ICICI Lombard GIC : Online Approvals for Health Claims E-CASHLESS OPD/IPD

The Problem: This project aims at bringing the provider network into the platform designed by ICICI LOMBARD GIC, which enables seamless communication between the insurance company and the hospitals. This application also enables online approvals, real-time tracking, document upload, portfolio management which otherwise would not be possible using Fax (that was used earlier). In a typical scenario, the provider networks (hospitals) normally raise pre-authorization requests (cashless requests) through fax as the medium of communication. With fax-based communication, the data sent by the providers normally was not validated, which results in further delay once a discrepancy is found. These transactions are very sensitive, since they involve patients being treated at the hospitals.

The Solution: The e-Cashless module has been developed to address this concern and provide the service providers with a single-window interface through which all the communication on the transactions could be taken care of. The application effectively serves as the portfolio management tool for the service providers where authorization requests could be raised and tracked till approvals, documents could be uploaded & MIS generated which includes historical data also.

The Result: Effectively, this eradicates dependence on use of FAX and achieves online approval generation.