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Functions of IRIS

Claims adjudication:

Iris Health Services, a service provider for claims adjudication. Since we operate in medical adjudication, being streamlined, strategic and dependable are some of the qualities we proudly possess. We use the cutting-edge technology for our claims management, proving our worth in the market.

Flexibility: We individually cater to our high range of clients with the proven software platform.

Functionality and Technology: Since we use an online platform to store all the data and to process the claims, it has constantly helped in increasing our productivity level over the years.

 

Medical Tourism and Underwriting:

Along with claims adjudication, Iris Health Services also provide with medical tourism and underwriting for a smoother process. We provide with a one-stop platform for our clients who look for international assistance. With numerous doctors who are experts in their respective fields available around the clock for the emergency cases.

 

 Portfolio analysis and Evaluation:

Iris Health Services is able to do an analysis of the product mix to determine their capital allocation of resources in order to increase productivity. Analysis and evaluation are generally used to gain the knowledge of the market growth rate and relative market share which are both highly important.

 

Business process outsourcing: Being a third-party administrator, the claims adjudication is outsourced to us. Generally, companies with medical insurance outsource their business process to us. This is so because of our stand as the best third-party service provider.

 

Insuretech:

  • Electronic medical claims management software with features that allow providers, insurers, and reinsurers access the claims data online at their convenience.
  • Online Claims Submission portal for medical service providers for submittal of direct billing claims and for insured members to submit reimbursement claims.
  • Maintains international coding standards allowing risk carriers access to accurate claims data and trend reports.
  • Millions of inbuilt rules in the system to assess eligibility, medical necessity, maximum units per service etc.
  • An online pre-authorization module that allows providers to submit and check the status of the pre-auth.
  • Strong fraud, waste and abuse protection featured inbuilt into the system
  • Customizable reporting tool allows risk carriers review and manages their portfolio.