Empanelled Insurance Co. & TPA's

The biggest and the best Indian companies have for long trusted us for provision of hassle free healthcare for their employees. Empanelment with us ensures fast track admission and cashless hospitalization in case there is an emergency.

TPA Desk Guidelines

Planned Admission

The relative has to show TPA ID card and pay a deposit of Rs. 10,000/-

Emergency Admission

In case of emergency admission, if the patient requires Intensive Care Unit (ICU) / accident care, the patient can be admitted by showing their TPA ID card and paying a deposit of Rs. 10,000/-. The cashless process must be completed within 24 hours, failing which the patient's relative must pay the balance deposit amount as per hospital policy.
If the patient is in a ward, they must pay the prescribed hospital deposit and complete the cashless process within 24 hours of admission.
For emergency/walk-in admissions, if the patient requires ICU/ward care and their relative does not have TPA information, they must provide TPA details within 48 working hours of admission, before discharge, or before any surgical procedure, whichever is earlier.
The deposit amount paid at admission will be refunded after deducting the Security Deposit amount within 48 working hours from the time of discharge.

Security Deposit

A security deposit of Rs. 10,000/- (towards deductions at the time of bill settlement by TPA/Insurance Company) is collected from patients/relatives for availing TPA cashless facility. The deposit is refunded after payment is received from the TPA/Insurance Company, after deducting short payments, if any.
For HDFC Ergo, the security deposit is Rs. 10,000/- or 10% of the final authorization amount (received at discharge), whichever is higher.

Steps to Avail TPA Cashless Facility

The pre-authorization form must be filled by the patient/relative with details such as patient details, policy details, next of kin contact details, and email address. Forms are available at the TPA desk.
The admitting doctor/RMO/TPA doctor needs to fill in medical history, complaints, and the patient’s line of treatment.
The patient/relative must provide accurate medical history. If a claim is denied due to inconsistent information, the patient must settle the hospital bill.
Hospital TPA staff will provide an estimate based on the line of treatment mentioned by the doctor.
Relatives may need to make additional payments, which will be refunded as per hospital policy.
If the Authorization Letter (AL) limit is exhausted, relatives must make additional payments.

Queries Raised by TPA During Hospitalization

If the TPA requires clarification/documents, hospital staff will contact the relevant department or primary doctor.
If the query is patient-related, the hospital TPA staff will inform the patient’s relative to address the issue.

TPA Cashless Discharge Process

Discharge Timing: 10:00 AM. Discharge requisitions should be prepared by wards/ICUs before 10:00 AM, with discharge papers reaching the billing department by 10:30 AM.
Discharge requests prepared after 10:00 AM will result in accommodation charges for the discharge day.
The hospital TPA staff sends the final bill, discharge card, pharmacy, and material breakdown to the concerned TPA.
Relatives must follow up with the TPA for final cashless approval.
If any query is raised, hospital staff must respond to obtain the Authorization Letter (AL).
If the AL amount is lower than the bill amount, the difference must be paid by the relative.
For discharges before 10:00 AM, accommodation charges apply if the TPA takes more than 3 hours to approve.
On average, approval time is 3 hours on working days and 4-6 hours on Sundays/Public Holidays.
If a patient/relative does not want to wait for the final AL, they must pay the bill amount difference.
Once the final AL is received, any excess amount paid will be refunded within 48 working hours.
If the initial AL amount is reduced/rejected, the patient/relative must settle dues within 48 hours.
The TPA company has the final authority on claim approvals/denials. Any disputes must be addressed to the TPA company/insurance agent.

General TPA Information

The patient’s settlement type can be changed from self-payee to TPA or from one TPA to another within 48 hours of admission.
For surgical/cathlab/endoscopy procedures, approval from the primary doctor is required.

After Receiving Final Cashless Approval

TPA staff reviews the approval letter’s terms and updates it in hospital records.
The billing staff follows the TPA staff’s instructions regarding patient payments.
Patients/relatives acknowledge the original bill and receive a duplicate copy.
If any balance payment is required, it must be settled at discharge.

Hospital TPA Desk Working Hours

Working Days: 8:00 AM – 8:00 PM
Sundays/Public Holidays: 8:00 AM – 3:00 PM

For Any Further Queries, Please Contact:

After TPA working hours, please contact our IP Billing Department.

Kindly cooperate & assist us in providing hassle-free cashless service.

For queries, please contact the TPA Desk during working hours.

TPA Desk: Mr. Khan – (Contact No: 022‐69318089)

Email ID: tpa@lilavatihospital.com

Billing Department: 022‐69318000, Extn. 1560