HOSPITAL BENEFIT MANAGEMENT

We ensure that all medical scheme rules and exclusions, as well as related protocols, plus procedures are managed in a cost-effective manner to meet the highest demands of quality and service.

Hospital benefit management comprises the following:

• Hospital and day theatre utilisation mangement (pre-authorisations, case management, and account audits)
• Secondary services utilisation management (pre-authorisations and the operation of a secondary referral centre)
• In practice, patients are linked to appropriate healthcare service providers and resources through a 24-hour authorisation centre, ensuring that quality of care provided is effective, timely and appropriate

DISEASE MANAGEMENT

We have designed programmes that are specifically structured to support members by improving the quality of care.

Rx Health actively manages the following disease management programmes:

• Oncology Disease Management Programme
• HIV Disease Management Programme
• Diabetes Management Programme
• Musculo-skeletal Management Programme
• Renal Disease Management Programme

PHARMACEUTICAL BENEFIT MANAGEMENT

We focus on providing members of medical schemes with appropriate, cost-effective quality treatment according to scheme rules, plus defined benefits.

Pharmaceutical benefit managment comprises the following:

• An electronic claims processing service
• Oncology and specialised medicines management
• CDL and chronic formulary management