Our solution is a comprehensive platform designed to streamline and manage health insurance processes, including member management, pre-authorizations, claims processing, financial transactions, and member validations at check-in points or service points. 

The system is intended for use by health insurance companies, healthcare providers, and their authorized personnel. Members of the insurance plan will also interact with the system for services like check-ins and claims submissions. 

Authorized personnel can add a new member by accessing the ‘Member Management’ module, selecting ‘Add New Member’, and filling out the required information such as personal details, insurance plan, and contact information. Members can also self-enrol onto the system by using their mobile application or web portals provided. Please also refer to “How to add member” on our knowldge base platform.

Members can update certain personal details through the member portal. However, changes to critical information such as insurance plans or primary contact details may require authorization and validation by system administrators. 

A pre-authorization is the insurance company’s permission of a healthcare service before it is performed. It verifies that the service is covered by the member’s health plan.

To submit a pre-authorization request, go to the ‘Pre-Authorizations’ module, which can be accessed via the service provider practice management, mobile app, or web portal, and provide the necessary information about the service, provider, and member. Submit a request for evaluation and approval.

The period for approval varies based on the complexity of the request and the insurance provider’s policies. Typically, it takes one to three business days.

Healthcare providers and members can file claims using the ‘Practise Management module’ module or mobile Application. Enter the service information, attach any required documents (e.g., receipts, medical reports), and submit the claim for processing.

You can check the progress of your claim by entering into the system, going to the ‘Claims Processing’ module, and selecting ‘Claim progress’, or by contacting us via instant messaging systems such as WhatsApp, USSD, LiveChat, or by phone. The system will show the current status and any pertinent modifications.

When a member arrives at a check-in location, the system validates their membership information using their membership card (with QR code), Mobile Digital Card from the mobile app, offline pin, or other identifiers. This assures that they can receive services covered by their health plan.

If validation fails, the member will be directed to contact their insurance company or system administrator to rectify the problem. This could be due to erroneous information, an expired membership, or other issues.