3Sixty Health performs end-to-end administration services which include:
Claims administration services encompasses the full cycle of processing, from receipt of a claim to its payment and reporting. 3Sixty Health has the ability to accommodate all relevant healthcare tariff codes, with cross-references and monetary values applied. All tariff codes can be updated on notification of changes with effective dates. Claims can be traced from the time of capturing through to payment, which means that at any stage of the process, the status of the claim can be accessed should there be an enquiry. All claims are validated to ensure that duplicate and inappropriate claims are detected and minimized. The system has the ability to suspend or withhold payment to any supplier or member. Moreover, ad-hoc payments can be accommodated on the system. 3Sixty Health’s online claims processing system has an automated verification system that checks membership status, name, date of birth, membership number, service provider, practice codes, identity tariff codes and discounts applicable.
Electronic Data Interchanges
Suppliers are encouraged to submit claims electronically, either via a hub or directly to 3Sixty Health. The benefits to suppliers and service providers are evident as claims are adjudicated and member benefit accounts are interrogated for usage and availability and debited – all in a fraction of a second. Service providers now submit about 95% of the claims electronically, with half being executed in real time.
Contact Centre Management
We have one national contact center, situated in Johannesburg. Calls managed through the call center operate on hybrid model to allow flexibility as and when required. All calls are voice-recorded and reviewed on a consistent basis to ensure service quality and continuous process improvement. We provide courteous and efficient handling of members’ queries by trained staff who are fluent in all South African languages.
We offer a complete one-stop shop service in our contact center, maintaining service levels of above 95%.
Our query tracking system allows us to track all queries, ensuring that any escalated queries are responded to within 48 hours.
Our engaged telephony system gives members and providers who interact with our contact center the opportunity to provide feedback on their experience.