The Ultimate Guide to Paramount Insurance TPA Claim Process

Paramount Health Services & Insurance TPA Pvt. Ltd. was founded in 1996 and it acquired a license from the IRDA in 2002 as a TPA. PHS has created benchmarks in the insurance industry with its expertise in claims processing and quality customer service. The company operates in more than 165 locations across India.

Read further to get a detailed explanation of Paramount TPA claim process which includes, advice on filling the claim form, completing the documentation, and other intricacies of claim submission.

Paramount TPA Cashless Claim Process

  • Show your Paramount TPA health card at the hospital at one of the Paramount health insurance network hospitals.
  • Fill the pre-authorisation form to check your eligibility for a cashless claim through Paramount’s network hospital.
  • After the request is verified subject to policy terms, Paramount gives an authorisation letter to the hospital which states that the insurance company guarantees payment.
  • Once the patient is discharged, the hospital submits all the original documents related to the treatment to Paramount medical insurance company and the payment is directly released to the hospital.
If the hospital you choose for the treatment isn’t within Paramount TPA hospital list, then you can’t opt for a cashless claim. So, to check the Paramount TPA hospital list, click here.

Paramount TPA Reimbursement Claim Process

  • Intimate Paramount TPA as soon as you establish the need for hospitalization. In case of emergency admission, intimate the company within 24 hours of hospitalization.
  • Within 7 days after the patient gets discharged, fill the Paramount TPA claim form.
  • Attach the bills as well as the treatment related papers as specified in the policy with the claim form.
  • Track the claim status until the claim gets settled.

Documents Required for Paramount Health TPA Claim

There are 4 categories the claim documents can be divided into. Depending on the type of claim, some of these may not apply.

KYC Documents

'Know Your Customer' documents verify the identity of the policyholder. The list of KYC documents includes:

  • Patient’s Aadhar card copy
  • A copy of PAN card or any other government ID proof of the main policyholder
  • Original cancelled cheque in the name of policyholder
  • A copy of the Paramount TPA e-card or insurance certificate

To generate your Paramount Insurance TPA E-card online, click here.

Hospitalization Documents

With the Paramount TPA insurance reimbursement claim form, you will need to attach all the hospital originals. Which means that the documents must be on the official letterhead of the network hospital. The documents include breakup of all the hospital bills, the discharge summary, payment receipts, break up of the package amount added to the bills, etc. Moreover, these few things must be ensured:

  • The bills you will receive from the hospital are summarized, so ask for the breakup of the total amount in the bill.
  • If one or more surgery packages were added to the bill, ask for its breakup on the official letterhead or on a plain paper with the hospital’s seal.
  • Get receipts of the payment against the hospital bill to attach with the claim form. Total amount in the receipt should be equal to the total bill amount.

In case of pre and post hospitalization claims, just the originals of consultation, pharmacy or lab bills are enough. You need not ask for a bill breakup after the discharge.

Note: Check if you’re eligible for the claim as per pre and post hospitalization duration specified in the policy. Without a doctor's prescription as a proof, Paramount won’t pay for pre and post hospitalization expenses.

Investigation Reports

Examine the lab investigation reports and submit the original reports to the insurance company. Reports printed on plain paper with lab’s or hospital’s seal will not be accepted by Paramount Health Insurance.

If you do not have the reports handy yet, add a cover-note and the missing reports’ date-wise list to the claim. Paramount will raise a query and you will get enough time to get hold of all the necessary documents.

If you do not submit originals of the reports or if reports are missing, there will be a deduction in the claim amount.

If you’re claiming pre and post hospitalization expenses, the investigation reports must be supported by the doctor’s prescription on the official letterhead.

Accident Details, if Applicable

If the patient has had an accident, submitting a Medico-legal certificate is mandatory. If the accident has been reported, attach the FIR of the case with the claim form.

Paramount Insurance Reimbursement Claim Form

Attach the documents mentioned above with the Paramount TPA claim form.

Download Paramount Health TPA Claim Form

How to Fill Paramount Health TPA Claim Form

The form (also called Part A form) is divided into 8 sections from Section A to Section F.

Section A-C

In the form, you must fill primary policyholder’s and patient’s information in sections A, B and C. Corporate employees are primary policyholders when you’re filling a corporate health insurance.

Section D

The treatment related details must be filled in section D. The details would include admission date, discharge date, nature or type of treatment, the date of detection of illness, etc.

Section E-F

Billing related details must be captured in the sections E and F. You can put the expenses incurred in 3 main segments: Pre-hospitalization, hospitalization, and post hospitalization. Based on the sequence of these segments, list your bills in the form.

For specific expenses such as health-check, ambulance, daily hospital cash, etc., use the separate field given in the form.

Reduce the pharmacy bill’s amount from the total bill amount and fill it separately in section F. The form consists of space for 10 bills. Use this space for pre-hospitalization, hospitalization, and post-hospitalization charges.

Section G-H

Fill the bank details of the primary policyholder’s bank account in Section G. Ensure that the name you fill is exactly what is on the cheques and DD payable details.

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Paramount Health Submission Timeline

Usually there is a period of 15 to 30 days after the discharge that you can file the claim. However, the timeline is different for various TPAs.

If you do not have all the documents specified in your policy, submit the form with just the documents you have available with you. This way, you will get enough time until Paramount raises a query and you are asked to respond with the remaining documents.

Usually the delay results in rejection of the claim. But, if you’re able to justify the delay, you stand a chance of getting your claim settled.

Claim Submission Address

For corporate policy, the address remains their office. They must submit the form to Paramount Health representative during anyone of their visits. You can either submit your claim to the addresses mentioned here.

After submitting the claim, do not misplace the receipt. Also, keep tracking the status of your claim to ensure that you do not miss a query raised by Paramount.

Most of the rejections of the claims filed are because claimants fill the claim form incorrectly. And if not rejection, the mistakes can lead to deductions and payment delays.

Frequently Asked Questions

You can either call customer care and intimate Paramount TPA about the claim beforehand or visit this link and fill out the claim intimation form online.

First of all, your claim will be verified by Paramount TPA and approved if you have specified all the information clearly and submitted all medical documents. Claim approval takes 2 to 3 weeks if Paramount TPA doesn’t raise any query. Once the claim is approved, the settlement figure is sent to the insurance company which processes the claim amount in another 2-4 weeks. The payment is credited to the account that you have specified in the claim form.

The claim must be submitted to Paramount TPA using the Paramount reimbursement claim form. Once the TPA verifies all the documents and approves the claim, it intimates the insurance company. The insurance company then transfers the amount you are liable to in your bank account mentioned in the claim form.

Usually, the claim should be submitted within 7 days after the discharge and the original hospitalization documents must be sent within 15 days. However, if you don’t have all the original documents, submit a claim with the ones you have. With the application, enclose a note that has the list of missing documents. Paramount TPA will raise a query, but by then you will get enough time to get the remaining documents and resolve the query.

Yes, pre and post hospitalization expenses can be recovered. The process is the same as filing reimbursement for hospitalization. Fill the claim form and enclose the originals of the medical documents as specified by Paramount TPA. Once your claim is approved, the insurance company will settle the payment.

Documents to be attached with Paramount TPA claim form:

  • Paramount card photocopy
  • Policy certificate copy
  • First prescription and admission advice document
  • Investigation reports or any other reports that Paramount TPA has requested

You can check the Paramount TPA claim status here.

You can get the Paramount TPA e-card here. All you have to do is fill the policy number and you will get the e-card.

There is only a single page reimbursement form. This Paramount TPA claim form is the same as the IRDA claim form A.

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