NephroPlus is a leading chain of dialysis centers with presence in India, Kazakhstan, and Philippines. Despite being the market leader in India, NephroPlus was unable to offer insurance-based cashless coverage for its customers.
NephroPlus approached Vitraya to help.
Vitraya determined that NephroPlus needed help in four areas fronts:
0.1. agreeing on pricing terms and entering into an agreement
0.2. onboarding with the insurer
0.3. processing of claims
0.4. collecting payments from the insurer
NephroPlus utilized Vitraya’s simple web-based platform to get onboarded as a cashless provider with the insurer. Utilizing Vitraya’ DIY tools, NephroPlus got enrolled with the two largest health insurers within 2 days.
The onboarding process included -
0.1. Vitraya’s automated contracting / smart contract framework
0.2. automated market-based price inputs for both parties to alert them if their pricing was away from the market market range
0.3. automated contract processing through alerts and reminders
Two days after onboarding, NephroPlus began using Vitraya’s simple web-based tool for submitting claims to insurers. Claims were approved within 5-6 seconds and with a 99% accuracy rate. Practically everything cent claimed by the hospital was paid by the insurer.
In raising the claims, Vitraya was able to automate medical coding by reading and understanding images of prescriptions, discharge summaries, and investigation reports.
NephroPlus also got access to Vitraya’s automated payment settlement and reconciliation stack. The NephroPlus CFO was able to get a complete view of claims raised, amounts credited, amounts received. Whenever he needed to get into details, for instance, on what claims had payments less than the claim amount, he was able to pick out the exact claims that were causing problems and see why they had been underpaid.
NephroPlus had just access to Vitraya’s entire Insurance in a box solution. With an accuracy of 99%.