Health Insurance Claims Software for TPA and HMO

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HealthX is an advanced software consisting every aspect of functionalities that are required by TPAs or HMOs to handle end-to-end processing of Health Insurance Claims. A single system can handle policies and claims for Retail as well as for Group-Business. Front end driven configurator provides easy steps to configure the products for multiple insurers.

In built workflow management along with smart que handling makes handling of claims easy and cost efficient. Its customer communication modules allows easy set up for sending communication through SMS or email or WhatsApp to ensure customers are kept informed on status of their claims.

Its unique feature of implementing SLAs of insurers makes adherence to insurer’s processes totally system driven.

System based validation of Policy conditions, Provider Tariff Management during claims processing allows it to ensure claims processing faster and accurate.

With ability to seamlessly connect with external entities like Providers, Insurers and Intermediaries ensures flow of communication effortless.

Challenges That Impede Business Growth

Increased Operational Costs

Delay in the claim’s management process due to manual procedures, claims leakage, inaccurate payments (in case of frauds), lost opportunities, and so on, lead to unwarranted operational costs.

Increased IT Costs

Complex and outdated systems that make IT departments to spend more time and money on their maintenance and user support.

Erratic Service Delivery

Lack of ability to prioritize the steps of claims process causing delays, inaccuracies, and erroneous decision making, thereby affecting customer satisfaction.

Increased Fraudulent Claims

One of the major issues insurance industry face globally is the increasing number of fraudulent claims. Excessive time is spent on scrutinizing false statistics and checking databases. Also, payments approved in such fraudulent cases lead to misrepresentation of costs.

Changing Government Compliances

New regulations are introduced from time to time and to keep up with these changing legal compliances is an exhausting process for a company when working in a complex system with the issues mentioned above.

HealthX - Health Insurance Claims Software for TPA and HMO

Key Functionalities include:

Handle product configuration for multiple insurers.

In-built auto adjudication system

In-built API based functionalities for seamless integrations with hospital systems, web portals and mobile apps

Intelligent product configuration with separate ceilings for out-patient and in-patient care. Employee count-linked limit capping

Intelligent product configuration with separate ceilings for out-patient and in-patient care. Employee count-linked limit capping

Configure limit caps for a multitude of categories such as chronic or pre-existing diseases, Dental, Ophthalmology and other critical cases.

Configure corporate buffer while processing claims

Enable policy enrolment and card printing

An end-to-end case tracking tool

Dashboards for customised granular reporting

A centralised repository for complete and unified grievance management

User-friendly web portals for easy navigation

An intuitive document management system

Integrate with SMS, Email and Fax

Eicore offers comprehensive software services and products for brokers, insurers, HMOs, insurance TPAs, self-funded schemes and retail users. Eicore’s health insurance claims management software is an end-to-end and client-focused software providing solutions for claims handling, delivering significant benefits to insurance organizations with its wide-ranging functionalities. The claims management software integrates seamlessly with the existing policy administration system and external entities, thus digitalizing the claim process and saving resources, operational cost, and time, increasing efficiency, and preventing fraud.