Payer

Healthcare Insurance Company

The first health insurance policy was formulated in 1985 and since then healthcare insurance industry in India has grown over the years and it has matured in its modus operandi of service delivery.

Today the payer (Insurance provider) has to provide his patients with impeccable, speedy, efficient and accurate information. With increasing competition the payer must be able to handle enquiries or claims reimbursements with equal ease and ensure a high level of customer satisfaction. This leads to customer retention and referrals, thereby increasing his database of customers and impacting his bottom line positively.

With HCX, the payer can now manage his customer data and records with ease. With the elimination of manual intervention and automation of payer services, the process of managing customers can be improved. The simplified online web-based portal provided by HCX empowers the payer to make decisions quickly by eliminating delays occurring due to protracted and complicated processes.

Payer can now avail of

• On boarding data
• Patient/ customer data repository
Electronic pre-auth processing
Electronic Claims processing
• Reports


Electronic Pre-auth processing

When a patient approaches a healthcare services provider for treatment of a medical condition, which could involve hospitalization, the payer/ insurer has to provide the hospital management with a pre-authorization for the patient insured with them.

This would normally involve exchange of data via faxes and emails and could result in loss of time and perhaps valuable information.

Electronic Claim Processing

Electronic Claims Processing allows the payer/ TPA to process the claimant’s application for treatment of a medical condition. The real-time exchange of data between hospital administration and the payer ensures that it is streamlined, follows a systematic process and is easy to deploy.

HCX’s web based applicatsion simplifies the tedious process of filling out various forms, searching for records

MIS Reports

Patient records, number of claims, amount of claims, kind of treatment, hospital data, and more can now be easily sorted with the generation of reports thanks to HCX’s web based applications.

For instance if you wish to see reports on the immunization status, or claims settlement or the enrollment into various government healthcare schemes, it can be achieved easily.