oDoc

What we offer

oDoc offers a cutting edge technological solution for claims processing. In partnership with Vidal Health, India’s leading TPA provider, oDoc is leading the way in revolutionising the Sri Lankan Health Insurance industry. We aspire to offer a frictionless service for you and your policyholders by taking care of your entire claims processing operations while ensuring best-in-class standards.

What we offer?

oDoc has partnered with Vidal Health, India’s leading TPA provider, to revolutionise the Sri Lankan Health Insurance industry by offering a cutting edge technological solution for claims processing.
We aspire to offer a frictionless service for you and your policyholders, ensuring optimal industry standards by taking care of your claims processing operations entirely.

Benefits for insurance companies

Total visibility on policyholder claim requests

A fully automated rule-based system for claims adjudication

24/7 pre-approval process

Float fund management and payment settlements

Enrolment of  policyholders and unique ID card issuance

Improved productivity and minimal operational overheads due to process automation

Reduced cost due to negotiated rates with hospitals

Benefits for Policyholders

Cashless hospitalisation access to leading hospitals in Sri Lanka, India, and GCC countries

Ability to monitor and manage claim requests via the oDoc app

Frictionless claims reimbursement facilities

24/7 dedicated trilingual customer care hotline

On request second opinion service

Exclusive discounts at partnering firms 

Make your claims processing operations digital

Network Hospitals

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durdans

Durdans Hospital

nawaloka-logo

Nawaloka Hospital Colombo

western

Western Hospital

medihelp

Medihelp Hospital

Get Started

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Frequently Asked Questions.

Please call our dedicated hotline and notify us of your hospitalisation needs. 

Following that, you can proceed to any hospital in our network. 

Submit your insurance card and NIC details to the hospital representative to verify your identity. 

The hospital will then contact us to receive pre-authorisation to proceed with your treatment. 

At the time of discharge, the hospital will send us your final bill. We will check it against your policy coverage and inform the hospital of the approved cashless payment within 45 minutes. 

We will keep you informed by SMS at each step of this journey.

You can either settle your claims through our cashless facility or through reimbursement.

Please fill in the information requested under the “submit a claim” section on the oDoc app.

Attach your final invoices and other supporting documents to authorise the claim (doctor’s reports, prescriptions, lab reports, etc.) and submit the request.

Upon successful submission, we will adjudicate your request according to your policy’s coverage and submit the judgment through the app.

Once your request is approved, you must submit your original documents to the nearest branch of your insurance company.

We will then initiate your payment within 7-10 working days.
We assess the validity of each claim through our state of the art TPA system, VINGS. 

The VINGS system utilises five million-plus edit combination checks with ICD, CPT, CDT, HCPCS and drug codes to prevent fraudulent and erroneous claims. 

This system adjudicates requests by validating the documents submitted, policy rules, ‘Table of Benefits’, and the treatment undergone by policyholders to settle claims according to the settlement parameters agreed with the insurance provider.

oDoc offers dashboards to insurance providers, network hospitals and policyholders to keep all parties up to date with all information.

Policyholders can monitor the status of their claims via the oDoc mobile app or by contacting our dedicated hotline provided to insurance companies.

Policyholders can reach out to our 24×7 dedicated trilingual customer care team for queries or assistance.

Insurance companies will be appointed a personal relationship manager to assist with all business requirements.
oDoc facilitates telemedicine services, second opinion services from Sri Lankan and international medical professionals, medicine delivery, mobile lab services, and discounts from partnering health and wellness companies.

oDoc also provides international cashless hospitalisation facilities in India and GCC countries.

oDoc currently has a network of 70+ leading hospitals in Sri Lanka and also covers cashless hospitalisation at renowned hospitals in India and GCC countries.

Yes, oDoc accommodates reimbursement facilities for OPD claims through the oDoc app.

The same hospital claims reimbursement process detailed above, will be followed for OPD claims.
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