In Odisha, HSTP with support from Tata Trusts, is providing technical support to the state government for the implementation of the state health insurance scheme - Biju Swasthya Kalyan Yojana (BSKY). HSTP works closely with the implementation agency - State Health Assurance Society (SHAS) building capacities of the personnel, improving business & clinical processes, targeting better stakeholder engagement and beneficiary experience that contributes to better financial risk protection and good health outcomes.

This workshop on pre-authorization & claims processing is part of HSTP’s program for enhancing the capacities of practitioners and functionaries at the state-level health programs. SHAS is transitioning to implementing BSKY directly without the support of third-party administrators (TPA). This workshop provided an opportunity to provide re-orientation training to the scheme functionaries, especially the doctors who play a key role in this transition and to build their skills in reviewing the pre-authorization and claims processes. This was executed in collaboration with the State Health Assurance Society Odisha and the Department of Medical Education & Training (DMET), Odisha. The workshop provided a learning opportunity to about 20 doctors working for SHAS, TPAs & DMET to improve the implementation of Biju Swasthya Kalyan Yojana in the state.

This report titled ‘Strengthening BSKY Operations: Pre-authorization & Claims Processing’ shares the summary of proceedings of this training.