G8 Nexum gives your HMO one platform to run everything - claims, pre-auth, capitation, fraud detection, finance, and AI. Purpose-built for Nigerian health insurance operations.
In manual HMO operations, duplicate claims, tariff padding, and ghost enrollees are only discovered at year-end audit - after the money has left the building.
Claims tracked in spreadsheets. Officers lose batches. No audit trail. HCPs frustrated by delayed payments. Corporate clients complaining about turnaround. SLAs broken weekly.
Capitation calculated from guesses, not live headcounts. PA approvals existing only in someone's WhatsApp DM. No cross-HCP pattern visibility until the damage is done.
G8 Nexum covers the entire operation - from the moment a claim is submitted to the moment payment hits an HCP's account. No gaps, no workarounds, no spreadsheets.
Structured digital submission, 10 automated fraud checks at entry, real-time status board, full audit trail on every action.
3-tier approval workflow, unique PA codes, TAT countdown timers, emergency 4-hour expedited path. No more WhatsApp DM approvals.
Members, dependants, bulk CSV import, live benefit tracking, digital health ID card, expiry alerts.
Accreditation records, agreed tariff schedules, blacklisting, performance scoring, capitation rates per tier.
Monthly capitation cycle with live headcount snapshots, variance flagging, payment batching, bank file export.
10 automatic checks per claim plus monthly AI clustering that surfaces billing rings invisible to per-claim analysis.
7 built-in report types - claims aging, loss ratio, HCP performance, cost by corporate - each with AI executive summary.
Staff portal, corporate client self-service portal, and member-facing enrollee portal - all included at no extra cost.
Most Nigerian HMOs discover fraud at year-end audit. By then, millions have already left the building. G8 Nexum runs 10 automated checks the moment a claim is submitted.
Upload a hospital receipt - PDF or image. AI reads it and extracts patient name, diagnosis, itemised procedures, and total amount. Zero manual re-entry.
Paste claim text - AI identifies claim type, suggests ICD-10 codes, flags if PA is required, and gives a confidence score with reasoning.
AI analyses risk score, amount, fraud flags, and PA status to recommend the correct processing queue and urgency level for every claim.
Every report has an AI Summary button. Returns a 2-sentence executive brief, 5 bullet insights, and one actionable recommendation. Instantly.
Monthly DBSCAN machine learning over all fraud flags. Surfaces billing rings invisible to per-claim analysis. Each cluster labelled in plain English.
Staff ask claims workflow and NHIA regulation questions. Enrollees ask benefit questions via HealthBot. Three persona modes. 24/7, no call centre.
All plans include a 30-day satisfaction guarantee. If the system doesn't meet specification, we refund your first payment.
For regional HMOs, TPAs & startups
For established HMOs with 10k–50k enrollees
For national HMOs, SHIA, government
Own the software forever
All plans include onboarding & training. Talk to us about custom pricing for SHIA or government-affiliated HMOs.
No slides. No generic demo. We walk through your actual claims process, your fraud scenarios, your capitation challenges - in the live system.
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