Public Hospitals

Since 2004, MediKredit has proudly facilitated the correct classification of patients and reimbursement for insured patients by ensuring that EDI submissions contain the correct membership and clinical information.

In our many years of experience in the public sector MediKredit has introduced electronic claims processing solutions in the Western Cape, Limpopo, Gauteng, Free State and the Eastern Cape. This has brought about significant change in operational processes, resulting in increased revenue generation for state hospitals. MediKredit’s hospital clients have experienced that 96% of claimed amounts are paid and debtor days have been reduced to 14 days or less, depending on the funder client’s payment schedules.

MediKredit has a proven track record in managing the UPFS billing structure as well as the stock coding for consumables, pharmaceuticals, and surgical items. At this stage, no other provider of EDI services has equivalent experience.

MediKredit’s proud offering to the provinces includes the following:

  • The eligibility transaction of insured patients
    • The validation of a patient’s healthcare funder membership status.
  • Claims and medical scheme rules validations
    • Claims submitted are checked for validity of healthcare funder patients, ICD-10 codes, UPFS tariffs and are verified against the specific healthcare funder rules related to the condition, patient and provider. Errors are communicated back to the billing clerk in real-time for corrective action.
  • Uninsured patient verification
    • MediKredit has a real-time link to a credit bureau to validate patient information during the admission process of patients. This allows the hospital to ascertain the contact details and employment status of the patient for correct economic classification.
  • Uninsured claims processing for reporting purposes
    • The adjudication of claims processing for uninsured patients is conducted for reporting purposes. The processing of uninsured cases allows for budgeting, compliance of ICD-10 codes and accurate UPFS and stock code billing.
  • Insured patient validation (FamCheck)
    • This feature allows the healthcare official to submit a request to MediKredit for the healthcare funder profile of the entire family for a patient belonging to a healthcare funder. This check can be done using the medical scheme number or ID number.
  • Electronic Remittance Advice (ERA)
    • The Electronic Remittance Advice (ERA) is an electronic version of a payment advice statement from the respective healthcare funders. These ERAs can be imported into the health information system for electronic reconciliation against the associated claims billed.
  • Reporting 
    • Reports are provided to the hospitals and provincial departments to track progress on operational efficiencies, utilisation of admissions, and revenue generation and condition profile analysis. 
  • User training and support
    • MediKredit manages the Electronic Data Interchange (EDI) process directly and takes full responsibility for ongoing training, support, and change management.