Most pre-auth queries are raised on the same handful of fields. Fill these properly and the approval comes back the same day instead of three days later.
A pre-authorisation query is not a rejection, but it costs you a day or two every time, and on a busy cashless floor that compounds into a real number. Across the files we see, queries cluster on the same eight fields.1. Date of first diagnosisThe most consequential field on the form and the most carelessly filled. Writing "since 5 years" because the patient said so invites a non-disclosure investigation that can end the claim. Write the date you can support from a record. If it is not known, say it is not known — that is a defensible answer; a guessed date is not.2. Duration of the presenting complaintMust be consistent with the date of first diagnosis, the clinical notes and the investigation dates. Insurers read these three against each other. A complaint of two days alongside a diagnosis of five years needs the relationship spelled out.3. Provisional diagnosis with ICD codeA diagnosis in free text alone slows the file. The ICD code lets the assessor match it to the policy's exclusion list immediately. A missing code often means a query purely to obtain it.4. Line of treatment, stated explicitlyMedical management, surgical management, intensive care, investigation. If surgical, the proposed procedure with its code. "Conservative management" with no further detail on a patient being admitted for three days is the classic trigger for a medical-necessity query.5. Why admission is requiredThis is the field that answers medical necessity, and it is frequently left as a single word. Insurers deny cashless on day-care-able procedures constantly. Two lines from the treating doctor on why this patient needs an inpatient bed prevents most of it.6. Room category and per-day rateState the category and the rate, and state whether it is within the patient's entitlement. If the entitled category was unavailable, record that on the form at admission. Trying to establish it after settlement, when a proportionate deduction has already been applied, is much harder.7. Estimated cost, broken upRoom, investigations, surgeon and anaesthetist, OT, implants, pharmacy, other. A single lump-sum estimate gets queried almost every time. A broken-up estimate also gives you a better position when the settlement comes in lower.8. Past medical and surgical historyComplete it, including nil where it is nil. A blank field is read as concealment later; "no known comorbidities" is a statement. This is also the field to note a policy that has run many years, because once the pre-existing disease waiting period is complete the whole non-disclosure argument weakens considerably.Two habits that cut query ratesAttach the investigation that supports the diagnosis. Not the whole file — the one report that establishes it. Assessors approve faster when they do not have to ask.Send it from an address that gets replies. Pre-auth email IDs differ by insurer and by TPA, and they change. A form sent to a dead address is not queried, it simply never moves.We keep the current pre-authorisation form, provider portal link and pre-auth email ID for every major insurer and TPA in India in a free directory. If one is out of date, tell us and we will update it.