Cashless claim verification is a time-sensitive process that requires immediate action. **Grace Power Verification India Pvt Ltd** provides rapid response audits for insurance providers to verify the necessity and legitimacy of hospital admissions. We act as the bridge between the insurer and the healthcare provider, ensuring that the "cashless" facility is utilized only for genuine medical requirements.
In the cashless insurance model, hospitals may sometimes recommend unnecessary admissions or inflate treatment costs because the patient is not paying out-of-pocket. Our live audit service prevents "Triggered Admissions" where a patient is admitted purely to satisfy insurance criteria for minor ailments.
Operating extensively in **Salem**, our medical auditors conduct surprise visits to networked hospitals to confirm the patient’s presence and evaluate the line of treatment against the reported diagnosis.
To ensure high-speed accuracy, we follow a streamlined verification protocol during the patient's stay at the hospital:
Our field team conducts a physical bedside check to confirm the patient is actually admitted and that the identity matches the policyholder.
We review the 'Case Sheet' and 'Indoor Case Papers' (ICP) to verify if the symptoms justify the admission or if the patient could have been treated as an OPD case.
We check for 'Unbundling' of services or over-billing of consumables and medicines to ensure the final claim amount is fair and accurate.
