The MediSwitch switching mechanism will initially route claims from pharmacies electronically to Medihelp, reducing the time it takes for claims to reach the scheme and speeding up the assessment process and ultimately the payment of claims by Medihelp.
Subsequent projects will cater for similar functionality for transacting with other service providers such as general practitioners and hospitals.
Anton Rijnen, Acting General Manager of Medihelp comments: "With MediSwitch, we hope to receive the maximum amount of claims from service providers electronically.
"Up to now we are confident about the integrity of the data that will pass through MediSwitch and the integrity of the entire electronic process."
MediSwitch, through its strategic alliances with major practice management software vendors provides Medihelp with the capability of receiving thousands of electronic transactions daily without the problems of different direct connections to each individual service provider.
Says Rijnen: "Medihelp currently receives an average of 27% of all directly submitted claims electronically. We aim to dramatically improve on this by using MediSwitch.
"Medihelp has been pro-active in making the claims processing process as transparent and accessible to service providers as possible.
"We already have a sophisticated Internet audit trailing system in place whereby providers can log on to our Web site and confirm membership and check claims information and the medical benefits available. Moreover, Medihelp's existing turnaround time for processing claims is currently twelve days and details of payment runs are updated and reflected on a daily basis.
"Now, MediSwitch compliments our drive to process claims payments even faster by receiving claims electronically. There is the added benefit of extended audit trail facilities for processed claims effected by MediSwitch's electronic transacting technology.
"We believe that the biggest benefit for service providers will be the elimination of HUB's and VAN's traditionally associated with EDI networks, which have mostly caused time delays in claims submissions.
"With MediSwitch, communication with the Scheme is direct."
Says Alan Day, MediSwitch's managing director: "With approximately 170 000 principle members, Medihelp receives significant claims volumes (electronic and paper-based) from service providers and members. MediSwitch is confident that it will substantially increase the volume of electronic claims that come directly from service providers as they grow increasingly confident in the delivery of data through MediSwitch."
"Since its incorporation into the USKO Group14 months ago, MediSwitch has been enhanced continuously and is fast achieving an enviable reputation for its comprehensiveness as a single connection communication system, affordability and ease of use."
Says Usko's CEO, John Beck: "From USKO's perspective, the Medihelp project is indeed a very exciting development for MediSwitch and it goes some way to justify our confidence in the extensive investment we have made in developing the MediSwitch technology."
Rijnen concludes, "We ultimately aim to receive the majority of claims electronically. We believe that MediSwitch, in their ability to deliver electronic transactions to Medihelp, is a crucial partner in our drive to become an increasingly active and, indeed, major player in the South African Healthcare environment."
Editors note
MediSwitch, a division of JSE listed technology group, USKO has offices in Johannesburg and Cape Town.
The MediSwitch Virtual Private Healthcare Network (VPHN) provides a single communication connection for SA healthcare service providers to effect real-time electronic transfer of medical fund membership details and claims related information.
Its business objective is to establish a secure connection between service providers and medical fund administrators so that it can guarantee the delivery of electronic transactions.
To date, MediSwitch has invested in excess of R25 Million in the development and testing of the switch. This investment, which includes the embedding of a communication interface into the major doctor and pharmacy management software systems, will offer service providers instant access to the switch's on-line, real-time electronic transacting functionality.
This also suggests that providers can retain existing investments in their current computer systems. They do not need to re-train on a new system; they will not require any additional hardware or software and, they no longer require any additional third party claiming systems on their desks.
The many time and cost saving features of MediSwitch include less manual data entry, less paperwork, increased flexibility, improved cost control, improved cash flow and greater accuracy of information.
With the focus on real-time electronic transfer of information and, ultimately, the elimination of paper based claims, service providers can now exploit the power of having the right information available, at the right time and in the right format.
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