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TOSHFA

“TOSHFA” is a comprehensive ERP solution for Insurers & Third Party Administrators for Health Insurance Quotation Engine, policy administration module and claims management module, hospital network module, analysis module, accounting module , Reinsurance module as well as 360 degree reporting to TPA, Insurers, Hospital, Corporate, Individuals, and Brokers & Agents.

Empower Your Workforce: Connect with Ease through the Employee Portal.

Transform Your Insurance Operations with our Cutting-Edge Medical System. From Client Administration to Claims Management, Prior Approvals, and Re-Insurance Handling, Our Platform Handles it All. Enjoy Seamless Integration with Multi-Currency Support and Multi-User Access for Payers, Corporates, Hospitals, and Re-Insurers. With Individual Logins for Sales Agents and Corporate Modules for Client Management, Enroll Members, Verify Eligibility, and Process Claims Effortlessly.

Our Hospital Module and Waseel Integration Streamline Online Member Eligibility Verification, Approvals, and Claims Submission, Simplifying the Entire Process. Corporate Clients Benefit from Online Member Management, Verification, and Approval Submission, All Sent Directly to CCHI for Swift Approval.

But what sets us apart is our User-Friendly System's Tractability. Our Table-Driven Structure Allows Easy Tailoring of Operations to Suit Each Client's Unique Business Logic, All Without the Need for Re-Programming.

Enhance Efficiency, Simplify Operations, and Stay Ahead of the Curve with Our Comprehensive Medical System. Explore Our Solutions Today.

SME Portal

Discover the Future of SME Insurance Sales through Our State-of-the-Art Online Portal. Designed for Efficiency and Convenience, Our Platform Simplifies the Entire Sales Process, from Policy Enrollment to Premium Calculation and CCHI Approval.

With Seamless Integration of Yakeen Web Services, We Ensure Lightning-Fast Debit/Credit Note Generation via the Employee Portal, Saving You Time and Effort.

Moreover, Our Portal Empowers Authorized Users to Print Cards and Policy Templates with Ease, Whether Handling Individual Applications or Managing Bulk Submissions. Experience Seamless Insurance Sales Like Never Before.

Master Level Entry Data

Unlock Enhanced Data Management Capabilities with Our Medical System's Master Level Entries. Seamlessly Standardize and Manage Crucial Data Sets Including Medical Codes (ICD and Dental), Demographic Information (Territories, Countries, Cities), Provider Contracts, Insurance Plans, Client and Policy Details, and Member Information.

Effortlessly Categorize and Manage Accounts, Streamlining Main and Sub-Accounts for Clients Across Relevant Categories. Additionally, Simplify Reinsurance and Treaty Set-Up, Ensuring Standardization and Clarity in Agreements with Primary Payers.

Experience Consistency and Reproducibility Across Your System, Empowering Seamless Operations and Improved Efficiency.

Hospital Network

Provider Classification to classify the providers based on a particular
territory, grouping the providers, DB Provider to add/ edit providers, after
adding DB provider system auto assigns a doctor and can find the
doctor in doctor’s list.

The Reim. Provider Master allows to add / edit reimbursement providers.
Whereas, Provider Contract allows to provide an agreement with an
Insurer that includes various pricelists & with the type of plan (preferred
provider plan or exclusive provider plan etc.). This master also facilitates
to upload valid providers directly into the system. Prompt payments are
also available.

Quote Management System

Empower Insurance Underwriters with Our Quote Management System. Key Features Include Automated Quote Generation, Multi-Level Approval Processes, and Quotation Extension Capabilities.

Easily Issue Quotations by Uploading Member Data, Exporting for Premium Calculation, and Updating in the Quotation Screen. Streamline the Process with Technically Whet Products and Automated Options.

Efficiently Create Prospects, Define Prospect Groups, and Issue Quotations Using Pre-Defined Products and Network Plans. Stay Organized with Quotation Expiry Date Updates, Renewal Lists, and Frame Limits.

Experience Seamless Quote Management for Enhanced Efficiency Today.

Policy Administration

Policy Administration is a comprehensive table-driven architecture
that supports rapid insurance product definition along with some
reports that lets the user to generate reports on relevant data to
manage the policy transactions and complete policy life cycle
management.

This transaction facilitates to define the policy in a hierarchical
manner (Prospect Group — Prospect — Quote Creation — Quote
Conversion to Policy — Client Group — Client — Policy — Class —
Member — Upload to CCHI) which implies defining a policy (with
stakeholder calculations) for a client and thus providing class level
as well as member level benefits to the insured by freezing the
policy to carry out financial transactions on defined terms and
conditions. The following components are available in our medical
system

Approval Process

With our Medical System, healthcare providers can electronically submit pre-approval requests to payers and receive decisions in real-time. Streamline the process by defining rules for emergency/non-emergency, inpatient/outpatient services, and submit all required information instantly.

Our system ensures fast and convenient transactions, reducing errors by quickly obtaining responses or requesting additional information. Easily process online approval requests with options for Pending/Approved/Rejected/Cancelled/Second Opinion decisions, printable for documentation.

Access the 'Customer Service/Member System Info' interface to view approval and claim transactions for specific members, empowering users to raise approval requests themselves. Additionally, include provider discounts directly in policies for seamless inclusion in approval requests.

Experience Efficient Healthcare Approval Processes with Our Medical System Today.

Claim Process

Our Claim Transaction feature facilitates the creation of claim batches, organized either by hospital or policy, for formal submission to insurance companies. These claims represent requests for reimbursement of services rendered to patients, or by insured individuals, on a periodic basis. The insurer then processes and disburses the claim amount to the insured (cash claims) or healthcare providers (cashless claims) based on the terms of the member's insurance policy.

Our system enables efficient processing of claims by assessing and reviewing them at both member and class levels to determine benefits. Additionally, it supports bulk upload of claims directly, along with the provision for reviewing individual or grouped claims within a batch.

 

Finally, providers and insured individuals can track their reimbursements through detailed reports, ensuring transparency and accountability in the payment process. Experience streamlined claim management with our Medical System today.

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