+971553270186 | +971521046832

[email protected]

Prior Authorization System

A novel method to obtain prior authorization from an insurance provider is the Cortex Prior Authorisation system.

One of the main issues hospitals, clinics, and pharmacies encounter when interacting with their insurance providers is prior authorization.

Prior permission from insurance companies is made easier for clinics and pharmacies with the aid of Cortex prior authorization. International standards are used in the previous authorisation software called Cortex. Cortex will assist doctors and pharmacists with get prior authorization for their patients using the appropriate procedure codes. An improved system for patient registration will keep track of all the patient's information, assist in creating a prior approval xml file with the correct procedure code depending on the diagnosis, and allow the attachment of supporting documentation to the xml file.

Through a webservice, the relevant insurance provider will connect, authorize the processes, and send a response with information about the prior approval, after which cortex will capture the specifics from the answer details. Additionally, Cortex will keep track of the insurance companies' response codes and permit the doctors to resubmit the request for a procedure authorization. The entirety of the earlier authorization-related activities will be stored in a database that can be used as a resource in the future. Prior authorization using Cortex can be used independently or connected with any type of clinical, hospital, or pharmacy management system. Cortex can be accessed from any location in the world because it is a web-based program. Cortex is a master-based system, thus it will guarantee that the doctors send requests without mistakes.

Features of this application:

  • It helps pharmacies to generate the Eclaim XML for claim of medicines for the Existing patients in the pharmacy.
  • It helps to generate the XML for claim of medicines for the new patients in the pharmacy.
  • The data for the new and existing patient will be saved in the pharmacy database for future reference
  • Application have masters for entering the approved drug list from ministry of health, Clinician licenses and insurance.
  • Modified Encounter Page to list out claim as per Claim Status like Not Submitted/Submitted/Rejected/Resubmitted
  • Option to submit claim in TEST/PRODUCTION mode to for testing . Once submitted as PRODUCTION can’t submit again till get a response from the provider.
  • Option for Submitting Claims will be available for Combination search via Insurance/Group, From&To Date and Status with NOT SUBMITTED.
  • Option for Re Submit Claims will be available for Combination search via Insurance/Group, From & To Date and Status with REJECTED.
  • Auto Search option with Member ID in Patient Registration Page
  • Option to change Insurance/Group/Plan under the same Member ID.
  • Give proper title to text boxes used to saving activity.
  • Change color to readable color in table contents of diagnosis, activity & claims.