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Mailroom / Document Management

HeC’s mailroom services allow clients to free themselves from opening, sorting and storing headaches of a large amount of paper work.

  • Clients send their documents in bulk to reduce the mailroom expense by routing mail directly to an HeC post office box.
  • Documents are prepped, sorted and fed through a scanner
  • Scanner imprints document control number and date – this eliminates the need to manually date and stamp each document.
  • Data is uploaded in the HeC System
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Policy Administration

Administration of our client’s policy is given careful attention and is conducted as per the following:

  • Data of insured members of Insurance companies entered into the HeC system
  • Printing of Health ID Cards
  • All policy endorsements, eligibility, additions / terminations / deletions
  • Call Centre services required for policy administration
  • Any other services mutually agreed by both parties.

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Customer Services

At HeC we believe in customer’s satisfaction. In order to provide the same, our 24/7/365 dedicated Call Centre personnel who have access to the updated HeC client data in real time and is well equipped to handle customer queries.

  • Assistance is given by phone, fax and email
  • Assistance is provided to members, non members, network providers, corporate and insurance companies.
  • Details of network providers and their contact details are also provided.
  • Claim status including details of reasons why claim may be pending or rejected.

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Utilization Management

HeC encourages the highest quality of medical care through Utilization Management.

  • Pre authorization services are provided
  • review of claims as per clients limits and policy terms,
  • co-ordination with doctors, hospitals, network providers to determine the proper amount of benefits under terms of the insurance policy / cover and Insurance Company guidelines.
  • Call Centre services required for utilization management
  • Any other services mutually agreed by both parties.
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Case Management

HeC follows a gatekeeper concept in counseling patients and directing for required services. We have a qualified team of medical doctors as case managers, who monitor health status from admission to discharge and control unnecessary tests, medicines or malpractice thus being cost effective.

  • Record Verification – Hospital record, member record, member record at HeC
  • Panel Discussion – In house, Specialist, Treating Doctor
  • Random Visit and periodic inspection to network provider
  • Interview with patient and Treating Doctor
  • Second opinion services
  • Periodic Health Check up Camps

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Claims Management

HeC strives towards complete implementation of automated end to end customer satisfaction i.e. from the time the paper claims are managed in the mail room till they are successfully resolved.

The objective of the present medical scrutiny done at HeC is to identify as follows:

  • Inappropriate billing pattern
  • Detection of customary overcharge
  • Duplicate billing detection
  • Visiting Doctors charges
  • Fee Schedule
  • Verification of pharmacy and investigation bills for reasonableness
  • Filter unnecessary admissions
  • Monitor length of stay
  • Necessity of hospitalization

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MIS Reporting

Our cutting edge IT infra structure enables us to provide clients with tailor made periodical reports as per client requests and requirements. The highly advanced MIS System within HeC ensures that every customer service representative can provide our clients with the desired information so as to help them achieve their goal. HeC provides a range of reports which include:

  • Phone Call Log Report
  • Benefit Utilization Report
  • Preauthorization Detail Report
  • Claims Details Report
  • Disease Trend Report
  • Group Summary Report
  • Other reports mutually agreed by both parties

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Other Value Added Services includes:

HeC also provides additional value added services which are as follows:

  • Disease Management
  • Preventive Care Programs
  • Advanced Case Management
  • Provider Network Management
  • Product Development

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Claims Only Outsourcing

HeC has experienced claim professionals who provide claims only outsourcing to Managed Care Organizations such as PPOs (Preferred Provider Organization) and TPAs in USA and UAE.
The following are done according to clients own protocols and business rules:

  • medical insurance paper claims processing
  • EDI Claims review and re-pricing

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Direct Billing Services

HeC also offers direct billing services to its Client base outside Pakistan.
The objective is to offer :

  • A negotiated discounted network of hospitals and diagnostic centres
  • Cashless hospitalization services in a cost effective manner
  • Coverage for both emergency and elective cases
  • Local point of contact for service delivery