What Is Cashless Facility ? In Nursing Home and Hospital.

Cashless claim facility is an advantage given by an insurance company. This facility will provide by insurance company only for health insurance policyholders. This facility enables the insured to get hospitalized at any network hospital of the insurer. These insurers will admit without having to pay the hospitalization charges. This relieves the policyholder of a major financial cost. It is especially with the rising cost of medical care. This facility is offered by hospitals of the insurer’s tie-up with the hospital. All those hospitals and such hospitals are called network hospitals. This network hospitals lists will be provided by your insurance company. The costs usually covered under the cashless claim facility are- hospital room rent, doctor’s charges, cost of medicines, treatment cost, which are referred to as admissible expenses. Insurer will avail of the cashless facility. You would need to go through a Third Party Administrator (TPA) who is an intermediary between the insurer and the hospital. To provide cashless claim facilities your hospital or nursing home should be managed by hospital management system software. However, some IT company such as Dvna Softech Pvt. Ltd. has their own in-house team to handle all patient management system software. They will provide IT solution for your Hospital and nursing homes. You can contact the company directly on their mobile or phone number. They would guide you to make complete IT infrastructure for your hospital or nursing home.

Who Can Avil Cashless Facility ?

The cashless facility can be availed by both types of health policyholders it may be an individual policy or a group policy. These policy holders have planned that he/she flashes the health card at the concerned network hospital. It is most important that you are aware of the nearest network hospital, by checking with your insurer.

Cashless facility can be useful for both planned and emergency hospitalization. But something is difference between planed and emergency hospitalization. It is important to keep in mind that in case of a planned hospitalization, you must inform your insurer or TPA at least 3 days prior to hospitalization. In case of an emergency you must inform your insurer within 24 hours of hospitalization. This step is important so that the pre-authorization approval can be done well in time and it will help for same approval. This pre-authorization procedure is necessary to ensure that you can avail of the cashless procedure. To ensure that this approval process is smooth, provide the hospital with all relevant details about the patient and the policy details, which the hospital would be sharing with the insurer along with the treatment details.

Procedure For Cashless Facility

1.   When the policy holder approaches the network hospital, the hospital verifies the policy holder details with the insurer by sending a pre-authorization letter.

2.    The insurer then verifies details such as policy number, benefits, etc., and sends it back to the hospital.

3.  If the insurer approves the cashless facility request, the hospital proceeds, with the treatment. However, in case of any denial, there could either be a query, or the customer may have to pay for the required treatment on his own. He/she can submit bills to the insurer for reimbursement. If the claim is admissible, it will be processed/settled as per policy terms conditions.