IRS, Healthcare Insurance Solution

About our healthcare insurance management system core package specifications, This software suitable for healthcare insurance operators and payers, They can manage and processes all business requirements. IRS software, suitable for healthcare companies or for large companies need to run onsite private healthcare, IRS software can manage both methods of healthcare operations, like premium contracts and TPA contracts, software can serve all departments in healthcare insurance company starting from healthcare billing to auditing department, you can reach the customization suitable for your company, all company staff will use IRS software to do their work. Our staff can serve you to make your company work with IRS software in just days; we can do all related IT work to make your system up and running starting from server installation until client installations, and then do the training for your staff and make it running. Starting from 2018 you can lease our IRS software on the cloud to work without any IT burden, just register to our cloud and start work after your staff ready. IRS software support bilingual usage, most common of our customers use English and Arabic, You may also ask to be in English and French, or any bilingual suitable for the country of use. Our software can support defines multi-users and can set privileges for each one suitable for his/her job activities. All your company departments can get benefits of IRS software and communicate with each other through the IRS to accomplish the tasks. And can communicate through your global account to interchange data or information with another parties involved in healthcare operations.

[The main parts of IRS core package software]

Define and manage healthcare services directory, diagnosis and basic data like deductions types so on, so you can use the default available or do the customization which is suitable for your business.

Define and manage healthcare groups of members like corporate contract; include all information to make the contract effective and applicable.

Define and manage healthcare services providers’ contracts including price list and deductions and so on.

Define and manage healthcare services providers’ contracts including price list and deductions and so on.

Define and manage members’ details with his healthcare corporate or as individual including personal data and contracted.

Define the family of members and so, and can be in another class or benefit.

Member ID printing, where you can do printing job from IRS directly with suitable devices.

Batch of claims and claims processing

Indemnity processing

Healthcare Services providers’ payment processing, with full functionality of bank balance and paid and unpaid claims.

Reimbursement payment processing with full functionality of bank balance and paid and non-paid form.

Can process and manage both types of contracts, premium or TPA

Calculate premium table due to healthcare classes and age and gender, that let you customize your premium table.

Produce premium collection invoice, give alert of collection due, you can customize this too.

Process account receivables and account payables

You can import data from excel, this can done where ever needed like import service directory from excel or members data from excel.

General ledgers, financial statements, trial balance.

Complaint cases “customers’ services”, fully functionality search for healthcare network and record customers complaints to do more quality service for customers.

Record and manage approval up to services level, with estimated prices or budget.

Operation of periodically chronic medication and with automated way that make the monthly or periodically dispensing process faster and more precise, or separate medicine approval.

Reports, IRS has varied of reports can give information for whatever need in the healthcare insurance processes, we can talk about reports in IRS for a long time where it contain a very large numbers of reports, where it will help you find any information you look for, and in the ways needed for healthcare insurance.

IRS, Medical Services

In healthcare insurance you will need to have medical services coded and classified in a way to be used inside insurance contract which is the contract of benefits where members will get served and covered as this contract limits and percentage state, you’ll find definition for benefits and sub-benefits and services. You can use your custom medical codes for services or use the CPT codes or the suitable modifications used in your market.

In the part of approval and claims you can use custom diagnosis codes or use codes like ICD 10 or any suitable modifications. Medical coding became the suitable way to define the services and diagnosis in medical billing, and the right way to let parties whom share data, like insurance company and members and service providers understand each other without misunderstand or confused parts.

Our software has full flexibility of what you plan to use of medical coding and its modifications or extensions, and what you are going to use of diagnosis coding for sure we recommend use a common coding like ICD where it help you to communicate with other firms on the medical network and simplify the recode process if any. Our new version already lunched with option to load common international codes and its CM, and available to use through system modules.

Primary Care physician (PCP) Module

A primary care physician (PCP), or primary care provider, is a health care professional who practices general medicine. PCPs are our first stop for medical care. , our IRS has new module developed to serve doctors and can communicate with the IRS core package to fully automate the processes for PCP or doctors in the providers list.

Onsite Clinic Module

A workplace “onsite clinic” is a setting where an employer offers one or more medical and wellness services, delivered by licensed providers to the staff and their families. Onsite healthcare clinics have gained traction with large businesses and are helping create a focus of wellness and prevention. Our IRS projects, has software work independently for Onsite clinic and can use to manage all your onsite clinic including pharmacy and manage your medical network for providers and approval processing and all required processing to manage your onsite clinic with professional services for your staff.