If you are the beneficiary of an insurance company, we will request you to please spare some time to
understand the processing of insurance claims. Insurance companies have appointed TPA’s (Third Party
Administrator) to give you the facility of cashless claims. The claim is processed by the hospital
which is further subjected to approval by your TPA.
“TPA Helpdesk” is only helping you to get your claim processed by TPA. In the event of the
cashless authorization request being rejected by TPA, the patient has to pay the bill to the
hospital and try to claim the expenses subsequently from the Insurance company or TPA.
What is Third Party Administrator (TPA)?
Third Party Administrators (TPA) is an important link between insurance companies, policy holders &
healthcare providers (hospitals and nursing homes). A TPA’s role is to provide administrative
support to the insurance companies for servicing their insurance policies.
In order to avail cashless facility, you are requested to submit the following documents to the
hospital based on which the TPA helpdesk will process your case.
- TPA Card Copy / Policy Copy
- I.D. Proof
- In-door advise case paper
- Relevant diagnostic reports
Please check the following details if you are Medically Insured:
- Have you received the insurance cards from Third Party Administrator? If not, contact your agent
or
TPA
- If you have received the Insurance ID cards; check the name of the TPA before getting
hospitalized
- If you have a fresh policy / first year policy or recently got your policy renewed; check with
your
TPA about your policy enrollment, failure of which can result in rejection of your cashless
authorization request.
- Medical insurance does not cover your OPD consultation/procedure/investigation done before being
hospitalized.
- All claims of the discharge from the hospitals will be processed by the TPA directly/or for
reimbursements of all your post discharge expenses, directly file all originals documents, bill,
prescription in TPA.
- In case the authorized limit gets exhausted, get in touch with the “TPA Helpdesk”.
- At the time of discharge, the policy holder has to inform the “TPA Helpdesk”
and
is supposed to sign the claim form and a copy of the final bill.
TPA Helpdesk at SS HOSPITAL:
- SS HOSPITAL TPA Helpdesk is situated on the ground floor of the hospital.
- Only policy holders (those who have medical insurance) can avail the cashless service from
TPA.
- SS HOSPITAL TPA Helpdesk only helps the policy holders in getting cashless approval from
TPA.
- TPA will issue an authorization letter for the coverage as per the policy to SS HOSPITAL.
The
answer will come from TPA in the form of authorization letter.
- Policy holders can directly approach the hospital’s Admission Counter for admission with the ID
card
and one copy of the authorization letter will be given to the Admission/IP billing section.
- Hospital will extend cashless treatment to the policyholder up to the authorized amount.
- At the time of discharge, the policyholder has to inform the “TPA Helpdesk”
and
is supposed to sign the claim form and a copy of final bill.
Do’s and Dont’s for availing cashless services from Third Party Administrators
(TPA)
Do's
- Obtain pre – authorization form from SS HOSPITAL TPA Helpdesk 1 – 2 days prior to
the
admission for planned hospitalization.
- Pre – authorization form is to be filled in by treating doctor.
- Check about the pre – authorization approval at the “SS HOSPITAL TPA Helpdesk”
within
next
24hrs.
- You can avail cashless treatment at the hospital after receipt of written
authorization from TPA
for
the covered ailment.
- Leave back all the original documents and signed claim form with the hospital at the
time of
discharge.
- Contact local TPA office in case of any query.
- The policy holder has to bear the expense which is not covered under the terms and
condition of
the
policy.
Dont's
- Don’t insist upon admission at the hospital merely for investigation, evaluation
or health check –
up as these are not approved by TPAs.
- Don’t insist on admission on cashless basis at the hospital without obtaining
the pre-authorization
approval from TPA.
- Don’t carry back any original documents at the time of discharge from the
hospital, if your cashless
is approved by the TPA.
- Don’t forget to sign the claim form.