1. Effective linkage and Support supervision under Health Insurance
Mr. Pankaj Kumar Bansal. I.A.S.,
Managing Director, CMRL

2. Linking to other programmes
UHC
NHM
RBSK
RCH
DEIC
Differently abled
Dental packages
Mental Health
The CMCHIS can be linked to other Govt. Programmes.
This can help in leveraging the benefits of the National programs and CMCHIS.
By this we can also expand the coverage of CMCHIS towards Universal Health Coverage.
But attending to primary care including RBSK, we can avoid morbidity due to dormant diseases.
The primary care can also help us reducing the health expenditure on a long run.

3. Expansion of CMCHIS to cover Thalassemia and other blood disorders
The Blood disorders are more common in tribal populations in Tamil Nadu.
The CMCHIS can expand to cover the treatment for Thalassemia and other major blood disorders.
The NGOs in the tribal region who are already giving medical care can be contract with bed grants.
The expenditure by the NGOs can be partly covered by CMCHIS.

4. Community monitoring in health insurance
Co-ordinating with JD and DD health of the district
Tapping the PHCs for effective awareness on DC Procedures that can be prescribed by PHC Doctors
Health camp schedules with range of speciality screenings
Joint camps by services providers in the single venue.
SHGs and other local bodies to mobilise local public for screening camps.
SHGs to ensure that the drug distributed is undertaken asper the course.
SHGs should ensure patient feedback on investigations recommended by screening doctors.
Co ordinating with JD and DD Health for understanding the disease load of the location .
Analysing the percentage of smart card distributed and co relating it with state incidence rate of state bench mark to understand/monitor justified incidence.

5. Challenges in monitoring and rectification of errors
The monitoring of utilisation and misuse can be effected by periodic verification of the documents, facility inspections and beneficiary reviews.
Any defects in the review can be addressed by imposing penalties and / or suspension of empanelment.
Any out of pocket expenditures can be handled by repayment to the beneficiaries and penalty imposition.
The strict enforcement of the penalties and suspension may affect the beneficiaries from accessing care from these facilities.

6. Challenges in regulating Govt. Health facilities
Adherence of guidelines
Poor knowledge of platform Usage
Uploading of documents both in Preauth and claim level
Delay in Submission of Preauth
Preauth Applied after the surgery without securing EI Numbers
Preauth applied after the discharge of patients
Delay in Claim Submission
Improper and inadequate documents
Poor response for need more info for both preauth and claims
No linkages between TNMSC and DC Procedures conducted

7. Improving the Utilization in Govt. Health Facilities
The Govt. health facilities can be retrained in the workflow of the application software and the process of insurance claims.
The protocols and the user manuals can be made available in the the website.
The software helpdesk can be established to rectify the software issues which may cause the delay in claim submission.
Special camps can be held for Govt. Health facilities to facilitate the interaction with the TPAs to sort out the long standing NMIs and other issues causing delay in claims.

8. Thank You