Claims Management

Claims management is a core function of health insurance organizations. Managing payments on time for customers and service providers is the heart of seamless operations and financial planning. Processing claims in multiple environments digitally, manually, inside, and outside of the organization is an overwhelming task and is subjected to many errors, which can result in delays and irreparable harm to customer relationships. EwaveMD Medical’s platform enables your organization to increase productivity and reduce operational costs, while boosting its capabilities with a powerful automated claims management system that evaluates claims faster with less human resources and errors in a cost-effective manner.

Automatic Claims Adjudication:

No matter how claims are being submitted via digital interface or manual key-in, automatic adjudication workflows simplifies claims processing based on automated workflows that include litigation, negotiation, settlement communications, relevant policy information, and claim assessments. This reduces adjudication errors dramatically, increases business financial optimization, and enables the organization to direct important and expansive resources to other disciplines.

Integrated Backoffice Module:

Having all relevant information always accessible, helps manage the entire process flow of claims, notifications of payment, customer policies, service provider contracts, price lists and more. Everything can easily be viewed and edited (privilege based) in one platform for fast, accurate adjudication to reduce backlogs.

Dynamic and Hassle Free:

With just a little training, anyone with the appropriate privilege can edit business rules or logic used by the adjudication engine. All information is viewable in a user-friendly integrated interface. Increase the team’s productivity and ability to carry out simple tasks they can do themselves without waiting endlessly for the IT team.

Claims Management