Medical Card Claims processing guidance encompasses several administrative and customer service stages, involving review, investigation, adjustment (if required), and the final decision on whether to remit or deny the claim.
The medical billing insurance claims process initiates when a healthcare provider treats a patient and submits a bill for the services rendered to a designated payer, typically a health insurance company.
Enjoy hassle-free admission at Allianz panel hospitals with the Allianz Medical Card.
Allianz features an eClaims process designed to enhance the efficiency of claim processing, ensuring faster turnaround times.
The Objectives of this claims processing guidance are as follows:
- To facilitate a seamless claim processing experience, thereby enhancing customer satisfaction.
- To reduce the time taken for claim processing and mitigate delays or rejections caused by unmet basic requirements. This includes instances such as incomplete documentation or insufficient information submitted.
Frequently Asked Questions(FAQ) of Medical Card Claims Process
What should I do if I have a pre-scheduled hospital admission or day surgery?
During an outpatient visit, the doctor determines that hospital admission or day surgery is necessary, kindly sign the Admission Form provided at the Hospital Admission Counter on the same outpatient visit date. Following this, the hospital will initiate a request for the Guarantee Letter (GL) from Allianz’s Third Party Administrator. This proactive approach helps eliminate the waiting time for GL issuance on the actual admission day.
Where can I get the list of Panel Hospitals?
The list of Panel Hospitals is available here. Please note that the list is subject to change. For corporate plans, specific Panel Hospitals may be appointed by employers, please refer to your Human Resource Department for more information.
Why Guarantee Letter is not issued for some doctors in the Panel Hospitals?
There may be some non-participating doctors in the Panel Hospitals. For more information, please call the Allianz’s Third Party Administrator (TPA) stated on your medical card.
For Individual Customers: 1-800-88-1311, 03-7954 4629
For Corporate Customers: 1-800-88-8019, 03-7628 3600
For Corporate Customers: 1-800-87-7928, 03-7843 9459
Can I enjoy the medical card services when I am abroad?
No, the medical card services are only applicable to Allianz’s Panel Hospitals in Malaysia.
How long does Allianz’s Third Party Administrator take to process the Guarantee Letter?
Upon receiving complete documents from the hospital, the Guarantee Letter will be processed within 45 minutes for straightforward cases. However, if the documentation or information received is incomplete, it may take longer or until the necessary documentation has been received.
Will I be notified on the status of Guarantee Letter?
Yes, upon approval of Guarantee Letter, customer will be notified via SMS if mobile number is provided on the Admission Form.
If Guarantee Letter has been approved, do I still need to pay admission deposit?
Some hospitals may request for deposit as part of the admission requirement. However, the deposit will be refunded by the hospital after deducting the non-covered charges.
Can I stay in a room that has higher charges than my Room and Board Benefit?
Yes, however you need to pay the difference of amount incurred (excess Room and Board charges), and a Co-Payment if applicable.
How long do I need to wait at the hospital after the doctor has certified that I am fit for discharge?
The doctor has to complete the medical report, before hospital staff can prepare the bills and fax to Allianz’s Third Party Administrator for assessment. The whole process may take several hours, subject to the hospital’s available resources.
Under what circumstances would I have to settle the hospital bill? Can I submit a claim after that?
There could be several reasons when you have to settle the bill, just to list a few:
- Policy lapsed/terminated
- Outpatient, pre-hospitalisation or post-hospitalisation treatment
- Hospitalisation at non-panel hospital or non-participating doctor
- Hospitalisation outside of Malaysia
- Admission for investigation or diagnostic purpose
- Exclusions under the policy terms and conditions
You may settle the bill with the hospital and submit a claim for reimbursement consideration, subject to your policy’s terms and conditions.
My hospital bill is not fully covered, how can I find out what are the non-covered charges?
You may request for the Discharge Notice / Notification of Excess Charges from hospital personnel, which indicates the breakdown for non-covered charges.
Admission and discharge process
- Step 1: Present medical card, NRIC/Passport & referral letter (If any)
- Step 2: Sign admission form
- Liaises with Allianz’s Third Party Administrator (TPA)
- Patient to pay Deposit (if requested by hospital)
- Step 1: Hospital faxes bill to TPA for assessment
- Step 2: Discharge guarantee letter issued
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