HospiCHEQ is an electronic hospital claim processing and adjudication system. Medical Schemes require more data in order to measure managed care interventions and redirect managed care efforts for greater effectiveness. The current process of manual and semiautomatic data capturing of hospital claims is a slow & costly procedure but, with HospiCHEQ. Receipt of the claim from the hospital in a standard electronic format enables the details to be imported directly into the schemes processing system. This direct importation enables significantly speedier claim assessment and hospital reimbursement. This becomes a win-win situation for all parties.

HospiCHEQ Services Include:

  • Immediate rejection of fatal errors resulting in total rejection of claim - and the ability to correct and re-submit
  • Confirmation of receipt of claim to service provider
  • Reconciliation file to enable electronic reconciliation of claims
  • Adjudication per line item
  • Ability to accommodate various tariffs per hospital groups
  • 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