The organization of the provision of all types of medical care (ambulance, hospital, outpatient care, provision of medicines, preventive care, health services).
Fixing information (the entire sequence of actions on the occasion, the insured person’s call, the type of assistance, the order of assistance, the result of the assistance provided).
Case control (until the case is completed, employees see additional actions on this event in the current mode).
Quality assessment (an opportunity to ask a question about the quality of the services rendered and the help received) during the event management.
Analysis of documents for the payment, organization and conduct of medical and economic expertise.
Fixing costs (at the same time as organizing the service costs are fixed, which allows you to immediately see the remaining balance of the limit and the sum insured).
Integrity of information (for each Insured person there is a separate unit, in which the entire history of appeals during the term of the contract, with renewal - including for the past periods).
Analysis and management of the insurance portfolio (using the software any analysis of the portfolio is possible).
Increase customer loyalty.
Continuous monitoring of the level of damages due to regular reports.
Prevention of fraud on the part of medical institutions (analysis and examination of all documentation for each treatment).
More about features
1. The process of "handling insured persons".
Maintaining contracts and insurance policies:
registration of insurance policies:
automatic import of insurance policies fr om files "Exel";
saving change history.
insurance packages, programs and options;
by amount and quantity;
by action period (per year, days in a month, courses per quarter, sessions per year, for an assistance case, and others).
registration of clinic levels:
by insurance packages, by programs;
registration of eligible health facilities:
by insurance packages, by programs;
registration of exceptions:
under the contract as a whole, by insurance packages;
accounting for general exceptions.
automatic determination of the active policy and the assistance / insurance event.
2. Configuration insurance policies.
Fig. 1. List of insurance policies, search by insured person.
Fig. 2. Insurance policy card, information on assistance cases under this policy.
Fig. 3. Insurance policy card, information on service orders from suppliers under this policy.
3. Insurance contract as organized in configuration.
Fig. 4. Form of insurance contract. The form specifies the contract details - the number, the organization, the main contract (the contract may be subject to another insurance contract, the main one is pre-insurance).
To the right of the details there is a table of insurance packages and insurance amounts for them. In the table, you can specify for which packages to display columns in insurance programs and insurance options.
Below is the table of insurance programs, in columns data on general limits, covering all insurance packages, as well as individual limits for each insurance package . In the same table, on separate tabs, exclusions and insurance policies attached to this insurance contract are displayed, as well as the Informational Materials tab with attached Bordero files, insurance programs and other.
Under the table "Insurance programs" there is a table "Options insurance programs", wh ere options for the current insurance program are displayed with data on general and individual limits, similar to how they are set for the insurance program. On separate tabs in this table, conditions for clinic levelsand medical institutions are set, in which the insured can be served according to the insurance package.
Fig. 5. Exceptions in the insurance contract.
Fig. 6. Levels of clinics for the Inpatient Assistance insurance program.
4. The process of ordering services from a supplier to assist the insured person.
5. Selection of a performer (supplier) to assist the insured person
Fig. 7. Selection of counterparty by specialty for ordering services
Fig. 8. Selection of the counterparty from the list of possible (red labels), nearest for the insured person (blue label).
6. Order a service from a supplier.
Fig. 9. Order to supplier. The document specifies the counterparty, the assistance case, the insured, the insured person. In the tabular part is filled with a list of services and medicines.
Fig. 10. Printed order form to the supplier, sent to the supplier with confirmation. E-mail is sent immediately from the print form.
Fig. 11. Ability to send SMS-messages, the formation of the text sms templates.
7. Process "Feedback with the insured".
8. Conducting Assistance, tasks.
Fig.12. Journal of documents "Assistance deeds". The "General" tab filled in the data: policy and insurance contract, insurance company and policyholder.
In the form on the right there is a list of tasks to be performed by the persons responsible for the Assistance Case document.
Fig.13. Printed form of the document "Assistance".
Fig.14. On the "Events" tab of the "Assistance Case" document, a list of tasks with an indication of the performer and a reminder.
9. Process "Analysis and processing of information".
10. Claimed, actual losses.
Fig.15. Journal of documents "Orders to suppliers." Related documents "Fixing costs", with the selection of the counterparty, order, assistance case and the amount.
Fig.16. Report "Insurance Contract Expenses".
11. Policy cover.
Fig.17. Report "Insurance coverage for individual limits".
12. Debt Analysis.
Fig.18. Report "Receivables". Presentation of data in the form of a chart.
13. Managers Performance Indicators.
Fig.19. Report "Managers Performance Indicators".
The report displays the following figures: the number of new assistance cases, the number of closed assistance cases, the number of orders to the supplier, the amount of orders to the supplier and the number of completed tasks with selection by manager.
Fig. 20. The report "The performance of managers", the data are presented in the form of a histogram.
The configuration is integrated with accounting and management accounting implemented in a typical configuration.
The peculiarity of the conduct of settlements:
documents “Fixing costs” carry out movements for the accrual of debt to service providers and medicines;
realized the possibility of accruing debt when the central office of the supplier pays for subsidiaries.