Operation

Automated claims adjudication software is to process claims with sufficient speed and accuracy, automates complex benefit calculations to drive high auto-adjudication rates and increasing number of fraudulent claims. Insurance recover significant savings and meet cost containment by leveraging real-time alerts, automatic audits and responsive reporting

replaces paper-based and manual exchanges of business documents via postal mail, fax and even email. In other words, Powerful EDI creates seamless and direct communication of key documentation between trading partners, as business information is exchanged paperlessly and quickly between each partner’s business system.

Rules are coded with configurable options, Rules configuration drives automated complex decision making

Reusable templates and electronic editing capability sends out adjudicated claims to our partners whose engines maintain thousands of claim editing rules. These solutions are fully-customizable to meet specific billing guidelines for institutional and professional claims, significantly reducing FWA (fraud, waste, and abuse).

Flexible integration to provide a lot of capabilities to non-technical people without the hassle, expense, and complexity of custom code. Private insurance and BPJS can stand up a reliable and elegant integration. It’s that simple

Basic, gap/advantage and introduce cost sharing scheme: co-pay, deductible, out of pocket (OOP), Etc. Cost sharing can potentially increase ownership of the members

Jalin Health Platform automates complex benefit calculations to drive high auto-adjudication rates and minimize the risk of paying claims incorrectly. Insurance recover significant savings and reduce utilization costs by leveraging Jalin Health real-time alerts, automatic audits, responsive reporting, and more.

Designed for more sophisticated reimbursement products to providers. It’s essential to have a claim system that facilitates both payment models (Capitation and non-Capitation). Additionally, with Our Platform, insurance can create a maximum claim payment on either model. We elegantly support both capitation and non-capitation.

Our platform offers Real-Time Eligibility and Benefits Lookups. simplifying your workflow by connecting directly to insurance to verify patient eligibility before admitting or rendering services. Eligibility lookups instantly display the information and the data can be automatically inserted into the patient ADT record.

The process of using visualization tools so you can present and analyze data in the form of charts, graphs and interactive content. These charts and other visual aids typically represent key performance indicators (KPIs) and metrics a business uses to track its success and operational performance.

Jalin Health claims queueing solution allows insurance to better manage claim inventory and work distribution in an automated fashion. Automatically sort individual analyst queue based on configurable prioritization such a oldest claim by receive date, greatest total billed charges and greatest total net payment.

Jalin Health’ front-end customer service experience enhances call management capabilities, provides a streamlined user experience (UX), and delivers fast access to critical data. Customer service representatives find information far more quickly and deliver better customer service with accurate answers.

Utilization reviews, resource allocations to reduce unnecessary services in healthcare. Utilization management in healthcare is commonly thought of as a strategy that insurance employ to control resource use within physician offices and hospitals to keep healthcare costs down.

Advanced encryption and configurable access across multiple roles and position designated personnel custom tailor a detailed security configuration, tightly controlling access to data at the Form level, Field level, Group data level,C-level or the Individual member level.