Health Claims Management

Maintain Precise Provider Data and Streamline Workflows

Provider Management solution helps in the management of network providers grading and standardized schedule of charges. It maintains comprehensive information about the providers and provides end-to-end empanelment of various service providers

Overview

ClaimsLive Health, our state-of-the-art and customizable technology platform for end-to-end digital claims management and fraud detection for health insurance offers an exclusive ‘Healthcare Provider Data Management Module’ that can manage the complexities associated with empaneling providers on your network such as hospitals, diagnostic centers, pharmacies, clinics, etc. and optimize their configuration to enable claim automation.

Functionalities

Leverage user friendly functionalities of the Healthcare Provider Data Management Module and achieve operational excellence

Pre-empanelment verification – Capture infrastructure, specialty, facilities, medical and para-medical staff details under each provider

Grade providers based on empanelment details captured and verified

Configure provider Schedule-of-Charges (SOC)/tariff

Configure provider billing policies

Add/remove providers to watch list

Handle request for voluntary termination from providers

Workflow for empanelment/de-empanelment, watch listing, suspension, de-empanelment and blacklisting of providers

Capture details for non-networked providers

Convert non-networked providers to networked hospital via empanelment process

Value Proposition

Healthcare Provider Data Management Module comes with a host of benefits to help you enhance your provider engagement

  • Create Common Repository

    Provide a one stop shop of provider information for increased operational transparency and improve data integrity

  • Provide Data Accuracy

    Streamlined workflows for provider empanelment reduces human error and eliminates data discrepancy with reliable data

  • Enhance Provider Engagement

    Improved provider data quality, leads to more accurate claim adjudication and reimbursement leading to overall provider satisfaction

  • 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

Related Solutions

Digital Claims Management & Fraud Detection Platform

Streamline your claims management with a state-of-the-art technology platform for end-to-end digital claims management and fraud detection for health insurance Know More

Health Claims Investigation Solution

Increase productivity of your health claims investigators and reduce TAT for your customers, with an intuitive mobile app to investigate cases, prepare and submit reports directly from the field Know More

Interested to learn more about our Healthcare Provider Portal?

Request Demo

We use cookies to ensure that we give you the best experience on our website.