Healthcare Providers

MediKredit assists with the reimbursement for the care provided by healthcare providers ensuring that their EDI submission contains the correct membership and clinical submission, every step of the way.

MediKredit’s processing capabilities give healthcare providers a switching solution that ensures an electronic claim is delivered to a healthcare funder or administrator via a secure medium, with the necessary information for the healthcare funder to successfully re-imburse the healthcare provider for the services rendered. Each submission undergoes a membership validation and is also validated against industry standard checks such as ICD-10 coding, tariff checks and NAPPI® validation.

Where applicable, healthcare funder specific rules are also applied to the submission. If the submission does not meet the required criteria to be successfully processed, resulting in short payment, this is communicated back to the provider in real-time, within seconds of submission. The provider can make an informed decision at point of submission based on the Risk Management Responses (RMR®) sent back on such claims.

Claims can be reversed, amended and resubmitted, with the correct information if the claim was upfront rejected. Claim responses are written back into the provider’s Practice Management Software (PMS). Each submission is issued with a unique tracking number that guarantees proof of submission. Once payment has been allocated by the healthcare funder, or administrator, MediKredit also provides the healthcare provider with an Electronic Remittance Advice (ERA) that quickly and accurately reconciles payments within their PMS.

MediKredit’s healthcare switching interface is seamlessly integrated into the provider’s PMS and therefore requires minimal setup and training for successful electronic claim switching.

The switching fees are competitive to that of the market. MediKredit only charges switching fees for transactions flagged as having been successfully submitted to the healthcare funder.