Payer
Connect
The live coordination layer between healthcare delivery and healthcare funding.
A secure, real-time platform connecting hospitals, clinics, specialists, medical aids, insurers, HMOs, and patients into one operating layer. Verify cover. Approve care. Route patients. Reduce claim friction. All live.
One coordination layer. Live.
Eligibility, authorisation, claims, and referrals flow through a single intelligent hub — connecting every provider to every payer in real time. Hover the flow types to explore.
Move the patient faster
Approve care smarter
Reduce claim friction
Connect payer & provider live
The space between payer and provider is chaos
Every day, millions of healthcare interactions are slowed by manual processes, broken workflows, and zero shared visibility between the people providing care and the people funding it.
Slow eligibility checks
Providers don't know if a patient is active, covered, or in-network until after delays — sometimes hours.
Broken authorisation workflows
Approvals handled through fragmented portals, emails, PDFs, call centres, and endless back-and-forth.
Bad patient routing
Patients sent to the wrong facility, wrong specialist, or non-optimal provider — even when a better covered option exists.
Weak transfer coordination
Moving a patient between facilities or care levels is slow, manual, and badly documented.
Claims leakage & rejection
Claims delayed or rejected from missing codes, bad attachments, missing auth, or benefit misalignment.
Poor payer-provider visibility
Insurers can't see what's happening fast enough. Providers can't see payer logic fast enough. Everyone's blind.
From patient entry to claim resolution
Eight steps. One platform. Complete payer-provider coordination.
Patient enters system
Arrives physically, books online, or is referred in
Eligibility checked live
Membership, policy, benefits, network, co-pay, exclusions — all verified instantly
Best care route determined
Medical need + payer rules + provider network + urgency + cost efficiency
Pre-authorisation triggered
Structured request with diagnosis, notes, attachments, urgency
Payer reviews & responds
Approve, reject, pend, request info, or escalate — with full context
Care proceeds
Patient treated, referred, admitted, scanned, transferred, or discharged
Claim readiness checked
Codes, attachments, auth status, benefit alignment, rejection risk — all validated
Case timeline stays live
Provider, payer, patient, coordinator, billing — everyone sees progress
Every layer of the coordination stack
From eligibility verification to AI-powered decision support — ten modules that turn payer-provider chaos into a single live workflow.
Four layers, ten modules — hover to explore how they connect
Eligibility & Benefits Engine
Phase 1The fastest wedge.
Instantly confirms whether a patient is covered and what they're entitled to. Active/inactive status, benefit availability, network match, co-pay warnings, plan limits, authorisation needs — all in seconds.
Pre-Authorisation Engine
Phase 2The approval workflow layer.
Digitises and structures medical approvals between providers and payers. Handles admissions, surgery, radiology, specialist referrals, high-cost treatments, chronic care, maternity, and oncology workflows.
Smart Routing Engine
Phase 3The intelligence layer.
Routes patients to the best covered provider or facility based on specialty, insurer network, distance, urgency, capacity, and cost efficiency. The right care at the right place, every time.
Referral & Transfer Engine
Phase 3The movement layer.
Coordinates patient transfers and referrals safely. Provider-to-provider handoffs, facility acceptance, transfer approvals, care continuation documentation, and receiving facility confirmation.
Claims Readiness Engine
Phase 4The protection layer.
Validates claims before submission. Checks authorisation presence, code alignment, benefit match, documentation completeness, policy validity, and rejection risk. Stops bad claims before they happen.
Shared Case Timeline
Phase 2The visibility layer.
A single live journey for every case — registration, eligibility, authorisation, referral, transfer, admission, treatment, discharge, claim status. Every party sees what they need, nothing more.
Patient Portal
Phase 2The patient-facing layer.
Keeps patients informed. Cover status, approval progress, required documents, where to go, next steps, transfer instructions, out-of-pocket warnings, and current case stage. No more confusion.
Provider Portal
Phase 2The provider operations layer.
Used by front desk, case managers, doctors, admissions, finance, and transfer coordinators. Verify cover, submit authorisation, upload documents, track responses, initiate referrals, validate claims.
Payer Portal
Phase 2The funder-side layer.
Used by authorisation teams, medical officers, claims teams, and case managers. Review requests, manage approvals, monitor urgent cases, track network usage, flag suspicious patterns.
AI Copilot
Phase 4The Visio intelligence layer.
Summarises clinical requests and benefit logic, flags missing items, suggests covered options, explains payer responses, identifies claim risks, recommends best next provider, surfaces delays and bottlenecks.
Every party in healthcare financing
Provider Side
Payer Side
Five phases to infrastructure
Start with the easiest wedge. End as the coordination layer for African healthcare.
Eligibility & Benefits Verification
The easiest wedge. Fast ROI. Easy to demo. Easy to understand. Providers see value in minutes.
Eight revenue streams. One product.
Provider SaaS fee
Monthly subscription per facility
Payer enterprise fee
Annual contract per insurer/scheme
Implementation & setup
Onboarding, training, integration
Integration fees
Per-connection to existing systems
Transaction-based fees
Per eligibility check or auth request
Premium AI usage
Advanced copilot features
Analytics & reporting
Network intelligence dashboards
White-label licensing
Branded deployments for large groups
Built for regulated healthcare
Not a feature set. Part of the product foundation. Every module is built for healthcare and insurance compliance from day one.
This product sits in the middle of the money
Measurable operational transformation
Every metric that matters — red bars (before) vs coloured bars (with Payer Connect)
friction points
The coordination layer
healthcare has been missing
Payer Connect is where healthcare delivery meets healthcare funding. One platform. Live. Secure. Intelligent.
Get notified when Payer Connect launches