Today, getting preauthorization is a must to avail cashless treatment, especially through TPAs, in the Indian healthcare setting. So, if your health insurance is serviced by Ericson TPA, the Ericson TPA Pre Auth Form should be known to you, and its proper utilization will facilitate your hospitalization, reduce your expenses during the meantime, and keep you from lingering in unnecessary delays. The entire blog attempts to give the reader a complete understanding of the Ericson Preauthorization Form, instructions for filling it out, a description of supporting documents required, and tips from experts on how to expedite the approval process.
What Is the Ericson TPA Pre Auth Form?
The Ericson TPA Preauth Form is an important document that has to be submitted by policyholders to ensure approval beforehand for a hospitalization or medical procedure in a network hospital. This document, also known as the Ericson insurance TPA pre auth form, has at least three important uses:
- It informs Ericson TPA (on behalf of the insurer) about the proposed treatment.
- It allows the insurer to check for eligibility, medical necessity, and estimated costs.
- It allows cashless hospitalization, whereby you do not pay in advance but instead pay for non-covered expenses at discharge.
Without a duly filled Ericson Preauth Form, the hospital cannot initiate a cashless claim, and you might have to pay cash or at least face delays in claim processing.
Key points about the Ericson Pre authorization Form:
- It is mandatory for all hospitalization admissions in Ericson-empanelled hospitals.
- It should preferably be submitted 2 to 3 days before hospitalization.
- Submission is expected within 24 hours of admission when there is an emergency pre-auth.
- Should be undertaken by the policyholder and the treating doctor/hospital.
A duly filled/filled correctly and submitted within time, Ericson TPA Preauth Form, hospital admission goes smoothly, minimizing delays and establishing greater trust between the insurers, hospitals, and policyholders.
Step-by-Step: How to Fill the Ericson TPA Preauth Form
The sooner you complete the Ericson insurance TPA pre auth form, the sooner you’ll receive approval. Let’s walk through each section:
Section 1: Patient & Policyholder Details
- Policyholder Name: Should be exactly as printed on the INSURANCE card
- Policy Number & Card Number: Should be cross-checked for accuracy
- Relationship to Policyholder: Self, Spouse, Child, etc.
- Patient’s Age and Gender
- Contact Number & Email Address
Section 2: Hospital Details
- Hospital Name and Address
- Hospital Empanelment Status: Make sure it is empanelled with Ericson TPA
- Hospital ID Number (if any)
Section 3: Admission Details
- Admission Type: Planned / Emergency (Tick whichever applicable)
- Expected Date and Time of Admission
- Length of Stay: Approximate number of days
Section 4: Medical Information
- Symptoms and History
- Provisional Diagnosis (if already advised)
- Pre-existing Medical Condition
- Any kind of Hospitalizations related to the current complaint (if any)
- If Possible, ICD-10 Codes
Section 5: Treatment Plan and Estimated Cost
- Proposed Procedure or Surgery
- Mode of Treatment: Medical / Surgical / Day-care / Inpatient
- Cost Break-up Estimation
- Room Rent
- Surgeon Fees
- nursing and consultation
- OT charges
Section 6: Declarations and Signatures
- Patient’s Signature & Date
- Hospital/Doctor Declaration: This must include the name, medical registration number, signature, and hospital stamp/seal.
Documents You May Need with the Ericson Insurance TPA Preauth Form
To strengthen your submission, the following documents must accompany the Ericson TPA pre auth form download:
- Insurance Card / Policy in Copy: A copy of the insurance e-card issued by Ericson.
- Identity Proof: Could be Aadhaar, Driving License, PAN, etc.
- Doctor’s Prescription / Admission Advice: Medical instruction for hospitalization
- Diagnostic Reports: With tests about the treatment, like blood reports, X-rays, and ECGs
- Previous Medical Records (if necessary): In particular, those concerning pre-existing conditions or re-appearance
- Hospital Registration Form (if demanded by your hospital)
- Treatment Estimate: Document related to the hospital cost estimation
These accompanying documents substantiate your request and reduce the need for additional follow-ups by Ericson TPA.
Tips to Ensure Faster Preauth Approval with Ericson TPA
A precious commodity at times of admission into the hospital comes into play. These will ensure expeditious approaches in granting Ericson TPA Preauth:
1. Submit Early
A procedure that is scheduled should be finalized, and the form sent for approval at least 48-72 hours before admission. This allows Ericson to seek clarification or to run a scrutiny.
2. Keep Accurate & Complete Data
Double-check the policy number, patient name, and hospital. Any inconsistent or missing details can delay approval or processing.
3. Provide an Easy-To-Understand Medical Justification
The diagnosis (clean form), estimated cost, treatment justification, and doctor’s comments are helpful for quick evaluation from the TPA.
4. Provide ICD Codes
At least for the speedy validation of claims, note that these are not mandatory! Have your doctor add these in Part B for you.
5. Check Hospital Empanelment
Use Ericson’s helpline to verify if the hospital supports Ericson TPA cashless pre auth form processing.
6. Keep Copies & Track Submission
Keep scanned copies or photographs of the form and submitted documents. Kindly ask for case or reference numbers and keep following up with Ericson regularly.
7. Be Quick with Queries
Whenever Ericson raises any query, do not delay in replying with the requested documents or clarifications, so as not to put the whole process on hold.
8. Coordinate with TPA Desk
Keep in touch with the hospital’s TPA desk. They are the intermediaries between your hospital and Ericson. Inform them about any updates or changes.
9. Digital Submissions
If available, use an online portal or mobile app instead of email/fax to hasten the processing.
10. Inform if Treatment Overshoots
If the stay overshoots the estimate, initiate preauth enhancement immediately so as not to keep them waiting for denial thereafter.
Conclusion
The Ericson TPA Preauth Form is crucial for the cashless provision of hospitalizations in India. When filed on time, with support documents attached, it will smooth hospital admissions; payment of claims will be fast, and the insured will be saved from financial stress.
Brushing oneself along with service providers, such as hospital staff, doctors, and insurance agents, on best practices, such as early filing, comprehensive documentation, and persistent follow-up, ensures a successful and straightforward hospital experience. Stay informed, prepare well in advance, and download the Ericson TPA pre auth form download from your hospital portal or Ericson’s official site. A properly prepared Ericson Preauth Form is your cashless ticket, whether it’s for scheduled surgery or an emergency hospital stay. Be proactive, stay informed, and let your health insurance do its thing.
Frequently Asked Questions (FAQs)
1. Is the Ericson Preauth Form mandatory?
Yes—If you wish to seek cashless treatment in an Ericson-empanelled hospital. For reimbursement, it is optional but recommended.
2. How soon will I get the preauthorization?
Usually within 6 to 24 hours in planned admissions and about 1-6 hours in emergencies.
3. What if my filled form gets rejected?
The reasons for rejection are shared with the insurer by the TPA, such as having the case in a non-empaneled hospital, a request for additional information, etc. If the insurer feels that he can resolve these issues, he can rectify and resell, or if it is after treatment, they could go ahead with reimbursement.
4. Can I submit the form digitally?
Yes, most hospitals allow submission through their online portals or mobile apps. Please check with your hospital.
5. Will I get any notification for confirmation of pre-authorisation?
Yes, the confirmation will be sent to the policyholder and the hospital via email/SMS.
6. What if my hospital stay extends beyond what I had estimated?
A revised preauth (enhancement) needs to be done for the new estimated cost.
7. Do I need ICD codes?
Not compulsory, but it helps for quicker approval. Most doctors do provide them.
8. Can one form be used for multiple days or procedures?
No. Each new procedure or hospitalization episode needs a separate preauthorization.