It helps in Making, Submitting & Managing claims electronically on standards provided by Health Authority of Abu Dhabi. It records and maintains Patient’s demographics & Encounter History. It also provides dynamic claim generation to meet insurer requirement. User can view & analyze with actual claim Prepares resubmission of claims efficiently.
Advantages
It helps in Making, Submitting & Managing claims electronically on standards provided by Health Authority Abu Dhabi (HAAD)
Records and maintains Patient’s Info & Encounter History
Dynamic Claims generation to meet insurer requirement
View & Analyze with Actual Claim
Prepares resubmission of Claims efficiently
Key Concepts
A person can be a Patient who has an Encounter with a Provider (clinic, hospital). The Provider then Claims some or all of the charges from the Payer (Insurance company).
The Payer evaluate claims and response back to Provider as Remittance Advice with approved amount and with Denial code/s (if any), against each Claim.
The Provider analyze the Payer Response and decide if any claim needs to be resubmitted for correction, legacy or internal complaint. And resubmit the Claim after making required modification.
When a patient has an encounter with a provider, the provider needs to know what was done with the patient – an Activity such as a lab test – to be able to charge for it. And the patient’s personal information with insurance identification.