A medical aid claim submission via EDI offers one the ability to get a faster response on the claim receipt with each medical aid, and also the potential to get paid faster (since the claim is processed quicker and can make it’s way into the payment batches faster). Another two major benefits of EDI claim submissions rather than email based claim submissions is the ability to do a claim benefit check (ie. will the medical aid claim be accepted by the medical aid) and can you reverse the claim if there is a mistake. In terms of the latter benefit, the only way to reverse a claim on an email based claim or after the claim is outside the claim reversal window, is to phone the call-centre of the medical aid and get them to reverse this for you.
Three notes on this functionality:
1. The claim benefit check is only available for Discovery and GEMS medical aid schemes.
2. The ability to reverse an EDI submitted claim is only available in the day that the claim was submitted.
3. There is a cost for each claim benefit check, and for each claim reversal.
Claim Benefit Check
This functionality is available when you generate your invoice and click the Submit button.
Claim Reversal
This functionality is available when you have submitted your claim to the medical aid via EDI and then click on the Claim History button.
Need Further Help from Our Team
You can either send an email with the description of your query to support@smemetrics.com, or you can book a training session with our team at https://www.smemetrics.com/demo/
