Solution Summary

TOTVS solution for authorization of procedures enables agility and maximization of processes of authorization of procedures. It integrates, in a single tool, processes of reception, eligibility, medical audit and customer service center.
The release process enables user to view all beneficiaries who had service restrictions, as well as determination and description of the rule that limited automatic authorization. As support of the process of decision making, user can have a unified view of payment information, damage and patient history.
 

Processes

• Registration of processes and care units
• Maintenance of rules
• Check in
• Service request
• Workflow
• Single vision
• Medical report
• Request situation
• Account complement

Benefits

• Reduction of costs with undue services due to non-identification of beneficiaries
• Effective management of customers' contracts
• Eligibility to release services
• Reduction of costs to release services
• Management of business processes, resulting in the best control and achievement of company's targets
• Quality in the process to attend beneficiaries and in the relationship with associate members and service providers
• Reduction of variable and fixed costs
• For Patients
  • Agility attending by electronic release system
• Service Providers
  • Safety attending plan clients and receiving invoices
• Associate Members
  • Agility issuing management reports, helping the decision making
  • Safety transferring to associate members through financial-administrative reports