Cashless Pre-Auth
Every cashless request checked against policy and tariff, ready for a doctor well inside the 1-hour clock.
Why it matters
Pre-auth requests arrive as scanned forms and notes; processors look up cover, waiting periods and tariffs by hand while the 1-hour clock and the family wait.
How the solution handles it
Agents read the request, check cover, waiting periods and sub-limits, price it against the hospital’s tariff, look for fraud signals and summarise the case. Missing papers become one query. A medical officer approves every amount.
How a request moves
Six agents read the request, check cover and tariff, look for fraud signals, summarise and draft queries; a medical officer approves every amount.
What it reads, and what it hands back.
What goes in
- Hospital pre-auth request form
- Doctor’s notes and investigations
- Policy schedule and member history
- Hospital tariff and package rates
What comes out
- Authorisation ready for decision
- Single query to the hospital
- Approved amount by line
- Clock on every request
Who uses it
The difference, in numbers.
Every figure is labelled: a target the solution is built to, an estimate, a typical published result, or a proven one.
target median
Source: IRDAI Master Circular on Health Insurance Business (May 2024), cashless decision within 1 hour · “Target” = design goal, measured in the live solution · “Estimated” = our estimate · agents = the live solution’s configuration
6 specialist agents. One person decides.
More in this division.
Every final bill checked against the pre-auth and tariff, so final authorisation lands well inside 3 hours.
Reimbursement ClaimsEvery reimbursement claim read, checked and priced, with a cited file ready for decision in a day.
Bill & Tariff AuditEvery hospital bill audited line by line against agreed tariffs and packages, every deduction cited.
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