Product purpose:

The main purpose of the product is automation of management and administration of the state financial programs in health care. The system helps form a unified informational space for administration of medical services and operations between the patients, assigned persons of the medical services and the state. It allows improving the efficiency of management and monitoring of the state financed programs for health care and state medical insurance. The analytical tools of the system allow improving quality of planning of the state health care programs.

Scope:

The software product is used to build a unified centralized national system of the state medical insurance. The system is used by the employees of the medical service providers, who complete the system with - the data on the medical services which are rendered within the state programs, and the employees of the state bodies, who control fulfillment of programs, pay compensations to the providers, initiate new programs, certify providers and medical personnel, etc.

Main benefits:

  • Improvement of the transparency of the financial data, prevention of fraud and reduction of administrative expenses
  • Rich analytical tools allow to increase the efficiency of decision making
  • The unified system of classifiers and standards allowing to unify data exchange between providers of medical services and the state
  • The basis for change-over to the paperless document circulation between the patients, providers of services, and the state
  • The option to integrate with the hospital systems of providers of medical services
  • Security of transfer and storage of the confidential data

 

Functional structure:

Subsystem

Description

Program management

The subsystem allows to maintain information on the national health care programs, cost and rules of estimation of compensations for medical cases, rules of calculations of the limits by patients.

The module also has an option to maintain the registry of providers and their participation in the national programs.

Beneficiary management

The subsystem allows to maintain information on beneficiaries participating in the state financed programs.

It is possible to integrate with the national registry of population or registry of patients

Provider portal

The main function of the Provider portal is provision of the following options to the provider:

  • Maintenance of the financial and statistical information on the provided medical services within the state financed programs of medical insurance
  • Generation of the detailed reports for insurance companies and medical institutions
  • Record keeping of the outpatient care, dialysis, tuberculosis, drug addiction, autism, immunization and vaccination programs

Guarantee management

The subsystem allows to manage the procedure of issuance of the state referral to treatment and receipt of medicines as well as the rules of calculation of compensations.

Billing

The subsystem allows to manage and monitor the process of services provision, program budgets and maintenance of contracts, acts, invoices, cooperation with the treasury and control of payments.

Analytics and reporting

The subsystem represents a rich set of tools for business analysis and statistical reporting which allows the users to review financial and statistical information from different perspectives.