Vipul MedCorp Insurance TPA Private Limited, vipul medcorp claim form.#Vipul #medcorp #claim #form

vipul medcorp claim form

We at Vipul MedCorp Insurance TPA are a group of professionals dedicated to our mission of providing excellent services to our clients (Corporate as well as Retail). For deliverance of services the SLA (Service Level Agreements) are in place, which would be signed with various Insurance companies and the corporate groups. These broadly define the Turn around Time (TAT) for the deliverance of the following services:

  1. ID Cards Printing and Dispatch
    • Vipul MedCorp Insurance TPA TAT for the Delivery of cards is within seven (7) days of the receipt of the complete data of insured members and the details of the policy from the insurance company
  2. Cashless Authorization / Rejection
    • Cashless authorization requests are to be scrutinized and the decision of acceptance or rejection is to be conveyed to the service provider within 24 hrs. of the receipt of the Pre Hospitalization Authorization Form.
    • In case where a query has been raised the query has to be satisfied by the concerned party and the authorization will be given within 24 hrs. of the receipt of the reply.
  3. Claims Settlement / Reimbursement
    • Turn-Around-Time (TAT) for the settlement of all claims is 15 days
  4. Customer Grievance Redressal
    • TAT for response is max. 2 working days, for any queries or grievance raised by the client.
  5. Call Center Responses
    • Vipul MedCorp Insurance TPA operates a 24 * 7 / 365 days Call center to provide instant accessibility to the clients for all information required for medical services facilitation and claims status.
  6. MIS Reports
    • Weekly/ Monthly MIS are prepared for the following:
      1. Claims Paid /Outstanding
      2. Premium Collection
      3. ID Cards Processed Dispatched
      4. Special reports annually for disease wise analysis, total age wise claim incidences etc.
  7. Adequate Coverage of Network Hospitals
    • Providing a comprehensive coverage of network hospitals at all locations of client operations.

Vipul MedCorp Insurance TPA has service level agreement for all the above-defined parameters and the same can be incorporated in the client agreement.

Cashless Facilitation Procedure

  • Receipt & Record of Data & Member Enrollment (Issuance of Photo ID Card)
  • Pre-Admission Authorisation after checking Doctor Prescription, Admission Form, Hospital Information
  • Claim form is submitted with Original bills along with Doctor Prescription, Diagnostic Reports & Discharge summary

When Cash Less Facility is not accorded or Insured goes to a Non Network Hospital then following documents are required :

  • Claim Forms
  • Original bills with Diagnostic reports
  • Doctor’s First prescription
  • Discharge summary/certificate
  • Original Bills are verified & scrutinised against Standard Discounted Tariff
  • Cost Containment by Medical procedure audit & Bill scrutiny
  • 2nd Medical opinion taken for complicated cases
  • Repricing done on case to case basis.

Cash Less medical services lead to: :

  • Bill Scrutiny before release of payment
  • Discounted Rates
  • Eliminates Reimbursement Frauds

All the above leads to Cost Containment and lowering of Claims/Premium Ratio

Vipul MedCorp Insurance TPA Private Limited, vipul medcorp claim form.#Vipul #medcorp #claim #form

vipul medcorp claim form

  • Enrollment Card against your policy, which would give you access to our TPA services.
  • Cash Less service facilitation at network hospitals up to limit authorized by Mediclaim / Hospitalization Insurance
  • Claims Processing and Reimbursement for non-network hospitals
  • 24hr access to our Call Center through our Toll Free line
  • Online assistance during hospitalization and filing of claim documents
  • Other services as defined by your Employer / Insurer

The executive may verify other details like your Address, Insurer, Date of Birth, Employer Details etc. On establishing your identity, we will be happy to answer your queries.

A : In case you are in an emergency situation, we can search your details through our software based on the following:

  • Name, Address, Date of Birth
  • Insurer
  • Underwriting Office Code

A copy of the bills Discharge Summary can be carried by the patient for his records and for submission along with Pre Post Hospitalization bills.

A : Pre-Existing disease are excluded in Mediclaim Policy (Exclusion No 4.1). Our doctor panel will verify / check the inception of disease based on your medical records and in case the disease has an origin before the inception of the policy, then your claim is not payable, as per the policy

A : Mediclaim policies have a waiting period of 30 days. Only accidents if occurred during the first 30 days of the policy are covered. Any other disease is not payable.

A : Yes. mediclaim policy does not cover a few disease which have occurred within one year of policy commencement.

Diseases which are not payable during the first year of the operation of insurance cover are :

  1. Cataract Benign Prosthetic Hypertrophy
  2. Hysterectomy for Menorhegia or Fibromioma
  3. Hernia, Hydrocele
  4. Congenital, Internal Diseases
  5. Fistula in anus, Piles, Sinusitis

A : Yes, the TPA can reject / deny your claim based on their evaluation / analysis. The rejection letter will cover the reasons for rejection of the claim.

Remedy :- In case you are not satisfied by the reasons for rejection, you can represent to the insurer within 15 days of such denial

A : Yes, you may send a request letter along with a cheque of Rs.50/- [per card] favouring Vipul MedCorp Insurance TPA Private Limited The duplicate ID Card will be dispatched to you within 7 days of clearance of your cheque.

A : Along with your ID Card, you will get a kit comprising of a Guide Book and List of Network Hospitals.

You can also download the list from our website from the “Hospital Network” section.

A : You may approach the Insurance Company for your policy renewal. The ID Card issued to you by Vipul MedCorp Insurance TPA does not have a validity date and as such you can continue using the same card. After every renewal, your data will be sent to us by the Insurance Company, and the same will be updated in our records.

A : You will need to contact your Insurance Company for any addition / deletion of the above type. Once we get a notification from them, we will update our records similarly.

A : Yes. your mediclaim policy covers 30 days Pre-hospitalization expense reimbursement and 60 days Post-hospitalization expenses. You may lodge your Pre-hospitalization claim along with hospitalization claim. The Post-hospitalization claim may be lodged after 60 days of the hospitalization. However, please quote your Claim Number for easy referral and sorting.

The claim will be put in a folder and after assessment will be stored in our record room. We will have online access to your claim details based on the assigned claim number

A : No. The TPA Card is issued to you against your mediclaim policy which only covers hospitalization expenses. The outpatient / domicillary expenses pertaining to the treatment of disease which is the cause of hospitalization is however covered (Please see Pre Post Hospitalization benefits)

A : There could be a chance that the Insurance Company has still not forwarded your details to us. Also there is a possibility that your card has been dispatched and you have not received the same.