FOR OPTIMAL, EFFICIENT AND INFORMED MANAGEMENT

An optimal, efficient and informed management
 
Implementing a claims reimbursement system impacts the entire value chain, notably healthcare institutions and professionals.

Amongst the challenges facing you:
  • Access to care limited by reimbursement timeframes and having to settle fees in advance
  • Tangible productivity losses due to manual document management, which hampers claims management teams as well as healthcare institutions and professionals
  • Lack of reliable and detailed data, resulting in suboptimal decision-making
  • Fraud that is hitting your bottom line yet can prove hard to quantify and tackle

By implementing a shared platform, you can connect your ecosystem of healthcare lifecycles, linking its components to accelerate your digital transformation.
CEGEDIM is a leading provider of health lifecycle management solutions. In France, for example, it is the leader in the collection and management of digital flows for the State-run SESAM-Vitale scheme, third-party payments and health chipcards.

2.9 billion claims
reimbursed every year

380 million invoices managed,
across all categories of healthcare providers

4 million invoices processed
electronically every year

200,000 business transactions
conducted online on a daily basis

By connecting all parties on a single online platform, you can:

Improve the services enjoyed by your members

  • Better care provision
  • More efficient processing
    and reimbursement times
  • Third-party payments

Contain processing costs

  • By eliminating redundancies in data capture and automating the handling of low value claims

Strengthen checks

  • Spot fraudulent behavior
  • Assess entitlements in real-time
  • Validate prescriptions

Reinforce your
health policy governance

  • With structured and centralised prescriptions and consumption data, allowing you to implement healthcare control policies and introduce new services (third-party outpatient payers

Reduce the administrative burden
on healthcare professionals and institutions

  • Institutions by decreasing levels of rejected and reprocessed claims and establishing direct billing, thereby lessening any financial burdens patients may face

Automate your business processes

By digitising orders and invoices, you can improve guarantee management whilst delivering productivity gains for Third Party Administrators (‘TPAs’) and reducing reimbursement times for healthcare professionals.

Develop value-added services

Develop value added services
 
Additional controls and services can be developed leveraging the platform as a foundation:
  • Real-time management of each beneficiary's entitlement and benefit cap
  • Digital management of health records and invoices
  • Digital management of prescriptions
  • Management of blacklists of health professionals
  • Monitoring of shared medical files

The relationship with health professionals: a strategic issue

The platform enables providers to deliver high value-added business services so that healthcare professionals may, in real-time:
  • View, on a claim-by-claim basis, the remaining entitlement and any outstanding balances
  • Deliver digital pre-authorisations and orders
  • Create invoices for care
High value added business services for healthcare professional in real time  

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