PQ Africa`s medical e-commerce division, QEDI, has become a provider of electronic pharmacy claims to the medical aid scheme Medihelp. As one of the largest schemes in South Africa Medihelp provides health care cover to more than 411 000 people.
The move is set to give market leader, QEDI an even stronger foothold in the electronic claims switching market, which currently sees QEDI processing more than 6 million claims per month, worth more than R300 million for the private medical industry. QEDI has already negotiated agreements with a range of medical aid organisations to submit claims electronically on behalf of pharmacies as it bids to provide greater "value add" to its service menu.
In spite of the fact that Medihelp takes an average 12 days to process claims, the implementation of the QEDI system would offer pharmacies a better cash-flow arising from much quicker claims processing. Traditional paper-based systems have been known to take up to six weeks for processing and payment. The company is also the only service provider to offer a comprehensive claims validation and verification service, which cuts down dramatically on rejected claims and administration time.
Medihelp has installed the infrastructure to allow real-time eligibility testing of members through QEDI.
QEDI`s traditional services have been expanded this year to include on-line validation and eligibility checking of claims. Registered users will be able to query the status of their submitted claims on-line at www.qedi.co.za/engine, where the reasons for any rejected claims will be displayed. This will allow corrective measures to be taken almost immediately.
According to Anton Rijnen, General manager of Medihelp the Scheme`s contract with QEDI is not exclusive and although negotiations with other such service providers are ongoing Medihelp decided to start off with QEDI, because of their good track record, the quality of their service and their pricing structure. Hennie du Plessis, managing director of QEDI confirms this: "We have a long and fruitful working relationship with Medihelp, and this agreement recognises the high levels of quality of our processed claims. We have associations and contracts with almost all the players in the private medical industry, and are fully committed to taking care of the interests of all medical professionals, including pharmacists."
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