ClaimsLive Health is a state-of-the-art health insurance claims management software, for Insurance Companies and Third Party Administrators (TPAs). It provides end-to-end claims management, enables fraud detection and reduces claims leakage.
ClaimsLive Health enables effective control and management of health insurance claims – right from enrolment to settlement.
Core Building Blocks – A Modular Approach
ClaimsLive Health has flexible core modules. They can be leveraged independently to address specific business requirements.
Configuration of health insurance products including benefits, covers, limits, co-pay, deductibles, exclusions etc. Configuration of benefits in ICD 10 terms Know More
Management of network providers grading, standardized schedule of charges Know More
Front end interface for individual members, HR administrators to enable respective functionalities Know More
Business Rule Engine
Configuration of business rules to enable automation of claim processing and identification of fraudulent/suspect claims Know More
Suspect Case Management
Identify and investigate suspect claims using configured business rules Know More
End-to-end empanelment of third party administrators (TPAs) Know More
Manages users across the applications
Master Data Management
Managing and configuring master values
Capture member details for group policies
Manage logistics of printing and distributing health cards
Workflow driven claims processing from Pre-Auth to Settlement
Payment & Settlement
Calculation of net liability and generation of settlement reports
Capture and track status of complaints
Enable configuration of medical and/or surgical protocols, claim costs and identify outliers