With a customer base that spans Medical Scheme providers from brokers to insurance companies, Turnkey understands the nuances of running an efficient and profitable Medical Schemes business.
1. Insured schemes i.e. covers underwritten by insurance companies and administered by Scheme administrator. They include Insured binder and Insured Non-binder schemes
2. Health Maintenance Organizations schemes
3. Self funded schemes i.e. the employer sets aside a fund for payment of medical expenses and fund is managed by the company itself or by a scheme administrator.
TurnQuest Medical provides unprecedented flexibility in management of Medical Schemes. Its comprehensive parameterization enables you to manage the various business rules that form the basis of the medical schemes management and claims processing. These parameters include scheme benefits, covered and excluded ailments, drugs dosage units, drugs prices with related ailment mapping, and many more to give you solid control on your medical claims processing.
The system comprises several modules:
TurnQuest Medical Marketing
The Marketing module enables you to react to client and brokers queries in a timely and efficient manner. It deals with volume processing and allows you to illustrate "what if" scenarios that include multiple proposed alterations.
Client & Service Provider Management
TurnQuest Medical provides detailed information about your clients and service providers. Record and easily access detailed activity on every customer or service provider.
TurnQuest Medical Underwriting
The Underwriting Module supports all critical policy Administration transactions, including;
- New Policy Processing
- Deletion & Additional of Members
- Extension of cover
- Policy lapsing, reinstatement and cancellation
- Fund replenishment for self funded schemes
- Change of non-premium items
- Change of member category
TurnQuest Medical Reinsurance
TurnQuest Medical Reinsurance processing is embedded within the processing functions for underwriting transactions processing and claims processing, rather than as a separate module as seen in many systems.
This means that your underwriters and claims adjusters are always aware of the reinsurance relationship(s) that exists for a given policy and are able to make sure your exposure and recoveries are appropriately managed.
TurnQuest Medical Claims enables your claims department to have control over the claim process right from intimation to payment or rejection. TurnQuest Medical Claims is designed to allow easy search of details for the alleged claim based on scheme, member, employee or status while ensuring that processing rules and decisions can be implemented to create significant efficiencies over current work flow processes.
TurnQuest Medical Accounts
TurnQuest Medical Accounts enables your accounts department to have control over the financial transaction arising due to the underwriting, reinsurance and claims processes. It cater for the full administration of credit facilities – settling of bills and account reconciliation. The medical accounts module is fully interfaced with the TurnQuest Financials General Ledger and Cash Book for company wide reporting.
TurnQuest Medical Reports
TurnQuest Medical Reports provides statistical information for easy management and business tracking.