Cashless claim rejected or unpaid — for hospitals
Insurers must decide a cashless request within one hour and give final discharge authorisation within three hours under IRDAI's 2024 master circular. When a cashless claim is approved and never paid, repudiated after discharge, short-paid after a tariff deduction, or closed without intimation, the hospital can recover it through a documented escalation with the insurer and the TPA. Medilock Cashless Recovery runs that escalation for hospitals across India, including Ayushman Bharat PM-JAY, CGHS and state scheme claims.
Step by step
Classify the claim
Pending for payment, rejected, short-paid, or closed without intimation. Each needs a different document to reverse it.
Assemble the file
Pre-authorisation and approval letters, the final bill and discharge summary, the settlement advice or rejection letter, and the empanelment tariff.
Escalate in writing
To the TPA and the insurer's provider desk, then the grievance officer, with a written trail the insurer has to answer.
Upload to Medilock
Our recovery desk reviews the claim and takes it from representation to release, with legal support where needed.
What we recover
- Approved by the insurer or TPA but never credited
- Repudiated on non-disclosure, waiting period or documentation
- Short-paid: tariff deductions, "reasonable and customary" cuts, co-pay not in the policy
- Closed at the insurer's end without a letter to the hospital
- Ayushman Bharat PM-JAY, CGHS, ECHS and state scheme claims
Related guides
How quickly must an insurer approve a cashless request?
Within one hour for the cashless authorisation, and within three hours for final discharge authorisation, under IRDAI's 2024 health insurance master circular.
Can a hospital recover a short-paid cashless claim?
Yes, where the deduction is not supported by the policy or the empanelment tariff. A documented representation to the insurer and TPA is the first step.