Health Claims Management

Healthcare Benefits Administration

Automate your Benefit Validation for Streamlined Healthcare Claims Management

Healthcare Benefit Administration system helps in the configuration of health insurance products including benefits, covers, limits, co-pay, deductibles, exclusions etc. and configuration of benefits in ICD 10 terms

Overview

ClaimsLive Health, our state-of-the-art and customizable health claims management software offers an exclusive ‘Benefit Administration Module’ that is fully capable of configuring health insurance products including benefits, covers, limits, co-pay, deductibles, exclusions etc.

It helps health insurance companies setup multiple plans under each product for retail, group medical insurance policies and social sector schemes.

What can be configured?

    • Configure multiple plans with different sum insured
    • Configure treatment/provider zones
    • Benefit eligibility at a member level
    • Inclusions, in ICD 10 terms under each plan
    • Define add-on covers
    • Define limits and sub limits for each benefit
    • Setup copay on multiple parameters
    • Setup deductibles based on multiple parameters
    • Define other terms and conditions applicable to the policy
    • Setup corporate buffer at family level and policy level

An API can be provided for each of items configured under each plan. On receiving an API call, the ‘Benefit Administration’ module can provide you with inputs on whether the claim condition is covered or not.

Value Proposition

Leverage the various benefits of Healthcare Benefit Administration system and ensure seamless claims processing

  • Operational Flexibility

    Configure all products in a single module

  • ICD 10 Compliant

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

  • Seamless Configuration Capacity

    Configuration capability of 70K ICD codes

  • Versatile & Diverse

    Supports a wide range of products such as retail products and multiple sub plans, group health insurance products and multiple plans. Self-funded social sector schemes, government plans and hybrid plans

  • Quick Turnaround Times

    Enables very high turnaround time for claims processing

  • Straight Through Processing (STP)

    Enables straight through processing of Pre-auth/Claims with real time claims data

  • 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

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Interested to learn more about Health Insurance Product Design using Benefit Administration Module?

Request Demo

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