Insurance and Finance Marketing (IFM) has signed an outsourcing contract with MIP Health to support and maintain all its medical aid administration systems, including additional software customisation and hardware management and maintenance.
IFM is the only black-owned medical aid administrator in South Africa. IFM was registered in 1992 and has enjoyed phenomenal growth. It administers two registered medical aid schemes: the KwaZulu Natal Medical Scheme, one of the major government medical aid schemes, representing 14 000 principal members, and the Regional Medical Scheme, representing 17 000 principal members.
"Can you imagine managing all these members` and their dependants` medical aid requirements in a paper-based environment?" quips Graeme van Bergen, principal officer of the schemes.
The Medstar system has 64 users, from data capture through to assessing retrospective reviews to check service provider trends and activities. Users at the Johannesburg head office and IFM`s 14 branches are connected via an internally managed WAN and have different levels of access, ranging from enquiry only to the ability to log claims.
"We decided to outsource most of our IT requirements because we wanted to concentrate on our core business activity," says Van Bergen. "We chose MIP because of their expertise in medical aid software. They add value because they understand our business needs.
"The main benefits we expect are that there are dedicated onsite MIP staff to attend to urgent needs, and dedicated off-site programming resources for customisation," says Van Bergen. "Costs are billed at a fixed fee per month based on the number of principal members recorded on the system instead of the hourly rate that applied before."
Van Bergen says the system has enabled IFM to provide a better service to its members. In one case, data revealed that several thousand members in a particular geographical area did not have enough doctors to serve them. IFM informed the regional medical fraternity and the situation was rectified. In another case, IFM negotiated with a privately owned hospital to deliver services in an area where it had a large number of members and no state-owned hospital.
MIP has made several enhancements to IFM`s Medstar system since it was implemented:
An interface with IFM`s Quintron IVR system enables service providers to check and update members` files online when they call in for authorisation.
An interface with pharmacy processing house MediKredit which is updated weekly, but which will soon be upgraded to operate in realtime.
An interface with MSO, the managed healthcare service provider, which allows MSO staff to check IFM members` and hospital service providers` information and usage.
MIP is working on several more enhancements:
An interface with QEDI (due for completion this month) which will enable realtime online transactions; and
An interface to Afrox Group hospitals, which will enable realtime, online processing and guarantee of payment.
The system is running on IFM`s Sun 450 server, managed by MIP, which can store records for 250 000 principal members.
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