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Medi Assist India TPA Pvt Ltd

Palakkad, Kerala

| GST  32AACCM8044R1Z2

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Cashless Process

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Mediclaim Policy

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Medi Assist India Tpa Private Limited
We are a Third Party Administrator (TPA) of Health Insurance Policies and we form a vital link connecting all other stakeholders of the Health Care Domain. We enable cashless hospitalization at pre designated points of healthcare delivery like hospitals and nursing homes, and in case of reimbursement claims, we assure speedy settlement of the same.
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Nature of Business

Service Provider

Legal Status of Firm

Limited Company (Ltd./Pvt.Ltd.)

GST Number

32AACCM8044R1Z2

Cashless Process
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Cashless Process

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This section will guide you through various aspects of Mediclaim policy with particular reference to the Claims Settlement and Cashless service procedures.

What is Cashless Hospitalization?

Cashles hospitalization Process & Procedures are described below

 

  • Cashless hospitalization can be availed only at Medi Assist network of hospitals. The essence of cashless hospitalization is that the insured individual need not make an upfront payment to the hospital at the time of admission.
  • Note : The listed network hospitals in the booklet issued may have undergone changes in the form of additios and deletions. Please check the website for the updated list of network hospitals.
  • Once you are covered under a Health Insurance policy administered by us, you will be issued a Medi Assist ID card.
    Please note that this card is issued only for identification and information purposes.
  • At the time of hospitalization at a network hospital, you will have to produce this card as proof of being covered by a health insurance policy. In case your Medi Assist ID card is not a photo card (as in the case of some large corporates), it is advisable to carry some form of photo ID (Ration card, Driving license, Voted Id card, etc.) with you in case the hospital wants to verify your identity
  • The network hospitals have a preauthorization request form available with them. This form can also be downloaded from this website. The form has to be jointly filled in by you and your treating doctor. Please make sure all the details asked in the form are completely filled. This will ensure speedy processing of your request.
  • This form is faxed to the Medi Assist toll free fax number.
  • At Medi Assist, we receive the request and process it. The medical team will determine whether the condition requiring admission and the treatment plan are covered by your health insurance policy. They will also check with other terms and conditions of your insurance policy.
  • In case coverage is available, Medi Assist will issue an approval to the hospital for a specified amount depending on the disease, treatment, how much you are insured for, etc. This is sent by fax and/or email (if available). The approval is called a "Preauthorization". This preauthorization entitles you to avail cashless facility at the hospital without paying for the medical expenses. Note: Further enhancement approvals may be issued on request, subject to terms and conditions of the policy.
  • At the time of discharge, please make sure that you check and sign the original bills and discharge summary. Please carry home a copy of the signed bill, discharge summary and all your investigation reports. This is for your reference and will also be useful during your future healthcare needs.
  • The hospital will ask you to pay for all the Non-Medical Expenses in your bill. You have to make this payment before discharge.
  • In case, for whatever reason, the preauthorization request cannot be approved, a letter denying preauthorization will be sent to the hospital. In this case, you will have to settle the hospital bill in full by yourself.
  • Please note that denial of a preauthorization request is in no way to be construed as denial of treatment or denial of coverage. You can go ahead with the treatment, settle the hospital bills and submit the claim for a possible reimbursement.
  • For the Complete Process kindly refer Preauthorization Procedure

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TPA Services
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TPA Services

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Under Regular TPA Services, we offer the following: Enrolment of insured employees and their families
  • Issue of Health Insurance ID cards to the insured employees and families
  • Enabling cashless hospitalization for employees and their families
  • Healthcare Claims Processing
  • Analysis of claim data pertaining to the corporate

As a part of these services, we enter into Service Level Agreements for issuing ID Cards, turn around Time for Reimbursement Claim Settlement, & turn around time for Pre-Authorization response, and endeavour to honor the same.

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Insured
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Insured

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The essence of our service offering ends here when we deliver various services to the Insured. We serve all the insured, who are covered under the TPA Services of Medi Assist.

Kindly visit the insurer's website for more details on the various insurance policies being offered by them

New India Assurance Company Ltd.
National Insurance Company Ltd.
Oriental Insurance Company Ltd.
United India Insurance Company Ltd.
Reliance General Insurance Company Ltd.
ICICI Lombard General Insurance Company Ltd.
Cholamandalam MS General Insurance Company Ltd.
Royal Sundaram Alliance Insurance Company Ltd.

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Non Admissible Expenses

Non Admissible Expenses

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Mediclaim Policy

Mediclaim Policy

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Notice Of Claim
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Notice Of Claim

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Upon the happening of any event which may give rise to a claim under the health insurance policy, a notice with full particulars of the event has to be sent to the Insurance Company within 7 days of the event.

Once the treatment is complete, the claim has to be filed within the policy specified duration from the date of discharge

The notice of claim and filing of claim apply especially to reimbursement claims.

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Pre & Post Hospitalization Expenses
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What are Pre-Hospitalization & Post-Hospitalization Expenses?

When one falls sick, one usually consult a family physician and gets relevant investigations done. On the advice of the physician, one gets hospitalized for further management of the disease if required. Such medical expenses incurred before hospitalization are called Pre-Hospitalization expenses.

During hospitalization, a major part of the treatment is complete but some part of the treatment extends beyond the hospitalization. It may involve follow-up visits to the doctor, medicines to be taken or further investigations to be done. Such medical expenses are called Post-Hospitalization expenses.

There is provision to claim these expenses through your health insurance policy.These expenses are payable for a policy-defined period. Both pre-hospitalization and post-hospitalization expenses can be claimed only after the settlement of the main hospitalization claim.

The claim submission process for pre-hospitalization expenses and post-hospitalization expenses is the same as Reimbursement.

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Insurers
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Insurers

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We are the Preferred TPA Service Provider to several Health Insurance companies, both in public and private sectors, operating in India. We believe in and deliver the following to various stakeholders:

  • Timely Enrolment & issue of ID cards
  • Speedy settlement of submitted claims
  • Timely communication of claims adjudication decision (Information Required / Approved / Declined) on received Pre Authorization Requests.
Cater accurate information related to enrolled beneficiaries & claims to respective insurers
  • 1. Periodical Enrolment Data
  • 2. Periodical Settlement Data
  • 3. Management Information Systems
  • 4. Relevant Analysis & Reports
Cater to Corporate (Group) Medi Claim Policy Holders with
  • 1. Account Management
  • 2. Benefit Utilization Analysis & Reporting

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Health Care Services
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Health Care Services

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We provide Cashless Hospitalization for our customers through a network of Healthcare Service Providers across India. Healthcare Service Providers in the form of hospitals, nursing homes, diagnostic centers, etc. form the vital façade of our services in the process of Cashless Hospitalization

Currently, we have over 4000 such Health Care Service providers in our network and we continue to add more service providers to widen the presence of cashless healthcare delivery points.

Interested Healthcare Service providers shall sign an MOU with Medi Assist to become a member of the Medi Assist Network. Thereby, they can become points of presence to deliver cashless hospitalization to Medi Assist card holders as per the Cashless Hospitalization Procedure.

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IVRS Usage
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IVRS Usage

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Greeting from Medi Assist !

As you are aware, operating a Call Centre is one of the many Customer Service operations at Medi Assist. The bane of almost any Call Center is the number of calls which are in queue, causing irritation to the caller who is forced to listen to some inane music while waiting to speak to a Customer Service Officer. The Interactive Voice Response System (IVRS) is a fully interactive system which allows callers to check their claims' status without having to wait to speak to a call agent.

We, at Medi Assist India TPA Pvt. Ltd., have introduced the IVRS system in order to be able to provide our customers - your employees - with a quick and easy-to-use facility which allows them to get status updates instead of having to wait in queue to be able to speak to a Customer Service Officer. This facility, in addition to the web login and the SMS alerts, should be able to provide every customer with an instant alert on any change in status of their claims.

Options are available for callers to check their claim status based on their Medi Assist ID Card Number (MAID). It is therefore very important for the employees to have their MAID numbers at hand when calling. MAID is a unique 10 digit numeric ID generated by Medi Assist for all enrolled employees and their dependents who are insured. This number is available in the E-card / physical card issued by Medi Assist. Employees are required to key in the 10 digit MAID of the patient when prompted during the call. This will allow them to check status for Cashless requests and Reimbursement claims submitted for that patient. MAID is a unique number allotted to each person who is insured.

Incase you do not have your Medi Assist ID number yet; please contact any of our offices with your policy number and obtain the Medi Assist Id number.

Looking forward to your co-operation and assuring you of our best services at all times.

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Identity Card

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This section will guide you through various aspects of Mediclaim policy with particular reference to the Claims Settlement and Cashless service procedures.

What is the Medi Assist Identity Card?

On the basis of details provided by Insurer Medi Assist will issue a Medi Assist ID (Physical or Electronic) to each one of the beneficiaries covered under the policy. This card is issued only for identification purpose and should not be construed as an authorization to the hospitals to proceed with the treatment.

Medi Assist ID card may or may not have the photograph. It can be issued in the form of e-Card (soft copy of ID Card). In case e-Card is issued, physical ID card may not be issued.

Note :
It is very important to remember that the Medi Assist ID card is NOT a credit card. It is issued only for identification and information purposes.

 

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Reimbursement Process

Reimbursement Process

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IRDA on Critical Illnesses
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IRDA Standard Definitions
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Communication To The Network
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Electronic Clearing Service Format
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Standard Discharge Summary And Bill Format
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Medi Assist India TPA Pvt Ltd ★★★★★ ★★★★★ /5 ★★★★★ ★★★★★ 5★ 4★ 3★ 2★ 1★ 47/1, 9th Cross, 1st Main Road, Sarakki Industrial Layout, 3rd Phase, J P Nagar, J P Nagar,
Palakkad-560078, Kerala, India

VISWANATHAN P R (Ceo)

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