MedinClaim Overview

MedinClaim is an automated expert insurance management system. The innovative, robust and flexible software enables the centralized management of the interaction between the insurer, the medical provider, and the insured.
MedinClaim can automatically process claims filed under any type of insurance that covers medical expenses, such as health, workers compensation, liability, bodily injury, travel, personal accident, or malpractice. MedinClaim can share, process in parallel, and cross-check claims data from different claims, plans, and types of insurance. It offers a streamlined, cost-efficient solution to replace the labor intensive, costly, and inefficient methods used today to process medical claims. A high level of automation and flexibility ensure that all processes and verifications are carried out exactly according to the organization’s decision tree and rules.

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.