The Medigent Pharmacy module is designed to automate and streamline the daily business processes required to manage a jurisdiction’s drug insurance programs. The module supports claim submission by individual transaction, in batch via standard messaging, or through manual entry. All claims are adjudicated in real-time. Medigent Pharmacy is a full implementation of a multi-plan drug and drug product benefits delivery solution, with direct support for CPhA3 and NeCST (HL7 v3) messaging for the online submission of pharmacy claims. The Pharmacy module provides direct linkages between the service provided, the client, the service provider, and plan structures, such as covered drugs, in an integrated solution for the purposes of management, adjudication, patient safety, and payment.

The Medigent Medical module is designed to automate and streamline the daily business processes required to manage a jurisdiction’s medical insurance program. The module provides claim submission and adjudication in real-time and batch. Medigent Medical captures a rich set of claim data elements related to the service provided, the client, and the service provider. The module provides concurrent support for both existing Canadian diagnosis standards in use today, ICD9 and ICD10. The complete claim life cycle is configured in the Medical module which determines the permitted status changes that are conducted by the system or the user. This flexibility permits the system owner to fully control the business flow of each claim. The module is flexible in terms of setting up adjudication rules and managing a complete fee schedule and all claim types associated with the program, including in-jurisdiction and out-of-jurisdiction ones. The module also supports all types of payment modes, including fee-for-service, sessional claims, and salaried. Medigent Medical also has the ability to integrate with financial systems for payment.

The Medigent Dental module manages the assessment and adjudication of dental insurance claims for a jurisdiction’s dental program. The module supports claim submission and adjudication in real-time and batch. The Dental module can handle a very intricate layering of business and financial rules and incorporates a very complex fee code structure with numerous properties, such as age restrictions, frequency limitations, fiscal elements, and any other properties that the client may want for the purposes of rules creation or report generation.

Medigent Dental has recently been enhanced to make it more comprehensive. One of the enhancements, CDAnet compliance, allows the electronic submission of claims from dentists across Canada. The system also meets the Canadian standards for Dental Claims Processing. In addition, the process for dental pre-authorizations has become more compliant with the workflow used by dental program administrators. The pre-authorization assessor, for example, has the ability to run a trial adjudication on each request to determine what the outcome would be if it were a real submission. The assessor can then decide if they would like to agree with these results or override them.

The Medigent Medical Travel module is a full-featured claims entry and adjudication module that allows a jurisdiction to tightly manage the submission, approval, and payment of claims for travel expenses related to the delivery of medical services. The module utilizes a case-based sub-system to encapsulate the complete travel episode, from a patient leaving their home until they return. Travel and invoice information can be electronically loaded from other systems to automate the information-capture process. The Medical Travel module provides complete versioning of changes, enabling the user to track a complete transactional history. The module also provides healthcare users with the ability to pre-authorize and track costs related to a client's need for medical transportation for a generic range of expense types such as scheduled air, medevac, or ambulance services. Vendor invoices may also be linked back to pre-authorizations to provide an end-to-end record of travel costs approved and spent, as well as to flag unauthorized travel during data collection and adjudication. Medigent Medical Travel provides various transaction types including payments and credits, and has the ability to integrate with financial systems for payment.