REQUIREMENTS FOR CASHLESS TPA
PRE-ADMISSION AND ADMISSION REQUIREMENTS
FOR CASHLESS TPA PATIENTS
Most of the eye surgeries are elective (planned). If you are scheduled for surgery after all investigations, please take an appointment for surgical date by counsellor.
• In such a case, you must apply for approval of the estimated hospital expenses directly by your TPA at least 4-5 days prior to the date of hospitalization.
• In case you have not applied for pre-authorization sufficiently in advance or if the doctor treating you advises you to get hospitalized immediately after the consultation, our Corporate/TPA Help Desk (Contact No- 8001192094) will assist you through the preauthorization procedure. Normal working hours are from 9:00am to 5:00 pm, Monday to Saturday
However the Corporate/ TPA Help Desk is only a facilitator and can in no way influence the decision on the approval. Your TPA may not grant approval due to any of the following reasons:
• If the ailment for which you are hospitalized is not covered in your policy.
• If the information contained in pre-authorization form is insufficient to approve the request, though most of the time the TPA will request the hospital if additional information is needed.
• If you have exhausted the sum assured for that year.
The pre-authorization procedure is detailed below:
• STEP 1: Establish contact with the Corporate/TPA Help Desk at the hospital or please refer here for all the information related to cashless processing or reimbursement.
• STEP 2: Collect the pre-authorization forms pertaining to your TPA+TPA checklist+TPA undertaking form from help desk. Please present your Health Insurance card for the staff to assist you appropriately.
• STEP 3: Form Filling your pre-authorization form will have two sections-
General details on the health insurance policy to be filled in by you (the Corporate/ TPA Help Desk will assist you in case you have any difficulty).
The treatment recommended for you to be filled in and duly signed by the doctor who is treating you (Do not attempt to fill this section, contact the TPA Help Desk in case of any difficulty). TPA Checklist+ TPA undertaking forms are self explanatory.
• STEP 4: Return the completed form ( filled and signed), along with the copies of the document mentioned in TPA check list to the TPA Help Desk make a single pdf file of all your documents ( as per TPA checklist) and email to rashiray97@gmail.com with subject as ‘Patient’s name, Hospital Registration Number and mobile number’. The personnel at the desk will verify the form for its completeness and let you know in case of any discrepancy.
• STEP 5: Once the form is completely filled, the Corporate/ TPA Help Desk will upload the documents on the portal and transmit to the office to your TPA.
• STEP 6: The Corporate/ TPA Help Desk will revert to you with the approval/ denial status and also the status of approval is updated on registered mobile number.
• STEP 7: At the time of admission, you shall be required to pay differential amount of admission deposit and TPA approval. The differential amount would be refunded on discharge after receiving the final approval as per the final bill.
Kindly contact Corporate/TPA Help desk on the 1st floor in hospital between 9:00 am to 5:00 pm for any further information.
TPA Cashless empanelments change from time to time. Please call Corporate/TPA Help Desk for latest information.
