July 14, 2021

PSMAS Moves To Reduce Claims Processing Turnaround Times


Newly rebranded Premier Service Medical Aid Society (PSMAS) has moved to reduce claims processing turn-around times by adopting an electronic claims processing platform in line with its digitalisation programme.

Introduced in partnership with a local company Health 263, the platform enables service providers to submit claims for services rendered to members in real-time to the Society electronically, a progression from manual submissions. The move addresses both a migration towards technology and a clear support for local entrepreneurship efforts.

Previously, patients would be required to complete hard copy claim forms upon presenting at a health facility. These forms would then be compiled and submitted to the health insurer at a later stage for reimbursements. Upon receipt, the health insurer would first capture details on the claim forms in their system, a process that would sometimes take time before the claim is eligible for payment.

This new process not only speeds up the claim submission process, but also reduces errors associated with manual processes as it brings less manual claims thereby offering convenience to service providers.

In addition, the platform provides for biometric member verifications. This enables enrolled members to verify their credentials electronically without necessarily presenting a membership card at point of care. Furthermore, enrolled members would not need to complete sets of claim forms when they present for treatment, a process that sometimes becomes cumbersome when one is not feeling well.

On the other hand, service providers can attach prescriptions, laboratory and radiology request.

The electronic system also fits very well in the current operating environment, where minimal contact is encouraged to reduce risk of Covid-19 transmission.

PSMAS said, in conformity with the “new normal” it is therefore calling upon its various service providers and members to embrace the electronic claim switching and biometric member authentication platform and enjoy this convenience.

Members can enrol from service providers who have since incorporated this platform as part of their administrative and operational process while health care service provider can enrolling from any PSMAS branch.

Implementation of the Health 263 platform is part of PSMAS’s broader strategy to improve service delivery to members as well as enhancing relationships with healthcare service providers through reducing delays in reimbursements.

PSMAS spokesperson Ms Paidamwoyo Chipunza said this milestone was one of the initiatives the Society has put in place in its quest to digitalise a majority of its services.

She said this was also part of the Society’s rebranding exercise, which sought to improve services and relationships between PSMAS and key stakeholders.

“PSMAS rebranding was a combination of internal and external processes hence, as we changed our corporate identity, we also endeavoured to improve our service offerings in tandem with the new norm, which is technologically inclined”.

“The electronic claims processing and biometric member verification platform is therefore one of the initiatives we will be rolling,” said Ms Chipunza.

She said the Society will continue exploring other functionalities for this platform for extra convenience.

Some of the innovations, already launched to the public include the PSMAS 24/7 Mobile Application. The Mobile App is downloadable on both Google Play and App Store and allows members to get responses to frequently asked questions, payment of subscriptions via multiple platforms, registration of new members, location of service providers and PSMAS branches among others.

The Society is also piloting a wellness wearable smart watch through its Premier Lifestyle programme. The device is meant to assist PSMAS members in better managing their health.