Healthcare Benefits Administration

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.

• 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