BI in healthcare

BI well-being in the healthcare sector

PBT Insurance Technologies is a PBT Group subsidiary that provides software package solutions for the medical administration market.

With substantial experience in providing solutions and services to leading medical aid firms, PBTit has developed a professional service offering that addresses the particular specifications of the healthcare industry.

Maintaining a reputation for economically producing the desired results, has led to PBTit being recognised as a foremost provider of medical aid software solutions and products.

PBTit’s medical fund and managed care solutions consist of user-friendly, parameter-driven design, providing high levels of flexibility. This enables fast reaction to market changes with minimal effort and permits rapid adoption of new business opportunities.

PBTit products

I² / iMed

The i² application is designed to support the configuration and administration of multiple medical funds with different rule sets, an unlimited number of products, benefit limits and pricing structures per fund, on a single platform. i² is a technically robust solution that can easily be modified or enhanced to meet the client’s specific needs and provides seamless integration into the existing or preferred financial system.

Products include:

  • i² Business Solutions Platform
  • i² Healthcare Management System
  • i² Healthcare Analytics

Key technology services

Real-time claims processing

i²’s on-line, real-time claims processing function provides an environment that ensures consistency and accuracy in the processing of all disciplines. The handling of claim documents, pre-authorisations, inclusions, exclusions, disease management and clinical auditing are integrated into this process.

Query management

i² provides powerful query capabilities which enable the prompt and accurate handling of queries. In addition, access to full payment records is available.

Membership and contribution management

i² makes provision for automated member eligibility adjustments. These adjustments are immediately and automatically applicable to all claims, including those already paid.

Advanced medical savings account management

i² supports new generation medical fund products and provides advanced support for savings account management, empowering the member to effectively manage their own savings account.

Episode and disease management

Making provision for the full control of disease management, i² ensures that the controls are integrated into the claims process and that the fund does not incur any unnecessary costs. Should the member exceed an authorisation or limit, claims and clinical audit personnel are alerted accordingly.

Provider management

i² includes the full set of practitioner data as supplied by the Board of Healthcare Funders. The solution also makes provision for an internal classification to assist with reporting and benefit calculation.

Security control

i²’s advanced security control enables the user to easily set up access on various levels within the application and its functions.

Document management (supports client service)

i²’s document management supports the access to and retrieval of documentation (e.g. various file formats and faxes) according to practice, member, group or claim. This contributes to improved client service.

Auditable electronic data interchange (EDI)

A fully integrated electronic data interchange (EDI) ensures rapid claims processing, enabling staff to deal with more complex claims. The EDI facility provides a comprehensive reconciliation of received and processed data.