- Check the medical admissibility of a claim by confirming the diagnosis and treatment details.
- Scrutinize the claims, as per the terms and conditions of the insurance policy
- Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc.
- Verify the required documents for processing claims and raise an IR in case of an insufficiency.
- MOU deductions
- Approve or deny the claims as per the terms and conditions within the TAT.