Preauthorization & Claims Process

In the ever-changing healthcare industry, effective preauthorization and claims processing management is not an option, but a necessity. Without it, it’s difficult for the organization to provide quality, timely, correct and proper judgement of services or requests that helps to improve and save lives.
At MAKL there is patient- centric approach in reviewing of the preauthorization requests from the empaneled service providers through our online claims management system (Patient Service Management system).
The process is manned 24/7 by qualified medical personnel who reviews the request as they stream in and provide adequate response within a Turn-around Time (TAT) of 30minutes

Features of MAKL Preauthorization & Claims Process

1. Timely and Accurate Preauthorization Processing : MAKL's dedicated team of medical experts’ processes preauthorization promptly, with a TAT of 20 minutes.

2. Comprehensive Documentation and Verification : MAKL requires the service provider to submit all necessary documentation for a preauthorization request, which is then thoroughly verified to ensure adherence to policy terms and conditions.

3. Paperless Online Claims Management system : MAKL has an end to end online system (Patient Service Management System) deployed at the service provider end for purposes of member identification, MVC generation, preauthorization, claims submissions and payments.

4. Member Engagement : There is constant member engagement throughout the client’s journey while seeking treatment services i.e SMS prompts and notification when preauthorization has been actioned on by MAKL team, auto- calls to admitted patients on preauthorization requests.

Process & Protocols

1. What should I do when am unwell?
  • Visit any of the accredited healthcare facilities

  • The service provider shall check and confirm membership on PSMS system

  • Biometric verification shall be used by the service provider to authenticate yourself or your dependents

  • Once authenticated a Member Verification Code shall be generated and treatment shall commence.

2. What should I do in case of an emergency?
  • An emergency is a situation/condition that requires urgent medical intervention to prevent Life-threatening condition

  • Call the MAKL emergency lines which are on 24/7 contact center number.

  • In the event of an emergency admission in a non-paneled service provider, the admission has to be reported to MAKL within 24 hours from time of admission by the member or next of kin

  • Pre-authorization for scheduled admissions should be obtained 48hrs before such admissions.