Healthcare
Medical Billing and Insurance Management System
Captures every billable service, applies payer price lists, prepares and tracks insurance claims, and reconciles payments, rejections and patient balances.
- Web-based
- Server-based
Overview
Medical Billing and Insurance Management System
For many healthcare providers, revenue is earned at the bedside but lost in the paperwork. A Medical Billing and Insurance Management System makes sure each consultation, test, drug and procedure is charged at the correct price for the patient’s payer, then turns insured services into complete, well-supported claims and follows them through to payment.
Extrion Tech develops billing and claims systems in-house for hospitals, clinics, laboratories and pharmacies in Zanzibar and Tanzania. Price lists, scheme benefits, co-payments, pre-authorisation rules and claim formats are configured per insurer and corporate client. Electronic submission to NHIF or private insurers, GePG control numbers and mobile money collections can be included where the provider offers an API and the project scope covers it.
Finance teams see what has been billed, claimed, paid, rejected and is still outstanding for each payer, with ageing reports that show where follow-up is needed. Rejected claims are tracked with reasons so recurring errors can be fixed at source. Requirements for financial records, patient data and retention are agreed with the client for the relevant jurisdiction.
Business problems it addresses
- Services are delivered but never billed because charges depend on manual slips.
- Insurance claims are rejected for missing signatures, codes or authorisation numbers.
- Claims preparation at month-end takes days and delays cash flow.
- Insurer payments cannot be matched to individual claims, hiding short payments.
- Management lacks a clear view of outstanding balances per insurer and corporate client.
Interface
Five screens of the system
Illustrative mockups with sample data — not screenshots of a client’s system.
Workflow
From service to settled claim
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1
Verify cover
Front desk records the member number, scheme and any pre-authorisation before services begin.
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2
Capture charges
Each service ordered is charged automatically at the payer’s agreed price.
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3
Apply co-payment
The patient’s share is calculated and collected, and the balance is assigned to the insurer.
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4
Prepare the claim
Claims are compiled with diagnoses, items, signatures and attachments, then checked for errors.
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5
Submit
Claims are submitted electronically where supported, or exported in the insurer’s required format.
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6
Reconcile payment
Remittances are matched to claims, with short payments and rejections recorded by reason.
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7
Follow up
Rejected items are corrected and resubmitted, and ageing reports guide collections.
Functions covered
Modules and what they do
01 Billing
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Charge capture
Posts charges automatically from consultations, orders, dispensing and bed-days.
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Price lists and schemes
Holds tariffs per payer, with benefit limits, exclusions and co-payment rules.
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Patient invoices and receipts
Produces itemised invoices, receipts, deposits and refunds.
02 Insurance
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Eligibility and authorisation
Records member validation and pre-authorisation numbers for each visit.
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Claims preparation
Builds claims per insurer and checks for missing codes, signatures or limits.
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Electronic claim submission
Optional / subject to scope
Submits claims to NHIF or private insurers where an API is available.
03 Collections
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Remittance reconciliation
Matches insurer payments to claims and records variances.
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Rejections management
Tracks rejected items by reason and manages corrections and resubmission.
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Online payments
Optional / subject to scope
Accepts mobile money or GePG payments where the provider offers an API.
04 Finance reporting
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Debtor ageing
Shows outstanding balances per insurer and corporate client by age.
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Accounting export
Optional / subject to scope
Exports summarised revenue and receipts to the accounting system.
Technology stack
Technology selected for this solution
These are the technologies planned for this type of system. The final stack depends on scale, performance, licensing, infrastructure, integrations and your requirements.
Frontend
Backend
Database
Infrastructure
Integrations
Security & data integrity
Protecting your data and its accuracy
Billing staff see only the clinical details needed to support a claim, and discounts, write-offs and refunds require approval. Financial and patient record retention is agreed with the client for the relevant jurisdiction.
Standard protections
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Role-based access control
Each user sees only what their role allows.
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Authentication and authorisation
Every request is checked for a signed-in, permitted user.
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Fine-grained permissions
Permissions per module and action, such as view, edit or approve.
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Secure password storage
Passwords are stored using strong one-way hashing, never in plain text.
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Encryption in transit
HTTPS/TLS protects data between users and the server.
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Server-side input validation
All input is validated on the server before it is saved.
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Protection against common web vulnerabilities
Defences against injection, cross-site scripting and request forgery.
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Database constraints and transactions
Constraints and transactions keep related records consistent.
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Audit logs
Important actions are recorded with who, what and when.
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User activity history
A history of each user’s activity for supervisors and administrators.
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Backup and restoration
Scheduled backups with tested restoration procedures.
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Session management
Session time-outs and the ability to sign out other devices.
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Data export controls
Exports limited to authorised roles and recorded.
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Data retention and deletion policies
Retention periods and deletion rules agreed with you.
Optional advanced protections
- Multi-factor authentication A second sign-in step for selected or all users.
- Encryption at rest Sensitive data encrypted on disk where the infrastructure supports and is configured for it.
- Secure API access Authenticated, rate-limited access for integrations.
- Disaster recovery planning A documented plan to restore service after a major failure.
Data integrity
Charges are generated from service orders and priced from the effective tariff on the service date, so totals cannot be typed in freely. Invoices, receipts and claims are numbered and locked once issued, credit notes reverse them with a reason, and every remittance is reconciled line by line against its claim.
Security controls are configured for each project. We do not claim certification, compliance or immunity from attack unless independently verified for your deployment.
Customisation & integration
Tailored to how you work
We tailor modules, reports, permissions, workflows, branding and integrations to your organisation. Tell us which features you need when you request a quote.
- Insurer and corporate schemes, tariffs and benefit rules
- Claim forms, attachments and validation checks
- Approval limits for discounts, waivers and write-offs
- Invoice and statement layouts with facility branding
- Integrations with insurers, payment providers and accounting
Deployment & support
From go-live to continuous improvement
Onboarding, data migration, training, maintenance, technical support and future enhancements are services we scope into your project.
Bringing records from spreadsheets or older systems, checked and reconciled.
Role-based training for users, supervisors and administrators.
Technical support and maintenance under an agreed support plan.
New modules, reports and integrations as your organisation grows.
Pricing
Pricing tailored to your requirements
Every organisation has different workflows, users, infrastructure, and integration needs. Request a quotation for a solution designed around your requirements.
- Number of users, branches and modules
- Customisation and integrations
- Hosting: cloud, your server or hybrid
- Data migration and training
- Support and maintenance plan
Healthcare
Related systems
Hospital Management System An integrated hospital system connecting registration, outpatient and inpatient care, laboratory, pharmacy, billing and reporting in one secure platform.
Clinic Management System A lean system for private clinics and dispensaries that handles patient visits, consultations, dispensing, simple lab work and cash or insurance billing.
Pharmacy Management System Point-of-sale and stock control for retail and wholesale pharmacies, with batch and expiry tracking, prescriptions, supplier orders and branch reporting.
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