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SATAOnline

for Health Insurance

Simson

SATA (TPA-Third Party Administrator)

“SATA” is a comprehensive health insurance agency management software for third party administrators & insurers for health insurance policy and claims management, hospital network, analysis, accounting as well as 360° reporting to TPA, Insurers, Hospital, Corporate, Individuals, Brokers & Agents.

Developed in year 2005, SATA has gone through various functional and technological revolutions. Around 8 million lives covered and more then 110,000 claims handled.

It is a web based application, which is integrated with TPA website so external users like Hospital, Corporate, broker, Agent and customer can view their various status and reports from the website login section.

It can notify your policyholders about policy renewal date and even send SMS if a policy is terminated.

It can manage all policy details received from insurers, preparation of ID cards, tracking of ID cards, dispatches of the cards, endorsement of employees and import policy data from excel files.

Our health insurance management system maintains the record of network hospitals which includes hospitals detail entry, tracking blacklist hospitals, record details of discount offered and claim analysis.

Using our health insurance software solutions, you can manage all aspects of your health insurance claims, including Health, Scrutiny, Billing, Settlement, preparation, and dispatch. Our software for health insurance manages receiving claim intimations and preparation of check list for scrutiny department.

Some of our key clients : Ericson TPA Healthcare Pvt Ltd Mumbai and Happy TPA Limited Kolkata.

  • SATA is the kind of ERP solutions for third party administrators for claims management, analysis, accounting as well as 360° reporting to TPA, insurers, hospital, corporate, individuals, brokers & agents.
  • SATA is a web based application, which needs to hosted on web server and it has to be integrated with TPA website so external users like hospital, corporate, broker, agent and customer can view their various status and reports from the website login section.
  • SATA software is the key piece to insurance company’s competitive Edge that is catering various aspects of health insurance policies for group and individual policyholders. It can notify your policyholders about policy renewal date and even send SMS if a policy is terminated.
  • Our health insurance software is helpful to manage all policy details received from insurers, preparation of ID cards, tracking of ID cards, dispatches of the cards, endorsement of employees and import policy data from excel files.
  • SATA health insurance software maintains the record of network hospitals which includes hospitals detail entry, tracking blacklist hospitals, record details of discount offered and claim analysis.
  • It is specially developed to manage all aspects of claims related to health, scrutiny, billing, settlement, preparation and dispatch. Our software for health insurance manages receiving claim intimations and preparation of check list for scrutiny department.
  • This product is being used by safeway TPA services (p) limited, ericson TPA healthcare pvt. Mumbai, padre pio insurance service uganda.

Some of the key features of SATA are:

  • Comprehensive policy data management
  • End to end claims management starting from intimation of claims to the reimbursement of payments to insured or hospitals.
  • Comprehensive accounts management through our multi-currency financial accounting system SiFAMs.
  • Inbuilt document management of soft files. complete file processing electronically if required.
  • Integrated SMS and email management. Sending emails and SMS at various steps to insured.
  • Flexibility of customization to suite your requirement and changes requested by growing business process, insurers, regulators etc.
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  • SATA has been build using microsoft .Net framework 3.5 technologies using C#.
  • Microsoft SQL server 2008 is being used as database in all of our applications, Which is one of the most trusted database in the world.
  • SAP crystal report 2008 is being used for reporting in SATA applications which helps in making more versatile reports for user.
  • XML is also being used in business intelligence section to generate various reports.
  • This module is for processing of data received in hard or soft form from insurers. key functions in this module are:
  • Import of policy data to SATA either by manual policy data entry or import through excel or CSV files.
  • Scanning of photographs for ID cards or real time smart card preparation.
  • Preparation of ID cards and delivery of the same to insured.
  • Endorsement of employees or insured, manually or through excel/csv files received from insurer.
  • Attachment of files or data received from insurer to a policy.
  • Renewal tracking of the policy data.
  • Ensure proper availability of data to claims department as and when required.
  • One of the primary job of TPA is add good hospital to its network, who can provide best treatments on best rates benefiting insured and the insurer both. Key function in this section are:
  • Registration of hospital to SATAOnline.
  • Maintaining packages and rates offered by hospital.
  • Maintaining discount, credit limits, and other terms and conditions mutually set with the hospital.
  • Management of fee or security collected or remitted by or to hospital.
  • Process in this section starts when an intimation / information or file received for claim. key functions here are:
  • Generation of claim ID for a claim.
  • If type of claim is cashless then pre-authorization of funds for networked hospitals based on balance sum insured, disease or package requirement, policy conditions, claim history etc.
  • Receiving of bills, and other documents required for processing of documents.
  • Attachment of bills and other documents collected from insured or hospital to SATA through scanning.
  • Forwarding the claim file to scrutiny department.
  • In today’s scenario when incident of manipulation and frauds are increasing, importance of scrutiny department became more significant. Key functions in this section are:
  • Preparation of check list for scrutiny of claims.
  • Auditing of claims documents, bills and other records.
  • Generating queries if any and asking for additional documents and clarifications from insured/hospitals.
  • Based on final scrutiny setting of status of claim for further action:
  • Settlement of claim: Proceed to billing and accounts.
  • Rejection of claim: Issuance of denial letter specifying the reason of denial.
  • Billing department is key department in ensuring the claimed amount passed by the scrutiny department. Key functions of this section are:
  • Billing of the claimed amount passed by scrutiny department.
  • Ensuring hecks applied in the system for various limits on sum insured, disease, packages and treatment plans etc.
  • A final check on claim papers before proceeding the claim file to accounts department for payment remittance or cheque preparations.
  • In any organization accounting is the key functions. Accounting function here can be divided into two major sections, which are:
Business accounting:
  • Integrated part of SATA for preparation of cheques/DD or remittance of funds to hospital/insured/customer accounts.
  • Management of float funds received from insurer.
  • Billing of TPA service to insurer and reconciliation of the same.
  • Receiving of the service Fee.
Financial accounting:
  • We have our own multi-currency financial accounting system SiFAMs already being used hundreds of clients.
  • It can be fully integrated with SATA to manage financial accounting to generate trial balance, P&L and balance sheet from the system.
  • Some of the key feature in support desk module is:
Call centre & File management:
  • SATA assist you in managing physical files or box files. You may keep the files and its document details in SATA and get the system generated file number.
  • Store files based on system generated file numbers.
Inward/Outward document management:
  • This section of our TPA software SATA help you in tracking of inward and outward couriers and packets from or to your office.
  • Track movement of file and find physical location of your files.
  • Manage courier company billing.
  • Analysis of inward and outward documents.
  • Ultimate thing which we want from any software is the powerful reporting system. in SATA we have three defined type set of reports in MIS section :
Management reports:
  • Internal reports for TPA management and business analysis.
  • Claim status and float status reports.
  • Various claim analysis reports.
Regulatory reports:
  • Reports required by regulators on regular interval or time to time.
Insurer Reports:
  • Reports asked by each insurer in their given formats.

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