Insurance claims, organized from care to reimbursement.
eMedicVerse helps facilities prepare, review, track and follow up insurance claims across public, private and corporate payer workflows.
Work with the payers your patients use
Capture payer details at reception, connect covered services to the patient visit and maintain organized claim records for review and submission.
NHIF
Support member verification, covered-service records, claim preparation and facility claim follow-up workflows.
Jubilee Insurance
Organize outpatient and inpatient claim records, approvals, referrals and payer documentation.
Britam
Maintain complete service, billing and supporting-document records for medical insurance claims.
Private insurers
Configure workflows for additional insurance companies and facility-contracted health schemes.
Corporate schemes
Manage employer-sponsored patient visits, agreed benefits, billing and service utilization records.
Self-pay top-ups
Record patient cash or electronic top-ups where insurance cover does not fully meet billed charges.
Bring every claim step into one clear workflow
Follow care services from eligibility checks through quality review, payer submission, response tracking and re-claim follow-up.
- 1 Verify patient and payer details
Confirm patient identity, membership information, payer plan details and applicable authorization requirements.
- 2 Capture covered care services
Link consultations, medicines, laboratory work, diagnostics, procedures and admissions to the patient visit.
- 3 Prepare the claim record
Compile eligible services, charges, clinical documentation and supporting information into an organized claim.
- 4 Run quality assurance checks
Review completeness and consistency before submission, then flag exceptions for correction by the responsible team.
- 5 Submit and track payer feedback
Record submissions, responses, approvals, pending items and payer decisions in one traceable workflow.
- 6 Resolve rejections and re-claim
Capture rejection reasons, correct the required information and prepare eligible claims for re-submission.
Review claims before they become costly rejections.
The Quality Assurance workflow gives your team a structured place to inspect claim records before submission, flag missing information and organize rejected claims for correction and re-submission.
- Review patient details, payer information and service records.
- Verify clinical services, medicines, diagnostics and charges.
- Track pending, approved, rejected and re-submitted claims.
- Analyze rejection reasons and assign follow-up actions.
Support claims across facility services
Maintain clearer documentation for outpatient, inpatient, pharmacy, laboratory, diagnostic, procedure and other covered service records.
Outpatient claims
Consultation, diagnosis, medicine and outpatient service records.
Inpatient claims
Admission, ward, treatment, discharge and inpatient billing records.
Pharmacy claims
Dispensed medicine, quantities, batches and prescription-linked services.
Laboratory claims
Requests, samples, results and diagnostic service documentation.
Radiology claims
Imaging requests, investigation records and reporting workflows.
Procedures claims
Procedure records, theater activity and supporting clinical documentation.
Make claim operations easier to manage.
Bring patient services, payer details, quality review and claim follow-up into one connected facility workflow.