Solutions by type of client
A solution tailored to every health insurance stakeholder
Complementary solutions that simplify contract management, beneficiary enrollment and medical care coverage.
Health insurance companies
ApplicationPolicyHub
Challenges
- Information on policies, beneficiaries, premiums and claims is scattered.
- Difficulty tracking pre-authorization and reimbursement requests effectively.
Solutions provided by Pether Insure
- Centralized management of contracts, beneficiaries, premiums and claims.
- Tracking and traceability of pre-authorization and reimbursement requests.
Contracted healthcare providers
ApplicationMedServe
Challenges
- Fraud risks from false declarations, misuse of benefits and unjustified reimbursement claims.
- Difficulty verifying beneficiaries’ entitlements and checking that pre-authorization requests comply.
Solutions provided by Pether Insure
- Stronger controls and information checks to better prevent fraud and abuse.
- Better traceability of services and pre-authorization requests, making them easier for insurers to verify.
Medical advisers and medical case managers
ApplicationMedLine
Challenges
- Difficulty reviewing prior approval requests and medical files.
- Possible delays in processing files and communicating medical decisions.
Solutions provided by Pether Insure
- Centralized tracking of medical files and prior approval requests.
- Organized processing of files and tracking of medical decisions.
Subscribing companies and organizations
ApplicationSelfService
Challenges
- Difficulty tracking covered beneficiaries and group contract information.
- Reliance on the insurer’s teams to access coverage information.
Solutions provided by Pether Insure
- Self-service access to contract and beneficiary information.
- Better tracking of coverage information.
Health insurance beneficiaries
ApplicationMyCare
Challenges
- Difficulty viewing information about their health coverage.
- The need to contact the insurer to report a claim.
Solutions provided by Pether Insure
- Access to coverage information from a mobile app.
- Simpler access to claim reporting and to all information related to their health insurance policy.
Beneficiary enrollment
ApplicationEnrollio
Challenges
- Difficulty enrolling a large number of beneficiaries quickly.
- Constraints linked to clients having to travel and to traditional enrollment and payment procedures.
Solutions provided by Pether Insure
- Bulk enrollment to quickly register many beneficiaries.
- Field enrollment: agents go directly to clients to carry out registration.
- Digital payment to simplify and secure the payment of contributions.
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