Medical Insurance Software and MIS for Medical Insurance Plans and Insurance Policy

Medical Insurance Software Companies Management Information System

Medi-claim insurance is a contract of indemnity where only the actual costs are covered that incur due to ill medical condition. A medical insurance software help governing all the medical insurance activities. Here is Medical Insurance System project planning by Medical Insurance Software Companies for profit maximization and benefits to the policy holders.

I. System Overview and Feasibility Analysis
Prerequisites for Feasibility Studies
1.1 Required Function

1. Realize the management of the basic information of the insured by the medical management system.

2. Realize the management of the medical management system for the policyholder’s account and settlement payment process.

3. Realize the basic information management of the insurance card held by the insured.

4. Realize the basic functions of fixed-point hospital bill payment, drug review, system query.

5. Provides the information modification of the insured’s information and the service function of the medical-insurance card loss reporting.

6. The insurance card service is set up in the system to make the function realization of the whole insurance coverage process more convenient and convenient.

7. The consent management and review of the insured, social security center, insured institution and designated hospital are realized.


1.2. Goal of Medical Insurance

Optimized the business process in the medical insurance process, with the medical-insurance card as the core, unified management of the insured, social security center, participating institutions, and designated hospitals to maximize the efficiency of the entire medical insurance system business process. Among them, the saving of human resources, the improvement of business processing speed, the improvement of management information service and the payment operation of various expenses in the medical-insurance process have obvious efficiency improvements. Achieve the consent management of the insurance information, making the data information in the entire medical insuring process more clear, accurate and open.


3. Conditions, Assumptions and Limitations

A. Suitable for small-scale community health insurance work

B. Assume that the selected community is not using the health insurance system

C. Assume that the number of participants in the entire health care process is 10 and the related service costs are extra.

D. Assume that the average salary of business personnel in the medical-insurance work is $3,000/ month.


Technical Feasibility Analysis

2.1 Brief Description of the System

The medical or health insurance system uses a Web management system based on the B/S architecture, which is more user-friendly and easier to operate than the current system interface. Including information on policyholders, insured institutions, social security centers, information management of designated hospitals, policy information cataloging, insurance bill payment management, insurance information retrieval, etc., subsystems have added some functions and improved the system’s fault tolerance.


2.2. Technical Feasibility Evaluation

The software is developed, debugged and directed by the teacher. The development language used and the development environment have both early learning and development experience, so the completion is very high.


Economic Feasibility Analysis 3.1 Expenditure

3.1.1. Infrastructure Investment
  • Server, and device spending on the client. A total of $300,000, the service life of 5-8 years.
  • Other one-time expenditures. The software purchase expenses are $50,000.
  • Recurring expenditure system maintenance costs, system management staff.
1.2. Benefits

It can reduce the number of medical insurance service personnel by 20 people. It can more accurately deal with problems in the insurance business process, effective policy information and policy claim information. At the same time, for insurance companies that have basically realized computer processing and management, there is no need to invest in hardware equipment. The use of new systems will inevitably speed up the flow of business information, speed up work efficiency, enhance company efficiency, and realize financial operators. The increase in revenue and expenditure will also improve the level of customer service and increase customer satisfaction and loyalty. In short, the development and commissioning of the new system is in line with economic feasibility, both in terms of short-term benefits and long-term benefits.


1.3. Income/investment ratio

Reduced 20 business managers. 3000*12*20*5/350000=10.2857

1.4. Investment Recovery Cycle

* 2 years to recover investment.


Feasibility Analysis of Social Factors
4.1 Management Feasibility of Medical Insurance Companies

1.1.The medical insurance company can use the insurance management system to record the policy information more accurately than if the system is not used, and process the insurer’s emergency situation more timely and accurately. At the same time, the system uses the system for the insured, the policy information, and the insured unit. The unified management of designated hospitals will make business processing more efficient, and the business processing information will be more open and transparent. It is consistent with the principle of openness and transparency advocated in the current society, and has certain social benefits.


1.2. User Feasibility

In the enterprises and work units involved in this system, most people have received a certain degree of understanding and experience from the undergraduate education, and the management system is friendly and easy to operate. Most users use the requirements of the system.


Concluding Comments on Medical Insurance Project

According to the above analysis, the insurance management information system not only has great economic benefits, but also has greater social benefits, which makes the system development valuable and saves a lot of resources. The system administrator’s work efficiency is improved, the medical or health insurance business process management costs are reduced, and the business operations in the entire insurance process are greatly facilitated. In summary, the project is completely feasible in terms of technical, economic and social benefits.


II. System Requirements and Analysis


Developing a medical information management system can speed up information flow, improve work efficiency, and achieve effective management. At present, business informationization and management informationization have become the main trend. Also, the level of informationization has become an important indicator for measuring the core competitiveness of an insurance company.

In the insurance business process, a large amount of information needs to be collected, processed, transmitted and stored, such as the insured, the designated hospital, the basic information of the insured company. The financial information also needs to be collected that is involved in the later claims. If this information is inevitably caused by human intervention, it will require a unified system platform to complete the integration of business, data and customer service, thereby improving efficiency, reducing leakage, and improving the quality of service and management of the medical or health insurance company.


Social Needs

With the rapid development of computer and network technologies, Internet applications are becoming more and more popular around the world. Today’s society is rapidly advancing toward the information society, and the role of information automation is also growing. This frees us from complicated matters and improves our work efficiency. Therefore, the medical insurance information system is required: 1. The personal information of the insured person, the insured item, and the insured amount can be managed.

The system administrator can view, record and modify the information of the insured, set the basic information of the hospital, and insured claims and other information.

At the same time it can connect to the network and realize the joint supervision of the insured, the insured community, the insured company and the designated hospital through the network.


 System Management

Through the system, the system administrator can obtain the comprehensive information of the insured person and the insurance business such as the designated hospital, so that the service can be processed faster.

The user can complete drug review, medical or health insurance card management, fee payment and other related operations through the system.


Detailed Medical Insurance System Goals

 1. The system administrator will query and manage the basic information of the insured’s insurance card, the amount of insurance, whether compensation is obtained, and the amount of compensation.

2. Implement administrators to implement new policy additions, processing of existing policies, and clearing of obsolete policies.

3. Query and modify the information of the designated personnel by entering the medical insurance card number of the insured person.

4. Establish a database related to medical insurance to facilitate the management and storage of information related to medical insurance.

5. The medi-calim insurance card number can be used to operate related items such as drug review and fee payment in the business process.

6. It is possible to replace the insurance card and report the loss.

7. Increase the history of the query function. Manage users and logout features.


System Performance Requirements

  1. The system is safe and reliable.
  2. Full-featured.
  3. Easy to operate and friendly interface.
  4. Easy to maintain and expand.


1. Systematic Functional Analysis

i. Password settings: Different people have different people’s accounts, passwords and permissions. The system administrator manages user information as a system administrator. The insured and the designated hospital staff are ordinary users.

ii. Maintenance of medical or health insurance related information: All data of the insured person, designated hospital, and relevant units. The system manages the information of each insured person and its related designated hospitals based on the medical insurance card. System maintenance includes operations such as modifying, deleting, and adding various table records.

iii. System query: You can query according to the medical insurance number and other related information.

iv. System management: The system administrator edits user information and maintains system security.

Report statistics: including statistical medical or health insurance card information, designated hospital information, policy information and compensation information.


2. Data Dictionary

Name – Insured institution Abbreviation: CBJG Description: Affiliation unit of participating insurance employees Data value type: Discrete Type: Number Length: 10 Relevant data structure:

Total number: 1-03 Number: 03

Name – Hospital Number Abbreviation: YYBH Description: Qualified fixed-point hospital number Data value type: Discrete Type: Character Length: 10 Relevant data structure:

Total number: 1-04 No.: 04

Name – Insured Time Abbreviation: CBSJ Description: Time to participate in medical insurance Data value type: Discrete Type: Number Length: 10 Relevant data structure:

Total number: 1-05 No.: 05

Name – Overdue time Abbreviation: YQSJ Description: Time of violation of unpaid fees Data value type: Discrete Type: Number Length: 10 Relevant data structure:

Total number: 1-06 Number: 06

Name – Stopping list Brief description: Data stream source: P1.2 Data stream going: Insured personnel Contained data structure: Name Student number

Total number: 1-08 Number: 08

Name – Medical Insurance Card Brief Description: Medical insurance card for medical insurance. Structure: No. Name Medical Insurance Center Date of Validation Validity Period Name: Patient Management Information Brief Description: Hospital Visiting Patient Structure: Medical Insurance Card No. Name Treatment Item Drug Cost Date

Total number: 1-08 No.: 01 For data flow, data storage:

Total No.: 1-09 No.: D1 Relevant data flow: P3.1.1——D1 P3.1.2——D2 Is there an immediate query: Yes


III. System Structure Design

System model overall design 1.1 overall system structure diagram

  • Overall system structure
  • System Sub-function Description
  • List of functional demand points


2.1. Basic information settings

The basic information settings include:

  1. Insured information: Insured items and the amount of insurance
  2.  System parameter setting: set the specific parameters of the medical insurance management system
  3.  Administrator settings: administrator information login and operation
  4.   Permission settings: insured and administrator’s permission settings


1.2.2 Insured information management

Insured information management includes:


  1. The insured person is insured: the insured person participates in the medical insurance project and obtains the medical claim insurance card.
  2. Other information management: the insured person’s designated hospital, policy claim and other information management.



1.2.3. Medical Insurance Policy Information Management

Medical insurance system is all about medical claim insurance premia paid by the people. It is this insurance premium that puts this insurance service into action.

Policy Information Management includes:

New recruits: New people’s insurance, new insurance policy records

Policy information: In accordance with the data of the insured person corresponding to the insurance card number.

Policy cancellation: Cancellation of the payment of the insurance or the end of the business of the insured and related medical insurance or health card information.


1.2.4 Information Inquiry

Information Inquiry Includes:

The Insurance Card Information Inquiry: The insured person or the administrator queries the database according to the medical insurance card number.

2. Inquiries of the insured person: The insured person or the administrator enters the information of the insured person according to the insurance card number.






See also:


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