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Ibn Sina

Ibn Sina is an Oracle-based application that orchestrates all the stakeholders of medical insurance, starting from sales and closing with insurance and reinsurance, going through policy's building, providers' building, insured beneficiaries, claims processing, medical approval, call center and accounting.

Dynamic Dashboard that gives the decision maker a high-level overview of a personalized view for the essential key performance indicators.

Analytical reports to help clarify worthful information and enhance the creation of full management reports.

Powerful checkbook module that allows the design and print on the preprinted chequeen forms.

Electronic archiving system allows the users to consult physical records and the image of the document.

SMS Notification Module enables both alarm notification and acknowledgment via text messages.

The solution should be based on ICD-10-CM, International Classification of Diseases version 10 or later, Clinical Modification version.

Ibn Sina Features

Provider Building

Ibn Sina offers a comprehensive database for medical service providers includes detailed contact information, branch locations, and a price list for medical procedures. Additionally, it features a smart linkage between ICD 10 codes and drugs, which are mapped to internationally recognized standards such as HCP CSII, CDT, or ATC

Accounting

Ibn Sina platform Guarantee a complete payment cycle - covering accrual, review, check printing, and delivery - that is supported by standardized protocol to integrate and communicate with different accounting and financial systems.

Policy Building

Ibn Sina is engineered to support all types of carriers , insurance and reinsurance treaties in policies configuration with a flexible structure for brokers’ commissions, reimbursement modules and exclusion lists that can be built on policy, plan, contracts and beneficiary level which meets market’s demands.

Analytical Reports

Ibn Sina generates analytical reports covering clients/portfolio balances and the over dues balance, in addition to statistical claims reports covering loss ratio based on earned/unearned premium, demographic parameter like gender, age groups and ratios of approvals.

Claims

Ibn Sina Platform provides a simple way to process claims in all lines of medical insurance business for entire claim settlement process with the ability to import claims from excels sheets. Ibn Sina also enables automatic claim auditing for network and non-network provider claims along with a financial auditing engine that combines the provider’s price list with validations defined in the system.

Medical Audit

The Medical Audit engine is a meticulous and all-encompassing tool, meticulously crafted to serve the interests of medical insurance companies by preventing insurance fraud, combating medical overtreatment, and curbing wasteful practices within the healthcare domain. This report is designed to provide a panoramic view of medication management, incorporating an array of critical analyses to ensure optimal utilization of healthcare resources.

Nice Deer

Medi-Insights 360 Report

A comprehensive medical audit report, tailored for medical insurance companies Specifically useful for monitoring acute chronic prescriptions aims to combat insurance fraud, medical overtreatment wasteful practices within the health insurance sector.

Crafted to offer a comprehensive overview of medication management, integrating various critical analyses to ensure the optimal utilization of healthcare resources.

Medi-Insights 360 Report Features

Drug-to-Drug Contraindications and Drug-to-Disease Interactions

The report carefully aligns treatment frequencies and quantities to identify patterns of excessive or overly frequent treatments. Recognizing potential overtreatment allows for timely interventions to venture the appropriate utilization of medical resources.

Insurance Policy Exclusion Compliance

An essential component of this report entails cross-referencing dispensed drugs with the insurance policy exclusion list. This ensures that prescribed and dispensed medications adhere to the terms of the insurance policy, thereby preventing unnecessary expenses.

Inpatient and Acute Medicine Scrutiny

In-depth scrutiny is applied to inpatient and acute medications to assess their suitability and necessity within the monthly medication regimen. This focused evaluation enables the identification of potentially excessive or unnecessary treatments.

Drug Duplication Check

A comprehensive evaluation is conducted to detect any duplication of medications that the patient is already using. This involves a detailed review of medications, regardless of their brand name, active ingredient, or therapeutic class, intending to prevent redundant prescriptions.

Detection of Overtreatment

The report carefully aligns treatment frequencies and quantities to identify patterns of excessive or overly frequent treatments. Recognizing potential overtreatment facilitates timely interventions, ensuring the appropriate utilization of medical resources.

Age and Gender Compatibility Verification

The report guarantees that prescribed medications are in harmony with the patient's age and gender, aligning pharmaceutical interventions with the distinct healthcare needs of each individual.

Dosage Monitoring

The report meticulously examines the prescribed dosage, comparing it to the typical and maximum daily dosage ranges for each medication. This process aids in pinpointing instances where the prescribed dosage surpasses recommended limits, thereby ensuring patient safety and adherence to medical guidelines.

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