Realtime Claims

eMD offers the ability for a healthcare professional, pharmacist, practice manager or hospital administration staff to submit an electronic claim on behalf of the patient, to the appropriate medical scheme.

But there are many other services around this core competence that provide substantially more than just switching of claims.

eMD offers various transaction-based services to both the healthcare professional and the medical schemes / administrators.

Electronic claims delivery in batch and online using our Ontime Realtime Routing Engine with a varying degree of validation checks.

Claims are submitted through Ontime to the medical scheme in various ways depending on the implementation by the software vendor of the practice.

The submission of practice and hospital claims forms a seamless part of validating the information related to the patient encounter.

The benefits of using Realtime Claims

  • Reducing administrative costs associated with claims processing, patient invoicing and statements and collections/write offs.
  • Significantly reducing and eliminating costs like postage and handling fees.
  • Eliminating the need to call customer services to check on claims status.
  • Reducing reliance on paper-based transactions.
  • Estimating patient responsibility to pay at the point of service.
  • Reducing reconciliation activity for both physician or health care professional and patient.
  • Earlier payment of electronic claims.
  • Earlier detection of errors.

Service providers we switch claims to in realtime, covering 70% of insured lives in South Africa

Discovery Health Lincare Medscheme
Metropolitan Health Group Spectramed Liberty Health