TOSHFA - 2026 Pricing, Features, Reviews & Alternatives

TOSHFA is Acess Meditech Group’s cloud-based health insurance administration platform, developed to meet the dynamic and complex needs of health insurers and third-party administrators (TPAs). Built with a modular architecture and scalable cloud infrastructure, TOSHFA offers insurers a fully digital ecosystem to manage everything from policy issuance to claims settlement — with real-time insights, process automation, and complete operational control.

The platform is engineered to solve the specific challenges that health insurance stakeholders face, including fragmented systems, manual claims processing, lack of data visibility, and difficulty complying with evolving health sector regulations. TOSHFA offers a powerful combination of efficiency, configurability, and intelligence — enabling insurers and TPAs to scale operations, reduce processing time, and enhance stakeholder satisfaction.

End-to-End Functional Modules

TOSHFA covers all the core components required to run a health insurance operation. Its integrated modules include:

• Quotation Engine: TOSHFA supports dynamic, rules-driven quote generation based on customer profile, group size, and plan selection. The quote engine enables real-time pricing, benefit configuration, and quote approval workflows.

• Policy Administration: This module facilitates policy creation, premium management, endorsements, cancellations, renewals, and member lifecycle management. It supports hierarchical group structures, multiple plan tiers, and policy-level customizations, making it ideal for both retail and group health business models.

• Claims Management: TOSHFA offers a complete claims processing module, covering pre-authorization, hospitalization, reimbursement, and settlement workflows. The platform supports multi-level approval hierarchies, medical coding (ICD/DRG), automated validations, and integration with provider billing systems to minimize fraud and improve processing speed.

• Hospital Network Management: This feature allows TPAs and insurers to manage provider onboarding, credentialing, rate negotiations, and service-level agreements. It also enables real-time claims routing, provider performance tracking, and contract-based pricing logic.

• Master-Level Data Management: TOSHFA includes robust tools for managing master data sets across the ecosystem — such as benefit definitions, diagnostic codes, treatment packages, provider details, and pricing matrices. This ensures standardization and clarity across operational units, enabling accurate decision-making and regulatory reporting.

• Reporting and Analytics: With 360-degree visibility into operations, TOSHFA provides dashboards and real-time reports for underwriting, claims performance, network utilization, and compliance. Customizable reports can be generated for management, clients, and regulators — supporting both strategic planning and day-to-day operations.

Automation and Efficiency

What makes TOSHFA especially valuable is its emphasis on automation. Through process triggers, rule-based validations, and digital workflows, the platform significantly reduces manual intervention. Key automation features include:

• Auto-adjudication of claims based on predefined rules

• Automated notifications for approvals, rejections, and renewals

• Integrated document verification and OCR compatibility

• Smart flagging for anomalies or potential fraud cases

This results in faster processing times, lower administrative overhead, and improved service turnaround for both members and providers.