Flow Chart For Cashless Hospitalization

Planned Emergency
Hospitalization Hospitalization

Approach hospital 48 hrs. prior to

admission , produce TPA card and
Admission in Hospital
complete pre-authorization
formalities

Pre-Authorization formalities to be
Fax Pre-Authorization letter to
completed within 24 hrs and sent to TPA
TPA for Approval
for Approval

If all the documents are in order, If all the documents are in order, TPA
TPA will issue authorization letter will issue authorization letter to hospital
to hospital within 3 hours within 3 hours

If the case is Declined, Denial If the case is Declined, Denial Letter will
Letter will be issued to be
hospital (denial of issued (denial
cashless does not mean denial of of cashless does not mean denial of
treatment or claim) treatment or claim)

In case additional information is In case additional information is

required, TPA will inform the required, TPA will inform the Hospital /
Hospital / Employee Employee
 Flow Chart For Reimbursement Process

1 2 3 4
Submit all Original
Collects all Original
Hospital
documents,
Insured visit non documents along
Takes Discharge , receipts and
network hospital with filled claim
pays for treatment investigation
for treatment form within 30
reports from
days from date of
Hospital
discharge to TPA

5 6 7 8
TPA Helpdesk Incase additional
acknowledges information is If Claim Payable,
receipt of claim required, TPA will payment will be If Claim Declined,
documents via inform the made to Corporate Denial mail will be
email and Employee via via NEFT within 15 sent.
commences claim email with 3 working days
process reminders