Documents required for a cashless claim: the complete hospital checklist

Most claim queries are about a document that was not in the file. Every payer has its own list, but the core is the same everywhere. Use this as the base of your hospital checklist and add each payer's extras on top.

Front office and TPA desk

• Signed claim form, both parts where the payer uses two.
• Copy of the health card or policy, and photo ID of the patient.
• Pre-authorisation request, the approval letter and every enhancement approval.
• For a road traffic accident or medico-legal case: the MLC or FIR copy, or a hospital declaration if none was filed.

Doctors

• Discharge summary with diagnosis, treatment given, dates, condition at discharge and advice, signed with the doctor's name and registration number.
• Operation notes for any procedure, with the surgeon's and anaesthetist's names.
• Consultation notes that explain why the patient needed admission.

Nursing

• Daily progress notes, vitals and medication chart for the whole stay, with no missing days.
• Intake and output chart where relevant.

Laboratory and radiology

• Every report the bill charges for. A test on the bill with no report is one of the most common reasons for a deduction.
• Imaging reports signed by the radiologist.

Billing and pharmacy

• Final bill with an item-wise breakup, matching the approved room category.
• Pharmacy bills with batch numbers, and implant stickers or invoices for any implant.
• Payment receipt for any amount the patient paid.

Keep it in order

Put the documents in the same order every time. The person reading the file at the TPA will find what they need faster, and so will your own team when a query comes back.