Insurers & HMOs - Heala Tech

Connect Members, Providers, and Claims in One System

Manage consultations, medications, diagnostics, medical records, and claims processing in one connected system.

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Harness the power of our connected health operations platform without disrupting your existing systems.

Member & Patient Management

Manage member and patient profiles, coverage, clinical history, eligibility, and service activity from a single source of truth.

Plans, Benefits & Care Programs

Configure benefit packages, pricing, exclusions, authorization rules, care workflows, and renewal logic.

Claims & Service Processing

Automate claims submission, validation, adjudication, approvals, reimbursements, and related care transactions.

Provider Network Management

Manage hospitals, clinics, labs, and pharmacies, including tariffs, service rules, accreditation, and performance insights.

Authorisations, Referrals & Utilisation

Digitise referrals, pre-authorizations, care pathways, and utilization review with real-time decision support.

Billing, Capitation & Payment Operations

Automate capitation, invoicing, fee-for-service billing, reimbursements, and provider settlement cycles.

Frequently Asked Questions

Who is this system designed for?
The system tis built for insurers, HMOs, TPAs, hospitals, clinics, and health networks that want to manage members, care workflows, claims, and provider operations in one connected system.
Do we need to replace our existing software to use Heala?
No. You can integrate Heala with your current tools and start by automating specific workflows such as claims, authorizations, or enrollee services. Full replacement is optional and can be phased over time.
Can we start with one module and add more later?

Yes. You can begin with the areas that matter most, like claims automation, member management, or provider payments, and then roll out additional modules as your operations evolve.

 

How long does implementation usually take?

Timelines vary based on scope and integrations, but many teams go live with core workflows in a few weeks. More complex, multi-entity deployments may take longer and are planned with you in advance.

How does Heala handle data security and privacy?

Heala uses secure, encrypted connections, strict access controls, and best practice governance for health data. We work with your team to align on policies and ensure compliance with local regulations.

Ready to get started?

Get started today and take the first step towards revolutionising your healthcare delivery!

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