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Direct Billing Claims
CHECK LIST FOR PROVIDERS FOR SUBMISSION OF DIRECT BILLING CLAIMS
□ Covering Letter
□ Claim Form Duly filled & Signed by the insured & the treating doctor.
□ Doctors Prescription for medication
□ Original Detailed Medicine Invoices
□ If there is a Outpatient Procedure or Investigation then a medical report / investigation report is mandatory
□ If there is a Outpatient Procedure or Investigation then a Approval Copy has to be attached.
If the above claim documents are in order then the claim can be accepted otherwise it should be returned.
Please read this carefully before submitting your claims to us
PLEASE ENSURE THAT
The claim form is duly filled, signed and stamped by the treating doctor
The pre-approval request is sent for inpatient/day care admission and outpatient cases exceeding pre-approval limit to our helpdesk team
You submit all invoices and investigation reports in original
You submit the Medical report and Discharge Summary for all inpatient and Day care admission cases
You enter ALL member details on the claim form
You submit the claims within 30 days from date of treatment.
You submit the original medicine prescription and detailed invoices for medications
You submit detailed invoices that is break up of all services viz Medication/investigations/Hospital charges etc
You submit a copy of the Member ID card and Iqama / CPR
You submit claims in sequential order as mentioned in the covering sheet
You ensure that agreed contractual discounts and agreed prices are applied
You collect deductible as per the policy from our mutual clients
You send approval for dental, maternity and optical cases
You ensure that submissions of invoices for dental services are per the visit
You submit claims policy wise
In case of Emergency admission, it is not mandatory to send approval immediately, but the following day our Helpdesk should be intimated about the admission and the approval request with all relevant information has to be sent
PLEASE DO NOT
submit claims without claim form as the claim will not be paid
submit photocopied claim forms/invoices and investigation report
submit claims without investigation reports
send pre-approval after the service availed
Gulf Electronic Management Systems Co. W.L.L.
Offices 61 - 81,
Bldg. 737, Road 1510, Block 115,
Opp Customs office, BIIP Main gate,
Kingdom of Bahrain.