Healthcare Transaction Management
We offer financial and clinical risk management solutions to both funders and providers of healthcare, through online real-time management of healthcare transactions.
Our adaptable healthcare claims processing and managed care services are designed to accommodate the complex benefit design as well as other processing requirements of our clients and our functionality extends to all healthcare claim types, including pharmacy, doctor, public and private hospital claims.
Our service is enabled by our proprietary claims processing and managed care systems that adjudicate medical claims allowing patients and healthcare providers to have immediate and accurate information on the financial and clinical impacts of, and payment responsibilities for services and products provided by healthcare providers.
Our proprietary software allows for real-time claim adjudication involving the submission of an electronic data interchange claim and receipt of a response with the adjudication details within seconds.
Our system allows for real-time messaging with an immediate response to an enquiry within a single, synchronous communication session.
Our intellectual property incorporates "rule stacking" technology that allows for the creation of a rule for a specific patient for a specific healthcare product or service, which rule is then used to adjudicate against in real-time.
This unique technology offers complex rule applications in a scalable and flexible manner on all medical claim types - it is a heuristic computerized framework that dynamically creates scenario-specific rules.