R X H E A L T H

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PAYER SOLUTION
(Rx Claim)

We provide electronic solutions that allow all types of payers (health insurance, TPAs, corporate bodies, donors) to reduce fraud and wastage whilst improving healthcare access, transparency and sustainability.

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The RxClaims is Africa’s largest online to offline system which is perfectly suited for many parts of the emerging world with unstable internet connectivity

Awesome Features

ENROLMENT & MEMBERSHIP

Electronic Member Enrolment (Online registration of members, Bulk Excel upload of members and single member registration)
Member management (Status, Benefit options, Policy Expiries), Pricing and Reporting.

RISK, BENEFITS & PRICING

Big Data reports for Risk Analysis, Underwriting (with relevant underwriting data and elements)

Policy and Premium calculations, policy holder details and reporting

POLICY MANAGEMENT

Contract version management capabilities with policy detail management.
Billing of policy holders and members, payment made by policy holder and reporting

CLAIMS MANAGEMENT

Clinical claim adjudication system with online and offline capabilities.
Financial claim adjudication system with online and offline capabilities.
Tracking of unsubmitted claims by providers and reporting.

PAYMENT MANAGEMENT

Adjudicated and approved claim payment management. Financial management and reporting

Patient interaction

With our custom Mobile application patients get to monitor their claims , benefits utilization and submit refund

Irrespective of the location, size or reach of your business, the RX CLAIMS is perfectly engineered for your needs.

Benefits

Simplicity

Easy to manage and manage insurance rules

Security

Flag suspicious and fraudulent claims

Realtime

Faster turn around of claims

Notification

Patient alert system

Access

Sync Data asynchronously both from online to offline. 

Interoperability

With our custom API, you can integrate to other HMS

Number of claims processed

# 5M+

Amount of processed claim

$ 100M+

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