Ultimate Guide to Park Mediclaim TPA Claim Process

Park Mediclaim Insurance TPA Pvt. Ltd. was incorporated in 2001 under the Company’s act 1956 with the main objective to act as a Third Party Administrator in Health Services.

Their main objective is to act as a service provider to the Insurance Companies. The services of the company were widely accepted, acclaimed and appreciated by the PSU Insurance Companies.

Park Mediclaim TPA Cashless Claim Process

  • Cashless facility is only available at network hospitals.
  • Fill up the pre-authorization form and get it signed by the attending doctor.
  • Upon receiving the pre-authorization form, the treatment will begin.
  • The hospital will not charge you for expenses other than the ones not covered by the insurance policy.

Click here to find a Park Mediclaim TPA network hospital closest to the place you live.

Park Mediclaim TPA Reimbursement Claim Process

  • Intimate Park Mediclaim immediately upon hospitalisation.
  • Submit the necessary documents within 7 days after the discharge from the hospital.
  • After verification of the documents, the claim will be settled within 3 days from the receipt of complete information.

Documents Required for Park Mediclaim TPA Insurance Claim

The documents needed will vary depending upon the type of the treatment. They are typically 4 types of documents.

Know Your Customer Documents

Know Your Customer (KYC) documents are needed to establish the identity of the policyholder/patient.

  • Policyholder’s PAN card or government ID proof
  • Patient’s Aadhaar card
  • Park Mediclaim TPA card or the policy document
  • A cancelled cheque

Generate your Park Mediclaim TPA E-card here.

Hospitalization & Treatment Documents

Submit the following documents in original along with your claim form:

  • Duly signed claim form
  • Copy of the claim intimation
  • Hospital main bill
  • Hospital break-up bill
  • Hospital bill payment receipt
  • Hospital discharge summary
  • Pharmacy bill
  • Operation theatre notes
  • Surgery package breakup if added in the hospital bill

Investigation Reports

All investigation/lab reports have to be submitted in original on the lab/hospital’s letterhead. The reports have to be backed by the doctor’s request for investigation/prescriptions.

If you do not have all the reports in your possession, you can still go ahead and submit your claim with a cover note listing all the missing reports in a date-wise order. You will then have enough time to get hold of the reports.

Park Mediclaim TPA will raise a query and ask you to submit the missing documents. If you don’t have those reports, the TPA will deduct the amount from the total claim amount.

If you are claiming pre and post-hospitalization expenses, your investigation reports/bills have to be supported with the doctor’s prescriptions.

Accident Details, if Applicable

Document required for accident-related claims

  • Medico-legal Certificate (MLC) from the hospital
  • An FIR copy if the case had been reported to the policy

In cases of self-injury, write a letter giving details of the accident. The letter is proof that the self-injury is an accident and not an attempt at self-harm.

Park Mediclaim TPA Claim Form

The claim form has to be accompanied along with the above-mentioned documents.

Download the Park Mediclaim TPA Claim Form

How to Fill Park Mediclaim TPA Claim Form

Park Mediclaim TPA reimbursement claim form has eight sections. Read on to know how to fill these sections correctly:

Section A

Fill the first section with the primary policyholder’s insurance and contact details. Fill the details correctly as Park Mediclaim TPA use the information entered here to contact you.

Section B

This information is about whether the patient is covered under any other insurance policy.

Section C

This section is for the patient’s demographic details. Information such as the patient’s relationship with the policyholder, gender, age, occupation, etc. has to be filled in this section.

Section D

Fill the hospitalization details in this section. The information includes admission date, type of the room, the reason for hospitalization, discharge date, etc. In case of accident claims, details on the FIR and/or medico-legal certificate may need to be added.

Section E

Fill billing details in this section. The expenses have to be divided into 3 categories on the form:

  • Pre-hospitalization: Includes a total of all the bills prior to admission
  • Hospitalization: Includes charges incurred during the hospital stay
  • Post-hospitalization: Includes a total of all bills after discharge from hospital

Other charges like the ambulance charges need to be entered separately in the field provided on the form.

Enter the total of all the bills in the field provided.

Section F

Mention all the bills in this section. The form has a space to write a list of 10 bills. If you have more than 10 bills to mention, write it on a plain paper and then attach it to the form. Total up all the bill minus the pharmacy bills and enter the amount in the field provided. The pharmacy amount needs to be entered in a separate field provided on the form.

Section G

This section is for policyholder’s bank account details. Fill the details correctly as it ensures successful NEFT transaction into your bank account.

Section H

Here, a declaration needs to be signed by the claimant with the date and place.

Fill a Claim with No Scope for Error.

Park Mediclaim TPA Claim Submission Timeline

While submission dates vary from policy to policy, most of them have 15-30 days to submit the claim after the patient is discharged. Ensure that you file your claim before the submission deadline ends. Otherwise, your claim can get rejected.

However, if you have a valid reason for submitting late, write a letter to Park Mediclaim TPA. If the TPA finds the reason justifiable, your claim will get processed. If not, it will be rejected.

If by chance you don’t have all the documents ready and you are near to your submission deadline, send your claim along with whatever documents you have – you’ll submit the claim before the deadline and you’ll also get time to get hold of the missing documents.

Claim Submission Address

The completed claim form along with all the documents mentioned above needs to be sent to the following address:
702, Vikrant Tower, Rajendra Place, New Delhi – 110008

For other contact details, click here.

Corporate insurance policyholders can submit their claim to the visiting Park Mediclaim TPA representative.

Keep your courier or post office receipt safe until your claim gets approved. Meanwhile, you can keep tracking Park Mediclaim TPA claim status to get updates on the claim.

Frequently Asked Questions

For planned hospitalization, intimate 48 hours before admission. For unplanned or emergency hospitalization, intimate within 24 hours of the admission. Click here for the intimation link, or call Park Mediclaim Insurance TPA’s customer care.

No. You just need to fill Part A of the Park Mediclaim Insurance TPA claim form, which is the same as the IRDA Claim Form Part A.

After discharge from the hospital, make sure you submit your claim to Park Mediclaim Insurance TPA within 15 days. A safe period would be between 15-30 days after the discharge date. If you go beyond this period, you can still submit your claim with a letter explaining the reason for the delay. If the reason is accepted by Park Mediclaim Insurance TPA, your claim will be processed.

If you are very near to the submission deadline and do not have all the documents to submit your claim, our suggestion is to submit the claim with whatever documents you have. The benefit of doing this is that you’ll submit the claim on time. Also, when Park Mediclaim Insurance TPA processes your claim, they’ll raise a query asking you to submit the missing documents, giving you enough time to arrange for the documents and submit them.

Yes. If your cashless claim exhausts the sum insured in your Park Mediclaim Insurance TPA, you can claim the unclaimed amount through your second insurance.

Firstly, you need the get the hard copies of your settled claim documents from Park Mediclaim Insurance TPA. Write to them and ask for your cashless claim settlement letter and attested copies of your claim documents (hospital bill, discharge summary, hospital bill break up, lab investigation reports and payment receipts).

These documents need to be submitted to your other insurance company to claim the unclaimed amount.

The claim is reimbursed within 3 days from the date of receipt of complete claim documents. If Park Mediclaim Insurance TPA asks for additional information or documents, your claim can get delayed by another 2-3 weeks.

Firstly, verify the hospital bill before signing it. Obtain photocopies of all the documents. These documents will facilitate your post-discharge medical treatment.

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