MHS ELECTRONIC CLAIMS

Hospitals, Medicines, Doctors, Optometry, Dentistry and Radiology claims

ADVANTAGES OF ELECTRONIC CLAIMS:

• Elimination of slow and costly data capture as claims can automatically be imported into the processing system,
• No delays in claim processing – rapid turn-around times according to Service Level Agreements,
• Speedier payment of claims can mean significant savings, as certain funders are prepared to offer additional discounts for earlier settlement,
• Less chance of claims being lost or misplaced,
• Reduction in transport delays,
• Elimination of post-event repudiation of claims.

• Immediate rejection of fatal errors resulting in total rejection of claim - ability to correct and re-submit,
• Confirmation of receipt of claim to service provider,
• Reconciliation file to enable electronic reconciliation of claims,
• Full claim status reporting available via the Web,
• Monitoring of claim submissions to ensure that they are submitted on a regular basis according to agreed parameters,
• Data residing in the system can more easily be translated into meaningful analyses and reports,
• Data integrity is monitored.

• Claim format validation,
• Mandatory field validation,
• Tariff validations,
• Scheme rule validations,
• Member eligibility - if information available from scheme,
• Pricing validations,
• Clinical validations,
• Duplicate checks,
• Drug Utilisation Review (DUR).

Electronic claiming is not necessarily synonymous with expensive hardware and software, as various methods of data transfer are catered for by MHS Electronic Claims, i.e. FTP, e-mail, Internet, MQ Series or through any of the data switching companies.

MHS Electronic Claims respects the confidential nature of the data passing through the system. MHS Electronic Claims has two confidentiality agreements - one with each medical scheme and one with each provider, ensuring complete confidentiality of the data being transmitted.