PROCESS FLOW OF MEDICLAIM DEPARTMENT
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.
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.
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.
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
Initial approval is very meager and if bill of the patient is on higher side, then enhancement process is Initiated by mediclaim co-ordinator.
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.
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.
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.
Physical File Dispatching
After submission online, physical files are necessary to sent to the concerning mediclaim companies for settlement of claim.
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.