CREDIT AND CORPORATE TIE-UPS
Healthcare Credit Revenue Cycle Management {HCRCM}
We are ready to increase your healthcare organization’s credit revenue, we use our competence and ready to deploy a systematic approach to enhance the smooth transaction experience to patients as well as the institutions.
- Generate a System for proper and timely patient reporting at concerned healthcare organization’s credit management departments.
- Patient communications and provide guidelines along with cashless eligibility cross verifications.
- Eligibility for various categories of room occupancy may purely depends upon the patient’s policy details/plans/sum assured.
- Exact and proper pre-authorizations handling with maintaining the TAT.
- Prepare clear-cut replay to the pre-authorizations query and its speedy management.
- Communicate and provide the details of thepossibilities of co-payments and deductible charges to patient/bystander.
- Maintain the treatments and LOS as per the agreed package tariff with the stakeholders.
- Proper and clear enhancements should be given to the concerned cashless scheme providers for the prolongation stays other than the LOS in the packages signed.
- Claim submissions, must gather entire patient documents and upload the same after the sign and stamp of the treating doctor/healthcare organizations.
- Claim processing by cashless providers starts only after the receipts of final claim docs to concerned cashless providers through portal/email.
- If any query/additional information from the cashless provider, then revert it as soon as possible.
- Claim may also denied by the cashless provider with clarifications.
- If the cashless provider finds all the relevant documents are exactly correct from the healthcare organization, then the final approval may get within 2-4 hours of the receipts of the docs.
- Once the claim has approved, 50% of the works for credit revenue is completed, now we need a fine tuned system for the settlement follow-ups.
- Approval letter, settlement statement and actual credit of each and every claim should be cross verify, once the discrepancy found out of it, our system will work with concerned stakeholder/cashless providers departments for strict follow-ups.
Our core Team have proven experiences in the field of Pvt. Cashless Insurance Providers from various insurance and TPA companies. We have strong knowledge in the fields of Govt. aided cashless scheme managements like, CGHS, ECHS, ESIC, KASP and MEDISEP. We have already tie-up with abroad patient’s insurance providers….
Claim Denial Management {CDM}
According to the existing healthcare standards the average cashless claim denial rate across the industry is 5-10%. If your healthcare organization’s denial rate is above 10%, then you need to have a perfect working model to your organization. So we will help you to restructure your existing claim processing practises and patterns with our proven expertise and also provide the best tips for managing the unwanted denials…
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