MediKredit is a privately held information technology company incorporated in Johannesburg, South Africa. MediKredit established its footprint in healthcare as far back as 1941. The company is considered to be a pioneer that changed the face of healthcare processing by moving from a paper-based environment to an EDI one, where medical claims are received electronically in a real-time environment.
The philosophy behind MediKredit is to create value for existing investors, staff and business partners by being the processing solutions leader for Health Care Plans (“HCP’s”). MediKredit has been funded by its shareholders with the aim of developing and commercialising a world class suite of software applications and processing services enabling on-line real-time (“OLRT”) claims adjudication and processing of medical claims for HCP’s.
Private healthcare is moving towards the empowerment of patients by enabling them to take ownership of the financial and clinical management of their HCP’s. This has necessitated the need for the implementation of managed healthcare principles, medical savings accounts and member co-payments, where appropriate. MediKredit is uniquely positioned to take advantage of this significant shift in the provision of healthcare by providing OLRT processing and automated claims adjudication processes.
MediKredit offers financial and clinical risk management solutions to both HCP’s and providers of healthcare. This is achieved by the ability to OLRT adjudicate medical claims allowing patients and healthcare providers to have immediate and accurate information on the financial and clinical impacts of, and payment responsibilities for services and products provided by healthcare providers. Our copyrighted software allows for real-time claim adjudication involving the submission of an EDI claim and receipt of a response with the adjudication details within seconds. The MediKredit System allows for real-time messaging with an immediate response to an enquiry within a single, synchronous communication session.
The MediKredit System is compatible with any systems and protocols and is able to receive and exchange data with most operating system. MediKredit is able to manage transactions from all healthcare providers ensuring consistent application of health care plan rules and benefits.
MediKredit's internally developed intellectual property is centered on unique processes and expertise in real-time claims adjudication and health care plan processing. These processes and expertise have been developed and utilised in real-time environments for over 20 years. These processes are also backed by a set of international quality management system standards and guidelines (ISO 9001:2008).
MediKredit's intellectual property incorporates its “rule stacking” technology that allows for the creation of a rule for a specific patient for a specific healthcare product or service, which rule is then adjudicated against in real-time. This unique technology offers complex rule applications in a scalable and flexible manner on all medical claim types i.e. a heuristic computerized framework to dynamically create scenario specific rules. Our technology provides immense benefits to HCP’s, Healthcare Providers and HCP Members. These benefits include:
• Significant time and cost savings by working in a paperless EDI environment
• Cutting out time taken to manually adjudicate claims
• Elimination of manual processing errors
• Adaptability allowing for the successful implementation of complex benefit or rule designs
• The ability for patients to make informed decisions regarding the utilisation of their healthcare benefits
• The ability for healthcare providers to immediately assess, at the point of service, what the payment obligations are between the HCP and its members
• The ability for healthcare providers to ask for member co-payments at the time of service delivery eliminating administration and non-payment risk
• The improvement of cash flow and reconciliation issues are ensured
• The ability to highlight the clinical risk of services and products provided
• The elimination of duplicated products and services, drug interaction concerns, overdoses and inappropriate medication based on symptoms diagnosed (based on historic processing data, 8% of claims adjudicated are faulty in some form).
Currently, Medikredit is processing 42 771 701 million Claims in 3436 Pharmacies, 306 Private Hospitals, 122 Public Sector Hospitals, 5559 Doctor Practices on behalf of 78 Medical Schemes.
In 2020 Medikredit received and Processed almost R29 Billion worth of general Healthcare Claims, Saving Customers close to R1.6 Billion through its accredited electronic managed care interventions.
Having established MediKredit as the processor of choice within the South African healthcare market, focus has been placed on building strategic relationships with business partners offshore where the healthcare environment is similar to that of South Africa. These relationships would include licensing the MediKredit software application and/or processing on behalf of offshore service providers.
• Head Office: Johannesburg, South Africa
• Secondary Office: Cape Town, South Africa
• Number of staff: 209 (2019)
Corporate contact details:
Director: Performance Health: Krish Pather
Phone Number: +27 (11) 7706013