Health Insurance Claims Management Software

Health Insurance Claims Management Software

Digitizing Every Step of Health Insurance Claims Management

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


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

Core Building Blocks – A Modular Approach

ClaimsLive Health addresses all the major health insurance functional areas through a structured approach. This health insurance claims management software comes 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 of health claims management.

  • 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

    The innovative health insurance claims management software provides readily available modules that make it easy to effortlessly build your own 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 and streamline healthcare claims management

  • Highly Configurable Business Rules

    Create your own business rules to suit your organization

  • Supports Retail, Group, and Social Sector scheme

    Versatile healthcare claims management 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

  • 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

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