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Health Claim Process

The document provides information about Chola MS Help's health claim and customer service processes. It discusses: 1) The enrollment process which includes printing ID cards containing member details to access the network of hospitals. 2) How members can access and print e-cards containing their health insurance details from the Chola website. 3) The process for availing cashless claims for both planned and emergency hospitalizations which involves submitting authorization forms to Chola for approval before treatment. 4) The reimbursement claims process which requires submitting original bills and documents within 30 days of discharge to file a claim. 5) Contact details for Chola's customer relationship managers and 24/7 helpline numbers for claims

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91 views

Health Claim Process

The document provides information about Chola MS Help's health claim and customer service processes. It discusses: 1) The enrollment process which includes printing ID cards containing member details to access the network of hospitals. 2) How members can access and print e-cards containing their health insurance details from the Chola website. 3) The process for availing cashless claims for both planned and emergency hospitalizations which involves submitting authorization forms to Chola for approval before treatment. 4) The reimbursement claims process which requires submitting original bills and documents within 30 days of discharge to file a claim. 5) Contact details for Chola's customer relationship managers and 24/7 helpline numbers for claims

Uploaded by

srinvas_107796724
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
You are on page 1/ 11

CHOLA MS HELP

Presentation
on
Health Claim Process

1
Health Claim Process
Enrolment- Process

• In house card printing monitored by


Enrolment Dept

What the ID card would contain;


• Name ,Unique alpha-numeric ID no, DOB,
• Age, Gender, Policy No., Valid from date
• Help Line & Toll Free No. and Address of the claims office.

• It is not a Credit Card, but an Identity Card which will identify you as
the beneficiary of Chola MS Help and will give you access to our
Network Hospitals
Chola website access

The E-Cards are available on our website www.cholainsurance.com.


The member can login by using the Policy Number.

To access the E-cards follow the below mentioned Steps.


Please take the Family code as employee Id

Step 1 - Go To “Do More” Link


Step 2 - Click on “Individual Login” Icon
Step 3 - Enter Policy Number-
Step 4 - Enter Emp. ID as “Login ID”
Step 5 - Enter Emp. ID as “Password”
Step 6 - Print the E - card & set the new Password
Availing Cashless facility from Chola MS Help
Cashless Claims – Planned Hospitalization
Identify the network hospital from the list provided by Chola
HELP.
Approach the hospital at least 48 hrs prior admission and flash
the ID card in the billing dept.
Hospital will capture the information of the patient in a Pre-
auth request, provided by us, and will fax the same to our toll
free fax
On receipt of the request our panel of doctors will scrutinize
the same as per policy terms and conditions and fax the
approval back to the hospital.
 Cashless response time (TAT) 4 hours
On receipt of the approval the hospital will extend cashless
hospitalization
Certain non medical expenses like registration fee, admission
fee, diet etc has to be born by the claimant.
After discharge, the hospital send the bills to Chola HELP and
gets it reimbursed.
Contd….
Emergency Hospitalization
 Patient get admitted as per the hospital procedure
 Attendant flashes ID card in the billing dept
 Hospital will capture the information of the patient in a Pre-
auth request, provided by us, and will fax the same to our toll
free fax
 On receipt of the request our panel of doctors will scrutinize
the same as per policy terms and conditions and fax the reply
back to the hospital.
 On receipt of the approval the hospital will extend cashless
hospitalization
 Certain non medical expenses like registration fee, admission
fee, diet etc has to be born by the claimant.
 After discharge, the hospital send the bills to Chola HELP and
gets it reimbursed.
 Please note that unless the ID flashed, the hospital will not
know that the patient is covered under mediclaim and may
ask for a advance.
Claim Processing & Settlement Service
(Reimbursement claims)

 Reimbursement claim documents can be


submitted to any of our regional/branch offices

 Supported by experienced domain knowledge


and medical team

 Settlement of reimbursement claims would be


made within 30 working days from the receipt of
complete set of document.
REIMBURSEMENT CLAIM PROCESS….
What documents are required to be submitted under a claim under
REIMBURSEMENT
You must submit following documents in Original within 30 days of
discharge from the hospital to CHOLA MS HELP.
 Signed Claim Form (mentioning Total Claimed Amount)
 Original Final Hospital Bill alongwith Payment Receipt
 Original Discharge Summary / Card
 All Original Investigation Reports (x-ray, MRI etc.)
 Original Bills & Receipts for investigations done outside hospital.
 Doctors Prescription, Pre – Post Hospitalisation bills (in original)
 Original Bills of medicines and surgical appliances if purchased.
 EACH & EVERY PAYMENT RECIPT / BILL SHOULD BE SUPPORTED BY
RELATED DOCUMENT.
CRM Cell

Chola MS HELP LINE will operate


24/7 basis. CRM team will be
available between 7AM to 9PM. After
9 PM, calls will be forwarded to a pre-
designated mobile

The customer care number is All


India

Toll Free no -(1800-200-5544)


Mail ID for inquiry
[email protected]

and is also supported by

Toll free fax -(1800-425-2200)


Mail ID for cashless
[email protected]
Customer Relations

 Chola MS Help Customer Relationship Managers will be


available across India at our regional/branch offices, to assist
the client in Health related issues

Chola MS Help Team at Delhi are-


1- Mr. Sandeep Srivastava
ID – [email protected]
2- Dr. Mantosh Kumar
ID - [email protected]
Thank You

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