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Health Insurance
Systems, Overview |
Paragon21 is a Multi Fund, Web-enabled, Scalable Health Insurance Computer System with a Relational Database Management System (RDBMS), and On-Line Transaction Processing
(OLTP) facilities.
The Paragon21 package includes a powerful Data Warehouse with reporting and interactive graphical analysis enabling users to create multiple three-dimensional colour charts from varying perspectives and drill-down capability. Paragon21 was developed and implemented in 1999 to meet the needs of the
changing face of health insurance.
The key to the Paragon21 success is the easy to learn and use modules plus the system architecture. It allows organisations to manage multiple funds, with multiple products and retail practices such as optical dispensers and dental clinics, via the traditional real-time method and via the Internet, Intranet or Extranet.
The entire system is designed around the Distributed Three-Tier Architecture and Transaction Pooling methodology.
Distributed three-tier software architecture has been adopted by Paragon21 to overcome the scalability limitations of the two-tier architecture. The third tier (middle tier Application Server) is located between the user PC and the data base File Server.
With this approach, it is possible to deploy multiple Application Servers and multiple File Servers including multiple web servers to scale the requirements of any size Health Fund, making the Paragon21 system a true cost effective scalable business solution..
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Key
Functional Areas |
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Membership Management
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The Membership Management Modules tracks applications from the first enquiry, through the quotation and approval process. These Modules eliminate and automate all the manual steps involved in calculating rates and tracking new member cases. Prospective Members or ex-Members are converted to members without the need to re-enter any information. Contact details are validated against the Australian Post 10 million postal addresses database and the correct DPID (barcode) is allocated.
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Customer Service
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The Customer Service Notes Modules have optional voice recording facilities, are used to track phone calls, customer enquiries and to place warning messages in the Members or Service Providers records. By maintaining calls information in an integrated central location, the Customer Service Modules keep support personnel up-to-date and “in the loop”. The users can also direct the Note to a supervisor or other person for action to be taken or set the note as a reminder for future action.
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Correspondence
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The Correspondence Modules allow authorised person/s to create and automatically generate customised letters for ‘member, prospective member or providers specific’ needs. All correspondence includes the corresponding DPID code (with potential postage cost savings from 5% to 50%) and is stored in the Paragon21 Database as part of the correspondence history and can be viewed, printed, faxed or emailed at any time direct from the Paragon21 workstation.
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Claims Processing
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The Claims Processing Modules provide real-time analytical assessment and administration of hospital/medical, dental, physiotherapy, chiropractic, optical, natural therapies, and unlimited types of services. These Modules include a number of customisable smart features such as “Customary and Reasonable Charges” calculation checks.
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Interface Connectivity
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Electronic interfaces such as EDI, HICAPS,
Heath-Point and THELMA are fully supported by Paragon21. An integrated Provider Payment Service via EFT and/or the Internet/Intranet/extranet is available. Interface connectivity with any Open Client or Open Database Connectivity system such as a General Ledger Package or Travel Insurance is a standard feature of Paragon21. Full integration of claims processing and member’s management with a number of Practice Management Systems developed by Network Logic is also available.
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Data Access and Reporting
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The “On Demand Knowledge” Data Warehouse stores all data elements throughout the Paragon21 System and can include information from other systems in the Fund. Analytical information such as profiles of best practice
behaviour as well as identifying providers billing patterns; member claims patterns and potential fraud activities are available. All the Legislative required reporting such as
HIC-30%-40% Rebate, PHIAC, ATO; H&AC/HCP etc are incorporated in Paragon21.
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Security and Recover Procedures
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Comprehensive security, audit trails reporting, data access and functionality restrictions based on three levels of security. In addition, compressive backup, on-site/off-site data replication and recovery procedures are standard features.
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Training and Documentation
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The documentation package includes user guides and system administrator manuals, all of which are available to authorised person, on-line, CD-ROM or on the Paragon21 Web Site. Furthermore, all user documentation is consistent with the Paragon21 Courseware and Help Screens including Question and Answer facility throughout the system.
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Print additional information |
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Click
HERE to
download and print the Paragon21 Summary Guide.
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Please Note: You will need Adobe Acrobat Reader to view or print
the key feature guide. If you do not have the program and require it click the logo below.
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