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Medical management:

  • Pre-authorization for Admissions
  • Concurrent Renewal Review
  • Retrospective Assessment & Review
  • Quality Assurance & Control
  • Medical Protocol Management
  • 24 hours, 7 days a week Helpdesk

Financial management:

  • Cheque Issuing
  • Accounts payable
  • Accounts receivable/ billing
  • Explanation of Benefits “EOB”

IT management:

  • Availability of technology in accordance with market needs.
  • Availability of technology that is concurrent with future needs.
  • Availability of needed functionalities
  • System Reliability & Consistency
  • Utilization of Smart Card Technology
  • System Alignment
Operations management:
  • Policy compliance
  • Traceability & Transparency
  • Claims processing and review
  • Capacity Building
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