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Please note the procedure to be followed by all the providers of UMSL

The Beneficiaries (UMSL Cardholder) Patients desirous of admission when they walk into the Hospital are identified on the basis of the ID Cards issued by UMSL
The Consultant will assess the need for hospitalization. If hospitalization is not required the beneficiary will be treated on OPD basis and the fees collected from the beneficiary directly. UMSL shall not pay such fees.
If Hospitalization is required, the PROVIDER will send the details in the format prescribed by UMSL in the "Hospitalization Letter". On receipt of the hospitalization letter, UMSL according to the Health Insurance policy coverage will issue the Authority Letter (A/L) [Guarantee of Payment Letter].
It is possible that certain ailments may or may not be covered by the insurer depending on various factors. Though all efforts are made to check this requirement by the UMSL while issuing the A/L it is also the responsibility of the PROVIDER to verify the eligibility of the coverage.
It is advisable and requested to keep UMSL informed of the primary Diagnosis, Duration of sickness or illness past History of the sickness, similar, related and relevant sickness, disease or disorder, any history of diabetes or hypertension. UMSL has a 24 hour help line 011 702 59 26 for assistance and inquiries.
To avoid any uncertainty and for the Hospital's assistance and convenience the identification of the coverage will be done by UMSL and eligibility will be informed in the form of Authority Letter (A/L) [Guarantee of Payment Letter].
A/L is a precursor to the confirmation of the credit facility to the beneficiary by UMSL without which the onus of extended credit will not be on UMSL.
The ID Cards issued to the members of UMSL are just to confirm the identity of the beneficiary which possibly could help him/her in the critical times of Accidental Emergencies, on the humanitarian ground, involving the beneficiary approach the PROVIDER directly without the UMSL A/L.
Before Discharge of the patient, the PROVIDER will get the final bill authenticated by the signature of the patient on it.

Post Discharge Procedure:

The PROVIDER shall submit the following documents in ORIGINAL to UMSL maximum within a week after the discharge of the beneficiary/Cardholder.

Hospital final bill duly countersigned by the patient and as per the format given by UMSL.

Insurer/TPA can't pay what is not covered under the Insurance policy, which is a contractual obligation. Therefore the hospital must collect the amount of such services directly from the patient.

Services Which Are Generally Not Covered Are:
a.	Investigations and Tests, which are not related to the ailment.
b.	Telephone charges, Food & beverage charges, Barber services, Relative stay charges, Dental treatment not related to the ailment for which the Authorization Letter (A/L) is issued, transport/ambulance to hospital/home (unless specified otherwise), external implants, and others as mentioned in the A/L.

Discharge Card/ Summary (Original): This should narrate the patient's history of the present complaints, past history, clinical findings, investigation's comments, treatment & follow-up.
Reports:
- Original Reports of all investigations mentioned in the bills.
- In case of X-rays, MRI & CT scans only reporting (Not Plates) is needed except in cases of fractures.
IN CASE REQUEST FOR THE DISCHAGE CARD/ANY REPORTS, PHOTO COPIES MARKED AS DUPLICATE IN BOLD MAY BE HANDED OVER TO THE PATIENT (patient will bear the cost of Photo copy.)
Prescriptions: Prescriptions of medicines & consumables mentioning patient name & date on hospital or doctor's letterhead.
Claim form of the respective Insurance co. signed by the patient.
Claim forms are provided to you by UMSL. You can also use photocopies or download the same from our website UMSLTPA.com

On receiving the documents without any deficiency the Bills of the Provider are settled, within the stipulated time as agreed in the MOU.

Kindly also advise & intimate the concerned Departments - like Reception, Telecommunication, admission, Accounts, Billing, Cash, Marketing and other relevant departments / personnel.

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