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Medical Bill Submission Tips for Chronic Care

The document outlines essential Do's and Don'ts for submitting medical bills under the Chronic option to ensure faster reimbursement. Key recommendations include submitting original bills with valid prescriptions, separating claims for serious ailments, and adhering to specific guidelines for costly investigations. Following these guidelines will help mitigate issues during the reimbursement process.

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Anbezhil Deiva
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32 views1 page

Medical Bill Submission Tips for Chronic Care

The document outlines essential Do's and Don'ts for submitting medical bills under the Chronic option to ensure faster reimbursement. Key recommendations include submitting original bills with valid prescriptions, separating claims for serious ailments, and adhering to specific guidelines for costly investigations. Following these guidelines will help mitigate issues during the reimbursement process.

Uploaded by

Anbezhil Deiva
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Some Do’s and Don’ts of submission of Medical Bills (Chronic Option)

All of us under the Chronic option are submitting medical bills to WR and some of us are facing
lot of issues during reimbursement. In order to simplify the issues and ensure faster
reimbursement by WR, we have drafted some DO’s and Don’ts of submission of the medical
bills. Request each one to please go through the same and follow them to mitigate the issues
from our end to those working in WR for clearing our medical bills.
Sr Dos Don’t’s
No
1 Ensure every medical bill is accompanied by Do not submit bills without a valid
a valid prescription. For chronic conditions, prescription.
the prescription should be valid for 3, 6, or 12
months, as specified by the doctor.
2 Properly bunch the bills with the applicable Do not submit loose bills or expired
valid prescriptions. prescriptions.
3 Submit only original bills. Do not submit Xerox copies or duplicate
bills; they will not be accepted.
4 Submit prescriptions with valid dates only. Do not submit expired or invalid
prescriptions.
5 For serious ailment claims (e.g., post-bypass Do not claim chronic and serious ailment
surgery, cancer treatment, post-angioplasty, bills together in one claim.
Parkinson's, kidney dialysis, organ failure,
paralysis), ensure the prescription is from a
nominated hospital. Submit bills with valid
prescriptions for other conditions separately
under chronic claims.
6 Submit bills with valid prescriptions for serious Do not claim chronic and serious ailment
investigations/tests (e.g., bypass, cardiac, bills together in one claim.
dialysis) separately.
7 Submit costly investigation bills (more than Do not bunch costly investigation bills
₹1,500) with valid prescriptions from with regular claims.
nominated hospitals separately. This applies
to those claiming under domiciliary (6-
monthly) claims.
8 Submit patient-wise bills separately (i.e., Do not club the bills of self and spouse in
separate the bills for self and spouse with one claim. Submit separate claims for
their respective valid prescriptions). each.
9 Ensure costly tests and investigations (more Do not undergo costly tests in non-
than ₹1,500) are done in nominated hospitals nominated hospitals.
only for reimbursement.
10 Claim for 30 days pre- and post- Do not submit claims for periods before or
surgery/admission in the hospital, with a valid after the 30-day window of surgery.
discharge summary from the nominated
hospital only.

Note: These are just some of the points to ensure that your claims are processed faster. All claims need to be
in line with the prevalent Medical Policy.

Aug’24 IOROA, Pune Chapter

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