The presenting problem
Prior to 1993, claiming payment from medical funders was typically lengthy, inefficient and frustrating for South African patients and practitioners alike. Health practitioners struggled with delayed payment, financial risk, claim-related administrative overload and cash-flow challenges.
In 1993 MediSwitch pioneered electronic data interchange (EDI) for healthcare in South Africa and revolutionised practice administration via the SwitchOn claims submission and management process.
MediSwitch continues to pioneer claims management in South Africa, adding value to a huge range of healthcare businesses. We have built our competitive advantage on the following:
- Online claiming via the SwitchOn ‘Now or Later’ methodology
- Extensive claim-validation processes, based on specific administrative requirements for each funder, which ensures rapid access and payment
- Electronic real-time or batch claim delivery to funders
- Online membership status validation
- Member benefit verification
- Electronic remittance advice including a process to allocate payments
- A dedicated electronic messaging system that avoids the security issues inherent to the internet
- Continuous system availability via two independent but interlinked systems, hosted at different locations in case of power outages or other local disruptions
More than 12 000 healthcare businesses, including all retail pharmacies in South Africa, already benefit from using MediSwitch for electronic claim submission.
MediSwitch also delivers claims to all electronically-enabled, registered medical schemes and covers virtually all South African medical-aid scheme members.