Healthcare Claims Administration Service

  • Electronic claims receipt via real time, batch, email or fax
  • Paper claims are scanned/ imaged and indexed
  • Validation of Claims, Membership and Service Provider
  • Electronic application of clinical funding and protocols
  • Benefit Validation
  • Payment Instructions to members or healthcare providers
  • Quality Assurance to measure accuracy including random sampling of claims processed per employee per month
  • Delivery of detailed and accurate claims statements
  • Management of specialised claims such as ex gratia or third party claims.

Claims Administration Factsheet