Tie up with the insurance company

Our hospital has a tie-up with the leading health insurance providers to facilitate a cashless admission and treatment for patients covered under the insurance. You do not have to worry about finances in case of hospitalization, thus giving you peace of mind. You are assured of receiving the best medical treatment when you know you are adequately covered.

Procedure For Cashless Claims

A. Admission Procedures
B. Pre – authorization
C. Discharge Procedures

A. Admission Procedures

• To check the availability for cashless treatment through ID Cards
• The beneficiaries (patient) will be identified by the provider (hospital) on the basis of an ID card issued from TPA to all the beneficiaries.
• The ID card shall have photograph and signature or thumb impression of the Patient.
• Whenever there is a need for hospitalization the policyholder should bring their ID card and policy copy.
Insurance clerk will verify following details through ID card & policy copy
• TPA Name
• Corporate name
• Patients name and spelling
• Card validity from and To
• Age verification
• Photograph verification
• Pre existing coverage
• Sum-insured
To explain clearly about the terms & conditions for availing cashless facility to the patient.

B.Pre-Authorization

• The terms & conditions for providing cashless facilities to the patient.
• When a Doctor plans for surgery, the insurance clerk will fill the pre-authorization form and mail it to TPA. This should be done at least 2 days prior to the expected date of admission.
• In case of emergency hospitalization, the form is to be filled by the concern Doctor and the insurance clerk should complete the pre-authorization form and mail it within 24 hours of admission. In case if there is any delay in sending the form to TPA, it will be properly communicated by insurance clerk to TPA through phone/e-mail.
• The Pre authorization certificate which was sent by the insurance company will have the following details like amount guaranteed, class of admission, eligibility of beneficiary or sub limits for rooms & board, surgical fees etc. As per the benefit plan of the insured, the insurance company should strictly follow the above rules.
• The guarantee of payment is given only for the necessary treatment cost of the ailment covered and mentioned in the request for hospitalization. Non medical expenses will be collected directly from the patient. Any investigation or treatment carried out at the request of the patient apart from the authorization those treatment charges are collected from the patient.

C.Discharge Procedures

• To check the authorized limit of the patient & certain exclusions mentioned i n the pre-authorization.
• Hospital amount when exceeding the authorized limit, to send enhancement for the Exceeded amount.
• The final authorization for the enhancement when received, to discharge the Patient once the payment towards the exclusions is collected
• If the enhancement amount is unauthorized, it should be collected from the patient.