Medicloud has completely automated our operations. We've reduced staffing needs and significantly streamlined our workflows—it's been a game-changer for our business
Benefits
Medicloud CBA simplifies and automates health insurance operations, improving efficiency, reducing manual work, and enhancing collaboration between insurers, healthcare providers, and enrollees.
Automate the entire insurance lifecycle
Improves operational accuracy and transparency
Reduces staffing requirements
Customizable to different HMO needs
Integrated notifications and alerts
Key Features
End-to-end HMO automation that manages enrollment, claims, payments, and reporting—all in one secure platform.
Claims Adjudication & Member Management
Efficient claims processing is at the heart of Medicloud's Core Business Application. With its rule-based adjudication engine, the system automatically verifies eligibility, applies plan-specific logic, and flags anomalies in real-time, reducing fraud and speeding up turnaround time. Enrollees are also easily managed through unique ID systems, renewal notifications, and detailed audit logs, ensuring data consistency and compliance.
This feature ensures transparency between HMOs and healthcare providers while improving the overall claims experience for all stakeholders. Administrators can monitor processing stages via dynamic dashboards and resolve discrepancies through an intuitive user interface, which reduces staffing costs and accelerates service delivery.
Customizable Portals & Mobile App
Medismarts offers tailored experiences for providers, HR teams, administrators, and enrollees through secure, role-based portals and a mobile app. From eligibility checks and claims submissions to onboarding and HR management, every stakeholder gets access to relevant tools available anytime, anywhere.
These self-service portals reduce support overhead while empowering users to interact directly with the platform. Clients can also customize the interface to reflect their brand and workflows, offering a cohesive and responsive user experience across all devices.
Integrated Notifications & Dashboards
The platform delivers automated notifications via SMS, email, and in-app alerts to keep all stakeholders informed at every step?whether it?s a pre-authorization approval, claim submission, or plan renewal notice.
These notifications are not only timely but also customizable based on business rules.
Real-time dashboards complement these notifications by providing data visualizations for claims volume, client activity, premium collections, and SLA performance. These insights support decision-making and enable proactive management of both administrative and clinical workflows.
One Platform.
Multiple Solutions. Unmatched Efficiency.
Medismarts delivers powerful, integrated digital solutions that streamline operations across the entire healthcare value chain—from insurers to providers and patients. Our goal is simple: transform healthcare management through smart technology that drives automation, insight, and growth.
Medicloud Core Business Application (CBA)
The Medicloud core business application is an end-to-end enterprise solution that is built to manage the day-to-day operations of health insurance. The application is integrated with additional platforms such as the provider portal and mobile application to ease communication, health record sharing, and approvals with providers and enrollees.
