Our inspiration to build a fully integrated system to support the end-to-end insurance claim processing flow started from one of our colleague’s personal experiences with an insurer at a hospital. In one incident, his dependent had to queue and wait for almost an hour just to be authenticated at the HMO’s concierge, but only to be denied when her turn to be attended came because of a delay on the update of the members’ database. Another remarkable experience was the time when the same dependent needed to secure a Letter of Approval (LOA) for a simple outpatient procedure and the insurer’s representative had to call their customer support for approval. Unable to get a reply (as no one was available to take the telephone call), the representative issued an LOA for the procedure without the benefit of validating the extent of the contractual obligations of the insurer to the member as provided for on the policy.
But perhaps the most confusing customer experience our colleague went through was having to wait for eight (8) hours from the time of hospital discharge to receipt of the bills, because of the paperwork that had to be completed by the hospital for the health insurer.
There must be a better and efficient way of doing these processes!
Coming from a rich background of knowledge and expertise in different industries (Information Technology, Airline, Telecommunication, Energy, Education, Commerce – Wholesale and Retail Trade, Public Sector, Utilities) including Healthcare, our combined experience spans more than 100 years! We started conceptualizing the system design for an integrated Claims Management solution in October 2018. Employing the Business Process Management (BPM) approach and knowledge in the healthcare industry, we started the development of the software in March 2019. Using the latest IT programming tools, project management methodologies, and testing discipline, we completed Version 1.0 of Aurora MedClaim System in December 2020, just a month after our company, SageLogx Inc., was incorporated!
Automating claims application, adjudication, and payment processing is the future, now – it is inevitable!