Pre-Authorization Support

Pre-authorization (pre-auth) generally means seeking the insurer’s or TPA’s prior approval for a proposed hospitalisation or procedure under a health policy, especially for cashless pathways at network hospitals. It is a process step—not a guarantee of final claim settlement.

Hospitals often submit clinical and estimate details; insurers or TPAs may approve in full, approve partially, query or decline based on policy terms and the information provided. Claims Saathi helps customers and, where appropriate, hospital desks organise commonly requested inputs and track available status updates.

Approval remains with the insurer or TPA. We do not authorise treatments, medical necessity or cashless amounts.

• Patients planning elective procedures who need organised pre-auth paperwork
• Families coordinating between treating doctors’ estimates and TPA portals
• Hospital claim-desk staff seeking clearer customer document packs
• Customers who received a pre-auth query for additional clinical or policy information
• Members unsure which identifiers the TPA needs on the request

• Scheduled surgery with a hospital estimate awaiting insurer or TPA review
• Emergency intimation followed by formal pre-auth document completion
• Query asking for past medical history papers or investigation results
• Enhancement request when the treating team revises the procedure plan
• Room-category or package clarification sought before admission

1. 1

   Confirm policy and hospital pathway

   Verify member details and whether the hospital will file cashless pre-auth.

2. 2

   Assemble clinical and estimate inputs

   Collect doctor’s advice, planned procedure notes and hospital cost estimates as issued.

3. 3

   Submit through authorised channels

   Hospital desk or customer submits via insurer or TPA prescribed modes.

4. 4

   Respond to queries

   Provide additional information without altering clinical records.

5. 5

   Receive insurer or TPA decision

   Approval, query or denial is issued by the insurer or TPA alone.

6. 6

   Align admission paperwork

   Carry approval references and complete any remaining hospital formalities.

• Member ID, policy number and patient demographics
• Hospital name, treating doctor and planned admission date
• Provisional diagnosis and planned procedure as stated by the hospital
• Estimated billing or package information from the hospital
• Contact numbers for hospital claim desk and customer
• Any previous pre-auth or claim references linked to the same episode

Documents commonly requested may include the items below. Requirements vary based on the insurer, TPA, policy terms and claim circumstances.

• Estimate totals that omit doctor fees or implant lines the hospital later bills
• Clinical notes that do not match the procedure coded on the request
• Late replies to TPA query clocks
• Wrong member ID selected on the hospital portal
• Assuming verbal discussions equal written pre-auth approval

• Clarifying what pre-authorization generally involves in plain language
• Helping customers gather hospital estimates and supporting reports
• Organising responses to additional-information requests
• Coordinating communication with hospital claim desks where authorised
• Tracking available pre-auth status updates from authorised channels
• Reminding that final approval authority stays with insurer or TPA

• Do not admit assuming cashless approval until written confirmation exists as required by the hospital and insurer or TPA
• Provide accurate medical history papers when queried
• Keep copies of every pre-auth reference number
• Understand that pre-auth amounts may differ from final bill adjudication
• Never ask Claims Saathi to pressure clinical staff for altered diagnoses

The insurer or TPA decides whether to approve, query, enhance or deny pre-authorization and on what terms.

Final claim settlement after discharge can still differ from pre-auth based on actual bills, policy limits and review.

Claims Saathi assists with documentation and coordination but does not determine claim approval.

You may also find these related assistance pages useful.