Mediscor is a South African pharmaceutical benefits management (PBM) organisation. We specialise in electronic claims processing and the management of medicine benefits, covering more than 1.8 million lives and processing in excess of 150 000 transactions per day.
Our main offering is the ability to electronically adjudicate a medicine provider’s claim in real time against complex financial, clinical and pharmaceutical utilisation rules. We implement a customised set of rules for each client. Various electronic processing solutions are available, including real-time, electronic batch, web input and paper submissions.
We offer a high-performance real-time claims processing solution, consisting of the following key components
Real-time Electronic Claims Processing
- Data integrity validation
- Eligibility management
- Utilisation management
- Clinical management
Chronic Medicine Registration Services
Mediscor ChroniLine® is our comprehensive chronic medicine authorisation service. Authorisations are performed by qualified pharmacists and pharmacy assistants.
Pharmacy Network Management
Mediscor provides a comprehensive Pharmacy Network Management service. The service includes engagement with all levels of pharmacy.
Consulting and Advisory Services
- Benefit-related clinical advice
- Benefit design
- What-if studies and impact analyses
- Formulary selection
Data Analysis and Reporting Services
- Patient Experience Monitor
- Expenditure Overview Report
Client Support Services
- Contact centres
- Dedicated client support teams
- On-line search facilities
- SMS patient communication