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  • Paramount Health Services (tpa) Pvt. Ltd.

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GIPSA NETWORKDECLARATION FORM (To be filled by the Hospitals)Name of the Hospital:Date of Admission. Address:. PATIENT NAME/INSURED NAME (BLOCK LETTERS):.

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How to fill out the Paramount Health Services (TPA) Pvt. Ltd. form online

Filling out the Paramount Health Services (TPA) Pvt. Ltd. form is an essential step for accessing health services. This guide will provide clear and supportive instructions to help you complete the form accurately.

Follow the steps to complete the form easily and accurately.

  1. Click ‘Get Form’ button to obtain the form and open it for completion.
  2. Start by providing the name of the hospital and the date of admission in the designated fields.
  3. Fill in the address of the hospital, making sure it is clear and complete.
  4. In block letters, enter the patient name or insured person's name, followed by their age and sex.
  5. Indicate whether you have an insurance policy by selecting 'Yes' or 'No'. If 'Yes', choose from the list of available insurance providers.
  6. Provide your policy number and the TPA name in the respective fields.
  7. Fill in the TPA card number accurately.
  8. Answer whether you have contacted TPA or the insurance company for the cashless facility.
  9. Indicate if the patient has opted for an eligible room category under the policy by selecting 'Yes' or 'No'. If 'No', specify the opted room category.
  10. Acknowledge and agree to the terms regarding the facility and treatment costs by signing in the designated space.
  11. Provide the name of the patient or the patient's attendant along with their mobile number and email address.
  12. Fill in the PAN/Form 60 and Aadhar card number in the required sections.
  13. The hospital representative must sign and add the hospital seal in the indicated areas.
  14. Once you have completed the form, ensure all information is accurate, save your changes, and proceed to download, print, or share the completed form.

Complete your documents online to ensure a smooth health service experience.

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Paramount, an affiliate of ProMedica, is an Ohio-based health insurance company, headquartered in Maumee, Ohio.

The TPA offers the ID card and a Unique Identification Number to the patient, which helps in claim settlement. Thus, the TPA is the link between the insurance company and the policyholder when it comes to availing the hospitalisation cover and processing claims.

Helpline No. & Email ID Helpline No. : +91 22 666 20 808. Toll free No. : 1800 22 66 55. Senior Citizen Helpline No. : +91 22 666 29 813. Cashless Authorization Email Id : al.request@paramounttpa.com. Email Us : contact.phs@paramounttpa.com. Claim Intimation Email Id : claim.intimation@paramounttpa.com.

Contact Us Address. Call Now. +91 22 40004219/216. Fax. +91 22 4000 4280. Whatsapp no. +91 7718806681. Email. travelhealth@paramount.healthcare.

The full form of TPA is Third Party Administrator. TPA is the agent of the health insurance corporation. It acts as a mediator between the insurance provider & the insured individual. Its primary role is to address all cashless and insurance claims linked to hospitalisation and medical expenses.

Paramount Health Services & Insurance TPA Pvt. Ltd. (PHS) began its journey in 1996.

Your Personal Health Statement (PHS) is designed to help you better understand your recent medical and prescription claims including: Total amounts charged. Your discounts just for being a member. What your health plan paid on your claims.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232