Emergency No.011 4225 5225

Process

Process Flow for Cashless Planned / Emergency Hospitalization

Admission Process

Admission Process for TPA Patients

  • Patient / Attendant Reports to Corporate Desk
  • Analysis of the Details of Insurance Company / TPA
  • Provision of Documents of Relevant TPA /Insurance Company made by Patient/ Attendant
    • Pre Authorization Form
    • Copy of  TPA / Insurance Company ID Card
    • Copy of Health Insurance Policy Papers
    • Copy of Photo ID Proof (If Required by TPA / Insurance Company)
    • Copy  of letter of Undertaking
  • Receiving of the Pre Authorization form filled by Treating Consultant.
    • Checking & Completion of blank fields of Pre Authorization Form
    • Enclosure of Doctor Prescriptions / OPD Card / Previous Discharge Summary
    • Enclosure of relevant Investigation Reports
    • Enclosure of relevant papers of treatment taken prior to hospitalization (if required by TPA / Insurance Company)
  • After Final Check of TPA /Insurance Documents & interaction with Insured / Patient/ Relative, fax all the documents to TPA/ Insurance Company.
  • Confirmation of Faxed papers from concerned TPA / insurance Company.
  • Intimation of reply  received  from TPA / Insurance Company
    • Intimation of Approval of cashless to Patient and Billing
    • Intimation of Query of cashless to Patient / Consultant / Hospital
    • Intimation of Denial of cashless to Patient / Billing

Approval Process

Intimation to Patient/ Relative about the approved amount with applicable capping or eligibilities (as pre Insurance / TPA Policy).

Query Process

Inform and Collect the documents relevant to the query raised by the TPA / Insurance Company.

  • Information & Collection of Query Papers / Information if related to consultant / hospital.
  • Intimation of query related to Patient / Attendant.
  • Faxing the complete query reply to TPA / Insurance Company.
  • Confirmation of Faxed papers from concerned TPA / insurance Company.

Denial Process

  • Intimation to Patient/ Relative/ Finance about the Denial
  • Copy of Denial letter hand over to Patient/Relative/billing

Discharge Process

Discharge Image

Process flow for TPA/Corporate Bills of Discharged Patients

  • Bills received from billing department
  • Keep office copy of documents
  • Make TPA copy as per check list
    • Original Final bill with break up
    • Copy of Approval
    • Copy of Pre authorization form
    • Copy of Insurance ID Card / Policy Copy
    • Original Claim Form
    • Original Discharge Summary
    • All original investigation reports
  • Forward the above complete set of documents to recovery department for dispatch to TPA / Corporate

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