1. Enrolment

In this module, the system will allow the user to upload/ enroll members based on their enrollment count and requirement. Once uploaded, the system is capable to set- up, monitor and modify the membership variables within the scope of their medical benefits.

     Key Features:
             a. Claims Fund and Replenishment Ledger for ASO Accounts.
             b. Account/Member restrictions, waivers and announcements.
             c. Principal/Dependent Membership declaration system
                 *Setting of Individual Plans
                 *Uploading feature to handle membership listing from excel, open calc, csv or text file sources.
                 *Grouping facility System to generate membership numbers both for principal and dependent.
             d. Identification of Major Hospital Access

2. Benefit Plan Package & Inner Limits

In this module, the system will allow and guide the user to create and input the desired or customized benefit plan coverage and limits of their enrollees.

Note: The Benefit Coverages and Limits can be customized and may vary in each enrollment type.

     Key Features:
            a. Overall Annual Benefit Limit or Dreaded Disease Limit for In-Patient and Out-Patient or combined.
            b. Aggregate benefit per family unit
            c. Inner Benefit Limits set-up for Dental, Modalities, Out-Patient, In-Patient and
                other medical and non- medical special benefits.
            d. Room and Board Limit set-up
            e. Limit per Illness
            f. Assignment of Benefit Package per Member
            g. Allowable coverage assigned per member such as In-Patient/ Out-Patient only, or both.

3. Hospitals/Doctors

In this module, all Medical Provider' s and Doctor' s Accreditation Records can be set- up, viewed and stored in this module. Overall, the system will grant the user to have an overall access to all Medical-related information records.

     Key Features:
          Features of the Hospital module are as follows:
            *Accreditation Information
            *Medical Coordinator Information Services and Room Rate in line with CPT Billing
            *Addressee Information
            *Hospital Facilities ( Hospital Type, Bed Capacity, Availment Procedure)
            *Credit Terms, Credit Ceiling, Discount Schemes, Referral, rebate and Interest,
            *Hospital Level: Primary, Secondary and Tertiary Provision for Variable Withholding Tax Set-up

4. Letter of Authorization (LOA) Tracking System

Similar to the Medical Module, the Letter of Authorization Tracking system also covers medical related transactions and approvals. From encoding of availment, selection of provider , benefit type and rates and up to the approval and issuance of benefit limit is being facilitated in this module.

Data Analytic Reports and other related medical reports and statistics can be generated in this module.

     Key Features:
          a. LOA and Case Transaction Details
          b. Case/ Call Transaction Features
          c. LOA and Case Query Option Features
          d. Document Automation Report/ Data Analytics Report
          e. Claims Batch Posting

5. Claims Processing

All features available under Call Center are inherited in this module. This is treated as an extension of Call Center/ Case Transaction where the Claims are finalized based on the Hospital billing Statements.

Actual Bills receiving from the Hospitals is being encoded and assigned in this module.

Once bill number is assigned the user can screen and validate the accuracy of the bill and the benefit plan of the enrollee as part of the adjudication process prior the final settlment to the Hospital or any Medical Provider/Doctor.

     Key Features:
          a. Monitors Inner Benefit Limit: Tracking based on Benefit Package (Per Member and Per Account)
          b. Claims Additional entries
          c. Document Automation report

6. Premium Features

          Claims Adjudication / Processing
          Patient Support - 24/7 Call Center
          Nationwide Network Access
          Utilization Management / Data Analytics
          ADD-ON FEATURE: Front-End System using smartphone technology