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Processing of medical claims

  • Capturing of patient information on debtor's system (with positive validation of patient's medical aid details - where available - on the internet for accurate real time submission) 
  • Accurate capturing of daily debits (using ICD10 codes provided by specialist) - if marked as PMB we will assist with the relevant code
     
  • Electronic submission of claims to medical schemes with proof obtained of submissions (and re-submission of rejections);
     
  • Printing of a detailed Audit Trail for verification purposes on weekly basis.
     
  • Reconciliation of remittance advices received from medical schemes
     
  • Reconciliation of bank statements to verify payments of medical aids and patients
     
  • Capture of payment as verified on bank statements
     
  • Monthly statements printed and sent to patients via email or sms
     
  • Comprehensive management of debtors, patients liable and medical aid accounts(constant follow-up on accounts from submission to full settlement)
     
  • Legal collection letters sent to 60 day accounts
     
  • Payment arrangements in writing where applicable
     
  • Final demands sent to 90 day accounts
     
  • Non/bad payers handed over to DMA (Daily Morgan Association) that deals with the collection.
     
  • Monthly financial reports to the client with a full debtor's report