Claims management & cost containment
Claims handled by doctors, not just processors.
From a single reimbursement to a cancer case that runs for months, our in-house medical team pre-approves, pays and cost-contains claims for international health insurers and MGAs. It all runs on MediClaim, our own claims platform.
What we do
Three services, one claim journey.
Pre-approvals and reimbursements.
We check cover, issue guarantees of payment to hospitals and process reimbursement claims to your policy rules, so providers are paid and members are reimbursed.
Medical case management and cost containment.
Our doctors and nurses follow complex and high-cost cases from admission to discharge, in touch with the hospital, the patient and you. Our medical coders then audit the invoice against local rates and the care given.
Direct billing.
Members don't pay up front. We issue guarantees of payment, hold direct-billing agreements with hospitals and clinics for inpatient and outpatient care, and have flash-the-card options at selected facilities. For out-of-network facilities, we have the option of issuing virtual payment cards.
Our own network in Europe, partners in 150+ countriesCost containment
Savings come from managing the case – not just from discounts.
In much of Europe, discounts are rare or forbidden. We contain costs at every stage of the patient's stay instead. Savings are made case by case, and reach up to 50% on the most complex claims.
01 · Before admission
Is the treatment needed, and where?
- Questioning medical necessity and length of stay
- Steering to the right provider based on quality and costs
- Contracted rates where the country allows them
02 · During the stay
Local rates and close medical follow-up.
- Securing local rather than international rates
- Monitoring the treatment with the hospital's medical team
- Negotiating with the facility where needed
03 · At discharge
No extra days, no extra lines.
- Discharge on time, without unneeded extensions
- Invoice audit by our medical coders
- Medical re-coding and correction of errors
Delegated authority.
We can adjudicate claims on your behalf under delegated authority. The process is documented end to end and audited externally, so you keep a full audit trail.
Reporting.
Dashboards and scheduled reports from MediClaim, set up for each client: claims, costs, service levels and savings. Bordereaux for group schemes.
In practice
Three situations we handle every week.
A member is admitted to hospital abroad.
We issue a GOP to the hospital so the member doesn't pay, manage the case through to discharge, and send you an audited invoice.
A cancer case that runs for months.
Our doctors coordinate between the treating team, the patient and you, keeping treatment on track and costs under control.
You want to hand over adjudication.
We handle pre-approvals, reimbursements and large-loss reporting under your authority, with reporting set up in MediClaim.
Explore further
See a claim from start to finish for insurers and MGAs, TPAs and assistance partners or employers.
Tell us about your portfolio.
Share your claim volumes, the countries you cover and how you handle claims today. We'll come back with a proposal.
Request a proposal