ClaimsLive Health - End-to-End Claims Management

ClaimsLive Health, is a new age state-of-the-art technology platform, that provides end-to-end health claims management and prevents claims fraud with effective control and management of health insurance claims – right from enrollment to settlement.

The modular platform comes with mobility extensions for on-field activities, with secure cloud storage to help investigate fraudulent and suspect claims with real-time data, through Live Video Streaming.

Who are the Users of this Solution?

• Insurance Claims Team
• Providers
• Members (Corporate & Individuals)
• Third Party Administrators (TPAs)
• Corporate HR
• Claim Investigators
• Regulators

Salient Features

1.       ICD 10 Based Benefit Administration

2.       Fully Digitized Schedule-Of-Charges (SOC), Tariff, Billing Policies

3.       Supports Retail Health Policies, Group Health Policies and Social Sector Health Schemes

4.       Role Based Privileges and Configurable Workflow

5.       Highly Configurable Business Rule Engine

6.       Exhaustive Stakeholder Portals

Value Proposition

Provide Quick Turnaround Times

Boost claims auto-adjudication rates by straight through processing of Pre-auth/Claims and enhance operational efficiency

Reduce Claims Leakage

Eliminate inconsistencies in the claim management process and prevent over payments and errors

Reduce Claims Fraud

Enable auto flagging of claims, assign suspect cases for investigation and capture suspect claims details

Enhance Customer Engagement

Real-time flow of data from the field with accurate evidence enables faster claims processing