| Business Overview |
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| Healthcare |
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| Healthcare in South Africa is taking an exciting turn in the form of new age products such as capitation and also new legislation such as Prescribed Minimum Benefits (PMB), as stipulated by the Registrar of Medical Schemes. Thus Medical Aid Schemes are not only challenged by their members for value for money health care insurance and cost effective services, but also by the Government via the Registrar of Medical Aid Schemes. |
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| The hub of any Medical Aid Scheme is the Administrator, who must ensure that the members receive the correct benefits at all times. The Board of Trustees must also receive timely and accurate information that will enable them to manage the Scheme optimally in a cost effective way to the member's benefit. It is the Administrator's responsibility to remove the guesswork on allowed and disallowed payments from the Provider's remittance to allow the Provider to take the correct actions. |
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| As both legislation and trends in the Health Industry are changing rapidly as mentioned above, the Administrator must not only be able to supply the traditional administration services, but also to be able to accommodate any current and future changes cost effectively and timely. Not only must the cost of administration be kept to a minimum, with no compromise on service, but also the Scheme should not be held responsible for costs involved in changing circumstances in the Health Industry. |
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| Exponªnt, through a partnership with Virtual Health (Pty) Ltd, is able to offer full scheme administration, or provide software solutions in the form of a Medical Aid Administration system, named V-HEALTH, which is available on a rental basis of fee per member. |
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| Functionality of the V-HEALTH system includes the following modules: |
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Call Centre Module |
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Membership |
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Assessing and Pre-assessing |
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Financials and Reconciliations |
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Reporting and Management Reporting |
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Mail Room Functionalities |
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Tariffs and Rules |
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Payments and Remittances to suppliers |
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| The system is fully comprehensive, with accurate and effective handling of Capitation and Capitation Payments (while still pricing for use in what-if calculations), fee for service pricing and discount structures for supplier and supplier groups. Per Diem, CPT4, ICD10 as well as medicine pricing enabled. |
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| Brokers, Broker commissions and payments are also catered for. Case management is available with reporting per case or diagnosis also available. |
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| Exponªnt and Virtual Health share the vision of providing the most cost effective and value for money service in the Healthcare arena, without compromising on quality. |
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| Through comprehensive solutions, competitive pricing and superior service, we can take the headache out of Healthcare. |
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