Claim Management System (CMS)

Claim Management System (CMS) is a comprehensive automated health claim management solution that automates the functions carried out by Universiti Utara Malaysia (UUM), panel clinics and panel hospitals. It carries the process from health claim processing / adjudication over the Internet to the financial and medical auditing of all activities in the organization. It is regarded as a technical breakthrough in the administration of health care that guarantees prompt investigation and accurate claims settlement over the Internet with no human intervention, while maintaining the highest levels of security. CMS manages the claims records more consistently and effectively where the paper-based ways will be reduced or even eliminated. Furthermore, CMS introduces a new way in managing organization's activities in a Web-based applications environment, which is more productive and time-saving. In addition, CMS provides the UUM, panel clinics and panel hospitals abilities to work efficiently and effectively using the Web-based application. The study was carried out in order to produce a Web-based application of Claim Management System (CMS). CMS is a Web-based application system that offers online transaction in managing health claims or medical benefit. The System Development Research Methodology is the methodology used in the study. The CMS prototype is built using the Microsoft SQL Server 2000 as relational database, together with Active Server Pages (ASP) as the middleware and Internet Information Server (11s) 5.0 as the Web server. The benefits of these technologies are discussed in this study. The combination of these technologies makes the CMS featured with many benefits that are believed can enhance today's claim system