Solutions

Real-time data validation

This is the most powerful feature of the Conexia system that revolutionizes the way healthcare transactions are processed.

We provide an easy-to-use rules engine, which gives the insurer access to the pre-defined business rules in the system. These rules are applied in real-time allowing data validation to take place before the service is rendered.

Based on the requirements of the client, three different levels of validation are available.

Real-time adjudication

With real-time adjudication, the need to process individual healthcare claims is completely eliminated. Services are approved (or denied) prior to being rendered, meaning both the provider and the patient have certainty of the costs involved.

The contracts with each provider are entered in to the system, which allows real-time confirmation of all costs involved in the transaction. It shows both how much will be covered by the insurance company and how much needs to be paid by the patient in the form of a co-payment.

A decision is provided in real-time, meaning the provider has certainty of payment and can immediately invoice the patient for the co-payment, should this be required. This drastically reduces administrative costs and increases customer satisfaction.

Real-time estimation

With real-time estimation, the providers receive confirmation of the patient's insurance status and are also provided with an estimation of coverage. This means they can inform the patient how much they are likely to receive from the insurance company for the requested service.

By providing this information in real-time at the point of service, both the provider and the patient are able to make informed decisions. This leads to better service and less misunderstandings.

Real-time eligibility

This is the most basic level of validation, which provides a simple yes/no answer on whether the patient is currently insured and whether the requested treatment or medication is included in their healthcare plan.

By providing this information in real-time, before the service is rendered, both the patient and the provider are pre-informed and avoid receiving any unpleasant surprises later on.