Dear Sir/ Ma’am,

Greetings from Team ABI Health...!!

Hope you are safe and well.

At the outset we thank you for being associated with us.

We would like to inform you that we have added few new features to update our application for the Hospital users.

Introducing “Dispute” tab in Claims Dashboard

Dispute management allows to contest with TPA when the user disagree with the disallowances.

DISPUTING

Users can initiate a Dispute from Approved/Partially Paid/Fully Paid states.

On    Once initiated, the cases will appear under the Dispute tab. Here, the disputed cases have been categorized into 2 sub states – 

 

Ø Dispute Initiation in progress – At this stage users can decide on the Contest amount, upload documents, and send the email.

# In order to initiate the process, the user can click on ‘Initiate Dispute’ in the case sheet.

                                                                                                       “OR”

# The user can also initiate the dispute in the Reconciliation page on ticking the ‘Disputed Case?’ box and confirming the case to have a

               

# On initiating the dispute, the user have to put the ‘Contest Amount’ => to send for ‘Contest’ => (

Ø Dispute initiated – Once the Email has been sent, it is considered as Dispute Initiated.

# ‘Dispute Details’ button are available in case sheet Left Hand Side.

# On clicking the ‘Dispute Details’ opens the Dispute Details pop up. This is a further step to add Recovered amount, change Contested Amount and add Remarks to Save it.

# Click on the ‘Transaction Details’ link is available in Dispute Details popup user to check and update the TPA transaction details.

UNDISPUTING

Ø Undisputing will move the case from dispute Tab to previous status (Approved/Partially paid /Fully paid) i.e Undisputed the case.

Ø Undisputing a Disputed case can be done by two ways:

# From the ‘Dispute Details’ popup, by click on ‘Undispute’ Button

‘OR’

# By unchecking the Dispute Checkbox, in Reconciliation window.

Presenting ‘Dispute’ data in Reports

Ø   Dispute/Recovery report has been added.

                                                            

Ø Usage Report covering Dispute status of both ‘Initiation & Initiated’ has been added.

Changes in DOA, DOD, Case ID during Enhancement/Discharges 

ENHANCEMENT

Ø Now the Enhancement popup will prepopulate DOA, user will be able to edit it and it is a mandatory field.

Ø DOD will be Blank and since it is a mandatory field user must fill it to proceed further.

Ø Case ID field is editable, user can update or change it.

DISCHARGE

Ø Now the Discharge popup will prepopulate DOA, user will be able to edit it and it is a mandatory field.

Ø DOD will be prepopulated as Current Date. User can update it if required.

Ø Case ID to be editable, if user want to update or change, he/she will be able to do.

Ø For death cases users can check the ‘Death Case’ box while proceeding for discharge.

Introducing Validation data in MIS Report

Following 5 MIS Validation reports has been added in MIS Report

Ø No of cases submitted for validation per day in a month.

Ø TAT for Pre-auth submitted Time to validation-initiated Time (for the month).

Ø TAT from Validation requested Time to validation completed Time (for the month)

Ø TAT for Query raised to Query responded for validation (in the month).

Ø TAT for Validation completed Time to Claim submitted Time. (in the month)

Adding ‘Others’ as Department under ‘Treatment Info’ – CORPORATE MODULE

‘Other’ has been added in department list of ‘Treatment Info’ in the case sheet to add new doctor name in Treating Doctor field.

‘Pre-auth type’ addition in Claims Dashboard

Ø ‘Preauth Type’ column has been added in Claims Dashboard and it can be found under all the tabs here (Action Pending/ Submitted/ Approved/ Rejected/ Partially Paid/ Fully Paid/ Dispute/ Reconciled).

                                                                                              

Addition of Covid/ Non Covid tag in Case sheet

To identify Covid/Non Covid cases, a tagging has been incorporated under ‘Medical History’ in Pre-Auth Form in the case sheet. For Vidal, Paramount & Bajaj this field has been made mandatory.