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JAAHIZ INSURANCE SOLUTIONS
Your way to really own your insurance system
Why JAAHIZ Insurance Solutions?
Because it's a rare fully integrated web-based insurance solution that gives you a real full autonomy to take control of your system with very low Total Cost of Ownership.
Health Care Claim Management

JAAHIZ health care claim, as all other life and health care system parts, is fully integrated web based module that allows a cost effective and efficient medical claim management process with all necessary controls and validation related to diagnosis types, benefits limits, overall limits and patient status, exclusions, etc. It helps you streamline your relationship with agents and medical providers as well.
As this is the case for all JAAHIZ modules, JAAHIZ Platform allows you to change any existing Health Care Claim module functionality and process or add completely new ones without complex coding and within an extremely short period of time.

With health care claim management you can:
1 Open a claim file from anywhere…
Claim Opening Give users as well as other partners such as agents and providers a secured access to open a claim with limited authorizations to reduce claim processing cycle time and improve quality. Let them use the document imaging module to upload supporting documents and reduce the paperwork.
2 Use claim bordereau to simplify payments and follow up…
Claim Bordereaux You can use medical claim bordereaux management process to handle reimbursement, when bordereaux are received from agents or direct settlement for both in-patient and out-patient claims with unlimited number of claim files. Give one complete response to the agent or provider for each bordereau to simplify the payments and follow up processes and streamline your relationship with agents and medical providers as well.
3 Process claims with automatic controls and validations…
Claim Processing Insured and/or agents can be notified of claim opening through an automatic SMS or emails. Process medical claims with all necessary controls and validation related to diagnosis types, benefits limits, overall limits, patient status & exclusions, deductibles, waiting period etc...
4 Chose the most effective and convenient payment method…
Payments The payment amount is automatically calculated on the basis of member, policy and benefits information. Claim status and reason are maintained and automatically updated or manually by the user if required. The system generates accounting entries once a claim is settled. Process the payment by choosing the most appropriate method, to you and to the beneficiary: cheque, account (credit note) and EFT. There is also an option to reverse a payment.
5 Implement a collaborative online claim management process…
Providers Provider can be selected from list or manually entered. In case of a plan with authorized provider’s network, like for example Preferred Provider Organization Plan, the selection list shows only those providers. The system has a facility to pre-authorize claims, especially those related to in-patient treatment. You can also assign unlimited number of second opinion missions per claim to doctor and capture (manually or online) unlimited number of reports per mission. All online processing updates and initiations are controlled in terms of authorized limits and access rights.
6 Automate reinsurance claim transactions…
Reinsurance During the claim process, the system performs reinsurance computation and allocation automatically per outward policy and participant and generates the reinsurance bordereaux.
7 Record claim events and view claim details at event time…
Claim Events Track all movements on a claim and detailed information can be provided online. Any claim event is recorded with date and user who initiates it. You can view the claim details and status at the event time.
8 Consult the list of all claims registered under the same policy…
Claims History You can view the list of all claims linked to the policy, life insured or a member in case of group policy. You can view any claim details and status from the displayed list.
9 Close claims with or without a payment…
Claim Closing Close any claim with or without payment using different processes. Closed claims are available for view only or to be reopened if needed.
10 Reopen a closed claim if needed with required controls…
Claim
Re-Opening
After the settlement of claim, the amount may be revised. This is usually the case where the claim settlement goes through a court case. You can reopen the claim and use an option available in the system to revise, through a provisions decrease/increase mechanism, the claim amount for the same claim number.
"Seeing is believing"; to learn how JAAHIZ Insurance Solutions can save you time and keep the Total Cost of Ownership very low by simplifying your system maintenance, changes and enhancements processes please contact us
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