A synergetic approach to Healthcare Benefits plan management designed for organizations operating their programs independently from insurance companies

Overview

Benefis is a software system that enables the management of Healthcare Benefits Programs. It contains a policy framework to manage claims and approval of health-related services in the following fields:

  • Vision Care
  • Dental Care
  • Medication
  • Transportation
  • Medical Equipment & Supplies
  • Professional Services / Other Services

The Benefis software solution is currently used by local Healthcare Authorities in Canada to manage their benefit programs, more specifically for Inuit & First Nations populations.

Key Features

  • Manage a database of beneficiaries
  • Emit service pre-authorizations
  • Process claims
  • Validate claims and pre-authorizations against system policies and beneficiary history
  • View beneficiary authorizations and dental history
  • Manage service policies with extensive validation rules
  • Reconcile invoices received from suppliers with emitted authorizations
  • Transfer invoices to the accounting system for automated payment

Integrations

Benefis can interface with your existing systems to provide you with a fully integrated, optimal workflow. Possible interfacing solutions include:

  • Synchronizing patient demographic information from external sources, using HL7 messaging or flat-file import;
  • Importing a list of drugs that are covered from various sources;
  • Importing a list of dental-related services, with dental codes (from CDA or other sources);
  • Updating reimbursement rate information from external sources
  • Interfacing with your Accounting/ERP system
  • Synchronizing supplier accounts
  • Transferring invoices/claims to Accounts Payable