ESIC — Employees' State Insurance — pre-authorisation process

How an empanelled hospital raises a ESIC — Employees' State Insurance pre-authorisation: who approves it, what to verify, which documents to upload, and what to do when it is queried or rejected.

Step by step

  1. Verify the beneficiary

    Check the beneficiary card, its validity and the category of ward or package the patient is entitled to under ESIC — Employees' State Insurance.

  2. Check the referral or emergency rule

    Identify the package for the procedure. Emergency admissions can usually be raised after treatment starts; planned procedures need approval before admission.

  3. Raise the pre-authorisation

    Raise it on the scheme portal (esic.gov.in) or the state's transaction system, as your empanelment requires.

  4. Attach the clinical evidence

    Upload the doctor's notes, the provisional diagnosis and the investigation reports that support the package — the approving doctor sees only what you attach.

  5. Answer queries the same day

    A query that sits unanswered is the most common reason a scheme pre-auth lapses. Reply with the exact document asked for.

  6. Close the case at discharge

    Upload the discharge summary, the final bill and any implant stickers or invoices, then raise the claim within the scheme's submission window.

Who handles ESIC — Employees' State Insurance cashless requests

State government health schemes each run their own cashless process for empanelled hospitals, usually through an online portal managed by the state health agency or an appointed insurer/TPA. The pre-authorisation is raised on that portal for the approved package before or at the time of admission.

Documents to attach

Avoid a query

Most pre-auth queries come from three gaps: no duration of illness, no ICD-10 code, and a cost estimate given as one figure. The full field-by-field list is in how to fill a pre-auth form.

If ESIC — Employees' State Insurance queries or denies the pre-auth

A query is not a rejection. Reply the same day, answering only what was asked, with the supporting document attached — see how to reply to a pre-auth query.

If a scheme pre-auth is rejected, the hospital can usually re-submit with the missing evidence or raise it with the State Health Agency's grievance desk.

Related guides

ESIC — Employees' State Insurance at a glance

All pre-auth forms · Recover an unpaid ESIC — Employees' State Insurance claim · Rejected claim assistance for patients

Pre-auth forms of other insurers and TPAs

Where can I download the ESIC — Employees' State Insurance pre-auth form?

ESIC — Employees' State Insurance pre-authorisation is raised online on the scheme's system, not on a paper form. Anything the scheme publishes is linked on this page.

What is the ESIC — Employees' State Insurance pre-auth email ID?

No pre-auth email ID is on file for ESIC — Employees' State Insurance; requests are raised on the provider portal (esic.gov.in). If your hospital has been given an email ID, use the one in your empanelment letter.

How long does ESIC — Employees' State Insurance take to approve a pre-auth?

Scheme pre-authorisations are decided under the State Health Agency's own timelines. Answer queries the same day to avoid lapse.

What if ESIC — Employees' State Insurance denies cashless?

Re-submit with the missing evidence or take it to the scheme's grievance desk. Medilock's recovery desk takes up scheme claims for hospitals.

ESIC — Employees' State Insurance का प्री-ऑथ फ़ॉर्म कहाँ से डाउनलोड करें?

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