Medical Aid Solutions

Success in the healthcare industry, perhaps more than in most other business sectors, depends on the effective use of information.

The collection, organisation, collaboration and subsequent sharing of this information have become mission critical as healthcare organisations must ensure proper management of resources.

Successful management has become increasingly difficult, especially with the continuous pressure to reduce costs and maximise efficiency without sacrificing quality patient care – resulting in the industry turning towards technology to respond to these challenges.

PBT Insurance Technologies (PBTit) can provide you with specialist healthcare management solutions and services.

Our Products – Insurance x Intelligence = i2

As an information and technology services provider, PBTit provides solutions that are specifically designed for the healthcare sector. Our significant industry experience, exceptional product – and professional services offering have contributed to being a recognised leader in Medical Aid Solutions.

i2 - The new flagship product for the Medical Fund and Managed Care environments

The i2 healthcare management system retains the best of iMed, its predecessor, but incorporates enhancements built on experiences attained in developing, installing and supporting the latter, to cater for the dynamic managed care environment. Financial system independence, improved web integration, cutting-edge technology, complemented by a flexible and competitive pricing structure, makes this the most comprehensive solution available in the market.

The i2 application is designed to support the configuration and administration of multiple medical funds with different rule sets, an unlimited number of products, benefit limits and pricing structures per fund, on a single platform. i2 is a technically robust solution that can easily be modified or enhanced to meet the client’s specific needs and provides seamless integration into the existing or preferred financial system.

• High level of flexibility

  The user-friendly, parameter-driven design provides a high level of flexibility when defining benefits as well as contribution and payment rules, enabling the fund to react to market changes with minimal effort.

• Real-time claims processing

  i2’s on-line, real-time claims processing function provides an environment that ensures consistency and accuracy in the processing of all disciplines. The handling of claim documents, pre-authorisations, inclusions, exclusions, disease management and clinical auditing are integrated into this process.

• Powerful query capabilities

  i2 provides powerful query capabilities which enable the prompt and accurate handling of queries. In addition, access to full payment records is available.

• Auditable electronic data interchange

  A fully integrated Electronic Data Interchange (EDI) ensures rapid claims processing, enabling staff to deal with more complex claims. The EDI facility provides a comprehensive reconciliation of received and processed data.

• Document management supports client service

  i2’s document management supports the access to and retrieval of documentation (e.g. various file formats, faxes) according to practice, member, group or claim; furthermore contributing to improved client service.

• Membership and contribution management

  i2 makes provision for automated member eligibility adjustments. These adjustments are immediately and automatically applicable to all claims, including claims already paid.

• Advanced medical savings account management

  i2 supports new generation medical fund products and provides advanced support for savings account management - empowering the member to effectively manage his/her own savings account.

• Episode management

  Making provision for the full control of disease management, i2 ensures that the controls are integrated into the claims process and that the fund does not incur any unnecessary costs. Should the member exceed an authorisation or limit, claims and clinical audit personnel are alerted accordingly.

• Provider management

  i2 includes the full set of practitioner data as supplied by the Board of Healthcare Funders. The solution also makes provision for an internal classification to assist with reporting and benefit calculation.

• Comprehensive security

  i2’s advanced security control enables the user to easily set up access on various levels within the application and its functions.

Our services can be provided as:

• End-to-end project contracting and execution
• Specialist consulting
• Maintenance and support