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Insurance And Funders.
OmniSol Scheme Genius.

Our solution, HealthCare Funds, Benefits & Claims Administration , has a benefit/treatment/scheme mapping framework that fully accommodates the funder’s packages both for corporate and individual (micro-Aid) products. These fund definitions are integrated with the claims adjudication engine so that the system automatically determines if a particular claim is eligible for payment, and flags whatever needs human attention.

The fund definitions can all be managed from the user interface, without need to continuously review the programming aspect. It is possible for the funder to invent fund/benefit structures which are quite different for different corporations, whilst managing them all from within the same user interface, on the same database; thus making it possible to draw reports and analytics across multiple clients in one click.

Fund Setup

All the schemes/funds/companies are managed using this feature, Corporate receipts are made from this window, Any monthly fixed charges per member are configured from this window, Benefit limits for the whole fund can be set as global, annual or monthly, Member numbering can be set here in terms of prefix and number range and If the particular scheme is restricted to specific providers, these providers are listed using this feature.


Membership Administration

Billing, Tariff Code Management, Member Data Configuration, Member Tag, Membership Reports and Membership movement reports.


EDI - Claims

EDI file decryption is done with a password chosen by the provider, An EDI (Electronic Data Interchange) feature to load encrypted claims files sent by providers and Claims received thru this platform will be instantly processed (and awarded per inbuilt rules) unless otherwise indicated for human intervention.


Claims Management

Benefit status query in real-time, Pre-authorization of services and Electronic claims submission in batch or real-time mode.


Benefits Management

All schemes and plans are based on this feature, and This is where the fundamental benefits which the system is capable of managing are configured.


Billing Management and Loss Control

Recurring billing, Loss Control and Cost strategy characteristics in the insurance company.

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