Claims Processing: Fast, Accurate, Automated
The end of the month looms, and healthcare administrators brace themselves for the avalanche of claims. Each claim is a potential minefield of errors: outdated tariff codes, incorrect practice numbers, or misaligned ICD-10 codes. The result? Delays, rejections, and dissatisfied members. This chaos is not just a logistical nightmare; it threatens the financial stability and reputation of medical schemes.
Enter MedAPI, the transformative force in claims processing. By maintaining up-to-date industry reference data—including tariff codes and NAPPI medicine pricing—MedAPI ensures that your claims are always aligned with the latest standards from authorities like HPCSA and SAHPRA. This automatic updating eliminates the guesswork, allowing administrators to focus on more strategic tasks.
Beyond data accuracy, MedAPI revolutionizes the validation process. Comprehensive validation rules and exception queues quickly flag invalid claims, providing specific error codes for rapid resolution. This streamlined approach reduces processing times and minimizes human intervention, leading to faster approvals and happier members.
MedAPI's open policy language further sets it apart. By enabling detailed benefit plan annotation, this feature enhances pre-authorization processes and claims auto-approval, going beyond traditional managed care modules. Coupled with its API-first platform, MedAPI allows seamless integration with multiple claims switches and third-party systems, giving schemes the flexibility to connect with their preferred partners.
Here's what scheme administrators commonly ask about claims processing—and the answers that matter.
Frequently Asked Questions
How does MedAPI keep industry reference data like tariff codes, ICD-10, and medicine pricing current?
MedAPI automatically updates all industry reference data as published by relevant authorities, ensuring your claims are always processed with the most current information.
Can MedAPI validate claims data and handle exceptions?
Yes, MedAPI includes comprehensive validation rules and exception queues, automatically flagging invalid claims with specific error codes for quick resolution.
Does MedAPI include managed care and PMB modules?
MedAPI offers advanced benefit management capabilities, including detailed benefit plan annotation, which enhances managed care and PMB processes.
Can MedAPI integrate with claims switches and third-party systems?
As an API-first platform, MedAPI supports integration with multiple claims switches and third-party systems, allowing flexibility in connecting with preferred partners.
Does MedAPI support pre-authorisation for hospital, medicine, and disease management?
Yes, MedAPI provides comprehensive pre-authorisation workflows with intelligent auto-approval for routine cases in hospital admissions, chronic medicine, and disease management programs.
Can MedAPI generate electronic remittance advice for healthcare providers?
MedAPI automatically generates and distributes electronic remittance advice, providing detailed claim-by-claim breakdowns for seamless payment reconciliation.
What This Means for NHI
For the National Health Insurance (NHI) initiative, leveraging a platform like MedAPI means streamlined claims processing that aligns with national healthcare standards. By reducing errors and speeding up approvals, MedAPI supports NHI's goal of providing efficient and equitable healthcare access across South Africa. The integration capabilities ensure that all stakeholders, from government payers to private schemes, can collaborate effectively.
Ready to Transform Your Claims Processing?
Contact our team to see how MedAPI can revolutionize your claims management processes.
MedAPI is a health technology company dedicated to enhancing healthcare administration through innovative solutions. We do not provide medical aid or insurance services.