Claims management
Episcript designs, builds and supports Claims Management Systems in Singapore: submission, benefit checks, approvals, panel clinic claims and payments, with AI we build in to read receipts, answer members and flag unusual claims.
For third-party administrators, brokers, insurers' claims teams and employers running medical and employee benefits.
Core modules
The modules most administrators start with, all working from one claim record.
Members, HR or clinics submit claims online with receipts, referral letters and medical certificates attached, and each claim receives a reference number and a status as it arrives.
Every claim is checked against the member's plan: covered treatments, per-visit and annual limits, co-payments and waiting periods, with anything outside the rules held for an assessor.
Approval levels send each claim to the right assessor or manager by amount, benefit type or client company, and every decision is logged with the approver's name and reason.
Panel clinics confirm a member's cover before the visit and submit the claim after it, and approved claims gather into one monthly statement per clinic for payment.
Approved claims are grouped into payment batches for clinics or members, paid by bank transfer or PayNow once a second user confirms, and marked paid on each claim.
Reports for each client company show claims paid, benefits used per member and claims pending, with costs broken down by plan, department or clinic ahead of renewal.
Claims processing
A claim becomes a record the moment it is submitted, holding the member, the plan, the documents and every check the system ran. Assessors work from a queue sorted by age and status, and a disputed claim can be followed up as a case in our Case Management System.
Benefit rules
Set each plan's rules once, and every claim against that plan is checked the same way.
Outpatient, specialist, dental, hospital and wellness benefits per plan
Caps per benefit, per visit and per policy year
The member's share worked out on every claim
Spouse and children claimed under the employee's plan
Treatments outside cover held for an assessor
Used and remaining amounts per member, updated with each claim
Limits pro-rated from the date a member joins or leaves
Limits reset for the new year, with past claims kept
Panel clinics and payments
Clinic claims, member reimbursements and the reports your clients read all come from the same claim records.
By role
Each person sees what their role needs, from the same claim records.
Claims received, claims pending, approval times and spend per client company on one dashboard, with AI answering questions about your own claims data.
A queue of claims waiting at their approval level, with the documents, plan rules and member's balance on one screen and receipts read in by AI.
Payment batches to clinics and members, bank lines matched to claims, and journals passed to your accounting system at month end.
Their own employees' claims, balances and monthly reports in one login, with joiners and leavers updated online rather than by spreadsheet.
Claims submitted from a phone with a photo of the receipt, status and balance visible online, and routine questions answered on WhatsApp.
Cover checked before the visit, claims submitted online, and payment status visible against every claim and monthly statement.
Built to order
Built in phases using information from your own system, with staff approving every output.
Module library
Add these as your claims operation needs them.
Every member, dependant and policy on one record.
Hold each member's details, dependants, plan and employer, with every claim they have made in one history.
Record each client company's policies, plans and policy years, with members imported from the HR list it sends.
Members, HR and clinics log in through a portal like our E-Services Portal, each seeing only their records.
Brokers can keep policies and renewals in an Insurance Agency Management System → on the same client records.
Your panel network and its claims kept in one place.
Keep each clinic's details, agreed rates, bank details and the client companies whose members it treats.
Clinics confirm a member's cover and remaining balance online before treatment, with each check logged against the visit.
Generate one monthly statement per clinic listing approved, rejected and pending claims with the amount payable.
Clinics on our Electronic Medical Record System can be connected to attach a claim's diagnosis and visit details.
Claims paid, matched and posted without retyping.
Send claim payments, recoveries and fees to Xero, QuickBooks or your own accounting system as journals.
Track the amount claimed back from the insurer for each paid claim, with outstanding recoveries listed by policy.
Bill client companies for administration fees and claim funding through our Invoicing Software, from the same records.
Charge members for co-payments or amounts over their limit, with the balance shown on each member's statement.
Records, permissions and messages kept in order for audits.
Log every change to a claim, plan or payment against a named user, with access set by role.
Keep receipts, medical certificates and letters filed against each claim, searchable for audits and client reviews.
Tell members and clinics by email, SMS or WhatsApp when a claim is received, approved, queried or paid.
Log calls, emails and complaints from members, clients and clinics in a custom CRM linked to every claim.
Integrations
Connect the system to the identity, payment, accounting, signing and messaging tools you already use.
Singpass, Corppass and Myinfo
PayNow and payment gateways
Xero
QuickBooks
WhatsApp Business
Google Workspace
DocuSignCustom build
Packaged claims platforms suit administrators whose plans and approval steps match the product. When your benefit rules, panel arrangements or client reporting do not, we build the system around them, and change it when a client's plan changes.
Questions
A Claims Management System is software that runs a claim from submission to payment: member and policy records, documents, benefit checks, approvals, payments and reports, all on one claim record. We build ours around medical and employee benefit claims.
The best Claims Management Software is the one that follows your own plans, approval levels and client reporting. A packaged platform suits standard processes, and a custom build fits when your benefit rules and panel arrangements keep breaking that standard.
It automates the routine checks. Eligibility, benefit limits, co-payments, duplicate receipts and missing documents are checked as each claim arrives, and claims within the rules can be approved automatically up to an amount you set.
Members, HR and panel clinics each log in to see claim status, and members also see their remaining benefit balance. Messages by email, SMS or WhatsApp tell them when a claim is approved, queried or paid.
Cost depends on scope: the modules in the first phase, the benefit rules to build, the data to migrate and the systems to connect. We quote after a scoping session and price each phase separately.
It depends on the first phase. A release covering submission, validation and approvals goes live sooner than a full build with panel clinics, portals and client reporting, and we give you a schedule once scope is agreed.
We move them for you. We map your spreadsheets or old system to the new structure, run a test import for you to check, then load members, plans, balances and open claims on an agreed cut-off date.
Our solutions are eligible for government grants. We explain how the schemes apply to your project and what the agency looks for, so you can budget with the full picture in front of you.
The system connects to Xero, QuickBooks and other accounting software, and claim payments post as journals without retyping. Payment batches can go out by bank transfer or PayNow; tell us your bank or provider and we will confirm the connection.
AI features can be added in their own phase, using information from your system: reading receipts and medical certificates, answering members on WhatsApp and flagging unusual claims for review by staff. Your assessors make every decision.
The system supports your PDPA obligations through permissions, activity logs, consent records and access controls. Medical details are visible only to the roles that need them, and every change is logged against a named user.
Related solutions
Registration, consultations, billing and panel claims on one patient record.
Read more Case Management SystemDisputed claims and investigations followed up as cases with tasks and notes.
Read more E-Services PortalOnline forms, applications and status tracking for members and clients.
Read moreNext step
Bring a month of claims and your plan rules, and we will show you those claims checked, approved and paid, with AI reading the receipts and flagging unusual ones.