Evolutionary management of benefit pay-outs for private health insurance.

Consistent and swift management of benefit pay-outs is decisive when it comes to the cost efficiency of an insurance company. However, often old systems or media disruptions can thwart cost-effective work. WIth in|sure Health Claims we are offering good value introductory projects and an efficient one-system solution.

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Cost-efficient

With in|sure Health Claims you benefit from a standardised industry solution with all the associated cost benefits which will relieve your budget and pay for itself in a short space of time.

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Automated

The wide-ranging automation of a large number of insurance processes releases staff resources for your core business.

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Holistic

Our software for managing insurance pay-outs encompasses all pay-out-related processes, interfaces and their configuration, plausibility and product customisation.

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Flexible

A mature interface concept supporting uncomplicated integration vis-a-vis every system context.

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Leading technology

in|sure Health Claims are based on a framework which has been granted the XCelent Technology Award for technical innovations.

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Adaptable

Open frameworks offer optimal adaptation to your own systems and interfaces. In addition, individually necessary processes can be defined simply.

Do you need more information on in|sure Health Claims? You can find our brochure here

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Evolutionary management of benefit pay-outs for private health insurance at a glance

  • Features of our product:

    • Simulation options for treatment and cost plans, and recourse proceedings
    • Generation/management of test cases
    • Payment clearing with open items
    • Commissioning/managing care needs assessments
    • Generation of reports (private health insurance pool reports, Pharmaceutical Market Restructuring Act or AMNOG etc.)
    • Support for automated auditing of accounts
  • in|sure Health Claims give you a cost-effective tool for managing insurance benefits, giving you all the freedom you need to adapt it to your situation and also freeing up staff resources for your core business. And also supports you with the following functionality:

    • Black box processing of incoming benefit claims, taking into account rules specific to the customer in question
    • Automated verification of insurance pay-outs due
    • Option of automated allocation of processing times, taking account of a change of year, a change of tariff, a change of insurance year or interruptions
    • Automated calculation of a refund due
    • Option of limit account management for automated calculation of deductibles, maximum rates and tooth scales
    • Automated deduction of hospital daily benefit or compensation to cover hospital daily benefit
    • Automated recalculation of past invoices based on tariff changes or corrections
    • Automated consideration of promises made when calculating a refund due
    • Automated separation and amalgamation of benefit claims
    • Establishing, maintaining and managing statutory tariffs (mandatory nursing care insurance / mandatory nursing care insurance for civil servants, basic tariff, standard tariff, emergency tariff)
    • Quality control of benefit claims (two-man rule), bearing in mind individual customer rules

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