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MediKredit is a technology company that currently provides on-line real time claims processing of prescriptions being filled in pharmacies for members of medical aid schemes who are contracted either directly, or through medical scheme administrators.

The MediKredit product differs from data carriers or on-line carriers of data because MediKredit processes the claims in real-time. Therefore at the time the claim is submitted, the checks are made and the claim is processed. Any corrections to the claim is communicated back to the practice in seconds. Health Focus is the first software house to be accredited for the MediKredit facility.

All versions of Eminance Version 2.00.01 with a release date on or after 31 May 2003 are MediKredit accredited. MediKredit offers numerous benefits to practices submitting claim scripts to selected medical aids, including;

  • Consistent application of medical scheme rules
  • Data integrity is validated on-line in real time and any finger problems corrected in seconds.
  • Consistent validation pricing as per the agreement between the medical scheme and provider
  • Dramatically reduce the delay in claim delivery after the date of service and reducing the payment turnaround.
  • In the event of switch-out schemes the claim for payment is logged immediately at the time of dispensing.
  • Validated record of claim submission date.
  • Eliminates any paperwork.
  • Assured payment where the scheme has applied and agreed to this principle.
  • Immediate identification of the patient liable portion.
  • Ability to collect funds from the patient at the time of service.
  • Management of risk at the time of dispensing.
  • Direct payment to provider for contracted schemes
  • Less than 1% rejection rate, reducing bad debt.
  • Improved cash flow management

Claims are checked when submitted and include;

  • The BHF number, along with the high level data integrity check.
  • Verification of member and or dependant membership number
  • Verify the patient name in accordance with the rules.
  • Verify the date of birth as per schemes rules
  • Verify the ID number as per the schemes rules.
  • Apply all the exclusions as per the schemes rules
  • Applies the levies and discounts as indicated in the rules or as agreed between the service provider and the scheme.
  • A message returned to the service provider with the final information regarding the claim.
  • Once submitted, the claim is processed and no further submissions are necessary.

MediKredit currently has contracts managing in excess of 3.2 million lives of the 7 million privately insured lives in South Africa. Amongst those administrators currently contracted, include;

  • Bankmed / Methealth Sanlam Bestmed
  • CAMAF Discovery Health KOPANO
  • Liberty Healthcare Mpumalana Managed Old Mutual Health
  • Sovereign Health