IRDAI's 1-hour cashless and 3-hour discharge rule: what hospitals need to do

In May 2024 the Insurance Regulatory and Development Authority of India issued a master circular on health insurance. Two lines in it matter most to every hospital billing team: insurers should decide on a cashless request within one hour, and should give the final authorisation at discharge within three hours of the hospital's request.

What the circular asks of insurers

• A decision on cashless authorisation within an hour of the request.
• Final authorisation within three hours of the discharge request, so patients are not kept waiting in a bed.
• Any extra hospital charges caused by a delay beyond the three hours are to be borne by the insurer, not the patient.

What it does not change

The clock only runs well on a complete request. A pre-auth with a missing investigation report, or a discharge request with a bill that does not match the approval, still comes back as a query, and the time starts again.

What hospitals should do

• Send complete requests: diagnosis, plan, cost estimate and supporting reports in the first submission.
• Prepare the final bill and discharge summary before the patient is ready to leave, not after.
• Check names, dates, room category and approved amounts against the bill before sending.
• Record the time each request was sent and answered, so delays can be raised with the insurer with evidence.

The bottom line

The rule rewards hospitals whose files are right the first time. A pre-check of every file, before it is sent, is the simplest way to make the one-hour and three-hour limits work for you.