INTRODUCTION:

Aafiya is a specialized Healthcare Management service provider in UAE, which works together with their partners to provide high quality health care for their members. UAE have health regulation for every visa holder compulsory by the government.

OBJECTIVE

  • Finding a right balance b/w Cost and Healthcare services.
  • Remain Competitive and understand the need and expectation of healthcare industry.

THE SOLUTION

Badri proposed a solution using BI tool to make above goals achievable and a couple of customized dashboards are designed for Aafiya according to their requirement in order to optimize their performance by managing claims, by focusing on approval process, identifying risk and less profitable clients and reduce claim cost. By keeping facts and figures in mind TPAs can take informed decision.

Badri provided them Management, Approval, Claim, Production and Trend Dashboard and gave access to them for Self Service BI.

MANAGEMENT DASHBOARD:

Helps to empower high level management to get overall picture of the organization, to identify business opportunities, business trend over the past few years, Loss ratio and sales by company and size of business, Reveal loss pattern, High bleeding areas. Optimize sales by keeping an eye on performance. Managers can target and focus to make informed decision based on given KPIS.

CLAIMS DASHBOARD:

Is one of the detailed dashboards that is really useful for Claim Management and can help to improve its strategies for Claim payment. Analysis of rejecting claims Tracking batch and registered claims. Lag Calculation. Helps management in maintaining sustainability in future.

APPROVAL DASHBOARD:

Helps to identify Approved amount or approved claims by Request Nature and With Emergency and Non-Emergency Tag? Monitor average TAT spent for IP and OP with Emergency or Non-emergency Tag.

PRODUCTION DASHBOARD:

Pendency Report Payer wise, Details of Retention, Addition and Cancellation of Policies, Classification of Group and Individual Payer wise.

TREND DASHBOARD:

Business Outcomes

Right decision at right time:

Portfolio Monitoring and claims control:

Retention of Clients:

Expedite process:

Self Service BI: