EIP - Mediclaim

Flow Chart

Sensitivity: LNT Construction Internal Use Prepared By EIP-Insurance-ISD, dated March-2019

EIP – Mediclaim Process – Index

1.Mediclaim - Brief

2.Mediclaim – Salient features

3.Flow Chart

4.Process flow

Sensitivity: LNT Construction Internal Use Prepared By EIP-CSTI-ISD, dated Aug-2017

EIP – Mediclaim Process – Brief

 Mediclaim – for Hospital expenses

o Reimbursement - Staff have provision to raise claim intimation and can gets settlement where hospital
expenses paid by staff (as Reimbursement).
o Credit Letter - Staff have provision to raise claim intimation and gets Credit letter by HR and gets hospital
services. Payment will be paid to Hospital by company directly.
• The differences of the claim & Settlement would be bare by staff (might deduct through salary or
respective Accounts advises (company payment).
o Cashless Card – Staff can get hospital services by referring the cashless card number , the payment will be
paid by Insurer directly to hospital.

Sensitivity: LNT Construction Internal Use Prepared By EIP-Insurance-ISD, dated March-2019

EIP – Mediclaim Process – Salient Features
 Claim intimation is standard access (Means all staff have provision to create the claim intimation as default
without requesting access in EIP-access module).
 Dash board provided where the following options provided.
o Financial year selection (by default current year)
o Document Status wise count & XL output options (for self & Privilege users)
o As of Privilege user is DC-Insurance team.
o Latest 5 document list with status display.
o Balance medical limit display.
 Send back option provided during Acknowledgment, Scrutinize. (option will revert creator work flow, enable
for edit and resubmit, if required).
 Cancel option provided for creator, DC Insurance team whenever the document is in their workflow.
 For Every action , auto email will be triggered to initiator & receiver.
 Customize filter option provided in every filter screen on the first column.
 Graphical work flow displays for overall process also the specific document’s current status and further
pending & completed indications displays.

Sensitivity: LNT Construction Internal Use Prepared By EIP-Insurance-ISD, dated March-2019

EIP – Mediclaim Process 1/10

Start

Payment by SELF Cashless Card Payment by Company

Claim Intimation
Request Additional options
• Cancel / Auto email
• Hospital Estimate document is
mandatory for company payment
B

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EIP – Mediclaim Process 2/10
B Claim Request Initiated by Staff

Additional options
Acknowledgment by DC
• Send back - send to creator
Insurance
• Cancel
• Auto email

No
Credit Letter
Payment By
Generation by HR D
SELF
Yes Additional options
Additional options • Send back – send to creator
• Cancel Claim Submission by • Cancel
• Auto email Staff • Auto email

• Printout of Claim form , documents as per Checklist (with signed) need to send respective IC coordinator.
• Cancelled Cheque need to attach / send along with the form submission.

C
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EIP – Mediclaim Process 3/10
C Paid by Staff - Claim Submission by Staff

Additional options
Approve by IC • Send back / Auto email

Additional options
• Send back – Send to creator Scrutinize by DC Insurance
• Auto email
• Re-scrutinize , if send back from
Insurer.
Covering Letter creation by Consolidated of scrutinized documents.
DC Insurance

• DC Insurance will send the covering letter and the relevant Scrutinized documents to insurer settlement

E
Sensitivity: LNT Construction Internal Use Prepared By EIP-Insurance-ISD, dated March-2019
EIP – Mediclaim Process 4/10
E Claim Submission by Staff

Additional options
• Send back to Scrutinizer
• Queries update Claim Receive
Acknowledgment by Insurer

• Insurer will transfer the settlement amount directly to Staff Bank account.

Settlement Updates against Additional options

Claim Submissions by Insurer • Send back / Cancel / Auto email

F
End for Mediclaim – Paid by Self

Sensitivity: LNT Construction Internal Use Prepared By EIP-Insurance-ISD, dated March-2019

EIP – Mediclaim Process 5/10
D Payment by Company - Credit Letter generated by HR

1. Credit Letter will be submitted at Hospital by Staff

2. After Discharges, the Hospital will send the complete
details to Company.

Payment Advice – Work order

request initiate by DC Insurance

• Auto Work order Request Creation.

• Further process continues in Work order module.
• Work order Number would be generated after successful flows completed.

Sensitivity: LNT Construction Internal Use Prepared By EIP-Insurance-ISD, dated March-2019

EIP – Mediclaim Process 6/10
G Payment by Company - Initiation WO request & Work Order Number
gets created

Initiate Work Order Bill request by

DC Insurance

Approve - Work Order Bill request

by DC Insurance

• Auto Work order Bill Creation.

• Further process continues in Work order
module & FAS (as Bill creation, approvals,
Payment Disbursement).

H
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EIP – Mediclaim Process 7/10
H Payment by Company – WOD & WOM-Bill generated

As document received from Hospital Claim Submission by DC Insurance

Covering Letter creation Consolidate of claim submissions

• DC Insurance will send the covering letter and the relevant claim submission to Insurer

Claim Receive Acknowledgment by

Insurer

G
Sensitivity: LNT Construction Internal Use Prepared By EIP-Insurance-ISD, dated March-2019
EIP – Mediclaim Process 8/10
H Payment by Company – After insurer receive the claims

Insurer transfer the settlement to company Insurer settled the settlement

account through Online against the claims.

Receipt document generate by DC By Individual / consolidate of settlement details

Insurance

• On Receipt creation, Integrate with EIP-FAS module to proceed further updates in FAS as per
the accounting process.

END – Payment by Company

G

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EIP – Mediclaim Process 9/10
A Cashless Card Usage

• Staff have provision to download the cashless card detail from

ICICI portal through link provided in EIP-Mediclaim module.
• Hospital admissions, treatment and discharges can be
performed with the reference of the cashless card.
• Hospital bill payment would be settled directly by Insurer.

Cashless card transaction detail

update by Insurer

• Update Data could be viewed by staff.

• Cashless card paid details will be considered on staff Medical
H
expenses and taken into calculation for balance of current
policy period.

Sensitivity: LNT Construction Internal Use Prepared By EIP-Insurance-ISD, dated March-2019

EIP – Mediclaim Process 10/10

F H G

• Payment by Self • Cashless card usage • Payment by Company

• Settlement made directly • Insurer will directly • Hospital Bill will send
to staff account by pay to Hospital to company directly.
Insurer. • Company will pay to
Hospital through
WO/Bill.
• Claim submission to
End
Insurer for
reimbursement

Sensitivity: LNT Construction Internal Use Prepared By EIP-Insurance-ISD, dated March-2019

EIP – Mediclaim Process – Process Flows 1/7
• Minimum inputs of the Claim.
Claim Intimation Request
Paid by Staff
By Staff
• On successful submission, auto email to DC Insurance. 1
• Cancel Provision allowed before action take by recipient.

Acknowledgement of • Auto email will received after document created by sender.

Claim intimation Request • Send back option allowed to revert creator with auto email.
• On acknowledgement , auto email to creator for submission.
2
By DC Insurance

• Bill Number wise amount & check list wise document

Claim Submission attachment provision during submission.
By Staff
• After successful submission, docs. has to send as per detail 3
provided in the option, Auto workflow to IC coordinator.

Approve – Claim • Auto email will receive by sender.

Submission • Send back option provided – will send back to creator for
resubmission.
4
By IC Coordinator

Scrutinize – Claim • Auto email will receive by approver.

Submission • Editable and send back actions allowed, on sendback , doc.
Will send to creator where sender can have provision 5
by DC Insurance resubmission.

Sensitivity: LNT Construction Internal Use Prepared By EIP-Insurance-ISD, dated March-2019

EIP – Mediclaim Process – Process Flows 2/7
Covering Letter
Paid by Staff generation • Consolidate scrutinize document can make one covering letter 6
by DC Insurance
• Contd..2
Claim Forms & Document
• Covering letter & relevant documents will send to insurer
sending to Insurer 7
By DC Insurance

Acknowledgement on • Auto email will receive by receiver from sender

receipt of documents. • Action is acknowledge only 8
by Insurer

If any Queries , send • Queries will update by Insurer against the claim ref.no.
against the Claim Ref. No. • Respective user can able to view & response in query option.
• Auto email will trigger for every action.
9
By Insurer

• Insurer will settle the claim to staff bank account.

Claim Settlement
By Insurer
• Auto email / SMS will send to staff 10
• Status will reflected immediately on every action taken.

Sensitivity: LNT Construction Internal Use Prepared By EIP-Insurance-ISD, dated March-2019

EIP – Mediclaim Process – Process Flows 3/7
• Minimum inputs of the Claim.
Claim Intimation Request
Paid by Company
By Staff
• On successful submission, auto email to DC Insurance.
• Cancel Provision allowed before action take by recipient.
1

Acknowledgement of • Auto email will received after document created by sender.

Claim intimation Request • Send back option allowed to revert creator with auto email.
• On acknowledgement , auto email to creator for submission.
2
By DC Insurance

Credit Letter generate

By HR
• Credit letter will generate by HR
3

Hospital Admission &

Discharges with credit • Manual process / activity 4
letter – by Staff

Hospital expense details

send to DC Insurance •Manual process / activity 5
by Hospital

Sensitivity: LNT Construction Internal Use Prepared By EIP-Insurance-ISD, dated March-2019

EIP – Mediclaim Process – Process Flows 4/7
Initiate Work Order
Paid by Company Request • To initiate payment process, Integrated with Work order
module 6
By DC Insurance
• Contd..2
Auto WOR & WOD • Actions happened in Work order module.
number generates at WO • Work order request and the approval work flow will be taken
care in WOM as per the policy exists in WOM
7
module.

Initiate Bill document • To imitate the payment disbursement , integrated wth Work
number by DC Insurance order & FAS module. 8

Approve - Bill request by • On request approval, integration will be take placed instantly at
DC Insurance WOM & FAS 9

Auto WO Bill & Payment • Action in WOM & FAS.

disbursement at WO & • On successful process, the payment will disbursed to Hospital 10
FAS module as per the process exists in FAS.

Sensitivity: LNT Construction Internal Use Prepared By EIP-Insurance-ISD, dated March-2019

EIP – Mediclaim Process – Process Flows 5/7
Claim Submission • Bill wise inputs & attachment submissions.
Paid by Company
By DC Insurance
• Covering letter can generate on consolidation of claim
submissions
11
• Contd..3
Covering Letter generates
By DC Insurance
• Consolidate submitted Claims document in one covering letter.
12

Claim Forms & Document • Claim Print out and relevant documents will send to insurer by
sending to Insurer DC Insurance team 13
By DC Insurance

Acknowledgement on
• Acknowledgement in system after receiving the physical
receipt of documents. documents by Insurer. 14
by Insurer

If any Queries , send • Insurer have option to update the queries against the claim
against the Claim Ref. No. ref.no. the respective queries will reflect in respective query
option where individual can take action.
15
By Insurer

Sensitivity: LNT Construction Internal Use Prepared By EIP-Insurance-ISD, dated March-2019

EIP – Mediclaim Process – Process Flows 6/7

Paid by Company Claim Settlement

By Insurer
• Insurer will settle the claims to company account 16
• Contd..4
• Receipt creation on settled details.
Receipt request creation
by DC Insurance
• On successful creation, data integrated with EIP-FAS to
complete the accounting process.
17

18

19

20

Sensitivity: LNT Construction Internal Use Prepared By EIP-Insurance-ISD, dated March-2019

EIP – Mediclaim Process – Process Flows 7/7
Hospital Admission & • Staff will have provision to download the cashless card details
By Cashless Card from EIP / ICICI portal .
Discharge with Cashless • Every year / whenever require Insurer will update the cashless 1
card by Staff card number in EIP.

Hospital will send the

expense details to Insurer
• Manual action. 2

Hospital expense details • System have to provision to update the expense details in EIP. 3
Update in EIP by Insurer • Where respective staff can view the same.

Settlement to Hospital by • Lodging the claim with Insurance Co.

Insurer • Change of claim status to ‘Under processing by Ins. Co. 4

• System have to provision to update the expense details in EIP.

Settlement details update • Where respective staff can view the same.
in EIP by Insurer. 5
• Settled amount will be considered for balance calculation.

Sensitivity: LNT Construction Internal Use Prepared By EIP-Insurance-ISD, dated March-2019

 EIP - Mediclaim
Flow Chart

Thank You

Sensitivity: LNT Construction Internal Use Prepared By EIP-Insurance-ISD, dated March-2019