Group Health Insurance

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Insurers required policyholders to submit original claim documents for processing reimbursement claims. Policyholders used to courier claim documents to insurers/ TPAs for processing. However, this has changed since the Covid-19 pandemic hit the world. It has brought all transportation and logistics to a standstill due to government-imposed lockdown throughout the country. Courier services were not operational and therefore policyholders could not send claim documents to the respective insurer/TPA office. This gave rise to the e-claim process work for group health insurance policies.

 

Electronic claim processing (commonly known as e-claims) was the answer insurers found to address this problem. They acted fast to implement self-service e-claims solutions to help policyholders submit and track their claims until settled.

 

To file an e-claim under a group health insurance policy, the policyholder needs to upload a scanned image of the claim documents over the e-claims module on the insurer/TPA website or mobile application. The list of claim documents required for reimbursement are –

 

  1. Claim form (part A and part B)
  2. Discharge summary
  3. Hospital bill with detailed cost breakup
  4. Payment receipts
  5. Medicine prescriptions and bills
  6. Laboratory test reports and bills
  7. Copy of the invoice/sticker/barcode in case of implants
  8. Patient’s ID proof
  9. Canceled cheque/ NEFT details of the policyholder

 

Upon successful document upload, a unique claim reference no. is generated which is used for all future reference and tracking purposes. The process is extremely intuitive and hassle-free.

 

Filing claims electronically offers multiple benefits, including:

 

  1. Processing time –

An e-claim under a group health insurance policy is processed quickly, resulting in faster settlement time and payment to policyholders.

 

  1. Track status – 

You can check the status of your submitted claims at your convenience, any time during the day or night.

 

  1. Increase accuracy and reduce claim rejections –

Often rejected paper claims due to inaccuracies, omissions, or lost documents. If submitted claims electronically, it results in fewer lost or incomplete claims. You can also check claims for accuracy before asking policyholders to submit an original copy of claim documents.

 

  1. Record keeping –

Electronic claims help cut down on paperwork. In fact, it eliminates the need to store paper claims helping in streamlining billing procedures and simplifying record-keeping.

 

  1. Overhead costs and staff time –

Submitting claims electronically reduces the clerical time and cost of processing, mailing, resubmitting, and tracking the status of paper claims also, freeing up the time of administrative staff to perform other important functions.