Members who are not who they say they are
Cards are shared, dependants age out, terminations arrive late, and the claim is already paid.
MedicalBytes administers health risk from the moment a policy is signed to the moment a provider is paid. Nothing enters the chain unverified, and nothing leaves it unrecorded.
Built for the organisations that carry health risk
Very little of the loss in a health benefit pool comes from one dramatic event. It accumulates a few percent at a time, in places that are individually defensible and collectively expensive.
Cards are shared, dependants age out, terminations arrive late, and the claim is already paid.
Sub-limits kept on spreadsheets, so the limit becomes known only after it has been exceeded.
Every manual capture is a transcription risk, a payment delay and a dispute waiting to happen.
Two assessors, two answers, and a variance nobody can price, defend or explain to a regulator.
The design principle behind every feature: capture data once, at source, verified; validate it against rules held in one place; then let every later decision be made automatically from that trusted data, escalating to human judgement only where judgement genuinely adds value.
How the chain worksFrom the moment a member presents to the moment a provider is settled, MedicalBytes keeps every record, rule and receipt in one place, and every decision inherits verified data from the step before it.
Fingerprint or face verification at the front desk, matched against the enrolled member register.
Cover, clinical appropriateness and affordability settled up front, automatically where the rules allow.
Paper, PDF, photograph or electronic feed converted into clean, coded, validated structured data.
The full rulebook applied per line, then a reconciled payment run with approval ceilings enforced.
Trust is not a badge on a website. It is a process behind every encounter: identity verified at source, entitlement resolved from one rulebook, and a decision on every claim line that can be traced back to the rule, the version and the user that produced it.
What the chain records
IllustrativeTariff sets, scheme rules and provider contract terms are loaded per client, so the engine adjudicates against your rulebook, not a generic one.
The same chain, entered from three directions. Each stakeholder gets the control they are accountable for, and none of them has to trust a number they cannot trace.
Administer more lives with the same desk.
Know you will be paid before you treat.
See the risk while you can still price it.
Give us a set of real claims and we will run them through the engine line by line: identity, entitlement, authorisation, coding, adjudication and settlement.
Tell us what you want to see and we will reply within one business day.