SHIELD

Software for Health Insurance Eligibility Detection


SHIELD enables insurers reduce the costs of health insurance claims and improve the quality of their claims adjudication process.

It is a high performance claims management solution that automatically checks invoices for medical plausibility and accuracy in real time. It works either stand-alone or can be integrated with any core insurance back-office system.

How you benefit

• Automated and consistent claims adjudication
• Lower health insurance claims costs
• Reduction of risk caused by fraudulent actions
• Improvement of claims turn-around-times and customer satisfaction

Key features

• Rule Editing Platform for creation, storage and maintenance of the medical knowledge base (rules/edits)
• Easy customization to the specific claims practices and rules of the customer
• Ability to deploy in various aspects of the claims process e.g. back-office claims/authorizations, electronic claims/authorizations as well as electronic prescriptions
• Ability to check correctness of diagnosis, procedures and drag codes
• Ability to manage complex medical rules e.g. length of stay and drug refill
• Stand-alone operation as well as Integration with any core insurance back-office system

Key benefits

• Automated and consistent claims adjudication
• Lower health insurance claims costs
• Reduction of risk caused by fraudulent actions
• Improvement of claims turn-around-times and customer satisfaction

Key features

• Rule Editing Platform for creation, storage and maintenance of the medical knowledge base (rules/edits)
• Easy customization to the specific claims practices and rules of the customer
• Ability to deploy in various aspects of the claims process e.g. back-office claims/authorizations, electronic claims/authorizations as well as electronic prescriptions
• Ability to check correctness of diagnosis, procedures and drag codes
• Ability to manage complex medical rules e.g. length of stay and drug refill
• Stand-alone operation as well as Integration with any core insurance back-office system