Medexa. Moving in the world to achieve better health care Jordan, Syria, Libya, Egypt, & Oman [Company Profile] 2009

Transcription

1 Medexa Moving in the world to achieve better health care Jordan, Syria, Libya, Egypt, & Oman [Company Profile] 2009 Usage of unified global adopted and approved notations in the medical and healthcare sectors leads to an orderly sequence of better services and promptly manage, control and audit medical and healthcare data and information, thus, providing precise data, statistical information and better services for all sectors parties.

2 Medexa is a privately-owned, Third Party Administrator (TPA) located in Amman, Jordan. Founded in 1999, Medexa has grown tremendously over the last 10 years, both in its customer base as well as in its knowledge and skills on current trends and emerging healthcare and insurance sectors. Medexa prides itself on its dynamic environment never content with the status quo, Medexa constantly strives to challenge conventional knowledge in healthcare and insurance sectors to bring the best solutions any for a given client. Medexa business approach is based on partnering with our clients and understanding their exact needs to encourage success through mutual benefit and over the past 10 years our business has grown; however, our commitment to customer satisfaction has not been deterred. In fact, the changes the company initiated were for the sole purpose to fit the ever changing needs of our customers. Established Neutral Third Party Administrator (TPA). Capital exceeds 3,000,000 U.S. dollar. Passionate for Technology. 1 st regional smart card implementer. Serves 150,000 satisfied subscribers. Serves 5 countries in Middle East & Africa regions. Enjoys 87 th skilled & specialized staff members. Availability & support 365 x 7 x 24. Serves more than 20 satisfied Client. Medexa working to provide health insurance expenses management services, for insurance and self-funded companies, using the most advanced and sophisticated technologies, to provide distinguished and quality healthcare and billing service, that helps in the reduction of misuse and/or fraud malpractice which ensures the reduction and reduce the high-costs resulting, without decreasing the rights of any parties. P a g e 2

3 Global Domination Medexa continually seeking to better serving its clients and disseminate its knowledge and expertise gained from more than 15 years, in order to achieve business excellence, clients and customers satisfactions by providing unparalleled and outstanding healthcare services for all parties. Medexa since inception have established a number of regional branches, and will continue establishing several branches in the globe, however, Medexa currently exists and covering 5 countries in Middle East and Africa regions. P a g e 3

4 Success Elements Medexa continue its success by developing key points and elements continuously outlines the management structure of health insurance, which distinguish Medexa from others. Medexa strongly believes in the six essential success factors that allowed accomplishing so much more than the rest of similar competitors and having a sophisticated understanding of how to provide and shape our services competitively while still making a satisfactory profit. Self-awareness Medexa & its staff are eagerly passionate learning and developing their knowledge & skills. Specific Goals Medexa have strategically developed its goals targeting to contribute to the world economy. Powerful Networks Medexa is partnering with its clients, which means that their success is its success. Surprising Idealism Medexa want to make a difference, fulfill a lifepurpose, & pursue a dream. Medexa motivated by a desire to create a better world. Extraordinary Curiosity Medexa concern of every aspect & it gives attention to every details, even small issues & details. Personal Discipline Medexa when it comes to honesty and business are true, & clear in its communication & commitments with mutual respect. P a g e 4

5 Distinguished Factors Medexa managed to adopt a unified global standards certified and approved by the World Health Organization (WHO) that distinguished and moved Medexa to a new level in health insurance management. Medexa established state-of-the-art Advanced Research & Development Center (R&DC) for the purpose of studying world global notations and standards and its implementation at all aspects, moreover to continue develop and modernize the mechanisms of standard operation (SOP) actions to gain accurate and ideal access to insurance solutions and services for all insurance parties. Medexa established a unique strategic partnership with CoreTech, an advanced software development company, where Medexa s R&D center and CoreTech teams managed to develop and implements state-of-the-art artificial intelligence products that facilitates and promotes the health insurance management to the 21 st century in unparalleled professionalism and quality. P a g e 5

6 Corporate Staffs Medexa corporate operates by highly talented and skilled professional administrative, gained more than twenty years of practical experience in the health insurance management. Medexa's professional team is committed to acting in the best interests of its regional clients Medexa polarized 87 talented, intelligent and precognition staff, where the company provided all the support and training in faith and believes that medical claims management needs to possess a distinct specifications to work and operate on specialized and advanced systems. Staff [87 Employee] Secretary Consultants Pharmacists Doctors Accountants IT & MIS 8% 17% 26% 9% 8% 32% P a g e 6

7 Global Medical Network Medexa realized the importance of medical service providers in achieving optimal medical health insurance services, which focused the company's to build a network based on strict pillars such as: Client s needs Scientific qualifications and service quality Medical Specialization Geographical location to suit the subscriber s residential and work sites. Medexa provides wide range of services to manage health insurance; therefore the adoption of regional geographical medical service providers network distinguished us from others, as Medexa is the first TPA providing a Global Medical Service Providers Network. Medexa annually issuing the medical service providers network booklet indexed geographically based on the international categories taken in consideration the Prevailing custom for each country according to country, governorate, city, area, street, and building. P a g e 7

8 Outstanding Services Optimal Care Medexa is a market leader in TPA business process and healthcare claim management, Medexa s team spirit and initiatives shapes the future of TPAs with imagination, creativity and intelligence. Medexa provides the region's most innovative structures and services for managing health insurance services. Medexa provides wide range of services shaped to suits every customer needs, Medexa s Services ranges from providing captive insurance services, insurance management services, insurance and risk management consulting. Feasibility studies. Formation support. Insurance management. Insurance financial management. Administrative services. Insurance advisory services. Ongoing client support. Programs design, development, implementation and administration. P a g e 8

9 Facts & Actions We do care for all our insured members, risk-carriers, medical providers and insured companies, therefore we have provided and established plan of action to solve, support and follow-up health insurance parties by providing: A dedicated helpdesk operated 24x7x365 tailored and devoted to communicate with all health insurance parties that are qualified to solve any issues and/or enquiries raised by any parties instantly. A dedicated hotline and emergency for immediate plan of action whenever needed especially for inpatient cases and for all health insurance parties. A dedicated online information services categorized and developed for each health insurance parties needs through our URL [ We do care for our health insurance claim management and services quality for all parties, while providing state-of-the-art technological and science services by providing: Free automated software s that facilitates medical providers services. Accurate and prompt claims settlement and payments. Advanced and detailed statistical and MIS automated reports. Unparalleled and accurate automated claims management and auditing through a very advanced and sophisticated health insurance management system. We do care for our risk carriers (insurance and self-funded), by constantly evolving our knowledge in favor to provide distinguished health services and simplifies day-to-day routine activities that positively reflected to all health insurance parties by providing: Customized communication mechanisms that suits the way they like it. Accurate and detailed implementation of issued policies whatever its rules. Consultancy and training for our clients staff, medical service providers, and our staff. P a g e 9

10 Medexa periodically follow-up with insurance parties, either through direct telephone contact or through site visits which assures the quality of services provided. Medexa contribute and/or organize specialized seminars, conferences or participate as lecturer which is valuable in terms of mutual cooperation, learning, expanding knowledge and sharing expertise are important to develop the health insurance sector and staff. Medexa arranged and/or participated in more than 20 health insurance seminars and conferences worldwide, especially in the middle east region (Jordan, Syria, Saudi Arabia, Oman, Egypt, Libya etc.). Medexa is first regional TPA implements the smart card technology and techniques in the health insurance services. Medexa is the first regional TPA adopts and implements unparalleled health insurance and claim management system that implements business intelligence, WHO standard notations and complies with the 21 st century e-health demands. Medexa business process uniquely automates hundreds of checking rules and conditions when performing health insurance claims auditing and managements (such as medical factoid, eligibility information, contracts rules and conditions etc). P a g e 10

11 Innovation Online Technologies &Partners Medexa always seeking for the best in their fields, where innovation, flexibility and performance their targets, that s why Medexa realized and established a strategic partnership with CoreTech [ both teams have been able to produce a fully automated health insurance and claim management system, that caters to all the industry s requirements. Medexa is the first in the regions that implements comprehensive state-of-the-art technologies through the Medex Management System which developed by Medexa and CoreTech teams that specifically designed to: Contain all the notations of the World Health Organization (WHO). Shape customized pricing techniques based on different factors for each insurance party such as each medical provider, insurer, insured, medical procedure etc. Simplify claims data entry from the point of receiving till the end of settlement cycle. Facilitates and customize the health insurance policies rules and conditions whatever the needs are. Incorporate business intelligence techniques, such as auto translation, identification, management etc. The solution tailored to facilitate all health insurance management aspects, rules and conditions that are simply demonstrated to facilitate business life cycle. P a g e 11

12 Smart Card Benefits Medexa as technology passionate always implements the latest technologies. Medexa provides its clients and health insurance parties with premier sophisticated and integrated Internet-based services, combining electronic transactional techniques with a comprehensive infrastructure that is specifically designed to facilitate our customers' needs in an efficient and timely manner which allows instant: Electronic claim data and information transfer. Claim data checking, validation, and auditing. Data and information updates. Financial payments and settlements. Risk control and management. Secure online authentication. Statistical and aggregate MIS reports for health insurance parties, through Medexa s URL [ Computer Internet Computer Computer Internet Connection(s) Firewall Automatic Claim validation, checking and response. Adding and/or Modifying Subscribers. Filing and logging transactions and system auto responses. Manage TPA doctors monitoring & approvals. Claims Sorting. Sending Manual Responses when required. Internet Connection Login to dedicate interface, using secure authentication (Smart Card and/or User Name &password) Filling Electronic claim data form Sorting Claims Confirming and Sending Claims Medex Claim Management System & Other Application Servers Database Server P a g e 12

13 Promise &Contacts Medexa is the first and leader regional TPA Company uses the smart card technology in the healthcare insurance sector, positioning Medexa regional TPA leader in the sector due to the facts that smart card allows to instantly: Check and authenticate the patient eligibility information. Retrieves patient medical history when required. Assures no financial debits are logged on patient Validate and audit claim information such as medical procedures (HCPCS), ICD etc. Improve the quality of medical care Reduces costs and administrative issues. Optimize claim management processes Medexa realized that smart cards can provide clean data for eligibility verification and claims processing. They not only can prevent administrative errors and streamline the payment process; they also can prevent medical errors that arise when one practitioner doesn t know what another has been doing. In addition, test results conducted by one practitioner can be available to all practitioners. Before prescribing a drug, a physician can review a patient s recent diagnoses, allergies, and prescription history and be aware of any over-the-counter drugs that could conflict with the proposed course of treatment. In the long run, the data carried by smart cards not only can prevent illness and save lives; they also can save the healthcare industry billions of dollars. Smart cards are among the few technologies that enhance both control and privacy, with ability to disaggregate data and encrypt information to protect an individual s right and privacy. P a g e 13

14 Medexa makes one simple promise, to provide our clients with unparalleled and unequalled services in professional, timely and friendly environments. Medexa s teams and partners are dedicated to making Medexa and its services your first and most preferred TPA Company worldwide as we also provides our customers tailored services with a commitment and passion. Thank you for choosing Medexa TPA, you can count on Headquarter Wadi Saqrah, Qaraman Building (7) Amman, Jordan Telephone: Fax: tpa@medexa.net URL: P a g e 14