Our solutions

A portal for every role in the chain

Everyone works in the same data, scoped by role-based access control, so the provider, the administrator and the HR client are never arguing about different versions of the same claim.

  • Five portals on one platform
  • Omni-channel intake, however providers already work
  • Interfaces built and tested per system
One chain, five desks

Same record, scoped to the role

  1. 01 Scheme & TPA console The administration floor, where the book is run.
  2. 02 Provider portal Where treatment is verified, authorised and invoiced.
  3. 03 Pharmacy portal Where a script is adjudicated before it is dispensed.
  4. 04 HR & client portal Where the employer manages who is covered.
  5. 05 Member app Where the member carries the card and the balances.
Core

Scheme & TPA console

The administration floor: membership, benefits, authorisations, adjudication queues, payment runs and reporting: everything the desk needs, in one place.

Workspaces
Claims, finance, membership
Registers
Consultation and pre-authorisation
Dashboards
Per scheme, client, plan and provider
Book a walkthrough
MedicalBytes scheme and TPA console

Provider portal

Scoped to the facility

For hospitals, clinics, laboratories and imaging centres.

  • Verify the member and check entitlement before treating
  • Request and track pre-authorisations
  • Submit invoices and follow them to settlement
  • Maintain credentials, licences and banking details
Enrol your facility

Pharmacy portal

Scoped to the counter

Script-level control at the dispensing counter.

  • Member verification and chronic programme status
  • Formulary, generic reference and quantity limits
  • Real-time script adjudication before dispensing
  • Claim submission and reimbursement tracking
Join the network

HR & client portal

Scoped to your own employees

For the employer or scheme administrator carrying the payroll.

  • Bulk enrolment, endorsements and terminations
  • Dependant capture and document upload
  • Premium schedules, invoices and receipting
  • Utilisation reporting scoped to your own employees
See the HR view

Member app & digital card

Scoped to the family

The member's side of the same record.

  • Virtual, QR-coded membership card for the whole family
  • Benefit balances and sub-limits, live
  • Authorisation status and visit history
  • Nearest in-network provider by tier
Preview the member app
Integration

It has to fit the estate you already run

Intake is deliberately omni-channel, because providers will not change how they work to suit an administrator. Interfaces are built and tested per system during implementation.

How work arrives

  • Direct system-to-system integration with hospital information systems
  • Provider portal submission, with tracking and acknowledgement
  • Bulk file upload for batched claims and member schedules
  • Monitored email inbox for attachments
  • Mobile capture and scanned paper batches
  • USSD and call-centre capture for authorisation requests

What we interface to

  • Membership and policy administration systems
  • Provider and practice management systems
  • Finance and general ledger, for posting and reconciliation
  • Banking and EFT, for payment files and status write-back
  • Clinical systems, for documentation and coding
  • BI and data warehouse, for scheduled export

Integration is priced per interface and scoped in discovery, so the number reflects your estate rather than an average.

Walk your own claims

Bring a sample. We will show you the chain.

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.