Claims management and payment processing

Segic provides real time processing of claims submitted electronically by health service providers as well as those submitted manually or electronically by participants. Real time claims lead to efficient adjudication and payment, with amounts reimbursed based on strict, predetermined rules.

Key elements:

  • Management of health and dental claims submitted via the participants’ portal
  • Management of dental claims submitted in real time and requiring human intervention
  • Access to all drug claims submitted in real time, with the response sent to the pharmacist
  • Manual entry of health and dental claims
  • Management of amounts due in cases where already-paid claims are later denied
  • Manage rejected bank transfers and erroneous account information
  • Flexible search function: search claims by date of submission, treatment or payment
  • Health spending account (HSA)
  • Global search of participants
  • Cash flow management for each plan
  • Customized with  our customers or Group branding (participants’ portal, insurance card, reports)
  • Document vault (electronic document management for each Segic platform user)
  • Comprehensive management of all historical data
  • Data transfer to select insurers

The organization will benefit from a tool available at all times to help clients or participants better manage their health costs and ensure that the right amount is paid for legitimate claims.

  • Thanks to its cloud-based design and delivery in software as a service (SaaS) mode, the Segic platform can assign roles or permissions to members of the adjudication team, allowing the team to decentralize operations.
  • Given the complexities and stringent criteria involved in claims adjudication, Segic has built an experienced team that can, using strict rules, manage and pay for the health products and services covered by the group plan.
  • The Segic platform is integrated with banking systems in order to process reimbursements for participants and health service providers alike.

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