AdMedika Claim Management

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.

With the Front-end Healthcard Network Technology that leverages on the existing Banking Credit Card Infrastructure and our state-of-the-art back-end AdCPS (AdMedika Claims Processing Systems) technology, we are able to electronically automate the administrative process of eligibility verification, data capture, admission authorization and claims processing at the point of care in real-time mode.

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.