Automate Benefit Validation for Streamlined Healthcare Claims Management
Healthcare Benefits Administration system helps to automate benefit validation and administration processes. It is fully capable of configuring all types of healthcare insurance products such as retail, group and government funded healthcare schemes at the most granular level. It helps in the configuration of health insurance products including benefits, covers, limits, co-pay, deductibles, exclusions etc.
ClaimsLive Health, our state-of-the-art and customizable health claims management software offers an exclusive Healthcare Benefits Administration Module that is fully capable of configuring health insurance products including benefits, covers, limits, co-pay, deductibles, exclusions etc.
The healthcare benefits administration system seamlessly maps benefits of ICD10 codes and enhances efficiency of health claims processing by automatically classifying permissible and exempt limits. The scalable and versatile system can be deployed independently in order to augment an existing health claims management system for validation.
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.
Leverage the various benefits of Healthcare Benefits Administration system and ensure seamless claims processing
Easily Integrate with External Applications
Expose readily available APIs for third parties to consume, easily integrate and collaborate
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
Replace time consuming manual checks and validations of benefits and limits with automated benefit administration system leading to quick turnaround times
Increase Claim Adjudication Rates with Automated Processing
Facilitates 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
Gain Better Oversight
Take complete control over your distribution network with configurable levels of pricing and underwriting
Manage complex commission structures and make payments online
Help the environment by enabling end-to-end paperless process for policy issuance
Interested to learn more about Healthcare
Benefits Administration Module?