Direct Billing Claims

CHECK LIST FOR PROVIDERS FOR SUBMISSION OF DIRECT BILLING CLAIMS
□ Covering Letter
□ Claim Form Duly filled & Signed by the insured & the treating doctor.
□ Doctors Prescription for medication
□ Original Detailed Medicine Invoices
□ If there is a Outpatient Procedure or Investigation then a medical report / investigation report is mandatory
□ If there is a Outpatient Procedure or Investigation then a Approval Copy has to be attached.

If the above claim documents are in order then the claim can be accepted otherwise it should be returned.

Dear Providers,

Please read this carefully before submitting your claims to us

PLEASE ENSURE THAT

  • The claim form is duly filled, signed and stamped by the treating doctor
  • The pre-approval request is sent for inpatient/day care admission and outpatient cases exceeding pre-approval limit to our helpdesk team
  • You submit all invoices and investigation reports in original
  • You submit the Medical report and Discharge Summary for all inpatient and Day care admission cases
  • You enter ALL member details on the claim form
  • You submit the claims within 30 days from date of treatment.
  • You submit the original medicine prescription and detailed invoices for medications
  • You submit detailed invoices that is break up of all services viz Medication/investigations/Hospital charges etc
  • You submit a copy of the Member ID card and Iqama / CPR
  • You submit claims in sequential order as mentioned in the covering sheet
  • You ensure that agreed contractual discounts and agreed prices are applied
  • You collect deductible as per the policy from our mutual clients
  • You send approval for dental, maternity and optical cases
  • You ensure that submissions of invoices for dental services are per the visit
  • You submit claims policy wise

In case of Emergency admission, it is not mandatory to send approval immediately, but the following day our Helpdesk should be intimated about the admission and the approval request with all relevant information has to be sent

PLEASE DO NOT

  • submit claims without claim form as the claim will not be paid
  • submit photocopied claim forms/invoices and investigation report
  • submit claims without investigation reports
  • send pre-approval after the service availed