Negotiated tariff workflow
Providers and HMOs can create, send, counter and approve tariffs. The approved tariff becomes the payable benchmark used later in service assessment.
Case study
Vinzel / Cordily Connectvinzel.cordily.com ↗
Health-benefit decisions that stay traceable from eligibility to remittance.
A multi-party health-benefits operating platform connecting HMOs, employers, providers, enrollees and dependants through plans, tariffs, encounters, authorisation, claims, remittance and renewal.
9declared user roles
6encounter workflow queues
7benefit decision outcomes
40+role-specific routes
The operating problem
Eligibility, tariffs and claims could not live in separate truths.
The challenge
Healthcare administration crosses organisations with different responsibilities. The system had to keep plan eligibility, negotiated provider tariffs, encounters, referral and authorisation rules, claims and remittance connected without turning clinical or commercial exceptions into automatic commitments.
The design question
How do you let routine activity move quickly when the rules are clear, while making every exception visible to the HMO or provider team that has authority to decide it?
The connected operating journey
Plan rules, encounters and claims stay connected to the same member context.
01Plan & tariffCoverage and negotiated prices
→02EnrolPolicy, staff and dependant records
→03EncounterProvider service record
→04AssessBenefits, tariff and authorisation rules
→05SettleClaims, remittance and payment
→06RenewEligibility and plan continuation
What the system connects
Apply plan and tariff rules automatically. Escalate exceptions visibly.
Rules-led benefit assessment
Policy status, plan cover, benefit caps, care type, referral rules and agreed tariff shape whether a service is eligible, balance due, pending approval or held as an exception.
Controlled claims and remittance
Encounter services move through authorisation, claim, payment-advice and remittance workflows while preserving the underlying service evidence.
Employer and enrollee operations
Employer teams manage staff, dependants, plan assignment and renewal while enrollee policy and benefit context stays connected to the commercial plan.
Role-scoped portals
Core admin, HMO, employer/client, provider, staff and dependant contexts each receive access appropriate to their role on the shared operating record.
Management visibility
Cases, service authorisations, payment advice, remittance breakdowns, activity logs and analytics views expose where work is waiting and why.
What changed
Fewer disconnected benefit decisions. More traceability between plan rules and payment.
Healthcare administration crosses organisations with different responsibilities. The system had to keep plan eligibility, negotiated provider tariffs, encounters, referral and authorisation rules, claims and remittance connected without turning clinical or commercial exceptions into automatic commitments.
Plans, tariffs, enrolment, encounters, authorisations, claims and payment decisions now form one controlled lifecycle with explicit exception handling and auditable handoffs.
The system does not pretend every healthcare decision is automatic. It makes the rules repeatable and the exceptions impossible to hide.
Benefits administration review
If benefits administration crosses too many disconnected records, show us the decision points.
We will map eligibility, pricing, approvals, claims and payment handoffs and identify where stronger controls or connectivity can remove avoidable work.