C ategories
How we generate Revenue Domestically?

Scope of Services would be provided by the Domain Specialist by Ethon in the Hospital:

Patient Counseling

Pre-Authorization

Pre-Discharge Validation

Claim Validation

Claim Query Handling


Patient Counseling

When there is a requirement for an insured to be hospitalized, the Insured/Patient/Relative will contact the hospital. Hospital will guide them to health insurance Department.


Pre-Authorization

The Domain Specialist will provide assistance to the patient for filling the Demographic details. The Patient's age to be verified with a relevant Photo Id proof of the patient.

Medical Details In the Preauth form should be duly filled and signed by the Treating Doctor / Consultant / Duty doctor of the Hospital.

Hospital details Hospital/Billing Department to provide assistance to Domain Specialist. Domain Specialist will check the filled PreAuth form.


Processing of the PreAuth Form

Relevant Policy/Medical Documents to be attached along with Pre Auth Request.

Approval

Denial

Enhancements


Pre-Discharge Validation

Health Insurance Department prior to Discharge of Health Insurance Patient will do Pre-Discharge validation if necessary with the information (Discharge Summary, Final Bill and Bill Breakup) provided.

Claim Validation

Post Discharge of patient all documents related to claim will be made available to Health Insurance department within 3 days from date of discharge, documents will be validated/scrutinized for completeness.

Claims Query Handling

Health Insurance Department/Domain Specialist will assist billing/collection department in addressing queries raised by the TPA/Insurance companies.