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MEDNETSERVICE PROPOSITION
Ap
ril
20
21
Commercial Department
This presentation provides a brief outline of the MedNet Global Healthcare Services LLC structured solution and it is not in
any way an offer/proposal to DIC. An offer/ proposal can only be provided to DIC after MedNet undertakes due diligence and
internal approvals.
The information contained herein is provided to you on a strictly confidential basis and you agree that it may not be copied,
reproduced or otherwise shared/distributed by you (other than to your professional advisors) without MedNet’s prior written
consent.
MedNet Global Healthcare Solutions LLC, Insurance Authority Registration No.: REG000011201, ADED Commercial License
No: CN-2149549 / TRN: 100222352500003. P.O. Box 35899, AYA Business Centre, Hamdan Street, Abu Dhabi – UAE
Compliance teamMEDNET
DISCLAIMER
MedNetJordan, KSA
Gulf
MedNetInternational
Beirut
1990 1995 1996 2005 2013 2015
STORY OF MEDNET
MedNet Bahrain
MedNetEgypt
MedNetUAE
MedNetOman
500 + MedNet employees manage a portfolio of over 1 million members across the region
205 2013 2015
MEDNET’S VALUE CHAIN
Proprietary administration and medical management solution
Established footprints in ME emerging markets (Egypt, Jordan, Saudi Arabia, UAE,
Bahrain, Oman, Kurdistan, Kuwait) and Europe (Greece, Cyprus ,Romania)
Sound technical capabilities across the complete value chain of health insurance
administration.
Cost-effective comprehensive medical network
Digitalized automation solutions (e.g. digital provider interface, digital policy &
premium administration and billing tool, rule engine etc.)
Full range of high-quality customer services for outstanding customer experience
State-of-the-art specialized health IT system for primary health insurance
(MedNext) – comprehensive and integrated system for
administration/management
ACKNOWLEDGEMENTOVER THE YEARS
POLICYADMINISTRATION
POLICYMANAGEMENT
Digitalized interface between all stakeholders
Functionalities
Member data collection and validation
Endorsements
Dashboards
Traditional: On email and coordinated between, Insured Group, Broker, Insurer,
MN
Digital Client Portal :A web-based digital system that provides an error-free user-
friendly mechanism to collect, validate and approve member data for card
printing.
TURN AROUND TIME (TAT)
01 02 03
1 to 5 Working days(subject to receive complete information)
New Policy set up
Outside client portal 3 Working daysClient Portal 1.5 working days
Endorsement validation
5 Working days
Renewal Policy validation
MEDICALMANAGEMENT & PRE-APPROVAL
Out-Patient
• Digital upload through DHPO / MNC.
• Pre-approvals for selected OP services and limit based benefits (Dental,
Physiotherapy,
• Vaccinations)
• Authorized in less than 30 minutes for online portal transactions
• Manual Approvals:
• Approval requests are exchanged through the manual route and responded
within TAT of 6 hours
• Digital upload through DHPO / MNC.
• Pre-approvals for all IP admissions and day care
hospitalizations.
• Authorized verbally for emergencies and within 24 hours
for elective cases.
• Elective cases: 1 working day after receipt of request at
TPA or 24 hours before scheduled appointment, whichever
is earlier.
• Emergency cases: Do not need prior-approval; Approval
(network Providers 24 hours before discharge or within 48
hours of admission, whichever is earlier )
• Emergency treatment : GOP and coverage
confirmation within one working day
• Elective treatment requested by members or
referred by MN : 5 working days from initial
notification.
In-Patient ( All Elective In-patient
treatment need approval)
PRE- AUTHORIZATION
I n t e r n a t i o n a l C l a i m s
PRIORAPPROVAL PROTOCOL – OUT-PATIENT→ No approval threshold
→ Approval restricted to following conditions
→ TAT of 30 Minutes
Ad
va
nce
d R
ad
iolo
gy
/in
va
siv
e A
sse
ssm
en
t
• MRI’s
• CT scans
• Endoscopies
• Nuclear Studies
• Nerve / Muscle Studies
• Biopsies
Ad
va
nce
d C
ard
iov
asc
ula
r A
sse
ssm
en
t
• Echo
• Stress Test
• Doppler Study L
imit
Ba
sed
Be
ne
fits
• Dental
• Physiotherapy
• Vaccination
• Alternative Medicine
• Optical
Scr
ee
nin
g P
rofi
les
• Allergen Test
• Vitamin D Test
• Mammogram
• All Hospitalizations
• Day Care Admissions
RESPONSE
TIME
97% responded within
10 minutes
RESPONSE
TIME
97% responded within
10 minutes
RESPONSE
TIME
97% responded within
10 minutes
PHARMACYBENEFITS MANAGEMENT (PBM)
• 70% approval < 1 minute
• 95% approval < 5 mins
• 98% approvals < 10 minutes
TAT
Prior Authorization
Policy Eligibility Check (member,
provider & benefit eligibility)
MEDICAL MANAGEMENT ELEMENTS
Policy Eligibility Check (member,
provider & benefit eligibility)
Policy Eligibility Check (member,
provider & benefit eligibility)
Case Management/second medical Opinion
Peer Review (prior to service)
Concurrent Review (during the service)
Retrospective Review (after the
service)
Fraud andAbuse Management
Fraud & Abuse Identification through
various mechanisms deployed in MedNet
In depth analysis of
identified trends
Audit & Action against abusive
provider/member
NETWORK& PROVIDER RELATIONS
Kuwait 123
Egypt 2500+
Saudi Arabia 2000+
Bahrain 331
Greece 185
Jordan 1,063
International Network Access
Qatar 300
UAE 3000+
Oman 340
UAE 3000+
Oman 340
Bahrain 331
Qatar 300Kuwait 123
Saudi Arabia 2000+
Cyprus 36Jordan 1063
Egypt 2500+
Germany 30UK 483
France 175
Spain 135
USA 30,000+
Angola 26
Nigeria 182
Ghana 110
Kenya 64
Congo 97
South Africa 1,191
Turkey 35Lebanon 404
China 350
Pakistan 425
India 3,081
Philippines 4
Greece 186
Cyprus 36
MEDNET NETWORK UAE
Green NW Provider Silver Classic Provider Silver Premium Provider
Gold NW Member2862 Providers
Silver Premium Member2727 Providers
Gold NW Provider
Silver Classic Member2366 Providers
Green NW Member2261 Providers
Silk Road NW Member2082 Providers
EBP NW Member1100 Providers
460 Dental NW for all eligible members
DUBAI
46.4%
ABU DHABI
26.4%
SHARJAH
16.4%
AJMAN
4.2%
RAS AL KHAIMAH
3.8%
UMM AL QUWAIN
0.7%
PHARMACY
53.7%
CLINIC
38.6%
HOSPITAL
5.5%
DIAGNOSTICS
2.2%
NETWORK PROVIDER DISTRIBUTION IN THE UAE
INTERNATIONALNETWORK ACCESS Out-patient & In-patient access
• U.A.E 3000+ Providers
• Oman 340 Providers
• Bahrain 300+ Providers
• Qatar 300 Providers
• Kuwait 123 Provider
• Jordan 1000+ Providers
• Egypt 2500+ Providers
• Greece: 185 Providers
• KSA: 2000+ Providers
• Africa 2,222 Providers across Africa, including SA, Kenya, Nigeria
Out-patient & In-patient1 access
In-patient only access
➢ These are countries where MN has direct contracts with Hospitals due to its local presence, hence cashless access can be obtained by showing MN’s card for both OP and IP services
➢ Africa: is a rented network and will require co-branding with MN’s local partner
INTERNATIONALNETWORK ACCESS In-patient only access
• United States > 30,000 Providers
• Europe 2000+ Providers
• Pakistan 425 Providers
• India 5610 Providers
• Philippines 450 Providers
• Sri Lanka 38 Providers
• Thailand 1433 Providers
Out-patient & In-patient1 access
In-patient only access
• Nepal 2 Providers
• Turkey 35 Providers
• China 726 Providers
• Singapore 1555 Providers
• SE Asia 4500+ Providers
• Latin America 1000+
Providers
➢ Direct access in these countries is facilitated by partner companies via a Guarantee of Payment (GoP) basis where a Member is granted Network access by a provider based on a payment guarantee issued by MedNet or by a Network access partner on behalf of MedNet
MEMBER’S EXPERIENCE JOURNEY
Oman
Bahrain
Qatar
Kuwait
Jordan
Egypt
KSA
All other countries on
international access on
+971 4 3900749
AVAILABLE 24/7 OUR TEAM IS HERE FOR YOU!
Languages
English
Arabic
Hindi
Tagalog
Professional Local lines in UAE Toll free access
Nurses
Physiotherapists
Pharmacists
8004882
REIMBURSEMENT (CASH) CLAIMS
Any claim incurred (services taken) outside eligible Network
Provider and paid in cash by the insured member will be
reimbursed based on terms and conditions of coverage specified
under the policy.
Various method of submission
Website
Mobile app
Rembeirsumentcash (claims)
MEMBER EMPOWERMENT:EMAIL RECEIPT ON
1-Claims Receipt
2-Claims Processing complete + Claims bordereau
3-Claims Payment under process
4-Claim paid with details
MOBILE ENABLED
1-Anytime, anywhere submission of claims
2-Real time tracking of claim status
Claims processing TAT: 3 to 5 days
Claims settlement TAT: Within 5 working days from
Receipt to Payment
Incomplete Claims Management : Member contacted directly in 2 working days, with Insurer/Payer on copy
Member
registration
Overview of the
member information
Locate nearest
eligible Network
Provider
Policy
details
Submit a Claim:
allows you to submit
a reimbursement
claim via mobile app
Contact us
MOBILE APP FEATURESKey functions of the mobile App
My Claims:
allows you to
view previously
utilized claims
My authorizations:
allows you to check
the status of
your authorizations
Available 24/7 in English and Arabic and
current services include:
• COVID-19 Info Hub
• Authorization Status
• Submit a Complaint
• E-card
• Locate Provider
• Table of Benefits
• Chatting platform with our agent
• And much more..
MEDNET’S VIRTUAL ASSISTANT
•With one click: medications delivery
service to the doorstep
• Confirmation and delivery details on
SMS
• Available all over the UAE through
our virtual assistant.
RAHTAK: MEDNET’S ONLINE MEDICATION DELIVERY SOLUTION
PRE-APPROVALAUTHORIZATION CHECKER
Allows member to track
their medical approval
requests.
All cases are justified
by comments with
transparency
Allow our member to
call/chat with our agent for
any rejected/partially
approved service .
• Non covered service
• Optical
• Dental
• Allergy testing
• Flu shots
• Health and fitness centers
• Dermatology and cosmetics …
MEDNET EXCLUSIVE MEMBER DISCOUNTS AND OFFERINGSValid till 31st December 2021
ask for more details
THANK YOU!
Follow us on: WhatsApp +971 800 4882
OUR PROMISE!We operate round-the-clock helpline, 365-days-a-year, which offers
real-time access, on telephone, email, facsimile to our team of
experienced, qualified and multi-lingual healthcare professionals.
International Phone: +971 4 2757800
Email: [email protected]