

PROCESS FLOW OF MEDICLAIM DEPARTMENT
1. | Counseling of the patient to initiate the mediclaim process. | Mediclaim Co-ordinator provides all the details regarding cashless process at Choithram hospital & research centre i.e. Regarding enhancement, consumables, disposable and other deductions at the time of final approval and discharge which is paid by patient. |
2. | Request the customer to fill pre- authorization form of the Insurance company | Providing preauthorization form to the patient attandant and requests them to fill basic details& Signed properly & later mediclaim co-cordinator contacts the treating consultant to fill & sign it. |
3. | Collect patient ID’s & Policy detail | Mediclaim Co-ordinator collects customer ID card (ex. Aadhar Card)/ Pan Card etc.) With Insurance Card copies & policy paper of last 3 years. |
4. | Login/Initiate for Initial Approval | Mediclaim Co-ordinator will send all the necessary documents to Insurance company / TPA for initial approval and Change the Inpatient category of the patient as cashless and add the name of concerning company in HIMS, and after initial approval He/She update the approval amount in same IPD in HIMS |
5. | Enhancement process | Initial approval is very meager and if bill of the patient is on higher side, then enhancement process is Initiated by mediclaim co-ordinator. |
6. | Initialization for Final Approval/ Discharge process | The entire original documents i.e. Discharge summary, Final Bill, Medical bills, Investigation reports etc. is to be sent to the concerning TPA/Insurance company for the final approval. |
7. | Settlement of mediclaim patient bills | After receiving final approval of the mediclaim patient, Entries done in settlement register which is sent to the billing department to collect difference amount. Then no-dues sent to concern ward to release the patient from hospital. |
8. | Uploading, Online file Submission | All the original documents attached and filled properly by billing department along with the covering letter of Assistant director – Health services are to be sent online via using particular portals. |
9. | Physical File Dispatching | After submission online, physical files are necessary to sent to the concerning mediclaim companies for settlement of claim. |
10. | Settlements of Claims | All the settlements are thoroughly checked and verified by Mediclaim Coordinator and receipt are generated against the settlement then it sent to accounts department to settle the patient bill accordingly. |