Health insurance fraud is a growing concern, making it crucial to verify the legitimacy of claims. Our Health Claims Investigation service ensures that every claim undergoes thorough scrutiny, assessing medical records, hospital documents, and treatment history. We verify patient details, analyze hospital bills, and cross-check with medical practitioners to detect discrepancies or fraudulent activities. This service helps insurers make informed decisions and ensures that only genuine claims receive approval.
Cashless and Reimbursement Claims
We facilitate a seamless claim verification process for both cashless and reimbursement claims, ensuring that policyholders receive their entitled benefits without delays. For cashless claims, we coordinate with hospitals to validate treatment details and pre-approved expenses. In the case of reimbursement claims, we thoroughly review submitted bills, prescriptions, and supporting documents to confirm their authenticity. This process minimizes errors and prevents fraudulent claims, ensuring fair settlements.
Retail Policy
Designed for individuals and families, Retail Policy verification ensures that claims align with policy terms and conditions. Our team carefully examines medical history, diagnosis reports, and billing statements to ensure transparency and legitimacy. This service prevents fraudulent claims and helps insurers manage risks efficiently while ensuring that genuine policyholders receive timely payouts.
Group Policy
Businesses and organizations provide health coverage to employees under Group Insurance Policies. Our service ensures that claims made under these policies comply with the predefined terms and coverages. We validate employee details, medical treatments, and submitted documents to prevent misuse and fraudulent claims. By conducting a thorough assessment, we help insurers maintain fair claim settlements while protecting companies from potential liabilities.
Personal Accident Policy
Accidents can lead to severe financial burdens, making Personal Accident Insurance a critical support system. Our investigation process includes verifying accident reports, medical records, and police documentation to ensure that claims are legitimate. We check the severity of injuries, hospitalization details, and whether the accident falls within policy coverage. This meticulous verification prevents fraudulent or exaggerated claims, ensuring fair compensation for policyholders.
Critical Illness Policy
A Critical Illness Policy provides financial support for life-threatening diseases such as cancer, heart attacks, or kidney failure. Our service verifies the authenticity of medical diagnoses, treatment plans, and hospitalization records to confirm compliance with policy terms. We cross-check with medical professionals and institutions to validate the necessity of treatment, ensuring that claim approvals are based on genuine medical conditions.
SME Verification
Small and Medium Enterprises (SMEs) often purchase health and accident policies for their employees. Our SME Verification service ensures that businesses adhere to policy terms and that claims are genuine. We verify employee records, business registration details, and policyholder eligibility to prevent fraudulent claims and ensure smooth claim processing for legitimate cases.
Bill Verification
Hospital bills and medical expenses can sometimes be inflated or misrepresented. Our Bill Verification service meticulously reviews invoices, medical procedures, and treatment costs to ensure that charges are reasonable and accurate. We cross-check with standard pricing, hospital records, and policy coverage to detect overbilling or unnecessary expenses. This service helps insurers control costs and ensure fair payouts while maintaining transparency in the claims process.
Frequently Asked Questions
We use a combination of medical document verification, claimant background checks, hospital audits, and advanced data analytics to detect inconsistencies, inflated bills, or staged treatments. Our team works closely with healthcare providers and insurance companies to ensure accurate claim processing.
The duration of an investigation depends on the complexity of the case. Typically, a standard claim verification takes 5 to 15 business days, while more complex cases may require additional time for detailed scrutiny and on-ground verification.
Yes, all investigations are conducted with strict confidentiality and adherence to data privacy regulations. We ensure that sensitive medical and personal information is handled securely and shared only with authorized personnel involved in the claims process.