Healthcare Claims Processing Software

Improve financial performance with clean, data-driven, and automated medical claims management. Automatically check that each claim is error-free before it is submitted. Eliminate the time-consuming, costly rework typically associated with claims management. 
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Rules Based

Yoroclaims uses the Yororules to bring the rule authoring an effortless task for even a non-technical person.

Cloud Native

Cloud is a basic standard, and Yoroclaims is cloud-native that runs in any cloud, hybrid cloud, or on-premise deployment.

Big data

Claims processing has been traditionally slow because of the data involved. Significantly, the history data for various history-based editing.

Yoroclaims allows providers to enroll in the program, update enrollment information, and verify patient eligibility. Therefore, Yoroclaims makes it easy to submit a claim online and know almost instantly if it is approved for payment. Additionally, providers can request service authorization ahead of time. A beneficiary can inquire about their coverage, eligibility status, and service authorizations. At the core of Yoroclaims provides claim, member, and provider management.  
Yoroclaims architecture followed the Micro-services architecture and was orchestrated through API Gateway. Developing loosely coupled components separates everyday activities, tasks, and business events into standard reusable components. The API Gateway is the core service mediator for a successful MITA architecture implementation.  

API Gateway and Micro-services are flexible in integrating the system with external sources or COTS products and security management. Each component interacts through API Gateway/Service Discovery, and all the interfaces follow the standard (X12).

Application is engineered to interact with legacy or public administrative sources to facilitate data migration and other necessary data sources.  

Key Features

Yorosis’s claim processing software centralizes processing for enhanced accuracy and speed. It simplifies processes for insurers, saves operation time and cost, and increases efficiency. Deploy Agile and fully-automated claims processing system to maximize ROI.

Support for multi-source claims (via EDI, mail, fax, web, web services), provider enrollment, prior authorization entry via multi-channel, and flat file

A proven technology platform with extensive throughput of claims processing based on our big data implementation

Efficient, accurate, and timely claim processing for providers and beneficiaries

Highly automated on healthcare policies by reducing the claim resolution process

Integrated machine learning techniques to guide and help automate across systems

Post-payment and pre-payment detection capabilities to analyze past incidents and automate claim payment

Customer controlled and configurable business rules engine

Reduce claims costs and risk through proactive detection, recovery of claims payments

Developed on NoSQL MongoDB for any big data systems. The system Scales Out rather than the traditional RDBMS way of Scale up

Built for Cloud Deployment – As needed, it can scale out on the performance without any code changes

Improve customer satisfaction and retention by making it easy to provide detailed and sophisticated analytic assessments of the claims

A complete modern web based healthcare claims processing architecture