IQ Health delivers HEALTHe solution to health claims payments

South Africa`s largest healthcare technology provider IQ Health has launched HEALTHe CASH, believed to be Africa`s first fully electronic, daily medical aid claims settlement facility. More than 100 healthcare providers have already registered with the system.

"HEALTHe CASH forms part of a range of industry standard e-commerce products from IQ Health designed to transform the notorious inefficiencies in medical industry transactions," says Andre Sharpe, Operations Director of IQ Health.

The HEALTHe CASH product introduces a secure e-commerce service for the daily settlement of ready-to-pay medical aid claims, thus reducing administrative overload and improving cash flows for health care providers.

It gives the provider same day payment of all claims authorised by the funder, and is the final step towards achieving full electronic realtime settlement of claims. Prior to HEALTHe CASH, the claims transaction process could take between 20 to 60 days - from the initial patient visit, to when the doctor is finally reimbursed by the medical aid or insurance company.

"The new technology allows one to complete the entire transaction in about six seconds," says Sharpe.

The product`s biggest benefit is when it works in conjunction with provider software that is enabled with a switching facility and a funder that has auto claim assessing capabilities.

HEALTHe CASH allows the provider, i.e. the doctor or pharmacist, to submit claims to the healthcare funder or medical aid in the normal manner such as via existing switches (e.g. HealthBridge, Interpharm, MediKredit or MediSwitch, batch EDI or paper. Once approved, a quick process if auto assessed, the claim is transferred directly into the provider`s account within 24 hours. This means that there is no need to wait for the medical aid`s next payment run to receive claims payments.

All information relating to HEALTHe CASH payments is available on-line via the HEALTHe ZONE (www.healthe.co.za), a secure Internet facility. Detailed remittances can be downloaded at any time or e-mailed to the healthcare provider daily, weekly or monthly, as preferred. This aids the provider in monitoring cash flow and greatly simplifies administration.

"Currently healthcare processes are plagued by inefficiencies, resulting in frustration for both practitioners and patients as well as an unhealthy contribution to spiralling healthcare costs which are escalating far faster than inflation," says Sharpe.

"HEALTHe CASH will go a long way towards reducing these inefficiencies," he adds.

Three of IQ Health`s practice management products - ComPharm (pharmacies), Renaissance (general practitioners), and Optimax (optometrists) - are currently being enabled to take advantage of HEALTHe CASH`s electronic remittance advices for automated reconciliation.

IQ Health`s key strategy is to manage and improve all aspects of healthcare transactions across the industry, focussing on the `single health care event`. It also aims to help establish the industry standards required to manage IT in healthcare effectively.

"Rather than trying to deal with the originator and receiver of the transaction at arm`s length, we believe that with our understanding of the industry and technology, we could fast track the development of industry standards and improve communication at a technical level," says Sharpe.

Sharpe attributes the slowness in the online progress of the medical industry partly to the lack of infrastructure and appropriate technology.

He explains that within a single healthcare claim there are about 112 checks that have to be completed. Details such as membership status, scheme rules, drug prices, procedural tariffs and fraudulent submissions all have to be verified.

Complex technology is required so that these rules can be applied automatically to a claims transaction in a real-time online environment. It doesn`t help you to get a transaction in fast if your own administration system is incapable of processing it online," says Sharpe. "The next development for HEALTHe is the online, automatic reconciliation of accounts between providers and funders. IQ Health is committed to building a technology infrastructure for the healthcare industry to ensure that all role-players benefit," he adds.