Ultimate Guide to MedSave TPA Health Insurance Claim Process

MedSave Health Insurance TPA Limited is a leading TPA company, licensed by the IRDAI in 2002. It is an ISO 9001-2015 compliant company, committed to providing quality and secure services in health insurance. They provide 24*7 easy access to services across India.

MedSave TPA Cashless Claim Process

  • A pre-authorisation request is sent by the network hospital to MedSave Health Insurance TPA Ltd.
  • In case of planned hospitalization, after authorisation is received from MedSave, the treatment starts.
  • In case of emergency hospitalisation, authorisation from MedSave can be obtained within 24 hours of admission.
  • Before discharge, fill the insurance claim form and sign it.
  • In case of cashless treatment, don’t collect the original documents from the hospital. The insurance provider will directly pay the hospital.
  • The validity period of authorisation is 3 days from the date of issue or date of hospitalisation, whichever is later.
  • For expenses pertaining to pre and post-hospitalisation, submit all original documents like prescriptions, cash memos, investigation report etc., to MedSave directly for reimbursement.
Before you get hospitalised, make sure that it is a Medsave TPA Network Hospital. To check your nearest network hospital, please click here.

MedSave TPA Reimbursement Claim Process

  • Intimate MedSave TPA within 24 hours of hospitalization.
  • Pay the total expenses directly to the hospital.
  • After discharge from the hospital, claim for the reimbursement from MedSave TPA.

Documents Required for MedSave Health Insurance Claim

You need to submit 4 types of documents along with your MedSave claim form. However, some categories mentioned below may not apply depending on the type of your claim.

KYC Documents

Know Your Customer (KYC) documents are required to establish and verify the identity of the patient and the insurance policy holder. These documents typically include:

  • Aadhaar card copy of the patient
  • A copy of PAN card of the primary policyholder (If PAN card is not available, any other valid proof may be submitted)
  • MedSave health card or the policy certificate
  • A cancelled cheque (original) primary policyholder’s bank account

Hospitalization Documents

All the hospitalization documents have to be original and on the hospital’s letterhead. The hospitalization documents may include discharge summary, the breakup of the complete package, hospital bills, payment receipts, breakup of the bill, etc.

Consider these things while collecting the documents from the hospital:

  • Hospital bills are usually just a summary of all the expenses. So, make sure you request the hospital to give you the medical bill breakup.
  • Also request for the surgery package breakup on the hospital’s letterhead if the surgery expense was added to the bill.
  • Get all payment receipts from the hospital and ensure that the total receipt amount is equal to the amount in the bill.
  • For pre-hospitalization and post-hospitalization claims, the discharge summary is good enough for the claim process. You don’t need not ask for hospital bill breakups.
  • Attach the original bills including consultation, pharmacy, or lab along with your MedSave Health claim form.

Ensure that you check your eligibility for pre and post hospitalization duration. This will be specified in your policy document. Don’t forget to attach the doctor’s original prescriptions that serve as proof of pre and post-hospitalization. If these documents aren’t in your claim file, MedSave will not reimburse that amount.

Investigation Reports

Check the lab investigations costs the hospital has billed you for and reconcile them with your reports. Get all the reports in the original. Reports on plain paper with the hospital’s seal may not be accepted by MedSave Health Insurance. If you don’t have the reports, include a cover note stating the date-wise list of reports you will not be submitting.

If any of the reports are missing, MedSave may raise a query asking you to submit the report or it may deduct the investigation/lab report amount bill from the claim requested.

In pre and post-hospitalization cases, attach the doctor’s prescription on the lab requisition slip or the letterhead to support your lab reports.

Accident Details, if Applicable

In case of accidents, a Medico-legal certificate (MLC) from the hospital is a must. If the accident was reported to the police, submit the FIR copy.

If the accident was due to self-injury such as injury while playing or self-fall, write a letter explaining the accident in detail. Get the letter signed by the patient before submitting.

MedSave Health TPA Claim Form

Download the MedSave Health claim form here and attach the documents mentioned above.

Download MedSave Health Claim Form

How to Fill MedSave Health Claim Form

There are 8 sections in MedSave Health claim form, which is also known as Part A form.

Section A-C

Fill section A, B and C with primary policyholder’s details and also of the patient. If it’s a corporate policy, the employee is the primary policyholder.

Section D

Fill section D with treatment-related details that may include the date when the illness was diagnosed, hospital admission date, the nature of the treatment, discharge date, etc.

Section E-F

Sections E and F are for medical billing details. Categorize the expenses into 3 segments.

  • Pre-hospitalization – Expenses incurred before hospitalization
  • Hospitalization – Expenses incurred during the hospital stay
  • Post-hospitalization – Expenses incurred after the discharge

List your medical bills based on the sequence of the segments mentioned above. Calculate the expenses for each of the segments and fill the amount in the form. If your policy allows you to claim expenses such as daily hospital cash, ambulance, health-check, etc. fill those expenses in the separate field given in the form.

In section F, the same information has to be filled here but a bit differently. Deduct pharmacy bill amount from the total amount and fill the amount separately in the F section.

You can fill 10 bill details in the space. Use this space to fill expenses incurred during pre-hospitalization, pre-hospitalization and post-hospitalization.

Section G-H

Section G is for filling the bank details of the primary policyholder. Write down the exact name of the account holder as it appears on the cheque.

Don't forget to sign the declaration in section H.

Make no mistakes while filling MedSave TPA claim form – Contact a SureClaim Expert to Help You

MedSave Health Claim Submission Timeline

Different health insurance TPAs may have different submission timeline, but it typically falls between 15-30 days. If there is any delay in the claim submission, there are high chances of getting your claim rejected. However, if you have a justifiable reason for the delay, your claim can get settled.

If you don’t have all the required documents and if getting them may delay your claim, initiate the claim process with whatever documents you have within 30 days of discharge. When MedSave Health processes your claim, they will raise a query asking you to submit the missing documents and they’ll give you some time to gather those documents.

Claim Submission Address

If you have the corporate health insurance plan through your employer, submit the claim form in their office to the MedSave Health representative. Otherwise, click here to get the addresses of MedSaveHealth’s TPA centres in various cities.

Note: Keep the receipt of post office or courier slip until you get your claim approved. It is always better to choose a courier service with a real-time tracking system.

Once MedSave Health Insurance office receives your claim form, they will send you a message with the tracking link. You can check the status of the claim by clicking on this link.

Most people make mistakes while filling the claim form. These mistakes can delay the claim process, reduce the claim amount and even lead to claim rejection.

Frequently Asked Questions

Visit this link to send MedSave TPA claim intimation. If the hospitalisation is pre-planned, send claim intimation at least 3 to 4 days before the admission. If the hospitalisation is not pre-planned, intimate MedSave TPA within 24 hours of admission.

If you have submitted all the required medical documents on time, claim approval takes 3 to 4 weeks. Otherwise, it may take longer since the TPA raises a query for you to submit the missing/original documents. And once the claim is approved, the insurance company takes another 2 to 4 weeks to send you the claim settlement amount.

The claim should be filed with MedSave TPA. The insurance company only transfers the claim settlement amount to your bank account after the TPA has verified and approved the claim.

Since you’re getting cashless treatment, the hospital will keep the originals of your bills and the discharge certificate. At the time of discharge, the patient has to countersign the original bills, fill the claim form, and submit these documents at the hospital. And, for the record, the patient can keep copies of the original bills and the discharge summary.

You can check MedSave TPA claim status here.

You can get your MedSave TPA e-card here.

No, you do not need to fill part B claim form. To file a claim with MedSave TPA you must only fill MedSave TPA claim form which is the equivalent of IRDA claim form part A.

The MedSave TPA claim form must be filled and sent within 7 days after the discharge. You can, however, submit the medical documents within 15 days of discharge.

Yes, you can. In any case, you can claim more than the sum insured.

Your mediclaim policy covers pre and post hospitalisation expenses incurred 30 days before the hospitalisation and 60 days after the discharge. You can file a post-hospitalisation claim within 7 days post treatment completion date or within 60 days after the discharge - whichever is earlier.

Opting for cashless or reimbursement claim is your call. But it is advised to opt for cashless treatment if you are admitted in a network hospital. It will allow you to get the treatment without having to pay. This also allows you to claim for your post-hospitalisation expenses without exhausting the limit.

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