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  1. Gain operational and financial insight.

  2. Dynamic management, financial and administrative reports.

  3. Graphical presentation of reports – bar graphs, pie chartsReports by client, society, age, home area, diagnosis, tariff, branch.

  4. Age Analyses and various financial analyses reports.

  5. Income statements.

  6. ICD-10 reporting & analytics

    Billing Reports

  1. Bills List – lists all the generated bills. Enables filtering by date and billing cycle

  2. Income Analyses by Fund – a breakdown of revenue, showing # number of bills, total value, total outstanding.

  3. Corporate Invoices.

  4. Corporate Member Statements.

  5. Detailed Corporate Bill.

  6. Manage Benefits Definitions.

    Claims Reports

  1. Claims List – this lists claims, using filters by:

  2. Payment batch

  3. Payee

  4. Fund

  5. Date treated, received, captured, paid

  6. Shortfall status

  7. Banking details availability

  8. Diagnosis

  9. Payment Status

  10. Award decision

  11. Amount paid

  12. Overpaid claims – this show claims paid above the set tariff amount when the policy is “pay in full”

  13. Claims with Tariffs – this is similar to the report in (1) except that it is itemised, showing the details of each claim

  14. User-defined report – this is a report defined by the user in terms of what columns are shown and printed

  15. Claims data capture report – this tracks the rate of data capture by users.

  16. Claims capture statistics.

    Analysis Reports

  1. Provider’s claims age analysis (condensed report).

  2. Symptom prevalence table and graph

  3. Claiming trends by tariff Code

  4. Funds Consumption by Benefit

  5. Claiming Trends by Age/Gender – age group, total value, outstanding, total paid, average per-claim

  6. Claims Analysis by Provider.

  7. Reimbursement Claims Overview.

  8. Benefits Utilisation Overview.

  9. Members' Benefit Utilization.

  10. Benefits and Rejection Reasons Overview.

    Service Provider Management

  1. This feature is for setting up the service providers.

  2. >Multiple practitioner registration (e.g AHFoZ) numbers per provider. A provider can have multiple entries as long as each one has a unique practice registration number.

  3. Providers who are contracted (preferred provider network) are so indicated using this feature.

  4. Banking details are managed thru this feature.

  5. Default decision regarding payment of claims can be set here:

  6. Pay – All Ok

  7. Pay – on hold

  8. Don’t Pay – Warning

  9. Don’t Pay – Fatal

  10. Their EDI files decryption password is set here

  11. Their tax clearance status is set here

  12. The service units at their facility are indicated using this feature

    Membership Reports

  1. The columns of membership reports are user-defined

  2. The following filtering parameters are used for each report:

  3. Fund

  4. Current Status (Active, Suspended, Terminated, Black-listed)

  5. Date of Birth

  6. Join-date

  7. Principal Members only

  8. Date captured

  9. Last membership event

  10. Card printing status

  11. Record verification status

  12. Account balance (plus, minus or zero)

  13. Report can be printed

  14. Report can be exported to CSV or XML

  15. Send personalized SMSes to all listed in report

  16. Drill down into more detail about each listed member.

  17. Membership data capture report – shows the number of new members captured by each user.

    General Audit Trail Report

  1. This feature is used to configure various aspects of the system:

  2. There are actions which are automatically logged when they occur

  3. This report shows these actions, along with the user and time

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