On the one hand, the range of actors in the complementary health insurance service chain, which includes a diverse range of stakeholders from different areas, such as healthcare, businesses, banking network, insurance, and persons, and the need to create ease, and on the other hand, the need to create the ease and speed of service delivery, in the event of damage that in this insurance branch means the occurrence of a variety of diseases for the insured, which is the final consumer of health insurance services, have changed the health insurance services complex to on the most complicated and costly insurance branches.
Therefore, Toranj has carried out to design and presents a software package entitle with RASA, which has become the center of the health insurance services to its beneficiaries, especially insurance companies, and while communicating with the various health insurance beneficiaries, each of them uses RASA capabilities based on the role and position they serve in this chain.
Advantages of RASA:
Increasing services quality
Integration between health provider network and insurance companies
Increasing monitoring and controlling the quality of services
Enhancing the provision of insuring services
Financial & operational transparency
Comprehensive health service
Decreasing the costs of service management
the main need, service integrity
According to identified requirements in complementary health insurance service chain, the service structure of this insurance category is defined in a 3-part framework:
Service of claim estimation
Health provider network(RASA system)
Using RASA can be effective on solving the existing issues according to the following considerations:
Systematic communication of health care provider with the insurer will minimize the unnecessary visits of insured to the branches.
Due to the electronic record of claim files, administrative procedures are accelerated and the process is carried out more agility.
By activating the RASA communication capability with HIS system of health care provider, the need for re-registration of information in the system is solved and avoiding rework results in saving time and cost.
By providing clearance in the process and possibility of receiving
performance report of insured operation, health provider network and claim estimation, the possibility of fraud detection and prevention of financial abuse is provided.
These services serve as an advantage in a competitive market and with acceleration and facilitation of giving services to insured, Insuring entities are more interested in choosing insurers which provide these services.
By detecting fraud, the field of providing more flexible insurance products, such as the sale of individual life insurance, is provided.
This system can be accessible for users by the minimum communicative necessities and provide different advantages for beneficiaries that is specified as follows:
Saving time and cost of insured
Increasing insured satisfaction and insuring entities from received services
Agility of the processes
Decreasing final costs of providing services through ICT-based solutions
Preventing Financial Misuse
More expressive than RASA
RASA can create possibilities and proper features for managers, experts and users through side systems which includes as following:
Smart claim payment
Besides the possibilities and RASA software features, Toranj provides the following services which is a complementary of RASA services and part of
TPA (Third Party Administration) service complex :
Data analysis services and consulting in identifying fraud patterns
Data analysis services and consulting in providing solutions to improve final customer services
Services of consulting in designing new products of health insurance
Services consulting in supply chain management of health insurance
Toranj designed ITIL (Information Technology Infrastructure Library) based support services for delivering the best and sufficient service.so provided
videos: Training videos that observable online from different part in the system.
local courses: online exam and certifying users in direct panels
. 7*24 service desk which is single point of contact for all channels
. Ticketing system integrated in RASA
. Technical support which divided in 3 layers of technical teams