Claims Management

Claims Management

Claims Management is Ailaaj’s corporate benefits console — enroll employer organizations and members, review OPD/IPD/pharmacy/lab claims, and adjudicate against plan balances with an audit trail.

Start here

• Claims Management guide — dashboard, claims queue, adjudication, members, organizations, plans, and panel hospitals.
• New tenant? Set up Claims Management then Run a claims day.
• Claims operator? Process a claim.
• Setup? Create an organization · Create a benefit plan · Panel hospitals.

What you can do

Daily operations

• Triage the pending claims queue from the dashboard.
• Filter and search claims by status, organization, category, and service date.
• Create a claim on behalf of a member (with attachments).
• Approve, partially approve, reject, or request more information — with advisory flags and balance context.

Setup

• Register employer organizations.
• Enroll members (and dependents) onto benefit plans.
• Maintain the panel hospital network used for on-panel checks.

Where it lives

In the app sidebar: Claims Management → Dashboard / Claims / Members / Organizations / Plans / Panel Hospitals.

Routes are under /corporate/*.

Related

• Clinic CMS handles outpatient bookings and OPD billing at the practice — Claims Management settles employee benefit claims against corporate plans.