Health Insurance Hospital System

We developed the Amjad Hospital Health Insurance System (HMS) for Amjad Company — integrating patient management, electronic medical records (EMR), health insurance, claims, pre-authorization, billing, laboratory, pharmacy, and inpatient care in one platform.

Overview

Designed for a hospital serving Amjad employees and clients within a health insurance network (Gold, Silver, Platinum) — with instant coverage verification, insurance/patient co-pay calculation, and claims tracking from submission to approval.

Dashboard & Patient Registration

Dashboard shows 248 patients today, 86 active appointments, 34 pending claims, 12 inpatient cases — with appointment distribution by department and 89.2% claim approval rate. New patient registration with instant insurance policy linking: membership number, plan (Gold 80%/90%), and remaining annual limit.

EMR & Appointments

Electronic medical record: visits, diagnoses, prescriptions, lab results, imaging, and claims — with doctor notes, allergies, chronic conditions, and insurance coverage verification. Appointment management by doctor and department with check-in, waiting status, no-show tracking, and 94% insurance verification before visits.

Insurance, Claims & Pre-Authorization

Insurance plan management: Gold (80% outpatient / 90% inpatient), Silver, Platinum, Basic — with 4,820 active members and 18 partner companies. Claims submission and tracking for MRI, surgery, labs, dental — with insurance/patient split and Approve/Reject/Query workflow. Pre-authorization for major procedures with attachments (referral, lab, estimate) — 24-hour SLA with 6-hour average approval.

Reception, Departments & Billing

Digital queue system: Token A-014, A-015... — display screen, SMS notification, and insurance verification at check-in. Six departments: internal medicine, surgery, pediatrics, OB/GYN, dental, orthopedics. Detailed billing with automatic split between insurance amount and patient co-pay — Cash, Visa, Instapay.

Lab, Pharmacy, Inpatient & Reports

Lab orders linked to EMR and insurance with automatic results. Pharmacy with drug interaction check, insurance formulary, and automatic allergy rejection (Penicillin). Room and ICU management with admission, daily rate, expected discharge, nursing notes, and vitals chart. Reports: monthly revenue (4.2M EGP — 78% insurance), 89% claim approval, outpatient visits, inpatient days, 4.6/5 patient satisfaction.