Hospital and Clinic Management Made Easy

Insurance

  • Insurance bill estimation
  • Generation of Preauthorization forms
  • Registering OP / IP patients with Insurance Company and TPA details
  • Capturing Pre-authorization amount and the way pre-authorization is received
  • Capturing Insurance card image in registration
  • Edit / Change Insurance company details and Pre-auth approval amount from Billing/Registration
  • Automatic Calculation of Rates for different Insurance Plans
  • Facility to split the item amount into the Insurance and Patient co-pay
  • Advance/Refund option for patient payments
  • Sending the claims to TPA's as Single Claim / Claim Batch
  • Facility to mail the clinical and supportive documents through mail directly from Patient Medical Records to TPA's
  • Tracking the Payments / Dues from TPA's using Reports
  • Facility to record receipts from insurance/corporate sponsors using Claim Batch number or individual claim number with TDS preferences
  • Pending Age Reports analysis to increase efficiency.
  • Audit Log

Insurance e-Claims

  • XML based Claim Processing as per specs of HAAD (Health Authority of Abu Dhabi) and DHA (Dubai Health Authority)
  • Coding of various services provided in hospital. Supports CTP codes, HCPCS codes, DRG codes, ICD codes, Dental codes, LOINC codes, etc.
  • Remittance Upload and Reconciliation / Entering the Payments using Claim Batch number or individual claim number.

Hospital and Clinic Management Made Easy

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