Health Insurance Claims Administrator

Project Description

Industry: Insurance

Description:
Insurance claims management system is a comprehensive portal for an insurance provider who manages the medical claims of the customers.

This is a complete online system where the network provider can directly raise an E-Claim with the insurance administrator and get them approved without any manual intervention.

Features:

• The system follows the below international medical codes
• International classification of diseases – ICD
• Current Procedural Terminology – CPT
• Drug code

Policy Management

• Policy coverage details maintenance.
• Table of the maintenance of the benefits under a policy.
• Contractual dates with the customer can be created and maintained under this module.

Member Management

• Details of the members who are enrolled for the insurance are maintained in this module.
• The addition/deletion of the members can be done on the fly and the premium gets auto-calculated.
• Member validation page for the providers.

Provider Management

• Maintain provider details
• Addition/deletion of the providers to a network.

E-Claims Management

• Claims directly from the different types of providers like a clinic, pharmacy, lab, etc will be able to handle.
• Realtime approval and tracking of the claims & Online redressals were possible through the system.

Admin Dashboard

• Approve / Reject Claims
• View real-time Statistics on the # of Claims processed, Queued rejected, etc and monitor the performance of the claims processed on a real-time basis.

Accounting Details

• Claims payment processing
• Invoicing and premium collection

Project Type
Ecommerce – ERP – Insurance – Mobile – Web