AdMedika’s Claim Management Services called AdClaim , are conceptualized on the fact that paper-based medical claims process proved inefficient, lacks transparency and prone to abuse and fraud. Our proven methods and procedures of claim administration simplify and standardize healthcare information, reduce cost, enhance service at point of care and create convenience for members (policy holders / patients) when seeking healthcare services. This service will enable our clients to focus on strategic activities of their organization, relieving them from infrastructure cost and back office management, reduce provider billing aging, reduce data entry cost, improves data accuracy and accelerate claim payment to the providers and/or policy holder.
Our experienced claim professionals utilize AdCPS (AdMedika Claims Processing Systems) technology. This state-of-the-art, on-line, real-time system provides instant claim and eligibility information and able to process even the most complex transactions efficiently. We strive to process claims with 100% accuracy and with the fastest time possible. When speed, accuracy and cost are critical, our solution alleviates the pressure.
AdMedika Claim Management Services are able to accommodate both Indemnity & Managed Care healthcare scheme. And with our flexible processing system, we are able to customize our service to handle Hybrid healthcare scheme which is a fusion between Indemnity & Managed Care
Our unique approach and efficient methods is what distinguished AdMedika from other Third Party Administrators in Indonesia.
Learn more what makes AdMedika Claim Management Service only provide the best solution from start to end.
We always maintain a close relationship with all of our partners including the healthcare providers. The healthcare provider's is the front-line of the healthcare activities. Full and constant support is needed to ensure efficiency of the entire administration process.
Each of our healthcare provider's networks is equipped with EDC terminal and connected to the AdMedika Claims Processing Systems (AdCPS). Our provider relations helpdesk will advice and assists with policy and procedure interpretation, training needs, development and implementation of training programs regarding AdMedika's system services and EDC maintenance and support.
Our goal is to bring as much quality healthcare providers (hospitals and clinics) as possible to be in our provider network whilst maintains accurate and current provider databases relating to provider facilities, specialties, practice limitation and physician information. This will help our insurance partners to expand their healthcare providers network and for our members to choose the best provider based on their needs.
Entrusted with millions of members / policy holders, AdMedika’s membership administration service is proven to be the most efficient and benefits all our partners and members. The membership administration, including member enrollment is done electronically utilizing the latest technology and method.
- Health benefit plan setting according to each insurance policies.
- ASO (Administrative Service Only) settings to maintain insurance limitation with report and alert.
- Customizable setting of benefits covering hospitalization and surgical (inpatient), GP and Specialist (outpatient), Maternity including prenatal treatment, dental, optical, etc.
- Collection and maintenance of member’s record including its benefit schemes, policy extension and exclusions.
- Daily update of member’s record pertaining to addition, deletion, endorsements, renewal, lapsed policy. This will be done online and real-time to minimize abuse and excess.
Each of the policy holders including its family members will be given a personalized healthcard with unique 16 digits identification number (ISO-standards) magnetically encoded. Each health insurance company will have its own personalized design.
We understand the importance of communication in this business and there is no “office hour” for one to seek healthcare treatment. That's why our in-house Call Centre and Customer Care staff is working in 3 shifts, 24 hrs a day and 7 days a week, all year long to handle all queries or complaints regarding Benefit Coverage (plan/limit), Procedure (inpatient / outpatient) and Providers Referral.
We handle customer service with a team approach. Team members are cross-trained, so they can assist other team members and taking pride in providing the best service to our partners and members.
Hospitalization or treatment phase is the most significant and critical phase in the whole healthcare process. We understand that in this phase the patient will expect the best care and all the attention they can get.
The Medical Team - which is supported by expert medical advisers- continues to monitor and assess the patient's condition, progress and quality of care throughout the period of admission. Our doctors will closely discuss with the treating doctors and provide recommendations and advice as to how the patient's condition is being treated, what further action might be required and its necessity with the objective of giving the most effective treatment.
A thorough case management will ensure cost containment by minimizing excess of hospitalization claims caused by exhaustive benefit limit, policy exclusion and non-medically necessary treatment.
Keeping our partners in track on their information regarding the claim processing is an important part of our commitment of giving fast and quality services to them. Our online web systems are accessible by the insurance companies and policy holders (members) through unique and secure username and password provided by AdMedika. Information on Members Enquiry, Claims Enquiry, Claims maintenance, claims adjustment), Online real-time reporting and online alert can be accessed anytime, anywhere.
We handle thousands of claim documents on daily basis and every each of these documents may consist up to dozens of papers. The Claim Verification process is the most crucial steps in our claim management service. We focus on maintaining the highest quality, best-trained and most professional claim analysts in the industry and we only hire claim analysts with medical or public health educational background.
Full Service / ASO
|Member Data administration|
|Online Monitoring Web Access|
|24/7 Contact Center|
|24/7 Case Monitoring|
|Admin Payment (Optional)|
AdMedika Claim Management Service has a wide range of types, schemes and service level that would provide the best solution for every type of healthcare insurance. The services are flexible and can be tailor made to fit your specific requirements.
Here are a quick guide on how to find your best Claim Management solution.
TypeChoose the Claim Management Service Type that suits your requirements. Full Service / ASO, Partial Service or Technology.
SchemeChoose the Healthcare Scheme that fits you best. Indemnity, Managed Care or Hybrid.
LevelChoose your Claim Management Service Level that suits your requirements like dedicated contact center team or dedicated claim team
Add & CustomizeYou can add On-Top services to your AdClaim suchs as AdClaim Plus, AdClaim CoB, I-Assist or AdBrief. AdMedika Claim Management can be tailor made to best fit your requirements.