How the hospital will send the cashless claim documents to TPA/Insurance company?
Hospitals typically follow a specific process to send cashless claim documents to Third-Party Administrators (TPAs) or insurance companies. Here’s a general overview of the steps involved:
- Online/Hospital Portal:
- By using a hospital portal, the insurance company can receive real-time information about the patient’s treatment and expenses.
- This helps them process claims quickly and the TAT will start once the hospital upload the documents on the portal, it always takes a laser time compare to offline claim submission.
- Hospital portals are designed to integrate with the insurance company’s backend systems. This integration allows for the automatic verification of policy details and coverage, reducing the need for manual intervention.
- Overall, the shift towards receiving cashless requests through a hospital portal aligns with the broader trend of digitalization in the insurance industry. It benefits all stakeholders involved by making the claims process more efficient, transparent, and user-friendly.
2. Offline/E-mail: - The hospital as well approaches the cashless approval through E-mail, but it doesn’t mean that the insurer/TPA will not entertain your claim.
- It takes more time compared to the online process because once the hospital sent the documents through E-mail now the insurance company/TPA’s backend team will register the claim on the portal including documents upload, bill entry, selection of room type, diagnosis, Etc which will take approx. 30 -45 minutes time.
3. Challenges: What can go wrong and what are the risks
In case the insurance company/TPA has an online cashless claim process but the hospital is not uploading documents on the portal and approaching through E-mail, the insurer/TPA may be denied for the same. In this case, you have to ask the hospital to upload the documents through the portal, you may also include the network-provided team if the hospital is not agreed to online claim upload. The insurance company/TPA only accept the request through E-mail if there is any technical error on the portal or the patient doesn’t have a valid E-card/policy copy(Endorsement pending/Policy document awaited).
