Anyuta Insurance TPA in Health Care Authorize the Hospitals Empaneled with RSI&PF Department

Anyuta Insurance TPA in Health Care Authorize the Hospitals Empaneled with RSI&PF Department

Dear Sir
Subject: Patient Information on Cashless Health Care
Anyuta InsuranceTPA in Health care Authorize Hospitals to provide Cashless Health care and Process the Claim Documents submitted to it. The RSI&PF Department Settles the Claims.
Procedure for Cashless Health Care
  1. Anyuta Insurance TPA in Health care “Authorize” the hospitals empaneled with RSI&PF Department to provide Cashless Health Care to the Policyholders

  1. When the Patient gets admitted to any of these empanelled Hospitals, they send us a request form detailing the Diagnosis, Line of Treatment and the cost involved

  1. Anyuta Insurance TPA in Health care after receiving this above request “Authorize” the hospital to provide Cashless Health Care at CGHS Rate.

  1. Hospital then treats you without taking any money from you and sends all original Medical, Billing and accounting documents, to us to Process and send it to the Insurer RSI&PF Department

  1. Anyuta InsuranceTPA process the Claims as per the CGHS Code and Rate for the Investigations, Hospitalized Care and the Procedures as per RSI&PF Department Policy guidelines, prepares a Claim Float and submits to RSI&PF

  1. RSI&PF checks the Claim Float submitted by Anyuta InsuranceTPA and Settles the Claim by RTGS

Procedure for Reimbursement
  1. Only the RSI&PF Department can order reimbursement the treatment taken in non-empanelled hospitals

  1. Anyuta InsuranceTPA only Process the Claims and send it to the Insurer RSI&PF Department to Settle the Claims

  1. The Claim Settlement will be as per CGHS Rates and Policy guidelines only

Draft Authorization Letter from Anyuta TPA to the Hospital is as follows,
You are here by authorized to provide Cashless Health Care Services to
  1. Mr./Mrs./Miss/Master…... Aged….. Yrs. Female / Male, Daughter/ Son / Spouse of Mr. /Mrs.…….

  1. The total cost of treatment is mentioned as Rs. ………../- only

We request the Doctor in charge of the Patient send a letter justifying the costs along with the final bill
We also request you to follow the conditions in your agreement with the Insurer. Please note that,
  1. You are responsible for correctly identifying the Beneficiary and treating him/ her.

  1. You will also indemnify Anyuta TPA in Health Care and the Insurer from the legal cases, financial and of any type of losses that may arise because of the Medical Negligence in this case.

After discharge please send the
  1. Original Claim Documents to Rajasthan State Insurance & Provident Fund Department “RSI&PF” 2nd Floor, ‘D” Block, Vitta Bhawan, Janpath, Jaipur 302006, Rajasthan

  1. Anyuta Insurance TPA in Health Care will Process the Claims without prejudice

  1. Anyuta Insurance TPA contact: Help line : 917877205152, 0141- 6550002, 0141- 6596565

  1. E mail: ww.anyuta.co

  1. Rajasthan State Insurance & Provident Fund Department “RSI&PF” will settle the Claim as per the Tripartite Agreement entered by you. The claim processing will be as per RSI&PF Policy conditions applying CGHS Package Rates. To avoid confusion please provide the CGHS Package rate against the Procedures done.

  1. SIPF Contact : 0141-2202395, 2202347, 2202348, 2200349, 2201349, 2201336

  1. E – mail :

  1. Original Claim documents should be as per Anyuta check List, filed in order, with a covering letter listing the documents and the billed items should carry the CGHS Code & rate against each item.

  1. The Claim File should be in duplicate and one should be handed over to the Policyholder

  1. The Doctor`s certificate enclosed should state that the admission, investigations, procedures were needed and the costs are reasonable. The illness, line of treatment, prognosis and the costs payable by RSI&PF and the costs that he may have to pay, were explained to the patient and the relatives.

  1. The Pharmacy Bill should contain all the medicines purchased with name of the drug, manufacturer, cost per unit, dispensed medicine number, the Doctor`s and the Pharmacist`s name, registration number, signature and seal, along with the Pharmacy License number and name.

  1. Use the SRIT link to view your claim process in each stage till Settlement by RSI&PF

Please Note
  1. Relapse within 45 days from the date of discharge is considered as one illness

  1. Medical expenses incurred during period up to 30 days prior to hospitalization will be considered as part of claim
This facility would be given in critical diseases
  1. Medical expenses incurred during period up to 45 days after hospitalization
  2. This facility would be given in critical diseases

3.7 CASHLESS FACILITY – Cashless facility would be extended to the Insured in the private networking Hospitals for the critical ailments
  1. (Means: -i. Coronary Artery Surgery ii.Cancer iii.Renal Failure i.e. failure of both the kidneys iv. Stroke v. Multiple Sclerosis vi. Meningitis vii. Major Organ transplants like Kidney, Lung, Pancreas or Bone marrow Transplantation) and the treatment requiring surgical treatments. However,

  1. The TPA would decide the merit of the case and it will not be claimed as a matter of right by the insured. The denial of cashless facility does not mean the denial of treatment from concerned hospital & reimbursement thereof.

Reimbursement
Patient getting treated with any Private Hospital is reimbursable with the permission of the Director of the Insurer
(GIC Rajasthan SIPF Department)
3.8 CLAIM INTIMATION TO TPA - It is required by the employees that the claims arising in private hospitals should be
  1. Intimated by cashless request form/ claim intimation form, available in the hospital, to the TPA positively.

  1. If the claim intimation does not reach the TPA the same day when the patient is admitted to the hospital, then the employee shall not be entitled for re-imbursement.

  1. 6.5 All supporting documents relating to the claim must be filed with TPA/GIF within 90 days from the date of discharge from the hospital. In case of post-hospitalization, treatment (limited to 45 days), all claim documents should be submitted within 90 days after completion of such treatment.

Anyuta Corporate Office: No: 31/18. Main Road, Loyola Layout, Main Road, Ward No: 111, Shanthala Town, Bangalore 5600 47.

E-Mail

Mobile: 98450 10136, 94480 54311. 94484 56986 Tele : 080 41128311. 25364766

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