Remedinet Technologies: Simplifying Claim SettlementPosted: July 6, 2015
This story was first published in SME World magazine’s June issue. Remedinet Technologies – An Overview Remedinet originated as a platform to provide technology solutions for overcoming the limitations of the current claim settlement process. Remedinet solutions enable capturing and exchange of relevant data for claim settlement in a structured and electronically readable format. By providing tailor made solutions for the payers and the providers, Remedinet brings them on the same platform and simplifies the claim adjudication and settlement process. The solutions provided by Remedinet eliminate inaccuracies and make it easier to monitor the progress of the entire process. They bring in greater transparency thereby, reducing the overheads of disputes and multiple to and fro between hospitals and payers.
Their simple solutions for the seamless exchange of information between payer and provider have made Remedinet a key technology partner in implementation of various government health insurance schemes and in ensuring their success. By shifting the data capturing and exchange to Remedinet platforms, several insurance companies, TPAs and hospitals have made the claim settlement process accurate, simpler and standardized. With their technology solutions, Remedinet is facilitating the adoption of global best practices by the Indian health care industry.
Electronic Preauthorization Manager (EPM): All cashless treatment processes require pre-authorization from the insurance companies. EPM provides web-based electronic forms for entering all the information. This has helped in reducing the instances of incomplete data and has brought down the Turn-Around Time (TAT) of 4-24 hours to less than 4 hours in 85% cases. The platform provides an overview of all the transactions, their status and past history. This technology makes the pre-authorization system fast, accurate, reliable and accountable.
Electronic Claims Manager (ECM): ECM helps in easing out the most critical phase of the entire process viz. cashless insurance claim. ECM allows hospitals to submit claims electronically by using the standard IRDA compliant claim & bill formats and soft copies of all supporting documents required by various insurance companies. By configuring mandatory fields and documents at pre-authorization phase, ECM significantly reduces queries from insurance companies regarding incomplete claim forms and missing documents. ECM also makes it possible to track the status of a claim settlement process.
This company received series A funding from Bessemer and Nirvana in 2012 and series B funding from Rakesh Jhunjhunwala’s Rare Enterprise in 2014.
Remedinet’s Business Model
Remedinet follows a pay-per-use model. Being a cloud-based platform, they do not charge for integration or installation.
The Idea behind Remedinet
The Health Insurance space uses outdated mechanisms for exchange of information and processing that information. The idea was to bring in technology that would enable the transformation of this space to use completely electronic data and automate large parts of the decision making process. Remedinet’s platform helps to do-away with manual exchange and processing of data, giving way to increase in efficiency, transparency, reliability and thus, standardization of processes.
Remedinet as the Bridge
There are more than 25 Insurance Companies and more than 25 TPAs in the health insurance Space. A typical Hospital would have relationships with more than 20 of these. However all the interactions between the two take place via email or fax – electronically non-readable formats that require human intervention for processing. Technology was not being used either in the exchange of information or in the whole adjudication and decision-making process. Thus, there was a great need for enabling technology to change the way health insurance was administered and that is the opportunity and challenge that formed the basis of Remedinet.
More than 15000 cashless claims in the commercial space are processed every month and close to 50000 cashless claims are processed as part of various government schemes powered by Remedinet. These schemes include the Tamil Nadu Chief Minister’s Health Insurance Scheme that covers 1.32cr families and two Karnataka Government Schemes; The Jyothi Sanjeevini Schemes and Rajiv Aarogya Bhagya that covers 1.6cr families. In addition, Remedinet’s platform also supports a health insurance scheme for Maharashtra Police. Nearly 8% of the cashless claims volume in India annually is routed through Remedinet.com for pre-authorization. Till date, a total of 4,15,396 transactions have been processed through Remedinet’s platform.
Remedinet is associated with well known and leading providers of healthcare such as Manipal Hospitals, Lilavati Hospital, Fortis Healthcare, Columbia Asia, Sagar Hospitals, St. John’s Hospital, Mallya Hospital, Narayana Hrudalaya Pvt. Ltd., Vasan Eye Care Hospital, and many more that form a network of over 200 hospitals. On the payer front (insurance companies and TPAs), Remedinet is associated with Max Bupa Health Insurance Co. Ltd., United Healthcare, Star Health Insurance, Bajaz Allianz, Medi Assist TPA and many more. In the public sector, Remedinet’s also provides technology support to Karnataka and Tamil Nadu governments, and the Maharashtra Police.
Remedinet’s Customers Speak
Remedinet has helped various healthcare providers to move away from redundant methods of data collection and integrate technology in the process of cashless health insurance claim settlement. Several customers vouch for the technology solutions provided by Remedinet to make the entire cashless health insurance claim settlement process faster and accurate. Remedinet’s platform has enabled its customer to monitor claims on a real-time basis. The technology has been able to bring down significantly the claim settlement turnaround time for the hospitals. In several cases, the time required for processing a claim has gone down by as significantly as 50%. This has helped hospitals to minimize the time taken in discharging patients. Additionally, the reduced turnaround time has helped the hospitals to optimize their resources, provide better customer service and thus, increase revenues. Our public sector customers assert that Remedinet’s support has enabled them to make the claim settlement process faster and simpler for the beneficiaries. The technology has facilitated in electronic data collection, claims processing and records maintenance for the health schemes which has resulted in a substantial improvement in the operational efficiency of the scheme. Accuracy in maintaining records and real-time monitoring of claims has enabled them to expedite the settlement process to ensure that more people benefit from the initiative.
Like many other industries, Remedinet faces inertia from the healthcare industry regarding adoption of technology. We have observed that it is difficult for our customers to shift from methods being practiced for decades and evolve with changing trends. This involves myths such as integration of such technology would be difficult, training employees would be harder and operating and maintaining such technology would add to the work load. We assure our customers that Remedinet is an easy to use and operate platform that seamlessly processes cashless claims through a single interface, enabling higher efficiency and transparency.
Remedinet and the Industry
The insurance sector needs to continuously reinvent itself with the constantly evolving and increasing demands of the customer. However, progress has been slow and is not on par with other verticals such as finance and banking, which are already leveraging IT to increase customer base and provide customized services. With the growth volume that is expected in the coming future, if the health insurance sector has to scale and bring in greater transparency, accuracy, and service levels there is no alternative but to use appropriate technology to enable these aspects. Insurance companies are slowly reaching a stage where adoption of solid technology solutions is not just another value add but becoming a necessity. Market forces will drive adoption of technology because the end consumer; be it the patient or the hospital will demand better service levels, accuracy and transparency. Insurance companies too, need to make their business more predictive and analyzable to maximize profitability. In the effort to meet the constantly scaling consumer needs, we at Remedinet are doing our bit to leverage technology in such a way that cashless health care insurance transactions are carried out in the most seamless and effortless manner.
The Latest from Remedinet
Remedinet is always at the forefront to develop cutting-edge technology that benefits the health insurance sector and its beneficiaries – the consumers. Keeping this in mind, we have launched; the Remedinet – Hospital mobile app and the Remedinet – Consumer app.
Remedinet – Hospital app Authorized people from the hospital with valid user ID on the Remedinet platform will be able to log in anytime from anywhere and check the status of their claim. Hospitals housed in large complexes with multiple buildings will benefit tremendously from this app as the hospital staff will now be able to access the progress of the claims through their mobile phone – from any building, wing or department, any time. They can access the entire history of the claim on the app simply by entering either the name of the patient or the reference number of the claim.
Remedinet – Consumer app This app gives power to the patients and their family to access the latest status of their cashless health insurance claim at kiosks installed in hospitals. Information can be accessed by entering either the name of the patient or the reference number of the claim. The system does not require the customer to approach the customer service department or the claims office and wait in a queue to seek information. Using this convenient option, consumers can obtain information on their handheld devices as well as enjoy the freedom of access – anytime and from anywhere.