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

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