Family Health Plan Insurance
Objectives
Our healthcare system streamlines enrollment, claim processing, and inward management while offering efficient provider management and a user-friendly admin panel. With features like reporting, document management, e-card generation, and access to wide hospital networks, members can easily track claim status and enjoy anywhere and instant cashless services for convenient healthcare.
Client Overview
Our Client is a premier health insurance provider, committed to delivering comprehensive and accessible health coverage. Their mission integrates wellness and preventive care into their services while managing a vast network of hospitals and healthcare providers. To enhance operational efficiency and service delivery, we sought a cutting-edge TPA (Third Party Administrator) app and web solution.
Industry
Medical
Region
India
Project Size
Non-Disclosable
Highlights
Business Challenges
Integration Complexity
Integrating various functionalities such as claim processing, provider management, and hospital networks into a single platform
Data Security
Ensuring the security and privacy of sensitive patient and insurance data.
User Experience
Designing an intuitive interface for diverse users, including administrators, providers, and insured members.
Scalability
Building a scalable solution to handle increasing volumes of data and users.
Compliance
Adhering to regulatory standards and compliance requirements for health insurance.
Solutions That Niotechone Software Pvt. Ltd. Developed!
Integrating various functionalities such as enrollment, claim processing, inward mamagement, DMS, E-card generation, claim status tracing and many more.
Enrollment
- Developed a user-friendly enrollment module allowing new members to register and existing members to update their information.
- Integrated with the National Health Stack for seamless data verification and validation.
Claim Processing
- Automated claim submission and adjudication processes.
- Implemented a rule-based engine to validate claims against policy terms and conditions.
Inward Management
- Created a module to manage incoming documents and requests.
- Enabled tracking and categorization of all incoming correspondence.
Provider Management
- Developed a provider management module to maintain and update information about network hospitals and healthcare providers.
- Facilitated easy onboarding and credentialing of new providers.
Admin Panel
- Built a comprehensive admin panel for managing users, roles, permissions, and overall system settings.
- Provided tools for monitoring system performance and generating usage reports.
Reporting
- Implemented a robust reporting module to generate detailed reports on enrollment, claims, network providers, and more.
- Integrated with BI tools for advanced analytics and insights.
Document Management System (DMS)
- Developed a DMS to store, retrieve, and manage electronic documents securely.
- Enabled easy access to policy documents, claim forms, and other important files.
E-Card Generation
- Automated the generation of digital health insurance cards for members.
Hospital Networks
- Created a comprehensive database of network hospitals, including details of specialties and services offered.
- Enabled members to search and locate network hospitals easily.
Claim Status Tracking
- Provided real-time updates on claim status through the app.
- Implemented notifications and alerts to keep members informed.
Anywhere Cashless Services
- Enabled members to avail cashless services at network hospitals across the country.
- Integrated with the provider network for seamless billing and settlement.
Instant Cashless Services
- Facilitated instant approval for cashless services in case of emergencies.
- Reduced the turnaround time for claim approvals.
Result & Benefits
Improved Efficiency
Automated processes reduced manual intervention, leading to faster turnaround times for claims and enrollments.
Enhanced User Experience
A user-friendly interface and real-time updates improved member satisfaction.
Data Security
Implemented robust security measures to protect sensitive data, ensuring compliance with regulatory standards.
Are You Ready For Better
More Productive Business?
Conclusion
The development of this comprehensive insurance software solution for Family Health Plan Insurance significantly improved operational efficiency, enhanced customer experience, and ensured compliance with regulatory standards. The successful implementation of this project demonstrates our expertise in developing robust, user-friendly, and scalable solutions for the insurance industry.
Get In Touch With Us
Do you have any questions, would like to provide feedback, or would like a quote for your mobile or web needs? Send us an email, and we’ll respond as soon as we can – Contact Us Now!!
805, 1107, 1108-Rk Empire, Near Mavdi circle, Rajkot-360004
Sales +91 9925 66 2323
Sales +91 9925 66 8383
sales@niotechone.com
sejal@niotechone.com
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