The document discusses improving harmony between healthcare service providers and insurance companies in cashless management. It notes that the number of health insurance policies and claims have grown significantly in recent years. The current system of pre-authorization and claims processing is described as chaotic and unsystematic, leading to delays, ambiguous invoices, and undefined documentation. The proposed solution is a training module and software to bring dynamic change through benefits like customer satisfaction, well-defined documentation, transparent invoicing, and faster pre-authorization approvals.

1. Improving the harmony between the service
provider and insurance company
A New Paradigm in Cashless Management
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2. Bringing Total Harmony, Proper Transparency and
Technical Skills to the Cashless Management Process
Health Insurance is emerging fast as an important mechanism to finance the
healthcare needs of the people.
Opening up of insurance sector and growth of private healthcare system, particularly
characterized by setting up of corporate hospitals, poses lot of challenges to be
addressed by the insurance industry and its regulators.
Service providers must start the planning process now and proactively project the
needs of this new wave of consumers in order to have the organisational structure
and delivery systems required to meet this new demand.
The IRDA data gives an amazing insight into this growth.
The number of health insurance policies issued have increased from
22,65,451 in 2003 – 2004 to 68,84,687 in 2009 – 2010.
The number of members covered under health insurance policies have increased from
83,61,629 in 2003 – 2004 to 5,48,93,453 in 2009 – 2010.
The number of claims settled under health insurance policies have increased from
3,60,088 in 2003 – 2004 to 32,63,597 in 2009 – 2010.
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3. You have a problem, We have a solution
You have a problem
The service provider and TPA share a completely inharmonious relationship. This
leads to
Delay in approvals
Ambiguous invoicing
Undefined documentation
Increasing outstanding
Mismanaged customer handling
Unfortunately it is always the hospitals who take the major brunt of customer
dissatisfaction that may be due to ignorance of the policy condition by the members
and also due to inefficient handling by TPAs.
In a world where information is available at the click of a button, a member has to
wait hours after the discharge for the enhancement to come from the TPAs.
The current system of enhancement of the prior approval is chaotic and unsystematic
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4. We have a solution
We have developed a training module and software to bring a dynamic change in the
current cashless management scenario.
We are equipped to offer our consultancy ensuring the following benefits to your
organisation.
Customer satisfaction
Well defined documentation
Transparent invoicing
Expected returns
Minimisation of loss
Analysis and providing solutions for current outstanding
Faster and assured enhancement
System generated feedback from TPAs
We offer a concised, simplified, user friendly approach to clear ambiguities
surrounding health policies.
We work with you to develop goals with respect to corporate strategy and cost
savings, and then help you achieve those goals through proper plan design,
administration and utilisation
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5. Who we are
A truly independent consultant that provides its clients with the appropriate
intellectual capital, uncommon strategic vision, personal attention and commitment to
building long-term client partnerships.
We are a group of Fellow of Insurance Institute of India having more than 8 years of
experience in managing the claim processing vertical in a leading TPA.
Having experience of strict insurance and CAG audits, we are well aware of the types
of documents that the regulators sift through.
Let PANACEA share strategic positioning and creative approaches designed to help
you seize this opportunity as you
Develop a framework for assessment of your customer needs
Ensure your revenue cycle processes are fully compliant
Establish a plan of action to position your organization ahead of the curve
Prepare for the inevitable escalating pressures on margins
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6. Our services at a glance
As discussed earlier, we are equipped to offer our consultancy ensuring the following
benefits to your organisation.
Customer satisfaction
 Fast and accurate approval can go a long way in satisfying an otherwise irate
and confused member
 A proactive, well informed insurance helpdesk ensures better customer
satisfaction
Well defined documentation
 Checklist for intimation to TPA
 Checklist for pre-authorisation documents
 Checklist for enhancements
 Frequently asked additional documents by TPA panel of doctors
 Software enabled decisions for arrangement of documents insurance
companywise.
Transparent invoicing
 Checklist for submission of documents to TPA for settlement
 Invoicing as per insurance norms
 Inclusion of breakups and supporting documents
Expected returns
 Accurate estimates sent to TPA guided by software modelled on insurance
norms
 Eradication of short payments during settlement by TPA, in short it means
whatever due to the hospital MUST be realised.
Minimisation of loss
 Avoidance of short payments from TPA
 Ensuring realisation of all inadmissible expenses as per insurance norms
 Minimisation of bedtime loss due to unnecessary delay in approval /
enhancement
MIS generation
 Generation of MIS at different levels of process.
 System generated feedback from TPAs
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