We Assist chooses ERPNext to lodge one Million Transactions per day.

We assist is one of the leading Insurance claim Specialists headquartered in Bangalore. They started their operations in 2015 providing Insurance claim assistance to Cashless treatment for

1. Patients having valid insurance cards. Still, the hospital may only have a Cashless facility, then some NBFCs need to finance the patient to continue the treatment.

1. The hospital is a Cashless facility and there will be a delay in settling the claims from insurance companies until then some NBFCs need to finance the bills until insurance claim settlements.

In Both cases, they need Insurance claim specialists to coordinate with NBFCs to assess the documents, treatment documents, and procedures from the hospital to audit and help to streamline the whole insurance claim process.

History of We Assist

We Assist Parent company Karthika Consulting (KCPL) started its operations in 1971 as an Insurance advisor for LIC and later emerged as a wealth management specialist. They have rich experience in providing insurance claim assistance to health, Automotive, shipping industries etc.

Delay in insurance claim approval and until payment realisation is really painful for Hospitals as well as patients. They tied up their expertise with NBFCs for hassle-free claim assistance and approval.

They formed a separate entity “We Assist” with the rich expertise from KCCPL and started their operation in 2015 for a hassle-free insurance claim process.

They do have a hospital network of around 200 hospitals across India and are planning to expand to Tier two and tier 3 cities.

Key Requirements and the reason to Chose ERPNext:

1. Rapid development,
2. Third Party Hosting , Infrastructure is Azure for Production and pre-production. Inhouse DC: Training, Quality instance
3. Objective: Improve Productivity and TAT thus improving the overall Insurance Claim experience and support hospitals provide to provide faster and more efficient discharges with or without funding to its patients.
4. Automation: 180+ Doc Types to help capture, validate, assess and submit to reduce mundane efforts
5. Integration: Integrate with partners of different types to ensure information is digitally transferred, vetted and confirmed.
6. Alignment: Aligning to industry standard is required to help interact with partners of interest efficiently and effectively.
7. Data Management: With claims, there is need to capture lot of documents in structured and phased manner ensuring the same are verified in-time.
8. Data Life Cycle Management: With large claims comes document and the need to manage them through the life of the claim and the document based on the company’s data life cycle policy.

The Process in ERPNext:

The insurance claim process starts in We Assist from CAR ( Claim Assistance request) from the Hospital desk along with the Insurance documents, and patient PAN card details. These details are send to the back office team. They verify the insurance documents to verify and approve the validity.

PAN details and Adhar is used to verify the creditworthiness of the patient for the loan approval for the treatment from NBFC.

After this lot of documentation are created and passed to various documents to the back-end team for approvals and verifications, some of the key document flows are 

1. CAR from hospital desk to back office.
2. Patient contract approvals.
3. Clinical examination procedures and verification by panels of in-house/third-party medical specialists.
4. Approvals of treatments and procedures.
5. While discharging verification of all discharge summaries and as per insurance standards.
6. Bill transfers from NBFC account to hospitals and transfer of amount from Insurance companies to patients and back to the NBFC’s account for loan closure.

All these document verification procedures and approvals need to happen within Half hour to 2 hours as these timelines are critical for patient admissions, treatments and discharges.

Project Stats

1. Doc Types: 185 to capture different information across the business.
2. Workflows: 25 + to review the actions on every stage to ensure efficient and complete claim submission to the Ins. Co & TPA
3. Checks: 3 Critical checks that evaluate the Insured/Patient across Finance, Insurance and medical admissibility for required approvals and consider the case for admission/discharge.
4. Unified Cash Ledger (5+ Ledgers) to track and help drive closure of all transactions from Lender, Hospital, Insured / Patient and any other participating partner.

Future

Currently, We Assist has having limited network of hospitals and around 5000 Transactions per day and planning to add more healthcare facilities to reach the milestone of One Million transactions per day.