We are a professionally managed outfit with team members having vast experience in the insurance and healthcare industry to manage Insurer/TPA/Corporate/Govt. Panel’s (TPA/Panel) cashless claim. Our team members are well versed with the claims related processes and therefore are well capable of dealing with issues with the TPA/Panel for Empanelment, Pre-Auth Processing, Bill Submission, Payment Recovery, Repudiated Claims and Deduction etc.
We follow a methodical process teenage with TPA/Panel to ensure the early redressal of claim to get the dues on time.
Why we are into this business and Why hospital require our services.
The cashless process is depth documentation process where it become necessary for hospital to deploy a qualified and experienced one who have ability to handle these challenges (i) documentation verification, (ii) policy eligibility checking (iii) equal understanding of MoUs and agreed tariff (iv) understanding of agreed package cost for implant/machinery/facility and its upgradation (excess) charges (v) AL content understanding for Pro-data amount and excess payment collection and (vi) reachable approach to concerned TPA/Panel for early of grievance and payment recovery etc.
We being into the business of Insurance/Health since years, understand the need and requirement of Healthcare Provider/TPA/PSUs. Therefore, we have trained and deployed peoples in hospital and others to take care all of the process of cashless transaction. Our efforts, are not only to ensure payment to hospital on time but also to give lots of convenient to handle patient smoothly in hospital for their early approval of Pre-Auth.
Our Key Pillars
o Dedicated team of industry experts based at the hospital as well as at our office to manage back end.
o Engagement with TPAs and Panels through detailed MIS to track cases and closing them on time using our long-term relationships with TPAs and Panels.
o Detailed reporting to the hospital using advanced data analytics.
o Weekly reconciliation of outstanding amount with the relevant team at the hospital to avoid any pendency.
o Performance driven approach tightly governed by TAT (turnaround time) with provision of reward as well as penalty for us.
Benefits for Hospitals
Save time on the day to day monitoring of the recovery process.
Reduce hospital risk to loss the credit revenues
Have greater expertise through us to understand the insurance product tailor made for the corporate.
Avoid delay in settlement of high value claims by the TPAs/Panels.
Quick resolution of queries raised by the TPAs/Panels.
Reduce deductions on claims by the TPAs/Panels.
Single Point of Contact (SPOC) to resolve queries of all Insures/TPAs/Corporates/Govt. Panels.
Better understanding of ailment capping, co-payment, deduction of non payable items by hospitals and other different clauses in tailor made policies of corporate houses.
**Without an effective monitoring and detailed tracking of MIS, all the above might lead to the hospital to lose money.
- ON SITE ASSISTANCE
- OFF SITE ASSISTANCE
- REPUDIATED CASES
- DEDUCTIONS FROM THE CLAIM
- ADMINISTRATIVE SUPPORT
- EMPANELMENT SUPPORT
We being in Hospital Business for such a long time and as form Insurance Industry we have closely observed that a hospital must do and focus on what it does best, as you are well aware that any hospital is best known for its treatment and facilities provided to its patients, and other operational tasks like Cashless Management must be taken care by respective experts to keep hospital free from additional burdens of managing these processes for payment recovery.[/vc_column_text][vc_empty_space height=”35px”][/vc_column][/vc_row]