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 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
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
Option to change Insurance/Group/Plan under the same
Give proper title to text boxes used to saving activity.
Change color to readable color in table contents of
diagnosis, activity & claims.