Medware offers a comprehensive interactive website that empowers members,
doctors, brokers and other stakeholders to review their financial and
benefit status from any web browser. Access is granted to all
relevant information, including claims, contributions, scanned images of
paper correspondence, statements and benefits used and available.
Medware: Product FAQ's
Your full understanding of the Medware system is important to us. Please click
on the appropriate question below.
Existing Administrators using Medware do not organise their claims
departments according to scheme or option.
The system is multi-administrator, multi-scheme, multi-option, and all
benefit rules are held in user-maintainable tables (parameter lists).
Claims data-capturers do not have to be aware of scheme- or
option-specific rules, and error messages can be set up to prevent lesser
skilled data capturers/assessors from overriding messages by staff
The system has been designed in such a way that the data
capturing/assessing function can be distributed across wide area networks,
facilitating assessing from home or regions.
How do you handle
exclusions and/or waiting periods?
Currently we use our comprehensive case management system to load waiting
period cases for these people. We load a Diagnosis code and some free
text. The system will display a message for the assessor that such a case
exists. The assessor then has to evaluate the claim accordingly and decide
to pay or reject.
Are you able to store
The Medware system comes with an integrated comprehensive scanning
solution which handles the acquisition, storage and presentation on demand
of all types of documents, paper and electronic.
These include paper claims and correspondence, claims statements,
These images are available to authorised staff, and are visible to
authorised users on the website.
Does your system handle
Electronic data and interfaces?
It does so in various forms:
Real-time Electronic claims:
The Claims "Engine" within Medware is a rules based, parameter driven
subroutine (object), that is callable from many points:
Switched claims automatically reserve relevant benefits, and are ready for
payment immediately. The system is able to receive these claims 24 hours a
day, 7 days a week. Standing facilities are available in the event of
connection failures. This has however proven to seldom exceed 0.5% of all
switched claims. Response times on switched claims are sub-second.
Development is underway to receive switched claims from Healthbridge, as
well as switching medicine claims to MediKredit for price and clinical
Medware accepts electronic claims in batch from various Pharmaceutical
Management Companies. The receipt of batch claims may be enabled at short
The system caters for cheques, and direct deposits and collections via ACB
Contributions, eg "Nedinform":
The system handles downloading of reconciliation information from a number
of banking institutions, including Nedbank, Absa and Standard Bank.
Email of Invoices:
Medware will email members and providers a mini-statement each night
showing claims received and processed.
All statements are available on the website, and can be downloaded from
Emailing of statements to members and providers is under development.
Medware offers a comprehensive 24x7 website, allowing authorised members,
providers, groups and brokers access to most data from the real time
databases. Access, and depth of data available, is controlled by
indicators on Broker and Group records.
Managed Health Care Interfaces:
Medware currently generates the files as required by MHS and is able to
link with other managed health care providers or re-insurance companies.
The system has a comprehensive case management system, and caters for
import of cases from Sanlam Health. QA Care cases will be programmed,
making use of existing code.
Pro-Sort Address Details:
This is not available but can be achieved with light system modification
Medware generates the correct files for upload to Persal.
Does your system handle
the "new age" plans?
Medware handles savings options and thresholds, and the origin of benefits
is stamped onto assessed claim lines. The decision from where the benefits
are taken is automatically handled by the rules system.
Since all claims contain rich accounting information, the MIS tools can be
effectively used to summarise and drill down into claims information.
More clarity is required regarding payment of claims on a cash as well as
credit basis, but the system will handle pre-funding of savings balances,
as well as payments based on actual monies receipted into savings accounts
How is Invoicing and
All contribution tables contain a breakdown of total contributions, and
raisings and reconciliations of receipts is done and held at member level,
regardless of how the contributions are received.
Since contributions raised and received are held in detail at member
level, it is possible to view the reconciliation at group, option and
Claims Debtors and Contribution accounts are held as open items.
Can Medware process a
Capitation type product?
A better understanding of these requirements would be necessary, but the
system can handle "pre-paid" claims, and capitation payments to provider
groups will be handled in the same way that brokers' commissions are
handled - ie a formula will be used based on the number of members
assigned to providers, modified by factors such as actual usage and
Customisation may be necessary to achieve the client's exact requirements.
Will my membership
number change if I move plans?
You will be given only one membership number. The system allows transfer
of a member between options within a scheme without a change to member
numbers, and the claims processing engine correctly calculates benefits
based on conditions prevailing at date of service. Rules may be changed at
any time, and can last as little as one day in duration.
What access will my
The system contains a comprehensive Broker commission and membership
status tracking system, which is Internet enabled.
Authorised Brokers have limited to complete access (controlled by
indicators) to only their own members. Provision is made for a hierarchy
Submission of applications via e-mail and web has been signed off in
Do you record all
Medware has a comprehensive online Audit system. All changes to master
files are logged in audit trails, and information stored includes who,
when, which programmes, before and after images.
What type of Management
Information does the system include?
Medware exports data into PowerPlay cubes for drill-down access by
These cubes are constantly under refinement, and are driven by clients'
Reports - standard reports are produced on request, daily, weekly,
monthly. All clients' reporting requirements not yet handled will be
specified during due diligence, and will be included with Medware when
deployed or shortly thereafter.
What accounting system
do you use?
Medware does not handle scheme general ledger requirements internally, but
instead interfaces to a variety of standard accounting packages. As part
of the due diligence process, NHA will work with the client to interface
to the client's choice of packages, and may, at the client's request,
recommend packages with which our clients have had great success.
How long does it take
to go live?
The target LIVE data is usually determined by signature of the contract
and is typically three months from conclusion of contract until LIVE.
After contract signature, NHA will conduct a more detailed on-site
investigation which should last between two and four weeks. This phase
allows our team a more thorough look at all the current processes,
procedures, paper trails and data availability, cleanliness and richness.
This will help us to determine any "gaps" and therefore what customisation
is required. This phase includes a technical inspection of all equipment
and infrastructure to determine any other hardware and software
As output to this phase, a detailed project plan will be developed
highlighting the areas of customisation, data take-on, training, hardware
and software required.
Immediately after this NHA will begin with a data take-on from the old
system into Medware. We would require detailed data maps and availability
of existing data, and would work with existing IT people ...
The last phase pre-live is dedicated to training, running in parallel
including payment runs, detailed data cross checks between old and new,
and further customisation. In these months all the "missing" hardware and
software to enable the Medware system will be configured and installed.
How is security
The main server and image servers can be located behind existing
firewalls. The information supplied for the web is not directly exposed to
the internet, but is requested and delivered through defined sockets
(similar to ODBC) between the web server and HP3000 and other servers as
Access to the HP3000 is via the proprietary logon security system and will
only be available from the LAN.
The website can make use of certification and https encryption at very
little cost and inconvenience to web users.
All claims are fully assessed against a set of prices or tariffs. Claims
that exceed those prices (by a user-defined percentage) are highlighted,
and require assessor intervention.
All forced claims are logged as such, along with the reasons why they were
forced. Staff are assigned a user level, and error messages are pegged at
certain levels, enabling fine control over staff functions and
capabilities throughout the system.
All changes to data are logged along with date time and user, before and
after values, and these form a powerful tool for managing the audit
Reports exist that highlight outlying transaction values (higher than
threshold claims, etc).
How is training
Training will take place on site, and will form part of implementation and
Our philosophy here is to train all staff to use Medware in an offline,
dedicated environment, and we would request the client to provide
facilities for 8 - 10 staff per session.
Trainers will be drawn from NHA's 100 staff members. User manuals exist, and are used as work books during
training, and are retained by the staff.
Onsite IT personnel act as backup and reinforcement following training.
We have dedicated user liaison staff in Gauteng, and these people rove
between sites monitoring user access and usage of Medware and attending to
ongoing training requirements.