Q1: Is MediKredit a Medical Scheme Administrator?
MediKredit is NOT a Medical Scheme Administrator company. MediKredit is a technology company that offers financial and clinical risk management services to both funders and providers of healthcare.
Q2: What is Healthnet ST, and where does it fit into the MediKredit Product offering?
Healthnet ST is the front-end system owned by MediKredit which provides real-time integration into vendor packages and delivers:
Consistent claims information across the provider, MediKredit and Administrator systems
Guaranteed up-time and response-time
Regular vendor accreditation
Robust audit trail (claims processed through HealthNet ST are never lost)
MediKredit does not need to rely on a third party switch to deliver claims, as Healthnet ST is wholly owned by MediKredit and integrated into the claims processing capability.
Q3: Is MediKredit a Managed Care organization?
Whilst MediKredit is not a managed care organisation, Performance Health is the wholly owned managed care subsidiary of MediKredit Integrated Healthcare Solutions, involved in the design and development of managed care technology solutions, namely Swift Online™.
Performance Health was registered as a managed care organization with the Council for Medical Schemes in 2004
Q4: Does the SwiftOnline Chronic authorization process require paperwork?
MediKredit has been in the pre-authorisation business since 1995. Up until 1998, the entire pre-auth program was paper based and required approximately 40 people to support the managed care needs of 100 000 lives under management. In 1999 the paperless electronic Swift OnlineTM system was introduced. This system has enjoyed a steady stream of innovation and today the Performance Health Unit comprises eight people who support approximately 750 000 lives.
All that is required is a phone call by your doctor or pharmacist. The average Performance Health call takes approximately two minutes to complete pre-authorisation for a patient, the benefit is available for claims processing within 20 seconds. The system has enjoyed acceptance in the market mainly because it delivers on the promise of cost effective, member friendly managed care techniques.
Q5: Is MediKredit not just another “Switching House”?
MediKredit does not believe in merely switching a claim. A claim is processed in full by MediKredit in a real time environment. HealthNet ST, the front-end system owned by MediKredit, provides real-time integration into vendor packages and switches the claims to MediKredit. MediKredit processes these claims in a real time environment against scheme rules and offers healthcare claims management as one of its products. See the rest of MediKredit’s product offering here.
Q6: My medical scheme is contracted to MediKredit, how do I as a member benefit from this?
MediKredit guarantees systems availability and never goes off-line (not even for scheduled downtime). Response times to healthcare providers are generally measured in milli-seconds.This means that at the point of service, the provider and you, the member, know exactly what the status of the claim is. What co-pays apply, if there are any clinical warnings, what benefits are available, and if any authorisations are required. All of these features create a positive member experience.
Q7: Is MediKredit a Pharmaceutical Benefit Management (PBM) company?
MediKredit offers PBM services as one of its products, however MediKredit is more than a traditional PBM, as it incorporates claims processing across pharmacy, doctor and hospital provider groups. MediKredit believes that balancing costs as well as patient well being should always be viewed in a holistic manner. Health electronic Benefit Management (HeBM) is where MediKredit is best positioned. See more about our product offering here.
Q8: MediKredit is ISO9001:2008 (previously ISO9001:2000)certified. What does this actually mean?
ISO9001:2008 (previously ISO9001:2000) is a set of international quality management system standards and guidelines that supports MediKredit in identifying, measuring and continually improving organisational performance. MediKredit holds Certificate No: FS 651952 and operates a Quality Management System which complies with the requirements of ISO 9001 : 2008 for the following scope: The design and development of software for the provision of electronic health benefit management services. Excluding ISO 9001 : 2008 clause 7.6 Control of Monitoring and Measuring Equipment.
MediKredit is the first online real-time claims processing supplier in the healthcare industry to achieve ISO Certification. ISO9001:2008 (previously ISO9001:2000) certification was a significant step for MediKredit towards fulfilling the strategy of technology excellence.