Introduction

The Osigu Claims platform is designed to streamline the authorization and claims processes for healthcare payers and providers, ensuring seamless collaboration, operational efficiency, and real-time communication. By integrating with Osigu, payers can automate claim validations, enforce business rules, and ensure compliance, while providers gain access to tools for submitting, tracking, and managing authorizations efficiently.

Benefits for Payers

Osigu simplifies claims management for payers by providing powerful tools to automate and optimize authorization workflows. Key benefits include:

• Real-Time Validations: Automate checks for policy status, eligibility, and medical appropriateness in seconds.
• Custom Business Rules: Configure rules to match your specific operational needs, including fraud prevention, medication substitutions, and manual review protocols.
• Streamlined Communication: Receive notifications for all key events (authorizations, cancellations, dispensations) via webhooks or other integration methods.
• Comprehensive Reporting: Gain insights into claims activity with transaction and settlement reports, ensuring financial and operational transparency.

Benefits for Providers

For healthcare providers, Osigu enhances the claims submission and authorization process, reducing administrative burdens and accelerating workflows. Key features for providers include:

• Simplified Authorization Requests: Submit authorization requests through the web portal, REST API, or pre-configured widgets.
• Beneficiary Verification: Instantly validate patient eligibility and policy coverage during the claims submission process.
• Authorization Management: Track the status of authorizations, view results, and access all associated documentation in one place.
• Seamless Dispensation Reporting: Report dispensed products or services directly to payers, ensuring accurate and timely claim settlements.

Key Features of the Claims Platform

The platform is built on robust features that facilitate the end-to-end claims and authorization process:

1. Authorization Creation:

   • Automate the issuance of authorizations for medications, lab tests, imaging, and other healthcare services.
   • Leverage real-time validation protocols for accuracy and speed.

2. Authorization Dispensation:

   • Manage the reporting of dispensed services or products and ensure compliance with payer requirements.
   • Validate transactions and track financial settlements.

3. Webhooks and Notifications:

   • Stay informed with real-time updates on claims and authorization events.
   • Integrate seamlessly with your systems using Osigu’s webhook infrastructure.

4. Flexible Integration Options:

   • For payers: Utilize webhooks, REST APIs, or consolidation files for integration.
   • For providers: Submit claims via API, web portal, or custom widgets.

Why Choose Osigu Claims?

The Osigu Claims platform is built to address the challenges of traditional claims management, delivering a streamlined, efficient, and transparent experience for both payers and providers. With real-time automation, flexible integration methods, and robust reporting tools, Osigu Claims ensures faster authorizations, improved collaboration, and better outcomes for all stakeholders in the healthcare ecosystem.

Explore the following sections for detailed guides and API references to get started with Osigu Claims.