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a) Nameof TPA: Safeway Insurance TPA Pvt Ltd b) Toll Free Phone Number: 1800 102 5671 c) Toll Free F AX Number: 011- 41425672 Email ID : info@safewaytpa.in Telephone No: 011-45451300 To Be ed in By Insured / Patient a) Nameof the Patient: b) Gender: Male Female c) Age: Years Months e) Contactnumber: f) Insured CardID Number:
Microsoft PowerPoint - REVISED CLAIM PROCESS FLOW CASHLESS REIMBURSEMENT. Step 3: Hospital sends Pre-authorization Request with the treatment details; past history and clinical notes along with estimate of hospitalization expense to SAFEWAY local office. Step 4: SAFEWAY verifies all the submitted documents before processing the claim as per ...
6. Original Claim Form B duly Signed 7. PPN Declaration letter form duly signed 8. Pre-Auth Form Part –C & D in Original. The Hospital is requested to submit the claim within 7 days from the date of discharge or else it will be deemed as this Authorization Letter has not been used & company holds no responsibility for payments
the terms and conditions ofthe policy. In case the lnsurer / TPA is not liable tosettle the hospital. and expenses not relevant to current hospitalization and the amounts over & abovethe limit authorized by the Insu. .P.A is in no way warranting the service of the hospital & that the Insurer / TPAis in no way guaranteeing that.
Step 3: Hospital will send Pre-authorization Request with the treatment details, past history and clinical notes along with estimate of hospitalization expense to the TPA. Step 4: The TPA will verify all the documents before processing the claim for cashless facility as per the terms and conditions of the Policy.
Safeway Insurance TPA Pvt. Ltd. All India Toll Free No 1800-102-5671 . Customer Care Helpline 011-45451300. Dedicated Helpline For Senior Citizen 011-45451300 Ext. 206
Please send this duly filled and signed claim form to our TPA at below address: Family Health Plan Insurance TPA Limited Srinilaya - cyber spazio suite, 101,102,Ground Floor, Road No. 2, Banjara Hills, Hyderabad, Telangana 500034 CLAIM FORM FOR HEALTH INSURANCE POLICIES OTHER THAN TRAVEL AND PERSONAL ACCIDENT - PART A TO BE FILLED IN BY THE INSURED
