Electronic Gateway
Between Payers & Healthcare Providers

E-TRANSACTIONS MANAGEMENT

Eligibility Verification
A real-time process that allows users to query payer’s systems and validate the eligibility of the insured patient to receive medical care.

Approvals Request Management
Allows providers to submit and receive approvals electronically. This is a round trip transaction that could extend to further requests and replies back & forth. The process is designed for both real-time & manually reviewed approvals

Claims Management
This process allows providers to submit their claims electronically and later inquire about them. The process is designed for both real-time & batch submission.

Policy Management
Allows the provider full access to policy details and updates. It can be linked to the payer to automate the process of appointing and notifying providers.

Values for Payers & Providers:

  • Paperless Environment
  • Fraud Control
  • E-Policy Briefing
  • Instant Eligibility responses
  • Instant Approval responses
  • Time & Cost Saving
  • Streamlining & Automation
  • Improved Staff Efficiency
  • Seamless integration with backend systems
  • Reduction of administrative efforts
  • Electronic processing of approvals & claims