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Medical Insurance Claim Management

Business value

 

Through a powerful range of products and services our Customer has pioneered, they help doctors to significantly improve the day­to­day running of their practices. This saves them more than R1 billion a year in operational inefficiencies. Our Customer has over 7000 medical practitioners (GP’s, Dentists, Optometrists, Specialists and Auxiliaries) on their books countrywide, both generalist and specialist. Through their sophisticated medical information exchange services, they are integrated with hospitals, pathology laboratories, radiologists and medical aids they process more than R30­ billion of transactions in real ­time every year, About 500 thousands claims per month are processed.

 

The Solution built by Extrawest

 

The solution is aimed at providing communication tool to connect clinics and doctors with insurance companies. It allowed online creation of patient visit card with further automated processing of insurance claim and confirmation of insurance payment availability. Doctors receive an information about amount compensated by insurance company and can charge patients respectively. That allows to avoid inconvenience of a legacy process when patients visits data was accumulated and cleared in the end of a period. The solution can be accessed from computer interface as well as from a tablet (Android, iOS) with extended functionality built for Windows ­based tablets.
The solution built by Extrawest consists of 2 major parts:
● Medical insurance claim processing and routing between clinics and insurance companies. The software provides a medical personnel a single UI to interact with different insurance companies.
● Platform that automates various processes in small clinics, like treatment scheduling, visits scheduling etc.

Category

Android, Hibernate, Insurance, iOS, JavaEE, Medical services, Spring GWT, Tibco BPM, Tibco EMS, Tibco ServiceGrid, Windows Phone