Page 186 - Ebook health insurance IC27

The Insurance Times

settlements, turnaround time, impact of prior-authorization etc, as also to
improve the business intelligence of their processing systems which can help
automatically alert outliers.
(i) For other stakeholders - Providers, brokers, consulting firms, industry bodies
(FII, CII) and international bodies (WHO, World Bank) also uses the data for
different purposes.

Q2. Which are the data tables to be submitted to IRDA?
Ans. IRDA requires insurers/TPAs to capture and report data in a specified format to

ascertain that the data is collected and reported in a standardized format across
all insurers. Following are the tables in which data is to be submitted :
(a) Policy Data ( Table A) - The policy level information is contained in this table. It
holds details such as total number ofpeople covered under apolicy, policy premium,
start date and end date of policy.
(b) Member Data (Table B) - This table contains information about the individual
members covered under the policy. The details include the age or date of birth of
member, sum insured, gender and relationship with the insured.
(c) Claims Data (Table C) - Information on claims made by the covered members
is contained in this table. The details include the date of admission and discharge,
diagnosis description and code, name of the hospital, amount paid as well as
claimed and date of payment.

Q3. Write a note on data ware housing. What are the qualities of a good data
ware housing system ?

Ans. A data ware house is a repository of an organization's electronically stored data,
designed to facilitate reporting and analysis. The means to retrieve and analyze
data, to extract, transform and load data , and to manage the data dictionary are

190 Guide for Health Insurance