NANO Health Insurance Management
Policy, claims and member administration in one system, for insurers and TPAs
Claims
Processing
Tracking
Policy
Management
Nano Health Insurance Claims Management
Health insurance companies are contested with high standards for consumer service delivery and rigid compliance with government regulations. This makes the efficiency of time, data, and business process management essential to success.
The following processes need to be supported by Health Insurance Claims Management Software:
Compliance
Administration
- Claims entry and health insurance claims processing
- Service Level Agreement tracking and management
- Fraud and compliance administration
- Policy management
Nano Health Insurance Claims Management solution delivers compelling claims processing. It permits the elimination of inappropriate and error-prone writing and email-based processes handling all communications, data, and procedures in a harmonious working environment.
It ensures increased compliance with regulations and improves the general team performance and resource utilization.
With Nano Health Insurance Health Insurance Management, you will expand the number of claims processed, strictly adhere to the service level agreements, and boost customer happiness.
Accelerate Health Insurance Claim Processing
Entrust your health insurance claims processing workflow with advanced data capture and routing technology and positively affect your business.
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Robust automation and elimination of operational inefficacies and legacy matters
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Visual workflow editor for building health insurance claim processes and configuring business rules without development work
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Visual workflow editor for building health insurance claim processes and configuring business rules without development work
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Sequential or parallel workflows to specify whether documents are reviewed and approved in a specific order or by multiple reviewers simultaneously.
Health Insurance Claim Management
Scale on the fly, tailored to your distinctive business demands and essentials - your health insurance claims management solution guarantees delivery of the highest possible ROI.
- Automatic claim route by-product, amount, department or any field data
- Both manual and automated claims routing and processing are based on configurable business rules
- On-the-fly modifications to web-forms and procedures
- Improved operational efficiency
Regulatory Compliance
The health insurance claims management software ensures automatic data validation and transparent claim processing.
- The translucent sight of the complete health insurance claims process - from initial notification to claims disposition and settlement
- Regulatory and service level agreement compliance
- Fraud and compliance administration
- Data and document centralization
- Reports on the efficiency of the claims management process in general or for individual claims
Risk Management
Nano Health allows real-time control of products and benefits that enable the insurer to:
- Reach sound audit decisions quickly, with relevant and current information in front of you
- Understand, report and control benefit utilisation down to member level
- Control benefits through flexible product configuration allowing tighter limit control — NANO Health can control limits by:
- Term — day, week, month or year, by benefit available
- Give TPAs a framework on the same system, so the payer can outsource administration while keeping operational control.
Benefits & Products Management
Nano Health insurance permits intricate products with base/rider product relationships to be specified by users directly in minutes.
Products are defined for a distinct underwriter and a restricted set of benefits. Benefits have associated rules that compel the automated claims adjudication procedure and comprehensive policy management process.
Business Rules Engine
Nano Health insurance operates on a dedicated rules engine to define benefits. Rules are assigned to help and permit wide flexibilities in limits. Numerous rules may be laid to individual benefits, and the identical rules applied to other services:
- Financial - benefits & limits with internal and external values, e.g. limitation per procedure, limits per annum, the restriction for policy lifetime
- Numeric, e.g. number of physician visits
Nano Health insurance management solution gives rapid consummation of the claims and payment process by permitting members to input a large volume of claims into the system and real-time analysis of claims, fraud detection and commands under the claim adjudication engine rules, and loss ratio management control.
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More about this product
How this works with the rest of the suite
- NANO IMS
The health line sits inside the wider platform, sharing its policy, member and claim record with every other line written.
- NANO HUB
The hub is how claims and approvals actually reach providers, so administration and exchange are two halves of one flow.
- NANO FWA
Fraud and compliance administration is named as a required process here; payment integrity is the system that performs it at claim volume.
- NANO PBM
Pharmacy benefit is administered on the same member and policy record, and a large share of a health insurer claim count sits there.
Frequently asked questions
What does health insurance claims management software have to support?
- Compliance administration, claims entry and processing, service level agreement tracking and management, fraud and compliance administration, and policy management. Health insurers are held to high standards for consumer service delivery and to rigid compliance with government regulations at the same time, which is what makes efficiency of time, data and process essential rather than desirable.
What does the visual workflow editor do?
- It lets you build health insurance claim processes and configure business rules without development work. That matters because claim rules change with regulation and with each contract, and a process that needs a release cycle to change is a process that stays wrong for a quarter.
Can claims be reviewed by several people at once?
- Yes. Workflows can be sequential or parallel, so you specify whether documents are reviewed and approved in a particular order or by multiple reviewers simultaneously. Which one is right depends on the claim, which is why it is configurable rather than fixed.
What does it remove?
- Inappropriate and error-prone writing and email-based processes. Communications, data and procedures move into one working environment instead, which is what lifts compliance with regulations and improves team performance and resource utilisation together.
Does it scale with claim volume?
- It is designed to scale on the fly and to be tailored to the specific demands of the business, with automatic claim routing by product, amount and other attributes. The measure that matters is claims processed against service level agreements adhered to, not throughput alone.