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PEHCS (Pether Health Claim System)

Automation where it counts: Health Claims Processing

The PEHCS suite is a powerful claims software solution designed for insured plans. The main purpose is to automate health benefits administration by improving the accuracy and efficiency of processing healthcare claims. Streamline your business processes while improving service to your customers.

Customers will henceforth be able to receive a service from an approved service provider without delay and the service provider will be able to process claim automatically. All this culminates in our objective to provide you with a system that will help you increase sales by at least 10% and net earnings by say 15 to 20%.

Our powerful health claims technology supports multiple claim types on a single, easy to use platform. Achieve auto-adjudication rates that you didn’t think were possible and transform your operations into a paperless office for routine tasks freeing you to handle your top priorities.

With our claims software, you can reduce time, effort, and expenses while improving your efficiency and processes in managing claims related to:

  • Medical, Dental, Vision consultations
  • Medication from pharmacies and hospitals
  • Hospitalizations
  • General Consultations 

How Our Claims Software Works

  • Insurance benefits of the insured are preloaded onto PEHCS or PEHCS is granted access to this information sitting with the insurance company’s internal system.
  • A health insurance benefit card with a chip containing the details of the insured is issued to each insured individual or family. 
  • The card is configured to capture the benefit details which may include:
    • List of services/products (dental, eye, hospitalization etc.)
    • Percentage of coverage
    • Maximum cover in monetary terms per service/product
  • The card may also be used to make virtual payments to the service providers. The actual payments will come from the insurance company once the invoice is received
  • Service providers (partner hospitals/clinics/pharmacies etc) are given access to a vendor module of PEHCS which can be made available on their devices (tablet/laptop/computer).
  • The insured will have to present this card to approved service provider each time they are need of a service.
  • For the very first time, this service provider will work with the insured to complete a form which basically authorizes the service provider to bill the insurance company on their behalf.
  • The service provider logs onto PECHS, swipes the card presented by the insured and his/her insurance benefit details are immediately made available on their screens.
  • The specific service is selected and additional comments entered if need be.
  • A service request is generated automatically and a notification is sent to the insurance company for validation if need be.
  • An automatic/manual purchase order is generated by the insurance company and sent via PEHCS to the service provider.
  • The service provider renders the service and gets an acknowledgement from the insured
  • The service request is updated once the service is rendered.
  • A bill is then generated and sent to the insurance company for payment.
  • Payment is made once the manual proof from service provider is received. 

Additional benefits

  • Keep confidential documents secure with centralized document storage
  • Manage exceptions efficiently with easy-to-use workflow
  • Search for patterns in claims that can help detect fraud
  • Our application captures medical records and other documents and links them to group or files electronically. The internally conceived workflow automatically routes files to the right people for immediate action.
  • Your customers are very demanding and should be able to be rendered a service using any device, anywhere, and at any time. Crucial business processes like filing a claim, admitting a patient, should be fast, accurate and frictionless. Executing them seamlessly is how your organization gains a lasting competitive advantage.

Automated Claims Processing

There are two levels of technology to consider—yours and ours. No matter what technology enhancement route you travel, the solution must seamlessly integrate multiple systems, platforms and processes to automate your claim processing workflow. Whether you have a legacy system that needs a complete overhaul or are looking to replace part or all of your manual processes, PEHCS has the automated claims management solution. 

Automation Improves Outcomes

Automating a health claims operations has measurable payback. It profits the company when claims are processed quickly, accurately and routed to the right person for key decisions.

Integration Creates System Synergy

PECHS works because it has intelligent integration capabilities that can be incorporated into existing processes and workflow without the upfront infrastructure investment. We build our products so that they can be installed and running in a matter of weeks and so that they require minimal internal IT time. We integrate adjustments for your specified work rules and reporting requirements into the core system.

Cloud Platform Delivers Secure Solutions

PECHS utilizes industry accepted cloud-based applications to facilitate secure technology upgrades, solution enhancements. There is no new “version” to install or buy. You are always up-to-date and ready to capitalize on new software technology innovations and advancements. The Cloud allows PEHCS to continually test and refine for functional reliability and protection. Multiple backups and layers of security protocols protect your data.

You can choose an on premise Next Generation Solution, housed in your own data center, or choose our online hosting services. You never have to purchase, upgrade or maintain new servers again, all for one easy, budget-friendly service. Our optimized and secure servers give you the freedom to worry about other things besides purchasing and maintaining hardware.