(2) Other. Other software systems / services that your company provides. HealthCare Management Softare, Insurance UnderWriting and Claims processing Software. Systems Services. e solution related to Health care and Insurance. Has your company set up partnerships for the healthinsurance market? with health insurance Institutions?. no. with Resellers? with Consulting companies? with NGO's? with other type of institutions?. Main evolutions since 3 years Trends for next 3 years. SOFTWARE OVERVIEW. althcare and Insurance pro. State of the Art Halthcare and Insurance product development. E-M. Software versions Date of 1st release Number of releases Latest version number Number of installations latest version Number of installations previous version Date of last released version. 1-aug-10 4 1,4 3 0 31-dec-12. Type of institutions targeted Commercial Insurers. YES. Hospitals. YES. Non-profit Organizations. YES. Others. YES. Market references. 5 26 clients as of now and 1.2 million lives average per year. Number of operating clients in 2010/2011/2012 Lowest and highest number of branches within health insurance clients. 10 and 1000.
(3) Average number of branches per client Lowest and highest nb of accounts handled within clients Number of health insurance clients by country (2011) Number of ongoing installations by country. 6 million lives 3. Number of clients in 2010/2011/2012 by type Commercial_Insurers Hospitals Non-profit Organizations Other. 26 4000 0 0. Commercial offices (including resellers) Number of commercial offices Location of commercial offices. Support center (including resellers) Number of support centers Location of support centers Support center staff (number of people) Hotline Support in which languages. 0 0 0 0 INDIA 10 by e-mail. ENGLISH. Technical documentation available. YES. User documentation available. YES. User club existence. YES. Main evolutions since 3 years. World Class Datacenter, Datacenter & Server Virtualisation, Infrastructure High Avalability & Maximum Up time By DR/BCP with Latest Technologies, DMS, FAX INNTIGRATION, PAPERLESS CLAIMS PROCESSING COMPLETE PAPERLESS ENVORONMENT, SMARTCARD BASE HEALTH CAR. Trends for next 3 years Forecast features under development for the software. YES.
(4) Further innovation in pipeline for health insurance market. YES. Outsourcing. NO. All Insurance Companies related to Group, Retail & Micro. Targeted new clients for next 3 years. According to you, who are your (3 main) competitors as health insurance software editor?. CMC-CSC. Current competitors. CMC-CSC. Estimated future competitors. Table Driven, Inbuilt Capability of DMS, BPM & Data within Single Interface, Comprehensive, Felxible,Expandable, Configurable, Based on Advance Technology,. The five major strengths of your software Flexibility Consolidation / Possible network configurations Single PC. YES. Decentralised. NO. Decentralised with consolidation tool. NO. Centralised on line. YES. Centralised on line with off-line option. NO. Other. NO. Technical Deployement of software Stand-alone. YES. Client/Server. YES. ASP. YES. Web Interface. YES. Multi-Tier. YES. Delayed posting. NO. Tracking flexibility Tracks clients at different levels (individual, group, village, branch, region, institution. YES. Track current and historical client portfolio of loan officer / supervisor. YES. Multiple branches or regions Mechanisms for separating information on an office basis. YES. Presentation of financial or statistical information by branch or region. YES. Ability to neutralize inter-branches transactions. YES.
(5) Multi institutions Maximum number of accounts handled by software. YES. 1000000. Maintenance of indicator lists for selected data (like region list). YES. Is there any field that can be modified or added by user ?. NO. Multiple languages Technical documentation and user guides languages Languages available within software Can support languages on a user basis. ENGLISH ENGLISH YES. All messages are in the language of choice. YES. All screen information is presented in language of choice. YES. Multiple language support requires recoding (language is hardcode) or is intrinsic to the system (language is parameterized). YES. Statements can be in different languages? If yes, possibility to allocate a language to a client ?. YES. Ability to handle non roman scripts. NO. Multiple currencies Supports local currencies and foreign currencies. YES. Supports loan / deposits accounts and teller transactions in different currencies. YES. Supports foreign exchange exposure calculation facilities. YES. Handles maintenance of value accounts and other inflationary risk mitigation functions. YES. Possibility to add a currency. YES. Rounding Rounding per currency to fit cash constraints (5, 10, 50, 100, …), possibility to set it up by product. YES. Rounding of installment amounts (Principal + interests). YES. Provision Calculation set by ageing rules and product type. YES. Calculation modes (total outstanding, past dues only, ...). YES. Provision automatically calculated at disbursement. YES. FUNCTIONAL COVERAGE Beneficiary Management Enroll beneficiary or insured • Demographics. YES.
(6) • Financial information. YES. • Geographic information. YES. • Qualifying criteria (see qualifying conditions). YES. • Proof of identity. YES. • (e.g. national identification card, personal identification number, biometric information, photos) • Medical history. YES. • Current medical condition. YES. Assign insured to a PCP or primary care unit • insured identifier. YES (CARD NO). • Provider identifier. YES(NSP CODE). • Census. YES. • Benefit class. YES. • Benefit plan. YES. • Physical proximity (e.g. work or home). YES. • List of available providers. YES. • Family relationships. YES. • Maximum number of insured to which a provider can attend. YES. Eligibility inquiry by provider • Insured identifier. YES. • Provider identifier. YES. • Benefits class. YES. • Benefit plan. YES. • Encounter date. YES. • Insured accumulator. YES. • Demographic criteria. YES. • Clinical criteria. YES. Eligibility inquiry by insured • Insured identifier. YES. • Benefits class. YES. • Benefit plan. YES. • Date of inquiry. YES. • Demographic criteria. YES.
(7) Pre-authorization • Insured identifier. YES. • Provider identifier. YES. • Benefits class. YES. • Benefit plan. YES. • Clinical information. YES. • Supporting documents. YES. • Treatment plan. YES. • Fee schedule. YES. • Diagnosis. YES. Provider Management. criteria, provider sellection takes place and after signing SLA, provider brough into. Register/empanel provider • Provider license. YES. • Physical proximity. YES. • Qualifying criteria. YES. • Maximum number of insured to which a provider can attend. YES. • (i.e., level of services available based on staff). YES. • Provider type (doctor, hospital, health center, pharmacist, etc.). YES. • Provider banking information (e-payment). YES. Provider agreement • Provider identifier. YES. • Privacy restrictions. YES. • Fee schedule. YES. • Previous agreement/ contract. YES. • agreement template. YES. • Region of the provider (there may be rural differentials in the fee schedule) • Specialty of the provider (there may be a difference in fee amount based on the specialty). Premium collection Premium collection. YES. Premium is collected on quaterly basis from underwriting offes across country..
(8) • List of insured. YES. • Insured identifier. YES. • Sponsor classification (i.e., company, government). YES. • Benefit class. YES. • Premium rate. YES. • Payment status (arrears, current). YES. • Eligibility status. YES. Claims Management. Claims are registerd into the system from all over the branches and they process the claims in their respective region. Being claims document as digitally stored withing the system under DMS process, claim can be handled by any user sitting on processing terminal across country.. Claims Processing • Claim. LTILEVEL APPROVAL, AUDIT, FRAUD CONTROL. • Insured identifier. YES. • Adjustments. YES. • Voids. YES. • Benefit plan. YES. • Re-submitted claims. YES. • Claims-related policies. YES. • Pre- authorization match. YES. • Eligibility status. YES. • Benefit class. YES. • Insured accumulators. YES. • Co-insurance. YES.
(9) • Copayments. YES. • Deductibles. YES. • Fee schedule. YES. • Provider identifier. YES. • Provider accumulators. YES. Claims Status inquiry • Claim identifier • Insured identifier • Provider identifier • Encounter date. UNIQUE CLAIM NUMBER CARD NO NSP CODE INTIMATION DATE. Claims dispute and appeals • Claim identifier. CLAIM NO. • Insured identifier. INS CODE. • Provider identifier. NSP CODE. • Claim information. INTIMATION NO. • (e.g., encounter date, claim number) • Dispute notes. FREE TEXT. Claims adjustment and voids • Claim identifier. CLAIM NO. • Insured identifier. INS CODE. • Provider identifier. NSP CODE. • Claim information. INTIMATION NO. • (Encounter date, claim number). ?. • Claim adjustment amount. ?. • Increase of claim payout. ?. • Decrease of claim payout. ?. • Void. Accounting Payment to providers. NSP CODE WITH Bank Detail. • Financial transactions from accounts payable and receivable GL. YES. • (approved claim, adjusted claim, void claim). YES. • Capitation list. YES.
(10) • Summary of current outstanding premiums. YES. • Summary of premium amounts received to date. YES. • Summary of subsidy received from national/regional government agencies. YES. • Summary of subsidy to be received. YES. • Interest from investments. YES. Accounts receivable • Summary of current outstanding premiums. FROM ENROLMENT DATA. • Summary of premium amounts received to date. YES. • Summary of subsidy received from national/regional government agencies. YES. • Summary of subsidy to be received. YES. • Interest from investments. YES. Accounts payable • Summary of provider payments paid to date. YES. • Standard business operations (non-claim related) (e.g., utilities, consulting services, vendors). YES. • Premium refunds. YES. • Miscellaneous claims (e.g., those lost on appeal). YES. Reporting Existing operational reports. YES. Existing financial reports. YES. Existing management reports. YES. Regulatory authority reporting (Central Bank) configurable. YES. Microinsurance Key Performance Indicators. YES. User defined reports. YES. SQL QUERY SQL QUERY SQL QUERY SQL QUERY SQL QUERY SQL QUERY. Possibility to perform trend analysis / comparisons (i.e. this month vs last month, payment performance analysis ...). YES. SQL QUERY. Export utility (Word, Excel, other format,…). YES. Customized statistics. YES. SQL QUERY SQL QUERY. Additional functionalities Payment cards. core banking system. Check management. core banking system. Payment services (bills, utility management). core banking system. Money exchange service. core banking system.
(11) Credit scoring. core banking system. Customer relationship management. core banking system. HR administration Batch transfer functionality Other products and services. additional module core banking system additional module. EASE OF CONFIGURATION Configurator exists. YES. Parameterization steps. YES. Calendar (holidays / working days). YES. Configuration printing. YES. Configuration interface/ergonomy. YES. Possibility to replicate the configuration from one system to another. YES. SECURITY Audit Audit methodology. YES. Unique teller identification number. YES. Traceability of products parametrization. YES. Traceability of connections - loggings. YES. Traceability of transactions. YES. Identification Users profiles (roles and privileges). YES. Activate / deactivate a user. YES. Technology used. Accountability by transaction. YES. by consultation. YES. data collected in log file. YES. Backup management Using an external tool. YES. Internal tool: specify whether manual or automatic. YES. Automatic recovery tool. YES. AUTOMATIC AUTOMATIC.
(12) Data protection on database. YES. between remote stations. YES. on external floppies and backup cartridges. YES. LTO 4. TECHNICAL ARCHITECTURE Server requirements Operating system. Minimal configuration for 15.000, 50.000, 100.000 clients. Optimal configuration for 15.000, 50.000, 100.000 clients. Windows 2008 64 Bit Standard Edition Dual Xeon Quad Core 3.0 Ghz, 4 GB RAM, 2 * 300 GB HDD with RAID1 Database Server (Recommended IBM X3400) Dual Xeon Quad Core 3.0 Ghz, 8 GB RAM, 2 * 300 GB HDD with RAID1 Application Server with DMS (Recommended IBM X3400) Dual Xeon Hexa Core 3.0 Ghz, 16 GB RAM, 2 * 300 GB HDD with RAID1 Database Server (Recommended IBM X3650M4) Dual Xeon Hexa Core 3.0 Ghz, 32 GB RAM, 3 * 600 GB HDD with RAID5 Application Server with DMS (Recommended IBM X3650M4). Size of server application for 15.000, 50.000, 100.000 clients. Network requirements Describe the usual configuration Protocol Database requirements. N/WAN) with Minimum configuration of Layer2+ Switch Internet TCP/IP. Server 2008/12 (64bit) Standard Edition. Supported native databases ODBC, JDBC. Workstation. ODBC.
(13) Operating system. Minimal configuration Optimal configuration Size of client application. Supports Microsoft Windows XP above, Linux Ubuntu with Internet Explorer 6 above, Mozila Firefox or Google Chrome Brwoser Processor, 512 MB RAM, 80 GB HDD Processor, 2 GB RAM, 250 HDD olution So no Space required at Client side. Existing interface Excel, Word, text formats (TXT, CSV) Other. Software Programming language. SQL 2008 and Dot Net 4.0. Open source. NO. FAX VIEWER. Other integrated tools. PLANNING, TRAINING AND BUDGET System implementation Implementation methodology. YES. Describe how you build capacity at your client to replicate implementation N of one branch to other branches by itself Installation & training partners (please indicate installation and training languages where appropriate) Average implementation time (from contract signature to service launch) Quickest implementation Longest implementation. POSSIBLE AND DATA WILL BE TAGGED WITH THAT BRANCH ENGLISH 15 Day 7 Day 6 Months. Guarantee period Installation CD ROM available Software update procedure. Training. NO. On Line nt material and online training material. User training If yes, how long? Who? Cost System administrator training If yes, how long? Who? Cost. E-Meditek, Free (included in pricing).
(14) Training local IT specialist If yes, how long? Who? Cost Cost of programmer man-days for customization. 20 USD per hour. System pricing License (basis, range cost). nterprise License 200k USD. License expiry Annual maintenance fee (basis, range, % license) Cost per transaction (basis, range). 20% of base price sactions range can be from 1 usd to 10 usd. Assistance included in the initial license cost Average cost of installation, with standard training included (% license) Additional modules (not included in the standard software) - List features. COMMENTS, NOTES Questions Comments. + Travelling +Hotel Exp + Perdiem NA.