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@2DSharp thank you for raising such an important aspect. While focus has been on reimbursement, we are conscious of applicability and consequences in other process as well. We will take it up for upcoming working group call. Would like to request you to attend our upcoming call (Thursday 230 pm IST) and discuss with the community. |
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Currently, to validate that the BSP raising the reimbursement request on behalf of the patient is legitimate, we are using a consent cycle. Similarly, it would be a good idea to ask for user consent when a provider is raising a cashless claim request on behalf of the patient as well for OPD flows.
Although, in case of IPD, hospitals under network are well validated and trusted entities - consent may not be necessary, however, in the OPD scenario, individual doctors may have their in-clinic consultations with small ticket sizes. In our experience, given the volume of transactions that happen everyday, we do find discrepancies in the payouts made to doctors and we have fair usage policies implemented to circumvent that at our end.
Having a beneficiary app that allows us to only raise transactions to a closed network solves the problem of authenticating cashless transactions because the requests are raised by the patients themselves against appointments, however, if a provider/doctor does have the access to raise a claim against a patient's policy (through mobile number or ABHA ID), there should a process to validate that the request itself was raised with the patient's consent and requirement.
It could be as simple as OTP, which we have implemented in our systems currently wherein doctors updating certain claims at their end to add procedures are validated by the patients before the payout is made. The protocol may decide to make it optional depending on the payer's policies.
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