Seasia’s Healthcare Management System (HMS) benefits the admins, employers, and employees by offering a digitized, modern, and dynamic system to provide quick access to the healthcare spending account. Our end-to-end enterprise software offers swift employee enrollment, automated member management system, billing, and claims workflow, for efficient and fast claim approvals and settlement, according to the organization’s policies. The Adjudication engine checks that no false claims pass through.
Based in Canada, our client supports various businesses, ranging from large enterprises, SMBs, to start-ups, for more than 30 years. The company offers innovative & flexible Employee Benefit solutions, and Group plans for medium to large businesses and individuals and sole proprietors for dental, medical, life, vision, and disability insurance. They process thousands of claims in a year worth millions of dollar.
Our client’s legacy system was more than two decades old and was based on out-dated technology. The existing system was not dynamic, scalable, and did not offer quick data visualization access for accurate decision-making. The company wanted a revamped system designed with the new-age and advanced software platforms to offer best-in-class User Experience. An automated and strategic report generation system for a variety of health claims was required to design the most-suited plans at affordable costs for various businesses.
The continued process of transforming Legacy Systems aims to reduce IT environment complexity and costs, while increasing data consistency, enabling collaboration across platforms and improving process flexibility. We studied the existing system to retain and extend the legacy investment value through migration to new media. One of the major challenges was to ensure that the modernized system has similar capabilities with compatibility with existing data formats. Our developers successfully transformed the old IT system into a new digitized environment and improved business agility using the latest technologies, contributing to rapid results with reduced costs. It also added more flexibility across diverse organizational processes, according to their client requirements.
Processing claims becomes more comfortable with Seasia’s HMS, and claim processors can easily manage and track different claims. The claimant can also communicate effortlessly any information that is required for the processing of claims. The online repository of documents aids in faster multi-level approvals.
Original receipts can be attached electronically and for better verification and authenticity checks, whereas a paper-based portion can still be retained for those who require original receipts.
The HMS leads to easy access to health spending account and provides quicker access to getting approvals from managers, anywhere, on any device, at any time. The Accounts and Finance Departments have complete visibility and control over the information flow.
HMS offers complete flexibility as business owners can choose a standard plan design or create a customized program to ensure that their organization’s unique needs are met. Customizable plans allow them to set their own set of coverage for different groups of people.
Depending on the client’s needs, Seasia’s HMS provides a customized plan that works and strategically incorporates some or all the elements of different algorithms like, Sliding, Tiered co-pay, Annual Deductibles, Customized Formulary Creation, and Maintenance.
There are specialized plan design options for varied fee guide options for dental, vision, health, and drug fee guide options. HMS also offers grouping of various categories with variable maximums, deductibles, and time definitions.
The HMS offers easy and quick access to claimsecure login that provides claim benefits on your health spending account, vision care, dental care, prescription drugs, etc.
HMS is capable of automatically identifying the employee’s province and calculates the fee accordingly. The Latest Fee Guide linkages are dynamic, and the employee need not make changes every year, even if a new fee guide is prepared.
The system validates all the pre-defined rules set before making any commitments to provide to the customer. iHMS allows admins to make as many rules as crucial to define the diverse trigger points, including the input-output parameters.
Seasia’s HMS allows a hierarchical allocation of services under different sets of benefits. It helps in easy identification of services/benefits relation, and the employees/admins can select or unselect any benefits of their choice or customize as per requirements. The Adjudication engine ensures that no false claims pass through.
Our system provides full flexibility to the user so that the Maximum Coverage Limits can be specified on an individual and/or family level. It helps in capping payouts and can be defined at various levels, depending upon the requirements.
Define suggested fees that serve as a guide for each province; Add dental codes corresponding to every guide. Create a fee guide using the previous year’s fee guide or create a new one from USCLS (Universal Fee Guide).
It is a simple yet essential function that lets you import Proc. Codes list corresponding to provincial guide, Sample Proc. Code list is already provided for you to help with the import process and template.
Next time when Federal/Provincial fee guide rates are updated, simply open Fee Guide and update proc. Codes amount in no time by clicking any line entry and update the amount. For cases when full series amounts are updated, use the Bulk update operation.
Operators who have limited programming languages can also easily add rules. Defining rules for different benefit coverage categories, contributes in setting of inputs and dependent parameters.
HMS allows the admins to define rules as per the requirement, and attach rules to respective plans. The “Rules Screen” allows attaching rules directly, without the need of visiting every plan repeatedly, for designing new rules.
Attach Plan specific or universal rules as defining rules is easy with the Rules engine. Choose trigger points for all rules – as you might be interested when these rules should be called and what should be their action.
Generating Reports automatically, at the end of the day, helps in sharing the details of the claims which are approved/ unapproved to track the daily progress.
Sending claims back to the claim processors or supervisors when additional information (like X-ray or Medical) reports are required, improves workflow.
The system allows adding EOB (Explanation of Benefits) and internal comments to the claims. EOB comments are made available in the EOB form for detailed analysis.
Once a customized plan is developed to the employer’s satisfaction, our client provides an option to add benefit cards for their employees. Smartphone users will also register and receive electronic health cards from their secure Member account, which they can store electronically for display upon purchase. All this can be done online, and Plan members are now ready to submit claims.
Our clients count on us to save on time and money, and we prove this by sending timely updates and critical information in the form of notifications. The software informs Plan Administrators on all the approvals required and information to be transferred using the Plan Administrator Portal and allows administrators to quickly respond to that online.
We put together a customized plan on the agreement of the right approach, strategically incorporating some or all of the elements required. However, there can always be a need to change things like maximums; and the Administrator portal will allow you to manage this online easily
Taxation in Canada is a prerogative, which is shared between the federal government and the various provincial and territorial legislatures. Hence, there are many taxes and rules. Our software allows setting as many taxes for different states; and our Tax engine allows you to add and change taxes in the simplest of ways.
The shared prerogative between federal and provincial governments allows provinces to set different rules for taxing the principal amount. Our Tax engine enables the admin to define new taxes and select one or more transactions from the Benefit Process to choose as the principal to be taxed.
Our Tax engine allows you to set which province’s tax is applicable on a transaction if it has taken place in the region or the beneficiary was of the area, or the benefit provider company belongs to the province. We allow multiple rules to be set and hence admins and employees are comfortable handling these scenarios.
The HMS allows Cardholders to submit claims online by having free access to our Cardholder Online benefit Tool, powering the submission of new claims, viewing compensation statements and available benefits.
The HMS allows providers to connect to their Benefits Program in real-time and have the pre-authorizations, inquiries and claim processing done in real-time, letting providers and Cardholder know approvals and rejections.
Direct Submissions by providers allow real-time approvals enabling Service providers to allow Cashless treatments. The system allows real-time payments via Electronic Funds Transfer pay Service Providers, without delays.
Our unique benefits’ management system allows providers and Benefit management software to use our services; Third-party can request data using our APIs and get the specified response hence making them use our services without doing custom coding.
Seasia, a CMMi Level 5 Certified Company, offers a bouquet of services to automate, digitize, and modernize your business network. An authorized partner of Hewlett Packard (HP), and Google, we are a global leader in providing next-gen consulting and digital services for business transformation. Our strong clientele across 50+ countries leverage our wide range of customized services to suit their business needs. At Seasia, we are committed to delivering high-quality solutions to build a long-lasting alliance. Our clients trust us as we empower them by: