Promed Health provide services as an independent medical claims Third Party Administrator (TPA), providing independent access and claims management on a third party basis.
Access the Private Healthcare system with expert management of medical claims
We provide access to Private Healthcare system through our comprehensive provider network, giving clients the benefit of our direct billing arrangements and discounted fees.
And for further savings, with robust clinical case management and negotiation of Specialist fees, we offer an ‘end-to-end’ solution with professionally trained case managers handling medical cases right through from taking the first call from a patient to settlement of the final invoice. We also adopt a proactive nurse-managed approach to more complex claims. For high cost and complex claims such as cardiovascular, mental health, cancer etc, a qualified nurse will be assigned to case manage the claim from inception to settlement of the final claim.
We can also provide clients with access to Chief Medical Officer and second opinion services.
Benefits of PROMED HEALTH Medical Claims Management
Access to Promed Health Provider Network
Clients have access to our extensive provider network, benefiting from our direct billing arrangements with private hospital groups, independent hospitals, private practitioners and medical centres.
End to End Support
PROMED HEALTH case managers handle claims straight through from taking the first call from a claimant to settlement of the final invoice. They check that treatment is covered under the scheme rules, manage treatment and authorise bills for payment.
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Tailored administration services
Our flexible approach means that we can tailor our service to each client’s requirements – from providing access to our Provider Network through to full medical case management and everything in between.
We also have our own in-house claims management systems and technology, which means we have the ability to accommodate varying requests specific to our clients’ requirements.
Where detailed case management is required, our nurse case managers can provide a full micro-management service. This ensures that the appropriate medical care pathway is always taken, without any hospital restrictions or delays in authorisation. We also provide tailored access to hospitals to make optimal use of our clients’ spend on healthcare related services.
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