Step 1: Collect pre authorization form from the TPA Counter by showing your TPA ID card.

Step 2: The pre authorization form has three parts.

• Part 1: Has to be filled by the patient / relatives.
• Part 2: Has to be filled by the doctor.
• Part 3: Has to be filled by the TPA Cell.

Step 3: After the doctor has filled the form submit it at the TPA cell, along with the enlisted documents. The TPA at the counter fills in the cost estimate and forwards it for scrutinization.

List Of Documents To Be Submitted (Xerox)

• Insurance ID card and photo identification
• Policy copy / Renewal copy
• First consultation letter (OPD Letter)
• Previous Discharge Summary (if any)
• Investigation reports (if any)

Other than the documents above mentioned, please submit the following documents if applicable:

For Surgeries:

• All relevant investigation reports
• Documents of any previous surgery

If Medico‐Legal Case

• MLC Report
• Narration of incident
• FIR

Step 4: After that form is mailed to the concerned TPA.

Step 5: After 3‐4 hrs. inquire with the TPA cell about the status of the authorization.

Step 6: If any query is raised submit the relevant documents at the TPA cell as soon as possible.

Step 7: It will take at least 3‐4 hrs. for the TPA to send final approval.

If the bill amount exceeds the authorized limit, the billing department will send a reminder for further enhancement to the TPA. In case, the TPA denies the enhancement of the amount, the patient needs to start making interim payments and settle the bill. 

If the bill amount exceeds the authorized limit, the billing department will send a reminder for further enhancement to the TPA. In case, the TPA denies the enhancement of the amount, the patient needs to start making interim payments and settle the bill. 

In case of denial the patient has to bear the expenses and later can go for reimbursement.

KEY POINTS TO NOTE:

• A certain defined procedure has to be followed for obtaining approval from the TPA. Possessing a TPA card does not entitle the patient to get cashless benefits.
• If the patient opts for a higher class than the approved class by the TPA, the difference will be collected from the patient with proportionate amount at the time of discharge.
• It is mandatory to sign the indemnity form (for balance payment) given at the TPA desk while submitting the pre authorization form.
• The patient must provide proper and accurate 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, history, or treatment papers, the patient has to settle the hospital bill.
• The right to approve or deny the claim remains with your TPA Company. Any disputes regarding the claim will need to be addressed to your TPA Company / insurance agent. The hospital is not liable for any denials.
• This is a value added service, and the final responsibility to obtain authorization for cashless service rests with the customer. The role of the hospital is purely to assist the customer in the authorization process.