Cashless treatment is the present trend in health insurance in India. The facility allows any health insurance customer to avail treatment from a listed hospital in India without paying the hospital bill upfront. The bill will be paid by insurance company at a later date to the service provider hospital.
To make the whole system effective, insurance companies utilize services of intermediaries called Third Party Administrator (TPA) licensed by the Insurance Regulatory and Development Authority. The cashless treatment system works based on a communication from hospital to the TPA, generally referred to as “Pre Authorisation Request (PAR)” and a reply from the TPA admitting claim and guaranteeing payment to a certain limit which is referred to as “Cashless Authorization”.
Many a time, information in PAR may not be sufficient for the medical experts of TPA to decide whether a hospital bill is payable in the context of the insurance contract. This causes unusual delay in decisions from TPAs causing unpleasant situations with Insurers, their customers and hospital concerned.
VR Assurance Patient Information system ensures a smooth functioning of the cashless treatment facility. Trained paramedics of VR Assurance visit a hospitalized customer and collect medical information from them and also from the hospital. This information is made available to TPA for enabling them to take a quick and correct decision on a claim.
Quick decisions on cashless claims increase customer satisfaction and ensure better business for insurance companies.
In addition to the information in PAR, all required additional information is made available through the reports of paramedics of VR Assurance. This would reduce work load of hospitals in responding to the many queries of the TPAs. These make documentation work at hospitals simple and easy. Further it improves relation between TPA and hospital.
Correct information on the illness allows TPAs to avoid all fraudulent claims which ensure a profitable portfolio for insurer. TPAs also benefit from the lower claim ratios. Fraudulent claims account for 25 to 35% of the total claim outgo. In US, 29% of Medicare claim paid for durable medical equipment was erroneous in FY 2006. (Inspector General Report, Department of Health and Human Services, August 2008)
The data collected on all hospitalized cases is stored and analyzed by VR Assurance so that many useful reports on the claims shall be generated and studied by TPA experts for their future planning. Further VR Assurance system is a very cost effective one for TPA to reach all hospitalized customers.
VR Assurance is a group of highly experienced healthcare professionals from the fields of insurance, clinics, labs, IT, finance and support functions. Currently we have offices and staff across Kerala. Capital city of Trivandrum holds our headquarters.