Ultimate Guide to Rothshield
TPA Health Insurance Claim Process

Rothshield Insurance TPA Limited is a third-party administrator specialising in providing managed care services. Licensed by IRDA, Rothshield is affiliated with some of the most reputed insurance companies from the public and private sector in India.

Backed by a team of experienced industry professionals, Rothshield aims to provide a healthy environment to insurance companies and policyholders during cashless settlements.

This article is aimed at providing you a clear understanding of how the Rothshield TPA claims work. The detailed information below will help you fill the form easily, complete the documentation, and understand the intricacies of the claim process.

Rothshield TPA Claim Process – Cashless

  • Visit a network hospital and produce the Rothshield card for identification.
  • Wait for the network hospital to send the authorisation request to Rothshield TPA. If authorized, you need not pay for the medical expenses at the time of discharge except for the deductibles mentioned in the policy.
  • Sign the voucher on the authorisation letter at the time of discharge.
  • Source the photocopies of all the treatment documents from the hospital for the record. Originals will be submitted to Rothshield TPA.
View Rothshield TPA’s list of network hospitals here.

Rothshield TPA Claim Process – Reimbursement

  • The policyholder needs to send an intimation letter to Rothshield TPA within 24 hours of hospitalisation by sending a letter, fax, or an e-mail at info@rothshield.co.in. To download Rothshield TPA Claim Intimation Request form, please click here.
  • Fill the claim form and send it to the TPA within 7 days after the discharge.
  • Ensure that you attach medical documents and bills with the form before sending it to the TPA.
  • Track Rothshield TPA claim status and resolve queries, if raised, until the claim gets settled.

Documents Required for Rothshield TPA Claim

The documents you will need to submit to the TPA to claim your health insurance are divided in 4 categories:

KYC Documents

KYC stands for Know Your Customer. These documents help Rothshield TPA establish your identity before settling a claim. You will need to submit:

  • A copy of the patient’s Aadhar card.
  • A PAN card copy or a copy of any other valid government ID proof of the insured.
  • An original cancelled cheque of the policyholder’s bank account.
  • A Rothshield insurance or e-card copy.

Hospitalization Documents

With the Rothshield Insurance claim form, attach all the original documents related to the treatment of the patient. ‘Original’ here is referred to documents on hospital’s official letterhead. Review your policy thoroughly and check if you have attached all the originals with the form including:

  • The summary of patient’s discharge
  • The receipts of payment
  • The complete breakup of the bills
  • Breakup of bills against additional packages, if any
  • Pharmacy Bills
  • Doctor’s Prescriptions
  • Operation Theater Notes, etc.

Note: If you have not been given the package breakup on hospital’s letterhead, then you can ask for the bill breakup on a plain paper with the hospital’s seal. For pre-hospitalization claim and post-hospitalization claim, ensure that you submit doctor’s original prescription with pharmacy bills and the original proof of diagnosis.

Investigation Reports

Lab investigation reports that you send to the insurance TPA must be original, i.e., printed on hospital’s letterhead. While some documents such as the bill breakup can be accepted on a plain paper with hospital’s seal for proof, the investigation reports must definitely be printed on the letterhead. Do not forget to enclose the reports since missing reports can result in:

  • Significant deductions from the claim amount.
  • Queries raised by Rothshield TPA.

If you do not have the investigation reports with you, add a cover-note with the list of reports that are missing on top of the form. In cases of pre and post hospitalization claim processes, do not forget to enclose your doctor’s prescription on a lab requisition slip or the official letterhead to back the reports.

Accident Details, if Applicable

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

Note: Enclose a letter written and signed by the patient explaining the accident in detail. The purpose of the letter is to establish that the injury wasn’t the result of an attempt at self-harm.

Rothshield TPA Claim Form

Get Rothshield TPA’s claim form here. Make the Process of Correctly Filling the Claim Form Completely Hassle-Free

Download Rothshield TPA Claim Form

How to Fill Rothshield Claim Form

Section A-C

Sections A to C are for the primary policyholder and the patient. These sections take the personal information which includes the names, addresses, and other details. According to the corporate policies, the employee is the primary policyholder.

Section D

Section D consists of all the details related to the treatment of the patient. You will need to use this section of the form to fill the admission date of the patient, the discharge date, the type or nature of treatment, the date when the illness was detected, etc.

Section E-F

Section E consists of billing related information during:

  • Pre-hospitalization: Expenses before the treatment
  • Hospitalization: Expenses during the treatment
  • Post-hospitalization: Expenses after the treatment

You will need to list the bills in section E based on this sequence above. Individual expenses will be filled in the fields of this section. Moreover, there’s an extra field given for expenses including health check-ups, daily HospiCash, ambulance, etc.

Section F consists of separate space for similar information. Use it to fill the pharmacy expenses separately rather than along with the total bill amount. The form has 10 spaces for bills which will be sufficient for all the expenses during the diagnosis and the treatment.

Section G-H

Enter the bank details of the primary policyholder in section G. Many people make mistakes while filling the bank details incorrectly and the most common mistake is incorrect name in the form. Ensure that the name and its spelling is exactly how it is on the DD payable details or on the cheque.

Sign the declaration in the Section H of Rothshield claim form.

Avoid common mistakes done when filling Rothshield TPA claim form

Rothshield TPA Submission Timeline

The policyholders are usually allowed a 15-30-day time period after the discharge to file a claim. And though submission timelines vary with the policy, you can stay on the safe side by filing the claim within 15 days of the discharge. If you think that you are missing a couple of necessary documents specified in the policy, you can avoid the delay and ultimately the rejection by sending only the documents that you have. This will allow you some time until Rothshield TPA raises a query. It is then that you can resolve the query by submitting the required documents.

Ensure that you continue tracking the status of your claim until it is settled. Click here to check Rothshield TPA claim status.

Claim Submission Address

Policyholders can check the addresses of Rothshield TPA centres in various cities using this link.

Corporate policyholders can submit their claim forms in their office premises to a Rothshield representative.

The medical insurance claim, whether cashless or reimbursement, can be very tricky and requires you to be proactive. Moreover, filing an insurance claim is one of the most time-consuming processes.

Frequently Asked Questions

To intimate Rothshield TPA regarding the claim, fill the form available on this link. The claim intimation must be sent at least 3 to 4 days in advance. In case of emergency hospitalisation, intimate the TPA within 24 hours of the admission.

It usually takes Rothshield TPA 3 to 4 weeks to approve the claim. After your claim is approved, the TPA contacts the insurance company which then takes 2 to 3 weeks to settle the amount with you.

The claim should be submitted to Rothsheild TPA. The TPA checks your eligibility, your medical history, and your supporting medical documents before it approves the claim. Once approved, the insurance company is informed about the claim. The insurance company then settles the claim amount with the policyholder.

  • A copy of Rothshield TPA e-card
  • A policy certificate copy
  • Doctor’s prescription or a formal letter explaining the need for hospitalisation
  • Original investigation reports

To know your Rothshield TPA claim status, fill a small form available on this page.

You can get your Rothshield TPA e-card here.

No, you need not fill part B of the IRDA claim form. You must only fill the Rothshield TPA claim form which is the equivalent of part A of IRDA claim form.

You must submit a claim within 7 days of the discharge date when filing a claim with Rothshield TPA. However, the documents can be submitted within 15 days of discharge. If you do not have all the original documents, submit the ones you have to Rothshield TPA. The TPA will raise a query which will buy you enough time to collect the originals. You can then resolve the query by submitting the required documents.

Perfect Your Claim Experience with Zero Efforts

We're Here to Help

Get 360 degree claim assistance from our in-house claim experts.