Med ClaimAssist Services
Our services to corporate clients span from providing support to healthcare intermediaries on claim queries to providing Value Added Products (VAPs) on insurance products. See below for the full range of our corporate services.
MCA supporting UMAs administering
gap insurance products
We provide a service to Underwriting Management Agents (UMAs) that administer gap cover
insurance products.
MCA currently provides its specialist service to 6 UMAs for 7 different gap cover insurers
Our clients provide more than 50% of gap cover policies in South Africa
Collectively save our clients approx R1.5 million per month
Two critical features underpin our ability to do this:
o Clinical know-how built into our system and the medical scheme experience of our staff. These capabilities are not available within UMA’s currently administering gap cover products
o The aggregation of the number and value of claims referred to MCA enables MCA to negotiate discounts from providers more effectively than each UMA attempting to negotiate these themselves
Our service involves:
o Easy referral of claims into MCA for action
o Liaison with the billing practice and patient/policyholder to ensure validity and accuracy of the claim
o Identifying billing errors in the provider’s claim and interacting with the provider to get these corrected
o Identifying clinical issues that have resulted in a claim being partially paid by
the scheme
o Working with the medical scheme to correct payment errors where a claim has been incorrectly underpaid. This usually involves PMB claims
o Negotiating discounts with doctors in exchange for direct payment of the claim
o Establishing and maintaining a network of providers in which a standing direct payment arrangement is agreed in exchange for automatic direct payment (provided conditions are met)
Service levels:
o Claims worked on are reported on daily to the client (UMA)
o Average turnaround time is 4 working days
o Where claims take longer than 4 working days the member and/or broker are contacted proactively with an explanation of what MCA is doing and aims to achieve.
MCA as a component of EAPs
Our service is a good fit and of value for employees on medical schemes and who benefit from Employee Assistance Programmes (EAPs). This gives employers peace of mind that their employees are not spending time, energy, and angst trying to get payouts that they are entitled to from medical schemes.
Clinical IP available via API
Our system and process has, at its core, an extensive database of clinical intellectual property (Clinical IP) which enables the system to identify coding errors, clinical inconsistencies, and other problems with medical scheme and/or insurance claims. This functionality is available via an application programmers interface (API) to clients.
Contact Us
We look out for you!
+27 21 007 4516
Trading hours
08:00 - 16:30 Monday - Friday
info@medclaimassist.co.za
Claremont,
Cape Town, 7708