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GPS Health

The platform

Sri Lanka's first digital platform for managing medical insurance claims.

One case, visible at the same moment to the insurer, the hospital and the administrator. Admission to settlement, without the paper.

  • Simpler
  • Quicker
  • Better
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GPS Health is the company. The GPS Health platform is the software it builds and runs.

What it does

Three capabilities, and a claim that no longer waits.

01

Real-time hospital admission tracking

The claim opens the moment the patient is admitted. Insurer, hospital and administrator see the same case at the same time.

  • Notification at the point of admission, not at discharge.
  • One shared case record rather than three separate ones.
  • Status visible to insurer, hospital and administrator simultaneously.

02

Instant claims submission

The hospital submits from the ward, not from a filing cabinet a week later.

  • Submission at the point of care.
  • Document capture against the open case.
  • Validation before submission, rather than rejection afterwards.

03

Faster discharge settlements

Settlement is agreed while the patient is still in the building, so discharge is not held up by paperwork.

  • Decision returned before discharge.
  • The patient's out-of-pocket exposure known before they leave.
Full feature detail

Turnaround

Two processes with a clock on them.

Most claims administration is described in adjectives. These two are described in units of time, which is the only version a prospect can hold us to.

3 days

Reimbursement claim

Submitted from the member app and settled end to end. A failure at any check returns the claim for correction rather than rejecting it outright.

  1. 01Claim submitted through the app
  2. 02Supporting pictures uploaded
  3. 03Documents verified for legibility
  4. 04Confirmation
  5. 05Bills scrutinised against the supporting documents
  6. 06Payable amount approved
  7. 07Payment processed
  8. 08SMS confirmation of payment

20 minutes

Discharge

From the hotline call to the Guarantee of Payment reaching the ward. Documents can be uploaded by the hospital, the member or a rider.

  1. 01Discharge initiated on the hotline
  2. 02Discharge documents requested
  3. 03Documents uploaded through the app
  4. 04Documents checked
  5. 05Confirmation
  6. 06Bill scrutinised and the Guarantee of Payment calculated
  7. 07GOP shared with the hospital
  8. 08GOP shared with the patient, who is discharged

The core system

One platform, three parties, one record between them.

Insurers, hospitals and GPS Health each work in the same system rather than sending each other files. What differs is what each one sees and does.

Insurance companies

Policies and clients, and the numbers behind them.

  • Policies and clients
  • MIS
  • Operations
  • Finance

Hospitals

The two points where a hospital touches the claim.

  • Reporting
  • Discharge process

GPS Health

The administration itself, run from the middle.

  • Onboarding
  • Incident management
  • Call centre
  • Claims management
  • Reports and business intelligence

Core modules

  • Onboarding
  • Incident management
  • Health insurance claim management
  • Claim process
  • Data management and integration
  • Finance management

The claim journey

Seven steps, one record, no re-keying.

  1. 01

    Admission

    Patient admitted at an empanelled hospital.

  2. 02

    Tracking

    Admission tracked in real time. The case opens.

  3. 03

    Submission

    Claim submitted from the ward.

  4. 04

    Adjudication

    Claim adjudicated, with the doctor panel on medical scrutiny.

  5. 05

    Validation

    On-site assessor validates in person where required.

  6. 06

    Settlement

    Settlement agreed.

  7. 07

    Discharge

    Patient discharged.

Running alongside every step

  • 24/7 multilingual contact centre
  • CSAT and NPS captured on every hospital interaction

Adjudication and clinical review

  • Claim adjudication and claims processing is one of the eight TPA functions.
  • A panel of highly qualified doctors from diverse specialisations performs swift and accurate medical evaluations, strengthening scrutiny and approval and giving 360-degree clinical insight on every case.
  • Automated systems and AI reduce errors and speed up approvals.

Integration and data

  • Seamless interoperability and real-time data sharing.
  • Data management and integration is one of the eight TPA functions.

Security and continuity

  • Advanced encryption, secure cloud storage and regulatory compliance measures.
  • Security protocols for data and processes, inside a business continuity plan covering uninterrupted power supply, dedicated leased-line connectivity and remote locations in the event of major disruption.

Reporting

What comes out of it.

  • Claims report
  • Ailment summary report
  • Payments report
  • Cashless: ailment-wise payment report
  • Cashless: hospital-wise payment report
  • Settlement service

Who it is for

One record. Three sets of eyes on it.

Insurers

Visibility of a claim from admission rather than after the fact, with adjudication and a doctor panel attached to the same case.

Hospitals

One submission route, and a settlement decision that arrives while the patient is still admitted.

Patients

Less time at the discharge counter, and less of the bill fronted out of pocket.

In production

Live with Sri Lankan insurers.

Co-operative Insurance

Co-operative Insurance

Strategic partnership and the launch of the GPS Health platform.

15 May 2025, Daily Mirror

Orient Insurance Limited

Orient Insurance Limited

Partnership to advance Sri Lanka's first digital medical claims platform.

Daily Mirror

Walk through a real claim with us.

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