ENFRSW
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Who it is for

Three buyers, three problems

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 back to a rule.

  • Third party administrators · throughput
  • Providers · certainty before treating
  • Insurers and schemes · risk while it is still priceable
Who it is for

Three buyers, three problems

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.

Third party administrators

Administer more lives with the same desk.

  • Straight-through adjudication on the clean majority of claims
  • Exceptions routed by reason code to the desk that can resolve them
  • Defensible variance on every claim line, with the rule attached
  • Multi-client, multi-scheme separation enforced by access control
Talk to us about your book

Hospitals, pharmacies & clinics

Know you will be paid before you treat.

  • Biometric verification and a live benefit check at the front desk
  • Pre-authorisation decided up front, with the amount and validity stated
  • Fewer rejections at submission, because the checks ran before the visit
  • Submission tracking, remittance advice and predictable settlement dates
See the provider portal

Insurers & medical schemes

See the risk while you can still price it.

  • Live loss ratio and utilisation by scheme, client, plan and benefit
  • Leakage isolated by cause instead of reported as a single number
  • Product design evidence taken from real consumption, not assumption
  • Examinable evidence for internal audit, external audit and the regulator
Request a risk review
Our solutions

One platform, a portal for every role

Everyone in the chain 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.

Scheme & TPA console

Membership, benefits, authorisations, adjudication queues, payment runs and reporting on one floor.

Provider & pharmacy portals

Verify the member, check entitlement, request authorisation and follow an invoice to settlement.

HR portal & member app

Bulk enrolment and premium schedules on one side; a digital card and live balances on the other.
See all five portals
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.

Book a walkthrough Download the datasheet