Pharmacy Providers

MediKredit is proud to say that 94% of pharmacies registered with the BHF and SAPC place their trust in MediKredit.

As an electronic health benefit management (HeBM®) provider, MediKredit offers flexible, stable information technology solutions with real-time smart switching, guaranteeing 99.9% connectivity uptime. MediKredit’s unique patented rule stacking capabilities offer customisable, complex, innovative benefit design, affording the pharmacy provider seamless claim submissions.

MediKredit’s offering includes:

  • Online realtime claiming 24/7 with 99.9% guaranteed up-time
  • Statements, including auto-statements, for easy reconciliation
  • Healthcare funder option lists
    • Updated listing of healthcare funders and their destination or option codes required for the submission of claims
  • A tariff code brochure
  • Risk Message Responses (RMR®s) at point of service
    • A wide range of messages assisting the healthcare provider to manage the patient at point of service
    • Ensuring a positive client experience by alerting the patient to potential co-payments
  • Patient SMS functionality at point of service
    • Ensuring healthcare funder costs are well managed through interacting at the point of sale, facilitating proactive interventions
    • Facilitating patient buy-in in discussions around more cost-effective medicine and clinical management
  • Call centre services
    • Clinical, operational and provider call centre services
  • Circulars
    • Industry regulation changes and updates
    • New RMR®s, including background to the message and pointers on what the provider can do to resolve issues such as an upfront rejection, for example:
      • Medical scheme rule changes
      • Administrator rule changes
  • Pharmacy provider network (PPN) connectivity and assistance with complying to specific healthcare funder rules
    • MediKredit engages and collaborates with pharmacies rather than driving down a “least cost” approach to networks
    • The network runs on a “willing pharmacy” basis, where participating pharmacies can commit to the following:
      • To charge members at the healthcare funder specific dispensing fee
      • To avoid additional administration and non-scheme surcharges
      • To drive generic medicine utilisation for all beneficiaries
      • To ensure that reference price co-payments are dealt with by switching beneficiaries to medication below reference prices
      • To comply with such other lawful and reasonable network rules as may be notified to network pharmacies in writing, from time to time
  • Increase income to the pharmacy
    • MediKredit negotiates, on behalf of the pharmacy, an increase in their dispensing fee. This is facilitated by the implementation of the Dispensing for Choice (D4C™) functionality
    • D4C™ is a value-added service initiated by MediKredit
    • The aim is to drive down the cost of medication by paying the pharmacy a higher dispensing fee within the legislated dispensing fee framework
    • In return, the pharmacist engages with the patient and encourages the patient to use a less expensive alternative, where available
    • There is no impact to the member as long as the generic item is priced lower than the MMAP® price. The patient still has the choice to elect not to take the less expensive generic medicine
  • Reporting
    • Monthly compliance reports for dispensing fee surcharges, generic utilisation and substitution
    • D4C™ reports