nasNtouch is a complete ERP solution for managing NAS's Health Insurance business.

nasNtouch is a suite of modules that manage core business processes, such as;

• Entity Setup
• Healthcare Provider Setup
• Product Setup
• Policy Administration
• Authorization Processing
• Claim Processing
• Finance
• Payment Order
• Reporting

Entity Setup :

• Manage entities (Service Provider/Payers/Distributor/Treaties)
• Manage agreements b/w entities
• Manage accounts / misc applicable fees / refund setup
• Manage Insurance Card Type/License/Logo etc

Healthcare Provider Setup :

• Manage Provider Groups & Providers (Clinic / Pharmacy / Hospital).
• Manage provider network / services / standards / schedules.
• Manage provider agreement.
• Manage professionals (doctors).

Product Setup :

This module help to create different types of insurance product (Group/Individual/Travel/Domestic) by using parameters like premium mode, currency, Regulator, Age definition etc.

Policy Administration :

Fully dedicated module to assist production team that assist customers in their policy administration tasks that include census management, incorporation of policy terms on the system and generation of members’ cards. User manage their endorsement requests for additions, deletions, corrections, and category changes.

Authorization Processing :

This module handles the authorization request received from providers by checking drugs' coverage / benefits / plan limits and others conditions relevant to patient's health insurance plan in real time, auto process 75% pharmacy requests. System also creates manual authorization.

Claim Processing :

This module handles the network / reimbursement claims.

Finance :

This module manages the bank, currencies etc.

Payment Order :

This module help to generate payment order for reimbursement & network claims.

Reporting :

This module allows the NAS staff and our clients to generate different reports like active members list, claim list, price list etc.

This cloud application is an advanced version of PBM Application (Pharmacy Benefit Management System) which provide an interface between our clients (Insurance companies & TPA) and pharmacies in Abu Dhabi & Dubai to manage the pharmaceutical approval better and in real time. This application also process the ePresription (eRx).

This cloud application is ideal for those clients who don't want capital investment in hardware and infrastructure, however, can deploy at client premises also.

PBM Connect automatically check for coverage of drugs, benefits and plan limits and others conditions relevant to patient's health insurance plan.

key features of PBMConnect :

• Manage the real-time transaction between the pharmacy and insurance company / TPA.
• 75% auto process pharmacy approval requests.
• Process the ePresription received from Dubai Physician in real time.
• Provider / Network / Member eligibility check.
• View patient history
• Create Manual Authorization
• Print Manual Authorization & send to Health Provider by system integrated messaging system.
• SMS notification to the patient for approval status.
• Exposed web services to transfer authorization data from PBM Connect to client's internal system.

Medically adjudicate all the pharmaceutical approval request for ;

• Drug - Age
• Drug - Gender
• Drug - Drug Interaction
• Drug - Disease Contraindication
• Drug - Disease Indication
• Duplicate Therapy

Applying approx 45+ business rules of different categories and client has full control of switch off / on any rule and also fully customizable from the client level to Payer / Policy / Category level.

Below are top-level rule categories available for customization;

• Eligibility
• Coverage
• Healthcare Provider [Pharmacy stopped / system not able to identify drug price etc]
• Exclusion [Drugs / Diagnosis]
• Medical [Duplicate Therapy etc]
• Submission [Professional stopped / eRx number missing etc]
• Cost [Maxiumu request cost exceeded etc]
• Quantity
• Duration

This is a standalone application for pure Medical Adjudication of Pharmacy request. This Engine can integrate with any pharmacy approval / claim processing system. We build this application on the top of FDB (First Databank - https://www.fdbhealth.com) API and daily its process more than 30, 000 pharmacy requests.

Easy to use integration process make it simple to integrate with any pharmacy approval/claim system for medical adjudication. Currently, this Engine is not only used by our Internal applications but also used by our clients (TPA / Insurance companies) for medical adjudication.

key features of PBM Engine :

• Drug - Age [eg. Medication is not appropriately prescribed given the patient age]
• Drug - Gender [eg. Medication used exclusively \ likely for the other gender]
• Drug - Drug Interaction [Strict \ Moderate \ Severe Interaction]
• Drug - Disease Contraindication [Absolute \ Relative \ Warning Contraindication]
• Drug - Disease Indication [eg. Medication to diagnosis is inconsistent]
• Duplicate Therapy

This is an online Web based Health Insurance portal used by 2000+ of Health Service Provider (Pharmacy / Polyclinics & Diagnostics Center / Hospital) all over the Gulf. Provider can submit approval request, their medical claims, check their account status. On the other end, the Medical Claim Center can view the request of Provider and send back the approval / rejection or can communicate with them by messaging system. It also includes notification system (E-Mail, SMS), E-Claim generation etc. This application is more than a complex banking application.

Our new ERP solution nasNtouch replaced this system.

As part of the OpenJeT V-II project, the inHealth team requested a web service that utilizes the member's Insurance Card or Emirates ID to check for a member’s insurance information (Eligibility). .

The web service is to be used by providers to check the insurance coverage information for patients before proceed any treatment. The insurance information will be pulled from the central database of NAS.

This is an online Web based portal for issuing the Health Insurance Policies for citizens of GCC and also the expatriates.

In the emirates of Abu Dhabi & Dubai, provider (Pharmacy / Clinic / Hospital) submit their approval request in the form of XML file to the central data repository of Health Authority of Abu Dhabi (HAAD) and Dubai Health Authority (DHA) which called Post Office.

This Windows Service application is responsible to download the authorization request from the Post Office and store in the concerned database schema. Once the authorization request processes, application generate the xml file from the data and upload back to the post office..

Normally, if the authorization request is auto process, authorization cycle completed within one minute.

In the emirates of Abu Dhabi & Dubai, provider (Pharmacy / Clinic / Hospital) submit their claims (eClaim) in the form of XML file to the central data repository of Health Authority of Abu Dhabi (HAAD) and Dubai Health Authority (DHA) which called Post Office.

This Windows Service application is responsible to download the eClaim from the Post Office and store in the concerned database schema. eClaim engine & nasNtouch application take care the rest of the process.