TPA HELP DESK
Insurance Pre-Authorization
Checklist in Hospitals
INSURANCE
PRE-AUTHORIZATION
1
Patient & Policy Verification
Patient identity verified with valid ID
UHID / Registration number confirmed
Insurance/TPA card verified
Policy validity checked
Patient eligibility confirmed
Network/empanelment status verified
Room-rent eligibility checked
Co-payment / deductible applicable?
Exclusions, waiting periods & sub-limits checked
2
Clinical Documentation
Treating consultant's diagnosis documented
Presenting complaints & clinical findings recorded
Provisional/final diagnosis documented
Relevant investigation reports attached
Treatment plan documented
Proposed procedure/surgery clearly specified
Medical necessity established
Expected length of stay mentioned
Previous treatment history, if relevant
3
Pre-Authorization Form
Correct insurer/TPA pre-auth form used
Patient & policy details completed accurately
Diagnosis and ICD/procedure details entered
Procedure/CPT or applicable coding verified
Estimated package/procedure cost entered
Expected admission & discharge dates mentioned
Consultant details and signature completed
Hospital seal/signature completed
4
Financial Estimate
Room category & tariff verified
Package applicability checked
Professional charges included
Procedure/OT charges included
Investigation charges estimated
Pharmacy/consumables estimated
Implant/stent details and cost, if applicable
Non-medical items identified separately
Expected patient contribution calculated
5
Supporting Documents
ID proof
Insurance/TPA card
Doctor consultation notes
Investigation reports
Imaging reports, if applicable
Previous medical records, if relevant
Proposed surgery/procedure details
Implant quotation, if applicable
Other documents specifically requested by TPA/insurer
6
Submission & Tracking
Pre-auth submitted through approved portal/email
Submission reference number recorded
Date & time of submission documented
TPA/insurer query monitored
Queries responded to within defined TAT
Additional documents submitted promptly
Approval/rejection status tracked
Approved amount documented
7
Before Admission / Procedure
Authorization validity checked
Approved procedure matches planned procedure
Approved room category confirmed
Approved amount reviewed
Conditions/limitations of approval communicated
Patient informed about non-payable/excess amount
Consent obtained for patient-payable components
8
Quality & Audit Controls
No discrepancy between clinical records and pre-auth
No unnecessary/inappropriate upcoding
Diagnosis and procedure documentation consistent
Pre-auth TAT monitored
Query rate monitored
Rejection rate analysed
Partial approval rate monitored
Common rejection reasons reviewed monthly
Corrective actions implemented
9
Key KPIs
Pre-auth TAT
Approval Rate
Query Rate
Rejection Rate
Partial Approval Rate
First-Time-Right %
Patient Out-of-Pocket %
Pending Pre-auth > TAT
TPA HELP DESK
- Enhanced Patient Safety
- Improved Quality of Healthcare
- Better Hospital Management
- Enhanced Patient Safety
- Support for TPA Empanelment
- Enhanced Patient Safety
- Improved Quality of Healthcare
- Better Hospital Management
- Enhanced Patient Safety
- Support for TPA Empanelment
BENEFITS
BENEFITS
- Faster Patient Assistance
- Better Patient Support
- Reduced Administrative Work
- Improved TPA Coordination
- Fewer Claim Delays & Errors
- Faster Claim Processing
- Better Patient Support
- Faster Patient Assistance
- Reduced Administrative Workload
- Improved Patient Experience
Our Consultancy Support Includes:
Our Consultancy Support Includes
- TPA Desk Setup & Management
- Insurance & TPA Coordination –
- Cashless & Claim Support
- Staff Training & Process Guidance
- Documentation & Compliance Support
- TPA Desk Setup & Management
- Insurance & TPA Coordination
- Cashless & Claim Support
- Staff Training & Process Guidance
- Documentation & Compliance Support
Achieve TPA HELP DESK Registration with Expert Guidance from AR Health World get started today
Achieve TPA HELP DESK Registration with Expert Guidance from AR Health World get started today
Request for Quote
Kindly Fill Enquiry Form
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+91-8448902637
Request for Quote
Kindly Fill Enquiry Form
Click to call
+919792769806
Address
8 th floor,Levana Cyber Heights, Vibhuti Khand,Gomti Nagar, Lucknow, Uttar Pradesh -226010
Contact Number
+91-9792769806
Email -Id
info@arhealthworld.in
Adddress
8 th floor,Levana Cyber Heights, Vibhuti Khand,Gomti Nagar, Lucknow, Uttar Pradesh -226010
Contact Number
+91-8448902637
Email -Id
info@arhealthworld.in