1. Conducting an audit from his desk, without visiting the hospital
2. Verifying case-related documents (prescription, clinical notes, investigation reports, discharge summary, etc.) presented by the hospital at the time of the pre-auth request or claim submission, with the purpose to ascertain the necessity of treatment, qualifications of treating doctor, and authenticity of the claim as evidenced by the documents
Requirements:
1. Only MBBS students
Additional information:
Desk audits can be conducted virtually, and the team can be based anywhere in India. However, the team lead may be asked to come to the SHA office for meetings or review as per the requirement of SHA. Any work related to the project may be done off-site i.e., at Agency's location (anywhere in India). However, for requirement gathering, and project discussions the resources may have to come to the SHA's office as may be desired.
In-depth analysis of the procedure performed and verification of associated clinical notes, diagnostics, and documentation to validate if:
Was the procedure actually carried out?
If carried out, was it medically justified or necessary?
Could the case have been treated more conservatively?
Does the hospital have the necessary infrastructure, facilities, and manpower including specialists for carrying out the said procedure?
For the said activity, the necessary data/information as accessible on the NHA portal pertaining to hospital infrastructure, facilities, manpower, etc. will be made available to the selected bidder. In case, there is a requirement for field investigation, upon conveying this requirement by the bidder to the SHA, the same shall be got executed by the district team of the SHA and the report will be made available to the selected bidder.
Skill(s) required
English Proficiency (Spoken)English Proficiency (Written)MS-Office
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