| Insurance
company side features |
|
Healthcare
provider side features |
| Accreditation
and Contracting of Providers. |
|
Verification
of the member registration with the insurance company |
| Designing
of benefit plans. |
|
Verification
of member grade, eligibility, limits, balances as per
the insurance plan |
| Registration
of Employer Organizations |
|
Verification
of authorization given by the gatekeeper of the insurance
company. |
| Enrollment
of members of the organization. |
|
Daily billing
is uploaded into the insurance company. |
| Pre-authorization |
|
Claim submission
and processing |
| Real-time
checks on member limits and issues warning when 75% of
the limit is utilized. |
|
|
| Claims
submission after the treatment given to the member can
be done online. |
|
|
| Manual,
automatic and semi-automatic claim adjudication for
better service to the member and employer |
|
|
