Private Hospitals

Count on MediKredit to assist with reimbursement by ensuring that your EDI submission includes the correct membership and clinical information.

MediKredit has seamlessly integrated the switching interface within the various hospital information systems (HIS) within the South African private hospital sector, to allow for admissions and billings clerks to submit claims to MediKredit and receive an online real-time response within seconds of submission.

Responses received contain all the information required to allow for informed decision making at point of submission. The billings clerks also have the ability to amend information and immediately resubmit claims that receive responses indicating unsuccessful submissions.

The MediKredit offering includes:

  • Patient validation
  • Online real-time claims submission
  • Tracking numbers for each submission to assist with proof of submission
  • Adjudication of claims against industry standard rules and healthcare funder-specific rules
  • Alternative reimbursement model conversions
  • Extensive reporting packs to assist in improving efficiency in billings and case management
  • High level reporting packs for senior management to assist in improving financial outcomes and highlighting compliance in respect to submission and agreements with healthcare funders
  • A support centre to assist with claim related queries
  • Electronic Remittance Advices (ERAs) to accurately reconcile payments received more quickly

The benefits of MediKredit switching for private hospitals include:

  • Membership validation at admission and point of claim submission
  • Responses on submissions within seconds
  • Adjudication of claims to ensure compliance to healthcare funder processing rules, reducing backend rejections
  • Ability to apply healthcare funder specific rules to submissions e.g., customised tariff codes  
  • Ability to analyse and convert claims against alternative reimbursement models and to report on these cases
  • Reduced debtors’ days, resulting in increased cash flow
  • Reduction in reconciling time, due to ERA functionality
  • Effective financial management with informative claim responses and extensive reporting packs for various levels of the business
  • A support centre to reduce administrative burden