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Guidebook for TPA Patients

If you are the beneficiary of an insurance company, we will request you to please spare some time to understand the processing of insurance claims.
Insurance companies have appointed TPA’s (Third Party Administrator) to give you the facility of cashless claims.
The claim is processed by the hospital which is further subjected to approval by your TPA.
“SBH TPA Desk” is only helping you to get your claim processed by TPA. In the event of the cashless authorization request being rejected by TPA, the patient has to pay the bill to the hospital and try to claim the expenses subsequently from the Insurance company or TPA (REIMBURSEMENT).


What is Third Party Administrator (TPA)?

Third Party Administrator (TPA) is an important link between insurance companies, policy holders & healthcare providers (hospitals and nursing homes).
A TPA’s role is to provide administrative support to the insurance companies for servicing their insurance policy holders.
In order to avail cashless facility, you are requested to submit the following documents to the hospital based on which the TPA desk will process your case.
• TPA Card Copy / current year policy copy
• ID. Proof
• Doctor advise paper, if any.
• Relevant diagnostic reports


Please check the following details if you are Medically Insured:

• Have you received the insurance cards from Third Party Administrator? If not, contact your agent or TPA.
• If you have received the Insurance ID cards; check the name of the TPA before getting hospitalized.
• If you have a fresh policy / first year policy or recently got your policy renewed; check with your TPA about your policy enrollment, failure of which can result in rejection of your cashless authorization request.
• Medical insurance does not cover your OPD consultation/procedure/investigation done before being hospitalized.
• All claims of the discharge from the hospitals will be processed by the TPA directly/or for reimbursements of all your post discharge expenses, directly file all originals documents, bill, prescription in TPA.
• In case the authorized limit of your policy gets exhausted, get in touch with the “SBH TPA Desk”.
• At the time of discharge, the policy holder has to inform the “SBH TPA Desk” and is supposed to sign the claim form and a copy of the final bill.


TPA Desk at Satyabhama Hospital Pvt. Ltd. :

• SBH TPA Desk is in the basement of the hospital building, which is open 24 Hrs. every day for better assistance of the patients.
• Only policy holders (those who have medical insurance) can avail the cashless service from TPA.
• SBH TPA Desk only helps the policy holders in getting cashless approval from TPA.
• TPA will issue an authorisation letter for the coverage as per the policy to Satyabhama hospital pvt. ltd.
• Policy holders can directly approach the hospital’s Admission Counter for admission with the ID card and one copy of the authorization letter will be given to the Admission/IP billing counter.
• Hospital can extend cashless treatment (if required) to the policyholder up to the authorized amount.


Do's & Dont's

Do’s

• Obtain pre – authorization form from SBH TPA Desk 7 days prior to the admission for planned hospitalization/ surgeries.
• Pre – authorization form is to be filled in by treating doctor.
• Check about the pre – authorisation approval at the “SBH TPA Desk” within next 48hrs.
• You can avail cashless treatment at the hospital after receipt of written authorization from TPA for the covered ailment.
• Leave back all the original documents and signed claim form with the hospital at the time of discharge.
• Contact local TPA office in case of any query.
• The policy holder has to bear the expense which is not covered under the terms and condition of the policy.

Dont’s

• Don’t insist upon admission at the hospital merely for investigation, evaluation or health check – up as these are not approved by TPAs.
• Don’t insist on admission on cashless basis at the hospital without obtaining the pre-authorization approval from TPA.
• Don’t carry back any original documents at the time of discharge from the hospital, if your cashless Treatment is approved by the TPA.
• Don’t forget to sign the claim form.

Empanelment

TPA

INSURANCE COMPANY

PARK MEDICLAIM

NEW INDIA INSURANCE

VIPUL MEDCORP

ORIENTAL INSURANCE

MEDI ASSIST INDIA

UNITED INSURANCE

PARAMOUNT HEALTH

NATIONAL INSURANCE

SAFEWAY MEDICLAIM

HEALTH INSURANCE

EAST WEST ASSIST

CHOLAMANDALAM MS GENERAL

T.T.K. HEALTH CARE/VIDAL

STAR HEALTH & ALLIED

UNITED HEALTHCARE TPA

ICICI LOMBARD

HEALTH INIDA TPA SERVICES

BAJAJ ALLIANZ GENERAL

MD INIDA HEALTH CARE

ICICI PRUDENTIAL LIFE

MEDSAVE HEALTH CARE

IFFCO TOKIO

GENINS INDIA TPA

HDFC ERGO

GOOD HEALTH TPA

RELIANCE HEALTH INSURANCE

ALANKIT HEALTH CARE

RELIANCE GENERAL INSURANCE

GRAND HEALTH CARE TPA

ADITYA BIRLA

UNIVERSAL SOMPO HEALTHCARE

VISION INSURANCE

ERICSION

ROYAL SUNDRAM (PARAMOUNT

RAKSHA TPA CORPORATE

LIBERTY 360

PPN/GIPSA

LIBERTY VIDEOCON

F.H.P.L

ACKO INSURANCE

 

SBI GENERAL

 

DHFL (NAVI GENERAL)

 

HEALTH INSURANCE OF INDIA

 

EDELWISE

 

BHARTI INSURANCE

 

KOTAL INSURANCE

 

GO DIGIT INSURANCE

 

MAGMA INSURANCE

 

MANIPAL CIGNA

Government Panels

  1. BSES RAJDHANI
  2. DELHI POLICE
  3. DELHI TRANSCO LIMITED
  4. DELHI GOVERTMENT EMPLOYEE HEALTH SCHEME – PENSIONERS
  5. TATA POWER LIMITED
  6. PENSIONERS (N.H.A)
  7. DELHI HIGH COURT
  8. DELHI AROGYA KOSH
  9. FOOD CORPORATION OF INDIA
  10. BSNL – REIMBURSMENT
  11. BUREAU OF INDIAN STANDARDS (BIS)
  12. MUNICIPAL CORPORATION OF DELHI
  13. DELHI DEVELOPMENT AUTHORITY
  14. DELHI JAL BOARD
  15. DELHI UNIVERSITY
  16. DELHI TRANSPORT CORPORATION (DTC)
  17. DELHI GOVERNMENT EMPLOYEE SCHEME – WORKING
  18. DELHI MILK SCHEME
  19. FOOD & AGRICULTURE DEPARTMENT
  20. I.C.R.A – INDIAN AGRICULTURE STATISTICS RESEARCH INSTITUTE
  21. MINISTRY OF DEFENCE
  22. MINISTRY OF PETROLEUM
  23. POST OFFICE WORKING
  24. COMPITITION COMMISSION OF INDIA (CCI)
  25. INDIRA GANDHI DELHI TECHNICAL UNIVERSITY FOR WOMEN
  26. BHARTIYA JANJAGRITI SAHKARI VIPANAN VIKASH SAGNARTHI
  27. BUREAU OF INDIA
  28. EAZY HEALTH MASTER
  29. INDRAPRATHA
  30. PRAGATI POWER CORPORATION
  31. DELHI URBAN SHELTER IMPROVEMENT BOARD (DUSIB)
  32. REHABILITATION COUNCIL OF INDIA
  33. COUNCIL OF SCIENTIFIC & INDUSTRIAL RESEARCH
  34. NATIONAL INSTITUTE OF OPEN SCHOOLING (NIOS)
  35. TELECOM REGULATORY AUTHORITY OF INDIA
  36. TRIBAL CO-OPERATIVE MARKETING DEVELOPMENT FED INDIA (TRIFED)
  37. NAVODAYA VIDHYALAYA SAMITI
  38. INDIAN COUNCIL OF AGRICULTURE RESEARCH (ICAR)
  39. CENTRAL ELECTRICITY REGULATORY COMMISSION
  40. CENTRAL WAREHOUSING CORPORATION
  41. CENTRAL COUNCIL OF HOMEOPATHY
  42. INDIAN COUNCIL OF SOCIAL SCIENCE RESEARCH
  43. NATIONAL INSTITUTE OF EDUCATIONAL PLANNING AND ADMINISTRATION
  44. CENTRAL BOARD OF SECONDARY EDUCATION
  45. CABINET SECRETARIATE
  46. NATIONAL COUNCIL OF EDUCATIONAL RESEARCH AND TRAINING
  47. TECHNOLOGY INFORMATION, FORECASTING & ASSESSMENT COUNCIL (TIFAC)
  48. AGRICULTURE AND PROCESSED FOOD PRODUCTS EXPORT DEVELOPMENT AUTHORITY
  49. DELHI ELECTRICITY REGULATORY COMMISSION
  50. DEENDAYAL UPADHYAYA NATIONAL INSTITUTE FOR PERSONS WITH PHYSICAL DISABILITIES (DIVYANGJAN)
  51. PRESS COUNCIL OF INDIA
  52. NATIONAL CAPITAL REGION PLANNING BOARD
  53. UNIVERSITY GRANTS COMMISSION
  54. MUNICIPAL CORPORATION OF DELHI PENSIONERS / WORKING
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