Clinical Care Assistant & Prior Authorization Support
Support your HMO medical review nurses and doctors with instant benefit checks, clinical prescription matching, and effortless reading of handwritten hospital notes—so patients waiting at the clinic receive fast care approvals.
Instant Prior Authorization Guidance
Helps HMO nurse reviewers and medical officers check health plan benefits, maternity or surgical waiting periods, and NHIA care protocols in seconds.
- Automatically checks policy waiting periods for maternity, dental, optical, and surgical care
- Verifies remaining annual family benefit limits and member co-pay terms
- Issues clear Care Authorization Codes so patients can begin treatment without delay
Prescription & Diagnosis Matching
Reads doctor clinical notes and matches prescribed medications to standard WHO ICD-10/11 diagnosis codes and approved medicine lists.
- Translates clinical shorthand like "tab augmentin 625mg bd x 5/7" into standard Co-amoxiclav rates
- Matches branded medications to the Essential Medicines List (EML) where appropriate
- Highlights unsafe drug dosages or medications unrelated to the stated diagnosis
Handwritten Case Note & Slip Reader
Reads photographed paper encounter forms, laboratory request slips, and hospital discharge summaries with care and accuracy.
- Captures member HMO numbers, hospital file references, and visit dates cleanly
- Organizes itemized ward, lab, and pharmacy charges into a structured digital claim
- Saves hospital billing staff hours of manual typing at the end of every month
Dr. Bello • Lagoon Hospital Ikoyi
“Patient Olumide Ademola (AXA-CORP-98214-B) requires prior authorization for an urgent Diagnostic Colonoscopy with Polypectomy due to persistent lower GI bleeding. Estimated hospital bill is ₦185,000.00.”
1. Member Coverage: Member is active under the Nestlé Nigeria Corporate Comprehensive Plan. Specialist & surgical procedures are covered up to ₦500,000 annually.
2. Waiting Period Verification: The 90-day surgical waiting period has been completed (member has been enrolled for 312 days).
3. Hospital Tariff Alignment: Requested amount of ₦185,000 has been aligned to the agreed Band A specialist hospital rate of ₦145,000.00 (all-inclusive procedure rate covers the ₦40,000 endoscopy tray fee).