Case Studies

Case Study 1 – Large International Insurer

  • Services offered by Medscheme:
  • Receipt of Claims (Inpatient & Outpatient)
  • Medical Coding
  • ICD 9 Coding
  • Data Capture and Transcription of Claims
  • Adjudication of Claims


Key Benefits:

  • Improvement on Turnaround Time for claims refund from several days to 6 hours only.
  • Approximately 50% savings in administrative cost




Case Study 2 – Large Government Employee Medical Scheme

  • Services offered by Medscheme:
  • Pharmaceutical Benefit Management
  • Hospital Benefit Management
  • Protocol and Policy Development
  • Ambulatory Benefit Management
  • Member Care Co-ordination
  • Disease Management
  • Provider Network Management
  • Customer Care Centres
  • Member Communication Management
  • Fraud Management


Key Benefits:

  • Savings on Pharmaceutical Benefit Management estimated at Euro 4.5 Million per annum
  • Savings on Hospital Benefit Management estimated at Euro 4.5 Million per annum




Case Study 3 – Employer Based Medical Fund in Petrochemical Sector

  • Services offered by Medscheme:
  • Membership Administration
  • Claims Administration
  • Profiling and Data Analytics
  • Provider Network Management
  • Hospital Benefit Management
  • Pharmaceutical Benefit Management
  • HIV Disease Management
  • Member Care Co-ordination

Key Benefits:

  • Direct savings on Hospital Benefit Management of Euro 7 Million per annum
  • Return on Investment for interventions consistently above 200%
Copyright © 2016 Medscheme Mauritius