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LCT E-CLAIM

PLEASE FILL IN THE CLAIM DATA AS ACCURATELY AS POSSIBLE FOR EASY VETTING

ENTER BILL AMOUNT

ENTER DISCOUNT AMOUNT ENTER COPAY AMOUNT TOTAL AMOUNT

Upload Invoice

Attach Invoice

SELECT ICD10 DIAGNOSIS INFORMATION ENTER OTHER DIAGNOSIS INFORMATION DOCTOR'S NOTES

Does Patient Need LAB Services?

Enter Lab Tests

Upload Lab Results

Lab Results

Upload Any other Documents

Discharge Summary