Medical Claims and Case Management

Interhealth Technologies is equipped to manage all medical treatment bills, both in - patient and out - patient. This service applies to claims within South Africa as well as Africa, portions of the Middle East and India.

All medical cases are managed from prior to admission, during the hospital stay, as well as after discharge. All management is in accordance to agreed guidelines between Interhealth and the respective clients.

Member validation, payment guarantees, medical case management, bills auditing and bills payable are all part of this service offering.

More complex cases require special management, ensuring that the treatment is in accordance with what has been approved by the funder (insurer or corporate). This management extends to examining the actual charges, ensuring that there are no overcharges and that the rates charged are in line with agreed prices between Interhealth and its service providers. (Interhealth has preferential agreements with most prominent service providers in Africa and the regions mentioned above. Within South Africa, our network extends way beyond the 3 major hospital groups and includes most of the prominent secondary providers. i.e. Radiology, pathology, accommodation etc.)

Where necessary, our medically qualified case management staff visit with the patients and service providers, ensuring that patient satisfaction is a priority at all times. We have case managers in various cities throughout South Africa.

All bills received pass through an audit process to ensure that charges are according to agreed tariffs between Interhealth and the provider. Discrepancies are addressed prior to the bills being processed and forwarded to the funders. It is through this intervention that treatment costs are contained. These savings are passed on to the client.

Please feel free to Contact Us to discuss your company requirements.

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