Base Medical Insurance System

Base Medical Insurance System is a robust enterprise management solution for the health insurance industry. The system automates health insurance business processes thus reducing the time and cost of performing essential tasks for improved efficiency. The insurer is also able to manage documents, workflows and records all from within the same system.

Base Medical Insurance System has in-built scalability giving the insurer the flexibility to quickly adopt to changing business, customer and regulatory needs at minimal costs. The system is parameterized to cater for the various business rules that form the basis of the medical schemes management and claims processing.

These parameters include scheme benefits, covered and excluded ailments, drugs dosage units, drugs prices with related ailment mapping, and many more to give you solid control on your medical claims processing.

Base Medical Insurance System caters for;

Insured Schemes
Health Maintenance Organizations Schemes
Self-Funded Schemes

The Base Medical Insurance System comprised of several modules which include;

Marketing Module enables the insurer to react to client and brokers queries promptly, deal with volume processing and illustrate “what if” scenarios
Client & Service Provider Management – Records and provides instant access to detailed information about clients and service providers.
Underwriting Module supports all critical policy Administration transactions, including; New Policy Processing, Deletion & Additional of Members, Extension of cover, Policy lapsing, reinstatement and cancellation, Fund replenishment for self-funded schemes, Change of non-premium items and Change of member category.
Reinsurance Module is embedded within the processing functions for underwriting transactions processing and claims processing, rather than as a separate module as seen in many systems. This means that your underwriters and claims adjusters are always aware of the reinsurance relationship(s) that exists for a given policy and are able to make sure your exposure and recoveries are appropriately managed.
Claims Module takes care of claim processing from intimation to payment or rejection and is also designed to allow easy search of claim while ensuring that processing rules and decisions are implemented.
Accounts module gives the accounts department visibility and control over the financial transactions arising due to the underwriting, reinsurance and claims processes. The medical accounts module caters for the full administration of credit facilities and is fully interfaced with the Base Financials General Ledger and Cash Book for companywide reporting.
Reports module provides statistical information for easy management and business tracking