DHS Presentation_15!03!2013 V1.1 SP1

5/27/2018 DHS Presentation_15!03!2013 V1.1 SP1

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Dedicated Healthcare Services TPA (India) Pvt. Ltd.

www.dhs-india.com

evotion Guaranteed

DHS

An ISO 9001: 2008

Certified TPA
http://www.dhs-india.com/http://www.dhs-india.com/http://www.dhs-india.com/http://www.dhs-india.com/


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Table of Contents

Dedicated Healthcareservices TPA (India)Pvt. Ltd.

CompanyOverview

Processes & Procedures

The DHS Advantage


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Table of Contents


CompanyOverview


The DHS Advantage


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Company Overview

An Integrated Health Insurance Service provider servicing valued clients since April

2006

Head Office located in Mumbai

Network of 23 branches across India

Clients include 1134 Corporates

Service mix of both Corporate and Individual clients

Major Corporates successfully serviced for over 5 years.

Ventured into Micro Insurance in the year 2008

ISO 9001 : 2008 Certified by TV NORD Group

Highly qualified, experienced and dedicated Management Team of industry

professionals


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Mission & Vision Statement


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Corporate Office:

Maharashtra : Mumbai

Branch Offices:

Haryana : Chandigarh

Delhi : New Delhi

Uttar Pradesh : Lucknow

Madhya Pradesh : Indore

Chhattisgarh : Raipur

West Bengal : Kolkatta

Orissa : Bhubaneshwar

Gujarat : Ahmedabad

BarodaSurat

Maharashtra : Pune

Andhra Pradesh : Hyderabad

Tamil Nadu : Chennai

Dedicated Healthcareservices TPA (India) Pvt. Ltd.

Pan India Presence

Karnataka : BangaloreMangalore

Hubli

Kerala : Kochi

Residential Representatives:Punjab : Amritsar

Ludhiana

Bihar : Patna

Madhya Pradesh : Bhopal

Raigarh

Maharashtra : Nasik

Gujarat : Jamnagar


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The Company is headed by the Chief Administrative Officer, a certified Charted

Account having over 10 years of experience in Insurance Industry

The Chief Medical Officer, a qualified MD with over 30 years of experience in the

Healthcare Insurance Industry heads a team of dedicated Medical Officers

The Executive Team at Head Office and all branches include qualified Doctors,

Accountants, Business Administrators and Management Professionals with degree /

diplomas in Insurance

Excellent Client Relationship Management (CRM) Team, ensuring highest level of

personalized services to clients

Internal and external processes monitored highly experienced Investigation and

Audit Team


Management & Executive Team

Professionals at your serviceDHS


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Servicing More than 11 insurance companies in India in line with their business aspirations


Insurance Companies serviced
http://www.uiic.co.in/http://www.royalsundaram.in/http://www.cholainsurance.com/


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Servicing More than 1400 group insurance policies for corporate clients & groups

Servicing More than 3.5 million satisfied health insurance policy holders in India


Partial list of Corporates serviced


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Table of Contents


CompanyOverview


The DHS Advantage


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Enrollment

Hospital Network

Cashless Facilities

Claim Processing and Controls

Enhanced IT Infrastructure

Call Centre and Website


Process & ProceduresPatient Information Form


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TAT 48 HoursGuaranteed

Receipt of Data

for Enrollment

Data upload and

auto check

system

Errors in

data

Send data for correction to

Corporate/ Insurance

Company

YES

No

Generation of

E-Card and

Physical Health

Cards


Enrollment Process


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Online addition of dependents Online deletion of Members by Corporate HR.

Generation of Login Id and Password for E- card

generation

Welcome letter to every person along with ID cards

Speedy enrollment of members


Value Addition - Enrollment


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Over 3700 network hospitals throughout India

Standardized grading technique is devised for all hospitals. Possible bench mark rates implemented ensure new network hospitals are

added to Preferred Provider Network.

Rates negotiated as per location,, infrastructure, expertise etc.


Provider Network - Hospitals

Tier 1: Mumbai, Kolkata, Chennai, Delhi

Tier 2: Pune, Ahmedabad, Hyderabad, Bengaluru, Goa, Raigad

(District)

Tier 3: Indore, Vadodara, Raipur, Kochi and rest of the Cities

Tier 1 Tier 2 Tier 3 Total Primary Secondary Tertiary Only for GIPSA Only for RSBY/UHIS Total

East 83 0 316 399 85 58 43 2 211 399

North 207 153 706 1066 397 199 161 93 216 1066

South 176 496 397 1069 461 242 237 128 1 1069

West 328 519 487 1334 833 184 119 80 118 1334

Total 794 1168 1906 3868 1776 683 560 303 546 3868

Type of NetworkType of CityRegional

Distibution


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Cashless Process

Request for pre-authorizationRequest from at least 24 hrsprior to getting hospitalized

or within 24 hrs ofhospitalization incase of

emergency

show your insurance Cardand photo identiy card

Get the preauthorizationform filled and signed by thetreating doctor, put your signon the form and hand over tothe hospital for the process

Hospital will stamp the formand fax it to insurer / TPA for

authorization

Processing thepreauthorization and

authorize the reasonableamount for hospitalizationbased on policy terms and

conditions

Authorization letter will befaxed to the hospital from

TPA office and simultaneouslyyou will be kept informed on

authorization


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Comprehensive and detailed review of records.

Constant communication for treatment given with hospitals / nursing

home.

Communication to the insured and its family members.

Evaluation of the effectiveness of the treatment given. Cost analysis

Identification and resolution of claims issue.


Claims Processing & Controls


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Enhanced IT Infrastructure

Secured VPN connectivityacross HO and all Branches

System generated Mediclaim

cards

Policy T&C coded in the

system for claim settlement

Diseases coded in the systemto avoid human errors

Online intimation and claims

status

System login IDs for

Employees and Corporate HR

DVista

-A comprehensive onlineMediclaim settlement solution


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Real-time backup server at our Regional Office BCP provides uninterrupted Pre Authorization, Enrollment and Claims

processing

The BCP is implemented in the event of fire, earthquake, floods and technical

failures

Data restored to back-up server within 1 hour New Primary Server restored within 72 hours.


Business Continuity Plan (BCP)


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MIS is generated to provide analytical information on the policy ,and

service standards maintained

i) Analysis of Underwriting Data

a)Details of addition and deletion of employees and

dependents

b) Age-wise / Relation-wise incidence ratio

ii) Analysis of claims data (both in numbers and in percentile)

a) Age wise

b) Disease wise

c) Hospital wiseiii) Analysis of the costs incurred (amount wise / percentile wise)

a) % towards Room rent , surgery charges, medicines,

investigations

iv) Analysis of DHS standards and performance

a) TAT reports

b) Cost reduction due to cost control measures adopted

Management Information System provides analysis of historical and

current aspects of a policy , provide means to reduce claims ratio withoutreducing employee benefits offered


Management Information System


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State of the Art 24 * 7 Call Centre

Courteous and well trained staff

Solutions for customer specific queries

Cash claims customer support

Service Features

Hiend telephony and real time information retrieval systems Automatic redialing of calls dropped.

Automatic SMS/Email facility for claim status changes.

Toll free fax number.

System generated reports for measuring customer satisfaction

Customer Care toll free number 1800 209 0201


Call Center


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Website Features

Online generation of e-cards

Online claim status

Online intimation form

Online hospital network

Medical features

Wellness & Life style features

www.dhs-india.com


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Website Features: E-cards generation


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Website Features: Claim Status


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Website Features: Claim intimation


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Website Features: Hospital network


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Table of Contents


CompanyOverview


The DHS Advantage


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Interactive sessions with eminent doctors from the healthcareindustry:

In-depth analysis of the most common ailments suffered bythe employees

Discussions on lifestyle and fitness Sessions on health and wellness Common hazards faced daily

Some Common Topics for Health Talks

Diabetes Management Cardiology Prevention of Cancer Importance of Correct Posture Stress Management and Yoga Obesity: An epidemic in India Basic First aid in Emergencies Snoring and Sleep Apnea Arthritis and Joint problems Exercise and lifestyle modification in Low backache Exercise in Pregnancy and easing childbirth Correct Posture Smoking Hazards Asthama


The DHS Advantage - Health Talks


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Health Camps can be organized across India .Some of the most common camps organizedby us so far are listed below :

Diabetes check up

Cardiac Check up

Weight control with Dietitian meet and BMIcheck

Dental check up

Blood donation camps

Eye check up camps

Basic Blood investigations like CBC, ESR,Blood group Total cholesterol with BMI

and Physical checkup

Bone Density check up for Osteoporosis


The DHS Advantage - Health Camps


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Employee Benefits

Health Check ups for

Employees at theirlocation

Evaluation of the Health

Check up Results

Health Guidance

Based on theresults

Lifestyle improvement

planning (Implementing

Achievable actions )

Promotion of

Health and

Healthy Habits

Maintenance of Health data for every member over a period of years

Scanned reports available to members on line

Arrange for appointments with networked doctors for second opinions in caserequired

Availing Executive Health Check ups at discounted rates


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DHS offers certain value added service at no cost

Monthly newsletter - HAOMA:

Informative health tips Detailed explanation on diseases

Current developments in the health industry

New innovations at DHS.

Automatic SMS/Email facility for cashless and reimbursement claims:

SMS / Email for cashless approvals or Reimbursement amount payable SMS / Email on query sent to hospital / employee

Systematic follow ups with hospital, insurance company etc.

Specialist doctors visit at multiple locations:

In specific cases, specialists in cardiology, oncology, ophthalmology,

dieticians etc could be made available for consultationDiscounts on Pharmacy

As a pilot project DHS has recently started discounts on medicine andother pharmacy products in Mumbai Only.

Besides discounts the medicines will be delivered at the doorstep of theclient


Other Wellness Programmes Conducted


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The Help Desk manned by a qualified and experienced executive

Query letters generated at the help desk and sent to the various employees

Follow up on the queries can be done at the help desk

Assistance provided for smooth and fast cashless services

Assistance and guidance on:

a) Understanding the terms and conditions of the policy

b) Filing of claims

c) Process for availing cashless cervices


The DHS AdvantageHelp Desk


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Exclusive Account Management team comprising of

a customer relation executive and a manager

Separate team of executives and doctors handlingpre authorizations and claim processing at client

location

A senior Manager heading the team will be present

at monthly service meetings

A robust system of escalations management directly

reporting to the Chief Administrative Officer. shall be

established


The DHS AdvantageServicing Team


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Authorization of cashless claims within a period of 1 - 3 hours

Claims settlement within 7 days of receipt of complete documentation

ID Cards issued within 5 days

E-cards within 1 day

Conformity to any Specific Client requirements

Regular client service meetings to analyze feedback.

Presentation of claims analyses to predict future trends, take correctiveactions and design future covers


The DHS AdvantageService standards

h d l


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Advise clients on:

Policy Benefits Employee Utilization patterns

o Cashless Vs reimbursement

o Specific requirements e.g. OPD, Superspecialty care, choice of provider

o Fraud control practices

Budgetary allocations for renewals

Ailment wise health profiling of the group

Inputs based on client requirements

Value added services

Effectiveness of wellness programmes utilized by

groups


The DHS AdvantageServices at renewal


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dh i di
http://www.dhs-india.com/http://www.dhs-india.com/http://www.dhs-india.com/http://www.dhs-india.com/

DHS Presentation_15!03!2013 V1.1 SP1

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