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Medical scheme liaison

Structured follow-through for your medical scheme queries.

Medical scheme queries, escalations and correspondence take a practice's front desk out of the room. HealthAdmin follows up agreed funding and claims-related queries, records reference numbers and outcomes, tracks required actions and escalates administratively where appropriate.

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You will recognise some of these.

  • Staff are spending mornings waiting on medical scheme queues
  • Scheme correspondence arrives and nobody owns the reply
  • Queries get raised, then lost, because no reference was recorded
  • The same question is being asked of three different people at the scheme

What this covers

The work itself

  1. Medical scheme follow-up

    Following up agreed funding and claims-related queries, recording reference numbers and outcomes, tracking required actions and escalating administratively where appropriate.

  2. Handling correspondence

    Answering scheme letters and requests on your practice's instruction, within the mandate you have agreed.

  3. Escalating properly

    Taking a query up the scheme's own escalation path when the first line cannot resolve it, and keeping the trail.

  4. Recording every interaction

    A reference, a date, a contact and an outcome for every query, so the practice's position is always documented.

  5. Reporting back in writing

    A clear written summary rather than a verbal account that nobody can find again in three months.

The record

Every query carries five things

Unresolved revenue can disappear into silence when queries are not systematically tracked, followed up or escalated. A query with no reference and no date is a query nobody can defend, chase or escalate. This is the minimum record HealthAdmin keeps on every one.

  1. Reference

    The scheme's own reference for the query, captured at the moment it is raised.

  2. Date logged

    When it went in, so the age of the query is a fact rather than a recollection.

  3. Contact

    Who at the scheme it was raised with, by name where the scheme gives one.

  4. Outcome

    What the scheme said, recorded in the words they used.

  5. Next action

    What happens next and when, so nothing closes by being forgotten.

Where this stops

HealthAdmin acts on your practice's instruction within an agreed written mandate. It does not represent the medical scheme, and it does not give legal advice or act as a representative in any statutory complaint process.

Questions practices ask first.

Which schemes do you deal with?

HealthAdmin deals with registered medical schemes and their administrators generally. There is no affiliation with, or endorsement by, any scheme.

Will the scheme talk to you about our practice?

Within the mandate your practice puts in place, yes. Establishing that mandate correctly is part of getting started.

Do you handle complaints to the Council for Medical Schemes?

HealthAdmin handles administration and correspondence. Anything that becomes a formal statutory or legal process should be taken up with an appropriately qualified adviser.

Read more on this

The rest of what HealthAdmin handles

All services

Remote support for practices across all nine provinces. Call 084 301 6520.

Where is your practice losing time or revenue?

Tell us where the administrative pressure sits. PMBs, claims, authorisations, scheme queries, or a backlog nobody has time to work.

Book a Practice Assessment084 301 6520

Please do not submit patient medical information through this website.

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