Mazecare
Eligibility & Pre-Authorization

Know coverage.
Before care starts.

Check patient eligibility, remaining benefits, and obtain letters of guarantee instantly at registration, before any service begins.

HOW IT HELPS

Verify coverage before treatment starts.

Real-time checks eliminate payment surprises for patients and financial risk for providers.

Instant eligibility at registration desk.

Know exactly what's covered and remaining benefits before patient sees clinician.

Real-time benefit verification system

Check active coverage, remaining limits, co-pay amounts, and exclusions in seconds.

Digital letter of guarantee

Request and receive pre-authorization electronically with automatic tracking and expiry alerts.

How It Works

Registration to guarantee. Fully automated.

From patient check-in to coverage confirmation with automatic benefit calculation throughout.

Key Capabilities

Complete coverage verification system.

Works for individual insurance, corporate panels, government schemes, employee benefits, and integrated care networks.

Real-Time Eligibility Verification

Instant check of active coverage, policy status, and member validity at registration.

Remaining Benefits Display

Visual dashboard showing used and available limits for consultations, procedures, medications, and diagnostics.

Simulated Claim Estimation

Preview coverage for planned treatments based on diagnosis and procedure codes before service.

Digital Letter of Guarantee

Electronic pre-authorization request and approval with automatic tracking and validity monitoring.

Multi-Plan Policy Support

Handle patients with multiple insurance policies with coordination of benefits logic.

Co-Payment Calculation

Automatic calculation of patient responsibility based on plan rules and deductibles.

Exclusion Warning Alerts

Immediate flags for non-covered services, pre-existing conditions, and waiting periods.

Annual Limit Tracking

Real-time monitoring of annual caps, lifetime maximums, and per-visit limits across categories.

Dependent Coverage Verification

Automatic validation of family member eligibility with relationship and age checks.

Corporate Panel Validation

Check employee eligibility for corporate schemes with company code and employment status.

Pre-Existing Condition Logic

Apply waiting periods and exclusions for chronic conditions based on policy terms.

Mobile Eligibility Access

Verify coverage on mobile devices for home visits and satellite clinic operations.