USKO Provides On-Line Claim Payments For Fedsure Health With MediSwitch

The e-commerce division of leading listed IT company USKO has consolidated Fedsure Health`s telephonic claims processing service, FastCash, with its electronic transaction system, MediSwitch. MediSwitch offers real time on-line claim payments and was implemented to improve Fedsure Health`s service levels to healthcare professionals by providing swift claim processing and payment procedures. As a consequence, time-consuming paper-based transactions have been eliminated and expenditure has been reduced.

In February 1998, Fedsure Health launched a revised claims processing and auto payment system, FastCash, to consolidate its existing telephone-linked reservation system, that functions to provide guaranteed payment to healthcare professionals. FastCash allows medical practitioners and pharmacies to process claims over the telephone. The interactive voice response system is able to confirm member benefits, process the claim on-line and trigger guaranteed payment at the end of the telephone call.

According to Fedsure Health executive chairman, Dave Avnit, the organisation is now able to enhance its FastCash fast payment system with MediSwitch`s real-time electronic claims submission system. Contracted service providers are now able to process their claims in real-time through the MediSwitch electronic transaction mechanism. The MediSwitch service is aimed at doctors, pharmacists, specialists, hospitals and clinics, as well as Medical Aids and Pharmaceutical Benefit Managers.

"MediSwitch has partnered major medical practice management software vendors to embed the MediSwitch communication interface into their software packages," says Wendy Strauss, Marketing Director of USKO`s e-commerce division. "As a consequence, vendors have been able to update their clients with the latest MediSwitch enabled version of their practice management and dispensing software systems. Once the service provider accesses his or her accounting or dispensing programme, there is an automatic live dial-up through MediSwitch into the FastCash system," Strauss explains.

"No additional third party devices are needed and service providers can retain the investment already made in their existing systems." Strauss continues. "Moreover, the service providers simply pay when using the MediSwitch system, as it is offered on a pay-for-use basis and there are no registration or monthly maintenance costs."

Strauss goes on to say that the Fedsure Health FastCash system confirms the processed transaction on-line and the confirmed amount is transferred electronically directly into the service provider`s bank account within seven days.

Dave Avnit believes the new system will help improve Fedsure service levels to service providers by speeding up the organisation`s claims processing and payment procedure. "Real-time processing will eliminate the time delay caused by the costly and lengthy claims paper trail," he says. "Typically, paper claims submitted via the post office may only reach the medical aid`s administration office ten to fifteen days after the medical service has been rendered and medicines have been dispensed to the patient. This system does away with paper claims."

Avnit points out that the MediSwitch system provides many benefits. "It ensures faster claims payment, reduced manual data entry and improved cost control," he adds. "The service provider has the option to send batch claims electronically, and is assured of greater information accuracy. The system is also capable of verifying membership eligibility electronically."

He explains that Fedsure is now in a position to provide its doctors and pharmacies with hassle-free and convenient online claims processing.

Avnit goes on to say that service providers often call on medical schemes to guarantee payment of claims. "Without this assurance from a scheme, many service providers will request patients to pay for the medical service up-front and claim from schemes in their individual capacity. This often places substantial financial strain on patients," he says.

"Through the use of leading technology, Fedsure Health, in conjunction with MediSwitch, is now in a position to offer guaranteed, fast, on-line payment to contracted service providers. We believe that this will greatly assist pharmacists in reducing their high rate of rejected claims and their administration costs,"Avnit concludes.