Cashless – Available Only
Planned & At Network
Emergency Hospitals
Claim Procedure
Non-network
Hospitals/ Not
Reimbursement
listed Hospitals
Cashless Planned Hospitalization Process Flow
The member informs the TPA of the planned hospitalization at least 2 days prior to the
hospitalization with the Ecard.
Inform the insurance desk of the hospital to send a preauthorization request to TPA
(contact details of TPA will be available with the insurance desk at the hospital).
TPA issues an authorization letter of planned hospitalization to the hospital (the
employee receives a mail approval copy and an SMS alert about the authorization).
Member gets treated; apparently, the hospital sends the complete set of claim
documents via mail to TPA.
TPA approves the case and releases the payment. If there is any shortfall, the same will
be informed to the hospital.
TPA receives the shortfall document from the hospital (if any). TPA will send the final
approval amount or rejection letter to the hospital.
If the claim is approved Member gets discharged from hospital. If the claim gets rejected,
the member needs to pay the hospitalization bill amount.
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17/10/2024
Cashless Emergency Hospitalization Process Flow
A member gets admitted into the nearest network hospital in case of emergency by showing their
TPA-Card. Treatment starts (some hospitals request a nominal depository amount).
Member or hospital applies for pre-authorization to TPA within 24 hours of admission.
TPA verifies the applicability of the claim to be registered and issues a pre-authorization to the
hospital (approval or rejection).
The hospital sends the complete set of claim documents via mail to TPA.
TPA approves the case and releases the payment. If there is any shortfall, the same will be
informed to the hospital.
TPA receives the shortfall document from the hospital (if any). TPA will send the hospital the final
approval amount or rejection letter (the member gets an SMS alert about the approval).
If the claim is approved Member gets discharged from hospital. If the claim gets rejected, the
member needs to pay the hospitalization bill amount.
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17/10/2024
Reimbursement Claim – Check List
Procedure in a Non network hospital – Reimbursement Claim
Get admitted as per the norms of the hospital.
Documentation required for reimbursement claim :
Duly filled & signed Claim Form Part A & Part B of National Insurance Co Limited
Original Final Hospital Bill with detailed break-up along with the Payment Receipt.
Original Discharge Summary /cards along with sign & seal of treating Doctor.
All Original Investigation Reports with the prescriptions prior to hospitalization
If any medicines purchased or investigation done outside the hospital, kindly obtain prescription and
investigation/lab report along with proper Cash Memo / Receipt for payment made.
Original Bills of medicines and surgical appliances if purchased by you.
Photocopy of Patients photo ID (Govt ID) & TPA Mediclaim card
Personalized Cancelled cheque leaf in the name of employee(NEFT) or Bank Pass Book
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Note:- Submit all above documents in original and retain the copies for your reference. 17/10/2024
Claim Intimation & Submission Procedure.
Claim Intimation: Not applicable
Reimbursement claim submission
a) Main Claim Hospitalisation: Original hospitalisation documents should be submitted to TPA within 30
days from the date of discharge.
b) Pre- and post-hospitalization: Pre-post claim documents should be submitted within 30 days of the
completion of post-hospitalization treatment or the post-hospitalization days limit stated in the policy,
whichever is earlier.
TAT Cashless Claims
The general TAT time after submitting all queries and documents to the TPA is 2 hours.
For all the above, the employee can be in touch with the SPOC, Ms. Tejashwini after the
hospital submits all documents, including the query report.
If the cashless process is still pending after 2 hours, kindly escalate to Escalation 1. Mr.
Prem Kumar and if the same is not resolved by 2 hours and 30 minutes, then please
connect to Escalation 2. Mr. Pramod G R. Refer to the contact matrix for coordinates
Communication Matrix
SL No Particular Name Contact Number Email ID
1 Assistant Manager Tejashwini 8484981404 tejashwini.s@mdindia.com
2 Deputy Manager Prem Kumar 7058034964 premk@mdindia.com
3 Assistant General Manager Pramod G R 9175455185 pramod.r@mdindia.com
