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الملحق الفني

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6 views25 pages

الملحق الفني

Uploaded by

tarhuni
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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New Era – AZDO

Telecommunication and software solutions

Customized TPA software

Third Party Administrator Solution Software Provides


Superior Administrative Efficiencies & Effectiveness

Third Party Administrators (TPAs) gain significant cost-savings and rate on investment by replacing
legacy claims & benefits administration systems. Renovating administrative practices requires a
consolidated platform solution to rationalize workflows and track providers, benefit plans, and core
administrative processes.

AZDO’ integrated clinical, financial, and administrative smart platform delivers the cutting edge
technology that you need for cost-effective administrational advantages. The AZDO platform not only
helps TPAs cut-off physical workloads. However, it contains reactive portal capabilities to allow
members, providers, and administrators to connect, communicate, and share data in real-time. AZDO’
Third Party Administrator software ensures your technology infrastructure will stay up-to-date to
provide long-term value for your existing clients while helping you win new business.
This is the main interface of the TPA, logged-in from a browser. A logo of the administrative third party
will be shown up in the screen as a preference.

TPA Home page and dash board. All features listed on the left. Dash board has shortcuts to
major feature that are used frequently

POLICIES

This feature makes you choose and allocate integrated policies between insurance companies and
insured companies
The policies allocated are then added by which services are needed for which policy

Add a new insurance company contact to have it coded and ready for a new policy. You can also remove
any insurance company from the same panel
Add an insured company to have it simultaneously allocated for its insurer & later on create a policy.

Select an insured contract then add the services needed, if they need approvals, service duration and if
the service is to be co-payed with the insured employee
Select an insured entity to fully see their contract policy and what type of insurance they have

Members

This feature tab opens up a new member register and contain all patient related contact information
You can add a patient ID as a new register or search for an existing one

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An insured patient could also be searched using the first or last name in both English and Arabic, email,
FID or a mobile number

Services

This tab features a self-constructed variety of medical categories to extract ICD10 medical services for
each category constructed.

Services

Allocate ICD-10 services to a variety of categorized medical related entities, pharmacies, chronic
diseases, Labs…. etc.
Make up your own chain of commands by categorizing what medical related term is best-fit for a long
list of ICD-10

Now for a selected category, add up whatever medical classification is correlated to the categorized
entity

Medical Network

Connect all parties together with a map view and a variety of data base linking clinics to price lists in
terms of internal and external networks
Create your own networks which in turn have all clinics and medical entities listed with all detailed
information for each entity
Each Network will show all clinics covered. With all contact information, including latitude and longitude

To each and every service selected and added to a benefit list, a price, discount, comments and an active
status mark could be implemented. This is called a price list
Data Entry

Data Entry: This tab allows you to check and edit all entries for each member

Select a provider and an ID member to view all data for each patient
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Claims management

You can easily find any claims sought for editing all claim related adjustments
Claims

Batches are invoice baskets which holds several claims for several invoices functioning of patient
Batches consists of claims & invoices for patients on a certain time periods

Claims can also be accessed from claim management of a certain batch


Accepted claims that are editable with all related information

Rejected claims that are also editable with a reason given for the rejection on each claim
Invoices

In invoices you are able to create and manage all invoices in addition to browsing between clinics and
networks.

Access all invoices by selecting the desired clinics and their policies
This will show you how many invoices a medical entity has with the ability to edit each batch of invoices
Approvals tabs are a short cut to what batches have been approved

Reports : Features auditing , payment summaries , policies and all claim related accumalative data
Reports

Member claim summary


Subscriber payment summary

Subscriber payment by age


User Management

Register a variety of functioning users to easily allocate each user a certain specified task

Add a new user and select what type of roles are needed for the user
Add a new role to a previously added user , you can also demote any user roles
Edit and manage all users tasks, roles , passwords and accesses

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