Real-Time Cashless Claim Scrutiny
The cashless claim facility is a major convenience for policyholders, but it also presents a window for rapid medical insurance fraud. Because the transaction happens directly between the TPA/Insurer and the hospital, there is a risk of "Bill Padding," where unnecessary procedures are added or hospital stays are artificially extended.
Aziza acts as the "eyes and ears" for the insurer on the ground. We perform real-time audits while the patient is still admitted to ensure that the medical necessity aligns with the policy terms.
