As a Healthcare provider you work in a constantly competitive market replete with concerns of reducing medical errors, improving cash flow, public policy developments and regulatory compliance – All this, while maintaining a high quality of patient care services. We wish the hospital to become a true center of excellence when it comes to patient care. There is no doubt that claims volumes are on the rise due to the steep increase in the sale of health insurance policies. The situation now demands that you have efficient systems, technology and business processes. To stay ahead of the crowd providers you will have to raise the bar – by not merely meeting these challenges, but emerging as market leaders who can successfully transform their operations and business processes to suit these changing conditions.
Enormousit brings you iClaims – a unique web-based solution for online Claims Management. Our innovative solution will help you to effectively manage claims processing, meet client demands, pressing regulatory concerns and stay competitive.
iClaims’ management minimizes administrative burdens and allows claims staff to bring greater focus to the servicing of claims. It aims to reduce and eliminate paperwork, and will give “claim specialist’s faster access to the information they need, facilitating timelier claim resolution for insured’s.” “iClaims brings state-of-the-art electronic claims management capabilities to Payers of health insurance, thereby making the providers of Healthcare happy and making cashless treatment hassle free. iClaims increases the speed and efficiency with which claims are handled, enhances file sharing among Healthcare providers, claims staff, clients and brokers, and improves data quality and document security. The implementation of iClaims will bring about a commitment to optimizing the claims handling experience of the insurance company for their clients.
iClaims is a fully compliant solution which allows for web-based processing and management of claims and electronic medical records. This solutions brings more efficiency at a lower cost than traditional paper file and transport methods. We understand the implications of IRDA regulations and other standards followed by the insurance industry, with respect to cashless hospitalization, will need to be adhered to strictly. Our solution helps you reduce human error by providing intuitive user controls for navigation and information entry.
Our primary objective is to help you accomplish significant savings while implementing cashless hospitalization and realizing the payments at the earliest from the insurance provider.
Features of the System:
|1.Web-based real-time eligibility verification of Insurance through online pre-authorization forms|
|2.Inputs patient health encounter data and submits claim immediately – before the patient even leaves your office|
|3.Features Electronic Health Records (EHR)|
|4.Does not have software that requires periodic replacement – All claims can be submitted using your web-browser, without installing expensive software|
|5.Validates encounter transactions for all compliances during online entry, services and tariffs are pre-loaded|
|6.Total EHR privacy and security|
|7.Allows you to Perform Deposit and Payment Posting Online|
|8.Performs Electronic Claims Inquiries|
|9.Retrieves Electronic Remittance Advices|
|10.Generates web-based reports|
Advantages of iClaims:
|1.Saves money on all Claim Forms & Inventory|
|2.Reduces Operating Overheads|
|3.Features Electronic Health Records (EHR)|
|4.Accelerates Payments from Insurance Companies|
|5.Increased profits can be retained in your practice|
In Addition, Our Solution:
|1.Is Built on Web-based technologies|
|2.Implements E-Security solutions|
|3.Interfaces with medical facilities, practitioners and equipment based on HL-7 interfacing standards|
TQM and Benchmarking
In pursuit of rendering excellence in healthcare, performance measurement tools and processes like TQM, SAS 70, and ISO9001-2000 are used to achieve operational efficiencies and benchmarking is used to achieve high level of quality standards. A process of reviewing and implementing new benchmarks standards regularly results in continuous improvement in the quality of facility management and optimal use of resources.
Here’s an example to illustrate the cost effectiveness of using iClaims:
A small hospital may use the services of a billing department or an agency to submit their paper claims electronically. The hospital provides 10 claims – worth a net collection of Rs 200,000 – to be submitted to the insurance carrier.
If the billing department or agency spends 5 to 10 % of the net claims worth as administrative expenses or service fees, the total expenditure for the provider will be:
200,000 x .05 = 10,000 or 200,000 x .1 = 20,000M
With iClaims: In the same situation you would only be charged per claim. In this case, the provider would pay Rs 1000 for 10 claims. (@ Rs 100/Claim)
If it is on a monthly basis, may be Rs 10,000 max for all your claims put together.
Technology & Architecture
iClaims is an Internet/Intranet based system developed on the Microsoft web technology platform and the Oracle database. The application is based on n-tier model, which means that you can implement it as an intranet system, as well as a hosted system. The entire hosting functions on a very secure VPN mode; therefore the customer can see only his related application and database. The entire application is connected to a very high connectivity system. This model also facilitates easy integration with e-health systems.