OUR MISSION STATEMENT

Ensuring executive outcomes for our doctors from medical schemes.

OUR SPECIALITIES

We specialize in: Medical Aid and Insurance Claims, Injury on Duty (IOD) Claims, Worker’s Compensation (WCAs), Claims, International medical insurance claims

OUR CLIENTS

We provide complete claims management to the following: Physicians, ENTs, Gynaecologists, General Practitioners, Anaesthetists, Ophthalmologists, Opticians, Dieticians, Physiotherapists, Paediatricians, etc.

We ease the medical billing and claims process!

ABOUT US

We are a registered company that specializes in medical claims and billing services at a very low cost. Efficient Claims will provide peace of mind regarding all claims processing payments.

We are dedicated in providing the best administration solution for your practice. Our goal is to minimize risk on collections from medical, international and private funders. We make time to listen to our clients needs and aim to achieve individual best practice solutions.

Technology is what we use, administration is what we do. We are just a phone call away. We provide complete management oversight for the registration process to facilitate the collection of accurate patient demographic and establish quality control techniques to ensure that the correct billing information is collected to produce and generate clean claims for submission. Provide excellent customer service including problem solving, timely follow up, assisting in customer follow up via internet, phone and email.

HOW WE CAN ASSIST YOU

  •  Accurate patient information validation and capturing.
  • Billing and posting of your claims in real-time giving prompt responses.
  • Attending to and fixing your rejections on a daily basis.
  • Accurate processing of all PMB claims (300%) and ensuring their payments are made.
  • Collection of your remittances from medical schemes on a monthly basis.
  • Account reconciliation and allocation.
  • Debt collection from owing patients and medical aid short-payments.
  • Effective and efficient age- analysis management.
  • Accurate coding of your claims: ICD10, CPT, RPL.
  • Handling of all medical schemes’ requirements and updates.
  • Full administration support on practice administration of all accounts.

HOW WE OPERATE

  • An Account Manager is allocated to administer your practice’s claims on inception.
  • Our services are billed at an economical percentage of 3.5% of the total paid on a monthly basis with no annual increase.
  • All medical aid payments are deposited directly into the Practice’s bank account.
  • We have flexible billing options for our customers:

             – By remittance total or
             – Bank statement total

  • Importing of patient database from old system to our system at no cost.
  • Free system training of the Practice’s staff at no additional cost.

THE PROCESS

SUMMARY

  1. Capturing data.
  2. Submitting of all claims electronically via EDI.
  3. Submitting all international claims via emails.
  4. Timely follow up on claims to ensure that  they are processed within 30 days (medical aids /private funders) and 60 days (international funders).
  5. Timely follow up on short payments from beneficiaries and private portions if benefits are exhausted.
  6. Ensure outstanding claims are resolved within 60 days.
  7. Follow up with SAMA regarding reimbursements disputes.
  8. Full administration support on practice administration of all accounts.
  9. Minimise bad debt to 2% and below.
  10. Invoice only on monthly received payments and not on accounts billed.

SOFTWARE

The Medical Practice management software that we use is called Medis Online.

OUR WORKFLOW

  • Correct submitting of all claims electronically via EDI.
  • Correct data capture including – membership validation details, member option and confirming patient information.
  • Billing according to membership option, billing guide line and according to medical aid contract
    billing  ( payment agreements).
  • Following up with medical aid in confirming receiving account, confirm amount accepted for processing. If any rejection on day to day benefits member to be informed on outstanding accounts.
  • Following up on any rejections, short payments and submitting any documents in regards of short fall on account – i.e. Letter of Motivation, referral letters. 
  • Following up with patients on any short payments because of day to day benefits exhausted.
    Posting account to member informing member that account needs to be settled in 30 days.
  • Private accounts are followed up on the day of billing Guarantor is informed on the day about
    outstanding amount, requesting email address to email account and informing them account needs to be settled in 7 days. If international funds, all required documents are posted/emailed to
    Guarantor for quick and easy payment result.
  • Allocating payments to correct service date as per remittances from the medical aids and from patients on a weekly basis ( payment will be made to the practice bank). 
  • Monthly recon on all accounts to ensure all accounts are processed correctly and that account are on zero balance to close account.

HOW CAN WE HELP?

Feel free to ask any question
or leave a comment.

  • +27 81 437 3810
  • +27 81 335 9500
  • info@efficientclaims.co.za

Copyright 2019 - Efficient Claims (Pty) Ltd.