Medical Benefits Management

The Medigent® Medical Benefits Management module allows users to submit and adjudicate claims in real-time and batch, and capture a rich set of claim data elements related to the service provided, the client, and the service provider.

The module provides concurrent support for both existing diagnosis standards in use today, ICD9 and ICD10.

The complete claim life cycle is configurable, which allows the permitted status changes that are conducted by the system or an assessor to be tailored to the jurisdiction’s specific requirements. This flexibility permits the client to fully control the business flow of each claim.

Adjudication rules and fee schedules are also customizable, as are all claim types associated with the program, including in-jurisdiction and out-of-jurisdiction claims. All types of payment modes are supported, including fee-for-service, sessional claims, and salaried.

The Medical Benefits Management module integrates with enterprise financial systems for payment and includes a set of processes for managing the beneficiary and provider populations of a jurisdiction’s medical benefits program.