Preauthorization and claims Sample Clauses

Preauthorization and claims. (i) The Provider agrees to follow and adhere to the online pre-authorization and claims workflow of the Scheme in providing services to its Beneficiaries. (ii) The Provider shall submit the pre-authorization request on the web portal, after admitting the patient as inpatient. The documents will include signed copy of consent, digital photograph, all relevant test reports, X ray, CT Scan, MRI films, biopsy/cytology reports along with those taken in the hospital should be scanned/ digitized and uploaded, with the proposed treatment along with doctor notes etc. The ISA shall approve the preauthorization within 6 hours of submission of documents by the Hospital any queries by ISA shall be answered without delay. (iii) The pre-authorization is applicable only for a period of 14 (fourteen) days, including the date of issue. The pre-authorization is only provided to a specific provider and is not transferable. However may be extended for additional 7 (seven) days, if a written request is made by the provider/ hospital. Beyond 21 (twenty one) days, the pre-authorization will stand cancelled. In such cases the provider should obtain fresh approval for the cancelled pre-authorizations by mentioning valid reasons. (iv) In case of extended stay, additional procedure or any readmission arising out of complication authorization is required, a fresh query will be raised by the Provider. (v) In cases of emergency, the Provider will obtain emergency telephonic approval. The ISA in coordination with State Health Agency reserves the right to cancel the emergency telephonic approval, if the Provider fails to update the details of the Beneficiary, online within 6 (six) hours of emergency telephonic approval. The Provider also agrees to update the Surgery / Therapy details online for telephonic approvals, mentioning the date and time along with specific remarks and photographic evidences, starting from the telephonic intimation. (vi) The Provider, will update the Surgery/ procedure details on the portal, online after performing the surgery including surgical notes and other clinical documents, within 7 (seven) days of the date of the surgery or prior to the last day of validity of the pre-authorization, whichever is earlier. This information is required to confirm, if the surgery/ procedure has been undertaken, as per the available approvals. (vii) The Provider, after 10 (ten) days of discharge of the Beneficiary, will uploads the original ▇▇▇▇, discharge summary and other rele...