Contents:
- Medical Video: Jo Moore CMS1500 Claim Form Tutorial
- What are the procedures for health insurance claims?
- Steps for private health insurance claims
- Steps for BPJS health insurance claims
Medical Video: Jo Moore CMS1500 Claim Form Tutorial
As a health insurance customer, you have the right to make a claim to get the benefits provided by the insurance company. However, before actually submitting the claim, it never hurts to understand step by step deeper to facilitate your health insurance claim process later. So how?
What are the procedures for health insurance claims?
Health insurance currently available is divided into two types. There are conventional (private) health insurance, and government health insurance (JKN-KIS managed by BPJS). Both have different claims.
Well, so that your health insurance claim goes smoothly, try following the following procedures:
Steps for private health insurance claims
1. Understand the claim procedure
There are two methods that can be used to make insurance claims, namely systems without cash (cashless) and replacement system (reimburse) Understanding the claim procedure is very important, because then you will be facilitated when you want to make a claim.
Especially if the insurance that you use applies the systemreimburse, where the submission of a new claim can be made after all treatment is complete. While for the systemcashlessYou do not need to make any claims because all maintenance costs have been paid by the insurance company.
2. Submit a claim as soon as possible
Each health insurance company has a maximum time limit for filing claims. If you make a claim past the specified date, the insurance company does not hesitate to reject the claim.
In essence, the faster you submit a claim, the faster the claim process will be completed and the replacement fee.
3. Fill out the insurance claim form
Submitting an insurance claim is incomplete without filling in the claim form. Completion of this form usually includes all policy holder data in detail. Starting from the full name, ID card number, insurance member number, hospital data, health care data, and so forth.
4. Attach all required documents
After completing the form, don't forget to attach all documents related to your treatment. Whether it's outpatient or hospitalization.
Some health insurance companies usually advise you to contact insurance before starting the treatment process. The goal is to ensure that the treatment you are about to take can be covered by insurance.
After that, to simplify the insurance claim process, make sure you complete a document consisting of your identity, medical bill receipt, original medical record or photocopy, a letter of introduction from a doctor, and other supporting documents that are related to your treatment.
Do not let errors in the document you submit. This error can make a claim postponed or even rejected by the insurance.
5. Save a copy of the insurance claim file
If everything is done, don't forget to keep all copies of the files related to your health insurance claim. That way, you can maintain the possibility of loss of claim data on the insurance side.
Steps for BPJS health insurance claims
1. Health BPJS claims are different from private health insurance
Claims for medical expenses with BPJS Health will be automatically carried out by health facilities (health facilities) or hospitals in collaboration with BPJS Kesehatan.
So, you only need to show the membership card that you have for treatment, without having to ask for reimbursement later. Medical expenses borne by the BPJS Health will be sent directly to the health facility or hospital.
2. Complete all required documents
Just like the way health insurance claims are generally, you will also be asked to submit documents that support this claim process. For example photocopies of ID cards, photocopies of family cards, referral letters from the first health facility if treated at the hospital, your Health BPJS membership card, and others.
3. Health BPJS claims can be directly used for treatment
Furthermore, without needing a long time you can immediately use the benefits provided by BPJS Health for treatment. It is important to remember, that BPJS Health implements a tiered referral system. So the plot, you have to go through the first health facility as the initial gate of treatment, such as a health center or clinic.
If it can still be handled in the first facility, you do not need to be referred to an advanced level of health facility (FKRTL). However, if necessary, health facility 1 will provide a referral to the nearest hospital that has collaborated with BPJS Kesehatan.
4. Always make sure the referral letter is still valid
Medical conditions that do not allow for treatment in the first health facility, will be transferred to the hospital with a reference letter. Even so, this reference letter has a validity period, up to three months from the beginning of the issuance of the letter.
If after three months the conditions have not improved, you can extend the validity period of the letter by repeating the procedure from the beginning.
