Hospital Claims Outsourcing

Hospital Claims Outsourcing

Outsourcing of Claims Department of Hospitals:

Hospitals presently have their own claims department catering to the needs of the policy holders. This claims department coordinates between the Insurance Company and the Policy Holder and in turn provide the much needed Cashless Facility to the patient admitted in the hospital.
However, in the Hospitals Claims department, the staff does not have much knowledge about Health Insurance and its conditions leading to unnecessary delays or non cooperation with the patient. Hence the experience of a patient at the Hospital sometimes leads to unsavory experience.

Our Service:

We would be able to take over the claims department of the hospital and would provide the following facilities:

  • Completion of and sending the pre authorization form to the Insurance Company or to their nominated TPA’s. We will involve the patient only minimally.
  • Prior to sending the pre authorization to examine whether the sickness falls into any of the exclusions. In such cases the patient can be informed immediately so that he is able to take a decision.
  • Answering queries of the Insurance Companies/TPA’s. We will ensure that the patient or their attendant is not disturbed for getting the query reply from the Doctor concerned.
  • Regular follow up with the Insurance Company/TPA’s regarding the approval which would result in Customer Delight.

Our service charges can be worked out as a percentage of the Claim amount so received by the Hospital.

For Hospitals that do not have Cashless facility:

For such of those hospitals that do not have cashless facility, we could help them to get this facility from the respective Insurance Company/TPA’s.

Hospitals in remote areas:

In certain cases Hospitals in remote areas may have cashless facility but would not have the requisite staff to cater to the need of the patients. Where there are more than two hospitals in such areas we can coordinate for the said hospitals and have our personnel who will assist in getting the cashless facility.
In delivering our services we will handle from intimation to approval and from approval to final receipt of money by the hospital.
Our service charges can be worked out as a percentage on the claims amount received by the Hospital.