Cashless Facility

PRE-AUTHORISATION:

  1. Beneficiary should meet the Aarogyamitra at helpdesk in Network Hospital.
  2. Aarogyamitra validates the Atal Amrit Abhiyan Health card and register the patient under cashless scheme.
  3. The process of Pre-Authorization commences post inpatient REGISTRATION of the beneficiary.
  4. The Network Hospital (EMPANELLED HOSPITALS) based on the diagnosis admits the patients and sends e-preauthorization to the ISA. Only in cases, where the patient is admitted in the hospital, the preauthorization will be processed.

VERIFICATION OF PRE-AUTHORIZATION DETAILS

During the Pre Authorization Process, the following details will be verified & processed accordingly

  1. Beneficiary Details
  2. Identity of beneficiary
  3. Date of Admission
  4. Diagnosis
  5. Estimated Duration of stay
  6. Clinical Notes/ Clinical history
  7. All mandatory investigation reports & other relevant investigations if any
  8. Package selected by hospital along with clinical data form wherever applicable
  9. Name & Qualification along with registration number of treating doctor

Note: The list of investigation reports required for various procedures has been finalized & attached along, however these will be ascertain based on the need established based on the documents received from hospitals

PREAUTH PROCESSING

Doctor @ ISA will scrutinize the documents and process the preauth request (Approve/Query/Denied).

PROCESS OF EMERGENCY PREAUTHORISATION APPROVALS

In case of technical emergencies, such as:

  • Emergency case / urgent clinical intervention required
  • Internet not working along with medical emergency
  • System not working along with medical emergency
  • Kiosk Not functional in hospital due to technical reasons

The medical / surgical preauth approval has to be taken by EMPANELLED HOSPITALS over telephone – Emergency Telephonic Intimation (ETI) which has a voice recording facility.

  • Provisional approval is given by collecting minimal essential data on Diagnosis, Mandatory investigation reports, reason for Emergency
  • Call conferencing between the treating Doctors, Preauth executive will be conducted.
  • An emergency telephonic intimation (ETI) number will get created.
  • Ensure commencement of treatment within 24 hours
  • Non production of required nonclinical documents should not be reason for raising ETI.
  • EMPANELLED HOSPITALS will follow up for the relevant documents to ensure eligibility in the next 48 hours.
  • Deviation from approved pre-auth procedure needs to be informed by ETI within 6 hours

In case the patient fails to provide identification within 48 hours, the Authorization will stand cancelled and patient will have to bear the expenses of the treatment and the Hospital has to take a suitable declaration from the Patient in this regard.