Custom Medical Guidelines • Patient Privacy First

Custom Clinical Guidelines & Patient-Safe Care Review

Every HMO has its own medical governance policies, corporate benefit riders, and clinical review standards. Manticore lets your medical directorate apply your organization’s own clinical rules while keeping patient records strictly confidential.

Your Own Medical Rulebooks

Apply your HMO’s custom clinical care pathways, negotiated corporate riders, and specialist referral rules without sharing proprietary benefit schedules outside your organization.

Strict Patient Confidentiality

Personal patient details—such as full names, phone numbers, and National Identity Numbers—are automatically protected so clinical reviews focus solely on medical necessity and benefit eligibility.

Final Decision Always by Your Doctors

Complex inpatient admissions and specialist surgical requests are clearly summarized for your Chief Medical Officer or nursing team to make the final clinical decision.

Interactive Clinical Review Walkthrough

Explore how clinical checks verify diagnoses, member benefits, and duplicate visits in real time.

Interactive Clinical Care Assistant

How Manticore Supports Medical Reviewers

MRI Brain Scan — Pre-Authorization Check

Doctor at Lagoon Hospital requests approval for an MRI Brain scan (ICD-10 G44.1) for member Olumide Ademola under the Platinum Family Plan.

Automated Care & Policy Checks
Member Benefit CoverCovered under Platinum Family Plan
Waiting Period CheckCompleted (Enrolled 284 days ago; 90-day requirement met)
Agreed Hospital Rate₦95,000.00 (0% member co-pay)
Care Approval CodePA-202610-AXA-88219 — Issued Immediately
Approved — Patient can proceed to radiology without delay
Supports medical reviewers while keeping every patient record privateNDPA 2023 Compliant

Standard Clinical Verification Checks

Every patient encounter can be automatically checked across three core medical and benefit safeguards.

Standard Diagnosis & Medication Review
Clinical Safeguard

Checks clinical notes against official WHO ICD-11 medical terminology and verifies that prescribed medications match the diagnosis and safe dosage guidelines.

Clinical Information Reviewed:Doctor Clinical Notes, Proposed Diagnosis, Prescribed Medications
Guidance Provided to Care Team:Verified Diagnosis Code, Approved Generic Equivalent, Dosage Safety Confirmation
Member Plan Benefit & Waiting Period Check
Clinical Safeguard

Reviews the member’s health plan tier, maternity or surgical waiting periods, and annual family benefit balance before treatment begins.

Clinical Information Reviewed:Member ID Card Number, Proposed Procedure, Estimated Hospital Cost (₦)
Guidance Provided to Care Team:Coverage Status, Completed Waiting Period Days, Approved Hospital Tariff Ceiling (₦)
Duplicate Visit Protection Across Hospitals
Clinical Safeguard

Checks whether the same member has already had an identical consultation or prescription billed across partner hospitals within the same care period.

Clinical Information Reviewed:Member ID Card Number, Treating Hospital, Consultation Date & Time
Guidance Provided to Care Team:Duplicate Visit Alert, Recent Hospital Visit Summary, Clinical Review Recommendation
NDPA 2023 Patient Medical Confidentiality

How Manticore Protects Patient Medical Records

During automated clinical and policy reviews, Manticore protects personal patient identifiers—including full names, National Identity Numbers (NIN), and private contact details—ensuring full compliance with the Nigeria Data Protection Act (NDPA) 2023 and medical ethics standards.

Review Patient Privacy StandardsExplore Clinical Care Assistant →