Health

When it comes to healthcare, Nigeria is faced with a number of challenges.

These include everything from lack of adequate internal technology infrastructure and high operational costs to the manual submission and processing of health claims.

Simply put, Health Insurers and Providers don’t have the capacity to manage all of these non-core functions, while still giving their patients the proper care they need.

To address these, we have developed a shared outsourcing infrastructure to help manage non-core functions such as record keeping, claims processes, administration services and much more.  This means that health insurers and care providers are no longer burdened with these time-consuming tasks, and can focus on keeping their patients healthy instead. 

Switch to Smarthealth

Smarthealth is an automated service platform that outsources day-to-day operations and administration easily and efficiently. This intuitive technology also offers biometric identification at hospitals, online submission and processing of claims, capitation payments and other payments such as salaries, vendors, suppliers, taxes and pensions.

How it works

Once a health insurer signs up for Smarthealth, all of the organisation’s patient records are transferred and hosted in our secure server. When a patient goes to hospital for treatment, they will receive a Chip and PIN-based identification card. This biometric card is not only used to identify patients easily, but can also be used to make payments. Each ID card is issued to the cardholder by the bank, once the cardholder has agreed to the premiums and minimum balances. 

The ID card can also be used to submit a claim by the hospital. The claim is processed through Smarthealth, using the World Health Organization's ICD 9 coding. Payment is then settled with the hospital once it has been successfully processed.

Case Study:

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Sector – Medical Services, Healthcare maintenance

Health Partners Limited – Health Maintenance Organization (HMO), since 1999 has become one of the leading managed care companies in Nigeria with a firm base anchored within the organized private sector. 

Business Challenge;

With Health Partners’ growth in operations and clientele base over the years came operational bottlenecks and challenges stemming from:

      - Poor / Non availability of claims reconciliation

      - Inability to provide detailed claims payment breakdown to Providers

      - Poor claims processing with respect to varying tariffs

      - Non tracking of Benefit utilization

      - Non tracking of Pre Authorizations issued

      - Inability to keep track in cases of fraudulent providers

      - Difficulty with Utilization reports for clients

      - Prolonged claims processing time

Health Partners therefore sought out a partner which could provide an end-to-end solution that would help address these operational challenges. Interswitch was engaged to assess Health Partners’ operational value chain and implement a solution – Smarthealth.

 

The Solution;

Smarthealth’s solution remarkably improved claims reconciliation with the ability to provide detailed breakdown to the providers. This made it possible for proper tariffs to be uploaded for the necessary providers, whilst tracking benefit utilization after claims has been incurred. The solution also facilitated more efficient reporting in addition to markedly reducing processing time.

Claims processing reduced from 30 days cycle to between 15-20 days, Utilization reports are typically now available within a week and claims payment breakdown are now available a week post payment (down from about a month previously), all thanks to Interswitch Health Solutions.