HOW TPA CLAIMS PROCESSING WORKS AT HOSPITAL

ADDMISSIONS

- Client requested whether He/She is a contributor to TPA.

- If yes,give membership number or national ID number.

CLIENT REFFERED TO TPA/BILLING OFFICE

- The computer is linked to TPA office.

- Billing clerk accesses the clients details.

- If the is registered - notify TPA through the system.

AFTER NOTIFICATION

- The client is informed to bring a copy of national ID card and TPA card before discharge.

ON DISCHARGE

- The bill is prepared.

- TPA rebate is deducted from the bill per the Hospitalized days.

- The client is requested to sign the claim form.

REQUIREMENTS ARE ATTACHED TO THE CLAIM FORM

- Hospital bill

- Discharge summary of the patient.

- Copy of national Identity card

- Copy of TPA card.

- The attachments are forwarded to medical records officer for disease coding on the claim form and the TPA data base(system)

- The Hospital Launches the claim for payment to TPA. This is done on Half Monthly basis (after every 15 days).

- The Hospital waits for payment.