Shining in Mediclaim and Group Insurance: MDIndia Health Insurance TPA

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MDIndia is a young, vibrant team with 5,000 members working in sync with customers and clients. It recently completed 15-years of existence. It has set benchmarks by servicing total claims to the tune of 11,42,720 amounting to R2,632 crore in premium covered during FY 2016. This is up from 963,575 and R861 crore respectively during FY 2011. Thus, creating a niche in the vertical services provided to the end-customers, encompassing the ‘who’s who’ to the ‘poorest of the poor’.

MDI is headquartered in Maharashtra with 185 satellite offices and 10 project offices spread across India. It caters to all the verticals of Health Insurance, including Medical Tourism from the Middle East. Forty per cent of its revenue comes from Mass Policies; 37 per cent from Group Policies; and, 23 per cent from Retail Policies.

It partners with multifaceted healthcare institutions, catering to Primary, Secondary and Tertiary healthcare needs including standalone diagnostic and dialysis centres.

Challenges

In Health Insurance, the biggest challenge faced is non-standardisation of costing, fee structures, treatments and protocols. MDI has been working as a Knowledge Processing Body for guidelines with evidence-based medicine, creating transparency in claims management. Another challenge has been to create a benchmark of quality in service provision with service flexibility and efficiency that differentiates it from the pack. Further, the doctor-patient relationship in India is sacrosanct and efforts of create a 2nd opinion have not met with much success.

Solution

MDI has been able to lead a project where networking and negotiating for Quality & Cost Optimisation with treating doctors has resulted in better retention of repeat customers and acquiring new business especially in the corporate vertical. India primarily works on physical claim dockets for claims management, leaving a long paper trail, which is difficult to manage as a claim repository. MDI has created a user-friendly, web-based Enterprise system with wide accessibility to all stakeholders involved.

Latros has helped MDI customise needs as per client, thus improving cost, document and time management by being an entire paperless end-toend system.

The MDI Call Centres operate 27x7 with dedicated lines. Manned by a strong team of 800, the answer time is 20 seconds including doctors answering questions in over 15 vernacular languages.

In addition, it launched a mobile app—HAWK—that has registered 50,000 downloads in 8 months.

Outcome

MDI has 378 doctors, graduates to super specialists on its rolls, who adjudicate claims and create standard treatment protocols for the industry. These have been accepted by many insurers as best practices.

It has created databases for frequent claims in order to bring about cost optimisation. This has also been accepted as an industry practice. With the medical expertise at hand, the company has been successful in being a solo in giving third level opinion on high-ticket claims for overseas accident and life insurance.

Working with more than 10 states has given the company a capability of scaling up and implementing projects in varied geographic, contextual and cultural locations. Cashless outpatient and pharmacy claims have been implemented in two states with the capacity of structuring a well-designed operational team within tight timelines.

It believes that training is the cornerstone of success and has created a core Training Team consisting of 14-members headed by a Cardiologist to ensure quality and calibration while dealing with the customers.

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