The Complete Guide to Grand TPA Health Insurance Claim Process

Grand Healthcare TPA is India’s one of the most preferred third party insurance service provider licensed by the Insurance Regulatory and Development Authority (IRDA License No. 029). It was set up in 2007 when the healthcare industry was growing at a tremendous pace. Grand Health TPA has a team of experts who with collective experience in the insurance field.

This guide is to help you with the entire claim process including cashless claim, filling the reimbursement claim form and the complete documentation.

Grand Insurance TPA Claim Process - Cashless

Here’s the cashless claim process at a Grand Healthcare TPA network hospital:

  • The insured visits a network hospital for treatment and presents their insurance e-card and a government ID proof for pre-authorization.
  • On authorization, the insurance company sends an authorization letter, which states that the insurance company will pay hospital for the treatment.
  • The policyholder pays the deductibles out of their pocket, if any.
  • The insurance company pays to the hospital directly after the patient is discharged based on the medical documents of the patient.
To check out the list of Grand Health TPA network list, please click here..

Grand Insurance TPA Claim Process - Reimbursement

Below is the reimbursement claim process simplified:

  • The insured sends intimation to the TPA about the forthcoming claim. In a planned admission, the intimation is sent 3-4 in advance and in emergency hospitalization, the intimation is sent within 24 hours of hospitalization.
  • Within 7 days of discharge, the insured fills a Grand Healthcare TPA claim form and attached all the medical documents listed in the sections below with the form.
  • After the form is submitted, the policyholder frequently checks the claim status.
  • If the TPA has raised a query, the insured resolves it before 3 reminders.
  • Once the case is proven justified according to the policy terms and conditions, the claimant receives the amount.

Documents Required for Grand healthcare TPA Claim

KYC Documents

  • Copies of the policyholder’s government ID proof or PAN card
  • An insurance or e-card copy
  • Cancelled cheque that belongs to the policyholder
  • Patient’s Aadhar card copy

These documents are important since they help the TPA establish your identity.

Hospitalization Documents

  • Breakup of Bills
  • Sum total Bill
  • Patient’s discharge Summary
  • Payment Receipt
  • Pharmacy Bills
  • Operation Theatre Notes
  • Doctor’s Prescriptions
  • Bill breakup against additional packages, etc.

All hospitalization documents must be original. However, bill breakup and additional package breakup can be accepted on a plain paper with the hospital’s bill.

Investigation Reports

  • ECG Doctor’s request for an investigation
  • Investigation Reports (Including MRI / CT / USG / HPE)

All original investigation reports must be submitted to Grand Healthcare TPA.

Accident Details, if Applicable

  • Medico Legal Certificate
  • FIR (If you have filed a report)

The patient also needs to submit a self-attested letter to Grand TPA explaining how the incident took place and what caused the injury. This is to prove that the injury is not because of self-harm.

Grand Healthcare TPA Claim Form

The Grand TPA claim form for reimbursement must be downloaded in addition to the documents mentioned above.

Download Grand TPA Claim Form

How to Fill Grand Healthcare Claim Form

There are 8 sections in the Part A reimbursement claim form.

Section A

In section A, fill contact details of the primary policyholder as well as the policy details. The information must include the policy number, certificate number, TPA ID as well as the name, address, and contact details of the insured.

Section B

Section B consists of the information of the additional policy that the patient may have. If the patient isn’t covered under any other policy, you can leave out this section.

Section C

Patients demographic details such as their gender, occupation, age, and their relationship with the insured must be filled in section C.

Section D

Section D is for the hospitalization details. You need to fill the name of the hospital, room category, the reason behind hospitalization, date of admission and discharge, and a few other details pertaining FIR and Medico-Legal certification (only if the injury is due to an accident).

Section E

This section would contain the summary total of all the bills. All the bills during the patient’s stay in hospital including the main bill summary, outside pharmacy bills, blood bank bills, diagnostic bills, etc. have to be mentioned in this section.

The bill amount incurred to you before hospitalization must be filled in the pre-hospitalization expenses section and the bill amount incurred after hospitalization must be filled in the post-hospitalization expenses section. If you have incurred additional charges such as ambulance charges, then mention them separately.

Section F

The list of all the bills must be filled in section F. There is a total of 10 spaces in this section. You can use a separate page altogether to list extra bills, if any. On the right hand side, mention the sum total of bills in this order: Hospital main bill, pre-hospitalization expenses, post-hospitalization expenses, pharmacy bills.

Section G

Enter the bank account details of the insured in this section. Be careful because this information because NEFT transfer will be made in the account mentioned. If the total claim amount exceeds 1 Lakh, it is advised that the policyholder’s PAN details be mentioned too.

Section H

The claimant signs the declaration with date and time in this section.

Avoid common mistakes done when filling Grand Healthcare TPA claim form

Grand Healthcare TPA Submissions Timeline

Policyholder’s usually get a 15 to 30-day time after the patient is discharged to file the claim. However, if you do not have all the documents, add a cover-note with the list of documents missing. This way, you will get some time to get hold of the documents and then you can always resolve the query raised by Grand Healthcare TPA.

Ensure that you also keep track of the claim status so that you don’t miss out on the query.

Claim Submission Address

Visit this link you can visit to get the address of various Grand TPA centres.

Corporate employees can submit their claim documents to a Grand TPA representative in their office premises.

Frequently Asked Questions

For planned hospitalization, make sure that you intimate the claim 48 hours prior to hospitalization. For unplanned or emergency hospitalization, intimate Grand Insurance TPA after admission. You can click here or call customer care to intimate the claim.

For your claim to get approved, it typically takes 2 to 3 weeks from the submission date. Once the claim approval comes through, Grand Insurance TPA will inform the insurance company about the claim approval. The insurance company will then transfer the approved claim account into the bank account that is specified in the claim form.

However, if any query is raised, it may take another 4 to 8 weeks.

No, fill only Part A of the claim form. The Part A section of the Grand Insurance TPA’s reimbursement claim form is the same as the IRDA Claim Form Part A.

The ideal timeframe to submit the claim to Grand Insurance TPA is within 15 days from the date of discharge. However, you can submit the claim within 15-30 days after the discharge.

If you are unable to submit your claim within the specified time, you can still go ahead and submit it with a letter stating the reason for the late submission. If Grand Insurance TPA is convinced with the reason, it will process the claim. Regardless of the time elapsed between the discharge and now, we advise you to submit your claim with adequate justification. Who knows, you might get lucky with your claim.

If you are approaching your deadline for claim submission and you do not have all the documents needed to file the claim, file it anyways with whatever documents you have. Once your claim is with Grand Insurance TPA, they will raise a query asking you to submit the missing documents. You will have enough time to arrange for those documents and then submit them.

Yes. If the sum insured gets exhausted in a cashless claim with Grand Insurance TPA, you can claim the remaining amount from your second insurance policy.

Write to Grand Insurance TPA requesting the hard copies of the following documents: attested copies of the claim documents (hospital bill, the bill break up, discharge summary, and lab investigation reports) and the cashless claim settlement letter. You need to submit these documents to the other insurance company to claim the remaining amount.

Improve the chances of claim approval and minimize the deductions.

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