Transcript discharge summary

Presentation
By
TTK Healthcare Services
Incorporated in March 2002 to provide third party
administration Services
Our Vision
“To be the most preferred third party administrator”
ISO Certified
TTK Healthcare
Services exudes
operational excellence
in delivery of customer
requirements, through
defined quality
processes
Only TPA to be ISO
certified for branches
as well as H.O
Role of a TPA
PROVIDERS
Desiring less administrative
burden, greater autonomy,
faster payments, and greater
incomes
Policy Holders
TTK
Insurance Co
Striving to reduce premiums.
Make better policies.
Aim at Claims Control
Demanding better service,
more information, and greater
convenience
Pan India Presence
Branches
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Bangalore
Mangalore
Manipal
Hubli
Hyderabad
Vizag
Chennai
Coimbatore
Madurai
Trivandrum
Cochin
Ahmedabad
Mumbai
Pune
Jaipur
Ludhiana
Delhi
Patna
Jamshedpur
Bhopal
Kolkota
Bhuwaneshwar
Sambalpur
All branches
connected
through leased
lines
Redundant
connectivity
CASHLESS APPROVAL
Planned Hospitalization
&
Emergency Hospitalization
Planned Hospitalization
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If it is a Pre planned treatment, the cashless request should be sent before a week time
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Insurance coordinator in the Network hospital will give assistance & he is the only point of contact
in hospital for insurance.
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Fill the Pre-Authorizations Form, available with the Network Hospitals upon showing TTK Health
Card. This can also be obtained from any of the TTK branch offices or can be downloaded from
this site
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Submit/Fax the Pre-Authorisation Form at our local branch office 4 days in advance
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If your hospitalisation is authorised, then ensure
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You pay for non-medical expenses and
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Before getting discharge, the final bill should be sent to ttk before a 6 hours time.
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Sign the relevant documents including a claim form before leaving the hospital/ getting discharged
Emergency Hospitalization
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Insurance coordinator in the Network hospital will give assistance & he is the only point of contact in
hospital for insurance.
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Get admitted into a network immediately
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Please inform your family member /relative to contact the billing dept in the hospital to inform them to
intimate TTK
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If your hospitalisation is authorised, then ensure
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You pay for non-medical expenses and
Sign the relevant documents before leaving the hospital/ getting discharged
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If your hospitalisation is rejected, your treatment will be continued at the hospital. After discharge, you can
then submit a claim for reimbursement purpose at the TTK Branch office near you.
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After sending the fax, the insured person can get confirmation about the fax delivery by contacting the
following HELPLINE NUMBERS:
044-42894444 / 044-42894445 (24hrs) & 9884604485(9am to 6pm)
Mandatory details to be filled up in Cashless
request
• Insured name & Patient name with age & sex
• TTK ID NUMBER. (If the insured person doesn’t received the TTK ID Number, as an alternate the
corporate name & Employee Id should be mentioned in the request).
• Mobile Number of the Insured person so that the Confirmation message will be sent once the
approval is sanctioned.
• Ailment & its duration & plan of treatment.
• After sending the fax, the insured person can get confirmation about the fax delivery by contacting
the following HELPLINE NUMBERS:
• 044-42894444 / 044-42894445 (24hrs) & 9884604485(9am to 9pm)
DON’TS WHILE SUBMITTING AS AN CASHLESS
•
Incompletely filled Cashless form
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Sending the Final bill/Enhancement at the time of discharge
sharply.
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Filling the Patient Name in short (Whatever the name uploaded
in the intranet should be filled in the cashless form).
MEDICAL REIMBURSEMENT
Non - Cashless Hospitalization
MEDICAL REIMBURSEMENT

Claim form 1st & 2nd page (Available in the Internet ).

Medical Certificate duly filled by the Treating consultant with Hospital Seal
(Available in the Internet).

DISCHARGE SUMMARY :
Discharge summary (Detailed) in Original With Hospital Seal & Treating consultant’s sign
(Should be in Hospital Letter head).
Date of admission & Discharge with time.
Detailed explanation about the treatment undergone.
Duration of the ailment.
Advice On discharge (Which contains Prescription).
Brief description about the investigation undergone.
IN CASE OF MATERNITY: Obstetric Score/History (Number of live children) should be mentioned in the
Discharge summary.
LAB REPORTS
(DO’S WHILE SUBMITTING AS AN MEDICAL REIMBURSEMENT)
 Lab Reports in Original with Dr.prescription.
Lab bills (If not mentioned in Main Bill ).
IN CASE OF FRACTURE : X-Ray report with Film
IN CASE OF ACCIDENT : FIR Copy/MLC/AR Entry.
[MLC: Medical Legal Certificate, AR : Accident Registration Entry]
BILLS
(DO’S WHILE SUBMITTING AS AN MEDICAL REIMBURSEMENT)
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Consolidated Main bill with detailed breakup.
Numbered Payment Receipt for the Payment made.
NUMBERED PAYMENT RECEIPT
Numbered payment receipt is different from the cash bill, even if the cash bill
is submitted, numbered payment receipt is necessary for the claims to process.
If in case, the hospital doesn’t have a option of providing numbered payment
receipt
the alternate document insured person can provide is a payment receipt
in the
hospital letter head with the revenue stamp pasted & sign & seal on it.
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Consultant bill/Surgeon bill.
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Pharmacy bills with prescription.
(The above mentioned are only the basic documents required for processing, once the claim
is scrutinized,. If necessary, medical queries will be raised for further processing)
Pre & Post Hospitalization
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Up to 30’days prior to the date of admission any treatment related expenses
for pharmacy, lab, consultation charges is payable.
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Up to 60’days the post hospitalization treatment related expenses for
pharmacy, lab, consultation charges is payable.
General Exclusions
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Injury or disease directly or indirectly caused by or arising from or attributable to War or War-like situations Injury or
disease caused directly or indirectly by nuclear weapons
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Circumcision unless necessary for treatment of disease
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Dental treatment of any kind unless requiring hospitalisation
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Congenital external diseases or defects / anomalies
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HIV and AIDS or treatment for Venereal diseases
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Hospitalisation for convalescence, general debility, intentional self-injury, use of intoxicating drugs/ alcohol.
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Naturopathy - including spas, therapeutic massages etc….
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Any non-medical expenses like registration fees, admission fees, charges for medical records, cafeteria charges,
telephone charges, etc
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Cost of spectacles, contact lenses, hearing aids
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Any cosmetic or plastic surgery except for correction of injury
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Hospitalisation for diagnostic tests only
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Vitamins and tonics unless used for treatment of injury or disease
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Infertility treatment
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Voluntary termination of pregnancy during first 12 weeks (MTP)
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Natural calamities / acts of God – floods, storms, earthquakes etc….
DON’TS WHILE SUBMITTING AS AN MEDICAL REIMBURSEMET
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Submitting the claim documents after 30days from the discharge date. If in
case of submitting after 30days, the letter from the insurance company to
be enclosed for processing. (Letter from insurance should contain a valid
reason for the late submission. Insured person can request to the New
India Assurance for the above mentioned letter.
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Photocopies of the documents are strictly not applicable as per the policy.
ORIGINAL DOCUMENTS RETURN
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If the insured person needs the original documents back for the
further treatment, It will be provided by submitting a request
letter signed by the insured person.
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Discharge summary & Bills will not be returned at any cost.
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Request for the original documents is applicable, only if the
claim is settled.
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Original documents will be returned to the insured person within
20 working days from the requested date.
PROCESS
Provider Network
4749 Hospitals / Nursing Homes in 390 cities and
3536 Diagnostic Centers in 31 locations.
Network – Empanelment
Extensive Service Provider Network
390 Locations
Goa
12
Madhya
Pradesh
101
Gujarat
340
Maharashtra
Daman and Diu
966
West Zone
1419
Delhi
NCR,HP,Uttaranchal
269
Uttar Pradesh
201
Rajasthan & Jammu&
Kashmir
124
Punjab & Haryana
266
North Zone
860
Network
Strength in
India
Karnataka
734
Andhra Pradesh
545
Tamil Nadu &Pondy
693
Pondichery
Kerala
South India
13
209
2194
4749
Hospitals
West Bengal
164
Bihar
18
Jharkand &
hattisgharh
42
Assam & Orissa
92
East Zone
316
Network – Empanelment
Extensive Diagnostic Center Network
31 Locations
Goa
13
Madhya
Pradesh
92
Gujarat
283
Maharashtra
Daman and Diu
509
West Zone
897
3536Diagnostic
centers
Delhi
NCR,HP,Uttaranchal
115
Uttar Pradesh
311
Rajasthan & Jammu&
Kashmir
140
Punjab & Haryana
212
North Zone
778
Network
Strength in
India
Karnataka
585
Andhra Pradesh
397
Tamil Nadu &Pondy
341
Kerala
268
South India
1591
West Bengal
106
Bihar
20
Jharkand &
hattisgharh
34
Assam & Orissa
69
East Zone
229
Misuse and Fraud Prevention
Investigations Department
• Verification of hospitalization records
• Validation of Medical Records
• Case Selection based on Past Data Analysis.
• 10% of All Claims Investigated.
• Investigations Team Visits for all high Value Cases
• Visits as a WELL-WISHER
• Carries a Get Well Soon Card!
Geared for Customer Convenience
E Alerts
098452 48885
SMS Facility:
Give us your mobile number in the
preauthorization form and you will get an
•SMS sent when request received.
•SMS sent when authorization processed
Email Notification:
Give us your employees email id in the proposal
form and you will get an email when
• pre auth request is received.
•Pre authorization request is processed
•claims notification
HELPLINE NUMBERS
GENERAL HELPLINE NUMBERS
CHENNAI:
044-42894444
1800-425-7575
Chennai Fax:
044-42183300
044-42024343
CORPORATE PRIORITY CALL CENTER NUMBER:
044-42894445
&
9884604485 (9AM TO 9PM) CALLS HANDLED BY CALL CENTER AGENTS
CONNECT TTK
TOLL FREE NOS.
TTK HO CALL CENTER
1800 425 8885
TTK HO CALL CENTER
1800 425 7878
TTK CHENNAI CALL CENTER
1800 425 7575
TTK MUM CALL CENTER
1800 22 1717
TTK COCHIN CALL CENTER
1800 425 6264
TTK HYD CALL CENTER
1800 345 4051
ICICI CALL CENTER
1800 229 229
CITI BANK TOLL FREE NO.
1800 425 4448
TTK KOL CALL CENTER
1800 345 7069
ZERO COST
TO CONSUMER
* Airtel subscribers only
TOLL FREE FAX NOS.
TTK HO FAX NO.
1800 425 2626
MUMBAI FAX NO.
1800 22 1919
COCHIN FAX NO.
1800 425 6262
CHENNAI FAX.NO.
1800 425 7474
FIRST TPA IN INDIA
to introduce
New Toll free number
Reachable from mobile*
1800-102 -1234
CITY
SPECIFIC
TOLL-FREE
NUMBERS
UNIQUE TO
TTK
ONLY.
24/7 Call center
24 hour toll free helpline to provide assistance with
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Hospitalization-Pre-authorization related queries – approval status,
reason for partial rejection etc
Policy Scope and Coverage related queries
Enrollment ID Card queries
Information on Network hospitals
Claim Related queries
Online Features
Claims
• Online enrollment by Corporate – real time
process, easy to access, no fear of
misplacing documents/details, fewer errors
• Online MIS for Corporate – All details
available a click away
• Online Authorization facility at top hospitals,
for faster processing and convenient ( paper
free)
• ONLINE PAYMENT OF SETTLED CLAIMS
DIRECTLY TO CUSTOMERS ACCOUNT
All forms
available
online
Self
Access
Medical Information
Medical second opinion
Visit us at www.ttkhealthcareservices.com
Please login to www.ttkhealthcareservices.com
Please
click he
& sele
Employe
Login
Extended Value for our clients
Medical Information section on website
Information adapted
for Indian scenario
and available in
small, easy to digest
pieces with simple
language and
illustrative diagrams
More Facts about Cataract
1. What is cataract?
Cataract is clouding of natural lens in the eye which is responsible for focusing light
and producing clear sharp images. With age, the old cells of the lens die, which
accumulate and disrupt/diffuse light resulting in blurred vision.
2. Who is Prone to getting cataracts?
Cataracts are leading cause of vision loss among adults aged 55 years and above.
They can also result from hereditary factors, medications or injury in younger age
groups or children.
3. What are the symptoms of cataracts?
The most common signs of cataract development are blurred of fuzzy vision
(Picture) and sensitivity to light. For some people, it makes day-to-day activities like
driving and reading difficult. Colours appear dull or faded. Tasks once simple
become difficult or impossible to perform.
4. What are the treatment Options?
The only treatment currently available for cataracts is surgery. In cataract surgery
the clouded lens (Cataract) is removed leaving a very thin shell or the 'bag' which
held the cataract. After surgery the 'bag' will hold the new lens implant.
Thank You