At Medi Assist, we understand that hospital discharge can often be a time-consuming and confusing experience for patients and their families. That’s why we introduced Raksha Prime—a smart, technology-driven solution designed to streamline the discharge process and make it more predictable, faster, and stress-free.
Raksha Prime accurately predicts a patient’s out-of-pocket expense for cashless claims without the need for claim adjudication. Raksha Prime revolutionises discharge
The value it creates for the stakeholders:
Patients
During discharge, it makes the process simple and predictable for the patient.
It makes the billing/settlement experience at the network hospitals super smooth and convenient.
Provider Network
- Reduces concurrent load during discharge, freeing up bandwidth of the patient-facing teams.
- Delivers good Net Promoter Scores for end-to-end clinical and billing experience.
- Better bed churn due to quicker patient exits.
Using this feature, a patient can be discharged from the hospital without requiring explicit claim approval.
Raksha Prime Process Flow
- PA Approved Cases: The Raksha Prime team gathers data on pre-authorisation (PA) approved cases for the selected hospital and assigns them to the counselling team.
- Raksha Prime Counselling Call: The counselling team calls the patient’s attendant to explain the Raksha Prime process in detail and seek their consent.
- Service Confirmation: If the patient’s attendant agrees to use the Raksha Prime service, the counselling team will give a reminder call on the discharge date (as per the hospital’s schedule) or the patient can call back on the discharge day.
- Collecting Bill value: On the discharge day, the counselling team asks for the current bill value from the patient, or the hospital directly shares the bill value with the Raksha Prime operations team.
- Out-Of-Pocket Calculation: The Raksha Prime team calculates the estimated out-of-pocket (OOP) expenses and shares this information with the hospital and counselling team.
- OOP Communication: The counselling team informs the patient’s attendant about the estimated OOP expenses, which can be paid at the hospital billing counter for immediate discharge.
- Payment and Discharge: The patient’s attendant pays the estimated amount to the hospital billing team, and the patient is discharged.
- Document Submission: After the patient is discharged, the hospital sends the discharge documents to Medi Assist for final approval. The patient doesn’t need to wait for this.
Reconciliation
Post Final Approval Scenarios
- No Difference: If the estimated and final out-of-pocket (OOP) amounts are the same, no further action is needed.
- Overpayment: If the patient’s attendant has paid more than necessary, the hospital will refund the excess amount within 5-7 working days.
- Underpayment: If the patient’s attendant has paid less than necessary, they must pay the difference within 24-48 hours. This can be done online, so there is no need to visit the hospital.
- Denial: If the final approval is denied, the patient’s attendant must pay the full bill amount, minus the estimated OOP already paid at discharge.
Note: Raksha Prime Ops Team follows up with the hospital and patients to ensure they pay their respective dues.
Why Raksha Prime Matters
In today’s fast-paced healthcare environment, predictability and speed are just as important as quality care. Raksha Prime offers a future-ready discharge experience—designed around the needs of both patients and hospitals.
With Raksha Prime, Medi Assist continues to innovate in making healthcare more transparent, timely, and trustworthy for every member.
