Available
A multitenant platform that runs the full revenue cycle for health insurers and hospitals, from enrollment to claims settlement, built to the NHIA 2025 specification.
The problem
Many health insurers and hospitals still run enrollment, preauthorisation and claims on spreadsheets, email and separate systems. Payments run late, denials are hard to explain, and nobody shares one record of what happened to a claim.
How it works
One platform shared by four kinds of organisation: health insurers, providers, employers and regulators, each with its own workspace on the same audit trail.
- Enrollment and plans: enrollee records, dependants, member cards, bulk import for corporate clients, and versioned health plans, so a tariff change never rewrites claims made under the old rates.
- Encounters and preauthorisation: a 42 step benefit check covering eligibility, facility level, quantity caps, tariff ceilings and copay rules before an authorisation code is issued, with the NHIA one hour response target tracked.
- Claims and settlement: monthly claim batches, line by line review with NHIA standard denial reasons, versioned decisions for appeals, and remittance tracking against the 60 day settlement window.
- Analytics: separate dashboards for insurers, providers and employers, covering denial rates, payment timelines and utilisation.
- Administration: branches, departments, teams and staff for each organisation, with four layers of role based access and subscription billing.
Stack
| Area | Tools |
|---|---|
| Backend | Python, Django REST Framework, Celery, Redis, PostgreSQL |
| Frontend | React, TypeScript, Vite, Redux Toolkit, MUI; Next.js for the marketing site |
| Infrastructure | Google Cloud: Cloud Run, Cloud Storage, Secret Manager, Cloud Build |