These terms govern our Claim Audit service for TPAs, hospitals, insurers, and other organisations. They add to our general Terms of Use and the engagement letter for your audit, and — because we handle personal data on your behalf — our Data Processing Agreement applies.
Scope
We audit the claim files you provide against documentation, policy, and regulatory standards, and issue a written audit report for each file. We audit; we do not adjudicate or settle claims, and we do not act as your broker or insurer.
Turnaround
Single claim: 72 hours from complete information. Bulk batches: as agreed in the engagement letter.
Independence
Our audit opinions are independent and honestly held. They are advisory to you — decisions on the claim remain yours (or the insurer's).
Confidentiality and data protection
All files are covered by confidentiality obligations and processed under our Data Processing Agreement, with access limited to the personnel who need it.
Fees
₹500 per claim for ad-hoc audits; ₹2 lakh for the Starter pack (500 claims); ₹7 lakh for the Growth pack (2,000 claims); custom pricing for Enterprise. Billed as set out in the engagement letter. GST is not charged (we are not GST-registered) and will apply only if and when we register.
Liability
Our liability for the audit is as set out in the engagement letter and our Terms of Use; audit opinions do not transfer to us the legal responsibility for the underlying claim decision.
Questions about this page?
Write to info@bimahaq.com. We respond within one working day.