CURRENT INDIAN SCENARIO: 1.

Pain Points of Hospitals: Cashless pre-authorization form is submitted with empanelled hospital The hospital sends the form to the third-party administrator (TPA) Depending on sum insured, disease, etc., TPA approves or rejects the application (In case approved) Further enhancement of amount may be done Treatment becomes cashless Only medical costs not covered in contract have to paid by the patient If not Hospital bills to be settled by the patient and, later, re-imbursement claim to be filed

2. Faced By Insurers Emergence of Corporatization or hospital chains in urban areas Limited bargaining power for the insurers Limited data on consumers and disease patterns

3. Faced By Hospitals y Low penetration by insurers in tier-II/III cities y y Challenges in getting reimbursements for cashless schemes run by Government Schemes. Lack of automated claims processing

y Lack of interoperability with TPAs and insurers 4. Faced By TPAs Limited funding support from the insurers No accreditation

5. Impact On Health Insurance Policy Holder Ballooning costs Healthcare restricted to few top cities No healthcare costs standardisation Lack of quality hospitals Longer disbursement time Difficulty in judging authenticity of procedures and costs

Issues with respect to HH claimsconnect application y Operational level:

1. Infrastructure: Unavailability of required hardware 2. Unavailability of required hardware at a one specified location. i.e. Hospital helpdesk 3. Lack of trained Staff 4. Attrition y Execution level: Approval: Taking the consent of all the people involved for the roll out y Management level:

1. Convincing the management as to what all benefits HH claims application can provide. 2. Cost involved in using the HH claims application. y Staff level:

1. Reluctance in using the Application. 2. They don t want to do task which involves any amount of data entry. 3. They find it easy to send fax as they are used to faxing.

Application /Software level:

1. User friendliness 2. Response Time of TPAs 3. Over all task involved in pushing 1 pre auth to the TPA 4. Customization of Application according to the Hospitals need.

Usage:

1. Unavailability of staff during odd hours to process claims using online application 2. At the time of discharge, staffs prefer to receive a fax for the approval of enhancement. 3. Approvals received on Hospital Fax or Email.

Steps that can be taken in order to minimize the above mentioned issues: 1. Selective target (Clientele ) for the HH Application. y y i.e. Approaching hospitals with huge volume of cashless Approaching hospitals with proper infrastructure and staff

2. To have a proper Presales team for demo and making the client understand the value proposition that HH calims application can add. 3. Understanding the exact client requirement before demonstrating the product.

4. Try to address at least some amount of requirements shouted by the Hospital which is not a part of the claims process. i.e. in case the hospital needs to automate the registration process, we should be in a condition to provide a module for the same. 5. 6. 7. Flexibility in price points. Interoperability of the HH claims application with all the TPAs. Minimize data entry for the users.

8. Provide built in database for almost all the fields. i.e. In built diagnosis set, problem set, investigation set, Allergy set although the fields are not mandatory. 9. Provide Drug database in the HH claims application.

10. Providing patient data security at every level. 11. Eadjudiconnect dash board is preferred more than claimsconnect application. So providing a similar dash board. 12. Customizing the application as per Government Hospitals needs and PSU Hospitals needs. Then the same can be pitched to these Hospitals. 13. Try to maintain 99% of uptime for the application. 14. Providing certain Analytics to the hospitals which is useful in determining the Cashless Patients treatment pattern and also TPAs and Insurers promptness 15. Providing a follow up from our end with the TPAs and Insurers if required for the final settlement of claims. 15. To have a centralized call centre (toll free/landline) for Pan India Users. 16. Assigning a relationship Manager for contracted or trial hospitals who can basically plan and roll engagement with the hospitals and also explore any new client requirement where in we can fit in with HH products.