What is the TAT for a cashless claim approval?
The specific TAT for cashless claim approval can vary from one insurance company to another and may depend on factors such as the complexity of the claim, the volume of claims being processed, and the efficiency of the insurance company’s processes. Generally, it takes 2-3 Hours from last document submission time. The insurance companies aim to keep the TAT as short as possible to provide prompt service to their policyholders.
Example:
- Hospital Admission: Mr. John is admitted to the network hospital for angioplasty surgery, and the hospital initiates the cashless claim request by submitting the necessary details through the hospital portal/E-mail to XYZ Insurance Company.
- TAT Initiation: The insurance company receives the cashless claim request at 10 AM and acknowledges its receipt. At this stage, the TAT clock starts.
- Claim Assessment: The insurance company reviews the claim, verifying Mr John’s policy details, the terms of coverage, and the hospital’s treatment plan. They may also cross-check any pre-existing conditions or previous claims history. In the assessment process, the processing team found that the angiography report is missing and the claim can’t be processed without that. Now the insurance company intimated about the shortfall of claim documents to the Hospital at 12 PM. Again the hospital arranged the shortfall claim documents and submitted the same at 2 PM, in such cases the insurance company will recount the TAT from the last document submission time, like in this case it will start from 2 PM.
- TAT Completion: After processing the claim, the insurance company communicates its decision (Approved/Query/Denial) to the hospital and the insured.
It’s important for policyholders to check the terms and conditions of their specific health insurance policy, as well as any updates or communications from their insurance provider. If there are concerns or if the approval process is taking longer than expected, policyholders can contact the insurer’s customer service for clarification and updates on the status of their cashless claim request.