Health Claims Management Software

Software Solutions for Healthcare Claims Management

Digitizing Every Step of Healthcare Claims Management

Digital Claims Management & Fraud Detection solution powered by ClaimsLive Health, a new age state-of-the-art technology platform, provides end-to-end health claims management and enables fraud detection

Health Claims Management and Claims Fraud Detection

ClaimsLive Health is a new age platform for health claims management enabling effective control and management of health insurance claims – right from enrolment to settlement.

  • Manages all complexities in medical claim processing
  • Enables straight through processing of Pre-auth/Claims
  • Provides a robust and configurable benefits administration module
  • Readily integrates with iNube’s ‘Evidens’ platform to route suspect cases on field and eliminate fraud
  • Provides ready to use data models and cubes to facilitate business intelligence and analytics on enrolled data, claims data and financial data analysis

 

Core Building Blocks – A Modular Approach

ClaimsLive Health addresses all the major health insurance functional areas through a structured approach, with a modular setup of its core building blocks. Each of these blocks can be leveraged independently to provide realistic solutions that meet business requirements.

  • Benefit Administration

    Configuration of health insurance products including benefits, covers, limits, co-pay, deductibles, exclusions etc. Configuration of benefits in ICD 10 terms
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  • Provider Management

    Management of network providers grading, standardized schedule of charges
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  • Corporate Portal

    Front end interface for individual members, HR administrators to enable respective functionalities
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  • Business Rule Engine

    Configuration of business rules to enable automation of claim processing and identification of fraudulent/suspect claims
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  • Suspect Case Management

    Identify and investigate suspect claims using configured business rules
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  • TPA Management

    End-to-end empanelment of third party administrators (TPAs)
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  • User Management

    Manages users across the applications

  • Master Data Management

    Managing and configuring master values

  • Enrolment Management

    Capture member details for group policies

  • Dispatch management

    Manage logistics of printing and distributing health cards

  • Claims Management

    Workflow driven claims processing from Pre-Auth to Settlement

  • Payment & Settlement

    Calculation of net liability and generation of settlement reports

  • Grievance Management

    Capture and track status of complaints

  • Case Management

    Enable configuration of medical and/or surgical protocols, claim costs and identify outliers

  • Mobility Extensions

    Native mobile apps for on-field activities including health claims investigations, hospital audit etc.

  • Float Management

    Maintain float for payment of claims by TPAs

  • Communication Management

    Configurable notifications to all stakeholders, on defined trigger events

Value Proposition

ClaimsLive Health, a comprehensive health insurance claims management software comes with a host of benefits, designed to meet your business objectives.

  • Seamlessly Integrate Modules

    Readily available modules make it easy to effortlessly build your own claims management system

  • 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

    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 organization. Automatically route claims to specific roles with defined privileges

  • Highly Configurable Business Rules

    Create your own business rules to suit your organization

  • 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

  • Issue1 Real Time Quotes/Policies

    Instantly generate quotes and issue policies. Reduce load on your core insurance system

  • Provide Quick Turn Around Time (TAT)

    Delight your customers by providing quicker turnaround times for policy issuance, renewals, endorsements

  • Ensure Greater Flexibility

    Allows insurance companies to configure different privileges for pricing, underwriting and operations to
    different intermediaries

  • Gain Better Oversight

    Take complete control over your distribution network with configurable levels of pricing and underwriting
    privileges

  • Increase Transparency

    Manage complex commission structures and make payments online

  • Be Eco-friendly

    Help the environment by enabling end-to-end paperless process for policy issuance

Related Solutions

Mobility Solutions for Health Insurance Customers

Medsync mobile application, caters to the critical needs of your health insurance customers and provides a stress-free experience Know More

Health Claims Investigation Solution

Reduce TAT for your customers, with an intuitive mobile app to investigate cases, prepare and submit reports directly from the field Know More

Interested to learn more on how our solution can help you in streamlining Health Claims Management?

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