Products & Services

Medscheme International provides the full spectrum of quality health administration, health risk management and business process outsourcing products and services including:

  • Capacity to process medical fund and health insurance membership and claims
  • Real-time interfacing and processing of transactions together with communication to members and healthcare providers.
  • Dedicated client contact centres
  • Fund management
  • Electronic customer care services
  • Special investigations (benefit exploitation, over-servicing and fraud)
  • Evaluation of technologies, pharmaceuticals and clinical practice, cost and quality
  • Actuarial and health informatics and analysis
  • Hospital authorisation, case management and Disease Management Programme
  • Intelligent data management and analysis
  • Health risk management protocol formulation and review



Medscheme’s offering includes strategic support services and operational services.

Strategic Support Services includes:

  • Regular and ad hoc clinical risk reports and analysis.
  • “Value” and operational reporting.
  • Patient risk management information.
  • Doctor behaviour and performance monitoring.
  • Hospital cost projections and performance monitoring.
  • Clinical outcomes models.
  • Oversight of health risk management reports for all medical schemes.
  • An annual actuarial review if contracted by a scheme.
  • Monitoring scheme financials and risks.
  • Consulting services.

 

Operational processes and systemsare equipped to apply the clinical funding policies for both in-hospital and ambulatory care.The range of services covers:

  • Hospital risk management
  • Chronic medicine risk management
  • Dental, optometry and pathology risk management
  • Healthcare professional risk management (network contract management) programmes to improve quality and cost of healthcare delivery and implementation of innovative reimbursement models
  • Beneficiary (clinical) risk management (including facilitation of disease-specific management)

 

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