One of South Africa`s largest independent administrators of medical schemes, processing an average of 3.8 million claim lines for 33 medical schemes every month, Medscheme commits its reputation to its strategic and technological ability to manage information.
The task is complicated by the policy, administrative and pricing turmoil created by the ongoing transformation of the South African healthcare industry.
As a result, Medscheme`s managed care and administration systems and product lines have to be constantly updated and enhanced to comply with legislation and deliver innovative business solutions for the administered schemes. All of which creates an extremely fluid situation for Medscheme`s 3 200 internal users of its three major systems - NEXUS, UMS and Medware.
Quickly and effectively resolving queries from users is therefore critical - not only in terms of keeping hundreds of thousands of medical scheme members and medical providers happy but also providing appropriate and ongoing management information to trustees of medical schemes to enable them to implement optimal benefit structures suited to their individual beneficiary profile.
This is why Medscheme turned to FrontRange`s service and support solution, HEAT - used by 7 500 companies in over 70 industries to automatically track, escalate and report on helpdesk calls. Extensible via Information Technology Infrastructure Library (ITIL) compliant modules to enable best-practice, HEAT is the world-leading enabler of cost-effective incident, problem, change, knowledge and service level management for mid-market and distributed organisations.
Although Medscheme has used HEAT since 1999, the solution has been extensively customised in recent months to provide greater clarity of Medscheme-specific process management.
"The permutations for support calls are immense," says Kevin Wright, Medscheme chief executive officer. "The rules for the 33 schemes (each with at least three to four plan options) are revised annually. We also develop, test, implement and maintain to the very last detail all the fee structures, provider and member master data and managed care rules. And, we simultaneously implement leading edge technology solutions, revising (and sometimes decommissioning!) existing system functionality. Because of the specialisation involved, queries have to be routed to appropriate support groups, each of which follows a different procedure to resolve the query.
"A request for a functionality change, for example, is analysed by the IT support staff, assigned to a review committee that checks the quality of the change specification and then forwarded to developers. When the changes are complete, we test them. If successful, the changes have to be implemented and users alerted to and possibly trained on them. HEAT manages that workflow for us, giving us an audit trail and alerting us to delays.
"By contrast, a payment query might go to our financial IT division, where a different process is followed. HEAT tracks that process, too. But users have not always known how to categorise their calls and many have fallen through the cracks. We`ve therefore customised HEAT to make the categories more obvious and to track calls based on the type of query and the responsible product stream rather than how it was assigned - massively improving our efficiency and responsiveness.
"We couldn`t have done it without HEAT. Its rich functionality and high levels of automation and ease of use enable us to pull the whole organisation together. And, because we`ve now begun to explore HEAT`s functionality, we`re developing other ideas for streamlining our capabilities and thereby enabling Medscheme to understand just how far it can push its systems in order to enhance its offerings to the market."
FrontRange Solutions SA managing director, Tracey Newman, says that while Medscheme`s demands on HEAT are unusually complex - "most companies don`t have to cover so many different internal requirements and processes" - the solution`s capabilities are a long way from being stretched." About FrontRange Solutions
FrontRange Solutions is the leading independent provider of service management and CRM applications designed specifically for the SME and distributed enterprise markets. Our applications and solutions allow organisations to manage extraordinary customer relationships and provide exceptional service. The company is headquartered in Pleasanton, California in the United States, with offices in Colorado, United Kingdom, Germany, Italy, South Africa, Australia, China and Singapore.
FrontRange product families include GoldMine, for customer relationship management, team-based contact management and sales forces automation solutions; and HEAT, for complete service management including Help Desk, Knowledge Management, Asset Management and Service Level Management.
FrontRange Solutions drives business decisions for market-leading companies such as Affinity Logic, Barloworld, British American Tobacco (SA), Nissan, Coris Capital, Daimler-Chrysler, Datacentrix, De Beers, Financial Services Board, Johannesburg Water, Standard Bank and Volkswagen SA.
FrontRange has earned more than 60 major industry awards, including: Software Magazine "Hot 500," Windows Magazine "Win 100," Call Center CRM Solutions Magazine Editor`s Choice, RealWare Award for CRM, WinMag.com WinList Award, Entrepreneur Magazine Best Software, Call Center Solutions Product of the Year, and InformationWeek Top 50 Application Service Providers.
For more information, please visit our website at www.frontrange.co.za or contact us on (011) 325 5600.
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