NMP implements USKO`s MediSwitch for speedy electronic claims processing

National Medical Plan (NMP), a leader in the new managed healthcare environment, is implementing USKO`s MediSwitch real-time electronic data switch to enable medical service providers to check patients` membership eligibility details online and submit claims electronically. MediSwitch will reduce the time it takes for claims to reach NMP and specifically, speed up the assessment process and ultimately the administration of claims payments.

"One of the challenges that always face medical aid administrators is the flexibility to accommodate a host of system suppliers each with their own formats and technical standards," says Dave van der Berg, Operations Director of Sovereign Healthcare, formerly known as NMP Administrators. "Our preliminary tests with MediSwitch indicate a compliance with accepted standards as far as claims submissions are concerned."

Through its strategic alliances with major practice management software vendors, MediSwitch will provide NMP with the capability of receiving thousands of electronic transactions daily without the concomitant problems of direct connections to each service provider.

Van der Berg says that each transaction passing through the `switch` will be instantly read, translated and routed by the `switch` to match NMP`s prescribed format, thereby guaranteeing real-time delivery of claims related data through industry standard protocols.

"Through the accreditation of MediSwitch, NMP hopes to achieve improvement in practitioner administration efficiency by offering accurate and improved processing of accounts," says Van der Berg. "This in turn will result in improved service to our members and providers of service."

NMP administers funds of which the membership is spread geographically throughout South Africa. It is dominant in the Kwa-Zulu region and accounts for a relatively larger percentage of business for service providers in this region.

According to Rob Abraham, managing director of MediSwitch, the MediSwitch Virtual Private Healthcare Network (VPHN) provides a single communication connection for SA healthcare service providers to effect real-time electronic transfer of medical fund membership details and claims related information.

He says the advantage of real-time eligibility checking of members by service providers is that it enables service providers to know when patients are not covered by NMP and to request up-front payment of fees for services rendered.

"We are delighted with the NMP accreditation and trust that the MediSwitch implementation will compliment NMP`s already significant investment in Information Technology and its initiatives to improve administrative efficiency," says Abraham. "To date, MediSwitch has invested in excess of R25 million in the development and testing of the `switch`. This investment, which includes the embedding of a communication interface into the major doctor and pharmacy management software systems, will offer service providers instant access to the `switch`s` on-line, real-time electronic transaction functionality."

Abraham goes on to say that providers can retain existing investments in their current computer systems. "Service providers will not require any additional hardware or software and, they no longer require any additional third party claiming system on their desks," he adds.