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

 

 

Members Database
   
Provides on-line, real-time access to the latest member and prospective member information
    
Paragon21 relational database contains information on insurers, members, groups, and dependants. Real-time, on-line eligibility maintenance and inquiry capabilities provide efficient and accurate determination of insured and dependent status.

The relational database in the Paragon21 System is used to provide support to members and to determine eligibility for claims payments. 

Some of the information stored and maintained for the member is: 
  
First contact date and reference source. 
  
Join/termination date. 
  
Date of birth and gender. 
  
Title and name/s (including maiden name), Post nominal. 
  
Unlimited number of Addresses (including e-mail). 
  
Marital Status. 
  
Clearance certificate status and waiting periods. 
  
Medicare number and date. 
  
Work, Home and Mobile phone numbers/Fax numbers (unlimited numbers) and e-mail address. 
  
All correspondence sent to the member. 
  
Notes from all phone communication and comments. 
  
Cover and products description. 
  
Unlimited number of dependents with the same information (or different) as the main member. 
  
Links to other members for payment and/or historical reasons. 

If the member or dependent changes group, changes location, suspends, or terminates and rejoins, all previous information and history can still be accessed on-line. 

To protect confidentiality and privacy, the access rights to records are controlled for different levels of personnel.
  

Significant Strengths 
 
Produces on-line updates that result in real-time inquiries of eligibility status.
  
Accesses records via member number, name (or part of), address (or part of). 
  
Retains extensive free-form notes for each individual including reminders. 
  
Maintains prior name/s, previous cover and prior addresses. 
  
Supports rates that may vary based on age e.g. Lifetime Health Cover. 
  
Reduces billing errors by not billing dependent coverage until it becomes effective. 
  
Allows members and dependents to have separate benefits by tracking the dependentís effective and termination dates.
  
Provides direct access maintenance of dependent eligibility records. 
  
Monitors dependantsí age (e.g. 18th & 25th birthday/s) for student dependant review/eligibility.
  
Supports unlimited numbers of dependents per membership. 
  
All correspondence with each member, dependent, prospective member and service providers is retained in the database and is available on-line for viewing and/or re-printing.
  
Provides access to coverage history for an unlimited period of time. 
  
Keeps a complete audit trail for all activity on an event-by-event basis. 
  
Contains data duplication features to speed the entry of information. (The data duplication feature carries repeated information forward to the next entry screen.) 
  
Can provide a batch update facility, which alleviates manual entry of data from another system to Paragon21. 

 

 

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