We provides TPAs with a best-in-class integration framework to manage complex claims processing faster than ever before, to efficiently accelerate claim adjudication processes and other operational routines
Streamlines and automates workflows
Third Party Administrators (TPAs) gain significant cost-savings and ROI by Modernizing administrative processes, streamlining workflow, tracking providers, benefit plans, core administrative processes, and Reducing paper/manual processes with powerful EDI.
Electronic Edits for accuracy
Electronic editing capability sends adjudicated claims and maintains 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).
Auto-adjudication reduces unnecessary services (operation and collaboration)
Automates complex benefit configuration and payment calculations to drive high auto-adjudication rates and minimize the risk of paying claims incorrectly. TPAs recover significant savings and meet cost containment by leveraging Jalin Health platform real-time alerts, automatic audits, and responsive reporting.
Better coding, no code required
Rules are coded with configurable options. Rules configuration drives automated complex decision making.
More about features
of Jalin Health Solution for Payers
Claim management, including auto-adjudicationand batch re-adjudication
Flexible benefit plan administration (multiple product, multiple line of business support)
Referral and authorization management
Robust member and eligibility management
Premium billing administration
Configurable add-ons, such as external Medicare grouper and pricer routines
Real-time portals and batch EDI services
Real-time claim editing
Intelligent alerts and reporting
Capitation capabilities
Easy-to-manage multi-level security
In today's environment, driven by emerging trends, including new models of healthcare, collaboration is an important thing to accelerate transformation and drive greater efficiency throughout the healthcare system.
Configuration to meet TPA’s needs
Jalin Health Platform integrated clinical, financial, and administrative insurance platform gives TPAs a competitive edge in total cost comparison and empowers the TPA to offer more proactive and creative benefit consulting services with numerous advantages for the stop-loss carrier.
No coding expert required/COB-Standardization
Flexible integration to provide a lot of capabilities to non-technical people without the hassle, expense, and complexity of custom code. You can stand up a reliable and elegant integration in minutes or hours instead of days or weeks. It’s that simple.
Auto-adjudication reduces unnecessary services (operation and collaboration)
Automates complex benefit configuration and payment calculations to drive high auto-adjudication rates and minimize the risk of paying claims incorrectly. TPAs recover significant savings and meet cost containment by leveraging Jalin Health platform real-time alerts, automatic audits and responsive reporting.
More about features
of Jalin Health Solution for Payers
Claim management, including auto-adjudicationand batch re-adjudication
Flexible benefit plan administration (multiple product, multiple line of business support)
Referral and authorization management
Robust member and eligibility management
Premium billing administration
Configurable add-ons, such as external Medicare grouper and pricer routines
Real-time portals and batch EDI services
Real-time claim editing
Intelligent alerts and reporting
Capitation capabilities
Easy-to-manage multi-level security
Detailed reporting functions will help insurance focus on areas in which it can further optimize customer service functions and others. The end result will be increased efficiency and more cost effective operations.
Provides Powerful Reporting BI/AI
Quantitative analytics and powerful reporting BI/BA provides predictive modeling and actionable intelligence to give TPA a competitive advantage in total cost comparisons. Our platform is also designed to process large transactions, yet we include a scalable pricing option for smaller TPAs.
Enhance transparency for evolving compliance requirements
Accelerate growth while minimizing risk through end-to-end transparency and reporting capabilities. Jalin Health Platform provides holistic visibility for compliance requirements.
Security Level
Advanced encryption and configurable access across multiple roles and position designated personel 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.
Reduce the cost of managing your customer service
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 more quickly and deliver more accurate answers.
More about features
of Jalin Health Solution for Payers
Claim management, including auto-adjudicationand batch re-adjudication
Flexible benefit plan administration (multiple product, multiple line of business support)
Referral and authorization management
Robust member and eligibility management
Premium billing administration
Configurable add-ons, such as external Medicare grouper and pricer routines
Real-time portals and batch EDI services
Real-time claim editing
Intelligent alerts and reporting
Capitation capabilities
Easy-to-manage multi-level security