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Electronic Discharge Manager (EDM)

Discharge Management is generally defined as a process in which the patient hospitalisation will be completed and patient is discharged from hospital after collecting the patient payable expenses towards hospitalisation expenses. This Process is also known as Pre-Discharge Computation/Calculation.

The discharge management process varies widely depending upon the type of patient hospitalisation billing, such as cash billing, credit billing and cashless billing. Both in cashless and credit billing computation of patient payable hospitalisation expenses is done manually , which is error prone and give raises to lots of disallowance on the payment management.

Current Process

  • Hospital manually goes through every line item in the bill to
    • identify non medical expenses
    • compare the bill with the payer tariff agreement manually to figure out payable and non payable amounts
    • computation of Payer specific discounts done manually
    • computation of Corporate specific discounts done manually 
  • As a result of all the above it is quite difficult to arrive at an accurate patient payable amount
  • Manual calculation required to be done by hospital based on contents of Authorisation Letter received from payer
    • Proportionate calculation
    • Room charge based limitations • Other items based limitations
    • Co-payment etc. 
    • Required documents put into the file based on human experience based knowledge

    QuiClaims enables

    • Ability to process an electronic bill on the platform eliminating manual work on the bill
    • Configuration of Payer Provider tariff on the platform
    • Automation of bill comparison against tariff to identify non payables and disallowances
    • Automated computation of corporate and payer specific discounts based on configuration
    • Form driven and easy to use interface to capture all the rules mentioned in the Authorisation Letter
    • Auto computation based on the different rules and exceptions
    • Ability to calculate the final patient payable amount on the platform with minimal manual intervention
    • System configured to enforce mandatory fields and mandatory documents based on medical condition

    Benefits

    • Minimize the possible disallowance Management
    • Helps achieving the accuracy in computation of patient payable hospitalization expenses (eg. Like Room Rent Restriction, Disease or Procedure Sub limits Capping, Services Capping, Co-Payment etc.)
    • Eradicate the conflicts which can arise by manual computation
    • Minimize the Time taken for Pre-discharge Computation Process and Patient Discharge Process
     

    Preview

     

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