NANO Health Insurance Management
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 effortless health insurance claim process creation and Business Rules configuration
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Visual workflow editor for effortless health insurance claim process creation and Business Rules configuration
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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:
- Create effortless auditor judgments rapidly with relevant and up-to-date information
- Comprehend, report, and control utilization of benefits down to member level
- Control benefits through adaptable product configuration allowing tighter limit control - Nano Health can control limits by:
- Term - day, week, month, year by benefit obtainable
- Provide a framework where TPAs work the same system allowing the payer to outsource management but maintain operations 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.
