Business Lines
Health
Acsel's architecture and flexible component configuration allow it to handle and manage any health product or plan. Through this platform, clients can create bundled or customized plans, fee schedules, negotiated agreements, and more. They can also define specific conditions at any level they require for any aspect of the value chain, including sales conditions, service provider networks and their lifecycles, payments, terms, illnesses, coverage, payment types, and so on. In short, clients have a robust tool to create and maintain customized products tailored to their business needs.
The system has no limits to handling
products and plans
(both individual and collective, as applicable)
Hospitalization, Surgery and Maternity
Medical and major expenses
Compensation
Terminal Illnesses
Supplementary Health Insurance
Cancer Insurance
Medical Care for Specific Diseases
Travelers
Managed Plans
Improve productivity and increase customer satisfaction.
The following are some of the various system options specific to the configuration and management of health and medical expense insurance. Prepaid medicine, administrative plans.
The system includes a dynamic configurator to manage any field, table, formula, or business rule for the healthcare value chain. Pre-configured templates with various options are available. Some of these variables and functionalities are listed below:
Setting group rates by age and kinship.
Deductibles, benefits, waiting periods, diagnoses, treatments, types of procedure (surgical, medical, etc.), type of care (urgent, scheduled, etc.).
Congenital diseases.
Plans with coverage in foreign territory.
Service access type: network, off-network both.
Types of limits: Unlimited, Amount, or Agreements
Doctors according to the type of access to the service, whether online or offline.Co-payment, Letters of guarantee or pre-admission.
Consumption of the maximum benefit amount.
Indicators to monitor service usage
Medicines, materials and supplies with cost history.
Benefits.
Benefit Details (services).
Health Declaration Questionnaire.
Management of fee schedules, medical agreements for costs per event and per procedure package.
Management of physicians and providers affiliated and non-affiliated with the network.
Medical Network Management with Fee-Based Contract Types.
The system allows you to configure all business rules, formulations, requirements, processes, etc.
To process health claims or losses regarding all aspects related to compensation, reimbursement, and service payments. Among others:
Authorizations and reimbursements
Control of clusters over coverage limits, benefits, usage, etc.
Online integration with external partner systems and service providers for claims authorization and processing
(also portals, IVR, etc.).Compensation to medical service providers,
doctors and reimbursements.
Management of invoiced amounts, authorized amounts, unauthorized amounts, amounts to be compensated, deductible values and applied co-payments
Compensation for non-medical services (Income and Convalescence, Maternity Allowance, Funeral Expenses).
Registration and control of amounts not paid by authorization.
Breakdown of Clinical Services applying the established medical agreements.
Handling and control of partial payments per invoice.
