Services Offered

Empanelment Assistance

Backed by years of experience in the insurance sphere, we assist with getting the hospital empanelled with the TPAs and insurance companies. With our scientific approach to costing we are able to help the Hospital arrive at competitive rates for packages that are mutually beneficial to the hospital and insurance companies. We will bring the TPA representatives for hospital visits and negotiate the best possible package rates on behalf of hospitals with the insurance providers.

Insurance Help Desk

• Patient Advisory services provided by industry experts with a passion for healthcare resulting in improved hospitalization experience and increased goodwill towards the hospital.
• Services experts gather policy information, glean details therein and clearly explain inclusions and exclusions to patients / policy holder.
• Services experts gather policy information, glean details therein and clearly explain inclusions and exclusions to patients / policy holder.

Metrics

• We enable better decision making using quality provided at the right time
• Our reports are customized to meet the needs of people at various levels in the hospital’s management hierarchy
• Meaningful and better MIS provided at the right time will enable the management to better negotiate with TPAs, planning equipment upgrades and infrastructure improvements
• Reports that we will provide are below. We are open to discussion regarding any additional reports required by the hospital

Health Insurance Claim Processing

• We will secure pre-authorization and enhancement for the medical procedure from the TPA / insurance company using electronic communication using technological tools which guarantees no transmission delay or loss of transmission
• We determine the amount to be collected from the patient based on the final bill. This is communicated to the billing staff thereby eliminating the burden to determine patient responsible portion of the bill.
• We prepare the claim packet after the patient is discharged
• Our QC expert reviews the claim packet to ensure completeness of documentation
• We file the claim with the TPA/insurance Company, and follow – up with the TPA/insurance company to secure approval/payment.

To Insurance Holders

If the healthcare facility is not in-network with the TPA / Insurance company, we provide re-imbursement assistance to the insurance holder. We willreview the available documentation, point out any necessary corrections and / or missing documents (if any) to ensure smooth claim processing. We will fill and file the insurance claim on the patient’s behalf; and follow-up with the insurance company to secure payment.iServices will charge a nominal fee for this service.
The patient / insurance holder is explained that reimbursement assistance is a service offered by iServices and not by the hospital. The fee for this service is directly borne by the patient / insurance holder.