Consistent 3-Tier Care Vetting & Duplicate Visit Protection
Replace slow, stressful manual paperwork reviews with clear, consistent clinical vetting. Prevent split surgical bills, unsafe medication quantities, and duplicate hospital charges automatically so medical teams can focus on patient care.
Transparent 3-Tier Hospital Fee Schedule
Every medication, doctor consultation, and surgical procedure is checked fairly across three clear care tiers.
Direct Hospital Partner Agreements
Honors the exact medical service rates agreed upon between the HMO and partner hospitals (such as Lagoon, Reddington, or Cedarcrest) first.
Regional Hospital Care Bands (Band A / B / C)
Applies fair, agreed regional care band rates whenever a specific treatment or medication is not listed on an individual hospital schedule.
Standard NHIA National Care Guidelines
Uses the statutory NHIA Act 2022 national medical fee schedule as a reliable safety net to keep healthcare costs predictable and fair.
Clinical Safeguards Against Billing Errors
Designed alongside Nigerian medical directors and hospital pharmacists to prevent the most common causes of billing disputes in private health insurance.
Protects patients and health plans by flagging when the same member has identical consultations or prescriptions billed across partner hospitals within the same care period.
Identifies when routine surgical supplies are billed separately from an all-inclusive procedure package (such as charging extra for a surgical tray and sutures during a standard appendectomy).
Reviews prescribed drug quantities against standard clinical treatment guidelines for the patient’s diagnosis (for example, flagging a 30-day antibiotic supply prescribed for a 5-day acute infection).
Assists your clinical review nurses and doctors by checking family benefit limits, waiting periods, and policy riders during complex hospital admissions.
See Clinical Claims Review in Action
Upload a sample monthly hospital statement to see instant care tariff checks and clear explanations.