Healthcare payers
Visibility and control over every service you fund.
Health funds, prepaid plans and public systems with unified data, full traceability and paperless audits.
The problem
Little control over what you pay for
Manual audits, fragmented data across providers, hard to control both cost and quality simultaneously. Uncontrolled spending grows without clear signals.
Services arrive from multiple providers in different formats and with inconsistent data.
Manual audits delay authorizations and payments and consume hours of team time.
It is hard to verify which service was delivered before approving payment.
Costs, quality and compliance are reviewed separately, without a shared view for decisions.
The solution
Data layer for payers
Unifies provider information and gives control and traceability over every funded service.
How Simfinix works
- Real-time service dashboard by provider
- Cost audit and control without spreadsheets
- Quality and compliance indicators
- Reports to make better decisions
How it works
From admission to billing, on a single platform
This is how Simfinix covers each patient's full journey.
- 01
Admission
The patient enters the system
The front desk logs the request with the patient's and the case's details. With the ID number, Simfinix checks whether an active case already exists.
- Complexity A, B, C or D
- Agreement, modules, services and supplies
- Case operator assigned
- 02
Case
One case, the whole follow-up
A confirmed request becomes a case: the hub where authorizations, scheduling, progress notes and billing are managed.
- Operable and reportable cases
- Status of every authorization
- Direct access to each operation
- 03
Care plan
What is provided, how often and until when
Authorized services are loaded with their frequency and validity, along with supplies and the agreement with each professional.
- Frequency and validity drive the schedule
- Supplies with vendor, cost and orders
- Care agreement per professional
- 04
Providers
The right professional, close to the patient
The map search filters by specialty and the patient's address, showing each provider's work area and status.
- Map with work area and address
- Active, possible and cancelled statuses
- Licenses verified with SISA
- 05
Schedule
Every visit, on the calendar
Visits are scheduled within what was authorized: the platform checks hours on shifts and frequency on visits.
- Calendar or list view
- Overlap warning on shifts
- Blocked if frequency is exceeded
- 06
Care and progress notes
What happened at each visit, on record
Each visit gets a progress note with its type, description and attachments, and you choose who sees it: the payer or the providers.
- Notes with attachments
- Visibility by recipient
- Tasks for the team
- 07
Billing
Billable or debitable, no spreadsheets
With the care plan in view, each visit is marked billable or debitable. Debiting requires a reason.
- Split view with the care plan
- Bulk status changes
- Mandatory reason when debiting
- 08
Consolidation
From the case to the ERP
Billable visits are consolidated and reported to the billing system. Each submission creates a downloadable settlement.
- Individual or grouped submission
- Settlement as PDF
- Retry if the ERP fails