CLAIMSLIVE

A state-of-the art Technology Platform for effective
management of Health Insurance Claims

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ClaimsLive Manages over

ClaimsLive Manages over

ClaimsLive Manages over

A COMPREHENSIVE PLATFORM WITH SMART FEATURES

Auto Adjudication

Reduce processing time for straight forward claims. Setup business rules for straight through processing claims



Self Service Portals

Separate portals for each stakeholders to carryout specific functionality

Smart Validation

Built in rules to flag duplicate claims, insufficient BSI, package mismatch etc. To enable effective claims processing

Alert for Suspect claims

Set parameters to identify suspect claims and take appropriate action

Integrated Mobile Apps

Readily integrates with Mobile Apps to investigate fraud and suspect cases

LET US CONNECT

A COMPREHENSIVE PLATFORM WITH SMART FEATURES


Auto Adjudication

Reduce processing time for strait forward claims.setup business rules for straight through processing claims


Self Service Portals

Separate portals for each stakeholders to carryout specific functionality


Smart Validation

Built in rules to flag Duplicate claims, Insufficient BSI, Package Mismatch etc.To enable effective claims processing


Alert for Suspect Claims

Set parameters to identify suspect claims and take appropriate action


Integrated Mobile Apps

Readily integrates with Mobile Apps to investigate fraud and suspect cases

LET US CONNECT

BUSINESS ADVANTAGES

Seamlessly integrate modules

Readily available modules make it easy to effortlessly build your own claims management system. Start with the core modules and customise as per your requirement

ICD 10 based benefit administration

Benefits mapped to ICD 10 codes make processing of claims more efficient by automatically classifying permissible and exempt claims

Fully digitized SOC, Tariff, Billing policies

Fully digitized SOC, Tariff, Billing policies Insurance companies / TPAs can digitize the voluminous SOC, tariff data of each provider to make data processing easier

Role based privileges and configurable workflow

Define a path to process claims. Configure it to suit your organisation. Automatically route claims to specific roles with defined privileges

Highly configurable business rules

Create your own business rules to suit your organisation

Supports Retail, Group, and Social Sector scheme

Versatile system capable of handling individual retail claims or scaling up to handle large volumes of claims under social sector schemes

product Architecture

An extensive system To handle all aspects Of Health Claims Management

TECHNICAL ATTRIBUTES

  • Performance benchmarked and Certified
  • VAPT and Security compliance and Certified
  • On-premise and On-Cloud Hosting Compatible
  • ICD -10-PCS Certified
  • Seamless Integration flexibility with any Middle ware and with Legacy Core Systems
  • Plug and Play interfaces available to integrate with peripherals such as MS CRM, DMS, LCU and eFax systems
  • Responsive UI adhered with Industry UI patterns
  • Componentized architecture and All core modules are loosely coupled
  • Built using .NET along with MVC Framework which are RESTFUL in Nature with High degree of Control
  • System is built with SQL Server and already MS SQL Server 2016 compliance certified
  • Persistent Data framework which can work with any ORDBMS