Organization of all types of medical care (ambulance, hospital, outpatient care, provision of medicines, preventive care, health services).
Fixing information (the entire sequence of actions on the occasion, the call of the Insured person, type, order, the result of the assistance provided).
Case control (until the case is completed, employees see additional actions on this event in the current mode).
Quality assessment (the ability to ask a question about the quality of the services rendered and the help received) while maintaining the event.
Analysis of documents for payment, organization and conduct of medical and economic expertise.
Fixing costs (along with the organization of the service, expenses are fixed, which allows you to immediately see the remaining balance of the limit and the sum insured).
Integrity of information (for each Insured person there is a separate unit, in which the entire history of appeals during the contract period, during renewal - including and for past periods).
Analysis and management of the insurance portfolio (using software, any analysis of the portfolio is possible).
Increase customer loyalty.
Permanent control of the level of losses due to regular reports.
Prevention of fraud on the part of medical institutions (analysis and examination of all documentation for each treatment).
More about features
1. The process of "handling insured persons".
Maintaining contracts and insurance policies:
• registration of insurance policies:
automatic import of insurance policies from files "Exel";
save change history.
• limit registration:
by insurance packages, by programs and options;
by amount and quantity;
by validity period (per year, days in a month, courses per quarter, sessions per year, for an assistance case, and others).
• registration of clinic levels:
by insurance packages, by programs;
accounting for franchises.
• registration of eligible health facilities:
by insurance packages, by programs;
• registration of exceptions:
under the contract as a whole, by insurance packages;
accounting for general exceptions.
• automatic determination of the active policy and the insurance case/insurance event.
2. Search, identification.
Fig. 1. List of insurance policies, search by insured person.
Fig. 2. Card of the insurance policy, information about assistance cases, orders and history of changes under this policy.
Fig.3. Technical Assistance Card.
3. Insurance contract.
Fig. 4. Form of insurance contract.
Fig.5. Reference "Types of documents for settlement".
Fig.6. Appearance of the document for settlement "Statement of an insured event".
4. The process of ordering services from a supplier to assist the insured person.
5. Choice of the performer.
Fig. 7. Selection of contractor by code for ordering services.
Fig. 8. Selection of the counterparty from the list of possible (red labels), nearest for the insured person (blue label)
6. Service order, SMS info.
Fig. 9. Order to supplier. The document specifies the counterparty, the assistance business, the insurance company, the insured and the settlement scheme.
Fig. 10. Printed order form to the supplier, sent to the supplier with confirmation. E-mail is sent immediately from the print form.
Fig. 11. Ability to send SMS-messages, the formation of the text sms templates.
7. Process "Feedback with the insured".
8. Event form, print.
Fig.12. Document "Event Form". The document indicates: the insurance company (filia), the policyholder and the type of event, as well as the addresses of the insured event and the location of the transport.
Fig. 13. Printed event application form.
9. Conducting Assistance, tasks.
Fig.14. Journal of documents "Assistance technical cases". Bookmark "package of documents", which indicate the collection of documents for settlement.
Fig.15. Printed form "Monitoring on Assistance".
Fig.16. On the tab "Events", the document "Assistance", a list of tasks with an indication of the artist and a reminder.
10. Process "Analysis and processing of information".
11. Debt Analysis.
Fig.17. Accounts Receivable Report.
12. Managers Performance Indicators.
Fig.18. Report "Managers Performance Indicators".
The report displays the following figures: the number of assistance cases, the number of closed assistance cases, the number of orders to the supplier, the amount of orders to the supplier and the number of completed tasks with selection by manager.
Fig.19. The performance of managers in the form of a histogram.
The configuration is integrated with accounting and management accounting implemented in a typical configuration.
The peculiarity of the conduct of settlements:
documents “Fixing costs” carry out movements for the accrual of debt to service providers and medicines;
realized the possibility of accruing debt when the central office of the supplier pays for subsidiaries.