healthsprint data exchange platform
DESCRIPTION
"I-SPRINT-electronic health care data exchange platform" for hassle free and seamless real-time health care data exchange b/n payers and providers for faster cashless hospitalizations.currently used by around 700 hospitals and 10 payers across india.TRANSCRIPT
i i SprintSprint: Connecting Healthcare Ecosystem
Healthcare Payer Provider Network
This document is confidential and is intended solely for the use and information of the client to whom it is addressed.
Presentation
HealthSprint Networks Pvt. Ltd.
i i SprintSprint: Connecting Healthcare Ecosystem
Outline
iSprint Goals Healthcare Insurance Payer Provider Ecosystem Key Challenges Current Processes Web Enabled & Improved Processes by iSprint Integrated Solution Architecture Summary: Value Proposition to Key Stakeholders
i i SprintSprint: Connecting Healthcare Ecosystem
i Sprint Goals
i Sprint aims to be the pioneer in enabling efficiency in the healthcare ecosystem by providing innovative Internet enabled services and technology solutions to the healthcare industry.
The key objectives:
Enabling efficiencies among Providers, Payers and Patients by providing solutions that streamline the information exchange processes. Bridging the digital divide between payer and providers.
Enabling new cost effective business models for healthcare insurance processes.
Enabling more effective processes to deliver better value proposition in terms of customer satisfaction and money.
i i SprintSprint: Connecting Healthcare Ecosystem
HealthCare Ecosystem
People/Patient
Doctors (General/Specialist)
Key Stake Holders
Hospitals/Healthcare Institutes
Verification Entity/TPAs
Insurers
Medical colleges
Pharmaceutical Companies
Government Regulatory Authority
Transaction Banks
i i SprintSprint: Connecting Healthcare Ecosystem
Annexure: Initiative of IT Department & IRDA;HealthSprint’s Role
iSprint
i i SprintSprint: Connecting Healthcare Ecosystem
Healthcare Internet:Payer-Provider Network
Need Seamless & timely exchange of information between TPAs & Hospitals for providing best services to patients. This necessitates following processes to be more efficient: Pre-Authorization Discharge Summary & Billing Validation of Submitted Info Payment of Claims
Internet Enabled Payer Provider Network To provide more effective process and work-flow for information
and money flow between Hospitals and TPAs. To manage payment risks for hospitals, TPAs and insurers.
Task 2
e-Preauth e-Claims
e-Validatione-Payment
i i SprintSprint: Connecting Healthcare Ecosystem
FaxedTPA/
Insurance Company
Batched
Need for moreInformation Sent by fax
Examined by Auditor:Rejected/Accepted
Data Entry Clerk:
Key in Data
Current Pre-Auth Process: Paper Based Workflow
Provider
Sent by fax
Authorised
i i SprintSprint: Connecting Healthcare Ecosystem
Current Issues – Pre-authorization
Incomplete information Fax transmission errors and fax transmission losses High Turnaround time No mapped flow of information Traceability & Accountability is absent
Current Process Pain Points
i i SprintSprint: Connecting Healthcare Ecosystem
TPA/Insurance Company
Need for moreInformation
Examined by Auditor:Rejected/Accepted
ePre-auth work flow
Provider
Authorised
HS
HS HS
i i SprintSprint: Connecting Healthcare Ecosystem
i Sprint Pre-Auth Module
All required information mandatory – complete Pre-Authsent electronically.
No transmission losses. Integrated with TPA software drastic reduction in
Turnaround time for Pre-Authorization.• Real time information to patients through SMS and e-mail alerts
Intelligent Monitoring and AnalyticsIntelligent Monitoring and Analytics
iSprint iSprint –– Connecting the Healthcare EcosystemConnecting the Healthcare Ecosystem
Intelligent Monitoring and Intelligent Monitoring and Analytics(Graphical MIS)Analytics(Graphical MIS)
i i SprintSprint: Connecting Healthcare Ecosystem
Browser (IE)
Pre-Auth
DischargeSummary /Case History
Billing
Claims
Browser (IE)
Pre-Auth
Case History
Discharge Summary
Request
Response
Request
Secure InternetiSprint
iSprint TPA
TPA Server
ClaimsDB
SyncB
illin
g
Pro
vide
r H
ost A
pplic
atio
nM
edic
al R
ecor
dsA
ccou
nts
Rec
eiva
ble
Sync
TP
A H
ost Application
Provider WWW Payer
Bank Application
i Sprint Network Architecture
i i SprintSprint: Connecting Healthcare Ecosystem
i Sprint Improvement over Current paper Based Process
Current Paper Based Process
i Sprint Process
Pre-Auth turnaround time
4-48 hrs 30 min -2 hrs
Rejection: Discharge Summary/Billing
3-8 % 0.5%
Payment Realization time
1-3 months 15-30 days
This information is based on iSprint network operations in 15 hospitals in Bangalore.
i i SprintSprint: Connecting Healthcare Ecosystem
i Sprint Network: Bringing Benefits to All Key Stakeholders
Patients
Providers
TPA
Reduced wait time for Pre-authorization
Early identification of out of pocket payments
Eliminates need for reimbursements
Payment Risk Management
Ability to collect Balance payment from Patients
Faster Settlement of Claims-Improved cash flow
Reduction in erroneous claims- Saving processing cost, & payment risk management
Greater Visibility on cash flow commitments
IT solutions reducing transaction cost / complexity
Customer BaseCustomer Base
More than 150 Healthcare providers More than 150 Healthcare providers and 8 TPAs and Insurance and 8 TPAs and Insurance
companies using the platform in companies using the platform in IndiaIndia
C A R E H O S P I T A L
St.John's Medical College
iSprint iSprint –– Connecting the Healthcare EcosystemConnecting the Healthcare Ecosystem
i i SprintSprint: Connecting Healthcare Ecosystem