Solutions > Insurance
Provide on-line policy status information, streamline your claims processing and utilize strategic data to provide better service to your existing policy holders and brokers while reducing costs.
eInsurance provides a proven, flexible, standards-based platform to e-enable your Insurance solutions. It scales easily to process high transaction volumes.
Gradual and controlled deployment of your applications on an as-needed basis and in the timeframe to meet your business requirements will ensure success and enable you to achieve a maximum return on investment:
· Higher rates of electronic adjudication.
· Reduced pending claims processing rate.
· Reduced administration and claims processing costs.
· Efficient and timely claims resolution.
· Accurate and secure payment process.
· Convenient and easy to use.
· Fraud detection and prevention.
· Improved reporting and trending analysis.
· More strategic use of data.
· New business opportunities.
Plug and play architecture ensures complete flexibility, integrating your existing, disparate systems with our modules and processes. Integration can be a huge part of the implementation and eInsurance enables you to control costs and reduce complexity. It provides you with the control to determine which components of your existing systems will remain in place, which components you wish to replace and the timing of the deployment.
:: Claims Submission: Flexible submission options for brokers, carriers, providers, policy holders and members. Integrate EDI submissions, enable form based web submission over the Internet, etc.
:: Claims Management: Provides B2B claims routing to any combination of your internal adjudication systems, or external, outsourced ones.
:: Claims Adjudication: Includes comprehensive pended claims management capabilities.
:: Plan Management: Rules setup including any plan association to the Group.
:: Group and Member Administration: Create extremely flexible group and member benefit plans. Full reporting options include association with organization structure for benefit reporting.
:: Payments, EOB and Correspondence: Flexible payments support. Correspondence administration, Explanation of Benefits (EOB), etc.
:: Reporting: Full integration with industry standard report writers provides powerful ad hoc reporting capability with executive level drill down. Get the big picture, then "slice and dice", perform trending analysis and more with ad hoc and/or custom reports. Extract data from any source and deliver perfectly formatted e-reports to the web, print in PDF format or to XML for interaction with third party applications.
:: Audit: Full compliance with industry requirements.
:: Interfaces to Legacy Systems: Workflow management of internal and external information exchange eases the integration process to your existing, disparate systems.
:: EBPP - Electronic Bill Presentment and Payment: End-to-end paperless billing, client statements, agent commission statements and more.
The open architecture design ensures the ability to leverage all of the sophisticated application management tools and achieve enterprise-class performance, scalability, portability, and extensibility. It speeds implementation, eases integration with existing corporate standards on a robust platform capable of handling very high transaction volumes.
eHealth Care
eHealthCare provides a proven, flexible, standards-based platform to e-enable solutions as you migrate to an e-Business model. It scales easily to process high transaction volumes. The fast track development toolkit supports configurable business rules and all the variables necessary to effectively customize the solution to your unique specifications.
eHealthCare Business Objects serve as the building blocks of collaborating functional areas. Combined, they enable more complex business processes integrating policy rules, data requirements and other variables relating to your unique processes. Integrated with your legacy structure, they provide a comprehensive solution tailored to your unique requirements providing:
· Products and Pricing: Flexible and easy to use options for the administration and management of HealthCare products (health, dental, drug, vision etc.). Input the rules outlining product/price associations from the administration fee guide. The rules engine locates the right fee association.
· Providers: Flexible and easy to use options for the administration and management of health care providers. Track relevant information including provider jurisdiction, credentials and provider/carrier agreements related to fees.
· HealthCare Claims Submission: Flexible submission options for carriers, providers and members. Integrate EDI submissions, enable form based web submission over the Internet, etc.
· HealthCare Claims Management: Provides B2B claims routing to any combination of your internal adjudication systems, or external, outsourced ones for health, dental, drug and vision adjudication.
· HealthCare Claims Adjudication: Health, dental, drug, vision claims adjudication includes comprehensive pended claims management capabilities.
· Group and Member Administration: Create extremely flexible group and member benefit plans including flex benefit plans. Group management includes flex benefits. Full reporting options include association with organization structure for benefit reporting.
· Benefit Plan Management: Benefit rules setup and plan association to the Group. Comprehensive support for flex benefits.
· Payments, EOB and Correspondence: Flexible payments support. Explanation of Benefits (EOB) and correspondence administration.
· Reporting: Full integration with industry standard report writers provides powerful ad hoc reporting capability with executive level drill down. Get the big picture, then "slice and dice", perform trending analysis and more with ad hoc and/or custom reports. Extract data from any source and deliver perfectly formatted e-reports to the web, print in PDF format or to XML for interaction with third party applications.
· Audit: Full compliance with HIPAA/C6 requirements.
· Interfaces to Legacy Systems: Workflow management of internal and external information exchange eases the integration process to your existing, disparate systems.
· EBPP - Electronic Bill Presentment and Payment: End-to-end paperless billing, health care statements, agent commission statements and more.
The open architecture design ensures the ability to leverage all of the sophisticated application management tools and achieve enterprise-class performance, scalability, portability, and extensibility. It speeds implementation, eases integration with existing corporate standards on a robust platform capable of handling very high transaction volumes.
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