Cashless Facility

  • A. Cashless facility is offered by the
    • a. Hospitals (Infrastructure Providers)
    • b. Doctors (Care Providers) to the Insured,
  • B. Insurer offers to settle the claims on behalf of its policyholder as per the policy conditions
  • C. Anyuta Insurance TPA in Health Care Private Limited,
    • a. Issues the Authorization Letter (AL) to treat the Policyholder
    • b. Process the claims as per the Insurer`s Policy conditions and guidelines
    • c. Submits the Claim Settlement Float to the insurer along with the original claim documents to settle the claims

Procedure

  • A. Identification
    • a. The onus of identifying the Beneficiary and the Policy details rests on the Hospital and the Doctors.
    • b. The Hospital and the Doctors. Should identify the BeneficiaryPolicyholder by cross checking with the original Policy.
    • c. The following points should be verified and recorded,
      • a. Policy Number and Policyholders name along with the Beneficiaries details
      • b. Cover Value and period / validity,
      • c. Claimed Amount (in order of Claim)
      • d. Balance in the Policy for the present usage
    • B. Request for Authorization Letter (RAL) by the Hospital
    • With the above data a Request for Authorization Letter (RAL) should be sent to Anyuta Insurance TPA in Health Care
      • a. Anyuta Insurance TPA in Health Care then issues the Authorization Letter (AL) to the Hospital to commence treatment
      • b. Hospital treats the patient on Cashless basis
    • C. Documents needed by Anyuta Insurance TPA in Health to process the claim
      • a. Claim Form,
      • b. Discharge Summary should be signed by the admitting Physician / Surgeon with his specialty, Qualifications and contact details
      • c. It should contain the Differential Diagnosis / Final Diagnosis / Investigations done / Medications given / Procedures done / Bills of Investigations / Procedures / Medical and Surgical Sundries / Implants, etc.)
      • d. The Diagnosis and the Procedures done should carry the ICD – 10 Code
      • e. The spit bill should carry the individual items with the CGHS or any other excepted Code with rate
      • f. The Hospital should file the documents as per Anyuta Check List and sends it to Anyuta TPA Office along with a covering letter listing all documents in the file, date of submission of the file.
      • g. The Hospital takes an acknowledgement from Anyuta TPA for having submitted the file.
      • h. Hospital should give an identical File to the Policyholder
    • D. Claim Settlement is by the Insurer
      • a. Anyuta Insurance TPA in Health Care will process each and every Claim file received and generates a Claim Settlement Float and submits it to the Insurer to settle the claims within 2 weeks of it receiving it
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080 41128311 080 25364766
ravi@anyuta.co

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