In 2002, Naspers Medical Fund was taking care of 12,000 members and 9,500 claims a month.
Finding source documentation for medical aid claims and queries was an enormous problem: it was time-consuming and extremely labour-intensive.
The client needed a solution that would:
- Capture all relevant documentation electronically
- Provide a specific solution for chronic medicine claims
- Facilitate the easy retrieval of hardcopy documents if required
- Enable quick and easy access to proof of payment information
- Provide a central repository for member information that was searchable and accessible from a number of office locations.
Capturing claims
FirstCoast consulted with Naspers Medical Fund to identify their needs and then recommended OpenText Alchemy as the perfect document management solution for them.
The client then asked FirstCoast to handle all their document capture, which was done by FirstCoast's scanning bureau. Alchemy provides optical character recognition (OCR), meaning that text became searchable. After claim assessment, our bureau scanned and indexed all source documents according to member number, service provider practice number and assessment date. This provided three search criteria for every claim - information that was then just a mouse-click away.
Each document is also indexed according to an archive batch number. The batches are then vacuum-packed industrially for environmental protection and stored for five years. Original documents can be retrieved easily by recalling the document on the system and tracking it through the index to its warehouse location for retrieval.
Handling repeat claims
As is the case at most medical aids, another problem for Naspers Medical Fund was chronic medication, because while assessment takes place only once, claims are multiple. For every repeat claim, the assessor has to refer to an approval document. FirstCoast created a separate database for chronic medicine approvals, where all approvals are indexed according to member number, approval code and date. This allowed assessors to verify approvals quickly and as a result, turnaround time improved from seven days to one day.
Streamlining payments to service providers
The next step was to solve the problem of lengthy electronic payment reports to various service providers. All reports were scanned and subjected to optical character recognition (OCR), then indexed according to report and payment dates. This means that claims assessors were then able to conduct a full text search of a practice number to retrieve the relevant payment history. Should queries regarding proof of payment arise, the information would be a mouse click away.
Centralised member information
All other source documentation, including membership information, application forms and amendments are scanned, indexed by membership number and stored. This benefits Naspers Medical Fund as their staff can now retrieve a member's complete file within seconds, simply by conducting a simple search.
Technical information:
The products that FirstCoast uses to streamline Naspers Medical Fund's patient information are:
- Inotec Scamax M06 150 page scanners: For fast, high quality scanning of larger volumes.
- OpenText Alchemy: For creating a digital archive and searchable materials.
More information
For more information or to find out how FirstCoast can help your company manage member, patient or payment records, please contact This e-mail address is being protected from spambots. You need JavaScript enabled to view it on +27 (0) 861 313 300.
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