“Other Services”

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