Designed to streamline claims processing and bill auditing via its sophisticated automated checking algorithms, Mediclaims allows for flexible and rapid customization and integration to customer-specific environments (regulation, medical guidelines) and internal procedures.
Mediclaims also provides a unique 360° view of the claims processing and bill auditing process via its unique technology which is based on several unique key components:
- Interactive Central Medical File
Central computerized medical file for the insured and/or the claimant providing unique decision-making support for fast and accurate claims settlement.
- Comprehensive Rule Engine
Complex medical algorithms for the automatic checking of the insured’s entitlement to specific treatments in accordance with medical guidelines, logical and insurance checks. Simultaneous checking of claims and bills according to insurer specific rules, policies, and insurance scheme benefits.
- Data Repository
Reliable storage of provider, claims, billing, fraud and medical record data. Enables fast, efficient, accurate data mining for cost analysis, early trend awareness, actuarial calculations, provider negotiations and the development of new insurance schemes and underwriting policies.
- Transparent Communication with Insurer Information System
Seamless interfacing with insurer Legacy Information Systems and databases, including: insurance schemes, policies (health status declaration and personal exclusion), claims and payment orders.
- Table Driven User Interface
Easy adaptation to claims processing of additional or non-medical insurance plans and the easy addition of fields where required.
- Traceability Capabilities
Full backup and retrieval of EDR (Event Data Records) in the event of possible litigation.
- Advanced Optional Functions
Additional functions including: hospitalization monitoring, integral imaging archive, task management, provider and consultant agreements, automatic letter generation and C.R.M (Client Relationship Management).
Providing all the necessary functional components, 360° visibility and processing capabilities, Mediclaims ensures that insurers and additional payers receive optimal, professional and efficient processing of medical claims and bill auditing, at minimal operational costs for maximal savings.