(精选)【医学英文课件】 Indian Institute of Technology Guwahati教学课件.ppt

Hospitalization Through Networking Hospital Employee Approaches Network Hospital with Raksha TPA ID Card Hospital Intimates Raksha TPA and sends Pre-Authorisation Request Raksha TPA issues Authorisation Letter As per Eligibility and Coverage At The Time Of Discharge Employee Leaves Back All The Documents Employee Bears Outpocket Expenses if Hospitalisation Not Covered Under Policy Conditions - Minimum TAT of 2 Hours and in emergencies 1 Hour. - Incase of planned hospitalisation intimation at least 2-3 days before admission and incase of emergency as early as possible Advantages: -Regulated Payouts in form of medical expenses -Access to Top Quality Service Providers( Hospitals) -No Arrangement of Funds required for hospitalisation Raksha TPA Maximum Turn Around Time Subject To Availability Of All Necessary Documents Will Be 10 working days Claim Passed / Rejected Claim is Processed Claim Folder Is Sent To Raksha TPA Insured Gets Hospitalised In Non-network Hospital If Documents Are Insufficient Immediately Intimated To Employee/Student REIMBURSEMENT HOSPITALISATION SERVICES Raksha TPA How to submit the documents for Reimbursement? Documents need to be submitted within 30 days from date of discharge from the hospital . In case of query is being raised while processing the claim, satisfactory query reply need to be submitted within 30 days from query raised date failing to which file will be closed and insurer consent would be required to reopen the claim file. Pre (30 days from date of admission) Post (60 days from date of discharge) claim need to be submitted within 30 days after completion of such treatment. Raksha TPA Previous Year Claim Analysis M/s Raksha TPA Pvt. Ltd. Insurance Company - The Oriental Insurance Co. Ltd. Corporate Name :- Indian Institute Of Technology Guwahati Policy Number :- 321104/48/2016/374 Policy Period: - 01-Aug-2015 To 31-Jul-2016 Summary - Claim Status As On 03-Sep-2016 02:04 PM Status No of Claim