Transcript Emergency Hospitalization
PRESENTATION TO VA TECH
17TH JUNE 2011 June 2011 Slide No. 1
June 2011 Slide No. 2
Presentation By TTK Healthcare Services
Incorporated in March 2002 to provide third party administration Services Our Vision “To be the most preferred third party administrator”
June 2011 Slide No. 3
ISO Certified
TTK Healthcare Services exudes operational excellence in delivery of customer requirements, through defined quality processes
June 2011
Only TPA to be ISO certified for branches as well as H.O
Slide No. 4
June 2011 Slide No. 5
Role of a TPA
PROVIDERS Desiring less administrative burden, greater autonomy, faster payments, and greater incomes
TTK
Policy Holders Demanding better service, more information, and greater convenience Insurance Co Striving to reduce premiums.
Make better policies.
Aim at Claims Control June 2011 Slide No. 6
Pan India Presence
Branches
• • • • • • • • • • • • • • • • • • • • • • •
Bangalore Mangalore Manipal Hubli Hyderabad Vizag Chennai Coimbatore Madurai Trivandrum Cochin Ahmedabad Mumbai Pune Jaipur Ludhiana Delhi Patna Jamshedpur Bhopal Kolkota Bhuwaneshwar Sambalpur June 2011 Slide No. 7
All branches connected through leased lines Redundant connectivity
June 2011 Slide No. 8
CASHLESS APPROVAL Planned Hospitalization
&
Emergency Hospitalization
Planned Hospitalization
• •
If it is a Pre planned treatment, the cashless request should be sent before a week time Insurance coordinator in the Network hospital will give assistance & he is the only point of contact in hospital for insurance.
•
Fill the Pre-Authorizations Form, available with the Network Hospitals upon showing TTK Health Card. This can also be obtained from any of the TTK branch offices or can be downloaded from this site
• • • • •
Submit/Fax the Pre-Authorisation Form at our local branch office 4 days in advance If your hospitalisation is authorised, then ensure You pay for non-medical expenses and June 2011 Before getting discharge, the final bill should be sent to ttk before a 6 hours time.
Sign the relevant documents including a claim form before leaving the hospital/ getting discharged Slide No. 9
June 2011
Emergency Hospitalization
• • • • • •
Insurance coordinator in the Network hospital will give assistance & he is the only point of contact in hospital for insurance.
Get admitted into a network immediately Please inform your family member /relative to contact the billing dept in the hospital to inform them to intimate TTK If your hospitalisation is authorised, then ensure You pay for non-medical expenses and Sign the relevant documents before leaving the hospital/ getting discharged
•
If your hospitalisation is rejected, your treatment will be continued at the hospital. After discharge, you can then submit a claim for reimbursement purpose at the TTK Branch office near you.
•
After sending the fax, the insured person can get confirmation about the fax delivery by contacting the following HELPLINE NUMBERS: 044-42894444 / 044-42894445 (24hrs) & 9884604485(9am to 6pm) Slide No. 10
Mandatory details to be filled up in Cashless request
•
Insured name & Patient name with age & sex
•
TTK ID NUMBER. (If the insured person doesn’t received the TTK ID Number, as an alternate the corporate name & Employee Id should be mentioned in the request).
•
Mobile Number of the Insured person so that the Confirmation message will be sent once the approval is sanctioned.
•
Ailment & its duration & plan of treatment.
•
After sending the fax, the insured person can get confirmation about the fax delivery by contacting the following HELPLINE NUMBERS:
•
044-42894444 / 044-42894445 (24hrs) & 9884604485(9am to 9pm) June 2011 Slide No. 11
DON’TS WHILE SUBMITTING AS AN CASHLESS
• Incompletely filled Cashless form • Sending the Final bill/Enhancement at the time of discharge sharply.
• Filling the Patient Name in short (Whatever the name uploaded in the intranet should be filled in the cashless form).
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MEDICAL REIMBURSEMENT
Non - Cashless Hospitalization
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MEDICAL REIMBURSEMENT
Claim form 1 st & 2 nd page
(Available in the Internet ).
Medical Certificate duly filled by the Treating consultant with Hospital Seal
(Available in the Internet).
DISCHARGE SUMMARY :
Discharge summary (Detailed) in Original With Hospital Seal & Treating consultant’s sign (Should be in Hospital Letter head).
Date of admission & Discharge with time.
Detailed explanation about the treatment undergone.
Duration of the ailment.
Advice On discharge (Which contains Prescription).
Brief description about the investigation undergone.
IN CASE OF MATERNITY
: Obstetric Score/History (Number of live children) should be mentioned in the Discharge summary.
June 2011 Slide No. 14
LAB REPORTS (DO’S WHILE SUBMITTING AS AN MEDICAL REIMBURSEMENT)
Lab Reports in Original with Dr.prescription.
Lab bills (
If not mentioned in Main Bill
).
IN CASE OF FRACTURE :
X-Ray report with Film
IN CASE OF ACCIDENT :
FIR Copy/MLC/AR Entry. [MLC: Medical Legal Certificate, AR : Accident Registration Entry]
June 2011 Slide No. 15
(DO’S WHILE SUBMITTING AS AN MEDICAL REIMBURSEMENT) BILLS June 2011
Consolidated Main bill with detailed breakup.
Numbered Payment Receipt for the Payment made.
NUMBERED PAYMENT RECEIPT
Numbered payment receipt is different from the cash bill, even if the cash bill is submitted, numbered payment receipt is necessary for the claims to process.
If in case, the hospital doesn’t have a option of providing numbered payment the alternate document insured person can provide is a payment receipt in the receipt hospital letter head with the revenue stamp pasted & sign & seal on it.
Consultant bill/Surgeon bill.
Pharmacy bills with prescription.
(The above mentioned are only the basic documents required for processing, once the claim is scrutinized,. If
necessary,
medical queries will be raised for further processing)
Slide No. 16
Pre & Post Hospitalization
• Up to 30’days prior to the date of admission any treatment related expenses for pharmacy, lab, consultation charges is payable.
• Up to 60’days the post hospitalization treatment related expenses for pharmacy, lab, consultation charges is payable.
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• • • • • • • • • • • • • • •
General Exclusions
Injury or disease directly or indirectly caused by or arising from or attributable to War or War-like situations Injury or disease caused directly or indirectly by nuclear weapons Circumcision unless necessary for treatment of disease Dental treatment of any kind unless requiring hospitalisation Congenital external diseases or defects / anomalies HIV and AIDS or treatment for Venereal diseases Hospitalisation for convalescence, general debility, intentional self-injury, use of intoxicating drugs/ alcohol.
Naturopathy including spas, therapeutic massages etc….
Any non-medical expenses like registration fees, admission fees, charges for medical records, cafeteria charges, telephone charges, etc Cost of spectacles, contact lenses, hearing aids Any cosmetic or plastic surgery except for correction of injury Hospitalisation for diagnostic tests only Vitamins and tonics unless used for treatment of injury or disease Infertility treatment Voluntary termination of pregnancy during first 12 weeks (MTP) Natural calamities / acts of God – floods, storms, earthquakes etc….
June 2011 Slide No. 18
DON’TS WHILE SUBMITTING AS AN MEDICAL REIMBURSEMET
• Submitting the claim documents after 30days from the discharge date. If in case of submitting after 30days, the letter from the insurance company to be enclosed for processing. (Letter from insurance should contain a valid reason for the late submission. Insured person can request to the New India Assurance for the above mentioned letter.
• Photocopies of the documents are strictly not applicable as per the policy.
June 2011 Slide No. 19
ORIGINAL DOCUMENTS RETURN
• If the insured person needs the original documents back for the further treatment, It will be provided by submitting a request letter signed by the insured person.
• Discharge summary & Bills will not be returned at any cost.
• Request for the original documents is applicable, only if the claim is settled.
• Original documents will be returned to the insured person within 20 working days from the requested date.
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PROCESS
ID card Process
Insurance Company issues Policy ID card printed and dispatched along with Guide Book.
Insurance company sends Data to TTK HCS Direct login by Corporate Employees to access E-cards Generation of Unique TTK ID no/email notification to emps with Login id & password Photographs scanned And uploaded By TTK Data validation Process Contents of Policy Transferred to TTK Data Base.
Physical Cards (Photo/Non-Photo)
7 working days
E-Cards
June 2011 Slide No. 22
Cashless access for Hospitalization Hospital faxes Pre Authorisation to TTK on Toll Free Number Patient approaches Network hospital Based on recommendation of physician and displays Tafe Id Request received at TTK Pre Auth dept thru fax servers
CYCLE TIME 6 hrs.
Authorisation faxed to Hospital Claims Dept checks for coverage and eligibility Medical Dept checks for Treatment costs and also verifies tariff If query raised to the Hospital, a dedicated helpdesk at TTK calls the hospital and closes the query.
Help Desk at Select Hospitals: Authorization & Billing
June 2011 Slide No. 23
Claims Reimbursement Insured submits Claim to TTK help desk/ courier/ TTK office Discharge Voucher with claim Computation sent To customer Claim Approval Validation of customer Id Document Completion Verification Yes
CYCLE TIME 7 days
Claim checked By Medical professionals Claims registered and Pre computation taken Claim checked by Insurance trained executives.
No
Communication sent to Customer for Documents within 3 working days Receipt Of Missing Document
ECS Claim Settlement
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Very large Provider Network
Provider Network 4749 Hospitals / Nursing Homes in 390 cities and 3536 Diagnostic Centers in 31 locations.
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Network – Empanelment Extensive Service Provider Network Delhi NCR,HP,Uttaranchal 390 Locations 12 Uttar Pradesh Rajasthan & Jammu& Kashmir Punjab & Haryana North Zone Goa Madhya Pradesh Gujarat Maharashtra Daman and Diu West Zone 101 340 966 1419
Network Strength in
Karnataka Kerala
India
Andhra Pradesh Tamil Nadu &Pondy Pondichery South India 269 201 124 266 860 734 545 693 13 209 2194 June 2011 Slide No. 27 4749 Hospitals West Bengal Bihar Jharkand & hattisgharh Assam & Orissa East Zone 164 18 42 92 316
Network – Empanelment Extensive Diagnostic Center Network Delhi NCR,HP,Uttaranchal 31 Locations 13 Uttar Pradesh Rajasthan & Jammu& Kashmir Punjab & Haryana North Zone Goa Madhya Pradesh Gujarat Maharashtra Daman and Diu West Zone 3536Diagnostic centers 92 283 509 897
Network Strength in India
Karnataka Andhra Pradesh Tamil Nadu &Pondy Kerala South India 115 311 140 212 778 585 397 341 268 1591 June 2011 Slide No. 28 West Bengal Bihar Jharkand & hattisgharh Assam & Orissa East Zone 106 20 34 69 229
Misuse and Fraud Prevention Investigations Department •
Verification of hospitalization records • Validation of Medical Records • Case Selection based on Past Data Analysis.
• 10% of All Claims Investigated.
• Investigations Team Visits for all high Value Cases • Visits as a WELL-WISHER • Carries a Get Well Soon Card!
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Geared for Customer Convenience
E Alerts
SMS Facility: Give us your mobile number in the preauthorization form and you will get an •SMS sent when request received.
•SMS sent when authorization processed
098452 48885
Email Notification: Give us your employees email id in the proposal form and you will get an email when • pre auth request is received.
•Pre authorization request is processed
•claims notification
June 2011 Slide No. 31
HELPLINE NUMBERS
GENERAL HELPLINE NUMBERS CHENNAI: 044-42894444 1800-425-7575 Chennai Fax: 044-42183300 044-42024343 CORPORATE PRIORITY CALL CENTER NUMBER: 044-42894445 & 9884604485 (9AM TO 9PM) CALLS HANDLED BY CALL CENTER AGENTS June 2011 Slide No. 32
CONNECT TTK
TOLL FREE NOS.
TTK HO CALL CENTER TTK HO CALL CENTER TTK CHENNAI CALL CENTER TTK MUM CALL CENTER TTK COCHIN CALL CENTER TTK HYD CALL CENTER ICICI CALL CENTER CITI BANK TOLL FREE NO.
TTK KOL CALL CENTER ZERO COST TO CONSUMER
* Airtel subscribers only
TTK HO FAX NO.
MUMBAI FAX NO.
COCHIN FAX NO.
CHENNAI FAX.NO.
1800 425 8885 1800 425 7878 1800 425 7575 1800 22 1717 1800 425 6264 1800 345 4051 1800 229 229 1800 425 4448 1800 345 7069 TOLL FREE FAX NOS.
1800 425 2626 1800 22 1919 1800 425 6262 1800 425 7474 June 2011 Slide No. 33 FIRST TPA IN INDIA
to introduce New Toll free number Reachable from mobile*
1800-102 -1234 CITY SPECIFIC TOLL-FREE NUMBERS UNIQUE TO TTK ONLY.
24/7 Call center
24 hour toll free helpline to provide assistance with • • • • • Hospitalization-Pre-authorization related queries – approval status, reason for partial rejection etc Policy Scope and Coverage related queries Enrollment ID Card queries Information on Network hospitals Claim Related queries
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