Download the following documents below and ensure that you have read through and understand all the terms and conditions thoroughly and carefully.

1  Request for Determination Form (RFD)

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2  CCRP Rules (Annex A)

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3  RFD Annex B

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You are required to ensure that you have met the following prevailing requirements before submitting your application. You may use the checklist criteria as a guide.

1

Applicant aimed to seek a final and binding determination of the dispute which is of a clinical nature and related to a claim under an Integrated Shield Plan through the Clinical Claims Resolution Process.

2

Applicant confirmed that the dispute is not already the subject of court, arbitral, regulatory, criminal or other adjudicatory proceedings.

3

Applicant have provided supporting document(s), if Applicant is:
IP Policy Holder, Medical Practitioner, Healthcare Institution, IP Insurer

Supporting Document(s) to show past attempt(s) at resolving dispute with Respondent

4

In consideration for the CCRP Secretariat processing this Request and the Panel members making a determination of our dispute, Applicant have agreed to be bound by the CCRP Rules in force at the time the determination commences and agree to be bound by the determination or amended determination (if any) issued by CCRP.

5

Applicant have noted that the determination or amended determination (if any) by CCRP is final and there shall be no appeal allowed.

1. Applicant should complete and sign the Request for Determination (RFD) form. (Ensure that all the Respondent's contact details are also completed.);
2. Email the RFD form and Annex B along with the necessary supporting documents as outlined in the form to the CCRP Secretariat via application@ccrp.com.sg with the subject header: "CCRP Application Request for Determination - Name of Applicant".
3. CCRP Secretariat will subsequently assist to contact the Respondent to obtain their signatory & agreement.
4. If Respondent agrees, Applicant to proceed to Step 4 on making payment.

1. Applicant to note the below Application Fee Charges applicable for the category that they are in i.e., IP Policyholder (Patient) or medical practitioner, etc.
2. Proceed to make Payment via the following modes

   Paynow

   To UEN No: 197702012E
   (Academy of Medicine, Singapore)
   Indicate “CCRP Fee – Applicant Name”

   Bank Transfer

   Payable to: “Academy of Medicine, Singapore”
   Indicate “CCRP Fee – Applicant Name”
   

   Beneficiary Name: Academy Of Medicine, Singapore
   Beneficiary Account: 0039042809
   Bank Name: ACADEMY OF MEDICINE, SINGAPORE
   Bank Code: 7171 Swift Code: DBSSSGSG
   Bank Address: 12 Marina Boulevard, Tower 3, level 6, Marina Bay Financial Centre, S(018982), Singapore 018982

3. Email the Proof of Payment to CCRP Secretariat via application@ccrp.com.sg.

1. For applications that have been accepted and deemed suitable for CCRP evaluation:
   1. CCRP Secretariat will send a notification email to both Applicant and Respondent to submit their respective Statements and all the relevant supporting documents for the case.
      1. Clearly name each file so it is easy to identify.
      2. If you need to submit emails as evidence, or supporting documentation, make sure they are not in one of the following file formats as they are not allowed: msg, eml, html and htm.
      3. Files with these formats must be converted into an acceptable format such as: text, PDF, Word Doc or a photo.