IRDA Preauth Form

Hi I would like to have information which has to be the part of the Pre authorization Form for the request for cashless hospitalisation for medical insurance policy made mandatory by IRDA?

[pawan]

The information which has to be the part of the Pre Authorization Form for the request for cashless hospitalisation for medical insurance policy made mandatory by IRDA is as follows:

Reports to be provided by the hospital in support of the claim

1. Point by point Discharge Summary and all Bills from the clinic.

2. Money Memos from the Hospitals/Chemists bolstered by appropriate remedy.

3. Receipts and Pathological Test Reports from Pathologists, Supported by note from the going to Medical Practitioner/Surgeon prescribing such obsessive Tests.

4. Specialist's Certificate expressing nature of Operation performed and Surgeon's Bill and Receipt.

5. Endorsements from going to Medical Practitioner/Surgeon that the patient is completely cured.

HOSPITAL DECLARATION

1. have no protest to any approved TPA/Insurance Company official confirming records pertaining to hospitalization

2. All legitimate unique archives properly countersigned by the safeguarded/persistent according to the agenda underneath will be sent TPA/Insurance Company inside 7 days of the patient's release.

2. All non therapeutic costs, OR costs not applicable to hospitalization or disease, OR costs refused in the Authorization Letter of the TPA/Insurance Co. On the other hand emerging out of wrong data in the pre-authorisation structure will be gathered from the patient.

4. Agree That Tpa/Insurance Company Will Not Be Liable To Make The Payment In The Event Of Any Discrepancy Between The Facts In This Form Furthermore, discharge summary or different reports.

5. The patient presentation has been marked by the patient or by his speak to in our nearness.

6. concur give illumination to the questions raised in regards to this hospitalization and we assume the sole liability for any postponement in offering elucidations.

7. will comply with the terms and conditions concurred inthe MOU

Announcement by the patient/representative

1. I consent to permit the healing center to present all unique records relating to hospitalization to the Insurer/TPA after the release. I consent to sign on the Final Bill and the Discharge Summary, prior to my release.

2. Payment to healing center is administered by the terms and states of the approach. On the off chance that the Insurer/TPA is not subject to settle the healing center bill, I attempt to settle the bill according to the terms and states of the arrangement.

3.All non-therapeutic costs and costs not significant to current hospitalization and the sum over and over the point of confinement approved by the Insurer/T.P.A. not represented by the terms and states of the arrangement will be paid by me.

4. I thusly proclaim to submit to the terms and states of the strategy and if at any certainties uncovered by me are observed to be false or mistaken I relinquish my case and consent to reimburse the safety net provider/T.P.A.

5. I concur and comprehend that T.P.A. is not the slightest bit justifying the administration of the healing facility and that the Insurer/TPA is no chance ensuring that the administrations gave by the doctor's facility will be of a specific quality or standard.

6. I thus warrant reality of the swearing off particulars in each appreciation and I concur that in the event that I have made or should put forth any false or untrue articulation, Suppression or camouflage with deference

to the case, my entitlement to claim repayment of the said costs might be totally relinquished.

7. I consent to repay the healing centre against all costs brought about for my benefit, which are not reimbursed by the back up plan/TPA.