Medscheme offers a comprehensive range of fully outsourced administration and managed care solutions of exceptional quality that cater for both medical schemes and corporate clients. They include:
Health Administration
- Dedicated business units
- Dedicated client contact centres
- Efficient claims processing and payment
- Claims assessing aligned with scheme rules
- Fund management
- Client-centric servicing and support
- Scheme governance, reporting and secretarial functions
- Scheme finance, accounting and reporting
- Membership processing and communication
- Member statements
- Sales and distribution
- Broker support
- Broker commission statements
- Healthcare professional support
- Healthcare professional statements
- Electronic communication
- Web-based self-help facilities for members, healthcare professionals, brokers and employers
Managed Care
- Integrated managed care and lifestyle management solutions
- Positive relationships and contracts with healthcare professionals
- Access to general practictioner, specialist and dental networks
- Negotiations and strategic purchasing on behalf of clients
- Evaluation of health technologies, pharmaceuticals and clinical practice
- Actuarial and health informatics analyses
- Product design informed by actuarial and clinical analysis
- Detailed scheme reporting
- Client-centric interactions with members/clients/patients and providers through health risk management operations
- Disease and high risk member management programmes
- Client Support
- Pre-authorisation to access hospital benefits
- Access to dental benefits
- Access to ambulatory benefits
