UTI Infrastructure Technology And Services Limited
e-Adjudication of Claims – ESIC
(Online Referral & Admission Intimation)
Start
(Normal Referral) ESIC / ESIS Hospital / Institution
ESI Beneficiary to ESIC / ESIS validates and captures the Beneficiary
Hospital / Institution for Referral Information & Generate Referral Letter
Referral Details are
available to the
respective Empanelled
Facility
Empanelled Facility
Verifies the Referal Details Invalid Deny Referal
Online
Valid
Intimate to BPA
Empanelled Facility
Submits More Information
BPA Acknowledger
Acknowledgement Process
More Information Yes
Required
No
Acknowledge / Reject Intimation
End
UTI Infrastructure Technology And Services Limited
e-Adjudication of Claims – ESIC
(Emergency Intimation)
Start
(Emergency) Empanelled Facility captures the
ESI Beneficiary to Empanelled Beneficiary Information &
Facility Emergency Details
Intimate to ESIC / ESIS
Hospital / Instituion
More Information Empanelled Facility
Yes
Required Submits More Information
No
Deny Admission No Admission Justified
Yes
Intimate to BPA
Empanelled Facility
Submits More Information
BPA Acknowledger
Acknowledgement Process
More Information
Yes
Required
No
Acknowledge / Reject Intimation
End
UTI Infrastructure Technology And Services Limited
e-Adjudication of Claims – ESIC
(ESIC Model Hospital - Receiving / Verification Process)
Start
Physical
Claim Submission by Empanelled
Facility
Empanelled Facility
Submits More Information
ESIC / ESIS Hospital
Receive Claims
ESIC / ESIS Hospital
Verify Documents
Yes
More Information
Required
No
End
UTI Infrastructure Technology And Services Limited
e-Adjudication of Claims – ESIC
(BPA Validation Process)
Start
Claim Submission by Empanelled
Facility & Verification by ESIC /ESIS
Hospital
BPA Scrutinzer Empanelled Facility
Validation Process Submits More Information
More Information
Yes
Required
No
BPA
Authorize / Reject Claim
End
UTI Infrastructure Technology And Services Limited
e-Adjudication of Claims – ECHS
(ESIC - Approval Process)
Start
Empanelled Facility
Submits More Information
ESIC Level 1
Recommend to Authorize /
Reject Claim
More Information Required Yes
No
BPA Review Yes Review Required
No Yes
Yes ESIC Level 2
Recommend to Approve / Reject
Claim
More Informaion Required
No
Review Required
Yes
No
ESIC CFA
Sanction / Reject Claim
Review Required
No
Fund Disbursal Process
End
