Indemnity Claim Management

About Indemnity Claim Management

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Indemnity is heath care systems that emphasized more on the plan coverage limit, it provide their members with flexibility and more control over their medical options. Individuals and families who are insured by indemnity health plans may visit a physician of their choice within their specified network of hospitals, doctors, labs, and other providers with no referrals required.

The traditional indemnity plans often require up-front payment in the point of care then request for reimbursement to their payer / insurance company. With AdMedika Indemnity Claim Management, the members (policy holders / patients) can enjoy cashless treatment and the member can see their coverage details on the registration receipt. Our Indemnity Claim Management will enhance service at point of care and create convenience for members when seeking healthcare services.

 

Patient Workflow

  • Outpatient
  • Inpatient

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Key Benefits

key benefits
Members

  • Cashless treatment
  • Leverage quality & convenience
  • Accelerate service speed

Costs

  • Cost Containment
  • Accelerate claims processing time
  • Transparency of costs
  • Efficiency of reports

Compliance

  • Prevent fraud
  • Reduce claims processing errors
  • Cost analysis accuracy
  • Comprehensive and accurate report

EDC Receipt Sample

  • Outpatient Receipt
  • Inpatient Receipt
  • Billing Confirmation Receipt
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Reporting

AdMedika Claim Management service can generate comprehensive reporting that can simplify the process of analysis and decision making. In addition to standard reporting scheme, we can also generate customized reports in accordance with the needs of our client’s business processes. Reports can be provided on a monthly, weekly and daily basis. And will be sent through email and can be accessed directly via FTP.
Below are some of our Indemnity Claim Management reports

  • Daily, weekly & monthly claim transaction
  • Inpatient & outpatient detail report
  • Claim submission report
  • Data upload report
  • Active case report
  • Total claims by coverage and type
  • Members report by excess, limit and plan type
  • Top 10/20/30 diagnosis report
  • Top 10/20/30 member's consumption report
  • Top 10/20/30 provider report
  • Reimbursement detail report

Claim Verification Workflow

We handle thousands of claim documents on daily basis and every each of these documents may consist up to dozens of papers. The Claim Verification process is the most crucial steps in our claim management service. We focus on maintaining the highest quality, best-trained and most professional claim analysts in the industry and we only hire claim analysts with medical or public health educational background.

Reception & Registration

Claim documents are registered into our system while we check for the completeness and double check the document coherence with existing data. After that the documents will be scanned and sorted and then be ready to be verified.

Verification

Before the verification process starts, the documents will be double checked for completeness. The process start with verifying of treatment and drugs are according to the health benefits and limit, check for claim excess. After all the documents are validated, the claim verification reports are generated and it’s ready for the next process.

Splitting

Make copies of the claim documents and sorted by payer, provider, diagnosis and treatment.

Delivery

Sent the verified claim documents to its payers. The report and scanned copies of the documents can be sent through emails or it can be accessed through FTP access.

PT. Administrasi Medika
Telkom Gambir, Gedung C, Jl. Medan Merdeka Selatan No. 12, Jakarta Pusat 10110 - Indonesia
021 3483 1100   021 3483 0101   Contact Us   Find on map
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