Members Management

Members Database

Cover/Product Database

Group & Individual Contribution Billing

Agency Administration Module (Optional)

Customer Service Notes System

Correspondence Module Features

Claims Processing Modules

Claims System Versatility

Claims Administration & Assessment

Claims System Summary

Reasonable & Customary Charges

Electronic Claims Processing

Dental Claims Module

Pharmaceutical Processing Modules

Claim Adjustment & Cheques Cancellation

Cheques & Remittances Advice

Report & File Generation



Claim System Summary
Claims administration in a powerful data management and reporting environment

Increasing demands are being made to bring health care costs under control.  The Paragon21 Claims modules:

Reduces administration costs;

Promotes cost containment efforts;

Promotes utilisation review efforts; and

Provides meaningful statistical information for analysis.

The Paragon21 Claims Modules automates virtually every claims assessment, administration, and reporting activity.  The system’s comprehensive components manage:

Rules/benefits/limits and conditions.

Hospital and Medical Contracts.

Per case, calendar year/s, policy year, or rolling benefits periods.

Casemix and episodic claims (tracking episodes and events).

Provider arrangements/contracts.

Dental cover.

Optical cover.

Well being therapies cover.

Health Management services.

Medical services.

Pharmaceutical (non-PBS).

Hospital Cover.

Ambulance Cover.

Any other type of Cover.


Paragon21 Claims Modules provides…  
Greater efficiencies in claim processing through:
1) Reduction of internal administrative costs.
2) Accommodation and automation of unique assessing procedures previously managed manually.
Greater productivity through:
1) Reduced assessors clerical tasks.
2) Increased assessors output.
3) Increased assessors efficiency and consistency.
4) User documentation and Courseware containing step-by-step instructions for using the system.
5) On-line help screens with natural language interface (for questions and answers) that reduces research time.
Cost analysis and cost containment through:
1) Useful information collection, maintenance, and reporting features.
2) Audit facilities.
3) Claim editing/validation.
4) Auto generated and stored correspondence.
Lower Data Processing Costs through:
1) Scalable design.
2) Member specific user exits/parameters.
3) Utilisation of a relational database.
4) Screen driven operations and reporting functions.
5) Six monthly updated system releases, which provide base system enhancements and respond to legislative and technical changes.
6) Knowledgeable product support and state of the art systems from The Paragon21Team staff.
7) Complete history including all correspondence available on-line.
Paragon21 Claims Modules perform real-time, on-line claims assessment and administration. The system retains comprehensive historical claim data on-line. It is the most effective claims control tool, available for cost containment reporting and analysis. 
Using the Paragon21 Claims Modules, you can offer maximum flexibility, whether your Fund has 100 members or 100,000. Paragon21 Claims Modules also provide you with access to a wealth of statistical information for monitoring and reporting purposes. 
The Paragon21Team staff understand the claims administration business. We know how important it is to have a reliable and efficient claims administration system to handle the business for today and tomorrow.


For more information or to organise a demo of the Paragon21 Package,
Please contact
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