Hospital room & services during hospital confinement General nursing care during hospital stay Intensive Care Unit expenses, if found necessary by attending specialist Fees of the consultant, physician, surgeon and anesthetist Drugs’ expenses Local Road ambulance for emergencies from hospital to hospital Pre Hospitalization diagnostic tests, Consultation & Medicines Post follow-up treatment

Services - Crescent Care Private Limited

SERVICES

Mailroom / Document Management

Mailroom Services

Customers send documents in bulk and reduce mailroom costs by routing mail directly to Crescent Care's post office box. Crescent Care's mailroom service frees customers from the headaches of opening and sorting, enabling them to benefit from naturally occurring economies of scale and making this process automated.

Document management

After preparing and classifying the document, they are sent to the scanner. The scanner can print a document control number (usually the date followed by a sequential number) on each page that passes through the scanner. This embossing feature eliminates the need to manually date stamp each document.

POLICY ADMINISTRATION

The Customer/insurer/policyholder details are entered in the Crescent Care application
system. After carefully checking the uploaded data, the insured person’s health insurance cards are printed.

Policy administration includes appropriate additions, deletions, and changes to policy benefits and coverage throughout the year. 24/7 call center service is available to provide support and handle insured inquiries.

Utilization Management

The network claims pre -approved services for elective treatments and surgeries . Review claims and coordinate with physicians, hospitals and other providers within & outside the network to determine the appropriate level of benefit consumption under policy/privilege terms as per client protocol and established guidelines.

Case Management

We employ a gatekeeper approach of advising patients and assisting qualified physicians as case managers to direct the services they need, ensuring the quality of care provided to our members and its cost effectiveness. Expert case managers monitor members' well -being from admission to discharge and manage unnecessary tests, medications and malpractice.

Claims Management

Our service strives for a complete implementation of an automated end-to-end process flow until successful claim settlement. The aim of the current medical scrutiny done at CC to identify some of the points listed below: • Inappropriate billing pattern • Detection of customary overcharge • Duplicate billing detection • Visiting Doctor charges • Fee schedule • Verification of pharmacy and investigation bills for reasonableness • To filter unnecessary admissions • To monitor length of stays • Necessity of hospitalization

Claims Management

Inappropriate billing pattern
Detection of customary overcharge
Duplicate billing detection
Visiting Doctor charges
Fee schedule
Verification of pharmacy and investigation bills for reasonableness
To filter unnecessary admissions
To monitor length of stays
Necessity of hospitalization

Liaison with Insurance Companies

Crescent Care Services Healthcare policies are tailored to the needs of the customer/insurer. CC can also assist clients/insurers in designing healthcare plans with their needs in mind. By working with existing policies, CC allows clients to monitor medical policies without interfering with daily administrative processes.

MIS Reporting

Crescent Care can create customizable MIS reports for their customers. With the latest software available, CC can produce a variety of regular MIS reports according to standard protocols and customer requirements. A sophisticated MIS system with CC enables all customer service representatives to provide customers with the information they need to reach their goals.

Reports

• Call history report • Benefit redemption report • Pre-approval detail report • Billing Detail Report • Disease trends report • Group overview report • Other reports as per the mutual agreement

Value Added Services

• Disease management • Preventive care programs • Advanced case management • Provider network management • Product development • Other value additions as per understanding

Technology Infrastructure

Crescent Care technology infrastructure includes the
latest technology servers, workstations and high speed scanners, networked through state-of-the-art technologies.
CC uses encrypted SSL and VPN technology for communication between Insurance Companies, Providers and Groups with CC systems that ensure secure transmission of data. We use load balancer to ensure 24/7 internet connectivity through multiple providers.

Disaster Recovery:

Crescent Care has developed a disaster recovery process as an integral part of its business continuity plan. Below are some of the key components of disaster recovery:

• Data backup and recovery plan
• Simultaneous onsite and offsite backup
• Proactive server maintenance
• Log changes to the server system
• Hardware-level fault tolerance
• Availability of identical replacement hardware
• Staff training on disaster recovery procedures
• Document recovery procedures
• Regular exercises to test the disaster recovery process

CASHELESS Hospitalization Services

Want To Know More

Categorization of Employees

PLANS

DIRECTORS

MANAGERS

OTHERS

ENTITLEMENT

PRIVATE ROOMS

SEMI PRIVATE

WARDS

AGE ELIGIBILITY

5 years –Employees/Spouses
25 years- Dependent sons
No age limit for unmarried daughters
No age limit for retired staff & their dependents

Ideal for self managed companies to cover their employees’ In-Patient, Maternities, Daycare surgeries & procedures on cashless basis through credit services
Out Patient Medical Expenses (Credit/Reimbursement) both
Reimbursement through Inter Bank Fund Transfer (IBFT)
No Pre-authorization (OR) prior approval required for emergency medical treatment at network hospitals
All employees and insured members can enjoy full cover from day one
No health questionnaire forms required
100% pre existing conditions coverage

MEDICAL EXPENSE BENEFITS

INPATIENT SERVICES

Hospital room & services during hospital confinement
General nursing care during hospital stay
Intensive Care Unit expenses, if found necessary by attending specialist
Fees of the consultant, physician, surgeon and anesthetist
Drugs’ expenses
Local Road ambulance for emergencies from hospital to hospital
Pre Hospitalization diagnostic tests, Consultation & Medicines
Post follow-up treatment

Daycare Surgeries & Specialized Investigations

Dialysis, Cataract Surgery
MRI, CT Scan & Thallium Scan
Endoscopy & Angiography
Treatment of Fractures
Emergency Dental Treatment due to accidental injuries within 48 hours (for pain relief)

Crescent Care has a list of approved network hospital of 340+ which provides care to all insured persons without any deposit or advance payment. We reimburse hospital bills directly
Crescent Care’s doctors and staff monitor the care and treatment of the insured while patients are hospitalized. They are also available for advice regarding selection of appropriate of doctors and hospital for treatment of specific conditions
Crescent Care’s specialized staff work closely with the employer’s representative to control and prevent misuse of benefits provided to an individual insured

MATERNITY EXPENSE BENEFITS

Maternity expense benefits pays for medical expenses related to pregnancy and childbirth, up to the pre determined limits and has sub limits for the following expenses:

Pre-natal treatment
Post-natal treatment
C- Sections/ Multiple Births/ Complicated delivery; wherein the maternity sub-limits are increased from the amount of normal delivery(the additional limit is provided free of cost)

OUTPATIENT EXPENSE

This benefit provides for all the costs incurred in respect of General Practitioner and specialist outpatient treatment including:

• General Practitioner’s or Homeopathic, Hikmat, Physician’s services and supplies
• Specialist Consultations
• Prescription Drugs
• Lab Tests, X –ray tests, ECGs & EEGs, Eye Testing
• Physiotherapy and similar treatment
• Dental care & Outpatient Prescription Drugs

CORPORATE MAJOR MEDICAL EXPENSE

To meet the extra-ordinary medical expenses on major and complicated cases where an insured’s hospitalization expense benefit limit exhausts, subject to other terms and conditions of the policy. This benefit is not applicable for any Pregnancy related hospitalization OR Out-Patient Expense Benefit

These benefit covers all eligible expenses incurred by participant for hospitalizations and surgical procedures due to any sickness or injury, subject to pre-determined limits for each category of employees.

Claim Procedure

AT PATIENT HOSPITALS

Following procedure applies in cases requiring emergency hospitalization:

Identify yourself at the providers facility
Produce Health Card & CNIC
Get the treatment required on credit, up to the limits available
Pay only amount that exceeds the limit or utilized in non-medical items

AT NON HOSPITAL PANELS

Inform Crescent Care 24/7 Call Centre within 24 hours of the hospitalization

• Pay cash for the treatment
• Submit all original bills/ supporting documents with our claim form for reimbursement
• Submit all original bills / supporting documents with our claim form for reimbursement, within 30 days of discharge from the hospital
• Settlement of claim will be done in line with policy terms prevailing

THE FOLLOWING BENEFITS ARE PART OF OUR HEALTHCARE:

CREDIT FACILITY in the best hospitals known as PPN (Preferred Provider Network)
REIMBURSEMENT in case of treatment from non-PPN hospitals
INTERNATIONAL COVER – reimbursement for EMERGENCY hospitalization only as per company policy
Issuance of PERSONAL CARD of Insurance to each insured employee
EMERGENCY HOTLINE SERVICE is available round the clock
MINIMUM TURNAROUND TIME for claim settlement 5 working days

Note for non-panel cases We reimburse the benefits utilised outside our Preferred Provider Network (PPN) hospitals in line with reasonable and customary charges rates as in Panel Hospitals.

Looking For Some inquiry ?

Contact Now