Practice Management Software Vendors

As the leader in claims processing in the South African private healthcare sector, integration with the MediKredit switch is strategically important for any Practice Management Software Vendor.

  • The MediKredit switch offers an online real-time, end-to-end claims adjudication integration via an XML specification. This single XML specification accommodates multiple transaction types such as eligibilities, FamCheck™ (membership information download functionality), AuthCheck™ (authorisation patient rule download functionality), claims, reversals, resubmissions and re-sends.
  • MediKredit also has comprehensive XSDs available for all request and response transaction types against which any created or received XML can be validated.
  • The specification accommodates all integration types from pharmacies, hospitals (both private and public), doctors, and specialists of all disciplines to healthcare funders.
  • MediKredit switching integrates with all healthcare funders and administrators and accommodates the funder preference, such as batch or online real-time switching for their transactions. This applies to discipline type transactions as well as hospital transactions.
  • Regardless of whether a vendor wants to do a single integration or multiple integrations, the specification is the same for all.

Claims submissions to MediKredit are done either via web services or MediKredit’s in-house application, Healthnet ST®, which has been at the forefront of claims submission technology for more than 20 years. MediKredit has a dedicated testing environment specifically for its vendors, which is available 24/7/365 and includes all the latest funder rules, NAPPI® and tariff pricing and configurations. The environment mirrors the information that is loaded in MediKredit’s live environment to ensure that testing is done in accordance with all the latest rules. A comprehensive list of test beneficiaries, which consists of dummy data, is also available and conforms to POPIA standards, as no live beneficiary information was used during the creation of said information.

Any vendor wishing to integrate with the MediKredit switch is provided with a complete integration pack containing the above information as well as an explanation of what is required, why it is required and how the integration should function. On completion of the integration, an accreditation will be conducted with the vendor to ensure the integration functions flawlessly in a live environment.

A dedicated team, whose sole focus is integrations and vendor support, is also available to vendors from the very beginning of their journey with MediKredit.