Step 1: Pre-Authorization Request

• Lima goes to the hospital for treatment.
• She shares her Policy No. or Mobile No. or Membership No. at the Reception or Insurance desk.
• In LC360 provider portal, hospital executive can see the member information and high-level benefits eligibility

Step 2: Member Verification

Lima's membership can be verified by any one of the LC360 advanced features

• Biometric Validation
• Facial Recognition
• OTP Based Validation

Step 3: Pre-Authorization Approval

Pre-Authorization evaluation by Rule Engine and subsequent approval for cashless hospitalization

Step 4: Case Management, Discharge and Claim Initiation

A detailed Case Management module to handle pre-hospital, in-hospital and post-discharge activities. Generative AI driven invoice automation for claim invoice processing.

5. Claims Audit and Payments

Approved claims are duly audited and marked as Ready for Payment in case they are in order. Integration with payment ERP solution ensures payment clearing and reconciliation.