This Programme is developed by Healthcare SSC with support of World Bank, National Health Authority (NHA), General Insurance Council and key insurance companies, TPAs and healthcare service providers from across India.
Objective: This program would be beneficial for all healthcare professionals to understand the various aspects of health insurance which would help faster claim management of patients and thereby faster healthcare delivery services along with better patient satisfaction.
Target Audience: All healthcare professionals should undergo this Competency Enhancement Program, ranging from MBBS doctors, AYUSH doctors, pharmacists, nurses, hospital administrators or any professional working in healthcare service/ insurance industry.
Structure of Program: It is running into 6 modules each consisting of a few sub-modules which allows the participants to learn at their own pace in completely online mode incorporating interactive activities and exercises as a learning mechanism.
Participants would be expected to view all the videos, activities and exercises thoroughly as well as attempt both Formative and summative assessments in order to get the Certificate.
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Health Insurance Concepts would provide you a good understanding of Healthcare financing and the role of health insurance in Universal Health Coverage, the various models of healthcare financing and the key concepts of health insurance
Stakeholders and Health Insurance Regulations in India would provide you a good understanding of the Indian health insurance market– the key stakeholders, customer segments and products including both self and government-funded health insurance schemes such as Ayushman Bharat Pradhan Mantri -Jan Arogya Yojana as well as the role played by Insurance Regulator - IRDAI, various Health Insurance Regulations in India, and the key provisions and guidelines pertaining to COVID-19
Health Insurance underwriting, distribution and policy administration would provide you a good understanding of the key concepts of health insurance underwriting and actuarial pricing, the key products and clauses in health insurance- inclusions and exclusions, standard definitions etc.
Health insurance claims management would provide you a good understanding about provider experience – the Health insurance claims management and reimbursement giving a comprehensive view of the standard medical terminology, formats and documentation for claims processing, standard treatment guidelines and most importantly how to ensure a timely and hassle-free pre-auth, claim approvals and payments experience and handle queries, rejections and repudiations.
Digitalization of health insurance would make you more savvy in health tech with key concepts like - Data standards and digital exchange platforms, Different Coding methodologies- ICD, PCS, Snowmed City, ICHI etc. and the impact of the Ayushman Bharat Digital Mission (ABDM) on healthcare.
Issues and challenges in health insurance would prepare you to deal with key issues and challenges faced by key stakeholders in health insurance relating to pre-existing disease (PED), non-disclosure, exclusions, Fraud and abuse, Customer Experience and Grievance Redressal as well as Medico-Legal aspects.
Paid
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Course Duration9 hrs
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Course LevelMedium
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Student Enrolled0
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LanguageEnglish