Medical Billing
Medical Billing Solutions
Billing accuracy is the single biggest driver of revenue performance in a medical practice. Our solutions combine intelligent billing technology with specialist PMB motivation and denial management expertise — ensuring fewer claims are rejected, complex PMB conditions are paid in full, and cash reaches your account faster.
Direct EDI connectivity with all major South African medical schemes
Discovery Health
GEMS
Bonitas
Medscheme
Momentum Health
Bestmed
Fedhealth
Bankmed
Medihelp
CompCare
High-performance claims management, direct EDI switching, PMB (Prescribed Minimum Benefits) motivations across 270 conditions, and automated rejection turnaround pipelines.
Core Advantage
Engineered for South African Healthcare
We eliminate billing friction with direct scheme connectivity, HPCSA compliance, and clinical coding precision.
100% Scheme Coverage
Discovery Health, GEMS, Bonitas, Medscheme, Momentum, Bestmed, Fedhealth & more.
Rapid Cashflow Settlement
Daily EDI switching & proactive rejection resolution to compress your payment cycle.
Service Pillars
Key capabilities that power your practice
Detailed breakdown of how our medical billing solutions service operates to protect your revenue.
Direct EDI Electronic Claim Switching
Direct electronic data interchange links to all South African medical aids with instant receipt acknowledgements and validation checks.
- Sub-second claim transmission to medical schemes
- Immediate syntax and member validation feedback
- Elimination of paper claims and postal delays
Specialised PMB Motivations (270 Conditions + 25 CDL)
Expert motivation drafting and clinical evidence submission to secure 100% cost coverage on legally protected chronic and emergency conditions.
- Comprehensive motivation letters citing Medical Schemes Act regulations
- Coverage across all 270 PMB conditions and 25 Chronic Disease List categories
- Direct dispute resolution with scheme medical advisory panels
Rapid Rejection & Denial Turnaround
A structured rejection resolution engine that categorises errors (stale dates, invalid codes, dependants) and resubmits within 24–48 hours.
- Automated categorisation of rejection error codes
- Fast correction workflows for coding and demographic discrepancies
- Zero claims left to lapse past the statutory 120-day limit
Automated Tariff & Price Updates
Never submit on outdated tariffs. Our platform automatically syncs with latest medical aid base rates, RPL rates, and medicine prices.
- Annual scheme rate adjustments updated automatically
- Single Exit Price (SEP) medicine database synchronization
- Customizable practice surcharge and private fee structures
What we deliver
- Direct EDI electronic switching to all SA medical schemes with immediate delivery verification
- PMB (Prescribed Minimum Benefits) claim motivation covering 270 conditions and 25 CDL diseases
- Predictive ICD-10 diagnosis matching with automated procedure code pairing
- Rapid rejection turnaround pipeline — resolving and resubmitting claims within 24–48 hours
- Automatic tariff updates aligned to annual NHRPL, scheme rates, and Single Exit Price (SEP)
- ERA (Electronic Remittance Advice) processing for automatic line-by-line payment reconciliation
- Discipline-specific billing templates tailored for GPs, surgeons, anaesthetists, and allied health
- Audit-proof claim history retention compliant with HPCSA and Medical Schemes Act guidelines
Business outcomes
- Maximise revenue recovery on complex PMB and chronic disease cases
- Dramatically reduce rejection rates with pre-submission validation engines
- Eliminate manual tariff updates with automated medical scheme schedule feeds
- Shorten claim settlement turnaround times from weeks to days
- Gain real-time visibility over claim progression from submission to bank payout
Step-by-Step Workflow
How our process works for your practice
Transparent, systematic, and aligned with statutory Medical Schemes Act guidelines.
Electronic Claim Generation
Claims are generated with validated ICD-10 diagnostic codes, correct procedure tariffs, and applicable clinical modifiers.
Real-Time EDI Transmission
Claims are switched electronically to the medical scheme gateway with instant delivery and status verification.
PMB & Clinical Motivation Filing
For chronic conditions and high-cost surgical procedures, our specialists submit clinical motivation documents for full benefit release.
Denial Interception & Fast Resubmission
Any technical rejection is flagged immediately, rectified by billing officers, and resubmitted within 24–48 hours.
Frequently Asked Questions
Answers to common practice queries
How do you handle PMB (Prescribed Minimum Benefits) claims?
We identify claims eligible under the 270 PMB conditions and 25 Chronic Disease List (CDL) categories and draft comprehensive clinical motivation letters, ensuring medical schemes pay in full at cost as mandated by the Medical Schemes Act.
How does ERA (Electronic Remittance Advice) save time?
ERA automatically ingests digital payment schedules from medical aids and matches each payment line by line to the patient's invoice, eliminating tedious manual allocation.
What happens when a claim is rejected by a medical scheme?
Our system categorises the rejection reason immediately (e.g. benefit exhausted, authorisation missing, invalid dependent code) and our billing officers correct and resubmit the claim within 48 hours.
Explore More
Other specialised billing pillars
Practice Management
More than an admin tool — a complete clinical and practice management system that handles appointments, electronic health records, real-time medical aid eligibility verification, and ICD-10 diagnostic coding across all major South African medical schemes.
Bureau Services
Fully outsourced billing and claims administration — our dedicated medical bureau team handles daily claims submission, medical aid follow-ups, ERA reconciliation, and patient credit control on your behalf.
Reporting & Analytics
Comprehensive financial intelligence — including Electronic Remittance Advice (ERA) bank reconciliation, 30/60/90/120+ day debtor age analysis, and accountant-ready revenue packs.
Medical billing enquiry
Let's talk about medical billing solutions for your practice
Tell us about your practice — size, disciplines, and how billing is handled today — and our billing team will recommend the right fit.