SEVENSIGMA

Pursuit of perfection by Working Differently.

A SevenSigma initiative

Augmenting Govt.
Healthcare
schemes with Our
Hospital and
Healthcare Partners
A SevenSigma initiative

Promoted by Doctor R.
Satheesh - 30 years of
experience as a Doctor and
Admin

who we are Supported by a 70 member

(and growing) Team of Experts
in Insurance, IT, and Finance

Cumulative experience of 100

years in their respective fields
A SevenSigma initiative

Enabling smoother claim

processing to strengthen
Revenue Cycles
what we do
by capturing, thoroughly analyzing,
managing, claiming, and settling the
revenue receivable from a patient
A SevenSigma initiative

what makes us different

We have identified 163 issues that impact claim settlements

We handle from the patient’s admission (cashless) to discharge

We negotiate tariffs with TPAs and suggest and make recommendations on

issues that have an adverse impact on the hospital

We collaborate with the hospital to ensure that there are no shortcomings in the
patient’s care through our communication infrastructure

We regularly follow up with TPAs for a speedy approval of preauthorization

We coordinate with all departments for a smooth discharge

A SevenSigma initiative

KASP - Ayushman Bharat

ESIC
schemes we ECHS

handle Various TPAS (20+)

Major Organizations (BPCL,
FCI, BSNL)
A SevenSigma initiative
Healthcare
is now
highly
regulated

Price control in Improvement

drugs, implants;
Importance of in state of
price-sensitive Credit Schemes public
clientele hospitals

Current
economic
situation;
competitive
market
A SevenSigma initiative

Benefit 3 Benefit 1
Attain your social objective
Increase your Revenue and
Penetrate to the lower
EBITDA
economic strata
Benefits of
Credit
Schemes

Benefit 2

Increase the patient

footfall, OP and IP
A SevenSigma initiative

front office management

We conduct a thorough analysis of the claimant’s validity and the cards issued
under various schemes or initiate a temporary card facility

We help the patient in filling the various forms required

We ensure seamless documentation by procuring the required paperwork

We help in completing the pre-authorization requests, on the hospital’s behalf

We coordinate with the doctors and departments to complete their formalities

We assist Billing to ensure the required expenses are included, and send the
request to various TPAs and in the reconciliation of settlements
A SevenSigma initiative

Bifurcating the bills at the time of

discharge into the respective
co-payments and disallowances,
including non-medical expenses

discharge Coordinate with billing staff to

suggest the best alternatives to the
management hospital’s benefit

Claim submission sent to the TPA

and reimbursement is collected
within 60 days from discharge
A SevenSigma initiative

claim rejection and arbitration

We take up unduly rejected cases with TPA for reconsideration with proper
justification, provide additional documentation if needed

In case of any unjustifiable deductions from the TPA’s end, we raise a query with
them to verify their deductions from the claimed amount

We verify the deductions and any arbitration required is done with the TPA,
providing adequate reasoning
A SevenSigma initiative

we conduct periodic
reviews of the
different schemes,
and make
amendments, if
required
A SevenSigma initiative

Positive
healthy cash Overall business
environment for
flow doctors and staff growth

facility Proper vendor

optimization management,
better profitability
A SevenSigma initiative

ASTER MIMS, CALICUT

RAJAGIRI HOSPITAL, ALUVA
STARCARE HOSPITAL, CALICUT
MOTHERCARE, MANNARKKAD
WELCARE, PALAKKAD

our clientele MES MEDICAL COLLEGE

CARITAS HOSPITAL, KOTTAYAM
MODERN HOSPITAL
CO-OP HOSPITAL, IRINJALAKUDA
CARMEL HOSPITAL, ALUVA
LAKSHMI HOSPITAL, ALUVA
ANAAMAYA HOSPITAL PAYYANNUR
A SevenSigma initiative

thank you.
Dr Satheesh:
+919447147689

Shaji Kumar:
+919645345084

Kochi, Calicut, Trichur, Trivandrum, Bangalore