Guidebook for TPA Patients

If you are the beneficiary of an insurance company, we will request you to please spare some time to understand the processing of insurance claims. Insurance companies have appointed TPA’s (Third Party Administrator) to give you the facility of cashless claims. The claim is processed by the hospital which is further subjected to approval by your TPA.

“Nulife Hospital Corporate desk” is only helping you to get your claim processed by TPA. In the event of the cashless authorization request being rejected by TPA, the patient has to pay the bill to the hospital and try to claim the expenses subsequently from the Insurance company or TPA.

 

What is Third Party Administrator (TPA)?

Third Party Administrators (TPA) is an important link between insurance companies, policy holders & healthcare providers (hospitals and nursing homes). A TPA’s role is to provide administrative support to the insurance companies for servicing their insurance policies.

In order to avail cashless facility, you are requested to submit the following documents to the hospital based on which the corporate desk will process your case.

  •        TPA Card Copy / Policy Copy
  •        D. Proof
  •        In-door advise case paper
  •        Relevant diagnostic reports

 

 Please check the following details if you are Medically Insured:

  • 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 a 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 does 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 expenses, directly file all originals documents, bill, prescription in TPA.
  • In case the authorized limit gets exhausted, get in touch with the “Nulife Hospital Corporate desk”.
  • At the time of discharge, the policy holder has to inform the “Shri Balaji Action Medical Institute Corporate desk” and is supposed to sign the claim form and a copy of the final bill.