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