April 4, 2021 4:44:14 am
The Vadodara Municipal Corporation (VMC) on Saturday issued an order making it mandatory for insurance companies to clear cashless claims 12 hours ahead of the discharge of the Covid-19 patients, to extend coverage to those under home isolation due to the VMC’s previous order for hospitalisation procedures issued on March 31 as well as to consider claims of those patients who are testing negative on RT-PCR due to a trend in the current strain of the virus that has hit the country.
The order comes days after the civic body issued a notification laying down Standard Operative Procedures (SOPs) for hospitalisation of Covid-19 patients in the city hospitals empanelled for Covid-19 treatment.
Officer on Special Duty Vinod Rao issued a notification under the Epidemic Diseases Act, 1897, laying down Standard Operative Procedures (SOPs) for insurance companies and hospitals for hospitalised and home-isolated Covid-19 patients for VMC and Vadodara District, enforceable immediately from Saturday until further notice.
The notice directs all insurance companies, Third Party Administrators (TPAs) and hospitals to expedite claims so as to ensure that patients awaiting discharge do not have to stay back in the hospital for claim disbursal. The claims, the order issued on Saturday states, will have to follow the earlier notifications issued by the VMC related to the rate regulation of Covid-19 hospitals as well as the SOPs for hospital admissions and home isolation. It will also allow coverage of up to Rs 15,000 for home-based Covid Care, as per the notification of the VMC issued on March 31 making it mandatory for Covid19 positive persons not needing hospitalisation for clinical reasons to be home isolated.
Interestingly, the notification states that the current strain of the virus has shown infected patients as “negative” on RT-PCR tests although other laboratory tests indicate viral etiology and such claims have to be considered. The notification states, “The current strain of Covid19 does not necessarily show a positive test on RT-PCR. In such cases, where RT-PCR is negative but the findings in HRCT and lab investigations are suggestive of viral etiology, the claim should be treated as that of Covid unless proved otherwise.”
The notification orders TPAs to work round the clock including on Sundays and Holidays to ensure that at least one executive is available to make immediate clearance of claims and ensure that the patient is discharged in time from hospitals.
The initiation of the cashless claim has to be made at the time of admission and the “The Turn Around Time (TAT) of Insurance Companies and TPAs has been set to eight hours after submission of the claim and the companies can raise a query on the claim only once during the process of authorisation.”
The hospitals have also been ordered to submit an “Expected Date of Discharge” of the patient at the time of initiating the cashless claim. Later, all bills and reports must be submitted in one single copy. For verification of ICMR numbers of laboratories conducting the tests, the insurance companies can verify directly with the VMC, the notification says. The process of the final authorisation of the claim disbursement has to be initiated on the previous day of the discharge, 12 hours before the planned date. The insurance companies have been given a TAT of two hours to clear the files, after the submission of the last document needed, on the day of discharge. If the insurance company fails to adhere to the stipulated TAT and revert with a reply, it will have to make payment of “full eligible amount without deductions”.
The notification disallows coverage of treatment given by any non-allopathic practitioners. Rao held a joint meeting of insurance companies, including major PSUs, hospital representatives and TPAs to discuss the issue of insurance claims of those admitted to Covid-19 hospitals as well as those put under home isolation, as per the notice of the VMC issued earlier this week, laying down SOPs for hospital admissions and prohibiting hospitals from admitting Covid-19 patients who did not fit into the parameters laid down in the said notification.
Rao told this newspaper, “This step can help prevent clogging and blocking of Covid-19 hospital beds for non-medical reasons. The notification will be binding on private insurance companies and other players involved pertaining to claims sent from Vadodara.”
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