3Sixty Health performs end-to-end administration services which include:
- Receipt and processing of member applications and registration in terms of the scheme rules
- Arrangement of the receipt and banking contributions
- Maintenance and updating of member records
- Issuing of membership cards
- Billing the client
- A list of active members is produced monthly and reconciled electronically to the company return
- Suspension of benefits and/or termination of membership as dictated by the scheme rules
- Timeous issuing of annual tax certificates to the members; and
- Issuing of membership certificates at termination
Claims administration services encompass the full cycle of processing from receipt of a claim, to payment and reporting thereof. 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 upon notification of changes with effective dates.
Claims can be traced from time to time of capturing through to payment, which means that at any stage of the process, the status of the claim can be accessed should an enquiry be made.
All claims are validated to ensure that duplicate and inappropriate claims are detected and minimised. 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 on-line claims processing system has an automated verification system that checks:
- Membership status, name, date of birth and membership number
- Service provider, practice codes, identity
- Tariff codes
- Discounts applicable
Electronic Data Interchanges
Suppliers are encouraged to submit claims electronically, either via a hub or directly to 3Sixty Health Solutions. The benefits to suppliers and service providers are evident as claims are adjudicated, member benefit account interrogated for usage and availability and benefit account are debited – all in a fraction of a second. Service providers now submit about 95% of the claims electronically, of which half are executed real time.
We have one national call centre situated in Johannesburg. All calls managed through the call centre are virtual and can be answered from any location. 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 fluent in all South African languages.