Can an Indian TPA or Insurance Company Reject a Claim Only Because Bills Are Not Pre-Numbered?

When it comes to healthcare claims, the process can be complicated, especially when dealing with Third-Party Administrators (TPAs) in India. One common concern among clients is whether a TPA or insurance company can reject a claim solely because the bills were not pre-numbered.

The Key Points to Understand

It’s essential to note that TPAs cannot outright reject a claim just because the bills are not pre-numbered. Instead, they may choose to place the claim on hold. In such cases, it is crucial for the client to seek a numbered bill from the hospital as soon as possible. The TPA will wait for a reasonable period, typically 15–30 days. If the client fails to provide the documented evidence within this period, the claim will ultimately be rejected.

Ensuring Genuine Bills

TPAs have a critical role in ensuring that the reimbursement claims are genuine and not inflated. One way TPAs achieve this is by verifying the authenticity of the bills by ensuring they are numbered. The presence of numbered bills can lend credibility to the claims. However, it is important to understand that TPAs should not reject a claim solely based on the absence of pre-numbered bills.

Addressing Potential Rejections

Understanding the genuine reasons for rejection is crucial. If a TPA does inquire about pre-numbered bills, the client should explore all possible options for attesting the bills. Often, hospitals may provide a facility to attest the bills, which can be a solution to resolve the issue. Checking with the hospital directly about attesting the bills is a critical step that clients should undertake.

Ensuring Smooth Claim Processing

To ensure a smooth claim processing experience, it is advisable to maintain constant communication with the TPA and the hospital. Clear communication can help avoid misunderstandings and ensure that the claim process is handled efficiently. Clients should proactively seek clarifications and take timely actions to address any issues that arise during the process.

Conclusion

In summary, while TPAs may require numbered bills for certain verifications, they cannot outright reject claims based solely on the absence of such bills. Clients should be proactive in seeking numbered bills and exploring options such as attesting bills. Clear communication and timely action can go a long way in ensuring the successful resolution of healthcare claims.