Aarogyasri Health Care Trust Functions
The initial period of coverage under the scheme by Aarogyasri Health Care Trust will be Six months
The offices of the Aarogyasri Health Care Trust will house the staff administering the Scheme.
A "Run Off period" of one month shall be allowed after the expiry of the policy period. This means that pre-authorizations can be done till the end of policy period and surgeries for such pre-authorizations can be done up to one month after the expiry of policy period and all such claims shall be honoured.
Back Office Departments:
- Round-the-Clock Pre-authorization wing with specialist doctors for each category of diseases shall work along with the Aarogyasri Health Care Trust doctors to process the pre-authorization within 12 hours of the electronic request by the network hospital on the web portal of the Aarogyasri Health Care Trust.
- Claims settlement wing with required staff shall function to settle valid claims within 7 days.
- Call Centre The Aarogyasri Health Care Trust portal receives calls through 104 Call Centre handling all the incoming and outgoing phone calls, grievances received through various means. The Aarogyasri Health Care Trust provides executive support for the purpose of guiding and redressing the grievances of the stake holders. This service shall be referred to as the "Call Centre Service". Queries relating to coverage, benefits, procedures, network hospitals, cashless treatment, balance available, claim status and any other information under the scheme anywhere in the state on a 24x7 basis shall be answered in Telugu.
- Grievance Wing :
This wing is manned by JEO and other staff to address the grievances from time to time as per the guidelines. The Aarogyasri Health Care Trust shall attempt to solve the grievance at the field level. The Aarogyasri Health Care Trust shall provide the beneficiaries or NWH with details of the follow-up action taken as regards the grievance as and when the beneficiaries require it to do so.
The Aarogyasri Health Care Trust records in detail the action taken to solve the grievance of the beneficiaries NWH in the form of an Action Taken Report (ATR) within 2 working days of the recording of the grievance. The Aarogyasri Health Care Trust shall provide the Government with the comprehensive action taken report (ATR) on the grievances reported in pre-agreed format. The entire process will be done through the call center and Aarogyasri Health Care Trust portal.
Administration, Training and HR wing with required staff for the purpose of office management, legal matters, accounts. It will manage human resources, arrange the workshops / training sessions for capacity building of the stakeholders in respect of the scheme and their roles.