The modern general practitioner (GP) is under increasing pressure to implement better practice management and business procedures and, with medical claims fraud on the rise, is constantly searching for ways to reduce the associated financial risks.
Eligibility Checker, the online validation service from the leader in electronic claims delivery in South African healthcare, DHSwitch, is a cost-effective, real-time solution to the problem.
GPs who have registered with DHSwitch can now check the validity of patients` medical scheme membership numbers and, depending on the particular medical fund, receive an update on their current status.
The goal of this service is to allow the GP to make an informed and on-the-spot decision on the level of risk associated with each individual patient and, in line with DHSwitch`s commitment to customer service, the company now offers one free Eligibility Check per claim submitted. This translates into what is effectively a free service.
Access to Eligibility Checker is through the DHSwitch Web site (www.dhsolutions.co.za) and users have the option of either downloading the software for themselves or using it directly through the Internet. As the package is large (some 16Mb), the latter option is recommended.
The process is geared for ease-of-use. The user simply logs on as a registered GP at the DHSwitch home page and then selects the Eligibility Checker option from where he/she is clearly guided through a series of menus.
Options include a comprehensive search facility catering for both medical fund member number and the patient`s surname, and a list option that allows the GP to build lists of members.
To generate a search report, the user selects the Eligibility Type, completes the fields required and submits to receive the results of the Eligibility check. For a list report, the user selects the appropriate medical fund, supplies the patient`s member number and clicks the >> button to add the member to the list. Once all members have been added to the list, the user selects the type of report required (either Display or Download) and clicks submit.
Selecting Display brings up an onscreen version of the report, while the Download option generates a spreadsheet that can be saved to the GP`s personal computer.
Thirty-eight of SA`s leading medical aids have been signed for Eligibility Checker and DHSwitch is currently in negotiation with the others to include the service.
The enhanced Eligibility Checker is just one of the innovative, value-added solutions DHSwitch has initiated in its drive to assist GPs streamline business processes and improve practice management.
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