Healthcare Benefits Administration

Healthcare Benefits Administration

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.

Value Proposition

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
    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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Benefits Administration Module?

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