Benefit & Comparison

Claim Management Key Features

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.
  • Provider Relation
  • Membership Administration
  • System and Network
  • Real Support
  • Case Monitoring
  • Online Web Monitoring

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.

Claim Management Benefits

For Insurance & Corporations
  • The vast increasing needs for health insurance and its variety of benefit plans has made health insurance companies or self-insured companies administrative works become more complex than ever. AdMedika provides services pertaining to healthcare claims administration management for members of health insurance and employees of self-insured companies.
  • 24/7 Call Center & Case Monitoring
  • Largest healthcare network providers.
  • First hand information on risk exposure.
  • Minimizing claim excess
  • Minimizing fraud & abuses.
  • Increasing corporate image and adding value to its services.
  • Standardization of health care services for policy holders.
  • Making administration process easier, thus increasing employees productivity.
  • Minimizing labor cost
  • Online and real-time web reporting and claim status
For Healthcare Providers
  • No more data contra-distinctions, excess claims quarrel and time consuming claims verification and administration between healthcare providers and payers. Our comprehensive Healthcard Network and back-end AdCPS technology cover both the outpatient and inpatient.
  • 24/7 Call Center & Case Monitoring
  • Increasing corporate image and adding value to its services
  • Broadening hospital clientele
  • Standardization of health care services for policy holders
  • Easier to monitor billings and/or account receivable management
  • Acceleration of service process (patient and billing administration)
  • Online and real-time verification, minimizing ineligible claims.
  • Simplify administration process, thus increase the employees productivity
For Members / Policy Holders
  • The members / policy holders are the center of healthcare providers' activities. Giving fast and first class quality services insured consumer loyalty and increases corporate image. Each member / policy holder will be given electronic ID cards needed to validate their identity at the time of admission. The member / policy holder can enjoy cashless hospitalization, easy and hassle-free claims administration process.
  • 24/7 call center service with medical advisory
  • Quality choices of healthcare providers, nationwide
  • Received the best quality treatment and/or health insurance
  • Cashless treatment
  • Online, real time verification with information on benefit, plan and limit.
  • Information on policy term and condition, exclusion, limitation of benefit and administrative process
  • SMS notification updates
  • AdMedika Valuecard Program

Comparison

Components AdMedika Claim Management Other Third Party Administrators
Identity Electronic card Plastic/Paper based laminated cards (showcards)
Eligibility Electronic Eligibility individually assessed Through Identity Only
Deletion of member Real-time, if employee status changes, the card is blocked immediately upon notification Providers continue treating ex-employees
Claims Flow Data entered at provider, Insurer confirms entry and approves payment Return of Claims to Organization for Manual Entry
Visitation Details On Line, Real Time Data Entry at provider Entry of Data Manually
Utilization / Limits Tracking On Line, Real Time Delayed, aware only when claims are received from providers
Reporting Daily, Weekly, Monthly & Highly Customizable Monthly / Quarterly
Exclusion based on diagnosis On Line, Real Time When documents received from provider
Claim notification On Line, Real Time When documents received from provider
PT. Administrasi Medika
Telkom Gambir, Gedung C, Jl. Medan Merdeka Selatan No. 12, Jakarta Pusat 10110 - Indonesia
021 3483 1100   021 3483 0101   Contact Us   Find on map
Official Social Channels
 Facebook  Twitter  Twitter
iso-admedika topit
metralogo telkomlogo