Trust Office Functions
The initial period of coverage under the scheme by Trust will be two years.
The offices of the Trust will house the staff administering the Scheme.
A "Run Off period" of one month shall be allowed after the expiry of the policy period. This means that pre-authorisations can be done till the end of policy period and surgeries for such pre-authorisations can be done up to one month after the expiry of policy period and all such claims shall be honoured.
Back Office Departments
- Round-the-Clock Pre-authorization wing with specialist doctors for each category of diseases shall work along with the Trust doctors to process the preauthorization within 12 hours of the electronic request by the network hospital on the web portal of the Trust.
- Claims settlement wing with required staff shall function to settle valid claims within 7 days.
- IT and MIS wing
IT wing with required staff shall ensure that the entire process of back office operations of e-preauthorization, claim settlement, grievance redressal, and other activities dependent on the Trust portal are maintained on real-time basis.
MIS wing shall collect, collate and report data on a real-time basis. This department will collect, compile information from field staff of the Trust and generate reports as desired by the Trust.
- Call Centre
The Trust portal receives calls through 104 Call Centre handling all the incoming and outgoing phone calls, grievances received through various means. The Trust provides executive support for the purpose of guiding and redressing the grievances of the stake holders. This service shall be referred to as the "Call Centre Service". Queries relating to coverage, benefits, procedures, network hospitals, cashless treatment, balance available, claim status and any other information under the scheme anywhere in the state on a 24x7 basis shall be answered in Telugu.
- Grievance wing
It sends feedback formats, collects and analyze sfeedback of the patients as per the directions of the Trust. The department will also document each case and upload the same in the Trust portal. The Trust shall also collect the satisfaction slip from the beneficiaries at the time of discharge who had obtained the cashless services. The beneficiaries shall submit the Satisfaction slip issued by the Trust at the time of discharge through Provider. The Trust shall also carry out the Customer Satisfaction Survey by using the rating card for the purpose.
This wing is manned by doctors and other staff to address the grievances from time to time as per the guidelines. The Trust shall also attempt to solve the grievance at the field level. The Trust shall provide the beneficiaries or NWH with details of the follow-up action taken as regards the grievance as and when the beneficiaries require it to do so.
The Trust records in detail the action taken to solve the grievance of the beneficiaries NWH in the form of an Action Taken Report (ATR) within 2 working days of the recording of the grievance. The Trust shall provide the Government with the comprehensive action taken report (ATR) on the grievances reported in pre-agreed format. The entire process will be done through the call center and Trust portal. The Trust shall co-ordinate with Provider in order to solve the grievance as and when required by the nature and circumstances of the grievance.
- Administration, Training and HR wing with required staff for the purpose of office management, legal matters, accounts. It will manage human resources, arrange the workshops / training sessions for capacity building of the stakeholders in respect of the scheme and their roles.