Medifema offers franchisees the tools and expertise to fully manage their network of healthcare providers and administer health insurance claims from pre-certification of admissions and service provision to case management, claims adjudication and payment settlement. The process is facilitated by an e-claims portal available to Mest Medifema’s healthcare providers’ networks, allowing them to verify the patient’s eligibility, based on policy-defined benefits and medical necessity, and process claims online at every step of the patient service cycle.
In addition, our franchising model gives franchisees access to the following services:
Benefits administration and members’ enrolment services, including the definition of benefits and restrictions, technical and medical underwriting automation and rules, card issuing, policy management and policy owner services.
Reporting services and business intelligence capabilities to provide business analysis and performance monitoring.
Special customer service tools, including specialized call centers such as a policy and network information desk, complaint desk, IT helpdesk, and health information helpdesk.