|
|
IRDAI Registration No : 016 Valid upto : 15-May-2026
|
Products & Services
|
Vidal Health Insurance TPA Private Limited TPA Services:
|
Our service professionals deploy innovative technology and best practices to manage
the administration of your health and welfare plans. We endeavor to become a comprehensive
and complete source for health and mediclaim administration and management for the
insured as well as the insurer. Our corporate services team have expertise in managing
administration during open enrollment and throughout the plan year, notifying employees
of their benefits, changes, and ensuring that related systems receive accurate data.
Our in house systems team has build a full-service record keeping and administration
platform tailored to suit health insurance requirements across all levels of clients.
All the above can be offered online through web-based access. At the moment the
following services are offered to the clients :
|
Services:
|
- Cashless medical service facilitation at network hospital up to the limit authorized
by mediclaim/hospitalization Insurance
- Claim processing & reimbursement, for non-network hospitals
- Computerized Medical History records
- Hospitals/ nursing Homes all over India
|
Service Level Agreements:
|
We at Vidal Health Insurance TPA are a group of professionals dedicated to our mission of
providing excellent services to our clients (Corporate as well as Retail). For deliverance
of services the SLA (Service Level Agreements) are in place, which would be signed
with various Insurance companies and the corporate groups. These broadly define
the Turn around Time (TAT) for the deliverance of the following services:
- ID Cards Printing and Dispatch
- Vidal Health Insurance TPA TAT for the Delivery of cards is within seven (7) days of the
receipt of the complete data of insured members and the details of the policy from
the insurance company
- Cashless Authorization / Rejection
- Cashless authorization requests are to be scrutinized and the decision of acceptance
or rejection is to be conveyed to the service provider within 24 hrs. of the receipt
of the Pre Hospitalization Authorization Form.
- In case where a query has been raised the query has to be satisfied by the concerned
party and the authorization will be given within 24 hrs. of the receipt of the reply.
- Claims Settlement / Reimbursement
- Turn-Around-Time (TAT) for the settlement of all claims is 15 days
- Customer Grievance Redressal
- TAT for response is max. 2 working days, for any queries or grievance raised by
the client.
- Call Center Responses
- Vidal Health Insurance TPA operates a 24 * 7 / 365 days Call center to provide instant accessibility
to the clients for all information required for medical services facilitation and
claims status.
- MIS Reports
- Weekly/ Monthly MIS are prepared for the following:
- Claims Paid /Outstanding
- Premium Collection
- ID Cards Processed & Dispatched
- Special reports annually for disease wise analysis, total age wise claim incidences
etc.
- Adequate Coverage of Network Hospitals
- Providing a comprehensive coverage of network hospitals at all locations of client
operations.
Vidal Health Insurance TPA has service level agreement for all the above-defined parameters
and the same can be incorporated in the client agreement.
|
Claim Management & Control
|
Cashless Facilitation Procedure
- Receipt & Record of Data & Member Enrollment (Issuance of Photo ID Card)
- Pre-Admission Authorisation after checking Doctor Prescription, Admission Form, Hospital Information
- Claim form is submitted with Original bills along with Doctor Prescription, Diagnostic Reports & Discharge summary
Claim Reimbursement
When Cash Less Facility is not accorded or Insured goes to a Non Network Hospital then following documents are required :
- Claim Forms
- Original bills with Diagnostic reports
- Doctor’s First prescription
- Discharge summary/certificate
Claims Control
- Original Bills are verified & scrutinised against Standard Discounted Tariff
- Cost Containment by Medical procedure audit & Bill scrutiny
- 2nd Medical opinion taken for complicated cases
- Repricing done on case to case basis.
Cost Containment
Cash Less medical services lead to: :
- Bill Scrutiny before release of payment
- Discounted Rates
- Eliminates Reimbursement Frauds
All the above leads to Cost Containment and lowering of Claims/Premium Ratio
|
|
|