Munish Daga, CEO of Remedinet Technologies gives a rundown on how the deployment of a Remedinet solution helped Manipal Hospitals streamline their health insurance claims
Healthcare in India is experiencing phenomenal growth and development. Cashless health insurance schemes have witnessed remarkable adoption across sectors, including at the grass root level. To ensure profitability and efficiency of operations, it is crucial for all the participants in the health insurance claim settlement process to maintain transparency, accuracy and a quick turn-around-time (TAT) during the entire process. However, dependency of these participants on manual methods for data capturing and record maintenance is detrimental to the overall efficiency of the claim settlement and adjudication process as well as the growth of the healthcare sector in India.
Challenges faced by Manipal Hospitals
A key player in the healthcare ecosystem is the provider – the hospital. Without the right hospital infrastructure, it will not be possible to cater to the needy. To cater to the rising demands and to continue providing services as well as ensuring customer satisfaction, it is crucial for hospitals to constantly evolve and adopt latest innovations. While India is at the forefront in adopting latest technology for medical devices and equipment, adoption of technology at the back end, particularly for health insurance claim adjudication is required.
Remedinet has provided the technology support that we needed to handle the huge influx of health insurance claims and thus, helped us to ensure customer satisfaction. Their EPM and ECM solutions have made it possible for us to get pre-authorisation approvals from TPAs/ insurance companies within 2/3 hours and reduce the time taken to process a discharge by half. The entire process has become faster and accurate, enabling us to emerge as one of the best in the business.
– Dr Niranjan Rai, Head, Patient Support Services, Manipal Hospitals
Manipal Hospitals, a leading integrated healthcare service provider in India, is focused at providing quality healthcare services with facilities and infrastructure on par with global standards. As a trusted name in the healthcare sector, Manipal witnesses a huge inflow of patients and thus, health insurance claims on a day-to-day basis to seek the best medical services. To avail of cashless insurance, upon getting admitted to the hospital, the patient must produce a cashless health insurance card. They are required to fill a form provided by the hospital staff. This form has details of their policy and the treatment recommended by the doctor. Based on the information disclosed in this form, the insurance company/ TPA decides the amount of expenses they would cover for the treatment. This information is then communicated to the hospital. At the end of the treatment, the hospital communicates the final amount to the insurance company/ TPA for reimbursement. Thus, to handle the influx of cashless claims, ensure a hassle-free experience for the patient, maintain transparency, accuracy and efficiency, undoubtedly, a standard platform facilitated by technology connecting all the players of the healthcare insurance ecosystem would prove beneficial.
To make the health insurance claim settlement process fluid, Manipal had to address the following issues regarding the current claim settlement process:
- The information shared by patients in their form is typed manually and fed into computers by data operators. This information is then shared with the TPAs/ insurance company in the form of PDFs/ JPEGs. Inaccuracies while keying in this information often results in the form being sent back to the hospital for corrections
- Data entered at different stages is also open to subjective human interpretation, increasing the possibility of errors
- The entire process of collecting and sharing the relevant data becomes a time-consuming exercise adding to the patient’s discomfort
- Real time tracking and monitoring the progress of a claim proved to be difficult due to the absence of a web-based software that can facilitate instantaneous flow of information
- Owing to the delays in processing claims, patients had to go through additional waiting time after discharge
Remedinet to the rescue
Remedinet team offered Manipal simplistic solutions for the challenges faced by them during pre-authorisation and claim management. In 2006 they started using Electronic Pre-authorisation Manager (EPM), a web-based electronic form for entering all relevant information at the time of hospitalisation. This helped in reducing the instances of incomplete data entry and brought down the TAT for processing pre-authorisation requests significantly. This web-based platform also provided an overview of all the transactions, their status and past history to keep a track on the progress and thereby, define the accountability of the staff members.
In 2014, Manipal Hospitals started using the Electronic Claims Manager (ECM). ECM helps in easing out the most critical phase of the entire cashless insurance claim process. It allows hospitals to submit claims electronically by using the standard IRDA compliant claim and bill formats and soft copies of all supporting documents required by various insurance companies. By configuring mandatory fields and documents at pre-authorisation phase, ECM significantly reduces queries from insurance companies/TPAs regarding incomplete claim forms and missing documents. ECM also makes it possible to track the status of a claim settlement process. Thus, by using ECM, Manipal has been able to track the details of each case at each stage, identifying gaps or errors and rectifying them to speed up the process.
With their simple solutions and value added services Remedinet has emerged as a key technology partner for Manipal.
Impact
A technology platform makes it possible to identify lags or delays and fix the error in real-time. Quick responses to queries raised, real time tracking of the claims process, and retrievable archives become possible too. Making the process faster, error-free and reliable thus, improves the overall efficiency of claims adjudication process. Remedinet solutions enhanced the efficiency of the claim settlement process and benefitted the hospital and insurance companies/ TPA as well as the patients in the following ways:
Benefits to the hospital
- Accuracies in maintaining records improved as the manual process of filling forms was done-away with
- A transparent dashboard showed all relevant details for monitoring the claim settlement process
- Inconvertible platforms for exchanging information were eliminated to make room for electronic readable platforms
- As all patient records were maintained electronically, the time involved in the claim settlement process was reduced drastically
- The time required for pre-authorisation reduced from 6/8 hours to 3/4 hours
- Real-time monitoring of claims made it possible for hospitals, TPAs and insurance company to expedite the settlement process
- Assured delivery of all crucial information to various participants in the claim settlement process
Benefits to the patient
- The time taken to process a discharge reduced from 3/4 hours to 1/2 hours
- Faster claim settlement process resulted in minimising the waiting time for patients, enabling them to manage bed utilisation and other resources better
- Archive of treatment history made it possible for patients to refer this information for further treatment without actually furnishing the report copies
To be on par with global best practices and be prepared for the current as well as the future demands of Indians for healthcare services, a healthcare provider’s focus on delivering efficient healthcare services using cutting-edge technology will go a long way in ensuring customer satisfaction and thus, customer loyalty. Remedinet has supported Manipal in enhancing the overall experience of the patients.
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