Sixty minutes is within which health insurers must convey their decision on cashless treatment claim authorisation to hospitals. Similarly, they must inform their decision on the final bill also within one hour.
Instructions in this regard were issued by Insurance Regulatory and Development Authority of India on Thursday. It followed an April 28 order of Delhi High Court, on a writ petition, directing IRDAI to advise insurers to communicate cashless approvals to hospitals/establishments within a maximum of 30-60 minutes. This was to ensure against delay in discharge of patients and hospital beds do not remain unoccupied, the IRDAI said referring to the court order.
In a circular to the insurers, the regulator said “decision on authorisation for cashless treatment for COVID-19 claims shall be communicated to the network provider (hospital) within a period of 60 minutes from the time of receipt of authorisation request along with all necessary requirements from the hospital.”
Also, the decision on final discharge of patients covered in COVID-19 claims has to be communicated to the hospital within one hour from the time of receipt of final bill along with all necessary requirements from the hospital. Noting that these were outer limits, General Manager (Health) D.V.S Ramesh said, “Insurers are advised to process such requests promptly so that both authorisation for cashless treatment and discharge of the patient can be hastened to the maximum extent.”
The insurers were also advised to issue appropriate directions to the respective Third Party Administrators (TPAs) for ensuring compliance with the timelines. According to IRDAI, a circular issued earlier this month had fixed a turnaround time of two hours for granting both cashless pre-authorisation and for final discharge of the insured patient.
Sources said the time taken by insurers to give approval to the hospitals was one of the reasons for hospitals denying cashless treatment.
