Real Time Transaction Enabler

Real Time Electronic electronic switching of transactions between healthcare professionals and medical schemes.

claim

New Health263 claims switching core business lies in the switching of transactions between healthcare professionals and medical schemes. New Health 263 is pioneering real time electronic transaction enabling for the healthcare industry in Zimbabwe and the region. Primarily, the business offers the ability for a healthcare service providers, pharmacist, practice manager or hospital administration staff to submit an electronic claim on behalf of the patient, to the appropriate medical scheme or insurance /healthcare funder. Electronic claims are delivered online with a varying degree of validation checks. Meaning instantaneous processing of a request or claim. The healthcare professional remains connected to the network whilst the claim is processed and the resultant reply is fed directly back into the provider’s system. Eligibility verification, prior authorization, claim status confirmation and processing payments from health insurers can all be done digitally and in a fraction of the time necessary for traditional paper claim processing.

We are a majority management-owned and completely independent transaction enabler and switch with a cumulative total of 10 years of industry experience. Our primary focus is on medical transaction switching, but we have expanded that knowledge to be able to switch transactions for any industry and need. We have setup an independent medical switch that is fast, secure, reliable, user-friendly and can be used anywhere in the world. The switch has no country-specific restrictions and abides by each country’s local regulations and requirements. Best practices were adhered to from the start, which makes the system flexible to each client’s needs and the requirements of their country or regulatory body.

Our goal is to provide fast, accurate, high quality and value-for-money real-time transaction without compromise so as to:

  • Reduce fraudulent claiming
  • Immediate validation and adjudication
  • Improved cash flow
  • Reduced exposure to financial risk
  • More transparent
  • Fewer errors
  • Go green ( Paperless)

Core functionalities of the Electronic Claim Switch include but are not limited to:

Bio-metric Member Validation We enable service providers to check medical aid membership right from their Practice Management Applications using fingerprint authentication. Every claim is sent with a fingerprint signature electronically to the funder who then approves the claim is seconds.
Benefit Eligibility Checks Enabling providers of service to check the benefits that the patient is eligible for in real time. This includes all the categories of benefits e.g. inpatient, outpatient, pharmacy, dental etc.
Electronic Claim Authentication and Submission The system is able to send bio-metrically authenticated claims to medical schemes online through one platform. Claims can be sent in real-time or in batches.   All stakeholders are equipped with a monitoring interface to check the status and the flow of claims in the system.
Electronic Remittance Processing This allows the service providers to receive and upload electronic remittance advises straight into their Practice Management Applications(PMAs)and reconciliation is done automatically.
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