INITIAL APPROVAL (Before admit)
Hospital send request TPA (mediassist) (with estimated amount)
TPA (mediassist) Hospital send request (Approved/Denied)
WITHIN 2-4 HRS
ENHANCEMENT
Hospital send request TPA (mediassist) (with FINAL amount)
TPA (mediassist) Hospital send request (How much amount got approved)
WITHIN 2-4 HRS
And after that based on that if approval is given, patient gets discharged after paying the due
amount.
CASHLESS
After patient gets discharged, hospital need to send the original documents to TPA for final bill
settlement within 7 Days from the date of Discharge
PLANNED CASHLESS
Customer needs to do pre intimation atleast 72 hrs before Admission through portal.
REIMBURSEMENT
1. 24HRS HOSPITALIZATION IS MANDATORY
2. NON NETWORK HOSPITAL
3. NEED TO CHECK INTIMATION IS REQUIRED OR NOT
4. TREATMENT IS COVERED OR NOT
5. For Pre and post hospitalization you have to claim under Reimbursement
PROCEDURE
VISIT PORTAL – portal.mediassist.in
Click on option “Submit Claims”
Fill all the details like “kyc details, hospitalization details, beneficiary details, bank details
Upload Documents
Submit
You will receive Reference ID starting with “H”
C
Claim ID will get generated within 5 -7 working Days
C
You will get the first update within 7-10 working Days
DOMICILLARY
ONLY COVER OPD EXPENSES
NEED TO CHECK DOMI BALANCE
TREATMENT IS COVERED OR NOT
PROCEDURE
VISIT PORTAL – portal.mediassist.in
Click on option “Submit Claims”
Fill all the details like “kyc details, , beneficiary details, bank details
Upload Documents
Submit
You will receive Reference ID starting with “D”
C
Claim ID will get generated within 5 -7 working Days
You will get the first update within 7-10 working Days
DAY CARE TREATMENT – Treatment which need
hospitalization less than 24 hrs is known as Day care treatment.
It can be claimed under cashless and Reimbursement.
ENROLLMENT
ADDING DEPENDENT: ONLY AT THE TIME OF RENEWAL OF THE POLICY
EXCEPTION (CAN BE ADDED IN MID TERM ALSO):
NEWLY WEDDED SPOUSE – 30 DAYS FROM THE DATE OF EVENT
NEWLY BORN BABY - 30 DAYS FROM THE DATE OF EVENT
DELETING DEPENDENT: ONLY AT THE TIME OF RENEWAL OF THE POLICY
EXCEPTION (CAN BE DELETED IN MID TERM ALSO):
DEMISE OR DEATH
DIVORCE
PROCEDURE
VISIT PORTAL – PORTAL.MEDIASSIST.IN
CLICK ON “Online Enrolment “
Add Member
Submit
Customer will get an “Acknowledgement Pop- Up “
(It is an confirmation that enrollment has been done successfully)
Name will reflect in portal within 30 -45 days
Now if customer wants to get ecard immediately then {EMERGENCY E- CARD}
Ask customer to share the screenshot of the Acknowledgment Pop-up
In dedicated Email Id
They will receive a Ticket ID
Take that ticket ID and escalate
For baby E card For Dependent E card
Need to wait for 24 Hrs will get an update ASAP
Q.WHEN CAN I PURCHASE TOP UP POLICY?
OR
I AM NOT SATISFIED WITH EXISTING SUM INSURED .WHAT SHOULD I DO?
Ans. You can purchase Top up policy at the time of Renewal of policy.
Q. When can I use top up policy?
Ans. you can use top up policy when, when your base policy gets exhausted
Q. What is my buffer amount?
Ans. We have limited Information. Kindly contact your corporate.
Q. What is co-pay?
Ans. It is cost sharing on admissible amount
Q. What if Intimation is not given?
Ans. Co-pay may be deducted if intimation is not given based on your policy
Q. I want to get cashless in Non network hospital .is that possible?
Ans. Yes, it is cashless everywhere.
PROCEDURE
Hospital mail to TPA at “ [email protected] “
When
PLANNED THEN BEFORE 48HRS OF HOSPITALIZATION
EMERGENCY (WITHIN 48HRS OF HOSPITALIZATION)
MATERNITY - NORMAL + C- SECTION + PRE AND POIST NATAL + NO. OF DELIVERIES + WELL BABY
EXPENSES
ROOM - CHECK GRADE FIRST (NORMAL ROOM RENT + ICU + PROPORTIONATE DEDUCTION)
MAIL TAT – YOU WILL GET REVERT WITHIN 24- 48 HRS
+ PROVIDE DEDICATED EMAIL ID + UPLOAD DOCTORS PRESCRIPTION
