Transcript Claims Online with e

MEDILINK
What is the Claims Online with
e-Card XP Debit card?
• Solution subscribed by Generali Pilipinas from
MediLink to be able to offer electronic hospitalization
program to its corporate clients
• First membership and payment system in the
healthcare industry
• Offers “real-time” processing and settlement of
claims
• Members are treated as private patients (own choice
of doctors)
• Utilizes the Multi-purpose application of Equitable
Card Network’s e-Card XP VISA Debit card
MEDILINK
e-Card XP VISA Debit Card
GENERALI PILIPINAS
Front
MEDILINK
Equitable Card Hotline: to report lost / damaged cards
Jane De La Cruz
Back
MEDILINK
Existing Availment vs Claims
Online with e-Card XP
NESTLE
• Manual Issuance of
Letter of Guarantee
(LOG)
• Claims settlement after
confinement.
– Hospital sends bill to
NESTLE
– Excess determination
largely up to
accredited hospital.
• Accepted in 76 Service
Providers nationwide
Claims Online with e-Card XP
• Swipe technology
• Electronic Eligibility
verification prior to
Admission
• Plus claims settlement during
confinement
– Electronic claims settlement
– Excess to be identified and
paid prior to discharge.
• Accepted in 94 key
Designated Hospitals
nationwide (to become
160++ by mid year)
MEDILINK
BENEFITS TO
NESTLE EMPLOYEES
• Cash-less hospitalization plan in more hospitals
• Members are treated in hospitals as “private” patients.
– Member can choose his own doctor/s
• Automatic reconciliation of hospital bills.
– Members informed of updated benefits on the day of Admission
at e-Card XP designated hospitals.
– Electronic loading of benefits on the day of discharge.
• No need to secure Letter of Guarantee prior to admission
• Employee and Dependents will be given individual Medilink e-Card
XP Debit Cards (except those below 13 years old)
MEDILINK
IN-PATIENT (IP) AVAILMENT
STEP 1:
CARD ACTIVATION
WHEN
Admission
EMPLOYEE or
Qualified
Dependent
Presents card for swiping at the
MediLink’s POS Terminal. If eligible: Signs
the electronic Notice of Activation (NOA)
generated by the terminal
DESIGNATED
HOSPITAL
Swipes card to signify admission.
Performs normal admission process.
MEDILINK
Sample Notice of
Activation
(NOA) Slip
MEDILINK
SAN JUAN DE DIOS HOSPITAL
ROXAS BLVD., PASAY CITY
61000295
80000000009238
MEDILINK
MEDILINK
4559689100003333*
CARD VER
000001
GENERALI PILIPINAS –INPATIENT 29P
MAY 25, 05
09:45
NOA# 782808
499222750145
782808 25DEC2006
TRANSPOS47
HUMILDE, MARILYN
TOTAL
PHP0.00
Line 1:
Generali Pilipinas ; Coverage; Age
Line 2:
Activation Number ; Date of
Transaction
Line 3:
Name of Member
Line 4:
Policy Number
Line 5:
Corporation Name
Line 6:
Card Number
Line 7:
Room and Board
Line 8:
With PHILHEALTH/NONE
Line 9:
Disclaimer
N11111-2-00
NESTLE PHILS.
CARD# 4559689100003333
RNB: Php550/DAY
PHILHEALTH REQUIRED
SLIP MEANS CARD HAS
PLEASE SWIPE DURING
LOADING OF BENEFIT.
HOSPITAL TO PROVIDE
GENERALI PILIPINAS.
BEEN ACTIVATED.
DISCHARGE FOR
MEMBER AUTHORIZE
ALL RECORDS TO
Marilyn Humilde
•
Note: Pls. Ask your HR for a copy of the
signed PHILHEALTH FORM
IN-PATIENT (IP) AVAILMENT
STEP 2:
VERIFICATION OF COVERABILITY
GENERALI
Authorizes admission (w/n 24 hours).
Calls the Patient confined in the MediLink
Designated Hospital
MEDILINK
IN-PATIENT (IP) AVAILMENT
STEP 3:
LOAD PROCESSING
WHEN
Discharge
EMPLOYEE or
Qualified
Dependent
Presents card for swiping at the MediLink POS
Terminal to signify discharge. Signs the
Notice of Load processing slip.
HOSPITAL
Swipes Member’s card
Faxes Final Statement of Account (SOA) upon
request of the member.
MEDILINK
Sample Notice of
Load Processing
(NLP) Slip
MEDILINK
SAN JUAN DE DIOS HOSPITAL
ROXAS BLVD., PASAY CITY
61000295
880000000009238
MEDILINK
4559689100003333*
AUTHORIZE
000001
GENERALI
PILIPINAS
–INPATIENT
MAY 30, 05
09:45
29P
499222750145145
782145
TRANSPOS47
NLP#
782145
30DEC2006
TOTAL
PHP0.01
MEDILINK
HUMILDE, MARILYN
Line 1:
Generali Pilipinas ;
Coverage; Age
Line 2:
Load Processing
Number ; Date of Transaction
Line 3:
Instructions
Authorization
Disclaimer
KINDLY FAX SOA: 8865238
BENEFITS WILL BE LOADED TO
CARD:4559689100003333
I WILL USE AMOUNT LOADED TO SETTLE
HOSPITAL BILL.
I AUTHORIZE HOSPITAL
TO PROVIDE GENERALI ALL DOCS OF MY
CONFINEMENT.
Marilyn Humilde
IN-PATIENT (IP) AVAILMENT
STEP 4:
COMPUTATION OF BENEFITS
(FAX LOA) AND MEMBER ALERT
WHEN
Discharge
GENERALI
Received Final SOA from the Hospital
Processes claim and loads Member’s card
based on approved benefits.
Alerts/Informs the Member of approved
amount (via SMS Notification)
MEDILINK
Sample Member’s Text Notification
Total Hospital Bill
P30,300.00.GENERALI
has loaded P30,300.00
inclusive of PF of DR.
ABELARDO MENDEZ
(PHP12,000.00),
DR.INOCENTE PEREZ
(PHP 6,000.00). Pls
proceed to cashier to
settle bill.Thank you.
Options
Options
Back
MEDILINK
Back
IN-PATIENT (IP) AVAILMENT
STEP 5:
PAYMENT
WHEN
Discharge
EMPLOYEE or
Qualified
Dependent
Presents card at the Cashier. Signs Credit Card
Receipt
HOSPITAL
Swipes the card in the Credit Card Terminal and
enters amount given by the Member. Accepts
payment
MEMBER
Submits original hospitalization documents to
NESTLE Site Nurse within five (5) working days
(from date of Employee’s return to work)
MEDILINK
Sample Credit Card Receipt
SAN JUAN DE DIOS HOSPITAL
ROXAS BLVD.PASAY CITY
TERM# 60000005
MER#720500007
CARD TYPE VISA
4559689100003333
MARILYN HUMILDE
AUTHORIZE
EXPY DATE
05/06
BATCH NO.000001
TRACE NO.
597201
DATE/TIME MAY 30, 05 13:25
REF.NO.000040597143
APPR.CODE015424
TOTAL
PHP 30,300.00
Marilyn Humilde
REMINDERS
•
•
•
•
•
Present your e-Card XP Debit Card on the day of your admission (Card
Activation) and on the day of discharge (Load Processing and Payment).
Qualified Dependent is defined as a NESTLE Principal Member’s Dependent
who is 13 years old and above and qualified to be given an e-Card XP VISA
Debit card
For Dependents of Principal Member less than 13 years of age, it will be the
Principal’s e-Card XP which be loaded on the day of discharge. Only the
Principal Member is allowed to sign on behalf of the Dependent
Be familiar and read your customized e-Card XP Member Guide.
In cases where the Professional Fee of your Attending Doctor is not part of
the Hospital Final Statement of Account (SOA), the Employee/Patient will
have to advance the payment. However, as an alternative, you can ask for
Generali’s help by calling the 24/7 hotline. Generali will try to convince your
doctor to include his PF in the hospital Statement of Account. But of
course, final decision rests on the doctor and you should still be ready to
advance payment if ever they don’t agree to include it in the Hospital bill
MEDILINK
REMINDERS
• Special Arrangement hospitals
– These are hospitals that accept VISA payments, but has no
Medillink POS facility for card activation upon admission
– For these hospitals, please contact Generali to notify them of
your admission and discharge via these numbers:
• (02) 894-1135
(Mon-Friday: 7 am to 10 pm;
Sat-Sun: 8 am – 5 pm)
• 0917 – 8941135 up to 36 (24 by 7 hotline)
– Or send a Text Message given the format below
• NOA <Card number> <Hospital Code*> IP then send to 0917
8942901
• NLP <Card number> <Hospital Code*> IP then send to 0917
8942901
* Refer to Member Guide
MEDILINK
REMINDERS
• Take care of your E-Card XP:
– Report any damage / loss immediately (see back of
card or call Generali) and advise Nestle HR
– Replacement cards will have the ff charges:
• Lost Cards: Php150.00
• Damaged Cards: Php100.00
• Notify HR of personal changes immediately:
– Especially NEW dependents or change in Marital
Status
– Nestle HR should report these changes to Generali
within 30 days from the effectivity date.
IN-PATIENT (IP) AVAILMENT
MEDILINK
Thank You!