Ironbridge Consulting, a division of Abraxas Holdings, has landed Medihelp`s year 2000 conversion project, and is scheduled to complete the project by November this year. The project involves code conversion, and a radical rewrite of systems to bring them in line with new legislation which is set to shake up the medical aid industry.
Medihelp is one of the largest medical schemes in the country, with 172 000 members and 179 000 dependants. The scheme is run on a co-operative basis, giving members the opportunity to provide input through representation on the Control Board.
Medihelp is unique in the medical scheme market in that it manages its own administration, and boasts the lowest administration costs in the industry. The scheme has been awarded an A+ rating by the Duff & Phelps Credit Rating Company for its claim-paying ability.
The scheme runs its entire management and administration on a centralised mainframe. In addition to processing membership claims, the scheme has contracts and payment agreements with more than 13 000 medical practitioners, and 2 400 pharmacies, optometrists and hospitals. "The past four years have seen radical changes in the medical scheme industry," says Medihelp GM Sakkie Marais.
"Today medical costs are twice as high as the inflation rate, and to make medical aid affordable to members we have had to offer a range of benefit options. In addition we had to build in checks against fraud - something which is not a real problem at the moment, but which has to be taken into account - and keep pace with technology advances in the industry.
"Because up to 1994 medical schemes were fairly rigid, there was no need for management information. To remain profitable and competitive this information is vital today, and our new system has to be able to provide that information.
The core system which manages the paying of claims, membership records and financials, is being rewritten by Ironbridge consultants and the scheme`s in-house development team. IT manager Reinette Fourie says Medihelp has built up a team of developers which can respond quickly to business changes, and which as a strong rapport with users. "In conjunction with the project management and business analysis skills supplied by Ironbridge, we will upgrade our systems and have them compliant for year 2000 within the deadline."
Medihelp has installed the latest range of products from the Software AG stable, and will rectify Cobol code manually and Adabas Natural applications using Natural Construct.
The systems will interface with a call centre, an Internet-based member and service provider query and registration service, and an image-based claims enquiry system. A data mart will also be established on a dedicated server.
MediHelp recently made headlines with the installation of an image storage and retrieval system for paper claims, thereby eliminating paper from the enquiry process and increasing productivity. The scheme handles as many as 150 000 on-line queries per month.
"The strength of any company lies in its ability to handle change, and Medihelp has proven repeatedly to be a leader in the industry," says Marais.
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