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Insights on HealthCare in India - A Medicos Perspective

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INSURANCE

Traditionally, the Insurance industry & medicos have worked in ethical silos, and the collusion between the panel doctor and insurance advisor is costing the industry billions. Medical fraud, essentially, occurs at two stages: Pre-Policy Issuance & Claims; both greatly influenced by the practicing medico. Deep insight into the physician attitude and behaviour is a common denominator to prevent one and tackle the other! CM Health Solutions was formed with a vision to partner leading Life and Health Insurance organizations and channel it's knowledge of medicine and medical practitioners towards operational excellence.

We specialize in three areas:

Claims

Currently we are providing claim related services to

  • ICICI Prudential Life Insurance Co Ltd
  • Birla Sun Life Insurance Co Ltd
  • CRP Technologies Pvt Ltd

Why C M Health Solutions?
Most life insurance fraud schemes involve purposeful omissions, non-disclosures, or misrepresentations. Having spent over three decades in active clinical practice; gathered deep insights into Consumer attitudes and Physician behaviour leading to fraudulent claims and first hand experience of scrutiny of Medical claims, we have prepared a module for assessing Life Insurance claims.

We understand the way the Indian mind set works especially when perpetrating a medical fraud and have used it greatly in preparing this module. Our panel of specialists and super specialists have prepared checklist protocols for most commonly claimed ailments.

We empower your team through:

  • Continuous claims team education
  • Claims assessment and control
  • Compliance

Medical panel

Why C M Health Solutions?
Network of over 6500+ medical establishments across 1400+ locations:

Network

The Medical panel is handpicked with the common denominator(s) of Ethicality, Cost effectiveness and Comprehensive healthcare delivery. Today we proudly boast of over 6500+ empanelled establishments spread over 1400+ locations.

More significantly, we also carry a database of over 1200 dis-empanelled establishments in INDIA.

  • Empanelment
    • Identification,
    • Scrutiny,
    • Credibility checks
  • Measurement
    • Protocols and analytic tools of audit.
    • Reprimanding
    • Dis-empaneling
  • Management
    • Handling medical discrepancies
    • Handling member grievance
    • Providing member contentment

Stakeholders Medico Management

  • All queries relating to medicals being done/ XRT levied/ policy decline
  • Training of top 20% advisors in health related content - complex medical knowledge in user friendly language as they have to answer HNIs.

We at C M Health Solutions strongly believe that the ethical empanelment, claims and fraud management propositions are the need of the hour. They go a long way in cementing the foundation of the organization in an environment where the awareness of risk is on the rise.

We welcome your views or queries on our broad framework of services. If achieving Transparency in Healthcare remains your objective we look forward to working with you. You can write to us on: businesssolutions@cmhealthsolutions.com