Naspers Medical Fund has signed a licensing agreement with software development specialist MIP Holdings to run its N Option Medical Fund on MIP`s MedStar medical scheme administration system, incorporating the AstraFin financial system. The sought-after three-year contract includes customisation, maintenance and support.
Naspers N Option serves the staff of multi-national media company, Naspers, and has 4000 principal members. MedStar has been implemented and is being hosted on Naspers`s existing Sun Microsystems Ultra Enterprise 450 server. It serves all N Option`s operations including claims assessment, accounting, and client services.
Naspers Medical Fund needed a new system to replace its inflexible legacy system. "We found that it would not only be difficult to amend our old, custom-built, in-house system to accommodate changes to the Medical Schemes Act, but that the changes would take too long to implement," says Janine Louw, principal officer of the Naspers Medical Fund. "As the new Act was already in place, we needed to accommodate it as soon as possible. We also constantly need to keep the scheme competitive, a demand the old system could not meet."
Key was the need to find a solution in time to enable N Option to meet the requirement, effective from 1 January 2002, that doctors and other service providers be paid within 30 days. "This requires more than one billing run a month, something the legacy system could not do."
The fund administration had four choices:
Upgrade the in-house system to meet the statutory requirements;
Purchase a new system that was already in line with the statutory requirements;
Outsource the back-office administration or claims assessment function to an outside administration company; or
Outsource the whole fund to an open scheme.
"We did not consider upgrading the old system or total outsourcing as real options, so we began to look at alternative systems as well as external administrators," says Louw. "We chose MedStar because of its feature-rich functionality and close fit to our requirements. Other systems we viewed were either as rigid as our old system or too expensive for a small corporate medical fund such as ours. We wanted to get away from the mainframe environment and into the flexibility of the open systems environment. MedStar meets both criteria."
Other key benefits were:
The ability to pay doctors electronically and within 30 days as per the requirements of the new legislation.
The ability to pull more detailed statistics for effective management of the fund and regulatory purposes.
The integrated AstraFin accounting package.
The ability for staff to view claims history via the Naspers corporate intranet;
Electronic interface to Mediscor for automatic benefit checking and submission of pharmacy claims.
Electronic interface to Digital Healthcare Systems (DHS) for automatic doctors claims submission, cutting out manual paper-based processes and speeding up claims payment.
Electronic interface to the Medical Services Organisation (MSO) for hospital utilisation management, resulting in the delivery of clean, audited claims to Naspers.
The ability to integrate with the Naspers corporate payroll running under QPAC to enable smooth payment of contributions and claims.
The system`s use of recognised principles of reconciliation management, which ensures billing matches contributions received.
Says Louw: "When we began the project we had a three-month timeline and, to be honest, I did not hold out hope of meeting our deadline. However, the project team, comprising Naspers and MIP staff, held together well under tremendous time pressures. A smooth implementation was delivered on time on 1 October 2001, and within budget. A job well done for MIP."
"MedStar has enabled Naspers`s N Option to improve the quality of service to its members by processing their claims faster and more accurately, and paying their service providers faster," says Stuart Watson, MIP Holdings regional manager, Western Cape. "The latter is key to maintaining good relationships between patient and service provider." The system`s reporting facilities allow senior management to keep a tight control on day-to-day expenditure and monthly billing, thus improving business performance.
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