The form that needs to be filled by the HOSPITAL
The Claim Form Part B is simply the hospital reinstating to the Insurer the comprehensive details of the patient on behalf of the primary policyholder. IRDAI has mandated the Part B claim form as a non-negotiable requisite to completing the claim registration.
The Claim Form Part B confirms the hospitalisation details thus validating the legitimacy of the coverage of the medical expenses incurred. The information provided by the hospital helps confirm and cross-validate the date and time of admission and discharge, the diagnosis, details of the treating doctors, and the documents disclosed upon discharge. Each section has paramount importance to the claim process. By missing out on any field in the form, there can be delays in the claim process. Thus, every field in the form must be filled out accurately.
Following are the components of the Medi Assist Claim Form Part B:
Section A
Basic information about the hospital/medical institution and the treating doctor, like the hospital’s name, hospital ID, and the hospital’s communication details, along with the treating doctor’s name, license number, and qualification are highlighted in this section.
Section B
The patient’s basic information is provided in this section, including the name, age, gender, date of birth, and the date & time of admission & discharge. This section also acknowledges other technical information such as confirming if the admission was an emergency or planned, In-Patient (IP) registration number, the Gravida, Para, Live, and Abortion (GPLA) status in case of maternity-treatments like pregnancy, abortion, infertility, ,sterility, and MTP, patient’s condition at the time of discharge, and the final bill amount.
Section C
Comprehensive information on the treatment provided must be shared in this section. This comprises primary and secondary diagnoses, comorbidities, surgical procedures, details of pre-authorisation acquired but not utilised, and causes of hospitalisation.
Section D
The hospital must confirm the complete list of documentation that has been shared with the primary policyholder at the time of discharge. This information helps identify any missing documentation to complete the claim registration.
Section E
If the hospital is not partnered with the Insurance Company, additional details are required which are enlisted in this section. These include the hospital’s communication details (address and phone number of either the hospital’s Insurance department or the doctor’s department), the hospital’s registration number and PAN Card number along with a few technical information.
Section F
Declaration by the hospital must be provided in this section acknowledging that the information is accurate and thorough.
Some useful information:
Make use of the following tips to avoid delays in claim processing:
- If the hospital is afar or staff is not available to help with the details, it is recommended to register the reimbursement claim with the Part A form and share the Part B form later. However, the Part B form is mandatory for processing the claim.
- For any non-network hospital, it is advised to attach an attested copy of the hospital’s registration certificate while providing other mandatory documents.
