In our quest for powerful software solutions that are also easy to use, we have generated a “Smart Rule Engine” as the core of CGM CLAIMER ECP . This gives health payers the opportunity to incorporate their own policy rules and the contract conditions of healthcare providers into the software directly. Using modern web services, CGM CLAIMER ECP can be fully integrated into health payer’s IT-systems in an easy and effective manner. By utilizing CGM´s medical data bank, developed and maintained by CGM, health payers can access actual information that provides the ability to control their costs and processes effectively.

What are the main features?

• Online and real-time health claim verification.
• Decrease claims, increase operational efficiency.
• Claim adjudication within seconds for both outpatients and in-patients.
• Operationalized through built-in web services or interfaces at health care providers.
• Provides a structured base for decision-making systems.
• Multi-language support available.
• Modular architecture.

What does CGM CLAIMER ECP control?

Please contact our experts directly to find out more about the detailed functions of CGM CLAIMER ECP. A live demonstration will convince you of the effectiveness and user-friendliness of our newest claim management solution. Here are the main features of the software at a glance:

• Eligibility check:
  insurance company / name and surname / citizenship ID no. / age / gender
• Check of medical and administrative rules:
  age and gender appropriateness for the requested procedures / compliance to doctor’s specialty / relation of the claim to previously requested treatments / policy control / global medical rules control / medical procedure list / ICD-10 control)
• Check of insurance policy:
  benefits / limits and co-pays / special conditions such as waiting times, exclusions,… / exceptions such as exemption for certain diseases
• Check of contract conditions of healthcare providers:
  negotiated prices / principles of application and the content of the contract

Its flexible modular structure makes CGM CLAIMER ECP scalable and customizable. Multi-language support enables the software to be used generically in different countries.

CGM CLAIMER ECP is specifically designed to comply with the expectations of health payers and health care providers all over the world.