The robust and flexible platform was designed to accommodate all the intricacies and regulatory requirements of a mixed system of private and public payers and providers. Using a centralized patient-based medical record, MedinClaim provides the insurer better visibility and service and faster response time. It is ideally suited for insurance companies, PPOs, HMOs, medical networks, self-insured organizations, TPAs, bill auditors (RACs) etc.
At the heart of the system is a sophisticated rules engine that runs thousands of user-defined insurance, logistic, and medical algorithms to check each claim against policies, plan benefits and exclusions, provider agreements, patient records, pre-authorizations, and more.
The universality and extreme flexibility of MedinClaim make it easy to customize it for any environment and any local regulations, diversity of benefits and exclusions, complex agreements with medical providers, clinical guidelines, and company-specific policy, rules, and processes.