Thursday, June 11, 2009

Process Flow

Process Flow

Process Flow of the Beneficiary Treatment in the Network Hospital

Step 1:

Beneficiaries approach nearby PHC/Area Hospitals/District Hospital/Network Hospital. Aarogya Mithras placed in the above hospitals facilitate the beneficiary.If beneficiary visits any other PHC/Government hospital other than the Network Hospital, he/she will be given a referral card to the Network Hospital after preliminary diagnosis by the doctors. The Beneficiary may also attend the Health Camps being conducted by the Network Hospital in the Villages and can get the referral card based on the diagnosis

Step 2:

The Aarogya mithras at the Network Hospital examines the referral card and BPL ration card and facilitates the beneficiary to undergo preliminary diagnosis and basic tests.

Step 3:

The Network Hospital, based on the diagnosis, admits the patient and sends preauthorization request to the Insurance company and the Aarogyasri Health Care Trust.

Step 4:

Specialists of the Insurance Company and the Trust examine the preauthorization request and approve preauthorization if all the conditions are satisfied.

Step 5:

The Network Hospital extends cashless treatment and surgery/therapy to the beneficiary.

Step 6:

Network Hospital after performing the surgery/therapy forwards the original bill, discharge summary with signature of the patient and other relevant documents to Insurance Company for settlement of the claim.

Step 7:

Insurance Company scrutinize the bills and gives approval for the sanction of the bill.

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