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.
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.
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.
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.