Claims Management System – TPA’s

eOxegen - Products

Claims Management System – TPA’s

  • Provider contracting, empanelment
  • Pre authorization management & adjudication
  • Fraud predictive KPIs
  • Reporting & BI Analytics dashboard

In today's complex insurance market, Third Party Administrators software help insurers, governments, corporations, and self-insured organizations by reducing the cost of claims and ensuring better outcomes for all parties.

Simplified claims administration and quick claim resolution are highly valued aspects of the TPA model. The data acquired during the claims management process makes it possible to quickly assess risk factors. Benefits include:

  • Faster and more focused claim processing
  • Reduced expenses and overhead
  • Easy access to extremely competent claims coordinators
  • Retaining positive customer relationships, protecting the brand's reputation
  • Exerting more control over the outcomes of claims

eOxegen's claim management system for third-party administrators (TPAs) is equipped with a range of powerful features designed to optimize claims processing and enhance operational efficiency:

Provider Contracting and Empanelment
Our TPA software simplifies the process of provider contracting and empanelment, allowing TPAs to efficiently onboard and manage a network of healthcare providers. Through centralized management capabilities, TPAs can seamlessly negotiate contracts, verify credentials, and maintain up-to-date provider databases. This ensures smooth collaboration between TPAs and healthcare providers, facilitating timely claims adjudication and improving provider satisfaction.

Pre-authorization Management and Adjudication
eOxegen's TPA claims management system streamlines pre-authorization management and adjudication processes, enabling TPAs to efficiently review and approve treatment requests. By automating pre-authorization workflows and integrating decision support tools, TPAs can expedite the approval process while ensuring compliance with medical policies and guidelines.Real-time adjudication capabilities further enhance efficiency, allowing for prompt resolution of claims and reduced turnaround times

Fraud Predictive Key Performance Indicators (KPIs)
Our third party administrator software incorporates advanced fraud predictive KPIs to detect and mitigate fraudulent activities proactively. By leveraging data analytics and machine learning algorithms, TPAs can identify suspicious patterns and anomalies in claims data, flagging potentially fraudulent cases for further investigation. This proactive approach to fraud detection helps TPAs minimize financial losses, protect against reputational damage, and uphold the integrity of the claims process.

Reporting and BI Analytics Dashboard
eOxegen's TPA management system includes robust reporting and business intelligence (BI) analytics capabilities, empowering TPAs with actionable insights into claims performance and trends. Through customizable dashboards and comprehensive reports, TPAs can track key metrics, monitor KPIs, and identify areas for process improvement. This data-driven approach enables TPAs to make informed decisions, optimize resource allocation, and drive operational excellence

eOxegen's TPA claims management system offers a comprehensive solution for third-party administrators, enabling them to streamline operations, enhance fraud detection, and improve decision-making through advanced analytics. With its user-friendly interface and powerful features, our TPA software is poised to revolutionize claims management in the insurance industry, delivering tangible benefits to TPAs and their stakeholders.

One of the preferred tools in the industry, the TPA or third party administrator claim management system comes with many unique features, particularly the one which enhances the value for the self-funded scheme clients. The system provides features such as contracting empanelment, network management, discount & rate configuration and rate negotiation management that makes the process of claim management seamless and efficient. In the dynamic world of insurance, the TPAs can leverage the automated client management systems as a value add to the services being offered to their customers. The embedded efficient benefit administration that supports auto-adjudication is one of the well-known characteristics of the system. As the third party administrator plays a vital role in health insurance, it is equipped to process both cashless and reimbursement settlements in a minimal turnaround time frame.

Our product aims to reduce or almost do away with loss of value claims for TPAs that arise due to inefficiency, unorganised or disconnected claim management process. We help TPA monitor every claim on a real time basis using third-party administrator insurance. The claim audit, fraud predictive KPIs and grievance management options empower to provide the settlement that is accurate and secure. Our customised reporting formats for third party administrators in health insurance are inbuilt and help overcome the obstacles arising due to repeated changes and statutory updates which need to be done periodically.

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