Balance Check, Treatment Sample Clauses

Balance Check, Treatment. Discharge and Claim Request a) Based on selection of package(s), the operator will check from the Central AB PM-XXX Server if sufficient balance is available with the beneficiary to avail services. b) States using their own IT system for hospital transaction will be able to check and update balance from Central AB PM-XXX server using API c) If balance amount under available covers is not enough for treatment, then remaining amount (treatment cost - available balance), will be paid by beneficiary (OOP expense will also be captured and stored) d) The hospital will only know if there is sufficient balance to provide the selected treatment in a yes or no response. The exact amount will not be visible to the hospital. e) SMS will be sent to the beneficiary registered mobile about the transaction and available balance f) List of diagnostic reports recommended for the blocked package will be made available and upload of all such reports will be mandatory before discharge of beneficiary. g) Transaction System would have provision of implementation of Standard Treatment Guidelines for providing the treatment h) After the treatment, details will be saved and beneficiary will be discharged with a summary sheet. i) Treatment cost will be deducted from available amount and will be updated on the Central AB PM-XXX Server. j) The operator/AM fills the online discharge summary form and the patient will be discharged. In case of mortality, a flag will be raised against the deceased member declaring him as dead or inactive. k) At the same time, a printable receipt needs to be generated and handed over to the patient or patient’s attendant. l) After discharge, beneficiary gets a confirmation and feedback call from the AB PM-XXX call centre; response from beneficiary will be stored in the database m) Data (Transaction details) should be updated to Central Server and accessible to Insurance Company/ SHA/ ISA for Claim settlement. Claim will be presumed to be raised once the discharge information is available on the Central server and is accessible to the SHA/ ISA/ Insurance Company n) SMS will be sent to beneficiary registered mobile about the transaction and available balance
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