The software handles complete life cycle of Insurance Health Claims process for this Insurance Company. It covers Cashless and Reimbursement mode all the Health Product of the insurance company.

With the use of the software the claim processing is almost paperless. It is helping the company maintain its Service Level Agreement with its customer.

Salient Features

Incoming communication

Integrated with incoming Fax server and Mail for incoming Health claim related communication on real-time basis.

All Manual (hard copy ) mail/ Courier are tracked. The documents in the mail/courier are scanned and uploaded in system for further processing.

Categorization and detail entry.

The incoming communication is viewed and categorized as per the content of the communication. The details are entered including the patient, bill, and estimate details.

Provision is built to trigger mail/sms at completion of each stage of Claim processing. This keeps the related parties up dated in real time basis.

Doctors Action

Doctor view all the communication document received along with the Policy, Member, and Provider and Claim details on the system through one screen, enabling Doctors to take support Doctor take appropriate decision.

System has facility to propose the claim amount based on the Claim received, Tariff rate agreed with the service provider and Benefits as per the Policy of the member (patient) . This helps in reducing the manual checking effort and time.

System allows multiple actions by doctor. Depending on case doctor and Approve and/or raise a deficiency query and/or put up investigation and/or put up approval request for additional corporate buffer ( for Group case only) Alternatively Doctor can Reject or Close a Claim as per the case

Committee Approval

All action taken by Doctor undergoes a Doctors' Committee Approval. Provision has been made for multistage approval. Committee can view the Member detail, Policy Detail, Provider details, Claims Detail and the action taken by Doctor. On Committee's approval all outward formal communication is triggered (Fax/ Mail/ SMS). A Claim rejected by committee, with remarks, is reviewed and re-submitted by Doctor. Before approving the user can view all the outward documents that will trigger on approval.

Payment

All payment approval from committee generates payment request. The payment requests are grouped as per fund availability and through batch interface NEFT transfer is done. The NEFT confirmation is updated back in the system and outward document of payment confirmation is generated from system.

Technology

Visual Studio 4.5 with MVC 4.0, Microsoft SQL Server 2008 R2, Crystal Report - 13.0.2000.0

Portal for Online purchase of following Health Policy:

  1. Individual Health Policy
  2. Sampoorna Swasthaya Kawach
  3. IOB Health Care Plus
  4. K Family Care

Process is user inputs the details of the members that need to be insured, selects the cover required and system calculates premium based on the input by user. If user is interested system accepts online payment. The Policy Schedule in user hand on successful payment of premium. System accepts request for new and renewal of health Policy

Portal for Online purchase of Motor Policy:

Process is, user inputs the details of the vehicle, system calculates premium based on make, age and declared value. If user is interested system accepts online payment. On successful payment of premium, user gets the policy schedule. System accepts new and renewal of Motor Policy.

Portal for Online purchase of Personal Accident Policy:

Process is, user inputs the individual's details. Like profession, age, area of work and the cover required, system calculates the premium. If user is interested system accepts online payment. On successful payment of premium user gets the Policy Schedule.

The software takes care of complete back office for this Security Company

Salient Features

Configurable Wages as per minimum wages of different states Handling Attendance with multiple duty hours approval mechanism from customer. Configurable Salary processing, as per different statutory requirements at different locations. Configurable Invoicing as per configurable billing sheet and Attendance Customer Portal, giving access to customer to view their related information

Handling other process like

  1. Employee advance, request , its approval and payment through NEFT
  2. Expense booking, its approval and payment through NEFT
  3. Travel Advance, Travel expense booking , its approval and payment through NEFT
  4. Payment of Rent, security deposit through NEFT
  5. Alert for all compliance document that are missing or approaching expiry.
  6. Access to Branch for all activities at branch level
  7. Role based login ID, that has access control up to field level.