Remedium HIMS - Insurance Management Module

The Health insurance coverage is growing and large number of patients have moved from out of pocket expenditure to health insurance cover. Health Insurance companies are entering into contract binding rates which effectively shifts the burden of managing costs to hospitals. Hospitals that can reduce costs through their use of a comprehensive HIMS offered by Remedium will benefit from the associated savings. Remedium Hospital Insurance Management Module is a comprehensive end-to-end solution designed to handle various types of insurance processing requirements and scenarios. The easy-to-use solution helps in quick processing of pre-authorisation and post hospitalisation insurance claims and will help reduce the accounts receivable and improve the revenue cycle management at Hospitals. The system is future-ready with the capability to transmit claims electronically to insurance gateways, as and when these are opened up in the country. The system can handle multiple insurance companies, multiple Third Party Administrators and also can store all the relevant inclusions and exclusions associated with each insurance company's policies, and, map the same to the insurance covered patients. The end-to-end system has facility to provide insurance in Out-patient module also, and, registers insurance patients, obtains pre-authorizations, checks the limits and exclusions against every order and ensures 100% compliance with individual insurance policy guidelines, ensuring excellent acceptance rate of the bills submitted to the insurance companies as well as ensuring 100% patient satisfaction with billing process.

Handles Insurance exclusions

Every health insurance product has defined coverage limits, which are clearly stated in the policy wordings of the plan. Every plan has a list of exclusions which will not be covered by the insurer. Hospitals can define what is covered and not against different plans and packages in Remedium Hospital Insurance Management Solution and the billing is handled automatically based on these business rules.

Handles PPN / NPPN providers

Hospitals can designate the insurance Companies or the TPAs with whom they have been empanelled as a Preferred Provider Network (PPN) partner. In such cases, the package prices agreed with the insurance company/ TPA is automatically shown at the time of billing. Co-pay amount, if any, can also be collected separately. In case of a Non PPN (NPPN) insurance company, or TPA, the case is dealt as per the NPPN requirements.

Remedium HIMS - Insurance Management Features

  • Authentication of insurance coverage of admitted patient
  • Instant verification of every service order against exclusions and limits
  • Incorporates Insurance Pre-authorization number against patient
  • Can handle multiple policies against the same patient
  • Easy process for insurance claim submission and reconciliation
  • Future-ready for automated claims submission

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