MediNEXT - AI Powered TPA/HMO/Health Insurance Software

MediNEXT is a software system for enabling third party administrators and health insurance companies manage their operations. Health Insurance is one of the largest growing industries in India as well as in other countries. It has played a vast role in developing the country economy. Earlier Health Insurance companies were providing all the services to the insured persons directly. But in the year 2001, a Third Party Administration system was introduced in India which acts like an intermediate between the Health Insurance Companies and the Insured Persons.

We have grown in the Middle East and Africa markets in the past decade with operations in the UAE after the advent of regulations in the health insurance space in the UAE with support for both HAAD/DOH/Shafafiya in Abu Dhabi and the DHA regulations in Dubai, CCHI in the KSA, etc..

Our Solution is built on the Open Source Platforms. This platform gives us the flexibility of speed, scalability, security, performance and allows for independence of hardware, CPU, platforms. Unlike .NET/Windows, our platform does not have per user license issues and is not limited to specific operating systems. The system is developed using industry standard MVC architecture using a template engine, a model, view and controller for each module and sub-module. The system is very modular and can work with any standard database system like Oracle, SQL Server, MySQL, etc.

Some modules:

  • Underwriters Policy, Insurer, Policy Collection, Data entry, Verification
  • Complete ecosystem for Insurers, Brokers, Providers, Re-Insurers, Corporates
  • Health Cards & Records Team
  • Claims Process Claim Intimation, Claim Authorisation, Automated Claim Processinig
  • Machine Learning Artificial Intelligence
  • AI Powered Claim Documents Reader
  • AI Powered, 400 Million+ Claim/Auth Processing and Fraud Prevention Rules
  • AI Powered Email Engine
  • Network Hospital and Tariff Management
  • Audit Trail
  • Accounts/Finance Module
  • CRM Team CRM Screen for any Insured
  • Reports: Required Reports (MIS Insurance, Float Report, Premium Report, Claims Report etc)
  • Document Management System
  • Workflow Management
  • Grievance System
  • Trouble Ticket System
  • Electronic Data Interchange for Approvals and Claims
  • Capitation Module for TPA/HMO
  • Corporate Customers Management
  • Correspondence Management Modules
  • Performance and TAT monitoring Modules
  • Dashboard with task push features
  • Investigation Management System
  • Auto SMS/WhatsApp/Email Notifications