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



Paragon 21
Paragon 21 is the Health Fund Management System for the 21st Century

Designed and developed by The Paragon 21 Team to comply with the International Quality Standard ISO 9001 and in line with the AS/NZS ISO 9000.3 Guideline for the development, supply installation and maintenance of computer software.

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Key Features
Significant Technical Strengths


Paragon21 is a Multi Fund, Web-enabled, Scalable Health Insurance Computer System with a Relational Database Management System (RDBMS), and On-Line Transaction Processing (OLTP) facilities.

The Paragon21 package includes a powerful Data Warehouse with reporting and interactive graphical analysis enabling users to create multiple three-dimensional colour charts from varying perspectives and drill-down capability.

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Key Features
Paragon21 contains Members Management Modules that tracks applications from the first enquiry (prospective members), through the quotation, verification of previous cover and approval. Our unique Member Management system tracks and documents both group and individual new business from the initial enquiry to acceptance of membership.
The Members Management Modules eliminates and automates many of the manual steps involved in tracking a new member case. Prospective members are converted to full membership without the need to re-enter any information in the database.
The Member Service Notes Modules is used to track phone calls, Member enquiries and to place warning messages in Members’ or Providers’ records. By maintaining notes in a central location, the Member Service system keeps support personnel up-to-date and “in the loop”. For every enquiry, users enter information concerning the nature of the enquiry. The users can also forward the Note to a supervisor or other person for action to be taken.
The Paragon21 Correspondence Modules allows authorised staff to create and generate letters for member/s, prospective members’ or providers’ specific needs. Once a set of letters is established in the Paragon21 database, the system allows authorised persons to create and control the modification of letters. All changes are managed through the Request Information Tracking System (RITS). This ensures staff utilise only authorised letters. All correspondence is stored in the Paragon21 Database and can be viewed at any time.
Paragon21’s Claims Modules provides real-time assessment and administration of hospital/medical, dental, physiotherapy, chiropractic, optical, natural, and other services. It is available to Health Insurance companies, third-party administrators and self-insurers who demand an efficient, cost-effective system.
Electronic interfaces such as EDI, HICAPS and Optus Health Claims are fully supported by Paragon21. Also, an integrated “Provider Payment Service” via the Internet/Intranet is available.  Interface connectivity with any Open Client or Open Database Connectivity (ODBC) system such as a General Ledger Package is also available.
Paragon21 Contribution Modules provide comprehensive administration for individuals, agents, groups, associations and multiple employer plans. Insurance companies and third-party administrators can use Paragon21 Contribution Modules to administer billing and collection functions, pay commissions, and issue certificates.
The “On Demand Knowledge” Data Warehouse stores all data elements reported throughout the Paragon21 System and can include information from other systems in the Fund. Through the use of report generation tools such as Brio, users are able to provide analytical information such as profiles of best practice behavior within the Organisation as well as identifying providers billing patterns, member’s claims patterns and potential fraud activities.
Comprehensive security administration, audit trails and reporting are standard in the Paragon21 system. Data access and functionality restrictions are based on three levels of passwords.
The Paragon21Team provides system documentation developed by a professional staff of technical writers. The documentation package includes instructional user guides, system administrator manuals, and technical reference manuals, all of which are available in paper, on-line and CD-ROM formats or can be downloaded from the Paragon21 Web Site. Further, all user documentation is consistent with the Paragon21 Courseware and Help Screens including the Question and Answer facility throughout the system.

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The key to Paragon21’s adaptability is its system architecture. Paragon21 allows organisations to manage multiple funds with multiple marketing plans and products. Contracts can be established with individual providers and group practices as well as institutions such as the Australian Health Service Alliance.

The entire System is designed around a Distributed Three-Tier architecture and Transaction Pooling methodology. 

Distributed Three-Tier software architecture has been adopted by The Paragon21Team to overcome the limitations of a two-tier architecture. The extra tier (middle tier Application Server) is between the user PC (client) and the Database management (file server) components. This middle tier provides process management where business rules are executed. Paragon21 can accommodate hundreds of users. 

With this Three-Tiered approach, it is possible to install enough Application Servers to serve the requirements of any Fund, small or large, making Paragon21 a truly cost effective and scalable system. 

The Transaction Pooling feature in Paragon21 allows users to share database connections. The advantage is that when users request service/data from the database, a connection will be taken from a pool of connections. The database server will process the request, and when the request is satisfied, the connection is placed back into the pool and made available to other users.

The Paragon21 Client Framework ensures that only one Application Server interaction is made per “user transaction”. That is, if several data windows (screens) require updating in a logical unit of work, the one Application Server request will satisfy the entire transaction, hence improving network performance and scalability. 

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Significant Technical Strengths

Minimal technical knowledge is required to operate our systems. However, to accommodate Health Funds who have technical staff interested in customising programs, we have designed our systems for the Health Fund programming convenience. 

Utilises object-oriented architecture with an event driven methodology that is easier for programmers to follow and maintain. Event driven code operates more efficiently, and makes it easier to customise a program for unique Health Fund needs. 

Utilises an externally defined database table, which facilitates modifications and reduces the cost for implementing modifications. 

Provides a modifiable system parameter table, which ensures the lowest possible cost to customise the system to meet business or regulatory requirements. 

Uses the Microsoft Multiple Document Interface (MDI) to enable users to work with multiple documents at the same time. Each document is in a separate space with its own controls for scrolling. The user can see and work with different documents such as Membership query, a Claims assessment and/or a Quotation by simply moving the cursor from one space to another. 

Provides audit facilities allowing an administrator to specify the period of time over which data will be retained on-line for auditing purposes. 

The Paragon21Team provides regular updated product releases as part of the maintenance agreement, providing the latest enhancements to the base system. (Product Releases are issued in response to legislative changes, technical changes, and the All Paragon21 documentation included in the Paragon21 Documentation Guide is designed to comply with the International Quality Standard ISO 9001 and follows the ISO 9000-3 Guideline for the development, supply, installation and maintenance of computer software.

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Please contact
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