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Claims guide document classification internal

Claims Guide DocumentClassi ?cationInternal CClaim procedure Cashless hospitalisation Cashless Hospitalisation means the Administrator may authorize upon an Insured person ? s request for direct settlement of eligible services and the corresponding charges between a Network Hospital and the Administrator In such case the Administrator will directly settle all eligible amounts with the Network Hospital and the Insured Person may not have to pay any deposits except for the non medical charges at the commencement of the treatment or bills after the end of treatment to the extent these services are covered under the Policy Note In some preferred hospital deposit amount is mandatory which can be refunded at the time of credit payment settlement by the hospital a Pre-authorisation process Step The insured employee shall call the call center numbers and give the following details Insured employee shall approach TPA desk counter to complete preauthorisation formalities by showing Photo id proof of the claimant and mediclaim card Name of Employee Employee I D Number Ailment Surgery for which he intends to be hospitalized for Preferred name and address of the network hospital Step The pre authorisation form should be ?lled by the treating doctor in consultation with the insured and then send it to the TPA Step TPA would then internally check on the hospital the estimated amounts quoted and the eligibility of the employee and issue an authorisation query denial letter to the network hospital Step The medical bills of the hospital would be directly forwarded to United Healthcare TPA and processed by them for payment Bills that are not settled through the cashless mechanism will have to be settled via reimbursement with the appropriate documents Refer to the document check-list given below Note Maternity can be cashless or reimbursement All maternity claims should be pre-authorized in case of cashless However in case you go for reimbursement under an emergency C section or non-network hospital you are required to provide justi ?cation for the same with supporting documents Failing to do so will result in a co pay on the total claimed amount b Planned hospitalisation Step All non-emergency Hospitalisation instances must be pre-authorized with the TPA This is done to ensure that the best healthcare possible is obtained and the insured member is not inconvenienced when taking admission into a Network Hospital Step DocumentClassi ?cationInternal CAfter your Hospitalisation has been pre-authorized you need to secure admission to a hospital A letter of credit will be issued by TPA to the hospital Kindly present your ID card at the Hospital admission desk The insured member is not required to pay the hospitalisation bill except for the non medical charges in case of a network hospital The bill will be sent directly to and settled by TPA Note Patients seeking treatment under cashless Hospitalisation are eligible to make claims under pre and post Hospitalisation expenses For all such expenses the original bills payment receipt and other required documents need to be submitted separately as part of non-cashless claims c Emergency