Health insurance funds · Integrated management system
Integrated management for Health Insurance Funds
Members, providers and agreements, authorizations and audits, reimbursements, hospital stays and claims control, together with administrative, accounting and financial management, in a single web system on one database. It includes workflow, task inboxes and a web portal and mobile app for members.
- 38
- OSPF branches across Argentina, plus its head office, run on our system.
- Single database
- for members, providers, audits, payments and accounting.
- Workflow
- processes defined by the organization and a task inbox per user and role.
- Traceability
- every access, transaction and data change is logged for audit.
Advantages
A system that adapts to the fund
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Configurable
Every component is configured to the fund’s requirements: plans, coverage, agreements, co-payments and audit rules.
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Defined processes
The system follows each area’s way of working; every user operates from their task inbox.
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Security and audit
Users, roles and data-level permissions, with a log of every action by each user.
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Web access
All areas and branches reach the same system over the Internet, with information online.
Modules
Benefits, audit and administration, in one system
Fourteen modules, implemented together or in stages, according to management’s priorities.
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Members
- Personal data and family group
- Coverage plan and medical history
- Other linked health insurers
- Credit limit and member account
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Providers and agreements
- Provider registry and accounts
- Agreements: fee schedule, services and eligible plans
- Fee and co-payment calculation formulas
- Agreement history and statistical reports
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Fee schedules and services
- Fee schedule setup
- Services by group, chapter and subchapter
- Valuation components: fees and expenses
- Predefined validations and controls
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Service authorization
- Orders and authorizations
- Configurable audit requirements
- Co-payments by plan, provider, amount or percentage
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Audits
- Medical, dental, administrative and management
- Approval, rejection or observation, with reasons
- Escalation to other audit levels
- History by patient and by auditor
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Hospital stays
- Admission registration and authorization
- Follow-up record
- Extensions, transfers and auditor visits
- Current stays and history
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Reimbursements
- Reimbursement registration
- Configurable calculation formulas
- Partial settlement and debt offsetting
- Payment order generation
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Order intake and claims control
- Submissions by provider and period
- Orders by file import or barcode
- Debits and credits
- Automated administrative audit
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Pharmacy
- Sales to own members and third parties
- Agreement registry
- Integration with external validators
- Integration with ANMAT
- Purchase orders and goods receipt
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Cash, payments and banking
- Multiple cash desks: opening, closing and reports
- Settlement and approval of payments to providers and suppliers
- Bank accounts, checkbooks and checks
- Bank ledger and securities in portfolio
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Accounting, purchasing and expenses
- Automatic, manual and template entries
- Journal, ledger and trial balance
- Quotes, purchase orders and goods receipt
- Invoice control and payment orders
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Workflow, dashboard and security
- Processes, steps, conditions and roles
- Task inbox per user and role
- Online indicators aligned with the strategic plan
- Users, profiles, permissions and action audit
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Member web portal
- Personal data, family group and member card
- Request history
- Provider directory
- Consultation vouchers and branch appointments
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Member mobile app
- Medications and authorizations
- Provider directory and care centers
- My account, my plan and digital member card
- Requests, invoices and notifications
- Service validation token
- Travel assistance
Implementation
Gradual implementation, without stopping operations
In stages and in the order management decides: the most urgent or strategic first.
- 01
Assessment
Detailed assessment of all the fund’s administrative processes.
- 02
Adaptation
Adaptation of the system to the fund’s specific needs.
- 03
Validation
Validation of each subsystem with the fund’s team.
- 04
Training
Training for administrative, technical and professional staff.
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Go-live
Gradual rollout of the subsystems, without interrupting service to members.
Innovation
Automation and artificial intelligence at the service of management
We support each organization in the continuous improvement of its processes: we simplify workflows, automate repetitive tasks and apply artificial intelligence where it adds real value.
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Process improvement
Analysis and redesign of administrative workflows to remove redundant steps and shorten processing times.
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Automation
Validations, notifications, repetitive tasks and data exchange with other systems, without manual work.
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Artificial intelligence
Analysis of services, consumption and authorizations to detect unusual patterns and support audit and decision-making.
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Information to decide
Online indicators and alerts to anticipate deviations and act in time.
References
Organizations working with the system
Health insurance funds, and professional pension funds that provide health coverage to their members.
Support
Post-implementation support
Keep your system stable with our monthly support, maintenance and specialized technical assistance service.
- Expert team: professionals with extensive knowledge and technical experience who know the system inside out.
- Efficient management: every request —by phone, email or chat— logged and tracked in a structured ticketing system.
- Fast response: incidents handled within 24 hours at most, with on-site support at the fund as needed.
- Assured quality: processes audited and certified under the IRAM-ISO 9001:2015 standard.
Contact
Discover what our solution can do
We invite you to schedule a demo session to see the system running in real time. We will analyze the specifics of your fund to prepare a tailored technical and commercial proposal.
Salta AR
O'Higgins 544, Salta, Argentina
+54 387 422-8263 · +54 387 421-6090
info@digio.com.ar
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Buenos Aires AR
Av. Scalabrini Ortiz 3064, Office 14B, Buenos Aires City, Argentina
+54 11 5278-4189
info@digio.com.ar
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Lima PE
Germán Schreiber 276, San Isidro, Lima, Peru
+51 1 480-1221 · +51 947 427 003
info@digio.com.ar
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Technical support
Monday to Friday, 8:00 to 21:00 (Argentina time)
Phone lines: +54 387 422-8263
soporte@digio.com.ar