1. Health Benefit Consultants (HBC)
Independent Third Party Administrator
Found in 1993
Address
849 Vorawat Building, Floor 19th
Silom Road, Bangrak
Bangkok 10500

2. HBC’s Services Design MEI and PA products Establish hospital network
Claim assessment services
Concurrent review
Case management

3. HBC’s Competencies
Full-time Nurses, experienced claim assessors, and Medical Consultants
303 Hospital Network throughout Thailand
Specifically designed computer software
We have 3 relevant data bases

4. HBC have been performing claim administration more than 1,000,000 claims since 1993

5. HBC’s Competencies
Full-time Nurses, experienced claim assessors, and Medical Consultants
303 Hospital Network throughout Thailand
Specifically designed computer software
We have 3 relevant data bases

6. Main contents in the hospital contract To ensure that HBC can proceed the claims efficiently and accurately
To provide best service to the patient (the claimant)
To gather essential information/profile
Hospital’s specialists and medical equipments
Drug and medical supplies’ price lists and discount structures
Doctor profile
To cooperate with HBC i.e., supplying all relevant medical information and documents, coordinating the claim to ensure timely and accurately communication

7. Hospital network location

13. HBC’s Competencies
Full-time Nurses, experienced claim assessors, and Medical Consultants
303 Hospital Network throughout Thailand
Specifically designed computer software
We have 3 relevant data bases

14. Major characteristics-Computer software
Open platform system
Data Security
Data back up system
Data control system
HBC-Link

15. HBC’s Competencies
Full-time Nurses, experienced claim assessors, and Medical Consultants
303 Hospital Network throughout Thailand
Specifically designed computer software
We have 3 relevant data bases

16. IPD--WITHOUT MATERNITY5 10 15 20 25 30 35 40 45 50 55 60 65
AGE (0 to 70 years old) 0% 5%
10%
15%
20%
% OF POPULATION
M: Act.
M: Est.
F: Act.
F: Est.
HBC
IPD--WITHOUT MATERNITY

17. Changes in Health Continuum of Managed Care

18. Stakeholders and Claim Control Mechanism
What they want?
Claim control through…
Outcome
Insured / Patient
The best medical treatment
Full cover
Deductible
Co-payment
Least attractive product
Highly claim control efficiency
Insurer / NSSF
Satisfy insureds
Maximize sales
Low claim ratio
Sophisticated policy conditions
Not so attractive product
Poor claim control
Provider
Satisfy the patient/the claimant
Free hand to provide the most appropriate treatment
Capitation
Package price policy
High attractive product
Sophisticated claim management

19. Kurnia-HBC Common Objectives
Accurate To reflex the accurate Loss Ratio, Drawing Rate etc.
To maximize clients’ satisfaction
Clear 80% of the reimbursement claims will done within 6 working days
Clean All claim assessments must be able to explain to claimants
Convenience Claimants can access 24 hours a day, 7 days a week

20. Our services offer

21. Free-of-charge product development services
Analyze and comment NSSF’s existing scheme
Initiate / create new schemes

22. Claim processing Provide claim pre-certification Concurrent review
Provide fax-claim services
Q & A claim form insured members

23. Case Management / Concurrent Review
Membership
data update
MAIN STEPS
Pre-certification
Case Management / Concurrent Review
<< REAL-TIME RESPONSE >>
FAX Claim
Claim assessment
U/R Reports

24. Financial & Actuarial Reporting
DATA ANALYSIS

25. Financial & Actuarial Reporting
Time Series Analysis

26. Thank you