1. Planned admission – Cashless approval has to be taken in advance, i.e. before admission, max 7 days before admission.
2. Emergency Admission

(a) In case of emergency admission if patient requires Intensive Care Unit (ICU) / accident case then patient can get admitted by showing their concern TPA ID card and paying deposit of Rs.10,000/-and then complete the cashless process with 24 hours failing which patient relative need to pay balance deposit amount as per hospital policy. 

(b) If the patient is in the ward then the patient has to pay the prescribed hospital deposit and then complete the cashless process finalization within 24 hours of admission.

(c) In case of emergency / walk in admission, if patient requires Intensive Care Unit (ICU) / ward patient is admitted as self-payee as the relative do not have patient’s TPA information, in such case to avail TPA cashless facility the relative need to provide TPA information within 48 working hours of admission /before discharge / before any surgical procedure is performed whichever is earlier. 

(d) In all cases, the deposit amount paid at the time of admission / interim will be refunded within 48 working hours from the time of discharge.

3. Security Deposit – ∙€A security deposit of Rs.10,000/-  or 10% of estimate of treatment is collected from patients / patient relatives at the time of admission. The security deposit is refunded to the patient after the final authorization is received from TPA / Insurance Company at the time of discharge and after deduction of short payments if any.Steps to avail TPA cashless facility

4. (a) Pre authorization form has to be filled by the patient / relative (patient details, policy details and next of kin contact details and email address) TPA cashless forms are available at our TPA desk.

   (b) Admitting doctor / dedicated RMO / admitting doctor’s RMO / TPA doctor need to fill up medical history, medical complaint and patient’s line of treatment to be given. The hospital TPA staff will facilitate the patient /relative for the TPA cashless process.

   (c) The patient / relative must give a proper and true medical history and details to the doctor while filling the pre authorization form. If the claim is denied due to inconsistent information in pre authorization and history or treatment papers, the patient has to settle the hospital bill.

   (d) Hospital TPA staff need to fill the class of admission & give estimates as per line of treatment mentioned by the doctor.

5. List of documents to be submitted along with pre authorization form

   (a) Insurance / TPA ID card or Policy copy.

   (b) PAN card & Aadhar Card of the patient and Proposer.

   (c) Positive Investigation reports.

   (d) Treating Doctor’s consulting paper.

   (e) Discharge card of previous hospitalization (Chemotherapy, PTCA, CABG, D J Stent Removal procedure & Transfer from other hospital).

   (f) If MLC case (MLC / FIR copy).

   (h) In case of surgery, grade of surgery and approximate estimate of OT Materials & OT Pharmacy to be provided by the admitting doctor.

   (i) Consent Form to Avail Cashless Facility form (This form has to be filled by the patient / relative).

   (j) NEFT / RTGS Refund Form (The bank detail of the patient / patient relative is to be provided with cancelled cheque,  this can be provided at the time of discharge of patient if there is a refund).

6. After the patient / relative has submitted a cashless pre-authorization form along with the required documents, they need to be scanned and uploaded on the portal and sent to the concerned TPA. An auto SMS goes to patient relative mobile (on the number which is provided at the time of filling the cashless pre authorization) this SMS goes from TPA/Insurance Net portal.
7. 1. The concern TPA response after sending cashless pre-authorization form can be as below:

   (a) Authorization Letter (AL) – The AL will have the authorized amount.: Once the AL is received, hospital TPA staff need to check the patient’s details, date of admission, class of admission, AL amount, and any special remarks for example co- payment, etc.

   (b) Query Letter – Query Letter has to be replied to get the AL processed:

   (c) In case of a query related to a patient, the hospital TPA staff need to inform the patient’s relative.

   (d) In case of a medical query the hospital TPA staff need to inform RMO/ patient relative.

   (e) In case queries related to hospital the hospital TPA staff need to be replied the same.

   (d) Additional document requirement –Additional document requirement if any has to be provided to get the AL processed: The hospital TPA staff may need to collect additional documents from the patient relative / nursing counter / concern department and send it to the concerned TPA.

   (d) Denial Letter – Denial Letter means denied cashless facility: The hospital TPA staff need to inform the patient relative that their TPA has rejected the cashless and they need to make payment.

8. At the time of admission: Based on the AL the patient is admitted as per their entitled class mentioned in their AL. 

9. During the hospitalization following documents need to be sent by hospital TPA staff to the concern TPA

   (a) History sheet (Initial assessment sheet).

   (b) Progress notes.

   (c) Treatment sheet.

   (d) If surgery is done then the OT/ Cath lab / Endoscopy notes.

   (e) Case summary as and when requested by concerned TPAs.

   (f) If the bill exceeds the AL then a billing statement needs to be sent for additional cashless enhancement.

   (g) Letter from primary doctor in case change in line of treatment.

10. Payment follow up during hospitalisation

    (a) If the bill amount exceeds more than Rs. 1.0 lac of initial authorization then the hospital TPA staff need to send the billing statement to the concerned TPA with current treatment details for additional cashless enhancement and inform the patient relative to do follow up with their TPA for additional AL. If the AL is not received within 24 hours, inform the patient relative that they need to do additional payment (the same will be refunded at the time of discharge as per hospital refund policy).

    (b) If the AL limit is exhausted then the patient relative need to do payment as and when asked by the hospital

11. Queries raised by TPA during hospitalisation

    (a) If TPA needs any clarification / documents from the hospital, in such cases the hospital TPA staff need to contact the concerned department / primary doctor to reply to the query / provide the document.

    (b) If the query is related to the patient, in such cases the hospital TPA staff informs patient relatives in order to address the TPA query.

12. TPA cashless discharge process

    (a) Discharge Timing: 10:00 am, discharge requisition should be prepared by the ward /ICUs on or before 10:00 am and discharge paper should come to the billing department on or before 10:30 am.

    (b) Room charges will be applicable based on the admission date and time.

    (c) Once the final bill is ready the hospital TPA staff send the same along with discharge card, pharmacy & material break-up to the concerned TPA.

    (d) Once the bill is sent to the concerned TPA, patient relatives need to follow up with their TPA for final cashless approval.

    (e) If any query is raised then the hospital TPA staff need to reply to the query in order to get the AL.

    (f) If AL amount is lesser than patient bill amount then the difference amount needs to be paid by the patient relative.

    (g) On an average, time taken for getting cashless approval from TPA / Insurance Company on all working days is 3-4  hours and 4 – 6 hours on Sundays / Public Holidays & after TPAs working hours. In some scenarios wherever TPA/Insurance Representatives are not not available on Sundays, discharges are postponed to Monday.

    (h) If any patient / patient relative does not want to wait for the final AL from their concern TPA and wants to leave the hospital, in such case the patient relative needs to pay the difference amount (bill amount & initial AL amount). 

    (i) Once the final AL is received from the TPA the excess amount paid by patient relatives will be refunded to them within 48 working hours.

    (j) If due to any reason the initial AL amount is reduced / rejected, in such cases the hospital TPA staff will intimate the patient / relative and they have to settle their due within 48 working hours from the time they are informed.

    (k) The right to approve or deny the claim remains with your TPA Company. Any disputes about claims will need to be addressed to your TPA Company/ insurance agent. The hospital is not liable for any denials.

    (l) However you are requested to note that this is a value added service, and the final responsibility to obtain the authorization for cashless service, will rest with the customer. The role of the hospital TPA desk will be purely to assist the customer in the authorization process.