Mediclaim

What is a Third Party Administrator (TPA) & How does it work?

Third Party Administrators (TPA) is an important link between Insurance company’s policyholders & healthcare providers (Hospitals and nursing homes).TPA’s role is to provide administrative support to the insurance companies for servicing their insurance policies.

Service offered by TPA for policyholder & Health care provides & Healthcare Provider.

Cashless Hospitalization : Each policy holders is provided with a list of empanelled hospitals where in he/she can avail cashless hospitalization.

ID card : TPA provides ID cards to all their policy holder in order to validate their Identity at the time of admission.

Claims Management : On behalf of insurance companies TPA administers & settle claims for hospitals & policyholders.

24 hours customers support services : TPA provides assistance through its 24 hrs call center information regarding policyholder’s data, provider network, claim status, benefits available with existing cardholder, etc is furnished on request.

If you have a medical insurance please check out the following details:

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 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 do 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 expanses directly file all originals documents, bill, prescription in TPA

Policyholder can be hospitalized in emergency after showing their Insurance card or policy copies and are supposed to fill an undertaking form at the emergency reception. They should complete pre-authorizations formality filled by the concerned doctor .

TPA will issue an authorisation letter for the coverage as per the policy to Sanjeevani Hospital & research Centre. The answer will come from TPA in the form of authorization letter.

Medical insurance do not cover your OPD consultation / procedure / investigation done before being hospitalized.

Policy holder can directly approach the hospital Admission Counter for admission with the ID Card and one copy of the authorization letter will be given to the Admission / IP billing counter.

Hospital will extend cashless treatment to the policyholder up to the authorized amount.

In case the authorized limit gets exhausted get in touch with Insurance helpdesk.

At the time of discharge, policyholder has to inform the Insurance desk & is supposed to signs the claim form.

We help you with cashless mediclaim processing, please contact Reception for checking if your Third Party Administrators (TPA) is registered with us

Patient Requirements  

Patient should carry following Documents to expedient Mediclaim Procedure
  • Carry all your policy copies in original.
  • Carry photo ID proof & Residential Proof.
  • Carry Details of past hospitalization (if any) with discharge card / bill etc.
  • Carry all past & present medical reports & case files.

  Patient should understand that :

  • Mediclaim is a facility for your defense, do not misuse it – use it judiciously.
  • Cash less mode of payment is service given by hospital is to facilitate recovery in an unexpected ill health.