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Claims Management

Introducing hospiclaims.com, India’s first unique and hassle free, clear, highly responsive, claims information and settlement management system which not controls the efficiency of claims documentation but also expedites claim closures through a team of claim experts, Doctors and Medical specialists on panel and a dedicated and highly trained team operations team! If you are an hospital owner or administrator, this is the opportunity to put an end to your woes with delays in settlement of cashless claims, deploying manpower unnecessarily in unending and frustrating follow up work especially when it is not your core activity, and of course pacing up working capital flow by opening up blockages in the entire claim settlement process from involving the hospital, TPA and Insurer.
  • While the primary purpose of outsourcing claims settlement is to minimise the claim period, claims processing, in several cases, is riddled with delays.
  • Many hospitals also report additional expenditure incurred by them in terms of smooth coordination with TPAs for efficient delivery of services to the policyholders
  • Average number of cashless claims lodged with TPA (both PSU / Pvt) per hospital per month is 400-500 per month or 14-16 per day, in a typical Metro city based 100-150 bed hospital.
  • A large proportion of claims exceed the assigned / committed time frame for settlement period by the Insurer, whether Pvt or public. There is an inordinate delay in the settlement of an estimated at 40-50% of cashless claims lodged with private health insurance companies, and almost 50-60% of cashless claims lodged with public insurers , mostly due to the oscillating correspondence and efforts to gather missing / inadequate documents .
  • The average time frame for claim settlement is found to be between 45-60 days, with about 10-20% cashless claims exceeding even the 90 days frame to get settled.
The major reasons for this are:
  • Low level of automation prevailing amongst hospitals with claim coordination and follow up happening with TPA / Insurer through mainly through mails / calls / manual documentation.
  • High dependency with the TPA to expedite the process the O/S amounts, with no dedicated support system or agency for the Hospital.
  • Doctors / Surgeons fees and other operational expenses get delayed, leading to churn of team and also delayed cash-flows.
  • Escalation of interest cost and hence working capital locks in due to substantial cash-flow getting stuck in this loop.

There is a pressing need to reduce the Claims clearance TAT by at least 30-40%, in order to reduce huge amounts of working capital expense locked up, improve the loyalty of doctors and other staff by timely dues clearance, and also reducing interest cost escalation through a smart, responsive, and mission critical system which combines project management and document management application coped with dedicated and trained manpower for outsourcing and optimising the entire cashless claims information & settlement process .
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- Anjali Samuel, Managing Partner
Mindfield Resources FZ LLC, Dubai, UAE


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Ritz Search, Dubai, UAE

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Ideal Technosoft Pvt. Ltd. have meticulously proven to be an extremely cost effective and professional resource and we definitely see the company as our long-term technology partner.

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Oman Agencies

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