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TPA process steps



LIC PRE-POLICY CHECK –UPS 



STEPWISE DISCRIPTION TO ATTEND TO THE LIC PRE-POLICY CHECK-UP CLIENT 



Aim: - We, THE HOPE HOSPITALS, are empanelled with different Third Party Administrator (TPA) Organizations. We provide pre policy health check-up services to the clients who have opted for Life Insurance and other Insurance through the different Life Insurance companies. 





Life Insurance Corporation 



Step 1:- The client who comes for pre policy check-up is attended within 05-08 minutes after arriving in HCO/Hospital. 

(HCO:-Health Care Organization) 



Step 2:- Ask for Photo Identity from which we identify the client. 

This Photo Identity will be 
Pan Card 
Driving License 
Passport 
Bank Pass book 
Office ID card ( if client is working with any government organization) 



Step 3:- We have to take a photocopy of photo ID which is self attested, from the client. 



Step 4:- After taking photo ID or after identifying the client, we take client to the chamber for further process. 



NOTE*: - At the time we are taking the (Full Medical Report) FMR of Client don’t give permission to any agent to sit in the chamber. 



Step 5:- Give call to Pathology to take a blood sample & urine sample of client as per requirement ask in the TPA requisition form attached with the docket. 



NOTE: - Docket is a file by LIC, in which all required documents are attached by the client / Agent and the same docket is carried by client for FMR by MD doctors in Health Care Organization. 



Step 6:- First we have to fill the rough FMR sheet where we have all relevant questions ask in FMR by LIC. 



Step 7:- Ask the client for relevant history of any physical abnormality or any disease, undergoing any treatment, any history of surgeries and hospitalization etc. (As per questions asked in FMR) 



Step 8:- Ask the client for physical and health history of his/her family. 

Father- Age diagnosed – Condition 

Mother- Age diagnosed – Condition 

Brother- Age diagnosed – Condition 

Sister- Age diagnosed – Condition 





Step 9:- After completion of questionnaire asked to client as per FMR we have to take his/her BP, Pulse, Height, Weight, inspiration and expiration. 



Step 10: Take a blood and urine sample of client. (If required and asked by TPA in TPA requisition form) 



NOTE: - We have to check the wash room where we ask the patient to visit for taking the urine sample of client; it must be neat and clean before he/she enters the wash room. 



Step 11:- (If ECG required) 



If there is a requirement of ECG, take the client to ECG room, accompanied by nurse or patient assistant. 



Step 12:- (If TMT required) 



If there is a requirement of TMT, take the client to ECG room, accompanied by nurse or patient assistant. 



Step 13 :- (If X-Ray required) 



If there is a requirement of X-ray, take the client to ECG room, accompanied by nurse or patient assistant. 



Note: - We have to take care of privacy policy of client and this thing is very important for all our clients. 



That is, while taking the ECG, TMT, and X-RAY; don’t open the door of corresponding room, as per privacy policy of clients. 



There should be only doctor and attendant present while taking the ECG, TMT and X-ray of the client. 



Step 14:- After completion of ECG, TMT, X-RAY, take the client to the chamber for signature of client on FMR, TMT & TMT form, X-RAY & X-RAY form, ECG & ECG form and Regular client register. 







Note:- 



Important things- 



Do not use whitener on FMR sheet. 



Don’t overwrite on FMR sheet. 



The sheet & other documents must be neat & clean. 



We have to take the client’s signature where Signature of LA (i.e. Life Assured) is written. 



Step 15:- Before submission these reports to TPA, we have to register the list of all reports attached by us in a LIC client record register maintained by us. 



NOTE:- 



Don’t forget to take the agent’s and client’s contact number. 



We have to use a pin point ball pen (Blue) to write on FMR sheet. 



We have to use pin point ball pen (Black) to write on pathology reports (policy no. & Time at which we take a sample of a client). 










MAX NEW YORK LIFE 









Aim: - To provide the pre-policy check–ups to the client from MAX NEW YORK LIFE. 



We have an empanelment with MAX NEW YORK LIFE INSURANCE to give service to their clients for a pre policy check up. 



In MNYL we have category wise distribution of requirement by MNYL. 



As, 

CAT 1- MER 

CAT 2- MER, CBC 

CAT 3- MER, BLOOD PROFILE 

CAT 4- MER, BLOOD PROFILE, ECG, MSU 

CAT 5- MER, BLOOD PROFILE, ECG, CBC, MSU 

CAT 6- MER, BLOOD PROFILE, CBC, TMT, MSU 

CAT 7- MER, BLOOD PROFILE, CBC, TMT, MSU, CXR 



Where, 

MER: - Medical Examination Report 

MSU: - Urine Routine 





Step wise Description 



Step 1:- We have to attend the clients within 5-8 minutes after their arriving and after their being attended by front office executive. 





Step 2:- Firstly we have to ask the client for photo ID, the photo ID will be 

Pan card, 

Driving license, 

Pass port 

Pass book 

Any government office ID card 



Step 3:- We have to take two photocopies of photo identity from client. 



Step 4:- After taking that and identifying the client we have to take the client in the chamber. 



Step 5:- Give a call to Pathology attendant to take a blood & urine sample of the client. (If Required) 



Step 6:- First we have to take the client FMR in rough FMR sheet, where we have all the relevant questions asked in FMR by MNYL. 



Step 7:- Before that we have to check the category required/ Category wise test required. 



Step 8:- We have to ask the client about His /Her physical history that- is the client undergoing any treatment, ever hospitalized, operated, and has undergone any biochemical or radiological test. 



Step 9:- We have to take a complete family history of client as, 

Father- Age diagnosed – Condition 

Mother- Age diagnosed – Condition 

Brother- Age diagnosed – Condition 

Sister- Age diagnosed – Condition 



Step 10:- Then we have to take the BP, Pulse, Height, Weight, Inspiration & expiration of the client. 



Step 11:- (If Required) 

Then we have to take a client for ECG/TMT/X-RAY accompanied by nurse & patient attendant. 



Step 12:- After that we have to take a signature of client on FMR, TMT, and ECG. 



Step 13:- After completion of all these processes, we have to register complete details of client in MNYL record register maintained by us with contact number and photo ID No. 



Note*: - Here also we strictly do not use a whitener. 



Or don’t over write on FMR sheet and corresponding report. 



Use only fine point ball pen (blue) to write on the FMR. 



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PRE POLICY HEALTH CHECK-UP 

By 



SBI, FUTURE GENRALI, UCO BANK, BIRLA SUN LIFE, MET LIFE, TATA AIG, BAJAJ ALLIANZ.BHEL, RAYMOND AND OTHERS 





Step 1:- The client from any of these companies is strictly attended by us within 5-8 minutes after he /she is attended by the front office executive. 



Step 2:- Firstly we have to ask him the company name for which they want FMR and other test. 



Step 3:- Ask the client for photo Identification. 



Step 4 Take a photocopy of photo Id from client and that should be self attested by client. 

This Photo Identity will be 

Pan Card 

Driving License 

Pass port 

Bank Pass book 

Government office ID card (If Government Employee) 



Step 5:- After identifying the client through photo Id, we have to take a client to the examination chamber. 



Step 6:- Ask the client for requisition by corresponding organization /companies. 



Step 7:- Give the call to pathology if company wants any blood & urine Investigation of client. 



Step 8:- Firstly we have to fill rough FMR sheet where we have all relevant questions that ask in FMR sheet. 



Note: - This step to avoid overwriting and other corrections on final FMR. 



Step 9:- Ask the questions to the client as per the FMR from the relevant company. 



Step 10:- Take a family history of client as, 

Father- Age diagnosed – Condition 

Mother- Age diagnosed – Condition 

Brother- Age diagnosed – Condition 

Sister- Age diagnosed – Condition 



Step 11:- After completion of questionnaire, take BP, Pulse, Inspiration, Expiration & Height, weight of the client. 



Step 12:- Take a urine and blood sample (if any) of client by pathology attendant. 



Step 13:- (If ECG / TMT / X-ray etc) Take the client to relevant department for the corresponding test accompanied by patient attendant or nurse. 



(Where ever the test is under process, we have to be there with the client.) 



Step 14:- After completion of test we have take client to the chamber for signature. 

(Take the signatures of client on ECG, TMT/ X-ray) 



Step 15:- Check all the forms are signed by client wherever required. 



Step 16:- Give thank you notes to the clients for choosing our hospital / HCO. 






IMPORTANT NOTE 



As the pre policy check up is concern of any TPA or Life Insurance Companies, we don’t have to tell or show the reports of the clients to any agent etc. These reports are strictly confidential.






MEDICARE TPA & ALL OTHER TPA ORGANIZATION 



Step 1:- Ask the client for TPA – ID card. 



Step 2:- Confirmed that the TPA is on our panel or not. 



Step 3:- If yes, then only we can give a cashless admission to the patient. 



Step 4:- Take a complete history of patient required for IPD Registration. 



Step 4A- Fill the consent form (Hindi) from the patient / relatives. 



Step 5:- Fill the pre- youth form and sent it to the corresponding TPA organization with Photo ID and TPA card / ID Xerox. 



Step 6:- Wait for query from TPA organization. 



Step 7:- After receiving, we have to send the answer to the query as required. 



Note*: - Send the pre-youth form to TPA organization within 72 hours from the time of patient admitted. 



Take the telephonic confirmation after every sending of E-mail or Fax. 



Step 8:- We have to tell the patient that what amount we have received from their policy. 





MAHARASHTRA POLICE 



Step 1:- Ask the Patient / Relatives for Family Health Plan Ltd. (FHPL) card. 



Step 2:- Take a complete history of patient required for IPD registration. 



Step 3:- Fill the consent from (Hindi) / take a sign of patient relative on consent form. 



Step 4:- Fill the pre-youth form on Health hiway site 

ID 

Password: 



Step 5:- 4 forms or patient information of FHPL have to be filled by the patient / relatives and to be signed by the employee of Maharashtra Police. 



Step 6:- After fill the pre-youth form on Health Hiway site and attaching the scanned copy of that 4 forms (patient details form) with this form and sent it to FHPL. 



Step 7:- Wait for query. 



Step 8:- After receiving a query we have to give the answer as per the query. 



Step 9:- After approval is received by us, we have to show the approval and take the sign of patient on that approval. 



Step 10:- Thanking Notes for choosing our hospital for treatment. 




Note: - This is applicable for all TPA that if a total bill amount is not received by TPA organization the difference between the total bill amount and stagnation amount will be paid by patient. 



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