Presentation



Healthcare Payer Provider
Network


                               This document is confidential and is in...
Outline

   iSprint Goals
   Healthcare Insurance Payer Provider Ecosystem
   Key Challenges
   Current Processes
   ...
i Sprint Goals

i Sprint aims to be the pioneer in enabling efficiency in the healthcare
ecosystem by providing innovative...
HealthCare Ecosystem

      Key Stake Holders

                            Doctors                      Medical colleges
...
Annexure: Initiative of IT Department & IRDA;
              HealthSprint’s Role




                                  iSpr...
Healthcare Internet:
                        Payer-Provider Network
   Need Seamless & timely exchange of information bet...
Current Pre-Auth Process:
               Paper Based Workflow

                                                           ...
Current Process Pain Points


Current Issues – Pre-authorization

   Incomplete information
   Fax transmission errors a...
ePre-auth work flow


                                                            TPA/
                           HS      ...
i Sprint Pre-Auth Module




 All required information mandatory – complete Pre-Auth
   sent electronically.
 No transmi...
Intelligent Monitoring and Analytics




        iSprint – Connecting the Healthcare Ecosystem
Intelligent Monitoring and
 Analytics(Graphical MIS)
i Sprint Network Architecture
                                                  Provider                   WWW            ...
i Sprint Improvement over Current paper
                         Based Process

                              Current Pape...
i Sprint Network:
           Bringing Benefits to All Key Stakeholders

                     Reduced wait time for Pre-au...
Customer Base



More than 150 Healthcare providers
   and 8 TPAs and Insurance
 companies using the platform in
         ...
i Sprint: Connecting Healthcare Ecosystem
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Healthsprint Data Exchange Platform

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"I-SPRINT-electronic health care data exchange platform" for hassle free and seamless real-time health care data exchange b/n payers and providers for faster cashless hospitalizations.

currently used by around 700 hospitals and 10 payers across india.

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Healthsprint Data Exchange Platform

  1. 1. Presentation Healthcare Payer Provider Network This document is confidential and is intended solely for the use and information of the client to whom it is addressed. HealthSprint Networks Pvt. Ltd. i Sprint: Connecting Healthcare Ecosystem
  2. 2. Outline  iSprint Goals  Healthcare Insurance Payer Provider Ecosystem  Key Challenges  Current Processes  Web Enabled & Improved Processes by iSprint  Integrated Solution Architecture  Summary: Value Proposition to Key Stakeholders i Sprint: Connecting Healthcare Ecosystem
  3. 3. i Sprint Goals i Sprint aims to be the pioneer in enabling efficiency in the healthcare ecosystem by providing innovative Internet enabled services and technology solutions to the healthcare industry. The key objectives: Enabling efficiencies among Providers, Payers and Patients by providing solutions that streamline the information exchange processes. Bridging the digital divide between payer and providers. Enabling new cost effective business models for healthcare insurance processes. Enabling more effective processes to deliver better value proposition in terms of customer satisfaction and money. i Sprint: Connecting Healthcare Ecosystem
  4. 4. HealthCare Ecosystem  Key Stake Holders Doctors Medical colleges (General/Specialist) Hospitals/Healthcare Transaction People/Patient Institutes Banks Verification Pharmaceutical Entity/TPAs Companies Insurers Government Regulatory Authority i Sprint: Connecting Healthcare Ecosystem
  5. 5. Annexure: Initiative of IT Department & IRDA; HealthSprint’s Role iSprint i Sprint: Connecting Healthcare Ecosystem
  6. 6. Healthcare Internet: Payer-Provider Network  Need Seamless & timely exchange of information between TPAs & Hospitals for providing best services to patients. This necessitates following processes to be more efficient:  Pre-Authorization  Discharge Summary & Billing  Validation of Submitted Info e-Preauth e-Claims  Payment of Claims Task 2 e-Payment e-Validation  Internet Enabled Payer Provider Network  To provide more effective process and work-flow for information and money flow between Hospitals and TPAs.  To manage payment risks for hospitals, TPAs and insurers. i Sprint: Connecting Healthcare Ecosystem
  7. 7. Current Pre-Auth Process: Paper Based Workflow TPA/ Provider Faxed Insurance Company Batched Sent by fax Data Entry Clerk: Key in Data Authorised Examined Need for more by Auditor: Information Rejected/ Sent by fax Accepted i Sprint: Connecting Healthcare Ecosystem
  8. 8. Current Process Pain Points Current Issues – Pre-authorization  Incomplete information  Fax transmission errors and fax transmission losses  High Turnaround time  No mapped flow of information  Traceability & Accountability is absent i Sprint: Connecting Healthcare Ecosystem
  9. 9. ePre-auth work flow TPA/ HS Insurance Provider Company HS HS Authorised Examined Need for more by Auditor: Information Rejected/ Accepted i Sprint: Connecting Healthcare Ecosystem
  10. 10. i Sprint Pre-Auth Module  All required information mandatory – complete Pre-Auth sent electronically.  No transmission losses.  Integrated with TPA software drastic reduction in Turnaround time for Pre-Authorization. • Real time information to patients through SMS and e-mail alerts i Sprint: Connecting Healthcare Ecosystem
  11. 11. Intelligent Monitoring and Analytics iSprint – Connecting the Healthcare Ecosystem
  12. 12. Intelligent Monitoring and Analytics(Graphical MIS)
  13. 13. i Sprint Network Architecture Provider WWW Payer Browser (IE) Accounts Receivable iSprint TPA Sy nc Pre-Auth Provider Host Application TPA Host Application Claims Discharge DB Sy Summary / TPA Server Medical Records nc Case History Secure iSprint Internet Billing Browser (IE) Pre-Auth Billing Case History Claims Request Discharge Summary Response Bank Application i Sprint: Connecting Healthcare Ecosystem
  14. 14. i Sprint Improvement over Current paper Based Process Current Paper Based i Sprint Process Process Pre-Auth turnaround 4-48 hrs 30 min -2 hrs time Rejection: Discharge 3-8 % 0.5% Summary/Billing Payment Realization 1-3 months 15-30 days time This information is based on iSprint network operations in 15 hospitals in Bangalore. i Sprint: Connecting Healthcare Ecosystem
  15. 15. i Sprint Network: Bringing Benefits to All Key Stakeholders  Reduced wait time for Pre-authorization  Early identification of out of pocket payments Patients  Eliminates need for reimbursements  Payment Risk Management Providers  Ability to collect Balance payment from Patients  Faster Settlement of Claims-Improved cash flow  Reduction in erroneous claims- Saving processing cost, & payment risk management TPA  Greater Visibility on cash flow commitments  IT solutions reducing transaction cost / complexity i Sprint: Connecting Healthcare Ecosystem
  16. 16. Customer Base More than 150 Healthcare providers and 8 TPAs and Insurance companies using the platform in India CARE HOSPITAL St.John's Medical College iSprint – Connecting the Healthcare Ecosystem
  17. 17. i Sprint: Connecting Healthcare Ecosystem

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