Appointment
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Insurance Information
Here’s the streamlined process flow for the Mediclaim Department at Choithram Hospital & Research Centre:
Patient Counseling:
The Mediclaim Coordinator explains the mediclaim process by providing comprehensive details regarding the cashless process at our facility, including information on enhancements, consumables, disposables, and other deductions during final approval and discharge, which are borne by the patient.
Pre-authorization Form:
Patients are requested to fill out the pre-authorization form of their insurance company. The form is provided to the patient’s attendant, who is asked to fill in basic details and sign it properly. The Mediclaim Coordinator then contacts the treating consultant to complete (fill in the patient health details) and sign the form.
Collection of Patient ID and Policy Details:
The Mediclaim Coordinator collects copies of the patient’s ID (e.g., Aadhar Card, PAN Card) along with insurance card copies and policy papers from the last three years.
Initial Approval:
The Mediclaim Coordinator submits all necessary documents to the insurance company/Third Party Administrator (TPA) for initial approval. The patient’s category is changed to cashless, and the name of the concerned company is added to the Hospital Information Management System (HIMS). Upon receiving initial approval, the coordinator updates the approval amount in the same Inpatient Department (IPD) record in HIMS.
Enhancement Process:
If the initial approval amount is insufficient due to a higher bill, the enhancement process is initiated by the Mediclaim Coordinator.
Final Approval/Discharge Process Initialization:
The original documents, including discharge summary, final bill, medical bills, and investigation reports, are sent to the concerned TPA/insurance company for final approval.
Settlement of Mediclaim Patient Bills:
After receiving final approval, entries are made in the settlement register. The register is then sent to the billing department to collect the difference amount. A no-dues certificate is sent to the concerned ward to release the patient from the hospital.
Uploading and Online File Submission:
The billing department ensures that all original documents are properly attached and filled out. They are then sent online via specific portals along with a cover letter from the Deputy Director – Health Services.
Physical File Dispatch:
Following the online submission, physical files are dispatched to the respective mediclaim companies for claim settlement.
Settlement of Claims:
The Mediclaim Coordinator thoroughly checks and verifies all settlements. Receipts are generated against the settlements, which are then sent to the accounts department to settle the patient’s bill accordingly.
Through meticulous coordination and adherence to protocol, our team ensures that patients receive the necessary support and assistance throughout their mediclaim journey. By streamlining procedures and upholding the highest standards of professionalism, we aim to alleviate the administrative burdens associated with healthcare financing, allowing patients to focus on their recovery with peace of mind.