About

Nano Health blends healthcare services and information technology to provide solutions for healthcare providers, payers, and regulators.

84 +
Insurance&
TPA Company
5.3
Million
Patient File
4+
Thousand
Healthcare Facility
18 +
Thousand
Physician
190 +
Requests Managed
Per Second
9.5+
Billion AED
in Transactions
Services

Analytics

Through appropriate data collection, mining, and analysis; Nano Health has developed extensive expertise in data analysis and reporting. The company has also partnered with a number of leading organizations to support in delivering our clients with quality healthcare data analysis, while maintaining the protection of patient privacy and data confidentiality.

Consultancy

Nano Health realizes that the transformation of the healthcare industry in the region is accompanied with challenges at the level of healthcare providers, payers, and regulators. Therefore, we have designed consultancy service packages that address technical, coding, operational, and policy making needs of our clients.

Training

Nano Health provides training services as a main component for most of its solution offerings. Our trainers are team members that have been engaged in the design, development, testing of our systems, and are actual system users on almost daily basis.

All Solutions

Nano Health solutions can be deployed and operated as stand-alone solutions or as loosely coupled platform solutions communicating standard common language. HealthConnect is the flagship comprehensive platform coupling all of Nano Health solutions. Stand-Alone Solutions Health Insurance Community Portal Health Insurance Product Marketplace Transactions Post Office Payer Transaction Manager Provider Transaction Manager Dashboards & Analytics Checks for Drugs and Services Adjudication Insurance Management System Insurance Registries e-Prescribing Solutions Pharmacy Benefit Manager (PBM) Health Insurance Data Dictionary Drug Databases & Registries Pharmacy Management System Clinic Management System Provider Insurance Scrubber Computer Assisting Coding System
Commonly Coupled Solutions:
Payer eRx & Pharmacy Benefit Management Platform Payer Insurance Management Solution Health Insurance Community Platform Regulator E-Prescribing Platform Pharmacy Enterprise Solution Clinical Enterprise Solution Scrubber Enterprise Solution .

Health Insurance Community Portals
Portals that serve the health insurance community stakeholders: providers, payers, regulators and insured members. Community portals provide various capabilities such as informative pages for public audience and provider/payer system users, provider/payer online training registration system and provider/payer technical support ticketing system.
The solution also provides a registration and access control managed gateway for various connecting health insurance platform solutions such as applications, data dictionaries, and analytics. Moreover, the solution has medical profilers for healthcare facilities, its departments, and associated doctors, and covered plans/products at their facilities.
In addition, the solution profiles the payers (Insurance Companies and Third Party Administrators) for its offered healthcare insurance products and its networks.
Health Insurance Product Marketplace
A solution that allows payers or regulators to promote health insurance products. The marketplace provides clients with search capabilities for detailed information about the insurance products including benefits, limits, provider networks, and can download handbooks and policy documents. The solution allows creating individual and corporate purchase orders with detailed information to enable completing purchasing transactions online. The solution provides payers with a management system to build and publish insurance products and generate policies in addition to managing requests/orders from clients. Moreover, the solution provides the ordering client with a profile management tool. The system is connected to various online payment gateway options.
Transactions Post Office
A solution that facilitates and manages all transactional messages between the different stakeholders. Transactions will be validated on multiple levels to ensure the provision of minimum data sets, correct formats, authorized users, and the utilization of standard data sets mandated by the client. Clean transactional data will be logged into the post office database to enable the analysis and evidence-based decision making to increase the quality of healthcare services in a cost-effective approach. Transactions include but not limited to e-authorization, e-claim, e-prescription, registry transaction and more.
Payer Transaction Manager
Although Payers are expected to integrate directly through web services from their existing and legacy management and information systems to providers’ solutions or regulators post offices to enable their transactions, it is expected that some Payers do not have the IT capacity to enable such integration. Accordingly, a transaction manager would be offered to enable payers to generate, manage, submit, and receive transactions.
It includes generating and managing the following transactions: Remittance Advice, Eligibility Response, Authorization Response, Message Post. The solution enables receiving and parsing the following transactions: Claim Submission, Eligibility Request, Authorization Request, Prescription Request, and Message Download.
Provider Transaction Manager
Although Providers are expected to integrate directly through web services from their existing, and legacy management and information systems to payers and regulators to enable their transactions, it is expected that many Providers do not have the IT capacity to enable such integration. Accordingly, a transaction manager is offered to enable providers to generate, manage, submit, and receive transactions.
It includes generating, managing and submitting the following transactions: Claim Submission, Eligibility Request, Authorization Request, Prescription Request, Referral Post, Message Post. The solution enables receiving and parsing the following transactions: Remittance Advice, Eligibility Response, Authorization Response, Prescription Response, Referral Download, and Message Download.
Dashboards & Analytics
A solution used to analyze data uploaded or downloaded by users (providers or payers). Users can access their own information and analyze various aspects. Real-time dashboards on data collected from various solutions on the platform mainly the central health post office.
Monitors for quality indicators, potential fraud, waste & abuse are the focus of these analytics and dashboards. It covers indicators for efficiency, clinical outcomes and patient experience. These monitors are offered through Nano Health’ existing built solutions such as Nano bI.
Checks for Drugs and Services
Nano Health provider different types of checks covering the spectrum of medical codes used in the healthcare community, including diagnosis, drugs & medical services (labs, radiology, procedures, dental, consumables and more).

NANO MED Medical Coding Edits: A decision support system developed by Nano Health that enables industry stakeholders to check and alert on potential mistakes and reviews in medical coding. The solution provides more than 16+ Million Edit Combination Checks grouped into Medical Necessity/Cross Coding Checks ICD10AM – CPT, ICD10AM – HCPCS, ICD10AM – CDT ICD10CM – CPT, ICD10CM – HCPCS, ICD10CM – CDT ICD9CM – CPT, ICD9CM – HCPCS, ICD9CM – CDT ICD9CM mapping to ICD10CM ICD10CM mapping to ICD10AM , as well as Coding Checks. The solution also manages edits for bundling, mutually exclusive coding, duplication, maximum allowed frequencies, services relationship errors, encounter related edits. The system is totally independent and based on guidelines from recognized bodies such as CMS, AMA, ADA, local authorities, and other recognized societies. A decision support system for medical coding edits including millions of edits validating medical necessity, coding error and more.

Drug Administration & Control System: A decision support system to monitor drug safety and medical necessity (interactions, indications, contraindications and more). The system is built to cater to local settings including localized medications, prescribing trends, and commonly encountered safety issues pertaining to drug and medication dispensing.

Nano Insurance Management System
We are in the business of keeping insurance payers fit. As insurance solutions provider experts, Winsoft can provide you with the precise information and methodology needed to systematically and continuously optimize your revenue. What is NANO-IMS? The NANO-IMS Insurance management system is a web-based ERP application designed to control and manage the process in insurance companies and third-party administrators, it works in modular bases which allows the different departments to interact and meet their needs for maximum functionality and usability NANO-IMS has all the international aspects and configuration to match the maximum of the clients requirements over the world, It has been built in such way to allows you customized the functionality and the templates behind in the way suite
  • Network
  • Quotations and online payment
  • Underwriting
  • Claim processing
  • Auto eClaim processing
  • Approvals and call center
  • Portals for providers, members, brokers, and clients
  • Members mobile app
  • Reinsurance management
  • Bi – Analytics engine tools
  • Finance
  • Human Resources, time attendance, and payroll management Modules
Nano Insurance Management System (Nano IMS) is a platform for insurance companies and third-party administrators (TPAs) that enables automated real-time adjudication for the vast majority of the healthcare authorizations and claims with advanced modules to administer its processing capabilities in relation to plans & products parameters such as benefits, groups members, networks and others aspects. Nano IMS offers as well e-authorization and e-claim management modules for those transactions that require human intervention by the processers. Nano IMS has a transaction management & tracking module that enables users to real-time track transaction received and generated by Nano IMS. Moreover, Nano IMS has a dynamic reporting, dashboard and analytical module with a user-friendly interface to create standard and ad-hoc reports and dashboards. Nano IMS can be integrated with other products such as post office, providers’ transaction managers, decision support systems and much more.
Insurance Registries
Regulators and payers are to standardize the definitions of various health insurance terminologies including those for products and policies. In addition, standard profiling is expected for the person (insured member), payer, and provider.
The process of updating the above registries is expected to be a transaction-based process. However, many Providers and Payers lack the necessary IT capability to develop systems to generate, update and manage through transactions. The registries would provide a user-friendly access interface to enable the generation and management for these registry transactions.
The following are the registries provided: Person Registry, Product Registry, Payer Registry, Provider Registry and Complain Registry.
Person Register transaction services shall enable the Payer from sending the insured members details. Product Register transaction services shall enable the Payer to register the healthcare insurance products that are being sold under its portfolio. Payer Register transaction services facilitate the registration of Payer related details as per the requirements. Provider Register transaction services facilitate the registration of Provider related details as per the requirements. Complain Registry is a system to capture health insurance stakeholders complains. The system coordinates and manages the requests (complains, suggestions, responses, messages) with a priority and escalation controlled mechanism.
e-Prescribing Solutions

Doctor Portal

Nano PBM doctor portal contains facility to submit and track requests status with references, and ability to print e-prescriptions that contains the digital reference that patients can use at the pharmacies allowed for his/her polices.
With the simple straight forward screen doctors can practice adding new e-Prescription case by log into The NANO PBM e-Prescription portal and submit the patient case details, diagnosis and drugs then submit the requests, in case the patient was invalid or provider (doctors) out of network system will stop at that stage directly and alert doctors about it, for instant (system will say member is in active, or, card is not found, or you are out of network cannot treat this patient as direct billing ....).

Pharmacy Portal

Once the pharmacy logged in, they can see simple dashboard that helps them to do their daily work supporting the patients flow, they have the ability to see the below: Landing action page with options to navigate to dashboard, list of prior requests, navigate to the analytics (If it was enabled by payer), search prior request or submit a new prior request.
  • Submit new prior request
  • Submit new prior request with e-RX (e-Prescription)
  • Search historical requests, and export the data if needed
  • Submit claims (if not set by payer as auto submission enabled, if payer set auto submission the pharmacist cannot decide because
    once they dispense the claim will be sent to the payer electronically via NANO HUB).
  • Brows the dashboard.
Pharmacy Benefit Manager (PBM)
A set of solutions that serve payer needs to manage PBM and eRx requests.

e-PBM Switch: A Pharmacy Benefit Management transaction switch that connects provider solutions with payer solutions and the regulator's post office. The switch also runs a rule engine to validate transactions.

e-PBM Engine: A PBM engine to respond to ePrescriptions and pharmacy claims. PBM services are currently provided through Nano Health.

Health Insurance Data Dictionary
A unified health language and its structured schema to be communicated on a health insurance platform or system. It also includes business and validation rules, transaction flows, web services documentation, coding guidelines and more. It includes definitions of various fields and code sets. Standard code sets are fully maintained through a list management utility decoupled from the schema of the solution. A detailed schema is provided for accommodating the Data Dictionary requirements and transaction types used. XML file formats, as well as XSD, are to be provided. Clear rule structures and numbering shall be provided to ensure easy delivery to the end user. Rules are managed through an electronic utility with a user-friendly user interface that will enable easy user access to add, update, or retire a given rule. In addition, clear business documentation to provide a clear understanding for the business user in relation to the system functionalities and requirements are populated.
Drug Databases & Registries
A key aspect to manage and monitor medication utilization properly in any community.
Drug Registry System: A system developed to manage an authority's drug registries. The system enters information, codes the information, and generates the drug codes for each drug based on the information entered. The system is managed through a privilege control and audit trail.
Drug Databases: A centralized structured drug database comprising of commercial and scientific details of drugs. Currently, it comprises of several countries’ drug databases, the system links the core drug codes to international decision support systems.
Pharmacy Management System
Pharmacy Management System is developed to serve pharmacies with a comprehensive solution to process and manage the daily transactions efficiently and appropriately with advanced and reliable technology. The solution is developed to be compliant with the health authorities' requirements specifically with e-Prescribing, Pharmacy Benefit Management (PBM) and eClaims management.

Modules: e-Prescription | e-Claims & Insurance Management | Pharmacy Benefit Management (PBM) | Point of Sale | Inventory Management | Drug Information | Patient Records | Financial Management | Basic Reports & Analytics | Rx Labels | Electronic Ordering for Chain Pharmacies | Admin Management | Add-Ons (Safety Checks, advanced Dashboards, and Analytics).
Clinic Management System
Apex CMS is an online clinic management system (CMS) for healthcare providers (clinics and medical centers), enabling them to manage their operations and patient records efficiently. The system is highly customizable and is capable of integration with medical devices (with appropriate APIs.)
Modules: Registration and Admission | Dental Module | Appointment System | Outpatient Management | Laboratory Ordering | Radiology Ordering | Billing and Accounting | Medical Records | E-Prescriptions | Medical e-Authorizations | E-Claim Management | Basic Reports |Add-Ons (Dashboards, CEED, Drug Checks, Dashboards, and Analytics).
Provider Insurance Scrubber
An advanced dynamic insurance transaction scrubber serving providers’ needs to validate eligibility, benefit coverage, complex insurance rules and more. The solution includes capabilities to interface with hospital information systems, payers’ solutions, and regulators post office systems. The system enables automated real-time scrubbing for the authorizations and claims with advanced modules to administer its processing capabilities in relation to plans & products parameters such as benefits, groups members, payers, and others aspects.
Computer Assisting Coding System
A solution that assists providers and payers to code medical notes/records and text-based (non-coded) authorizations and claims, whether data is coming from patient medical records or from insurance authorizations and claims records. The solution is based on established logics in differentiating between negations, history and encounter patient details. The system can accommodate various diagnosis and activities coding sets and can be linked to various decision support systems.
Payer eRx & Pharmacy Benefit Management Platform
A solution is intended to create a comprehensive platform to manage medications and their real-time authorization of e-prescriptions, e-authorizations, and e-claims between a payer and its provider network. The solution includes the following components:

e-Prescribing Solutions | Pharmacy Benefit Manager | Dashboards & Analytics | Drug Databases & Registries
Payer Insurance Management Solution
The solution allows the payer to manage its authorizations and claims processing internally. It includes adjudication, analytics, clinical checks, and transaction management. The system can handle e-authorizations, e-prescriptions, and e-claims and process it real-time and manually. The solution includes the following components:

Adjudication Insurance Management System | Payer Transaction Manager | Code & Drug Checks | Dashboard & Analytics
Health Insurance Community Platform
A comprehensive insurance community platform that is intended to establish a connected community between regulators, payers, and providers in addition to serving the insured members community. A set of solutions that provides comprehensive capabilities with a standard language to be communicated via an online portal or web service based integrations. This covers all regulator, payer, and provider-related transactions including e-prescriptions, e-referrals, e-authorizations, and e-claims. The platform includes the following components:

Health Insurance Community Portal | Health Insurance Product Marketplace | Transaction Post Office | Payer Transaction Manager | Provider Transaction Manager | Dashboards & Analytics | Checks for Drugs and Services | Insurance Registries | e-Prescribing Solutions | Health Insurance Data Dictionary | Drug Databases & Registries
Regulator E-Prescribing Platform
A solution that is intended to create a comprehensive platform to manage medications and their real-time authorization of e-prescriptions and its related e-claims between the insurance community of payers and providers. The solution includes the following components:

e-Prescribing Solutions | Transaction Post Office | Dashboards & Analytics | Insurance Data Dictionary | Drug Databases & Registries
Pharmacy Enterprise Solution
A solution comprising a suite of systems to manage the pharmacy day-to-day business related to inventory, sales, safety, medical necessity edits, analytics, insurance, eRx, and patient record management. The solution includes the following components:

Pharmacy Management System | Checks for Drugs and Services | Dashboards & Analytics
Clinical Enterprise Solution
A solution comprising a suite of systems to manage the clinic day-to-day business related to encounter management, related services orderings, analytics, insurance, and patient record management. The solution includes the following components:

Clinic Management System | Checks for Drugs and Services | Dashboards & Analytics
Scrubber Enterprise Solution
A Solution comprising a suite of systems to manage large enterprises needs related to insurance transaction management. It includes a scrubber for insurance transactions such as e-authorizations, e-prescriptions, and e-claims with a robust rule engine to manage benefits and complex insurance rules. In addition, links to clinical checks and advanced analytics for enhanced capabilities. The solution includes the following components:

Provider Insurance Scrubber | Checks for Drugs and Services | Dashboards & Analytics

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