Summary

GET's   Medical   Insurance   System     allows complete claims processing and benefit management to help Third Party Administrators (TPAs) to reduce their workload, save costs and add value for their client services.

The system is based on using a smart card that carries all patient policy limits and
medical history.

Utilizing the smart card features and capabilities, the system is able to work in both off-line and on-line scenarios.

• Web based system for easy access from anywhere
• Work online or offline
• Patients enrollment and smart card issuing
• Support different policy limits and rules for different medical services like In-Patient, Out-Patient, Emergency and Surgeries
• Patients Smart card contains all the policy limits and rules to prevent any abuse before happening
• Very complex tunable policy rules including:
  • Coverage of services and benefits
  • Different Types of limits (monetary, time , number of occasions etc)
  • Different provider list
  • Deductibles(excess and co-payment)
  • Premium billing
• Indemnity claims support
• Multiple pricing scheme for every service
• Customizable sub-coverage per every insurance company
• Different pricing scheme for every provider and insurer
• Handle both manual and electronic authorization requests
• Standalone provider application that fits all provider types(hospital - pharmacy - laboratory - radiology)
• The provider application supports powerful synchronisation module for data synchronisation between the provider application and TPA database
• Claim automatic processing and clearing