Current Situation

Insurance

Fraud

unreliable beneficiary identification

Delayed Payments

Inaccessibility to primary healthcare

Healthcare

Manual Data Entry Errors

Claim Denials and Rejections

Difficulty in Tracking Claims

Compliance Risks

Medismart

Our Solution

Our Automated Medical Scheme Management Solution dubbed MediSmart is the premier solution in medical scheme management powered by a biometric technology engine and mobile technology (App and USSD). The solution ensures improved service delivery to the Medical Scheme Administrators.

MediSmart guarantees, efficiency creation, and the elimination of fraud, waste, and abuse of medical schemes that occurs through impersonation. It controls the setting up of benefits and their limits as well as the provision of online real-time reports on expenditure/utilisations. It covers all aspects of medical scheme management

Explore MediSmart

1

Unmatched System Uptime

The system boasts an impressive 99.6% uptime, ensuring continuous access for users. The solution offers seamless access at all providers, extending its reach countrywide. This accessibility ensures that members can avail medical services without any hindrance, regardless of their location.

2

Guaranteed Cost Savings

The solution’s analytics capabilities empower informed decision-making by providing insights into scheme utilization and expenditure.

3

Accurate Member Validation

Biometric Member Validation guarantees the accurate identification of members using biometric data, reducing the risk of fraudulent claims and impersonation.

Key Features and Benefits

1

Guaranteed Member Identification through Biometrics

This feature ensures the accurate identification of scheme members using biometric data, such as fingerprints or facial recognition, reducing the risk of impersonation and fraudulent claims. Biometrics provides a secure and foolproof method for confirming the identity of members.

2

Benefit Verification before Service

Before a member receives a medical service, the system verifies their eligibility and benefits in real-time. This includes checking benefit coverage and limits, ensuring that members receive the appropriate services and that they are within their coverage limits. Any changes to benefits can be implemented remotely, providing flexibility and ease of management.

3

Member Management

This feature allows for the remote management of members, including activations and cancellations. Administrators can efficiently handle membership changes without the need for physical presence, streamlining the administrative process.

4

Service Provider Management

The system provides robust service provider management, enabling access control and generating detailed provider reports. Access control ensures that only authorized providers deliver services, enhancing security and quality control. Provider reports offer valuable insights into service utilization and performance.

5

Online Information Management

The solution offers online information management through features like switched Smart e-claims and online reports. Members and administrators can submit and access claims electronically, simplifying the claims process. Real-time online reports provide visibility into expenditure and utilization patterns, supporting informed decision-making.

Result

Medismart Impact

The Medismart solution is being used by millions of people across the region to access medical services in a simplified, convenient, reliable, and secure way. The solution, which has been installed in over 7,000 healthcare facilities across Africa, has led to more than 40% Cost savings on medical budgets by driving efficiency that leads to the elimination of fraud, waste, and abuse. Furthermore, it has entrenched trust between involved stakeholders through the provision of positive biometric identification.