAMBADI
PUTTUR
DAKSHINA
KANNADA
Mysore
75
Others MALUVANAHALLI
NAGAMANGALA MANDYA
Female
57
Others KAMAGERE
KOLLEGAL
1092 H_20082302756
Female
63
Others
1093 H_22586303879
Male
50
Others HORAMAVU
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
PRAGATHI
SPECIALITY
HOSPITAL
Kidwai
Memorial
Institute of
Oncology
Final
Diagnosis
IHD
Diseases
CARDIOLOGY
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
3-Jul-15
9-Jul-15
65000
65000
65000
1950
63050
IDBI - 321
30-Oct-15
PUTTUR
LEFT UVJ
RENAL
CALCULUS 7MM
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
1-Jul-15
7-Jul-15
25000
25869
25000
2500
22500
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
chang of voice
t3n0m0
Surgical Oncology
Head & Neck
617
617
9-Jul-15
18-Jul-15
40000
40000
35150
3515
31635
IDBI - 321
30-Oct-15
563
563
4-Jul-15
17-Jul-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
CANCER
Krishnarajendra
MYSORE
Hospital
CA. ESOHAGUS
CANCER
STAGE, TXN0M0
Radiation Oncology
Radiotherapy
Treatment
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
ca breast
t3n1m0
CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
7-Jul-15
15-Jul-15
25000
25000
23750
2375
21375
IDBI - 321
30-Oct-15
Bangalore
HBS HOSPITAL
TRUST
BANGALORE
NORTH
CAD-SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
3-Jul-15
7-Jul-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
CARDIOLOGY
Truncus
Arteriosus Surgery
168
168
26-Jun-15
14-Sep-15
95000
95000
96900
2907
93993
IDBI - 321
30-Oct-15
BIJAPUR
Belgaum
Narayana
Hrudayalaya
Private Limited
Bangalore
Others SHARAVATHI NAGAR SHIMOGA
SHIMOGA
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
ca Thyroid
T3N1Mo
CANCER
Nuclear Medicine
Thyroid
Radioiodine
Treatment > 100
Millicuries
575
575
13-Jul-15
15-Jul-15
25000
27450
22000
2200
19800
IDBI - 321
30-Oct-15
52
Others MADLERI
HAVERI
Belgaum
KASTURBA
HOSPITAL
UDUPI
RECENT IWMI
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
30-Jun-15
10-Jul-15
65000
65000
65790
6579
59211
IDBI - 321
30-Oct-15
64
Others KUNTARAIHNAPALYA TUMKUR
TUMKUR
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
CA STOMACH
T2NoMx
CANCER
Surgical Oncology
Gastrectomy - any
type
636
636
2-Jul-15
12-Jul-15
50000
50000
16150
1615
14535
IDBI - 321
30-Oct-15
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Ca Buccal
Mucosa Post Op
CANCER
Stage II
pT2N0M0
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
13-Jul-15
2-Sep-15
102000
102000
102000
10200
91800
IDBI - 321
30-Oct-15
MANGALORE
CARCINOMA
HYPOPHARYNX
T4aN2c
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
17-Jun-15
29-Aug-15
90000
116000
116000
11600
104400
IDBI - 321
30-Oct-15
CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
30-Jun-15
30-Aug-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
Male
4
Others BENAKANAHALLI
1095 H_20082301517
Female
35
1096 H_19564303777
Male
1097 H_20082303303
Male
Male
BANGALORE URBAN
Hospital
District
TRUNCUS
ARTERIOSUS
A4(TYPE I)
TRUNCUS
ARTERISIOUS +
TYPE B
IMTERUPTTED
AORTIC ARCH
LARGE
SUBTRUNCAL
VSD BD SHUNT
1094 H_19528303868
1098 H_19504303157
CHAMARAJANA
Mysore
GAR
MADEGOWDANAHAL
LI
BANGALORE
EAST
Mysore
Hospital Name
45
Others Bailhongal
INDI
RANEBENNUR
BYLAHONGALA
BELGAUM
1099 H_19522303150
Male
40
Others NISARANI
SORABA
SHIMOGA
Bangalore
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
1100 H_19574303465
Male
61
Others KAMMASANDRA
HOSAKOTE
BANGALORE RURAL
Bangalore
VYDEHI
HOSPITAL
BANGALORE
Glioblastoma
muliformae
Grade IV WHO
1101 H_19574303222
Male
42
GUDIBANDE
CHIKKABALLAPU
Bangalore
R
VYDEHI
HOSPITAL
BANGALORE
Neuroendocrine
carcinoma
CANCER
rectum with lira
mets
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
8-Jul-15
29-Aug-15
22500
22500
22500
2250
20250
IDBI - 321
30-Oct-15
1102 H_20332302416
Male
70
DEVANAHALLI
BANGALORE RURAL
Bangalore
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
non functioning
RENAL
of kidney
Genito Urinary
Surgery
Urology
Simple
918
918
14-Jul-15
6-Aug-15
35000
35000
34500
3450
31050
IDBI - 321
30-Oct-15
1103 H_19574303471
Female
37
SC
PURASANAHALLI
MALUR
KOLAR
Bangalore
VYDEHI
HOSPITAL
Carcinoma cervix
CANCER
III B
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
25-Jun-15
29-Aug-15
73000
73000
73000
7300
65700
IDBI - 321
30-Oct-15
1104 H_20079303635
Female
56
SC
DOONA BENAVALLI
HOSANAGARA
SHIMOGA
Bangalore
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
ACOM
ANEURYSM
NEURO SURGERY
Neuro Surgery
Brain
Aneurysm
Clipping
422
422
4-Jul-15
15-Jul-15
100000
100000
90000
9000
81000
IDBI - 321
30-Oct-15
1105 H_20025303510
Female
72
Others BELAMBADI
GUNDLUPET
CHAMARAJANA
Mysore
GAR
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
LT MEDIAL
SPHENOID WING NEURO SURGERY
MENINGIOMA
Neuro Surgery
Brain Tumour
Excision of Brain
Tumor
SupratentorialBasal
404
404
18-Jul-15
27-Jul-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
1106 H_20332303131
Male
64
Minorit
GURAPPANAPALYA
y
BANGALORE
NORTH
BANGALORE URBAN
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
ca bladder
Genito Urinary
Surgery
Urology
TURBT
916
916
6-Jul-15
21-Jul-15
30000
30000
27000
2700
24300
IDBI - 321
30-Oct-15
SC
JAYANTI GRAMA
Others BUDIGERE
Bangalore
BANGALORE
RENAL
Sl.No
Preauth No
Caste
Village
Taluk
Patient District
Patient
Division
Age
1107 H_20082302753
Female
35
Others WARD 12
PANDAVAPURA MANDYA
Mysore
1108 H_20017303526
Female
52
Others MADAWAL
GOKAK
Belgaum
1109 H_20790303490
Male
60
Others Thirumalapura
NAGAMANGALA MANDYA
Mysore
Sri
Adichunchanagi
B G Nagara
ri Hospital and
Research Center
1110 H_19577303457
Female
42
Others MUDDATANURU
SIRAGUPPA
Gulbarga
SJICR
Mysore
Bharath
Hospital
Institute of
Oncology
Mysore
Sri
Adichunchanagi
B G Nagara
ri Hospital and
Research Center
BELGAUM
BELLARY
1111 H_19505302704
Male
71
Others GOPHANHALLI
HASSAN
1112 H_20790303393
Male
4
Others Manchenahalli
NAGAMANGALA MANDYA
1113 H_20619296520
Female
29
1114 H_19491303111
Male
67
1115 H_19574302752
Male
72
1116 H_20575302924
Male
68
1117 H_21254303226
Male
31
ST
KUMBALURU
Others SANGALAPURA
SC
BOMMENAHALLI
Others MUTHALLI
HASSAN
Hospital Name
Hospital
District
Gender
Kidwai
BANGALORE
Memorial
SOUTH
Institute of
Oncology
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
Final
Diagnosis
Diseases
Net Amt
Paid
25000
25000
22000
2200
19800
IDBI - 321
30-Oct-15
IHD USA CAD
DVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - 2 stent
(non-medicated)
104
104
29-Jun-15
7-Jul-15
70000
70000
70000
7000
63000
IDBI - 321
30-Oct-15
BPH, AUR Renal
RENAL
dysfunction .
Genito Urinary
Surgery
Urology
TURP
917
917
2-Jul-15
8-Aug-15
20000
20000
19000
1900
17100
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
IHD - EA, DM,
DVD
CABG
132
132
15-Jul-15
29-Jul-15
95000
95000
95000
0
95000
IDBI - 321
30-Oct-15
Mysore
CA PENIS WITH
LEFT INGUINAL
NODE LEFT
CANCER
PARTIAL
PENIECTOMY IV
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 cycles)
555
555
7-Jul-15
28-Aug-15
22500
22500
22500
0
22500
IDBI - 321
30-Oct-15
Lft Pelvic
ureteric function RENAL
abstraction.
Genito Urinary
Surgery
Urology
905
905
2-Jul-15
17-Jul-15
35000
35000
31500
3150
28350
IDBI - 321
30-Oct-15
10
10
3-Jul-15
7-Jul-15
30000
30000
21000
2100
18900
IDBI - 321
30-Oct-15
566
566
6-Jul-15
17-Jul-15
20000
20000
19000
76
18924
IDBI - 321
30-Oct-15
CARDIOLOGY
Post Burn
Contracture
surgeries for
Functional
Improvement(Pack
age including
splints, pressure
garments and
physiotherapy),
Moderate
Palliative
Treatment with
Photons (linear
accelarator)
HONNALI
DAVANGERE
Bangalore
SUKSHEMA
HOSPITAL
PVTLTD
DAVANGERE
POST BURN
CONTRACTURE
RIGHT ELBOW
BURNS
Burns
Burns
TURVEKERE
TUMKUR
Bangalore
BGS GLOBAL
HOSPITAL
BANGALORE
SOUTH
Multiple
myeloma Right
humerus
CANCER
Radiation Oncology
Linear Accelerators
BANGALORE
EAST
BANGALORE URBAN
Bangalore
VYDEHI
HOSPITAL
BANGALORE
Carcinoma
esophagus with
CANCER
cervical,vertebral
metastasis.
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
22-Jun-15
20-Jul-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
SHIKARIPURA
SHIMOGA
Bangalore
MANGALORE
INSTITUTE OF
ONCOLOGY
MANGALORE
CA
HYPOPHARNYX
T4N1M0 STAGE
IV
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
2-Jul-15
1-Sep-15
82000
74000
74000
7400
66600
IDBI - 321
30-Oct-15
Gulbarga
DR RAGHOJI
KIDNEY
HOSPITAL AND
RESEARCH
CENTER PV
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
1-Jul-15
7-Jul-15
25000
25000
22500
2250
20250
IDBI - 321
30-Oct-15
k/c/o Ca Cervix
III B
CANCER
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
8-Jul-15
31-Aug-15
96000
97447
94000
9400
84600
IDBI - 321
30-Oct-15
AML
CANCER
Medical Oncology
Induction/1st
Phase
547
547
6-Jul-15
31-Aug-15
50000
50585
44650
4465
40185
IDBI - 321
30-Oct-15
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
1-Jul-15
16-Jul-15
25000
25000
22500
2250
20250
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
26-Jun-15
13-Aug-15
81000
81000
79000
7900
71100
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
25-Jun-15
7-Jul-15
65000
65000
45500
4550
40950
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
27-Jun-15
22-Aug-15
87000
87000
75000
7500
67500
IDBI - 321
30-Oct-15
Others 0
GULBARGA
Belgaum
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
GULBARGA
SOLAPUR
CANCER
Rt Renal Calculus RENAL
HARAPANAHALL
DAVANGERE
I
Bangalore
Kidwai
Memorial
Institute of
Oncology
1120 H_22706302847
Male
38
Others YEDLAPUR
BIDAR
Gulbarga
S P Institute of
Solapur
Neuro Sciences
L2 L3 Protuded
Disc nerve root
comression
Bangalore
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
MANGALORE
CARCINOMA
OESOPHAGUS
STAGE T4aNx IIIc
Bangalore
M S Ramaiah
Hospital
BANGALORE
NORTH
CA LEFT BREAST
POST OP
CANCER
YPT1N1M0
BIDAR
Others SANTEKADURU
SHIMOGA
Others SHENNIGARAPETE
RURAL
Others HONNALI
TDS
4-Aug-15
Others ITLUGUNDI
65
Gross
Amount
approved by
1-Aug-15
10
Male
Hospital
claimed
Amount
575
Male
1123 H_21052302973
Preauth
Approved
Amt
575
1119 H_20082302431
48
Date of
Discharge
Radioiodine
Treatment > 100
Millicuries
Others Ambalanur
Female
Date of
Admission
Thyroid
65
1122 H_20010300992
Nuclear Medicine
Female
51
Plan of
treatment
CANCER
1118 H_20613303185
Male
ca thyroid
t3n1m0
BASAVANABAGE
BIJAPUR
WADI
1121 H_19522302161
Disease Main
Category
HONNALI
SHIMOGA
DAVANGERE
Bangalore
BANGALORE
SOUTH
CANCER
CA HYPO
PHARYNGEAL T3 CANCER
NOMO
Sl.No
Preauth No
Gender
Age
Caste
1124 H_19586303050
Male
43
Others
1125 H_20079300083
Male
42
1126 H_20790303029
Female
20
1127 H_19504301083
Female
48
Village
Taluk
Patient District
Patient
Division
Hospital Name
HOLENARSIPUR HASSAN
Mysore
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
Minorit
TIPPU NAGAR
y
SHIMOGA
Bangalore
Others Govindagatta
NAGAMANGALA MANDYA
WARD NO;17
HOUSING BOARD
Others Daddi
BELGAUM
SHIMOGA
BELGAUM
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
IHD DVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
30-Jun-15
9-Jul-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
RIGHT ACE
PORTAL
ARACHNOID
CYST.
NEURO SURGERY
Neuro Surgery
Brain
Ventriculoatrial
/Ventriculoperiton
eal Shunt
411
411
9-Jul-15
13-Jul-15
25000
25000
23750
2375
21375
IDBI - 321
30-Oct-15
Mysore
Sri
Adichunchanagi
B G Nagara
ri Hospital and
Research Center
Lft Distal
Uretteric
Calculus.
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
1-Jul-15
11-Jul-15
25000
25000
22500
2250
20250
IDBI - 321
30-Oct-15
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Ca Cervix Stage
III B
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
10-Jul-15
20-Aug-15
94500
94500
88500
8850
79650
IDBI - 321
30-Oct-15
Ca Cervix IIIB
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
8-Jul-15
17-Aug-15
81000
81000
81000
8100
72900
IDBI-294
9-Oct-15
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
1-Jul-15
11-Aug-15
58000
58000
52000
5200
46800
IDBI - 321
30-Oct-15
239
239
25-Jun-15
3-Jul-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
BANGALORE
CANCER
1128 H_19567301103
Female
55
Others Betageri
GADAG
GADAG
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
1129 H_20077302961
Female
28
Others TAVRAGERA
KUSTAGI
KOPPAL
Gulbarga
Ca Esophagus
CANCER
M/3rd, T3N0M0
1130 H_20733301685
Female
52
Others TUMBALA
T NARASIPUR
MYSORE
Mysore
SJICR MYSORE
MYSORE
IHD-ACS ACUTE
AWMI CADCRITICAL LMAD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
1131 H_19577302669
Male
37
Others YELHANKA
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
SJICR
BANGALORE
SOUTH
LEFT UPPER
CARDIOLOGY
LIMB ISCHAEMIA
Cardiology
Cardiology
Peripheral
Angioplasty
109
109
7-Jul-15
12-Jul-15
55000
55000
55000
0
55000
IDBI - 321
30-Oct-15
1132 H_20061302896
Male
58
Others
H.NO.3-4-95 ASAR
YADGIR
MOHALLHA YADGIRI.
YADGIRI
Gulbarga
NARAYANA
HOSPITALS
CAD-TRIPLE
CARDIOLOGY
VESSEL DISEASE.
CABG
132
132
29-Jun-15
11-Jul-15
95000
95000
96900
9690
87210
IDBI - 321
30-Oct-15
1133 H_20435302856
Male
60
ST
TABAKADAHONALLI
DHARWAD
Belgaum
Kolhapur Cancer
Karveer
Centre
CA TOUNGE
T4N1M0
Medical Oncology
Head & Neck
Carboplatin +
Paclitaxel/Cycle
Max. of 6 cycles
only
521
521
6-Jul-15
19-Aug-15
31500
40500
31500
3150
28350
IDBI - 321
30-Oct-15
Mysore
THE RADIANT
INSTITUTE
MYSORE
CA BUCCAL
MUCOSA STAGE CANCER
II
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
7-Jul-15
20-Aug-15
85000
85000
84500
8450
76050
IDBI - 321
30-Oct-15
KALAGATAGI
CANCER
1134 H_23069301444
Female
65
Others SHRAVANARI
CHANNARAYAP
HASSAN
ATNA
1135 H_21658302832
Male
31
Others Ukkunda
RANEBENNUR
HAVERI
Belgaum
SRI SAI
SPECIALITY
HOSPITAL
RANEBENNUR
Right PIVD
sciatica
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
14-Jul-15
18-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
1136 H_19577302791
Male
48
Others KALYANGARA
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
SJICR
BANGALORE
SOUTH
IHD - USA, SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
7-Jul-15
10-Jul-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
PUTTUR
DAKSHINA
KANNADA
Mysore
MANGALORE
INSTITUTE OF
ONCOLOGY
MANGALORE
CA
OESOPHAGUS
M/3 T3N1M0
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
1-Jul-15
22-Aug-15
87000
87000
81000
8100
72900
IDBI - 321
30-Oct-15
Mysore
Apollo BGS
Hospital
MYSORE
IHDIPWMI,SURVICAL
CARDIOLOGY
OF CARDICA
ARREST,LV
DYSFUNCTION
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
30-Jun-15
4-Jul-15
90000
90000
91800
9180
82620
IDBI - 321
30-Oct-15
MANGALORE
MODERATELY
DIFFERENTIATED
SCC OF
CANCER
VELLECULA
T1N2M0
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
1-Jul-15
19-Aug-15
94000
94000
86000
8600
77400
IDBI - 321
30-Oct-15
1137 H_20575302571
1138 H_19587302682
Male
Male
63
31
Others BOLARU
ST
WARD -01
NANJANAGUD
MYSORE
CANCER
1139 H_20015302684
Male
82
Others KALGOLI
UDUPI
UDUPI
Mysore
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
1140 H_19528302690
Female
40
Others KOTHA
LINGASUGUR
RAICHUR
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
CAD-TVD
CARDIOLOGY
CABG
132
132
18-Jul-15
25-Jul-15
95000
95000
96900
2907
93993
IDBI - 321
30-Oct-15
1141 H_20079302675
Male
63
Others SUTTAKOTI
HIREKERUR
HAVERI
Belgaum
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
CAD-TVD.
CARDIOLOGY
CABG
132
132
4-Jul-15
21-Jul-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
Sl.No
Preauth No
1142 H_20010301885
1143 H_23069301164
1144 H_19505302515
Gender
Female
Male
Male
Age
62
54
Caste
Village
Others YELLODU
Others HEMMARAGALLA
Taluk
GUDIBANDE
NANJANAGUD
Patient
Division
CHIKKABALLAPU
Bangalore
R
M S Ramaiah
Hospital
MYSORE
Mysore
THE RADIANT
INSTITUTE
Mysore
Bharath
Hospital
Institute of
Oncology
BANGALORE
NORTH
CARCINOMA
KOF RIGHT
BUCCAL
MUCOSA
CT4AN0M0
MYSORE
CA-RENAL CELL
CRACINOMA
STAGE II
Mysore
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Surgical Oncology
Head & Neck
612
612
25-Jun-15
29-Jul-15
60000
60000
57000
5700
51300
IDBI - 321
30-Oct-15
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
7-Jul-15
13-Aug-15
76000
76000
75500
7550
67950
IDBI - 321
30-Oct-15
CA FLOOR OF
THE MOUTH
CANCER
TIN0M0 STAGE 1
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
20-Jul-15
16-Aug-15
94000
94000
89300
0
89300
IDBI - 321
30-Oct-15
RT RENAL (PUJ)
CALCULUS.
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
22-Jun-15
10-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
30-Jun-15
19-Aug-15
58000
85600
58000
5800
52200
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
5-Jul-15
17-Aug-15
87000
87000
87000
8700
78300
IDBI-294
9-Oct-15
CANCER
CANCER
CHINCHOLI
GULBARGA
Gulbarga
BELLARY
BELLARY
Gulbarga
CA CERVIX
STAGE IIIB
Ca Oesophagus
middle stage III
Ca Nasopharynx
CANCER
Stage III
Medical Oncology
Head & Neck
Carboplatin +
Paclitaxel/Cycle
Max. of 6 cycles
only
521
521
8-Jul-15
31-Aug-15
31500
35350
31500
3150
28350
IDBI-294
9-Oct-15
BANGALORE
SOUTH
L5-S1 PIVD
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
11-Jun-15
30-Jun-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
MANGALORE
PITUITARY
MACROADENOM NEURO SURGERY
A.
Neuro Surgery
Brain Tumour
404
404
29-Jun-15
20-Jul-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Cervix III B
CANCER
Radiation Oncology
573
573
26-Jul-15
28-Jul-15
20000
20000
16150
1615
14535
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
ca breast
t4bn1m0
CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
2-Jul-15
4-Jul-15
25000
29245
15050
1505
13545
IDBI - 321
30-Oct-15
Bangalore
M S Ramaiah
Hospital
BANGALORE
NORTH
CA ESPHAGUS
UPPER
Y3T3N0M0
STAGE :- IIB
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
18-Jun-15
8-Aug-15
96000
96000
81000
8100
72900
IDBI - 321
30-Oct-15
Gulbarga
BGS GLOBAL
HOSPITAL
BANGALORE
SOUTH
Carcinoma Right
buccal Mucosa CANCER
cT4aN2bM0
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
3-Jul-15
3-Aug-15
60000
60000
60000
240
59760
IDBI - 321
30-Oct-15
Belgaum
MANGALORE
INSTITUTE OF
ONCOLOGY
MANGALORE
CA RIGHT RMT
T4N1M0
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
30-Jun-15
18-Aug-15
87000
87000
87000
8700
78300
IDBI - 321
30-Oct-15
Bangalore
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca cervix Post op CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
7-Jul-15
19-Aug-15
62000
62000
62000
6200
55800
IDBI-294
9-Oct-15
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Upper GBS Rt.
T3: M0:N0 Stage CANCER
II
Surgical Oncology
Head & Neck
612
612
6-Jul-15
18-Aug-15
60000
60000
60000
6000
54000
IDBI-294
9-Oct-15
Belgaum
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
k/c/o ca
hypopharynx (Rt
CANCER
PFS +AP fold)T3
N0 M0
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
2-Jul-15
20-Aug-15
92000
111283
86000
8600
77400
IDBI - 321
30-Oct-15
22
1146 H_20077302464
Female
50
Others SINDANVALA
Others Karmadi
YELBURGA
KOPPAL
Gulbarga
Karnataka
Cancer Therapy
Hubli
and Research
Institute
YELBURGA
KOPPAL
Gulbarga
Karnataka
Cancer Therapy
Hubli
and Research
Institute
1147 H_19567300683
Female
43
1148 H_19567301097
Male
55
1149 H_20006299773
Female
55
Others Holenarshipur
HOLENARSIPUR HASSAN
1150 H_20015302462
Female
57
Others HUKKUNDA
Mysore
R
UR
1151 H_20082301550
Female
52
1152 H_20082300807
Female
62
Minorit
YALMADYUM
y
TUMKUR
BASAVAKALYAN
BIDAR
A
ST
ST
Guntamadu
KALLADEVARA
1153 H_20010302030
Male
47
Minorit
NAZARABAD
y
1154 H_19491300995
Male
45
Others ROLAWADI
HAVERI
Belgaum
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
TUMKUR
UTTARA
KANNADA
Male
51
Others BELASHE
ANKOLA
1156 H_19567302356
Female
47
Others Harpanahalli
HARAPANAHALL
DAVANGERE
I
1157 H_19567299500
Female
40
Others Haliyal
HALIYAL
65
Others Mangavati
Mysore
BYADAGI
1155 H_20575302085
Male
Final
Diagnosis
PATIL NURSING
HOME
GULBARGA
GULBARGA
Male
KODAGU
Hospital
District
Others A VILLAGE
1145 H_19571298958
1158 H_20613299273
Hospital Name
56
Minorit
S BASAVANTHPUR
y
SOMAVARPET
Patient District
ATHANI
UTTARA
KANNADA
BELGAUM
Sanjay Gandhi
Institute of
Trauma and
Orthopaedic
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
CANCER
CANCER
Excision of Brain
Tumor
SupratentorialBasal
ii. HDR - one
application and
multiple dose
fractions
Sl.No
Preauth No
Gender
Age
1159 H_19504301048
Male
45
1160 H_19577302126
Male
19
ST
GUMMAREDDY
PURA
1161 H_19574301734
Female
12
ST
AMBALAGERE
1162 H_20079302078
Male
63
1163 H_19567302044
Female
65
Caste
Village
Others Surpur
Others BILAGI
ST
SC
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Ca Supraglottis
Stage IVA
T4N1M0
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
SREENIVASAPUR KOLAR
Bangalore
SJICR
BANGALORE
SOUTH
HIRIYUR
CHITRADURGA
Bangalore
VYDEHI
HOSPITAL
BANGALORE
SIDDAPUR
UTTARA
KANNADA
Belgaum
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
Bangalore
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Cervix PO
KHANAPUR
BELGAUM
DAVANGERE
Diseases
Davageri
DAVANAGERE
YELANDURU
Mysore
GAR
GAR
THE RADIANT
INSTITUTE
MYSORE
CA EPIGLOTTIS
STAGE II
Bangalore
CA CERVIX
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
9-Jul-15
21-Aug-15
22500
22500
20700
2070
18630
IDBI - 321
30-Oct-15
Double Valve
Replacement
149
149
29-Jun-15
29-Jul-15
150000
150000
140000
0
140000
IDBI - 321
30-Oct-15
NEURO SURGERY
Neuro Surgery
Spinal
Spina Bifida
Surgery Major
437
437
1-Jul-15
14-Jul-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
3-Jul-15
6-Jul-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
7-Jul-15
19-Aug-15
81000
81000
79000
7900
71100
IDBI-294
9-Oct-15
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
6-Jul-15
21-Aug-15
85000
85000
84500
8450
76050
IDBI - 321
30-Oct-15
CANCER
Medical Oncology
Cervical Cancer
Weekly
Cisplatin/Week
509
509
6-Jul-15
13-Aug-15
100500
100500
72420
2173
70247
IDBI - 321
30-Oct-15
CANCER
RHD - SEVERE
MR, MODERATE
CARDIOLOGY
AR, MODEREATE
TR
Low lying cord
with tethered
cord with
kyphoscoliosis
RECENT AWMI
WITH POST
INFRACTION
ANGINA WITH
CAD:SVD.
Disease Main
Category
CANCER
Medical Oncology
unlisted regimen
1164 H_23069301430
Male
69
1165 H_19528302024
Male
62
Others CHANDRA BANDA
RAICHUR
RAICHUR
Gulbarga
Narayana
Hrudayalaya
Private Limited
1166 H_20079300327
Male
54
Minorit
SOOLEBAIL
y
SHIMOGA
SHIMOGA
Bangalore
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
LEFT CP ANGLE
TUMORS WITH
NEURO SURGERY
HYDROCEPHALU
S.
Neuro Surgery
Brain
Ventriculoatrial
/Ventriculoperiton
eal Shunt
411
411
2-Jul-15
6-Jul-15
25000
25000
23750
2375
21375
IDBI - 321
30-Oct-15
1167 H_19576302040
Male
65
Others Hulagi
KOPPAL
KOPPAL
Gulbarga
SDM Narayana
Hrudayalaya
IHD-AWMI, CADCARDIOLOGY
DVD
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
9-Jul-15
11-Jul-15
90000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
1168 H_19567301896
Male
72
Others Alwandi
KOPPAL
KOPPAL
Gulbarga
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Hypopharynx
CANCER
Lt PFS
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
6-Jul-15
19-Aug-15
62000
62000
61750
6175
55575
IDBI-294
9-Oct-15
1169 H_19574301067
Female
56
Others KESARUKODIGE
SHRUNGERI
CHIKKAMANAGL
Mysore
UR
VYDEHI
HOSPITAL
Carcinoma
esophagus
T3NoM1
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
3-Jun-15
26-Jul-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
Cancer Pyriform Fossa. ( CANCER
Stage III )
Surgical Oncology
Head & Neck
612
612
2-Jul-15
16-Jul-15
40000
52905
40000
4000
36000
IDBI - 321
30-Oct-15
CA STOMACH
T3N1M0
Surgical Oncology
Gastrectomy - any
type
636
636
9-Jul-15
27-Jul-15
40000
40435
33300
3330
29970
IDBI - 321
30-Oct-15
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
3-Jul-15
21-Aug-15
110000
95680
82000
8200
73800
IDBI - 321
30-Oct-15
909
909
1-Jul-15
4-Jul-15
25000
25000
22500
2250
20250
IDBI - 321
30-Oct-15
901
901
27-Jun-15
6-Jul-15
20000
20000
19380
1938
17442
IDBI - 321
30-Oct-15
1170 H_22472301868
Male
50
Others 0
AFJALPUR
GULBARGA
Gulbarga
1171 H_20082297155
Male
47
Others DAVANAGERE
DAVANAGERE
DAVANGERE
Bangalore
Shri
Siddheshwar
and Research
Cent
Kidwai
BANGALORE
Memorial
SOUTH
Institute of
Oncology
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
CANCER
CANCER
ca esophagus
mid 1/3 T3 N1
M0
CANCER
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
BANGALORE
NORTH
LOW URETENIE
CALCULAS
RENAL
Genito Urinary
Surgery
Urology
LAKDIKAPUL
LEFT RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
CARDIOLOGY
CABG with IABP
133
133
22-Jun-15
17-Jul-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
Female
50
Others Kalatippi
JAMAKHANDI
1173 H_20010300550
Male
40
Others CHETHAN NAGAR
RURAL
Bangalore
1174 H_21079301661
Male
6
Others HONAGUNTA
CHITTAPUR
GULBARGA
Gulbarga
1175 H_20242301881
Male
61
Others BETAGERI
KOPPAL
KOPPAL
Gulbarga
MEDIHOPE
HOSPITALS AND
BANGALORE
RESEARCH
CENTRE PVT LTD
IHD, TVD (LEFT
MAIN) WITH LV
DYSFUNCTION
1176 H_21701300222
Male
31
BIDAR
BIDAR
Gulbarga
SUNSHINE
HEART
INSTITUTE
cad single vessel
CARDIOLOGY
disease
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
20-Jun-15
2-Jul-15
55000
55000
50490
5049
45441
IDBI - 321
30-Oct-15
1177 H_20254298374
Female
63
GANGAVATHI
KOPPAL
Gulbarga
Shakuntala
Memorial
Hubli
Hospital and
Research Centre
ca soft pallite
(T2N0M0) STAGE CANCER
II
Medical Oncology
Cervical Cancer
Weekly
Cisplatin/Week
509
509
6-Jul-15
17-Aug-15
62000
62000
62000
6200
55800
IDBI - 321
30-Oct-15
gunalli
Others Ramadurga
Belgaum
BANGALORE
1172 H_20613301699
ST
BAGLAKOT
Dharwad
M S Ramaiah
Hospital
LOTUS
CHILDREN S
HOSPITAL
Paradise, S.D.
Road
URSL - Single Side
+ DJ Stent
Open
Sl.No
Preauth No
Gender
Age
1178 H_20082301560
Female
72
1179 H_20661300969
Male
30
1180 H_19574301169
Female
50
1181 H_23069301436
1182 H_19574301160
Female
Male
70
37
Caste
Village
Taluk
Others VRUNDAVANAHALLI ARASIKERE
Patient District
Patient
Division
Hospital Name
HASSAN
Mysore
Kidwai
Memorial
Institute of
Oncology
Hospital
District
BANGALORE
SOUTH
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
ca esophagus
t2n0m0
CANCER
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
8-Jul-15
13-Jul-15
20000
20000
4750
475
4275
IDBI - 321
30-Oct-15
CANCER
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
25-Jun-15
11-Sep-15
32000
32000
26000
2600
23400
IDBI - 321
30-Oct-15
Surgical Oncology
Gynaec
Surgery for Ca
Ovary - advance
stage
596
596
1-Jul-15
16-Jul-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
6-Jul-15
13-Aug-15
94500
94500
80500
8050
72450
IDBI - 321
30-Oct-15
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
24-Jun-15
8-Jul-15
65000
65000
20000
2000
18000
IDBI - 321
30-Oct-15
BALLARI
BELLARY
BELLARY
Gulbarga
Vijayanagara
Institute of
BELLARY
Medical Science
CA CX -3B
SQUCELL
CARCINOMA
Others GURUMATAKAL
YADGIR
YADGIRI
Gulbarga
VYDEHI
HOSPITAL
BANGALORE
Carcinoma ovary
CANCER
stage FIGO III
Mysore
THE RADIANT
INSTITUTE
MYSORE
CA
CANCER
ENDOMETRIUM
BANGALORE
AAAAAACS AWMI CAG-SVD- CARDIOLOGY
LAD
Cardiology
Mitral Valve
Replacement
145
145
29-Jun-15
17-Jul-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
SC
Others HITNE HEBBAGILU
Others KACHAKNOOR
PIRIYAPATNA
SURPUR
MYSORE
YADGIRI
DHARWAD
Gulbarga
VYDEHI
HOSPITAL
Belgaum
SDM Narayana
Hrudayalaya
Dharwad
Mitral Valve
Prolapse Grade
III Mitral
Regurgitation
Mangala
Hospital
K R Puram
BPH with urinary
RENAL
retention
Genito Urinary
Surgery
Urology
TURP
917
917
30-Jun-15
4-Jul-15
20000
26660
14000
1400
12600
IDBI - 321
30-Oct-15
BPH+ VESICAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
23-Jun-15
3-Jul-15
20000
20000
19000
1900
17100
IDBI - 321
30-Oct-15
Bilateral Uriteric
RENAL
Stone.
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
2-Jul-15
6-Jul-15
37500
37500
33750
3375
30375
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
1-Jul-15
13-Aug-15
85000
85000
84500
8450
76050
IDBI - 321
30-Oct-15
DiscectomyLumbar
433
433
23-Jun-15
5-Jul-15
25000
25328
24910
2491
22419
IDBI - 321
30-Oct-15
435
435
26-Jun-15
4-Jul-15
50000
50000
45000
4500
40500
IDBI - 321
30-Oct-15
509
509
29-Jun-15
6-Aug-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
1183 H_19576301511
Male
50
Others Hubli
HUBLI
1184 H_20118301065
Male
50
Others Hosahalli
HOLENARSIPUR HASSAN
Mysore
1185 H_20017300264
Male
76
Others BALIGERI
ATHANI
BELGAUM
Belgaum
1186 H_20118301173
Male
48
Others Yadiyuru
HASSAN
HASSAN
Mysore
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
Mangala
K R Puram
Hospital
1187 H_23069301080
Male
65
ST
SAGARE
HD KOTE
MYSORE
Mysore
THE RADIANT
INSTITUTE
1188 H_22860299155
Male
48
SC
DEVANAHALLI
DEVANAHALLI
BANGALORE RURAL
Bangalore
AKASH
HOSPITAL
DEVANAHALLI
Lumbar disc
prolapse L3 L4 L4 NEURO SURGERY
L5
Neuro Surgery
Spinal
1189 H_23124301529
Female
43
Others 0
GADAG
GADAG
Belgaum
SPARSH SUPER
SPECIALITY
HOSPITAL
BANGALORE
NORTH
L3-4 GRADE-I
LISTHESIS
Neuro Surgery
Spinal
1190 H_20968301488
Female
47
Others ,LASHKAR MOHLLA
MYSORE
MYSORE
Mysore
Krishnarajendra
MYSORE
Hospital
Medical Oncology
Cervical Cancer
1191 H_20010300544
Female
49
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
M S Ramaiah
Hospital
BANGALORE
NORTH
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
10-Jun-15
30-Jul-15
25000
25000
9500
950
8550
IDBI - 321
30-Oct-15
1192 H_20733301189
Male
64
MYSORE
MYSORE
Mysore
SJICR MYSORE
MYSORE
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
25-Jun-15
1-Jul-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
1193 H_20164301084
Male
30
KOLAR
KOLAR
Bangalore
R L JALAPPA
HOSPITAL AND
RESEARCH
CENTRE
KOLAR
Genito Urinary
Surgery
Urology
Cystolithotripsy
906
906
1-Jul-15
14-Jul-15
12500
12500
11875
1188
10687
IDBI - 321
30-Oct-15
THE RADIANT
INSTITUTE
CA SKIN STAGE II CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
1-Jul-15
12-Aug-15
85000
85000
84500
8450
76050
IDBI - 321
30-Oct-15
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT UPPER
RENAL
URETRIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
25-Jun-15
8-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Spinal
Anterior Cervical
Discectomy
Multiple level with
Implants
(procedure
30000+ Implants
10000)
429
429
29-Jun-15
7-Jul-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
ST
YALECHENAHALLI
Minorit
GOWSIYANAGAR
y
SC
KOLAR
1194 H_23069301448
Male
70
Others KABBALLI
GUNDLUPET
CHAMARAJANA
Mysore
GAR
1195 H_19571300181
Male
29
Others BRAHMPUR GBL
GULBARGA
GULBARGA
1196 H_22226301267
Male
65
Others KALGOD
GOKAK
BELGAUM
Gulbarga
Belgaum
Viajya Ortho
and Trauma
Centre
MYSORE
CA PYRIFORM
FOSSA STAGE II
CARDIOLOGY
MYSORE
BELGAUM
CANCER
NEURO SURGERY
CA. CERVIX
CANCER
STAGE:IIIB
L3-L4-L5
SPONDYLODISAT NEURO SURGERY
IS
IHD-ACS IWMI
CADCARDIOLOGY
SIGNIFICANT
RCA
VESICAL
CALCULUS WITH
RENAL
BALATERAL
RENAL CALCULI.
C3-C4 and C4-C5
NEURO SURGERY
Disc Prolapse
Neuro Surgery
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
Weekly
Cisplatin/Week
Sl.No
Preauth No
Gender
Age
1197 H_22933301228
Male
56
1198 H_20059299682
Male
24
Caste
Village
Others Basthi halli
SC
karehalli
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
HASSAN
b/l renal
calcul;us failed
medical
managment
TIPTUR
right uretric
calculus
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
30-Jun-15
9-Jul-15
25000
25000
17500
1750
15750
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
28-Jun-15
30-Jun-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
1-Jul-15
12-Aug-15
81000
81000
81000
8100
72900
IDBI-294
9-Oct-15
HASSAN
HASSAN
Mysore
Janapriya
Hospital
RENAL
Genito Urinary
Surgery
ARASIKERE
HASSAN
Mysore
KUMAR
HOSPITAL
RENAL
Ca Cervix IIIB
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
MANGALORE
CAD-ACSNSTEMI
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
29-Jun-15
3-Jul-15
90000
161222
90000
9000
81000
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
29-Jun-15
14-Aug-15
85000
85000
84500
8450
76050
IDBI - 321
30-Oct-15
1199 H_19567301116
Female
65
Others Javur
DHARWAD
DHARWAD
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
1200 H_20322300831
Male
43
Others SHIRALAKOPPA
SHIKARIPURA
SHIMOGA
Bangalore
INDIANA
HOSPITAL AND
HEART
INSTITUTE LTD
MYSORE
CA PYRIFORM
CANCER
FOSSA STAGE III
1201 H_23069301066
Male
54
Others HINKAL
MYSORE
MYSORE
Mysore
THE RADIANT
INSTITUTE
1202 H_19528300774
Male
62
Others GULE
YELBURGA
KOPPAL
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
RIGHT
SUBCLAVION
ARTERIAL
STENOSIS (90)
CARDIOLOGY
Cardiology
Cardiology
Peripheral
Angioplasty
109
109
30-Jun-15
6-Jul-15
55000
55000
56100
1683
54417
IDBI - 321
30-Oct-15
1203 H_20010300558
Male
15
Others
BANGALORE
NORTH
HEREDITHRY
SPHEROUPOSIS
NEONATAL
Splenectomy
312
312
25-Jun-15
8-Jul-15
35000
35000
31500
3150
28350
IDBI - 321
30-Oct-15
1204 H_20079301056
Male
47
SC
Excision of Brain
Tumor
SupratentorialBasal
404
404
6-Jul-15
20-Jul-15
60000
60000
57000
5700
51300
IDBI - 321
30-Oct-15
1205 H_20082300554
Female
28
1206 H_20790300990
Male
75
DASARI KONDAPPA
STRRET
Bangalore
R
R
M S Ramaiah
Hospital
PEELAPURE
HOSADURGA
CHITRADURGA
Bangalore
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
ACF BASE
MENINGIOMA .
NEURO SURGERY
Neuro Surgery
Brain Tumour
Others NELLURU
MULABAGILU
KOLAR
Bangalore
Kidwai
Memorial
Institute of
Oncology
ca cervix III B
CANCER
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
30-Jun-15
6-Aug-15
20000
20000
17000
1700
15300
IDBI - 321
30-Oct-15
Others Godenahalli
NAGAMANGALA MANDYA
Mysore
Sri
Adichunchanagi
B G Nagara
ri Hospital and
Research Center
BPH
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
25-Jun-15
13-Jul-15
20000
20000
18000
1800
16200
IDBI - 321
30-Oct-15
a case of ca
cervix IIIB
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
13-Jun-15
5-Aug-15
88500
88500
74239
7424
66815
IDBI - 321
30-Oct-15
AORTIC
STENOSIS, ILIAC
OCCLUSION
CARDIOLOGY
Cardiology
Cardiology
Peripheral
Angioplasty
109
109
29-Jun-15
2-Jul-15
70000
70000
70000
0
70000
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
1207 H_22254300986
Female
53
Others 0
GULBARGA
GULBARGA
Gulbarga
BIBI GENERAL
CANCER CENTER
1208 H_19577300712
Male
54
Others THOVINAKERE
KORATAGERE
TUMKUR
Bangalore
SJICR
1209 H_20017299450
Female
65
Others SHIRGAONWADI
CHIKKODI
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
PSEUDOANEURY
SM OF THE LEFT
CARDIOLOGY
INTERNAL ILIAC
ARGERY
Surgery for
Arterial
Aneursysm -Distal
Abdominal Aorta
214
214
15-Jun-15
10-Jul-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
1210 H_19574300806
Female
52
Others KAMANAHALLI
ANEKAL
BANGALORE URBAN
Bangalore
VYDEHI
HOSPITAL
BANGALORE
Carcinoma mid
thoracic
CANCER
esophagus stage
T4aN2Mo
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
29-Jun-15
18-Aug-15
60000
60000
59904
5990
53914
IDBI - 321
30-Oct-15
Mysore
THE RADIANT
INSTITUTE
MYSORE
CA LARYNX
STAGE II
T3M0M0
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
2-Jul-15
17-Aug-15
85000
85000
84500
8450
76050
IDBI - 321
30-Oct-15
Bangalore
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
stricture urethra RENAL
Genito Urinary
Surgery
Urology
Urethroplasty for
913
913
27-Jun-15
10-Jul-15
20000
20000
18000
1800
16200
IDBI - 321
30-Oct-15
Mysore
BGS GLOBAL
HOSPITAL
CARCINOMA
B
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
30-Jun-15
8-Aug-15
105000
105000
75000
300
74700
IDBI - 321
30-Oct-15
Mysore
Sri
Adichunchanagi
B G Nagara
ri Hospital and
Research Center
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
24-Jun-15
8-Jul-15
25000
25718
17500
1750
15750
IDBI - 321
30-Oct-15
1211 H_23069300940
Male
75
Others BHAKTHNAVITLE
CHANNARAYAP
HASSAN
ATNA
1212 H_20332300651
Male
56
Others PAVAGADA
PAVAGADA
1213 H_19491300412
1214 H_20790300476
Female
Male
50
39
Others HUTHAGERE
Others Halebudanuru
MADDUR
MANDYA
TUMKUR
MANDYA
MANDYA
BANGALORE
SOUTH
BANGALORE
SOUTH
CANCER
B/L multiple
renal calculai +
Lft mild
RENAL
Hydronephrosis
due to renal
pelvic.
Genito Urinary
Surgery
Sl.No
Preauth No
Gender
Age
Caste
Village
1215 H_20698299914
Male
55
Others M B AIYYANAHALLI
1216 H_19574300546
Female
42
Others
Taluk
KUDLIGI
GUMMAVANDLAPAL
BAGEPALLI
LI
Patient District
BELLARY
Patient
Division
Gulbarga
CHIKKABALLAPU
Bangalore
R
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
YENEPOYA
MEDICAL
COLLEGE
HOSPITAL
MANGALORE
carcinoma base
of tongue
TXN2M0
CANCER
VYDEHI
HOSPITAL
BANGALORE
Carcinoma cervix
CANCER
III B
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
22-Jun-15
19-Aug-15
87000
87000
87000
8700
78300
IDBI - 321
30-Oct-15
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
12-Jun-15
21-Aug-15
73500
73500
71500
7150
64350
IDBI - 321
30-Oct-15
Surgical Oncology
Gynaec-Ca.Cervix
Radical
Hysterectomy
+Bilateral Pelvic
Lymph Node
Dissection (BPLND)
Ophorectomy
(BSO) / Ovarian
transposition
648
648
30-Jun-15
7-Jul-15
45000
45370
42750
4275
38475
IDBI - 321
30-Oct-15
Cardiology
Cardiology
3D Maping +
Ablation
127
127
1-Jul-15
20-Jul-15
50000
50000
50000
0
50000
IDBI - 321
30-Oct-15
567
567
9-Jul-15
22-Aug-15
80000
80000
80000
0
80000
IDBI - 321
30-Oct-15
1217 H_20082298914
Female
62
Others CHINTHAMANI
CHINTAMANI
CHIKKABALLAPU
Bangalore
R
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca Cervix IB1
1218 H_19577300302
Female
63
Others ANEKAL
ANEKAL
BANGALORE URBAN
Bangalore
SJICR
BANGALORE
SOUTH
ATRIAL FLUTTER CARDIOLOGY
Mysore
RIGHT PETROUS
MENINGIOMA
CANCER
GRADE II
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
Ca cervix IV A
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
12-Jul-15
29-Aug-15
22500
24880
22500
2250
20250
IDBI-294
9-Oct-15
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
1-Jul-15
12-Aug-15
81000
81000
80080
8008
72072
IDBI-294
9-Oct-15
CANCER
1219 H_19505300123
Male
22
Others CHIKKANAHALLAI
HOLENARSIPUR HASSAN
Mysore
Bharath
Hospital
Institute of
Oncology
1220 H_19567300445
Female
55
Others Gadag
GADAG
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca cervix III B
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
1221 H_19567300291
Female
52
1222 H_20025300433
Male
30
1223 H_21052300294
Male
47
1224 H_21897300092
1225 H_19577300236
Male
Male
79
13
GADAG
CANCER
HAVERI
HAVERI
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Others KESERE
MYSORE
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
RT VUJ
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
23-Jun-15
27-Jun-15
25000
25000
17500
1750
15750
IDBI - 321
30-Oct-15
Others ARASINAMAKKI
BELTHANGADI
DAKSHINA
KANNADA
Mysore
SUPRAGLOTTIS
MALIGNANCY
STAGE III
CANCER
Surgical Oncology
Tracheostomy
675
675
16-Jun-15
27-Jun-15
3000
30265
2100
210
1890
IDBI - 321
30-Oct-15
GLOBAL
MULTISPECIALIT
MANGALORE
Y HOSPITAL
INDIA PVT LTD
GROSS
PROSTATOMEGA
LY WITH URINary
BLADDER
RENAL
&OUTLET
OBSTRUCTION
B/L RENAL
CALCULUS
Genito Urinary
Surgery
Urology
TURP
917
917
22-Jun-15
1-Jul-15
20000
20000
14000
1400
12600
IDBI - 321
30-Oct-15
Cardiology
Cardiology
Balloon
Pulmonary
Valvotomy
/Pulmonary Artery
and Branch
Vessels(LPA/RPA)
Stenosis for
Balloon Dilatation
107
107
29-Jun-15
4-Jul-15
20000
20000
20000
0
20000
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
20-Jun-15
4-Aug-15
85000
85000
86190
8619
77571
IDBI - 321
30-Oct-15
ST
Chikkalingadhalli
Others 0
Others HOSAKERE
KUNDAPURA
UDUPI
MADHUGIRI
TUMKUR
Mysore
BANGALORE
SOUTH
CHD - COR
TRIATRIUM
Belgaum
KASTURBA
HOSPITAL
UDUPI
CARCINOMA
ESOPHAGUS
POST OP
MARGINE +VE
Bangalore
SJICR
CARDIOLOGY
1226 H_19564300255
Male
45
Others MALAGAON
SIRSI
UTTARA
KANNADA
1227 H_19528298114
Male
58
Minorit
HOLENEREKERE
y
BHADRAVATHI
SHIMOGA
Bangalore
Narayana
Hrudayalaya
Private Limited
Bangalore
CA POST
CRICOID PT2NO, CANCER
II WITH CLOSE
Medical Oncology
Cervical Cancer
Weekly
Cisplatin/Week
509
509
9-Jul-15
17-Aug-15
98000
98000
93840
2815
91025
IDBI - 321
30-Oct-15
1228 H_19505299211
Female
68
Others KEREHUNDI
MYSORE
MYSORE
Mysore
Bharath
Hospital
Institute of
Oncology
Mysore
CA LOWER
OESOPHAGUS
cT2/3N0
Surgical Oncology
Esophagus
Oesophagectomy
with Two field
Lymphadenectomy
673
673
29-Jun-15
11-Jul-15
85000
85000
80750
0
80750
IDBI - 321
30-Oct-15
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
22-Jun-15
26-Jun-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
1229 H_20025299671
Male
43
Others MENASAGERE
MADDUR
MANDYA
CANCER
CANCER
IHD - ACS AWMI
, DELAYED
CARDIOLOGY
PRESENTATION
Sl.No
Preauth No
Caste
Village
Taluk
Patient District
Patient
Division
Final
Diagnosis
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
575
25-Jul-15
28-Jul-15
25000
25000
22000
2200
19800
IDBI - 321
30-Oct-15
433
433
22-Jun-15
29-Jun-15
25000
25000
23750
2375
21375
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
19-Jun-15
11-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Medical Oncology
Non-small cell lung
cancer
Carboplatin +
Paclitaxel/cycle
526
526
27-Jun-15
8-Aug-15
31500
31500
31500
3150
28350
IDBI - 321
30-Oct-15
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
29-Jun-15
12-Aug-15
87000
87000
83000
8300
74700
IDBI-294
9-Oct-15
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
29-Jun-15
1-Jul-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
30-Jun-15
8-Sep-15
87000
87000
82650
8265
74385
IDBI - 321
30-Oct-15
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
23-Jun-15
17-Aug-15
60000
82550
60000
6000
54000
IDBI - 321
30-Oct-15
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
1-Jul-15
17-Aug-15
96000
96000
96000
9600
86400
IDBI-294
9-Oct-15
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
29-Jun-15
5-Aug-15
81000
81000
76950
308
76642
IDBI - 321
30-Oct-15
Male
67
Others HUBBALLI
HUBLI
DHARWAD
Belgaum
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
ca thyroid
t3n1m0
CANCER
Nuclear Medicine
Thyroid
Radioiodine
Treatment > 100
Millicuries
575
1231 H_23124299435
Male
21
Others GANGAVATHI
GANGAVATHI
KOPPAL
Gulbarga
SPARSH SUPER
SPECIALITY
HOSPITAL
BANGALORE
NORTH
L5-S1 PIVD
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
YENEPOYA
MEDICAL
COLLEGE
HOSPITAL
MANGALORE
LEFT PUJ
CALCULUS
RENAL
Genito Urinary
Surgery
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
CA LUNG
T3N1Mo
CANCER
Ca Oesophagus
upper & middle
stage III
HASSAN
right uppear
ureteric stone
SHIMOGA
Ca.(L) PFS
cT3N0M0
Female
37
Others HAWALLI ALDUR
1233 H_20082297994
Female
42
Others TURUVANOOR
CHITRADURGA
1234 H_19567296724
Male
80
1235 H_22558296401
Male
27
Others Adaragunchi
SC
Rudrapatna
CHITRADURGA
DHARWAD
DHARWAD
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
ARAKALAGUD
HASSAN
Mysore
Vaatsalya
Hospital
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
Gulbarga
Ca Rectum L/3rd, CANCER
Gulbarga
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Supraglottis
CT3 : N2c: M0 IVA
CARCINOMA
ESOPHAGUS
T3N1M1
CANCER
Radiation Oncology
1236 H_19562290758
Male
58
Others KAMANAKERE
KADUR
CHIKKAMANAGL
Mysore
UR
1237 H_20077299943
Female
43
Others GANGAVAHI
GANGAVATHI
KOPPAL
66
Minorit
Sindhanur
y
1238 H_19567299503
Male
SINDNUR
RAICHUR
1239 H_19491296416
Female
52
Others KOLAGUNDA
ARASIKERE
HASSAN
Mysore
BGS GLOBAL
HOSPITAL
1240 H_20025299333
Male
40
Others KELAGANAHALLI
PIRIYAPATNA
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
LT EMPYEMA
CARDIOLOGY
Decortication
192
192
27-Jun-15
4-Jul-15
50000
50000
47500
4750
42750
IDBI - 321
30-Oct-15
1241 H_20082299293
Female
66
Others HEGGERE
HOSADURGA
CHITRADURGA
Bangalore
Kidwai
Memorial
Institute of
Oncology
ca cervix II B
CANCER
Medical Oncology
Cervical Cancer
Weekly
Cisplatin/week
509
509
30-Jun-15
10-Aug-15
32000
35670
29000
2900
26100
IDBI - 321
30-Oct-15
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
BENIGN
ENLARGEMENT
OF PROSTATE +
BLADDER
GROWTH.
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
19-Jun-15
30-Jun-15
40000
41755
36000
3600
32400
IDBI - 321
30-Oct-15
CA LEFT
PYRIFORM
CANCER
FOSSA T3N2bM0
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
8-Jul-15
11-Sep-15
83000
83000
83000
0
83000
IDBI - 321
30-Oct-15
IHD USA CAD
SVD
Cardiology
Cardiology
PTCA - 2 stent
(non-medicated)
104
104
17-Jun-15
1-Jul-15
70000
70000
70000
7000
63000
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
25-Jun-15
30-Jul-15
88500
88500
74500
7450
67050
IDBI - 321
30-Oct-15
Medical Oncology
unlisted regimen
Palliative
Chemotherapy/Cy
cle (Max. 6 Cycles)
555
555
25-Jun-15
27-Jul-15
45000
45000
15000
75
14925
IDBI - 321
30-Oct-15
1242 H_19571298014
Male
Others ANKALAGA
SOMAVARPET
KODAGU
Mysore
Bharath
Hospital
Institute of
Oncology
HUNAGUNDA
BAGLAKOT
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
MYSORE
CA CERVIX IIB
Bangalore
CARCINOMA OF
OVERY WITH
CANCER
RECURENCE
STAGE IIIC
1243 H_19505297232
Male
62
1244 H_20017298959
Female
70
Others ILKAL
GULBARGA
BANGALORE
SOUTH
65
Minorit
HARADURU
y
JEVARGI
BANGALORE
SOUTH
CANCER
Plan of
treatment
1230 H_20082297172
1232 H_20698300053
Diseases
Disease Main
Category
Age
Mysore
R
UR
Hospital Name
Hospital
District
Gender
1245 H_23069299525
Female
39
Others K.R.NAGAR
KR NAGAR
MYSORE
Mysore
THE RADIANT
INSTITUTE
1246 H_20782297621
Female
60
Others RABBNA HALLI
SHAHPUR
YADGIRI
Gulbarga
HEALTHCARE
GLOBAL
ENTERPRISES
LTD
Mysore
CARDIOLOGY
CANCER
Sl.No
Preauth No
1247 H_20086294160
1248 H_19567299438
Gender
Age
Male
55
Male
60
Caste
Village
Taluk
Others BADAMAKANAHALLI BANGARPET
Others Aminghad
MANVI
Patient District
KOLAR
RAICHUR
Patient
Division
Gulbarga
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Oropharynx
CT2:N2a:M0
SRI SHANKARA
CANCER
HOSPITAL AND
RESEARCH
CENTRE
Others sabanahalli
HOLENARSIPUR HASSAN
Mysore
1250 H_20082298895
Male
56
Others HOSAHALLI
PIRIYAPATNA
MYSORE
Mysore
1251 H_20082298900
Female
47
Others KAMSANDRA
ARASIKERE
HASSAN
Mysore
Others CHIKKODI
CHIKKODI
BELGAUM
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Mitral Valve
Repair
141
141
1-Jun-15
24-Jun-15
100000
100000
70000
7000
63000
IDBI - 321
30-Oct-15
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
9-Jul-15
24-Aug-15
96000
96000
90000
9000
81000
IDBI-294
9-Oct-15
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
24-Jun-15
14-Aug-15
74000
74000
74000
0
74000
IDBI - 321
30-Oct-15
Gastrectomy - any
type
636
636
17-Jun-15
2-Jul-15
60000
62450
33250
3325
29925
IDBI - 321
30-Oct-15
512
512
2-Jul-15
12-Aug-15
31500
43510
28500
2850
25650
IDBI - 321
30-Oct-15
Ca Stomach
T3N1Mo
CANCER
Surgical Oncology
BANGALORE
SOUTH
ca Cervix Stage
IV B
CANCER
Medical Oncology
Ovarian Cancer
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
14-Jul-15
27-Aug-15
86000
131000
86000
8600
77400
IDBI - 321
30-Oct-15
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
6-Jul-15
2-Sep-15
102000
102000
100000
10000
90000
IDBI - 321
30-Oct-15
Carboplatin/Paclit
axel/Cycle
Belgaum
Kolhapur Cancer
Karveer
Centre
CA
OROPHARYNX
T2N0M0
Ca Larynx Stage
III cT2N2bM0
CANCER
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
BANGALORE
SOUTH
ca ovary III
CANCER
Surgical Oncology
Gynaec
Surgery for Ca
Ovary - advance
stage
596
596
25-Jun-15
3-Jul-15
40000
43080
28000
2800
25200
IDBI - 321
30-Oct-15
Mysore
CA BASE OF
TONGUE
/VALECULLA
WITH
LYMPHNODE
METS IV
CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
11-Jul-15
28-Aug-15
60000
58000
58000
0
58000
IDBI - 321
30-Oct-15
MANGALORE
CARCINOMA
ESOPHAGUS
STAGE T3N2
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
18-Jun-15
13-Aug-15
81000
81000
79000
7900
71100
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
25-Jun-15
28-Jun-15
90000
90000
63000
6300
56700
IDBI - 321
30-Oct-15
RAIBAGH
BELGAUM
Belgaum
1254 H_20082297909
Female
19
Others MASTI
MALUR
KOLAR
Bangalore
Kidwai
Memorial
Institute of
Oncology
Mysore
Bharath
Hospital
Institute of
Oncology
CANCER
HD KOTE
MYSORE
Mysore
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
Belgaum
Suguna Hospital BANGALORE
Bangalore
NORTH
CAD- RECNT
AWMI, MILD LV
DIS FUNCTION
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
CAD - TVD, LVEFCARDIOLOGY
35-40%.
CABG
132
132
26-Jun-15
9-Jul-15
95000
95000
90250
9025
81225
IDBI - 321
30-Oct-15
RT.RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
DJ stent (One
side)
911
911
12-Jun-15
27-Jun-15
10000
10000
6650
665
5985
IDBI - 321
30-Oct-15
CA BILATERAL
OVARY III C
CANCER
Medical Oncology
Ovarian Cancer
512
512
24-Jun-15
25-Aug-15
42000
42000
42000
0
42000
IDBI - 321
30-Oct-15
POST PTCA /CX
WITH INSTENT
RESTENOST S
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
29-Aug-15
2-Sep-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
IHD-ACS-ACUTE
IWMI CAD-SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
26-Aug-15
31-Aug-15
90000
90000
88500
8850
79650
IDBI - 321
30-Oct-15
RT PUJ
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
2-Sep-15
7-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
1256 H_19522298572
Male
68
Others NAVOOR
BANTWAL
DAKSHINA
KANNADA
1257 H_20076298772
Male
50
Others 0
INDI
BIJAPUR
1258 H_20079299081
Male
49
Others LINGADA HALLI
TARIKERE
CHIKKAMANAGL
Mysore
UR
1259 H_20017299049
Female
11
Minorit
BALEKUNDRI
y
BELGAUM
BELGAUM
Belgaum
1260 H_19505298260
Male
72
Others MALAVALLII
MALAVALLI
MANDYA
Mysore
1261 H_21695324365
Male
40
SINDAGI
BIJAPUR
Belgaum
1262 H_20733323936
Male
52
Others Aktagur
MANDYA
MANDYA
Mysore
1263 H_20025324080
Female
33
Others PAALYA
KOLLEGAL
CHAMARAJANA
Mysore
GAR
CHANDAKOTE
Date of
Admission
BANGALORE
SOUTH
Others Harugeri
ST
Radiation Oncology
61
Others G.B.SARAGURU
Plan of
treatment
Ca cervix stage II CANCER
Male
56
3D Conformational
Radio Therapy
1253 H_19504298980
Male
CANCER
Disease Main
Category
BANGALORE
SOUTH
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
1255 H_19505298309
Diseases
RHD-SEVERE
AS,MR,MVR,SEV
CARDIOLOGY
ERE TR,S/P PTCA
TO LCX
41
34
Final
Diagnosis
R L JALAPPA
NARAYANA
KOLAR
HRUDAYALAYA
HEART CENTRE
Female
Male
Hospital
District
Bangalore
1249 H_22163299129
1252 H_20435299037
Hospital Name
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
Bharath
Hospital
Mysore
Institute of
Oncology
Ashwini
Sahakari
Rugnalaya Ani Solapur
Sansodhan
Kendra
SJICR MYSORE
MYSORE
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
Carboplatin/Paclit
axel/Cycle
Sl.No
Preauth No
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Gender
Age
1264 H_19586324028
Male
68
Others GANIMADI
GADAG
GADAG
Belgaum
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
BANGALORE
C3-4
SPONDYLOLISTH NEURO SURGERY
ESIS GRADE -I
Neuro Surgery
Spinal
1265 H_19577324138
Female
27
Others SHETTIKERE
YADGIR
YADGIRI
Gulbarga
SJICR
BANGALORE
SOUTH
RHD - SEVERE
MS, SEVERE TR
CARDIOLOGY
Cardiology
Cardiology
1266 H_19577324152
Male
62
Others KALLUDI
GOWRIBIDANUR
CHIKKABALLAPU
Bangalore
R
SJICR
BANGALORE
SOUTH
ACS - USA, SVD
CARDIOLOGY
Cardiology
Cardiology
1267 H_19576324297
Male
49
Others Ramadurga
RAMADURGA
BELGAUM
Belgaum
CAD-TVD
CARDIOLOGY
1268 H_20200324275
Male
48
Others NAIDU NAGAR
MYSORE
MYSORE
Mysore
1269 H_19564324238
Male
39
Others BADANIDIYUR
UDUPI
UDUPI
Mysore
KASTURBA
HOSPITAL
MANDYA
Plan of
treatment
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
Balloon Mitral
Valvotomy
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
435
435
28-Aug-15
7-Sep-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
105
105
28-Aug-15
1-Sep-15
20000
20000
19000
0
19000
IDBI - 321
30-Oct-15
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
25-Aug-15
2-Sep-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
CABG
132
132
26-Aug-15
8-Sep-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
CHD+SVASD+PAP
CARDIOLOGY
VC L-R SHUNT
ASD
151
151
5-Sep-15
12-Sep-15
80000
80000
80000
0
80000
IDBI - 321
30-Oct-15
NSTEMI,DOUBLE
CARDIOLOGY
VESSEL DISEASE
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
28-Aug-15
1-Sep-15
90000
90000
91800
9180
82620
IDBI - 321
30-Oct-15
Mysore
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
l4-5 pvd
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
1-Sep-15
7-Sep-15
25000
25000
25000
0
25000
IDBI - 321
30-Oct-15
HAVERI
Belgaum
KASTURBA
HOSPITAL
UDUPI
CORONARY
ARTERY DISEASE,
CARDIOLOGY
CHRONIC STABLE
ANGINA
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
27-Aug-15
2-Sep-15
90000
90000
91800
9180
82620
IDBI - 321
30-Oct-15
HIRIYUR
CHITRADURGA
Bangalore
SJICR
BANGALORE
SOUTH
CHD - TOF
CARDIOLOGY
ICR for TOF
154
154
1-Aug-15
3-Sep-15
100000
100000
100000
0
100000
IDBI - 321
30-Oct-15
Others kadechur
YADGIR
YADGIRI
Gulbarga
SUNSHINE
HEART
INSTITUTE
Paradise, S.D.
Road
CAD SINGLE
VESSEL DISEASE
DES STENT
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
27-Aug-15
2-Sep-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
Minorit
MAKKALGERI
y
GOKAK
BELGAUM
Belgaum
LEFT TESTICULAR
CANCER
TUMOUR
Surgical Oncology
High
Orchidectomy
587
587
27-Aug-15
3-Sep-15
15000
15000
15000
1500
13500
IDBI - 321
30-Oct-15
BELGAUM
BELGAUM
Belgaum
L1-L2,L2-L3,L3L4,L4-L5 DISC
PROLAPSE.
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
1-Sep-15
7-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
RIGHT RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
29-Aug-15
5-Sep-15
25000
29728
25000
2500
22500
IDBI - 321
30-Oct-15
RT PUJ CALCULI
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
28-Aug-15
31-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
TIPTUR
left ureteric
calculus
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
29-Aug-15
31-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
RANEBENNUR
PIVD Sciatica at
L4-L5 B/L lower
limb L>R.
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
4-Sep-15
11-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
BANGALORE
NORTH
LEFT RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
24-Aug-15
4-Sep-15
25000
25000
20000
2000
18000
IDBI - 321
30-Oct-15
CARDIOLOGY
CABG
132
132
2-Sep-15
18-Sep-15
95000
95000
96900
2907
93993
IDBI - 321
30-Oct-15
1270 H_20200324268
Male
45
Others KODUKOLE HALLI
1271 H_19564324247
Male
41
Others CHIKKAKURUVATTHI RANEBENNUR
1272 H_19577318471
Male
13
1273 H_21701323517
Male
55
1274 H_20017323616
Male
11 Months
1275 H_22226324233
Female
51
SC
ST
AJJANAHATTI
BODKENATTI
MADDUR
SDM Narayana
Dharwad
Hrudayalaya
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
UDUPI
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
Viajya Ortho
BELGAUM
and Trauma
Centre
1276 H_22337324245
Male
33
Others MITTALAKOD
KUSTAGI
KOPPAL
Gulbarga
BARAGI
HOSPITAL
BAGALKOT
1277 H_20025324237
Female
22
Others ULUGULI
SOMAVARPET
KODAGU
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
1278 H_21925324109
Male
50
Others 0
TURVEKERE
TUMKUR
Bangalore
1279 H_20215324240
Female
30
Others Shriram Nagara
GANGAVATHI
KOPPAL
Gulbarga
KOLAR
KOLAR
Bangalore
M S Ramaiah
Hospital
MUDRA
HOSPITAL
SRI LAXMI
SURGICAL
TRAUMA
ORTHO AND
MULTISPECILIT
BAGALKOT
NEURO SURGERY
1280 H_20010324221
Male
11
Minorit
RAHAMATH NAGAR
y
1281 H_19528324173
Male
44
Others KALAKNAGARA
KANAKAPURA
RAMANAGAR
Bangalore
Narayana
Hrudayalaya
Private Limited
Bangalore
cad-tvd
1282 H_19528324177
Female
9
Others HANDIGANUR
SINDAGI
BIJAPUR
Belgaum
Narayana
Hrudayalaya
Private Limited
Bangalore
SMALL TO
MODERATE
CARDIOLOGY
SECUNDUM ASD
L-R SHUNT
Cardiology
Device Closure
ASD Device
Closure
120
120
1-Sep-15
3-Sep-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
Bangalore
CHD-LARGE
OSTIUM SEC ASD
WITH MULTIPLE CARDIOLOGY
FENESTRATION LR SHUNT
Cardiology
Device Closure
ASD Device
Closure
120
120
31-Aug-15
1-Sep-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
Paradise, S.D.
Road
cad triple vessel
CARDIOLOGY
disease
CABG
132
132
26-Aug-15
10-Sep-15
95000
95000
96900
9690
87210
IDBI - 321
30-Oct-15
1283 H_19528324189
Female
50
1284 H_21701323850
Male
58
Others KUFALTOD
SC
post kotha
HUMNABAD
BIDAR
Gulbarga
Narayana
Hrudayalaya
Private Limited
LINGASUGUR
RAICHUR
Gulbarga
SUNSHINE
HEART
INSTITUTE
Sl.No
Preauth No
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
132
27-Aug-15
16-Sep-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
132
132
26-Aug-15
7-Sep-15
95000
302119
95000
0
95000
IDBI - 321
30-Oct-15
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
26-Aug-15
1-Sep-15
90000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
Urology
Urethroplasty for
913
913
18-Aug-15
1-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
Urology
Cystolithotripsy
906
906
31-Aug-15
3-Sep-15
12500
12500
12500
1250
11250
IDBI - 321
30-Oct-15
Mitral Valve
Repair
141
141
11-Sep-15
21-Sep-15
100000
100000
100000
10000
90000
IDBI - 321
30-Oct-15
RIGHT L4-5
SEXTRUDED DISC
L5 S1 DISC
NEURO SURGERY
BULGE WITH B/L
FORAMINAL
STENOSIS
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
1-Sep-15
3-Sep-15
25000
25000
25500
765
24735
IDBI - 321
30-Oct-15
(R)RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
27-Aug-15
3-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
BANGALORE
CAD-SVD LMCA
CARDIOLOGY
CABG
132
132
31-Aug-15
11-Sep-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
Bangalore
DIASTOMETAMY
NEURO SURGERY
ELIA
Neuro Surgery
Spinal
Spina Bifida
Surgery Major
437
437
18-Aug-15
5-Sep-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
RT RENAL PELVIC
CALCULUS + RT
MID URETERIC RENAL
CALCULUS WITH
HUN
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
1-Sep-15
7-Sep-15
37500
37500
37500
3750
33750
IDBI - 321
30-Oct-15
Others KOGANALI
CHIKKODI
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
CAD TVD
CARDIOLOGY
CABG
132
1286 H_20083324174
Female
57
Others Karlapura
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
Bhagwan
Mahaveer Jain
Hospital
Bangalore
NSTEMI DOUBLE
CARDIOLOGY
VESSEL DISEASE
CABG
1287 H_19549324142
Male
45
Minorit
0
y
CHITRADURGA
CHITRADURGA
Bangalore
Sagar Hospitals
BANGALORE
SOUTH
IHD, RECENT
IWMI
Cardiology
Cardiology
1288 H_20531324169
Male
42
Others KETHOHALLI
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
RAJARAJESWARI
MEDICALCOLLE
BANGALORE
GE AND
HOSPITAL
Stricture urethra RENAL
Genito Urinary
Surgery
1289 H_20025322507
Male
44
Others BENDGHALLI
NANJANAGUD
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
VESICAL
CALCULUS
Genito Urinary
Surgery
1290 H_23124323393
Female
12
Others JIVESHWAR NAGAR
SHAHPUR
YADGIRI
Gulbarga
SPARSH SUPER
SPECIALITY
HOSPITAL
BANGALORE
NORTH
RHD, severe MR
with severe TR
CARDIOLOGY
with SEVERE PAH
in NSR
Belgaum
Narayana
Hrudayalaya
Private Limited
Bangalore
GLOBAL
MULTISPECIALIT
MANGALORE
Y HOSPITAL
INDIA PVT LTD
INDI
BIJAPUR
1292 H_21897323988
Male
22
Others 0
SHIMOGA
SHIMOGA
Bangalore
1293 H_19574323619
Male
58
Minorit
HUSUR GALLI
y
HALIYAL
UTTARA
KANNADA
Belgaum
1294 H_20300322617
Female
HASSAN
Mysore
Hospital Name
VYDEHI
HOSPITAL
BMCRI SSH
PMSSY
8
Others NA GOLLARAHATTI
ARASIKERE
Mysore
GAR
GAR
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
Diseases
CARDIOLOGY
RENAL
Plan of
treatment
61
Minorit
HIREBEVANURU
y
Patient District
Disease Main
Category
Male
35
Taluk
Final
Diagnosis
1285 H_20017324183
Female
Village
Hospital
District
Age
1291 H_19528323668
Caste
Patient
Division
Gender
1295 H_20025323831
Male
34
Minorit
HONGANUR
y
1296 H_19549323352
Male
52
Others 0
MADDUR
MANDYA
Mysore
Sagar Hospitals
BANGALORE
SOUTH
L3-4 SEVERE
CANAL STENOSIS
NEURO SURGERY
WITH
HYPRDOPHYS
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
5-Sep-15
9-Sep-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
1297 H_19528324103
Male
9
Others KALLUR
MANVI
RAICHUR
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
mod secundum
asd l-r shunt
Cardiology
Device Closure
ASD Device
Closure
120
120
1-Sep-15
3-Sep-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
1298 H_19520323902
Male
26
BAGALKOTE
BAGLAKOT
Belgaum
SNMC HSK
HSopital
BAGALKOTE
L4-5 PROLAPSED
NEURO SURGERY
DISC
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
28-Aug-15
16-Sep-15
25000
55692
25000
2500
22500
IDBI - 321
30-Oct-15
1299 H_21057323984
Female
23
BHATKALA
UTTARA
KANNADA
Belgaum
NEW
RHD SEVERE MR,
MILD MS, MOD CARDIOLOGY
PAH, MOD AR
Double Valve
Replacement
149
149
27-Aug-15
10-Sep-15
150000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
1300 H_19586324009
Male
55
SIRA
TUMKUR
Bangalore
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
BPH
Genito Urinary
Surgery
Urology
TURP
917
917
24-Aug-15
10-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
Cardiology
Permanent
pacemaker
VVI) including
Pacemaker value
114
114
21-Aug-15
2-Sep-15
75000
75000
73500
7350
66150
IDBI - 321
30-Oct-15
SC
NAVANAGAR
BAGALKOT
Others BILURAMANE
ST
SHAKADADU
1301 H_20733323775
Male
77
Others Nagamgala
MANDYA
MANDYA
Mysore
1302 H_20322324071
Male
62
Others KOLNADU
BANTWAL
DAKSHINA
KANNADA
Mysore
1303 H_20017324067
Male
51
Minorit
0
y
BIJAPUR
BIJAPUR
Belgaum
SJICR MYSORE
BANGALORE
MYSORE
INDIANA
HOSPITAL AND
MANGALORE
HEART
INSTITUTE LTD
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
CHB
CARDIOLOGY
RENAL
CARDIOLOGY
ACS-STEMI IWMI CARDIOLOGY
CABG with IABP
133
133
31-Aug-15
19-Sep-15
115000
170345
115000
11500
103500
IDBI - 321
30-Oct-15
IHD USA CAD
SVD
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
25-Aug-15
2-Sep-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Sl.No
Preauth No
1304 H_19577323793
1305 H_20200323905
Gender
Age
Male
61
Others AYNUR
69
Minorit
GUTTALU
y
Male
Caste
Village
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
BANGALORE
B M Sri Nagara,
Metagalli
MYSORE
MYSORE
Mysore
SJICR MYSORE
MYSORE
SAVADATTI
BELGAUM
Belgaum
1308 H_20733324039
Male
48
SC
1309 H_20017323750
Male
45
31
1313 H_19576323965
Male
57
1314 H_21044323362
Male
45 Days
1315 H_20332323915
Male
42
1316 H_19564323727
Female
74
1317 H_20880323948
Male
66
1318 H_20127322995
Male
48
1319 H_20112323771
Female
7
1320 H_20203323747
Male
46
1321 H_19564323868
Female
65
Minorit
0
y
Others ALLATHURU
Others KADUMANE
SC
BANGALORE
SOUTH
Bangalore
Others
Male
Mysore
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
BANGALORE RURAL
33
1312 H_19571322519
SJICR
NELEMANGALA
Female
59
BANGALORE
SOUTH
Gulbarga
BAGAVANTA RAO
LEYOUT
1307 H_19586324011
Male
Hospital
District
Belgaum
Others Laxmeshwar
1311 H_20015323969
MANDYA
Hospital Name
GADAG
25
56
MANDYA
RAICHUR
Patient
Division
SIRAHATTI
Female
Male
SINDNUR
Patient District
TRINITY
HOSPITAL AND
HEART
FOUNDATION
1306 H_19593324059
1310 H_20200324003
Taluk
KARIAMBARGA
Minorit
Gangavathi
y
PVD LEFT CIA
99% LEASION
CARDIOLOGY
Cardiology
Cardiology
COMPLETE
HEART BLOCKE
CARDIOLOGY
Cardiology
Rheumatic Heart
Disease - Severe
Mitral Stenosis CARDIOLOGY
with Moderate
MR
RIGHT
PROXIMAL
RENAL
URETERIC
CALCULUS
Plan of
treatment
Peripheral
Angioplasty
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
109
109
3-Sep-15
7-Sep-15
55000
55000
54000
0
54000
IDBI - 321
30-Oct-15
Temporary
implantation
113
113
28-Aug-15
3-Sep-15
79000
79000
77000
0
77000
IDBI - 321
30-Oct-15
Mitral Valve
Replacement
145
145
28-Aug-15
7-Sep-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
28-Aug-15
9-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Cardiology
Cardiology
Medical
treatment of
Acute MI with
Thrombolysis
128
128
25-Aug-15
29-Aug-15
10000
10000
8500
850
7650
IDBI - 321
30-Oct-15
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
WPW
SYNDROME
WITH SVT
CARDIOLOGY
Cardiology
Cardiology
EP study
125
125
24-Aug-15
2-Sep-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
CHAMARAJANA
Mysore
GAR
NARAYANA
HRUDAYALAYA
SURGICAL
MYSORE
HOSPITAL PVT
LTD
ACS ACUTE
AWMI .KILLIP
CLASSA 1
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
27-Aug-15
2-Sep-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
SAKLESHPURA
HASSAN
Mysore
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
WELL
DIFFERENTIATED
ADENOCARCINO
CANCER
MAPYLORUS.T4N2M
0.
Surgical Oncology
Gastro
Jejunostomy
681
681
20-Aug-15
18-Sep-15
35000
45000
45000
4500
40500
IDBI - 321
30-Oct-15
ALAND
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
25-Aug-15
1-Sep-15
25000
35769
25000
2500
22500
IDBI - 321
30-Oct-15
GANGAVATHI
KOPPAL
Gulbarga
SDM Narayana
Hrudayalaya
Dharwad
CAD-LMCA+LAD
CARDIOLOGY
& LCX Disease
CABG
132
132
31-Aug-15
12-Sep-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
MANGALORE
CONGENITAL
LOBAR
EMPHYSEMA
LEFT UPPER
LOBE
NEONATAL
Thorax
Thoracic Wall
defects Correction
325
325
21-Aug-15
9-Sep-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
vesical calculus
RENAL
Genito Urinary
Surgery
Urology
Cystolithotripsy
906
906
31-Aug-15
3-Sep-15
12500
12500
12500
1250
11250
IDBI - 321
30-Oct-15
239
239
26-Aug-15
3-Sep-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
GUNDLUPET
MANGALORE
SHIMOGA
SHIMOGA
Bangalore
Others SHRAVANAGERE
HIRIYUR
CHITRADURGA
Bangalore
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
Madhbhavi
Disease Main
Category
CARDIOLOGY
Others HOLEHATTI
SC
Diseases
IHD-ACS-ACUTE
AWMI
WENLOCK
DISTRICT
HOSPITAL
Others KANNUKERE
Final
Diagnosis
CARDIOLOGY
CARDIOLOGY
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
IHD UNSTABLE
ANGINA,DOUBLE CARDIOLOGY
VESSEL DISEASE
Cardiology
Cardiology
PTCA - 2 stent
(non-medicated)
104
104
28-Aug-15
1-Sep-15
70000
70000
55000
5500
49500
IDBI - 321
30-Oct-15
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
24-Aug-15
29-Aug-15
65000
119746
66300
6630
59670
IDBI - 321
30-Oct-15
UDUPI
UDUPI
Mysore
KASTURBA
HOSPITAL
ATHANI
BELGAUM
Belgaum
Wanless
Hospital Miraj
Miraj
Medical Center
miraj
CAD
CARDIOLOGY
Cardiology
UDUPI
IWMI/CHB/DM
CHITRADURGA
CHITRADURGA
Bangalore
A J HOSPITAL
CENTRE
DAVANAGERE
DAVANGERE
Bangalore
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
CHD- LARGE OS
ASD WITH L->R
SHUNT
CARDIOLOGY
ASD
151
151
26-Aug-15
8-Sep-15
80000
80000
80000
2400
77600
IDBI - 321
30-Oct-15
Others Veerapur
HUBLI
DHARWAD
Belgaum
KARNATAKA
INSTITUTE OF
MEDICAL
SCINCES
HUBLI
Single Vessel
Disease
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
30-Aug-15
2-Sep-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
Others BARUVE
SHIMOGA
SHIMOGA
Bangalore
KASTURBA
HOSPITAL
UDUPI
AWMI/DM/TVD CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
25-Aug-15
29-Aug-15
90000
90000
91800
9180
82620
IDBI - 321
30-Oct-15
Others G R HALLI
SC
PAMENAHALLI
Sl.No
Preauth No
Taluk
Diseases
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
240
27-Aug-15
1-Sep-15
65000
65000
64000
0
64000
IDBI - 321
30-Oct-15
241
241
26-Aug-15
29-Aug-15
90000
90000
91800
9180
82620
IDBI - 321
30-Oct-15
URSL - Single Side
+ DJ Stent
909
909
31-Aug-15
1-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Anterior Cervical
Discectomy
Multiple level with
Implants
(procedure
30000+ Implants
10000)
429
429
30-Aug-15
2-Sep-15
40000
40000
40800
1224
39576
IDBI - 321
30-Oct-15
Plan of
treatment
59
Others PG HALLI
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
SJICR
BANGALORE
SOUTH
IHD AWMI POST
CARDIOLOGY
MI ANGINA SVD
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
1323 H_19564323707
Male
50
Others CHANTHARU
UDUPI
UDUPI
Mysore
KASTURBA
HOSPITAL
UDUPI
ANTERIOR WALL
CARDIOLOGY
MI /DM
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
38
LOKANAYAKA
Others
NAGARA
Mysore
BRINDAVAN
HOSPITAL
MYSORE
Left lower
segment large
(14mm) ureteric RENAL
calculus with
HUN
Genito Urinary
Surgery
Urology
Spinal
MYSORE
Hospital Name
Disease Main
Category
Male
MYSORE
Patient District
Final
Diagnosis
1322 H_19577323910
Female
Village
Hospital
District
Age
1324 H_22658323900
Caste
Patient
Division
Gender
1325 H_19528320891
Female
45
Others MUDALAGIRICAMP
SINDNUR
RAICHUR
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
CERVICAL CANAL
NEURO SURGERY
STENOSIS
Neuro Surgery
1326 H_19576323636
Female
27
Others Dharwad
DHARWAD
DHARWAD
Belgaum
SDM Narayana
Hrudayalaya
Dharwad
RHD Severe MR
Severe AS with
Grade II AR.
Double Valve
Replacement
149
149
27-Aug-15
12-Sep-15
150000
150000
150000
15000
135000
IDBI - 321
30-Oct-15
1327 H_21919323298
Male
36
ANEKAL
BANGALORE URBAN
Bangalore
NU Hospitals
Pvt Ltd
Bangalore
RIGHT URETERIC
RENAL
CALCULUS
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
30-Aug-15
1-Sep-15
25000
25000
25500
2550
22950
IDBI - 321
30-Oct-15
1328 H_20300323878
Male
7 Days
Others NITTARAHALLI
MADHUGIRI
TUMKUR
Bangalore
BMCRI SSH
PMSSY
Bangalore
HIGH ARM
Anorectal
Malformations
Stage 1
305
305
24-Aug-15
30-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
1329 H_19510320964
Male
20
Others CHIMMALAGI
BASAVANABAGE
BIJAPUR
WADI
Belgaum
M/s Kerudi
Hospital And
Bagalkot
Research Centre
Bagalkot
LEFT URETERAL
AND LEFT RENAL RENAL
CALCULUS
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
10-Sep-15
11-Sep-15
25000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
1330 H_20212323867
Male
42
Others Satti
ATHANI
Belgaum
Mahatma
Gandhi Cancer
Hospital
Miraj
Ca (L) RMT T3 N1
CANCER
M0 [Stage-III]
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
28-Aug-15
10-Sep-15
60000
70403
57000
5700
51300
IDBI - 321
30-Oct-15
MAHALINGPUR
Right renal pelvic
RENAL
calculus
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
29-Aug-15
1-Sep-15
25000
29760
25000
2500
22500
IDBI - 321
30-Oct-15
SC
Hennagara
BELGAUM
CARDIOLOGY
NEONATAL
1331 H_22458323448
Male
47
Others Hanagandi
JAMAKHANDI
BAGLAKOT
Belgaum
VENKATESH
HOSPITAL
1332 H_20880323855
Male
31
Others Athani
ATHANI
BELGAUM
Belgaum
Wanless
Hospital Miraj
Miraj
Medical Center
miraj
IHD UNSTABLE
ANGINA,SINGLE CARDIOLOGY
VESSEL DISEASE
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
28-Aug-15
31-Aug-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
1333 H_20880323836
Female
54
Others Ainapur
ATHANI
BELGAUM
Belgaum
Wanless
Hospital Miraj
Miraj
Medical Center
miraj
IHD UNSTABLE
ANGINA,SINGLE
CARDIOLOGY
VESSEL DISEASE
with HTN
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
28-Aug-15
1-Sep-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
1334 H_19505323749
Female
37
Minorit
NANJANGUD
y
NANJANAGUD
MYSORE
Mysore
Bharath
Hospital
Institute of
Oncology
Mysore
CA LEFT BREAST
CANCER
cT3N0M0
Surgical Oncology
Breast
Wide excision +
Reconstruction
601
601
31-Aug-15
3-Sep-15
32500
32500
22300
0
22300
IDBI - 321
30-Oct-15
1335 H_20511323608
Female
61
Others Bhoj
CHIKKODI
BELGAUM
Belgaum
SWASTIK
HOSPITAL
KOLHAPUR
CAD, UNSTABLE
CARDIOLOGY
ANGINA
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
25-Aug-15
31-Aug-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
1336 H_20015323818
Female
39
Others BALNADU
PUTTUR
DAKSHINA
KANNADA
Mysore
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
MANGALORE
Surgical Oncology
Gastro
Jejunostomy
681
681
12-Aug-15
29-Aug-15
35000
35000
35000
3500
31500
IDBI - 321
30-Oct-15
1337 H_19576323815
Male
48
Others Javoor
NAVALAGUND
DHARWAD
Belgaum
SDM Narayana
Hrudayalaya
Dharwad
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
25-Aug-15
31-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
CHAMARAJANA
Mysore
GAR
1338 H_20200322597
Male
8
Others UPPINA MOLLE
YELANDUR
1339 H_20619322583
Male
61
Others ARASANALU
HARAPANAHALL
DAVANGERE
I
25
Minorit
Anthapur
y
1340 H_22458323781
Male
MUDHOLA
BAGLAKOT
Bangalore
Belgaum
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
SUKSHEMA
DAVANGERE
HOSPITAL
PVTLTD
VENKATESH
HOSPITAL
MAHALINGPUR
CARCINOMA
TAIL OF THE
CANCER
PANCREAS.STAG
E IV
CAD-Acute
interior wall MICARDIOLOGY
Significant RCA
disease
asd tr
CARDIOLOGY
ASD
151
151
2-Sep-15
7-Sep-15
100000
100000
80000
0
80000
IDBI - 321
30-Oct-15
BEP
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
28-Aug-15
31-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
Right renal pelvic
RENAL
calculus
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
29-Aug-15
1-Sep-15
25000
29800
25000
2500
22500
IDBI - 321
30-Oct-15
Sl.No
Preauth No
1341 H_19522323713
Gender
Female
Age
16
1342 H_20733322990
Male
45
1343 H_19562323159
Male
51
Caste
Village
Others MAALA
Others PALIBETTA
SC
NEW TOWN
Taluk
KARKALA
Patient District
UDUPI
Patient
Division
Mysore
Hospital Name
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
Hospital
District
MANGALORE
Final
Diagnosis
Diseases
UP TO 36% 3RD
BURNS
DEGREE BURNS.
Disease Main
Category
Burns
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Burns
upto-40% Mixed
Burns(with
grafting)
3
3
26-Aug-15
29-Aug-15
50000
18627
18627
1863
16764
IDBI - 321
30-Oct-15
239
239
25-Aug-15
29-Aug-15
90000
90000
89500
8950
80550
IDBI - 321
30-Oct-15
VIJAPET
KODAGU
Mysore
SJICR MYSORE
MYSORE
IHD-ACS ACUTE
CARDIOLOGY
AWMI CAD-DVD
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
BHADRAVATHI
SHIMOGA
Bangalore
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
SHIMOGA
A known case of
ca. (R) RMT
CANCER
T3N0M0 Stage II
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
9-Sep-15
18-Sep-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
aortic stenosis
mitral stenosis
mitral
regurgitation
CARDIOLOGY
Double Valve
Replacement
149
149
29-Aug-15
9-Sep-15
150000
150000
150000
0
150000
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
16-Aug-15
1-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
114
114
26-Aug-15
31-Aug-15
75000
75000
75000
7500
67500
IDBI - 321
30-Oct-15
1344 H_20200322593
Male
48
SC
DEVALAPURA
HD KOTE
MYSORE
Mysore
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
1345 H_21132321613
Male
50
SC
KIRAGADALU
ALUR
HASSAN
Mysore
Shree
Hospital/HIMS
BPH with AUR
BANGALORE
Sagar Hospitals
SOUTH
COMPLETE
HEART BLOCK,
2:1 AV BLOCK.
CARDIOLOGY
Cardiology
Permanent
pacemaker
VVI) including
Pacemaker value
Belgaum
SVT
CARDIOLOGY
Cardiology
Cardiology
EP study
125
125
24-Aug-15
1-Sep-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
MYSORE
BIL PROXIMAL
RENAL
URETRIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
4-Sep-15
8-Sep-15
37500
15000
15000
0
15000
IDBI - 321
30-Oct-15
Nampally
CARDIAC TAPVC CARDIOLOGY
TAPVC
160
160
27-Aug-15
9-Sep-15
95000
256148
95000
9500
85500
IDBI - 321
30-Oct-15
Solapur
ACC HTN WITH
ACUTE
CORONARY
SYNDRON
CARDIOLOGY
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
27-Aug-15
1-Sep-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
SHIMOGA
IHD, TVD
CARDIOLOGY
CABG
132
132
31-Aug-15
14-Sep-15
95000
95000
95000
950
94050
IDBI - 321
30-Oct-15
Bangalore
Large pericardial
effusion with RA CARDIOLOGY
and RV collapse
Cardiology
Cardiology
Pericardiocentesis
115
115
26-Aug-15
29-Aug-15
3000
29065
3000
0
3000
IDBI - 321
30-Oct-15
1346 H_19549323728
Male
62
Others HALASABALE
MAGADI
RAMANAGAR
Bangalore
1347 H_20017323446
Male
40
Others 0
ATHANI
BELGAUM
Belgaum
1348 H_20200323438
Male
35
Others YADUVANA HALLI
GUNDLUPET
CHAMARAJANA
Mysore
GAR
1349 H_20107323548
Female
1
BIDAR
BIDAR
Gulbarga
1350 H_21695323657
Male
57
Others SULTANPUR
ALAND
GULBARGA
Gulbarga
1351 H_19513323695
Male
54
Others GODLABEEL
SIDDAPUR
UTTARA
KANNADA
Belgaum
1352 H_20083323667
Male
69
Others HOSAPALYA
MULABAGILU
KOLAR
Bangalore
Bhagwan
Mahaveer Jain
Hospital
1353 H_20242323388
Female
62
CHITRADURGA
Bangalore
MEDIHOPE
HOSPITALS AND
BANGALORE
RESEARCH
CENTRE PVT LTD
CAD - SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
25-Aug-15
3-Sep-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
1354 H_22439323531
Male
29
HAVERI
Belgaum
BHS lakeview
Hospital
RT UPPER
URETERIC
CALCULI
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
29-Aug-15
31-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Gynaec-Ca.Cervix
Radical
Hysterectomy
+Bilateral Pelvic
Lymph Node
Dissection (BPLND)
Ophorectomy
(BSO) / Ovarian
transposition
648
648
27-Aug-15
10-Sep-15
45000
66698
45000
4500
40500
IDBI - 321
30-Oct-15
Aortic Valve
Replacement
146
146
12-Aug-15
1-Sep-15
130000
130000
120000
12000
108000
IDBI - 321
30-Oct-15
1355 H_20212323622
1356 H_20015320583
Male
Female
46
65
SC
SC
BIDAR
PARUSHURAMPURA CHALLAKERE
Others HAVERI
Others Savalagi
Others BOGRIBAIL
HAVERI
JAMAKHANDI
ANKOLA
BAGLAKOT
UTTARA
KANNADA
KLES Dr
Prabhakar Kore
Hospital and
MRC
NARAYANA
HRUDAYALAYA
SURGICAL
HOSPITAL PVT
LTD
CARE Hospital A
unit of Quality
Care India
Limite
Ashwini
Sahakari
Rugnalaya Ani
Sansodhan
Kendra
NANJAPPA LIFE
CARE
Belgaum
Mahatma
Gandhi Cancer
Hospital
Belgaum
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
BELGAUM
Miraj
Ca Cervix T2 N0
M0 [Stage-II]
MANGALORE
VALVULAR
HEART DISEASEMODERATE TO
CARDIOLOGY
SEVERE CALCIFIC
AS.CAD-SINGLE
VESSEL DISEASE.
CANCER
Surgical Oncology
Cardiology
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Cardiology
PTCA - one Drug
Eluting stent (
emergency,
inclusive of
angiogram) at the
same admission.
239
239
26-Aug-15
28-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
1357 H_20025323594
Male
58
Others VIRAJPET
VIJAPET
KODAGU
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
1358 H_19528320194
Male
74
Others GOGI
SHAHPUR
YADGIRI
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
CERVICAL
COMPRESSIVE
MYELOPATHY
NEURO SURGERY
Neuro Surgery
Spinal
LaminectomyCervical
431
431
30-Aug-15
2-Sep-15
25000
25000
25500
765
24735
IDBI - 321
30-Oct-15
1359 H_19528321124
Female
60
Minorit
MANVI
y
MANVI
RAICHUR
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
L3-L4 GRADE I
ANTEROLISTHESI NEURO SURGERY
S
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
1-Sep-15
5-Sep-15
50000
50000
51000
1530
49470
IDBI - 321
30-Oct-15
1360 H_19528323399
Male
3
Others SHETTIKERE
CHIKKANAYAKA
TUMKUR
NAHALLI
Bangalore
Narayana
Hrudayalaya
Private Limited
Bangalore
MODERATE
SECUNDUM ASD CARDIOLOGY
L-R SHUNT
ASD
151
151
28-Aug-15
9-Sep-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
1361 H_19528323249
Male
61
Others KAMPLI
HOSPET
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
CAD-DVD
CABG
132
132
29-Aug-15
9-Sep-15
95000
95000
96900
2907
93993
IDBI - 321
30-Oct-15
Neuro Surgery
Spinal
Anterior Cervical
Discectomy
Multiple level with
Implants
(procedure
30000+ Implants
10000)
429
429
30-Aug-15
2-Sep-15
40000
40000
40800
1224
39576
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
Cystolithotripsy
906
906
29-Aug-15
1-Sep-15
12500
24250
12500
1250
11250
IDBI - 321
30-Oct-15
Ureteric
Genito Urinary Surgeries Reimplantations
Unilateral
315
315
16-Aug-15
7-Sep-15
32500
32500
32500
3250
29250
IDBI - 321
30-Oct-15
BELLARY
IHD -EVOLVED
IWMI
CARDIOLOGY
Cardiology
CARDIOLOGY
1362 H_19528323484
Male
25
Others KYADIGERE
DEVADURGA
RAICHUR
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
C4-5 PROLAPSED
INTERVERTEBRA
L DISC WITH
NEURO SURGERY
SEVERE CANAL
STENOSIS WITH
CORD
1363 H_22458322886
Female
24
Others Gurlapur
GOKAK
BELGAUM
Belgaum
VENKATESH
HOSPITAL
MAHALINGPUR
vesicle calculus
1364 H_21044322027
Female
38
Others MARPADY
MANGALORE
DAKSHINA
KANNADA
Mysore
WENLOCK
DISTRICT
HOSPITAL
MANGALORE
RIGHT PRIMARY
OBSTRUCTIVE
NEONATAL
MEGAURETER
1365 H_19586323460
Male
57
Minorit
BETAGIRI
y
GADAG
GADAG
Belgaum
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
BANGALORE
IHD- TVD
CABG with IABP
133
133
25-Aug-15
7-Sep-15
115000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
1366 H_19571322503
Male
49
Others HOSPET
SHAHPUR
YADGIRI
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
25-Aug-15
29-Aug-15
25000
32357
25000
2500
22500
IDBI - 321
30-Oct-15
1367 H_19528323417
Female
29
Minorit
KATIBES
y
SINDNUR
RAICHUR
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
L5-S1 RIGHT
NEURO SURGERY
EXTRUDED DISC
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
30-Aug-15
2-Sep-15
25000
25000
25367
761
24606
IDBI - 321
30-Oct-15
MYSORE
SINGLE VESSEL
DISEASE.
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
31-Aug-15
3-Sep-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
Dharwad
CAD-Significant
LAD and RCA
disease
CARDIOLOGY
CABG with IABP
133
133
11-Aug-15
3-Sep-15
115000
115000
115000
11500
103500
IDBI - 321
30-Oct-15
MANGALORE
RIGHT PELVIC
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
24-Aug-15
7-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
NEONATAL
Anorectal
Malformations
Stage 2
306
306
19-Aug-15
1-Sep-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
1368 H_19542323145
Male
57
Others BELURU
MANDYA
MANDYA
Mysore
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
1369 H_19576318736
Male
42
Minorit
Hangal
y
HANAGAL
HAVERI
Belgaum
SDM Narayana
Hrudayalaya
RENAL
CARDIOLOGY
1370 H_20698323504
Male
42
Others BASAVANAHOLE
SAGARA
SHIMOGA
Bangalore
YENEPOYA
MEDICAL
COLLEGE
HOSPITAL
1371 H_21223323521
Male
1
Others BAVALAGAVA
AURAD
BIDAR
Gulbarga
INDIRA GANDHI
BANGALORE
INSTITUTE OF
SOUTH
CHILD HEALTH
anorectal
malformation
1372 H_19571323503
Male
60
Others SHADUPUR
CHINCHOLI
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
27-Aug-15
29-Aug-15
25000
31709
25000
2500
22500
IDBI - 321
30-Oct-15
1373 H_19586323465
Male
41
Others CHIKKABIDARAKALU
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
ACUTE AWMISVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
27-Aug-15
31-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
1374 H_20061323479
Female
50
Others
YADGIR
YADGIRI
Gulbarga
NARAYANA
HOSPITALS
CAD-SINGLE
CARDIOLOGY
VESSEL DISEASE.
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
25-Aug-15
31-Aug-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
1375 H_19581323466
Male
23
SC
MYSORE
Mysore
Cauvery
Hospital
LEFT VUJ
CALCULUS.
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
30-Aug-15
1-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
VEKATSHA NAGAR
YADGIRI
ELEMUDDANAHALLI KR NAGAR
BANGALORE
MYSORE
RENAL
Sl.No
Preauth No
1376 H_21254323268
Gender
Male
Age
23
Caste
Village
Taluk
Patient District
Patient
Division
Gulbarga
Hospital Name
Hospital
District
Final
Diagnosis
DR RAGHOJI
KIDNEY
HOSPITAL AND
RESEARCH
CENTER PV
SOLAPUR
Pan Urethral
Stricture
SYMPTOMATIC
SINUS NODDE
DYSFUNCTION
Others 0
BIDAR
BIDAR
BANGALORE URBAN
Bangalore
SJICR
BANGALORE
SOUTH
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Genito Urinary
Surgery
Urology
Urethroplasty for
a year can be
considered)
912
912
25-Aug-15
3-Sep-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Permanent
pacemaker
VVI) including
Pacemaker value
114
114
29-Aug-15
5-Sep-15
75000
75000
73500
0
73500
IDBI - 321
30-Oct-15
RENAL
1377 H_19577323406
Female
40
Others SOMANA HALLI
BANGALORE
SOUTH
1378 H_19528323386
Male
9
Others MALEBENNUR
HARIHARA
DAVANGERE
Bangalore
Narayana
Hrudayalaya
Private Limited
Bangalore
MOD UPPER
MUSCULAR VSD CARDIOLOGY
L-R SHUNT
Cardiology
Device Closure
VSD Device
Closure
121
121
31-Aug-15
2-Sep-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
1379 H_19577323300
Male
38
Minorit
SRIRAMNGARA
y
TUMKUR
TUMKUR
Bangalore
SJICR
BANGALORE
SOUTH
ACUTE AWMISVD
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
2-Sep-15
5-Sep-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
1380 H_20020323273
Male
23
kakubalu
HOSPET
BELLARY
Gulbarga
DIPALI
HOSPITAL
HOSPET
LEFT LOWER
URETERIC
RENAL
CALCULUS WITH
HDUN
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
28-Aug-15
31-Aug-15
25000
27750
25000
2500
22500
IDBI - 321
30-Oct-15
1381 H_19528321162
Male
37
Minorit
YADIGIRI
y
YADGIR
YADGIRI
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
MODERATELY
DIFFERENT
CANCER
SQUAMOUS CELL
CARCINOMA
Surgical Oncology
Reconstruction
Micro vascular
reconstruction
685
685
31-Aug-15
7-Sep-15
61500
61500
35700
1071
34629
IDBI - 321
30-Oct-15
1382 H_21044322452
Female
27
Others VADOORU
SAKLESHPURA
HASSAN
Mysore
WENLOCK
DISTRICT
HOSPITAL
MANGALORE
LEFT UPPER
URETERIC
CALCULUS
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
17-Aug-15
4-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Bangalore
TRICUSPID
ATRESIA TYPE III
LARGE
CARDIOLOGY
UNRESTRICTIVE
VSD L-R SHUNT
MOD SEC ASD
181
181
29-Aug-15
12-Sep-15
50000
50000
51000
1530
49470
IDBI - 321
30-Oct-15
CHANNAGIRI
DAVANGERE
Bangalore
Minorit PO: Asundi Tq:
y
Savadatti
SAVADATTI
BELGAUM
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Anorectum
stage IV
CT4,N0,M0
CANCER
Surgical Oncology
Colostomy
679
679
14-Aug-15
25-Aug-15
20000
20000
20000
2000
18000
IDBI-294
9-Oct-15
64
Others INNA
KARKALA
UDUPI
Mysore
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
SCC OF RIGHT
BUCCAL
MUCOSA
T4N0M0
CANCER
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
24-Aug-15
18-Sep-15
60000
47500
47500
4750
42750
IDBI - 321
30-Oct-15
48
Others Khanapur
KHANAPUR
BELGAUM
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Ca Tongue Stage
CANCER
II T2N0M0
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
28-Aug-15
8-Sep-15
60000
60000
30900
3090
27810
IDBI - 321
30-Oct-15
Mysore
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
MYSORE
CONGENITAL
BICUSPID
CARDIOLOGY
AORTIC VALVE
DISEASE,SEVERE
AS.
Aortic Valve
Replacement
146
146
2-Sep-15
10-Sep-15
120000
120000
122400
12240
110160
IDBI - 321
30-Oct-15
Mysore
Vaatsalya
Hospital
HASSAN
Rt Upper
ureteric calculus
20mmand 11mm RENAL
, VUJ caculus
7mm
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
25-Aug-15
27-Aug-15
37500
37500
25000
2500
22500
IDBI - 321
30-Oct-15
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
25-Aug-15
28-Aug-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
Male
1384 H_19567323363
Male
57
1385 H_20015323219
Male
1386 H_19504321309
Male
1388 H_22558320937
Male
Male
RENAL
Narayana
Hrudayalaya
Private Limited
1383 H_19528323113
1387 H_19542323149
ST
CARDIOLOGY
11 Months Others SANTHEBENNURU
27
45
Others BILIGERE
Others kere kodi konanur
HUNSUR
ARAKALAGUD
MYSORE
HASSAN
1389 H_19564323233
Male
40
Others KUKKE HALLI
UDUPI
UDUPI
Mysore
1390 H_20017323329
Male
65
Others GIRGAON
BILAGI
BAGLAKOT
Belgaum
1391 H_20017323332
Female
9
Minorit
KADARAVALLI
y
BYLAHONGALA
BELGAUM
Belgaum
1392 H_23172322371
Female
36
Others Chikkerur
HIREKERUR
HAVERI
Belgaum
KASTURBA
HOSPITAL
MANGALORE
UDUPI
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
Sri Nandi
Hospital
RANEBENNUR
ACUTE AWMI
CARDIOLOGY
Cardiology
CAD TVD
CARDIOLOGY
CABG
132
132
26-Aug-15
9-Sep-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
CHD LARGE ASD CARDIOLOGY
ASD
151
151
26-Aug-15
5-Sep-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
Left sided upper
uretric calculus
RENAL
with imapaired
renal excretion
Genito Urinary
Surgery
URSL - Single Side
+ DJ Stent
909
909
30-Aug-15
3-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Urology
Sl.No
Preauth No
Gender
Age
Caste
1393 H_20815323206
Male
75
Others MARGUTTI
GULBARGA
GULBARGA
1394 H_19586322034
Male
45
Minorit
0
y
CHINTAMANI
1395 H_19577322241
Female
4 Months
Others SARASWATIPURA
1396 H_19581323301
Male
28
1397 H_19586323292
Female
25
SC
Village
BANNUR
Others 0
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
GULBARGA
Basal cell Ca
Right
Preauricular
region
CANCER
Surgical Oncology
CHIKKABALLAPU
Bangalore
R
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
BANGALORE
IHD TVD
CARDIOLOGY
KADUR
CHIKKAMANAGL
Mysore
UR
SJICR
BANGALORE
SOUTH
T NARASIPUR
MYSORE
Mysore
MUDHOLA
BAGLAKOT
Belgaum
Cauvery
Hospital
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
MYSORE
HYPOPLASTIC
RV/TV SEVER PS
CARDIOLOGY
PDA L--> R
SHUNT
RIGHT RENAL
RENAL
CALCULUS.
Bangalore
IDBI - 321
30-Oct-15
CABG
132
132
20-Aug-15
7-Sep-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
109
109
24-Aug-15
4-Sep-15
65000
65000
63500
0
63500
IDBI - 321
30-Oct-15
909
909
28-Aug-15
31-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Peripheral
Angioplasty
URSL - Single Side
+ DJ Stent
241
24-Aug-15
28-Aug-15
90000
90000
91800
9180
82620
IDBI - 321
30-Oct-15
CANCER
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
26-Aug-15
11-Sep-15
20000
20000
19000
1900
17100
IDBI - 321
30-Oct-15
Cancer - Lung
CANCER
with Brain mets.
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
31-Aug-15
9-Sep-15
20000
21950
20000
2000
18000
IDBI - 321
30-Oct-15
bph
Genito Urinary
Surgery
Urology
TURP
917
917
5-Sep-15
15-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
RENAL
Bangalore
LONG STANDING
HYDROPNEUMO
THORAX
CARDIOLOGY
LEADING ON TO
EMPYEMA
Decortication
192
192
1-Sep-15
12-Sep-15
50000
50000
51000
1530
49470
IDBI - 321
30-Oct-15
Bangalore
MODERATE
SECUNDUM ASD
WITH SMALL
CARDIOLOGY
ADDITIONAL
ASDS
ASD
151
151
31-Aug-15
8-Sep-15
80000
255345
80000
0
80000
IDBI - 321
30-Oct-15
1403 H_20083323136
Male
5
Others HEDAGINABELE
MALUR
1404 H_20074323182
Female
12
Others ITTAPPANAHALLI
Bangalore
R
R
M S RAMAIAH
NARAYANA
BANGALORE
HRUDAYALAYA
ACCHD
SECONDUM ASD CARDIOLOGY
WITH LR SHUNT
ASD
151
151
28-Aug-15
7-Sep-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
1405 H_20017317862
Male
KHANAPUR
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
CHD TRUNCUS
ARTERIOSUS
CARDIOLOGY
WITH VSD WITH
SEVERE PAH
Truncus
Arteriosus Surgery
168
168
6-Aug-15
14-Sep-15
142500
142500
142500
14250
128250
IDBI - 321
30-Oct-15
1406 H_20017323242
Male
1
RAIBAGH
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
CHD LARGE VSD
WITH SEVERE
CARDIOLOGY
PAH
VSD
152
152
25-Aug-15
10-Sep-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
1407 H_20074323199
Female
8
M S RAMAIAH
NARAYANA
BANGALORE
HRUDAYALAYA
ACHD
SECUNDUM ASD
CARDIOLOGY
LEFT TO RIGHT
SHUNT
ASD
151
151
28-Aug-15
7-Sep-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
SJICR MYSORE
MYSORE
IHD-UNSTABLE
ANGINA CADSVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
25-Aug-15
28-Aug-15
65000
65000
64500
6450
58050
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
Simple
918
918
25-Aug-15
11-Sep-15
35000
35000
35000
3500
31500
IDBI - 321
30-Oct-15
11 Months Others AVAROLLI
Others MORAB
ST
BANDAHALLI
KOLAR
Bhagwan
Mahaveer Jain
Hospital
31500
241
Shri
Siddheshwar
and Research
Cent
KUMAR
TIPTUR
HOSPITAL
Gulbarga
3500
PTCA - Two stent
(Drug Eluting
Stents , elective)
CA
SUPRAGLOTTIS
T3N3M0 STAGE
IV
RAICHUR
35000
Cardiology
MANGALORE
LINGASUGUR
35199
Cardiology
MANGALORE
INSTITUTE OF
ONCOLOGY
Others MAVINABHAVI
35000
30-Oct-15
Belgaum
18
31-Aug-15
IDBI - 321
UTTARA
KANNADA
Narayana
Hrudayalaya
Private Limited
28-Aug-15
18000
KARWAR
Bangalore
684
2000
Minorit
BINAGA
y
CHIKKANAYAKA
TUMKUR
NAHALLI
684
20000
72
Others chikkarangapura
Myocutaneous /
cutaneous flap
20000
Male
54
20000
1399 H_20575323138
Male
Net Amt
Paid
3-Sep-15
UDUPI
1401 H_20059322920
TDS
24-Aug-15
KASTURBA
HOSPITAL
Belgaum
Gross
Amount
approved by
105
Mysore
BIJAPUR
Hospital
claimed
Amount
105
UDUPI
INDI
Urology
Preauth
Approved
Amt
Balloon Mitral
Valvotomy
KUNDAPURA
Others 0
Genito Urinary
Surgery
Date of
Discharge
Cardiology
Others HANGALURU
42
Cardiology
Date of
Admission
Cardiology
66
Male
Cardiology
Female
1400 H_22472323275
Reconstruction
Plan of
treatment
BANGALORE
1398 H_19564322842
Male
CHIRAYU
HOSPITAL
Gulbarga
CORONARY
ARTERY DISEASE
DOUBLE VESSEL
DISEASE-LCX
CARDIOLOGY
DISTAL 80%
PROXIMAL LAD
80 %
1402 H_19528317013
Disease Main
Category
Bangalore
R
R
1408 H_20733323137
Male
50
Others DHANAGANALLI
HOLENARSIPUR HASSAN
Mysore
1409 H_20010323213
Male
70
Others VARD 15
Bangalore
R
R
M S Ramaiah
Hospital
BANGALORE
NORTH
LEFT POORLY
FUNCTIONING
KIDNEY
1410 H_19562323174
Female
59
Minorit
SIGE HALLI
y
BHADRAVATHI
SHIMOGA
Bangalore
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
SHIMOGA
A known case of
ca. (L) Breast
CANCER
T3N0M0 Stage II
B
Surgical Oncology
Breast
Mastectomy - any
type
598
598
2-Sep-15
8-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
1411 H_19581323218
Male
54
Others RAMANAHALLI
MYSORE
MYSORE
Mysore
Cauvery
Hospital
MYSORE
SINGLE VESSEL
CORONARY
CARDIOLOGY
ARTERY DISEASE
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
25-Aug-15
28-Aug-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
BANTWAL
DAKSHINA
KANNADA
BANGALORE URBAN
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Mysore
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
MANGALORE
ANORECTAL
MALFORMATION NEONATAL
S
Anorectal
Malformations
Stage 3
307
307
26-Aug-15
5-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
Bangalore
SJICR
BANGALORE
SOUTH
REC PSVT
CARDIOLOGY
Cardiology
Cardiology
EP study
125
125
30-Aug-15
2-Sep-15
30000
30000
29500
0
29500
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
Urethroplasty for
a year can be
considered)
912
912
22-Aug-15
14-Sep-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
25-Aug-15
3-Sep-15
65000
65000
63500
0
63500
IDBI - 321
30-Oct-15
1412 H_19522322927
Female
1
Minorit
MANCHI
y
1413 H_19577323086
Male
75
Others YELAHANKA
BANGALORE
NORTH
M S Ramaiah
Hospital
BANGALORE
NORTH
STRICTURE
URETHRA
1414 H_20010322848
Male
29
Others BOYINAHALLI
Bangalore
R
R
1415 H_19577323075
Male
70
Others PANNENAHALLI
KORATAGERE
TUMKUR
Bangalore
SJICR
BANGALORE
SOUTH
IHD-AWMI-DVD CARDIOLOGY
Cardiology
1416 H_19528323106
Male
21
Others YALABURTHI
KUSTAGI
KOPPAL
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
RHD SEV AR MR
MILD MOD LV
CARDIOLOGY
DYSFUNCTION
Aortic Valve
Replacement
146
146
7-Aug-15
8-Sep-15
120000
120000
122400
3672
118728
IDBI - 321
30-Oct-15
1417 H_19528323110
Male
49
Others KITHAGANUR
BANGALORE
EAST
BANGALORE URBAN
Bangalore
Narayana
Hrudayalaya
Private Limited
Bangalore
CAD-TVD
CARDIOLOGY
CABG
132
132
30-Aug-15
7-Sep-15
95000
95000
96900
2907
93993
IDBI - 321
30-Oct-15
1418 H_19577323068
Male
8 Months
KOLAR
Bangalore
SJICR
BANGALORE
SOUTH
CHD SS TOF
CARDIOLOGY
ICR for TOF
154
154
25-Aug-15
5-Sep-15
80000
80000
79000
0
79000
IDBI - 321
30-Oct-15
1419 H_19577321627
Male
48
Bangalore
SJICR
BANGALORE
SOUTH
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
23-Aug-15
27-Aug-15
90000
90000
90000
0
90000
IDBI - 321
30-Oct-15
Mysore
KASTURBA
HOSPITAL
UDUPI
LEFT UPPER
URETERIC
CALCULUS
+RIGHT RENAL
CALCULUS
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
24-Aug-15
31-Aug-15
37500
37500
38250
3825
34425
IDBI - 321
30-Oct-15
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
25-Aug-15
28-Aug-15
65000
65000
64500
6450
58050
IDBI - 321
30-Oct-15
145
145
12-Aug-15
28-Aug-15
140000
140000
140000
0
140000
IDBI - 321
30-Oct-15
11
11
24-Aug-15
7-Sep-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
907
907
24-Aug-15
1-Sep-15
25000
36173
25000
2500
22500
IDBI - 321
30-Oct-15
1420 H_19564322869
Male
75
SC
GONNAMAKANAHAL
BANGARPET
LI
Others TITTAMARANAHALLY CHANNAPATNA RAMANAGAR
Others BALKUR
KUNDAPURA
HOSATIRUMAKUDAL
T NARASIPUR
U
UDUPI
RENAL
MYSORE
Mysore
SJICR MYSORE
MYSORE
IHD-ACS ACUTE
IWMI CAD-SVD
CARDIOLOGY
Cardiology
BANGARPET
KOLAR
Bangalore
SJICR
BANGALORE
SOUTH
RHD - SEVERE
MR
CARDIOLOGY
ATHANI
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
POST BURN
CONTRACTURE
OF B/L HAND
AND B/L FOOT
BURNS
Burns
BIJAPUR
Belgaum
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT RENAL
CALCULUS.
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
1421 H_20733323085
Male
52
Others
1422 H_19577319008
Female
35
Minorit
C RAHIM NGARA
y
1423 H_20017323094
Female
15
Others YALAGI
BIJAPUR
Burns
Mitral Valve
Replacement
Post Burn
Contracture
surgeries for
Functional
Improvement(Pack
age including
splints, pressure
garments and
physiotherapy),
Severe
1424 H_19571322496
Female
23
Minorit JUNEDI SHANI
y
DARGA
1425 H_20010320922
Male
58
Others RAYANAHALLI
CHITRADURGA
CHITRADURGA
Bangalore
M S Ramaiah
Hospital
BANGALORE
NORTH
CERVICAL CANAL
NEURO SURGERY
STENOSIS OPLL
Neuro Surgery
Spinal
LaminectomyCervical
431
431
17-Aug-15
14-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
1426 H_19528317233
Male
43
Others KANCHIPURA
HOSADURGA
CHITRADURGA
Bangalore
Narayana
Hrudayalaya
Private Limited
Bangalore
? BLADDER
TUMOUR WITH
METASTASES
Genito Urinary
Surgery
Urology
TURBT
916
916
31-Aug-15
5-Sep-15
30000
30000
30600
918
29682
IDBI - 321
30-Oct-15
Cardiology
PTCA - one Drug
Eluting stent (
emergency,
inclusive of
angiogram) at the
same admission.
239
239
24-Aug-15
27-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
1427 H_20025322980
Male
52
1428 H_19577323046
Female
9 Months
1429 H_19577323034
1430 H_22286322891
Male
Male
1
71
Others DEVEGOWDANAGAR HASSAN
HASSAN
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
Others ANKALE
HUKKERI
BELGAUM
Belgaum
SJICR
BAGEPALLI
CHIKKABALLAPU
Bangalore
R
ST
POOLAVARAPALLI
WARD NO-18
CHITTANAHALLI
Others
BEEDI
HOLENARASIPURA
HOLENARSIPUR HASSAN
Mysore
SJICR
PUNYA
HOSPITAL CRP
BANGALORE
SOUTH
BANGALORE
SOUTH
Hassan
RENAL
IHD RECENT
IWMI/POST MI
ANGINA
CARDIOLOGY
Cardiology
CHD-PDA
CARDIOLOGY
CHD-PDA
CARDIOLOGY
GRADE III
PROSTATOMEAG RENAL
LY
Cardiology
Device Closure
PDA Device
Closure
Genito Urinary
Surgery
Urology
TURP
176
176
25-Aug-15
8-Sep-15
20000
20000
20000
0
20000
IDBI - 321
30-Oct-15
119
119
31-Aug-15
3-Sep-15
60000
60000
60000
0
60000
IDBI - 321
30-Oct-15
917
917
26-Aug-15
6-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
433
433
1-Sep-15
7-Sep-15
25000
25000
25000
0
25000
IDBI - 321
30-Oct-15
C5-6 & C6-7 PVD NEURO SURGERY
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
30-Aug-15
5-Sep-15
50000
50000
50000
0
50000
IDBI - 321
30-Oct-15
NARAYANA
HOSPITALS
CAD-DOUBLE
CARDIOLOGY
VESSEL DISEASE.
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
24-Aug-15
31-Aug-15
90000
90000
91800
9180
82620
IDBI - 321
30-Oct-15
Belgaum
M/s Kerudi
Hospital And
Bagalkot
Research Centre
Bagalkot
Left ureteral
calculus
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
29-Aug-15
30-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
BASAVAKALYAN
BIDAR
A
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
MALROTATION
OF THE
NEONATAL
INTESTINE(OBST
RUCTION)
Intestinal Atresias
& Obstructions
303
303
25-Aug-15
10-Sep-15
40000
40000
40800
1224
39576
IDBI - 321
30-Oct-15
Others AJJIKYATANAHALLI
HOLALKERE
CHITRADURGA
Bangalore
SPARSH SUPER
SPECIALITY
HOSPITAL
BANGALORE
NORTH
CHD-OS ASD
(25mm) WITH L- CARDIOLOGY
R SHUNT
Cardiology
Device Closure
ASD Device
Closure
120
120
25-Aug-15
3-Sep-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
61
Others GACHINAKATTI
BIJAPUR
BIJAPUR
Belgaum
MEDIHOPE
HOSPITALS AND
BANGALORE
RESEARCH
CENTRE PVT LTD
IHD, LEFT MAIN,
DVD WITH LV
CARDIOLOGY
DYSFUNCTION
CABG with IABP
133
133
18-Aug-15
9-Sep-15
115000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
48
Others SINDHANUR
SINDNUR
RAICHUR
Gulbarga
VYDEHI
HOSPITAL
BANGALORE
L4-L5 PIVD
Neuro Surgery
DiscectomyLumbar
433
433
27-Aug-15
8-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Minorit
Aman Nagar
y
BANGALORE
SOUTH
Acute Coronary
Syndrome Unstable Angina CARDIOLOGY
CAD - Two Vessel
Disease
CABG
132
132
25-Aug-15
7-Sep-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
1432 H_20200323032
Female
37
Others
SHARAVANA BELA
GOLA
1433 H_20061323037
Male
55
Others
(V) KHATGON (T,Q)
AURAD
AURAD (DIST) BIDAR.
BIDAR
Gulbarga
1434 H_19510322883
Male
20
SC
RUDAGI
BIJAPUR
1435 H_19528322763
Male
18
Others MACHALAMBA
1436 H_23124323016
Female
11
1437 H_20242322660
Female
1438 H_19574320697
Male
CHANNARAYAP
HASSAN
ATNA
MUDDEBIHAL
Mysore
Mysore
RENAL
NEURO SURGERY
Spinal
GULBARGA
Gulbarga
HEGGADIHALLI
ARAKALAGUD
HASSAN
Mysore
PUNYA
HOSPITAL CRP
Hassan
GRADE III
PROSTATOMEGA RENAL
LY
Genito Urinary
Surgery
Urology
TURP
917
917
26-Aug-15
22-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
KADAVATHI
Mysore
R
UR
WENLOCK
DISTRICT
HOSPITAL
MANGALORE
RIGHT PUJ
OBSTRUCTION
Genito Urinary
Surgery
Urology
905
905
24-Aug-15
15-Sep-15
35000
35000
35000
3500
31500
IDBI - 321
30-Oct-15
Others KODADURA
CHITTAPUR
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
LEFT TEMPORAL
NEURO SURGERY
EPENDYMOMA
Neuro Surgery
Brain Tumour
Excision of Brain
Tumor
Supratentorial &
others
407
407
31-Aug-15
3-Sep-15
45000
45000
45900
1377
44523
IDBI - 321
30-Oct-15
Others BEVURU
HARAPANAHALL
DAVANGERE
I
Bangalore
SUKSHEMA
HOSPITAL
PVTLTD
DAVANGERE
HYPOSPADIAS
NEONATAL
322
322
26-Aug-15
28-Aug-15
22000
22000
22000
2200
19800
IDBI - 321
30-Oct-15
Gulbarga
SUKSHEMA
HOSPITAL
PVTLTD
DAVANGERE
STRICTURE
URETHRA
RENAL
Genito Urinary
Surgery
Urology
Urethroplasty for
a year can be
considered)
912
912
26-Aug-15
29-Aug-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
Gulbarga
VYDEHI
HOSPITAL
BANGALORE
Left renal
calculus
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
27-Aug-15
8-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
107
107
30-Aug-15
2-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
43
1440 H_22286322851
Male
60
SC
1441 H_21044322907
Male
26
SC
1442 H_19528320198
Male
18
1443 H_20619320840
Male
2
57
MANDYA
GULBARGA
Male
35
KR PET
TRINITY
HOSPITAL AND
HEART
FOUNDATION
1439 H_19593322970
Female
Disease Main
Category
DiscectomyLumbar
Others Kabbalagere
L3-4 L4-5 pivd
with lcs
Diseases
Spinal
59
1445 H_19574319655
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
Final
Diagnosis
Neuro Surgery
Female
Male
Hospital
District
NEURO SURGERY
1431 H_20200319619
1444 H_20619321775
Hospital Name
ST
BUDANURU
Others KARAMUDI
GULBARGA
HUVINAHADAG
BELLARY
ALI
YELBURGA
KOPPAL
RENAL
1446 H_20079322941
Male
5
Others TADAKANA HALLI
HIREKERUR
HAVERI
Belgaum
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
SEVERE
VALVULAR PS.
CARDIOLOGY
Cardiology
Cardiology
Balloon
Pulmonary
Valvotomy
/Pulmonary Artery
and Branch
Vessels(LPA/RPA)
Stenosis for
Balloon Dilatation
1447 H_20017322888
Female
4
Others NINGAPUR
MUDHOLA
BAGLAKOT
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
CHD PDA
CARDIOLOGY
Cardiology
Device Closure
PDA Device
Closure
119
119
24-Aug-15
3-Sep-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
1448 H_19577319521
Male
35
Others NIDAGHATTA
MADDUR
MANDYA
Mysore
SJICR
IHD - EA, DM,
SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
18-Aug-15
27-Aug-15
90000
90000
90000
0
90000
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Sl.No
Preauth No
Age
1449 H_20017322916
Female
2
Others MARADINAGALPUR
BYLAHONGALA
BELGAUM
Belgaum
1450 H_20015322910
Male
33
Others IRA
BANTWAL
DAKSHINA
KANNADA
Mysore
1451 H_20017322919
Female
GOKAK
BELGAUM
Belgaum
1452 H_20733322758
Male
63
MYSORE
MYSORE
Mysore
SJICR MYSORE
1453 H_19581322899
Male
59
Minorit
EDGA
y
BELUR
HASSAN
Mysore
Cauvery
Hospital
1454 H_20880322895
Male
49
Others Yadurwadi
CHIKKODI
BELGAUM
Belgaum
1455 H_20698322624
Male
Caste
Village
10 Months Others UPPARHATTI
47
ST
#4644,
Basavanagudi,
Kyathamaranahally,
Mysuru
Others YADEHALLI
Taluk
BHADRAVATHI
Patient District
Patient
Division
Gender
SHIMOGA
Hospital Name
Hospital
District
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
JUSTICE KS
HEGDE
MANGALORE
CHARITABLE
HOSPITAL
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
CHD TRICUSPID
ATRESIA WITH
VSD WITH
SEVERE PS
CARDIOLOGY
EDH IN LEFT
OCCIPITAL
REGION.
NEURO SURGERY
Neuro Surgery
CHD VSD WITH
PAH
CARDIOLOGY
MYSORE
IHD-EVOLVED
IWMI CAD-SVD
MYSORE
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
181
181
24-Aug-15
9-Sep-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
Craniotomy and
Evacuation of
Haematoma Extradural
402
402
23-Aug-15
27-Aug-15
45000
45000
45000
4500
40500
IDBI - 321
30-Oct-15
VSD
152
152
25-Aug-15
7-Sep-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
25-Aug-15
28-Aug-15
65000
65000
63500
6350
57150
IDBI - 321
30-Oct-15
DOUBLE VESSEL
CORONARY
CARDIOLOGY
ARTERY DISEASE
Cardiology
Cardiology
PTCA - 2 stent
(non-medicated)
104
104
25-Aug-15
28-Aug-15
70000
70000
70000
7000
63000
IDBI - 321
30-Oct-15
Wanless
Hospital Miraj
Miraj
Medical Center
miraj
IHD UNSTABLE
ANGINA,DOUBLE CARDIOLOGY
VESSEL DISEASE
Cardiology
Cardiology
PTCA - 2 stent
(non-medicated)
104
104
26-Aug-15
28-Aug-15
70000
70000
70000
7000
63000
IDBI - 321
30-Oct-15
Bangalore
YENEPOYA
MEDICAL
COLLEGE
HOSPITAL
MANGALORE
MODERATELY TO
POORLY
DIFFERENTIATED
CANCER
ADENOCARCINO
MA STOMACH
T3 N3 MX
Surgical Oncology
Gastrectomy - any
type
636
636
26-Aug-15
14-Sep-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
KOLAR
B/L RENAL
CALCULI L&R
Genito Urinary
Surgery
Urology
ESWL (Extra
Stent
908
908
28-Aug-15
29-Aug-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
10% 2Â° Thermal
burns to face
BURNS
and trunk.
Burns
Burns
upto-40% with
Scalds(
Conservative/
without grafting)
2
2
24-Aug-15
31-Aug-15
35000
35000
35000
3500
31500
IDBI - 321
30-Oct-15
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
26-Aug-15
29-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
Brain
1456 H_20164322139
Male
30
Others MANJALANAGARA
SREENIVASAPUR KOLAR
Bangalore
R L JALAPPA
HOSPITAL AND
RESEARCH
CENTRE
1457 H_20790322877
Male
45
Others Mathigatta
CHANNARAYAP
HASSAN
ATNA
Mysore
Sri
Adichunchanagi
B G Nagara
ri Hospital and
Research Center
1458 H_19577322502
Male
53
Others C.K.PURA
PAVAGADA
TUMKUR
Bangalore
SJICR
BANGALORE
SOUTH
CAD RECENT
IWMI
1459 H_19577322513
Female
10
Others GOWRASAMUDRA
CHALLAKERE
CHITRADURGA
Bangalore
SJICR
BANGALORE
SOUTH
CHD SS OS 2 ASD
L-->R SHUNT
CARDIOLOGY
MOD MR
ASD
151
151
17-Aug-15
5-Sep-15
80000
80000
79500
0
79500
IDBI - 321
30-Oct-15
1460 H_19586322030
Male
65
Others 0
MUNDARGI
GADAG
Belgaum
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
BANGALORE
L4-L5 CANAL
STENOSIS
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
22-Aug-15
10-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
BVDU MEDICAL
COLLEGE AND
WANLESSWADI
HOSPITAL
SANGLI
lt renal Calculi
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
24-Aug-15
2-Sep-15
25000
25395
25000
2500
22500
IDBI - 321
30-Oct-15
SUBDURAL SDH
NEURO SURGERY
Neuro Surgery
Brain
Craniotomy and
Evacuation of
Haematoma Subdural
401
401
24-Aug-15
9-Sep-15
45000
45000
45000
4500
40500
IDBI - 321
30-Oct-15
CHD with Atrial
Septal Defect
CARDIOLOGY
ASD
151
151
25-Aug-15
4-Sep-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
L Ureteric
calculus
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
19-Aug-15
31-Aug-15
25000
28300
25000
2500
22500
IDBI - 321
30-Oct-15
Urology
URSL - Single Side
+ DJ Stent
909
909
29-Aug-15
30-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
ICR for TOF
154
154
17-Aug-15
9-Sep-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
RENAL
CARDIOLOGY
1461 H_22748322319
Male
35
Others Terdal
JAMAKHANDI
BAGLAKOT
Belgaum
1462 H_19586322831
Female
38
Others BUDASHETNALA
KOPPAL
KOPPAL
Gulbarga
1463 H_20880322730
Female
24
Others Jambagi
ATHANI
BELGAUM
Belgaum
1464 H_22867321693
Male
30
HOLALKERE
CHITRADURGA
Bangalore
1465 H_19510320390
Male
50
MUDHOLA
BAGLAKOT
Belgaum
M/s Kerudi
Hospital And
Bagalkot
Research Centre
Bagalkot
Right ureteral
Calculus
RENAL
Genito Urinary
Surgery
1466 H_19586319947
Female
10
Bangalore
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
CHD TOF
CARDIOLOGY
SC
KALLAVVANAGATHI
Others MUDHOL
SC
0
RURAL
SAPTHAGIRI
SUPER
BANGALORE
SPECIALITY
HOSPITAL
Wanless
Hospital Miraj
Miraj
Medical Center
miraj
Chitradurga
CHITRADURGA
Government
Hospital
BANGALORE
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Urology
Urethroplasty for
a year can be
considered)
912
912
31-Aug-15
7-Sep-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
Anorectal
Malformations
Stage 2
306
306
21-Aug-15
8-Sep-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
2-Sep-15
5-Sep-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
KR PET
MANDYA
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
KHANAPUR
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
Others KANAKAPURA
KANAKAPURA
RAMANAGAR
Bangalore
SJICR
26
Others indi
INDI
BIJAPUR
Belgaum
BLDE University
Shri BM Patil
Bijapur
Medical College
Hosp
Left Ureteric
calculus
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
2-Sep-15
5-Sep-15
25000
27256
20000
2000
18000
IDBI - 321
30-Oct-15
Male
72
Others BELAGATTI
HONNALI
DAVANGERE
Bangalore
RAJARAJESWARI
MEDICALCOLLE
BANGALORE
GE AND
HOSPITAL
BPH
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
17-Aug-15
31-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
1472 H_19510320345
Female
23
SC
MUDUR
MUDDEBIHAL
BIJAPUR
Belgaum
M/s Kerudi
Hospital And
Bagalkot
Research Centre
Bagalkot
Left ureteral
calculus
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
29-Aug-15
30-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
1473 H_19593322790
Male
38
SC
Yaragol Tanda
YADGIR
YADGIRI
Gulbarga
TRINITY
HOSPITAL AND
HEART
FOUNDATION
BANGALORE
SOUTH
Unstable Angina,
CAD - Single
CARDIOLOGY
Vessel Disease
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
24-Aug-15
28-Aug-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
25-Aug-15
27-Aug-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
Open
Nephrolithotomy Single Side
902
902
29-Aug-15
3-Sep-15
20000
30450
20000
2000
18000
IDBI - 321
30-Oct-15
1467 H_20025322514
Male
47
1468 H_20017322383
Male
1469 H_19577322599
Male
60
1470 H_20031322800
Female
1471 H_20531322278
Others MYLANAHALLI
18 Months Others KHANAPUR
BANGALORE
SOUTH
STRICTURE
URETHRO
Genito Urinary
Surgery
ANORECTAL
NEONATAL
MALFORMATION
IHD EVOLVED
IWMI+PWMI
SVD
RENAL
Recent AWMI
Post Infarct
CARDIOLOGY
Angina, CAD Single Vessel
Disease
TWO RIGHT
RENAL CALCULI
RENAL
WITH
HYDRONEPHROS
IS
1474 H_19593322786
Male
42
Others Bharama Samudra
JAGALURU
DAVANGERE
Bangalore
TRINITY
HOSPITAL AND
HEART
FOUNDATION
1475 H_20020322369
Male
44
Others MUNIRABAD
KOPPAL
KOPPAL
Gulbarga
DIPALI
HOSPITAL
HOSPET
1476 H_20083322542
Female
39
Minorit
MASUR
y
HIREKERUR
HAVERI
Belgaum
Bhagwan
Mahaveer Jain
Hospital
Bangalore
IHD, Single
vessel disease
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
24-Aug-15
28-Aug-15
65000
204135
65000
0
65000
IDBI - 321
30-Oct-15
1477 H_20733322761
Male
48
Others Gundapura
MALAVALLI
MANDYA
Mysore
SJICR MYSORE
MYSORE
IHD-ACS-ACUTE
AWMI
CARDIOLOGY
Cardiology
Cardiology
Medical
treatment of
Acute MI with
Thrombolysis
128
128
23-Aug-15
26-Aug-15
10000
10000
8500
850
7650
IDBI - 321
30-Oct-15
1478 H_20061322725
Female
54
Others
BIDAR
BIDAR
Gulbarga
1479 H_20619322279
Male
30
Others MARIKUNTE
CHALLAKERE
CHITRADURGA
Bangalore
1480 H_20619322270
Male
46
1481 H_20083322713
Male
10 Months
1482 H_20083322669
Female
67
(V) ISLAMPUR (T,Q)
BIDAR (DIST) BIDAR.
Others MITTALAKATTE
SC
KOTEPURA
NARAYANA
HOSPITALS
SUKSHEMA
DAVANGERE
HOSPITAL
PVTLTD
HARIHARA
DAVANGERE
Bangalore
SUKSHEMA
HOSPITAL
PVTLTD
SHIKARIPURA
SHIMOGA
Bangalore
Bhagwan
Mahaveer Jain
Hospital
Bangalore
Bhagwan
Mahaveer Jain
Hospital
Others SUBBAGUNDALAPALI SREENIVASAPUR KOLAR
CAD-TRIPLE
CARDIOLOGY
VESSEL DISEASE.
CABG
132
132
24-Aug-15
2-Sep-15
95000
95000
96900
9690
87210
IDBI - 321
30-Oct-15
RIGHT MID
URETERIC
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
27-Aug-15
29-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
27-Aug-15
31-Aug-15
31250
31250
31250
3125
28125
IDBI - 321
30-Oct-15
DAVANGERE
RIGHT RENAL
CALCULI WITH
BLADDER NECK
CALCULUS
Bangalore
TOF, Confluent
branch PAS
CARDIOLOGY
ICR for TOF
154
154
1-Sep-15
12-Sep-15
80000
351000
80000
0
80000
IDBI - 321
30-Oct-15
Bangalore
L4 L5 teraminal
dura with left
red. History of
failure and
numbness left
leg
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
27-Aug-15
31-Aug-15
25000
101134
25000
0
25000
IDBI - 321
30-Oct-15
Bangalore
L5 S1 Isthmia
spondylolithiasis
with bilateral
NEURO SURGERY
neurogenic
claudication (R >
L)
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
31-Aug-15
4-Sep-15
50000
228851
50000
0
50000
IDBI - 321
30-Oct-15
CABG
132
132
24-Aug-15
7-Sep-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
Cardiology
PDA Device
Closure
119
119
26-Aug-15
28-Aug-15
60000
60000
61200
1836
59364
IDBI - 321
30-Oct-15
1483 H_20083322675
Female
28
Others KANCHIGANALA
RURAL
Bangalore
Bhagwan
Mahaveer Jain
Hospital
1484 H_20017322049
Female
46
Others MANJARI
CHIKKODI
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
CAD DVD
1485 H_19528322722
Female
1
Others KARIMNAGAR
INDI
BIJAPUR
Belgaum
Narayana
Hrudayalaya
Private Limited
MODERATE PDA
CARDIOLOGY
L-R SHUNT
Bangalore
CARDIOLOGY
Device Closure
Sl.No
Preauth No
1486 H_22080322724
Gender
Male
Age
31
1487 H_20017322718
Male
7 Months
1488 H_19586322715
Male
50
1489 H_19574321570
Female
50
1490 H_19503322692
Male
21
1491 H_20107322666
Female
19
1492 H_20200322589
1493 H_19564322643
Female
Male
44
66
Caste
Village
Others HIRENDEHELLI
Taluk
BYLAHONGALA
Patient District
BELGAUM
Patient
Division
Hospital Name
Belgaum
VIJAYA
HOSPITAL
Hospital
District
BELGAUM
ATHANI
BELGAUM
Belgaum
Minorit
0
y
BELLARY
BELLARY
Gulbarga
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
BANGALORE
KOLAR
KOLAR
Bangalore
VYDEHI
HOSPITAL
BANGALORE
Carcinoma
buccal mucossa
(T2N1Mx)
Others Aigali
SINDAGI
BIJAPUR
Belgaum
Bijapur Kidney
Foundation
Bijapur
Others SIRGAPUR
BASAVAKALYAN
BIDAR
A
Gulbarga
Mysore
KHAGIKALLAHALLI
Minorit
RAJEEV NAGAR
y
Others KIKRE
MYSORE
SHRUNGERI
MYSORE
1500 H_19520322169
Female
40
ST
1501 H_19564322351
Female
54
SC
909
26-Aug-15
29-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
NEURO SURGERY
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
19-Aug-15
5-Sep-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
CANCER
Surgical Oncology
Head & Neck
Wide excision
621
621
27-Aug-15
6-Sep-15
20000
20000
9970
997
8973
IDBI - 321
30-Oct-15
Left PUJ
Obstruction
RENAL
With Gross
Hydronephrrosis
Genito Urinary
Surgery
Urology
905
905
25-Aug-15
3-Sep-15
35000
43629
35000
3500
31500
IDBI - 321
30-Oct-15
CARE Hospital A
unit of Quality
Nampally
Care India
Limite
CRHD SVERE MS CARDIOLOGY
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
25-Aug-15
28-Aug-15
20000
86414
20000
2000
18000
IDBI - 321
30-Oct-15
NARAYANA
HRUDAYALAYA
SURGICAL
MYSORE
HOSPITAL PVT
LTD
CAD-ACUTE AW
STEMI CARDIO CARDIOLOGY
SENIC SHOCK
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
24-Aug-15
28-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
239
239
21-Aug-15
26-Aug-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
CHIKKAMANAGL
Mysore
UR
KASTURBA
HOSPITAL
UDUPI
SJICR
59
909
30-Oct-15
Bangalore
Female
URSL - Single Side
+ DJ Stent
IDBI - 321
BANGALORE URBAN
1499 H_19564322499
45000
BANGALORE
EAST
Others HARADI
Net Amt
Paid
5000
Others NEW THIPPESANDRA
67
TDS
50000
68
Female
Gross
Amount
approved by
50000
Female
1498 H_19564322481
Hospital
claimed
Amount
50000
1495 H_19577322605
HANUMAN NAGAR
Preauth
Approved
Amt
10-Sep-15
Belgaum
SC
Date of
Discharge
20-Aug-15
HAVERI
51
Date of
Admission
189
HIREKERUR
Female
189
Others HIREMORABA
1497 H_20815322558
Urology
Plan of
treatment
Lobectomy
70
Others PADUKERE
Genito Urinary
Surgery
Male
53
Disease Main
Category
CARDIOLOGY
1494 H_20079322664
Male
LEFT UPPER
LUNG LOB
CONGENITAL
LOBER
EMPHYSEMIA
COMPRESSION
FRACTION TO
D12
VERTEBROW
Others KEMPAWAD
SC
Diseases
(L)
HYDROURETERO
NEPHRISIS SECO
RENAL
TO UPPER
URETERIC 12
MM CALCULI
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
1496 H_19564322569
Final
Diagnosis
BANGALORE
SOUTH
Cardiology
UNSTABLE
ANGINA/DM
CARDIOLOGY
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
RECENT IWMI
WITH POST
INFRACTION
ANGINA WITH
MILD LV
DYSFUNCTION.
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
8-Sep-15
11-Sep-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
IHD-EA
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
22-Aug-15
28-Aug-15
90000
65000
65000
0
65000
IDBI - 321
30-Oct-15
239
239
23-Aug-15
26-Aug-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
Mysore
KASTURBA
HOSPITAL
UDUPI
ACUTE INFERIOR
CARDIOLOGY
WALL MI
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
BASAVAKALYAN
BIDAR
A
Gulbarga
CHIRAYU
HOSPITAL
GULBARGA
Ca Breast left
side- cT2N1
Surgical Oncology
Breast
Mastectomy - any
type
598
598
26-Aug-15
31-Aug-15
25000
25324
25000
2500
22500
IDBI - 321
30-Oct-15
UDUPI
Mysore
KASTURBA
HOSPITAL
UDUPI
IHD/HTN/T2DM CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
22-Aug-15
28-Aug-15
90000
90000
91800
9180
82620
IDBI - 321
30-Oct-15
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
24-Aug-15
27-Aug-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
KUNDAPURA
UDUPI
UDUPI
CANCER
UDUPI
Mysore
KASTURBA
HOSPITAL
UDUPI
ACUTE
MI
WARD 10 BAGALKOT BAGALKOTE
BAGLAKOT
Belgaum
SNMC HSK
HSopital
BAGALKOTE
LEFT U/3RD
URETERIC
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
22-Aug-15
31-Aug-15
25000
25380
25000
2500
22500
IDBI - 321
30-Oct-15
NADA
UDUPI
Mysore
KASTURBA
HOSPITAL
UDUPI
INFERIOR WALL
MI
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
23-Aug-15
28-Aug-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
Others BASRUR
KUNDAPURA
KUNDAPURA
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
65000
63500
0
63500
IDBI - 321
30-Oct-15
MANGALORE
DUCTAL
CARCINOMA (L) CANCER
BREAST STAGE II
Surgical Oncology
Breast
Mastectomy - any
type
598
598
21-Aug-15
7-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
KOLHAPUR
30 MM OSTIUM
CARDIOLOGY
SECONDUM ASD
Cardiology
Device Closure
ASD Device
Closure
120
120
28-Aug-15
29-Aug-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
BAGALKOT
RIGHT L/3RD
URETERIC
CALCULUS WITH
RIGHT HUN
RENAL
WITH RIGHT
RENAL
CALCULUS
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
25-Aug-15
30-Aug-15
30000
31940
30000
3000
27000
IDBI - 321
30-Oct-15
44
Others RANGOLI HALLI
HASSAN
HASSAN
Mysore
SJICR
BANGALORE
SOUTH
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
SWASTIK
HOSPITAL
Belgaum
65000
Female
BELGAUM
Net Amt
Paid
7-Sep-15
1503 H_19577322492
CHIKKODI
TDS
3-Sep-15
C3-C4 CANAL
STENOSIS
Others SHENDUR
Gross
Amount
approved by
240
NEAR RAILWAY
UNDERPASS
51
Hospital
claimed
Amount
240
GANGAMAI
HOSPITAL
Female
Preauth
Approved
Amt
PTCA - one stent
(Drug Eluting
Stents , elective)
Gulbarga
1505 H_20511321789
Date of
Discharge
Cardiology
GULBARGA
KADUR
Date of
Admission
Cardiology
ALAND
Others MALLESWARA
IHD EA DVD RHD
CARDIOLOGY
MODERATE MS
Others BHANGARGA
60
Plan of
treatment
Spinal
35
Female
Neuro Surgery
Male
1504 H_19522322494
Disease Main
Category
Anterior Cervical
Discectomy
Multiple level with
Implants
(procedure
30000+ Implants
10000)
1502 H_21214322362
CHIKKAMANAGL
Mysore
UR
Diseases
NEURO SURGERY
429
429
22-Aug-15
31-Aug-15
40000
72437
40000
4000
36000
IDBI - 321
30-Oct-15
1506 H_22337322544
Male
63
Others HONNAKATTI
BAGALKOTE
BAGLAKOT
Belgaum
BARAGI
HOSPITAL
BAGALKOT
1507 H_20061322367
Female
53
H.NO.1/109
Others BHASKAR NAGAR
CHITGUPPA.
HUMNABAD
BIDAR
Gulbarga
NARAYANA
HOSPITALS
CAD-TRIPLE
CARDIOLOGY
VESSEL DISEASE.
CABG
132
132
24-Aug-15
31-Aug-15
95000
95000
96900
9690
87210
IDBI - 321
30-Oct-15
1508 H_19567322540
Female
48
Others kannal
LINGASUGUR
RAICHUR
Gulbarga
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca cervix IV A
CANCER
Radiation Oncology
Palliative
Treatment with
Photons (linear
accelarator)
566
566
24-Aug-15
5-Sep-15
20000
22230
20000
2000
18000
IDBI-294
9-Oct-15
1509 H_19528322526
Male
9
Others GOUDGERA
SURPUR
YADGIRI
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
MITRAL VALVE
PROLAPSE SEV
MR
CARDIOLOGY
Mitral Valve
Replacement
145
145
26-Aug-15
9-Sep-15
120000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
Bangalore
SUKSHEMA
HOSPITAL
PVTLTD
DAVANGERE
LEFT RENAL
PELVIC
CALCULUS WITH RENAL
LEFT RENAL
CALCULUS
Genito Urinary
Surgery
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
25-Aug-15
28-Aug-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
Bangalore
Moderate MS
with moderately
severe MR,
CARDIOLOGY
Severe TR with
mild PAH
Mitral Valve
Replacement
145
145
31-Aug-15
7-Sep-15
120000
416346
120000
0
120000
IDBI - 321
30-Oct-15
Mastectomy - any
type
598
598
31-Aug-15
3-Sep-15
25000
25000
25000
0
25000
IDBI - 321
30-Oct-15
1510 H_20619320857
Male
24
Others SHIVAGANGE
HOLALKERE
CHITRADURGA
INDI
BIJAPUR
Belgaum
Bhagwan
Mahaveer Jain
Hospital
Linear Accelerators
Urology
1511 H_20083321337
Male
40
Minorit
SALOTAGI
y
1512 H_19505322006
Female
46
Others K.R MILL
MYSORE
MYSORE
Mysore
Bharath
Hospital
Institute of
Oncology
Mysore
CA LEFT BREAST
CANCER
T3N2M0
Surgical Oncology
1513 H_19564322454
Male
55
Others CHIKKAKOGALURU
CHANNAGIRI
DAVANGERE
Bangalore
KASTURBA
HOSPITAL
UDUPI
RHD; MODERATE
SEVERE MS,
CARDIOLOGY
MODERATE MR
Mitral Valve
Replacement
145
145
22-Aug-15
7-Sep-15
120000
120000
122400
12240
110160
IDBI - 321
30-Oct-15
1514 H_19593322478
Female
15
Others Narasingpur
HUKKERI
BELGAUM
Belgaum
TRINITY
HOSPITAL AND
HEART
FOUNDATION
BANGALORE
SOUTH
Rheumatic Heart
Disease - Severe
CARDIOLOGY
Mitral
Regurgitation
Mitral Valve
Replacement
145
145
24-Aug-15
5-Sep-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
1515 H_19571321638
Male
36
Others HOSUR
CHITTAPUR
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
22-Aug-15
26-Aug-15
25000
32559
25000
2500
22500
IDBI - 321
30-Oct-15
1516 H_19528320819
Male
67
Minorit
RAICHUR
y
RAICHUR
RAICHUR
Gulbarga
Narayana
Hrudayalaya
Private Limited
C3-C4 PIVD
NEURO SURGERY
CANAL STENOSIS
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
27-Aug-15
31-Aug-15
50000
50000
51000
1530
49470
IDBI - 321
30-Oct-15
1517 H_22971321939
Female
55
SC
RANGANATH PURA
KR PET
MANDYA
Mysore
CSI Holdsworth
Memorial
Mysore
Hospital
RIGHT FRONTAL
PARASAGITTAL
NEURO SURGERY
TUMOR GOING
TO LEFT SIDE
Neuro Surgery
Brain Tumour
Excision of Brain
Tumor
SupratentorialBasal
404
404
21-Aug-15
1-Sep-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
1518 H_19593322451
Female
24
SC
Muchandi
BELGAUM
BELGAUM
Belgaum
TRINITY
HOSPITAL AND
HEART
FOUNDATION
BANGALORE
SOUTH
RHD - Severe
Mitral Stenosis,
S/P PTMC
Mitral Valve
Replacement
145
145
24-Aug-15
7-Sep-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
1519 H_22458322469
Female
20
Others Mahalingpur
MUDHOLA
BAGLAKOT
Belgaum
VENKATESH
HOSPITAL
MAHALINGPUR
Right distal
RENAL
ureteric calculus
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
29-Aug-15
1-Sep-15
25000
29720
25000
2500
22500
IDBI - 321
30-Oct-15
1520 H_21868322445
Male
69
Others Thejur
HOLENARSIPUR HASSAN
Mysore
NAGESH
HOSPITAL
Retention of
CHANNARAYAPA
Urine with BPH
TNA
Gr3 55.86g
Genito Urinary
Surgery
Urology
TURP
917
917
9-Sep-15
16-Sep-15
20000
36305
20000
2000
18000
IDBI - 321
30-Oct-15
Bangalore
CARDIOLOGY
RENAL
Breast
Sl.No
Preauth No
Gender
Age
1521 H_20332322037
Female
36
1522 H_20200322402
Male
54
Caste
Village
Others YALAPALLI
SC
KOLATTHURU
Taluk
Patient District
Patient
Division
BAGEPALLI
CHIKKABALLAPU
Bangalore
R
MYSORE
MYSORE
Mysore
Hospital Name
Hospital
District
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
vvf
RENAL
Genito Urinary
Surgery
Urology
VVF Repair
904
904
14-Aug-15
2-Sep-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
LUMBER DISC
PROLAPSE L4-5
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
31-Aug-15
5-Sep-15
25000
25000
25000
0
25000
IDBI - 321
30-Oct-15
239
239
23-Aug-15
27-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
ATHEROSCLEROT
IC SIGNIFICANT
SINGLE VESSEL CARDIOLOGY
CORONARY
ARTERY DISEASE.
Cardiology
Cardiology
PTCA - one Drug
Eluting stent (
emergency,
inclusive of
angiogram) at the
same admission.
Urology
URSL - Single Side
+ DJ Stent
909
909
24-Aug-15
29-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
1523 H_19522322422
Male
52
Others ADYAR
MANGALORE
DAKSHINA
KANNADA
Mysore
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
1524 H_20531322038
Male
24
Others P C PALYA
MAGADI
RAMANAGAR
Bangalore
RAJARAJESWARI
MEDICALCOLLE
BANGALORE
GE AND
HOSPITAL
B/l uretric
calculus Rt side
RENAL
(5X4mm); Lt side
(8X5mm)
Genito Urinary
Surgery
1525 H_23124322437
Male
13
Others RANGAPUR
HOLALKERE
CHITRADURGA
Bangalore
SPARSH SUPER
SPECIALITY
HOSPITAL
BANGALORE
NORTH
CHD-15mm
Large Sub aortic
CARDIOLOGY
VSD with left to
right shunt
VSD
152
152
22-Aug-15
8-Sep-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
1526 H_19574321465
Female
55
BANGARPET
KOLAR
Bangalore
VYDEHI
HOSPITAL
BANGALORE
LAD- LMCA +
SVD (LAD)
CARDIOLOGY
CABG
132
132
26-Aug-15
8-Sep-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
1527 H_19567320914
Male
34
HUBLI
DHARWAD
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Tongue
Lateral Border
stage III
T2,N1,M0
CANCER
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
27-Aug-15
14-Sep-15
60000
71830
60000
6000
54000
IDBI-294
9-Oct-15
TUMKUR
Bangalore
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
RT RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
ESWL (Extra
Stent
908
908
22-Aug-15
28-Aug-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
BANGALORE URBAN
Bangalore
RENAL
Genito Urinary
Surgery
Urology
918
918
31-Aug-15
5-Sep-15
35000
35000
35000
3500
31500
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
105
105
19-Aug-15
27-Aug-15
20000
20000
20000
0
20000
IDBI - 321
30-Oct-15
CHD - OS ASD
CARDIOLOGY
ASD
151
151
19-Aug-15
29-Aug-15
80000
80000
80000
0
80000
IDBI - 321
30-Oct-15
Tethered cord
syndrome
NEURO SURGERY
Neuro Surgery
Spinal
Spina Bifida
Surgery Major
437
437
1-Sep-15
7-Sep-15
30000
47308
20000
2000
18000
IDBI - 321
30-Oct-15
L4-L5 PIVD
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
3-Sep-15
15-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
ACHD,OS ASD
1.8cm Left>Right Shunt
CARDIOLOGY
ASD
151
151
26-Aug-15
15-Sep-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
27-Aug-15
29-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
26-Aug-15
5-Sep-15
60000
44958
35000
3500
31500
IDBI - 321
30-Oct-15
11
11
21-Aug-15
16-Sep-15
40000
36685
36685
3669
33016
IDBI - 321
30-Oct-15
SC
KGF
Minorit
PO:OLD HUB LI
y
1528 H_20332321958
Male
29
Others HULIGERE
1529 H_20332322412
Female
29
Others
1530 H_19577321661
Male
37
Minorit
WARD NO 51
y
MANDYA
MANDYA
Mysore
1531 H_19577321639
Female
25
Others MUNGASAVALI
HIRIYUR
CHITRADURGA
Bangalore
1532 H_20021320730
Male
2
Others Nagura
BIDAR
BIDAR
Gulbarga
1533 H_19574321576
Male
44
TURVEKERE
TUMKUR
Bangalore
ST
SIRA
SHAYANABOGANAH BANGALORE
ALLII
NORTH
MAYASANDRA
MANGALORE
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
BANGALORE
SJICR
SOUTH
BANGALORE
SJICR
SOUTH
BASAVESHWAR
TEACHING AND
GULBARGA
GENERAL
HOSPITAL
VYDEHI
BANGALORE
HOSPITAL
RT NON
FUNCTIONING
OF KIDNEY
RHD - SEVERE
MS
1534 H_19574322109
Male
6
Others SITHAPANAHALLI
MALUR
KOLAR
Bangalore
VYDEHI
HOSPITAL
1535 H_22478321915
Male
43
Others LASKAR MOHALLA
MYSORE
MYSORE
Mysore
SHREE
MAHADESHWA
MYSORE
RA NURSING
HOME
LEFT SIDE HUN
1536 H_20613322333
Male
38
Minorit
Solapur
y
HUKKERI
BELGAUM
Belgaum
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
ca .tongue +FOM
CANCER
III
Female
14
1538 H_20322321417
Female
51
Minorit
BADAGANNUR
y
PUTTUR
1539 H_20575320997
Female
45
Others 0
HONNAVAR
1540 H_20619322176
Male
37
ST
HYRADA
Others MUKTINA HALLI
Gulbarga
S.S. INSTITUTE
Post Burn
OF MEDICAL
NH-4,Bypass PB
contracture of
SCIENCES &
Road Davanagere
neck and elbow
RESEARCH CENT
BURNS
Burns
Burns
Post Burn
Contracture
surgeries for
Functional
Improvement(Pack
age including
splints, pressure
garments and
physiotherapy),
Severe
DAKSHINA
KANNADA
Mysore
INDIANA
HOSPITAL AND
HEART
INSTITUTE LTD
MANGALORE
PALPITATION
PRESENT ?SVT
CARDIOLOGY
Cardiology
Cardiology
EP study
125
125
22-Aug-15
26-Aug-15
30000
39252
30000
3000
27000
IDBI - 321
30-Oct-15
UTTARA
KANNADA
Belgaum
MANGALORE
INSTITUTE OF
ONCOLOGY
MANGALORE
CA LEFT BUCCAL
MUCOSA
CANCER
T4N1M0
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
20-Aug-15
22-Sep-15
60000
60000
57000
5700
51300
IDBI - 321
30-Oct-15
Bangalore
SUKSHEMA
HOSPITAL
PVTLTD
DAVANGERE
LARGE LEFT
RENAL
CALCULUS
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
24-Aug-15
27-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
HUVINAHADAG
BELLARY
ALI
1537 H_19583321810
HONNALI
BANGALORE
Simple
Balloon Mitral
Valvotomy
DAVANGERE
RENAL
Sl.No
Preauth No
Village
Taluk
Age
Caste
1541 H_20619321783
Male
20
SC
CHANNAHALLI
THANDA
HARAPANAHALL
DAVANGERE
I
Bangalore
1542 H_19586322344
Female
20
SC
0
GUBBI
TUMKUR
Bangalore
1543 H_21701321766
Male
43
SC
kenal roda
MANVI
RAICHUR
Gulbarga
1544 H_19581322321
Male
49
Others MAHADEVANAHALLI MYSORE
MYSORE
1545 H_19574320907
Male
49
Others BELURE
GULBARGA
GULBARGA
Patient District
Patient
Division
Gender
Hospital Name
SUKSHEMA
HOSPITAL
PVTLTD
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
Hospital
District
Final
Diagnosis
Diseases
DAVANGERE
RIGHT LOWER
URETERIC
CALCULUS
RENAL
Genito Urinary
Surgery
BANGALORE
CHD-ASD
CARDIOLOGY
SUNSHINE
HEART
INSTITUTE
Paradise, S.D.
Road
Mysore
Cauvery
Hospital
Gulbarga
VYDEHI
HOSPITAL
30-Oct-15
ASD
151
151
20-Aug-15
9-Sep-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
cad single vessel
CARDIOLOGY
diseases
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
21-Aug-15
28-Aug-15
90000
90000
91800
9180
82620
IDBI - 321
30-Oct-15
MYSORE
TRIPLE VESSEL
CORONARY
CARDIOLOGY
ARTERY DISEASE
CABG
132
132
21-Aug-15
1-Sep-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
BANGALORE
RHD and wall MI CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
31-Aug-15
8-Sep-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
Neuro Surgery
Spinal
Anterior Cervical
Discectomy
Multiple level with
Implants
(procedure
30000+ Implants
10000)
429
429
29-Aug-15
8-Sep-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
25-Aug-15
28-Aug-15
65000
65000
63500
0
63500
IDBI - 321
30-Oct-15
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
23-Aug-15
26-Aug-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
239
239
23-Aug-15
26-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
Female
66
Others WARD NO 26
HASSAN
HASSAN
Mysore
SJICR
BANGALORE
SOUTH
ACS NSTEMI SVD CARDIOLOGY
NEURO SURGERY
ACS ACUTE
INFEROIR
POSTERIOR MI
LYSED
CARDIOLOGY
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
CANCER
Surgical Oncology
Head & Neck
Wide excision
621
621
27-Aug-15
10-Sep-15
35000
41680
35000
3500
31500
IDBI-294
9-Oct-15
CABG
132
132
14-Aug-15
26-Aug-15
115000
131164
117300
11730
105570
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
3D Maping +
Ablation
127
127
20-Aug-15
30-Aug-15
50000
50000
50000
0
50000
IDBI - 321
30-Oct-15
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
26-Aug-15
29-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
22-Aug-15
26-Aug-15
25000
33745
25000
2500
22500
IDBI - 321
30-Oct-15
Burns
Post Burn
Contracture
surgeries for
Functional
Improvement(Pack
age including
splints, pressure
garments and
physiotherapy),
Mild
9
9
27-Aug-15
31-Aug-15
20000
22100
20000
2000
18000
IDBI - 321
30-Oct-15
912
912
26-Aug-15
2-Sep-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
240
240
26-Aug-15
29-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
1549 H_20200322137
Male
62
Minorit
THOUTANAHALLI
y
Bangalore
1550 H_19567320903
Female
65
Others TIMMAPUR PETH
RAICHUR
RAICHUR
Gulbarga
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Basal cell
carcinoma
1551 H_20127319558
Male
62
Others KUMTA
KUMTA
UTTARA
KANNADA
Belgaum
A J HOSPITAL
CENTRE
CAD,TVD,ACS,ST
EMI(ANTERIOR CARDIOLOGY
WALL)
1552 H_19577322218
Male
20
Minorit
BANGALORE
y
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
SJICR
BANGALORE
SOUTH
1553 H_19549319941
Male
42
SC
0
GANGAVATHI
KOPPAL
Gulbarga
Sagar Hospitals
BANGALORE
SOUTH
1554 H_19571321827
Male
41
Others
M B NAGAR
AFZLAPUR
AFJALPUR
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
1556 H_22080322199
Male
23
1557 H_19577322050
Male
52
SC
HIREKUMBI
Others JYOTHINGARA
SHIMOGA
SHIMOGA
Cardiology
KASTURBA
HOSPITAL
UDUPI
ACUTE INFERIOR
CARDIOLOGY
WALL MI
Urology
Mysore
NARAYANA
HRUDAYALAYA
SURGICAL
MYSORE
HOSPITAL PVT
LTD
DODDAKERI
HARMAGATTA
IDBI - 321
1547 H_19577322250
Others
Net Amt
Paid
22500
C5-6 PIVD, C3-4
PIVD
40
TDS
2500
BANGALORE
Female
Gross
Amount
approved by
25000
VYDEHI
HOSPITAL
1555 H_21211321989
Hospital
claimed
Amount
25000
Gulbarga
UDUPI
Preauth
Approved
Amt
25000
KOPPAL
UDUPI
Date of
Discharge
27-Aug-15
YELBURGA
BOMMARABETTU
Date of
Admission
24-Aug-15
Others MAGALORE
ST
909
29
56
Plan of
treatment
909
Male
Female
URSL - Single Side
+ DJ Stent
1546 H_19574319951
1548 H_19564322256
Disease Main
Category
FASICULAR
VENTRICULAR
TACHYCARDIA
L5-S1 EXTRAIED
DISC
LT LOWER
RENAL
URETERIC STONE
Cardiology
Bangalore
mcgann
teaching district SHIMOGA
hospital
Hand
Contracture
BELGAUM
STRICTURE
BULBAR &
RENAL
PENILE URETHRA
Genito Urinary
Surgery
Urology
Urethroplasty for
a year can be
considered)
BANGALORE
SOUTH
IW+PW+RVMI,SV
CARDIOLOGY
D
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
SAVADATTI
BELGAUM
Belgaum
VIJAYA
HOSPITAL
SIRA
TUMKUR
Bangalore
SJICR
BURNS
Burns
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Others JAMBARADI
SAKLESHPURA
HASSAN
Mysore
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
14
Others UOODAGI
SEDAM
GULBARGA
Gulbarga
SJICR
BANGALORE
SOUTH
Female
47
Others Rampur
SINDAGI
BIJAPUR
Belgaum
Bijapur Kidney
Foundation
Bijapur
1561 H_19549319931
Male
72
0
ALAND
GULBARGA
Gulbarga
Sagar Hospitals
BANGALORE
SOUTH
1562 H_19571321628
Male
26
Others KUDALAGI
JEVARGI
GULBARGA
Gulbarga
Gulbarga
1558 H_19522321979
Female
8 Months
1559 H_19577322097
Male
1560 H_19503320626
1563 H_19571322040
1564 H_20212322153
1565 H_20017322167
Female
Female
Male
51
37
55
SC
Others GOTTUR
ST
Hittanahalli
Others 0
GULBARGA
BIJAPUR
BELGAUM
GULBARGA
BIJAPUR
BELGAUM
Diseases
ANORECTAL
NEONATAL
MALFORMATION
RHD - SEVERE
AS, MODERATE
AR, SEVERE MS
B/L renal and
Left ureteric
calculus
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Anorectal
Malformations
Stage 1
305
305
20-Aug-15
27-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
CARDIOLOGY
Double Valve
Replacement
149
149
21-Aug-15
10-Sep-15
150000
150000
149000
0
149000
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
28-Aug-15
2-Sep-15
30000
40371
30000
3000
27000
IDBI - 321
30-Oct-15
L4-5 GRADE
LISTESS WITH
NEURO SURGERY
CANAL STENOSIS
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
31-Aug-15
7-Sep-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT UPPER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
22-Aug-15
26-Aug-15
25000
32655
25000
2500
22500
IDBI - 321
30-Oct-15
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT RENAL
CALCULUS
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
21-Aug-15
29-Aug-15
25000
35037
25000
2500
22500
IDBI - 321
30-Oct-15
Gynaec-Ca.Cervix
Radical
Hysterectomy
+Bilateral Pelvic
Lymph Node
Dissection (BPLND)
Ophorectomy
(BSO) / Ovarian
transposition
648
648
24-Aug-15
10-Sep-15
45000
70062
45000
4500
40500
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
11-Aug-15
2-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
239
239
24-Aug-15
26-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
RENAL
Belgaum
Mahatma
Gandhi Cancer
Hospital
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
Mysore
NARAYANA
HRUDAYALAYA
SURGICAL
MYSORE
HOSPITAL PVT
LTD
IHD-DOUBLE
VESSEL CAD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
Miraj
Ca. Cervix [Stage CANCER
IIA] T2 N0 M0
Surgical Oncology
LT.RENAL
CALCULUS
Genito Urinary
Surgery
RENAL
1566 H_20200322140
Male
48
Others BELAVADI
MYSORE
1567 H_20300321193
Male
37
Others CHIKKAMALURU
Bangalore
BMCRI SSH
PMSSY
Bangalore
GRADE II L5-S1
LITHESIS
NEURO SURGERY
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
17-Aug-15
1-Sep-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
1568 H_20733322106
Male
T NARASIPUR
MYSORE
Mysore
SJICR MYSORE
MYSORE
IHD-IWMI CADDVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
24-Aug-15
27-Aug-15
90000
90000
89500
8950
80550
IDBI - 321
30-Oct-15
1569 H_19571321633
Female
45
Others MASKI
LINGASUGUR
RAICHUR
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT UPPER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
22-Aug-15
31-Aug-15
25000
34614
25000
2500
22500
IDBI - 321
30-Oct-15
1570 H_19574322042
Male
4
Minorit
BANNIKERE
y
SHIMOGA
SHIMOGA
Bangalore
VYDEHI
HOSPITAL
BANGALORE
Recurrent
Retinoblastoma
Right eye
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
24-Aug-15
5-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
1571 H_19576320777
Female
28
Minorit
Savadatti
y
SAVADATTI
BELGAUM
Belgaum
SDM Narayana
Hrudayalaya
Dharwad
Echo donRHD
severe mitral
CARDIOLOGY
stenosis(MVOA1.
0cm2)Severe TR
Mitral Valve
Replacement
145
145
20-Aug-15
8-Sep-15
150000
150000
150000
15000
135000
IDBI - 321
30-Oct-15
1572 H_20074321985
Male
12
Others KALLADEVANAHALLI SHAHPUR
YADGIRI
Gulbarga
M S RAMAIAH
NARAYANA
BANGALORE
HRUDAYALAYA
CHD LARGE
SECONDUM ASD CARDIOLOGY
L-R
ASD
151
151
22-Aug-15
31-Aug-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
1573 H_19564320808
Male
74
Others DAVALAPPANA BIDI
MOLAKALMURU CHITRADURGA
UDUPI
L4-5 CANAL
STENOSIS
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
17-Aug-15
29-Aug-15
25000
25000
25500
2550
22950
IDBI - 321
30-Oct-15
1574 H_20322322022
Male
52
Minorit
NARINGANA
y
BANTWAL
KASTURBA
HOSPITAL
INDIANA
HOSPITAL AND
HEART
INSTITUTE LTD
MANGALORE
CAD ACS NSTEMI
CARDIOLOGY
AWMI
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
22-Aug-15
26-Aug-15
65000
79184
65000
6500
58500
IDBI - 321
30-Oct-15
58 Months Others TALKADU
MYSORE
MANGALORE
Final
Diagnosis
DAKSHINA
KANNADA
Bangalore
Mysore
CANCER
NEURO SURGERY
Sl.No
Preauth No
Gender
Age
1575 H_20017321814
Male
28
1576 H_20815320733
Male
52
1577 H_20531321987
1578 H_20661320500
Female
Female
37
9
Caste
Village
Others YALBURGA
SC
NAVADAGI (B)
Others KURUDI HALLI
Others RALADODDI
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
RECURRENT
POST BURN
CONTRCATURE
BURNS
OF RIGHT HAND
+ 2ND & 3RD
FINGERS
Burns
Burns
Post Burn
Contracture
surgeries for
Functional
Improvement(Pack
age including
splints, pressure
garments and
physiotherapy),
Severe
Cervical
compressive
NEURO SURGERY
myelopathy with
qaudriparesis
Neuro Surgery
Spinal
LaminectomyCervical
431
431
26-Aug-15
31-Aug-15
25000
26224
25000
2500
22500
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
24-Aug-15
29-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
17-Jun-15
1-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
907
907
31-Aug-15
3-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
KOPPAL
KOPPAL
Gulbarga
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
GULBARGA
GULBARGA
Gulbarga
CHIRAYU
HOSPITAL
Bangalore
RAJARAJESWARI
MEDICALCOLLE
BANGALORE
GE AND
HOSPITAL
Lt proximal
ureteric calculus RENAL
10X5mm
Genito Urinary
Surgery
Gulbarga
Vijayanagara
Institute of
BELLARY
Medical Science
Righa renal
calculus
RENAL
Genito Urinary
Surgery
KOLAR
(RT) RENAL
CALCULI
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
21-Aug-15
26-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
Neuro Surgery
Brain
Intervention with
coiling
410
410
17-Aug-15
25-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
KUNIGAL
RAICHUR
TUMKUR
RAICHUR
GULBARGA
11
11
21-Aug-15
2-Sep-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
1579 H_20164320932
Male
38
Others PAPARAJANAHALLI
KOLAR
KOLAR
Bangalore
R L JALAPPA
HOSPITAL AND
RESEARCH
CENTRE
1580 H_19549321755
Male
53
Minorit
0
y
KOPPAL
KOPPAL
Gulbarga
Sagar Hospitals
BANGALORE
SOUTH
1581 H_20010319874
Female
40
Others NANDHINI LAYOUT
BANGALORE
EAST
BANGALORE URBAN
Bangalore
M S Ramaiah
Hospital
BANGALORE
NORTH
1582 H_19549321792
Male
70
Others 0
T NARASIPUR
MYSORE
Mysore
Sagar Hospitals
BANGALORE
SOUTH
IHD- NSTEMI,
CAD-SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
20-Aug-15
25-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
1583 H_23124321912
Male
65
Others A D COLONY
HOLALKERE
CHITRADURGA
Bangalore
SPARSH SUPER
SPECIALITY
HOSPITAL
BANGALORE
NORTH
IHD-LV
DYSFUNCTION, CARDIOLOGY
EFFORT ANGINA
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
22-Aug-15
26-Aug-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
1584 H_19574320877
Female
75
Others
KOPPAL
KOPPAL
Gulbarga
VYDEHI
HOSPITAL
BANGALORE
Carcinoma anal
canal T4N3M1
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
26-Aug-15
8-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
1585 H_22971320489
Male
6 Days
MALAVALLI
MANDYA
Mysore
CSI Holdsworth
Memorial
Mysore
Hospital
Hirschprungs
Disease stage 1
308
308
17-Aug-15
31-Aug-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
Burns
Burns
Post Burn
Contracture
surgeries for
Functional
Improvement(Pack
age including
splints, pressure
garments and
physiotherapy),
Moderate
10
10
21-Aug-15
15-Sep-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
Head & Neck
615
615
24-Aug-15
27-Aug-15
20000
23161
20000
2000
18000
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
31-Aug-15
5-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
DEVARAJA ARAS
COLONY
Minorit
MUSLIM BLOCK
y
1586 H_20010321381
Female
37
Others SUNKADAKATTE
BANGALORE
SOUTH
BANGALORE URBAN
1587 H_20613321657
Female
33
Others Kolar
BASAVANABAGE
BIJAPUR
WADI
BANGALORE
NORTH
IHDRECENT
AWMI,THROMB
CARDIOLOGY
OLYSED, CADSVD.
LEFT ICACARATICU -OPMTHMACMIC NEURO SURGERY
SEGMENT ANEURYSM
CANCER
HIRSCHESPRUNG
NEONATAL
'S DISEASE
Bangalore
M S Ramaiah
Hospital
PSOT BURNS &
CAN ACTIVE
Belgaum
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
k/c/o Ca Thyroid
CANCER
Stage III
Surgical Oncology
RANEBENNUR
B/L
Hydroureterone
phrosis due to
RENAL
renal & ureteric
calculi.
Genito Urinary
Surgery
BURNS
1588 H_20215321508
Male
38
Others B.S.Betageri
RONA
GADAG
Belgaum
SRI LAXMI
SURGICAL
TRAUMA
ORTHO AND
MULTISPECILIT
1589 H_19577321672
Female
22
Minorit
WARD NO 20
y
BIJAPUR
BIJAPUR
Belgaum
SJICR
BANGALORE
SOUTH
RHD - SEVERE
MS, MODERATE
CARDIOLOGY
MR, MODERATE
TR
Mitral Valve
Replacement
145
145
22-Aug-15
27-Aug-15
140000
20000
20000
0
20000
IDBI - 321
30-Oct-15
1590 H_19577321191
Female
4
Others TURVIHAL
SINDNUR
RAICHUR
Gulbarga
SJICR
BANGALORE
SOUTH
CHD - VSD
VSD
152
152
21-Aug-15
31-Aug-15
80000
80000
80000
0
80000
IDBI - 321
30-Oct-15
CARDIOLOGY
Sl.No
Preauth No
Gender
Age
Caste
Village
1591 H_19577321630
Male
40
Others
1592 H_19577321665
Female
9
Others MANTAPA
Taluk
SIDDESWARANADUR
CHALLAKERE
GA
ANEKAL
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
25-Aug-15
29-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
ASD
151
151
20-Aug-15
5-Sep-15
80000
80000
80000
0
80000
IDBI - 321
30-Oct-15
109
109
1-Sep-15
11-Sep-15
55000
45000
19000
0
19000
IDBI - 321
30-Oct-15
CHITRADURGA
Bangalore
SJICR
BANGALORE
SOUTH
Cardiology
BANGALORE URBAN
Bangalore
SJICR
BANGALORE
SOUTH
CHD - ASD
CARDIOLOGY
Cardiology
1593 H_19577321629
Male
43
Others MADAPURA
Mysore
GAR
GAR
SJICR
BANGALORE
SOUTH
LEFT LOWER
LIMB CRITICAL
ISCHAEMIA
CARDIOLOGY
Cardiology
Cardiology
Peripheral
Angioplasty
1594 H_19581321922
Female
40
Others B T MILL ROAD
MYSORE
MYSORE
Mysore
Cauvery
Hospital
MYSORE
RECURRENT
PSVT
CARDIOLOGY
Cardiology
Cardiology
EP study
125
125
23-Aug-15
25-Aug-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
1595 H_19581321533
Male
32
Others
HUNSUR
MYSORE
Mysore
Cauvery
Hospital
MYSORE
SINUS
BRADYCARDIA,
CARDIOLOGY
PRE-EXCITATION
SYNDROME
Cardiology
Cardiology
EP study
125
125
23-Aug-15
25-Aug-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
1596 H_23124321907
Male
14
Others KOLAL
HOLALKERE
CHITRADURGA
Bangalore
SPARSH SUPER
SPECIALITY
HOSPITAL
BANGALORE
NORTH
CHD-SEVERE
VALVULAR PS
CARDIOLOGY
Cardiology
Cardiology
Balloon
Pulmonary
Valvotomy
107
107
22-Aug-15
27-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
1597 H_23124321902
Male
3
Others THALIKOTTE
HOLALKERE
CHITRADURGA
Bangalore
SPARSH SUPER
SPECIALITY
HOSPITAL
BANGALORE
NORTH
CHD-OS ASD13MM WITH L-R CARDIOLOGY
SHUNT
Cardiology
Device Closure
ASD Device
Closure
120
120
22-Aug-15
26-Aug-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
IHD- EFFORT
ANGINA, CADSIGNIFICANT
LEFT MAIN WITH CARDIOLOGY
DOUBLE VESSEL
CORONARY
DISEASE.
CABG
132
132
19-Aug-15
1-Sep-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
ASD
151
151
21-Aug-15
2-Sep-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
Cardiology
Thrombolysis for
peripheral
ischemia
129
129
21-Aug-15
29-Aug-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
CABG
132
132
21-Aug-15
1-Sep-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
PTCA - one Drug
Eluting stent (
emergency,
inclusive of
angiogram) at the
same admission.
239
239
21-Aug-15
24-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
MARALAIAH
KOPPALU
1598 H_19549321776
Female
62
Others 0
DEVADURGA
RAICHUR
Gulbarga
Sagar Hospitals
BANGALORE
SOUTH
1599 H_19549321762
Male
38
Others 0
TURVEKERE
TUMKUR
Bangalore
Sagar Hospitals
BANGALORE
SOUTH
1600 H_21057321892
Female
31
Others KUKKUDURU
UDUPI
UDUPI
Mysore
NEW
1601 H_20017321886
Male
61
Others BORGAON
CHIKKODI
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
Bangalore
SPARSH SUPER
SPECIALITY
HOSPITAL
BANGALORE
NORTH
IHD - ACS-ACUTE
CARDIOLOGY
PWMI
Cardiology
Mysore
Narayana
Hrudayalaya
Private Limited
Bangalore
LARGE
L-R SHUNT
ASD
151
151
25-Aug-15
5-Sep-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
LAKDIKAPUL
LARGE UPPER
MUSCULAR VSD,
CARDIOLOGY
SMALL PFO,
DILATED LEFT
HEART
VSD
152
152
21-Aug-15
29-Aug-15
80000
80000
81600
8160
73440
IDBI - 321
30-Oct-15
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
21-Aug-15
26-Aug-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
1602 H_23124321864
Male
60
Others GOLLAHALLI
MADHUGIRI
TUMKUR
1603 H_19528321869
Male
18
Others MELAPUR
SHRIRANGAPAT
MANDYA
NA
CHD-ASD, L TO R
CARDIOLOGY
SHUNT (BD
SHUNT)
ACUTE
CARDIOLOGY
PULMONARY
EMBOLISM
CAD TVD WITH
LM
CARDIOLOGY
Cardiology
Cardiology
1604 H_21079321828
Female
4 Months
Others VILASPUR
BIDAR
BIDAR
Gulbarga
LOTUS
CHILDREN S
HOSPITAL
1605 H_21225321655
Male
55
Minorit
RAICHURE
y
RAICHUR
RAICHUR
Gulbarga
CAD SINGLE
VESSEL DISEASE
1606 H_19571321234
Female
32
Minorit
YADRAMI
y
JEVARGI
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT UPPER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
21-Aug-15
26-Aug-15
25000
32626
25000
2500
22500
IDBI - 321
30-Oct-15
1607 H_19564321754
Male
79
Others SAVANTHURU
HOSANAGARA
SHIMOGA
Bangalore
KASTURBA
HOSPITAL
BPH
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
19-Aug-15
27-Aug-15
20000
20000
20400
2040
18360
IDBI - 321
30-Oct-15
1608 H_19571320766
Male
52
Others MIRAKHAL
BASAVAKALYAN
BIDAR
A
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
BENIGN
ENLARGEMENT
OF PROSTATE
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
20-Aug-15
27-Aug-15
20000
23957
20000
2000
18000
IDBI - 321
30-Oct-15
1609 H_20083321268
Female
27
Others HONDALAGERE
KUNIGAL
TUMKUR
Bangalore
Bhagwan
Mahaveer Jain
Hospital
Bangalore
RHD, Severe MS,
Mild MR, Severe CARDIOLOGY
PAH
Mitral Valve
Replacement
145
145
25-Aug-15
1-Sep-15
120000
393284
120000
0
120000
IDBI - 321
30-Oct-15
1610 H_19562321598
Female
41
Others KALMANE
SIDDAPUR
UTTARA
KANNADA
Belgaum
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
SHIMOGA
A known case of
ca. (R) G B Sulcus CANCER
T2N0M0 Stage II
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
30-Aug-15
10-Sep-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
1611 H_20074320381
Male
43
Others SINGAPURA
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
M S RAMAIAH
NARAYANA
BANGALORE
HRUDAYALAYA
IHD
Cardiology
Temporary
implantation
113
113
16-Aug-15
24-Aug-15
4000
4000
4000
400
3600
IDBI - 321
30-Oct-15
UDUPI
CARDIOLOGY
CARDIOLOGY
Sl.No
Preauth No
1612 H_21868321780
1613 H_20127321732
1614 H_20025321743
Gender
Age
Caste
Male
67
SC
Male
Female
53
43
KARWAR
MADIKERI
UTTARA
KANNADA
KODAGU
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Retention of urie
CHANNARAYAPA
RENAL
with BPH Gr3
TNA
66cc
Mysore
NAGESH
HOSPITAL
Belgaum
A J HOSPITAL
CENTRE
CAD,SVD
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
RT RENAL AND
PELVIC
CALCULUS
LT PUJ + RENAL
CALCULI
ACHD PDA(5 TO
6MM)WITH LEFT
CARDIOLOGY
TO RIGHT
SHUNT.
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Urology
TURP
917
917
4-Sep-15
9-Sep-15
20000
30023
20000
2000
18000
IDBI - 321
30-Oct-15
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
18-Aug-15
25-Aug-15
65000
110607
66300
6630
59670
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
29-Aug-15
3-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
29-Aug-15
8-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
176
176
23-Aug-15
1-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
RENAL
Genito Urinary
Surgery
RENAL
Genito Urinary
Surgery
Others KOTEKAR
MANGALORE
DAKSHINA
KANNADA
Mysore
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
29
Others 0
BADAMI
BAGLAKOT
Belgaum
VIMS Speciality
Bangalore
Hospital
RHD, SEVERE
MS, MILD MR,
SEVERE PAH/TR
CARDIOLOGY
Mitral Valve
Replacement
145
145
22-Aug-15
30-Aug-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
65
Minorit
CHITTAGUPPA
y
HUMNABAD
BIDAR
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
BENIGN
ENLARGEMENT
OF PROSTATE
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
20-Aug-15
26-Aug-15
20000
23778
20000
2000
18000
IDBI - 321
30-Oct-15
SULYA
DAKSHINA
KANNADA
Mysore
YENEPOYA
MEDICAL
COLLEGE
HOSPITAL
RIGHT DUPLEX
KIDNEY WITH
LOWER MOIETY NEONATAL
HYDROURETERO
NEPHROSIS
Congenital
Genito Urinary Surgeries Hydronephrosis
Open/Lap
313
313
15-Aug-15
4-Sep-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
GUNDLUPET
CHAMARAJANA
Mysore
GAR
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
SEVER MR
Mitral Valve
Replacement
145
145
22-Aug-15
1-Sep-15
120000
100000
100000
0
100000
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
15-Aug-15
24-Aug-15
47500
48926
47500
4750
42750
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
19-Aug-15
25-Aug-15
25000
32396
25000
2500
22500
IDBI - 321
30-Oct-15
429
429
27-Aug-15
1-Sep-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
5 Months
1617 H_20026321742
Female
1618 H_19571320772
Male
9 Months
38
Others ALETTY
Others NALURUMOLE
MANGALORE
MANGALORE
CARDIOLOGY
1621 H_22337319331
Male
78
Others KOTNALLI
BADAMI
BAGLAKOT
Belgaum
BARAGI
HOSPITAL
BAGALKOT
BAGALKOT
B/L URETERIC
CALCULUS WITH
B/L HUN WITH RENAL
B/L RENAL
STONE
1622 H_19571320621
Female
55
Others CHALAGERA
ALAND
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT LOWER
RENAL
URETERIC STONE
Female
Genito Urinary
Surgery
Mysore
Male
1623 H_22439321034
Disease Main
Category
MANDYA
1616 H_20015321741
Female
Others KADYATHOOR
HOLENARSIPUR HASSAN
Patient
Division
MALAVALLI
69
1620 H_20200318567
Others HEDDEVANAGARA
Patient District
Others HANGRAPURA
Male
Male
Pooje Koppalu
Taluk
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
1615 H_20025321757
1619 H_20698319653
Village
38
Others DEVPUR
SURPUR
YADGIRI
Gulbarga
BHS lakeview
Hospital
BELGAUM
C4/5 PIVD RT
NEURO SURGERY
Neuro Surgery
Spinal
Anterior Cervical
Discectomy
Multiple level with
Implants
(procedure
30000+ Implants
10000)
MANGALORE
WEDGE
COMPRESSION
FRACTURE OF C2
VERTIBRA WITH NEURO SURGERY
RETROPULSION
COMPRESSING
THE THECAL SAC.
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
21-Aug-15
5-Sep-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
Cardiology
Balloon Mitral
Valvotomy
105
105
20-Aug-15
27-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
1624 H_20015321509
Male
53
Others SONAGINAMANE
SIRSI
UTTARA
KANNADA
Belgaum
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
1625 H_20017321679
Female
43
Others 0
BELGAUM
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
RHD SEVERE MS
CARDIOLOGY
WITH MVO
Cardiology
1626 H_20112321224
Female
8
CHALLAKERE
CHITRADURGA
Bangalore
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
CONGENITAL
HEART DISEASE
ICR for TOF
154
154
20-Aug-15
8-Sep-15
80001
80000
80000
2400
77600
IDBI - 321
30-Oct-15
1627 H_19562321591
Male
55
Minorit
KATTE PURA
y
ARAKALAGUD
HASSAN
Mysore
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
SHIMOGA
A known case of
ca. Rectum
CANCER
T2N0M0 Stage II
Surgical Oncology
Abdomino
Perineal Resection
(APR) +
Sacrectomy
629
629
27-Aug-15
5-Sep-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
1628 H_19491320051
Female
43
Others MARAKUNDA
BIDAR
BIDAR
Gulbarga
BGS GLOBAL
HOSPITAL
BANGALORE
SOUTH
RHD - SEVERE
MITERAL
STENOSIS
Mitral Valve
Replacement
145
145
26-Aug-15
3-Sep-15
120000
120000
120000
480
119520
IDBI - 321
30-Oct-15
SC
HIREHALLI
CARDIOLOGY
CARDIOLOGY
Ca.Rectum
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
1629 H_20212321322
Male
42
Others Kemlapur
RAIBAGH
BELGAUM
Belgaum
Mahatma
Gandhi Cancer
Hospital
Miraj
CA Cervix T2 N0
CANCER
M0 [Stage-II]
Surgical Oncology
Gynaec-Ca.Cervix
Radical
Hysterectomy
+Bilateral Pelvic
Lymph Node
Dissection (BPLND)
Ophorectomy
(BSO) / Ovarian
transposition
1630 H_19564321279
Male
56
Others KODITALE
UDUPI
UDUPI
Mysore
KASTURBA
HOSPITAL
UDUPI
CARCINOMA OF
CANCER
BLADDER
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
12-Aug-15
8-Sep-15
20000
20000
18360
1836
16524
IDBI - 321
30-Oct-15
1631 H_19564320942
Male
33
Others MASIDIKERE
NARASAPURA
CHIKKAMANAGL
Mysore
UR
KASTURBA
HOSPITAL
UDUPI
Neuro Surgery
Neuro Surgery
Peripheral Nerve
Surgery Major
453
453
13-Aug-15
27-Aug-15
35000
35000
35700
3570
32130
IDBI - 321
30-Oct-15
1632 H_20112321605
Female
8
CHALLAKERE
CHITRADURGA
Bangalore
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
VSD
152
152
21-Aug-15
1-Sep-15
80000
80000
80000
2400
77600
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
17-Aug-15
2-Sep-15
25000
32033
25000
2500
22500
IDBI - 321
30-Oct-15
CARDIOLOGY
Aortic Valve
Replacement
146
146
20-Aug-15
3-Sep-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
25-Aug-15
31-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
ST
ST
NAYAKANAHATTY
1633 H_19583319842
Male
40
GUNDUMUNUGU
1634 H_20017321603
Male
63
Minorit
KUDACHI
y
RIGHT MEDIAN
NERVE-NERVE
NEURO SURGERY
SHEATH
TUMOUR
CONGENITAL
HEART DISEASE
LARGE
CARDIOLOGY
SUBAORTIC VSD
WITH L->R
SHUNT
PANDAVAPURA MANDYA
Mysore
RT PELVIC
CALCULUS
Mysore
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
MANGALORE
?LEOMYOSARCO
CANCER
MA.T2N0M0.
Surgical Oncology
Gynaec
Radical
Hysterectomy
594
594
8-Aug-15
24-Aug-15
30000
30000
21000
2100
18900
IDBI - 321
30-Oct-15
RIGHT URETERIC
RENAL
CALCULUS
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
22-Aug-15
24-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
EP study
125
125
23-Aug-15
24-Aug-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Device Closure
PDA Device
Closure
119
119
21-Aug-15
24-Aug-15
60000
60000
59500
5950
53550
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
TURBT
916
916
13-Aug-15
27-Aug-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
22-Aug-15
26-Aug-15
65000
78525
65000
6500
58500
IDBI - 321
30-Oct-15
Intestinal Atresias
& Obstructions
303
303
21-Aug-15
27-Aug-15
40000
41377
40000
4000
36000
IDBI - 321
30-Oct-15
1637 H_21925320785
Male
55
Others 0
KADUR
CHIKKAMANAGL
Mysore
UR
MUDRA
HOSPITAL
TIPTUR
1638 H_19581321593
Male
56
Others BAILAKUPPE
PIRIYAPATNA
MYSORE
Mysore
Cauvery
Hospital
MYSORE
1639 H_20733321367
Female
8
Others NORTH BLOCK
PANDAVAPURA MANDYA
Mysore
SJICR MYSORE
MYSORE
M S Ramaiah
Hospital
INDIANA
HOSPITAL AND
HEART
INSTITUTE LTD
BANGALORE
NORTH
NARROW
COMPLEX
TACHYCARDIA
CHD/SS PDA L >R SHUNT
CARCINOMA
BLADDER
MANGALORE
CAD SVD
Male
46
BANGALORE URBAN
Bangalore
Minorit
BANNUR
y
PUTTUR
DAKSHINA
KANNADA
Mysore
Others 0
ARASIKERE
HASSAN
Mysore
Rajeev Nursing
Home
Hassan
meconium ileus
(neonatal
NEONATAL
intesinal
obstruction
Gulbarga
Ashwini
Sahakari
Rugnalaya Ani
Sansodhan
Kendra
Solapur
TV CAD
ISCHEMIC HEART CARDIOLOGY
DISESAE
CABG
132
132
21-Aug-15
31-Aug-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
Surgical Oncology
Head & Neck
Hemiglossectomy
613
613
21-Aug-15
7-Sep-15
32500
32500
32500
3250
29250
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
24-Aug-15
27-Aug-15
90000
109634
90000
9000
81000
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
ESWL (Extra
Stent
908
908
24-Aug-15
25-Aug-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
SC
VANARAPETE
Others HIPPARGA
ALAND
GULBARGA
1644 H_20308321553
Male
35
Others MANNAEKHELI
HUMNABAD
BIDAR
Gulbarga
MEDWIN
HOSPITALS
HYDERABAD
1645 H_20322321530
Male
77
Minorit
BOLANTHOOR
y
BANTWAL
DAKSHINA
KANNADA
Mysore
INDIANA
HOSPITAL AND
HEART
INSTITUTE LTD
MANGALORE
CAD RECENT
IWMI
Bangalore
SUKSHEMA
HOSPITAL
PVTLTD
DAVANGERE
RIGHT RENAL
CALCULUS
Male
40
Urology
BANGALORE
EAST
CA TONGUE LEFT
LATERAL
BORDER WITH
CANCER
CERVICAL NODE
METS
CT3N2BMX
1646 H_20619320847
30-Oct-15
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
HASSAN
1643 H_21695321563
IDBI - 321
RHD SEVERE AS
BELUR
5 Days
40500
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
Others YAMASANDI
Female
4500
Belgaum
31
1642 H_22932321565
45000
BELGAUM
Female
66
68245
RAIBAGH
1636 H_20015319004
Male
45000
Gulbarga
66
1641 H_20322321538
2-Sep-15
BELLARY
Male
56
21-Aug-15
KUDLIGI
1635 H_20025321186
Male
648
S.S. INSTITUTE
OF MEDICAL
NH-4,Bypass PB Lt Stag horn
SCIENCES &
Road Davanagere calculi
RESEARCH CENT
VISHWESHWARA
Others
NAGAR
1640 H_20010320796
648
Others LABANI HATTI KU
HOLALKERE
CHITRADURGA
Sl.No
Preauth No
1647 H_19586321481
1648 H_20025321441
Gender
Age
Female
43
Male
55
Caste
Village
Others KADASHETTAHALLI
Others BELAWADI
Taluk
TUMKUR
MYSORE
Patient District
TUMKUR
MYSORE
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Bangalore
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
IHD - NSTEMIS/P CAG - LAD
BANGALORE
LEFT DISTAL
URETERIC
CALCULUS
Diseases
RENAL
Disease Main
Category
Genito Urinary
Surgery
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Urology
URSL - Single Side
+ DJ Stent
909
909
21-Aug-15
3-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Cardiology
PTCA - one Drug
Eluting stent (
emergency,
inclusive of
angiogram) at the
same admission.
239
239
18-Aug-15
22-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
908
908
21-Aug-15
4-Sep-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
BANGALORE
B/L RENAL
CALCULUS
URETERIC
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
ESWL (Extra
Stent
BANGALORE
IHD SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
20-Aug-15
27-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
Urology
Urethroplasty for
a year can be
considered)
912
912
14-Aug-15
8-Sep-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
1649 H_19586321486
Male
43
SC
NINGAPURA
YELBURGA
KOPPAL
Gulbarga
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
1650 H_19586321217
Male
39
SC
GANJIGUNTE
CHITRADURGA
CHITRADURGA
Bangalore
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
STRICTURE
URETHRA
RENAL
Genito Urinary
Surgery
Mysore
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
TVD LV
Dysfunction
CARDIOLOGY
CABG
132
132
5-Sep-15
12-Sep-15
90000
90000
90000
0
90000
IDBI - 321
30-Oct-15
VSD
152
152
20-Aug-15
1-Sep-15
80000
80000
80000
2400
77600
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
905
905
17-Aug-15
31-Aug-15
35000
58120
35700
3570
32130
IDBI - 321
30-Oct-15
322
322
21-Aug-15
3-Sep-15
22000
22000
22000
2200
19800
IDBI - 321
30-Oct-15
128
128
18-Aug-15
24-Aug-15
10000
10000
9500
950
8550
IDBI - 321
30-Oct-15
105
105
22-Aug-15
26-Aug-15
20000
20000
20000
0
20000
IDBI - 321
30-Oct-15
1651 H_20017321498
1652 H_20200320852
Male
Male
55
60
Others 0
Others ward no 9
BYLAHONGALA
BELGAUM
PANDAVAPURA MANDYA
CHITRADURGA
Bangalore
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
CONGENITAL
HEART DISEASE
LARGE
CARDIOLOGY
SUBAORTIC VSD
WITH L - R
SHUNT
KUNDAPURA
UDUPI
Mysore
A J HOSPITAL
CENTRE
RIGHT PUJ
OBSTRUCTION
Others MUGALI
CHIKKODI
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
HYPOSPADIASIS NEONATAL
Others VASANATHAPURA
KR PET
MANDYA
Mysore
SJICR MYSORE
MYSORE
IHD-ACS ACUTE
CARDIOLOGY
AWMI CAD-SVD
Cardiology
Cardiology
MOODANAHALLI
ALUR
HASSAN
Mysore
SJICR
BANGALORE
SOUTH
CARDIOLOGY
Cardiology
Cardiology
CHITTAWADGI
HOSPET
BELLARY
Gulbarga
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
CARDIOLOGY
ASD
151
151
20-Aug-15
2-Sep-15
80000
80000
80000
2400
77600
IDBI - 321
30-Oct-15
SURPUR
YADGIRI
Gulbarga
SJICR
BANGALORE
SOUTH
CARDIOLOGY
CABG with IABP
133
133
12-Aug-15
5-Sep-15
115000
95000
95000
0
95000
IDBI - 321
30-Oct-15
MYSORE
DOUBLE VESSEL
CARDIOLOGY
DISEASE.
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
24-Aug-15
26-Aug-15
90000
90000
91800
9180
82620
IDBI - 321
30-Oct-15
hypospadias
NEONATAL
322
322
17-Aug-15
28-Aug-15
22000
22000
22000
2200
19800
IDBI - 321
30-Oct-15
CARDIOLOGY
VSD
152
152
21-Aug-15
2-Sep-15
80000
80000
80000
0
80000
IDBI - 321
30-Oct-15
Lt. Hepatectomy
643
643
21-Aug-15
1-Sep-15
75000
87806
71250
7125
64125
IDBI - 321
30-Oct-15
146
146
18-Aug-15
31-Aug-15
120000
120000
120000
0
120000
IDBI - 321
30-Oct-15
146
146
13-Aug-15
30-Aug-15
120000
125000
120000
0
120000
IDBI - 321
30-Oct-15
240
240
17-Aug-15
26-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
105
105
30-Aug-15
7-Sep-15
20000
20000
19000
0
19000
IDBI - 321
30-Oct-15
128
128
17-Aug-15
24-Aug-15
10000
10000
9500
950
8550
IDBI - 321
30-Oct-15
THAPPAGONDANHAL
CHALLAKERE
LY
1653 H_20112321229
Female
4
Others
1654 H_20127321453
Female
32
Others KARIKATTE
1655 H_20017321463
Male
1
1656 H_20733321470
Male
51
1657 H_19577320469
Female
46
SC
1658 H_20112321451
Male
4
ST
1659 H_19577320814
Male
52
Others TEERTH
RHD - SEVERE
MS
LARGE SINUS
VENOSUS ASD
WITH L _> R
SHUNT
IHD - LMCA,
TVD, ANGINA
RENAL
1660 H_19542321410
Male
67
Others SIDDARAHALLI
ARASIKERE
HASSAN
Mysore
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
1661 H_21223320367
Male
2
Minorit
BIDADI
y
RAMANAGAR
RAMANAGAR
Bangalore
INDIRA GANDHI
BANGALORE
INSTITUTE OF
SOUTH
CHILD HEALTH
1662 H_19577321184
Male
4
Minorit
JALAHALLI
y
DEVADURGA
RAICHUR
Gulbarga
SJICR
BANGALORE
SOUTH
CHD - VSD
Belgaum
Mahatma
Gandhi Cancer
Hospital
Miraj
Ca Liver.HCC T2
CANCER
N0 M0 [Stage-II]
Surgical Oncology
SEVERE AS
CARDIOLOGY
SEVERE AR
CARDIOLOGY
1663 H_20212321433
Male
62
Others Divapur
BIJAPUR
1664 H_19577321188
Female
42
Others KALU PETE
RURAL
Bangalore
SJICR
1665 H_19577321250
Male
12
Others GABASAVALAGI
SINDAGI
BIJAPUR
Belgaum
SJICR
1666 H_19577321262
Male
50
Minorit
ADUGODI
y
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
SJICR
BANGALORE
SOUTH
Cardiology
Cardiology
1667 H_19577321395
Female
37
Minorit
MURUGAMALLA
y
CHINTAMANI
CHIKKABALLAPU
Bangalore
R
SJICR
BANGALORE
SOUTH
RHD - SEVERE
MS
CARDIOLOGY
Cardiology
Cardiology
1668 H_20733321404
Male
71
Others
MYSORE
SJICR MYSORE
MYSORE
IHD-ACS ACUTE
CARDIOLOGY
AWMI CAD-SVD
Cardiology
Cardiology
MANCHE GOWDANA
MYSORE
KOPPALU
BIJAPUR
Mysore
BANGALORE
SOUTH
BANGALORE
SOUTH
Hepato Billiary System
Medical
treatment of
Acute MI with
Thrombolysis
Balloon Mitral
Valvotomy
Aortic Valve
Replacement
Aortic Valve
Replacement
PTCA - one stent
(Drug Eluting
Stents , elective)
Balloon Mitral
Valvotomy
Medical
treatment of
Acute MI with
Thrombolysis
Sl.No
Preauth No
Age
1669 H_19528321403
Female
25
Others NAGNTAGI
SHAHPUR
YADGIRI
Gulbarga
Narayana
Hrudayalaya
Private Limited
1670 H_19571320618
Male
35
Others KEMBHAVI
SURPUR
YADGIRI
Gulbarga
Minorit
GURMIT KAL
y
Gulbarga
1671 H_20107320861
Female
13
1672 H_19513321374
Female
62
1673 H_19581321362
Male
53
1674 H_19581321357
Female
1675 H_20511321355
Caste
Village
Taluk
Patient District
Patient
Division
Gender
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
RHD SEV MS MR,
CARDIOLOGY
CHB
Mitral Valve
Replacement
145
145
24-Aug-15
21-Sep-15
120000
150000
153000
4590
148410
IDBI - 321
30-Oct-15
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
19-Aug-15
24-Aug-15
25000
33347
25000
2500
22500
IDBI - 321
30-Oct-15
CARE Hospital A
unit of Quality
Nampally
Care India
Limite
CONGENTAL
COMPLETE
HEART BLOCK
CARDIOLOGY
Cardiology
Permanent
pacemaker
VVI) including
Pacemaker value
114
114
20-Aug-15
26-Aug-15
75000
107788
75000
7500
67500
IDBI - 321
30-Oct-15
Bangalore
YADGIR
YADGIRI
TARIKERE
CHIKKAMANAGL
Mysore
UR
NANJAPPA LIFE
SHIMOGA
CARE
ISCHEMIC HEART
DISEASE,
CARDIOLOGY
CAD:DVD
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
19-Aug-15
23-Aug-15
65000
65000
65000
650
64350
IDBI - 321
30-Oct-15
Others HASSAN
HASSAN
HASSAN
Mysore
Cauvery
Hospital
MYSORE
DOUBLE VESSEL
CORONARY
CARDIOLOGY
ARTERY DISEASE
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
20-Aug-15
24-Aug-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
51
Others MADHUVANAHALLI
KOLLEGAL
CHAMARAJANA
Mysore
GAR
Cauvery
Hospital
MYSORE
SINGLE VESSEL
CORONARY
CARDIOLOGY
ARTERY DISEASE
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
20-Aug-15
26-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
Male
56
Others SANKESWAR
HUKKERI
BELGAUM
Belgaum
SWASTIK
HOSPITAL
KOLHAPUR
CAD, UNSTABLE
CARDIOLOGY
ANGINA
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
17-Aug-15
24-Aug-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
1676 H_20203321345
Female
59
Others Lakshmeshawar
SIRAHATTI
GADAG
Belgaum
KARNATAKA
INSTITUTE OF
MEDICAL
SCINCES
HUBLI
Single Vessel
Disease
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
25-Aug-15
28-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
1677 H_19576321293
Male
51
Others Agalakera
KOPPAL
KOPPAL
Gulbarga
SDM Narayana
Hrudayalaya
Dharwad
CAD-Significant
LAD&OM1
diseasse
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
19-Aug-15
24-Aug-15
90000
90000
65000
6500
58500
IDBI - 321
30-Oct-15
1678 H_19571319505
Male
26
Others HUNASAGI
SURPUR
YADGIRI
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
17-Aug-15
31-Aug-15
25000
40334
25000
2500
22500
IDBI - 321
30-Oct-15
1679 H_20061320200
Male
53
(V) KEREBUDURU
Others (T,Q) RAICHUR (DIST) RAICHUR
RAICHUR.
RAICHUR
Gulbarga
NARAYANA
HOSPITALS
CAD-TRIPLE
CARDIOLOGY
VESSEL DISAESE.
CABG
132
132
18-Aug-15
29-Aug-15
95000
95000
96900
9690
87210
IDBI - 321
30-Oct-15
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
LT.RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
7-Aug-15
28-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
UP TO 10%
FACIAL+B/L.
HANDS
BURNS(IST
DEGREE)
BURNS
Burns
Burns
upto-40% with
Scalds(
Conservative/
without grafting)
2
2
18-Aug-15
22-Aug-15
15000
15000
15000
1500
13500
IDBI - 321
30-Oct-15
BPH
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
7-Aug-15
29-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
IHD- S/P PTCA
WITH STENT TO
LAD, EFFORT
ANGINA , CADDVD
CARDIOLOGY
CABG
132
132
17-Aug-15
7-Sep-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
URSL - Single Side
+ DJ Stent
909
909
22-Aug-15
26-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
1680 H_20017321318
Male
SC
LAKKAVALLI
45
Others 0
RAMADURGA
BELGAUM
MANGALORE
DAKSHINA
KANNADA
Mysore
ATHANI
BELGAUM
Belgaum
FATHER
MULLER
MANGALORE
MEDICAL
COLLEGE
HOSPITAL
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
1681 H_19522321231
Male
57
Minorit
ARKULA
y
1682 H_20017321284
Male
71
Others 0
MAGADI
RAMANAGAR
Bangalore
BANGALORE
Sagar Hospitals
SOUTH
KOLAR
KOLAR
Bangalore
R L JALAPPA
HOSPITAL AND
RESEARCH
CENTRE
KOLAR
RIGHT UPPER
URETRIC
CALCULOUS
WITH HUN
ALAND
GULBARGA
Gulbarga
Sagar Hospitals
BANGALORE
SOUTH
CHD-ASD, LARGE
BOS ASD WITH
CARDIOLOGY
PREDOMINANTL
Y L TO R SHUNT.
ASD
151
151
12-Aug-15
27-Aug-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
MANGALORE
DAKSHINA
KANNADA
Mysore
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
MANGALORE
L-1 FLEXION
DISTRACTION
INJURY
Neuro Surgery
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
19-Aug-15
5-Sep-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
1683 H_19549321210
Male
43
Minorit
0
y
1684 H_20164320400
Male
30
Others MANIGATTA
1685 H_19549321248
Female
11
1686 H_19522321211
Male
30
SC
0
Others SHIRTHADY
NEURO SURGERY
Urology
Spinal
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
BAGALKOT
RIGHT LARGE
RENAL PELVIC
CALCULUS WITH
RENAL
RIGHT
HYDRONEPHROS
IS
Genito Urinary
Surgery
BANGALORE
NORTH
CERVICO
MEDULLANY SOL NEURO SURGERY
HEMANFGROMA
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
20-Aug-15
24-Aug-15
25000
28775
25000
2500
22500
IDBI - 321
30-Oct-15
Neuro Surgery
Spinal
Spinal Intra
Medullary
Tumours
436
436
17-Aug-15
14-Sep-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
1687 H_22337320838
Female
33
Others KERUR
BADAMI
BAGLAKOT
Belgaum
BARAGI
HOSPITAL
BAGALKOT
1688 H_20010320929
Male
15
Minorit
KURAKUNDA
y
SEDAM
GULBARGA
Gulbarga
M S Ramaiah
Hospital
1689 H_21223319982
Female
8
HASSAN
Mysore
INDIRA GANDHI
BANGALORE
INSTITUTE OF
SOUTH
CHILD HEALTH
hirschprungs
diease
NEONATAL
Hirschprungs
Disease stage 1
308
308
17-Aug-15
29-Aug-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
1690 H_21052321214
Male
60
Others JAIN PETE
MANGALORE
DAKSHINA
KANNADA
Mysore
CA RECTUM
STAGE III
CANCER
Surgical Oncology
Anterior
Resection
638
638
17-Aug-15
3-Sep-15
50000
92892
50000
5000
45000
IDBI - 321
30-Oct-15
1691 H_19574320101
Female
41
Minorit
MARIYAPPA LYT
y
ANEKAL
BANGALORE URBAN
Bangalore
VYDEHI
HOSPITAL
Carcinoma endo
CANCER
metriam Stage I
Surgical Oncology
Gynaec
Radical
Hysterectomy
594
594
22-Aug-15
31-Aug-15
40000
40000
30000
3000
27000
IDBI - 321
30-Oct-15
1692 H_20698321148
Male
74
Others SAGAR
SAGARA
SHIMOGA
Bangalore
BPH
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
7-Aug-15
3-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
1693 H_20575318607
Female
56
Others DEVANOOR
KADUR
CHIKKAMANAGL
Mysore
UR
CA OVARY
STAGE IIIC
CANCER
Surgical Oncology
Gynaec
Surgery for Ca
Ovary - advance
stage
596
596
20-Aug-15
10-Sep-15
40000
40000
28000
2800
25200
IDBI - 321
30-Oct-15
1694 H_20017321201
Male
4
ATHANI
BELGAUM
Belgaum
1695 H_23099319968
Female
4
CHITRADURGA
CHITRADURGA
Bangalore
Others TARIKERE
TARIKERE
CHIKKAMANAGL
Mysore
UR
Others C. HOSURU
SREENIVASAPUR KOLAR
1696 H_20698319622
Female
58
1697 H_20300321175
Male
9 Months
SC
SC
MURANDI B THANDA ARASIKERE
HALYAL
Others THURAVANURU
BANGALORE
YENEPOYA
MEDICAL
MANGALORE
COLLEGE
HOSPITAL
MANGALORE
MANGALORE
INSTITUTE OF
ONCOLOGY
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
ASD
151
151
20-Aug-15
1-Sep-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
Bapuji Child
Health Institute
Davanaere
and Research
Centre
CLOACA
ANRECTEL
NEONATAL
MALFORMATION
Anorectal
Malformations
Stage 3
307
307
20-Aug-15
28-Aug-15
20000
29214
20000
2000
18000
IDBI - 321
30-Oct-15
YENEPOYA
MEDICAL
COLLEGE
HOSPITAL
MANGALORE
LEFT RENAL
CALCULI + DJ
STENTING
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
13-Aug-15
1-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Bangalore
BMCRI SSH
PMSSY
Bangalore
HIGH ANO
RECTAL
NEONATAL
MALFORMATION
Anorectal
Malformations
Stage 3
307
307
18-Aug-15
28-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
Bangalore
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
MANGALORE
CARCINOMA
PENIS STAGE II
CANCER
Surgical Oncology
Partial Penectomy
593
593
10-Aug-15
3-Sep-15
22500
15000
15000
1500
13500
IDBI - 321
30-Oct-15
Bangalore
VYDEHI
HOSPITAL
BANGALORE
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
24-Aug-15
29-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
CHINTAMANI
CHIKKABALLAPU
Bangalore
R
VYDEHI
HOSPITAL
BANGALORE
CANCER
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
24-Aug-15
5-Sep-15
60000
60000
57500
5750
51750
IDBI - 321
30-Oct-15
CARDIOLOGY
CABG
132
132
27-Aug-15
3-Sep-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
1698 H_19522320693
Male
60
Others BEERANAHALLI
SHIMOGA
1699 H_19574319937
Male
64
Others NAGADENAHALLI
SREENIVASAPUR KOLAR
1700 H_19574320888
Female
56
1701 H_22193321000
Female
44
Others 0
HAVERI
HAVERI
Belgaum
1702 H_19586320726
Male
51
Others BANKAPUR
SHIGGAON
HAVERI
Belgaum
1703 H_22867320472
Male
25
Others DHARMAPURA
HIRIYUR
CHITRADURGA
Bangalore
1704 H_19542320100
Male
46
Minorit
MANDIMOHALLA
y
MYSORE
MYSORE
Mysore
1705 H_22867320463
Male
49
CHITRADURGA
Bangalore
1706 H_20308320646
Female
31
Others (V)MUNGNAL.
AURAD
BIDAR
Gulbarga
MEDWIN
HOSPITALS
1707 H_20025320443
Female
68
Others
MYSORE
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
SC
SC
KAIVARA
DEVARAMARIKUNTE CHALLAKERE
PARASAYYANA
HUNDI
SHIMOGA
Tatwadarsha
Hospital
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
Chitradurga
Government
Hospital
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
Chitradurga
Government
Hospital
Right lower
bureteric
calculus
Carcinoma left
lower alveolus
T4aN1My
RENAL
HUbli
IHD,USA,AWMI
BANGALORE
IHD-OLD AWMICARDIOLOGY
SVD
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
18-Aug-15
31-Aug-15
90000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
CHITRADURGA
Verical calculus
RENAL
Genito Urinary
Surgery
Urology
Cystolithotripsy
906
906
18-Aug-15
24-Aug-15
12500
13300
12500
1250
11250
IDBI - 321
30-Oct-15
MYSORE
CAD-DISTAL
LMCA & OSTIAL
LAD DISEASE &
RCA DISEASE.
CARDIOLOGY
CABG
132
132
26-Aug-15
3-Sep-15
95000
95000
96900
9690
87210
IDBI - 321
30-Oct-15
CHITRADURGA
Left Ureteric
Calculus
RENAL
Genito Urinary
Surgery
URSL - Single Side
+ DJ Stent
909
909
29-Aug-15
31-Aug-15
25000
28300
25000
2500
22500
IDBI - 321
30-Oct-15
HYDERABAD
CRHD SEVERE
MR MOD MS
MODERATE TR
MOD PAH
CARDIOLOGY
Mitral Valve
Replacement
145
145
18-Aug-15
25-Aug-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
Cardiology
Peripheral
Angioplasty
109
109
18-Aug-15
22-Aug-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
RT LOWER LIMB
CARDIOLOGY
ACUTE ISCHEMIA
Urology
Cardiology
Sl.No
Preauth No
1708 H_20332321131
Gender
Male
Age
27
Caste
Village
Minorit
ARFATH NAGAR
y
Taluk
BANGALORE
EAST
Patient District
BANGALORE URBAN
Patient
Division
Hospital Name
Others AGGADALU
BELUR
HASSAN
Mysore
1710 H_20308320644
Male
11
Others (V)BETAGERA.
SEDAM
GULBARGA
Gulbarga
MEDWIN
HOSPITALS
40
Others Siddapur
1712 H_22478320210
Male
43
Others
1713 H_20215321106
Male
41
Others Jallapura
1714 H_20215321100
Male
54
1715 H_20127320047
Male
47
1716 H_20215321085
Male
27
SRI LAXMI
SURGICAL
TRAUMA
ORTHO AND
MULTISPECILIT
SHREE
MAHADESHWA
RA NURSING
HOME
SRI LAXMI
SURGICAL
TRAUMA
ORTHO AND
MULTISPECILIT
SRI LAXMI
SURGICAL
TRAUMA
ORTHO AND
MULTISPECILIT
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
908
908
3-Sep-15
5-Sep-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
12-Aug-15
4-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
Mitral Valve
Replacement
145
145
18-Aug-15
26-Aug-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
PIVD Sciatica left
lower with
NEURO SURGERY
neurological
deficit.
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
28-Aug-15
3-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
MYSORE
PIVD L3-L4
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
21-Aug-15
2-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
RANEBENNUR
PIVD L4-5
Sciatica B/L
lower limb L>R.
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
26-Aug-15
1-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
RANEBENNUR
PIVD Sciatica
L4,5 & L5,S1 B/L NEURO SURGERY
lower limb R>L
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
26-Aug-15
4-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
MANGALORE
48
Disease Main
Category
Urology
Bangalore
Female
Diseases
ESWL (Extra
Stent
rt proximal
uretric calculus
1709 H_19522320695
Female
Final
Diagnosis
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
1711 H_20215321113
Hospital
District
RENAL
Genito Urinary
Surgery
CARCINOMA
VAGINA STAGE
IV A
CANCER
Radiation Oncology
HYDERABAD
ACHD SEVERE
MR SEVERE TR
WITH SEVERE
PAH
CARDIOLOGY
RANEBENNUR
GANGAVATHI
KOPPAL
Gulbarga
MARAGOWDANAHAL
T NARASIPUR
LI BANNUR
MYSORE
Mysore
SAVANUR
HAVERI
Belgaum
Others Hirekerur
HIREKERUR
HAVERI
Belgaum
Minorit
MALLOTTU
y
BELTHANGADI
DAKSHINA
KANNADA
Mysore
A J HOSPITAL
CENTRE
IHD ACUTE
INFERIOR + RVMI CARDIOLOGY
HTN
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
16-Aug-15
24-Aug-15
90000
154744
91800
9180
82620
IDBI - 321
30-Oct-15
Belgaum
SRI LAXMI
SURGICAL
TRAUMA
ORTHO AND
MULTISPECILIT
RANEBENNUR
Left
hydroureteronep
hrosis due to
RENAL
14mm lower
ureteric calculus.
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
21-Aug-15
25-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Neuro Surgery
Spinal
Anterior Cervical
Discectomy
Multiple level with
Implants
(procedure
30000+ Implants
10000)
429
429
25-Aug-15
28-Aug-15
40000
40000
40800
1224
39576
IDBI - 321
30-Oct-15
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
20-Aug-15
28-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
Others Devikoppa
KALAGATAGI
DHARWAD
1717 H_19528320901
Female
35
Others CHIKKABANASAVADI MANDYA
MANDYA
Mysore
Narayana
Hrudayalaya
Private Limited
Bangalore
C6-7 EXTRUDED
DISC WITH
NEURO SURGERY
SEVERE CORD
COMPRESSION
1718 H_21214321080
Male
38
Others SANGOLGI
GULBARGA
Gulbarga
GANGAMAI
HOSPITAL
NEAR RAILWAY
UNDERPASS
C4-C5,C5-C6
DISC PROLAPSE
Bangalore
LARGE
MALALIGNED
SUBAORTIC VSD
CARDIOLOGY
L-R SHUNT
MITRAL VALVE
PROLAPSE
VSD
152
152
22-Aug-15
10-Sep-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
19-Aug-15
26-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
HOSADURGA
CHITRADURGA
Bangalore
BANGARPET
KOLAR
Bangalore
MEDIHOPE
HOSPITALS AND
BANGALORE
RESEARCH
CENTRE PVT LTD
CAD - SVD
CARDIOLOGY
Cardiology
Others YATTHIHALLI
HASSAN
HASSAN
Mysore
NEW
SEVERE MR
CARDIOLOGY
Mitral Valve
Replacement
145
145
19-Aug-15
15-Sep-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
55
Others HUNASAVALU
NANJANAGUD
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
L4 L5 PIVD WITH
GRADE 1
NEURO SURGERY
LYSTHESIS
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
24-Aug-15
2-Sep-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
62
Minorit
SHINGEWADI
y
KARWAR
UTTARA
KANNADA
Belgaum
INDIANA
HOSPITAL AND
HEART
INSTITUTE LTD
RECENT AWMI
ILD LV
DYSFUNCTION
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
21-Aug-15
25-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
Spinal
Corpectomy for
Spinal
Fixation(40000) +
cost of
implant(20000)
447
447
21-Aug-15
4-Sep-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
Male
1 Months
1720 H_20242321059
Male
43
1721 H_21057321042
Male
69
1722 H_20025321058
Male
1723 H_20322321056
Male
Male
NEURO SURGERY
Narayana
Hrudayalaya
Private Limited
1719 H_19528321070
1724 H_20025320934
ALAND
72
Others MADADAKERE
SC
OORGAUM POST
Others BANNAHALLI HUNDI T NARASIPUR
MYSORE
MANGALORE
CARDIOLOGY
L4 COLLAPSE
FRACTURE WITH
L3 -4 , L4-5 PIVD NEURO SURGERY
WITH
COMPRESSION
Neuro Surgery
Cardiology
Sl.No
Preauth No
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Gender
Age
1725 H_19528320845
Female
35
Others DURGA
YADGIR
YADGIRI
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
RIGHT
TENTORIAL
MENINGIOMA
NEURO SURGERY
Neuro Surgery
Brain Tumour
1726 H_19528320849
Male
40
Others RAMATHALA
SINDNUR
RAICHUR
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
RIGHT FRONTAL
NEURO SURGERY
GLIOMA
Neuro Surgery
Brain Tumour
1727 H_20025320975
Male
11
Others MADRAHALLI
GUNDLUPET
CHAMARAJANA
Mysore
GAR
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
LT PUJ
OBSTRUCTION
RENAL
Genito Urinary
Surgery
Urology
1728 H_20107320802
Male
48
Minorit
BASAVAKALYAN
y
BASAVAKALYAN
BIDAR
A
Gulbarga
CARE Hospital A
unit of Quality
Nampally
Care India
Limite
CAD TWO
VESSEL DISEASE
CARDIOLOGY
Cardiology
RIGHT FRONT
PARIETO
OCCIPITAL
NEURO SURGERY
INFARCT, RIGHT
ICA STENOSIS
Plan of
treatment
Excision of Brain
Tumor
SupratentorialBasal
Excision of Brain
Tumor
SupratentorialBasal
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
404
404
25-Aug-15
31-Aug-15
60000
60000
61200
1836
59364
IDBI - 321
30-Oct-15
404
404
26-Aug-15
31-Aug-15
60000
60000
61200
1836
59364
IDBI - 321
30-Oct-15
905
905
25-Aug-15
2-Sep-15
35000
35000
35000
3500
31500
IDBI - 321
30-Oct-15
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
20-Aug-15
26-Aug-15
65000
135378
65000
6500
58500
IDBI - 321
30-Oct-15
Neuro Surgery
Brain
Carotid
angioplasty with
stent
423
423
26-Aug-15
29-Aug-15
150000
150000
153000
4590
148410
IDBI - 321
30-Oct-15
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
18-Aug-15
25-Aug-15
90000
90000
91800
9180
82620
IDBI - 321
30-Oct-15
1729 H_19528320870
Male
62
Others LAKKUNDI
MUDDEBIHAL
BIJAPUR
Belgaum
Narayana
Hrudayalaya
Private Limited
1730 H_20061320992
Female
58
(V) MANDAKNALLI
Others (T,Q) BIDAR (DIST)
BIDAR.
BIDAR
BIDAR
Gulbarga
NARAYANA
HOSPITALS
CAD-DOUBLE
CARDIOLOGY
VESSEL DISEASE.
Cardiology
1731 H_20017321015
Male
67
Others HUNSHIKATTI
BYLAHONGALA
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
SEVERE CALCIFIC
CARDIOLOGY
AS
Aortic Valve
Replacement
146
146
19-Aug-15
3-Sep-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
1732 H_19567319185
Female
35
Others SOPPINAPET
RANEBENNUR
HAVERI
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Breast Rt II
Surgical Oncology
Breast
Mastectomy - any
type
598
598
3-Sep-15
14-Sep-15
32500
41480
25000
2500
22500
IDBI-294
9-Oct-15
1733 H_19577320928
Male
50
Others MUKTHENAHALLI
HONNALI
DAVANGERE
Bangalore
SJICR
BANGALORE
SOUTH
IWMI, 1 DEGREE
AV BLOCK, LVD, CARDIOLOGY
DVD
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
24-Aug-15
27-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
1734 H_19577320786
Male
50
KUDLIGI
BELLARY
Gulbarga
SJICR
BANGALORE
SOUTH
ACS - AWMI,
HTN, SVD
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
14-Aug-15
26-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
Cardiology
Balloon
Pulmonary
Valvotomy
/Pulmonary Artery
and Branch
Vessels(LPA/RPA)
Stenosis for
Balloon Dilatation
107
107
20-Aug-15
30-Aug-15
20000
20000
20000
0
20000
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
27-Aug-15
31-Aug-15
25000
32002
25000
2500
22500
IDBI - 321
30-Oct-15
Intestinal Atresia
NEONATAL
& Obstruction
Intestinal Atresias
& Obstructions
303
303
18-Aug-15
22-Aug-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
Left Renal Calculi RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
24-Aug-15
26-Aug-15
25000
29359
25000
2500
22500
IDBI - 321
30-Oct-15
103
103
19-Aug-15
22-Aug-15
55000
55000
55000
550
54450
IDBI - 321
30-Oct-15
1735 H_19577320924
Male
10 Days
ST
NADUVALAHATTI
Others KODEGARJE
BELUR
HASSAN
Mysore
SJICR
Bangalore
BANGALORE
SOUTH
1736 H_19515320289
Female
31
Others JAMPANNAHATTI
CHITRADURGA
CHITRADURGA
Bangalore
CITY CENTRAL
HOSPITAL
PRIVATE
LIMITED
1737 H_22520320955
Male
11
Others Kalahalli
BIJAPUR
BIJAPUR
Belgaum
Paediatric
Surgery Centre SANGLI
and PG Institute
Bangalore
CITY CENTRAL
HOSPITAL
PRIVATE
LIMITED
1738 H_19515318576
Male
38
Others SHIVAGANGA
HOLALKERE
CHITRADURGA
DAVANGERE
DAVANGERE
CANCER
CARDIOLOGY
CHD - SEVERE PS CARDIOLOGY
Right Renal
Calculi
RENAL
Cardiology
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
emergency,
inclusive of
angiogram) at the
same admission.
1739 H_19513320941
Male
55
Others SAGARA
SAGARA
SHIMOGA
Bangalore
NANJAPPA LIFE
SHIMOGA
CARE
ISCHEMIC HEART
DISEASE:AWMI
CARDIOLOGY
SINGLE VESSEL
DISEASE.
1740 H_20025319884
Female
54
Others NILAVAGILU
HUNSUR
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
CA RT BREAST
(T2 N0)
CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
22-Aug-15
31-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
1741 H_20139320564
Male
26
Others ROYALKERI
HONNAVAR
UTTARA
KANNADA
Belgaum
SRIDEVIMULTIS
HONAVAR
PECIALITY
HOSPITAL
LT URETERIC
CALCULLY
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
20-Aug-15
21-Aug-15
12500
12500
12500
1250
11250
IDBI - 321
30-Oct-15
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
MANGALORE
IHD,POSTPTCA,ACUTE
NSTEMI,CADSINGLE VESSEL CARDIOLOGY
DISEASE,NORMA
L LV FUNCTION
EF 60%.
Cardiology
1742 H_20015320910
Male
47
Others RENJILADY
PUTTUR
DAKSHINA
KANNADA
Mysore
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
1743 H_20511320912
Female
34
Others JANAWAD
CHIKKODI
BELGAUM
Belgaum
SWASTIK
HOSPITAL
KOLHAPUR
RVHD
CARDIOLOGY
1744 H_20733320873
Male
60
SOMAVARPET
KODAGU
Mysore
SJICR MYSORE
MYSORE
IHD-ACS AWMI
CAD-DVD
1745 H_19571319496
Male
52
Minorit KHAJA COLONY
y
GULBARGA
GULBARGA
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
1746 H_19571320603
Male
2
Others IBRAHIMPUR
SHAHPUR
YADGIRI
Gulbarga
1747 H_21052320550
Male
41
Others MOTTETHADKA
PUTTUR
DAKSHINA
KANNADA
1748 H_19577319638
Male
39
Minorit WARD NO 19
y
VADARA ONI
GANGAVATHI
1749 H_20127320835
Male
35
Others KUNJATHBAIL
MANGALORE
ST
KUSHALNAGAR
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
18-Aug-15
24-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
Mitral Valve
Replacement
145
145
21-Aug-15
26-Aug-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
19-Aug-15
22-Aug-15
90000
90000
88500
8850
79650
IDBI - 321
30-Oct-15
BENIGN
ENLARGEMENT
OF PROSTATE
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
17-Aug-15
25-Aug-15
20000
25658
20000
2000
18000
IDBI - 321
30-Oct-15
PATIL NURSING
HOME
GULBARGA
GULBARGA
VESICAL
CALCULUS.
RENAL
Genito Urinary
Surgery
Urology
Cystolithotripsy
906
906
19-Aug-15
27-Aug-15
12500
17715
12500
1250
11250
IDBI - 321
30-Oct-15
Mysore
MUCOEPIDERM
CANCER
OID CARCINOMA
Surgical Oncology
Head & Neck
Parotidectomy any type
616
616
17-Aug-15
3-Sep-15
20000
47930
20000
2000
18000
IDBI - 321
30-Oct-15
KOPPAL
Gulbarga
SJICR
COARCTATION
CARDIOLOGY
OF AORTA, RSOV
Cardiology
Device Closure
ASD Device
Closure
120
120
14-Aug-15
21-Aug-15
85000
85000
85000
0
85000
IDBI - 321
30-Oct-15
DAKSHINA
KANNADA
Mysore
A J HOSPITAL
CENTRE
RHD WITH
MODERATE
SEVERE AR
Aortic Valve
Replacement
146
146
22-Aug-15
1-Sep-15
120000
119999
122399
12240
110159
IDBI - 321
30-Oct-15
RIGHT UV
JUNCTION
CALCULUS WITH RENAL
RIGHT RENAL
CALCULUS
Genito Urinary
Surgery
URSL - Single Side
+ DJ Stent
909
909
20-Aug-15
22-Aug-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
CABG
132
132
19-Aug-15
28-Aug-15
95000
107678
96900
9690
87210
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
CARDIOLOGY
Cardiology
1750 H_20619318721
Female
28
Others HALGERE
RANEBENNUR
HAVERI
Belgaum
SUKSHEMA
HOSPITAL
PVTLTD
1751 H_20127320787
Male
55
Others MAVINAKURVA
HONNAVAR
UTTARA
KANNADA
Belgaum
A J HOSPITAL
CENTRE
CAD, TVD, GOOD
CARDIOLOGY
LV FUNCTION
1752 H_19528320795
Male
7 Months
Others NARONA
ALAND
GULBARGA
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
MOD PDA L-R
SHUNT
176
176
21-Aug-15
31-Aug-15
20000
20000
20400
612
19788
IDBI - 321
30-Oct-15
Bangalore
LARGE
MALALIGNED
SUB AORTIC VSD
BD SHUNT
CARDIOLOGY
PREDOMINATELY
L-R SHUNT MOD
FENESTRETED
SEC ASD
VSD
152
152
21-Aug-15
10-Sep-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
1753 H_19528320799
Male
8 Months
1754 H_20017320798
Female
28
1755 H_21991320806
Male
46
Others GANWAR
Others CHAVAT GALLI
SC
Nasalapur
JEVARGI
GULBARGA
DAVANGERE
CARDIOLOGY
Urology
Gulbarga
Narayana
Hrudayalaya
Private Limited
40-45% 2ND
DEGREE SUPDEEP ALLEGED
ACCIDENTAL
THERMAL
BURNS
BURNS
Burns
Burns
upto-50% Mixed
Burns( with
surgery grafting)
5
5
18-Aug-15
26-Aug-15
70000
70000
70000
7000
63000
IDBI - 321
30-Oct-15
GOKAK
Left Ureteric
Calculi
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
20-Aug-15
31-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
20-Aug-15
22-Aug-15
25000
29550
25000
2500
22500
IDBI - 321
30-Oct-15
BELGAUM
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
RAIBAGH
BELGAUM
Belgaum
SHRI J G COOPERATIVE
HOSPITAL
SOCIETY LTD
1756 H_20648319857
Male
57
Others DHONEAWADI
CHIKKODI
BELGAUM
Belgaum
PIOS HOSPITAL
JAYSINGPUR
RIGHT
MIDURETERIC
CALCULUS WITH RENAL
HYDROURETERO
NEPHROSIS
1757 H_20015320790
Male
50
Others MALAGI
MUNDAGODA
UTTARA
KANNADA
Belgaum
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
MANGALORE
RIGHT
VESTIBULAR
NEURO SURGERY
SCHWANNOMA.
Neuro Surgery
Brain Tumour
Excision of Brain
Tumor
Supratentorial-C P
Angle
406
406
20-Aug-15
8-Sep-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
1758 H_19513314943
Female
42
BHADRAVATHI
SHIMOGA
Bangalore
NANJAPPA LIFE
SHIMOGA
CARE
RHEUMATIC
HEART DISEASE,
CARDIOLOGY
SEVERE MS,
SEVERE TR
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
22-Aug-15
25-Aug-15
20000
20000
20000
200
19800
IDBI - 321
30-Oct-15
DEVANAHALLI
BANGALORE RURAL
Bangalore
VICTORIA
HOSPITAL
POST BURNS
37% RAW
SURFACE AREA
for superficial
skin grafting
Burns
Burns
upto-40% Mixed
Burns(with
grafting)
3
3
17-Aug-15
28-Aug-15
50000
50300
50000
5000
45000
IDBI - 321
30-Oct-15
1759 H_22330320601
Female
22
ST
NEHARU NAGARA
Others VIJAYPURA
BANGALORE
SOUTH
BURNS
Sl.No
Preauth No
Gender
Age
1760 H_20017320698
Male
7 Months
1761 H_19522320269
Male
63
Caste
Village
Taluk
Patient District
Patient
Division
Others PARWAD
KHANAPUR
BELGAUM
Belgaum
Others KATTA BELTHUR
KUNDAPURA
UDUPI
Mysore
Hospital Name
Hospital
District
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
FATHER
MULLER
MANGALORE
MEDICAL
COLLEGE
HOSPITAL
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
ANORECTAL
NEONATAL
MALFARMATION
Anorectal
Malformations
Stage 2
306
306
12-Aug-15
31-Aug-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
MULTIPLE
MYELOMA
STAGE IV
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
8-Aug-15
4-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
CABG with
Aneurismal repair
135
135
26-Aug-15
3-Sep-15
95000
95000
96900
2907
93993
IDBI - 321
30-Oct-15
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
18-Aug-15
25-Aug-15
20000
20000
20000
0
20000
IDBI - 321
30-Oct-15
Colectomy - any
type
637
637
19-Aug-15
2-Sep-15
40000
64224
40000
4000
36000
IDBI - 321
30-Oct-15
CANCER
ANEUYSMAL
DILATION OF LV
CARDIOLOGY
WITH POOR
SYSTOLIC
FUCTION
RHD - SEVERE
CARDIOLOGY
MS
1762 H_19528320364
Male
32
Others SANVASGI
HANAGAL
HAVERI
Belgaum
Narayana
Hrudayalaya
Private Limited
1763 H_19577320711
Male
29
Others HOSUR
BADAMI
BAGLAKOT
Belgaum
SJICR
BANGALORE
SOUTH
Miraj
Ca.Colon [StageCANCER
III] T3 N0 M0
Surgical Oncology
BANGALORE
SOUTH
RHD SEVERE AS
MOD AR
CARDIOLOGY
Aortic Valve
Replacement
146
146
17-Aug-15
31-Aug-15
120000
120000
119000
0
119000
IDBI - 321
30-Oct-15
neurogenic
bladder
NEONATAL
Bladder
Augumentation
323
323
14-Aug-15
29-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
TIPTUR
right uretric
calculus
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
20-Aug-15
25-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
MYSORE
CAD-TVD.
CARDIOLOGY
CABG
132
132
29-Aug-15
7-Sep-15
95000
95000
96900
9690
87210
IDBI - 321
30-Oct-15
MANGALORE
LEFT RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
7-Aug-15
27-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Gynaec
Surgery for Ca
Ovary - advance
stage
596
596
6-Aug-15
3-Sep-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
Bangalore
HUKKERI
BELGAUM
Belgaum
Mahatma
Gandhi Cancer
Hospital
Others HOSABIROHALLI
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
SJICR
Minorit
BATTARAHALLI
y
BANGALORE
EAST
BANGALORE URBAN
Bangalore
INDIRA GANDHI
BANGALORE
INSTITUTE OF
SOUTH
CHILD HEALTH
TURVEKERE
TUMKUR
Bangalore
MYSORE
MYSORE
Mysore
1764 H_20212320721
Female
56
SC
1765 H_19577319914
Male
77
1766 H_21223319991
Male
9
1767 H_20059316419
Male
27
1768 H_19542318006
Male
71
Minorit
NR MOHALLA
y
Minorit
THIRTHAHALLI
y
SC
Kesti
doddamargonahalli
KUMAR
HOSPITAL
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
THIRTHAHALLI
SHIMOGA
Bangalore
WENLOCK
DISTRICT
HOSPITAL
UDDURU
HUNSUR
MYSORE
Mysore
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
BANGALORE
CARCINOMA OF
OVARY IIIc POST CANCER
NACT
Surgical Oncology
ST
KODKOL
JAMAKHANDI
BAGLAKOT
Belgaum
VYDEHI
HOSPITAL
BANGALORE
IHD Left Main
CARDIOLOGY
and CAD disease
CABG
132
132
21-Aug-15
8-Sep-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
SC
0
MADHUGIRI
TUMKUR
Bangalore
L5-S1
SPONDYLOLITHE NEURO SURGERY
SIS GRADE I
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
19-Aug-15
3-Sep-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
Others some gowda street
MADDUR
MANDYA
Mysore
Rt carpel tunnel
NEURO SURGERY
syndrome
Neuro Surgery
Neuro Surgery
Peripheral Nerve
Surgery Minor
454
454
25-Aug-15
27-Aug-15
25000
25000
25000
0
25000
IDBI - 321
30-Oct-15
65
Minorit
KUDACHI
y
RAIBAGH
BELGAUM
Belgaum
CAD TVD
CABG
132
132
18-Aug-15
31-Aug-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
Male
32
Others
PIRIYAPATNA
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
RT HUN DUE TO
DISTAL URETERIC RENAL
CALCULUS
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
25-Aug-15
27-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Male
74
Others CHANNGUNDI
HD KOTE
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
PROSTATOMEGA
RENAL
LY
Genito Urinary
Surgery
Urology
TURP
917
917
21-Aug-15
7-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
UTTARA
KANNADA
ATHEROSCLEROT
IC CORONARY
CARDIOLOGY
ARTERY DISEASE
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting Stent
, elective)
240
240
17-Aug-15
24-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
CAD TVD
CABG with IABP
133
133
19-Aug-15
29-Aug-15
115000
168836
95000
9500
85500
IDBI - 321
30-Oct-15
1769 H_21044320708
Male
54
1770 H_19586315876
Female
39
SC
1771 H_19574320265
Male
37
1772 H_19586320549
Female
70
1773 H_20200319680
Female
49
1774 H_20017320684
Male
1775 H_20025320454
1776 H_20025320426
SINRRIGOWDANA
KOPPALU
1777 H_19522320512
Female
60
Others NANDANGADDA
KARWAR
1778 H_20107320542
Male
51
Others UMAPUR
BASAVAKALYAN
BIDAR
A
1779 H_22971318139
Male
33
Others
1780 H_21701320022
Male
60
Minorit
aziz colony
y
RAGIMUDDANAHALL SHRIRANGAPAT
MANDYA
I
NA
YADGIR
YADGIRI
Belgaum
Gulbarga
SAPTHAGIRI
SUPER
BANGALORE
SPECIALITY
HOSPITAL
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
FATHER
MULLER
MANGALORE
MEDICAL
COLLEGE
HOSPITAL
CARE Hospital A
unit of Quality
Nampally
Care India
Limite
CARDIOLOGY
CARDIOLOGY
Mysore
CSI Holdsworth
Memorial
Mysore
Hospital
PROLAPSE OF
INTERVERTEBRA
NEURO SURGERY
L DISC C5-C6
LEFT SIDE
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
7-Sep-15
14-Sep-15
50000
50000
40000
4000
36000
IDBI - 321
30-Oct-15
Gulbarga
SUNSHINE
HEART
INSTITUTE
PSVT,EPS+RFA
Cardiology
Cardiology
EP study
125
125
17-Aug-15
27-Aug-15
30000
30000
30600
3060
27540
IDBI - 321
30-Oct-15
Paradise, S.D.
Road
CARDIOLOGY
Sl.No
Preauth No
Caste
54
Others CHIKKABALLAPURA
Bangalore
R
R
SJICR
BANGALORE
SOUTH
IHD - IWMI, DM,
CARDIOLOGY
HTN, SVD
Cardiology
1782 H_19577320457
Male
38
Others GULBARGA
GULBARGA
GULBARGA
Gulbarga
SJICR
BANGALORE
SOUTH
HOCM
CARDIOLOGY
1783 H_19577320494
Male
45
BANGALORE
EAST
BANGALORE URBAN
Bangalore
SJICR
BANGALORE
SOUTH
IHD - AWMI,
HTN, SVD
1784 H_19577320328
Female
65
Minorit
RAICHUR
y
RAICHUR
RAICHUR
Gulbarga
SJICR
BANGALORE
SOUTH
IHD - EA, SVD
1785 H_19577320401
Male
43
Others CHANNAPATNA
Bangalore
SJICR
BANGALORE
SOUTH
1786 H_19577320340
Female
35
Minorit
GULBARGA
y
GULBARGA
GULBARGA
Gulbarga
SJICR
BANGALORE
SOUTH
1787 H_19577320478
Female
30
Others DAVANAGERE
DAVANAGERE
DAVANGERE
Bangalore
SJICR
BANGALORE
SOUTH
1788 H_19577320474
Female
34
SC
BANGALORE
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
SJICR
1789 H_19577320317
Female
38
ST
HONNARANAHALLI
KORATAGERE
TUMKUR
Bangalore
SJICR
1790 H_19577320509
Male
43
SC
BANGALORE
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
1791 H_20308320645
Female
47
HUMNABAD
BIDAR
1792 H_20020320659
Female
4 Months
HOSPET
BELLARY
ST
HOSPET
Hospital Name
Diseases
Disease Main
Category
Male
Others (V)BORAM PALLI.
Patient District
Final
Diagnosis
1781 H_19577320502
JEEVANAHALLI
Taluk
Hospital
District
Age
SC
Village
Patient
Division
Gender
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
16-Aug-15
26-Aug-15
90000
90000
88500
0
88500
IDBI - 321
30-Oct-15
Surgery for HOCM
157
157
18-Aug-15
4-Sep-15
80000
80000
78500
0
78500
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
16-Aug-15
21-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
17-Aug-15
22-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
IHD - IWMI, SVD CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
16-Aug-15
22-Aug-15
65000
65000
61750
0
61750
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
18-Aug-15
24-Aug-15
20000
20000
20000
0
20000
IDBI - 321
30-Oct-15
CARDIOLOGY
213
213
18-Aug-15
27-Aug-15
20000
20000
20000
0
20000
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
105
105
31-Aug-15
10-Sep-15
20000
20000
19000
0
19000
IDBI - 321
30-Oct-15
105
105
20-Aug-15
24-Aug-15
20000
20000
20000
0
20000
IDBI - 321
30-Oct-15
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
23-Aug-15
26-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
Mitral Valve
Replacement
145
145
17-Aug-15
25-Aug-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
Anorectal
Malformations
Stage 3
307
307
19-Aug-15
27-Aug-15
20000
22500
20000
2000
18000
IDBI - 321
30-Oct-15
Device Closure
ASD Device
Closure
120
120
22-Aug-15
25-Aug-15
80000
80000
80000
800
79200
IDBI - 321
30-Oct-15
Cardiology
BANGALORE
SOUTH
BANGALORE
SOUTH
RHD - SEVERE
MS
ACUTE ON
CHRONIC LEFT
LOWER LIMB
ISCAHEMIA
RHD - SEVERE
MS
RHD - SEVERE
MS
CARDIOLOGY
Cardiology
Cardiology
SJICR
BANGALORE
SOUTH
IHD - IWMI, DM,
CARDIOLOGY
DVD
Cardiology
Cardiology
Gulbarga
MEDWIN
HOSPITALS
HYDERABAD
Gulbarga
DIPALI
HOSPITAL
HOSPET
CONGENITAL
HEART DISEASE,
OSTIUM
CARDIOLOGY
SECUNDUM, ASD
L->R SHUNT.
Cardiology
CH- OSTIUM ASD
CARDIOLOGY
L-R SHUNT
ASD
151
151
20-Aug-15
25-Aug-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
BHADRAVATHI
SHIMOGA
Bangalore
NANJAPPA LIFE
SHIMOGA
CARE
CRHD SEVERE
MR SEVERE MS
CARDIOLOGY
MILD TR MOD
PAH
ANORECTAL
HIGH TYPE
Thromboembolect
omy
Balloon Mitral
Valvotomy
Balloon Mitral
Valvotomy
1793 H_19513320656
Female
1
KURUBARA
Others
VITTALAPURA
1794 H_19528320592
Male
22
Others IMDAPUR
SEDAM
GULBARGA
Gulbarga
Narayana
Hrudayalaya
Private Limited
1795 H_22971320612
Female
42
Others GHOUSIA NAGAR
MYSORE
MYSORE
Mysore
CSI Holdsworth
Memorial
Mysore
Hospital
?RECURRENT ?
METACHRONOU CANCER
S CA COLON
Surgical Oncology
Colectomy - any
type
637
637
12-Aug-15
31-Aug-15
40000
40000
10000
1000
9000
IDBI - 321
30-Oct-15
ARM
Anorectal
Malformations
Stage 2
306
306
21-Aug-15
3-Sep-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
Bangalore
MALAVALLI
MANDYA
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
1796 H_20025319850
Male
9 Months
Minorit DHANAGUR,
y
MALAVALLI
1797 H_22337320598
Male
25
Others TOLAMATTI
BILAGI
BAGLAKOT
Belgaum
BARAGI
HOSPITAL
BAGALKOT
BAGALKOT
LEFT L/3RD
URETERIC
RENAL
CALCULUS WITH
HUN
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
19-Aug-15
23-Aug-15
25000
29326
25000
2500
22500
IDBI - 321
30-Oct-15
1798 H_19528320588
Female
42
Others HALABHAVI
LINGASUGUR
RAICHUR
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
RHD-SEV MITRAL
CARDIOLOGY
STENOSIS
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
20-Aug-15
24-Aug-15
20000
20000
20400
612
19788
IDBI - 321
30-Oct-15
1799 H_20083320318
Female
53
JAMAKHANDI
BAGLAKOT
Belgaum
Bhagwan
Mahaveer Jain
Hospital
Bangalore
OLD ANTERIOR
WALL MI EFFORT
CARDIOLOGY
ANGINA TRIPLE
VESSEL DISEASE
CABG
132
132
18-Aug-15
27-Aug-15
95000
272389
95000
0
95000
IDBI - 321
30-Oct-15
1800 H_20733320600
Male
59
HD KOTE
MYSORE
Mysore
SJICR MYSORE
MYSORE
IHD-ACS ACUTE
AWMI
Cardiology
Medical
treatment of
Acute MI with
Thrombolysis
128
128
17-Aug-15
21-Aug-15
10000
10000
9500
950
8550
IDBI - 321
30-Oct-15
Belgaum
Narayana
Hrudayalaya
Private Limited
Bangalore
MIXED TAPVC
(CARDIAC AND
SUPRA CARDIAC)
CARDIOLOGY
MOD SEC ASD RL SHUNT MOD
PDA L-R SHUNT
TAPVC
160
160
21-Aug-15
14-Sep-15
95000
95000
96900
2907
93993
IDBI - 321
30-Oct-15
1801 H_19528320579
Female
1 Months
SC
HIREPADASALAGI
Others PINJA HALLI
Others GADAG
GADAG
GADAG
NEONATAL
CARDIOLOGY
Cardiology
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
CHAMARAJANA
Mysore
GAR
1802 H_20200320581
Male
55
Others ANNUKERI
GUNDLUPET
1803 H_19542319081
Male
50
Minorit
KOLEGALA
y
Mysore
GAR
GAR
1804 H_19586320526
Male
46
1805 H_20017320551
Male
46
1806 H_20025320484
Male
40
Hospital
District
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
VIKRAM
HOSPITAL
MYSORE
PRIVATE
LIMITED
MYSORE
Final
Diagnosis
Diseases
Disease Main
Category
ANTEROLATERAL
CARDIOLOGY
STEMI
Cardiology
TRIPPLE VESSEL
DISEASE.
CARDIOLOGY
RIGHT RENAL
CALCULUS
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Coronary Balloon
Angioplasty
101
101
19-Aug-15
24-Aug-15
55000
55000
55000
0
55000
IDBI - 321
30-Oct-15
CABG with IABP
133
133
24-Aug-15
31-Aug-15
115000
95000
96900
9690
87210
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
ESWL (Extra
Stent
908
908
19-Aug-15
3-Sep-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
Cardiology
HANAGAL
HAVERI
Belgaum
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
Others 0
MUDHOLA
BAGLAKOT
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
IHD EVOLVED
AWMI
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
12-Aug-15
24-Aug-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
Others CHIKKONAHALLI
KR PET
MANDYA
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
LT HUN
SECONDARY TO
LT VUJ
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
22-Aug-15
25-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
B/L RENAL
PELVIC
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
22-Aug-15
31-Aug-15
37500
37500
37500
3750
33750
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
27-Aug-15
29-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
ST
0
BANGALORE
T NARASIPUR
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
Others HEMMADAHALLI
KR PET
MANDYA
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
LT HUN DUE TO
LT VUJ
CALCULUS
25
Others NARASAPURA
KOLAR
KOLAR
Bangalore
VICTORIA
HOSPITAL
32% Accidental
Thermal Burns 2
BURNS
degree to 3d
degree
Burns
Burns
upto-40% Mixed
Burns(with
grafting)
3
3
14-Aug-15
20-Aug-15
50000
53800
34500
3450
31050
IDBI - 321
30-Oct-15
Male
36
Others GUNAVANTE
HONNAVAR
UTTARA
KANNADA
Belgaum
SRIDEVIMULTIS
HONAVAR
PECIALITY
HOSPITAL
LT URETERIC
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
19-Aug-15
22-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Female
65
Others PONNAMPET TOWN VIJAPET
KODAGU
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
RT POPLITEAL
ARTERY
OCCLUSION
CARDIOLOGY
Cardiology
Cardiology
Peripheral
Angioplasty
109
109
22-Aug-15
26-Aug-15
55000
55000
20000
2000
18000
IDBI - 321
30-Oct-15
LaminectomyCervical
431
431
28-Aug-15
3-Sep-15
25000
25000
25000
0
25000
IDBI - 321
30-Oct-15
563
563
21-Aug-15
26-Aug-15
10000
12465
7000
700
6300
IDBI - 321
30-Oct-15
1807 H_20025320490
Male
47
1808 H_20025320456
Male
67
1809 H_22330320531
Female
1810 H_20139320491
1811 H_20025320415
ST
HALE NAYAKARA
STREET, BANNUR
CHIARI
NEURO SURGERY
MALFORMATION
Neuro Surgery
Spinal
BANGALORE
SOUTH
ca lung
T2bN3M0
Radiation Oncology
Radiotherapy
Treatment
HONAVAR
RIGHT URETERIC
RENAL
CALCULY
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
19-Aug-15
21-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
BPH
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
20-Aug-15
27-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
Bangalore
KASTURBA
HOSPITAL
IHD CAG TVD
CARDIOLOGY
CABG
132
132
14-Aug-15
29-Aug-15
95000
95000
96900
9690
87210
IDBI - 321
30-Oct-15
Mysore
A J HOSPITAL
CENTRE
PDA MODERATE
(L-R SHUNT),
MILD MS, GOOD CARDIOLOGY
BIVENTRICULAR
FUNCTION
Cardiology
Device Closure
PDA Device
Closure
119
119
2-Sep-15
5-Sep-15
60000
60000
61200
6120
55080
IDBI - 321
30-Oct-15
Cardiology
Cardiology
PTCA - 2 stent
(non-medicated)
104
104
18-Aug-15
20-Aug-15
70000
70000
70000
700
69300
IDBI - 321
30-Oct-15
ASD
151
151
20-Aug-15
29-Aug-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
Female
41
Others HARANAHALLI
PIRIYAPATNA
MYSORE
1813 H_20082320433
Male
47
Others HIREKATTE
GUNDLUPET
CHAMARAJANA
Mysore
GAR
1814 H_20139320447
Male
34
Others UPPINAPATTANA
KUMTA
UTTARA
KANNADA
Belgaum
1815 H_20025319889
Male
90
Others MANCHANAHALLI
KR PET
MANDYA
Mysore
1816 H_19564319823
Male
38
Minorit
URUGADURU
y
SHIMOGA
SHIMOGA
1
Minorit
BELLYARU VILLAGE
y
MANGALORE
DAKSHINA
KANNADA
Female
1818 H_19513320413
Male
56
1819 H_19574319908
Female
11
Minorit
KEREBILACHI
y
ST
HANAMANAL
NARAYANA
HRUDAYALAYA
SURGICAL
HOSPITAL PVT
LTD
Kidwai
Memorial
Institute of
Oncology
SRIDEVIMULTIS
PECIALITY
HOSPITAL
BANGALORE
SOUTH
MYSORE
1812 H_20200320347
1817 H_20127319878
Hospital Name
Mysore
UDUPI
CANCER
CHANNAGIRI
DAVANGERE
Bangalore
NANJAPPA LIFE
SHIMOGA
CARE
ISCHEMIC HEART
DISEASE, ACUTE
CORONARY
CARDIOLOGY
SYDROME,
DOUBLE VESSEL
DISEASE
KUSTAGI
KOPPAL
Gulbarga
VYDEHI
HOSPITAL
ACHD 1.4cm OS
ASD Left -> Right CARDIOLOGY
Shunt
BANGALORE
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
1820 H_20139320373
Male
28
Others GUNAVANTE
HONNAVAR
UTTARA
KANNADA
1821 H_19564320313
Male
72
Others BARAMASAMUDRA
JAGALURU
DAVANGERE
Bangalore
1822 H_19505319064
Female
70
Others
KR NAGAR
MYSORE
Mysore
1823 H_21223320346
Male
6 Days
Others YALLAMBASALE
KADUR
CHIKKAMANAGL
Mysore
UR
1824 H_19528320357
Male
55
Others HULIKHAL
GANGAVATHI
KOPPAL
KANCHUGARA
KOPPALU
Belgaum
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
BLADDER
OUTFLOW
OBSTRUCTION
RENAL
DUE TO VESICAL
CALCULLY
Genito Urinary
Surgery
UDUPI
IHD,CAGTVD,DM
Mysore
SRIDEVIMULTIS
PECIALITY
HONAVAR
HOSPITAL
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Cystolithotripsy
906
906
19-Aug-15
21-Aug-15
12500
12500
12500
1250
11250
IDBI - 321
30-Oct-15
CABG
132
132
14-Aug-15
31-Aug-15
95000
95000
96900
9690
87210
IDBI - 321
30-Oct-15
CA LEFT BREAST
CANCER
cT3N1
Surgical Oncology
Breast
Mastectomy - any
type
598
598
25-Aug-15
28-Aug-15
25000
25000
25000
0
25000
IDBI - 321
30-Oct-15
INDIRA GANDHI
BANGALORE
INSTITUTE OF
SOUTH
CHILD HEALTH
meningomyeloce
NEURO SURGERY
le
Neuro Surgery
Brain
Meningomyelocel
e
417
417
13-Aug-15
1-Sep-15
35000
35000
35000
3500
31500
IDBI - 321
30-Oct-15
Gulbarga
Narayana
Hrudayalaya
Private Limited
CAD-TVD
CARDIOLOGY
CABG
132
132
29-Aug-15
5-Sep-15
95000
95000
96900
2907
93993
IDBI - 321
30-Oct-15
LT RENAL
CALCULI
RENAL
Genito Urinary
Surgery
Urology
ESWL (Extra
Stent
908
908
26-Aug-15
29-Aug-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
KASTURBA
HOSPITAL
Bharath
Hospital
Institute of
Oncology
Bangalore
CARDIOLOGY
Urology
Plan of
treatment
1825 H_20332320320
Female
46
Others KOTTAVALLI
PIRIYAPATNA
MYSORE
Mysore
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
1826 H_19528318591
Female
31
Others JALAPURA
MANVI
RAICHUR
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
PAPILLARY CA
THYIROID
CANCER
Surgical Oncology
Head & Neck
615
615
30-Aug-15
3-Sep-15
20000
20000
14280
428
13852
IDBI - 321
30-Oct-15
1827 H_19562318263
Female
73
Others BILUVALA GRAMA
KADUR
CHIKKAMANAGL
Mysore
UR
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
SHIMOGA
A known case of
ca. (L) G B Sulcus CANCER
T2N0M0 Stage II
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
26-Aug-15
4-Sep-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
1828 H_19505319030
Female
66
Others
SOMAVARPET
KODAGU
Bharath
Hospital
Institute of
Oncology
Mysore
CA LEFT BREAST
CANCER
cT3N1M0
Surgical Oncology
Breast
Mastectomy - any
type
598
598
24-Aug-15
27-Aug-15
25000
25000
25000
0
25000
IDBI - 321
30-Oct-15
MANGALORE
POORLY
DIFFERENTIATED
ADENOCARCINO
MA-PROSTATE
WITH
CANCER
VERTEBRAL
METASTASIS.GLE
ASON SCORE
5+5=10(GRADE
IV)
Surgical Oncology
Bilateral
Orchidectomy
588
588
10-Aug-15
27-Aug-15
30000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
BANGALORE
L4-5
SPANDYLYSTHESI NEURO SURGERY
CS GRADE
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
21-Aug-15
3-Sep-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
Mysore
CHONDRO
SARCOMA RIGHT CANCER
HUMERUS
Surgical Oncology
Bone / soft tissue
tumors
Bone resection
659
659
25-Aug-15
31-Aug-15
30000
30000
30000
0
30000
IDBI - 321
30-Oct-15
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
18-Aug-15
20-Aug-15
90000
90000
90000
900
89100
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
22-Aug-15
25-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
ESWL (Extra
Stent
908
908
18-Aug-15
21-Aug-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
24-Aug-15
28-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Spinal
DiscectomyLumbar
433
433
24-Aug-15
1-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
GUMMANAKOLLI
MULLUSOGE
Mysore
1829 H_20015320355
Male
79
Others INDIRANAGARA
SIDDAPUR
UTTARA
KANNADA
Belgaum
1830 H_19586319450
Male
33
Others 0
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
1831 H_19505319027
Male
45
Others VALLABHAI ROAD
HASSAN
HASSAN
Mysore
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
Bharath
Hospital
Institute of
Oncology
1832 H_19513320319
Female
46
Others KOMMANALU
SHIMOGA
SHIMOGA
Bangalore
NANJAPPA LIFE
SHIMOGA
CARE
ISCHEMIC HEART
DISEASE
UNSTABLE
CARDIOLOGY
ANGIOMA
SINGLE VESSEL
DISEASE.
1833 H_21658318767
Male
67
Others Agadi
HAVERI
HAVERI
Belgaum
SRI SAI
SPECIALITY
HOSPITAL
RANEBENNUR
BPH
Gulbarga
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
BANGALORE
LEFT RENAL
CALCULI
Bangalore
R L JALAPPA
HOSPITAL AND
RESEARCH
CENTRE
KOLAR
(RT) RENAL
CALCULI
RENAL
Genito Urinary
Surgery
Gulbarga
SRI LAXMI
SURGICAL
TRAUMA
ORTHO AND
MULTISPECILIT
RANEBENNUR
PIVD sciatica @
L4-L5 & L5-S1
with
neurological
deficit
NEURO SURGERY
Neuro Surgery
1834 H_19586320292
1835 H_20164318734
1836 H_20215320223
Male
Male
Male
32
32
45
SC
0
Others VITAPANAHALLI
Others Eralagaddi
SINDNUR
KOLAR
MANVI
RAICHUR
KOLAR
RAICHUR
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Mysore
TVD
1837 H_20200318075
Male
59
1838 H_20164320111
Male
45
Others TAMAKA
KOLAR
KOLAR
Bangalore
R L JALAPPA
HOSPITAL AND
RESEARCH
CENTRE
1839 H_21223319986
Male
1 Days
Others HAROHALLI
BANGARPET
KOLAR
Bangalore
1840 H_19528319757
Female
5
Minorit
HATTIMATHURU
y
1841 H_19504320249
Female
72
Others Amminbhavi
Final
Diagnosis
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
Minorit
HANEEF MOHALLA
y
NAGAMANGALA MANDYA
Hospital
District
Diseases
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
CABG with IABP
133
133
29-Aug-15
8-Sep-15
95000
95000
95000
0
95000
IDBI - 321
30-Oct-15
RIGHT URETRIC
CALCULUS WITH
RENAL
HYDROURETERO
NEPHROSIS
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
19-Aug-15
22-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
INDIRA GANDHI
BANGALORE
INSTITUTE OF
SOUTH
CHILD HEALTH
intestinal
obstruction
Intestinal Atresias
& Obstructions
303
303
7-Aug-15
31-Aug-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
LARGE SALID
CYSTIC SELLAR
NEURO SURGERY
SUPRA SELLAR
CARANIOPHARY
NGIOMA
Neuro Surgery
Brain Tumour
Excision of Brain
Tumor
SupratentorialBasal
404
404
23-Aug-15
29-Aug-15
60000
60000
61200
1836
59364
IDBI - 321
30-Oct-15
KOLAR
CARDIOLOGY
Disease Main
Category
NEONATAL
SAVANUR
HAVERI
Belgaum
Narayana
Hrudayalaya
Private Limited
HUKKERI
BELGAUM
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Ca Lung
adenocarcinoma
CANCER
with Multiple
brain Mets
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
24-Aug-15
4-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
17-Aug-15
21-Aug-15
25000
25000
25500
765
24735
IDBI - 321
30-Oct-15
CARDIOLOGY
Femoro Distal
Bypass with
Synthetic Graft
230
230
31-Aug-15
7-Sep-15
30000
30000
30600
918
29682
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
ESWL (Extra
Stent
908
908
29-Aug-15
30-Aug-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
Bangalore
1842 H_19528319682
Male
31
Others PALKADODDI
RAICHUR
RAICHUR
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
LARGE
EXTRUDED L4-5
DISC WITH
INFERIOR
MIGRATIN
NEURO SURGERY
CAUSING SEVERE
CANAL AND
BILATERAL
FORAMINAL
STENOSIS
1843 H_19528313772
Female
65
Others BANDIWADA
HUBLI
DHARWAD
Belgaum
Narayana
Hrudayalaya
Private Limited
Bangalore
RIGHT LOWER
LIMB CRITICAL
ISCHEMIA
Left renal
calculus
CRHD-LARGE OS
ASD WITH L->R CARDIOLOGY
SHUNT
ASD
151
151
14-Aug-15
25-Aug-15
80000
80000
81600
8160
73440
IDBI - 321
30-Oct-15
HUNAGUNDA
BAGLAKOT
Belgaum
M/s Kerudi
Hospital And
Bagalkot
Research Centre
Bagalkot
BELLARY
BELLARY
Gulbarga
SUNSHINE
HEART
INSTITUTE
Minorit
ATANOOR
y
AFJALPUR
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
BENIGN
ENLARGEMENT
OF PROSTATE
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
17-Aug-15
22-Aug-15
20000
22265
20000
2000
18000
IDBI - 321
30-Oct-15
65
Others DRAGA SIROR
ALAND
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
BENIGN
ENLARGEMENT
OF PROSTATE
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
17-Aug-15
22-Aug-15
20000
22573
20000
2000
18000
IDBI - 321
30-Oct-15
50
Minorit AT" GOGIPET TQ:
y
SHAHPUR
SHAHPUR
YADGIRI
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
17-Aug-15
21-Aug-15
25000
32410
25000
2500
22500
IDBI - 321
30-Oct-15
SANTOSH COLONY
Others
GULBARGA
LT RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
17-Aug-15
4-Sep-15
25000
42932
25000
2500
22500
IDBI - 321
30-Oct-15
LT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
18-Aug-15
24-Aug-15
25000
35246
25000
2500
22500
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
6-Aug-15
25-Aug-15
35000
42994
35000
3500
31500
IDBI - 321
30-Oct-15
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
18-Aug-15
21-Aug-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
1844 H_19510319773
Male
27
1845 H_21701320013
Male
7
1846 H_19571319478
Male
61
1847 H_19571319485
Male
1848 H_19571319469
Male
1849 H_19571319491
Male
21
1850 H_19571320149
Male
20
Others AMARAVATI
SC
SC
3rd ward
sanganakallu
MATAKI
Paradise, S.D.
Road
GULBARGA
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
ALAND
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
SEDAM
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
Minorit
Rastrapathi Street
y
DEVADURGA
RAICHUR
Gulbarga
TRINITY
HOSPITAL AND
HEART
FOUNDATION
BANGALORE
SOUTH
51
Others DEVARAHIPPAGI
SINDAGI
BIJAPUR
Belgaum
Narayana
Hrudayalaya
Private Limited
Bangalore
32
Others SOMESHWARA
MANGALORE
DAKSHINA
KANNADA
Mysore
NEW
1851 H_19571316450
Male
66
1852 H_19593320224
Male
58
1853 H_19528320211
Male
1854 H_21057320192
Female
SC
NEELHALLI
BENIGN
ENLARGEMENT
OF PROSTATE + RENAL
LT URETERIC
STONE
Effort Angina,
DM, Old MI CAD CARDIOLOGY
Single Vessel
Disease
RHD MS + CADSVD
Urology
CARDIOLOGY
Mitral Valve
Replacement
145
145
20-Aug-15
31-Aug-15
120000
120000
122400
3672
118728
IDBI - 321
30-Oct-15
Mitral Valve
Replacement
145
145
13-Aug-15
29-Aug-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
Sl.No
Preauth No
Gender
Age
1855 H_21057320152
Male
68
Minorit
KOKKADA
y
1856 H_20575319415
Male
54
Others
1857 H_19581320005
1858 H_20025319896
Male
Male
50
58
Caste
Village
NELAGETHANA
HATTI
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
BELTHANGADI
DAKSHINA
KANNADA
Mysore
NEW
SEVERE CALCIFIC
CARDIOLOGY
AS
Aortic Valve
Replacement
146
146
17-Aug-15
1-Sep-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
CHALLAKERE
CHITRADURGA
Bangalore
MANGALORE
INSTITUTE OF
ONCOLOGY
MANGALORE
CA LEFT LUNG
WITH BRAIN
METS
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
17-Aug-15
30-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
Mysore
Cauvery
Hospital
MYSORE
RIGHT URETERIC
RENAL
CALCULUS.
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
20-Aug-15
24-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
31-Aug-15
7-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
20-Aug-15
24-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Others KUSHALNAGAR
SOMAVARPET
Others KEMPANAPURA
Mysore
GAR
GAR
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
RT STAGHORN
CALCULUS
RENAL
Genito Urinary
Surgery
PIRIYAPATNA
MYSORE
Cauvery
Hospital
LEFT PUJ
CALCULUS WITH
MILD
RENAL
HYDRONEPHROS
IS.
Genito Urinary
Surgery
KOLLEGAL
CHAMARAJANA
Mysore
GAR
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
IHD, DVD
CABG
132
132
19-Aug-15
27-Aug-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
IHD, NSTEMI
,CAD-SVD OF
LAD
CARDIOLOGY
Cardiology
PTCA - one Drug
Eluting stent (
emergency,
inclusive of
angiogram) at the
same admission.
239
239
17-Aug-15
20-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
EMPYEMA
CARDIOLOGY
Decortication
192
192
21-Aug-15
29-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
Cauvery
Hospital
MYSORE
COMPLETE
HEART BLOCK
114
114
20-Aug-15
25-Aug-15
75000
75000
75000
7500
67500
IDBI - 321
30-Oct-15
MANGALORE
Excision of Brain
Tumor
SupratentorialParasagital
403
403
17-Aug-15
28-Aug-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
1859 H_19581320001
Male
23
Others JAVARI KOPPALU
1860 H_20025319875
Male
56
Others
KEMPAYYANAHA
HATTI
BACHEGOWDANAHA
HD KOTE
LLI
KODAGU
CANCER
Mysore
1861 H_20025319855
Male
46
Others
1862 H_20025319881
Male
58
Others SUNDAVALLI
VIJAPET
KODAGU
Mysore
SAKLESHPURA
HASSAN
Mysore
BIDAR
BIDAR
Gulbarga
PIRIYAPATNA
MYSORE
Cardiology
RIGHT PARIETAL
NEURO SURGERY
MENINGIOMA.
Neuro Surgery
Brain Tumor
Nampally
TOF
CARDIOLOGY
ICR for TOF
154
154
18-Aug-15
31-Aug-15
80000
235022
80000
8000
72000
IDBI - 321
30-Oct-15
Belgaum
SEVERE AORTIC
STENOSIS
CARDIOLOGY
Aortic Valve
Replacement
146
146
17-Aug-15
28-Aug-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
TIPTUR
bph
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
1-Sep-15
10-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
CA RECTUM
CANCER
Surgical Oncology
Colostomy
679
679
13-Aug-15
24-Aug-15
20000
25272
20000
2000
18000
IDBI - 321
30-Oct-15
IHD-EFFORT
ANGINA TVD
HTN EF 58%
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
6-Aug-15
24-Aug-15
90000
90000
90000
0
90000
IDBI - 321
30-Oct-15
1863 H_19581320144
Female
49
1864 H_20015320116
Female
61
Others UDEVARA
1865 H_20107319965
Male
1
1866 H_20017320128
Male
16
Others HARSANWADI
KHANAPUR
BELGAUM
Belgaum
1867 H_20059320104
Male
50
Others hiralahalli
KR PET
MANDYA
Mysore
1868 H_21052320068
Male
42
Others THIMLAPURA
BHADRAVATHI
SHIMOGA
Bangalore
1869 H_19577320085
Female
57
Others APPAYYANAHALLI
BELLARY
BELLARY
Gulbarga
SJICR
CHANNARAYAP
HASSAN
ATNA
Mysore
SC
BIDAR
BANGALORE
SOUTH
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
BANGALORE
SJICR
SOUTH
1870 H_20200320008
Male
7
SHARAVANA
Others
BELAGOLA
1871 H_19577319883
Male
4
Others DODDAGULI
KANAKAPURA
RAMANAGAR
Bangalore
1872 H_19577319929
Male
37
Others VIJAYNGARA
BELLARY
BELLARY
Gulbarga
SJICR
1873 H_19528320021
Male
64
Others KAMALAPURA
HOSPET
BELLARY
Gulbarga
Narayana
Hrudayalaya
Private Limited
Cardiology
Permanent
pacemaker
VVI) including
Pacemaker value
Minorit
NEHRU NAGAR
y
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
CARE Hospital A
unit of Quality
Care India
Limite
KLES Dr
Prabhakar Kore
Hospital and
MRC
KUMAR
HOSPITAL
CARDIOLOGY
CARDIOLOGY
CHD+OS ASD+L-R
CARDIOLOGY
SHUNT
ASD
151
151
22-Aug-15
31-Aug-15
80000
80000
80000
0
80000
IDBI - 321
30-Oct-15
CHD-VSD
CARDIOLOGY
Cardiology
Device Closure
VSD Device
Closure
121
121
20-Aug-15
23-Aug-15
80000
80000
80000
0
80000
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
ACS-AWMI,SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
18-Aug-15
23-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
Bangalore
CAD-TVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - 2 stent
(non-medicated)
104
104
31-Aug-15
3-Sep-15
70000
70000
71400
2142
69258
IDBI - 321
30-Oct-15
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
1874 H_20200318571
Female
68
Others RAMADEVAPURA
HASSAN
HASSAN
Mysore
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
1875 H_19528320036
Female
14
Others ITGA
SHAHPUR
YADGIRI
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
1876 H_19528320046
Female
28
Others MAJADA
CHITTAPUR
GULBARGA
Gulbarga
Narayana
Hrudayalaya
Private Limited
1877 H_19577319970
Male
51
Others VJJANI
KUNIGAL
TUMKUR
Bangalore
1878 H_19564319948
Female
62
Others BANKERA KATTE
UDUPI
UDUPI
Mysore
KOLLEGAL
CHAMARAJANA
Mysore
GAR
SIRAGUPPA
BELLARY
1879 H_20200319975
Female
53
#11/108 VINAYAKA
Others
BEEDI
1880 H_19528316841
Female
48
Others GUNDIGANURU
1881 H_19586319939
Male
57
1882 H_20733319923
Male
41
1883 H_19515317639
1884 H_20733319913
Male
Male
29
55
SC
0
Others ANAGAHALLI
Others GOLLARAHATTI
Others BETTADAHOSURU
MOD
L-R SHUNT
Cardiology
ASD Device
Closure
120
120
19-Aug-15
21-Aug-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
Bangalore
CHD-SMALL
SUBPULMONIC CARDIOLOGY
VSD, L-R SHUNT
VSD
152
152
19-Aug-15
29-Aug-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
SJICR
BANGALORE
SOUTH
CRITICAL RIGHT
LOWER LIMB
ISCHAEMIA
CARDIOLOGY
Cardiology
Cardiology
Peripheral
Angioplasty
109
109
18-Aug-15
21-Aug-15
55000
45000
20000
0
20000
IDBI - 321
30-Oct-15
KASTURBA
HOSPITAL
UDUPI
IHD/HTN/CSA
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
17-Aug-15
22-Aug-15
90000
90000
91290
9129
82161
IDBI - 321
30-Oct-15
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
IHD LM+TVD
CARDIOLOGY
CABG
132
132
17-Aug-15
24-Aug-15
95000
95000
95000
0
95000
IDBI - 321
30-Oct-15
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
LEFT LOWER
URETHRAL
STONE , RIGHT
RENAL STONE
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
21-Aug-15
31-Aug-15
27500
27500
28050
842
27208
IDBI - 321
30-Oct-15
BANGALORE
RIGHT RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
ESWL (Extra
Stent
908
908
18-Aug-15
3-Sep-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
MYSORE
IHD-ACS ACUTE
IWMI PWMI
CARDIOLOGY
Cardiology
Cardiology
Medical
treatment of
Acute MI with
Thrombolysis
128
128
14-Aug-15
19-Aug-15
10000
10000
9500
950
8550
IDBI - 321
30-Oct-15
DAVANGERE
Left Renal
Calculus
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
24-Aug-15
26-Aug-15
25000
29326
25000
2500
22500
IDBI - 321
30-Oct-15
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
16-Aug-15
20-Aug-15
65000
65000
63500
6350
57150
IDBI - 321
30-Oct-15
SJICR MYSORE
Bangalore
CITY CENTRAL
HOSPITAL
PRIVATE
LIMITED
IHD-ACS AWMI
CAD-SVD
Belgaum
Bhagwan
Mahaveer Jain
Hospital
Bangalore
RHD DILATED LA
SEVERE MS
WITH GRADE II
CARDIOLOGY
MR MILD TR
SEVERE PAH
NORMAL LVEF
Mitral Valve
Replacement
145
145
18-Aug-15
27-Aug-15
120000
420603
120000
0
120000
IDBI - 321
30-Oct-15
DAVANGERE
BEP
RENAL
Genito Urinary
Surgery
TURP
917
917
20-Aug-15
24-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
OS ASD
CARDIOLOGY
ASD
151
151
24-Aug-15
31-Aug-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
435
435
21-Aug-15
29-Aug-15
62500
62500
62500
6250
56250
IDBI - 321
30-Oct-15
433
433
24-Aug-15
29-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
SJICR MYSORE
Male
65
ST
MAGALA
HUVINAHADAG
BELLARY
ALI
Gulbarga
SUKSHEMA
HOSPITAL
PVTLTD
1887 H_20079319953
Female
19
SC
SANTEKADUR
SHIMOGA
SHIMOGA
Bangalore
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
1888 H_22226318991
Female
22
Minorit
AP- ANGOL
y
BELGAUM
BELGAUM
Belgaum
Viajya Ortho
and Trauma
Centre
BELGAUM
1889 H_22439318478
Male
36
Others HOGARATI
BYLAHONGALA
BELGAUM
Belgaum
BHS lakeview
Hospital
BELGAUM
1890 H_19577315232
Female
63
Others 0
MAGADI
RAMANAGAR
Bangalore
SJICR
BANGALORE
SOUTH
63
Minorit
MILLATHA
y
Device Closure
MYSORE
Mysore
1886 H_20619318932
Male
30-Oct-15
HUBLI
1892 H_20079319916
Net Amt
Paid
IDBI - 321
PALE
MANURU
TDS
95000
ST
SC
Gross
Amount
approved by
0
28
65
Hospital
claimed
Amount
95000
Female
Female
Preauth
Approved
Amt
95000
1885 H_20083319902
1891 H_19564319704
Date of
Discharge
95000
Mysore
DHARWAD
Date of
Admission
29-Aug-15
MYSORE
MANDYA
22-Aug-15
MYSORE
KR PET
Plan of
treatment
132
Gulbarga
CHITRADURGA
132
BELLARY
CARDIOLOGY
Disease Main
Category
CABG
SIRAGUPPA
tvd ef 40%
Diseases
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
HOSADURGA
Final
Diagnosis
UDUPI
UDUPI
Mysore
KASTURBA
HOSPITAL
CHANNAGIRI
DAVANGERE
Bangalore
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
UDUPI
CARDIOLOGY
L4-L5 DISC
PROLAPSE D12
NEURO SURGERY
COMPRESSION
FRACTURE.
L4/L5 PIVD WITH
NEURO SURGERY
LCS
SPLENIC ARTERY
CARDIOLOGY
ANEURYSM
Cardiology
Urology
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
DiscectomyLumbar
Neuro Surgery
Spinal
Neuro Surgery
Spinal
Cardiology
Device Closure
PDA Device
Closure
119
119
7-Aug-15
17-Aug-15
102500
102500
75000
0
75000
IDBI - 321
30-Oct-15
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
16-Aug-15
20-Aug-15
65000
65000
65790
6579
59211
IDBI - 321
30-Oct-15
CABG
132
132
18-Aug-15
2-Sep-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
NSTEMI
CARDIOLOGY
Cardiology
CAD-TVD
CARDIOLOGY
Sl.No
Preauth No
1893 H_19549319041
1894 H_19564319882
Gender
Age
Male
59
Female
Caste
Village
Others 0
Taluk
ANKOLA
Patient District
UTTARA
KANNADA
Patient
Division
Belgaum
38
Others SUNKADAKATTE
HONNALI
DAVANGERE
Bangalore
SHAHPUR
YADGIRI
Gulbarga
Hospital Name
Sagar Hospitals
Hospital
District
BANGALORE
SOUTH
KASTURBA
UDUPI
HOSPITAL
NARAYANA
HOSPITALS
Final
Diagnosis
IHD RECENT
AWMI TVD
Diseases
CARDIOLOGY
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
CABG with IABP
133
133
13-Aug-15
29-Aug-15
115000
115000
115000
11500
103500
IDBI - 321
30-Oct-15
145
145
14-Aug-15
31-Aug-15
120000
120000
122400
12240
110160
IDBI - 321
30-Oct-15
SEVERE MS
CARDIOLOGY
Mitral Valve
Replacement
D7-D10 CORD
COMPRESSION.
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
13-Aug-15
24-Aug-15
25000
25000
25500
2550
22950
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
17-Aug-15
25-Aug-15
20000
24078
20000
2000
18000
IDBI - 321
30-Oct-15
NEURO SURGERY
Neuro Surgery
Spinal
LaminectomyCervical
431
431
3-Aug-15
20-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
1895 H_20061319792
Male
43
(V) HUNDEKAL
Others (TQ)SHAHAPUR
(DIST) YADAGIRI
1896 H_19583319859
Male
59
Others GOLLARAHATTI
DAVANAGERE
DAVANGERE
Bangalore
S.S. INSTITUTE
OF MEDICAL
NH-4,Bypass PB
BPH
SCIENCES &
Road Davanagere
RESEARCH CENT
1897 H_20300319563
Male
64
Others GADASALLI
KANAKAPURA
RAMANAGAR
Bangalore
BMCRI SSH
PMSSY
1898 H_19583319502
Male
49
Others KUDINIRAKATTE
HOLALKERE
CHITRADURGA
Bangalore
S.S. INSTITUTE
OF MEDICAL
NH-4,Bypass PB Rt Uretric
SCIENCES &
Road Davanagere Calculus
RESEARCH CENT
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
17-Aug-15
22-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
1899 H_19567319731
Female
70
SAVADATTI
BELGAUM
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Rt Breast
stage II .
CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
21-Aug-15
4-Sep-15
25000
32060
25000
2500
22500
IDBI-294
9-Oct-15
1900 H_19503318749
Male
21
GULBARGA
GULBARGA
Gulbarga
Bijapur Kidney
Foundation
Bijapur
Right lower
RENAL
ureteric calculus
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
24-Aug-15
28-Aug-15
25000
29519
25000
2500
22500
IDBI - 321
30-Oct-15
Bangalore
ASCENDING
AORTA
ANEURYSM
AORTIC SINUS
SINO TUBULAR
CARDIOLOGY
JUNCTION,ARCH
DILATED ARMODERATELY
MR MILD TO
MODERATE
Root Replacement
(Aortic Aneurysm/
Aortic Dissection)
/ Bental Procedure
169
169
18-Aug-15
1-Sep-15
125000
125000
127500
3825
123675
IDBI - 321
30-Oct-15
SC
SAVADATTI
Others Naganur
1901 H_19528319561
Female
45
Others NERALEGUDDA
1902 H_20025319475
Female
74
Others
1903 H_19574318733
Female
29
Others SHANTHI NAGAR
1904 H_21316319349
Male
29
SC
COMPRESSIVE
CERVICAL
MYELOPATHY
Bangalore
Narayana
Hrudayalaya
Private Limited
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
RT PLEURAL
EFFUSION
CARDIOLOGY
Decortication
192
192
19-Aug-15
26-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
BANGALORE URBAN
Bangalore
VYDEHI
HOSPITAL
BANGALORE
Right VUJ
Calculus
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
19-Aug-15
25-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Bangalore
PUNYA
HOSPITAL
CHANNAPATNA
RIGHT URETERIC
RENAL
CALCULUS (VUJ)
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
15-Aug-15
21-Aug-15
25000
25000
24000
2400
21600
IDBI - 321
30-Oct-15
MANGALORE
BONE
SECONDARIES
WITH
CANCER
UNKNOWN
PRIMARY STAGE
TXNXM1
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
3-Aug-15
28-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
MANGALORE
CAD DVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
17-Aug-15
21-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
Urology
ESWL (Extra
Stent
908
908
25-Aug-15
26-Aug-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
SIRA
TUMKUR
DODDABYADARAHAL
PANDAVAPURA MANDYA
LI
KUNTHRUDODDI
Bangalore
BANGALORE
EAST
1905 H_19522319595
Female
58
Others KUNTALPADY
KARKALA
UDUPI
Mysore
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
1906 H_20322319807
Male
62
Minorit
NADA
y
BELTHANGADI
DAKSHINA
KANNADA
Mysore
INDIANA
HOSPITAL AND
HEART
INSTITUTE LTD
Mysore
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
non obstrctive
reanl calculi
RENAL
Genito Urinary
Surgery
RT.RENAL
CALCULI+LT.URE
RENAL
TERIC
CALCULUS+B/L
DJ STENTING
Genito Urinary
Surgery
Urology
Open
901
901
28-Jul-15
25-Aug-15
32500
32500
32500
3250
29250
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Unstable Angina,
CARDIOLOGY
CAD - Old IWMI
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
17-Aug-15
20-Aug-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
HOSPET
RIGHT
HYDRONEPHROS
IS SECONDARY
TO PU JUNCTION RENAL
OBSTUCTION
WITH VERY
POOR FUNCTION
Genito Urinary
Surgery
Urology
905
905
20-Aug-15
27-Aug-15
35000
35000
35000
3500
31500
IDBI - 321
30-Oct-15
1907 H_20332314557
Female
46
Others GAVADAGERE
HUNSUR
MYSORE
1908 H_20017317884
Male
43
Others 0
RAIBAGH
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
1909 H_19593319791
Male
50
Others Hosahalli
KANAKAPURA
RAMANAGAR
Bangalore
TRINITY
HOSPITAL AND
HEART
FOUNDATION
1910 H_20020319795
Male
17
Others BUKKASAGARA
HOSPET
BELLARY
Gulbarga
DIPALI
HOSPITAL
Sl.No
Preauth No
1911 H_19581319634
Gender
Male
Age
77
Caste
Village
Others KOLLEGAL
Others Anjanapura
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Cardiology
PTCA - one stent
(non-medicated,
emergency,
inclusive of
angiogram) at the
same admission.
103
103
16-Aug-15
19-Aug-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
239
239
16-Aug-15
19-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
CHAMARAJANA
Mysore
GAR
Cauvery
Hospital
RAMANAGAR
RAMANAGAR
Bangalore
NARAYANA
HRUDAYALAYA
SURGICAL
MYSORE
HOSPITAL PVT
LTD
ACS-Acute
Inferior wall MI
CARDIOLOGY
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
HUMNABAD
BIDAR
Gulbarga
NANO
HOSPITALS
PRIVATE
LIMITED
CORONARY
CARDIOLOGY
ARTERY DISEASE
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
11-Aug-15
20-Aug-15
55000
64100
55000
5500
49500
IDBI - 321
30-Oct-15
Device Closure
PDA Device
Closure
119
119
17-Aug-15
22-Aug-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
KOLLEGAL
MYSORE
ACS-AIWMI, DVD CARDIOLOGY
Cardiology
1912 H_20200319774
Male
33
1913 H_21736318820
Male
63
1914 H_20074319761
Male
2
Others HALIYALA
HONNAVAR
UTTARA
KANNADA
Belgaum
M S RAMAIAH
NARAYANA
BANGALORE
HRUDAYALAYA
CHD
CARDIOLOGY
Cardiology
1915 H_20017319762
Male
2 Months
Others MUNYAL
GOKAK
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
CHD
SUPRACARDIAC
TAPVC WITH
SEVERE PAH
CARDIOLOGY
TAPVC
160
160
6-Aug-15
14-Sep-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
1916 H_19528319640
Male
48
Minorit
B BAGEWADI
y
BASAVANABAGE
BIJAPUR
WADI
Belgaum
Narayana
Hrudayalaya
Private Limited
Bangalore
CA
SUPRAGLOTTIS
CANCER
Surgical Oncology
612
612
30-Aug-15
9-Sep-15
52500
52500
53550
1607
51943
IDBI - 321
30-Oct-15
1917 H_19528319717
Female
30
Others TUMKUR
TUMKUR
TUMKUR
Bangalore
Narayana
Hrudayalaya
Private Limited
Bangalore
RHD MR MILD
TO MODERATE
NORMAL PA
PRESSURE
CARDIOLOGY
Mitral Valve
Replacement
145
145
24-Aug-15
3-Sep-15
120000
100000
102000
3060
98940
IDBI - 321
30-Oct-15
1918 H_19528319744
Male
3 Months
Others Mahishasavadagi
ATHANI
BELGAUM
Belgaum
Narayana
Hrudayalaya
Private Limited
Bangalore
Large Upper
muscular VSD L R CARDIOLOGY
Shunt
VSD
152
152
31-Aug-15
18-Sep-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
1919 H_20164318563
Male
58
Others YADAHALLI
MULABAGILU
KOLAR
Bangalore
R L JALAPPA
HOSPITAL AND
RESEARCH
CENTRE
KOLAR
RIGHT UPPER
URETRIC
CALUCALUS
WITH HUN
Genito Urinary
Surgery
URSL - Single Side
+ DJ Stent
909
909
18-Aug-15
22-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Mitral Valve
Replacement
145
145
18-Aug-15
3-Sep-15
120000
120000
122400
3672
118728
IDBI - 321
30-Oct-15
ST
CHANGLERA
HYDERABAD
RENAL
Head & Neck
Urology
1920 H_19528319712
Female
19
Others HONKONA
HANAGAL
HAVERI
Belgaum
Narayana
Hrudayalaya
Private Limited
Bangalore
RHD S/P PT,C
MOD MITRAL
RESTENOSIS SVE
MITRAL
CARDIOLOGY
REGURGITATION
MILD TO MOD
AR MILD AS
1921 H_19576319728
Female
3
Others Ramateerha
HIREKERUR
HAVERI
Belgaum
SDM Narayana
Hrudayalaya
Dharwad
ACHD with VSD
With PS with
IE/CCF/NSR
CARDIOLOGY
ICR for TOF
154
154
17-Aug-15
3-Sep-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
1922 H_19528319720
Male
4
Others Jadkal
KUNDAPURA
UDUPI
Mysore
Narayana
Hrudayalaya
Private Limited
Bangalore
Moderate
Secundum ASD L- CARDIOLOGY
R Shunt
ASD
151
151
4-Sep-15
15-Sep-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
1923 H_19567319694
Female
35
Minorit
Hirehalli
y
MUNDAGODA
UTTARA
KANNADA
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Breast Lt
stage II
CANCER
Surgical Oncology
Mastectomy - any
type
598
598
19-Aug-15
31-Aug-15
25000
31600
25000
2500
22500
IDBI-294
9-Oct-15
1924 H_20079319701
Male
59
Others LINGADAHALLI
TARIKERE
CHIKKAMANAGL
Mysore
UR
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
CAD-TVD
CARDIOLOGY
CABG
132
132
11-Aug-15
1-Sep-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
239
239
13-Aug-15
18-Aug-15
65000
65000
65790
6579
59211
IDBI - 321
30-Oct-15
Breast
1925 H_19564319537
Female
67
Others MOODUBETTU
UDUPI
UDUPI
Mysore
KASTURBA
HOSPITAL
UDUPI
NSTEMI/DM/HT
CARDIOLOGY
N
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
1926 H_19564319611
Male
57
Others NALLUEU
KARKALA
UDUPI
Mysore
KASTURBA
HOSPITAL
UDUPI
UNSTABLE
ANGINA
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
13-Aug-15
18-Aug-15
90000
90000
91290
9129
82161
IDBI - 321
30-Oct-15
1927 H_19564319526
Male
46
Others BALEKONDA
KOPPA
CHIKKAMANAGL
Mysore
UR
OSTIUM
SEUNDUM ASD
CARDIOLOGY
Cardiology
Device Closure
ASD Device
Closure
120
120
14-Aug-15
22-Aug-15
80000
80000
81090
8109
72981
IDBI - 321
30-Oct-15
1928 H_21897319377
Female
21
Others 0
KUNDAPURA
UDUPI
(L)URETERIC
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
14-Aug-15
27-Aug-15
25000
25000
23750
2375
21375
IDBI - 321
30-Oct-15
Mysore
KASTURBA
UDUPI
HOSPITAL
GLOBAL
MULTISPECIALIT
MANGALORE
Y HOSPITAL
INDIA PVT LTD
Sl.No
Preauth No
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Gender
Age
1929 H_20017318931
Male
60
Others 0
CHIKKODI
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
IHD RECENT
IWMI
1930 H_19571319472
Male
35
Others YADRAMI
JEVARGI
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
1931 H_19577319549
Male
48
Others MEERASABIHALLI
CHALLAKERE
CHITRADURGA
Bangalore
SJICR
1932 H_19577319517
Female
6
Others
HALAGONDANAHALL
CHALLAKERE
I
CHITRADURGA
Bangalore
SJICR
1933 H_19577319543
Male
55
Others SP ROAD
RANEBENNUR
HAVERI
Belgaum
SJICR
1934 H_19577319531
Male
44
Minorit
MOHALA NAGAR
y
KUNIGAL
TUMKUR
Bangalore
SJICR
Others SHRAVANURU
RURAL
Bangalore
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
1935 H_19586319594
Female
65
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
6-Aug-15
21-Aug-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
BILATERAL
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
17-Aug-15
19-Aug-15
37500
39409
37500
3750
33750
IDBI - 321
30-Oct-15
ACS - AWMI,
DVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
18-Aug-15
21-Aug-15
90000
90000
90000
0
90000
IDBI - 321
30-Oct-15
CHD - VSD
CARDIOLOGY
Cardiology
Device Closure
VSD Device
Closure
121
121
22-Aug-15
26-Aug-15
80000
80000
60000
0
60000
IDBI - 321
30-Oct-15
IHD - EA, HTN,
TVD
CARDIOLOGY
CABG
132
132
14-Aug-15
2-Sep-15
95000
95000
94000
0
94000
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
IHD - EA, DM,
SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
18-Aug-15
21-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
BANGALORE
LEFT RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
ESWL (Extra
Stent
908
908
17-Aug-15
25-Aug-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
LT DISTAL
URETERIC
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
ESWL (Extra
Stent
908
908
24-Aug-15
28-Aug-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
24-Aug-15
29-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
BANGALORE
SOUTH
BANGALORE
SOUTH
CARDIOLOGY
1936 H_20332319584
Male
41
Others INDIRANAGAR
KANAKAPURA
RAMANAGAR
Bangalore
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
1937 H_19577319525
Male
55
Minorit PUTTAIAHNAPALYA
y
JAYANGARA
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
SJICR
BANGALORE
SOUTH
ACS - NSTEMI,
SVD
1938 H_19549319046
Female
2
Others 0
ANKOLA
UTTARA
KANNADA
Belgaum
Sagar Hospitals
BANGALORE
SOUTH
CHD,VSD WITH
PREDOMINANTL
CARDIOLOGY
Y LEFT TO RIGHT
SHUNT,NO PAH
VSD
152
152
13-Aug-15
24-Aug-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
RANEBENNUR
B/L Renal Calculi
with
RENAL
hydronephrosis
of Lt kidney,
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
21-Aug-15
25-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Bangalore
RCC
Genito Urinary
Surgery
Urology
Lap. Nephrectomy
Radical (Lap
920
920
25-Aug-15
31-Aug-15
50000
50000
51000
1530
49470
IDBI - 321
30-Oct-15
1939 H_20215319571
Male
37
Others Koddivada
KUNDAGOL
DHARWAD
Belgaum
SRI LAXMI
SURGICAL
TRAUMA
ORTHO AND
MULTISPECILIT
1940 H_19528318303
Female
56
Others HARAWAD
JEVARGI
GULBARGA
Gulbarga
Narayana
Hrudayalaya
Private Limited
IHD UNSTABLE
VESSEL DISEASE
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
17-Aug-15
19-Aug-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
RENAL
1941 H_20880319562
Male
63
Others Athani
ATHANI
BELGAUM
Belgaum
Wanless
Hospital Miraj
Miraj
Medical Center
miraj
1942 H_19491318884
Female
71
Others KARATAGI
GANGAVATHI
KOPPAL
Gulbarga
BGS GLOBAL
HOSPITAL
BANGALORE
SOUTH
Carcinoma
Hypopharynx/
CANCER
upper esophagus
cT4N0M0
Surgical Oncology
Jejunostomy
677
677
19-Aug-15
22-Aug-15
20000
20000
16710
67
16643
IDBI - 321
30-Oct-15
1943 H_20308315949
Male
48
Others (V)CHINKKAMCHALI. RAICHUR
RAICHUR
Gulbarga
MEDWIN
HOSPITALS
HYDERABAD
CRHD SEVERE
MR MILD MS ,
MODERATE AR
Double Valve
Replacement
149
149
4-Aug-15
23-Aug-15
150000
150000
150000
15000
135000
IDBI - 321
30-Oct-15
1944 H_19503319359
Female
30
Others Roona
GADAG
Belgaum
Bijapur Kidney
Foundation
Bijapur
Right lower
RENAL
ureteric calculus
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
19-Aug-15
22-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
LT HUN
SECONDARY TO
LOWER
URETERIC
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
18-Aug-15
21-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
19-Aug-15
25-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
CABG + Valve
Replacement +
IABP
134
134
27-Jul-15
10-Aug-15
130000
130000
130000
13000
117000
IDBI - 321
30-Oct-15
RONA
CARDIOLOGY
1945 H_20025319461
Male
70
Others BIDARAHALLI HUNDI HD KOTE
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
1946 H_20025319489
Male
68
Others TERAMBALLI
CHAMARAJANA
Mysore
GAR
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
BPH WITH
RETENTION
MANDYA
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
RHD , CAD-SVD
SEVERE MR MILD
AR , EF 58% ,
CARDIOLOGY
CALCIFIED
AORTA , SMALL
LA
1947 H_20025319482
Male
57
KOLLEGAL
Others KEREMEGALADODDI MADDUR
Mysore
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
6-Aug-15
24-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
1948 H_20017319398
Male
58
Others 0
HUKKERI
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
1949 H_20017319224
Male
21
Others 0
HALIYAL
UTTARA
KANNADA
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
B/L PUJ
OBSTRUCTION
RENAL
Genito Urinary
Surgery
Urology
905
905
29-Jul-15
28-Aug-15
35000
35000
35000
3500
31500
IDBI - 321
30-Oct-15
1950 H_20575319405
Male
53
Minorit
BIJADI
y
KUNDAPURA
UDUPI
Mysore
MANGALORE
INSTITUTE OF
ONCOLOGY
CA BLADDER
T3N1M1
CANCER
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
17-Aug-15
30-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
1951 H_19567314650
Male
31
HOSPET
BELLARY
Gulbarga
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Penis stage II CANCER
Surgical Oncology
Inguinal Block
Dissection-one
side
591
591
21-Aug-15
4-Sep-15
22500
25050
22500
2250
20250
IDBI-294
9-Oct-15
1952 H_19576319445
Male
45
Others Hanapur
KUSTAGI
KOPPAL
Gulbarga
SDM Narayana
Hrudayalaya
Dharwad
RHD Moderate
Mitral stenosis
MVOA 1.02cm2
CARDIOLOGY
Mitral Valve
Replacement
145
145
10-Aug-15
29-Aug-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
1953 H_19586319453
Male
22
Others 0
NARAGUNDA
GADAG
Belgaum
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
BANGALORE
RSOV TO RX
CARDIOLOGY
Aortic Valve
Replacement
146
146
10-Aug-15
27-Aug-15
120000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
1954 H_19581319452
Male
67
Others HOLENARASIPURA
HOLENARSIPUR HASSAN
Mysore
Cauvery
Hospital
MYSORE
TRIPLE VESSEL
CORONARY
CARDIOLOGY
ARTERY DISEASE
CABG
132
132
15-Aug-15
26-Aug-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
Mysore
YENEPOYA
MEDICAL
COLLEGE
HOSPITAL
MANGALORE
WELL
DIFFERENTIATED
SQUAMOUS CELL
CANCER
CARCINOMA
STAGE III T2 N1
M0.
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
13-Aug-15
26-Aug-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
M S Ramaiah
Hospital
BANGALORE
NORTH
RECTO
VESTIBULAR
FISTULA
NEONATAL
ANORECTAL
MALFORMATION
Anorectal
Malformations
Stage 1
305
305
12-Aug-15
31-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
VYDEHI
HOSPITAL
KARNATAKA
INSTITUTE OF
MEDICAL
SCINCES
BANGALORE
Vesicle calculus. RENAL
Genito Urinary
Surgery
Urology
Open
Cystolithotomy
903
903
10-Aug-15
1-Sep-15
15000
15000
15000
1500
13500
IDBI - 321
30-Oct-15
HUBLI
Double Vessel
Disease
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
19-Aug-15
24-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
1955 H_20698318891
Male
55
ST
Chitawadgi
Others PERUVAJE
SULYA
DAKSHINA
KANNADA
1956 H_20010318595
Female
4 Months
SC
ALLIPURA
CHIKKABALLAPU
GOWRIBIDANUR
Bangalore
R
1957 H_19574317989
Male
59
SC
PERESANDRA
Bangalore
R
R
1958 H_20203319418
Female
65
Others Neharu Nagar
1959 H_20112318602
Male
61
Others
1960 H_20164318698
Female
38
Others ANKTHATTINALLI
BYADAGI
CHINNAMULAGUND
HIREKERUR
A
BANGARPET
MANGALORE
B/L RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
HAVERI
Belgaum
HAVERI
Belgaum
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
IHD, SEVERE
AORTIC
STENOSIS
CARDIOLOGY
CABG + Valve
Replacement +
IABP
134
134
13-Aug-15
27-Aug-15
130000
130000
120000
3600
116400
IDBI - 321
30-Oct-15
KOLAR
Bangalore
R L JALAPPA
HOSPITAL AND
RESEARCH
CENTRE
KOLAR
RIGHT URETRIC
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
17-Aug-15
20-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
DAVANGERE
RIGHT RENAL
CALCULI WITH
LEFT RENAL
CALCULI
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
18-Aug-15
21-Aug-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
29-Jul-15
21-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
ESWL (Extra
Stent
908
908
31-Aug-15
3-Sep-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
17-Aug-15
20-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
Urology
Urethroplasty for
a year can be
considered)
912
912
13-Aug-15
21-Aug-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
1961 H_20619318714
Male
25
Others CHAPPARADALLI
KUDLIGI
BELLARY
Gulbarga
SUKSHEMA
HOSPITAL
PVTLTD
1962 H_20017319408
Female
65
Others 0
RAIBAGH
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
RT.URETERIC
CALCULUS
RT RENAL
CALCULUS
1963 H_20025319341
Male
35
Others KUTTA
VIJAPET
KODAGU
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
1964 H_19577318951
Male
50
Others GIRINAGARA
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
SJICR
BANGALORE
SOUTH
ACS - IWMI, SVD CARDIOLOGY
Cardiology
Others JC NAGAR
BANGALORE
EAST
BANGALORE URBAN
Bangalore
M S Ramaiah
Hospital
BANGALORE
NORTH
URETHERAL
STRUCTURE
Genito Urinary
Surgery
1965 H_20010318744
Male
44
RENAL
Sl.No
Preauth No
1966 H_20215319392
Gender
Female
Age
28
Caste
Village
Others Katapura
Net Amt
Paid
Burns
Burns
Post Burn
Contracture
surgeries for
Functional
Improvement(Pack
age including
splints, pressure
garments and
physiotherapy),
Mild
Post obstructive
& Post infective
RENAL
Atropic right
kidney.
Genito Urinary
Surgery
Urology
Lap. Nephrectomy
Simple (Lap
919
919
20-Aug-15
27-Aug-15
45000
45000
45000
4500
40500
IDBI - 321
30-Oct-15
Gulbarga
SRI LAXMI
SURGICAL
TRAUMA
ORTHO AND
MULTISPECILIT
RANEBENNUR
post burn
contracture of
right wrist with
dorsiflexion
deformities.
RANEBENNUR
BURNS
9
9
4-Sep-15
9-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
25000
33088
25000
2500
22500
IDBI - 321
30-Oct-15
CHINCHOLI
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
BENIGN
ENLARGEMENT
OF PROSTATE
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
8-Aug-15
22-Aug-15
20000
27403
20000
2000
18000
IDBI - 321
30-Oct-15
Others RAJAPUR GULBARGA GULBARGA
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
14-Aug-15
19-Aug-15
25000
33331
25000
2500
22500
IDBI - 321
30-Oct-15
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
BENIGN
ENLARGEMENT
OF PROSTATE
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
13-Aug-15
22-Aug-15
20000
25598
20000
2000
18000
IDBI - 321
30-Oct-15
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT LOWER
URETERIC STONE
+ BENIGN
RENAL
ENLARGEMENT
OF PROSTATE.
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
7-Aug-15
21-Aug-15
35000
40522
35000
3500
31500
IDBI - 321
30-Oct-15
Belgaum
SRI LAXMI
SURGICAL
TRAUMA
ORTHO AND
MULTISPECILIT
PIVD Sciatica L4L5 & L5-S1 with
NEURO SURGERY
neurological
deficit.
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
20-Aug-15
25-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
10-Aug-15
28-Aug-15
25000
43126
25000
2500
22500
IDBI - 321
30-Oct-15
Mysore
GAR
GAR
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
RT GROSS
PYONEPHROSIS
DUE TO PUJ
OBSTRUCTION
RENAL
Genito Urinary
Surgery
Urology
905
905
18-Aug-15
1-Sep-15
35000
35000
35000
3500
31500
IDBI - 321
30-Oct-15
SHIMOGA
A known case of
ca. (L) Breast
CANCER
T2N0M0
Surgical Oncology
Breast
Mastectomy - any
type
598
598
25-Aug-15
31-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Others Jangamarahatti
SC
SC
NAGANHALLI GBL
ARANKAL
Others HIPPARAGA
25
Others Hanumanahalli
CHITTAPUR
JEVARGI
HAVERI
1974 H_19571317321
Female
40
Minorit NEAR BARI COMPLEX
CHITTAPUR
y
STATION ROAD
1975 H_20025317697
Male
44
Others KOTHTHALAVADI
ST
VIDYA NAGAR
Minorit NOORANI MOHALLA
GULBARGA
y
DARGA GULBARGA
ST
MATHI GATTA
GULBARGA
HAVERI
GULBARGA
RANEBENNUR
SHIMOGA
Bangalore
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT UPPER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
13-Aug-15
18-Aug-15
25000
32705
25000
2500
22500
IDBI - 321
30-Oct-15
Bangalore
Kidwai
Memorial
Institute of
Oncology
ca oropharynx
T4N2M0
CANCER
Medical Oncology
Head & Neck
Carboplatin +
only)
521
521
19-Aug-15
19-Aug-15
31500
32020
7125
713
6412
IDBI - 321
30-Oct-15
BENIGN
ENLARGEMENT
OF PROSTATE +
VESICAL
CALCULUS.
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
11-Aug-15
22-Aug-15
20000
25905
20000
2000
18000
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
13-Aug-15
22-Aug-15
25000
36135
25000
2500
22500
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
14-Aug-15
18-Aug-15
25000
30591
25000
2500
22500
IDBI - 321
30-Oct-15
CHIKKANAYAKA
TUMKUR
NAHALLI
SHIMOGA
BANGALORE
SOUTH
1979 H_19571317742
Male
51
Others ANOOR
AFJALPUR
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
1980 H_19571318716
Male
35
Others WADI
CHITTAPUR
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT PUJ STONE
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT RENAL
CALCULUS.
14
TDS
19-Aug-15
52
Female
Gross
Amount
approved by
14-Aug-15
Male
1981 H_19571319218
Hospital
claimed
Amount
909
1971 H_19571318530
48
Preauth
Approved
Amt
909
63
Male
Date of
Discharge
URSL - Single Side
+ DJ Stent
Female
1978 H_20082317953
Date of
Admission
Urology
1970 H_19571319034
26
Genito Urinary
Surgery
Others MOGHA
Male
Plan of
treatment
RT LOWER
RENAL
URETERIC STONE
48
1977 H_19571318512
PATIL NURSING
HOME
GULBARGA
GULBARGA
Male
47
Disease Main
Category
Gulbarga
1969 H_19571317228
Female
Diseases
GULBARGA
40
1976 H_19562318146
Final
Diagnosis
GULBARGA
Male
Male
Hospital
District
Gulbarga
1968 H_19571319047
1973 H_20215319354
Hospital Name
RAICHUR
33
56
KOPPAL
Patient
Division
SINDNUR
Female
Male
KUSTAGI
Patient District
SRI LAXMI
SURGICAL
TRAUMA
ORTHO AND
MULTISPECILIT
1967 H_20215319382
1972 H_19571316643
Taluk
Others MUTHANGI
HUMNABAD
BIDAR
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
c6 VERTEBRA
FRACTURE WITH
C6-7 WITH OPLL
NEURO SURGERY
& MULTILCUR
CERVICAL DISCA
INJURY
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
13-Aug-15
2-Sep-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
12-Aug-15
19-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
VSD
152
152
7-Aug-15
25-Aug-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
313
313
10-Aug-15
24-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
1982 H_21695319052
Male
60
Others shahabad
CHITTAPUR
GULBARGA
Gulbarga
Ashwini
Sahakari
Rugnalaya Ani
Sansodhan
Kendra
1983 H_21225319121
Male
45
Others BEMALKHEDA
HUMNABAD
BIDAR
Gulbarga
CAD SINGLE
VESSEL DISEASE
1984 H_20017319239
Female
1
Others TERADAL
JAMAKHANDI
BAGLAKOT
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
CHD LARGE VSD
WITH PDA WITH CARDIOLOGY
SEVERE PAH
1985 H_20366318404
Male
7
Others SHAMANEWADI
CHIKKODI
BELGAUM
Belgaum
SALAGARE
CHILDRENS AND CHIKKODI
EYE HOSPITAL
HYDRONEPHROS
IS WITH RENAL NEONATAL
CALCULI
Congenital
Open/Lap
1986 H_20083318583
Male
35
Minorit
AMARAPURA
y
BELLARY
BELLARY
Gulbarga
Bhagwan
Mahaveer Jain
Hospital
AWMI, Post
infarct angina,
CAG-SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
12-Aug-15
19-Aug-15
65000
193680
65000
0
65000
IDBI - 321
30-Oct-15
1987 H_20061319031
Female
49
(V) SAGAR (T,Q)
Others SHAHAPUR (DIST)
YADGIRI.
SHAHPUR
YADGIRI
Gulbarga
NARAYANA
HOSPITALS
PIVD-L4-L5/L5S1.
NEURO SURGERY
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
13-Aug-15
24-Aug-15
50000
50000
51000
5100
45900
IDBI - 321
30-Oct-15
1988 H_20017319217
Male
17
Others 0
GOKAK
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
RT.RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
Open
901
901
10-Aug-15
10-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
Minorit
VITTAL KASABA
y
BANTWAL
DAKSHINA
KANNADA
Mysore
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
MANGALORE
ATHEROSCLEROT
IC TRIPLE VESSEL
CARDIOLOGY
CORONARY
ARTERY DISEASE.
CABG
132
132
13-Aug-15
28-Aug-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
BELLARY
BELLARY
Gulbarga
Bhagwan
Mahaveer Jain
Hospital
Bangalore
CHD, Large OS
ASD (Left to
right) shunt
ASD
151
151
12-Aug-15
22-Aug-15
80000
278436
80000
0
80000
IDBI - 321
30-Oct-15
MANGALORE
RIGHT TEMPOROPARIETAL
INTRAPARENCHY
MAL BLEED
NEURO SURGERY
WITH SUBDURAL
EXTN ?AVM
BLEED.
Neuro Surgery
Brain
Craniotomy and
Evacuation of
Haematoma Subdural
401
401
13-Aug-15
31-Aug-15
45000
45000
45000
4500
40500
IDBI - 321
30-Oct-15
BELGAUM
(R) RENAL
STAGHORN
CALCULUS
3X2.9X2.2 CMS
Genito Urinary
Surgery
Urology
Open
Nephrolithotomy Single Side
902
902
18-Aug-15
25-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
MANGALORE
HTN,ACUTE
NSTEMI,CADDOUBLE VESSEL
CARDIOLOGY
DISEASE,NORMA
L LV FUNCTION
EF 60%.
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
12-Aug-15
24-Aug-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
1
1
17-Aug-15
24-Aug-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
1989 H_19522319135
Male
56
1990 H_20083319016
Female
57
ST
JALIHAL
1991 H_20698319055
Male
51
Others BIJERU
PUTTUR
DAKSHINA
KANNADA
Mysore
YENEPOYA
MEDICAL
COLLEGE
HOSPITAL
1992 H_22080319177
Female
43
Others B.ALLUR
HUKKERI
BELGAUM
Belgaum
VIJAYA
HOSPITAL
Solapur
Bangalore
CARDIOLOGY
CARDIOLOGY
RENAL
1993 H_20015319158
Male
61
Others SOMESHWARA
MANGALORE
DAKSHINA
KANNADA
Mysore
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
1994 H_20025319178
Male
49
Others JEEGUNDIPATTANA
MANDYA
MANDYA
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
POST ELECTRIC
BURNS WOUNDS
BURNS
OVER B/L UPPER
LIMBS
Burns
Burns
upto 30% (with
grafting)
1995 H_22226319138
Female
42
Others RAMNAGAR
JOIDA
UTTARA
KANNADA
Belgaum
Viajya Ortho
and Trauma
Centre
L4-L5 DISC
PROLAPSE,DISC
NEURO SURGERY
BULGE AT L2L3,L3-L4,& L5-S1
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
17-Aug-15
24-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
1996 H_21057319111
Male
44
Minorit
THANNIRPANTHA
y
BELTHANGADI
DAKSHINA
KANNADA
Mysore
NEW
IHD,ASMI
CABG
132
132
12-Aug-15
26-Aug-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
1997 H_19571318535
Male
36
Minorit
HULSUR
y
BASAVAKALYAN
BIDAR
A
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
URSL - Single Side
+ DJ Stent
909
909
13-Aug-15
15-Aug-15
25000
31760
25000
2500
22500
IDBI - 321
30-Oct-15
1998 H_19577318916
Male
47
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
SJICR
BANGALORE
SOUTH
IHD - NSTEMI,
CARDIOLOGY
LMCA STENOSIS
CABG with IABP
133
133
13-Aug-15
21-Aug-15
115000
95000
95000
0
95000
IDBI - 321
30-Oct-15
1999 H_19581319150
Female
64
MANDYA
MANDYA
Mysore
Cauvery
Hospital
MYSORE
DOUBLE VESSEL
CORONARY
CARDIOLOGY
ARTERY DISEASE
Cardiology
PTCA - 2 stent
(non-medicated)
104
104
13-Aug-15
17-Aug-15
70000
70000
70000
7000
63000
IDBI - 321
30-Oct-15
SC
P G HALLI
Others KALLAHALLI
BELGAUM
CARDIOLOGY
Urology
Cardiology
Sl.No
Preauth No
Gender
Age
2000 H_19577319096
Male
40
Others BYADANUR
2001 H_19513319137
Male
64
Others
2002 H_19515318593
Female
23
Others 0
2003 H_20025319079
2004 H_20025319091
Female
Male
20
1
Caste
Village
DEVANAYAKANA
HALLI
Others A K DODDI
Others BELAVATHTHA
Taluk
Patient District
Patient
Division
Hospital Name
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
105
11-Aug-15
19-Aug-15
20000
20000
20000
0
20000
IDBI - 321
30-Oct-15
NANJAPPA LIFE
SHIMOGA
CARE
ISCHEMIC HEART
DISEASE,
CARDIOLOGY
CAD:SINGLE
VESSEL DISEASE
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
16-Aug-15
21-Aug-15
55000
55000
55000
550
54450
IDBI - 321
30-Oct-15
CITY CENTRAL
HOSPITAL
PRIVATE
LIMITED
Urinary Baldder
Mass
Genito Urinary
Surgery
Urology
TURBT
916
916
18-Aug-15
24-Aug-15
30000
39442
30000
3000
27000
IDBI - 321
30-Oct-15
Burns
Burns
Post Burn
Contracture
surgeries for
Functional
Improvement(Pack
age including
splints, pressure
garments and
physiotherapy),
Severe
11
11
17-Aug-15
25-Aug-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
Congenital
Open/Lap
313
313
18-Aug-15
26-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
239
239
12-Aug-15
17-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
DAVANGERE
Bangalore
GANGAVATHI
KOPPAL
Gulbarga
MYSORE
Plan of
treatment
105
HONNALI
MYSORE
Balloon Mitral
Valvotomy
SJICR
RAMANAGAR
Disease Main
Category
Cardiology
Bangalore
DAVANGERE
RHD - SEVERE
MS
Diseases
Cardiology
TUMKUR
BANGALORE
SOUTH
Final
Diagnosis
CARDIOLOGY
PAVAGADA
KANAKAPURA
Hospital
District
RENAL
Bangalore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
POST BURNS
CONTRACTURE
OF NECK
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
RT PUJ
OBSTRUCTION (
NEONATAL
CONGENITAL
HN)
IHD-NSTEMI,
MILD LV
DYSFUNCTION, CARDIOLOGY
HTN, DM, CAD LAD 100%
Cardiology
Cardiology
PTCA - one Drug
Eluting stent (
emergency,
inclusive of
angiogram) at the
same admission.
Ca Breast stage II
CANCER
(T2N1Mx)
Surgical Oncology
Breast
Mastectomy - any
type
598
598
17-Aug-15
20-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Cardiology
Device Closure
PDA Device
Closure
119
119
17-Aug-15
20-Aug-15
60000
60000
60000
0
60000
IDBI - 321
30-Oct-15
BURNS
2005 H_20025319098
Male
53
Others MACHENAHALLI
BELUR
HASSAN
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
2006 H_19504318411
Female
40
Others New Vantmuri
BELGAUM
BELGAUM
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
2007 H_19577318928
Female
7
Others HOSUR MAIN ROAD
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
SJICR
BANGALORE
SOUTH
CHD - PDA
2008 H_19528319068
Male
53
Others RING ROAD
GULBARGA
GULBARGA
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
RHD-MILD
LITRAL STENOSIS
CARDIOLOGY
SEV MITRAL
REGURGITATION
Mitral Valve
Replacement
145
145
19-Aug-15
3-Sep-15
120000
120000
122400
3672
118728
IDBI - 321
30-Oct-15
2009 H_19577318947
Female
60
Others KUNUR
KANAKAPURA
RAMANAGAR
Bangalore
SJICR
BANGALORE
SOUTH
IHD - OLD AWMI,
CARDIOLOGY
USA, DM, SVD
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
18-Aug-15
21-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
RANEBENNUR
Left
Hydronephrosis
RENAL
due mid ureteric
calculi
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
19-Aug-15
24-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
2010 H_20215318369
Male
46
Others Taruvinahal
SINDNUR
RAICHUR
Gulbarga
SRI LAXMI
SURGICAL
TRAUMA
ORTHO AND
MULTISPECILIT
2011 H_19577318926
Female
27
Others BHIMAGANAHALLI
BANGARPET
KOLAR
Bangalore
SJICR
BANGALORE
SOUTH
2012 H_21044318963
Male
1 Months
Others PATRAME
BELTHANGADI
DAKSHINA
KANNADA
Mysore
WENLOCK
DISTRICT
HOSPITAL
MANGALORE
2013 H_19504318505
Male
50
Others Tangadi
ATHANI
BELGAUM
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
2014 H_19505317646
Female
57
2015 H_20067319012
Male
64
ST
AMACHAVADI
Minorit
KUCCHI GUDDI
y
Mysore
GAR
GAR
MANGALORE
DAKSHINA
KANNADA
Mysore
Bharath
Hospital
Institute of
Oncology
YENEPOYA
SPECIALTY
HOSPITAL
Mysore
MANGALORE
2016 H_20619315674
Male
30
Others HIREKERURU
HIREKERUR
HAVERI
Belgaum
SUKSHEMA
HOSPITAL
PVTLTD
2017 H_21052318549
Male
55
Others KONAJE
PUTTUR
DAKSHINA
KANNADA
Mysore
2018 H_19491318282
Male
30
Others KOLIHALA
YELBURGA
KOPPAL
Gulbarga
BGS GLOBAL
HOSPITAL
BANGALORE
SOUTH
2019 H_21079318940
Male
3
Others wadi
CHITTAPUR
GULBARGA
Gulbarga
LOTUS
CHILDREN S
HOSPITAL
LAKDIKAPUL
DAVANGERE
RHD - SEVERE
MR
CONGENITAL
HYPERTROPHIC
PYLORIC
STENOSIS
Ca Anala canal
With Liver Mets
stage IV
(T4N1M1)
RECURRENT
PHYLLOIDES
TUMOR OF
RIGHT BREAST
ACUTE IWMI
(TRIPLE VESSEL
DISEASE )
CARDIOLOGY
CARDIOLOGY
Mitral Valve
Replacement
145
145
13-Aug-15
26-Aug-15
120000
100000
99000
0
99000
IDBI - 321
30-Oct-15
NEONATAL
Intestinal Atresias
& Obstructions
303
303
7-Aug-15
17-Aug-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
CANCER
Surgical Oncology
Colostomy
679
679
20-Aug-15
24-Aug-15
20000
20000
18840
1884
16956
IDBI - 321
30-Oct-15
CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
20-Aug-15
24-Aug-15
25000
25000
25000
0
25000
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
PTCA - 2 stent
(non-medicated)
104
104
12-Aug-15
18-Aug-15
70000
70000
70000
7000
63000
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
20-Aug-15
22-Aug-15
37500
37500
37500
3750
33750
IDBI - 321
30-Oct-15
CANCER
Surgical Oncology
Head & Neck
617
617
11-Aug-15
9-Sep-15
40000
69453
40000
4000
36000
IDBI - 321
30-Oct-15
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
17-Aug-15
22-Aug-15
25000
25000
25000
100
24900
IDBI - 321
30-Oct-15
NEONATAL
322
322
10-Aug-15
25-Aug-15
22000
22000
22440
2244
20196
IDBI - 321
30-Oct-15
RIGHT LOWER
URETERIC
CALCULUS WITH RENAL
LEFT RENAL
CALCULUS
CARCINOMA
LARYNX STAGE
T3NOMX
L4-5 Prolapsed
intervertebral
disk
DISTAL PENILE
HYPOSPADIAS
Sl.No
Preauth No
Gender
Age
Caste
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
AMDEDKAR NAGAR
MANVI
MANVI
RAICHUR
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
13-Aug-15
17-Aug-15
25000
32247
25000
2500
22500
IDBI - 321
30-Oct-15
SHIRDAWAD
CHIKKODI
BELGAUM
Belgaum
Kolhapur Cancer
Karveer
Centre
CA LEFT BREAST
CANCER
T4N0M0
Surgical Oncology
Breast
Mastectomy - any
type
598
598
21-Aug-15
24-Aug-15
25000
31020
25000
2500
22500
IDBI - 321
30-Oct-15
HUKKERI
BELGAUM
Belgaum
Miraj
Ca (R) BM T4 N1
CANCER
M0 [Stage-IV]
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
13-Aug-15
27-Aug-15
60000
78643
60000
6000
54000
IDBI - 321
30-Oct-15
CHITTAPUR
GULBARGA
Gulbarga
GULBARGA
L4-L5 Disc
prolapse
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
17-Aug-15
26-Aug-15
25000
25791
25000
2500
22500
IDBI - 321
30-Oct-15
Minorit
MYSORE
y
MYSORE
MYSORE
Mysore
Mysore
CA POST
CRICOID
cT4bN2M0
CANCER
Surgical Oncology
Jejunostomy
677
677
18-Aug-15
25-Aug-15
20000
20000
20000
0
20000
IDBI - 321
30-Oct-15
Others THENKALHUNDI
GUNDLUPET
CHAMARAJANA
Mysore
GAR
Mysore
CA STOMACH
cT2/3N1/2M0
CANCER
Surgical Oncology
Gastrectomy - any
type
636
636
18-Aug-15
27-Aug-15
50000
50000
20000
0
20000
IDBI - 321
30-Oct-15
AVSD/ AV Canal
Defect
153
153
17-Aug-15
8-Sep-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
Anorectal
Malformations
Stage 2
306
306
12-Aug-15
25-Aug-15
40000
40000
39500
3950
35550
IDBI - 321
30-Oct-15
Cardiology
Permanent
pacemaker
VVI) including
Pacemaker value
114
114
11-Aug-15
18-Aug-15
75000
75000
75000
7500
67500
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
19-Aug-15
31-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Cardiology
Balloon
Pulmonary
Valvotomy
/Pulmonary Artery
and Branch
Vessels(LPA/RPA)
Stenosis for
Balloon Dilatation
107
107
10-Aug-15
15-Aug-15
20000
20000
20400
2040
18360
IDBI - 321
30-Oct-15
50
SC
2024 H_20212318753
Male
36
2025 H_20021317984
Male
45
2026 H_19505318449
Female
41
2027 H_19505318877
Female
65
Female
Date of
Admission
12.9 mm sinus
venosus ASD
With LR Shunt
Female
2032 H_20127318788
B L D E ROAD
2023 H_20435318700
SC
amlapur
Minorit
Shivanagi
y
Others Shirahatti
ST
Ingalgai
Others GOPALAPUR
10 Months Others NADARGA
67
Plan of
treatment
DR BIDARIS
ASHWINI
HOSPITAL
BIJAPUR
SC
Male
Belgaum
22
2031 H_19574318702
Disease Main
Category
BIJAPUR
Male
73
Diseases
BIJAPUR
2022 H_19571318708
Male
Final
Diagnosis
LAKDIKAPUL
5
2030 H_21057318382
Hospital
District
LOTUS
CHILDREN S
HOSPITAL
Female
Male
Hospital Name
Gulbarga
2021 H_19580318913
2029 H_21695318487
Patient
Division
BIDAR
3 Months
13
Patient District
BIDAR
Male
Female
Taluk
LARGE UPPER
MUSCULAR VSD,
SMALL PFO,
MILD MITRAL
VALVE
CARDIOLOGY
REGURGITATION
, LEFT HEART
DILATATION,
SEVERE PAH.
2020 H_21079318930
2028 H_19528318873
Village
Others ULLAL
SC
KGF
11 Months Others HIREWADA
HIRIYUR
CHITRADURGA
Mahatma
Gandhi Cancer
Hospital
BASAVESHWAR
TEACHING AND
GENERAL
HOSPITAL
Bharath
Hospital
Institute of
Oncology
Bharath
Hospital
Institute of
Oncology
Bangalore
Bangalore
Gulbarga
Ashwini
Sahakari
Rugnalaya Ani
Sansodhan
Kendra
Solapur
SSS WITH
JUNCTIONAL
ESCAPE
Left Midureteric
RENAL
calculus
GULBARGA
MANGALORE
DAKSHINA
KANNADA
Mysore
NEW
BANGARPET
KOLAR
Bangalore
VYDEHI
HOSPITAL
GADAG
TRANSITIONAL
AV CANAL
ADDITIONAL
CARDIOLOGY
MOD
SCECUNDUM
ASD L-R SHUNT
ANORECTAL
MALFORMATION
NEONATAL
WITH
COLOSTOMY
DONE
Narayana
Hrudayalaya
Private Limited
AFJALPUR
MUNDARGI
CARDIOLOGY
BANGALORE
CARDIOLOGY
VSD
152
152
10-Aug-15
29-Aug-15
80000
80000
81600
8160
73440
IDBI - 321
30-Oct-15
ASD
151
151
19-Aug-15
27-Aug-15
80000
98950
80000
8000
72000
IDBI - 321
30-Oct-15
Belgaum
A J HOSPITAL
CENTRE
CHD-RVH+
SEVERE
VALVULARIS+
LEFT
VENTRICULAR
HYDATID +
CARDIOLOGY
SEVER MITRAL
REGURGITATION
Mitral Valve
Replacement
145
145
10-Aug-15
27-Aug-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
CABG
132
132
8-Aug-15
27-Aug-15
95000
111763
96900
9690
87210
IDBI - 321
30-Oct-15
2033 H_21057318836
Female
20
2034 H_20127318678
Male
64
Others KENI
ANKOLA
UTTARA
KANNADA
Belgaum
A J HOSPITAL
CENTRE
CAD-TVD
2035 H_20017318835
Female
53
Others 0
JAMAKHANDI
BAGLAKOT
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
RHD MODERATE
MITRAL
CARDIOLOGY
STENOSIS WITH
MVO
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
10-Aug-15
20-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
Mysore
CSI Holdsworth
Memorial
Mysore
Hospital
PIVD L5-S1 ON
EXAMINATION :
NEURO SURGERY
SLR 60', RIGHT
ANCLE JERK
ABSENT
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
18-Aug-15
26-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Male
51
SC
N R MOHALLA
MYSORE
Bangalore
Cardiology
HOLEHANASANAVAD
Others
SHIMOGA
I
2036 H_22971316823
SHIMOGA
NEW
CARDIOLOGY
MYSORE
CARDIOLOGY
Sl.No
Preauth No
Age
Caste
2037 H_22932318823
Male
4 Months
Others
Ravindra nagara
balegadde
SAKLESHPURA
HASSAN
Mysore
Rajeev Nursing
Home
2038 H_19567318795
Female
51
SC
TAMYANKOPPA
MUNDAGODA
UTTARA
KANNADA
Belgaum
2039 H_20074318769
Male
43
NELEMANGALA
BANGALORE RURAL
Bangalore
2040 H_19576318814
Female
29
2041 H_19528318811
Female
3
2042 H_19513318802
Male
31
2043 H_19528318794
Female
31
2044 H_20200318565
Male
49
Village
Others NELAMANGALA
SC
Honakuppi
Others J.R.NAGAR
SC
BESURU
Others ADIHUDI
Others NENEKATE
Taluk
Patient District
Patient
Division
Gender
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Anorectal
Malformation
NEONATAL
Anorectal
Malformations
Stage 2
306
306
13-Aug-15
19-Aug-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Breast Rt
stage II
CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
17-Aug-15
31-Aug-15
25000
27550
25000
2500
22500
IDBI-294
9-Oct-15
M S RAMAIAH
NARAYANA
BANGALORE
HRUDAYALAYA
IHD
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
29-Jul-15
18-Aug-15
90000
90000
65000
6500
58500
IDBI - 321
30-Oct-15
Hassan
GOKAK
BELGAUM
Belgaum
SDM Narayana
Hrudayalaya
Dharwad
CHD-Large
Ostuim
Secundum ASD
measuring
30mm with Left
to Right Shunt
CARDIOLOGY
ASD
151
151
13-Aug-15
26-Aug-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
GULBARGA
GULBARGA
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
MODERATE
L-R SHUNT
ASD
151
151
17-Aug-15
22-Aug-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
SAGARA
SHIMOGA
Bangalore
NANJAPPA LIFE
SHIMOGA
CARE
ISCHEMIC HEART
DISEASE, SINGLE CARDIOLOGY
VESSEL DISEASE
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
12-Aug-15
17-Aug-15
65000
65000
65000
650
64350
IDBI - 321
30-Oct-15
JAMAKHANDI
BAGLAKOT
Belgaum
Narayana
Hrudayalaya
Private Limited
CHD-TOF LARGE
SUB AORTIC VSD CARDIOLOGY
WITH BD SHUNT
ICR for TOF
154
154
25-Aug-15
3-Sep-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
12-Aug-15
17-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
Bangalore
Cardiology
GUNDLUPET
CHAMARAJANA
Mysore
GAR
NARAYANA
HRUDAYALAYA
SURGICAL
MYSORE
HOSPITAL PVT
LTD
KOLLEGAL
CHAMARAJANA
Mysore
GAR
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
RHD CALCIFIC
MS
CARDIOLOGY
Mitral Valve
Replacement
145
145
20-Aug-15
2-Sep-15
120000
120000
120000
0
120000
IDBI - 321
30-Oct-15
INFERO
POSTERIOR
STEMI
CARDIOLOGY
Cardiology
Cardiology
2045 H_20200318574
Male
41
Others NAGANATHA
2046 H_19528318796
Female
31
Others MAHADHAV NAGAR BIDAR
BIDAR
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
RHD- S/P PTMC
MITRAL
CARDIOLOGY
REGURGITATION
SEV
Mitral Valve
Replacement
145
145
20-Aug-15
3-Sep-15
120000
120000
122400
3672
118728
IDBI - 321
30-Oct-15
2047 H_19549318474
Male
18
Minorit
0
y
ALAND
GULBARGA
Gulbarga
Sagar Hospitals
BANGALORE
SOUTH
CHD ASD LEFT
TO RIGHT SHUNT CARDIOLOGY
MOD PAH
ASD
151
151
12-Aug-15
24-Aug-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
2048 H_19549318096
Male
48
Others 0
PIRIYAPATNA
MYSORE
Mysore
Sagar Hospitals
BANGALORE
SOUTH
RHD SEVERE
MS,LA CLOP
SEVERE PAH
Mitral Valve
Replacement
145
145
12-Aug-15
22-Aug-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
114
114
10-Aug-15
21-Aug-15
75000
75000
75000
7500
67500
IDBI - 321
30-Oct-15
CARDIOLOGY
COMPLETE
HEART BLOCK
CARDIOLOGY
Cardiology
Permanent
pacemaker
VVI) including
Pacemaker value
RIGHT PUJ
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
8-Aug-15
18-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Surgical Oncology
Breast
Mastectomy - any
type
598
598
13-Aug-15
31-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
16-Aug-15
21-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
CARDIOLOGY
CABG + Valve
Replacement +
IABP
134
134
8-Aug-15
21-Aug-15
130000
469006
130000
0
130000
IDBI - 321
30-Oct-15
2049 H_20017318776
Male
49
Others 0
GOKAK
BELGAUM
Belgaum
2050 H_21897318737
Male
40
Others 0
KUNDAPURA
UDUPI
Mysore
2051 H_20575318613
Female
40
Others KULURU
KOPPA
CHIKKAMANAGL
Mysore
UR
2052 H_20815318601
Female
63
Others BAGDAL
BIDAR
BIDAR
Gulbarga
2053 H_20083317229
Male
60
Others SINGARAHALLI
DEVANAHALLI
BANGALORE RURAL
Bangalore
Bhagwan
Mahaveer Jain
Hospital
Bangalore
2054 H_20575317673
Female
71
Others THALLURANGADY
THIRTHAHALLI
SHIMOGA
Bangalore
MANGALORE
INSTITUTE OF
ONCOLOGY
MANGALORE
CA COLON WITH
CANCER
OBSTRUCTION
Surgical Oncology
Colectomy - any
type
637
637
11-Aug-15
24-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
2055 H_19564318652
Male
29
Others BOMMANA HALLI
HOSADURGA
CHITRADURGA
Bangalore
KASTURBA
HOSPITAL
UDUPI
INTERAVENTRIC
NEURO SURGERY
ULAR TUMOR
Neuro Surgery
Brain Tumour
Excision of Brain
Tumor
SupratentorialBasal
404
404
7-Aug-15
4-Sep-15
60000
60000
61200
6120
55080
IDBI - 321
30-Oct-15
GLOBAL
MULTISPECIALIT
MANGALORE
Y HOSPITAL
INDIA PVT LTD
MANGALORE
MANGALORE
INSTITUTE OF
ONCOLOGY
CHIRAYU
GULBARGA
HOSPITAL
CA LEFT BREAST
CANCER
T2N0M0 II
Ca Breast Right
side
OLD ANTERIOR
WALL MI RHD
SEVERE MR
SEVERE PAH
SINGLE VESSEL
DISEASE
Sl.No
Preauth No
Gender
Age
2056 H_23069318684
Female
49
2057 H_19571318647
Female
28
2058 H_19491317528
Male
70
Caste
Village
Others BANNURU
SC
CHOWADAPUR
Others SRIRAMANAGAR
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
T NARASIPUR
MYSORE
Mysore
THE RADIANT
INSTITUTE
AFJALPUR
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
Gulbarga
BGS GLOBAL
HOSPITAL
Belgaum
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
GANGAVATHI
KOPPAL
UTTARA
KANNADA
MYSORE
BANGALORE
SOUTH
2059 H_20079318625
Male
47
Others SIDDAPURE
SIDDAPUR
2060 H_19577318651
Male
52
Others AKKANAHALLI
CHANNARAYAP
HASSAN
ATNA
Mysore
SJICR
2061 H_19571317297
Male
47
SEDAM
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
2062 H_23069317008
Female
49
SC
UOODAGI
Others KOLLEGALA
GULBARGA
CHAMARAJANA
Mysore
GAR
Bangalore
RURAL
THE RADIANT
INSTITUTE
MYSORE
SJICR
BANGALORE
SOUTH
SJICR
BANGALORE
SOUTH
KOLLEGAL
2063 H_19577318635
Female
30
Others AVALAKUPPE
2064 H_19577318531
Male
65
Others JAYAMANGALA
MALUR
KOLAR
Bangalore
2065 H_20332318145
Male
73
Minorit
MOTHI MOHALLA
y
SIRA
TUMKUR
Bangalore
2066 H_19577318479
Female
26
HUNSUR
MYSORE
Mysore
2067 H_19577318517
Female
23
Others MADALU
ARASIKERE
HASSAN
Mysore
48
RAMACHANDRAPUR BANGALORE
Others
AM
NORTH
2068 H_20332318116
Female
ST
HANUMATHAPURA
BANGALORE
SOUTH
BANGALORE URBAN
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
BANGALORE
SJICR
SOUTH
BANGALORE
SJICR
SOUTH
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
18-Aug-15
28-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
LT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
13-Aug-15
17-Aug-15
25000
32502
25000
2500
22500
IDBI - 321
30-Oct-15
ischaemic heart
disease old
Anterior Wall
Myocardial
CARDIOLOGY
Infarction
coronary
angiography DVD
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
17-Aug-15
20-Aug-15
65000
65000
65000
260
64740
IDBI - 321
30-Oct-15
ACUTE INFERIOR
WALL MI WITH
POSTINFARCTIO
CARDIOLOGY
N ANGINA WITH
S/P RECUSE
PTCA TO RCA
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
21-Aug-15
24-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
ACS - AWMI,
ANGINA, DVD
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
19-Aug-15
22-Aug-15
90000
65000
65000
0
65000
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
10-Aug-15
15-Aug-15
25000
33062
25000
2500
22500
IDBI - 321
30-Oct-15
CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
18-Aug-15
21-Aug-15
25000
25000
23750
2375
21375
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
EP study
125
125
17-Aug-15
20-Aug-15
30000
30000
30000
0
30000
IDBI - 321
30-Oct-15
IHD - IWMI, DVD CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
19-Aug-15
22-Aug-15
90000
90000
89000
0
89000
IDBI - 321
30-Oct-15
BPH
Genito Urinary
Surgery
Urology
TURP
917
917
14-Aug-15
24-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
146
146
7-Aug-15
24-Aug-15
120000
120000
120000
0
120000
IDBI - 321
30-Oct-15
120
120
20-Aug-15
24-Aug-15
80000
80000
80000
0
80000
IDBI - 321
30-Oct-15
907
907
17-Aug-15
25-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
417
417
4-Aug-15
24-Aug-15
47500
47500
47500
4750
42750
IDBI - 321
30-Oct-15
CA CERVIX
STAGE IIIB
CANCER
CARDIOLOGY
LT LOWER
RENAL
URETERIC STONE
CA BREAST
STAGE II
RECURRENT
PSVT
RENAL
BAV - SEVERE AS CARDIOLOGY
CHD - OS ASD
Cardiology
CARDIOLOGY
Device Closure
Bangalore
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
LT RENAL LOWER
RENAL
CALCULI
Genito Urinary
Surgery
Urology
meningomyeloce
le + ventriculo
pritoneal shunt NEURO SURGERY
for
hydrocephalas
Neuro Surgery
Brain
Aortic Valve
Replacement
ASD Device
Closure
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
2069 H_21223316443
Male
1
Others GANEKAL
DEVADURGA
RAICHUR
Gulbarga
INDIRA GANDHI
BANGALORE
INSTITUTE OF
SOUTH
CHILD HEALTH
2070 H_20613318611
Male
43
Others Kagawad
ATHANI
BELGAUM
Belgaum
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
k/c/o Ca Axilla
Stage III
CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
17-Aug-15
22-Aug-15
25000
32185
25000
2500
22500
IDBI - 321
30-Oct-15
2071 H_20619316983
Male
41
Others DAVANAGERE
DAVANAGERE
DAVANGERE
Bangalore
SUKSHEMA
HOSPITAL
PVTLTD
DAVANGERE
LEFT LOWER
URETERIC
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
12-Aug-15
15-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
2072 H_20300318588
Male
40
Others GOWDIHALLI
TUMKUR
TUMKUR
Bangalore
BMCRI SSH
PMSSY
Bangalore
CORPUS
CALLOSAL SOL
NEURO SURGERY
Neuro Surgery
Brain Tumour
Excision of Brain
Tumor
Supratentorial &
others
407
407
6-Aug-15
4-Sep-15
45000
45000
45000
4500
40500
IDBI - 321
30-Oct-15
2073 H_20127316449
Female
64
Others DANDI BALI
MANGALORE
DAKSHINA
KANNADA
Mysore
A J HOSPITAL
CENTRE
IHD,HTN
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
5-Aug-15
14-Aug-15
90000
152392
91800
9180
82620
IDBI - 321
30-Oct-15
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
Spinal
Anterior Cervical
Discectomy
Multiple level with
Implants
(procedure
30000+ Implants
10000)
429
429
17-Aug-15
29-Aug-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
2074 H_20025318196
Male
42
Others G MARAHALLI
NANJANAGUD
MYSORE
C6-7, LT
PARACENTRALPI NEURO SURGERY
VD
Neuro Surgery
Meningomyelocel
e
Sl.No
Preauth No
Age
2075 H_19505318432
Female
50
Others DEVANURU
VIJAPET
KODAGU
Mysore
2076 H_22439318472
Male
58
Others HALLUR
GOKAK
BELGAUM
Belgaum
2077 H_19491316030
Female
62
Minorit
G.G.HALLI
y
BANGALORE
EAST
BANGALORE URBAN
Bangalore
2078 H_19549317994
Female
45
Minorit
0
y
BANGALORE
SOUTH
BANGALORE URBAN
2079 H_20017318536
Male
5
Minorit
PALBHAVI
y
RAIBAGH
BELGAUM
2080 H_22439318468
2081 H_19571317284
2082 H_21919316423
2083 H_20015318499
2084 H_19528318504
Male
Male
Male
Female
Female
29
29
56
61
Caste
Village
Others BELGAUM
Others ALLAGI K.
Others Dasapura
Others SHIRAWAD
1 Months
Others GABBUR
Taluk
BELGAUM
AFJALPUR
Patient District
Patient
Division
Gender
BELGAUM
GULBARGA
SIRAGUPPA
BELLARY
KARWAR
UTTARA
KANNADA
Hospital Name
Bharath
Hospital
Institute of
Oncology
BHS lakeview
Hospital
Diseases
Disease Main
Category
CA LEFT BREAST
CANCER
cT2N0
Surgical Oncology
Breast
BELGAUM
L4/L5 LARGE
PIVD
Neuro Surgery
Spinal
BGS GLOBAL
HOSPITAL
BANGALORE
SOUTH
Carcinoma cervix
CANCER
Stage II B
Radiation Oncology
Bangalore
Sagar Hospitals
BANGALORE
SOUTH
RHD SEVERE
MS,SEVERE PAH
CARDIOLOGY
MOD LV
DYSFUNCTION
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
MENINGOCELE
NEURO SURGERY
Neuro Surgery
Belgaum
BHS lakeview
Hospital
RT RENAL
CALCULI
RENAL
Genito Urinary
Surgery
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Gulbarga
NU Hospitals
Pvt Ltd
Bangalore
Right renal
calculi
RENAL
Genito Urinary
Surgery
Belgaum
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
MANGALORE
TYPE II
DM,IHD,CADLEFT MAIN
CARDIOLOGY
DISEASE+TRIPLE
VESSEL DISEASE.
Narayana
Hrudayalaya
Private Limited
YELLAPUR
UTTARA
KANNADA
Belgaum
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
RAICHUR
Final
Diagnosis
Mysore
Gulbarga
DEVADURGA
Hospital
District
Plan of
treatment
Mastectomy - any
type
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
598
598
22-Aug-15
26-Aug-15
32500
32500
32500
0
32500
IDBI - 321
30-Oct-15
433
433
19-Aug-15
24-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
573
573
20-Aug-15
22-Aug-15
20000
20000
19500
78
19422
IDBI - 321
30-Oct-15
Mitral Valve
Replacement
145
145
11-Aug-15
22-Aug-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
Brain
Meningocele
Excision
420
420
10-Aug-15
26-Aug-15
35000
35000
35000
3500
31500
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
18-Aug-15
24-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
10-Aug-15
19-Aug-15
25000
37061
25000
2500
22500
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
16-Aug-15
21-Aug-15
25000
25000
22950
2295
20655
IDBI - 321
30-Oct-15
CABG
132
132
8-Aug-15
24-Aug-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
Bangalore
MIXED TAPVC
(CARDIAC AND
SUPRACARDIAC)
UNOBSTRUCTED
CARDIOLOGY
,TWO MID
MUSCLE VSDs LR SHUNT,MOD
ASD R-L
TAPVC
160
160
12-Aug-15
5-Sep-15
95000
95000
96900
2907
93993
IDBI - 321
30-Oct-15
MANGALORE
ATHEROSCLEROT
IC TRIPLE VESSEL
CARDIOLOGY
CORONARY
ARTERY DISEASE.
CABG
132
132
10-Aug-15
25-Aug-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
Aortic Valve
Replacement
146
146
12-Aug-15
21-Aug-15
120000
135856
116280
11628
104652
IDBI - 321
30-Oct-15
Neuro Surgery
Brain Tumour
Excision of Brain
Tumor
Supratentorial &
others
407
407
10-Aug-15
24-Aug-15
45000
45000
45900
4590
41310
IDBI - 321
30-Oct-15
114
114
11-Aug-15
22-Aug-15
75000
75000
74500
7450
67050
IDBI - 321
30-Oct-15
BELGAUM
NEURO SURGERY
2085 H_19522318319
Female
56
Minorit
KIRWATTI
y
2086 H_20127318077
Male
46
Others GOLITHOTTU
PUTTUR
DAKSHINA
KANNADA
Mysore
A J HOSPITAL
CENTRE
SEVERE
AS,GOOD
LVF,MODERATE
AR,RHD
2087 H_19564318221
Female
69
Others AJEKARU
KARKALA
UDUPI
Mysore
KASTURBA
HOSPITAL
RIGHT FRONTAL
NEURO SURGERY
MENINGIOMA
UDUPI
2088 H_20733318190
Male
49
Others SOWDENAHALLI
MANDYA
MANDYA
Mysore
SJICR MYSORE
MYSORE
2089 H_20079316661
Male
48
Others CHILAKADRI HALLI
SHIMOGA
SHIMOGA
Bangalore
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
2090 H_20643317972
Male
21
Others Hokkundi
BIJAPUR
BIJAPUR
Belgaum
2091 H_21897318452
Male
36
Others 0
HOSANAGARA
SHIMOGA
Bangalore
2092 H_21057318383
Male
61
Others UJIRE
BELTHANGADI
DAKSHINA
KANNADA
Mysore
SANJEEVINI
SUPERSPECIALIT BIJAPUR
Y HOSPITAL
GLOBAL
MULTISPECIALIT
MANGALORE
Y HOSPITAL
INDIA PVT LTD
NEW
CARDIOLOGY
DiscectomyLumbar
ii. HDR - one
application and
multiple dose
fractions
CHB
CARDIOLOGY
Cardiology
Permanent
pacemaker
VVI) including
Pacemaker value
LEFT POLITICAL
ARTERY
STENOSIS
CARDIOLOGY
Cardiology
Cardiology
Peripheral
Angioplasty
109
109
2-Sep-15
5-Sep-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
RTight uretric
calculi
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
14-Aug-15
16-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
LEFT UPPER
URETERIC
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
11-Aug-15
18-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
UNSTABLE
ANGINA
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
12-Aug-15
17-Aug-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
2093 H_20107317819
Female
58
Minorit
BASAVAKLYAN
y
BASAVAKALYAN
BIDAR
A
2094 H_21044318017
Male
55
Others KONDEMOOLA
MANGALORE
DAKSHINA
KANNADA
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Gulbarga
CARE Hospital A
unit of Quality
Nampally
Care India
Limite
CAD TWO
VESSEL DISEASE
Mysore
WENLOCK
DISTRICT
HOSPITAL
MANGALORE
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
11-Aug-15
15-Aug-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
PROSTATOMEGA
LY WITH ACUTE
RENAL
URINARY
RETENTION
Genito Urinary
Surgery
Urology
TURP
917
917
4-Aug-15
19-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
MANGALORE
CARCINOMA
CERVIX STAGE
IB2
CANCER
Radiation Oncology
ii. HDR per
application
571
571
10-Aug-15
1-Sep-15
13500
13500
13500
1350
12150
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
ischaemic heart
disease Angina
Class II
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
17-Aug-15
20-Aug-15
90000
90000
65000
260
64740
IDBI - 321
30-Oct-15
CARDIOLOGY
2095 H_19522318065
Female
46
Others KORGI
KUNDAPURA
UDUPI
Mysore
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
2096 H_19491315517
Male
51
Others LAKKIHALLA
LINGASUGUR
RAICHUR
Gulbarga
BGS GLOBAL
HOSPITAL
2097 H_20017317913
Male
65
Others 0
HUKKERI
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
BPH
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
5-Aug-15
22-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
2098 H_20308318132
Male
55
Others (V)TARNELLY.
BHALKI
BIDAR
Gulbarga
MEDWIN
HOSPITALS
HYDERABAD
CAD 2VD LAD
AND RCA
DISEASE
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
11-Aug-15
17-Aug-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
RANEBENNUR
Right
Hydronephrosis
RENAL
due to lower
ureteric calculi.
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
19-Aug-15
24-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
2099 H_20215318366
Male
55
Others Parvatasidagiri
HIREKERUR
HAVERI
Belgaum
SRI LAXMI
SURGICAL
TRAUMA
ORTHO AND
MULTISPECILIT
2100 H_19567315606
Female
70
Others BETGERI
GADAG
GADAG
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Oesophagus
midle & lower
CANCER
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
17-Aug-15
7-Sep-15
20000
22230
20000
2000
18000
IDBI-294
9-Oct-15
2101 H_19567318212
Male
36
Others HAVERI
HAVERI
HAVERI
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
SQCA Of Scalp
stage I
CANCER
Surgical Oncology
Tumors
Wide excision +
Reconstruction for
soft tissue and
bone tumors
687
687
26-Aug-15
11-Sep-15
25000
34540
25000
2500
22500
IDBI-294
9-Oct-15
2102 H_20021316804
Female
65
Others CHINCHANSUR
ALAND
GULBARGA
Gulbarga
L3-L4 & L4--L5
PIVD
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
24-Aug-15
1-Sep-15
25000
25162
25000
2500
22500
IDBI - 321
30-Oct-15
2103 H_22080318305
Male
57
Others HATTARAWAT
CHIKKODI
BELGAUM
Belgaum
BPH
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
17-Aug-15
22-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
2104 H_20127316949
Male
60
Minorit
BILIYOORU
y
BANTWAL
DAKSHINA
KANNADA
Mysore
A J HOSPITAL
CENTRE
IHD,ACUTE
INFUID WALL
CARDIOLOGY
MI,CAD,TVD,PVD
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
5-Aug-15
13-Aug-15
90000
98521
91800
9180
82620
IDBI - 321
30-Oct-15
BELTHANGADI
DAKSHINA
KANNADA
Mysore
A J HOSPITAL
CENTRE
MODERATE
SIZED
PERIMEMBRANE CARDIOLOGY
OUS VSD LEFT
TO RIGHT SHUNT
VSD
152
152
17-Aug-15
25-Aug-15
80000
87895
81600
8160
73440
IDBI - 321
30-Oct-15
Ca Buccal
mucosa,
CANCER
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
11-Aug-15
29-Aug-15
60000
68950
60000
6000
54000
IDBI - 321
30-Oct-15
Bangalore
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
BPH
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
20-Aug-15
25-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT UPPER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
10-Aug-15
15-Aug-15
25000
32707
25000
2500
22500
IDBI - 321
30-Oct-15
Bangalore
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
RT UPPER
URETERIC
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
ESWL (Extra
Stent
908
908
17-Aug-15
18-Aug-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
WENLOCK
DISTRICT
HOSPITAL
RIGHT
NONFUNCTIONI RENAL
NG KIDNEY
Genito Urinary
Surgery
Urology
Simple
918
918
11-Aug-15
3-Sep-15
35000
35000
35000
3500
31500
IDBI - 321
30-Oct-15
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
11-Aug-15
13-Aug-15
65000
65000
61275
6128
55147
IDBI - 321
30-Oct-15
2105 H_20127318159
Male
6
Minorit
KALIYA GRAMA
y
2106 H_20077318288
Female
45
Others
2107 H_20332318103
Male
71
SC
2108 H_19571317294
Male
36
SC
SRINIVASACHARLAH
CHIKKABALLAPU
GOWRIBIDANUR
Bangalore
ALLI
R
SUBASHNAGAR
ALLOLI ANDOLA
2109 H_20332318095
Male
27
Minorit
SATANUR
y
2110 H_21044318239
Male
55
Others AMBLE
2111 H_20733318186
Male
73
Minorit
GOWSIYANAGAR
y
BANGALORE
NORTH
JEVARGI
BANGALORE URBAN
GULBARGA
KANAKAPURA
Mysore
R
UR
MYSORE
RAMANAGAR
MYSORE
Mysore
BASAVESHWAR
TEACHING AND
GULBARGA
GENERAL
HOSPITAL
VIJAYA
BELGAUM
HOSPITAL
SJICR MYSORE
MANGALORE
MYSORE
IHD-ACTE AWMI
CARDIOLOGY
CAD-SVD
Cardiology
Sl.No
Preauth No
Gender
Age
Caste
2112 H_19513318246
Male
36
2113 H_19528318241
Male
5 Months
2114 H_20733318195
Male
56
2115 H_20015317535
Female
8 Months
2116 H_20082317659
Female
51
2117 H_23124318226
Female
12
2118 H_20112318208
Male
57
2119 H_22971313320
Male
33
SC
2120 H_19571317754
Male
59
SC
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
RHD, SEV MR,
SEV AR GR II SEV CARDIOLOGY
PAH
LARGE
PERIMEMBRANO
US VSD WITH
UPPER
MUSCULAR
CARDIOLOGY
EXTENSION
WITH
BIDIRECTIONAL
RIGHT SHUNT
Minorit
BYADAGI
y
BYADAGI
HAVERI
Belgaum
NANJAPPA LIFE
SHIMOGA
CARE
Others KINYA
MANGALORE
DAKSHINA
KANNADA
Mysore
Narayana
Hrudayalaya
Private Limited
Bangalore
Others NAGANAHALLI
MYSORE
MYSORE
Mysore
SJICR MYSORE
MYSORE
Others MUNDKUR
KARKALA
UDUPI
Mysore
Others WEAVERS COLONY
NELEMANGALA
BANGALORE RURAL
Bangalore
GANGAVATHI
KOPPAL
Gulbarga
SPARSH SUPER
SPECIALITY
HOSPITAL
RANEBENNUR
HAVERI
Belgaum
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
ISCHEMIC HEART
CARDIOLOGY
DISEASE
RAGHAVENDRA
NAGAR
MYSORE
MYSORE
Mysore
CSI Holdsworth
Memorial
Mysore
Hospital
PIVD C5-6
TALWAD
BHALKI
BIDAR
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
SC
NAVALI
Minorit
KODIYAL
y
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
Kidwai
Memorial
Institute of
Oncology
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Double Valve
Replacement
149
149
25-Aug-15
10-Sep-15
150000
150000
150000
1500
148500
IDBI - 321
30-Oct-15
VSD
152
152
17-Aug-15
2-Sep-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
SVD
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
13-Aug-15
15-Aug-15
65000
65000
42275
4228
38047
IDBI - 321
30-Oct-15
MANGALORE
BLADDER
EXSTROPHY.
NEONATAL
Exstropy Bladder
Stage 1
316
316
4-Jul-15
24-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
ca thyroid
T3N1M0
CANCER
Nuclear Medicine
Thyroid
Radioiodine
Treatment > 100
Millicuries
575
575
17-Aug-15
18-Aug-15
25000
26900
21500
2150
19350
IDBI - 321
30-Oct-15
BANGALORE
NORTH
RHD SEVERE
MS,MOD TR
SEVERE PAH
CARDIOLOGY
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
12-Aug-15
14-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
CABG with IABP
133
133
12-Aug-15
10-Sep-15
115000
115000
115000
3450
111550
IDBI - 321
30-Oct-15
Neuro Surgery
Spinal
Anterior Cervical
Discectomy Single
level
428
428
24-Aug-15
31-Aug-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
RT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
11-Aug-15
14-Aug-15
25000
31882
25000
2500
22500
IDBI - 321
30-Oct-15
MANGALORE
LEFT RENAL
CALCULUS.
Genito Urinary
Surgery
Urology
ESWL (Extra
Stent
908
908
17-Aug-15
21-Aug-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
NEURO SURGERY
2121 H_20015318167
Male
36
Others KYAMANAHALLI
SAKLESHPURA
HASSAN
Mysore
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
2122 H_19577318052
Female
65
Minorit ASHOK NGA PAKIR
y
PALYA
TUMKUR
TUMKUR
Bangalore
SJICR
BANGALORE
SOUTH
IWMI, DM, HTN,
CARDIOLOGY
SVD
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
12-Aug-15
20-Aug-15
90000
45000
20000
0
20000
IDBI - 321
30-Oct-15
2123 H_19577318093
Male
60
Minorit
LAKYA
y
Mysore
R
UR
SJICR
BANGALORE
SOUTH
ACS - IWMI, DVD CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
24-Aug-15
27-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
2124 H_19528318105
Female
58
Others ALMEL
SINDAGI
BIJAPUR
Belgaum
Narayana
Hrudayalaya
Private Limited
Bangalore
RHD-SEV MITRAL
CARDIOLOGY
STENOSIS
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
13-Aug-15
17-Aug-15
20000
20000
20400
612
19788
IDBI - 321
30-Oct-15
2125 H_20613318011
Female
56
Others Hulagabali
ATHANI
BELGAUM
Belgaum
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
ca Buccal
mucosa III
Surgical Oncology
Head & Neck
612
612
13-Aug-15
22-Aug-15
37500
39072
37500
3750
33750
IDBI - 321
30-Oct-15
2126 H_19586318109
Female
48
HIREKERUR
HAVERI
Belgaum
2127 H_20200318089
Female
48
Others CHINYA
NAGAMANGALA MANDYA
Mysore
2128 H_22971313313
Male
38
Others BANNANAKERE
KR PET
Mysore
SC
HOLABIKONDA
MANDYA
SAPTHAGIRI
SUPER
BANGALORE
SPECIALITY
HOSPITAL
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
RENAL
CANCER
Mitral Valve
Replacement
145
145
10-Aug-15
29-Aug-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
MS MR AR TR
CARDIOLOGY
Double Valve
Replacement
149
149
14-Aug-15
28-Aug-15
150000
150000
150000
0
150000
IDBI - 321
30-Oct-15
CSI Holdsworth
Memorial
Mysore
Hospital
PIVD C5-6
NEURO SURGERY
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
20-Aug-15
29-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
Lt Mid Ureteric
calculus with HN RENAL
& HU
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
10-Aug-15
15-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
IHD EVOLEVED
IWMI
Cardiology
Cardiology
PTCA - 2 stent
(non-medicated)
104
104
3-Aug-15
20-Aug-15
70000
70000
70000
7000
63000
IDBI - 321
30-Oct-15
2129 H_21254318062
Male
29
Others 0
INDI
BIJAPUR
Belgaum
DR RAGHOJI
KIDNEY
HOSPITAL AND
RESEARCH
CENTER PV
2130 H_20017318049
Female
60
Others 0
GOKAK
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
SOLAPUR
CARDIOLOGY
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
8-Aug-15
1-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
2131 H_19586317317
Male
54
Others NANDIHALLI
SHAHPUR
YADGIRI
Gulbarga
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
2132 H_20242317090
Male
51
Others MANTUR
RAIBAGH
BELGAUM
Belgaum
MEDIHOPE
HOSPITALS AND
BANGALORE
RESEARCH
CENTRE PVT LTD
IHD, TVD WITH
LV
DYSFUNCTION
CARDIOLOGY
CABG
132
132
5-Aug-15
21-Aug-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
2133 H_19549317244
Male
48
SC
0
GANGAVATHI
KOPPAL
Gulbarga
Sagar Hospitals
BANGALORE
SOUTH
L3-4 PIVD WITH
SEVERE CANAL
STENOISIS
NEURO SURGERY
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
17-Aug-15
25-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
2134 H_19549317238
Female
40
ST
0
DEVADURGA
RAICHUR
Gulbarga
Sagar Hospitals
BANGALORE
SOUTH
D9-11
HYPERROPHIED
L3-5 CANAL
STENOSIS
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
16-Aug-15
24-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
2135 H_19574317557
Male
73
Others ENIGADALE VILAGE
CHINTAMANI
CHIKKABALLAPU
Bangalore
R
VYDEHI
HOSPITAL
BANGALORE
BPH with vesical
RENAL
calculus
Genito Urinary
Surgery
Urology
TURP
917
917
17-Aug-15
1-Sep-15
26250
26250
26250
2625
23625
IDBI - 321
30-Oct-15
2136 H_23124317894
Male
41
Others Settikere
CHIKKANAYAKA
TUMKUR
NAHALLI
Bangalore
SPARSH SUPER
SPECIALITY
HOSPITAL
BANGALORE
NORTH
L4 L5 Prolapsed
Intervertebral
Disc
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
24-Aug-15
28-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Mysore
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
MANGALORE
ADENOCARCINO
MA OF COLON CANCER
STAGE IIA
Surgical Oncology
Colectomy - any
type
637
637
7-Aug-15
24-Aug-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
A J HOSPITAL
CENTRE
CARCINOID
TIMOR LEFT
MAIN
BRONCHUS
Pneumonectomy
190
190
11-Aug-15
20-Aug-15
50000
50000
51000
5100
45900
IDBI - 321
30-Oct-15
Left uretir calculi RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
14-Aug-15
16-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Single Vessel
Disease
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
16-Aug-15
19-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
NEONATAL
Biliary Atresia &
Choledochal Cyst
304
304
23-Jul-15
26-Aug-15
45000
45000
45000
4500
40500
IDBI - 321
30-Oct-15
BANGALORE
RIGHT
STAGHORN
CALCULUS
RENAL
Genito Urinary
Surgery
NEURO SURGERY
Urology
2137 H_19522317767
Female
52
Others KANDAK
MANGALORE
DAKSHINA
KANNADA
2138 H_20127317914
Female
33
Others BELAKE
BHATKALA
UTTARA
KANNADA
Belgaum
2139 H_20643317974
Male
13
Others Hukkundi
BIJAPUR
BIJAPUR
Belgaum
2140 H_20203317970
Female
64
Others Kanakur
DHARWAD
DHARWAD
Belgaum
2141 H_21223317546
Male
1 Months
Others KARIGANUR
HOSPET
BELLARY
Gulbarga
INDIRA GANDHI
BANGALORE
INSTITUTE OF
SOUTH
CHILD HEALTH
biliary atresia
ISCHEMIC HEART
DISEASE,
MI, SINGLE
VESSEL DISEASE
Cardiology
Cardiology
Medical
treatment of
Acute MI with
Thrombolysis
128
128
11-Aug-15
13-Aug-15
70000
70000
70000
700
69300
IDBI - 321
30-Oct-15
Urology
Urethroplasty for
Stricture DiseasesSecond Stage
914
914
31-Aug-15
7-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
907
907
10-Aug-15
17-Aug-15
25000
25000
24990
2499
22491
IDBI - 321
30-Oct-15
2142 H_19513317966
Male
50
Others KARURU
2143 H_20332313016
Male
56
Others
2144 H_19564317738
Male
49
MUNIRAMAPPA
GARDEN
Others KOTE
SANJEEVINI
Y HOSPITAL
KARNATAKA
INSTITUTE OF
HUBLI
MEDICAL
SCINCES
CARDIOLOGY
DAVANAGERE
DAVANGERE
Bangalore
NANJAPPA LIFE
SHIMOGA
CARE
BANGALORE
EAST
BANGALORE URBAN
Bangalore
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
stricture urethra RENAL
Genito Urinary
Surgery
Mysore
KASTURBA
HOSPITAL
UDUPI
RIGHT RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
SOLAPUR
Lt Mid Ureteric
Calculus
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
10-Aug-15
14-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
11-Aug-15
17-Aug-15
25000
34040
25000
2500
22500
IDBI - 321
30-Oct-15
Spinal
DiscectomyLumbar
433
433
13-Aug-15
17-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
12-Aug-15
15-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
UDUPI
UDUPI
2145 H_21254317505
Male
60
Others 0
YADGIR
YADGIRI
Gulbarga
DR RAGHOJI
KIDNEY
HOSPITAL AND
RESEARCH
CENTER PV
2146 H_19571317749
Female
19
Minorit
GANDHI CHOWK
y
YADGIR
YADGIRI
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT RENAL
CALCULUS
2147 H_23124317875
Male
55
Others Naikal
SHAHPUR
YADGIRI
Gulbarga
SPARSH SUPER
SPECIALITY
HOSPITAL
BANGALORE
NORTH
L4 L5 PIVD L5 S1
NEURO SURGERY
PIVD
Neuro Surgery
Bangalore
SUKSHEMA
HOSPITAL
PVTLTD
DAVANGERE
RIHT RENAL
CALCULUS
Genito Urinary
Surgery
2148 H_20619316994
Female
60
Others ANNAPURA
DAVANAGERE
DAVANGERE
RENAL
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
2149 H_20619315697
Male
54
Others DANDAGI HALLI
RANEBENNUR
HAVERI
Belgaum
SUKSHEMA
HOSPITAL
PVTLTD
2150 H_20619317230
Male
75
Others KURUBA GONDA
HAVERI
HAVERI
Belgaum
SUKSHEMA
HOSPITAL
PVTLTD
Others 0
Mysore
R
UR
GLOBAL
MULTISPECIALIT
MANGALORE
Y HOSPITAL
INDIA PVT LTD
MUDHOLA
BAGLAKOT
Belgaum
YASHODHARA
SUPER
SPECIALITY
HOSPITAL PVT
LTD
SOLAPUR
KUNDAPURA
UDUPI
Mysore
Narayana
Hrudayalaya
Private Limited
Bangalore
2151 H_21897317019
Male
32
2152 H_20198317874
Female
28
2153 H_19528317932
Female
5 Months
SC
MADABHAVI
Others KUNDAPURA
Final
Diagnosis
DAVANGERE
RIGHT RENAL
CALCULUS
DAVANGERE
BEP
2154 H_20017317930
Male
50
Others 0
BIJAPUR
BIJAPUR
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
2155 H_20575317352
Male
43
Minorit
HORAPETE
y
CHITRADURGA
CHITRADURGA
Bangalore
MANGALORE
INSTITUTE OF
ONCOLOGY
MANGALORE
MYSORE
RT.PUJ
CALCULUS
Diseases
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
908
908
11-Aug-15
13-Aug-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
Urology
TURP
917
917
24-Aug-15
28-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
7-Aug-15
18-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Mitral Valve
Replacement
145
145
11-Aug-15
27-Aug-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
VSD
152
152
13-Aug-15
7-Sep-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
Urethroplasty for
a year can be
considered)
912
912
3-Aug-15
21-Aug-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
Surgical Oncology
Gastrectomy - any
type
636
636
10-Aug-15
26-Aug-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
905
905
19-Aug-15
24-Aug-15
35000
35000
34680
3468
31212
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
TURP
917
917
4-Aug-15
22-Aug-15
26250
26250
26250
2625
23625
IDBI - 321
30-Oct-15
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
10-Aug-15
14-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
908
908
19-Aug-15
19-Aug-15
10000
10000
10200
1020
9180
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
RENAL
Genito Urinary
Surgery
CA STOMACH
CANCER
WITH
OBSTRUCTION
MODERATE
DILATATION OF
PCS OF LT
RENAL
KIDNEY PARTIAL
PUJ
OBSTRUCTION.
Plan of
treatment
Urology
RENAL
RENAL
ESWL (Extra
Stent
Genito Urinary
Surgery
RHD WITYH
SEVERE MR
WITH MILD MS
WITH SEVERE TR CARDIOLOGY
WITH SEVERE
PAH WITH MILD
AR
LARGE SUB
AORTIC VSD L-R
SHUNT,MOD
CARDIOLOGY
FENESTRATED
SAC ASD L-R
SHUNT
STRICTURE
URETHRA
Disease Main
Category
2156 H_19542317685
Female
44
Others AYARAHALLI
MYSORE
MYSORE
Mysore
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
2157 H_20017317919
Male
75
Others 0
MUDHOLA
BAGLAKOT
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
BPH+VESICAL
CALCULUS
CHIKKABALLAPU
Bangalore
R
TRINITY
HOSPITAL AND
HEART
FOUNDATION
BANGALORE
SOUTH
Unstable Angina,
CAD - S/P
PTCA/Stenting to
LAD 2011
Diabetes
CARDIOLOGY
Mellitus,
Hypertension
CAD -Single
Vessel Disease
Cardiology
MADDUR
MANDYA
Mysore
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
MYSORE
MULTIPLE B/L
RENAL CALCULI
RENAL
CALCULUS IN LT
PUJ.
Genito Urinary
Surgery
Urology
ESWL (Extra
Stent
DEVANAHALLI
BANGALORE RURAL
Bangalore
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
BANGALORE
RIGHT LOWER
VRETERIC
CALCULUS
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
5-Aug-15
19-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
2158 H_19593317911
Female
51
Minorit
Gedare
y
2159 H_19542317787
Male
40
2160 H_19586317324
Female
28
2161 H_19583317588
Male
2
Minorit
MYSARAGERE
y
HARAPANAHALL
DAVANGERE
I
Bangalore
S.S. INSTITUTE
OF MEDICAL
NH-4,Bypass PB 40% mixed burns
BURNS
SCIENCES &
Road Davanagere with scald
RESEARCH CENT
Burns
Burns
upto-40% with
Scalds(
Conservative/
without grafting)
2
2
10-Aug-15
21-Aug-15
35000
35000
17770
1777
15993
IDBI - 321
30-Oct-15
2162 H_19528317245
Male
66
Others CHURCH ROAD
Bangalore
Narayana
Hrudayalaya
Private Limited
Surgical Oncology
Head & Neck
612
612
23-Aug-15
31-Aug-15
35000
35000
35700
1071
34629
IDBI - 321
30-Oct-15
Mysore
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
Genito Urinary
Surgery
Urology
Cystolithotripsy
906
906
13-Aug-15
15-Aug-15
12500
12500
12113
1211
10902
IDBI - 321
30-Oct-15
2163 H_19542317463
Male
65
Others KYATHAGATTA
CHINTAMANI
RENAL
SC
VIJAYAPURA
Others SHETTAHALLI
MADDUR
MANDYA
RENAL
Bangalore
PAPILLARY
THYROID
CARCINOMA
MYSORE
LT SIDED
MODERATE HUN
RENAL
WITH AN
VESICAL
CALCULUS.
CANCER
Sl.No
Preauth No
2164 H_20015317847
2165 H_19581317857
Gender
Female
Female
Age
57
45
Caste
Village
Others MALA
SC
BASAVAPURA
Taluk
KARKALA
Patient District
UDUPI
Patient
Division
Mysore
Mysore
GAR
GAR
Hospital Name
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
Cauvery
Hospital
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
MANGALORE
HTN , IHD , CAD ,
SINGLE VESSEL
DISEASE
CARDIOLOGY
NORMAL LV
FUNCTION EF
60%.
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
10-Aug-15
17-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
MYSORE
Granulosa cell
tumour of ovary,
post right
ovarian
cystectomy and CANCER
adjuvant
chemotherapy
status with
residual lesion.
Surgical Oncology
Gynaec
Surgery for Ca
Ovary - advance
stage
596
596
19-Aug-15
25-Aug-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
Gynaec-Ca.Cervix
Radical
Hysterectomy
+Bilateral Pelvic
Lymph Node
Dissection (BPLND)
Ophorectomy
(BSO) / Ovarian
transposition
648
648
24-Aug-15
31-Aug-15
45000
45000
45000
4500
40500
IDBI - 321
30-Oct-15
2166 H_19581317865
Female
50
Others DMG HALLI
MYSORE
MYSORE
Mysore
Cauvery
Hospital
MYSORE
CA. CERVIX
CANCER
Surgical Oncology
2167 H_19577317835
Male
50
Others THANDKAL
MANVI
RAICHUR
Gulbarga
SJICR
BANGALORE
SOUTH
IHD - USA, TVD
CARDIOLOGY
CABG
132
132
7-Aug-15
23-Aug-15
95000
95000
95000
0
95000
IDBI - 321
30-Oct-15
2168 H_19577317831
Male
35
Others BESAGARAHALLI
MADDUR
MANDYA
Mysore
SJICR
BANGALORE
SOUTH
IHD - USA, SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
18-Aug-15
21-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
2169 H_19581317813
Male
24
Others VARUNA
MYSORE
MYSORE
Mysore
Cauvery
Hospital
MYSORE
LEFT RENAL
CALCULUS.
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
13-Aug-15
16-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
2170 H_19577317827
Male
50
Others HACHEHOLU
SIRAGUPPA
BELLARY
Gulbarga
SJICR
BANGALORE
SOUTH
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
18-Aug-15
22-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
2171 H_20025317772
Female
48
Others NH PALYA
MYSORE
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
IHD - NSTEMI,
HTN, DM
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
6-Aug-15
12-Aug-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
2172 H_19577317683
Female
25
Others KOLAR
BIDAR
BIDAR
Gulbarga
SJICR
BANGALORE
SOUTH
RHD - SEVERE
MS
CARDIOLOGY
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
23-Aug-15
26-Aug-15
20000
20000
20000
0
20000
IDBI - 321
30-Oct-15
2173 H_19564317663
Female
67
Others ULLIYARAGOLI
UDUPI
UDUPI
Mysore
KASTURBA
HOSPITAL
UDUPI
UNSTABLE
ANGINA
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
8-Aug-15
14-Aug-15
90000
90000
91290
9129
82161
IDBI - 321
30-Oct-15
2174 H_19528317766
Male
29
Others KALARI
MAGADI
RAMANAGAR
Bangalore
Narayana
Hrudayalaya
Private Limited
Bangalore
L4-5 GRADE I
ANTEROLISTHESI NEURO SURGERY
S
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
18-Aug-15
21-Aug-15
50000
50000
51000
1530
49470
IDBI - 321
30-Oct-15
Bangalore
RHD, dilated LA
& RA, Severe
MS, Trivial MR, CARDIOLOGY
Severe PAH, Fair
LV function
Mitral Valve
Replacement
145
145
11-Aug-15
11-Sep-15
120000
341988
120000
0
120000
IDBI - 321
30-Oct-15
RT SFA
OCCLUSION
CARDIOLOGY
Femoropopliteal
by pass procedure
with graft (inclu.
Graft)
212
212
13-Aug-15
22-Aug-15
45000
45000
45000
4500
40500
IDBI - 321
30-Oct-15
DAVANGERE
Right SFA Block +
Right Infro
CARDIOLOGY
Popliteal Block
Femoro Distal
Bypass with
Synthetic Graft
230
230
13-Aug-15
24-Aug-15
92500
131447
92500
9250
83250
IDBI - 321
30-Oct-15
BANGALORE
RIGHT
PROXIMAL
URETERIC
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
8-Aug-15
20-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
MANGALORE
RIGHT RENAL
PELVIC
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
29-Jul-15
3-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Ca Carvix IIIB
CANCER
Radiation Oncology
ii. HDR per
application
571
571
17-Aug-15
7-Sep-15
13500
13500
13500
1350
12150
IDBI - 321
30-Oct-15
2175 H_20083317727
Female
27
Others MAILAPURA
GANGAVATHI
KOPPAL
Gulbarga
Bhagwan
Mahaveer Jain
Hospital
2176 H_20025317730
Male
79
Others KARUHATTI
T NARASIPUR
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
2177 H_19515316567
Male
45
Others 0
DAVANAGERE
DAVANGERE
Bangalore
2178 H_19586317155
Male
65
Others NARAYANAKERE
TUMKUR
TUMKUR
Bangalore
CITY CENTRAL
HOSPITAL
PRIVATE
LIMITED
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
2179 H_21044317154
Female
25
Others BANNURU
SHIKARIPURA
SHIMOGA
Bangalore
WENLOCK
DISTRICT
HOSPITAL
2180 H_19504315509
Female
45
Others Bijapur
BIJAPUR
BIJAPUR
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
MANGALORE
ACUTE AWMI
CAD-DOUBLE
VESSEL DISEASE
CARDIOLOGY
MODERATE LV
DYSFUNCTION.E
F 40%
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
9-Aug-15
14-Aug-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
KARKALA
UDUPI
Mysore
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
MYSORE
MYSORE
Mysore
SJICR MYSORE
MYSORE
IHD-ACUTE MI
OLD AWMI
CARDIOLOGY
Cardiology
Cardiology
Medical
treatment of
Acute MI with
Thrombolysis
128
128
4-Aug-15
13-Aug-15
10000
10000
9500
950
8550
IDBI - 321
30-Oct-15
Others HASSAN
HASSAN
HASSAN
Mysore
Cauvery
Hospital
MYSORE
SINGLE VESSEL
CORONARY
CARDIOLOGY
ARTERY DISEASE
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
11-Aug-15
14-Aug-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
Gulbarga
Shri
Siddheshwar
and Research
Cent
Cancer-Lip
CANCER
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
17-Aug-15
24-Aug-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
NEURO SURGERY
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
10-Aug-15
16-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
2181 H_20015317731
Male
48
Others BOLA
2182 H_20733317708
Male
57
Others
2183 H_19581317689
Male
35
RAGAVENDRA
BADAVANE
2184 H_22472317670
Male
62
Others 0
BASAVAKALYAN
BIDAR
A
2185 H_22525317353
Male
66
Others 0
CHITTAPUR
GULBARGA
Gulbarga
Balawant
Institute of
Solapur
Neurosurgery
Intensive Trama
D12
compression
fracture
2186 H_20613317596
Female
75
Others Bharamakodi
ATHANI
BELGAUM
Belgaum
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
ca right breast III CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
17-Aug-15
24-Aug-15
25000
27961
25000
2500
22500
IDBI - 321
30-Oct-15
2187 H_20082316362
Female
34
Others MULLURU
KOLLEGAL
CHAMARAJANA
Mysore
GAR
Kidwai
Memorial
Institute of
Oncology
CA THYROID
CANCER
Nuclear Medicine
Thyroid
Radioiodine
Treatment > 100
Millicuries
575
575
24-Aug-15
25-Aug-15
25000
25050
15000
1500
13500
IDBI - 321
30-Oct-15
2188 H_20025315280
Male
75
Others HD KOTE
MYSORE
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
CA STOMACH
CANCER
Surgical Oncology
Gastrectomy - any
type
636
636
13-Aug-15
3-Sep-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
2189 H_19564317459
Male
45
Others HENNABAILU
KUNDAPURA
UDUPI
Mysore
KASTURBA
HOSPITAL
ACUTE POSTERO
LATERAL WALL CARDIOLOGY
MI
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
9-Aug-15
12-Aug-15
90000
90000
91290
9129
82161
IDBI - 321
30-Oct-15
2190 H_20531317612
Female
51
Others
Bangalore
RAJARAJESWARI
MEDICALCOLLE
BANGALORE
GE AND
HOSPITAL
Lt ureteric stone RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
10-Aug-15
17-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
2191 H_20254317428
Female
40
Others Bailur
BYLAHONGALA
Belgaum
Shakuntala
Memorial
Hubli
Hospital and
Research Centre
CA larynxy stage
CANCER
IV
Surgical Oncology
Jejunostomy
677
677
13-Aug-15
17-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
9-Aug-15
14-Aug-15
65000
65000
65790
6579
59211
IDBI - 321
30-Oct-15
D V T - IVC Filter
237
237
6-Aug-15
13-Aug-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
UDUPI
ANTERIOR WALL
MI WITH SINGLE CARDIOLOGY
VESSEL DISEASE
Cardiology
Mysore
GAR
GAR
Cauvery
Hospital
MYSORE
DEEP VEIN
THROMBOSIS - CARDIOLOGY
LEFT ILLIAC VEIN
Others HOGARANALA
SINDNUR
RAICHUR
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
MOD TO LARGE
PDA L-R SHUNT
CARDIOLOGY
176
176
14-Aug-15
31-Aug-15
20000
20000
20400
612
19788
IDBI - 321
30-Oct-15
28
Others MAHADEVANAGAR
GULBARGA
GULBARGA
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
LEFT FEMORAL
CCL LARI ON
CARDIOLOGY
Thromboembolect
omy
213
213
17-Aug-15
27-Aug-15
20000
20000
20400
612
19788
IDBI - 321
30-Oct-15
3
Others
TUMKUR
TUMKUR
Bangalore
INDIRA GANDHI
BANGALORE
INSTITUTE OF
SOUTH
CHILD HEALTH
vesical calculus
RENAL
Genito Urinary
Surgery
Urology
Open
Cystolithotomy
903
903
6-Aug-15
17-Aug-15
15000
15000
10000
1000
9000
IDBI - 321
30-Oct-15
Gynaec-Ca.Cervix
Radical
Hysterectomy
+Bilateral Pelvic
Lymph Node
Dissection (BPLND)
Ophorectomy
(BSO) / Ovarian
transposition
648
648
18-Aug-15
25-Aug-15
45000
45000
45000
4500
40500
IDBI - 321
30-Oct-15
Male
69
2193 H_19581316287
Female
22
2194 H_19528317585
Female
2 Months
2195 H_19528316194
Male
2196 H_21223317538
Female
Female
BELGAUM
UDUPI
KASTURBA
HOSPITAL
2192 H_19564317452
2197 H_19581314398
MAILANAIKANA
HALLI
BANGALORE
SOUTH
45
Others INNANJE
SC
SC
NAGAVALLI
CHOTUSABARA
PALYA
KUMBARAHALLI
UDUPI
BANGALORE
SOUTH
UDUPI
BANGALORE URBAN
Mysore
Bangalore
Cauvery
Hospital
MYSORE
CA CERVIX
CANCER
Surgical Oncology
Sl.No
Preauth No
2198 H_21223317533
Gender
Age
Male
8 Months
Caste
Village
Others AIDANAL
Taluk
LINGASUGUR
Patient District
RAICHUR
Hospital Name
Final
Diagnosis
INDIRA GANDHI
BANGALORE
INSTITUTE OF
SOUTH
CHILD HEALTH
anorectal
malformation
Bangalore
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
Male
61
Others MALLIGENAHALLI
BHADRAVATHI
2200 H_20332317232
Male
73
Others SUGANAHALLI
CHANNARAYAP
HASSAN
ATNA
Mysore
2201 H_20017316873
Female
20 Days
BELGAUM
BELGAUM
Belgaum
2202 H_19515317332
Male
51
Others S K HALLI
HOSADURGA
CHITRADURGA
Bangalore
2203 H_19577316806
Female
58
Minorit
THILAKNGARA
y
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
SJICR
ANKALAGI
Hospital
District
Gulbarga
2199 H_20332316065
SC
SHIMOGA
Patient
Division
INSTITUTE OF
NEPHROUROLO
GY
KLES Dr
Prabhakar Kore
Hospital and
MRC
CITY CENTRAL
HOSPITAL
PRIVATE
LIMITED
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Anorectal
Malformations
Stage 3
307
307
3-Aug-15
18-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
14-Aug-15
2-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
BPH
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
20-Aug-15
25-Aug-15
20000
20000
19460
1946
17514
IDBI - 321
30-Oct-15
Belgaum
HIRSEHPRUNGS
DISEASE
NEONATAL
Hirschprungs
Disease stage 1
308
308
6-Aug-15
19-Aug-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
DAVANGERE
D12 L4
Intradural Spinal NEURO SURGERY
Tumor
Neuro Surgery
Spinal
Spinal Cord
Tumours
426
426
12-Aug-15
25-Aug-15
35000
62937
35000
3500
31500
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
IHD - OLD AWMI,
CARDIOLOGY
DVD, DM, HTN
CABG
132
132
3-Aug-15
24-Aug-15
95000
95000
95000
0
95000
IDBI - 321
30-Oct-15
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
13-Aug-15
27-Aug-15
20000
22850
20000
2000
18000
IDBI-294
9-Oct-15
Neuro Surgery
Brain
417
417
12-Aug-15
17-Aug-15
35000
35000
34720
347
34373
IDBI - 321
30-Oct-15
Congenital
Open/Lap
313
313
7-Aug-15
11-Aug-15
50000
50000
51000
1530
49470
IDBI - 321
30-Oct-15
NEONATAL
RENAL
CALCULUS
BANGALORE
EAST
BYLAHONGALA
BELGAUM
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
SAGARA
SHIMOGA
Bangalore
NANJAPPA
HOSPITAL
SHIMOGA
Minorit
KEMPAIAH BLOCK
y
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
Narayana
Hrudayalaya
Private Limited
Bangalore
56
Others HOSAKATTE
HIREKERUR
HAVERI
Belgaum
A J HOSPITAL
CENTRE
grade ii
prostatomegaly
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
7-Jul-15
26-Aug-15
20000
45084
20400
2040
18360
IDBI - 321
30-Oct-15
Male
40
Others KUNJALA
MADIKERI
KODAGU
Mysore
INDIANA
HOSPITAL AND
HEART
INSTITUTE LTD
MANGALORE
CAD-UA
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
17-Aug-15
21-Aug-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
2209 H_19528317312
Male
29
Others BANDRI
SANDUR
BELLARY
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
PSEUDOMENING
IOCELE WITH
NEURO SURGERY
HYDROCEPHALU
S
Neuro Surgery
Brain
Cranioplasty
419
419
16-Aug-15
29-Aug-15
42500
42500
43350
1301
42049
IDBI - 321
30-Oct-15
2210 H_20025317006
Female
63
Others NAZARBAAD
MYSORE
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
TVD
CABG
132
132
12-Aug-15
27-Aug-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
114
114
6-Aug-15
14-Aug-15
75000
75000
74500
7450
67050
IDBI - 321
30-Oct-15
2204 H_19567317474
Female
75
2205 H_20773316892
Male
6
2206 H_19528317488
Male
3 Months
2207 H_20127317387
Male
2208 H_20322317466
Others Holihosur
SC
HANDIGODU
Ca Cervix IV a
CANCER
SAIRAL
MENINGOMYEL NEURO SURGERY
OCELE,
B/L PELVIC
URETERIC
NEONATAL
JUNCTION
OBSTRUCTION
CARDIOLOGY
Meningomyelocel
e
2211 H_20733317359
Male
71
Others Hanahalli
HD KOTE
MYSORE
Mysore
SJICR MYSORE
MYSORE
CHB
CARDIOLOGY
Cardiology
Permanent
pacemaker
VVI) including
Pacemaker value
2212 H_20733317364
Male
38
Others Alanahalli
HD KOTE
MYSORE
Mysore
SJICR MYSORE
MYSORE
IHD-ACS
EVOLVED AWMI CARDIOLOGY
CAD-SVD
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
11-Aug-15
13-Aug-15
65000
65000
60325
6033
54292
IDBI - 321
30-Oct-15
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
9-Aug-15
12-Aug-15
65000
65000
61275
6128
55147
IDBI - 321
30-Oct-15
2213 H_20733317390
Male
58
Others Madduru
2214 H_20198316929
Male
51
SC
BIJAPUR
2215 H_22525317368
Male
45
Others 0
2216 H_20074315231
Female
61
Others
BHUVANESHWARI
NAGAR
CHAMARAJANA
Mysore
GAR
SJICR MYSORE
MYSORE
IHD-ACS IWMI
CAD-SVD
BIJAPUR
BIJAPUR
Belgaum
YASHODHARA
SUPER
SPECIALITY
HOSPITAL PVT
LTD
SOLAPUR
DECOMPRESSIO
NEURO SURGERY
N CRANIOTOMY
Neuro Surgery
Brain
Cranioplasty
419
419
7-Aug-15
18-Aug-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
CHITTAPUR
GULBARGA
Gulbarga
Balawant
Institute of
Solapur
Neurosurgery
Intensive Trama
C4-C5 left PID C6C7 Right PID
NEURO SURGERY
cervical
discectomy
Neuro Surgery
Spinal
LaminectomyCervical
431
431
10-Aug-15
17-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
M S RAMAIAH
NARAYANA
BANGALORE
HRUDAYALAYA
left sided
loculated
simpyema
Thoracotomy,
Thoraco
Abdominal
Approach
202
202
21-Aug-15
1-Sep-15
70000
70000
50000
5000
45000
IDBI - 321
30-Oct-15
KOLLEGAL
CARDIOLOGY
CARDIOLOGY
Sl.No
Preauth No
Gender
Age
Caste
2217 H_19577317249
Male
50
ST
2218 H_19577317234
Male
45
2219 H_20059315595
Male
2220 H_22971316840
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
BASAVAKALYAN
BIDAR
A
Gulbarga
SJICR
BANGALORE
SOUTH
Minorit
UGAR KHURD
y
ATHANI
BELGAUM
Belgaum
SJICR
BANGALORE
SOUTH
55
Others goragondanahalli
TIPTUR
TUMKUR
Bangalore
KUMAR
HOSPITAL
TIPTUR
Female
44
Others GERASANAHALLI
HUNSUR
MYSORE
Mysore
CSI Holdsworth
Memorial
Mysore
Hospital
2221 H_19583316161
Female
77
GADAG
GADAG
Belgaum
S.S. INSTITUTE
Carcinoma of
OF MEDICAL
NH-4,Bypass PB
Rectum post op
SCIENCES &
Road Davanagere
AR+
RESEARCH CENT
2222 H_22586317278
Male
42
Others D J HALLI
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
2223 H_20619316988
Male
1
Others HOSALLI
HOSADURGA
CHITRADURGA
Bangalore
2224 H_20619317204
Male
51
Others BANAVIKALLU
KUDLIGI
BELLARY
Gulbarga
2225 H_20079304777
Male
14
Others SINDGERE
Mysore
R
UR
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
PANDAVAPURA MANDYA
2226 H_20200317220
2227 H_22337316686
Male
Male
50
26
SC
BASAKALYANA
BETAGERI
Others CHIKKADE
Others HIREALAGUNDI
RONA
GADAG
HBS HOSPITAL
TRUST
SUKSHEMA
HOSPITAL
PVTLTD
SUKSHEMA
HOSPITAL
PVTLTD
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
18-Aug-15
21-Aug-15
65000
65000
64000
0
64000
IDBI - 321
30-Oct-15
Double Valve
Replacement
149
149
7-Aug-15
25-Aug-15
150000
150000
150000
0
150000
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
10-Aug-15
15-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
13-Aug-15
21-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
CANCER
Surgical Oncology
Ca. Gastro Intestinal
Tract
Closure of
Ileostomy/
Colostomy
628
628
21-Jul-15
28-Aug-15
20000
20177
20000
2000
18000
IDBI - 321
30-Oct-15
CABG
132
132
17-Aug-15
21-Aug-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
RHD - SEVERE
AS, MODERATE CARDIOLOGY
MS
right uretric
RENAL
calculus
PIVD L4-5 LEFT
ON
EXAMINATION
NEURO SURGERY
SLR 60', LEFT EHL
WEAKNESS
PRESENT
Cardiology
Cardiology
BANGALORE
NORTH
IHD-DVD
CARDIOLOGY
DAVANGERE
HYPOSPADIAS
NEONATAL
322
322
24-Aug-15
27-Aug-15
22000
22000
22000
2200
19800
IDBI - 321
30-Oct-15
DAVANGERE
BEP
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
10-Aug-15
14-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
RHD:MODERATE
MS WITH
CARDIOLOGY
SEVERE PAH.
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
19-Aug-15
21-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
Mysore
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
L5 S1 PVD WITH
RIGHT NR
NEURO SURGERY
COMRESTION
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
19-Aug-15
24-Aug-15
25000
25000
25000
0
25000
IDBI - 321
30-Oct-15
Belgaum
BARAGI
HOSPITAL
BAGALKOT
BAGALKOT
B/L RENAL
CALCULUS WITH
RENAL
LEFT PUJ
CALCULUS
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
7-Aug-15
13-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
MANGALORE
SPONDYLOLISTH
ESIS WITH
NEURO SURGERY
GRADE I
LISTHESIS OF L5
OVER S1.
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
6-Aug-15
24-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
Ca Stomacch
Stage III
(T4N2M0)
Surgical Oncology
Gastrectomy - any
type
636
636
12-Aug-15
21-Aug-15
50000
50000
35000
3500
31500
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
27-Jul-15
15-Aug-15
25000
43876
25000
2500
22500
IDBI - 321
30-Oct-15
2228 H_20015317211
Female
50
Others SHIRUR
KUNDAPURA
UDUPI
Mysore
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
2229 H_19504315980
Female
55
Others Jabbalgudda
KOPPAL
KOPPAL
Gulbarga
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
RT KIDNEY
STONE
CA LEFT BREAST
CANCER
cT2N0
Surgical Oncology
Breast
Mastectomy - any
type
598
598
11-Aug-15
17-Aug-15
25000
25000
25000
0
25000
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
8-Aug-15
12-Aug-15
25000
32331
25000
2500
22500
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
918
918
19-Aug-15
29-Aug-15
35000
35000
35000
3500
31500
IDBI - 321
30-Oct-15
909
909
10-Aug-15
12-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
CANCER
2230 H_19571317184
Male
27
Others BANAKANALLI
SURPUR
YADGIRI
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
2231 H_19505315383
Female
65
Others MALAVALLI
MALAVALLI
MANDYA
Mysore
Bharath
Hospital
Institute of
Oncology
2232 H_19571317014
Male
31
Others HARAVAPURA
MANVI
RAICHUR
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT UPPER
RENAL
URETERIC STONE
2233 H_20332316043
Male
29
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
2234 H_21925316399
Female
37
Others 0
ARASIKERE
HASSAN
Mysore
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
MUDRA
TIPTUR
HOSPITAL
LT POORLY
FUNCTIONING
KIDNEY
RIGHT VUJ
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
2235 H_19571317026
Female
44
Others TARFILE GULBARGA
GULBARGA
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
8-Aug-15
11-Aug-15
25000
31987
25000
2500
22500
IDBI - 321
30-Oct-15
2236 H_19571317038
Male
34
Others KOGNOOR
AFJALPUR
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT UPPER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
8-Aug-15
11-Aug-15
25000
29496
25000
2500
22500
IDBI - 321
30-Oct-15
2237 H_20332316068
Male
82
Others RAMANAHALII
MAGADI
RAMANAGAR
Bangalore
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
BPH
Genito Urinary
Surgery
Urology
TURP
917
917
10-Aug-15
18-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
SC
GOKULA
Mysore
RENAL
RENAL
Simple
URSL - Single Side
+ DJ Stent
Sl.No
Preauth No
Gender
Age
Caste
Village
Others KAMANADURGA
Taluk
Patient District
Patient
Division
Hospital Name
TARIKERE
CHIKKAMANAGL
Mysore
UR
WENLOCK
DISTRICT
HOSPITAL
HUMNABAD
BIDAR
Gulbarga
Hospital
District
Final
Diagnosis
BILATERAL
RENAL
CALCULUS
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
29-Jul-15
19-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Urology
URSL - Single Side
+ DJ Stent
909
909
7-Aug-15
12-Aug-15
25000
33425
25000
2500
22500
IDBI - 321
30-Oct-15
D V T - IVC Filter
237
237
5-Aug-15
12-Aug-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
Urology
URSL - Single Side
+ DJ Stent
909
909
7-Aug-15
11-Aug-15
25000
32497
25000
2500
22500
IDBI - 321
30-Oct-15
907
907
5-Aug-15
18-Aug-15
25000
38265
25000
2500
22500
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT UPPER
RENAL
URETERIC STONE
Genito Urinary
Surgery
2238 H_21044316434
Male
40
2239 H_19571316634
Female
56
2240 H_20017317145
Male
31
Others 0
BYLAHONGALA
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
SUBMASSIVE
PULMANARY
EMBALISM
2241 H_19571316649
Female
43
Others KUKKUNDA
SEDAM
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
HUMNABAD
BIDAR
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
CHINCHOLI
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
BENIGN
ENLARGEMENT
OF PROSTATE
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
9-Aug-15
13-Aug-15
20000
22370
20000
2000
18000
IDBI - 321
30-Oct-15
Mysore
A J HOSPITAL
CENTRE
IHD., ACUTE
INFRIOR WALL
MI. OLD ASMI.
SEVERE LV
DYSFUNCTION
CAD-DVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
5-Aug-15
14-Aug-15
90000
270225
87210
8721
78489
IDBI - 321
30-Oct-15
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
7-Aug-15
17-Aug-15
25000
37568
25000
2500
22500
IDBI - 321
30-Oct-15
Belgaum
A J HOSPITAL
CENTRE
ACS HTN CAD
SVD
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
4-Aug-15
10-Aug-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
Belgaum
TSS-Shripad
Hegde Kadave
Institute of
Medical Scie
907
907
20-Aug-15
24-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
241
241
24-Aug-15
29-Aug-15
90000
65000
65000
0
65000
IDBI - 321
30-Oct-15
105
105
19-Aug-15
28-Aug-15
20000
20000
20000
0
20000
IDBI - 321
30-Oct-15
105
105
3-Sep-15
5-Sep-15
20000
20000
19000
0
19000
IDBI - 321
30-Oct-15
ST
MANNAKHELI
2242 H_19571315418
Male
37
Minorit
MUSTARI
y
2243 H_19571307345
Male
72
Others KRISHNAPUR
2244 H_20127316930
2245 H_19571316652
2246 H_20127316937
Female
Female
Female
70
Others KILPADI
26
Minorit
UMAR COLONY GBL
y
62
Others ANILAGODA
MANGALORE
GULBARGA
HONNAVAR
DAKSHINA
KANNADA
GULBARGA
UTTARA
KANNADA
MANGALORE
CARDIOLOGY
CARDIOLOGY
Cardiology
SIRSI
Left renal
calculus.
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
BANGALORE
SOUTH
IHD - AWMI,
DVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
BANGALORE
SOUTH
BANGALORE
SOUTH
RHD - SEVERE
MS, SEVERE TR
RHD - SEVERE
MS
CARDIOLOGY
Cardiology
Cardiology
CARDIOLOGY
Cardiology
Cardiology
2247 H_20237317033
Female
52
Others Heruratta
HANAGAL
HAVERI
2248 H_19577316818
Female
44
Others HIREBIDANUR
GOWRIBIDANUR
CHIKKABALLAPU
Bangalore
R
SJICR
2249 H_19577316831
Female
41
Others NAYANDANAHALLI
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
SJICR
2250 H_19577316810
Female
20
Others KURIKOTA
GULBARGA
GULBARGA
Gulbarga
SJICR
2251 H_19577316796
Male
74
Others
TUMKUR
Bangalore
SJICR
BANGALORE
SOUTH
IHD - NSTEMI,
SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
6-Aug-15
12-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
2252 H_19577316474
Male
50
Others NIDAGODI
Bangalore
SJICR
BANGALORE
SOUTH
AVNRT
HONNAMACHANAHA
TUMKUR
LLI
CARDIOLOGY
Cardiology
Cardiology
EP study
125
125
23-Aug-15
25-Aug-15
30000
30000
30000
0
30000
IDBI - 321
30-Oct-15
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
4-Aug-15
10-Aug-15
90000
90000
91800
9180
82620
IDBI - 321
30-Oct-15
Urology
URSL - Single Side
+ DJ Stent
909
909
27-Jul-15
17-Aug-15
25000
45633
25000
2500
22500
IDBI - 321
30-Oct-15
Surgery for
Cardiac Tumour/
LA Myxoma/ RA
Myxoma
174
174
8-Aug-15
17-Aug-15
95000
166100
90250
9025
81225
IDBI - 321
30-Oct-15
2253 H_20127316520
Male
50
Others SARALAGI
HONNAVAR
UTTARA
KANNADA
Belgaum
A J HOSPITAL
CENTRE
CD- SUDDEN
INCREASE IN
ONSET,
CARDIOLOGY
UNEASINESS+,
PALPITION+ RCA2 LESION
2254 H_19571312491
Male
23
Others MANDAKANALLI
BIDAR
BIDAR
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT UPPER
RENAL
URETERIC STONE
Genito Urinary
Surgery
2255 H_21736317102
Female
48
Others SRIRAM NAGAR
GANGAVATHI
KOPPAL
Gulbarga
NANO
HOSPITALS
PRIVATE
LIMITED
LA MYXOMA
Cardiothoracic Surgery Acquired
HYDERABAD
Balloon Mitral
Valvotomy
Balloon Mitral
Valvotomy
CARDIOLOGY
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Cardiology
PTCA - one stent
(non-medicated,
emergency,
inclusive of
angiogram) at the
same admission.
103
103
8-Aug-15
10-Aug-15
55000
55000
55000
550
54450
IDBI - 321
30-Oct-15
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
15-Aug-15
26-Aug-15
25000
30880
25000
2500
22500
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
10-Aug-15
20-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
CAD TVD WITH
S/P CABG
CARDIOLOGY
CABG
132
132
4-Aug-15
29-Aug-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
MANGALORE
MVP,SEVERE
ECCENTRIC MR,
GRADE II TR
CARDIOLOGY
Mitral Valve
Replacement
145
145
8-Aug-15
20-Aug-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
Belgaum
CHD TOF WITH
VSD WITH
SEVERE PS
CARDIOLOGY
BT Shunt
Cardiothoracic Surgery Closed Heart Procedures (inclusives of
grafts)
180
180
7-Aug-15
21-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
31-Jul-15
13-Aug-15
20000
27529
20000
2000
18000
IDBI - 321
30-Oct-15
ISCHEMIC HEART
DISEASE, ACUTE
CORONARY
CARDIOLOGY
SYNDROME,
CAD:SVD
Cardiology
GULBARGA
L4-L5,L3-L4, L5S1 PIVD WITH
STENOSIS
NEURO SURGERY
TIPTUR
bph
Belgaum
NANJAPPA LIFE
SHIMOGA
CARE
2256 H_19513317100
Male
32
Others CHORADI
SHIMOGA
SHIMOGA
Bangalore
2257 H_20021314697
Male
59
Others GURJAPUR
RAICHUR
RAICHUR
Gulbarga
2258 H_20059316907
Male
86
KADUR
CHIKKAMANAGL
Mysore
UR
2259 H_20017317022
Female
60
Minorit
BAGALKOT
y
BAGALKOTE
BAGLAKOT
Belgaum
2260 H_20015317017
Female
61
Others MADHURAVALLI
SIRSI
UTTARA
KANNADA
Belgaum
2261 H_20017317010
Male
1
BYLAHONGALA
BELGAUM
Belgaum
2262 H_19571313945
Male
52
DEVADURGA
RAICHUR
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
BENIGN
ENLARGEMENT
OF PROSTATE
GRADE II
SPONDYLOLISTH
ESIS OF C6 OVER
NEURO SURGERY
C7 CAUSING
CORD
COMPRESSION.
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
7-Aug-15
19-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
2263 H_20015316964
Male
48
2264 H_19571316009
Male
56
2265 H_19571313893
Male
82
ST
ST
hanumanthapura
HOSAKOTI
Others MADARKAL
Others PUTTAMANE
SC
TARFILE GULBARGA
Others GHATBORAL
BASAVESHWAR
TEACHING AND
GENERAL
HOSPITAL
KUMAR
HOSPITAL
KLES Dr
Prabhakar Kore
Hospital and
MRC
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
KLES Dr
Prabhakar Kore
Hospital and
MRC
SIRSI
UTTARA
KANNADA
Belgaum
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
GULBARGA
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT UPPER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
6-Aug-15
9-Aug-15
25000
32282
25000
2500
22500
IDBI - 321
30-Oct-15
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
BENIGN
ENLARGEMENT
OF PROSTATE +
VESICAL
CALCULUS.
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
31-Jul-15
11-Aug-15
20000
31930
20000
2000
18000
IDBI - 321
30-Oct-15
RT RENAL
CALCULY
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
12-Aug-15
17-Aug-15
25000
25000
20000
2000
18000
IDBI - 321
30-Oct-15
MANGALORE
HUMNABAD
BIDAR
Belgaum
SRIDEVIMULTIS
PECIALITY
HONAVAR
HOSPITAL
Sagar Hospitals
2266 H_20139316948
Male
62
Others NAGARBASTIKERI
HONNAVAR
UTTARA
KANNADA
2267 H_19549315978
Female
48
Minorit
0
y
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
2268 H_20619315637
Male
40
Others BELURU
RANEBENNUR
HAVERI
Belgaum
2269 H_21736316896
Male
64
Others KOWTHAL
MANVI
RAICHUR
Gulbarga
2270 H_20025315292
Male
44
Others HOREYALA
GUNDLUPET
CHAMARAJANA
Mysore
GAR
2271 H_20773314481
Male
42
Others BARUVE GRAMA
HOSANAGARA
SHIMOGA
Mysore
Bangalore
2272 H_19581316699
Male
32
Others DODDAPALYA
SHRIRANGAPAT
MANDYA
NA
2273 H_19586316872
Male
54
Others KARASAVADI
MANDYA
MANDYA
Mysore
2274 H_19571315426
Male
43
Others MOTANALLI
YADGIR
YADGIRI
Gulbarga
SUKSHEMA
HOSPITAL
PVTLTD
NANO
HOSPITALS
PRIVATE
LIMITED
BANGALORE
SOUTH
L4-5 GRADE I L5
NEURO SURGERY
CANAL STENOSIS
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
18-Aug-15
29-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
DAVANGERE
LEFT VUJ
CALCULUS
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
10-Aug-15
13-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
HYDERABAD
CORONARY
CARDIOLOGY
ARTERY DISEASE
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
7-Aug-15
12-Aug-15
65000
80700
65000
6500
58500
IDBI - 321
30-Oct-15
429
429
11-Aug-15
18-Aug-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
CERVICAL PIVD
C5-6 WITH CORD NEURO SURGERY
COMPRESSION
Neuro Surgery
Spinal
Anterior Cervical
Discectomy
Multiple level with
Implants
(procedure
30000+ Implants
10000)
SHIMOGA
CRANIOPLASTY
NEURO SURGERY
Neuro Surgery
Brain
Cranioplasty
419
419
11-Aug-15
14-Aug-15
30000
30000
30000
300
29700
IDBI - 321
30-Oct-15
MYSORE
LEFT URETERIC
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
9-Aug-15
11-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
BANGALORE
B/L URETERIC
CALCULUS WITH RENAL
AZOTEMIA
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
7-Aug-15
21-Aug-15
37500
37500
37500
3750
33750
IDBI - 321
30-Oct-15
BENIGN
ENLARGEMENT
OF PROSTATE
Genito Urinary
Surgery
Urology
TURP
917
917
5-Aug-15
11-Aug-15
20000
23266
20000
2000
18000
IDBI - 321
30-Oct-15
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
NANJAPPA
HOSPITAL
Cauvery
Hospital
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
RENAL
PATIL NURSING
HOME
GULBARGA
GULBARGA
RENAL
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
3-Aug-15
22-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Head & Neck
Composite
Resection &
Reconstruction
611
611
13-Aug-15
8-Sep-15
60000
95955
60000
6000
54000
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
28-Jul-15
15-Aug-15
25000
43376
25000
2500
22500
IDBI - 321
30-Oct-15
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
10-Aug-15
18-Aug-15
50000
50000
47500
4750
42750
IDBI - 321
30-Oct-15
180
180
24-Aug-15
1-Sep-15
50000
50000
51000
1530
49470
IDBI - 321
30-Oct-15
907
907
3-Aug-15
19-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
2275 H_20017316835
Male
28
Others 0
BYLAHONGALA
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
2276 H_20815316805
Female
55
Others RAJOLA
CHITTAPUR
GULBARGA
Gulbarga
CHIRAYU
HOSPITAL
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
L1 FRACTURE
NEURO SURGERY
Neuro Surgery
Narayana
Hrudayalaya
Private Limited
{s,d,s}
LEVOCARDIA
,DORV (NRGA)
LARGE
CARDIOLOGY
MALALIGNED
PERIMEMBRANO
US VSDS VD
SHUNT SEV PS
BT Shunt
Cardiothoracic Surgery Closed Heart Procedures (inclusives of
grafts)
BIL RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
UDUPI
PDA/CHD
CARDIOLOGY
Cardiology
Device Closure
PDA Device
Closure
119
119
6-Aug-15
11-Aug-15
60000
60000
60690
6069
54621
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
CA (RT) (Lt)
BREAST
CT4bN1M0
CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
1-Aug-15
12-Aug-15
37500
40720
34500
3450
31050
IDBI - 321
30-Oct-15
Burns
Burns
Post Burn
Contracture
surgeries for
Functional
Improvement(Pack
age including
splints, pressure
garments and
physiotherapy),
Mild
9
9
5-Aug-15
1-Sep-15
20000
19981
19981
1998
17983
IDBI - 321
30-Oct-15
2277 H_19571312408
Male
38
2278 H_20079316794
Male
54
2279 H_19528316695
Female
3 Months
Others KAILASH NAGAR BDR BIDAR
SC
CHITTENAHALLI
Others SATYAMPET
TARIKERE
SURPUR
BIDAR
CHIKKAMANAGL
Mysore
UR
YADGIRI
Gulbarga
2280 H_21225315679
Male
27
Others VENKATAPUR
CHINCHOLI
GULBARGA
Gulbarga
2281 H_19564316455
Female
26
Others KORAVADI
KUNDAPURA
UDUPI
Mysore
2282 H_20082314310
Female
67
Minorit
WARD 26
y
BIJAPUR
BIJAPUR
Belgaum
2283 H_19583315739
2284 H_21223316382
Male
Male
52
1 Days
Minorit RAJIV GANADI
y
NAGAR
Others KGF
KUDLIGI
BANGARPET
BELLARY
KOLAR
GULBARGA
Bangalore
KASTURBA
HOSPITAL
Kidwai
Memorial
Institute of
Oncology
RT.RENAL
CALCULUS
Genito Urinary
Surgery
Ca Ulcero
proliferative
CANCER
lesion over right
lower alveolus
Surgical Oncology
RENAL
Gulbarga
S.S. INSTITUTE
Post Burn
OF MEDICAL
NH-4,Bypass PB
contracute of Lt BURNS
SCIENCES &
Road Davanagere
hand finger
RESEARCH CENT
Bangalore
INDIRA GANDHI
BANGALORE
INSTITUTE OF
SOUTH
CHILD HEALTH
oesophageal
atresia+
anorectal
malformation
stage 1
NEONATAL
Oesophageal
Atresia
301
301
6-Aug-15
15-Aug-15
62500
62500
62500
6250
56250
IDBI - 321
30-Oct-15
L5 S1 DISC
PROLAPSE
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
13-Aug-15
18-Aug-15
25000
25000
25000
0
25000
IDBI - 321
30-Oct-15
2285 H_20200314924
Male
47
Others KABBALGERE
KR PET
MANDYA
Mysore
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
2286 H_20074316569
Female
64
Others ALAND COLONY
GULBARGA
GULBARGA
Gulbarga
M S RAMAIAH
NARAYANA
BANGALORE
HRUDAYALAYA
IHD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
5-Aug-15
12-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
2287 H_19515315640
Male
46
JAGALURU
DAVANGERE
Bangalore
CITY CENTRAL
HOSPITAL
PRIVATE
LIMITED
DAVANGERE
PIVD L4-5
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
13-Aug-15
25-Aug-15
25000
44706
25000
2500
22500
IDBI - 321
30-Oct-15
Gulbarga
SRI LAXMI
SURGICAL
TRAUMA
ORTHO AND
MULTISPECILIT
RANEBENNUR
Right
Hydronephrosis
due to pelvic
RENAL
calculus with
ratained B/L DJ
stent.
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
13-Aug-15
17-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
NEAR RAILWAY
UNDERPASS
C4-C5-C6 CANAL
NEURO SURGERY
STENOSIS
Neuro Surgery
Spinal
Corpectomy for
Spinal
Fixation(40000) +
cost of
implant(20000)
447
447
6-Aug-15
18-Aug-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
VESICAL
CALCULUS
Genito Urinary
Surgery
Urology
Cystolithotripsy
906
906
4-Aug-15
12-Aug-15
12500
12500
12500
1250
11250
IDBI - 321
30-Oct-15
2288 H_20215312760
Male
21
SC
B GOLLARAHALLI
Others Bhattar Narsapur
GANGAVATHI
KOPPAL
2289 H_21214316126
Male
55
Others KASARTUGAON
BHALKI
BIDAR
Gulbarga
GANGAMAI
HOSPITAL
2290 H_21897315960
Male
67
Others 0
MANGALORE
DAKSHINA
KANNADA
Mysore
GLOBAL
MULTISPECIALIT
MANGALORE
Y HOSPITAL
INDIA PVT LTD
RENAL
Genito Urinary
Surgery
Sl.No
Preauth No
2291 H_19542316212
Gender
Male
Age
72
Caste
Village
Others YECHAGAHALLI
Taluk
NANJANAGUD
Patient District
MYSORE
Patient
Division
Hospital Name
Mysore
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
MYSORE
DOUBLE VESSEL
CARDIOLOGY
DISEASE.
CABG
132
132
17-Aug-15
26-Aug-15
95000
95000
96900
9690
87210
IDBI - 321
30-Oct-15
SOLAPUR
CORONARY
ARTERY DISEASE,
PDA STENT ISR,
CARDIOLOGY
D V D, IHD
UNSTABLE
ANGINA
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
6-Aug-15
13-Aug-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
2292 H_20198316452
Female
49
Others 0
BASAVAKALYAN
BIDAR
A
Gulbarga
YASHODHARA
SUPER
SPECIALITY
HOSPITAL PVT
LTD
2293 H_19576316677
Female
44
Minorit
Gangavati
y
GANGAVATHI
KOPPAL
Gulbarga
SDM Narayana
Hrudayalaya
Dharwad
CAD-Single
vessel disease
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
12-Aug-15
14-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
2294 H_21718316276
Male
46
Others GOWREPURA
HASSAN
HASSAN
Mysore
SSM Hospital
HASSAN
Left VUJ Calculi
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
8-Aug-15
11-Aug-15
25000
27425
25000
2500
22500
IDBI - 321
30-Oct-15
2295 H_20733316619
Male
45
Others CHIKKUNDA
HD KOTE
MYSORE
Mysore
SJICR MYSORE
MYSORE
DVD
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
11-Aug-15
14-Aug-15
90000
90000
64500
6450
58050
IDBI - 321
30-Oct-15
2296 H_20733316610
Male
60
Others MULLLURU
HUNSUR
MYSORE
Mysore
SJICR MYSORE
MYSORE
SVD
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
7-Aug-15
10-Aug-15
65000
65000
60325
6033
54292
IDBI - 321
30-Oct-15
2297 H_19577316543
Male
37
Others GAVANAHALLI
Mysore
R
UR
SJICR
BANGALORE
SOUTH
Aortic Valve
Replacement
146
146
20-Jul-15
31-Aug-15
120000
120000
118500
0
118500
IDBI - 321
30-Oct-15
2298 H_20015316597
Male
62
Others KUMTA
KUMTA
UTTARA
KANNADA
Belgaum
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
MANGALORE
Surgical Oncology
612
612
31-Jul-15
27-Aug-15
47500
47500
47500
4750
42750
IDBI - 321
30-Oct-15
2299 H_20083316095
Male
47
Minorit ANSARI MASJID
y
KOLAR
KOLAR
KOLAR
Bangalore
Bhagwan
Mahaveer Jain
Hospital
Bangalore
CABG
132
132
4-Aug-15
10-Aug-15
95000
95000
95000
0
95000
IDBI - 321
30-Oct-15
2300 H_19564316427
Male
65
Others KIRIMANJESHWARA
KUNDAPURA
UDUPI
Mysore
KASTURBA
HOSPITAL
UDUPI
NSTEMI/HTN
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
5-Aug-15
11-Aug-15
90000
90000
91290
9129
82161
IDBI - 321
30-Oct-15
2301 H_21718316562
Female
33
Others MARENAHALLI
HASSAN
HASSAN
Mysore
SSM Hospital
HASSAN
Right VUJ Calculi RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
10-Aug-15
11-Aug-15
25000
26825
25000
2500
22500
IDBI - 321
30-Oct-15
Bangalore
SPINAL CELL
TUM OUR OF
PARA
PHARYNGEAL
SPACE
Surgical Oncology
Head & Neck
Wide excision
621
621
18-Aug-15
24-Aug-15
20000
20000
20400
612
19788
IDBI - 321
30-Oct-15
Bangalore
LARGE UPPER
MUSCULAR VSD
CARDIOLOGY
PREDOMINATELY
L-R SHUNT
VSD
152
152
15-Jul-15
12-Sep-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
l4-5 pivd
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
5-Aug-15
24-Aug-15
25000
51371
25000
2500
22500
IDBI - 321
30-Oct-15
L4-5 & L5 S1 PVD NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
9-Aug-15
13-Aug-15
25000
25000
25000
0
25000
IDBI - 321
30-Oct-15
L4-5 ,L5-S1 DISC
NEURO SURGERY
PROLAPSE
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
11-Aug-15
14-Aug-15
25000
25000
25000
0
25000
IDBI - 321
30-Oct-15
2
2
10-Aug-15
17-Aug-15
35000
35000
34000
3400
30600
IDBI - 321
30-Oct-15
2302 H_19528316513
Male
38
Others MATAMARI
2303 H_19528316584
Female
3 Months
2304 H_19520316545
Male
43
2305 H_20200316489
Male
41
SC
2306 H_20200316542
Female
52
Others
2307 H_21211316461
Male
36
2308 H_20025315361
Male
2309 H_19577316535
Female
2310 H_20254312385
Male
RAICHUR
RAICHUR
Gulbarga
Narayana
Hrudayalaya
Private Limited
Narayana
Hrudayalaya
Private Limited
ANEURYSMAL
RUPTURE OF
CARDIOLOGY
SINUS OF
VALSALVA
WELL
DIFFERENCIATED
SCC OF LEFT
CANCER
UPPER BUCCAL
MUCOSA.
T3N1M0
IHD UNSTABLE
ANGINA LEFT
CARDIOLOGY
MAIN
CORONARY
DISEASE
CARDIOLOGY
CANCER
Head & Neck
Others HEBBAL
MYSORE
MYSORE
Mysore
Minorit
MUDAGALL
y
LINGASUGUR
RAICHUR
Gulbarga
NANJANAGUD
MYSORE
Mysore
NEELAKANTANAHALL
MADDUR
I
MANDYA
Mysore
SC
KANAGALASAR
SHIMOGA
SHIMOGA
Bangalore
mcgann
teaching district SHIMOGA
hospital
35-40% Burns
BURNS
Burns
Burns
upto-40% with
Scalds(
Conservative/
without grafting)
62
Others
DODDA MASIDI
BEEDI, HUNSUR
HUNSUR
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
CA PROSTATE
GLEASONS 9
CANCER
Surgical Oncology
Bilateral
Orchidectomy
588
588
11-Aug-15
14-Aug-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
45
Others KONGARAHALLI
KOLLEGAL
CHAMARAJANA
Mysore
GAR
SJICR
CHD - ASD ,
SEVERE TR
CARDIOLOGY
ASD
151
151
10-Aug-15
17-Aug-15
100000
100000
100000
0
100000
IDBI - 321
30-Oct-15
DHARWAD
Shakuntala
Memorial
Hubli
Hospital and
Research Centre
recurrent
carcinoma
oesophagus
stage III
CANCER
Surgical Oncology
Gastrostomy
676
676
11-Aug-15
15-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
72
HALE PURA
Others Virapur Oni
HUBLI
Belgaum
SNMC HSK
BAGALKOTE
HSopital
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
BANGALORE
SOUTH
Sl.No
Preauth No
2311 H_19577316414
Gender
Age
Male
67
2312 H_19577316420
Male
20
2313 H_20086316508
Male
60
2314 H_19577316398
Female
2315 H_19574316306
Caste
Village
Others CHIKKA JAALA
SC
CHAMUNDIPURA
Taluk
BANGALORE
NORTH
Patient District
BANGALORE URBAN
Patient
Division
Bangalore
Hospital Name
SJICR
Hospital
District
BANGALORE
SOUTH
BANGALORE
SOUTH
Final
Diagnosis
IHD - PWMI,
HTN, TVD
RHD - SEVERE
MR
Diseases
CARDIOLOGY
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
CABG with IABP
133
133
6-Aug-15
25-Aug-15
115000
95000
95000
0
95000
IDBI - 321
30-Oct-15
Mitral Valve
Replacement
145
145
10-Aug-15
17-Aug-15
120000
120000
120000
0
120000
IDBI - 321
30-Oct-15
IHD-NSTEMI,CAGCARDIOLOGY
TVD
CABG
132
132
23-Jul-15
22-Aug-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
KANAKAPURA
RAMANAGAR
Bangalore
SJICR
Others VENKTAPURA
MULABAGILU
KOLAR
Bangalore
R L JALAPPA
NARAYANA
KOLAR
HRUDAYALAYA
HEART CENTRE
22
Others HONNENAHALLI
NAGAMANGALA MANDYA
Mysore
SJICR
BANGALORE
SOUTH
CHD - ASD
CARDIOLOGY
ASD
151
151
7-Aug-15
20-Aug-15
80000
80000
80000
0
80000
IDBI - 321
30-Oct-15
Male
49
Others ANANTAPUR
ATHANI
BELGAUM
Belgaum
VYDEHI
HOSPITAL
BANGALORE
Atlanto axial
dislocation
NEURO SURGERY
Neuro Surgery
AAD Surgeries
Transoral surgery
and CV Junction
441
441
8-Aug-15
1-Sep-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
2316 H_19528315833
Male
53
Others BAGALAWADA
MANVI
RAICHUR
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
CA LUNG WITH
BONE METS
CANCER
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
10-Aug-15
21-Aug-15
20000
20000
19380
581
18799
IDBI - 321
30-Oct-15
2317 H_21223316385
Male
9
Minorit
KGF
y
BANGARPET
KOLAR
Bangalore
INDIRA GANDHI
BANGALORE
INSTITUTE OF
SOUTH
CHILD HEALTH
intestinal
obstruction
NEONATAL
Intestinal Atresias
& Obstructions
303
303
3-Aug-15
17-Aug-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
2318 H_21736315096
Female
36
Others KANISANGAVI
ALAND
GULBARGA
Gulbarga
HYDERABAD
OS-ASD,L--R
SHUNT
CARDIOLOGY
ASD
151
151
31-Jul-15
17-Aug-15
80000
165000
80000
8000
72000
IDBI - 321
30-Oct-15
2319 H_19576316404
Female
3
Minorit
Bijapur
y
BIJAPUR
BIJAPUR
Belgaum
Dharwad
ACHD QP L-R OSCARDIOLOGY
ASD IE/CCF
ASD
151
151
6-Aug-15
29-Aug-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
2320 H_22458316352
Female
36
Others Mugalkod
RAIBAGH
BELGAUM
Belgaum
MAHALINGPUR
right lower
RENAL
ureteric calculus
Genito Urinary
Surgery
URSL - Single Side
+ DJ Stent
909
909
8-Aug-15
12-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
2321 H_21736315995
Female
65
Others BIDAR
BIDAR
BIDAR
Gulbarga
HYDERABAD
SEVERE CALCIFIC
CARDIOLOGY
AS
Aortic Valve
Replacement
146
146
3-Aug-15
14-Aug-15
120000
221600
120000
12000
108000
IDBI - 321
30-Oct-15
2322 H_19505315451
Male
49
Others
Mysore
CA BASE OF
TONGUE IV
Medical Oncology
Head & Neck
Carboplatin +
only)
521
521
11-Aug-15
1-Sep-15
21000
21000
21000
0
21000
IDBI - 321
30-Oct-15
2323 H_22337316359
Male
30
Others CHIMMALAGI
BADAMI
BAGLAKOT
Belgaum
BAGALKOT
Right VUJ
Calculus with Rt RENAL
HUN
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
6-Aug-15
10-Aug-15
25000
28456
25000
2500
22500
IDBI - 321
30-Oct-15
2324 H_21132316067
Male
52
Others 0
TIPTUR
TUMKUR
Bangalore
Shree
Hospital/HIMS
40%mixed
degree burn
injury
BURNS
Burns
Burns
upto-40% with
Scalds(
Conservative/
without grafting)
2
2
2-Aug-15
25-Aug-15
35000
35000
35000
3500
31500
IDBI - 321
30-Oct-15
2325 H_19574315541
Female
55
ST
DURGADAHALLI
TUMKUR
TUMKUR
Bangalore
VYDEHI
HOSPITAL
BANGALORE
Carcinoma left
Buccal mucosa
T4aN1Mo
CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
10-Aug-15
9-Sep-15
54000
54000
32000
3200
28800
IDBI - 321
30-Oct-15
2326 H_19562309532
Male
20
SC
PADMAVATHIPURA
RANEBENNUR
HAVERI
Belgaum
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
SHIMOGA
A known case of
ca. Ewing
CANCER
Sarcoma Stage IV
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
12-Aug-15
25-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
Belgaum
VENKATESH
HOSPITAL
MAHALINGPUR
right renal pelvic
RENAL
calculus
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
8-Aug-15
12-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
RAGIMUDDANAHALL
PANDAVAPURA MANDYA
I
VENKATESH
HOSPITAL
NANO
HOSPITALS
PRIVATE
LIMITED
Bharath
Hospital
Institute of
Oncology
BARAGI
HOSPITAL
BAGALKOT
CANCER
Urology
2327 H_22458316345
Male
9
Others Chinagundi
JAMAKHANDI
2328 H_19528316338
Male
60
Others MANDYAKOPPALU
SHRIRANGAPAT
MANDYA
NA
Mysore
Narayana
Hrudayalaya
Private Limited
Bangalore
RIGHT LL
CRITICAL LIMB
CARDIOLOGY
ISCHEMIA CAT V
Femoro Distal
Bypass with
Synthetic Graft
230
230
7-Aug-15
27-Aug-15
70000
70000
71400
2142
69258
IDBI - 321
30-Oct-15
2329 H_20082314806
Female
51
KANAKAPURA
RAMANAGAR
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
ca lt breast
T3N1M0
Surgical Oncology
Mastectomy - any
type
598
598
21-Jul-15
19-Aug-15
25000
31050
25000
2500
22500
IDBI - 321
30-Oct-15
2330 H_20127315718
Male
62
Others KUNDAVALLI
KUMTA
UTTARA
KANNADA
Belgaum
A J HOSPITAL
CENTRE
CAD, TVD, GOOD
CARDIOLOGY
LV FUNCTION
CABG
132
132
9-Aug-15
19-Aug-15
95000
106973
96900
9690
87210
IDBI - 321
30-Oct-15
2331 H_19581314443
Female
60
Others 0
Mysore
GAR
GAR
Cauvery
Hospital
MYSORE
CA.BREAST
Surgical Oncology
Breast
Mastectomy - any
type
598
598
12-Aug-15
19-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
2332 H_19577316165
Male
71
Others HASSAN
HASSAN
Mysore
SJICR
BANGALORE
SOUTH
IHD - S/P PTCA RCA, DM, HTN, CARDIOLOGY
EA
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
1-Aug-15
10-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT RENAL
CALCULUS.
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
30-Jul-15
18-Aug-15
25000
32310
25000
2500
22500
IDBI - 321
30-Oct-15
2333 H_19571313275
Female
24
SC
ATHIKUPPE
Others GOUR K
AFJALPUR
BAGLAKOT
Mysore
NANO
HOSPITALS
PRIVATE
LIMITED
SDM Narayana
Hrudayalaya
CARDIOLOGY
HASSAN
GULBARGA
CANCER
CANCER
RENAL
Breast
Sl.No
Preauth No
Gender
Age
Caste
2334 H_19581316048
Male
62
2335 H_21044316333
Female
23
Others KADESHWALYA
2336 H_19577315963
Male
33
Others SUBASHNGARA
2337 H_20025316210
Female
47
SC
Village
Taluk
Others ALAGERI
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
10-Aug-15
13-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Urology
905
905
3-Aug-15
3-Sep-15
35000
35000
35000
3500
31500
IDBI - 321
30-Oct-15
Mysore
BANTWAL
DAKSHINA
KANNADA
Mysore
WENLOCK
DISTRICT
HOSPITAL
MANGALORE
RIGHT PUJ
OBSTRUCTION
RENAL
Genito Urinary
Surgery
GULBARGA
GULBARGA
Gulbarga
SJICR
BANGALORE
SOUTH
CHD - SUB
AORTIC
OBSTRUCTION,
MODERATE AR
CARDIOLOGY
Aortic Valve
Replacement
146
146
7-Aug-15
26-Aug-15
120000
120000
120000
0
120000
IDBI - 321
30-Oct-15
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
18-Aug-15
24-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
MANGALORE
MUCINIOUS
ADENOCARCINO
MA OF COLON CANCER
STAGE I T2N0M0
Surgical Oncology
Colectomy - any
type
637
637
18-Jul-15
15-Aug-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
DAVANGERE
Bilateral Lower
Limb Ischemia
CARDIOLOGY
Femoro Distal
Bypass with
Synthetic Graft
230
230
10-Aug-15
31-Aug-15
70000
121042
70000
7000
63000
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
4-Aug-15
10-Aug-15
92000
92000
92000
9200
82800
IDBI - 321
30-Oct-15
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
6-Aug-15
22-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
MANDYA
ANKOLA
UTTARA
KANNADA
2338 H_19522314103
Female
55
2339 H_19515312136
Male
56
2340 H_20074315797
Male
67
Others GOVENAHALLI
NELEMANGALA
BANGALORE RURAL
Bangalore
M S RAMAIAH
NARAYANA
BANGALORE
HRUDAYALAYA
IHD
2341 H_20575316169
Female
57
Others HARALI KOPPA
SORABA
SHIMOGA
Bangalore
MANGALORE
INSTITUTE OF
ONCOLOGY
MANGALORE
HEPATOCELLULA
R CARCINOMA CANCER
STAGE III
Radiation Oncology
2342 H_20083316282
Female
10
Others Bisalahalli
BELLARY
BELLARY
Gulbarga
Bhagwan
Mahaveer Jain
Hospital
Bangalore
RHD, Moderate
MS, Severe MR,
CARDIOLOGY
Severe TR, PAH,
Mild AR
Mitral Valve
Replacement
145
145
17-Aug-15
24-Aug-15
120000
397410
120000
0
120000
IDBI - 321
30-Oct-15
2343 H_21057316183
Female
45
Minorit
SAJIPA MUUNUR
y
BANTWAL
DAKSHINA
KANNADA
Mysore
NEW
CAD- TVD
CABG
132
132
5-Aug-15
18-Aug-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
PUJ
OBSTRUCTION
LEFT WITH DTPA
RENAL
SHOWING
REDUCING
FUNCTION
Genito Urinary
Surgery
Urology
905
905
3-Aug-15
20-Aug-15
35000
35719
35700
3570
32130
IDBI - 321
30-Oct-15
SC
NANDIBEVENURU
TANDA
HARAPANAHALL
DAVANGERE
I
Belgaum
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
CITY CENTRAL
HOSPITAL
PRIVATE
LIMITED
RT MULTIPLE
RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
MYSORE
MALAVALLI
MYSORE
LEFT RENAL
CALCULUS
Diseases
Cauvery
Hospital
ELEMUDDANAHALLI KR NAGAR
Others GOLLARAHALLI
Patient District
Bangalore
CARDIOLOGY
Minorit
haduvina kone
y
KUNDAPURA
UDUPI
Mysore
A J HOSPITAL
CENTRE
19
Others H D KOTE TOWN
HD KOTE
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
COMPRESSION
FRACTURE D4
NEURO SURGERY
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
7-Aug-15
19-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
Male
59
Others SEELANERE
KR PET
MANDYA
Mysore
SJICR MYSORE
MYSORE
IHD-ACS ACUTE
IWMI
CARDIOLOGY
Cardiology
Cardiology
Medical
treatment of
Acute MI with
Thrombolysis
128
128
5-Aug-15
7-Aug-15
10000
10000
9500
950
8550
IDBI - 321
30-Oct-15
2347 H_21701316182
Female
54
Minorit
yadulla colony
y
GULBARGA
GULBARGA
Gulbarga
Paradise, S.D.
Road
CAD-DVD
CARDIOLOGY
CABG
132
132
3-Aug-15
18-Aug-15
95000
95000
96900
9690
87210
IDBI - 321
30-Oct-15
2348 H_19542315962
Male
75
Others THONACHIKOPAL
MYSORE
MYSORE
Mysore
MYSORE
DOUBLE VESSEL
CARDIOLOGY
DISEASE.
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
5-Aug-15
10-Aug-15
90000
90000
66300
6630
59670
IDBI - 321
30-Oct-15
2349 H_21718316050
Male
57
Others CHWOLAGERE
ALUR
HASSAN
Mysore
SSM Hospital
HASSAN
Left Ureteric
calculi
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
8-Aug-15
11-Aug-15
25000
26965
25000
2500
22500
IDBI - 321
30-Oct-15
2350 H_20733316064
Female
73
Others VANTIKOPPALU
MYSORE
MYSORE
Mysore
SJICR MYSORE
MYSORE
IHD-EVOLVED
CAD-DVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
6-Aug-15
10-Aug-15
65000
65000
61275
6128
55147
IDBI - 321
30-Oct-15
2351 H_19513316189
Male
56
Others WARD-5
BHADRAVATHI
SHIMOGA
Bangalore
NANJAPPA LIFE
SHIMOGA
CARE
IHD, SVD
CARDIOLOGY
CABG
132
132
14-Aug-15
25-Aug-15
95000
95000
95000
950
94050
IDBI - 321
30-Oct-15
2352 H_20242316176
Male
5
Others VIRUPAPURA
GANGAVATHI
KOPPAL
Gulbarga
MEDIHOPE
HOSPITALS AND
BANGALORE
RESEARCH
CENTRE PVT LTD
CHD, PDA L-> R
SHUNT
CARDIOLOGY
Cardiology
Device Closure
PDA Device
Closure
119
119
4-Aug-15
24-Aug-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
2353 H_19571314755
Male
72
BHALKI
BIDAR
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
BENIGN
ENLARGEMENT
OF PROSTATE
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
3-Aug-15
9-Aug-15
20000
22495
20000
2000
18000
IDBI - 321
30-Oct-15
2344 H_20127315958
Male
18 Months
2345 H_20025315434
Male
2346 H_20733316209
SC
JAMKHANDI
SUNSHINE
HEART
INSTITUTE
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
Sl.No
Preauth No
Caste
Village
Patient District
Hospital Name
Hospital
District
Final
Diagnosis
Age
2354 H_20107316159
Male
67
Minorit
0
y
AURAD
BIDAR
Gulbarga
CARE Hospital A
unit of Quality
Nampally
Care India
Limite
CAD SINGLE
VESSEL DISEASE
2355 H_19564316090
Male
51
Minorit
KARIKATTI
y
SAVADATTI
BELGAUM
Belgaum
KASTURBA
HOSPITAL
UDUPI
SIDDAPUR
UTTARA
KANNADA
Belgaum
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
Others KONDLI
Taluk
Patient
Division
Gender
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
6-Aug-15
11-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
SQUAMOUS CELL
CARCINOMA OF
CANCER
RIGHT BUCCAL
MUCOSA
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
31-Jul-15
16-Sep-15
60000
60000
61200
6120
55080
IDBI - 321
30-Oct-15
MANGALORE
LEFT RENAL
STAGHORN
CALCULUS AND
RIGHT RENAL
CALCULUS.
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
3-Aug-15
14-Aug-15
30000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca Thyroid
T2N1Mo
CANCER
Nuclear Medicine
Thyroid
Radioiodine
Treatment > 100
Millicuries
575
575
10-Aug-15
12-Aug-15
25000
26145
20425
2043
18382
IDBI - 321
30-Oct-15
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
6-Aug-15
9-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
CARDIOLOGY
2356 H_20015316139
Male
52
2357 H_20082314992
Female
33
2358 H_19577316100
Male
52
Others THUNGANI
KANAKAPURA
RAMANAGAR
Bangalore
SJICR
BANGALORE
SOUTH
IHD - OLD
NSTEMI, S/P
PTCA-LAD, DM,
HTN, SVD
CARDIOLOGY
Cardiology
2359 H_19577315957
Female
67
Others KALASIPALYA
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
SJICR
BANGALORE
SOUTH
SEVERE AS
CARDIOLOGY
Aortic Valve
Replacement
146
146
4-Aug-15
27-Aug-15
120000
120000
120000
0
120000
IDBI - 321
30-Oct-15
2360 H_21044314826
Male
62
Others CHACHIHALA
SAKLESHPURA
HASSAN
Mysore
WENLOCK
DISTRICT
HOSPITAL
MANGALORE
BEP WITH AUR
(ACUTE URINARY RENAL
RETENTION)
Genito Urinary
Surgery
Urology
TURP
917
917
30-Jul-15
10-Aug-15
20000
20000
19000
1900
17100
IDBI - 321
30-Oct-15
MANGALORE
VERRUCOUS
CARCINOMA
LEFT BUCCAL
MUCOSA
T3N2M0.
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
30-Jul-15
7-Sep-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
MYSORE
SINGLE VESSEL
CORONARY
CARDIOLOGY
ARTERY DISEASE
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
5-Aug-15
8-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
ST
G G HALLI
2361 H_20015316070
Male
43
Others PADUR
UDUPI
UDUPI
Mysore
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
2362 H_19581316054
Male
50
Others YARAGANAHALLI
MYSORE
MYSORE
Mysore
Cauvery
Hospital
2363 H_19571315058
Male
31
DEVADURGA
RAICHUR
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT LOWER
RENAL
URETRIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
4-Aug-15
11-Aug-15
25000
36279
25000
2500
22500
IDBI - 321
30-Oct-15
2364 H_22971315130
Male
66
CSI Holdsworth
Memorial
Mysore
Hospital
PIVD C4-5 & C5-6
AND CERVICAL
NEURO SURGERY
CANAL STENOSIS
FROM C3-C6
Neuro Surgery
Spinal
LaminectomyCervical
431
431
11-Aug-15
19-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
INFERIOR WALL
MYOCARDIAL
INFRACTION
239
239
4-Aug-15
7-Aug-15
65000
65000
65790
6579
59211
IDBI - 321
30-Oct-15
2365 H_19564315915
Female
68
2366 H_19583315175
Male
5
2367 H_19503311905
Male
35
2368 H_19574315225
Male
70
2369 H_19571313931
Male
17
2370 H_19574315129
2371 H_20025314615
Female
Male
51
44
SC
K. IRABAGERA
Minorit
MUDNAKUDU
y
Others HEBLE
ST
NITUVALLI
Others Mandewal
SC
CHAMBENAHALLI
Others SHARAN NAGAR
Others BHAGYANAGAR
Others CHOWDAHALLI
Mysore
GAR
GAR
BHATKALA
UTTARA
KANNADA
Belgaum
KASTURBA
HOSPITAL
DAVANAGERE
DAVANGERE
Bangalore
S.S. INSTITUTE
OF MEDICAL
NH-4,Bypass PB Accidental
SCIENCES &
Road Davanagere thermal burns
RESEARCH CENT
UDUPI
CANCER
CARDIOLOGY
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
BURNS
Burns
Burns
upto-40% with
Scalds(
Conservative/
without grafting)
2
2
3-Aug-15
27-Aug-15
35000
35000
23227
2323
20904
IDBI - 321
30-Oct-15
908
908
6-Aug-15
8-Aug-15
10000
10000
9500
950
8550
IDBI - 321
30-Oct-15
Bijapur
LEFT RENAL
CALCULI WITH
RENAL
HYDRONEPHROS
IS
Genito Urinary
Surgery
Urology
ESWL (Extra
Stent
BANGALORE
Carcinoma left
CANCER
Tonsil T4aN1M1
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
10-Aug-15
27-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
JEVARGI
GULBARGA
Gulbarga
Bijapur Kidney
Foundation
ANEKAL
BANGALORE URBAN
Bangalore
VYDEHI
HOSPITAL
CHITTAPUR
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
31-Jul-15
7-Aug-15
25000
33065
25000
2500
22500
IDBI - 321
30-Oct-15
VYDEHI
HOSPITAL
Cervical
compressive
myelopathy +
Multi-level
cervical
compression
NEURO SURGERY
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
8-Aug-15
30-Aug-15
50000
50000
25000
2500
22500
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
Urethroplasty for
a year can be
considered)
912
912
10-Aug-15
29-Aug-15
30000
30000
20000
2000
18000
IDBI - 321
30-Oct-15
KOPPAL
KOPPAL
Gulbarga
GUNDLUPET
CHAMARAJANA
Mysore
GAR
BANGALORE
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
PAN URETHRAL
STRICTURE
Sl.No
Preauth No
Gender
Age
Caste
Village
2372 H_20200315896
Male
18
SASALAPURA
Others
KOPPALU
2373 H_20025315353
Female
5
Others MAHANTHALAPURA
2374 H_19583314968
Female
38
2375 H_22586315912
Female
23
2376 H_20025314550
Male
5
2377 H_19586315015
Male
60
2378 H_20082315529
Female
45
2379 H_19505315534
Female
26
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Mysore
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
LARGE OS
ASD(23MM)
Mysore
GAR
GAR
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
CONGENITAL RT
PUJ
NEONATAL
OBSTRUCTION
CHANNARAYAP
HASSAN
ATNA
120
10-Aug-15
13-Aug-15
80000
80000
80000
0
80000
IDBI - 321
30-Oct-15
313
313
14-Aug-15
31-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
648
648
2-Aug-15
28-Aug-15
45000
45054
45000
4500
40500
IDBI - 321
30-Oct-15
119
119
17-Aug-15
20-Aug-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
322
322
7-Aug-15
21-Aug-15
22000
22000
22000
2200
19800
IDBI - 321
30-Oct-15
CARDIOLOGY
CABG with IABP
133
133
31-Jul-15
7-Sep-15
115000
95000
94500
9450
85050
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
ca thyroid
T3N1M0
CANCER
Nuclear Medicine
Thyroid
Radioiodine
Treatment > 100
Millicuries
575
575
11-Aug-15
13-Aug-15
25000
26600
22000
2200
19800
IDBI - 321
30-Oct-15
Mysore
BORDER LINE
TUMOR OF
CANCER
OVARY cT3N0M0
Surgical Oncology
Gynaec
Surgery for Ca
Ovary - advance
stage
596
596
10-Aug-15
14-Aug-15
40000
40000
10000
0
10000
IDBI - 321
30-Oct-15
RT RENAL
CALCULUS.
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
5-Aug-15
19-Aug-15
25000
40768
25000
2500
22500
IDBI - 321
30-Oct-15
L5-S1 IVDP
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
11-Aug-15
18-Aug-15
25000
25000
23750
2375
21375
IDBI - 321
30-Oct-15
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
Mysore
120
IHD-TVD
Mysore
SHRIRANGAPAT
MANDYA
NA
BANGALORE
MYSORE
Others SABBANAKUPPE
Net Amt
Paid
T NARASIPUR
Bangalore
TDS
Others KODAGAHALLI
KOLAR
Gross
Amount
approved by
NEONATAL
HBS HOSPITAL
TRUST
KOLAR
Hospital
claimed
Amount
MID PENILE
HYPOSPADIAS
Belgaum
Minorit
KITHRADUR
y
Congenital
Open/Lap
Preauth
Approved
Amt
PDA Device
Closure
DHARWAD
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
Kidwai
Memorial
Institute of
Oncology
Bharath
Hospital
Institute of
Oncology
Date of
Discharge
Device Closure
HUBLI
Bangalore
Device Closure
Date of
Admission
Cardiology
Others THORVI HAKKAL
SREENIVASAPUR KOLAR
ASD Device
Closure
Cardiology
CHD-PDA 45MM WITH LEFT CARDIOLOGY
TO RIGHT SHUNT
S.S. INSTITUTE
OF MEDICAL
NH-4,Bypass PB Carcinoma of
SCIENCES &
Road Davanagere Cervix
RESEARCH CENT
THADIGOL
Plan of
treatment
Gynaec-Ca.Cervix
Bangalore
ST
Surgical Oncology
CHITRADURGA
JANUKONDA
CARDIOLOGY
Disease Main
Category
Radical
Hysterectomy
+Bilateral Pelvic
Lymph Node
Dissection (BPLND)
Ophorectomy
(BSO) / Ovarian
transposition
CHITRADURGA
ST
Diseases
BANGALORE
NORTH
CANCER
2380 H_19571315457
Male
47
Others LENGANTI
ALAND
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
2381 H_22933315423
Male
27
Others Maradikere
SAKLESHPURA
HASSAN
Mysore
Janapriya
Hospital
2382 H_19571314745
Male
62
Others HALGADLA
JEVARGI
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
BENIGN
ENLARGEMENT
OF PROSTATE
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
3-Aug-15
9-Aug-15
20000
22048
20000
2000
18000
IDBI - 321
30-Oct-15
2383 H_19571313856
Male
30
HUMNABAD
BIDAR
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
31-Jul-15
7-Aug-15
25000
33409
25000
2500
22500
IDBI - 321
30-Oct-15
Belgaum
Shri
Siddhivinayak
Miraj
Ganapati Cancer
Hospital Miraj
ca anal canal T2
N1 M0
Radiation Oncology
Intensity Modulated
Radiotherpy(IMRT)
Radical Treatment
& Post Operative
RT(IMRT) Upto 40
fractions in 8
weeks
567
567
3-Aug-15
9-Sep-15
76000
87311
76000
7600
68400
IDBI - 321
30-Oct-15
CAD-SVD
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
31-Jul-15
6-Aug-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
31-Jul-15
10-Aug-15
31250
38248
31250
3125
28125
IDBI - 321
30-Oct-15
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
5-Aug-15
7-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
2384 H_20613311097
Male
75
2385 H_20127315036
Male
42
2386 H_19571313863
Female
49
2387 H_19593315862
Male
46
SC
MEENKERA
Others Kajibilagi
Others KALABAGA
SC
ADAVIBHAVI
THANDA
Others Sadalaga
JAMAKHANDI
BAGLAKOT
HASSAN
CANCER
KUMTA
UTTARA
KANNADA
Belgaum
A J HOSPITAL
CENTRE
LINGASUGUR
RAICHUR
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT LOWER
URETERIC STONE
RENAL
+ BLADDER
STONE
Belgaum
TRINITY
HOSPITAL AND
HEART
FOUNDATION
Post Infarct
Angina, Recent
IWMI Diabetes
Mellitus CAD Single Vessel
Disease
CHIKKODI
BELGAUM
BANGALORE
SOUTH
CARDIOLOGY
CARDIOLOGY
Cardiology
Sl.No
Preauth No
Others KOLUR
BILAGI
BAGLAKOT
Belgaum
M/s Kerudi
Hospital And
Bagalkot
Research Centre
Bagalkot
Right ureteral
calculus
2389 H_19576315847
Female
3
Others Jantali
MUNDARGI
GADAG
Belgaum
SDM Narayana
Hrudayalaya
Dharwad
ACHD QP L-R PMCARDIOLOGY
VSD with
IE/CCF/NSR
Narayana
Hrudayalaya
Private Limited
Bangalore
COMPLETE
HEART BLOCK
CARDIOLOGY
Cardiology
BANGALORE
CHD-SINGLE
VENTRICLE
CARDIOLOGY
BANGALORE
CHD OS ASD
CARDIOLOGY
Cardiology
Belgaum
CAD TVD
CARDIOLOGY
Belgaum
Belgaum
2391 H_19586315388
Male
7
2392 H_19586315782
Male
11
2393 H_20017315767
Male
66
2394 H_20017315780
Male
7
2395 H_20017315807
Female
52
2396 H_19571315411
Male
42
2397 H_19567315495
Female
65
2398 H_20127315610
Male
24
2399 H_22439315778
2400 H_20790315645
Male
Male
26
8
2401 H_20083315136
Male
60
2402 H_20025315684
Female
10
2403 H_19542315521
Male
42
2404 H_19571311992
Male
25
2405 H_20619315584
Female
49
Hospital Name
Diseases
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
URSL - Single Side
+ DJ Stent
909
909
21-Aug-15
22-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
VSD
152
152
6-Aug-15
3-Sep-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
114
114
24-Aug-15
27-Aug-15
75000
75000
76500
2295
74205
IDBI - 321
30-Oct-15
181
181
6-Aug-15
27-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
ASD Device
Closure
120
120
6-Aug-15
29-Aug-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
CABG
132
132
27-Jul-15
17-Aug-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
ASD
151
151
4-Aug-15
18-Aug-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
IHD EVOLVED
AWMI CAD SVD
Cardiology
Cardiology
PTCA - 2 stent
(non-medicated)
104
104
28-Jul-15
8-Aug-15
70000
70000
55000
5500
49500
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Plan of
treatment
42
Others KALAKERI
Patient District
Disease Main
Category
Female
21
Taluk
Final
Diagnosis
2388 H_19510315809
Female
Village
Hospital
District
Age
2390 H_19528315247
Caste
Patient
Division
Gender
Urology
Permanent
pacemaker
VVI) including
Pacemaker value
KOPPAL
KOPPAL
Gulbarga
HUNSUR
MYSORE
Mysore
Others 0
HUNSUR
MYSORE
Mysore
Others HIREKOPPA
SAVADATTI
BELGAUM
Belgaum
RAMADURGA
BELGAUM
Belgaum
Others 0
SIRAHATTI
GADAG
Belgaum
Others KARIKANALLI
JEVARGI
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
5-Aug-15
7-Aug-15
25000
30115
25000
2500
22500
IDBI - 321
30-Oct-15
HAVERI
HAVERI
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Cervix I B1
CANCER
Surgical Oncology
Gynaec
Radical
Hysterectomy
594
594
27-Aug-15
12-Sep-15
30000
38950
30000
3000
27000
IDBI-294
9-Oct-15
MANGALORE
DAKSHINA
KANNADA
Mysore
A J HOSPITAL
CENTRE
LEFT URETERIC
CALICULI
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
31-Jul-15
10-Aug-15
25000
25000
25500
2550
22950
IDBI - 321
30-Oct-15
Belgaum
BHS lakeview
Hospital
PFUDD
STRICTURE
URETHRA WITH
AUR
RENAL
Genito Urinary
Surgery
Urology
Urethroplasty for
a year can be
considered)
912
912
12-Aug-15
24-Aug-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
Bangalore
Sri
Adichunchanagi
B G Nagara
ri Hospital and
Research Center
Distal Penies
Hypospadias
with chordee.
NEONATAL
322
322
4-Aug-15
18-Aug-15
22000
22000
20900
2090
18810
IDBI - 321
30-Oct-15
Bangalore
Bhagwan
Mahaveer Jain
Hospital
ACS ACUTE
ANTERROLATER
AL WALL MI
CARDIOLOGY
DOUBLES VESSEL
DISEASE
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
3-Aug-15
6-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
RT HUN WITH
UPPER URETERIC RENAL
CALCULUS
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
1-Aug-15
6-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
4-Aug-15
6-Aug-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
SC
SC
SC
KADANAKOPPALU
RAMDURG
Budapanhalli
Others KUNJATHBAIL
Others ZINGATIHAL
Others Hulipura
SC
ATTUR
Others KAMAGERE
Minorit
HASSAN
y
SC
QUTER VISHAL
NAGAR GBL
Others BEVINAHALLI
HUKKERI
BELGAUM
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
KLES Dr
Prabhakar Kore
Hospital and
MRC
KLES Dr
Prabhakar Kore
Hospital and
MRC
KLES Dr
Prabhakar Kore
Hospital and
MRC
BELGAUM
CARDIOLOGY
Device Closure
KUNIGAL
TUMKUR
BANGALORE
NORTH
BANGALORE URBAN
KOLLEGAL
CHAMARAJANA
Mysore
GAR
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
HASSAN
HASSAN
Mysore
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
GULBARGA
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
BILATERAL
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
27-Jul-15
8-Aug-15
37500
44955
37500
3750
33750
IDBI - 321
30-Oct-15
HARIHARA
DAVANGERE
Bangalore
SUKSHEMA
HOSPITAL
PVTLTD
RIGHT LOWER
URETERIC
CALCULUS
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
5-Aug-15
8-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Bangalore
MYSORE
DAVANGERE
SINGLE VESSEL
DISEASE.
CARDIOLOGY
RENAL
Sl.No
Preauth No
Female
75
Minorit
TIPPA NAGAR
y
SHIMOGA
SHIMOGA
Bangalore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
ca Lt breast
t2n0m0
2407 H_19577315675
Male
56
Others SIDDANAHOSALLI
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
SJICR
BANGALORE
SOUTH
IHD - NSTEMI,
DM, HTN, LMCA CARDIOLOGY
+ DVD
2408 H_19577315481
Male
2
Minorit
BOLIYAR
y
MANGALORE
DAKSHINA
KANNADA
Mysore
SJICR
BANGALORE
SOUTH
CHD - TOF
2409 H_19577315502
Female
64
Others SANTEBACHAHALLY
KR PET
MANDYA
Mysore
SJICR
BANGALORE
SOUTH
2410 H_19577315456
Male
54
Others MADDUR
KUNIGAL
TUMKUR
Bangalore
SJICR
BANGALORE
SOUTH
61
Others VITAKODU
Taluk
KOLLEGAL
Patient District
CHAMARAJANA
Mysore
GAR
Hospital Name
Final
Diagnosis
2406 H_20082315707
Male
Village
Hospital
District
Age
2411 H_20733315576
Caste
Patient
Division
Gender
SJICR MYSORE
MYSORE
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Mastectomy - any
type
598
598
29-Jul-15
12-Aug-15
25000
26845
23750
2375
21375
IDBI - 321
30-Oct-15
CABG with IABP
133
133
31-Jul-15
18-Aug-15
95000
95000
94500
0
94500
IDBI - 321
30-Oct-15
ICR for TOF
154
154
4-Aug-15
10-Sep-15
80000
80000
79000
0
79000
IDBI - 321
30-Oct-15
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
2-Aug-15
7-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
IHD - USA, DM,
SVD
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
6-Aug-15
9-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
3-Aug-15
6-Aug-15
65000
65000
64500
6450
58050
IDBI - 321
30-Oct-15
114
114
3-Aug-15
12-Aug-15
75000
75000
74500
7450
67050
IDBI - 321
30-Oct-15
IHD-ACS ACUTE
PWMI
CANCER
CARDIOLOGY
CARDIOLOGY
CARDIOLOGY
Surgical Oncology
Breast
2412 H_20733315564
Female
72
Others CHAMARAJANGAR
Mysore
GAR
GAR
SJICR MYSORE
MYSORE
CHB
CARDIOLOGY
Cardiology
Permanent
pacemaker
VVI) including
Pacemaker value
2413 H_20733315558
Male
58
Others SHIRANGALA
SOMAVARPET
SJICR MYSORE
MYSORE
IHD-EVOLVED
CARDIOLOGY
AWMI CAD-TVD
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
6-Aug-15
10-Aug-15
90000
90000
89500
8950
80550
IDBI - 321
30-Oct-15
239
239
5-Aug-15
7-Aug-15
65000
65000
61275
6128
55147
IDBI - 321
30-Oct-15
KODAGU
Mysore
2414 H_20733315596
Male
60
Others GANAMGURU
SHRIRANGAPAT
MANDYA
NA
Mysore
SJICR MYSORE
MYSORE
IHD-ACS ACUTE
IWMI
CARDIOLOGY
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
2415 H_20733314376
Male
52
Minorit
KONANURU
y
ARAKALAGUD
HASSAN
Mysore
SJICR MYSORE
MYSORE
SVD
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
4-Aug-15
8-Aug-15
90000
90000
85025
8503
76522
IDBI - 321
30-Oct-15
2416 H_22254315591
Female
35
Others 0
BIDAR
BIDAR
Gulbarga
BIBI GENERAL
CANCER CENTER
a case of ca
breast right
Surgical Oncology
Breast
Mastectomy - any
type
598
598
6-Jul-15
10-Aug-15
25000
25000
23750
2375
21375
IDBI - 321
30-Oct-15
2417 H_22586315565
Male
47
Others JIGALUR
HUBLI
DHARWAD
Belgaum
HBS HOSPITAL
TRUST
BANGALORE
NORTH
IHD-RECENT
CARDIOLOGY
AWMI,CAG-SVD
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
7-Aug-15
9-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
2418 H_19503315531
Male
22
Others Tungal
JAMAKHANDI
BAGLAKOT
Belgaum
Bijapur Kidney
Foundation
Bijapur
left puj
obstrucation
Genito Urinary
Surgery
Urology
905
905
10-Aug-15
20-Aug-15
35000
35000
35000
3500
31500
IDBI - 321
30-Oct-15
429
429
25-Aug-15
1-Sep-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
CANCER
RENAL
2419 H_22971315140
Male
66
Others PEEHALLI
SHRIRANGAPAT
MANDYA
NA
Mysore
CSI Holdsworth
Memorial
Mysore
Hospital
PIVD AT C3-C4
NEURO SURGERY
THROUGH C6-C7
Neuro Surgery
Spinal
Anterior Cervical
Discectomy
Multiple level with
Implants
(procedure
30000+ Implants
10000)
2420 H_22054315535
Male
40
Others Kembhavi
SURPUR
Gulbarga
DR MUNIR
BANGI
HOSPITAL
BIJAPUR
LEFT DISTAL
URETERIC
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
3-Aug-15
8-Aug-15
25000
25070
22800
2280
20520
IDBI - 321
30-Oct-15
DAVANGERE
LEFT STAGHORH
CALCULUS WITH
LEFT LOWER
RENAL
URETERIC
CALCULUS
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
10-Aug-15
13-Aug-15
37500
37500
37500
3750
33750
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
Open
Cystolithotomy
903
903
30-Jul-15
11-Aug-15
15000
21789
15000
1500
13500
IDBI - 321
30-Oct-15
Congenital
Open/Lap
313
313
20-Jul-15
17-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
2421 H_20619311523
Male
53
2422 H_19571313284
Male
7
2423 H_21052315278
Male
1
Others THOLAHUNSE
SC
SAKRYANAYAK
THANDA
Others KEYYURU
YADGIRI
DAVANAGERE
DAVANGERE
Bangalore
SUKSHEMA
HOSPITAL
PVTLTD
YADGIR
YADGIRI
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
VESICAL
CALCULUS.
PUTTUR
DAKSHINA
KANNADA
PUJ
OBSTRACTION
NEONATAL
WITH
HYDRONEPHROS
IS
Mysore
RENAL
Sl.No
Preauth No
4000
36000
IDBI - 321
30-Oct-15
909
909
31-Jul-15
7-Aug-15
25000
33374
25000
2500
22500
IDBI - 321
30-Oct-15
Sennings
165
165
4-Aug-15
26-Aug-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
8-Aug-15
12-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
4-Aug-15
7-Aug-15
37500
37500
37500
3750
33750
IDBI - 321
30-Oct-15
Mitral Valve
Replacement
145
145
28-Jul-15
17-Aug-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
Urology
Urethroplasty for
a year can be
considered)
912
912
22-Aug-15
5-Sep-15
30000
48100
30000
3000
27000
IDBI - 321
30-Oct-15
Belgaum
MAHALINGPUR
right renal pelvic
RENAL
calculus
Genito Urinary
Surgery
DAVANGERE
LEFT PUJ
CALCULUS WITH
RENAL
LEFT URETERIC
CALCULUS
Genito Urinary
Surgery
RHD MS
2426 H_20017315462
Male
5 Months
Others K K KOPPA
BELGAUM
BELGAUM
Belgaum
Hospital Name
Diseases
CANCER
CARDIOLOGY
Disease Main
Category
HAVERI
HAVERI
Belgaum
SUKSHEMA
HOSPITAL
PVTLTD
RAIBAGH
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
BIJAPUR
Belgaum
BLDE University
Shri BM Patil
Bijapur
Medical College
Hosp
Stricture Urethra RENAL
Genito Urinary
Surgery
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
31-Jul-15
7-Aug-15
25000
33216
25000
2500
22500
IDBI - 321
30-Oct-15
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
PERIAMPULLARY
CANCER
CA
Surgical Oncology
Pancreas
Whipples - any
type
582
582
22-Jul-15
19-Aug-15
75000
75000
75000
7500
67500
IDBI - 321
30-Oct-15
MADDUR
MANDYA
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
CYST LT LUNG
Lobectomy
189
189
7-Aug-15
17-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
GULBARGA
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT UPPER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
30-Jul-15
8-Aug-15
25000
35264
25000
2500
22500
IDBI - 321
30-Oct-15
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
7-Aug-15
14-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
Cardiothoracic Surgery Closed Heart Procedures Pericardiectomy
184
184
10-Aug-15
25-Aug-15
50000
50000
51000
1530
49470
IDBI - 321
30-Oct-15
Male
64
2431 H_19571313935
Male
23
Minorit AMBORSE CONVENT
CHITTAPUR
y
SCHOOL
2432 H_20025314538
Male
56
Others
2433 H_20025314951
Male
35
Others KOOLAGERE
2434 H_19571313291
Male
50
Others
2435 H_22439314290
Female
47
Others HERE NAGANURU
LINGASUGUR
RAICHUR
Gulbarga
BHS lakeview
Hospital
BELGAUM
2436 H_19528315390
Female
55
Others BARDEVANAL
SURPUR
YADGIRI
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
2437 H_19571314739
Female
26
CHITTAPUR
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
3-Aug-15
12-Aug-15
25000
34702
25000
2500
22500
IDBI - 321
30-Oct-15
2438 H_23069314461
Female
35
Others KYASAMBALLI
KOPPAL
KOPPAL
Gulbarga
THE RADIANT
INSTITUTE
CA BREAST
STAGE II
Surgical Oncology
Breast
Mastectomy - any
type
598
598
28-Jul-15
8-Aug-15
25000
25000
23750
2375
21375
IDBI - 321
30-Oct-15
2439 H_19571313285
Male
18
Others PARTAPUR
BASAVAKALYAN
BIDAR
A
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
30-Jul-15
7-Aug-15
25000
32061
25000
2500
22500
IDBI - 321
30-Oct-15
2440 H_21925314935
Male
32
Others 0
TIPTUR
TUMKUR
Bangalore
MUDRA
HOSPITAL
TIPTUR
prostatic uretral
RENAL
calculus
Genito Urinary
Surgery
Urology
Cystolithotripsy
906
906
4-Aug-15
7-Aug-15
12500
12500
12500
1250
11250
IDBI - 321
30-Oct-15
2441 H_19577315148
Male
8
BANGALORE RURAL
Bangalore
SJICR
BANGALORE
SOUTH
CHD - PDA
CARDIOLOGY
Cardiology
Device Closure
PDA Device
Closure
119
119
17-Aug-15
19-Aug-15
60000
60000
60000
0
60000
IDBI - 321
30-Oct-15
2442 H_19510315090
Male
56
Others PANCHAGANV
RAMADURGA
BELGAUM
Belgaum
M/s Kerudi
Hospital And
Bagalkot
Research Centre
Bagalkot
BENIGN
ENLARGEMENT
OF PROSTATE
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
21-Aug-15
23-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
2443 H_20733315317
Male
39
Others HInkal
MYSORE
MYSORE
Mysore
SJICR MYSORE
IHD-ACS-ACUTE
IWMI
CARDIOLOGY
Cardiology
Cardiology
Medical
treatment of
Acute MI with
Thrombolysis
128
128
2-Aug-15
7-Aug-15
10000
10000
8075
808
7267
IDBI - 321
30-Oct-15
SC
BIJAPUR
CARDIOLOGY
2430 H_20031315409
SC
Hokkundi
40000
VENKATESH
HOSPITAL
PATIL NURSING
HOME
GULBARGA
GULBARGA
ST
40000
Gulbarga
NILAJI
40000
CHD TGA WITH
ASD WITH DMALPOSED
AORTA
GULBARGA
ST
20-Aug-15
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
GULBARGA
30
8-Aug-15
URSL - Single Side
+ DJ Stent
Minorit SHALIMAR
y
FUNCTION HALL
Male
636
Urology
30
2429 H_20017315431
Net Amt
Paid
Genito Urinary
Surgery
Female
Others GUTTALA
TDS
LT LOWER
RENAL
URETERIC STONE
2425 H_19571313939
43
Gross
Amount
approved by
636
CARCINOMA
STOMACH PROXIMAL
CANCER
Female
Hospital
claimed
Amount
Gastrectomy - any
type
CSI Holdsworth
Memorial
Mysore
Hospital
2428 H_20619314586
Preauth
Approved
Amt
Mysore
GAR
GAR
BAGLAKOT
Date of
Discharge
Surgical Oncology
Others ALLURU
MUDHOLA
Date of
Admission
Plan of
treatment
66
Others Bisanal
Patient District
Male
32
Taluk
Final
Diagnosis
2424 H_22971315145
Male
Village
Hospital
District
Age
2427 H_22458315435
Caste
Patient
Division
Gender
KANNANAYAKANAH
T NARASIPUR
ALLI
SIDDESHAWAR
COLONY GBL
SEVALAL NAGAR
THANDA WADI
AMBEDKAR COLONY HOSAKOTE
MYSORE
MYSORE
CARDIOLOGY
L4/L5 LISTHESIS
WITH
NEURO SURGERY
L4/L5+L5/S1
PIVD
PROBABLY
RESTRICTED
CARDIOMYOPAT CARDIOLOGY
HY BIATRIAL
ENLARGEMENT
CANCER
Sl.No
Preauth No
Age
2444 H_19528315239
Male
60
Others ARYA NAGAR
GULBARGA
GULBARGA
Gulbarga
Narayana
Hrudayalaya
Private Limited
2445 H_20880315291
Female
69
Others Athani
ATHANI
BELGAUM
Belgaum
2446 H_19528315284
Male
1
Others HIREMORAB
HIREKERUR
HAVERI
2447 H_19571314784
Female
35
BANGALORE
NORTH
2448 H_20017315281
Male
4
Others SANKESHWAR
2449 H_19574311910
Male
70
2450 H_20242315194
Female
10
2451 H_20212315250
Male
50
2452 H_19515311871
Female
60
2453 H_19574313121
2454 H_20619310374
Male
Male
61
18
Caste
Village
Taluk
Patient District
Patient
Division
Gender
Hospital Name
Hospital
District
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
CAD-TVD
CARDIOLOGY
CABG
132
132
8-Aug-15
18-Aug-15
95000
95000
96900
2907
93993
IDBI - 321
30-Oct-15
Wanless
Hospital Miraj
Miraj
Medical Center
miraj
IHD -CAD-DVD
with Dm with
HTN
CARDIOLOGY
Cardiology
Cardiology
PTCA - 2 stent
(non-medicated)
104
104
4-Aug-15
8-Aug-15
70000
70000
70000
7000
63000
IDBI - 321
30-Oct-15
Belgaum
Narayana
Hrudayalaya
Private Limited
MOD PDA L-R
SHUNT
CARDIOLOGY
Cardiology
Device Closure
PDA Device
Closure
119
119
21-Aug-15
24-Aug-15
60000
60000
61200
1836
59364
IDBI - 321
30-Oct-15
BANGALORE URBAN
Bangalore
PATIL NURSING
HOME
GULBARGA
GULBARGA
VVF
RENAL
Genito Urinary
Surgery
Urology
VVF Repair
904
904
3-Aug-15
11-Aug-15
30000
30556
30000
3000
27000
IDBI - 321
30-Oct-15
HUKKERI
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
HYPOPADIAS
NEONATAL
322
322
4-Aug-15
17-Aug-15
22000
22000
22000
2200
19800
IDBI - 321
30-Oct-15
Others DASANAPURA
ANEKAL
BANGALORE URBAN
Bangalore
VYDEHI
HOSPITAL
Prostatomegaly
with vesical
RENAL
calculus and B/L
Ureteric Calculi
Genito Urinary
Surgery
Urology
TURP
917
917
5-Aug-15
1-Sep-15
37500
37500
37500
3750
33750
IDBI - 321
30-Oct-15
Others VARDHGANHALLI
MULABAGILU
KOLAR
Bangalore
MEDIHOPE
HOSPITALS AND
BANGALORE
RESEARCH
CENTRE PVT LTD
CHD, ASD L->R
SHUNT
ASD
151
151
3-Aug-15
14-Aug-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
Medical Oncology
Carboplatin +
Paclitaxel/Cycle
Max. of 6 cycles
only+Oesophagect
omy with Three
field
Lymphadenectomy
521+674
521+674
4-Aug-15
27-Aug-15
31500
27336
21000
2100
18900
IDBI - 321
30-Oct-15
CARDIOLOGY
CABG
132
132
14-Aug-15
4-Sep-15
95000
170528
95000
9500
85500
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
6-Aug-15
18-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Burns
Post Burn
Contracture
surgeries for
Functional
Improvement(Pack
age including
splints, pressure
garments and
physiotherapy),
Severe
11
11
10-Aug-15
14-Aug-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
SC
SC
YALHANKA
Hosa Padanur
Minorit
0
y
Others KAGGALADU
SC
BAGAYYANAHALLI
Bangalore
Final
Diagnosis
Bangalore
BANGALORE
CARDIOLOGY
INDI
BIJAPUR
Belgaum
Mahatma
Gandhi Cancer
Hospital
Miraj
Ca. M/3 / L/3
Esophagus
CANCER
[Stage- III] T3 N0
M0
HAVERI
HAVERI
Belgaum
CITY CENTRAL
HOSPITAL
PRIVATE
LIMITED
DAVANGERE
CAD - DAV
Bangalore
VYDEHI
HOSPITAL
BANGALORE
Right Renal
calculus
SIRA
JAGALURU
TUMKUR
DAVANGERE
Bangalore
SUKSHEMA
HOSPITAL
PVTLTD
Head & Neck
DAVANGERE
POST BURN
CONTRACTURE
OF NECK
MANGALORE
CHD LARGE
OSTIUM
SECUNDUM ASD
WITH LEFT TO
RIGHT SHUNT
CARDIOLOGY
MODERATE
TR/MODERATE
PAH NORMAL
BIOVENTRICULA
R FUNCTION
ASD
151
151
5-Aug-15
10-Aug-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
BPH
Genito Urinary
Surgery
Urology
TURP
917
917
22-Jun-15
17-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
BURNS
Burns
CHITRADURGA
Bangalore
INDIANA
HOSPITAL AND
HEART
INSTITUTE LTD
NELEMANGALA
BANGALORE RURAL
Bangalore
RAJARAJESWARI
MEDICALCOLLE
BANGALORE
GE AND
HOSPITAL
Others K GANGANAHALLI
TURVEKERE
TUMKUR
Bangalore
SJICR
BANGALORE
SOUTH
ACS - LWMI, SVD CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
1-Aug-15
7-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
68
Minorit
WARD NO 30
y
BELLARY
BELLARY
Gulbarga
SJICR
BANGALORE
SOUTH
ACS - USA, SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
2-Aug-15
8-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
71
Others BANAKOPPA
YELBURGA
KOPPAL
Gulbarga
SJICR
BANGALORE
SOUTH
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
15-Aug-15
19-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
ECHALANAGENAHAL
CHITRADURGA
LI
2455 H_20322315212
Female
10
Others
2456 H_20531315201
Male
73
Others KODIGE HALLI
2457 H_19577315156
Male
45
2458 H_19577315062
Male
2459 H_19577315142
Female
RENAL
Sl.No
Preauth No
2460 H_23069315034
Gender
Age
Female
41
Caste
Village
Others MALIKUNDI
Taluk
NANJANAGUD
Patient District
MYSORE
Patient
Division
Hospital Name
Mysore
THE RADIANT
INSTITUTE
Hospital
District
MYSORE
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
CA BREST STAGE
CANCER
II T2N1M0
Surgical Oncology
Breast
Mastectomy - any
type
598
598
18-Aug-15
22-Aug-15
20000
25000
19000
1900
17100
IDBI - 321
30-Oct-15
ACS (TROP +)
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
3-Aug-15
5-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
L4-5 PIVD
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
13-Aug-15
19-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
IHD - EFFORT
ANGINA CAG
DVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
3-Aug-15
8-Aug-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
Cardiology
Cardiology
Peripheral
Angioplasty
109
109
23-Aug-15
25-Aug-15
70000
55000
56100
1683
54417
IDBI - 321
30-Oct-15
Double Valve
Replacement
149
149
3-Aug-15
11-Aug-15
150000
150000
150000
15000
135000
IDBI - 321
30-Oct-15
IHD OLD IWMI /
NOEMAL LV
CARDIOLOGY
FUNCTION
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
31-Jul-15
7-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
Radiation Oncology
Radical Treatment
Radiotherapy
562
562
11-Aug-15
21-Sep-15
20000
20000
19000
1900
17100
IDBI - 321
30-Oct-15
2461 H_20200315124
Male
70
Others LASHKAR MOHALLA
MYSORE
MYSORE
Mysore
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
2462 H_20079315118
Female
45
Minorit
WARD-15
y
SHIMOGA
SHIMOGA
Bangalore
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
2463 H_19549315024
Female
59
RAICHUR
RAICHUR
Gulbarga
Sagar Hospitals
BANGALORE
SOUTH
2464 H_19528315022
Male
45
HARIHARA
DAVANGERE
Bangalore
Narayana
Hrudayalaya
Private Limited
Bangalore
2465 H_19549315021
Male
41
SC
0
ATHANI
BELGAUM
Belgaum
Sagar Hospitals
BANGALORE
SOUTH
2466 H_19549315016
Male
49
SC
0
BIDAR
BIDAR
Gulbarga
Sagar Hospitals
BANGALORE
SOUTH
Cancer - Penis
CAD-AIWMI,
Significant RCA & CARDIOLOGY
OM2
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
31-Jul-15
6-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
PIVD L4-5 AND
L5-S1
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
6-Aug-15
18-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
CA TRANSVERSE
CANCER
COLON stge V
Surgical Oncology
Colectomy - any
type
637
637
27-Jul-15
17-Aug-15
50000
54595
47000
4700
42300
IDBI - 321
30-Oct-15
ACHD QP S/A
CARDIOLOGY
VSD with IE/CCF
VSD
152
152
3-Aug-15
12-Aug-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
Thalessemia
major with
hypersplenism
NEONATAL
Splenectomy
312
312
6-Jul-15
29-Aug-15
35000
45625
35000
3500
31500
IDBI - 321
30-Oct-15
bph
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
5-Aug-15
15-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
Simple
918
918
8-Aug-15
17-Aug-15
35000
35000
35000
3500
31500
IDBI - 321
30-Oct-15
Urology
URSL - Single Side
+ DJ Stent
909
909
8-Aug-15
10-Aug-15
25000
25000
10000
1000
9000
IDBI - 321
30-Oct-15
Urology
ESWL (Extra
Stent
908
908
20-Jul-15
6-Aug-15
10000
10000
9500
950
8550
IDBI - 321
30-Oct-15
SC
0
Others DEVARA BELEGERE
2467 H_22472313155
Male
38
Others 0
JEVARGI
GULBARGA
Gulbarga
Shri
Siddheshwar
and Research
Cent
2468 H_19576314946
Male
58
Others Hospet
HOSPET
BELLARY
Gulbarga
SDM Narayana
Hrudayalaya
2469 H_22478314733
Female
36
Others HEBBAL KOPPALU
KR NAGAR
MYSORE
Mysore
2470 H_20082314194
Male
52
Others JAKKANAHALLI
TURVEKERE
TUMKUR
Bangalore
2471 H_19576314651
Female
5
Others Hallikeri
NAVALAGUND
DHARWAD
Belgaum
2472 H_20021313796
Male
12
Others ANDOLA
JEVARGI
GULBARGA
Gulbarga
2473 H_20059315018
Male
66
Others kurubarahalli
TIPTUR
TUMKUR
Bangalore
Dharwad
SHREE
MAHADESHWA
MYSORE
RA NURSING
HOME
Kidwai
BANGALORE
Memorial
SOUTH
Institute of
Oncology
SDM Narayana
Hrudayalaya
Dharwad
BASAVESHWAR
TEACHING AND
GULBARGA
GENERAL
HOSPITAL
KUMAR
TIPTUR
HOSPITAL
RIGHT LOWER
LIMB ACUTE ON
CARDIOLOGY
CHRONIC LIMB
ISCHEIA
RHD,SEVERE
MS,MILD MR ,
MODERATE
CARDIOLOGY
SEVERE
AS,MODERATE
AR
CANCER
NEURO SURGERY
2474 H_22080314672
Female
29
Others WAGHAWADE
BELGAUM
BELGAUM
Belgaum
VIJAYA
HOSPITAL
BELGAUM
LIFT POORLY
FUNCTIONING
KIDNEY 05% ON
RENAL
DTPA SCAN &
MULTIPLE
CALCULUS
2475 H_19503314469
Male
44
Others Bijapur
BIJAPUR
BIJAPUR
Belgaum
Bijapur Kidney
Foundation
Bijapur
Right Ureteric
calculus with
RENAL
Hydronephrosis
Genito Urinary
Surgery
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
LT.RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
MYSORE
RHD-MV
THICKENED
SEVERE
MR,MILD AS.
CARDIOLOGY
Mitral Valve
Replacement
145
145
8-Aug-15
18-Aug-15
120000
120000
122400
12240
110160
IDBI - 321
30-Oct-15
Mysore
CA
HYPOPHARYNX
cT4aN2M0
CANCER
Surgical Oncology
Laryngectomy
with Voice
Prosthesis
618
618
11-Aug-15
24-Aug-15
60000
40000
40000
0
40000
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
BANGALORE
SOUTH
RHD - SEVERE
MR
RHD - SEVERE
MS
CARDIOLOGY
145
145
29-Jul-15
17-Aug-15
120000
120000
120000
0
120000
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
105
105
6-Aug-15
9-Aug-15
20000
20000
20000
0
20000
IDBI - 321
30-Oct-15
2476 H_20017315006
Female
56
2477 H_19542314959
Female
38
2478 H_19505314936
Male
49
2479 H_19577314289
Female
28
2480 H_19577314727
Female
29
Others 0
Others BILIDEGULA
SC
THAGADURU
Others THAVAREKOPPA
ST
HINNAKKI
ATHANI
BELGAUM
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
Bharath
Hospital
Institute of
Oncology
MANDYA
MANDYA
Mysore
KR PET
MANDYA
Mysore
SHIMOGA
SHIMOGA
Bangalore
SJICR
ANEKAL
BANGALORE URBAN
Bangalore
SJICR
Head & Neck
Cardiology
mitral valve
replacement
Balloon Mitral
Valvotomy
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
2481 H_20619310814
Male
14
Others DAVAGIRI
HAVERI
HAVERI
Belgaum
SUKSHEMA
HOSPITAL
PVTLTD
DAVANGERE
POST BURN
CONTRACTURE
BURNS
OF FINGERES OF
RIGHT HAND
Burns
Burns
2482 H_19528314448
Female
14
Others GOREBALA
SINDNUR
RAICHUR
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
T CELL
LYMPHOBLASTIC CANCER
LYMPHOMA
Medical Oncology
Acute Lymphoblastic
Leukemia
36
Minorit
Hassan
y
HASSAN
Right Renal
Calculi
RENAL
Genito Urinary
Surgery
2483 H_21718314862
Female
HASSAN
HASSAN
Plan of
treatment
Post Burn
Contracture
surgeries for
Functional
Improvement(Pack
age including
splints, pressure
garments and
physiotherapy),
Moderate
Induction &
Consolidation/1st
phase - 1st ,2nd ,
3rd , 4th & 5th
months
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
10
10
3-Aug-15
7-Aug-15
30000
30000
28500
2850
25650
IDBI - 321
30-Oct-15
550
550
8-Aug-15
14-Aug-15
70000
70000
6120
184
5936
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
8-Aug-15
13-Aug-15
25000
27744
25000
2500
22500
IDBI - 321
30-Oct-15
Urology
ESWL (Extra
Stent
908
908
23-Jul-15
8-Aug-15
10000
26331
10000
1000
9000
IDBI - 321
30-Oct-15
128
128
31-Jul-15
7-Aug-15
10000
10000
9025
903
8122
IDBI - 321
30-Oct-15
2
2
31-Jul-15
25-Aug-15
35000
35000
26840
2684
24156
IDBI - 321
30-Oct-15
Mysore
SSM Hospital
RT RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
KNOWN TVD
CARDIOLOGY
Cardiology
Cardiology
Medical
treatment of
Acute MI with
Thrombolysis
2484 H_19571310596
Female
33
Others BUDHA MANDIR BDR BIDAR
BIDAR
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
2485 H_20733314856
Male
65
Others TANDAVAPURA
NANJANAGUD
MYSORE
Mysore
SJICR MYSORE
2486 H_19583314343
Female
29
Others HADADI
DAVANAGERE
DAVANGERE
Bangalore
S.S. INSTITUTE
OF MEDICAL
NH-4,Bypass PB
SCIENCES &
Road Davanagere
RESEARCH CENT
Mixed Burns
with Scalds over
BURNS
chest,face,Rt
upper limb
Burns
Burns
upto-40% with
Scalds(
Conservative/
without grafting)
2487 H_19574313178
Male
67
Others SOREKAYIPURA
CHANNARAYAP
HASSAN
ATNA
Mysore
VYDEHI
HOSPITAL
Carcinoma Base
Tongue
CANCER
T4aN2cMo
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
3-Aug-15
23-Sep-15
54000
54000
54000
5400
48600
IDBI - 321
30-Oct-15
2488 H_19571311130
Female
29
YADGIR
YADGIRI
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
24-Jul-15
8-Aug-15
25000
39408
25000
2500
22500
IDBI - 321
30-Oct-15
2489 H_19491313696
Male
31
HIRIYUR
CHITRADURGA
Bangalore
BGS GLOBAL
HOSPITAL
atrial septal
defect,
ASD
151
151
6-Aug-15
11-Aug-15
80000
80000
80000
320
79680
IDBI - 321
30-Oct-15
2490 H_19571313293
Female
46
CHITTAPUR
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT UPPER
RENAL
URETERIC STONE
Genito Urinary
Surgery
URSL - Single Side
+ DJ Stent
909
909
30-Jul-15
6-Aug-15
25000
30600
25000
2500
22500
IDBI - 321
30-Oct-15
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
CHD
SUPRACARDIAC
TAPVC WITH ASD CARDIOLOGY
WITH SEVERE
PAH
TAPVC
160
160
30-Jul-15
20-Aug-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
right renal pelvic
RENAL
calculus
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
8-Aug-15
12-Aug-15
25000
30430
25000
2500
22500
IDBI - 321
30-Oct-15
2491 H_20017314833
Male
5 Months
ST
HATTIKUNNI
Others SANGENAHALLI
SC
DHARMA THANDA
Others MURKIBHAVI
BANGALORE
SOUTH
CARDIOLOGY
Urology
Chimmad
JAMAKHANDI
BAGLAKOT
Belgaum
BHEEM NAGAR
MALKHED
SEDAM
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
29-Jul-15
5-Aug-15
25000
34786
25000
2500
22500
IDBI - 321
30-Oct-15
CHIKKODI
BELGAUM
Belgaum
Mahatma
Gandhi Cancer
Hospital
Ca. (Lt) Breast
[Stage- III] T3 N0 CANCER
M0
Surgical Oncology
Breast
Mastectomy - any
type
598
598
3-Aug-15
12-Aug-15
25000
37162
5000
500
4500
IDBI - 321
30-Oct-15
Others JANTA COLONY HBD HUMNABAD
BIDAR
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT UPPER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
31-Jul-15
6-Aug-15
25000
32097
25000
2500
22500
IDBI - 321
30-Oct-15
64
Others ALLOLLI
CHITTAPUR
GULBARGA
Gulbarga
SJICR
BANGALORE
SOUTH
IHD - AWMI,
DM, HTN, DVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
31-Jul-15
7-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
46
Minorit
MARUVEKERE
y
MADHUGIRI
TUMKUR
Bangalore
SJICR
BANGALORE
SOUTH
MVP - SEVERE
MR
CARDIOLOGY
Mitral Valve
Replacement
145
145
26-Jul-15
25-Aug-15
120000
120000
120000
0
120000
IDBI - 321
30-Oct-15
Belgaum
Kolhapur Cancer
Karveer
Centre
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
10-Aug-15
11-Sep-15
50000
102500
50000
5000
45000
IDBI - 321
30-Oct-15
Male
26
SC
2493 H_19571313132
Female
17
Others
2494 H_20212314793
Female
44
Others Chikkodi
2495 H_19571313860
Male
37
2496 H_19577314621
Male
2497 H_19577314730
Male
Female
BELGAUM
BANGALORE
VENKATESH
HOSPITAL
2492 H_22458314819
2498 H_20435314426
BYLAHONGALA
MYSORE
45
SC
MAHALINGAPUR
MUDHOLA
BAGLAKOT
MAHALINGPUR
Miraj
CA (L) BREAST
T4N1Mx
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Sl.No
Preauth No
Gender
Age
Caste
Village
2499 H_19577314606
Female
65
ST
2500 H_19571314647
Male
35
Others MAILAPUR
HOSASIDDAPURA
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
29-Jul-15
9-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
3-Aug-15
7-Aug-15
37500
38792
37500
3750
33750
IDBI - 321
30-Oct-15
MANGALORE
CARCINOMA
RECTOSIGMOID
CANCER
cT3NoMo STAGE
III
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
22-Jul-15
7-Aug-15
81000
81000
21000
2100
18900
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
2-Aug-15
6-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
IHD - USA, DM,
HTN, TVD
SHIMOGA
SHIMOGA
Bangalore
SJICR
CARDIOLOGY
YADGIR
YADGIRI
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
BILATERAL
RENAL
URETERIC STONE
BANTWAL
DAKSHINA
KANNADA
Mysore
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
2501 H_19522313635
Male
50
Minorit
ALADYI
y
2502 H_20237314662
Male
31
Others Chikkeri
HANAGAL
HAVERI
Belgaum
TSS-Shripad
Hegde Kadave
Institute of
Medical Scie
SIRSI
Rt VUJ Calculus
with Mod HUN
2503 H_19491314545
Male
62
Others CHIKKONAHALLI
MADDUR
MANDYA
Mysore
BGS GLOBAL
HOSPITAL
BANGALORE
SOUTH
CARCINOMA
PROSTATE WITH
CANCER
BONE
METASTASTASE
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
5-Aug-15
17-Aug-15
20000
20000
20000
80
19920
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
12-Aug-15
14-Aug-15
65000
55000
52250
5225
47025
IDBI - 321
30-Oct-15
CANCER
Surgical Oncology
Gynaec
Radical
Hysterectomy
594
594
17-Aug-15
26-Aug-15
30000
32380
30000
3000
27000
IDBI-294
9-Oct-15
ii. HDR - one
application and
multiple dose
fractions
573
573
18-Aug-15
20-Aug-15
20000
20000
20000
80
19920
IDBI - 321
30-Oct-15
Mysore
R
UR
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
AWMI WITH
MODERATE LV
DYSFUNCTION
WITH POST
INFRACTION
ANGINA
DAVANAGERE
DAVANGERE
Bangalore
Karnataka
Cancer Therapy
Hubli
and Research
Institute
ca Cervix I b
HONNALI
DAVANGERE
Bangalore
BGS GLOBAL
HOSPITAL
CARCINOMA
CERVIX STAGE III CANCER
B
Radiation Oncology
CAD+TVD, Rec.
IWMI+LV
DYSFUNCTION
CARDIOLOGY
CABG
132
132
6-Aug-15
13-Aug-15
95000
95000
95000
0
95000
IDBI - 321
30-Oct-15
MENINGOCELE.
NEURO SURGERY
Neuro Surgery
Brain
Meningomyelocel
e
417
417
3-Aug-15
21-Aug-15
35000
35000
35000
3500
31500
IDBI - 321
30-Oct-15
MODERATELY
DIFFERENTIATED
CANCER
SCC OF
TONGGUE.T4N2
M0.
Surgical Oncology
Head & Neck
Wide excision
621
621
31-Jul-15
24-Aug-15
47500
47500
47500
4750
42750
IDBI - 321
30-Oct-15
VSD
152
152
31-Jul-15
12-Aug-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
2504 H_20079314695
Male
53
2505 H_19567314694
Female
45
2506 H_19491314020
Female
58
Others BASAVANAHALLI
Minorit
LANKE
y
HD KOTE
MYSORE
Mysore
Others MALKOD
HONNAVAR
UTTARA
KANNADA
Belgaum
SIDDAPUR
UTTARA
KANNADA
2507 H_20200314474
Male
42
2508 H_20015314676
Female
9 Months
2509 H_20015314659
Female
49
Others SHANKAR PURA
SC
Davanageri
Others BEDKANI
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
JUSTICE KS
HEGDE
MANGALORE
CHARITABLE
HOSPITAL
Belgaum
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
HAVERI
Belgaum
MEDIHOPE
HOSPITALS AND
BANGALORE
RESEARCH
CENTRE PVT LTD
CHD,VSD L->R
SHUNT
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT UPPER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
28-Jul-15
11-Aug-15
25000
40461
25000
2500
22500
IDBI - 321
30-Oct-15
CHD-Large
Ostium
CARDIOLOGY
Secundum ASD
with left to right.
Cardiology
Device Closure
ASD Device
Closure
120
120
6-Aug-15
8-Aug-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
MANGALORE
Female
10
2511 H_19571312419
Male
24
2512 H_19576314653
Female
8
Others Dharwad
DHARWAD
DHARWAD
Belgaum
SDM Narayana
Hrudayalaya
2513 H_19571313286
Female
18
Others GADWANTHI
HUMNABAD
BIDAR
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT UPPER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
30-Jul-15
6-Aug-15
25000
34036
25000
2500
22500
IDBI - 321
30-Oct-15
2514 H_20575312961
Female
71
Minorit
SURALESHWAR
y
HANAGAL
HAVERI
Belgaum
MANGALORE
INSTITUTE OF
ONCOLOGY
CA RIGHT LUNG
CANCER
T3N1M1(BRAIN)
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
1-Aug-15
11-Aug-15
20000
14000
13300
1330
11970
IDBI - 321
30-Oct-15
Bangalore
NANJAPPA LIFE
SHIMOGA
CARE
ISCHEMIC HEART
DISEASE, HBP,
TRIPLE VESSEL
CARDIOLOGY
DISEASE, CVA
POSTERIOR MI
Cardiology
Cardiology
Medical
treatment of
Acute MI with
Thrombolysis
128
128
1-Aug-15
4-Aug-15
75000
75000
75000
750
74250
IDBI - 321
30-Oct-15
Belgaum
Belgaum Cancer
BELGAUM
Hospital Pvt Ltd
Ca Cervix stage
IIIB
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
4-Aug-15
5-Aug-15
94500
22922
16230
1623
14607
IDBI - 321
30-Oct-15
2516 H_19504313741
Male
Female
52
47
SC
SAVANUR
BANGALORE
SOUTH
2510 H_20242314652
2515 H_19513314473
Others KADAKOLA
RENAL
PATAWADA THANDA GULBARGA
Others GADIKOPPA
Others Dharwad
SHIMOGA
DHARWAD
SHIMOGA
DHARWAD
Dharwad
MANGALORE
CARDIOLOGY
CANCER
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
2517 H_19571313826
Female
42
Others HAVNOOR
AFJALPUR
2518 H_20010313393
Male
60
Others PACHALARAHALLI
2519 H_19571313280
Female
20
2520 H_19574311954
Female
2521 H_19562313575
2522 H_19574313744
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
RT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
31-Jul-15
5-Aug-15
25000
31943
25000
2500
22500
IDBI - 321
30-Oct-15
RURAL
Bangalore
M S Ramaiah
Hospital
L2-L5 CARVAL
STENOSUS
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
27-Jul-15
24-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
Others SAVALGI
GULBARGA
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
30-Jul-15
5-Aug-15
25000
32177
25000
2500
22500
IDBI - 321
30-Oct-15
70
Others KADIREHALLI
SIRA
TUMKUR
Bangalore
VYDEHI
HOSPITAL
BANGALORE
Carcinoma
esophagus Lower CANCER
1/3
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
7-Aug-15
19-Sep-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
Female
77
Minorit
LAKKAVALI
y
TARIKERE
CHIKKAMANAGL
Mysore
UR
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
SHIMOGA
A known case of
ca. BM T3N0ZM0 CANCER
Stage II
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
2-Aug-15
12-Aug-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
Female
63
Others RAMPURA
SIRAGUPPA
BELLARY
Gulbarga
VYDEHI
HOSPITAL
BANGALORE
L4-L5 Listhesis
NEURO SURGERY
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
4-Aug-15
14-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
SUVARNA NAGAR
Others
SHAHBAZAR
RT RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
21-Jul-15
8-Aug-15
25000
43031
25000
2500
22500
IDBI - 321
30-Oct-15
2523 H_19571309707
Female
63
2524 H_19571313157
Female
49
2525 H_19571313851
Female
10
2526 H_20332314359
Female
38
GULBARGA
BANGALORE
NORTH
NEURO SURGERY
GULBARGA
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
BILWAR
JEVARGI
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
BILATERAL
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
29-Jul-15
13-Aug-15
37500
44053
37500
3750
33750
IDBI - 321
30-Oct-15
Others BILWAR
JEVARGI
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT UPPER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
31-Jul-15
5-Aug-15
25000
31910
25000
2500
22500
IDBI - 321
30-Oct-15
MAGADI
RAMANAGAR
Bangalore
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
rt lower ureteric
RENAL
calculus
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
19-Aug-15
24-Aug-15
25000
25000
23940
2394
21546
IDBI - 321
30-Oct-15
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
RECURRENT
URETHRAL
STRICTURE
RENAL
Genito Urinary
Surgery
Urology
Urethroplasty for
a year can be
considered)
912
912
17-Aug-15
3-Sep-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
AML
CANCER
Medical Oncology
Induction/1st
Phase
547
547
27-Jul-15
21-Aug-15
50000
56599
50000
5000
45000
IDBI - 321
30-Oct-15
CHD - TOF
CARDIOLOGY
ICR for TOF
154
154
30-Jul-15
18-Aug-15
80000
80000
80000
0
80000
IDBI - 321
30-Oct-15
URSL - Single Side
+ DJ Stent
909
909
4-Aug-15
6-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
SC
SC
DAMMANAKATTE
2527 H_20025312034
Male
27
Others BENDARAHALLI
KOLLEGAL
CHAMARAJANA
Mysore
GAR
2528 H_21052314387
Female
47
Others THIRTHAHALLI
THIRTHAHALLI
SHIMOGA
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
SJICR
BANGALORE
SOUTH
MYSORE
MYSORE
Mysore
Mangala
Hospital
K R Puram
Lt upper ureteric
RENAL
stone 712.8mm
Genito Urinary
Surgery
SAVANUR
HAVERI
Belgaum
SJICR
BANGALORE
SOUTH
CHD - ASD,
TAPVC
TAPVC
160
160
30-Jul-15
21-Aug-15
95000
95000
95000
0
95000
IDBI - 321
30-Oct-15
Bangalore
INDIANA
HOSPITAL AND
HEART
INSTITUTE LTD
MANGALORE
BRADYARRYTHM
IA(SYMPTOMATI CARDIOLOGY
C)
Cardiology
Cardiology
EP study
125
125
1-Aug-15
7-Aug-15
30000
30000
10000
1000
9000
IDBI - 321
30-Oct-15
Mysore
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
MYSORE
20 MM (450-650
HU) LT RENAL
RENAL
UPPER & LOWER
POLES.
Genito Urinary
Surgery
Urology
ESWL (Extra
Stent
908
908
28-Jul-15
3-Aug-15
10000
10000
10200
1020
9180
IDBI - 321
30-Oct-15
SOLAPUR
CAD, NATIVE
TRIPLE VESSEL
DISEASE, LIMA
PATENT, SVG
OCCLUDED
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
1-Aug-15
8-Aug-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
29-Jul-15
3-Aug-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
9-Aug-15
14-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Cardiology
Medical
treatment of
Acute MI with
Thrombolysis
128
128
30-Jul-15
3-Aug-15
10000
10000
9025
903
8122
IDBI - 321
30-Oct-15
2529 H_19577314284
Male
1
Others DEVINAGAR
2530 H_20118314423
Male
32
Others
2531 H_19577314361
Male
9 Months
2532 H_20322314125
2533 H_19542313012
Male
Male
28
54
#370 5th cross c
block Gousiya nagar
Minorit
SALAGERI ONI
y
Others SAMANAVALLI
Others NAGARAGATTA
SORABA
KR PET
SHIMOGA
MANDYA
Bangalore
CARDIOLOGY
2534 H_20198314360
Male
69
Others 0
ALAND
GULBARGA
Gulbarga
YASHODHARA
SUPER
SPECIALITY
HOSPITAL PVT
LTD
2535 H_20074314223
Male
62
Others T.DASARAHALLI
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
M S RAMAIAH
NARAYANA
BANGALORE
HRUDAYALAYA
EFFORT ANGINA CARDIOLOGY
Cardiology
SIRSI
UTTARA
KANNADA
Belgaum
TSS-Shripad
Hegde Kadave
Institute of
Medical Scie
SIRSI
Rt Renal calculus
RENAL
with Azotoemia
Genito Urinary
Surgery
MYSORE
IHD-ACS ACUTE
IWMI
2536 H_20237314392
2537 H_20733314394
Female
Female
65
Others Gerusoppa
47
Minorit
KALYANAGIRI
y
MYSORE
MYSORE
Mysore
SJICR MYSORE
CARDIOLOGY
Cardiology
Urology
Sl.No
Preauth No
Gender
Age
2538 H_21223314251
Female
1 Days
2539 H_21701314249
Male
2540 H_19522314165
Male
2541 H_19513314375
Male
Caste
Village
Taluk
Patient District
Patient
Division
Others AMBEDKAR NAGARA BANGARPET
KOLAR
Bangalore
58
Others shetkar galli
AURAD
BIDAR
Gulbarga
40
Others PALADKA
MANGALORE
DAKSHINA
KANNADA
Mysore
45
Minorit
VIDHYA NAGARA
y
SHIMOGA
SHIMOGA
Hospital Name
Hospital
District
INDIRA GANDHI
BANGALORE
INSTITUTE OF
SOUTH
CHILD HEALTH
SUNSHINE
HEART
INSTITUTE
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
Final
Diagnosis
Diseases
Disease Main
Category
Oesophageal
atresia
NEONATAL
Paradise, S.D.
Road
CAD-DVD
CARDIOLOGY
MANGALORE
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Oesophageal
Atresia
301
301
1-Aug-15
7-Sep-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
CABG
132
132
24-Jul-15
8-Aug-15
95000
95000
96900
9690
87210
IDBI - 321
30-Oct-15
CA(L)GINGIVOBU
CCAL SULCUS
CANCER
STAGE II
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
24-Jul-15
9-Sep-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
Cardiology
Cardiology
PTCA - 2 stent
(non-medicated)
104
104
5-Aug-15
8-Aug-15
70000
70000
55000
550
54450
IDBI - 321
30-Oct-15
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
30-Jul-15
11-Sep-15
75000
75000
76500
7650
68850
IDBI - 321
30-Oct-15
Bangalore
NANJAPPA LIFE
SHIMOGA
CARE
ISCHEMIC HEART
DISEASE, ACUTE
CORONARY
CARDIOLOGY
SYNDROME,
TRIPPLE VESSEL
DISEASE
Bangalore
KASTURBA
HOSPITAL
RECURRENCE
GIANT CELL
TUMOUR
Male
24
Others H B HALLI
PAVAGADA
TUMKUR
2543 H_20332314294
Male
38
Others THATTAHALLI
GUDIBANDE
CHIKKABALLAPU
Bangalore
R
INSTITUTE OF
BANGALORE
NEPHROUROLO
EAST
GY
rt lower ureteric
RENAL
calculus
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
7-Aug-15
12-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
PIRIYAPATNA
MYSORE
Mysore
Bharath
Hospital
Institute of
Oncology
Mysore
CA
ENDOMETRIUM
POST OP
CANCER
p1BNxMx WITH
RECURRENT
DISEASE
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
3-Aug-15
5-Sep-15
60000
60000
60000
0
60000
IDBI - 321
30-Oct-15
NANJANAGUD
MYSORE
Mysore
SJICR MYSORE
MYSORE
IHD-ACS ACUTE
AWMI
CARDIOLOGY
Cardiology
Cardiology
Medical
treatment of
Acute MI with
Thrombolysis
128
128
30-Jul-15
3-Aug-15
10000
10000
8075
808
7267
IDBI - 321
30-Oct-15
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
BILATERAL
RENAL STONES
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
25-Jul-15
5-Aug-15
25000
36825
25000
2500
22500
IDBI - 321
30-Oct-15
Female
64
2545 H_20733314319
Female
65
Others SATHYAGALA
SC
ALAGANJI
CANCER
2542 H_19564314302
2544 H_19505312395
UDUPI
2546 H_19571311675
Female
38
Others BHAKNAL
BASAVAKALYAN
BIDAR
A
2547 H_20082306911
Female
57
Others BELURU
BELUR
HASSAN
Mysore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
CA OVARY Stage
CANCER
III
Surgical Oncology
Gynaec
Surgery for Ca
Ovary - early stage
595
595
30-Jul-15
6-Aug-15
35000
35000
21000
2100
18900
IDBI - 321
30-Oct-15
2548 H_19528314311
Female
41
Others TU NGAL
JAMAKHANDI
BAGLAKOT
Belgaum
Narayana
Hrudayalaya
Private Limited
Bangalore
CAD-SVD
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
3-Aug-15
5-Aug-15
55000
55000
56100
1683
54417
IDBI - 321
30-Oct-15
DAVANAGERE
DAVANGERE
Bangalore
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
COMPLETE
HEART BLOCK
CARDIOLOGY
Cardiology
Permanent
pacemaker
VVI) including
Pacemaker value
114
114
3-Aug-15
9-Aug-15
75000
75000
75000
7500
67500
IDBI - 321
30-Oct-15
CHIKKODI
BELGAUM
Belgaum
Kolhapur Cancer
Karveer
Centre
CA LATERAL
BORDER OF
TONGUE
T2N0M0
CANCER
Surgical Oncology
Head & Neck
612
612
4-Aug-15
8-Aug-15
32500
32500
32500
3250
29250
IDBI - 321
30-Oct-15
CA CERVIX II B
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
7-Aug-15
10-Sep-15
75000
113500
75000
7500
67500
IDBI - 321
30-Oct-15
CARDIOLOGY
CABG
132
132
28-Jul-15
14-Aug-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
2549 H_20079314314
Male
61
Minorit
JALINAGAR
y
2550 H_20435314061
Male
32
Others BHOJ
CARDIOLOGY
CHIKKODI
BELGAUM
Belgaum
Kolhapur Cancer
Karveer
Centre
Others DYAPALAPURA
HASSAN
HASSAN
Mysore
MEDIHOPE
HOSPITALS AND
BANGALORE
RESEARCH
CENTRE PVT LTD
IHD, TVD
21
Others Chialdinni
BIJAPUR
BIJAPUR
Belgaum
DR MUNIR
BANGI
HOSPITAL
BIJAPUR
Left Side Ureteric
RENAL
Calculus
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
28-Jul-15
3-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
46
Minorit
jeevangi
y
GULBARGA
GULBARGA
Gulbarga
SUNSHINE
HEART
INSTITUTE
Paradise, S.D.
Road
CRHD SEVER
MS,NO MR
CARDIOLOGY
TRIVIAL TR,MILD
PAH
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
30-Jul-15
6-Aug-15
20000
20000
20400
2040
18360
IDBI - 321
30-Oct-15
2551 H_20435312913
Female
22
2552 H_20242314280
Male
55
2553 H_22054313847
Male
2554 H_21701314184
Female
SC
KALLOL
Sl.No
Preauth No
Gender
Age
2555 H_19528313990
Female
68
2556 H_21701314171
Male
43
2557 H_20254313771
Female
2558 H_19567314228
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
AFJALPUR
GULBARGA
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
CA CERVIX III
CANCER
Medical Oncology
kunchavaram
CHINCHOLI
GULBARGA
Gulbarga
SUNSHINE
HEART
INSTITUTE
Paradise, S.D.
Road
CAD-DVD
CARDIOLOGY
34
Others Thirumatturu
HIREKERUR
HAVERI
Belgaum
Shakuntala
Memorial
Hubli
Hospital and
Research Centre
carcinoma right
breast stage II
Male
66
Others Sunnal
RAMADURGA
BELGAUM
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Tongue RT
Border Post op
with neck node
mets
2559 H_20017314215
Female
36
Others SARAPUR
HUKKERI
BELGAUM
Belgaum
S/P A V REPAIR
WITH SEVERE AS
CARDIOLOGY
WITH SEVERE
PAH
2560 H_20017314218
Male
55
Others NAVALAGI
JAMAKHANDI
BAGLAKOT
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
CAD TVD WITH
LM
2561 H_21718314160
Male
23
Others HASAGANURU
ALUR
HASSAN
Mysore
SSM Hospital
Right VUJ Calculi RENAL
58
#94, Haleem Nagara,
Others Banni Mantapa,
MYSORE
Mysuru
2562 H_20733313570
Male
Others KARAJAGI
SC
BANGALORE
SOUTH
MYSORE
BANGALORE URBAN
Mysore
2563 H_20300314166
Male
65
Others YALACHAGUPPE
2564 H_20082314111
Male
66
Others
2565 H_20017314148
Female
4 Months
Others PAMALADINNI
GOKAK
BELGAUM
Belgaum
2566 H_20082309547
Male
45
Others ACHENAHALLI
MADHUGIRI
TUMKUR
Bangalore
2567 H_20025313580
Female
31
2568 H_19574310349
Male
14
2569 H_20010313804
Female
31
SC
MARINAYAKANAHAL
CHINTAMANI
LI
KUKKARAHALLI
Others EVANI
ST
MAMBHALLI
Bangalore
CHIKKABALLAPU
Bangalore
R
SJICR MYSORE
BMCRI SSH
PMSSY
Kidwai
Memorial
Institute of
Oncology
KLES Dr
Prabhakar Kore
Hospital and
MRC
Kidwai
Memorial
Institute of
Oncology
HASSAN
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Weekly
Cisplatin/Week
509
509
10-Aug-15
11-Sep-15
77000
69000
70380
2111
68269
IDBI - 321
30-Oct-15
CABG
132
132
29-Jul-15
11-Aug-15
95000
95000
96900
9690
87210
IDBI - 321
30-Oct-15
CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
3-Aug-15
10-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
CANCER
Surgical Oncology
Head & Neck
612
612
1-Sep-15
14-Sep-15
25000
40090
25000
2500
22500
IDBI-294
9-Oct-15
Aortic Valve
Replacement
146
146
28-Jul-15
17-Aug-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
CABG
132
132
29-Jul-15
19-Aug-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
1-Aug-15
4-Aug-15
25000
26615
23750
2375
21375
IDBI - 321
30-Oct-15
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
30-Jul-15
3-Aug-15
65000
65000
60325
6033
54292
IDBI - 321
30-Oct-15
CARDIOLOGY
Cervical Cancer
MYSORE
IHD-ACS-Acute
AWMI
Bangalore
ANTERIOR
COMMUNICATIN
G ARTERY
NEURO SURGERY
ANEUSYSUM ,
SUBARCHNOID
HEMMORRAGE
Neuro Surgery
Brain
Aneurysm
Clipping
422
422
30-Jul-15
13-Aug-15
100000
100000
100000
10000
90000
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Oesophagus
CANCER
TxNxM1 Stage IV
Radiation Oncology
Radiotherapy
Treatment
563
563
3-Aug-15
7-Aug-15
10000
10000
7000
700
6300
IDBI - 321
30-Oct-15
Belgaum
MENINGOMYEL
NEURO SURGERY
OCELE
Neuro Surgery
Brain
417
417
30-Jul-15
12-Aug-15
35000
35000
35000
3500
31500
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
Ca Lung T3N1M0 CANCER
Radiation Oncology
Radiotherapy
Treatment
563
563
11-Aug-15
22-Aug-15
10000
14200
7000
700
6300
IDBI - 321
30-Oct-15
MUCO EPIDERMOID CA
OF LT SALIVARY CANCER
GLAND
(PAROTID)
Surgical Oncology
Head & Neck
Parotidectomy any type
616
616
5-Aug-15
18-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
NEURO SURGERY
Neuro Surgery
Brain Tumour
Excision of Brain
Tumors Subtentorial
408
408
4-Aug-15
24-Aug-15
48000
48000
48000
4800
43200
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
Lap. Nephrectomy
Simple (Lap
919
919
16-Jul-15
14-Aug-15
45000
45000
45000
4500
40500
IDBI - 321
30-Oct-15
239
239
31-Jul-15
3-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
MYSORE
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
CHITTAPUR
GULBARGA
Gulbarga
VYDEHI
HOSPITAL
BANGALORE
YELANDUR
CHAMARAJANA
Mysore
GAR
M S Ramaiah
Hospital
BANGALORE
NORTH
Cerebellar
vermian Astrocytoma
LAP SIMPLE
NEPNECTOMY
(LEFT SIDE)
CARDIOLOGY
Meningomyelocel
e
BANGALORE
SOUTH
Recent IWMI
Post Infarct
Angina CAD Single Vessel
Disease
CARDIOLOGY
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
CHANNAPATNA
LEFT URETERIC
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
30-Jul-15
5-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Hosakere
JAGALURU
DAVANGERE
Bangalore
TRINITY
HOSPITAL AND
HEART
FOUNDATION
27
CHANNEGOWDA
Others BADAVANE ,
MADDUR TOWN
MADDUR
MANDYA
Mysore
PUNYA
HOSPITAL
Male
54
(V) MUSTARI WADI
Others (T,Q) HUMNABAD
(DIST) BIDAR.
HUMNABAD
BIDAR
Gulbarga
NARAYANA
HOSPITALS
CAD-SINGLE
CARDIOLOGY
VESSEL DISEASE.
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
29-Jul-15
6-Aug-15
65000
65000
62985
6299
56686
IDBI - 321
30-Oct-15
2573 H_20061314004
Female
59
H.NO.1-6-79
Others SHAHARAN NAGAR
YADGIRI.
YADGIR
YADGIRI
Gulbarga
NARAYANA
HOSPITALS
CAD-DOUBLE
CARDIOLOGY
VESSEL DISEASE.
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
29-Jul-15
7-Aug-15
90000
90000
87210
8721
78489
IDBI - 321
30-Oct-15
2574 H_22289314008
Female
69
Others Shiradawad
CHIKKODI
BELGAUM
Belgaum
APPLE
HOSPITALS AND
KOLHAPUR
RESEARCH
INSTITUTE LTD
CAD-DVD
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
31-Jul-15
20-Aug-15
90000
90000
65000
6500
58500
IDBI - 321
30-Oct-15
2570 H_19593314099
Female
47
2571 H_21316313348
Male
2572 H_20061314017
ST
CARDIOLOGY
Sl.No
Preauth No
2575 H_19583313968
2576 H_20200314045
2577 H_21718313312
Gender
Age
Male
16
Male
Male
63
30
2578 H_22525308870
Male
39
2579 H_22525313259
Male
44
2580 H_20733313984
Male
45
Caste
Village
Minorit
K T JA NAGAR
y
Minorit
RAJIVANAGAR
y
Others MADIHALLI
Taluk
DAVANAGERE
MYSORE
HASSAN
Patient District
DAVANGERE
MYSORE
HASSAN
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Bangalore
S.S. INSTITUTE
OF MEDICAL
NH-4,Bypass PB Electrical burns
SCIENCES &
Road Davanagere upto 30%
RESEARCH CENT
Mysore
NARAYANA
HRUDAYALAYA
SURGICAL
MYSORE
HOSPITAL PVT
LTD
CAD ACUTE IW
/PW STEMI
Mysore
SSM Hospital
Fracture of right
Zygomatic
complex, Right
Frontal,
Dentoalveolar
POLYTRAUMA
fracture of
anterior maxilla
with soft tissue
injuries and head
injury.
lumbar
laminictomy
NEURO SURGERY
with stabilization
HASSAN
BURNS
CARDIOLOGY
Disease Main
Category
Plan of
treatment
Burns
upto 30% (with
grafting)
Cardiology
Polytrauma
Burns
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
1
1
29-Jul-15
26-Aug-15
40000
40740
40000
4000
36000
IDBI - 321
30-Oct-15
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
31-Jul-15
3-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
Plastic Surgery
Facial bone
807
807
1-Aug-15
4-Aug-15
35000
39859
33250
3325
29925
IDBI - 321
30-Oct-15
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
16-Jul-15
25-Jul-15
50000
50000
25000
2500
22500
IDBI - 321
30-Oct-15
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
28-Jul-15
6-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
ALAND
GULBARGA
Gulbarga
Balawant
Institute of
Solapur
Neurosurgery
Intensive Trama
Others 0
BIJAPUR
BIJAPUR
Belgaum
Balawant
Institute of
Solapur
Neurosurgery
Intensive Trama
lumbar
discectomy
Minorit
K.R.NAGAR
y
KR NAGAR
MYSORE
Mysore
SJICR MYSORE
MYSORE
IHD-EVOLVED
CARDIOLOGY
AWMI CAD-SVD
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
1-Aug-15
5-Aug-15
65000
65000
61275
6128
55147
IDBI - 321
30-Oct-15
RANEBENNUR
BPH
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
3-Aug-15
9-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
SC
PADSAVALI
NEURO SURGERY
2581 H_20215313944
Male
71
Others Khanapur
NARAGUNDA
GADAG
Belgaum
SRI LAXMI
SURGICAL
TRAUMA
ORTHO AND
MULTISPECILIT
2582 H_19528313903
Male
29
Others sugur
CHITTAPUR
GULBARGA
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
RHD MS AS AR
CARDIOLOGY
Double Valve
Replacement
149
149
1-Aug-15
12-Aug-15
150000
150000
153000
4590
148410
IDBI - 321
30-Oct-15
2583 H_20082313119
Female
76
Others MYKAND HALLI
CHINTAMANI
CHIKKABALLAPU
Bangalore
R
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca rt breast
T2N0Mx
CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
5-Aug-15
8-Aug-15
25000
27150
25000
2500
22500
IDBI - 321
30-Oct-15
2584 H_19577313825
Female
45
Others KOLLIGANAHALLI
KANAKAPURA
RAMANAGAR
SJICR
BANGALORE
SOUTH
IHD - AWMI,
DM, HTN, SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
3-Aug-15
6-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
Cardiology
Cardiology
EP study
125
125
1-Aug-15
5-Aug-15
30000
30000
30000
0
30000
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
25-Jul-15
8-Aug-15
25000
25000
23750
2375
21375
IDBI - 321
30-Oct-15
Bangalore
WPW
SYNDROME,
CARDIOLOGY
RIGHT
POSTEROLATERA
L PATHWAY
RIGHT
PROXIMAL
RENAL
URETERIC
CALCULUS
RAICHUR
RAICHUR
Gulbarga
SJICR
BANGALORE
SOUTH
Others PETEBANAVARA
ARASIKERE
HASSAN
Mysore
YENEPOYA
MEDICAL
COLLEGE
HOSPITAL
MANGALORE
65
Others AVALAGARTHI
Bangalore
R
R
M S RAMAIAH
NARAYANA
BANGALORE
HRUDAYALAYA
CHRONIC TABLE
CARDIOLOGY
ANGINA
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
10-Aug-15
14-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
52
Others HANCHINAL CAMP
SINDNUR
Gulbarga
NANO
HOSPITALS
PRIVATE
LIMITED
CORONARY
CARDIOLOGY
ARTERY DISEASE
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
16-Jul-15
7-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
RIGHT FRONTAL
TEMPORAL
PARIETAL ACUTE NEURO SURGERY
TO SUBDURAL
SDH.
Neuro Surgery
Brain
Craniotomy and
Evacuation of
Haematoma Subdural
401
401
31-Jul-15
4-Aug-15
45000
45000
45000
4500
40500
IDBI - 321
30-Oct-15
Left Lower
Ureteric calculi
with bladder
calculi
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
31-Jul-15
4-Aug-15
25000
28529
23750
2375
21375
IDBI - 321
30-Oct-15
2585 H_19577313888
Male
55
2586 H_20698313480
Female
34
2587 H_20074313817
Male
2588 H_21736313252
Male
ST
MALLAPURA
2589 H_20079313841
Female
47
Others RAMAGIRE
2590 H_21718313855
Male
35
Others
KATTHI
MALLENAHALLI
RAICHUR
HYDERABAD
HOLALKERE
CHITRADURGA
Bangalore
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
ARAKALAGUD
HASSAN
Mysore
SSM Hospital
HASSAN
RENAL
Sl.No
Preauth No
Gender
Age
2591 H_20200313857
Male
29
2592 H_20017313839
Male
9
2593 H_19562309546
Female
36
2594 H_20733313578
Male
48
2595 H_22478313647
Male
26
Caste
Village
Others BANNUR ROAD
SC
MEDIKINAL
Others HULUGINAKATTE
SC
Someshwarapura
Others KERETHONNUR
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
IDBI - 321
30-Oct-15
HYPOSPADIAS
322
322
31-Jul-15
6-Aug-15
22000
22000
20900
2090
18810
IDBI - 321
30-Oct-15
A known case of
ca. (R) Lung
CANCER
CT3N1M0
Medical Oncology
Non-small cell lung
cancer
Carboplatin +
Paclitaxel/Cycle
526
526
8-Aug-15
3-Sep-15
21000
21000
21000
2100
18900
IDBI - 321
30-Oct-15
MYSORE
IHD-UNSTABLE
ANGINA CADSVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
28-Jul-15
3-Aug-15
90000
90000
61275
6128
55147
IDBI - 321
30-Oct-15
Mysore
SHREE
MAHADESHWA
MYSORE
RA NURSING
HOME
Right HUN with
U V junction
calculus
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
1-Aug-15
3-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Bangalore
CA RECTUM
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
5-Aug-15
10-Sep-15
71000
71000
72420
2173
70247
IDBI - 321
30-Oct-15
BANGALORE
NORTH
ARM S/P
COLOSTOMY
NEONATAL
Anorectal
Malformations
Stage 2
306
306
20-Jul-15
27-Aug-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
CAD,DVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
29-Jul-15
1-Aug-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
CA BREAST
cT1N1Mo
CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
5-Aug-15
8-Aug-15
25000
28085
20900
2090
18810
IDBI - 321
30-Oct-15
BANGALORE
EAST
BPH
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
3-Aug-15
10-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
BANGALORE
OLD AWMI- TVD CARDIOLOGY
CABG with IABP
133
133
24-Jul-15
10-Aug-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
DAVANGERE
BEP WITH
VASICAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
28-Jul-15
4-Aug-15
26250
26250
26250
2625
23625
IDBI - 321
30-Oct-15
c/a breast left
side
CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
27-Jul-15
18-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
IHD - TVD,
CARDIOLOGY
AWMI, DM, HTN
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
10-Jul-15
7-Aug-15
90000
90000
90000
0
90000
IDBI - 321
30-Oct-15
IHD EVOLVED
AWMI CAD SVD
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
23-Jul-15
8-Aug-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
Burns
Post Burn
Contracture
surgeries for
Functional
Improvement(Pack
age including
splints, pressure
garments and
physiotherapy),
Severe
11
11
24-Jul-15
8-Aug-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
239
239
29-Jul-15
31-Jul-15
65000
65000
65790
6579
59211
IDBI - 321
30-Oct-15
240
240
8-Aug-15
11-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
LINGASUGUR
RAICHUR
Gulbarga
SHIKARIPURA
SHIMOGA
Bangalore
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
SHIMOGA
MYSORE
MYSORE
Mysore
SJICR MYSORE
PANDAVAPURA MANDYA
Gulbarga
Female
44
Others MARANGERE
TIPTUR
TUMKUR
Bangalore
2600 H_20332313740
Male
67
Others THOTANAHALLI
NELEMANGALA
BANGALORE RURAL
Bangalore
2601 H_19586311924
Male
49
Others WARD NU;10
BAGALKOTE
BAGLAKOT
Belgaum
2602 H_20619312595
Male
77
Others KABBALA
HOSADURGA
CHITRADURGA
Bangalore
2603 H_21132313437
Female
43
Others BELURU
BELUR
HASSAN
Mysore
Shree
Hospital/HIMS
2604 H_19577313413
Male
66
Others ANEKERE
TURVEKERE
TUMKUR
Bangalore
SJICR
2605 H_20017313725
Male
60
Others KALARKOPPA
GOKAK
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
2607 H_19564313501
2608 H_20079313674
Male
Male
KOLAR
KOLAR
UDUPI
30000
BASAVAKALYAN
BIDAR
A
Others KUVEMPUNAGAR
Net Amt
Paid
0
Others RAJOLA
16
TDS
30000
60
Female
Gross
Amount
approved by
30000
M S Ramaiah
Hospital
2606 H_20300313467
Hospital
claimed
Amount
30000
Bangalore
2599 H_20082308906
Preauth
Approved
Amt
7-Aug-15
BANGALORE URBAN
Male
Date of
Discharge
3-Aug-15
BANGALORE
EAST
2598 H_21225313432
Date of
Admission
419
Others KAMALANAGAR
3 Months
419
Gulbarga
Male
Plan of
treatment
Cranioplasty
KOPPAL
2597 H_20010311281
Brain
Mysore
KOPPAL
60
Disease Main
Category
Neuro Surgery
MYSORE
Others KANDAKURA
Female
Diseases
POSTCRANIRCTO
MY STATUS
NEURO SURGERY
DEFECT
MYSORE
Narayana
Hrudayalaya
Private Limited
2596 H_19528311110
Final
Diagnosis
Bangalore
61
Others KATBETHURU
KUNDAPURA
Mysore
65
Minorit
NEHARU NAGAR
y
Mysore
R
UR
Kidwai
Memorial
Institute of
Oncology
INSTITUTE OF
NEPHROUROLO
GY
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
SUKSHEMA
HOSPITAL
PVTLTD
BMCRI SSH
PMSSY
KASTURBA
HOSPITAL
BANGALORE
SOUTH
Bangalore
UDUPI
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
PBSC NECK
NEONATAL
CARDIOLOGY
BURNS
Burns
CARDIOLOGY
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
ANTERIOR WALL
MI WITH MILD
LV
CARDIOLOGY
DYSFUNCTION
WITH CAD-SVD.
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
ACUTE IWMI
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
24-Jul-15
11-Sep-15
87000
87000
82650
8265
74385
IDBI - 321
30-Oct-15
2609 H_20575313454
Male
56
Others KENCHANA HALLI
BHADRAVATHI
SHIMOGA
Bangalore
MANGALORE
INSTITUTE OF
ONCOLOGY
2610 H_19567313008
Female
51
Others Tondihal
YELBURGA
KOPPAL
Gulbarga
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca ovary stage II CANCER
Surgical Oncology
Gynaec
Surgery for Ca
Ovary - early stage
595
595
3-Aug-15
22-Aug-15
25000
25000
25000
2500
22500
IDBI-294
9-Oct-15
2611 H_19576313652
Male
55
Others Mundaragi
GADAG
GADAG
Belgaum
SDM Narayana
Hrudayalaya
Dharwad
IHD-AWMI, CADSignificant LAD & CARDIOLOGY
D1 disease
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
31-Jul-15
3-Aug-15
90000
90000
65000
6500
58500
IDBI - 321
30-Oct-15
2612 H_19581312924
Female
61
Others AMBEDKAR NAGAR
KR PET
MANDYA
Mysore
Cauvery
Hospital
MYSORE
RT RENAL
CALCULUS
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
2-Aug-15
4-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
ACS ACUTE
INFEROPOSTERI CARDIOLOGY
OR WALL + RVMI
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
29-Jul-15
31-Jul-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
MANGALORE
CA RIGHT LUNG
CANCER
T3N1M0 III
RENAL
2613 H_20200313641
Male
55
Others MODURU
KR PET
MANDYA
Mysore
NARAYANA
HRUDAYALAYA
SURGICAL
MYSORE
HOSPITAL PVT
LTD
2614 H_20025313564
Male
47
Others DASANAPURA
HUNSUR
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
PRE-EXCITATION WPW
CARDIOLOGY
SYNDROME
Cardiology
Cardiology
EP study
125
125
15-Aug-15
17-Aug-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
2615 H_20010313388
Male
62
Others JANGAMAKOTE
SIDLAGATTA
CHIKKABALLAPU
Bangalore
R
M S Ramaiah
Hospital
LEFT BUCCAL
MUCOSA
CARCINOMA
CT2N1M0
Surgical Oncology
Head & Neck
Hemimandibulect
omy
620
620
20-Jul-15
24-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
MYSORE
SINGLE VESSEL
DISEASE.
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
28-Jul-15
31-Jul-15
65000
65000
62985
6299
56686
IDBI - 321
30-Oct-15
BANGALORE
NORTH
CANCER
2616 H_19542313164
Male
71
Minorit
MIRZA MOHALLA
y
HASSAN
HASSAN
Mysore
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
2617 H_20083313492
Male
1
Minorit
K.R PURAM
y
SHIMOGA
SHIMOGA
Bangalore
Bhagwan
Mahaveer Jain
Hospital
Bangalore
LARGE ASD WITH
CARDIOLOGY
SEVERE PAH
ASD
151
151
10-Aug-15
19-Aug-15
80000
285384
80000
0
80000
IDBI - 321
30-Oct-15
2618 H_19564313017
Male
58
Others AMPARU
KUNDAPURA
UDUPI
Mysore
KASTURBA
HOSPITAL
UDUPI
ANTERIOR WALL
CARDIOLOGY
MI(AWMI)
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
28-Jul-15
31-Jul-15
90000
90000
91290
9129
82161
IDBI - 321
30-Oct-15
2619 H_20061313476
Male
55
(V) KUDLOOR (T,Q)
Others YADGIRI (DIST)
YADGIRI.
YADGIR
YADGIRI
Gulbarga
NARAYANA
HOSPITALS
PIVD-C3-C4-C5C6 AND
COMPRESSION.
NEURO SURGERY
Neuro Surgery
Spinal
LaminectomyCervical
431
431
29-Jul-15
4-Aug-15
25000
25000
25500
2550
22950
IDBI - 321
30-Oct-15
Ca Breast T2 N1
Mo
CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
16-Jul-15
21-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
RHD SEVERE
MITRAL
STENOSIS
CARDIOLOGY
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
22-Jul-15
5-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
JUNTA RENAL
AORTIC
OCCLUSION
CARDIOLOGY
Axillo bifemoral
bypass with
Synthetic Graft
228
228
25-Jul-15
1-Aug-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
IHD - AWMI,
DVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
20-Aug-15
24-Aug-15
90000
65000
65000
0
65000
IDBI - 321
30-Oct-15
907
907
24-Aug-15
29-Aug-15
25000
35200
25000
2500
22500
IDBI - 321
30-Oct-15
2620 H_21194313317
Female
35
2621 H_20017313565
Female
25
2622 H_20025312347
Male
55
2623 H_19577313544
Male
52
SC
MADDUR
MANDYA
Mysore
Others SOMAPUR
SAVADATTI
BELGAUM
Belgaum
Others SATHAGALLI
MYSORE
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
KORATAGERE
TUMKUR
Bangalore
SJICR
BASAVANABAGE
BIJAPUR
WADI
Belgaum
SANJEEVINI
Y HOSPITAL
ST
MANIGERE
Mandya
Institute of
Mandya
Medical
Sciences
Mandya
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
THARATI
Others Ksalwadgi
BANGALORE
SOUTH
CARDIOLOGY
Cardiology
Cardiology
Right renal Pelvic
RENAL
Calculi
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
2624 H_20643311187
Female
22
2625 H_19577313374
Male
47
ST
BENDRE NAGARA
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
SJICR
BANGALORE
SOUTH
IHD - LWMI, SVD CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
26-Jul-15
3-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
2626 H_19577313363
Female
35
SC
GURUVADERAHALLI
MADHUGIRI
TUMKUR
Bangalore
SJICR
BANGALORE
SOUTH
RHD - SEVERE
MS
CARDIOLOGY
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
19-Aug-15
24-Aug-15
20000
20000
20000
0
20000
IDBI - 321
30-Oct-15
2627 H_22971312929
Male
21
Others
MYSORE
Mysore
CSI Holdsworth
Memorial
Mysore
Hospital
PIVD L4-5
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
18-Aug-15
28-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
HALLADAMANUGAN
HD KOTE
AHALLI
Sl.No
Preauth No
2628 H_19577313395
Gender
Age
Male
47
Caste
Village
Minorit
H B R LAYOUT
y
2629 H_20698313106
Male
31
Others MALEBENNUR
2630 H_19562311326
Female
64
SC
2631 H_19577313405
Female
3
Others
2632 H_21223313488
Male
1 Days
2633 H_20300313490
Male
42
2634 H_19567313465
Male
45
SC
2635 H_19586311930
Male
63
SC
2636 H_20164311959
Male
55
2637 H_19491312988
Male
2638 H_20082312888
NARAYANA PURA
Taluk
BANGALORE
NORTH
Patient District
BANGALORE URBAN
Patient
Division
Hospital Name
Bangalore
SJICR
Hospital
District
Final
Diagnosis
Diseases
BANGALORE
SOUTH
IHD - AWMI,
DVD
MANGALORE
LEFT PROXIMAL
URETERIC
CALCULUS
RENAL
CAUSING
HUDROURETERO
NEPHROSIS
CARDIOLOGY
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
18-Aug-15
21-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
27-Jul-15
12-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Cardiology
HARIHARA
DAVANGERE
Bangalore
YENEPOYA
MEDICAL
COLLEGE
HOSPITAL
BHADRAVATHI
SHIMOGA
Bangalore
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
SHIMOGA
A known case of
ca. (R) GB Sulcus CANCER
T3N1M0
Surgical Oncology
Head & Neck
Maxillectomy any type
614
614
20-Aug-15
27-Aug-15
60000
60000
50000
5000
45000
IDBI - 321
30-Oct-15
Bangalore
SJICR
BANGALORE
SOUTH
CHD - PDA
Cardiology
Device Closure
PDA Device
Closure
119
119
3-Aug-15
6-Aug-15
60000
60000
60000
0
60000
IDBI - 321
30-Oct-15
417
417
25-Jul-15
24-Aug-15
35000
35000
35000
3500
31500
IDBI - 321
30-Oct-15
BHEERAGONDANAH
ALLI
RURAL
CARDIOLOGY
Others WARD 3
SREENIVASAPUR KOLAR
Bangalore
INDIRA GANDHI
BANGALORE
INSTITUTE OF
SOUTH
CHILD HEALTH
lumbar
meningomyeloce NEURO SURGERY
le
Neuro Surgery
Brain
Others MAHADEVAPURA
MYSORE
MYSORE
Mysore
BMCRI SSH
PMSSY
RT TEMPORAL
SOL
Neuro Surgery
Brain Tumour
Excision of Brain
Tumor
Supratentorial &
others
407
407
28-Jul-15
17-Aug-15
45000
45000
45000
4500
40500
IDBI - 321
30-Oct-15
Kotabagi
HUBLI
DHARWAD
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Rt. Buccal
Mucosa & angle CANCER
of mouth IV a
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
4-Aug-15
26-Aug-15
60000
68580
60000
6000
54000
IDBI-294
9-Oct-15
PATTADAKALLU
BADAMI
BAGLAKOT
Belgaum
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
BANGALORE
IHD TVD
CARDIOLOGY
CABG
132
132
24-Jul-15
7-Aug-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
Others HOLLAMBALLI
KOLAR
KOLAR
Bangalore
R L JALAPPA
HOSPITAL AND
RESEARCH
CENTRE
KOLAR
BPH WITH BOO
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
1-Aug-15
12-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
38
Others SARAGUR
KR NAGAR
MYSORE
Mysore
BGS GLOBAL
HOSPITAL
BANGALORE
SOUTH
Carcinoma
Cervix Interstitial CANCER
Brachytherapy
Radiation Oncology
ii. HDR - one
application and
multiple dose
fractions
573
573
4-Aug-15
6-Aug-15
20000
20000
20000
80
19920
IDBI - 321
30-Oct-15
Female
43
Others HALLIMYRAA
HOLENARSIPUR HASSAN
Mysore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca ovary III
Surgical Oncology
Gynaec
Surgery for Ca
Ovary - advance
stage
596
596
3-Aug-15
12-Aug-15
40000
43600
37000
3700
33300
IDBI - 321
30-Oct-15
2639 H_19564313038
Male
50
Others MUDRADI
KARKALA
UDUPI
Mysore
KASTURBA
HOSPITAL
UDUPI
ASD+MITRAL
VALVE
CARDIOLOGY
REPLACEMENT/R
EPAIR
Mitral Valve
Replacement
145
145
22-Jul-15
12-Aug-15
120000
120000
121890
12189
109701
IDBI - 321
30-Oct-15
2640 H_20079313339
Male
46
HIREKERUR
HAVERI
Belgaum
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
CAD-TVD.
CARDIOLOGY
CABG
132
132
31-Jul-15
14-Aug-15
95000
95000
90250
9025
81225
IDBI - 321
30-Oct-15
2641 H_20082310829
Female
53
Others HUMANABAD
HUMNABAD
BIDAR
Gulbarga
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca Cervix III B
CANCER
Surgical Oncology
Miscellaneous
689
689
3-Jul-15
6-Aug-15
55000
55000
52000
5200
46800
IDBI - 321
30-Oct-15
2642 H_19577313290
Female
42
Others GOWDANAPALYA
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
SJICR
BANGALORE
SOUTH
IHD - AWMI,
DM, HTN, SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
27-Jul-15
4-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
2643 H_20079313295
Female
42
BHADRAVATHI
SHIMOGA
Bangalore
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
CAD-SVD.
CARDIOLOGY
CABG
132
132
8-Aug-15
21-Aug-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
2644 H_19567312885
Male
63
Others Devasamudra
HOSPET
BELLARY
Gulbarga
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Lt. PFS Stage CANCER
IV A
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
9-Aug-15
22-Aug-15
20000
20000
20000
2000
18000
IDBI-294
9-Oct-15
2645 H_20010312708
Male
43
Others ANNAHALLI
RAMANAGAR
RAMANAGAR
Bangalore
M S Ramaiah
Hospital
L4-5 CANAL
STENOSIS
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
20-Jul-15
11-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
LT RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
23-Jul-15
3-Aug-15
25000
27002
25000
2500
22500
IDBI - 321
30-Oct-15
BENIGN
ENLARGEMENT
OF PROSTATE
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
22-Jul-15
3-Aug-15
20000
27000
20000
2000
18000
IDBI - 321
30-Oct-15
ST
SC
NAGAVANDA
DONABAGATTA
2646 H_19571310522
Female
33
SC
SHAHBAD ROAD
RAJAPUR GBL
2647 H_19571310109
Male
71
SC
BHEDSUR
Bangalore
BANGALORE
NORTH
GULBARGA
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
CHITTAPUR
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
NEURO SURGERY
CANCER
Meningomyelocel
e
VATS/Laparoscopy
Sl.No
Preauth No
2648 H_19571310501
Gender
Age
Male
77
Caste
Village
Others YANKANCHI
Taluk
SINDAGI
Patient District
BIJAPUR
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Belgaum
PATIL NURSING
HOME
GULBARGA
GULBARGA
BENIGN
ENLARGEMENT
OF PROSTATE
RENAL
Genito Urinary
Surgery
LT RENAL STONE
+
NEPHROSTOMY RENAL
TUBE + RT DJ
STENT & STONE.
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Urology
TURP
917
917
28-Jul-15
3-Aug-15
20000
23523
20000
2000
18000
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
27-Jul-15
5-Aug-15
25000
34870
25000
2500
22500
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
27-Jul-15
7-Aug-15
25000
37217
25000
2500
22500
IDBI - 321
30-Oct-15
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
4-Aug-15
15-Sep-15
75000
76880
75000
7500
67500
IDBI-294
9-Oct-15
2649 H_19571311978
Female
21
Others KAWALGA GBL
GULBARGA
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
2650 H_19571311879
Male
31
Others RAMASAMUDRA
YADGIR
YADGIRI
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT LOWER
RENAL
URETERIC STONE
Ca maxilla RT
Stage II
CANCER
Radiation Oncology
3D Conformational
Radio Therapy
2651 H_19567310874
Male
48
Others Bellary
BELLARY
BELLARY
Gulbarga
Karnataka
Cancer Therapy
Hubli
and Research
Institute
2652 H_19567313216
Male
50
Others Hulakatti
DHARWAD
DHARWAD
Belgaum
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Lt. Buccal
Mucosa
CANCER
Surgical Oncology
Head & Neck
Composite
Resection &
Reconstruction
611
611
7-Aug-15
3-Sep-15
60000
68580
60000
6000
54000
IDBI-294
9-Oct-15
2653 H_23069313210
Male
50
Others YASHODHARAPURA
HUNSUR
MYSORE
Mysore
THE RADIANT
INSTITUTE
MYSORE
CA STOMACH
STAGE II
CANCER
Surgical Oncology
Gastrectomy - any
type
636
636
29-Jul-15
8-Aug-15
40000
40000
37525
3753
33772
IDBI - 321
30-Oct-15
Belgaum
INDIANA
HOSPITAL AND
HEART
INSTITUTE LTD
MANGALORE
ACHD
PERIMEMBRANO
US VSD WITH
LEFT TO RIGHT CARDIOLOGY
SHUNT.NORMAL
BIVENTRICULAR
FUNCTION
VSD
152
152
30-Jul-15
11-Aug-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
2654 H_20322313126
Male
3
Others DOLLESHWARA
HANAGAL
HAVERI
2655 H_22586313196
Female
11
Others MUDALODU
GOWRIBIDANUR
CHIKKABALLAPU
Bangalore
R
HBS HOSPITAL
TRUST
BANGALORE
NORTH
?RHD,WITH
MODERATE TO
CARDIOLOGY
SEVERE MR,AML
PROLAPSE
Mitral Valve
Repair
141
141
4-Aug-15
8-Aug-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
2656 H_21701312572
Male
49
GULBARGA
GULBARGA
Gulbarga
SUNSHINE
HEART
INSTITUTE
Paradise, S.D.
Road
CAD-SVD
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
25-Jul-15
1-Aug-15
65000
65000
62985
6299
56686
IDBI - 321
30-Oct-15
Mysore
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
MANGALORE
PVD-LONG
SEGMENT
STENOSIS OF
CARDIOLOGY
BILATERAL
COMMON ILIAC
ARTERIES.
Aorto Billiac /
Bifemoral bypass
with Synthetic
Graft
227
227
21-Jul-15
26-Aug-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
L5-S1 GRADE II
LISTHESIS .
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
9-Aug-15
15-Aug-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
239
239
27-Jul-15
30-Jul-15
65000
65000
62985
6299
56686
IDBI - 321
30-Oct-15
2657 H_20015313179
Male
69
2658 H_20079313035
Female
35
2659 H_19542313158
Male
41
2660 H_20079313031
Male
20
SC
bapu nagar
Others PALIMARU
ST
ST
MALLANDUR
RAMPURA
Others JIRALEKOPPA
UDUPI
UDUPI
NARASAPURA
CHIKKAMANAGL
Mysore
UR
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
ARASIKERE
HASSAN
Mysore
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
SORABA
SHIMOGA
Bangalore
2661 H_20017313151
Male
21
Others 0
SAVADATTI
BELGAUM
Belgaum
2662 H_19586312493
Male
65
Others MUTKURU
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
2663 H_20017313090
Male
64
Others VIJAYAPUR
BIJAPUR
BIJAPUR
Belgaum
2664 H_19491313039
Male
57
Others VALLUR
PAVAGADA
TUMKUR
Bangalore
CARDIOLOGY
NEURO SURGERY
Cardiology
SINGLE VESSEL
DISEASE.
CARDIOLOGY
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
L4-5 PIVD.
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
4-Aug-15
13-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
RT.RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
ESWL (Extra
Stent
908
908
20-Jul-15
1-Aug-15
10000
10000
9000
900
8100
IDBI - 321
30-Oct-15
IHD-SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
27-Jul-15
6-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
MYSORE
SAPTHAGIRI
SUPER
BANGALORE
SPECIALITY
HOSPITAL
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
BGS GLOBAL
HOSPITAL
BANGALORE
SOUTH
S/P CABG WITH
SEVERE CALCIFIC CARDIOLOGY
AS
Aortic Valve
Replacement
146
146
27-Jul-15
12-Aug-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
ischaemic heart
disease ACS
Recent Anterior CARDIOLOGY
Wall Myocardial
Infarction
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
28-Jul-15
30-Jul-15
90000
90000
85500
342
85158
IDBI - 321
30-Oct-15
Cardiology
Sl.No
Preauth No
Caste
Village
Taluk
Patient District
Patient
Division
Gender
Age
Hospital Name
2665 H_20017313094
Female
9
Others BAMBALWAD
CHIKKODI
BELGAUM
Belgaum
2666 H_20619312591
Male
83
Others KABBALA
HOSADURGA
CHITRADURGA
Bangalore
2667 H_19577313056
Male
48
Minorit
LAKSHMI PURA
y
ARASIKERE
HASSAN
Mysore
SJICR
2668 H_19577313043
Female
22
Minorit
GINAL
y
SHAHPUR
YADGIRI
Gulbarga
SJICR
2669 H_19567312942
Male
59
Others Hospet
HOSPET
BELLARY
Gulbarga
2670 H_21701311718
Male
36
Others bibi galli
HUMNABAD
BIDAR
2671 H_20619312683
Male
14
Others ARPALU
2672 H_19587312750
Female
51
2673 H_20322312898
Male
2674 H_19505312384
2675 H_20322312860
Hospital
District
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
SUKSHEMA
DAVANGERE
HOSPITAL
PVTLTD
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
CHD PDA
CARDIOLOGY
Cardiology
Device Closure
PDA Device
Closure
119
119
27-Jul-15
1-Aug-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
BEP
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
28-Jul-15
3-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
IWMI, DVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
23-Aug-15
26-Aug-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
CHD - VSD, MOD
CARDIOLOGY
PR, SEVERE PAH
ICR for TOF
154
154
28-Jul-15
17-Aug-15
80000
80000
80000
0
80000
IDBI - 321
30-Oct-15
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Stomach
stage II
CANCER
Surgical Oncology
Gastrectomy - any
type
636
636
17-Aug-15
1-Sep-15
40000
46850
40000
4000
36000
IDBI-294
9-Oct-15
Gulbarga
SUNSHINE
HEART
INSTITUTE
Paradise, S.D.
Road
CAD-SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
24-Jul-15
1-Aug-15
65000
65000
62985
6299
56686
IDBI - 321
30-Oct-15
HARAPANAHALL
DAVANGERE
I
Bangalore
SUKSHEMA
HOSPITAL
PVTLTD
DAVANGERE
RIGHT LOWER
URETERIC
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
3-Aug-15
7-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Others JANIVARA VILLAGE
HASSAN
HASSAN
Mysore
Apollo BGS
Hospital
MYSORE
UNSTABLE
ANGINA
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
28-Jul-15
31-Jul-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
52
Others SAMANAVALLI
SORABA
SHIMOGA
Bangalore
MANGALORE
CAD SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
28-Jul-15
5-Aug-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
Male
75
Others GAGENAHALLI
HUNSUR
MYSORE
Mysore
Mysore
CA PANCREAS
LOCALLY
ADVANCED
CANCER
Radiation Oncology
Linear Accelerators
Radical Treatment
with Photons
565
565
31-Jul-15
3-Sep-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
Male
52
Others CHITRATTE
SORABA
SHIMOGA
Bangalore
MANGALORE
CAD-Recent UA
SEVERE LV
DYSFUNCTION
CARDIOLOGY
CABG with IABP
133
133
28-Jul-15
6-Aug-15
115000
115000
115000
11500
103500
IDBI - 321
30-Oct-15
PUTTUR
DAKSHINA
KANNADA
Mysore
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
MANGALORE
WELL
DIFFERENTIATED
SQUAMOUS CELL CANCER
CARCINOMA.T4
N1M0.
Surgical Oncology
Tumors
Amputation for
bone / soft tissue
tumours (Major /
Minor)
688
688
22-Jul-15
10-Aug-15
27500
27500
27500
2750
24750
IDBI - 321
30-Oct-15
SHRIRANGAPAT
MANDYA
NA
Mysore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
ca rt breast
cT2N1M0
CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
1-Aug-15
5-Aug-15
25000
26150
20900
2090
18810
IDBI - 321
30-Oct-15
INDI
Belgaum
BLDE University
Shri BM Patil
Bijapur
Medical College
Hosp
Left ureteric
calculus
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
12-Aug-15
19-Aug-15
25000
25722
25000
2500
22500
IDBI - 321
30-Oct-15
648
648
30-Jul-15
6-Aug-15
45000
46500
42000
4200
37800
IDBI - 321
30-Oct-15
2676 H_20015312832
Male
51
Minorit
BETTAMPADY
y
2677 H_20082311385
Female
68
Others KAREGURU
2678 H_20031311496
Female
56
SC
revathgaon
BIJAPUR
INDIANA
HOSPITAL AND
HEART
INSTITUTE LTD
Bharath
Hospital
Institute of
Oncology
INDIANA
HOSPITAL AND
HEART
INSTITUTE LTD
Uterine tumor III CANCER
Surgical Oncology
Gynaec-Ca.Cervix
Radical
Hysterectomy
+Bilateral Pelvic
Lymph Node
Dissection (BPLND)
Ophorectomy
(BSO) / Ovarian
transposition
Shakuntala
Memorial
Hubli
Hospital and
Research Centre
CA right breast
T1N1 stage II A
CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
3-Aug-15
10-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Bangalore
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Oesophagus
stage II
CANCER
Surgical Oncology
Esophagus
Oesophagectomy
with Two field
Lymphadenectomy
673
673
3-Aug-15
14-Aug-15
75000
75000
20000
2000
18000
IDBI-294
9-Oct-15
GULBARGA
Gulbarga
SUNSHINE
HEART
INSTITUTE
CRHD,SEVERE
MS,NO MR
CARDIOLOGY
Mitral Valve
Replacement
145
145
27-Jul-15
6-Aug-15
120000
120000
116280
11628
104652
IDBI - 321
30-Oct-15
UDUPI
Mysore
A J HOSPITAL
CENTRE
RHD WITH
SEVERE AR
CARDIOLOGY
Aortic Valve
Replacement
146
146
22-Jul-15
7-Aug-15
120000
120000
122400
12240
110160
IDBI - 321
30-Oct-15
SEDAM
GULBARGA
Gulbarga
Kidwai
Memorial
Institute of
Oncology
BADAMI
BAGLAKOT
Belgaum
Others Davanagere
DAVANAGERE
DAVANGERE
32
Others ranjol
SEDAM
25
Others KERVASHE GRAMA
KARKALA
2679 H_20082311451
Female
55
2680 H_20254312381
Female
47
2681 H_19567312092
Female
51
2682 H_21701312560
Male
2683 H_20127309995
Male
Others RIBBANAPALLI
SC
Hullikeri
BANGALORE
SOUTH
Paradise, S.D.
Road
Sl.No
Preauth No
Gender
Age
Caste
Village
2684 H_19587312768
Male
64
Others
2685 H_20083308517
Male
25
Others SADALI
Taluk
MADHUVANAHALLY
KR NAGAR
VILLAGE
SIDLAGATTA
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
240
240
28-Jul-15
1-Aug-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
Aortic Valve
Replacement
146
146
5-Aug-15
13-Aug-15
140000
140000
120000
0
120000
IDBI - 321
30-Oct-15
MANGALORE
S/P
BMV.MODERATE
MITRAL RE
STENOSIS.12MM CARDIOLOGY
OS ASD WITH
LEFT TO RIGHT
SHUNT.
Mitral Valve
Replacement
145
145
30-Jul-15
18-Aug-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
MYSORE
IHD-ACS
CARDIOLOGY
EVOLVED AWMI
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
28-Jul-15
31-Jul-15
65000
45000
17575
1758
15817
IDBI - 321
30-Oct-15
239
239
26-Jul-15
31-Jul-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
MYSORE
IHD - OLD AWMI
CARDIOLOGY
,DM,HTN
Cardiology
CHIKKABALLAPU
Bangalore
R
Bhagwan
Mahaveer Jain
Hospital
Bangalore
RHD, moderate
AS with mild AR,
CARDIOLOGY
Mild MS with
grade II MR
Mysore
Plan of
treatment
PTCA - one stent
(Drug Eluting
Stents , elective)
Apollo BGS
Hospital
MYSORE
Cardiology
2686 H_20015312770
Female
28
Minorit
HEBLE
y
BHATKALA
UTTARA
KANNADA
Belgaum
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
2687 H_20733312440
Female
49
Others HALLAGERE
MANDYA
MANDYA
Mysore
SJICR MYSORE
NSTEMI DM,HT
CARDIOLOGY
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
2688 H_20200312613
Female
56
Others maragowda nahalli
KR NAGAR
MYSORE
Mysore
NARAYANA
HRUDAYALAYA
SURGICAL
MYSORE
HOSPITAL PVT
LTD
2689 H_20531312621
Male
77
Others GOPA HALLI
RAMANAGAR
RAMANAGAR
Bangalore
RAJARAJESWARI
MEDICALCOLLE
BANGALORE
GE AND
HOSPITAL
BPH
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
24-Jul-15
11-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
2690 H_20203312409
Female
47
Others Shishuvinahallii
SHIGGAON
HAVERI
Belgaum
KARNATAKA
INSTITUTE OF
MEDICAL
SCINCES
Double Vessel
Disease
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
30-Jul-15
1-Aug-15
90000
90000
61750
6175
55575
IDBI - 321
30-Oct-15
2691 H_20127311436
Male
70
Others HIREKEROOR
HIREKERUR
HAVERI
Belgaum
A J HOSPITAL
CENTRE
BPH WITH
RETENTION OF
URINE
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
24-Jul-15
13-Aug-15
20000
56196
19380
1938
17442
IDBI - 321
30-Oct-15
2692 H_19515309774
Male
50
Others 0
HARIHARA
DAVANGERE
Bangalore
CITY CENTRAL
HOSPITAL
PRIVATE
LIMITED
DAVANGERE
B/L renal
Calculus
RENAL
Genito Urinary
Surgery
Urology
Open
901
901
5-Aug-15
13-Aug-15
25000
25000
22500
2250
20250
IDBI - 321
30-Oct-15
2693 H_19564312712
Male
67
Others HOSAMANE
SHIMOGA
SHIMOGA
Bangalore
KASTURBA
HOSPITAL
UDUPI
NSTEMI
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
25-Jul-15
1-Aug-15
90000
90000
65790
6579
59211
IDBI - 321
30-Oct-15
2694 H_19562312638
Female
52
Others WARD-6
SAGARA
SHIMOGA
Bangalore
MALNAD
HOSPITAL AND
INSTITUTE OF
ONCOLOGY
SHIMOGA
A known case of
ca. Tongue
CANCER
T1N0M0 Stage I
Surgical Oncology
Head & Neck
612
612
30-Jul-15
6-Aug-15
35000
35000
35000
3500
31500
IDBI - 321
30-Oct-15
2695 H_19571309696
Male
65
Others BANNUR
GULBARGA
GULBARGA
Gulbarga
PATIL NURSING
HOME
GULBARGA
GULBARGA
LT LOWER
RENAL
URETERIC STONE
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
21-Jul-15
6-Aug-15
25000
39415
25000
2500
22500
IDBI - 321
30-Oct-15
2696 H_20619310809
Male
42
Others KALLIHAL
HAVERI
HAVERI
Belgaum
SUKSHEMA
HOSPITAL
PVTLTD
BEP WITH LARGE
VASICAL
RENAL
CALCULUS
Genito Urinary
Surgery
Urology
TURP
917
917
27-Jul-15
3-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
DOUBLE VESSEL
CARDIOLOGY
DISEASE
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
25-Jul-15
29-Jul-15
90000
90000
91800
9180
82620
IDBI - 321
30-Oct-15
CRHD
CARDIOLOGY
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
28-Jul-15
8-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
27-Jul-15
30-Jul-15
25000
25000
22440
2244
20196
IDBI - 321
30-Oct-15
VSD
152
152
27-Jul-15
8-Aug-15
120000
120000
122400
12240
110160
IDBI - 321
30-Oct-15
2697 H_19542311863
Male
56
2698 H_20107312391
Female
20
2699 H_19564312605
2700 H_21079312565
Male
Male
57
12
Others HOSAKOTE
SC
BELGERA
Others PEJAMANGOOR
ST
MUDOL
NANJANAGUD
MYSORE
Mysore
YADGIR
YADGIRI
Gulbarga
UDUPI
SEDAM
UDUPI
GULBARGA
Mysore
Gulbarga
HUBLI
DAVANGERE
VIKRAM
HOSPITAL
MYSORE
PRIVATE
LIMITED
MYSORE
CARE Hospital A
unit of Quality
Nampally
Care India
Limite
KASTURBA
HOSPITAL
LOTUS
CHILDREN S
HOSPITAL
UDUPI
RT PROXIMAL
URETERIC
CALCULUS
LAKDIKAPUL
LARGE DOUBLY
COMMITTED
VSD, RCC
PROLAPSED
WITH SEVERE
CARDIOLOGY
ECCENTRIC
AORTIC VALVE
REGURGITATION
, DILATED LEFT
HEART
Sl.No
Preauth No
2701 H_20017312592
Gender
Age
Male
6
Others HUDALI
Minorit
KROPADI
y
2702 H_21057312506
Male
1
2703 H_19574311923
Male
58
2704 H_21044311938
Female
34
Caste
ST
Village
KOTHADODDI
Others HOSANGADI
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
BANTWAL
DAKSHINA
KANNADA
Mysore
NEW
CHB
DEVADURGA
RAICHUR
Gulbarga
VYDEHI
HOSPITAL
BANGALORE
KUNDAPURA
UDUPI
Mysore
WENLOCK
DISTRICT
HOSPITAL
Gulbarga
BELGAUM
BELGAUM
DUDDENAL
ATRESIA
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Intestinal Atresias
& Obstructions
303
303
28-Jul-15
11-Aug-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Permanent
pacemaker
VVI) including
Pacemaker value
114
114
26-Jul-15
6-Aug-15
75000
75000
75000
7500
67500
IDBI - 321
30-Oct-15
Carcinoma
bladder
(T4aNoMx)
CANCER
Surgical Oncology
Radical
Cystectomy
585
585
30-Jul-15
3-Sep-15
60000
60000
60000
6000
54000
IDBI - 321
30-Oct-15
MANGALORE
CA - BREAST
LABC
CANCER
Surgical Oncology
Breast
Mastectomy - any
type
598
598
25-Jul-15
14-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
YENEPOYA
MEDICAL
COLLEGE
HOSPITAL
MANGALORE
HIGH
ANORECTAL
STAGE 2
PROCEDURE
Anorectal
Malformations
Stage 2
306
306
20-Jul-15
29-Aug-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
NEONATAL
2705 H_20698311830
Male
8
Others GANGAVATHI
GANGAVATHI
KOPPAL
2706 H_19564311181
Male
63
Others HONNAVALLI
SHRUNGERI
CHIKKAMANAGL
Mysore
UR
KASTURBA
HOSPITAL
UDUPI
CAD -TVD +
MITRAL
CARDIOLOGY
RAGURGITATION
WITH STENOSIS.
CABG + Valve
Replacement +
IABP
134
134
22-Jul-15
20-Aug-15
130000
130000
121890
12189
109701
IDBI - 321
30-Oct-15
2707 H_19577312552
Male
28
MULABAGILU
KOLAR
Bangalore
SJICR
BANGALORE
SOUTH
SEVERE AS, ASC
AORTIC
ANEURYSM
CARDIOLOGY
Root Replacement
(Aortic Aneurysm/
Aortic Dissection)
/ Bental Procedure
169
169
29-Jul-15
21-Aug-15
125000
125000
125000
0
125000
IDBI - 321
30-Oct-15
2708 H_19577312538
Male
32
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
SJICR
BANGALORE
SOUTH
RIGHT LOWER
LIMB CRITICAL
ISCHAEMIA
CARDIOLOGY
213
213
28-Jul-15
1-Aug-15
20000
20000
20000
0
20000
IDBI - 321
30-Oct-15
239
239
23-Jul-15
29-Jul-15
65000
65000
57150
5715
51435
IDBI - 321
30-Oct-15
407
407
12-Jul-15
31-Aug-15
45000
45000
45000
4500
40500
IDBI - 321
30-Oct-15
145
145
13-Jul-15
19-Aug-15
140000
140000
140000
0
140000
IDBI - 321
30-Oct-15
146
146
27-Jul-15
15-Aug-15
120000
120000
120000
0
120000
IDBI - 321
30-Oct-15
239
239
23-Jul-15
29-Jul-15
65000
65000
58050
5805
52245
IDBI - 321
30-Oct-15
SC
MULIBAGILU
Others NANDINI LAYOUT
2709 H_20733311480
Female
58
Others KAMPALAPURA
PIRIYAPATNA
MYSORE
Mysore
SJICR MYSORE
MYSORE
2710 H_20531312134
Male
39
Others AGARA
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
RAJARAJESWARI
MEDICALCOLLE
BANGALORE
GE AND
HOSPITAL
2711 H_19577312441
Female
16
Others KUREKUPPA
SANDUR
BELLARY
Gulbarga
SJICR
2712 H_19577312387
Male
71
Others Y N HOSAKOTE
PAVAGADA
TUMKUR
Bangalore
SJICR
BANGALORE
SOUTH
BANGALORE
SOUTH
20000
2000
18000
IDBI - 321
30-Oct-15
ACS-NSTEMI,CADDOUBLE VESSEL
DISEASE.MILD LV CARDIOLOGY
DYSFUNCTION EF
45-45%.
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
28-Jul-15
1-Aug-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
Bangalore
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
RECENT IWMI
WITH OLD AWMI
WITH
CARDIOLOGY
MODERATE
WITH LV
DYSFUNCTION.
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
29-Jul-15
1-Aug-15
90000
90000
85500
8550
76950
IDBI - 321
30-Oct-15
Gulbarga
SHREE
BASAVALINGAP
PA NISTY
GULBARGA
MEMORIAL
HEART CENTRE
CAD SVD TYPE II
CARDIOLOGY
DM
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
28-Jul-15
1-Aug-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
PUTTUR
DAKSHINA
KANNADA
Mysore
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
Others JEWARAGI
JEVARGI
GULBARGA
20000
BYLAHONGALA
55
CARDIOLOGY
20000
Minorit
HUNASHIKATTI
y
Female
SEVERE AS
Mitral Valve
Replacement
Aortic Valve
Replacement
17-Aug-15
4
2717 H_21537312483
21-Jul-15
Female
DAVANGERE
CARDIOLOGY
307
2714 H_20017312517
MACHANAYAKANAH
CHANNAGIRI
ALLI
RHD - SEVERE
MR, SEVERE TR
307
SJICR MYSORE
ST
Excision of Brain
Tumor
Supratentorial &
others
Anorectal
Malformations
Stage 3
Mysore
39
Brain Tumour
MANDYA
Male
Neuro Surgery
MALAVALLI
2716 H_20079312461
Lt Temporal
(perisyliven)
NEURO SURGERY
Hemangioblasto
ma
ANORECTAL
NEONATAL
MALFORMATION
Others RAVANI
Others SHIRADI
Cardiology
Cardiology
72
49
Cardiology
Cardiology
Male
Male
IHD-ACS ACUTE
CARDIOLOGY
AWMI CAD-SVD
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
2713 H_20733310786
2715 H_20015312507
Thromboembolect
omy
MYSORE
MANGALORE
IHD-ACS ACUTE
IWMI
CARDIOLOGY
Sl.No
Preauth No
Gender
Age
Caste
2718 H_19593312480
Male
43
ST
2719 H_20025312423
Male
44
Others
2720 H_20025312315
Male
40
2721 H_20164312414
Male
80
2722 H_20733312434
Male
47
2723 H_20733312431
Male
62
2724 H_20082312386
Female
42
2725 H_20010310832
Male
38
2726 H_20164310534
Female
35
2727 H_19564312066
Male
11 Days
Village
Janatha Colony
Others CHIGALURU
BASAVANAPURA
Others PANDAVAPURA
SC
GADAG
BABURAYANAKOPPA
MANDYA
LU
Others KALKUNIKE
SC
Taluk
VADDARABANDE
HUNSUR
Patient District
Patient
Division
Hospital Name
GADAG
Belgaum
TRINITY
HOSPITAL AND
HEART
FOUNDATION
MANDYA
Mysore
MYSORE
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Rheumatic Heart
Disease - Severe
CARDIOLOGY
MS with Mild
MR
Mitral Valve
Replacement
145
145
27-Jul-15
9-Aug-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
PROSTATOMEGA
RENAL
LY
Genito Urinary
Surgery
Urology
TURP
917
917
31-Jul-15
6-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
RT RENAL PELVIC
RENAL
CALCULIC
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
1-Aug-15
6-Aug-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
KOLAR
BPH WITH
BLADDER
OUTLET
OBSTRCUTION
ON CATHETER
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
8-Aug-15
17-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
128
128
24-Jul-15
29-Jul-15
10000
10000
9025
903
8122
IDBI - 321
30-Oct-15
128
128
24-Jul-15
29-Jul-15
10000
10000
8075
808
7267
IDBI - 321
30-Oct-15
566
566
29-Jul-15
29-Jul-15
20000
20350
19000
1900
17100
IDBI - 321
30-Oct-15
912
912
9-Jul-15
29-Aug-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
BANGARPET
KOLAR
Bangalore
R L JALAPPA
HOSPITAL AND
RESEARCH
CENTRE
MYSORE
MYSORE
Mysore
SJICR MYSORE
MYSORE
IHD-ACS ACUTE
AWMI
CARDIOLOGY
Cardiology
Cardiology
PANDAVAPURA MANDYA
Mysore
SJICR MYSORE
MYSORE
IHD ACS ACUTE
IWMI
CARDIOLOGY
Cardiology
Cardiology
BELLARY
Gulbarga
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Recurrent Ca (Rt)
CANCER
BREAST T2N2Mo
Radiation Oncology
Linear Accelerators
BANGALORE
NORTH
THRICTURE
URETHE
RENAL
Genito Urinary
Surgery
Urology
Urethroplasty for
a year can be
considered)
BELLARY
Medical
treatment of
Acute MI with
Thrombolysis
Medical
treatment of
Acute MI with
Thrombolysis
Palliative
Treatment with
Photons (linear
accelarator)
JEVARGI
GULBARGA
Gulbarga
M S Ramaiah
Hospital
Others MATAMARI
RAICHUR
RAICHUR
Gulbarga
R L JALAPPA
HOSPITAL AND
RESEARCH
CENTRE
KOLAR
VESICO VAGINAL
FISTUAL
RENAL
Genito Urinary
Surgery
Urology
VVF Repair
904
904
28-Jul-15
25-Aug-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
Others KURUBAGERI
HAVERI
HAVERI
Belgaum
KASTURBA
HOSPITAL
UDUPI
MYELOMENING
OCELE/ACM
TYPE II
NEURO SURGERY
Neuro Surgery
Brain
Meningomyelocel
e
417
417
18-Jul-15
1-Sep-15
35000
35000
35700
3570
32130
IDBI - 321
30-Oct-15
MANGALORE
CARCINOMA
OESOPHAGUS T4 CANCER
Nx M0
Radiation Oncology
3D Conformational
Radio Therapy
Radical Treatment
& Post Operative
RT(3DCRT) Upto
30 fractions in 6
weeks
568
568
24-Jul-15
10-Sep-15
87000
83000
83000
8300
74700
IDBI - 321
30-Oct-15
TAPVC
160
160
27-Jul-15
25-Aug-15
95000
95000
96900
2907
93993
IDBI - 321
30-Oct-15
SC
SHASTRICHOWKHA
Others NMC 5TH CROSS
BHADRAVATHI
SHIMOGA
Bangalore
YENEPOYA
MEDICAL
COLLEGE
HOSPITAL
Others Anekal
ANEKAL
BANGALORE URBAN
Bangalore
Narayana
Hrudayalaya
Private Limited
Bangalore
Supracardiac
TAPVC
Restrictive
Secundum ASD
18
Minorit
Shahapur
y
SHAHPUR
YADGIRI
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
Large Secundum
CARDIOLOGY
ASD
ASD
151
151
2-Aug-15
12-Aug-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
Male
69
Others 0
BELUR
HASSAN
Mysore
BANGALORE
VESICAL
CALCULUS OF
SIZE 1.1CM
RENAL
Genito Urinary
Surgery
Urology
Cystolithotripsy
906
906
29-Jul-15
3-Aug-15
26250
26250
26250
2625
23625
IDBI - 321
30-Oct-15
2732 H_19586311224
Male
74
Others YARADAHALLI
TUMKUR
TUMKUR
Bangalore
BANGALORE
VESICAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
Cystolithotripsy
906
906
24-Jul-15
3-Aug-15
12500
12500
12500
1250
11250
IDBI - 321
30-Oct-15
2733 H_19528311974
Female
65
Others
HASSAN
Mysore
Narayana
Hrudayalaya
Private Limited
Bangalore
MALIGNANCY OF
UNKNOWN
CANCER
ORIGIN
Surgical Oncology
Head & Neck
Hemimandibulect
omy
620
620
10-Aug-15
18-Aug-15
50000
50000
51000
1530
49470
IDBI - 321
30-Oct-15
2734 H_20082311457
Female
49
Others MURNADA
MADIKERI
KODAGU
Mysore
Kidwai
Memorial
Institute of
Oncology
BANGALORE
SOUTH
Ca Ovary stage II CANCER
Surgical Oncology
Gynaec
Surgery for Ca
Ovary - advance
stage
596
596
7-Aug-15
21-Aug-15
40000
41530
36500
3650
32850
IDBI - 321
30-Oct-15
2735 H_19574311217
Female
80
Others MEGIPALYA
BANGALORE
EAST
BANGALORE URBAN
Bangalore
VYDEHI
HOSPITAL
BANGALORE
Recurrent STS
Right elbow joint CANCER
(T2bNMx)
Surgical Oncology
Tumors
Amputation for
bone / soft tissue
tumours (Major /
Minor)
688
688
30-Jul-15
6-Aug-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
2736 H_20661312050
Female
60
Others K RAYAPURA
KUDLIGI
BELLARY
Gulbarga
Vijayanagara
Institute of
BELLARY
Medical Science
ca breat
CANCER
recurence st-4b.
Radiation Oncology
Radiotherapy
Treatment
563
563
3-Aug-15
17-Aug-15
10000
10000
9500
950
8550
IDBI - 321
30-Oct-15
2728 H_20698312266
Female
65
2729 H_19528312337
Male
2 Months
2730 H_19528312326
Male
2731 H_19586311541
CHICKKABASAVANAH
HASSAN
AL
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
CARDIOLOGY
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Mysore
Mandya
Institute of
Medical
Sciences
Mandya
Mandya
Ca Breast Left
2737 H_21194310959
Female
60
Minorit
MANDYA CITY
y
2738 H_20300311092
Female
35
Others SHIROL
NARAGUNDA
GADAG
Belgaum
BMCRI SSH
PMSSY
Bangalore
2739 H_22439309701
Female
22
Others BADAMI
BADAMI
BAGLAKOT
Belgaum
BHS lakeview
Hospital
2740 H_19528311648
Male
2
Minorit
KUMBARAONI
y
KOPPAL
KOPPAL
Gulbarga
Narayana
Hrudayalaya
Private Limited
2741 H_20079312142
Female
46
HONNALI
DAVANGERE
Bangalore
2742 H_20575311569
Male
75
Others UPPINAKUDRU
KUNDAPURA
UDUPI
Mysore
2743 H_22971311478
Female
15 Days
Others CHIKKAMOLE
Mysore
GAR
GAR
2744 H_20082311376
Male
42
2745 H_20082311617
Male
43
2746 H_20082311377
Female
2747 H_20015311892
SC
GANTYPURA
MANDYA
MANDYA
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
598
598
10-Aug-15
8-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
ATLANTO AXIAL
NEURO SURGERY
DISLOCATION
Neuro Surgery
AAD Surgeries
Transoral surgery
and CV Junction
441
441
22-Jul-15
7-Aug-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
BELGAUM
LT UPPER
URETERIC
RENAL
CALCULI WITH DJ
STENT IN SITU
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
29-Jul-15
1-Aug-15
12500
12500
12500
1250
11250
IDBI - 321
30-Oct-15
Bangalore
TUBE DEFECTMMC WITH
NEURO SURGERY
HYDROCEPHALU
S
Neuro Surgery
Brain
Meningomyelocel
e
417
417
2-Aug-15
12-Aug-15
35000
35000
35700
1071
34629
IDBI - 321
30-Oct-15
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
CAD-TVD.
CARDIOLOGY
CABG
132
132
30-Jul-15
25-Aug-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
MANGALORE
INSTITUTE OF
ONCOLOGY
CA POST
CRICOID
T4N1M0
CANCER
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
25-Jul-15
2-Aug-15
20000
20000
8000
800
7200
IDBI - 321
30-Oct-15
LEFT
CONGENITAL
NEONATAL
DIAPHRAGMATI
C HERNIA
Diaphragmatic
Hernia
302
302
21-Jul-15
3-Aug-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
SCC rt buccal
mucossa
T2N1M0
Surgical Oncology
Head & Neck
Laser Surgery
622
622
8-Jul-15
13-Aug-15
35000
37970
29925
2993
26932
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
B cell Lymphoma CANCER
Radiation Oncology
Radiotherapy
Treatment
563
563
7-Jul-15
17-Jul-15
55000
55000
1900
190
1710
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
ca buccal
mucosa (lt)
TAaN2aMx
CANCER
Radiation Oncology
Radiotherapy
Treatment
563
563
4-Aug-15
8-Aug-15
10000
13300
5000
500
4500
IDBI - 321
30-Oct-15
NEURO SURGERY
Neuro Surgery
Brain
Aneurysm
Clipping
422
422
25-Jul-15
21-Aug-15
100000
100000
100000
10000
90000
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
30-Jul-15
3-Aug-15
90000
90000
85500
8550
76950
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
POST ICD REC VT CARDIOLOGY
Cardiology
Cardiology
3D Maping +
Ablation
127
127
2-Aug-15
8-Aug-15
25000
25000
25000
0
25000
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
VENTRICULAR
TACCHYCARDIA,I
HD:OLD
CARDIOLOGY
AWMI,SEVERE
LV
DYSFUNCTION
Cardiology
Cardiology
3D Maping +
Ablation
127
127
2-Aug-15
12-Aug-15
50000
50000
50000
0
50000
IDBI - 321
30-Oct-15
MANGALORE
CSI Holdsworth
Memorial
Mysore
Hospital
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
Kidwai
Memorial
Institute of
Oncology
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
Others CHAMARAJ PETE
BANGARPET
KOLAR
Bangalore
54
Others KAMALAPUR
GOWRIBIDANUR
CHIKKABALLAPU
Bangalore
R
Female
46
Others BIRALBAIL
ANKOLA
UTTARA
KANNADA
2748 H_20079311839
Female
46
Minorit
WARD NO:06
y
KADUR
CHIKKAMANAGL
Mysore
UR
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
2749 H_19577311552
Male
43
Minorit
SUBASH NGARA
y
NELEMANGALA
BANGALORE RURAL
SJICR
Bangalore
Mastectomy - any
type
Bangalore
Belgaum
Disease Main
Category
Breast
BANGALORE URBAN
DOMALUR
Diseases
Surgical Oncology
BANGALORE
NORTH
ST
Final
Diagnosis
MANGALORE
LEFT
SUPRALENOID
ICA SACCULAL
ANEURYSM.
AWMI WITH
MODERATE LV
DYSFUNCTION
WITH POST
INFRACTION
ANGINA.
CANCER
CANCER
2750 H_19577311640
Male
30
Others KONNATAMBIGGI
RANEBENNUR
HAVERI
Belgaum
SJICR
2751 H_20017310863
Male
44
Others KAVATKOPPA
ATHANI
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
Mitral Valve
Replacement
145
145
22-Jul-15
14-Aug-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
2752 H_19567332324
Male
71
Others PO:HIREMAKERI
HUVINAHADAG
BELLARY
ALI
Gulbarga
Karnataka
Cancer Therapy
Hubli
and Research
Institute
Ca Esopphagus
middle third
CANCER
Surgical Oncology
Jejunostomy
677
677
4-Sep-15
12-Sep-15
20000
30540
20000
2000
18000
IDBI-294
9-Oct-15
2753 H_22520331389
Male
12 Days
Others Ainapur
ATHANI
BELGAUM
Belgaum
Paediatric
and PG Institute
Acute intestinal
obstruction
NEONATAL
Intestinal Atresias
& Obstructions
303
303
16-Sep-15
21-Sep-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
2754 H_20112331201
Male
44
KUDLIGI
BELLARY
Gulbarga
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
OW IHD EWMI
POST IA
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
18-Sep-15
21-Sep-15
90000
90000
90000
2700
87300
IDBI - 321
30-Oct-15
Mysore
NARAYANA
HRUDAYALAYA
SURGICAL
MYSORE
HOSPITAL PVT
LTD
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
16-Sep-15
19-Sep-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
2755 H_20200331001
Male
51
SC
KUDLIGI
Minorit
SHANKAR PURA
y
MANDYA
MANDYA
ACS ACUTE IWMI CARDIOLOGY
Cardiology
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
17-Sep-15
21-Sep-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
2756 H_19564330817
Male
45
Others BALAKORA
HONNAVAR
UTTARA
KANNADA
Belgaum
KASTURBA
HOSPITAL
UDUPI
IHD/ACUTE/NST
EMI/CAGCARDIOLOGY
SVD/PCI+ DES TO
RCA DONE
2757 H_19528329819
Male
28
Minorit MEHABHUBIYA
y
COLONY
SINDNUR
RAICHUR
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
CARCINOMA
PELVIS
CANCER
Surgical Oncology
Total Penectomy
590
590
18-Sep-15
23-Sep-15
25000
25000
25500
765
24735
IDBI - 321
30-Oct-15
2758 H_20112330265
Male
73
Others 0
DAVANAGERE
DAVANGERE
Bangalore
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
IHD CAG SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
15-Sep-15
21-Sep-15
65000
65000
65000
1950
63050
IDBI - 321
30-Oct-15
2759 H_21223329517
Female
5 Months
Others NAIGERE
ARAKALAGUD
HASSAN
Mysore
INDIRA GANDHI
BANGALORE
INSTITUTE OF
SOUTH
CHILD HEALTH
choledochal cyst NEONATAL
Biliary Atresia &
Choledochal Cyst
304
304
11-Sep-15
24-Sep-15
45000
45000
45000
4500
40500
IDBI - 321
30-Oct-15
2760 H_21057330067
Male
22
Others HERANJALU
KUNDAPURA
UDUPI
Mysore
NEW
TACHYARRYTHM
CARDIOLOGY
IA
Cardiology
Cardiology
EP study
125
125
15-Sep-15
21-Sep-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
2761 H_21223330128
Female
6 Months
Others HULIMAVU
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
INDIRA GANDHI
BANGALORE
INSTITUTE OF
SOUTH
CHILD HEALTH
anorectal
malformation
stage 3
NEONATAL
Anorectal
Malformations
Stage 3
307
307
14-Sep-15
23-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
2762 H_23124329685
Male
25
Others SIRWARA
MANVI
RAICHUR
Gulbarga
SPARSH SUPER
SPECIALITY
HOSPITAL
BANGALORE
NORTH
L4-L5 PIVD
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
15-Sep-15
19-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
2763 H_19528330087
Male
40
Others DHUMANSUR
HUMNABAD
BIDAR
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
CAD CAG SINGLE
CARDIOLOGY
UESSEL SISEASE
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
16-Sep-15
19-Sep-15
55000
55000
56100
1683
54417
IDBI - 321
30-Oct-15
2764 H_22286329837
Male
44
Others MADAPURA
KR PET
MANDYA
Mysore
PUNYA
HOSPITAL CRP
Hassan
RIGHT VU
JUNCTION
CALCULUS
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
15-Sep-15
23-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
2765 H_19528329932
Female
3
Others BIJAVARA
MADHUGIRI
TUMKUR
Bangalore
Narayana
Hrudayalaya
Private Limited
Bangalore
MODERATE
SECUNDUM ASD, CARDIOLOGY
L-R SHUNT
Cardiology
Device Closure
ASD Device
Closure
120
120
21-Sep-15
23-Sep-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
239
239
14-Sep-15
16-Sep-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
2766 H_19564329775
Male
64
Others NALKUR
UDUPI
UDUPI
Mysore
KASTURBA
HOSPITAL
RENAL
Cardiology
UDUPI
ANTERIOR WALL
CARDIOLOGY
MI
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
SOLAPUR
Lt Mid Ureteric
calculus with HN
& HU with Rt
RENAL
Multiple Renal
calculus
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
14-Sep-15
18-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Bangalore
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
17-Sep-15
19-Sep-15
25000
25000
25500
765
24735
IDBI - 321
30-Oct-15
Cardiology
Device Closure
ASD Device
Closure
120
120
11-Sep-15
18-Sep-15
80000
80000
81600
8160
73440
IDBI - 321
30-Oct-15
2767 H_21254329854
Male
46
Others 0
CHITTAPUR
GULBARGA
Gulbarga
DR RAGHOJI
KIDNEY
HOSPITAL AND
RESEARCH
CENTER PV
2768 H_19528329717
Male
42
Others SOMPUR
SINDAGI
BIJAPUR
Belgaum
Narayana
Hrudayalaya
Private Limited
2769 H_20061329691
Male
12
Others
LINGASUGUR
RAICHUR
Gulbarga
NARAYANA
HOSPITALS
2770 H_19549329440
Female
54
Others 0
HUMNABAD
BIDAR
Gulbarga
Sagar Hospitals
BANGALORE
SOUTH
IHD - EFFORT
ANGINA TMT
POSTIVE
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
11-Sep-15
16-Sep-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
2771 H_21223329555
Male
9 Days
Others KADABA VILL
GUBBI
TUMKUR
Bangalore
INDIRA GANDHI
BANGALORE
INSTITUTE OF
SOUTH
CHILD HEALTH
posterior
urethral valve
NEONATAL
Urinary Diversion Temporary
318
318
9-Sep-15
16-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
2772 H_20112329503
Male
49
DAVANAGERE
DAVANGERE
Bangalore
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
IHD CAG-SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
11-Sep-15
18-Sep-15
65000
65000
65000
1950
63050
IDBI - 321
30-Oct-15
2773 H_21897329535
Male
49
Others 0
MUDIGERE
CHIKKAMANAGL
Mysore
UR
GLOBAL
MULTISPECIALIT
MANGALORE
Y HOSPITAL
INDIA PVT LTD
(R)UPPER
URETERIC
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
13-Sep-15
20-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
2774 H_20112329210
Male
62
Others BELAGALPETE
HANAGAL
HAVERI
Belgaum
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
IHD CAG SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
14-Sep-15
18-Sep-15
90000
90000
90000
2700
87300
IDBI - 321
30-Oct-15
2775 H_20880329421
Male
59
Others Halaga
BELGAUM
BELGAUM
Belgaum
Wanless
Hospital Miraj
Miraj
Medical Center
miraj
IHD UNSTABLE
VESSEL DISEASE
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
14-Sep-15
16-Sep-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
SC
(V) AMARAVATI
SARJAPUR(T,Q)
LINGASUGUR (D)
RAICHUR
KADAJJI
LEFT L4/5
PROLAPSED
NEURO SURGERY
INTERVERTEBRA
L DISC
ACHD-LARGE OS
ASD WITH L---CARDIOLOGY
>R SHUNT (
MEASURED:2830MM ).
Sl.No
Preauth No
2776 H_20061329182
Gender
Age
Male
43
Caste
Village
(V) MUDGAL (T,Q)
Others LINGASUGUR (DIST)
RAICHUR.
Taluk
LINGASUGUR
Patient District
RAICHUR
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Gulbarga
NARAYANA
HOSPITALS
PIVD-L4-L5/L5S1.
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
RT GROIN
PSEUDOANEURY
CARDIOLOGY
SM WITH
CONTAINED
RUPTURE
NEURO SURGERY
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
11-Sep-15
21-Sep-15
50000
50000
51000
5100
45900
IDBI - 321
30-Oct-15
Aorto Billiac /
Bifemoral bypass
with Synthetic
Graft
227
227
30-Aug-15
2-Sep-15
45000
90000
45000
4500
40500
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
12-Sep-15
20-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Neuro Surgery
Spinal
2777 H_20025324401
Male
65
Others BETTADAPURA
PIRIYAPATNA
2778 H_21897329247
Male
22
Others 0
Mysore
R
UR
GLOBAL
MULTISPECIALIT
MANGALORE
Y HOSPITAL
INDIA PVT LTD
RIGHT VUJ
CALCULUS
2779 H_21057329152
Male
38
Others THALAHALLI
SAGARA
SHIMOGA
Bangalore
NEW
ANTERIOR WALL
CARDIOLOGY
MI
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
12-Sep-15
16-Sep-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
2780 H_19528329125
Female
27
Others NEELAHALLI
SEDAM
GULBARGA
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
CHO-LARGE
OSTIUM
CARDIOLOGY
SECUNDUM ASD
L-R SHUNT
Cardiology
Device Closure
ASD Device
Closure
120
120
14-Sep-15
16-Sep-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
2781 H_19549329098
Male
42
Others 0
HOSPET
BELLARY
Gulbarga
Sagar Hospitals
BANGALORE
SOUTH
IHD-IWMI,CADSVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
11-Sep-15
15-Sep-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
2782 H_19528326911
Male
14
Others KALLANGA
JEVARGI
GULBARGA
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
RHD- SEV MR
CARDIOLOGY
Mitral Valve
Repair
141
141
8-Sep-15
19-Sep-15
100000
100000
102000
3060
98940
IDBI - 321
30-Oct-15
Belgaum
VENKATESH
HOSPITAL
MAHALINGPUR
right renal pelvis
RENAL
calculus
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
12-Sep-15
15-Sep-15
25000
29750
25000
2500
22500
IDBI - 321
30-Oct-15
UDUPI
EVOLVED
MI
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
10-Sep-15
14-Sep-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
Bangalore
RHEUMATIC
HEART
DISEASE+CORON
ARY DISEASE
SEVERE MITRAL
REGURGITATION
MODERATE
AORTIC
CARDIOLOGY
REGURGITION
MILD TO
MODERATE
AORTIC
STENOSIS MILD
TO MODERATE
TR
Double Valve
Replacement
149
149
14-Sep-15
23-Sep-15
150000
120000
122400
3672
118728
IDBI - 321
30-Oct-15
OmphaloceleMajor
310
310
6-Sep-15
15-Sep-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
239
239
11-Sep-15
14-Sep-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
2783 H_22458329007
2784 H_19564328963
Male
Female
40
50
2785 H_19528328964
Male
55
2786 H_20017328502
Female
5 Days
Others Sambaragi
Others KAMSAMUDRA
ATHANI
HOLALKERE
MYSORE
Patient
Division
BELGAUM
CHITRADURGA
Bangalore
KASTURBA
HOSPITAL
RENAL
Others KADLEWAD
SINDAGI
BIJAPUR
Belgaum
Narayana
Hrudayalaya
Private Limited
Others HOOLI
SAVADATTI
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
OMPHALOCELE
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
NEONATAL
2787 H_19564328905
Female
63
Others VODEYARA HOBALI
KUNDAPURA
UDUPI
Mysore
KASTURBA
HOSPITAL
UDUPI
DM2/HTN/IHD/A
CS/ACUTE
CARDIOLOGY
AWSTEMI
2788 H_19593328595
Male
64
Others At post Kamatagi
HUNAGUNDA
BAGLAKOT
Belgaum
TRINITY
HOSPITAL AND
HEART
FOUNDATION
BANGALORE
SOUTH
Unstable Angina,
CAD - Single
CARDIOLOGY
Vessel Disease
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
10-Sep-15
14-Sep-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
2789 H_19549328930
Male
54
Others BALAKUNDI
HUNAGUNDA
BAGLAKOT
Belgaum
Sagar Hospitals
BANGALORE
SOUTH
IHD- NSTEMI,
CAD-SVD.
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
10-Sep-15
14-Sep-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
2790 H_20112328781
Male
45
DAVANAGERE
DAVANGERE
Bangalore
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
RHD SEVERE
CALCIFIC AORTIC CARDIOLOGY
VALVE
Aortic Valve
Replacement
146
146
8-Sep-15
22-Sep-15
120000
120000
120000
3600
116400
IDBI - 321
30-Oct-15
Mysore
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
ACUTE INFERIOR
WALL MI WITH CARDIOLOGY
HEART BLOCK
Cardiology
PTCA - one Drug
Eluting stent (
emergency,
inclusive of
angiogram) at the
same admission.
239
239
9-Sep-15
14-Sep-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
2791 H_19522328376
Male
68
SC
DODDAOBAJIHALLI
Others PILIMOGARU
BANTWAL
DAKSHINA
KANNADA
MANGALORE
CARDIOLOGY
Cardiology
Sl.No
Preauth No
Gender
Age
Caste
Village
2792 H_19564328635
Male
50
2793 H_21223328587
Male
6
2794 H_21868328664
Male
35
Others Dindaguru
CHANNARAYAP
HASSAN
ATNA
2795 H_20698328585
Male
74
Others KALLENAHALLI
TARIKERE
Others KIDIYUR
SC
KACHAHALLI
Taluk
Patient District
Patient
Division
UDUPI
UDUPI
Mysore
SIDLAGATTA
CHIKKABALLAPU
Bangalore
R
Hospital Name
KASTURBA
HOSPITAL
Hospital
District
UDUPI
INDIRA GANDHI
BANGALORE
INSTITUTE OF
SOUTH
CHILD HEALTH
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
PTCA - Two stent
(Drug Eluting
Stents , elective)
NSTEMI
CARDIOLOGY
Cardiology
Cardiology
hypospadias
NEONATAL
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
241
241
9-Sep-15
12-Sep-15
90000
90000
91747
9175
82572
IDBI - 321
30-Oct-15
322
322
10-Sep-15
19-Sep-15
22000
22000
22000
2200
19800
IDBI - 321
30-Oct-15
NAGESH
HOSPITAL
RT Mild HN with
CHANNARAYAPA
VUJ Calculi
RENAL
TNA
14x8mm
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
13-Sep-15
16-Sep-15
25000
30216
25000
2500
22500
IDBI - 321
30-Oct-15
CHIKKAMANAGL
Mysore
UR
YENEPOYA
MEDICAL
COLLEGE
HOSPITAL
MANGALORE
BPH
Genito Urinary
Surgery
Urology
TURP
917
917
5-Sep-15
16-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
Bangalore
CONGENITAL
HEART DISEASE
MODERATE
CARDIOLOGY
SIZED OSTIUM
SEANDUM AND
WITH L-R SHUNT
Cardiology
Device Closure
ASD Device
Closure
120
120
14-Sep-15
16-Sep-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
BANGALORE
L4-L5 disc
Prolapse.
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
11-Sep-15
21-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Mysore
RENAL
2796 H_19528328144
Male
43
Others NIMBARGA
ALAND
GULBARGA
Gulbarga
Narayana
Hrudayalaya
Private Limited
2797 H_19574327571
Male
45
Others UDHAYANAGAR
BANGALORE
EAST
BANGALORE URBAN
Bangalore
VYDEHI
HOSPITAL
2798 H_20112328431
Male
57
Others GANDHINAGAR
CHALLAKERE
CHITRADURGA
Bangalore
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
ACSAWMI CONT
CARDIOLOGY
LYSED EF-46%
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
10-Sep-15
12-Sep-15
65000
65000
65000
1950
63050
IDBI - 321
30-Oct-15
2799 H_20112328409
Female
50
RANEBENNUR
HAVERI
Belgaum
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
IHD- Effort
Angina, CADSVD
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
9-Sep-15
12-Sep-15
90000
90000
90000
2700
87300
IDBI - 321
30-Oct-15
IHD-UA, HTN,
DM
CARDIOLOGY
Cardiology
Cardiology
PTCA - one Drug
Eluting stent (
emergency,
inclusive of
angiogram) at the
same admission.
239
239
8-Sep-15
11-Sep-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
NEURO SURGERY
Neuro Surgery
Brain
Craniotomy and
Evacuation of
Haematoma Subdural
401
401
11-Sep-15
16-Sep-15
45000
45000
45000
4500
40500
IDBI - 321
30-Oct-15
SC
RANEBENNUR
NEURO SURGERY
CARDIOLOGY
MYSORE
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
MUDHOLA
BAGLAKOT
Belgaum
BHS lakeview
Hospital
BELGAUM
LT F'T'P
SUBACUTE SUB
DURAL
HAEMETOMA
MUDHOLA
BAGLAKOT
Belgaum
VENKATESH
HOSPITAL
MAHALINGPUR
right upper
RENAL
ureteric calculus
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
12-Sep-15
15-Sep-15
25000
29850
25000
2500
22500
IDBI - 321
30-Oct-15
Others JADAR ONI
BILAGI
BAGLAKOT
Belgaum
Narayana
Hrudayalaya
Private Limited
Bangalore
ECG,SVT
Cardiology
Cardiology
EP study
125
125
11-Sep-15
14-Sep-15
30000
30000
30600
918
29682
IDBI - 321
30-Oct-15
Others HUNASHYAL
GOKAK
BELGAUM
Belgaum
Kolhapur Cancer
Karveer
Centre
CA METASTATIC
ADENOCARCINO
CANCER
MA(MULTIPLE
BONE) TxNxM1
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
11-Sep-15
16-Sep-15
20000
47500
10000
1000
9000
IDBI - 321
30-Oct-15
Mysore
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
L4-5 PVD
(LARGE)
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
13-Sep-15
18-Sep-15
25000
25000
25000
0
25000
IDBI - 321
30-Oct-15
UNSTABLE
ANGINA
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
8-Sep-15
14-Sep-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
NEONATAL
322
322
9-Sep-15
15-Sep-15
22000
22000
22000
2200
19800
IDBI - 321
30-Oct-15
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
9-Sep-15
14-Sep-15
90000
90000
90000
2700
87300
IDBI - 321
30-Oct-15
907
907
7-Sep-15
22-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
435
435
9-Sep-15
21-Sep-15
25000
95879
25000
2500
22500
IDBI - 321
30-Oct-15
V V MARKET
MYSORE
2800 H_20025328406
Female
64
Others
2801 H_22439328367
Male
59
Others NAGARAL
2802 H_22458328194
Male
20
2803 H_19528328232
Male
19
2804 H_20435328377
Male
56
SC
Nagaral
2805 H_20200327064
Male
40
Others TATTE KERE
HUNSUR
2806 H_19564328099
Male
64
Others KUREMAGANA HALLI
HARAPANAHALL
DAVANGERE
I
Bangalore
KASTURBA
HOSPITAL
2807 H_22520328350
Male
6 Months
Others Koligudda
RAIBAGH
BELGAUM
Belgaum
Paediatric
and PG Institute
Hypospadias
2808 H_20112327975
Female
57
KUDLIGI
BELLARY
Gulbarga
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
IHD- IWMI(LYSED
WITH STK), CAG- CARDIOLOGY
DVD
Cardiology
Gulbarga
M S Ramaiah
Hospital
LEFT RENAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
Gulbarga
CARE Hospital A
unit of Quality
Nampally
Care India
Limite
MULTIPLE
LUMBAR PIVD
WITH THECAL
SAC
COMPRESSION.
NEURO SURGERY
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
2809 H_20010328104
2810 H_20107327508
Male
Female
60
56
ST
KUDLIGI
Others JALAKI
Others DHUMSAPUR
ALAND
HUMNABAD
MYSORE
CARDIOLOGY
GULBARGA
BIDAR
UDUPI
BANGALORE
NORTH
Sl.No
Preauth No
Gender
Age
2811 H_22971328267
Female
5 Months
2812 H_20017328198
Female
2813 H_20017313689
2814 H_23124328128
Caste
Village
Taluk
Patient District
Others MUSLIM BLOCK
KR NAGAR
35
Others MANGULI
BASAVANABAGE
BIJAPUR
WADI
Belgaum
Female
60
Minorit
KODAGULI
y
SINDAGI
BIJAPUR
Belgaum
Male
9
AURAD
BIDAR
Gulbarga
SC
BADALGAON
MYSORE
Patient
Division
Mysore
Hospital Name
Hospital
District
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Brain
Ventriculoatrial
/Ventriculoperiton
eal Shunt
411
411
7-Sep-15
16-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
RHD MILD
MITRAL
STENOSIS WITH
MVO
CARDIOLOGY
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
7-Sep-15
16-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
IHD IWMI CAD
DVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - 2 stent
(non-medicated)
104
104
27-Jul-15
12-Aug-15
70000
70000
66500
6650
59850
IDBI - 321
30-Oct-15
ASD
151
151
9-Sep-15
21-Sep-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
9
9
10-Sep-15
15-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
909
909
11-Sep-15
12-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
306
306
8-Sep-15
15-Sep-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
SPARSH SUPER
SPECIALITY
HOSPITAL
BANGALORE
NORTH
Others KEBBEKOPPALU
HUNSUR
MYSORE
Mysore
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
BANGALORE
2816 H_22558327139
Male
38
Others Ward-10 Pete beedi
ARAKALAGUD
HASSAN
Mysore
Vaatsalya
Hospital
HASSAN
2817 H_20300327953
Female
4 Months
Others SRIRAMPURA
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
BMCRI SSH
PMSSY
Bangalore
Gulbarga
DR RAGHOJI
KIDNEY
HOSPITAL AND
RESEARCH
CENTER PV
SOLAPUR
YADGIRI
Neuro Surgery
10
48
Disease Main
Category
CONGENITAL
HYDROCEPHALU NEURO SURGERY
S
Female
Male
Diseases
CSI Holdsworth
Memorial
Mysore
Hospital
2815 H_19586325779
2818 H_21254328093
Final
Diagnosis
Others 0
SHAHPUR
Mysore
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
CHD-OS ASD L-R
CARDIOLOGY
SHUNT(30MM)
RT POST BURN
ELBOW
CONTRACTURE
BURNS
Post Burn
Contracture
surgeries for
Functional
Improvement(Pack
age including
splints, pressure
garments and
physiotherapy),
Mild
URSL - Single Side
+ DJ Stent
Anorectal
Malformations
Stage 2
Burns
Burns
Left ureteric
RENAL
stone
RECTOVESTIBUL
NEONATAL
AR FISTULA
(ARM)
Genito Urinary
Surgery
Urology
Lt Ureteric
calculus
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
7-Sep-15
14-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
ACS EVOLVED
AWMI WITH
CARDIOLOGY
POST MI ANGINA
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
31-Aug-15
4-Sep-15
90000
90000
90000
0
90000
IDBI - 321
30-Oct-15
RENAL
2819 H_20200325038
Male
58
Others D H HALLI
SHRIRANGAPAT
MANDYA
NA
2820 H_20112327951
Male
41
Others SHIGGAON
SHIGGAON
HAVERI
Belgaum
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
IHD AWMI CAGCARDIOLOGY
DVD
CABG
132
132
7-Sep-15
22-Sep-15
95000
95000
95000
2850
92150
IDBI - 321
30-Oct-15
2821 H_21057328078
Female
47
Others PADUVANNUR
PUTTUR
DAKSHINA
KANNADA
Mysore
NEW
RVOT VT
Cardiology
Cardiology
EP study
125
125
1-Sep-15
10-Sep-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
Lt Renal Calculus RENAL
Genito Urinary
Surgery
Urology
ESWL (Extra
Stent
908
908
8-Sep-15
15-Sep-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
CARDIOLOGY
2822 H_21254328054
Female
35
Others 0
ALAND
GULBARGA
Gulbarga
DR RAGHOJI
KIDNEY
HOSPITAL AND
RESEARCH
CENTER PV
2823 H_20074327910
Male
65
Others YARRANGALLY
BELLARY
BELLARY
Gulbarga
M S RAMAIAH
NARAYANA
BANGALORE
HRUDAYALAYA
IHD
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
4-Sep-15
14-Sep-15
90000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
2824 H_20112327925
Female
5
Others KALASA
KUNDAGOL
DHARWAD
Belgaum
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
CONGENTAL
HEART DISEASE
PDA WITH L - R
SHUNT
CARDIOLOGY
Cardiology
Device Closure
PDA Device
Closure
119
119
8-Sep-15
14-Sep-15
60000
60000
60000
1800
58200
IDBI - 321
30-Oct-15
2825 H_20112327957
Male
69
Minorit
HARIHARA
y
HARIHARA
DAVANGERE
Bangalore
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
IHD- AWMI,
TYPE 2 DM, CAG- CARDIOLOGY
DVD
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
7-Sep-15
12-Sep-15
90000
90000
90000
2700
87300
IDBI - 321
30-Oct-15
2826 H_20112327916
Male
60
Minorit
HAMSABAVI
y
HIREKERUR
HAVERI
Belgaum
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
IHD- IWMI(LYSED
WITH STK), CAG- CARDIOLOGY
SVD
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
9-Sep-15
14-Sep-15
65000
65000
65000
1950
63050
IDBI - 321
30-Oct-15
2827 H_22558327844
Male
24
Others Madegowdanahalli
CHANNARAYAP
HASSAN
ATNA
Mysore
Vaatsalya
Hospital
HASSAN
Rt Ureteric stone RENAL
Genito Urinary
Surgery
Urology
909
909
10-Sep-15
12-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Gulbarga
SJICR
BANGALORE
SOUTH
RHD - SEVERE
MS
CARDIOLOGY
Cardiology
Cardiology
105
105
9-Sep-15
12-Sep-15
20000
20000
19000
0
19000
IDBI - 321
30-Oct-15
HASSAN
Mysore
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
MYSORE
SINGLE VESSEL
DISEASE.
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
7-Sep-15
10-Sep-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
HAVERI
Belgaum
Narayana
Hrudayalaya
Private Limited
Bangalore
L4-L5 PARS
DEFECT WITH L5NEURO SURGERY
51 GRADE I
LISTHESIS
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
13-Sep-15
16-Sep-15
50000
50000
51000
1530
49470
IDBI - 321
30-Oct-15
2828 H_19577327687
Female
45
Others WARD NO 03
BELLARY
KADAGADAHOSAHAL
HASSAN
LI
2829 H_19542327394
Male
68
Others
2830 H_19528327740
Male
36
Others SAVASAGI
HANAGAL
BELLARY
SOLAPUR
URSL - Single Side
+ DJ Stent
Balloon Mitral
Valvotomy
Sl.No
Preauth No
Gender
Age
2831 H_19528326937
Male
3 Months
2832 H_22439327826
Female
42
2833 H_21044325678
2834 H_20107327584
Male
Male
52
72
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Others SAVASUDDI
RAIBAGH
BELGAUM
Belgaum
Narayana
Hrudayalaya
Private Limited
Bangalore
LEFT UPPER
LOBE CONGEITL
CARDIOLOGY
LOBEY
EMPHYSEMA
Lobectomy
189
189
15-Sep-15
21-Sep-15
62500
62500
51000
1530
49470
IDBI - 321
30-Oct-15
Others VAKKUND
BYLAHONGALA
BELGAUM
Belgaum
BHS lakeview
Hospital
BELGAUM
L4/L5 PIVD RT
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
11-Sep-15
15-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
MANGALORE
CA RECTUM
WITH ACUTE
INTESTINAL
OBSTRUCTION
CANCER
Surgical Oncology
Colectomy - any
type
637
637
29-Aug-15
14-Sep-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
Cardiology
Permanent
pacemaker
VVI) including
Pacemaker value
114
114
8-Sep-15
14-Sep-15
75000
148851
75000
7500
67500
IDBI - 321
30-Oct-15
Others KOTESHWARA
Others THANAKUSHNOOR
KUNDAPURA
AURAD
UDUPI
BIDAR
Mysore
WENLOCK
DISTRICT
HOSPITAL
Gulbarga
CARE Hospital A
unit of Quality
Nampally
Care India
Limite
COMPLETE
HEART BLOCK
ANTEROLISTHESI
S L5 OVER S1
VERTEBRA WITH
NEURO SURGERY
PID L5-S1 WITH
NEUROLOGICAL
CLAUDICATION
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
10-Sep-15
15-Sep-15
50000
78100
50000
5000
45000
IDBI - 321
30-Oct-15
2835 H_20648327315
Female
38
Others HONNALLI
BIJAPUR
BIJAPUR
Belgaum
PIOS HOSPITAL
2836 H_19510327406
Female
56
Others YARAZERI
MUDDEBIHAL
BIJAPUR
Belgaum
M/s Kerudi
Hospital And
Bagalkot
Research Centre
Bagalkot
LEFT URETERAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
15-Sep-15
16-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Gulbarga
Ashwini
Sahakari
Rugnalaya Ani
Sansodhan
Kendra
ANT INFARCT
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
5-Sep-15
9-Sep-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
L4-L5 lumbar
decompression
L2-L5
laminectomy
+stabilazation
NEURO SURGERY
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
8-Sep-15
15-Sep-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
RANEBENNUR
BPH
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
12-Sep-15
15-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
HOSPET
LEFT HDUN
WITH LOWER
URETERIC
CALCULUS11MM
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
8-Sep-15
12-Sep-15
25000
27750
25000
2500
22500
IDBI - 321
30-Oct-15
2837 H_21695326802
Female
60
Others BALLURGI
AFJALPUR
GULBARGA
JAYSINGPUR
CARDIOLOGY
Solapur
2838 H_22525327647
Male
54
Others 0
ALAND
GULBARGA
Gulbarga
Balawant
Institute of
Solapur
Neurosurgery
Intensive Trama
2839 H_21658327557
Male
56
Others Hanumapur
RANEBENNUR
HAVERI
Belgaum
SRI SAI
SPECIALITY
HOSPITAL
2840 H_20020327586
Male
25
SC
Malapanagudi
HOSPET
BELLARY
Gulbarga
DIPALI
HOSPITAL
2841 H_19510326969
Male
51
ST
BAGALKOT
BAGALKOTE
BAGLAKOT
Belgaum
M/s Kerudi
Hospital And
Bagalkot
Research Centre
Bagalkot
LEFT URETERAL
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
10-Sep-15
11-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
KOLAR
BPH WITH BOO
ON CATHETER
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
9-Sep-15
16-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
2842 H_20164327634
Male
65
2843 H_23124325139
Male
56
2844 H_22439327483
Female
36
KOLAR
KOLAR
Bangalore
R L JALAPPA
HOSPITAL AND
RESEARCH
CENTRE
Others KADAGANDODDI
RAICHUR
RAICHUR
Gulbarga
SPARSH SUPER
SPECIALITY
HOSPITAL
BANGALORE
NORTH
L4_5 PIVD
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
8-Sep-15
12-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Others SALAPUR
RAMADURGA
BELGAUM
Belgaum
BHS lakeview
Hospital
BELGAUM
L3/4 +L4/5 PIVD
WITH SEVERE
NEURO SURGERY
CANAL STENOSIS
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
9-Sep-15
14-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Bangalore
STRICTURE
URETHRA
RENAL
Genito Urinary
Surgery
Urology
Urethroplasty for
a year can be
considered)
912
912
10-Sep-15
15-Sep-15
30000
30000
30600
918
29682
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
1-Sep-15
12-Sep-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
SC
HONENAHALLI
2845 H_19528324662
Male
32
Others ANTHAPURA
SANDUR
BELLARY
Gulbarga
Narayana
Hrudayalaya
Private Limited
2846 H_20017327551
Male
56
Others ATHANI
ATHANI
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
IHD -EVALUED
AWMI
2847 H_20112327513
Female
5
Others MATHIHALLI
HARAPANAHALL
DAVANGERE
I
Bangalore
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
CONGENINTAL
HEART DISEASR CARDIOLOGY
LARGE OS ASD
WITH L-R SHUNT
ASD
151
151
7-Sep-15
18-Sep-15
80000
80000
80000
2400
77600
IDBI - 321
30-Oct-15
Gulbarga
CARE Hospital A
unit of Quality
Nampally
Care India
Limite
CAD TWO
VESSEL DISEASE
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
8-Sep-15
11-Sep-15
65000
178312
65000
6500
58500
IDBI - 321
30-Oct-15
2848 H_20107327492
Male
65
Others NELAWAD
BIDAR
BIDAR
CARDIOLOGY
Cardiology
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Urology
ESWL (Extra
Stent
908
908
3-Sep-15
11-Sep-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
2849 H_19586325872
Male
48
Others 0
KOPPAL
KOPPAL
Gulbarga
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
2850 H_19564327478
Male
54
Others GURURAJAPURA
CHANNAGIRI
DAVANGERE
Bangalore
KASTURBA
HOSPITAL
UDUPI
RHD WITH
SEVERE MS
CARDIOLOGY
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
8-Sep-15
11-Sep-15
20000
20000
20400
2040
18360
IDBI - 321
30-Oct-15
2851 H_19564327432
Female
45
Others MAVINAKURVE
BHATKALA
UTTARA
KANNADA
Belgaum
KASTURBA
HOSPITAL
UDUPI
STABLE ANGINA
CARDIOLOGY
AND SVD
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
7-Sep-15
11-Sep-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
2852 H_20880327421
Female
17
Others Kiranagi
ATHANI
BELGAUM
Belgaum
CARDIOLOGY
Cardiology
Device Closure
ASD Device
Closure
120
120
7-Sep-15
12-Sep-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
2853 H_19491326132
Female
43
Others MUDUGERE
Bangalore
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
11-Sep-15
15-Sep-15
25000
25000
21500
86
21414
IDBI - 321
30-Oct-15
2854 H_21868327019
Male
23
Others Beeraganahalli
KUNIGAL
TUMKUR
Bangalore
NAGESH
HOSPITAL
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
13-Sep-15
16-Sep-15
25000
30117
25000
2500
22500
IDBI - 321
30-Oct-15
2855 H_19576327381
Female
3
Others Kavaloor
KOPPAL
KOPPAL
Gulbarga
SDM Narayana
Hrudayalaya
CARDIOLOGY
VSD
152
152
7-Sep-15
15-Sep-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
2856 H_22867327037
Male
65
Others 0
CHALLAKERE
CHITRADURGA
Bangalore
Chitradurga
Government
Hospital
CHITRADURGA
Vesical Calculus
RENAL
Genito Urinary
Surgery
Cystolithotripsy
906
906
7-Sep-15
14-Sep-15
12500
13300
12500
1250
11250
IDBI - 321
30-Oct-15
2857 H_19574327015
Female
8
Others SIDDESHWAR ROAD
ATHANI
BELGAUM
Belgaum
VYDEHI
HOSPITAL
BANGALORE
ACHD OS ASD
(Size 0.4 cm &
0.2 cm) Left >Right Shunt
CARDIOLOGY
ASD
151
151
10-Sep-15
22-Sep-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
2858 H_20015327163
Male
54
Others MANCHI
BANTWAL
DAKSHINA
KANNADA
Mysore
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
MANGALORE
PERIAMPULLARY
CARCINOMA.T2 CANCER
N1M0.
Surgical Oncology
Pancreas
Whipples - any
type
582
582
22-Jul-15
9-Sep-15
75000
75000
75000
7500
67500
IDBI - 321
30-Oct-15
2859 H_20575327255
Female
60
Others HONNENAHALLI
HOSADURGA
CHITRADURGA
Bangalore
MANGALORE
INSTITUTE OF
ONCOLOGY
MANGALORE
CA THYROID
WITH LUNG
METS STAGE IV
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
8-Sep-15
25-Sep-15
20000
20000
19000
1900
17100
IDBI - 321
30-Oct-15
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
9-Sep-15
15-Sep-15
50000
80500
50000
5000
45000
IDBI - 321
30-Oct-15
BANGALORE
LEFT RENAL
CALCULUS
Wanless
Hospital Miraj
Miraj
Medical Center
miraj
BGS GLOBAL
BANGALORE
HOSPITAL
SOUTH
ACHD-large os
ASD (25x27 mm)
with Left to Right
Shunt
LEFT L4-5 DISC
PROLAPSE
Lt Mild HN with
CHANNARAYAPA
VUJ calculi
TNA
8x4mm
ACHD QP L-R
juxon ductal VSD
Dharwad
with VSD with
IE/CCF
RENAL
Genito Urinary
Surgery
CANCER
Urology
2860 H_20648327192
Female
34
Others KALLOL
CHIKKODI
BELGAUM
Belgaum
PIOS HOSPITAL
JAYSINGPUR
ANTERIOLISTHES
ISI L4-L5 WITH
PID L4-L5,L5-S1
WITH LUMBAR
SPINAL CANAL
NEURO SURGERY
STENOSIS AND
WITH
NEUROLOGICAL
CLAUDICATION
2861 H_20815324869
Female
22
Minorit
GOLA K
y
CHITTAPUR
GULBARGA
Gulbarga
CHIRAYU
HOSPITAL
GULBARGA
Cervical
tuberculosis with
NEURO SURGERY
cord
compression
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
3-Sep-15
12-Sep-15
50000
50120
50000
5000
45000
IDBI - 321
30-Oct-15
2862 H_20017327160
Female
58
BDE SOCIETY BDE,
Minorit
GIRL HIGH SCHOOL,
y
BIJAPUR
BIJAPUR
BIJAPUR
Belgaum
IHD RECENT
AWMI
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
26-Aug-15
12-Sep-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
2863 H_19522326877
Male
65
Minorit
BANKANHITLU
y
HONNAVAR
UTTARA
KANNADA
Belgaum
UNSTABLE
ANGINA LV
DYSFUNCTION
IHD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting Stent
, elective)
240
240
3-Sep-15
12-Sep-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
2864 H_19577327061
Male
31
Minorit
CHOLAGUDDA
y
CHITRADURGA
CHITRADURGA
Bangalore
SJICR
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
8-Sep-15
12-Sep-15
65000
65000
63500
0
63500
IDBI - 321
30-Oct-15
Mysore
NARAYANA
HRUDAYALAYA
SURGICAL
MYSORE
HOSPITAL PVT
LTD
ACS ACUTE
INFERIOR
+RVMI,TYPE2
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
7-Sep-15
10-Sep-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
ISCHEMIC HEART
DISEASE
DIABETIC
CARDIOLOGY
MELITUS
HTYPERTENSION
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
3-Sep-15
9-Sep-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
IHD- OLD AWMI CARDIOLOGY
Cardiology
Cardiology
PTCA - 2 stent
(non-medicated)
104
104
29-Aug-15
12-Sep-15
70000
70000
70000
7000
63000
IDBI - 321
30-Oct-15
2865 H_20200327053
Male
47
Minorit
KALYAN GIRI
y
MYSORE
MYSORE
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
FATHER
MULLER
MANGALORE
MEDICAL
COLLEGE
HOSPITAL
BANGALORE
SOUTH
2866 H_19564327060
Female
69
Minorit
BAILUR
y
UDUPI
UDUPI
Mysore
KASTURBA
HOSPITAL
2867 H_20017327075
Male
54
Minorit
KUDACHI
y
RAIBAGH
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
UDUPI
CARDIOLOGY
Cardiology
Sl.No
Preauth No
Gender
Age
2868 H_19528327017
Male
62
Others LAKKUR
MALUR
2869 H_21868326971
Male
39
Others Jamburu
2870 H_20017326956
Female
50
Others YADGUD
2871 H_19542326857
Male
49
2872 H_19574324963
Male
31
2873 H_20010326705
Female
40
2874 H_21044326454
Female
4 Days
2875 H_20112326531
Male
37
2876 H_20112326514
Male
51
2877 H_19515326429
Female
2878 H_20061326751
Male
2879 H_20010326722
Female
Caste
Village
Others HIREHALLI
ST
Hospital Name
Hospital
District
Narayana
Hrudayalaya
Private Limited
Bangalore
CHANNARAYAP
HASSAN
ATNA
Mysore
NAGESH
HOSPITAL
Lt Mild HN with
CHANNARAYAPA
Lower Uretric
TNA
calculi 17x6mm
HUKKERI
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
Mysore
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
HD KOTE
BELGAUM
MYSORE
VYDEHI
HOSPITAL
MYSORE
Others HOSADODDI
MAGADI
RAMANAGAR
Bangalore
Others IDOORKUNHADY
KUNDAPURA
UDUPI
Mysore
HANAGAL
HAVERI
Belgaum
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
Others NADVELPET ROAD
HARIHARA
DAVANGERE
Bangalore
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
56
Others 0
DAVANAGERE
DAVANGERE
Bangalore
28
H.NO.6-5-104
Others THIMMAPURPET
RAICHUR.
RAICHUR
RAICHUR
Gulbarga
32
Minorit
BADRAPPA LAYOUT
y
BANGALORE
EAST
BANGALORE URBAN
SAKLESHPURA
MANGALORE
ARISHINAGUPPI
Male
74
2881 H_20127326670
Female
19
Others JAPPINA MOGARU
36
Others CHALAGANAHALLI
Final
Diagnosis
Bangalore
KOLAR
Gulbarga
2880 H_19522326634
Male
Patient
Division
BIDAR
Minorit
MATASAGARA
y
2882 H_20010326667
Patient District
BIDAR
ST
GORANALLI
Taluk
BANGARPET
M S Ramaiah
Hospital
WENLOCK
DISTRICT
HOSPITAL
ECG-SVT
IHD AWMI
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
CARDIOLOGY
Cardiology
Cardiology
EP study
125
125
8-Sep-15
10-Sep-15
30000
30000
30600
918
29682
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
13-Sep-15
16-Sep-15
25000
30198
25000
2500
22500
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
25-Aug-15
14-Sep-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
4-Sep-15
7-Sep-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
9
9
8-Sep-15
25-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
909
909
4-Sep-15
14-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
DOUBLE VESSEL
CARDIOLOGY
DISEASE.
Cardiology
Post Burn
Contracture
surgeries for
Functional
Improvement(Pack
age including
splints, pressure
garments and
physiotherapy),
Mild
URSL - Single Side
+ DJ Stent
BANGALORE
PBC Right Hand
BURNS
Burns
Burns
BANGALORE
NORTH
LEFT URETRIC
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
MANGALORE
MALROTATION
NEONATAL
Intestinal Atresias
& Obstructions
303
303
28-Aug-15
9-Sep-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
IHD- AWMI, CAGCARDIOLOGY
SVD
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
4-Sep-15
9-Sep-15
65000
65000
65000
1950
63050
IDBI - 321
30-Oct-15
IHD- EVOLVED
CARDIOLOGY
AWMI, CAG-SVD
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
4-Sep-15
10-Sep-15
65000
65000
65000
1950
63050
IDBI - 321
30-Oct-15
ACUTE AWMI
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
8-Sep-15
12-Sep-15
55000
67329
55000
5500
49500
IDBI - 321
30-Oct-15
PIVD-C1-C2.
NEURO SURGERY
Neuro Surgery
Spinal
Spinal Cord
Tumours
426
426
4-Sep-15
12-Sep-15
35000
35000
35700
3570
32130
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
3-Sep-15
14-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
CITY CENTRAL
HOSPITAL
DAVANGERE
PRIVATE
LIMITED
NARAYANA
HOSPITALS
Bangalore
M S Ramaiah
Hospital
HASSAN
Mysore
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
DAKSHINA
KANNADA
Mysore
A J HOSPITAL
CENTRE
RIGHT VUJ
CALCULUS WITH RENAL
HDUN
Genito Urinary
Surgery
Bangalore
M S Ramaiah
Hospital
BANGALORE
NORTH
RIGHT RENAL
CALCULUS
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
3-Sep-15
14-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
S/P PPI, END OF
CARDIOLOGY
PACEMAKER LIFE
Cardiology
Permanent
pacemaker
VVI) including
Pacemaker value
114
114
7-Sep-15
12-Sep-15
75000
75000
74000
0
74000
IDBI - 321
30-Oct-15
KOLAR
BANGALORE
NORTH
LEFT RENAL
CALCULUS
MANGALORE
ATHEROSCLEROT
IC SIGNIFICANT
CORONARY
ARTERY DISEASE.
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
2-Sep-15
11-Sep-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
Urology
URSL - Single Side
+ DJ Stent
909
909
3-Sep-15
10-Sep-15
25000
26819
25500
2550
22950
IDBI - 321
30-Oct-15
RENAL
2883 H_19577326535
Male
45
Others NEW MEDAR WADI
RAICHUR
RAICHUR
Gulbarga
SJICR
BANGALORE
SOUTH
2884 H_19577326606
Male
47
Others BALAKUNDI
HUNAGUNDA
BAGLAKOT
Belgaum
SJICR
BANGALORE
SOUTH
IHD - AWMI,
LVD, DM, DVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
10-Sep-15
13-Sep-15
90000
90000
89000
0
89000
IDBI - 321
30-Oct-15
2885 H_19577326372
Male
37
Others BIDALURU
DEVANAHALLI
BANGALORE RURAL
Bangalore
SJICR
BANGALORE
SOUTH
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
31-Aug-15
10-Sep-15
90000
90000
88500
0
88500
IDBI - 321
30-Oct-15
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Hospital
District
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
BANGALORE
NORTH
ASD MODERATE
MITRAL
REGURGITATION CARDIOLOGY
WITH RPA
STENISIS
Mitral Valve
Repair
141
141
3-Sep-15
12-Sep-15
100000
100000
100000
10000
90000
IDBI - 321
30-Oct-15
DAVANGERE
left lower
RENAL
uretesic calcules
Genito Urinary
Surgery
URSL - Single Side
+ DJ Stent
909
909
8-Sep-15
10-Sep-15
25000
31943
25000
2500
22500
IDBI - 321
30-Oct-15
MULTI
LOCULATED
PLEURAL
EFFUSION
CARDIOLOGY
Decortication
192
192
8-Sep-15
14-Sep-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
2886 H_23124326658
Female
9
Others HEGGANADODDI
SURPUR
YADGIRI
Gulbarga
SPARSH SUPER
SPECIALITY
HOSPITAL
2887 H_19515323357
Male
25
Minorit
0
y
DAVANAGERE
DAVANGERE
Bangalore
CITY CENTRAL
HOSPITAL
PRIVATE
LIMITED
2888 H_20025326629
Male
80
Others
KALLUMALLENAHALL CHANNARAYAP
HASSAN
I
ATNA
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
2889 H_19549325812
Male
4
SC
0
2890 H_21701326329
Male
61
2891 H_20061326366
Male
2892 H_19528326349
2893 H_19528326337
Urology
INDI
BIJAPUR
Belgaum
Sagar Hospitals
BANGALORE
SOUTH
CHD,BICUSPID
AV SEVERE AS
CARDIOLOGY
Cardiology
Cardiology
Balloon Aortic
Valvotomy
108
108
7-Sep-15
9-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
Others malkapur
MANVI
RAICHUR
Gulbarga
SUNSHINE
HEART
INSTITUTE
Paradise, S.D.
Road
CAD-SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
4-Sep-15
9-Sep-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
61
(v) KARPAKPALLI
Others (T,Q) HUMNABAD
(DIST) BIDAR.
HUMNABAD
BIDAR
Gulbarga
NARAYANA
HOSPITALS
CAD-TRIPLE
CARDIOLOGY
VESSEL DISEASE.
CABG
132
132
3-Sep-15
14-Sep-15
95000
95000
96900
9690
87210
IDBI - 321
30-Oct-15
Male
60
Others
BELLARY
BELLARY
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
SEVERE DOUBLE
VESSEL DISEASE CARDIOLOGY
CAD
CABG
132
132
7-Sep-15
14-Sep-15
95000
95000
96900
2907
93993
IDBI - 321
30-Oct-15
Female
68
Others DURGA colony
DHARWAD
DHARWAD
Belgaum
Narayana
Hrudayalaya
Private Limited
Bangalore
ECG-PVST
CARDIOLOGY
Cardiology
EP study
125
125
7-Sep-15
9-Sep-15
30000
30000
30600
918
29682
IDBI - 321
30-Oct-15
LEFT
SUPERFICIAL
FEMORAL
POPLITEAL
ARTERY
OCCLUSION
CARDIOLOGY
Thromboembolect
omy
213
213
31-Aug-15
5-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
CAD-TRIPLE
CARDIOLOGY
VESSEL DISEASE.
CABG
132
132
3-Sep-15
14-Sep-15
95000
95000
96900
9690
87210
IDBI - 321
30-Oct-15
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
4-Sep-15
7-Sep-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
RAMANJANEYA
NAGAR
2894 H_20079326279
Male
36
Others DANDURU
TARIKERE
CHIKKAMANAGL
Mysore
UR
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
2895 H_20061326507
Female
61
H.NO.10/120
Others SHIVPUR GALLI
HUMNABAD.
HUMNABAD
BIDAR
Gulbarga
NARAYANA
HOSPITALS
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
2896 H_19542326311
Female
59
Others HEBBALE
SOMAVARPET
KODAGU
Mysore
2897 H_19564326373
Female
41
Others PADU
UDUPI
UDUPI
Mysore
2898 H_19574326377
Female
55
Others SANGAPUR
GANGAVATHI
KOPPAL
Gulbarga
2899 H_23124325125
Male
25
Others ABUMOHALLA
DEVADURGA
RAICHUR
Gulbarga
2900 H_19542326413
Final
Diagnosis
Male
17
Gulbarga
KASTURBA
HOSPITAL
VYDEHI
HOSPITAL
Cardiology
MYSORE
SINGLE VESSEL
DISEASE.
CARDIOLOGY
Cardiology
UDUPI
CHD LARGE 31
MM OS ASD
CARDIOLOGY
ASD
151
151
2-Sep-15
10-Sep-15
80000
80000
81600
8160
73440
IDBI - 321
30-Oct-15
Urology
Open
Cystolithotomy
903
903
8-Sep-15
15-Sep-15
15000
15000
15000
1500
13500
IDBI - 321
30-Oct-15
Spinal
DiscectomyLumbar
433
433
9-Sep-15
12-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Cardiology
BANGALORE
Vesical calculus
RENAL
Genito Urinary
Surgery
BANGALORE
NORTH
L4_5 PIVD
NEURO SURGERY
Neuro Surgery
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
MYSORE
RT MODERATE
HYN WITH
LARGE
PARSHALLY
OBSTRUCTIVE
CALCULUS IN
THE RENAL
PELVIS WITH
DELAYED
EXCRETION.
RENAL
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
6-Sep-15
10-Sep-15
25000
25000
25500
2550
22950
IDBI - 321
30-Oct-15
SYMPTOMATIC
2:1 AV BLOCK
CARDIOLOGY
Cardiology
Permanent
pacemaker
VVI) including
Pacemaker value
114
114
3-Sep-15
11-Sep-15
75000
75000
74000
0
74000
IDBI - 321
30-Oct-15
DOUBLE VESSEL
CORONARY
CARDIOLOGY
ARTERY DISEASE
Cardiology
Cardiology
104
104
4-Sep-15
7-Sep-15
70000
70000
70000
7000
63000
IDBI - 321
30-Oct-15
DISTAL PENILE
HYPOSPADIAS
322
322
7-Sep-15
15-Sep-15
22000
22000
22000
2200
19800
IDBI - 321
30-Oct-15
SPARSH SUPER
SPECIALITY
HOSPITAL
Others ECHANALA
LINGASUGUR
RAICHUR
BANGALORE URBAN
Bangalore
SJICR
BANGALORE
SOUTH
MYSORE
2901 H_19577326227
Female
49
Others H. GOLLAHALLI
BANGALORE
SOUTH
2902 H_19581326400
Male
52
Others KADUMANE
SAKLESHPURA
HASSAN
Mysore
Cauvery
Hospital
2903 H_22971326165
Male
2
Minorit
SHANTHI NAGAR
y
MYSORE
MYSORE
Mysore
CSI Holdsworth
Memorial
Mysore
Hospital
NEONATAL
PTCA - 2 stent
(non-medicated)
Sl.No
Preauth No
2904 H_20698326025
Gender
Male
Age
33
2905 H_19564326199
Male
45
2906 H_20448326053
Male
2 Days
2907 H_22439326264
Male
36
2908 H_20020326327
Male
7 Months
2909 H_19528324548
Male
60
Caste
Village
Others YAMAGUNDI
ST
HEGUNJJE
Others Benakanal
Taluk
KUNDAPURA
Patient District
UDUPI
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
MANGALORE
RIGHT RENAL
STONE
RENAL
Genito Urinary
Surgery
Diseases
Gulbarga
Vaatsalya
Healthcare
Solutions Pvt
Ltd
Others GOKAK
GOKAK
BELGAUM
Belgaum
BHS lakeview
Hospital
BELGAUM
Minorit
GANDHI NAGAR
y
SINDNUR
RAICHUR
Gulbarga
DIPALI
HOSPITAL
HOSPET
Others ILALAPUR
SINDNUR
RAICHUR
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
15-Sep-15
25000
5000
5000
500
4500
IDBI - 321
30-Oct-15
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
31-Aug-15
10-Sep-15
37500
37500
38250
3825
34425
IDBI - 321
30-Oct-15
Anorectal
Malformations
Stage 1
305
305
4-Sep-15
11-Sep-15
25000
25000
24500
2450
22050
IDBI - 321
30-Oct-15
Neuro Surgery
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
7-Sep-15
14-Sep-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
Hirschprungs
Disease stage 1
308
308
4-Sep-15
11-Sep-15
40000
42300
40000
4000
36000
IDBI - 321
30-Oct-15
CABG with IABP
133
133
2-Sep-15
9-Sep-15
115000
115000
117300
3519
113781
IDBI - 321
30-Oct-15
SVD (PROXIMAL
CARDIOLOGY
LAD)
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
2-Sep-15
7-Sep-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
ANORECTAL
MALFORMETION NEONATAL
STAGE-I
KOPPAL
Date of
Discharge
28-Aug-15
GADAG
KUSTAGI
Date of
Admission
907
UDUPI
Mysore
907
RIGHT UPPER
URETERIC
RENAL
CALCULUS +LEFT
VVJ CALCULES
UDUPI
Plan of
treatment
Urology
Mysore
UDUPI
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
YENEPOYA
MEDICAL
COLLEGE
HOSPITAL
KASTURBA
HOSPITAL
Disease Main
Category
D12-L1
COLLAPSE
SECONDARY TO
NEURO SURGERY
POTTS SPINE
WITH
RETROPHERIS
HIRSCHSPRUNGS
NEONATAL
DISEASE
CAD-DVD
CARDIOLOGY
2910 H_20200326297
Male
45
Others KEKKERI
KR PET
MANDYA
Mysore
NARAYANA
HRUDAYALAYA
SURGICAL
MYSORE
HOSPITAL PVT
LTD
2911 H_19549324846
Female
53
Others 0
INDI
BIJAPUR
Belgaum
Sagar Hospitals
BANGALORE
SOUTH
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
1-Sep-15
7-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
2912 H_19577326103
Male
68
Others APASANAHLLI
CHINTAMANI
CHIKKABALLAPU
Bangalore
R
SJICR
BANGALORE
SOUTH
IHD - AWMI,
HTN, SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
2-Sep-15
7-Sep-15
65000
65000
63500
0
63500
IDBI - 321
30-Oct-15
2913 H_20017326250
Female
41
Others 0
BELGAUM
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
IHD ACUTE
IWMW RVMI
CARDIOLOGY
Cardiology
Cardiology
PTCA - 2 stent
(non-medicated)
104
104
27-Aug-15
8-Sep-15
70000
70000
70000
7000
63000
IDBI - 321
30-Oct-15
2914 H_23124325950
Male
22
Others WARD NO 22
GANGAVATHI
KOPPAL
Gulbarga
SPARSH SUPER
SPECIALITY
HOSPITAL
Right Chronic
SDH
NEURO SURGERY
Neuro Surgery
Brain
401
401
8-Sep-15
12-Sep-15
45000
45000
45000
4500
40500
IDBI - 321
30-Oct-15
2915 H_20021325916
Male
68
Others Devasugur
RAICHUR
RAICHUR
Gulbarga
BASAVESHWAR
TEACHING AND
GULBARGA
GENERAL
HOSPITAL
Chronic subdural
NEURO SURGERY
haematoma
Neuro Surgery
Brain
401
401
1-Sep-15
7-Sep-15
45000
47308
45000
4500
40500
IDBI - 321
30-Oct-15
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
RT SFA STENOSIS
(75 - 80 % ) + LT CARDIOLOGY
SFA OCCLUSION
Cardiology
Peripheral
Angioplasty
109
109
5-Sep-15
8-Sep-15
55000
55000
20000
2000
18000
IDBI - 321
30-Oct-15
239
239
1-Sep-15
5-Sep-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
2916 H_20025325672
Male
77
Others RATHNAPURI
HUNSUR
MYSORE
BANGALORE
NORTH
Cardiology
Craniotomy and
Evacuation of
Haematoma Subdural
Craniotomy and
Evacuation of
Haematoma Subdural
2917 H_19564326189
Male
48
Others SALIGRAMA
UDUPI
UDUPI
Mysore
KASTURBA
HOSPITAL
UDUPI
NSTEMI
CARDIOLOGY
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
2918 H_19577326077
Male
12
Others YALHERI
YADGIR
YADGIRI
Gulbarga
SJICR
BANGALORE
SOUTH
RHD - SEVERE
MS
CARDIOLOGY
Cardiology
Cardiology
Balloon Mitral
Valvotomy
105
105
3-Sep-15
10-Sep-15
20000
20000
19000
0
19000
IDBI - 321
30-Oct-15
MANGALORE
L4-L5 DISC
PROLAPSE.
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
31-Aug-15
18-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
2919 H_19522325416
Male
25
Others HEGGAVARA VALLI
Mysore
R
UR
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
2920 H_23124325134
Male
27
Others JAINAPUR
SURPUR
YADGIRI
Gulbarga
SPARSH SUPER
SPECIALITY
HOSPITAL
BANGALORE
NORTH
L2-L3 PIVD
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
7-Sep-15
11-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
2921 H_19577326133
Male
65
Others SHRUTHI NGAR
GULBARGA
GULBARGA
Gulbarga
SJICR
BANGALORE
SOUTH
IHD - NSTEMI,
DM, SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
6-Sep-15
9-Sep-15
65000
65000
64000
0
64000
IDBI - 321
30-Oct-15
2922 H_20017326217
Female
24
Others 0
HUKKERI
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
LARGE OSITUM
CARDIOLOGY
SECUNDUM ASD
Cardiology
Device Closure
ASD Device
Closure
120
120
1-Sep-15
11-Sep-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
Sl.No
Preauth No
Gender
Age
Caste
Village
Taluk
Patient District
2923 H_19577326063
Male
61
Others MAHALKSHMIPURA
BANGALORE
SOUTH
2924 H_20107326177
Male
49
Minorit
BASAVAKLYANA
y
BASAVAKALYAN
BIDAR
A
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
0
89000
IDBI - 321
30-Oct-15
CARE Hospital A
unit of Quality
Nampally
Care India
Limite
CAD SINGLE
CARDIOLOGY
VESSELE DISEASE
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
4-Sep-15
9-Sep-15
90000
130718
65000
6500
58500
IDBI - 321
30-Oct-15
KADUR
CHIKKAMANAGL
Mysore
UR
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
IHD IWMA T2
DM CAG ATHEROSCLEROT CARDIOLOGY
IC CAD - SINGLE
VESSEL DISEASE
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
3-Sep-15
9-Sep-15
65000
65000
65000
1950
63050
IDBI - 321
30-Oct-15
LEFT
CONGENITAL PUJ NEONATAL
OBSTRUCTION
Congenital
Open/Lap
313
313
1-Sep-15
16-Sep-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
Cardiology
Cardiology
EP study
125
125
3-Sep-15
7-Sep-15
30000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
Double Valve
Replacement
149
149
7-Sep-15
18-Sep-15
150000
150000
153000
4590
148410
IDBI - 321
30-Oct-15
Aortic Valve
Replacement
146
146
3-Sep-15
18-Sep-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
Cardiology
Cardiology
PTCA - 2 stent
(non-medicated)
104
104
4-Sep-15
7-Sep-15
70000
70000
70000
7000
63000
IDBI - 321
30-Oct-15
Gulbarga
WENLOCK
DISTRICT
HOSPITAL
2927 H_21057325889
Male
67
Others BELUVAI
MANGALORE
DAKSHINA
KANNADA
Mysore
NEW
PSVT
2928 H_19528325729
Male
14
Others CHIKBERGI
SINDNUR
RAICHUR
Gulbarga
Narayana
Hrudayalaya
Private Limited
RHD-SEV AS
GRADE II AR SEV CARDIOLOGY
MS MILD MR
2929 H_20015326175
Female
36
Others HONNEKOMBU
SIDDAPUR
UTTARA
KANNADA
Belgaum
2930 H_20880326137
Male
74
Others Kudchi
RAIBAGH
BELGAUM
Belgaum
2931 H_19528325265
Male
64
Others
CHIKKANAYAKA
TUMKUR
NAHALLI
AORTIC VALVE
DISEASE.MILD
CARDIOLOGY
AS,MODERATE
TO SEVERE AR.
IHD UNSTABLE
ANGINA,DOUBLE
CARDIOLOGY
VESSEL
DISEASE,HTN
Bangalore
Narayana
Hrudayalaya
Private Limited
Bangalore
MALIGNANCY OF
UNKNOWN
CANCER
ORIGIN
Surgical Oncology
Head & Neck
612
612
6-Sep-15
11-Sep-15
25000
25000
25500
765
24735
IDBI - 321
30-Oct-15
MYSORE
SINGLE VESSEL
DISEASE.
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
8-Sep-15
10-Sep-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
Mysore
HARIHARA
DAVANGERE
Bangalore
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
CONGENITAH
HEART DISEASE
CARDIOLOGY
OS - ASD WITH LR SHUNT
ASD
151
151
2-Sep-15
15-Sep-15
80000
80000
80000
2400
77600
IDBI - 321
30-Oct-15
YADGIR
YADGIRI
Gulbarga
M S RAMAIAH
NARAYANA
BANGALORE
HRUDAYALAYA
IHD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
1-Sep-15
7-Sep-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
CHIKKABALLAPU
Bangalore
R
CHIKKABALLAPU
Bangalore
R
M S Ramaiah
Hospital
M S Ramaiah
Hospital
BANGALORE
NORTH
BANGALORE
NORTH
LEFT URETERIC
CALCULUS
L4-5
DISCESTOMY
RENAL
Genito Urinary
Surgery
Urology
909
909
5-Sep-15
9-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
NEURO SURGERY
Neuro Surgery
Spinal
433
433
1-Sep-15
14-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
HOSPET
BELLARY
Gulbarga
DIPALI
HOSPITAL
HOSPET
LEFT VU
JUNCTION 9MM
RENAL
CALCULUS WITH
HDUN
Genito Urinary
Surgery
Urology
909
909
4-Sep-15
8-Sep-15
25000
27750
25000
2500
22500
IDBI - 321
30-Oct-15
HOSAKOTE
BANGALORE RURAL
Bangalore
NEURO SURGERY
Neuro Surgery
Spinal
433
433
5-Sep-15
11-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
RENAL
Genito Urinary
Surgery
Urology
909
909
3-Sep-15
6-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
NEURO SURGERY
Neuro Surgery
Spinal
435
435
5-Sep-15
21-Sep-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
2933 H_20112320818
Female
49
2934 H_20074325879
Male
40
2935 H_20010325536
Male
37
Others D PALYA
GOWRIBIDANUR
2936 H_20010325689
Male
49
Others SIDLAGATTA
SIDLAGATTA
Others DODDA ARALAGERE
JUSTICE KS
HEGDE
MANGALORE
CHARITABLE
HOSPITAL
Wanless
Hospital Miraj
Miraj
Medical Center
miraj
HASSAN
61
29
Bangalore
CARDIOLOGY
HASSAN
Male
Male
MANGALORE
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
2932 H_19542325719
2938 H_19574325592
89000
Bangalore
CHINNAPURA
Net Amt
Paid
90000
RAMANAGAR
SC
TDS
90000
KANAKAPURA
41
Gross
Amount
approved by
7-Sep-15
Others FORT
Male
Hospital
claimed
Amount
2-Sep-15
2 Months
2937 H_20020326046
Preauth
Approved
Amt
241
Male
VISHWAPUR
Date of
Discharge
241
2926 H_21044326170
SC
Date of
Admission
PTCA - Two stent
(Drug Eluting
Stents , elective)
BANGALORE
SOUTH
45
Others JIGALI
Cardiology
SJICR
Male
IDHALAKA
Plan of
treatment
Cardiology
Bangalore
2925 H_20112326040
ST
ACS - IWMI, TVD CARDIOLOGY
BANGALORE URBAN
Minorit
BIRUR
y
GILYANAYAKANA
THANDA
Disease Main
Category
2939 H_21925325593
Male
33
Others 0
TURVEKERE
TUMKUR
Bangalore
2940 H_19574325606
Female
60
Others SALAGARA
ALAND
GULBARGA
Gulbarga
2941 H_19586325969
Male
19
Others 0
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
2942 H_19586323069
Female
30
Minorit
TEKKALAKOTE
y
SIRAGUPPA
BELLARY
Gulbarga
2943 H_19576325957
Male
48
Others Panigatti
SHIGGAON
HAVERI
Belgaum
2944 H_19522324523
Male
60
Others MALLANA HALLI
BELUR
HASSAN
Mysore
VYDEHI
HOSPITAL
MUDRA
HOSPITAL
VYDEHI
HOSPITAL
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
SDM Narayana
Hrudayalaya
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
BANGALORE
TIPTUR
BANGALORE
L5-S1 PIVD extruded disc.
LEFT URETERIC
CALCULUS
L4-5 Grade I
Listhesis+ with
PIVD L4-5 with
cord stenosis.
CARDIOLOGY
URSL - Single Side
+ DJ Stent
DiscectomyLumbar
URSL - Single Side
+ DJ Stent
DiscectomyLumbar
URSL - Single Side
+ DJ Stent
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
BANGALORE
RIGHT LOWER
URETERIC
CALCULUS
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
7-Sep-15
11-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
BANGALORE
L4-L5 MLD
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
26-Aug-15
14-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Dharwad
CAD-IWMI
CARDIOLOGY
CABG
132
132
4-Sep-15
15-Sep-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
MANGALORE
MASS IN THE
HEAD OF
PANCREAS
STAGE PT3N0
CANCER
Surgical Oncology
Whipples - any
type
582
582
13-Aug-15
11-Sep-15
75000
75000
75000
7500
67500
IDBI - 321
30-Oct-15
Pancreas
Sl.No
Preauth No
2945 H_19586325561
Gender
Male
Age
40
Caste
Village
Others MYLAPPANAHALLI
Taluk
BANGALORE
NORTH
Patient District
BANGALORE URBAN
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
10000
1000
9000
IDBI - 321
30-Oct-15
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
20-Aug-15
4-Sep-15
65000
127164
66300
6630
59670
IDBI - 321
30-Oct-15
Spinal
Spinal Fusion
Procedure(30000)
+ cost of
implant(20000)
435
435
31-Aug-15
14-Sep-15
50000
25000
25500
2550
22950
IDBI - 321
30-Oct-15
907
907
2-Sep-15
9-Sep-15
25000
25000
23800
2380
21420
IDBI - 321
30-Oct-15
Urology
DAKSHINA
KANNADA
Mysore
2947 H_19564325373
Male
56
Others HILIYANA
UDUPI
UDUPI
Mysore
KASTURBA
HOSPITAL
SOLAPUR
Rt Multiple renal
RENAL
Calculus with HN
CARDIOLOGY
10000
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
MANGALORE
Net Amt
Paid
25000
Genito Urinary
Surgery
Others ALANGAAR
TDS
11-Sep-15
Neuro Surgery
61
Gross
Amount
approved by
1-Sep-15
CAUDA EQUINA
NEURO SURGERY
SYNDROME
Female
Hospital
claimed
Amount
907
UDUPI
2946 H_20127325753
A J HOSPITAL
CENTRE
Preauth
Approved
Amt
907
CAD-SVD,IHD
RENAL
Date of
Discharge
Urology
Bangalore
BANGALORE
Date of
Admission
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
RT RENAL
CALCULS
Genito Urinary
Surgery
2948 H_21254325721
Male
20
Others 0
BIJAPUR
BIJAPUR
Belgaum
DR RAGHOJI
KIDNEY
HOSPITAL AND
RESEARCH
CENTER PV
2949 H_19528325674
Female
1
Others D S HALLI
CHITRADURGA
CHITRADURGA
Bangalore
Narayana
Hrudayalaya
Private Limited
Bangalore
MOD PDA L-R
SHUNT
CARDIOLOGY
Cardiology
Device Closure
PDA Device
Closure
119
119
7-Sep-15
14-Sep-15
60000
60000
61200
1836
59364
IDBI - 321
30-Oct-15
2950 H_19528325912
Male
49
Others
DAVANGERE
Bangalore
Narayana
Hrudayalaya
Private Limited
Bangalore
CAD SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
31-Aug-15
8-Sep-15
55000
55000
56100
1683
54417
IDBI - 321
30-Oct-15
2951 H_22867325876
Male
29
Others BOMMASAMUDRA
CHALLAKERE
CHITRADURGA
Bangalore
Chitradurga
Government
Hospital
CHITRADURGA
Left Ureteric
Calculus
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
1-Sep-15
7-Sep-15
25000
28300
25000
2500
22500
IDBI - 321
30-Oct-15
2952 H_21057325898
Male
62
Minorit
IRDE
y
PUTTUR
DAKSHINA
KANNADA
Mysore
NEW
CAD TVD
CARDIOLOGY
CABG
132
132
2-Sep-15
18-Sep-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
2953 H_20017325875
Female
48
Others 0
BELGAUM
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
IHD AWMI CAD
DVD
CARDIOLOGY
Cardiology
PTCA - 2 stent
(non-medicated)
104
104
24-Aug-15
9-Sep-15
70000
70000
70000
7000
63000
IDBI - 321
30-Oct-15
2954 H_19576325870
Male
64
Others Nilandoor
SHRUNGERI
CHIKKAMANAGL
Mysore
UR
SDM Narayana
Hrudayalaya
P/IWMI, CADCARDIOLOGY
TVD with EF 45%
CABG
132
132
1-Sep-15
14-Sep-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
2955 H_20017325852
Female
64
Others 0
BELGAUM
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
IHD USA CAD
SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
26-Aug-15
9-Sep-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
BHATKALA
UTTARA
KANNADA
Belgaum
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
IVDP L4-L5
CAUSING
COMPRESSION
OF NERVE
ROOTS.
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
1-Sep-15
15-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
HUKKERI
BELGAUM
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
ANORECTAL
NEONATAL
MALFARMATION
Anorectal
Malformations
Stage 1
305
305
1-Sep-15
9-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
SJICR
ACS - AWMI, SVD CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
31-Aug-15
10-Sep-15
65000
65000
64000
0
64000
IDBI - 321
30-Oct-15
HOSPET
BELLARY
Gulbarga
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
IHD RECENT
IWMI CAG
CARDIOLOGY
ATHEROSCLEROT
IC CAD SVD
Cardiology
Cardiology
PTCA - 2 stent
(non-medicated)
104
104
3-Sep-15
9-Sep-15
70000
55000
55000
1650
53350
IDBI - 321
30-Oct-15
KUNDAPURA
UDUPI
Mysore
KASTURBA
HOSPITAL
UDUPI
ATABLE ANGINA
CARDIOLOGY
WITH IHD
CABG
132
132
29-Aug-15
19-Sep-15
95000
95000
96900
9690
87210
IDBI - 321
30-Oct-15
GOPAGONDANAHALL
JAGALURU
I
Others MUTTALLI
Dharwad
2956 H_20015325374
Male
68
2957 H_20017325814
Female
3
2958 H_19577325666
Male
43
2959 H_20112325754
Female
62
2960 H_19564324470
Male
45
Others AMPARU
2961 H_19564325382
Male
56
Others KADAGAVALLI HATTI HOLALKERE
CHITRADURGA
Bangalore
KASTURBA
HOSPITAL
UDUPI
LEFT LOWER
LIMB PERPHERAL
CARDIOLOGY
VASCULAR
DESIASE
Femoro Distal
Bypass with Vein
Graft
229
229
26-Aug-15
15-Sep-15
50000
50000
51000
5100
45900
IDBI - 321
30-Oct-15
2962 H_19581325641
Female
52
Others SAKLESHPURA
SAKLESHPURA
HASSAN
Mysore
Cauvery
Hospital
MYSORE
DOUBLE VESSEL
CARDIOLOGY
DISEASE
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
2-Sep-15
6-Sep-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
2963 H_21925325757
Male
34
Others 0
TURVEKERE
TUMKUR
Bangalore
MUDRA
HOSPITAL
TIPTUR
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
3-Sep-15
4-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
2964 H_20112325613
Male
28
Others SHIVANAKATTE
HOSADURGA
CHITRADURGA
Bangalore
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
3-Sep-15
7-Sep-15
65000
65000
65000
1950
63050
IDBI - 321
30-Oct-15
2965 H_20112325619
Female
67
Others MUGIDARAGIHALLI
JAGALURU
DAVANGERE
Bangalore
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
1-Sep-15
7-Sep-15
65000
65000
65000
1950
63050
IDBI - 321
30-Oct-15
ST
BENAKANAHOLI
Others VALMUKINGARA
ST
CHITRAKERE
MANGALORE
Cardiology
BANGALORE
SOUTH
RIGHT VUJ
CALCULUS
IHD- IWMI(STK
LYSED), CAG:
MID PLV 90%
STENOSIS
NSTEMI T2 DM
CAG MIL LAD
80% STWNOSIS
Sl.No
Preauth No
2966 H_21223325595
Gender
Age
Female
2 Days
Caste
Village
Minorit
TAVAREGERE
y
Taluk
MANDYA
Patient District
MANDYA
Patient
Division
Hospital Name
Hospital
District
Final
Diagnosis
Diseases
Mysore
INDIRA GANDHI
BANGALORE
INSTITUTE OF
SOUTH
CHILD HEALTH
anorectal
malformation
Dharwad
CHD-Large
Fenestrated Sub
CARDIOLOGY
Muscular ASD
with Left to Right
Shunt.
NEONATAL
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
Anorectal
Malformations
Stage 1
305
305
2-Sep-15
7-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
ASD
151
151
3-Sep-15
8-Sep-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
2-Sep-15
8-Sep-15
90000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
2967 H_19576325692
Male
20
Others Sarjapur
RONA
GADAG
Belgaum
SDM Narayana
Hrudayalaya
2968 H_19576325670
Male
70
Others Gangavathi
GANGAVATHI
KOPPAL
Gulbarga
SDM Narayana
Hrudayalaya
Dharwad
CAD-DVD
2969 H_19574324494
Male
62
Others GOREBAL
SINDNUR
RAICHUR
Gulbarga
VYDEHI
HOSPITAL
BANGALORE
Carcinoma left
lung with
CANCER
metastasis to
bone left scapula
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
5-Sep-15
21-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
2970 H_20059324969
Male
61
Others kuntanahatti
SIRA
TUMKUR
Bangalore
KUMAR
HOSPITAL
TIPTUR
bph
RENAL
Genito Urinary
Surgery
Urology
TURP
917
917
5-Sep-15
15-Sep-15
20000
20000
19600
1960
17640
IDBI - 321
30-Oct-15
2971 H_20025325604
Male
47
Others UDBOORU
MYSORE
MYSORE
Mysore
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
LEFT EMPYEMA
CARDIOLOGY
Decortication
192
192
5-Sep-15
12-Sep-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
2972 H_19576325594
Male
26
Minorit
Kundralli
y
SIRAHATTI
GADAG
Belgaum
SDM Narayana
Hrudayalaya
Dharwad
CAD-Single
vessel disease
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
3-Sep-15
5-Sep-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
2973 H_19574324977
Male
45
Others NAVALIHALA
ATHANI
BELGAUM
Belgaum
VYDEHI
HOSPITAL
BANGALORE
L5-S1 PIVD
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
3-Sep-15
24-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Anorectal
Malformations
Stage 3
307
307
31-Aug-15
14-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
114
114
29-Aug-15
10-Sep-15
75000
75000
76500
7650
68850
IDBI - 321
30-Oct-15
URSL - Single Side
+ DJ Stent
909
909
1-Sep-15
8-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
313
313
25-Aug-15
16-Sep-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
2974 H_20698325050
Female
1
2975 H_21701325087
Male
45
2976 H_20010324871
Female
45
2977 H_21044325530
Female
1
2978 H_20010324737
Male
64
2979 H_19593325528
2980 H_19528325495
2981 H_20575324994
Male
Male
Male
52
Others
RAGHAVENDRANAG
SAKLESHPURA
AR
HASSAN
CARDIOLOGY
Mysore
YENEPOYA
MEDICAL
COLLEGE
HOSPITAL
MANGALORE
LOW
ANORECTAL
WITH
COLOSTOMY
Paradise, S.D.
Road
vvi only(perment
CARDIOLOGY
pacemekar)
Cardiology
Permanent
pacemaker
VVI) including
Pacemaker value
SIRAGUPPA
BELLARY
Gulbarga
SUNSHINE
HEART
INSTITUTE
Others NAGAVARA
MULABAGILU
KOLAR
Bangalore
M S Ramaiah
Hospital
BANGALORE
NORTH
RIGHT VERTICAL
RENAL
CALCULUS
Genito Urinary
Surgery
Urology
Others JANNAPURA
SHIMOGA
SHIMOGA
Bangalore
WENLOCK
DISTRICT
HOSPITAL
MANGALORE
LEFT
CONGENITAL
NEONATAL
HYDRONEPHROS
IS
Congenital
Open/Lap
HANAGAL
HAVERI
Belgaum
M S Ramaiah
Hospital
BANGALORE
NORTH
L4-5 LUMBAR
NEURO SURGERY
CANAL STENOSIS
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
29-Aug-15
14-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Gulbarga
TRINITY
HOSPITAL AND
HEART
FOUNDATION
BANGALORE
SOUTH
Post Infarct
Agina, Recent
IWMI DM,
Hypertension
CAD - Single
Vessel Disease
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
2-Sep-15
4-Sep-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
Bangalore
C3/4 PROLAPSED
MTERVERTEBRA
L DISC CAUSING NEURO SURGERY
SEVER CORD
COMPRESSION
Neuro Surgery
Spinal
Anterior Cervical
Discectomy
Multiple level with
Implants
(procedure
30000+ Implants
10000)
429
429
6-Sep-15
10-Sep-15
40000
40000
40800
1224
39576
IDBI - 321
30-Oct-15
MANGALORE
CA LUNG WITH
OESOPHAGEAL
COMPRESSION
T4N2M1 STAGE
IV
Radiation Oncology
Linear Accelerators
Palliative
Treatment with
Photons (linear
accelarator)
566
566
1-Sep-15
21-Sep-15
20000
20000
20000
2000
18000
IDBI - 321
30-Oct-15
239
239
31-Aug-15
4-Sep-15
65000
65000
63500
6350
57150
IDBI - 321
30-Oct-15
128
128
29-Aug-15
4-Sep-15
10000
10000
8500
850
7650
IDBI - 321
30-Oct-15
SC
SC
taluru
SHIRAGONDA
Others Poppanalu
MEMABOOB
COLONY
46
Others
58
Minorit
PADUKONAJE
y
SIRAGUPPA
BELLARY
SINDNUR
RAICHUR
MANGALORE
DAKSHINA
KANNADA
Gulbarga
Narayana
Hrudayalaya
Private Limited
Mysore
MANGALORE
INSTITUTE OF
ONCOLOGY
CARDIOLOGY
CANCER
2982 H_20733325451
Male
55
Others KONNURU
ARAKALAGUD
HASSAN
Mysore
SJICR MYSORE
MYSORE
IHD-ACS AWMI
CAD-SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
2983 H_20733325455
Female
65
Others HONDARAHALLI
KOLLEGAL
CHAMARAJANA
Mysore
GAR
SJICR MYSORE
MYSORE
IHD-ACS ACUTE
IWMI
CARDIOLOGY
Cardiology
Cardiology
Medical
treatment of
Acute MI with
Thrombolysis
Sl.No
Preauth No
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
433
1-Sep-15
10-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
305
305
1-Sep-15
9-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
239
239
31-Aug-15
3-Sep-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
GULBARGA
Gulbarga
Balawant
Institute of
Solapur
Neurosurgery
Intensive Trama
Lumbar
NEURO SURGERY
discectomy L4-L5
Neuro Surgery
Spinal
DiscectomyLumbar
433
2985 H_20017325459
Female
9
Others TERDAL
JAMAKHANDI
BAGLAKOT
Belgaum
KLES Dr
Prabhakar Kore
Belgaum
Hospital and
MRC
ANORECTAL
NEONATAL
MALFARMATION
Anorectal
Malformations
Stage 1
Gulbarga
KASTURBA
HOSPITAL
IHD AWMI DVD
SEVERE LV
DYSFUNCTION
HTN
Bangalore
2987 H_19513325410
Male
40
Minorit
SADATH COLONY
y
BHADRAVATHI
SHIMOGA
Cardiology
Cardiology
NANJAPPA LIFE
SHIMOGA
CARE
ISCHEMIC HEART
DISEASE,
INFERIOR WALL CARDIOLOGY
MYOCARDIAL
INFARCTION
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
2-Sep-15
4-Sep-15
65000
65000
65000
650
64350
IDBI - 321
30-Oct-15
OLD
AWMI/USA/MO
DERATE LV
CARDIOLOGY
DYSFUNCTION
/SEVERE
MR/PAH
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
30-Aug-15
3-Sep-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
1-Sep-15
7-Sep-15
90000
90000
90000
9000
81000
IDBI - 321
30-Oct-15
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
31-Aug-15
11-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
31-Aug-15
2-Sep-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
908
908
1-Sep-15
11-Sep-15
10000
10000
10000
1000
9000
IDBI - 321
30-Oct-15
45
Others KUKKUNDURU
KARKALA
UDUPI
Mysore
KASTURBA
HOSPITAL
2989 H_20074325129
Male
42
Others KENCHIKOPPA
HONNALI
DAVANGERE
Bangalore
M S RAMAIAH
NARAYANA
BANGALORE
HRUDAYALAYA
ACS
Belgaum
JUSTICE KS
HEGDE
CHARITABLE
HOSPITAL
L3-L4 AND L4-L5
IVDP WITH
CANAL STENOSIS
AND
NEURO SURGERY
COMPRESSION
OF NERVE
ROOTS.
Mysore
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
2991 H_19542325104
Male
52
53
Others BEDKANI
SIDDAPUR
UTTARA
KANNADA
CARDIOLOGY
UDUPI
Male
Male
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
2988 H_19564325305
2990 H_20015325309
Date of
Discharge
GULBARGA
KOPPAL
Diseases
Date of
Admission
Others 0
GANGAVATHI
Hospital Name
Plan of
treatment
64
Others WARD NO 22
Patient District
Disease Main
Category
Male
70
Taluk
Final
Diagnosis
2984 H_22525325181
Male
Village
Hospital
District
Age
2986 H_19564325332
Caste
Patient
Division
Gender
UDUPI
MANGALORE
Others MYSURU
MYSORE
MYSORE
BANGALORE URBAN
Bangalore
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
Belgaum
Wanless
Hospital Miraj
Miraj
Medical Center
miraj
CARDIOLOGY
MYSORE
SIGNIFICANT SVD CARDIOLOGY
Cardiology
BANGALORE
RIGHT RENAL
CALCULUS
Genito Urinary
Surgery
Urology
ESWL (Extra
Stent
IHD UNSTABLE
ANGINA,SINGLE
CARDIOLOGY
VESSEL DISEASE
with HTN
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
2-Sep-15
5-Sep-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
2992 H_19586325300
Male
40
Others 0
BANGALORE
NORTH
2993 H_20880325298
Male
63
Others Kottalagi
ATHANI
BELGAUM
NANJAPPA LIFE
SHIMOGA
CARE
ISCHEMIC HEART
DISEASE,
INFERIOR WALL CARDIOLOGY
MI,
HBP:CAD:SVD
Cardiology
Cardiology
Medical
treatment of
Acute MI with
Thrombolysis
128
128
1-Sep-15
2-Sep-15
10000
10000
9500
95
9405
IDBI - 321
30-Oct-15
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
2-Sep-15
5-Sep-15
55000
55000
55000
5500
49500
IDBI - 321
30-Oct-15
RENAL
2994 H_19513325315
Male
47
Others CHAKONAHALLI
TARIKERE
CHIKKAMANAGL
Mysore
UR
2995 H_20880325307
Male
79
Others Chandur
CHIKKODI
BELGAUM
Belgaum
Wanless
Hospital Miraj
Miraj
Medical Center
miraj
IHD UNSTABLE
ANGINA,SINGLE
CARDIOLOGY
VESSEL DISEASE
with HTN
Cardiology
2996 H_19586325302
Female
16
Others 0
KOPPAL
KOPPAL
Gulbarga
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
CHD OS ASD
CARDIOLOGY
ASD
151
151
31-Aug-15
14-Sep-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
2997 H_20112325233
Female
43
Others BHARAMASAGARA
CHALLAKERE
CHITRADURGA
Bangalore
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
LARGE ASD WITH
CARDIOLOGY
L->R SHUNT
ASD
151
151
31-Aug-15
14-Sep-15
80000
80000
80000
2400
77600
IDBI - 321
30-Oct-15
NANJAPPA LIFE
SHIMOGA
CARE
ISCHEMIC HEART
DISEASE,
ANTERIOR WALL
MYOCARDIAL
CARDIOLOGY
INFARCTION,
SINGLE VESSEL
DISEASE
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
1-Sep-15
4-Sep-15
65000
65000
65000
650
64350
IDBI - 321
30-Oct-15
2998 H_19513325273
Male
41
Others ARAKERE
HONNALI
DAVANGERE
Bangalore
BANGALORE
Cardiology
Sl.No
Preauth No
Gender
Age
2999 H_19528325268
Male
49
3000 H_21223325015
Male
1 Days
3001 H_21223325010
Female
2 Months
3002 H_19549325239
Female
3003 H_19528324654
Male
Caste
Village
Taluk
Patient District
Patient
Division
Hospital Name
Others HEBBAL
CHITTAPUR
GULBARGA
Gulbarga
Narayana
Hrudayalaya
Private Limited
Others RAYASANDRA
BANGARPET
KOLAR
Bangalore
Others DASARA HOSAHALLI BANGARPET
KOLAR
46
Minorit
NAZARABAD
y
TUMKUR
55
Others ZAHEERABAD
Minorit
NARAVI
y
3004 H_19522325029
Male
48
3005 H_19577324906
Female
70
3006 H_22586325177
Male
56
ST
k g halli
Others ANKALI
Hospital
District
Bangalore
Final
Diagnosis
Diseases
Disease Main
Category
Plan of
treatment
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
CAD-DVD
CARDIOLOGY
CABG
132
132
4-Sep-15
16-Sep-15
95000
95000
96900
2907
93993
IDBI - 321
30-Oct-15
INDIRA GANDHI
BANGALORE
INSTITUTE OF
SOUTH
CHILD HEALTH
anorectal
malformation
NEONATAL
Anorectal
Malformations
Stage 1
305
305
1-Sep-15
7-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
Bangalore
INDIRA GANDHI
BANGALORE
INSTITUTE OF
SOUTH
CHILD HEALTH
hydrocephalus
NEURO SURGERY
Neuro Surgery
Brain
Ventriculoatrial
/Ventriculoperiton
eal Shunt
411
411
25-Aug-15
7-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
TUMKUR
Bangalore
Sagar Hospitals
BANGALORE
SOUTH
IHD - EFFORT
ANGINA TMT
POSITIVE CAD LEFT MAIN
CARDIOLOGY
CABG
132
132
31-Aug-15
14-Sep-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
RAICHUR
RAICHUR
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
CAD-SVD
CARDIOLOGY
CABG
132
132
3-Sep-15
8-Sep-15
95000
95000
96900
2907
93993
IDBI - 321
30-Oct-15
BELTHANGADI
DAKSHINA
KANNADA
Mysore
FATHER
MULLER
MEDICAL
COLLEGE
HOSPITAL
MANGALORE
ATHEROSCLEROT
IC SIGINIFICANT
CORONARY
ARTERY DISEASE.
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting Stent
, elective)
240
240
30-Aug-15
7-Sep-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
SJICR
BANGALORE
SOUTH
IHD - AWMI,
DM, HTN, TVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
3-Sep-15
6-Sep-15
90000
90000
90000
0
90000
IDBI - 321
30-Oct-15
CHIKKODI
BELGAUM
Belgaum
HBS HOSPITAL
TRUST
BANGALORE
NORTH
MODERATE
AORTIC
STENOSIS
CARDIOLOGY
Aortic Valve
Replacement
146
146
1-Sep-15
8-Sep-15
120000
120000
120000
12000
108000
IDBI - 321
30-Oct-15
Acute AWMI
CARDIOLOGY
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
31-Aug-15
6-Sep-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
CAD-DVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - Two stent
(Drug Eluting
Stents , elective)
241
241
31-Aug-15
6-Sep-15
90000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
1-Sep-15
7-Sep-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
907
907
8-Sep-15
11-Sep-15
25000
5000
5100
153
4947
IDBI - 321
30-Oct-15
3007 H_20074325159
Male
45
Others ANDARHALLI
BANGALORE
NORTH
BANGALORE URBAN
Bangalore
M S RAMAIAH
NARAYANA
BANGALORE
HRUDAYALAYA
3008 H_22586325161
Male
57
Others KUDROLI
MANGALORE
DAKSHINA
KANNADA
Mysore
HBS HOSPITAL
TRUST
3009 H_21057325144
Female
75
Others MARAVANTHE
KUNDAPURA
UDUPI
Mysore
NEW
IHD,,OLD
INFERIOR WALL
MI, UNSTABLE
ANGINA
RIGHT RENAL
CALCULY PAIN ->
RENAL
RIGHT URETERIC
CALCULI
Genito Urinary
Surgery
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
Device Closure
PDA Device
Closure
119
119
1-Sep-15
5-Sep-15
60000
60000
60000
1800
58200
IDBI - 321
30-Oct-15
Urology
PCNL
(Percutaneous
Nephro Lithotomy)
- Single Side + DJ
Stent
907
907
3-Sep-15
7-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
3010 H_19528325152
Male
7
3011 H_20112325112
Female
3
3012 H_19549324533
3013 H_19528325118
Female
Female
38
1
Others BALASHETTIHALLI
SC
KUMBALURU
Minorit
0
y
Others KURTKOTI
BANGALORE
NORTH
SURPUR
YADGIRI
Gulbarga
Narayana
Hrudayalaya
Private Limited
HARIHARA
DAVANGERE
Bangalore
SS NARAYANA
DAVANAGERE
HRUDAYALAYA
PDA, 6MM with
CARDIOLOGY
L->R shunt
Cardiology
Bangalore
BANGALORE
Sagar Hospitals
SOUTH
LEFT RENAL
PLELNIC AND LPC RENAL
STONES
Genito Urinary
Surgery
Narayana
Hrudayalaya
Private Limited
Bangalore
LARGE
MALALIGNED
PERIMEMBRANO
US VSD
CARDIOLOGY
PREDOMINATELY
L-R SHUNT (TOF
ANATOMY)
ICR for TOF
154
154
3-Sep-15
18-Sep-15
80000
80000
81600
2448
79152
IDBI - 321
30-Oct-15
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
3-Sep-15
5-Sep-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
TUMKUR
TUMKUR
Belgaum
Bangalore
GADAG
GADAG
VIKRAM
HOSPITAL
PRIVATE
LIMITED
MYSORE
MYSORE
SINGLE VESSEL
DISEASE.
3014 H_19542324485
Male
64
Others KODAHALLI
GUNDLUPET
CHAMARAJANA
Mysore
GAR
3015 H_19581325101
Male
7
Minorit
KESARE
y
MYSORE
MYSORE
Mysore
Cauvery
Hospital
MYSORE
CHD-26MM
LARGE OS ASD
CARDIOLOGY
WITH L-R SHUNT
ASD
151
151
1-Sep-15
7-Sep-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
3016 H_20083325061
Female
5
SAGARA
SHIMOGA
Bangalore
Bhagwan
Mahaveer Jain
Hospital
Bangalore
Tetralogy of
Fallot
ICR for TOF
154
154
10-Sep-15
15-Sep-15
80000
262375
80000
0
80000
IDBI - 321
30-Oct-15
SC
JOGAPALS
CARDIOLOGY
CARDIOLOGY
Cardiology
Sl.No
Preauth No
Gender
Age
3017 H_21044324423
Female
69
3018 H_19586325031
Female
6
3019 H_19586325033
Male
31
3020 H_20025324819
Female
33
3021 H_19574323502
Female
20
3022 H_19528325018
Female
22
3023 H_22330324727
Female
24
Caste
Village
Others 0
Taluk
Patient District
Patient
Division
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
911
28-Aug-15
14-Sep-15
5000
5000
5000
500
4500
IDBI - 321
30-Oct-15
BANGALORE
CHD OS ASD
CARDIOLOGY
Cardiology
Device Closure
ASD Device
Closure
120
120
31-Aug-15
5-Sep-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
BANGALORE
RIGHT URETERIC
RENAL
CALCULUS
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
1-Sep-15
9-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
JAGADGURU SRI
SHIVARATHREES
MYSORE
HWARA
HOSPITAL
LT SFA,
POPLITEAL
ARTERY
OCCLUSION
CARDIOLOGY
Femoro Distal
Bypass with Vein
Graft
229
229
4-Sep-15
12-Sep-15
50000
50000
50000
5000
45000
IDBI - 321
30-Oct-15
Bangalore
VYDEHI
HOSPITAL
BANGALORE
Right PUJ
obstruction
RENAL
Genito Urinary
Surgery
905
905
8-Sep-15
22-Sep-15
35000
35000
35000
3500
31500
IDBI - 321
30-Oct-15
BIJAPUR
Belgaum
Narayana
Hrudayalaya
Private Limited
Bangalore
RHD SEVERE MR
MOD MS MOD CARDIOLOGY
AR
Mitral Valve
Replacement
145
145
2-Sep-15
11-Sep-15
120000
120000
122400
3672
118728
IDBI - 321
30-Oct-15
KOLAR
Bangalore
VICTORIA
HOSPITAL
BANGALORE
SOUTH
33% Thermal
Burns
Burns
Burns
upto-40% Mixed
Burns(with
grafting)
3
3
30-Aug-15
14-Sep-15
50000
83900
35000
3500
31500
IDBI - 321
30-Oct-15
BANGALORE
C5-C6
RADICLOPATHY
NEURO SURGERY
Neuro Surgery
Spinal
Anterior Cervical
Discectomy
Multiple level with
Implants
(procedure
30000+ Implants
10000)
429
429
27-Aug-15
11-Sep-15
40000
30000
30000
3000
27000
IDBI - 321
30-Oct-15
BANGALORE
L4-5 PIVD
NEURO SURGERY
Neuro Surgery
Spinal
DiscectomyLumbar
433
433
29-Aug-15
10-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
UDUPI
ACUTE INFERIOR
WALL MI, COPD
CARDIOLOGY
,DM,LV
DYSFUNCTION
Cardiology
Cardiology
PTCA - one Drug
Elutingstent
(emergency,
inclusive of
angiogram) at the
same admission.
239
239
31-Aug-15
3-Sep-15
65000
65000
66300
6630
59670
IDBI - 321
30-Oct-15
D V T - IVC Filter
237
237
29-Aug-15
3-Sep-15
80000
80000
80000
8000
72000
IDBI - 321
30-Oct-15
YELBURGA
KOPPAL
Gulbarga
Minorit
NOOR MOHALLA
y
KOLLEGAL
CHAMARAJANA
Mysore
GAR
BANGALORE
EAST
BANGALORE URBAN
BIJAPUR
KOLAR
HARATHI
911
Others MUDHOLA
SC
Plan of
treatment
DJ stent (One
side)
Gulbarga
Others KOTYAL
Urology
KOPPAL
RAMAMURTHY
NAGAR
Disease Main
Category
Genito Urinary
Surgery
KOPPAL
SC
Diseases
RENAL
Bangalore
GHATTIRADDIHAL
Final
Diagnosis
LEFT HYDRO
URETERO
NEPHROSIS
SHIMOGA
WENLOCK
DISTRICT
HOSPITAL
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
Hospital
District
MANGALORE
BHADRAVATHI
SC
Hospital Name
3024 H_19586324992
Female
43
Others MALAGUNDA
GADAG
GADAG
Belgaum
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
3025 H_19586324952
Female
32
Minorit
JAVULA GALLI
y
GADAG
GADAG
Belgaum
SAPTHAGIRI
SUPER
SPECIALITY
HOSPITAL
BURNS
Urology
3026 H_19564324674
Male
66
Others THALLURU
KUNDAPURA
UDUPI
Mysore
KASTURBA
HOSPITAL
3027 H_21057324405
Male
66
Minorit
HOLALKERE
y
HOLALKERE
CHITRADURGA
Bangalore
NEW
DVT B/LLI WITH
PUL EMBOLISM
3028 H_20061324957
Male
29
(V) KODAMBAL (T,Q)
Others HUMNABAD (DIST) HUMNABAD
BIDAR.
BIDAR
Gulbarga
NARAYANA
HOSPITALS
CRHD-SEVERE
MS,NO MR,MILD
CARDIOLOGY
TR WITH MILD
PAH.
Mitral Valve
Replacement
145
145
30-Aug-15
9-Sep-15
120000
120000
122400
12240
110160
IDBI - 321
30-Oct-15
3029 H_21919324598
Male
25
Others Kamalapura
KANAKAPURA
RAMANAGAR
Bangalore
Bangalore
LEFT VUJ
CALCULI
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
3-Sep-15
5-Sep-15
25000
25500
25500
2550
22950
IDBI - 321
30-Oct-15
3030 H_22867324922
Male
33
Others DEVAPURA
HOSADURGA
CHITRADURGA
Bangalore
CHITRADURGA
Left Ureteric
Calculus
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
24-Aug-15
4-Sep-15
25000
28300
25000
2500
22500
IDBI - 321
30-Oct-15
3031 H_19549324541
Male
47
Minorit
0
y
BANGALORE
SOUTH
BANGALORE URBAN
Bangalore
Sagar Hospitals
BANGALORE
SOUTH
IHD RECENT
INFERIOR WALL
MI CAD-TVD
CARDIOLOGY
CABG
132
132
31-Aug-15
12-Sep-15
95000
95000
95000
9500
85500
IDBI - 321
30-Oct-15
3032 H_19528324849
Male
38
Others LALASANGI
INDI
BIJAPUR
Belgaum
Narayana
Hrudayalaya
Private Limited
Bangalore
RHD SEVERE MS
CARDIOLOGY
MILD MR
Mitral Valve
Replacement
145
145
3-Sep-15
14-Sep-15
120000
120000
122400
3672
118728
IDBI - 321
30-Oct-15
3033 H_19528324463
Male
40
Others ASHRAYA COLONY
HARAPANAHALL
DAVANGERE
I
Bangalore
Narayana
Hrudayalaya
Private Limited
Bangalore
CAD-SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
102
102
1-Sep-15
3-Sep-15
55000
55000
56100
1683
54417
IDBI - 321
30-Oct-15
Bangalore
SAHYADRI
NARAYANA
SHIMOGA
HRUDAYALAYA
UNSTABLE
ANGINA
CAD:DVD
DIABETES
MELLITUS,
HYPERTENSION
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
2-Sep-15
4-Sep-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
2 VCAD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
4-Sep-15
8-Sep-15
65000
65000
65000
0
65000
IDBI - 321
30-Oct-15
Left Ureteric
stone
RENAL
Genito Urinary
Surgery
Urology
URSL - Single Side
+ DJ Stent
909
909
2-Sep-15
4-Sep-15
25000
25000
25000
2500
22500
IDBI - 321
30-Oct-15
3034 H_20079324872
Female
74
Others KOWRIHAKLU
THIRTHAHALLI
SHIMOGA
3035 H_20200324829
Male
55
Others RAJEEV NAGAR
MYSORE
MYSORE
Mysore
3036 H_22558324610
Female
13
Others Gangur
BELUR
HASSAN
Mysore
NU Hospitals
Pvt Ltd
Chitradurga
Government
Hospital
NARAYANA
HRUDAYALAYA
MYSORE
SURGICAL
HOSPITAL PVT
LTD
Vaatsalya
HASSAN
Hospital
CARDIOLOGY
Sl.No
Preauth No
Caste
Patient District
Hospital Name
Final
Diagnosis
Date of
Admission
Date of
Discharge
Preauth
Approved
Amt
Hospital
claimed
Amount
Gross
Amount
approved by
TDS
Net Amt
Paid
128
27-Aug-15
2-Sep-15
10000
10000
8500
850
7650
IDBI - 321
30-Oct-15
102
102
3-Sep-15
5-Sep-15
55000
55000
56100
1683
54417
IDBI - 321
30-Oct-15
PTCA - one stent
(Drug Eluting
Stents , elective)
240
240
29-Aug-15
5-Sep-15
65000
65000
65000
6500
58500
IDBI - 321
30-Oct-15
CABG
132
132
31-Aug-15
12-Sep-15
95000
95000
95000
380
94620
IDBI - 321
30-Oct-15
Burns
Burns
upto 30% (with
grafting)
1
1
30-Aug-15
7-Sep-15
40000
40000
40000
4000
36000
IDBI - 321
30-Oct-15
Radical
Hysterectomy
+Bilateral Pelvic
Lymph Node
Dissection (BPLND)
Ophorectomy
(BSO) / Ovarian
transposition
648
648
26-Aug-15
14-Sep-15
45000
45000
45000
4500
40500
IDBI - 321
30-Oct-15
41
Others HITAGALLI
PIRIYAPATNA
MYSORE
Mysore
SJICR MYSORE
MYSORE
IHD-ACS ACUTE
ASMI
CARDIOLOGY
Cardiology
Cardiology
Medical
treatment of
Acute MI with
Thrombolysis
128
3038 H_19528324852
Male
49
Others HOGARNALA
SINDNUR
RAICHUR
Gulbarga
Narayana
Hrudayalaya
Private Limited
Bangalore
CAD-SVD
CARDIOLOGY
Cardiology
Cardiology
PTCA - one stent
(non-medicated,
elective)
3039 H_20242324865
Female
61
BIJAPUR
BIJAPUR

VAS Beneficiary Details OCT 2015-DEC 2015

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