Home | Sitemap | Contact Us

HOW TO AVAIL CASHLESS MEDICLAIM FROM THIRD PARTY ADMINISTRATORS?

Q. What is a Third Party Administrators (TPA) & What is its function? How  does it work?

Third Party Administrators (TPA ) is an important link between Insurance companies policyholders & Healthcare Providers (Hospitals and Nursing Homes).TPA’s role is to provide administrative support to the insurance companies for servicing their insurance policies.

Service offered by TPA for policyholder & Health care provides & Healthcare Provider.

1 Cashless Hospitalization: Each policyholders is provided with a list of empanelled hospitals where in he/she can avail cashless hospitalization.

2. ID card : TPA provides ID cards to all their policy holder in order to validate  their Identity at the time of admission.

3. Claims Management: On behalf of insurance companies TPA administers & settle claims for hospitals & policyholders.
 
4. 24 hours customers support services: TPA provides assistance through its 24 hrs call center information regarding policyholder’s data, provider network,claim status, benefits available with existing cardholder, etc is furnished on request.

Remember If you have a medical insurance please check out the following details:

• Have you received the insurance cards from Third Party Administrator? If not contact  your agent or TPA.

If you have received the Insurance ID cards check the name of the TPA before  getting hospitalized.
• If you have fresh policy / first year policy or recently got your policy renewed  check with your TPA about your policy enrollment, failure of which can result in rejection of your cashless authorisation request.

• Medical insurance do not cover your OPD consultation / procedure / investigation done before being hospitalized.

• All claims of the discharge from the hospitals will be processed by the TPA  directly / or for reimbursements of all your post discharge expanses directly file  all originals documents, bill, prescription in TPA.

Do’s and Don’ts of availing cashless services from Third Party Administrators (TPA) Do’s

1. Obtain pre – authorisation form from Insurance Helpdesk 3 – 4 days prior to  the admission for planned hospitalization.

2. Pre – authorisation form is to be filled in by treating doctor.

3. Check about the pre – authorisation approval at the Insurance helpdesk within next 24hrs.

4. You can avail cashless treatment at the hospital after receipt of written authorisation from TPA for the covered.

5. Leave back all the original documents and signed claim form with the hospital at the time of discharge.
6. Contact local TPA office in case of any query.
7. Make payment to the hospital for the expenditure over and above the TPA  approved limit and for the treatment not covered under the package.

Don’ts

1. Don’t insist upon admission at the hospital merely for investigation, evaluation or Health check – up as these are not approved by TPAs.

2. Don’t insist on admission on cashless basis at the Hospital without obtaining the pre –authorization approval from TPA.

3. Don’t carry back any original documents at the time of discharge from the  Hospital, if your cashless is approved by the TPA.

4. Don’t forget to sign the claim form.

About Us | Cashless | Academics | Careers | Newsletter | Panel of Doctors | Charity Services | Photo Gallery | Our Services & Facilities | Expertise Super Speciality | Road Map