Payor
System

Create your insurance networks and add health providers/doctors. Set your primary care physicians and create health provider contracts with max tariffs and allowed amounts per item.

Create insurance plans, attach networks, define benefits, conditions and map conditions to benefits. We supports individual plans, employer sponsored plans, employee benefits, fully insured or self insured/administrative service only (ASO), optional benefits, deductibles, co-pay/co-insurance, max approved per claim, max out of pocket, per disability, age limits, gender limits and more.

Issue insurance policies from insurance plans and define policy holders, insureds and dependents, policy parameters and options.

Allow connectivity with health providers (via APIs or login in the payor system). Handle eligibility checks and pre-authorizations. Be in constant communication with providers and check with them which expenses are claimable.

Allows creation and management of claims. Check remaining benefits of an insurance policy.

Adjudicate claims automatically, semi-manually or manually and calculate approved amount and excess amount, per expense and for the entire claim.

Manage the payment of the claims from payor to patient / member.