i i SprintSprint: Connecting Healthcare Ecosystem

Healthcare Payer Provider Network

This document is confidential and is intended solely for the use and information of the client to whom it is addressed.

Presentation

HealthSprint Networks Pvt. Ltd.

i i SprintSprint: Connecting Healthcare Ecosystem

Outline

iSprint Goals Healthcare Insurance Payer Provider Ecosystem Key Challenges Current Processes Web Enabled & Improved Processes by iSprint Integrated Solution Architecture Summary: Value Proposition to Key Stakeholders

i i SprintSprint: Connecting Healthcare Ecosystem

i Sprint Goals

i Sprint aims to be the pioneer in enabling efficiency in the healthcare ecosystem by providing innovative Internet enabled services and technology solutions to the healthcare industry.

The key objectives:

Enabling efficiencies among Providers, Payers and Patients by providing solutions that streamline the information exchange processes. Bridging the digital divide between payer and providers.

Enabling new cost effective business models for healthcare insurance processes.

Enabling more effective processes to deliver better value proposition in terms of customer satisfaction and money.

i i SprintSprint: Connecting Healthcare Ecosystem

HealthCare Ecosystem

People/Patient

Doctors (General/Specialist)

Key Stake Holders

Hospitals/Healthcare Institutes

Verification Entity/TPAs

Insurers

Medical colleges

Pharmaceutical Companies

Government Regulatory Authority

Transaction Banks

i i SprintSprint: Connecting Healthcare Ecosystem

Annexure: Initiative of IT Department & IRDA;HealthSprint’s Role

iSprint

i i SprintSprint: Connecting Healthcare Ecosystem

Healthcare Internet:Payer-Provider Network

Need Seamless & timely exchange of information between TPAs & Hospitals for providing best services to patients. This necessitates following processes to be more efficient: Pre-Authorization Discharge Summary & Billing Validation of Submitted Info Payment of Claims

Internet Enabled Payer Provider Network To provide more effective process and work-flow for information

and money flow between Hospitals and TPAs. To manage payment risks for hospitals, TPAs and insurers.

Task 2

e-Preauth e-Claims

e-Validatione-Payment

i i SprintSprint: Connecting Healthcare Ecosystem

FaxedTPA/

Insurance Company

Batched

Need for moreInformation Sent by fax

Examined by Auditor:Rejected/Accepted

Data Entry Clerk:

Key in Data

Current Pre-Auth Process: Paper Based Workflow

Provider

Sent by fax

Authorised

i i SprintSprint: Connecting Healthcare Ecosystem

Current Issues – Pre-authorization

Incomplete information Fax transmission errors and fax transmission losses High Turnaround time No mapped flow of information Traceability & Accountability is absent

Current Process Pain Points

i i SprintSprint: Connecting Healthcare Ecosystem

TPA/Insurance Company

Need for moreInformation

Examined by Auditor:Rejected/Accepted

ePre-auth work flow

Provider

Authorised

HS

HS HS

i i SprintSprint: Connecting Healthcare Ecosystem

i Sprint Pre-Auth Module

All required information mandatory – complete Pre-Authsent electronically.

No transmission losses. Integrated with TPA software drastic reduction in

Turnaround time for Pre-Authorization.• Real time information to patients through SMS and e-mail alerts

Intelligent Monitoring and AnalyticsIntelligent Monitoring and Analytics

iSprint iSprint –– Connecting the Healthcare EcosystemConnecting the Healthcare Ecosystem

Intelligent Monitoring and Intelligent Monitoring and Analytics(Graphical MIS)Analytics(Graphical MIS)

i i SprintSprint: Connecting Healthcare Ecosystem

Browser (IE)

Pre-Auth

DischargeSummary /Case History

Billing

Claims

Browser (IE)

Pre-Auth

Case History

Discharge Summary

Request

Response

Request

Secure InternetiSprint

iSprint TPA

TPA Server

ClaimsDB

SyncB

illin

g

Pro

vide

r H

ost A

pplic

atio

nM

edic

al R

ecor

dsA

ccou

nts

Rec

eiva

ble

Sync

TP

A H

ost Application

Provider WWW Payer

Bank Application

i Sprint Network Architecture

i i SprintSprint: Connecting Healthcare Ecosystem

i Sprint Improvement over Current paper Based Process

Current Paper Based Process

i Sprint Process

Pre-Auth turnaround time

4-48 hrs 30 min -2 hrs

Rejection: Discharge Summary/Billing

3-8 % 0.5%

Payment Realization time

1-3 months 15-30 days

This information is based on iSprint network operations in 15 hospitals in Bangalore.

i i SprintSprint: Connecting Healthcare Ecosystem

i Sprint Network: Bringing Benefits to All Key Stakeholders

Patients

Providers

TPA

Reduced wait time for Pre-authorization

Early identification of out of pocket payments

Eliminates need for reimbursements

Payment Risk Management

Ability to collect Balance payment from Patients

Faster Settlement of Claims-Improved cash flow

Reduction in erroneous claims- Saving processing cost, & payment risk management

Greater Visibility on cash flow commitments

IT solutions reducing transaction cost / complexity

Customer BaseCustomer Base

More than 150 Healthcare providers More than 150 Healthcare providers and 8 TPAs and Insurance and 8 TPAs and Insurance

companies using the platform in companies using the platform in IndiaIndia

C A R E H O S P I T A L

St.John's Medical College

iSprint iSprint –– Connecting the Healthcare EcosystemConnecting the Healthcare Ecosystem

i i SprintSprint: Connecting Healthcare Ecosystem