Every Insurer and Client wants to reduce the claims ratio and improve the performance of their health Insurance policy and we at WAPMED acknowledge the importance of putting systems & protocols in place to ensure that unnecessary expenses are eliminated. First step in achieving this is negotiating discounts with all providers get special rates for large Group Policies. Regular monitoring of / visits to hospitals to detect any unhealthy practices and excess / unwarranted billing / admissions is also an important part of this exercise. Few others steps that helps achieve WAPMED its goal are as follows-
- Investigation of suspicious member claims and random visits to hospitals by our Doctor’s / Investigators to confirm the admissions and also to validate the information provided by the hospital in the Pre Auth request with the actual facts.
- Every claim irrespective of claimed amount or no. of invoices is scrutinized by a staff with clinical background.The objective of the present medical scrutiny done at WAPMED is to identify Inappropriate billing pattern, Detection of customary overcharges, Duplicate billing detection, Visiting Doctors charges, Fee schedule, filter out unnecessary admissions, monitor length of stays.
- The software used by WAPMED is highly sophisticated and has in built checks and restrictions, which makes claims processing faster and reduces the error rate, since there are few points where manual intervention or decision making is required. Every member enrolled in WAPMED’s software has Unique Health Identification no. (UHID). All the policies and their respective claims for the particular member are mapped under the same UHID no. Hence all the medical history (Pre-existing / Chronic) are available in the same window which is accessible by all the assessors for medical scrutiny.
- Discounts: Based on the business volume WAPMED has been able to negotiate considerable discounts on the published rates from providers on its network. WAPMED has also been successful in negotiating package rates for a large number of procedures with majority of the hospitals, which reduces the claims ratio and improves the performance of the Health policy. For large groups where a majority of the employees go to specified few providers, WAPMED has been able to negotiate a higher discount or a lower tariff for those groups, by restricting the network. Many optical centers, pharmacies, diagnostic centers have agreed to give special discounts to WAPMED clients even on services which are not covered under the Insurance plan.