123 Kolkata: A Swasthya Sathi official said that the TPA would have to verify that the required images had been uploaded, and if not, why the hospital had failed to do so. Approval of the claims will depend on a satisfactory clarification from the hospital.
The app has been built to prevent editing of photos, videos and GPS location once the images are uploaded. For patients undergoing dialysis, chemotherapy and other surgical procedures, the hospitals will have to capture and upload the start and end time of the procedure, which will again be analysed by the AI tool. The onus of verifying compliance will be on the TPA. In case of non-compliance by a hospitals, the claim will be released only after a satisfactory clarification.
"After developing the app and the AI tool, we ran a pilot project in a few hospitals. After testing its efficacy, we are now rolling this out in all SS-empanelled hospitals. In addition to detecting false claims and fraudulent means, we hope these new tools will streamline the use of the health scheme," said the official.
The health department has also asked private hospitals to upload details of all doctors treating patients under the SS scheme.