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
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