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

 

 

Cover/Product Database
  
Customised products support Health Fund business requirements
  
Paragon21 coverage/product database defines the benefit limits and methods of administration for all of the Health Fund products. The system supports individual and dependent, medical, dental, pharmaceutical, optical and any other coverage that may be unique to the Health Fund business. 

By maintaining control of administration rules for each benefit and product, you create (without program modifications) the Health Fundís own product structures and tables.
  
Significant Strengths 
 
Supports multiple effective dates and termination dates coverage. 
  
Maintains and controls coverage descriptions at the group, account or individual level.
  
Provides member-defined coverage descriptions that are in everyday language, to significantly lower the learning curve for new staff. 
  
Supports coverage rates by plan, geographic area (State), age, marital status, corporate subsidy, coverage option and other user-defined functions such as students. 
  
Maintains historical tracking of changes to member cover (single to family, cover changes and additions) that has occurred through the membership. 
  
Accommodates premium discounts, corporate subsidies and rebates. 
  
The Product Listing screen provides a list of all the products in the system. When selecting the cover for an individual, the Product Listing screen provides the ability to select the various products that make up an individualís cover. 

 

 

For more information or to organise a demo of the Paragon21 Package,
Please contact projectmanager@paragon21.com.au
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